Does Fall Arrest Strategy Training Improve Capacity to Prevent Fall-Related Injury in Older Women?

NCT04844047 | Completed

• 1 other identifier: BIO-REB 16-72
• Study Type: interventional
• Target: 40
• Locations: 0 countries
• Sites: N/A

Brief Summary

Falls are the leading cause of injury hospitalization for seniors across Saskatchewan and addressing the underlying causes is a provincial health priority. Older women are more vulnerable to the most common fall-related injuries (upper body) during forward falling while walking. Exercise programs designed to improve balance and strength can reduce fall risk but it is not known if specific exercises targeted to upper body strength and agility can improve chances for safe landing when a fall is inevitable. The investigators have developed such a program, Fall Arrest Strategy Training (FAST) and successfully piloted the feasibility of the exercises to be included in a standard fall prevention program. FAST is meant to increase arm strength, reaction time, trunk control, and teach better landing techniques. The potential efficacy of such an intervention to improve landing capacity has not been studied in older women. Thirty-two women age 60 years or older will be randomly assigned to either FAST or a Standard Exercise group. Half will do standard exercises targeting balance, mobility and lower extremity strength; the other half will do the same exercises with the addition of FAST. Both groups will exercise twice per week for 12 weeks. Participants will be tested before and after for arm strength, reaction time, balance, mobility and the ability to control body descent (absorb energy) using a technique we developed in our lab. While in a safety harness, participants will simulate a forward fall onto a platform that measures energy during impact. While completely preventing falls is not possible, this study will help the investigators learn if simple exercises like FAST combined with balance training can decrease fall risk AND reduce the risk of serious injury when a fall is unavoidable. It will help address the growing personal and societal cost of fall-related injury. This study will also inform future research targeted to include a large-scale trial evaluating the impact and implementation of FAST training in older adults across the spectrum of care and development of a computer simulation model to determine which factors are most important for reducing the risk of fall-related injury.

Conditions

Fall Injury

Keywords

fall risk; older adult; injury prevention

Outcome Measures

Primary Outcomes (16)

• UE Strength - Isometric

  Measured with a hand-held dynamometer; mean of three trials for shoulder abduction, shoulder flexion and elbow extension

  12 weeks

• UE Strength - Grip

  Measured with a dynamometer; participant in sitting, standardized elbow flexion position and handle position, gripping maximum exertion; mean of three trials for shoulder abduction, shoulder flexion and elbow extension

  12 weeks

• UE Strength - Isometric Push-off Test

  Measured with a hand-held dynamometer for grip strength with the handle inverted and stabilized on a table top. Participant pushes downward in a standing position; mean of 3 trials used

  12 weeks

• UE Strength - Isokinetic Concentric and Eccentric

  Using a protocol developed in the investigators' lab, with the Humac Norm isokinetic dynamometer. An upper extremity pushing motion of primarily elbow extension measuring maximal force for concentric and eccentric motion. Mean of three trials used

  12 weeks

• UE Mobility

  Shoulder Extension and Wrist Extension Active Range of Motion with passive overpressure measure with a manual goniometer in a sitting position

  12 weeks

• UE Response Time

  Time from the start of an auditory cue to lift hands from a position standing with arms at side of body to the first touch on a force from auditory cue to touching a forceplate at shoulder level. Mean of three trials for right, left and both hands together used.

  12 weeks

• Balance - One Leg Standing

  Timed ability to stand on one leg with no support, up to 60 seconds. Two trials on each leg

  12 weeks

• Balance - Tandem Standing

  This is a standard test first described by Hile et al (2012) where the participant tries standing in a tandem position, one foot in front of the other first with and then without support for up to 30 seconds without support. Scored on a scale of 5, with maximum score of 5 meaning standing without support for full 30 seconds

  12 weeks

• Self Report Fall Risk - FROP-Com

  Fall Risk for Older People living in the Community (National Aging Research Institute, 2012 http://www.mednwh.unimelb.edu.au/nari\_tools/nari\_tools\_falls.html) measures fall risk in 13 categories, for a total possible score of 60 (higher risk)

  12 weeks

• Self Report Balance Confidence

  Activities Balance Confidence Scale (ABC; Powell \& Myers 1995) rating of confidence for 16 day to day functional tasks on a scale 0 - 100; mean of 16 items used as total score

  12 weeks

• Sit to Stand Test

  Number of full sit to stand movements completed within 30 seconds with arms crossed. One practice followed by actual test

  12 weeks

• Timed Up and Go Test (TUG)

  Timed test to stand up from a chair, walk 3 meters, turn to chair and sit down. One practice trial, followed by one timed test (Podsiadlo \& Richardson 1991)

  12 weeks

• Ground Reaction Force

  Forward Descent and Landing Apparatus used to measure a controlled and unexpected release onto outstretched hands (simulated forward fall). Bilateral force platforms recorded ground reaction forces as participants performed a controlled descent with body at an angle 30 degrees from vertical, and then in an unexpected release while tethered to the ceiling, shoulders in 90 degrees of flexion and hands just hovering above force plate. Mean of 3 trials.

