https://doi.org/10.4081/ejtm.2024.12010
Sensorimotor and proprioceptive exercise programs to improve balance in older adults: a systematic review with meta-analysis
Submitted: 20 October 2023
Accepted: 20 November 2023
Published: 11 January 2024
Accepted: 20 November 2023
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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The primary aim of this study was to systematically review and meta-analyze the impact of sensorimotor and proprioceptive exercises on balance in older adults. We also sought to define how researchers describe proprioceptive and sensory-motor training and their respective protocols. The review was conducted following the PRISMA guidelines, with searches performed in March 2023. Both authors carried out independent searches using the PubMed and PEDro databases. From a total of 320 identified records, 12 studies were deemed eligible for meta-analysis after screening and removal of duplicates. The average PEDro score was 5.11 ± 1.11 indicating overall fair quality of studies. Common outcome measures included the Berg balance scale, Timed up and go test, Tinetti balance scale, Functional reach test and various single-leg stance tests. All outcomes were significantly improved by the interventions (standard mean difference = 0.65 – 1.29), with little difference between proprioceptive and sensorimotor training. However, the quality of evidence ranged from “very low” to “low” based on GRADE guidelines, suggesting further high-quality studies are needed. This review underscores the potential benefits of sensorimotor and proprioceptive exercises for enhancing balance in older adults, while also highlighting the ambiguity and inconsistency regarding the usage of the terms proprioceptive and sensorimotor training.
Rogers ME, Page P, Takeshima N. Balance training for the older athlete. Int J Sports Phys Ther. 2013 Aug;8(4):517-30. PMID: 24175135; PMCID: PMC3812830.
Cameron ID, Dyer SM, Panagoda CE, Murray GR, Hill KD, Cumming RG, Kerse N. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev. 2018 Sep 7;9(9):CD005465. doi: 10.1002/14651858.CD005465.pub4. PMID: 30191554; PMCID: PMC6148705.
DOI: https://doi.org/10.1002/14651858.CD005465.pub4
Vieira ER, Freund-Heritage R, da Costa BR. Risk factors for geriatric patient falls in rehabilitation hospital settings: a systematic review. Clin Rehabil. 2011 Sep;25(9):788-99. Epub 2011 Apr 19. PMID: 21504956.
DOI: https://doi.org/10.1177/0269215511400639
Hauer K, Rost B, Rütschle K, Opitz H, Specht N, Bärtsch P, Oster P, Schlierf G. Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls. J Am Geriatr Soc. 2001 Jan;49(1):10-20. PMID: 11207837.
DOI: https://doi.org/10.1046/j.1532-5415.2001.49004.x
Muir SW, Berg K, Chesworth B, Klar N, Speechley M. Application of a fall screening algorithm stratified fall risk but missed preventive opportunities in community-dwelling older adults: a prospective study. J Geriatr Phys Ther. 2010 Oct-Dec;33(4):165-72. PMID: 21717920.
DOI: https://doi.org/10.1519/JPT.0b013e3181ff23cc
Lamb SE, McCabe C, Becker C, Fried LP, Guralnik JM. The optimal sequence and selection of screening test items to predict fall risk in older disabled women: the Women's Health and Aging Study. J Gerontol A Biol Sci Med Sci. 2008 Oct;63(10):1082-8. PMID: 18948559.
DOI: https://doi.org/10.1093/gerona/63.10.1082
Montero-Odasso MM, Kamkar N, Pieruccini-Faria F, Osman A, Sarquis-Adamson Y, Close J, Hogan DB, Hunter SW, Kenny RA, Lipsitz LA, Lord SR, Madden KM, Petrovic M, Ryg J, Speechley M, Sultana M, Tan MP, van der Velde N, Verghese J, Masud T; Task Force on Global Guidelines for Falls in Older Adults. Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults: A Systematic Review. JAMA Netw Open. 2021 Dec 1;4(12):e2138911. PMID: 34910151; PMCID: PMC8674747.
Chantanachai T, Sturnieks DL, Lord SR, Payne N, Webster L, Taylor ME. Risk factors for falls in older people with cognitive impairment living in the community: Systematic review and meta-analysis. Ageing Res Rev. 2021 Nov;71:101452. Epub 2021 Aug 25. PMID: 34450352.
DOI: https://doi.org/10.1016/j.arr.2021.101452
Borges NCS, Pletsch AHM, Buzato MB, Terada NAY, Cruz FMFD, Guirro RRJ. The effect of proprioceptive training on postural control in people with diabetes: A randomized clinical trial comparing delivery at home, under supervision, or no training. Clin Rehabil. 2021 Jul;35(7):988-998. Epub 2021 Jan 28. PMID: 33508955.
