Sports Medicine

, Volume 46, Issue 2, pp 143–149 | Cite as

Exercise-Based Fall Prevention in the Elderly: What About Agility?

  • Lars Donath
  • Jaap van Dieën
  • Oliver Faude
Current Opinion


Annually, one in three seniors aged over 65 years fall. Balance and strength training can reduce neuromuscular fall risk factors and fall rates. Besides conventional balance and strength training, explosive or high-velocity strength training, eccentric exercises, perturbation-based balance training, trunk strength, and trunk control have also been emphasized. In contrast, aerobic exercise has to date not been included in fall-prevention studies. However, well-developed endurance capacity might attenuate fatigue-induced declines in postural control in sports-related or general activities of daily living. Physical performance indices, such as balance, strength, and endurance, are generally addressed independently in exercise guidelines. This approach seems time consuming and may impede integrative training of sensorimotor, neuromuscular, and cardiocirculatory functions required to deal with balance-threatening situations in the elderly. An agility-based conceptual training framework comprising perception and decision making (e.g., visual scanning, pattern recognition, anticipation) and changes of direction (e.g., sudden starts, stops and turns; reactive control; concentric and eccentric contractions) might enable an integrative neuromuscular, cardiocirculatory, and cognitive training. The present paper aims to provide a scientific sketch of how to build such an integrated modular training approach, allowing adaptation of intensity, complexity, and cognitive challenge of the agility tasks to the participant’s capacity. Subsequent research should address the (1) link between agility and fall risk factors as well as fall rates, (2) benefit–risk ratios of the proposed approach, (3) psychosocial aspects of agility training (e.g., motivation), and (4) logistical requirements (e.g., equipment needed).


Strength Training Eccentric Exercise Fall Risk Fall Prevention Balance Training 
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.


Compliance with Ethical Standards

This article was written according to the ethical standards of scientific writing and publishing.


No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Lars Donath, Jaap van Dieën, and Oliver Faude declare that they have no conflicts of interest relevant to the contents of this review.


