The Comparison of Effectiveness of Mindfulness, Balance and Combined Exercises on the Balance and Fear of Falling in the Elderly

Document Type : Original Article

Authors

1 Dept. of Sport Sciences, Imam Reza International University, Mashhad, Iran

2 Dept. of ُSport Injuries and Corrective Exercises, Sport Sciences, Research Institute, Tehran, Iran

Abstract

Although the phenomenon of aging cannot be stopped, the disorders and disabilities of this period can be prevented or postponed through proper planning and the use of methods and principled cares. Therefore, this study was to evaluate the effectiveness of mindfulness, balance and combined exercises (balance-mindfulness) on the balance and fear of falling in the elderly. The research method was quasi-experimental with pretest-posttest design and a control group. The statistical population included all the elderly living in Mashhad, Iran with balance problem or fear of falling. Participants included 48 elderly women (60 to 79 years old) who were randomly assigned into four groups of 12 people. In order to collect data, the international falling efficiency questionnaire and Berg’s balance test were used. Univariate analysis of covariance (ANCOVA) was used to analyze the data in SPSS-20 and Excel 2013 software. The findings revealed that compared to control group, all three training methods of mindfulness, balance, and the combination of mindfulness-balance had a significant effect on balance performance and fear of falling in the elderly women, as such, increased the balance and reduced the fear of falling. Besides, the findings indicated that there is a significant difference between the mindfulness, balance and combined methods in terms of their effectiveness on balance performance and fear of falling in the elderly women. In this sense, the combined exercise, mindfulness and balance methods had a greater effect on improving balance and reducing the fear of falling, respectively. Therefore, in order to improve the level of motor (balance) and psychological (fear of falling) indicators affecting the performance of the elderly women, it is recommended to use a combination of balance exercises and mindfulness, considering the characteristics of exercise.
References
Åberg, A. C., Frykberg, G. E., & Halvorsen, K. (2010). Medio-lateral stability of sit-to-walk performance in older individuals with and without fear of falling. Gait & Posture 31(4), 438-443.
Azim Khani, A., Abbasian, P., Anoushirvani, S., Rastegar Moghadam, Mahsa., Zibaei, Amir., And Shibak, Manijeh. (2021). Aging and Sports Activities. Mashhad, Imam Reza University. [Persian]
Bahrami, L., Salianeh, M., Farsi, A., & Nik Ravan, A. (2017). The effect of mindfulness exercises and motor working memory on the quality of life of active elderly. Sports Psychology Studies, 6 (21), 1-16. [Persian]
Baluchi, R. (2015). The effect of a balance training course on the postural factors of the elderly. Journal of Applied Sport Psychology, (11) 21, 93-102. [Persian]
Binda, S. M., Culham, E. G., & Brouwer, B. (2003). Balance, muscle strength, and fear of falling in older adults. Expermimental Aging Reserch, 29(2), 205-219.
Boivin, J., Griffiths, E., & Venetis, C. A. (2011). Emotional distress in infertile womenand failure of assisted studies. BMJ, 342, Article d223.
Boyd, R., & Stevens, J. A. (2009). Falls and fear of falling: burden, beliefs and behaviours. Age and Aging, 38(4), 423-428.
Britton, W. B., Shahar, B., Szepsenwol, O., & Jacobs, W. J. (2012). Mindfulness-based cognitive therapy improves emotional reactivity to social stress: results from a randomized controlled trial. Behavior Therapy, 43(2), 365-380.
Costa, S. N., Vieira, E. R., & Bento, P. C. (2020). Effects of home-and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial. Journal of Aging and Physical Activity, 28(1), 122-130.
Di Lorito, C., Long, A., Byrne, A., Harwood, R. H., Gladman, J., Schneider, S., Logan, P., Bosco, A., & van der Wardt, V. (2021). Exercise interventions for older adults: A systematic review of meta-analyses. Journal of Sport and Helath Science, 10(1), 29-47.
