Elsevier

Maturitas

Volume 79, Issue 4, December 2014, Pages 456-463
Maturitas

Effects of supervised whole body vibration exercise on fall risk factors, functional dependence and health-related quality of life in nursing home residents aged 80+

https://doi.org/10.1016/j.maturitas.2014.09.010Get rights and content

Highlights

  • Whole Body Vibration (WBV) training has been suggested to be an effective way to reduce risk of falls among elderly but has been rarely investigated among nursing home residents.

  • The application of an 8-wk WBV-based intervention in a nursing home setting is feasible and effective to reduce fall risk factors, improve performance in activities of daily living and increase health-related quality of life in nursing home residents over the age of 80 years.

  • The intervention presented here could operate as a model for nursing home practitioners to implement WBV as an exercise-based management intervention for residents in nursing homes.

Abstract

Objective

To test the feasibility and effectiveness of whole-body vibration (WBV) therapy on fall risk, functional dependence and health-related quality of life in nursing home residents aged 80+ years.

Design

Twenty-nine 80–95 years old volunteers, nursing home residents were randomized to an eight-week WBV intervention group) (n = 15) or control group (n = 14). Functional mobility was assessed using the timed up and go (TUG) test. Lower limb performance was evaluated using the 30-s Chair Sit to Stand (30-s CSTS) test. Postural stability was measured using a force platform. The Barthel Index was used to assess functional dependence and the EuroQol (EQ-5D) was used to evaluate Health-Related Quality of Life. All outcome measures were assessed at baseline and at a follow-up after 8 weeks.

Results

At the 8-week follow up, TUG test (p < 0.001), 30-s CSTS number of times (p = 0.006), EQ-5Dmobility (p < 0.001), EQ-5DVAS (p < 0.014), EQ-5Dutility (p < 0.001) and Barthel index (p = 0.003) improved in the WBV intervention group when compared to the control group.

Conclusions

An 8-week WBV-based intervention in a nursing home setting is effective in reducing fall risk factors and quality of life in nursing home residents aged 80+.

Introduction

Falls are a major public health problem worldwide. Most incidents of falling are observed in older adults. At least 30% of people over the age of 65 experiences a fall each year, and this percentage increases up to 50% for those over 80 years [1]. Thus, falls are the leading cause of mortality [2] and morbidity [3] in older adults and account for extensive health care and social costs [4]. The incidence is about three times higher in institutionalized older adults compared to independently-living older adults [5]. Moreover, independence in activities of daily living are compromised in fallers [6]. Therefore, health-related quality of life is often reduced in this population group [4].

It has been well established that balance, postural control and mobility function decline with aging [7]. Also, muscle weakness and reduced strength [8] (identified as major modifiable risk factors for falls [9]) are part of the aging process. Moreover, older adults living in a nursing home often have reduced mobility and poor balance when compared with their peers living in the community [10]. Hence, feasible and effective interventions to modify these fall-related risk factors are warranted among the older adult population. Within this context, exercise is one of the most common strategies for fall prevention [11], even for those living in nursing homes [5].

There is also strong evidence for the effectiveness of strength and balance exercise intervention programs for fall risk reduction [12], [13], even for older adults living in nursing homes [5], [14]. However, an appropriate the appropriate combination of vibration frequency and amplitude (dose) is necessary for successful fall risk reduction [15]. Therefore, it has been stated that high-dose exercise programs produce more significant results than a lower-dose strategies [16]. Such programs seem to be feasible among individuals over 80 years of age [17], but frailer individuals, such as nursing home residents, have difficulty performing such programs because of the fatigue [17] or even fear of falling [14]. Thus, other alternatives need to be evaluated with these individuals.

Whole-body vibration (WBV) training has become increasingly popular over the past several years as an effective alternative to conventional exercise programs. WBV training minimizes the need for conscious exertion and stress on the musculoskeletal, respiratory and cardiovascular systems in comparison with traditional exercises [18]. In addition, over a short period of time, it can be useful for improving postural control among older adults [19], thereby reducing risk of falls in this population [20]. Subsequently, WBV training can be applied in frailer persons as well as in those that report a previous sedentary status [20]. Therefore, WBV training has been shown to be feasible among older adults living in nursing homes [21]. The same study demonstrated that dynamic exercises upon WBV have been shown to be more effective on some functional outcomes than static exercise.

Unfortunately, few studies have been conducted to test the usefulness of WBV training to reduce the risk of falling (or related factors) among nursing home residents and those that have been conducted have yielded inconsistent results [21], [22], [23], [24], [25]. The feasibility and effectiveness of WBV for this purpose have rarely been investigated among those over 80 years [22], [24], [25]. Moreover, only one of these studies assessed health-related quality of life [22] and, to our knowledge, none of these studies have assessed the effects of this type of therapy on either functional dependence or in lower limb muscle performance (including power) among this population. Therefore, the aim of this study was to determine if 8-weeks of a dynamic WBV exercise program is feasible and effective for nursing home residents aged 80+ years and whether it offers any additional benefits to the usual nursing home care for fall-related risk factors, health-related quality of life and functional dependence among this clinical population.

Section snippets

Participants and study design

A randomized controlled trial (ACTRN12613000189729) was conducted. The study was approved by the research ethics committee of the University and conducted in accordance with the Declaration of Helsinki, as revised in Edinburgh, 2008. All participants signed an informed consent form prior to participation in the study. Participants in the study were recruited via health care staff from a nursing home facility. Residents were eligible for the study if they were at least 80 years old and were

Results

Twenty-nine nursing home residents were finally randomized into one of the two groups (Fig. 1). None of the participants in the intervention group reported any adverse health effects during the treatment. In the intervention group, 73% (11 out of 15) of all participants completed at least 80% of the sessions offered in the program and were included in the per protocol analysis. In the control group, 78% were assessed at baseline and during an 8-week follow-up and were also included in the per

Discussion

Falls are one of the leading causes of mortality [2] and morbidity [3] among institutionalized older adults. In this study, we investigated the feasibility and effectiveness of WBV therapy in nursing home residents over the age of 80 years. Of interest in this study is the fact that fall-related risk factors, performance in daily life activities and health-related quality of life outcomes were included and assessed in the same group of participants so that more certain conclusions might be

Conclusion

The application of an 8-wk WBV-based intervention in a nursing home setting is feasible and effective to reduce fall risk factors, improve performance in activities of daily living and increase health-related quality of life in nursing home residents over the age of 80 years. In practice, these findings could operate as a model for nursing home practitioners to implement WBV as an exercise-based management intervention for residents in nursing homes.

Contributors

J.P.C and B.P.C designed the study and directed its implementation, including quality assurance and control. R.A.R and Y.Z helped supervise the field activities and designed the study's analytic strategy. F.A.B helped conduct the literature review and prepare the introduction, Materials and Methods sections on the text. M.E.R. prepared the discussion and helped in stat analysis. All authors approved the final version of the manuscript.

Competing interest

The authors declare no conflict of interest.

Funding

Author disclosures: No financial disclosures were reported by the authors of this paper. The work is original and has not been presented or published elsewhere. There are not financial benefits to the authors.

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