Effectiveness of exercise interventions on physical function in community-dwelling frail older people: an umbrella review of systematic reviews The Seattle FICSIT/MoveIt study: the effect of exercise on gait and balance in older adults. A community-based group exercise program for persons with chronic stroke. Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenarians Effect of high-intensity strength-training on functional measures of balance ability in balance-impaired older adults. 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 The effectiveness of a combined exercise intervention on physical fitness factors related to falls in community-dwelling older adults Multifactorial Intervention with Balance Training as a Core Component Among Fall‐prone Older Adults Effects of a group-based exercise program on functional abilities in frail older women after hospital discharge The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. Effects of a targeted multimodal exercise program incorporating high-speed power training on falls and fracture risk factors in older adults: a community-based randomized controlled trial. Whole body vibration for older persons: an open randomized, multicentre, parallel, clinical trial Physical activity, muscle function, falls and fractures Balance Confidence Improves with Resistance or Agility Training The effect of a training program combined with augmented afferent feedback from the feet using shoe insoles on gait performance and muscle power in older adults: a randomised controlled trial The effect of supervised Tai Chi intervention compared to a physiotherapy program on fall-related clinical outcomes: a randomized clinical trial Low-intensity exercise as a modifier of physical frailty in older adults. Exercise training is beneficial for Alzheimer's patients. Tablet-Based Strength-Balance Training to Motivate and Improve Adherence to Exercise in Independently Living Older People: Part 2 of a Phase II Preclinical Exploratory Trial Tablet-Based Strength-Balance Training to Motivate and Improve Adherence to Exercise in Independently Living Older People: A Phase II Preclinical Exploratory Trial Effects of a fall prevention program including exercise on mobility and falls in frail older people living in residential care facilities A cognitive-motor intervention using a dance video game to enhance foot placement accuracy and gait under dual task conditions in older adults: a randomized controlled trial Comparative effects of horse exercise versus traditional exercise programs on gait, muscle strength, and body balance in healthy older adults. A HOME-BASED MULTIDIMENSIONAL EXERCISE PROGRAM REDUCED PHYSICAL IMPAIRMENT AND FEAR OF FALLING Effects of combined exercise on gait variability in community-dwelling older adults Supervised Balance Training and Wii Fit-Based Exercises Lower Falls Risk in Older Adults With Type 2 Diabetes. The effect of resistance training on muscle strength and physical function in older, postmenopausal breast cancer survivors: a randomized controlled trial
Objectives : This umbrella review aim ed to determine the effectiveness of exercise interventions , alone or in combination with other interventions , in improving physical function in community-dwelling older people identified as pre-frail or frail . Introduction : Exercise is said to have a positive impact on muscle mass and strength which improves physical function and hence is beneficial for the treatment of frailty . Several systematic review s discuss the effects of exercise interventions on physical function parameters , such as strength , mobility , gait , balance and physical performance , and indicate that multi-component exercise , including resistance , aerobic , balance and flexibility training , appears to be the best way in which to improve physical function parameters in frail older people . However , there is still uncertainty as to which exercise characteristics ( type , frequency , intensity , duration and combinations ) are the most effective and sustainable over the long-term . Inclusion criteria : Participants were adults , 60 years or over , living in the community and identified as pre-frail or frail . Quantitative systematic review s , with or without meta- analysis that examined the effectiveness of exercise interventions of any form , duration , frequency and intensity , alone or in combination with other interventions design ed to alter physical function parameters in frail older people , were considered . The quantitative outcome measures were physical function , including muscular strength , gait , balance , mobility and physical performance . Methods : An iterative search strategy for ten bibliometric data bases and gray literature was developed . Critical appraisal of seven systematic review s was conducted independently by two review ers using a st and ard Joanna Briggs Institute tool . Data was extracted independently by two review ers using a st and ard Joanna Briggs Institute data extraction tool and summarized using a narrative synthesis approach . Results : Seven systematic review s were included in this umbrella review , with a total of 58 relevant r and omized controlled trials and 6927 participants . Five systematic review s examined the effects of exercise only , while two systematic review s reported on exercise in combination with a nutritional approach , including protein supplementations , as well as fruit and dairy products . The average  exercise frequency was 2–3 times per week ( mean 3.0 ± 1.5 times per week ; range 1–7 weekly ) for 10–90 minutes per session ( mean of 52.0 ± 16.5 mins ) and a total duration of 5–72 weeks with the majority lasting a minimum of 2.5 months ( mean 22.7 ± 17.7 weeks ) . Multi-component exercise interventions can currently be recommended for pre-frail and frail older adults to improve muscular strength , gait speed , balance and physical performance , including resistance , aerobic , balance and flexibility tasks . Resistance training alone also appeared to be beneficial , in particular for improving muscular strength , gait speed and physical performance . Other types of exercise were not sufficiently studied and their effectiveness is yet to be established . Conclusions : Interventions for pre-frail and frail older adults should include multi-component exercises , including in particular resistance training , as well as aerobic , balance and flexibility tasks . Future research should adopt a consistent definition of frailty and investigate the effects of other types of exercise alone or in combination with nutritional interventions so that more specific recommendations can be made While exercise is generally recommended for older adults , the specific role of exercise in preventing falls and frail health is unclear . The Seattle FICSIT/MoveIt study is a population -based , r and omized , controlled trial comparing the effects of three 6-month exercise interventions ( endurance training , strength training , or combined endurance and strength training ) , and three 3-month endurance training interventions ( stationary cycle , walking , or aerobic movement ) . Primary study outcomes are aerobic capacity , strength , gait , balance , and physical functional status . The study enrolls adults age 68 - 85 who have leg weakness and impaired gait . It differs from most previous community-based exercise studies in several respects : recruitment of subjects from a defined population ; eligibility criteria based upon physiologic and functional status deficits ; r and om assignment to exercise groups ; assessment of both physiologic and functional status outcomes ; follow-up beyond the completion of supervised exercise ; and a large sample size ( Total N = 180 ) PURPOSE The purpose of this study was to evaluate the physical and psychosocial effects of an 8-wk community-based functional exercise program in a group of individuals with chronic stroke . METHODS Twenty-five subjects ( mean age 63 yr ) participated in a repeated measures design that evaluated the subjects with two baseline assessment s 1 month apart , one postintervention assessment , and one retention assessment 1 month postintervention . Physical outcome measures assessed were the Berg Balance Test , 12-Minute Walk Test distance , gait speed , and stair climbing speed . Psychosocial measures assessed were the Reintegration to Normal Living Index ( RNL ) and Canadian Occupational Performance Measure ( COPM ) . The 8-wk training consisted of a 60-min , 3 x wk-1 group program that focused on balance , mobility , functional strength , and functional capacity . The program was design ed to be accessible by reducing the need for costly one-on-one supervision , specialized setting s , and expensive equipment . RESULTS Improvements from the exercise program were found for all physical measures and these effects were retained 1-month postintervention . Subjects with lower function improved the most relative to their initial physical status . Significant effects were found for the COPM , but not the RNL Index ; however , subjects with lower RNL improved the most relative to their initial RNL Score . CONCLUSION A short-term community-based exercise program can improve and retain mobility , functional capacity , and balance and result in a demonstrable impact upon the performance of activities and abilities that were considered meaningful to the subjects . Implementation of such community-based programs has potential for improving activity tolerance and reducing the risk for secondary complications common to stroke ( e.g. , falls result ing in fractures and cardiac events ) This r and omized controlled trial examined the effects of multicomponent training on muscle power output , muscle mass , and muscle tissue attenuation ; the risk of falls ; and functional outcomes in frail nonagenarians . Twenty-four elderly ( 91.9 ± 4.1 years old ) were r and omized into intervention or control group . The intervention group performed a twice-weekly , 12-week multicomponent exercise program composed of muscle power training ( 8–10 repetitions , 40–60 % of the one-repetition maximum ) combined with balance and gait retraining .  Strength and power tests were performed on the upper and lower limbs . Gait velocity was assessed using the 5-m habitual gait and the time-up- and -go ( TUG ) tests with and without dual-task performance . Balance was assessed using the FICSIT-4 tests . The ability to rise from a chair test was assessed , and data on the incidence and risk of falls were assessed using question naires . Functional status was assessed before measurements with the Barthel Index . Midthigh lower extremity muscle mass and muscle fat infiltration were assessed using computed tomography . The intervention group showed significantly improved TUG with single and dual tasks , rise from a chair and balance performance ( P < 0.01 ) , and a reduced incidence of falls . In addition , the intervention group showed enhanced muscle power and strength ( P < 0.01 ) . Moreover , there were significant increases in the total and high-density muscle cross-sectional area in the intervention group . The control group significantly reduced strength and functional outcomes . Routine multicomponent exercise intervention should be prescribed to nonagenarians because overall physical outcomes are improved in this population OBJECTIVE The aim of this study was to evaluate the effect of a 10-week , high-intensity strength-training program targeting key lower extremity muscles for the purpose of improving postural control in balance-impaired older adults . METHODS A quasi-experimental , delayed entry controlled design was used to evaluate balance ability in balance-impaired older adults after participation in 10 weeks of high-intensity strength training focused on the quadriceps , hamstrings , tibialis anterior , and gastrocnemius muscles . Participants were evaluated using vali date d clinical measures of functional balance ability : the Berg Balance Scale , the Timed Up and Go , and the Activities-Specific