DOI: https://doi.org/10.1177/0269215521989016
Martínez-Amat A, Hita-Contreras F, Lomas-Vega R, Caballero-Martínez I, Alvarez PJ, Martínez-López E. Effects of 12-week proprioception training program on postural stability, gait, and balance in older adults: a controlled clinical trial. J Strength Cond Res. 2013 Aug;27(8):2180-8. PMID: 23207891.
DOI: https://doi.org/10.1519/JSC.0b013e31827da35f
MacKinnon CD. Sensorimotor anatomy of gait, balance, and falls. Handb Clin Neurol. 2018;159:3-26. PMID: 30482322; PMCID: PMC7069605.
DOI: https://doi.org/10.1016/B978-0-444-63916-5.00001-X
Allison LK, Kiemel T, Jeka JJ. Multisensory reweighting of vision and touch is intact in healthy and fall-prone older adults. Exp Brain Res. 2006 Nov;175(2):342-52. Epub 2006 Jul 21. PMID: 16858599.
DOI: https://doi.org/10.1007/s00221-006-0559-7
Setti A, Burke KE, Kenny RA, Newell FN. Is inefficient multisensory processing associated with falls in older people? Exp Brain Res. 2011 Mar;209(3):375-84. Epub 2011 Feb 4. PMID: 21293851.
DOI: https://doi.org/10.1007/s00221-011-2560-z
Shadrach JL, Gomez-Frittelli J, Kaltschmidt JA. Proprioception revisited: where do we stand? Curr Opin Physiol. 2021 Jun;21:23-28. Epub 2021 Mar 1. PMID: 34222735; PMCID: PMC8244174.
DOI: https://doi.org/10.1016/j.cophys.2021.02.003
Jamet M, Deviterne D, Gauchard GC, Vançon G, Perrin PP. Higher visual dependency increases balance control perturbation during cognitive task fulfilment in elderly people. Neurosci Lett. 2004 Apr 8;359(1-2):61-4. PMID: 15050712.
DOI: https://doi.org/10.1016/j.neulet.2004.02.010
Daneshjoo A, Sadeghi H, Yaali R, Behm DG. Comparison of unilateral and bilateral strength ratio, strength, and knee proprioception in older male fallers and non-fallers. Exp Gerontol. 2023 May;175:112161. Epub 2023 Apr 3. PMID: 37003443.
DOI: https://doi.org/10.1016/j.exger.2023.112161
Aman JE, Elangovan N, Yeh IL, Konczak J. The effectiveness of proprioceptive training for improving motor function: a systematic review. Front Hum Neurosci. 2015 Jan 28;8:1075. PMID: 25674059; PMCID: PMC4309156.
DOI: https://doi.org/10.3389/fnhum.2014.01075
Ahmad I, Noohu MM, Verma S, Singla D, Hussain ME. Effect of sensorimotor training on balance measures and proprioception among middle and older age adults with diabetic peripheral neuropathy. Gait Posture. 2019 Oct;74:114-120. Epub 2019 Aug 30. PMID: 31499405.
DOI: https://doi.org/10.1016/j.gaitpost.2019.08.018
Asan AS, McIntosh JR, Carmel JB. Targeting Sensory and Motor Integration for Recovery of Movement After CNS Injury. Front Neurosci. 2022 Jan 21;15:791824. PMID: 35126040; PMCID: PMC8813971.
DOI: https://doi.org/10.3389/fnins.2021.791824
Okubo Y, Schoene D, Lord SR. Step training improves reaction time, gait and balance and reduces falls in older people: a systematic review and meta-analysis. Br J Sports Med. 2017 Apr;51(7):586-593. Epub 2016 Jan 8. PMID: 26746905.
DOI: https://doi.org/10.1136/bjsports-2015-095452
Ashton-Miller JA, Wojtys EM, Huston LJ, Fry-Welch D. Can proprioception really be improved by exercises? Knee Surg Sports Traumatol Arthrosc. 2001 May;9(3):128-36. PMID: 11420785.
DOI: https://doi.org/10.1007/s001670100208
Haas CT, Buhlmann A, Turbanski S, Schmidtbleicher D. Proprioceptive and sensorimotor performance in Parkinson's disease. Res Sports Med. 2006 Oct-Dec;14(4):273-87. PMID: 17214404.
