title: Effects of a targeted multimodal exercise program incorporating high-speed power training on falls and fracture risk factors in older adults: a community-based randomized controlled trial. A water-based training program that include perturbation exercises to improve stepping responses in older adults: study protocol for a randomized controlled cross-over trial Low- and High-Volume Water-Based Resistance Training Induces Similar Strength and Functional Capacity Improvements in Older Women: A Randomized Study. Effects of prolonged and maintenance strength training on force production, walking, and balance in aging women and men. Functional autonomy, bone mineral density (BMD) and serum osteocalcin levels in older female participants of an aquatic exercise program (AAG). Effects of Aqua Aerobic Therapy Exercise for Older Adults on Muscular Strength, Agility and Balance to Prevent Falling during Gait A water-based training program that includes perturbation exercises improves speed of voluntary stepping in older adults: a randomized controlled cross-over trial. The effects of a water-based exercise program on strength and functionality of older adults. Hip muscle and hand-grip strength to differentiate between older fallers and non-fallers: a cross-sectional validity study A best practice fall prevention exercise program to improve balance, strength / power, and psychosocial health in older adults: study protocol for a randomized controlled trial Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: a 6-month randomized, controlled trial. Comparison of the effects of exercise in water and on land on the rehabilitation of patients with intra-articular anterior cruciate ligament reconstructions. Reliability of the PEDro scale for rating quality of randomized controlled trials. Water-based exercise improves health-related aspects of fitness in older women. THE EFFECTS OF A TWENTY‐FOUR‐‐WEEK AQUATIC TRAINING PROGRAM ON MUSCULAR STRENGTH PERFORMANCE IN HEALTHY ELDERLY WOMEN Effects of Water-Based Training on Static and Dynamic Balance of Older Women. Validation of the Timed Up and Go Test for Assessing Balance Variables in Adults Aged 65 and Older. Does Fall Arrest Strategy Training Added to a Fall Prevention Programme Improve Balance, Strength, and Agility in Older Women? A Pilot Study.
abstract: Multimodal exercise programs incorporating traditional progressive resistance training ( PRT ) , weight-bearing impact training and /or balance training are recommended to reduce risk factors for falls and fracture . However , muscle power , or the ability to produce force rapidly , has emerged as a more crucial variable to functional decline than muscle strength or mass . The aim of this 12-month community-based r and omized controlled trial , termed Osteo-cise : Strong Bones for Life , was to evaluate the effectiveness and feasibility of a multimodal exercise program incorporating high-velocity (HV)-PRT , combined with an osteoporosis education and behavioral change program , on bone mineral density ( BMD ) , body composition , muscle strength and functional muscle performance in older adults . Falls incidence was evaluated as a secondary outcome . A total of 162 older adults ( mean ± SD ; 67 ± 6 years ) with risk factors for falls and /or low BMD were r and omized to the Osteo-cise program ( n = 81 ) or a control group ( n = 81 ) . Exercise consisted of fitness center-based HV-PRT , weight-bearing impact and challenging balance/mobility activities performed three times weekly . After 12 months , the Osteo-cise program led to modest but significant net gains in femoral neck and lumbar spine BMD ( 1.0 % to 1.1 % , p < 0.05 ) , muscle strength ( 10 % to 13 % , p < 0.05 ) , functional muscle power ( Timed Stair Climb , 5 % , p < 0.05 ) and dynamic balance ( Four Square Step Test 6 % , p < 0.01 ; Sit-to-St and , 16 % , p < 0.001 ) relative to controls . There was no effect on total body lean mass or mobility ( timed-up- and -go ) , and no difference in falls rate ( incidence rate ratio [ IRR ] , 1.22 ; 95 % confidence interval [ CI ] , 0.72 - 2.04 ) . In conclusion , this study demonstrates that the Osteo-cise : Strong Bones for Life community-based , multimodal exercise program represents an effective approach to improve multiple musculoskeletal and functional performance measures in older adults with risk factors for falls and /or low BMD . Although this did not translate into a reduction in the rate of falls , further large-scale trials are needed to evaluate the efficacy of this multimodal approach on reducing falls and fracture Background Gait and balance impairments may increase the risk of falls , the leading cause of accidental death in the elderly population . Fall-related injuries constitute a serious public health problem associated with high costs for society as well as human suffering . A rapid step is the most important protective postural strategy , acting to recover equilibrium