Impact of Skills Acquired Through Judo Training on Risk Factors for Falling in Elderly Men and Women
Impact of Skills Acquired Through Judo Training on Risk Factors for Falling in Elderly Men and Women
Falls and injuries from falls are one of the greatest threats to public health. One of the
 risk factors for accidental falls is a low self-efficacy regarding the perceived capability
 to perform activities without the risk of falling. Judo is a sport which include "break fall"
 strategies where falls with correct landing strategies and rolling movements are in focus in
 order to avoid injuries. The investigators expect that a judo inspired training
 (Judo4Balance) will strengthen self-efficacy when it comes to the perceived ability to
 perform daily tasks without the risk of falling and thereby reduce the risk for falling. Judo
 based training also includes a well rounded training with focus on strength, balance,
 explosive power, stamina, proprioception and flexibility. These physical qualities are of
 importance for reducing the risk of falling. Therefore the investigators' hypothesis is that
 a 12 week long judo inspired training program could be a suitable tool for reducing falls.

 The aim of the project is to evaluate and document whether a 12 week standardized judo
 inspired exercise program including both the training of above mentioned physical qualities
 as well as "break fall" techniques can influence the risk of falling as well as reduce the
 negative consequences such as injuries from an accidental fall.

 For the evaluation of the 12 week intervention a validated test battery will be used which
 gives an indication of the risk for falling in the near future. Furthermore, a specifically
 designed "Falling Competence" Test has been developed by the investigators' M. Tonoknogi and
 K Strömqvist Bååthe to measure "break fall" technique.

 If it can be proven that the intervention group reaches the expected positive results then
 the control group will be offered the same type of Judo4Balance training after that they have
 been participating as a randomized control group.

 There is evidence that the risk of falling can be reduced by training, nevertheless judo
 based training has not to the investigator's knowledge been scientifically investigated among
 the elderly with the aim of reducing the risk of falls. Neither has it been studied if this
 type of group training is motivational for continuing physical activity after the
 intervention.

 Due to the Covid-19 pandemic and the Swedish Govt. recommendations (in mid March 2020) to
 avoid group exercises for older adults (to decrease the risk of the spread of Covid-19) the 9
 exercise intervention groups where put on hold/paused after 6-9 weeks into the exercise
 program.

 We applied for and received an approval for an addition to the ethical approval (2019-03048),
 in order to follow up with the study subject after 6-7 months of self-quarantine in the homes
 with a self rating of: Fall EfficacyScale (FES), EQ3D as well as questionnaire about the
 subjects perceived physical and mental health. These questionnaires were sent by post.
The aim of this study is to evaluate and document whether a 12 week standardized judo based
 exercise program which include both the physical as well as "break fall" technique can
 influence the risk of falling as well as reduce the negative consequences of an accidental
 fall.

 Questions asked:

 -  Can a 12 week standardized judo based exercise program improve the physical status with
 regard to risks for falls among elderly ?

 -  Can a 12 week standardized judo based exercise program improve the balance among
 elderly.

 -  Can a 12 week standardized judo based exercise program improve the self-efficacy among
 elderly so they can perform their daily chores without the fear of falling

 -  Can a 12 week standardized judo based exercise program increase the level of physical
 activity among elderly?

 -  Can a 12 week standardized judo based exercise program decrease the risk of falls among
 elderly?

 -  Is there a difference between men and women regarding the effects on fall rate and on
 physical factors influencing fall injuries after the completed sixteen week standardized
 judo based training program

 The intervention study is conducted in cooperation with the Swedish Judo Federation who has
 developed as standardized exercise program for the elderly named Judo4Balance. The
 recommended training is well in accordance with the physical exercises that are intrinsic to
 a judo practice. Therefore the hypothesis is that a 12 week long judo inspired training
 program could be a suitable tool for reducing falls and injuries from falls.

 For the evaluation of the 12 week intervention a validated test battery which gives an
 indication of the risk of falling for an individual in the near future will be used. There
 will also be a specifically designed Falling Competence test to measure the effectiveness of
 the "break fall" training.

 Furthermore a follow up of the participants' physical status and break fall technique as well
 as their level of physical activity will be conducted with the same set of tests two years
 after the first intervention.

 The persons included in the study will where it is possible be followed up regarding fall
 incidents for several years.

 If it can be proven that the intervention group reaches the expected positive results such as
 improved physical status, higher self-efficacy with regards to falling and increased
 technical "break fall" skills then the control group will be offered the same type of
 Judo4Balance training one or two terms after that they have been participating as a
 randomized control group.

 There is evidence that the risk of falling can be reduced by training, nevertheless judo
 based training has not to the investigators's knowledge been scientifically investigated
 among the elderly with the aim of reducing the risk of falls. Neither has it been studied if
 this type of group training is motivational for continuing physical activity after the
 intervention.

