Effectiveness of Exercise Interventions to Improve Postural Control in Older Adults: A Systematic Review and Meta-Analyses of Centre of Pressure Measurements

Abstract

BackgroundPrevious reviews have shown balance in older adults to be improved with exercise. However, it is currently unclear whether postural control, indicated by centre of pressure (COP) measurement, can be improved in older adults and thus whether postural control could be a mechanism to improve balance.ObjectivesThe purpose of this systematic review was to assess the effectiveness of force platform COP variables to identify changes in postural control following exercise interventions in older adults. In addition, a secondary purpose was to determine whether the exercise types (balance, resistance or multi-component exercise interventions) are equally effective to improve postural control.MethodsRandomised controlled trials were identified using searches of databases and reference lists (PROSPERO registration number CRD42014010617). Trials performing exercise interventions, reporting force platform COP measurements, in participants with a mean age of ≥60 years were included. Risk of bias assessments were performed following the Cochrane guidelines. Data were pooled in meta-analyses, and standardised mean differences (SMDs) with 95 % confidence intervals (CIs) were calculated.ResultsTwenty-three trials met the inclusion criteria for the systematic review. Twenty-two trials could be defined as either utilising a balance, resistance or multi-component exercise intervention. These 22 trials were used in the meta-analyses. All trials reported measurements of double leg stance; eight trials reported additional stance conditions. The meta-analyses of double leg stance showed that balance exercise interventions significantly decreased total sway path length/velocity [SMD −1.13, 95 % CI −1.75 to −0.51 (eyes open); SMD −0.79, 95 % CI −1.33 to −0.26 (eyes closed)] and anterior-posterior sway path length/velocity [SMD −1.02, 95 % CI −2.01 to −0.02 (eyes open); SMD −0.82, 95 % CI −1.46 to −0.17 (eyes closed)] in both eyes open and eyes closed conditions. Balance exercise interventions also decreased sway area in eyes closed conditions (SMD −0.57, 95 % CI −1.01 to −0.13) and medio-lateral sway path length/velocity in eyes open conditions (SMD −0.8, 95 % CI −1.48 to −0.12). In contrast, neither resistance nor multi-component exercise interventions affected any of the included COP measurements.ConclusionsPostural control is improved by balance exercise interventions. In contrast, strength or multi-component exercise interventions did not influence postural control measurements in older adults. In addition, a lack of standardisation in collection protocol and COP variables calculated across trials was identified.Electronic supplementary materialThe online version of this article (doi:10.1007/s40279-016-0559-0) contains supplementary material, which is available to authorized users.

Postural sway normative data across the adult lifespan: Results from 6280 individuals on the Balance Tracking System balance test

“…[5][6][7][8][9]21,22 Fortunately, once identified, postural sway deficits can be treated by using exercise-based training interventions. 29 To this extent, it is worth noting that a recent study showed that BBT (i.e. postural sway) reductions were possible for older adults using a 90-day resistance training intervention.…”

“…Such abnormalities have previously been associated with a number of poor clinical outcomes including, importantly, increased fall risk . Fortunately, once identified, postural sway deficits can be treated by using exercise‐based training interventions . To this extent, it is worth noting that a recent study showed that BBT (i.e.…”

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“…They can focus, for example, on balance or muscle strength exercises, virtual reality and active game exercises (i.e. Wii Fit balance game training, exergames), whole‐body vibration platform exercises, hippotherapy exercises, tai chi chuan or qigong exercises, or combinations of several exercises . If the balance data were not available in the article or after sending a request to the author, the study was excluded from the meta‐analysis.…”

“…This conclusion is in accordance with results observed in the literature in other populations. [15][16][17][18] Indeed, types of exercise inducing greater increases of postural stability in older persons [15][16][17] or in children with cerebral palsy are those specifically targeting balance abilities. 18 Moreover, standing balance measured by stabilometry in children with cerebral palsy was not improved after a strength exercise intervention (resisted ankle and knee exercise).…”

The effects of exergaming on pain, postural control, technology acceptance and flow experience in older people with chronic musculoskeletal pain: a randomised controlled trial

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