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Balance and Posture in the Elderly: An Analysis of a Sensorimotor Rehabilitation Protocol
Abstract
Regular training programs are a concrete means to prevent and/or reduce functional decline due to aging. A multisensory training approach seems to obtain better results in the elderly with regard to both balance and quality of life. Forty subjects (age 65+/-10 years, height 165+/-4 cm, weight 73.0+/-4.6 kg) were randomized into two groups (GrHu and GrCl). Participants in the GrHu group received 3 months of balance and postural training, 3 sessions per week, with the use of a multisensory training approach. Those in the GrCl group received 3 months of training with a classical rehabilitation protocol that included isotonic training for the lower limbs and spine. With regard to walking, there was an improvement in step symmetry for participants in the GrHu group compared to baseline (0.93+/-0.09 vs. 0.84+/-0.1; p<0.05). Further, all subjects in the GrHu group showed a significant reduction in the energy used during a 4-min walk. Analysis of stabilometry data also showed a significant improvement in balance for those in the GrHu group, which was independent of age or gender. The multisensory training approach yields an improvement of balance in the elderly, which reduces the risk of falls. The observed improvement is significantly greater than that seen with the classical training program.
... The total time spent in exercising during the multisensory exercise interventions varied from 0.5 [30,40] to 180 h [33] , while the intervention duration ranged from 2 [41] to 16 weeks [31] . Studies of intervention time showed that multisensory exercises worked within 6 weeks [34,38,42] , 8 weeks [20,39,43] , 12 weeks [36,37,44] ) respectively. However, there are still studies which reported effective intervention duration was less than 6 weeks or more than 12 weeks. ...
... The interventions most commonly evaluated by included studies were multisensory exercises, which consist of activities simultaneously stimulating at least two sensory modalities of multiple sensory systems including visual, auditory, tactile, vestibular, somatosensory systems, and so on. Auditory stimulation mainly includes music, natural sound, voice, machine work sound, closing sound, etc [40,41,44] . Tactile was stimulated using vibratory stimulation above the perception threshold of the soles of both feet at 100 Hz frequency, baths in alternately cold and warm water, training by touching soft hardness, texture, or 1-2 mm vibrating items [20,33,36,40,41] . ...
Objective
To examine the effect of multisensory exercise on balance disorders.
Methods
PubMed, Scopus and Web of Science were searched to identify eligible studies published before January 1, 2020. Eligible studies included randomized control trials (RCTs), non-randomized studies, case-control studies, and cohort studies. The methodological quality of the included studies was evaluated using JBI Critical Appraisal Checklists for RCTs and for Quasi-Experimental Studies by two researchers independently. A narrative synthesis of intervention characteristics and health-related outcomes was performed.
Results
A total of 11 non-randomized studies and 9 RCTs were eligible, including 667 participants. The results supported our assumption that multisensory exercise improved balance in people with balance disorders. All of the 20 studies were believed to be of high or moderate quality.
Conclusion
Our study confirmed that multisensory exercise was effective in improving balance in people with balance disorders. Multisensory exercises could lower the risk of fall and enhance confidence level to improve the quality of life. Further research is needed to investigate the optimal strategy of multisensory exercises and explore the underlying neural and molecular mechanisms of balance improvement brought by multisensory exercises.
... Besides muscle, aging also influences some body postures, particularly those in the upper and lower body, because it is a key indicator for assessing health and quality of life, especially for the elderly (Gong et al., 2019). Furthermore, poor posture leads to decreased movement and a reduced ability to respond appropriately to external and internal stimuli (Bellomo et al., 2009). According to previous studies, good posture alignment and muscle quality are critical for elderly people's balance control (Hsu et al., 2014). ...
According to previous research, the toilet and bathroom are the most common locations where injuries and accidents involving elderly people occur. Thus, the purpose of this paper is to investigate the issues and challenges of existing toilets and bathrooms among the Malaysian elderly and to identify appropriate solutions for them. The Focus Group Discussion (FGD) and Quality Function Deployment (QFD) sessions were implemented in this study, which involved a total of nineteen respondents, including elderly aged 60 years and above, their caregivers/family members, and agencies/authorities related to housing planning/development and technologies as well as researchers/experts. The recorded data were transcribed into text and organized systematically in the House of Quality (HoQ) for technical analysis. The focus group findings revealed that the four categorized issues raised by respondents in this study were quality, design, cost, and function. Furthermore, based on the HoQ analysis, it indicated that the top five highest ranks of customer requirements (CRs) for a new bathroom and toilet design requirement were comfortable (Rank 1), safety (Rank 2), affordable price (Rank 3), easy to enter bathroom/toilet (Rank 4) and anti-slippery floor (Rank 5). Meanwhile, the top five highest rank of technical requirements (TRs) refer to the existing OKU toilet design (Rank 1), anti-slip ramp & small drain under toilet door (Ranks 2 and 3), relocating existing toilet accessories, e.g., sink bow (Rank 4) and categories the cost according to the minor, major or new design (Rank 5). The information gathered could be used to develop appropriate bathrooms and toilets for the elderly in Malaysia.
