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CompletedNCT03446352Updated Dec 16, 2021

Multimodal Exercise Programs for Fall Prevention: A Randomized Controlled Trial

An interventional study of Psychomotor exercise program and Combined exercise program in Fallers and High Risk of Falling, sponsored by University of Évora. Completed at 1 site in Portugal. Open to participants aged 65 Years and older. Per ClinicalTrials.gov, last updated 2021-12-16.

Sponsored by University of Évora · Not applicable, Interventional, and Prevention

Phase
Not applicable
Study type
Interventional
Enrollment
60
Allocation
Randomized
Ages
65 Years and older
Sex
All
01

Study summary

The aim of present study is to analyze and compare the effect of two exercise programs - psychomotor exercise program vs exercise combined program (psychomotor + whole body vibration) - on risk factors for falls of community-dwelling older adults who are fallers or are "at high risk of falling".

This experimental study is a randomized controlled trial. The program will run for 24 weeks (3 sessions / week of 75 minutes), followed by 12 weeks of follow-up without intervention. Participants of the groups will be assessed 1) at baseline, 2) at 12 weeks, 3) at 24 weeks, and 4) after the follow-up. Participants will be randomly allocated to three groups: experimental group 1 (psychomotor program); experimental group 2 (combined program) and control group.

Read the detailed description

Aging is associated with a decline in executive functions, negatively influencing the motor, social and emotional capacities of older adults. (1) These losses will contribute to increase the risk of falling, so much that most falls occur during the performance of a dual-task (DT) (2).

The lack of balance, strength and poor body composition are seen as causes of falls, and should therefore be considered in the prevention programs of these events in older adults. (3-5) A psychomotor exercise program uses the body and movement as mediators, relying on the prevention of cognitive, sensory, perceptive, emotional and affective deterioration, exploring the neuroplasticity. (6,7) Therefore, this sensorimotor and neurocognitive program may prevent falls, but it is important to analyze its real impact in reducing either falls or the risk factors for falls in the older adults. No studies focusing on this subject were found.

The intervention through the whole body vibration (WBV) is referred in the literature as promoting the improvement of balance, mobility and agility, and preventing falls in the older adults.(8,9) WBV will have long-term therapeutic effects promoting the increase of muscle strength and increased bone mineral density. (10) Being two intervention methods with potential good results on falls prevention, it is not known whether there will be additional benefits in an intervention that combines both methods.

02

Conditions studied

  • Fallers
  • High Risk of Falling

Keywords

  • Falls
  • Elderly
  • Psychomotor exercise program
  • Whole body vibration
03

Who can participate

Ages eligible
65 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Male or female participants aged ≥65 years;
  • Community-dwelling older adults;
  • Older adults who have fallen in the last 6 months or who are at high risk of falling (scoring ≤25 points on Fullerton Advanced Balance Scale);
  • Participation agreement;

Exclusion criteria

Exclusion Criteria:

  • Presence of severe cognitive decline (patients with a Mini-Mental State Examination ≤9);
  • Fracture in one or both lower limbs for less than 4 months;
  • Diagnosed of health conditions compromising the program participation, such as: severe osteoporosis (T ≤ 2.5, with the occurrence of one or more associated osteoporotic fractures); hip or knee prostheses; incapacitating cardiovascular conditions; epilepsy; cancer or metastases;
  • Do not wish to participate in the study;
04

Study design

Phase
Not applicable
Primary purpose
Prevention
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
60 participants (actual)

Study arms

  • Experimental
    Psychomotor exercise program

    The experimental group 1 (EG1) intervention comprises a psychomotor program. The program integrates 3 sessions / week of 75 minutes on alternated days. The psychomotor intervention includes exercises promoting simultaneous motor and cognitive stimulation (interval training).

    Other: Psychomotor exercise program

  • Experimental
    Combined exercise program

    The experimental group 2 (EG2) intervention combines the psychomotor program with a WBV program. The program integrates 3 sessions / week of 75 minutes (including the 6 minutes of WBV) on alternated days.

    Other: Combined exercise program

  • No intervention
    Control Group

    Usual care. After the study, control group (CG) participants will be offered the opportunity to integrate a similar fall prevention program.

