Effect of hemibridge with ball and balloon exercise on balance, gait speed, fear of fall, and quality of life in elderly – A randomized controlled trial

Anil Rachappa Muragod; Shikha Vedprakash Paasi

doi:10.4103/ijptr.ijptr_42_22

ORIGINAL ARTICLE

Year : 2023 | Volume : 5 | Issue : 1 | Page : 88-93

Effect of hemibridge with ball and balloon exercise on balance, gait speed, fear of fall, and quality of life in elderly – A randomized controlled trial

Anil Rachappa Muragod, Shikha Vedprakash Paasi
Department of Geriatric Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India

Date of Submission	30-Mar-2022
Date of Decision	26-Feb-2023
Date of Acceptance	30-Jun-2023
Date of Web Publication	11-Aug-2023

Correspondence Address:
Dr. Anil Rachappa Muragod
Department of Geriatric Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijptr.ijptr_42_22

Abstract

Context: Hemibridge with ball and balloon exercise causes co-contraction of the core, pelvic floor muscles, and lower limb muscles. However, limited data exist about the efficacy of these exercises in elderly individuals.
Aim: The aim of this study was to determine the effect of hemibridge with ball and balloon exercise on balance, gait speed, fear of falls, and quality of life in elderly individuals.
Settings and Design: A randomized controlled trial was conducted at a tertiary care center and old age homes.
Subjects and Methods: Thirty-six (n = 36) elderly individuals were randomly allocated to the control and experimental groups. The control group received conventional balance training, while the experimental group received hemibridge with ball and balloon exercises with conventional balance training exercises. The outcome measures were the Timed-Up and Go test (TUG), 4-m gait speed (4MGS) test, Short Falls-Efficacy Scale (SFES), and RAND 36-Item Short-Form Survey (SF-36). Both groups received treatment for 3 weeks with three sessions a week.
Statistical Analysis: The test used for between-group analysis was the Mann–Whitney U-test and for within-group analysis was the Wilcoxon matched-pair test.
Results: The between-group results for TUG, 4MGS test, and SFES for the experimental group showed a statistical significance compared to the control group. However, the results of the RAND SF-36 health survey for the experimental group were not statistically significant compared to the control group.
Conclusion: Hemibridge with ball and balloon exercise with conventional balance exercises showed beneficial effects on balance, gait speed, fear of falls, and quality of life for the elderly.

Keywords: Elderly, Fear of falls, Gait speed, Hemibridge, Quality of life

How to cite this article:
Muragod AR, Paasi SV. Effect of hemibridge with ball and balloon exercise on balance, gait speed, fear of fall, and quality of life in elderly – A randomized controlled trial. Indian J Phys Ther Res 2023;5:88-93

How to cite this URL:
Muragod AR, Paasi SV. Effect of hemibridge with ball and balloon exercise on balance, gait speed, fear of fall, and quality of life in elderly – A randomized controlled trial. Indian J Phys Ther Res [serial online] 2023 [cited 2023 Sep 27];5:88-93. Available from: https://www.ijptr.org/text.asp?2023/5/1/88/383679

Introduction

In the elderly population, falls are a life threat to their physical health and well-being. Falls leading to injuries, come under the 6^th major reason of mortality in the geriatric population.^[1] Fear of falling (FOF) is stated as a concern about falling that leads an individual to restrict activities that he/she remains capable of performing.^[2] FOF leads to a change in gait, a decrease in the activity level, and the use of assistive devices for ambulation.^[3],[4] The literature has stated that with aging, the gait speed has been known to deteriorate with functional balance.^[5] A wide range of exercise protocols has been devised to enhance the balance and gait parameters in the elderly population, which include flexibility exercises, high- and low-intensity strengthening exercises, agility training, directional training, and home-based self-performing exercises.^[4],[6]

Few studies have shown that when examined, FOF and quality of life have a significant association. The association between them is due to the decline in physical activity due to the presence of FOF.^[3] Evidence has established the connection between weakened trunk musculature strength and balance with functional ability in the elderly population. Furthermore, investigations have found that the composition of the trunk muscle can be used to predict functional ability in the elderly.^[3],[7] Multiple authors have established the relationship between core musculature strength and co-activation and its contribution to balance, and lower limb impairments in the elderly. The combination of the co-activation of the core muscles with contraction of the diaphragm on balance, gait speed, fear of falls, and quality of life for the elderly was paucity in the studies. Hence, the study was intended to take.

Hence, the hemibridge is one such exercise that brings about a co-contraction of the diaphragm, the core muscle, and the pelvic musculature. It leads to repositioning the zone of apposition (ZOA) correctly with the spine and letting the diaphragm execute its role in respiration and postural stability correctly.^[8] This helps to attain the diaphragm's correct ZOA, which may optimize the functioning of the diaphragm and with the overall recruitment of the deep core muscles, allow them to perform as better stabilizers.^[9] It was hypothesized that the hemibridge exercise can bring about a change in the mobility, stability, and quality of life of the elderly. Hence, the present study aimed to determine the effectiveness of the hemibridge with ball and balloon exercise on balance, gait speed, FOF, and quality of life in the elderly population.