... Sensorimotor exercises on an unstable surface had a greater effect on sensory motor function than exercises on a stable surface, and a report 19 that postural reactions were faster on a moving surface. ...
Background: SMT (sensorimotor training) is a form of exercise aiming to decrease the muscle imbalance by maximizing the sensory input coming from three sites in the body where there is a large number of propioception(the foot, sacroiliac joint ,cervical spine).The purpose of study is to check the effect of SMT on neuromuscular control, balance and reaction time using three levels i.e. stable surface , unstable surface and sand in elderly population. Method:The study was an experimental study with a sample size of 30 elderly subjects of age group 60-80 years. They had performed exercises in st three levels 1 in stable then foam then sand. They were assessed using SOT test, test for neuromuscular control and reaction time. Conclusion: The study shows that the sensorimotor training which is given in three levels i.e., in stable surface , foam and sand are effective in improving balance, increasing neuromuscular control and decreasing reaction time in elderly for decreasing risk of fall and improving quality of life in elderly.
... Based on the second hypothesis, we assumed that the SMST improves static balance of older women with DPN. The results confirmed this hypothesis, which is consistent with previous studies related to postural control [7,19,20]. The sensory-motor integrity resulted from the multisensory training can reduce postural sways and lead to increased postural control [3,21]. ...
Background and Aims: Older adults with diabetic peripheral neuropathies (DPN) are at higher risk of motor control, slower reaction time, and increased postural sways. There is increasing evidence that exercise-based interventions have a positive impact on the health of older people. This study aims to assess the effectiveness of a selected multisensory training (SMST) program in improving the balance of older women with DPN. Methods: In this study, 30 older women (Mean±SD age=62.35±1.87 years) were randomly assigned into the SMST and control groups. All participants underwent dynamic and static balance tests before and after the training. The SMST program included the balance training with eyes open and closed on different surfaces to stimulate visual, proprioception, and vestibular system. The intervention was conducted for 12 weeks, two times per week. Results: There was a significant difference in the dynamic balance between the SMST and control groups (t(28)=-6.74, P=0.000, ƞ2=0.61). The results of analysis of variance showed that the SMST program improved the static balance in the X direction (F(1,28)=14.16, P=0.001, ƞ2=0.33) and in the Y direction (F(1,28)=5.38, P=0.028, ƞ2=0.16) in older women with DPN. Conclusion: The SMST can improve the dynamic and static balances of older women with DPN. Older women with DPN are at increased risk of falling. This program can be used to enhance their balance and postural control.
... 대상자는 각각의 동작 을 모니터 상에 표시되는 지점까지 수행하도록 하면서 체중을 이동하도록 하였다. 이 훈련은 변화하는 무게중심에 하체의 관절과 근 육, 인대, 힘줄 등을 사용하여 균형을 잡을 수 있도록 하며, 균형 능력뿐만 아니라 협응력 그리고 상하지 근 력을 필요로 한다[21]. 웜업과 본 운동은 주 3회, 30분 동안 실시하였다(Fig. ...
... Worth to notice also that already at T1 (5 months) FES induced improvement in the ST test. These results suggest that the subject's balance may depend on muscle mass and strength (Figures 3, 4), as previously suggested (48,49). The comparison of results in eyes-open and eyes-closed conditions (a) indicates that muscle force (likely needed to maintain balance) has a relatively greater role in eyes-closed condition, (i.e., the condition without visual perceptual information) and (b) suggests that the strength of lower limbs is crucial for the transfer of balance control skills to all environmental situations (50). ...
