Skip to main content
Log in

The Importance of Trunk Muscle Strength for Balance, Functional Performance, and Fall Prevention in Seniors: A Systematic Review

  • Systematic Review
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

Background

The aging process results in a number of functional (e.g., deficits in balance and strength/power performance), neural (e.g., loss of sensory/motor neurons), muscular (e.g., atrophy of type-II muscle fibers in particular), and bone-related (e.g., osteoporosis) deteriorations. Traditionally, balance and/or lower extremity resistance training were used to mitigate these age-related deficits. However, the effects of resistance training are limited and poorly translate into improvements in balance, functional tasks, activities of daily living, and fall rates. Thus, it is necessary to develop and design new intervention programs that are specifically tailored to counteract age-related weaknesses. Recent studies indicate that measures of trunk muscle strength (TMS) are associated with variables of static/dynamic balance, functional performance, and falls (i.e., occurrence, fear, rate, and/or risk of falls). Further, there is preliminary evidence in the literature that core strength training (CST) and Pilates exercise training (PET) have a positive influence on measures of strength, balance, functional performance, and falls in older adults.

Objective

The objectives of this systematic literature review are: (a) to report potential associations between TMS/trunk muscle composition and balance, functional performance, and falls in old adults, and (b) to describe and discuss the effects of CST/PET on measures of TMS, balance, functional performance, and falls in seniors.

Data Sources

A systematic approach was employed to capture all articles related to TMS/trunk muscle composition, balance, functional performance, and falls in seniors that were identified using the electronic databases PubMed and Web of Science (1972 to February 2013).

Study Selection

A systematic approach was used to evaluate the 582 articles identified for initial review. Cross-sectional (i.e., relationship) or longitudinal (i.e., intervention) studies were included if they investigated TMS and an outcome-related measure of balance, functional performance, and/or falls. In total, 20 studies met the inclusionary criteria for review.

Study Appraisal and Synthesis Methods

Longitudinal studies were evaluated using the Physiotherapy Evidence Database (PEDro) scale. Effect sizes (ES) were calculated whenever possible. For ease of discussion, the 20 articles were separated into three groups [i.e., cross-sectional (n = 6), CST (n = 9), PET (n = 5)].

Results

The cross-sectional studies reported small-to-medium correlations between TMS/trunk muscle composition and balance, functional performance, and falls in older adults. Further, CST and/or PET proved to be feasible exercise programs for seniors with high-adherence rates. Age-related deficits in measures of TMS, balance, functional performance, and falls can be mitigated by CST (mean strength gain = 30 %, mean effect size = 0.99; mean balance/functional performance gain = 23 %, mean ES = 0.88) and by PET (mean strength gain = 12 %, mean ES = 0.52; mean balance/functional performance gain = 18 %, mean ES = 0.71).

Limitations

Given that the mean PEDro quality score did not reach the predetermined cut-off of ≥6 for the intervention studies, there is a need for more high-quality studies to explicitly identify the relevance of CST and PET to the elderly population.

Conclusions

Core strength training and/or PET can be used as an adjunct or even alternative to traditional balance and/or resistance training programs for old adults. Further, CST and PET are easy to administer in a group setting or in individual fall preventive or rehabilitative intervention programs because little equipment and space is needed to perform such exercises.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2a–b

Similar content being viewed by others

References

  1. United Nations. World population prospects: the 2008 revision. New York: United Nations; 2009.

  2. Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012;9:CD007146.

    PubMed  Google Scholar 

  3. Granacher U, Zahner L, Gollhofer A. Strength, power, and postural control in seniors: Considerations for functional adaptations and for fall prevention. Eur J Sport Sci. 2008;8(6):325–40.

    Article  Google Scholar 

  4. Orr R, Raymond J, Fiatarone SM. Efficacy of progressive resistance training on balance performance in older adults: a systematic review of randomized controlled trials. Sports Med. 2008;38(4):317–43.

    Google Scholar 

  5. Behm DG, Drinkwater EJ, Willardson JM, et al. The use of instability to train the core musculature. Appl Physiol Nutr Metab. 2010;35(1):91–108.

    Article  PubMed  Google Scholar 

  6. Richardson C, Jull G, Hodges P, et al. Therapeutic exercise for spinal segmental stabilization in low back pain: scientific basis and clinical approach. Edinburgh: Churchill Livingstone; 1999.

    Google Scholar 

  7. Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Med. 2006;36(3):189–98.

    Article  PubMed  Google Scholar 

  8. Kim KJ. Effects of core muscle strengthening training on flexibility, muscular strength and driver shot performance in female professional golfers. Int J Appl Sports Sci. 2010;22(1):111–27.

    Google Scholar 

  9. Nourbakhsh MR, Arab AM. Relationship between mechanical factors and incidence of low back pain. J Orthop Sports Phys Ther. 2002;32(9):447–60.

