Exercises for Seniors – Directory of Scientific Studies

By Maurice

Exercises for Seniors
This page contains the largest directory of scientific studies on seniors’ exercises on the Web. (Know of a study that we’ve missed? Please contact us.)

You can filter the studies by clicking one of the buttons below, to choose the topic(s) you’re interested in:

Types of Exercises

Study Name

Strength and Endurance Training Prescription in Healthy and Frail Elderly

Publication Aging and Disease
Purpose The first purpose of this review was discuss the neuromuscular adaptations to strength training, as well as the cardiovascular adaptations to endurance training in healthy and frail elderly subjects.
In addition, the second purpose of this study was investigate the concurrent training adaptations in the elderly.

The article provides a review on existing literature on strength and enduarnce training. Subjects covered:

  1. Effects on muscle strength and power output: the influence of intensity, volume and velocity of movement.
  2. The functional benefits of the inclusion of power training in elderly.
  3. Effects on muscle hypertrophy.
  4. Special issue: positive effects of strength and muscle power training on frail elderly.
  5. Effects on cardiorespiratory fitness.
  6. Special issue II: Endurance training on frail elderly.
  7. Concurrent strength and endurance training in healthy elderly: Effects on muscle strength and power, Effects on muscle hypertrophy, Effects on cardiorespiratory fitness.

Strength training is an effective intervention to improve muscle strength, power output, and muscle mass in healthy and frail elderly populations. Endurance training induces improvements on VO2max and submaximal endurance capacity in these populations.

Therefore, a combination of strength and endurance training (i.e., concurrent training) in elderly populations is the most effective way to improve both neuromuscular and cardiorespiratory functions. Based on recent evidence, concurrent training performed at moderate weekly frequency (i.e., 2 times per week) may promote marked gains on muscle hypertrophy, strength and power gains in elderly subjects. The strength training should be performed at moderate- to high-intensity (i.e., 60–80% of 1RM), and moderate volume (i.e., 2 to 3 sets per exercise). Also, endurance training should be performed at moderate- to high-intensity (i.e., 60–85% of VO2max), and moderatevolume (i.e., 25 to 40 minutes).

For concurrent training protocols in which both strength and endurance training are performed on the same day, the strength and endurance gains may be optimized with strength training prior to endurance intra-session exercise sequence.

Moreover, twice per week may be an optimal weekly frequency to promote additional muscle mass and strength gains, as well as cardiorespiratory fitness in previously concurrent trained elderly.

Regarding improving the functional capacity of the elderly, the concurrent strength and endurance training prescription should include high-velocity strength training, designed to improve muscle power output, as muscle power has been associated with the functional capacity in elderly.


Based on the results found, the combination of strength and endurance training (i.e., concurrent training) performed at moderate volume and moderate to high intensity in elderly populations is the most effective way to improve both neuromuscular and cardiorespiratory functions. Moreover, exercise interventions that include muscle power training should be prescribed to frail elderly in order to improve the overall physical status of this population and prevent disability.

In addition to the positive effects of concurrent training on the functional capacity of healthy elderly individuals, another issue that must be further investigated is the potential benefits of combined strength and endurance training on the functional capacity of physically frail individuals, because such intervention improve the overall physical status of this population, maintain the independency and prevent disability and other adverse outcomes.

Based on the current knowledge, it seems that exercise interventions that include endurance, strength, and muscle power training should be prescribed to frail elderly in order to improve the functional capacity.

Study Name

Resistance Exercise for Knee Osteoarthritis

Publication PM&R
Purpose This article presents the effects of Resistance exercise (RX) on knee osteoarthritis (OA) and provides clinical guidelines for the prescription and expected adaptations to RX in the population with knee OA.
Methods This article will summarize the highest quality evidence (from randomized controlled trials) of the effects of Resistance exercise (RX) on knee osteoarthritis (OA).

Resistance exercise (RX) has been shown to be an effective intervention both for decreasing pain and improving physical function and self-efficacy.

RX may restore muscle strength and joint mechanics while improving physical function. RX also may normalize muscle firing patterns and joint biomechanics, leading to reductions in joint pain and cartilage degradation. These physical adaptations could lead to improved self-efficacy and decreased anxiety and depression.

RX can be prescribed and performed by patients across the spectrum of OA severity. When designing and implementing an RX program for a patient with knee OA, one should consider both the degree of OA severity and the level of pain. RX, either in the home or at a fitness facility, is an important component of a comprehensive regimen designed to offset the physical and psychological limitations associated with knee OA.

Unique considerations for this population include (1) monitoring pain during and after exercise, (2) providing days of rest when disease flares occur, and (3) infusing variety into the exercise regimen to encourage adherence.

Study Name

Exercise and depressive symptoms: A comparison of aerobic and resistance exercise effects on emotional and physical function in older persons with high and low depressive symptomatology

Publication The Journals of Gerontology Series B: Psychological Sciences and Social Sciences
Purpose This study examines and compares the effect of aerobic and resistance exercise on emotional and physical function among older persons with initially high or low depressive symptomatology.
Methods Data are from the Fitness, Arthritis and Seniors Trial, a trial among 439 persons 60 years or older with knee osteoarthritis randomized to health education (control), resistance exercise, or aerobic exercise groups. Depressive symptoms (assessed by the Center for Epidemiologic Studies–Depression scale) and physical function (disability, walking speed, and pain) were assessed at baseline and after 3, 9, and 18 months.

Compared with results for the control group, aerobic exercise significantly lowered depressive symptoms over time. No such effect was observed for resistance exercise.

The reduction in depressive symptoms with aerobic exercise was found both among the 98 participants with initially high depressive symptomatology and among the 340 participants with initially low depressive symptomatology and was the strongest for the most compliant persons.

Aerobic and resistance exercise significantly reduced disability and pain and increased walking speed both, and to an equal extent, in persons with high depressive symptomatology and persons with low depressive symptomatology.

Conclusion Consequently, exercise may be a more complete treatment option for depression, as this not only improves emotional function but also has a positive influence on physical function. There exist strong reciprocal associations between depression and health decline in older persons (Penninx et al., 1998, 1999). An exercise intervention could play an important role in preventing the process whereby physical and emotional dysfunction interact to cause a progressive downward spiral in the health of older persons.
Study Name

A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST)

Publication JAMA.
Purpose Objective: To determine the effects of structured exercise programs on self-reported disability in older adults with knee osteoarthritis.

Setting and design: A randomized, single-blind clinical trial lasting 18 months conducted at 2 academic medical centers.

Participants: A total of 439 community-dwelling adults, aged 60 years or older, with radiographically evident knee osteoarthritis, pain, and self-reported physical disability.

Interventions: An aerobic exercise program, a resistance exercise program, and a health education program.

Main outcome measures: The primary outcome was self-reported disability score (range, 1-5). The secondary outcomes were knee pain score (range, 1-6), performance measures of physical function, x-ray score, aerobic capacity, and knee muscle strength.

Results A total of 365 (83%) participants completed the trial. Overall compliance with the exercise prescription was 68% in the aerobic training group and 70% in the resistance training group. Postrandomization, participants in the aerobic exercise group had a 10% lower adjusted mean (+/- SE) score on the physical disability questionnaire (1.71 +/- 0.03 vs 1.90 +/- 0.04 units; P<.001), a 12% lower score on the knee pain questionnaire (2.1 +/- 0.05 vs 2.4 +/- 0.05 units; P=.001), and performed better (mean [+/- SE]) on the 6-minute walk test (1507 +/- 16 vs 1349 +/- 16 ft; P<.001), mean (+/-SE) time to climb and descend stairs (12.7 +/- 0.4 vs 13.9 +/- 0.4 seconds; P=.05), time to lift and carry 10 pounds (9.1 +/- 0.2 vs 10.0 +/- 0.1 seconds; P<.001), and mean (+/-SE) time to get in and out of a car (8.7 +/- 0.3 vs 10.6 +/- 0.3 seconds; P<.001) than the health education group. The resistance exercise group had an 8% lower score on the physical disability questionnaire (1.74 +/- 0.04 vs 1.90 +/- 0.03 units; P=.003), 8% lower pain score (2.2 +/- 0.06 vs 2.4 +/- 0.05 units; P=.02), greater distance on the 6-minute walk (1406 +/- 17 vs 1349 +/- 16 ft; P=.02), faster times on the lifting and carrying task (9.3 +/- 0.1 vs 10.0 +/- 0.16 seconds; P=.001), and the car task (9.0 +/- 0.3 vs 10.6 +/- 0.3 seconds; P=.003) than the health education group. There were no differences in x-ray scores between either exercise group and the health education group.
Conclusion Older disabled persons with osteoarthritis of the knee had modest improvements in measures of disability, physical performance, and pain from participating in either an aerobic or a resistance exercise program. These data suggest that exercise should be prescribed as part of the treatment for knee osteoarthritis.
Study Name

Training for older adults

Publication Annales de Réadaptation et de Médecine Physique
Purpose This article presents training methods used in the literature and their associated effects in order to adapt training protocols to older populations.

The article provides a review on existing literature and includes:

  1. Table 1 Health benefits of regular physical activity; 
  2. Improvement of muscle function using weights or elastic bands to place adjustable resistance on movements; the most common types of training sessions and their duration.
  3. Improvement in aerobic capacity: typical endurance training activities include cycling, walking, and swimming. Everyday activities that recruit a large muscle mass—such as window washing, vacuuming and gardening—are further examples.
  4. Risk management: It is important to get a thorough physical examination and undergo stress testing before resuming a relatively intense physical activity (e.g. cycling, hiking, jogging) [16].

Major contraindications to exercise and stress testing typically include recent myocardial necrosis, aortic stenosis, decompensated congestive heart failure, unstable angina, complex aneurysm, pulmonary embolism, and ventricular dysrhythmia. Relative contraindications include moderate aortic stenosis, uncontrolled supraventricular tachycardia and uncontrolled hypertension.


Strength and force exercises are safe for elderly subjects [8,9] and accidents are extremely rare provided the instructions given on the following pages are followed [3].

Osteoarthritis sufferers should be prescribed movement exercises to improve their mobility. These exercises should focus on rising from a chair, walking and everyday activities.

Individuals with established osteoporosis should be prescribed exercises that improve their balance and mobility and strengthen their muscles. All steps should be taken to reduce the risk of falls. Quick movements, such as jumping and running, should be avoided. Exercises that place too much stress on the spinal column, such as repeated bending, are contraindicated. Muscle strengthening exercises may be performed almost two to three times a week provided sessions are short (30 min) and weights and movements are moderate.

In the case of people with diabetes, the initial physical examination should be conducted to assess the cardiovascular, nervous, renal and visual functions and gauge the risk of complications. Patients should then be prescribed endurance exercises lasting for 20 min at the start of a protocol to several hours after a few weeks of training. In all cases, the weekly amount of exercise should make patients burn an extra 1000–2000 kcal/week, which corresponds to 3–6 hours of moderate to high-intensity exercise [6]. Extra attention should be paid to patients’ feet and gear (socks and shoes).

Patients who are severely overweight to obese should be prescribed a retraining protocol that includes endurance exercises, such as walking or cycling, and strength exercises. As endurance exercises are designed to raise calorie consumption, they should last for over 45 min and be of moderate intensity (40–60% of VO2 max or the heart rate reserve). Muscle strengthening exercises improve mobility by developing a certain level of functional reserve in everyday activities.

Moreover, endurance exercises offer the advantage of raising the metabolism during recovery and via the increase in muscle mass. It should be noted that equipment, such as bicycle seats and weight machines, may not always be suited to the geriatric population and may have to be changed.

Patients with hypertension should be prescribed a daily endurance activity lasting 40–60 min and at moderate intensity (40–70% of VO2 max). This activity may be supplemented with muscle strengthening activities after a long learning period on technique, such as proper breathing during strengthening exercises. To avoid increasing their blood pressure, subjects should never hold their breath while exercising.

Exercise is not ruled out for patients with respiratory failure. They should be prescribed endurance exercises that are intermittent at first (four sets lasting 3 min each) then continuous after a few weeks (20–30 min of exercise). The exercise intensity should be limited and ventilation and blood saturation should be monitored to control the risks of exceeding comfort and safety thresholds. Walking and cycling are recommended for such patients.

In the light of the risks involved and the fact that they are very deconditioned, cardiac failure patients should always perform a retraining protocol in the presence of a cardiologist and in a specialised facility. Their heart rate should be monitored at least during the first few months of readjustment.


To maximise benefits from adoption of a program to which the patient can adhere for long time, it is important to tailor the exercise prescription to the individual.

Ageing causes changes in a person’s cardiocirculatory fitness and muscle function. Physical exercise can mitigate the effects of age on these functions and preserve the functional reserve in elderly people [38].

In addition, it can maintain a person’s quality of life and help them to continue pursuing everyday activities. Scores of studies have shown that maintaining the quantity and quality (intensity) of physical activity can diminish the risk of cardiovascular mortality, prevent the development of some cancers, lower the risk of osteoporosis and increase longevity. Specific exercise programmes to improve cardiocirculatory fitness and muscle function have been developed over the past 20 years [3,23,29,36].

The possibility of improving both elements, essential even in extremely elderly subjects, has been proven [38]. Given the fact that the elderly population is growing, the adherence of elderly patients to this type of programme and the difficulty they encounter in adopting a more active lifestyle are a major concern [22,39].

Study Name

Strength Training in the Elderly

Publication Sports Medicine
Purpose The purpose of this article is to analyze the research literature on the effects of ST on risk factors for age-related diseases and disabilities that have been most commonly studied.
Methods Therefore, this review will discuss and critically evaluate the research literature on the effects of ST on risk factors for age-related diseases and disabilities that have been most commonly studied. For the purpose of this review, the topics will be limited to include the effects of ST on risk factors for sarcopenia, coronary heart disease (CHD), hypertension, diabetesmellitus,metabolic syndrome, obesity, osteoporosis and osteoarthritis. In addition, the prevention of disability will be discussed by focusing on the research literature that pertains to the effects of ST on the loss of flexibility with age and fall prevention.

Table 1 provides an overview comparing the effects of aging to the effects of ST on indicators of muscle function and health status. The following conclusions can be made about the effects of ST on risk factors for age-related diseases or disabilities:

(i) Approximately 2 decades worth of ageassociated losses in strength and muscle mass can be regained within the first couple of months of heavy resistance ST.

(ii) ST fails to produce substantial changes in VO2max, but can improve endurance performance.

(iii) There is little or no evidence that ST can improve mean values of lipoprotein-lipid profiles. It is possible that people with certain genotypes may be able to improve their profiles with ST, but no evidence for this exists at the present time.

(iv) There is no evidence that ST can reduce BP in elderly hypertensives, but there is now evidence for normalising BP in the high normal category.

 (v) Some studies show no changes in glucose tolerance with ST and others show reductions in plasma glucose in response to oral glucose tolerance tests. However, most studies show that ST can improve insulin action either through reductions ininsulin responses from oral glucose tolerance tests or increased glucose uptake from glycaemic clamp studies.

(vi) There is evidence for reductions in total body fat and intra-abdominal fat with ST. However, no studies that have reported this have been able to completely rule out the effects of diet.

(vii) There is some evidence that ST can increase RMR in older men, but there is little evidence for this effect in women. An explanation for this gender difference has not been determined, but differences in sympathetic neural activity in response to ST has been suggested.

(viii) The evidence for increases in BMD with ST is mixed, but there is good evidence for the effectiveness of ST in preventing age-associated losses in BMD.

(ix) Although there is little or no evidence for ST preventing falls, there is strong evidence for reduction in several risk factors for falls.

(x) There is no evidence from properly controlled studies that ST improves flexibility, even when both the agonist and antagonist muscle groups are trained through the full ROM. There is suggestive evidence that ST in itself may even worsen flexibility. Therefore, prolonged stretching should be a part of any well designed ST programme.

(xi) There is some evidence that ST may reduce symptoms of osteoarthritis in the knee, but better controlled studies are needed.

Study Name

Benefits of exercise training and the correlation between aerobic capacity and functional outcomes and quality of life in elderly patients with coronary artery disease

Publication The Kaohsiung Journal of Medical Sciences
Purpose The purpose of the current study is to investigate the beneficial effects of exercise training in elderly people with coronary artery disease (CAD), integrating exercise stress testing, functional mobility, handgrip strength, and health-related quality of life.
Methods Elderly people with CAD were enrolled from the outpatient clinic of a cardiac rehabilitation unit in a medical center. Participants were assigned to the exercise training group (N = 21) or the usual care group (N = 15). A total of 36 sessions of exercise training, completed in 12 weeks, was prescribed. Echocardiography, exercise stress testing, the 6-minute walking test, Timed Up and Go test, and handgrip strength testing were performed, and the Short-Form 36 questionnaire (SF-36) was administered at baseline and at 12-week follow-up.

Peak oxygen consumption improved significantly after training. The heart rate recovery improved from 13.90/minute to 16.62/minute after exercise training.

Functional mobility and handgrip strength also improved after training. Significant improvements were found in SF-36 physical function, social function, role limitation due to emotional problems, and mental health domains. A significant correlation between dynamic cardiopulmonary exercise testing parameters, the 6-minute walking test, Timed Up and Go test, handgrip strength, and SF-36 physical function and general health domains was also detected. 

