As winter kicks into high gear, snow and ice become a dangerous surface for older adults. With these worsening conditions, clinicians should be preparing their patients to improve the factors associated with falling to lessen the likelihood of injury.  Staying on top of current research can help clinicians develop and maintain the best in evidence-based practice for fall prevention. A 2015 paper by Narita M et al. noted that, while there are many factors that can put older men and women at risk for falling, balance is a key component to reduce falls in older adults...and the importance of balance exercises is clear:

In many cases, reduced balance control is a primary risk factor for falls. Reducing fall risk in older people will not only avoid increasing health-care costs, but also, most importantly, provide older adults with a more active and enjoyable life. However, little is known about the effects of balance training in many subsets of the older adult population.

Recently, Islam et al. (2004) found that a customized balance exercise is effective in improving balance and lower body strength in older adults. Improvement was also observed for limit of stability (LOS—how far one can move the center of gravity over the base of support in a given direction without stepping) in the directions that are most associated with fall-related hip fractures (Greenspan et al., 1998).

In support of evidence-based practice, clinicians can use this study as a model to help build their own fall prevention program with several easy steps.

1. Patient Assessment for Fall Risk

Neurocom balance assessmentBefore starting the fall prevention exercise program, it is crucial to test the participant to get a baseline measurement of balance and agility. In Narita et al.’s study, only older women with poor balance participated in the study. They excluded others without balance deficits who applied for the study. This is an important feature of the study, in that only those with poor balance were included in the study. The subjects’ balance ability was assessed as poor according to computerized balance measurement (Neurocom), when the measured Maximum Excursion composite (MXEcomp) score on the Level of Stability (LOS) test was 70% or lower at the time of pre- exercise testing.

When developing your fall prevention program, use several objective measures to quantify fall risk. In Narita et al.’s study, the following four methods were used:

Dynamic balance

  • Dynamic balance was determined using the Limits of Stability assessment in which eight targets appeared around a center square at 0, 45, 90, 135,180, 225, 270, and 315 degrees.
  • Subjects shifted their weight toward an identified target, holding the position for 5 seconds.

Static balance

  • This measure was taken using the Balance Master while standing on different surfaces for 10 seconds with the eyes open or closed and different surface conditions (firm or foam pad). The test requires the participant to stand:
    • On a flat surface with the eyes open
    • On a flat surface with the eyes
    • On thick foam with the eyes open
    • On thick foam with the eyes closed


  • 8-Foot Up and Go Test
    • Participants were fully seated in a chair, hands on thighs and feet flat on the floor. On a signal, participants stood from the chair, walked as quickly as possible around a cone that was placed 8 feet (2.44 m) ahead of the chair, and returned to a fully seated position on the chair.
  • Functional Reach Test
    • A scale graduated in centimeters was hung from a wall at a height suitable for the participant. The participant stood by the wall with feet together, hands clasped and both arms raised in front horizontally and held at the 0 cm level of the scale. On a signal, the participant leaned forward, moving the hands forward along the scale as far possible while keeping the heels in contact with the ground.
  • All subjects also completed a questionnaire on the frequency of falls and fall-induced injuries.

2. Fall prevention exercise program

older-theraband-kick-standThe fall prevention exercise program consisted of balance exercises (static and dynamic) combined with resistance exercises using body weight and Theraband resistance bands. The program was designed to actively train the visual, somatosensory, and vestibular systems, all of which affect balance ability.

The exercise group performed the program during the first 12 weeks, and subjects in the non-exercise (control) group eventually performed the exercise program during the second 12-week session later in the year. To provide a comparison to the exercise group, the non-exercise group took part only in the measurements performed before and after the exercise program and spent the rest of the 12-week period engaging in their normal activities of daily living.

Subjects performed each exercise for 10 to 30 seconds, and gradually extended the time as they became more accustomed to the exercises.

Stage 1 (weeks 1–4): Performed on a solid support base (on the floor)

  • Warm up (10–15 min.): Seated flexibility exercises
  • Static balance and postural exercises (40–50 min.)
    • Seated and standing exercises (various foot positions such as semitandem, tandem, single stance; head rotations; initially with eyes open, subsequently with eyes closed; all on firm floor surface)
    • Lower body muscular (quadriceps, hamstrings, gluteus medius, etc.) training (sitting and straight-leg raises, etc.)
    • Upper and lower-body-range of motion (3) Recreational activities (5–10 min.)
  • Cool down (10–15 min.)

Stage 2 (weeks 5–8): Performed on a soft support base (TheraBand Stability Trainer) to enhance somatosensory input

  • Warm up (10–15 min.): Walking and standing flexibility exercises
  • Balance exercise (50–60 min.)
    • Static balance exercises on unstable surface (Stability Trainer)
    • Dynamic balance exercises in the standing position and moving (forward, side, and backward stepping, tandem walk, tiptoe walk, and heel walk) on firm floor and/or foam surface
    • Coordination and resistance exercises using TheraBand elastic resistance band
  • Cool down (10–15 min.)

Stage 3 (weeks 9–12): Exercises involved walking along several Stability Trainer foam pads placed in a row to challenge dynamic balance further.

  • Warm up (10–15 min.): Walking and standing flexibility exercises
  • Balance exercise (50–60 min.)
    • Static balance exercises on Stability Trainer
    • Dynamic balance exercises in the standing position (forward, side, and backward stepping, tandem walk)
    • Coordination and resistance exercises using TheraBand elastic band
  • Cool down (10–15 min.)

3. Assess Program Success

After 12 weeks of balance exercises, the participants in the study showed improvement in several measures of dynamic balance, clearly indicating the effectiveness of the balance exercises for fall prevention. For a full chart of results, visit the TheraBand Academy to read the study. Based on the results of the study, it is recommended that balance exercises should be performed by individuals with poor balance ability.

Older Adult Stability Trainer Balance

Source: Narita M et al. 2015. Effects of customized balance exercises on older women whose balance ability has deteriorated with age. J Women Aging. 27(3):237-50.

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