title: Training to Reduce Postural Sway and Increase Functional Reach in the Elderly Effectiveness of balance training programme in reducing the frequency of falling in established osteoporotic women: a randomized controlled trial Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: prospective observational cohort study Short- and Long-Term Effects of Balance Training on Physical Activity in Older Adults With Osteoporosis: A Randomized Controlled Trial Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial Physical activity, muscle function, falls and fractures Can the control of bodily orientation be significantly improved in a group of older adults with a history of falls? Deterioration in Quality of Life Following Hip Fracture: A Prospective Study
   Association of Opioids with Falls, Fractures, and Physical Performance among Older Men with Persistent Musculoskeletal Pain Training of balance under single- and dual-task conditions in older adults with balance impairment. Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65–75 year old women with osteoporosis Postural control in elderly women with osteoporosis: comparison of balance, strengthening and stretching exercises. A randomized controlled trial A 12-month randomized controlled trial of balance training in elderly women with osteoporosis: improvement of quality of life. Randomized controlled trial of exercise intervention for the prevention of falls in community-dwelling elderly Japanese women
abstract: Poor balance is one of the most common risk factors for falling , a common cause of work-related injury and death . 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-B and ® ) . Several postural sway composite scores ( determined while st and ing with feet apart and semit and em , 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 % ) . 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 % ) . 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 Objective : To investigate the effect of a 12-month sensomotor balance exercise programme on postural control and the frequency of falling in women with established osteoporosis . Design : R and omized controlled trial where the intervention group was assigned the 12-month Balance Training Programme and the control group did not undertake any intervention beyond regular osteoporosis treatment . Subjects : A total of 100 osteoporotic women – at least with one osteoporotic fracture – aged 65 years old and above . Main measures : Balance was assessed in static and dynamic posture both with performance-based measures of balance , such as the Berg Balance Scale and the Timed Up and Go Test , and with a stabilometric computerized platform . Interventions : Patients in the intervention group completed the 12-month sensomotor Balance Training Programme in an outpatient setting , guided by physical therapists , three times a week , for 30 minutes . Results : The Berg Balance Scale and the Timed Up and Go Test showed a statistically significant improvement of balance in the intervention group ( p = 0.001 and p = 0.005 , respectively ) . Balance tests using the stabilometer also showed a statistically significant improvement in static and dynamic postural balance for osteoporotic women after the completion of the Balance Training Programme . As a consequence , the one-year exercise programme significantly decreased the number of falls in the exercise group compared with the control group . Conclusion : The Balance Training Programme significantly improved the balance parameters and reduced the number of falls in postmenopausal women who have already had at least one fracture in the past Abstract Objectives To evaluate postoperative medical complications and the association between these complications and mortality at 30 days and one year after surgery for hip fracture and to examine the association between preoperative comorbidity and the risk of postoperative complications and mortality . Design Prospect i ve observational cohort study . Setting University teaching hospital . Participants 2448 consecutive patients admitted with an acute hip fracture over a four year period . We excluded 358 patients : all those aged < 60 ; those with periprosthetic fractures , pathological fractures , and fractures treated without surgery ; and patients who died before surgery . Interventions Routine care for hip fractures . Main outcome measures Postoperative complications and mortality at 30 days and one year . Results Mortality was 9.6 % at 30 days and 33 % at one year . The most common postoperative complications were chest infection ( 9 % ) and heart failure ( 5 % ) . In patients who developed postoperative heart failure mortality was 65 % at 30 days ( hazard ratio 16.1 , 95 % confidence interval 12.2 to 21.3 ) . Of these patients , 92 % were dead by one year ( 11.3 , 9.1 to 14.0 ) . In patients who developed a postoperative chest infection mortality at 30 days was 43 % ( 8.5 , 6.6 to 11.1 ) . Significant preoperative variables for increased mortality at 30 days included the presence of three or more comorbidities ( 2.5 , 1.6 to 3.9 ) , respiratory disease ( 1.8 , 1.3 to 2.5 ) , and malignancy ( 1.5 , 1.01 to 2.3 ) . Conclusions In elderly people with hip fracture , the presence of three or more comorbidities is the strongest preoperative risk factor . Chest infection