Review shows exercise therapy one of the best shoulder treatments

Comprehensive study needed to pull together all research on the topic

Complaints related to shoulder pain are the third-most common after those of the back and neck. About 29 out of every 1,000 individuals will have an issue with shoulder pain each year, and it has the highest incidence in women and people between the ages of 45-64. About 36% of these individuals have a condition called shoulder impingement syndrome (SIS), which is a generic term for several shoulder disorders that all lead to pain, disability and a reduced quality of life. There are many conservative (non-surgical) treatments available for SIS and an abundance of research on their effectiveness, but there is yet to be a comprehensive overview that has pulled all of these studies together and compared them to one another. For this reason, a powerful pair of studies called a systematic review and meta-analysis was conducted to provide this needed overview on various conservative treatments for SIS.

Six databases searched for relevant studies

Investigators performed a search of six major medical databases for high-quality studies called randomized-controlled trials (RCTs) that evaluated the effectiveness of a conservative treatment for SIS. RCTs randomly assign participants to a treatment group and then compare them to one—or more—other groups to gauge how well an intervention works, and they are considered the gold standard of individual research studies. This search led to 324 RCTs being screened and 200 of these being accepted into the final analysis. Conservative treatments evaluated in these studies included exercise therapy, a form of hands-on therapy called manual therapy, steroid injections, taping and non-steroidal anti-inflammatory drugs (NSAIDs), among others. Once collected, the findings from these RCTs were compared to one another and the quality of each study was assessed to determine how reliable these findings actually were.

Despite low quality of evidence, exercise is still recommended for patients with SIS

On the whole, results were supportive of both exercise therapy and manual therapy for SIS patients. For pain alone, studies showed that manual therapy was superior to no treatment or a sham treatment, and that when combined with exercise, it was more effective than exercise alone. Manual therapy was also found to have immediate effects. Regarding pain and function, exercise therapy was found to be superior to no treatment, and specific exercises were found to be more effective than non-specific exercises. Finally, studies also showed that exercise therapy was superior to non-exercise modalities—like ultrasound and electrical stimulation—for improving flexibility. Unfortunately, the quality of the research was deemed very low, which was due to lack of consistency across studies and a high risk of bias. But in spite of this shortcoming, the researchers still concluded that exercise therapy should be recommended as the first line of treatment for SIS patients, and that adding manual therapy may lead to even better results. Individuals dealing with SIS symptoms are therefore encouraged to see a physical therapist for a comprehensive treatment program that is sure to include various exercises and manual therapy. Patients should also be aware that visiting a physical therapy clinic now can be especially advantageous if they already met their insurance deductible or out-of-pocket maximum for 2018, since these visits may be covered for the rest of the year.

-As reported in the September ’17 issue of the British Journal of Sports Medicine

Exercise found to reduce risk of experiencing episodes of neck pain

All reviews on the topic up to this point suffered from certain flaws

Neck pain is one of the most common and significant health problems throughout the world. It ranks as the fourth leading cause of disability, and it’s estimated that about 48.5% of the population will deal with neck pain at some point in their lives. Individuals with neck pain generally improve over time, but in many cases the pain comes back and can end up becoming a long-term problem. This shows why it’s important to establish measures that will prevent neck pain from developing in the first place, but the available guidelines for neck pain treatment don’t include any specific recommendations for prevention. In addition, although there are large-scale reviews—systematic reviews—on the topic, they all suffer from some flaws and limitations, which means that better quality evidence is needed. For these reasons, researchers decided to conduct a powerful pair of studies called a systematic review and meta-analysis to determine what strategies were most effective for preventing an initial episode of neck pain in individuals without symptoms.

Five databases searched for relevant studies

Investigators used five medical databases to search for randomized-controlled trials (RCTs) that evaluated the effectiveness of prevention strategies for neck pain, and only accepted those that fit specific criteria. RCTs randomly assign participants to a treatment group and then compare them to one—or more—other groups to gauge how well an intervention works, and they are considered the gold standard of individual research studies. This search led to 5 RCTs being accepted into the systematic review and meta-analysis, which contained data on 3,852 participants. Once collected, the findings of these five RCTs were compared to one another, and their quality was assessed to better indicate if these findings were reliable.

