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 Table of Contents  
Year : 2021  |  Volume : 15  |  Issue : 1  |  Page : 28-32

Effect of an early administration of a structured exercise protocol on balance and gait in premenopausal women: A quasi-experimental study

Physiotherapy Centre, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Date of Submission02-Jun-2020
Date of Decision19-Nov-2020
Date of Acceptance23-Dec-2020
Date of Web Publication19-Aug-2021

Correspondence Address:
Dr. Tittu Thomas James
Physiotherapy Centre, National Institute of Mental Health and Neuro Sciences, Bengaluru - 560 029, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/PJIAP.PJIAP_32_20

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CONTEXT: Elderly population deals with many health problems, especially women, owing to menopause. A decline in balance leads to an increase in episodes of falls, increased fear of falls, along with an occurrence of a cautious gait pattern with reduced velocity and increased variability, which have also reported in women from 40 years of age and above.
AIMS: The aim of this study was to identify the role of a structured exercise protocol in improving balance and gait parameters in premenopausal women.
SETTINGS AND DESIGN: A single group quasi-experimental study was undertaken.
SUBJECTS AND METHODS: Seventeen females between the age group of 30 and 45 participated in the study. We administered a predesigned supervised exercise protocol for 5 days a week, 60 min per session, and for a period of 1 year.
STATISTICAL ANALYSIS USED: Pre- and posttest measures on balance and gait were assessed and analyzed using the Wilcoxon test.
RESULTS: The study identified an improvement in the balance performance of subjects in terms of a reduction in stability and sway parameters assessed using the Biodex Balance System. The temporal and spatial parameters of gait assessed using the GAITRite system also demonstrated significant improvement in postexercise sessions, with a net increase in velocity and cadence. All improvements in outcome parameters assessed were statistically significant (P < 0.05).
CONCLUSIONS: The study signifies the importance of an early commitment toward a structured exercise protocol by premenopausal women in maintaining their balance and gait performance which may be altered with aging and menopause.

Keywords: Balance, gait, premenopausal women, prevention of menopausal symptoms, structured exercise protocol

How to cite this article:
Beena AS, James TT, Dhargave P. Effect of an early administration of a structured exercise protocol on balance and gait in premenopausal women: A quasi-experimental study. Physiother - J Indian Assoc Physiother 2021;15:28-32

How to cite this URL:
Beena AS, James TT, Dhargave P. Effect of an early administration of a structured exercise protocol on balance and gait in premenopausal women: A quasi-experimental study. Physiother - J Indian Assoc Physiother [serial online] 2021 [cited 2022 Oct 5];15:28-32. Available from: https://www.pjiap.org/text.asp?2021/15/1/28/324126

  Introduction Top

The lack of physical activity in modern life is the main reason for the decline of physical fitness and work efficiency. This leads to an increase in the occurrence of chronic diseases, which leads to increase in medical costs and the economic burden on the individuals as well as on the country. Guiding people to involve in exercise properly to enhance physical fitness is more important.

Lifestyle interventions should be the primary strategy for the prevention and treatment of metabolic diseases owing to their safety and effectiveness. Reasonable diet and weight control have received widespread attention, but the role of an exercise intervention is often overlooked by medical professionals and patients. Research shows that a reasonable exercise intervention can increase energy consumption, strengthen muscle, reduce blood pressure and blood lipids, increase bone density, and regulate psychological processes.[1]

Exercise therapy is a safe method for improving one's physical performance. Exercise prescription is generally a specific plan for a specific purpose, and it is usually developed by physical therapists based on the patient's condition which focuses on long-term health maintenance and in programs for the prevention of secondary complications.[2]

