Journal of the Korean Society of Physical Medicine (대한물리의학회지)

The Korean Society of Physical Medicine (대한물리의학회)
권호 표지
DOI QR코드

DOI QR Code

Impact of a Fall-Prevention Exercise Program on Balance, Gait, Lower Limb Strength, and Psychosocial Characteristics in Older Adults with Dementia

낙상예방 운동 프로그램이 치매 노인의 균형, 보행과 하지 근력, 심리사회적 특성에 미치는 영향

  • Choi, Gi-young (Dept. of Physical Therapy, Graduate School of Health and Medicine, Daejeon University) ;
  • Kim, Suhn-yeop (Dept. of Physical Therapy, College of Health and Medical Science, Daejeon University)
  • 최기영 (대전대학교 보건의료대학원 물리치료학과) ;
  • 김선엽 (대전대학교 물리치료학과)
  • Received : 2018.10.22
  • Accepted : 2018.11.27
  • Published : 2019.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

PURPOSE: This study measured the impact of a 12-week fall-prevention exercise program on balance, ambulatory ability, lower limb strength, and psychosocial characteristics in older adults diagnosed with dementia. METHODS: The participants comprised 31 older adults (9 men, 22 women) diagnosed with Alzheimer's or vascular dementia at a long-term care hospital located in Gunsan City. A fall-prevention exercise program was provided to the experimental group, while the control group was only provided with instruction and materials related to the fall-prevention exercise program. The participants were evaluated before the intervention, 6 weeks after the intervention, and 12 weeks after the intervention on static and dynamic balance abilities (using Timed Up and Go test: TUG, Tinetti-balance scale, one-leg standing test: OLS), gait (Tinetti-balance scale, 6-minute walk test: 6MWT), lower limb strength (sit to stand test; STS), and psychosocial characteristics (Short Form 36 Health Survey-Korean version, Korean Mini-Mental State Exam). RESULTS: An independent samples t-test and repeated measures analysis of variance were used for the statistical analysis. There were statistically significant improvements after the intervention (p<.05) in dynamic balance abilities (TUG and OLS using the left foot), gait (6MWT), and lower limb strength (STS) for the experimental group, but not for the control group. No difference was seen in psychosocial characteristics. CONCLUSION: Older adults with dementia who participated in the fall-prevention exercise program showed significant improvements in their static and dynamic balance abilities, lower limb strength, and ambulatory ability after the intervention.

