Effectiveness of Balance Exercise Circuit (BEC) on Improving Gait Parameters and Functional Performance in Older Adults.

 

Gitasri  Chakraborty¹, A. Kumaresan^2*, Kiruthika. S³  Manoj Abraham⁴

¹MPT (Neurology) 2^nd Year, Saveetha college of Physiotherapy, Saveetha University, Chennai, India

²Assistant professor, Saveetha College of Physiotherapy, Saveetha University, Chennai, India

³Tutor, Saveetha College of Physiotherapy, Saveetha University, Chennai, India.

⁴Principal, Saveetha College of Physiotherapy, Saveetha University, Chennai, India

 

ABSTRACT:

Introduction: As age progresses, the degree of body sway increases even in simple postural forms, such as an upright posture, causing elderly individuals to sway more than young adults. Changes associated with the aging process, especially those associated with balance, start around the age of 60 years and affect the sensory system (visual, vestibular, and somatosensory) and physical attributes like flexibility, strength, balance, and coordination.  These changes also affect reaction time, causing the elderly to develop many  balance-related issue. Balance Exercise circuit (BEC) program, a new comprehensive design that includes exercise stations that specifically challenge sensory inputs from mechanoreceptors as well as form the visual and vestibular systems. Exercise stations were also designed to stimulate activities of daily living and potential to improve Gait and functional performance on older adults. This study intends to examine the effects of balance exercise circuit (BEC) improve gait parameters and functional performance in older adults Aim and objectives- This study aims to examine the effects of balance exercise circuit (BEC) improve gait parameters and functional performance in older adults. Methodology-Quasi Experimental study design was used in this study. Total 30 patients were selected. Pre-test and post test values were measured by using Time up and Go test (TUG) and Gait Parameters (cadence, stride length, step length)  as outcome measure and were given Balance exercise circuit(BEC) for 40 minute 2 weeks and 5 days per week. Results-The collected data was tabulated and analyzed using paired t test were used. Paired t-test was used to analyze significant changes between pre-test and post-test measurements in the group. There was a significant difference between the pre test and post test measurements p value was P<0.0001. Conclusion-From this study it is concluded that the Balance exercise circuit (BEC) exercises in older adults improved gait parameters and functional performance.

 

 

INTRODUCTION:

Normal postural control or balance is depend on normal integrative functioning of body systems such as somatosensory inputs, vision and motor systems.¹As age progresses, the degree of body sway increases, in simple posture may deviate, such as an upright posture, causing elderly individuals to sway more than young adults. Aging process, with balance starts around the age of 60 years and affect the sensory system (visual, vestibular, and somatosensory) and physical attributes like flexibility, strength, balance, and coordination. These changes also affect reaction time and developed many balance-related issues.²

 

Aging is associated with a general decline in the musculoskeletal and sensory systems involved in the maintenance of postural control. Lower extremity weakness and balance impairment are major independent intrinsic risk factors for falls and loss of independence.² Gait and balance disorders are among the most common causes of falls in older adults and often lead to injury, disability, loss of independence, and limited quality of life. Most changes in gait that occur in older adults.³

 

At least 30 percent of persons 65 years older report difficulty walking and climbing one flight of stairs, and approximately 20 percent require the use of a mobility aid to ambulate. 35 percent were found to have an abnormal gait. The prevalence of abnormal gait increases with age and is higher in persons in the acute hospital setting and in those living in long-term care facilities.10 to 20 percent reduction in gait velocity and stride length in the older population. Other characteristics of gait that commonly change with aging include an increased stance width, increased time spent in the double support with both feet in the ground because of forward bent posture, and less vigorous force development at the moment of push off phase in gait.³

 

Age related morphologic changes occur in all body systems, including those essential for the maintenance of posture. Aging has been shown to be associated with a significant loss of hair cells in the vestibular sensors, decrease of primary vestibular neurons, a diminution in the neuronal cell density of the cerebral cortex, and a decrease in the number of purkinje’s cells in the cerebellum. There are degenerative changes in the sensory and motor systems, in the tendon receptors in the lower extremities and in the musculoskeletal system.⁴

 

Balance Exercise circuit (BEC) program, a new comprehensive design that includes exercise stations that specifically challenge sensory inputs from mechanoreceptors as well as form the visual and vestibular systems. Exercise stations were also designed to stimulate activities of daily living and potential to improve Gait and functional performance on older adults. The circuit were published research about the characteristics of effective fall prevention programs. Gillespie et al 2012.⁴

 

The circuit is composed of 13 stations, involving static and dynamic balance exercises, including tandem walking, forward- backward stepping, wide stance gait, functional reach, heel lift, toe press, balance on unstable surfaces, and standing on one leg.⁴

This study intends to examine the effects of balance exercise circuit (BEC) improve on gait parameters and functional performance in older adults.

