The aim of this study is to present an agility training program for older people. The feasibility of this program is described, and the training protocol demonstrated by video imaging.
Aging impairs physical and cognitive functions and limits daily activities. Agility training can improve or maintain physical functioning in older people. The purpose of this study is to report the physical fitness benefits of a training program for independent community-dwelling older adults using an agility ladder. Each training session lasted approximately 30 minutes, and the benefits were achieved with two sessions per week for 14 weeks. Training was timed and involved four different drills and varying levels of difficulty through time. The exercises were performed at the School of Physical Education of the University of Campinas, São Paulo state, Brazil. The study participants (n = 16; mean age of 66.9 ± 5.0 years) were instructed to perform the exercises as quickly as possible without making mistakes and were assisted by a physical trainer when they made mistakes. Assessments were performed both before and after training using five functional tests (i.e., Illinois agility, five times sit-to-stand, timed up-and-go, walking usual speed, and one-leg stand). Although the study sample was not compared with a control group, the results indicate that training protocols using an agility ladder are easy and practical and improve physical function performance in older adults.
Being active while aging can optimize opportunities to improve physical, social, and mental health, enabling older people to participate actively in society1. Older adults should be payed attention to because of the consequences of aging2. People worldwide are living longer, and life expectancy is greater than 70 years for the first time in history. The number of individuals aged 60 years or older is increasing rapidly, and the health of these populations is usually poor. Aging impairs physical functions, mental capacity, and social interactions as a direct result of diseases or syndromes2.
Decrease in physical function may lead to falls, fractures, less access to health care, depression, and poor quality of life. Agility is crucial to prevent falls and maintain independence in older people. Sheppard and Young3 reported that agility involved "whole-body movements in different directions in response to a stimulus."
Most studies evaluate agility in high-performance athletes4, although a few studies assess this parameter in older adults. Agility training for older people comprises preplanned gait adaptability training and reaction training (i.e., response to a signal)5. Liu-Ambrose et al.6,7 found that agility training improved postural stability, balance, and balance confidence, and decreased the risk of falls in older people. Moreover, this type of training is integrative and improves cognitive functions (e.g., perception, mental flexibility, and working memory) as well as neuromuscular and cardiovascular functions8,9.
Agility training is characterized by a set of exercise drills and can be automated. However, a physical trainer/instructor is necessary to create and teach the drills and indicate the right moment to increase the level of difficulty. Some studies found that step training improved physical fitness (e.g., balance, agility, lower limb strength and power, and decreased risk of falls) and cognitive function (e.g., choice stepping reaction time, inhibitory action, and executive function)5,10,11. The present study uses an agility ladder as a cost-effective instrument to assess the effects of preplanned gait training on the physical fitness of independent community-dwelling older adults.
The agility ladder used in the present study was previously employed to train school children and athletes12,13. The ladder had a length of 4.8 meters and 12 transverse rungs and was drawn on the floor using a 2 cm wide adhesive tape (Figure 1). Building a ladder on the floor avoided interruptions during training12 and decreased the risk of injuries. The study population was healthy, with a mean age of 66.9 ± 5.0 years, and lived independently in a community setting. The participants received 30 minute training sessions twice a week for 14 weeks.
The study was approved by the Research Ethics Committee of the University of Campinas (UNICAMP) under Protocol Number 2479761. Written informed consent was obtained in-person from all study participants. Sixteen participants of both sexes were recruited from the community of the metropolitan region of Campinas by searching the database of the Applied Kinesiology Laboratory (AKL). The inclusion criteria were 1) individuals aged 60 and older; 2) ability to answer the questionnaires used in this study; 3) ability to walk independently without difficulty; 4) availability to participate in the intervention during 3 months with at least 90% attendance. The exclusion criteria were 1) severe cardiovascular or pulmonary diseases; 2) orthopedic diseases that prevented performing daily activities; and 3) diseases that increased the risk of falls such as Parkinson's and Alzheimer's. All assessments were performed by researchers and professional physical trainers from the AKL.
1. Assessment
2. Training program design
3. Agility ladder
4. Familiarization period
5. Training program
NOTE: All drills start with both feet together on the start line.
Sixteen male and female independent community-living older people with a mean age of 66.9 ± 5.0 years were enrolled in the study. The interventions and assessments were performed at the School of Physical Education of UNICAMP.
Statistical analysis was performed using Minitab 18 software. The Mann-Whitney test was used to compare the functional test results before and after training. P values smaller than 0.05 were considered significant. Delta was calculated as follows: (baseline values – post-training values) / baseline values x 100.
Significant differences between before and after training were determined using physical function tests to assess agility (Illinois test), lower limb strength and power (five times sit-to-stand), dynamic balance (TUG), gait (walking usual speed test), and static balance (one-leg stand).
Figure 1: Agility ladder. The ladder had a length of 4.8 m and 12 rungs, forming 12 squares (40 cm x 40 cm). Please click here to view a larger version of this figure.
Figure 2: Walking usual speed test. Please click here to view a larger version of this figure.
Figure 3: Exercise set. Each 3-min set was composed of four 30 s subsets and a 15 s rest between subsets. Please click here to view a larger version of this figure.
Figure 4: Sequence 1. (A) the left foot in the first square, (B) the right foot in the second square, (C) the left foot in the third square. Please click here to view a larger version of this figure.
