THE EFFECT OF STRENGTHENING AND BALANCE ...rku.ac.in/spt/wp-content/uploads/2015/08/GROUP-10.pdfTHE EFFECT OF STRENGTHENING AND BALANCE EXERCISE TRAINING ON GERIATRIC POPULATION Submitted

“THE EFFECT OF STRENGTHENING AND BALANCE EXERCISE TRAINING ON GERIATRIC POPULATION”

Submitted by:

Krishna Dhamecha (12sptpt11023)

Hiral Dholariya (12sptpt11024)

6Th semester July, 2015

Guide BY:

Dr. Nilesh Telaiya

Lecturer school of physiotherapy, RKU

CERTIFICATE

This is to certify that the project work entitled “The effect of strengthening and balance exercise training on geriatric population. “has been undertaken and written under my supervision and it describes the original research work carried out by Ms. Krishna Dhamecha and Ms. Hiral Dholariya registered at RK University in 6th semester Bachelors of Physiotherapy.

Signature of Guide Name: Dr.Nilesh Telaiya Degree: MPT (peridritric) Designation: Assistant professor

DECLARATION

We hereby certify that we are the authors of this project work. We certify to the best of

our knowledge, our project does not infringe upon anyone’s copyright nor violate any

proprietary rights and that any ideas, techniques, quotations, or any other material from

the work of other people included in our project published or otherwise, are fully

acknowledged in accordance with the standard referencing practices. We declare that

this is a true copy of our project, including any final revisions, as approved by my project

review committee.

Signature of candidate Signature of candidate

Dhamecha Krishna Dipakbhai Dholariya Hiral Nileshbhai

Enrolment no: 12sptpt11023 Enrolment no: 12sptpt11024

Date: 16/07/2015 Date: 16/07/2015

Place: Rajkot Place: Rajkot

ACKNOWLEGEMENT

First and foremost we would like to thank ours parents Dipakbhai,Ritaben and

Nileshbhai, Jyoshnaben_who who who are my living Gods and our brother Sumit and Akhil

for their valuable support and encouragement, blessing and love which has always been a

source of inspiration and strength in accomplishing this academic task.

our heartfelt gratitude to almighty God who has guided us this far and to whom goes all the

honor and glory for the successful completion of this study.

we wish to express our regards to our Director Dr. priyanshu Rathod School of Physiotherapy,

R.K.University for his whole hearted guidance and meticulous suggestions in the completion of

this work and for all the facilities and support extended to us during this study. We are extremely

thankful for his constant encouragement and inspiration during the course of this study.

With due respect, we would like to express our sincere thanks to our guide Dr. Nilesh Telaiya

Senior lecturer of School of Physiotherapy, R.K.University, for his judicious information, expert

suggestions, valuable guidance, continuous support, incessant reassurance during every stage of

this work and interest shown in this dissertation without which this work would not have been

possible.

we would like to extend our heartfelt thanks to assistant lecturer, Dr. Kajal Mam for their

valuable guidance, constant help and support throughout this study and all the lecturers of our

college who have taught us and gave their valuable suggestions during the course of the study.

we sincere thanks to colleagues and friends for taking keen interest in our study, guiding us

through the path, giving me support and motivation during the course of study.

We wish to express our thanks to Mr. Harshal Anjariya our librarian for their timely help in

lending us books and journals for our reference all the time.

We shall fail our duties if we don’t acknowledge our Colleagues and Friends for their

suggestions and criticism while assisting us in this study.

Last but not the least we would like to thanks all the Individuals in our study without whom this

task would not have been possible.

we sincere thanks to all the contributors whose names we may have missed but who truly deserve

our gratitude.

We would like to thank once again to all who have helped us all the while.

