Comparative Effects Between a Resistance Training and a Combined Balance and Strength Training on Functional Fitness and Fall Risk in Older Adults

Effects of Resistance Training Versus Combined Dynamic Balance and Strength Training on Functional Fitness and Fall Risk in Older Adults. A Randomized Controlled Trial

The aim of this study was to compare the effects of two different training protocols on muscle strength, flexibility, aerobic endurance, balance and walking ability in older adults in order to reduce their fall risk. The participants (n=110) aged 65-85 years, self-sufficient and physically active, were randomly assigned to a resistance training (RT) group and a combined balance and strength (BS) group. Both groups attended supervised sessions of 3 hours twice a week for 6 weeks. To measure the functional fitness, before and after the training program the Senior Fitness Test Battery was used, while physical activity level and fear of falling were assessed with self-reported questionnaires. Moreover, participants were asked to record the number of falls they had over the next two years after the end of the training program.

Study Overview

• Status: Completed
• Conditions: Accidental Fall
• Intervention / Treatment: Behavioral: Elastic-band resistance training; Behavioral: Functional and balance circuit training

Detailed Description

This randomized controlled trial was conducted within the Physical Activity Promotion Domestic and Accidents Prevention (PAP & DAP) project in older adults. A total of 110 participants aged 65-85 years, independent and physically active, were randomly allocated to one of two supervised exercise programs: a resistance training (RT) group using elastic bands and a combined balance and strength (BS) group following a multi-station circuit of body-weight strengthening tasks and dynamic balance exercises. Both interventions lasted 6 weeks, with two sessions per week (3 hours/week), and all sessions were carried out by qualified exercise professionals.

Functional fitness was assessed before and after the intervention using the Senior Fitness Test battery (chair stand, arm curl, sit-and-reach, back scratch, timed up-and-go, and two-minute step test). Fear of falling was evaluated with the Short Falls Efficacy Scale-International (Short FES-I), and physical activity levels were measured using the International Physical Activity Questionnaire for Italian Elderly (IPAQ-EIT). Falls history was collected at baseline (previous 12 months), and the occurrence of at least one fall was recorded at 1- and 2-year follow-up, allowing estimation of fall incidence and crude risk ratios between groups.

The RT program focused on progressive resistance exercises for major upper- and lower-limb muscle groups using elastic bands, organized into a standardized warm-up, central training phase, and cool-down, with progression in band resistance over the 6 weeks. The BS program consisted of a fixed-order multi-station circuit including gait, stepping, and weight-shifting tasks designed to challenge vestibular, visual, muscular, and plantar components of balance, combined with lower-limb strengthening exercises. Both protocols were designed to be feasible in community settings and to target key determinants of functional independence and fall risk in older adults.

Analyses included repeated-measures ANOVA to examined significant differences within and between groups, correlations among gain scores in functional fitness variables and fear of falling, and calculation of fall incidence and risk ratios at follow-up.

• Study Type: Interventional
• Enrollment (Actual): 111
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Italy
  • Sicily
    • Palermo, Sicily, Italy, 90144
      • University of Palermo

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Older Adults;
• Age ≥ 60 years;
• Independent in carrying out activities of daily living.

Exclusion Criteria:

