Reduced Balance Confidence Significantly Mediates Fear of Falling Avoidance Behavior and Effectiveness of Balance Training in Older Adults With Type II Diabetes

Background and Purpose: Older adults with chronic diabetes have been shown to exhibit reduced balance function and increased fear of falling; however, the contextual inter-relationships between diabetes and its psychological consequences on physical functioning are not fully understood. This study examined the relationships between diabetes disease status, balance confidence, fear of falling avoidance behavior, and changes in performance and confidence after massed practice of a balance task in participants with and without diabetes (PWD and PWOD). Methods: Older adult PWD and PWOD were recruited for the pre-post control group study (n = 27 PWD, n = 26 PWOD). Participants underwent practice of a novel stabilometer-based balance task over a 2-day period (40 practice trials in 8 blocks). Changes in balance task performance and balance confidence were assessed pre- and post-training. Balance confidence and activity avoidance behavior associated with fear of falling were assessed using the Activities-Specific Balance Confidence Scale and Fear of Falling Avoidance Behavior Questionnaire, respectively. Repeated measures analysis of variance and mediation analyses were conducted to examine the effects of diabetes and training on balance performance and confidence, as well as how baseline balance confidence affects the training outcomes. Results and Discussion: Fifty-three participants (27 with type II diabetes, 29 men, 23 women, and 1 gender nonconforming, mean age = 63.8, range 50-89 years) were enrolled in the study. Of them, 48 (90.6%) successfully completed the balance training with significant balance task performance improvement of approximately 30% in both groups (PWD: 3.04 [95% confidence interval, 1.77-4.31], P < .001; PWOD: 4.39 [95% confidence interval, 3.04-5.74], P < .001). Activities-Specific Balance Confidence Scale score significantly mediated the effect of diabetes on balance confidence after training and fear of falling avoidance behavior. Conclusions: Despite the physical and psychological deficits associated with diabetes, individuals with chronic diabetes are capable of improving balance confidence and performance through targeted training. Balance confidence was identified as an important mediating factor, explaining the relationship between diabetes disease status and activity-related psycho-physical outcomes. Future research should focus on the potentially self-reinforcing effects of psycho-physical gains induced by exercise training.