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 Effects of progressive resistance training on body composition in frail older adults: results of a randomized, controlled trial. Fall and Balance Outcomes After an Intervention to Promote Leg Strength, Balance, and Walking in People With Diabetic Peripheral Neuropathy: “Feet First” Randomized Controlled Trial Effects of balance Vestibular Rehabilitation Therapy in elderly with Benign Paroxysmal Positional Vertigo: a randomized controlled trial 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. A randomized controlled trial of high versus low intensity weight training versus general practitioner care for clinical depression in older adults. A randomized controlled trial of progressive resistance training in depressed elders. Sensory-Specific Balance Training in Older Adults: Effect on Proprioceptive Reintegration and Cognitive Demands Selected as the best paper in the 1990s: Reducing frailty and falls in older persons: an investigation of tai chi and computerized balance training. Interactive Sensor-Based Balance Training in Older Cancer Patients with Chemotherapy-Induced Peripheral Neuropathy: A Randomized Controlled Trial The effects of strength and power training on single-step balance recovery in older adults: a preliminary study Progressive resistance training did not improve walking but can improve muscle performance, quality of life and fatigue in adults with multiple sclerosis: a randomized controlled trial Reducing risk of falling in older people discharged from hospital: a randomized controlled trial comparing seated exercises, weight-bearing exercises, and social visits. Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls. High-Intensity Resistance Training Improves Muscle Strength, Self-Reported Function, and Disability in Long-Term Stroke Survivors Progressive resistance training improves gait initiation in individuals with Parkinson's disease. Lower limb power rehabilitation (LLPR) using interactive video game for improvement of balance function in older people.
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 : BACKGROUND Progressive resistance exercise training ( PRT ) has been shown to increase muscle strength and fat-free mass ( FFM ) in elderly persons . Limited information is available regarding the effects of PRT on lean and fat mass in frail elderly persons . METHODS Ninety-one community-dwelling sedentary men and women , 78 years and older with physical frailty ( defined using st and ardized objective criteria ) were enrolled in a 9-month trial of exercise training ( ET ) . Physical frailty was defined as having 2 of the 3 following criteria : modified Physical Performance Test score between 18 and 32 , peak aerobic power between 10 and 18 ml/kg/min , or self-report of difficulty or assistance with two instrumental activities of daily living or one basic activity of daily living . Participants were r and omly assigned to either a control ( CTL ) group that performed a low intensity home exercise program or a supervised ET group that performed 3 months of low intensity exercise and 3 months of PRT . RESULTS After completion of PRT , ET participants had greater improvements than did CTL participants in maximal voluntary force production for knee extension ( mean Delta + 5.3 + /- 13 ft/lb vs + 1.1 + /- 11 ft/lb , p = .05 ) , measured using isokinetic dynamometry . Total body FFM ( measured using dual energy x-ray absorptiometry ) increased in the ET group , but not in the CTL group ( mean Delta + 0.84 + /- 1.4 kg vs + 0.01 + /- 1.5 kg , p = .005 ) . Total , trunk , intra-abdominal , and subcutaneous fat mass ( measured using dual energy x-ray absorptiometry and (1)H-magnetic resonance imaging ) did not change in response to PRT . CONCLUSIONS Three months of supervised PRT induced improvements in maximal voluntary thigh muscle strength and whole body FFM in frail , community-dwelling elderly women and men . This supervised exercise program may not be sufficient to reduce whole-body or intra-abdominal fat area in this population Background Weight-bearing exercise has been discouraged for people with diabetes mellitus and peripheral neuropathy ( DM+PN ) . However , people with diabetes mellitus and insensate feet have an increased risk of falling .  