Pilates exercise and postural balance in older adults: A systematic review and meta-analysis of randomized controlled trials

IntroductionThe effects of exercising with the Pilates method on aspects such as balance for the general population have been reported by recent systematic reviews. However, whereas the effects of the Pilates method on improving general balance have been well studied, less is known about postural balance and the respective determinants of Pilates effects.Objectives(1) provide more up-to-date evidence to determine the effects of Pilates on postural balance and (2) examine the effects of length of intervention, Pilates amount per week (times per week X session duration), and study quality (risk of bias) on postural balance in older adults.MethodsA systematic electronic search in Medline and Scientific Electronic Library Online (SciELO) was completed in December 2018 identifying randomized controlled trials investigating the effect of a Pilates method on postural balance in healthy older adults. A subsequent meta-analysis was performed.ResultsThe meta-analysis involved 6 studies and 261 individuals (128 Pilates and 133 control groups). We observed an overall effect favoring the Pilates group SMD_95% = 0.89 [0.29–1.49]. The subgroup mean effects were similar for “length of intervention” (low vs high) [P = 0.557], “Pilates amount per week” (low vs high) [P = 0.565], and “study quality” (low vs high) [P = 0.869].ConclusionAccordingly, our findings suggest that a Pilates training program can be considered as an effective form of exercise to improve balance in older adults. Additionally, length of intervention, Pilates amount per week, and study quality were not related to the magnitude of effect on postural balance.     

Specific balance training included in an endurance-resistance exercise program improves postural balance in elderly patients undergoing haemodialysis

Purpose: The purpose of this study was to evaluate the effects of 6 months of specific balance training included in endurance-resistance program on postural balance in haemodialysis (HD) patients.

Methods: Forty-nine male patients undergoing HD were randomly assigned to an intervention group (balance training included in an endurance-resistance training, n?=?26) or a control group (resistance-endurance training only, n?=?23). Postural control was assessed using six clinical tests; Timed Up and Go test, Tinetti Mobility Test, Berg Balance Scale, Unipodal Stance test, Mini-Balance Evaluation Systems Test and Activities Balance Confidence scale.

Results: All balance measures increased significantly after the period of rehabilitation training in the intervention group. Only the Timed Up and Go, Berg Balance Scale, Mini-Balance Evaluation Systems Test and Activities Balance Confidence scores were improved in the control group. The ranges of change in these tests were greater in the balance training group.

Conclusions: In HD patients, specific balance training included in a usual endurance-resistance training program improves static and dynamic balance better than endurance-resistance training only.

• Implications for rehabilitation

• Rehabilitation using exercise in haemodialysis patients improved global mobility and functional abilities.

• Specific balance training included in usual endurance resistance training program could lead to improved static and dynamic balance.

     

Effects of myofascial release or self-myofascial release and control position exercises on lower back pain in idiopathic scoliosis: A systematic review

BackgroundIdiopathic scoliosis is associated, among others, to muscular imbalance, functional limitations, and the most prevalent, back pain. The treatments usually applied are exercise, bracing or surgery. The objective of corrective exercise is to reduce symptoms and improve functional capacity and quality of life. Myofascial release (MFR) or Self-Myofascial release (SMFR) are manual techniques, intended to restore optimal muscle and fascia length, decrease pain, and improve function.Purposeto analyze the effects of MFR and postural control programs in lower back pain and scoliosis curves.MethodsA systematic literature review was conducted in high quality databases to identify the existing evidence of the effects of MFR and postural control on reducing back pain and scoliosis curves.ResultsSeventeen studies met inclusion criteria. 533 subjects and 94 MFR/SMFR applied interventions lasting one to 24 weeks/sessions were identified. Ten studies used MFR, six SMFR and one mixes techniques. Seven MFR and five SMFR studies shown positive result. One study using MFR and one using SMFR applied also postural control exercises. MFR was useful to reduce back pain in all studies included that aimed in that matter. In addition, 12 studies reported improvements in flexibility and/or stiffness reduction, and two studies observed improvements in postural control and balance.ConclusionsThe combination of MFR and postural control programs might be suitable for reducing scoliosis and back pain. However, due to the reduced number of studies and the relatively small sample sizes used, results may be carefully interpreted, and more studies are needed.     

