Genetic and environmental influences on variation in balance performance among female twin pairs aged 21-82 years

Genetic and environmental influences on variation in balance performance were measured in 93 monozygous and 83 dizygous female twin pairs aged 21–82 years (mean age, 50.5 years) in Melbourne, Australia, between 1999 and 2003. The authors administered clinical (Lord's Balance Test and Step Test) and laboratory tests of static and dynamic balance from the Chattecx Balance System with and without distractor tasks. The authors conducted factor analysis and estimated genetic and environmental variance components and heritability (defined as additive genetic variance as a proportion of all variance, after adjustment for age) using a multivariate normal model with the statistical package FISHER. Three factors were identified and adjusted for age. Heritability was 46% (standard error (SE), 9) for the "sensory balance tests" factor and 30% (SE, 9) for the "static and dynamic perturbations" factor. For both factors, the remaining variance was attributed to unique environmental effects. There was no evidence that genetic factors influenced variation in the "dynamic weight shift tests" factor, with environmental effects shared by twins accounting for 38% (SE, 7) of variance. Neither genetic nor environmental proportions of variance differed significantly between twin subgroups by age (≤50/>50 years). An age-related decline in performance measures was found across the whole sample. These results imply that balance impairments may have a heritable element.

The combination of plyometric and balance training improves sprint and shuttle run performances more often than plyometric-only training with children

Because balance is not fully developed in children and studies have shown functional improvements with balance only training studies, a combination of plyometric and balance activities might enhance static balance, dynamic balance, and power. The objective of this study was to compare the effectiveness of plyometric only (PLYO) with balance and plyometric (COMBINED) training on balance and power measures in children. Before and after an 8-week training period, testing assessed lower-body strength (1 repetition maximum leg press), power (horizontal and vertical jumps, triple hop for distance, reactive strength, and leg stiffness), running speed (10-m and 30-m sprint), static and dynamic balance (Standing Stork Test and Star Excursion Balance Test), and agility (shuttle run). Subjects were randomly divided into 2 training groups (PLYO [n = 14] and COMBINED [n = 14]) and a control group (n = 12). Results based on magnitude-based inferences and precision of estimation indicated that the COMBINED training group was considered likely to be superior to the PLYO group in leg stiffness (d = 0.69, 91% likely), 10-m sprint (d = 0.57, 84% likely), and shuttle run (d = 0.52, 80% likely). The difference between the groups was unclear in 8 of the 11 dependent variables. COMBINED training enhanced activities such as 10-m sprints and shuttle runs to a greater degree. COMBINED training could be an important consideration for reducing the high velocity impacts of PLYO training. This reduction in stretch-shortening cycle stress on neuromuscular system with the replacement of balance and landing exercises might help to alleviate the overtraining effects of excessive repetitive high load activities.

A comparison of four functional test in discriminating fallers from non-fallers in older people

Purpose : Which functional tests on mobility and balance can better screen older people at risk of falls is unclear. This study aims to compare the Berg Balance Scale (BBS), Tinetti Mobility Score (TMS), Elderly Mobility Scale (EMS) and Timed Up and Go test (TUG) in discriminating fallers from non-fallers in older people.
Method : This was a case-control study involving one rater who conducted a mobility and balance assessment on subjects using the four functional tests in random sequence. Subjects recruited included 17 and 22 older people with a history of single and multiple falls respectively from a public Falls Clinic, and 39 community-dwellers without fall history and whose age, sex and BMI matched those of the fallers. All subjects underwent the mobility and balance assessment within one day.
Results : Single fallers performed better than multiple fallers in all four functional tests but were worse than non-fallers in the BBS, TMS and TUG. The BBS demonstrated the best discriminating ability, with high sensitivity and specificity. The BBS item 'pick up an object from the floor' was the best at screening fallers.
Conclusion : BBS was the most powerful functional test of the four in discriminating fallers from non-faller.

Does balance or motor impairment of limbs discriminate the ambulatory satus of stroke survivors?

