Perturbation-based Balance Training in Adults Aged Above 55 Years with Chronic Low Back Pain: A Comparison of Effects of Water versus Land Medium - A Preliminary Randomized Trial.

BACKGROUND: 'Rapid balance reaction' or 'perturbation' training is an emerging paradigm in elderly back pain rehabilitation due to its connection to postural stability. OBJECTIVE: This study aimed to inform the feasibility and practicality of perturbation-based balance training (PBT) using a stratification approach and to determine the effectiveness of land versus water-based PBT in elderly individuals with chronic low back pain (CLBP). METHODS: Elderly CLBP participants (n=24) received exercise interventions as per treatmentbased classification (TBC) and were randomly allotted into water-based perturbation exercises (WBPE, Mean age=63.0±2.6years, n=12) and land-based perturbation exercise group (LBPE, 62.3±2.6 years, n=12). Pain intensity, disability, scores of fear-avoidance beliefs, fall efficacy, and rate of perceived exertion (RPE) were assessed before and at the end of 6 weeks. RESULTS: WBPE group reported a significant reduction in pain score (median difference(MD)):2, p<0.03), fear avoidance behaviour for work (MD:9, p<0.01) and fear avoidance behaviour for physical activity (MD:10, p< 0.05), improved straight leg raise right (SLR) (MD:37.5°, p<0.05), and improved modified fall efficacy scores (MFES, MD:25, p<0.05) compared to the LBPE group at post-intervention. Within-group analysis in both groups revealed significant improvement in clinical outcomes except for fear-avoidance beliefs related to physical activity in the LBPE group. Subgroup analysis revealed that the high BMI elderly CLBP group of LBPE had significant improvements similar to the WBPE group except for scores of FABQ physical activity scores and SLR. CONCLUSION: Possible key factors for future research are discussed in the realms of perturbation exercise in the elderly with CLBP.

Power walking based outpatient cardiac rehabilitation in patients with post-coronary angioplasty: Randomized control trial.

PURPOSE: The purpose of this trial was to compare the effectiveness of standardized outpatient cardiac rehabilitation combined with treadmill power walking versus standardized outpatient cardiac rehabilitation alone on health-related quality of life (HQoL), functional exercise capacity (FEC), left ventricular ejection fraction (LVEF) and metabolic equivalent of tasks (METs) in patients who went post coronary angioplasty (CA). Further this study evaluated the association between average numbers of steps taken with above clinical outcomes. METHODS: In a pragmatic sequential randomized clinical trial, 24 patients were randomized into two groups (n = 12) and participated in a standardized outpatient cardiac rehabilitation program (SOCRP) with treadmill power walking as an intervention group and SOCRP alone in control group. Scores obtained before and after 4 weeks of intervention, that is, after 12 treatment sessions were assessed using a HQoL questionnaire and 6-min walk test (6 MWT). Average number of steps taken throughout the 4 weeks, METs and LVEF values were obtained by pedometer, exercise stress testing and echocardiogram respectively. RESULTS: Significant improvements were found in intergroup and intragroup comparison after 4 weeks of cardiac rehabilitation (p < 0.05). Scores of 6 MWT and LVEF significantly improved in the intervention group (p < 0.003) compared to the control group (p < 0.032). HQoL components that is, global and physical, MET values and average number of steps were significantly higher in the intervention group compared to the control group (p < 0.001). CONCLUSION: SOCRP with power walking was more effective in improving HQoL, FEC, LVEF, METs and average numbers of steps than SOCRP alone although both interventions were significant after 4 weeks in patients underwent CA and completed cardiac rehabilitation program. Positive significant associations were found between the average number of steps taken with scores of METs and scores of global and physical domains of HQoL.