Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

A weak balance: the contribution of muscle weakness to postural instability and falls

Nature Clinical Practice Neurology volume 4, pages 504–515 (2008)Cite this article

Abstract

Muscle strength is a potentially important factor contributing to postural control. In this article, we consider the influence of muscle weakness on postural instability and falling. We searched the literature for research evaluating muscle weakness as a risk factor for falls in community-dwelling elderly individuals, for evidence that strength training reduces falls, and for pathophysiological evidence from patients with neuromuscular disease that supports the link between muscle weakness and falls. In virtually all studies that included strength testing, muscle weakness was a consistent risk factor for falls in the elderly. Studies that evaluated the merits of muscle strength training often showed a reduction in fall rates, particularly when strength training was a component of a multifactorial intervention, although it was unclear whether strength training alone led to a fall reduction. Surprisingly few studies addressed the pathophysiological relationship between muscle strength and balance control. We conclude that muscle weakness is an important risk factor for falls that is potentially amenable to therapeutic intervention, and that future studies should further clarify the role of muscle weakness in balance control and the pathophysiology of falls.

Key Points

  • Muscle weakness is a consistent and important risk factor for falls, but its contribution to falls is surprisingly underestimated in the literature

  • The exact pathophysiology of muscle weakness as a risk factor for falls remains unclear

  • Reducing falls by strength training as a component of a multifactorial intervention strategy seems to be superior to pure strength training

  • Fundamental studies of balance control and falling mechanisms in patients with focal and pure neuromuscular diseases are needed to increase our understanding of the influence of muscle weakness on falls, and to provide new leads for the development of prevention and intervention strategies

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Neuromuscular diseases affecting the various components of the efferent motor system.
Figure 2: Muscle weakness and the risk of falling: a hypothesis.
Figure 3: The underlying theory regarding the link between muscle weakness and falls.

Similar content being viewed by others

References

  1. Creath R et al. (2002) Limited control strategies with the loss of vestibular function. Exp Brain Res 145: 323–333

    Article  PubMed  Google Scholar 

  2. Allum JH et al. (2008) Differences in coding provided by proprioceptive and vestibular sensory signals may contribute to lateral instability in vestibular loss subjects. Exp Brain Res 184: 391–410

    Article  PubMed  Google Scholar 

  3. Bloem BR et al. (2002) Triggering of balance corrections and compensatory strategies in a patient with total leg proprioceptive loss. Exp Brain Res 142: 91–107

    Article  CAS  PubMed  Google Scholar 

  4. Nardone A et al. (2007) Balance control in sensory neuron disease. Clin Neurophysiol 118: 538–550

    Article  PubMed  Google Scholar 

  5. Van de Warrenburg BP et al. (2005) Trunk sway in patients with spinocerebellar ataxia. Mov Disord 20: 1006–1013

    Article  PubMed  Google Scholar 

  6. Bloem BR et al. (2001) Prospective assessment of falls in Parkinson's disease. J Neurol 248: 950–958

    Article  CAS  PubMed  Google Scholar 

  7. Adkin A et al. (2005) Trunk sway measurements during stance and gait tasks in Parkinson's disease. Gait Posture 22: 240–249

    Article  CAS  PubMed  Google Scholar 

  8. Moreland JD et al. (2004) Muscle weakness and falls in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 52: 1121–1129

    Article  PubMed  Google Scholar 

  9. Pieterse AJ et al. (2006) Falls in patients with neuromuscular disorders. J Neurol Sci 251: 87–90

    Article  CAS  PubMed  Google Scholar 

  10. Horlings CGC et al. (2008) Trunk sway analysis to quantify the warm-up phenomenon in myotonia congenita patients. J Neurol Neurosurg Psychiatry [10.1136/jnnp.2008.143982]

  11. Grüneberg C et al. (2004) The influence of artificially increased hip and trunk stiffness on balance control in man. Exp Brain Res 157: 472–485

