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Randomised controlled trial
A music-based multitask exercise programme is a promising intervention for improving gait, balance and fall risk in older adults
  1. Lesley Brown1,
  2. Natalie de Bruin1
  1. 1Department of Kinesiology, University of Lethbridge, Lethbridge, Alberta, Canada
  1. Correspondence to: Lesley Brown
    Department of Kinesiology, University of Lethbridge, 4401 University Drive E, Lethbridge, AB T1K 3M4, Canada; l.brown{at}uleth.ca

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Implications for nursing practice and research

  • A music-based multitask exercise programme can improve gait, balance and risk of falling among community living older adults.

  • A music-based exercise programme may be effective in encouraging adherence to an exercise intervention.

  • Adding music to a multitask exercise programme does not interfere with programme efficacy.

Context

Falls are a major health concern among older adults, with an estimated one-third of older adults experiencing at least one fall annually.1 With an ageing population, the cost of falls to society and the healthcare system sets to pose an increasing problem. Walking, particularly accompanied by one or more motor or cognitive tasks, has been implicated as a major risk factor for the falls occurring in older adults.

Trombetti et al investigated the effectiveness of a music-based multitask exercise programme (Jaques-Dalcroze eurhythmics) on improving gait, balance and fall risk in community living older adults at high risk of falling.

Methods

The effect of the music-based multitask exercise programme was assessed using a repeated measures cross-over design. The study utilised an intervention (n=66) and delayed-intervention (n=68) group of community-dwelling older adults (>65 years of age, mean age 75.5 years) at high risk of falling. The intervention group participated in a structured 1 h weekly class exercise programme, involving various multitask exercises performed to a rhythmic piano accompaniment. The delayed-intervention group maintained their physical and social activities. At 6 months, the groups crossed over, with the delayed-intervention group participating in the eurhythmics programme and the (early-)intervention group completing the control intervention for the subsequent 6 months. Gait variability under dual-task conditions, balance, functional performance and fall risk were assessed at 0, 6 and 12 months using standard measures.

Findings

The intervention group decreased gait variability under dual-task conditions and improved balance and functional test performance when compared with the delayed-intervention group. Furthermore, improvements to gait variability and some measures of balance were maintained at 6 months. The incidence of falls (incidence rate ratio 0.46, 95% CI 0.27 to 0.79) and risk of falling (RR 0.61, 95% CI 0.39 to 0.96) were lower in the intervention group than the delayed-intervention group. Similar results were observed for the delayed-intervention group following the active intervention.

Commentary

Reducing fall risk and the incidence of falls among older adults is a major healthcare priority. A number of systematic reviews have concluded that exercise interventions can be effective in reducing fall risk and incidence among community-dwelling older adults.2 This study by Trombetti and colleagues supports this outcome and adds to the current literature by investigating the effects of administering a multitask exercise programme that has music accompaniment. The nature of the intervention directly addresses the identification of dual tasking as a major risk factor for falls among older adults.3

This study has a number of strengths. The sample size ensured that the study was well powered, and the use of well-established and reliable tools for the assessment of gait and balance serves to ensure the generalisability of the findings. There was a fairly high rate of attrition during the study (134 enrolled with 84 completing the 6- and 12-month assessments), yet the attendance rates of those who completed the study were high (78%). This finding supports the possibility of participant enjoyment and motivation.

Although the originality of the intervention may be effective in modulating adherence to the exercise programme, the limited availability of suitably qualified eurhythmics instructors may restrict widespread accessibility. Furthermore, the inherent individuality of the lessons and instruction provided may lead to considerable variation between sites. Nevertheless, the unique contribution from this work is that the benefits of multidimensional exercise training to gait and balance are not compromised if the exercise intervention is presented with music accompaniment.

Although the possibility of gender differences in the outcome effects warrants further investigation, this study provides exciting foundation for continued investigation to parse the possibility that music accompaniment improves the benefit of exercise training to gait and balance. In this proposed investigation, the effect of a training intervention could be explored with and without music accompaniment. Although this scenario requires extension beyond the Jaques-Dalcroze eurhythmics technique, there is rich opportunity to improve the generalisability of the findings by exploring whether music selections that are individualised to participant preference for genre or enjoyment can similarly benefit gait and balance outcome measures.

View Abstract

Footnotes

  • Competing interests None.

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