J. Phys. Ther. Sci.
24: 1345–1348, 2012
Effect of Jumping Exercise on Muscle Strength and
Balance of Elderly People: a Randomized Controlled
Trial
Jinnam Park, PT, Msc1), K ihun Cho, PT, Msc1), Wanhee Lee, PT, PhD1)
1) Department of Physical Therapy, Sahmyook University: 26-21 Gongneung 2-dong, Nowon-gu, Seoul
139-742, Republic of Korea. TEL: +82 2-3399-1633, FAX: +82 2-3399-1639, E-mail: [email protected]
Abstract. [Purpose] The purpose of this study was to investigate the effect of jumping exercise on the muscle
strength and balance of elderly people. [Subjects] Participants were randomly allocated to one of two groups: a
jumping exercise group (n=16) or a control group (n=15). [Methods] Both groups participated in a therapeutic exer-
cise program for 30 minutes, five days a week, for 4 weeks. The experimental group performed an additional jump-
ing exercise for 20 minutes a day, five days a week, for 4 weeks. A forceplate (PDM, Multifunction Force Measuring
Plate, Zebris, Germany, 2004) was used to evaluate postural sway. The Berg Balance Scale (BBS) and the Timed
Up-and-Go test (TUG) were used to assess dynamic abilities, and a Commander™ Muscle Tester (J Tech Medi-
cal) was used to measure muscle strength. [Results] Postural sway amplitudes (anteroposterior and mediolateral),
dynamic balance abilities (BBS and TUG), and muscle strength (hip, knee, and ankle) showed significant inprove-
ments in both groups, after the intervention. In addition, changes in dynamic balance abilities (BBS and TUG) and
muscle strength (hip, knee, and ankle) differed significantly between the experimental group and the control group.
[Conclusion] Performance of the jumping exercise resulted in improvements in muscle strength and balance ability.
Therefore, we recommend jumping exercise as an effective exercise for elderly people.
Key words: Balance, Elderly, Jumping
(This article was submitted Aug. 8, 2012, and was accepted Aug. 30, 2012)
INTRODUCTION Sherrington et al. reported that the incidence of falls
among the elderly can be reduced by 30–49% by improving
For maintenance of stable posture and performance of strength and balance through group exercise, home-based
voluntary movement in activities of daily living, postural exercise, and Tai Chi9). Gu et al. reported positive results in
control, which is the ability to react to external stimuli, a 16-week tailored fall-prevention exercise program (regular
and postural stability are needed. Humans maintain body stretching, strengthening exercise, and aerobic exercise)
equilibrium through balance control, making it possible to aimed at improving strength, static and dynamic balance
perform movements without falling1). Balance, which is ability, and reducing the fall frequency of 59 elderly people
defined as the ability to maintain the center of mass above the living in nursing homes. Jumping has been reported to have
base of support, and afferent information (motor, sensory, positive effects on improvement of physical function10).
cognition, etc.) makes stable postural control possible by In addition, according to the results of previous studies on
their integration through central processing of the brain2). jumping exercise, jumping exercise provides the greatest
Weakness of physical function (atrophy, weakness, stimulation for bone formation, and, therefore, improves
reduced muscular function) is caused by aging3). In addition, bone density leading to the prevention of fractures and
physiological changes occur due to aging, and reduction in osteoporosis, which often occur in the elderly11, 12).
muscle volume creates difficulties for postural control4). A recent study by Cakar et al. reported on the impor-
Strength of the lower extremities is a factor that enables tance of a regular combined exercise program (consisting
going up stairs and rising from a chair5). In order to prevent of strength, stretching and aerobic exercises, and additional
falls, maintenance of the remaining muscle quality is jumping training) for improvement of balance and reduction
important for the elderly, who experience increases in body of fall risk of elderly people living in a long-term care
fat and decreases in muscle mass6, 7). Previous studies have facility. They underlined the need for jumping exercise to
reported an association between the balance and gait of improve the strength of the lower extremities13). However,
the elderly, whose proprioception, vestibular, and strength these are only the results of group exercise. Actual study
of lower extremity have been important relationships in of jumping exercises conducted on a one-on-one basis is
the independent living of the elderly8). Therefore, studies insufficient. In particular, studies reporting on variations
regarding improvement muscle strength and balance control of postural sway resulting from performance of jumping
of the elderly continue to be performed. exercise are scarce. Thus, the purpose of the present study
1346 J. Phys. Ther. Sci. Vol. 24, No. 12, 2012
was to investigate the effect of jumping exercise on muscle square-centimeter), and the static and dynamic pressures
strength and balance (postural sway and dynamic balance of the feet when standing or walking were recorded (1–120
abilities) of elderly people. N/cm2, 2–5 Hz). Participants were instructed to stand
comfortably on the forceplate with their arms at their sides.