Figure 5: Sequence 2A. (A) The right foot in the first square, (B) the left foot in the first square, (C) the left foot in the second square, (D) the right foot in the second square. Please click here to view a larger version of this figure.
Figure 6: Sequence 2B. (A) The right foot in the first square and the toes of the left foot in the first square, (B) the left foot in the second square and the toes of the right foot in the second square, (C) the right foot in the third square and the toes of the left foot in the third square. Please click here to view a larger version of this figure.
Figure 7: Sequence 3A. (A) The left foot outside the ladder to the left next to the first square, (B) the right foot outside the ladder next to the left foot, (C) the right foot in the first square, (D) the left foot in the first square, (E) the right foot outside the ladder to the right next to the first square, (F) the left foot next to the right foot. Please click here to view a larger version of this figure.
Figure 8: Sequence 3B. (A) The left foot outside the ladder to the left next to the first square, (B) the right foot in the first square, (C) the left foot next to the right foot, (D) the right foot outside of the ladder to the right next to the first square, (E) the left foot next to the right foot. Please click here to view a larger version of this figure.
Figure 9: Sequence 4. (A) The right foot in the first square, (B) the left foot outside the ladder to the left next to the rung that separates the first and second squares, (C) the right foot outside the ladder to the right across from the left foot, (D) the left foot in the second square, (E) the right foot outside the ladder to the right next to the rung that separates the second and third squares, (F) the left foot outside the ladder across from the right foot. Please click here to view a larger version of this figure.
Figure 10: Delta values of the function test results. The percentage of training (delta) of each measurement was assessed over time. FTSS, five times sit-to-stand; WS, walking speed; TUG, timed up-and-go; OLS, one-leg stand using the right left (R) and left leg (L). Please click here to view a larger version of this figure.
Tests | Pre | Post | P-Value |
Illinois (s) | 35.9 ± 5.4 | 31.5 ± 4.5 | 0.02* |
FTSS (s) | 10.7 ± 2.0 | 7.7 ± 1,1 | <0.01* |
TUG (s) | 7.7 ± 1.2 | 5.8 ± 0.7 | <0.01* |
WS (m/s) | 1.3 ± 0.1 | 1.5 ± 0,1 | <0.01* |
OLS R (s) | 16.4 ± 10.4 | 23.7 ± 9.0 | 0.03* |
OLS L (s) | 15.7 ± 8.5 | 24.6 ± 8.1 | 0.01* |
Table 1: Functional test results at baseline and post-training. Data are presented as means ± standard deviations and were considered significantly different at p < 0.05. *The Mann-Whitney test was used to compare differences between before and after training. FTSS, five times sit-to-stand; WS, walking speed; TUG, timed up-and-go; OLS, one-leg stand (OLS); R, right leg; L, left leg.
Several agility training programs are used for different populations, including sports teams4, children12, and older people6,10. These programs include square stepping exercises10,11 like the sequences described in the present study and can significantly improve the overall physical fitness of older adults by decreasing the risk of falls, fractures, immobilizations, and dependence.
The training protocol presented in this study, with explanations about exercise drills and training volume and intensity, constitutes another approach to improve agility in older people. This protocol is cost-effective, practical, readily accessible, and easily adapted to specific populations by changing velocity and complexity19. Furthermore, this method improved physical fitness even in robust and healthy populations.
The literature stresses the importance of using power exercises for older people. Muscle power is decreased with advancing age20. Therefore, neuromuscular performance is reduced even in robust and healthy older adults. This study reports an alternative training method using an agility ladder to help improve or maintain muscle power. Furthermore, the outcomes can be compared with those of other training programs, such as square stepping, which present physical and cognitive benefits10. Older people can benefit from several stimuli from a single exercise8,10.
This type of training can be included in multicomponent exercise programs for older people and has been shown to improve muscle strength and power, physical endurance, flexibility, and balance21. Nonetheless, few studies have evaluated the benefits of agility training in multicomponent programs, and most of these programs do not contemplate agility training21. Nevertheless, agility training can be included in multicomponent training because it improves physical functioning in older adults5,10,11, as demonstrated in the present study.
Agility ladders are effective for health training in specific population groups (e.g., populations with mild cognitive impairment who had a stroke). Furthermore, the complexity of coordination in preplanned gait and reaction training improves executive function5,6,9,11.
The study population was robust, healthy, and physically active. Therefore, further studies are necessary to assess the potential benefits of this protocol in frail and inactive older people. The two main limitations of this study were the small sample size and the lack of a control group. For this reason, the present results were not compared with those of a group that did not receive the intervention or those in traditional strength or endurance training programs. Notwithstanding, the present exercise protocol significantly improved overall physical fitness in this population.
The authors have nothing to disclose.
This study was funded by the Coordination for the Improvement of Higher Education Personnel of Brazil (CAPES- #1800789).
Bluetooth speaker | JBL | – | Used to time all protocol and signal the 30 s of each subset |
Chair | – | – | Used on assessments |
Clipboard | Tilibra | – | Used to support documents |
Crepe Tape of 2cm | Dexter | – | Used to create the agility ladder on the floor |
Measuring Tape | Stakley | – | Used to measure assessments distance |
Pen | Bic | – | Used to note data |
Saucer Cone | Kipsta | – | Used on assessments |
Stowatch | Vollo | – | Used to time assessments results |
Sulfite Paper | Chamex | – | used to write all data |