  12 weeks

• Elbow ROM during simulated forward descent

  Forward Descent and Landing Apparatus used to measure a controlled and unexpected release onto outstretched hands (simulated forward fall). An eight camera motion capture system collected 3D upper extremity kinematics. Maximal elbow ROM was measured as participants performed a controlled descent with body at an angle 30 degrees from vertical, and then in an unexpected release while tethered to the ceiling, shoulders in 90 degrees of flexion and hands just hovering above force plate. Mean of 3 trials.

  12 weeks

• Peak elbow moment and elbow stiffness during simulated forward descent

  Forward Descent and Landing Apparatus used to measure a controlled and unexpected release onto outstretched hands (simulated forward fall). An eight camera motion capture system collected 3D upper extremity kinematics. Elbow moments and stiffness values were calculated, normalized to height and body weight. Participants performed a controlled descent with body at an angle 30 degrees from vertical, and then in an unexpected release while tethered to the ceiling, shoulders in 90 degrees of flexion and hands just hovering above force plate. Mean of 3 trials.

  12 weeks

• Energy Absorption during simulated forward descent

  Forward Descent and Landing Apparatus used to measure a controlled and unexpected release onto outstretched hands (simulated forward fall). An eight camera motion capture system collected 3D upper extremity kinematics. Energy absorption was calculated calculated using the total ground reaction force and the movement of the shoulders as a measure of the vertical displacement of the body, normalized to height and body weight. Participants performed a controlled descent with body at an angle 30 degrees from vertical, and then in an unexpected release while tethered to the ceiling, shoulders in 90 degrees of flexion and hands just hovering above force plate. Mean of 3 trials.

  12 weeks

Secondary Outcomes (2)

• Falls

  64 weeks

• Muscle Activity

  12 weeks

Study Arms (2)

FAST

ACTIVE COMPARATOR

Twice per week exercise program, 45 minutes duration for 12 weeks conducted in the community. Participants attended a 30-minute fall prevention education session once per week. FAST followed the same principles as Standard, with the addition of the following goals: 1) Increase UE strength (shoulder girdle/arm) utilizing both concentric and eccentric contractions, 2) Improve trunk and neck postural control during slow and fast body motions, 3) Optimize forward descent strategies via practice of quick response reaching, landing and controlled descent with hands on the wall or on the floor as able. Training progression for strength and body control included increasing the distance standing from the wall, progressing to one arm descents, increasing reps and speed and moving to greater gravity and body weight resistance such as hands and knees position on the floor as able. Quick movement practice targeted unexpected reaching activities, balloon and ball toss

Other: Exercise

Standard

PLACEBO COMPARATOR

Twice per week exercise program, 45 minutes duration for 12 weeks conducted in a community site (assisted living residence). Participants also attended a 3o minute fall prevention education session once per week. The Standard intervention consisted of a fall prevention exercise program designed for community-dwelling older adults. Exercises focussed on balance, leg strength, walking and mobility exercises designed to decrease fall risk.

Other: Exercise

Interventions

Exercise OTHER

refer to arm descriptors

Also known as: FAST

FAST

Eligibility Criteria

• Age: 60 Years+
• Gender Eligibility Details: Self identification as female is inclusion criteria
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• \- Women aged 60 years or older living in the community.

You may not qualify if:

• Any recent upper body (hand, wrist, shoulder, trunk, neck) injury or painful joint problem that limited day to day activities or resulted in pain on a daily basis,
• A prior distal radius fracture in the past 2 years,
• Any fracture in the past year, or multiple fractures of the wrist or forearm,
• Any history of UE neurological problems (i.e. Stroke, Multiple Sclerosis, Parkinson's Disease, Reflex Neuropathy),
• Any cardio-vascular problems that would contradict UE strength testing or training,
• Any signs of severe cognitive impairment or
• Unable to safely ambulate independently (with or without a walking aid) in the community.
• A medical and demographic screening questionnaire as well as the Mini-Cog (Borson et al, 2000) were used to determine eligibility.

Sponsors & Collaborators

• University of Saskatchewan: lead

Related Publications (14)

• DeGoede KM, Ashton-Miller JA. Fall arrest strategy affects peak hand impact force in a forward fall. J Biomech. 2002 Jun;35(6):843-8. doi: 10.1016/s0021-9290(02)00011-8.