Lower-extremity exercise and balance training reduce fall risk in some older adults . It is unknown whether those with neuropathy experience similar benefits . Objective As part of a study of the effects of weight-bearing exercise on foot ulceration in people with DM+PN , the effects of a lower-extremity exercise and walking intervention on balance , lower-extremity strength ( force-generating capacity ) , and fall incidence were determined . Design The study was an observer-masked , 12-month r and omized controlled trial . Setting Part 1 of the intervention took place in physical therapy offices , and part 2 took place in the community . Patients The participants were 79 people who were mostly sedentary , who had DM+PN , and who were r and omly assigned to either a  control group  ( n=38 ) or an intervention group ( n=41 ) . Intervention Part 1 included leg strengthening and balance exercises and a graduated , self-monitored walking program ; part 2 included motivational telephone calls . Both groups received regular foot care , foot care education , and 8 sessions with a physical therapist . Measurements The measurements collected were strength , balance , and participant-reported falls for the year after enrollment . Results There were no statistically significant differences between the groups for falls during follow-up . At 12 months , there was a small increase in the amount of time that participants in the intervention group could st and on 1 leg with their eyes closed . No other strength or balance measurements differed between the groups . Limitations The study was design ed to detect differences in physical activity , not falls . The intensity of the intervention was insufficient to improve strength and balance in this population . Conclusions The training program had a minimal effect on  participants  ' balance and lower-extremity strength . Increasing weight-bearing activity did not alter the rate of falling for participants in the intervention group relative to that for participants in the control group . People who are sedentary and who have DM+PN appear to be able to increase activity without increasing their rate of falling Abstract Purpose : To evaluate short-term effects of balance Vestibular Rehabilitation Therapy ( VRT ) on balance , dizziness symptoms and quality of life of the elderly with chronic Benign Paroxysmal Positional Vertigo ( BPPV ) . Method : In this r and omized , single-blind and controlled trial , older adults with chronic BPPV were r and omized into two groups , the experimental group ( n = 7 , age : 69 ( 65–78 ) years ) and the control group ( n = 7 , age : 73 ( 65–76 ) years ) . Patients in the experimental group underwent balance VRT ( 50 min per session , two times a week ) and Canalith Repositioning Maneuver ( CRM ) as required , for 13 weeks . The control group was treated using only CRM as required . St and ing and dynamic balance , dizziness symptoms and quality of life were measured at the baseline , and at one , five , nine and thirteen weeks . Results : There were no between-group differences in dizziness , quality of life and st and ing balance over the 13 weeks . Significant differences were observed in dynamic balance measures between groups ( p < 0.05 for most tests ) through assessment s. In intragroup analysis , both groups showed improvements in all measurements except no improvement was found in majority of the dynamic balance tests in the control group . Conclusions : The patients who received additional balance VRT demonstrated better results in dynamic balance than those who received only CRM . Implication s for Rehabilitation The findings that balance VRT in addition to CRM improves dynamic balance in elderly people with BPPV should be useful in guiding rehabilitation professionals ’ clinical decision making to design interventions for seniors suffering from BPPV ; Improvements in tests of dynamic balance suggest that the risk of adverse consequences of BPPV in the elderly such as falls and fractures can be potentially reduced through implementation of CRM in conjunction with balance VRT ; Lack of additional improvement in Visual Analogue Scale of dizziness and Dizziness H and icap Index suggests that addition of balance VRT does not influence dizziness symptomatology , per se , and CRM alone is effective to ameliorate vertiginous symptoms and potentially improve quality of life 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 Although exercise has been shown to relieve depression , little is known about its mechanism or dose-response characteristics . We hypothesized that high intensity progressive resistance training ( PRT ) would be more effective than either low intensity PRT or st and ard care by a general practitioner ( GP ) in depressed elderly persons , and that high intensity PRT would provide