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The effect of single-task and dual-task balance exercise programs on balance performance in adults with osteoporosis: a randomized controlled preliminary trial

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Abstract

Summary

Osteoporosis is a serious disease characterized by muscle weakness in the lower extremities, shortened length of trunk, and increased dorsal kyphosis leading to poor balance performance. Although balance impairment increases in adults with osteoporosis, falls and fall-related injuries have been shown to occur mainly during the dual-task performance. Several studies have shown that dual-task performance was improved with specific repetitive dual-task exercises.

Introduction

The aims of this study were to compare the effect of single- and dual-task balance exercise programs on static balance, dynamic balance, and activity-specific balance confidence in adults with osteoporosis and to assess the effectiveness of dual-task balance training on gait speed under dual-task conditions.

Methods

Older adults (N = 42) (age range, 45–88 years) with osteoporosis were randomly assigned into two groups. Single-task balance training group was given single-task balance exercises for 4 weeks, whereas dual-task balance training group received dual-task balance exercises. Participants received 45-min individualized training session, three times a week. Static balance was evaluated by one-leg stance (OLS) and a kinesthetic ability trainer (KAT) device. Dynamic balance was measured by the Berg Balance Scale (BBS), Time Up and Go (TUG) test, and gait speed. Self-confidence was assessed with the Activities-specific Balance Confidence (ABC-6) scale. Assessments were performed at baseline and after the 4-week program.

Results

At the end of the treatment periods, KAT score, BBS score, time in OLS and TUG, gait speeds under single- and dual-task conditions, and ABC-6 scale scores improved significantly in all patients (p < 0.05). However, BBS and gait speeds under single- and dual-task conditions showed significantly greater improvement in the dual-task balance training group than in the single-task balance training group (p < 0.05). ABC-6 scale scores improved more in the single-task balance training group than in the dual-task balance training group (p < 0.05).

Conclusions

A 4-week single- and dual-task balance exercise programs are effective in improving static balance, dynamic balance, and balance confidence during daily activities in older adults with osteoporosis. However, single- and dual-task gait speeds showed greater improvement following the application of a specific type of dual-task exercise programs.

Clinical trial registration number

24102014–2.

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Abbreviations

ABC-6:

Activities-specific Balance Confidence

BBS:

Berg Balance Scale

BMD:

Bone mineral density

BMI:

Body mass index

KAT:

Kinesthetic ability trainer

MMSE:

Mini-mental state examination

OLS:

One-leg stance

TUG:

Time Up and Go

References

  1. Kuczynski M, Ostrowska B (2006) Understanding falls in osteoporosis: the viscoelastic modeling perspective. Gait Posture 23(1):51–58

    Article  PubMed  Google Scholar 

  2. Lynn SG, Sinaki M, Westerlind KC (1997) Balance characteristics of persons with osteoporosis. Arch Phys Med Rehabil 78:273–277

    Article  CAS  PubMed  Google Scholar 

  3. Campbell AJ, Borrie MJ, Spears GF (1989) Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 44:M112–M117

    Article  CAS  PubMed  Google Scholar 

  4. Delbaere K, Crombez G, Vanderstraeten G, Willems T, Cambier D (2004) Fear-related avoidance of activities, falls and physical fraility. A prospective community-based cohort study. Age Aging 33:368–373

    Article  Google Scholar 

  5. Reelick MF, van Lersel MB, Kessels RP, Rikkert MG (2009) The influence of fear of falling on gait and balance in older people. Age Aging 38:435–440

    Article  Google Scholar 

  6. Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929–1936

    Article  PubMed  Google Scholar 

  7. Lajoie Y, Teasdale N, Bard C, Fleury M (1993) Attentional demands for static and dynamic equilibrium. Exp Brain Res 97(1):139–144

    Article  CAS  PubMed  Google Scholar 

  8. Brown LA, Shumway-Cook A, Woollacott MH (1999) Attentional demands and postural recovery: the effects of aging. J Gerontol Ser A Biol Sci Med Sci 54(4):M165–M171

    Article  CAS  Google Scholar 

  9. Doumas M, Rapp MA, Krampe RT (2009) Working memory and postural control: adult age differences in potential for improvement, task priority, and dual tasking. J Gerontol B Psychol Sci Soc Sci 64(2):193–201

    Article  PubMed  Google Scholar 

  10. Yamada M, Aoyama T, Arai H et al (2011) Dual task walk is a reliable predictor of falls in robust elderly adults. J Am Geriatr Soc 59(1):163–164

    Article  PubMed  Google Scholar 

  11. Beauchet O, Annweiler C, Dubost V et al (2009) Stops walking when talking: a predictor of falls in older adults? Eur J Neurol 16(7):786–795

