Sarcopenia
Conditions
Keywords
Sarcopenia, PNF exercises, Balance, Fear of falling, Resistance exercise
Brief summary
Age-related declines in muscle strength and physical performance may impair balance, mobility, and independence in older adults. Exercise may help preserve these functions; however, thethe comparative benefits of PNF-based exercise versus conventional exercise remain unclear in older women who screen positive for sarcopenia risk. This randomized study compared a PNF-based exercise program with conventional exercise in community-dwelling women aged 65 years or older with SARC-F scores of 4 or higher. Although all participants screened positive for sarcopenia risk, none met the criteria for confirmed sarcopenia according to the revised European Working Group on Sarcopenia in Older People framework (EWGSOP2). Forty participants were randomly allocated to two groups, with 20 participants in each group. Thirty-four participants completed the study and were included in the analysis, with 17 participants in each group. Both groups followed a 10-week exercise program comprising three sessions per week, with each session lasting approximately 45 minutes. The first three sessions were conducted at the clinic under physiotherapist supervision. The remaining sessions were performed independently at home, with adherence monitored through weekly telephone follow-up. The conventional exercise program included lower-extremity strengthening, balance training, functional mobility exercises, sit-to-stand practice, gait exercises, and stretching. The PNF-based program incorporated diagonal and multiplanar movement patterns and task-oriented functional movements into conventional therapeutic exercises. Manual contacts, manual resistance, and hands-on facilitation were used only during the first three supervised sessions. Participants were assessed at baseline and at one and three months after completion of the 10-week program. Outcomes included balance, functional mobility, walking capacity, lower-extremity functional strength, stair performance, falls efficacy, and depressive symptoms. Assessments included the Berg Balance Scale, Timed Up and Go Test, 6-Minute Walk Test, Five Times Sit-to-Stand Test, stair ascent and descent test, Tinetti Falls Efficacy Scale, and 15-item Geriatric Depression Scale.
Detailed description
Age-related declines in muscle strength and physical performance may contribute to impaired balance, mobility limitations, and reduced independence. A positive sarcopenia screening result does not establish a diagnosis of sarcopenia. This study focused on community-dwelling older women who screened positive for sarcopenia risk using the SARC-F questionnaire but did not meet EWGSOP2 criteria for confirmed sarcopenia. The rationale for the study was to investigate whether incorporating proprioceptive neuromuscular facilitation (PNF) principles into a predominantly home-based exercise program provides additional functional benefits compared with conventional therapeutic exercise of comparable duration and frequency. This prospective, single-center, two-arm randomized study was conducted at the outpatient Physical Medicine and Rehabilitation and Medical Ecology and Hydroclimatology Clinic of Uşak Training and Research Hospital, Uşak, Türkiye. Participants were women aged 65 years or older with SARC-F scores of 4 or higher who could safely participate in the prescribed exercise program. Participants were randomly allocated in a 1:1 ratio using a computer-generated random-number table. Both groups followed a 10-week program consisting of three approximately 45-minute sessions per week. The first three sessions were supervised by a physiotherapist at the clinic to demonstrate the exercises, correct performance, and prepare participants for independent practice. Subsequent sessions were performed at home, with weekly telephone follow-up to monitor adherence and address participants' questions. Exercise intensity and progression were individualized according to functional capacity and clinical tolerance. The PNF-based program incorporated diagonal and multiplanar movement patterns, coordinated neuromuscular activation, and task-oriented functional movements into conventional therapeutic exercises. Manual contacts, manual resistance, and hands-on facilitation were restricted to the first three supervised clinic sessions. Home sessions used PNF-derived movement patterns that participants could perform independently. Participants and treating physiotherapists could not be blinded because of the nature of the interventions. Outcome assessments were performed by a physician who was not involved in delivering the exercise programs. Assessments were conducted before the intervention and at one and three months after completion of the 10-week program to examine functional changes and their persistence beyond the intervention period. Outcomes covered balance, functional mobility, walking capacity, sit-to-stand and stair performance, falls efficacy, and depressive symptoms. Forty participants were randomized, and 34 completed the study. Analyses included participants with complete data, without imputation of missing follow-up measurements. The trial was retrospectively registered, and between-group outcome analyses were interpreted as exploratory.
Interventions
BEHAVIORALConventional Exercise Program
Participants received a conventional therapeutic exercise program including lower-extremity strengthening, balance training, functional mobility exercises, sit-to-stand practice, gait exercises, and stretching. The program comprised three sessions per week for 10 consecutive weeks, with each session lasting approximately 45 minutes. The first three sessions were conducted at the clinic under physiotherapist supervision. The remaining sessions were performed independently at home, with adherence monitored through weekly telephone follow-up. Exercise intensity and progression were individualized according to each participant's functional capacity and clinical tolerance.