Efectividad de los ejercicios de equilibrio entre los adultos mayores en Depok,Indonesia

ObjectiveFalls are a serious problem for older adults. Balance impairment is one of the most significant reasons why adults fall from a standing position. This study aims to investigate the effect of an eight-week postural balance exercise intended to reduce the risk of falls among older adults in a community in Depok City, Indonesia.MethodThis quasi-experimental study employed a pre- and post-test design using a control group. The study involved an intervention group of 30 respondents and a control group of a further 30 respondents. The sample was selected using multistage random sampling. The data were analyzed using a t-test.ResultsThe balance exercise significantly affected the respondents’ postural balance and reduced their risk of falling. There were significant differences between the two groups (intervention group and control group) in postural balance (p < 0.001) and the risk of suffering a fall (p = 0.023).ConclusiónBalance exercises can be utilized as one of the preventive efforts to maintain postural balance and reduce the risk of falls among older adults. Future studies may consider the variation of age to more accurately determine the effectiveness of this balance exercise.     

Acute effect of core stability and sensory-motor exercises on postural control during sitting and standing positions in young adults

SummaryCore stability exercises and exercises that stimulate sensory-motor information are recommended for the prevention of injuries and the maintenance and rehabilitation of deficits related to postural control (PC). However, the comparison of results between core stability and sensory-motor exercises in the literature is limited to sitting and standing positions.ObjectiveTo determine the acute effect of core stability and sensory-motor exercises on PC during sitting and standing in young adults.MethodsA total of 39 participants, with a mean age of 23 years, were randomly divided into three groups (1) Core stability exercises; (2) Sensory-motor exercises; (3) Control. Each group performed a sequence of five specific exercises of core stability and sensory-motor exercises (except controls). PC was evaluated before and after exercise in the seated and the one-legged stance conditions using a force platform.ResultsNo significant difference was found for any variables of postural oscillation (P > 0.05) among the three groups studied. The magnitude of the effect of interventions in general was a small to moderate effect (d = 0.02/-0.48).ConclusionThe findings show that acute intervention with core stability and sensory-motor exercises did not produce any significant effects (reduction of postural oscillation) on PC during sitting and standing positions in young adults.     

Comparison of the effects of virtual reality-based balance exercises and conventional exercises on balance and fall risk in older adults living in nursing homes in Turkey

Objectives: There is limited information on effective balance training techniques including virtual reality (VR)-based balance exercises in residential settings and no studies have been designed to compare the effects of VR-based balance exercises with conventional balance exercises in older adults living in nursing homes in Turkey. The objective of our study was to investigate the effects of VR-based balance exercises on balance and fall risk in comparison to conventional balance exercises in older adults living in nursing homes. Methods: A total sample of 18 subjects (65–82 years of age) with fall history who were randomly assigned to either the VR group (Group 1, n = 7) or the conventional exercise group (Group 2, n = 11) completed the exercise training. Results: In both groups, Berg balance score (BBS), timed up & go duration, and left leg stance and tandem stance duration with eyes closed significantly improved with time (p < 0.05), but changes were similar in both groups (p > 0.05) after training, indicating that neither the exercise method was superior. Conclusion: Similar improvements were found in balance and fall risk with VR-based balance training and conventional balance training in older adults living in the nursing home. Both exercise trainings can be preferable by health care professionals considering fall prevention. Appropriate patient selection is essential.     

