Effect of a group-based exercise program on balance in elderly

Figures & data

Table 1 Functional balance class content

Week #	Element trained	Sample exercises-all exercises performed in unsupported standing with handhold in close proximity and close supervision of instructor
1	Stance stability	Emphasis initially placed on equal weight bearing. Participants resist self-initiated and external perturbations (mini squats, “tug of war” with elastic band). Progressed to eyes closed and compliant surface if tolerated.
2	Initiation of weight shift	Weight shifting ant-post/left-right. Ball pass (forced reaching and weight shift). Looking over shoulder to promote weight shifting.
3	Advanced weight shifting	Same as class 2 yet perform exercises with narrowed base of support, in step stance position or with lights dimmed or eyes closed. Add element of timing to tasks: use metronome or music.
4	Introduction to stepping	Repeated stepping, alternating side taps or tap-ups to 2” riser. Kick stationary soccer ball.
5	Dynamic base of support	Resisted stepping (elastic band around waist and step away). Multi-directional stepping. Incorporate various surfaces if capable and/or alter visual input.
6	Vestibular stimulation	Gaze stabilization exercises in standing. Cone stacking side to side with associated head motion.
7	Multi-directional locomotion	Cross-overs, braiding, backwards walking. Direction changing drills: random, sudden change in directions requested.
8	High-level coordination activities and multi-tasking	High-level gait training: speed changes, ambulation with alternating claps. Dribbling soccer ball, balloon volleyball, obstacle course

Table 2 Rank order of fall risk factors

Risk factor	Number
Peripheral neuropathy	27
Centrally-acting medications	26
Deconditioning	19
Pain	12
Vestibular problems, Dizziness/Vertigo,	11
Orthostasis	9
Residuals of stroke	8
Impaired Vision	8
Impaired central sensory integration	6
Parkinson’s disease	6
Other	34

Table 3 Berg balance scores

Scores		Mean	SD	p-value
Berg score	Pre	46.80	2.85	<0.0001
	Post	52.50	2.73

Table 4 Limits of stability test

Variables:	Pre: mean(sd)	Post: mean(sd)	p-value
LOS_composite RT	1.19 (0.24)	1.08 (0.19)	0.0158
LOS_composite MVL	2.61 (0.89)	2.93 (0.93)	0.0192
LOS_composite EPE	40.91 (9.19)	49.64 (11.42)	<0.0001
LOS_composite MXE	53.67 (10.29)	63.85 (13.27)	<0.0001
LOS_composite DCL	53.45 (10.68)	64.82 (10.05)	<0.0001

1. Reaction Time (RT) is the time in seconds between the command to move and he patient’s first movement.

2. Movement Velocity (MVL) is the average speed of COG movement in degrees per second.

3. Endpoint Excursion (EPE) is the distance of the first movement toward the designated target, expressed as a percentage of maximum LOS distance. The endpoint is considered to be the point at which the initial movement toward the target ceases.

4. Maximum Excursion (MXE) is the maximum distance achieved during the trial.

5. Directional Control (DCL) is a comparison of the amount of movement in the intended direction (towards the target) to the amount of extraneous movement (away from the target).

Table 5 Modified clinic test for sensory interaction in balance (mCTSIB) results

Variables:	Pre: Mean center of gravity sway Velocity (degrees/sec)(sd)	Post: Mean center of gravity sway Velocity (degrees/sec)(sd)	p-value
Firm-Eyes Open (firm-EO)	0.52 (0.24)	0.48 (0.20)	0.2350
Firm-Eyes Closed (firm-EC)	0.80 (0.65)	0.77 (0.40)	0.7648
Foam-Eyes Open (foam-EO)	3.13 (1.83)	2.38 (1.68)	0.0039
Foam-Eyes Closed (foam-EC)	5.55 (1.01)	5.18 (1.31)	0.0262
Composite	2.50 (0.67)	2.20 (0.67)	0.0004

Figure 1 The distribution of Berg score with respect to differenct classes attended.