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Balance Strategy Exercise versus Lower Limb-ROM Exercise for Reducing the Risk of Falls among Older People

Zakia Azkia  -  Universitas Jenderal Soedirman, Indonesia
*Rahmi Setiyani  -  Universitas Jenderal Soedirman, Indonesia
Lita Heni Kusumawardani  -  Universitas Jenderal Soedirman, Indonesia
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Abstract

Background: Falls are a significant health problem and the most common cause of injuries in older people. Different types of exercise have been recommended to prevent falls, including balance exercise and range of motion. However, there is a lack of evidence to compare the effect of the two exercises.
Purpose: This study aimed to compare the effect of Balance Strategy Exercise (BSE) and Lower Limb-Range of Motion (ROM) exercise on reducing the risk of falls among older people living in long-term care facilities.
Methods: This was a quasi-experimental study using a pre-post design without a control group. A total of 30 older adults from two nursing homes who met the inclusion and exclusion criteria participated in the study. A cluster randomization technique was used to assign the older people into either BSE or Lower-Limb ROM groups evenly. Treatment was given for 30 minutes per session, three sessions per week for three weeks. The risk of falls was measured using the Timed Up and Go (TUG) test. The paired t-test, Wilcoxon and Mann-Whitney U-test were used to analyze the data.
Results: Results showed significant differences in the TUG scores before and after the intervention within both the BSE (p=0.001) and the Lower Limb-ROM group (p=0.001). However, the Lower Limb-ROM group demonstrated a significantly higher reduction in TUG score than the BSE group after the intervention (p=0.008).
Conclusion: Lower Limb-ROM exercise is better to reduce the risk of falls among older people living in institutional care than BSE. This exercise can be applied as part of a fall prevention program in nursing homes.

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Keywords: BSE; falls; long-term care; lower-limb ROM; older people

