This presentation attached are of ownership of Justin Brooks and the Exercise and Sports Science Program of the University of Memphis. It discusses how exercise with focus on visual- reactive stimuli can be highly beneficial when training the geriatric population. Research gathered showed large increases in confidence, as well as slight increases in muscle strength, balance, agility, and a drop in reaction time. For more information associated with this presentation, please feel free to contact me at my email or phone which can be found upon my profile.

1. Reactive Stepping Training to Improve
Balance Performance in Older Adults:
A Preliminary Investigation
Justin Brooks
Mentor: Max R. Paquette, PhD

2. Background
• Estimated that 30% of the population of 65
years or older fall (Gillespie et. al, 2003)
• CDC Reported in 2010 that 2.3 non-fatal
injuries were treated (CDC, 2015)
• $30 Billion direct medical cost (Stevens et. Al, 2006)
• Exercise proven to be a beneficial and
effective intervention (Freiberger et. Al, 2012)

3. Falling
• Significant Risk Factors for the Elderly Population Falling
(Daley et. al, 2008)
– Impaired Gait, Muscle Weakness, Poor Balance & Trip Recovery,
Confidence
• Multi-Sensory and Dynamic Balance Training Methods
(Cadore et al. 2013)
• Tripping-Specific Training (Grabiner et. al, 2008 )
– Forward-directed stepping responses to postural perturbations can reduce
the number of falls compared to a non-trained control group
• Task-specific stepping response and reactive visual
training may be effective for fall prevention through
balance improvements in older adults.

4. The Quickboard
6-weeks of training in older
adults (Paquette, 2015)
– Involves quick stepping
responses based on
random visual stimuli
Results?
– Improved balance
confidence
– Improved foot speed
and reaction time
Figure 1. Quickboard setup and
control mechanism.

5. Research Aims
1. To compare the effects of six-week QuickBoard
training on fall risk (using a standardized scale)
– We expected improvements in ratings of fall risk following
training
2. Effects of six-week QuickBoard training on mobility,
balance confidence, trip response and muscle
strength.
– We expected improved mobility, confidence, stepping
response and muscle strength following training

6. Methods
• Participants
– 7 older adults between (71 ± 5.9 years)
• Testing
– 3 Testing Sessions: 1) baseline, 2) post-training and 3) 4-
week follow-up
• Training
– 6 Weeks of Training
– 3 sessions per week lasting ~30-45minutes/session
– Foot Speed and Reaction Drills

7. Dependent Variables
1. Berg Balance Scale (BBS) (Berg et. al, 1992)
– Fall Risk
2. Activities-specific Balance Confidence Scale (Portegijs et.
al, 2012)
3. TUG Test
– Mobility
4. Lab-Induced Tripping
– Reaction time (foot movement using Motion Capture (Qualisys, AB))
– Step time (foot movement to foot landing)
5. Isometric Knee Extensor Strength
– Muscle strength

8. Tripping Protocol

9. Data analyses
– Preliminary Analyses
– Small sample size (N=7)
• Cohen’s d effect sizes to compare dependent variables
before and after training.

10. Results

11. Fall Risk (BBS)
Pre to Follow
+9.0%
d = 0.3
Post to Follow
+5.0%
d = 0.2
Pre to Post
+3.3%
d = 0.2

12. Mobility (TUG)
Pre to Post
-0.3%
d = 0.2
Post to
Follow
+4.0%
d = 0.1
Pre to Follow
+3.0%
d = 0.1

13. Balance Confidence (ABC scale)
Pre to Post
+29.6%
d = 1.0
Post to
Follow
-2.0%
d = 0.1
Pre to Follow
+27.0%
d = 0.9

14. Trip Response – Reaction Time
Post to
Follow
-2.0%
d = 0
Pre to Follow
-4.0%
d = 0.11
Pre to Post
-2.0%
d = 0.11

15. Trip Response – Step Time (s)
Pre to Follow
-4.0%
d = 0.0
Pre to Post
+1.0%
d = 0.34
Post to
Follow
-3.0%
d = 0.34

16. Knee Extensor Strength (N)
Small improvement
Pre to Post
+9.1%
d = 0.3
Post to
Follow
-2.0%
d = 0.05
Pre to Follow
+7.0%
d = 0.25

