SA JOURNAL OF PHYSIOTHERAPY 2006 VOL 62 NO 3          17

GENDER INFLUENCE ON
BALANCE PERFORMANCES IN THE ELDERLY

INTRODUCTION
Balance is the process by which one
controls the body’s centre of mass with
respect to the base of supports whether it
is stationary or moving (Blackburn and
Voight, 2001).  

Balance control is multi-dimensional,
and requires a complex sensory, neuro-
muscular and central processing system
(Light et al, 1995). The ability to main-
tain balance depends on the visual,
vestibular, auditory, somato-sensory and
motor systems (Iverson et al, 1990).
Disorders involving any of these sys-
tems cause disequilibrium (West, 1995).

Balance is either static or dynamic.
Dynamic balance involves a combination
of stability and mobility which is neces-
sary to hold a position in space or move
in a controlled and coordinated manner
(Kisner and Colby, 1996). Coordination,
balance and functional motor skills are
all dependent upon and affected by the
sensory systems, particularly the somato-
sensory and proprioceptive systems if 
a person is to lean and carry out func-
tional skills (Kisner and Colby, 1996).

The sense of balance declines with
age (Harada et al, 1995). The likelihood
of having difficulty in carrying out basic
life activities increases as individual’s
ages. The elderly are among those at

greatest risk for disequilibrium (Iverson
et al, 1990). Therefore balance in the
elderly deserves special attention
because of its importance in functional
mobility and safety.

Various types of balance tests 
exist ranging from expensive laboratory
measures, which are often clinically
impractical, to the narrative descriptions
used most often by physical therapists
(Light et al, 1995). Many of the objec-
tive measures used in the clinical setting
have focused on an evaluation of static-
standing balance (Light et al, 1995).
Such a method is the Romberg Test (RT)
used to evaluate the ability of a subject
to maintain balance. Another one is
One-Leg Stance Test (OLST), which is
commonly used in the clinical setting.
The Sharpened Romberg Test (SRT),
which is a modification of the Romberg
Test and has been used as a substitute 
for the RT by some clinicians, is also a
static balance test measure. The OLST is
more difficult to perform than either the
SRT or RT because of the decreased area
of weight bearing and the narrow base of
support (Briggs et al, 1989).

The Functional Reach Test (FRT),
developed and tested by Duncan et al
(1990), is one of the more familiar of
these newer balance tests used by

physiotherapists in the clinical setting
today (Arnadottir and Mereer, 2000).
Functional reach is a measure of the
client’s margin of stability during volun-
tary forward maximal reach (Duncan et
al, 1990). They have proposed that this
test is a good screening tool for balance
problems in the elderly population. 

Some factors have been shown to
have an effect on balance such as: age
(Balogun et al, 1994), physical activity
(Iverson et al, 1990) and weight (Smith
et al, 1998). The influence of gender
needs to be investigated in the balance
performance in the elderly population
given the importance of balance in func-
tional performance. Therefore, the aim of
this study is to investigate the influence
of gender on balance in the elderly.

ABSTRACT: This study was carried out to investigate gender influence
on balance performance of apparently healthy elderly using the Sharpened
Romberg Test (SRT) for static balance and the Functional Reach Test
(FRT) for dynamic balance assessments. 

One hundred and three (103) apparently healthy male and 100 
apparently healthy female elderly subjects of age ranging from 60 to 74
years participated in this study. They had no history of neurological
deficits, postural hypotension, orthopaedics conditions or injury to the
back and / or upper and lower extremities within the past five years.

Descriptive statistics of range, means and standard deviation were used to analyze the physical characteristics and
each of the two tests. The independent t-test was used to compare the balance performances in elderly males and females.

The results showed that males performed significantly higher than females in FRT: ( 31.46 ± 12.34) and
(24.00 ± 10.73) respectively. Males performed significantly higher than females in SRT in eyes opened (58.51 ± 4.43)
and (56.58 ± 6.03) and eyes closed: (46.98 ± 14.89) and (42.59 ± 14.70) performances respectively.

