مقایسه اثربخشی آموزش شفقت به خود، تمرینات حرکتی و مداخله ترکیبی بر هماهنگی عصبی- ‌عضلانی و تعادل سالمندان مبتلا به درد مزمن در حین راه‌رفتن

Background: The aging period is associated with a decline in cognitive and physical abilities, as well as a loss of social status. This reduces the resilience of older adults in the face of physical activities and life’s adversities, which in turn leads to a decrease in their mobility and balance. The present study aimed to compare the effectiveness of self-compassion training, motor exercises, and a combined intervention on neuromuscular coordination and balance in older adults with chronic pain during walking.
Method: The research method was quasi-experimental with a pretest-posttest control group design. The statistical population comprised all older adults in Tehran aged 65 to 80 years, among whom a sample of 48 individuals was selected using convenience sampling and randomly assigned into four groups (n=12 per group): a self-compassion training group, a motor exercise group, a combined intervention group, and a control group. The interventions were implemented over four weeks in eight sessions lasting 40 minutes for the self-compassion and motor exercise groups, and 60 minutes for the combined intervention group. Research instruments included the Sit-to-Stand Test (Guralnik et al.), the Timed Up and Go Test (Richardson et al.), and the Visual Analogue Scale for Pain (Hayes & Patterson). Data were analyzed using univariate analysis of covariance (ANCOVA) and the Bonferroni post hoc test in SPSS v26.
Results: The findings indicated that, compared to the control group, all three interventions led to a significant improvement in the neuromuscular coordination and balance of older adults, whereas the control group showed no significant change over time. Furthermore, the results of the Bonferroni post hoc comparisons revealed that despite the effectiveness of all three interventions, no statistically significant differences were observed among the intervention groups themselves. Nevertheless, the combined intervention demonstrated the highest mean improvement in the investigated variables.
Conclusion: Self-compassion training, motor exercises, and a combined intervention are effective approaches for improving neuromuscular coordination and balance in older adults with chronic pain. Integrating psychological and motor interventions can provide a comprehensive strategy to enhance functional outcomes in this population.
EXTENDED ABSTRACT
 Introduction
Neuromuscular coordination and balance are essential components of mobility and functional independence in older adults, particularly those with chronic pain. Impairment in these components often leads to altered gait patterns, decreased postural stability, and an increased risk of falls, which in turn affect daily activities and quality of life. Interventions targeting these outcomes may benefit from simultaneously addressing physical and psychological factors. Motor exercises, aimed at increasing strength, coordination, and sensory integration, can directly improve neuromuscular function and postural control. In parallel, self-compassion training, which focuses on cultivating a non-judgmental and supportive attitude toward oneself, may indirectly affect neuromuscular function by reducing pain-related anxiety, muscle tension, and stress, thereby facilitating better motor control during walking. Integrating these approaches into a combined intervention may have synergistic benefits by simultaneously enhancing psychological well-being and physical function. Accordingly, the present study aimed to compare the effectiveness of self-compassion training, motor exercises, and a combined intervention on neuromuscular coordination (NC) and balance in older adults with chronic pain during walking. The hypotheses of this study included: (1) self-compassion is effective on the NC and balance of older adults; (2) motor exercises are effective on the NC and balance of older adults; (3) the combined intervention is effective on the NC and balance of older adults. Additionally, the research question was: Is there a difference in the effectiveness of self-compassion training, motor exercises, and the combined intervention on NC and balance in older adults with chronic pain during walking?
Method
In terms of purpose, this research was applied, and regarding its methodology, it employed a quasi-experimental design with a pretest-posttest control group. The statistical population of this study included adults aged 65 to 80 years residing in Tehran. Participants were selected using convenience sampling from the Yas Older Adult Care Center. Based on G*Power 3.1.7 software, 48 participants were randomly assigned to four groups: self-compassion training, motor exercises, combined intervention, and control. Inclusion criteria consisted of: (1) age 65 years and older; (2) ability to walk independently without assistive devices; (3) experiencing chronic pain during walking; and (4) scoring above the mean on the Timed Up and Go test (indicating that task completion time is greater than the average of peers, reflecting reduced functional mobility and poorer balance), as well as scoring above the mean on the Visual Analogue Scale for pain (indicating a pain intensity above average, typically a score above 4 out of 10, confirming significant chronic pain during walking). Exclusion criteria included: (1) lower limb amputation; (2) unhealed fractures; (3) ligament or tendon tears; (4) orthopedic surgery in the past six months; (5) progressive neurological diseases (such as advanced Parkinson’s or acute stroke); (6) uncontrolled cardiovascular diseases; and (7) severe cognitive impairments. Research instruments included the Visual Analogue Scale for Pain (Hayes & Patterson, 1921), the Five Times Sit to Stand Test (Guralnik et al., 1995), and the Timed Up and Go Test (Richardson & Podsiadlo, 1991), which assessed pain intensity, NC, and functional balance of the older adults, respectively. The intervention protocols included self-compassion training (Neff, 2009), motor exercises (King et al., 2000), and a combined intervention (designed by the researchers), which were implemented in eight 40-minute sessions (60-minute sessions for the combined group). Data analysis was performed using univariate analysis of covariance (ANCOVA) and the Bonferroni post hoc test in SPSS-26.