superior benefits in quality of life , sleep quality , and self-efficacy . METHODS Sixty community-dwelling adults > 60 years with major or minor depression were r and omized to supervised high intensity PRT ( 80 % maximum load ) or low intensity PRT ( 20 % maximum load ) 3 days per week for 8 weeks , or GP care . RESULTS A 50 % reduction in the Hamilton Rating Scale of Depression score was achieved in 61 % of the high intensity , 29 % of the low intensity , and 21 % of the GP care group ( p = .03 ) . Strength gain was directly associated with reduction in depressive symptoms ( r = 0.40 , p = .004 ) , as was baseline social support network type ( F = 3.52 , p = .015 ) , whereas personality type , self-efficacy , and locus of control were unrelated to the antidepressant effect . Vitality quality -of-life scale improved more in the high intensity group than in the others ( p = .04 ) . Sleep quality improved significantly in all participants ( p < .0001 ) , with the greatest relative change in high intensity PRT ( p = .05 ) . CONCLUSIONS High intensity PRT is more effective than is low intensity PRT or GP care for the treatment of older depressed patients BACKGROUND Depression in elderly people may be contributed to by the multiple losses of aging . Exercise has the potential to positively impact many of these losses simultaneously . We tested the hypothesis that progressive resistance training ( PRT ) would reduce depression while improving physiologic capacity , quality of life , morale , function and self-efficacy without adverse events in an older , significantly depressed population . METHODS We conducted a 10-week r and omized controlled trial of volunteers aged 60 and above with major or minor depression or dysthymia . Subjects were r and omized for 10 weeks to either a supervised PRT program three times a week or an attention-control group . RESULTS A total of 32 subjects aged 60 - 84 , mean age 71.3 + /- 1.2 yr , were r and omized and completed the study . No significant adverse events occurred . Median compliance was 95 % . PRT significantly reduced all depression measures ( Beck Depression Inventory in exercisers 21.3 + /- 1.8 to 9.8 + /- 2.4 versus controls 18.4 + /- 1.7 to 13.8 + /- 2 , p = .002 ; Hamilton Rating Scale of Depression in exercisers 12.3 + /- 0.9 to 5.3 + /- 1.3 versus controls 11.4 + /- 1.0 to 8.9 + /- 1.3 , p = .008 ) . Quality of life subscales of bodily pain ( p = .001 ) , vitality ( p = .002 ) , social functioning ( p = .008 ) , and role emotional ( p = .02 ) were all significantly improved by exercise compared to controls . Strength increased a mean of 33 % + /- 4 % in exercisers and decreased 2 % + /- 2 % in controls ( p < .0001 ) . In a multiple stepwise regression model , intensity of training was a significant independent predictor of decrease in depression scores ( r2 = .617 , p = .0002 ) . CONCLUSIONS PRT is an effective antidepressant in depressed elders , while also improving strength , morale , and quality of life Background and Purpose : Age-related changes in the ability to adjust to alterations in sensory information contribute to impaired postural stability . The purpose of this r and omized controlled trial was to investigate the effect of sensory-specific balance training on proprioceptive reintegration . Subjects : The subjects of this study were 36 older participants who were healthy . Methods : Participants were r and omly assigned to a  balance exercise group  ( n=17 ) or a falls prevention education group ( n=19 ) . The primary outcome measure was the center-of-pressure ( COP ) velocity change score . This score represented the difference between COP velocity over 45 seconds of quiet st and ing and each of six 5-second intervals following proprioceptive perturbation through vibration with or without a secondary cognitive task . Clinical outcome measures included the Fullerton Advanced Balance ( FAB ) Scale and the Activities-specific Balance Confidence ( ABC ) Scale . Assessment s were conducted at baseline , postintervention , and at an 8-week follow-up . Results : Following the exercise intervention , there was less destabilization within the first 5 seconds following vibration with or without a secondary task than there was at baseline or in the falls prevention education group . These training effects were not maintained at the 8-week follow-up . Postintervention improvements also were seen on the FAB Scale and were maintained at follow-up . No changes in ABC Scale scores were identified in the balance exercise group , but ABC Scale scores indicated