    Article  CAS  PubMed  Google Scholar 

  12. Kramer AF, Larish JF, Strayer DL (1995) Training for attentional control in dual task settings: a comparison of young and older adults. J Exp Psychol Appl 1:50–76

    Article  Google Scholar 

  13. Silsupadol P, Lugade V, Shumway-Cook A, van Donkelaar P, Chou L-S, Mayr U, Woollacott M (2009) Training-related changes in dual-task walking performance of elderly persons with balance impairment: a double-blind, randomized controlled trial. Gait Posture 29:634–639

    Article  PubMed  PubMed Central  Google Scholar 

  14. Shumway-Cook A, Woollacott MH (2007) Aging and postural control. In: Shumway-Cook A, Woollacott MH (eds) Motor controltranslating research into clinical practice, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 212–232

    Google Scholar 

  15. Silsupadol P, Shumway-Cook A, Lugade V et al (2009) Effects ofsingle-task versus dual-task training on balance performance in older adults: a double-blind, randomized controlled trial. Arch Phys Med Rehabil 90(3):381–387

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wollesen B, Voelcker-Rehage C (2013) Training effects on motor–cognitive dual-task performance in older adults. Eur Rev Aging Phys Act 1–20.

  17. Turner PA (2000) Osteoporosis—its causes and prevention: an update. Physiother Theory Pract 16:135–149

    Article  Google Scholar 

  18. Brown AP (1999) Reducing falls in elderly people: a review of exercise interventions. Physiother Theory Pract 15:59–68

    Article  Google Scholar 

  19. Halvarsson A, Franzén E, Ståhle A (2015) Balance training with multi-task exercises improves fall-related self-efficacy, gait, balance performance and physical function in older adults with osteoporosis: a randomized controlled trial. Clin Rehabil 29:365–375

    Article  PubMed  Google Scholar 

  20. WHO (1994) Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 843:1–129

    Google Scholar 

  21. Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12(3):189–198

    Article  CAS  PubMed  Google Scholar 

  22. American College of Sports Medicine, Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, Skinner JS (2009) American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 41:1510–1530

    Article  Google Scholar 

  23. Buchner DM, Cress ME, de Lateur BJ et al (1997) The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. J Gerontol A Biol Sci Med Sci 52:M218–M224

    Article  CAS  PubMed  Google Scholar 

  24. Bohannon R (2006) Single limb stance times. A descriptive meta-analysis of data from individuals at least 60 years of age. Top Geriatr Rehabil 22:70–77

    Article  Google Scholar 

  25. Newton R (1989) Review of tests of standing balance abilities. Brain Inj 3:335–343.23

    Article  CAS  PubMed  Google Scholar 

  26. Vellas B, Wayne S, Romero L, Baumgartner R, Rubenstein L, Garry P (1997) One-leg balance is an important predictor of injurious falls in older persons. J Am Geriatr Soc 45:735–738

    Article  CAS  PubMed  Google Scholar 

  27. Bohannon R, Larkin P, Cook A, Gear J, Singer J (1984) Decrease in timed balance test scores with aging. Phys Ther 64:1067–1070

    Article  CAS  PubMed  Google Scholar 

  28. Hansen MS, Dieckmann B, Jensen K, Jakobsen BW (2000) The reliability of balance tests performed on the kinesthetic ability trainer (KAT 2000). Knee Surg Sports Traumatol Arthrosc 8:180–185

    Article  CAS  PubMed  Google Scholar 

  29. Berg KO, Wood-Dauphinee SL, Williams JI, Maki B (1992) Measuring balance in the elderly: validation of an instrument. Can J Public Health 83(Suppl 2):S7–S11

    PubMed  Google Scholar 

  30. Sahin F, Yilmaz F, Ozmaden A, Kotevolu N, Sahin T, Kuran B (2008) Reliability and validity of the Turkish version of the Berg Balance Scale. J Geriatr Phys Ther 31:32–37

    Article  PubMed  Google Scholar 

  31. Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148

    Article  CAS  PubMed  Google Scholar 

  32. Shumway-Cook A, Brauer S, Woollacott M (2000) Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther 80(9):896–903

    CAS  PubMed  Google Scholar 

  33. Bohannon RW (2006) Reference values for the timed up and go test: a descriptive meta-analysis. J Geriatr Phys Ther 29(2):64–68

    Article  PubMed  Google Scholar 

  34. Hardy SE, Perera S, Roumani YF, Chandler JM, Studenski SA (2007) Improvement in usual gait speed predicts better survival in older adults. J Am Geriatr Soc 55:1727–1734