  PMID: 12021005 BACKGROUND

• DeGoede KM, Ashton-Miller JA. Biomechanical simulations of forward fall arrests: effects of upper extremity arrest strategy, gender and aging-related declines in muscle strength. J Biomech. 2003 Mar;36(3):413-20. doi: 10.1016/s0021-9290(02)00396-2.

  PMID: 12594989 BACKGROUND

• Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive 'vital signs' measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000 Nov;15(11):1021-7. doi: 10.1002/1099-1166(200011)15:113.0.co;2-6.

  PMID: 11113982 BACKGROUND

• Sran MM, Stotz PJ, Normandin SC, Robinovitch SN. Age differences in energy absorption in the upper extremity during a descent movement: implications for arresting a fall. J Gerontol A Biol Sci Med Sci. 2010 Mar;65(3):312-7. doi: 10.1093/gerona/glp153. Epub 2009 Oct 27.

  PMID: 19861641 BACKGROUND

• Lee Y, Ashton-Miller JA. The effects of gender, level of co-contraction, and initial angle on elbow extensor muscle stiffness and damping under a step increase in elbow flexion moment. Ann Biomed Eng. 2011 Oct;39(10):2542-9. doi: 10.1007/s10439-011-0308-3. Epub 2011 Apr 12.

  PMID: 21484509 BACKGROUND

• Lo J, McCabe GN, DeGoede KM, Okuizumi H, Ashton-Miller JA. On reducing hand impact force in forward falls: results of a brief intervention in young males. Clin Biomech (Bristol). 2003 Oct;18(8):730-6. doi: 10.1016/s0268-0033(03)00124-4.

  PMID: 12957559 BACKGROUND

• Maki BE, McIlroy WE. Control of rapid limb movements for balance recovery: age-related changes and implications for fall prevention. Age Ageing. 2006 Sep;35 Suppl 2:ii12-ii18. doi: 10.1093/ageing/afl078.

  PMID: 16926197 BACKGROUND

• Public Health Agency of Canada. Seniors' Falls in Canada. 2nd Report. 2014; www.phac-aspc.gc.ca/seniors-aines [On-line].

  BACKGROUND

• Schonnop R, Yang Y, Feldman F, Robinson E, Loughin M, Robinovitch SN. Prevalence of and factors associated with head impact during falls in older adults in long-term care. CMAJ. 2013 Nov 19;185(17):E803-10. doi: 10.1503/cmaj.130498. Epub 2013 Oct 7.

  PMID: 24101612 BACKGROUND

• Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JC. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc. 2008 Dec;56(12):2234-43. doi: 10.1111/j.1532-5415.2008.02014.x.

  PMID: 19093923 BACKGROUND

• Chiu J, Robinovitch SN. Prediction of upper extremity impact forces during falls on the outstretched hand. J Biomech. 1998 Dec;31(12):1169-76. doi: 10.1016/s0021-9290(98)00137-7.

  PMID: 9882050 BACKGROUND

• Arnold CM, Walker-Johnston J, Lanovaz JL, Lattimer LJ. Does Fall Arrest Strategy Training Added to a Fall Prevention Programme Improve Balance, Strength, and Agility in Older Women? A Pilot Study. Physiother Can. 2017;69(4):323-332. doi: 10.3138/ptc.2016-27EP.

  PMID: 30369700 BACKGROUND

• Lattimer LJ, Lanovaz JL, Farthing JP, Madill S, Kim S, Robinovitch S, Arnold C. Female Age-Related Differences in Biomechanics and Muscle Activity During Descents on the Outstretched Arms. J Aging Phys Act. 2017 Jul;25(3):474-481. doi: 10.1123/japa.2016-0102. Epub 2017 Jun 28.

  PMID: 28095094 BACKGROUND

• Lattimer LJ, Lanovaz JL, Farthing JP, Madill S, Kim SY, Robinovitch S, Arnold CM. Biomechanical and physiological age differences in a simulated forward fall on outstretched hands in women. Clin Biomech (Bristol). 2018 Feb;52:102-108. doi: 10.1016/j.clinbiomech.2018.01.018. Epub 2018 Feb 3.

  PMID: 29407858 BACKGROUND

MeSH Terms

Interventions

Exercise

Intervention Hierarchy (Ancestors)

Motor Activity; Movement; Musculoskeletal Physiological Phenomena; Musculoskeletal and Neural Physiological Phenomena

Study Officials

• Cathy Arnold, PhD

  School Of Rehabilitation Science, University Of Saskatchewan

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Assessors were blinded to intervention
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: March 8, 2021
• First Posted: April 14, 2021
• Study Start: August 24, 2016
• Primary Completion: April 18, 2017
• Study Completion: April 18, 2017
• Last Updated: April 14, 2021

Record last verified: 2021-04

Data Sharing

• IPD Sharing: Will not share