The effect of exercise on gait patterns in older women: a randomized controlled trial

Restoring walking ability in older adults with arm-in-arm gait training: study protocol for the AAGaTT randomized controlled trial

CONTEXT

Falls are a significant problem among older adults. While balance and functional exercises have been shown to be effective, it remains unclear whether regular walking has specific effects on reducing the risk of falls.

RATIONALE

Older people who fall frequently have impaired gait patterns. Recent studies have suggested using interpersonal synchronization: while walking arm-in-arm, an older person synchronizes steps with a younger person to reinstate a better gait pattern. This method of gait training may reduce the risk of falls.

OBJECTIVE

The aim is to assess the efficacy of an arm-in-arm gait-training program in older people.

DESIGN

The arm-in-arm gait training trial (AAGaTT) is a single-site, open label, two-arm, randomized controlled trial.

PARTICIPANTS

We will enroll 66 dyads of older people and their younger "gait instructors". The older participants must be > 70 years old with adequate walking ability. They must have experienced a fall in the year prior to study entry.

INTERVENTION

Dyads will walk an indoor course for 30 min either side-by-side without contact (control group) or arm-in-arm while synchronizing their gait (intervention group). The gait training will be repeated three times a week for four weeks.

OUTCOMES

The main outcome will be the walking speed measured in five-minute walking trials performed at baseline and at the end of each intervention week (week 1 - week 4), and at week 7. Gait quality will be assessed using accelerometers. We will also assess perceived physical activity and health using questionnaires. Finally, we will monitor fall incidence over 18 months. We will evaluate whether outcomes are more improved in the intervention group compared to the control group. In addition, interviews will be conducted to assess the perception of the gait training.

EXPECTED RESULTS

Recent advances in the neurophysiology of motor control have shown that synchronizing gait to external cues or to a human partner can increase the efficiency of gait training. The expected benefits of arm-in-arm gait training are: reduced risk of falls, safe treatment with no adverse effects, and high adherence. This gait training program could be a low-cost intervention with positive effects on the health and well-being of seniors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05627453. Date of registration: 11.25.2022.

Responsiveness of Daily Life Gait Quality Characteristics over One Year in Older Adults Who Experienced a Fall or Engaged in Balance Exercise

Gait quality characteristics obtained from daily-life accelerometry are clinically relevant for fall risk in older adults but it is unknown whether these characteristics are responsive to changes in gait quality. We aimed to test whether accelerometry-based daily-life gait quality characteristics are reliable and responsive to changes over one year in older adults who experienced a fall or an exercise intervention. One-week trunk acceleration data were collected from 522 participants (65-97 years), at baseline and after one year. We calculated median values of walking speed, regularity (sample entropy), stability (logarithmic rate of divergence per stride), and a gait quality composite score, across all 10-s gait epochs derived from one-week gait episodes. Intraclass correlation coefficients (ICC) and limits of agreement (LOA) were determined for 198 participants who did not fall nor participated in an exercise intervention during follow-up. For responsiveness to change, we determined the number of participants who fell (n = 209) or participated in an exercise intervention (n = 115) that showed a change beyond the LOA. ICCs for agreement between baseline and follow-up exceeded 0.70 for all gait quality characteristics except for vertical gait stability (ICC = 0.69, 95% CI [0.62, 0.75]) and walking speed (ICC = 0.68, 95% CI [0.62, 0.74]). Only walking speed, vertical and mediolateral gait stability changed significantly in the exercisers over one year but effect sizes were below 0.2. The characteristic associated with most fallers beyond the LOA was mediolateral sample entropy (4.8% of fallers). For the exercisers, this was gait stability in three directions and the gait quality composite score (2.6% of exercisers). The gait quality characteristics obtained by median values over one week of trunk accelerometry were not responsive to presumed changes in gait quality after a fall or an exercise intervention in older people. This is likely due to large (within subjects) differences in gait behaviour that participants show in daily life.