Conclusion Twelve-week, 36-session exercise training, including moderate-intensity cardiopulmonary exercise training, strengthening exercise, and balance training, is beneficial to elderly patients with CAD, and cardiopulmonary exercise testing parameters correlate well with balance and quality of life.
Study Name

Improved Cardiorespiratory Endurance Following 6 Months of Resistance Exercise in Elderly Men and Women

Publication JAMA Internal Medicine
Purpose Objective: To examine the effect of 6 months of high- or low-intensity resistance exercise on aerobic capacity and treadmill time to exhaustion in adults aged 60 to 83 years.

Sixty-two men and women completed the study protocol. Subjects were matched for strength and randomly assigned to a control (n = 16), low-intensity exercise (LEX, n = 24), or high-intensity exercise (HEX, n = 22) group.

Subjects trained at either 50% of their one repetition maximum (1-RM) for 13 repetitions (LEX) or 80% of 1-RM for 8 repetitions (HEX) 3 times per week for 24 weeks. One set each of 12 exercises was performed. Strength was measured for the leg press, chest press, leg curl, leg extension, overhead press, biceps curl, seated row, and triceps dip. Muscular endurance was measured for the leg press and chest press.

Aerobic capacity (peak oxygen consumption [V̇O2 peak]) was measured during an incremental treadmill test (Naughton). Treadmill time to exhaustion was measured as the time to exhaustion during the incremental exercise test.

Results The 1-RM significantly increased (P≤.05) for all exercises tested for both the HEX and LEX groups. Aerobic capacity increased (P≤.05) by 23.5% (20.2 to 24.7 mL · kg−1· min−1) and by 20.1% (20.9 to 24.4 mL · kg−1· min−1) for the LEX and HEX groups, respectively. Treadmill time increased (P≤.05) by 26.4% and 23.3% for the LEX and HEX groups, respectively.
Conclusion Significant improvements in aerobic capacity and treadmill time to exhaustion can be obtained in older adults as a consequence of either high- or low-intensity resistance exercise. These findings suggest that increased strength, as a consequence of resistance exercise training, may allow older adults to reach and/or improve their aerobic capacity.
Study Name

Effects of stair‐climbing on balance, gait, strength, resting heart rate, and submaximal endurance in healthy seniors

Publication Scandinavian Journal of Medicine & Science in Sports
Purpose The purpose of this study is to provide data on neuromuscular and cardiorespiratory performance after regular stair‐climbing in seniors. Stair‐climbing serves as a feasible opportunity to remain physically active within everyday‐life.
Methods Forty‐eight seniors were stratified to a one‐ (taking every step, INT1) or two‐step strategy (every second step, INT2) or a control group (CON). Thirty‐nine seniors [females: n = 22, males: n = 17; age: 70.5 (SD 5.1) years; BMI: 25.8 (3.1) kg/m2] completed the 8‐week intervention (three weekly sessions). Before and after the intervention, balance, gait, strength, and submaximal endurance (at different intensities) were assessed.
Results Maximal strength and explosive power did not improve significantly (0.10 < P < 0.78). Resting heart rate was significantly reduced in INT2 (−8/min) compared with INT1 (0/min, P = 0.02) and CON (0/min, P = 0.03). Compared with CON, perceived exertion for all intensities (0.007 < P < 0.03) and submaximal exercise heart rate during moderate uphill walking significantly decreased (−11/min; P < 0.05) in INT2. Step counts for forward beam balancing (4.5 cm width) increased in INT2 (P = 0.007) compared with CON. With more pronounced effects in INT2, stair‐climbing significantly improved resting and exercise heart rates, perceived exertion, and dynamic balance performance in healthy seniors and may contribute to better overall fitness, reduced fall risk, and less perceived strain during daily life activities.

In this respect, the results of the present study provide evidence that small amounts of regular stairclimbing can result in relevant adaptations in submaximal endurance, resting heart rate, and dynamic balance in active and healthy community-dwelling elderly. No significant effects were present in static balance, strength, and gait.

The observed adaptations may contribute to better overall fitness, reduced fall risk, and less exertion during daily life activities. Regular stair-climbing, thus, can contribute to a healthy lifestyle and limit the aging induced physical decline in seniors. The observed benefits seem to be more pronounced when taking only every second step. This strategy might be suitable and effective for healthy and active seniors. More frail seniors might also benefit from using the one-step strategy.

However, this remains an interesting perspective for future research. The widespread implementation of stair-climbing activities into everyday life, for instance by multicomponent campaigns (Lewis & Eves, 2012) including motivational and volitional measures such as point-of-decision prompts (Soler et al., 2010) with particular regard to relevant target groups and more frail elderly seems promising from a public health perspective.

Study Name

Resource Manual for Active Seniors

Publication International Institute for Sport and Human Performance, University of Oregon
Purpose This paper provides organized information on topics of interest for active seniors, including exercises.

This manual includes articles on various topics related to exercises for seniors, such as:

  1.  The Benefit of Exercise
  2.  The Proper Way to Stretch
  3.  Working Out in the Water
  4.  Walking is a Workout
  5.  Ideas for Resistance Training
  6. Working Out at Home with Exercise Bands
  7. Dance
  8. Fitness and Exercise
  9. Lap Swimming
  10. Stretching
  11. Tai Chi and Qigong
  12. Walking
  13. Yoga
Conclusion This paper is a resource manual for active seniors and includes refferences to studies/articles, assesses benefits of various exercises and offers some tips for acvtive seniors.
Study Name

Programs on People Older Than 80 Years

Publication Rejuvenation Research
Purpose This study aimed at comparing the effects of three chair-based exercise programs on people older than 80 years.
Methods Thirty-six participants (87.91 ± 4.70 years) were randomly allocated to an aerobic, muscular resistance, or joint mobility exercise program. The participants exercised 3 days per week during 3 months. A hand-held dynamometer, the Tinetti Gait Balance, the Barthel Index, and the Timed Up and Go Test (TUG) (assessed by means of the Wiva® science sensor) were used to evaluate the effects of the programs on the participants’ strength, balance, functional independence, and functional mobility, respectively.
Results After the intervention, it was observed that only the elastic-band program resulted in significant improvements in strength and balance.
Conclusion These results imply that when choosing a low-cost exercise program for very old people, the use of elastic bands stands as a far better option than pedaling on a pedal exerciser or performing mobility exercises.
Study Name
Publication American Journal of Health Promotion
Purpose Purpose: Determine the effects of 16 weeks of strength training using Thera-Band resistive bands on measures of functional ability in elderly who are functionally limited.

Design: Quasi-experimental trial in which elderly volunteers were assigned to either an exercise group or a control group.

Participants: Eighty-seven participants (65–93 years) living independently but with some functional limitations.

Intervention: Thirteen different strength training exercises using Thera-Band resistive bands (Hygenic Corporation, Akron, Ohio). The program was 16 weeks in duration, and the frequency was three times per week. Participants exercised in a group setting one time per week and were given a home exercise book to follow for two additional sessions per week.

Measures: Functional ability was operationalized to include a variety of measures related to functional ability that impact activities of daily living, morbidity, and mortality in the elderly, including upper- and lower-body strength and gait.

Analysis: Intervention effects were analyzed using a 2 (groups: exercise group vs. control group) X 3 (time: baseline vs. mid vs. post) analysis of variance.

Results The exercise group demonstrated significant improvements in upper-body strength as measured by biceps curl (F[2,140] = 39.870; p < .05) and lower-body strength as measured by chair sit-to-stand (F[2,124] = 25.887; p < .05). Gait velocity (F[2,140] = 37.317; p < .05) and step length (F[2,140] = 4.182; p < .05) both increased for the exercise group at week 9, but this increase disappeared by week 17. Compared with minimal changes in the control group, the exercise group demonstrated significant improvements in upper-body strength as measured by biceps curl and lower-body strength as measured by chair sit-to-stand.
Conclusion Some measures of function ability were improved after a 16-week structured exercise program for functionally limited elderly. Because functional ability has been inversely correlated with short-term morbidity and the need for assisted living among older adults, providing opportunities to exercise is crucial to future functioning and independence of the elderly population. (Am J Health Promot 2011;25[4]:237–243.)
Study Name

Resistance Exercise for Muscular Strength in Older Adults: A Meta-Analysis

Publication Ageing Research Reviews
Purpose The effectiveness of resistance exercise for strength improvement among aging persons is inconsistent across investigations, and there is a lack of research synthesis for multiple strength outcomes.

The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. A meta-analysis was conducted to determine the effect of resistance exercise (RE) for multiple strength outcomes in aging adults. Randomized controlled trials and randomized or non-randomized studies among adults ≥ 50 years, were included. Data were pooled using random effect models.

Outcomes for 4 common strength tests were analyzed for main effects. Heterogeneity between studies was assessed using the Cochran Q and I2 statistics, and publication bias was evaluated through physical inspection of funnel plots as well as formal rank-correlation statistics. A linear mixed model regression was incorporated to examine differences between outcomes, as well as potential study-level predictor variables

Results Forty-seven studies were included, representing 1079 participants. A positive effect for each of the strength outcomes was determined however there was heterogeneity between studies. Regression revealed that higher intensity training was associated with greater improvement. Strength increases ranged from 9.8 – 31.6 kg, and percent changes were 29 ± 2, 24 ± 2, 33 ± 3, and 25 ± 2, respectively for leg press, chest press, knee extension, and lat pull.
Conclusion RE is effective for improving strength among older adults, particularly with higher intensity training. Findings therefore suggest that RE may be considered a viable strategy to prevent generalized muscular weakness associated with ageing.
Study Name

Effects of combined strength and endurance training on treadmill load carrying walking performance in aging men

Publication Journal of Strength and Conditioning Research
Purpose The present study examined the effects of twice weekly total body strength training (ST), endurance cycling (ET), and combined ST and ET (2+2 times a week) (SET) training on the load carrying walking test performance on the treadmill (TM) and changes in neuromuscular and endurance performance during a 21-week training period in aging men.

Forty healthy men (54.8+/-8.0 years) were divided into 3 training groups (ET n=9, ST n=11, SET n=11) and a control group (C, n=9). Peak oxygen uptake (VO2peak), heart rate, and blood lactate concentration were measured before and after a 21-week training program using a graded TM and maximal incremental bicycle ergometer (BE) tests. Isometric forces, vertical jump, and electromyographic activity of leg extensor and/or forearm flexor (F) muscles were measured before and after training and the TM tests.
Strength training: was a total body program for the lower and upper extremities and trunk.

However, each training session included 2 exercises for the leg extensor muscles (bilateral leg press and knee extension), one exercise for the knee flexors (bilateral or unilateral knee flexion), and 4–5 other exercises for the other main muscle groups of the body (bench press, triceps pushdown, or lateral pull-down exercise for the upper body; sit-up exercise for the trunk flexors or another exercise for the trunk extensors; bilateral or unilateral elbow extension exercise and leg adduction or abduction exercise). Muscle strength exercises used during the first cycle of the training were carried out with light loads (40–60% of the 1 repetition maximum [1RM]) but with a high number of repetitions with multiple sets.

To optimize muscle mass development during the second cycle, the loads increased progressively up to 60–80% of the 1RM with a relatively short recovery time to produce muscle growth (31). The third cycle included somewhat higher loads (70–85% of the 1RM) to optimize strength gains. Both overall intensity and volume of training increased progressively throughout the training period after a periodized training program. The supervised training sessions averaged from 60 to 90 minutes in length (Table 2).

Results Increases of 20-21% in strength and of 7-12% in cycling BE VO2peak occurred in the training groups, whereas the changes of C remained minor. VO2peak was associated, both before and after training, with TM exercise time in all groups (from r=0.65, p=0.030 to r=0.93, p<0.001). Only SET showed a significant training-induced increase (p=0.011) in exercise time of the TM walking with no significant increase in TM VO2peak.
Conclusion The present data suggest that in older men ET and SET induced specific increases in BE VO2peak and ST and SET in strength. However, only SET increased walking exercise time indicating improved load carrying walking performance because of large individual differences in the magnitude of the development of either strength or endurance capacities.
Study Name

Effects of Different Exercise Interventions on Risk of Falls, Gait Ability, and Balance in Physically Frail Older Adults: A Systematic Review

Publication Rejuvenation Research
Purpose The aim of this review was to recommend training strategies that improve the functional capacity in physically frail older adults based on scientific literature, focusing specially in supervised exercise programs that improved muscle strength, fall risk, balance, and gait ability.
Methods Scielo, Science Citation Index, MEDLINE, Scopus, Sport Discus, and ScienceDirect databases were searched from 1990 to 2012. Studies must have mentioned the effects of exercise training on at least one of the following four parameters: Incidence of falls, gait, balance, and lower-body strength.

Twenty studies that investigated the effects of multi-component exercise training (10), resistance training (6), endurance training (1), and balance training (3) were included in the present revision. Ten trials investigated the effects of exercise on the incidence of falls in elderly with physical frailty. Seven of them have found a fewer falls incidence after physical training when compared with the control group. Eleven trials investigated the effects of exercise intervention on the gait ability.

Six of them showed enhancements in the gait ability. Ten trials investigated the effects of exercise intervention on the balance performance and seven of them demonstrated enhanced balance. Thirteen trials investigated the effects of exercise intervention on the muscle strength and nine of them showed increases in the muscle strength.

Conclusion The multi-component exercise intervention composed by strength, endurance and balance training seems to be the best strategy to improve rate of falls, gait ability, balance, and strength performance in physically frail older adults.
Study Name

Effects of exercise training on frailty in community-dwelling older adults: results of a randomized, controlled trial

Publication Journal of the American Geriatrics Society
Purpose Objectives: Although deficits in skeletal muscle strength, gait, balance, and oxygen uptake are potentially reversible causes of frailty, the efficacy of exercise in reversing frailty in community-dwelling older adults has not been proven. The aim of this study was to determine the effects of intensive exercise training (ET) on measures of physical frailty in older community-dwelling men and women.

Design: Randomized controlled trial.
Setting: Medical school research center.

Participants: One hundred fifteen sedentary men and women (mean age +/- standard deviation = 83 +/- 4) with mild to moderate physical frailty, as defined by two of the following three criteria: Modified Physical Performance Test (modified PPT) score between 18 and 32, peak oxygen uptake (VO2 peak) between 10 and 18 mL/kg/min, and self-report of difficulty or assistance with one basic activity of daily living (ADL), or two instrumental ADLs.

Intervention: Participants were randomly assigned to a control group that performed a 9-month low-intensity home exercise program (control) or an exercise-training program (ET). The control intervention primarily consisted of flexibility exercises. ET began with 3 months of flexibility, light-resistance, and balance training. During the next 3 months, resistance training was added, and, during the next 3 months, endurance training was added.

Measurements: Modified PPT score, VO2 peak, performance of ADLs as measured by the Older Americans Resources and Services instrument, and the Functional Status Questionnaire (FSQ).

Results ET resulted in significantly greater improvements than home exercise in three of the four primary outcome measures. Adjusted 95% confidence bounds on the magnitude of improvement in the ET group compared with the control group were 1.0 to 5.2 points for the modified PPT score, 0.9 to 3.6 mL/kg/min for VO2 peak, and 1.6 to 4.9 points for the FSQ score.
Conclusion Our results show that intensive ET can improve measures of physical function and preclinical disability in older adults who have impairments in physical performance and oxygen uptake and are not taking hormone replacement therapy better than a low-intensity home exercise program.
Study Name

Long-term effects of three multicomponent exercise interventions on physical performance and fall-related psychological outcomes in community-dwelling older adults: a randomized controlled trial

Publication Journal of the American Geriatrics Society
Purpose Objectives: To determine the long-term effects of three strength and balance exercise interventions on physical performance, fall-related psychological outcomes, and falls in older people.

Design: A single-blinded, four-group, randomized controlled trial.

Setting: Community, Germany.
Participants: Community-dwelling adults aged 70 to 90 who had fallen in the past 6 months or reported fear of falling.

Intervention: After baseline assessment, 280 participants were randomly assigned to the control group (CG; no intervention; n = 80) or one of three strength and balance exercise interventions (the strength and balance group (SBG; strength and balance only; n = 63), the fitness group (FG; strength and balance plus endurance training; n = 64), or the multifaceted group (MG; strength and balance plus fall risk education; n = 73). The interventions consisted of 32 one-hour group sessions in 16 weeks.

Measurements: Data on physical performance, fall-related psychological outcomes, and falls were collected for 24 months.

Results Mixed-effects regression analyses showed improved short- and long-term (12 and 24 months, respectively) physical performance for the SBG and FG, particularly regarding mobility, balance, and walking speed (P < .05). The improvements in physical performance outcomes were most prominent in the FG. Fall-related psychological outcomes, number of falls, and injurious falls were not significantly different from in the control group.
Conclusion Training focusing on strength, balance, and endurance can enhance physical performance for up to 24 months in community-dwelling older adults. These findings did not translate to improved fall-related psychological outcomes or reduced incidence of falls. This demonstrates the need for a different approach (e.g., regarding intervention dose and components) to gain intervention benefits in the multiple domains that contribute to independence and well-being in older adults.
Study Name

Intense tai chi exercise training and fall occurrences in older, transitionally frail adults: a randomized, controlled trial

Publication Journal of the American Geriatrics Society
Purpose Objectives: To determine whether an intense tai chi (TC) exercise program could reduce the risk of falls more than a wellness education (WE) program in older adults meeting criteria for transitioning to frailty.