reduced balance confidence in the falls prevention education group postintervention . Discussion and Conclusion : The results of this study support short-term enhanced postural responses to proprioceptive reintegration following a sensory-specific balance exercise program OBJECTIVES To evaluate the effects of two exercise approaches , tai chi ( TC ) and computerized balance training ( BT ) , on specified primary outcomes ( biomedical , functional , and psychosocial indicators of frailty ) and secondary outcomes ( occurrences of fall ) . DESIGN The Atlanta Frailty and Injuries : Cooperative Studies and Intervention Techniques , a prospect i ve , r and omized , controlled clinical trial with three arms ( TC , BT , and education ( ED ) ) . Intervention length was 15 weeks , with primary outcomes measured before and after intervention and at 4-month follow-up . Falls were monitored continuously throughout the study . SETTING Persons aged 70 and older living in the community . PARTICIPANTS A total of 200 participants , 162 women and 38 men ; mean age was 76.2 . MEASUREMENTS Biomedical ( strength , flexibility , cardiovascular endurance , body composition ) , functional instrumental activities of daily living ( IADL ) , and psychosocial well-being ( Center for Epidemiological Studies for Depression scale , fear of falling question naire , self-perception of present and future health , mastery index , perceived quality of sleep , and intrusiveness ) variables . RESULTS Grip strength declined in all groups , and lower extremity range of motion showed limited but statistically significant changes . Lowered blood pressure before and after a 12-minute walk was seen following TC participation . Fear of falling responses and intrusiveness responses were reduced after the TC intervention compared with the ED group ( P=.046 and P=.058 , respectively ) . After adjusting for fall risk factors , TC was found to reduce the risk of multiple falls by 47.5 % . CONCLUSION A moderate TC intervention can impact favorably on defined biomedical and psychosocial indices of frailty . This intervention can also have favorable effects upon the occurrence of falls .  TC warrants further study as an exercise treatment to improve the health of older people Background : Cancer patients with chemotherapy-induced peripheral neuropathy ( CIPN ) have deficits in sensory and motor skills leading to inappropriate proprioceptive feedback , impaired postural control , and fall risk . Balance training programs specifically developed for CIPN patients are lacking . Objective : This pilot study investigated the effect of an interactive motor adaptation balance training program based on wearable sensors for improving balance in older cancer patients with CIPN . Methods : Twenty-two patients ( age : 70.3 ± 8.7 years ) with objective ly confirmed CIPN [ vibration perception threshold ( VPT ) > 25 V ] were r and omized to either an intervention ( IG ) or a control ( CG ) group . The IG received interactive game-based balance training including repetitive weight shifting and virtual obstacle crossing tasks . Wearable sensors provided real-time visual/auditory feedback from the lower limb trajectory and allowed the perception of motor errors during each motor action . The CG received no exercise intervention and continued their normal activity . Outcome measures were changes in sway of ankle , hip , and center of mass ( CoM ) in both mediolateral and anteroposterior ( AP ) directions during 30-second balance tests with increasing task difficulty [ i.e. st and ing in feet-closed position with eyes open ( EO ) and eyes closed ( EC ) , and in semi-t and em position with EO ] at baseline and after the intervention . Additionally , gait performance ( speed , variability ) and fear of falling [ Falls Efficacy Scale-International ( FES-I ) ] were measured . Results : Training was safe despite the participants ' impaired health status , great severity of CIPN ( VPT 49.6 ± 26.7 V ) , and great fear of falling ( FES-I score 31.37 ± 11.20 ) . After the intervention , sway of hip , ankle , and CoM was significantly reduced in the IG compared to the CG while st and ing in feet-closed position with EO ( p = 0.010 - 0.022 , except AP CoM sway ) and in semi-t and em position ( p = 0.008 - 0.035 , except ankle sway ) . No significant effects were found for balance with EC , gait speed , and FES-I score ( p > 0.05 ) . Conclusions : This proof-of-concept study demonstrates that older cancer patients with CIPN can significantly improve their postural balance with