None listed
Conditions
Brief summary
Falls are a major public health concern because they are associated with injury, pain, impaired function, loss of independence and even death. Reduced muscle power, or the ability to produce a rapid movement such as a quick step to recover from a loss in balance, is a strong predictor of disability and falls in older adults. In this population, the requirements to produce rapid movements often occurs whilst simultaneously performing other attention demanding cognitive-motor tasks such as walking while talking or negotiating obstacles. This study will evaluate whether a community-based, dual task functional power training (DT-FPT) program can reduce the rate of falls and improve risk factors for falls in elderly women at increased risk of falling. Secondary aims are to: 1) evaluate the efficacy of a 'step-down' maintenance program on fall rates; 2) assess the cost-effectiveness of the program; 3) evaluate the effects of the program on neural and cognitive health and function. This is an 18-month randomised controlled trial involving 6-months of supervised DT-FPT, a 6-month 'step-down' maintenance program, and a 6-month follow-up. Elderly women (n=300) at increased risk of falling will be randomised to: 1) DT-FPT plus a 6-month step-down program or 2) a usual care group. The primary outcome measure will be the number of falls throughout the study. Secondary outcomes will include: lower limb muscle power, gait, reaction time and balance under single and dual task conditions; falls related self efficacy, cognitive function and quality of life. All measures will be assessed at baseline, 6, 12 and 18 months. We expect that the results from this trial will guide the development and implementation of future community-based falls prevention programs that specifically focus on optimising muscle power, gait and function and reducing falls risk in the elderly under ‘real-life’ conditions. We also expect that the ‘step-down’ program will provide new information about the efficacy of a less intensive maintenance program for reducing the risk of falls over an extended period.
Interventions
This is an 18-month randomised controlled trial involving 6-months of supervised dual task functional power training, a 6-month 'step-down' maintenance program, and a 6-month follow-up. Men and women at increased risk of falling will be randomised to: 1) Dual task functional power training plus a 6-month step-down program or 2) a usual care control group.
The dual task functional power training is an individually tailored high speed progressive resistance training program. The community based
This is an 18-month randomised controlled trial involving 6-months of supervised dual task functional power training, a 6-month 'step-down' maintenance program, and a 6-month follow-up. Men and women at increased risk of falling will be randomised to: 1) Dual task functional power training plus a 6-month step-down program or 2) a usual care control group. The dual task functional power training is an individually tailored high speed progressive resistance training program. The community based program will be supervised by accredited exercise trainers and conducted twice a week. Each session will last 45-60 minutes and consist of high velocity functional and resistance training with the goal to increase lower limb muscle power, including gait speed, movement speed and force, and mobility. Participants will be instructed to perform all repetitions for each concentric (shortening) phase of the exercise as quickly as possible, while the eccentric (lengthening) phase of the exercise action will be controlled over 3-4 seconds. The exercises will become progressively more challenging by increasing the difficulty or changing the exercise to another more complex task and adding a secondary task (such as counting backwards, or performing the exercise to the beat of the music). As a guide, participants will perform 2 sets of 10-20 repetitions progressing to 50 reps for the stepping exercises. For the resistance exercises, participants will perform 2 sets of 10-15 repetitions at an intensity of 4 to 6 (moderate to hard) on the 10 point Borg’s Rating of Perceived Exertion scale (RPE). Resistance will be increased as tolerated using this scale. Compliance to the exercise program will be monitored with exercise cards and session attendance records.
Sponsors
Deakin University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
65 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Sedentary community dwelling men and women living in retirement villages or their own home who fulfill the defined criteria for an increased risk of falls (a score 3 or more on our falls risk assessment questionnaire); English speaking; and able to walk unaided or with minimal assistance for at least 50 metres.
Exclusion criteria
Participants will be excluded based on the following: 1) current participation in a progressive resistance or balance program; 2) acute or terminal illness likely to compromise exercise participation; 3) unstable or ongoing cardiovascular / respiratory disorders; 4) musculoskeletal or neurological diseases disrupting voluntary movement or that might limit training; 5) upper or lower extremity fracture in the past 3 months, and 6) visual impairment not corrected with glasses.
Outcome results
None listed