    Article  PubMed  Google Scholar 

  12. Bloem BR et al. (2000) Is lower leg proprioception essential for triggering human postural responses? Exp Brain Res 130: 375–391

    Article  CAS  PubMed  Google Scholar 

  13. Edwards WT (2007) Effect of joint stiffness on standing stability. Gait Posture 25: 432–439

    Article  PubMed  Google Scholar 

  14. Hsu WL et al. (2007) Control and estimation of posture during quiet stance depends on multijoint coordination. J Neurophysiol 97: 3024–3035

    Article  PubMed  Google Scholar 

  15. Kim S et al. (2008) Direct parameterization of postural stability during quiet upright stance: effects of age and altered sensory conditions. J Biomech 41: 406–411

    Article  PubMed  Google Scholar 

  16. Loram ID et al. (2002) Direct measurement of human ankle stiffness during quiet standing: the intrinsic mechanical stiffness is insufficient for stability. J Physiol 545: 1041–4053

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Grüneberg C et al. (2004) The influence of artificially increased hip and trunk stiffness on balance control in man. Exp Brain Res 157: 472–485

    Article  PubMed  Google Scholar 

  18. Bakker M et al. (2005) Postural responses to multidirectional stance perturbations in cerebellar ataxia. Exp Neurol 202: 21–35

    Article  Google Scholar 

  19. Bloem BR et al. (2004) Gait and balance in basal ganglia disorders. In Clinical Disorders of Balance, Posture and Gait, 173–206 (Eds Bronstein AM et al.) London: Arnold

    Google Scholar 

  20. Horak FB et al. (2005) Direction-specific postural instability in subjects with Parkinson's disease. Exp Neurol 193: 504–521

    Article  PubMed  Google Scholar 

  21. Portegijs E et al. (2006) Asymmetrical lower extremity power deficit as a risk factor for injurious falls in healthy older women. J Am Geriatr Soc 54: 551–553

    Article  PubMed  Google Scholar 

  22. Clark RD et al. (1993) Clinical parameters associated with falls in an elderly population. Gerontology 39: 117–123

    Article  CAS  PubMed  Google Scholar 

  23. Schwartz AV et al. (1999) Falls in older Mexican-American women. J Am Geriatr Soc 47: 1371–1378

    Article  CAS  PubMed  Google Scholar 

  24. Sorock GS et al. (1992) Peripheral neuromuscular dysfunction and falls in an elderly cohort. Am J Epidemiol 136: 584–591

    Article  CAS  PubMed  Google Scholar 

  25. Davis JW et al. (1999) Risk factors for falls and for serious injuries on falling among older Japanese women in Hawaii. J Am Geriatr Soc 47: 1371–1378

    Article  Google Scholar 

  26. Campbell AJ et al. (1989) Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol 44: M112–M117

    Article  CAS  PubMed  Google Scholar 

  27. Gerdhem P et al. (2005) Clinical history and biologic age predicted falls better than objective functional tests. J Clin Epidemiol 58: 226–232

    Article  PubMed  Google Scholar 

  28. Robbins AS et al. (1989) Predictors of falls among elderly people: results of two population-based studies. Arch Intern Med 149: 1628–1633

    Article  CAS  PubMed  Google Scholar 

  29. Tinetti ME et al. (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319: 1701–1707

    Article  CAS  PubMed  Google Scholar 

  30. Tromp AM et al. (2001) Fall-risk screening tests: a prospective study on predictors for falls in community-dwelling elderly. J Clin Epidemiol 54: 837–844

    Article  CAS  PubMed  Google Scholar 

  31. Maki BE et al. (1994) A prospective study of postural balance and risk of falling in an ambulatory and independent elderly population. J Gerontol 49: M72–M84