SUBJECTS AND METHODS For measurements taken with their eyes open, subjects
stared at a disc with a diameter of 15 cm, which was placed
A total of 35 elderly people living in a long-term care 3 m in front of them. During measurements with their eyes
facility were recruited for this study. The subjects under- closed, an assistant stood at the side of the subjects for
stood the contents of the study and agreed to participation. safety. Subjects positioned their feet 8 cm apart as measured
This study used a randomized pretest and posttest control by the distance between the two medial malleoli, with the
group design. After the pretest, the 32 selected participants angle of the feet at 10°. The postural sway of all participants
were randomly assigned to either the jumping exercise group was measured for 30 seconds, and the mean was calculated
(n = 16) or the control group (n = 16). Participants were after repeating the measurement three times. A rest period of
randomized to the experimental group or control group by an two minutes was provided between measurements.
independent person who selected sealed envelopes one hour The Berg Balance Scale (BBS)15) and the Timed
prior to the start of the intervention. The inclusion criteria Up-and-Go test (TUG)16) were used to assess dynamic
were as follows: ability to communicate and understand with balance abilities.
a Mini-Mental Status Examination score of over 21 points; A handheld dynamometer (Commander™ Muscle Tester,
no visual disorders or visual field deficits; no known muscu- J Tech Medical) was used to measure the lower extremity
loskeletal conditions that would have affected patients’ isometric muscle strength. Muscle strength testing of hip
ability to walk safely, repeatedly; and ability to walk 10 m flexion and knee extension was performed with the subjects
independently with or without the use of an assistive device. in a sitting position. Testing of hip extension and knee flexion
Exclusion criteria were unregulated cardiac failure, or muscle strength was performed with the subjects in the prone
congenital or acquired structural or functional limb failures, position, and testing of ankle dorsiflexion and plantarflexion
such as amputation, or hemiplegia. muscle strength was performed with the subjects in the long
Because of poor concentration, one subject in the control sitting position (sitting with the knees in full extension)17).
group withdrew from the training program after three days. SPSS version 12.0 software was used for the statistical
Thus, 16 patients were evaluated in the experimental group, analyses. After confirming the normality of the data using
and 15 patients were evaluated in the control group. the Shapiro-Wilks test, pre- and post-intervention data
Both groups assembled five times a week for a period were examined using the paired t-test within each group of
of four weeks at the gymnasium of the facility. Each group subjects and the independent t-test between the groups. The
performed a warm-up lasting 5 min, 30 min of therapeutic level of significance was chosen as 5% for all the analyses.
exercise, and 5 min of cooling down. The total exercise time
was 40 minutes for both groups. In order to prevent falls, RESULTS
subjects performed the training under the supervision of an
assistant. A summary of the general characteristics of the subjects
Therapeutic exercise included stretching, aerobic is shown in Table 1.
exercise, such as fast walking, sideways walking with Comparisons of balance abilities and muscle strength
accelerations and decelerations, ball throwing and catching, within groups and between groups are summarized in Tables
squats, and sitting down and getting up from a chair. In 2 and 3.
addition, the experimental group participated in a jumping Compared to the pre-intervention values, the postural
exercise program, 20 minutes a day, five times a week, for sway amplitudes (anteroposterior and mediolateral) and
4 weeks. dynamic balance abilities (BBS and TUG) after the four
Subjects performed jumping exercise in the vertical weeks of intervention had significantly inproved in both
direction. Only jumps of more than 2 cm above the ground groups (p<0.05). In addition, muscle strength (hip, knee, and
were recognized13). The jumping frequency was not limited. ankle) had significantly increased in both groups, compared
However, all subjects performed more than thirty jumps to pre-intervention (p<0.05). Furthermore, changes in
during a session. Therapeutic exercise and jumping exercise dynamic balance abilities (BBS and TUG) and muscle
were performed one-to-one with a physical therapist. strength (hip, knee, and ankle) differed significantly between
Although the intensity of jumping was self-paced, the the experimental group and the control group (p<0.05).
