Geriatr Gerontol Int 2009; 9: 75–80

ORIGINAL ARTICLE

Impact of low cost strength

training of dorsi- and plantar
flexors on balance and functional
mobility in institutionalized
elderly people
Fernando Ribeiro,1 Fantina Teixeira,2 Gabriela Brochado2 and José Oliveira1
1
Research Centre in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Porto,
and 2Physiotherapy Department, Health School of Vale do Sousa, Gandra, Portugal

Aim: To evaluate the effects of a low cost strength training program of the dorsi- and
ankle plantar flexors on muscle strength, balance and functional mobility, in elderly
institutionalized subjects; and to determine the association between strength gain and
balance and/or functional mobility gain.
Methods: Forty-eight volunteers were recruited and equally divided into two groups:
intervention (aged 78.44 1 3.84 years) and control (aged 79.78 1 3.90 years). Both groups
were tested at baseline and outcome for ankle dorsi- and plantar flexors muscle strength,
balance and functional mobility. The intervention group participated in a 6-week program,
three-sessions-per-week, of resisted ankle dorsi- and plantar flexion exercises using elastic
bands.
Results: In the intervention group, maximal isometric dorsi- (from 8.4 1 0.45 to
12.6 1 0.95 kg; P 2 0.001) and plantar flexors strength (from 13.0 1 0.85 to 17.5 1 0.93 kg;
P 2 0.001), balance (from 14.6 1 0.54 to 22.3 1 1.81 cm; P 2 0.001) and functional mobility
(from 18.4 1 0.51 to 11.0 1 0.66 s; P 2 0.001) increased significantly after the 6-week
strength training program. In the control group, no significant differences were detected.
In the intervention group, a significant correlation between plantar flexor strength gain and
balance gain was found (r = 0.826; P = 0.01).
Conclusion: The proposed low cost strength training of dorsi- and plantar flexors
improved strength, balance and functional mobility in institutionalized elderly people;
moreover, the improvement in plantar flexor strength was associated with the improve-
ment in balance.

Keywords: ankle, balance, elderly, functional mobility, strength.

Accepted for publication 3 November 2008.
Correspondence: Mr Fernando Ribeiro MSc, Research Centre in
Physical Activity, Health and Leisure, Faculty of Sport, Rua
Dr. Plácido Costa, 91; 4200-450 Porto, Portugal. Email:
fernando.silva.ribeiro@gmail.com
All authors designed and performed the research and contrib-
uted to manuscript redaction.
Introduction
Decreased mobility among older people is often related
to a combination of impairments in balance, gait and
lower limb strength, which are also risk factors for falls
and dependency in activities of daily living.1–3
In old aged people, muscle weakness due to sarcope-
nia is responsible for the development of frailty and

© 2009 Japan Geriatrics Society doi: 10.1111/j.1447-0594.2008.00500.x 兩 75

 F Ribeiro et al.
significant disability.4,5 Especially in institutionalized
elderly subjects, muscle strength can deteriorate to a
point where it becomes critical for independence of
transfers and walking.6 Because strength loss is associ-
ated with functional decline, falls and need for health
care, improving strength might improve outcomes. The
published work suggests that lower limb strength
improvement is associated with mobility task improve-
ment, in areas such as gait, gait speed, transfers, stoop-
ing, stair climbing and chair rise performance.7 Strength
training exercises seem to play a key role in preventing
falls among older adults, with several authors suggesting
that the participation of elderly subjects in strength
training programs increases muscle mass and
strength,8–10 dynamic balance,8 therefore reducing the
risk of falls7,8,11 and reducing the incidence of
osteoporotic fractures.8
With the growing aging population, the number of
falls will likely increase in coming years. Therefore,
there it is necessary to develop and implement low cost,
time-efficient, exercise intervention programs targeting
particular muscle groups in order to increase strength,
functional mobility and balance in older adults and,
subsequently, to decrease the risk of falls. Moreover, in
a recent review concerning the efficacy of resistance
training on balance in older adults, Orr et al.12 suggested
that it could be more prudent to center the strength
training on specific muscles essential to balance, such
as the hip abductors and adductors, knee flexors and
extensors and ankle plantar flexors and dorsiflexors,
than provide whole-body or lower extremity strength
training. In this sense, the purpose of this study was
to evaluate the effects of a low cost strength training
program of the ankle plantar flexors and dorsiflexors on
muscle strength, balance and functional mobility, in
elderly institutionalized subjects. Additionally, it was
also our objective to determine the association between
muscle strength gain and balance and/or functional
mobility gain.
