Effects of 9-Square Exercise and Traditional Balance Exercise on Balance and Cognition in Older Women with Mild Cognitive Impairment
Keywords:
nine-square exercise, mild cognitive impairment, older adults, balance, cognitonAbstract
Background and Objectives: Older adults’ with mild cognitive impairment frequently experience significant balance issues and are at double the risk of falls. The purpose of this study was to compare the effects of nine-square exercise and traditional balance exercise on balance performance and cognitive abilities in older women with mild cognitive impairment
Methods: The sample group consisted of 43 elderly female volunteers with mild cognitive impairment, aged 60-79 years, divided into three groups random simple sampling: 14 individuals in the nine-square exercise group, 14 individuals in the traditional balance exercise group, and control group of 15 non-exercising subjects. The exercise groups participated in 30 minutes of exercise per day, three time per week, for 12 weeks. Balance was evaluated using the Berg balance scale and timed up & go test, while cognition was assessed using the mini-mental state examination and the Montreal cognitive assessment. Data were analyzed by using Kruskal Wallis test and Mann Whitney U test.
Results: At the end of the study, the results showed that both the nine-square exercise group and the traditional balance exercise group demonstrated significant improvements in balance performance and cognitive abilities (p < 0.001), while no significant differences were observed in the control group. When comparing between groups after exercise, it was found that both the nine-square exercise group and the traditional exercise group showed significant improvements in balance performance and cognitive abilities (p < 0.001) compared to the control group.
Conclusions: This study concluded that exercising with nine-square exercise and traditional balance exercise improves balance ability, cognition increased significantly.
References
Belleville S, Gilbert B, Fontaine F, Gagnon L, Ménard E, Gauthier S. Improvement of episodic memory in persons with mild cognitive impairment and healthy older adults: evidence from a cognitive intervention program. Dement Geriatr Cogn Disord 2006;22(5-6):486-99. doi:10.1159/000096316
Gillis C, Mirzaei F, Potashman M, Ikram MA, Maserejian N. The incidence of mild cognitive impairment: A systematic review and data synthesis. Alzheimers Dement Amst Neth 2019;11: 248-56. doi:10.1016/j.dadm.2019.01.004
Hongsawat J, Suvichanaragul P, Manon K, Kaochim P. The prevalence of mild cognitive impairment (MCI) among elderly people in Samphraeng community, Phra Nakhon district, Bangkok. TRC Nurse J 2022;15(1):97-109.
Williamson J, Yabluchanskiy A, Mukli P, Wu DH, Sonntag W, Ciro C. et al. Sex differences in brain functional connectivity of hippocampus in mild cognitive impairment. Front Aging Neurosci 2022;14:1-9. doi:10.3389/fnagi.2022.959394
Tiyapanit C, Tangwongchai S, Champaiboon J. Prevalence and fall risk in mild cognitive impairment and dementia at outpatient clinics, King Chulalongkorn Memorial Hospital. Chula Med J 2018;62(5):799 - 813.
Kitro A, Panumasvivat J, Sirikul W, Wijitraphan T, Promkutkao T, Sapbamrer R. Associations between frailty and mild cognitive impairment in older adults: Evidence from rural Chiang Mai Province. PloS One 2024;19(4):1-11. doi:10.1371/journal.pone.0300264
Bahureksa L, Najafi B, Saleh A, Sabbagh M, Coon D, Mohler MJ. The impact of mild cognitive impairment on gait and balance: A systematic review and meta-analysis of studies using instrumented Assessment. Gerontology 2017;63(1):67-83. doi:10.1159/000445831
Farias ST, Mungas D, Reed BR, Harvey D, DeCarli C. Progression of mild cognitive impairment to dementia in clinic vs community-based cohorts. Arch Neurol 2009;66(9):1151-7. doi:10.1001/archneurol.2009.106
Subindee S, Sritanyarat W. Mild cognitive impairment in older persons with chronic illness attended at a chronic care clinic of a primary care unit Khon Kaen province. J Nurs Sci Health 2014;37(1):43-50.
Nualnetr N, Aonsri C, Chaipipat N. A comparison of 9-square exercise and conventional balance exercise on balance in older women. Thai J Phys Ther 2016;38(3):93-102.
Wannapong S, Nakmareong S, Bennett S, Nualnetr N. The effects of nine-square exercise on balance and cognitive function in older women. Thai J Phys Ther 2016;43(2):67-79.
