The association between balance and free-living physical activity in an older community-dwelling adult population: a systematic review and meta-analysis

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Abstract

BackgroundPoor balance is associated with an increased risk of falling, disability and death in older populations. To better inform policies and help reduce the human and economic cost of falls, this novel review explores the effects of free-living physical activity on balance in older (50 years and over) healthy community-dwelling adults.MethodsSearch methods: CENTRAL, Bone, Joint and Muscle Trauma Group Specialised register and CDSR in the Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, and AMED were searched from inception to 7th June 2016.Selection criteria: Intervention and observational studies investigating the effects of free-living PA on balance in healthy community-dwelling adults (50 years and older).Data extraction and analysis: Thirty studies were eligible for inclusion. Data extraction and risk of bias assessment were independently carried out by two review authors. Due to the variety of outcome measures used in studies, balance outcomes from observational studies were pooled as standardised mean differences or mean difference where appropriate and 95% confidence intervals, and outcomes from RCTs were synthesised using a best evidence approach.ResultsLimited evidence provided by a small number of RCTs, and evidence from observational studies of moderate methodological quality, suggest that free-living PA of between one and 21 years’ duration improves measures of balance in older healthy community-dwelling adults. Statistical analysis of observational studies found significant effects in favour of more active groups for neuromuscular measures such as gait speed; functionality using Timed Up and Go, Single Leg Stance, and Activities of Balance Confidence Scale; flexibility using the forward reach test; and strength using the isometric knee extension test and ultrasound. A significant effect was also observed for less active groups on a single sensory measure of balance, the knee joint repositioning test.ConclusionThere is some evidence that free-living PA is effective in improving balance outcomes in older healthy adults, but future research should include higher quality studies that focus on a consensus of balance measures that are clinically relevant and explore the effects of free-living PA on balance over the longer-term.
LanguageEnglish
Article number431
JournalBMC Public Health
Volume18
Early online date2 Apr 2018
DOIs
Publication statusE-pub ahead of print - 2 Apr 2018

Fingerprint

Independent Living
Observational Studies
Meta-Analysis
Population
Accidental Falls
Outcome Assessment (Health Care)
Knee Joint
MEDLINE
Patient Selection
Libraries
Leg
Knee
Joints
Economics
Confidence Intervals
Costs and Cost Analysis
Bone and Bones
Muscles
Wounds and Injuries

