Balance training improves postural control and performance-related prefrontal brain activation in healthy older adults: Results of a six-month randomized controlled training intervention.

Age-related deterioration in postural control is an important factor decreasing quality of life. Functional neuroimaging studies have shown that the activation of the prefrontal cortex (PFC) during balancing is typically higher in older (OA) compared to younger adults (YA), probably reflecting a mechanism contributing to worsened balance control with aging. Here, we hypothesized that balance training (BAL) shifts PFC activation towards a more efficient pattern, enabling improved balance performance. To test this hypothesis, we conducted a randomized controlled trial with healthy older (65-80 y) and young adults (18-35 y) of both sexes (n = 63) comparing the effects of a 6-month BAL intervention (1 h of BAL twice weekly) against age-matched, non-BAL controls (CON). In both age groups, we found that BAL led to a significant reduction in sway in trained and untrained balance tasks compared to CON, which could still be observed 6 months after the end of training (multivariate p's < .003). In OA, we found a larger reduction in PFC activation assessed with functional near-infrared spectroscopy in BAL compared to CON after training (multivariate p < .02), and a similar yet not significant trend was observed in YA (p < .06). Importantly, in OA, both cross-sectional correlations and longitudinal correlated changes showed that reduced PFC activation was associated with better balance performance. Our results support the idea that BAL may reduce dysfunctional PFC activation in OA, resulting in activation patterns more similar to those of YA, with positive effects on postural control and possibly fall risk.