The Effects of an Eight-week Cawthorne-Cooksey Training Program on Bal- ance and Lower Limb Strength in the Elderly

* Corresponding Author: Seyyed Mojtaba Tabatabai Asl Address: Department of Sport Injuries and Corrective Exercise, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran. Tel: +98 (915) 6278418 E-mail: syd.mojtaba75@gmail.com 1. Department of Sport Injuries and Corrective Exercise, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran. Mohammad Javad Azimizadeh1 , *Seyyed Mojtaba Tabatabai Asl1 , Seyyed Hosein Hoseini1


Introduction
ging 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 A 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].

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.

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).

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.  [18][19][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 divid- ed 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.

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.

Funding
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.