Physical activity, muscle function, falls and fractures A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: study protocol for a randomized controlled trial Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial. Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Does Fall Arrest Strategy Training Added to a Fall Prevention Programme Improve Balance, Strength, and Agility in Older Women? A Pilot Study. The effect of 15 weeks of exercise on balance, leg strength, and reduction in falls in 40 women aged 65 to 89 years. The effectiveness of a combined exercise intervention on physical fitness factors related to falls in community-dwelling older adults Efficacy of a short multidisciplinary falls prevention program for elderly persons with osteoporosis and a fall history: a randomized controlled trial. Effectiveness of virtual reality using video gaming technology in elderly adults with diabetes mellitus. The evaluation of a strength and balance exercise program for falls prevention in community primary care Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women Fall prevention by nursing assistants among community‐living elderly people. A randomised controlled trial Balance Confidence Improves with Resistance or Agility Training Effectiveness of a falls-and-fracture nurse coordinator to reduce falls: a randomized, controlled trial of at-risk older adults. Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65–75 year old women with osteoporosis Comparative Effects of Home- and Group-Based Exercise on Balance Confidence and Balance Ability in Older Adults: Cluster Randomized Trial Community-based exercise program reduces risk factors for falls in 65- to 75-year-old women with osteoporosis: randomized controlled trial. Balance, Muscle Strength, and Fear of Falling in Older Adults Old women with a recent fall history show improved muscle strength and function sustained for six months after finishing training Improvement in balance, strength, and flexibility after 12 weeks of Tai chi exercise in ethnic Chinese adults with cardiovascular disease risk factors. Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men. Falls Assessment Clinical Trial (FACT): design, interventions, recruitment strategies and participant characteristics A Wii Bit of Fun: A Novel Platform to Deliver Effective Balance Training to Older Adults
Study design A thematic review . Objectives To evaluate if physical activity enhances muscle strength , improves balance , and reduces the fall frequency and the fracture incidence .  Background One of the major medical problems of today is the increasing incidence of fragility fractures .  Muscle strength and fall is one of the major determinants of a fracture . If physical activity could increase muscle strength , improve balance and reduce the fall frequency , then training could be recommended as prevention for fractures . Methods The review used Medline ( Pub Med ) and the search words exercise , physical activity , muscle strength , balance , falls , fractures . R and omized controlled trials ( RCT ) were predominantly included , although this not is a systematic review . Results The evidence that physical activity modifies the risk factors for fall is compelling , although RCT with fractures as end point are lacking . Physical activity is associated with improved muscle strength , co-ordination and balance .  Physical training increases muscle strength also in octogenarians by up to 200 % , i.e. a much more pronounced effect than the corresponding increase in muscle volume or bone mass . There is also evidence that physical activity decreases the actual number of falls . Observational cohort and case-control studies imply that physical activity is associated with reduced hip fracture risk . If exercise reduces the number of vertebral fractures and other fragility fractures are less evaluated . Conclusions Physical activity in older ages can be recommended to improve muscle strength and balance , to reduce the risk to fall and fractures , although the highest level of evidence – RCT with fracture as endpoint – is lacking Background With increasing age neuromuscular deficits ( e.g. , sarcopenia ) may result in impaired physical performance and an increased risk for falls . Prominent intrinsic fall-risk factors are age-related decreases in balance and strength / power performance as well as cognitive decline . Additional studies are needed to develop specifically tailored exercise programs for older adults that can easily be implemented into clinical practice . Thus , the objective of the present trial is to assess the effects of a  fall prevention program that was developed by an interdisciplinary expert panel on measures of balance , strength / power , body composition , cognition , psychosocial well-being , and falls self-efficacy in healthy older adults . Additionally , the time-related effects of detraining are tested . Methods / Design Healthy old people ( n = 54 ) between the age of 65 to 80 years will participate in this trial . The testing protocol comprises tests for the assessment of static / dynamic steady-state balance ( i.e. , Sharpened Romberg Test , instrumented gait analysis ) , proactive balance ( i.e. , Functional Reach Test ; Timed Up and Go Test ) , reactive balance ( i.e. , perturbation test during bipedal stance ; Push and Release Test ) , strength ( i.e. , h and grip strength test ; Chair St and Test ) , and power ( i.e. , Stair Climb Power Test ; countermovement jump ) . Further , body composition will be analysed using a bioelectrical impedance analysis system . In addition , question naires for the assessment of psychosocial ( i.e. , World Health Organisation Quality of Life Assessment -Bref ) , cognitive ( i.e. , Mini Mental State Examination ) , and fall risk determinants ( i.e. , Fall Efficacy Scale – International ) will be included in the study protocol . Participants will be r and omized into two intervention groups or the control / waiting group . After baseline measures , participants in the intervention groups will conduct a 12-week balance and strength / power exercise intervention 3 times per week , with each training session lasting 30 min . ( actual training time ) . One intervention group will complete an extensive supervised training program , while the other intervention group will complete a short version ( ' 3 times 3 ’ ) that is home-based and controlled by weekly phone calls . Post-tests will be conducted right after the intervention period . Additionally , detraining effects will be measured 12 weeks after program cessation . The control group / waiting group will not participate in any specific intervention during the experimental period , but will receive the extensive supervised program after the experimental period . Discussion It is expected that particularly the supervised combination of balance and strength / power training will improve performance in variables of balance , strength / power , body composition , cognitive function , psychosocial well-being , and falls self-efficacy of older adults . In addition , information regarding fall risk assessment , dose – response-relations , detraining effects , and supervision of training will be provided . Further , training-induced health-relevant changes , such as improved performance in activities of daily living , cognitive function , and quality of life , as well as a reduced risk for falls may help to lower costs in the health care system . Finally , practitioners , therapists , and instructors will be provided with a scientifically evaluated feasible , safe , and easy-to-administer exercise program for fall prevention . Trial registration Clinical Trials.gov Identifier : OBJECTIVES To determine the long-term effects of three strength and balance exercise interventions on physical performance , fall-related psychological outcomes , and falls in older people . DESIGN A single-blinded , four-group , r and omized controlled trial . SETTING Community , Germany . PARTICIPANTS Community-dwelling adults aged 70 to 90 who had fallen in the past 6 months or reported fear of falling . INTERVENTION After baseline assessment , 280 participants were r and omly assigned to the control group ( CG ; no intervention ; n = 80 ) or one of three strength and balance exercise interventions ( the strength and balance group ( SBG ; strength and balance only ; n = 63 ) , the fitness group ( FG ; strength and balance plus endurance training ; n = 64 ) , or the multifaceted group ( MG ; strength and balance plus fall risk education ; n = 73 ) . The interventions consisted of 32 one-hour group sessions in 16 weeks . MEASUREMENTS Data on physical performance , fall-related psychological outcomes , and falls were collected for 24 months . RESULTS Mixed-effects regression analyses showed improved short- and long-term ( 12 and 24 months , respectively ) physical performance for the SBG and FG , particularly regarding mobility , balance , and walking speed ( P < .05 ) . The improvements in physical performance outcomes were most prominent in the FG . Fall-related psychological outcomes , number of falls , and injurious falls were not significantly different from in the control group . CONCLUSION Training focusing on strength , balance , and endurance can enhance physical performance for up to 24 months in community-dwelling older adults . These findings did not translate to improved fall-related psychological outcomes or reduced incidence of falls . This demonstrates the need for a different approach ( e.g. , regarding intervention dose and components ) to gain intervention benefits in the multiple domains that contribute to independence and well-being in older adults BACKGROUND recent studies have found that moderate intensity exercise is an effective intervention strategy for preventing falls  in older people . However , research is required to determine whether supervised group exercise programmes , conducted in community setting s with at-risk older people referred by their health care practitioner are also effective in improving physical functioning and preventing falls in this group . OBJECTIVES to determine whether participation in a weekly group exercise programme with ancillary home exercises over one year improves balance , muscle strength , reaction time , physical functioning , health status and prevents falls in at-risk community-dwelling older people . METHODS the sample comprised 163 people aged over 65 years identified as at risk of falling using a st and ardised assessment screen by their general practitioner or hospital-based physiotherapist , residing in South Western Sydney , Australia . Subjects were r and omised into either an exercise intervention group or a control group .  Physical performance and general health measures were assessed at baseline and repeated 6-months into the trial . Falls were measured over a 12-month follow-up period using monthly postal surveys . RESULTS at baseline both groups were well matched in their physical performance , health and activity levels . The intervention subjects attended a median of 23 exercise classes over the year , and most undertook the home exercise sessions at least weekly . At retest , the exercise group performed significantly better than the controls in three of six balance measures ; postural sway on the floor with eyes open and eyes closed and coordinated stability . The groups did not differ at retest in measures of strength , reaction time and walking speed or on Short-Form 36 , Physical Activity Scale for the Elderly or fear of falling scales . Within the 12-month trial period , the rate of falls in the intervention group was 40 % lower than that of the control group ( IRR=0.60 , 95 % CI 0.36 - 0.99 ) . CONCLUSIONS these findings indicate that participation in a weekly group exercise programme with ancillary home exercises can improve balance and reduce the rate of falling in at-risk community dwelling older people Purpose : The purpose of this study was to determine the effect of a unique exercise programme ( Fall Arrest Strategy Training , or FAST ) on upper body strength , range of motion ( ROM ) , and fall risk  in older women .  