    Article  CAS  PubMed  Google Scholar 

  32. Nevitt MC et al. (1989) Risk factors for recurrent nonsyncopal falls: a prospective study. JAMA 261: 2663–2668

    Article  CAS  PubMed  Google Scholar 

  33. Bergland A et al. (2003) Predictors of falls in the elderly by location. Aging Clin Exp Res 15: 43–50

    Article  PubMed  Google Scholar 

  34. Graafmans WC et al. (1996) Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol 143: 1129–1136

    Article  CAS  PubMed  Google Scholar 

  35. Tinetti ME et al. (1995) Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc 43: 1214–1221

    Article  CAS  PubMed  Google Scholar 

  36. Lord SR et al. (1991) Physiological factors associated with falls in an elderly population. J Am Geriatr Soc 39: 1194–1200

    Article  CAS  PubMed  Google Scholar 

  37. Lord SR et al. (1994) Physiological factors associated with falls in older community-dwelling women. J Am Geriatr Soc 42: 1110–1117

    Article  CAS  PubMed  Google Scholar 

  38. Stalenhoef PA et al. (2002) A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. J Clin Epidemiol 55: 1088–1094

    Article  CAS  PubMed  Google Scholar 

  39. Tinetti ME et al. (1995) Shared risk factors for falls, incontinence, and functional dependence. JAMA 273: 1348–1353

    Article  CAS  PubMed  Google Scholar 

  40. Koski K et al. (1996) Physiological factors and medications as predictors of injurious falls by elderly people: a prospective population-based study. Age Ageing 25: 29–38

    Article  CAS  PubMed  Google Scholar 

  41. Koski K et al. (1998) Risk factors for major injurious falls among the home-dwelling elderly by functional abilities. Gerontology 44: 232–238

    Article  CAS  PubMed  Google Scholar 

  42. Rooks DS et al. (1997) Self-paced resistance training and walking exercise in community-dwelling older adults: effect on neuromotor performance. J Gerontol A Biol Sci Med Sci 52: M161–M168

    Article  CAS  PubMed  Google Scholar 

  43. Topp R et al. (1993) The effect of a 12-week dynamic resistance strength training program on gait velocity and balance of older adults. Gerontologist 33: 501–506

    Article  CAS  PubMed  Google Scholar 

  44. Shaw JM et al. (1998) Weighted vest exercise improves indices of fall risk in older women. J Gerontol A Biol Sci Med Sci 53: M53–M58

    Article  CAS  PubMed  Google Scholar 

  45. Wolfson L et al. (1996) Balance and strength training in older adults: intervention gains and Tai Chi maintenance. J Am Geriatr Soc 44: 498–506

    Article  CAS  PubMed  Google Scholar 

  46. Chandler JM et al. (1998) Is lower extremity strength gain associated with improvement in physical performance and disability in frail, community-dwelling elders? Arch Phys Med Rehabil 79: 24–30

    Article  CAS  PubMed  Google Scholar 

  47. Buchner DM et al. (1997) The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. J Gerontol A Biol Sci Med Sci 52: M218–M224

    Article  CAS  PubMed  Google Scholar 

  48. Liu-Ambrose T et al. (2004) Resistance and agility training reduce fall risk in women aged 75–85 with low bone mass: a 6 month randomized, controlled trial. J Am Geriatr Soc 52: 657–665

    Article  PubMed  PubMed Central  Google Scholar 

  49. Luukinen H et al. (2007) Pragmatic exercise-oriented prevention of falls among the elderly: a population-based, randomized, controlled trial. Prev Med 44: 265–271

    Article  PubMed  Google Scholar 

  50. Latham NK et al. (2003) A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: the frailty interventions trial in elderly subjects (FITNESS). J Am Geriatr Soc 51: 291–299

    Article  PubMed  Google Scholar 

  51. Woo J et al. (2007) A randomized controlled trial of Tai Chi and resistance exercise on bone health, muscle strength and balance in community-living elderly people. Age Ageing 36: 262–268

    Article  PubMed  Google Scholar 

  52. Carter ND et al. (2002) Community-based exercise program reduces risk factors for falls in 65–75 year-old women with osteoporosis: a randomized controlled trial. Can Med Assoc J 167: 997–1004