Keywords

  • balance
  • physical activity
  • older population

Cite this

@article{18eb34f6993b494eabb077897fcc4e24,
title = "The association between balance and free-living physical activity in an older community-dwelling adult population: a systematic review and meta-analysis",
abstract = "BackgroundPoor balance is associated with an increased risk of falling, disability and death in older populations. To better inform policies and help reduce the human and economic cost of falls, this novel review explores the effects of free-living physical activity on balance in older (50 years and over) healthy community-dwelling adults.MethodsSearch methods: CENTRAL, Bone, Joint and Muscle Trauma Group Specialised register and CDSR in the Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, and AMED were searched from inception to 7th June 2016.Selection criteria: Intervention and observational studies investigating the effects of free-living PA on balance in healthy community-dwelling adults (50 years and older).Data extraction and analysis: Thirty studies were eligible for inclusion. Data extraction and risk of bias assessment were independently carried out by two review authors. Due to the variety of outcome measures used in studies, balance outcomes from observational studies were pooled as standardised mean differences or mean difference where appropriate and 95{\%} confidence intervals, and outcomes from RCTs were synthesised using a best evidence approach.ResultsLimited evidence provided by a small number of RCTs, and evidence from observational studies of moderate methodological quality, suggest that free-living PA of between one and 21 years’ duration improves measures of balance in older healthy community-dwelling adults. Statistical analysis of observational studies found significant effects in favour of more active groups for neuromuscular measures such as gait speed; functionality using Timed Up and Go, Single Leg Stance, and Activities of Balance Confidence Scale; flexibility using the forward reach test; and strength using the isometric knee extension test and ultrasound. A significant effect was also observed for less active groups on a single sensory measure of balance, the knee joint repositioning test.ConclusionThere is some evidence that free-living PA is effective in improving balance outcomes in older healthy adults, but future research should include higher quality studies that focus on a consensus of balance measures that are clinically relevant and explore the effects of free-living PA on balance over the longer-term.",
keywords = "balance, physical activity, older population",
author = "Ilona McMullan and McDonough, {Suzanne M} and Tully, {Mark A} and Margaret Cupples and Karen Casson and Brendan Bunting",
note = "Reference text: References 1. Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing. 2006:35–52. https://doi.org/10.1093/ageing/afl077. 2. Shumway-Cook A, Woollcott MH. Motor control: translating research into clinical practice. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2007. 3. Thomas JC, Odonkor C, Griffith L, Holt N, Percac-Lima S, Leveille S, Ni P, Latham NK, Jette AM, Bean JF. Reconceptualizing balance: attributes associated with balance performance. Exp Gerontol. 2014;57:218–23. 4. Bandeen-Roche K, Seplaki CL, Huang J, Buta B, Kalyani RR, Varadhan R, Xue Q, Walston JD, Kasper JD. Frailty in older adults: a nationally representative profile in the United States. J Gerontol A Biol Sci. 2015;70(11):1427–34. 5. Brigola AG, Rossetti ES, Rodrigues dos Santos B, Neri AL, Zazzetta MS, Inouye K, Lost Pavarini SC. Relationship between cognition and frailty in elderly: a systematic review. Dement Neuropsychol. 2015;9(2):110–9. 6. Bucknix F, Rolland Y, Reginster JY, Ricour C, Petermans J, Bruyere O. Burden of frailty in the elderly population: perspectives for a public health challenge. Archives of Public Health. 2015;73:19. https://doi.org/10.1186/s13690-015-0068-x. 7. Chen X, Mao G, Leng SX. Frailty syndrome: an overview. Clinical Interventions in Ageing. 2014;9:433–41. 8. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012; Art. No.: CD007146. https:// doi.org/10.1002/14651858.CD007146.pub3 9. Karlsson MK, Magnusson H, Schewelov T, Rosengren BE. Prevention of falls in the elderly-a review. Osteoporos Int. 2013;24:747–62. https://doi. org/10.1007/s00198-012-2256-7. 10. Worldwide Health Organisation (WHO). WHO global report on falls prevention in older age. Downloaded from: http://www.who.int/ageing/ publications/Falls_prevention7March.pdf. 2007. Accessed 27 Sept 2015. 11. Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, Skinner JS. (2009). American college of sports medicine stand on exercise and physical activity for older adults. Med Sci Sports Exerc. 2009; 41(7):1510–30. 12. Cooper R, Kuh D, Hardy R. Mortality review group, FALCon & HALCyon study teams. Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ. 2010;341:c4467. https://doi.org/10.1136/bmj. c4467. 13. Howe TE, Rochester L, Neil F, Skelton DA, Ballinger C. Exercise for improving balance in older people. Cochrane Database Syst Rev. 2011;(11) Art. No. CD004963. https://doi.org/10.1002/14651858.CD004963.pub. 14. Stubbs B, Brefka S, Denkinger MD. What works to prevent falls in community dwelling older adults? Umbrella review of meta-analyses of randomized controlled trials. 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TY - JOUR

T1 - The association between balance and free-living physical activity in an older community-dwelling adult population: a systematic review and meta-analysis