Design: Randomized, controlled trial of 48 weeks duration.
Getting: Twenty congregate living facilities in the greater Atlanta area.

Participants: Sample of 291 women and 20 men aged 70 to 97.

Measurements: Demographics, time to first fall and all subsequent falls, functional measures, Sickness Impact Profile, Centers for Epidemiologic Studies-Depression Scale, Activities-specific Balance Confidence Scale, Falls Efficacy Scales, and adherence to interventions.

Results The risk ratio (RR) of falling was not statistically different in the TC group and the WE group (RR=0.75, 95% confidence interval (CI)=0.52-1.08), P=.13). Over the 48 weeks of intervention, 46% (n=132) of the participants did not fall; the percentage of participants that fell at least once was 47.6% for the TC group and 60.3% for the WE group.
Conclusion TC did not reduce the RR of falling in transitionally frail, older adults, but the direction of effect observed in this study, together with positive findings seen previously in more-robust older adults, suggests that TC may be clinically important and should be evaluated further in this high-risk population.
Study Name

Tai Chi and Low Impact Exercise: Effects on the Physical Functioning and Psychological Well-Being of Older People

Publication Journal of Applied Gerontology
Purpose The effects of tai chi (TC) and low impact exercise (LIE) interventions on physical functioning and psychological well-being of sedentary older people were contrasted.
Methods Participants were randomized to TC, LIE, or non-exercise control groups with interventions running for 12 weeks.
Results Post-intervention assessments with 72 participants who completed the study revealed that participants in both exercise groups improved with respect to upper body strength, balance, cardiovascular endurance, lower body strength, sleep disturbances, and anxiety. Participants in the LIE group reported better functional ability while those in the TC group reported better subjective health.
Conclusion Findings suggest that tai chi and low impact exercise are safe, cost-effective ways to improve both physical and psychological functioning of older people.
Study Name
Publication Archives of Gerontology and Geriatrics
Purpose The aim of this report is to investigate the effects of 8 weeks of intensive Tai Chi Chuan (TCC) training on physiological function and fear of falling (FOF) in the less-robust elderly.
Methods Forty-nine community-dwelling elderly, aged 60 or older, were classified randomly into a TCC training or control group. Physical performance measures (including one-leg stance, trunk flexion, and walking speed) and interviews were conducted before and after the intervention. The TCC group showed significant improvements in balance and flexibility, and a reduced FOF, when compared with the control group after the intervention. However, walking speed did not change significantly.
Results The results suggest that a high-frequency, short-term TCC training program can improve balance, flexibility, and increase the confidence of less-robust elderly.
Conclusion These suggest the effectiveness of TCC for intervention as a means to prevent falling among high-risk elderly populations.
Study Name

Balance and strength training in older adults: intervention gains and Tai Chi maintenance

Publication Journal of the American Geriatrics Society
Purpose Objective: To determine the effect on balance and strength of 3 months of intensive balance and/or weight training followed by 6 months of low intensity Tai Chi training for maintenance of gains.

Design: Randomized control intervention. Four groups in 2 x 2 design: Control, Balance, Strength, Balance + Strength, using blinded testers.

Setting: Exercise and balance laboratory at University of Connecticut Health Center.

Participants: Subjects were 110 healthy community dwellers (mean age 80) who were free of dementia, neurological disease, and serious cardiovascular or musculoskeletal conditions.

Interventions: Short-term training (3 months) occurred 3 times/week (45 minutes Balance and Strength, 90 minutes Balance + Strength). Balance training included equilibrium control exercises of firm and foam surfaces and center-of-pressure biofeedback. Strengthening consisted of lower extremity weight-lifting. All subjects than received long-term group Tai Chi instruction (6 months, 1 hour, 1 time/week).

Measurements: Losses of balance during Sensory Organization Testing (LOB), single stance time (SST), voluntary limits of stability (FBOS), summed isokinetic torque of eight lower extremity movements (ISOK), and usual gait velocity (GVU).

Results Balance training meaningfully improved all balance measures by restoring performance to a level analogous to an individual 3 to 10 years younger: LOB = -2.0 +/- 0.3 (adjusted paired differences, P < .005 ANOVA); SST = 7.0 +/- 1.2 sec; and FBOS = 9.0 +/- 2.0% of foot length (P < .05). Strengthening increased ISOK by 1.1 +/- 0.1 Nm kg-1 (P < .005). There was no interaction between balance and strength training. Significant gains persisted after 6 months of Tai Chi, although there was some decrement.
Conclusion Balance training meaningfully improved all balance measures by restoring performance to a level analogous to an individual 3 to 10 years younger. There was no interaction between balance and strength training. Significant gains persisted after 6 months of Tai Chi, although there was some decrement.
Study Name

Effects of Tai Chi and Western Exercise on Physical and Cognitive Functioning in Healthy Community-Dwelling Older Adults

Publication Journal of Aging and Physical Activity
Purpose Objective: To compare the effects of Tai Chi (TC, n = 37) and Western exercise (WE, n = 39) with an attention-control group (C, n = 56) on physical and cognitive functioning in healthy adults age 69 ± 5.8 yr, in a 2-phase randomized trial.
Methods TC and WE involved combined class and home-based protocols. Physical functioning included balance, strength, flexibility, and cardiorespiratory endurance. Cognitive functioning included semantic fluency and digit-span tests. Data were analyzed using intention-to-treat analysis.

The WE program incorporated endurance, resistance/strength, and flexibility exercises.

Results At 6 mo, WE had greater improvements in upper body flexibility (F = 4.67, p = .01) than TC and C. TC had greater improvements in balance (F = 3.36, p = .04) and a cognitive-function measure (F = 7.75, p < .001) than WE and C. The differential cognitive-function improvements observed in TC were maintained through 12 mo.
Conclusion The TC and WE interventions resulted in differential improvements in physical functioning among generally healthy older adults. TC led to improvement in an indicator of cognitive functioning that was maintained through 12 mo.
Study Name

Group and home-based tai chi in elderly subjects with knee osteoarthritis: a randomized controlled trial

Publication Clinical Rehabilitation
Purpose Objective: To evaluate the effects of tai chi consisting of group and home-based sessions in elderly subjects with knee osteoarthritis.

Design: A randomized, controlled, single-blinded 12-week trial with stratification by age and sex, and six weeks of follow-up.

Setting: General community.
Participants: Forty-one adults (709 / 9.2 years) with knee osteoarthritis.

Interventions: The tai chi programme featured six weeks of group tai chi sessions, 40 min/session, three times a week, followed by another six weeks (weeks 7 -12) of home-based tai chi training. Subjects were requested to discontinue tai chi training during a six-week follow-up detraining period (weeks 13-18). Subjects in the attention control group attended six weeks of health lectures following the same schedule as the group-based tai chi intervention (weeks 0 -6), followed by 12 weeks of no activity (weeks 7-18).

Main outcome measures: Knee pain measured by visual analogue scale, knee range of motion and physical function measured by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were recorded at baseline and every three weeks throughout the 18-week study period. Data were analysed using a mixed model ANOVA.

Results The six weeks of group tai chi followed by another six weeks of home tai chi training showed significant improvements in mean overall knee pain (P = 0.0078), maximum knee pain (P = 0.0035) and the WOMAC subscales of physical function (P = 0.0075) and stiffness (P = 0.0206) compared to the baseline. No significant change of any outcome measure was noted in the attention control group throughout the study.
Conclusion The tai chi group reported lower overall pain and better WOMAC physical function than the attention control group at weeks 9 and 12. All improvements disappeared after detraining.
Study Name

Direction-Induced Effects of Visually Guided Weight-Shifting Training on Standing Balance in the Elderly

Publication Gerontology
Purpose The purpose of this study was to investigate the impact of two direction-specific, visually guided WS training protocols on standing balance of healthy elderly women.
Methods Forty-eight community-dwelling elderly women, all free of any neurological or musculoskeletal impairment, were randomly assigned into: a group that practiced WS in the anterior/posterior direction (A/P group, n = 19), a group that practiced WS in the medio/lateral direction (M/L group, n = 15) and a control group (n = 14). Participants performed 12 training sessions of visually guided WS (3 sessions a week for 25 minutes per session). Static balance was measured before and after training in normal (bipedal) quiet stance (NQS) and sharpened-Romberg stance (SRS) by recording center of pressure (CoP) variations and angular segment kinematics.
Results In NQS, neither of the two training protocols had a significant impact on postural sway measures, although a significant decrease in interlimb asymmetry of CoP displacement was noted for the A/P group. In SRS, A/P training induced a significant reduction of CoP displacement, lower limb pitch and upper trunk roll rotation.
Conclusion The results of the study stress the importance of using direction-specific WS tasks in balance training, particularly in the A/P direction, in order to improve control of static balance in elderly women.
Study Name

Balance training in 70-year-old women

Publication Physiotherapy Theory and Practice
Purpose The aim of this study was to discover whether or not the balance of a group of older women could be improved using nine simple, clinical balance tests before and after a training period.
Methods A total of 34 healthy 70-year-old women volunteered for the study and they were randomised into two groups: the first received 1 hour’s training twice a week for 5 weeks; the second the control group did not receive any training. The tests included: standing on one leg (a) with or without visual feedback and (b) with or without rotation of the neck; walking along a beam; walking in a figure-of-eight; and walking as fast as possible.
Results The balance of the training group improved significantly in six out of the nine tests, whereas no such improvement was seen among the controls.
Conclusion We conclude that healthy women aged 70 years are able to improve their balance both when standing and walking.
Study Name

The Effect of 6 Months Training on Leg Power, Balance, and Functional Mobility of Independently Living Adults Over 70 Years Old

Publication Journal of Aging and Physical Activity
Purpose Where strength training has been used in conjunction with functional-task training in older people, not only have there been improvements in leg strength but also improved function has been measured (e.g., Skelton & McLaughlin, 1996). Many studies use participants from care homes rather than community dwellers. We investigated changes in leg power, balance, and functional mobility in community-dwelling sedentary men and women over 70 years of age.

We investigated changes in leg power, balance, and functional mobility in community-dwelling sedentary men and women over 70 years of age (n = 6 for training group [TR]; n = 10 for control group [CN]). Progressive training took place over 24 weeks using seated and nonseated exercise.

During Weeks 0–4, exercises were mainly performed seated on a chair (e.g., knee raises, ankle rotation, swinging the legs forward and backward, and half-squats—the latter two exercises using the chair as support), and simple step sequences (forward and, later, backward movements) were used to challenge balance and coordination. This was followed by exercises that involved getting down on to and up from the floor with the use of (body) weight-bearing exercises to improve lower limb strength, flexibility (e.g., Achilles and hamstring stretches), and mobility.

After 12 weeks, use of dynabands provided additional resistance for the arms (e.g., extending the triceps and pectoral muscles) and legs (e.g., abduction of the thighs, single-leg extensions), floor work was introduced to challenge the back and stomach muscles (e.g., tummy-strengthening exercises, hamstring stretch), and simple ball games (throwing and catching) and movement exercises provided an opportunity for increased movement, balance, and coordination.

A 5-min cool-down period followed each class, which provided further opportunities for stretching. Progression during the classes was achieved by gradually building up the number of repetitions of an exercise (0–12 weeks) and then increasing the resistance and speed of movement (12–24 weeks), the latter by changing the rhythm and content of the background music. Exercises to improve lower limb power, balance, and coordination were taken from the booklet Exercise for Healthy Ageing (1998). Mobility exercises were taken from the leaflet Take a Seat and Stretch (Keep Fit Association, 2001).

Results For TR, leg power increased 40%, from 108 ± 40 to 141 ± 53 W (p < .01); dynamic balance increased 48%, from 22.3 ± 7.9 to 33.1 ± 6.1 cm (p < .01; functional reach); and functional mobility increased 12%, from 7.46 ± 1.32 to 6.54 ± 1.41 s (p < .05; timed walk). CN showed no significant change.
Conclusion In conclusion, a community-based exercise program led to large improvements in leg-extensor power, dynamic balance, and functional mobility.
Study Name

Fall Incidence in Frail Older Women after Individualized Visual Feedback-Based Balance Training

Publication Gerontology
Purpose The aim of this study was to examine the effects of a 4-week individualized visual feedback-based balance training on the fall incidence during 1-year follow-up among frail older women living in residential care.
Methods Twenty-seven older women from 2 residential care homes were randomized into exercise (n = 20) and control (n = 7) groups. Balance measurements were carried out before and after a 4-week training period and falls were monitored by monthly diaries for 1 year. An interview about fear of falling and physical activity was completed before and after the intervention and after the 1-year follow-up.
Results A positive effect of balance training on fall incidence was found. A dynamic Poisson regression model showed that during the follow-up the monthly risk of falling was decreased in the exercise group compared to controls (risk ratio 0.398, 95% CI 0.174–0.911, p = 0.029). In addition, the exercise group reported a reduced fear of falling and increased physical activity after a training period but these changes declined during the follow-up period.
Conclusion Individualized visual feedback-based balance training was shown to be a promising method for fall prevention among frail older women. High compliance (97.5%) with the training program showed that carefully targeted training programs can be carried out among older people with health limitations.
Study Name

A Controlled Trial of Exercise by Residents of Old People’s Homes

Publication Age and Ageing
Purpose This study reports the findings of a controlled trial of seated exercise in residents of local authority homes for the elderly.
Methods Forty-nine residents aged 64–91 years volunteered for the 7-month project, and participated in either twice-weekly exercise or reminiscence sessions. Primary outcome measures were postural sway, flexibility of the spine and knees, hand-grip strength and functional capacity. The average (range of) attendance at the exercise sessions was 91% (64–100%), and at the reminiscence sessions was 86% (46–100%).
Results By the end of the project, the change observed in the exercise group was significantly different from that of the reminiscence group in terms of grip strength (p<0.02), spinal flexion (p<0.001), chair-to-stand time (p<0.001), activities of daily living (p<0.05), and self-rating of depression (p<0.01).
Conclusion Even very elderly residents of old peoples homes can benefit from participation in regular seated exercise and improve their functional capacity.
Study Name

The Effect of Functional Circuit Training on Physical Frailty in Frail Older Adults: A Randomized Controlled Trial

Publication Journal of Aging and Physical Activity
Purpose The purpose of this study was to evaluate whether a 12-wk functional circuit-training program (FCT) could alter markers of physical frailty in a group of frail community-dwelling adults.
Methods Fifty-one individuals (31 women, 20 men), mean age (± SD) 84 (± 2.9) yr, met frailty criteria and were randomly assigned into groups (FCT = 26, control group [CG] = 25). FCT underwent a 12-wk exercise program. CG met once a week for health education meetings. Measures of physical frailty, function, strength, balance, and gait speed were assessed at Weeks 0, 12, and 36.
Results Physical-frailty measures in FCT showed significant (p < .05) improvements relative to those in CG (Barthel Index at Weeks 0 and 36: 73.41 (± 2.35) and 77.0 (± 2.38) for the FCT and 70.79 (± 2.53) and 66.73 (± 2.73) for the CG.
Conclusion These data indicate that an FCT program is effective in improving measures of function and reducing physical frailty among frail older adults.
Study Name

Effect of additional functional exercises on balance in elderly people

Publication Clinical Rehabilitation
Purpose Objective: To evaluate the additional effect of functional exercises on balance and lower extremity function among hostel-dwelling elderly people partaking in strength,training.

Design: A randomized two-group parallel controlled trial.
Setting: A senior resident’s hostel in Switzerland.

Participants: Thirty-two individuals randomized to either strength or strength and functional exercise groups.

Interventions: Both groups received machine-driven strength training for 45 min, twice weekly, for 12 weeks. The strength and functional exercises group received an additional 30 min of functional exercise training, once weekly.

Main outcome measures: Tinetti test, balance tests and a physical performance test. Assessments were performed before and after the intervention.

Results Improvements for the balance test depended on the type of training (significant interaction effects [F(1,20)= 6.7; P = 0.018]). This test improved from 11.3 ∓ 11.7 to 17 ∓ 11.2 (P = 0.009) in the combined training group (n = 12) and remained from 7.3 ∓ 9.5 to 6.9 ∓ 9.2 unchanged (P = 0.821) in the strength training group (n = 13). A significant difference between groups following training was observed (P = 0.031). The Tinetti balance score and the chair stand test of the physical performance assessment improved from 14.3 ∓ 1.9 to 15.3 ∓ 1.1 (P = 0.026) and 1.8 ∓ 1.2 to 2.8 ∓ 1.1 (P = 0.012) respectively in the combined training group only.
Conclusion Our findings suggest that twice-weekly lower extremity strength training of 12 weeks’ duration in hostel-dwelling elderly people only improves task-specific balance performance and lower extremity physical function when additional functional exercises are added.
Study Name

Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial

Publication BMJ
Purpose Objectives: To determine whether a lifestyle integrated approach to balance and strength training is effective in reducing the rate of falls in older, high risk people living at home.

Design: Three arm, randomised parallel trial; assessments at baseline and after six and 12 months. Randomisation done by computer generated random blocks, stratified by sex and fall history and concealed by an independent secure website.

