Posture-balance-motor skills and health education method or “PEM-ES” method

• Risk of fall https://icd.who.int/browse10/2019/en#/W00-W19
• Reduction in the frequency and severity of falls at the end of the program (Dyer, 2023; Hopewell, 2018; Guirguis-Blake, 2024; Wang, 2023).
• ICD11: MB47.C

• Chutes à conséquences mineures (Bernard, 2018; Sherrington, 2019).
• Fatigue et douleurs mineures.

• Optimization of the balancing function (perceptive via the visuo-vestibular and proprioceptive systems, effector via the musculo-articular system) (WHO, 2021).
• Optimization of muscle function such as muscle mass, strength and power (INSERM, 2014).
• Optimisation of locomotor skills (Hue, 2001)
• Improvement of control self-perception (INSERM, 2014). 
• Improvement of physical self-esteem (INSERM, 2014).
• Adoption of more physically active behaviours (INSERM, 2004).

• Session of 90 minutes.
• 30 minutes of health education in themed sessions followed by 60 minutes of motor activities. 
• Initial assessment of functional abilities to personalize objectives according to an individual motor profile (posture, balance and motor skills grids).
• Final assessment to highlight the benefits of practice and guide the person towards the most appropriate activities. 
• Themes specific to the prevention of the risk of falls among the elderly covered during health education sequences: dietetics, lifestyle hygiene, medication, adaptation of the home and environment, physical fitness and health. 

• 30-minute group health education sessions.
• 60 minutes of posture, balance and motor skills exercises (10-minute warm-up, 40-minute session, 10-minute cool-down).
• 40 minutes of exercises adapted to individual motor profile.
• Exercises with instructions and success criteria.
• Awareness of hydration, stretching, breathing, recovery, risk of falling (avoid cluttered floors at home, remove carpets or stick double-sided tape, add grab bars in bathrooms, toilets and staircases, install lighting), ability to fall and get up again. 

• Mats of varying thickness and density.
• Balls of varying size and weight.
• Slats, hoops, studs, targets, floor markers of varying size and color.
• Chairs and sticks.

• Indoors, preferably in a gymnasium or well-lit room.
• Residence, multi-professional health center, health sports center, association, independent living center.

• Physical (static or dynamic work, mono-articular or pluri-articular, mono-segmental or pluri-segmental, isometric or anisometric, concentric or eccentric, monopodal or bipodal),
• Sensitivo-sensory (hard or soft ground, eyes open or closed, barefoot or shod, flat or sloping, uphill or downhill),
• Cognitive (with or without time constraint, with or without spatial constraint, single or double task),
• Relational (individual or group exercise, cooperative or oppositional exercise),
• Physiological (increased heart rate with or without inability to speak, effort with or without shortness of breath),
• Psychological (with or without uncertainty, with or without encouragement, with or without success feedback, with or without spatio-temporal constraints).

Learning to lift from the ground must be integrated into the program.

The personalization of exercises is a component of program effectiveness (Montero-Odasso, 2022).

• The NPI prepares all participants to pursue pleasant, independent physical activity in their immediate environment, in line with public health recommendations on frequency, intensity and variety.
• Medication and dietary supplements should be regularly reviewed by the attending physician (HAS, 2024). 
• Alcohol consumption should be limited, particularly in cases of dizziness or drowsiness (HAS, 2024).
• Regular visits to an ophthalmologist are recommended, as visual impairment caused by advanced glaucoma or cataracts, for example, is a risk factor for falls (HAS, 2024).
• Footwear should fit snugly, with good support both inside and out (HAS, 2024).

• Warm-up at the beginning of the session and cool-down at the end.
• Organization of safe practices adapted to difficulties and/or disabilities.

• Medical certificate of no contraindication to physical exercise and medical follow-up.
• Free of charge, but the practitioner must systematically quote the program.
• University diploma (DU) PEMS-ES from the University of Montpellier required.

• Kinesiologist (adapted physical activity teacher).
• University diploma (DU) from the University of Montpellier.

