Balance retraining in community-dwelling older adults: Highlights of interventions strategies that hold promise in physical therapy practice

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Objectives: To review the literature that describes effective intervention strategies to improve balance in older community-dwelling adults. Data Sources: Cinahl, PubMed, Cochrane, and Cochrane Center Register for Controlled Trial Databases. Review Methods: A search of the terms "balance and exercise," "fall risk and exercise," "fall risk and physical therapy," and "balance and rehabilitation" in Community Index to Nursing and Allied Health Literature (CINAHL) and PubMed. Interventions must be able to be reproduced in standard rehabilitation practice or at home or easily in the community recreation center. Results: The literature is robust with reports that describe the benefits and limitations of balance retraining exercises programs, most in combination with other objectives such as strength training, mobility improvement, functional improvement, and fall prevention within the timeframe of 2000 to 2013. Randomized controlled trial studies are becoming more evident in the literature and assist with greater generalizability; however, much more study is warranted to understand priorities of intervention selection, dosing, duration, and sensitive outcome measures. Conclusion: Multicomponent exercise programs that specifically address the older adult's physical impairments based on a therapist evaluation is more effective in promoting increased strength, balance, and fall prevention than general, nonspecific approaches. This individualized approach, whether conducted in a health care facility or at home guided specifically by a rehabilitation clinician, will result in more immediate gains. This may also improve the long-term compliance that is needed for long-term balance improvement, fall prevention, and maximizing physical function in older adults. Rehabilitation professionals should consider expanding their role in prevention and ongoing primary care practices that monitor the physical function of older adults on a routine basis to assist in optimal aging. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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