FAST was design ed to improve upper body capacity to prevent injury when a fall can not be avoided . Method : A quasi-r and omized site design included 71 older women ( aged 67 - 95 y , mean age 83 years ) , who participated either in a st and ard fall prevention programme ( Staying on Your Feet , or SOYF ;  n=29  ) or in SOYF combined with FAST ( n=42 ) . The women were measured three times-at baseline , after the 12-week intervention , and again 12 weeks later-for upper body strength , ROM , and fall risk factors ( fall risk question naire , balance , mobility , and leg strength ) . Results : No significant differences were found in age , physical activity , or cognitive or functional status between the SOYF-st and ard and the SOYF-FAST groups . Both groups improved their fall risk status after the intervention , with no significant differences between them ; however , the SOYF-FAST group showed greater improvements in upper extremity strength and ROM ( p=0.007 ) . Conclusion : FAST can feasibly be integrated into fall prevention programming , with additional gains in upper body strength and ROM in older women OBJECTIVE Risk of falling increases as people age , and decreased leg strength and poor balance have been implicated as contributors . Our aims were to:1 ) assess the efficacy of a fall-prevention exercise program on balance and leg strength in women aged 65 to 89 years and 2 ) conduct a 1-year follow-up to determine the effect of exercise on fall rates . METHODS Forty women were classified by falling history and fear of falling and assigned to exercise and control groups using stratified r and omization . We used the Berg Balance Scale , Get-up and Go , Functional Reach , and Wall-Sit Tests to evaluate changes in balance and leg strength before and after a supervised 15-week exercise program ( 31-hr sessions/week ) . We conducted 1-year follow-up telephone interviews and compared the number of falls reported by exercise and control groups . The study used a 2 x 2 ( exercise/control by pretest/post-test ) factorial design with the testing times being a repeated factor , so we used analysis of variance ( ANOVA ) to evaluate differences between the 2 groups across testing times . Power analysis computed a priori with STPLAN software ( Version 4.2 ) showed that a sample size of 40 was necessary to determine statistical differences in balance and leg strength . RESULTS Exercise subjects showed significant improvement on 5 of 14 items ( 5.2 % , p < or = 05 to 34.4 % , p < or = .01 ) in the Berg Balance Scale and on the total score ( 6.8 % , p < or = .05 ) . Leg strength increased significantly ( p < or = .05 ) on post-test as measured by the Wall-Sit Test . Control subjects reported 6 falls and exercise subjects no falls during the follow-up year , but this difference was not significant using Fischer 's exact test ( p=.106 ) . CONCLUSION The exercise program result ed in increased balance and leg strength , but did not result in a significant difference in falls during the follow-up period . Further research with a larger and possibly older sample is needed to more adequately investigate this question . Health care providers who work with older women should provide exercise programs in which balance and leg strength are emphasized This study aim ed to evaluate the effectiveness of an innovative exercise program on muscle strength , balance , and gait kinematics in elderly community-dwellers . The exercise program included strength and balance training and the 8-form Tai Chi Chuan . The measurements were carried out at baseline and 12 weeks , and consisted of four physical performance tests , joint isokinetic strength tests , and three-dimensional gait analysis . Fifty-six community-dwelling older adults aged 60–80 years old were r and omly assigned to an intervention or control group . After 12 weeks , the intervention group showed a 17.6 % improvement in the timed up and go test , accompanied by a 54.7 % increase in the 30-second chair st and test score . Significant increases in the score of star excursion balance tests , and the strength of the extensor and flexor muscles at knee and ankle joints were also observed . In addition , the intervention group walked at a faster speed with a longer step length , shorter support phase , and a greater sagittal plane range of motion at the hip and ankle joints . No statistical improvements were seen in the control group . This study provided an effective , evidence -based falls prevention program that can be implemented in community setting s to improve physical fitness and reduce fall risks among community-dwelling older adults .  The star excursion balance test could be a sensitive measure of physical performance for fall risk assessment in older people OBJECTIVE To evaluate the efficacy of the Nijmegen Falls Prevention Program ( NFPP ) for persons with osteoporosis and a fall history in a r and omized controlled trial . Persons with osteoporosis are at risk for fall-related fractures because of decreased bone strength . A decrease in the number of falls therefore is expected to be particularly beneficial for these persons . DESIGN R and omized controlled trial . SETTING Hospital . PARTICIPANTS Persons with osteoporosis and a fall history ( N=96 ; mean ± SD age , 71.0±4.7y ; 90 women ) . INTERVENTION After baseline assessment , participants were r and omly assigned to the exercise ( n=50 ; participated in the NFPP for persons with osteoporosis [ 5.5wk ] ) or control group ( n=46 ; usual care ) . MAIN OUTCOME MEASURES Primary outcome measure was fall rate , measured by using monthly fall calendars for 1 year . Secondary outcomes were balance confidence ( Activity-specific Balance Confidence Scale ) , quality of life ( QOL ; Quality of Life Question naire of the European Foundation for Osteoporosis ) , and activity level ( LASA