SciELO - Scientific Electronic Library Online

vol.30 issue2Comparison of Amphotericin B Lipid Complex (Abelcet) and Liposomal Amphotericin B (Ambisome) on Rat Kidney: a Morphological EvaluationEvaluation of the Effect of Treatment with Lipoic Acid Administered to the Wistar Rat Intoxicated with the Fruit of Karwinskia humboldtiana author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand




Related links


International Journal of Morphology

On-line version ISSN 0717-9502

Int. J. Morphol. vol.30 no.2 Temuco June 2012 

Int. J. Morphol., 30(2):567-571, 2012.


The Effect of a Group Exercise Program on Muscular Function among Fall-Prone Elderly Women


Efecto de un Programa de Ejercicios Grupales sobre la Función Muscular entre Mujeres de Edad Avanzada Propensas a Caídas


*Naser Behpoor; **Mohammad Reza Darabi; **Leila Hojatoleslami; **Parvin-Dokht Bayat & ***Ali Ghanbari

* Physical Exercise Department, Islamic Azad University, Boroujerd Branch, Boroujerd, Iran.

** Department of Anatomy, Arak University of Medical Sciences, Arak, Iran.

*** Fertility and Infertility Research center, Kermanshah University of medical sciences, Kermanshah, Iran.

Correspondence to:

SUMMARY: In a sampled population of fall-prone elderly women, an exercise protocol was performed for 12 weeks on experimental group and at the end of exercise period, the strength and endurance of muscles and SF-6 Health Surveys were analyzed. Results showed that endurance and strength of muscles and also physical activity were improved in experimental group (P<0.05). Group exercise program causes improvement in both strength and endurance of muscles in fall-prone elderly women. The effect of group exercise program on women may be related to differences in central nervous system of this gender in comparison with men.

KEY WORDS: Physical activity; Exercise therapy; Frail elderly; Female.

RESUMEN: En una población de mujeres de edad avanzada propensas a las caídas, se realizó un protocolo de ejercicios durante 12 semanas. Al final del período de ejercicios, se analizó la fuerza y resistencia muscular junto a la encuestas de salud SF-6. Los resultados mostraron que tanto la resistencia y la fuerza muscular, así como la actividad física mejoraron en el grupo experimental (p <0,05). El programa de ejercicio grupal mejoró la fuerza y la resistencia de los músculos en las mujeres de edad avanzada propensas a las caídas. El efecto del programa ejercicio grupal en las mujeres puede estar relacionada con diferencias en el sistema nervioso central de este sexo en comparación con los hombres.

PALABRAS CLAVE: Actividad física; Terapia de ejercicios; Ancianos frágiles; Mujer.



Because of, impaired balance, muscular weakness, and slowed reaction time, older people undergo to fall repeatedly and also reduce their physical activity (Carter et al., 2001). In this regard, one third of people over 65 years old fall each year that the ratio of falling increases by ageing of individuals (Tinetti, 2003).

Exercises by correcting physiological impairments can reduce falls and the risk factors of fall in both community based general exercise program and by tai chi quan, home-based strength and balance training program in selected population based studies (Rosendahl et al., 2006; Wolf et al., 1996).

However, exercise comes in many forms, and further research is needed to delineate the specifics of exercise prescription for optimal fall risk and fall reduction. Defining the components of exercise that are effective in reducing fall risk would provide some insight into the possible underlying mechanisms by which exercise exerts its effect and allow those prescribing exercise to do so more effectively (Liu-Ambrose et al., 2004).

The present study was undertaken to show the effect of exercise on daily physical activities of frail elderly women.



This randomized controlled trial research was carried out in the year 2011 on 40 women aged 65-70 years old in Mehrvarzan Adult Care Center of Kermanshah-Iran. The participant received care according research committee guidelines of the University. A pre test- post test researcher's made questionnaire was undertaken by an expert Physical exercise therapist and the co efficiency of reliability (Cronbach's a) was 0.86. Individuals were included if they had fallen at least two times during past 6 months. Individuals were excluded if they exercised regularly or had severe cardiac or pulmonary disease, a terminal illness, severe joint pain, dementia, medically unresponsive depression, or progressive neurologic disease (e.g., Parkinson's disease) (Rubenstein et al., 2000). The intervention consisted of three 90-minute sessions per week for 12 weeks, led by exercise physiology graduated students. The exercise protocol is outlined in Table I. Control subjects were asked to continue their usual activities during the 12-week control period.

Physical performance tests used to assess strength, endurance, gait, and balance included a sit-to-stand test on a chair during 30 seconds (Hopkins et al., 1990), a 6-minute walk test (by high speed) (Butland et al., 1982), and a 15-second one-leg standing balance test.

Three subscales of the RAND 36-item Health Survey (SF-36) (Ware & Sherbourne, 1992) were used to measure physical functioning, role limitations, and general health perceptions. Physical activity was measured with the Yale Physical Activity Survey (Dipietro et al., 1993). The data analyzed with SPSS version 16 for Windows.