Elderly population deals with many health problems, especially women, owing to menopause. According to the literature, the level of bone loss in a postmenopausal woman increases with age, with a loss of 0.6%, 1.1%, and 2.1% per year for the 60–69, 70–79, and >80 years age groups, respectively. Most precisely, the loss is 1.5% per year for the spine and 1.1%–1.4% for the femoral neck in the first 4–5 years.[3] An increase in the incidence of heart diseases, high blood pressure, and diabetes are correlated with an increase in waist size measurement of more than 35 inches.[4] Reduced efficiency of somatosensory, visual, and vestibular systems bring about deficiency in postural control and a higher risk of falls.[5],[6],[7],[8]

A decline in balance leads to an increase in episodes of falls, increased fear of falls, along with an occurrence of a cautious gait pattern with reduced velocity and increased variability. There is a fourteen-fold increase in bone fracture risk in women who had experienced falls more than once.[9] It is, therefore, imperative to initiate a healthy lifestyle in premenopausal women, foreseeing the problems and symptoms arise out of the menopausal stage. Initiating an exercise-based lifestyle in an early phase of menopause may help in the long-term benefits in individuals. There is a paucity in the literature on exercises in premenopausal women and its effect on their balance and gait performance. This study, thus, focuses on developing a structured exercise protocol which can be adopted by premenopausal women and their effects on their balance and gait.

  Subjects and Methods Top

A quasi-experimental single-group study was conducted for a period of 1 year and 6 months from September 2018 to March 2020. Female subjects between the age group of 30 and 45 were included if they have not attained menopause and have not actively participating in exercise programs regularly. Subjects with any medical comorbidity indicating a contraindication for regular exercises, or with any orthopedic or neurologic illness which restrict them from performing the exercises prescribed were excluded from the study. Signed informed consent was collected from the subjects who were willing to participate in the study.

Before the study, anthropometric measurements such as height, weight, and body mass index (BMI) were documented. Balance measurements such as overall, anteroposterior (AP) and mediolateral (ML) stability as well as sway indices were assessed using Biodex Balance Master SD. Gait parameters such as velocity, cadence, and functional ambulation profile (FAP) as well as step length, step time, stride length, and cycle time of both legs were assessed using the GAITRite Walkway System. Lateral reach test (LRT) to the dominant side was also assessed and measured using inch tape.

A predesigned supervised exercise protocol was administered to the subjects after the pretest. Exercises were done for 5 days a week, 60 min per session, as circuit training, for a period of 1 year. The details about the protocol are depicted in [Table 1]. Posttest measurements of the same outcome measures were assessed after that.
Table 1: Structured exercise protocol of the study

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Statistical analysis

The normality was assessed using the Shapiro–Wilk test. The mean values of pre- and posttest scores were analyzed using the Wilcoxon signed-rank test.

  Results Top

Seventeen females with a mean age of 39.94 ± 5.36 participated in the study. The mean height and weight of the subjects before the study were 155.41 ± 3.91 and 69.44 ± 14.08, respectively. The mean BMI of individuals before the study was 28.77 ± 5.93. After 1 year of intervention, BMI reduced to 27.67 ± 5.82. The comparison of pre- and posttest mean values of outcome measures of balance and gait using the Wilcoxon signed-rank test showed a significant difference in all parameters [Table 2]. [Table 3] depicts the comparison of gait variability measures analyzed using the coefficient of variation of spatial and temporal parameters. A positive mean difference indicates a net increase in parameter postexercise sessions and a negative value indicates a net decrease.
Table 2: Analysis of pre- and posttest mean values of balance and gait parameters using the Wilcoxon signed-rank test

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Table 3: Analysis of pre- and posttest mean values of gait variability parameters using the Wilcoxon signed-rank test

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The participants demonstrated a significant reduction in stability and sway indices of balances which shows an increase in balance performance. Overall sway index exhibited greater reduction compared to other indices with a mean difference of −2.02. LRT also showed an improvement in post exercises.

