How to Reduce Falls in Postmenopausal Women
Before the beginning of the study, there was no statistical difference between groups in the variables considered, except for serum creatinine ( Table 1 ), and all volunteers presented measurements within the reference range, except for serum 25(OH)D levels in the CG.
The mean (SD) body mass measurements after the protocol were 74.50 (14.60) and 73.80 (16.40) kg for the CG and the AEG, respectively. Comparisons showed no significant differences in this parameter between moments (P=0.377) or groups (P=0.747).
There was a significant time effect for both groups after the 24-week supplementation with cholecalciferol (P<0.001), evidencing an increase in 25(OH)D levels by 21% and 23% in the CG and the AEG (mean [SD], 58.2 [28.5] and 63.7 [31.3] nmol/L, respectively). No difference was found between groups at the end of the study (P=0.265). According to the initial serum 25(OH)D levels, 54.6% of the participants in the AEG and 45.5% of the participants in the CG presented sufficient levels of this vitamin (>50 nmol/L); at the end of the study, these numbers changed to 87.7% in the AEG and to 100% in the CG. There was a time-group interaction in the analysis of serum iPTH levels (P=0.003), and multiple comparisons showed that it increased by 19% only in the CG (from 43.6 to 51.9 pg/mL; P=0.003), with no difference in the AEG (P=0.285).
For FLEX evaluation, ANOVA revealed a significant interaction effect (P=0.021); multiple comparisons showed that the CG had a 12.2% increase (P= 0.009), but the AEG presented an even more expressive increase (26.6%; P< 0.0001) at the end of the study. We also found an interaction effect in TUG comparisons (P<0.001), and although there were significant improvements in both groups after the study (10.1% in the CG, P<0.001; 23.7% in the AEG, P<0.001), the AEG was significantly better than the CG (P<0.001).
Considering body balance measured by UST, we observed a significant increase from the moment before to the moment after (time effect) among all participants, independently of the group (P=0.005). Although the AEG improved balance by 14.1% and the CG enhanced this variable only by 4.5%, we found no significant differences between the two groups (P=0.143). A significant interaction effect was observed for HGS (P<0.001), and further comparisons demonstrated that only the AEG improved after the study (13.4%; P<0.001), being significantly better than the CG (P=0.004).
For SBE measurements, ANOVA revealed an interaction effect (P<0.001), and multiple comparisons showed that an improvement could be seen only in the AEG (P<0.001), which was better than that in the CG at the end of the study (P<0.001; Figure 2).
(Enlarge Image)
Figure 2.
Strength of back extensor muscles at baseline and after 6 months of aquatic exercises in both groups. a, compared to before Δ=26.2% (P = 0.001); b, compared to before (P = 0.23). AEG, aquatic exercise group; CG, control group.
Concerning SHF, we could only find a time effect (P = 0.039), demonstrating that the AEG, as well as the CG, showed substantial improvements after the study (18.5% and 5.7%, respectively). In contrast, a significant time-group interaction was observed for SKE (P<.001), and subsequent comparisons demonstrated that the AEG improved SKE, whereas the CG lost strength in this muscle group (Figure 3).
(Enlarge Image)
Figure 3.
Strength of knee extensor muscles at baseline and after 6 months of aquatic exercises in both groups. a, compared to before Δ=7.7% (P = 0.001); b, compared to before Δ= 4.0% (P = 0.018). AEG, aquatic exercise group; CG, control group.
ANOVA detected an interaction effect on the number of falls (P=0.009), and multiple comparisons showed that there was a significant reduction in the mean number of falls after the protocol only in the AEG (from 2.00 to 0.29; P<0.0001). In the same direction, investigation of the number of fallers in each group revealed an interaction effect (P=0.006). The following multiple comparisons demonstrated that only the AEG had a reduction in the number of fallers after the study (P<0.001), causing this group to differ from the CG at the end (P<0.0001; Figure 4).
(Enlarge Image)
Figure 4.
Number and percentage of fallers in both groups before and after the study. AEG, aquatic exercise group; CG, control group.
Considering the participants of both groups together before the study, we found modest and moderate negative correlations between TUG and some other neuromuscular variables: HGS (r=-0.201, P<0.037), SBE (r= -0.294, P<0.002), SKE (r=-0.356, P<0.0001), and UST (r=-0.539, P<0.0001).
During the 24 weeks of the aquatic exercise protocol, no exercise-related injury was reported by the participants in the AEG.
