Review/Mise au point
Effects of physical training on age-related balance and postural controlEffets de l’entraînement physique sur l’équilibre et le contrôle postural des personnes vieillissantes

https://doi.org/10.1016/j.neucli.2015.09.008Get rights and content

Summary

In this paper, we review the effects of physical activity on balance performance in the elderly. The increase in the incidence of falls with age reflects the disorders of balance-related to aging. We are particularly interested in age-related changes in the balance control system as reflected in different static and dynamic balance tests. We report the results of studies demonstrating the beneficial effects of physical activity on postural balance. By comparing groups of practitioners of different physical activities, it appears that these effects on postural control depend on the type of activity and the time of practice. Thus, we have focused in the present review on “proprioceptive” and “strength” activities. Training programs offering a combination of several activities have demonstrated beneficial effects on the incidence of falls, and we present and compare the effects of these two types of training activities. It emerges that there are differential effects of programs of activities: while all activities improve participants’ confidence in their ability, the “proprioceptive” activities rather improve performance in static tasks, while “strength” activities tend to improve performance in dynamic tasks. These effects depend on the targeted population and will have a greater impact on the frailest subjects. The use of new technologies in the form of “exergames” may also be proposed in home-based exercises.

Résumé

Dans cet article, nous passons en revue les effets de l’activité physique sur l’équilibre de la personne âgée. L’augmentation de l’incidence des chutes avec l’âge témoigne des troubles de l’équilibre intervenant avec le vieillissement. Ainsi, nous nous sommes intéressés aux modifications qui affectent le système de contrôle de l’équilibre avec l’âge. Après avoir présenté différents tests d’évaluation de l’équilibre statique et de l’équilibre dynamique, nous avons reporté les résultats d’études démontrant les effets bénéfiques de l’activité physique sur l’équilibre postural. En comparant différents groupes de pratiquants d’activités physiques, il apparaît que ces effets sur le contrôle postural dépendent du type d’activité mais aussi du temps de pratique. Ainsi, nous nous sommes focalisés sur des activités de type « proprioceptives » et de « force ». Si les programmes proposant une combinaison de plusieurs activités ont démontré des effets bénéfiques sur l’incidence des chutes, nous avons présenté puis comparé les effets de l’entraînement des deux types d’activités. Il se dégage des effets différentiels des programmes d’activités : si toutes les activités permettent d’améliorer chez les participants la confiance en leur capacité, les activités « proprioceptives » vont plutôt améliorer les performances dans les tâches statiques tandis que les activités « force » vont plutôt améliorer les performances dans les tâches dynamiques. Ces effets dépendent de la population cible et auront un effet plus important chez les sujets les plus fragiles. L’utilisation de nouvelles technologies de type « exergame » permet de diversifier les activités mais également une prise en charge individuelle à domicile.

Section snippets

Aging, falls, autonomy and quality of life in older adults

People aged 65 years and older represent the fastest-growing population segment of the European Union. With increased longevity in industrialized countries, aging of the population has highlighted the need to manage balance disorders in the elderly subjects. The World Heath Organisation (WHO) has classified fall prevention as a public health challenge worldwide [121]. Indeed, the economic costs to society and individual consequences of falls have led to the creation of fall prevention programs

Postural control and aging

Falls result from inadequacy of motor response to a disturbance of balance. For example, inappropriate stepping in response to unexpected balance perturbations is more prevalent in older people and in those at risk of falling [68]. Prospective and retrospective epidemiological studies were performed to identify specific risk factors that place individuals at increased risk of falling [92]. However, the identification of at risk populations remains difficult because the causes of the fall are

Postural control and sedentary versus physically active lifestyles

Studies comparing several groups of participants have shown better postural performance in physically active people. Indeed, practitioners of physical activities have better postural performance than sedentary subjects, both in younger [39] and in older age ranges [13], [31], [82].

In previous studies, it has been demonstrated that regular walking in healthy older subjects has beneficial effects on postural control as compared to a sedentary group [69]. Bird et al. demonstrated that regular

Effects of physical training

Most studies describing the effects of physical activity programs compared the effects of an activity with a control group (typically: stretching, awareness education, or muscle relaxation groups) (Table 1).

Comparison of different physical activities

Some recent studies were carried out with the aim of comparing different physical activities and of determining whether a certain training program is superior to another. As reported below, some studies have compared the balance performance of different types of practice [31], [72]. From biomechanical analyses of Tai Chi exercises, Tai Chi exercises were found to be more challenging than walking. Indeed, studies reported that Tai Chi exercises simulate the gait challenges that may be

Conclusion

In older individuals, the cause of falls is not simple. The multifactorial nature of the fall makes establishment of a falls prevention program difficult. In the elderly, several factors contribute to an increased risk of falling: reduction of physical activity, fear of falling, loss of muscle strength and loss of proprioception.

It is difficult to answer the question of what activity might be most effective in preventing falls. Indeed, the older population is very heterogeneous (frail or robust

Disclosure of interest

The authors declare that they have no competing interest.

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