Shuichi Kakurai

Specific effects of balance and gait exercises on physical function among the frail elderly

Objective: To evaluate the specific effects of balance and gait exercises among frail elderly individuals. Design: A randomized three-group parallel controlled study. Setting: Geriatric health services facility in Japan. Subjects: Thirty-four frail elderly subjects attending the care facility were randomized into a control group, an exercise group with emphasis on balance or an exercise group with emphasis on gait re-education. Interventions: The two exercise groups received balance or gait exercise for 40 minutes, 2–3 times weekly, for 12 weeks. Main outcome measures: One Leg Standing Test, Functional Reach Test, Manual Perturbation Test, Functional Balance Scale, Performance-Oriented Mobility Assessment, Timed ‘Up and Go’ Test and Stair Climbing/Descending Test. These assessments were performed before and after 12-week intervention. Results: Comparison of the performance before and after intervention demonstrated significant improvement in One Leg Standing Test, Functional Reach Test and Functional Balance Scale in the balance exercise group, and Functional Balance Scale, Timed ‘Up and Go’ Test and Stair Descending Test showed improvement in the gait exercise group. All test items showed no significant differences in the control groups. Among the three groups, the balance exercise group showed more significant improvement in Functional Balance Scale, and the gait exercise group showed more significant improvement in Performance-Oriented Mobility Assessment than the control group. The balance exercise group showed greater improvement in performance in Functional Reach Test than the gait exercise group. Conclusions: Balance exercises led to improvements in static balance function, and gait exercises resulted in improvements to dynamic balance and gait functions in the very frail elderly.

Relationship with dynamic balance function during standing and walking.

Shimada H, Obuchi S, Kamide N, Shiba Y, Okamoto M, Kakurai S: Relationship with dynamic balance function during standing and walking. Am J Phys Med Rehabil 2003;82:511-516. ObjectiveTo investigate the relationship between dynamic balance functions in young adults and elderly adults while standing and walking. DesignIn standing balance tests, the Sensory Organization Test (SOT) of six combinations of three visual and two support-surface conditions was used to measure standing balance, and the Motor Coordination Test (MCT) was used to provoke automatic postural reactions through a series of sudden translations of support surface. The gait test measured maximum anterior acceleration (MAA) and maximum posterior acceleration (MPA) of the trunk during perturbed walking using a bilaterally separated treadmill, and calculated latency until MAA and latency until MPA. ResultsThe elderly adults showed more significant functional decline than young adults in SOT1, SOT4, SOT6, medium intensity MCT, large intensity MCT, and MPA. In the correlation analysis of the outcome from the standing examinations, close correlations among SOT4, SOT5, and SOT6 conditions were observed in both groups of young adults and elderly adults. In the MCT, there was very close correlation between varied translation intensity in two groups. On the other hand, the only weak correlation between SOT and MCT findings was between SOT4 and large intensity MCT in elderly adults (r = −0.471, P = 0.049). In the gait test, although correlation was not significant in young adults, the significant correlations between MAA and latency until MAA (r = 0.705, P = 0.001) and latency until MAA and latency until MPA (r = 0.497, P = 0.036) were recognized in elderly adults. In the balance function findings of the standing examinations and the gait examinations, there was significant correlation between medium intensity MCT and latency until MAA (r = −0.552, P = 0.018) in young adults, and SOT6 and latency until MPA (r = −0.473, P = 0.047) in elderly adults. However, no relationship was observed in most of other factors. ConclusionsMost falls experienced by elderly people are caused by tripping or slipping during walking. The fact that walking balance function did not correlate with standing balance function indicates that multifaceted evaluation is important to comprehend dynamic balance function while standing and walking.

Influence of daily activity on changes in physical fitness for people with post-stroke hemiplegia.

To investigate the influence of daily activity on changes in the physical fitness of people with post-stroke (cerebrovascular disorders) hemiplegia, we evaluated the follow-up exercise load test of 30 ambulatory male patients with post-stroke hemiplegia. Between the times of the two tests, patients had no special supervised training. They were advised by their physicians to exercise according to the result of an exercise-loading test. We determined peak oxygen uptake and O2 consumption at the ventilatory threshold point. After 9.4 months, the mean peak oxygen uptake improved significantly from 17.7 to 21.1 ml/min/kg, and ventilatory threshold point also improved significantly from 11.4 to 13.6 ml/min/kg. Among the nine subjects who returned to their jobs, subjects who previously went to their offices by public transportation showed more improvement in ventilatory threshold point level than did subjects who previously walked to their offices. Among the 21 subjects who did not return to work, those who exercised regularly (primarily by walking) showed more improvement of peak oxygen uptake level than did subjects who did not exercise regularly. In conclusion, people with hemiplegia who are living in the community can improve their physical fitness without formal supervised training by simply increasing their daily activities.