Subjects and Methods

Approval from the Institutional Ethical Committee was obtained for the study. The participants were recruited from a tertiary care center and old age homes in Belagavi City, Karnataka, India. All the participants underwent an assessment for the inclusion and exclusion criteria and were informed about the aims and procedure of the study. An informed consent form was acquired from all the participants who were willing to participate. The sample size obtained was 36 (18 in each group), using the formula, where Z1–α/2 = standard value for the corresponding level of confidence, which was 1.96 for 95% confidence interval, and Z1–β = value for desired power, which was 0.84 for 80%.

[Figure 1] is the CONSORT flow diagram, which shows 48 elderly participants who were screened for eligibility; out of which 36 participants were recruited. The inclusion criteria – participants were functionally independent, with low to moderate fall scores on the Short Falls-Efficacy Scale (SFES), with an MMSE score of more than 24, and willing to participate were included in the study. Participants with lower limb deformities, unstable cardiorespiratory disease, postoperative abdominal surgery, or coronary artery bypass graft within the past 6 months or diagnosed with cerebrovascular accident (CVA), vertigo, diabetic neuropathy, chronic osteoarthritis, and rheumatoid arthritis were excluded from the study (n = 12). The 36 participants were randomly allocated using the envelope method into two groups, i.e., the control group (Group A = 18) and the experimental group (Group B = 18).

Figure 1: CONSORT flow diagram

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Outcome assessment

The assessment was done by a certified physiotherapy practitioner. The assessment and collection of pre- and postintervention data were done twice in the entire timespan of the study. The assessment and collection of data were done before the beginning of the intervention and postintervention after 3 weeks. The outcome measures quantified balance, gait speed, fear of falls, and quality of life with the Timed-Up and Go test (TUG),^[10] 4-m gait speed (4MGS),^[11] SFES,^[12],[13] and RAND Short-Form (SF-36) Health Survey.^[14]

Procedure for intervention

The control group (Group A) consisted of 18 participants recruited from tertiary care centers and old age homes and received conventional balance exercises which were tandem stance, tandem walking, Romberg stance, walking forward and backward on a line, standing on the toe and heel, and one-leg standing. Each exercise was performed in 10 repetitions in two sets. The exercises were performed in a group setting of 3–4 participants per group without footwear, without assistive mobility devices, and under supervision. Moreover, the duration of the exercises was for 3 weeks, three sessions a week for 30 min per session^[15] [Table 1].

Table 1: The exercise protocol of the control group

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In the experimental group (Group B), 18 participants received the hemibridge with ball and balloon exercise. The exercises were performed in a group setting of 3–4 participants per group without footwear, without assistive mobility devices, and under supervision [Table 2] and [Figure 2]. The exercises have been used with copyright permission from the Postural Restoration Institute (Copyright © Postural Restoration Institute™ 2012).

Table 2: The exercise protocol for the experimental group

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Figure 2: Hemibridge with ball and balloon exercise

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The steps of the exercise were as below:

The participants lie on their back and their knees and hips at a 90° angle from each other with their feet placed on a wall
A 4–6-inch ball is placed between their knees
The participants should keep their right arm above their head and hold a balloon in their left hand
They must breathe in through the nose, and as they exhale through the mouth, the participants must perform a posterior pelvic tilt, keeping their low back flat on the floor. The participants must not press their feet flat on the wall. They must press only their heels on the wall
The participants must move their left knee down such that it is below the right knee, and without moving the feet, they must press their left knee into the ball and engage the left inner thigh
Keeping the left knee down, the participants should lift their right foot away from the wall, and let the back of the left thigh feel engaged or under contraction. Ask the participants to maintain this position throughout the exercise
Now, the participants must place the balloon on their lips and inhale through their nose and slowly blow out into the balloon
Stop for 3 s with the tongue touching the roof of the mouth to prevent airflow out of the balloon
Without closing the neck of the balloon, ask the participants to keep their tongue on the roof of their mouth and inhale again through the nose
Next, ask the participants to slowly blow out as they hold the balloon with their hand
Advise the participants not to strain their cheeks while doing so
After the fourth inspiration, close the balloon neck, remove it from the mouth, and let the air out of the balloon
Relax and repeat the sequence four more times.

The exercise sessions were done for five repetitions in each session, with 30 min of conventional balance training exercises for three sessions a week for 3 weeks.^[8]

Statistical analysis

The present study used the Statistical Package for the Social Sciences (IBM SPSS Chicago, Illinois- U.S.A) version 23 for statistical analysis. The normality of demographic data such as age, sex, height, weight, and body mass index (BMI) was evaluated using an unpaired t-test. The normality of all the variables at the pretest and posttest scores was compared between the two groups using the Kolmogorov–Smirnov test. The pretest and posttest values were not normally distributed; hence, the Mann–Whitney U-test was applied for between the groups and the Wilcoxon matched-pair test was applied for within the groups.

