Copyright (c) 2021 Anwar K Nazar, Vinu S Raj
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Comparison of Lower Extremity Stretching and Wobble Board Exercises on Improving Balance Among Geriatric Population
Corresponding Author(s) : Anwar K Nazar
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 9 No. 3 (2021): 2021 Volume - 9 Issue - 3
Abstract
Background and objective
Methods
Results and discussion
Conclusion
Ageing is a physiological process accompanied by functional, morphological, biochemical and psychological changes. In geriatric population, there is deterioration in balance, postural control and gait due to impaired cognitive function, decline of sensory, visual vestibular, somatosensory input, motor responses, and musculoskeletal systems that are resulting into postural instability and fall. The number of persons above the age of 60 years is fast growing, especially in India. Falls are the leading cause of traumatic brain injury, fractures & the leading cause of emergency department visits by older adults. Low balance confidence is a major health problem among older adults restricting their participation in daily life. Even though there are many methods to improve balance, it is necessary to investigate an effective method to improve balance in geriatric population. The aim of the study is to compare between the effects of lower extremity stretching and wobble board exercise on balance in geriatric population.
Methods
Thirty subjects were selected for the study on the basis of inclusion criteria and exclusion criteria, and were assigned into two groups of 15 subjects each: Group A underwent lower extremity stretching twice daily for 10 weeks and Group B was treated with wobble board exercise for 15 minutes for 8 weeks. The outcome measures were Berg Balance Scale (BBS), Activity specific Balance Confidence (ABC) scale, Timed Up and Go (TUG) test. Using these outcome measures, pre-test and post-test values were obtained.
Results and discussion
The result was analyzed using t-test and it was found that in paired t-test in lower extremity stretching group, the Berg Balance Scale has improved significantly (p<0.001), the Timed Up and Go Test has improved significantly (p<0.001) and the Activity specific Balance Confidence scale has increased significantly (p<0.001). In wobble board group, the Berg Balance Scale has improved significantly (p<0.001), the Timed Up and Go Test has improved significantly (p<0.001), the Activity specific Balance Confidence scale has increased significantly (p<0.001) between pre and post intervention.
On comparing the difference in the results between the groups, the Berg Balance Scale (p<0.001) and Activity specific Balance Confidence scale (p<0.05) in wobble board group showed greater change than the lower extremity stretching group; Timed Up and Go Test in lower extremity stretching group showed greater but insignificant change than the wobble board group.
Conclusion
In this study, it is concluded that wobble board exercise group is better in improving Berg Balance Score and Activity specific Confidence scale when compared to the lower extremity stretching group.
Keywords
Balance
Geriatric population
Lower extremity stretching
Wobble board exercise
References
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1. K.Park. Park’s textbook of preventive and social medicine. 23rd ed. preventive medicine in obstetrics, paediatrics and geriatrics. p. 594
2. Liaw MY, Chen CL, Pei YC, Leong CP, Lau YC. Comparison of the static and dynamic balance performance in young, middle-aged, and elderly healthy people. Chang Gung Med J. 2009 May; 32(3):297-304.
3. Das CP, Joseph S. Falls in elderly. Journal of the Indian Medical Association. 2005;103(3):136-8.
4. Bishop MD, Patterson TS, Romero S, Light KE. Improved fall-related efficacy in older adults related to changes in dynamic gait ability. Physical therapy. 2010 Nov 1;90(11):1598-606.
5. Lindemann U, Rupp K, Muche R, Nikolaus T, Becker C. Improving balance by improving motor skills. Zeitschrift für Gerontologie und Geriatrie. 2004 Feb 1;37(1):20-6.
6. Beebe JA, Hines RW, McDaniel LT, Shelden BL. An isokinetic training program for reducing falls in a community-dwelling older adult: a case report. Journal of geriatric physical therapy. 2013 Jul 1;36(3):146-53.
7. Chou CH, Hwang CL, Wu YT. Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis. Archives of physical medicine and rehabilitation. 2012 Feb 1;93(2):237-44.
8. Au-Yeung SS, Ho HP, Lai JW, Lau RW, Wong AY, Lau SK. Did mobility and balance of residents living in private old age homes improve after a mobility exercise programme? A pilot study. Hong Kong Physiotherapy Journal. 2002 Jan 1;20(1):16-21.
