Effect of Balance Training on Balance and Confidence in Older Adults

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1 International Journal of Sport Studies. Vol., 4 (6), , 2014 Available online at http: ISSN ; Science Research Publications Effect of Balance Training on Balance and Confidence in Older Adults Hamid Reza Taheri 1, Farzaneh Bagheri Asl 2*, Mehdi Sohrabi 1, Alireza Saberi Kakhki 1 1- Ferdowsi University, Faculty of Sports and Physical Education, Mashhad, Iran 2- Ferdowsi University of Mashhad, International Branch, Mashhad, Iran *Corresponding author, Bagheli2005@yahoo.com Abstract Balance training may can the prevalence of falls and increase confidence. The purpose of this study is Effect of balance training on balance and confidence in older adults. In this study 15 old adults (over 65 years old) participated in eight weeks exercise. MMSE, BBS, MFES, BES, CS and 8-foot-up-and-go record were collected before and after intervention. A repeated measures ANOVA was utilized to determine whether a significant change occurred over time and statistical significance was assessed at (p<0.05) level. The results indicated that the experimental group for BBS, MMSE, 8 foot-up-and-go, BES and CS variables achieved a significant improvement in balance from pre- testing to post-testing. Improvement for control group was not significant. These finding provide evidence that while all physical activity could improve balance may be necessary to promote the greatest improvements in balance. Key Words: Balance Training, Confidence, Mini Mental State Exam Introduction Todays, the elderly population is increasing day to day, population, much concern and interest within the field of study has emphasized this population s health (Kaneda at al., 2008). One of the elderly problems is falling. Falls also is one of the most debilitating accidents for the elderly, by impairing their ability to perform their daily activities (Cyarto et al., 2008). Moreover this falling may cause hip fractures and prove to be fatal in many persons (Riggs and Melton, 1986). Based on reports by Centers for Disease Control and Prevention (2001), falling has been estimated to cost between 75 to 100 billion dollars per year. Increase in dependence and decreases of physical activity are at even greater risk for these events, making it necessary to develop intervention strategies (Mihalko and Wickley, 2003). Any exercise and physical activity may be benefit to this population. One of the most beneficial training and appropriate intervention for this population could be balance training, because this specific type of exercise may improve their ability to perform basic tasks, such as getting up from a chair (Buckwalter, 1997). The main reason falls occur in elderly persons is loss of physical function attributed to decreases in balance, muscular strength, and flexibility (Edelberg, 2001). Balance may provide the postural control to prevent these events, as well as the self-assurance to keep up certain life behaviors (Kaneda et al., 2008). While financial burdens could be greatly reduced, as stated above, exercise has been shown as a way to intervene in this population and cause improvements. Campell et al. (1997) studied the effect of balance training on functional ability in older women. They reported a 58% decrease in falls during the intervention. In their study the intervention was balance training exercise, though its primary focus was strength. Hill, Schwarz, Kalogeropoulos, and Gibson (1996) in their study reported that the Modified Falls Efficacy Scale (MFES) indicated less skew than the original 10-item Falls Efficacy Scale. The research also indicated a high test-retest reliability with intraclass correlation coefficients of 0.93 (p<.05). So, the MFES has been estimated reliable via statistical evidence (Hill et al, 1996). Ambrose et al. (2008) examined the benefits of a resistance and balance training intervention on fall risk, functionality, and executive function. They used the Otago Exercise Program (OEP) for consisted of a variety of strengthening exercises, as well as numerous balancing techniques, such as walking backwards, sit to stand, and heel-to-toe walking. All subjects (N=52, older adult over the age of 70) who participated in the falls clinic scored greater than a one on the Physiological Profile Assessment (PPA). Subjects were randomly assigned to a 681