Results

The baseline demographic profile was tabulated according to the participant's age, height, weight, and BMI [Table 3]. [Table 4], [Table 5], [Table 6], [Table 7], [Table 8] describe the comparison of pre–postintervention values between and within the groups in terms of TUG, 4MGS, Falls-Efficacy Scale, and RAND SF-36 Health Survey.

Table 3: Comparison of the baseline demographic parameters between two groups (n=36)

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Table 4: Comparison of Group A and Group B within and between the groups with respect to the Timed-Up and Go test scores

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Table 5: Comparison of Group A and Group B within and between the groups with respect to 4-m gait speed scores

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Table 6: Comparison of Group A and Group B within and between the groups with respect to the Short Falls-Efficacy Scale scores

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Table 7: Comparison of Group A and Group B between groups with respect to all eight domains of RAND Short-Form 36-Item Health Survey scores

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Table 8: Comparison of Group A and Group B within groups with respect to all eight domains of RAND Short-Form 36-Item Health Survey scores

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In within the groups analysis for TUG, the P value for the control group was 0.3003, and the experimental group had P = 0.0004, which was statistically significant. In between the groups analysis for the TUG, the P value for the difference in the mean values between the groups was 0.0001, which showed a statistically significant difference.

For this 4MGS test, within the two groups, the P value for the control group was 0.5049, and the experimental group had P = 0.0008, which was statistically significant. Between the groups analysis showed that the P value for the difference in the mean values between the groups was 0.0010, which was statistically significant.

Within the groups comparison of the SFES scores, the control group had P = 1.0000, and the experimental group had P = 0.0077. Between the groups analysis showed that the P value of the mean difference values between the groups was 0.0068, which was statistically significant.

For this within the groups analysis for all the eight domains of the RAND SF-36 Health Survey, none of the P values of the eight domains were not statistically significant. The same was noted in the between-group analysis for all eight domains, where the P values of each domain were statistically not significant.

Discussion

The present study has stated that the group which had received the Hemibridge with ball and balloon exercise had better improvement in the outcome measures except for the quality of life.

Hemibridge exercise with ball and balloon is a type of exercise that brings about the integration of activation of the deep abdominal muscles with the proper positioning of the diaphragm and pelvic floor musculature.^[8] Research has now shown that core strengthening exercises bring about lumbar stabilization and motor control. Moreover, motor learning causes an enhancement in the muscle reflex and proprioceptive sensation, which in turn controls the balance of an individual. Thus, improving the core musculature strength, in turn, improves the individual's balance control.^[16] To assess the effects of core stabilization exercise on the gait function and dynamic balance in stroke patients, a study was conducted, whose results stated that the group receiving the core stabilization exercises had an improvement in the dynamic balance, gait velocity, and cadence.^[17] The reason stated that these exercises may cause the pelvis to undergo a posterior tilt and that may have led to the transfer of the center of gravity during the swing phase, which could be the reason for the improvement in the gait parameters. This could be the same reason for the improvement of gait speed as these exercises cause the pelvis to move into a posterior tilt and maintain it throughout the exercises.^[17] As the results of this present study have stated that there is an improvement in the balance and gait speed of the participants after the intervention of hemibridge with ball and balloon exercise, it can be assumed that this improvement in balance and gait speed can be associated with a decrease in the FOF as these three factors are interdependent.

A randomized controlled study was conducted to examine the Pilates exercise effects in aged adults on muscle strength, postural balance, and quality of life.^[18] Pilates is seen as a holistic method of strengthening the core muscles with muscles of all the limbs, which is similar to the hemibridge with ball and balloon exercise. The results of the study in context to SF-36 and all its eight domains showed that after 12 weeks of Pilates, there was a significant improvement in all the domains of SF-36. This result does not correspond to the results obtained in the present study. The reason could possibly be due to less time allotted for intervention; week-wise. This study had 24 sessions of Pilates for 12 weeks, twice a week for 60 min per session,^[18] while the exercise protocol for the present study was for nine sessions only, where three sessions a week for 30 min per session. This could have played a role in not improving the quality of life of the participants as the duration of the intervention was not sufficient enough to help transfer the benefits of the exercises into the daily life activities of the participants.

The present study had a few limitations. First, we were unable to assess the efficiency of hemibridge with ball and balloon exercises and core strengthening exercises, which could have given a clearer picture of the clinical efficiency of the exercises individually. Second, it was not possible to assess the strength of the abdominals and back extensors separately. In the future, long-term effects and follow-up studies can be conducted to understand the maintenance of the results achieved due to the hemibridge with ball and balloon exercise.

Conclusion

The study concluded that hemibridge with ball and balloon exercise is effective in improving the balance, gait speed, FOF, and quality of life in elderly people with balance issues.

Acknowledgment

We would like to thank the residents of Vrudhashram old age home for their cooperation.

Financial support and sponsorship

The study was funded by the KAHER Institute of Physiotherapy, Belagavi, Karnataka.

Conflicts of interest

There are no conflicts of interest.

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