Objective: This study was performed to determine if ambulatory function is governed by motor impairment of limbs or balance ability in subjects with hemiplegia caused by stroke.
Design: Seven patients who walked with physical assistance (FIM(TM) 4) after stroke and 13 who walked independently with assistive devices (FIM 6) were compared with 13 healthy subjects. Motor impairment of limbs was evaluated with the Fugl-Meyer Assessment. The Berg Balance Scale and limit of stability test of the Smart Balance Master were used to evaluate balance ability.
Results: The FIM 6 group and the controls were best differentiated by motor impairment of the paretic limbs and limit of stability in the backward direction. Motor impairment of the upper limb and limit of stability in direction toward the paretic side separated the FIM 4 from the FIM 6 group. Upper limb motor impairment and the Berg Balance Scale consistently separated the three subject groups.
Conclusions: Motor impairment in the paretic upper limb and balance dysfunction should be addressed in treatments working toward independent ambulation.

The relative and absolute reliability of two balance performance measures in chronic stroke patients

Purpose. To examine the relative reliability and absolute reliability of the Berg Balance Scale (BBS) and the Postural Assessment Scale for Stroke Patients (PASS) in chronic stroke patients. Method. A total of 52 mild to moderate stroke patients, who had a stroke more than 6 months previously, participated in the study. Both balance measures were administered twice, seven days apart, to the patients. A relative reliability index (intra-class correlation coefficient, ICC2,1) was used to examine the level of agreement between test and retest. Absolute reliability indices, including the Bland and Altman method, the standard error of measurement (SEM), and the smallest real differences (SRD), were used to define the extent to which a balance score varies on test-retest measurements. Results. Test-retest agreements were high (ICC2,1: BBS = 0.98; PASS = 0.97), indicating excellent agreement from a relative perspective. The SEM of the BBS and PASS, representing the smallest change threshold that indicates a real improvement for a group of individuals, were 2.4 and 1.1, respectively. The SRD of the BBS and PASS were 6.7 and 3.2, respectively, exhibiting the smallest change threshold that indicates a real improvement for a single individual. Conclusions. The test-retest agreements of the BBS and PASS were high in mild to moderate chronic stroke patients. The thresholds of both measures to detect real change are acceptable in research and clinical settings.

The monetary approach to understanding the balance of payments for the Fiji Islands

The monetary approach to the balance of payments postulates a unidirectional, negative causality running from domestic credit to net foreign assets. Using data for Fiji for the period 1974–2003, we find a statistically significant, negative correlation between domestic credit and net foreign assets; but the Granger causality test reveals no statistical evidence of causality running from domestic credit to net foreign assets. This finding suggests that domestic credit is mainly passive and is not the central tool of monetary policy to which the balance of payments adjusts.

High volume versus low volume balance training on postural sway in adults with previous ankle inversion injury

Balance training is commonly used in the rehabilitation process of ankle injuries; however, the exercise prescription guidelines for prescribing balance training are poorly understood. The aim of the present study was to determine if high or low volume balance training is more effective in improving postural sway after an 8 week balance training program utilising the same exercises. Seventeen subjects (14 male, 3 female) with a mean age of 24.06 ± 5.6 years were randomly allocated into a control group (CG), low volume training (LVT) or high volume training (HVT). All subjects had sustained at least two inversion ankle injuries within the last 18 months. Subjects completed 8 weeks of balance training of up to 30 mins duration, 3 times per week. LVT consisted of 40 repetitions for week 1, progressing to 90 repetitions by week 8. HVT consisted of 60 repetitions for week 1, progressing to 130 repetitions by week 8. The maximum centre of pressure (COP) excursion was obtained from the porce plate in the medial-lateral (ML) direction and subsequently used for pre-test and post-test analysis. After the 8 week training intervention, there was a significant (P<0.001) difference in postural sway between pre and post testing for both the LVT (pre = 88.69mm ± 25.08mm, post = 72.17mm ± 27.53mm) and HVT (pre = 77.47mm ±10.57mm, post = 58.54mm ± 7.01mm) groups. There was no significant (P>0.01) difference detected for improvements between the LVT and HVT, however reported effect sizes (ES) showed large effect size chances in the high volume training (ES = 1.7) whereas low volume training showed medium effect sizes changes (ES = 0.6). This preliminary study demonstrates the importance of training volume in the rehabilitation of ankle injuries, with the HVT being superior to LVT.