 A randomized control study consisting of an intervention study and a control group that is
 carried out between 2019 - 2021 at different places throughout Sweden.

 Recruitment will be made at local health centers, judo clubs, and through cooperation with
 clubs and activity centers for retired people.

 Older adults interested in the intervention will be informed about the study both in written
 form and verbally and are signing a consent form. Independent research assistants perform the
 tests. After the tests are made the participants in the study will be randomized into one of
 two groups. One group will participate in the standardized judo inspired 12 week practice and
 one group will not participate. Practical tests and questionnaires are repeated again after
 the 12 weeks regardless of group affiliation.

 The judo based exercise program (Judo4Balance)is divided into three blocks and is lead by
 experienced and especially trained judo teachers during 12 - 16 weeks (12 -16 sessions)

 Block 1) Good technique during break fall training and strength training, accustom the body
 to regular training, find the right level of training for the group, build up load resistance
 in muscles, tendons and bones, challenge the balance through new movements that are not used
 during daily living activities such as getting down and up from the floor, flexibility
 training för stiff joints such as neck, upper back and shoulders.

 Block 2) Improve "break fall" technique and strength exercises, increase the load in the
 strength exercises, challenge the balance and coordination, increase the range of motion,
 introduce "power" exercises when the participants master the technique, continue to build up
 the load resistance in muscles, tendons, and bones.

 Block 3) Train the skill of explosive power during strength exercises and break falls.
 Challenge the balance with increased complexity and difficulty.

 Before the intervention and after the 12 week of standardized judo training program and for
 the control group no specific program given the following tests will be made:

 The participants fill in a health declaration and a questionnaire that besides demographic
 information also includes questions about motivation through two questions regarding
 readiness for change and self-efficacy regarding performing daily tasks without fear of
 falling.

 Modified Falls-Efficacy Scale - Swedish version (FES(S)) is a validated questionnaire which
 measures the self confidence in performing an activity without falling on an 11 grade scale,
 where 0 is not sure at all and 10 is totally confident when performing the activity without
 falling. The participant rates oneself based on 13 described activities where maximum score
 is 130 points.

 The physical status with relevance to fall risk will be evaluated using the modified Short
 Physical Performance Battery (SPPB) where each physical function, balance, strength and
 walking is evaluated on a 4 grade scale. The test has a max points of 12 and has proven to
 have a good reliability according to test - retest.

 The Mini-Balance Evaluation System Test (Mini-BESTest) is used to measure balance. The test
 includes 14 different tasks on 4 sub-scales. All tasks are graded from 0 to 2 points, with a
 total maximum score of 28 points. The test has high reported test-retest reliability and
 inter rater reliability.

 Since there are no previously known tests for the evaluation of judo "break fall" techniques
 for adults or elderly people, two tests have been designed by Professor M. Tonkonogi &
 Research Assistant K. Strömqvist Bååthe at Dalarna University in cooperation with The Swedish
 Judo Federation to test the acquired skills for falling backwards as well as falling forwards
 in a safe setting, with progressive difficulty. The judo fall techniques are graded on a 0-4
 scale. Where 0 represents the minimum score and 4 the maximum score. Four judo puzzle mats
 are needed for the exercises.

 Frändin/Grimby Activity Scale will be used to measure the level of physical activity. The
 scales range from 1 to 6, with 1 representing 'hardly active at all' and 6 representing
 'intensive exercise regularly and several times per week.' The scale has been evaluated and
 shown to have good validity.

 European Quality of Life Questionnaire (EQ-5D or EQ3D) will be used to measure quality of
 life in five dimensions, hygiene, main activities, pain, worry and mood/depression.
 Furthermore an evaluation of the participant's health status is made on a vertical analogue
 scale (VAS) graded 0-100. EQ-5D is proven to have a good test-retest reliability and a high
 validity.

 The pattern of movement will be analyzed before, and after the intervention with the help of
 "surface - electromyograph electrodes placed bilaterally on the participant's back muscles
 and accelerometer based mobility sensors placed on the perons's wrists, ankles and chest.

 Change over time will be calculated with paired non-parametric statistics for nominal and
 original data. Change over time for interval and quote data is calculated with parametric
 statistics. Uni-variate data and multivariate data analysis will be used for calculating
 change and outcome variables between the groups over time A p-Value <0.05 is needed to show a
 significant difference.
Inclusion Criteria:

 -  55 - 110 years of age

 -  Understanding oral and written communication in Swedish

 Exclusion Criteria:

 -  Cannot sit up without support

 -  Not being able to hold up neck when laying on the floor or rolling backwards.

 -  Aortic aneurysm,

 -  Angina pectoris

 -  Cataract operation within the last 6 months