and heart failure are the most common postoperative complications and lead to increased mortality . These groups offer a clear target for specialist medical assessment Background and Purpose : We have developed a 12-week balance training program for older adults shown to improve fall-related concerns , gait speed , balance performance , and physical function . We hypothesized that this balance training would also contribute to higher habitual physical activity ( PA ) levels and improved health-related quality of life ( HRQoL ) . The primary aim was to evaluate short- and long-term effects of the balance training program on objective ly measured habitual PA in older adults with osteoporosis . Secondary aims were to assess the effects of the balance training on HRQoL , and to study whether any effects on PA were associated with changes in HRQoL , gait speed , balance performance , fall-related concerns , and physical function . Methods : A r and omized controlled trial with follow-up at 3 , 9 , and 15 months , including 91 participants with osteoporosis ( 75.6 ± 5.4 years ) , compared a balance training group  ( n = 61 ) with a control group ( n = 30 ) . The primary outcome was effect on habitual PA measured as steps/day , dichotomized into less than 5000 or 5000 or more steps/day . Physical activity was assessed with pedometers ( Yamax ) and accelerometers ( Actigraph ) , HRQoL with the Short Form-36 ( SF-36 ) , gait with a GAITRite walkway , balance performance with Modified-Figure-Eight test and one-leg stance , fall-related concerns with Falls Efficacy Scale International , and physical function with the advanced lower extremity subscale of the question naire Late Life Function and Disability Instrument . Statistical methods used were multivariate logistic regression and logistic generalized estimating equation . Results : Sixty-eight participants completed the short-term follow-up at 3 months , and 53 participants completed the long-term follow-up at 15 months . Per- protocol analysis ( n = 68 ) showed that the odds ratio for having a daily step count of 5000 or more at 3 months was 6.17 ( 95 % confidence interval , 1.23 - 30.91 ) , P = .027 , for the intervention group compared with the control group . The longitudinal analysis ( n = 91 ) showed that the odds ratio for having a daily step count of 5000 or more at 15 months was 2.02 ( 95 % confidence interval , 0.88 - 4.64 ) , P = .096 , for the intervention group compared with the control group . The mental component sum of the SF-36 improved significantly from baseline to 3 months in the intervention group , and the physical component sum improved in both groups , but no statistically significant differences were found between groups . No associations were found between PA and changes in covariates . Discussion and Conclusions : The short-term evaluation showed that balance training increased habitual PA in community-dwelling older adults with osteoporosis . A significantly higher proportion of participants in the intervention group reached a level of 5000 or more steps/day , which is important for overall health . This effect was not associated with improvements in HRQoL , gait speed , balance performance , or fall-related concerns , and did not persist through the long-term follow-up . To accomplish a sustained PA change , a prolonged intervention or more support regarding habitual PA may be required , such as reinforcement with personalized behavior change counseling or PA on prescription Introduction The purpose of this study was to investigate the effect of a 12-month Balance Training Program on balance , mobility and falling frequency in women with osteoporosis . Methods Sixty-six consecutive elderly women were selected from the Osteometabolic Disease Outpatient Clinic and r and omized into 2 groups : the ‘ Intervention ’ , su bmi tted for balance training ; and the ‘ Control ’ , without intervention .  Balance , mobility and falling frequency were evaluated before and at the end of the trial , using the Berg Balance Scale ( BBS ) , the Clinical Test Sensory Interaction Balance ( CTSIB ) and the Timed “ Up & Go ” Test ( TUGT ) . Intervention used techniques to improve balance consisting of a 1-hour session each week and a home-based exercise program . Results Sixty women completed the study and were analyzed . The BBS difference was significant higher in the Intervention group compared to Control ( 5.5 ± 5.67 vs −0.5 ± 4.88 score , p < 0.001 ) . Similarly , the number of patients in the Intervention group presented improvement in two conditions of CTSIB compared to Control ( eyes closed and unstable surface condition : 13 vs one patient , p < 0.001 and eyes open , visual conflict and unstable surface condition : 12 vs one patient , p < 0.001 ) . Additionally , the differences between the TUGT were reduced in the Intervention group compared to Control ( −3.65 ± 3.61 vs 2.27 ± 7.18 seconds , p < 0.001 ) . Notably , this improvement was paralleled by a reduction in the number of falls/patient in the Intervention group compared to Control ( −0.77 ± 1.76 vs 0.33 ± 0.96 , p = 0.018 ) . Conclusion This longitudinal prospect i ve study demonstrated that an intervention using balance training is effective in improving functional and static balance , mobility and falling frequency in elderly women with osteoporosis Study design A thematic review . Objectives To evaluate if physical activity enhances muscle strength , improves balance , and reduces the fall frequency and the fracture incidence .  