Repeated measures two-way analysis of variance (ANOVA (was performed on outcome variables. Significant interactions were examined (Tukey's test) to determine if effects were greater in the exercise or control group.


The effects of group exercise program on muscle strength of fall-prone elderly women are presented in Table II. In experimental group, strength of the muscles of both lower limbs significantly increased (P<0.05). Group exercise program was the most effective on the strength of Right ankle plantar flexors and Left ankle dorsi flexors (P=0.033) and the least effective on Right thigh extensors and Left thigh extensors (P=0.040). Table III shows the data of Siconolfi step test that indicates group exercise program increases endurance in fall-prone elderly women (P=0.034).

The effects of group exercise program on physical function among fall-prone elderly women are presented in Table IV. There was a significant increased in sit to stand test in 30 second (P=0.034) and six minute walk (P=0.035) of group exercised women that showed the positive effect of these exercises on movement ability of individuals. The balance tests on one legs of dominant (P=0.034) and non dominant (P=0.037) showed also an increased ability in balancing of the body according to the group exercises. In overall, physical functioning of fall-prone elderly women that was calculated according SF-36 health survey subscales significantly increased (P=0.034).



Falling in the elderly is associated with muscle weakness, balance impairment and gait deficit especially in lower extremity muscles (Daubney & Culham, 1999; Lord & Dayhew, 2001; Lord et al., 2003). Furthermore, leg muscle strength is positively related to mobility (Aagard et al., 2007), and inversely related to the incidence of hip fractures (Aniansson et al., 1984). According to sit to stand test in 30 second and six minute walk tests, we can say that group exercise increases the strength of lower extremity muscles. This data is in parallel with other studies (Daubney & Culham; Karavirta et al., 2011; Rubenstein et al.).

On the other hand, control of posture that is important for the successful performance of most daily activities is under control of sensory system and deterioration in postural stability may be a major contributor to many falls, resulting in an impaired ability to correct for the many postural disturbances in daily life (Daubney & Culham). For normal relaxed standing posture requires continuing muscle activity (primarily of the gastrocnemious muscles) and also an integrated reflex response to visual, vestibular and somatosensory inputs (Rogers & McClosky).

In elderly the capacity of neuromuscular responses decreases and causes postural sway (Aagard et al.). Although, there is a small amount of postural sway in standing, this sway increases by aging either in elderly healthy subjects.

Thus, increased time of standing test shows improvement in peripheral somatosensory and neuromuscular responses induced by group exercise. Moreover, either standing test of dominant and non dominant legs improved that shows the affectivity of group exercise on central nervous system of prone failed fall-prone elderly women. Falling rates are higher in older women than in older men and continue to increase with age above 65 years and after the age of 75; the frequency is similar for both (Varas-Frabra et al., 2006).

But Baltimore Longitudinal Study on aging (Metter et al., 1999) reported that men had greater rates of strength decline in muscles than women, and that increasing age was associated with greater loss of strength.

Thus, we suggest that in fall-prone elderly the role of central nervous system is more prominent in women than men and improvement in strength of muscles is secondary response to group exercise in women.

Anatomical studies revealed that males have more overall volume of gray and white matter than females, which may mean that females might use more neural resources (e.g.,in both hemispheres) to achieve the same cognitive performance (Good et al., 2001).

Consistent with this hypothesis, it has been revealed that females have a relatively larger isthmus segment of the callosum, perhaps reflecting a sex-specific difference in the inter-hemispheric connectivity (Steinmetz et al., 1992; Steinmetz et al., 1995). These issues maybe considered as explanation of improvement in balance of both dominant and non dominant legs in this study and either callosum that connects cerebral hemispheres or other related connections such as vermis that connects cerebellar hemispheres are involved in process of recovery of fall-prone elderly.


ACKNOWLEDGEMENT. This study was supported by Islamic Azad University of IRAN- Boroujerd Branch.



Aagaard, P.; Magnusson, P. S.; Larsson, B.; Kjaer, M. & Krustrup, P. Mechanical muscle function, morphology, and fiber type in lifelong trained elderly. Med. Sci. Sports Exerc., 39(11):1989-96, 2007.         [ Links ]

Aniansson, A.; Zetterberg, C.; Hedberg, M. & Henriksson, K.G. Impaired muscle function with aging. A background factor in the incidence of fractures of the proximal end of the femur. Clin. Orthop. Relat. Res., (191):193-201, 1984.         [ Links ]

Butland, R. J.; Pang, J.; Gross, E. R; Woodcock, A. A. & Geddes, D. M. Two, six, and 12 minute walking tests on respiratory disease. Br. Med. J., 284(6329):1607-8, 1982.         [ Links ]

Carter, N. D.; Kannus, P. & Khan, K. M. Exercise in the prevention of falls in older people: A systematic literature review examining the rationale and the evidence. Sports Med., 31(6):427-38, 2001.         [ Links ]

