Functional reach: does it really measure dynamic balance?

BACKGROUND: Functional reach (FR) is a new clinical measurement intended to assess dynamic balance. The purposes of this study were (1) to measure the mean FR distance in healthy elders compared with individuals with known balance impairments, (2) to analyze the extent to which FR measures dynamic balance, and (3) to describe movement strategies used during FR. METHODS: Thirteen healthy elders and 15 individuals with vestibular hypofunction (VH) were tested during FR and free gait. Whole body kinematic and kinetic data including the center of gravity (CG) and center of pressure (CP) using 11 body segments and two force plates, respectively, were collected. RESULTS: There was no difference in FR distance between healthy elders and individuals with VH. FR distance was not correlated to lateral stability measures, but was related to anterior-posterior postural control measures of FR (r = .69 to .84) in both groups. Although FR distance strongly correlated with maximum moment arm during FR in both groups, the correlations were not as strong when the subjects were then classified by movement strategy. The mean moment arm during FR was significantly less than that of free gait. CONCLUSIONS: These data suggest FR does not measure dynamic balance; healthy elders and balance-impaired individuals with vestibular dysfunction attained the same FR distance and did so without increasing the moment arm during or at the end of FR. Recording the strategy used during FR, however, may provide other valuable information necessary in addressing balance control. Clinical implications of assessing movement strategy are discussed.

Exercise--it's never too late: the strong-for-life program.

OBJECTIVES: This investigation determined whether an in-home resistance training program achieved health benefits in older adults with disabilities. METHODS: A randomized controlled trial compared the effects of assigning 215 older persons to either a home-based resistance exercise training group or a waiting list control group. Assessments were conducted at baseline and at 3 and 6 months following randomization. The program consisted of videotaped exercise routines performed with elastic bands of varying thickness. RESULTS: High rates of exercise adherence were achieved, with 89% of the recommended exercise sessions performed over 6 months. Relative to controls, subjects who participated in the program achieved statistically significant lower extremity strength improvements of 6% to 12%, a 20% improvement in tandem gait, and a 15% to 18% reduction in physical and overall disability at the 6-month follow-up. No adverse health effects were encountered. CONCLUSIONS: These findings provide important evidence that home-based resistance exercise programs designed for older persons with disabilities hold promise as an effective public health strategy.

Reliability of clinical balance outcome measures in the elderly.

BACKGROUND AND PURPOSE: Simple, practical and reliable clinical balance outcome measures are needed to assess baseline status and response to treatment in older people. The reliability of the clinical measures used in this testing protocol had not been determined for this population. This study assessed the inter-rater reliability of three commonly used clinical measures of balance: one leg standing, tandem gait and functional reach. METHOD: Two samples of older people were used: (1) non-disabled and (2) disabled community dwellers. All testing was performed in a single session by two trained examiners according to a standardized protocol. Intra-class correlations were calculated comparing the means of each clinical balance test for Examiner 1 with Examiner 2. RESULTS: Reliability coefficients were 0.75 for one leg standing, 0.73 for functional reach, and 0.31 for tandem gait for the non-disabled sample. Reliability coefficients were 0.85 for one leg standing, 0.79 for functional reach, and 0.62 for tandem gait for the disabled sample. CONCLUSIONS: These findings for the one leg standing and functional reach testing protocols in disabled and non-disabled older people can be used as outcome measures. Further study should be directed towards improving the reliability of the tandem gait test for use with older people.

Home-based resistance training: predictors of participation and adherence.

This study identified factors associated with exercise participation and adherence in a sample of 102 sedentary, functionally limited, community-dwelling adults aged 60 to 94 years who participated in a home-based resistance training program. Stepwise regression analyses revealed that baseline physical factors (i.e., higher levels of mobility, weaker muscle strength, and fewer numbers of new medical conditions) were associated with higher rates of participation in the home program. Positive attitudes and a sense of control toward exercise, lower levels of confusion and depressive moods, and the development of fewer new medical problems during the program were related to higher levels of adherence to the program. Findings revealed that although physical health variables were the primary indicators of an older person's overall participation in the program, it was the psychological factors that were most important to adherence to this home-based program.