The study showed a significant increase in gait velocity and cadence after a period of 1 year. There was a net decrease in temporal variables of gait such as step time and cycle time and a net increase in spatial parameters of gait such as step length and stride length poststudy period. The changes were statistically significant (P < 0.05). The FAP score provided by the GAITRite walkway showed a net increase of 5.76 denoting a better gait pattern in the study population after the exercise sessions. There was a significant reduction in gait variability measures of spatial and temporal parameters except for the cycle time of the left leg. The greatest reduction was seen in the variability of stride length of the left leg with a mean deviation of −7.64 cm (P = 0.025).

  Discussion Top

The postural instability in older women attributes to the combination of an increased reliance on vision, peripheral sensory deficits, lower extremity strength deficits, and an increased demand for greater muscle activity and co-activation.[5],[8],[10],[11] It is observed that deficits in any of the contributing factors lead to increased postural sway and imbalance, which leads to falls. The ill effects of falls are intensified by a reduced bone mineral density and prolonged bed rest in menopausal women. Studies have identified an increased sway in AP direction in elderly fallers.[11],[12] We identified that the structured exercise program had a significant effect in reducing the AP sway than that of ML sway in the study population which suggests a better control on falls prevention with the prescribed exercises (mean difference AP sway = −1.51 ± 0.15 vs. mean difference ML sway = −1.29 ± 016). LRT to the dominant side also showed significant improvement in postexercise sessions, which suggest an increased capacity of the center of pressure excursion and improved lateral stability limits.[13]

The gait variations identified in menopausal elderly women are mostly due to an increased balance deficit which is a threat to their stability. This compels them to adopt a cautious gait pattern with a reduced velocity, step length, and increased variability in spatial parameters.[14] This conservative gait pattern is also associated with the lower limb strength and flexibility, mainly quadriceps strength and ankle ROM.[15],[16] Body weight also induces a significant variation in gait speed owing to a sedentary lifestyle adopted by many postmenopausal periods.[17] Schrack et al. have identified the need of increasing fitness and minimizing energetic cost in the elderly to delay the mobility loss. They identified that the reduction in gait velocity adopted by individuals is to maintain an inherent level of energy, which may ultimately leads to mobility limitations and disability.[18] The systematic review by Latham et al. has identified that progressive resistance strength training shows improvement in muscle strength and in few aspects of functional limitations such as gait speed.[19] It is in this context that a need of an early administration of a structured exercise protocol is mandatory to maintain the energy levels of menopausal women by which the gait variations are minimized to a large extent. We identified that these exercises helped in improving the spatial and temporal parameters of gait including velocity and step length, which were statistically significant. The study also showed a significant reduction in gait variability suggesting a better gait pattern in individuals postexercise sessions.

Lack of sleep in postmenopausal women leads to an impaired quality of life due to fatigue and daytime sleepiness. Yang et al. have proposed an improved sleep quality with exercise training through increased energy consumption, endorphin release, etc.[20] The participants in our study also perceived an improvement in sleep quality and increased energy levels throughout the day during the study period. This was observed at their working environment as well as for the household chores which directly improved their quality of life.

Thus, our study identified that administering an early structural exercise protocol in premenopausal women helps in reducing body weight and BMI, as well as improves balance and gait performance in terms of the outcome parameters assessed in this study. In accordance with the available literature, a reduction in gait variability also indicates a better gait pattern and a reduction in falls postintervention. Reduced sample size and a lack of follow-up assessment were the limitations of this study. A nonacceptance by subjects for a 1-year supervised exercise program leads to a reduced sample size in the study.