Interventions

  • OtherPsychomotor exercise program

    Each session includes: beginning ritual (5 min), warm-up (15 min), main section comprising the multimodal exercises (40 min), cool-down (10 min), and finishing ritual (5 min). At the initial stage, the activation of different muscle groups will be performed, providing an elevation of the neurophysiological parameters. The main section (multimodal exercises) will be focused on the specific objectives through sensorimotor and neurocognitive activities. This section includes periods ranging 10-15 min of exercises mainly focused on motor stimulation- physical performance (cardiovascular, strength, balance, flexibility, agility and movement accuracy)- alternating with exercises mainly focused on cognitive stimulation- executive functions (planning ability, information processing speed, attention and dual-task performance). At the cool-down the participants will normalize their physiological parameters. Finally, at the finishing ritual the participants share their sensations experienced.

  • OtherCombined exercise program

    The EG2 intervention combines the psychomotor exercise program with a WBV program. The program integrates 3 sessions / week of 75 minutes (including the 6 minutes of WBV) on alternated days. The WBV will integrate 3 sessions / week of 6 minutes each, with programed increased exercise time, series, and frequencies throughout the intervention.

05

What researchers measure

Primary outcomes

  1. Change from Baseline, between and within groups comparison, in Executive Function

    Outcome Measure - Trial Making Test (Part A and B) to assess information processing speed

    Time frame: 0,3,6,9 months

  2. Change from Baseline, between and within groups comparison, in Executive Function

    Outcome Measure - Deary-Liewald Reaction Timed task to assess single and dual-task performance

    Time frame: 0,3,6,9 months

  3. Change from Baseline, between and within groups comparison, in Executive Function

    Outcome Measure - Timed Up and Go (dual-task version) to assess dual-task performance

    Time frame: 0,3,6,9 months

  4. Change from Baseline, between and within groups comparison, in Executive Function

    Outcome Measure - The d2 Test of Attention to assess attention

    Time frame: 0,3,6,9 months

  5. Change from Baseline, between and within groups comparison, in Physical Performance

    Outcome Measure - Biodex (Peak Torque) to assess lower-body strength

    Time frame: 0,3,6,9 months

  6. Change from Baseline, between and within groups comparison, in Physical Performance

    Outcome Measure - Senior Fitness Test (30-s Chair Stand Test) to assess lower-body strength

    Time frame: 0,3,6,9 months

  7. Change from Baseline, between and within groups comparison, in Physical Performance

    Outcome Measure - Timed Up and Go (single and dual-task version) to assess agility

    Time frame: 0,3,6,9 months

  8. Change from Baseline, between and within groups comparison, in Physical Performance

    Outcome Measure - Static Posturography Platform to assess balance

    Time frame: 0,3,6,9 months

  9. Change from Baseline, between and within groups comparison, in Physical Performance

    Outcome Measure - Fullerton Advanced Balance Scale, ranging from 0 (worst) to 40 (best) points, to assess balance

    Time frame: 0,3,6,9 months

  10. Change from Baseline, between and within groups comparison, in Body Composition

    Outcome Measure - Dual-energy X-ray Absorptiometry to assess body fat mass (%) and body lean mass (%)

    Time frame: 0,3,6,9 months

  11. Change from Baseline, between and within groups comparison, in Body Composition

    Outcome Measure - Dual-energy X-ray Absorptiometry to assess bone mineral density