It was concluded that males performed significantly better than females in both static and dynamic balance
performances.

KEY WORDS:  GENDER, BALANCE PERFORMANCE, ELDERLY.

Gbiri CA, B.Sc PT (Hon),
M.Sc PT (Neurological-
Physiotherapy), MNSP1

Fabunmi AA,
B.Sc PT (Hon.), M.Ed, MNSP1

1
Physiotherapy Department, College of Medicine,
University of Ibadan, Ibadan, Nigeria.

CORRESPONDENCE TO:
Caleb Ademola, Gbiri
Physiotherapy Department,
College of Medicine,
University of Ibadan,
Ibadan,
Nigeria.
Email: calebgbiri@yahoo.com
Tel: 234-0803-359-8072;

234- 0805-206-8345;
234- 0802-460-7201.

R E S E A R C H
A R T I C L E

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18 SA JOURNAL OF PHYSIOTHERAPY 2006 VOL 62 NO 3

METHODOLOGY

SUBJECTS 
A sample of convenience of 103 males
and 100 females who were apparently
healthy (those who met the inclusion
criteria), and whose consents were
sought and obtained were recruited for
this study from churches, mosques,
homes and markets in Ibadan, Nigeria.
Subjects were between 60 and 74 years
of age. They did not have any history 
of postural hypotension, neurological
deficits and orthopedics conditions
within the past five years. This number
was arrived at using the standard equa-
tion recommended by World Health
Organization (WHO, 2004).

VENUE
The procedures were performed at a
comfortable, suitable designated centre
(level floor) in churches, mosques,
homes and markets in Ibadan, Nigeria.

INSTRUMENTATION
1. A Swiss precision (Herwins) stop-

watch was used to measuring balance
time of the subjects in seconds to the
nearest second.

2. A bathroom weighting scale (Seca
Model) was used to measure the
subject’s body weight in kilogram to
the nearest kilogram.

3. A portable height metre (Seca Model)
was used to measure subject’s height
to the nearest centimeter.

4. A plumbline (Swordfish brands) was
used to provide for the leveled floor-
ing for the standing landmark.

5. A 3-inch by 48-inch (7.5cm by 120cm)
transparent meter rule (built by 
the Instrument Department U.C.H.,
Ibadan, Nigeria) was used to measure
the functional reach of each subject 
to the nearest 0.1cm.

6. Plain sheets of paper were used to mark
the feet during the tests performances.

PROCEDURE
Prior to testing, the procedure was
explained to subjects after their informed
consent had been sought and obtained.
The subjects responded orally to ques-
tions on their general health state with
specific questions on whether they had
pain in any part of their body or had any
recent fractures. Tests such as Romberg
test, dysdiadikokenesia and drift test were
performed to assess their neurological
status. They also answered questions on

past and recent events in society to test
their mental state (dementia). Any sub-
ject who passed these tests participated
in the study.

HEIGHT MEASUREMENT: The
height metre was placed against the
wall. The subjects were asked to stand
vertically parallel to the height metre
with their backs to it. They stood verti-
cally erect with their hands by their 
sides while looking straightforward. The
height was read-off by gradually lower-
ing the height meter pointer to touch the
tip of the subjects’ heads.

WEIGHT MEASUREMENT: The
weighing scale was placed on a leveled
floor and the zero error well corrected
for each subject with his or her hands 
by the side while looking forward. The
head was straight in the erect position.
Then their weight was read-off. The 
subjects had minimal clothing and had
their shoes-off.

DETERMINATION OF LIMB
DOMINANCE 

Limb dominance of subjects was
assesses from there response to the 
following questions:
1. Which hand will you preferentially

use for? 
Writing?
Eating?
Throwing?
Opening and closing doors and win-
dow shutters?

