Model of Fall Prevention in The Elderly by Nine-Square Exercise

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Yaowadee Maneesub* Jenchira Sereekittikul* Netima Nerunchorn* Thanaree Krajaengjang*


Background: In the elderly, falls are a major cause of injuries, which can constrain daily activities, and can result in functional impairment, disability, or even death. Given that the number of older people is rising, the costs, which are associated with falls, are increasing. Therefore, preventing falls is an important aspect of protecting health. Exercise is one of the interventions, which can be used to prevent falls in the elderly.

Objectives: The purpose of this study was to examine the outcomes of exercise using the Nine-Square Table in elderly patients and to determine the effects that it has on promoting balance and in gaining muscle strength in the lower extremities, as well as to investigate the use of this exercise table as a model for preventing falls.

Materials and methods: This quasi-experimental study was conducted with 55 elderly males and females, who were 60 years of age and above. The samples were divided into 2 groups: an intervention group consisting of 29 participants, who performed the Nine-Square Exercise 3 days per week for 40 minutes per day, and a control group of 26 participants, who performed their usual daily activities. Before starting the program and at periods of 2, 4, and 6 months after the training, the participants were tested on balance (3-meter timed up and go test) and on the strength of their lower extremities (5-time sit to stand test). The data was obtained and then analyzed to obtain percentages, means, and standard deviations. The hypothesis was tested by the T-Test, the Mann- Whitney U- Test, and the Repeated measure ANOVA.

Results: The experimental group significantly exhibited better balance and greater muscle strength in their extremities than the control group, which had a significantly lower average score on the Timed Up and Go test and the Five-Time Sit to Stand test (F = 5.33, p < 0.05 and F = 16.96, p < 0.05).

Conclusion: This study demonstrated that intervention using the Nine-Square Exercise is effective for the elderly by improving their balance and strengthening the muscles of their lower extremities. Therefore, this exercise model is appropriate and should be used for fall prevention.     


Article Details

นิพนธ์ต้นฉบับ (Original article)


1. Kuptniratsaiku V. Exercise for the elderly. J Thai Rehabil 2000; 10: 44-50.
2. Ministry of Information and Communication Technology. Survey of the elderly in
Thailand 2014. Bangkok: National Statistical Office ; 2014.
3. Srichang n, Kawee l. Forecast to fall and crash of elderly (age 60 and up) in Thailand.
2017-2021.Nonthaburi: Bureau of Non CommunicableDiseases, Ministry of public health;
4. Tasuwanin T. Falling in the elderly. UBRU Journal for Public Health Research2016; 5(2):
5. Social situation report inRayong province, 2017 [internet]. 2017 [cited 2018 Nov 13].
Available from:
6. Nualnetr N, Aonsri C, Chaipipat N. A comparison of 9-square exercise and conventional
balance exercise on balance in older women. Thai Journal of Physical Therapy 2559; 38:
7. Jeoung BJ, Lee YC. A Study of relationship between frailty and physical performance in
elderly women. JExercRehabil 2015; 11: 215-9.
8. Ronnarithivichai C, Thaweeboon T, Petchpansri S, Sujijantararat R, Boonchan N,
Kridiborworn C. TheeEvaluation of physical fitness before and after 9-square-table aerobic
exercise and rubber ring stretching of elders in the health promotion program for the
elderly, Faculty of Nursing, Mahidol University. J NursSci 2009;27(3): 68–77.
9. Poncumhak P, Insorn T, Prasittimet N, Manota P. A pilot study on the risk of fall prediction
in Thai elderly using fivetimes sit-to-stand test. Srinagarind Med J 2014; 29:237-42.
10. Jalayondeja C. Falls screening by Timed Up and Go (TUG). J Med Tech PhyTher 2014;
11. Nokham R, Panuthai S, Khampolsiri T. Effect of square-stepping exercise on balance
among older persons. Nursing Journal 2016;43(3):58-68.
12.Junprasert S, Toonsiri C, Chala-em T, Choojun N, Kirdnoil P, Songprasert A, et al.
Impact of nine-square Thai dancing on elderly people’s health. Thai Journal of Nursing
Council 2013;28(4):68-80.