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Objectives The objective of this systematic review and meta-analysis was to quantify the effectiveness of supervised vs. unsupervised balance and/or resistance training programs on measures of balance and muscle strength/ power in healthy older adults. In addition, the impact of supervision on training-induced adaptive processes was evaluated in the form of dose-response relationships by analyzing randomized controlled trials that compared supervised with unsupervised trials. Data Sources A computerized systematic literature search was performed in the electronic databases PubMed, Web of Science, and SportDiscus to detect articles examining the role of supervision in balance and/or resistance training in older adults. Study Eligibility Criteria The initially identified 6041 articles were systematically screened. Studies were included if they examined balance and/or resistance training in adults aged >= 65 years with no relevant diseases and registered at least one behavioral balance (e.g., time during single leg stance) and/or muscle strength/ power outcome (e.g., time for 5-Times-Chair-Rise-Test). Finally, 11 studies were eligible for inclusion in this meta-analysis. Study Appraisal Weighted mean standardized mean differences between subjects (SMDbs) of supervised vs. unsupervised balance/resistance training studies were calculated. The included studies were coded for the following variables: number of participants, sex, age, number and type of interventions, type of balance/strength tests, and change (%) from pre- to post-intervention values. Additionally, we coded training according to the following modalities: period, frequency, volume, modalities of supervision (i.e., number of supervised/unsupervised sessions within the supervised or unsupervised training groups, respectively). Heterogeneity was computed using I 2 and chi(2) statistics. The methodological quality of the included studies was evaluated using the Physiotherapy Evidence Database scale. Results Our analyses revealed that in older adults, supervised balance/resistance training was superior compared with unsupervised balance/resistance training in improving measures of static steady-state balance (mean SMDbs = 0.28, p = 0.39), dynamic steady-state balance (mean SMDbs = 0.35, p = 0.02), proactive balance (mean SMDbs = 0.24, p = 0.05), balance test batteries (mean SMDbs = 0.53, p = 0.02), and measures of muscle strength/power (mean SMDbs = 0.51, p = 0.04). Regarding the examined dose-response relationships, our analyses showed that a number of 10-29 additional supervised sessions in the supervised training groups compared with the unsupervised training groups resulted in the largest effects for static steady-state balance (mean SMDbs = 0.35), dynamic steady-state balance (mean SMDbs = 0.37), and muscle strength/power (mean SMDbs = 1.12). Further, >= 30 additional supervised sessions in the supervised training groups were needed to produce the largest effects on proactive balance (mean SMDbs = 0.30) and balance test batteries (mean SMDbs = 0.77). Effects in favor of supervised programs were larger for studies that did not include any supervised sessions in their unsupervised programs (mean SMDbs: 0.28-1.24) compared with studies that implemented a few supervised sessions in their unsupervised programs (e.g., three supervised sessions throughout the entire intervention program; SMDbs: -0.06 to 0.41). Limitations The present findings have to be interpreted with caution because of the low number of eligible studies and the moderate methodological quality of the included studies, which is indicated by a median Physiotherapy Evidence Database scale score of 5. Furthermore, we indirectly compared dose-response relationships across studies and not from single controlled studies. Conclusions Our analyses suggest that supervised balance and/or resistance training improved measures of balance and muscle strength/power to a greater extent than unsupervised programs in older adults. Owing to the small number of available studies, we were unable to establish a clear dose-response relationship with regard to the impact of supervision. However, the positive effects of supervised training are particularly prominent when compared with completely unsupervised training programs. It is therefore recommended to include supervised sessions (i.e., two out of three sessions/week) in balance/resistance training programs to effectively improve balance and muscle strength/power in older adults.
Background: Age-related postural misalignment, balance deficits and strength/power losses are associated with impaired functional mobility and an increased risk of falling in seniors. Core instability strength training (CIT) involves exercises that are challenging for both trunk muscles and postural control and may thus have the potential to induce benefits in trunk muscle strength, spinal mobility and balance performance. Objective: The objective was to investigate the effects of CIT on measures of trunk muscle strength, spinal mobility, dynamic balance and functional mobility in seniors. Methods: Thirty-two older adults were randomly assigned to an intervention group (INT; n = 16, aged 70.8 +/- 4.1 years) that conducted a 9-week progressive CIT or to a control group (n = 16, aged 70.2 +/- 4.5 years). Maximal isometric strength of the trunk flexors/extensors/lateral flexors (right, left)/rotators (right, left) as well as of spinal mobility in the sagittal and the coronal plane was measured before and after the intervention program. Dynamic balance (i.e. walking 10 m on an optoelectric walkway, the Functional Reach test) and functional mobility (Timed Up and Go test) were additionally tested. Results: Program compliance was excellent with participants of the INT group completing 92% of the training sessions. Significant group x test interactions were found for the maximal isometric strength of the trunk flexors (34%, p < 0.001), extensors (21%, p < 0.001), lateral flexors (right: 48%, p < 0.001; left: 53%, p < 0.001) and left rotators (42%, p < 0.001) in favor of the INT group. Further, training-related improvements were found for spinal mobility in the sagittal (11%, p < 0.001) and coronal plane (11%, p = 0.06) directions, for stride velocity (9%, p < 0.05), the coefficient of variation in stride velocity (31%, p < 0.05), the Functional Reach test (20%, p < 0.05) and the Timed Up and Go test (4%, p < 0.05) in favor of the INT group. Conclusion: CIT proved to be a feasible exercise program for seniors with a high adherence rate. Age-related deficits in measures of trunk muscle strength, spinal mobility, dynamic balance and functional mobility can be mitigated by CIT. This training regimen could be used as an adjunct or even alternative to traditional balance and/or resistance training.
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.