Balance In Healthy Older Adults Research Articles

Transcranial Direct Current Stimulation for Improving Balance in Healthy Older Adults and Older Adults with Stroke: A Scoping Review.

Background/Objectives: Age-related decline in balance and postural control is common in healthy elders and is escalated in aging adults with stroke. Transcranial direct current stimulation (tDCS) has emerged as one of the promising brain stimulations adjoining therapeutic exercise to enhance the recovery of balance and motor functions in persons with and without neurological disorders. This review aims to summarize and compare the available evidence of the tDCS on improving balance in the older adults without neurological disorders and the older adults with stroke. Methods: The Ovid (Medline) database was searched from its inception through to 06/15/2024 for randomized controlled trials investigating tDCS for improving balance in older adults with and without stroke. Results: Overall, 20 appropriate studies (including 271 stroke subjects and 259 healthy older adults) were found. The data indicate mixed results of tDCS for improving balance in older adults with and without stroke. Conclusions: Based on current research evidence, we have not found a specific tDCS protocol that is more effective than other tDCS protocols for improving balance and postural control in healthy older adults and older adults with stroke. Further research should explore the ideal tDCS approach, possibly in conjunction with standard interventions, to optimize postural control and balance in healthy older adults and older adults with stroke.

Age-based stereotype threat effects on dynamic balance in healthy older adults.

Stereotype threat can lead older adults to perceive their experiences in a biased manner, giving rise to interfering thoughts and negative emotions that generate stress and anxiety. Negative beliefs about aging may serve as an additional factor that increases the need for attentional demand, potentially resulting in a performance level below their actual capabilities. In the present study, we asked whether negative aging stereotypes influence a dynamic balance task and explored the means to counteract them in healthy elderly participants. The performance of balance was compared in two groups of participants aged 65 to 75 years (n = 22) under stereotype threat or reduced-threat situation. Balance abilities were tested under dynamic conditions, requiring participants to maintain balance on a moving platform and using a gradient of difficulty (with eyes open or closed, without or with foam). Postural performance was evaluated by means of posturographic evaluation of the center of pressure displacement and motion analysis. Additionally, we investigated the effects of stereotype threat on a preferred walking speed task and on the Timed Up and Go (TUG) test. Participants under stereotype threat showed poorer balance, particularly in challenging conditions (eyes closed, on foam), with less effective body segments stabilization. Their postural stabilization on foam was worse compared to a solid surface. Conversely, those in the reduced threat condition maintained better body segment stabilization across all conditions, indicating consistent postural control regardless of the presence of foam. Stereotype threat did not affect preferred walking speed or the time to complete the "Time Up and Go" test. This study provides the first description of age-based stereotype threat effects on a dynamic balance task and how to counteract them in healthy older adults. We suggest that the decrease in postural performance observed in participants exposed to stereotype threat can be attributed to a split in attentional focus between negative intrusive thoughts and the attention needed for maintaining balance. These findings open new perspectives on how to overcome negative expectations when evaluating and training physical abilities, thereby contributing to fall prevention among older adults.

Effects of Modified-Otago Exercise Program on Four Components of Actual Balance and Perceived Balance in Healthy Older Adults

Falls are a serious problem for older adults, leading to adverse injuries and decreased quality of life. Balance impairment is a key factor in falls. The Otago Exercise Program (OEP) is a promising intervention for preventing falls, thereby improving balance and gait. Previous studies reported improved effects on balance using the OEP conducted in a group setting, and recommended additional walking. Walking is a feasible exercise that benefits both fall-related physical and physiological functions. This study aims to investigate the effects of a modified-Otago Exercise Program (modified-OEP) on four components of actual balance (static, dynamic, proactive, and reactive balance) and perceived balance in healthy older adults, by conducting the modified-OEP in a groupsetting, and including additional walking in one session to gain better efficacy. Participants aged 60–85 years old were randomly assigned to the modified-OEP group or the control group (CT). The modified-OEP consisted of 60 min sessions made up of 30 min of OEP and 30 min of walking, three times a week for 12 weeks, while no intervention was assigned to the control group. The modified-OEP group showed significant improvement in the four components of actual balance and in perceived balance. Furthermore, the modified-OEP group outperformed the control group in all parameters except for dynamic balance, after 12 weeks. The present study highlights the beneficial effects of a modified-OEP on all balance components. Additionally, this study is the first to demonstrate the measurement of all actual balance components as well as perceived balance.

