Exercise Interventions on Balance in Older People: a Systematic Review

  • Vânia Azevedo Ferreira Brandão Loureiro Portugal
  • Carlos Paixão Polytechnic Institute of Beja, Beja, Portugal
  • Estefania Castillo-Viera University of Huelva, Huelva, Spain
Keywords: exercise program; physical activity; balance; elderly


Introduction: Age-related changes in the sensorimotor and neuromuscular
system negatively affect performance in static and dynamic postural control
even in healthy older adults, leading to deficits in balance and gait performance
with negatively impact on the functional ability of the older person.
Regular exercise can elicit many favourable responses that contribute to balance
improvement. Objectives: The objective of this systematic review is to
present evidence for effectiveness of exercise interventions designed to improve
balance in healthy older people. Methods: The studies were identified
from four databases (PubMed, Web of Science, Cochrane Library and Sportdiscus)
from January 2011 to January 2020. A total of 17 articles meet the
inclusion criteria. Results: Statistically significant effects were reported for
static and dynamic balance, translated into several balance abilities improve-ments. The most used type of exercise was the gait, balance and functional
training, followed by the strength/resistance training. There is a lack of consensus
regarding to balance programs methodology. Conclusion: Exercise
appears to have beneficial effects on balance ability. We considered fundamental
that the studies should include the specifications of the intervention
program regarding to intensity control, exercises performed, guidelines used
in the balance exercises and the exercise progression and variation during
training. This information will help instructors to provided validated routine

Author Biographies

Vânia Azevedo Ferreira Brandão Loureiro, Portugal

Department of Arts, Humanities and Sports, School of Education,
Polytechnic Institute of Beja
 Physical Activity and Health Laboratory, Polytechnic Institute of Beja
 Faculty of Medicine/ ISAMB, Research Centre supported by FCT

Carlos Paixão, Polytechnic Institute of Beja, Beja, Portugal

Physical Activity and Health Laboratory

Estefania Castillo-Viera, University of Huelva, Huelva, Spain

Faculty of Education, Psychology and Sport Sciences


Ansai J., Aurichio T., Gonçalves R. & Rebelatto J. (2016). Effects

of two physical exercise protocols on physical performance related

to falls in the oldest old: A randomized controlled trial.

Geriatr Gerontol Int, 16 (4): 492-499. DOI:10.1111/ggi.12497.

Bernard, P., Blain, H., Gerazime A., Maurelli O., Bousquet J. &

Ninot G. (2018). Relationship between a three-month physical

conditioning “posture-balance- motricity and health education”

(PBM-HE) program on postural and balance capacities of sedentary

older adults: influence of initial motor profile. European

Review of Aging and Physical Activity, 15 (14). DOI: 10.1186/


Boisgontier, M., Cheval, B., Chalavi, S., Ruitenbeek, P., Leunissen,

I., Levin, O., . . . Swinnen, S. (2017). Individual differences

in brainstem and basal ganglia structure predict postural control

and balance loss in young and older adults. Neurobiology of Aging,

, 47-59. DOI:10.1016/j.neurobiolaging.2016.10.024.

Clemson, L., Fiatarone Singh, M. Bundy, A., Cumming, R.

Manollaras, K., O’Loughlin, P. & Black, D. (2012). Integration

of balance and strength training into daily life activity to reduce

rate of falls in older people (the LiFE study): randomised parallel

trial. BMJ, 345, e4547. DOI:10.1136/bmj.e4547.

De Labra, C., Guimarães-Pinheiro C., Maseda A., Lorenzo T. &

Millán-Calenti J. (2015). Effects of physical exercise interventions

in frail older adults: a systematic review of randomized

controlled trials. BMC Geriatrics, 15:154. DOI:10.1186/s12877-


Eckardt, N. (2016). Lower-extremity resistance training on unstable

surfaces improves proxies of muscle strength, power and

balance in healthy older adults: a randomised control trial. BMC

Geriatr, 16 (1): 191. DOI:10.1186/s12877-016-0366-3.

Fisher J., Steele J., Gentil P., Giessing J., & Westcott W. (2017).

A minimal dose approach to resistance training for the older

adult; the prophylactic for aging. Experimental Gerontology 99:

–86. DOI:10.1016/j.exger.2017.09.012.

Fraser, S. A., Li, K. Z., Berryman, N., Desjardins-Crepeau, L.,

Lussier, M., Vadaga, K., ... Bherer, L. (2017). Does Combined

Physical and Cognitive Training Improve Dual-Task Balance

and Gait Outcomes in Sedentary Older Adults? Front Hum Neurosci,

, 688. DOI:10.3389/fnhum.2016.00688.

Gillespie L., Robertson M., Gillespie W., Lamb S., Gates S.,

Cumming R., Rowe B. (2009). Interventions for preventing

falls in older people living in the community. Cochrane Database

of Systematic Reviews, Issue 2. Art. No.: CD007146. DOI:


Gschwind, Y., Kressig, R., Lacroix, A., Muehlbauer, T., Pfenninger,

B., & Granacher, U. (2013). A best practice fall prevention

exercise program to improve balance, strength/power,

and psychosocial health in older adults: study protocol for a

randomized controlled trial. BMC Geriatrics, 13 (105). DOI:


Gusi, N., Carmelo, J., Corzo, H., del Pozo-Cruz, B., Olivares,

P., & Parraça, J. (2012). Balance training reduces fear of falling

and improves dynamic balance and isometric strength in institutionalised

older people: a randomised trial. Journal of Physiotherapy,

(2), 97-104. DOI:10.1016/s1836-9553(12)70089-

Hamed, A., Bohm, S., Mersmann, F., & Arampatzis, A. (2018).