Photobiomodulation Therapy to Promote Angiogenesis in Diabetic Mice with Hindlimb Ischemia

Objective: To assess whether photobiomodulation therapy (PBMT) induces angiogenesis in diabetic mice with hindlimb ischemia (HLI). Background: Patients with diabetes mellitus (DM) are at high risk of developing peripheral arterial disease (PAD) in the lower extremities. PBMT has been shown to promote angiogenesis both in vitro and in vivo and could be a treatment for DM patients with PAD. Methods: Femoral artery ligation/excision in mice was performed to induce HLI as an animal model of PAD. PBMT at a dose of 660 nm and 1.91 J/cm² was delivered for 10 min on 5 consecutive days after the HLI surgery. Control mice received HLI only. Mice in the DM group were injected with streptozocin to induce diabetes before HLI surgery. Mice in the laser and DM+ laser groups received both HLI and PBMT, and the latter group had induced DM. After the laser treatment, lower limb blood flow was evaluated by laser Doppler. The capillary density and CD31 were analyzed by immunofluorescence staining, and protein levels of vascular endothelial growth factor (VEGF)-A, hypoxia-inducible factor-1α (HIF-1α), inducible nitric oxide synthase (iNOS), endothelial nitric oxide synthase (eNOS), and extracellular signal-regulated kinases (ERK) were measured by Western blotting of tissue samples. Results: Compared with the control and DM mice, the laser and DM+ laser groups had more than double the capillary density and blood perfusion rate. Levels of CD31 and VEGF-A proteins in groups that received laser were increased by 1.9- to 3.2-fold compared with groups that did not undergo laser treatment. Animals treated with PBMT exhibited significantly increased HIF-1α expression and ERK phosphorylation compared with animals that did not receive this treatment, and the amount of phospho-eNOS and iNOS increased and decreased, respectively. Conclusions: PBMT can induce therapeutic angiogenesis, indicating that low intensity laser could be a novel treatment for PAD patients.

Accuracy and Repeatability of Spatiotemporal Gait Parameters Measured with an Inertial Measurement Unit

In recent years, interest in finding alternatives for the evaluation of mobility has increased. Inertial measurement units (IMUs) stand out for their portability, size, and low price. The objective of this study was to examine the accuracy and repeatability of a commercially available IMU under controlled conditions in healthy subjects. A total of 36 subjects, including 17 males and 19 females were analyzed with a Wiva Science IMU in a corridor test while walking for 10 m and in a threadmill at 1.6 km/h, 2.4 km/h, 3.2 km/h, 4 km/h, and 4.8 km/h for one minute. We found no difference when we compared the variables at 4 km/h and 4.8 km/h. However, we found greater differences and errors at 1.6 km/h, 2.4 km/h and 3.2 km/h, and the latter one (1.6 km/h) generated more error. The main conclusion is that the Wiva Science IMU is reliable at high speeds but loses reliability at low speeds.

Effects of multimodal agility-like exercise training compared to inactive controls and alternative training on physical performance in older adults: a systematic review and meta-analysis

Background

Multimodal exercise training (MT) as a time-efficient training modality promotes a wide range of physical dimensions. Incorporating agility-like training aspects (coordination, changes of direction and velocity) into MT may further enhance physical outcomes highly relevant for activities of daily living. This meta-analysis investigated the effects of multimodal agility-like exercise training (MAT) on physical and cognitive performance compared to inactive (IC) and active controls (AC) in older adults.

Methods

Literature search was conducted in four health-related databases (PubMed, SCOPUS, SPORTDiscus and Web of Science). Randomized controlled trials with pre-post testing applying MAT (including aspects of training with at least two different traditional domains: strength, balance, endurance) and an agility-like component in community-dwelling older adults were screened for eligibility. Standardized mean differences (SMD) adjusting for small sample sizes (hedges’ g) were used to extract main outcomes (strength, gait, balance, mobility, endurance, cognition). Statistical analysis was conducted using a random effects inverse-variance model.

Results

Twenty trials with 1632 older adults were included. All effects were significantly in favour of MAT compared to IC: Strength, mobility and endurance revealed large overall effects (SMD: 0.88, 0.84, 1.82). Balance showed moderate effects (SMD: 0.6). Small overall effects were observed for gait (SMD: 0.41). Few data were available to compare MAT vs. AC with negligible or small effects in favour of MAT. Funnel plots did not reveal clear funnel shapes, indicating a potential risk of bias.