9. Choi JH, Moon JS, Song R. Effects of Sun?style Tai Chi exercise on physical fitness and fall prevention in fall?prone older adults. Journal of advanced nursing. 2005 Jul;51(2):150-7.
10. Faber MJ, Bosscher RJ, Paw MJ, van Wieringen PC. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: a multicenter randomized controlled trial. Archives of physical medicine and rehabilitation. 2006 Jul 1;87(7):885-96.
11. Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?. Age and ageing. 2006 Sep 1; 35(suppl_2):ii7-11.
12. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Physical therapy. 2000 Sep 1;80(9):896-903.
13. Alfieri FM, Riberto M, Abril-Carreres À, Boldó-Alcaine M, Rusca-Castellet E, Garreta-Figuera R, Battistella LR. Effectiveness of an exercise program on postural control in frail older adults. Clinical interventions in aging. 2012;7:593.
14. Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: a systematic review and meta?analysis. Journal of the American Geriatrics Society. 2008 Dec;56(12):2234-43.
15. Hrysomallis C. Balance ability and athletic performance. Sports medicine. 2011 Mar 1;41(3):221-32.
16. Lundin-Olsson L, Nyberg L, Gustafson Y. Stops walking when talking as a predictor of falls in elderly people. Lancet. 1997 Mar 1;349(9052):617.
17. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. New England journal of medicine. 1988 Dec 29;319(26):1701-7.
18. Province MA, Hadley EC, Hornbrook MC, Lipsitz LA, Miller JP, Mulrow CD, Ory MG, Sattin RW, Tinetti ME, Wolf SL, Schechtman KB. The effects of exercise on falls in elderly patients: a preplanned meta-analysis of the FICSIT trials. Jama. 1995 May 3;273(17):1341-7.
19. Rubenstein LZ, Josephson KR, Trueblood PR, Loy S, Harker JO, Pietruszka FM, Robbins AS. Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2000 Jun 1; 55(6):M317-21.
20. Winter DA, Patla AE, Frank JS, Walt SE. Biomechanical walking pattern changes in the fit and healthy elderly. Physical therapy. 1990 Jun 1;70(6):340-7.
21. Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Interventions for preventing falls in elderly people. Cochrane database of systematic reviews. 2003(4).
22. Carmeli E, Kessel S, Coleman R, Ayalon M. Effects of a treadmill walking program on muscle strength and balance in elderly people with Down syndrome. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2002 Feb 1;57(2):M106-10.
23. Behm DG, Bambury A, Cahill F, Power K. Effect of acute static stretching on force, balance, reaction time, and movement time. Medicine & Science in Sports & Exercise. 2004 Aug 1;36(8):1397-402.
24. Godges JJ, MacRae H, Longdon C, Tinberg C, MacRae P. The effects of two stretching procedures on hip range of motion and gait economy. Journal of Orthopaedic & Sports Physical Therapy. 1989 Mar;10(9):350-7.
25. Decoster LC, Cleland J, Altieri C, Russell P. The effects of hamstring stretching on range of motion: a systematic literature review. Journal of Orthopaedic & Sports Physical Therapy. 2005 Jun;35(6):377-87.
26. Lima BN, Lucareli PR, Gomes WA, Silva JJ, Bley AS, Hartigan EH, Marchetti PH. The acute effects of unilateral ankle plantar flexors static-stretching on postural sway and gastrocnemius muscle activity during single-leg balance tasks. Journal of sports science & medicine. 2014 Sep; 13(3):564.
27. Waddington GS, Adams RD. The effect of a 5?week wobble?board exercise intervention on ability to discriminate different degrees of ankle inversion, barefoot and wearing shoes: a study in healthy elderly. Journal of the American Geriatrics Society. 2004 Apr; 52(4):573-6.
28. Carolyn K, Lynn AC. Therapeutic Exercise. 5thed. New Delhi: Jaypee Brothers Medical Publishers; 2007. p. 253-257.
29. Bloem BR, Allum JH, Carpenter MG, Honegger F. Is lower leg proprioception essential for triggering human automatic postural responses? Experimental brain research. 2000 Feb 1; 130(3):375-91.
30. Shiratori T, Latash M. The roles of proximal and distal muscles in anticipatory postural adjustments under asymmetrical perturbations and during standing on rollerskates. Clinical neurophysiology. 2000 Apr 1; 111(4):613-23.
