Improving Balance and Mobility in Older Veterans
| Status: | Not yet recruiting |
|---|---|
| Healthy: | No |
| Age Range: | 65 - Any |
| Updated: | 4/2/2016 |
| Start Date: | January 2015 |
| End Date: | December 2018 |
| Contact: | Gregory Steinbrenner, MS |
| Email: | Gregory.Steinbrenner@va.gov |
| Phone: | 4106057000 |
Falls are dangerous leading to injuries and even death. The VA has made fall prevention a
priority but effective programs only reduce falls by 30%. Tai Chi, a standing exercise
program, has been effective at improving balance but may not prevent falls. Most falls occur
during walking when an individual experiences a slip or a trip. Programs that focus on
walking, stepping, and recovery from a slip may be more effective at fall reduction. This
study will compare Tai Chi to the investigators new multimodal balance intervention (MMBI).
MMBI focuses on standing balance, walking, stepping, strength training, and recovery from a
slip. A multimodal program will most likely be more effective than Tai Chi at improving
balance and preventing falls in older Veterans and the investigators will use the results of
this study to develop a larger study on fall prevention in older Veterans.
priority but effective programs only reduce falls by 30%. Tai Chi, a standing exercise
program, has been effective at improving balance but may not prevent falls. Most falls occur
during walking when an individual experiences a slip or a trip. Programs that focus on
walking, stepping, and recovery from a slip may be more effective at fall reduction. This
study will compare Tai Chi to the investigators new multimodal balance intervention (MMBI).
MMBI focuses on standing balance, walking, stepping, strength training, and recovery from a
slip. A multimodal program will most likely be more effective than Tai Chi at improving
balance and preventing falls in older Veterans and the investigators will use the results of
this study to develop a larger study on fall prevention in older Veterans.
Background: Falls are currently the leading cause of injurious death and non-fatal injuries
for adults over the age of 65. Older veterans may be at greater risk for falls due to their
high burden of medical co-morbidity. The VA has made research into fall prevention a high
priority. Falls are complex with numerous deficits including impaired balance, decreased
postural control, muscle weakness, and an inability to successfully negotiate environmental
hazards contributing. Tai Chi is currently considered to be one of the most effective fall
prevention exercise interventions, with an endorsement from the CDC that widely influences
health care policy. However, there are few studies comparing Tai Chi with another active
intervention. Tai Chi may generally improve balance, decrease fall risk, and provides a
general lower body strengthening however Tai Chi may not sufficiently improve gait and
dynamic mobility and does little to target obstacle negotiation, one of the largest
contributors to a fall. The majority of falls occur during walking, with slips and trips
being the most common causes and targeted interventions focused on improving stepping and
walking ability may be even more effective at improving balance and reducing falls.
The investigators plan to enroll 56 older (age > 65 years) community dwelling veterans with
a history of a fall in the last year who are at high risk for a recurrent fall. After
baseline testing Individuals will be randomized to either MMBI or a Tai Chi intervention
modeled after the Tai Chi Moving for Better Balance Program. All participants will
participate in a group exercise class in their assigned intervention for 1 hour, 3 times per
week for 24 weeks. After the completion of 24 weeks of exercise group changes will be
compared for 1) balance (4-square step test), 2) mobility and fall risk (functional gait
assessment, clinical gait assessment and gait variability on a GAITrite), 4) questionnaires
(falls efficacy and ABC) 5) lower extremity isometric strength testing (biodex), 6) a whole
body DXA and CT scan of the abdomen, hips and thighs for determination of lower extremity
and core muscle composition. The investigators also plan for follow all participants for 6
months after completion of the intervention to examine differences in fall rates after the
cessation of the program between the groups.
Impact: This research directly benefits veterans as it may lead to new and effective
interventions that could reduce fall risk, injury-related hospitalization and death in older
veterans. MMBI is also readily exportable to the community and with minimal resources could
be widely implemented at other VAs as part of standard of care, similar to MOVE!. Results
from this SPIRE grant will be used to power a larger randomized clinical trial that will
examine the effectiveness of the two interventions to reduce rate of falls and risk of
falling in older veterans at high risk for falls.
for adults over the age of 65. Older veterans may be at greater risk for falls due to their
high burden of medical co-morbidity. The VA has made research into fall prevention a high
priority. Falls are complex with numerous deficits including impaired balance, decreased
postural control, muscle weakness, and an inability to successfully negotiate environmental
hazards contributing. Tai Chi is currently considered to be one of the most effective fall
prevention exercise interventions, with an endorsement from the CDC that widely influences
health care policy. However, there are few studies comparing Tai Chi with another active
intervention. Tai Chi may generally improve balance, decrease fall risk, and provides a
general lower body strengthening however Tai Chi may not sufficiently improve gait and
dynamic mobility and does little to target obstacle negotiation, one of the largest
contributors to a fall. The majority of falls occur during walking, with slips and trips
being the most common causes and targeted interventions focused on improving stepping and
walking ability may be even more effective at improving balance and reducing falls.
The investigators plan to enroll 56 older (age > 65 years) community dwelling veterans with
a history of a fall in the last year who are at high risk for a recurrent fall. After
baseline testing Individuals will be randomized to either MMBI or a Tai Chi intervention
modeled after the Tai Chi Moving for Better Balance Program. All participants will
participate in a group exercise class in their assigned intervention for 1 hour, 3 times per
week for 24 weeks. After the completion of 24 weeks of exercise group changes will be
compared for 1) balance (4-square step test), 2) mobility and fall risk (functional gait
assessment, clinical gait assessment and gait variability on a GAITrite), 4) questionnaires
(falls efficacy and ABC) 5) lower extremity isometric strength testing (biodex), 6) a whole
body DXA and CT scan of the abdomen, hips and thighs for determination of lower extremity
and core muscle composition. The investigators also plan for follow all participants for 6
months after completion of the intervention to examine differences in fall rates after the
cessation of the program between the groups.
Impact: This research directly benefits veterans as it may lead to new and effective
interventions that could reduce fall risk, injury-related hospitalization and death in older
veterans. MMBI is also readily exportable to the community and with minimal resources could
be widely implemented at other VAs as part of standard of care, similar to MOVE!. Results
from this SPIRE grant will be used to power a larger randomized clinical trial that will
examine the effectiveness of the two interventions to reduce rate of falls and risk of
falling in older veterans at high risk for falls.
Inclusion Criteria:
- Veterans
- 65 years of age and older
- History of fall in past year or fear of falling
- Balance dysfunction as indexed by four square step test (FSST) >10 sec
Exclusion Criteria:
- Poorly controlled hypertension (>160/100); Coronary event in past 6 months; Class III
or IV CHF; symptomatic angina at rest or during exercise; Syncope in past year,
without known resolution of cause;
- COPD requiring home oxygen Contraindications to resistance training, including:
history of intracranial or retinal bleeding; Diabetes with active proliferative
retinopathy
- History of significant spinal osteoarthritis or spinal stenosis.
- Dementia (on medical record review or mini-mental status exam score <24).
- Conditions limiting response to strength or balance training, such as :severe
vestibular disorders, prior stroke with residual weakness or other progressive
neurologic disorders (e.g. Parkinson's disease, myasthenia gravis);Non-ambulatory;
Prosthetic joint in prior year; transtibial or above the knee amputation
- Other severe medical illness, examples include: chemotherapy or radiation therapy for
active cancer; diabetes with HgbA1c > 10; chronic wounds on legs; thrombocytopenia;
peripheral vascular disease with claudication limiting the ability to walk; anemia
with HCT <30%.
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