    Google Scholar 

  10. Airaksinen O, Brox JI, Cedraschi C, et al. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2):192–300.

    Article  Google Scholar 

  11. van der Burg JC, Pijnappels M, van Dieen JH. Out-of-plane trunk movements and trunk muscle activity after a trip during walking. Exp Brain Res. 2005;165(3):407–12.

    Article  PubMed  Google Scholar 

  12. Hwang JH, Lee YT, Park DS, et al. Age affects the latency of the erector spinae response to sudden loading. Clin Biomech. 2008;23(1):23–9.

    Article  Google Scholar 

  13. Ferreira PH, Ferreira ML, Maher CG, et al. Changes in recruitment of transversus abdominis correlate with disability in people with chronic low back pain. Br J Sports Med. 2010;44(16):1166–72.

    Article  PubMed  CAS  Google Scholar 

  14. Cosio-Lima LM, Reynolds KL, Winter C, et al. Effects of physioball and conventional floor exercises on early phase adaptations in back and abdominal core stability and balance in women. J Strength Cond Res. 2003;17(4):721–5.

    PubMed  Google Scholar 

  15. Mallen C, Peat G, Croft P. Quality assessment of observational studies is not commonplace in systematic reviews. J Clin Epidemiol. 2006;59(8):765–9.

    Article  PubMed  Google Scholar 

  16. Maher CG, Sherrington C, Herbert RD, et al. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83(8):713–21.

    PubMed  Google Scholar 

  17. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1–12.

    Article  PubMed  CAS  Google Scholar 

  18. Verhagen AP, de Vet HC, de Bie RA, et al. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol. 1998;51(12):1235–41.

    Article  PubMed  CAS  Google Scholar 

  19. Cohen J. Statistical power for the behavioral sciences. Hillsdale: Erlbaum; 1988.

    Google Scholar 

  20. Sunil B, Venkadesan R, Marnta S. Comparison of lower limb and trunk muscle strength training on balance in elderly population. Indian J Physiother Occup Ther. 2009;3(4):39–43.

    Google Scholar 

  21. Granacher U, Lacroix A, Muehlbauer T, et al. Effects of core instability strength training on trunk muscle strength, spinal mobility, dynamic balance and functional mobility in older adults. Gerontology. 2013;59(1):105–13.

    Article  PubMed  Google Scholar 

  22. Hosseini SS, Asl AK, Rostamkhany H. The effect of strength and core stabilization training on physical fitness factors among elderly people. World Appl Sci J. 2012;16(4):479–84.

    Google Scholar 

  23. Kang KY, Choi JH, Lee SB. Effect of core strengthening exercise programs on symmetric double limb support and balance ability in the elderly. J Int Acad Phys Ther Res. 2012;3(1):378–82.

    Article  Google Scholar 

  24. Nichols JF, Medina D, Dean E. Effects of strength, balance, and trunk stabilization training on measures of functional fitness in older adults. Am J Med Sports. 2001;3(5):279–85.

    Google Scholar 

  25. Bird ML, Hill KD, Fell JW. A randomized controlled study investigating static and dynamic balance in older adults after training with Pilates. Arch Phys Med Rehabil. 2012;93(1):43–9.

    Article  PubMed  Google Scholar 

  26. Irez GB, Ozdemir RA, Evin R, et al. Integrating Pilates exercise into an exercise program for 65+ year-old women to reduce falls. J Sport Sci Med. 2011;10(1):105–11.

    Google Scholar 

  27. Rodrigues B, Cader S, Torres N, et al. Pilates method in personal autonomy, static balance and quality of life of elderly females. J Bodyw Mov Ther. 2010;14(2):195–202.

    Article  Google Scholar 

  28. Seo BD, Yun YD, Kim HR, 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(1):11–5.

    Article  Google Scholar 

  29. Sinaki M, Brey RH, Hughes CA, et al. Significant reduction in risk of falls and back pain in osteoporotic-kyphotic women through a Spinal Proprioceptive Extension Exercise Dynamic (SPEED) program. Mayo Clin Proc. 2005;80(7):849–55.

    Article  PubMed  Google Scholar 

  30. Petrofsky JS, Cuneo M, Dial R, et al. Core strengthening and balance in the geriatric population. J Appl Res. 2005;5(3):423–33.

    Google Scholar 

  31. Katzman WB, Sellmeyer DE, Stewart AL, et al. Changes in flexed posture, musculoskeletal impairments, and physical performance after group exercise in community-dwelling older women. Arch Phys Med Rehabil. 2007;88(2):192–9.

    Article  PubMed  Google Scholar 

  32. Kaesler DS, Mellifont RB, Swete Kelly P, et al. A novel balance exercise program for postural stability in older adults: a pilot study. J Bodyw Mov Ther. 2007;11(1):37–43.

    Article  Google Scholar 

  33. Newell D, Shead V, Sloane L. Changes in gait and balance parameters in elderly subjects attending an 8-week supervised Pilates programme. J Bodyw Mov Ther. 2012;16(4):549–54.

