, Volume 22, Issue 5, pp 497–506 | Cite as

Static and dynamic balances of patients with acromegaly and impact of exercise on balance

  • Ozlem Haliloglu
  • Nuri Topsakal
  • Filiz Camliguney
  • Ozge Polat Korkmaz
  • Serdar Sahin
  • Birol Cotuk
  • Pinar KadiogluEmail author
  • Oya Erkut



Patients with acromegaly may have balance abnormalities due to changes in body composition. We aim to compare static and dynamic balances in patients with acromegaly and healthy volunteers, and to evaluate the effects of exercise on balance in patients with acromegaly.


This prospective study included 25 patients with acromegaly followed at endocrinology clinic of Cerrahpasa Medical Faculty and 13 healthy volunteers. The acromegalic patients were divided into 2 groups. Group A (n = 11) attended an exercise program 3 days/week for 3 months, whereas group B (n = 14) and healthy volunteers (Group C) were exercise-free. Bipedal and unipedal stance static and dynamic balance tests were performed using a Prokin 252N device.


The ages, demographic characteristics, and body compositions were similar. In acromegalic patients, the static balance parameters of displacement of center-of-pressure in anterior–posterior direction (C.o.P.Y) while eyes open (p = 0.002) and on left leg (p = 0.001), in left–right direction (C.o.P.X) on right leg (p = 0.03), eyes-closed average medio-lateral velocity (AMLV) (p = 0.001) and the dynamic parameter of forward/backward front/right standard deviation (FBFRSD) (p = 0.02) were significantly different from healthy controls. When the exercise effect on balance was evaluated between group A and B, there were significant improvements in most parameters of dynamic balance measurements of both forward–backward and medial–lateral sway (FBFRSD, FBDME, and RLBLSD) (p = 0.02, p = 0.02, and p = 0.004, respectively) after exercise in group A.


Patients with acromegaly had impairments at various static and dynamic balance parameters, especially in posterior direction. After a 3-month exercise program, the dynamic balance profoundly improved, but static balance was relatively preserved in patients with acromegaly.


Acromegaly Dynamic balance Exercise Static balance 



We thank Mr. David F. Chapman for his help regarding English language editing.


The study was supported by the Research Fund of Istanbul University, Istanbul, Turkey (Project No: 22561).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights

The study was approved by the local ethics committee of Istanbul University Cerrahpasa Medical Faculty and all procedures performed in studies involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Colao A, Ferone D, Marzullo P, Lombardi G (2004) Systemic complications of acromegaly: epidemiology, pathogenesis, and management. Endocr Rev 25(1):102–152CrossRefGoogle Scholar
  2. 2.
    Woodhouse LJ, Mukherjee A, Shalet SM, Ezzat S (2006) The influence of growth hormone status on physical impairments, functional limitations, and health-related quality of life in adults. Endocr Rev 27(3):287–317CrossRefGoogle Scholar
  3. 3.
    Ben-Shlomo A, Sheppard MC, Stephens JM, Pulgar S, Melmed S (2011) Clinical, quality of life, and economic value of acromegaly disease control. Pituitary 14(3):284–294CrossRefGoogle Scholar
  4. 4.
    Katznelson L (2009) Alterations in body composition in acromegaly. Pituitary 12(2):136–142CrossRefGoogle Scholar
  5. 5.
    Johanson NA, Vigorita VJ, Goldman AB, Salvati EA (1983) Acromegalic arthropathy of the hip. Clin Orthop Relat Res 173:130–139Google Scholar
  6. 6.
    Claessen KM, Mazziotti G, Biermasz NR, Giustina A (2016) Bone and joint disorders in acromegaly. Neuroendocrinology 103(1):86–95CrossRefGoogle Scholar
  7. 7.
    Wassenaar MJ, Biermasz NR, Bijsterbosch J, Pereira AM, Meulenbelt I, Smit JW, Roelfsema F, Kroon HM, Romijn JA, Kloppenburg M (2011) Arthropathy in long-term cured acromegaly is characterised by osteophytes without joint space narrowing: a comparison with generalised osteoarthritis. Ann Rheum Dis 70(2):320–325CrossRefGoogle Scholar
  8. 8.
    Lopes AJ, da Silva DP, Kasuki L, Gadelha MR, Camilo GB, Guimaraes FS (2014) Posture and balance control in patients with acromegaly: results of a cross-sectional study. Gait Posture 40(1):154–159CrossRefGoogle Scholar
  9. 9.
    Kinzey SJ, Armstrong CW (1998) The reliability of the star-excursion test in assessing dynamic balance. J Orthop Sports Phys Ther 27(5):356–360CrossRefGoogle Scholar
  10. 10.
    Goldie PA, Bach TM, Evans OM (1989) Force platform measures for evaluating postural control: reliability and validity. Arch Phys Med Rehabil 70(7):510–517Google Scholar
  11. 11.
    Sell TC (2012) An examination, correlation, and comparison of static and dynamic measures of postural stability in healthy, physically active adults. Phys Ther Sport 13(2):80–86CrossRefGoogle Scholar
  12. 12.
    do Carmo CM, Almeida da Rocha B, Tanaka C (2017) Effects of individual and group exercise programs on pain, balance, mobility and perceived benefits in rheumatoid arthritis with pain and foot deformities. J Phys Ther Sci 29(11):1893–1898CrossRefGoogle Scholar
  13. 13.
    Duregon F, Vendramin B, Bullo V, Gobbo S, Lucia C, Di Blasio A, Neunhaeuserer D, Zaccaria M, Bergamin M, Ermolao A (2017) Effects of exercise on cancer patients suffering chemotherapy-induced peripheral neuropathy undergoing treatment: a systematic review. Crit Rev Oncol Hematol 121:90–100CrossRefGoogle Scholar
  14. 14.
    Hamed A, Bohm S, Mersmann F, Arampatzis A (2017) Exercise dynamic stability under unstable conditions increases muscle strength and balance ability in the elderly. Scand J Med Sci Sports 28(3):961–971CrossRefGoogle Scholar
  15. 15.
    Katznelson L, Laws ER Jr, Melmed S, Molitch ME, Murad MH, Utz A, Wass JA, Endocrine S (2014) Acromegaly: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 99(11):3933–3951CrossRefGoogle Scholar
  16. 16.
    Hugel F, Cadopi M, Kohler F, Perrin P (1999) Postural control of ballet dancers: a specific use of visual input for artistic purposes. Int J Sports Med 20(2):86–92CrossRefGoogle Scholar
  17. 17.
    Freda PU, Shen W, Reyes-Vidal CM, Geer EB, Arias-Mendoza F, Gallagher D, Heymsfield SB (2009) Skeletal muscle mass in acromegaly assessed by magnetic resonance imaging and dual-photon x-ray absorptiometry. J Clin Endocrinol Metab 94(8):2880–2886CrossRefGoogle Scholar
  18. 18.
    Khaleeli AA, Levy RD, Edwards RH, McPhail G, Mills KR, Round JM, Betteridge DJ (1984) The neuromuscular features of acromegaly: a clinical and pathological study. J Neurol Neurosurg Psychiatr 47(9):1009–1015CrossRefGoogle Scholar