Effect of balance training on postural balance control and risk of fall in children with diplegic cerebral palsy

Abstract

Purpose: The purpose of this study was to evaluate the effects of balance training on postural control and fall risk in children with diplegic cerebral palsy. Methods: Thirty spastic diplegic cerebral palsied children (10–12 years) were included in this study. Children were randomly assigned into two equal-sized groups: control and study groups. Participants in both groups received a traditional physical therapy exercise program. The study group additionally received balance training on the Biodex balance system. Treatment was provided 30?min/d, 3?d/week for 3 successive months. To evaluate the limit of stability and fall risk, participated children received baseline and post-treatment assessments using the Biodex balance system. Overall directional control, total time to complete the test, overall stability index of the fall risk test and total score of the pediatric balance scale were measured. Results: Children in both groups showed significant improvements in the mean values of all measured variables post-treatment (p?<?0.05). The results also showed significantly better improvement in the measured parameters for the study group, as compared to the control group (p?<?0.05). Conclusion: Balance training on Biodex system is a useful tool that can be used in improving postural balance control in children with diplegic cerebral palsy.

• Implications for Rehabilitation

• Postural problems play a central role in the motor dysfunction of children with diplegic cerebral palsy.

• Balance control is important in the competence in the performance of most functional skills.

• The Biodex Balance System is an important balance assessment and training tool.

• Balance training in children with cerebral palsy can improve performance in postural control.

     

Intervention study of finger-movement exercises and finger weight-lift training for improvement of handgrip strength among the very elderly

ObjectivesTo examine the effects of finger-movement exercises and finger weight-lift training on handgrip strength and Activities of Daily Living Scale (ADLS) values.MethodsA total of 80 very elderly adults (aged ≥80 years) were assigned to either an intervention group (n = 40) or a control group (n = 40). Subjects in the intervention group performed finger-movement exercises and weight-lift training for a period of 3 months, while subjects in the control group received no intervention, and were unaware of the interventions received in the other group.ResultsAfter completing 3 months of finger-movement exercises and weight-lift training, the average handgrip strength of the 40 participants in the intervention group had increased by 2.1 kg, whereas that in the control group decreased by 0.27 kg (P < 0.05). After receiving intervention, the number of subjects in the intervention group with an ADLS score >22 points decreased by 7.5% (P < 0.05, vs. pre-intervention).ConclusionsThe combined use intervention with finger-movement exercises and proper finger weight-lift training improved the handgrip strength and ADLS values of very elderly individuals. These rehabilitation exercises may be used to help the elderly maintain their self-care abilities.     

Effects of different exercise modalities on ataxia in multiple sclerosis patients: a randomized controlled study

Purpose: To investigate the effects of different exercise protocols on ataxia in patients with multiple sclerosis (MS).

Method: A total of 42?MS patients, 17 male and 25 female (Expanded Disability Status Scale (EDSS): 3–5), were enrolled in this randomized controlled study. The patients were divided into three groups: a balance training (BT) group, a lumbar stabilization (LS) group and a task-oriented training (TT) group. All groups received balance training; additionally, the LS group received lumbar stabilization exercises, and the TT group received task-oriented training. The Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS), Functional Reach Test (FRT), 2-Minute Walk Test (2MWT), Sensory Organization Test (SOT), and measurement of Somatosensory Evoked Potentials (SSEPs) were performed before and at the end of the 18 training sessions.

Results: The BBS, ICARS, FRT, 2MWT, and composite balance score of the SOT were improved in all groups. The ICARS kinetic function sub-score and the left limb cortical onset amplitudes of SSEPs were increased significantly in both the TT and the LS groups. The ICARS total score, composite balance score, and 2MWT were different between groups (p?p?p?>?0.005). The 2MWT results were better for the LS group than the BT group, while the BT and the TT groups improved similarly.

Conclusion: Balance training alone is not sufficient for rehabilitation of ataxic MS patients. A combination of lumbar stabilization exercises or task-oriented training increases the success of balance rehabilitation.

• Implications for rehabilitation

• Multiple sclerosis is a chronic inflammatory and autoimmune disease of central nervous system and ataxia is one of the most challenging symptoms of this disease.

• Different exercise modalities are commonly employed to control ataxic symptoms in MS patients.

• Lumbar stabilization exercises or task-oriented training should be considered as complementary approach to improve balance and coordination in ataxic multiple sclerosis patients.

