Accepted Manuscript Comparative impacts of Tai Chi, balance training and a specially-designed yoga program on balance in older fallers Meng Ni , BS Kiersten Mooney , BS Luca Richards , BA Anoop Balachandran , MS Mingwei Sun , BA Kysha Harriell , PhD Melanie Potiaumpai , BS Joseph F. Signorile , PhD PII:
S0003-9993(14)00342-6
DOI:
10.1016/j.apmr.2014.04.022
Reference:
YAPMR 55827
To appear in:
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
Received Date: 10 December 2013 Revised Date:
14 April 2014
Accepted Date: 18 April 2014
Please cite this article as: Ni M, Mooney K, Richards L, Balachandran A, Sun M, Harriell K, Potiaumpai M, Signorile JF, Comparative impacts of Tai Chi, balance training and a specially-designed yoga program on balance in older fallers, ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION (2014), doi: 10.1016/j.apmr.2014.04.022. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Running title: Balance training for older fallers Title: Comparative impacts of Tai Chi, balance training and a specially-designed yoga program on balance in older fallers
RI PT
Authors/Institutions: Meng Ni, BS (1) Kiersten Mooney, BS (2)
SC
Luca Richards, BA (2) Anoop Balachandran, MS (1)
M AN U
Mingwei Sun, BA (1) Kysha Harriell, PhD (1) Melanie Potiaumpai, BS (1) Joseph F. Signorile, PhD (1,3)
of Miami, Coral Gables, FL
TE D
(1) University of Miami, Laboratory of Neuromuscular Research and Active Aging, University
(2) BalaVinyasa Yoga, Naples, FL
EP
(3) Miller School of Medicine, Center on Aging, University of Miami, Miami, FL Corresponding author and address for reprints:
AC C
Joseph F. Signorile, PhD
University of Miami, Department of Kinesiology and Sport Sciences 1507 Levante Ave, Rm MO114, Coral Gables, FL 33146 Phone: 305-284-3105 Fax: 305-284-4183 Email: [email protected]
ACCEPTED MANUSCRIPT Balance training for older fallers 1 2 3
Abstract Objective: To compare the effect of a custom-designed yoga program with two other balance training programs. Design: Randomized controlled trial.
5
Setting: University neuromuscular research laboratory, Miami, US.
6
Participants: A group of 39 older adults (74.15 ± 6.99 years) with a history of falling.
7
Interventions: Three different exercise interventions, Tai Chi, standard balance training (SBEP) or yoga (BYOGA) were given for 12 weeks.
SC
8
RI PT
4
Main Outcome Measures: Balance performance was examined during pretest and
10
post-test using field tests including the 8-Foot Up & Go, One-Leg Stance, Functional Reach,
11
usual and maximal walking speed. The static and dynamic balance was also assessed by
12
postural sway and dynamic posturography, respectively.
13
M AN U
9
Results. Training produced significant improvements in all field tests (p < .005), but no group difference or time x group interaction were detected. For postural sway, significant
15
decreases in the area of center of pressure with eyes open (p = .001) and closed (p = .002)
16
were detected after training. For eyes open, maximums medial-lateral velocity significantly
17
decreased for the sample (p = .013). For eyes closed, medial-lateral displacement decreased
18
for Tai Chi (p < .01). For dynamic posturography, significant improvements in overall score
19
(p = .001), Time on the test (p = .006) and two linear measures in lateral (p = .001) and
20
anterior/posterior (p < .001) direction were seen for the sample.
EP
AC C
21
TE D
14
Conclusions. BYOGA was as effective as Tai Chi and SBEP for improving postural
22
stability and may offer an alternative to more traditional programs.
23
Key words: Training, Balance, Fall, Exercise
24 25
1
ACCEPTED MANUSCRIPT Balance training for older fallers
2
Introduction
27
Falls are the leading cause of death from injury in older individuals; while non-injurious falls
28
often result in inactivity and functional dependence.1 One-third of persons over 65 experience
29
one or more falls annually.2 Additionally, fall probability increases four percent per year.3
30
Lack of physical activity, reduced muscle strength and power, and low postural stability, are
31
all strongly correlated with increased fall risk.4
RI PT
26
Exercise interventions targeting postural stability, attenuate fall incidence,5 improve
33
walking speed,6 increase ADL function,7 and reduce fear of falling.8 Tai Chi is widely used to
34
improve older persons’ balance and reduce fall risks9 through improved strength, flexibility,
35
kinesthetic awareness and coordination.
