Main Article Content
Abstract
Background: Fall risks among middle-aged women are relatively high. However, there is a lack of studies on tools of balance tests and their accuracy among middle-aged women.
Objective: The aim of this study is to compare three tools of balance tests to predict falls of middle-aged women who exercise regularly and who do not.
Methods: Eighty-five middle-aged women (50-64 years old) were included in this study, and 40 women of them (47.1%) exercised regularly. The Berg Balance Scale (BBS), Timed Up and Go Test (TUG), and 30-second Chair Stand Test (30-s CST) were the tools examined in this study. The numerical data of this study were analyzed by using a Mann-Whitney test. Those were significant if p<0.05. Accuracy of the tools of balance tests was evaluated by using Receiver Operating Characteristic (ROC) curve. Area under the curve (AUC) was significant if =0.70.
Results: Based on this study, the middle-aged women (EG) indicated lower score of TU than sedentary (SG) test (6.9 ± 0.9 vs 8.3 ± 1.7, p = <0.000), and higher score of 30-s than sedentary (SG) test (20.1 ± 3.6 vs 17.2 ± 5.6, p = 0.026). Three participants (3.53%) reported history of falls. The TUG test had better accuracy to predict the falls (AUC 0.922, 95% CI 0.840 - 1.005, sensitivity 1.00, specificity 0.84, p=0.013). Mostly, the participants (˜70%) preferred to practice Tai Chi and Yoga.
Conclusion: The middle-aged women who exercised could have a better score of the balance tests, and the TUG test could predict falls of them.
Keywords
Article Details
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References
- Yoshida S. A Global Report on Falls Prevention Epidemiology of Falls. WHO report. 2012.
- Talbot LA, Musiol RJ, Witham EK, Metter EJ. Falls in young, middle-aged and older community dwelling adults: Perceived cause, environmental factors and injury. BMC Public Health. 2005;5:1–9.
- Timsina LR, Willetts JL, Brennan MJ, Marucci-Wellman H, Lombardi DA, Courtney TK, et al. Circumstances of fall-related injuries by age and gender among community-dwelling adults in the United States. PLoS One. 2017;12(5):1–21.
- Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: A review of the literature. Maturitas. 2013;75(1):51–61.
- Dhargave P, Sendhilkumar R. Prevalence of risk factors for falls among elderly people living in long-term care homes. Journal of Clinical Gerontology and Geriatrics. 2016;7(3):99–103.
- Brown RT, Diaz-Ramirez LG, Boscardin WJ, Lee SJ, Steinman MA. Functional Impairment and Decline in Middle Age: A Cohort Study. Annals of internal medicine. 2017;167(11):761–8.
- Akbari M, Mousavikhatir R. Changes in the muscle strength and functional performance of healthy women with aging. Medical Journal of the Islamic Republic of Iran. 2012;26(3):125–31.
- Caban-Martinez AJ, Courtney TK, Chang WR, Lombardi DA, Huang YH, Brennan MJ, et al. Leisure-Time Physical Activity, Falls, and Fall Injuries in Middle-Aged Adults. American Journal of Preventive Medicine. 2015;49(6):888–901.
- Takano E, Teranishi T, Watanabe T, Ohno K, Kitaji S, Sawa S, et al. Differences in the effect of exercise interventions between prefrail older adults and older adults without frailty: A pilot study. Geriatrics and Gerontology International. 2017;17(9):1265–9.
- Liu CJ, Changa WP, De Carvalho IA, Savagea KEL, Radforda LW, Thiyagarajan JA. Effects of physical exercise in older adults with reduced physical capacity: Meta-analysis of resistance exercise and multimodal exercise. International Journal of Rehabilitation Research. 2017;40(4):303–14.
- Campbell AJ, Spears GF, Borrie MJ. Examination by logistic regression modelling of the variables which increase the relative risk of elderly women falling compared to elderly men. Journal of Clinical Epidemiology. 1990;43(12):1415–20.
- Cheng SJ, Yang YR, Cheng FY, Chen IH, Wang RY. The changes of muscle strength and functional activities during aging in male and female populations. International Journal of Gerontology. 2014;8(4):197–202.
- Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: A systematic review and meta- analysis. BMC Geriatrics. 2014;14(1):1–14.
- Macfarlane DJ, Chou KL, Cheng YH, Chi I. Validity and normative data for thirty-second chair stand test in elderly community-dwelling Hong Kong Chinese. American journal of human biology : the official journal of the Human Biology Council. 2006;18(3):418–21.
