Otago Home-Based Strength and Balance Retraining Improves Executive Functioning in Older Fallers: A Randomized Controlled Trial
September 15, 2008
Journal of the American Geriatrics Society Volume 56, Issue 10, October 2008.
Effective falls prevention exercise programs, such as the Otago Exercise Program (OEP), consist of resistance training and balance training exercises. The current thought is that these types of exercises reduce falls by improving physiology functions, although improved cognitive functions, specifically improved executive functioning, may be another mechanism by which these types of exercises reduce falls in older adults. However, this research question has been largely unaddressed, because few exercise trials of falls prevention have included measure of cognitive function. Furthermore, no previous study of the influence of exercise on cognition has specifically included older adults with a history of falls.
To primarily ascertain the effect of the Otago Exercise Program (OEP) on physiological falls risk, functional mobility, and executive functioning after 6 months in older adults with a recent history of falls and to ascertain the effect of the OEP on falls during a 1-year follow-up period.
Physiological falls risk was assessed using the Physiological Profile Assessment. Functional mobility was assessed using the Timed Up and Go Test. Three central executive functions were assessed: set shifting, using the Trail Making Test Part B; updating, using the verbal digits backward test; and response inhibition, using the Stroop Color-Word Test. Falls were prospectively monitored using daily calendars.
At 6 months, there was no significant between-group difference in physiological falls risk or functional mobility (P≥ .33). There was a significant between-group difference in response inhibition (P=.05). A falls histogram revealed two outliers. With these cases removed, using negative binomial regression, the unadjusted incidence rate ratio of falls in the OEP group compared with the control group was 0.56. The adjusted incidence rate ratio was 0.47.
The OEP may reduce falls by improving cognitive performance