specifically tailored , sensor-based exercise training . The training approach has potential as a therapy for improving CIPN-related postural control deficits . However , future studies comparing the proposed technology-based training with traditional balance training are required to evaluate the benefit of the interactive joint movement feedback Improving muscle strength and power may mitigate the effects of sarcopenia , but it is unknown if this improves an older adult ’s ability to recover from a large postural perturbation . Forward tripping is prevalent in older adults and lateral falls are important due to risk of hip fracture . We used a forward and a lateral single-step balance recovery task to examine the effects of strength training ( ST ) or power ( PT ) training on single-step balance recovery in older adults . Twenty older adults ( 70.8±4.4 years , eleven male ) were r and omly assigned to either a 6-week ( three times/week ) lower extremity ST or PT intervention . Maximum forward ( FLeanmax ) and lateral ( LLeanmax ) lean angle and strength and power in knee extension and leg press were assessed at baseline and follow-up . Fifteen participants completed the study ( ST = 7 , PT = 8) . Least squares means ( 95 % CI ) for ΔFLeanmax ( ST : + 4.1 ° [ 0.7 , 7.5 ] ; PT : + 0.6 ° [ −2.5 , 3.8 ] ) and ΔLLeanmax ( ST : + 2.2 ° [ 0.4 , 4.1 ] ; PT : + 2.6 ° [ 0.9 , 4.4 ] ) indicated no differences between groups following training . In exploratory post hoc analyses collapsed by group , ΔFLeanmax was + 2.4 ° ( 0.1 , 4.7 ) and ΔLLeanmax was + 2.4 ° ( 1.2 , 3.6 ) . These improvements on the balance recovery tasks ranged from ~15%–30 % . The results of this preliminary study suggest that resistance training  may improve balance recovery performance , and that , in this small sample , PT did not lead to larger improvements in single-step balance recovery compared to ST Background : Few high- quality trials have examined the effects of progressive resistance training ( PRT ) on people with multiple sclerosis ( MS ) . Objective : To determine the effectiveness of PRT for people with MS , focusing on improving the gait deficits common in this population . Methods : Using a single blind r and omized controlled trial , people with relapsing – remitting MS were r and omly allocated to either a PRT program targeting the lower limb muscles twice a week for 10 weeks ( n = 36 ) , or usual care plus an attention and social program conducted once a week for 10 weeks ( n = 35 ) . Outcomes were recorded at baseline , week 10 and week 22 . Results : Participants attended 92 % of training sessions , with no serious adverse events . At 10 weeks , no differences were detected in walking performance . However , compared with the comparison group PRT demonstrated increased leg press strength ( 16.8 % , SD 4.5 ) , increased reverse leg press strength ( 29.8 % , SD 12.7 ) , and increased muscle endurance of the reverse leg press ( 38.7 % , SD 32.8 ) . Improvements in favor of PRT were also found for physical fatigue ( Mean difference −3.9 units , 95%CI −6.6 to −1.3 ) , and the physical health domain of quality of life ( Mean difference 1.5 units , 95%CI 0.1 to 2.9 ) . At week 22 almost no between-group differences remained . Conclusion : PRT is a relatively safe intervention that can have short-term effects on reducing physical fatigue , increasing muscle endurance and can lead to small improvements in muscle strength and quality of life in people with relapsing – remitting MS . However , no improvements in walking performance were observed and benefits do not appear to persist if training is completely stopped OBJECTIVE To compare the efficacy of seated exercises and weight-bearing ( WB ) exercises with social visits on fall risk factors  in older people recently discharged from hospital . DESIGN Twelve-week r and omized , controlled trial . SETTING Home-based exercises . PARTICIPANTS Subjects ( N=180 ) aged 65 and older , recently discharged from hospital . INTERVENTIONS Seated exercises ( n=60 ) , WB exercises ( n=60 ) , and social visits ( n=60 ) . MAIN OUTCOME MEASURES Primary outcome factors were Physiological Profile Assessment ( PPA ) fall risk score , and balance while st and ing ( Coordinated Stability and Maximal Balance Range tests ) . Secondary outcomes included the component parts of the PPA and other physical and psychosocial measures . RESULTS Subjects were tested at baseline and at completion of the intervention period . After 12 weeks of interventions , subjects in the WB exercise group had significantly better