Methods
Subjects
Forty-eight institutionalized volunteers who were
70 years of age or older (range, 72–87 years) were
recruited to participate in this study and divided into
two groups: intervention and control. The intervention
group was composed of 24 older adults, seven men and
17 women. The control group was composed of 24
older adults, nine men and 15 women, who did not
want to participate in the strength training program.
Both groups were tested at baseline and outcome for
ankle dorsiflexor and plantar flexor muscle strength,
balance and functional mobility, but only the inter-
vention group received strengthening exercises while
76 兩 © 2009 Japan Geriatrics Society
Table 1 Description of subjects (values are
mean 1 standard deviation)
Intervention group Control group
Age (years) 78.44 1 3.84 79.78 1 3.90
Height (cm) 165 1 6 167 1 5
Weight (kg) 73.6 1 4.94 75.2 1 3.60
control subjects continued their normal activities. The
characteristics of the subjects regarding chronological
age, weight and height are presented in Table 1.
Participants were ambulatory and did not use walking
aids, did not have any medical history of lower back or
lower extremity pathology, any diagnosed vestibular or
central nervous system pathology, postural hypotension
or cognitive impairment severe enough to interfere with
the ability to follow instructions, or any other medical
conditions that may have affected their ability to partici-
pate in the study.
The study was approved by the local ethics commit-
tee. All participants provided written informed consent
and all procedures were conducted according to the
Declaration of Helsinki.
Strength assessment
A dynamometer (Globus Ergometer, Globus, Codogne,
Italy) was used to assess the maximal isometric strength
of the ankle plantar flexors and ankle dorsiflexor
muscles. Maximal isometric strength was assessed in
each subject’s dominant limb, defined as the limb used
to kick a ball, which was the right limb in all partici-
pants. Ankle plantar flexor muscle strength was tested
with the subject in the supine position with the hip and
knee extended and the ankle in neutral dorsiflexion.
Ankle dorsiflexor muscle strength was tested with the
subject in a “long” sitting position with the hip flexed
70–80°, the knee extended and the ankle in neutral
plantar flexion.13 The subject was asked to dorsiflex and
plantar flex the ankle actively as a warm-up. One prac-
tice trial was given prior to testing for each movement.
The mean of the three measurements was used for data
analysis. Each trial lasted 5 s so the subjects could be
instructed to increase their strength to maximum over
that period. Instructions were standardized for each test,
and the digital display on the dynamometer was covered
to minimize experimenter bias. Strength assessment was
performed in all subjects by the same examiner with the
same instrument.
Balance and functional mobility assessment
Balance was assessed using the Functional Reach Test
(FRT) and functional mobility was assessed using the
 Strength, balance and functional mobility
Timed Up and Go Test (TUG). Before the assessments,
the subjects were asked to perform two TUG and FRT
practice trials in order to familiarize themselves with the
assessment procedures. Subjects used the same shoes in
the two assessment moments.
The FRT is a performance-based test that measures
the maximal distance an individual who is standing can
reach forward while the feet are in a fixed position. A
level yardstick was secured to a wall at the height of
the participant’s acromion process, and the participant
raised his or her dominant arm to approximately 90° of
shoulder flexion. Participants were asked to reach as far
forward as possible without raising their heels, taking a
step or touching the wall. The starting and final posi-
tions were denoted relative to the yardstick so that a
reaching distance could be attained. Distance reached
was attained by taking the average of three trials.14
To measure the TUG, subjects were given verbal
instructions to stand up from a chair, walk 3 m as
quickly and as safely as possible, cross a line marked on
the floor, turn around, walk back and sit down. The
time taken for subjects to rise from a chair, walk 3 m,
turn and return to the chair was measured (in sec-
onds).15 Time taken was attained by taking the average
of three trials.
