Effects of a progressive exercise program for static and dynamic stability of elderly people: a clinical trial

Abstract

Introduction: Several studies have demonstrated the importance of balance training and resistance training for improving postural stability and muscle strength, aiming to reduce the risk of falls and improve functionality in the elderly population. However, little is discussed about the use of progressions in the level of difficulty when performing balance exercises throughout the programs. This approach is advantageous because it offers continuous stimulation, avoiding stagnation, and helps physiotherapists to offer appropriate challenges to their patients. This can boost motivation and adherence, optimizing clinical effectiveness. Objective: To investigate the effectiveness of the systematic progression of stability demands, during a program of static and dynamic balance and muscle strengthening exercises, in improving the body stability of independent elderly people; and report patients' subjective perceptions about the program. Methods: Controlled and randomized clinical trial. Nineteen elderly people were assigned to one of two groups: intervention (N = 9) and control (N = 10). The intervention group (IG) participated in an exercise program for static and dynamic stability with systematic progression of difficulties (dual-task, resistance and modification of sensory inputs) and exercises for muscle strengthening of the lower limbs. The control group (CG) performed the same exercise program, except for the difficulty progressions. The program lasted 12 weeks, with two 1-hour sessions per week. Individuals were evaluated before and after the program, using the following instruments: Timed up and Go Test (TUG), Four Stage Balance Test (4stage), Berg Balance Scale (BBS) and modified Dynamic Gait Index (mDGI). A two-way ANOVA including group (IG vs. CG) and moment (before vs. after treatment) was used to analyze the results of BBE, mDGI and TUG. Fisher's exact test was used to analyze the results of the 4Stage test. At the end of the intervention, in order to obtain the participants' subjective perception regarding the treatment, a qualitative study was carried out through an individualized semi-structured interview. The analysis of the responses was carried out using the “Framework Approach” method, which consists of removing excerpts from the patients' statements (codes), grouping the codes into categories, and finally choosing themes that faithfully represent the perceptions and ideas of the interviewees. Results: After the intervention, there was a significant increase in performance on the BSS (P<0.001) and mDGI (P=0.001), with no group or interaction effect (P>0.263). There was an improvement in the performance of the 4Stage test for 5 (50%) individuals in the CG and for 4 (44%) individuals in the IG, with no statistical differences between the groups (P=0.344). The themes that emerged from the interviews were: satisfactory experience; health benefits; reception and bonding; commitment, motivation and persistence; perception of challenge; continuity; challenges to staying in the program and performance difficulties. Conclusion: The proposed exercise program promoted improvements in functional performance and the risk of falls, although difficulty progression strategies do not seem to increase the effect of the program. The program was satisfactory for the participants, and they reported improvements in several aspects of their health, cited some obstacles to remaining in the program and performing the exercises, in addition to expressing the desire to continue practicing physical exercises.