Name: a training program using an agility ladder for community-dwelling older adults
Uploaded: 2020-03-07T13:00:00
Description: Watch this Scientific Journal Video about A Training Program Using an Agility Ladder for Community-Dwelling Older Adults at JoVE.com

This study was funded by the Coordination for the Improvement of Higher Education Personnel of Brazil (CAPES- #1800789).

The study was approved by the Research Ethics Committee of the University of Campinas (UNICAMP) under Protocol Number 2479761. Written informed consent was obtained in-person from all study participants. Sixteen participants of both sexes were recruited from the community of the metropolitan region of Campinas by searching the database of the Applied Kinesiology Laboratory (AKL). The inclusion criteria were 1) individuals aged 60 and older; 2) ability to answer the questionnaires used in this study; 3) ability to walk in...

<ol>
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Several agility training programs are used for different populations, including sports teams4, children12, and older people6,10. These programs include square stepping exercises10,11 like the sequences described in the present study and can significantly improve the overall physical fitness of older adults by decreasing the risk of falls, fractures, immobili...

Being active while aging can optimize opportunities to improve physical, social, and mental health, enabling older people to participate actively in society1. Older adults should be payed attention to because of the consequences of aging2. People worldwide are living longer, and life expectancy is greater than 70 years for the first time in history. The number of individuals aged 60 years or older is increasing rapidly, and the health of these populations is usually poor. Aging impairs physical functions, mental capacity, and social interactions as a direct result of diseases or syndromes2.
Decrease in physical function may lead to falls, fractures, less access to health care, depression, and poor quality of life. Agility is crucial to prevent falls and maintain independence in older people. Sheppard and Young3 reported that agility involved &#34;whole-body movements in different directions in response to a stimulus.&#34;
Most studies evaluate agility in high-performance athletes4, although a few studies assess this parameter in older adults. Agility training for older people comprises preplanned gait adaptability training and reaction training (i.e., response to a signal)5. Liu-Ambrose et al.6,7 found that agility training improved postural stability, balance, and balance confidence, and decreased the risk of falls in older people. Moreover, this type of training is integrative and improves cognitive functions (e.g., perception, mental flexibility, and working memory) as well as neuromuscular and cardiovascular functions8,9.
Agility training is characterized by a set of exercise drills and can be automated. However, a physical trainer/instructor is necessary to create and teach the drills and indicate the right moment to increase the level of difficulty. Some studies found that step training improved physical fitness (e.g., balance, agility, lower limb strength and power, and decreased risk of falls) and cognitive function (e.g., choice stepping reaction time, inhibitory action, and executive function)5,10,11. The present study uses an agility ladder as a cost-effective instrument to assess the effects of preplanned gait training on the physical fitness of independent community-dwelling older adults.
The agility ladder used in the present study was previously employed to train school children and athletes12,13. The ladder had a length of 4.8 meters and 12 transverse rungs and was drawn on the floor using a 2 cm wide adhesive tape (Figure 1). Building a ladder on the floor avoided interruptions during training12 and decreased the risk of injuries. The study population was healthy, with a mean age of 66.9 &#177; 5.0 years, and lived independently in a community setting. The participants received 30 minute training sessions twice a week for 14 weeks.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Bluetooth speaker</td>
			<td>JBL</td>
			<td>-</td>
			<td>Used to time all protocol and signal the 30 s of each subset</td>
		</tr>
		<tr>
			<td>Chair</td>
			<td>-</td>
			<td>-</td>
			<td>Used on assessments</td>
		</tr>
		<tr>
			<td>Clipboard</td>
			<td>Tilibra</td>
			<td>-</td>
			<td>Used to support documents</td>
		</tr>
		<tr>
			<td>Crepe Tape of 2cm</td>
			<td>Dexter</td>
			<td>-</td>
			<td>Used to create the agility ladder on the floor</td>
		</tr>
		<tr>
			<td>Measuring Tape</td>
			<td>Stakley</td>
			<td>-</td>
			<td>Used to measure assessments distance</td>
		</tr>
		<tr>
			<td>Pen</td>
			<td>Bic</td>
			<td>-</td>
			<td>Used to note data</td>
		</tr>
		<tr>
			<td>Saucer Cone</td>
			<td>Kipsta</td>
			<td>-</td>
			<td>Used on assessments</td>
		</tr>
		<tr>
			<td>Stowatch</td>
			<td>Vollo</td>
			<td>-</td>
			<td>Used to time assessments results</td>
		</tr>
		<tr>
			<td>Sulfite Paper</td>
			<td>Chamex</td>
			<td>-</td>
			<td>used to write all data</td>
		</tr>
	</tbody>
</table>