- Park SH, Lee YS. The Diagnostic Accuracy of the Berg Balance Scale in Predicting Falls. Western Journal of Nursing Research. 2017;39(11):1502–25.
- Rubenstein LZ, Robbins AS, Josephson KR, Schulman BL, Osterweil D. The value of assessing falls in an elderly population. A randomized clinical trial. Annals of Internal Medicine. 1990;113(4):308–16.
- Hayes KW, Johnson ME. Measures of adult general performance tests: The Berg Balance Scale, Dynamic Gait Index (DGI), Gait Velocity, Physical Performance Test (PPT), Timed Chair Stand Test, Timed Up and Go, and Tinetti Performance-Oriented Mobility Assessment (POMA). Arthritis & Rheumatism. 2003;49(S5):S28–42.
- Kear BM, Guck TP, McGaha AL. Timed Up and Go (TUG) Test. Journal of Primary Care & Community Health. 2017 Jan 25;8(1):9–13.
- Jones J, Rikli RE. Measuring functional. In: The Journal on Active Aging. 2002. p. 24–30.
- Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: Validation of an instrument. In: Canadian Journal of Public Health. 1992.
- Downs S, Marquez J, Chiarelli P. The Berg Balance Scale has high intra- and inter-rater reliability but absolute reliability varies across the scale: a systematic review. Journal of Physiotherapy. 2013;59(2):93–9.
- Applebaum EV., Breton D, Feng ZW, Ta A-T, Walsh K, Chassé K, et al. Modified 30-second Sit to Stand test predicts falls in a cohort of institutionalized older veterans. Bowen M, editor. PLOS ONE. 2017;12(5):e0176946.
- Jeon Y-J, Kim G-M. Comparison of the Berg Balance Scale and Fullerton Advanced Balance Scale to predict falls in community-dwelling adults. Journal of Physical Therapy Science. 2017;29(2):232–4.
- Hefny AF, Abbas AK, Abu-Zidan FM. Geriatric fall-related injuries. African Health Sciences. 2016 Jul 1;16(2):554.
- Rimland JM, Abraha I, Dell’Aquila G, Cruz-Jentoft A, Soiza R, Gudmusson A, et al. Effectiveness of Non-Pharmacological Interventions to Prevent Falls in Older People: A Systematic Overview. The SENATOR Project ONTOP Series. Laks J, editor. PLOS ONE. 2016;11(8):e0161579.
- El-Khoury F, Cassou B, Charles MA, Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: Systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347(20):1348.
- Alvarez KJ, Kirchner S, Chu S, Smith S, Winnick-Baskin W, Mielenz TJ. Falls reduction and exercise training in an assisted living population. Journal of Aging Research. 2015;2015:1–4.
- Pettee Gabriel K, Sternfeld B, Colvin A, Stewart A, Strotmeyer ES, Cauley JA, et al. Physical activity trajectories during midlife and subsequent risk of physical functioning decline in late mid-life: The Study of Women’s Health Across the Nation (SWAN). Preventive Medicine. 2017;105:287–94.
- Arrieta H, Rezola-Pardo C, Gil SM, Irazusta J, Rodriguez-Larrad A. Physical training maintains or improves gait ability in long-term nursing home residents: A systematic review of randomized controlled trials. Maturitas. 2018;109:45–52.
- Hu YN, Chung YJ, Yu HK, Chen YC, Tsai CT, Hu GC. Effect of Tai Chi Exercise on Fall Prevention in Older Adults: Systematic Review and Meta-analysis of Randomized Controlled Trials. International Journal of Gerontology. 2016;10(3):131–6.
- Huang ZG, Feng YH, Li YH, Lv CS. BMJ Open Systematic review and meta-analysis: Tai Chi for preventing falls in older adults. BMJ Open. 2017;7(2).
- Lomas-Vega R, Obrero-Gaitán E, Molina-Ortega FJ, Del-Pino-Casado R. Tai Chi for Risk of Falls. A Meta-analysis. Journal of the American Geriatrics Society. 2017;65(9):2037–43.
- Day L, Hill KD, Stathakis VZ, Flicker L, Segal L, Cicuttini F, et al. Impact of Tai-Chi on falls among preclinically disabled older people: A randomized controlled trial. Journal of the American Medical Directors Association. 2015;16(5):420–6.
- Taylor D, Hale L, Schluter P, Waters DL, Binns EE, McCracken H, et al. Effectiveness of tai chi as a community-based falls prevention intervention: A randomized controlled trial. Journal of the American Geriatrics Society. 2012;60(5):841–8.