    Google Scholar 

  53. Day L et al. (2002) Randomised factorial trial of falls prevention among older people living in their own homes. BMJ 325: 128–131

    Article  PubMed  PubMed Central  Google Scholar 

  54. Lord SR et al. (1994) Physical activity program for older persons: effect on balance, strength, neuromuscular control, and reaction time. Arch Phys Med Rehabil 75: 648–652

    Article  CAS  PubMed  Google Scholar 

  55. Lord SR et al. (1995) The effect of a 12-month exercise trial on balance, strength, and falls in older women: a randomized controlled trial. J Am Geriatr Soc 43: 1198–1206

    Article  CAS  PubMed  Google Scholar 

  56. Means KM et al. (2005) Balance, mobility, and falls among community-dwelling elderly persons. Am J Phys Med Rehabil 84: 238–250

    Article  PubMed  Google Scholar 

  57. Rubenstein LZ et al. (2000) Effects of a group exercise program on strength, mobility, and falls among fall-prone elderly men. Gerontol A Biol Sci Med Sci 55: M317–M321

    Article  CAS  Google Scholar 

  58. Suzuki T et al. (2004) Randomized controlled trial of exercise intervention for the prevention of falls in community-dwelling elderly Japanese women. J Bone Mineral Metab 22: 602–611

    Article  Google Scholar 

  59. Swanenburg J et al. (2007) Effects of exercise and nutrition on postural balance and risk of falling in elderly people with decreased bone minteral density: randomized controlled trial pilot study. Clin Rehabil 21: 523–534

    Article  PubMed  Google Scholar 

  60. Hauer K et al. (2001) Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls. J Am Geriatr Soc 49: 10–20

    Article  CAS  PubMed  Google Scholar 

  61. Lord SR et al. (2005) The effect of an individualized fall prevention program on fall risk and falls in older people: a randomized, controlled trial. J Am Geriatr Soc 53: 1296–1304

    Article  PubMed  Google Scholar 

  62. Carter ND et al. (2001) Results of a 10 week community based strength and balance training programme to reduce fall risk factors: a randomised controlled trial in 65–75 year old women with osteoporosis. Br J Sports Med 35: 348–351

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Barnett A et al. (2003) Community-based group exercise improves balance and reduces falls in at-risk older people: a randomised controlled trial. Age Ageing 32: 407–414

    Article  PubMed  Google Scholar 

  64. Campbell AJ et al. (1997) Randomised controlled trial of a general practice programme of home based exercise to prevent falls in elderly women. BMJ 315: 1065–1069

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Lord SR et al. (2003) The effect of group exercise on physical functioning and falls in frail older people living in retirement villages: a randomized, controlled trial. J Am Geriatr Soc 51: 1685–1692

    Article  PubMed  Google Scholar 

  66. Tinetti ME et al. (1994) A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 331: 821–827

    Article  CAS  PubMed  Google Scholar 

  67. Tinetti ME et al. (1996) Does multiple risk factor reduction explain the reduction in fall rate in the Yale FICSIT trial? Am J Epidemiol 144: 389–399

    Article  CAS  PubMed  Google Scholar 

  68. Campbell AJ et al. (1999) Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized controlled trial. J Am Geriatr Soc 47: 850–853

    Article  CAS  PubMed  Google Scholar 

  69. Campbell AJ et al. (1999) Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age Ageing 28: 513–518

    Article  CAS  PubMed  Google Scholar 

  70. Clemson L et al. (2004) The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial. J Am Geriatr Soc 52: 1487–1494

    Article  PubMed  Google Scholar 

  71. Davison J et al. (2005) Patients with recurrent falls attending Accident & Emergency benefit from multifactorial intervention—a randomised controlled trial. Age Ageing 34: 162–168

    Article  PubMed  Google Scholar 

  72. Hornbrook MC et al. (1994) Preventing falls among community-dwelling older persons: results from a randomized trial. Gerontologist 14: 16–23

