Intervention 1 – Group Physiotherapy
Participants attended a weekly hour long class for 10 weeks. The circuit style class will consist of exercises that combine strength and balance. Participants will complete 6 different exercises at each class. The exercises were adapted from the falls prevention literature where similar programmes have been seen to improve, balance and reduce the number of falls in an elderly population.
The six exercises and possible progressions are described below. These are to be performed in sets of 12. When a participant is able to perform 12 repetitions of an exercise safely this can be progressed up to 3 sets of 12 repetitions. When a participant can perform 3 sets safely the exercise will be progressed so as to continuously challenge the participant. Not all participants will progress through all the exercises. The progression is dependent on the ability of the participant and their safety while performing the exercises
1. Sit to Stand, progressed by altering;
Hand Positioning – Participants may initially need to use hands for support to rise from chair, then progressing to hands by side and then to hands across chest.
Seat Height – Participants may initially require a higher seat height which can be lowered to increase the intensity of the exercise.
Repetitions – To be performed in sets of 12 and number of sets to be increased to 3 as participant progresses.
Weights – Handheld weights may be given to participants who need further progression.
2. Squat, progressed by altering;
Support – Participants may initially need bilateral support, this can be decreased to unilateral and then to no support as participants' ability increases.
Repetitions – To be performed in sets of 12 and number of sets to be increased to 3 as participant progresses.
Weights – May be given to participants who are able to perform 3 sets of 12 squats safely with no support.
3. Calf Raises, progressed by altering;
Support – Participants may initially need bilateral support, this can be decreased to unilateral support and then to independent calf raises as participant progresses.
Repetitions – To be performed in sets of 12, to be increased as participant progresses.
Other options – If participants are able they may perform single leg calf raises or if they can perform 3 sets of 12 independent calf raises weights can be added as further progression.
The following three exercises are to be completed within parallel bars.
4. Step ups, progressed by altering;
Support – Participants may begin with bilateral support, and then decrease to unilateral support, then to no support.
Stepping – Initially participants may step onto step and back to starting position, then step onto step and over, and then onto step, over and backwards to starting position.
Step Height – When participants are comfortable with all directions of stepping step height may be increased.
5. Side Stepping – progressed by altering;
Support – Participants may begin with bilateral support, and then decrease to unilateral support, then to no support.
Number of steps – Initially participants may only take one step in each direction. This can be increased as participants' ability increases.
If a participant is unable to take a step to the side, weight shifting from side to side in standing may be performed and progressed to stepping when the participant is able.
6. Tandem Stepping/Walking – progressed by altering;
Support – Participants may begin bilateral support, and then decrease to unilateral support, then to no support.
Stepping – Participants may initially just place one foot in front of the other and hold this position. The number of steps can then be increased as the participant progresses.
Crossover – Participants may become competent at tandem walking. This can then be progressed to one foot crossing over in front of the other.