Effectiveness of Progressive Resistance Strength Training and Balance Exercises in Preventing Falls among Elderly People

This nursing assignment discusses the effectiveness of progressive resistance strength training and balance exercises in preventing falls among elderly people. It includes a summary of three randomized control trials and their strengths and limitations.

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NURSING ASSIGNMENT
Name of the Student
Name of the university
Author’s note

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Summary
Falls are considered as one of the single largest cause of death among the elderly people.
Falls in elderly not only decreases the quality of their life but also poses considerable financial
and emotional burden on these group of people. Balance training for the elderly people is the
main stay of the most fall prevention program. A large number of literary evidences claim that it
improves muscle strength, endurance, and gait to prevent falls.
Joshua et al., (2014), have conducted a randomized control trial to evaluate the
effectiveness of progressive resistance strength training (PRT) program in comparison to the
traditional balance exercises, to improve the balance in elderly with balance impairment. Three
groups have been included in the randomized control trial from the elderly care centre of the
Mangalore city in India- the PRT, TBE and COMBI groups. The sample size was 54 elderly
subjects with 18 members in each of the groups. The intervention received by The TBE group
are- 8 components of the traditional balance exercise 4 times in a week for 6 months. The PRT
group got resistance training exercises by following the DeLormes and Watkins protocol.
COMBI group got TBE and PRT respectively. Functional reach test (FRT) was used as the
instrument for measuring the forward limits of the stability.
Data analysis was performed by using the SPSS tool. As per the results, a steady
progression could be found in the PRT group from the base line data till 6 month (p<0.001).
Initial improvement could be noticed in the TBE and COMBI group and after 3 months moderate
improvement could be noticed. FRT tests also found to be better for PRT and the COMBI group
than TBE.

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The strength of this study is that it demonstrated a significant improvement in the forward limits
of the balance stability in the older adults. One of the limitations of this study is the small sample
size and it could not be clearly understood whether PRT training can be much effective as a
stand-alone intervention.
On the other hand Hewitt et al., (2018), conducted a randomized control trial for
evaluating the effectiveness of the practice exercise in a long term aged care facility. The trial
was specifically developed for determining whether a combination of high level balance and
moderate intensity progressive resistance training is effective to reduce the fall rate among the
residential older adults. The sample consisted of 16 residential aged care facilities with 221
participants.
The interventions used were - progressive resistance training along with balance
exercises performed in a group for about 50 hours for around 25 weeks, followed by a
maintenance period of 6 months. The primary outcome measures for this study was the rate of
falls and the secondary outcomes measures considered were functional mobility, physical
performance and cognition. The different instruments used were short physical performance
battery, 36 item short form health survey for measuring the quality of life, University of
Alabama Life Space Assessment for assessing the functional mobility, Falls Efficacy Scale
International for measuring the fear of falling; Addenbrooke’s Cognitive Evaluation revised
scale for measuring the cognitive status. As per the results the rate of falls was found to have
been reduced by about 55 % in the exercise group and a statistically significant increase was
noticed in physical performance (p=.02).

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The strength of this study is that the program targeted many important risk factors for the
falls and suggested with some essential recommendations. It provides the future scopes of studies
here measurement of the serum Vitamin levels can be brought in to consideration after
prescribing vitamin to the participants. The main limitation of this study is the small sample size
that has restricted the generalizability of the results to the overall population of the elderly
people.
According to Alvarez et al., (2015), multicomponent exercise programs are efficient in
preventing falls among the community dwelling older adults. In relation to this study aims to
investigate the relation between Boston FICSIT (Frailty and Injuries: Cooperative Studies of
Intervention Techniques) exercise program (the original exercise program for demonstrating that
residents of the nursing home can increase strength) and incident of falls in an residential
community.
A descriptive cross sectional study was conducted with participants from one community.
The inclusion criteria for the participation included 1) the person has to be a current resident of
the community 2) should attend a meeting with the director responsible for the community
activity and 3) should get an acknowledgement formed signed from the participant's physician.
The interventions included aerobic and strength training performed on Keiser Air Resistance
Equipment and also involved leg extension, leg press machines, leg curl and shoulder press.
Aerobic training was done using NuStep machines or treadmills. The outcome measures were
rate of falls, history of falls, the aerobic training per minutes and the number of training
exercises. The statistical analysis was performed by using the SAS version 9.2. As per the results
about 33% of the 39 participants reported fall incidents. Adults without a fall history reported
more time in aerobic and the strength training sessions compared to those having a fall history. A

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significant protective association was found between fall incidents and strength training
exercises (OR = 0.25; 95% CI = 0.07, 0.85). The weakness of this study design is the cross
sectional design and the secondary limitation is that the baseline health among the participants
cannot be controlled and there were no additional activity outside the stipulated exercise
program. Finally, lack of any comparison group did not give any information about the ones who
did not participate in the program.

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References
Alvarez, K. J., Kirchner, S., Chu, S., Smith, S., Winnick-Baskin, W., & Mielenz, T. J. (2015).
Falls reduction and exercise training in an assisted living population. Journal of aging
research, 2015.
Hewitt, J., Goodall, S., Clemson, L., Henwood, T., & Refshauge, K. (2018). Progressive
resistance and balance training for falls prevention in long-term residential aged care: A
cluster randomized trial of the Sunbeam program. Journal of the American Medical
Directors Association, 19(4), 361-369.
Joshua, A. M., D’Souza, V., Unnikrishnan, B., Mithra, P., Kamath, A., Acharya, V., &
Venugopal, A. (2014). Effectiveness of progressive resistance strength training versus
traditional balance exercise in improving balance among the elderly-a randomised
controlled trial. Journal of clinical and diagnostic research: JCDR, 8(3), 98.