Comparative Effects of Strength and Balance Training on Fall- Risk Indicators in Older Adults with Knee Osteoarthritis: A Randomized Trial With 9-Month Follow-Up

Abstract

Background: Knee osteoarthritis is associated with pain, lower-limb weakness, impaired proprioception,
altered gait, and increased fall risk. Strength and balance exercises address different mechanisms, but direct
comparative evidence with longer follow-up remains limited.
Objective: To compare the effects of progressive lower-limb strength training and progressive balance
training on functional mobility, postural control, concern about falling, and composite fall risk in older adults
with knee osteoarthritis.
Methods: This prospective randomized comparative trial included 60 adults aged 50-75 years with clinically
and radiologically diagnosed knee osteoarthritis. Participants were allocated equally to strength training
(n=30) or balance training (n=30). Both groups completed 24 supervised sessions over 6 weeks. Outcomes
were assessed at baseline, 3 months, and 9 months using the Timed Up and Go test (TUG), Berg Balance
Scale (BBS), Falls Efficacy Scale-International (FES-I), and Falls Risk Assessment Tool (FRAT). Between-
group mean differences, 95% confidence intervals (CIs), and Hedges g were calculated.
Results: Baseline outcome values did not differ significantly. At 9 months, balance training was superior for
TUG (10.36+/-1.67 vs 13.19+/-1.29 s; mean difference [MD] -2.83 s, 95% CI -3.60 to -2.06; p<0.001), BBS
(47.60+/-3.32 vs 44.40+/-2.28; MD 3.20, 95% CI 1.72 to 4.68; p<0.001), FES-I (22.20+/-4.74 vs 25.67+/-
3.12; MD -3.47, 95% CI -5.55 to -1.39; p=0.002), and FRAT (2.93+/-1.23 vs 3.87+/-0.90; MD -0.94, 95%
CI -1.50 to -0.38; p=0.001). Hedges g ranged from 0.85 to 1.87 in magnitude.
Conclusion: Both interventions improved fall-risk indicators, but progressive balance training produced
greater and more sustained benefits. Rehabilitation for older adults with knee osteoarthritis should include
challenging static and dynamic balance activities, supported by lower-limb strengthening.