Effects of 8 Weeks of Balance Training, Virtual Reality Training, and Combined Exercise on Lower Limb Muscle Strength, Balance, and Functional Mobility Among Older Men: A Randomized Controlled Trial

Abstract

Background: Poor muscle strength, balance, and functional mobility have predicted falls in older adults. Fall prevention guidelines recommend highly challenging balance training modes to decrease falls; however, it is unclear whether certain modes are more effective. The purpose of this study was to determine whether traditional balance training (BT), virtual reality balance training (VR), or combined exercise (MIX) relative to a waitlist control group (CON) would provoke greater improvements in strength, balance, and functional mobility as falls risk factor proxies for falls in older men. Hypothesis: We hypothesized that 8 weeks of MIX will provoke the greatest improvements in falls risk factors, followed by similar improvements after BT and VR, relative to the CON. Study Design: Single-blinded randomized controlled trial NCT02778841 (ClinicalTrials.gov identifier). Level of Evidence: Level 2. Methods: In total, 64 community-dwelling older men (age 71.8 ± 6.09 years) were randomly assigned into BT, VR, MIX, and CON groups and tested at baseline and at the 8-week follow-up. The training groups exercised for 40 minutes, 3 times per week, for 8 weeks. Isokinetic quadriceps and hamstrings strength on the dominant and nondominant legs were primary outcomes measured by the Biodex Isokinetic Dynamometer. Secondary outcomes included 1-legged stance on firm and foam surfaces, tandem stance, the timed-up-and-go, and gait speed. Separate one-way analyses of covariance between groups were conducted for each outcome using baseline scores as covariates. Results: (1) MIX elicited greater improvements in strength, balance, and functional mobility relative to BT, VR, and CON; (2) VR exhibited better balance and functional mobility relative to BT and CON; and (3) BT demonstrated better balance and functional mobility relative to CON. Conclusion: The moderate to large effect sizes in strength and large effect sizes for balance and functional mobility underline that MIX is an effective method to improve falls risk among older adults. Clinical Relevance: This study forms the basis for a larger trial powered for falls.

The Effects of Exergaming on Sensory Reweighting and Mediolateral Stability of Women Aged Over 60: Usability Study

“…Several studies have previously confirmed the beneficial effects of exergames on postural control among older adults [ 22 , 23 , 26 , 29 , 31 - 35 ]. This usability study shows that a simple Kinect game–based balance training might be beneficial for older women by improving balance in the ML direction.…”

“…The m-CTSIB test was initially developed by Shumway-Cook and Horak [ 45 ] to differentiate sensory (somatosensory, visual, and vestibular) inputs involved in postural stability during a steady-state balance assessment, and it explored balance on various surface types, with and without vision, using 4 sensory conditions: (1) firm surface, eyes open; (2) firm surface, eyes closed; (3) foam surface, eyes open; and (4) foam surface, eyes closed. The results provided by the Balance Master 6.0’s software package gave 3 measurements of COG (3 × 10 s) in the anteroposterior (AP) and ML directions [ 35 ]. Based on a previous study [ 43 ] with elderly females in all 4 sensory conditions, this test had good to excellent reliability of ML (intraclass correlation coefficient 0.88-0.93) and AP path length (intraclass correlation coefficient 0.85-0.90).…”

“…The Balance Master 6.0's software provided the location of both the COG and center of pressure across all tests for the m-CTSIB. The m-CTSIB test was initially developed by Shumway-Cook and Horak [45] [35]. Based on a previous study [43] with elderly females in all 4 sensory conditions, this test had good to excellent reliability of ML (intraclass correlation coefficient 0.88-0.93) and AP path length (intraclass correlation coefficient 0.85-0.90).…”

“…In the last decade nonimmersive VR (without the use of a head-mounted device) exergame trainings with the Kinect system have been proven to be favorable in improving postural control among older adults [29][30][31][32][33]. A recent study revealed significant effects on balance in older adults who had VR exercise training versus an inactive control group [34], as well as a conventional exercise training group [35]. However, the exact mechanism of action of exergaming in improving the balance ability of older adults is a complex process that remains unclear [26].…”

Lower-Extremity Intra-Joint Coordination and Its Variability between Fallers and Non-Fallers during Gait

“…More than 70% of falls in older adults take place during gait [9]. For a normal gait, many systems are required, such as sensation and coordination, lower limb and core muscle strength, balance, and function in an integrated fashion [10,11]. A decrease in gait speed with an increase in age can be viewed as an adaptation to compensate for declining sensory-motor function in order to prevent the occurrence of falls.…”