Effects of an 18-week strength and balance exercise intervention: physiological, biomechanical and psychological changes in older adult fallers.

Introduction The aims were to investigate the effects of an 18-week PSI intervention on muscle mass, balance, exercise motivation (EM), well-being (WB) and falls incidence.

Methodology A sample of twenty-two patient volunteers (age 77.14 ± 7.2 years) were referred onto the PSI intervention from a local falls clinic service.

Clinic-based tests (e.g. Timed-Up and Go (TUGT), Romberg Balance (ROM), Falls Efficacy Scale-International) were administered by the PSI instructor before first PSI class attendance (T0) and after 6 PSI classes (T1). At T0, T1 and after attending a further twelve community-based weekly PSI classes (T2), laboratory-based assessments of balance were conducted using force plate data; and well-being and exercise motivation by questionnaires. Whole body composition was measured using a DXA scanner at T0 and T2. Monthly falls incidence was recorded via telephone interview for six months following T2.

Results There were no significant changes (P >0.05) in EM, WB, or in lean, fat or bone mass, (T0-T2).

Significant reductions (P<0.05) were found between T0-T2 in the laboratory-based balance assessments for medio-lateral (ML; T0 9.58 ± 4.32; T2 8.69 ± 5.05) and antero-posterior (AP; T0 3.59 ± 4.93; T2 2.80 ± 1.83) sway and elliptical area (T0 479.50 ± 1064.17; T2 263.90 ± 331.50). Significant improvements were found in performance of all clinic-based tests – except for TUGT (T0-1), but were not replicated in the laboratory-based tests (T0-1). In the first month after the PSI intervention 13.4% of participants fell one or more times, this increased to 46.2% 6 months after the intervention

Conclusion Clinic-based tests showed significant improvements in performance (T0-1); that were not replicated in objective laboratory-based tests. Taken together the results suggest that changes in neural control were the cause of improved functional test scores. Short PSI interventions do not replicate the long-term reduction in falls seen after 48 week PSI programmes.