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Engineering improved balance confidence in older adults with complex health care needs: learning from the muscling up against disability study.

Hetherington, Sharon; Henwood, Tim; Swinton, Paul; Keogh, Justin; Gardiner, Paul; Tuckett, Anthony; Rouse, Kevin


Sharon Hetherington

Tim Henwood

Justin Keogh

Paul Gardiner

Anthony Tuckett

Kevin Rouse


This study investigated the correlation between balance confidence, and physical and cognitive markers of wellbeing. The study was particularly focused on the demographic of older adults who were in receipt of government-funded aged-care services. The research also investigated whether progressive resistance plus balance training could positively influence change. The study was designed as an intervention study at a community-based, older-adult exercise clinic. Participants consisted of older adults (N=245) who had complex care needs and who were receiving government-funded aged-care support. The intervention consisted of 24 weeks of twice-weekly progressive resistance plus balance training, carried out under the supervision of accredited exercise physiologists. The primary outcome measure for the sutdy was the activity-specific balance confidence score. Secondary measures included the short physical performance battery, fall history, hierarchical timed balance tests, geriatric anxiety index, geriatric depression score, FRAIL scale and EuroQol 5D 3L. Results: At baseline, higher physical performance (r = 0.54, p < 0.01) and quality of life (r = 0.52, p < 0.01) predicted better balance confidence. In contrast, at baseline, higher levels of frailty predicted worse balance confidence (r = -0.55, p < 0.01). Change in balance confidence following the exercise intervention was accompanied by improved physical performance (+12%) and decreased frailty (-11%). Baseline balance confidence was identified as the most consistent negative predictor of change scores across the intervention. This study shows that reduced physical performance and quality of life, and increasing frailty, are predictive of poor balance confidence among older adults with aged-care needs. However, when a targeted intervention of resistance and balance exercise is implemented, reducing frailty and increasing physical performance, balance confidence will also improve. Given the influence of balance confidence on a raft of wellbeing determinants, including the capacity for positive physical and cognitive change, this study offers important insights relevant for researchers investigating how to reduce falls among older adults.


HETHERINGTON, S., HENWOOD, T., SWINTON, P., KEOGH, J., GARDINER, P., TUCKETT, A. and ROUSE, K. 2018. Engineering improved balance confidence in older adults with complex health care needs: learning from the muscling up against disability study. Archives of physical medicine and rehabilitation [online], 99(8), pages 1525-1532. Available from:

Journal Article Type Article
Acceptance Date Mar 4, 2018
Online Publication Date Apr 5, 2018
Publication Date Aug 31, 2018
Deposit Date Mar 29, 2018
Publicly Available Date Apr 6, 2019
Journal Archives of Physical Medicine and Rehabilitation
Print ISSN 0003-9993
Electronic ISSN 1532-821X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 99
Issue 8
Pages 1525-1532
Keywords Aging; Exercise; Balance; Balance confidence
Public URL


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