Square-stepping exercise in older inpatients in early geriatric rehabilitation. A randomized controlled pilot study.

BACKGROUND: Preservation of mobility and fall prevention have a high priority in geriatric rehabilitation. Square-Stepping Exercise (SSE) as an evaluated and standardized program has been proven to be an effective training for older people in the community setting to reduce falls and improve subjectively perceived health status. This randomized controlled trial (RCT), for the first time, examines SSE in the context of inpatient early geriatric rehabilitation compared to conventional physiotherapy (cPT). METHODS: Data were collected in a general hospital in the department of acute geriatric care at admission and discharge. Fifty-eight inpatients were randomized to control (CG, n = 29) or intervention groups (IG, n = 29). CG received usual care with cPT five days per week during their hospital stay. For the IG SSE replaced cPT for at least six sessions, alternating with cPT. Physical function was measured with the Short Physical Performance Battery (SPPB) and Timed "Up & Go" (TUG). Gait speed was measured over a distance of 10 m. In a subgroup (n = 17) spatiotemporal gait parameters were analyzed via a GAITRite® system. RESULTS: Both the SPPB total score improved significantly (p = < 0.001) from baseline to discharge in both groups, as did the TUG (p < 0.001). In the SPPB Chair Rise both groups improved with a significant group difference in favor of the IG (p = 0.031). For both groups gait characteristics improved: Gait speed (p = < 0.001), walk ratio (p = 0.011), step length (p = < 0.001), stride length (p = < 0.001) and double support (p = 0.009). For step length at maximum gait speed (p = 0.054) and stride length at maximum gait speed (p = 0.060) a trend in favor of the IG was visible. CONCLUSIONS: SSE in combination with a reduced number of sessions of cPT is as effective as cPT for inpatients in early geriatric rehabilitation to increase physical function and gait characteristics. In the Chair Rise test SSE appears to be superior. These results highlight that SSE is effective, and may serve as an additional component for cPT for older adults requiring geriatric acute care. TRIAL REGISTRATION: DRKS00026191.

Effects of square-stepping exercise on executive function in individuals with Parkinson's disease: A randomized controlled pilot study.

With the aging population, the incidence of Parkinson's disease (PD) increases over time. In this study, a popular and interesting exercise called the square-stepping exercise (SSE) was chosen as an intervention for people with PD. The purpose of the study was to investigate the effects of SSE on cognitive function, especially executive function. Twenty-eight participants were recruited and randomly assigned to the experimental group (n=14) or the control group (n=14). The duration of the intervention for both groups was 8 weeks, twice a week. The outcomes, including the trail making test, the digit span task, the Montreal cognitive assessment, and the Parkinson's disease questionnaire, were evaluated before the intervention, after the intervention, and at 1-month follow-up. The results showed that executive function improved significantly on the digit span task after SSE training. Consequently, SSE could be an effective intervention to improve executive function in people with PD.

Balance Training Modulates Cortical Inhibition in Individuals with Parkinson's Disease: A Randomized Controlled Trial.

BACKGROUND: Most individuals with Parkinson's disease (PD) develop balance dysfunction. Previous studies showed that individuals with PD have abnormal corticomotor changes related to severity of motor symptoms and disease progression. Cortical disinhibition was observed in PD and this alteration can be an early sign of PD. Balance training seems to be an effective intervention to improve balance in individuals with PD. However, it is not much known about the effect of balance training on cortical neuroplasticity in PD population. OBJECTIVE: To investigate the effects of balance training on corticomotor excitability in individuals with PD. METHODS: Twenty-eight PD participants were recruited and randomly assigned to either the balance training (BT) or the control (CON) group. Both groups underwent 16 training sessions over 8 weeks. Outcome measures for corticomotor inhibition included the cortical silent period (CSP) and short-interval intracortical inhibition (SICI) on transcranial magnetic stimulation. Balance performance was measured using the Mini-Balance Evaluation Systems Test (Mini-BEST) and the Timed Up and Go (TUG) test. RESULTS: Participants in the BT group showed a significant increase in corticomotor inhibition (CSP: P = .028, SICI: P = .04) and a significant improvement in balance performance (Mini-BEST: P = .001, TUG: P = .04) after training. Compared to the CON group, the BT group showed a greater increase in corticomotor inhibition (CSP: P = .017, SICI: P = .046) and better improvement in balance (Mini-BEST: P = .046). CONCLUSION: Balance training could modulate corticomotor inhibition in the primary motor cortex and improve balance performance in individuals with PD.

Effects of Square-Stepping Exercise on Motor and Cognitive Skills in Autism Spectrum Disorder Children and Adolescents: A Study Protocol.