Strength training program
The strength training program was initiated within
2 days of baseline testing. Intervention group subjects
were supervised by a physiotherapist in a 6-week
program, three-sessions-per-week, of resisted ankle
dorsiflexion and ankle plantar flexion exercises using
elastic bands (Theraband, Hygenic Corporation, Akron,
OH, USA). Each session lasted for approximately
15 min and included a 5-min warm-up and 5-min cool-
down. Elastic resistance for each participant was sys-
tematically increased during the 6-week program. The
control subjects were asked not to initiate any new exer-
cise program during the 6-week period. Within 2 days
of the end of the intervention/control period, all sub-
jects were retested for post-test measures of strength,
balance and functional mobility.
This progressive resistance exercise program incorpo-
rated the physiological principles of overload and speci-
ficity and was consistent with the American College of
Sports Medicine guidelines for strength training. The
exercises were designed to improve lower extremity
strength at slow velocities of movement. After a 5-min
warm-up consisting of gentle stretching and marching
in place, each participant was systematically positioned
to perform exercises for ankle dorsiflexor and ankle
plantar flexor muscles.
Therabands, a color-coded series of elastic bands
with varying tensions, were used to provide progressive
resistance to the muscles. Different Theraband colors
© 2009 Japan Geriatrics Society
identified the strength of the resistance applied. Partici-
pants were started at a Theraband color for each muscle
that was consistent with their initial strength capacity.
The starting level of Theraband was determined by
finding the point at which the participant could perform
6–8 repetitions of the exercise with good quality (e.g.
full range of motion, no substitution with other muscle
groups) before fatigue. The participant exercised three
times per week, progressing to 3 sets of 10 repetitions
for each exercise. Once the participant could perform 3
sets of 10 easily with a given color of elastic band, the
resistance was increased by replacing the elastic band
with the next color. During the course of the 6-week
intervention, the physiotherapist used these guidelines,
coupled with his clinical knowledge, to determine the
appropriate time for and amount of increased resistance
for each participant.
Data analysis
All data was analyzed using SPSS ver. 13.0 (SPSS,
Chicago, IL, USA) statistical software. Average values
are given mean 1 standard deviation. An independent
Student’s t-test was performed to compare: mean age,
mean weight, mean height, baseline and final muscle
strength, balance and functional mobility between the
intervention group and control group; the mean per-
centage of isometric muscle strength gain between ankle
dorsi- and plantar flexor muscles; and the mean per-
centage of gain in balance with the gain in functional
mobility. To test mean differences between moments in
the measures of muscle strength, balance and functional
mobility, a paired Student’s t-test was used. Pearson’s
correlation coefficient was calculated to assess if
strength gain was associated with improvement in
balance and/or in functional mobility. The level of sig-
nificance was set at P = 0.05.
Results
All 48 subjects successfully completed the study. At
baseline, no significant differences were detected
between groups in any of the variables. In the interven-
tion group, mean maximal isometric strength and mean
values of FRT and TUG increased significantly after
the 6-week strength training program. However, in the
control group, there were no significant differences in
strength, balance and functional mobility. At the end of
the strength training program, the intervention group
performed significantly better in FRT and TUG and
expressed higher isometric muscle strength than the
control group (Table 2).
Figure 1 shows the mean gain induced by the
strength training program in the intervention group. No
significant differences were found in the isometric
muscle strength gain when comparing muscle groups.
兩 77

Table 2 Muscle strength, balance (FRT) and functional mobility (TUG) before and after the strength training
program period in both groups
Intervention group
Before
Dorsiflexors (kg) 8.4 1 0.45
Plantar flexors (kg) 13.0 1 0.85
FRT (cm) 14.6 1 0.54
TUG (s) 18.4 1 0.51
*Significantly different before versus after; P 2 0.001. **Significantly different between groups; P 2 0.001.
100.00
80.00
60.00
Mean%
40.00
20.00
0.00
Dorsiflexors Plantar flexors FRT
Figure 1 Isometric muscle strength, balance (FRT) and
functional mobility (TUG) gain (mean percentage) in the
intervention group. Error bars are 95% confidence intervals.
In the same way, when comparing the gain in balance to
the gain in functional mobility, no significant difference
was observed.
In the subjects participating in the strength training
program, a significant correlation between plantar flexor
strength gain and FRT gain was found (r = 0.826;
P = 0.01); 68.2% of the FRT gain was explained by the
strength gain of the plantar flexors.
Discussion
The proposed low cost strength training of dorsi- and
plantar flexors induced significant improvement in
muscle strength, balance and functional mobility.