Exercise identified as an effective strategy for preventing neck pain

Two of the five RCTs investigated the use of exercise programs, and researchers deemed that there was moderate-quality evidence that exercise does substantially reduce the risk of a new episode of neck pain. These exercise programs lasted for 9-12 months and consisted of various exercises that were intended to improve the strength and flexibility of the neck muscles and improve body awareness, stability and aerobic abilities. The individuals who participated in these programs reduced their risk for developing neck pain by about half. The three other RCTs investigated the use of ergonomic programs, which instruct patients make modifications to their workstations and homes that are intended to improve posture. Researchers concluded that there was low-quality evidence that these ergonomic programs do not reduce the risk of a new episode of neck pain. Based on these findings, it appears that exercise is a particularly effective strategy for reducing the risk of developing neck pain. Individuals who work a desk job and are concerned that neck pain may be a problem in the future are therefore encouraged to see a physical therapist for a preventative exercise program, which can put them ahead of the game. Now is also a great time of year to visit a physical therapist for those who have already met their insurance deductible or out-of-pocket maximum for 2018, as treatment may be covered for the rest of the year under some healthcare plans.

-As reported in the July ’18 issue of the Journal of Physiotherapy

Spine strengthening exercises lead to improvements

Condition generally tends to progress with age

Kyphosis is a disorder in which an excessive outward curvature of the spine results in an abnormal rounding of the upper back. Kyphosis generally tends to get worse with age, and once the angle progresses past 40°, it’s referred to as hyperkyphosis. Up to 40% of adults over the age of 65 have hyperkyphosis, and those with severe cases are at an increased risk for falls and fractures. Many older adults with hyperkyphosis suffer from poor and worsening quality of life and physical function due to their condition, and it’s therefore important to develop strategies to address their disorder. Previous research has shown that strengthening exercises for the back muscles can lead to improvements in patients with hyperkyphosis, but most of the included studies on the topic suffered from limitations of some sort. For this reason, a powerful study called a randomized-controlled trial (RCT) was conducted to evaluate if strengthening exercises were, in fact, effective for patients with hyperkyphosis. In the research world, RCTs are considered the gold standard for determining the benefits of a particular treatment.

99 older adults are randomly assigned to one of two groups

Individuals over the age of 60 diagnosed with hyperkyphosis were invited to participate in the study and screened by the team of researchers. In order to be accepted to the RCT, they had to be able to walk one block without an assistive device, climb one flight of stairs and rise from a chair without the use of their arms. From a pool of 598 individuals, 99 were deemed eligible and then randomly assigned to one of two groups. Half the participants were placed in the treatment group, which consisted of three hour-long weekly exercise sessions every week for six months. These sessions were led by a physical therapist and included various exercises that targeted muscle impairments that were known to be associated with hyperkyphosis. In particular, the exercises focused on strengthening and improving the flexibility of certain back muscles, and participants were also given the training to help improve their posture. The other half of participants were placed in the control group, which attended an education session every month for four months. All patients were assessed at the start of the study and then six months later for the curvature of the spine and several other outcomes.

Treatment leads to significant improvements

Results showed that patients who followed the physical therapist-led exercise program experienced several significant improvements when compared to the control group. Most importantly, the angle of the curvature of the spine reduced by an average of 3.3° in the treatment group, compared to only 0.3° in the control group. In addition, the treatment group reported better self-image and satisfaction with their appearance after completing their treatment. The findings of this RCT suggest that a treatment program that consists of strengthening exercises for the spine and posture training can lead to physical improvements in patients with hyperkyphosis, which appears to boost their confidence in turn. Individuals with hyperkyphosis interested in improving should, therefore, think about seeking out the services of a physical therapist to address their condition.

-As reported in the July ’17 issue of the Osteoporosis International

Reducing elbow injury in young pitchers requires effective prevention

Far too many players are being encouraged to ‘play through their pain’

Participation in youth sports has been increasing at a rapid rate throughout the country, and there are now more young players involved in Little League baseball than ever before. But unfortunately, the growth in popularity of baseball has also led to an epidemic of arm injuries in young throwers: recent statistics suggest that between 30-40% of 7-18 year-old baseball players experience elbow and shoulder pain during each season. To make matters worse, it’s been found that about 46% of these injured adolescents are encouraged to stay active and “play through the pain,” as it were. This is incredibly dangerous for young, developing athletes, as failing to recognize and treat an injury can lead to a far worse problems later in a career. Of particular interest are overuse injuries, which result from too much time playing one sport-like baseball-without enough rest. Tears of the ulnar collateral ligament (UCL) in the elbow are one of the more common overuse injuries in youth baseball, and the rate for surgery to treat these injuries is increasing significantly. Together, this highlights the need for a better understanding of why the number of elbow injuries in youth baseball is so high and for appropriate, effective strategies to prevent and treat them. With this in mind, two surgeons authored a commentary on the topic and their opinion on how to address the issue.

Why specializing in one sport is so risky

Perhaps the biggest factor that contributes to the high rate of injuries in youth baseball is specializing in one sport. This essentially means that these young players are involved in baseball exclusively-or nearly exclusively-and do not participate in other sports as well. Studies have shown that young athletes who play a single sport for more than nine months in a year have a 36% increase in risks associated with severe overuse injury compared to those who do not. The reason is that baseball is a demanding sport, and without sufficient time to let the body recover, the repeated trauma can lead to small damage that will grow into a more serious injury over time.

Conditioning programs created by physical therapists can help prevent overuse injuries

Due to this issue with one-sport specialization, one of the most effective ways to prevent overuse injuries is by educating baseball players about these dangers and encouraging them to not overdo it. This can be accomplished by enforcing pitch counts for young players and regulating the number of leagues and number of months that they participate in baseball throughout the year. In addition, conditioning programs that improve the strength and flexibility of the hips, back and legs can actually reduce strain on the arms and therefore reduce the risk of elbow injuries. Physical therapists are movement experts that can create these types of conditioning programs for any level of play and can modify them according to the demands of the team. Finally, young players should be urged to engage in other sports aside from baseball to increase their fitness levels and protect them from overuse injuries.

Injured players must adhere to their rehabilitation programs and take them seriously

If an injury of any sort does occur, it’s important to carefully discuss the details of it with the player, and to include their parents. Although many players and parents may have difficulty accepting that playing time needs to be stopped for a period of time or that surgery is required, these recommendations need to be taken seriously. Fortunately, most partial UCL tears can be successfully treated without surgery through a course of rehabilitation administered by a physical therapist. These programs typically include a variety of stretching and strengthening exercises, baseball-specific movements and recommendations to take some time off from throwing. In more severe cases, surgery may be needed to repair a completely torn UCL, but physical therapy will still be needed during the recovery afterwards. Regardless of the recommended treatment, it’s essential that young patients adhere to the rehabilitation program given to them and do not rush their return to baseball until they are given the OK to do so. Together, following these guidelines will reduce the risk of throwing-related elbow injuries in youth baseball and help to ensure longer, healthier careers for these developing athletes.

-As reported in the May ’18 issue of JOSPT

Two types of strength exercises lead to improvements for tennis elbow

Unclear whether one intervention is superior to the other

Lateral epicondylitis, or tennis elbow, is a common condition that results from inflammation of the tendons that join the forearm muscles on the outside of the elbow. Tennis elbow develops from overuse in sports and is frequently seen in athletes that play tennis and other racquet sports, but it can also develop in anyone that repeatedly performs activities that require the elbow and wrist. Although the majority of individuals that develop tennis elbow will improve after some basic treatments and lifestyle changes, about 20% will continue to have symptoms one year later. When tennis elbow does not improve after three months, it’s referred to as “chronic,” which is more difficult to treat. There are many treatment options available for chronic tennis elbow, including a variety of exercises guided by physical therapists, such as eccentric and concentric elbow exercises. Eccentric exercises use the elongation phase of muscle activity, which occurs while lowering weights, while concentric exercises use the contraction phase that occurs when lifting weights. It’s not clear which of these—or a combination of the two—is better, and research is limited on the topic. For this reason, a powerful study called a randomized controlled trial (RCT) was conducted to determine if eccentric or concentric exercises led to better outcomes in pain and function for patients with chronic tennis elbow.

Patients are evaluated regularly over the course of one year

Individuals who had symptoms of tennis elbow for at least three months and a verified diagnosis were recruited and asked to participate in the RCT, which led to 120 of them being accepted. These participants were then randomly and evenly assigned to either the eccentric or concentric exercise group. Both groups were instructed to perform an at-home exercise program designed by a physical therapist for the next three months. The “weight” used for the exercises was a plastic water container with a handle that weighed 1 kg (2.2 lbs) for women and 2 kg (4.4 lbs) for men. Both groups were instructed to hold the handle of the container using a clenched fist with their forearm on the armrest or adjacent table. The eccentric exercise group was instructed to lower the weight downwards while flexing their wrist, while the concentric group was instructed to lift the weight while extending the wrist, both for three sets of 15 repetitions. Participants were to perform these exercises once a day for three months, and the load was increased each week by one dL (0.22 lbs). All participants were evaluated at the start of the study and then one, two, three, six and 12 months later for pain, strength, function and several other outcomes.

Both interventions are beneficial, but eccentric exercises lead to better results

After one year, results showed that patients in both groups improved in their scores for pain and muscle strength, but the eccentric exercise group experienced greater overall improvements. This was based on the fact that the eccentric group reported a faster decrease in pain during muscle contraction and elongation, as well as a faster increase in muscle strength compared to the concentric group. This difference between groups was most noticeable at two months, but the trend continued up to the final follow-up at one year. Regarding the other outcomes of disability, function and quality of life, there were no significant differences between the two groups, which suggests that they both improved to a similar extent. Based on these findings, it appears that both an eccentric and concentric exercise program are beneficial for patients with chronic tennis elbow for up to one year, but an eccentric program provides a slight advantage of faster and greater improvements in pain and strength. Both of these exercises are routinely included in treatment programs provided by physical therapists in order to elicit positive changes. Patients currently dealing with symptoms of tennis elbow are therefore encouraged to seek out treatment at a local physical therapy clinic to help them start the path to recovery and better overall functioning.

-As reported in the September ’14 issue of Clinical Rehabilitation

Elbow injuries of the ulnar collateral ligament don’t require surgery

The number of surgeries for these injuries is increasing significantly at all levels of play

The ulnar collateral ligament (UCL) is a band of tissue that connects the inside of the upper arm bone to the inside of the forearm at the elbow. It helps to support and stabilize the arm during movements like throwing a ball, but is commonly injured in sports that require lots of overhead motions, particularly baseball. In fact, UCL injuries are often considered the most prevalent overuse injury in baseball, meaning it results from too much time throwing without enough rest. The number of UCL injuries in baseball has been steadily increasing in recent years, and along with it, so has the rate of surgeries to address them. This is true on all levels of play, as the incidence of UCL reconstruction (surgery for UCL injuries) is increasing in the major leagues and down to the level of 15-19-year-olds. However, it’s important to point out that the majority of injuries to the UCL do not actually require surgery. Research has shown that 84% of professional baseball players with partial UCL tears have been able to successfully return to play after completing non-surgical treatment like physical therapy, yet many players continue to have surgery. For this reason, a review was published to explain why non-surgical treatment should be used for most UCL injuries and what can be done to ensure a safe return to baseball.