Physical Activity Question naire , pedometer ) , assessed posttreatment subsequent to the program and after 1 year of follow-up . RESULTS The fall rate in the exercise group was 39 % lower than for the control group ( .72 vs 1.18 falls/person-year ; risk ratio , .61 ; 95 % confidence interval , .40-.94 ) . Balance confidence in the exercise group increased by 13.9 % ( P=.001 ) . No group differences were observed in QOL and activity levels . CONCLUSION The NFPP for persons with osteoporosis was effective in decreasing the number of falls and improving balance confidence . Therefore , it is a valuable new tool to improve mobility and independence of persons with osteoporosis BACKGROUND Diabetes in elderly adults is associated with an increased risk of  fall . The aim of study was to determine whether a virtual reality exercise ( VRE ) program would improve balance , strength , gait , and falls efficacy in elderly adults with diabetes . SUBJECTS AND METHODS Fifty-five subjects with diabetes mellitus over 65 years of age were r and omly assigned to a VRE group ( VREG ) ( n=27 ) and a control group ( CG ) ( n=28 ) . The VREG received the VRE program and diabetes education , whereas the CG received only the diabetes education . The VRE program used video gaming ( PlayStation ( ® ) 2 ; Sony , Tokyo , Japan ) and was conducted for 50 min twice a week for 10 weeks . Balance , muscle strength , gait , and falls efficacy were measured at baseline and after intervention . Measurements were taken using a clinical tests ( the one-leg-st and ing test , the Berg Balance Scale , the functional reach test , the timed up- and -go test , and the sit-to-st and test ) , and gait analysis . A self-administered question naire was used to measure falls efficacy . RESULTS After training , the VREG showed significantly improved balance , decreased sit-to-st and times , and increased gait speed , cadence , and falls efficacy . CONCLUSIONS The VRE program was to maximize the effects of exercise by triggering players was to be fully immersed into the games and enhanced major influential factors on the falls of subject . This study suggests VRE programs are feasible and effective for reduced the risk of falls in elderly adults with type 2 diabetes ABSTRACT We aim ed to evaluate a strength and balance program delivered in the community . There is little evidence of implementation of evidence -based exercise in practice . The program was a step-down model , design ed to encourage long-term exercise in community classes . The program consisted of a fully funded referral only evidence -based 12-week strength and balance ( Community Otago ) class  , followed by an evidence -based continuous open-access community strength and balance class ( Active Always ) . The program was offered to patients : 1 ) after formal falls rehabilitation ( falls and fracture service ) ; 2 ) after falls rehabilitation in intermediate care ; and 3 ) referred by a GP who were not eligible for rehabilitation ( preventative measure ) . Outcome evaluation used descriptive statistics to report changes in function , confidence in balance , hospital attendance/admission for falls/fractures and transition to community classes . Focus groups established participant experience/satisfaction . Seventy-nine participants were included , aged 56–96 , and 53 ( 67 % ) were women . About 63.3 % of patients transitioned to Active Always classes , demonstrating improvement in maintenance . Follow-up scores from baseline attendance at falls and fracture service to 12-weeks follow-up ( 24 weeks ) in Community Otago showed the majority of patients improved their function ( Timed up and Go ) , confidence ( ConfBal ) and lowered their falls risk ( Tinetti ) . Follow-up of participants from Community Otago baseline to the end of 12-weeks showed improvement in function and confidence , but only a third of participants lowered their falls risk . Focus groups data suggest that continuity of delivery , the role of the instructor , health professional , and social and physical outcomes were essential for maintenance . A supportive environment can be created which encourages older adults ’ continued participation in group-based strength and balance , helping the delivery of evidence -based practice Abstract Objective : To assess the effectiveness of a home exercise programme of strength and balance retraining exercises in reducing  falls and injuries in elderly women . Design : R and omised controlled trial of an individually tailored programme of physical therapy in the home ( exercise group , n=116 ) compared with the usual care and an equal number of social visits ( control group , n=117 ) . Setting : 17 general practice s in Dunedin , New Zeal and . Subjects : Women aged 80 years and older living in the community and registered with a general practice in Dunedin . Main outcome measures : Number of falls and injuries related to falls and time between falls during one year of follow up ; changes in muscle strength and balance measures after six months . Results : After one year there were 152 falls in the control group and 88 falls in the exercise group . The mean ( SD ) rate of falls was lower in the exercise than the control group ( 0.87 ( 1.29 ) v 1.34 ( 1.93 ) falls per year respectively ; difference 0.47 ; 95 % confidence interval 0.04 to 0.90 ) . The relative hazard for the first four falls in the exercise group compared with the control group was 0.68 ( 0.52 to 0.90 ) . The relative hazard for a first fall with injury in the exercise group compared with the control group was 0.61 ( 0.39 to 0.97 ) . After six months , balance had improved in the exercise group ( difference between groups in change in balance score 0.43 ( 0.21 to 0.65 ) . Conclusions : An individual programme of strength and balance retraining exercises improved physical function and was effective in reducing  falls and injuries in women 80 years and older . Key messages Modifiable risk factors for falls in elderly people have been well defined ; they include loss of muscle strength and impaired balance A programme to improve strength and balance in women aged 80 years and older can be set up safely with four home visits from a physiotherapist This programme reduced falls and moderate injuries appreciably over the subsequent year in Dunedin , New Zeal and The benefit was most noticeable in elderly people who fell Falls among elderly are a major public health issue in Sweden . The aim was to determine whether nursing assistants can prevent falls by supervising community-living elderly individuals with a history of falling in performing individually design ed home exercise programmes . A r and omised controlled trial was performed in Sweden , in eight municipalities in the county of Örebro , during 2007 - 2009 . Community-living persons 65 years or older having experienced at least one fall during the last 12 months were included . The intervention group consisted of 76 participants , and there were 72 in the control group . The interventions were free of charge and were shared between a physiotherapist and a nursing assistant . The former design ed a programme aim ing to improve balance , leg strength and walking ability . The nursing assistant supervised the performance of activities during eight home visits during a 5-month intervention period . The measures and instruments used were health-related quality of life ( SF-36 ) , activity of daily living ( ADL-staircase ) , balance , ( Falls Efficacy Scale , and Berg Balance Scale ) , walking ability ( Timed Up and Go and the 3-metre walking test ) , leg strength , ( chair st and test ) . All participants were asked to keep a structured calendar of their physical exercise , walks and occurrence of falls during their 12-month study period . Hospital healthcare consumption data were collected . Although the 5-month intervention did not significantly decrease the risk for days with falls , RR 1.10 ( 95 % CI 0.58 , 2.07 ) , p = 0.77 , significant changes in favour of the intervention group were noted for balance ( p = 0.03 ) , ADL ( p = 0.035 ) , bodily pain ( p = 0.003 ) and reported health transition over time ( p = 0.008 ) as well as less hospital care due to fractures ( p = 0.025 ) . Additional studies with more participants are needed to establish whether or not falls can be significantly prevented with this model which is workable in home-based fall prevention Background : While the fear of falling is a common psychological consequence of falling , older adults who have not fallen also frequently report this fear . Fear of falling can lead to activity restriction that is self-imposed rather than due to actual physical impairments . Evidence suggests that exercise can significantly improve balance confidence , as measured by falls-related self-efficacy scales . However , there are no prospect i ve reports that correlate change in balance confidence with changes in fall risk and physical abilities as induced by participating in a group-based exercise program . Objective : The primary purpose of this prospect i ve study was to examine the relationship between the change in balance confidence and the changes in fall risk and physical abilities in older women with confirmed low bone mass after 13 weeks of exercise participation . The secondary purpose of this study was to examine the relationship between the change in balance confidence and the change in physical activity level . Methods : The sample comprised 98 women aged 75–85 years with low bone mass . Participants were r and omly assigned to one of three groups : resistance training ( n = 32 ) , agility training ( n = 34 ) , and stretching ( sham ) exercises ( n = 32 ) . The 50-min exercise classes for each study arm were held twice weekly at a local YMCA community centre . Results : Both resistance training and agility training significantly improved balance confidence by 6 % from baseline after 13 weeks . However , the change in balance confidence was only weakly correlated with improved general physical function and not significantly correlated with the changes in fall risk score , postural stability , gait speed , or physical activity level . As well , we observed balance confidence enhancement in the presence of increased fall risk or deterioration in physical abilities . Conclusions : Two different types of exercise training  improved balance confidence in older women with low bone mass . This change in balance confidence was significantly correlated with change in general physical function . Because of the observation of discordance between balance confidence change and changes in fall risk and physical abilities , those who design group-based exercise programs for community-dwelling older adults may wish to consider including an education component on factors that influence fear of falling . Objective changes in fall risk factors can not be assumed to mirror change in fear of falling and physical abilities in older adults in the short-term OBJECTIVES To assess the effectiveness of a community-based falls- and -fracture nurse coordinator and multifactorial intervention in reducing  falls in older people . DESIGN R and omized , controlled trial . SETTING Screening for previous falls in family practice followed by community-based intervention . PARTICIPANTS Three hundred twelve community-living people aged 75 and older who had fallen in the previous year . INTERVENTION Home-based nurse assessment of falls- and -fracture risk factors and home hazards , referral to appropriate community interventions , and strength and balance exercise program . Control group received usual care and social visits . MEASUREMENTS Primary outcome was rate of falls over 12 months . Secondary outcomes were muscle strength and balance , falls efficacy , activities of daily living , self-reported physical activity level , and quality of life ( Medical Outcomes Study 36-item Short Form Question naire ) . RESULTS Of the 3,434 older adults screened for falls , 312 ( 9 % ) from 19 family practice