Balance confidence improves with resistance or agility training. Increase is not correlated with objective changes in fall risk and physical abilities

Abstract

Background: While the fear of falling is a common psychological consequence of falling, older adults who have not fallen also frequently report this fear. Fear of falling can lead to activity restriction that is self-imposed rather than due to actual physical impairments. Evidence suggests that exercise can significantly improve balance confidence, as measured by falls-related self-efficacy scales. However, there are no prospective reports that correlate change in balance confidence with changes in fall risk and physical abilities as induced by participating in a group-based exercise program.

Objective: The primary purpose of this prospective study was to examine the relationship between the change in balance confidence and the changes in fall risk and physical abilities in older women with confirmed low bone mass after 13 weeks of exercise participation. The secondary purpose of this study was to examine the relationship between the change in balance confidence and the change in physical activity level.

Methods: The sample comprised 98 women aged 75-85 years with low bone mass. Participants were randomly assigned to one of three groups: resistance training (n = 32), agility training (n = 34), and stretching (sham) exercises (n = 32). The 50-min exercise classes for each study arm were held twice weekly at a local YMCA community centre.

Results: Both resistance training and agility training significantly improved balance confidence by 6% from baseline after 13 weeks. However, the change in balance confidence was only weakly correlated with improved general physical function and not significantly correlated with the changes in fall risk score, postural stability, gait speed, or physical activity level. As well, we observed balance confidence enhancement in the presence of increased fall risk or deterioration in physical abilities.

Conclusions: Two different types of exercise training improved balance confidence in older women with low bone mass. This change in balance confidence was significantly correlated with change in general physical function. Because of the observation of discordance between balance confidence change and changes in fall risk and physical abilities, those who design group-based exercise programs for community-dwelling older adults may wish to consider including an education component on factors that influence fear of falling. Objective changes in fall risk factors cannot be assumed to mirror change in fear of falling and physical abilities in older adults in the short-term.

Figure 1

Flow chart outlining number of participants in each study arm.

Figure 2. Scatterplot of change in fall risk score versus change in balance confidence

*Negative change value in fall risk score indicates improvement. Positive value in balance confidence indicates improvement. ^†Quadrants 2 and 3 indicate discord between changes in Fall Risk Score and balance confidence.

Figure 3. Scatterplot of change in normal gait speed versus change in balance confidence

*Positive change in gait speed and in balance confidence indicates improvement. ^†Quadrants 1 and 4 indicate discord between changes in gait speed and balance confidence.

Figure 4. Scatterplot of change in general physical function versus change in balance confidence

*Positive change in general function and in balance confidence indicates improvement. ^†Quadrants 1 and 4 indicate discord between changes in gait speed and balance confidence.