But many of our participants have found that our Specialty Certificates are very valuable marketing tools which document that you have specialized training in a concentrated area of fitness. After you have completed all 4 of our live classes you will receive access to a special page on our website. All you need to do is click on that link, enter your email address and then fill out a short attendance form. Then, your special certificate will be emailed to you instantly. For assessment, the single leg stance SLS test was used, in which the individual should balance on only one leg for 30 seconds, with his or her eyes open.
Time was measured in three attempts, and the best of the three was considered the longest one, limited to the maximum time. Dynamic balance refers to posture maintenance during the performance of a motor skill that tends to disturb body orientation It was assessed through the Timed Up and Go TUG 28 , in which the individual is asked to stand up from a chair, walk three meters, turn around and sit back in the chair. Afterwards, a trunk flexion was requested, up to the maximum limit, maintaining the initial position, without executing any compensatory strategy.
The distance from the first marking to the second one is measured.
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Subjects who reached between The higher the number of repetitions, the greater the strength of the individual. For the classification of these results, the normative table proposed by the authors was used, which establishes whether the value obtained is within an expected limit for the age and sex. The questions refer to activities of daily living, in which the individual indicates his or her degree of concern about performing the activity.
The objective of the physical program was to improve balance capacity and other physical fitness components, aiming at reducing the fear of falling in daily activities. The modality that proved most efficient for reducing the risk of falls is the combination of strengthening, stretching and coordination Currently, studies 33 , 34 advocate the implementation of multifaceted interventions for prevention of falls in the elderly population, which work mainly on the strength of the lower limbs, especially feet and ankles, static and dynamic balance, in addition to reinforcing that physical exercise programs that offer a greater challenge as to balance, often offered, including intensity progression over time and without interruption, are more effective in preventing falls.
The literature has indicated strategies for better postural control, defined as ankle, hip and stepping strategies Exercises that focus on the strength and flexibility of the muscles of the feet and ankles have been considered as important components to a successful fall prevention strategy. The contents of the program were: a balance movement of the center of mass, reduced base of support, decreased support of the upper limbs, stimulation of the somatosensory, visual and vestibular sensory systems ; b strength emphasis on the lower limbs with ankle movements dorsiflexion and plantar flexion , knee movements knee flexion and extension , hip movements abduction, adduction, flexion and extension , c flexibility hips, knees, ankles and spine ; d gait different directions, steps and paces, Tandem gait, reaction speed.
Functional exercises were proposed, whenever possible, due to similarities with activities of daily living, such as standing and sitting, climbing stairs, transfers. The program, created by the researchers and adjusted to the sample, consisted of two weekly classes lasting 50 minutes, divided into: warm-up, exercises for adjustment control plantar grasp; variation of supports, heights and types of floor; proprioceptive training; displacement in different directions , strength exercises with emphasis on lower limb muscles, stretching and relaxation exercises. The class methodology used was in the form of a circuit composed of 6 exercise stations, with an average duration of 3 minutes each, which could vary.
The stations were planned so as to encompass the following variables: lower limb strength 1 station , lower limb flexibility 1 station , balance 2 stations , reaction speed 1 station and vestibular system 1 station. Gait was present in the stations, being inherent to the course of the circuit, but also directed. The volume and intensity of the program were incremented, based on the difficulty progression that happened according to how the elderly adapted to the course, using: increase in loads, increase in the course and height of steps, use of more difficult postures reduced base of support, movements that disturbed the center of gravity , reduction of sensorial stimuli.
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All participants signed a free and informed consent form. Statistical analysis was adopted, starting from data normality assessment, using the Shapiro Wilk test. To analyze the classification of the tests, distribution calculations frequency and percentage of pre and post-training periods were used, as well as variation delta calculation.
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Limitations of the study include the fact that previous experience in physical exercises or use of medication were not controlled. The study sample consisted of 17 people 1 man and 16 women aged on average The TUG obtained a higher mean in the post-test, indicating that the participants took longer to execute the test, revealing worse results. The FES also had a higher post-test result, which evidences a greater fear of falls. On the other hand, the TUG obtained significantly lower scores in the post-test when compared to the pre-test.
Results evidence that there was a change in the risk of fall, based on the assessment of balance, in the SLS. In the FES, the no risks and sporadic risks categories increased, indicating improvement in prevention, but recurrent fall increased as well. In the post-test, most of these classifications continued, with the majority increasing, except for FR. However, in the latter the post-test mean was less effective than in the pre-test. The different results found for the SLS and TUG tests coincide with statements of another study 25 that reports that the tests used for assessing body balance in the elderly are complementary, since each one has its own different particularity and limitation.
Results indicated an improvement in static body balance. Similarly, elderly women who underwent a progressive functional balance training showed significant improvement in functional balance, evidencing the efficacy of the proposed exercises Besides, proprioceptive and kinesiotherapy training 36 also seem to be effective in improving body balance.
However, it should be noted that in the findings of the present research the results were effective only for the static balance test. We can consider that these results relate to the content developed in the intervention.
Static balance exercises in various situations suppression of senses and support on irregular surfaces , as well as flexibility stimuli, such as joint mobility in the lower limbs, are examples of activities developed in the intervention that induced the improvement of results in the SLS and LLFLEX. On the other hand, lack of improvement in the TUG can be explained by the low level of stimulus for exercises focused on variables such as agility, reaction time and explosive strength, which are more present components in the test. It is important to stress that variables such as level of physical activity and use of medication were not controlled in the research and could interfere with test results.
Specific interventions as to falls and flexibility have not been explored in researches; nonetheless, they are deemed important for balance maintenance.
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Regarding flexibility, it is believed that a decrease in it with aging may be related to risk of falls, mainly due to reduction in joints such as hip, knees and ankles, which directly influence the gait pattern of seniors 7. Thus, we consider that our positive results, in this variable, seem to be effective in reducing concern with falls. Regarding FR, in a study 37 with this type of assessment after intervention of strength, flexibility and balance exercises, effective results were found. In this way, it is indicated that exercises can be effective in improving performance in this test.
Although strength is associated with body balance 26 , 27 , few studies have subjected seniors to a specific program for balance improvement and measured this variable after training. In a program that had individualization as characteristic, those with less satisfactory results received 10 minutes of extra activities in specific variables Recognizing the wisdom of making the program sustainable by adapting it for community-based administration and dissemination, the PRC continued its partnership with GHC and SS.
SS obtained funding from the local Area Agency on Aging to make the program available to community-dwelling seniors via senior centers.
Working with its partners, SS adapted the program for local dissemination and portability by developing standards; manuals for instructors, administrators, and participants; and procedures for monitoring outcomes. By June of , more than 14, participants had taken EnhanceFitness classes, and the program was available at more than sites in 25 states, plus Washington DC. In , in order to help track program dissemination and implementation more accurately and efficiently, Senior Services launched a new online data-entry system.
These numbers are expected to continue to rise as additional partners, such as retirement communities and private health and wellness clubs start to offer the program to their members.
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One analysis of GHC Medicare enrollees showed that people who participated in EnhanceFitness at least once per week had significantly fewer hospitalizations by 7. Consistent with the research findings, EnhanceFitness is proving to be feasible and well-attended when offered in senior centers and other community-based settings.
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The availability of such a successful program becomes more and more pertinent as the US population ages and disability prevention among the elderly becomes a high national priority.
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