title: Exercise interventions, gait, and balance in older subjects with distal symmetric polyneuropathy: a three-group randomized clinical trial.
abstract: OBJECTIVE
  Older patients with a distal symmetric polyneuropathy are at markedly increase risk for falls and fall-related injuries. Despite this, few studies have investigated the effect of exercise regimens on gait and balance in this high-risk group.
  
  
  METHODS
  One hundred older patients with distal symmetric polyneuropathy were randomized to one of three interventions: functional balance training, Tai Chi, or education-only control. The subjects in each group received instruction in ten 1-hr weekly sessions. Outcome measures were determined at baseline and the end of the 10-wk intervention. Gait, balance, and falls self-efficacy were assessed with various well established clinical (Berg Balance Scale, 8 Foot Up and Go Test, and Modified Falls Efficacy Scale) and laboratory-based measures (three-dimensional gait analysis and NeuroCom limits of stability and sensory organization tests).
  
  
  RESULTS
  The Tai Chi subjects demonstrated a decreased (faster) Timed Up and Go and increased stride length and time spent in single limb support at the end of intervention as compared with baseline. The functional balance training group demonstrated a significant increase in ankle plantar flexor power and near significant decreases in step width and step width variability. No changes in the education-only control group were observed.
  
  
  CONCLUSIONS
  Older patients with distal symmetric polyneuropathy may benefit from Tai Chi and/or functional balance training, with the former improving functional mobility and gait and the latter possibly improving trunk stabilization and forward progression (Lythgo N, Cofré LE: Relationship between ankle plantar flexor power and EMG muscle activity during gait. 30th Annual Conference of Biomechanics in Sports [Melbourne, 2012]. Available at: https://ojs.ub.uni-konstanz.de/cap/article/viewFile/5320/4891). Whether these laudable changes can be maintained or translate into decreased risk for falls and fall-related injuries is unknown.
authors.affiliation: From the VISN 8 Patient Safety Center of Inquiry, James A. Haley Veterans Hospital, Tampa, Florida (PAQ, TB, YF, SH-H); Department of Veterans Affairs, Washington, DC (BS); Department of Physical Medicine and Rehabilitation, University of Michigan Health Systems, Ann Arbor (JKR); and Health Services Research & Development, Center of Innovation and Disability Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, Florida (SB).
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Quigley
authors.forename: Tatjana
authors.initials: T
authors.lastname: Bulat
authors.forename: Brian
authors.initials: B
authors.lastname: Schulz
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Friedman
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hart-Hughes
authors.forename: James K
authors.initials: JK
authors.lastname: Richardson
authors.forename: Scott
authors.initials: S
authors.lastname: Barnett
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000367:Age Factors; D000368:Aged; D004502:Education, Medical, Continuing; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D026741:Physical Therapy Modalities; D011115:Polyneuropathies / Q000175:diagnosis / Q000534:rehabilitation*; D004856:Postural Balance / Q000502:physiology*; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D026302:Tai Ji / Q000379:methods*; D016896:Treatment Outcome