Signature Signature

Name: Krishna Dhamecha Name: Hiral Dholariya

LIST OF ABBREVIATIONS

1. TUG : Timed up and go test

2. MMT : Manual muscle testing

IV

ABSTRACT

“THE EFFECT OF STRENGTHENING AND BALANCE EXERCISE TRAINING ON

GERIATRIC POPULATION”

SUBMITTED BY: Krishna Dhamecha, Hiral Dholariya

Key word:- Time up and go test, MMT, Balance, Strengthening exercise, fall risk,

Geriatric

Background: - Ageing leads to musculoskeletal, cardiovascular, respiratory problem

along with balance impairment and increase in fall incidence. Exercise training is used

as fall prevention intervention and can decrease risk factors associated with falls

including reduced muscle strength and impaired balance. The need of study is there are

very few studies which are testing both muscle strength and balance of an older

individual following balance training and strengthening exercise.

AIM: To find out the effect of strengthening exercise and balance training in elderly

people.

Methodology: This study includes 30 subject elderly people more than 65 year age.

This people were screened for the inclusion and exclusion criteria. An informed consent

was taken from the participants prior to study. TUG and MMT is outcome measured.

Study same was taken from RKU campus and near by trumba village using

convenience sampling method study is experimental and comparative study.

Result: There is significant difference in TUG and MMT after giving balance and

strengthening exercise.

I

DISCUSSION: This study evaluated the effect of exercises on balance and muscle

strength by TUG test and MMT.

CONCLUSION: There is significant difference in pre and post TUG test and MMT.

This result shows that effect of balance and strengthening exercise training (2 weeks)

leads to improve balance and muscle strength.

II

TABLE OF CONTENTS

SR NO. TITLE PAGE NO.

1 List of tables III 2 List of figures IV 3 List of chart V 4 Structured Abstract I 5 Introduction 1 6 Need of study 5 7 Aim & objective of the study 7 8 Hypothesis 9 9 Review of literature 11

10 Methodology 14 11 Results 22 12 Discussion 28 13 Conclusion 32 14 Summary 34 15 Rererence 36

III

LIST OF TABLES

SR NO.

TABLE PAGE NO

11.1 MEAN AND STANDARD DEVIATION OF PRE AND POST QUADRICEPS MUSCLE STRENTH

24

11.2 MEAN AND STANDARD DEVIATION OF PRE AND POST CALF MUSCLE STRENGTH

25

11.3 MEAN AND STANDARD DEVIATION OF TUG TEST 26

IV

LIST OF FIGURES

SR NO FIGURE PAGE NO

10.1 MATERIAL USED IN STUDY 17

10.2 STRECHING OF HAMSTRING AND CALF MUSCLE

20

10.3 STRENGTHENING OF KNEE EXTENSION 20

10.4 STRENGTHENING OF PLANTER FLEXION 20

10.5 ONE LEG STANDING 21

10.6 REACH OUT 21

V

LIST OF CHART

SR NO CHART PAGE NO

11.1 MEAN OF PRE AND POST QUADERICEPS MUSCLE STRENGTH

24

11.2 MEAN OF PRE AND POST CALF MUSCLE STRENGTH 25

11.3 MEAN OF PRE AND POST TUG TEST 26

VI

INTRODUCTION

THE EFFECT OF STRENGTHENING AND BALANCE EXERCISE TRAINING ON GERIATRIC POPULATION 2

INTRODUCTION

Physical fitness is a general state of health and well being and more specifically,

the ability to perform aspect of sports or occupation. Physical fitness is generally

achieved through correct nutrition, exercise, hygiene and rest (1).

With aging older people facing more problem associated with impaired vestibular

function, cardiovascular problem, neuromuscular problem, musculoskeletal problem, etc

(1)

1. Impaired muscle strength

2. Impaired balance

3. Impaired gait

4. Impaired vision

5. Impaired cognitive function

The most common risk factors for falls include muscle weakness, arthritis,

history of falls, limited gait, balance or vision problem use of assistive device, limited

of daily living depression cognitive impairment and elderly people. (1)

Exercise training is used as fall prevention intervention and can decrease risk

factor associated with falls including reduced muscle strength and impaired balance.