subjects were constantly encouraged to maintain a high level
of effort with supervision by a physical therapist in order DISCUSSION
to prevent. All exercises were performed while wearing
gymnastic shoes. In order to prevent the training program The elderly experience deterioration of flexibility,
being monotonous, music was played during the training. strength, balance control, and gait with aging18, 19). In
A forceplate (PDM Multifunction Force Measuring particular, the decrease of muscle mass causes not only a
Plate; Zebris, Germany) was used to measure postural sway reduction in physical activity and strength, but also a decline
for analysis of postural imbalance14). A total of 1504 force in bone density, exposing elderly people to increased risks
sensors are embedded in the 32×47 cm plate (one for each of dependent living and various chronic degenerative
1347
diseases20). Thus, strength, stretching, and aerobic exercises 45 to 56 point range needed a change of 4 points; those
have commonly been recommended for the improvement of with 35 to 44 required 5 points; and those with 25 to 34
balance and the prevention of falls13). Recently, interest has needed 7 points. In this study, the subjects’ BBS scores
increased in jumping exercise, which is easily performed showed an increase, from 39.8 to 46.4, indicating a 6.6 point
not only in clinical sitiuations but also in activities of daily improvement, higher than the required MDC (5 points). In
living. Thus, the purpose of this study was to investigate the addition, if the BBS score is less than 45, the possibility of
effect of one-to-one jumping exercise on muscle strength falls is much higher28). However, after the four week training
and balance of elderly people. period, the subjects’ BBS scores showed an increase to
In this study, a forceplate was used to determine the 46.4. Therefore, we consider that performance of jumping
change in static balance ability arising from the performance exercise can reduce the risk of falls for the elderly. Decline of
of the jumping exercise; BBS and TUG were also used to cognitive information processing and weakness of physical
determine changes in dynamic balance abilities. Many factors (strength, endurance, flexibility, agility, and reaction
studies have measured postural sway as a variable that time) occur with the advance of age, hindering independent
contributes to postural stabilization, regarding mean speed living17). In particular, lower extremity strength is the most
of the center of pressure as a suitable variable for distin- important factor for independent walking24). Muscles around
guishing differences in balance ability21, 22). the hip joint maintain the body’s stabilization in the stance
In this study, anteroposterior and mediolateral postural
sway amplitudes and dynamic balance abilities (BBS and
TUG) after four weeks of intervention showed significant
improvements in both groups (p<0.05). In particular, Table 1. General characteristics of subjects
changes in dynamic balance abilities (BBS and TUG)
Parameters JEG (n=16) CG (n=15)
differed significantly between the experimental group and
the control group (p<0.05). Gender 7/9 (43.7/56.3) 7/8 (46.6/53.4)
Fatouros et al. reported that performance of regular Male/Female (%)
physical activity generally results in improvement of cardio- Height, cm 154.6 (11.6) 156.8 (9.4)
vascular function and flexibility. In addition, it also reduces Weight, kg 55.9 (13.5) 56.4 (9.1)
postural sway and increases postural control23). Donoghue Age, years 76.7 (8.6) 77.0 (7.9)
and Stokes reported that the minimal detectable change MMSE, score 23.2 (2.1) 23.9 (1.9)
(MDS) of BBS is variable, depending on the initial score. NOTE. Values are n (%) or mean (SD). Abbreviation: JEG,
They found that, for 95% confidence, a participant in the jumping exercise group; CG, control group
Table 2. Comparison of balance abilities within groups and between groups
Values Change Values
Parameters JEG (n=16) CG (n=15) JEG (n=16) CG (n=15)
pre post pre post post–pre post–pre
AP, PSA (m/s) 55.4 (15.8) 44.8 (11.5)*** 56.8 (22.1) 44.3 (24.1)* 9.6 (6.5) 12.5(21.7)
ML, PSA (m/s) 54.9 (17.8) 42.9 (11.8)** 61.3 (24.9) 46.8 (19.3)** 12.0 (12.1) 14.5 (24.9)
BBS (scores) 39.8 (4.2) 46.4 (3.6)*** 39.8 (7.9) 41.5 (7.7)* 6.6 (2.7) 1.6 (5.7)***
TUG (sec) 23.1 (10.3) 15.7 (6.2)*** 23.5 (9.4) 22.0 (8.7)* 7.3 (6.5) 1.5 (2.0)**
NOTE. Values are mean (SD), *p<0.05, **p<0.01, ***p<0.001. Abbreviation: AP, anteroposterior; ML, mediolateral;
PSA, postural sway amplitude; JEG, jumping exercise group; CG, control group; BBS, Berg Balance Scale; TUG,
Timed Up-and-Go test
Table 3. Comparison of muscle strength within groups and between groups
Values Change Values
Parameters (kg) JEG (n=16) CG (n=15) JEG (n=16) CG (n=15)
pre post pre post post–pre post–pre
Hip flexor 21.0 (9.4) 25.4 (6.9)** 26.7 (15.3) 28.4 (13.9)** 4.3 (3.9) 1.7(2.1)*
Hip extensor 17.5 (5.3) 26.0 (4.9)*** 21.0 (9.5) 22.6 (9.2)* 8.5 (2.6) 1.6 (2.1)***
Knee flexor 21.7 (10.7) 27.4 (8.9)*** 24.7 (10.0) 26.7 (8.8)** 5.6 (3.8) 1.9 (1.7)**
Knee extensor 19.2 (6.5) 26.3 (7.9)*** 24.4 (8.7) 26.7 (7.4)* 7.0 (2.2) 2.3 (3.5)***
Ankle dorsiflexor 17.6 (8.0) 25.2 (5.9)*** 18.9 (7.7) 20.9 (6.8)** 7.5 (3.9) 1.9 (2.5)***
Ankle plantarflexor 13.6 (4.3) 23.4 (7.7)*** 16.0 (4.5) 17.4 (4.0)* 9.7 (5.7) 1.3 (2.0)***
NOTE. Values are mean (SD), *p<0.05, **p<0.01, ***p<0.001. Abbreviation: JEG, jumping exercise group; CG, control group
1348 J. Phys. Ther. Sci. Vol. 24, No. 12, 2012
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