Results
Before the beginning of the study, there was no statistical difference between groups in the variables considered, except for serum creatinine ( Table 1 ), and all volunteers presented measurements within the reference range, except for serum 25(OH)D levels in the CG.
The mean (SD) body mass measurements after the protocol were 74.50 (14.60) and 73.80 (16.40) kg for the CG and the AEG, respectively. Comparisons showed no significant differences in this parameter between moments (P=0.377) or groups (P=0.747).
There was a significant time effect for both groups after the 24-week supplementation with cholecalciferol (P<0.001), evidencing an increase in 25(OH)D levels by 21% and 23% in the CG and the AEG (mean [SD], 58.2 [28.5] and 63.7 [31.3] nmol/L, respectively). No difference was found between groups at the end of the study (P=0.265). According to the initial serum 25(OH)D levels, 54.6% of the participants in the AEG and 45.5% of the participants in the CG presented sufficient levels of this vitamin (>50 nmol/L); at the end of the study, these numbers changed to 87.7% in the AEG and to 100% in the CG. There was a time-group interaction in the analysis of serum iPTH levels (P=0.003), and multiple comparisons showed that it increased by 19% only in the CG (from 43.6 to 51.9 pg/mL; P=0.003), with no difference in the AEG (P=0.285).
For FLEX evaluation, ANOVA revealed a significant interaction effect (P=0.021); multiple comparisons showed that the CG had a 12.2% increase (P= 0.009), but the AEG presented an even more expressive increase (26.6%; P< 0.0001) at the end of the study. We also found an interaction effect in TUG comparisons (P<0.001), and although there were significant improvements in both groups after the study (10.1% in the CG, P<0.001; 23.7% in the AEG, P<0.001), the AEG was significantly better than the CG (P<0.001).
Considering body balance measured by UST, we observed a significant increase from the moment before to the moment after (time effect) among all participants, independently of the group (P=0.005). Although the AEG improved balance by 14.1% and the CG enhanced this variable only by 4.5%, we found no significant differences between the two groups (P=0.143). A significant interaction effect was observed for HGS (P<0.001), and further comparisons demonstrated that only the AEG improved after the study (13.4%; P<0.001), being significantly better than the CG (P=0.004).
For SBE measurements, ANOVA revealed an interaction effect (P<0.001), and multiple comparisons showed that an improvement could be seen only in the AEG (P<0.001), which was better than that in the CG at the end of the study (P<0.001; Figure 2).
(Enlarge Image)
Figure 2.
Strength of back extensor muscles at baseline and after 6 months of aquatic exercises in both groups. a, compared to before Δ=26.2% (P = 0.001); b, compared to before (P = 0.23). AEG, aquatic exercise group; CG, control group.
Concerning SHF, we could only find a time effect (P = 0.039), demonstrating that the AEG, as well as the CG, showed substantial improvements after the study (18.5% and 5.7%, respectively). In contrast, a significant time-group interaction was observed for SKE (P<.001), and subsequent comparisons demonstrated that the AEG improved SKE, whereas the CG lost strength in this muscle group (Figure 3).
(Enlarge Image)
Figure 3.
Strength of knee extensor muscles at baseline and after 6 months of aquatic exercises in both groups. a, compared to before Δ=7.7% (P = 0.001); b, compared to before Δ= 4.0% (P = 0.018). AEG, aquatic exercise group; CG, control group.
ANOVA detected an interaction effect on the number of falls (P=0.009), and multiple comparisons showed that there was a significant reduction in the mean number of falls after the protocol only in the AEG (from 2.00 to 0.29; P<0.0001). In the same direction, investigation of the number of fallers in each group revealed an interaction effect (P=0.006). The following multiple comparisons demonstrated that only the AEG had a reduction in the number of fallers after the study (P<0.001), causing this group to differ from the CG at the end (P<0.0001; Figure 4).
(Enlarge Image)
Figure 4.
Number and percentage of fallers in both groups before and after the study. AEG, aquatic exercise group; CG, control group.
Considering the participants of both groups together before the study, we found modest and moderate negative correlations between TUG and some other neuromuscular variables: HGS (r=-0.201, P<0.037), SBE (r= -0.294, P<0.002), SKE (r=-0.356, P<0.0001), and UST (r=-0.539, P<0.0001).
During the 24 weeks of the aquatic exercise protocol, no exercise-related injury was reported by the participants in the AEG.
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