Setting: Residents in metropolitan Sydney, Australia.
Participants: Participants aged 70 years or older who had two or more falls or one injurious fall in past 12 months, recruited from Veteran’s Affairs databases and general practice databases. Exclusion criteria were moderate to severe cognitive problems, inability to ambulate independently, neurological conditions that severely influenced gait and mobility, resident in a nursing home or hostel, or any unstable or terminal illness that would affect ability to do exercises.

Interventions: Three home based interventions: Lifestyle integrated Functional Exercise (LiFE) approach (n=107; taught principles of balance and strength training and integrated selected activities into everyday routines), structured programme (n=105; exercises for balance and lower limb strength, done three times a week), sham control programme (n=105; gentle exercise). LiFE and structured groups received five sessions with two booster visits and two phone calls; controls received three home visits and six phone calls. Assessments made at baseline and after six and 12 months.

Main outcome measures: Primary measure: rate of falls over 12 months, collected by self report. Secondary measures: static and dynamic balance; ankle, knee and hip strength; balance self efficacy; daily livingactivities; participation; habitual physical activity; quality of life; energy expenditure; body mass index; and fat free mass.

Results After 12 months’ follow-up, we recorded 172, 193, and 224 falls in the LiFE, structured exercise, and control groups, respectively. The overall incidence of falls in the LiFE programme was 1.66 per person years, compared with 1.90 in the structured programme and 2.28 in the control group. We saw a significant reduction of 31% in the rate of falls for the LiFE programme compared with controls (incidence rate ratio 0.69 (95% confidence interval 0.48 to 0.99)); the corresponding difference between the structured group and controls was non-significant (0.81 (0.56 to 1.17)). Static balance on an eight level hierarchy scale, ankle strength, function, and participation were significantly better in the LiFE group than in controls. LiFE and structured groups had a significant and moderate improvement in dynamic balance, compared with controls.
Conclusion The LiFE programme provides an alternative to traditional exercise to consider for fall prevention. Functional based exercise should be a focus for interventions to protect older, high risk people from falling and to improve and maintain functional capacity.
Study Name

Functional Training Induces Greater Variety and Magnitude of Training Improvements than Traditional Resistance Training in Elderly Women

Publication Journal of Sports Science and Medicine
Purpose The objective was to investigate the effects of functional (FT) and traditional (TT) training on trunk muscles maximal isometric strength, rate of force development and endurance with trained elderly women.
Methods Forty-five elderly women were directed into three groups: FT (n =1 6), TT (n = 14) and Control (n = 15). The FT (multi-planar, and multi-articular movements) and TT (primarily machine-based resistance exercises) performed mobility, muscle strength and power exercises. Both training groups also performed intermittent cardiometabolic activities. The maximum strength and endurance of the trunk muscles were verified, both at baseline and after 12 weeks of training (3xweek for 50 min each). Data were analyzed using a 2-way ANCOVA with contrast of adjusted mean values.
Results FT significantly increased all variables: maximum trunk flexor strength (p = 0.002, 22%); rate of flexor force development (p = 0.001, 84%); trunk extensors maximal strength (p = 0.003, 17%); trunk extensor rate of force development (p = 0.05, 16%); trunk flexors (p = 0.001, 19%) and extensors (p = 0.017, 13%) endurance compared to baseline. TT showed an increase only in RFD of trunk extensors (p = 0.003, 53%), and flexors (p = 0.033, 42%), and trunk flexors endurance (p = 0.008, 11%).
Conclusion However, there was no statistically significant difference between groups. FT promoted improvement in all variables; strength, endurance and rate of force development of the trunk flexors and extensors of the elderly. On the other hand, TT improved only the rate of force development of trunk flexors and extensors and endurance of the trunk flexors. FT is recommended for elderly women as it improves a broader array of physiological parameters.
Study Name

Effects of prolonged and maintenance strength training on force production, walking, and balance in aging women and men

Publication Scandinavian Journal of Medicine & Science in Sports
Purpose Objective: To examine effects of 21-week twice/week strength training (ST) period followed by an additional 21-week twice or once/week ST period on force production, walking and balance in aging people.
Methods Seventy-two women (58 ± 7 years; W) and 63 (58 ± 6 years) men (M) were randomized for the first 21-week ST period: STW and STM, control (C) CW and CM. Training participants were randomized for the second 21-week ST period: once/week STWx1 and STMx1, twice/week STWx2 and STMx2. LegPress, isometric leg extension rate of force development (RFD), walking time, and balance.
Results First 21-week ST period: leg press, RFD, balance, and walking improved significantly in STW and STM. Second 21-week ST period: leg press first increased in STMx1 and STMx2, and then decreased to the level of 21 weeks in STMx2 and remained unchanged in STWx2 and decreased in STWx1 and STMx1. Walking and balance improved significantly in STWx1 and STWx2.
Conclusion A progressive 21-week ST period twice/week in aging people can lead to large improvements in maximal strength, walking time, and balance in both genders. A further strength training period with the same amount of training may maintain the strength gains, whereas balance and walking may be maintained with less training.
Study Name

3 Different types of strength training in older women

Publication International Journal of Sports Medicine
Purpose The objective of the present study was to evaluate and compare the neuromuscular, morphological and functional adaptations of older women subjected to 3 different types of strength training.

58, healthy women (67 ± 5 year) were randomized to experimental (EG, n=41) and control groups (CG, n=17) during the first 6 weeks when the EG group performed traditional resistance exercise for the lower extremity.

Afterwards, EG was divided into three specific strength training groups; a traditional group (TG, n=14), a power group (PG, n=13) that performed the concentric phase of contraction at high speed and a rapid strength group (RG, n=14) that performed a lateral box jump exercise emphasizing the stretch-shortening-cycle (SSC). Subjects trained 2 days per week through the entire 12 weeks.

Results Following 6 weeks of generalized strength training, significant improvements occurred in EG for knee extension one-repetition (1RM) maximum strength (+19%), knee extensor muscle thickness (MT, +15%), maximal muscle activation (+44% average) and onset latency ( -31% average) for vastus lateralis (VL), vastus medialis (VM) and rectus femoris (RF) compared to CG (p<0.05). Following 6 more weeks of specific strength training, the 1RM increased significantly and similarly between groups (average of +21%), as did muscle thickness of the VL (+25%), and activation of VL (+44%) and VM (+26%). The onset latency of RF (TG=285 ± 109 ms, PG=252 ± 76 ms, RG=203 ± 43 ms), reaction time (TG=366 ± 99 ms, PG=274 ± 76 ms, RG=201 ± 41 ms), 30-s chair stand (TG=18 ± 3, PG=18 ± 1, RG=21 ± 2) and counter movement jump (TG=8 ± 2 cm, PG=10 ± 3 cm, RG=13 ± 2 cm) was significantly improved only in RG (p<0.05). At the end of training, the rate of force development (RFD) over 150 ms (TG=2.3 ± 9.8 N·s(-1), PG=3.3 ± 3.2 N·s(-1), RG=3.8 ± 6.8 N·s(-1), CG=2.3 ± 7.0 N·s(-1)) was significantly greater in RG and PG than in TG and CG (p<0.05).
Conclusion In conclusion, rapid strength training is more effective for the development of rapid force production of muscle than other specific types of strength training and by consequence, better develops the functional capabilities of older women.
Study Name

Exercise for improving balance in older people

Publication Cochrane Database of Systematic Reviews
Purpose To examine the effects of exercise interventions on balance in older people, aged 60 and over, living in the community or in institutional care.

Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL (The Cochrane Library 2011, Issue 1), MEDLINE and EMBASE (to February 2011).

Selection criteria: Randomised controlled studies testing the effects of exercise interventions on balance in older people. The primary outcomes of the review were clinical measures of balance.

Data collection and analysis: Pairs of review authors independently assessed risk of bias and extracted data from studies. Data were pooled where appropriate.


This update included 94 studies (62 new) with 9,821 participants. Most participants were women living in their own home.

Most trials were judged at unclear risk of selection bias, generally reflecting inadequate reporting of the randomisation methods, but at high risk of performance bias relating to lack of participant blinding, which is largely unavoidable for these trials. Most studies only reported outcome up to the end of the exercise programme.

There were eight categories of exercise programmes. These are listed below together with primary measures of balance for which there was some evidence of a statistically significant effect at the end of the exercise programme. Some trials tested more than one type of exercise. Crucially, the evidence for each outcome was generally from only a few of the trials for each exercise category.

1. Gait, balance, co‐ordination and functional tasks (19 studies of which 10 provided primary outcome data): Timed Up & Go test (mean difference (MD) ‐0.82 s; 95% CI ‐1.56 to ‐0.08 s, 114 participants, 4 studies); walking speed (standardised mean difference (SMD) 0.43; 95% CI 0.11 to 0.75, 156 participants, 4 studies), and the Berg Balance Scale (MD 3.48 points; 95% CI 2.01 to 4.95 points, 145 participants, 4 studies).

2. Strengthening exercise (including resistance or power training) (21 studies of which 11 provided primary outcome data): Timed Up & Go Test (MD ‐4.30 s; 95% CI ‐7.60 to ‐1.00 s, 71 participants, 3 studies); standing on one leg for as long as possible with eyes closed (MD 1.64 s; 95% CI 0.97 to 2.31 s, 120 participants, 3 studies); and walking speed (SMD 0.25; 95% CI 0.05 to 0.46, 375 participants, 8 studies).

3. 3D (3 dimensional) exercise (including Tai Chi, qi gong, dance, yoga) (15 studies of which seven provided primary outcome data): Timed Up & Go Test (MD ‐1.30 s; 95% CI ‐2.40 to ‐0.20 s, 44 participants, 1 study); standing on one leg for as long as possible with eyes open (MD 9.60 s; 95% CI 6.64 to 12.56 s, 47 participants, 1 study), and with eyes closed (MD 2.21 s; 95% CI 0.69 to 3.73 s, 48 participants, 1 study); and the Berg Balance Scale (MD 1.06 points; 95% CI 0.37 to 1.76 points, 150 participants, 2 studies).

4. General physical activity (walking) (seven studies of which five provided primary outcome data).

5. General physical activity (cycling) (one study which provided data for walking speed).

6. Computerised balance training using visual feedback (two studies, neither of which provided primary outcome data).

7. Vibration platform used as intervention (three studies of which one provided primary outcome data).

8. Multiple exercise types (combinations of the above) (43 studies of which 29 provided data for one or more primary outcomes): Timed Up & Go Test (MD ‐1.63 s; 95% CI ‐2.28 to ‐0.98 s, 635 participants, 12 studies); standing on one leg for as long as possible with eyes open (MD 5.03 s; 95% CI 1.19 to 8.87 s, 545 participants, 9 studies), and with eyes closed ((MD 1.60 s; 95% CI ‐0.01 to 3.20 s, 176 participants, 2 studies); and the Berg Balance Scale ((MD 1.84 points; 95% CI 0.71 to 2.97 points, 80 participants, 2 studies).

Few adverse events were reported but most studies did not monitor or report adverse events.

In general, the more effective programmes ran three times a week for three months and involved dynamic exercise in standing.

Conclusion There is weak evidence that some types of exercise (gait, balance, co‐ordination and functional tasks; strengthening exercise; 3D exercise and multiple exercise types) are moderately effective, immediately post intervention, in improving clinical balance outcomes in older people. Such interventions are probably safe. There is either no or insufficient evidence to draw any conclusions for general physical activity (walking or cycling) and exercise involving computerised balance programmes or vibration plates. Further high methodological quality research using core outcome measures and adequate surveillance is required.
Study Name

Healthy Elderly Women Using the T-Bow® Device

Publication The Physician and Sportsmedicine
Purpose This study aims to determine the effects of a training program to develop balance using a new device called the T-Bow®.
Methods A total of 28 women > 65 years were randomly assigned to an experimental group (EG) (n = 18; 69.50 [0.99] years), or a control group (CG) (n = 10; 70.70 [2.18] years). A program for lower limbs was applied for 8 weeks using 5 exercises on the T-Bow®: squat, lateral and frontal swings, lunges, and plantarflexions. The intensity of the exercises was controlled by time of exposure, support base, and ratings of perceived exertion. Clinical tests were used to evaluate variables of balance. Static balance was measured by a 1-leg balance test (unipedal stance test), dynamic balance was measured by the 8-foot-up-and-go test, and overall balance was measured using the Tinetti test.
Results Results for the EG showed an increase of 35.2% in static balance (P < 0.005), 12.7% in dynamic balance (P < 0.005), and 5.9% in overall balance (P > 0.05). Results for the CG showed a decline of 5.79% in static balance (P > 0.05) but no change in the other balance variables.
Conclusion Thus the data suggest that implementing a training program using the T-Bow® could improve balance in healthy older women.
Study Name

A comparison of the effects of three types of endurance training on balance and other fall risk factors in older adults

Publication Aging Clinical and Experimental Research
Purpose We hypothesized that short-term endurance training improves balance in older adults, if training involves movements that “stress” balance. We tested the hypothesis by looking for a dose-response relationship between movement during exercise and balance improvement.

The study was a single-blinded, randomized controlled trial. Subjects were sedentary adults (N=106) aged 68–85 with at least mild deficits in balance. Exercise groups were: stationary cycle (low movement), walking (medium movement), and aerobic movement (high movement).

Subjects attended supervised exercise classes three times a week for three months, followed by self-directed exercise of any type for three months. The primary test of the hypothesis compared changes in balance after three months of supervised exercise. 

Results The study hypothesis was supported only for one balance measure. Only walking improved at least one measure of all major outcomes (endurance, strength, gait, balance, health status), suggesting that walking is most useful for fall prevention. Cycle exercise appeared least useful.
Conclusion The study hypothesis was supported only for one balance measure. Only walking improved at least one measure of all major outcomes (endurance, strength, gait, balance, health status), suggesting that walking is most useful for fall prevention. Cycle exercise appeared least useful.
Study Name
Publication Journal of the American Geriatrics Society
Purpose OBJECTIVES: To examine the effects of 18‐month aerobic walking and strength training programs on static postural stability among older adults with knee osteoarthritis.

DESIGN: Randomized, single‐blind, clinical trial of therapeutic exercise.

SETTING: Both center‐based (university) and home‐based.
PARTICIPANTS: A cohort of 103 older adults (age = 60 years) with knee osteoarthritis who were participants in a large (n = 439) clinical trial and who were randomly assigned to undergo biomechanical testing.

INTERVENTION: An 18‐month center‐ (3 months) and home‐based (15 months) therapeutic exercise program. The subjects were randomized to one of three treatment arms: (1) aerobic walking; (2) health education control; or (3) weight training.

MEASUREMENTS: Force platform static balance measures of average length (Rm) of the center of pressure (COP), average velocity (Vel) of the COP, elliptical area (Ae) of the COP, and balance time (T). Measures were made under four conditions: eyes open, double‐ and single‐leg stances and eyes closed, double‐ and single‐leg stances.

Results In the eyes closed, double‐leg stance condition, both the aerobic and weight training groups demonstrated significantly better sway measures relative to the health education group. The aerobic group also demonstrated better balance in the eyes open, single‐leg stance condition.
Conclusion Our results suggest that long‐term weight training and aerobic walking programs significantly improve postural sway in older, osteoarthritic adults, thereby decreasing the likelihood of larger postural sway disturbances relative to a control group.
Study Name

Effects of Resistance- and Flexibility-Exercise Interventions on Balance and Related Measures in Older Adults

Publication Journal of Aging and Physical Activity
Purpose This research explored the balance benefits to untrained older adults of participating in community-based resistance and flexibility programs.
Methods In a blinded randomized crossover trial, 32 older adults (M = 66.9 yr) participated in a resistance-exercise program and a flexibility-exercise program for 16 weeks each. Sway velocity and mediolateral sway range were recorded. Timed up-and-go, 10 times sit-to-stand, and step test were also assessed, and lower limb strength was measured.
Results Significant improvements in sway velocity, as well as timed up-and-go, 10 times sit-to-stand, and step test, were seen with both interventions, with no significant differences between the 2 groups. Resistance training resulted in significant increases in strength that were not evident in the flexibility intervention.
Conclusion Balance performance was significantly improved after both resistance training and standing flexibility training; however, further investigation is required to determine the mechanisms responsible for the improvement.
Study Name

Changes in spinal range of motion after a flexibility training program in elderly women

Publication Clinical Interventions in Aging
Purpose The purpose of this study was to investigate the effects of an 8-week specific and standardized flexibility training program on the range of spinal motion in elderly women.

Participants were recruited in a senior center of Palermo and randomly assigned in two groups: trained group (TG) and control group (CG), which included 19 and 18 women, respectively. TG was trained for 8 weeks at two sessions/week. In particular, every session included three phases: warm up (~10 minutes), central period (~50 minutes), and cool down (~10 minutes).

CG did not perform any physical activity during the experimental period. Spinal ranges of motion (ROM) were measured from neutral standing position to maximum bending position and from neutral standing position to maximum extension position before and after the experimental period, using a SpinalMouse® device (Idiag, Volkerswill, Switzerland).