  19. 19.
    Nagulesparen M, Trickey R, Davies MJ, Jenkins JS (1976) Muscle changes in acromegaly. Br Med J 2(6041):914–915CrossRefGoogle Scholar
  20. 20.
    Guedes da Silva DP, Guimaraes FS, Dias CM, Guimaraes Sde A, Kasuki L, Gadelha MR, Camilo GB, Lopes AJ (2013) On the functional capacity and quality of life of patients with acromegaly: are they candidates for rehabilitation programs? J Phys Ther Sci 25(11):1497–1501CrossRefGoogle Scholar
  21. 21.
    Homem TS, Guimaraes FS, Soares MS, Kasuki L, Gadelha MR, Lopes AJ (2017) Balance control and peripheral muscle function in aging: a comparison between individuals with acromegaly and healthy subjects. J Aging Phys Act 25(2):218–227CrossRefGoogle Scholar
  22. 22.
    Atmaca A, Tander B, Kan EK, Ulus Y, Ecemis GC, Akyol Y, Tomak L (2013) Assessment of balance performance and fear of falling in acromegalic patients: a comparative study. J Endocrinol Invest 36(9):759–763Google Scholar
  23. 23.
    Liu ZQ, Yang F (2017) Obesity may not induce dynamic stability disadvantage during overground walking among young adults. PLoS ONE 12(1):e0169766CrossRefGoogle Scholar
  24. 24.
    Bučková K, Lobotková J, Hirjaková Z, Bzdúšková D, Hlavačka F (2014) Postural control assessed by limit of stability in obese adults. Act Nerv Super Rediviva 56(3–4):87–90Google Scholar
  25. 25.
    Hue O, Simoneau M, Marcotte J, Berrigan F, Doré J, Marceau P, Marceau S, Tremblay A, Teasdale N (2007) Body weight is a strong predictor of postural stability. Gait Posture 26(1):32–38CrossRefGoogle Scholar
  26. 26.
    Pompeu JE, Romano RS, Pompeu SM, Lima SM (2012) Static and dynamic balance in subjects with ankylosing spondylitis: literature review. Rev Bras Reumatol 52(3):409–416CrossRefGoogle Scholar
  27. 27.
    Lam FM, Huang MZ, Liao LR, Chung RC, Kwok TC, Pang MY (2018) Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review. J Physiother 64(1):4–15CrossRefGoogle Scholar
  28. 28.
    Lee JH, Howell DR, Meehan WP 3rd, Iverson GL, Gardner AJ (2017) Effects of exercise on sport concussion assessment tool-third edition performance in professional athletes. Orthop J Sports Med 5(9):2325967117727261CrossRefGoogle Scholar
  29. 29.
    Kargarfard M, Shariat A, Ingle L, Cleland JA, Kargarfard M (2017) Randomized controlled trial to examine the impact of aquatic exercise training on functional capacity, balance, and perceptions of fatigue in female patients with multiple sclerosis. Arch Phys Med Rehabil 99(2):234–241CrossRefGoogle Scholar
  30. 30.
    Lacroix A, Hortobagyi T, Beurskens R, Granacher U (2017) Effects of supervised vs. unsupervised training programs on balance and muscle strength in older adults: A systematic review and meta-analysis. Sports Med 47(11):2341–2361CrossRefGoogle Scholar
  31. 31.
    Demontis A, Trainito S, Del Felice A, Masiero S (2016) Favorable effect of rehabilitation on balance in ankylosing spondylitis: a quasi-randomized controlled clinical trial. Rheumatol Int 36(3):333–339CrossRefGoogle Scholar
  32. 32.
    Atilgan OE (2013) Effects of trampoline training on jump, leg strength, static and dynamic balance of boys. Sci Gymnast J 5(2):15–25Google Scholar
  33. 33.
    Hatipoglu E, Topsakal N, Atilgan OE, Alcalar N, Camliguney AF, Niyazoglu M, Cotuk HB, Kadioglu P (2014) Impact of exercise on quality of life and body-self perception of patients with acromegaly. Pituitary 17(1):38–43CrossRefGoogle Scholar
  34. 34.
    Hatipoglu E, Topsakal N, Erkut Atilgan O, Camliguney AF, Ikitimur B, Ugurlu S, Niyazoglu M, Cotuk HB, Kadioglu P (2015) Physical and cardiovascular performance in cases with acromegaly after regular short-term exercise. Clin Endocrinol (Oxf) 83(1):91–97CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Endocrinology-Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical FacultyIstanbul University-CerrahpasaIstanbulTurkey
  2. 2.Department of Sport Health and Science, School of Physical Education and SportsMarmara UniversityIstanbulTurkey

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