- Cooper N, Suri P, Litman A, Morgenroth DC. The Effect of Yoga on Balance and Mobility in Populations with Balance and Mobility Impairment: a Systematic Review with Meta-Analysis. Current Physical Medicine and Rehabilitation Reports. 2018;6(1):1–14.
- Subramaniam S, Bhatt T. Effect of Yoga practice on reducing cognitive-motor interference for improving dynamic balance control in healthy adults. Complementary Therapies in Medicine. 2017;30:30–5.
- Ross A, Thomas S. The health benefits of yoga and exercise: A review of comparison studies. Journal of Alternative and Complementary Medicine. 2010;16(1):3–12.
- Li Y, Devault CN, Van Oteghen S. Effects of extended Tai Chi intervention on balance and selected motor functions of the elderly. American Journal of Chinese Medicine. 2007;35(3):383–91.
References
Yoshida S. A Global Report on Falls Prevention Epidemiology of Falls. WHO report. 2012.
Talbot LA, Musiol RJ, Witham EK, Metter EJ. Falls in young, middle-aged and older community dwelling adults: Perceived cause, environmental factors and injury. BMC Public Health. 2005;5:1–9.
Timsina LR, Willetts JL, Brennan MJ, Marucci-Wellman H, Lombardi DA, Courtney TK, et al. Circumstances of fall-related injuries by age and gender among community-dwelling adults in the United States. PLoS One. 2017;12(5):1–21.
Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: A review of the literature. Maturitas. 2013;75(1):51–61.
Dhargave P, Sendhilkumar R. Prevalence of risk factors for falls among elderly people living in long-term care homes. Journal of Clinical Gerontology and Geriatrics. 2016;7(3):99–103.
Brown RT, Diaz-Ramirez LG, Boscardin WJ, Lee SJ, Steinman MA. Functional Impairment and Decline in Middle Age: A Cohort Study. Annals of internal medicine. 2017;167(11):761–8.
Akbari M, Mousavikhatir R. Changes in the muscle strength and functional performance of healthy women with aging. Medical Journal of the Islamic Republic of Iran. 2012;26(3):125–31.
Caban-Martinez AJ, Courtney TK, Chang WR, Lombardi DA, Huang YH, Brennan MJ, et al. Leisure-Time Physical Activity, Falls, and Fall Injuries in Middle-Aged Adults. American Journal of Preventive Medicine. 2015;49(6):888–901.
Takano E, Teranishi T, Watanabe T, Ohno K, Kitaji S, Sawa S, et al. Differences in the effect of exercise interventions between prefrail older adults and older adults without frailty: A pilot study. Geriatrics and Gerontology International. 2017;17(9):1265–9.
Liu CJ, Changa WP, De Carvalho IA, Savagea KEL, Radforda LW, Thiyagarajan JA. Effects of physical exercise in older adults with reduced physical capacity: Meta-analysis of resistance exercise and multimodal exercise. International Journal of Rehabilitation Research. 2017;40(4):303–14.
Campbell AJ, Spears GF, Borrie MJ. Examination by logistic regression modelling of the variables which increase the relative risk of elderly women falling compared to elderly men. Journal of Clinical Epidemiology. 1990;43(12):1415–20.
Cheng SJ, Yang YR, Cheng FY, Chen IH, Wang RY. The changes of muscle strength and functional activities during aging in male and female populations. International Journal of Gerontology. 2014;8(4):197–202.
Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: A systematic review and meta- analysis. BMC Geriatrics. 2014;14(1):1–14.
Macfarlane DJ, Chou KL, Cheng YH, Chi I. Validity and normative data for thirty-second chair stand test in elderly community-dwelling Hong Kong Chinese. American journal of human biology : the official journal of the Human Biology Council. 2006;18(3):418–21.
Park SH, Lee YS. The Diagnostic Accuracy of the Berg Balance Scale in Predicting Falls. Western Journal of Nursing Research. 2017;39(11):1502–25.
Rubenstein LZ, Robbins AS, Josephson KR, Schulman BL, Osterweil D. The value of assessing falls in an elderly population. A randomized clinical trial. Annals of Internal Medicine. 1990;113(4):308–16.
Hayes KW, Johnson ME. Measures of adult general performance tests: The Berg Balance Scale, Dynamic Gait Index (DGI), Gait Velocity, Physical Performance Test (PPT), Timed Chair Stand Test, Timed Up and Go, and Tinetti Performance-Oriented Mobility Assessment (POMA). Arthritis & Rheumatism. 2003;49(S5):S28–42.
Kear BM, Guck TP, McGaha AL. Timed Up and Go (TUG) Test. Journal of Primary Care & Community Health. 2017 Jan 25;8(1):9–13.