     

What works in delivering dementia education or training to hospital staff? A critical synthesis of the evidence

BackgroundThe quality of care delivered to people with dementia in hospital settings is of international concern. People with dementia occupy up to one quarter of acute hospital beds, however, staff working in hospitals report lack of knowledge and skills in caring for this group. There is limited evidence about the most effective approaches to training hospital staff on dementia.ObjectiveThe purpose of this literature review was to examine published evidence on the most effective approaches to dementia training and education for hospital staff.Design and review methodsThe review was conducted using critical synthesis and included qualitative, quantitative and mixed/multi- methods studies. Kirkpatrick’s four level model for the evaluation of training interventions was adopted to structure the review.Data sourcesThe following databases were searched: MEDLINE, PsycINFO, CINAHL, AMED, British Education Index, Education Abstracts, ERIC (EbscoHost), The Cochrane Library-Cochrane reviews, Economic evaluations, CENTRAL (Wiley), HMIC (Ovid), ASSIA, IBSS (Proquest), Conference Proceedings Citation Indexes (Web of Science), using a combination of keyword for the following themes: Dementia/Alzheimer’s, training/education, staff knowledge and patient outcomes.ResultsA total of 20 papers were included in the review, the majority of which were low or medium quality, impacting on generalisability. The 16 different training programmes evaluated in the studies varied in terms of duration and mode of delivery, although most employed face-to-face didactic techniques. Studies predominantly reported on reactions to training and knowledge, only one study evaluated outcomes across all of the levels of the Kirkpatrick model. Key features of training that appeared to be more acceptable and effective were identified related to training content, delivery methods, practicalities, duration and support for implementation.ConclusionsThe review methodology enabled inclusion of a broad range of studies and permitted common features of successful programmes to be identified. Such features may be used in the design of future dementia training programmes, to increase their potential for effectiveness. Further research on the features of effective dementia training for hospital staff is required.     

Effects of training with a custom-made visual feedback device on balance and functional lower-extremity strength in older adults: A randomized controlled trial

IntroductionTraining with a slow and sustained mechanical load, such as standing on one leg, is an effective method for improving balance and increasing lower-extremity strength. Also, visual feedback during motor learning is important in facilitating efficient postural responses and balance skills. In this study, a custom-made visual feedback device was invented to provide the training modality and program based on single-leg standing combined with augmented visual feedback training. This study aimed to investigate the effects of visual feedback training using the custom-made visual feedback device on balance and functional lower-extremity strength in older adults.MethodsThirty-four independent older adults were randomly allocated to a training group (TG) and a control group (CG). The participants in the TG received training with the custom-made visual feedback device. The training duration was three sessions per week, for four weeks. The participants in the CG continued their routine activities. Balance (static and dynamic balances, and balance confidence) and functional lower-extremity strength were assessed pre- and post-training.ResultsImprovements in static balance (sway velocity and limit of balance during one-leg standing with eyes open) and dynamic balance (directional control of limits of stability in the backward direction) were found after training in the TG compared with the CG. No significant differences in balance confidence or functional lower-extremity strength were found between groups after training.ConclusionIn older adults, training with a custom-made visual feedback device could be used to improve both static and dynamic balances, but not balance confidence and functional lower-extremity strength.     

Effect of simulation training on the development of nurses and nursing students' critical thinking: A systematic literature review

