NCT Number: NCT02551666
Falls are the leading cause of injuries and injury-related deaths among older adults over the age of 65 in the United States. To help reduce the number of these falls, there is growing interest in using reactive balance training to improve the reactive response to common perturbations (e.g., tripping and slipping). The goal of this study was to compare treadmill-based reactive balance training versus Tai Chi performed at, and among residents of, older adult senior housing. We hypothesized that participants randomized to reactive balance training (RBT) would show better performance on reactive balance tests compared to participants randomized to Tai Chi. We also hypothesized that participants randomized to Tai Chi would show better performance on clinical tests of balance and mobility compared to participants randomized to RBT. The long-term goal of this work is to demonstrate the value of RBT over Tai Chi for preventing falls resulting from sudden, external perturbations.
Thirty-five residents of five senior housing facilities were allocated to either treadmill-based reactive balance training or Tai Chi training. Both interventions were performed three times per week for four weeks, with each session lasting approximately 30 minutes. A battery of balance tests was performed at baseline, and again one week, one month, three months, and six months post-training. The battery included six standard clinical tests of balance and mobility, and a test of reactive balance performance.
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Notify Me70 year and older
All sexes
Interventional
Not applicable
Healthy volunteers accepted: Yes
Only the study team can determine whether someone qualifies for participation.
Inclusion criteria
Participants will practice recovering their balance after a perturbation similar to tripping while walking. Each of these 'balance recovery training' sessions will last approximately 30 minutes, and will be performed 3 times per week for 4 weeks.
Participants will perform Tai Chi exercises (Yang short form) for 30 minutes, 3 times a week for 4 weeks. Each session will be led by an experienced Tai Chi instructor.
Time frame: 1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
maximum torso angle during a simulated trip, and be measures in degrees. Larger angles indicate worse performance.
Time frame: 1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
maximum torso angle during a simulated trip, and be measures in degrees. Larger angles indicate worse performance.
Time frame: 1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
The reactive balance rating evaluates performance in response to six separate tests on a treadmill involving sudden acceleration of the belt to elicit a loss of balance from stance. The administrator scores as 0, 1, or 2: a) the overall effectiveness of the initial stepping response to each treadmill acceleration, and b) the amount of support provided by the harness or spotter next to the participant. These scores are then combined using a rubric to determine the overall reactive balance rating.
The reactive balance rating is a score on a scale from 0 to 12 where higher scores indicates a better outcome.
More details are available at: Madigan ML, Aviles J, Allin LJ, Nussbaum MA, Alexander NB. A Reactive Balance Rating Method That Correlates With Kinematics After Trip-like Perturbations on a Treadmill and Fall Risk Among Residents of Older Adult Congregate Housing. The Journals of Gerontology: Series A. 2018: 73(9): 1222-1228.
Time frame: 1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
step length during reactive balance trial.
Time frame: 1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
The timed-up-and-go tests is measured in seconds. Longer times indicate worse performance.
Time frame: 1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
The unipedal stance time is measured in seconds, up to a maximum of 30 seconds. Longer times indicate better performance.
Time frame: 1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
Maximum step length is measured in inches. Longer maximum step length indicates better performance.
Time frame: 1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
Activities-specific balance confidence scale ranges from 0 to 100. Larger values indicate more confidence (i.e. better outcome).
Time frame: 1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
The Performance-oriented Mobility Assessment is a common clinical test for assessing a person's static and dynamic balance abilities. The test is in two short sections that contain one examining static balance, and the other gait. The section examining static balance includes 9 individual tests scored 0, 1, or 2 by the test administrator based upon their observation of the balance performance (higher is better). The section on gait includes 7 individual tests scored 0, 1, or 2 by the test administrator based upon their observation of the gait performance (higher is better). All of these individual test scores are then summed to determine the overall Performance-oriented Mobility Assessment score.
The overall Performance-oriented Mobility Assessment score is on a scale from 0 to 28. Larger values indicate better mobility.
Additional details are published here: Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. JAGS 1986; 34: 119-126.
Time frame: 1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
The Berg balance test is measures that evaluates static balance and fall risk using 14 individual sub-tests. It includes static and dynamic activities of varying complexity. The test administrator scores performance on each sub-test as either a 0, 1, 2, 3, or 4. All scores are sub-tests are then summed to determine the overall Berg balance test score.
The Berg balance test score is on a scale from 0 to 56. Larger values indicate better balance.
More information is available at: Berg, K., Wood-Dauphine, S.L. and Williams, J.L. Measuring balance in the elderly: validation of an instrument. Can. J. Public Health, 83(S2): S7-S11, 1992.
Time frame: 1 week, 1 month, 3 months, and 6 months after completing four weeks of exercise intervention
step length during reactive balance trial.
Texas A&M University
Other
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