Effects of Multidirectional and Variable-Speed Body Weight Supported Treadmill Training on Balance Rehabilitation for Fall Prevention among Community-dwelling Elderly Persons Effects of Multidirectional and Variable-Speed Body Weight Supported Treadmill Training on Balance Rehabilitation for Fall Prevention among Community-dwelling Elderly Persons

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Simadamrong P Wongphaet P



Objectives: To assess the effectiveness of multidirectional and variable-speed body weight supported treadmill training (BWSTT) in walking and balance rehabilitation for elderly persons with a history of falls or with perceived impaired balance.

Setting: The Bang Mueang Commune Municipality, Ban Bang Khae (Bang Khae Home for Older Persons), Rachathewa Sub-district Health Promotion Hospital, Samrong Klang Sub-district Health Promotion Hospital and Public Health Center 25 (Huai Khwang).

Study design: Retrospective study.

Subjects: Elderly persons aged 60 years or over with a history of falls or with perceived impaired balance over the past six months.

Methods: The individual participants underwent BWSTT twice a week for six weeks, the difficulty of which was adjusted step-by-step. Before the training, they were interviewed about their history of falls over the past six months and were assessed with the following tests – the Berg Balance Scale (BBS) test, Timed Up and Go Test (TUGT) and stop-watch assisted analysis of average temporal spatial gait parameters such as gait speed, cadence and step length.  The tests were conducted two other times, with one carried out immediately at the end of the six weeks training and the other one six months after it (six months follow-up).

Results: Out of 233 participants (38 males and 195 females), 46 of them reported a history of falls over the past six months before their project enrollment, with an average fall rate of 0.59 falls/person/year. During the training period, no fall incident was reported; however, on the six months follow-up, 17 of them reported a fall/falls, with a rate of 0.20 falls/person/year, which was 66.10 percent lower than the average fall rate before the training. The assessments conducted immediately after the end of training and on the six months follow-up suggested that the scores of the BBS test, TUGT and the tests on comfortable gait para-meters, i.e. gait speeds, cadence and step lengths improved compared with those before the training at a statistically significant level with a p<0.001.

Conclusion: Biweekly 30-minute BWSTT over a six weeks period provided elderly persons with a history of falls or perceived impaired balance a significant improvement in walking and balance ability and a significant reduction in the fall rates at the end of the 12 training sessions and at six months follow-up.



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นิพนธ์ต้นฉบับ (Original article)


1. Singh M. Physical fitness and exercise. In: Pathy MSJ, Sinclair A, Morley JE, editors. Principles and practice of geriatric medicine, 4th ed. West Sussex: John Wiley & Sons, 2006. p. 123-40.
2. Tideiksaar R. Falls. In: Bonder BR, Bello-Hass VD, editors. Functional performance in older adults. 3rd ed. Philadephia: Davis, 2009. p. 193-214.
3. World Health Organization. WHO global report on falls prevention in older age. Geneva: WHO Press, 2007.
4. Shumway-Cook A, Gruber W, Baldwin M, Liao S. The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults. Phys Ther. 1997;77:46-57.
5. Aekplakorn W. Thai national health examination survey, NHES IV, 2008-2009. Nonthaburi: National Health Examination Survey Office. Health Systems Research Institute, 2010.
6. Sophonratanapokin B, Sawangdee Y, Soonthorndhada K. Effect of the living environment on falls among the elderly in Thailand. Southeast Asian J Trop Med Public Health. 2012;43:1537-47.
7. Thiamwong L, Thamarpirat J, Maneesriwongul W, Jitapunkul S. Thai falls risk assessment test (Thai-FRAT) developed for community-dwelling Thai elderly. J Med Assoc Thai. 2008;91:1823-31.
8. Kannus P, Niemi S, Palvanen M, Parkkari J. Continuously increasing number and incidence of fall-induced, fracture-associated, spinal cord injuries in elderly persons. Arch Intern Med. 2000;160: 2145-9.
9. Prachuabmoh V, Siribun S. The Thai elderly population. In: Chuharas S, editor. Situation of the Thai elderly 2010. Bangkok: TQP. 2012. p. 15-28.
10. Kannus P, Parkkari J, Koskinen S, Niemi S, Palvanen M, Järvinen M, et al. Fall-induced injuries and deaths among older adults. JAMA. 1999;281:1895-9.
11. Kim KI, Jung HK, Kim CO, Kim SK, Cho HH, Kim DY, et al. Evidence-based guideline for fall prevention in Korea. Korean J Intern Med. 2017;32:199-210.
12. Yamazaki Y, Cullen TH, Yontz V. Insights about fall prevention of older adults in the state of Hawai’i. Hawaii J Med Public Health. 2017;76:3-8.
13. Rao SS. Prevention of falls in older patients. Am Fam Physician. 2005;72:81-88.
14. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;9:CD007146.
15. Cameron ID, Gillespie LD, Robertson MC, Murray GR, Hill KD, Cumming RG, et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev. 2012;12:CD005465.
16. Grabiner MD, Bareither ML, Gatts S, Marone J, Troy KL. Task-specific training reduces trip-related fall risk in women. Med Sci Sports Exerc. 2012;44:2410-4.
17. Wongphaet P, Watchareeudomkarn W. Effect of partial body weight support treadmill training on improvement of walking and balance in elderly community-dwellers. J Thai Rehabil Med. 2016; 26:19-23.
18. Owings TM, Pavol MJ, Grabiner MD. Mechanisms of failed recovery following postural perturbations on a motorized treadmill mimic those associated with an actual forward trip. Clin Biomech. 2001;16:813-9.
19. Hannan MT, Gagnon MM, Aneja J, Jones RN, Cupples LA, Lipsitz LA, et al. Optimizing the tracking of falls in studies of older participants: comparison of quarterly telephone recall with monthly falls calendars in the MOBILIZE Boston study. Am J Epidemiol. 2010;171:1031-36.
20. Wang CY, Hsieh CL, Olson SL, Wang CH, Sheu CF, Liang CC. Psychometric properties of the Berg balance scale in a community-dwelling elderly resident population in Taiwan. J Formos Med Assoc. 2006;105:992-1000.
21. Barry E, Galvin R, Keogh C, Horgan F, Fahey T. Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta- analysis. BMC Geriatrics. 2014;14:1-14.