  1. 1.
    Lutz W, Sanderson W, Scherbov S. The coming acceleration of global population ageing. Nature. 2008;451(7179):716–9.CrossRefPubMedGoogle Scholar
  2. 2.
    Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35(Suppl 2):ii37–41.PubMedGoogle Scholar
  3. 3.
    Lamb SE, Jorstad-Stein EC, Hauer K, et al. Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. J Am Geriatr Soc. 2005;53(9):1618–22.CrossRefPubMedGoogle Scholar
  4. 4.
    Jones TS, Ghosh TS, Horn K, et al. Primary care physicians perceptions and practices regarding fall prevention in adult’s 65 years and over. Accid Anal Prev. 2011;43(5):1605–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Stevens JA, Corso PS, Finkelstein EA, et al. The costs of fatal and non-fatal falls among older adults. Inj Prev. 2006;12(5):290–5.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet. 1997;349(9063):1436–42.CrossRefPubMedGoogle Scholar
  7. 7.
    Peel NM, Kassulke DJ, McClure RJ. Population based study of hospitalised fall related injuries in older people. Inj Prev. 2002;8(4):280–3.PubMedCentralCrossRefPubMedGoogle Scholar
  8. 8.
    Skelton DA, Kennedy J, Rutherford OM. Explosive power and asymmetry in leg muscle function in frequent fallers and non-fallers aged over 65. Age Ageing. 2002;31(2):119–25.CrossRefPubMedGoogle Scholar
  9. 9.
    Hytonen M, Pyykko I, Aalto H, et al. Postural control and age. Acta Otolaryngol. 1993;113(2):119–22.CrossRefPubMedGoogle Scholar
  10. 10.
    Granacher U, Muehlbauer T, Zahner L, et al. Comparison of traditional and recent approaches in the promotion of balance and strength in older adults. Sports Med. 2011;41(5):377–400.CrossRefPubMedGoogle Scholar
  11. 11.
    Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;9:CD007146.PubMedGoogle Scholar
  12. 12.
    Donath L, Faude O, Bridenbaugh SA, et al. Transfer effects of fall training on balance performance and spatiotemporal gait parameters in healthy community-dwelling older adults: a pilot study. J Aging Phys Act. 2014;22(3):324–33.CrossRefPubMedGoogle Scholar
  13. 13.
    Karlsson MK, Vonschewelov T, Karlsson C, et al. Prevention of falls in the elderly: a review. Scand J Public Health. 2013;41(5):442–54.CrossRefPubMedGoogle Scholar
  14. 14.
    Sherrington C, Tiedemann A, Fairhall N, et al. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull. 2011;22(3–4):78–83.CrossRefPubMedGoogle Scholar
  15. 15.
    Heesch KC, Byles JE, Brown WJ. Prospective association between physical activity and falls in community-dwelling older women. J Epidemiol Community Health. 2008;62(5):421–6.CrossRefPubMedGoogle Scholar
  16. 16.
    Tiedemann A, Sherrington C, Close JC, Exercise, Sports Science Australia, et al. Exercise and Sports Science Australia position statement on exercise and falls prevention in older people. J Sci Med Sport. 2011;14(6):489–95.CrossRefPubMedGoogle Scholar
  17. 17.
    Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1435–45.CrossRefPubMedGoogle Scholar
  18. 18.
    Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, et al. American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009;41(7):1510–30.CrossRefPubMedGoogle Scholar
  19. 19.
    Muehlbauer T, Roth R, Bopp M, et al. An exercise sequence for progression in balance training. J Strength Cond Res. 2012;26(2):568–74.CrossRefPubMedGoogle Scholar
  20. 20.
    Granacher U, Muehlbauer T, Gruber M. A qualitative review of balance and strength performance in healthy older adults: impact for testing and training. J Aging Res. 2012;2012:708905.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Dorfman M, Herman T, Brozgol M, et al. Dual-task training on a treadmill to improve gait and cognitive function in elderly idiopathic fallers. J Neurol Phys Ther. 2014;38(4):246–53.CrossRefPubMedGoogle Scholar
  22. 22.
    Beauchet O, Kressig RW, Najafi B, et al. Age-related decline of gait control under a dual-task condition. J Am Geriatr Soc. 2003;51(8):1187–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Beauchet O, Annweiler C, Dubost V, et al. Stops walking when talking: a predictor of falls in older adults? Eur J Neurol. 2009;16(7):786–95.CrossRefPubMedGoogle Scholar
  24. 24.
    Lastayo PC, Reich TE, Urquhart M, et al. Chronic eccentric exercise: improvements in muscle strength can occur with little demand for oxygen. Am J Physiol. 1999;276(2 Pt 2):R611–5.PubMedGoogle Scholar
  25. 25.
    LaStayo PC, Ewy GA, Pierotti DD, et al. The positive effects of negative work: increased muscle strength and decreased fall risk in a frail elderly population. J Gerontol A Biol Sci Med Sci. 2003;58(5):M419–24.CrossRefPubMedGoogle Scholar
  26. 26.
    Cadore EL, Pinto RS, Bottaro M, et al. Strength and endurance training prescription in healthy and frail elderly. Aging Dis. 2014;5(3):183–95.PubMedCentralCrossRefPubMedGoogle Scholar
  27. 27.
    Latham NK, Bennett DA, Stretton CM, et al. Systematic review of progressive resistance strength training in older adults. J Gerontol A Biol Sci Med Sci. 2004;59(1):48–61.CrossRefPubMedGoogle Scholar
  28. 28.
    Pijnappels M, van der Burg PJ, Reeves ND, et al. Identification of elderly fallers by muscle strength measures. Eur J Appl Physiol. 2008;102(5):585–92.PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Pijnappels M, Bobbert MF, van Dieen JH. Push-off reactions in recovery after tripping discriminate young subjects, older non-fallers and older fallers. Gait Posture. 2005;21(4):388–94.CrossRefPubMedGoogle Scholar
