Effects of Action Observation Training and Exercises Over 65 Years Old
Condition: Fall Prevention; Elderly
Study type: Interventional

Summary: 
      With aging, the decrease in muscle strength in the musculoskeletal system , body biomechanics
      and posture changes and the risk of falling increase. The greatest danger of falling in this
      population is risky and the other danger is that it causes fractures, creates physical and
      psychological trauma, and increases the need for long-term care and health services.
      Increasing exercise efficiency for balance and preventing falls are extremely important for
      physical and cognitive health.

      İn recent years ,the''Action Observation''approach has been used as an added method to
      treatments to increase the effectiveness of exercise.Action observation ; it is a cognitive
      training that triggers motor learning by observing the desired activity and positively
      affects learning.

      The aim of the study : To investigate the effects of exercises on balance and fall risk
      together with action observation in individuals over 65 years of age . The researchers
      planned to combine action observation and traditional balance exercises as a group training
      and compare them with the control group .

      The hypothesis of the research is that action observation(AO) will be more useful in
      maintaining balance and preventing the risk of falling.

      Materials and methods of the research:Participants will consist of volunteers over 65 years
      of age(65-80 years old ). 60 participants to be selected randomly. The participants will be
      randomly assigned 2 groups.

      Experimental group :( 30 participants ) Action observation+ exercise combination Control
      group :( 30 participants ) will only exercise Study protocol:The randomized experimental and
      control group will study 3 days per week for a total of 8 weeks .Exercises difficulty;Borg
      Scale(0-10):It will be modarate.

      Evaluation:All evaluations will be made as a Pre-test/Post-test. The detailed descriptions
      and characteristics of the participants will be summarized at baseline and after 8 weeks, and
      the differences between groups, intergroup differences will be statistically evaluated.
    

Detailed description: 
      Purpose of the research:To investigate the effects of exercises combined with action
      observation on balance and fall risk in individuals over 65 years of age.

      The hypothesis of the research is that action observation will be more useful in maintaining
      balance and preventing the risk of failling.

      Action observation therapy (AOT)is a novel rehabilitation technique, which involves
      observation of purposeful actions with the intention to imitate and then performing those
      actions. AOT can be described as the patient being asked to carefully observe actions
      presented through a video-clip or performed by an operator, in order to imitate, try, and
      execute them after observation .This may include the mirror neuron system (MNS) processes on
      the upper limb function resulting from the observation of actions (new motor skills) and
      actual execution of similar neural structures . Current evidence have been limited to
      investigating AOT effectiveness on upper and lower limb rehabilitation in both neurological
      and orthopedic disorders, patients with stroke and brain injuries, limb pain, Parkinson
      disease, and in the old women. However, despite the volume of our understanding, there is a
      dearth of current scientific evidence evaluating the efficacy of AOT combined with exercises
      on balance and risk of fall in elderly both in men and women.

      Study Power Analysis:The effect size was calculated using the G Power Package Program(G Power
      3.0.10) over the data of the reference article(Leem SH et al,2019).The sample size required
      for the study according to the calculated effect size was determined as at least 38
      participants for %95 power and Type I error rate (alpha):0.05 were calculated.To increase the
      power of our study, we invited 100 volunteer participants and after the exclusion criteria,
      we started with 60 participants, but with 43 participants.We were able to complete our work.

      Our research is a randomized, controlled experimental study that examines the effect of
      Action Observation Therapy (EGT) on balance and fall risk in individuals over the age of 65,
      with a probabilistic, systematic sample.

      Study protocol:

      Participants will be randomly divided into two groups as experimental and control groups.

      Experimental group participants:(n=30) Action observation+ exercise combination Control group
      participants:(n=30) Only exercise A total of 43 participants completed the study as 22
      participants in the experimental group and 21 participants in the control group for various
      reasons.

      Experimental group , the participants will be asked to carefully observe actions presented
      through a video-clip exercise for 15 minutes, and then do same exercises for about 45 minutes
      in 5-10 repetitions.

      The Control group (only exercise group), the participants will perform exercises for about 45
      minutes in 5-10 repetitions without a video-clip observation.

      Study program:3 days a week for 8 weeks Exercise difficulty:Modified Borg Scale(0-10); The
      modified Borg Scale was used to evaluate the intensity and difficulty grades of the exercises
      . Initially, the scores of 3 and 4 were applied, and a gradual increase up to 5 and 6 at the
      end of the studyExercise program:Exercises will be easy to learn but not complex in terms of
      recall and performans. Depending on the fitness of the person, %50-75 of the maximum heart
      rate (220-years),the exercise intensity will be preferred over the Borg Scale.

      The center where the research will be conducted ,İstanbul-Beşiktaş District Abbasağa
      neighborhood.

      Exercises;sitting and standing from easy to difficult; it will be advanced from those done
      with two feed touching the ground to those done on one foot and walking. It will include
      warm-up period, strengthening exercises ,static and dynamic balance exercises, flexibility
      exercises and cooling periods. The exercises were repeated 5 times initially. Then their
      repetition numbers were gradually increased up to 8-10 repetitions in small groups of 5-7
      people.All AOT and exercise programs were performed in the Abbasağa garden park, a quiet
      place without noise. We obtained local permission from Besiktas Municipality, Istanbul,
      Turkey, and applied the general rules for the COVID-19 pandemic.The participant registration
      and acceptance of this study and the implementation of the exercises protocol were made by
      the same research physical therapist.

      Study start date: December-2020

      Study application date: 1 April / 31 May 2021

      Completion of research: December-2021

      Evaluation: All evaluations will be made as a Pre-test/ Post-test The detailed descriptions
      and characteristics of the participants will be summarized at baseline and after 8 weeks, and
      the differences between groups, intergroup differences will be statistically evaluated.

      Socio-demographic evaluation Blood pressure and heart rate measurement Mini-Mental Test
      İnternational Physical Activity Questionnaire Short Form(IPAQ-Short)

      Cognitive Level Tests :

      Montreal Cognitive Assessment(MoCA)

      Balance and Fall Risk Tests:

      Time Up&Go Test(TUG) 5 Times Sit & Stand Test Tinetti Balance and Walk Test Activity Specific
      Balance Confidence Scale(ABC) BORG Scale (0-10): To determine exercise intensity I have
      prepared '' Pain Location and İntensity" and "Fall Frequency Questioning"and "Participant
      Satisfaction" evaluation forms in the last year.

      Statistical evaluation: The evaluation of the all data will be done using the SPSS
      statistical package program.The data will be analyzed using the SPSS program with the
      significance level of p<0.05

      İstanbul Medıpol Unıversıty Non-İnterventional Clinical Research Ethıcs Committee Permission
      of the research was obteined(Number:10840098-772.02-E.58328,Date:10/26/2020).
    

Intervention name(s): Action observation; Exercise group
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Action observation group: The participants will first watch the conventional balance exercises with the action observation method on video for 15 minutes.After watching of conventional balance exercise for 45 minutes in 5-10 repetitions.; Exercise group is the control group.TheParticipants will only do the conventional balance exercise without action observation for 45 minutes in 5-10 repetitions.
Other intervention name(s): Conventional balance exercises
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Cross-sectional sampling / Randomized controlled trial
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Aging; Action observation; Balance exercise; Fall prevention