    Article  Google Scholar 

  73. McMurdo ME et al. (1997) Controlled trial of weight bearing exercise in older women in relation to bone density and falls. BMJ 314: 596

    Article  Google Scholar 

  74. Robertson MC et al. (2001) Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls: randomised controlled trial. BMJ 322: 697–701

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  75. Robertson MC et al. (2001) Effectiveness and economic evaluation of a nurse delivered home exercise programme to prevent falls: controlled trial in multiple centres. BMJ 322: 701–704

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Simmons V et al. (1996) Effectiveness of water exercise on postural mobility in the well elderly: an experimental study on balance enhancement. J Gerontol Med Sci 51: M223–M228

    Google Scholar 

  77. Steinberg M et al. (2000) A sustainable programme to prevent falls and near falls in community-dwelling older people: results of a randomised trial. J Epidemiol Community Health 54: 227–232

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Wiles CM et al. (2006) Falls and stumbles in myotonic dystrophy. J Neurol Neurosurg Psychiatry 77: 393–396

    Article  CAS  PubMed  Google Scholar 

  79. Stolze H et al. (2004) Falls in frequent neurological diseases: prevalence, risk factors and aetiology. J Neurol 251: 79–84

    Article  PubMed  Google Scholar 

  80. Modoni A et al. (2004) Characterization of the pattern of cognitive impairment in myotonic dystrophy type 1. Arch Neurol 61: 1943–1947

    Article  PubMed  Google Scholar 

  81. Hopkinson ND et al. (1993) Inclusion body myositis: an underdiagnosed condition. Ann Rheum Dis 52: 147–151

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  82. Bloem BR et al. (2003) Posturography. In Handbook of Clinical Neurophysiology, 295–336 (Ed Hallett M) Amsterdam: Elsevier Science BV

    Chapter  Google Scholar 

  83. Lord SR et al. (2002) Risk of falling: predictors based on reduced strength in persons previously affected by polio. Arch Phys Med Rehabil 83: 757–763

    Article  PubMed  Google Scholar 

  84. Lehmann K et al. (2006) Postural control in persons with late effects of polio. Acta Neurol Scand 113: 55–61

    Article  CAS  PubMed  Google Scholar 

  85. Barrett R et al. (1988) Changes in center of gravity in boys with Duchenne muscular dystrophy. Muscle Nerve 11: 1157–1163

    Article  CAS  PubMed  Google Scholar 

  86. Bloem BR et al. (1999) Are automatic postural responses in patients with Parkinson's disease abnormal due to their stooped posture? Exp Brain Res 124: 481–488

    Article  CAS  PubMed  Google Scholar 

  87. Jacobs JV et al. (2005) Can stooped posture explain multidirectional postural instability in patients with Parkinson's disease? Exp Brain Res 166: 78–88

    Article  PubMed  PubMed Central  Google Scholar 

  88. Topp R et al. (1997) Postural control and strength and mood among older adults. Applied Nurs Res 10: 11–18

    Article  CAS  Google Scholar 

  89. Lord SR et al. (1991) Postural stability and associated physiological factors in a population of aged persons. J Gerontol Med Sci 46: M69–M76

    Article  CAS  Google Scholar 

  90. Wu G (1998) The relation between age-related changes in neuromusculoskeletal system and dynamic postural responses to balance disturbances. J Gerontol 53: M320–M326

    Article  CAS  Google Scholar 

  91. Carter ND et al. (2002) Knee extension strength is a significant determinant of static and dynamic balance as well as quality of life in older community-dwelling women with osteoporosis. Gerontol 48: 360–368

    Article  Google Scholar 

  92. Allum JH et al. (2002) Age-dependent variations in the directional sensitivity of balance corrections and compensatory arm movements in man. J Physiol 542: 643–663

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  93. Bateni H et al. (2004) Resolving conflicts in task demands during balance recovery: does holding an object inhibit compensatory grasping? Exp Brain Res 157: 49–58

