Aging
Conditions
Keywords
Older Adults, Balance, Joint Position Sense, Muscle Strength, Fear of Falling, Foot Posture
Brief summary
The Otago Exercise Programme is a multicomponent exercise approach targeting strength, balance, and mobility in older adults. Short-foot exercises are designed to improve intrinsic foot muscle activation and medial longitudinal arch control. This randomized comparative study will investigate whether adding short-foot exercises to the Otago Exercise Programme provides additional benefits in older adults.
Detailed description
Age-related changes in sensory processing, proprioception, muscle strength, and postural control may contribute to impaired balance and reduced functional mobility in older adults. The ankle-foot complex plays an important role in postural control by providing mechanical support and sensory information during standing and walking. Changes in ankle proprioception, ankle muscle function, and foot posture may therefore influence balance-related performance in older adults. The Otago Exercise Programme is a structured, multicomponent exercise approach developed to improve lower extremity strength, balance, and walking ability in older adults. Short-foot exercises specifically target the intrinsic foot muscles and active control of the medial longitudinal arch. The addition of short-foot exercises to a conventional balance and strengthening programme may provide a complementary approach by addressing foot-related neuromuscular control. In this randomized comparative study, participants will be assigned to either the Otago Exercise Programme alone or the Otago Exercise Programme combined with Short-Foot Exercises. Both interventions will be administered under physiotherapist supervision for 8 weeks, twice weekly. The study will compare the effects of these two exercise approaches and evaluate whether the addition of short-foot exercises provides further benefit beyond the Otago Exercise Programme alone.
Interventions
BEHAVIORALOtago Exercise Programme
The Otago Exercise Programme will be delivered under physiotherapist supervision for 8 weeks, 2 days per week, for a total of 16 sessions. Each session will last 50 minutes and will include warm-up, lower extremity strengthening, static and dynamic balance exercises, functional balance and walking tasks, and cool-down. Exercises will be progressively adjusted according to participant performance and safety.
BEHAVIORALOtago Exercise Programme + Short-Foot Exercise
The combined intervention will be delivered under physiotherapist supervision for 8 weeks, 2 days per week, for a total of 16 sessions. Each 60-minute session will include 5 minutes of warm-up, 10 minutes of Short-Foot Exercises, 40 minutes of Otago exercises, and 5 minutes of cool-down. Short-Foot Exercises will target intrinsic foot muscle activation and medial longitudinal arch control and will progress from sitting to standing, mini-squat, and soft-surface standing according to participant performance.
Sponsors
Pamukkale University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Randomized, two-arm, parallel-group trial. Participants will be randomly assigned to either the Otago Exercise Programme group or the Otago Exercise Programme combined with Short-Foot Exercise group. Interventions will be delivered for 8 weeks, with 2 supervised sessions per week. Outcomes will be assessed at baseline and post-intervention.
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Willing to participate and provide written informed consent. * Aged 65 years or older. * Residing in the nursing home where the study will be conducted for at least 3 months. * Able to understand and follow test instructions, with a Standardized Mini-Mental Test score ≥24. * Able to walk at least 30 meters without physical assistance from another person. * Able to stand with eyes open for at least 30 seconds and safely complete sit-to-stand and balance assessments. * Able to perform the target ankle dorsiflexion and plantar flexion angles without pain or marked restriction of active range of motion. * Navicular Drop Test result between 6 and 9 mm.
Exclusion criteria
* History of neurological or neurodegenerative disease that may substantially affect postural control, proprioception, or motor responses, including stroke sequelae, Parkinson's disease, multiple sclerosis, advanced dementia, or marked cerebellar disorders. * Cardiopulmonary, vestibular, or systemic disease that may prevent safe completion of the interventions or assessments. * Diagnosed peripheral neuropathy, marked lower-extremity sensory loss, or diabetic neuropathy. * Use of an assistive device. * Lower-extremity amputation, prosthesis use, or severe structural deformity interfering with foot or ankle assessment. * Pain, instability, or severe range-of-motion limitation in the ankle, knee, or hip that prevents completion of the tests. * History of lower-extremity fracture, surgery, or major trauma within the previous 6 months. * Musculoskeletal injury of the foot, ankle, or lower extremity within the previous 3 months that limits participation in functional testing. * Open wound, ulcer, active skin lesion, or infection in the foot or ankle region that interferes with sensor or measurement placement. * Recent initiation of, or dose change in, medication that may affect balance, alertness, or motor performance.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Five Times Sit-to-Stand Test (5STS | Baseline (pre-intervention) and immediately post-intervention (Week 8). | Lower-extremity functional capacity will be assessed using the Five Times Sit-to-Stand Test (5STS). Participants will sit on a standard-height chair without armrests, with the arms crossed over the chest, and will be instructed to stand up fully and sit down five consecutive times as quickly as possible. The time from initiation of the first stand to completion of the fifth sitting will be recorded in seconds. Lower completion times indicate better functional performance |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Dynamic Balance - Mini-BESTest | aseline (pre-intervention) and immediately post-intervention (Week 8). | Dynamic balance will be assessed using the Mini-BESTest, a 14-item clinical balance test evaluating anticipatory postural adjustments, reactive postural control, sensory orientation, and dynamic gait. Each item is scored from 0 to 2, resulting in a total score ranging from 0 to 28. Higher scores indicate better dynamic balance performance. |
| Ankle Joint Position Sense | Baseline (pre-intervention) and immediately post-intervention (Week 8). | Ankle joint position sense will be assessed using the KFORCE Sens® electrogoniometer at target angles of 10° dorsiflexion and 20° plantar flexion. After passive positioning at the target angle, participants will actively reproduce the target position with eyes closed. Joint position sense error will be calculated as the absolute difference, in degrees, between the target and reproduced angles. Three trials will be performed for each movement direction, and the mean value will be used. Lower error values indicate better joint position sense. |
| Ankle Muscle Strength | Baseline (pre-intervention) and immediately post-intervention (Week 8). | Ankle dorsiflexor and plantar flexor muscle strength will be assessed using the JTECH PowerTrack II Commander hand-held dynamometer. Three measurements will be performed for each muscle group, and the mean value will be used for analysis. Higher force values indicate greater muscle strength. |
| Falls Efficacy Scale-International (FES-I) | Baseline (pre-intervention) and immediately post-intervention (Week 8). | Fear of falling will be assessed using the Falls Efficacy Scale-International (FES-I). The scale consists of 16 items, each scored from 1 to 4, resulting in a total score ranging from 16 to 64. Higher scores indicate greater concern about falling. |
| Navicular Drop Test | Baseline (pre-intervention) and immediately post-intervention (Week 8). | Foot posture will be assessed using the Navicular Drop Test. The vertical distance from the navicular tuberosity to the floor will be measured in a seated subtalar-neutral position and again during relaxed bilateral standing. The difference between the two measurements will be recorded in millimeters as the navicular drop value. Higher values indicate greater medial longitudinal arch collapse and pronation tendency. |
Countries
Turkey (Türkiye)
Contacts
CONTACTFatma Aksu, MSc
CONTACTMüge İçelli Güneş, PhD
PRINCIPAL_INVESTIGATORTuba Can Akman, PhD
Pamukkale University
Outcome results
None listed