s were enrolled and r and omized . The average age was 81+/-5 , and 69 % ( 215/312 ) were women . The incidence rate ratio for falls for the intervention group compared with the control group was 0.96 ( 95 % confidence interval=0.70 - 1.34 ) . There were no significant differences in secondary outcomes between the two groups . CONCLUSION This nurse-led intervention was not effective in reducing  falls in older people who had fallen previously . Implementation and adherence to the fall-prevention measures was dependent on referral to other health professionals working in their usual clinical practice . This may have limited the effectiveness of the interventions Objective —To test the efficacy of a community based 10 week exercise intervention to reduce fall risk factors in women with osteoporosis . Methods —Static balance was measured by computerised dynamic posturography ( Equitest ) , dynamic balance by timed figure of eight run , and knee extension strength by dynamometry . Subjects were r and omised to exercise intervention ( twice weekly Osteofit classes for 10 weeks ) or control groups . Results —The outcome in 79 participants ( 39 exercise , 40 control ) who were available for measurement 10 weeks after baseline measurement is reported . After confounding factors had been controlled for , the exercise group did not make significant gains compared with their control counterparts , although there were consistent trends toward greater improvement in all three primary outcome measures . Relative to the change in control subjects , the exercise group improved by 2.3 % in static balance , 1.9 % in dynamic balance , and 13.9 % in knee extension strength . Conclusions —A 10 week community based physical activity intervention did not significantly reduce fall risk factors in women with osteoporosis . However , trends toward improvement in key independent risk factors for falling suggest that a study with greater power may show that these variables can be improved to a level that reaches statistical significance Background : Exercise can modify fall risk factors such as balance and mobility impairments . However , can exercise improve balance confidence ? In one strength-training study , research ers reported that a change in balance confidence was not uniformly associated with changes in objective measures of fall risk or physical performance . In fact , some participants ’ balance confidence decreased while their physical abilities increased and vice versa . Objective : The aim of this study was to compare changes in balance confidence and balance ability result ing from three exercise interventions ( home-based resistance and balance training ( RBT ) , group-based RBT and group-based walking ) , and the concomitant relationships between change in balance confidence and change in ability . It was hypothesized that participants in the group-based RBT program would improve their balance confidence and performance more than those in the home-based or walking programs . Methods : In a cluster-r and omized design , nine retirement villages were assigned to one of the three exercise groups . One hundred and sixty-seven independent-living residents ( aged 65–96 years ) participated . Each group exercised twice weekly for 20 weeks . Objective balance ability was measured using timed t and em and one-leg st and s ( static balance ) , and the 8-foot ( 2.5 m ) up- and -go test ( dynamic balance/agility ) . Balance confidence was assessed using the self-report Activities-specific Balance Confidence ( ABC ) Scale . Results : Participants in the group-based RBT program improved their static balance scores more than those in the home-based program ; however , improvements in balance confidence were greater among participants in the home-based program ( all p < 0.05 ) . Discordance between static balance and balance confidence change scores was evident for up to 20 % of participants . Change in ABC score was weakly correlated with a change in the up- and -go test score . Conclusions : Exercise training can improve balance confidence and balance ability in retirement village residents . However , as has been shown previously , this study found that exercise interventions may improve balance ability without associated increases in balance confidence and vice versa . Whether the ABC score and balance ability can be enhanced by providing a tailored intervention to improve balance confidence in combination with a RBT program requires further study BACKGROUND Exercise programs improve balance , strength and agility in elderly people and thus may prevent falls . However , specific exercise programs that might be widely used in the community and that might be " prescribed " by physicians , especially for patients with osteoporosis , have not been evaluated . We conducted a r and omized controlled trial of such a program design ed specifically for women with osteoporosis . METHODS We identified women 65 to 75 years of age in whom osteoporosis had been diagnosed by dual-energy X-ray absorptiometry in our hospital between 1996 and 2000 and who were not engaged in regular weekly programs of moderate or hard exercise .  