Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women A HOME-BASED MULTIDIMENSIONAL EXERCISE PROGRAM REDUCED PHYSICAL IMPAIRMENT AND FEAR OF FALLING Physical activity program for older persons: effect on balance, strength, neuromuscular control, and reaction time. Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Training to Reduce Postural Sway and Increase Functional Reach in the Elderly The effectiveness of a combined exercise intervention on physical fitness factors related to falls in community-dwelling older adults The effect of a 12-week dynamic resistance strength training program on gait velocity and balance of older adults. [Strength and coordination training for prevention of falls in the elderly]. Physical Activity Across Adulthood and Physical Performance in Midlife 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 effect of a 12-month exercise trial on balance, strength, and falls in older women: a randomized controlled trial. A Randomized Trial of a Multifaceted Intervention to Reduce Falls Among Community-Dwelling Adults Physical activity in prefrail older adults: confidence and satisfaction related to physical function. Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial. Effects of a physical and nutritional intervention program for frail elderly people over age 75. A randomized controlled pilot treatment trial Long-term effects of a progressive and specific balance-training programme with multi-task exercises for older adults with osteoporosis: a randomized controlled study Best-practice physical activity programs for older adults: findings from the national impact study.
Abstract Objective : To assess the effectiveness of a home exercise programme of strength and balance retraining exercises in reducing  falls and injuries in elderly women . Design : R and omised controlled trial of an individually tailored programme of physical therapy in the home ( exercise group , n=116 ) compared with the usual care and an equal number of social visits ( control group , n=117 ) . Setting : 17 general practice s in Dunedin , New Zeal and . Subjects : Women aged 80 years and older living in the community and registered with a general practice in Dunedin . Main outcome measures : Number of falls and injuries related to falls and time between falls during one year of follow up ; changes in muscle strength and balance measures after six months . Results : After one year there were 152 falls in the control group and 88 falls in the exercise group . The mean ( SD ) rate of falls was lower in the exercise than the control group ( 0.87 ( 1.29 ) v 1.34 ( 1.93 ) falls per year respectively ; difference 0.47 ; 95 % confidence interval 0.04 to 0.90 ) . The relative hazard for the first four falls in the exercise group compared with the control group was 0.68 ( 0.52 to 0.90 ) . The relative hazard for a first fall with injury in the exercise group compared with the control group was 0.61 ( 0.39 to 0.97 ) . After six months , balance had improved in the exercise group ( difference between groups in change in balance score 0.43 ( 0.21 to 0.65 ) . Conclusions : An individual programme of strength and balance retraining exercises improved physical function and was effective in reducing  falls and injuries in women 80 years and older . Key messages Modifiable risk factors for falls in elderly people have been well defined ; they include loss of muscle strength and impaired balance A programme to improve strength and balance in women aged 80 years and older can be set up safely with four home visits from a physiotherapist This programme reduced falls and moderate injuries appreciably over the subsequent year in Dunedin , New Zeal and The benefit was most noticeable in elderly people who fell 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 Regular exercise has been recommended to improve balance , strength , and coordination in older persons . In this study , 44 persons , aged 50 to 75 years ( mean 62.4 yrs ) underwent assessment s of quadriceps strength , reaction time , neuromuscular control , and body sway on two occasions before beginning a 10-week exercise program . The subjects were retested for the same measures at the end of the program . The mean number of classes attended for the 40 subjects who were retested was 16.2 ( range 11 to 19 ) . On completion of the program , the subjects showed improved performance in the tests of quadriceps strength , reaction time , body sway on a firm surface with the eyes closed , and a compliant surface with the eyes open and closed . In contrast , a group of nonexercisers showed no improvements in any of the test measures . These results suggest that exercise may play a role in improving a number of sensorimotor systems that contribute to stability in older persons BACKGROUND recent studies have found that moderate intensity exercise is an effective intervention strategy for preventing falls  in older people . However , research is required to determine whether supervised group exercise programmes , conducted in community setting s with at-risk older people referred by their health care practitioner are also effective in improving physical functioning and preventing falls in this group . OBJECTIVES to determine whether participation in a weekly group exercise programme with ancillary home exercises over one year improves balance , muscle strength , reaction time , physical functioning , health status and prevents falls in at-risk community-dwelling older people . METHODS the sample comprised 163 people aged over 65 years identified as at risk of falling using a st and ardised assessment screen by their general practitioner or hospital-based physiotherapist , residing in South Western Sydney , Australia . Subjects were r and omised into either an exercise intervention group or a control group .  