and prevent a fall from initiating . It can arise from large perturbations , but also frequently as a consequence of volitional movements . We propose to use a novel water-based training program which includes specific perturbation exercises that will target the stepping responses that could potentially have a profound effect in reducing risk of falling . We describe the water-based balance training program and a study protocol to evaluate its efficacy ( Trial registration number # NCT00708136 ) . Methods / Design The proposed water-based training program involves use of unpredictable , multi-directional perturbations in a group setting to evoke compensatory and volitional stepping responses . Perturbations are made by pushing slightly the subjects and by water turbulence , in 24 training sessions conducted over 12 weeks . Concurrent cognitive tasks during movement tasks are included . Principles of physical training and exercise including awareness , continuity , motivation , overload , periodicity , progression and specificity were used in the development of this novel program . Specific goals are to increase the speed of stepping responses and improve the postural control mechanism and physical functioning . A prospect i ve , r and omized , cross-over trial with concealed allocation , assessor blinding and intention-to-treat analysis will be performed to evaluate the efficacy of the water-based training program . A total of 36 community-dwelling adults ( age 65–88 ) with no recent history of instability or falling will be assigned to either the perturbation-based training or a control group ( no training ) . Voluntary step reaction times and postural stability using stabiliogram diffusion analysis will be tested before and after the 12 weeks of training . Discussion This study will determine whether a water-based balance training program that includes perturbation exercises , in a group setting , can improve speed of voluntary stepping responses and improve balance control . Results will help guide the development of more cost-effective interventions that can prevent the occurrence of falls in the elderly BACKGROUND Water-based resistance training ( WRT ) has been indicated to promote strength gains in elderly population . However , no study has compared different training strategies to identify the most efficient one . The aim of this study was to compare the effects of 3 WRT strategies on the strength and functional capacity of older women . METHODS In total , 36 women were r and omly allocated to training groups : simple set of 30 seconds [ 1 × 30s ; 66.41 ( 1.36 ) y ; n = 12 ] , multiple sets of 10 seconds [ 3 × 10s ; 66.50 ( 1.43 ) y ; n = 11 ] , and simple set of 10 seconds [ 1 × 10s ; 65.23 ( 1.09 ) y ; n = 13 ] . Training lasted for 12 weeks . The maximal dynamic strength ( in kilograms ) and muscular endurance ( number of repetitions ) of knee extension , knee flexion , elbow flexion , and bench press , as well as functional capacity ( number of repetitions ) , were evaluated . RESULTS All types of training promoted similar gains in maximal dynamic strength of knee extension and flexion as well as elbow flexion . Only the 1 × 30s and 1 × 10s groups presented increments in bench press maximal strength . All 3 groups showed increases in muscular endurance in all exercises and functional capacity . CONCLUSIONS WRT using long- or short- duration simple sets promotes the same gains in strength and functional capacity in older women as does WRT using multiple sets 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 . Seventy-two women ( 58 ± 7 years ; W ) and 63 ( 58 ± 6 years ) men ( M ) were r and omized for the first 21-week ST period : STW and STM , control ( C ) CW and CM . Training participants were r and omized 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 . 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 . 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 The aim of the present study was to evaluate the effects of an AAG on BMD , osteocalcin and functional autonomy in older women . The sample consisted of eighty-two post-menopausal women with low BMD , r and omly divided into two groups : the Aquatic Aerobics Group [ AAG ; n=42 ; age : 66.8±4.2years ] , su bmi tted to two weekly sessions over eight months , and the  Control Group ( GC ; n=42 ; age : 66.9±3.2years ) , which did not participate in regular exercise . BMD was measured by  Dual Energy X-ray Absorptiometry [ DXA ] of the lumbar and femur , and serum osteocalcin was measured using electrochemiluminescence . A functional autonomy assessment protocol ( GDLAM , 2004 ) was also applied . Statistical analyses used were repeated measures ANOVA and Tukey 's post hoc tests . The results showed a significant improvement in tests following the GDLAM protocol : 10 meters walk ( 10mw ) -p=0.003 ; rising from a ventral decubitus position ( RVDP ) - Δ%=0.78 , p<0.001 ; rising from a chair and moving