Studies in Sport Medicine

Effects of Reactive Neuromuscular Exercise on Balance, Mobility, Fear of Fall and Muscle Strength in Older People with Sarcopenia

Document Type : Research Paper

Authors

Komeil Dashti Rostami 1
Raheleh Ghaffari Cherati 2
Donya Kargaran 2

1 Department of Motor Behavior and Biomechanics, Faculty of sports sciences, University of Mazandaran, Babolsar, Iran

2 Faculty of Sport Science, Shomal University, Amol, Iran

https://doi.org/10.22089/smj.2025.18082.1813
Abstract
Background and Purpose
Sarcopenia, or reduction of muscle mass, has been reported to occur in 50% of people over 80 years of age and is an important risk factor for functional disability and poor physical performance. Elderly people with sarcopenia experience problems such as balance, fear of falling, mobility, and decreased muscle strength. Previous studies have shown that reactive neuromuscular training (RNT) can lead to improved mobility and functional balance. RNT improves proprioception and dynamic stability, which can result in postural awareness, adaptations in balance, and improved position sense. RNT emphasizes precise body position to enhance dynamic stabilization of the muscular system, thus can improve functional activities. The purpose of this study was to investigate the effect of RNT exercises on functional mobility, balance, fear of falling, and muscle fitness of elderly people with sarcopenia.
 
Materials and Methods
In this semi-experimental study, 30 elderly people with the age range of 60 to 75 years (15 experimental group, N = 15; control group, N = 15) suffering from sarcopenia in Amol city were recruited as samples with the confirmation of a physician. The sampling method was purposeful in which participants were chosen according to inclusion and exclusion criteria. G-Power software was used to determine the sample size with a statistical power of 80%, a confidence interval of 95%, and an effect size of 0.7. Sarcopenia was assessed according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP). Berg Balance Scale (BBS) was used to evaluate balance. Fear of falling was assessed using the FES-I (International Fall Efficiency Scale) questionnaire, which has 16 items related to 16 activities of daily living. Timed Up and Go test (TUG) was used to evaluate functional mobility. For performing the TUG test, the subject sits on a standard chair with a height of 46 cm, and the time required for the participant to get up from the chair, walk a distance of three meters, go around a specified place, and return to sit on the chair is recorded by a digital timer.
For assessing upper and lower extremity muscle fitness, the 30-second bicep curl test and 30-second sit-to-stand test were used respectively. The muscular fitness of the upper limb was evaluated using the biceps curl with a dumbbell in 30 seconds. The weight of the dumbbell for men was 3.63 kg and for women 2.27 kg.
The experimental group performed eight weeks of reactive neuromuscular exercises, three sessions a week, a total of 24 sessions, each session lasting 45–60 minutes. The control group did not perform any activity during this period. The intensity of the exercises increased by manipulating the time of execution of the movement or the level and type of movement. In the final weeks, the maximum possible amount of pressure was considered according to the condition of the people. It should be noted that the intensity of the exercises used in the present study was recommended by the American College of Sports Medicine (ACSM).
SPSS software version 26 was utilized for data analysis. The normality of the data distribution was checked by the Shapiro-Wilk test. Analysis of covariance and Bonferroni’s post hoc test were used to compare research variables in two experimental and control groups at a significance level of p = 0.05.
 
Findings
The two groups included 30 elderly people with an average age of 64.93 ± 4.11 years, height 169.23 ± 7.88 cm, weight 73.70 ± 8.14 kg, and body mass index 25.55 ± 1.85 kg/m². There was no significant difference in demographic characteristics between the two groups.
ANCOVA results showed a significant difference between the experimental and control groups (F = 48.82, p = 0.001, η² = 0.64) in Berg Balance Scale. Specifically, the scores of the balance test in the experimental group increased significantly after the intervention. The results of the ANCOVA test showed a significant effect of RNT exercises on the functional mobility of the older people with sarcopenia (F = 64.26, p = 0.001, η² = 0.51). In fact, the time of the Timed Up and Go test was significantly reduced in the experimental group.
There was no significant difference between the experimental and control groups in the fear of falling variable (F = 2.86, p = 1.02, η² = 0.11). Also, RNT exercises significantly improved the muscle fitness of the upper limb (η² = 0.59, p = 0.001, F = 29) and lower limb (η² = 0.53, p = 0.001, F = 30.06) in the experimental group compared to the control group.
 
Conclusion
It seems that RNT is effective in improving balance, mobility, and muscle fitness. RNT could improve the sense of proprioception and movement control pattern. These exercises affect balance and functional mobility and, by improving muscle fitness, help older people to cope better in activities of daily living. The strength of the upper and lower limbs is one of the important factors in maintaining the balance of older people with sarcopenia. Additionally, maintaining functional independence and performing daily necessary tasks by older people should be achieved by improving the level of mobility and functional balance. Considering the lack of effect of RNT on the fear of falling, it is suggested to consider more time for exercises in future research.
Article Message
Reactive neuromuscular training can be considered an effective training modality for improving balance, joint mobility, and lower and upper limb strength in older adults with sarcopenia.
Ethical Considerations
The research ethics code was obtained from the ethics committee of Shahroud University of Technology with the number IR.SHAROODUT.REC.1404.003.
Authors’ Contributions
Conceptualization: Komeil Dashti Rostami, Raheleh Ghaffari
Data Collection: Donya Kargaran
Data Analysis: Komeil Dashti Rostami
Manuscript Writing: Komeil Dashti Rostami, Raheleh Ghaffari, Donya Kargaran
Review and Editing: Raheleh Ghaffari, Donya Kargaran
Project Manager: Komeil Dashti Rostami, Raheleh Ghaffari
Conflict of Interest
The authors of the article declare that they have no conflicts of interest related to the present research.
 
Acknowledgments
The authors express their gratitude and appreciation to all the dear elderly individuals who collaborated in this research project.
 

Keywords

Elderly, Muscle Atrophy, Proprioception, Muscle Strength
Subjects
 
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Studies in Sport Medicine
Volume 17, Issue 44
Spring 2025
Pages 111-128

  • Receive Date 02 June 2025
  • Revise Date 21 September 2025
  • Accept Date 29 September 2025

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