Conclusions

MAT may serve as a time-efficient training modality to induce positive effects in different physical domains. Compared to isolated training, MAT allows equal effect sizes at lower overall training volumes. More studies are needed to investigate the potential value of MAT with systematic training and load control, especially compared to other exercise-based interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s11556-021-00256-y.

The Effects of a Walking Intervention on Gait Parameters in Older Adults Residing in Long-Term Care: A Randomized Controlled Trial

OBJECTIVES

We examined the effects of a walking intervention in older adults residing in long-term care (LTC) homes on gait velocity (primary outcome), and stride length, cadence and heel-to-heel base of support (secondary outcomes) compared to those in an interpersonal interaction control group and a care-as-usual control group at 16-weeks post-intervention.

METHODS

These previously unpublished gait data were collected as part of a larger prospective, randomized, three group study. One hundred and sixty-eight participants residing in 12 LTC homes were randomized into: a) a walking group (n=57) - 1:1 supervised, individualized, progressive, 30 minutes, five times a week walking program for 16 weeks; b) an interpersonal interaction group (n=55) - stationary 1:1 conversation time with research personnel; and, c) a care-as-usual control group (n=56). Gait was assessed at baseline and 16-weeks post-intervention using the GAITRite® computerized system. One-way Analysis of Covariance (ANCOVA), controlling for age, sex, cognitive status and baseline gait parameter (velocity, stride length, cadence, heel-to-heel base of support) was used to examine differences among groups for velocity, stride length, cadence, and heel-to-heel base of support at 16-weeks post-intervention.

RESULTS

Ninety-one participants with available data were included in this analysis: walking group (n=31/57, mean age=82.77±6.75 years); interpersonal interaction group (n=31/55, mean age=82.74±9.27 years); care-as-usual control group (n=29/56, mean age=85.40±8.78 years). ANCOVA showed a significant difference in the mean gait velocity at 16-weeks post-intervention [F(2, 84) =6.99, p=0.0006); η2 (95%CI)=0.16 (0.02, 0.27)]. Post hoc comparisons using Sidak test showed that the estimated marginal mean (EMM) for velocity for the walking group [EMM (SE), 0.51m/s (0.03)] was significantly higher compared to the interpersonal interaction group [EMM (SE), 0.38m/s (0.03); t(83)=3.15, p=0.007] and the care-as-usual control group [EMM (SE), 0.38m/s (0.03)]; t(83)=3.32, p=0.004]. No significant difference was observed between groups for stride length, cadence or heel-to-heel base of support.

CONCLUSION

LTC residents with limited physical functioning showed significant improvement in gait velocity but not in stride length, cadence or heel-to-heel base of support after a 16-week walking intervention.

The effect of Qigong Wuqinxi for osteopenia and primary osteoporosis: A protocol for systematic review and meta analysis

INTRODUCTION

Osteoporosis (OP) and related fragility fractures are a significant public health problem which leads to pain, disability, loss function of independence, considerable complications and increased mortality. Exercise training is the only alternative strategy to improve multiple skeletal and fall risk factors simultaneously. Wuqinxi is 1 of the Chinese mind-body exercises using to improve physical and mental health and fight against diseases for thousands of years. Our study aims to systematically review the existing literature to further explore the efficacy and safety of Wuqinxi in the prevention and treatment of osteopenia and OP.

METHODS AND ANALYSIS

The following electronic databases (PubMed, Science Citation Index, Embase (Ovid) database, the Cochrane Library, the China National Knowledge Infrastructure, the China Biology Medicine disc, the China Science and Technology Journal Database, the Wan fang Database, ClinicalTrials.gov and the Chinese Clinical Trial Registry Platform) will be searched from the beginning to 1 June 2020. Only randomized controlled trials will be enrolled, in which the intervention group must include a form of Wuqinxi, while the control group can involve other conventional treatment or no intervention. The potential outcome measures will include bone mineral density values, bone turnover markers, fragility fractures, quality of life, pain scores, and adverse events. The Cochrane risk of bias assessment tool will be used to assess the risk of bias in each study.

RESULTS

The current study is a protocol for systematic review and meta-analysis without results, and data analysis will be carried out after the protocol. We will share our findings in the third quarter of 2021.