M AN U
36
SC
32
Yoga integrates physical, mental, emotional, and spiritual dimensions to promote health. Several studies have reported that yoga increases muscle strength, power, endurance,
38
flexibility,10 and balance and coordination11 in younger persons; however, there are a limited
39
number of controlled studies demonstrating its capacity to improve balance in older persons.
40
A study providing Kripalu yoga training to eight women reported positive impacts on gait
41
speed and postural control.12 A second study, used Iyengar Hatha yoga targeting older persons’
42
lower-body strength and flexibility, increased peak hip extension strength and stride length.13
43
Another study with independent-living elders, indicated a 12-week yoga program
44
significantly increased static balance and lower body flexibility, but not fear of falling.14
45
Finally, Tatum et al15 showed that therapeutic yoga could improve standing balance, lower
46
body strength, and floor transfer capacity of older persons.
AC C
EP
TE D
37
47
The purpose of this study was to compare the effect of our specially designed yoga
48
program (BYOGA) on balance and postural control in older fallers, to those produced by a
49
Tai Chi program and a standard balance exercise program (SBEP). We hypothesized BYOGA
50
would significantly improve static and dynamic balance and gait speed across 12 training
ACCEPTED MANUSCRIPT Balance training for older fallers 51
3
weeks, and these improvements would be greater than those resulting from Tai Chi or SBEP.
52
Methods
54
Participants
55
RI PT
53
Forty-eight healthy older persons participated in the study. To be included the individual must be 60 years of age or older, living independently, require no assistance in performing
57
ADL, and have fallen at least once in the past year. Individuals with neurological impairment
58
affecting balance, severe musculoskeletal impairment, unstable chronic disease state,
59
significant visual or vestibular impairment, uncontrolled hypertension, simultaneous use of
60
cardiovascular, psychotropic, and antidepressant drugs, and Mini Mental Status score
S0003-9993(14)00342-6
DOI:
10.1016/j.apmr.2014.04.022
Reference:
YAPMR 55827
To appear in:
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION
Received Date: 10 December 2013 Revised Date:
14 April 2014
Accepted Date: 18 April 2014
Please cite this article as: Ni M, Mooney K, Richards L, Balachandran A, Sun M, Harriell K, Potiaumpai M, Signorile JF, Comparative impacts of Tai Chi, balance training and a specially-designed yoga program on balance in older fallers, ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION (2014), doi: 10.1016/j.apmr.2014.04.022. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Running title: Balance training for older fallers Title: Comparative impacts of Tai Chi, balance training and a specially-designed yoga program on balance in older fallers
RI PT
Authors/Institutions: Meng Ni, BS (1) Kiersten Mooney, BS (2)
SC
Luca Richards, BA (2) Anoop Balachandran, MS (1)
M AN U
Mingwei Sun, BA (1) Kysha Harriell, PhD (1) Melanie Potiaumpai, BS (1) Joseph F. Signorile, PhD (1,3)
of Miami, Coral Gables, FL
TE D
(1) University of Miami, Laboratory of Neuromuscular Research and Active Aging, University
(2) BalaVinyasa Yoga, Naples, FL
EP
(3) Miller School of Medicine, Center on Aging, University of Miami, Miami, FL Corresponding author and address for reprints:
AC C
Joseph F. Signorile, PhD
University of Miami, Department of Kinesiology and Sport Sciences 1507 Levante Ave, Rm MO114, Coral Gables, FL 33146 Phone: 305-284-3105 Fax: 305-284-4183 Email: [email protected]
ACCEPTED MANUSCRIPT Balance training for older fallers 1 2 3
Abstract Objective: To compare the effect of a custom-designed yoga program with two other balance training programs. Design: Randomized controlled trial.
