Ml Bird

A randomized controlled study investigating static and dynamic balance in older adults after training with Pilates.

OBJECTIVE To evaluate effects of a Pilates intervention on balance and function in community-dwelling older (aged >60y) adults. DESIGN Randomized crossover study design lasting 16 weeks. SETTING University exercise clinic. PARTICIPANTS Ambulatory older community-dwelling adults (N=32) were recruited, and 27 (mean ± SD age, 67.3±6.5y) completed the program. INTERVENTION Participants were allocated to either 5 weeks of a group Pilates training intervention or 5 weeks of usual activity (control). After a 6-week washout period, participants performed the alternate intervention. MAIN OUTCOME MEASURES Static and dynamic balance measures (mediolateral sway range, Four Square Step Test, Timed Up and Go Test) and leg strength were recorded at 4 times before and after each intervention (baseline [t1], interim time immediately after the first group intervention [t2], after 5-week washout [before the second intervention period] [t3], and at study conclusion after the second group intervention [t4]). RESULTS There were no significant differences between the Pilates and control groups for any measured variables (P>.05) despite static and dynamic balance significantly improving during the study and from pre- to post-Pilates (P<.05) without significant changes occurring during the control phase. Improvements that occurred during Pilates between t1 and t2 did not return to baseline after the washout period (t3). There were no changes in leg strength. Mediolateral sway range standing on a foam cushion with eyes closed improved -1.64cm (95% confidence interval, -2.47 to -0.82) and had the largest effect size post-Pilates (d=.72). CONCLUSIONS Although there were no significant between-group differences, participation in the Pilates component of the study led to improved static and dynamic balance. The absence of differences between conditions may be a result of small sample size or the crossover study design because Pilates may produce neuromuscular adaptations of unknown resilience.

The long-term benefits of a multi-component exercise intervention to balance and mobility in healthy older adults.

We examined the long-term effects of a multi-component exercise program on balance, mobility and exercise behavior. The benefits of a community-based resistance and flexibility exercise intervention in a group of healthy older (60-75 years) individuals were recorded 12 months after completion of the randomized control intervention. Differences between those participants who continued to exercise and those who discontinued were investigated. Significant improvements from baseline in sit to stand (p<0.001), timed up and go (p=0.001), and sway (p<0.001) remained at follow up in the exercise intervention group, with a control group unchanged. Participants who continued exercising had significantly greater improvements in strength immediately after the intervention, compared to those who discontinued (p=0.004). Those who continued regular resistance training performed better in the step test at 12-month follow up (p=0.009) and believed that the program was of more benefit to their physical activity (p<0.001) than those who discontinued exercising. Benefits to balance and mobility persist 1 year after participation in a multi-component exercise program, due in part to some continuing participation in resistance training. Motivation to continue resistance training may be related real and perceived benefits attained from the intervention as well as the environmental context of the intervention.

Effect of Pilates Exercise for Improving Balance in Older Adults: A Systematic Review With Meta-Analysis

OBJECTIVES To investigate the effect of Pilates on balance and falls in older adults, and whether programs tested in prior studies met best-practice recommendations for exercise to prevent falls. DATA SOURCES MEDLINE, SPORTDiscus, CINAHL, PubMed, Physiotherapy Evidence Database, and The Cochrane Library were searched from earliest record to July 2014. STUDY SELECTION Randomized and controlled clinical trials evaluating the effect of Pilates on balance and/or falls in older adults. DATA EXTRACTION Two reviewers independently extracted demographic, intervention, and outcome data. Six studies were included in this review. DATA SYNTHESIS High-quality studies in this area are lacking. When compared with nonactive control groups, Pilates was shown to improve balance (standardized mean difference [SMD]=.84; 95% confidence interval [CI], .44-1.23; 6 studies) and reduce the number of falls (SMD=-2.03; 95% CI, -2.66 to -1.40; 1 study). Three studies provided sufficient detail to enable assessment of compliance with the recommendation of exercises providing a moderate or high challenge to balance. In these studies, 2% to 36% of exercises were assessed as providing a moderate or high challenge to balance. All studies provided ≥2 hours of exercise per week, and 1 study provided >50 hours of exercise during the study period. CONCLUSIONS The evidence suggests Pilates can improve balance, an important risk factor for falls in older adults. However, there is limited data on the impact of Pilates on falls. Effects may have been overestimated because of the low methodological quality of studies. Best-practice recommendations were rarely applied in prior studies, indicating greater effects may have been achieved if recommendations were incorporated.

Make vitamin D while the sun shines, take supplements when it doesn't: a longitudinal, observational study of older adults in Tasmania, Australia.

