Strength, power, and postural control in seniors: Considerations for functional adaptations and for fall prevention

The ageing neuromuscular system is affected by structural and functional changes that lead to a general slowing down of neuromuscular performance and an increased risk of falling. As a consequence, the process of ageing results in a reduced ability to develop maximal and explosive force, as well as in deficits in static and dynamic postural control. A decrease in the number and size of type II fibres in particular accounts for the age-related decline in muscle mass (sarcopaenia) and strength performance. Multiple denervation and re-innervation processes of muscle fibres seem to be responsible for the reduced number of muscle fibres. Recently, it has been suggested that it is not the decline in motoneurons that accounts for the loss in number of muscle fibres but the disturbed potential of fibre regeneration and re-innervation. Furthermore, an age-related reduction in the number of satellite cells has also been associated with sarcopaenia. The ability to compensate for platform and gait perturbations deteriorates with ageing as reflected in longer onset latencies and inefficient postural responses. All sites within the somatosensory system are affected by ageing and therefore contribute to postural instability. However, morphological changes of muscle spindles appear primarily to be responsible for the impaired ability to compensate for balance threats in old age. Given these neuromuscular limitations in old age, it is important to apply adequate training interventions that delay or even reverse the onset of these constraints. Strength training has the potential to enhance maximal as well as explosive force production capacity. This is accomplished by neural factors, including an improved recruitment pattern, discharge rate, and synchronization of motor units. Furthermore, an increase in number of satellite cells most likely accounts for training-induced muscle hypertrophy. Recent studies have investigated the impact of balance training in old age on the ability to develop maximal and explosive force. In addition, the effects of balance training on reflex activity during gait perturbations were also examined. Increases in maximal and explosive force production capacity and an improved ability to compensate for gait perturbations were observed. It is evident from the literature that researchers are increasingly studying the effects of more specifically designed training programmes on performance in populations of older adults. Thus, in the near future, strength training could be replaced by high-velocity forms of power training and balance training by perturbation-based training programmes. It is hypothesized that this new approach is more efficient in terms of fall prevention than the traditional approach.