AU - McMullan, Ilona

AU - McDonough, Suzanne M

AU - Tully, Mark A

AU - Cupples, Margaret

AU - Casson, Karen

AU - Bunting, Brendan

N1 - Reference text: References 1. Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing. 2006:35–52. https://doi.org/10.1093/ageing/afl077. 2. Shumway-Cook A, Woollcott MH. Motor control: translating research into clinical practice. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2007. 3. Thomas JC, Odonkor C, Griffith L, Holt N, Percac-Lima S, Leveille S, Ni P, Latham NK, Jette AM, Bean JF. Reconceptualizing balance: attributes associated with balance performance. Exp Gerontol. 2014;57:218–23. 4. Bandeen-Roche K, Seplaki CL, Huang J, Buta B, Kalyani RR, Varadhan R, Xue Q, Walston JD, Kasper JD. Frailty in older adults: a nationally representative profile in the United States. J Gerontol A Biol Sci. 2015;70(11):1427–34. 5. Brigola AG, Rossetti ES, Rodrigues dos Santos B, Neri AL, Zazzetta MS, Inouye K, Lost Pavarini SC. Relationship between cognition and frailty in elderly: a systematic review. Dement Neuropsychol. 2015;9(2):110–9. 6. Bucknix F, Rolland Y, Reginster JY, Ricour C, Petermans J, Bruyere O. Burden of frailty in the elderly population: perspectives for a public health challenge. Archives of Public Health. 2015;73:19. https://doi.org/10.1186/s13690-015-0068-x. 7. Chen X, Mao G, Leng SX. Frailty syndrome: an overview. Clinical Interventions in Ageing. 2014;9:433–41. 8. Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012; Art. No.: CD007146. https:// doi.org/10.1002/14651858.CD007146.pub3 9. Karlsson MK, Magnusson H, Schewelov T, Rosengren BE. Prevention of falls in the elderly-a review. Osteoporos Int. 2013;24:747–62. https://doi. org/10.1007/s00198-012-2256-7. 10. Worldwide Health Organisation (WHO). WHO global report on falls prevention in older age. Downloaded from: http://www.who.int/ageing/ publications/Falls_prevention7March.pdf. 2007. Accessed 27 Sept 2015. 11. Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, Skinner JS. (2009). American college of sports medicine stand on exercise and physical activity for older adults. Med Sci Sports Exerc. 2009; 41(7):1510–30. 12. Cooper R, Kuh D, Hardy R. Mortality review group, FALCon & HALCyon study teams. Objectively measured physical capability levels and mortality: systematic review and meta-analysis. BMJ. 2010;341:c4467. https://doi.org/10.1136/bmj. c4467. 13. Howe TE, Rochester L, Neil F, Skelton DA, Ballinger C. Exercise for improving balance in older people. Cochrane Database Syst Rev. 2011;(11) Art. No. CD004963. https://doi.org/10.1002/14651858.CD004963.pub. 14. Stubbs B, Brefka S, Denkinger MD. What works to prevent falls in community dwelling older adults? Umbrella review of meta-analyses of randomized controlled trials. Phys Ther. 2015;95(8) Downloaded from: http://ptjournal.apta.org/content/early/2015/05/14/ptj.20140461 15. Kannus P, Palvanen M, Niemi S, Parkkari J. Alarming rise in the number and incidence of fall-induced cervical spine injuries among older adults. J Gerontol A Biol Sci Med Sci. 2007;62A(2):180–3. 16. Worldwide Health Organisation (WHO). World report on ageing and health. 2015: http://apps.who.int/iris/bitstream/10665/186463/1/9789240694811- eng.pdf?ua=. Accessed 2 Nov 2015. 17. Cadore EL, Rodriguez-Manas L, Sinclair A, Izquierdo M. Effects of different exercise interventions on risk of falls, gait ability, and balance in physically frail older adults: a systematic review. Rejuvenation Res. 2013;16(2):105–14. https://doi.org/10.1089/rej.2012.1397. 18. Chief medical officer (CMO). Start active, stay active. A report on physical activity for health from the four home countries’ chief medical officers. 2011; Downloaded from https://www.gov.uk/government/publications/startactive- stay-active-a-report-on-physical-activity-from-the-four-homecountries- chief-medical-officers. Accessed 12 Oct 2015. 19. 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;22:78–83. 20. Worldwide Health Organisation. Global recommendations on physical activity for health. 2010; http://www.who.int/dietphysicalactivity/factsheet_ recommendations/en/. Downloaded 20 June 2017. 21. Hallal P, Anderson LB, Bull F, Gothold R, Haskell W, Ekelund U. Global physical activity levels: surveillance progress, pitfalls, and prospect. Lancet. 2012;386:247–57. 22. Schutzer KA, Graves S. Barriers and motivations to exercise in older adults. Prev Med. 2004;39:1056–61. 23. 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PY - 2018/4/2