2 control or experimental group and assessed at baseline and six months. The tests included the verbal digits backward test, the TUG, and the Stroop Color-Word Test. Falls and adherence were recorded each month. The researchers reported that following six months, no significant differences were found on functional mobility and falls risk. There was significantly different in Stroop Color-Word Test for the OEP group (p<.05). Their finding indicated that meaningfulness in the fact a 47% reduction in falls occurred in the OEP group and a 5% improvement of PPA and. Therefore, it was concluded that balance program and a home-based strength may be able to help reduce falls and improve cognition through executive functions as well (Ambrose et al., 2008). Balance training and strength training alone has provided insufficient evidence to cause improvement (Orr, Raymond, and Fiatarone, 2008). Orr et al. (2008) indicated that combination of balance training and strength training resulted in even greater benefits such as functional ability and flexibility. Leak of studies in this area and conflicting results on this field caused to investigate the effect of balance training on balance and confidence in older adults. Participants Materials and Methods According to the protocol of this study, the design of current research is pre- experimental randomized design. The sample size of this study was not feasible due to lack of help and resources. In this study participants were over the age of 65 were recruited from two assisted living communities. Participants of this study divided in two groups. Seven of them were in control group and 8 of them were in intervention group. Participants from one community were assigned to a control group. The participants passed the Mini-Mental State Exam with a score of 24 out of 30 in order to partake in current study. Subjects also fill out a physical activity readiness questionnaire. After filling the request questionnaires they participated in experimental protocol. Experimental program The study began by developing a stretching program and completed the tests over two different days. After that the control group completed the Mini Mental State Exam (MMSE). The MMSE is a series of ten questions which seek to assess memory, orientation, and comprehension of new information, language construction, and attention. Participants also completed the Berg Balance Scale (BBS) with14 item test of balance, Modified Falls Efficacy Scale (MFES) with 14 items which describe basic functional activities, 8-foot-up-and-go, and chair stand. Berg, Wood-Dauphinne, Williams, and Gayton (1989) reported results of high interrater reliability of (r=0.98) and high intrarater reliability (r=0.99) on the Berg Balance Scale. Some of the muscle groups consisted in this study. The quadriceps, hamstring, triceps and biceps were consisted in order to achieve a total body stretching workout. After the completion of the program (eight weeks), post- test was conducted. A balance training program was conducted for the experimental group. After gathering the data before intervention program as a pre-test, the program was conducted. The program consisted of warmup for 5 minutes, 15 minutes of balance exercises, 10 minutes upper body and 10 minutes lower body, finally 5 minutes cool down. The participants completed the experimental protocol in 45 minute sessions twice a week. Strength training exercises in experimental group were the same with control group. Balance exercises included tandem walks, and balance beam walks, stances with eyes closed, and stances with eyes open, heel to toe rocks, toe taps, and shuffles. The exercise program was applied for eight weeks, and after that the post-test was conducted. Statistical analysis A repeated measures ANOVA was utilized for the control and experimental group in order to determine whether the balance training had an effect on balance, and confidence in older adults. A dependent t-test was conducted to further analyze significant results. In this study the statistical significance was assessed at p< 0.05 level. Results The Results of this study indicated that the mean score for BBS score for control group was 46.00±3.27 and for experimental group were 38.00±1.38 points before intervention. The experimental group for BBS variable achieved a significant improvement in balance from pre- testing to post-testing. Improvement for control group 682

3 was not significant. The mean score for MMSE test for control group was 25.43±1.12 points, and for experimental group were 25.77±2.31 points before intervention. The mean time on the 8 foot-up-and-go for control group was 6.62±0.46, and for experimental group was 12.61±3.53 seconds before intervention. The 8 foot up-and-go time not improved in control group but improved in experimental group. Results also showed that the MFES for control group improved from ±16.32 to ±8.57 points, but in the experimental group scores non- significantly improved from 99.35±18.11 to ±18.83 points (Table 1). Table 1: Pre and Post-Testing Results on the Control and Experimental Groups Following an 8-Week Intervention Control Group Experimental Group Variable Pre-test Post-test Ch ES Pre-test Post-test Ch % ES % BBS 46.00± ± ± ± BES 66.54± ± ± ± ft 6.62± ± ± ± CS 6.43± ± ± ± MFES ± ± ± ± Results for Balance Efficacy Scale (BES) were not significant in control group but the BES score approached significance in the experimental group. The results for Chair Stand (CS) showed improved from 1.53±2.21 to 2.47±3.72 stands in the experimental group. This results for control group indicated that no improvement in chair stands variable (Figure 1 and 2). Group Control Experimental Fig 1: Berg Balance Scale (BBS) Scores for the Experimental and Control Group 683

4 Group Control Experimental Fig 2: Balance Efficacy Scale (BES) Scores for the Experimental and Control Group Discussion and Conclusion Impairments and lack of confidence in balance and functionality has been linked to an increase in falls risk. The assisted living population is at greater risk because of their dependence on others. This study intended to determine whether a balance training class would affect balance and confidence in assisted living older adults. The experimental group was compared with a control group to further assess changes in these factors. With such a limited number of subjects, significance was difficult to attain. However, findings indicate increases significantly. The result also showed that the control group, only consisting of four subjects, indicated a great increase in confidence, with an increase of 26.87% on the BES and 14.6% on the MFES. However, this was not the case. This increase in confidence in the experimental group could have been affected by a little over a 41 point increase of just one subject. It may have also had something to do with the interaction between the subjects and the primary researcher. Finding also indicated that the mean score on the BES variable, while a 7.9% decrease, could have been changed. In one subject a 12 point decrease in the control group may have played a primary role in the mean decrease of the BES score. These results may provide evidence that any physical activity, such as stretching on ergonomic discs, can help improve confidence. However, the control group was active in that it performed stretches of each muscle group. The aforementioned variables were identified at baseline and at eight weeks in each group. Finding of this study showed that the improvements which may be meaningful. The control group indicated a great increase in confidence, with an improvement of on the BES and the MFES. Furthermore, each of the subjects who participated in the stretching program experienced an increase in confidence on both groups, with the exception of one individual. This is contrary to the experimental group, in which each participant indicated a decrease in confidence on the BES. These findings indicated that may provide evidence that any exercise program, such as stretching on ergonomic discs, can help improve confidence (Kaneda at al., 2008). Finding for 8-foot-up-and-go time variable slightly improvement in dynamic balance for experimental group. The BBS score increased in each subjects from both control and experimental groups, with the exception of one who attained the same score, from pre- to post-testing. Results of current study supported by Shumway- Cook et al (2005) reported. This also provides evidence that each program was beneficial in improving balance, but the balance training program may have been the most effective. Finding showed that no significance was found within the chair stand test. The experimental group experienced notable improvements on the chair stand, as well (Mihalko and Wickley, 2003). These finding provide evidence that while all physical activity could improve balance may be necessary to promote the greatest improvements in balance. 684

5 References Ambrose L, Donaldson M, Ahamed Y, Graf P, Cook W, Close J, Khan K, Otago home-based strength and balance retraining improves executive functioning in older fallers: A randomized controlled trial. Journal of American Geriatrics Society, 56(10), Berg K, Wood-Dauphinne S, Williams J, Gayton D, Measuring balance in the elderly: Preliminary development of an instrument. Physiotherapy Canada, 41, Buckwalter J, Decreased mobility in the elderly: The exercise antidote. Physician and Sports Medicine, 25(9), Campell A, Robertson M, Gardner M, Norton R, Tilyard M, Buchner D, Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. British Medical Journal, 315(7115): Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Promoting Active Lifestyles Among Older Adults. Cyarto E, Brown W, Marshall M, Trost S, Comparison of the effects of a homebased and group-based resistance training program on functional ability in older adults. American Journal of Health Promotion, 23(1), Edelberg H.K, How to prevent falls and injuries in patients with impaired ability. Geriatrics, 56, Hill K, Schwarz J, Kalogeropoulos A, Gibson S, Fear of falling revisited. Archives of Physical Medical Rehabilitation, 77, Kaneda K, Sato D, Wakabayashi H, Hanai A, Nomura T, A comparison of the effects of different water exercise programs on balance ability in elderly people. Journal of Aging and Physical Activity, 16(4), Mihalko S, Wickley K, Active living for assisted living: Promoting partnerships within a systems framework. American Journal of Preventive Medicine, 25(3), Orr R, Raymond J, Fiatarone M, Efficacy of progressive resistance training on balance performance in older adults: A systematic review of randomized controlled trials. Sports Medicine, 38(4), Riggs B, Melton L, Involutional osteoporosis. New England Journal of Medicine 314, Shumway-Cook A, Ciol M, Gruber W, Robinson C, Incidence of and risk factors for falls following hip fractures in community-dwelling older adults. Physical Therapy, 85(7),