Low vitamin D status has been associated with a number of chronic conditions, particularly in older adults. The aim of this study was to identify how best to maintain optimum vitamin D status throughout the year in this high-risk population. The main objectives of the study were to assess seasonal vitamin D status; identify the main determinants of vitamin D status; determine if taking part in the study led to alterations in participant behaviour and vitamin D status. A longitudinal design across four consecutive seasons observed ninety-one 60–85 year old community-dwelling adults in Tasmania (41π S) over 13 consecutive months, with a follow-up assessment at next winters end. Associations between solar UVB exposure, sun protection behaviours, dietary and supplemental vitamin D with serum 25(OH)D concentrations were assessed. Variation in serum 25(OH)D demonstrated an identical pattern to solar UVB, lagging 8–10 weeks. Serum 25(OH)D was positively associated with summer UVB (mean 15.9 nmol/L; 95%CI 11.8–19.9 nmol/L, p<0.001) and vitamin D supplementation (100–600 IU/day: 95%CI 10.2 nmol/L; 0.8–19.6 nmol/L; p = 0.03; 800 IU/day: 21.0 nmol/L; 95%CI 8.1–34.0 nmol/L; p = 0.001). Seasonal variation in serum 25(OH)D was greatly diminished in supplement users. The most common alteration in participant behaviour after the study was ingesting vitamin D supplements. Post-study vitamin D supplementation ℘800 IU/day was seven times more likely than during the study resulting in mean difference in serum 25(OH)D between supplement and non-supplement users of 30.1 nmol/L (95%CI 19.4–40.8 nmol/L; p<0.001). The main limitation was homogeneity of participant ethnicity. Solar exposure in summer and ingestion of vitamin D supplements in other seasons are the most effective ways of achieving and maintaining year-round vitamin D sufficiency in older adults in the Southern hemisphere. Vitamin D supplementation has greatest effect on vitamin D status if ingested during and after winter, i.e. between the autumn and spring equinoxes.

Serum [25(OH)D] status, ankle strength and activity show seasonal variation in older adults: relevance for winter falls in higher latitudes

BACKGROUND seasonal variation exists in serum [25(OH)D] and physical activity, especially at higher latitudes, and these factors impact lower limb strength. This study investigates seasonal variation in leg strength in a longitudinal repeated measures design concurrently with serum vitamin D and physical activity. METHODS eighty-eight community-dwelling independently mobile older adults (69.2 ± 6.5 years) were evaluated five times over a year, at the end of five consecutive seasons at latitude 41.1°S, recruited in two cohorts. Leg strength, serum [25(OH)D] and physical activity levels were measured. Time spent outside was recorded. Monthly falls diaries recorded falls. Data were analysed to determine annual means and percentage changes. RESULTS significant variation in [25(OH)D] (±15%), physical activity (±13%), ankle dorsiflexion strength (±8%) and hours spent outside (±20%) (all P < 0.001) was demonstrated over the year, with maximums in January and February (mid-summer). Low mean ankle strength was associated with increased incidence of falling (P = 0.047). Quadriceps strength did not change (±2%; P = 0.53). CONCLUSION ankle dorsiflexor strength varied seasonally. Increased ankle strength in summer may be influenced by increased levels of outdoors activity over the summer months. Reduced winter-time dorsiflexor strength may predispose older people to increased risk of tripping-related falls, and warrants investigation in a multi-faceted falls prevention programme.

Age-Related Changes in Physical Fall Risk Factors: Results from a 3 Year Follow-up of Community Dwelling Older Adults in Tasmania, Australia

As the population ages, fall rates are expected to increase, leading to a rise in accidental injury and injury-related deaths, and placing an escalating burden on health care systems. Sixty-nine independent community-dwelling adults (60–85 years, 18 males) had their leg strength, physical activity levels and their annual fall rate assessed at two timepoints over three years, (summer 2010 and summer 2013) monitoring balance. Force platform measures of medio-lateral sway range increased significantly under conditions of eyes open (mean difference MD 2.5 cm; 95% CI 2.2 to 2.8 cm) and eyes closed (MD 3.2 cm; 95% CI 2.8 to 3.6 cm), respectively (all p < 0.001) indicating worsening static balance control. Dynamic balance showed similar changes (p < 0.036). Leg strength was not significantly different between visits (p > 0.26). Physical activity reduced significantly (MD −909 Cal/week; 95% CI −347 to −1,470 Cal/week; p = 0.002) during the course of the study. Participants maintained aerobic activities, however resistance and balance exercise levels decreased non-significantly. The likelihood of falling was higher at the end of the study compared to the first timepoint (odds ratio 1.93, 95% CI 0.94 to 3.94; p = 0.07). Results of this study indicate that despite maintenance of leg strength there was an increase in medio-lateral sway over a relatively short time frame, with higher than expected increases in fall rates.