Results After the training period, TG showed an increase in spinal inclination by 16.4% (P<0.05), in sacral/hip ROM by 29.2% (P<0.05), and in thoracic ROM by 22.5% (P>0.05) compared with CG from maximum extension position to maximum bending position. We did not observe any significant difference in TG’s lumbar ROM compared with CG after the training period (P>0.05).
Conclusion We found that an 8-week flexibility training program improved ROMs of the spine in elderly women. The training protocol appeared to be practicable for active elderly people with autonomy and the capability for self-care.
Study Name

Flexibility of the Elderly after One-Year Practice of Yoga and Calisthenics

Publication International Journal of Yoga Therapy
Purpose This study compared the flexibility of elderly individuals before and after having practiced hatha yoga and calisthenics for 1 year (52 weeks), at least 3 times/week.
Methods Sixty-six subjects (12 men) measured and assigned to 3 groups: control (n = 24, age = 67.7±6.9 years), hatha yoga (n = 22, age = 61.2±4.8 years), and calisthenics (n = 20, age = 69.0±5.8 years). The maximal range of passive motion of 13 movements in 7 joints was assessed by the Flexitest, comparing the range obtained with standard charts representing each arc of movement on a discontinuous and non-dimensional scale from 0 to 4. Results of individual movements were summed to define 4 indexes (ankle+knee, hip+trunk, wrist+elbow, and shoulder) and total flexibility (Flexindex).
Results Results showed significant increases of total flexibility in the hatha yoga group (by 22.5 points) and the calisthenics group (by 5.8 points) (p < 0.01 for each) and a decrease in the control group (by 2.1 points) (p < 0.01) after one year of intervention. Between-group comparison showed that increases in the hatha yoga group were greater than in the calisthenics group for most flexibility indexes, particularly the overall flexibility (p <0.05).
Conclusion In conclusion, the practice of hatha yoga (i.e., slow/passive movements) was more effective in improving flexibility compared to calisthenics (i.e., fast/dynamic movements), but calisthenics was able to prevent flexibility losses observed in sedentary elderly subjects.
Study Name

Effect of a Gentle Iyengar Yoga Program on Gait in the Elderly: An Exploratory Study

Publication Archives of Physical Medicine and Rehabilitation
Purpose Objective: To determine if a tailored yoga program could improve age-related changes in hip extension, stride length, and associated indices of gait function in healthy elders, changes that have been linked to increased risk for falls, dependency, and mortality in geriatric populations.

Design: Single group pre-post test exploratory study. A 3-dimensional quantitative gait evaluation, including kinematic and kinetic measurements, was performed pre- and postintervention. Changes over time (baseline to postintervention) in primary and secondary outcome variables were assessed using repeated-measures analysis of variance.

Setting: Yoga exercises were performed in an academic medical center (group classes) and in the subjects’ homes (yoga home-practice assignments). Pre- and postassessments were performed in a gait laboratory.
Participants: Twenty-three healthy adults (age range, 62–83y) who were naive to yoga were recruited; 19 participants completed the program.

Intervention: An 8-week Iyengar Hatha yoga program specifically tailored to elderly persons and designed to improve lower-body strength and flexibility. Participants attended two 90-minute yoga classes per week, and were asked to complete at least 20 minutes of directed home practice on alternate days.

Main Outcome Measures: Peak hip extension, average anterior pelvic tilt, and stride length at comfortable walking speed.

Results Peak hip extension and stride length significantly increased (F1,18=15.44, P<.001; F1,18=5.57, P=.03, respectively). We also observed a trend toward reduced average pelvic tilt (F1,18=4.10, P=.06); adjusting for the modifying influence of frequency of home yoga practice strengthened the significance of this association (adjusted F1,17=14.30, P=.001). Both the frequency and duration of yoga home practice showed a strong, linear, dose-response relationship to changes in hip extension and average pelvic tilt.
Conclusion Findings of this exploratory study suggest that yoga practice may improve hip extension, increase stride length, and decrease anterior pelvic tilt in healthy elders, and that yoga programs tailored to elderly adults may offer a cost-effective means of preventing or reducing age-related changes in these indices of gait function.
Study Name

Improving Flexibility And Endurance Of Elderly Women Through A Six-Month Training Programme

Publication Human Movement
Purpose The purpose of this study was to assess whether two slightly different half-year-long regular training programmes had a positive effect on flexibility, range of motion and endurance in a sample population of elderly persons. Also analysed was which programme was found to be more effective.
Methods A group of women (N = 42, M = 67.1 ± 4.5 years) was chosen from retired persons clubs from Eger, Hungary. They were randomly divided into three groups. The first group (N = 15, M = 66.2 ± 3.8 years) took part in a one-hour-long Pilates training session three times a week, the second group (N = 15, M = 67.1 ± 5.9 years) took part in an aqua-fitness class twice a week with one Pilates class once a week and the third group (N = 12, M = 68.2 ± 3.2 years) was the control group. Pre-and postmeasurements were conducted on: flexion of the right shoulder and hip, lumbar spine flexion, thoracolumbar spine flexion, trunk lateral flexion on the right side, a 6-minute walk test, and a 30-second sit-to-stand test. Significant inter-group differences could be found in all of the measurements. Data were analysed using statistical software with the Paired-Samples T-test and Multivariate Analysis of Variance (p < 0.05).
Results After the six-month regular training programmes no differences were found in the control group. For the two groups subjected to the training programmes all the other variables showed significant differences. The most remarkable results for the Pilates group were with the 6-minute walk and sit-to-stand test, while for the aqua-fitness and Pilates group shoulder and hip flexion.
Conclusion A half-year-long training program can considerably improve the physical performance elderly adults need in everyday life.
Study Name

Effect of a physical training program using the Pilates method on flexibility in elderly subjects

Publication AGE
Purpose We aimed to evaluate the effects of physical training using the Pilates method on body flexibility of elderly individuals.

Eighteen elderly women and two elderly men (aged 70 ± 4 years) followed a 10-week Pilates training program. Individuals were recruited from the local community via open invitations. At study entry, none of them had limited mobility (walking requiring the use of walkers or canes).

Furthermore, those with neurologic, muscular, or psychiatric disorders as well as those using an assistive device for ambulation were excluded secondary to limited participation. Flexibility assessment tests (flexion, extension, right and left tilt, and right and left rotation of the cervical and thoracolumbar spine; flexion, extension, abduction, and lateral and medial right and left rotation of the glenohumeral joint; flexion, extension, abduction, adduction, and lateral and medial rotation of the right and left hip; and flexion of the right and left knee) were performed by a blinded evaluator using a flexometer before and after the training period. All assessments were carried out at the same time of day. 

Results There was an observed increase in flexion (22.86 %; p < 0.001), extension (10.49 %; p < 0.036), and rotation to the left side (20.45 %; p < 0.019) of the cervical spine; flexion (16.45 %; p < 0.001), extension (23.74 %; p = 0.006), lateral bending right (39.52 %; p < 0.001) and left (38.02 %; p < 0.001), and right rotation (24.85 %; p < 0.001) and left (24.24 %; p < 0.001) of the thoracolumbar spine; flexion (right—8.80 %, p = 0.034; left—7.03 %, p = 0.050), abduction (right—20.69 %, p < 0.001; left—16.26 %, p = 0.005), and external rotation (right—116.07 % and left—143 %; p < 0.001 for both directions) of the glenohumeral joint; flexion (right—15.83 %, p = 0.050; left—9.55 %, p = 0.047) of the hips; and bending (right—14.20 %, p = 0.006; left—15.20 %, p = 0.017) the knees. The joint with the greatest magnitude of improvement was the thoracolumbar spine.
Conclusion Thus, this type of training may minimize the deleterious effects of aging and may improve the functionality of elderly individuals, which would reduce the likelihood of accidents (especially falls).
Study Name

Effects of flexibility training on enhancing spinal mobility in older women

Publication The Journal of Sports Medicine and Physical Fitness
Purpose The purpose of this study was to examine the extent to which spinal flexion and extension, or spinal mobility, could be improved in a population of older adults participating in a 10 week flexibility training program.

Twenty female volunteers, mean age 71.8, were randomly assigned to either the experimental group (flexibility training) or the control group (no training). Prior to the initiation of training, all subjects were tested for total spinal mobility, the combined sum of spinal flexion and extension.

Subjects in the experimental group were exposed to a series of flexibility exercises, three times per week, for 20-30 minutes in duration, for a total of 10 weeks. The control group participated in an alternative exercise program with the experimental group, including walking, swimming, dance, and other locomotor activities, however, they did not receive the additional flexibility training. At the conclusion of the 10 week period, all subjects were retested for spinal mobility, using back flexion and extension measures. 

Results Results indicated a significant improvement in spinal mobility in the experimental group, and virtually no measurable change in the control group.
Conclusion This study suggests that specialized training in back flexibility for older adults is warranted, and that significant gains in spinal mobility can be obtained, regardless of age.
Study Name

Effects of strength and flexibility training on functional performance of healthy older people

Publication Brazilian Journal of Physical Therapy
Purpose OBJECTIVE: To evaluate the effects of stretching and/or resistive exercise, followed by detraining, on the functional status of older people.

Forty-five subjects were divided into four groups: control (CG; n=13; 66±6 years), stretching (SG; n=10; 69±6 years), resistive exercise (RG; n=13; 69±5 years), and resistive exercise and stretching (RSG; n=9; 66±5 years). The CG did not perform any exercise. The SG, RG, and RSG had warm-up sessions prior to performing lower-body exercises twice a week. The SG performed 4 repetitions of stretching. Resistive exercise was performed at a load of 65% of 10 repetitions maximum (RM) for five weeks, 70% for the next four weeks, and 75% for the last three weeks of the program.

The RSG performed both exercises. Cardiorespiratory capacity was evaluated using the 6-minute walk test (6MWT) at baseline, at the six- and 12-week follow-ups, and after a six-week period of detraining. Lower limb muscle strength was assessed using the stand up from a chair and sit down test (SUCSD), and blood pressure was measured using a sphygmomanometer and a stethoscope. The results were analyzed using ANOVA (p<0.05).

Results Six weeks of training increased walking distance (6MWT) in the RG and decreased SUCSD time in the SG. However, detraining increased systolic blood pressure (SBP) in the RG compared to the SG. Diastolic blood pressure (DBP) decreased after six weeks in the RSG and 12 weeks in the SG.
Conclusion Six weeks of stretching or resistive training can improve the functional status of older people. Nevertheless, DBP decreased after six weeks with the combination of resistive exercise and stretching. Detraining increased SBP when resistive exercise alone was used.
Study Name

Exercise in the Elderly: Research and Clinical Practice

Publication Clinics in Geriatric Medicine
Purpose This article incorporates some of the latest available data on the benefits of exercise in the elderly.
Methods Exercise programs generally consist of four major components: strength, endurance, balance, and flexibility. This article outlines the normal physiology of each component, the natural effects of aging and the effects of medical comorbidities
on each, research into the primary effects of exercise in elderly patients, and specific prescription recommendations.
Conclusion Although this article focuses on individual types of exercise and their contributions to patient health, any exercise program for a senior will incorporate aspects of them all. The program must be tailored to the individual needs of the patient, based on physical examination and laboratory and diagnostic data.
Study Name

Efficacy of physical conditioning exercise in patients with rheumatoid arthritis and osteoarthritis

Publication Arthritis & Rheumatology
Purpose The purpose of this study is to assess the efficacy of aerobic and nonaerobic exercise in patients with rheumatoid arthritis and osteoarthritis.
Methods A group of 120 patients with rheumatoid arthritis or osteoarthritis volunteered to be subjects for this study of aerobic versus nonaerobic exercise. Patients were stratified by diagnosis and randomized into an exercise program of aerobic walking, aerobic aquatics, or nonaerobic range of motion (controls). The retention rate for the 12-week program was 83%. Exercise tolerance, disease-related measures, and self-reported health status were assessed.
Results The aquatics and walking exercise groups showed significant improvement over the control group in aerobic capacity, 50-foot walking time, depression, anxiety, and physical activity after the 12-week exercise program. There were no significant between-group group differences in the change scores for flexibility, number of clinically active joints, duration of morning stiffness, or grip strength.
Conclusion Our findings document the feasibility and efficacy of conditioning exercise for people who have rheumatoid arthritis or osteoarthritis.
Study Name

Is water-based exercise training sufficient to improve physical fitness in the elderly?

Publication European Review of Aging and Physical Activity
Purpose The purpose of this study was to critically review the existing evidence of a potential relationship between water-based exercise and improvement of physical fitness in healthy elderly subjects.
Methods A systematic database search for manuscripts and a quality control were performed. A system of rating was defined. Aerobic, muscular strength, flexibility and body composition outcomes were then extracted. Nine studies were analyzed after the screening for eligibility: five randomized controlled trials (RCT), three randomized uncontrolled trials (UT) and one controlled trial (CT). Four RCT and two randomized UT were classified as high quality studies. One RCT, one randomized UT and one CTwere considered low quality studies.

Strong evidence supports the use of water-based exercise for the improvement of aerobic capacity and strength. Moderate evidence highlights the benefits on flexibility, and inconclusive evidence was found supporting the modification of body composition.

The evidences provided from this review suggest that a minimum frequency of twice per week water-based exercise sessions performed at moderate–high intensities can lead to improvements in aerobic capacity. However, it seems that three sessions per week of combined aerobic and resistance training should be required in order to obtain significant improvements in both aerobic capacity and muscular strength.

Study Name

Water-based exercise improves health-related aspects of fitness in older women

Publication Medicine & Science in Sports & Exercise
Purpose The purpose of this study was to determine the physiological responses of elderly women to a well-rounded exercise program performed in water (WEX).
Methods The participants (60-75 yr of age) were randomly divided into a training (TR) group (N = 15) and a control group (N = 15). The TR group participated in a 12-wk supervised WEX program, 70 min x day(-1), 3 d x wk(-1). The WEX consisted of 20 min of warm-up and stretching exercise, 10 min of resistance exercise, 30 min of endurance-type exercise (walking and dancing), and 10 min of cool-down exercise.
Results The WEX led to an increase (P < 0.05) in peak VO2 (12%) and VO2 at lactate threshold (20%). Muscular strength evaluated by a hydraulic resistance machine increased significantly at resistance dial setting 8 (slow) for knee extension (8%), knee flexion (13%), chest press (7%) and pull (11%), shoulder press (4%) and pull (6%), and back extension (6%). Vertical jump (9%), side-stepping agility (22%), trunk extension (11%), and FEV1.0 (7%) also increased significantly. There was a significant decrease in skin-fold thickness (-8%), low-density lipoprotein (LDL) cholesterol (-17%), and total cholesterol (-11%). There were no significant changes in these variables in the control group.
Conclusion These results indicate that WEX elicits significant improvements in cardiorespiratory fitness, muscular strength, body fat, and total cholesterol in older adult women. Water-based exercise appears to be a very safe and beneficial mode of exercise that can be performed as part of a well-rounded exercise program.
Study Name

Water-based aerobic and combined training in elderly women: Effects on functional capacity and quality of life

Publication Experimental Gerontology
Purpose This study aimed to investigate the effects of two water-based training programs (aerobic and combined) and a non-periodized physical activity program on functional capacity and quality of life (QoL) of elderly women.
Methods Forty-one elderly female volunteers (65 ± 4 years) were divided into three groups: aerobic training group (WBA, n = 13), combined training (sequence: resistance/aerobic; WBC; n = 11) and a control group of non-periodized physical activity program (CG, n = 9). The participants performed the water-based trainings twice a week for 12 weeks. The resistance training sets were performed at maximal effort and the aerobic training was performed in the percentage of the heart rate corresponding to the anaerobic threshold (85–110%) determined in an aquatic progressive test. Assessments of QoL perception (WHOQOL-BREF) and functional tests 30-Second Chair Stand, 6-Minute Walk and 8-Foot Up-and-go were performed before and after training. The data were analyzed using Generalized Estimating Equations (GEE), and Bonferroni post-hoc test (α = 0.05).
Results In CG, QoL perception in the physical domain decreased (12 ± 10%) and there was no difference in the other domains. On the other hand, QoL perception was significantly increased in the water-based training groups after the training period in the physical (WBC: 13 ± 16%), psychological (WBA: 9 ± 16%; WBC: 10 ± 11%), social relationships (WBA: 19 ± 42%; WBC: 16 ± 21%) and environmental (WBA: 10 ± 17%; WBC: 16 ± 28%) domains and overall QoL (WBA: 17 ± 22%). No significant difference was observed in the physical domain for WBA and in the overall for WBC. Significant improvements were observed for all groups in the functional tests 30-Second Chair Stand (WBA: 32 ± 11%; WBC: 24 ± 14%; CG: 20 ± 9), 6-Minute Walk (WBA: 10 ± 7%; WBC: 7 ± 6%; CG: 7 ± 5%) and 8-Foot Up-and-go (WBA: 11 ± 5%; WBC: 10 ± 9%; CG: 10 ± 6%).
Conclusion Based on the results observed in this study, it can be concluded that both water-based trainings (aerobic and combined) are effective in improving functional capacity and QoL perception of elderly women. Although non-periodized physical activities seem to be sufficient to positively modify the functional capacity of this population, they are not efficient in improving QoL perception.
Study Name

Impact of two hydrogymnastics class methodologies on the functional capacity and flexibility of elderly women

Publication The Journal of Sports Medicine and Physical Fitness
Purpose The aim of this study was to compare the effects of performing two hydrogymnastic class methodologies on the functional capacity and flexibility in elderly women.
Methods Ninety women, aged 55-70 years, were divided into three groups, the control group (CG; N.=30) who did not exercise during the 12 weeks, experimental group 1 (EG1; N.=30), who performed water gymnastics classes with emphasis on lower limb exercises for 12 weeks, and experimental group 2 (EG2; N.=30), who performed conventional hydrogymnastics classes for 12 weeks. The volunteers were evaluated through the 30-second chair stand (30CST), 2-minute step test (2MST), timed up and go (TUG), static balance (SB) and chair sit-and-reach (CSR) tests.
Results In the intragroup comparison, there were significant improvements in the performance of 30CST tests (F=5.5, P=0.022), TUG (F=19.3, P<0.001), SB (F=5.3, P=0.025), and CSR (F=12.0, P=0.001) in EG1 and EG2. For intergroup comparisons, the EG1 presented better results than CG in CST (P<0.05). The EG2, presented better results than CG in CST, TUG, SB and CSR (P<0.05). There were no significant differences for the comparison between EG1 and EG2.
Conclusion It was concluded that 12 weeks of hydrogymnastics practice improved the functional capacity and flexibility of the elderly women evaluated, and no differences were found between the two types of methodologies used.
Study Name

The effect of Aerobics, water aerobic exercise, and water-based exercise training on working memory of elderly women diagnosed with Alzheimer’s disease

Publication Sport Science Research Institute
Purpose This study aimed to investigate the effect of Aerobics, ware aerobic exercise, and water-based exercise training on working memory of elderly women diagnosed with Alzheimer’s disease.