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  1. Apriani, N. P. R., Tianing, N. W., & Griadhi, I. P. A. (2015). Pemberian pelatihan balance strategy exercise lebih baik daripada pelatihan core stability exercise dalam meningkatkan keseimbangan dinamis pada Lansia di Banjar Bumi Shanti, Desa Dauh Puri Kelod, Kecamatan Denpasar Barat [Balance strategy exercise training is better than core stability exercise in improving dynamic balance for older people in Banjar Bumi Shanti, Dauh Puri Kelod Village, Denpasar Barat District] [Thesis, Universitas Udayana]. Repository of Universitas Udayana
  2. Avers, D., & Wong, R. A. (2020). Guccione’s geriatric physical therapy (4th ed.). Elsevier
  3. Battaglia, G., Bellafiore, M., Alesi, M., Paoli, A., Bianco, A., & Palma, A. (2016). Effects of an adapted physical activity program on psychophysical health in elderly women. Clinical Interventions in Aging, 11, 1009–1015. https://doi.org/10.2147/CIA.S109591
  4. Chiacchiero, M., Dresely, B., Silva, U., DeLosReyes, R., & Vorik, B. (2010). The relationship between range of movement, flexibility, and balance in the elderly. Topics in Geriatric Rehabilitation, 26(2), 147–154
  5. Cho, S. I., & An, D. H. (2014). Effects of a fall prevention exercise program on muscle strength and balance of the old-old elderly. Journal of Physical Therapy Science, 26(11), 1771–1774. https://doi.org/10.1589/jpts.26.1771
  6. Choi, J. H., & Kim, N. J. (2015). The effects of balance training and ankle training on the gait of elderly people who have fallen. Journal of Physical Therapy Science, 27(1), 139–142. https://doi.org/10.1589/jpts.27.139
  7. Del Brutto, O. H., Mera, R. M., Peinado, C. D., & Sedler, M. J. (2019). Prevalence, severity, and fisk of future falls in community-dwelling older adults living in a rural community: The Atahualpa project. Journal of Community Health, 44(3), 487–491. https://doi.org/10.1007/s10900-019-00664-3
  8. Dutton, M. (2012). Dutton’s orthopaedic examination evaluation and intervention (3rd ed.). McGraw Hill Education
  9. Esserman, D., Allore, H. G., & Travison, T. G. (2016). The method of randomization for cluster-randomized trials: Challenges of including patients with multiple chronic conditions. International Journal of Statistics in Medical Research, 5(1), 2–7. https://doi.org/10.6000/1929-6029.2016.05.01.1
  10. Fitriansyah, M. A., Susanto, T., & Rasni, H. (2014). Pengaruh latihan rentang gerak ekstremitas bawah terhadap keseimbangan tubuh lansia di Posyandu Alamanda 99 Kelurahan Jember Lor Kabupaten Jember [The effect of lower limb range of motion training on the body balance of the elderly at Posyandu Alamanda 99 Kelurahan Jember Lor, Jember Regency]. Pustaka Kesehatan, 2(3), 523–529
  11. Gale, C. R., Cooper, C., & Sayer, A. A. (2016). Prevalence and risk factors for falls in older men and women: The english longitudinal study of ageing. Age and Ageing, 45(6), 789–794. https://doi.org/10.1093/ageing/afw129
  12. Gschwind, Y. J., Kressig, R. W., Lacroix, A., Muehlbauer, T., Pfenninger, B., & Granacher, U. (2013). A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: Study protocol for a randomized controlled trial. BMC Geriatrics, 13(1), 105–117. https://doi.org/10.1186/1471-2318-13-105
  13. Jia, H., Lubetkin, E. I., DeMichele, K., Stark, D. S., Zack, M. M., & Thompson, W. W. (2019). Prevalence, risk factors, and burden of disease for falls and balance or walking problems among older adults in the U.S. Preventive Medicine, 126, 105737. https://doi.org/https://doi.org/10.1016/j.ypmed.2019.05.025
  14. Jiang, Y., Xia, Q., Zhou, P., Jiang, S., Diwan, V. K., & Xu, B. (2020). Falls and fall-related consequences among older people living in long-term care facilities in a megacity of China. Gerontology, 66(6), 523–531. https://doi.org/10.1159/000510469
  15. Joshua, A. M., D’Souza, V., Unnikrishnan, B., Mithra, P., Kamath, A., Acharya, V., & Venugopal, A. (2014). Effectiveness of progressive resistance strength training versus traditional balance exercise in improving balance among the elderly: A randomised controlled trial. Journal of Clinical and Diagnostic Research, 8(3), 98–102. https://doi.org/10.7860/JCDR/2014/8217.4119
  16. Jung, H., & Yamasaki, M. (2016). Association of lower extremity range of motion and muscle strength with physical performance of community-dwelling older women. Journal of Physiological Anthropology, 35(1), 1–7. https://doi.org/10.1186/s40101-016-0120-8
  17. Kim, H. J., Lee, Y., & Sohng, K.-Y. (2014). Effects of bilateral passive range of motion exercise on the function of upper extremities and activities of daily living in patients with acute stroke. Journal of Physical Therapy Science, 26(1), 149–156. https://doi.org/10.1589/jpts.26.149
  18. Konak, H. E., Kibar, S., & Ergin, E. S. (2016). The effect of single-task and dual-task balance exercise programs on balance performance in adults with osteoporosis: A randomized controlled preliminary trial. Osteoporosis International, 27(11), 3271–3278. https://doi.org/10.1007/s00198-016-3644-1
  19. Krishna, R., Maithreyi, R., & Surapaneni, K. (2010). Research bias: A review for medical students. Journal of Clinical and Diagnostic Research, 4(2), 2320–2324
  20. Lacroix, A., Kressig, R. W., Muehlbauer, T., Gschwind, Y. J., Pfenninger, B., Bruegger, O., & Granacher, U. (2016). Effects of a supervised versus an unsupervised combined balance and strength training program on balance and muscle power in healthy older adults: A randomized controlled trial. Gerontology, 62(3), 275–288. https://doi.org/10.1159/000442087
  21. Low, D. C., Walsh, G. S., & Arkesteijn, M. (2017). Effectiveness of exercise interventions to improve postural control in older adults: A systematic review and meta-analyses of centre of pressure measurements. Sports Medicine, 47, 101–112. https://doi.org/10.1007/s40279-016-0559-0