(2)

Balance disorder in the geriatric population are a multifactorial condition ,

weakness in the muscle strength, altered muscle activation patters, loss of


proprioception and inability to control normal posture sway can all result in

decreased balance in elderly. (3)

Routine group of exercise

1. Balance exercise

2. Strength training (resistance training)

Balance exercise as part of prevention program , you should follow an exercise

program designed to address your need for improved skill in walking balance,

coordination and increase muscle strength and less and feet. Exercise program and ask

programs can very from once 4 week to there or more times per week and session vary

in length.

Component:-

• Muscular power

• Muscular strength

• Flexibility

• Balance

• Speed

• Agility

• Reaction time

• Co-ordination (4)

Geriatric is a specially that focus on health care of older people. The age of

geriatric is >65 year. (5)

Strengthening exercise program 8 to 12 repetition of a resistance training

exercise for each major group at an intensity of 40% to 80% of one repetition (RM)

two–three minutes of rest is recommended between exercise sets to allow for proper


recovery. Two to four set are recommend for each muscle group, 3 to 4 time per

week. (6)

Benefit of strength training includes increase muscle strength, tendon and

ligament strength, bone density, flexibility, tone metabolic rate and postural support.

(6)

Balance exercise is effective in improving functional and static balance,

mobility and falling in geriatric people. Balance training shown beneficial result with

diminished risk of fall and balance exercise increased the confidence in geriatric and

give a positive well have and decreased fear of fall. (7)

TUG test is sensitive (87%) of specific measure for identifying older person

who are prone to falls. It is quicker and easy to perform. (8)


NEED OF THE STUDY


NEED OF THE STUDY

The need of study is there will be increase in balance and muscle strength in old

age people. There is no study by using TUG test and MMT to improve balance and

muscle strength. So using both the TUG and MMT and find that there is improve or not

in balance and muscle strength.


AIM AND OBJECTIVES


AIM & OBJECTIVES

AIMS:-

• To find out the effect of strengthening exercise and balance training in

geriatric person.

OBJECTIVE:-

• To study the effectiveness of 2 weeks of balance training on balance

performance in geriatric person.

• To study the effectiveness of 2 weeks of strengthening exercise on muscle

strength in geriatric person.


HYPOTHESIS


HYPOTHESIS Null hypothesis:

There will no significant difference in strength and balance in elderly people after exercise training.

Alternative hypothesis:

There will significant difference in strength and balance in elderly people after exercise

training.


REVIEW OF LITERATURE


REVIEW OF LITERATURE

Nishad Abdul L Atheef Majida 2015 has done study with the objective with

effect of core strength training on functional mobility in community dwelling people. 48

community dwelling elderly males taken in that studies with the age group of 55-70.

After giving a balance training(2 week-thrice a day) there was improvement in gait

performance and increase a gait velocity ,speed, and endurance .after giving a balance

training there was activation of propioception as before study. There is also

improvement in their quadriceps, knee flexors muscle strength. As result of above

study. (8)

Barbara l. Fischer, psy n 1 William T. Hoyt, PhD ; 2 Lawrence maucieri, phD3

Amy j. kind MD, PhD 1.4; etc all (volume 51, number 2, 2014 page -263 – 274).

Dr. John zettel volume 1, issue 2, winte r 2014, is used as fall preventive

intervention and decrease falls including balance and strength. Department of human

health and nutritional science, college of biological science, university of Guelph on

Canada.

Eduro .L.cadore et al. 2013 has done study with the objective to effects of

multicomponent training on muscle power output, muscle mass and functional

outcomes in frail nonagenarians. In that study Twenty four elderly were randomized into

intervention or control group. The intervention group performed a twice-weekly, 12-week

multicomponent exercise program composed of muscle power training (8-10 repetition)

combined with balance and gait training. Outcome measure for that research was TUG

test and barthel index. After giving balance training there was induced a positive

stimulus to promote the muscle hypertrophy enhance leg muscle power and functional

capacity and decrease incidence of fall and our study is correlate to that study.


