Effects of four-square exercise, nine-square exercise, and lower limb exercise video on balance and physical performance in Samutprakan Hospital older adult club

Abstract

Older adults often experience degenerative changes in their body systems, which can lead to falls and subsequently diminished quality of life. Lower limb strengthening exercises that focus on balance can enhance postural control and reduce risk factors for falls. The nine-square step exercise is one intervention aimed at fall prevention, while the four-square step exercise has been introduced for the same purpose in clinical settings.

This study aimed to compare the effects of three types of exercises—nine-square step, four-square step, and lower limb exercise video—on balance and physical performance in members of the Samutprakan Hospital Older Adult Club. This quasi-experimental study included a sample of 53 older adults who were randomly allocated into three exercise groups: Group 1 (four-square step, n = 18), Group 2 (nine-square step, n = 18), and Group 3 (lower limb exercise video, n = 17). Each participant followed a home-based exercise regimen of 25 minutes per session, three sessions per week, for eight weeks.

Balance and physical performance were evaluated before and after the exercise program using the Timed Up and Go (TUG) test, the One Leg Standing Test (OLST), and the Short Physical Performance Battery (SPPB). Data were analyzed using Two-Way Mixed ANOVA and the Kruskal-Wallis Test.

All three groups showed significant improvements in TUG and OLST scores after training (p<0.05), although there were no significant differences between the groups. Changes in SPPB post-training were significantly greater in Groups 1 and 2 compared to Group 3 in terms of gait speed and the chair stand test. There were no falls reported in any of the groups throughout the entire study period.

Therefore, the four-square step exercise is shown to enhance balance and physical performance to a degree comparable to the nine-square step exercise.