17. Take-home message
• Preliminary findings suggest that QuickBoard training
produces:
– Small reductions in fall risk
– Large improvement in balance confidence
– Small improvements in mobility
– Small improvements in tripping reaction time
– Small improvement in knee extensor muscle strength

18. Future Direction?
• Comparing QuickBoard training with other
intervention modalities?
• Implementation interventions in different
populations?
– Inactive older adults?
– Active older adults?
– Older adults with history of falling?
– Prevent falls (prospective analyses)?

19. Thank You!
QUESTIONS??

20. Trip Response – Reaction Time (s)
Pre to Follow
-16.0%
d = .92
Pre to Follow
-9.0%
d = 0.45

21. Trip Response – Step Time (s)
Small improvementSmall improvement
Pre to Follow
-6.0%
d = 0.42
Pre to Follow
-4.0%
d = 0.36

22. REFERENCES
• 1. Gillespie, L.D., W.J. Gillespie, M.C. Robertson, S.E. Lamb, R.G. Cumming, and B.H. Rowe, Interventions for preventing falls in elderly people.
Cochrane Database Syst Rev, 2003(4): p. CD000340.
• 2. Centers for Disease Control and Prevention, N.C.f.I.P.a.C., Web–based Injury Statistics Query and Reporting System (WISQARS).
• 3. Stevens, J.A., P.S. Corso, E.A. Finkelstein, and T.R. Miller, The costs of fatal and non-fatal falls among older adults. Inj Prev, 2006. 12(5): p. 290-5.
• 4. Freiberger, E., L. Haberle, W.W. Spirduso, and G.A. Zijlstra, Long-term effects of three multicomponent exercise interventions on physical performance
and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial. J Am Geriatr Soc, 2012. 60(3): p. 437-46.
• 5. Reed-Jones, R.J., S. Dorgo, M.K. Hitchings, and J.O. Bader, Vision and agility training in community dwelling older adults: incorporating visual
training into programs for fall prevention. Gait Posture, 2012. 35(4): p. 585-9.
• 6. Hennessey, J.V., J.A. Chromiak, S. DellaVentura, S.E. Reinert, J. Puhl, D.P. Kiel, C.J. Rosen, H. Vandenburgh, and D.B. MacLean, Growth hormone
administration and exercise effects on muscle fiber type and diameter in moderately frail older people. J Am Geriatr Soc, 2001. 49(7): p. 852-8.
• 7. Clemson, L., M.A. Fiatarone Singh, A. Bundy, R.G. Cumming, K. Manollaras, P. O'Loughlin, and D. Black, Integration of balance and strength training
into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. BMJ, 2012. 345: p. e4547.
• 8. Lustosa, L.P., J.P. Silva, F.M. Coelho, D.S. Pereira, A.N. Parentoni, and L.S. Pereira, Impact of resistance exercise program on functional capacity and
muscular strength of knee extensor in pre-frail community-dwelling older women: a randomized crossover trial. Rev Bras Fisioter, 2011. 15(4): p. 318-24.
• 9. Fiatarone, M.A., E.F. O'Neill, N.D. Ryan, K.M. Clements, G.R. Solares, M.E. Nelson, S.B. Roberts, J.J. Kehayias, L.A. Lipsitz, and W.J. Evans,
Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med, 1994. 330(25): p. 1769-75.
• 10. Hagedorn, D.K. and E. Holm, Effects of traditional physical training and visual computer feedback training in frail elderly patients. A randomized
intervention study. Eur J Phys Rehabil Med, 2010. 46(2): p. 159-68.
• 11. Barnett, A., B. Smith, S.R. Lord, M. Williams, and A. Baumand, Community-based group exercise improves balance and reduces falls in at-risk older
people: a randomised controlled trial. Age Ageing, 2003. 32(4): p. 407-14.
• 12. Hauer, K., B. Rost, K. Rutschle, H. Opitz, N. Specht, P. Bartsch, P. Oster, and G. Schlierf, Exercise training for rehabilitation and secondary prevention
of falls in geriatric patients with a history of injurious falls. J Am Geriatr Soc, 2001. 49(1): p. 10-20.
• 13. King, M.B., R.H. Whipple, C.A. Gruman, J.O. Judge, J.A. Schmidt, and L.I. Wolfson, The Performance Enhancement Project: improving physical
performance in older persons. Arch Phys Med Rehabil, 2002. 83(8): p. 1060-9.
• 14. Binder, E.F., K.B. Schechtman, A.A. Ehsani, K. Steger-May, M. Brown, D.R. Sinacore, K.E. Yarasheski, and J.O. Holloszy, Effects of exercise training
on frailty in community-dwelling older adults: results of a randomized, controlled trial. J Am Geriatr Soc, 2002. 50(12): p. 1921-8.