Individuals with autism spectrum disorder (ASD) diagnoses present not only cognitive, emotional, communicative, and social challenges but also movement issues that affect their everyday activities, learning, and leisure. The use of the square-stepping exercise (SSE), a motor program initially created to strengthen the lower limbs of older adults, is spreading because of its advantages (e.g., balance and lower limb strength improvements). A study protocol to assess the SSE effects on motor, sensory, and cognitive skills in Spanish children and adolescents between 6 and 12 years old with ASD diagnoses is presented. A randomised clinical will be performed, recruiting 52 children and adolescents with ASD who will be distributed into two groups: an experimental (n = 26) and a control (n = 26) group. The SSE sessions will be held for 9 weeks (two times per week). The main variable will be balance, which will be measured with the Movement Assessment Battery for Children 2 (MABC2), and secondary outcomes will include sensory processing, attention, and executive functions. Assessments will be carried out before and at the end of the program implementation, including an additional follow up one month later. If this program obtains positive results, it should be implemented in different settings (schools, clinics, associations, etc.) to improve the quality of movement and development in children and adolescents with ASD, as it is an easy-to-use and structured tool.

Effects of square-stepping exercise on motor and cognitive function in older adults - A systematic review and meta-analysis.

OBJECTIVES: To document the effects of square-stepping exercise (SSE) on motor and cognitive function in older adults. METHODS: Five online databases were searched in May 2021. Controlled studies published from 2006 to May 2021 were included. The experimental group received SSE alone or SSE combined with other exercise(s), whereas the control group received no training or other exercise(s). Motor and cognitive outcomes included balance, fall risk, agility, endurance, gait speed, flexibility, muscle strength, reaction time, global cognitive function, memory, and executive function. RESULTS: Ten articles with a total of 920 participants were included. Static balance (p=0.0009), dynamic balance (p=0.0008), fall risk (p<0.00001), and agility (p=0.02) improved more in the intervention group than in the control group. However, SSE did not seem to exert beneficial effects on cognitive function. CONCLUSION: In older adults, SSE provided beneficial effects on motor function, including static and dynamic balance, risk of falls, and agility. However, positive effects on cognitive function were not observed and require further investigation.

Pedagogical Proposal of Tele-Exercise Based on "Square Stepping Exercise" in Preschoolers: Study Protocol.

Early childhood education aims to achieve the motor, cognitive, emotional, and social development of preschoolers by providing them with a variety of learning opportunities. The square-stepping exercise (SSE) is a balance and lower limb strength training programme used to prevent falls and stimulate cognitive function in older adults. This project aims to propose an SSE tele-exercise (Tele-SSE) protocol to evaluate its effects on the motor and cognitive development of children aged between 3 and 6 years. A randomized controlled trial with experimental (Tele-SSE) and control (general education) groups will be carried out. The application of Tele-SSE will be performed for 9 months (three times per week) and one additional follow-up after the intervention at the beginning of the next academic year. One-hundred and two preschoolers will be recruited and randomly distributed into the two groups: experimental (n = 51) and control (n = 51). Although the main outcome will be balance due to the nature of the SSE, outcomes will include physical and motor (body mass index, waist circumference, handgrip and lower-limb strength, speed-agility, and cardiorespiratory fitness) and cognitive (executive functions and attention, episodic memory, and language assessment, using the Fitness Assessment in the Preschool Battery (PREFIT) and The National Institutes of Health Toolbox-Early Childhood Cognition Battery. This project aims to improve cognitive and motor skills in preschoolers aged between 3 and 6 years old, based on a 9-month Tele-SSE intervention. If this intervention proves to be effective, it could be implemented in those centres, entities and associations specializing in early childhood education.

The exercise intensity of square-stepping exercise in community-dwelling late elderly females.

[Purpose] Square-stepping exercise is recommended for elderly people, as it has a positive effect on cognitive and physical functions; however, few studies have examined the exercise intensity of square-stepping exercise. Therefore, we aimed to examine the exercise intensity of square-stepping exercise in community-dwelling late elderly females. [Participants and Methods] Study 1: The participants, constituting 12 community-dwelling late elderly females (age: 78.7 ± 3.8 years), performed the three target step patterns. Exhaled gas, heart rate, and rating of perceived exertion using the Borg Scale were measured during square-stepping exercise. Study 2: Participants were 57 community-dwelling elderly females (81.2 ± 4.3 years old). The exercise intensity, heart rate, and rating of perceived exertion using the Borg Scale during square-stepping exercise were measured. [Results] Study 1: The average METs of the 3 target step patterns was 3.6 ± 0.7, and the %heart rate reserve and rating of perceived exertion were 54.3 ± 20.0% and 11.4 ± 1.9%, respectively. Study 2: The average METs during the square-stepping exercise program was 2.1 ± 0.2, and the %heart rate reserve and rating of perceived exertion were 19.6 ± 10.2% and 11.3 ± 1.4%, respectively. [Conclusion] Square-stepping exercise was confirmed to be a low to moderate intensity exercise program and is expected to improve health and physical fitness.

