Effectiveness of progressive resistance strength training versus traditional balance exercise in improving balance among the elderly - a randomised controlled trial.
BACKGROUND
Falls are important health issues among the elderly people. Most falls in elderly result from abnormal balance control mechanisms. Balance and muscle force generation are directly related, and are associated with age related muscular changes. Studies addressing fall prevention have focused on various group and individualised strength training. However, evidence on strengthening of key muscles necessary for maintaining balance and postural control is lacking.


OBJECTIVE
To evaluate the effectiveness of individualised progressive resistance strength training (PRT) programme in improving balance for forward limits of stability in elderly with balance impairment, compared to traditional balance exercise (TBE), and combination of both (COMBI).


METHODS
This randomised controlled trial included three groups; 18 subjects in each aged ≥ 65 years, from the elderly care centres of Mangalore city in Southern India (between June 2008 and December 2012). Block randomisation technique was used and allocation concealment was done using sequentially arranged sealed opaque envelopes. The TBE group received 8 component traditional balance exercise; 4 times a week for 6 months. The PRT group received resistance training for the key muscles of lower extremities, using DeLormes and Watkins protocol. The COMBI group received PRT and TBE alternately (2 days of PRT and 2 days of TBE per week). Functional reach test (FRT) was used for measurement of forward limits of stability. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 15.


RESULTS
For functional reach, PRT group had steady progression from baseline to 6 months (p<0.001). The TBE and COMBI groups showed considerable initial improvement; beyond 3 months, moderate improvement was seen. The changes in scores of FRT were significantly better for PRT than TBE.


CONCLUSIONS
Individualised PRT intervention targeting the key muscles of lower limbs is more effective than TBE in improving forward limits of stability among non-frail elderly aged ≥65 years.
Associate Professor, Department of Physical Therapy, Kasturba Medical College , Mangalore, India .
Abraham M
AM
Joshua
Associate Dean Professor, Department of Biochemistry, Kasturba Medical College , Mangalore, India .
Vivian
V
D'Souza
Professor and Head, Department of Community Medicine, Kasturba Medical College , Mangalore, India .
B
B
Unnikrishnan
Associate Professor, Department of Community Medicine, Kasturba Medical College , Mangalore, India .
Prasanna
P
Mithra
Selection Grade Lecturer, Department of Community Medicine, Kasturba Medical College , Manipal, India .
Asha
A
Kamath
Associate Professor, Department of Pulmonary Medicine, Kasturba Medical College , Mangalore, India .
Vishak
V
Acharya
Medical Superintendent, Kasturba Medical College Hospital , Mangalore, India .
Anand
A
Venugopal
Balance; Elderly; Functional reach; Limits of stability; Postural stability; Progressive resistance strength training