Central Core Disease (CCD) is a congenital myopathy characterized by presence of amorphous central areas (or cores) lacking glycolytic/oxidative enzymes and mitochondria in skeletal muscle fibers. Most CCD families are linked to mutations in ryanodine receptor type-1 (RYR1), the gene encoding for the sarcoplasmic reticulum (SR) Ca2+ release channel of skeletal muscle. As no treatments are available for CCD, currently management of patients is essentially based on a physiotherapic approaches. Functional electrical stimulation (FES) is a technique used to deliver low energy electrical impulses to artificially stimulate selected skeletal muscle groups. Here we tested the efficacy of FES in counteracting muscle loss and improve function in the lower extremities of a 55-year-old female patient which was diagnosed with CCD at the age of 44. Genetic screening of the RyR1 gene identified a missense mutation (c.7354C>T) in exon 46 resulting in an amino acid substitution (p.R2452W) and a duplication (c.12853_12864dup12) in exon 91. The patient was treated with FES for 26 months and subjected before, during, and after training to a series of functional and structural assessments: measurement of maximum isometric force of leg extensor muscles, magnetic resonance imaging, a complete set of functional tests to assess mobility in activities of daily living, and analysis of muscle biopsies by histology and electron microscopy. All results point to an improvement in muscle structure and function induced by FES suggesting that this approach could be considered as an additional supportive measure to maintain/improve muscle function (and possibly reduce muscle loss) in CCD patients.
... Such a tool is clinically relevant since decline in ADL can be slowed down or prevented using different exercise approaches targeting specific ADL problems. These approaches are already available and commonly used in clinical practice, for example strength training (Hazell et al., 2007), functional training (Liu et al., 2014), and balance training (Bellomo et al., 2009). Training of multisensory integration in the OA population has been developed as well (de Vreede et al., 2005;Setti et al., 2014;Merriman et al., 2015). ...
Previous research showed that a simple target interception task reveals differences between younger adults (YA) and older adults (OA) on a large screen under laboratory conditions. Participants intercept downward moving objects while a horizontally moving background creates an illusion of the object moving in the opposite direction of the background. OA are more influenced by this illusory motion than YA. OA seem to be less able to ignore irrelevant sensory information than YA. Since sensory integration relates to the ability to perform Activities of Daily Living (ADL), this interception task can potentially signal ADL issues. Here we investigated whether the results of the target interception task could be replicated using a more portable setup, i.e., a tablet instead of a large touch screen. For YA from the same, homogeneous population, the main effects were replicated although the task was more difficult in the tablet set-up. After establishing the tablet’s validity, we analyzed the response patterns of OA that were less fit than the OA in previous research. We identified three different illusion patterns: a (large) illusion effect (indicating over integration), a reverse illusion effect, and no illusion effect. These different patterns are much more nuanced than previously reported for fit OA who only show over integration. We propose that the patterns are caused by differences in the samples of OA (OA in the current sample were older and had lower ADL scores), possibly modulated by increased task difficulty in the tablet setup. We discuss the effects of illusory background motion as a function of ADL scores using a transitional model. The first pattern commences when sensory integration capability starts to decrease, leading to a pattern of over-integration (illusion effect). The second pattern commences when compensatory mechanisms are not sufficient to counteract the effect of the background motion, leading to direction errors in the same direction as the background motion (reverse illusion). The third pattern commences when the task requirements are too high, leading OA to implement a probabilistic strategy by tapping toward the center of the screen.
... Visual inputs have been perturbed in different ways. First of all, visual input has been suppressed by some authors by asking participants to simply close their eyes (Stelmach et al., 1989;Teasdale et al., 1991;Cham et al., 2007;Bellomo et al., 2009). Other authors limited the visual input using active shutter googles (Allison et al., 2006;Eikema et al., 2014) or blurry vision (Deshpande and Patla, 2007). ...