Accuracy, Validity, and Reliability of an Electronic Visual Analog Scale for Pain on a Touch Screen Tablet in Healthy Older Adults: A Clinical Trial

Background New technology for clinical data collection is rapidly evolving and may be useful for both researchers and clinicians; however, this new technology has not been tested for accuracy, reliability, or validity. Objective This study aims to test the accuracy of visual analog scale (VAS) for pain on a newly designed application on the iPad (iPadVAS) and measure the reliability and validity of iPadVAS compared to a paper copy (paperVAS). Methods Accuracy was determined by physically measuring an iPad scale on screen and comparing it to the results from the program, with a researcher collecting 101 data points. A total of 22 healthy community dwelling older adults were then recruited to test reliability and validity. Each participant completed 8 VAS (4 using each tool) in a randomized order. Reliability was measured using interclass correlation coefficient (ICC) and validity measured using Bland-Altman graphs and correlations. Results Of the measurements for accuracy, 64 results were identical, 2 results were manually measured as being 1 mm higher than the program, and 35 as 1 mm lower. Reliability for the iPadVAS was excellent with individual ICC 0.90 (95% CI 0.82-0.95) and averaged ICC 0.97 (95% CI 0.95-1.0) observed. Linear regression demonstrated a strong relationship with a small negative bias towards the iPad (−2.6, SD 5.0) with limits of agreement from −12.4 to 7.1. Conclusions The iPadVAS provides a convenient, user-friendly, and efficient way of collecting data from participants in measuring their current pain levels. It has potential use in documentation management and may encourage participatory healthcare. Trial Registration Australia New Zealand Clinical Trials Registry (ANZCTR): 367297; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367297&isReview=true (Archived by Webcite at http://www.webcitation.org/6d9xYoUbD).

Exposure to 'exergames' increases older adults' perception of the usefulness of technology for improving health and physical activity: a pilot study

Background High rates of sedentary behaviors in older adults can lead to poor health outcomes. However, new technologies, namely exercise-based videogames (“exergames”), may provide ways of stimulating uptake and ongoing participation in physical activities. Older adults’ perceptions of the use of technology to improve health are not known. Objective The study aimed to determine use and perceptions of technology before and after using a 5-week exergame. Methods Focus groups determined habitual use of technology and the participant’s perceptions of technology to assist with health and physical activity. Surveys were developed to quantitatively measure these perceptions and were administered before and after a 5-week intervention. The intervention was an exergame that focused on postural balance (“Your Shape Fitness Evolved 2012”). Games scores, rates of game participation, and enjoyment were also recorded. Results A total of 24 healthy participants aged between 55 and 82 years (mean 70, SD 6 years) indicated that after the intervention there was an increased awareness that technology (in the form of exergames) can assist with maintaining physical activity (P<.001). High levels of enjoyment (Physical Activity Enjoyment Scale [PACES-8] score mean 53.0, SE 0.7) and participation rates over the whole study (83%-100%) were recorded. Conclusions Older adults’ have low perception of the use of technology for improving health outcomes until after exposure to exergames. Technology, in the form of enjoyable exergames, may be useful for improving participation in physical activity that is relevant for older adults.

The Association between Seasonal Variation in Vitamin D, Postural Sway, and Falls Risk: An Observational Cohort Study

Introduction. Low serum vitamin D levels are associated with increased postural sway. Vitamin D varies seasonally. This study investigates whether postural sway varies seasonally and is associated with serum vitamin D and falls. Methods. In a longitudinal observational study, eighty-eight independently mobile community-dwelling older adults (69.7 ± 7.6 years) were evaluated on five occasions over one year, measuring postural sway (force platform), vitamin D levels, fall incidence, and causes and adverse outcomes. Mixed-methods Poisson regression was used to determine associations between measures. Results. Postural sway did not vary over the year. Vitamin D levels varied seasonally (P < 0.001), peaking in summer. Incidence of falls (P = 0.01) and injurious falls (P = 0.02) were lower in spring, with the highest fall rate at the end of autumn. Postural sway was not related to vitamin D (P = 0.87) or fall rates, but it was associated with fall injuries (IRR 1.59 (CI 1.14 to 2.24, P = 0.007). Conclusions. Postural sway remained stable across the year while vitamin D varied seasonally. Participants with high values for postural sway demonstrated higher rates of injurious falls. This study provides important evidence for clinicians and researchers providing interventions measuring balance outcomes across seasons.

“FIND Technology”: investigating the feasibility, efficacy and safety of controller-free interactive digital rehabilitation technology in an inpatient stroke population: study protocol for a randomized controlled trial

Unfortunately, the original version of this article [1] contained an error. An acknowledgement was included incorrectly. Support for this trial was received from the National Stroke Association (Australia). We have also recieved funding to assit with publication costs from The Tasmanian Health Organisation (North). The correct acknowledgement can be found below: Support for this trial was received from the National Stroke Association (Australia). We have also received funding to assist with publication costs from The Tasmanian Health Service (Northern Region).