American age American geriatrics society falls – risk guidelines 2010 has

done study with objective was to assist health care professionals in their management

of older adults who have fallen or are at a risk of falling and to optimize assessment and

interventions for reducing the number of falls in older adults. Target population was >65

years, cognitive impairments and long term care facilities. Screening and assessment

taken.

Broolce sal2amv, MD. Thomas Jefferson University 2010 JUL; 82(1):61.68.

M.M. Mureira. L.takayma. A. L. Galliano V. F. Caparbo R. A. Costa R. M. R.

Pereira [osteoporosis Into (2007) 18: 419–425 DO1 10.1007/5. 00198–006– 0.252.5]

15/haskowski, (2006 – 07 – 08) “strength training: How many set for best result”

myo clinic Retrieved (2013 – 01 -24).

Age Bamett A, Smith B, lord s, Williams M, Baumand A: ageing 2003 ; 32;

407 – 414 Sterling M, Jull G, Wright A. the effect of musculoskeletal pain on motor

activity and control. J pain 2001: 2 (3): (135 – 45) community based group exercise

improves balance and reduces fall in at risk older people a randomized controlled trial.

President council on physical fitness & sports definition for health, fitness &

physical activity.


METHODOLOGY


METHODOLOGY

Study Design:

Experimental study

Study Setting:

RKU campus and near by trumba village

Sampling Technique:

Convenience sampling

Study Population:

Elderly people (>65 years age) male and female

Study Sample:

30 subjects

Study Duration:

Training duration – 2 weeks

Total Study duration:

14 weeks


CRITERIA FOR SELECTION

INCLUSION CRITERIA

Healthy older adults (male and female) >65 years of age

EXCLUSION CRITERIA

Other individuals have coronary heart disease

Uncontrolled hypertension and diabetes

Asthma

Any other severe cardio-pulmonary disorder, any other cerebro vascular disorder which

may affect their walking performance.

MATERIALS USED IN THE STUDY Stop watch

Measure tape

Chair

Pen

Chalk

Consent form

Assessment form


Material used in study 10.1

METHOD

MMT and TUG test can be use for the balance and muscle strength. The test has

been used as part of muscle strength and balance testing for more than 65 year age of

both male and female.

Present study was conducted on 30 older people in the age group of more than

65 year, of the r.k university campus and near by trumba village.High blood pressure,

dizziness, any musculoskeletal disorder, diabetes person were excluded from the study.

Informed consent was taken from all the older person. They were explained with the

whole test to be performed.

Subject was measured and subject was asked to perform the two test:

1. Time up and go test

2. Manual muscle testing

3. Treatment description


The experimental group was submitted to strengthening and balance training

thrice a week for 40 minutes, over 2 weeks, exercise innervations in the form of

strengthening and balance training program are now recognized as new strategy to

improve balance and muscle strength.

Participant were instructed to report any symptoms or feeling of falling during

training session, the therapist stood beside the participants to guarantee physical safety

in case of loss of balance.

A 5 minute warm up before the activity included head rotation, shoulder rotation,

upper limb stretching, lower limb stretching.(hamstring and calf stretching ) participants

were asked to walk sideways (4*/-minute), tendom walking (3minute), backward walking

(4minute), toe-walking (2minute), one leg standing (2minute) and reach out (5minute)

with eye open. Knee extension (Quadriceps muscle), and ankle planter flexion (calf

muscle) strengthening exercise with therabend and last 5 minute cool down phase

included-deep breathing in supine.

Time up and go test (TUG test)

The time up and go test is an effective method for assessing mobility and

quantifying locomotors performance, including a sequences of functional maneuvers

used in everyday life, basic mobility skills are tested, such as rising from a chair, walking

3 meters, turning and sitting down on the same chair A stopwatch is used to time the

test(seconds).the test is convenient in clinical as it is quick, requires no special

+equipment or training.TUG was proven to have a good interrater reliability(ICC-

0.99)(Steffen et al,2002) good test retest reliability(ICC-0.97-0.99)and spearman’s=0.93

have been demonstrated many studies.

