Physical Activity mini-review
Strength and Balance for Better Health and WellbeingJanuary
2017Louise AnsariAideen YoungThe Centre for Ageing Better received
50 million from the Big Lottery Fund in January 2015 in the form of
an endowment to enable it to identify what works in the ageing
sector by bridging the gap between research, evidence and
practice.
1
Declines in strength and balance with ageStrength and Balance
for Better Health and WellbeingStrength (muscle and bone)Loss of
muscle mass per decade in adults aged 4070 years1: 8% Loss of
muscle mass per decade in adults aged 70+: 15%Decrease in muscle
strength per decade for someone in their 50s and 60s: 15% Decrease
in muscle strength for someone aged 70+2: 30% Proportion of people
aged 85+ in the UK who suffer from sarcopenia (degenerative loss of
skeletal muscle mass quality and strength)3: 21%Bones become more
brittle with age, particularly for post-menopausal women
BalanceAs we age, our balance and reaction times and reflexes
get slowerProportion of adults 72+ who experience some form of
dizziness4: 20-30%Dizziness, caused by medical conditions or
medications can also affect balance
2
ReferencesGrimby G, Saltin B.Clin.
Physiol.1983;3:209218.American College of Sports Medicine. ACSM
position stand on exercise and physical activity for older adults.
Medicine and Science in Sports and Exercise 1998;30:9921008.Dodds
RM et al. Prevalence and incidence of sarcopenia in the very old:
findings from the Newcastle 85+ study. J. Cachexia, Sarcopenia
Muscle 2016;Nov 16. doi: 10.1002/jcsm.12157. [Epub ahead of
print]Iwasaki S, Yamasoba T. Dizziness and imbalance in the
elderly: age-related decline in the vestibular system. Aging Dis.
2014;6:3847.2
Strength and Balance for Better Health and WellbeingAge-related
changes+medication or disease
Cycles of adverse
outcomesDisabilityDependencyInstitutionalizationDeath3Reduced bone
strengthLoss of muscle mass (sarcopenia)Impaired balance
3
Frailty, a syndrome related to the ageing processStrength and
Balance for Better Health and Wellbeing
Frailty is a distinctive health state related to the ageing
process in which multiple body systems gradually lose their inbuilt
reserves1 Frailty is a social care and healthcare challenge because
it strongly predicts nursing home placement2Frailty is associated
with an increased risk of3:Difficulty staying upright, maintaining
balance and walking, leading to disability
Inability to take part in activities necessary for daily life
such as bathing
Leading to loss of memory, problems with language, thinking and
judgment and delirium
4The more vulnerable an individual is, the higher the risk of
falls,immobility or disability, institutionalisation and death
PHYSICAL DECLINEFUNCTIONAL DECLINECOGNITIVE DECLINE
Referenceshttp://www.bgs.org.uk/frailty-explained/resources/campaigns/fit-for-frailty/frailty-what-is-itKojima
G. Frailty as a predictor of nursing home placement among
community-dwelling older adults: a systematic review and
meta-analysis. J Geriatr Phys Ther. 2016 Jun 23. [Epub ahead of
print]Vermeiren S et al.. Frailty and the prediction of negative
health outcomes: A meta-analysis. J Am Med Dir Assoc.
2016;17:11634
Falls and fractures: the impact on peopleStrength and Balance
for Better Health and WellbeingOne-third of people aged 65+ and 50%
of over-80s living at home fall at least once a year1Over 60% of
those living in nursing homes fall repeatedly2Around 70,000-75,000
hip fractures occur in the UK each year, mainly due to falls3Of
those who experience hip fracture4:24% return to their pre-fracture
level of function42% require extra help with day to day
activities21% require an increased level of residential or hospital
care35% receive increased community health and social service care
at home1 month after hip fracture 1 in 12 people will have died and
only half will have returned home6Falls reduce confidence, increase
isolation and reduce independence, with around 1 in 10 older people
who fall becoming afraid to leave their homes in case they fall
again7
At 90 days post-fracture)5
ReferencesNICE Quality standard QS86, Falls in older people,
March 2015Baranzini F et al. Fall-related injuries in a nursing
home setting: is polypharmacy a risk factor? BMC Health Serv Res.
2009;9:228NICE Clinical guideline CG124. Hip fracture: management.
https://www.nice.org.uk/guidance/cg124/chapter/introduction.
Accessed January 7th 2017.Laxton C et al. Morbidity at 3 months
after hip fracture: data from the East Anglian audit. Health Trends
1997;29:5560.National Osteoporosis Society (2014) Life with
Osteoporosis report, Oct 2014Royal College of Physicians. Falls and
Fragility Fracture Audit Programme (FFFAP): National Hip Fracture
Database (NHFD) annual report 2014. London.Help the Aged, 2008.
Spotlight Report, 2008.
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Cost of fragility fractures: 2 billion per year2Increase in care
home admissions due to falls by 20201: 17.7%
Number of people in the UK who end up in A&E after a fall:
280,000; cost to the NHS: 1.5 billion1Number of hospital bed days
each year in England because of falls and fractures in people aged
65+: 4 million2
Falls and fractures: the impact on servicesPhysiotherapy and
tailored physical exercise programmes Strength and Balance for
Better Health and Wellbeing6
6ReferencesChartered Society of Physiotherapy. The costs of
falls.
http://www.csp.org.uk/professional-union/practice/your-business/evidence-base/cost-falls.
Accessed January 8th 2017.Royal College of Physicians. 2011.
Falling Standards, broken promises: report of the national audit of
falls and bone health in older people 2010.