Balance Confidence Scale . RESULTS After strength training , the exercisers were significantly stronger than the control subjects . They improved significantly on the Berg Balance Scale ( P = .030 ) from a mean score of 48.8 + /- 2.4 of 56 before training to 51.2 + /- 4.3 of 56 after training . The Timed Up and Go ( P = .045 ) and the Activities-Specific Balance Confidence Scale ( P = .038 ) also improved significantly in the experimental group . These changes are associated with a decrease in fall risk . CONCLUSIONS High-intensity strength training can safely and effectively strengthen lower extremity muscles in balance-impaired older adults , result ing in significant improvements in functional balance ability and decreased fall risk 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 : 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 ABSTRACT Purpose : The purpose of this r and omized controlled trial was to measure the effectiveness of A Matter of Balance , a small‐group based balance program , on muscle strength , gait , balance , and fall risk among older community‐dwelling adults at risk for falls . A secondary aim was to measure the effects of the program on actual fall rates over the 3‐month study . Methods : Twenty‐three older adults were r and omly assigned to either an experimental group that participated in a 12‐week small‐group based balance program or a control group . Subjects were assessed at baseline and following an intervention using the following outcome measures : lower extremity manual muscle testing ( MMT ) and range of motion ; gait analysis on the GAITRite ® system ; balance parameters on the SMART EquiTest ® , the Timed Up and Go test , the Berg Balance Scale , and incidence of falls . Results : A repeated measures ANOVA revealed that there was a significant interaction between groups over time in the Berg Balance Scale scores , P ≤.05 . The experimental group improved over time ( 48.1 to 52.9/56 , respectively ) , whereas the control group decreased in performance ( 49.1 to 47.8/56 , respectively ) , P ≤ .05 . The mean number of falls was significantly less in the experimental group during the intervention compared with the control group ( 0.09 and 0.50 , respectively ) , P ≤ .05 . Conclusions : A community‐based multifactorial intervention including individualized fall risk assessment , exercise , and home assessment appears to safely and effectively reduce the number of falls , result ing in significant improvements in functional balance ability and decreased fall risk Background and aims : An acute illness may place older frail people at increased risk of losing independence in functional abilities . Physical exercise may reduce the risk by improving muscle strength and balance . However , the effects of physical training on functional abilities have not been studied among frail , very old people recovering from an acute illness . The aim of this study was to determine the effects of a group-based exercise program on their ability to carry out self-care ( ADL ) and instrumental activities ( IADL ) relevant to daily life after discharge from hospital . Methods : This r and omized controlled trial examined 68 community-dwelling women aged 75 years or older ( mean age 83.0 , SD 3.9 ) who were hospitalized due to an acute illness , and were mobility-impaired at admission . Participants were recruited from the geriatric ward of a primary -care health-center hospital , and were r and omized into group-based strength training ( n=34 ) and control ( n=34 ) groups . The 10-week group-based intervention included strength training and functional exercises . The control group received instructions for a home exercise training program , including functional exercises but no further encouragement to exercise . The level of independence in ADL and IADL was evaluated , using a 13-item scale with stepwise grading from fully independent to fully dependent . Measurements took place immediately before and after the intervention , and three and nine months later . Results : The intervention did not have any significant main effect ( p=0.407 ) , nor was there any significant interaction between follow-up time and intervention ( p=0.854 ) . Conclusions : The multi-component outpatient strength training program did not improve autonomy in expert-evaluated ADL/IADL functions BACKGROUND The study tested the effect of strength and endurance training on gait , balance , physical health status , fall risk , and  health services use in older adults . METHODS The study was a single-blinded , r and omized controlled trial with intention-to-treat analysis . Adults ( n = 105 ) age 68 - 85 with at least mild deficits in strength and balance were selected from a r and om sample of enrollees in a health maintenance organization . The intervention was supervised exercise ( 1-h sessions , three per week , for 24 - 26 weeks ) , followed by self-supervised exercise . Exercise groups included strength training using weight machines ( n = 25 ) , endurance training using bicycles ( n = 25 ) , and strength and endurance training ( n = 25 ) . Study outcomes included gait tests , balance tests , physical health status measures , self-reported falls ( up to 25 months of follow-up ) , and inpatient and outpatient use and costs . RESULTS There were no effects of exercise on gait , balance , or physical health status . Exercise had a protective effect on risk of falling ( relative hazard = .53 , 95 % CI = .30-.91 ) . Between 7 and 18 months after r and omization , control subjects had more outpatient clinic visits ( p < .06 ) and were more likely to sustain hospital costs over $ 5000 ( p < .05 ) . CONCLUSIONS Exercise may have beneficial effects on fall rates and health care use in some subgroups of older adults . In community-living adults with mainly mild impairments in gait , balance , and physical health status , short-term exercise may not have a restorative effect on these impairments Multimodal exercise programs incorporating traditional progressive