Women who agreed to participate were r and omly assigned to participate in a twice-weekly exercise class or to not participate in the class . We measured baseline data and , 20 weeks later , changes in static balance ( by dynamic posturography ) , dynamic balance ( by a timed figure-eight run ) and knee extension strength ( by dynamometry ) . RESULTS Of 93 women who began the trial , 80 completed it . Before adjustment for covariates , the intervention group tended to have greater , although nonsignificant , improvements in static balance ( mean difference 4.8 % , 95 % confidence interval [ CI ] -1.3 % to 11.0 % ) , dynamic balance ( mean difference 3.3 % , 95 % CI -1.7 % to 8.4 % ) and knee extension strength ( mean difference 7.8 % , 95 % CI -5.4 % to 21.0 % ) . Mean crude changes in the static balance score were -0.85 ( 95 % CI -2.91 to 1.21 ) for the control group and 1.40 ( 95 % CI -0.66 to 3.46 ) for the intervention group . Mean crude changes in figure-eight velocity ( dynamic balance ) were 0.08 ( 95 % CI 0.02 to 0.14 ) m/s for the control group and 0.14 ( 95 % CI 0.08 to 0.20 ) m/s for the intervention group . For knee extension strength , mean changes were -0.58 ( 95 % CI -3.02 to 1.81 ) kg/m for the control group and 1.03 ( 95 % CI -1.31 to 3.34 ) kg/m for the intervention group . After adjustment for age , physical activity and years of estrogen use , the improvement in dynamic balance was 4.9 % greater for the intervention group than for the control group ( p = 0.044 ) . After adjustment for physical activity , cognitive status and number of fractures ever , the improvement in knee extension strength was 12.8 % greater for the intervention group than for the control group ( p = 0.047 ) . The intervention group also had a 6.3 % greater improvement in static balance after adjustment for rheumatoid arthritis and osteoarthritis , but this difference was not significant ( p = 0.06 ) . INTERPRETATION Relative to controls , participants in the exercise program experienced improvements in dynamic balance and strength , both important determinants of risk for falls , particularly in older women with osteoporosis This study examined balance ability , lower-extremity muscle strength , fear of falling and their inter-relationships in 40 community-dwelling older adults ( > 65 years ) . Subjects who self-identified either as being fearful offalling or not ( no concern ) were screened to exclude those with known risk factors for falling .  Limits of stability , maximal isometric strength , gait speed , and fear of falling were contrasted between groups ( 27 control subjects , 13 fearful subjects ) . Those fearful of falling demonstrated smaller center of pressure ( COP ) excursions in anterior , left , and right directions ( p < .0001 ) and used a smaller percentage of their base of support during maximal weight shifting in combined anterior-posterior and right-left directions ( p < .001 ) compared to the control group . Strength did not differ between groups , but was associated with the ability to shift the COP in the anterior-posterior direction ( p < .05 ) . Fear of falling also related to weight shifting ability ( p < .017 ) . Seniors fearful of falling demonstrated limitations in balance ability and balance confidence that could not be explained by muscle weakness Background and aims : Restricted physical activity as a consequence of chronic disease or injury is a predictor of functional decline . The aim of this study was to test the hypothesis that a 6-month multidimensional training program would have sustained beneficial effects upon the physiological , functional and psychological condition of old women with a recent history of falls . Methods : Participants were 65 home-dwelling women ( 70–90 years ) identified from hospital records as having had an accidental fall . After assessment of muscle strength , balance performance , walking speed , balance confidence , and physical activity level , the participants were r and omly assigned to a control group ( n=33 ) or a training group ( n=32 ) , who performed a multidimensional training program including moderate resistance exercise and balance exercise twice weekly for 6 months . Measurements were repeated after 6 and 12 months . Results : Six months of multidimensional training result ed in significant improvements and between-group differences in isometric knee extension strength ( p<0.05 ) , trunk extension/flexion strength ( p<0.001 ) , habitual/maximal walking speed ( p<0.001 ) and balance performance ( p<0.001 ) . At follow-up , 6 months after intervention , these improvements were preserved in the training group and there was also a significant between-group difference with regard to balance confidence . No between-group differences were found concerning number of falls or physical activity level during the one-year study period . Conclusions : A multi-dimensional training program produced significant improvements in physiological and functional risk factors for falls and disability in women aged 70–90 years with a recent history of falls CONTEXT Declines in physical performance are associated with aging and chronic health conditions . Appropriate physical activity interventions can reverse functional limitations and help maintain independent living . Tai chi is a popular form of exercise in China among older adults . OBJECTIVE To determine whether tai chi improves balance , muscular strength and endurance , and flexibility over time . DESIGN Repeated measures intervention ; data collected at baseline , 6 weeks , and 12 weeks . SETTING Community center in the San Francisco Bay Area . PARTICIPANTS Thirty-nine Chinese adults with at least 1 cardiovascular disease ( CVD ) risk factor . INTERVENTIONS A 60-minute tai chi exercise class 3 times per week for 12 weeks . MAIN OUTCOME MEASURES A battery of physical fitness measures specifically developed for older adults assessed balance , muscular strength and endurance , and flexibility . RESULTS Subjects were 65.7 ( + /- 8.3 ) years old , Cantonese-speaking ( 97 % ) immigrants , with 12 years or less of formal education ( 87 % ) and very low income ( 67 % ) . Reported CVD risk factors were hypertension ( 92 % ) , hypercholesteremia ( 49 % ) , diabetes ( 21 % ) , and 1 current smoker . Subjects were below the 50th percentile of fitness at baseline compared to age- and gender-specific normative US data . Statistically significant improvements were observed in all balance , muscular strength and endurance , and flexibility measures after 6 weeks , and they increased further after 12 weeks . CONCLUSIONS Tai chi is a potent intervention that improved balance , upper- and lower-body muscular strength and endurance , and upper- and lower-body flexibility in these older Chinese adults . These findings provide important information for future community-based tai chi