Manual muscle testing:

Before starting the MMT must care the person as free as possible form

discomfort or pain during test. The environment is quiet and no distracting. The patient

is a lying on met or plinth as testing muscle and gives a proper instruction after that

check the


The flow chart of procedure


Stretching of hamstring and calf strengthening of knee extension 10.3

Muscle 10.2

Strengthening of planter flexion 10.4


One leg standing 10.5

Reach out 10.6


RESULTS


RESULT

A comparative study was performed in which TUG and MANUAL MUSCLE

TESTING was assessed in elderly people. The value of TUG and MMT were collected

for the elderly people

Statistics was performed using paired t-test individual TUG and wilcoxon signed

rank test individual MAUNAL MUSCLE TESTING

• Paired t-test and Wilcoxon signed rank test taken subjects

• Calculate t-value of elderly people for MMT and TUG

• The two tailed P-value is 0.05

• The data was analyze by using Paired t-test and Wilcoxon signed rank

test and results were obtained

• There is significance difference between pre and post in subjects with

taken


Table 11.1: DIFFERNT BETWEEN QUDERICEPS MUSCLE STRE NGTH PRE AND POST BOTH THE LOWER LIMB

VARIABLE

(OUTCOME)

MEAN

SD

P-VALUE

PRE POST PRE POST

Quadriceps right 4.76 4.83 0.4302 0.3790

<0.0001

Quadriceps left 4.86 4.90 0.3457 0.3051

INTERPRETATION: The above table shows the mean of quadriceps muscle strength

score right i.e.: 4.76±0.4302 (pre) and post 4.83±0.3790 and left pre 4.86±0.3457 and

post 4.90±0.3051 result shows significant difference for quadriceps muscle strength (P<

0.05, p-value= <0.0001).

11.1: mean of pre and post quadriceps muscle streng th


Above graph shows pre and post quadriceps muscle strength of elderly people.

mean for pre and post quadriceps muscle strength of elderly people is pre (rt) 4.76 and

post (rt) 4.83 and pre (lt) 4.86 and post (lt) 4.90 respectively statistical analysis of the

data shows there is significant (p<0.0001 ) difference in quadriceps muscle strength.

Table 11.2: DIFFERENT BETWEEN CALF MUSCLE STRENGTH PRE AND POST BOTH THE LOWER LIMB

VARIABLE

(OUTCOME)

MEAN

SD

P-VALUE

PRE POST PRE POST

Calf right 4.33 4.43 0.5467 0.5683

Calf left 4.26 4.50 0.5208 0.5085 <0.0001

INTERPRETATION: The above table shows the mean of calf muscle strength score

right i.e.: 4.33±0.5467 (pre) and post 4.43±0.5683 and left pre 4.26±0.5208 and post

4.50±0.5085 result shows significant difference for calf muscle strength (P<0.05, p-

value=<0.0001).

11.2: mean of pre and post calf muscle strength


Above graph shows pre and post Calf muscle strength of elderly people. Mean for

pre and post calf muscle strength of elderly people is pre (RT) 4.33 and post (RT) 4.43

and pre (lt) 4.26 and post (lt) 4.50 respectively. Statistical analysis of the data shows

there is significant (p<0.0001) difference in muscle calf strength.

Table 11.3: DIFFERENT BETWEEN TUG TEST PRE AND POST

Variable

(Outcome)

MEAN SD N t

Value

P

Value

PRE POST PRE POST

TUG 10.36 9.16 2.1412 1.7436 30 10

<0.0001

INTERPRETATION: The above table shows the mean of TUG test score

i.e.:10.36±2.1412 pre and post 9.16±1.7436 post result shows significant difference for

TUG test (t=10, p-value=<0.0001).

11.3: mean of pre and post TUG test


Above graph shows pre and post TUG test of elderly people. Mean for pre and

post TUG test of elderly people is pre 10.36 and post 9.16 respectively. Statistical

analysis of the data shows there is significant (p<0.0001) difference in TUG test.