ObjectiveTo gain insight into the existing scientific evidence on the effect of simulation on critical thinking in nursing education.DesignA systematic literature review of original research publications.Data SourcesIn this systematic review, the papers published in English and Farsi databases of PubMed, Science Direct, ProQuest, ERIC, Google Scholar and Ovid, MagIran and SID, from 1975 to 2015 were reviewed by two independent researchers.Review MethodsOriginal research publications were eligible for review when they described simulation program directed on nursing student and nurses; used a control group or a pretest post-test design; and gave information about the effects of simulation on critical thinking. Two reviewers independently assessed the studies for inclusion. Methodological quality of the included studies was also independently assessed by the reviewers, using a checklist developed by Greenhalgh et al. and the checklist of Cochrane Center. Data related to the original publications were extracted by one reviewer and checked by a second reviewer. No statistical pooling of outcomes was performed, due to the large heterogeneity of outcomes.ResultsAfter screening the titles and abstracts of 787 papers, 16 ones were included in the review according to the inclusion criteria. These used experimental or quasi-experimental designs. The studies used a variety of instruments and a wide range of simulation methods with differences in duration and numbers of exposures to simulation. Eight of the studies reported that simulation training positively affected the critical thinking skills. However, eight studies reported ineffectiveness of simulation on critical thinking.ConclusionStudies are conflicting about the effect of simulation on nurses and nursing students' critical thinking. Also, a large heterogeneity exists between the studies in terms of the instruments and the methods used. Thus, more studies with careful designs are needed to produce more credible evidence on the effectiveness of simulation on critical thinking.     

Effect of suspension training on neuromuscular function,postural control,and knee kinematics in anterior cruciate ligament reconstruction patients

BACKGROUNDSuspension training (SET) is a method of neuromuscular training that enables the body to carry out active training under unstable support through a suspension therapy system. However, there have been few reports in the literature on the application of SET to anterior cruciate ligament reconstruction (ACLR) patients. It is not clear what aspects of the patient''s function are improved after SET.AIMTo investigate the effect of SET on the neuromuscular function, postural control, and knee kinematics of patients after ACLR surgery. METHODSForty participants were randomized to an SET group or a control group. The SET group subjects participated in a SET protocol over 6 wk. The control group subjects participated in a traditional training protocol over 6 wk. Isokinetic muscle strength of the quadriceps and hamstrings, static and dynamic posture stability test, and relative translation of the injured knee were assessed before and after training. RESULTSThe relative peak torque of the quadriceps and hamstrings in both groups increased significantly (P < 0.001), and the SET group increased by a higher percentage than those in the control group (quadriceps: P = 0.004; hamstrings: P = 0.011). After training, both groups showed significant improvements in static and dynamic posture stability (P < 0.01), and the SET group had a greater change than the control group (P < 0.05). No significant improvement on the relative translation of the injured knee was observed after training in either group (P > 0.05). CONCLUSIONOur findings show that SET promotes great responses in quadriceps and hamstring muscle strength and balance function in ACLR patients.     

Is a blended learning approach effective for learning in allied health clinicians?

Background: An increase in demand for professional development activities amongst the allied health workforce has seen the emergence of new technology-based training delivery methods. Blended learning, involving a combination of the traditional face-to-face teaching with the use of e-learning, is one emerging approach to the provision of professional development activities in allied health.

Objectives: This systematic review investigated the questions: ‘What is the effect on learning of a blended learning model of training delivery method for allied health clinicians?’ and, ‘From the perspective of stakeholders, what are the advantages, disadvantages and recommendations for successful implementation of a blended learning model of training delivery method for allied health clinicians?’

Methods: Eighteen databases were searched from inception. Only English language publications describing quantitative research (systematic reviews or primary quantitative studies) were included. All studies were appraised using the CASP critical appraisal tool (CAT) for Systematic Reviews and the McMaster CAT for Quantitative studies.

Results: Four Systematic Reviews and 14 primary studies describing quantitative data were included. The literature indicates that there was weak evidence regarding improved outcomes from blended learning interventions, compared with other educational models.

Conclusions: Whilst blended learning has advantages in terms of flexibility of learning, and economies of scale, there is no ‘one size fits all’ approach to optimizing the learning outcomes, no matter what the teaching and learning environment. A range of strategies for the effective provision of blended learning activities from the literature is provided.     

