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Background and objectives: Age-related losses of lower extremity muscle strength/power and deficits in static and particularly dynamic balance are associated with impaired functional performance and the occurrence of falls. It has been shown that balance and resistance training have the potential to improve balance and muscle strength in healthy older adults. However, it is still open to debate how the effectiveness of balance and resistance training in older adults is influenced by different factors. This includes the role of trunk muscle strength, the comprehensive effects of combined balance and resistance training, and the role of exercise supervision. Therefore, the primary objectives of this doctoral thesis are to investigate the relationship between trunk muscle strength and balance performance and to examine the effects of an expert-based balance and resistance training protocol on various measures of balance and lower extremity muscle strength/power in older adults. Furthermore, the impact of supervised versus unsupervised balance and/or resistance training interventions in the elderly will be evaluated.
Methods: Healthy older adults aged 63-80 years were included in a cross-sectional study, a longitudinal study, and a meta-analysis (range group means meta-analysis: 65.3-81.1 years) registering balance and muscle strength/power performance. Different measures of balance (i.e., static/dynamic, proactive, reactive) were examined using clinical (e.g., Romberg test) and instrumented tests (e.g., 10 meter walking test on a sensor-equipped walkway). Isometric strength of the trunk muscles was assessed using instrumented trunk muscle strength apparatus and lower extremity dynamic muscle strength/power was examined using clinical tests (e.g., Chair Stand Test). Further, a combined balance and resistance training protocol was applied to examine training-induced effects on balance and muscle strength/power as well as the role of supervision in older adults.
Results: Findings revealed that measures of trunk muscle strength and static steady-state balance as well as specific measures of dynamic steady-state balance were significantly associated in the elderly (0.42 ≤ r ≤ 0.57). Combined balance and resistance training significantly improved older adults' static/dynamic steady-state (e.g., Romberg test; habitual gait speed), pro-active (e.g., Timed Up and Go Test), and reactive balance (e.g., Push and Release Test) as well as muscle strength/power (e.g., Chair Stand Test) (0.62 ≤ Cohen’s d ≤ 2.86; all p < 0.05). Supervised compared to unsupervised balance and/or resistance training was superior in enhancing older adults' balance and muscle strength/power performance regarding all observed outcome categories [longitudinal study: effects for the supervised group 0.26 ≤ d ≤ 2.86, effects for the unsupervised group 0.06 ≤ d ≤ 2.30; meta-analysis: all between-subject standardized mean differences (SMDbs) in favor of the supervised training programs 0.24-0.53]. The meta-analysis additionally showed larger effects in favor of supervised interventions when compared to completely unsupervised interventions (0.28 ≤ SMDbs ≤ 1.24). These effects in favor of the supervised programs faded when compared with studies that implemented a small amount of supervised sessions in their unsupervised interventions (−0.06 ≤ SMDbs ≤ 0.41).
Conclusions: Trunk muscle strength is associated with steady-state balance performance and may therefore be integrated in fall-preventive exercise interventions for older adults. The examined positive effects on a large number of important intrinsic fall risk factors (e.g., balance deficits, muscle weakness) imply that particularly the combination of balance and resistance training appears to be a feasible and effective exercise intervention for fall prevention. Owing to the beneficial effects of supervised compared to unsupervised interventions, supervised sessions should be integrated in fall-preventive balance and/or resistance training programs for older adults.
During the last two decades, instability training devices have become a popular means in athletic training and rehabilitation of mimicking unstable surfaces during movements like vertical jumps. Of note, under unstable conditions, trunk muscles seem to have a stabilizing function during exercise to facilitate the transfer of torques and angular momentum between the lower and upper extremities. The present thesis addresses the acute effects of surface instability on performance during jump-landing tasks. Additionally, the long-term effects (i.e., training) of surface instability were examined with a focus on the role of the trunk in athletic performance/physical fitness.
Healthy adolescent, and young adult subjects participated in three cross-sectional and one longitudinal study, respectively. Performance in jump-landing tasks on stable and unstable surfaces was assessed by means of a ground reaction force plate. Trunk muscle strength (TMS) was determined using an isokinetic device or the Bourban TMS test. Physical fitness was quantified by standing long jump, sprint, stand-and-reach, jumping sideways, Emery balance, and Y balance test on stable surfaces. In addition, activity of selected trunk and leg muscles and lower limb kinematics were recorded during jump-landing tasks.
When performing jump-landing tasks on unstable compared to stable surfaces, jump performance and leg muscle activity were significantly lower. Moreover, significantly smaller knee flexion angles and higher knee valgus angles were observed when jumping and landing on unstable compared to stable conditions and in women compared to men. Significant but small associations were found between behavioral and neuromuscular data, irrespective of surface condition. Core strength training on stable as well as on unstable surfaces significantly improved TMS, balance and coordination.
The findings of the present thesis imply that stable rather than unstable surfaces provide sufficient training stimuli during jump exercises (i.e., plyometrics). Additionally, knee motion strategy during plyometrics appears to be modified by surface instability and sex. Of note, irrespective of surface condition, trunk muscles only play a minor role for leg muscle performance/activity during jump exercises. Moreover, when implemented in strength training programs (i.e., core strength training), there is no advantage in using instability training devices compared to stable surfaces in terms of enhancement of athletic performance.