Keywords

References

  1. Ministry of Health and Welfare. Available at http://www. mohw.go.kr. 2014-2018 Mid-term health insurance plan. Accessed October 16, 2018.
  2. Perry BC. Falls among the elderly: A review of the methods and conclusions of epidemiologic studies. J Am Geriatr Soc. 1982;30(6):367-71. https://doi.org/10.1111/j.1532-5415.1982.tb02833.x
  3. Prudham D, Evans JG. Factors associated with falls in the elderly: A community study. Age and Ageing. 1981;10(3):141-6. https://doi.org/10.1093/ageing/10.3.141
  4. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988b;319(26):1701-7. https://doi.org/10.1056/NEJM198812293192604
  5. Nevitt MC, Cummings SR, Kidd S, et al. Risk factors for recurrent non-syncopal falls: A prospective study. JAMA. 1989;261(18):2663-8. https://doi.org/10.1001/jama.1989.03420180087036
  6. Boulgarides LK, McGiney SM, Willett JA, et al. Use of clinical and impairment based tests to predict falls by community-dwelling older adults. Phys Ther. 2003;83(4):328-39. https://doi.org/10.1093/ptj/83.4.328
  7. Morris JC, Rubin EH, Morris EJ, et al. Senile dementia of the Alzheimer's type: An important risk factor for serious falls. J Gerontol. 1987;42(4):412-7. https://doi.org/10.1093/geronj/42.4.412
  8. Allan L, Ballard C, Rowan E, et al. Incidence and prediction of falls in dementia: A prospective study in older people. PLoS One. 2009;4(5):e5521. https://doi.org/10.1371/journal.pone.0005521
  9. Beauchet O, Allali G, Berrut G, et al. Gait analysis in demented subjects: Interests and perspectives. Neuropsychiatr Dis Treat. 2008;4(1):155-60. https://doi.org/10.2147/NDT.S2070
  10. Hauer K, Schwenk M, Zieschang T, et al. Physical training improves motor performance in people with dementia: A randomized controlled trial. J Am Geriatr Soc. 2012;60(1):8-15. https://doi.org/10.1111/j.1532-5415.2011.03778.x
  11. Heyn P, Abreu BC, Ottenbacher KJ. The effects of exercise training on elderly persons with cognitive impairment and dementia: A meta-analysis. Arch Phys Med Rehabil. 2004;85(10):1694-704. https://doi.org/10.1016/j.apmr.2004.03.019
  12. Franssen EH, Souren LE, Torossian CL, et al. Equilibrium and limb coordination in mild cognitive impairment and mild Alzheimer's disease. J Am Geriatr Soc. 1999;47(4):463-9. https://doi.org/10.1111/j.1532-5415.1999.tb07240.x
  13. Lam LC, Tam CW, Lui VW, et al. Prevalence of very mild and mild dementia in community-dwelling older Chinese people in Hong Kong. Int Psychogeriatr. 2008;20(1):135-48. https://doi.org/10.1017/S1041610207006199
  14. Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia: A Delphi consensus study. Lancet. 2005;366(9503):2112-7. https://doi.org/10.1016/S0140-6736(05)67889-0
  15. Baker NL, Cook MN, Arrighi HM, et al. Hip fracture risk and subsequent mortality among Alzheimer's disease patients in the United Kingdom, 1988-2007. Age Ageing. 2011;40(1):49-54. https://doi.org/10.1093/ageing/afq146
  16. Eriksson S, Gustafson Y, Lundin-Olsson L. Risk factors for falls in people with and without a diagnose of dementia living in residential care facilities: A prospective study. Arch Gerontol Geriatr. 2008;46(3):293-306. https://doi.org/10.1016/j.archger.2007.05.002
  17. Kim SH, Han SJ, Chun YJ. Verifying the effectiveness of one time a week fall prevention exercise program for elderly. Journal of Sport and Leisure Studies. 2011;46(1):913-20. https://doi.org/10.51979/KSSLS.2011.11.46.913
  18. Jo HE, Kim MJ. The effects of a fall prevention program on physical fitness, fall efficacy, and fall prevention behavior of the elderly. Korean J Rehabil Nurs. 2017;20(1):22-32. https://doi.org/10.7587/kjrehn.2017.22
  19. Kim SK, Kim TU, Lim CK. The effects of combined exercise program on activities of daily living and functional fitness in the elderly women with mild dementia. Journal of Sport and Leisure Studies. 2009;38(2):821-30. https://doi.org/10.51979/KSSLS.2009.11.38.821