Fallahpour, M., Jaghtai, M., Ashayeri, H., Salavati, M., & Hosseini, S. (2003). The effect of mental training on the balance of the elderly. Rehabilitation, 4 (3), 34-39. [Persian]
Fathi Rezaei, Z., Aslankhani, M., Farsi, A., Abdoli, B., & Zamani Thani, S. (2009). Comparison of three functional balance tests in identifying the elderly with and without a history of falls. Journal of Knowledge and Health, 4 (4), 21-26. [Persian]
Friedman, S. M., Munoz, B., West, S. K., Rubin, G. S., & Fried, L. P. (2002). Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. Journal of the American Geriatrcs Society, 50(8), 1329-1335.
Gavi S., Sohrabi, M., Gol Mohammadi, B., Karimi, N., Sahaf, R., and Rahimi, M. (2015). The effect of whole body vibration training and mental training on balance in older men. Elderly, 9 (4), 306-312. [Persian]
Ghasempour, L., Hoseini, F. S., Soleymani, M., Ahmadi, M. (2017). Effects of physical fitness exercise, mental exercise and mindfulness exercise on static and dynamic balance in elderly women. Salmand: Iranian Journal of Ageing, 12 (2), 180-191.
Goldin, P. R., & Gross, J. J. (2010). Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion, National Liberery of Medicine, 10 (1), 83-100.
Habibi, M., & Hanasabzadeh Esfahani, M. (2014). The effectiveness of mindfulness-based art therapy on depression, anxiety, stress and quality of life in postmenopausal women. Eledrly, 9 (1), 22-31. [Persian]
Hosseini, M., Lajevardi, L., & Taghizadeh, Q. (2019). The effect of mental exercises on fear of falling in daily life activities, satisfaction and lower limb function in the elderly living in community-clinical tria.  Komesh, 4(21) ,619-627. [Persian]
Hyun, J., Hwangbo, K., & Lee, C. W. (2014). The effects of pilates mat exercise on the balance ability of elderly females. Journal of Physical Therapy Science, 26(2), 291-293.
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future. Wiley Online Library.
Kamran Mehr, F., Farsi, A., & Kaviani, M. (2020). Comparison of the effectiveness of mindfulness exercises and bio-relaxation feedback on anxiety, depression and functional and static balance in elderly women with mild depression and anxiety. Psychology of Aging, 6 (3), 233-248. [Persian]
Kamrani Faraz, N., Letafat Kar, A., & Javdaneh, N. (2017). Effect of a water resistance combined training on balance and fall risk in elderly women over 60 years in Tehran. Iranian Journal of Rehabilitation Research in Nursing (IJRN), 4(1), 45-50.
Karami, M., Hadian, M., Abdul Wahab, M., Raji, P., Yakani Nejad, M., & Montazeri, A. (2014). The effect of mental exercises on improving the quality of life of older men 60 to 80 years. Modern Rehabilition, 8 (3), 30-21. [Persian]
King, M. B., Judge, J. O., Whipple, R., & Wolfson L. (2000). Reliability and responsiveness of two physical performance measures examined in the context of a functional training intervention. Physical Therapy, 80(1), 8-16.
Kumar, C. (2017). Comparison between Tai Chi and balance-strength training exercise to decrease fear of fall and improving balance and functional mobility in elderly. Journal of Novel Physiotherapies7, 350-363.
Mattes, J. (2016). Attentional focus in motor learning, the Feldenkrais method, and mindful movement. Perceptual and motor skills, National Liberery of Medicine, 123(1), 258-276.
Mokhtari, M., Bahram, M., Puruqar, M., & Akasheh, G. (2013). The effect of Pilates program on psychological and social factors related to falling in elderly women. Feiz, 17 (5), 453-462. [Persian]
Parry, S. W., Steen, N., Galloway, S. R., Kenny, R. A., & Bond, J. (2001). Falls and confidence related quality of life outcome measures in an older British cohort. Postgraduate Medical Journal, 77(904), 103-108.
Pfeiffer, K., Kampe, K., Klenk, J., Rapp, K., Kohler, M., Albrecht, D., & Becker, C. (2020). Effects of an intervention to reduce fear of falling and increase physical activity during hip and pelvic fracture rehabilitation. Age and Aging, 49(5), 771-778.
