Aging Clinical and Experimental Research

, Volume 9, Issue 1–2, pp 112–119 | Cite as

A comparison of the effects of three types of endurance training on balance and other fall risk factors in older adults

  • D. M. Buchner
  • M. E. Cress
  • B. J. de Lateur
  • P. C. Esselman
  • A. J. Margherita
  • R. Price
  • E. H. Wagner
Original Article


We hypothesized that short-term endurance training improves balance in older adults, if training involves movements that “stress” balance. We tested the hypothesis by looking for a dose-response relationship between movement during exercise and balance improvement. The study was a single-blinded, randomized controlled trial. Subjects were sedentary adults (N=106) aged 68–85 with at least mild deficits in balance. Exercise groups were: stationary cycle (low movement), walking (medium movement), and aerobic movement (high movement). Subjects attended supervised exercise classes three times a week for three months, followed by self-directed exercise of any type for three months. The primary test of the hypothesis compared changes in balance after three months of supervised exercise. One balance measure (distance walked on a six-meter narrow balance beam) improved in the hypothesized dose-response manner (cycle, 3% improvement; walking, 7% improvement; aerobic movement, 18% improvement: p<0.02, test of trend). Other balance measures did not improve with exercise. Only walking exercise improved gait speed (by 5%, p<0.02) and SF-36 role-physical score (by 24%, p<0.05). VO2max improved with walking (18%, p<0.004) and aerobic movement (10%, p<0.01), but improved less with cycling (8%, p>0.1). Leg strength improved significantly in all exercise groups. The study hypothesis was supported only for one balance measure. Only walking improved at least one measure of all major outcomes (endurance, strength, gait, balance, health status), suggesting that walking is most useful for fall prevention. Cycle exercise appeared least useful.