23. REFERENCES (continued…)
• 15. Lord, S.R., S. Castell, J. Corcoran, J. Dayhew, B. Matters, A. Shan, and P. Williams, The effect of group exercise on physical functioning and
falls in frail older people living in retirement villages: a randomized, controlled trial. J Am Geriatr Soc, 2003. 51(12): p. 1685-92.
• 16. Daley, M.J. and W.L. Spinks, Exercise, mobility and aging. Sports Med, 2000. 29(1): p. 1-12.
• 17. Lamoth, C.J., R. Alingh, and S.R. Caljouw, Exergaming for elderly: effects of different types of game feedback on performance of a balance
task. Stud Health Technol Inform, 2012. 181: p. 103-7.
• 18. Granacher, U., T. Muehlbauer, S.A. Bridenbaugh, M. Wolf, R. Roth, Y. Gschwind, I. Wolf, R. Mata, and R.W. Kressig, Effects of a salsa
dance training on balance and strength performance in older adults. Gerontology, 2012. 58(4): p. 305-12.
• 19. Lajoie, Y., Effect of computerized feedback postural training on posture and attentional demands in older adults. Aging Clin Exp Res, 2004.
16(5): p. 363-8.
• 20. Smith, S.T., C. Sherrington, S. Studenski, D. Schoene, and S.R. Lord, A novel Dance Dance Revolution (DDR) system for in-home training of
stepping ability: basic parameters of system use by older adults. Br J Sports Med, 2011. 45(5): p. 441-5.
• 21. Cadore, E.L., L. Rodriguez-Manas, A. Sinclair, and M. Izquierdo, Effects of different exercise interventions on risk of falls, gait ability and
balance in physically frail older adults. A systematic review. Rejuvenation Res, 2013.
• 22. Grabiner, M.D., M.L. Bareither, S. Gatts, J. Marone, and K.L. Troy, Task-specific training reduces trip-related fall risk in women. Med Sci
Sports Exerc, 2012. 44(12): p. 2410-4.
• 23. Paquette, M.R., Y. Li, J. Hoekstra, and J. Bravo, An 8-week reactive balance training program in older healthy adults: a preliminary
investigation. Journal of Sport and Health Science, 2015: p. 1-8.
• 24. Berg, K.O., S.L. Wood-Dauphinee, J.I. Williams, and B. Maki, Measuring balance in the elderly: validation of an instrument. Can J Public
Health, 1992. 83 Suppl 2: p. S7-11.
• 25. Portegijs, E., J. Edgren, A. Salpakoski, M. Kallinen, T. Rantanen, M. Alen, I. Kiviranta, S. Sihvonen, and S. Sipila, Balance confidence was
associated with mobility and balance performance in older people with fall-related hip fracture: a cross-sectional study. Arch Phys Med Rehabil,
2012. 93(12): p. 2340-6.
• 26. Klima, D.W., R.A. Newton, E.A. Keshner, and A. Davey, Fear of Falling and Balance Ability in Older Men: The Priest Study. J Aging Phys
Act, 2012.
• 27. Galpin, A.J., Y. Li, C.A. Lohnes, and B.K. Schilling, A 4-week choice foot speed and choice reaction training program improves agility in
previously non-agility trained, but active men and women. J Strength Cond Res, 2008. 22(6): p. 1901-7.