 

METHODS:

Patients were participate in this study was screened for inclusion(Subjects of both the gender within the age group of 60 years or more, physically independent, not currently engaged in a structural exercise program, Able to understand and follow simple verbal instructions, Who can able to stand more than 40 minute)and exclusion criteria(Physical or functional impairments, Dementia, Alzheimer’s disease, Parkinson’s disease, Any Musculoskeletal disorder) 30 sample was selected using convenient sampling technique. They were explained about safety and simplicity of the procedure and informed consent was obtained. This study is conducted in Saveetha College of physiotherapy OPD Thandalam, Chennai India. As Outcome measure pre test values was noted for all 30 subject using Timed up and go test (TUG) and Gait parameters (cadence, stride length, step length) . For Timed up and Go test - subject was sited in a Aram rest chair, then sit to stand, after that walking 3 m, and sitting again after coming back. The measuring method was used to record the time required for a subject to sit on a chair whose height is 50 cm, standing, walking 3 m and coming back and sitting down in the chair again at least twice, as well as to record average values was taken for measurements. For Gait parameters (cadence, stride length, step length) - All subject was walked barefoot, the subjects walked normally on the ground surface. Cadence is   calculated number of steps taken by a person per minute by using stop watch. Step length:- it is measured from the heel strike of one extremity to the heel strike of opposite extremity by using inch tape and marker. Stride length:-stride length is determined by measuring the linear distance from the point of one heel strike of one lower extremity to the point of the next heel strike of the same extremity by using inch tape and marker.30 subjects was received Balance exercise circuit training (BEC) was given for 2 weeks treatment duration, 5 session per week, 40 minutes per day. Balance Exercise Circuit (BEC) session comprised of warm-up and stretching (10 minute), exercise circuit (20 minute) and cool down (10 minute). After 2 weeks Time up and go test (TUG), Gait parameters (cadence, stride length, step length) was performed as post test measurement.

 

Intervention: stretching exercises and warm up was given for (10 minute)-Lower Limbs and upper Limbs stretching. Warm –up Exercises:-Multidirectional gait, Rhythmic gait, Hip flexion, Hip abduction, Hip adduction, Hip extension, Knee flexion, Plantar flexion.  Balance exercise circuit was given for -20 minute. (All exercise was performed in pairs and for 2minute)-Side steps to the right and to the left, Standing on one foot right or left, Waking on heels, Backward walking on heels, Back ward walking on whole foot, Balance and walking on unstable surface (mattress, balance board), Walking on toes, Forward walking, Multidirectional reach, Forward walking with crossed leg, Walking on narrow base, Tandem walking. Cooling down (10 minute):-Memory exercise, Ball game, Motor coordination, Breathing exercise.

 

RESULTS:

The statistical analysis revealed significant difference (P<0.0001) between pretest and posttest values of Timed up and Go test and Gait parameters – Cadence, Step Length, Stride Length within the group. The pretest mean values of Timed up and Go test (TUG) 20.40(SD=4.15) and posttest mean values of Timed up and Go test 16.33(SD=3.40). This shows that Timed up and Go test in posttest values were comparatively less than pretest value- p<0.0001 and t- value is 12.65. (Table no.1)

 

Table 1: Pre test and post test values of Timed up and Go test

Timed up and Go test	Pre test	Mean	Standard Deviation	t-value	p-value
		20.40	4.15	12.65	<0.0001
	Post test	16.33	3.40

 

Graph 1: pre and post values of Timed up and Go test

 

 

The pretest mean values of Gait parameters for cadence 110.47(SD= 16.91) and posttest mean values of cadence 106.37(SD=16.64). This shows gait parameters cadence posttest values were comparatively less than pretest values P<0.0001 and t value is 15.27. (Table no.2)

 

Table 2: Pre test and post test values of  Gait parameters Cadence

Cadence	Pre test	Mean	Standard Deviation	t value	P value
		110.47	16.91	15.27	<0.0001
	Post test	106.37	16.64

