All subjects were able to complete the training program and testing protocols without adverse events. Mean values (± SD) for the training group and controls for ABC pre intervention were 92.8 ± 4.3 and 90.1 ± 6.4, respectively. Postintervention scores for ABC were 96.6 ± 3.6 and 89.4 ± 4.7, respectively. Preintervention scores for training group and controls for TUG were 5.6 ± 0.6 and 5.9 ± 0.6 and postintervention scores were 5.5 ± 1.1 and 5.8 ± 0.9, respectively. A significant group × time effect for the ABC questionnaire was found (p = 0.04). Tukey post hoc analysis indicates that the USBT program significantly increased self-perceived balance ability in this population (d = 0.93; Figure 2). No significant group × time interactions were noted for TUG (Figure 3) or LOP (Figure 4), and no main effects were found for time.
Short-term unstable surface training as performed herein does not seem to affect measures of static balance and TUG for sexagenarians. However, because the ABC was positively affected, there is at least the perception by the subjects that this mode of training is beneficial. Because the control group participants maintained their normal activities and were not systematically attended to during the control period, it is likely that the increase in ABC results in the training group could indicate a subconscious attempt to please the investigators. The lack of change in static balance tests support this belief, but it is conceivable that the measures of sway in this investigation are not sensitive to the training intervention and, thus, not related to balance confidence. Measures of sway have shown improvements with USBT (15,18,32), but none used LOP as a performance indicator.
Inherent difficulties exist when comparing USBT protocols because of the large number of potential variables that can be manipulated. Such variables include lability of surface, stance, time of exposure to surface, length of session, frequency of sessions, visual feedback, strength requirements, and, perhaps most important, the length of the intervention. In addition, there is evidence that additional cognitive demand may enhance learning of postural skill (21). Because of these differences and the lack of detail given to the intervention programs in many published studies, it is difficult to recommend a precise training program. Although some investigations have used relatively simple and/or well-documented training protocols (7,8,15,32,33), other interventions have been somewhat vague in the descriptions of their training (4,5,13). The results of this investigation suggest that the balance training performed herein does not affect objective measures of sway in older adults. Because of the large number of variables that could be manipulated in the design of such studies, many unanswered questions remain about the utility of this type of training. However, the relative efficacy of unstable surface training needs to be established as a method of balance training before the comparison can be made.
Sponsored by the Life Fitness Michael L. Pollock Memorial Grant, University of Memphis Faculty Research Grant, and Power Systems, Inc. None of these entities played any role in the design, execution, analysis, or interpretation of the data. This study and all procedures were approved by the University of Memphis institutional review board.
1. Aagaard P. Training-induced changes in neural function. Exerc Sport Sci Rev
31: 61-67, 2003.
2. Anderson, K and Behm, DG. The impact of instability resistance training on balance
and stability. Sports Med
35: 43-53, 2005.
3. Brauer, SG, Burns, YR, and Galley, P. A prospective study of laboratory and clinical measures of postural stability to predict community-dwelling fallers. J Gerontol A Biol Sci Med Sci
55: 469-476, 2000.
4. Bruhn, S, Kullman, N, and Gollhofer, A. The effects of sensorimotor training and strength training on postural stabilization, maximum isometric contraction and jump performance. Int J Sports Med
25: 56-60, 2004.
5. Bruhn, S, Kullman, N, and Gollhofer, A. Compensatory effects of high-intensity-strength training and sensorimotor training on muscle strength. Int J Sports Med
27: 401-406, 2006.
6. Cohen, J. Statistical Power Analysis for the Behavioral Sciences
(2nd ed.). Hillsdale, NJ: Erlbaum, 1988.
7. Cressey, EM, West, CA, Tiberio, DP, Kraemer, WJ, and Maresh, CM. The effects of ten weeks of lower-body unstable surface training on markers of athletic performance. J Strength Cond Res
21: 561-567, 2007.
8. Crumps, E, Verhagen, E, and Meeusen, R. Efficacy of a sports specific balance
training programme on the incidence of ankle sprains in basketball. J Sports Sci Med
6: 212-219, 2007.
9. Eils, E and Rosenbaum, D. A multi-station proprioceptive exercise program in patients with ankle instability. Med Sci Sport Exerc
10. Fransson, PA, Gomez, S, Patel, M, and Johansson, L. Changes in multi-segmented body movements and EMG activity while standing on firm and foam support surfaces. Eur J Appl Physiol
101: 81-89, 2007.
11. Gantchev, G and Dimitrova, D. Anticipatory postural adjustments associated with arm movements during balancing on unstable support surface. Int J Psychophysiol
22: 117-122, 1996.
12. Gardner, MM, Robertson, MC, and Campbell, AJ. Exercise in preventing falls
and fall related injuries in older people: a review of randomized controlled trials. Br J Sports Med
34: 7-17, 2000.