resistance training ( PRT ) , weight-bearing impact training and /or balance training are recommended to reduce risk factors for falls and fracture . However , muscle power , or the ability to produce force rapidly , has emerged as a more crucial variable to functional decline than muscle strength or mass . The aim of this 12-month community-based r and omized controlled trial , termed Osteo-cise : Strong Bones for Life , was to evaluate the effectiveness and feasibility of a multimodal exercise program incorporating high-velocity (HV)-PRT , combined with an osteoporosis education and behavioral change program , on bone mineral density ( BMD ) , body composition , muscle strength and functional muscle performance in older adults . Falls incidence was evaluated as a secondary outcome . A total of 162 older adults ( mean ± SD ; 67 ± 6 years ) with risk factors for falls and /or low BMD were r and omized to the Osteo-cise program ( n = 81 ) or a control group ( n = 81 ) . Exercise consisted of fitness center-based HV-PRT , weight-bearing impact and challenging balance/mobility activities performed three times weekly . After 12 months , the Osteo-cise program led to modest but significant net gains in femoral neck and lumbar spine BMD ( 1.0 % to 1.1 % , p < 0.05 ) , muscle strength ( 10 % to 13 % , p < 0.05 ) , functional muscle power ( Timed Stair Climb , 5 % , p < 0.05 ) and dynamic balance ( Four Square Step Test 6 % , p < 0.01 ; Sit-to-St and , 16 % , p < 0.001 ) relative to controls . There was no effect on total body lean mass or mobility ( timed-up- and -go ) , and no difference in falls rate ( incidence rate ratio [ IRR ] , 1.22 ; 95 % confidence interval [ CI ] , 0.72 - 2.04 ) . In conclusion , this study demonstrates that the Osteo-cise : Strong Bones for Life community-based , multimodal exercise program represents an effective approach to improve multiple musculoskeletal and functional performance measures in older adults with risk factors for falls and /or low BMD . Although this did not translate into a reduction in the rate of falls , further large-scale trials are needed to evaluate the efficacy of this multimodal approach on reducing falls and fracture Background Institutionalized older persons have a poor functional capacity . Including physical exercise in their routine activities decreases their frailty and improves their quality of life . Whole-body vibration ( WBV ) training is a type of exercise that seems beneficial in frail older persons to improve their functional mobility , but the evidence is inconclusive . This trial will compare the results of exercise with WBV and exercise without WBV in improving body balance , muscle performance and fall prevention in institutionalized older persons . Methods / Design An open , multicentre and parallel r and omized clinical trial with blinded assessment . 160 nursing home residents aged over 65 years and of both sexes will be identified to participate in the study . Participants will be central ly r and omised and allocated to interventions ( vibration or exercise group ) by telephone . The vibration group will perform static/dynamic exercises ( balance and resistance training ) on a vibratory platform ( Frequency : 30 - 35 Hz ; Amplitude : 2 - 4 mm ) over a six-week training period ( 3 sessions/week ) . The exercise group will perform the same exercise protocol but without a vibration stimuli platform . The primary outcome measure is the static/dynamic body balance . Secondary outcomes are muscle strength and , number of new falls . Follow-up measurements will be collected at 6 weeks and at 6 months after r and omization . Efficacy will be analysed on an intention-to-treat ( ITT ) basis and ' per protocol ' . The effects of the intervention will be evaluated using the " t " test , Mann-Witney test , or Chi-square test , depending on the type of outcome . The final analysis will be performed 6 weeks and 6 months after r and omization . Discussion This study will help to clarify whether WBV training improves body balance , gait mobility and muscle strength in frail older persons living in nursing homes . As far as we know , this will be the first study to evaluate the efficacy of WBV for the prevention of falls . Trial Registration Clinical Trials.gov : 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 : 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 Background . Aged-related loss of afferent feedback of the feet plays an important role in gait performance . Although strength , balance and gait training can significantly improve the muscle power and functional abilities of older individuals , it remains unclear whether training effects can be enhanced by augmenting afferent feedback from the feet adding shoe insoles complementary to conventional training . Objective . The current study investigated the effect of physical exercise combined with wearing MedReflex ® shoe insoles on the gait performance and muscle power in older adults . Methods . Twenty-eight independent living , older adults aged 65–91 years were r and omly assigned to either an insole group ( IG ; n = 14 ) or a training group ( TG ; n = 14 ) . Further 14 subjects matched to the IG and TG were recruited as a control group ( CG ; n = 14 ) ( no exercise ) . The IG and TG completed the same training program consisting of aerobic exercises , progressive resistance strength training and stretching exercises twice per week for 12 weeks , whereas , the IG wore the insoles during everyday life and during training sessions . Assessment s included the Falls Efficacy Scale – International ( FES-I ) , gait analysis and muscle power measurements of the knee and ankle joint at pre- and post-training . Results . There were significant time × group interactions in walking speed , step length and in several muscle power measurements . The positive effects of gait parameters ranged between 1 % and 12 % and between 1 % and 8 % and the trend to improvements of muscle power ranged between 15–79 % and 20–79 % for the IG and TG , respectively . The IG and TG did not differ significantly in their improvements . The CG showed a trend to deteriorations between 0 % and −5 % for gait parameters and between −4 % and −14 % for muscle power . No significant change in FES-I score occurred in neither groups . Conclusions . The results of this study provide evidence of significant improvements in gait performance and muscle power after a conventional training program in independent living , older adults . However , there is no additional effect of long-term adaptation of gait caused by wearing insoles concurrent to physical training Purpose : To assess some fall-related clinical variables ( balance , gait , fear of falling , functional autonomy , self-actualization and self-efficacy ) that might explain the fact that supervised Tai Chi has a better impact on preventing falls compared to a conventional physiotherapy program . Methods : The participants ( 152 older adults over 65 who were admitted to a geriatric day hospital program ) were r and omly assigned to either a supervised Tai Chi group or the usual physiotherapy . The presence of the clinical variables related to falls was evaluated before the intervention ( T1 ) , immediately after ( T2 ) , and 12 months after the end of the intervention ( T3 ) . Results : Both exercise programs significantly improved fall-related outcomes but only the Tai Chi intervention group decreased the incidence of falls . For both groups , most variables followed the same pattern , i.e. showed significant improvement with the intervention between T1 and T2 , and followed by a statistically significant decrease at the T3 evaluation . However , self-efficacy was the only variable that improved solely with the Tai Chi intervention ( p = 0.001 ) . Conclusions : The impact of supervised Tai Chi on fall prevention can not be explained by a differential effect on balance , gait and fear of falling . It appeared to be related to an increase of general self-efficacy , a phenomenon which is not seen in the conventional physiotherapy program . Implication s for Rehabilitation Each participant received a multidisciplinary intervention with either Tai Chi or physical therapy . Both interventions were associated with improved balance , gait , less fear of falling , improved functional autonomy and greater self actualisation . Only Tai Chi decreased the incidence of falls which appeared to be related to self-efficacy .  Tai Chi seems to be a good alternative to physical therapy exercises to prevent falls in frail older people OBJECTIVE To examine the effects of a 3-month low-intensity exercise program on physical frailty . DESIGN R and omized clinical trial . SETTING Regional tertiary-care hospital and academic medical center with an outpatient rehabilitation fitness center . PARTICIPANTS Eighty-four physically frail older adults ( mean age , 83 + /- 4 yrs ) . INTERVENTION Three-month low-intensity supervised exercise ( n = 48 ) versus unsupervised home-based flexibility activities ( n = 36 ) . MAIN OUTCOME MEASURES Physical performance test , measures of balance , strength , flexibility , coordination , speed of reaction , peripheral sensation . RESULTS Significant improvement was made by the exercise group on our primary indicator of frailty , a physical performance test ( PPT ) ( 29 + /- 4 vs 31 + /- 4 out of a possible 36 points ) , as well as many of the risk factors previously identified as contributors to frailty ; eg , reductions in flexibility , strength , gait speed , and poor balance . Although the home exercise control group showed increases in range of motion , the improvements in flexibility did not translate into improvements in physical performance capacity as assessed by the PPT . CONCLUSIONS Our results suggest that physical frailty is modifiable with a program of modest activities that can be performed by virtually all older adults . They also indicate that exercise programs consisting primarily of flexibility activities are not likely to reverse or attenuate physical frailty . Although results suggest that frailty is modifiable , it is not likely to be eliminated with exercise , and efforts should be directed toward preventing the condition Decreased ability to perform activities of daily living ( ADLs ) associated with deterioration in physical capacity are key determinants of the poor quality of life and loss of independence of patients with Alzheimer 's disease ( AD ) . The purpose of this study was to determine the effects of a 12-week training program ( including resistance , flexibility , joint mobility and balance/coordination exercises ) for Spanish patients with AD on their i ) overall functional capacity ( muscle strength and flexibility , agility and balance while moving , and endurance fitness ) , and ii ) ability to perform ADLs . Using a r and omized block design , 16 patients were assigned to a training ( mean [ SD ] age : 76 [ 4 ] yrs ) or control group ( 73 [ 4 ] yrs ) ( n = 8 subjects [ 3 male , 5 female ] per group ) . The results showed significant improvements after training ( p < 0.05 ) in upper and lower body muscle strength and flexibility , agility and dynamic balance , and endurance fitness ( using the Senior Fitness test ) , gait and balance abilities ( with subsequent decrease in risk of falls ) ( Tinetti scale ) and in the ability to perform ADLs independently ( Katz and Barthel scores ) . No changes ( p > 0.05 ) were found in the control group over the 12-week period . Exercise training could be included in the overall medical/nursing care protocol for patients with AD Background Home-based exercise programs can improve physical functioning and health status of elderly people . Successful implementation of exercise interventions for older people presents major challenges and supporting elderly people properly while doing their home-based exercises is essential for training success . We developed a tablet-based system — ActiveLifestyle — that offers older adults a home-based strength-balance training program with