Influence of stance width on standing balance in healthy older adults

Posturography is an objective way to systematically interpret postural control. Recent evidence suggests self-selected stance width when conducting posturography in healthy young participants, as it is easy to perform yet standardized. It is unclear, if this is similarly applicable to healthy older adults which can better serve as comparison group for persons with specific impairments, like Parkinson’s disease, who might have problems with set foot distances. The aim of this study was to investigate the influence of different stance widths on a set of parameters in healthy older adults. Twenty-four healthy elderly (65.6 ± 5.0 years, BMI 26.2 ± 4.5 kg/m2) participated in the study. Posturographic measurement consisted of two tests (body sway, BS; limits of stability, LoS) each assessed in five stance widths on a force platform. A series of time domain and frequency domain parameters, such as BS and LoS range, sample entropy, mean velocity, and balance functional reserve were calculated. Anthropometric parameters and self-selected stance width (mean 17.7 ± 4.7 cm) showed positive correlation. One-way repeated measures MANOVA revealed significant differences between all parameters and foot positions. Except for sample entropy in A-P dimension, univariate analysis showed significant effects of stance widths on the parameters with stronger effects on M-L dimensions. Outcomes acquired in self-selected stance width provide comparable results to standardized stance widths 20 and 30 cm. The recommendation of self-selected stance width can be adopted to older healthy subjects. Furthermore, it reflects a natural stance and includes individual body composition.

Impact of strength and balance on Functional Gait Assessment performance in older adults

BackgroundThe Functional Gait Assessment (FGA) evaluates postural stability in gait and predicts fall risk in older adults. Individual tasks within the FGA consider aspects of mobility assumed to require strength and/or balance to complete. Identifying how quantitative measures of strength and balance relate to FGA performance would allow for more targeted interventions based on one’s pattern of performance on different tasks. Research QuestionIs performance on the FGA (total score and individual task scores) related to measures of strength and balance in healthy older adults? MethodsIn a cross-sectional study, healthy older adults (N = 46) were evaluated with the FGA, measures of knee extensor strength, and balance (static stance and weight shifting) (N = 46). Correlational analyses were performed between FGA scores (total and individual) and measures of strength and balance. ResultsTotal FGA performance was positively correlated with knee extensor strength (maximum torque and rate of torque development). Individual FGA tasks of walking backwards (task 9) and stair climbing (task 10) had the highest correlations with strength measures. Total FGA performance was correlated with reduced postural sway in static balance tasks, but not with balance performance on the weight shifting tasks. The individual FGA task that challenged proprioceptive (task 7) inputs for balance was associated with static balance. SignificanceThe total FGA score is related to domains of strength and static balance. The results indicate that the FGA can be influenced by reduced strength and balance. The pattern of performance on individual FGA tasks may indicate whether reduced postural stability in gait is related to deficits in strength or balance domains in this older population.

Adaptations in Reactive Balance Strategies in Healthy Older Adults After a 3-Week Perturbation Training Program and After a 12-Week Resistance Training Program.

Both resistance training (RT) and perturbation-based training (PBT) have been proposed and applied as interventions to improve reactive balance performance in older adults. PBT is a promising approach but the adaptations in underlying balance-correcting mechanisms through which PBT improves reactive balance performance are not well-understood. Besides it is unclear whether PBT induces adaptations that generalize to movement tasks that were not part of the training and whether those potential improvements would be larger than improvements induced by RT. We performed two training interventions with two groups of healthy older adults: a traditional 12-week RT program and a 3-week PBT program consisting of support-surface perturbations of standing balance. Reactive balance performance during standing and walking as well as a set of neuro-muscular properties to quantify muscle strength, sensory and motor acuity, were assessed pre- and post-intervention. We found that both PBT and RT induced training specific improvements, i.e., standing PBT improved reactive balance during perturbed standing and RT increased strength, but neither intervention affected reactive balance performance during perturbed treadmill walking. Analysis of the reliance on different balance-correcting strategies indicated that specific improvements in the PBT group during reactive standing balance were due to adaptations in the stepping threshold. Our findings indicate that the strong specificity of PBT can present a challenge to transfer improvements to fall prevention and should be considered in the design of an intervention. Next, we found that lack of improvement in muscle strength did not limit improving reactive balance in healthy older adults. For improving our understanding of generalizability of specific PBT in future research, we suggest performing an analysis of the reliance on the different balance-correcting strategies during both the training and assessment tasks.

