Effectiveness of Square-stepping Exercises on Lower Extremity Functions Using 10 Item-lower Extremity Functional Scale In Young Elderly Individuals -An Pre-post Experimental Study

Effectiveness of Square-stepping Exercises on Lower Extremity Functions Using 10 Item-lower Extremity Functional Scale In Young Elderly Individuals -An Pre-post Experimental Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effectiveness of Square-stepping Exercises on Lower Extremity Functions Using 10 Item-lower Extremity Functional Scale In Young Elderly Individuals -An Pre-post Experimental Study Rutuja R. Humnabade, Priyanka Honkalas This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8239104/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background A fall is an unexpected event where a person lands on the ground or a lower surface. In older adults, the fear of falling often results in less physical activity, which can harm mobility and independence. Regular physical activity, particularly structured exercise, is advised for older people—even those with ongoing health conditions—to enhance physical abilities. This study aimed to determine how effective Square-Stepping Exercises are in improving lower limb function using the 10-item LEFS Scale. Methods A pre-post experimental study was carried out with 60 young elderly participants aged between 65 and 75 years both male and female chosen using convenient sampling. The Mini-Mental Status Examination and Falls Efficacy Scale were also given before the intervention to evaluate cognitive abilities and fall risk, ensuring the participants were suitable for the study. People who have undergone any lower limb surgery, abdominal & Thoracic surgery in preceding 1–2 years, Individuals who have CVRS, neurological or psychological disorder, Patients diagnosed with vertigo & Dizziness, People who were using assistive devices were excluded from the study. The 10-item LEFS was used to assess lower limb function both before and after the intervention. Results After completing 6 weeks of SSE training, participants experienced a notable improvement in lower limb function, as measured by the 10-item LEFS. The statistical analysis showed a p-value of 0.0048, indicating that SSE had a significant positive effect on functional performance in daily activities. Conclusion The study concludes that Square-Stepping Exercises are effective in improving lower limb function among the elderly, which plays a key role in preventing falls. Enhancing mobility through SSE can help lower the risk of falls and promote greater independence in older adults. Falls LEFS (Lower Extremity Functional Scale) SSE (Square-Stepping Exercises) ADL (Activities of Daily Living) Figures Figure 1 BACKGROUND Rising life expectancy has contributed to a rapid increase in the global geriatric population, making aging a crucial phase of life marked by progressive physiological, functional, and psychosocial changes. These internal and external changes require continuous adaptation and significantly influence an individual’s overall health. ( 1 ) The number of people above 60 years is growing faster than any other age group worldwide, emphasizing the need to enhance the health, functional independence, and well-being of older adults. ( 2 ) The World Health Organization defines a fall as an incident in which a person inadvertently comes to rest on the ground, floor, or a lower level. Globally, approximately 26.5% of older adults experience falls, while in India the prevalence is even higher, estimated at 31–53%. Around 1.5 to 2 million elderly individuals in India sustain fall-related injuries each year, with nearly 1 million deaths attributed to complications arising from such incidents. ( 3 ) The consequences of falls extend beyond physical injuries and fractures; they also impact psychological health by causing fear of falling, anxiety, reduced confidence, and social withdrawal. Additionally, falls carry a significant economic burden due to increased healthcare and caregiving costs. Thus, falls represent a leading cause of injury, disability, loss of independence, and mortality in individuals aged 65 years and above. A variety of risk factors contribute to falls in older adults, including age-related sensory and neuromuscular decline, impaired balance, gait abnormalities, dizziness, poor vision and hearing, chronic diseases, functional limitations, cognitive impairment, depression, and the use of certain medications. Environmental hazards and lifestyle factors further compound the risk. The presence of multimorbidity and previous fall history further increases susceptibility. These risk factors collectively contribute to disability, which is traditionally assessed using individuals’ ability to perform tasks ranging from basic self-care to more strenuous household or mobility activities. ( 4 ) Models proposed by WHO and other researchers suggest that disease or impairment progresses through stages of functional decline, ultimately leading to disability. Reduced lower-extremity function is integral to this process, as the legs play a central role in maintaining balance and mobility required for daily activities. Thus, identifying a functional state that predicts disability is crucial for planning early interventions that prevent further decline. Fear of falling itself often leads to decreased physical activity, initiating a negative cycle of deconditioning. This is concerning because regular exercise is strongly recommended for older adults, even in the presence of chronic conditions. Age-related changes in posture, reduced flexibility, and declining lower-extremity strength—particularly in hip flexors and extension muscles—impair gait stability and increase the tendency to fall. These muscles are essential for controlling trunk movements during walking, especially in the single-leg support phase. With aging, individuals also commonly experience slower movements, diminished muscle power, and decreased fine motor coordination. ( 5 ) Scientific investigations have shown that proximal lower-limb muscles are particularly prone to age-related atrophy and reductions in maximum strength. Loss of muscle fibers, altered protein metabolism, decreased neuromuscular efficiency, and hormonal changes further contribute to the decline in muscle capacity. These physiological deterioration weaken functional fitness—encompassing strength, balance, agility, and endurance—which limits an older adult’s ability to safely perform activities of daily living (ADLs). Weakness in the lower extremities, particularly, is a major risk factor for falls. ( 6 ) ( 7 ) Given these challenges, evaluating and enhancing lower-extremity function is essential for maintaining independence and preventing disability. Current physical activity guidelines recommend at least 150 minutes of moderate-intensity aerobic activity per week for older adults. Regular participation can reduce the risk of chronic diseases and slow physiological decline associated with aging SSE is a group-based, low-cost motor-cognitive exercise developed by Shigematsu and Okura in Japan to improve balance and cognitive performance. It involves stepping in pre-designed patterns across a floor grid, using forward, backward, lateral, and diagonal movements. These multidirectional steps narrow the base of support and challenge balance and coordination, making SSE effective in training dynamic stability. As a form of simultaneous motor-cognitive training, SSE enhances neuromuscular control, improves vestibular and sensory integration, and strengthens the ability to react quickly to slips or trips—all essential skills for fall prevention. Long-term SSE practice has also been shown to improve cortical functioning, psychomotor speed, and information-processing abilities, contributing to better overall functional performance.