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Square-Stepping Exercise and Fall Risk Factors in Older Adults: A Single-Blind, Randomized Controlled Trial

¹ Faculty of Education, Mie University, Japan.
² Graduate School of Comprehensive Human Sciences, University of Tsukuba, Japan.
³ Research and Development Center for Higher Education, Nagasaki University, Japan.
⁴ Faculty of Social Studies, Doshisha University, Japan.
⁵ Department of Health Sciences and Finnish Centre for Interdisciplinary Gerontology, University of Jyväskylä, Finland.

Address correspondence to Ryosuke Shigematsu, PhD, Faculty of Education, Mie University, Kurimamachiya 1577, Tsu, Mie, 514-8507 Japan. E-mail: rshige{at}edu.mie-u.ac.jp

Background. Decreased fitness of the lower extremities is a potentially modifiable fall risk factor. This study aimed to compare two exercise programs—square-stepping exercise (SSE), which is a low-cost indoor program, and walking—for improving the fitness of the lower extremities.

Methods. We randomly allocated 68 community-dwelling older adults (age 65–74 years) to either the SSE or walking group (W group). During the 12-week regimen, the SSE group participated in 70-minute exercise sessions conducted twice a week at a local health center, and the W group participated in outdoor supervised walking sessions conducted weekly. The W group was instructed to increase the number of daily steps. Prior to and after the program, we obtained information on 11 physical performance tests for known fall risk factors and 3 self-reported scales. The fall incidence was followed-up for 8 months.

Results. At 12 weeks postregimen, significant differences were observed between the two exercise groups with respect to leg power (1 item), balance (2 items), agility (2 items), reaction time (2 items), and a self-reported scale (1 item); the SSE group demonstrated a marked improvement in the above-mentioned items with Group x Time interactions. Significant time effects were observed in the tests involving chair stands, functional reach, and standing up from a lying-down position without Group x Time interactions. During the follow-up period, the fall rates per person-year in the SSE and W groups were 23.4% and 33.3%, respectively (p =.31).

Conclusion. Although further studies are required, SSE is apparently more effective than walking in reducing fall risk factors, and it appears that it may be recommended as a health promotion exercise in older adults.

Key Words: Functional fitness • Walking • Fall risk • Health status