31. Bishop D, Bonetti D, Dawson B. The effect of three different warm-up intensities on kayak ergometer performance. Medicine and Science in Sports and Exercise. 2001 Jun; 33(6):1026-32.
32. Aruin AS, Forrest WR, Latash ML. Anticipatory postural adjustments in conditions of postural instability. Electroencephalography and Clinical Neurophysiology/Electromyography and Motor Control. 1998 Aug 1; 109(4):350-9.
References
1. K.Park. Park’s textbook of preventive and social medicine. 23rd ed. preventive medicine in obstetrics, paediatrics and geriatrics. p. 594
2. Liaw MY, Chen CL, Pei YC, Leong CP, Lau YC. Comparison of the static and dynamic balance performance in young, middle-aged, and elderly healthy people. Chang Gung Med J. 2009 May; 32(3):297-304.
3. Das CP, Joseph S. Falls in elderly. Journal of the Indian Medical Association. 2005;103(3):136-8.
4. Bishop MD, Patterson TS, Romero S, Light KE. Improved fall-related efficacy in older adults related to changes in dynamic gait ability. Physical therapy. 2010 Nov 1;90(11):1598-606.
5. Lindemann U, Rupp K, Muche R, Nikolaus T, Becker C. Improving balance by improving motor skills. Zeitschrift für Gerontologie und Geriatrie. 2004 Feb 1;37(1):20-6.
6. Beebe JA, Hines RW, McDaniel LT, Shelden BL. An isokinetic training program for reducing falls in a community-dwelling older adult: a case report. Journal of geriatric physical therapy. 2013 Jul 1;36(3):146-53.
7. Chou CH, Hwang CL, Wu YT. Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis. Archives of physical medicine and rehabilitation. 2012 Feb 1;93(2):237-44.
8. Au-Yeung SS, Ho HP, Lai JW, Lau RW, Wong AY, Lau SK. Did mobility and balance of residents living in private old age homes improve after a mobility exercise programme? A pilot study. Hong Kong Physiotherapy Journal. 2002 Jan 1;20(1):16-21.
9. Choi JH, Moon JS, Song R. Effects of Sun?style Tai Chi exercise on physical fitness and fall prevention in fall?prone older adults. Journal of advanced nursing. 2005 Jul;51(2):150-7.
10. Faber MJ, Bosscher RJ, Paw MJ, van Wieringen PC. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: a multicenter randomized controlled trial. Archives of physical medicine and rehabilitation. 2006 Jul 1;87(7):885-96.
11. Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?. Age and ageing. 2006 Sep 1; 35(suppl_2):ii7-11.
12. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Physical therapy. 2000 Sep 1;80(9):896-903.
13. Alfieri FM, Riberto M, Abril-Carreres À, Boldó-Alcaine M, Rusca-Castellet E, Garreta-Figuera R, Battistella LR. Effectiveness of an exercise program on postural control in frail older adults. Clinical interventions in aging. 2012;7:593.
14. Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: a systematic review and meta?analysis. Journal of the American Geriatrics Society. 2008 Dec;56(12):2234-43.
15. Hrysomallis C. Balance ability and athletic performance. Sports medicine. 2011 Mar 1;41(3):221-32.
16. Lundin-Olsson L, Nyberg L, Gustafson Y. Stops walking when talking as a predictor of falls in elderly people. Lancet. 1997 Mar 1;349(9052):617.
17. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. New England journal of medicine. 1988 Dec 29;319(26):1701-7.
18. Province MA, Hadley EC, Hornbrook MC, Lipsitz LA, Miller JP, Mulrow CD, Ory MG, Sattin RW, Tinetti ME, Wolf SL, Schechtman KB. The effects of exercise on falls in elderly patients: a preplanned meta-analysis of the FICSIT trials. Jama. 1995 May 3;273(17):1341-7.
19. Rubenstein LZ, Josephson KR, Trueblood PR, Loy S, Harker JO, Pietruszka FM, Robbins AS. Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2000 Jun 1; 55(6):M317-21.
20. Winter DA, Patla AE, Frank JS, Walt SE. Biomechanical walking pattern changes in the fit and healthy elderly. Physical therapy. 1990 Jun 1;70(6):340-7.
21. Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Interventions for preventing falls in elderly people. Cochrane database of systematic reviews. 2003(4).
22. Carmeli E, Kessel S, Coleman R, Ayalon M. Effects of a treadmill walking program on muscle strength and balance in elderly people with Down syndrome. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2002 Feb 1;57(2):M106-10.