2. Which leg would you preferentially
use for kicking a ball?
The favoured limbs of the subject

when replying to those questions and
actually carrying out those activities
with ease were considered to be their
dominant limbs.  Each of these activities
were performed and checked by us
before commencing the test procedures.

SHARPENED ROMBERG TEST:
Leveled flooring was confirmed by 
the use of a plumbline placed on the
ground and the indicator liquid settling
at the centre was used for testing.

This test was performed as described
by Briggs et al (1989). The subject
assumed a heel-to-toe standing position.
The dominant leg was placed at the back
of the non-dominant leg. All the tests
were performed with the shoes-off and
with the eyes opened or closed while
standing on a white plain sheet of paper.

Timing was started after the subjects
had assumed the proper test position and
indicated their readiness. 

Timing was stopped when any of
these occurred:
- If subject moved their foot/feet from

the proper starting position or swayed.
- If subject opened their eyes in the

eyes closed trial.
- If subject reached the maximum 

balance time of 60 seconds.
All the subjects performed three trials

and the longest time was used for data
analysis. 

FUNCTIONAL REACH TEST:
This test was performed as described by
Duncan et al (1990). Subjects stood with
their feet apart as wide as the measure 
of their shoulder girth in a comfortable
position. The metre rule was mounted
on the wall parallel to the floor with the
top edge at the level of the subject’s
acromion. The subjects stood with the
dominant arm near the wall of the metre
rule (subjects performed the test with
their dominant arm). The subject was
asked to make a fist and flex the arm at
the glenohumeral joint to 90 degrees and
parallel to the metre rule. The initial
position of the third metacarpal was
recorded as the initial position. Then the
subjects were asked to reach forward as
far as possible keeping their fist parallel
to the metre rule without taking a step.
The positions of the feet of the subjects
were marked on a plain sheet of paper
on which they maintained their stance
during the test.

Any strategy except the following
was encouraged for the subject:
- Touching the surface of the wall of

the metre rule with either the reach-
ing or non-reaching hand;

- Holding the wall or any nearby object
with the non-reaching hand 

- Taking a step during the test procedure.
- The subject’s reach was observed 

and recorded as the final position.
The functional reach was taken by
subtracting the initial position from
the final position (centimeters).

Any of the two tests were performed
without following a specific order. This
was done to avoid the subject getting
acquitted with the test, which may affect
their performances. 

DATA ANALYSIS
The Independent t-test was used to
establish:
(i) If there was any difference in FR in

elderly males and females

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SA JOURNAL OF PHYSIOTHERAPY 2006 VOL 62 NO 3          19

(ii) If there was any difference in 
balance time in elderly males and
elderly females.

RESULTS
Refer to Table 1 and Table 2 below.

DISCUSSION
There was a significant difference between
the performances of male and female
elderly on SRT in both the eyes opened
and eyes closed (p<0.05) with the males
performing better. This shows that male
elderly can perform better in SRT than
elderly female. It was however noted
that 80.58 % elderly male completed the
maximum 60-second on the eyes opened
performance as compared with 56.00%
elderly females who completed the 
maximum 60 seconds on the same test.
Thirty-nine percents of the elderly males
were able to complete the maximum 
60 second on the eyes closed perfor-
mance as compared with 29.00% elderly
females who completed the maximum
60 second on the same test. This further
strengthens the fact that male elderly can
perform significantly better than female
elderly in SRT. 

The higher percentages observed in
the eyes-opened performance in both the
males (80.58%) and females (56.00%)
as compared with lower percentages in
the eyes closed in males (39.00%) and

females (29.00%) shows the importance
of visual input on the balance perfor-
mance and control in the elderly
Therefore the elderly should be taught
how to compensate for balance when
there is distortion in the centre of equili-
brium. They should also be routinely
screened for visual acuity so that impair-
ment would be detected early and visual
aids could be prescribed to prevent falls
and their associated complications.  Early
detection of balance problem in the
elderly will go a long way in preventing
fall and its complication frequently
occurring in the elderly. It will also help
in limiting or preventing activity limi-
tation or participation limitation, which
is usually associated with aging (Briggs
et al, 1989).

