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. Physical activity, muscle function, falls and fractures Effects of 18-month low-magnitude high-frequency vibration on fall rate and fracture risks in 710 community elderly—a cluster-randomized controlled trial Effects of exercise and nutrition on postural balance and risk of falling in elderly people with decreased bone mineral density: randomized controlled trial pilot study Randomised controlled trial of effect of high-impact exercise on selected risk factors for osteoporotic fractures Effects of vertical and side-alternating vibration training on fall risk factors and bone turnover in older people at risk of falls. Ankle force and rate of force production increase following high intensity strength training in frail 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 Impact of Tai Chi exercise on multiple fracture-related risk factors in post-menopausal osteopenic women: a pilot pragmatic, randomized trial Posturography and Risk of Recurrent Falls in Healthy Non-Institutionalized Persons Aged Over 65 Selected as the best paper in the 1990s: Reducing frailty and falls in older persons: an investigation of tai chi and computerized balance training. Physical activity, functional limitations, and the risk of fall-related fractures in community-dwelling elderly. Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. The effects of muscle fatigue on and the relationship of arm dominance to shoulder proprioception. Does a Single Session of High-Intensity Interval Training Provoke a Transient Elevated Risk of Falling in Seniors and Adults? A cluster randomised controlled trial to prevent injury due to falls in a residential aged care population. Training to Reduce Postural Sway and Increase Functional Reach in the Elderly
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 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 Summary This study is a prospect i ve cluster-r and omized controlled clinical trial involving 710 elderly subjects to investigate the long-term effects of low-magnitude high-frequency vibration ( LMHFV ) on fall and fracture rates , muscle performance , and bone quality . The results confirmed that LMHFV is effective in reducing fall incidence and enhancing muscle performance in the elderly . Introduction Falls are direct causes of fragility fracture in the elderly . LMHFV has been shown to improve muscle function and bone quality . This study is to investigate the efficacy of LMHFV in preventing fall and fractures among the elderly in the community . Methods A cluster-r and omized controlled trial was conducted with 710 postmenopausal females over 60 years . A total of 364 participants received daily 20 min LMHFV ( 35 Hz , 0.3 g ) , 5 days/week for 18 months ; 346 participants served as control .  Fall or fracture rate was taken as the primary outcome . Also , quadriceps muscle strength , balancing abilities , bone mineral density ( BMD ) , and quality of life ( QoL ) assessment s were done at 0 , 9 , and 18 months . Results With an average of 66.0 % compliance in the vibration group , 18.6 % of 334 vibration group subjects reported fall or fracture incidences compared with 28.7 % of 327 in the control ( adjusted HR = 0.56 , p = 0.001 ) . The fracture rate of vibration and control groups were 1.1 and 2.3 % respectively ( p = 0.171 ) . Significant improvements were found in reaction time , movement velocity , and maximum excursion of balancing ability assessment , and also the quadriceps muscle strength ( p < 0.001 ) . No significant differences were found in the overall change of BMD . Minimal adverse effects were documented . Conclusion LMHFV is effective in fall prevention with improved muscle strength and balancing ability in the elderly . We recommend its use in the community as an effective fall prevention program and to decrease related injuries Objective : To compare the effect of calcium/vitamin D supplements with a combination of calcium/vitamin D supplements and exercise/protein on risk of falling and postural balance . Design : R and omized clinical trial . Setting : University hospital physiotherapy department . Subjects : Twenty-four independently living elderly females aged 65 years and older with osteopenia or osteoporosis and mean total hip T-score ( SD ) of —1.8 ( 0.8 ) . Interventions : A three-month programme consisting of exercise/protein including training of muscular strength , co-ordination , balance and endurance . Calcium/ vitamin D was supplemented in all participants for a 12-month period . Outcome measures : Assessment took place prior to and following the months 3 , 6 , 9 and at the end of the study ; primary dependent variables assessed were risk of falling ( Berg Balance Test ) and postural balance ( forceplate ) . Secondary measures included body composition , strength , activity level , number of falls , bone mineral content , biochemical indices , nutritional status and general health . Results : Significant reductions of risk of falling ( repeated measures ANOVA F = 8.90 , P = 0.008 ) , an increase in muscular strength ( ANOVA F = 3.0 , P = 0.03 ) , and an increase in activity level ( ANOVA F = 3.38 , P = 0.02 ) were found in the experimental group as compared to the control group . Further on , there was 89 % reduction of falls reported in the experimental group ( experimental pre/post 8/1 falls ; control group pre/post 5/6 falls ) . Conclusion : This study provides support for our intervention programme aim ed at reducing the risk of falling in elderly participants diagnosed with osteopenia or osteoporosis . The data obtained from the pilot study allow the calculation of the actual sample size needed for a larger r and omized trial BACKGROUND Osteoporotic fractures among the elderly are common , and without preventive measures the burden of these fractures on health-care systems will increase further . The purpose of this r and omised controlled study was to evaluate , in premenopausal women , the effects of high-impact loading on several determinants osteoporotic fractures . METHODS 98 healthy , sedentary female volunteers aged 35 - 45 years were r and omly assigned to either a training ( n = 49 ) or a control group ( n = 49 ) . Progressive high-impact exercises were done three times per week for 18 months . We measured bone mineral density ( BMD ) in specific axial and lower-limb sites , by dual-energy X-ray absorptiometry , at baseline and after 12 and 18 months . Maximum isometric strength , muscular and cardiovascular performance , and dynamic balance were also assessed . FINDINGS BMD at the femoral neck , a weightbearing site , increased significantly more in the training group ( mean 1.6 % [ 95 % CI 0.8 - 2.4 ] ) than in the control group ( 0.6 % [ -0.2 to 1.4 ] , p = 0.006 ) . By contrast , at non-weightbearing sites , such as the distal radius , there was no significant difference between the training and control groups ( -1.5 % [ -2.7 to -0.3 ] vs -0.7 % [ -1.9 to -0.5 ] , p = 0.60 ) . In the training group there was a significant improvement in vertical jump and predicted oxygen consumption per min at maximum exercise compared with controls . INTERPRETATION High-impact exercises that load bones with a rapidly rising force profile in versatile movements improve skeletal integrity , muscular performance , and dynamic balance in premenopausal women . If done on a regular basis , this type of exercise may help decrease the risk of osteoporotic fractures in later life . Long-term studies are required to show whether these 18-month results can be translated into long-term benefit BACKGROUND whole-body vibration training may improve neuromuscular function , falls risk and bone density , but previous studies have had conflicting findings . OBJECTIVE this study aim ed to evaluate the influence of vertical vibration ( VV ) and side-alternating vibration ( SV ) on musculoskeletal health in older people at risk of falls . DESIGN single-blind , r and omised , controlled trial comparing vibration training to sham vibration ( Sham ) in addition to usual care . PARTICIPANTS participants were 61 older people ( 37 women and 24 men ) , aged 80.2 + 6.5 years , referred to an outpatient falls prevention service . METHODS participants were r and omly assigned to VV , SV or Sham in addition to the usual falls prevention programme . Participants were requested to attend three vibration sessions per week for 12 weeks , with sessions increasing to six , 1 min bouts of vibration . Falls risk factors and neuromuscular tests were assessed , and blood sample s collected for determination of bone turnover , at baseline and following the intervention . RESULTS chair st and time , timed-up- and -go time , fear of falling , NEADL index and postural sway with eyes open improved in the Sham group . There were significantly greater gains in leg power in the VV than in the Sham group and in bone formation in SV and VV compared with the Sham group . Conversely , body sway improved less in the VV than in the Sham group . Changes in falls risk factors did not differ between the groups . CONCLUSIONS whole-body vibration increased leg power and bone formation , but it did not provide any additional benefits to balance or fall risk factors beyond a falls prevention programme in older people at risk of falls Background and aims : The most common cause of accidental injury and death in people over age 65 results from impacts associated with falling . Balance impaired older adults have poorer balance control than healthy young adults or healthy older adults . Lack of sufficient lower extremity strength and inability to rapidly produce muscle force may contribute to diminished balance control in the elderly . This study evaluated the effect of a 10-week high intensity strength- training program targeting key lower extremity muscles for the purpose of improving postural control in frail older adults . Methods : Thirteen experimental and fourteen control subjects , all balance impaired older adults were evaluated in response to unexpected platform perturbations that simulated slips . Results : Following strength training the experimental group was significantly stronger than the control group . Mean ankle moments improved in the experimental group following strength training during forward sway ( Right : p=0.067 , Left : p=0.009 ) and backward sway ( Right : p=0.031 , Left : p=0.058 ) . For the backward sway condition the ankle rate of torque