Results
Descriptive analysis of the results indicated an improvement in NC and balance in all three intervention groups from pretest to posttest, whereas the control group showed no significant change. Prior to hypothesis testing, the assumptions of ANCOVA were examined. The Shapiro-Wilk test confirmed the normal distribution of NC and balance scores (p>.05). Levene’s test indicated the homogeneity of variances across groups for NC (F=1.85, p>.05) and balance (F=1.92, p>.05).
Additionally, the assumption of homogeneity of regression slopes for NC (F=2.104, p>.05) and balance (F=1.987, p>.05) scores was met across groups. Furthermore, a significant linear relationship between pretest and posttest scores confirmed the appropriateness of using ANCOVA. The ANCOVA results for NC (F=23.759) and balance (F=6.703) revealed a significant posttest difference between the control group and the three experimental groups at the p<.001 level. These results indicate the positive effect of the self-compassion, motor exercise, and combined interventions on improving NC and balance compared to the control group. Bonferroni post hoc comparisons showed that all three intervention groups differed significantly from the control group in terms of NC and balance (p<.05); however, no statistically significant differences were observed among the self-compassion, motor exercise, and combined intervention groups (p>.05). A comparison between the methods showed that the mean difference between self-compassion and motor exercises was 1.72 (p=.089) for NC and 0.446 (p=.315) for balance. The difference between self-compassion and the combined intervention was 1.52 (p=.120) for NC and 0.99 (p=.098) for balance. Furthermore, the difference between motor exercises and the combined intervention was 3.39 (p=.067) for NC and 1.445 (p=.067) for balance. Thus, no statistically significant difference was observed among the three methods, although the combined intervention had the highest mean improvement. The effect sizes suggest that combining psychological and motor components might yield greater functional gains, although their superiority over single interventions was not statistically confirmed. Ultimately, the findings support the effectiveness of multidimensional rehabilitation approaches for improving mobility-related outcomes in older adults with chronic pain.
Conclusion
The primary explanation for the effectiveness of the interventions in this study lies in the complementary mechanisms through which psychological and physical processes affect motor function in older adults with chronic pain. Structured motor exercises directly stimulate neuromuscular pathways, enhancing muscle strength, sensorimotor integration, postural control, and movement efficiency. These physiological adaptations improve coordination and balance by optimizing motor unit recruitment and stabilizing gait patterns. In contrast, self-compassion training appears to indirectly influence motor function by reducing self-criticism, emotional distress, and pain-related fear. Indeed, self-compassion enhances emotional regulation and psychological resilience; this reduction in stress-related muscle tension and movement avoidance may facilitate greater engagement in physical activity and smoother execution of movements. On the other hand, the combined intervention demonstrated the greatest improvement as it simultaneously activated direct physiological adaptations and indirect psychological facilitators. While motor exercises strengthened neuromuscular function, self-compassion increased motivation, adherence, and emotional stability, creating a synergistic effect. Therefore, improvements in coordination and balance can be best explained by the integration of biomechanical strengthening and psychological regulation, which together provide a more comprehensive pathway for enhancing functional performance in older adults with chronic pain.
Ethical Consideration
Ethical Code
This study was approved by the Research Ethics Committee of the University of Tehran under the ethics code IR.UT.SPORT.REC.1402.091.
Funding:
This study received no external funding.
Financial Support
This study did not receive financial support.
Authors’ Contributions
E.N: Data curation; M.Gh: Project administration, supervision; Z.B: Writing-Review & editing; A.N: Investigation, methodology, software, Formal analysis, Writing–original draft.
Conflict of Interest
The authors declare that there is no conflict of interest regarding the publication of this article.
Acknowledgments
We sincerely thank all the participating older adults for their valuable participation and cooperation in this scientific research.
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