The Effects of Different Types of Dual Tasking on Balance in Healthy Older Adults.

Numerous of our daily activities are performed within multitask or dual task conditions. These conditions involve the interaction of perceptual and motor processes involved in postural control. Age-related changes may negatively impact cognition and balance control. Studies identifying changes related to dual-task actions in older people are need. This study aimed to determine the effects of different types of dual-tasking on the balance control of healthy older adults. The sample included 36 community-living older adults, performing two tests—a sway test and a timed up-and-go test—in three conditions: (a) single motor task; (b) dual motor task; and (c) dual motor task with cognitive demands. Cognitive processes (dual-task and cognition) affected static balance, increasing amplitude (p < 0.001) and frequency (p < 0.001) of the center of mass displacements. Dynamic balance revealed significant differences between the single motor condition and the other two conditions during gait phases (p < 0.001). The effect of dual-tasking in older adults suggests that cognitive processes are a main cause of increased variability in balance and gait when under an automatic control. During sit-to-stand, turning, and turn-to-sit movements under dual-tasking, the perceptive information becomes the most important focus of attention, while any cognitive task becomes secondary.

Effect of Transcranial Direct Current Stimulation on Walking Speed, Functional Strength, and Balance in Older Adults: A Randomized, Double-Blind Controlled Trial.

BackgroundThe purpose of this study was to investigate the immediate effect of transcranial direct current stimulation (tDCS) on walking speed, functional strength of lower limbs, and balance in healthy older adults. Through this study, we intend to introduce a new method to improve the physical function of older adults.Material/MethodsThis was a randomized, controlled, double-blind study in which participants and evaluators were blinded. Among 57 healthy adults (aged 65 years or older), 31 underwent tDCS, while 26 received sham stimulation. For the pre-test, participants performed a 10-meter walk test, functional strength test of lower limbs, and static and dynamic balance tests. Next, the primary motor cortex area was subjected to tDCS for 20 min. Tests were repeated as post-tests.ResultsThere were significant differences in group-by-time interaction for 10-meter walk speed, functional strength of lower limbs, and static balance on the left side (P<0.05). There was not a significant group-by-time interaction for dynamic and static balance on the right side (P>0.05). There were significant differences in the main effect of time for 10-meter walk speed, functional strength of lower limbs, static balance on the right side, and dynamic balance (P<0.05).ConclusionsResults showed tDCS was effective in improving gait and functional strength of the lower limbs in older adults. We recommend tDCS as a safe and effective way to improve motor performance and increase physical function, including walking and functional strength of lower limbs, in older adults.

Towards an Integrative “Lightness” of Being

Towards an Integrative “Lightness” of Being

Phase angle predicts physical function in older adults

BackgroundPhase angle (PhA) is recognized as an indicator of cellular health and may be a useful marker of physical functions in geriatric populations. AimsWe aim to analyse the ability of the Phase angle (PhA) to predict the physical function in older adults. Method113 healthy older adults (67 female and 46 male) performed physical tests using the Fullerton Battery – Senior Fitness Test, to assess their physical fitness. Bioelectrical impedance spectroscopy was used to determine PhA at 50KHz and dual-energy x-ray absorptiometry to assess body composition. ResultsPhA was positively associated with functional fitness composite, chair stand, arm curl and 6 min walk test and negatively related with chair sit-and-reach and 8-foot and go (p < 0.05). Even after adjusting for potential confounding variables such as age, sex and appendicular lean soft tissue, PhA showed an association with arm curl (ß = 0.23,p = 0.038), and 8-foot and go (ß=-0.214,p = 0.042). ConclusionsHigher values of PhA are related with a better physical function. Regardless of sex, age, and skeletal muscle, PhA predicts body strength, agility and dynamic balance in healthy older adults.

Lighten Up! Postural Instructions Affect Static and Dynamic Balance in Healthy Older Adults.

