The aim of this study was to compare the effects of two different training protocols on muscle strength, flexibility, aerobic endurance, balance and walking ability in older adults in order to reduce their fall risk. The participants (n=110) aged 65-85 years, self-sufficient and physically active, were randomly assigned to a resistance training (RT) group and a combined balance and strength (BS) group. Both groups attended supervised sessions of 3 hours twice a week for 6 weeks. To measure the functional fitness, before and after the training program the Senior Fitness Test Battery was used, while physical activity level and fear of falling were assessed with self-reported questionnaires. Moreover, participants were asked to record the number of falls they had over the next two years after the end of the training program.
This randomized controlled trial was conducted within the Physical Activity Promotion Domestic and Accidents Prevention (PAP \& DAP) project in older adults. A total of 110 participants aged 65-85 years, independent and physically active, were randomly allocated to one of two supervised exercise programs: a resistance training (RT) group using elastic bands and a combined balance and strength (BS) group following a multi-station circuit of body-weight strengthening tasks and dynamic balance exercises. Both interventions lasted 6 weeks, with two sessions per week (3 hours/week), and all sessions were carried out by qualified exercise professionals. Functional fitness was assessed before and after the intervention using the Senior Fitness Test battery (chair stand, arm curl, sit-and-reach, back scratch, timed up-and-go, and two-minute step test). Fear of falling was evaluated with the Short Falls Efficacy Scale-International (Short FES-I), and physical activity levels were measured using the International Physical Activity Questionnaire for Italian Elderly (IPAQ-EIT). Falls history was collected at baseline (previous 12 months), and the occurrence of at least one fall was recorded at 1- and 2-year follow-up, allowing estimation of fall incidence and crude risk ratios between groups. The RT program focused on progressive resistance exercises for major upper- and lower-limb muscle groups using elastic bands, organized into a standardized warm-up, central training phase, and cool-down, with progression in band resistance over the 6 weeks. The BS program consisted of a fixed-order multi-station circuit including gait, stepping, and weight-shifting tasks designed to challenge vestibular, visual, muscular, and plantar components of balance, combined with lower-limb strengthening exercises. Both protocols were designed to be feasible in community settings and to target key determinants of functional independence and fall risk in older adults. Analyses included repeated-measures ANOVA to examined significant differences within and between groups, correlations among gain scores in functional fitness variables and fear of falling, and calculation of fall incidence and risk ratios at follow-up.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
111
Supervised group-based resistance training with elastic bands, targeting major upper- and lower-limb muscle groups. Sessions include warm-up, a structured resistance phase with music-based exercises, and cool-down, with progressive increases in band resistance and exercise volume to improve lower-limb strength, dynamic balance, and reduce fall risk.
Supervised multistation circuit combining bodyweight strengthening exercises and dynamic balance tasks (e.g., directional changes, stepping, and weight-shifting activities). Sessions include warm-up, one or two rounds of the circuit, and cool-down, with progressive increases in task complexity to enhance postural control, dynamic stability, and reduce fall risk.
University of Palermo
Palermo, Sicily, Italy
Change in fear of falling (Short FES-I score)
Fear of falling will be assessed using the Short Falls Efficacy Scale-International (Short FES-I), a 7-item self-administered questionnaire that evaluates concern about falling during basic and social daily activities. Each item is rated on a 4-point scale (1 = not at all concerned to 4 = very concerned), yielding a total score from 7 to 28, with higher scores indicating greater fear of falling. Scores will be analysed as a continuous variable and, secondarily, categorized into low concern (7-8) versus moderate/high concern (≥9).
Time frame: Baseline and after 6 weeks of intervention
Lower-limb strength/endurance
Lower-limb strength and endurance will be measured using the 30-second chair stand test from the Senior Fitness Test battery, recording the number of full stands completed from a seated position in 30 seconds.
Time frame: Baseline and after 6 weeks of intervention
Upper-limb strength
Upper-limb strength will be assessed with the arm curl test from the Senior Fitness Test, counting the number of elbow flexion-extension repetitions completed in 30 seconds with a standardized hand weight.
Time frame: Baseline and after 6 weeks of intervention
Change in lower-back and hamstring flexibility
Flexibility of the lower back and hamstrings will be evaluated using the chair sit-and-reach test from the Senior Fitness Test, recording the distance (cm) between the extended fingers and the tip of the toe while seated.
Time frame: Baseline and after 6 weeks of intervention
Change in dynamic balance and mobility
Dynamic balance and functional mobility will be measured with the Timed Up and Go test, timing in seconds how long the participant takes to stand up from a chair, walk 3 meters, turn, walk back, and sit down.
Time frame: Baseline and after 6 weeks of intervention
Change in aerobic endurance
Aerobic endurance will be assessed using the 2-minute step test, counting the number of steps performed in place at a standardized knee height over 2 minutes, as part of the Senior Fitness Test battery.
Time frame: Baseline and after 6 weeks of intervention
Relative Fall Risk
Participants were asked to record the number of falls they had over the next two years after the end of the training program and relative fall risk was calculated.
Time frame: Over the next two years after the end of the training program
Change in self-reported physical activity
Self-reported physical activity will be assessed using the 7-item International Physical Activity Questionnaire for the Italian Elderly (IPAQ-EIT), which records the number of days and minutes spent walking, and in moderate and vigorous activities, as well as sedentary time over the previous week. For each intensity level, a specific MET value is assigned (walking = 3.3 METs, moderate activity = 4 METs, vigorous activity = 8 METs), and total physical activity is expressed as MET-minutes per week by summing the three components. According to total MET-minutes/week, participants will be classified as inactive (\<700 MET-min/week), sufficiently active (700-2519 MET-min/week), or active/very active (≥2520 MET-min/week).
Time frame: Baseline and after 6 weeks of intervention
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