Prototypical study
Hue O et al. Influence d'une pratique motrice de type "posture-équilibration-motricité" sur les capacités posturales du sujet âgé [Influence of a typical "posture-balance-motivity" motor practice on the postural capacities of elderly subjects]. Ann Readapt Med Phys. 2001 Mar;44(2):81-8. http://dx.doi.org/10.1016/s0168-6054(00)00064-7


Pivotal mechanistic study
Grasso C et al. Effects of a short period of postural training on postural stability and vestibulospinal reflexes. PLoS One. 2023 Jun 12;18(6):e0287123. http://dx.doi.org/10.1371/journal.pone.0287123


Pivotal intervention trials
Albinet C et al. Contrôle attentionnel de la stabilité posturale chez la personne âgée institutionnalisée: effets d'un programme d'activité physique [Attentional control of postural stability in institutionalised elderly people: effects of a physical exercise program]. Ann Readapt Med Phys. 2006 Dec;49(9):625-31. http://dx.doi.org/10.1016/j.annrmp.2006.06.004 

Bernard PL et al. Influence d'une activité physique sur les capacités posturales de personnages âgées: effets du temps de pratique [Influence of physical activity on postural capacities of elderly: effect of time of training]. Ann Readapt Med Phys. 2004 May;47(4):157-63. http://dx.doi.org/10.1016/j.annrmp.2004.01.006


Intervention studies assessing the risks
Albinet C et al. Contrôle attentionnel de la stabilité posturale chez la personne âgée institutionnalisée: effets d'un programme d'activité physique [Attentional control of postural stability in institutionalised elderly people: effects of a physical exercise program]. Ann Readapt Med Phys. 2006 Dec;49(9):625-31. http://dx.doi.org/10.1016/j.annrmp.2006.06.004 

Bernard PL, et al. Relationship between a three-month physical conditioning "posture-balance-motricity and health education" (PBM-HE) program on postural and balance capacities of sedentary older adults: influence of initial motor profile. Eur Rev Aging Phys Act. 2018 Nov 20;15:14. http://dx.doi.org/10.1186/s11556-018-0203-0


Implementation study in Europe
Bernard PL et al. Relationship between a three-month physical conditioning "posture-balance-motricity and health education" (PBM-HE) program on postural and balance capacities of sedentary older adults: influence of initial motor profile. Eur Rev Aging Phys Act. 2018 Nov 20;15:14. http://dx.doi.org/10.1186/s11556-018-0203-0


Others
Dyer SM et al. Exercise for falls prevention in aged care: systematic review and trial endpoint meta-analyses. Age Ageing. 2023 Dec 1;52(12):afad217. http://dx.doi.org/10.1093/ageing/afad217 

Guirguis-Blake JM et al. Interventions to prevent falls in older adults: Updated evidence report and systematic review for the US preventive services task force. JAMA. 2024 Jul 2;332(1):58-69. http://dx.doi.org/10.1001/jama.2024.4166 

HAS. Personnes âgées à risque de chute : Prescription d’activité physique. HAS, La Plaine, 2024. https://www.has-sante.fr/upload/docs/application/pdf/2024-04/synthese_aps_personnes_agees_a_risque_de_chute.pdf

Hopewell S et al. Multifactorial and multiple component interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews 2018;7(CD012221). http://dx.doi.org/10.1002/14651858.CD012221.pub2 

INSERM. Activité physique et prévention des chutes chez les personnes âgées. Paris, INSERM, 2014. https://www.inserm.fr/wp-content/uploads/media/entity_documents/inserm-ec-2015-chutespersonnesagees-synthese.pdf 

Montero-Odasso M et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing 2022;51(9). http://dx.doi.org/10.1093/ageing/afac205 

OMS. Lignes directrices de l’OMS sur l’activité physique et la sédentarité Genève: OMS; 2021. https://apps.who.int/iris/bitstream/handle/10665/349728/9789240032118-fre.pdf?sequence=1&isAllowed=y 

Sherrington C et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019 Jan 31;1(1):CD012424. http://dx.doi.org/10.1002/14651858.CD012424.pub2 

Wang BY et al. Exercise for fall prevention in community-dwelling people aged 60+: more effective in trials with higher fall rates in control groups. J Clin Epidemiol. 2023 Jul;159:116-127. http://dx.doi.org/10.1016/j.jclinepi.2023.05.003