Cost-Effectiveness of "Tele-Square Step Exercise" for Falls Prevention in Fibromyalgia Patients: A Study Protocol.

BACKGROUND: Women with fibromyalgia (FM) have 2.5 falls per year compared to the 0.5 falls in people without FM. This fact poses a significant health expense. Square Stepping Exercise (SSE) is a balance training system that has been shown to be effective in preventing falls in the elderly. However, there are neither studies in people with FM nor studies that apply SSE through video-conferencing (Tele-SSE). The objectives of this project are 1) to investigate the applicability, safety, decrease in the number of falls, and incremental cost-effectiveness ratio of prevention of falls program through Tele-SSE in women with FM, and 2) to study the transfer of obtained results to the public and private socio-health economy of Extremadura. Methods/Design: A randomized controlled trial with experimental (Tele-SSE) and control (usual treatment) groups will be carried out. The application of Tele-SSE will be performed for 12 months (three times per week) and one additional follow-up month after the intervention. A focus group including agents to identify key points to transfer the findings to the public and private sectors in Extremadura. One-hundred and eighteen women with FM will be recruited and randomly distributed into the two groups: Experimental (Tele-SSE; n = 59) and control group (Usual care; n = 59). Primary outcome measures will be: 1) Applicability; 2) safety; 3) annual number of falls; and 4) incremental cost-effectiveness ratio. Secondary outcomes will be: 1) Balance; 2) fear of falling; 3) socio-demographic and clinical information; 4) body composition; 5) physical fitness; 6) physical activity and sedentary behavior; 7) quality of life-related to health, mental health, and positive health; 8) pain; 9) disability level; 10) cognitive aspects; and 11) depressive symptoms. Regarding the focus group, the acceptability of the Tele-SSE will be evaluated in social-sanitary agents and will include Tele-SSE in their services offer. A statistical analysis will be carried out by treatment intention and protocol. In addition, a cost-effectiveness analysis from the perspective of the health system will be performed. DISCUSSION: This project aims to improve the efficiency and equity of physical therapy services based on tele-exercise in preventing falls in people with FM. Furthermore, orientations will be given in order to transfer the obtained findings into the social-sanitary system and market.

Effects of the Square-Stepping Exercise program on physical fitness and cognitive function in elderly / 体力科学

The purpose of this study was to examine the effects of a six-month Square-Stepping Exercise (SSE) program on physical fitness and cognitive function in elderly and the effects of differences in cognitive function levels before the program on cognitive function. Twenty-four elderly (≧75 years old, mean age: 80.7±3.8 years) participated in the SSE program (once a week, 90 minutes/session, for six months). Grip strength, single leg balance with eyes open, chair stand, figure-8 walking test, and cognitive function (Five Cog) were measured before and after the program. Physical function did not improve during the SSE program. Significant memory and language improvements in Five Cog were observed. There was no significant interaction between the pre cognitive function level and the pre results. In conclusion, the six-month SSE program is an effective exercise for improving memory and language in cognitive function of elderly women and prevented physical function decline. However, there was no difference in the improvement due to the pre cognitive function level.

Innovative Exercise as an Intervention for Older Adults with Knee Osteoarthritis: A Pilot Feasibility Study.

ABSTRACTExercise has potential to mitigate morbidity in knee osteoarthritis (OA). Participants with knee OA were randomized to a Square-stepping Exercise (SSE) group (2x/week for 24 weeks) or a control group. We assessed the feasibility of SSE and its effectiveness on symptoms (WOMAC), balance (Fullerton), mobility, and walking speed at 12 and 24 weeks. The SSE group had a 49.3% attendance rate and trended toward improvement in the 30-second chair stand at 12 (F = 1.8, p = .12, ηp2 = 0.16), and 24 weeks, (F = 3.4, p = .09, ηp2 = 0.18), and walking speed at 24 weeks, compared to controls. There were no differences in symptoms or balance. The low attendance and recruitment demonstrated limited feasibility of SSE in adults with knee OA. Trends suggest the potential for SSE to improve lower extremity functional fitness and walking speed. SSE should be further studied for effectiveness on symptoms and balance, in addition to improving feasibility.

Effect of square stepping exercise for older adults to prevent fall and injury related to fall: systematic review and meta-analysis of current evidences.