    Time frame: 0,3,6,9 months

  12. Fall occurrence in the previous 6 months at baseline and at post-intervention

    Comparasion of the number of falls between and within groups

    Time frame: 0,6 months

Secondary outcomes

  1. Borg Rating of Perceived Exertion

    Exercise intensity

    Time frame: 0-6 months

  2. Mini-Mental State Examination

    Cognitive state

    Time frame: 0 months

  3. Composite Physical Function scale

    Physical independence

    Time frame: 0 months

  4. International Physical Activity Questionnaire

    Physical activity

    Time frame: 0 months

06

Study locations

1 site
  • Universidade de Évora
    Évora, Portugal
07

References and documents

Publications

  • Bherer L. Cognitive plasticity in older adults: effects of cognitive training and physical exercise. Ann N Y Acad Sci. 2015 Mar;1337:1-6. doi: 10.1111/nyas.12682. PubMed 25773610 ↗
  • Lima LC, Ansai JH, Andrade LP, Takahashi AC. The relationship between dual-task and cognitive performance among elderly participants who exercise regularly. Braz J Phys Ther. 2015 Mar-Apr;19(2):159-66. doi: 10.1590/bjpt-rbf.2014.0082. Epub 2015 Apr 27. PubMed 25993629 ↗
  • Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, Nieman DC, Swain DP; American College of Sports Medicine. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011 Jul;43(7):1334-59. doi: 10.1249/MSS.0b013e318213fefb. PubMed 21694556 ↗
  • World Health Organization. Falls. [online]. 2016; Avaliable at: http://www.who.int/mediacentre/factsheets/fs344/en/
  • Latorre Roman PA, Garcia-Pinillos F, Huertas Herrador JA, Cozar Barba M, Munoz Jimenez M. Relationship between sex, body composition, gait speed and body satisfaction in elderly people. Nutr Hosp. 2014 Oct 1;30(4):851-7. doi: 10.3305/nh.2014.30.4.7669. PubMed 25335673 ↗
  • Oliveira V, Carvalho S, Cardoso T. (2015). Quando o envelhecimento acontece. Rio de Janeiro: Wak Editora. Atualidades da Prática Psicomotora. 2015; 217-233.
  • Fernandes, J. A Gerontopsicomotricidade como Práxis Terapêutica de Mediação Corporal. Journal of Aging and Innovation. 2014; 3 (3).
  • Smith DT, Judge S, Malone A, Moynes RC, Conviser J, Skinner JS. Effects of bioDensity Training and Power Plate Whole-Body Vibration on Strength, Balance, and Functional Independence in Older Adults. J Aging Phys Act. 2016 Jan;24(1):139-48. doi: 10.1123/japa.2015-0057. Epub 2015 Jul 23. PubMed 26215362 ↗
  • Orr R. The effect of whole body vibration exposure on balance and functional mobility in older adults: a systematic review and meta-analysis. Maturitas. 2015 Apr;80(4):342-58. doi: 10.1016/j.maturitas.2014.12.020. Epub 2015 Jan 12. PubMed 25631348 ↗
  • Rauch F. Vibration therapy. Dev Med Child Neurol. 2009 Oct;51 Suppl 4:166-8. doi: 10.1111/j.1469-8749.2009.03418.x. PubMed 19740225 ↗
  • Rosado H, Bravo J, Raimundo A, Carvalho J, Almeida G, Pereira C. Can two multimodal psychomotor exercise programs improve attention, affordance perception, and balance in community dwellings at risk of falling? A randomized controlled trial. BMC Public Health. 2022 Jul 11;21(Suppl 2):2336. doi: 10.1186/s12889-022-13725-5. Erratum In: BMC Public Health. 2024 Jun 10;24(1):1554. doi: 10.1186/s12889-024-19053-0. PubMed 35818044 ↗
  • Rosado H, Bravo J, Raimundo A, Carvalho J, Marmeleira J, Pereira C. Effects of two 24-week multimodal exercise programs on reaction time, mobility, and dual-task performance in community-dwelling older adults at risk of falling: a randomized controlled trial. BMC Public Health. 2021 Nov 10;21(Suppl 2):408. doi: 10.1186/s12889-021-10448-x. Erratum In: BMC Public Health. 2024 Jun 10;24(1):1554. doi: 10.1186/s12889-024-19053-0. PubMed 34758759 ↗

Individual participant data

Plan to share: No

08

Registry details

Key details

Study ID
NCT03446352
Lead sponsor
University of Évora
Collaborators
São João de Deus School of Nursing, Horizon 2020 - Portugal 2020 (ALT20-03-0145-FEDER-000007 - Project: ESACA)
Responsible party
Hugo Filipe Zurzica Rosado (MSc, University of Évora) — Principal investigator
First posted
Feb 26, 2018
Start date
Jan 1, 2018
Primary completion
Oct 30, 2018
Completion
Feb 28, 2019
Last update
Dec 16, 2021

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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