a training program using an agility ladder for community-dwelling older adults

Aging impairs physical and cognitive functions and limits daily activities. Agility training can improve or maintain physical functioning in older people. The purpose of this study is to report the physical fitness benefits of a training program for independent community-dwelling older adults using an agility ladder. Each training session lasted approximately 30 minutes, and the benefits were achieved with two sessions per week for 14 weeks. Training was timed and involved four different drills and varying levels of difficulty through time. The exercises were performed at the School of Physical Education of the University of Campinas, S&#227;o Paulo state, Brazil. The study participants (n = 16; mean age of 66.9 &#177; 5.0 years) were instructed to perform the exercises as quickly as possible without making mistakes and were assisted by a physical trainer when they made mistakes. Assessments were performed both before and after training using five functional tests (i.e., Illinois agility, five times sit-to-stand, timed up-and-go, walking usual speed, and one-leg stand). Although the study sample was not compared with a control group, the results indicate that training protocols using an agility ladder are easy and practical and improve physical function performance in older adults.

Sixteen male and female independent community-living older people with a mean age of 66.9 &#177; 5.0 years were enrolled in the study. The interventions and assessments were performed at the School of Physical Education of UNICAMP.
Statistical analysis was performed using Minitab 18 software. The Mann-Whitney test was used to compare the functional test results before and after training. P values smaller than 0.05 were considere...

Watch this Scientific Journal Video about A Training Program Using an Agility Ladder for Community-Dwelling Older Adults at JoVE.com

A Training Program Using an Agility Ladder for Community-Dwelling Older Adults

The aim of this study is to present an agility training program for older people. The feasibility of this program is described, and the training protocol demonstrated by video imaging.

Aging impairs physical and cognitive functions and limits daily activities. Agility training can improve or maintain physical functioning in older people. ...

Aging reflects a decrease in physical condition, mental capacity and social interaction. Decreases in physical condition can cause consequences such as falls and fractures. Physical ability and agility has an important relevance in preventing falls and improves independence in older people.Agility involves whole body movement with a change of direction in response to a stimulus. Agility training might enable an integrative training, comprising perception and decision making, as anticipation, changes of direction, an example, stop and turns, neuromuscular and cardiovascular capacities. The aim of the study is to clarify the benefits of the agility ladder training as a new exercise method for older people in independent community living.In the present study, all participants were robust men and women over 65 years old. Training programs involving human subjects have been approved by the ethics committee of the State University of Campinas, UNICAMP. To assess physical fitness, the follow functional tests were applied:Illinois test;five times sit-to-stand;timed up and go;walking speed and one-leg stand.All tests were applied in both periods of pre-training and post-training over 14 weeks. Illinois test. The Illinois course is marked by four center cones spaced 3.3 meters apart, with the four corner cones positioned 2.5 meters from the center cones, constructing a rectangle of 10 meters by five meters.At one of the base corner cones, the participant starts the test by reaching the first cone that is in front. Afterwards, they turn around and go back to the base center cone. At this time, the participant needs to weave back and forth through the four center cones.Then, the participant turns around to the base center cone and moves as quickly as possible to the far corner cone and back to the last base corner cone to finish the test. Five times sit-to-stand. In the five times sit-to-stand test, the participant rises from a chair as fast as possible with their arms crossed in front of their body.A stopwatch is started when the participant raises their hips off the chair and stopped when the participant sits down after the fifth time. Timed up and go. Timed up and go, or tug test, is started when the participant gets up from a chair without the help of their arms.Then, he or she walks three meters around a marker placed on the floor, comes back to the same position, and sits back down again. The stopwatch is started when the participant gets up from their chair and stopped when they sit down again. Walking usual speed test.The participant walks 10 meters as a usual gait to perform the walking usual speed test. Measurement initiates when one of their feet reaches the one meter line and is stopped when one of their feet reaches the 11 meter line. The one meter at the beginning and end are used in order to avoid early acceleration and or deceleration.One-leg stand. The participant stands in a unipedal stance with arms crossed in front of their chest. A stopwatch is initiated when a participant raises his or her foot off the floor and stopped when his or her foot touches the floor again.This is done with both legs. Training sessions were about 30 minutes twice a week for 14 weeks. The agility training is performed during 15 minutes.It composes of four sets of two minutes. The first set is performed with one sequence of coordination on the agility ladder. Each set of two minutes is divided into four subsets of 30 seconds of agility, plus a 15 second pause between subsets.Between sets, there is one minute of passive pause. Progressive methods are possible with this training program. For example, an increase in complexity and volume training.It can occur, depending on the participant's adaption in performing the program, or by the participant's report. The participant's adaption will coincide with the increase in execution velocity when completing the pathway of the ladder. The complexity can be increased after six weeks of training.In this study, it consisted of four sequences of coordination and two other different sequences to challenge the participants after a period of adaption of six weeks. Volume training can be increased after 10 weeks of training. In this study, it started with 12 minutes in four sets of agility training, and ended up being 15 minutes in five sets.To perform the training, an adapted agility ladder used in sports training is used. Its dimensions are 4.8 meters long with 12 quadrilateral spaces, and each square along its length measures 40 centimeters by 40 centimeters. Participants pay attention to step only in the quadrilateral spaces and not on the rungs.A flat ladder was created by used two centimeter width tape on the floor. The tape avoided any interruption during the training and the risk of injury in older people, as they wouldn't stumble on the plastic or nylon structure. Agility training program, sequence one.Move through the rungs by alternating your feet in each quadrilateral space. Begin with the left foot in the first space, position A.Position the right foot in the second space, B.Move the left foot to the third space and follow this progression until the end, C.Each coordination activity is performed using the 4.8 meter ladder, back and forth, until the participant completes each time set of 30 seconds. Sequence two A.Move through the rungs by positioning the feet in each quadrilateral space.However, it is required to alternate feet when moving to the next space. For example, if you start with the right foot in the first space, then the next space has to start with the left foot and so on. Begin with the right foot in the first space, diagram A.Move the left foot in the first space as well, B.Next, move the left foot to the second space, C.Follow the sequence by positioning the right foot next to the left foot in the second space, D.Sequence two B.Sequence two A can be modified to increase the difficulty level.At this time, sequence two B is performed with little jumps to move to the next quadrilateral space. The feet go out of and into the space together, diagram A and B, always alternating the foot that starts the movement. This is determined by the tiptoe movement of the sequence.Sequence three A.Step over the ladder, performing diagonal and lateral movements using the external area of the ladder and the internal spaces of the ladder. Start with the diagonal movement of your feet to the external side of the ladder and progress by moving to the internal side of the first space. Begin with the left foot, followed by the right foot, to the left external side of the first space, diagram A and B.Move the right foot laterally to the first space, followed by the left foot, C and D.Afterwards, move the right foot diagonally to the right external side, between the first and second spaces, diagram E.Follow the sequence by positioning the left foot to the side of the right foot on the right external side, F.Sequence three B.Sequence three A can be modified to increase the difficulty level.Perform this protocol by positioning only one foot, left or right, on the external side of the ladder, diagram A.When positioning the left foot to the left external side, the right foot does not follow the movement, diagram A and B.Follow the right foot forward to the next internal space, B.After moving the right foot to the next internal space, move the left foot next to it in that space, letter C.Then, continue the progression, moving the right foot to the right external side and then the left to the next internal space, followed by the right foot in that same space, diagram D and E.Sequence four. By alternately positioning one foot in each space. However, there is a second movement, where feet are positioned on the external side of the ladder.Begin with the right foot in the first space, as in diagram A.Move the left foot to the left external side of the second space, B.Afterwards, move the right foot to the right external side of the second space, C.Then, position the left Foot to the inside of the second space, D.Follow the sequence by positioning feet on both external sides of the third space, letters E and F.Results. The Mann-Whitney test was used to compare pre and post training, which was assessed by physical and functional tests. It was considered significant when the P value was less than 0.05.There were statistically significant differences identified between the pre-training and post-training periods. By the test assessed, it is possible to see a significant difference among these tests. Percentage of training, delta, of each measurement assessed over time.Illinois test, 12.1. Five times sit-to-stand, 28.0. Timed up and go, 24.3.Usual walking speed, 15.5. One-leg stand, right leg, 44.5. And one-leg stand, left leg, 57.2.Conclusion.The present results show the benefits of this new agility ladder training method and its improvement in older people overall physical fitness. Even in a robust and healthy population, it is possible to see an improvement of physical fitness. Furthermore, it is a cost-effective and practical protocol, which is possible to train anywhere.In addition, it would be interesting to include this protocol in multi-component training for older people.

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