The effectiveness of progressions of difficulty during an exercise program to improve balance and gait in older individuals: a randomized clinical trial

Abstract

Background: Little is discussed about the effectiveness and systematization of progressions of difficulty during balance exercises. Exercise progression provides continuous stimulation and assists physical therapists in offering challenges to patients.

Objective: To investigate the effectiveness of an exercise program with systematic progression of difficulty for older individuals.

Methods: Randomized clinical trial, with 22 older individuals allocated to experimental (EG, N = 12) or control (CG, N = 10) group. In EG, individuals performed an exercise program with progressions of difficulty for 12- weeks (2 days/week, 1 h/session). In the control group the participants performed the same program without progressions of difficulty. The Berg Balance Scale (BBS), Timed up and Go (TUG), and modified Dynamic Gait Index (mDGI) were assessed after and before the 24 exercise sessions. An intention-to-treat approach and multiple imputation by chained equations were utilized. Raw data were transformed into standardized individual differences (SID) and analyzed using one-way ANCOVA to test group effects, with baseline and age as covariates. A one-sample t-test was used to compare SIDs against zero. Effect sizes were estimated using partial eta squared (ηp²) and Cohen’s d.

Results: ANCOVA revealed no significant group effect across any of the variables. Baseline values emerged as significant predictor of changes in BBS (P = 0.038, ηp²=0.219), TUG (P = 0.042, ηp²=0.210), and mDGI (P < 0.001, ηp²=0.545), suggesting a substantial differences among participants with lower baseline values. Age also emerged as a significant predictor of change for mDGI (P = 0.002, ηp²=0.431). Comparison with zero-value produced significant differences for BBS and mDGI, indicating increases in post-intervention for both groups.

Conclusion: Applying progressions of difficulty to the exercises, did not lead to greater improvements than not applying them.