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The Effect of an Exercise-Based Balance Intervention on Physical and Cognitive Performance for Older Adults: A Pilot Study

Shubert, Tiffany E. PT, MPT, PhD1,2; McCulloch, Karen PT, NCS PhD2; Hartman, Marilyn PhD1,3; Giuliani, Carol A. PT, PhD2

Journal of Geriatric Physical Therapy: October/December 2010 - Volume 33 - Issue 4 - p 157–164
doi: 10.1097/JPT.0b013e3181ff22f5
Research Reports

Background: Several exercise-based falls prevention interventions produced significant long-term reductions in fall rate, but few demonstrate long-term improvements in falls risk factors. A strong body of evidence supports a protective effect of aerobic or strength-training exercise on cognition. Individuals participating in an exercise-based balance improvement program may also experience this protective effect. This may contribute to the decreased rate of falls reported in the literature.

Purpose: To determine if individuals participating in an evidence-based exercise program to reduce falls would demonstrate improvements in both physical and cognitive performance.

Methods: In this nonexperimental, pretest, posttest design study, 76 adults (65-93 years) participated in a scripted 12-week, 24 session exercise-based balance improvement program. Each 60 minute class incorporated balance, strength, endurance, and flexibility exercises. Participants completed baseline assessments of physical and cognitive performance measures 1 week prior and 1 week following the intervention.

Results: Fifty-two participants completed posttest measures. There were significant improvements in 3 physical performance measures (chair rise time, 360° turn, and 4 square step test). There also was similar improvement in the Symbol Digit Modality Test, a measure of processing speed and mental flexibility. When participants were dichotomized into 2 groups based on achieving/not achieving, a baseline walking speed of at least 1.0 meters/second, secondary analysis revealed greater improvements in cognitive performance measures of Trails A and Trails B tests by faster walkers compared to slower walkers.

Conclusions: Participation in balance programs can have a positive impact on cognition and physical outcomes. This may provide insight about how exercise influences fall risk. Therapists can utilize this information clinically by educating patients about the potential positive effect of balance exercises on cognition.

1UNC Chapel Hill Center for Aging and Health, Chapel Hill, North Carolina

2UNC Division of Physical Therapy, Chapel Hill, North Carolina

3UNC Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Address correspondence to: Tiffany E. Shubert, University of North Carolina at Chapel Hill, Institute on Aging, 720 Martin Luther King Jr. Blvd, CB # 1030, The University of North Carolina, Chapel Hill, NC 27599 (

Work on this project was supported partially by The University of North Carolina at Chapel Hill School of Medicine's “Investment in the Future” Internal Grant Program, 2007–2009.

The authors would like to acknowledge the staff at the Orange County Department on Aging for their assistance and support with this project and the student volunteers from the Division of Physical Therapy and Exercise and Sports Science Department at UNC Chapel Hill.

Copyright © 2010 the Section on Geriatrics of the American Physical Therapy Association