( 8 ) ( 9 ) To assess functional improvement, the Lower Extremity Functional Scale (LEFS), developed by Binkley et al. in 1999, is widely used as a reliable and valid tool for evaluating activity limitations associated with lower-limb dysfunction. The LEFS provides essential information for clinical decision-making, helps identify the degree of functional impairment, and guides the planning of goal-oriented rehabilitation interventions. As functional limitation is directly linked to quality of life, such evaluation tools are critical in assessing the outcomes of interventions aimed at improving mobility. ( 11 ) Although SSE has demonstrated potential benefits such as enhanced coordination, balance, cognition, and muscular strength, research focusing specifically on its effects on functional lower-extremity abilities related to ADLs in young elderly individuals is limited. This age group (60–69 years) represents a critical transitional stage where early functional declines begin, and timely intervention can significantly delay disability. Most existing studies have examined older or frail adults, leaving a gap in understanding SSE’s preventive impact on younger elderly populations who are still relatively active.( 10 ) ( 12 ) Given India’s rapidly aging population—classified as an “aging country” with 7.7% of citizens above 60 years—there is a pressing need for accessible, cost-effective, and evidence-based interventions to preserve functional independence. Aging is a dynamic, progressive, and irreversible process that affects multiple bodily systems. Although it cannot be stopped, evidence suggests that functional decline can be slowed or partially reversed through structured exercise programs. Thus, maintaining and improving lower-extremity function is essential for older adults, as it directly influences gait performance, balance, stair climbing, sit-to-stand ability, and other fundamental ADLs. Because SSE has shown promising outcomes but remains understudied in this specific context, this research aims to address the existing gap by evaluating the effect of SSE on lower-limb function in young elderly individuals using the LEFS. METHODS This pre-post experimental study was conducted in an urban setting and focused on the young elderly population. The study was initiated after receiving approval from the Institutional Ethical Committee of P.E.S.Modern College of Physiotherapy in Pune. Each participant received a comprehensive explanation of the study protocol and provided written informed consent prior to joining the study. Data, including the participants' names, ages, and addresses, were recorded on a data sheet.The outcome measure utilized was the 10-item Lower Extremity Functional Scale, with scores assessed both before and after the intervention. A total of 60 individuals were selected using convenient sampling. Participants were eligible if they scored between 0 and 35 on the Lower Extremity Functional Scale (LEFS) and between 16 and 19 on the Falls Efficacy Scale (FES). The study included both male and female participants aged between 65 and 75 years. Exclusion criteria comprised individuals who had undergone lower limb, abdominal, or thoracic surgeries in the past 1–2 years; those with cardiovascular, neurological, or psychological disorders; individuals experiencing vertigo or dizziness; and those using assistive devices. All participants underwent a baseline assessment of lower extremity function using the 10-item Lower Extremity Functional Scale (LEFS). This assessment was repeated after completion of the Square-Stepping Exercise (SSE) program to evaluate improvements in functional performance. SQUARE-STEPPING EXERCISE PROGRAM The intervention implemented was the Square-Stepping Exercise (SSE), which involves a series of multidirectional step movements—forward, backward, sideways, and diagonal—performed on a mat measuring 100 × 250 cm, divided into 40 squares (each 25 cm²). The exercise routines included patterns from Elementary Levels 1 and 2, Intermediate Level 1, and Advanced Level 3. Each training session began with a 5-minute warm-up, followed by 30 minutes of SSE, and concluded with a 5-minute cool-down, all conducted under supervision. The complete program spanned six weeks, with participants attending sessions three times per week, each lasting approximately 40 minutes. During the sessions, participants were instructed to follow the designated step patterns by moving from one end of the mat to the other. After reaching the end, they returned to the starting point by walking normally beside the mat, preparing for the next pattern. The first two weeks served as a familiarization phase, during which participants were introduced to the basic step sequences. As they became more comfortable, the complexity of the patterns was progressively increased. Each pattern was practiced 4 to 10 times to ensure participants were able to perform them successfully.( 13 ) STATISTICAL ANALYSIS Statistical analysis was performed using GraphPad Instat software. To assess the distribution of the data, the Kolmogorov-Smirnov test was applied, confirming normality for the 10-item Lower Extremity Functional Scale scores. Following this, paired t-tests (two-tailed) were employed to determine the significance of changes in continuous variables within the group. A 95% confidence interval was used, with p-values less than 0.05 considered statistically significant and values below 0.001 regarded as highly significant. RESULT Table 1 COMPARISON OF AGE & BMI IN TERMS OF {MEAN (SD)} OF THE EXPERIMENTAL GROUP USING UNPAIRED T TEST VARIABLES MEAN STANDARD DEVIATION Age 69 2.780 BMI 26.28 2.565 INFERENCE Table 1 & Graph 1 shows that the mean Age and BMI of study Population was 69 & 26.28 respectively with standard deviation of 2.78 & 2.56 respectively. Table 2 REPRESENTATION OF GENDER IN TERMS OF PERCENTAGE % OF THE EXPERIMENTAL GROUP USING UNPAIRED T TEST VARIABLE SUB-GROUP N % Gender Male 22 37% Female 38 63% INFERENCE Table 2 & Graph 2 shows that the study consisted of 22 Males and 38 Females which were 37% & 63% respectively. Table 3 COMPARISON OF THE PRE-POST VALUES OF 10-ITEM LOWER EXTREMITY