Dos Santos Marcos Paulo Gonçalves, Lemos Thiago, da Silva Débora Cristina Lima, Martins Camilla Polonini, Martins José Vicente Pereira, de Oliveira Laura Alice Santos
Graduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta UNISUAM, Rio de Janeiro, Brazil.
Graduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta UNISUAM, Rio de Janeiro, Brazil; Instituto Nacional de Traumatologia e Ortopedia-INTO, Rio de Janeiro, Brazil.
Braz J Phys Ther. 2025 May-Jun;29(3):101207. doi: 10.1016/j.bjpt.2025.101207. Epub 2025 Apr 16.
Little is discussed about the effectiveness and systematization of progressions of difficulty during balance exercises. Exercise progression provides continuous stimulation and assists physical therapists in offering challenges to patients.
To investigate the effectiveness of an exercise program with systematic progression of difficulty for older individuals.
Randomized clinical trial, with 22 older individuals allocated to experimental (EG, N = 12) or control (CG, N = 10) group. In EG, individuals performed an exercise program with progressions of difficulty for 12-weeks (2 days/week, 1 h/session). In the control group the participants performed the same program without progressions of difficulty. The Berg Balance Scale (BBS), Timed up and Go (TUG), and modified Dynamic Gait Index (mDGI) were assessed after and before the 24 exercise sessions. An intention-to-treat approach and multiple imputation by chained equations were utilized. Raw data were transformed into standardized individual differences (SID) and analyzed using one-way ANCOVA to test group effects, with baseline and age as covariates. A one-sample t-test was used to compare SIDs against zero. Effect sizes were estimated using partial eta squared (ηp²) and Cohen's d.
ANCOVA revealed no significant group effect across any of the variables. Baseline values emerged as significant predictor of changes in BBS (P = 0.038, η²=0.219), TUG (P = 0.042, η²=0.210), and mDGI (P < 0.001, η²=0.545), suggesting a substantial differences among participants with lower baseline values. Age also emerged as a significant predictor of change for mDGI (P = 0.002, η²=0.431). Comparison with zero-value produced significant differences for BBS and mDGI, indicating increases in post-intervention for both groups.
Applying progressions of difficulty to the exercises, did not lead to greater improvements than not applying them. CLINICAL TRIAS: https://ensaiosclinicos.gov.br/rg/RBR-8dpxgcf.
关于平衡训练中难度进阶的有效性和系统性讨论较少。训练进阶可提供持续刺激，并帮助物理治疗师向患者提出挑战。
研究一项具有系统性难度进阶的训练计划对老年人的有效性。
随机临床试验，将22名老年人分配至实验组（EG，N = 12）或对照组（CG，N = 10）。在实验组中，个体进行一项具有难度进阶的训练计划，为期12周（每周2天，每次训练1小时）。在对照组中，参与者进行相同的训练计划，但没有难度进阶。在24次训练前后评估伯格平衡量表（BBS）、计时起立行走测试（TUG）和改良动态步态指数（mDGI）。采用意向性分析方法和链式方程多重填补法。将原始数据转换为标准化个体差异（SID），并使用单因素协方差分析来测试组间效应，将基线和年龄作为协变量。使用单样本t检验将SID与零进行比较。效应量使用偏 eta 平方（ηp²）和科恩d值进行估计。
协方差分析显示，在任何变量上均未发现显著的组间效应。基线值是BBS（P = 0.038，η²=0.219）、TUG（P = 0.042，η²=0.210）和mDGI（P < 0.001，η²=0.545）变化的显著预测因子，表明基线值较低的参与者之间存在显著差异。年龄也是mDGI变化的显著预测因子（P = 0.002，η²=0.431）。与零值比较，BBS和mDGI产生了显著差异，表明两组干预后均有所增加。
对训练应用难度进阶，并未比不应用难度进阶带来更大的改善。临床试验：https://ensaiosclinicos.gov.br/rg/RBR-8dpxgcf。