Falls and fall related injuries become an emerging health problem among older adults. As a result a review of the recent evidences is needed to design a prevention strategy. The aim of this review was to determine the effect of square stepping exercise (SSE) for fall down injury among older adults compared with walking training or other exercises. An electronic database search for relevant randomized control trials published in English from 2005 to 2016 was conducted. Articles with outcome measures of functional reach, perceived health status, fear of fall were included. Quality of the included articles was rated using Physiotherapy Evidence Database (PEDro) scale and the pooled effect of SSE was obtained by Review Manager (RevMan5) software. Significant effect of SSE was detected over walking or no treatment to improve balance as well to prevent fear of fall and improve perceived health status. The results of this systematic review proposed that SSE significantly better than walking or no treatment to prevent fall, prevent fear of fall and improve perceived health status.

Effects of a Group Exercise Activity Managed by Elderly Volunteers on the Physical Function of Community-dwelling Older Women who Had Recently Completed an Exercise Program Led by Fitness Experts / 日本プライマリ・ケア連合学会誌

<p><b>Introduction: </b>The purpose of this study was to investigate the effects that a group exercise activity managed by elderly volunteers would have on the physical function of older women after they participated in a formal exercise program taught by fitness experts.</p><p><b>Methods: </b>Subjects were 47 community-dwelling older women who had completed a 3-month exercise program led by expert instructors in Kasama City, Ibaraki. After completing this exercise program, 28 subjects continued to participate in a group exercise activity led by elderly volunteers for approximately 11 months. The remaining 19 subjects did not join the group activities after the formal program. In both the initial, expert-led exercise program and the subsequent, volunteer-led group activity, subjects mainly engaged in the square-stepping exercise, which is a novel exercise for improving lower extremity physical function. In order to assess participants' physical function, we conducted five physical performance tests at both the baseline and follow-up; the former is the last day of the exercise program and the latter is approximately a year after the baseline.</p><p><b>Results: </b>Two-way ANOVA demonstrated a significant interaction in the timed up and go test (P=0.003). The performance of subjects who had participated in the volunteer-managed group activity improved between the baseline and follow-up tests (P=0.007).</p><p><b>Conclusion: </b>Participating in a group exercise activity managed by elderly volunteers can improve mobility skills of older women who had previously completed a formal exercise program led by expert instructors.</p>

Effects of square-stepping exercise on cognitive functions of older people.

AIM: Cognitive functions can decline with age, and interventions focusing on stimulating them may have positive results. Previous studies have shown that square-stepping exercise (SSE) has a good influence on balance, but this exercise also seems to promote cognitive stimulation. Therefore, the purpose of the present study was to analyse the effect of 16 weeks of SSE on cognitive functions in non-demented community-dwelling older people. METHODS: This was a longitudinal, non-randomized study. Forty-one older adults (60 years and older) were recruited, and 21 participated in the SSE group (practised only SSE sequences) and 20 were in the control group (continued with their activities of daily living). Both groups were evaluated using the Mini-Mental State Examination, the Digit Span test, the Toulouse-Pierón Attention Test and the Modified Card Sorting Test. RESULTS: The SSE group showed a significant improvement in global cognitive status, concentrated attention and mental flexibility after 16 weeks of the SSE intervention. CONCLUSION: Evidence shows that SSE is a physical activity that positively influences cognitive functions in non-demented older people.

Effects of static acceleration training with a whole-body vibration machine in community-dwelling older adults / 体力科学

The purpose of this study was to examine the effects of 9 weeks of resistance training, with and without static acceleration training (AT), on participants' lower-limb muscle strength, power, and physical function. Healthy participants (19 men and 28 women), aged 65-75 years, were assigned to a static AT group (AT, n = 31) or a non-AT control group (C, n = 16). The AT group and the C group trained three times/week for 9 weeks. The AT group performed unloaded static AT and low-intensity aerobic activity. The C group performed dynamic weight-bearing resistance training without whole-body vibration and the same aerobic activity as the AT group. We collected and analyzed data from 45 participants (AT = 30, C = 15) who completed pre- and post-tests. There was no significant Group × Time interaction on any measurements of lower-limb muscle strength, power, or physical function. Significant time effects were observed in the following tests:isokinetic knee extensor and flexor peak torque, 5-time sit-to-stand, usual gait speed, timed up and go, standing time from a long sitting position, and sit and reach. All of these 7 variables showed positive changes. These results suggest that static AT is a suitable training method having approximately the same efficiency as conventional, weight-bearing, dynamic resistance training for improving lower-limb muscle strength and power, mobility, and flexibility in community-dwelling Japanese older adults.