exercise programs and support current public health initiatives to reduce disability from chronic health conditions and enhance physical function in older adults OBJECTIVES This r and omized controlled trial studied the effects of a low- to moderate-intensity group exercise program on strength , endurance , mobility , and fall rates in fall-prone elderly men with chronic impairments . METHODS Fifty-nine community-living men ( mean age = 74 years ) with specific fall risk factors ( i.e. , leg weakness , impaired gait or balance , previous falls ) were r and omly assigned to a control group ( n = 28 ) or to a 12-week group exercise program ( n = 31 ) . Exercise sessions ( 90 minutes , three times per week ) focused on increasing strength and endurance and improving mobility and balance . Outcome measures included isokinetic strength and endurance , five physical performance measures , and self-reported physical functioning , health perception , activity level , and falls . RESULTS Exercisers showed significant improvement in measures of endurance and gait . Isokinetic endurance increased 21 % for right knee flexion and 26 % for extension . Exercisers had a 10 % increase ( p < .05 ) in distance walked in six minutes , and improved ( p < .05 ) scores on an observational gait scale . Isokinetic strength improved only for right knee flexion . Exercise achieved no significant effect on hip or ankle strength , balance , self-reported physical functioning , or number of falls . Activity level increased within the exercise group . When fall rates were adjusted for activity level , the exercisers had a lower 3-month fall rate than controls ( 6 falls/1000 hours of activity vs 16.2 falls/1000 hours , p < .05 ) . DISCUSSION These findings suggest that exercise can improve endurance , strength , gait , and function in chronically impaired , fall-prone elderly persons . In addition , increased physical activity was associated with reduced fall rates when adjusted for level of activity Background Guidelines recommend multifactorial intervention programmes to prevent falls in older adults but there are few r and omised controlled trials in a real life health care setting . We describe the rationale , intervention , study design , recruitment strategies and baseline characteristics of participants in a r and omised controlled trial of a multifactorial falls prevention programme in primary health care . Methods Participants are patients from 19 primary care practice s in Hutt Valley , New Zeal and aged 75 years and over who have fallen in the past year and live independently . Two recruitment strategies were used – waiting room screening and practice mail-out . Intervention participants receive a community based nurse assessment of falls and fracture risk factors , home hazards , referral to appropriate community interventions , and strength and balance exercise programme . Control participants receive usual care and social visits . Outcome measures include number of falls and injuries over 12 months , balance , strength , falls efficacy , activities of daily living , quality of life , and physical activity levels . Results 312 participants were recruited ( 69 % women ) . Of those who had fallen , 58 % of people screened in the practice waiting rooms and 40 % when screened by practice letter were willing to participate . Characteristics of participants recruited using the two methods are similar ( p > 0.05 ) . Mean age of all participants was 81 years ( SD 5 ) . On average participants have 7 medical conditions , take 5.5 medications ( 29 % on psychotropics ) with a median of 2 falls ( interquartile range 1 , 3 ) in the previous year . Conclusion The two recruitment strategies and the community based intervention delivery were feasible and successful , identifying a high risk group with multiple falls . Recruitment in the waiting room gave higher response rates but was less efficient than practice mail-out . Testing the effectiveness of an evidence based intervention in a ' real life ' setting is important . Trial registration Australian Clinical Trials Register ID 12605000054617 Abstract Background : Falls and fall-related injuries are symptomatic of an aging population . This study aim ed to design , develop , and deliver a novel method of balance training , using an interactive game-based system to promote engagement , with the inclusion of older adults at both high and low risk of experiencing a fall . Study Design : Eighty-two older adults ( 65 years of age and older ) were recruited from sheltered accommodation and local activity groups . Forty volunteers were r and omly selected and received 5 weeks of balance game training ( 5 males , 35 females ; mean , 77.18 ± 6.59 years ) , whereas the remaining control participants recorded levels of physical activity ( 20 males , 22 females ; mean , 76.62 ± 7.28 years ) . The effect of balance game training was measured on levels of functional balance and balance confidence in individuals with and without quantifiable balance impairments . Results : Balance game training had a significant effect on levels of functional balance and balance confidence ( P < 0.05 ) . This was further demonstrated in participants who were deemed at high risk of falls . The overall pattern of results suggests the training program is effective and suitable for individuals at all levels of ability and may therefore play a role in reducing the risk of falls . Conclusions : Commercial hardware can be modified to deliver engaging methods of effective balance assessment and training for the older population
This review found that muscle strength , balance , and endurance can be improved by physical activity in people aged 40 - 65 years .
There were bigger effects on muscle strength from programs that used resistance exercises , indicating the need to include a resistance training component if strength enhancement is the goal
QUESTION Can physical activity  in adults aged 40 - 65 years enhance strength and balance and prevent falls ?