around the house ( RCMH ) -p<0.001 and autonomy index ( AI ) -p=0.007 , with more favorable results observed in the AAG when compared to the CG . The AAG achieved the best results for BMD ; however , no inter or intragroup statistical differences were recorded for total femur -p=0.975 and lumbar L(2)-L(4)p=0.597 . For serum osteocalcin , intra and intergroup statistical differences of p=0.042 and p=0.027 were observed in the AAG , respectively . This demonstrates that an eight-month aquatic aerobic exercise program can improve functional autonomy and osteocalcin levels , although training did not improve lumbar and total femur BMD in the older women [ Purpose ] The purpose of the present study was to examine the effects of an aqua aerobic therapy exercise for older adults on biomechanical and physiological factors affecting gait . [ Subjects ] A total of 15 subjects participated in this study and they were r and omly divided into the experimental and the control group . [ Methods ] Physiological variables , leg strength , power and flexibility , and biomechanical variables , both kinematic and kinetic , were measured before and after the aqua aerobic therapy exercise . Each subject was instructed to walk along an elevated walkway and during the trials a trapdoor opened at r and om to create a 10 cm falling perturbation . Full body motion and kinetics was gathered during the gait . [ Results ] There were significant reductions in body weight , and body fat mass , and stride time after the perturbation . Significant increases in leg strength corresponded to the maximum joint moment of the l and ing leg showing that the subjects ' ability for recovery of balance after the perturbation improved . [ Conclusion ] As the results showed significant improvements in gait pattern and recovery time after perturbed gait , we conclude that aqua aerobic therapy is an effective exercise method for training older adults to reduce their risk of falling This study evaluated the effects of a water exercise training program that includes perturbation exercises ( WEP ) to improve the speed of voluntary stepping reaction in older adults .  Speed of voluntary stepping considered as an important skill to prevent a fall when balance is lost . In a single-blinded r and omized controlled trial with a crossover design thirty-six independent old adults ( 64 - 88 years old ) were divided into two groups . Group A received WEP for the first 12 weeks , followed by no intervention for the second 12 weeks . Group B did not receive intervention for the first 12 weeks and received WEP for the second 12 weeks . Voluntary Step Execution Test and postural stability in upright st and ing ( eyes open and closed conditions ) were measured at baseline , 12 weeks , and 24 weeks . A significant interaction effect between group and time was found for the step execution , due to improvement in initiation phase and swing phase duration s in the WEP group . Also significant improvement in postural stability parameters in eyes open and closed conditions is noted . The present results indicate that the primary benefit of WEP that include perturbations to induce stepping , was a reduction in voluntary stepping times . The WEP generalized to a better control of balance in up-right st and ing OBJECTIVE To analyze the effects of a water-based exercise program on peak torque ( PT ) and rate of torque development ( RTD ) during maximal voluntary ballistic isometric contractions of the lower limb muscles and the performance of a number of functional tests in the elderly . METHOD Thirty-seven elderly were r and omly assigned to water-based training ( 3 d/wk for 12 wk ) or a control group .  Extensor and flexor PT and RTD of the ankle , knee , and hip joints and functional tests were evaluated before and after training . RESULTS PT increased after training for the hip flexors ( 18 % ) and extensors ( 40 % ) and the plantar-flexor ( 42 % ) muscles in the water-based group . RTD increased after training for the hip-extensor ( 10 % ) , knee-extensor ( 11 % ) , and ankle plantar-flexor ( 27 % ) muscles in the water-based group . Functional tests also improved after training in the water-based group ( p < .05 ) . CONCLUSION The water-based program improved PT and RTD and functional performance in the elderly Background Hip muscle weakness in older people seems to be an influencing factor of falls . Currently , it is unclear which muscles out of the hip muscle group play an important role in older people . A validating process in the measurement regarding muscle strength related to falls is necessary before answering that question . Objective Firstly , we aim ed to investigate which hip muscle group strength shows an acceptable level of distinction between older adult fallers and non-fallers compared to a predefined external criterion regarding falling . Secondly , we aim ed to compare the same outcomes and questions for h and -grip strength in