Effect of balance training using virtual reality-based serious games in individuals with total knee replacement: A randomized controlled trial

BackgroundVirtual reality (VR) and serious games (SGs) are widespread in rehabilitation for many orthopedic and neurological diseases. However, few studies have addressed the effects of rehabilitation with VR-based SGs on clinical, gait, and postural outcomes in individuals with total knee replacement (TKR).ObjectiveThe primary objective was the efficacy of balance training using non-immersive VR-based SGs compared to conventional therapy in TKR patients on the Time Up and Go test. Secondary objectives included the efficacy on clinical, gait, and postural outcomes.MethodsWe randomly allocated 56 individuals with unilateral TKR to the experimental group (EG) or control group (CG) for 15 sessions (45 min; 5 times per week) of non-immersive VR-based SGs or conventional balance training, respectively. The primary outcome was functional mobility measured by the Timed Up and Go test; secondary outcomes were walking speed, pain intensity, lower-limb muscular strength, independence in activities of daily living as well as gait and postural parameters.ResultsWe found significant within-group differences in all clinical outcomes and in a subset of gait (p<0.0001) and postural (p ≤ 0.05) parameters. Analysis of the stance time of the affected limb revealed significant between-group differences (p = 0.022): post-hoc analysis revealed within-group differences in the EG (p = 0.002) but not CG (p = 0.834). We found no significant between-group differences in other outcomes.ConclusionsBalance training with non-immersive VR-based SGs can improve clinical, gait, and postural outcomes in TKR patients. It was not superior to the CG findings but could be considered an alternative to the conventional approach and can be added to a regular rehabilitation program in TKR patients. The EG had a more physiological duration of the gait stance phase at the end of the treatment than the CG.ClinicalTrials.govNCT03454256     

Using the Wii to Improve Balance in Older Adults: A Systematic Review

ABSTRACT

Aims: The purpose of this systematic review was to evaluate the effectiveness of the Wii at improving balance in older adults without documented neurologic or orthopedic deficits. Methods: A thorough investigation of the CINAHL Plus with Full Text, ProQuest Medical Library, and SPORTDiscus with Full Text databases was completed. The search terms utilized while analyzing the databases were “Wii” AND “randomized” AND “balance” OR “postural control” AND “elderly” OR “older adults”. Results: Eight studies were included in the qualitative analysis. Participants in the Wii therapy groups generally demonstrated more improvement in postural control compared to participants in the control groups. Although there were no significant differences in postural control between the Wii therapy groups and the conventional therapy groups following the respective intervention, the Wii participants generally expressed greater enjoyment, interest, and motivation. Conclusions: Wii balance training may be considered an effective alternative intervention for individuals with impaired postural control.     

Effects of Virtual Reality vs Conventional Balance Training on Balance and Falls in People With Multiple Sclerosis: A Randomized Controlled Trial

ObjectiveTo assess the efficacy of virtual reality (VR)-based vs conventional balance training on the improvement of balance and reduction of falls in people with multiple sclerosis (PwMS).DesignSingle-blinded, randomized, controlled trial.SettingMusculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences.ParticipantsPwMS (N=39), randomized into VR (n=19) and control (n=20) groups.InterventionThe VR group performed exergames using Kinect, while the control group accomplished conventional balance exercises. Both groups received 18 training sessions for 6 weeks.Main Outcome MeasuresLimits of stability, timed Up and Go (TUG) test, and 10-m walk tests with and without cognitive task and their dual-task costs (DTCs), Berg Balance Scale, Multiple Sclerosis Walking Scale-12, Fall Efficacy Scale-International, Activities-specific Balance Confidence Scale, and fall history were obtained pre- and post intervention and after a 3-month follow-up.ResultsAt both post intervention and follow-up, TUG^cognitive and DTCs on the TUG were significantly lower and the 10-m walk^cognitive was significantly higher in the VR group. At follow-up, reaction time and the number of falls demonstrated significant differences favoring the VR group, whereas the directional control revealed significant difference in favor of the control group (P<.05). The other outcomes showed no statistically significant difference at post intervention or follow-up.ConclusionsBoth the VR-based and conventional balance exercises improved balance and mobility in PwMS, while each acted better in improving certain aspects. VR-based training was more efficacious in enhancing cognitive-motor function and reducing falls, whereas conventional exercises led to better directional control. Further studies are needed to confirm the effectiveness of recruiting VR-based exercises in clinical settings.