Performance evaluation of e-government services using balance scorecard : an empirical study in Jordan

Purpose - the purpose of this paper is to emphasise on a balance between quantitative and qualitative measures, and examine the use of Balanced Scorecard to evaluate and estimate the performance of information and communication technologies (ICT) in delivering valuable e-government services through the internet. Design/methodology/approach - This study tests the hypotheses of e-government effectiveness using Balanced Scorecard technique by incorporating qualitative measures within a quantitative research methodology with data collected by means of a survey questionnaire. The survey sample of 383 stakeholders includes common customers, employees of e-government, and employees from the IT sector. The survey data were analysed to test the hypothesis in measuring e-government effectiveness from Balanced Scorecard's four dimensions: customer perspective, financial perspective, internal business process perspective, and innovation and learning perspective. Findings - The results show that the Balanced Scorecard factors fit very well with monitoring and measuring the performance of e-government in Jordan, and also in evaluating their success in IT project investments. Originality/value - This study attempts to address this gap in the literature and would benefit future studies in applying Balanced Scorecard for performance evaluation of various IT projects that are gaining huge investments from governments and organisations .

The Dutch Obesity Intervention in Teenagers (DOiT) cluster controlled implementation trial: intervention effects and mediators and moderators of adiposity and energy balance-related behaviours

 Background: The Dutch Obesity Intervention in Teenagers (DOiT) programme is an evidence-based obesity prevention programme tailored to adolescents attending the first two years of prevocational education in the Netherlands. The initial programme showed promising results during an effectiveness trial. The programme was adapted and prepared for nationwide dissemination. To gain more insight into the process of translating evidence-based approaches into ‘real world’ (i.e., ‘natural’) conditions, our research aims were to evaluate the impact of the DOiT-implementation programme on adolescents’ adiposity and energy balance-related behaviours during natural dissemination and to explore the mediating and moderating factors underlying the DOiT intervention effects.
Methods: We conducted a cluster-controlled implementation trial with 20 voluntary intervention schools (n=1002 adolescents) and 9 comparable control schools (n = 484 adolescents). We measured adolescents’ body height and weight, skinfold thicknesses, and waist circumference. We assessed adolescents’ dietary and physical activity behaviours by means of self-report. Data were collected at baseline and at 20-months follow-up. We used multivariable multilevel linear or logistic regression analyses to evaluate the intervention effects and to test the hypothesised behavioural mediating factors. We checked for potential effect modification by gender, ethnicity and education level.
Results: We found no significant intervention effects on any of the adiposity measures or behavioural outcomes. Furthermore, we found no mediating effects by any of the hypothesised behavioural mediators. Stratified analyses for gender showed that the intervention was effective in reducing sugar-containing beverage consumption in girls (B = -188.2 ml/day; 95% CI = -344.0; -32.3). In boys, we found a significant positive intervention effect on breakfast frequency (B = 0.29 days/week; 95% CI = 0.01; 0.58). Stratified analyses for education level showed an adverse intervention effect (B = 0.09; 95% CI = 0.02; 0.16) on BMI z-scores for adolescents attending the vocational education track.
Conclusions: Although not successful in changing adolescents’ adiposity, the DOiT-implementation programme had some beneficial effects on specific obesity-related behaviours in subgroups. This study underlines the difficulty of translating intervention effectiveness in controlled settings to real world contexts. Adaptations to the implementation strategy are needed in order to promote implementation as intended by the teachers.

Vibration or balance training on neuromuscular performance in osteopenic women

Maintaining neuromuscular function in older age is an important topic for aging societies, especially for older women with low bone density who may be at risk of falls and bone fracture. This randomized controlled trial investigated the effect of resistive exercise with either whole-body vibration training (VIB) or coordination/balance training (BAL) on neuromuscular function (countermovement jump, multiple 1-leg hopping, sit-to-stand test). 68 postmenopausal women with osteopenia or osteoporosis were recruited for the study. 57 subjects completed the 9-month, twice weekly, intervention period. All subjects conducted 30 min of resistance exercise each training day. The VIB-group performed additional training on the Galileo vibration exercise device. The BAL-group performed balance training. An "intent-to-treat" analysis showed greater improvement in the VIB-group for peak countermovement power (p=0.004). The mean [95% confidence interval] effect size for this parameter was a  + 0.9[0.3 to 1.5] W/kg greater change in VIB than BAL after 9 months. In multiple 1-leg hopping, a significantly better performance in the VIB-group after the intervention period was seen on a "per-protocol" analysis only. Both groups improved in the sit-to-stand test. The current study provides evidence that short-duration whole-body vibration exercise can have a greater impact on some aspects of neuromuscular function in post-menopausal women with low bone density than proprioceptive training.