Falls and fall-related injuries are a major public health concern, a financial challenge for health care providers, and critical issues for older adults. Poor balance and limited mobility are major risk factors for falls.
Objective:
The purpose of this study was to examine effects of Feldenkrais exercises in improving balance, mobility, and balance confidence in older adults.
Methods:
Participants (N = 47, mean age 75.6) were randomly assigned to a Feldenkrais group (FG, n = 25) or to a control group (CG, n = 22). The FG group attended a 5-week Feldenkrais program, 60 minutes three times per week, while the CG group was a waitlist control. The outcome measures were balance (tandem stance), mobility (Timed Up and Go), gait characteristics (GAITRite Walkway System), balance confidence (Balance Confidence Scale; ABC), and fear of falling (Falls Efficacy Scale). Pre- and post-tests were conducted.
Results:
After completion of the program, balance (p = 0.030) and mobility (p = 0.042) increased while fear of falling (p = 0.042) decreased significantly for the FG group. No other significant changes were observed. However, participants of the FG group showed improvements in balance confidence (p = 0.054) and mobility while performing concurrently a cognitive task (p = 0.067).
Conclusions:
These results indicate that Feldenkrais exercises are an effective way to improve balance and mobility, and thus offer an alternative method to help offset age-related declines in mobility and reduce the risk of falling among community-dwelling older adults. A long-term follow-up study of balance and mobility is warranted. Further research is needed to identify whether Feldenkrais exercises may impact cognitive processes.
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References
1.
SchillerJS, KramarowEA, DeyAN. Fall injury episodes among noninstutionalized older adults: United States, 2001–2003. Adv Data, 2007; 392:1–16.
2.
HausdorffJM, RiosDA, EdelbergHK. Gait variability and fall risk in community-living older adults: A 1-year prospective study. Arch Phys Med Rehabil, 2001; 82:1050–1056.
3.
StevensJA. Fatalities and injuries from falls among older adults—United States, 1993–2003 and 2001–2005. MMWR Morbid Mortal Weekly Rep, 2006; 55:45.
4.
RoudsariBS, EbelBE, CorsoPSet al.The acute medical care costs of fall-related injuries among the U.S. older adults. Injury, 2005; 36:1316–1322.
5.
StelVS, SmitJH, PluijmSM, LipsP. Consequences of falling in older men and women and risk factors for health service use and functional decline. Age Ageing, 2004; 33:58–65.
6.
TinettiME, SpeechleyM, GinterSF. Risk factors for falls among elderly persons living in the community. NEJM, 1988; 319:1701–1707.
7.
TinettiME, DoucetteJ, ClausE, MarottoliR. Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc, 1995; 43:1214–1221.
8.
KaramanidisK, ArampatzisA, MademliL. Age-related deficit in dynamic stability control after forward falls is affected by muscle strength and tendon stiffness. J Electromyogr Kinesiol, 2008; 18:980–989.
9.
HahnME, LeeHJ, ChouLS. Increased muscular challenge in older adults during obstructed gait. Gait Posture, 2005; 22:356–361.
10.
ElHaber N, ErbasB, HillKD, WarkJD. The relationship between age and measures of balance, strength and gait: Linear and non-linear analyses. Clin Sci (Lond), 2008; 114:719–727.
11.
PijnappelsM, ReevesND, MaganarisCN, van DieenJH. Tripping without falling; lower limb strength, a limitation for balance recovery and a target for training in the elderly. J Electromyogr Kinesiol, 2008; 18:188–196.
12.
SuettaC, AagaardP, MagnussonSPet al.Muscle size, neuromuscular activation, and rapid force characteristics in elderly men and women: Effects of unilateral long-term disuse due to hip-osteoarthritis. J Appl Physiol, 2007; 102:942–948.
13.
FriedmanSM, MunozB, WestSKet al.Falls and fear of falling: Which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. J Am Geriatr Soc, 2002; 50:1329–1335.
14.
AustinN, DevineA, DickI, PrinceR, BruceD. Fear of falling in older women: A longitudinal study of incidence, persistence, and predictors. J Am Geriatr Soc, 2007; 55:1598–1603.
