Intervention to Enhance Lateral Balance Function and Prevent Falls in Aging

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。本研究的长期目标是建立一种基于科学和机制的治疗干预措施，以改善老年人的平衡功能和预防跌倒。当人的平衡受到挑战时，保护性行走是在日常生活活动中防止跌倒的重要策略。许多有跌倒风险的老年人在侧向失去平衡时，很难成功地向侧面迈步作为一种保护性反应。我们认为，由于髋关节外展-内收肌（AB-AD）肌肉力量（扭矩和功率）的神经力学（NM）限制，与年龄相关的侧向平衡功能下降是由于保护性步进受损导致跌倒。此外，我们假设这些功能和NM损伤是可逆的，结合，高强度诱导，步进训练和肌肉强化。具体目标是进行一项双盲、随机和对照试验，包括四个训练组，比较12周训练的效果，并在有跌倒风险的社区生活老年人中评估3个月不训练后的持久性，通过确定：1) (a)腰部牵拉诱导的步速训练，(b)髋关节AB-AD肌肉强化，以及（c)与（d)涉及最小强度练习（控制）的标准柔韧性和放松计划相比，(c)步速训练和肌肉强化计划对外部平衡扰动的保护性步速反应的影响，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，有和没有强化干预的高强度步进训练对a)髋关节AB- AD关节最大扭矩和功率的影响。第二个目的是评估保护性踏步性能和髋关节AB- AD肌力是否在A)研究入组时通过回顾性跌倒史确定的跌倒者和非跌倒者之间存在差异，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。

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.