CONCLUSION

This review aims to evaluate up-to-date evidence of Wuqinxi for bone health in English or Chinese language studies, and explore whether Wuqinxi can be used as an adjuvant treatment for osteoporosis and osteopenia.

ETHICS AND DISSEMINATION

Ethical approval is not required as the review is a secondary study based on published literature. The results of the study will be published in peer-reviewed publications and disseminated electronically or in print.

PROTOCOL REGISTRATION NUMBER

INPLASY202040135.

Step Rate and Worsening of Patellofemoral and Tibiofemoral Joint Osteoarthritis in Women and Men: The Multicenter Osteoarthritis Study

OBJECTIVE

To determine the association of self-selected walking step rate with worsening of cartilage damage in the patellofemoral (PF) joint and tibiofemoral (TF) joint compartments at a 2-year follow-up visit.

METHODS

The Multicenter Osteoarthritis Study (MOST) is a prospective cohort of men and women with or at risk of knee osteoarthritis. Self-selected step rate was measured using an instrumented GAITRite walkway (CIR Systems) at the 60-month visit. Cartilage damage was semiquantitatively graded on magnetic resonance images at the 60- and 84-month visits in the medial and lateral PF and TF compartments. Step rate was divided into quartiles, and logistic regression was used to determine the association of step rate with the risk of worsening cartilage damage in men and women separately. Analyses were adjusted for age, body mass index, and knee injury/surgery.

RESULTS

A total of 1,089 participants were included. Mean ± SD age was 66.9 ± 7.5 years, mean ± SD body mass index was 29.6 ± 4.7 kg/m2 , and 62.3% of the participants were women. Women with the lowest step rate had increased risk of lateral PF (risk ratio [RR] 2.1 [95% confidence interval (95% CI) 1.1-3.8]) and TF (RR 1.8 [95% CI 1.1-2.9]) cartilage damage worsening 2 years later compared to those with the highest step rate. Men with the lowest step rate had increased risk of medial TF cartilage damage worsening 2 years later (RR 2.1 [95% CI 1.1-3.9]).

CONCLUSION

Lower step rate was associated with increased risk of cartilage damage worsening in the lateral PF and TF compartments in women and worsening medial TF joint damage in men. Future research is necessary to understand the influence of step rate manipulation on joint biomechanics in women and men.

Reference values of gait parameters measured with a plantar pressure platform in community-dwelling older Japanese adults

Background

Gait measures such as gait speed, stride length, step width, and stance duration change with advanced age and are associated with adverse health outcomes among older adults. The stride-to-stride variabilities of gait measures are also related to falls and cognitive decline in older adults; however, reference values of these gait parameters in older Japanese adults do not exist. This study aimed to determine the reference values of gait parameters as measured by a plantar pressure platform in community-dwelling older Japanese adults.

Methods

Community-dwelling adults (N=1,212) who were independent in basic activities of daily living and aged 70-96 years (491 men, 721 women) completed the gait performance measurement in a geriatric health assessment. We assessed 10 gait performance measures with a plantar pressure platform system (P-WALK, BTS Bioengineering) and calculated means and coefficient of variations (CVs) of the gait measures as well as quintiles for those gait parameters per age group among men and women.

Results

Mean (SDs) of gait speed, stride length, step width, and stance durations were 1.26 (0.24) meters per second (m/s), 121.9 (19.8) cm, 24.0 (3.2) cm, and 552.4 (60.4) milliseconds (ms), respectively, in men, and 1.27 (0.21) m/s, 115.7 (16.3) cm, 17.9 (2.8) cm, and 517.6 (59.8) ms, respectively, in women. Mean of CVs (SD) of stride length, step width, and single-stance duration were 2.76 (1.35), 12.06 (3.98), and 5.74 (2.66), respectively, in men and 2.69 (1.24), 15.65 (4.53), and 5.77 (2.40), respectively, in women. Gait parameters (except CVs of step width) declined significantly with age regardless of gender (P< 0.01 for trends).

Conclusion

This study determined age group dependent gait parameter reference values, presented as means with quintile ranges, in community-dwelling older Japanese adults. These reference values may be useful metrics for gait assessment in the elderly.

