As we age we experience a decline in balance and functional task performance. Can participation in mind body classes positively affect these changes?

Research paper: Twelve weeks of BODYBALANCE™ training improved balance and functional task performance in middle-aged and older adults
Research team: Vaughan P. Nicholson, Mark R. McKean, Brendan Burkett
Published: Clinical Interventions in Aging, Volume 2014:9
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Introduction: Age-related changes in balance and functional task performance are well-established and evident from the fourth and fifth decades of life in men and women. Deficits in balance are associated with falls, difficulties with activities of daily living and poor survival in older adults. Fortunately, appropriate exercise can improve balance performance and contribute to improved mobility, independence and a reduction in the risk of falling.

Interventions utilising traditional or holistic exercises such as Tai Chi, Pilates and yoga have all been found to improve balance in older adults. BODYBALANCETM is one fitness facility-based activity that has the potential to promote improvements in balance, as it comprises elements of these three disciplines.

The primary aim of this study was to determine whether 12 weeks of BODYBALANCETM classes would improve balance and functional task performance in healthy, active adults aged over 55 years. Secondary aims were to determine the effect of BODYBALANCETM training on fear of falling and self-reported quality of life. It was hypothesised that 12 weeks of BODYBALANCETM training would improve measures of balance and functional task performance without having an effect on fear of falling or self-reported quality of life.

Methods: Men and women aged between 55 and 75 years who had not participated in formal resistance or balance training in the previous six months, were invited to participate in the study. All participants were physically active, taking part in regular exercise such as walking, cycling and swimming. Exclusion criteria included: acute or terminal illness, myocardial infarction in the past six months, recent low impact fracture, or any condition that would interfere with moderate intensity exercise participation. Participants were allocated to either the intervention (BB) group in which they undertook two sessions of BODYBALANCE™ per week for 12 weeks (n = 15) or the control (CON) group, in which they continued with their normal activities but did not take part in any class (n = 13).

All BODYBALANCETM classes were instructed by experienced group fitness instructors who were not associated with testing or recruitment of participants. The focus of the first two weeks of the intervention was for each participant to appropriately learn the exercises and postures of the class. As such, the transitions between postures were deliberately slow in the first two weeks. From week three onwards all classes were instructed at a level that one would expect to encounter if they took part in a BODYBALANCETM class at a local gym. The class instructor provided basic, intermediate and advanced options for each pose or exercise.

Measures: All measures were completed during a single session for each participant at baseline and follow-up. Two questionnaires were completed at the start of the session to assess fear of falling and self-reported quality of life. The assessment of balance on a force platform was then conducted followed by a battery of established clinical balance assessments and functional tasks.

Balance and functional task assessments were conducted at baseline and immediately post-intervention. All measures were assessed with participants in bare feet. Participants performed a series of four different standing balance tasks on a strain gauge Bertec 4060-08 force platform (Bertec, Columbus, OH, USA). The balance tasks were comfortable stance (eyes open and closed) and narrow stance (eyes open and closed). Two successful repetitions of 30 seconds in each position were performed with 60 seconds rest between trials.

Other measures included single leg balance, functional reach, lateral reach, timed up and go (TUG), normal gait speed, fast gait speed, 30-second chair stand test, and floor rise to standing.

The 30-second article
  • The purpose of the study was to evaluate the effect of BODYBALANCE™ training on balance, functional task performance, fear of falling and health-related quality of life in adults aged over 55 years
  • 28 healthy, active adults completed the randomised controlled trial, with measures assessed at baseline and after 12 weeks
  • Significant group-by-time interactions were found for the timed up and go, 30-second chair stand and medio-lateral centre of pressure range in narrow stance with eyes closed.
  • There were no significant effects on fear of falling or self-reported quality of life.
  • Twelve weeks of BODYBALANCE™ training is effective at improving certain balance and functional-based tasks in healthy older adults.

Results: Twenty-eight participants aged between 57 and 73 years (BB n = 15, age = 66 ± 4.9 years, CON n = 13, age= 66 ± 5.1 years) completed all baseline and follow-up testing with a mean attendance of 22 ± 2.1 classes, resulting in an overall compliance of 92 per cent.

Significant group-by-time interactions were found for the timed up and go (p = 0.038), 30-second chair stand (p = 0.037) and medio-lateral centre of pressure (COP) range in narrow stance with eyes closed (p = 0.017). There were no significant effects on fear of falling or self-reported quality of life.

Discussion: This study provided the first controlled evaluation of the effects of BODYBALANCETM training on balance, functional task performance, fear of falling and health-related quality of life in middle-aged and older adults. The results of this study partly showed that measures of balance and function would improve after 12 weeks of BODYBALANCETM training. Interestingly, greater improvements were evident in the control group for single leg stance left – a measure of static standing balance. There were no significant improvements in fear of falling or self-reported quality of life following the BODYBALANCETM intervention.

Because BODYBALANCETM comprises elements of yoga, Tai Chi and Pilates, the improvements in a small selection of tasks in this study are in partial agreement with previous studies that have found improvements in balance and functional tasks after yoga, Tai Chi and Pilates-based interventions in similar aged adults. The improvement in medio-lateral COP range in narrow stance with eyes closed suggests an improvement in the most challenging static balance assessed in this study. Lower COP ranges in the medio-lateral direction are typically seen in younger adults and non-fallers while higher COP ranges in both narrow stance and normal stance positions are seen in fallers or those with poor clinical balance. The results from the current study suggest that static standing balance improvements provided by the intervention may be best observed in more demanding balance tasks where visual cues are limited.

The lack of significant improvement in reaching and single leg standing tasks in the BODYBALANCETM group is likely due to a number of factors, including the already good balance performance of participants at baseline and the high variability of some testing measures. For example, participants in the current study had single leg stance times approximately 10 seconds longer than previously reported normative values while lateral reach was approximately 15 per cent longer than previously reported. The intervention itself, although comprising elements of activities shown to improve balance, may not have been challenging enough to provide consistent improvements in balance outcome measures. As a number of options were available to participants for each exercise or pose, participants may have inadequately challenged their balance by performing less challenging options.

Balance exercise guidelines provided by the American College of Sports Medicine (ACSM) recommend using activities that include: progressively difficult postures that gradually reduce the base of support; dynamic movements that perturb the centre of gravity; stress to postural control muscles; or reducing sensory input. Like a number of other modalities such as yoga and Tai Chi, BODYBALANCETM achieves three of the four recommendations by incorporating progressively difficult postures, dynamic movements that perturb the centre of gravity and stressing postural control muscles. BODYBALANCETM may prove to be a more effective modality if greater challenges to sensory input and dual tasking are incorporated into its choreography.

Conclusion: Twelve weeks of BODYBALANCETM training was effective at improving performance in the TUG, 30-second chair stand test and reducing medio-lateral COP range in narrow stance with eyes closed in healthy, active adults aged 59-73 years. BODYBALANCETM training was not effective at improving single leg balance, reaching tasks, gait speed or floor rise to standing. BODYBALANCETM training did not positively influence fear of falling or self-reported quality of life any more than habitual activity. It appears that BODYBALANCETM training may be an appropriate modality for enhancing certain aspects of balance and functional performance in this age group. Future studies should assess the effect of such training on those with impaired balance, a fear of falling or a history of falls.

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