People with chronic obstructive pulmonary disease (COPD) have balance impairments and an increased risk of falls. The psychometric properties of short balance tests to inform fall risk assessment in COPD are unknown. Our objective was to determine the validity (concurrent, convergent, and known-groups) of short balance and mobility tests for fall risk screening. Participants with COPD aged ≥ 60 years attended a single assessment. Correlation coefficients described the relationships between the Brief Balance Evaluation Systems Test (Brief BESTest), Single-Leg Stance (SLS), Timed Up and Go (TUG), and Timed Up and Go Dual-Task (TUG-DT) tests, with the comprehensive Berg Balance Scale (BBS), chair-stand test, and measures of exercise tolerance, functional limitation, disability, and prognosis. Independent t-tests or Mann–Whitney U tests were used to examine differences between groups with respect to fall risk. Receiver operating characteristic curves examined the ability of the screening tests to identify individuals with previous falls. A total of 86 patients with COPD completed the study (72.9 ± 6.8 years; forced expiratory volume in 1 second: 47.3 ± 20.3% predicted). The Brief BESTest identified individuals who reported a previous fall (area under the curve (AUC) = 0.715, p = 0.001), and the SLS showed borderline acceptable accuracy in identifying individuals with a fall history (AUC = 0.684, p = 0.004). The strongest correlations were found for the Brief BESTest and SLS with the BBS ( r = 0.80 and r = 0.72, respectively) and between the TUG and TUG-DT with the chair-stands test ( r = 0.73 and r = 0.70, respectively). The Brief BESTest and SLS show the most promise as balance screening tools for fall risk assessment in older adults with COPD. These tests should be further evaluated prospectively.

Purpose: The purpose of this review is to examine the role of muscle strength in the assessment and management of balance problems among individuals with chronic obstructive pulmonary disease (COPD). Our specific aims are to (1) synthesize the literature on the role of muscle strength in balance control among older adults; (2) provide an overview of what is known about these relationships in people with COPD; and (3) describe clinical applications of assessing and training muscle strength in the context of improving balance among individuals with COPD. Summary of Key Points: Muscle strength is a key contributor to balance in both healthy populations and in people with COPD. Although impairments in skeletal muscle have been well studied in people with COPD, the contributions of this dysfunction to the observed balance deficits in COPD has not been as well studied to date. Furthermore, current research only supports associations between muscle strength and balance performance, and we are unable to determine cause and effect. Future research should address the impact of potential deficits in muscle power and endurance on postural control and fall risk in people with COPD. Recommendations: Comprehensive assessment of balance in people with COPD should include an assessment of muscle strength but also cannot ignore the many other subsystems underlying balance. When targeting muscle strength as part of a balance training program, specific considerations should be given to functional lower-body and core exercises that challenge different balance systems.