Online Exclusive Article

Strength and Balance Training for Adults With Peripheral Neuropathy and High Risk of Fall: Current Evidence and Implications for Future Research

Cindy Tofthagen

Constance Visovsky

Donna L. Berry

peripheral neuropathies, risk reduction
ONF 2012, 39(5), E416-E424. DOI: 10.1188/12.ONF.E416-E424

Purpose/Objectives: To evaluate the evidence for strength- and balance-training programs in patients at high risk for falls, discuss how results of existing studies might guide clinical practice, and discuss directions for additional research.

Data Sources: A search of PubMed and CINAHL® databases was conducted in June 2011 using the terms strength, balance training, falls, elderly, and neuropathy. Only clinical trials conducted using specific strength- or balance-training exercises that included community-dwelling adults and examined falls, fall risk, balance, and/or strength as outcome measures were included in this review.

Data Synthesis: One matched case-control study and two randomized, controlled studies evaluating strength and balance training in patients with diabetes-related peripheral neuropathy were identified. Eleven studies evaluating strength and balance programs in community-dwelling adults at high risk for falls were identified.

Conclusions: The findings from the reviewed studies provide substantial evidence to support the use of strength and balance training for older adults at risk for falls, and detail early evidence to support strength and balance training for individuals with peripheral neuropathy.

Implications for Nursing: The evidence demonstrates that strength and balance training is safe and effective at reducing falls and improving lower extremity strength and balance in adults aged 50 years and older at high risk for falls, including patients with diabetic peripheral neuropathy. Future studies should evaluate the effects of strength and balance training in patients with cancer, particularly individuals with chemotherapy-induced peripheral neuropathy.

Jump to a section

    References

    Allet, L., Armand, S., de Bie, R. A., Golay, A., Monnin, D., Aminian, K., … de Bruin, E. D. (2010). The gait and balance of patients with diabetes can be improved: A randomised controlled trial. Diabetologia, 53, 458-466. doi:10.1007/s00125-009-1592-4
    American Cancer Society. (2012). Cancer facts and figures 2012. Retrieved from http://www.cancer.org/Research/CancerFacts-Figures/ACSPC-031941
    Arampatzis, A., Peper, A., & Bierbaum, S. (2011). Exercise of mechanisms for dynamic stability control increases stability performance in the elderly. Journal of Biomechanics, 44(1), 52-58. doi:10.1016/j.jbiomech.2010.08.023
    Beling, J., & Roller, M. (2009). Multifactorial intervention with balance training as a core component among fall-prone older adults. Journal of Geriatric Physical Therapy, 32(3), 125-133.
    Bennett, G. J. (2010). Pathophysiology and animal models of cancer-related painful peripheral neuropathy. Oncologist, 15(Suppl. 2), 9-12. doi:10.1634/theoncologist.2009-S503
    Clemson, L., Singh, M. F., Bundy, A., Cumming, R. G., Weissel, E., Munro, J., … Black, D. (2010). LiFE Pilot Study: A randomised trial of balance and strength training embedded in daily life activity to reduce falls in older adults. Australian Occupational Therapy Journal, 57, 42-50. doi:10.1111/j.1440-1630.2009.00848.x
    Comans, T. A., Brauer, S. G., & Haines, T. P. (2010). Randomized trial of domiciliary versus center-based rehabilitation: Which is more effective in reducing falls and improving quality of life in older fallers? Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 65, 672-679. doi:10.1093/gerona/glq054
    Conroy, S., Kendrick, D., Harwood, R., Gladman, J., Coupland, C., Sach, T., … Masud, T. (2010). A multicentre randomised controlled trial of day hospital-based falls prevention programme for a screened population of community-dwelling older people at high risk of falls. Age and Ageing, 39, 704-710. doi:10.1093/ageing/afq096
    Ferri, A., Scaglioni, G., Pousson, M., Capodaglio, P., Van Hoecke, J., & Narici, M. V. (2003). Strength and power changes of the human plantar flexors and knee extensors in response to resistance training in old age. Acta Physiologica Scandinavica, 177, 69-78.
    Flatters, S. J., & Bennett, G. J. (2006). Studies of peripheral sensory nerves in paclitaxel-induced painful peripheral neuropathy: Evidence for mitochondrial dysfunction. Pain, 122, 245-257. doi:10.1016/j.pain.2006.01.037
    Gillespie, L. D., Robertson, M. C., Gillespie, W. J., Lamb, S. E., Gates, S., Cumming, R. G., & Rowe, B. H. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2, CD007146. doi:10.1002/14651858.CD007146.pub2
    Gustafsson, T., Puntschart, A., Kaijser, L., Jansson, E., & Sundberg, C. (1999). Exercise-induced expression of angiogenesis-related transcription and growth factors in human skeletal muscle. American Journal of Physiology, 276, H679-H685.
    Hagedorn, D. K., & Holm, E. (2010). Effects of traditional physical training and visual computer feedback training in frail elderly patients. A randomized intervention study. European Journal of Physical Rehabilitation Medicine, 46, 159-168.
    Hartmann, A., Murer, K., de Bie, R. A., & de Bruin, E. D. (2009). The effect of a foot gymnastic exercise programme on gait performance in older adults: A randomised controlled trial. Disability and Rehabilitation, 31, 2101-2110. doi:10.3109/09638280902927010
    Hile, E. S., Fitzgerald, G. K., & Studenski, S. A. (2010). Persistent mobility disability after neurotoxic chemotherapy. Physical Therapy, 90, 1649-1657. doi:10.2522/ptj.20090405
    Iwamoto, J., Suzuki, H., Tanaka, K., Kumakubo, T., Hirabayashi, H., Miyazaki, Y., … Matsumoto, H. (2009). Preventative effect of exercise against falls in the elderly: A randomized controlled trial. Osteoporosis International, 20, 1233-1240.
    Kaley, T. J., & Deangelis, L. M. (2009). Therapy of chemotherapy-induced peripheral neuropathy. British Journal of Haematology, 145, 3-14. doi:10.1111/j.1365-2141.2008.07558.x
    Kruse, R. L., Lemaster, J. W., & Madsen, R. W. (2010). Fall and balance outcomes after an intervention to promote leg strength, balance, and walking in people with diabetic peripheral neuropathy: "Feet First" randomized controlled trial. Physical Therapy, 90, 1568-1579. doi:10.2522/ptj.20090362
    Miller, K. L., Magel, J. R., & Hayes, J. G. (2010). The effects of a home-based exercise program on balance confidence, balance performance, and gait in debilitated, ambulatory community-dwelling older adults: A pilot study. Journal of Geriatric Physical Therapy, 33, 85-91.
    Morrison, S., Colberg, S. R., Mariano, M., Parson, H. K., & Vinik, A. I. (2010). Balance training reduces falls risk in older individuals with type 2 diabetes. Diabetes Care, 33, 748-750. doi:10.2337/dc09-1699
    Ojala, B., Page, L., Moore, M., & Thompson, L. (2001). Effects of inactivity on glycolytic capacity of single skeletal muscle fibers in adult and aged rats. Biological Research for Nursing, 3(2), 86-95.
    Paterson, D. H., Jones, G. R., & Rice, C. L. (2007). Ageing and physical activity: Evidence to develop exercise recommendations for older adults. Canadian Journal of Public Health, 98(Suppl. 2), S69-S108.
    Persch, L. N., Ugrinowitsch, C., Pereira, G., & Rodacki, A. L. (2009). Strength training improves fall-related gait kinematics in the elderly: A randomized controlled trial. Clinical Biomechanics, 24, 819-825. doi:10.1016/j.clinbiomech.2009.07.012
    Quasthoff, S., & Hartung, H. P. (2002). Chemotherapy-induced peripheral neuropathy. Journal of Neurology, 249, 9-17.
    Shumway-Cook, A., Brauer, S., & Woollacott, M. (2000). Predicting the probability for falls in community dwelling older adults using the Timed Up and Go Test. Physical Therapy, 80, 896-903.
    Siau, C., Xiao, W., & Bennett, G. J. (2006). Paclitaxel- and vincristine-evoked painful peripheral neuropathies: Loss of epidermal innervation and activation of Langerhans cells. Experimental Neurology, 201, 507-514.
    Smith, B. H., Torrance, N., Bennett, M. I., & Lee, A. J. (2007). Health and quality of life associated with chronic pain of predominantly neuropathic origin in the community. Clinical Journal of Pain, 23, 143-149.
    Smith, E. M., Cohen, J. A., Pett, M. A., & Beck, S. L. (2010). The reliability and validity of a modified total neuropathy score-reduced and neuropathic pain severity items when used to measure chemotherapy-induced peripheral neuropathy in patients receiving taxanes and platinums. Cancer Nursing, 33(3), 173-183.
    Symons, T. B., Vandervoort, A. A., Rice, C. L., Overend, T. J., & Marsh, G. D. (2005). Effects of maximal isometric and isokinetic resistance training on strength and functional mobility in older adults. Journals of Gerontology Series A Biological Sciences and Medical Sciences, 60, 777-781.
    Tofthagen, C. (2010). Patient perceptions associated with chemotherapy-induced peripheral neuropathy [Online exclusive]. Clinical Journal of Oncology Nursing, 14, E22-E28.
    Tofthagen, C., Overcash, J., & Kip, K. (2011). Falls in persons with chemotherapy-induced peripheral neuropathy. Supportive Care in Cancer, 20, 583-589. doi:10.1007/s00520-011-1127-7
    Uceyler, N., Rogausch, J., Toyka, K., & Sommer, C. (2007). Differential expression of cytokines in painful and painless neuropathies. Neurology, 69, 42-49.
    Visovsky, C. (2003). Chemotherapy-induced peripheral neuropathy. Cancer Investigation, 21, 439-451.
    Visovsky, C., Collins, M., Abbott, L., Aschenbrenner, J., & Hart, C. (2007). Putting Evidence Into Practice: Evidence-based interventions for chemotherapy-induced peripheral neuropathy. Clinical Journal of Oncology Nursing, 11, 901-913.
    Wampler, M., Topp, K., Miaskowski, C., Byl, N., Rugo, H., & Hamel, K. (2007). Quantitative and clinical description of postural instability in women with breast cancer treated with taxane chemotherapy. Archives of Physical Medicine and Rehabilitation, 88, 1002-1008.
    Xiao, W. H., & Bennett, G. J. (2007). Chemotherapy-evoked neuropathic pain: Abnormal spontaneous discharge in A-fiber and C-fiber primary afferent neurons and its suppression by acetyl-l-carnitine. Pain, 35, 262-270. doi:10.1016/j.pain.2007.06.001