Accidental Fall
Conditions
Keywords
Postural Balance, Aged, Accidental Falls, Fear of falling, Physical Fitness, Resistance Training, Elastic Resistance
Brief summary
The aim of this study was to compare the effects of two different training protocols on muscle strength, flexibility, aerobic endurance, balance and walking ability in older adults in order to reduce their fall risk. The participants (n=110) aged 65-85 years, self-sufficient and physically active, were randomly assigned to a resistance training (RT) group and a combined balance and strength (BS) group. Both groups attended supervised sessions of 3 hours twice a week for 6 weeks. To measure the functional fitness, before and after the training program the Senior Fitness Test Battery was used, while physical activity level and fear of falling were assessed with self-reported questionnaires. Moreover, participants were asked to record the number of falls they had over the next two years after the end of the training program.
Detailed description
This randomized controlled trial was conducted within the Physical Activity Promotion Domestic and Accidents Prevention (PAP & DAP) project in older adults. A total of 110 participants aged 65-85 years, independent and physically active, were randomly allocated to one of two supervised exercise programs: a resistance training (RT) group using elastic bands and a combined balance and strength (BS) group following a multi-station circuit of body-weight strengthening tasks and dynamic balance exercises. Both interventions lasted 6 weeks, with two sessions per week (3 hours/week), and all sessions were carried out by qualified exercise professionals. Functional fitness was assessed before and after the intervention using the Senior Fitness Test battery (chair stand, arm curl, sit-and-reach, back scratch, timed up-and-go, and two-minute step test). Fear of falling was evaluated with the Short Falls Efficacy Scale-International (Short FES-I), and physical activity levels were measured using the International Physical Activity Questionnaire for Italian Elderly (IPAQ-EIT). Falls history was collected at baseline (previous 12 months), and the occurrence of at least one fall was recorded at 1- and 2-year follow-up, allowing estimation of fall incidence and crude risk ratios between groups. The RT program focused on progressive resistance exercises for major upper- and lower-limb muscle groups using elastic bands, organized into a standardized warm-up, central training phase, and cool-down, with progression in band resistance over the 6 weeks. The BS program consisted of a fixed-order multi-station circuit including gait, stepping, and weight-shifting tasks designed to challenge vestibular, visual, muscular, and plantar components of balance, combined with lower-limb strengthening exercises. Both protocols were designed to be feasible in community settings and to target key determinants of functional independence and fall risk in older adults. Analyses included repeated-measures ANOVA to examined significant differences within and between groups, correlations among gain scores in functional fitness variables and fear of falling, and calculation of fall incidence and risk ratios at follow-up.
Interventions
BEHAVIORALElastic-band resistance training
Supervised group-based resistance training with elastic bands, targeting major upper- and lower-limb muscle groups. Sessions include warm-up, a structured resistance phase with music-based exercises, and cool-down, with progressive increases in band resistance and exercise volume to improve lower-limb strength, dynamic balance, and reduce fall risk.
BEHAVIORALFunctional and balance circuit training
Supervised multistation circuit combining bodyweight strengthening exercises and dynamic balance tasks (e.g., directional changes, stepping, and weight-shifting activities). Sessions include warm-up, one or two rounds of the circuit, and cool-down, with progressive increases in task complexity to enhance postural control, dynamic stability, and reduce fall risk.
Sponsors
University of Palermo
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Randomized Controlled Trial
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Older Adults; * Age ≥ 60 years; * Independent in carrying out activities of daily living.
Exclusion criteria
* Unstable cardiovascular, respiratory, or neurological conditions that contraindicate exercise; * Recent fractures, major orthopedic surgery, or acute musculoskeletal pain limiting safe exercise participation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in fear of falling (Short FES-I score) | Baseline and after 6 weeks of intervention | Fear of falling will be assessed using the Short Falls Efficacy Scale-International (Short FES-I), a 7-item self-administered questionnaire that evaluates concern about falling during basic and social daily activities. Each item is rated on a 4-point scale (1 = not at all concerned to 4 = very concerned), yielding a total score from 7 to 28, with higher scores indicating greater fear of falling. Scores will be analysed as a continuous variable and, secondarily, categorized into low concern (7-8) versus moderate/high concern (≥9). |
| Lower-limb strength/endurance | Baseline and after 6 weeks of intervention | Lower-limb strength and endurance will be measured using the 30-second chair stand test from the Senior Fitness Test battery, recording the number of full stands completed from a seated position in 30 seconds. |
| Upper-limb strength | Baseline and after 6 weeks of intervention | Upper-limb strength will be assessed with the arm curl test from the Senior Fitness Test, counting the number of elbow flexion-extension repetitions completed in 30 seconds with a standardized hand weight. |
| Change in lower-back and hamstring flexibility | Baseline and after 6 weeks of intervention | Flexibility of the lower back and hamstrings will be evaluated using the chair sit-and-reach test from the Senior Fitness Test, recording the distance (cm) between the extended fingers and the tip of the toe while seated. |
| Change in dynamic balance and mobility | Baseline and after 6 weeks of intervention | Dynamic balance and functional mobility will be measured with the Timed Up and Go test, timing in seconds how long the participant takes to stand up from a chair, walk 3 meters, turn, walk back, and sit down. |
| Change in aerobic endurance | Baseline and after 6 weeks of intervention | Aerobic endurance will be assessed using the 2-minute step test, counting the number of steps performed in place at a standardized knee height over 2 minutes, as part of the Senior Fitness Test battery. |
| Relative Fall Risk | Over the next two years after the end of the training program | Participants were asked to record the number of falls they had over the next two years after the end of the training program and relative fall risk was calculated. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in self-reported physical activity | Baseline and after 6 weeks of intervention | Self-reported physical activity will be assessed using the 7-item International Physical Activity Questionnaire for the Italian Elderly (IPAQ-EIT), which records the number of days and minutes spent walking, and in moderate and vigorous activities, as well as sedentary time over the previous week. For each intensity level, a specific MET value is assigned (walking = 3.3 METs, moderate activity = 4 METs, vigorous activity = 8 METs), and total physical activity is expressed as MET-minutes per week by summing the three components. According to total MET-minutes/week, participants will be classified as inactive (\<700 MET-min/week), sufficiently active (700-2519 MET-min/week), or active/very active (≥2520 MET-min/week). |
Countries
Italy
Outcome results
None listed