Motor Behavior

Effect of Electrical Muscle Stimulation Training on Balance, Self-Efficacy, and Fear of Falling in Elderly Women

Document Type : Research Paper

Authors

Maedeh Ahmadpour 1
meysam rezaei 2

1 PhD Student, Department of Sports Behavioral and Cognitive Sciences, Faculty of Sports and Health Sciences, University of Tehran, Tehran, Iran

2 Associate Professor of MotorBehavior Islsamic Azad University. Mashhad Branch, Islamic Azad University, Mashhad, Iran

https://doi.org/10.22089/mbj.2025.16243.2137
Abstract
Extended Abstract
Background and Purpose
Aging inevitably brings physiological changes, particularly within systems governing balance and mobility, often leading to reduced gait stability, diminished functional performance, and increased fear of falling. These alterations can severely impact the independence, confidence, and overall quality of life of elderly individuals—especially women, who face a higher risk of fall-related injuries. Given that falls remain a leading cause of morbidity and loss of autonomy among older adults, the identification of safe, non-invasive, and effective interventions is a pressing concern.
This quasi-experimental study aimed to evaluate the effects of electrical muscle stimulation (EMS) training on static and dynamic balance, task-specific self-efficacy, and fear of falling in elderly women aged 65 to 70 years. By addressing both physical and psychological aspects of fall risk, this research sought to determine the extent to which EMS might serve as a practical and accessible strategy to enhance motor function and psychological well-being in this vulnerable population.
 
Materials and Methods
The study employed a quasi-experimental pretest-posttest design involving an experimental group undergoing EMS training and a control group receiving no intervention. Twenty elderly women from Mashhad, Iran, aged between 65 and 70 years, voluntarily participated and were randomly assigned to one of the two groups, ensuring baseline equivalency.
Inclusion criteria included independent ambulation without assistive devices and no diagnosed neurological or musculoskeletal conditions impairing balance or mobility. The EMS protocol spanned eight weeks, consisting of two weekly sessions of 20 minutes each. The intervention unfolded in three progressive phases: a two-week adaptation period, a two-week initial training phase, and a four-week main training phase. Electrodes were placed on key lower limb and core muscles—namely, the quadriceps, hamstrings, gluteus, lumbar, and abdominal muscles—with stimulation intensity and duration gradually increased to foster neuromuscular adaptation.
Balance assessments encompassed static and dynamic domains. Static balance was measured using the Biodex Balance System and the Sharpened Romberg test, while dynamic balance was evaluated through the Timed Up and Go (TUG) test and the Fullerton Advanced Balance (FAB) scale. Psychological measures included the Persian-validated Self-Efficacy for Everyday Activities (SEEA) questionnaire and the Falls Efficacy Scale-International (FES-I), assessing task-specific self-efficacy and fear of falling, respectively.
Descriptive statistics summarized participant characteristics, and normality was confirmed via the Kolmogorov-Smirnov test. The effects of EMS were examined using multivariate analysis of covariance (MANCOVA), detecting within-group and between-group changes. All analyses were conducted in SPSS version 24, setting significance at p < 0.05.
 
Findings
Significant improvements emerged in both static and dynamic balance measures following EMS training. The experimental group demonstrated notable gains in static balance on the Biodex Balance System (p = 0.017) and the Sharpened Romberg test (p = 0.025). Similarly, dynamic balance improved significantly in the EMS group relative to controls, with substantial enhancements in FAB scale scores (p = 0.001) and TUG test performance (p < 0.001), reflecting better functional mobility and coordination.
However, EMS training did not elicit significant changes in task-specific self-efficacy or fear of falling. Although a modest non-significant reduction in fear of falling was observed (from 24.5 to 21.5), changes failed to reach statistical significance (p > 0.05). Likewise, perceived self-efficacy showed no meaningful improvement. These findings suggest that EMS alone may not be sufficient to impact psychological constructs closely tied to confidence and fear in daily activities.
Several factors likely contributed to the lack of significant psychological effects, including the relatively short intervention duration, the complex multifaceted nature of self-efficacy and fear of falling, and a modest sample size limiting power for detecting subtle psychosocial changes.
Despite these limitations, the physical benefits observed substantiate EMS as an effective modality for stimulating neuromuscular pathways, enhancing proprioceptive feedback, and improving muscle strength and coordination—key components underpinning postural control.
 
Conclusion
This study demonstrated that EMS training significantly enhances static and dynamic balance in elderly women, highlighting its promise as a safe, practical intervention to improve motor performance and postural stability in aging populations. Its role is particularly compelling in fall prevention programs by targeting neuromuscular activation, proprioceptive sensitivity, and lower limb strengthening.
While no significant psychological improvements were documented, this may be attributable to the intervention’s duration, sample size, or the complex interplay of factors influencing self-efficacy and fear of falling. Given the increasing elderly demographic and the high incidence of fall-related injuries, EMS can be integrated effectively into rehabilitation and fitness protocols to support greater independence and reduced fall risk.
Future research should explore longer EMS interventions and examine combined approaches integrating EMS with cognitive-behavioral or educational programs, aiming to holistically address both the physical and psychological dimensions relevant to fall prevention.
Keywords: Electrical Muscle Stimulation, Static Balance, Dynamic Balance, Fear of Falling, Task-specific Self-efficacy, Elderly Women
 
 
 
Article Message
EMS training improves static and dynamic balance in older women and represents a safe, feasible modality for inclusion in fall prevention initiatives. Although psychological benefits were not significant, combining EMS with targeted psychological interventions is recommended for more comprehensive outcomes.
Ethical Considerations
Prior to study initiation, informed consent was obtained from all participants. EMS interventions were supervised professionally, adhering strictly to safety standards. Participant confidentiality was ensured, and data were handled exclusively for research purposes.
Authors’ Contributions
Study design, data collection, data analysis, and manuscript drafting were conducted by Maedeh Ahmadpour. Final review, project oversight, and scientific guidance were provided by Meysam Rezaei. All authors approved the final manuscript.
Conflict of Interest
No conflicts of interest were declared by the authors.
 Acknowledgments
This work derives from a Master’s thesis completed at the Islamic Azad University, Mashhad Branch. The authors express sincere appreciation to all participants and supporting colleagues who contributed to the successful completion of this study.

Keywords

electrical muscle stimulation
balance
fear of falling
self-efficacy
elderly women
Subjects
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Motor Behavior
Volume 17, Issue 60
Summer 2025
Pages 87-104

  • Receive Date 25 January 2024
  • Revise Date 18 July 2025
  • Accept Date 26 July 2025

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