Ravnotežje je med ključnimi gibalnimi sposobnostmi, ki omogočajo starejšim odraslim neodvisno, učinkovito in varno gibanje. Proprioceptivna in senzorno-motorična vadba se v literaturi pogosto omenjata kot učinkovita pristopa za izboljšanje ravnotežja in gibalne funkcije pri tej populaciji. Hkrati ni povsem jasno, v čem se vadbena pristopa razlikujeta in kateri je učinkovitejši. Izsledki našega pregleda literature kažejo, da imata proprioceptivna in senzorno-motorična vadba podobne pozitivne učinke na ravnotežje pri starejših osebah. Predvsem pri dinamičnem ravnotežju so v dosedanjih študijah prišli do pomembnega izboljšanja in posledično tudi zmanjšanja števila padcev. Med vsemi študijami, v katerih so vadbo opredelili kot proprioceptivno, so le v dveh poročali, da se statično ravnotežje ni izboljšalo, v eni raziskavi pa se ni izboljšala stabilnost med hojo. Ugotavljamo, da so avtorji, ki trening oziroma vadbo opredeljujejo kot senzorno-motorično, prišli do podobnih rezultatov. Tudi v tem primeru le v dveh raziskavah niso ugotovili statistično pomembnega izboljšanja statičnega ravnotežja (gibanje centra pritiska na ploščah za merjenje sil), pri eni pa so ugotovili, da se je izboljšalo samo pri moških. Na podlagi vadbenih intervencij, ki so jih avtorji izvajali v svojih raziskavah, ugotavljamo, da avtorji nekonsi-stentno opredeljujejo proprioceptivni in senzorno-motorični trening. Prav tako smo ugotovili, da so avtorji v dveh raziskavah enako vadbeno intervencijo enkrat opredelili kot proprioceptivno, drugič pa kot senzorno-motorično, čeprav gre za različna izraza oziroma pristopa.
This review updates the knowledge on the use of bioprogressive philosophy in current rehabilitation paradigms, focusing on age-related ailments and antiaging strategies. It is a holistic approach that combines aspects of biology and function into the realm of rehabilitation therapy. The bioprogressive philosophy, with assistance of modern technological developments, such as microgravity-producing devices and techniques, enables personalized and targeted therapeutic approach that seems the most effective in rehabilitation and prevention of neuro-myo-sensory disorders that compromise the homeostatic body harmony, particularly in old age. The review defines the aging, discusses the most common physical dysfunctions, linked to posture, balance, or gait, and gives cues to modern antiaging rehabilitative approaches. The emphasis is put on the proprio-neuromuscular facilitation, a combination of stretch technique that steps into the bioprogressive approach, as currently the best method in the world of physical rehabilitation.
Full-text of this article is not available in this e-prints service. This article was originally published [following peer-review] in Journal of Sports Sciences, published by and copyright Routledge. The purpose of this multidisciplinary review paper is to critically review evidence from descriptive, efficacy and effectiveness studies concerned with physical activity and older people. Both levels of fitness (aerobic power, strength, flexibility and functional capability) and measures of physical activity involvement decline with age, and the extent to which this is due to a biological ageing processes or disuse (physical inactivity) is critically examined. The review will consider the evidence for a causal relationship between sedentary behaviour/physical activity programmes and cardiovascular, musculoskeletal and psycho-social health, independent living and health-related quality of life into old age. The review also considers the effectiveness of different physical activity interventions for older people and issues relating to cost-effectiveness. The implications for future policy in terms of research, health care services, and education and training are briefly discussed.
To determine the effect of posture on maximal O2 uptake (VO2 max) and other cardiorespiratory adaptations to exercise training, 16 male subjects were trained using high-intensity interval and prolonged continuous cycling in either the supine or upright posture 40 min/day 4 days/wk for 8 wk and 7 male subjects served as non-training controls. VO2 max measured during upright cycling and supine cycling, respectively, increased significantly (P less than 0.05) by 16.1 +/- 3.4 and 22.9 +/- 3.4% in the supine training group (STG) and by 14.6 +/- 2.0 and 6.0 +/- 2.0% in the upright training group (UTG). The increase in VO2 max measured during supine cycling was significantly greater (P less than 0.05) in the STG than in the UTG. The increase in VO2 max in the UTG was significantly greater (P less than 0.05) when measured during upright exercise than during supine exercise. However, there was no significant difference in posture-specific VO2 max adaptations in the STG. A postural specificity was also evident in other maximal cardiorespiratory variables (ventilation, CO2 production, and respiratory exchange ratio). In the UTG, maximal heart rate decreased significantly (P less than 0.05) only during supine cycling; there was no significant difference in maximal heart rate after training in the STG. We conclude that posture affects maximal cardiorespiratory adaptations to cycle training. Additionally, supine training is more effective than upright training in increasing maximal cardiorespiratory responses measured during supine exercise, and the effects of supine training generalize to the upright posture to a greater extent than the effects of upright training generalize to the supine posture.(ABSTRACT TRUNCATED AT 250 WORDS)
The effects of strength training on maximal aerobic power (VO2max) and some of its determinants were studied in 12 healthy older men (60-72 yr). They underwent 12 wk of strength conditioning of extensors and flexors of each knee with eight repetitions per set, three sets per session, and three sessions per week at 80% of the one repetition maximum (1 RM). Left knee extensors showed a 107% increase in 1 RM, a 10% increase in isokinetic strength at 60 degrees/s, and a 23% increase in total work performed during 25 contractions on an isokinetic dynamometer. Strength measurements of the untrained left elbow extensors showed no change. Leg cycle ergometer VO2max per unit fat-free mass increased by an average 1.9 ml (P = 0.034) whereas arm cycle VO2max was unchanged. Pulmonary function, hemoglobin concentration, erythrocyte volume, plasma volume, and total blood volume did not change. Biopsies of the vastus lateralis showed a 28% increase in mean fiber area, no change in fiber type distribution, a 15% increase in capillaries per fiber, and a 38% increase in citrate synthase activity. The data suggest that the small increase in leg cycle VO2max in older men may be due to adaptations in oxidative capacity and increased mass of the strength-trained muscles.