Players should be carefully examined to confirm the UCL injury

After a baseball player is injured, an athletic trainer, physical therapist or some other medical professional must examine him to diagnose the problem. Common symptoms of a UCL injury include swelling, tenderness, loss of throwing speed or control, and pain in the middle of the elbow that is particularly strong while throwing. UCL tears usually develop gradually over time and are noticed by a gradual decline in the ability to throw, although some players experience them suddenly during play with a “popping” sensation. If a UCL injury is suspected, an imaging test like an X-ray, MRI or ultrasound is often needed to confirm it.

Non-surgical rehabilitation usually broken down into three phases

Most experts recommend that non-surgical care should be used at first to treat most UCL injuries. Non-surgical rehabilitation of these injuries is usually guided by a course of physical therapy and broken down into three phases. The goals of phase 1 are to reduce pain and restore pain-free elbow and shoulder motion through a variety of strengthening exercises. Once the patient can perform certain movements with no pain and minimal tenderness, they may progress to phase 2, in which the goals are to normalize strength and to start performing sport-specific activities. In this phase, the intensity of the strengthening exercises should be increased and patients should begin preparing for throwing again with medicine ball exercises. Finally, phase 3 is the return-to-sport phase, which can begin once the patient has a satisfactory exam, usually after about six weeks. The central part of phase 3 is a return-to-sport interval-throwing program (ITP), in which players are instructed on how to throw and pitch properly in order to avoid future injuries, which may last several weeks. This should also be accompanied with the physical therapist identifying any other factors that may increase the risk for injury-such as pitching too many fastballs, pitching through pain and not taking enough time off each year-and offering advice on how to address them. If all of these components are followed, most patients with UCL injuries can expect to recover safely and return to baseball at a similar level as before the injury. Baseball players with these injuries are therefore encouraged to visit a physical therapist for an evaluation and treatment recommendations before considering surgery.

-As reported in the September ’17 issue of The Physician and Sportsmedicine

Hands-on movement by PT have a positive effect on tennis elbow

Lateral epicondylitis, often referred to as tennis elbow, is a painful condition that results from overuse. It occurs when the tendons that connect the muscles of the forearm to the outside of the elbow become damaged and inflamed, which leads to pain or a burning sensation in this region. Tennis elbow is-unsurprisingly-most common in tennis players, but can also affect other athletes and anyone who repeatedly performs movements that involve the elbow. Most patients with tennis elbow are treated conservatively (non-surgically) at first with various interventions that are often part of a treatment plan designed by a physical therapist. Although many of these interventions have been studied, most reviews focus on several of them being used at once, which makes it difficult to determine the effectiveness of each one individually. For example, the effectiveness of joint mobilization-a technique in which the therapist moves the elbow in a number of specific ways-has not yet been evaluated in a comprehensive manner. Therefore, a powerful pair of studies called a systematic review and meta-analysis was conducted to determine if joint mobilizations are effective for improving pain, grip strength and disability for patients with tennis elbow.

Three medical databases are searched for relevant studies

Researchers performed a search of three major medical databases for studies that investigated the use of any type of joint mobilizations being used to treat adult patients with tennis elbow. A total of 257 articles were originally identified and assessed to determine if they were eligible, of these 20 met the necessary criteria and were accepted into the study. Once these studies were identified, researchers analyzed their findings and compared them to one another with the goal of finding trends about joint mobilizations. The quality of each study was also assessed so that a consensus could be made as to how reliable their findings were.

High-quality evidence shows that two types of joint mobilization are beneficial

Overall, results were supportive of the effectiveness of joint mobilizations for tennis elbow. In particular, high-quality evidence was found that showed two types of joint mobilization-mobilization with movement (MWM) and Mill’s manipulation-were more beneficial than comparison groups for improving pain in the short term and intermediate term. There was also strong evidence that MWM is more beneficial than no treatment at improving grip strength in the short term. MWM consists of a technique in which the therapist glides the forearm while securing the shoulder with the other hand, during which the patient simultaneously performs a pain-free gripping action. In Mill’s manipulation, the therapist performs a maneuver that quickly stretches out the painful tissue from tennis elbow with a thrust mechanism. Based on these findings, researchers felt confident recommending either MWM or Mill’s manipulation for a moderate-sized positive effect on pain and grip strength. Patients with symptoms that suggest tennis elbow may therefore want to consider seeing a physical therapist for their condition, since they can provide these types of mobilizations and other techniques that will help them improve in the fastest and safest manner possible.

-As reported in the April ’18 issue of the Journal of Hand Therapy

Balance training improves sports performance & may reduce injury risk

Good balance comes with several important benefits

Balance is defined as the process of maintaining the body’s center of gravity vertically over the base of support, and it relies on rapid, continuous feedback from a number of structures throughout the body. Having good postural balance is important for many reasons, as it reduces the risk for falls and resulting injuries, and also helps to optimize movements in athletic performance. This is why balance exercises are very frequently included in training programs for athletes in various sports, fall prevention programs for the elderly, and rehabilitation programs designed by physical therapists. The benefits of balance training have been identified in many studies, but the exact type of training that is most efficient still remains unclear. For this reason, researchers decided to conduct a powerful study called a systematic review. In this review, all available literature on the topic was collected and analyzed to acquire a better understanding of the effects of balance training and what type, frequency, intensity and duration are best.

A total of 50 studies are accepted into the review

Investigators performed a search of two medical databases for studies that evaluated the effectiveness of a balance-training program for either improving sports performance or preventing injuries. This search led to 2,395 studies being screened, and 50 of these fit the necessary criteria and were accepted into the review. Once collected, the findings of these studies were analyzed and compared to one another, and their quality was assessed to determine their level of reliability.

Most studies show that balance training is effective for its intended goals

Overall, results were supportive of balance training in both applications. For the first focus of the review on athletic performance, the sports most commonly studied were soccer, basketball, and handball. The majority of these studies found significant differences between the groups that participated in balance training compared to those who did not, meaning that the training was effective for improving sports performance in these athletes. Similar findings were identified for the second focus of the review as well, as balance training was also found to reduce the incidence of sports injuries among athletes of various sports, including basketball, soccer, volleyball and football. These are all high-risk sports in which an injury can lead to long-term disability if severe enough, which highlights why prevention is so important. Finally, researchers discovered that the optimal balance-training program should last for about eight weeks and consist of two 45-minute training sessions per week. Based on these findings, it appears that balance training can serve a crucial role in sports by both enhancing performance and reducing the risk for injuries. Athletes who are looking to elevate their abilities while keeping their injury risk at a minimal are therefore encouraged to contact their local physical therapist to initiate a balance-training program. These programs are designed specifically for their sport, abilities, and goals, and participation will help them to optimize and extend their careers in the safest possible manner.

– As reported in the August ’17 issue of the Journal of Human Kinetics

Review finds that exercise is one of the best ways to prevent falls

The incidence of falls is expected to continue rising

Falls are one of the biggest problems that older adults face. Data has shown that approximately 36% of adults over the age of 65 will experience a fall every year, and each one of these accidents can have serious implications. Not only can a fall result in a serious injury or death, but older individuals that do fall go on to have more anxiety and depression, and a reduced quality of life as a result. The world’s population is also aging, which means that the incidence of falls is expected to continue rising with it. This shows why it’s so important to identify methods that will help prevent falls among older persons. Many prevention methods are available and a great deal of research has been conducted on this subject, but a comprehensive review that ranks all of these methods is yet to be performed. With this in mind, a team of researchers conducted a powerful pair of studies called a systematic review and meta-analysis to determine which interventions were most effective for preventing falls in older adults.

Four medical databases searched for relevant studies

The team of researchers performed a search of four major medical databases for studies that evaluated the effectiveness of fall-prevention programs for the elderly. This led to 1,210 articles being screened and 283 randomized-controlled trials (RCTs) being accepted. RCTs are high-quality individual studies that are considered the gold standard for determining how well a treatment or intervention works. Once collected, the data from each of these RCTs were analyzed and compared to one another to detect trends and develop conclusions on the most beneficial fall-prevention programs. Researchers also assessed the quality of studies, which helped them gauge how reliable their results were.