Strength and Balance for Better Health and Wellbeing
Specific, well-directed programmes that include strength and
balance training:improve body balance and muscle structure in older
people1can reduce the risk of falls by up to 55%2are beneficial
both in terms of preventing and treating frailty3,4 resulted in a
significant difference in the occurrence of frailty5significantly
improved knee joint pain among older adults6has positive effects on
risk factors for cardiovascular disorders, cancer, diabetes, and
osteoporosis7-10In contrast, in healthy, active men and women,
running alone was not sufficient to prevent the loss in muscle
strength that occurs with ageing11
Effectiveness of strength and balance trainingeither as a single
intervention or as a component of multicomponent interventions
Falls and frailty can be prevented through strength and balance
training
7
ReferencesZampieri S et al. Lifelong physical exercise delays
age-associated skeletal muscle decline. J. Gerontol. A Biol. Sci.
Med. Sci. 2015;70:163173.Logan PA. et al, Community falls
prevention for people who call an emergency ambulance after a fall:
randomised controlled trial. BMJ 11 May 2010.Fried LP.
Interventions for human frailty: physical activity as a model"Cold
Spring Harbor perspectives in medicine2016;6:a025916.Cesari M et
al; LIFE Study Group. A physical activity intervention to treat the
frailty syndrome in older persons-results from the LIFE-P study. J
.Gerontol. A Biol. Sci. Med. Sci. 2015;70:216222.Cruz-Jentoft AJ et
al. Prevalence of and interventions for sarcopenia in ageing
adults: a systematic review. Report of the International Sarcopenia
Initiative (EWGSOP and IWGS). Age Ageing 2014;43:748759.Hasegawa R,
Takeshima N. Effects of Combined Balance and Resistance Exercise on
Reducing Knee Pain in Community-Dwelling Older Adults. Phys. Occ.
Ther. Geriatr.. 2010;28:4456.Liu CJ, Latham NK: Progressive
resistance strength training for improving physical function in
older adults. Cochrane Database of Systematic Reviews 2009, Issue
3.Martyn-St James M, Carroll S: High-intensity resistance training
and postmenopausal bone loss: a meta-analysis. Osteoporosis Int
2006;17:122540. Daniels R et al. Interventions to prevent
disability in frail community-dwelling elderly: a systematic
review. BMC Health Services Research 2008;8:278. Mc Dermott AY,
Mernitz H: Exercise and older patients: prescribing guidelines. Am
Fam Physician 2006;74:43744. Marcell TJ et al. Leg strength
declines with advancing age despite habitual endurance exercise in
active older adults. J Strength Cond Res 2014;28:504513
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Examples of exercise for strength and balanceStrength and
Balance for Better Health and WellbeingEvidence-based
multicomponent exercise programmes: Otago falls programmeZumba Gold
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ReferencesKim SB, OSullivan DM. Effects of aqua aerobic therapy
exercise for older adults on muscular strength, agility and balance
to prevent falling during gait. J Phys Ther Sci.
2013;25:923927.Mohammadi M. et al. The effect of pilates exercise
on gait speed and strength of lower limb in elderly male. Adv Appl
Sci Res. 2015;6:16. Theodorou AA et al. Stair descending exercise
increases muscle strength in elderly males with chronic heart
failure. BMC Res Notes 2013;6:87.Hakim RM, Leininger PM. A
Cross-Sectional Study of Balance-Related Measures with Older Adults
Who Participated in Tai Chi, Yoga, or No Exercise. Phys Occ Ther
Geriatr. 2010;28:6374.Song QH et al. Effect of Tai-chi exercise on
lower limb muscle strength, bone mineral density and balance
function of elderly women. Int J Clin Exp Med. 2014;7:15691576.Liu
H, Frank A. Tai chi as a balance improvement exercise for older
adults: a systematic review. J Geriatr Phys Ther.
2010;33:103109.Grande GH et al. Effect of pilates exercise for
improving balance in older adults (PEDro synthesis). Br J Sports
Med. 2016 Nov 4.Kwak C-J. et al. Effects of elastic-band resistance
exercise on balance, mobility and gait function, flexibility and
fall efficacy in elderly people. J Phys Ther Sci.
2016;28;31893196.Seo B-D et al. Effect of 12-week Swiss Ball
Exercise Program on Physical Fitness and Balance Ability of Elderly
Women. J Phys Ther Sci. 2012;24:1115.De Oliveira MR et al. Effect
of different types of exercise on postural balance in elderly
women: a randomized controlled trial. Arch Gerontol Geriatr.
2014;59:506514.Lee C-W, Cho G-H. Effect of Stationary Cycle
Exercise on Gait and Balance of Elderly Women. J Phys Ther Sci.
2014;26:431433.Cromwell RL et al. Tae Kwon Do: an effective
exercise for improving balance and walking ability in older adults.
J Gerontol A Biol Sci Med Sci. 2007;62:641646.8
Chief Medical Officers guidelines (2011)Older adults should
undertake physical activity to improve muscle strength on at least
two days a weekOlder adults at risk of falls should incorporate
physical activity to improve balance and coordination on at least
two days a week Physical activities that strengthen muscles involve
using body weight or working against a resistance. This should
involve using all the major muscle groups. Examples include:
Carrying or moving heavy loads such as groceriesActivities that
involve stepping and jumping such as dancingChair aerobics
Activities to improve balance and coordination may include: Tai
chiYogaPilatesStrength and Balance for Better Health and
WellbeingFrom: Department of Health. UK physical activity
guidelines. 2011
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ReferencesDepartment of Health. UK physical activity guidelines.
https://www.gov.uk/government/publications/uk-physical-activity-guidelines.
Accessed July 25th 2016.
9
Who does muscle-strengthening activities? From: Health Survey
for England - 2012
Strength and Balance for Better Health and Wellbeing
10Proportion of men 5564 years who meet the guidelines for
muscle-strengthening activity: