title: Multitarget stepping program in combination with a standardized multicomponent exercise program can prevent falls in community-dwelling older adults: a randomized, controlled trial.
abstract: OBJECTIVE
  To investigate the effects of a twice-weekly multitarget stepping (MTS) task combined with a multicomponent exercise program on stepping accuracy, gaze behavior, fall risk factors, and fall rates.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Community.
  
  
  METHODS
  Community-dwelling adults aged 65 and older in Japan (N = 264) were randomized into an MTS group (n = 132) and a control group (n = 132).
  
  
  METHODS
  Twenty-four weeks of a twice-weekly community-based MTS program in combination with a standardized multicomponent exercise program.
  
  
  METHODS
  Number of falls and fall-related fractures during a 12-month follow-up period after completion of the intervention, stepping accuracy, gaze behavior while performing the MTS test, and results of four clinical tests relevant to assessment of risk of falls (Timed Up and Go (TUG), functional reach (FR), 10-m walking, and Five Chair Stand (5CS)) were measured.
  
  
  RESULTS
  Thirteen participants (11.6%) in the MTS group and 39 (33.0%) in the control group fell during the 12-month follow-up period (incidence rate ratio = 0.35, 95% confidence interval (CI) = 0.19-0.66). Three participants in the MTS group and 13 in the control group experienced fall-related fractures during the 12-month follow-up period (relative risk = 0.22, 95% CI = 0.06-0.80). After the intervention, a subset of participants in the MTS group had significantly greater improvement in stepping accuracy and gaze behavior during the MTS test, and all participants in the MTS group had significantly greater improvement in performing the TUG and 10-m walking (P < .001).
  
  
  CONCLUSIONS
  Participants who performed MTS tests combined with a multicomponent exercise program showed greater improvements in stepping accuracy, gaze behavior, and physical performance in a virtually complex environment. Considering the less-frequent fall rate in the follow-up assessment, these improvements could contribute to preventing falls in community-dwelling older adults.
authors.affiliation: Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Yamada
authors.forename: Takahiro
authors.initials: T
authors.lastname: Higuchi
authors.forename: Shu
authors.initials: S
authors.lastname: Nishiguchi
authors.forename: Kazuya
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Yuu
authors.initials: Y
authors.lastname: Kajiwara
authors.forename: Tomoki
authors.initials: T
authors.lastname: Aoyama
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D005080:Exercise Test / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D008297:Male; D051346:Mobility Limitation; D053580:Muscle Strength; D010349:Patient Compliance; D004856:Postural Balance; D012015:Reference Standards; D012307:Risk Factors; D013997:Time Factors; D016138:Walking / Q000502:physiology*
keywords: MTS program; falls; gaze behavior; older adults; randomized controlled trial