Volume 15, Issue 1 (Spring 2020)                   Salmand: Iranian Journal of Ageing 2020, 15(1): 81-68 | Back to browse issues page

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Zare Bidaki M, Azarkar Z, Sharifzadeh G, Ebrahim Zadeh A. An Evaluation of Infection Types and the Complications in Hospitalized Elders Admitted in ICU Wards. Salmand: Iranian Journal of Ageing. 2020; 15 (1) :81-68
URL: http://salmandj.uswr.ac.ir/article-1-1302-en.html
1- Infectious Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.
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1. Introduction
hroughout life, many factors cause the body’s balance processes to face disorders and functional defects. One of these disorders and functional defects is Parkinson disease [1]. In this disease, due to disorders in the brain, symptoms such as tremor, gait disturbance, movement, imbalance and lack of coordination are caused [2]. Therefore, the study of factors and methods affecting the improvement of balance in these patients can be of great importance to improve the quality of life of these people.
Although previous research has examined the effect of factors such as attention instructions and resistance training separately on improving the balance of the elderly, however, no research has been conducted to investigate the effect of attention instructions along with resistance training, especially with the use of resistance socks on improving the balance of Parkinson patients. So, the aim of this study was to investigate the collective effect of attention instructions and water resistance training on improving the balance of Parkinson patients.

2. Methods & Materials  
The method of the present study was quasi-experimental. The statistical population of this study consisted of female patients over 60 years of age with Parkinson disease in Shahroud City. All participants signed the informed consent form and the present study was approved by the research committee of Ferdowsi University of Mashhad. A total of 25 women with a mean age of 62.20±2.31 years, mean weight of 67.92±2.98, mean body mass index of 29.87±3.75, and balance confidence of 13.57±4.62 were purposefully selected and they were randomly assigned to five experimental groups. 
The present study consisted of pre-test and post-test stages. In the pre-test stage, participants first filled out a questionnaire of personal information and confidence in balance, then participated in some tests such as static balance (in open and closed eyes) and dynamic balance (in open eyes only). The training protocol of the present study was 90 minutes of water exercise for all 5 groups, in the form of resistance and non-resistance exercises three times a week for 8 weeks. Training protocols included 90 minutes of water exercise with 15 minutes of warm-up and flexibility, 60 minutes of resistance training and walking in the water, and 15 minutes of cooling.
In the first week, warm-up, stretching, and walking in water were performed forward, sideways, and backward with an intensity of 50-60% of heart rate. In the second week, complex exercises, including rehabilitation, abdominal twisting, and elbow to knee, were performed in addition to the first week protocol and with an intensity of 60-65% of the heart rate in water. In the third week, resistance exercise was performed with abdominal muscles such as knee rotation, knee holding and forward kicking in addition to the second week protocol and with an intensity of 65-75% of heart rate in water.
During the fourth to eighth weeks, the protocol of the third week and walking with long steps, abdominal twisting, kicking forward and rehabilitation were followed with an intensity of 65-70% of heart rate in water. Participants wore resistance socks designed to create more resistance while walking in the water during resistance training. Immediately after the training sessions, participants in the post-test phase participated in static and dynamic balance tests and their scores were recorded.

3. Results 
According to the results of One-way Analysis of Covariance (ANCOVA) for comparing experimental groups in the post-test stage with control of covariance variable (data related to experimental groups in the pre-test stage), it can be concluded that the static postural sways index in open eye conditions showed a significant difference between the experimental groups (Table 1). 


According to the results of LSD follow-up tests, it was found that there was a significant difference between the external attention group with resistance socks and other groups except the external attention group without resistance socks (P=0.04). In other words, according to the amount of effect size reported this difference was significant. There was no significant difference between the groups in other indicators related to static postural sways. There was a significant difference between the experimental groups in the index related to dynamic postural sways. 
According to the results of LSD follow-up test, it was found that there was a significant difference between the external attention group using resistance socks, with the control group, and also the external attention group without resistance socks (P=0.027). Also, the internal attention group -regardless of whether or not to wear resistance socks - was different from the control group. There was no significant difference between the other groups.

4. Conclusion
In general, it can be concluded that using these socks while walking in the water and in other water sports, drift and water resistance are used, which is normally performed by the elderly and can be useful.
In general, according to the results of this study, it is recommended that during their exercises and corrective interventions in water, educators and therapists use external attention instructions and resistance training with resistance socks to improve the static and dynamic balance of their patients, especially patients with Parkinson who suffer from balance problems. This method can have positive effects to improve balance.
Due to the low sample size in the present study and other possible limitations, this method could not be prescribed with high accuracy for all Parkinson patients, so the need for similar and complementary studies is still felt.

Ethical Considerations
Compliance with ethical guidelines

All ethical principles are considered in this article. The participants were informed about the purpose of the research and its implementation stages; they were also assured about the confidentiality of their information; moreover, they were free to leave the study whenever they wished, and if desired, the research results would be available to them.

The paper was extracted from the PhD. thesis or extracted from a research project of the first author, Fatemeh Khodaei, Department of Motor Behavior and Sports Management, Faculty of Sports Sciences, Ferdowsi University of Mashhad.
Authors' contributions
Conceptualization, Writing – review & editing: Fatemeh Khodaei, Hamidreza Taheri, Mehdi Sohrabi; Methodology: Hamidreza Taheri, Mehdi Sohrabi; Investigation: Fatemeh Khodaei, Hamid Reza Taheri, Mehdi Sohrabi, Mohammad Salari Zare; Supervision: Hamidreza Taheri, Mehdi Sohrabi, Mohammad Salari Zare; Supervision: Fatemeh Khodaei, Hamidreza Taheri; Funding Acquisition: Fatemeh Khodaei.
Conflicts of interest
The authors declared no conflict of interest.

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Type of Study: Research | Subject: Clinical
Received: 2017/02/26 | Accepted: 2019/02/06 | Published: 2020/04/01

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