静态骑行过程中基于反馈的扰动平衡训练可改善老年人的反应性和主动性平衡：一项单盲随机对照试验。

Feedback-based perturbation balance training during stationary cycling improves reactive and proactive balance among older adults: a single-blinded randomised controlled trial.

作者信息

Batcir Shani, Livne Koby, Lehman Rotem Lev, Berdichevsky Yuliya, Maoz Sarel, Shkedy Lilach Wolf, Adar Rafi, Rabaev Elena, Bachner Yaacov G, Shani Guy, Lubovsky Omri, Shapiro Amir, Alexander Neil B, Melzer Itshak

机构信息

Physical Therapy Département, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.

Department of Physical Therapy, Faculty of Social Welfare & Health Studies, University of Haifa, Haifa, Israel.

出版信息

Age Ageing. 2025 Aug 1;54(8). doi: 10.1093/ageing/afaf215.

DOI:10.1093/ageing/afaf215

PMID:40794910

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12341863/

Abstract

BACKGROUND

Perturbation balance training (PBT) is an effective regime that reduces fall rates by triggering and improving balance recovery skills. Controlling trunk movements consistently reflects effective reactive stepping, as it enhances proximal stability, providing a stable base for limb movements.

OBJECTIVE

To demonstrate the effect of PBT during seated hands-free stationery cycling on objective balance parameters of reactive and proactive balance control in standing.

DESIGN

Two-arm parallel-group, single-blinded randomised controlled trial with concealed allocation, blinded assessors and data analysers, with intention-to-treat analyses.

PARTICIPANTS

Fifty-six community-dwelling older adults, 70+ years of age (mean ± standard deviation: 76.43 ± 4.76 years, 39.3% of men and 60.7% of women), walking independently without assistive devices.

INTERVENTIONS

The two groups performed twenty sessions of seated stationary cycling, 20 minutes each, over 12 weeks, while performing concurrent cognitive tasks: (i) cycling hands free, received perturbations with real-time implicit sensorimotor feedback (PBT during hands-free stationary cycling, n = 29); (ii) standard cycling training (SCT, n = 27) cycled using hands without perturbations.

OUTCOME MEASURES

The primary outcome measures were the reactive balance measures in standing, e.g. single-step threshold, multiple-step threshold and the probability of stepping. Secondary outcomes were voluntary stepping Test and 6-Minute Walk Test (6MWT). Measures were taken at baseline and immediately postinterventions.

RESULTS

The group-by-time interactions indicate that PBT during hands-free stationary cycling improved balance reactive responses i.e. increased single- and multiple-step thresholds in mediolateral perturbations (P = .001, effect size [ES] = 0.88, and P = .001, ES = 0.64, respectively) and multiple-step threshold in anteroposterior perturbations (P = .022, ES = 0.34) and decreased the probability of stepping compared to standard cycling training. PBT during hands-free stationary cycling also resulted in faster voluntary step reaction (P = .011, ES = -0.84) and foot contact times (P = .037, ES = -0.56). Both groups significantly improved their 6MWT results.

CONCLUSION

Feedback-based PBT during hands-free stationary cycling has the potential to improve reactive and proactive balance measures in standing.

REGISTRATION

clinicaltrials.gov, NCT03636672, https://clinicaltrials.gov/study/NCT03636672.

摘要

背景

扰动平衡训练（PBT）是一种有效的训练方法，通过触发和提高平衡恢复技能来降低跌倒率。持续控制躯干运动能够有效反映出有效的反应性跨步，因为它增强了近端稳定性，为肢体运动提供了稳定的基础。

目的

证明在无手扶固定自行车骑行过程中进行PBT对站立时反应性和主动性平衡控制的客观平衡参数的影响。

设计

双臂平行组单盲随机对照试验，采用隐蔽分配、盲法评估和数据分析，进行意向性分析。

参与者

56名社区居住的老年人，年龄70岁以上（平均±标准差：76.43±4.76岁，男性占39.3%，女性占60.7%），无需辅助设备即可独立行走。

干预措施

两组在12周内进行20次坐姿固定自行车骑行，每次20分钟，同时进行并发认知任务：（i）无手扶骑行，接受实时隐式感觉运动反馈的扰动（无手扶固定自行车骑行时的PBT，n = 29）；（ii）标准骑行训练（SCT，n = 27），有手扶骑行且无扰动。

结局指标

主要结局指标为站立时的反应性平衡指标，如单步阈值、多步阈值和跨步概率。次要结局指标为自愿跨步测试和6分钟步行测试（6MWT）。在基线和干预后立即进行测量。

结果

组间时间交互作用表明，无手扶固定自行车骑行时的PBT改善了平衡反应，即增加了内外侧扰动的单步和多步阈值（分别为P = 0.001，效应量[ES] = 0.88；P = 0.001，ES = 0.64）以及前后扰动的多步阈值（P = 0.022，ES = 0.34），与标准骑行训练相比，跨步概率降低。无手扶固定自行车骑行时的PBT还导致自愿跨步反应更快（P = 0.011，ES = -0.84）和足部接触时间缩短（P = 0.037，ES = -0.56）。两组的6MWT结果均有显著改善。