Effect of Combined Cognitive and Motor Intervention on Muscles Strength, Balance and Daily Activities among Elderly at Risk for Falls

Background: One in three seniors falls at least once a year, making falls a serious public health concern. Increased mortality, injuries, loss of independence, and unfavorable psychosocial effects are all linked to falls. Aim of the study : To evaluate the effect of combined cognitive and motor interventions on muscle strength, balance, and daily activities among elderly people at risk for falls. Subjects and method: Design: A quasi-experimental study (study/control) was used in the current study. Setting: the study conducted at six geriatric homes at Minia governorate. Subject: total coverage of the elderly at selected places was comprised in the study . Tools of data collection: Four tools were used to gather data for this study : Structured interviewing sheet; Medical Research Council Scale for Muscle Strength and Berg Balance Scale and The Katz Activities of Daily Living. Results: It was found that, combined cognitive & motor exercises group had the highest scores for muscle strength, maintain balance, and becoming independently in performing activity of daily living (ADLs) post 24-week of exercises, compared with the control group. Conclusion: Combined cognitive and motor exercise interventions had an adequate influence on the improvement of balance, gait, activity of daily living, and muscle strength in the upper and lower limbs and decreased the risk of falling compared to motor intervention alone. Recommendation: Health education among elderly about the effects of combined and cognitive training exercises on balance, muscle strength, and activities of daily living through effective teaching media such as videos, role play, and demonstration.


Significance of the Study:
According to the World Health Organization's (WHO) global report on health prevention, aged adults frequently experience a decline in muscle strength that could affect their ability to balance.

Aim of The study
The current research aimed to evaluate the effect of combined cognitive and motor interventions on muscle strength, balance, and daily activities among elderly people at risk for falls.

Research Hypotheses:
The following research hypotheses were devel oped in order to achieve the goal of the current study: Null Hypothesis: Application of motor and cognitive exercises is expected to be not having effect on improving muscle strength, balance and activities of daily living among elderly people at risk for falls.

H1:
The muscle strength of the study participants who received combined cognitive and physical training is expected to be increased better than physical training group alone and control group.
H2: The balance of study subjects who received combined cognitive and physical training is expected to be better than physical training group only and control group.

Subjects and method:
Research design: - The current study employed a quasiexperimental study design (study/control); this form of research methodology involve one or more group subjects monitored before and after the implementation of an intervention, and was pertinent to the nature of the problem under examination.

Setting:
In

Tools for data collection:
Four tools were used to gather data of this study was selected after reviewing relevant literature.   -Pilot Study: A pilot study was conducted to test the tools applicability and feasibility of the study on 10 %( 27) elderly people who were included in the current study as no modifications were done.

Data collection phase:
Ethical Consideration: Research proposal was accepted from the ethical committee in Faculty of Nursing; Minia University. There was no risk for study subjects during application of research, the study followed the common ethical principles in clinical research, Informed consent was obtained from participants that were participated in the study after explaining the nature and purpose of the study, Confidentiality and anonymity was assured and study participants have the right to refuse to participate or withdraw from the study.

Phases of the intervention program:
Phase I: Preparatory and planning phase: Control group: Elderly people in the control group were observed and assessed for their usual daily routine using the three study tools and after finishing data collection.
Warm up exercises (5 minutes) before the basic exercises were performed to prepare the body for exercise and reduce the likelihood of injury. These included marching arms and marching legs.

Strength exercises Exercise Duration Frequency Sit-to-Stand Exercise
Perform 10 repetitions once a day

Mini-squats
Repeat for about 1 minute. once a day Knee Extensors (front of thigh) Hold for 5-10 seconds. once a day

Hip extensors (back of the hip)
Hold for 5-10 seconds. once a day Knee flexors (back of the thigh Hold for 5-10 seconds. once a day

Wall push-ups
Repeat up to 10 times once a day Walking over 10 meter forward-backward, sideways and turning figure of 8 walking twice a day.

Balance exercises Exercise Duration Frequency Single leg exercise
Hold for 10 to 15 seconds on each leg once a day Foot taps to step Perform 10 repetitions on each leg once a day Narrow Stance Reaches Perform 10 reaches with each arm. once a day Cool down exercises: repeat marching arms and legs exercises for 5 minutes. Cognitive training: it was performed for 30 minutes and included count money, name pictures, repeat a pattern, remember pictures in order (n-back), arranging items in an alternating pattern or from smallest to greatest. Dot copying; copying a drawing (of a pyramid, cylinder, or home). Calculation of allowance, costs, and modifications.

Evaluation phase:
Three measurements were made using the same study scale: once at the baseline, once throughout the 12-week intervention, and once at the end of the intervention at six months. The amount of falls that elderly people encounter was utilized to gauge how effective preventive exercises were.

Field work:
Data were gathered along six-month period starting in October 2022 and ending in March 2023. The researchers interviewed with the participant and his/ her care givers using the study's data collection tools.

Statistical analysis:
The statistical software for social sciences (SPSS) version 22 was used to arrange, classify, and analyze the collected data. For qualitative and quantitative variables, respectively, the mean and standard deviations of the data were reported using descriptive statistics. The ANOVA-test, repeated measures ANOVA, chi-square test, and correlation r-test were the statistical tests that were employed.
When the p-value was less than 0.05, high significance was assumed, and when the p-value was greater than 0.05, no statistical significance difference was taken into account. No statistically significant differences were found for these characteristics among the groups .

Control group n=92
Motor Exercise group n=92

Conclusion:
The results of a current study showed that combined cognitive and motor exercises interventions had an adequate impact on the improvement of balance, gait, activity daily living, and motor strength in upper and lower limbs, and decreased the risk of falling compared to motor intervention alone because cognitive training focused primarily on executive function exercises on cognitive outcomes, and it suggests that a combination of motor and cognitive treatment tends to maximize all these effects.

Recommendations:
• Use combined and cognitive training exercises that assist with balance and gait improvement and decrease fear of falling among elderly.
• Regular health education for senior people who are experiencing early-stage balance and gait problems.
• The relationship between enhancements in cognitive abilities and performance on physical tasks among elderly should be examined in future study in this area.
• Periodic follow up for elderly people to assure understanding health information. •