Objective

Exercise-based fall prevention programs mainly refer to multimodal and challenging balance exercises. Individual load monitoring and interpretations are crucial to enable adequate adaptation responses on the individual level. Thus, assessing internal responses to external stimuli throughout an intervention period need to be adequately addressed. The aim of this secondary analysis of a 3-armed randomized controlled trial was to analyze internal and external loads of unstable vs. stable balance Exergame training in healthy seniors. We intended to elucidate whether differences of external and internal load criteria occur over the intervention period.

Methods

A total of 51 healthy seniors (females: n = 34; males: n = 17; age: 69 ± 6 years; BMI: 27 ± 5) were allocated to either volitional stepping (VOL), volitional stepping under unstable conditions (VOL + US) or an inactive control group (CON). VOL and VOL + US completed 8 weeks of Exergame based step training (three weekly sessions, 45 min each) using the Dividat Senso device. Twelve different balance Exergames were used, consisting of virtual reality like video games. The original nonswinging, stable platform was employed for VOL, whereas VOL + US used an adapted Senso mounted on a swinging Posturomed Rack. The instability level was increased for VOL + US only every second week. External (game scores) and internal (perceived efforts, using the rated perceived exertion scale (RPE)) load measures were individually recorded for every session. Statistical analysis was carried out using linear mixed-effects modelling.

Results

Although VOL + US completed similar games at identical training volumes under unstable conditions, the achieved game scores did not significantly differ between both training groups (p = 0.71). Both intervention groups notably improved their game scores over the 8 training weeks (p < 0.01). A significant time x group interaction effect was observed for perceived effort (p < 0.01), serving as an internal load measure. Subsequent post-hoc testing revealed significant greater perceived exertion values in each of the first 7 weeks (p < 0.05) in VOL + US compared to VOL. No between-group differences were found for RPE in week 8. Whereas RPE values in VOL + US decreased over time (week 1: 4.6 ± 1.9; week 8: 3.1 ± 1.6), VOL indicated similar RPE values for all weeks (week 1: 3.1 ± 1.3; week 8: 2.9 ± 1.4). A detailed analysis of all twelve games revealed that differences in perceived exertion depend on the game content: in 75% of the involved games the RPE level was significantly higher in VOL + US compared to VOL (p < 0.05).

Conclusion

Monitoring internal and external loads on individual level are paramount for gaining adequate training adaptations. Our results indicate that between-group differences in perceived efforts a) can funnel over time, b) depend on game content and c) do not necessarily affect overall scoring. Future studies should individually employ and monitor measures of perceived efforts to guarantee an adequate challenge to the balance system within exercise-based fall prevention programs.

中文翻译：

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老年人平衡和不稳定平衡锻炼过程中的平衡训练监控和个人反应：来自随机对照试验的结果。

目的

以运动为基础的预防摔倒程序主要是指多模式和具有挑战性的平衡运动。单独的负载监视和解释对于在单个级别上实现适当的适应响应至关重要。因此，在整个干预期间评估内部对外部刺激的反应需要得到适当解决。这项针对三臂随机对照试验的二级分析的目的是分析健康老年人中不稳定平衡与稳定平衡的Exergame训练的内部和外部负荷。我们打算阐明在干预期间是否发生外部和内部负荷标准的差异。

方法

共有51名健康的老年人（女性：n = 34;男性：n = 17;年龄：69±6岁; BMI：27±5）被分配到自愿踏步（VOL），不稳定条件下的自愿踏步（VOL +美国）或无效的对照组（CON）。VOL和VOL + US使用Dividat Senso设备完成了8周的基于Exergame的逐步训练（每周3节，每节45分钟）。使用了十二种不同的平衡Exergames，其中包括视频游戏等虚拟现实。VOL使用了最初的非摆动稳定平台，而VOL + US使用了安装在摆动的Posturomed机架上的自适应Senso。VOL + US仅每第二周增加一次不稳定级别。每次会议分别记录外部（游戏得分）和内部（感知的努力，使用额定的感知运动量表（RPE））负荷量度。

结果

尽管VOL + US在不稳定的条件下以相同的训练量完成了类似的比赛，但两个训练组之间获得的比赛得分并没有显着差异（p = 0.71）。两个干预组在8个训练周内均显着提高了比赛得分（p <0.01）。对于感知的努力，观察到显着的时间x组交互作用（p <0.01），用作内部负荷量度。随后的事后测试显示，与VOL相比，在VOL + US的前7周中，每个人的感知劳累值均显着更高（p <0.05）。在第8周中没有发现RPE的组间差异。而VOL + US中的RPE值随时间下降（第1周：4.6±1.9；第8周：3.1±1.6），而VOL则表明所有周（第1周）的RPE值均相似：3.1±1.3；第8周：2.9±1.4）。

结论

在各个级别上监视内部和外部负载对于获得足够的培训适应性至关重要。我们的结果表明，在感知的努力方面，组间差异可能随着时间的流逝而发生； b）取决于游戏内容； c）不一定会影响整体得分。未来的研究应单独采用和监测所察觉的努力的措施，以确保在以运动为基础的防摔计划中对平衡系统提出适当的挑战。