Getting the Dosage Right in Balance Exercise Prescription: the Intensity Problem

As our population ages, finding effective interventions to treat balance impairments is critical. In the United States Medicare spent over $31 billion in 2015 managing fall injuries. More than 800,000 people a year were hospitalized because of a fall, most often a fractured hip or head injury. Fall injuries are among the top 20 most expensive medical conditions, with an average cost of over $30,000. Furthermore, these direct costs do not account for the long-term effects of these injuries such as disability, dependence on others, lost time from work and household duties, and reduced quality of life [1]. Thus, determining effective means of preventing falls is a significant health care need.

[1]  S. Lord,et al.  Otago Home‐Based Strength and Balance Retraining Improves Executive Functioning in Older Fallers: A Randomized Controlled Trial , 2008, Journal of the American Geriatrics Society.

[2]  D. Rose,et al.  Preventing falls among older adults: no "one size suits all" intervention strategy. , 2008, Journal of rehabilitation research and development.

[3]  Jennifer L Keating,et al.  Intensity of challenge to the balance system is not reported in the prescription of balance exercises in randomised trials: a systematic review. , 2013, Journal of physiotherapy.

[4]  Jennifer L Keating,et al.  Clinical Markers of the Intensity of Balance Challenge: Observational Study of Older Adult Responses to Balance Tasks , 2015, Physical Therapy.

[5]  T. Hortobágyi,et al.  Effects of Balance Training on Balance Performance in Healthy Older Adults: A Systematic Review and Meta-analysis , 2015, Sports Medicine.

[6]  B. S. Rich,et al.  ACSM???s Health-Related Physical Fitness Assessment Manual , 2004 .

[7]  Milena Simic,et al.  Exercise for osteoarthritis of the knee: a Cochrane systematic review , 2015, British Journal of Sports Medicine.

[8]  Sarah E Lamb,et al.  Reporting of complex interventions in clinical trials: development of a taxonomy to classify and describe fall-prevention interventions , 2011, Trials.

[9]  Avril Mansfield,et al.  Does Perturbation-Based Balance Training Prevent Falls? Systematic Review and Meta-Analysis of Preliminary Randomized Controlled Trials , 2014, Physical Therapy.

[10]  Linda Denehy,et al.  Safety and Feasibility of an Exercise Prescription Approach to Rehabilitation Across the Continuum of Care for Survivors of Critical Illness , 2012, Physical Therapy.

[11]  Chris Todd,et al.  Effectiveness of Non-Pharmacological Interventions to Prevent Falls in Older People: A Systematic Overview. The SENATOR Project ONTOP Series , 2016, PloS one.

[12]  Jennifer L Keating,et al.  Clinical Decision Making in Exercise Prescription for Fall Prevention , 2012, Physical Therapy.

[13]  Malcolm Campbell,et al.  Tailored group exercise (Falls Management Exercise -- FaME) reduces falls in community-dwelling older frequent fallers (an RCT). , 2005, Age and ageing.

[14]  Martin Underwood,et al.  Consensus on Exercise Reporting Template (CERT): Modified Delphi Study , 2016, Physical Therapy.

[15]  Marcia A. Ciol,et al.  The Effect of Cognitive Demand on Timed Up and Go Performance in Older Adults With and Without Parkinson Disease , 2003 .