    Article  PubMed  Google Scholar 

  94. Padberg GWAM (1982) Facioscapulohumeral Disease [thesis]. Leiden, The Netherlands: Leiden University

    Google Scholar 

  95. Becker PE et al. (1977) Myotonia congenita and syndromes associated with myotonia. In Topics in Human Genetics 3, 1–178. Stuttgart, Germany: Georg Thieme

    Google Scholar 

  96. Bloem BR et al. (2001) Postural instability and falls in Parkinson's disease. Adv Neurol 87: 209–223

    CAS  PubMed  Google Scholar 

  97. Busse ME et al. (2006) Community walking activity in neurological disorders with leg weakness. J Neurol Neurosurg Psychiatry 77: 359–362

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. Lauk M et al. (1999) Assessing muscle stiffness from quiet stance in Parkinson's disease. Muscle Nerve 22: 635–639

    Article  CAS  PubMed  Google Scholar 

  99. Richardson JK (2002) Factors associated with falls in older patients with diffuse polyneuropathy. J Am Geriatr Soc 50: 1767–1773

    Article  PubMed  Google Scholar 

  100. Bloem BR et al. (1999) Are automatic postural responses in patients with Parkinson's disease abnormal due to their stooped posture? Exp Brain Res 124: 481–488

    Article  CAS  PubMed  Google Scholar 

  101. Hue O et al. (2007) Body weight is a strong predictor of postural stability. Gait Posture 26: 32–38

    Article  PubMed  Google Scholar 

  102. Umapathi T et al. (2002) Head drop and camptocormia. J Neurol Neurosurg Psychiatry 73: 1–7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  103. Chua E et al. (2000) Myasthenia gravis and recurrent falls in an elderly patient. Age Ageing 29: 83–84

    Article  CAS  PubMed  Google Scholar 

  104. Van der Kooi EL et al. (2007) Effects of training and albuterol on pain and fatigue in facioscapulohumeral muscular dystrophy. J Neurol 254: 931–940

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  105. Van Baak MA et al. (2000) Effect of salbutamol on muscle strength and endurance performance in nonasthmatic men. Med Sci Sports Exerc 32: 1300–1306

    Article  CAS  PubMed  Google Scholar 

  106. Bischoff-Ferrari HA et al. (2004) Effect of vitamin D on falls. JAMA 291: 1999–2006

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

JHJ Allum was supported by the Swiss National Research Foundation (grant 320000-117950). BR Bloem was supported by a ZonMw VIDI grant (number 016.076.352).

Author information

Authors and Affiliations

  1. JHJ Allum is Head of the Department of Audiology and Neurootology at the University ORL Clinic, CGC Horlings is a PhD Student at the University Hospital Basel, Switzerland and the Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, BGM van Engelen is a Full Professor for Neuromuscular Diseases at the Radboud University Nijmegen Medical Centre, Basel, and BR Bloem is Associate Professor of Neurology at the Radboud University Nijmegen Medical Centre and Medical Director of the Parkinson Centre, Nijmegen.,

    Corinne GC Horlings, Baziel GM van Engelen, John HJ Allum & Bastiaan R Bloem

Authors
  1. Corinne GC Horlings
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Baziel GM van Engelen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John HJ Allum
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bastiaan R Bloem
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bastiaan R Bloem.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Supplementary information

Supplementary Table 1

Effects of muscle weakness on falls. (DOC 103 kb)

Supplementary Table 2

Muscle strength training: monofactorial intervention studies. (DOC 56 kb)

Supplementary Table 3

Muscle strength training: multifactorial intervention studies. (DOC 119 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Horlings, C., van Engelen, B., Allum, J. et al. A weak balance: the contribution of muscle weakness to postural instability and falls. Nat Rev Neurol 4, 504–515 (2008). https://doi.org/10.1038/ncpneuro0886

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpneuro0886

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing