Low-Intensity Resistance Exercise with Blood Flow Restriction Improves Balance in Elderly Women: A Comparative Study on the Lower Quarter Y-Balance Test
DOI:
https://doi.org/10.56294/saludcyt20251148Keywords:
Elderly , Exercise, Posture balance, BFR therapy, StrengtheningAbstract
Introduction: Enhancing leg muscle strength in elderly could play a crucial role in reducing fall risk. A novel approach to enhance muscular strength involves the use of low-intensity resistance exercises in conjunction with blood flow restriction (BFR), as an alternative to high-intensity exercise. This study aimed to evaluate the effects of low-intensity strength exercise with BFR on lower quarter Y-balance test (LQ-YBT) performance, compare to moderate-intensity strength exercise in elderly female.
Methods: The study employed a true experimental randomized design, assessing balance using the LQ-YBT in 26 elderly women over a six-week exercise period. Subjects were divided into two groups: one performing medium-intensity strengthening exercises (≥40-60% 1 RM (Repetition Maximum)) and another engaging in low-intensity strengthening exercises (20-30%1RM) with BFR. The BFR technique involved applying a cuff to the upper third of the thigh with a restrictive pressure of 50 mmHg or 40% Artery Occlusion Pressure, which was released during rest periods.
Results: The moderate and BFR groups exhibited notable distinctions in all directions (anterior, posterolateral, posteromedial and composite) for both left and right legs (p<0.001). The disparity in LQ-YBT values between groups was notable in the right anterior (p=0.017), right posterolateral (p<0.001), right composite (p<0.001), left anterior (p=0.007), and left composite (p=0.050) directions.
Conclusions: This study showed that low-intensity resistance exercise with BFR for six weeks may yield superior improvements in the LQ-YBT for elderly women compared to moderate-intensity strengthening exercises
References
1. Dunsky A, Zeev A, and Netz Y. Balance performance is task specific in elderly. BioMed Research International [Internet]. 2017 [Accessed: 20/03/2024]; 6987017. Available in: https://doi.org/10.1155/2017/6987017
2. Shkuratova N, Morris ME, and Huxham F. Effects of age on balance control during walking. Archives of Physical Medicine and Rehabilitation [Internet]. 2004 [Accessed: 20/03/2024]; 85(4):582–8. Available in: https://doi.org/10.1016/j.apmr.2003.06.021
3. Singer JC., Prentice SD, and McIlroy WE. Age-related changes in mediolateral dynamic stability control during volitional stepping. Gait Posture [Internet]. 2013 [Accessed: 15/03/2024]; 38(4):679–83. Available in: https://doi.org/10.1016/j.gaitpost.2013.03.003
4. Takeshima NL, Islam MM, Rogers ME, Koizumi D, Tomiyama N, Narita M, and Rogers, N. L. Pattern of age-associated decline of static and dynamic balance in community-dwelling older women. Geriatrics and Gerontology International [Internet]. 2014 [Accessed: 15/03/2024]; 14(3):556–60. Available in: https://doi.org/10.1111/ggi.12132
5. Hartantri W, Andriana M, Andriati A, Satyawati R, Mikami Y, Melaniani S. Impact of multicomponent exercise (Vivifrail©) to reduce risk of falls and fear of falling in nursing home residents with frailty syndrome: randomized controlled trial. Health, Sport, Rehabilitation [Internet]. 2023 [Accessed: 20/08/2024]; 11(1). Available in: https://hsr-journal.com/index.php/journal/article/view/675
6. Freund JE, Stetts DM, Oostindie A, Shepherd J, Vallabhajosula S. Lower quarter Y-balance test in healthy women 50–79 years old. Journal of Women & Aging [Internet]. 2018 [Accessed: 20/03/2024]; 31(6):475-91. Available in: https://doi.org/ 10.1080/08952841.2018.1510248
7. Cabell L, Pienkowski D, Shapiro R, Janura M. Effect of age and activity level on lower extremity gait dynamics: an introductory study. J Strength Cond Res [Internet]. 2013 [Accessed: 20/03/2024]; 27(6):1503-10. Available in: https://doi.org/ 10.1519/JSC.0b013e318269f83d
8. Lee DK, Kang MH, Lee TS, Oh JS. Relationships among the Y balance test, Berg Balance Scale, and lower limb strength in middle-aged and older females. Braz J Phys Ther [Internet]. 2015 [Accessed: 20/03/2024]; 19(3):227-34. Available in: https://doi.org/10.1590/bjpt-rbf.2014.0096
9. Kristiana T, Widajanti N, Satyawati R. Association between muscle mass and muscle strength with physical performance in elderly in surabaya. Surabaya Physical Medicine and Rehabilitation Journal [Internet]. 2020 [Accessed: 20/03/2024]; 2(1):24–34. Available in: https://doi.org/10.20473/spmrj.v2i1.16313
10. Angulo J, Assar ME, Alvarez-Bustos A, Rodriguez-Manaz L. Physical activity and exercise: Strategies to manage frailty. Redox Biology [Internet]. 2020 [Accessed: 20/03/2024]; 35: 101513. Available in: https://doi.org/10.1016/j.redox.2020.101513
11. Nurdiansyah F, Dharmanta RS, Firdausi H, Sulistiawati NN. Profile of sarcopenia in elderly patients at the medical rehabilitation outpatient department dr. soetomo general academic hospital. Surabaya Physical Medicine and Rehabilitation Journal [Internet]. 2024 [Accessed: 20/07/2024]; 6(2):148–58. Available in: https://doi.org/10.20473/spmrj.v6i2.55119
12. Hartholt KA, Van Beeck EF, Polinder S, Velde NVD, Van Lieshout EMM, Panneman MJM, et al. Societal consequences of falls in the older population: injuries, healthcare costs, and long-term reduced quality of life. J Trauma [Internet]. 2011 [Accessed: 20/07/2024]; 71(3):748-53. Available in: https://doi.org/10.1097/TA.0b013e3181f6f5e5
13. Verma SK, Willetts JL, Corns HL, Marucci-Wellman HR, Lombardi DA, Courtney TK. Falls and fall-related injuries among community-dwelling adults in the United States. PLoS ONE [Internet]. 2016 [Accessed: 20/07/2024]; 11(3): e0150939. Available in: https://doi.org/10.1371/journal.pone.0150939
14. Avionita N, Sudyasih T. Hubungan tingkat depresi dengan risiko jatuh pada lanjut usia di rumah pelayanan lanjut usia budi dharma yogyakarta. Thesis. Yogyakarta: Universitas Aisyiyah; 2017.
15. Bergeron E, Clement J, Lavoie A, Ratte S, Bamvita JM, Aumont F, et al. A simple fall in the elderly: not so simple. J Trauma [Internet]. 2006 [Accessed: 20/07/2024]; 60(2):268-73. Available in: https://doi.org/10.1097/01.ta.0000197651.00482.c5
16. Amor-Dorado JC, Barreira-Fernandez MP, Llorca J, Gonzalez-Gay MA. Oculographic, clinical test of sensory integration and balance and computerized dynamic posturography findings in patients with psoriatic arthritis. Otol Neurotol [Internet]. 2017 [Accessed: 20/07/2024]; 38(3):448-53. Available in: https://doi.org/10.1097/MAO.0000000000001296
17. Sipe, CL, Ramey KD, Plisky PP, Taylor JD. Y-Balance Test: A valid and reliable assessment in elderly. Journal of Aging and Physical Activity [Internet]. 2019 [Accessed: 20/07/2024]; 27:663-9. Available in: https://doi.org/10.1123/japa.2018-0330
18. Plisky P, Gorman P, Butler K, Underwood F, Elkins B. The reliability of an instrumented device for measuring components of the Star Excursion Balance Test. North American Journal of Sports Physical Therapy [Internet]. 2009 [Accessed: 20/07/2024]; 4(2):92-9. Available in: https://pubmed.ncbi.nlm.nih.gov/21509114/
19. Shaffer S, Teyhen D, Lorenson D, Warren R, Koreerat C, Straseske C et al. Y-balance test: a reliability study involving multiple raters. Military Medicine [Internet]. 2013 [Accessed: 20/07/2024]; 178(11):1264-70. Available in: https://doi.org/10.7205/MILMED-D-13-00222
20. Plisky P, Schwartkopf-Phifer K, Huebner B, Garner MB, Bullock G. Systematic review and meta-analysis of the Y-balance test lower quarter: reliability, discriminant validity, and predictive validity. IJSPT [Internet]. 2021 [Accessed: 20/07/2024]; 16(5):1190-209. Available in: https://doi.org/10.26603/001c.27634
21. Taaffe DR. Sarcopenia: exercise as a treatment strategy. Aust Fam Phys [Internet]. 2006 [Accessed: 20/07/2024]; 35(3):130-4. Available in: https://pubmed.ncbi.nlm.nih.gov/16525526/
22. Clarkson MJ, Conway L, Warmington SA. Blood flow restriction walking and physical function in elderly: A randomized control trial. J Sci Med Sport [Internet]. 2017 [Accessed: 20/07/2024]; 20(12):1041-6. Available in: https://doi.org/10.1016/j.jsams.2017.04.012
23. Patterson SD, Leggate M, Nimmo MA, Ferguson RA. Circulating hormone and cytokine response to low-load resistance training with blood flow restriction in older men. Eur J Appl Physiol [Internet]. 2013 [Accessed: 20/07/2024]; 113(3):713–9. Available in: https://doi.org/10.1007/s00421-012-2479-5
24. Laswati H, Sugiarto D, Poerwandari D, Pangkahila JA, Kimura H. Low-Intensity exercise with blood flow restriction increases muscle strength without altering hscrp and fibrinogen levels in healthy subjects. Chin J Physiol [Internet]. 2018 [Accessed: 20/07/2024]; 61(3):188-95. Available in: https://doi.org/10.4077/CJP.2018.BAG567
25. Stoddard CA, Wang-Price S, Lam SE. Limb dominance does not affect Y-balance test performance in non-athlete adolescents. International Journal of Sports Physical Therapy [Internet]. 2022 [Accessed: 20/07/2024]; 17(2):164–73. Available in: https://doi.org/10.26603/001c.30996
26. Michalska J, Kamieniarz A, Sobota G, Stania M, Juras G, Slomka KJ. Age-related changes in postural control in older women: transitional tasks in step initiation. BMC Geriatr [Internet]. 2021 [Accessed: 20/07/2024]; 21:17. Available in: https://doi.org/10.1186/s12877-020-01985-y
27. Remaud A, Thuong-Cong C, Bilodeau M. Age-related changes in dynamic postural control and attentional demands are minimally affected by local muscle fatigue. Frontiers in Aging Neuroscience [Internet]. 2016 [Accessed: 20/07/2024]; 7:257. Available in: https://doi.org/10.3389/fnagi.2015.00257
28. Plisky PJ, Rauh MJ, Kaminski TW, Underwood FB. Star excursion balance test as a predictor of lower extremity injury in high school. J Orthop Sports Phys Ther [Internet]. 2006 [Accessed: 20/07/2024]; 36(12):911–9. Available in: https://doi.org/10.2519/jospt.2006.2244
29. Shallan A, Lohman E, Alshammari F, Dudley R, Gharisia O, Al-Marzouki R, et al. Comparison of postural control between subgroups of persons with nonspecific chronic low back and healthy controls during the modified Star Excursion Balance Test. Phys Ther Rehabil Sci [Internet]. 2019 [Accessed: 20/07/2024]; 8(3):125-33. Available in: https://doi.org/10.14474/ptrs.2019.8.3.125
30. Yokokawa Y, Hongo M, Urayama H, Nishimura T, Kai I. Effects of low-intensity resistance exercise with vascular occlusion on physical function in healthy elderly people. Biosci Trends [Internet]. 2008 [Accessed: 20/07/2024]; 2(3):117-23. Available in: https://pubmed.ncbi.nlm.nih.gov/20103914/
31. Di Lorito C, Long A, Byrne A, Harwood RH, Gladman JRF, Schneider S, et al. Exercise interventions for elderly: A systematic review of meta-analyses. Journal of Sport and Health Science [Internet]. 2021 [Accessed: 20/07/2024]; 10(1):29–47. Available in: https://doi.org/10.1016/j.jshs.2020.06.003
32. Pinto RS, Correa CS, Radaelli R, Cadore EL, Brown LE, Bottaro M. Short-term strength training improves muscle quality and functional capacity of elderly women. Age (Dordr) [Internet]. 2014 [Accessed: 20/07/2024]; 36(1):365-72. Available in: https://doi.org/10.1007/s11357-013-9567-2
33. Kyselovičová O, Zemková E, Péliová K, Matejová L. Isokinetic leg muscle strength relationship to dynamic balance reflects gymnast-specific differences in adolescent females. Frontiers in Physiology [Internet]. 2021 [Accessed: 20/07/2024]; 13:1084019. Available in: https://doi.org/10.3389/fphys.2022.1084019
34. Earl JE, Hertel J. Lower-extremity muscle activation during the star excursion balance tests. Journal of Sport Rehabilitation [Internet]. 2001 [Accessed: 20/07/2024]; 10(2): 93-104. Available in: https://doi.org/10.1123/jsr.10.2.9
35. Mear E, Gladwell V, Pethick J. Knee extensor force control as a predictor of dynamic balance in healthy adults. Gait Posture [Internet]. 2021 [Accessed: 20/07/2024]; 100:230-5. Available in: https://doi.org/10.1016/j.gaitpost.2023.01.004
36. Kaur N, Bhanot K, Ferreira G. Lower extremity and trunk electromyographic muscle activity during performance of the Y-balance test on stable and unstable surfaces. IJSPT [Internet]. 2022 [Accessed: 20/07/2024]; 17(3):483-92. Available in: https://doi.org/10.26603/001c.32593
37. Bigdeli S, Dehghaniyan MH, Amani-Shalamzari S, Rajabi, Gahreman DE. Functional training with blood occlusion influences muscle quality indices in elderly. Arch. Gerontol. Geriatr [Internet]. 2020 [Accessed: 20/07/2024]; 90:104110. Available in: https://doi.org/10.1016/j.archger.2020.104110
38. Kim JS, Hwang UJ, Choi MY, Kong DH, Chung KS, Ha JK, et al. Correlation between Y-balance test and balance, functional performance, and outcome measures in patients following ACL reconstruction. International journal of Sports Physical Therapy [Internet]. 2022 [Accessed: 20/07/2024]; 17(2):193–200. Available in: https://doi.org/10.26603/001c.31873
39. Harper SA, Roberts LM, Layne AS, Jaeger BC, Gardner AK, Sibille KT, et al. Blood-flow restriction resistance exercise for elderly with knee osteoarthritis: a pilot randomized clinical trial. J Clin Med. [Internet]. 2019 [Accessed: 20/07/2024]; 8(2):265. Available in: https://doi.org/10.3390/jcm802026
40. Karabulut M, Sherk VD, Bemben DA, Bemben MG. Inflammation marker, damage marker and anabolic hormone responses to resistance training with vascular restriction in older males. Clinical Physiology and Functional Imaging [Internet]. 2013 [Accessed: 20/07/2024]; 33:393-9. Available in: https://doi.org/10.1111/cpf.1204
41. Yasuda T, Fukumura K, Iida H, Nakajima T. Effects of detraining after blood flow-restricted low-load elastic band training on muscle size and arterial stiffness in older women. Springerplus [Internet]. 2015 [Accessed: 20/07/2024]; 4:348. Available in: https://doi.org/10.1186/s40064-015-1132-2
42. Prayogo M, Tinduh D, Poerwandari D, Dharmanta RS, Wulan SMM, Mikami Y, et al. Improving capacity of elderly with locomotive syndrome stage 1 living in nursing home: a pilot clinical trial. Annals of Geriatric Medicine and Research [Internet]. 2022 [Accessed: 20/07/2024]; 26(4):323-9. Available in: https://doi.org/10.4235/agmr.22.0073.
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