  Conclusion Top

Early administration of a structured exercise program will improve the motor performance of premenopausal women in terms of balance and gait. The commitment of these exercise protocols for a longer time may help in coping up with the menopausal symptoms which arise in a later stage.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Luan X, Tian X, Zhang H, Huang R, Li N, Chen P, et al. Exercise as a prescription for patients with various diseases. J Sport Health Sci 2008;8:422-41.  Back to cited text no. 1
Larun L, Bruberg KG, Odgaard-Jenson J, Prince JR. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev 2016;12:CD003200.  Back to cited text no. 2
Benedetti MG, Furlini G, Zati A, Letizia Mauro G. The effectiveness of physical exercise on bone density in osteoporotic patients. Biomed Res Int 2018;2018:4840531.  Back to cited text no. 3
Stoppler MC, Shiel WC. Women's Health. Available from: https://www.medicinenet.com/womens_health/article.htm#/.2018. [Last accessed on 2020 Apr 10].  Back to cited text no. 4
Abrahamová D, Hlavacka F. Age-related changes of human balance during quiet stance. Physiol Res 2008;57:957-64.  Back to cited text no. 5
Horak FB. Postural orientation and equilibrium: What do we need to know about neural control of balance to prevent falls? Age Ageing 2006;35 Suppl 2:ii7-11.  Back to cited text no. 6
Dhargave P, Sendhilkumar R. Prevalence of risk factors for falls among elderly people living in long-term care homes. J Clin Gerontol Geriatr 2016;7:99-103.  Back to cited text no. 7
El Haber N, Erbas B, Hill KD, Wark JD. Relationship between age and measures of balance, strength and gait: Linear and non-linear analyses. Clin Sci (Lond) 2008;114:719-27.  Back to cited text no. 8
Bergland A, Wyller TB. Risk factors for serious fall related injury in elderly women living at home. Inj Prev 2004;10:308-13.  Back to cited text no. 9
Lord SR, Ward JA. Age-associated differences in sensori-motor function and balance in community dwelling women. Age and Ageing 1994;23:452-60.  Back to cited text no. 10
Laughton CA, Slavin M, Katdare K, Nolan L, Bean JF, Kerrigan DC, et al. Aging, muscle activity, and balance control: Physiologic changes associated with balance impairment. Gait Posture 2003;18:101-8.  Back to cited text no. 11
Howcroft J, Lemaire ED, Kofman J, McIlroy WE. Elderly fall risk prediction using static posturography. PLoS One 2017;12:e0172398.  Back to cited text no. 12
Brauer S, Burns Y, Galley P. Lateral reach: A clinical measure of medio-lateral postural stability. Physiother Res Int 1999;4:81-8.  Back to cited text no. 13
Menz HB, Lord SR, Fitzpatrick RC. Age-related differences in walking stability. Age Ageing 2003;32:137-42.  Back to cited text no. 14
Seidler RD, Bernard JA, Burutolu TB, Fling BW, Gordon MT, Gwin JT, et al. Motor control and ageing: Links to age-related brain structural, functional, and biochemical effects. Neurosci Biobehav Res 2010;34:721-33.  Back to cited text no. 15
Mecagni C, Smith JP, Roberts KE, O'Sullivan SB. Balance and ankle range of motion in community-dwelling women aged 64 to 87 years: A correlational study. Phys Ther 2000;80:1004-11.  Back to cited text no. 16
Buchner DM, Larson EB, Wagner EH, Koepsell TD, de Lateur BJ. Evidence for a non-linear relationship between leg strength and gait speed. Age Ageing 1996;25:386-91.  Back to cited text no. 17
Schrack JA, Simonsick EM, Chaves PH, Ferrucci L. The role of energetic cost in the age-related slowing of gait speed. J Am Geriatr Soc 2012;60:1811-6.  Back to cited text no. 18
Latham NK, Bennett DA, Stretton CM, Anderson CS. Systematic review of progressive resistance strength training in older adults. J Gerontol A Biol Sci Med Sci 2004;59:48-61.  Back to cited text no. 19
Yang PY, Ho KH, Chen HC, Chien MY. Exercise training improves sleep quality in middle-aged and older adults with sleep problems: A systematic review. J Physiother 2012;58:157-63.  Back to cited text no. 20


  [Table 1], [Table 2], [Table 3]


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