Moreover, it was found that strength gain of the plantar
flexors was significantly associated with gain in balance.
This program was a low cost, because it required
minimal equipment, minimal facilities and minimal
staff. The program was simple and no specific and/or
expensive installations and/or equipment was required.
It was also time-efficient, as it only took approximately
15 min to perform the entire program. In our opinion,
this low-technology, progressive resistive exercise
program can be implemented in almost all elderly insti-
tutions under the supervision of a rehabilitation team.
Given the wide variety of balance-demanding tasks
required in daily life, it was decided to evaluate balance
78 兩 © 2009 Japan Geriatrics Society
F Ribeiro et al.
Control group
After Before After
12.6 1 0.95* 8.5 1 0.53 8.4 1 0.52**
17.5 1 0.93* 12.4 1 0.73 11.7 1 0.62**
22.3 1 1.81* 14.6 1 0.92 14.6 1 0.82**
11.0 1 0.66* 18.9 1 1.73 19.6 1 1.08**
using FRT and functional mobility using TUG. These
tools are commonly available all around the world; they
are safe, reproducible and require minimal equipment
and training to be administered. Functional mobility is a
term used to refer to the balance and gait maneuvers
used in everyday life (e.g. getting in and out of a chair,
walking, turning).15 The TUG is a simple and inexpen-
sive tool that was developed to screen functional mobil-
ity.15 Within research, the use of the TUG has increased
over the last few years, and it is recommended by several
geriatric societies when screening for risk of falling.16,17
TUG
The strength training program was performed in
ankle muscles (dorsiflexors and plantar flexors), because
these muscles have a major role in the maintenance of
balance and functional mobility. In response to a pos-
tural perturbation, a human subject will slow the centre
of mass by generating muscle torque at the ankle or hip
(ankle and hip strategy) or by taking a step. The primary
muscle groups used to activate these balance strategies
are the ankle dorsiflexors and plantarflexors, knee
extensors and flexors, and hip abductor and adduc-
tors.12 In stance, a subject seems to responds to large
external postural perturbations through hip strategy,
and to smaller perturbations through ankle strategy.18
The ankle strategy requires adequate ankle muscle force
to correct the postural sway and to keep the centre of
mass located above the foot.19,20 A crucial role seem to
be played by the ankle dorsiflexors, as they stop back-
ward movement produced by a destabilizing movement,
lift the forefoot and contribute to the creation of a
counter-movement that helps to re-equilibrate the
body.21 Older adults with a history of falls have less
than half of the knee and ankle strength of non-falling
subjects. The strength decline is more pronounced in
the ankle than in the knee; and at the ankle such a
decline is even greater in the dorsiflexor muscles.22–24
Ankle dorsiflexion strength is a significant and indepen-
dent predictor of sit-to-stand performance,25 and
strongly associated with balance and functional ability.26
Compared to other muscles of the lower limb, the dorsi-
flexors seem to be the best predictor of falls in
older people;13,27 moreover, ankle dorsiflexor and ankle
plantar flexor muscle strength help to differentiate
 Strength, balance and functional mobility
between elders who had experienced multiple falls and
elders who had not fallen.28
The aged-related modifications on motor system can
be viewed as examples of an inevitable, genetically-
programmed process that causes both decline and
physiological adaptation in neuromuscular function.
These modifications, involving the loss of cells, lead to
the reduction in complement of motor neurons and
muscle fibers, inducing, in turn, the reduction of muscle
mass and strength, especially in the lower limbs.29
However, participation in a regular exercise program is
an effective intervention/modality to reduce or preven
t a number of functional declines associated with aging.8
The low cost strength training program of the ankle
plantar flexor and dorsiflexor muscles used in this study
induced strength gains of significant magnitude. This
data is supported by several studies30,31 that showed that
the participation of elderly subjects in strength training
programs increases muscle mass and strength. Lord
et al.32 and Chandler et al.7 separately reported that a
10-week strengthening exercise program promoted
approximately the same increase in strength as reported
in the present study. It is interesting to note that the
present results are similar to those reported by Krebs
et al.9 in a 6-month study of elastic band resistance
training at least three times a week. Indeed, short-term
(8–10-week) exercise programs that have targeted the
lower extremities resulted in significant improvements
in strength and balance among older adults.33,34
The strength training program used in this study
induced significant balance and functional mobility
improvement, which in turn may confer a modest
degree of protection from injurious falls among these
institutionalized older adults. The improvement in
balance and functional mobility is not unexpected,
because, as explained earlier in the discussion, the ankle
muscles have a major role in the maintenance of balance
and functional mobility. Human subjects respond to
postural disturbances primarily through movement at
the ankles and hips (ankle and hip strategy); however,
sufficient strength in the ankle muscles is required
to perform adequately the ankle strategy of postural
control.18
Plantar flexor strength gain explained 68.2% of the
FRT gain. Better balance, expressed by FRT values,
could in part be explained by improvement of plantar
flexor muscle strength. The strength gain of this muscle
group contributed to the explanation of the score on the
test (i.e. FRT) that measured the distance that an indi-
vidual who is standing can reach forward while the feet
are in a fixed position, because this test requires con-
trolled contractions of the plantar flexors to ensure
balance while the subject tries to perform maximally on
the test.