Key words

Balance elderly exercise falls walking 


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  1. 1.
    Tinetti M.E., Speechley M., Ginter S.F.: Risk factors for falls among elderly persons living in the community. N. Engl. J. Med. 319: 1701–1707, 1988.PubMedCrossRefGoogle Scholar
  2. 2.
    Wolfson L., Whipple R., Derby C., Judge J., King M., Amerman P., Schmidt J., Smyers D.: Balance and strength training in older adults: intervention gains and Tai Chi maintenance. J. Am. Geriatr. Soc. 44: 498–506, 1996.PubMedGoogle Scholar
  3. 3.
    Wolf S.L., Barnhart H.X., Kutner N.G., McNeely E., Coogler C., Xu T.: Reducing frailty and falls in older persons: an in-vestigation of Tai Chi and computerized balance training. J. Am. Geriatr. Soc. 44: 489–497, 1996.PubMedGoogle Scholar
  4. 4.
    Tinetti M.E., Baker D.I., McAvay G., Claus E.B., Garrett P., Gottschalk M., Koch M.L., Trainor K., Horwitz R.I.: A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N. Engl. J. Med. 331: 821–827, 1994.PubMedCrossRefGoogle Scholar
  5. 5.
    Hu M.H., Woollacott M.H.: Multisensory training of standing balance in older adults: I. Postural stability and one-leg stance balance. J. Gerontol. 49: M52–M61, 1994.PubMedCrossRefGoogle Scholar
  6. 6.
    Brown M., Holloszy J.O.: Effects of a low intensity exercise program on selected physical performance characteristics of 60- to 70-year olds. Aging Clin. Exp. Res. 3: 129–139, 1991.CrossRefGoogle Scholar
  7. 7.
    Lichtenstein M.J., Shields S.L., Shiavi R.G., Burger C.: Exercise and balance in aged women: a pilot controlled clinical trial. Arch. Phys. Med. Rehabil. 70: 138–143, 1989.PubMedGoogle Scholar
  8. 8.
    Crilly R.G., Willems D.A., Trenholm K.J., Hayes K.C., De-laquerriere-Richardson L.F.O.: Effect of exercise on postural sway in the elderly. Gerontology 35: 137–143, 1989.PubMedCrossRefGoogle Scholar
  9. 9.
    Clark B.A., Wade M.G., Massey B.H., VanDyke R.: Response of institutionalized geriatric mental patients to a twelve-week program of regular physical activity. J. Gerontol. 30: 565–573, 1975.PubMedCrossRefGoogle Scholar
  10. 10.
    Province M.A., Hadley E.C., Hornbrook M.C., Lipsitz L.A., Miller J.P., Mulrow C.D., Ory M.G., Sattin R.W., Tinetti M.E., Wolf S.L.: The effects of exercise on falls in elderly patients. A preplanned meta-analysis of the FICSIT trials. JAMA 273: 1341–1347, 1995.PubMedCrossRefGoogle Scholar
  11. 11.
    Pate R.R., Pratt M., Blair S.N., Haskell W.L., Macera C.A., Bouchard C., Buchner D.M., Ettinger W., Heath G.W., King A.C., Kriska A., Leon A.S., Marcus B.M., Morris J., Paffen-barger R.S., Patrick K., Pollock M.L., Rippe J.M., Sallis J., Wilmore J.H.: Physical activity and public health. A recommendation from the Centers of Disease Control and Prevention and the American College of Sports Medicine. JAMA 273: 402–407, 1995.PubMedCrossRefGoogle Scholar
  12. 12.
    Ory M.G., Schechtman K.B., Miller J.P., Hadley E.C., Fiatarone M.A., Province M.A., Arfken C.L., Morgan D., Weiss S., Kaplan M., and The FICSIT Group: Frailty and injuries in later life: the FICSIT trials. J. Am. Geriatr. Soc. 41: 283–296, 1993.PubMedGoogle Scholar
  13. 13.
    Buchner D.M., Cress M.E., Wagner E.H., de Lateur B.E., Price R., Abrass I.F.: The Seattle FICSIT study: the effect of exercise on gait and balance in older adults. J. Am. Geriatr. Soc. 41: 321–325, 1993.PubMedGoogle Scholar
  14. 14.
    Buchner D.M., Larson E.B., Wagner E.H., Koepsell T.D., de Lateur B.J.: Evidence for a non-linear relationship between leg strength and gait speed. Age Ageing 25: 386–391, 1996.PubMedCrossRefGoogle Scholar
  15. 15.
    Buchner D.M., Hornbrook M.C., Kutner N.B., Tinetti M.E., Ory M., Mulrow C.O., Schechtman K.B., Gerety M.B., Fiatarone M.A., Wolf S.L., Rossiter J., Arfken C., Kanten D., Lipsitz L.A., Sattin R., De Nino L.A., and the FICSIT Group: Development of the common database for the FICSIT trials. J. Am. Geriatr. Soc. 41: 297–308, 1993.PubMedGoogle Scholar
  16. 16.
    Bergner M., Bobbitt R.A., Carter W.B., Gilson B.S.: The Sickness Impact Profile: Development and final revision of a health status measure. Med. Care 19: 787–805, 1981.PubMedCrossRefGoogle Scholar
  17. 17.
    Ware J.E. Jr., Sherbourne C.D.: The MOS 36-item short-form health survey (SF-36): conceptual framework and item selection. Med. Care 30: 473–483, 1992.PubMedCrossRefGoogle Scholar
  18. 18.
    Lawton M.P., Brody E.M.: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9: 179–186, 1969.PubMedCrossRefGoogle Scholar
  19. 19.
    LaCroix A.Z., Leveille S.G., Hecht J.A., Grothaus L.C., Wagner E.H.: Does walking decrease the risk of cardiovascular disease hospitalizations and death in older adults? J. Am. Geriatr. Soc. 44: 113–120, 1996.PubMedGoogle Scholar

Copyright information

© Springer Internal Publishing Switzerland 1997

Authors and Affiliations

  • D. M. Buchner
    • 1
    • 2
  • M. E. Cress
    • 1
    • 2
  • B. J. de Lateur
    • 3
    • 4
  • P. C. Esselman
    • 3
  • A. J. Margherita
    • 3
  • R. Price
    • 3
  • E. H. Wagner
    • 1
    • 5
  1. 1.Northwest Prevention Effectiveness CenterUniversity of WashingtonSeattleUSA
  2. 2.Department of MedicineUniversity of WashingtonSeattleUSA
  3. 3.Department of Rehabilitation MedicineUniversity of WashingtonSeattleUSA
  4. 4.Department of Physical Medicine and RehabilitationThe Johns Hopkins UniversityBaltimoreUSA
  5. 5.Center for Health Studies, Group Health Cooperative of Puget SoundSeattleUSA

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