Exercises of dynamic stability under unstable conditions increase

muscle strenght and balance ability in the elderly. Scand

J Med Sci Sports (28), 961–971. DOI:10.1111/sms.13019.

Howe T., Rochester L., Jackson A., Banks P. & Blair V. (2007).

Exercise for improving balance in older people. Cochrane Database

of Systematic Reviews (4). DOI:10.1002/14651858.

Irez, G., Ozdemir, R., Evin, R., Irez, S., & Korkusuz, F. (2011).

Integrating pilates exercise into an exercise program for 65+

year-old women to reduce falls. Journal of Sports Science and

Medicine, 10 (1), 105–111.

Ishigaki E., Ramos L., Carvalho E., Lunardi A. (2014). Effectiveness

of muscle strengthening and description of protocols

for preventing falls in the elderly: a systematic review.

Braz J Phys Ther, 18 (2):111-118. DOI:10.1590/ S1413-

Kumar, A., Delbaere, K., Zijlstra, G., Carpenter, H., Iliffe, S.,

Masud, T., . . . & Kendrick, D. (2016). Exercise for reducing

fear of falling in older people living in the community: Cochrane

systematic review and meta-analysis. Age and Ageing,

(3), 345-352. DOI:10.1093/ageing/afw036.

Leem, S., Kim, J., & Lee, B. (2019). Effects of Otago exercise

combined with action observation training on balance and

gait in the old people. Journal of Exercise Rehabilitation, 15(6),

–854. DOI:10.12965/jer.1938720.360.

Lesinski M., Hortobágyi T., Muehlbauer T., Gollhofer A. &

Granacher U. (2015). Effects of Balance Training on Balance Performance in Healthy Older Adults: A Systematic Review and

Meta-analysis. Sports Med. DOI:10.1007/s40279-015-0375-y.

Maughan, K., Lowry, K., Franke, W., & Smiley-Oyen, A.

(2012). The Dose-Response Relationship of Balance Training

in Physically Active Older Adults. J Aging Phys Act, 20 (4),

–455. DOI:10.1123/japa.20.4.442.

Mesquita, L., Carvalho, F., Freire, L., Neto, O., & Zangaro, R.

(2015). Effects of two exercise protocols on postural balance of

elderly women: a randomized controlled trial. BMC Geriatr, 15

(61). DOI:10.1186/s12877-015-0059-3.

Moher D., Liberati A., Tetzlaff J. & Altman D. (2009). Preferred

Reporting Items for systematic reviews and meta-analysis:

The PRISMA Statement. BMJ, 339 (b2535). DOI:10.1136/


Nicholson, V., McKean, M., & Burkett, B. (2014). Twelve

weeks of BodyBalance(R) training improved balance and functional

task performance in middle-aged and older adults. Clin

Interv Aging, 9, 1895-1904. DOI:10.2147/CIA.S71769.

Oliveira M., Silva R., Dascal, J. & Teixeira, D. (2014). Effect of

different types of exercise on postural balance in elderly women:

a randomized controlled trial. Arch Gerontol Geriatr, 59 (3),

-514. DOI:10.1016/j.archger.2014.08.009.

Ordnung, M., Hoff, M., Kaminski, E., Villringer, A., & Ragert,

P. (2017). No Overt Effects of a 6-Week Exergame Training

on Sensorimotor and Cognitive Function in Older Adults.

A Preliminary Investigation. Front Hum Neurosci, 11, 160.


O’Sullivan, S., Schmitz, T., & Fulk, G. (2014). Physical Rehabilitation

(Sixth Edition). Philadelphia: F.A. Davis.

Raj, Y., Vadivelan, K., & SivaKumar, V. (2016). Comparison of

Multisensory vs. Strenghthening Exercises on Functional Mobility

and Balance in Elders. Int J Physiother, 3 (5), 557-561.


Sherrington C., Tiedemann A., Fairhall N., Close J., & Lord,

S. (2011). Exercise to prevent falls in older adults: an updated

meta-analysis and best practice recommendations. NSW Public

Health Bulletin., 22, 3-4. DOI: 10.1071/NB10056.

Schoene D., Valenzuela T., Lord S., & De Bruin, E. (2014).

The effect of interactive cognitive-motor training in reducing

fall risk in older people: a systematic review. BMC Geriatrics,

(107). DOI: 10.1186/1471-2318-14-107.

Taylor D. (2014). Physical activity is medicine for older adults.

Postgrad Med J, 0: 1–7. DOI:10.1136/postgradmedj-2012-

Thiamwong L. & Suwanno J. (2014). Effects of Simple Balance

Training on Balance Performance and Fear of Falling in Rural

Older Adults. International Journal of Gerontology, 8 (3), 143-


Tiedemann, Sherrington, & Lord. (2013). The role of exercise

for fall prevention in older age. Motriz, 19 (3), 541-547. DOI:


Treacy D., Schurr K., Lloyd B., & Sherrington, C. (2015). Additional

standing balance circuit classes during inpatient rehabilitation

improved balance outcomes: an assessor-blinded

randomised controlled trial. Age and Ageing, 44, 580-586.


Winter, D. (1995). A.B.C. Anatomy, biomechanics and control

of balance during standing and walking. Waterloo, Ont.: Waterloo


Zheng, J., Pan, Y., Hua, Y., Shen, H., Wang, X., Zhang, Y., . . .

& Yu, Z. (2013). Strategic targeted exercise for preventing falls

in elderly people. J Int Med Res, 41(2), 418-426. DOI:10.1177/