Participants received proprioceptive neuromuscular facilitation exercises program. The PNF intervention included diagonal movement patterns, proprioceptive stimulation, coordinated neuromuscular activation, manual resistance, and task-oriented functional movement patterns designed to improve postural control, balance, gait, and lower-extremity functional performance. The program was performed three days per week for 10 consecutive weeks, with each session lasting approximately 45 minutes.Manual contacts, manual resistance, and hands-on facilitation techniques were applied only during the first three supervised clinic sessions. The remaining sessions were performed independently at home using PNF-derived movement patterns taught at the clinic. Adherence was monitored through weekly telephone follow-up.
Sponsors
Uşak University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Forty participants were randomly allocated in a 1:1 ratio to two parallel groups using a computer-generated random-number table, with 20 participants assigned to a conventional exercise group and 20 to a PNF-based exercise group.
Eligibility
Sex/Gender
FEMALE
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Female sex. * Age 65 years or older. * SARC-F score of 4 or higher. * Ability to participate safely in the prescribed exercise programme. * Completion of the baseline assessment. * Written informed consent.
Exclusion criteria
* Clinically significant musculoskeletal pain, new-onset gait disturbance, or another active condition requiring additional treatment. * Parkinson's disease, stroke, multiple sclerosis, vestibular disorders, vertigo, or other major neurological diseases that could affect balance, gait, mobility, or physical performance. * Severe musculoskeletal disorders. * Uncontrolled cardiovascular disease. * Any condition precluding safe participation in the exercise programme. * Participation in a regular exercise programme during the preceding six months.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Berg Balance Scale score | Baseline and 1 and 3 months after completion of the 10-week exercise programm | Balance function was assessed using the Berg Balance Scale. Scores were measured at baseline, at the first-month assessment, and at the third-month assessment after completion of the 10-week exercise programme. Changes over time and differences between the groups were analyzed. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Tinetti Falls Efficacy Scale score | Baseline, 1 month, and 3 months after completion of the 10-week exercise programme | Description: Fear of falling was assessed using the Tinetti Falls Efficacy Scale. Scores were measured at baseline, at the first-month assessment, and at the third-month assessment after completion of the 10-week exercise programme. Changes over time and differences between the groups were analyzed. |
| Change in Timed Up and Go Test performance | Baseline and 1 and 3 months completion of the 10-week exercise programme | Description: Functional mobility and dynamic balance were assessed using the Timed Up and Go Test. Completion time were measured at baseline, at the first-month assessment, and at the third-month assessment after completion of the 10-week exercise programme. Changes over time and differences between the groups were analyzed. Lower completion times indicated better functional mobility. Changes over time and differences between the groups were analyzed. |
| Change in 6-Minute Walk Test distance | recorded at baseline, at the first-month assessment, and at the third-month assessment after completion of the 10-week exercise programme. | Description: Walking capacity was assessed using the 6-Minute Walk Test. Walking distance, measured in meters, was recorded at baseline, at the first-month assessment, and at the third-month assessment after completion of the 10-week exercise programme. Greater distances indicated better walking capacity. Changes over time and differences between the groups were analyzed. |
| Change in Five Times Sit-to-Stand Test time | Time Frame: Baseline, 1 month, and 3 months after initiation of the 10-week exercise programme. | Description: Lower-extremity functional performance was assessed using the Five Times Sit-to-Stand Test. Completion time, measured in seconds, was recorded at baseline, at the first-month assessment, and at the third-month assessment after t the third-month assessment after completion of the 10-week exercise programme. Lower completion times indicated better functional performance. Changes over time and differences between the groups were analyzed. |
| Change in stair ascent and descent test time | Time Frame: Baseline, 1 month, and 3 months after the third-month of the 10-week exercise programme. | Description: Functional stair performance was assessed using a stair ascent and descent test. Completion time, measured in seconds, was recorded at baseline, at the first-month assessment, and at the third-month assessment after the 10-week exercise programme. Lower completion times indicated better stair performance. Changes over time and differences between the groups were analyzed. |
| Change in Geriatric Depression Scale score | Baseline, 1 month, and 3 months after completion of the 10-week exercise programme | Description: Depressive symptoms were assessed using the Geriatric Depression Scale. Scores were measured at baseline, at the first-month assessment, and at the third-month assessmen the third-month assessment after completion of the 10-week exercise programme. Lower scores indicated fewer depressive symptoms. Changes over time and differences between the groups were analyzed. |
Countries
Turkey (Türkiye)
Outcome results
None listed