Males performed significantly better
in the FRT than females (p<0.05). This
implies that elderly male can perform
better in FRT than elderly females. In
this study, males were significantly
taller than females with mean values 
of 168.12 (±7.13) and 159.33 (±8.47)
respectively. This could have contributed
to the better reach observed in the males
than the females. This is in agreement
with Duncan et al (1990) who concluded
that there existed a positive significant
relationship between height and func-
tional reach in a sample of 156 volunteer
elderly. The significantly better reach

observed in males also agrees with Duncan
et al (1990) who noticed that gender 
was one of the most significant factors
that influences functional reach with the
males having a better reach. This shows
that at the elderly age: from 60 to 70
years, females are likely to surfer balance
deficit than their male counterparts. 

Therefore the balance in the elderly
population should be screened routinely
to avoid fall and its related compli-
cations that may be experienced by this
set of population as a result of the dis-
turbance in their sense of balance. The
female elderly should be given more
attention in balance screening. It will be
highly expedient for the elderly to be
screened for any balance impairment as
they approach the age of 60 years so as
to envisage their likely problem and to
teach them balance compensatory
mechanism which they may adopt when
balance seems to be distorted. Balance
should also be included as one of the 
primary screening for the elderly when
being clinically examined in normal and
routine clinical practice.  

CONCLUSION
There were significantly better perfor-
mances in both the static and dynamic
balance tests performances by the male
elderly. The elderly performed better in
eyes opened performance than eyes

EO60 %EO60 EC60 %EC60 DE60 %DE60 DEC60 %DEC60 NO

Male 83 80.58 41 39.00 20 19.42 62 60.19 103 

Female 56 56.00 29 29.00 44 44.00 71 71.00 100

N.B: E060 = Total number that reached 60 seconds in eyes opened performance 
% E060 = Percentage of the total number that reached 60secs in eyes opened performance
EC60 = Total number that reached 60secs in eyes closed performance
%EC60 = Percentage of the total number that reached 60sec in eyes closed performance
DE060 = Total number that didn’t reach 60secs in eyes opened performance
%DE060 = Percentage of total number that didn’t reach 60secs in eyes opened performance
DEC60 = Total number that didn’t reached 60secs in eyes closed performance
%DEC60 = Percentage of total number that didn’t reached 60secs in eyes closed performance

Table 1: Performance of subject in sharpened.   Romberg Test

Parameter      Sex No Range       Mean ± S D p-Value

Eye 
Opened Male 103 32.00 - 60.00 58.51 ± 4.43 0.010*
(Sec) Female 100 25.00 - 60.00 56.58   ± 6.03 0.010*

Eye
Closed Male 103 12.00 - 60.00 46.98  ± 14.89 0.036*
(Sec) Female      100 8.00 - 60.00 42.59  ± 14.70 0.036*

N.B: * Indicates Significant difference.

Table 2: Comparison between the performance of male and female (Independent t-test) in FRT and SRT.

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20 SA JOURNAL OF PHYSIOTHERAPY 2006 VOL 62 NO 3

closed performance in SRT.  It was how-
ever observed that a high percentage of
the elderly had a low performance in
both balance tests. This shows the need
to pay more attention to balance perfor-
mance in the elderly population in order
to prevent complications that may result
from balance impairment in this group
of individuals. If balance problem is
addressed in the elderly, it is likely that
their visit to the hospital will be reduced.
They might be able to perform all their
activity of daily living without any fear
of fall. This may consequently improve
their quality of life. The elderly is then
likely to have little or no  activity restric-
tion or limitation when their balance sense
is not impaired or when they can ade-
quately compensate for any disturbance
imposed on their balance while engaging
in their normal activity of daily living. 

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