Background and ObjectivesIncreased fall risk in older adults is associated with declining balance. Previous work showed that brief postural instructions can affect balance control in older adults with Parkinson’s disease. Here, we assessed the effects of brief instructions on static and dynamic balance in healthy older adults.Research Design and MethodsNineteen participants practiced three sets of instructions, then attempted to implement each instructional set during: (1) quiet standing on foam for 30 s with eyes open; (2) a 3-s foot lift. “Light” instructions relied on principles of reducing excess tension while encouraging length. “Effortful” instructions relied on popular concepts of effortful posture correction. “Relax” instructions encouraged minimization of effort. We measured kinematics and muscle activity.ResultsDuring quiet stance, Effortful instructions increased mediolateral jerk and path length. In the foot lift task, Light instructions led to the longest foot-in-air duration and the smallest anteroposterior variability of the center of mass, Relax instructions led to the farthest forward head position, and Effortful instructions led to the highest activity in torso muscles.Discussion and ImplicationsThinking of upright posture as effortless may reduce excessive co-contractions and improve static and dynamic balance, while thinking of upright posture as inherently effortful may make balance worse. This may partly account for the benefits of embodied mindfulness practices such as tai chi and Alexander technique for balance in older adults. Pending larger-scale replication, this discovery may enable physiotherapists and teachers of dance, exercise, and martial arts to improve balance and reduce fall risk in their older students and clients simply by modifying how they talk about posture.

Head and neck extension more than 30° may disturb standing balance in healthy older adults

Although there is clinical evidence of postural instability at extreme angles of head extension, the effects of lower angles on balance have been not investigated. This study aimed to investigate the effects of different head and neck extension angles on standing balance in older adults, and to determine the critical angle of instability. Twenty-eight healthy older adults were tested at 0°, 20°, 30° and 40° head and neck extension. The center of pressure (COP) parameters were recorded with a force plate. Significant differences were observed between 30° and 40° compared to 0° in anteroposterior and mediolateral COP displacement and total COP velocity, and between 40° and 0° in mediolateral COP velocity. Head and neck extension at 30° was the critical angle associated with the appearance of instability, and this value should be considered in the ergonomic design of work and living spaces, exercise programming and daily activities in older adults.

A randomized, double-blind, placebo-controlled crossover study of the effects of levetiracetam on cognition, mood, and balance in healthy older adults.

The cognitive and mood effects of levetiracetam (LEV) in older adults are not known. This study compared the cognitive and mood effects of LEV to placebo in healthy older adults. Cognitive, mood, and balance variables were compared between LEV and placebo using a randomized, double-blind, placebo-controlled crossover study with two 5-week treatment periods. Healthy volunteers (n = 20) aged 65-80 (mean age 72.4) received either LEV or placebo in which the LEV target dose was 1,000 mg/day. Volunteers, aged 65-80, were without epilepsy to limit potentially confounding the impact of seizures and/or underlying neuropathology on outcomes. LEV was initiated at 250 mg twice a day for 2 weeks, then increased to 500 mg twice a day for 2 weeks, and then tapered to 250 mg twice a day for 1 week. This was randomized with placebo for the two treatment arms. Measures included standardized neuropsychological, mood, and balance tests yielding 32 variables. Balance was assessed using subjective report (e.g., A-B neurotoxicity scale) and objective data (e.g., Berg Balance Scale). Average LEV serum concentration was 16.9 (standard deviation [SD} 7.7). Repeated-measures analysis of variance (ANOVA) found no differences between LEV and placebo phases for 29 (90.6%) of 32 variables including no change in balance. Performance on LEV was better than placebo on a visual memory (MCG Complex Figure Recall; p = 0.007) and two attention tests (Trail Making Test, Part A, p = 0.009; Stroop Interference, p = 0.004). There was a trend for greater irritability and fatigue (POMS Anger and Fatigue) during the LEV phase (p = 0.029, p = 0.035). Effect-size changes were generally small (Cohen d < 0.5). LEV was well tolerated in this elderly population in terms of cognition, mood, and balance. When anticonvulsant medication is indicated for older adults, LEV has pharmacokinetic advantages, and these data indicate no adverse impact on cognition or balance.

A Narrative Synthesis of Nintendo Wii Fit Gaming Protocol in Addressing Balance Among Healthy Older Adults: What System Works?

