Intensity of challenge to the balance system is not reported in the prescription of balance exercises in randomised trials: a systematic review

Farlie, Melanie; Robins, Lauren; Keating, Jenny; Molloy, Elizabeth; Haines, Terrence Peter

doi:10.1016/s1836-9553(13)70199-1

Cited by 48 publications

(45 citation statements)

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“…However, one could argue that the intensity in terms of the difficulty to maintain balance during the exercises is more important and warrants the use of perturbations to train postural reactions (Farlie et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

“…It is thus important to determine the difficulty of a balance task to be able to adapt and test the optimal training intensity to improve balance and postural responses during gait or other functional tasks. The level of challenge of any balance exercise is in general poorly evaluated or reported, likely due to the absence of adequate measure (Farlie et al, 2013). However, the level of challenge can be compared, as recently done between exergames and gait (Duclos et al, 2012) using the concepts of stabilizing and destabilizing forces to measure balance difficulty (Duclos et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Quantifying dynamic and postural balance difficulty during gait perturbations using stabilizing/destabilizing forces

Ilmane

Croteau

Duclos

2015

Journal of Biomechanics

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quantifying dynamic and postural balance difficulty during gait perturbations using stabilizing/destabilizing forces

Ilmane

Croteau

Duclos

2015

Journal of Biomechanics

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“…Farlie and colleagues [15] completed a systematic review of measures of balance training intensity, examining 148 randomized trials. They found that intensity of balance was typically measured by some other aspect of the activity, such as exercise time, aerobic intensity, or a hierarchy of task difficulty without reference to the patient's ability.…”

Section: Editorialmentioning

confidence: 99%

“…We also have some guidelines related to the frequency and duration needed for an exercise program to be effective in certain setting and with certain populations [14]. However, we do not have a tool or measure to quantify the intensity aspect of balance tasks [15]. To be effective, a balance exercise program must be challenging; to induce any training effect, the exercise must be performed near an individual's capacity [9].…”

mentioning

confidence: 99%

Getting the Dosage Right in Balance Exercise Prescription: the Intensity Problem

Reinthal¹

2017

J Nov Physiother

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EditorialAs our population ages, finding effective interventions to treat balance impairments is critical. In the United States Medicare spent over $31 billion in 2015 managing fall injuries. More than 800,000 people a year were hospitalized because of a fall, most often a fractured hip or head injury. Fall injuries are among the top 20 most expensive medical conditions, with an average cost of over $30,000. Furthermore, these direct costs do not account for the long-term effects of these injuries such as disability, dependence on others, lost time from work and household duties, and reduced quality of life [1]. Thus, determining effective means of preventing falls is a significant health care need.There have been a large number of investigations examining various aspects related to balance training and fall prevention, with more than 50 systematic reviews and meta-analyses of this research completed since 2009 [2]. Multiple types of balance interventions have been studied, with populations of varied ages as well as with differing disabilities, and in multiple types of settings [2,3]. However, there is no simple answer about the "best" exercise prescription to prevent falls because the construct of balance itself is so complicated [4]. The ability to maintain the center of mass within the base of support, or balance is a composite impairment that is influenced by strength, flexibility, sensation, cognition, and motor control.Despite the complexity, however, developing evidence based guidelines for effective balance exercise prescription is essential. Physical therapy exercise prescription typically follows the FITT principle [5], referring to frequency, intensity, type, and time, similar to medication administration. For example, when prescribing a drug, a physician determines the correct medication [TYPE] as well as the amount [INTENSITY] and frequency [FREQUENCY] of taking the medication, and the duration to continue taking the medication [TIME]. The physical therapy profession has taken a harder look at how we prescribe exercise over the last decade across multiple domains of practice, from acute care, to orthopedics to geriatric rehabilitation [6][7][8]. Similar to pharmacological interventions, incorrect exercise dosage can be ineffective in targeting the problem, and therefore costly in actual dollars and/or time. In addition, it can be damaging [9].Because balance is a multifactorial construct, exercise prescription is complex. It is for this reason that many individuals will do better with an exercise program customized by a physical therapist rather than attending a standardized group program [10,11]. There are often multiple types of exercise necessary to address different components of the balance problem. For example, it is common to use strengthening exercises in conjunction with exercises addressing motor control components of balance, such as seen in the widely used OTAGO exercise protocol [12]. We do have guidelines for determining types of exercise, based on an individualized evaluation [2], ...

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“…There does not exist, however, a measure of balance exercise intensity. This has been pointed out in studies and reviews of balance exercise effectiveness: experts found balance exercise intensity terminology to be vague [7], and reviews have noted that there is no appropriate balance intensity measure at all, even though other dosage parameters are well defined [8,9]. Further, other dosage parameters or inappropriate, unrelated measures are often substituted for balance intensity [9,10].…”

Section: Introductionmentioning

confidence: 99%

Intensity of Balance Task Intensity, as Measured by the Rate of Perceived Stability, is Independent of Physical Exertion as Measured by Heart Rate

Espy¹,

Reinthal²,

Meisel³

2017

J Nov Physiother

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Objective: To be safe and effective, all therapeutic aspects of balance training must be set and monitored appropriately. There has been no means to assess the intensity component of balance training. The Rate of Perceived Stability (RPS) measures the level of challenge posed to an individual by a balance task. If using the RPS with balance tasks that also tax the cardio-pulmonary systems, such as video game based balance training, individuals may confuse the physical exertion with the balance challenge. The purpose of this study was to determine that the RPS measures the intensity of the balance exercises, independent of physical exertion as measured by heart rate (HR).Methods: Thirty adults, 19 to 43 years old, played four Wii games (boxing, dancing, tennis, and batting) on four surfaces (foam, wobble, bosu-up and down). HR and RPS were taken at 4 and 8 minutes of each. Statistics performed included: within subjects ANOVA; correlation and ANOVA for all RPS and HR; correlation for each subject, and for all subjects at each condition; regression for HR predicting RPS for each condition.Results: Repeated measures ANOVA for HR and RPS across conditions were both significant (p<0.001). No correlations between HR's and RPS scores for all subjects, for each subject, or within any condition were significant (all >0.05). No regressions were significant (all >0.05). Conclusion:The self-ratings of stability using the RPS were independent by exertional effects as inferred through HR. The RPS can be used during video game based balance training to assess the intensity of the activity.

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Intensity of challenge to the balance system is not reported in the prescription of balance exercises in randomised trials: a systematic review

Abstract: The review highlights a serious gap in the methods used to prescribe, implement, and evaluate the effect of balance exercise programs. Comprehensive work in this area is required to develop a psychometrically sound measure of balance exercise intensity.

Cited by 48 publications

References 46 publications

Quantifying dynamic and postural balance difficulty during gait perturbations using stabilizing/destabilizing forces

Quantifying dynamic and postural balance difficulty during gait perturbations using stabilizing/destabilizing forces

Getting the Dosage Right in Balance Exercise Prescription: the Intensity Problem

Intensity of Balance Task Intensity, as Measured by the Rate of Perceived Stability, is Independent of Physical Exertion as Measured by Heart Rate

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