• Unstable cardiovascular, respiratory, or neurological conditions that contraindicate exercise;
• Recent fractures, major orthopedic surgery, or acute musculoskeletal pain limiting safe exercise participation.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Resistance Training group (RT); Participants in the Resistance Training group (RT) underwent a supervised, structured resistance training program using elastic bands, targeting the major muscle groups of the upper and lower limbs. The program was designed to progressively enhance lower-limb strength and dynamic balance through sessions including warm-up, music-based resistance exercises, and cool-down phases, ultimately aiming to reduce fall risk.	Behavioral: Elastic-band resistance training; Supervised group-based resistance training with elastic bands, targeting major upper- and lower-limb muscle groups. Sessions include warm-up, a structured resistance phase with music-based exercises, and cool-down, with progressive increases in band resistance and exercise volume to improve lower-limb strength, dynamic balance, and reduce fall risk.
Experimental: Balance and Strength group (BS); Participants in the Balance and Strength group (BS) took part in a supervised multi-station circuit combining bodyweight strengthening exercises with tasks that challenge dynamic balance (e.g., directional changes, stepping, and weight-shifting activities). The program progressively increased in difficulty across sessions to enhance postural control and dynamic stability, aiming to improve balance efficiency and reduce fall risk.	Behavioral: Functional and balance circuit training; Supervised multistation circuit combining bodyweight strengthening exercises and dynamic balance tasks (e.g., directional changes, stepping, and weight-shifting activities). Sessions include warm-up, one or two rounds of the circuit, and cool-down, with progressive increases in task complexity to enhance postural control, dynamic stability, and reduce fall risk.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in fear of falling (Short FES-I score)	Fear of falling will be assessed using the Short Falls Efficacy Scale-International (Short FES-I), a 7-item self-administered questionnaire that evaluates concern about falling during basic and social daily activities. Each item is rated on a 4-point scale (1 = not at all concerned to 4 = very concerned), yielding a total score from 7 to 28, with higher scores indicating greater fear of falling. Scores will be analysed as a continuous variable and, secondarily, categorized into low concern (7-8) versus moderate/high concern (≥9).	Baseline and after 6 weeks of intervention
Lower-limb strength/endurance	Lower-limb strength and endurance will be measured using the 30-second chair stand test from the Senior Fitness Test battery, recording the number of full stands completed from a seated position in 30 seconds.	Baseline and after 6 weeks of intervention
Upper-limb strength	Upper-limb strength will be assessed with the arm curl test from the Senior Fitness Test, counting the number of elbow flexion-extension repetitions completed in 30 seconds with a standardized hand weight.	Baseline and after 6 weeks of intervention
Change in lower-back and hamstring flexibility	Flexibility of the lower back and hamstrings will be evaluated using the chair sit-and-reach test from the Senior Fitness Test, recording the distance (cm) between the extended fingers and the tip of the toe while seated.	Baseline and after 6 weeks of intervention
Change in dynamic balance and mobility	Dynamic balance and functional mobility will be measured with the Timed Up and Go test, timing in seconds how long the participant takes to stand up from a chair, walk 3 meters, turn, walk back, and sit down.	Baseline and after 6 weeks of intervention
Change in aerobic endurance	Aerobic endurance will be assessed using the 2-minute step test, counting the number of steps performed in place at a standardized knee height over 2 minutes, as part of the Senior Fitness Test battery.	Baseline and after 6 weeks of intervention
Relative Fall Risk	Participants were asked to record the number of falls they had over the next two years after the end of the training program and relative fall risk was calculated.	Over the next two years after the end of the training program

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in self-reported physical activity	Self-reported physical activity will be assessed using the 7-item International Physical Activity Questionnaire for the Italian Elderly (IPAQ-EIT), which records the number of days and minutes spent walking, and in moderate and vigorous activities, as well as sedentary time over the previous week. For each intensity level, a specific MET value is assigned (walking = 3.3 METs, moderate activity = 4 METs, vigorous activity = 8 METs), and total physical activity is expressed as MET-minutes per week by summing the three components. According to total MET-minutes/week, participants will be classified as inactive (<700 MET-min/week), sufficiently active (700-2519 MET-min/week), or active/very active (≥2520 MET-min/week).	Baseline and after 6 weeks of intervention

Collaborators and Investigators

• Sponsor: University of Palermo

Publications and helpful links

General Publications

• Bellafiore M, Battaglia G, Bianco A, Paoli A, Farina F, Palma A. Improved postural control after dynamic balance training in older overweight women. Aging Clin Exp Res. 2011 Oct-Dec;23(5-6):378-85. doi: 10.1007/BF03337762. Epub 2010 Nov 17.

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2022
• Primary Completion (Actual): May 30, 2024
• Study Completion (Actual): May 30, 2025

Study Registration Dates

• First Submitted: April 21, 2026
• First Submitted That Met QC Criteria: April 21, 2026
• First Posted (Actual): April 29, 2026

Study Record Updates

• Last Update Posted (Actual): April 29, 2026
• Last Update Submitted That Met QC Criteria: April 21, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Resistance Training; Postural Balance; Aged; Physical Fitness; Accidental Falls; Fear of falling; Elastic Resistance
• Additional Relevant MeSH Terms: Public Health; Environment and Public Health; Health Services; Health Care Facilities Workforce and Services; Rehabilitation; Health Status; Demography; Epidemiologic Measurements; Activities of Daily Living; Functional Status
• Other Study ID Numbers: 111/2022

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Individual participant data (IPD) from this study will not be shared because the informed consent obtained from participants did not include permission for public data sharing and the available resources are not sufficient to ensure appropriate de-identification and data management.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No