DISCUSSION


DISCUSSION

Aim of study is to effective the balance and Strength performance in geriatric

person. The component of outcome measure was taken is TUG and manual muscle

testing. The results show that there is statistically significant difference in TUG score

(mean: -1.200 sec) before and after exercise Balance Training. There is significant

difference in MANUAL MUSCLE TESTING (Mean: 65.50) performance before and after

Strengthening training program.

Nishad Abdul Latheef Majida*1 (2015) which supports the study After giving a

balance training (2 week) there is improvement in increase speed and endurance. After

giving a Strength exercise and balance training there is activation of propioception as

before study. Which support the study there is also improvement in their quadriceps,

and Calf muscle strength. As result of above study (10)

Nizar Abdul Majeed kutty*(vol 24 no.2 (2013) which support the study after giving

balance exercise (2 week). There is improve speed and endurance because Wayne et

al (2004) reported that the activation of propioreceptor, because there is correlation

between sensory and motor process. The loss of sensory information can bring about

change in use of ankle and hip strategies. This suggests that selection of posture

movement strategies appears to be an automatic protective process dependent upon

accurate multisensory information.

Eduardo L. Cardore. Etc @ American Aging Association (2013) which support the

study after giving balance training there is induced a positive stimulus to promote the

muscle hypertrophy enhance leg muscle power and functional capacity and decrease

incidence of fall ( as above study (11))and our study is correlate to this study.


Scholar research library (2011) which supported study after giving balance

exercise, there is change in neuromuscular performance and balance. This training

improve balance and walking ability.


LIMITATIONS OF THE STUDY:

• Age group between > 65 year old age people

• Duration of timing 2 weeks

• Sample size 30 subject only

FURTHER RECOMMENDATIONS:

• Large sample size should be taken.

• This study can be further done with longer treatment duration


CONCLUSION


CONCLUSION

This result shows that effect of balance training and Strengthening exercise (2 weeks)

thrice a day per week. Leads to improve Balance and Functional Mobility in older adults.

Strengthening and Balance training Program could be successfully to improve Balance,

Mobility and potentially reduce the risk of falls.


SUMMARY


SUMMARY

30 elderly people were included for study. Outcome measure was TUG and MANUAL

MUSCLE TESTING.

The data was then tabulated and subjected to statistical analysis by paired t- test for

TUG and wilcoxon signed rank test for MANUAL MUSCLE TESTING outcome

measure. After Analysis the data the following inference were drawn:

1. There was significant difference in TUG test (t= 10, P<0.05) among elderly

people after strengthening exercise.

2. There was significant difference in MANUAL MUSCLE TESTING (p<0.05, P-

value=<0.0001) among elderly people after strengthening exercise..

Form the result of present study it was concluded that there was elderly people

which lead to increase in balance and strengthening exercise program to

reduced fear of fall risk and improve physical function (lower limb strength and

balance.


BIBLIOGRAPHY


BIBLIOGRAPHY

1. Balance training program is highly effective in improving functional status and

reducing the risk of fall in elderly a randomized controlled trial.

M.M.Madureria.L.takaynama.A.L.gallinar Osteoporoses int (2007)18:419-425

2. Balance training and exercise in geriatric patients. M.Runge, G.Rehfeld,.esnicek

Aerpah-klinik Esslingen,Germany 2000;1:61-65

3. Training exercises helps to manage fall risk in American geriatrics society fall risk

guidelines. www.americangeriatrics.org

4. Dhebar F et al have structured balance, co-ordination and strength older

individuals.2014

5. .ahmad Ali akbari kamarani (MD University of social welfare

6. .Nishad Abdul L Atheef Majida 2015.