Balance is crucial in performing functional tasks particularly among older adults. Exergaming is gaining attention as a novel approach to enhance balance in a number of clinical populations. The aim of this review was to synthesize and present published evidence for Nintendo Wii Fit™ gaming system protocols. These include game preference, intervention setting, and exercise dosage for improving balance in healthy older adults. Commonly used outcome measures were also identified. A literature search was developed using the PICOS strategy using keywords such as "older adult," "Nintendo Wii Fit," "exergaming," and "balance" in the databases: MEDLINE, PubMed, EMBASE, CINAHL, Scopus, Science Direct, and Web of Science. Sixteen articles were included with participants (n = 491) mostly female (69%), and mean age ranged between 71 and 85 years old. Participants were recruited mainly from the community. The most commonly used Wii Fit games were Table tilt, Soccer Heading, Ski Slalom, and Ski jump, performed three times per week, with a duration of 30 minutes per session for 6 weeks. Berg Balance Scale, Timed Up and Go Test, and Centre of Pressure were the most commonly used outcome measures. Wii Fit exergames can be a potential alternative to improve balance if safety and technical procedures are provided. With conflicting and mechanism-based evidence on dosage presented, exergaming parameters require further research before firm recommendations can be made. Clinically, effective dosage is an important component in any type of interventions, and exergaming should not be an exception.

Lower-extremity resistance training on unstable surfaces improves proxies of muscle strength, power and balance in healthy older adults: a randomised control trial.

BackgroundIt is well documented that both balance and resistance training have the potential to mitigate intrinsic fall risk factors in older adults. However, knowledge about the effects of simultaneously executed balance and resistance training (i.e., resistance training conducted on unstable surfaces [URT]) on lower-extremity muscle strength, power and balance in older adults is insufficient. The objective of the present study was to compare the effects of machine-based stable resistance training (M-SRT) and two types of URT, i.e., machine-based (M-URT) and free-weight URT (F-URT), on measures of lower-extremity muscle strength, power and balance in older adults.MethodsSeventy-five healthy community-dwelling older adults aged 65–80 years, were assigned to three intervention groups: M-SRT, M-URT and F-URT. Over a period of ten weeks, all participants exercised two times per week with each session lasting ~60 min. Tests included assessment of leg muscle strength (e.g., maximal isometric leg extension strength), power (e.g., chair rise test) and balance (e.g., functional reach test), carried out before and after the training period. Furthermore, maximal training load of the squat-movement was assessed during the last training week.ResultsMaximal training load of the squat-movement was significantly lower in F-URT in comparison to M-SRT and M-URT. However, lower-extremity resistance training conducted on even and uneven surfaces meaningfully improved proxies of strength, power and balance in all groups. M-URT produced the greatest improvements in leg extension strength and F-URT in the chair rise test and functional reach test.ConclusionAside from two interaction effects, overall improvements in measures of lower-extremity muscle strength, power and balance were similar across training groups. Importantly, F-URT produced similar results with considerably lower training load as compared to M-SRT and M-URT. Concluding, F-URT seems an effective and safe alternative training program to mitigate intrinsic fall risk factors in older adults.Trial registrationThis trial has been registered with clinicaltrials.gov (NCT02555033) on 09/18/2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0366-3) contains supplementary material, which is available to authorized users.

The Effectiveness of Pilates Exercise in Improving Balance in Healthy Older Adults: A Systematic Review

The Effectiveness of Pilates Exercise in Improving Balance in Healthy Older Adults: A Systematic Review

Balance, Attention and Concentration Improvements Following an Exergame Training Program in the Elderly

