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Peter Cavanagh
01-19-1997, 01:39 AM
EXERCISE AND POSTURAL STABILITY IN THE ELDERLY:
A SUMMARY

This is a summary of responses to the following original posting:
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"I have been asked by the American College of Sports Medicine to review the
evidence for and against exercise as an intervention to improve postural
stability in the elderly. This will eventually be incorporated into an
ACSM position statement.

Any references to published work on this topic would be much appreciated."

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Thanks to the following individuals who responded:

Art Kuo University of Michigan
Ron Zernicke University of Calgary
Jim Patton Northwestern U.
Cathie Sherrington University of NSW
Steve Robinovitch University of California, San Francisco
David G Lloyd University of Western Australia
Jeff Ives Ithaca College
Dean Kriellaars University of Manitoba
Mark Pearcy Queensland University of Technology
Calvin Hersh University of California, Davis
Todd Royer Arizona State University
Jiping Shih University of Nevada, Reno
Marjorie Woollacott University of Oregon
Kathleen Warling Arizona State University
Marybeth Brown

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REFERENCES

Buchner DM, Cress ME, Wagner EH, de Lateur BJ, Price R, Abrass IB. The
Seattle FICSIT/MoveIt study: the effect of exercise on gait and balance in
older adults. J Am Geriatr Soc 1993;41:321-325.

CAN MED ASSOC JOURNAL OCT 155(8), 1996 entitled "Clinical practice
guidelines for the diagnosis and management of osteoporosis".

Chandler JM, Hadley EC. Exercise To Improve Physiologic and Functional
Performance In Old Age. Clinics In Geriatric Medicine 1996; 12:761-784.

Crilly RG, Willems DA, Trenholm KJ, Hayes KC, Delaquerriere-Richardson,
LFO. Effect of exercise on postural sway in the elderly. Gerontology
1989;35:137-143.

Era P. Posture control in the elderly. Int J Technol Aging 1988;1:166-179.

Hu M-H, Woollacott MH. Multisensory training of standing balance in older
adults: I. Postural stability and one-leg stance balance. Journal of
Gerontology 1994;49:M52-M61.

Hu M-H, Woollacott MH. Multisensory training of standing balance in older
adults: II. Kinematic and electromyographic postural responses. Journal of
Gerontology 1994;49:M62-M71.

Hu MH, Woollacott MH. A training program to improve standing balance under
different sensory conditions. In: Woollacott M, Horak F, eds. Posture &
Gait: Control Mechanisms, Eugene, Oregon: U of O Books, 1992: 199-202.

Jarnlo, GB Hip fracture patients. Background and function. Scandinavian
Journal of Rehabilitation Medicine - Supplement. 24: 1-31.1991

Johansson G, Jarnlo G-B. Balance training in 70-year-old women.
Physiotherapy Theory and Practice 1991;7:121-125.

Judge JO, Lindsey C, Underwood M, Winsemius D. Balance improvements in
older women: effects of exercise training. Physical Therapy
1993;73:254-265.

Judge, J.O., Whipple, R.H., and Wolfson, L.I.: Effects of resitive and
balance exercises on isokinetic strength in older persons. J Am Geriatr
Soc, 42: 937- 946, 1994.

Lichtenstein MJ, Shields SL, Shavi RG, Burger C. Exercise and balance in
aged women. A pilot controlled clinical trial. Arch Phys Med Rehabil
1989;70:138-143.

Lord SR, Caplan GA, Ward JA. Balance, reaction time and muscle strength in
exercising and nonexercising older women: a pilot study. Archives of
Physical Medicine and Rehabilitation 1993;74:837-839.

Lord SR, Castell S. Physical activity program for older persons: effect on
balance, strength, neuromuscular control, and reaction time. Arch Phys Med
Rehabil 1994;75:648-652.

Lord SR. Lloyd DG. Nirui M. Raymond J. Williams P. Stewart RA. The
effect of exercise on gait patterns in older women: a randomized controlled
trial. Journals of Gerontology. Series A, Biological Sciences & Medical
Sciences. 51(2):M64-70, 1996 Mar.