performance than the social visit group on the following : PPA score ( P=.048 ) , Coordinated Stability ( P<.001 ) , Maximal Balance Range ( P=.019 ) ; body sway on floor with eyes closed ( P=.017 ) ; and finger-press reaction time ( P=.007 ) tests . The seated exercise group performed better than the social visit group in PPA score ( P=.019 ) but for no other outcome factor . The seated exercise group had the highest rate of musculoskeletal soreness . CONCLUSIONS In older people recently discharged from the hospital , both exercise programs reduced fall risk score in older people . The WB exercises led to additional beneficial impacts for controlled leaning , reaction time , and caused less musculoskeletal soreness than the seated exercises OBJECTIVE To determine the safety and efficacy of an exercise protocol design ed to improve strength , mobility , and balance and to reduce subsequent falls in geriatric patients with a history of injurious falls . DESIGN A r and omized controlled 3-month intervention trial , with an additional 3-month follow-up . SETTING Out-patient geriatric rehabilitation unit . PARTICIPANTS Fifty-seven female geriatric patients ( mean age 82 + /- 4.8 years ; range 75 - 90 ) admitted to acute care or inpatient rehabilitation with a history of recurrent or injurious falls including patients with acute fall-related fracture . INTERVENTION Ambulatory training of strength , functional performance , and balance 3 times per week for 3 months . Patients of the control group attended a placebo group 3 times a week for 3 months . Both groups received an identical physiotherapeutic treatment 2 times a week , in which strengthening and balance training were excluded . MEASUREMENTS Strength , functional ability , motor function , psychological parameters , and fall rates were assessed by st and ardized protocol s at the beginning ( T1 ) and the end ( T2 ) of intervention . Patients were followed up for 3 months after the intervention ( T3 ) . RESULTS No training-related medical problems occurred in the study group . Forty-five patients ( 79 % ) completed all assessment s after the intervention and follow-up period . Adherence was excellent in both groups ( intervention 85.4 + /- 27.8 % vs control 84.2 + /- 29.3 % ) . The patients in the intervention group increased strength , functional motor performance , and balance significantly . Fall-related behavioral and emotional restrictions were reduced significantly . Improvements persisted during the 3-month follow-up with only moderate losses . For patients of the control group , no change in strength , functional performance , or emotional status could be documented during intervention and follow-up . Fall incidence was reduced nonsignificantly by 25 % in the intervention group compared with the control group ( RR:0.753 CI:0.455 - 1.245 ) . CONCLUSIONS Progressive resistance training and progressive functional training are safe and effective methods of increasing strength and functional performance and reducing fall-related behavioral and emotional restrictions during ambulant rehabilitation in frail , high-risk geriatric patients with a history of injurious falls Background and Purpose — To evaluate the efficacy of supervised high-intensity progressive resistance training ( PRT ) on lower extremity strength , function , and disability in older , long-term stroke survivors . Methods — Forty-two volunteers aged 50 years and above , 6 months to 6 years after a single mild to moderate stroke , were r and omized into either a control group of upper extremity stretching or a PRT group that received a 12-week supervised high-intensity resistance training program consisting of bilateral leg press ( LP ) , unilateral paretic and nonparetic knee extension ( KE ) , ankle dorsiflexion ( DF ) , and plantarflexion ( PF ) exercises .  Functional performance was assessed using the 6-minute walk , stair-climb time , repeated chair-rise time , and habitual and maximal gait velocities . Self-reported changes in function and disability were evaluated using the Late Life Function and Disability Instrument ( LLFDI ) . Results — Single-repetition maximum strength significantly improved in the PRT group for LP ( 16.2 % ) , paretic KE ( 31.4 % ) , and nonparetic KE ( 38.2 % ) with no change in the control group . Paretic ankle DF ( 66.7 % versus −24.0 % ) , paretic ankle PF ( 35.5 % versus −20.3 % ) , and nonparetic ankle PF ( 14.7 % versus −13.8 % ) significantly improved in the PRT group compared with the control . The PRT group showed significant improvement in