Daubney, M. E. & Culham, E. G. Lower-extremity muscle force and balance performance in adults aged 65 years and older. Phys. Ther., 79(12):1177-85, 1999.         [ Links ]

Dipietro, L.; Caspersen, C. J.; Ostfeld, A. M. & Nadel, E. R. A survey for assessing physical activity among older adults. Med. Sci. Sports Exerc., 25(5):628-42, 1993.         [ Links ]

Good, C. D.; Johnsrude, I.; Ashburner, J.; Henson, R. N.; Friston, K. J. & Frackowiak, R. S. Cerebral asymmetry and the effects of sex and handedness on brain structure: A voxel-based morphometric analysis of 465 normal adult human brains. Neuroimage, 14(3):685-700, 2001.         [ Links ]

Hopkins, D. R.; Murrah, B.; Hoeger, W. W. & Rhodes, C. Effect of low-impact aerobic dance on the functional fitness of elderly women. Gerontologist, 30(2):189-92, 1990.         [ Links ]

Karavirta, L.; Häkkinen, A.; Sillanpää, E.; García-López, D.; Kauhanen, A.; Haapasaari, A.; Alen, M.; Pakarinen, A.; Kraemer, W. J.; Izquierdo, M.; Gorostiaga, E. & Häkkinen, K. Effects of combined endurance and strength training on muscle strength, power and hypertrophy in 40­67-year-old men. Scand. J. Med. Sci. Sports, 21(3):402-11, 2011.         [ Links ]

Liu-Ambrose, T.; Khan, K. M.; Eng, J. J.; Janssen, P. A.; Lord, S. R. & McKay, H. A. Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: a 6-month randomized, controlled trial. J. Am. Geriatr. Soc., 52(5):657-65, 2004.         [ Links ]

Lord, S. R.; Castell, S.; Corcoran, J.; Dayhew, J.; Matters, B.; Shan, A. & Williams, P. The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial. J. Am. Geriatr. Soc., 51(12):1685-92, 2003.         [ Links ]

Lord, S. R. & Dayhew, J. Visual risk factors for falls in older people. J. Am. Geriatr. Soc., 49(5):508-15, 2001.         [ Links ]

Metter, E. J.; Lynch, N.; Conwit, R.; Lindle, R.; Tobin, J. & Hurley, B. Muscle quality and age: crosssectional and longitudinal comparisons. J. Gerontol. A Biol. Sci. Med. Sci., 54(5):207-18, 1999.         [ Links ]

Rogers, M. A & Evans, W. J. Changes in skeletal muscle with aging: effects of exercise training. Exerc. Sports Sci. Rev., 21:65-102, 1993.         [ Links ]

Rosendahl, E. Fall prediction and high-intensity functional exercise program to improve physical functions and to prevent falls among older people living in residential care facilities. Clin. Rehabil., 21:130-41, 2006.         [ Links ]

Rubenstein, L. Z.; Josephson, K. R.; Trueblood, P. R.; Loy, S.; Harker, J. O.; Pietruszka, F. M. & Robbins, A. S. Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men. J. Gerontol. A Biol. Sci. Med. Sci., 5(6):M317-21, 2000.         [ Links ]

Steinmetz, H.; Jäncke, L.; Kleinschmidt, A.; Schlaug, G.; Volkmann, J. & Huang, Y. Sex but no hand difference in the isthmus of the corpus callosum. Neurology, 42(4):749-52, 1992.         [ Links ]

Steinmetz, H.; Staiger, J. F.; Schlaug, G.; Huang, Y. & Jäncke, L. Corpus callosum and brain volume in women and men. Neuroreport, 6(7):1002-4, 1995.         [ Links ]

Tinetti, M. E. Clinical practice. Preventing falls in elderly persons. N. Engl. J. Med., 348(1):42-9, 2003.         [ Links ]

Varas-Fabra, F.; Castro Martín, E.; Pérula de Torres, L. A.; Fernández Fernández, M. J.; Ruiz Moral, R. & Enciso Berge, I. Falls in the elderly in the community: prevalence, consequences, and associated factors. Aten. Primaria, 38:450-5, 2006.         [ Links ]

Ware, J. E. Jr. & Sherbourne, C. D. The MOS 36-item Short-Form Health Survey (SF-36): conceptual framework and item selection. Med. Care, 30(6):473-83, 1992.         [ Links ]

Wolf, S.; Barnhart, H.; Kutner, N.; McNeely, E.; Coogler, C. & Xu, T. Reducing frailty and falls in older persons: An investigation of tai chi and computerized balance training. J. Am. Geriatr. Soc., 44(5):489-97, 1996.         [ Links ]

Correspondence to:

Ali Ghanbari

Fertility and Infertility Research Center
Kermanshah University of Medical Sciences
Kermanshah, P.O. Box 1568
Tel-Fax: +98-831-4281563


Received: 18-11-2011
Accepted: 22-02-2012

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License