DOI: https://doi.org/10.1080/15438620600985902
Methley AM, Campbell S, Chew-Graham C, McNally R, Cheraghi-Sohi S. PICO, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Serv Res. 2014 Nov 21;14:579. PMID: 25413154; PMCID: PMC4310146.
DOI: https://doi.org/10.1186/s12913-014-0579-0
Iosa M, Fusco A, Morone G, Paolucci S. Development and decline of upright gait stability. Front Aging Neurosci. 2014 Feb 5;6:14. PMID: 24550829; PMCID: PMC3913994.
DOI: https://doi.org/10.3389/fnagi.2014.00014
Terrier P, Reynard F. Effect of age on the variability and stability of gait: a cross-sectional treadmill study in healthy individuals between 20 and 69 years of age. Gait Posture. 2015 Jan;41(1):170-4. Epub 2014 Oct 6. PMID: 25455699.
DOI: https://doi.org/10.1016/j.gaitpost.2014.09.024
de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009;55(2):129-33. PMID: 19463084.
DOI: https://doi.org/10.1016/S0004-9514(09)70043-1
Elkins MR, Herbert RD, Moseley AM, Sherrington C, Maher C. Rating the quality of trials in systematic reviews of physical therapy interventions. Cardiopulm Phys Ther J. 2010 Sep;21(3):20-6. PMID: 20957075; PMCID: PMC2941354.
DOI: https://doi.org/10.1097/01823246-201021030-00005
Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, Norris S, Falck-Ytter Y, Glasziou P, DeBeer H, Jaeschke R, Rind D, Meerpohl J, Dahm P, Schünemann HJ. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011 Apr;64(4):383-94. Epub 2010 Dec 31. PMID: 21195583.
DOI: https://doi.org/10.1016/j.jclinepi.2010.04.026
Furlan AD, Malmivaara A, Chou R, Maher CG, Deyo RA, Schoene M, Bronfort G, van Tulder MW; Editorial Board of the Cochrane Back, Neck Group. 2015 Updated Method Guideline for Systematic Reviews in the Cochrane Back and Neck Group. Spine (Phila Pa 1976). 2015 Nov;40(21):1660-73. PMID: 26208232.
DOI: https://doi.org/10.1097/BRS.0000000000001061
Borenstein M, Hedges L, Higgins J, Rothstein H. Introduction to meta-analysis. John Wiley & Sons
Elkins MR, Pinto RZ, Verhagen A, Grygorowicz M, Söderlund A, Guemann M, Gómez-Conesa A, Blanton S, Brismée JM, Ardern C, Agarwal S, Jette A, Karstens S, Harms M, Verheyden G, Sheikh U. Statistical inference through estimation: recommendations from the International Society of Physiotherapy Journal Editors. J Physiother. 2022 Jan;68(1):1-4. Epub 2021 Dec 21. Erratum in: J Physiother. 2022 Apr;68(2):89. PMID: 34952811.; 2021.
DOI: https://doi.org/10.1016/j.jphys.2022.03.008
Teixeira LE, Silva KN, Imoto AM, Teixeira TJ, Kayo AH, Montenegro-Rodrigues R, Peccin MS, Trevisani VF. Progressive load training for the quadriceps muscle associated with proprioception exercises for the prevention of falls in postmenopausal women with osteoporosis: a randomized controlled trial. Osteoporos Int. 2010 Apr;21(4):589-96. Epub 2009 Jun 27. PMID: 19562243.
DOI: https://doi.org/10.1007/s00198-009-1002-2
Salah MM, Rahmy AF, El-Dahdouh SS, El-Sayed MM. Effect of Proprioceptive Training with Muscle Strengthening on Postural Instability in Patients with Chronic Obstructive Pulmonary Disease. Med J Cairo Univ. 2022 Sep 1;90(9):1523–1529.
DOI: https://doi.org/10.21608/mjcu.2022.264609
da Silva KN, Teixeira LE, Imoto AM, Atallah AN, Peccin MS, Trevisani VF. Effectiveness of sensorimotor training in patients with rheumatoid arthritis: a randomized controlled trial. Rheumatol Int. 2013 Sep;33(9):2269-75. Epub 2013 Mar 3. PMID: 23455663.
DOI: https://doi.org/10.1007/s00296-013-2706-3
Espejo-Antúnez L, Pérez-Mármol JM, Cardero-Durán MLÁ, Toledo-Marhuenda JV, Albornoz-Cabello M. The Effect of Proprioceptive Exercises on Balance and Physical Function in Institutionalized Older Adults: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2020 Oct;101(10):1780-1788. Epub 2020 Jul 12. PMID: 32663479.