Rahal, M. A., Alonso, A. C., Andrusaitis, F. R., Rodrigues, T. S., Speciali, D. S., Greve, J. M. D., & Leme, L. E. G. (2015). Analysis of static and dynamic balance in healthy elderly practitioners of Tai Chi Chuan versus ballroom dancing. Clinics, National Liberery of Medicine,70, 157-161.
Salkeld, G., Cameron, I. D., Cumming, R. G., Easter, S., Seymour, J., Kurrle, S. E., & Quine, S. (2000). Quality of life related to fear of falling and hip fracture in older women: a time trade off studyBmj, 320(7231), 341-346.
Scheffer, A. C., Schuurmans, M. J., Van Dijk, N., Van Der Hooft, T., & De Rooij, S. E. (2008). Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age and ageing, Age and Aging, 37(1), 19-24.
Shamsi Purdakordi, P., Aslankhani, M., & Shams, A. (2010). The effect of physical, mental and combined exercises on static and dynamic balance of the elderly. Journal of Sharekord University of Medical Sciences, 12 (4), 71-77. [Persian]
Sharma, M., & Rush, S. E. (2014). Mindfulness-based stress reduction as a stress management intervention for healthy individuals: a systematic review. Journal of Evidence-Based Complementary & Alternative Medivine, 19(4), 271-286.
Shir Alizadeh, M., AzimKhani, A., & Nejat, H. (2021). The effect of combined exercises on the feeling of loneliness, pleasure and desire to continue the activity of the elderly (unpublished Master Thesis). Imam Reza University. Mashhad.
Stanghelle, B., Bentzen, H., Giangregorio, L., Pripp, A. H., Skelton, D. A., & Bergland, A. (2020). Effects of a resistance and balance exercise programme on physical fitness, health-related quality of life and fear of falling in older women with osteoporosis and vertebral fracture: a randomized controlled trial. Osteoporses Internatinal, 31(6), 1069-1078.
Taheri, M., Irandoost, Kh., Mir Moazi, M., & Taheri, Z. (2019). The effect of mental exercises, yoga and cook san do on functional tests in the elderly with mobility limitations. Journal of Disability, 9 (1), 1-8. [Persian]
Takeshima, N., Islam, M. M., Rogers, M. E., Rogers, N. L., Sengoku, N., Koizumi, D., Kitabayashi, Y., Imai, A., & Naruse, A. (2007). Effects of nordic walking compared to conventional walking and band-based resistance exercise on fitness in older adults. Journal of Sports Science & Medicine, 12(3), 422-430.
Yardley, L., Beyer, N, Hauer., K, Kempen, G., PiotZiegler, C., Todd, C. (2005). Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age and Ageing, 34(6), 614-619.
Zarei, H., Rajabi, R., & Minunjad, H. (2017). The effect of six weeks of balance ladder training on postural control and the risk of falls in the elderly. Aging, 2 (1), 11-19. [Persian]

Keywords


References
Åberg, A. C., Frykberg, G. E., & Halvorsen, K. (2010). Medio-lateral stability of sit-to-walk performance in older individuals with and without fear of falling. Gait & Posture 31(4), 438-443.
Azim Khani, A., Abbasian, P., Anoushirvani, S., Rastegar Moghadam, Mahsa., Zibaei, Amir., And Shibak, Manijeh. (2021). Aging and Sports Activities. Mashhad, Imam Reza University. [Persian]
Bahrami, L., Salianeh, M., Farsi, A., & Nik Ravan, A. (2017). The effect of mindfulness exercises and motor working memory on the quality of life of active elderly. Sports Psychology Studies, 6 (21), 1-16. [Persian]
Baluchi, R. (2015). The effect of a balance training course on the postural factors of the elderly. Journal of Applied Sport Psychology, (11) 21, 93-102. [Persian]
Binda, S. M., Culham, E. G., & Brouwer, B. (2003). Balance, muscle strength, and fear of falling in older adults. Expermimental Aging Reserch, 29(2), 205-219.
Boivin, J., Griffiths, E., & Venetis, C. A. (2011). Emotional distress in infertile womenand failure of assisted studies. BMJ, 342, Article d223.
Boyd, R., & Stevens, J. A. (2009). Falls and fear of falling: burden, beliefs and behaviours. Age and Aging, 38(4), 423-428.
