The Effect of Fallproof Group-Based Training with High and Low Intensity on Balance in the Elderly

According to the World Health Organization, aging is a biological period with its own dynamic and out of human control, starting from the fertilization and ending with death (1). Balance control is the foundation of human ability to move and function independently (2). By increasing age, changes are made in the systems related to balance and movement. Structural and functional changes in the central nervous system have the most visible effect on motor performance (3) and the risk of falling increases in the elderly (4). Decreased mobility and balance along with the fear of falling can lead to decrease motor performance (6). The result of falling is injury, which can have physical and psychological consequences. It also causes costs for the individual, family and society (7). Therefore, according to the growing trend of the elderly population in the world, the need to pay attention to the importance of intervention strategies in the field of improving balance has been noticed by researchers. One of the individual or group-based intervention strategies is Fallproof program, which was proposed in response to the needs of  the elderly at risk of falling. This theory-oriented program with a multidimensional approach is effective in improving balance, mobility and reducing the risk of falling in the elderly (11). By proper design of exercice interventions, as well as repeatedly exposing the elderly to task demands and changing environmental conditions with the aim of reducing balance disorders, balance and mobility and falls can be affected to some extent. Fall prevention programs target the underlying injuries associated with postural instability through a comprehensive screening and evaluation protocol and its multidimensional planning approach (3). Considering Fallproof program is known as one of the effective programs in the field of rehabilitation of the elderly, and also by reviewing the previous studies, it was found that no study has been done regarding the optimal intensity of these exercises; Therefore, assuming the efficiency of Fallproof training on balance of the elderly, we investigated the effect of  high and low intensity Fallproof group-based training on balance of the elderly at different ages.

The current semi-experimental research with a pre-test and post-test design and its statistical population consisted of 55-77 years community-doweling in Tehran. After announcing the readiness of the volunteers, 60 people (26 men and 34 women) were clinically evaluated by a physician before any physical activity to confirm their physical and cardiovascular health. According to the research criteria, participants were divided into low intensity (20 people), high intensity (20 people) and control (20 people) groups by targeted sampling. Before evaluation, Fall Proof Health and Activity Questionnaire was used in order to obtain information about the general state of health, lifestyle and physical activity patterns. It was consisted of 22 questions, which provided three questions in the field of physical activity and exercise patterns in addition to knowledge of diseases, types of diagnosed injuries, and drugs used by participants. Fullerton's advanced balance (FAB) scale was used as a pre-test and post-test to evaluate the multiple dimensions of balance in functionally independent elderly and examines musculoskeletal, sensory, and neuromuscular systems, which may be involved in disorders. The test consists of 10 items which are: stand with feet together and eyes closed, reaching forward to object, turn in full circle, step up and over, tandem walk, stand on one leg, stand on foam with eyes closed, two-footed jump, walk with head turns, reactive postural control. Two experimental groups participated in Fallproof group-based program  three times a week for eight weeks (45 minutes per session), While the control group only participated in the pre-test and post-test. The exercises included center of gravity (COG) control, posture strategies, multi-sensory, strength and endurance, flexibility and gait pattern enhancement to improve the sensory, motor and skeletal-muscular system involved in maintaining balance (3). This research mainly focused on group-based training using entertaining games. The participants were asked to cooperate with each other to accomplish all of the tasks. As soon as the intervention was completed, the participants were evaluated again in the post test, using the (FAB) scale. Shapiro-Wilk test was used to evaluate the normal data and Lune's test was used to evaluate the equality of variance of the variables. Analysis of variance with repeated measurements (composite analysis of variance) and Bonferroni and Tukey post hoc tests were used at a significance level of 0.05 For data analysis.

The results of the Paired sample t test showed that Fallproof group-based training with low intensity improve the balance of the elderly 55-65 years. In addition, the results revealed that high-intensity Fallproof group-based training improve the balance of the elderly 55-65 years (P<00.5). The results showed that low-intensity Fallproof group-based training improve the balance of the elderly 66-77 years. The results revealed that high intensity Fallproof group-based training improve the balance of the elderly 66-77 years (P<00.5). There is a significant difference between the balance of 55-65 year in Fallproof group-based  with low and high intensity (P<00.5). The results showed that the balance of high-intensity Fallproof training  improved by 4.20 units compared to low-intensity. Also, there is a significant difference between the balance of 66-77 years in Fallproof group-based training with low and high intensity (P<00.5). The results showed that the balance of high-intensity Fallproof group-based training  improved by 4.40 units compared to low intensity.The findings of the composite variance analysis test revealed that there is a significant difference between the pre-test and post-test, and the exercises improved the balance of the elderly from the pre-test (24/33) to the post-test (28/65).The results indicated that there is a significant difference in balance between the age of 55-65 years and 66-77 years, and the balance of the age group of 55-65 years (28.033)  is significantly better compared to the age group of 66-77 years ( 24/95). The results showed that there is a significant difference in balance between the high training intensity and low training intensity groups and the balance of the elderly in the high intensity group (28.72) is significantly better compared to the low intensity group (26.37). In addition, the results showed that there is no significant difference in balance between the high and low training intensity groups in the pre-test. However, in the post-test there is a significant difference in balance between the high and low training intensity groups and the balance of the high intensity group (32.90) was significantly better compared to the low intensity group (28.60).

  According to the findings of this research, it can be concluded that eight weeks of high intensity Fallproof group-based training are more effective in improving balance in the elderly. According to the obtained evidence, older people were also able to use the benefits of participating in high intensity Fallproof group-based training. Therefore, it can be concluded that this program is probably an effective strategy to improve balance which will reduce the risk of falling to some extent in the elderly. Many specialists and those who work with the elderly can use Fallproof group-based training with high intensity along with other exercise protocols to improve balance and motor function.