FUNCTIONAL SCALE SCORE IN TERMS OF {MEAN (SD)} IN EXPERIMENTAL GROUP USING PAIRED T TEST. 10-item lower extremity functional scale N Mean Standard deviation (SD) P value Pre 60 14.767 5.646 0.0048* Post 60 25.350 3.828 (p < 0.05 - Significant*, p < 0.001 - Highly significant**) INFERENCE Table 3 & Graph 3,4 shows that the Experimental Group was analysed using paired t-test, where p was 0.0048 (p < 0.05 -Significant* ). The 10-item Lower Extremity Functional Scale pre mean was 14.767 ± 5.646 as Standard deviation, 10-item Lower Extremity Functional Scale post mean was 25.350 ± 3.828 as Standard deviation. DISCUSSION The present study examined the effectiveness of Square Stepping Exercises (SSE) on lower limb function among older adults, addressing a notable gap in the literature regarding the impact of SSE on functional tasks associated with activities of daily living (ADLs). Aging is accompanied by progressive physiological decline that affects multiple body systems, often resulting in reduced mobility, functional limitations, and decreased independence. Fear of falling further contributes to diminished physical activity levels, creating a cycle of weakness and functional decline. Therefore, identifying exercise interventions that enhance lower extremity function is essential for promoting healthy aging. In this study, participants demonstrated significant improvements in 8 of the 10 items of the Lower Extremity Functional Scale (LEFS). Enhanced performance was observed in tasks such as squatting, lifting objects from the floor, walking, running on flat surfaces, stair climbing, and the ability to sit or stand for extended periods. These improvements suggest that SSE may meaningfully enhance lower limb strength, balance, and functional capacity—components that are critical for maintaining independence in older adults. The multi-directional and cognitively engaging nature of SSE likely contributed to these gains. SSE involves complex step patterns performed forward, backward, sideways, and diagonally, which challenge both primary and synergistic muscle groups and stimulate motor and cognitive processing. This aligns with Shigematsu’s earlier findings, which demonstrated improved stepping performance and enhanced rapid leg responses following SSE training, outcomes closely linked to fall prevention. The results further support the principle of training specificity. Unlike traditional linear exercises such as walking, SSE incorporates diverse, multidirectional movements that more closely mimic the motor demands of daily activities. This diversity may explain why participants experienced functional improvements in tasks requiring coordination, balance control, and lower extremity strength. Similar findings have been reported by Arun Thachil and colleagues, who highlighted SSE’s effectiveness in improving lower limb strength and functional fitness, as well as balance in older adults. Despite these positive outcomes, two LEFS items—making sudden turns while running at high speed and carrying out heavy physical tasks—did not show improvement. These tasks are not typically part of the daily routines of older adults, especially those with low to moderate physical activity levels, which characterized the participants in this study. Additionally, the relatively short duration of the intervention may not have been sufficient to influence higher-intensity or complex motor activities. More physically demanding tasks may require extended training periods or the inclusion of advanced SSE variations, such as toe- or heel-walking, to elicit improvements. Participant engagement evolved over the course of the intervention. Initial disinterest was noted during the first two weeks; however, enjoyment and adherence improved as participants became more familiar with the step sequences. This suggests that gradual progression in speed and complexity may be essential not only for physical adaptation but also for maintaining motivation and participation—factors that are crucial for long-term exercise adherence in older adults. Overall, the findings support SSE as a practical and effective intervention for improving lower limb function and mitigating the functional decline associated with aging. By enhancing strength, balance, coordination, and confidence in movement, SSE may contribute to improved ADL performance and reduced fall risk. Future studies with larger sample sizes, longer intervention durations, and comparative exercise groups are warranted to further validate these outcomes and determine the long-term sustainability of functional improvements. CONCLUSION The findings of this study indicate that Square-Stepping Exercises enhance lower extremity function, a key factor associated with fall risk in older adults, thereby contributing to fall prevention and improved mobility in the elderly. CLINICAL IMPLICATION Square-Stepping Exercises (SSE) can be applied as simple, low-cost intervention to improve lower extremity function and reduce fall risk in elderly individuals, it can be easily integrated into routine physiotherapy. FUTURE SCOPE Future studies can investigate the effectiveness of SSE on quality of life in elderly population. LIMITATIONS The study was limited by a small sample size and absence of control group, which may restrict generalizability of the findings. Declarations ETHICS APPROVAL AND CONSENT TO PARTICIPATE: Ethical approval has been taken from Institutional Ethical Committee of P.E.S.Modern College of Physiotherapy in Pune. CONSENT FOR PUBLICATION: NOT APPLICABLE. AVAILABILITY OF DATA AND MATERIALS: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. COMPETING INTERESTS: The authors declare no competing interest. FUNDING: NONE AUTHORS' CONTRIBUTIONS: Dr.Rutuja : Contributed to the conception and design of the study, data acquisition, data analysis, and interpretation. Drafted the initial manuscript and performed substantial revisions,Supported statistical analysis, contributed to methodology development, and participated in drafting and revising the manuscript, participant recruitment, and manuscript editing. Dr.Priyanka : Assisted with study design, supervised data collection, contributed to data interpretation, and critically revised the manuscript for important intellectual content. ACKNOWLEDGEMENTS: I extend my gratitude to my esteemed Principal and all my professors for helping me in This venture. I am deeply indebted to my guide for her invaluable guidance and support Who has contributed her expertise in bringing out the best of me in this piece of project Work. I thank her for solving all my queries, being available throughout and for being a Constant source of strength. I offer my regards to all those who supported me in any aspect during the completion of the study. Last, but not the least, I express my sincere gratitude to all the subjects who Participated and gave their full co-operation for the study. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Guccione AA, Avers D, Wong R. Geriatric Physical Therapy - eBook. Elsevier Health Sciences; 2011. p. 734. (PDF). What is Geriatrics? Geriatrics or Older Adults Health and Diseases? ResearchGate [Internet]. 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ResearchGate [Internet]. 2025 Aug 6 [cited 2025 Nov 30]; Available from: https://www.researchgate.net/publication/309104705_Effect_of_increased_daily_physical_activity_on_lower-extremity_physical_function_during_an_exercise_program_for_older_adults Harshika B, Vishnu V, Tushar P, Shilpa K, COMPARATIVE STUDY ON THE EFFECT, OF SQUARE STEPPING EXERCISES VERSUS BALANCE TRAINING EXERCISES ON FEAR OF FALL AND BALANCE IN ELDERLY POPULATION. Int J Physiotherapy Res. 2016;4(1):1352–9. Fisseha B, Janakiraman B, Yitayeh A, Ravichandran H. Effect of square stepping exercise for older adults to prevent fall and injury related to fall: systematic review and meta-analysis of current evidences. J Exerc Rehabil. 2017;13(1):23–9. Wang YH, Liu YH, Yang YR, Wang RY. Effects of square-stepping exercise on motor and cognitive function in older adults - A systematic review and meta-analysis. Geriatr Nurs. 2021;42(6):1583–93. Uchida R, Numao S, Kurosaki T, Noma A, Nakagaichi M. The exercise intensity of square-stepping exercise in community-dwelling late elderly females. J Phys Ther Sci. 2020;32(10):657–62. Graphs Graphs 1 to 4 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Graph1.png Graph 1- Demographic Characteristic Graph2.png Graph 2- Demographic Characteristic Graph3.png Graph 3: LEFS Pre and Post intervention MEAN Graph4.png Graph 4 : LEFS Pre and Post intervention SD Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 17 Jan, 2026 Reviewers invited by journal 06 Jan, 2026 Editor invited by journal 12 Dec, 2025 Editor assigned by journal 10 Dec, 2025 Submission checks completed at journal 10 Dec, 2025 First submitted to journal 10 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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10:25:01","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":83134,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8239104/v1/efe4d2897ead76c307dda8c2.html"},{"id":100036359,"identity":"84a4dc6e-c62d-4d5c-b39b-32e4f48ccfb0","added_by":"auto","created_at":"2026-01-12 10:24:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88867,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSQUARE-STEPPING EXERCISE PATTERNS\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8239104/v1/d9e7a257a36c804351e34a5f.png"},{"id":100381295,"identity":"0ea2ae75-5bc1-4ba7-a468-a6c7df4f8a29","added_by":"auto","created_at":"2026-01-16 10:37:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":610524,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8239104/v1/d561e57f-702e-4bb5-9426-c055b9d91f3d.pdf"},{"id":100036461,"identity":"cd362145-efe9-41dc-a7bd-19dde41c9c32","added_by":"auto","created_at":"2026-01-12 10:25:00","extension":"png","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":108473,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraph 1- Demographic Characteristic\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Graph1.png","url":"https://assets-eu.researchsquare.com/files/rs-8239104/v1/d615dca4c3909c6670a1cec4.png"},{"id":100363348,"identity":"03b37792-bb39-4d60-9ad0-9ef693b1bcee","added_by":"auto","created_at":"2026-01-16 07:49:31","extension":"png","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":124138,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraph 2- Demographic Characteristic\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Graph2.png","url":"https://assets-eu.researchsquare.com/files/rs-8239104/v1/3d5434ede86f0ba7ef7f8f72.png"},{"id":100363107,"identity":"02d57085-4e20-4b87-8b2a-471b0f3721d2","added_by":"auto","created_at":"2026-01-16 07:48:54","extension":"png","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":201622,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraph 3: \u0026nbsp;LEFS Pre and Post intervention MEAN\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Graph3.png","url":"https://assets-eu.researchsquare.com/files/rs-8239104/v1/05dfa9e7ce2d4435e7c98ed1.png"},{"id":100036474,"identity":"009a729c-d7bd-4125-aef0-f279973b8cea","added_by":"auto","created_at":"2026-01-12 10:25:01","extension":"png","order_by":4,"title":"","display":"","copyAsset":false,"role":"supplement","size":208096,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraph 4 : LEFS Pre and Post intervention SD\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Graph4.png","url":"https://assets-eu.researchsquare.com/files/rs-8239104/v1/95e2d8d4789e59558dd0a7fb.png"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eEffectiveness of Square-stepping Exercises on Lower Extremity Functions Using 10 Item-lower Extremity Functional Scale In Young Elderly Individuals -An Pre-post Experimental Study\u003c/p\u003e","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eRising life expectancy has contributed to a rapid increase in the global geriatric population, making aging a crucial phase of life marked by progressive physiological, functional, and psychosocial changes. These internal and external changes require continuous adaptation and significantly influence an individual\u0026rsquo;s overall health. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) The number of people above 60 years is growing faster than any other age group worldwide, emphasizing the need to enhance the health, functional independence, and well-being of older adults. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe World Health Organization defines a fall as an incident in which a person inadvertently comes to rest on the ground, floor, or a lower level. Globally, approximately 26.5% of older adults experience falls, while in India the prevalence is even higher, estimated at 31\u0026ndash;53%. Around 1.5 to 2\u0026nbsp;million elderly individuals in India sustain fall-related injuries each year, with nearly 1\u0026nbsp;million deaths attributed to complications arising from such incidents. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) The consequences of falls extend beyond physical injuries and fractures; they also impact psychological health by causing fear of falling, anxiety, reduced confidence, and social withdrawal. Additionally, falls carry a significant economic burden due to increased healthcare and caregiving costs. Thus, falls represent a leading cause of injury, disability, loss of independence, and mortality in individuals aged 65 years and above. A variety of risk factors contribute to falls in older adults, including age-related sensory and neuromuscular decline, impaired balance, gait abnormalities, dizziness, poor vision and hearing, chronic diseases, functional limitations, cognitive impairment, depression, and the use of certain medications. Environmental hazards and lifestyle factors further compound the risk. The presence of multimorbidity and previous fall history further increases susceptibility. These risk factors collectively contribute to disability, which is traditionally assessed using individuals\u0026rsquo; ability to perform tasks ranging from basic self-care to more strenuous household or mobility activities. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eModels proposed by WHO and other researchers suggest that disease or impairment progresses through stages of functional decline, ultimately leading to disability. Reduced lower-extremity function is integral to this process, as the legs play a central role in maintaining balance and mobility required for daily activities. Thus, identifying a functional state that predicts disability is crucial for planning early interventions that prevent further decline. Fear of falling itself often leads to decreased physical activity, initiating a negative cycle of deconditioning. This is concerning because regular exercise is strongly recommended for older adults, even in the presence of chronic conditions. Age-related changes in posture, reduced flexibility, and declining lower-extremity strength\u0026mdash;particularly in hip flexors and extension muscles\u0026mdash;impair gait stability and increase the tendency to fall. These muscles are essential for controlling trunk movements during walking, especially in the single-leg support phase. With aging, individuals also commonly experience slower movements, diminished muscle power, and decreased fine motor coordination. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eScientific investigations have shown that proximal lower-limb muscles are particularly prone to age-related atrophy and reductions in maximum strength. Loss of muscle fibers, altered protein metabolism, decreased neuromuscular efficiency, and hormonal changes further contribute to the decline in muscle capacity. These physiological deterioration weaken functional fitness\u0026mdash;encompassing strength, balance, agility, and endurance\u0026mdash;which limits an older adult\u0026rsquo;s ability to safely perform activities of daily living (ADLs). Weakness in the lower extremities, particularly, is a major risk factor for falls. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Given these challenges, evaluating and enhancing lower-extremity function is essential for maintaining independence and preventing disability. Current physical activity guidelines recommend at least 150 minutes of moderate-intensity aerobic activity per week for older adults. Regular participation can reduce the risk of chronic diseases and slow physiological decline associated with aging\u003c/p\u003e \u003cp\u003eSSE is a group-based, low-cost motor-cognitive exercise developed by Shigematsu and Okura in Japan to improve balance and cognitive performance. It involves stepping in pre-designed patterns across a floor grid, using forward, backward, lateral, and diagonal movements. These multidirectional steps narrow the base of support and challenge balance and coordination, making SSE effective in training dynamic stability. As a form of simultaneous motor-cognitive training, SSE enhances neuromuscular control, improves vestibular and sensory integration, and strengthens the ability to react quickly to slips or trips\u0026mdash;all essential skills for fall prevention. Long-term SSE practice has also been shown to improve cortical functioning, psychomotor speed, and information-processing abilities, contributing to better overall functional performance.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eTo assess functional improvement, the Lower Extremity Functional Scale (LEFS), developed by Binkley et al. in 1999, is widely used as a reliable and valid tool for evaluating activity limitations associated with lower-limb dysfunction. The LEFS provides essential information for clinical decision-making, helps identify the degree of functional impairment, and guides the planning of goal-oriented rehabilitation interventions. As functional limitation is directly linked to quality of life, such evaluation tools are critical in assessing the outcomes of interventions aimed at improving mobility. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAlthough SSE has demonstrated potential benefits such as enhanced coordination, balance, cognition, and muscular strength, research focusing specifically on its effects on functional lower-extremity abilities related to ADLs in young elderly individuals is limited. This age group (60\u0026ndash;69 years) represents a critical transitional stage where early functional declines begin, and timely intervention can significantly delay disability. Most existing studies have examined older or frail adults, leaving a gap in understanding SSE\u0026rsquo;s preventive impact on younger elderly populations who are still relatively active.(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eGiven India\u0026rsquo;s rapidly aging population\u0026mdash;classified as an \u0026ldquo;aging country\u0026rdquo; with 7.7% of citizens above 60 years\u0026mdash;there is a pressing need for accessible, cost-effective, and evidence-based interventions to preserve functional independence. Aging is a dynamic, progressive, and irreversible process that affects multiple bodily systems. Although it cannot be stopped, evidence suggests that functional decline can be slowed or partially reversed through structured exercise programs.\u003c/p\u003e \u003cp\u003eThus, maintaining and improving lower-extremity function is essential for older adults, as it directly influences gait performance, balance, stair climbing, sit-to-stand ability, and other fundamental ADLs. Because SSE has shown promising outcomes but remains understudied in this specific context, this research aims to address the existing gap by evaluating the effect of SSE on lower-limb function in young elderly individuals using the LEFS.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis pre-post experimental study was conducted in an urban setting and focused on the young elderly population. The study was initiated after receiving approval from the Institutional Ethical Committee of P.E.S.Modern College of Physiotherapy in Pune. Each participant received a comprehensive explanation of the study protocol and provided written informed consent prior to joining the study. Data, including the participants' names, ages, and addresses, were recorded on a data sheet.The outcome measure utilized was the 10-item Lower Extremity Functional Scale, with scores assessed both before and after the intervention. A total of 60 individuals were selected using convenient sampling. Participants were eligible if they scored between 0 and 35 on the Lower Extremity Functional Scale (LEFS) and between 16 and 19 on the Falls Efficacy Scale (FES). The study included both male and female participants aged between 65 and 75 years. Exclusion criteria comprised individuals who had undergone lower limb, abdominal, or thoracic surgeries in the past 1\u0026ndash;2 years; those with cardiovascular, neurological, or psychological disorders; individuals experiencing vertigo or dizziness; and those using assistive devices. All participants underwent a baseline assessment of lower extremity function using the 10-item Lower Extremity Functional Scale (LEFS). This assessment was repeated after completion of the Square-Stepping Exercise (SSE) program to evaluate improvements in functional performance.