Dynamic balance and rapid step training in impaired elders

福尔斯是老年人受伤的一个重要原因，而且可能造成高昂的费用。尽管被大力推广，传统的锻炼计划迄今为止在减少老年人福尔斯跌倒方面并不一致。这些锻炼计划中的许多集中于在身体移动时改善维持姿势，但以相对缓慢的方式，即缓慢的动态平衡。也许一个同样针对动态平衡但涉及相对快速运动的锻炼计划可能会提高对即将发生的跌倒的快速反应能力（即提高跌倒保护反应），因此在减少福尔斯方面显示出更强的效果。在这些跌倒保护反应中，通常需要快速踏步反应的能力来保持站立平衡。我们建议对老年人进行为期3个月的平衡训练计划，重点是提高保持站立的能力和提高快速踏步反应的能力。我们将有轻度-中度平衡障碍的老年人随机分为另外两组：1）综合平衡训练计划或2）太极。为期3个月的综合训练和太极之后，将进行为期12个月的家庭维护计划，每周一次的小组“复习”会议。通过明信片回复和电话，对两组患者的主要结局、福尔斯发生率和跌倒相关损伤进行监测。基线、3个月和15个月时的中期结局将包括保持站立和快速踏步的措施。二次分析将探索明显的潜在机制之间的关系，如快速力量发展和自我效能的变化，作为维持站立、快速踏步和福尔斯发生变化的解释。因此，除了改善参与受试者的平衡和快速行走能力外，还可以探索关于姿势控制和避免高危老年人人群福尔斯跌倒的能力的许多问题。

Falls are an important and potentially costly cause of injuries in older adults. Despite being heavily promoted, traditional exercise programs have thus far been inconsistently successful in reducing falls in older adults. Many of these exercise programs focus on improving maintenance stance as the body moves but in a relatively slow manner, i.e. slow dynamic balance. Perhaps an exercise program that is also directed toward dynamic balance but involving relatively fast movements might improve the ability to respond quickly to an impending fall (i.e. improving fall protective responses) and therefore show a stronger effect in reducing falls. Among these fall protective responses, the ability to make rapid stepping responses is often required to maintain standing balance. We propose to train older adults in a 3-month balance training program, combining a focus on improving both the ability to maintain stance and the ability to improve rapid stepping response. We will randomize older adults with mild-moderate balance deficits to one of other two groups: 1) the Combined Balance Training program or 2) T'ai Chi. The 3-month Combined Training and T'ai Chi will be followed by a 12 month home- based maintenance program with weekly group "refresher" sessions. Both groups will be under surveillance, via postcard responses and telephone calls, for the primary outcome, occurrence of falls and fall-related injuries. Intermediate outcomes at baseline, 3 months and 15 months will include measures of maintaining stance and rapid stepping. Secondary analyses will explore the relationships between apparent underlying mechanisms such as changes in rapid strength development and self efficacy as explanations for changes in maintenance of stance, rapid stepping, and the occurrence of falls. Thus, in addition to improving the balance and rapid stepping ability of participating subjects, a number of questions may be explored regarding postural control and the ability to avoid falls in an at-risk older adult population.