Balance assessment in cardio-respiratory conditions

Balance impairment is a complex problem in people with chronic obstructive pulmonary disease (COPD), which is not fully understood but has detrimental consequences. Physiological (skeletal muscle dysfunction), psychological (anxiety and cognitive decline) and environmental (poor housing conditions) factors likely contribute to altered balance. Lab-based mobility assessments provide detailed information about the musculoskeletal system's ability to respond to balance challenges, while clinical balance assessments (e.g. Berg Balance Scale) can screen for balance problems within the confinements of clinical settings. However, balance is probably best understood in the context of free-living, where falls occur, and wearable technology offers a promising measurement solution. Currently, balance training alongside pulmonary rehabilitation offers the best evidence-based intervention to improve balance in this population, but perturbation-based training appears a promising alternative given the likely prevalence of neuromuscular impairment. Home adaptations have been given little consideration in people with COPD but may be a simple way of reducing falls.