Effects of Pulmonary Rehabilitation on Gait Characteristics in Patients with COPD

Pulmonary rehabilitation (PR) improves lower-limb muscle function in patients with chronic obstructive pulmonary disease (COPD). However, it remains unclear whether patients improve gait characteristics, in particular stride-to-stride fluctuations that are associated with fall risks. This study aims to identify whether, and to what extent, PR affects positively gait characteristics in COPD. In this prospective observational study, 44 COPD patients (aged: 62 ± 7 years; Forced expiratory volume in 1 s 56 ± 20% predicted) performed self-paced, treadmill 6-min-walk tests (Gait Real-time Analysis Interactive Lab) before and after PR, while spatiotemporal parameters and center of mass position were recorded (100 Hz, Vicon Nexus). Standard deviation, coefficient of variation, predictability (sample entropy), and consistency in organization (local divergence exponent) were calculated. Sub-analysis was performed to identify gait differences between good and poor responders (<30 m change in a 6-min-walk distance). Patients demonstrated shorter stride times (p = 0.001) and improved lower-limb muscle function (p < 0.001) following PR. The good responders had a greater increase in stride length (p < 0.001) and a greater decrease in stride time (p < 0.001) compared to the poor responders. Current PR improved stride time in patients, while movement patterns within stride-to-stride fluctuations did not change. Training programs specifically targeting balance issues and gait function may be beneficial in improving gait characteristics in COPD.

Statistical prediction of load carriage mode and magnitude from inertial sensor derived gait kinematics

Load carriage induces systematic alterations in gait patterns and pelvic-thoracic coordination. Leveraging this information, the objective of this study was to develop and assess a statistical prediction algorithm that uses body-worn inertial sensor data for classifying load carrying modes and load levels. Nine men participated in an experiment carrying a hand load in four modes: one-handed right and left carry, and two-handed side and anterior carry, each at 50% and 75% of the participant's maximum acceptable weight of carry, and a no-load reference condition. Twelve gait parameters calculated from inertial sensor data for each gait cycle, including gait phase durations, torso and pelvis postural sway, and thoracic-pelvic coordination were used as predictors in a two-stage hierarchical random forest classification model with Bayesian inference. The model correctly classified 96.9% of the carrying modes and 93.1% of the load levels. Coronal thoracic-pelvic coordination and pelvis postural sway were the most relevant predictors although their relative importance differed between carrying mode and load level prediction models. This study presents an algorithmic framework for combining inertial sensing with statistical prediction with potential use for quantifying physical exposures from load carriage.

Multiple-modality exercise and mind-motor training to improve mobility in older adults: A randomized controlled trial

OBJECTIVE

To investigate the effects of multiple-modality exercise with or without additional mind-motor training on mobility outcomes in older adults with subjective cognitive complaints.

METHODS

This was a 24-week randomized controlled trial with a 28-week no-contact follow-up. Community-dwelling older adults underwent a thrice -weekly, Multiple-Modality exercise and Mind-Motor (M4) training or Multiple-Modality (M2) exercise with an active control intervention (balance, range of motion and breathing exercises). Study outcomes included differences between groups at 24weeks and after the no-contact follow-up (i.e., 52weeks) in usual and dual-task (DT, i.e., serial sevens [S7] and phonemic verbal fluency [VF] tasks) gait velocity, step length and cycle time variability, as well as DT cognitive accuracy.

RESULTS

127 participants (mean age 67.5 [7.3] years, 71% women) were randomized to either M2 (n=64) or M4 (n=63) groups. Participants were assessed at baseline, intervention endpoint (24weeks), and study endpoint (52weeks). At 24weeks, the M2 group demonstrated greater improvements in usual gait velocity, usual step length, and DT gait velocity (VF) compared to the M4 group, and no between- or within-group changes in DT accuracy were observed. At 52weeks, the M2 group retained the gains in gait velocity and step length, whereas the M4 group demonstrated trends for improvement (p=0.052) in DT cognitive accuracy (VF).

CONCLUSIONS

Our results suggest that additional mind-motor training was not effective to improve mobility outcomes. In fact, participants in the active control group experienced greater benefits as a result of the intervention.

