Volume 7, Issue 1 (6-2021)                   J Sport Biomech 2021, 7(1): 68-77 | Back to browse issues page

XML Persian Abstract Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:

Azimizadeh M J, Tabatabai Asl S M, Hoseini S H. The Effects of an Eight-week Cawthorne-Cooksey Training Program on Balance and Lower Limb Strength in the Elderly. J Sport Biomech. 2021; 7 (1) :68-77
URL: http://biomechanics.iauh.ac.ir/article-1-245-en.html
1- Department of Sport Injuries and Corrective Exercise, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran.
Full-Text [PDF 4053 kb]   (229 Downloads)     |   Abstract (HTML)  (316 Views)
Full-Text:   (168 Views)
1. Introduction
Aging is a natural and fast process, i.e., achieved as a result of leaving behind childhood, adolescence, youth, as well as middle age. Aging is an undeniable aspect of life. Decreased birth rates, improved health status, and enhanced life expectancy have led to an increase in life expectancy and consequently an increase in the elderly or the phenomenon of aging, globally [1]. With the onset of old age, changes occur in balance-related physiological systems. The balance control system is a complex mechanism in which coordination between balance systems plays an important role [2]. Common problems in the elderly that occur as a result of aging or illness are loss of balance and postural control. With aging, physical changes or fluctuations increase; consequently, the odds of falling elevated in this population [3].

2. Methods
This was a quasi-experimental and applied study. The required study sample was selected from the elderly volunteers referring to the elderly centers of Mashhad City, Iran by the convenience sampling method. In total, 24 elderly men and women were divided into two groups of 12 individuals. Explanations on how to perform the exercises were provided by the researcher to the study subjects. Furthermore, after providing the informed consent form, the research subjects started the exercises. The Berg Balance Scale (BBS) was used to assess balance (internal validity: 0.98, external validity: 0.99), and the Timed Up and Go (TUG) test was used to evaluate lower limb strength (reliability: 0.99) in the study participants.
After performing the pretest measurements, the experimental group performed Cawthorne-Cooksey Training Program (CCTP) 3 times a week for 2 months. After 8 weeks of training, the study subjects were re-evaluated by the BBS and TUG test. The normality of the data was evaluated using the Kolmogorov-Smirnov test. Dependent Samples t-test was used to compare the differences between pretest and posttest stages. Moreover, Analysis of Covariance (ANCOVA) was used to compare the differences between the research groups. The obtained data were analyzed in SPSS at the significance level of P˂0.05.

3. Results
The results of Shapiro–Wilk test confirmed the normality of the data concerning the variables of balance index and lower limb strength. The data respecting the demographic information and the effects of CCTP on balance and lower limb strength in the elderly are presented in Table 1. The anthropometric data of the study groups is provided in Table 1.

As per Table 1, in the pretest stage, there was no significant difference in the balance and lower limb strength index; thus, the study groups were homogeneous in this area. The ANCOVA data on the difference between the scores of these indicators in the posttest revealed a significant difference between the control and experimental groups in the balance and strength index of the lower limbs. Furthermore, the Dependent Samples t-test results indicated that the experimental group had a significant improvement in the balance and strength index of the lower limbs, compared to the pretest values (P˂0.05).

4. Discussion and Conclusion
The present study investigated the effects of CCTP on balance and lower limb strength in the elderly. The obtained results indicated that CCTP was effective in improving balance and lower limb strength of the elderly in the experimental group, compared to the control group (P˂0.05). Moreover, there was a significant difference in the pretest and posttest stages between the experimental groups of static and dynamic balance. Song et al. (2016) investigated the effects of trunk and neck stability exercises on balance among the elderly; accordingly, the related results reflected a significant increase in balance records [15].
Bratchman et al. (2015) conducted a study on the therapeutic effect of CCTP on balance development and fear of falling in the elderly. Another study positively assessed the effects of CCTP on improving balance and postural control, functional capacity, and quality of life in the elderly [16]. Abarghaei et al. (2018) investigated the effects of CCTP on balance and quality of life in the elderly with an age range of 60-80 years. They concluded that CCTP significantly affected balance and quality of life in the elderly due to complete involvement of the atrial and ocular systems [17], i.e., consistent with the present study findings.
Additionally, the findings of this study were in line with those of Farnada et al. (2016), Kamrani Faraz et al. (2016), and Mirzaeian et al. (2016) who reported the improvement of lower limb strength after exercise programs [18-20]. Zambar et al. (2015) explored the influence of CCTP on static and dynamic balance and the odds of falls in older women. In their study, they examined subjects were divided into two groups of routine treatment and CCTP. After the intervention, they found that in the CCTP group, static and dynamic balance, as well as the odds of falling, were significantly improved [21]. The dynamism of some exercise items also facilitates improving the lower limb strength of the research subjects. Furthermore, the BBS alone cannot express balance and strength; thus, the TUG test was used.