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSQUARE-STEPPING EXERCISE PROGRAM\u003c/h2\u003e \u003cp\u003eThe intervention implemented was the Square-Stepping Exercise (SSE), which involves a series of multidirectional step movements\u0026mdash;forward, backward, sideways, and diagonal\u0026mdash;performed on a mat measuring 100 \u0026times; 250 cm, divided into 40 squares (each 25 cm\u0026sup2;). The exercise routines included patterns from Elementary Levels 1 and 2, Intermediate Level 1, and Advanced Level 3. Each training session began with a 5-minute warm-up, followed by 30 minutes of SSE, and concluded with a 5-minute cool-down, all conducted under supervision. The complete program spanned six weeks, with participants attending sessions three times per week, each lasting approximately 40 minutes. During the sessions, participants were instructed to follow the designated step patterns by moving from one end of the mat to the other. After reaching the end, they returned to the starting point by walking normally beside the mat, preparing for the next pattern. The first two weeks served as a familiarization phase, during which participants were introduced to the basic step sequences. As they became more comfortable, the complexity of the patterns was progressively increased. Each pattern was practiced 4 to 10 times to ensure participants were able to perform them successfully.(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSTATISTICAL ANALYSIS\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using GraphPad Instat software. To assess the distribution of the data, the Kolmogorov-Smirnov test was applied, confirming normality for the 10-item Lower Extremity Functional Scale scores. Following this, paired t-tests (two-tailed) were employed to determine the significance of changes in continuous variables within the group. A 95% confidence interval was used, with p-values less than 0.05 considered statistically significant and values below 0.001 regarded as highly significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULT","content":"\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCOMPARISON OF AGE \u0026amp; BMI IN TERMS OF {MEAN (SD)} OF THE EXPERIMENTAL GROUP USING UNPAIRED T TEST\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVARIABLES\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMEAN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSTANDARD DEVIATION\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.780\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.565\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eINFERENCE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e \u0026amp; Graph 1 shows that the mean Age and BMI of study Population was 69 \u0026amp; 26.28 respectively with standard deviation of 2.78 \u0026amp; 2.56 respectively.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eREPRESENTATION OF GENDER IN TERMS OF PERCENTAGE % OF THE EXPERIMENTAL GROUP USING UNPAIRED T TEST\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVARIABLE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSUB-GROUP\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eINFERENCE\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e \u0026amp; Graph 2 shows that the study consisted of 22 Males and 38 Females which were 37% \u0026amp; 63% respectively.\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCOMPARISON OF THE PRE-POST VALUES OF 10-ITEM LOWER EXTREMITY FUNCTIONAL SCALE SCORE IN TERMS OF {MEAN (SD)} IN EXPERIMENTAL GROUP USING PAIRED T TEST.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e10-item lower extremity functional scale\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eStandard deviation (SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePre\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e60\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e14.767\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.646\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0048*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e60\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e25.350\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.828\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e(p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 - Significant*, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 - Highly significant**)\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003cp\u003e\u003cstrong\u003eINFERENCE\u003c/strong\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eTable \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e \u0026amp; Graph 3,4 shows that the Experimental Group was analysed using paired t-test, where p was 0.0048 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 -Significant* ). The 10-item Lower Extremity Functional Scale pre mean was 14.767\u0026thinsp;\u0026plusmn;\u0026thinsp;5.646 as Standard deviation, 10-item Lower Extremity Functional Scale post mean was 25.350\u0026thinsp;\u0026plusmn;\u0026thinsp;3.828 as Standard deviation.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe present study examined the effectiveness of Square Stepping Exercises (SSE) on lower limb function among older adults, addressing a notable gap in the literature regarding the impact of SSE on functional tasks associated with activities of daily living (ADLs). Aging is accompanied by progressive physiological decline that affects multiple body systems, often resulting in reduced mobility, functional limitations, and decreased independence. Fear of falling further contributes to diminished physical activity levels, creating a cycle of weakness and functional decline. Therefore, identifying exercise interventions that enhance lower extremity function is essential for promoting healthy aging.\u003c/p\u003e \u003cp\u003eIn this study, participants demonstrated significant improvements in 8 of the 10 items of the Lower Extremity Functional Scale (LEFS). Enhanced performance was observed in tasks such as squatting, lifting objects from the floor, walking, running on flat surfaces, stair climbing, and the ability to sit or stand for extended periods. These improvements suggest that SSE may meaningfully enhance lower limb strength, balance, and functional capacity\u0026mdash;components that are critical for maintaining independence in older adults. The multi-directional and cognitively engaging nature of SSE likely contributed to these gains. SSE involves complex step patterns performed forward, backward, sideways, and diagonally, which challenge both primary and synergistic muscle groups and stimulate motor and cognitive processing. This aligns with Shigematsu\u0026rsquo;s earlier findings, which demonstrated improved stepping performance and enhanced rapid leg responses following SSE training, outcomes closely linked to fall prevention.\u003c/p\u003e \u003cp\u003eThe results further support the principle of training specificity. Unlike traditional linear exercises such as walking, SSE incorporates diverse, multidirectional movements that more closely mimic the motor demands of daily activities. This diversity may explain why participants experienced functional improvements in tasks requiring coordination, balance control, and lower extremity strength. Similar findings have been reported by Arun Thachil and colleagues, who highlighted SSE\u0026rsquo;s effectiveness in improving lower limb strength and functional fitness, as well as balance in older adults.\u003c/p\u003e \u003cp\u003eDespite these positive outcomes, two LEFS items\u0026mdash;making sudden turns while running at high speed and carrying out heavy physical tasks\u0026mdash;did not show improvement. These tasks are not typically part of the daily routines of older adults, especially those with low to moderate physical activity levels, which characterized the participants in this study. Additionally, the relatively short duration of the intervention may not have been sufficient to influence higher-intensity or complex motor activities. More physically demanding tasks may require extended training periods or the inclusion of advanced SSE variations, such as toe- or heel-walking, to elicit improvements.\u003c/p\u003e \u003cp\u003eParticipant engagement evolved over the course of the intervention. Initial disinterest was noted during the first two weeks; however, enjoyment and adherence improved as participants became more familiar with the step sequences. This suggests that gradual progression in speed and complexity may be essential not only for physical adaptation but also for maintaining motivation and participation\u0026mdash;factors that are crucial for long-term exercise adherence in older adults.\u003c/p\u003e \u003cp\u003eOverall, the findings support SSE as a practical and effective intervention for improving lower limb function and mitigating the functional decline associated with aging. By enhancing strength, balance, coordination, and confidence in movement, SSE may contribute to improved ADL performance and reduced fall risk. Future studies with larger sample sizes, longer intervention durations, and comparative exercise groups are warranted to further validate these outcomes and determine the long-term sustainability of functional improvements.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe findings of this study indicate that Square-Stepping Exercises enhance lower extremity function, a key factor associated with fall risk in older adults, thereby contributing to fall prevention and improved mobility in the elderly.\u003c/p\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eCLINICAL IMPLICATION\u003c/h2\u003e\n \u003cp\u003eSquare-Stepping Exercises (SSE) can be applied as simple, low-cost intervention to improve lower extremity function and reduce fall risk in elderly individuals, it can be easily integrated into routine physiotherapy.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eFUTURE SCOPE\u003c/h2\u003e\n \u003cp\u003eFuture studies can investigate the effectiveness of SSE on quality of life in elderly population.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eLIMITATIONS\u003c/h2\u003e\n \u003cp\u003eThe study was limited by a small sample size and absence of control group, which may restrict generalizability of the findings.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eETHICS APPROVAL AND CONSENT TO PARTICIPATE:\u0026nbsp;\u003c/strong\u003eEthical approval has been taken from\u0026nbsp;Institutional Ethical Committee of P.E.S.Modern College of Physiotherapy in Pune.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONSENT FOR PUBLICATION:\u0026nbsp;\u003c/strong\u003eNOT APPLICABLE.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAVAILABILITY OF DATA AND MATERIALS:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOMPETING INTERESTS:\u003c/strong\u003e The authors declare no competing interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFUNDING:\u0026nbsp;\u003c/strong\u003eNONE\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAUTHORS' CONTRIBUTIONS:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr.Rutuja : Contributed to the conception and design of the study, data acquisition, data analysis, and interpretation. Drafted the initial manuscript and performed substantial revisions,Supported statistical analysis, contributed to methodology development, and participated in drafting and revising the manuscript, participant recruitment, and manuscript editing.\u003c/p\u003e\n\u003cp\u003eDr.Priyanka : Assisted with study design, supervised data collection, contributed to data interpretation, and critically revised the manuscript for important intellectual content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACKNOWLEDGEMENTS:\u003c/strong\u003e I extend my gratitude to my esteemed Principal and all my professors for helping me in This venture. I am deeply indebted to my guide for her invaluable guidance and support Who has contributed her expertise in bringing out the best of me in this piece of project Work. I thank her for solving all my queries, being available throughout and for being a Constant source of strength. I offer my regards to all those who supported me in any aspect during the completion of the study. Last, but not the least, I express my sincere gratitude to all the subjects who Participated and gave their full co-operation for the study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGuccione AA, Avers D, Wong R. Geriatric Physical Therapy - eBook. Elsevier Health Sciences; 2011. p. 734.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e(PDF). What is Geriatrics? Geriatrics or Older Adults Health and Diseases? ResearchGate [Internet]. 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Health Sci Rep. 2022 July;5(4):e637.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332(9):556\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeixeira CVL, Gobbi S, Pereira JR, Ueno DT, Shigematsu R, Gobbi LTB. Effect of square-stepping exercise and basic exercises on functional fitness of older adults. Geriatr Gerontol Int. 2013;13(4):842\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBatista FS, Gomes GA, de Neri O, Guariento AL, Cintra ME, Sousa FA. M da LR de, Relationship between lower-limb muscle strength and frailty among elderly people. Sao Paulo Med J. 2012;130(2):102\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThachil A, Thomas L. 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Effects of three home-based exercise programmes regarding falls, quality of life and exercise-adherence in older adults at risk of falling: protocol for a randomized controlled trial. BMC Geriatr. 