self-reported function and disability with no change in the control . There was no significant difference between groups for any performance-based measure of function . Conclusions — High-intensity PRT improves both paretic and nonparetic lower extremity strength after stroke , and results in reductions in functional limitations and disability An impaired ability to initiate walking is a common feature of postural instability and gait impairment in Parkinson 's disease . While progressive resistance training ( PRT ) has been proposed to be an effective modality to improve balance and gait function in people with Parkinson 's disease , there are a limited number of r and omized trials and no studies have evaluated gait initiation performance . Thus , the purpose of this study was to examine the potential benefits PRT on GI performance in people with Parkinson 's disease . Eighteen individuals with idiopathic PD were r and omly assigned to either a twice weekly PRT program or a non-contact control group for 10 weeks . Biomechanical analysis of GI was performed pre- and post-intervention . Dependent variables of interest included the displacement of the center-of-pressure ( COP ) during the anticipatory postural phase of GI as well as the initial stride length and velocity . The PRT group demonstrated improvements in the posterior displacement of the COP and the initial stride length and velocity . There were no improvements in any variables for the control subjects . These results suggest that PRT may be an effective non-pharmacological and nonsurgical treatment to improve GI performance in PWP Declined balance functions have adverse effects on elderly population .  Lower limbs muscle power training is currently an emerging concept in rehabilitation on individuals with decreased balance and mobility . In this prospect i ve , controlled study , we used a human-computer interactive video-game-based rehabilitation device ( LLPR ) for training of lower limb muscle power in the elderly . Forty ( aged > 65 years ) individuals were recruited from the community . Twenty participants in the exercise group received 30-min training , twice a week , using the LLPR system . The LLPR system allows participants to perform fast speed sit-to-st and ( STS ) movements . Twenty age-matched participants in the control group performed slow speed STS movements , as well as strengthening and balance exercises , with the same frequency and duration . The results were compared after 12 sessions ( 6 weeks ) of training . The mechanical and time parameters during STS movement were measured using the LLPR system . Modified falls efficacy scale ( MFES ) , Tinetti Performance-Oriented Mobility Assessment ( POMA ) , function reach test , five times sit to st and ( FTSS ) and Timed Up and Go ( TUG ) were administered to participants as clinical assessment s. Results showed that in the exercise group , all the mechanical and time parameters showed significant improvement . In control group , only the maximal vertical ground reaction force ( MVGRF ) improved significantly . For clinical assessment s ( balance , mobility , and self-confidence ) , exercise group showed significantly better scores . The STS movements in video-game-based training mimic real life situations which may help to transfer the training effects into daily activities . The effectiveness of lower limb muscle training is worthy of further investigation
It is also possible that PRT alone is not a robust intervention for balance control .
This is the first systematic synthesis of the literature to examine the effectiveness of PRT alone on balance performance in older adults .
The limited evidence presented in currently published data has not consistently shown that the use of PRT in isolation improves balance in this population .
The serious health , social and economic consequences of falls are well documented .
Lower extremity muscle weakness and power as well as balance impairment are major independent intrinsic contributors to falls and amenable to intervention .
Progressive resistance training ( PRT ) is widely accepted as an appropriate modality for treating sarcopenia and has been reported to improve balance .
However , other studies affirm no significant effect of PRT on balance .
To date , there is no clear , definitive statement or synthesis of studies that has examined the effect of PRT on balance .
Therefore , our objective was to systematic ally review the literature to probe the merit of PRT as a single intervention on balance performance in older adults .