    Article  PubMed  CAS  Google Scholar 

  34. Kahle N, Tevald MA. Core muscle strengthening improves balance performance in community-dwelling older adults: a pilot study. J Aging Phys Act. 2013 (Epub ahead of print).

  35. Pfeifer M, Begerow B, Minne HW, et al. Vitamin D status, trunk muscle strength, body sway, falls, and fractures among 237 postmenopausal women with osteoporosis. Exp Clin Endocrinol Diabetes. 2001;109(2):87–92.

    Article  PubMed  CAS  Google Scholar 

  36. Hicks GE, Simonsick EM, Harris TB, et al. Trunk muscle composition as a predictor of reduced functional capacity in the health, aging and body composition study: the moderating role of back pain. J Gerontol A Biol Sci Med Sci. 2005;60(11):1420–4.

    Article  PubMed  Google Scholar 

  37. Hicks GE, Simonsick EM, Harris TB, et al. Cross-sectional associations between trunk muscle composition, back pain, and physical function in the health, aging and body composition study. J Gerontol A Biol Sci Med Sci. 2005;60(7):882–7.

    Article  PubMed  Google Scholar 

  38. Suri P, Kiely DK, Leveille SG, et al. Trunk muscle attributes are associated with balance and mobility in older adults: a pilot study. PM R. 2009;1(10):916–24.

    Article  PubMed  Google Scholar 

  39. Kasukawa Y, Miyakoshi N, Hongo M, et al. Relationships between falls, spinal curvature, spinal mobility and back extensor strength in elderly people. J Bone Miner Metab. 2010;28(1):82–7.

    Article  PubMed  Google Scholar 

  40. Daubney ME, Culham EG. Lower-extremity muscle force and balance performance in adults aged 65 years and older. Phys Ther. 1999;79(12):1177–85.

    PubMed  CAS  Google Scholar 

  41. Granacher U, Muehlbauer T, Zahner L, et al. Comparison of traditional and recent approaches in the promotion of balance and strength in older adults. Sports Med. 2011;41(5):377–400.

    Article  PubMed  Google Scholar 

  42. Leteneur S, Gillet C, Sadeghi H, et al. Effect of trunk inclination on lower limb joint and lumbar moments in able men during the stance phase of gait. Clin Biomech. 2009;24(2):190–5.

    Article  CAS  Google Scholar 

  43. Balzini L, Vannucchi L, Benvenuti F, et al. Clinical characteristics of flexed posture in elderly women. J Am Geriatr Soc. 2003;51(10):1419–26.

    Article  PubMed  Google Scholar 

  44. Miyazaki J, Murata S, Horie J, et al. Lumbar lordosis angle (LLA) and leg strength predict walking ability in elderly males. Arch Gerontol Geriatr. 2013;56(1):141–7.

    Article  PubMed  Google Scholar 

  45. Kulas A, Zalewski P, Hortobagyi T, et al. Effects of added trunk load and corresponding trunk position adaptations on lower extremity biomechanics during drop-landings. J Biomech. 2008;41(1):180–5.

    Article  PubMed  Google Scholar 

  46. Akuthota V, Nadler SF. Core strengthening. Arch Phys Med Rehabil. 2004;85(3):S86–92.

    Article  PubMed  Google Scholar 

  47. Behm DG, Drinkwater EJ, Willardson JM, et al. Canadian Society for Exercise Physiology position stand: the use of instability to train the core in athletic and nonathletic conditioning. Appl Physiol Nutr Metab. 2010;35(1):109–12.

    Google Scholar 

  48. Hausdorff JM, Edelberg HK, Mitchell S. Increased gait unsteadiness in community-dwelling elderly fallers. Arch Phys Med Rehabil. 1997;78(3):278–83.

    Article  PubMed  CAS  Google Scholar 

  49. Cruz-Ferreira A, Fernandes J, Laranjo L, et al. A systematic review of the effects of pilates method of exercise in healthy people. Arch Phys Med Rehabil. 2011;92(12):2071–81.

    Article  PubMed  Google Scholar 

  50. Johnson EG, Larsen A, Ozawa H, et al. The effects of Pilates-based exercise on dynamic balance in healthy adults. J Bodyw Mov Ther. 2007;11(3):238–42.

    Article  Google Scholar 

  51. Sakari-Rantala R, Era P, Rantanen T, et al. Associations of sensory-motor functions with poor mobility in 75- and 80-year-old people. Scand J Rehabil Med. 1998;30(2):121–7.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This work was supported by a grant from the German Research Foundation (MU 3327/2-1). The authors have no conflicts of interest that are directly relevant to the content of this review.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Urs Granacher.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Granacher, U., Gollhofer, A., Hortobágyi, T. et al. The Importance of Trunk Muscle Strength for Balance, Functional Performance, and Fall Prevention in Seniors: A Systematic Review. Sports Med 43, 627–641 (2013). https://doi.org/10.1007/s40279-013-0041-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40279-013-0041-1

Keywords

Navigation