2019;19(1):13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKulkarni N, Pouliasi K, Theodoritsi M, Mahajan A, Panagiatopolous E, Subhash K et al. Impact of Group Exercise Programme on Fall Risk in Elderly Individuals: A Pilot Study. 2017;2657.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eindian journal of physiotherapy \u0026amp;. Occupational therapy-April-June 07 [Internet]. [cited 2025 Nov 20]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://ijpot.com/scripts/april-june%202007%20IJPOT%20issue.pdf\u003c/span\u003e\u003cspan address=\"https://ijpot.com/scripts/april-june%202007%20IJPOT%20issue.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLees MA, Edwards J, McCain JE, Bouchard DR. Potential value of home square-stepping exercises for inactive older adults: an exploratory case study. BMC Geriatr. 2022;22(1):14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShigematsu R, Okura T, Sakai T, Rantanen T. Square-stepping exercise versus strength and balance training for fall risk factors. Aging Clin Exp Res. 2008;20(1):19\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChoi JH, Kim NJ. The effects of balance training and ankle training on the gait of elderly people who have fallen. J Phys Ther Sci. 2015;27(1):139\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStasi S, Papathanasiou G, Korres N, Marinakis G, Chronopoulos E, Baltopoulos PI et al. Validation of the Lower Extremity Functional Scale in community-dwelling elderly people (LEFS-Greek); determination of functional status cut-off points using TUG test. European Geriatric Medicine. 2013 Sept 1;4(4):237\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEffect of increased daily physical activity on lower-extremity physical function during an exercise program for older adults | Request PDF. ResearchGate [Internet]. 2025 Aug 6 [cited 2025 Nov 30]; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.researchgate.net/publication/309104705_Effect_of_increased_daily_physical_activity_on_lower-extremity_physical_function_during_an_exercise_program_for_older_adults\u003c/span\u003e\u003cspan address=\"https://www.researchgate.net/publication/309104705_Effect_of_increased_daily_physical_activity_on_lower-extremity_physical_function_during_an_exercise_program_for_older_adults\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHarshika B, Vishnu V, Tushar P, Shilpa K, COMPARATIVE STUDY ON THE EFFECT, OF SQUARE STEPPING EXERCISES VERSUS BALANCE TRAINING EXERCISES ON FEAR OF FALL AND BALANCE IN ELDERLY POPULATION. Int J Physiotherapy Res. 2016;4(1):1352\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFisseha B, Janakiraman B, Yitayeh A, Ravichandran H. Effect of square stepping exercise for older adults to prevent fall and injury related to fall: systematic review and meta-analysis of current evidences. J Exerc Rehabil. 2017;13(1):23\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang YH, Liu YH, Yang YR, Wang RY. Effects of square-stepping exercise on motor and cognitive function in older adults - A systematic review and meta-analysis. Geriatr Nurs. 2021;42(6):1583\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUchida R, Numao S, Kurosaki T, Noma A, Nakagaichi M. The exercise intensity of square-stepping exercise in community-dwelling late elderly females. J Phys Ther Sci. 2020;32(10):657\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Graphs","content":"\u003cp\u003eGraphs 1 to 4 are available in the Supplementary Files section\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Falls, LEFS (Lower Extremity Functional Scale), SSE (Square-Stepping Exercises), ADL (Activities of Daily Living)","lastPublishedDoi":"10.21203/rs.3.rs-8239104/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8239104/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eA fall is an unexpected event where a person lands on the ground or a lower surface. In older adults, the fear of falling often results in less physical activity, which can harm mobility and independence. Regular physical activity, particularly structured exercise, is advised for older people\u0026mdash;even those with ongoing health conditions\u0026mdash;to enhance physical abilities. This study aimed to determine how effective Square-Stepping Exercises are in improving lower limb function using the 10-item LEFS Scale.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA pre-post experimental study was carried out with 60 young elderly participants aged between 65 and 75 years both male and female chosen using convenient sampling. The Mini-Mental Status Examination and Falls Efficacy Scale were also given before the intervention to evaluate cognitive abilities and fall risk, ensuring the participants were suitable for the study. People who have undergone any lower limb surgery, abdominal \u0026amp; Thoracic surgery in preceding 1\u0026ndash;2 years, Individuals who have CVRS, neurological or psychological disorder, Patients diagnosed with vertigo \u0026amp; Dizziness, People who were using assistive devices were excluded from the study. The 10-item LEFS was used to assess lower limb function both before and after the intervention.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAfter completing 6 weeks of SSE training, participants experienced a notable improvement in lower limb function, as measured by the 10-item LEFS. The statistical analysis showed a p-value of 0.0048, indicating that SSE had a significant positive effect on functional performance in daily activities.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study concludes that Square-Stepping Exercises are effective in improving lower limb function among the elderly, which plays a key role in preventing falls. Enhancing mobility through SSE can help lower the risk of falls and promote greater independence in older adults.\u003c/p\u003e","manuscriptTitle":"Effectiveness of Square-stepping Exercises on Lower Extremity Functions Using 10 Item-lower Extremity Functional Scale In Young Elderly Individuals -An Pre-post Experimental Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 10:24:01","doi":"10.21203/rs.3.rs-8239104/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"308509930773184908259403400287750624620","date":"2026-01-17T10:30:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-06T18:36:27+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-12T13:13:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-10T13:23:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-10T10:34:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-12-10T10:22:53+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"089717c9-2cf8-44f6-91bf-ba8d610c4e3e","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-12T10:24:01+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 10:24:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8239104","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8239104","identity":"rs-8239104","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}