 

 

 

 

 

 

Graph 2: pre and post values of gait parameters cadence

 

 

Step length pretest mean values of 24.37(SD=3.71) posttest mean values of step length 27.63(SD= 3.25), this shows that gait parameters step length pretest values is increased compared to the posttest values p<0.0001 and t value is 14.89. (Table no 3)

 

Table 3: Pre test and post test values of Gait parameters step length

Step Length	Pre test	Mean	Standard deviation	t value	P value
		24.37	3.71	14.89	<0.0001
	Post test	27.63	3.25

 

Graph 3: pre and post values of gait parameters step length

 

 

Stride length  pretest mean  values of 48.73 (SD=7.42) and posttest mean values of stride length52.90 (SD=6.67),  This shows that gait parameters stride length pretest values is  increased  compared to the  post test values p<0.0001 and t value is 17.35. (Table no 4)

 

Table 4: Pre test and post test values of Gait parameters stride length

Stride Length	Pre test	Mean	Standard Deviation	t-value	P-value
		48.73	7.42	17.35	<0.0001
	Post test	52.90	6.67

 

Graph 4: pre and post values of gait parameters stride length

 

 

The statistical analysis of posttest, Time up and Go test and Gait parameters Cadence, step length, Stride length revealed that there is highly statistically significant difference seen within the group.

 

DISCUSSION:

Aging impairs the central nervous system capability to process vestibular, visual and proprioceptive signals responsible for maintaining body balance, as well as for reducing the capacity of modifying adaptive reflexes and gait parameters like cadence, step length, stride length. These degenerative processes are responsible for the occurrence of vertigo and/or dizziness and imbalance in the geriatric population.⁵

 

The Balance Exercise Circuit program was feasible and acceptable above 91% adherence. These results indicate that the Balance Exercise Circuit intervention is likely to promote functional independence in older adults and may be effective in reducing the risk of falls. The  Balance Exercise Circuit program is a new format of exercise delivery, developed with reference to published evidence on effective exercise to maximize balance and function and prevents falls in older age. It is easy to reproduce the protocol used and to implement. Balance Exercise Circuit is low cost intervention, highly reproducible and attractive, enjoyable for older adults.⁴

 

Previous studies that included more than 24 exercises session elicited improved performance in these tests (Rubenstein et al 2000, canvalno et al 2010) and specific strength on aerobic training was also associated with significant improvements in these measures(Eyigon et al 2007). A number of this gait parameters including decrease walking speed, stride length, step length associated with age.

 

In this present study  proved that  the Balance Exercise circuit performed 2weeks for 5days a week improved functional performance and gait parameters in older adults and it also improved leg strength, power, static and dynamic balance and mobility. Balance Exercise Circuit shows improvement in pre-test and post-test measurements Timed up and Go test and gait parameters (cadence, stride length, step length) using as a outcome measurements. Exercise in older adults significant improvements in cadence, stride length and step length.

 

Exercise program was an appropriate nature, the stimulus sufficiently intensive and the program of adequate duration to produced considerable improvements in gait patterns. This finding showed that increased walking speed evident in exercises increased stride length, cadence, strength in specific muscle groups and certain gait parameters suggest that cadence was mediated at least in part by improved ankle dorsiflexion strength and increased stride length was mediated by improved hip flexion strength.

 

In this present study it proved that there is a significant difference between pre and post-test values of Timed Up and Go test and Gait parameters cadence, stride length and step length. Timed Up and Go  test result decrease compare to pre and post-test values, cadence decrease compare to pre and post-test values, stride and step length increase compare to pre and post-test values after the Balance Exercise Circuit  intervention and improved gait parameters and functional performance in older adults.

 

Finally, exercise programs also have to maintain adequate compliance to be effective public health interventions. Thus it appears that exercise interventions of this nature may offer an effective health promotion strategy for improving functional performance in older adults. We acknowledge this study has some limitations small sample size, long term follow up needed, no control group.

 

CONCLUSION:

These results show that the Balance Exercise Circuit program is an acceptable and effective intervention for older adults to promote improvements in important aspects of functional performance and gait parameters, intervention resulted in improved muscle strength and power, balance, and functional capacity in a sample of older adults.

 

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Received on 09.08.2017          Modified on 24.08.2017

Accepted on 13.09.2017        © RJPT All right reserved