5
Setting: University neuromuscular research laboratory, Miami, US.
6
Participants: A group of 39 older adults (74.15 ± 6.99 years) with a history of falling.
7
Interventions: Three different exercise interventions, Tai Chi, standard balance training (SBEP) or yoga (BYOGA) were given for 12 weeks.
SC
8
RI PT
4
Main Outcome Measures: Balance performance was examined during pretest and
10
post-test using field tests including the 8-Foot Up & Go, One-Leg Stance, Functional Reach,
11
usual and maximal walking speed. The static and dynamic balance was also assessed by
12
postural sway and dynamic posturography, respectively.
13
M AN U
9
Results. Training produced significant improvements in all field tests (p < .005), but no group difference or time x group interaction were detected. For postural sway, significant
15
decreases in the area of center of pressure with eyes open (p = .001) and closed (p = .002)
16
were detected after training. For eyes open, maximums medial-lateral velocity significantly
17
decreased for the sample (p = .013). For eyes closed, medial-lateral displacement decreased
18
for Tai Chi (p < .01). For dynamic posturography, significant improvements in overall score
19
(p = .001), Time on the test (p = .006) and two linear measures in lateral (p = .001) and
20
anterior/posterior (p < .001) direction were seen for the sample.
EP
AC C
21
TE D
14
Conclusions. BYOGA was as effective as Tai Chi and SBEP for improving postural
22
stability and may offer an alternative to more traditional programs.
23
Key words: Training, Balance, Fall, Exercise
24 25
1
ACCEPTED MANUSCRIPT Balance training for older fallers
2
Introduction
27
Falls are the leading cause of death from injury in older individuals; while non-injurious falls
28
often result in inactivity and functional dependence.1 One-third of persons over 65 experience
29
one or more falls annually.2 Additionally, fall probability increases four percent per year.3
30
Lack of physical activity, reduced muscle strength and power, and low postural stability, are
31
all strongly correlated with increased fall risk.4
RI PT
26
Exercise interventions targeting postural stability, attenuate fall incidence,5 improve
33
walking speed,6 increase ADL function,7 and reduce fear of falling.8 Tai Chi is widely used to
34
improve older persons’ balance and reduce fall risks9 through improved strength, flexibility,
35
kinesthetic awareness and coordination.
M AN U
36
SC
32
Yoga integrates physical, mental, emotional, and spiritual dimensions to promote health. Several studies have reported that yoga increases muscle strength, power, endurance,
38
flexibility,10 and balance and coordination11 in younger persons; however, there are a limited
39
number of controlled studies demonstrating its capacity to improve balance in older persons.
40
A study providing Kripalu yoga training to eight women reported positive impacts on gait
41
speed and postural control.12 A second study, used Iyengar Hatha yoga targeting older persons’
42
lower-body strength and flexibility, increased peak hip extension strength and stride length.13
43
Another study with independent-living elders, indicated a 12-week yoga program
44
significantly increased static balance and lower body flexibility, but not fear of falling.14
45
Finally, Tatum et al15 showed that therapeutic yoga could improve standing balance, lower
46
body strength, and floor transfer capacity of older persons.
AC C
EP
TE D
37
47
The purpose of this study was to compare the effect of our specially designed yoga
48
program (BYOGA) on balance and postural control in older fallers, to those produced by a
49
Tai Chi program and a standard balance exercise program (SBEP). We hypothesized BYOGA
50
would significantly improve static and dynamic balance and gait speed across 12 training
ACCEPTED MANUSCRIPT Balance training for older fallers 51
3
weeks, and these improvements would be greater than those resulting from Tai Chi or SBEP.
52
Methods
54
Participants
55
RI PT
53
Forty-eight healthy older persons participated in the study. To be included the individual must be 60 years of age or older, living independently, require no assistance in performing
57
ADL, and have fallen at least once in the past year. Individuals with neurological impairment
58
affecting balance, severe musculoskeletal impairment, unstable chronic disease state,
59
significant visual or vestibular impairment, uncontrolled hypertension, simultaneous use of
60
cardiovascular, psychotropic, and antidepressant drugs, and Mini Mental Status score