Associations of maximal voluntary isometric hip extension torque with muscle size of hamstring and gluteus maximus and intra-abdominal pressure

PURPOSE

Muscle size of the hamstring and gluteus maximus (GM) as well as intra-abdominal pressure (IAP) are considered as factors affecting the torque development during hip extension. This study examined the associations of torque development during maximal voluntary isometric hip extension with IAP and muscle size of the hamstring and GM.

METHODS

Anatomical cross-sectional area (ACSA) of the hamstring and thickness of GM were determined in 20 healthy young males using an ultrasonography apparatus (Experiment 1). Torque and IAP were simultaneously measured while subjects performed maximal voluntary isometric hip extension. The IAP was measured using a pressure transducer placed in the rectum and determined at the time at which the developed torque reached to the maximal. In Experiment 2, torque and IAP were measured during maximal voluntary isometric hip flexion in 18 healthy young males.

RESULTS

The maximal hip extension torque was significantly correlated with the IAP (r = 0.504, P = 0.024), not with the ACSA of the hamstring (r = 0.307, P = 0.188) or the thickness of GM (r = 0.405, P = 0.076). The relationship was still significant even when the ACSA of the hamstring and the thickness of GM were adjusted statistically (r = 0.486, P = 0.041). The maximal hip flexion torque was not significantly correlated with the IAP (r = -0.118, P = 0.642).

CONCLUSION

The current results suggest that IAP can contribute independently of the muscle size of the agonists to maximal voluntary hip extension torque.

Experimental Evaluation of Energy Efficiency for a Soft Wearable Robotic Suit

This paper presents a new soft wearable robotic suit for energy-efficient walking in daily activities for elderly persons. The presented robotic suit provides a small yet effective assistive force for hip flexion through winding belts that include elastic elements. In addition, it does not restrict the range of movement in the lower limbs. Moreover, its structure is simple and lightweight, and thus wearers can easily take the device on and off by themselves. Experimental results on nine elderly subjects (age = 74.23.7 years) show that the robotic suit worn and powered on (PON) significantly reduced energy expenditure by an average of 5.9 % compared with the condition of worn but powered off (POFF). Furthermore, compared with the POFF condition, there was a significant improvement in gait characteristics in the PON condition for all subjects.

Reliability of the OptoGait portable photoelectric cell system for the quantification of spatial-temporal parameters of gait in young adults

Determining progress in gait requires a reliable method. However, achieving standard assessment results in the clinical setting can be challenging. Searching for a reliable tool, we tested OptoGait, a tool that has floor-level, high-density photoelectric cells that can be used to determine patterns of spatial-temporal gait on the basis of 19 variables: step length, stride length, distance, total contact time, step time, walking speed, acceleration, progressive step time, cadence, gait cycle, stance phase, swing phase, heel contact phase, flatfoot phase, takeoff phase, single limb support, double limb support, load response phase, and pre-swing phase. The gait of 126 study participants (41 males, 85 females; 27.37±1.77 years) was assessed twice for each participant during 10 episodes of walking on a 10m walkway each 2 weeks apart. Intra-session and inter-session results were compared using data for each foot alone as well as both feet together. All variables resulted in a high consistency except for acceleration. The intra-session data showed substantial agreement; the intra-class correlation coefficient (ICC) ranged from 0.72-0.78 in the heel contact phase, 0.72-0.76 in the load response phase, and 0.76-0.85 in the pre-swing phase and a low SEM. The inter-session data for each foot alone and both feet together showed substantial agreement (0.77-0.79 in the load response phase) and slight agreement for acceleration (0.06-0.22) with a low SEM. Based on these results, we conclude that the OptoGait system can be used with confidence to evaluate spatial-temporal gait except for acceleration and progressive step time assessment.

Stakeholder involvement in the design of a patient-centered comparative effectiveness trial of the "On the Move" group exercise program in community-dwelling older adults

BACKGROUND

Group exercise programs for older adults often exclude the timing and coordination of movement. Stakeholder involvement in the research process is strongly encouraged and improves the relevance and adoption of findings. We describe stakeholder involvement in the design of a clinical trial of a group-based exercise program that incorporates timing and coordination of movement into the exercises.