  20. Cho SH, Kim SJ. The effects 12 weeks of combined exercise programs on activities of daily living and quality of living index in the vascular dementia elders. J Korean Soc Phys Med. 2010;5(4):633-44.
  21. Goshtigian GR, Swanson BT. Using the selective functional movement assessment and regional interdependence theory to guide treatment of an athlete with back pain: A case report. Int J Sports Phys Ther. 2016;11(4):575-95.
  22. Chai KJ. A literature review a program of intervention for prevention of falling in the patients with dementia. Journal of Occupational Therapy for the Aged and Dementia. 2010;4(2):27-34.
  23. Kim JE, Yim JE. Selective Functional Movement Assessment (SFMA)-based therapeutic corrective exercises reduces knee joint pain in a patient with patellofemoral pain syndrome after pregnancy (case study). International Journal of Bio-Science and Bio-Technology. 2016;8(6):83-92. https://doi.org/10.14257/ijbsbt.2016.8.6.09
  24. Podsiadlo D, Richardson S. The timed up & go: A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39(2):142-8. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
  25. Morris S, Morris ME, Iansek R. Reliability of measurements obtained with the timed up & go test in people with Parkinson disease. Phys Ther. 2001;81(2):810-8. https://doi.org/10.1093/ptj/81.2.810
  26. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community dwelling older adults using the timed up & go test. Phys Ther. 2000;80(9):896-903. https://doi.org/10.1093/ptj/80.9.896
  27. Richman J, Markrides L, Prince B. Research methodology and applied statistics. Part 3: Measurement procedures in research. Physiother Can. 1980;32(4):253-7.
  28. Kim DY, Choi JD, Ki KI. A Reliability study of sit-to-walk for dynamic balance assessment in stroke patient. J Korean Soc Phys Ther. 2013;25(5):303-10.
  29. Tinetti ME. Performance oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986;34(2):119-26. https://doi.org/10.1111/j.1532-5415.1986.tb05480.x
  30. Tinetti ME, Ginter SF. Identifying mobility dysfunction in elderly patients. Standard neuromuscular examination or direct assessment? JAMA. 1988a;259(8):1190-3. https://doi.org/10.1001/jama.1988.03720080024022
  31. Sterke CS, Huisman SL, Van Beeck EF, et al. Is the Tinetti performance oriented mobility assessment (POMA) a feasible and valid predictor of short-term fall risk in nursing home residents with dementia? Int Psychogeriatr. 2010;22(2):254-63. https://doi.org/10.1017/S1041610209991347
  32. Kegelmeyer DA, Kloos AD, Thomas KM, et al. Reliability and validity of the Tinetti mobility test for individuals with Parkinson disease. Phys Ther. 2007;87(10):1369-78. https://doi.org/10.2522/ptj.20070007
  33. Lee CH, An SH, Lee YB, et al. The reliability and concurrent validity of the Tinetti-balance scale(Korean version) in stroke patients. Journal of Special Education & Rehabilitation Science. 2013;52(4):435-52.
  34. Jeong TG, Park JS, Choi JD, et al. The effect of sensorimotor training on balance and muscle activation during gait in older adults. J Kor Soc Phys Ther. 2011;23(4):29-36. https://doi.org/10.1589/jpts.23.29
  35. Jung MS, Park JW. The relationship between balance test and fear of falling in community dwelling elderly. J Korean Soc Phys Ther. 2012;24(1):23-8.
  36. Springer BA, Marin R, Cyhan T, et al. Normative values for the unipedal stance test with eyes open and closed. J Geriatr Phys Ther. 2007;30(1):8-15. https://doi.org/10.1519/00139143-200704000-00003
  37. Daly JJ, Roenigk K, Holcomb J, et al. A randomized controlled trial of functional neuromuscular stimulation in chronic stroke subjects. Stroke. 2006;37(1):172-8. https://doi.org/10.1161/01.STR.0000195129.95220.77
  38. An SH, Lee DG, Lee YB, et al. Inter-rater, absolute reliability and concurrent validity of Tinetti-gait Scale (Korean version) in stroke patients. J Korean Soc Phys Med. 2014;9(2):201-11. https://doi.org/10.13066/kspm.2014.9.2.201
