Agility training for Better Balance
Balance training has been studied for many years but a majority of the research has focused on training different types of exercises in isolation to improve balance. Instead, new research is suggesting that these programs should be designed to be multifaceted to address the many different ways that our balance can be impaired. We have discussed many of these in previous blog posts such as strength, proprioceptive, visual and vestibular training. From previous research, we have learned that the most effective balance program should include exercises that gradually reduce the base of support, include dynamic movements, stress postural muscle groups and alter sensory inputs. Now, what if there was a balance program that could address all of them at once? What about agility training?
Agility training includes exercises that challenge coordination, change of direction and velocity. In addition to these physical demands, cognitive demands of agility training include divided and sustained attention, planning, decision making, visual scanning, pattern recognition and anticipation. Aspects of changes of direction include sudden starts, stops, turns and reactive control as well as fast concentric and eccentric muscle contractions. All of these mimic the demands of functional tasks. If you are walking around your house, try counting how many times you perform these tasks in a single minute! Now think about a more complex task, such as grocery shopping. This task may seem simple to some but it demands a lot of an individual both cognitively and physically. When walking around a grocery store, you must divide your attention between your walking and searching for an item. You also must visually scan the environment to avoid running into another person but also to find the item you are looking for. It requires you to start walking, turning, change directions, move quickly to get out of someone’s way and coordinate your ability to walk and carry an item at the same time. That’s a lot of demand on your body! Agility training challenges you to integrate all of these tasks to increase your ability to thrive in real life scenarios.
Agility training also has the ability to be highly variable. It can start with very simple patterns of movement and progressively increase both the physical and cognitive demand to further challenge the brain. Since agility training is multimodal in nature, each exercise has multiple components that can be adjusted to individualize the training session for each participant’s functional needs. The surface can be changed from a stable, stationary surface to a softer and dynamic surface. The exercise can focus on a single direction of movement or combine multi-directional movements of forwards, backwards, sideways and zig zags. The velocity of movement can be adjusted to start slower and progressively increase the speed to increase the physical demand. The length of the circuit completed can also increase the demand, allowing the clinician creating the circuit to make it more complex to mimic a more functional environment. Below is an example of a circuit program from Donath et al, who back in 2016 proposed the primary framework for an agility based program to be used for falls prevention for older adults.
Agility programs may even be beneficial for increasing compliance with physical activity. Compliance in exercise programs in adults of all ages is relatively low. The recommendation from the American College of Sports Medicine includes strength training 2-3 days a week, aerobic training 5 days a week and flexibility training 5-7 days a week. With all these recommendations, it’s understandable why it is challenging to include all these areas of exercise into a fall prevention program. In addition to these specific types of exercise programs, balance training should include neuromuscular training, cognitive training and proprioceptive training. These are important because research shows that these areas are often neglected and yet are important for carry over into activities of everyday life. Another aspect that makes compliance in exercise programs difficult is fear of falling, which deters individuals with balance challenges from being consistent with a balance program. With all these challenges for an effective, safe and efficient falls prevention program, new research is starting to ask the question; is there a better way to address all these areas in a time efficient manner?
While the research is still in its infancy, small pilot studies are showing promising initial results. Here are some of the initial thoughts coming out of these smaller studies:
Muscle strength has been thought to be the main factor in a falls prevention program and a MAT (multimodal agility-like exercise technique) has been shown to improve strength in the lower extremities. Focusing on an agility program that has a strength component can help translate strength gains into improved balance and independence with functional tasks.
MAT programs may also help improve walking speed and increase step length.
MAT programs have shown greater improvements in trunk strength and stability when compared to traditional strength or balance training alone.
MAT programs have a larger positive effect on dynamic versus static balance. Dynamic balance is important for a variety of functional tasks that we perform every single day!
A MAT program is seen as a time-efficient form of exercise to address strength, balance, motor performance, cardiovascular capacity and cognitive function.
When looking at outcome measures from a MAT program, initial results are showing the greatest improvements in functional mobility outcome measures such as the Timed up and Go and 6 minute walk test.
Multiple large research studies started in 2020 are being performed to determine what the best results may be for agility training in regards to frequency, type, time and intensity. These studies are proposing an agility based program that is performed for a 60 minute session with a 10 minute functional warm up including dance or exercises that incorporate a ball. This is followed by 45 minutes of agility training with a 1 minute work session and 1 minute rest session for circuits completed 4-5 times. Finally ending with a 5 minute cool down. Below is an example of a simple circuit program that would follow this design.
While the research is still limited, it is exciting to see the potential benefits of a well designed agility program to help individuals with balance deficits maximize their time and efforts when performing exercise! Another example of a multimodal exercise program is Tai Chi. Next week we will talk about the evidence for utilizing this type of exercise for balance!
Donath L, Dieen J, Faude O. Exercise-based fall prevention in the elderly: what about agility? Sports Med. 2016. 46:143-149.
Morat M, Faude O, Hanssen H, et al. Agility training to integratively promote neuromuscular, cognitive, cardiovascular and psychosocial function in healthy older adults: a study protocol of a one-year randomized-controlled trial. Int J Environ Res Public Health. 2020. 17
Lichtenstein E, Morat M, Roth R, et al. Agility-based exercise training compared to traditional strength and balance training in older adults: a pilot randomized trial. PeerJ. 2020. 8
Morat M, Morat T, Zijlstra W et al. Effects of multimodal agility-like exercise training compared to inactive controls and alternative training on physical performance in older adults: a systematic review and meta-analysis. European Review of Aging and Physical Activity. 2021. 18:4