DOI: https://doi.org/10.1016/j.apmr.2020.06.010
Sherrington C, Tiedemann A, Fairhall N, Close JC, Lord SR. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull. 2011 Jun;22(3-4):78-83. PMID: 21632004.
DOI: https://doi.org/10.1071/NB10056
Lesinski M, Hortobágyi T, Muehlbauer T, Gollhofer A, Granacher U. Effects of Balance Training on Balance Performance in Healthy Older Adults: A Systematic Review and Meta-analysis. Sports Med. 2015 Dec;45(12):1721-38. Erratum in: Sports Med. 2016 Mar;46(3):457. PMID: 26325622; PMCID: PMC4656699.
DOI: https://doi.org/10.1007/s40279-015-0375-y
Melzer I, Kurz I, Oddsson LI. A retrospective analysis of balance control parameters in elderly fallers and non-fallers. Clin Biomech (Bristol, Avon). 2010 Dec;25(10):984-8. Epub 2010 Aug 8. PMID: 20696509.
DOI: https://doi.org/10.1016/j.clinbiomech.2010.07.007
Emilio EJ, Hita-Contreras F, Jiménez-Lara PM, Latorre-Román P, Martínez-Amat A. The association of flexibility, balance, and lumbar strength with balance ability: risk of falls in older adults. J Sports Sci Med. 2014 May 1;13(2):349-57. PMID: 24790489; PMCID: PMC3990889.
Iram H, Kashif M, Junaid Hassan HM, Bunyad S, Asghar S. Effects of proprioception training programme on balance among patients with diabetic neuropathy: A quasi-experimental trial. J Pak Med Assoc. 2021 Jul;71(7):1818-1821. PMID: 34410254.
Song CH, Petrofsky JS, Lee SW, Lee KJ, Yim JE. Effects of an exercise program on balance and trunk proprioception in older adults with diabetic neuropathies. Diabetes Technol Ther. 2011 Aug;13(8):803-11. Epub 2011 May 11. PMID: 21561371.
DOI: https://doi.org/10.1089/dia.2011.0036
Esposito G, Altavilla G, Di Domenico F, Aliberti S, D’Isanto T, D’Elia F. Proprioceptive Training to Improve Static and Dynamic Balance in Elderly. Int J Stat Med Res. 2021 Dec 16;10:194–199.
DOI: https://doi.org/10.6000/1929-6029.2021.10.18
Demir F, Sahin M, Ergezen G. Effectiveness of Proprioceptive Exercise on Balance and Sensory Function in Nursing Home Geriatric Individuals with Diabetes: Randomized Controlled Trial. Turkiye Klin J Med Sci. 2022;42(1):27–34.
DOI: https://doi.org/10.5336/medsci.2021-86357
Peterka RJ. Sensorimotor integration in human postural control. J Neurophysiol. 2002 Sep;88(3):1097-118. PMID: 12205132.
DOI: https://doi.org/10.1152/jn.2002.88.3.1097
Assländer L, Peterka RJ. Sensory reweighting dynamics in human postural control. J Neurophysiol. 2014 May;111(9):1852-64. Epub 2014 Feb 5. PMID: 24501263; PMCID: PMC4044370.
DOI: https://doi.org/10.1152/jn.00669.2013
Morat M, Bakker J, Hammes V, Morat T, Giannouli E, Zijlstra W, Donath L. Effects of stepping exergames under stable versus unstable conditions on balance and strength in healthy community-dwelling older adults: A three-armed randomized controlled trial. Exp Gerontol. 2019 Nov;127:110719. Epub 2019 Sep 9. PMID: 31513877.
DOI: https://doi.org/10.1016/j.exger.2019.110719
Mansano Pletsch AH, de Souza Borges NC, Villar DM, Franzini Sutilo AL, de Oliveira Guirro EC, de Paula FJA, de Jesus Guirro RR. Does sensorimotor training influence neuromuscular responses, balance, and quality of life in diabetics without a history of diabetic distal polyneuropathy? J Bodyw Mov Ther. 2021 Jul;27:148-156. Epub 2021 Feb 2. PMID: 34391226.
DOI: https://doi.org/10.1016/j.jbmt.2021.01.012
How to Cite
Pšeničnik Sluga, S., & Kozinc, Z. (2024). Sensorimotor and proprioceptive exercise programs to improve balance in older adults: a systematic review with meta-analysis. European Journal of Translational Myology, 34(1). https://doi.org/10.4081/ejtm.2024.12010
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