This was a quasi-experimental study with three groups’ pre-test post-test design. The participants, 30 elderly women diagnosed with Alzheimer’s disease, with the mean age of 64 years were randomly assigned into three groups (aerobic, water aerobic exercise, and water-based exercise training). The training protocol consisted of 18 sessions, and each session lasted 45 minutes.

The Wechsler Memory Scale (WMS) was used to measure the memory and the N-Back software was used to assess the working memory of the study participants. Data were analyzed using the SPSS software version22. Two-way repeated measurement ANOVA (3 group × 2 times) and paired sample t-test were used to analyze the data.

Results After the training, participants in all groups had better working memory status. However, the participants in the water aerobic exercise group showed greater improvement in working memory compares to other groups. There were significant differences between the three groups in the three subscales of visual memory, associated learning, and memory span.
Conclusion The result of this study indicated that water aerobic exercise can effectively improve the cognitive function of elderly women diagnosed with Alzheimer’s disease. The study findings could be useful guidelines for enhancing the cognitive function of elderly patients.
Study Name

The Effect of Eight Weeks of Exercise in Water on the Levels of Stress, Anxiety and Depression of Elderly Men

Publication Report of Health Care
Purpose Nowadays, the trend of dramatic growth in the aging population and its relation with mental disorders is on the rise. In this vein, the present study aimed to investigate the effect of eight weeks of exercise in water on the levels of stress, anxiety and depression of elderly men in Gachsaran city.

In this semi-experimental study, 30 male volunteers with a mean age of 66 ± 0.5 years, who met the inclusion criteria of the study, were randomly selected and assigned into two control and experimental groups of 15 subjects. The experimental group performed the selected exercises in water in accordance with the planned protocol, and the control group just performed their daily routine activities during this period.

Running pretest and post-test, stress (GHQ questionnaire), anxiety (Cattle’s questionnaire) and depression (Beck’s questionnaire) were measured in both groups. To analyze the findings, analysis of covariance was employed using SPSS software (version 21) (p≤0.05).

Results Exercise in water had a significant effect on stress components such as reduction of physical symptoms, anxiety symptoms and symptoms of depression and an increase in symptoms of social action compared to control group (p≤0.05), exercise in water had a significant effect on anxiety reduction compared to control group (p≤0.05) Also, exercise in water had a significant effect on depression reduction compared to control group (p≤0.05).
Conclusion Regarding the results of this study, it seems that exercise in water reduces anxiety and depression and some stress factors in elderly people.
Study Name

The Effects of a Brief, Water-Based Exercise Intervention on Cognitive Function in Older Adults

Publication Archives of Clinical Neuropsychology
Purpose The current study evaluated the effects of a brief, water-based exercise intervention on cognitive functioning and cardiovascular fitness in a group of community dwelling older adults.
Methods The exercise group (n = 27, Mage = 63.26 ± 7.64, 78% female) attended one moderate intensity water aerobics class per day for six consecutive days whereas the control group (n = 33, Mage = 65.67 ± 6.69, 75% female) continued their typical routine. Neuropsychological and cardiovascular fitness tests were given the week before and the week after the intervention to both groups.
Results The exercise group demonstrated significant improvements in cardiovascular fitness, as well as executive function, attention, and memory over controls. This suggests a brief exercise program can provide benefits for older adults.
Conclusion In summary, the current study shows that older adults exhibit improved cardiovascular fitness and cognitive function after a brief, water-based exercise program. While future research is needed to confirm these effects, the current study raises the possibility that even brief exercise interventions can provide meaningful benefits in a high-risk population.
Study Name

Effects of a Water Aerobics Program on the Blood Pressure, Percentage of Body Fat, Weight, and Resting Pulse Rate of Senior Citizens

Publication Journal of Applied Gerontology
Purpose The aim of this study was to assess the effects of a 16-week water aerobics class on the blood pressure, percentage of body fat, weight, and resting pulse rate of senior citizens.
Methods Ten men and 18 women aged 57 to 76 participated in a 16-week water exercise class at Rose State College, Oklahoma City. The class met for one hour twice a week for the 16 weeks and was composed of flexibility exercises, aerobic exercises, and cool-down exercises. Pre- and postclass measurements were taken for blood pressure, weight, percentage of body fat, and resting pulse rate and were compared using a paired t-test.
Results Reductions significant at the .05 level were recorded for diastolic blood pressure, weight, and percentage of body fat. There were no significant reductions in systolic blood pressure and resting pulse rate.
Conclusion I concluded that water aerobics is an ideal modality for senior citizens’aerobic exercise because of the favorable changes it produces in the health parameters investigated and because it places little stress on the weight-bearing joints during exercise.
Study Name

Effect of Nordic Walking and Water Aerobics Training on Body Composition and the Blood Flow in Lower Extremities in Elderly Women

Publication Journal of Human Kinetics
Purpose The aim of the study was to evaluate the influence of regular health training on the venous blood flow in lower extremities and body composition in women over 50 years old.
Methods Twenty-four women of mean age 57.9 (± 3.43) years, randomly divided into three groups (Nordic walking, water aerobics, and non-training), participated in the study. The training lasted 8 weeks, with one-hour sessions twice a week. Dietary habits were not changed. Before and after training vein refilling time and the function of the venous pump of the lower extremities were measured by photoplethysmography. Body composition was determined by bioelectrical impedance.
Results Eight weeks of Nordic walking training improved the venous blood flow in lower extremities and normalized body composition in the direction of reducing chronic venous disorder risk factors. The average values of the refilling time variable (p = 0.04, p = 0.02, respectively) decreased in both the right and the left leg. After training a statistically significant increase in the venous pump function index was found only in the right leg (p = 0.04). A significant increase in fat-free mass, body cell mass and total body water was observed (p = 0.01), whereas body mass, the body mass index, and body fat decreased (p < 0.03). With regard to water aerobic training, no similar changes in the functions of the venous system or body composition were observed.

Eight weeks of NW training in women aged over 50 years improve the venous blood flow in lower extremities and normalize body composition towards the reduction of CVD risk factors.

Eight weeks of WA training in women aged over 50 years are not sufficient to significantly change body composition towards a reduction of body fat content and development of muscle mass and do not lead to an improvement of the function of the musculo-vascular pump of lower extremities.

Study Name

Balance as an Additional Effect of Strength and Flexibility Aquatic Training in Sedentary Lifestyle Elderly Women

Publication Hindawi Current Gerontology and Geriatrics Research Volume 2020
Purpose Objective: To evaluate the additional effects of on balance an aquatic muscle strengthening and flexibility training program in healthy sedentary lifestyle elderly women.
Methods This controlled clinical trial included 56 healthy sedentary women, aged from 65 to 70 years, divided into two groups. The aquatic group (AG) underwent aquatic training (45 minutes/session, 32 sessions), and the control group (CG) received no intervention. Data were collected pre- and post-intervention, during a one-week period. Lower limb muscle strength was measured by a force sensor (myometer). Flexibility was measured by biophotogrammetry. Functional balance was evaluated by the Performance Oriented Mobility Assessment (POMA) and the Berg Balance Scale (BBS).
Results Muscle strength, flexibility, and balance improved in AG (p<0.001), but not in CG.
Conclusion The aquatic exercises program, which was originally developed to promote muscle strength and flexibility, also improved functional balance. Aquatic training is an option for physical health promotion for sedentary lifestyle elderly women.
Study Name

The Effect of Thera Band Exercise on Muscle Flexibility, Balance Ability, Muscle Strength in Elderly Women

Publication Journal of Korean Academy of Community Health Nursing
Purpose The purpose of this study was to examine the effects of thera band exercise on muscle flexibility, balance ability, muscle strength and self-rated health in elderly women.
Methods The quasi-experimental research design (one-group pretest-post test) was employed. Participants were recruited in S-city and a total of 14 elderly women completed 15-week thera band exercise. Descriptive statistics, paired t-test and McNemar-test were used in data analysis by SPSS/WIN 12.0.
Results Compared with those before participation, the participants showed higher muscle flexibility, balance ability, and muscle strength after participation in thera band exercise.
Conclusion Findings of this study indicated that the 15-week thera band exercise program had a favorable effect on muscle flexibility, balance ability and muscle strength of elderly women. Future research needs to develop combined exercise programs with other types of exercise for the health of elderly women.
Study Name

Effects of elastic band exercises on physical ability and muscular topography of elderly females

Publication Journal of Physical Therapy Science
Purpose This study examined the effects of band exercise types on the physical ability and muscular topography for elderly females.
Methods Twenty-six females older than 65 years were divided into the dynamic band exercise (DBE; n=13) group and the Static band exercise (SBE; n=13) group. Each participant performed 12 weeks of elastic band exercises. Physical abilities were measured by leg extension power, sitting trunk flexion, closed eyes foot balance, and time to get up. Changes in muscle topography were evaluated with Moire measurement equipment for the chest, abdomen, and lumbar region. All results were compared before and after 12 weeks of exercise.
Results Changes in physical ability were significantly increased in both groups. The scores for the muscular topography of the chest, abdomen, lumbar region, and all body parts was significantly improved in both groups for closed eyes foot balance. There were more improvements in the DBE group.
Conclusion Two types of static and dynamic elastic band exercises effectively changed the physical fitness and muscle topography of elderly females. Therefore, to increase the effects of exercise, dynamic band exercises are considered useful. Because band exercises are simple, they can be used to maintain the health of elderly people.
Study Name

Effect of different types of exercise on postural balance in elderly women: A randomized controlled trial

Publication Archives of Gerontology and Geriatrics
Purpose This study aimed to evaluate the effect of three different exercises (mini-trampoline, MT; aquatic gymnastics, AG and general floor gymnastics, GG) on postural balance in elderly women.
Methods Seventy-four physically independent elderly women, mean age 69 ± 4 years, were randomly assigned to three intervention groups: (1) MT (n = 23), (2) AG (n = 28), and (3) GG (n = 23). Each group performed physical training, including cardiorespiratory, muscular strength and endurance, flexibility and sensory-motor exercises for 12 weeks. To determine the effects on each intervention group, five postural balance tasks were performed on a force platform (BIOMEC 400): the two-legged stand with eyes open (TLEO) and two-legged stand with eyes closed (TLEC); the semi-tandem stand with eyes open (STEO) and semi-tandem stand with eyes closed (STEC) and the one-legged stand. Three trials were performed for each task (with 30 s of rest between them) and the mean was used to compute balance parameters such as center of pressure (COP) sway movements.
Results All modalities investigated such as the MT, AG and GG were significantly (P < 0.05) efficient in improving the postural balance of elderly women after 12 weeks of training.
Conclusion These results provide further evidence concerning exercise and balance for promoting health in elderly women.
Study Name

Training to Reduce Postural Sway and Increase Functional Reach in the Elderly

Publication Journal of Occupational Rehabilitation
Purpose Poor balance is one of the most common risk factors for falling, a common cause of work-related injury and death. The aim of this study is to evaluate the effects of a 10-week intervention program on balance in older adults.
Methods To evaluate the effects of a 10-week intervention program on balance in older adults, 12 participants aged 61–77 years (age = 70.4 ± 5.4 years; mean ± SD) completed an exercise program (60 min, 2 days · week−1 for 10 weeks) performed while laying/sitting on large air-filled exercise balls (Thera-Band®). Several postural sway composite scores (determined while standing with feet apart and semitandem, eyes open and closed) improved (p ≤ 0.05) including medial–lateral amplitude and speed of sway (reduced by ∼9%), and instantaneous speed (reduced by ∼13%).
Results Reductions in XY area approached (p = 0.06) statistical significance and anterior–posterior amplitude and speed of sway did not change. Functional reach also improved (20.3%).
Conclusion These results suggest that challenging the physiological systems involved in balance control while on the nonstable support surface of the exercise balls improves both static and dynamic balance in older adults and may reduce the risk for falling.
Study Name

Exercises Including Weight Vests and a Patient Education Program for Women With Osteopenia: A Feasibility Study of the OsteoACTIVE Rehabilitation Program

Publication Journal of Orthopaedic & Sports Physical Therapy
Purpose The primary aim was to describe the OsteoACTIVE rehabilitation program and evaluate its feasibility in terms of progression, adherence, and adverse events in patients with low bone mineral density (BMD) and a healed forearm fracture. The secondary aim was to assess changes in measures of function and quality of life.
Methods Forty-two postmenopausal women with osteopenia and a healed forearm fracture attended the OsteoACTIVE program for 6 months (3 sessions of 60 minutes per week). Feasibility was assessed by documenting training progression (load and exercises), program adherence (aiming for greater than 80%), and adverse events (joint pain, muscle soreness, and falls). Secondary measures included quadriceps strength, BMD, dynamic balance, walking ability, and self-report functional outcome measures. All outcome measures were recorded preintervention (baseline), postintervention, and at 1-year follow-up
Results Thirty-five women (83%) completed the 6-month program and 31 women (74%) attended all the follow-up measurement sessions. All participants progressed during the rehabilitation program for both load and type of exercises. Furthermore, 87% of the participants met the a priori goal of 80% adherence, and no participants reported adverse events. Improvements in quadriceps strength and BMD of the femoral trochanter were noted at the end of the 6-month training period (P<.05). At 1-year follow-up, there were significant improvements in quadriceps strength and dynamic balance compared to baseline (P<.05).
Conclusion The OsteoACTIVE rehabilitation program was feasible and achieved progression of training level, had high adherence, and had no adverse events. Positive improvements were established in lower extremity function and femoral trochanter BMD.

The article has an Appendix with Active Rehabilitation Program with Examples of Some Exercises, including flexibility exercises, Exercises for strength, balance, core stability, and use of weight vest (40 minutes), Cool-down and flexibility (7 minutes).

