Effects of Combined Balance and Strength Training on Measures of Balance and Muscle Strength in Older Women With a History of Falls

Abstract

ObjectiveWe investigated the effects of combined balance and strength training on measures of balance and muscle strength in older women with a history of falls.MethodsTwenty-seven older women aged 70.4 ± 4.1 years (age range: 65 to 75 years) were randomly allocated to either an intervention (IG, n = 12) or an active control (CG, n = 15) group. The IG completed 8 weeks combined balance and strength training program with three sessions per week including visual biofeedback using force plates. The CG received physical therapy and gait training at a rehabilitation center. Training volumes were similar between the groups. Pre and post training, tests were applied for the assessment of muscle strength (weight-bearing squat [WBS] by measuring the percentage of body mass borne by each leg at different knee flexions [0°, 30°, 60°, and 90°], sit-to-stand test [STS]), and balance. Balance tests used the modified clinical test of sensory interaction (mCTSIB) with eyes closed (EC) and opened (EO), on stable (firm) and unstable (foam) surfaces as well as spatial parameters of gait such as step width and length (cm) and walking speed (cm/s).ResultsSignificant group × time interactions were found for different degrees of knee flexion during WBS (0.0001 < p < 0.013, 0.441 < d < 0.762). Post hoc tests revealed significant pre-to-post improvements for both legs and for all degrees of flexion (0.0001 < p < 0.002, 0.697 < d < 1.875) for IG compared to CG. Significant group × time interactions were found for firm EO, foam EO, firm EC, and foam EC (0.006 < p < 0.029; 0.302 < d < 0.518). Post hoc tests showed significant pre-to-post improvements for both legs and for all degrees of oscillations (0.0001 < p < 0.004, 0.753 < d < 2.097) for IG compared to CG. This study indicates that combined balance and strength training improved percentage distribution of body weight between legs at different conditions of knee flexion (0°, 30°, 60°, and 90°) and also decreased the sway oscillation on a firm surface with eyes closed, and on foam surface (with eyes opened or closed) in the IG.ConclusionThe higher positive effects of training seen in standing balance tests, compared with dynamic tests, suggests that balance training exercises including lateral, forward, and backward exercises improved static balance to a greater extent in older women.

Relationship between Postural Balance Training and Fall Risks for Elderly: a Systematic Review of Randomized Controlled Trials

“…The review involved 22 RCT reports with 4,847 older adults aged 65 years or over in community-dwelling . The 22 selected RCTs provided 10 RCTs for multi-modal exercises [9][10][11][12][13]16,18,21,22,24], 2 RCTs for bi-modal exercises [27,30], 8 RCTs for uni-modal exercises [17,19,20,23,25,26,2829], and 2 RCTs for home exercise program [14,15] to improve the risk of falls. The postural balance training of the selected RCT studies involved multimodal exercises which consisted of the stretching, dynamic and static balancing, resistance exercise, dual task exercise, gait training, proprioception exercises, aerobic exercise, reaction time, and flexibility, stepping, step-up exercises [9][10][11][12][13]16,18,21,22,24].…”

“…The postural balance training of the selected RCT studies involved multimodal exercises which consisted of the stretching, dynamic and static balancing, resistance exercise, dual task exercise, gait training, proprioception exercises, aerobic exercise, reaction time, and flexibility, stepping, step-up exercises [9][10][11][12][13]16,18,21,22,24]. Bi-modal exercises in the selected RCTs involved aerobic exercise, resistance exercise, balance and strengthening exercise [27,30]. The therapeutic exercises of the review also involved [17,19,20,23,25,26,28,29].…”

“…The therapeutic intensity varied from 12 sessions to 156 sessions, and also was from 24 minutes to 120 minutes per session. Twelve studies were no therapeutic intervention in control group [9,10,13,16-18, 23-27,29], five studies involved traditional exercise for control group [14,15,19,20,30], and two studies involved also health education for control group [12,21]. One…”

“…The additional therapy involved home exercise program, strengthening and balance training, physical therapy, and physical exercises. Nineteen records of the selected RCT studies reported that experimental group showed more improvement compared to control group [9][10][11][13][14][15][16][17][18][19][21][22][23][25][26][27][28][29][30], although thrive records showed more improvement on only one or two outcomes compared to control group [9,10,19]. Only three records of the selected RCT studies reported no statistically differential effects (Table 1).…”

“…Only five studies measured fall incidence to investigate the risk of falls in the involved RCTs [10,12,15,24,26]. Outcomes of the selected RCTs also involved timed up-and-go test (TUG) [9,10,[12][13][14][15]18,19,21,22,27,28], sit-to-stand (STS) [9,10,12,14,22,28,30], activities-specific balance confidence scale (ABC) [13,14,19], fall efficacy scale (FES) / fall efficacy scale-international (FES-1) [12,15,17,18,21,29], gait parameters [12,13,17,28,30], functional reach [15,22], Berg balance scale [9,14] and one leg standing [10,18] (Table 1).…”