Effectiveness of a targeted exercise intervention in reversing older people's mild balance dysfunction: a randomized controlled trial

Abstract

Background: Previous research has mainly targeted older people with high risk of falling. The effectiveness of exercise interventions in older people with mild levels of balance dysfunction remains unexplored.

Objective: This study evaluated the effectiveness of a home balance and strength exercise intervention in older people systematically screened as having mild balance dysfunction.

Design: This was a community-based, randomized controlled trial with assessors blinded to group allocation.

Participants: Study participants were older people who reported concerns about their balance but remained community ambulant (n=225). After a comprehensive balance assessment, those classified as having mild balance dysfunction (n=165) were randomized into the trial.

Intervention: Participants in the intervention group (n=83) received a 6-month physical therapist-prescribed balance and strength home exercise program, based on the Otago Exercise Program and the Visual Health Information Balance and Vestibular Exercise Kit. Participants in the control group (n=82) continued with their usual activities.

Outcome measures: Laboratory and clinical measures of balance, mobility, and strength were assessed at baseline and at a 6-month reassessment.

Results: After 6 months, the intervention group (n=59) significantly improved relative to the control group (n=62) for: the Functional Reach Test (mean difference=2.95 cm, 95% confidence interval [CI]=1.75 to 4.15), the Step Test (2.10 steps/15 seconds, 95% CI=1.17 to 3.02), hip abductor strength (0.02, 95% CI=0.01 to 0.03), and gait step width (2.17 cm, 95% CI=1.23 to 3.11). There were nonsignificant trends for improvement on most other measures. Fourteen participants in the intervention group (23.7%) achieved balance performance within the normative range following the exercise program, compared with 3 participants (4.8%) in the control group.

Limitations: Loss to follow-up (26.6%) was slightly higher than in some similar studies but was unlikely to have biased the results.

Conclusions: A physical therapist-prescribed home exercise program targeting balance and strength was effective in improving a number of balance and related outcomes in older people with mild balance impairment.