Background One of the major medical problems of today is the increasing incidence of fragility fractures .  Muscle strength and fall is one of the major determinants of a fracture . If physical activity could increase muscle strength , improve balance and reduce the fall frequency , then training could be recommended as prevention for fractures . Methods The review used Medline ( Pub Med ) and the search words exercise , physical activity , muscle strength , balance , falls , fractures . R and omized controlled trials ( RCT ) were predominantly included , although this not is a systematic review . Results The evidence that physical activity modifies the risk factors for fall is compelling , although RCT with fractures as end point are lacking . Physical activity is associated with improved muscle strength , co-ordination and balance .  Physical training increases muscle strength also in octogenarians by up to 200 % , i.e. a much more pronounced effect than the corresponding increase in muscle volume or bone mass . There is also evidence that physical activity decreases the actual number of falls . Observational cohort and case-control studies imply that physical activity is associated with reduced hip fracture risk . If exercise reduces the number of vertebral fractures and other fragility fractures are less evaluated . Conclusions Physical activity in older ages can be recommended to improve muscle strength and balance , to reduce the risk to fall and fractures , although the highest level of evidence – RCT with fracture as endpoint – is lacking OBJECTIVE To determine the short-term effectiveness of a biofeedback-based , computerized intervention that applied the principles of the ecological theory of perception and control of bodily orientation to the rehabilitation of older adults with a history of falling . PARTICIPANTS Forty-five older adults ( X = 78.5 years ) with a history of falls were assigned to either a control ( n = 21 ) or intervention group ( n = 24 ) . DESIGN A 2 x 2 ( Group x Time ) mixed factorial design with repeated measures on the second factor . SETTING A motor control research laboratory in a university setting . MEASUREMENT Impairments in multiple dimensions of balance ( i.e. , dynamic postural control and sensory organization ) were measured before and after an 8-week balance intervention using the 100 % Limits of Stability Test and Sensory Organization Test . More functional limitations in balance and /or mobility were measured using two clinical tests : Berg Balance Scale and Timed Up and Go test . MAIN RESULTS Repeated measures multivariate analyses and follow-up testing indicated significant improvements in the dynamic balance and sensory integration capabilities in the case of the intervention group only ( P < .03 ) . Significant improvements were also observed in the two clinical measures of balance and mobility evaluated before and after the intervention for the intervention group only . CONCLUSIONS Theory-driven rehabilitation programs that focus on manipulating individual , task , and environmental constraints concurrently can significantly improve the control of bodily orientation of older adults with a previous history of falls in both static and dynamic action environments . Moreover , the significant improvements in functional performance observed for the intervention group suggest that interventions emphasizing task-specific practice are not the only means by which an older adult 's ability to perform daily activities requiring postural control can be improved Abstract : To examine longitudinal change in health- related quality of life ( HRQoL )  following hip fracture in elderly subjects , 32 patients with hip fractures and 29 sex-matched non-fracture control subjects ( mean ± SD age 82 ± 8 and 86 ± 6 years respectively ) were enrolled in a prospect i ve , case – control study . Fracture subjects completed a generic question naire , Short Form 36 ( SF-36 ) , and a disease-targeted measure , the revised Osteoporosis Assessment Question naire ( OPAQ2 ) , on two separate occasions , within 1 week of fracture and 12–15 weeks after fracture . Controls completed both question naires on two occasions 12 weeks apart . SF-36 scores were significantly correlated with OPAQ2 in comparable domains of Physical Function ( r= 0.76 ) , General Health ( r= 0.70 ) and Mental Health/Tension ( r = 0.86 ) . Control subjects had stable scores with the OPAQ2 and SF-36 . At 3 months after fracture there was a significant reduction in HRQoL in the SF-36 domains Physical Function ( –51 % ) , Vitality ( –24 % ) and Social Function ( –26 % ) and in the OPAQ2 domains Physical Function ( –20 % ) , Social Activity ( –49 % ) and General Health ( –24 % ) . Hip fracture patients thus had a lower baseline HRQoL and experienced a significant deterioration in HRQoL after hip fracture on both the SF-36 and OPAQ2 . HRQoL should be part of a comprehensive assessment of the costs of osteoporosis including fracture-associated morbidity Background Although older adults are disproportionately affected by painful musculoskeletal conditions and receive more opioid