Study Name

Reducing Risk of Falling in Older People Discharged From Hospital: A Randomized Controlled Trial Comparing Seated Exercises, Weight-Bearing Exercises, and Social Visits

Publication Archives of Physical Medicine and Rehabilitation
Purpose Objective: To compare the efficacy of seated exercises and weight-bearing (WB) exercises with social visits on fall risk factors in older people recently discharged from hospital.
Methods Design: Twelve-week randomized, controlled trial.
Setting: Home-based exercises.
Participants: Subjects (N=180) aged 65 and older, recently discharged from hospital.
Interventions: Seated exercises (n=60), WB exercises (n=60), and social visits (n=60).
Main Outcome Measures: Primary outcome factors were Physiological Profile Assessment (PPA) fall risk score, and balance while standing (Coordinated Stability and Maximal Balance Range tests). Secondary outcomes included the component parts of the PPA and other physical and psychosocial measures.
Results Subjects were tested at baseline and at completion of the intervention period. After 12 weeks of interventions, subjects in the WB exercise group had significantly better performance than the social visit group on the following: PPA score (P=.048), Coordinated Stability (P<.001), Maximal Balance Range (P=.019); body sway on floor with eyes closed (P=.017); and finger-press reaction time (P=.007) tests. The seated exercise group performed better than the social visit group in PPA score (P=.019) but for no other outcome factor. The seated exercise group had the highest rate of musculoskeletal soreness.
Conclusion In older people recently discharged from the hospital, both exercise programs reduced fall risk score in older people. The WB exercises led to additional beneficial impacts for controlled leaning, reaction time, and caused less musculoskeletal soreness than the seated exercises.
Study Name

The Effects of Trunk Stabilization Exercises with a Swiss Ball on Core Muscle Activation in the Elderly

Publication Journal of Physical Therapy Science
Purpose The purpose of this study was to investigate the effects of trunk stabilization exercise on the muscle EMG activations related to core stability.
Methods Fifteen elderly people in a geriatric hospital performed trunk stabilization exercises with a Swiss ball for 20 minutes five times per week for 8 weeks. Trunk muscle activations were measured using electromyography before and after the intervention.
Results After the intervention, the muscle activations of the rectus abdominis, erector spinae, lateral low-back (quadratus lumborum and external oblique), and gluteus medius muscles increased significantly.
Conclusion The trunk stabilization exercise with a Swiss ball significantly increased the muscle activities of the elderly.
Study Name

Effect of Squat Exercises on Lung Function in Elderly Women with Sarcopenia

Publication Journal of Clinical Medicine
Purpose We explored whether a mechanically-assisted squat exercise improved muscle mass, muscle function, and pulmonary function in elderly women with or without sarcopenia.
Methods In total, 76 community-dwelling elderly subjects (>60 years of age) were screened. We ultimately included 30 subjects who completed more than 80% of the six-week course of mechanically-assisted squat exercises (three days per week, 30 min per day). We measured body composition, lung function, knee extensor strength, hand grip strength, and the 3-min walk distance (3MWD) before and after the exercise program. Subjects with sarcopenia had poor hand grip strength and knee extensor strength, and a slow walking speed. Their lung function parameters, including forced vital capacity (FVC), was lower than those of the controls.
Results After six weeks of squat exercises, the hand grip strength, knee extensor strength, and 3MWD increased significantly in both groups. Appendicular skeletal muscle mass and leg lean mass were increased in subjects without sarcopenia. The FVC (L) increased significantly only in the sarcopenia group (p = 0.019).
Conclusion The mechanically-assisted squat exercise program increased muscle function and lung function, including FVC, in patients with sarcopenia. Muscle mass increased in subjects without sarcopenia.
Study Name

Balance improvement and reduction of likelihood of falls in older women after Cawthorne and Cooksey exercises

Publication Brazilian Journal of Otorhinolaryngology
Purpose Aim: To verify whether specific therapeutic approach of the system can promote motor learning and can contribute to the improvement of balance and to decrease of likelihood of falls.
Methods Study design: Clinical prospective.
Material and Method: Fifteen women, aged 60 to 69, mean = 64.8 years old (±2.95), resident in Barra Mansa-RJ, were submitted to Cawthorne and Cooksey exercises during three months, three times a week, during sixty minutes. They were evaluated with Berg Balance Scale (BBS), whose scores determine the possibility of fall (PQ).
Results Comparing the data obtained before and after intervention, we observed significant difference (p < 0.05), showing improvement in BBS scores and decrease in PF.
Conclusion Cawthorne and Cooksey exercises were able to promote significant improvement in the balance of this sample and they can be applied as prevention and treatment in balance disturbances in elderly people.
Study Name

Comparison of the effects of two selected exercises of Theraband and Pilates on the balance and strength of lower limb in elderly women

Publication The Iranian Journal of Obstetrics, Gynecology and Infertility
Purpose The present study was performed with aim to compare the effects of two selected exercises of Theraband and Pilates on the balance and strength of lower limb in elderly women.

Methods: This semi-experimental (interventional) study was performed with pre-test and post-test on 45 women aged 60-75 years old in Mashhad in 2014. They were randomly divided into three groups: the Theraband training, Pilates training, and control groups. The experimental groups participated for six weeks in Theraband and Pilates trainings.

The control group did their daily activities during the project. Before and after the six weeks of training, Berg test (dynamic balance) and thirty Second Chair Stand test (strength of lower limb) were given. Data were analyzed by covariance analysis (ANCOVA), Analysis of variance (ANOVA), Bonferroni post hoc test and Mean Difference. P˂0.05 was considered significant.

Results Results: Pilates and Theraband trainings led to a significant improvement in the dynamic balance and strength of lower limb in elderly women. Furthermore, Theraband trainings was more affective on the dynamic balance and Pilates trainings on the strength of lower limb.
Conclusion Conclusions: both Pilates and Theraband trainings lead to the increase of the dynamic balance and strength of lower limb in elderly women, but, Pilates training was more effective on strength of lower limb and Theraband training was more effective on dynamic balance.
Study Name

Effects of Resistive and Balance Exercises on Isokinetic Strength in Older Persons

Publication Journal of the American Geriatrics Society
Purpose OBJECTIVE: To determine the safety and efficacy of 3 months of resistive training of multiple lower extremity muscle groups compared with balance training in persons over 75 years.
Methods DESIGN: Randomized 3‐month clinical trial. Subjects (n = 110, mean age 80) were randomized to 4 groups in a 2 × 2 design (control, resistive, balance, combined resistive/balance).
INTERVENTIONS: Resistive training involved knee extension and flexion, hip abduction and extension, and plantar and dorsiflexion using simple resistive machines and sandbags. Balance training consisted of exercises to improve postural control. The control group attended 5 health‐related discussion sessions.
MEASUREMENTS: Summed isokinetic moments (N m) of 8 leg movements: hip, knee and ankle flexion/extension, and hip abduction/adduction. Secondary outcomes were gait velocity and chair rise time.
Results Summed peak moment increased in both resistive exercise‐trained groups (13% increase in the resistive group and 21% in the combined training group, P < 0.001). The effect of resistance training was significant (MANOVA F = 21.1, P < 0.001), but balance training did not improve strength, and there was no interaction (positive or negative) between balance and resistive training. Maximal gait velocity and chair rise time did not improve. Eleven subjects (20%) had musculoskeletal complaints related to resistive training, but all were able to complete the program with modifications.
Conclusion Resistive training using simple equipment is an effective and acceptable method to increase overall leg strength in older persons. Resistive or balance training did not improve maximal gait velocity or chair rise time in this sample of relatively healthy older persons.
Study Name

Comparative Study of Balance Exercises (Frenkel) and Aerobic Exercises (Walking) on Improving Balance in the Elderly

Publication Elderly Health Journal
Purpose The aim of this study was to investigate the effect of Frenkel balance exercise and aerobic exercise (walking) on improving the balance of elderly patients in Kerman province in 2016-2017.
Methods We used a randomized block design, with 4 participants in each block; 48 elderly men and women living in the nursing homes of Kerman province were randomly assigned to two groups, balance (Frenkel) exercises and aerobic exercises (walking). The two groups performed Frenkel exercises and aerobic exercises (walking) for three 10- to 15-min sessions a week for five weeks. The balance time using the Sharpened Romberg test was recorded to measure static balance and the Get Up and Go test used to measure dynamic balance before and after the exercise program. To describe the variables studied, central tendency indicators and dispersion were used. Paired t-test was used to compare the time of balance before and after intervention and independent t-test to compare changes in balance time between two groups.
Results The mean static balance (with Sharpend Römberg test) was increased from 3.16 s to 6.01 s in Frenkel exercise, and from 3.33 s to 4.95 s in aerobic training group, indicating an improvement in the static balance after intervention. The mean time of dynamic balance (in the Get Up and Go test) during Frenkel exercise reduced from 17.07 s to 12.03 s, and during aerobic training from 17.08 s to 10.9 seconds, indicating an improvement in dynamic balance (p < 0.01). However, there was no significant difference in the mean changes in the duration of dynamic and static balance before and after intervention in the two groups.
Conclusion Both Frenkel exercise and walking equally improve static and dynamic balance in the elderly in different settings.
Study Name

Effect of a Home Program of Hip Abductor Exercises on Knee Joint Loading, Strength, Function, and Pain in People With Knee Osteoarthritis: A Clinical Trial

Publication Physical Therapy & Rehabilitation Journal
Purpose This study investigated the effect of an 8-week home strengthening program for the hip abductor muscles on knee joint loading (measured by the external knee adduction moment during gait), strength (force-generating capacity), and function and pain in individuals with medial knee OA.

Hip abductor muscle weakness may result in impaired frontal-plane pelvic control during gait, leading to greater medial compartment loading in people with knee osteoarthritis (OA).


Design: The study design was a nonequivalent, pretest-posttest, control group design.

Setting: Testing was conducted in a motor performance laboratory.

Patients: An a priori sample size calculation was performed. Forty participants with knee OA were matched for age and sex with a control group of participants without knee OA.
Intervention: Participants with knee OA completed a home hip abductor strengthening program.

Measurements: Three-dimensional gait analysis was performed to obtain peak knee adduction moments in the first 50% of the stance phase. Isokinetic concentric strength of the hip abductor muscles was measured using an isokinetic dynamometer. The Five-Times-Sit-to-Stand Test was used to evaluate functional performance. Knee pain was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire.

Results Following the intervention, the OA group demonstrated significant improvement in hip abductor strength, but not in the knee adduction moment. Functional performance on the sit-to-stand test improved in the OA group compared with the control group. The OA group reported decreased knee pain after the intervention.
Limitations: Gait strategies that may have affected the knee adduction moment, including lateral trunk lean, were not evaluated in this study.
Conclusion Hip abductor strengthening did not reduce knee joint loading but did improve function and reduce pain in a group with medial knee OA.
Study Name

Home exercise to improve strength and walking velocity after hip fracture: A randomized controlled trial

Publication Archives of Physical Medicine and Rehabilitation
Purpose Objective: To determine the effect of a home exercise program on strength, postural control, and mobility following hip fracture.

Design: Randomized controlled trial of 1 month’s duration.
Setting: Daily exercise carried out within the subjects’ home environments.

Participants: Forty-two people 64 to 94 years of age, 35 of whom were living independently in the community and 7 of whom were residing in institutional care. Subjects were recruited on average 7 months after a fall-related hip fracture and randomly allocated to either the intervention or the control group (n = 21 each). The groups were well matched in terms of medical conditions, medication use, disability, and activity levels.

Intervention: A “home-based” program of weight-bearing exercise established at a visit by a physiotherapist.
Main Outcome Measures: Quadriceps strength, postural sway, functional reach, weight-bearing ability, walking velocity, and self-rated fall risk. The subjects undertook these assessments at the beginning and end of the trial.

Results At pretest, exercisers and controls performed similarly in all tests. At the end of the trial, the intervention group showed significantly greater quadriceps strength in the affected (hip-fractured) leg and increased walking velocity. The intervention subjects also improved their weight-bearing ability and reported reduced subjective falls risk. In contrast, there were no significant improvements in any of the test measures in the controls. Within the intervention group, improvements in quadriceps strength were significantly associated with improved performances in the weight-bearing test measures and with increased walking.
Conclusion This exercise program improved strength and mobility following hip fracture. Further research is needed to ascertain whether the extent of this improvement in these fall risk factors is sufficient to prevent falls.
Study Name

Multicomponent Training Program with Weight-Bearing Exercises Elicits Favorable Bone Density, Muscle Strength, and Balance Adaptations in Older Women

Publication Calcified Tissue International
Purpose In this study we examined the effects of 8-month multicomponent training with weight-bearing exercises on different risk factors of falling, including muscle strength, balance, agility, and bone mineral density (BMD) in older women.

Participants were randomly assigned to either an exercise-training group (ET, n = 30) or a control group (CON, n = 30). Twenty-seven subjects in the ET group and 22 in the CON group completed the study. Training was performed twice a week and was designed to load bones with intermittent and multidirectional compressive forces and to improve physical function.

Outcome measures included lumbar spine and proximal femoral BMD (by dual X-ray absorptiometry), muscle strength, balance, handgrip strength, walking performance, fat mass, and anthropometric data. Potential confounding variables included dietary intake, accelerometer-based physical activity, and molecularly defined lactase nonpersistence.

Results After 8 months, the ET group decreased percent fat mass and improved handgrip strength, postural sway, strength on knee flexion at 180°/s, and BMD at the femoral neck (+2.8%). Both groups decreased waist circumference and improved dynamic balance, chair stand performance, strength on knee extension for the right leg at 180°/s, and knee flexion for both legs at 60°/s. No associations were found between lactase nonpersistence and BMD changes.
Conclusion Data suggest that 8 months of moderate-impact weight-bearing and multicomponent exercises reduces the potential risk factors for falls and related fractures in older women.
Study Name

Safe Antiaging Full-Body In-Bed Gym and FES for Lazy Persons: Home In-Bed Exercises for Fighting Muscle Weakness in Advanced Age

Publication In: Masiero S., Carraro U. (eds) Rehabilitation Medicine for Elderly Patients. Practical Issues in Geriatrics. Springer, Cham.
Purpose Inspired by the proven capability to recover skeletal muscle contractility and strength by home-based functional electrical stimulation and guided by common sense, we suggest a short (15–20 min) daily routine of 12 easy-to-perform physical exercises that may be performed in bed (full-body in-bed gym).

Sedentary people may gradually start, after asking their family physician’s advice, with five repetitions of each suggested exercise. The next week they may add groups of five additional repetitions up to 30. The daily routine exercises may last from 10 (in the beginning) to 30 min (for complete session in accustomed persons).

Suggested Exercises:

  1.  Flexion and extension of the ankles;
  2.  Cycling movements;
  3.  Arms up and arms down;
  4.  Deep breathing;
  5.  Forward bending;
  6.  To raise the pelvis;
  7.  Neck torsions;
  8.  Sit up;
  9. Lift the legs when in sitting position;
  10.  Stand up;
  11. Get up on toes.

Instructing and supporting patients to perform daily in-bed exercises are an effective and low-cost measure to limit disability and improve physical and mental being of older patients.

If sedentary persons, without major comorbidities but with rest-related muscle weakness, challenge themselves, avoiding stress, in a few days of full-body in-bed gym, they may increase their muscle strength, fatigue resistance, and independence in daily life activities. Cautious in-bed gym may help patient’s recovery after the acute phase of hospitalization, prevent the risk of thromboembolism after surgical interventions, and concur to reduce arterial hypertension.

Full-body in-bed gym could mitigate the bad mood that is usually associated to mobility limitations, strengthening patients’ confidence in recovering partial or total independence, thus reducing the risk of accidental falls.

Study Name

Effects of unsupported upper extremity exercise training in patients with COPD: a randomized clinical trial

Publication Chest
Purpose We studied the effects of 15 sessions of unsupported upper extremity exercise training (UEET) on functional exercise capacity, the ability to perform activities of daily living (ADL), and symptoms perceived during activities involving arms in patients with COPD.
Methods We conducted a randomized trial that consisted of 3 weeks of inpatient PR, comparing the short-term effects of unsupported UEET plus PR (intervention group) to those of PR alone (control group). A change in the 6-min ring test (6MRT) was the primary outcome; the ADL field test (four shuttle stations), the dyspnea score as assessed by the Medical Research Council scale, the London Chest Activity of Daily Living scale (LCADL), and the distance walked in 6 min served as secondary outcomes of the study. At the 6-month follow-up, we repeated the 6MRT and the LCADL.

The UEET involved 15 sessions of resistance exercises specificbbto five different muscular groups, which were performed by using dumbbells. This training consisted of five movements that specifically require the activation of muscles that may be involved in respiration and/or in the support of the shoulder girdle during the ADL performed with unsupported arms (see Appendix for details). Patients performed the training in a standing posture with slight hip abduction and knee flexion, without the support of the UEs.
Patients: 50 (33 men and 17 women), age 69.5+/- 8.9.

Results Fifty patients with COPD were randomly assigned to the two groups and completed the study. At the end of the study period, patients in the intervention group improved in the 6MRT and ADL field test compared with those patients in the control group (p = 0.018 and p = 0.010, respectively) with reduced perception of fatigue (p <or= 0.006). At the 6-month follow-up, 6MRT (p = 0.001) and LCADL (p = 0.039) scores were still significantly better in the intervention group compared with the control group.
Conclusion Our trial corroborates the effectiveness of unsupported UEET in specifically improving functional exercise capacity of patients with COPD. Moreover, it also provides evidence that this training modality may ameliorate and maintain the patients’ autonomy over and above standard PR.
Study Name

Leg press exercise can reduce functional hamstring: quadriceps ratio in the elderly

Publication Journal of Bodywork and Movement Therapies
Purpose The aim of this study was to investigate whether 12 weeks of leg press strength training exercise could affect the conventional and functional hamstring:quadriceps ratios in the elderly.
Methods Twelve elderly participants were submitted to a 12 week progressive training protocol (two sessions/week) using a 45° leg press exercise.
Results A significant increase in the one repetition maximum was observed after 4, 8, and 12 weeks (p = 0.001, p < 0.001, and p < 0.001, respectively) compared to week 0 and after 8 (p = 0.011) and 12 weeks (p = 0.001) compared to week 4. The concentric knee extensor peak torque was significantly higher at weeks 8 (p = 0.001) and 12 (p = 0.024) compared to week 0. There was no change in the concentric and eccentric knee flexor peak torques (p = 0.629 and 0.274, respectively) and conventional ratio (p > 0.314) after 12 weeks of training. The functional ratio (eccentric knee flexor peak torque:concentric knee extensor peak torque) reduced significantly after 8 (p = 0.034) and 12 (p = 0.036) weeks of strength training.
Conclusion Although the 45° leg press exercise requires knee extensor and flexor, hip extensor, and plantar flexor muscle strength, our findings suggest that the isolated use of the 45° leg press exercise reduces the knee functional ratio after 8 weeks of training. Therefore, 45° leg press exercise alone, without a hamstring exercise, should not be recommended for elderly individuals.
Study Name

The Importance of Trunk Muscle Strength for Balance, Functional Performance, and Fall Prevention in Seniors: A Systematic Review

Publication Sports Medicine
Purpose The objectives of this systematic literature review are: (a) to report potential associations between TMS/trunk muscle composition and balance, functional performance, and falls in old adults, and (b) to describe and discuss the effects of CST/PET on measures of TMS, balance, functional performance, and falls in seniors.

