Exercise for improving balance in older people

According to a new review of research, exercise helps people stay steady on their feet in later years, when diminished balance can put older adults at risk for falls.

The review shows gains in balancing ability across different groups of adults who participated in a variety of exercises including walking, strength and balance training, dancing and tai chi.

Some of the balance exercises included rising from a chair and training on one leg.

“Our message is that some form of exercise will improve balance and it's never too late to exercise. Specifically, exercise that challenges your balance is best,” said lead review author Tracey Howe.

The analysis gathered evidence from 34 studies, which collectively included more than 2,800 participants. On average the study participants were over age 75, generally healthy, and the majority were women.

The review appears in the latest issue of The Cochrane Library , a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

After engaging in an exercise program, study participants achieved improvements in different kinds of balance measures including walking speed, standing on one leg and reaching forward without tipping over.

Health researchers want to learn more about balance because they suspect it relates to an individual's risk for falls. In old age, falls can lead to disability and a loss of independence. Howe said the review did not gauge the effect of exercise on falls, so there is no way to tell from the review if balance improvements led to fall prevention.

Still, Howe said, the balance gains documented in the study are significant because balance is involved in almost everything we do.

“You use it every time you move positions, even walking. Walking is nothing more than movement without falling — controlled falling,” said Howe, director of HealthQWest, a research consortium based at Glasgow Caledonian University in Scotland.

“Good balance allows you to react to change. As they get older, some people have problems with their muscles being rigid. Think of the wind blowing through a tree. If the tree sways too much, or if it is rigid, the tree will fall over. If you can sway with the wind, by responding to the subtle changes in everyday life you are more stable and less likely to fall,” she said.

The American College of Sports Medicine recently revised its guidelines for older adults. The recommendations include balance exercise for people who are at risk for falls, but the Cochrane review did not find that one kind of exercise outperformed any other.

Healthy aging researcher Debra Rose said health professionals need more information on how the risk of falls interacts with different types of exercise.

“The type of physical activity or exercise that's appropriate is really going to be determined by a person's level of risk for falls,” said Rose, professor of kinesiology and co-director of the Center for Successful Aging and Fall Prevention at California State University, Fullerton.

“When you are at low risk for falls, there are lots of exercise options, but the choices narrow as balance diminishes and fall risk increases,” Rose said.

The reviewers' analysis could not determine if the balance gains for older adults were long lasting.

“I agree with the summary that there isn't sufficient evidence of the efficacy of exercise over the long term,” said Rose. “There's a notion that exercise is a quick fix — it isn't. It has to be incorporated into an overall lifestyle change.”

Howe, TE et al. Exercise for improving balance in older people (Review). Cochrane Database of Systematic Reviews 2007, Issue 4.

The Cochrane Collaboration is an international non-profit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.