Document Type : Original Article
1. Introduction and Purpose
Given the ever-increasing elderly population in Iran and the growing statistics of falls and their associated complications in this age group, finding safe, low-cost, and effective training methods to improve motor performance and reduce the fear of falling has become a primary priority of the health system. The present study aimed to compare the effects of six weeks of core stability training versus six weeks of dynamic neuromuscular stabilization (DNS) training on three key indicators of static balance, dynamic balance, gait speed, and fear of falling in institutionalized elderly women. This research sought to determine whether these two training approaches, which operate through different mechanisms, possess identical efficacy on the motor function of the elderly or if one demonstrates superiority over the other.
2. Materials and Methods
This study was conducted as a randomized controlled trial utilizing a pretest-posttest design. A total of 36 elderly women aged 60 to 75 years were selected from nursing homes in Shiraz and randomly assigned to three groups of 12 participants each: core stability, DNS, and control. The experimental groups participated in their respective training programs for six weeks, consisting of three 40-to-60-minute sessions per week under the supervision of a trainer. The control group continued their usual daily routines. The following instruments were used to measure the variables: the Sharpened Romberg test for static balance (with eyes open and closed), the Timed Up and Go (TUG) test for dynamic balance, the 10-meter walk test for gait speed, and the Falls Efficacy Scale-International (FES-I) for fear of falling. Data analysis was performed using paired t-tests, analysis of covariance (ANCOVA), and Bonferroni post-hoc tests, with the significance level set at 0.05.
3. Results
Following the six-week intervention, both experimental groups demonstrated significant improvements in all variables compared to the pretest (). The mean scores for static balance with eyes open increased from to seconds in the core stability group and from to seconds in the DNS group (higher values indicate longer balance maintenance). Static balance with eyes closed improved from to seconds in the core stability group and from to seconds in the DNS group. For dynamic balance, TUG times decreased from to seconds in the core stability group and from to seconds in the DNS group (lower times indicate better dynamic balance). Gait speed increased from to meters per second in the core stability group and from to meters per second in the DNS group. Fear of falling FES-I scores decreased from to in the core stability group and from to in the DNS group (lower scores indicate less fear). The control group showed no significant changes in any of the variables. The ANCOVA results revealed a significant difference among the three groups across all variables (). The Bonferroni post-hoc test indicated that both experimental groups performed significantly better than the control group (), but no significant differences were observed between the core stability and DNS groups in any of the variables (). The effect size (partial ) was large for all variables, ranging from 0.67 to 0.90.
4. Conclusions
Based on the findings of this study, it can be concluded with high confidence that both six-week training programs (core stability and dynamic neuromuscular stabilization) equally and significantly improve static balance, dynamic balance, gait speed, and fear of falling in institutionalized elderly women. Although the physiological mechanisms of these two approaches differ—one focusing on direct axial muscle strengthening through isometric and dynamic contractions, and the other on restoring developmental movement patterns, correcting diaphragmatic breathing, and integrating anterior and posterior kinetic chains—in practice, both achieved similar and highly favorable outcomes. Since no statistical superiority was observed between the two methods, the choice between them can be made based on available facilities, trainer preference, and the individual characteristics of the elderly. From a clinical application perspective, rehabilitation specialists, physical therapists, geriatricians, and exercise trainers can confidently utilize either protocol alone or in combination to prevent falls and improve motor function in the elderly. Particularly in nursing home environments where access to advanced equipment may be limited, both protocols are simple, safe, and cost-effective. Furthermore, combining these two approaches (direct core muscle strengthening along with the restoration of developmental movement patterns) could maximize efficacy and enhance training variety without adding high cost or time to the program. Researchers are recommended to investigate the long-term effects (e.g., 12 weeks or more) of these two protocols in future studies and to include more diverse populations, such as community-dwelling elderly, elderly men, individuals with mild cognitive impairment, and those with a history of recurrent falls. It is also suggested to design an optimal combined protocol in which both approaches are used alternately or integratively, allowing it to be considered as a national fall prevention program for the elderly in health and rehabilitation centers across the country.
5. Acknowledgment & Funding
The authors sincerely thank all the elderly individuals who participated in this research, as well as the trainers and evaluators whose diligent efforts contributed to the precise execution of the training protocols and measurements. This research received no funding from public, private, or non-profit entities, and all expenses were covered by the authors.
6. Ethical Consideration
This study was conducted in compliance with ethical guidelines and received approval under ethical code IR.SSRC.REC.1400.123 from the Ethics Committee in Biomedical Research of the Sport Sciences Research Institute.
7. Authors' Contributions
All authors contributed to the article. All authors have read and approved the final manuscript.
8. Conflict of interest
The authors declare no conflicts of interest.