  30. 30.
    Miszko TA, Cress ME, Slade JM, et al. Effect of strength and power training on physical function in community-dwelling older adults. J Gerontol A Biol Sci Med Sci. 2003;58(2):171–5.CrossRefPubMedGoogle Scholar
  31. 31.
    Donath L, Faude O, Bopp M, et al. Health-related strength and power training in seniors: Purpose and recommendations. Ther Umsch. 2015;72(5):335–42.CrossRefPubMedGoogle Scholar
  32. 32.
    Baechle TR, Earle RW. Essentials of strength training and conditioning. 3rd ed. Champaign: Human Kinetics; 2008.Google Scholar
  33. 33.
    Zecevic AA, Salmoni AW, Lewko JH, et al. Utilization of the seniors falls investigation methodology to identify system-wide causes of falls in community-dwelling seniors. Gerontologist. 2009;49(5):685–96.CrossRefPubMedGoogle Scholar
  34. 34.
    Blake AJ, Morgan K, Bendall MJ, et al. Falls by elderly people at home: prevalence and associated factors. Age Ageing. 1988;17(6):365–72.CrossRefPubMedGoogle Scholar
  35. 35.
    Berg WP, Alessio HM, Mills EM, et al. Circumstances and consequences of falls in independent community-dwelling older adults. Age Ageing. 1997;26(4):261–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Nevitt MC, Cummings SR, Hudes ES. Risk factors for injurious falls: a prospective study. J Gerontol. 1991;46(5):M164–70.CrossRefPubMedGoogle Scholar
  37. 37.
    Robinovitch SN, Feldman F, Yang Y, et al. Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study. Lancet. 2013;381(9860):47–54.PubMedCentralCrossRefPubMedGoogle Scholar
  38. 38.
    Donath L, Kurz E, Roth R, et al. Does a single session of high-intensity interval training provoke a transient elevated risk of falling in seniors and adults? Gerontology. 2015;61(1):15–23.CrossRefPubMedGoogle Scholar
  39. 39.
    Donath L, Zahner L, Roth R, et al. Balance and gait performance after maximal and submaximal endurance exercise in seniors: is there a higher fall-risk? Eur J Appl Physiol. 2013;113(3):661–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Stemplewski R, Maciaszek J, Salamon A, et al. Effect of moderate physical exercise on postural control among 65–74-years-old men. Arch Gerontol Geriatr. 2012;54(3):e279–83.CrossRefPubMedGoogle Scholar
  41. 41.
    Granacher U, Gollhofer A, Hortobagyi T, et al. The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: a systematic review. Sports Med. 2013;43(7):627–41.CrossRefPubMedGoogle Scholar
  42. 42.
    Close JC, Lord SL, Menz HB, et al. What is the role of falls? Best Pract Res Clin Rheumatol. 2005;19(6):913–35.CrossRefPubMedGoogle Scholar
  43. 43.
    van het Reve E, de Bruin ED. Strength-balance supplemented with computerized cognitive training to improve dual task gait and divided attention in older adults: a multicenter randomized-controlled trial. BMC Geriatr. 2014;14:134.CrossRefGoogle Scholar
  44. 44.
    Bridenbaugh SA, Kressig RW. Laboratory review: the role of gait analysis in seniors’ mobility and fall prevention. Gerontology. 2011;57(3):256–64.CrossRefPubMedGoogle Scholar
  45. 45.
    Granacher U, Bridenbaugh SA, Muehlbauer T, et al. Age-related effects on postural control under multi-task conditions. Gerontology. 2011;57(3):247–55.CrossRefPubMedGoogle Scholar
  46. 46.
    Gruber M, Taube W, Gollhofer A, et al. Training-specific adaptations of H- and stretch reflexes in human soleus muscle. J Mot Behav. 2007;39(1):68–78.CrossRefPubMedGoogle Scholar
  47. 47.
    Taube W, Gruber M, Beck S, et al. Cortical and spinal adaptations induced by balance training: correlation between stance stability and corticospinal activation. Acta Physiol (Oxf). 2007;189(4):347–58.CrossRefPubMedGoogle Scholar
  48. 48.
    Taube W, Kullmann N, Leukel C, et al. Differential reflex adaptations following sensorimotor and strength training in young elite athletes. Int J Sports Med. 2007;28(12):999–1005.CrossRefPubMedGoogle Scholar
  49. 49.
    Young WB, James R, Montgomery I. Is muscle power related to running speed with changes of direction? J Sports Med Phys Fitness. 2002;42(3):282–8.PubMedGoogle Scholar
  50. 50.
    Granacher U, Iten N, Roth R, et al. Slackline training for balance and strength promotion. Int J Sports Med. 2010;31(10):717–23.CrossRefPubMedGoogle Scholar
  51. 51.
    Donath L, Roth R, Rueegge A, et al. Effects of slackline training on balance, jump performance and muscle activity in young children. Int J Sports Med. 2013;34(12):1093–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Donath L, Roth R, Zahner L, et al. Slackline training and neuromuscular performance in seniors: a randomized controlled trial. Scand J Med Sci Sports. 2015. doi: 10.1111/sms.12423.PubMedGoogle Scholar
  53. 53.
    Lackner JR, DiZio P. Vestibular, proprioceptive, and haptic contributions to spatial orientation. Ann Rev Psychol. 2005;56:115–47.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Department of Sport, Exercise and HealthUniversity of BaselBaselSwitzerland
  2. 2.MOVE Research Institute Amsterdam, Faculty of Human Movement SciencesVU University AmsterdamAmsterdamThe Netherlands

Personalised recommendations