Britton, W. B., Shahar, B., Szepsenwol, O., & Jacobs, W. J. (2012). Mindfulness-based cognitive therapy improves emotional reactivity to social stress: results from a randomized controlled trial. Behavior Therapy, 43(2), 365-380.
Costa, S. N., Vieira, E. R., & Bento, P. C. (2020). Effects of home-and center-based exercise programs on the strength, function, and gait of prefrail older women: a randomized control trial. Journal of Aging and Physical Activity, 28(1), 122-130.
Di Lorito, C., Long, A., Byrne, A., Harwood, R. H., Gladman, J., Schneider, S., Logan, P., Bosco, A., & van der Wardt, V. (2021). Exercise interventions for older adults: A systematic review of meta-analyses. Journal of Sport and Helath Science, 10(1), 29-47.
Fallahpour, M., Jaghtai, M., Ashayeri, H., Salavati, M., & Hosseini, S. (2003). The effect of mental training on the balance of the elderly. Rehabilitation, 4 (3), 34-39. [Persian]
Fathi Rezaei, Z., Aslankhani, M., Farsi, A., Abdoli, B., & Zamani Thani, S. (2009). Comparison of three functional balance tests in identifying the elderly with and without a history of falls. Journal of Knowledge and Health, 4 (4), 21-26. [Persian]
Friedman, S. M., Munoz, B., West, S. K., Rubin, G. S., & Fried, L. P. (2002). Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention. Journal of the American Geriatrcs Society, 50(8), 1329-1335.
Gavi S., Sohrabi, M., Gol Mohammadi, B., Karimi, N., Sahaf, R., and Rahimi, M. (2015). The effect of whole body vibration training and mental training on balance in older men. Elderly, 9 (4), 306-312. [Persian]
Ghasempour, L., Hoseini, F. S., Soleymani, M., Ahmadi, M. (2017). Effects of physical fitness exercise, mental exercise and mindfulness exercise on static and dynamic balance in elderly women. Salmand: Iranian Journal of Ageing, 12 (2), 180-191.
Goldin, P. R., & Gross, J. J. (2010). Effects of mindfulness-based stress reduction (MBSR) on emotion regulation in social anxiety disorder. Emotion, National Liberery of Medicine, 10 (1), 83-100.
Habibi, M., & Hanasabzadeh Esfahani, M. (2014). The effectiveness of mindfulness-based art therapy on depression, anxiety, stress and quality of life in postmenopausal women. Eledrly, 9 (1), 22-31. [Persian]
Hosseini, M., Lajevardi, L., & Taghizadeh, Q. (2019). The effect of mental exercises on fear of falling in daily life activities, satisfaction and lower limb function in the elderly living in community-clinical tria.  Komesh, 4(21) ,619-627. [Persian]
Hyun, J., Hwangbo, K., & Lee, C. W. (2014). The effects of pilates mat exercise on the balance ability of elderly females. Journal of Physical Therapy Science, 26(2), 291-293.
Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future. Wiley Online Library.
Kamran Mehr, F., Farsi, A., & Kaviani, M. (2020). Comparison of the effectiveness of mindfulness exercises and bio-relaxation feedback on anxiety, depression and functional and static balance in elderly women with mild depression and anxiety. Psychology of Aging, 6 (3), 233-248. [Persian]
Kamrani Faraz, N., Letafat Kar, A., & Javdaneh, N. (2017). Effect of a water resistance combined training on balance and fall risk in elderly women over 60 years in Tehran. Iranian Journal of Rehabilitation Research in Nursing (IJRN), 4(1), 45-50.
Karami, M., Hadian, M., Abdul Wahab, M., Raji, P., Yakani Nejad, M., & Montazeri, A. (2014). The effect of mental exercises on improving the quality of life of older men 60 to 80 years. Modern Rehabilition, 8 (3), 30-21. [Persian]
King, M. B., Judge, J. O., Whipple, R., & Wolfson L. (2000). Reliability and responsiveness of two physical performance measures examined in the context of a functional training intervention. Physical Therapy, 80(1), 8-16.
