Enhancing Balance & Mobility in Hispanic Older Adults: A Fall Prevention Training Study

1. Rebecca Reed-Jones PhD Department of Kinesiology Perceptual and agility training in Hispanic older adults: a fall prevention intervention for an overlooked high-risk population Transitioning Faculty Award

2. The Problem • According to the Center for Disease Control and Prevention (CDC), the 7th leading cause of injury death for persons age 65 years and older is from unintentional falls • Hispanic older adults have the highest incidence of fall related injuries (41%) which is ~10% higher than others • 500 fall related deaths occurred annually between 1990-1998 in Hispanics 65 yrs or older • State of New Mexico is >67% above national average CDC, 2009; Stevens et al., 2008; Mallonee, 2003

3. The Problem • It is clear that falling among older adults in the El Paso region is a serious concern • This region needs fall prevention programs to be implemented and researched • To date there are limited studies addressing fall prevention specifically in predominantly Hispanic regions in the U.S.

4. Falling is not a simple problem • Extrinsic Factors (Environmental) • Stairs, rugs, low lighting • Intrinsic Factors • Physiology • Musculoskeletal • Psychosocial • Factors predictive of falls • Previous falls, underlying conditions Shumway-Cooke and Woollacott, 2009

5. Obstacle avoidance accounts for a majority of falls • 35-47% of falls result from tripping over an obstacle • 27-32% of falls result from a slip • 62-79% of all falls in older adults result from problems in adaptive postural and locomotor control Shumway-Cooke and Woollacott, 2009

6. Fall prevention programs • Guidelines from American College of Sports Medicine recommend aerobic activity, strength training, flexibility exercises, and balance exercises • The Center for Disease Control recommends regular physical activity, routine eye exams and medication education • These recommendations do not address the complexity of adaptive posture control and locomotion Nelson et al., 2007

7. What if we trained the visual system for obstacle detection and body movement? • Many older adults that experience a fall become afraid of future falls, therefore avoiding activities that may increase their risk of falling • Because of the reduced activity, many of them lose fitness and mobility and sensory processing efficiency! • This snowball effect can speed up the aging process, lead to a fall, and eventually lead to a loss of independence • It might also cause reductions in central neural pathways – what you do not use, you lose!

8. Purpose and Hypothesis • The purpose of this study was to investigate three different exercise programs and their effects on balance and mobility in adults over the age of 65. • We hypothesized that exercise programs with agility and dynamic balance drills, and added visual perception training would improve balance and mobility in older adults.

9. Methods • Participants: • 49 subjects (14 men and 35 women) age 65 years and older. • Independent community-living residents of El Paso • Participants were required to obtain written consent from their health care providers

10. Methods • Group 1 (Control) followed the an older adult exercise training program recommended by the ACSM only. • Group 2 (Agility) completed additional agility training. • Group 3 (VISUAL) completed additional agility training and visual training on the Nintendo® WiiFit Plus. • Soccer • Penguin Slide • Two 90 minute sessions per week for 12 weeks.

11. Variables • Obstacle course. • Simulated obstacles one might experience in day to day life Two trials • Time to finish the course. • Number of obstacle contacts made. • Other clinical tests of balance • Functional Reach and Timed Up and Go (TUG) • All tests were performed prior to the start of the training program (Pre), week 6 (Midterm), week 12 (Final)

12. Fig. 1 Pick up dumbell 5lb female 10lb male Weave through/step over Place dumbell 3” foam balance beam Duck (under) 360° around column Hurdle (over) Start/End seated

14. Course time significantly improved for all experimental groups p < .001 Mid -Pre Final -Pre VISUAL AGILITY Time (s) CONTROL

15. Only the VISUAL TRAINING group significantly reduced HITS Mid -Pre Final -Pre p = .120 p = .609 VISUAL AGILITY p = .002 p = .007 # of Obstacle Contacts * p = 1.0 CONTROL * p = .873

16. Combined time and contacts provides indication that the VISUAL group had the greatest improvement overall Pre-Mid Mid-Final CONTROL AGILITY VISUAL

17. Results Summary • Significant improvement of obstacle course time was observed for all groups over time BUT… • VISUAL was the only group to significantly reduce obstacle contacts • VISUAL group showed the greatest improvement (22%) over the 12 week training period • Agility group had an 18% improvement and the Control group had a 13% improvement

18. Benefits of Visual Training? • Results show that visual training significantly reduces collisions with obstacles • If obstacles account for ~ 75% of falls in older adults this is an area that requires further study • Exercise programs including agility training, and visual training improve balance and mobility in older adults • Tease apart the benefits of each • The Nintendo ® Wii Fit Plus may be a useful tool in helping older adults regain balance and mobility through improving visual reaction time and visual perception of obstacles experienced in daily life • Possible alternative to agility training?

19. Future Research • Data collected from this study will be used in future research examining visual training for fall prevention • We now need to implement such programs within the community and determine overall prevention of falls

20. Other Future Research • Why do Hispanic older adults have the greatest rate of fall related injuries? • Underlying conditions different from other groups? • Access to health care and fall programs? • Need to establish this knowledge • Perhaps a fall prevention program aimed at this particular population and their specific fall risk factors!

21. Thank you Questions?