Lord, S. R., P.N. Sambrook, C. Giblert, P.J. Kelly, T. Nguyen, I.W. Webster
Postural stability falls and fractures in the elderly: results from the
Dubo Osteoperosis Epidemiology Society. Medical journal of Australia.
160:684-685. 1994

Lord SR. Ward JA. Williams P. Exercise effect on dynamic stability in
older women: a randomized controlled trial. Archives of Physical Medicine &
Rehabilitation. 77(3):232-6, 1996 Mar.

Lord SR. Ward JA. Williams P. Strudwick M. The effect of a 12-month
exercise trial on balance, strength, and falls in older women: a randomized
controlled trial. Journal of the American Geriatrics Society.
43(11):1198-206, 1995 Nov.

MacRae et al. A 1-year exercise program for older women: effects on falls,
injuries, and physical performance. J. of Aging and Physical Activity. 2,
127-142.1994

Prior JC, Barr SI, Chow R, Faulkner RA. Physical activity as therapy for
osteoporosis. Can. Med. Assoc. Journal 155(7) October, 1996, 940-944.

Province, M.A., Hadley, E.C., Hornbrook, M.C., Lipsitz, L.A., Miller, J.P.,
Mulrow, C.D., Ory, M.G., Sattin, R.W., Tinetti, M.E., and Wolf, S.L. (1995)
The effects of exercise on falls in elderly patients. A preplanned
meta-analysis of the FICSIT Trials. Frailty and Injuries: Cooperative
Studies of Intervention Techniques. Journal of the American Medical
Association, 273(17): 1341-1347.

Rizzo JA Baker DI McAvay G Tinetti ME. The cost-effectiveness of a
multifactorial targeted prevention program for falls among community
elderly persons.Med Care (1996 Sep) 34(9):954-69.

Roberts (1989). Effects of walking on balance among elders. Nursing
Research. 38, 180-182.

Roberts BL, MI Srour, MH Woollacott, PF Tang. The effects of a twelve-week
aerobic walking program on gait of healthy elderly. In: Posture and Gait:
Vestibular and Neural Front. Taguchi K, ed. 1994.

Salgado, R., S.R. Lord, J Packer, F. Ehlich (1994) Factors associated
with falling in elderly hospital patients. Gerontology. 406:325-331.

Sauvage LR et al. A clinical trial of strengthening and aerobic exercise to
improve gait and balance in elderly male nursing home residents. Am J Phys
Med Rehabil 1992;71:333-342.

Shih, J. (1997) Basic Beijing twenty-four forms of tai chi exercise and
average velocity of sway. Perceptual and Motor Skills, 84, 287-290.

Simmons, V., & Hansen, P.D. (1996). Effectiveness of water exercise on
postural mobility in the well elderly: An experimental study on balance
enhancement. Journal of Gerontology: Medical Sciences, vol.51A, pp.
M233-238.

Tang, PF, S Moore, M Woollacott. Relationship between functional mobility
and static sensory balance testing in older adults with balance problems.
In: Posture and Gait: Vestibular and Neural Front. Taguchi K, ed. 1994.

Tang, P-F., Woollacott, M. H., Roberts, B. L., Srour, M., Lee, J-H., &
Martin, M. J. (1995) Effects of Walking Exercise Training on Gait
Characteristics of Healthy Older Adults. Neurology Report, 1995.

Tinetti ME Baker DI McAvay G Claus EB Garrett P Gottschalk M Koch ML
Trainor K Horwitz RI. A multifactorial intervention to reduce the risk of
falling among elderly people living in the community [see comments] N Engl
J Med (1994 Sep 29) 331(13):821-7

Tinetti, M.E.: Prevention of falls and fall injuries in elderly persons: A
research agenda. Preventive Medicine, 23: 756-762, 1994.

Topp R et al. The effect of a 12 week dynamic resistance strength training
program on gait velocity and balance of older adults. The Gerontologist
1993;33:501-6.