Our study had some limitations. First, all of the
subjects were volunteers and the control group was
© 2009 Japan Geriatrics Society
comprised of individuals that did not want to partici-
pate. This could reflect higher levels of motivation and
health consciousness in the intervention group com-
pared to the control group. Future study should be
randomized. Second, strength was assessed isometri-
cally and the strength program required dynamic con-
tractions; a dynamic measurement of strength, more
specific for the training exercises, might have been able
to show a better association between strength gain
and balance and/or functional mobility gain. Third, the
number of male subjects that participated in the study
was small and did not allow a subanalysis by sex. Future
studies should take into consideration these limitations.
In conclusion, the results of the present study show
that the proposed low cost strength training of dorsi-
and plantar flexors improved strength, balance and
functional mobility in institutionalized elderly people;
and that improvement in plantar flexor strength was
associated with improvement in balance.
References
1 Guralnik JM, Ferrucci L, Simonsick EM, Salive ME,
Wallace RB. Lower-extremity function in persons over
the age of 70 years as a predictor of subsequent disability.
N Engl J Med 1995; 332: 556–561.
2 Myers AH, Young Y, Langlois JA. Prevention of falls in the
elderly. Bone 1996; 18 (Suppl 1): S87–S101.
3 Tinetti ME. Clinical practice. Preventing falls in elderly
persons. N Engl J Med 2003; 348: 42–49.
4 Fried LP, Tangen CM, Walston J et al. Frailty in older
adults: evidence for a phenotype. J Gerontol A Biol Sci Med
Sci 2001; 56: M146–M156.
5 Bortz WM 2nd. A conceptual framework of frailty:
a review. J Gerontol A Biol Sci Med Sci 2002; 57: M283–
M288.
6 Bautmans I, Van Hees E, Lemper JC, Mets T. The
feasibility of Whole Body Vibration in institutionalised
elderly persons and its influence on muscle performance,
balance and mobility: a randomised controlled trial
[ISRCTN62535013]. BMC Geriatr 2005; 5: 17.
7 Chandler JM, Duncan PW, Kochersberger G, Studenski S.
Is lower extremity strength gain associated with improve-
ment in physical performance and disability in frail,
community-dwelling elders? Arch Phys Med Rehabil 1998;
79: 24–30.
8 American College of Sports Medicine Position Stand.
Exercise and physical activity for older adults. Med Sci
Sports Exerc 1998; 30: 992–1008.
9 Krebs DE, Jette AM, Assmann SF. Moderate exercise
improves gait stability in disabled elders. Arch Phys Med
Rehabil 1998; 79: 1489–1495.
10 Breen L, Stewart CE, Onambélé GL. Functional benefits of
combined resistance training with nutritional interventions
in older adults: a review. Geriatr Gerontol Int 2007; 7: 326–
340.
11 Mecagni C, Smith JP, Roberts KE, O’Sullivan SB. Balance
and ankle range of motion in community-dwelling women
aged 64 to 87 years: a correlational study. Phys Ther 2000;
80: 1004–1011.
12 Orr R, Raymond J, Fiatarone Singh M. Efficacy of progres-
sive resistance training on balance performance in older
兩 79
 F Ribeiro et al.
adults: a systematic review of randomized controlled trials.
Sports Med 2008; 38: 317–343.
13 Daubney ME, Culham EG. Lower-extremity muscle force
and balance performance in adults aged 65 years and older.
