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Balance Training in Pulmonary Rehabilitation to Reduce Fall Risk

Tymkew, Heidi, PT, DPT, CCS1,2; Burlis, Tamara, PT, DPT, CCS2; Baidy, Maureen, RRT3; Bennett, Deborah, MEd, RRT3; Hooper, Sandra, RRT3; Leidner, Melissa, RRT3; Morgan-Walker, Hope, BSN, RRT3; Sylvester, Lawrence, RRT3; Swafford, DeLana, BSRT3; Arroyo, Cassandra, PhD1

Cardiopulmonary Physical Therapy Journal: October 30, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/CPT.0000000000000099
Research Report: PDF Only

Purpose: To determine the efficacy of a balance training program for fall risk reduction in outpatient pulmonary rehabilitation (PR).

Methods: Forty-nine participants in an outpatient PR program participated in a balance training program in addition to the standard PR exercises. Balance was assessed with the Activities-Specific Balance Confidence (ABC) scale, Mini-BESTest (MBT), and Short Physical Performance Battery (SPPB). Gait speed, 5 times sit to stand test (5TSTS), and Timed Up and Go (TUG) data were extracted for analysis. Progressive lower-extremity strengthening and balance specific exercises were performed during each PR session.

Results: Over 90% of participants presented with at least one balance assessment that indicated an increased fall risk and 81% had mobility limitations based on an SPPB score <10. During the final assessment, only 16.2% of the participants were at fall risk and 13.5% had mobility limitations. Significant improvements (P < .001) were seen in the mean differences from baseline to final in the ABC scale 31.6% (95% CI [24.8, 38.5]), MBT 9.3 (95% CI [7.6, 11.0]), SPPB 4.1 (95% CI [3.4, 4.7]), gait speed 0.37 m/s (95% CI [0.29, 0.46]), 5TSTS −7.8 seconds (95% CI [−10.5, −5.0]), and TUG −4.7 seconds (95% CI [−5.7, −3.7]).

Conclusions: Incorporating a balance training program into a PR program may help to decrease fall risk and increase balance confidence in functional activities.

1Department of Research for Patient Care Services, Barnes-Jewish Hospital, St Louis, MO

2Program in Physical Therapy, Washington University, St Louis, MO

3Respiratory Department, Barnes-Jewish Hospital, St Louis, MO

Correspondence: Heidi Tymkew, PT, DPT, CCS, Department of Research for Patient Care Services, Barnes-Jewish Hospital, Mailstop 90-29-902, 4590 Children's Place, St Louis, MO, 63110 (

Pilot research grant funds were received from Washington University's Program in Physical Therapy. Approved by the Washington University Institutional Review Board (201605126).

The authors declare no conflicts of interest.

© 2019 Cardiovascular and Pulmonary Section, APTA
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