incorporated motivation strategies and support features . Objective The goal was to compare 3 different home-based training programs with respect to their effect on measures of gait quality and physical performance through planned comparisons between ( 1 ) tablet-based and brochure-based interventions , ( 2 ) individual and social motivation strategies , and ( 3 ) active and inactive participants . Methods A total of 44 autonomous-living elderly people ( mean 75 , SD 6 years ) were assigned to 3 training groups : social ( tablet guided , n=14 ) , individual ( tablet guided , n=13 ) , and brochure ( brochure guided , n=17 ) . All groups joined a 12-week progressive home-based strength-balance training program . Outcome measures were gait performance under single and dual task conditions , dual task costs of walking , falls efficacy , and physical performance as measured by the Short Physical Performance Battery ( SPPB ) . Furthermore , active ( ≥75 % program compliance ) and inactive ( < 75 % program compliance ) individuals were compared based on their characteristics and outcome measures . Results The tablet groups showed significant improvements in single and dual task walking , whereas there were no significant changes observable in the brochure group . Between-groups comparisons revealed significant differences for gait velocity ( U=138.5 ; P=.03 , r=.33 ) and cadence ( U=138.5 , P=.03 r=.34 ) during dual task walking at preferred speed in favor of the tablet groups . The brochure group had more inactive participants , but this did not reach statistical significance ( U=167 , P=.06 , r=.29 ) . The active participants outperformed the inactive participants in single and dual task walking , dual task costs of walking , and SPPB scores . Significant between-groups differences were seen between the tablet groups and the brochure group , in favor of the tablet groups . Conclusions A tablet-based strength-balance training program that allows monitoring and assisting autonomous-living older adults while training at home was more effective in improving gait and physical performance when compared to a brochure-based program . Social or individual motivation strategies were equally effective . The most prominent differences were observed between active and inactive participants . These findings suggest that in older adults a tablet-based intervention enhances training compliance ; hence , it is an effective way to improve gait Background Reaction time , coordination , and cognition performance typically diminish in older adults , which may lead to gait impairments , falls , and injuries . Regular strength – balance exercises are highly recommended to reduce this problem and to improve health , well-being , and independence in old age . However , many older people face a lack of motivation in addition to other strong barriers to exercise . We developed ActiveLifestyle , an information technology (IT)-based system for active and healthy aging aim ing at improving balance and strength . ActiveLifestyle is a training app that runs on a tablet and assists , monitors , and motivates older people to follow personalized training plans autonomously at home . Objective The objectives were to ( 1 ) investigate which IT-mediated motivation strategies increase adherence to physical exercise training plans in older people , ( 2 ) assess the impact of ActiveLifestyle on physical activity behavior change , and ( 3 ) demonstrate the effectiveness of the ActiveLifestyle training to improve gait speed . Methods A total of 44 older adults followed personalized , 12-week strength and balance training plans . All participants performed the exercises autonomously at home . Question naires were used to assess the technological familiarity and stage of behavior change , as well as the effectiveness of the motivation instruments adopted by ActiveLifestyle . Adherence to the exercise plan was evaluated using performance data collected by the app and through information given by the participants during the study . Pretests and posttests were performed to evaluate gait speed of the participants before and after the study . Results Participants were 75 years ( SD 6 ) , predominantly female ( 64 % ) , held a trade or professional diploma ( 54 % ) , and their past profession was in a sitting position ( 43 % ) . Of the 44 participants who enrolled , 33 ( 75 % ) completed the study . The app proved to assist and motivate independently living and healthy older adults to autonomously perform strength – balance exercises ( median 6 on a 7-point Likert scale ) . Social motivation strategies proved more effective than individual strategies to stimulate the participants to comply with the training plan , as well as to change their behavior permanently toward a more physically active lifestyle . The exercises were effective to improve preferred and fast gait speed . Conclusions ActiveLifestyle assisted and motivated independently living and healthy older people to autonomously perform strength – balance exercises over 12 weeks and had low dropout rates . The social motivation strategies were more effective to stimulate the participants to comply with the training plan and remain on the intervention . The adoption of assistive technology devices for physical intervention tends to motivate and retain older people exercising for longer periods of time Background and aims : Impaired mobility is one of the strongest predictors for falls in older people . We hypothesized that exercise as part of a fall prevention program would have positive effects , both short- and long-term , on gait , balance and strength in older people at high risk of falling and with varying levels of cognition , residing in residential care facilities . A secondary hypothesis was that these effects would be associated with a reduced risk of falling . Methods : 187 out of all residents living in 9 facilities , ≥65 years of age were at high risk of falling . The facilities were clusterr and omized to fall intervention or usual care . The intervention program comprised : education , environment , individually design ed exercise , drug review , post-fall assessment s , aids , and hip protectors . Data were adjusted for baseline performance and clustering . Results : At 11 weeks , positive intervention effects were found on independent ambulation ( FAC , p=0.026 ) , maximum gait speed ( p=0.002 ) , and step height ( ≥10 cm , p<0.001 ) , but not significantly on the Berg Balance Scale . At 9 months ( long-term outcome ) , 3 intervention and 15 control residents had lost the ability to walk ( p=0.001 ) . Independent ambulation and maximum gait speed were maintained in the intervention group but deteriorated in the control group ( p=0.001 ) . Residents with both higher and lower cognition benefited in most outcome measures . No association was found between improved mobility and reduced risk of falling . Conclusions : Exercise , as part of a fall prevention program , appears to preserve the ability to walk , maintain gait speed , ambulate independently , and improve step height . Benefits were found in residents with both lower and higher cognitive impairment , but were not found to be associated with a reduced risk of falling Background Computer-based interventions have demonstrated consistent positive effects on various physical abilities in older adults . This study aims to compare two training groups that achieve similar amounts of strength and balance exercise where one group receives an intervention that includes additional dance video gaming . The aim is to investigate the different effects of the training programs on physical and psychological parameters in older adults . Methods Thirty-one participants ( mean age ± SD : 86.2 ± 4.6 years ) , residents of two Swiss hostels for the aged , were r and omly assigned to either the dance group ( n = 15 ) or the control group ( n = 16 ) . The dance group absolved a twelve-week cognitive-motor exercise program twice weekly that comprised progressive strength and balance training supplemented with additional dance video gaming . The control group performed only the strength and balance exercises during this period . Outcome measures were foot placement accuracy , gait performance under single and dual task conditions , and falls efficacy . Results After the intervention between-group comparison revealed significant differences for gait velocity ( U = 26 , P = .041 , r = .45 ) and for single support time ( U = 24 , P = .029 , r = .48 ) during the fast walking dual task condition in favor of the dance group . No significant between-group differences were observed either in the foot placement accuracy test or in falls efficacy . Conclusions There was a significant interaction in favor of the dance video game group for improvements in step time . Significant improved fast walking performance under dual task conditions ( velocity , double support time , step length ) was observed for the dance video game group only . These findings suggest that in older adults a cognitive-motor intervention may result in more improved gait under dual task conditions in comparison to a traditional strength and balance exercise program . Trial registration This trial has been registered under IS RCT N05350123 ( http://www.controlled-trials.com This study evaluates the separate effect and retention of 12-week traditional ( TE ) and horse ( HE ) exercise programs on physical function in healthy older participants ( 61 to 87 years old ) . Thirty-eight participants were r and omly assigned to three groups : TE ( n = 17 ) , HE ( n = 10 ) , and control group ( n = 11 ) . TE and HE underwent a supervised exercise program ( 3 day/week ) . Maximal gait speed , muscle strength , and body balance were assessed at weeks 0 , 12 , and 16 . Only TE and HE displayed significant improvements ( P < .05 ) in knee extensor strength , and only HE had faster gait speed . Marginal balance improvements were found only in HE in the medial-lateral direction . However , TE showed larger improvements in h and grip than HE . The largest retention was in knee extensor strength but most of the exercise effects were lost in the follow-up . Besides TE , exercise with a horse may be an alternative option to older adults , provided that they want to interact with the animal Abstract Objective . To investigate the efficacy of a guided and grade d home-based exercise program for improving a range of physical outcomes in older people . Design . Controlled clinical trial of 16 weeks Setting . Two geographical areas in Gent , Belgium Participants . 66 independent-living older people ( age : 71 - 98 ) with a history of falls and moderate physical impairment Intervention . Twenty-four 30-minute training sessions were given by a trained physiotherapist over a period of 16 weeks in the participant ’s home . Different types of exercises on balance , aerobic performance , flexibility , and muscle strength were provided . Main outcome measures . Muscle strength , static and dynamic balance , aerobic performance , activities in daily living , fear of falling and avoidance of daily activities were assessed at baseline and after 16 weeks intervention . Results : At baseline , there were no significant differences in the measured variables between exercise and control groups . After 16 weeks , the exercise group showed significantly improved ankle muscle strength , balance performance and aerobic capacity , and decreased fear of falling , dependency in daily activities and avoidance of daily activities compared to the control group . The improvements in knee muscle strength , timed chair st and s , and functional reach were not significant . Conclusion : The home-based , individualized exercise program was effective in reducing several physical factors associated with falls in community-dwelling older people with moderate physical impairment . The decrease in fear of falling and other behavioural variables needs to be considered with care and needs further investigation Training that focuses on strength , balance , and endurance , the so-called combined exercise , can enhance physical function , including gait , according to a literature review . However , the effects of combined exercise on improving gait variability are limited . The objective of this study is to investigate the effects of 12 weeks of combined exercise comprised of resistance , endurance , and balance training on gait performance in older adults . Twenty-nine community-dwelling older adults were recruited and assigned to either the experimental group ( n = 17 ) or the control group ( n = 12 ) . The 12-week intervention was a combined exercise program at 1 h per day and 3 days per week . The participants received an assessment for both a 6-min walk and gait during both habitual walking and fast walking conditions at pre-intervention and after 8 and 12 weeks of exercise . The 6-min walk was used to assess gait endurance . GAITRite was used to evaluate gait . An analysis of covariance with the pretest score as the covariate was used to determine the difference in each dependent variable between groups . The level of significance was set as p less than 0.05 . Our results showed significant between-group effects in the 6-min walk and velocity , stride time , and stride length in both conditions after 8 weeks of exercise and significant between-group effects in the 6-min walk test and all selected gait parameters in both conditions after 12 weeks of exercise . Our findings demonstrate that a 12-week combined exercise program may positively affect gait endurance and gait performance including gait variability in habitual walking and fast walking conditions among older adults . The current study provides important evidence of short-term combined exercise effects on improvements in gait performance OBJECTIVES This study examined the benefits of and differences between 12 weeks of thrice-weekly supervised balance training and an unsupervised at-home balance activity ( using the Nintendo Wii Fit ) for improving balance and reaction time and lowering falls risk in older individuals with type 2 diabetes mellitus ( T2DM ) . DESIGN Before-after trial . SETTING University research laboratory , home environment . PARTICIPANTS Sixty-five older adults with type 2 diabetes were recruited for this study . Participants were r and omly allocated to either supervised balance training ( mean age 67.8 ± 5.2 ) or unsupervised training using the Nintendo Wii Fit balance board ( mean age 66.1 ± 5.6 ) . INTERVENTION The training period for both groups lasted for 12 weeks . Individuals were required to complete three 40-minute sessions per week for a total of 36 sessions . MEASUREMENT The primary outcome measure was falls risk , which was as derived from the physiological profile assessment . In addition , measures of simple reaction time , lower limb proprioception , postural sway , knee flexion , and knee extension strength were also collected . Persons also self-reported any falls in the previous 6 months . RESULTS Both training programs result ed in a significant lowering of falls risk ( P < .05 ) . The reduced risk was attributable to significant changes in reaction times for the h and ( P < .05 ) , foot ( P < .01 ) , lower-limb proprioception ( P < .01 ) , and postural sway ( P < .05 ) . CONCLUSIONS Overall , training led to a decrease in falls risk , which was driven by improvements in reaction times , lower limb proprioception , and general balance ability . Interestingly , the reduced falls risk occurred without significant changes in leg strength , suggesting that interventions to reduce falls risk that target intrinsic risk factors related to balance control ( over muscle strength ) may have positive benefits for the older adult with T2DM at risk for falls Introduction Older breast cancer survivors ( BCS ) report more falls and functional limitations than women with no cancer history .  Exercise training could reduce risk factors for future falls and disability . Methods We conducted a r and omized , controlled trial in 106 early-stage , postmenopausal BCS who were ≥50 years old at diagnosis and post-treatment . Women were r and omly assigned to a 1-year resistance + impact exercise program or a stretching placebo program . Endpoints were one repetition maximum bench press and leg press strength , timed five chair st and s , 4 m usual walk speed , timed stance tests , h and grip strength , self-report physical function , and fatigue . We also examined the influence of age , adjuvant hormone therapy use , and exercise adherence on study outcomes . Results Women in the resistance + impact training program significantly improved maximal leg ( p < 0 .02 ) and bench ( p < 0 .02 ) press strength compared to the stretching group . Women who attended 50 % or more of prescribed resistance training sessions had significantly better changes in maximal strength measures compared to less adherent women . Conclusions Resistance + impact exercise is superior to stretching at improving maximal muscle strength and exercise adherence contributes to the degree of improvement . Implication s for cancer survivorsOlder BCS can safely engage in resistance exercise that improves lower and upper body strength , thereby reducing a risk factor for falls and future disability . However , the ability of resistance training to shift other indices of fall and disability risk , i.e. , balance and function , is unclear . Strategies to promote adherence to resistance training could lead to greater improvements in strength
The multi-component exercise intervention composed by strength , endurance and balance training seems to be the best strategy to improve rate of falls , gait ability , balance , and strength performance in physically frail older adults
The aim of this review was to recommend training strategies that improve the functional capacity in physically frail older adults based on scientific literature , focusing specially in supervised exercise programs that improved muscle strength , fall risk , balance , and gait ability .