15.
Shumway-CookA, CiolMA, GruberW, RobinsonC. Incidence of and risk factors for falls following hip fracture in community-dwelling older adults. Phys Ther, 2005; 85:648–655.
16.
FriedLP, Bandeen-RocheK, ChavesPH, JohnsonBA. Preclinical mobility disability predicts incident mobility disability in older women. J Gerontol A Biol Sci Med Sci, 2000; 55:M43–M52.
17.
Shumway-CookA, SilverIF, LeMierMet al.Effectiveness of a community-based multifactorial intervention on falls and fall risk factors in community-living older adults: A randomized, controlled trial. J Gerontol A Biol Sci Med Sci, 2007; 62:1420–1427.
18.
MakiBE, ChengKC, MansfieldAet al.Preventing falls in older adults: New interventions to promote more effective change-in-support balance reactions. J Electromyogr Kinesiol, 2008; 18:243–254.
19.
HoweTE, RochesterL, JacksonAet al.Exercise for improving balance in older people. Cochrane Database Syst Rev, 2007; 4:CD004963.
20.
FaberMJ, BosscherRJ, ChinAPMJ, van WieringenPC. Effects of exercise programs on falls and mobility in frail and pre-frail older adults: A multicenter randomized controlled trial. Arch Phys Med Rehabil, 2006; 87:885–896.
21.
RobitailleY, LaforestS, FournierMet al.Moving forward in fall prevention: An intervention to improve balance among older adults in real-world settings. Am J Public Health, 2005; 95:2049–2056.
22.
ForkanR, PumperB, SmythNet al.Exercise adherence following physical therapy intervention in older adults with impaired balance. Phys Ther, 2006; 86:401–410.
23.
LeesFD, ClarkrPG, NiggCR, NewmanP. Barriers to exercise behavior among older adults: A focus-group study. J Aging Phys Act, 2005; 13:23–33.
24.
BerteraEM, BerteraRL. Fear of falling and activity avoidance in a national sample of older adults in the United States. Health Soc Work, 2008; 33:54–62.
25.
DeshpandeN, MetterEJ, BandinelliSet al.Psychological, physical, and sensory correlates of fear of falling and consequent activity restriction in the elderly: The InCHIANTI study. Am J Phys Med Rehabil, 2008; 87:354–362.
26.
CressME. Assessing physical performance in older adults. PoonLW, Chodzko-ZajkW, TomporowskiPD. Active Living, Cognitive Functioning, and Aging. Vol 1. Champaign, IL: Human Kinetics, 2006; 113–132.
27.
LuskinFM, NewellKA, GriffithMet al.A review of mind/body therapies in the treatment of musculoskeletal disorders with implications for the elderly. Altern Ther Health Med, 2000; 6:46–56.
28.
Taylor-PiliaeRE, HaskellWL, StottsNA, FroelicherES. Improvement in balance, strength, and flexibility after 12 weeks of Tai chi exercise in ethnic Chinese adults with cardiovascular disease risk factors. Altern Ther Health Med, 2006; 12:50–58.
29.
BostH, BurgesS, RussellRet al.Field study on the effects of the Feldenkrais Method in the work with MS-patients [in German]Saarbruecken, Germany: Deutsche Multiple Sklerose Gesellschaft, Landesverband Saar, 1993.
30.
JohnsonSK, FrederickJ, KaufmanM, MountjoyB. A controlled investigation of bodywork in multiple sclerosis. J Altern Complement Med, 1999; 5:237–243.
31.
StephensJ, CallS, EvansKet al.Responses to ten Feldenkrais Awareness Through Movement lessons by four women with multiple sclerosis: Improved quality of life. Phys Ther Case Rep, 1999; 2:58–69.
32.
StephensJ, DuShuttleD, HatcherCet al.Use of awareness through movement improves balance and balance confidence in people with multiple sclerosis: A randomized controlled study. Neurol Rep, 2001; 25:39–49.
33.
FolsteinMF, FolsteinSE, McHughPR. “Mini-mental state”: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 1975; 12:189–198.
