ABSTRACT
Background: The Timed up and Go Test (TUG) is often used as a mobility measure in older people. However, it is unclear whether the TUG is useful for identifying fall risk in people with diabetes mellitus (DM) and which physical and cognitive/psychological factors influence the performance of this test. Objectives: To investigate whether slow TUG times (standard test and when performed with a secondary cognitive task (c-TUG)) are a risk factor for falls in older people with DM and to determine the relative contributions of a range of sensorimotor, balance and cognitive/psychological factors to TUG performance in this population. Methods: Community-dwelling people (n=103, mean age 61.57, SD=6.3) underwent the TUG and c-TUG tests as well as quantitative tests of vision, peripheral sensation, strength, reaction time, balance, cognition, and fear of falling. Participants were then followed up for falls for six months. Results: Negative binomial regression analyses revealed that each 1s increase in TUG and c-TUG times increased the risk of falling by 29% and 13%, respectively. Multiple regression analyses identified vibration sense (p<0.001), knee extension strength (p=0.001, r²=0.430), edge contrast sensitivity (p=0.002), neuropathy examination score (p=0.001, r²=0.498) and controlled leaning balance (p=0.033) as significant and independent explanatory predictors of TUG performance. The regression model for c-TUG was similar, vibration sense (p=0.042), knee extension strength (p=0.009, r²=0.256), neuropathy examination score (p=0.156, r²=0.272) and sway path-floor (p=0.042) except that the MOCA cognitive assessment (p=0.015) was included instead of edge contrast sensitivity. The combined explanatory variable models explained 43% and 26% of the variance in TUG and c-TUG times, respectively. Conclusions: Slow TUG and c-TUG times significantly increased the risk of falls in community-dwelling older people with DM. Poor TUG and c-TUG performances were related independently to decreased vibration sense, lower limb weakness, and poor balance, with the c-TUG additionally influenced by cognitive function.
ABSTRACT
Falls are a common, costly and preventable consequence of sensorimotor impairments that increase in prevalence with advancing age. A fall occurs when the physical ability of the individual is unable to match the immediate demands of the environment and/or of the activity being undertaken. Targeted exercise aimed at improving the physical ability of the individual, such as balance and strength training, is crucial for promoting functional independence and mobility and reducing the risk of falling in older age. Exercise programs that provide a high challenge to balance, have a high dose, include progression of intensity over time and are ongoing are most effective for preventing falls. This paper provides guidance to health professionals involved with the prescription of physical activity and exercise to older people regarding the safe and effective provision of programs aimed at improving strength and balance and preventing falls in older age.
As quedas são uma consequência comum, caras e evitáveis decorrentes das deficiências sensoriomotoras que aumentam em incidência com o avanço da idade. A queda ocorre quando a capacidade física do indivíduo não responde às demandas imediatas do ambiente e/ou da atividade realizada. Exercícios específicos destinados a melhorar a capacidade física do indivíduo, tais como equilíbrio e treinamento de força, são fundamentais para promover a independência funcional e mobilidade, e reduzir o risco de cair em idade mais avançada. Programas de exercício que oferecem um desafio maior ao equilíbrio, oferecidos com frequência, que incluem a progressão da intensidade ao longo do tempo e sem interrupção são mais eficazes para a prevenção de quedas. Este documento fornece orientações para os profissionais de saúde envolvidos com a prescrição de atividade física e exercício físico para pessoas idosas em relação à prestação segura e eficaz de programas destinados a melhorar a força e equilíbrio e prevenção de quedas na velhice.
Las caídas son una consecuencia común, costosa y prevenibles de discapacidades sensoriomotoras resultantes de ese aumento de la incidencia con la edad. La caída se produce cuando la capacidad física del individuo no responde a las exigencias inmediatas del medio ambiente y/o de la actividad desarrollada. Los ejercicios específicos diseñados para mejorar la capacidad física del individuo, tales como el equilibrio y entrenamiento de la fuerza, es crucial para promover la independencia funcional y la movilidad, y reducir el riesgo de caer en la vejez. Los programas de ejercicios que ofrecen un mayor desafío al equilibrio, se ofrece con frecuencia, incluyendo la progresión de la intensidad con el tiempo y sin interrupción son los más efectivos para la prevención de caídas. Este documento proporciona una guía para los profesionales de la salud implicados en la prescripción de la actividad física y el ejercicio para las personas ancianas con respecto a la prestación segura y eficaz de los programas destinados a mejorar la fuerza y el equilibrio y la prevención de caídas en la vejez.