Data Sources: A systematic approach was employed to capture all articles related to TMS/trunk muscle composition, balance, functional performance, and falls in seniors that were identified using the electronic databases PubMed and Web of Science (1972 to February 2013).

Study Selection: A systematic approach was used to evaluate the 582 articles identified for initial review. Cross-sectional (i.e., relationship) or longitudinal (i.e., intervention) studies were included if they investigated TMS and an outcome-related measure of balance, functional performance, and/or falls. In total, 20 studies met the inclusionary criteria for review.

Study Appraisal and Synthesis Methods: Longitudinal studies were evaluated using the Physiotherapy Evidence Database (PEDro) scale. Effect sizes (ES) were calculated whenever possible. For ease of discussion, the 20 articles were separated into three groups [i.e., cross-sectional (n = 6), CST (n = 9), PET (n = 5)].


The cross-sectional studies reported small-to-medium correlations between TMS/trunk muscle composition and balance, functional performance, and falls in older adults. Further, CST and/or PET proved to be feasible exercise programs for seniors with high-adherence rates. Age-related deficits in measures of TMS, balance, functional performance, and falls can be mitigated by CST (mean strength gain = 30 %, mean effect size = 0.99; mean balance/functional performance gain = 23 %, mean ES = 0.88) and by PET (mean strength gain = 12 %, mean ES = 0.52; mean balance/functional performance gain = 18 %, mean ES = 0.71).

Limitations: Given that the mean PEDro quality score did not reach the predetermined cut-off of ≥6 for the intervention studies, there is a need for more high-quality studies to explicitly identify the relevance of CST and PET to the elderly population.

Conclusion Core strength training and/or PET can be used as an adjunct or even alternative to traditional balance and/or resistance training programs for old adults. Further, CST and PET are easy to administer in a group setting or in individual fall preventive or rehabilitative intervention programs because little equipment and space is needed to perform such exercises.
Study Name

Effect of Core Strengthening Exercise Programs on Symmetric Double Limb Support and Balance Ability for the Elderly

Publication Journal of International Academy of Physical Therapy Research
Purpose The purpose of this study effectiveness of core strengthening exercise programs on symmetric double limb support and balance ability for elderly.
Methods The subjects that 30 persons between the ages of 65~80 elderly participated were divided into two groups randomly for 8 weeks. Tetrax interactive balance system and Berg’s balance scale were used to assess support and stability. Paired t-tests were used to evaluate the changes before and after intervention. The difference between the groups was compared using an independent t-test.
Results The subjects that 30 persons between the ages of 65~80 elderly participated were divided into two groups randomly for 8 weeks. Tetrax interactive balance system and Berg’s balance scale were used to assess support and stability. Paired t-tests were used to evaluate the changes before and after intervention. The difference between the groups was compared using an independent t-test.
Conclusion Consequently, core strengthening exercise program should be considered as a therapeutic method for the elderly to improve the balance ability and effectiveness on falls.
Study Name

Effect of 12-week Swiss Ball Exercise Program on Physical Fitness and Balance Ability of Elderly Women

Publication Journal of Physical Therapy Science
Purpose This study examined the effect of a Swiss ball exercise program for elderly females on physical fitness and balance ability in order to offer basic data for the development of an exercise program to improve the quality of life and promote the health of elderly females.
Methods Sixty-five elderly women aged over 78 participated in this study. The subjects were divided into two groups: an exercise group and a control group.
The exercise group (n=38) performed a Swiss ball exercise program which consisted of 12 types of exercises required for balance and performance of functions twice a week for 12 weeks. Physical fitness (Sit-to-Stand, Arm Curl, Sit-and-Reach, Back Scratch) and balance ability (One-Legged Standing time, Timed Up & Go) were evaluated.
Results There was a significant increase in the physical fitness and balance ability of the exercise group.
Conclusion The Swiss ball exercise program had a positive effect on physical fitness and balance ability of elderly women. We consider that the ball which is easy, safe and interesting to use will encourage the elderly’s active participation in exercise.
Study Name

The Effects of Trunk Stabilization Exercise Using Swiss Ball and Core Stabilization Exercise on Balance and Gait in Elderly Women

Publication Journal of The Korean Society of Physical Medicine
Purpose The purpose of this study was to investigate the effects of trunk stabilization exercise using swiss ball and core stabilization exercise on balance and gait in elderly women.
Methods Subjects 19 elderly women were randomly divided by the swiss ball exercise group (n=10) and the core stabilization exercise group (n=9). In a period of 4 weeks, they took trunk stabilization exercise using swiss ball and core stabilization exercise for 60 minutes 3 times a week. Balance and gait were measured by Functional Reach Test (FRT), One Leg Stand Test with Open Eye (OLSTOE), One Leg Stand Test with Closed Eye (OLSTCE), Timed Up and Go Test (TUG) and 6 m Walking Test (6MWT). These tests were measured at before exercise, 4 weeks after exercise and after the follow-up period of 2 weeks.
Results As a result, in all measurement values there was no significant difference in two groups (p>.05). In FRT, TUG, OLSTOE and 6MWT before exercise and 4 weeks after exercise, there was significant difference in both of two groups (p<.05). Moreover, according to results from 4 weeks after exercise and after the follow-up period of 2 weeks, without any particular exercise, in FRT and 6MWT there was no significant difference (p>.05).
Conclusion These finding indicate that trunk stabilization exercise using swiss ball could improve balance and gait in elderly women. Accordingly, In this study trunk stabilization exercise using swiss ball and core stabilization exercise is judged to be used for elderly people with gait and balance problems to prevent hurts from fall.
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Improvement of Postural Balance and Trunk Muscle Strength: Effect of Free Exercise, Elastic Band Exercise and Balance Exercise

Publication Journal of the Korean Society for Precision Engineering
Purpose This study was to verify the effect of complex training programs on the postural balance and trunk muscle strength of the elderly.
Methods We recruited 40 elderly participants aged 60 to 75 years. Subjects were evaluated before, and 12 weeks after. The participants underwent complex training programs, including free exercise, elastic band and unstable plate. Exercise were performed as follows: 10 repeats in 50 minutes (0 to 4 weeks), 13 repeats in 50 minutes (5 to 8 weeks), and 15 repeats in 50 minutes (9 to 12 weeks). The training group underwent complex training, including warm up, thrice a week for twelve weeks. The control group did not perform any complex training.
Results Results indicate that the postural balance and trunk muscle strength in the training group significantly increased.
Conclusion Postural balance and trunk muscle strength in the training group significantly increased. Data generated from this study could be applied to develop a complex training program to efficiently build whole body muscle strength.
Study Name

The Effects of Fall Prevention Static and Dynamic Trunk Stabilization Exercises on the Balance of Elderly Females

Publication Indian Journal of Public Health Research & Development
Purpose The purpose of this study is to investigate the effects of static/dynamic trunk stabilization exercises on the balance abilities of female patients above the age of 65 years.
Methods This study included 30 females above the age of 65 years, who were randomly divided into the static trunk exercise stabilization group (n=15) and the dynamic trunk exercise stabilization group (n=15). The stabilization exercises were performed three times a week for four weeks. Static and dynamic balance abilities were measured before and after the exercise to determine its effects. Frailty and cooperative studies of intervention techniques-4 (FICSIT-4) and one leg standing test (OLST) were measured to evaluate static balance, while time up &amp; go test (TUG) and functional reach test (FRT) were measured to evaluate dynamic balance.
Results Our results showed that static trunk stabilization exercises significantly improved static balance ability (OLST) and dynamic balance ability (TUG) (p&lt;0.05). Dynamic trunk stabilization exercises significantly improved static balance abilities (FICSIT-4, OLST) and dynamic balance abilities (FRT, TUG) (p&lt;0.05). OLST, which reflects static balance ability, significantly differed between the two groups (p&lt;0.05).
Conclusion The static/dynamic trunk stabilization exercise group showed improvements in balance abilities, and in both groups, static and dynamic balances improved. In terms of effectiveness, no significant differences were observed between the outcomes of static and dynamic trunk stabilization exercises.
Study Name

Effects of Neck and Trunk Stabilization Exercise on Balance in Older Adults

Publication The Journal of Korean Physical Therapy
Purpose This study was conducted to evaluate the effects of neck and trunk stabilization exercise on static and dynamic balance in older adults.
Methods A total of 30 older adults participated in this study. Participants were randomly assigned to the neck and trunk stabilization exercise group (NTSG) (n=15) or the trunk stabilization exercise group (TSG) (n=15). The NTSG performed a trunk stabilization exercise added to a neck stabilization exercise that included biofeedback. Both groups received training for 30 minutes per day three times per week for eight weeks. The anterior, posterior limit of stability and sway length was used to measure static balance ability, while the timed up and go (TUG) test was used to measure dynamic balance ability.
Results Participants showed significant differences in sway length, anterior limit of stability, posterior limit of stability, and the results of the TUG test between their pre- and post mediation evaluations (p<0.05). The NTSG showed a more significant increase than the TSG (p<0.05).
Conclusion According to the results of this study, both exercises effectively improved static and dynamic balance ability. However, the neck and trunk stabilization exercise is more efficient for increasing the balance ability of older adults.
Study Name

The Effect Of Core Stabilization Training Program On Elderly Postural Control

Publication Turkish Journal of Sports Medicine
Purpose In view of this divergence, and because of the potential and obvious importance of core stability training on the balance and postural control of the elderly, the purpose of this study was to study the effects of a core stability training program on postural control in an elderly population.

Sixty females recruited from a total of 200 and aged more than 60 years (70.6 ± 6.0 yrs, 55.8 ± 5.8 kg of weight and 157.8 ± 7.8 cm of height) were classified as low falling risk and high falling risk. Then, these subjects were randomly divided into two experimental and control groups. A week prior to starting the training program, their balance status were measured with the Berg balance test (BBT) and compared with independent and dependent t-tests. The experimental group followed a core stabilization program of three days per week, for eight weeks.

The core stability training program was divided into three sections. The first week program consisted of simple exercises as finding neutral position, sitting stabilization, prone gluteal squeezes, supine pelvic bracing, pelvic progression, side bridging, knee stabilization and supine bridging.

“Physioball” exercises for the core were introduced in the following weeks: abdominal crunch, balancing exercise while seated, “Superman” prone exercise, modified push-up, pelvic bridging. Core strengthening exercises were performed in the last weeks: body weight and gravitational loading (push-ups, pull-ups, rope climbs), body blade exercises, medicine ball exercises (throwing and catching), dumbbell exercises in diagonal patterns, core stretching exercises, balance training on a labile surface, squats, and lunges.

Results At the end of this period, they performed better (p<0.05) than the controls. The training program had also better effects on the high risk group. Significant differences were observed for balance following the training program, in both the anteroposterior and mediolateral planes (p<0.05).
Conclusion In conclusion, significant differences were shown in improving balance and postural control after a related training program in elderly women.
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Effect of 12-week neck, core, and combined stabilization exercises on the pain and disability of elderly patients with chronic non-specific neck pain: A clinical trial

Publication Salmand: Iranian Journal of Ageing
Purpose Objectives: To investigate the effect of 12 weeks of neck stabilization, core stabilization, and combined stabilization exercises on pain and disability among elderly people in Tehran City, Iran.
Methods Methods & Materials: This study was a 12 weeks open-label clinical trial. A total of 18 elderly patients with chronic neck pain were randomly assigned into three groups: neck stabilization training (6 people), core stabilization training (6 people), and combined stabilization training (6 people). The severity of neck pain and disability before the beginning of the training, 8 weeks after training and one week after the completion of the exercises were measured using the Visual Analog Scale (VAS), Neck Disability Index (NDI) and Neck Pain and Disability Scale (NPDI). To investigate the effect of time, repeated measure analysis of variance was used to analyze the data in SPSS version 21.
Results The Mean±SD scores of pain before and after neck stabilization treatment were respectively 6.08±0.58, 4.83±0.52 for VAS and 49.17±2.86 and 39.17±2.79 for NDI; and 56.4±2.11 and 50.0±1.64 for NPDI; those differences between pairs were significant. The Mean±SD scores of pain before and after core stabilization treatment were respectively, 6.00±0.55, 4.92±0.20 for VAS; 49.67±1.86 and 39.17 ±1.94 for NDI; and 56.01±2.44, and 48.92±1.16 for NPDI; those differences between pairs were significant. Also, the Mean±SD scores of pain before and after combined stabilization treatment were respectively, 6.00±0.45, 4.00±0.32 for VAS; 49.83±2.23 and 37.17±2.86 for NDI; and 55.25±0.28 and 47.51±1.44 for NPDI; those differences between pairs were significant (P < 0.05). Among the underlying variables, gender was the only significant factor in pain relief in the elderly (F=6.21, P=0.02), while other variables were not significant (P > 0.05).
Conclusion The findings of this study showed that 12 sessions of neck, core, and combined stabilization training in the neck region could improve the tolerance and pain of the elderly with nonspecific chronic neck pain
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Four-week trunk-specific exercise program decreases forward trunk flexion in Parkinson’s disease: A single-blinded, randomized controlled trial

Publication Parkinsonism & Related Disorders
Purpose The primary aim was to compare the effects of a four-week trunk-specific rehabilitation program on the severity of the forward trunk flexion. The secondary aim was to compare the training effects on the motor impairments, dynamic and static balance, pain, falls, and quality of life.
Methods 37 patients with PD (H&Y ≤ 4) and forward trunk flexion were randomized in the experimental (n = 19) or control group (n = 18). The former consisted of active self-correction exercises with visual and proprioceptive feedback, passive and active trunk stabilization exercises and functional tasks. The latter consisted of joint mobilization, muscle strengthening and stretching, gait and balance exercises. Protocols lasted 4 weeks (60 min/day, 5 days/week). Before, after, and at 1-month follow-up, a blinded examiner evaluated patients using primary and secondary outcomes. The primary outcome was the forward trunk flexion severity (degree). Secondary outcomes were the UPDRS III, dynamic and static balance, pain falls, and quality of life assessment.
Results The experimental group reported a significantly greater reduction in forward trunk flexion than the control group from T0 to both T1 (p = 0.003) and T2 (p = 0.004). The improvements in dynamic and static balance were significantly greater for the experimental group than the control group from T0 to T2 (p = 0.017 and 0.004, respectively). Comparable effects were reported on the other outcomes. Pre-treatment forward trunk flexion values were highly correlated to post-treatment trunk deviation changes.
Conclusion The four-week trunk-specific rehabilitation training decreased the forward trunk flexion severity and increased postural control in patients with PD.
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Effects of Different Bridge Exercises for the Elderly on Trunk and Gluteal Muscles

Publication Journal of Physical Therapy Science
Purpose The purpose of this study was to show the effects of different bridge exercises for the elderly on trunk and gluteal muscles.
Methods Twenty elderly persons were recruited.
The EMG activities of the right side L5 paraspinal, external abdominal oblique (EO), and gluteus maximus (GM) muscles were measured during three bridge exercises: conditions 1, 2, and 3.
Results The EMG activities of the for the L5 paraspinal, EO, and GM muscles showed significant differences among the 3 bridge exercise conditions. The EMG activity of the EO muscle significantly increased in the order of condition 1<2<3. The EMG activity of the GM muscle also significantly increased in the order of condition 1<2<3.
Conclusion Bridge exercises with special boards are effective exercises because they help to strengthen and develop the EO and GM muscles that help to stabilize the spine of the elderly.
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Effect of spinal stabilization exercises to reduce urinary incontinence in the elderly

Publication Research in Sport Medicine and Technology
Purpose The purpose of this study is to investigate effect of 4 weeks Spinal Stabilization exercises on urinary incontinence of the elderly people.
Methods In this study, participants are elderly women from age of 50 to 70 years old (67±11kg and BMI of 27±4kg/m2), who were placed in two experimental and control groups (10 people in each group) for 4 weeks (3 sessions per week). Urinary incontinence of the participants was measured through ICIQ-OAB questionnaire in pretest and posttest steps. According to abnormal distribution of data, nonparametric tests are used such as Wilcoxon and U Mann Whitney tests to test intragroup and intergroup variations at the level of p≤0.05.
Results Spinal stabilization exercises caused significant reduction of urinary incontinence in elderly women (p=0.001), so that the exercises can result in insignificant reduction of urinary frequency per day (p=0.083), significant reduction of urinary frequency per night (p=0.001), stress of fast use of WC (p=0.001) and leakage of urine (p=0.002). Moreover, intergroup investigations showed that experimental group has lower urinary incontinence than control group (p=0.01).
Conclusion Spinal stabilization exercises can result in reduction of urinary incontinence and its components through strengthening pelvic floor and abdominal muscles.
Study Name

Exercises to Activate Seniors

Publication The Physician and Sportsmedicine
Purpose The article provides a list of sitting and standing exercises for seniors and a short description of each exercise.

Exercises cover a wide range of sitting and standing exercises:

  1.  Deep Breathing and Slow Stretching exercises;
  2.  Head and Face exercises;