Intervention to Enhance Lateral Balance Function and Prevent Falls in Aging

增强横向平衡功能并预防衰老的干预措施

• 批准号: 7988500
• 负责人: MARK W ROGERS
• 金额: $ 38.34万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7988500
• 关键词: Activities of Daily Living; Affect; Age; Aging; Anterior; Balance training; Biomechanics; Caring; Communities; Control Groups; Development; Double-Blind Method; Economics; Effectiveness; Elderly; Enrollment; Equilibrium; Exercise; Fall prevention; Flexor; Frequencies; Goals; Hip Fractures; Hip region structure; Human; Impairment; Incidence; Individual; Injury; Intervention; Joints; Lateral; Leg; Length; Limb structure; Link; Measures; Medical; Modeling; Muscle; Muscle function; Neuromechanics; Outcome; Pattern; Performance; Physiological; Prevention strategy; Public Health; Randomized Controlled Trials; Recording of previous events; Recovery; Relative (related person); Relaxation; Research; Secure; Specificity; Speed; Step training; Therapeutic Intervention; Time; Time Study; Torque; Training; Training Programs; Translating; Walking; Weight-Bearing state; age related; arm; base; community living; effective intervention; fall risk; falls; flexibility; follow-up; group intervention; improved; muscle strength; prevent; programs; prospective; public health relevance; response; strength training

DESCRIPTION (provided by applicant): Falls and their consequences are among the major problems in the medical care of older individuals. The long-term goal of this research is to establish the efficacy of a scientifically grounded and mechanism-based therapeutic intervention for improving balance function and preventing falls in older people. When human balance is challenged, protective stepping is a vital strategy for preventing a fall during activities of daily life. Many older people at risk for falls have particular difficulties with successfully stepping sideways as a protective response to loss of balance in the lateral direction. We propose that age-related declines in lateral balance function through impaired protective stepping that precipitates falls, result from neuromechanical (NM) limitations in hip abductor-adductor (AB-AD) muscle strength (torque and power). Moreover, we hypothesize that these functional and NM impairments are reversible with combined, high intensity induced, step training and muscle strengthening. The specific aims are to conduct a double blind, randomized, and controlled trial with four training arms that will compare the effects of 12 weeks of training and assess its durability after 3 months of no training in community living older adults at risk for falls by determining: 1) the effect of (a) waist-pull induced step training, (b) hip AB-AD muscle strengthening, and (c) a combined step training and muscle strengthening program compared to (d) a standard flexibility and relaxation program involving minimal-intensity exercises (control) on the protective stepping response to an external balance perturbation, as measured by i) the number of multiple balance recovery steps, and ii) first step length; and 2) the effect of high intensity step training, with and without the strengthening intervention, compared to the control group on a) maximum hip AB- AD joint torque and power. A secondary aim will assess whether protective stepping performance and hip AB- AD muscle strength discriminate between a) fallers and non-fallers identified by retrospective fall history at the time of study enrollment, and b) the prospective fall frequency of the different intervention groups during 1-year follow-up post-training. PUBLIC HEALTH RELEVANCE: The relevance of this research to public health lies in its focus on understanding the causes of age-associated falls and on the development of effective interventions for minimizing the devastating economic, societal, and personal consequences of falls among older people.

描述（由申请人提供）：跌倒及其后果是老年人医疗保健中的主要问题之一。这项研究的长期目标是确定一种有科学依据和机制的治疗干预措施对于改善老年人平衡功能和预防跌倒的功效。当人体平衡受到挑战时，保护性踏步是防止日常生活活动中跌倒的重要策略。许多有跌倒风险的老年人在成功侧向行走以作为对横向失去平衡的保护性反应方面存在特别困难。我们认为，与年龄相关的横向平衡功能下降是由于髋关节外展肌-内收肌 (AB-AD) 肌肉力量（扭矩和功率）的神经力学 (NM) 限制所致，保护性迈步受损导致跌倒。此外，我们假设这些功能和 NM 损伤可以通过高强度诱导的阶梯训练和肌肉强化相结合来逆转。具体目标是对四个训练组进行双盲、随机和对照试验，比较 12 周训练的效果，并评估社区老年人在有跌倒风险的情况下 3 个月没有训练后的持久性，方法是确定：1​​) (a) 腰部拉动诱导的阶梯训练，(b) 髋部 AB-AD 肌肉强化，以及 (c) 阶梯训练和肌肉强化组合计划与 (d) 标准灵活性和放松计划相比的效果 涉及对外部平衡扰动的保护性步进反应的最小强度练习（控制），通过 i）多个平衡恢复步骤的数量和 ii）第一步长度来衡量； 2) 与对照组相比，在有或没有强化干预的情况下，高强度踏步训练对 a) 最大髋关节 AB-AD 关节扭矩和功率的影响。第二个目标是评估保护性迈步性能和髋部 AB-AD 肌肉力量是否能区分 a) 通过研究登记时的回顾性跌倒历史确定的跌倒者和非跌倒者，以及 b) 不同干预组在训练后 1 年随访期间的预期跌倒频率。 公共卫生相关性：这项研究与公共卫生的相关性在于其重点是了解与年龄相关的跌倒原因，并制定有效的干预措施，以尽量减少跌倒对老年人造成的破坏性经济、社会和个人后果。