Kumar, C. (2017). Comparison between Tai Chi and balance-strength training exercise to decrease fear of fall and improving balance and functional mobility in elderly. Journal of Novel Physiotherapies7, 350-363.
Mattes, J. (2016). Attentional focus in motor learning, the Feldenkrais method, and mindful movement. Perceptual and motor skills, National Liberery of Medicine, 123(1), 258-276.
Mokhtari, M., Bahram, M., Puruqar, M., & Akasheh, G. (2013). The effect of Pilates program on psychological and social factors related to falling in elderly women. Feiz, 17 (5), 453-462. [Persian]
Parry, S. W., Steen, N., Galloway, S. R., Kenny, R. A., & Bond, J. (2001). Falls and confidence related quality of life outcome measures in an older British cohort. Postgraduate Medical Journal, 77(904), 103-108.
Pfeiffer, K., Kampe, K., Klenk, J., Rapp, K., Kohler, M., Albrecht, D., & Becker, C. (2020). Effects of an intervention to reduce fear of falling and increase physical activity during hip and pelvic fracture rehabilitation. Age and Aging, 49(5), 771-778.
Rahal, M. A., Alonso, A. C., Andrusaitis, F. R., Rodrigues, T. S., Speciali, D. S., Greve, J. M. D., & Leme, L. E. G. (2015). Analysis of static and dynamic balance in healthy elderly practitioners of Tai Chi Chuan versus ballroom dancing. Clinics, National Liberery of Medicine,70, 157-161.
Salkeld, G., Cameron, I. D., Cumming, R. G., Easter, S., Seymour, J., Kurrle, S. E., & Quine, S. (2000). Quality of life related to fear of falling and hip fracture in older women: a time trade off studyBmj, 320(7231), 341-346.
Scheffer, A. C., Schuurmans, M. J., Van Dijk, N., Van Der Hooft, T., & De Rooij, S. E. (2008). Fear of falling: measurement strategy, prevalence, risk factors and consequences among older persons. Age and ageing, Age and Aging, 37(1), 19-24.
Shamsi Purdakordi, P., Aslankhani, M., & Shams, A. (2010). The effect of physical, mental and combined exercises on static and dynamic balance of the elderly. Journal of Sharekord University of Medical Sciences, 12 (4), 71-77. [Persian]
Sharma, M., & Rush, S. E. (2014). Mindfulness-based stress reduction as a stress management intervention for healthy individuals: a systematic review. Journal of Evidence-Based Complementary & Alternative Medivine, 19(4), 271-286.
Shir Alizadeh, M., AzimKhani, A., & Nejat, H. (2021). The effect of combined exercises on the feeling of loneliness, pleasure and desire to continue the activity of the elderly (unpublished Master Thesis). Imam Reza University. Mashhad.
Stanghelle, B., Bentzen, H., Giangregorio, L., Pripp, A. H., Skelton, D. A., & Bergland, A. (2020). Effects of a resistance and balance exercise programme on physical fitness, health-related quality of life and fear of falling in older women with osteoporosis and vertebral fracture: a randomized controlled trial. Osteoporses Internatinal, 31(6), 1069-1078.
Taheri, M., Irandoost, Kh., Mir Moazi, M., & Taheri, Z. (2019). The effect of mental exercises, yoga and cook san do on functional tests in the elderly with mobility limitations. Journal of Disability, 9 (1), 1-8. [Persian]
Takeshima, N., Islam, M. M., Rogers, M. E., Rogers, N. L., Sengoku, N., Koizumi, D., Kitabayashi, Y., Imai, A., & Naruse, A. (2007). Effects of nordic walking compared to conventional walking and band-based resistance exercise on fitness in older adults. Journal of Sports Science & Medicine, 12(3), 422-430.
Yardley, L., Beyer, N, Hauer., K, Kempen, G., PiotZiegler, C., Todd, C. (2005). Development and initial validation of the Falls Efficacy Scale-International (FES-I). Age and Ageing, 34(6), 614-619.
Zarei, H., Rajabi, R., & Minunjad, H. (2017). The effect of six weeks of balance ladder training on postural control and the risk of falls in the elderly. Aging, 2 (1), 11-19. [Persian]