analgesics than persons in other age groups , insufficient evidence is available regarding opioid harms in this age group . Objective To examine longitudinal relationships between opioid use and falls , clinical fractures , and changes in physical performance . We hypothesized that opioid use would be associated with greater risks of falling and incident clinical fractures and greater declines in physical performance . Design We analyzed data from the Osteoporotic Fractures in Men Study ( MrOS ) , a large prospect i ve longitudinal cohort study . Participants completed baseline visits from 2000 to 2002 and were followed for 9.1 ( SD 4.0 ) years . Participants MrOS enrolled 5994 community-dwelling men ≥ 65 years of age . The present study included 2902 participants with back , hip , or knee pain most or all of the time at baseline . Main Measures The exposure of interest was opioid use , defined at each visit as participant-reported daily or near-daily use of any opioid-containing analgesic . Among patients , 309 ( 13.4 % ) reported opioid use at one or more visits . Participants were queried every 4 months about falls and fractures . Physical performance scores were derived from tests of grip strength , chair st and s , gait speed , and dynamic balance . Key Results In the main analysis , the adjusted risk of falling did not differ significantly between opioid use and non-use groups ( RR 1.10 , 95 % CI 0.99 , 1.24 ) . Similarly , adjusted rates of incident clinical fracture did not differ between groups ( HR 1.13 , 95 % CI 0.94 , 1.36 ) . Physical performance was worse at baseline for the  opioid use group , but annualized change in physical performance scores did not differ between groups ( −0.022 , 95 % CI −0.138 , 0.093 ) . Conclusions Additional research is needed to determine whether opioid use is a marker of risk or a cause of falls , fractures , and progressive impairment among older adults with persistent pain BACKGROUND AND PURPOSE Traditionally , rehabilitation programs emphasize training balance under single-task conditions to improve balance and reduce risk for falls . The purpose of this case report is to describe 3 balance training approaches in older adults with impaired balance . CASE DESCRIPTIONS Three patients were r and omly assigned to 1 of 3 interventions : ( 1 ) single-task balance training , ( 2 ) dual-task training under a fixed-priority instructional set , and ( 3 ) dual-task training under a variable-priority instructional set . OUTCOMES The patients who received balance training under dual-task conditions showed dual-task training benefits ; these training benefits were maintained for 3 months . The patient who received variable-priority training showed improvement on novel dual tasks . DISCUSSION Older adults may be able to improve their balance under dual-task conditions only following specific types of balance training . This case report gives insight on how this intervention might be combined with more traditional physical therapy intervention Objective —To test the efficacy of a community based 10 week exercise intervention to reduce fall risk factors in women with osteoporosis . Methods —Static balance was measured by computerised dynamic posturography ( Equitest ) , dynamic balance by timed figure of eight run , and knee extension strength by dynamometry . Subjects were r and omised to exercise intervention ( twice weekly Osteofit classes for 10 weeks ) or control groups . Results —The outcome in 79 participants ( 39 exercise , 40 control ) who were available for measurement 10 weeks after baseline measurement is reported . After confounding factors had been controlled for , the exercise group did not make significant gains compared with their control counterparts , although there were consistent trends toward greater improvement in all three primary outcome measures . Relative to the change in control subjects , the exercise group improved by 2.3 % in static balance , 1.9 % in dynamic balance , and 13.9 % in knee extension strength . Conclusions —A 10 week community based physical activity intervention did not significantly reduce fall risk factors in women with osteoporosis . However , trends toward improvement in key independent risk factors for falling suggest that a study with greater power may show that these variables can be improved to a level that reaches statistical significance Objective : To compare the efficacy of balance training associated with muscle strengthening or stretching , relative to no intervention , in the postural control of elderly women with osteoporosis . Design : A r and omized , controlled trial . Subjects and interventions : Sample consisted of 50 women aged 65 years or older , with osteoporosis , r and omized into one of three groups :  strengthening group ( n = 17 ) performed balance training with muscle strengthening ; stretching group ( n = 17 ) performed balance training with stretching ; and control group ( n = 16 ) , no activities . Interventions lasted eight weeks , twice a week , 60 minutes a day . Main measures : Postural control was evaluated by the modified Clinical Test of Sensory Interaction for Balance ( CTSIBm ) and Limits of Stability Test . Strength was assessed by dynamometry and the shortening of the hamstrings by goniometry . Results : Relative to controls , participants in