  39. Sim SM, Oh DW. Use of the 6-minute walk test as gait therapy for hemiplegic patients: Possibility of practice effect by providing knowledge of result. Korean J Health Promot. 2011;11(1):42-7.
  40. Mong Y, Teo TW, Ng SS. 5-repetition sit-to-stand test in subjects with chronic stroke: Reliability and validity. Arch Phys Med Rehabil. 2010;91(3):407-13. https://doi.org/10.1016/j.apmr.2009.10.030
  41. Lord SR, Murray SM, Chapman K, et al. Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people. J Gerontol A Biol Sci Med Sci. 2002:57(8):539-43. https://doi.org/10.1093/gerona/57.8.M539
  42. Cho HY, An SH, Lee YB, et al. The reliability and validity of the sit to stand test in chronic stroke patients. Journal of Special Education & Rehabilitation Science. 2013;52(3):361-79.
  43. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey(SF-36): I Conceptual framework and item selection. Med Care. 1992;30(6):473-83. https://doi.org/10.1097/00005650-199206000-00002
  44. Koh SB, Chang SJ, Kang MG, et al. Reliability and validity on measurement instrument for health status assessment in occupational workers. Korean J Prev Med. 1997;30(2):251-65.
  45. Lim YH, Cho YC. Relationship between job stress and health status(SF-36) among general hospital nurses. KAIS. 2015;16(7):4745-57.
  46. Kwon YC, Park JH. Korean version of mini-mental state examination (MMSE-K) Part I: development of the test for the elderly. J Korean Neuropsychiatr Assoc. 1989;28(1):125-35.
  47. Lee SE, Lee JM. The study on health-related physical fitness and bone mineral density in the elderly dementia and mild cognitive impairment. Korean J Sport Sci. 2011;20(4):789-98.
  48. Lach HW, Harrison BE, Phongphanngam S. Falls and fall prevention in older adults with early-stage dementia an integrative review. Res Gerontol Nurs. 2017;10(3):139-48. https://doi.org/10.3928/19404921-20160908-01
  49. Becker C, Essig M, Hauer K, et al. Physical training improves motor performance in people with dementia: a randomized controlled trial. J Am Geriatr Soc. 2012;60(1):8-15. https://doi.org/10.1111/j.1532-5415.2011.03778.x
  50. Uemura K, Doi T, Shimada H, et al. Effects of exercise intervention on vascular risk factors in older adults with mild cognitive impairment: A randomized controlled trial. Dement Geriatr Cogn Dis Extra. 2012;2(1):445-55 https://doi.org/10.1159/000343486
  51. Goldet G, Howick J. Understanding grade: An introduction. J Evid Based Med. 2013;6(10):50-4. https://doi.org/10.1111/jebm.12018
  52. Doi T, Makizako H, Shimada H, et al. Effects of multicomponent exercise on spatial-temporal gait parameters among the elderly with amnestic mild cognitive impairment (aMCI): Preliminary results from a randomized controlled trial (RCT). Arch Gerontol Geriatr. 2013;56(1):104-8. https://doi.org/10.1016/j.archger.2012.09.003
  53. Bergland A, Engedal K, Telenius EW. Long-term effects of a 12 weeks high-intensity functional exercise program on physical function and mental health in nursing home residents with dementia: A single blinded randomized controlled trial. BMC Geriatr. 2015;3;15:158. https://doi.org/10.1186/s12877-015-0151-8
  54. Steinberg M, Leoutsakos JM, Podewils LJ, et al. Evaluation of a home-based exercise program in the treatment of Alzheimer's disease: The Maximizing Independence in Dementia (MIND) study. Int J Geriatr Psychiatry. 2009;24(7):680-5. https://doi.org/10.1002/gps.2175
  55. Choi SH, Lee BH, Hahm DS, et al. The validity of the Korean version of global deterioration scale. J Korean Neurol Assoc. 2002;20(6):612-7.
  56. Reisberg B, Ferris SH, Kluger A, et al. Mild cognitive impairment (MCI): A historical perspective. Int Psychogeriatr. 2008 ;20(1):18-31. https://doi.org/10.1017/S1041610207006394

Cited by

  1. Analysis of Research Trends Using G-power in Physiotherapy Research in Korea: Systematic Review vol.32, pp.2, 2019, https://doi.org/10.18857/jkpt.2020.32.2.114
  2. 치매환자의 보행에 관한 근거기반 중재에 대한 체계적 고찰 vol.21, pp.2, 2021, https://doi.org/10.5392/jkca.2021.21.02.667