Jones J, Rikli RE. Measuring functional. In: The Journal on Active Aging. 2002. p. 24–30.
Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: Validation of an instrument. In: Canadian Journal of Public Health. 1992.
Downs S, Marquez J, Chiarelli P. The Berg Balance Scale has high intra- and inter-rater reliability but absolute reliability varies across the scale: a systematic review. Journal of Physiotherapy. 2013;59(2):93–9.
Applebaum EV., Breton D, Feng ZW, Ta A-T, Walsh K, Chassé K, et al. Modified 30-second Sit to Stand test predicts falls in a cohort of institutionalized older veterans. Bowen M, editor. PLOS ONE. 2017;12(5):e0176946.
Jeon Y-J, Kim G-M. Comparison of the Berg Balance Scale and Fullerton Advanced Balance Scale to predict falls in community-dwelling adults. Journal of Physical Therapy Science. 2017;29(2):232–4.
Hefny AF, Abbas AK, Abu-Zidan FM. Geriatric fall-related injuries. African Health Sciences. 2016 Jul 1;16(2):554.
Rimland JM, Abraha I, Dell’Aquila G, Cruz-Jentoft A, Soiza R, Gudmusson A, et al. Effectiveness of Non-Pharmacological Interventions to Prevent Falls in Older People: A Systematic Overview. The SENATOR Project ONTOP Series. Laks J, editor. PLOS ONE. 2016;11(8):e0161579.
El-Khoury F, Cassou B, Charles MA, Dargent-Molina P. The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: Systematic review and meta-analysis of randomised controlled trials. BMJ. 2013;347(20):1348.
Alvarez KJ, Kirchner S, Chu S, Smith S, Winnick-Baskin W, Mielenz TJ. Falls reduction and exercise training in an assisted living population. Journal of Aging Research. 2015;2015:1–4.
Pettee Gabriel K, Sternfeld B, Colvin A, Stewart A, Strotmeyer ES, Cauley JA, et al. Physical activity trajectories during midlife and subsequent risk of physical functioning decline in late mid-life: The Study of Women’s Health Across the Nation (SWAN). Preventive Medicine. 2017;105:287–94.
Arrieta H, Rezola-Pardo C, Gil SM, Irazusta J, Rodriguez-Larrad A. Physical training maintains or improves gait ability in long-term nursing home residents: A systematic review of randomized controlled trials. Maturitas. 2018;109:45–52.
Hu YN, Chung YJ, Yu HK, Chen YC, Tsai CT, Hu GC. Effect of Tai Chi Exercise on Fall Prevention in Older Adults: Systematic Review and Meta-analysis of Randomized Controlled Trials. International Journal of Gerontology. 2016;10(3):131–6.
Huang ZG, Feng YH, Li YH, Lv CS. BMJ Open Systematic review and meta-analysis: Tai Chi for preventing falls in older adults. BMJ Open. 2017;7(2).
Lomas-Vega R, Obrero-Gaitán E, Molina-Ortega FJ, Del-Pino-Casado R. Tai Chi for Risk of Falls. A Meta-analysis. Journal of the American Geriatrics Society. 2017;65(9):2037–43.
Day L, Hill KD, Stathakis VZ, Flicker L, Segal L, Cicuttini F, et al. Impact of Tai-Chi on falls among preclinically disabled older people: A randomized controlled trial. Journal of the American Medical Directors Association. 2015;16(5):420–6.
Taylor D, Hale L, Schluter P, Waters DL, Binns EE, McCracken H, et al. Effectiveness of tai chi as a community-based falls prevention intervention: A randomized controlled trial. Journal of the American Geriatrics Society. 2012;60(5):841–8.
Cooper N, Suri P, Litman A, Morgenroth DC. The Effect of Yoga on Balance and Mobility in Populations with Balance and Mobility Impairment: a Systematic Review with Meta-Analysis. Current Physical Medicine and Rehabilitation Reports. 2018;6(1):1–14.
Subramaniam S, Bhatt T. Effect of Yoga practice on reducing cognitive-motor interference for improving dynamic balance control in healthy adults. Complementary Therapies in Medicine. 2017;30:30–5.
Ross A, Thomas S. The health benefits of yoga and exercise: A review of comparison studies. Journal of Alternative and Complementary Medicine. 2010;16(1):3–12.
Li Y, Devault CN, Van Oteghen S. Effects of extended Tai Chi intervention on balance and selected motor functions of the elderly. American Journal of Chinese Medicine. 2007;35(3):383–91.