13. Gruber, M and Gollhofer, A. Impact of sensorimotor training on the rate of force development and neural activation. Eur J Appl Physiol
92: 98-105, 2004.
14. Heitkamp, HC, Horstmann, T, Mayer, F, Weller, J, and Dickhuth, HH. Gain in strength and muscular balance
training. Int J Sports Med
22: 285-290, 2001.
15. Hoffman, M and Payne, VG. The effects of proprioceptive ankle disk training on healthy subjects. J Orthop Sports Phys Ther
21: 90-93, 1995.
16. Ivanenko, Y, Levik, Y, Talis, V, and Gurfinkel, VS. Human equilibrium on unstable support: the importance of feet-support interaction. Neurosci Lett
235: 109-112, 2007.
17. Kannus, P, Palvanen, M, Niemi, S, Parkkari, J, and Järvinen, M. Epidemiology of osteoporotic pelvic fractures in elderly people in Finland: sharp increase in 1970-1997 and alarming projections for the new millennium. Osteoporos Int
11: 443-448, 2000.
18. Kidgell, DJ, Horvath, DM, Jackson, BM, and Seymour, PJ. Effect of six weeks of Dura Disc and mini-trampoline balance
training on postural sway in athletes with functional ankle instability. J Strength Cond Res
21: 466-469, 2007.
19. Lajoie, Y and Gallgher, SP. Predicting falls
within the elderly community: comparison of postural sway, reaction time, the Berg balance
scale and the Activities-specific Balance
Confidence (ABC) scale for comparing fallers and non-fallers. Arch Gerontol Geriatr
38: 11-26, 2004.
20. Lajoie, Y, Girard, A, and Guay, M. Comparison of reaction time, the Berg scale and the ABC in non-fallers and fallers. Arch Gerontol Geriatr
35: 215-225, 2002.
21. Laufer, Y. Effect of cognitive demand during training on acquisition, retention and transfer of a postural skill. Hum Mov Sci
27: 126-141, 2008.
22. Maki, BE, Cheng, KC, Mansfield, A, Scovil, CY, Perry, SD, Peters, AL, McKay, S, Lee, T, Marquis, A, Corbeil, P, Fernie, GR, Liu, B, and McIlroy, WE. Preventing falls
in older adults: new interventions to promote more effective change-in-support balance
reactions. J Electromyogr Kinesiol
18: 243-254, 2008.
23. Mathias, S, Nayak, US, and Isaacs, B. Balance
in elderly patients: the “get-up and go” test. Arch Phys Med Rehabil
67: 387-389, 1986.
24. O'Brien, K, Culham, E, and Pickles, B. Balance
and skeletal alignment in a group of elderly female fallers and nonfallers. J Gerontol A Biol Sci Med Sci
52: 221-226, 1997.
25. Powell, L and Myers, A. The Activities-specific Balance
Confidence (ABC) scale. J Gerontol A Biol Sci Med Sci
50: 28-34, 1999.
26. Rose, D. Fallproof! A Comprehensive Balance and Mobility Training Program
. Champaign: Human Kinetics, 2003.
27. Santana, JC. Stability and balance
training: performance training or circus acts? Strength Cond J
24: 75-76, 2002.
28. Slijper, H and Latash, M. The effects of instability and additional hand support on anticipatory postural adjustments in leg, trunk, and arm muscles during standing. Exp Brain Res
135: 81-93, 2000.
29. Stevens, JA, Corso, PS, Finkelstein, EA, and Miller, TR. The costs of fatal and nonfatal falls
among older adults. Inj Prev
12: 290-295, 2006.
30. Stokes, MJ. Reliability and repeatability of methods for measuring muscle in physiotherapy. Physiother Pract
1: 71-76, 1985.
31. Tinetti, ME, Lui, WL, and Claus, E. Predictors and prognosis of inability to get up after falls
in elderly persons. JAMA
269: 65-70, 1993.
32. Tropp, H and Askling, C. Effects of ankle disk training on muscular strength and postural control. Clin Biomech
3: 88-91, 1988.
33. Verhagen, E, van der Beek, A, Twisk, J, Bouter, L, and Bahr, R. The effect of a proprioceptive balance
board training program for the prevention of ankle sprains. Am J Sports Med
32: 1385-1393, 2004.
34. Waddington, GS and Adams, RD. The effect of a 5-week wobble board exercise intervention on ability to discriminate different degrees of ankle inversion, barefoot and wearing shoes: a study in healthy elderly. J Am Geriatr Soc
52: 573-576, 2004.
35. Woollacott, MH, Shumway-Cook, A, and Nashner, LM. Aging
and posture control: changes in sensory organization and muscular coordination. Int J Aging Hum Dev
23: 97-114, 1986.