relation to the same external criterion . Design This study was a cross-sectional validity study . Methods The  maximum voluntary isometric strength ( MVIS ) and the rate of force generation of hip abductors ( ABD ) , adductors , internal and external rotators , extensors , and flexors were measured with a dynamometer fixed to a custom-made frame as well as h and -grip strength with a Martin Vigorimeter in 60 older people aged over 65 years ( 38 females and 22 males ) . Results The area under the curve ( AUC ) and the results of the mean decrease in Gini index assessed by r and om forest approach show that of all the assessed parameters , hip ABD MVIS showed the highest discriminative value regarding the chosen external criterion in older people ( AUC ABD MVIS 0.825 , 95 % confidence interval : 0.712–0.938 ) . Conclusion Results indicate that ABD MVIS is a useful measure to distinguish between older adult fallers and non-fallers regarding the chosen external criterion Background With increasing age neuromuscular deficits ( e.g. , sarcopenia ) may result in impaired physical performance and an increased risk for falls . Prominent intrinsic fall-risk factors are age-related decreases in balance and strength / power performance as well as cognitive decline . Additional studies are needed to develop specifically tailored exercise programs for older adults that can easily be implemented into clinical practice . Thus , the objective of the present trial is to assess the effects of a  fall prevention program that was developed by an interdisciplinary expert panel on measures of balance , strength / power , body composition , cognition , psychosocial well-being , and falls self-efficacy in healthy older adults . Additionally , the time-related effects of detraining are tested . Methods / Design Healthy old people ( n = 54 ) between the age of 65 to 80 years will participate in this trial . The testing protocol comprises tests for the assessment of static / dynamic steady-state balance ( i.e. , Sharpened Romberg Test , instrumented gait analysis ) , proactive balance ( i.e. , Functional Reach Test ; Timed Up and Go Test ) , reactive balance ( i.e. , perturbation test during bipedal stance ; Push and Release Test ) , strength ( i.e. , h and grip strength test ; Chair St and Test ) , and power ( i.e. , Stair Climb Power Test ; countermovement jump ) . Further , body composition will be analysed using a bioelectrical impedance analysis system . In addition , question naires for the assessment of psychosocial ( i.e. , World Health Organisation Quality of Life Assessment -Bref ) , cognitive ( i.e. , Mini Mental State Examination ) , and fall risk determinants ( i.e. , Fall Efficacy Scale – International ) will be included in the study protocol . Participants will be r and omized into two intervention groups or the control / waiting group . After baseline measures , participants in the intervention groups will conduct a 12-week balance and strength / power exercise intervention 3 times per week , with each training session lasting 30 min . ( actual training time ) . One intervention group will complete an extensive supervised training program , while the other intervention group will complete a short version ( ' 3 times 3 ’ ) that is home-based and controlled by weekly phone calls . Post-tests will be conducted right after the intervention period . Additionally , detraining effects will be measured 12 weeks after program cessation . The control group / waiting group will not participate in any specific intervention during the experimental period , but will receive the extensive supervised program after the experimental period . Discussion It is expected that particularly the supervised combination of balance and strength / power training will improve performance in variables of balance , strength / power , body composition , cognitive function , psychosocial well-being , and falls self-efficacy of older adults . In addition , information regarding fall risk assessment , dose – response-relations , detraining effects , and supervision of training will be provided . Further , training-induced health-relevant changes , such as improved performance in activities of daily living , cognitive function , and quality of life , as well as a reduced risk for falls may help to lower costs in the health care system . Finally , practitioners , therapists , and instructors will be provided with a scientifically evaluated feasible , safe , and easy-to-administer exercise program for fall prevention . Trial registration Clinical Trials.gov Identifier : OBJECTIVES To compare the effectiveness of group resistance and agility-training programs in reducing fall risk in community-dwelling older women with low bone mass . DESIGN A r and omized , controlled , single-blind 25-week prospect i ve study with assessment s at baseline , midpoint , and trial completion . SETTING Community center . PARTICIPANTS Community-dwelling women aged 75 to 85 with low bone mass . INTERVENTION Participants were r and omly assigned to one of three groups : resistance training ( n=32 ) , agility training ( n=34 ) , and stretching ( sham ) exercises ( n=32 ) . The exercise classes for each study arm were held twice weekly . MEASUREMENTS The primary outcome measure was fall risk ( derived from weighted scores from tests of postural sway , reaction time , strength , proprioception , and vision ) , as measured using a Physiological Profile Assessment ( PPA ) . Secondary outcome measures were ankle dorsiflexion strength , foot reaction time , and Community Balance and Mobility Scale score . RESULTS Attendance at the exercise sessions for all three groups was excellent : resistance training ( 85.4 % ) , agility training ( 87.3 % ) , and stretching program ( 78.8 % ) . At the end of the trial , PPA fall-risk scores were reduced by 57.3 % and 47.5 % in the resistance and agility-training groups , respectively , but by only 20.2 % in the stretching group . In the resistance and agility groups , the reduction in fall risk was mediated primarily by improved postural stability , where sway was reduced by 30.6 % and 29.2 % , respectively . There were no significant differences between the groups for the secondary outcomes measures . Within the resistance-training group , reductions in sway were significantly associated with improved strength , as assessed using increased squat load used in the exercise sessions . CONCLUSION These findings support the implementation of community-based resistance and agility-training programs to reduce fall risk in older women with low bone mass . Such programs may have particular public health benefits because it has been shown that this group is at increased risk of falling and sustaining fall-related fractures BACKGROUND AND PURPOSE Exercises in water have been shown to be effective for improving strength and passive range of motion ( PROM ) . Traditional rehabilitation following intra-articular anterior cruciate ligament ( ACL ) reconstruction has taken place on l and . This study was design ed to compare the effects of exercises in water on strength and girth of the thigh musculature , knee PROM , joint laxity , effusion , and functional outcome with the effects of similar exercises on l and in subjects following intra-articular reconstruction of the ACL . SUBJECTS Twenty subjects were r and omly assigned to either a group that exercised on l and or a group that exercised in water . METHODS Thigh girth , joint effusion , and knee PROM measurements were recorded at 2-week intervals for the first 8 weeks postoperatively . Isokinetic and isometric peak torque measurements for the thigh musculature , knee joint laxity assessment s , and Lysholm scores were obtained at the end of 8 weeks . RESULTS Higher outcome scores were recorded in the water group than in the l and group , as measured by Lysholm scales . No differences were noted between groups for knee PROM , thigh girth , or quadriceps femoris muscle performance . In the water group , less joint effusion was noted after the 8 weeks . In the l and group , greater peak torque for isokinetic knee flexion was recorded . CONCLUSION AND DISCUSSION Although exercise in water may not be as effective as exercise on l and for regaining maximum muscle performance , rehabilitation in water may minimize the amount of joint effusion and lead to greater self-reports of functional improvement in subjects with intra-articular ACL reconstructions BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . 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 r and omly 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 The purpose of the present study was to determine the effectiveness of a 24-week aquatic training ( AT ) program , which included both aerobic and resistance components , on muscle strength ( isometric and dynamic ) , flexibility , and functional mobility in healthy women over 60 years of age . Twenty-two subjects were assigned r and omly to either an  AT ( n = 12 ) or a  control ( C , n = 10 ) group . Volunteers participated in a supervised shallow-water exercise program for 60 minutes a day , 3 days a week ; the exercise program consisted of a 10-minute warm-up and stretching , 25 minutes of endurance-type exercise ( dancing ) at 80 % of heart rate (HR)max , 20 minutes of upper- and lower-body resistance exercises with specialized water-resistance equipment , and a 5-minute cool down .  Maximal isometric torque of knee extensors ( KEXT ) and knee flexors ( KFLEX ) were evaluated by a Cybex Norm dynamometer , grip strength ( HGR ) was evaluated using a Jamar hydraulic dynamometer , and dynamic strength was evaluated via the 3 repetition maximum ( 3RM ) test for chest press , knee extension , lat pull down , and leg press . Jumping performance was evaluated using the squat jump ( SJ ) , functional mobility with the timed up- and -go ( TUG ) test , and trunk flexion with the sit- and -reach test . Body composition was measured using the bioelectrical impedance method . The AT induced significant improvements in KEXT ( 10.5 % ) and KFLEX ( 13.4 % ) peak torque , HGR strength ( 13 % ) , 3RM ( 25.7–29.4 % ) , SJ ( 24.6 % ) , sit- and -reach ( 11.6 % ) , and TUG ( 19.8 % ) performance . The AT group demonstrated a significant increase in lean body mass ( 3.4 % ) . No significant changes in these variables were observed in the C group . The results indicate that AT , with both aerobic and resistance components , is an alternative training method for improving neuromuscular and functional fitness performance in healthy elderly women OBJECTIVE The aim of this study was to evaluate the effects of a water-based exercise program on static and dynamic balance . METHOD Thirty-six older women were r and omly assigned to a water-based training ( 3 days/week for 12 weeks ) or control group . Water level was kept at the level of the xiphoid process and temperature at ∼28 - 30 ° C . Each session included aerobic activities and lower limb strength exercises . The medial-lateral , the anterior-posterior amplitude , and displacement of the center of pressure ( CP-D ) were measured in a quiet st and ing position ( 60 sec eyes opened and closed ) . The dynamic balance and 8-Foot Up- and -Go tests were also applied . Group comparisons were made using two-way analysis of variance ( ANOVA ) with repeated measures . RESULTS No differences were found in the center of pressure variables ; however , the WBT group showed better performance in the 8 Foot Up- and -Go Test after training ( 5.61±0.76 vs. 5.18±0.42 ; p<0.01 ) . CONCLUSION The water-based training was effective in improving dynamic balance , but not static balance The Timed Up and Go ( TUG ) test is recommended by the U.S. Centers for Disease Control and Prevention as an easy to administer clinical test to evaluate a senior citizen 's fall risk . Limited evidence has been presented in the literature validating the TUG test . In this study , the authors sought to assess correlations between the TUG test and various balance markers utilizing the OptoGait system .  A total of 51 healthy seniors completed r and omized trials of the TUG test and a gait test utilizing  OptoGait photoelectric technology .  Correlations among mean and SD values for these variables and TUG performance were calculated . Utilizing a Bonferroni adjustment and an alpha level of .05 , eight significant correlations of a moderately strong degree ( absolute r scores between .51 and .78 ) emerged . Correlation results indicate that the TUG test is a valid tool for screening balance deficits that lead to increased fall risk in senior citizens Purpose : The purpose of this study was to determine the effect of a unique exercise programme ( Fall Arrest Strategy Training , or FAST ) on upper body strength , range of motion ( ROM ) , and fall risk  in older women .  FAST was design ed to improve upper body capacity to prevent injury when a fall can not be avoided . Method : A quasi-r and omized site design included 71 older women ( aged 67 - 95 y , mean age 83 years ) , who participated either in a st and ard fall prevention programme ( Staying on Your Feet , or SOYF ;  n=29  ) or in SOYF combined with FAST ( n=42 ) . The women were measured three times-at baseline , after the 12-week intervention , and again 12 weeks later-for upper body strength , ROM , and fall risk factors ( fall risk question naire , balance , mobility , and leg strength ) . Results : No significant differences were found in age , physical activity , or cognitive or functional status between the SOYF-st and ard and the SOYF-FAST groups . Both groups improved their fall risk status after the intervention , with no significant differences between them ; however , the SOYF-FAST group showed greater improvements in upper extremity strength and ROM ( p=0.007 ) . Conclusion : FAST can feasibly be integrated into fall prevention programming , with additional gains in upper body strength and ROM in older women
target: However , aquatic exercise improved key predisposing physical fitness components that are modifiable and internal risk factors for falling .
  Conclusions There is limited , low- quality evidence to support the use of aquatic exercise for improving physiological components that are risk factors for falling .
background: Background According to the World Health Organization , the elderly are at the highest risk of injury or death from a fall .
  Age-related changes in strength , balance and flexibility are degenerative factors that may increase the risk of falling , and an aquatic training may offer a favourable environment to improve these modifiable risk factors .
  Methods A systematic review was conducted to assess the potential preventative role of aquatic exercise for reducing the risk of falls in the elderly by improving predisposing risk factors .