production increased significantly in the experimental group ( Right : p=0.016 , Left : p=0.031 ) . Conclusions : Enhancement of lower extremity strength contributed to improvements in balance stability demonstrated by greater ankle force production , in response to balance threats 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 Tai Chi ( TC ) is a mind-body exercise that shows potential as an effective and safe intervention for preventing fall-related fractures in the elderly . Few r and omized trials have simultaneously evaluated TC 's potential to reduce bone loss and improve fall-predictive balance parameters in osteopenic women . Methods In a pragmatic r and omized trial , 86 post-menopausal osteopenic women , aged 45 - 70 , were recruited from community clinics . Women were assigned to either nine months of TC training plus usual care ( UC ) vs. UC alone . Primary outcomes were changes between baseline and nine months of bone mineral density ( BMD ) of the proximal femur and lumbar spine ( dual-energy X-ray absorptiometry ) and serum markers of bone resorption and formation . Secondary outcomes included quality of life . In a sub sample ( n = 16 ) , quiet st and ing fall-predictive sway parameters and clinical balance tests were also assessed . Both intent-to-treat and per- protocol analyses were employed . Results For BMD , no intent-to-treat analyses were statistically significant ; however , per protocol analyses ( i.e. , only including TC participants who completed ≥ 75 % training requirements ) of femoral neck BMD changes were significantly different between TC and UC ( + 0.04 vs. -0.98 % ; P = 0.05 ) . Changes in bone formation markers and physical domains of quality of life were also more favorable in per protocol TC vs. UC ( P = 0.05 ) . Changes in sway parameters were significantly improved by TC vs. UC ( average sway velocity , P = 0.027 ; anterior-posterior sway range , P = 0.014 ) . Clinical measures of balance and function showed non-significant trends in favor of TC . Conclusions TC training offered through existing community-based programs is a safe , feasible , and promising intervention for reducing multiple fracture risks . Our results affirm the value of a more definitive , longer-term trial of TC for osteopenic women , adequately powered to detect clinical ly relevant effects of TC on attenuation of BMD loss and reduction of fall risk in this population .Trial Registration Clinical Trials.gov : Background : A poor postural stability in older people is associated with an increased risk of falling . The posturographic tool has widely been used to assess balance control ; however , its value in predicting falls remains unclear . Objective : The purpose of this prospect i ve study was to determine the predictive value of posturography in the estimation of the risk of recurrent falls , including a comparison with st and ard clinical balance tests , in healthy non-institutionalized persons aged over 65 . Methods : Two hundred and six healthy non-institutionalized volunteers aged over 65 were tested .  Postural control  was evaluated by posturographic tests , performed on static , dynamic and dynamized platforms ( static test , slow dynamic test and Sensory Organization Test [ SOT ] ) and clinical balance tests ( Timed ‘ Up & Go ’ test , One-Leg Balance , Sit-to-St and -test ) .  Subsequent falls were monitored prospect ively with self- question naire sent every 4 months for a period of 16 months after the balance testing . Subjects were classified prospect ively in three groups of Non-Fallers ( 0 fall ) , Single-Fallers ( 1 fall ) and Multi-Fallers ( more than 2 falls ) . Results : Loss of balance during the last trial of the SOT sensory conflicting condition , when visual and somatosensory inputs were distorted , was the best factor to predict the risk of recurrent falls ( OR = 3.6 , 95 % CI = 1.3–10.11 ) . Multi-Fallers showed no postural adaptation during the repetitive trials of this sensory condition , contrary to Non-Fallers and Single-Fallers . The Multi-Fallers showed significantly more sway when visual inputs were occluded . The clinical balance tests , the static test and the slow dynamic test revealed no significant differences between the groups . Conclusion : In a sample of non-institutionalized older persons aged over 65 , posturographic evaluation by the SOT , especially with repetition of the same task in sensory conflicting condition , compared to the clinical tests and the static and dynamic posturographic test , appears to be a more sensitive tool to identify those at high-risk of recurrent falls 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 This case-control study examines the association of vigorous and mild physical activity with  fall-related fractures in a community-dwelling population age 65 and older in South Florida .  Vigorous physical activity was defined as exercising , doing heavy housecleaning , or other hard labor three or more times per week in the month prior to the index date ; mild physical activity was defined as the number of hours per day subjects reported spending on their feet . A case was any subject who sustained a fall-related fracture ( ICD-9CM-800 through ICD-9CM-829 ) over a 21-month period ( n = 471 ) . Controls were at 10 % r and om sample selected from the Health Care Financing Administration Medicare files ( n = 712 ) . The presence of any limitation in activities of daily living ( ADL ) significantly modified the effect of vigorous physical activity . Physically active subjects with no limitations ( ADL = 0 ) were less likely to sustain a fall-related fracture than were inactive subjects with an adjusted odds ratio ( aOR ) of 0.6 , ( 0.5 - 0.8 95 % CI ) , and active subjects with any limitation ( ADL > or = 1 ) had an aOR of 3.2 ( 1.1 - 9.8 95 % CI ) . Limiting this analysis to 159 hip fracture cases produced similar results .  Mild physical activity  was not associated with fracture . These results suggest that vigorous physical activity is associated with a lower fracture risk among elderly persons who have no limitation in ADL and with a higher risk among those with any limitations OBJECTIVE To determine the relative importance of fall characteristics , body habitus , and femoral bone mineral density ( BMD ) in predicting hip fracture in community-dwelling elderly . DESIGN Prospect i ve case-control study . SETTING Community-based academic hospital . PARTICIPANTS A total of 149 ambulatory , community-dwelling fallers ( 126 women , 23 men ) aged 65 years and older , including 72 case patients ( fallers with hip fracture ) and 77 control fallers ( fallers with no hip fracture ) . MAIN OUTCOME MEASURES Fall characteristics , body habitus , femoral BMD . RESULTS Significant and independent risk factors for hip fracture in both sexes were direction of the fall ( adjusted odds ratio [ OR ] , 5.7 ; 95 % confidence interval [ CI ] , 2.3 to 14.0 ; P < .001 ) ; femoral neck BMD ( a decrease of 1 SD ; adjusted OR , 2.7 ; 95 % CI , 1.6 to 4.6 ; P < .001 ) ; potential energy of the fall ( an increase of 1 SD ; adjusted OR , 2.8 ; 95 % CI , 1.5 to 5.2 ; P < .001 ) ; and body mass index ( a decrease of 1 SD ; adjusted OR , 2.2 ; 95 % CI , 1.2 to 3.8 ; P < .01 ) . Importantly , the OR for the fall direction was unaffected by the addition or removal of BMD from the model . CONCLUSIONS We conclude that among elderly fallers -- in most of whom hip BMD is already less than the fracture threshold -- fall characteristics and body habitus are important risk factors for hip fracture and touch on a domain entirely missed by knowledge of BMD . These data suggest new targets for preventive therapy . In addition to the maintenance of bone density , reductions in fall severity ( eg , by use of trochanteric padding or enhancement of muscle strength ) may provide additional strategies for prevention of hip fracture in this age group It is hypothesized that proprioceptive information plays an important role in joint stabilization and that muscle fatigue may alter proprioceptive ability . The purpose of this study was to determine what effect shoulder muscle fatigue has on glenohumeral proprioception and to examine the relationship between arm dominance and shoulder proprioception . Eighty subjects without a history of glenohumeral pathology participated . Each was seated on an isokinetic dynamometer with a r and omly selected shoulder positioned in 90 degrees of abduction and elbow flexion . With vision blinded , the arm was passively positioned in 75 degrees of external rotation for 10 seconds , then passively returned to the neutral starting position . Three trials each of active and passive repositioning ( 2 degrees/sec ) were recorded . Following a fatigue protocol , both active and passive repositioning were reassessed . Testing order was r and omized . A significant difference was detected between pre- and post-fatigue scores . No significant difference was detected between dominant and nondominant extremities . No relationship between arm dominance and shoulder proprioception was established . It is concluded that shoulder proprioception is diminished in the presence of shoulder muscle fatigue , suggesting clinical rehabilitation protocol s must emphasize increasing muscular endurance Background : Balance and strength training can reduce seniors ' fall risk up to 50 % . Available evidence suggests that acute bouts of neuromuscular and endurance exercise deteriorate postural control . High-intensity endurance training has been successfully applied in different population s. Thus , it seemed valuable to examine the acute effects of high-intensity interval training ( HIIT ) on neuromuscular performance in seniors and young adults . Objective : The acute impact of a HIIT session on balance performance and muscle activity after exercise cessation and during post-exercise recovery was examined in young and old adults . We intended to investigate whether a transient exercise-induced fall-risk may occur in both groups . Methods : 20 healthy seniors ( age 70 ( SD 4 ) years ) and young adults ( age 27 ( SD 3 ) years ) were examined on 3 days . After exhaustive ramp-like treadmill testing in order to determine maximal heart rate ( HRmax ) on the first day , either a 4 × 4 min HIIT at 90 % of HRmax or a control condition ( CON ) was r and omly performed on the second and third day , respectively . Balance performance ( postural sway ) was assessed during single limb stance with open eyes ( SLEO ) and double limb stance with closed eyes ( DLEC ) . EMG was recorded for the soleus ( SOL ) , anterior tibialis ( TIB ) , gastrocnemius ( GM ) and peroneus longus ( PL ) muscles at the dominant leg . All measures were collected before , immediately as well as 10 , 30 and 45 min after HIIT and CON , respectively . Results : Compared to CON , HIIT induced significant increases of postural sway immediately after exercise cessation during SLEO in both groups ( adults : p < 0.001 , Δ = + 25 % sway ; seniors : p = 0.007 , Δ = + 15 % sway ) . Increased sway during DLEC was only found for seniors immediately and 10 min after HIIT ( post : p = 0.003 , Δ = + 14 % sway , 10 min post : p = 0.004 , Δ = + 18 % sway ) . Muscle activity was increased during SLEO for TIB until 10 min post in seniors ( 0.008 < p < 0.03 ) and immediately after HIIT in adults ( p < 0.001 ) . Conclusion : HIIT training may cause an acute ‘ open-fall-window ' with a transient impairment of balance performance for at least 10 min after exercise cessation in both groups . Occluded vision in seniors seems to prolong this period up to 30 min . Thus , the advantage of HIIT with regard to time efficiency seems debatable when considering transient HIIT-induced impairments of neuromuscular function OBJECTIVE To test the effectiveness of using a full-time project nurse to assist residential aged care facilities in using evidence -based approaches to falls injury prevention . DESIGN , SETTING AND PARTICIPANTS Cluster r and omised controlled trial involving 5391 residents in 88 aged care facilities in the Hunter and Lower Mid North Coast areas of New South Wales . Residents were followed for 545 days or until death or discharge . Data were collected from July 2005 to June 2007 . INTERVENTION Employment of a project nurse to encourage best- practice falls injury prevention strategies during the 17-month intervention period . MAIN OUTCOME MEASURES Monthly data about falls , falls injury and falls injury prevention programs ; audit of hospitalisation for fractured neck of femur . RESULTS Despite significant increases in the provision of hip protectors and use of vitamin D supplementation in both intervention and control facilities , there was no difference in the number of falls or falls injuries between the intervention and control groups , nor a reduction in falls overall . There was also no difference between the 7-month pre-intervention period and the intervention period in the number of falls or falls injuries . Factors related to residents having an increased risk of falls with fractured neck of femur included being ambulant , having dementia , increasing age , and having a high falls risk assessment score . CONCLUSION It is difficult to change falls risk among high-risk population s , including people with dementia . The use of important strategies such as hip protectors and vitamin D and calcium supplementation increased during the study , probably with contamination of control facilities . Longer follow-up may be required to measure the impact on falls outcomes of the strategy of using a facilitating nurse . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Registry ACTRN12605000540617 Poor balance is one of the most common risk factors for falling , a common cause of work-related injury and death . To evaluate the effects of a 10-week intervention program on balance in older adults , 12 participants aged 61–77 years ( age = 70.4 ± 5.4 years ; mean ± SD ) completed an exercise program ( 60 min , 2 days · week−1 for 10 weeks ) performed while laying/sitting on large air-filled exercise balls ( Thera-B and ® ) . Several postural sway composite scores ( determined while st and ing with feet apart and semit and em , eyes open and closed ) improved ( p ≤ 0.05 ) including medial – lateral amplitude and speed of sway ( reduced by ∼9 % ) , and instantaneous speed ( reduced by ∼13 % ) . Reductions in XY area approached ( p = 0.06 ) statistical significance and anterior – posterior amplitude and speed of sway did not change . Functional reach also improved ( 20.3 % ) . These results suggest that challenging the physiological systems involved in balance control while on the nonstable support surface of the exercise balls improves both static and dynamic balance in older adults and may reduce the risk for falling
CONCLUSION On the basis of systematic review of relevant literature , it appears that muscle fatigue induces clear deteriorations in reactive postural control .
BACKGROUND Falls are the leading cause of traumatic brain injury and fractures and the No. 1 cause of emergency department visits by older adults .
Although declines in muscle strength and sensory function contribute to increased falls in older adults , skeletal muscle fatigue is often overlooked as an additional contributor to fall risk .
In an effort to increase awareness of the detrimental effects of skeletal muscle fatigue on postural control , we sought to systematic ally review research studies examining this issue .
PURPOSE The specific purpose of this review was to provide a detailed assessment of how anticipatory and reactive postural control tasks are influenced by  acute muscle fatigue in healthy older individuals .