7. Brooke sazamv md Thomas Jefferson university Jul ;( 1):61-68. 2010


ANNEXURES


ANNEXURE 10.1


ANNEXURE 10.2

Assessment Form

Date: No:

Name: Age and sex:

Address:

M: _________________

Occupation:

Chief complaints:

History:

1. History of fall: 2. Medication history: 3. History of any other medical condition:

On observation:

1. Posture:____________________________________________________ 2. Deformity:_______________________________________________________


EXAMINATION

1. Strength testing(MMT) of lower limb

Muscle Pre-strength data Post strength data

right Left right Left

Quadriceps muscle

Calf muscle

2. Balance examination: TUG Test

Remark :______________________________________________

____________________________________________________

____________________________________________________

__________________________________________________

Outcome measure Pre-training data Po st-training data

TUG (in second) (in second)


MASTER CHART

SR NO GENDER AGE TUG PRE TUG POST

1 Female 62 11 9

2 Female 67 10 9

3 Female 65 14 12

4 Female 70 10 9

5 Female 75 12 11

6 Female 68 11 10

7 Female 65 10 9

8 Female 80 13 11

9 Male 64 8 7

10 Male 58 9 8

11 Male 60 12 11

12 Male 68 13 12

13 Male 71 12 10

14 Male 65 9 9

15 Male 68 12 10

16 Female 70 12 10

17 Male 70 15 13

18 Female 70 9 8

19 Female 80 14 12

20 Male 60 9 8

21 Male 55 10 8

22 Female 65 8 7

23 Male 65 8 7

24 Female 65 9 8

25 Female 60 8 7

26 Female 55 10 9

27 Male 58 7 7

28 Male 56 7 7

29 Female 65 9 8

30 Female 65 10 9


SE. NO

QUADRICEP MUSCLE

CALF MUSCLE

Pre-

Grade

Post-

Grade

Pre-

grade

Post- grade

rt Lt Rt Lt rt lt Rt Lt

1 5 5 5 5 4 4 4 5

2 5 5 5 5 4 4 5 4

3 4 5 4 5 4 4 4 4

4 5 5 5 5 4 4 4 4

5 5 5 5 5 4 4 5 4

6 5 5 5 5 4 4 4 4

7 4 5 5 5 5 5 5 5

8 4 5 4 5 4 4 4 5

9 5 5 5 5 5 5 5 5

10 5 5 5 5 4 4 4 4

11 5 5 5 5 4 4 4 4

12 4 5 4 5 4 4 4 5

13 5 5 5 5 4 5 4 5

14 5 5 5 5 5 5 5 5

15 4 5 5 5 4 4 5 4

16 5 5 5 5 4 4 4 4

17 4 4 4 5 4 4 4 4

18 5 4 5 4 4 4 4 5

19 4 4 4 4 3 3 3 4

20 5 5 5 5 5 5 5 5


21 5 5 5 5 5 5 5 5

22 5 5 5 5 5 4 5 4

23 5 4 5 4 5 4 5 5

24 5 5 5 5 5 5 5 5

25 5 5 5 5 4 4 4 5

26 5 5 5 5 5 5 5 5

27 5 5 5 5 5 5 5 5

28 5 5 5 5 4 4 4 4

29 5 5 5 5 4 4 4 4

30 5 5 5 5 5 4 5 4


ANNEXURE 10.3

MESUREMENT TOOLS

Time up and go test (TUG test)

The time up and go test is an effective method for assessing mobility and

quantifying locomotors performance, including a sequences of functional maneuvers

used in everyday life, basic mobility skills are tested, such as rising from a chair, walking

3 meters, turning and sitting down on the same chair A stopwatch is used to time the

test(seconds).the test is convenient in clinical as it is quick, requires no special

+equipment or training.TUG was proven to have a good interrater reliability(ICC-

0.99)(Steffen et al,2002) good test retest reliability(ICC-0.97-0.99)and spearman’s=0.93

have been demonstrated many studies.

Manual muscle testing:

Before starting the MMT must care the person as free as possible form

discomfort or pain during test. The environment is quiet and no distracting. The patient

is a lying on met or plinth as testing muscle and gives a proper instruction after that

check the muscle power by manual resistance.

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THE EFFECT OF STRENGTHENING AND BALANCE ...rku.ac.in/spt/wp-content/uploads/2015/08/GROUP-10.pdfTHE EFFECT OF STRENGTHENING AND BALANCE EXERCISE TRAINING ON GERIATRIC POPULATION Submitted