The influence of the progressive power squat on the risk of falls in community dwelling older trans-tibial amputees

Abstract

Background: Falls are prevalent in older adults especially in the amputee population. Apart from the normal effects of ageing, older adult amputees experience a number of soft tissue changes in their skeletal muscle that occur rapidly following an amputation. Muscle power declines earlier and at a greater rate than strength with advancing age, resulting in a dramatic loss in the ability to produce force rapidly, further leading to a reduction in mobility and an increased incidence of falls. Resistance training, in particular power training was shown to produce the greatest improvements in muscle power and functional performance and thus keeping older adults safer in their environment. The aim of the study was to explore the influence of the progressive power squat on the risk of falls in community dwelling older trans-tibial amputees. Participants and Methods: A single case study research design was used. Older adult unilateral trans-tibial amputees (aged 65+) who had an amputation resulting from diabetes and/or peripheral arterial disease, were established prosthetic users and who reflected cases of interest, were invited to participate following ethical approval. Participants underwent a 12-week home exercise programme, performing the progressive power squat exercise daily, with a weighted vest utilised for resistance purposes. Assessment of the participants was done prior and post-exercise programme using the Berg Balance Scale, Falls Efficacy Scale-International questionnaire, Timed Up and Go test. In addition, muscle strength and power assessment were carried out using the Lafayette dynamometer, and semi-structured interviews were conducted. Findings: Seven participants took part in the study with four completing the exercise programme. Improvements in muscle strength and power results were recorded in five of the participants, albeit not in all muscle groups in an equal manner. Three of the four participants who completed the exercise programme had improvements in their fall risk scores and reduced concern about falling, with the latter also noted by one of the participants who did not fully complete the exercise programme. In the qualitative findings, five participants reported improvement in either some or all of the following; mobility, strength, balance and pain. Most participants found the exercise programme to be well-structured and their motivation and determination to perform the exercise programme also came through, despite them facing some obstacles or challenges. However, the use of the weighted vest for such training proved to be challenging for all the participants. Conclusion: The findings suggest that such an exercise had a positive influence in the participants on reducing the risk of falls and improving muscle function. However, since this is an exploratory study, such findings cannot be generalised to the whole older adult trans-tibial amputee population and thus further research on a larger scale needs to be conducted in order to prove if power training is in fact effective. Other methods of resistance or different methods of progression of the weight should be considered.