34.
Shumway-CookA, BrauerS, WoollacottM. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther, 2000; 80:896–903.
35.
National Center for Chronic DiseasePrevention. Health Promotion. Behavioral Risk Factor Surveillance System Questionnaire. Online document. www.cdc.gov/brfss/questionnaires/pdf-ques/2006brfss.pdf 2006. 2007 August 18.
36.
WilliamsHG, UllmannG, HoLS. Functional Assessment of Older Adults: An Introduction to Tools, Techniques, Writing Profiles and Describing Activities. Columbia, SC: University of South Carolina.
37.
CIR Systems Inc. GAITRite Walkway System. Software. Online document. www.gaitrite.com/. 2008 September 5.
38.
JonssonE, SeigerA, HirschfeldH. Postural steadiness and weight distribution during tandem stance in healthy young and elderly adults. Clin Biomech (Bristol, Avon), 2005; 20:202–208.
39.
LordSR, RogersMW, HowlandA, FitzpatrickR. Lateral stability, sensorimotor function and falls in older people. J Am Geriatr Soc, 1999; 47:1077–1081.
40.
PodsiadloD, RichardsonS. The timed “Up & Go”: A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc, 1991; 39:142–148.
41.
Lundin-OlssonL, NybergL, GustafsonY. Attention, frailty, and falls: The effect of a manual task on basic mobility. J Am Geriatr Soc, 1998; 46:758–761.
42.
MenzHB, LattMD, TiedemannAet al.Reliability of the GAITRite walkway system for the quantification of temporo-spatial parameters of gait in young and older people. Gait Posture, 2004; 20:20–25.
43.
ShoreWS, deLateurBJ, KuhlemeierKVet al.A comparison of gait assessment methods: Tinetti and Gaitrite Electronic Walkway. JAGS, 2005; 53:2044–2045.
44.
van UdenCJ, BesserMP. Test-retest reliability of temporal and spatial gait characteristics measured with an instrumented walkway system (GAITRite)BMC Musculoskelet Disord, 2004; 5:13.
45.
WebsterKE, WittwerJE, FellerJA. Validity of the GAITRite walkway system for the measurement of averaged and individual step parameters of gait. Gait Posture, 2005; 22:317–321.
46.
TinettiME, RichmanD, PowellL. Falls efficacy as a measure of fear of falling. J Gerontol, 1990; 45:P239–P243.
47.
PowellLE, MyersAM. The Activities-specific Balance Confidence (ABC) Scale. J Gerontol A Biol Sci Med Sci, 1995; 50A:M28–M34.
48.
AlonR. Mindful Spontaneity—moving in tune with nature. Lessons in the Feldenkrais method. New York: Avery Publishing Group Inc., 1990.
49.
FeldenkraisM. Awareness Through Movement, Health Exercises for Personal Growth. New York: Harper & Row, 1972.
50.
SchenkmanM, DonovanJ, TsubotaJet al.Management of individuals with Parkinson's disease: Rationale and case studies. Phys Ther, 1989; 69:944–954.
HollmanJH, KovashFM, KubikJJ, LinboRA. Age-related differences in spatiotemporal markers of gait stability during dual task walking. Gait Posture, 2007; 26:113–119.
53.
WoollacottM, Shumway-CookA. Attention and the control of posture and gait: A review of an emerging area of research. Gait Posture, 2002; 16:1–14.
54.
ToulotteC, ThevenonA, WatelainE, FabreC. Identification of healthy elderly fallers and non-fallers by gait analysis under dual-task conditions. Clin Rehabil, 2006; 20:269–276.
55.
ZijlstraGA, van HaastregtJC, van EijkJTet al.Prevalence and correlates of fear of falling, and associated avoidance of activity in the general population of community-living older people. Age Ageing, 2007; 36:304–309.
56.
DeshpandeN, MetterEJ, LauretaniFet al.Activity restriction induced by fear of falling and objective and subjective measures of physical function: A prospective cohort study. J Am Geriatr Soc, 2008; 56:615–620.