  22. Ministry of Health Republic of Indonesia. (2018). Riset kesehatan dasar 2018 [Basic health research 2018]. Ministry of Health Republic of Indonesia. https://kesmas.kemkes.go.id/assets/upload/dir_519d41d8cd98f00/files/Hasil-riskesdas-2018_1274.pdf
  23. Mortazavi, F., & Nadian-Ghomsheh, A. (2018). Stability of kinect for range of motion analysis in static stretching exercises. PLoS ONE, 13(7), 1–15. https://doi.org/10.1371/journal.pone.0200992
  24. Murtaqib. (2013). Perbedaan latihan range of motion (ROM) pasif dan aktif selama 1-2 minggu terhadap peningkatan rentang gerak sendi pada penderita stroke di Kecamatan Tanggul Jember [The difference between passive and active range of motion (ROM) exercises for 1-2 weeks to increase the range of motion in stroke patients in Tanggul Jember District]. Jurnal Keperawatan Soedirman, 8(1), 56–68. http://dx.doi.org/10.20884/1.jks.2013.8.1.466
  25. Netz, Y., Lidor, R., & Ziv, G. (2019). Small samples and increased variability–discussing the need for restricted types of randomization in exercise interventions in old age. European Review of Aging and Physical Activity, 16(1), 1–8. https://doi.org/10.1186/s11556-019-0224-3
  26. Nirmalasari, N., Mardiyono, M., Dharmana, E., & Arifin, T. (2020). Deep breathing exercise and active range of motion influence physiological response of congestive heart failure patients. Nurse Media Journal of Nursing, 10(1), 57–65. https://doi.org/10.14710/nmjn.v10i1.25318
  27. Nitz, J. C., & Josephson, D. L. (2011). Enhancing functional balance and mobility among older people living in long-term care facilities. Geriatric Nursing, 32(2), 106–113. https://doi.org/10.1016/j.gerinurse.2010.11.004
  28. Pengpid, S., & Peltzer, K. (2018). Prevalence and risk factors associated with injurious falls among community-dwelling older adults in Indonesia. Current Gerontology and Geriatrics Research, 2018, 5964305, 1-8. https://doi.org/10.1155/2018/5964305
  29. Pongantung, H., Sampe, A., & Melchi, S. D. (2018). Pengaruh range of motion pada ekstremitas bawah terhadap keseimbangan berjalan pada pasien pasca stroke di RS Stella Maris Makasar [Effect of lower extremities range of motion on walking balance in post-stroke patients at Stella Maris Hospital, Makassar]. Jurnal Ilmiah Kesehatan Diagnosis, 12(3), 271–276
  30. Rhestifujiayani, E., Huriani, E., & Muharriza, M. (2015). Comparison of muscle strength in stroke patients between the given and not given range of motion exercise. Nurse Media Journal of Nursing, 5(2), 88–100. https://doi.org/10.14710/nmjn.v5i2.10534
  31. Safa’ah, N., & Srimurayani, I. D. (2017). Effectiveness of isometric and range of motion (ROM) exercise toward elderly muscle strenght in Pasuruan integrated service unit, elderly social services in Lamongan. Biomedical Engineering, 3(1), 7–15
  32. Seo, B. D., Kim, B. J., & Singh, K. (2012). The comparison of resistance and balance exercise on balance and falls efficacy in older females. European Geriatric Medicine, 3(5), 312–316. https://doi.org/10.1016/j.eurger.2011.12.002
  33. Shumway-Cook, A., Brauer, S., & Woollacott, M. (2000). Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go test. Physical Therapy, 80(9), 896–903. https://doi.org/10.1093/ptj/80.9.896
  34. Sibley, K. M., Beauchamp, M. K., Van Ooteghem, K., Straus, S. E., & Jaglal, S. B. (2015). Using the systems framework for postural control to analyze the components of balance evaluated in standardized balance measures: A scoping review. Archives of Physical Medicine and Rehabilitation, 96(1), 122–132. https://doi.org/10.1016/j.apmr.2014.06.021
  35. Silva, R. B., Eslick, G. D., & Duque, G. (2013). Exercise for falls and fracture prevention in long term care facilities: A systematic review and meta-analysis. Journal of the American Medical Directors Association, 14(9), 685–689. https://doi.org/10.1016/j.jamda.2013.05.015
  36. Susilowati, I. H., Nugraha, S., Sabarinah, S., Peltzer, K., Pengpid, S., & Hasiholan, B. P. (2020). Prevalence and risk factors associated with falls among community-dwelling and institutionalized older adults in Indonesia. Malaysian Family Physician: The Official Journal of the Academy of Family Physicians of Malaysia, 15(1), 30–38
  37. Tseng, C. N., Chen, C., Wu, S. C., & Lin, L. (2007). Effects of a range-of-motion exercise programme. Journal of Advanced Nursing, 57(2), 181–191. https://doi.org/10.1111/j.1365-2648.2006.04078.x
  38. Widyawati, I. Y., Irawaty, D., & Sabri, L. (2017). Active lower range of motion reduce the sign and symptom of diabetic neuropathy. Jurnal Ners, 5(2), 107–117. https://doi.org/10.20473/jn.v5i2.3930
  39. Williams, J. S., Kowal, P., Hestekin, H., O’Driscoll, T., Peltzer, K., Yawson, A., Biritwum, R., Maximova, T., Rodríguez, A. S., Espinoza, B. M., Wu, F., Arokiasamy, P., Chatterji, S., & SAGE collaborators. (2015). Prevalence, risk factors and disability associated with fall-related injury in older adults in low- and middle-incomecountries: Results from the WHO Study on global AGEing and adult health (SAGE). BMC Medicine, 13(1), 147–158. https://doi.org/10.1186/s12916-015-0390-8
  40. Worapanwisit, T., Prabpai, S., & Rosenberg, E. (2018). Correlates of falls among community-dwelling elderly in Thailand. Journal of Aging Research, 2018, 8546085. https://doi.org/10.1155/2018/8546085
  41. World Health Organization [WHO]. (2018). Falls. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/falls
  42. Yeşilyaprak, S. S., Yıldırım, M. Ş., Tomruk, M., Ertekin, Ö., & Algun, Z. C. (2016). Comparison of the effects of virtual reality-based balance exercises and conventional exercises on balance and fall risk in older adults living in nursing homes in Turkey. Physiotherapy Theory and Practice, 32(3), 191–201. https://doi.org/10.3109/09593985.2015.113800

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