Physical performance and general health measures were assessed at baseline and repeated 6-months into the trial . Falls were measured over a 12-month follow-up period using monthly postal surveys . RESULTS at baseline both groups were well matched in their physical performance , health and activity levels . The intervention subjects attended a median of 23 exercise classes over the year , and most undertook the home exercise sessions at least weekly . At retest , the exercise group performed significantly better than the controls in three of six balance measures ; postural sway on the floor with eyes open and eyes closed and coordinated stability . The groups did not differ at retest in measures of strength , reaction time and walking speed or on Short-Form 36 , Physical Activity Scale for the Elderly or fear of falling scales . Within the 12-month trial period , the rate of falls in the intervention group was 40 % lower than that of the control group ( IRR=0.60 , 95 % CI 0.36 - 0.99 ) . CONCLUSIONS these findings indicate that participation in a weekly group exercise programme with ancillary home exercises can improve balance and reduce the rate of falling in at-risk community dwelling older people 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 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 This study tested whether a 12-week dynamic resistance strength training program can change gait velocity and improve measures of balance among adults age 65 and older . Fifty-five community-dwelling adults ( mean age = 71.1 ) were r and omized into an exercise ( n = 25 ) or control ( n = 30 ) group . The exercisers were requested to complete three bouts of strength training per week for 12 weeks using elastic tubing . At posttest the exercisers demonstrated slower gait velocity , enhanced balance , and an improved ability to walk backward , although none of these posttest measures was significantly different from the control group Since muscle strength and coordination training in healthy elderly people has been effective in the primary prevention , a program for geriatric patients with falls is presented . Its aim is safer walking by an increase in muscular strength and improved coordination . The exclusion criteria and the size of the training program define a group of over 75 year old patients , who will be compared with a group with light physical exercise in a r and omized fashion . The first results show a remarkable increase in strength and a low complication rate . The functional relevance of our program remains to be proven Background Evidence , mainly from cross-sectional studies , suggests that physical activity is a potentially important modifiable factor associated with physical performance and strength in older age . It is unclear whether the benefits of physical activity accumulate across life or whether there are sensitive periods when physical activity is more influential . Purpose To examine the associations of leisure-time physical activity across adulthood with physical performance and strength in midlife , and to test whether there are cumulative benefits of physical activity . Methods Using data on approximately 2400 men and women from the UK Medical Research Council National Survey of Health and Development , followed up since birth in March 1946 , the associations of physical activity levels during leisure time self-reported prospect ively at ages 36 , 43 , and 53 years with grip strength , st and ing balance , and chair rise times , assessed by nurses at age 53 years ( in 1999 ) , were examined in 2010 . Results There were independent positive effects of  physical activity at all three ages on chair rise performance , and at ages 43 and 53 years on st and ing balance performance , even after adjusting for covariates . These results were supported by evidence of cumulative effects found when using structured life course models . Physical activity and grip strength were not associated in women and , in men , only physical activity at age 53 years was associated with grip strength . Conclusions There are cumulative benefits of physical activity across adulthood on physical performance in midlife . Increased activity should be promoted early in adulthood to ensure the maintenance of physical performance in later life 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 : OBJECTIVE To determine whether a 12-month program of regular exercise can improve balance , reaction time , neuromuscular control , and muscle strength and reduce the rate of falling in older women . DESIGN A r and omized , controlled trial of 12 months duration . SETTING Conducted as part of the R and wick Falls and Fractures Study in Sydney , Australia . PARTICIPANTS One hundred ninety-seven women aged 60 to 85 years ( mean age 71.6 , SD = 5.4 ) who were r and omly recruited from the community . OUTCOME MEASURES Accidental falls , postural sway , reaction time , neuromuscular control , and lower limb muscle strength . MAIN RESULTS Exercise and control subjects were tested before , midway through , and at the end of the trial . At initial testing , exercisers and controls performed similarly in all tests and were well matched in relevant health and lifestyle factors . The mean number of classes attended for the 75 exercise subjects who completed the program was 60.0 ( range 26 - 82 ) . At the end of the trial , the exercise subjects showed improved performance in all five strength measures , in reaction time , neuromuscular control , body sway on a firm surface with the eyes open , and body sway on a compliant surface with the eyes open and closed . In contrast , there were no significant improvements in any of the test measures in the controls . In one test measure , hip flexion strength , the exercisers showed continued improvement throughout the study year . There was no significant difference in the proportion of fallers between the exercise and control subjects . Interesting trends were evident , however , between falls frequency and adherence to the exercise program . CONCLUSIONS These findings show that exercise can produce long-term benefits with regard to improving sensorimotor function in older persons . The findings also suggest that high compliance to an exercise program may reduce falls frequency , although further studies are required to conclusively demonstrate that exercise offers an effective means of preventing falls Using a r and omized controlled trial , we tested the efficacy of a fall prevention intervention to reduce falls among adults in a community-based health promotion program . Adults aged 65 and older within two counties were recruited ( control n = 257 ; intervention n = 286 ) . After 12 months , there was a significant decrease in the number of falls in both groups ( odds ratio = 0.45 , p < .04 ) , but the time by group membership interaction was not significant ( χ 2 = 0.15 , p < .69 ) . Multivariate analysis did not find significant differences between the control and intervention groups for physical function as measured by a balance test or a sitting/st and ing test . Further research is needed on effective methods to deliver multifaceted fall interventions to older adults who are already being served by community health promotion programs We examined the hypothesis that physical activity will have favorable effects on measures of self-efficacy for a 400-m walk and satisfaction with physical functioning in older adults 70 + years of age who have deficits in mobility . We r and omized a total of 412 adults aged 70 - 89 years at elevated risk for mobility disability to either a physical activity or a successful aging educational control intervention for 12 months . Participants in the physical activity intervention had more favorable changes in both outcomes as a result of treatment than those in the successful aging intervention . Gender , age , and scores on a short physical performance battery did not moderate these effects . Physical activity is an effective means of intervening on self-efficacy and satisfaction with physical function in older adults with impaired lower extremity functioning . This is an important finding in light of the importance of these process variables in behavior change and quality of life OBJECTIVES To determine the long-term effects of three strength and balance exercise interventions on physical performance , fall-related psychological outcomes , and falls in older people . DESIGN A single-blinded , four-group , r and omized controlled trial . SETTING Community , Germany . PARTICIPANTS Community-dwelling adults aged 70 to 90 who had fallen in the past 6 months or reported fear of falling . INTERVENTION After baseline assessment , 280 participants were r and omly assigned to the control group ( CG ; no intervention ; n = 80 ) or one of three strength and balance exercise interventions ( the strength and balance group ( SBG ; strength and balance only ; n = 63 ) , the fitness group ( FG ; strength and balance plus endurance training ; n = 64 ) , or the multifaceted group ( MG ; strength and balance plus fall risk education ; n = 73 ) . The interventions consisted of 32 one-hour group sessions in 16 weeks . MEASUREMENTS Data on physical performance , fall-related psychological outcomes , and falls were collected for 24 months . RESULTS Mixed-effects regression analyses showed improved short- and long-term ( 12 and 24 months , respectively ) physical performance for the SBG and FG , particularly regarding mobility , balance , and walking speed ( P < .05 ) . The improvements in physical performance outcomes were most prominent in the FG . Fall-related psychological outcomes , number of falls , and injurious falls were not significantly different from in the control group . CONCLUSION Training focusing on strength , balance , and endurance can enhance physical performance for up to 24 months in community-dwelling older adults . These findings did not translate to improved fall-related psychological outcomes or reduced incidence of falls . This demonstrates the need for a different approach ( e.g. , regarding intervention dose and components ) to gain intervention benefits in the multiple domains that