Ethical Considerations
Compliance with ethical guidelines

All ethical principles are considered in this article. The participants were informed about the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them.

This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors. 

Authors' contributions
All authors equally contributed to preparing this article.

Conflicts of interest
The authors declared no conflict of interest.

The author would like to thank all staff of Mashhad Health Nursing Home for their help.

  1. Naeimikia M, Arab Ameri E, Ashayeri H, Hammayat Talab R, Azma K. The effect of external focus of attention instruction during walking training on old women’s gait kinematic parameters. J Mot Learn Mov. 2011; 3(2):137-53. https://jmlm.ut.ac.ir/article_24642_6123ce66011e14f6c262f76c7b4783e8.pdf?lang=en
  2. Goudarz M, Foroughan M, Makarem A, Rashedi V. Relationship between social support and subjective well-being in older adults. Iran J Ageing. 2015; 10(3):110-9. https://salmandj.uswr.ac.ir/browse.php?a_id=953&sid=1&slc_lang=en
  3. Farsi A, Ashayeri H, Mohammadzadeh S. The effect of six weeks balance training program on kinematic of walking in women elderly people. Iran J Ageing. 2015; 9(4):278-87. http://salmandj.uswr.ac.ir/browse.php?a_id=685&sid=1&slc_lang=en
  4. Beyranvand R. A survey on relationship between postural sway parameters and balance recovery strategies in older people. Daneshvar Med. 2016; 23(123):21-30. https://www.sid.ir/en/journal/ViewPaper.aspx?ID=505831
  5. Choi W, Joo Y, Lee S. Pilates exercise focused on ankle movements for improving gait ability in older women. J Women Aging. 2021; 33(1):30-40. [DOI:10.1080/08952841.2019.1618129] [PMID]
  6. Mirmoezzi M, Amini M, Khaledan A, Khorshidi D. Effect of 8-week of selected aerobic exercise on static and dynamic balance in healthy elderly inactive men. Iran J Ageing. 2016; 11(1):202-9. [DOI:10.21859/sija-1101202]
  7. Khajavi D, Farokhi A, Jaberi Moghadam AK, Kazemnejad A. Effect of a strength and balance training program on maintaining balance and quality of life in older male adults with fear of fall. Iran J Ageing. 2016; 11(2):270-9. [DOI:10.21859/sija-1102270]
  8. Khurana N, Gaur DK, Linjhara S. Effect of Cawthorne and Cooksey exercises on balance in elderly and risk of fall. Indian J Gerontol. 2015; 29(4):398-406. https://web.b.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=09714189&AN=110720645&h=
  9. Mańko G, Pieniążek M, Tim S, Jekiełek M. The effect of Frankel’s stabilization exercises and stabilometric platform in the balance in elderly patients: A randomized clinical trial. Medicina. 2019; 55(9):583. [DOI:10.3390/medicina55090583] [PMID] [PMCID]
  10. Nam KW, Go JC, Yang YP. Effects of a vestibular stimulation training program on the gait of chronic stroke patients. Korean Soc Phys Med. 2019; 14(1):35-41. [DOI:10.13066/kspm.2019.14.1.35]
  11. Kiyani P, Farahpour N. Evaluation of performance of the vestibular proprioception and vision systems on postural control of old men. Iran J Ageing. 2015; 10(3):44-53. https://www.sid.ir/en/journal/ViewPaper.aspx?ID=580067
  12. Kashani VO, Zarifkar M, Alinaghipoor Z. Determining validity and reliability of the Persian version of Activities-specific Balance Confidence Scale for elderly. Koomesh. 2018; 20(4):705-12. http://koomeshjournal.semums.ac.ir/article-1-3728-en.html
  13. Feshki F, Banaei Far A, Kasbparast M. The effects of a 6-week selected balance and Cawthorne-Cooksey exercises on static balance and mobility in female patients with multiple sclerosis. Med J. 2020; 10(3):169-76. [DOI:10.32598/ptj.10.3.449.1]