    Article  PubMed  Google Scholar 

  35. Schepens S, Goldberg A, Wallace M (2010) The short version of the Activities-specific Balance Confidence (ABC) scale: its validity, reliability, and relationship to balance impairment and falls in older adults. Arch Gerontol Geriatr 51:9–12

    Article  PubMed  Google Scholar 

  36. Kibar S, Konak HE, Ay S, Evcik D, Ergin S (2015) Turkish translation and validation of the short version of the Activities-specific Balance Confidence (ABC) scale in geriatric population. In: 25th National Physical Medicine And Rehabilitation Congress Abstract Book; 2015 Apr 22–26; Ankara, Turkey p 342.

  37. Cohen J (1988) Statistical power analysis for the behavioral science. Lawrence Erlbaum Associates, Hillsdala

    Google Scholar 

  38. Vaillant J, Vuillerme N, Martigne P, Caillat-Miousse JL, Parisot J, Nougier V, Juvin R (2006) Balance, aging, and osteoporosis: effects of cognitive exercises combined with physiotherapy. Joint Bone Spine 73(4):414–418

    Article  PubMed  Google Scholar 

  39. Donoghue D; Physiotherapy Research and Older People (PROP) group, Stokes EK. How much change is true change? The minimum detectable change of the Berg Balance Scale in elderly people. J Rehabil Med. 2009 Apr;41(5):343–6.

  40. Shumway-Cook A, Baldwin M, Polissar NL, Gruber W (1997) Predicting the probability for falls in community-dwelling older adults. Phys Ther 77:812–819

    Article  CAS  PubMed  Google Scholar 

  41. Whitehead C, Miller M, Crotty M (2003) Falls in community-dwelling older persons following hip fracture: impact on self-efficacy, balance and handicap. Clin Rehabil 17:899–906

    Article  PubMed  Google Scholar 

  42. Daley MJ, Spinks WL (2000) Exercise, mobility and aging. Sports Med 29:1–12

    Article  CAS  PubMed  Google Scholar 

  43. Rubenstein LZ, Powers CM, MacLean CH (2001) Quality indicators for the management and prevention of falls and mobility problems in vulnerable elders. Ann Intern Med 135:686–693

    Article  CAS  PubMed  Google Scholar 

  44. Langlois JA, Keyl PM, Guralnik JM, Foley DJ, Marottoli RA, Wallace RB (1997) Characteristics of older pedestrians who have difficulty crossing the street. Am J Public Health 87:393–397

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Watanabe K, Funahashi S (2014) Neural mechanisms of dual-task interference and cognitive capacity limitation in the prefrontal cortex. Nat Neurosci 17(4):601–611

    Article  CAS  PubMed  Google Scholar 

  46. Beurskens R, Bock O (2012) Age-related deficits of dual-task walking: a review. Neural Plast

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Acknowledgments

This study was presented as poster presentation in the 25th National Physical Medicine and Rehabilitation Congress, 2015 Apr 22–26; Ankara, Turkey; 2015. p 342: The Effect Of Single-Task And Dual-Task Balance Training On Balance Performance In Osteoporotic Patients With Balance Disorders.

We are grateful to Can Ateş, PhD (statistician), for her statistical recommendations and to our patients for their contributions.

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Ufuk University School of Medicine, Mevlana Bulvarı No88 Balgat, 06530, Çankaya, Ankara, Turkey

    H. E. Konak, S. Kibar & E. S. Ergin

Authors
  1. H. E. Konak
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  2. S. Kibar
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  3. E. S. Ergin
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Corresponding author

Correspondence to H. E. Konak.

Ethics declarations

This study was carried out in accordance with the Declaration of Helsinki and was approved by the research committee of the Ufuk University School of Medicine. Written informed consent forms were provided from all participants.

Conflicts of interest

None.

Additional information

Suppliers’ list

The software (The Predictive Analytics SoftWare (PASW) Statistics version 18.0) used in the present study was supplied by Ufuk University School of Medicine. G-Power is a free software on the Internet.

a. Sports Kinesthetic Ability Trainer 4000 device; SportKAT.

b. PASW Statistics 18.0; SPSS, Chicago, IL

c. G*Power 3.1.9.2. Available at: http://www.gpower.hhu.de/en.html

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Konak, H.E., Kibar, S. & Ergin, E.S. The effect of single-task and dual-task balance exercise programs on balance performance in adults with osteoporosis: a randomized controlled preliminary trial. Osteoporos Int 27, 3271–3278 (2016). https://doi.org/10.1007/s00198-016-3644-1

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