Effect of Balance Training on White Matter Tracts in Healthy Elderly Population

Study Overview
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Brief Summary
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Balance impairment increases the risk of falling and is associated with a fear of falling and immobility. Balance impairment can ultimately affect the morbidity of cardiovascular disease, cognitive impairment, and mortality, especially in an older population. Among the multiple types of exercise, balance training is the most effective in preventing falls. This study aims to investigate white matter plasticity in healthy elderly population, based on stepwise balance training. Healthy elderly participants will undergo four weeks of balance training. The investigators will analyze longitudinal changes in the microstructural integrity of the white matter tracts pre- and post-training.

Detailed Description
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Balance is an essential element of daily living. Balance impairment increases the risk of falling and is associated with a fear of falling and immobility. Balance impairment can ultimately affect the morbidity of cardiovascular disease, cognitive impairment, and mortality, especially in an older population. Among the multiple types of exercise, balance training is the most effective in preventing falls. Specific structures of the brain are highly associated with balance, and the integration of functions from these structures maintains balance function. Training-induced behavioral changes accompany white matter plasticity. White matter plasticity by practicing expert skills has been of particular interest because characteristic changes in white matter are expected to occur through repetitive and intensive motor skill training. Training-induced white matter plasticity regarding balance is less understood in the healthy adult population. Previous neuroimaging studies have focused on elucidating the cross-sectional associations between balance function and disease-specific characteristics in various clinical populations, such as patients with stroke, traumatic brain injury, Parkinson's disease, and other neurodegenerative diseases. Developing neuroimaging biomarkers is essential to provide individualized training or rehabilitation intervention and to evaluate its efficacy. Diffusion tensor imaging is a sensitive neuroimaging tool to detect myelin change quantitatively in human white matter in vivo. DTI is used to measure water molecules' diffusion anisotropy, called fractional anisotropy (FA). This study will explore white matter plasticity in a healthy elderly population which practices stepwise balance training for 4 weeks. The investigators adopt a longitudinal design to contrast the neuroplastic changes in white matter tracts linked to balance function. The investigators hypothesize that balance training would change the microstructural integrity of white matter tracts associated with balance improvement.

Official Title
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Effect of Balance Training on White Matter Tracts in Healthy Elderly Population

Conditions
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Postural Balance, Neuronal Plasticity, Elderly Population

Intervention / Treatment
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* Behavioral: Balance training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Mini-mental state examination ≥ 26 Independent outdoor ambulator Exclusion Criteria: Men/women with any metal implants in their body A prior history of psychopathology or a neurological disorders A prior history of osteoporosis, advanced osteoarthritis (K-L grade >=3), surgical history of hip or knee arthroplasty If any structural abnormalities are detected on their scan

Ages Eligible for Study
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Minimum Age: 60 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

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


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Balance training group<br>A single training group | Behavioral: Balance training<br>* Step-by-step training (5 levels) 30 minute per training 3 times per week 4 weeks<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fractional anisotropy of the motor-related white matter tracts | Measurement of the change of DTI-derived parameter before and after balance training Tracts of interest Corticospinal tract (CST) Cortico-ponto-cerebellar tract (CPCT) Dentato-rubro-thalamo-cortical tract (DRTCT) Dorsal spinocerebellar tract (DSCT) Measurement of DTI-derived parameter Fractional anisotropy (FA) values of the CST, CPCT, DRTCT, and DSCT Units and scoring of the Measurement FA No unit. The measurement ranges from 0 to 1 Higher scores indicate better microstructural integrity. | 4 weeks | 
| Community Balance & Mobility Scale | Performance measure before and after balance training Measurement 13 domain Unilateral stance, Tandem walking, 180° tandem pivot, Lateral foot scooting, Hopping forward, Crouch and walk, Lateral dodging, Walking & looking, Running with controlled stop, Forward to backward walking, Walk look and carry, Descending stairs, Step-ups x 1 step Scoring of the Measurement No units. The measurement ranges from 0 to 96 Higher scores indicate better postural balance and mobility. | 4 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mean diffusivity of the motor-related white matter tracts | Measurement of the change of DTI-derived parameter before and after balance training Tracts of interest CST CPCT DRTCT DSCT Measurement of DTI-derived parameter Mean Diffusivity (MD) values of the CST, CPCT, DRTCT, and DSCT Units and scoring of the Measurement MD mm^2/second There is no limit on the range (usually ranges 0.00005 - 0.0001 mm^2/second). Higher scores indicate worse microstructural integrity. | 4 weeks | 
| Tract volume of the motor-related white matter tracts | Measurement of the change of DTI-derived parameter before and after balance training Tracts of interest CST CPCT DRTCT DSCT Measurement of DTI-derived parameter Tract volume (TV) values of the CST, CPCT, DRTCT, and DSCT Units and scoring of the Measurement TV mm^3 There is no limit on the range. Higher scores indicate better microstructural integrity. | 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Postural Balance, White Matter, Neuronal Plasticity, Elderly Population, Rehabilitation, Diffusion Tensor Imaging