Effects Of A Short, Intensive, Multi-component Physical Exercise Program In Elderly At Risk Of Falls

Abstract

Among older adults, falls are the leading cause of injuries and are responsible for significant disability, hospitalization, loss of independence, and reduced quality of life. Previous research showed that physical exercise (PE) is effective in preventing falls and has the potential to reduce serious fall-related injuries, emergency department visits, hospitalizations, nursing home placements, and functional decline. In most clinical trials the effect of PE was assessed by means of tests which assess a single “balance system”, while balance control is very complex and involves many different underlying systems. The BESTest Scale consists of 36 items, grouped into 6 systems: biomechanical constraints, stability limits/verticality, anticipatory postural adjustments, postural responses, sensory orientation, and gait stability. PURPOSE: To investigate the effects of a short (4 weeks), intensive (75 min sessions 3 times per week) PE program which included strength, coordination, gait, multisensory training, and single- and dual-task balance exercises on the balance of elderly subjects at risk of falls. METHODS: Thirty sedentary subjects aged 70+ years at risk of falls (Berg’s Balance Scale < 52) were recruited and randomly allocated to a Multi-Component Exercise group (MCE) or a Control group (CON). Main outcome was change in BESTest Scale (BT) total score. RESULTS: At baseline, the two groups were similar with respect to age, gender distribution, anthropometric measures and risk of falls (BESTest Scale Score 53.7±14.8 in CON and 55.0±10.8 in MCE, n.s.). At the end of the study, BT total score was 55.5±16.7 in CON group (n.s. vs. baseline) and 72.7±8.8 in MCE group (p<0.001 vs. baseline). The change of BT total score was 1.8 (95% CI -1.9-5.5) in the CON group and 17.7 (13.4-22.1) in the MCE group (p<0.001 between groups). Also, the MCE group significantly increased the scores of all the six balance subsystems of the BT. Eventually, the change of Berg’s Scale score was 0.9 (-0.2-2.1) in CON and 6.0 (4.4-7.6) in MCE (p<0.001). At the end of the study MCE subjects could not be considered at risk for falling any more. CONCLUSIONS: A 4 weeks, intensive, multi-component training program significantly improved balance in elderly subjects at risk of falls. The improvement affected the many systems involved in balance control.