contribute to independence and well-being in older adults Background and aims : There are few studies published that combine the interventions of physical training and nutrition . The aim of the present study was to describe the impact of a physical and nutritional intervention program for frail community-dwelling elderly people over the age of 75 . Methods : Ninety-six community-dwelling elderly people ( 58 women ) were r and omized to four different groups : i ) a physical training program ( aerobic , muscle strength , balance ) , ii ) a nutritional intervention program ( individually targeted advice and group sessions ) , iii ) a combination of these interventions , and iv ) a control group . At baseline subjects were screened for physical performance such as muscle strength , balance , mobility and activities of daily living , as well as nutritional aspects such as energy intake , body weight and fat-free mass . These measurements were repeated immediately after the intervention , which lasted for 12 weeks , and after another 6 months . Results : The intention-to-treat analysis indicated significant improvements in lower-extremity muscle strength in both training groups compared with the nutrition group at 1st follow-up . There were small significant changes for some of the balance measurements in the training group without nutrition treatment . The nutrition intervention did not show any significant results . Conclusions : This study shows the positive effect on lower-extremity muscle strength directly after the intervention . Balance training most probably needs to be more individualized in order to be effective for frail elderly people . Further studies are needed , with larger sample sizes , to investigate the effects of these types of interventions before any further conclusions can be drawn Objective : To evaluate long-term effects of balance-training on concerns about falling , gait , balance performance , and physical function in older adults with osteoporosis and increased risk of falling . Design : R and omized controlled trial , including three groups ( training , training+physical activity , and control group ) , with follow-ups at three , nine , and 15 months . Short-term , three-month follow-up , benefits for those who fulfilled the first follow-up ( n = 69 ) have previously been reported . Setting : Stockholm , Sweden . Participants : A total of 96 elderly , age 66–87 , with verified osteoporosis . Interventions : Balance-training programme including dual- and multitasks , with or without supplementary physical activity , three times/week over 12 weeks . Measurements : Concerns about falling Falls Efficacy Scale -International ( FES-I ) , walking at preferred speed with and without a cognitive dual-task and at fast speed , balance tests ( one-leg stance and modified figure-of-eight ) , and physical function Late-Life Function and Disability Instrument ( LLFDI ) . Results : Participants in the training group maintained positive effects throughout the study period for concerns about falling ( baseline vs. 15 months , median 27.5 vs. 23 points , p < 0.001 ) and walking performance ( baseline vs. 15 months , p ⩽ 0.05 with an improvement of 0.9–1.4 m/s ) . The Training+physical activity group declined to baseline values at the nine-month follow-up , and were even lower at the 15-month follow-up for concerns about falling ( median 26 vs. 26 points ) , walking performance ( changes of −0.02 to 0.04 m/s ) , and physical function ( mean 44.0 vs. 42.9 points ) . The control group remained unchanged throughout the study period . Conclusions : This balance-training programme reduced concerns about falling , and also improved gait in older adults with osteoporosis and increased risk of falling in a long-term perspective – important issues for fall prevention OBJECTIVES We assessed the impact of existing best- practice physical activity programs for older adults on physical activity participation and health-related outcomes . METHODS We used a multisite , r and omized trial with 544 older adults ( mean age 66 years ) and measures at baseline , 5 , and 10 months to test the impact of a multiple-component physical activity program compared with results for a control group that did not participate in such a program . RESULTS For adults who participated in a multiple-component physical activity program , we found statistically significant benefits at 5 and 10 months with regard to self-efficacy for exercise adherence over time ( P < .001 ) , adherence in the face of barriers ( P = .01 ) , increased upper- and lower-body strength ( P = .02 , P = .01 ) , and exercise participation ( P = .01 ) . CONCLUSIONS Best- practice community-based physical activity programs can measurably improve aspects of functioning that are risk factors for disability among older adults . US public policy should encourage these inexpensive health promotion programs
This review found that muscle strength , balance , and endurance can be improved by physical activity in people aged 40 - 65 years .
There were bigger effects on muscle strength from programs that used resistance exercises , indicating the need to include a resistance training component if strength enhancement is the goal
QUESTION Can physical activity  in adults aged 40 - 65 years enhance strength and balance and prevent falls ?