Muscle dysfunction and associated mobility impairment, common among the frail elderly, increase the risk of falls, fractures, and functional dependency. We sought to characterize the muscle weakness of the very old and its reversibility through strength training. Ten frail, institutionalized volunteers aged 90 ± 1 years undertook 8 weeks of high-intensity resistance training. Initially, quadriceps strength was correlated negatively with walking time (r= -.745). Fat-free mass (r=.732) and regional muscle mass (r=.752) were correlated positively with muscle strength. Strength gains averaged 174% ±31% (mean ± SEM) in the 9 subjects who completed training. Midthigh muscle area increased 9.0%± 4.5%. Mean tandem gait speed improved 48% after training. We conclude that high-resistance weight training leads to significant gains in muscle strength, size, and functional mobility among frail residents of nursing homes up to 96 years of age.
(JAMA. 1990;263:3029-3034)
Isoprostanes (IsoP's) are a series of prostaglandin(PG)-like compounds that are formed independent of the cyclooxygenase by free radical catalyzed peroxidation of arachidonic acid esterified to phosophlipids. New insights regarding the enzymatic hydrolysis of preformed esterified Isop's will be presented. The initial series of Isop's identified had a prostanoid F-type ring structure (F2-Isop's). Subsequently, Isop's with prostanoid E-type and D-type ring structures were identified (E2D2-Isop's). Additional unique products of this pathway (isothromboxanes and isolevuglandins) have been recently identified and will be discussed. Two Isop's that have been tested for bioactivity (8-iso-PGF2α and 8-iso-PGE2) have been found to be potent vasoconstrictors via interaction with a receptor(s). Isolevuglandins, on the other hand, exert unique biological properties owing to their remarkable proclivity to form covalent adducts with proteins and DNA. A valuable aspect of the discovery of Isop's is that measurements of Isop's in biological fluids and tissues offers a reliable means to assess oxidative stress status in vivo. Examples of how measurement of Isop's has proven useful to assess the role of free radicals in human disease, with an emphasis on atherosclerosis/cardiovascular disease, will be discussed.
Oxidative stress is thought to be involved in the agingprocess in aerobic organisms and to play a role in thepathogenesis of several disease states. Since free radicals areextremely reactive, shortly half-lived and therefore verydifficult to measure directly, oxidative stress has been mainlystudied through the search of indirect biomarkers of freeradical-induced damage. In aerobic organisms, oxidative damage totissues and organs is prevented by a network of defenses whichincludes antioxidant and repairing enzymes as well as smallmolecules with scavenging ability, such as antioxidant vitamins.For these reasons, the assay of antioxidant vitamins and of smallmolecular free radical scavengers in biological milieus may beused, if appropriately performed, to quantify the defense statusagainst oxidative damage and to provide an indirect estimate offree radical production in aging humans. Since severalconflicting data have been reported in this area, this review isaimed to summarize the existing evidence and possible faults ofthe research focusing on the role of plasma concentrations ofsmall-molecular, non-enzymatic antioxidants in the process ofsenescence in healthy humans.