Phys Ther 1999; 79: 1177–1185.
14 Duncan PW, Weiner DK, Chandler J, Studenski S. Func-
tional reach: a new clinical measure of balance. J Gerontol
1990; 45: M192–M197.
15 Podsiadlo D, Richardson S. The timed “Up & Go”: a test
of basic functional mobility for frail elderly persons. J Am
Geriatr Soc 1991; 39: 142–148.
16 Sletvold O, Tilvis R, Jonsson A et al. Geriatric work-up
in the Nordic countries. The Nordic approach to compre-
hensive geriatric assessment. Dan Med Bull 1996; 43: 350–
359.
17 Guideline for the prevention of falls in older persons.
American Geriatrics Society, British Geriatrics Society, and
American Academy of Orthopaedic Surgeons Panel on
Falls Prevention. J Am Geriatr Soc 2001; 49: 664–672.
18 Horak FB, Shupert CL, Mirka A. Components of postural
dyscontrol in the elderly: a review. Neurobiol Aging 1989; 10:
727–778.
19 Kuo AD, Zajac FE. A biomechanical analysis of muscle
strength as a limiting factor in standing posture. J Biomech
1993; 26 (Suppl 1): 137–150.
20 Winter DA, Patla AE, Frank JS. Assessment of balance
control in humans. Med Prog Technol 1990; 16: 31–51.
21 Wolfson LI, Whipple R, Amerman P, Kleinberg A. Stress-
ing the postural response. A quantitative method for
testing balance. J Am Geriatr Soc 1986; 34: 845–850.
22 Whipple RH, Wolfson LI, Amerman PM. The relationship
of knee and ankle weakness to falls in nursing home resi-
dents: an isokinetic study. J Am Geriatr Soc 1987; 35: 13–20.
23 Studenski S, Duncan PW, Chandler J. Postural responses
and effector factors in persons with unexplained falls:
results and methodologic issues. J Am Geriatr Soc 1991; 39:
229–234.
24 Wolfson L, Judge J, Whipple R, King M. Strength is a
major factor in balance, gait, and the occurrence of falls.
J Gerontol A Biol Sci Med Sci 1995; 50: 64–67.
80 兩 © 2009 Japan Geriatrics Society
25 Lord SR, Murray SM, Chapman K, Munro B, Tiedemann
A. Sit-to-stand performance depends on sensation, speed,
balance, and psychological status in addition to strength in
older people. J Gerontol A Biol Sci Med Sci 2002; 57: M539–
M543.
26 Menz HB, Morris ME, Lord SR. Foot and ankle charac-
teristics associated with impaired balance and functional
ability in older people. J Gerontol A Biol Sci Med Sci 2005; 60:
1546–1552.
27 MacRae PG, Lacourse M, Moldavon R. Physical perfor-
mance measures that predict fall status in community-
dwelling older adults. J Orthop Sports Phys Ther 1992; 16:
123–128.
28 Lord SR, Clark RD, Webster IW. Postural stability and
associated physiological factors in a population of aged
persons. J Gerontol 1991; 46: M69–M76.
29 Vandervoort AA. Aging of the human neuromuscular
system. Muscle Nerve 2002; 25: 17–25.
30 Frontera WR, Meredith CN, O’Reilly KP, Knuttgen HG,
Evans WJ. Strength conditioning in older men: skeletal
muscle hypertrophy and improved function. J Appl Physiol
1988; 64: 1038–1044.
31 Kalapotharakos VI, Michalopoulos M, Tokmakidis SP,
Godolias G, Gourgoulis V. Effects of a heavy and a
moderate resistance training on functional performance
in older adults. J Strength Cond Res 2005; 19: 652–657.
32 Lord SR, Caplan GA, Ward JA. Balance, reaction time,
and muscle strength in exercising and nonexercising older
women: a pilot study. Arch Phys Med Rehabil 1993; 74:
837–839.
33 Schlicht J, Camaione DN, Owen SV. Effect of intense
strength training on standing balance, walking speed, and
sit-to-stand performance in older adults. J Gerontol A Biol
Sci Med Sci 2001; 56: M281–M286.
34 Yates SM, Dunnagan TA. Evaluating the effectiveness
of a home-based fall risk reduction program for rural
community-dwelling older adults. J Gerontol A Biol Sci Med
Sci 2001; 56: M226–M230.