Ballard Joyce E, McFarland Carol, Wallace Lorraine Silver, Holiday David B, Roberson Glenda
University of Texas at Tyler, Department of Health and Kinesiology, USA.
J Am Med Womens Assoc (1972). 2004 Fall;59(4):255-61.
Risk of falling increases as people age, and decreased leg strength and poor balance have been implicated as contributors. Our aims were to:1) assess the efficacy of a fall-prevention exercise program on balance and leg strength in women aged 65 to 89 years and 2) conduct a 1-year follow-up to determine the effect of exercise on fall rates.
Forty women were classified by falling history and fear of falling and assigned to exercise and control groups using stratified randomization. We used the Berg Balance Scale, Get-up and Go, Functional Reach, and Wall-Sit Tests to evaluate changes in balance and leg strength before and after a supervised 15-week exercise program (31-hr sessions/week). We conducted 1-year follow-up telephone interviews and compared the number of falls reported by exercise and control groups.The study used a 2 x 2 (exercise/control by pretest/post-test) factorial design with the testing times being a repeated factor, so we used analysis of variance (ANOVA) to evaluate differences between the 2 groups across testing times. Power analysis computed a priori with STPLAN software (Version 4.2) showed that a sample size of 40 was necessary to determine statistical differences in balance and leg strength.
Exercise subjects showed significant improvement on 5 of 14 items (5.2%, p < or = 05 to 34.4%, p < or = .01) in the Berg Balance Scale and on the total score (6.8%, p < or = .05). Leg strength increased significantly (p < or = .05) on post-test as measured by the Wall-Sit Test. Control subjects reported 6 falls and exercise subjects no falls during the follow-up year, but this difference was not significant using Fischer's exact test (p=.106).
The exercise program resulted in increased balance and leg strength, but did not result in a significant difference in falls during the follow-up period. Further research with a larger and possibly older sample is needed to more adequately investigate this question. Health care providers who work with older women should provide exercise programs in which balance and leg strength are emphasized.
随着人们年龄增长，跌倒风险会增加，腿部力量下降和平衡能力差被认为是导致跌倒的因素。我们的目标是：1）评估一项预防跌倒锻炼计划对65至89岁女性平衡能力和腿部力量的效果；2）进行为期1年的随访，以确定锻炼对跌倒发生率的影响。
根据跌倒史和对跌倒的恐惧对40名女性进行分类，并采用分层随机化方法将她们分配到锻炼组和对照组。我们使用伯格平衡量表、起立行走测试、功能性伸展测试和靠墙静蹲测试来评估在为期15周的有监督锻炼计划（每周3 - 1小时课程）前后平衡能力和腿部力量的变化。我们进行了为期1年的随访电话访谈，并比较了锻炼组和对照组报告的跌倒次数。该研究采用2×2（锻炼/对照×前测/后测）析因设计，测试时间为重复因素，因此我们使用方差分析（ANOVA）来评估两组在不同测试时间的差异。使用STPLAN软件（版本4.2）进行的先验功效分析表明，需要40的样本量才能确定平衡能力和腿部力量的统计学差异。
锻炼组在伯格平衡量表的14项中的5项上有显著改善（5.2%，p≤0.05至34.4%，p≤0.01），总分也有显著改善（6.8%，p≤0.05）。根据靠墙静蹲测试，锻炼组在后测时腿部力量显著增加（p≤0.05）。在随访的一年中，对照组报告有6次跌倒，锻炼组无跌倒，但使用费舍尔精确检验，这种差异不显著（p = 0.106）。
该锻炼计划使平衡能力和腿部力量有所提高，但在随访期间跌倒次数没有显著差异。需要对更大且可能年龄更大的样本进行进一步研究，以更充分地调查这个问题。与老年女性打交道的医疗保健提供者应提供强调平衡能力和腿部力量的锻炼计划。
