NMES to Improve Hip Abductor Strength and Balance

Study Overview
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Brief Summary
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This study will examine the addition of neuromuscular electrical stimulation (NMES) on the hip abductors during strength training and a fall prevention program for improving muscle strength and improving balance. All individuals in this study will receive NMES to their hip abductors and will participate in a fall reduction program.

Detailed Description
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Falls are a leading cause of disability in older adults. Decreased lower extremity muscle mass and strength contribute to balance and mobility limitations. Our more recent work also suggests that in addition to the traditional targets of muscle mass of the thigh and leg muscles, dysfunction of the hip abductors may contribute to balance and mobility limitations resulting in increased fall risk. Older adults with impaired hip abductor muscles demonstrate increased amounts of intramuscular fat (IMAT) in and around the muscles, decreased hip abductor strength, lower balance scores, increased gait variability (a predictor of future falls), and poor stepping mechanics when recovering from a balance perturbation. Increased IMAT and muscle dysfunction of the hip abductors may contribute to poor hip abductor muscle recruitment and make changing these muscle during a traditional intervention difficult. Neuromuscular electrical stimulation (NMES) is one method to improve muscle mass, strength and quality in older adults, but has not traditionally been used on the hip abductors. We propose that a targeted multimodality balance intervention (MMBI) focused on the lateral and diagonal stepping and hip abductor strengthening when combined with NMES will result in improvements in mobility and balance.

Official Title
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Neuromuscular Electrical Stimulation as an Adjunct to Improve Hip Abductor Muscle Quality and Reduce Fall Risk

Conditions
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Postural Balance

Intervention / Treatment
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* Other: Neuromuscular electrical stimulation (NMES)
* Other: Multi-Modality Balance Intervention (MMBI)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Mobility and balance limitations as demonstrated by a self-reported fall within the past year or requiring greater than 8 seconds to complete the 4-square step test - Exclusion Criteria: Cardiovascular Risks: Poorly controlled hypertension (>160/100); or patient report of: symptomatic angina at rest or during exercise, syncope without known resolution of cause, or a significant coronary event (such as a MI) in the past six months COPD requiring home oxygen Contraindications to resistance training, including a self-reported history of intracranial or retinal bleeding in the last year or Diabetes with active proliferative retinopathy Patient report of significant spinal stenosis that would limit participation in the exercise intervention Non-ambulatory mobility status or a transtibial or transfemoral amputation Dementia (on medical record review or mini-mental status exam score <24). Other severe medical illness or condition that would preclude safe participation in the study as determined by the study team

Ages Eligible for Study
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Minimum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: NMES + MMBI<br>Neuromuscular electrical stimulation applied to hip abductors along with participation in a multi-modality balance intervention | Other: Neuromuscular electrical stimulation (NMES)<br>* Participants will receive NMES to the hip abductors while performing strength training 3 times per week for 24 weeks<br>Other: Multi-Modality Balance Intervention (MMBI)<br>* Participants will attend a group balance class that focuses on movement and obstacle negotiation 3 times per week for 24 weeks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mobility | Mobility will be measured with the use of the mini-BesTest | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Balance | Balance will be measured with the four-square step test | 6-months | 
| Muscle Strength | Muscle strength will be measured as hip abductor strength quantified by use of a biodex | 6-months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Hip, Muscle, Skeletal/physiopathology