International Journal of Physical Education & Sports Sciences · Jun 2026
Combined balance and pulmonary rehabilitation in older adults with chronic respiratory disease: A narrative review of fall risk and respiratory outcomes
By B D, E J
Background. Ageing brings decline in musculoskeletal integrity, postural control and respiratory efficiency. Older adults with chronic respiratory conditions such as chronic obstructive pulmonary disease, asthma and interstitial lung disease face compounded risks of impaired balance, reduced pulmonary function and falls. The interaction between respiratory and balance impairment creates a case for rehabilitation strategies that address both together. Objective. This narrative review examines what is known about balance impairment and fall risk in older adults with chronic respiratory disease, what pulmonary rehabilitation achieves in this age group, and whether adding balance-oriented training to rehabilitation reduces fall risk or improves respiratory outcomes. Approach. Observational studies, randomised trials, prospective cohort studies and systematic reviews addressing balance, falls, respiratory muscle function and pulmonary rehabilitation in older adults with chronic respiratory disease were examined. Findings. Postural control is impaired in chronic obstructive pulmonary disease relative to age-matched peers, and fall rates are correspondingly raised. Pulmonary rehabilitation delivers measurable benefit across all age bands, including patients over 85. Programmes incorporating balance-oriented or supplementary training improved dynamic balance, chest mobility and expiratory muscle strength in prospective studies. Evidence that rehabilitation reduces falls themselves remains weak and inconsistent, and adults over 80 remain at substantially higher residual fall risk after rehabilitation than younger patients. Conclusion. Age alone is not a reason to withhold pulmonary rehabilitation. Balance-oriented components improve functional and respiratory measures, but fall prevention in the oldest patients requires explicit attention rather than being assumed to follow from rehabilitation itself.