Effects of Combined Balance and Strength Training on Measures of Balance and Muscle Strength in Older Women With a History of Falls.

Sghaier Zouita,Amira Ben Moussa Zouita,Hassane Zouhal,Urs Granacher,Catherine Dziri,Thierry Paillard,Habiba Ferchichi,Anthony C Hackney,Ismail Laher

doi:10.3389/fphys.2020.619016

Abstract

ObjectiveWe investigated the effects of combined balance and strength training on measures of balance and muscle strength in older women with a history of falls.MethodsTwenty-seven older women aged 70.4 ± 4.1 years (age range: 65 to 75 years) were randomly allocated to either an intervention (IG, n = 12) or an active control (CG, n = 15) group. The IG completed 8 weeks combined balance and strength training program with three sessions per week including visual biofeedback using force plates. The CG received physical therapy and gait training at a rehabilitation center. Training volumes were similar between the groups. Pre and post training, tests were applied for the assessment of muscle strength (weight-bearing squat [WBS] by measuring the percentage of body mass borne by each leg at different knee flexions [0°, 30°, 60°, and 90°], sit-to-stand test [STS]), and balance. Balance tests used the modified clinical test of sensory interaction (mCTSIB) with eyes closed (EC) and opened (EO), on stable (firm) and unstable (foam) surfaces as well as spatial parameters of gait such as step width and length (cm) and walking speed (cm/s).ResultsSignificant group × time interactions were found for different degrees of knee flexion during WBS (0.0001 < p < 0.013, 0.441 < d < 0.762). Post hoc tests revealed significant pre-to-post improvements for both legs and for all degrees of flexion (0.0001 < p < 0.002, 0.697 < d < 1.875) for IG compared to CG. Significant group × time interactions were found for firm EO, foam EO, firm EC, and foam EC (0.006 < p < 0.029; 0.302 < d < 0.518). Post hoc tests showed significant pre-to-post improvements for both legs and for all degrees of oscillations (0.0001 < p < 0.004, 0.753 < d < 2.097) for IG compared to CG. This study indicates that combined balance and strength training improved percentage distribution of body weight between legs at different conditions of knee flexion (0°, 30°, 60°, and 90°) and also decreased the sway oscillation on a firm surface with eyes closed, and on foam surface (with eyes opened or closed) in the IG.ConclusionThe higher positive effects of training seen in standing balance tests, compared with dynamic tests, suggests that balance training exercises including lateral, forward, and backward exercises improved static balance to a greater extent in older women.

Highlights

Falls are a major cause of unintentional injury worldwide (Caldevilla et al, 2013)
The inclusion criteria for the study were: (1) able to walk more than 10 meters, either without or with assisting devices such as orthotics, a walker or a cane; (2) no symptoms of any severe neurological function or orthopedic abnormalities; (3) a Mini Mental State Examination Test (MMSE) score higher than 24 points; (4) no pain of intensity greater than 4/10 evaluated by a visual analog scale and (5) able to read the words on a monitor 60 cm away at eye level (Rempel et al, 2007)
4 questions from the lateral preference inventory were used which include (i) with which foot would you kick a ball to hit a target?, (ii) if you want to pick up a pebble with your toes, which foot would you use?, (iii) which foot would you use to step on a bug?, and (iv) if you had to step up onto a chair, which foot would you place on the chair first?

Summary

Introduction

Falls are a major cause of unintentional injury worldwide (Caldevilla et al, 2013). For people aged 65 or older, falls are the most common accident and can result in death, hospitalization, disability, loss of independence. Fear of falling can lead to activity restriction and reduce daily functions (Baixinho et al, 2014). The economic costs of falls related to medical and social care are substantial (Herdman and Kamitsuru, 2014). Risk factors for falls include environmental factors such as poor lightning, or internal factors such as balance deficits, gait disorders, and muscle weakness (Iglesias et al, 2017). Medication use, and deficits in mobility, muscle strength, gait and balance, have frequently been listed as fall risk factors (Baixinho et al, 2014; Sousa et al, 2016). In addition to chronic diseases, falls constitute another health care burden that is associated with high treatment costs and reduced quality of life (Hortobágyi et al, 2020)

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