  14. Asadi Samani Z, Rahnama N, Reisi J, Lenjan Nejadian S. Correlation between new activity-based balance index with accelerometer data and postural balance in elderly woman. Koomesh. 2020; 22(1):92-8. [DOI:10.29252/koomesh.22.1.92]
  15. Song GB, Park EC. Effects of neck and trunk stabilization exercise on balance in older adults. J Korean Physic Ther. 2016; 28(4):221-6. [DOI:10.18857/jkpt.2016.28.4.221]
  16. Brachman A, Marszałek W, Kamieniarz A, Michalska J, Pawłowski M, Akbaş A, et al. The effects of exergaming training on balance in healthy elderly women-a pilot study. Int J Environ Res Public Health. 2021; 18(4):1412. [DOI:10.3390/ijerph18041412] [PMID] [PMCID]
  17. Abarghuei AF, Fadavi-Ghaffar M, Tousi S, Amini M, Salehi AR. Effect of cawthorne and cooksey exercises on balance and quality of life of 60 to 80 year-old individuals in Shiraz: A randomized clinical trial. Med J Islam Repub Iran. 2018; 23(4):32:74. [DOI:10.14196/mjiri.32.74] [PMID] [PMCID]
  18. Fernanda de Mattos, Neiva Leite, Arthur Pitta, Paulo Cesar Barauce Bento. Effects of aquatic exercise on muscle strength and functional performance of individuals with osteoarthritis: A systematic review. Rev Bras Reumatol; 2016; 6(6):530-42. [DOI:10.1016/j.rbre.2016.09.003] [PMID]
  19. Kamranifaraz N, letafatkar A, Javdaneh N. The effect of a compound exercises in the water on muscle strength, flexibility, and quality of life of elderly women 60-70 years old in Tehran. Nursing J Vulnerable. 2017; 3(9):24-37. http://njv.bpums.ac.ir/article-1-751-en.html
  20. Mirzaeian E, Kazemzade Y, Sokhangooei Y. Effect of 8 weeks of water exercises on static and dynamic balance, walking, strength of the lower extremity of elderly women. Presented at: The first National Conference of Sports Science Research New findings in the field of health, prevention, heroes and Tourism. 03 August 2017. Ahvaz; Shahid Chamran University of Ahvaz. https://www.en.symposia.ir/CDLC01
  21. Zambare PD, Soni N, Sharma P. Effect of Cawthorne and Cooksey exercise program on balance and likelihood of fall in older women. Indian J Physiother Occup Ther. 2015; 9(3):55. [DOI:10.5958/0973-5674.2015.00095.7]
  22. Ribeiro AD, Pereira JS. Balance improvement and reduction of likelihood of falls in older women after Cawthorne and Cooksey exercises. Brazil J Otorhinolaryngol. 2015; 71(1):38-46. [DOI:10.1016/S1808-8694(15)31283-0]
  23. Mahmoudi S, Heyrani A. The effect of 8 weeks of core stability and core stability_mindfulness exercises on the balance of older women in nursing centers of Kermanshah. J Motor Behav Sci. 2020; 3(3):247-56. http://www.jmbs.ir/article_118233.html?lang=en
  24. Jiakponnah NN, Unson C, Chukwurah QC. Correlates of strength and balance training exercises in older African American adults. Gerontologist. 2021; gnab016. [DOI:10.1093/geront/gnab016] [PMID]
  25. Gill TM, Pahor M, Guralnik JM, McDermott MM, King AC, Buford TW; LIFE Study Investigators, et al. Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: Randomized clinical trial (LIFE Study). BMJ. 2016; 352:i245. [DOI:10.1136/bmj.i245] [PMID] [PMCID]
  26. Farsi A, Abdoli B, Baraz P. The effect of balance, strength and combined training on balance in elderly women. Salmand. 2015; 10(3):54-61. https://salmandj.uswr.ac.ir/article-1-726-en.html
  27. Behm DG, Muehlbauer T, Kibele A, Granacher U. Effects of strength training using unstable surfaces on strength, power and balance performance across the lifespan: A systematic review and meta-analysis. Sports Med. 2015; 45(12):1645-69. [DOI:10.1007/s40279-015-0384-x] [PMID] [PMCID]
Type of Study: Research | Subject: Special
Received: 2021/01/9 | Accepted: 2021/02/16 | Published: 2021/06/21

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2022 CC BY-NC 4.0 | Journal of Sport Biomechanics

Designed & Developed by : Yektaweb