the strengthening group displayed significantly increased dorsiflexion strength and knee flexion strength , as well as centre of pressure velocity , directional control , and oscillation velocity ( CTSIBm test ) . The stretching group had significantly improvements in hamstring length , knee flexion strength , centre of pressure velocity , and amplitude of movements . Relative to the stretching group , the strengthening group yielded better knee extension strength and directional control . Conclusion : The results suggest that both interventions are effective in improving postural control when compared to the control group , and the strengthening group was superior to the stretching group in knee extension strength and in directional control OBJECTIVE Physical and psychological incapacity , including fear of falling is related to decreased satisfaction with life in osteoporosis ( OP ) . The impact of a balance exercise program on improving the quality of life is not well established . We have , therefore , investigated the effect of 12-month Balance Training Program in quality of life , functional balance and falls in elderly OP women . METHODS Sixty consecutive women with senile OP were r and omized into a Balance Training Group ( BT ) of 30 patients and no intervention control group ( CG ) of 30 patients . The BT program included techniques to improve balance over a period of 12 months ( 1h exercise session/week and home-based exercises ) . The quality of life was evaluated before and at the end of the trial using the Osteoporosis Assessment Question naire ( OPAQ ) , functional balance was evaluated by Berg Balance Scale ( BBS ) . Falls in the preceding year were noted and compared to the period of study . RESULTS The comparison of OPAQ variations ( INITIAL-FINAL ) revealed a significant improvement in quality of life in all parameters for BT compared to CG : well-being ( 1.61+/-1.44 vs. -1.46+/-1.32 , p<0001 ) , physical function ( 1.30+/-1.33 vs. -0.36+/-0.82 , p<0.001 ) , psychological status ( 1.58+/-1.36 vs. -1.02+/-0.83 , p<0.001 ) , symptoms ( 2.76+/-1.96 vs. -0.63+/-0.87 , p<0.001 ) , social interaction ( 1.01+/-1.51 vs. 0.35+/-1.08 , p<0.001 ) . Of note , this overall benefit was paralleled by an improvement of BBS ( -5.5+/-5.67 vs. + 0.5+/-4.88 p<0.001 ) and a reduction of falls in 50 % in BT group vs. 26.6 % for the CG ( RR : 1.88 , p<0.025 ) . CONCLUSION The long-term Balance Training Program of OP women provides a striking overall health quality of life improvement in parallel with improving functional balance and reduced falls Falls are common in elderly people . Possible consequences include serious injuries and the post-fall syndrome , with functional decline and limitation of physical activity . The present r and omized controlled study sought to clarify the benefits of a combined long-term and home-based fall prevention program for elderly Japanese women . The subjects were individuals aged over 73 years , living at home in a western suburb of Tokyo , who had attended a comprehensive geriatric health check . Persons with a marked decline in the basic activities of daily living ( ADL ) , hemiplegia , or those missing baseline data were excluded . Fifty-two subjects who expressed a wish to participate in the trial were r and omized , 28 to an exercise-intervention group and 24 to a control group .  Baseline data for age , h and grip force , walking speed , total serum cholesterol , serum albumin , basic ADL , visual and auditory impairments , self-rated health , and experience of falls did not differ significantly between the two groups . Beginning from June 2000 , the intervention group attended a 6-month program of fall-prevention exercise classes aim ed at improving leg strength , balance , and walking ability ;  this was supplemented by a home-based exercise program that focused on leg strength . The control group received only a pamphlet and advice on fall prevention . The average rate of attendance at exercise class was 75.3 % ( range , 64 % to 86 % ) . Participants showed significant improvements in t and em walk and functional reach after the intervention program , with enhanced self confidence . At the 8-month follow-up , the proportion of women with falls was 13.6 % ( 3/22 ) in the intervention group and 40.9 % ( 9/22 ) in the control group . At 20 months , the proportion remained unchanged , at 13.6 % in the intervention group , but had increased to 54.5 % ( 12/22 ) in the control group , which showed a statistically significant difference between the two groups ( Fisher ’s exact test ; P = 0.0097 ) . The total number of falls during the 20-month follow-up period was 6 in the intervention group and 17 in the control group . We conclude that a moderate exercise intervention program plus a home-based program significantly decreases the incidence of falls in both the short and the long term , contributing to improved health and quality of life in the elderly
target: Balance training may significantly reduce the frequency of falls in patients with osteoporosis
background: BACKGROUND Balance training may be beneficial for patients with osteoporosis , although current results are inconclusive .
  The aim of this systematic review and meta- analysis was to explore the effect of balance training on falls in patients with osteoporosis .