ObjectiveWe investigated the effects of combined balance and strength training on measures of balance and muscle strength in older women with a history of falls.MethodsTwenty-seven older women aged 70.4 ± 4.1 years (age range: 65 to 75 years) were randomly allocated to either an intervention (IG, n = 12) or an active control (CG, n = 15) group. The IG completed 8 weeks combined balance and strength training program with three sessions per week including visual biofeedback using force plates. The CG received physical therapy and gait training at a rehabilitation center. Training volumes were similar between the groups. Pre and post training, tests were applied for the assessment of muscle strength (weight-bearing squat [WBS] by measuring the percentage of body mass borne by each leg at different knee flexions [0°, 30°, 60°, and 90°], sit-to-stand test [STS]), and balance. Balance tests used the modified clinical test of sensory interaction (mCTSIB) with eyes closed (EC) and opened (EO), on stable (firm) and unstable (foam) surfaces as well as spatial parameters of gait such as step width and length (cm) and walking speed (cm/s).ResultsSignificant group × time interactions were found for different degrees of knee flexion during WBS (0.0001 < p < 0.013, 0.441 < d < 0.762). Post hoc tests revealed significant pre-to-post improvements for both legs and for all degrees of flexion (0.0001 < p < 0.002, 0.697 < d < 1.875) for IG compared to CG. Significant group × time interactions were found for firm EO, foam EO, firm EC, and foam EC (0.006 < p < 0.029; 0.302 < d < 0.518). Post hoc tests showed significant pre-to-post improvements for both legs and for all degrees of oscillations (0.0001 < p < 0.004, 0.753 < d < 2.097) for IG compared to CG. This study indicates that combined balance and strength training improved percentage distribution of body weight between legs at different conditions of knee flexion (0°, 30°, 60°, and 90°) and also decreased the sway oscillation on a firm surface with eyes closed, and on foam surface (with eyes opened or closed) in the IG.ConclusionThe higher positive effects of training seen in standing balance tests, compared with dynamic tests, suggests that balance training exercises including lateral, forward, and backward exercises improved static balance to a greater extent in older women.

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Environmental flows (eflows) refer to the amount of water required to sustain aquatic ecosystems. In its formal definition, three flow characteristics need to be minimally maintained: quantity, timing and quality. This overview paper highlights the challenges of some of the current methods used for eflow determination in the context of an evolving climate. As hydrological methods remain popular, they are first analyzed by describing some of the potential caveats associated with their usage when flow time series are non-stationarity. The timing of low-flow events will likely change within a season but will also likely shift in seasonality in some regions. Flow quality is a multi-faceted concept. It is proposed that a first simple step to partly incorporate flow quality in future analyses is to include the water temperature as a covariate. Finally, holistic approaches are also critically revisited, and simple modifications to the Ecological Limits of Flow Alteration (ELOHA) framework are proposed.

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