In Costa Rica, the elderly population has increased dramatically over the last decade. Little is known about the acute effects and chronic adaptations to video game (i.e., Exergames) training in this population. PURPOSE: To examine the acute effects and chronic adaptations to an exergame training program on attention, concentration, static and dynamic balance in older adults. METHODS: Twenty-seven healthy older adults (Mean age = 63.15 ± 5.79 yr.), were randomly assigned to an experimental and a control group. The experimental group played the Dance Dance Revolution (DDR) video game. A battery of physical and cognitive tests was applied before and after 15 sessions (3 sessions/week, 5 weeks) to measure attention, concentration, static and dynamic balance. RESULTS: Compared to controls, significant mean differences were found in the acute effect on dynamic balance (Pre = 5.19 ± 0.29 vs. Post= 4.78 ± 0.15 s, p = 0.0001), concentration (Pre = 740.71 ± 20.43 vs. Post = 766.14 ± 8.52 pts., p = 0.015), and attention (Pre = 54.93 ± 6.92 vs. Post = 69.14 ± 3.48 pts., p = 0.0001). Significant chronic effects were also found on concentration (Pre = 740.71 ± 20.43 vs. Post = 770.5 ± 7.22 pts., p = 0.002), attention (Pre = 54.93 ± 6.92 vs. Post = 72.86 ± 1.66 pts., p = 0.0001), and static (Pre = 0.0154 ± 0.0015 vs. Post = 0.0124 ± 0.0020 m/s, p = 0.006) and dynamic balance (Pre = 5.19 ± 0.29 vs. Post = 3.93 ± 0.27 s, p = 0.0001). CONCLUSIONS: Acute and chronic improvements were observed in attention, concentration, dynamic balance and static balance in healthy older adults playing the DDR exergame.

Comparative Effects of Horse Exercise versus Traditional Exercise Programs on Gait, Muscle Strength, and Body Balance in Healthy Older Adults

This study evaluates the separate effect and retention of 12-week traditional (TE) and horse (HE) exercise programs on physical function in healthy older participants (61 to 87 years old). Thirty-eight participants were randomly assigned to three groups: TE (n = 17), HE (n = 10), and control group (n = 11). TE and HE underwent a supervised exercise program (3 day/week). Maximal gait speed, muscle strength, and body balance were assessed at weeks 0, 12, and 16. Only TE and HE displayed significant improvements (P < .05) in knee extensor strength, and only HE had faster gait speed. Marginal balance improvements were found only in HE in the medial-lateral direction. However, TE showed larger improvements in handgrip than HE. The largest retention was in knee extensor strength but most of the exercise effects were lost in the follow-up. Besides TE, exercise with a horse may be an alternative option to older adults, provided that they want to interact with the animal.

The Effect of Transcutaneous Electrical Nerve Stimulation (TENS) Applied to the Foot and Ankle on Strength, Proprioception and Balance: A Preliminary Study

Background: Transcutaneous electrical nerve stimulation (TENS) promotes upper motor neuron excitability which has the potential to improve function. As a precursor to clinical trials, we investigated the potential efficacy of TENS on strength, proprioception and balance in healthy older adults. Method: Design: A paired-sample randomized crossover trial. No stimulation was the control. Intervention: A one-off session of TENS (Modulated frequency: 70-130Hz, 5 second cycle) via a conductive sock. Participants: 25 healthy older volunteers with no pre-existing balance or mobility limitations or contra-indications to TENS. Outcomes: Dorsiflexor and plantarflexor strength and proprioception using an isokinetic dynamometer and balance (postural sway and forward reach test). Analysis: Paired t-tests Results: None of the parameters showed any significant changes with TENS (p>0.05). Conclusions: The stimulation of cutaneous sensory nerve endings of the foot with the application of TENS showed no immediate effect on the ankle proprioception, lower leg muscle strength, and postural stability. The concern that TENS would have a distracting impact on sensation and balance was not supported according to these results.

Comparative Effects of Horse Exercise Versus Traditional Exercise Programs on Gait, Muscle Strength, and Body Balance in Healthy Older Adults

This study evaluates the separate effect and retention of 12-week traditional (TE) and horse (HE) exercise programs on physical function in healthy older participants (61 to 87 years old). Thirty-eight participants were randomly assigned to three groups: TE (n = 17), HE (n = 10), and control group (n = 11). TE and HE underwent a supervised exercise program (3 day/week). Maximal gait speed, muscle strength, and body balance were assessed at weeks 0, 12, and 16. Only TE and HE displayed significant improvements (P < .05) in knee extensor strength, and only HE had faster gait speed. Marginal balance improvements were found only in HE in the medial-lateral direction. However, TE showed larger improvements in handgrip than HE. The largest retention was in knee extensor strength but most of the exercise effects were lost in the follow-up. Besides TE, exercise with a horse may be an alternative option to older adults, provided that they want to interact with the animal.