Whipple, R.H., L. I. Wolfson, P.M. Amerman (1987) The relationship of
knee and ankle weakness to falls in nursing home residents: An isokinetic
study. Journal of the American Geriatric Society. 35:13-20.

Williams P. Lord SR. Predictors of adherence to a structured exercise
program for older women. Psychology & Aging. 10(4):617-24, 1995 Dec.

Wolf, S. L., Barnhart, H. X., Kutner, N. G., McNeely, E., Coogler, C., &
Xu, T. (1996) Reducing frailty and falls in older persons: an investigation
of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty
and Injuries: Cooperative Studies of Intervention Techniques. Journal of
the American Geriatric Society, 44, 489-497.

Wolfson, L., Whipple, R., Derby, C., Judge, J., King, M., Amerman, P.,
Schmidt, J., & Smyers, D. (1996) Balance and strength training in older
adults: intervention gains and tai chi maintenance. Journal of the American
Geriatric Society, 44, 498-506.

Woollacott,M.H, Moore,S., and Hu.M.H. Improvements in balance in the
elderly through training in sensory organization abilities. In: Stelmach G,
Homberg V, eds. Sensorimotor Impairment in the Elderly. Dordrecht,
Netherlands:Kluwer, 1993: 377-392.

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COMMENTS

>From Dean Kriellaars:
My comment relates to the phrasing of the statement "exercise as an
intervention to improve postural stability in the elderly". I sit on the
Scientific Review Committee for the Osteoporosis Society of Canada (MB
Branch) and it has produced a document related to fracture risk and
physical activity. The guideline document is published CAN MED ASSOC
JOURNAL OCT 155(8), 1996 entitled "Clinical practice guidelines for the
diagnosis and management of osteoporosis". I hope the guidelines are
useful. Also you will notice that physical activity is indicated in the
guidelines as to reduce the risk of falls. Postural stability is only one
factor in fall avoidance and I hope that your position statement will
address this issue broadly.

>From Steve Robinovitch:
Since fall prevention is the main goal of such exercise-based therapies, I
would suggest that in addition to addressing the relationship between
exercise and balance, the College statement also focus on the relationship
between exercise and falls. We cannot simply assume that improved balance
(as quantified by posturography, etc.) means decreased risk for falls. In
fact, the Tai Chi group in the Atlanta FICSIT trials actually had
decreased balance scores when compared to controls, but experienced 25-50
percent fewer falls (depending on the type of analysis). This is a greater
reduction in fall incidence than what has been seen with more traditional,
strength and balance-based training regimes.

>From Jim Patton:
Evidence of whether exercise can improve postural stability in the elderly
is confounded by many other factors. In a nursing home population study,
those individuals who fall more frequently were found to have either
reduced knee and ankle torque and power, or diminished sensorimotor
conduction and neuropathy (Whipple et al., 1987). Falling in elderly
populations has been shown to be associated with cognitive impairment and
psycho-active medications (Salgado et al., 1994), and with quadriceps
weakness, poor tactile sensitivity, and a greater visual field dependence
(Lord et al., 1994). However, postural control training regimes have been
shown to be effective in improving balance in elderly women (Jarnlo, 1991).

>From Kathleen Warling:
Though I only recently saw this subject on the email, I read that daily
exercise and stretching do indeed help the elderly in posture and other
physical imbalances, that could be" held" emotion, or past physical injury
at any time of their lives, that the client may not even remember. It may
require a watchful eye to see were it is held (contracted muscle tissue.
Other muscles will even take over to accomplish whatever required movement
is there, then the ones which could have done the activity. It is both an
emotional and physical issue, and has been done with dance therapy. There
is a website to the American Dance Therapy Asso.

>From Calvin Hersh:
Rather than trying to give you an exhaustive list of references, I will
refer you to an excellent review article that was recently published that
includes a discussion of your topic along with key references. In fact,
the entire issue of the journal is recommended.

Chandler JM, Hadley EC. Exercise To Improve Physiologic and Functional
Performance In Old Age. Clinics In Geriatric Medicine 1996; 12:761-784.

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{ Center for Locomotion Studies }
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