Exercise consistently found to reduce the risk for falling

A total of 54 RCTs with 39 different interventions focused on the risk of falls that caused injury, and the findings from these studies showed that some of the most effective interventions for reducing this risk included exercise, vision assessment, and environmental assessment and modification. Another 158 RCTs with 77 interventions focused on the number of fallers, and once again, exercise was amongst the most effective strategies for reducing this figure. Other positive interventions included orthotic devices, dietary modifications and calcium and vitamin D supplementation. Most of the included RCTs had a low risk of bias, which means their quality was high and their findings could be consistently relied upon. Taken together, these results strongly suggest that exercise is one of the best possible methods for reducing the risk for falling and the number of falls in the elderly population. Other interventions like dietary and home-based modifications, vision assessments, orthotics and supplements also appear to be helpful and may be recommended in addition to exercise. Older adults who may be at risk for falling are therefore encouraged to visit a physical therapist for an exercise treatment program. These programs are based on patients’ needs and abilities, and when followed, can help reduce the risk of falls and keep seniors safer.

– As reported in the November ’17 issue of JAMA

Two exercises programs are effective in reducing falls in older men

Prevention strategies are needed to address a major danger in the elderly community

As individuals grow older, several changes occur that are considered risk factors for falling. These include decreases in balance, control of posture, muscle strength and changes in walking performance. For this reason, prevention strategies are needed to address these risk factors and lower the risk for falls in the elderly community. There are many exercise programs that are used to accomplish this, and the majority of them are based on aerobic training, which is effective for reducing fall risk factors. More recent guidelines suggest that other elements should also be included to increase the impact of these exercise programs, such as resistance exercises, which are used to increase strength. Despite the evidence available on aerobic and resistance exercises, its not completely clear if combining the two of them is any more effective than each one of them individually. For this reason, a powerful study called a randomized-controlled trial (RCT) was conducted, which is considered the gold standard used to determine the effectiveness of a treatment.

55 older men complete the 32-week study

Men between the ages of 65-79 who were medically approved for exercise were recruited for the study and screened to determine if they were eligible to participate. A total of 55 individuals fit the necessary criteria and completed the study. These participants were randomly assigned to one of three groups: the aerobic exercise group, the combined exercise group or the control group. Both exercise programs consisted of three sessions each week for 32 weeks and were planned for moderate-to-vigorous intensity. The aerobic exercise group trained twice per week in a land environment and once per week in an aquatic environment. All sessions consisted of a 10-minute warm-up, 30 minutes of brisk walking, 10 minutes of strengthening exercises and a 5-minute cooldown. The combined exercise program was the same as the aerobic exercise program, but one of the weekly land sessions was replaced by a resistance exercise session. The main part of this session consisted of a circuit of seven resistance-based strengthening exercises, which increased in intensity for the first 24 weeks and then decreased afterward until the end. The control group had no exercise intervention and was instructed to pursue their habitual daily life activities. All participants were evaluated using a number of tests before the study and then at weeks 1, 8, 16, 24 and 32.

Both exercise programs are effective, but combining them is even more beneficial

Results showed that both aerobic and resistance exercises on their own were more effective than no exercise for reducing risk factors for falls such as balance, posture control, mobility and leg strength; however, combining these two types of exercise interventions was actually even more effective for reducing these falls risk factors. In particular, the combined exercise program was found to be more effective for increasing agility, two types of balance, and leg strength and power. Although this RCT did not evaluate the actual risk for falls or fear of falling, these results do suggest that following this type of combined exercise program can result in an added protection for falls in the elderly community. Based on these findings, it appears that either an aerobic or resistance exercise program can be effective for reducing the risk of falls in older men, but combining both of them is even more effective and may serve an important role in addressing this significant danger.

-As reported in the April 17 issue of Clinical Rehabilitation