Wannapong S, Nakmareong S, Bennett S, Nualnetr N. The effects of nine-square exercise on balance in the elderly with falls risk. Srinagarind Med J 2021;36(3):310-6.
Harnirattisai T, Thongtawee B, Raetong P. The effects of a physical activity program for fall prevention among Thai older adults. Pac Rim Int J Nurs Res 2015;19(1):4-18.
Rodsungnoen J. Effects of exercise programs on balance and fear of falling among elderly in the community. RHPC9 J 2021;15(38):541–60.
Na Chiangmai N, Wongupparaj P. Dementia screening tests in Thai older adults: a systematic review. J Ment Health Thai 2020;28(3):252-65.
Wongsa S, Amatachaya P, Saengsuwan J, Thaweewannakij T, Amatachaya S. Validity of kyphosis measure using the occiput-wall distance and effectiveness of outcomes on the identification of impairments on functional endurance. Srinagarind Med J 2012;27(2):125-32.
Kanjanapong S, Phannarus H, Muangpaisan W. Screening tests for cognitive impairment in elderly Thai adults: A systematic review. J Med Assoc Thai 2021;104(9):1433–46. doi:10.35755/jmedassocthai.2021.09.12332
Lima CA, Ricci NA, Nogueira EC, Perracini MR. The berg balance scale as a clinical screening tool to predict fall risk in older adults: a systematic review. Physiotherapy 2018;104(4):383-94. doi:10.1016/j.physio.2018.02.002
Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health 1992;83(2):7-11.
Intaruk R, Saengsuwan J, Amatachaya S, Gaogasigam C, Thaweewannakij T. The ability of timed-up and go test and five times sit-to-stand test to screen risk of fall in well-functioning elderly. Health Sci Sci Technol Rev 2021;14(1):54-63.
Jalayondeja C. Falls screening by timed up and go (TUG). Arch Allied Health Sci. 2014; 26(1): 5-16.
Tanglakmankhong K, Hampstead BM, Ploutz-Snyder RJ, Potempa K. Cognitive screening assessment in Thai older adults: a prospective study of the reliability and validity of the Abbreviated Mental Test. J Health Res 2021;36(1):99. doi:10.1108/JHR-02-2020-0049
Dautzenberg G, Lijmer J, Beekman A. Diagnostic accuracy of the montreal cognitive assessment (MoCA) for cognitive screening in old age psychiatry: Determining cutoff scores in clinical practice. Avoiding spectrum bias caused by healthy controls. Int J Geriatr Psychiatry 2020;35(3):261-9. doi:10.1002/gps.5227
Chirawatkul L. Statistics for health science research. Bangkok: Wittayaphat, 2013.
Charoensuksiri K, Saelim N, Saraphunt H, Promsuk T. Effect of square-stepping exercise and balance training on balance and health for quality of life in Thai elderly. Bcnnon Hlth Sci Res J 2018;12(2):98-107.
Donoghue D. How much change is true change? The minimum detectable change of the Berg Balance Scale in elderly people. J Rehabil Med 2009;41(5):343-6. doi:10.2340/16501977-0337
Romero S, Bishop MD, Velozo CA, Light K. Minimum detectable change of the Berg Balance Scale and dynamic gait index in older persons at risk for falling. J Geriatr Phys Ther2011;34(3):131-7. doi:10.1519/JPT.0b013e3182048006
Gulsatitporn S. Physical therapy in Elderly. Bangkok: Offset Press, 2009.
Varela S, Ayán C, Cancela JM, Martín V. Effects of two different intensities of aerobic exercise on elderly people with mild cognitive impairment: a randomized pilot study. Clin Rehabil 2012;26(5):442-50. doi:10.1177/0269215511425835
Huang B, Chen K, Li Y. Aerobic exercise, an effective prevention and treatment for mild cognitive impairment. Front Aging Neurosci 2023;15:1-11. doi:10.3389/fnagi.2023.1194559
Krabuanpatana C. The 9-square exercise and brain development. 2007. Bangkok: Grand Sport Group.
Azhdar M, Mirzakhany N, Irani A, Akbarzadeh A, Daryabor A, sangi samira, et al. The effect of balance training on cognitive and occupational performance of the elderly. J Babol Univ Med Sci 2022;24(1):41-9.
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