23. Behm DG, Bambury A, Cahill F, Power K. Effect of acute static stretching on force, balance, reaction time, and movement time. Medicine & Science in Sports & Exercise. 2004 Aug 1;36(8):1397-402.
24. Godges JJ, MacRae H, Longdon C, Tinberg C, MacRae P. The effects of two stretching procedures on hip range of motion and gait economy. Journal of Orthopaedic & Sports Physical Therapy. 1989 Mar;10(9):350-7.
25. Decoster LC, Cleland J, Altieri C, Russell P. The effects of hamstring stretching on range of motion: a systematic literature review. Journal of Orthopaedic & Sports Physical Therapy. 2005 Jun;35(6):377-87.
26. Lima BN, Lucareli PR, Gomes WA, Silva JJ, Bley AS, Hartigan EH, Marchetti PH. The acute effects of unilateral ankle plantar flexors static-stretching on postural sway and gastrocnemius muscle activity during single-leg balance tasks. Journal of sports science & medicine. 2014 Sep; 13(3):564.
27. Waddington GS, Adams RD. The effect of a 5?week wobble?board exercise intervention on ability to discriminate different degrees of ankle inversion, barefoot and wearing shoes: a study in healthy elderly. Journal of the American Geriatrics Society. 2004 Apr; 52(4):573-6.
28. Carolyn K, Lynn AC. Therapeutic Exercise. 5thed. New Delhi: Jaypee Brothers Medical Publishers; 2007. p. 253-257.
29. Bloem BR, Allum JH, Carpenter MG, Honegger F. Is lower leg proprioception essential for triggering human automatic postural responses? Experimental brain research. 2000 Feb 1; 130(3):375-91.
30. Shiratori T, Latash M. The roles of proximal and distal muscles in anticipatory postural adjustments under asymmetrical perturbations and during standing on rollerskates. Clinical neurophysiology. 2000 Apr 1; 111(4):613-23.
31. Bishop D, Bonetti D, Dawson B. The effect of three different warm-up intensities on kayak ergometer performance. Medicine and Science in Sports and Exercise. 2001 Jun; 33(6):1026-32.
32. Aruin AS, Forrest WR, Latash ML. Anticipatory postural adjustments in conditions of postural instability. Electroencephalography and Clinical Neurophysiology/Electromyography and Motor Control. 1998 Aug 1; 109(4):350-9.
2. Liaw MY, Chen CL, Pei YC, Leong CP, Lau YC. Comparison of the static and dynamic balance performance in young, middle-aged, and elderly healthy people. Chang Gung Med J. 2009 May; 32(3):297-304.
3. Das CP, Joseph S. Falls in elderly. Journal of the Indian Medical Association. 2005;103(3):136-8.
4. Bishop MD, Patterson TS, Romero S, Light KE. Improved fall-related efficacy in older adults related to changes in dynamic gait ability. Physical therapy. 2010 Nov 1;90(11):1598-606.
5. Lindemann U, Rupp K, Muche R, Nikolaus T, Becker C. Improving balance by improving motor skills. Zeitschrift für Gerontologie und Geriatrie. 2004 Feb 1;37(1):20-6.
6. Beebe JA, Hines RW, McDaniel LT, Shelden BL. An isokinetic training program for reducing falls in a community-dwelling older adult: a case report. Journal of geriatric physical therapy. 2013 Jul 1;36(3):146-53.
7. Chou CH, Hwang CL, Wu YT. Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis. Archives of physical medicine and rehabilitation. 2012 Feb 1;93(2):237-44.
8. Au-Yeung SS, Ho HP, Lai JW, Lau RW, Wong AY, Lau SK. Did mobility and balance of residents living in private old age homes improve after a mobility exercise programme? A pilot study. Hong Kong Physiotherapy Journal. 2002 Jan 1;20(1):16-21.
9. Choi JH, Moon JS, Song R. Effects of Sun?style Tai Chi exercise on physical fitness and fall prevention in fall?prone older adults. Journal of advanced nursing. 2005 Jul;51(2):150-7.
10. Faber MJ, Bosscher RJ, Paw MJ, van Wieringen PC. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: a multicenter randomized controlled trial. Archives of physical medicine and rehabilitation. 2006 Jul 1;87(7):885-96.
11. Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls?. Age and ageing. 2006 Sep 1; 35(suppl_2):ii7-11.
12. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Physical therapy. 2000 Sep 1;80(9):896-903.
13. Alfieri FM, Riberto M, Abril-Carreres À, Boldó-Alcaine M, Rusca-Castellet E, Garreta-Figuera R, Battistella LR. Effectiveness of an exercise program on postural control in frail older adults. Clinical interventions in aging. 2012;7:593.
14. Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: a systematic review and meta?analysis. Journal of the American Geriatrics Society. 2008 Dec;56(12):2234-43.
15. Hrysomallis C. Balance ability and athletic performance. Sports medicine. 2011 Mar 1;41(3):221-32.
16. Lundin-Olsson L, Nyberg L, Gustafson Y. Stops walking when talking as a predictor of falls in elderly people. Lancet. 1997 Mar 1;349(9052):617.
17. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. New England journal of medicine. 1988 Dec 29;319(26):1701-7.
18. Province MA, Hadley EC, Hornbrook MC, Lipsitz LA, Miller JP, Mulrow CD, Ory MG, Sattin RW, Tinetti ME, Wolf SL, Schechtman KB. The effects of exercise on falls in elderly patients: a preplanned meta-analysis of the FICSIT trials. Jama. 1995 May 3;273(17):1341-7.
19. Rubenstein LZ, Josephson KR, Trueblood PR, Loy S, Harker JO, Pietruszka FM, Robbins AS. Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2000 Jun 1; 55(6):M317-21.
20. Winter DA, Patla AE, Frank JS, Walt SE. Biomechanical walking pattern changes in the fit and healthy elderly. Physical therapy. 1990 Jun 1;70(6):340-7.
21. Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH. Interventions for preventing falls in elderly people. Cochrane database of systematic reviews. 2003(4).
22. Carmeli E, Kessel S, Coleman R, Ayalon M. Effects of a treadmill walking program on muscle strength and balance in elderly people with Down syndrome. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2002 Feb 1;57(2):M106-10.
23. Behm DG, Bambury A, Cahill F, Power K. Effect of acute static stretching on force, balance, reaction time, and movement time. Medicine & Science in Sports & Exercise. 2004 Aug 1;36(8):1397-402.
24. Godges JJ, MacRae H, Longdon C, Tinberg C, MacRae P. The effects of two stretching procedures on hip range of motion and gait economy. Journal of Orthopaedic & Sports Physical Therapy. 1989 Mar;10(9):350-7.
25. Decoster LC, Cleland J, Altieri C, Russell P. The effects of hamstring stretching on range of motion: a systematic literature review. Journal of Orthopaedic & Sports Physical Therapy. 2005 Jun;35(6):377-87.
26. Lima BN, Lucareli PR, Gomes WA, Silva JJ, Bley AS, Hartigan EH, Marchetti PH. The acute effects of unilateral ankle plantar flexors static-stretching on postural sway and gastrocnemius muscle activity during single-leg balance tasks. Journal of sports science & medicine. 2014 Sep; 13(3):564.
27. Waddington GS, Adams RD. The effect of a 5?week wobble?board exercise intervention on ability to discriminate different degrees of ankle inversion, barefoot and wearing shoes: a study in healthy elderly. Journal of the American Geriatrics Society. 2004 Apr; 52(4):573-6.
28. Carolyn K, Lynn AC. Therapeutic Exercise. 5thed. New Delhi: Jaypee Brothers Medical Publishers; 2007. p. 253-257.
29. Bloem BR, Allum JH, Carpenter MG, Honegger F. Is lower leg proprioception essential for triggering human automatic postural responses? Experimental brain research. 2000 Feb 1; 130(3):375-91.
30. Shiratori T, Latash M. The roles of proximal and distal muscles in anticipatory postural adjustments under asymmetrical perturbations and during standing on rollerskates. Clinical neurophysiology. 2000 Apr 1; 111(4):613-23.
31. Bishop D, Bonetti D, Dawson B. The effect of three different warm-up intensities on kayak ergometer performance. Medicine and Science in Sports and Exercise. 2001 Jun; 33(6):1026-32.
32. Aruin AS, Forrest WR, Latash ML. Anticipatory postural adjustments in conditions of postural instability. Electroencephalography and Clinical Neurophysiology/Electromyography and Motor Control. 1998 Aug 1; 109(4):350-9.