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Sports Medicine

, Volume 43, Issue 7, pp 627–641 | Cite as

The Importance of Trunk Muscle Strength for Balance, Functional Performance, and Fall Prevention in Seniors: A Systematic Review

  • Urs GranacherEmail author
  • Albert Gollhofer
  • Tibor Hortobágyi
  • Reto W. Kressig
  • Thomas Muehlbauer
Systematic Review

Abstract

Background

The aging process results in a number of functional (e.g., deficits in balance and strength/power performance), neural (e.g., loss of sensory/motor neurons), muscular (e.g., atrophy of type-II muscle fibers in particular), and bone-related (e.g., osteoporosis) deteriorations. Traditionally, balance and/or lower extremity resistance training were used to mitigate these age-related deficits. However, the effects of resistance training are limited and poorly translate into improvements in balance, functional tasks, activities of daily living, and fall rates. Thus, it is necessary to develop and design new intervention programs that are specifically tailored to counteract age-related weaknesses. Recent studies indicate that measures of trunk muscle strength (TMS) are associated with variables of static/dynamic balance, functional performance, and falls (i.e., occurrence, fear, rate, and/or risk of falls). Further, there is preliminary evidence in the literature that core strength training (CST) and Pilates exercise training (PET) have a positive influence on measures of strength, balance, functional performance, and falls in older adults.

Objective

The objectives of this systematic literature review are: (a) to report potential associations between TMS/trunk muscle composition and balance, functional performance, and falls in old adults, and (b) to describe and discuss the effects of CST/PET on measures of TMS, balance, functional performance, and falls in seniors.

Data Sources

A systematic approach was employed to capture all articles related to TMS/trunk muscle composition, balance, functional performance, and falls in seniors that were identified using the electronic databases PubMed and Web of Science (1972 to February 2013).

Study Selection

A systematic approach was used to evaluate the 582 articles identified for initial review. Cross-sectional (i.e., relationship) or longitudinal (i.e., intervention) studies were included if they investigated TMS and an outcome-related measure of balance, functional performance, and/or falls. In total, 20 studies met the inclusionary criteria for review.

Study Appraisal and Synthesis Methods

Longitudinal studies were evaluated using the Physiotherapy Evidence Database (PEDro) scale. Effect sizes (ES) were calculated whenever possible. For ease of discussion, the 20 articles were separated into three groups [i.e., cross-sectional (n = 6), CST (n = 9), PET (n = 5)].

Results

The cross-sectional studies reported small-to-medium correlations between TMS/trunk muscle composition and balance, functional performance, and falls in older adults. Further, CST and/or PET proved to be feasible exercise programs for seniors with high-adherence rates. Age-related deficits in measures of TMS, balance, functional performance, and falls can be mitigated by CST (mean strength gain = 30 %, mean effect size = 0.99; mean balance/functional performance gain = 23 %, mean ES = 0.88) and by PET (mean strength gain = 12 %, mean ES = 0.52; mean balance/functional performance gain = 18 %, mean ES = 0.71).

Limitations

Given that the mean PEDro quality score did not reach the predetermined cut-off of ≥6 for the intervention studies, there is a need for more high-quality studies to explicitly identify the relevance of CST and PET to the elderly population.

Conclusions

Core strength training and/or PET can be used as an adjunct or even alternative to traditional balance and/or resistance training programs for old adults. Further, CST and PET are easy to administer in a group setting or in individual fall preventive or rehabilitative intervention programs because little equipment and space is needed to perform such exercises.

Keywords

Resistance Training Strength Training Functional Performance Trunk Muscle Gait Variability 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

This work was supported by a grant from the German Research Foundation (MU 3327/2-1). The authors have no conflicts of interest that are directly relevant to the content of this review.

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Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • Urs Granacher
    • 1
    Email author
  • Albert Gollhofer
    • 2
  • Tibor Hortobágyi
    • 3
  • Reto W. Kressig
    • 4
  • Thomas Muehlbauer
    • 1
  1. 1.Department of Training and Movement Sciences, Cluster of Excellency in Cognition SciencesUniversity of PotsdamPotsdamGermany
  2. 2.Institute of Sport and Sport ScienceAlbert-Ludwigs-University of FreiburgFreiburgGermany
  3. 3.Centre for Human Movement SciencesUniversity Medical Centre GroningenGroningenNetherlands
  4. 4.Division of Acute GeriatricsBasel University HospitalBaselSwitzerland

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