Y1 - 2018/4/2

N2 - BackgroundPoor balance is associated with an increased risk of falling, disability and death in older populations. To better inform policies and help reduce the human and economic cost of falls, this novel review explores the effects of free-living physical activity on balance in older (50 years and over) healthy community-dwelling adults.MethodsSearch methods: CENTRAL, Bone, Joint and Muscle Trauma Group Specialised register and CDSR in the Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, and AMED were searched from inception to 7th June 2016.Selection criteria: Intervention and observational studies investigating the effects of free-living PA on balance in healthy community-dwelling adults (50 years and older).Data extraction and analysis: Thirty studies were eligible for inclusion. Data extraction and risk of bias assessment were independently carried out by two review authors. Due to the variety of outcome measures used in studies, balance outcomes from observational studies were pooled as standardised mean differences or mean difference where appropriate and 95% confidence intervals, and outcomes from RCTs were synthesised using a best evidence approach.ResultsLimited evidence provided by a small number of RCTs, and evidence from observational studies of moderate methodological quality, suggest that free-living PA of between one and 21 years’ duration improves measures of balance in older healthy community-dwelling adults. Statistical analysis of observational studies found significant effects in favour of more active groups for neuromuscular measures such as gait speed; functionality using Timed Up and Go, Single Leg Stance, and Activities of Balance Confidence Scale; flexibility using the forward reach test; and strength using the isometric knee extension test and ultrasound. A significant effect was also observed for less active groups on a single sensory measure of balance, the knee joint repositioning test.ConclusionThere is some evidence that free-living PA is effective in improving balance outcomes in older healthy adults, but future research should include higher quality studies that focus on a consensus of balance measures that are clinically relevant and explore the effects of free-living PA on balance over the longer-term.

AB - BackgroundPoor balance is associated with an increased risk of falling, disability and death in older populations. To better inform policies and help reduce the human and economic cost of falls, this novel review explores the effects of free-living physical activity on balance in older (50 years and over) healthy community-dwelling adults.MethodsSearch methods: CENTRAL, Bone, Joint and Muscle Trauma Group Specialised register and CDSR in the Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, and AMED were searched from inception to 7th June 2016.Selection criteria: Intervention and observational studies investigating the effects of free-living PA on balance in healthy community-dwelling adults (50 years and older).Data extraction and analysis: Thirty studies were eligible for inclusion. Data extraction and risk of bias assessment were independently carried out by two review authors. Due to the variety of outcome measures used in studies, balance outcomes from observational studies were pooled as standardised mean differences or mean difference where appropriate and 95% confidence intervals, and outcomes from RCTs were synthesised using a best evidence approach.ResultsLimited evidence provided by a small number of RCTs, and evidence from observational studies of moderate methodological quality, suggest that free-living PA of between one and 21 years’ duration improves measures of balance in older healthy community-dwelling adults. Statistical analysis of observational studies found significant effects in favour of more active groups for neuromuscular measures such as gait speed; functionality using Timed Up and Go, Single Leg Stance, and Activities of Balance Confidence Scale; flexibility using the forward reach test; and strength using the isometric knee extension test and ultrasound. A significant effect was also observed for less active groups on a single sensory measure of balance, the knee joint repositioning test.ConclusionThere is some evidence that free-living PA is effective in improving balance outcomes in older healthy adults, but future research should include higher quality studies that focus on a consensus of balance measures that are clinically relevant and explore the effects of free-living PA on balance over the longer-term.

KW - balance

KW - physical activity

KW - older population

U2 - 10.1186/s12889-018-5265-4

DO - 10.1186/s12889-018-5265-4

M3 - Article

VL - 18

JO - BMC Public Health

T2 - BMC Public Health

JF - BMC Public Health

SN - 1471-2458

M1 - 431

ER -