Elderly humans have altered cellular redox levels and dysregulated immune responses, both of which are key events underlying the progression of chronic degenerative diseases of ageing, such as atherosclerosis and Alzeimer's disease. Poorly maintained cellular redox levels lead to elevated activation of nuclear transcription factors such as NFkB and AP-1. These factors are co-ordinately responsible for a huge range of extracellular signalling molecules responsible for inflammation, tissue remodelling, oncogenesis and apoptosis, progessess that orchestrate many of the degenerative processess associated with ageing. It is now clear that levels of endogenous anti-oxidants such as GSH decrease with age. This study aimed to investigate the potential of exogenous anti-oxidants to influence inflammatory responses and the ageing process itself. We investigated the potential of the dietary antioxidant, quercetin, to reverse the age related influences of GSH depletion and oxidative stress using in vitro human umbilical vein endothelial cells (HUVEC) and human skin fibroblast (HSF) cell models. Oxidative stress-induced inflammatory responses were investigated in a GSH depletion and a Phorbol 12-myristate 13-acetate (PMA)-induced stress model. As measured with a sensitive HPLC fluorescence method, GSH in HUVEC was depleted by the addition of l-buthionine-[S,R]-sulfoxiniine (BSO), a γ-glutamylcysteine synthetase inhibitor, to the culture medium at a concentration of 0.25 mM. Time course studies revealed that the GSH half-life was 4.6 h in HUVEC. GSH depletion by BSO for 24 h led to a slight increase in intracellular adhesion molecule — 1 (ICAM1) expression and prostaglandin E2 (PGE2) secretion in both types of cells. However, GSH depletion markedly enhanced PMA-induced ICAM and PGE2 production in HUVEC. Responses were progressively elevated following prolonged BSO treatment. Inhibition studies showed that 1-(5-Isoquinolinylsulfonyl)-2-methylpiperazine (H7), a protein kinase C (PKC) inhibitor, not only abolished most of PMA-induced ICAM-1 expression and PGE2, production, but also eliminated GSH depletion-enhanced PMA stimulation. This enhancement was also inhibited by supplementation with quercetin. The results clearly demonstrate that GSH depletion increased the susceptibility of vascular endothelial cells and fibroblasts to oxidative stress associated inflammatory stimuli. This increased in vitro susceptibility may be extrapolated to the in vivo situation of ageing, providing a useful model to study the influence of micronutrients on the ageing process. In conclusion, these data suggest that dietary antioxidants could play a significant role in the reduction of inflammatory responses.
Fifteen well-trained master endurance athletes [62.0 +/- 2.3 (SE) yr] and 14 sedentary control subjects (61.4 +/- 1.4 yr) were reevaluated after an average follow-up period of approximately 8 yr to obtain information regarding the effects of physical activity on the age-related decline in maximal O2 uptake capacity (VO2max). The master athletes had been training for 10.2 +/- 2.9 yr before initial testing and continued to train during the follow-up period. The sedentary subjects' VO2max declined by an average of 3.3 ml.kg-1.min-1 (33.9 +/- 1.7 vs. 30.6 +/- 1.6, P less than 0.001) over the course of the study, a decline of 12% per decade. In these subjects maximal heart rate declined 8 beats/min (171 vs. 163) and maximal O2 pulse decreased from 0.20 to 0.18 ml.kg-1.beat (P less than 0.05). The master athletes' VO2 max decreased by an average of 2.2 ml.kg-1.min-1 (54.0 +/- 1.7 vs. 51.8 +/- 1.8, P less than 0.05), a 5.5% decline per decade. The master athletes' maximal heart rate was unchanged (171 +/- 3 beats/min) and their maximal O2 pulse decreased from 0.32 to 0.30 ml.kg-1.beat (P less than 0.05). These findings provide evidence that the age-related decrease in VO2max of master athletes who continue to engage in regular vigorous endurance exercise training is approximately one-half the rate of decline seen in age-matched sedentary subjects. Furthermore our results suggest that endurance exercise training may reduce the rate of decline in maximal heart rate that typically occurs as an individual ages.
Fifty female subjects, aged 72-92 (mean 82) years, were enrolled in a 12-week (36 classes) exercise program aimed at increasing postural stability. Subjects were residents of sheltered apartments, rest homes or nursing homes, well enough and mobile enough to participate in the classes. The subjects were randomized into an exercise or a control group. Their postural sway, standing at rest on a force platform, was measured with eyes open and eyes closed. The groups were well matched in all respects. The results showed no improvement in the postural sway as a result of the exercise program. We hypothesize that increasing postural sway in the elderly represents a deterioration in, for the most part, the nervous system and may at this extreme of life indicate an irreversible loss of function. For this reason no improvement in postural sway may be possible.