METHODS

The study was a cluster randomized, single-blind intervention trial to compare the effects on function, disability and mobility of a standard group exercise program and the "On the Move" group exercise program in older adults residing in independent living facilities and senior apartment buildings, and attending community centers. Exercise classes were twice weekly for 12weeks delivered by study exercise leaders and facility activity staff personnel.

OUTCOMES

The primary outcomes function, disability and mobility were assessed at baseline and post-intervention. Function and disability were assessed using the Late Life Function and Disability Instrument, and mobility using the Six-Minute Walk Test and gait speed.

STAKEHOLDERS

Patient and provider stakeholders had significant input into the study aims, design, sample, intervention, outcomes and operational considerations.

SUMMARY

A community-based exercise program to improve walking can be developed to address both investigator identified missing components in current exercise to improve walking and stakeholder defined needs and interest for the activity program. Involvement of stakeholders substantially improves the relevance of research questions, increases the transparency of research activities and may accelerate the adoption of research into practice.

Benefits of a Supervised Exercise Program After Lower Limb Bypass Surgery

This study evaluated the efficacy of an exercise program after arterial bypass surgery. Patients undergoing bypass surgery were randomized to a control group (group I), with standard preoperative and postoperative care, or the intervention group (group II) with a supervised exercise program of twice-weekly treadmill assessments from 4 to 10 weeks postoperatively. Ankle-brachial pressure indices and hemodynamic measurements were recorded before and after exercise. The mean increase of maximum walking distance was 3.8% in group I and 175.4% in group II ( P = .001). There was a significant difference between group I and II in the mean ankle-brachial pressure indices increase at the second assessment (0.08 versus 0.23; P = .02). A supervised exercise program leads to better improvement after lower limb bypass surgery for ischemia, but the feasibility of a formal exercise program would be undermined by the reluctance of patients to participate, both in the short-term and long-term.

Use of a physiological profile to document motor impairment in ageing and in clinical groups

Ageing decreases exercise performance and is frequently accompanied by reductions in cognitive performance. Deterioration in the physiological capacity to stand, locomote and exercise can manifest itself as falling over and represents a significant deterioration in sensorimotor control. In the elderly, falling leads to serious morbidity and mortality with major societal costs. Measurement of a suite of physiological capacities that are required for successful motor performance (including vision, muscle strength, proprioception and balance) has been used to produce a physiological profile assessment (PPA) which has been tracked over the age spectrum and in different diseases (e.g. multiple sclerosis, Parkinson's disease). As well as measures of specific physiological capacities, the PPA generates an overall 'score' which quantitatively measures an individual's cumulative risk of falling. The present review collates data from the PPA (and the physiological capacities it measures) as well as its use in strategies to reduce falls in the elderly and those with different diseases. We emphasise that (i) motor impairment arises via reductions in a wide range of sensorimotor abilities; (ii) the PPA approach not only gives a snapshot of the physiological capacity of an individual, but it also gives insight into the deficits among groups of individuals with particular diseases; and (iii) deficits in seemingly restricted and disparate physiological domains (e.g. vision, strength, cognition) are funnelled into impairments in tasks requiring upright balance. Motor impairments become more prevalent with ageing but careful physiological measurement and appropriate interventions offer a way to maximise health across the lifespan.

Translation of a Motor Learning Walking Rehabilitation Program Into a Group-Based Exercise Program for Community-Dwelling Older Adults

BACKGROUND

Traditional exercise programs for older adults, which focus on aerobic and strength training, have had only modest effects on walking. Recently, a motor learning exercise program was shown to have greater effects on walking compared with a traditional exercise program. Translating this novel motor learning exercise program into a group exercise program would allow it to be offered as an evidence-based, community-based program for older adults.

OBJECTIVE

To translate a walking rehabilitation program based on motor learning theory from one-on-one to group delivery (On the Move) and evaluate multiple aspects of implementation in older adults with impaired mobility.

DESIGN

The translation process involved multiple iterations, including meetings of experts in the field (Phase I), focus groups (Phase II), and implementation of the newly developed program (Phase III). Phase III was based on a one-group model of intervention development for feasibility, safety, potential effects, and acceptability.

SETTING

Community sites, including 2 independent living facilities, an apartment building, and a community center.

PARTICIPANTS

Adults 65 years of age or older who could ambulate independently and who were medically stable. Thirty-one adults, mean age 82.3 ± 5.6 years, were eligible to participate.

METHODS

The group exercise program was held twice a week for 12 weeks.

MAIN OUTCOME MEASUREMENTS

Acceptability of the program was determined by retention and adherence rates and a satisfaction survey. Risk was measured by adverse events and questions on perceived challenge and safety. Mobility was assessed pre- and postintervention by gait speed, Figure of 8 Walk Test, and 6-minute walk test.

RESULTS

Modifications to the program included adjustments to format/length, music, education, and group interaction. The 12-week program was completed by 24 of 31 entrants (77%). Adherence was high, with participants attending on average 83% of the classes. Safety was excellent, with only 1 subject experiencing a controlled, noninjurious fall. There was preliminary evidence for improved mobility after the intervention: gait speed improved from 0.76 ± 0.21 to 0.81 ± 0.22 m/s, P = .06; Figure of 8 Walk Test from 13.0 ± 3.9 to 12.0 ± 3.9 seconds, P = .07; and 6-minute walk test from 246 ± 75 to 281 ± 67 m, P = .02.

CONCLUSIONS

The group-based program was safe and acceptable to older adults with impaired mobility and resulted in potentially clinically meaningful improvements in mobility.

Effects of Three Types of Exercise Interventions on Healthy Old Adults' Gait Speed: A Systematic Review and Meta-Analysis

BACKGROUND

Habitual walking speed predicts many clinical conditions later in life, but it declines with age. However, which particular exercise intervention can minimize the age-related gait speed loss is unclear.

PURPOSE

Our objective was to determine the effects of strength, power, coordination, and multimodal exercise training on healthy old adults' habitual and fast gait speed.

METHODS

We performed a computerized systematic literature search in PubMed and Web of Knowledge from January 1984 up to December 2014. Search terms included 'Resistance training', 'power training', 'coordination training', 'multimodal training', and 'gait speed (outcome term). Inclusion criteria were articles available in full text, publication period over past 30 years, human species, journal articles, clinical trials, randomized controlled trials, English as publication language, and subject age ≥65 years. The methodological quality of all eligible intervention studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. We computed weighted average standardized mean differences of the intervention-induced adaptations in gait speed using a random-effects model and tested for overall and individual intervention effects relative to no-exercise controls.

RESULTS

A total of 42 studies (mean PEDro score of 5.0 ± 1.2) were included in the analyses (2495 healthy old adults; age 74.2 years [64.4-82.7]; body mass 69.9 ± 4.9 kg, height 1.64 ± 0.05 m, body mass index 26.4 ± 1.9 kg/m2, and gait speed 1.22 ± 0.18 m/s). The search identified only one power training study, therefore the subsequent analyses focused only on the effects of resistance, coordination, and multimodal training on gait speed. The three types of intervention improved gait speed in the three experimental groups combined (n = 1297) by 0.10 m/s (±0.12) or 8.4% (±9.7), with a large effect size (ES) of 0.84. Resistance (24 studies; n = 613; 0.11 m/s; 9.3%; ES: 0.84), coordination (eight studies, n = 198; 0.09 m/s; 7.6%; ES: 0.76), and multimodal training (19 studies; n = 486; 0.09 m/s; 8.4%, ES: 0.86) increased gait speed statistically and similarly.

CONCLUSIONS

Commonly used exercise interventions can functionally and clinically increase habitual and fast gait speed and help slow the loss of gait speed or delay its onset.

What type, or combination of exercise can improve preferred gait speed in older adults? A meta-analysis

BACKGROUND

Improved preferred gait speed in older adults is associated with increased survival rates. There are inconsistent findings in clinical trials regarding effects of exercise on preferred gait speed, and heterogeneity in interventions in the current reviews and meta-analyses.

OBJECTIVE

to determine the meta-effects of different types or combinations of exercise interventions from randomized controlled trials on improvement in preferred gait speed.

METHODS

DATA SOURCES

A literature search was performed; the following databases were searched for studies from 1990 up to 9 December 2013: PubMed, EMBASE, EBSCO (AMED, CINAHL, ERIC, Medline, PsycInfo, and SocINDEX), and the Cochrane Library.

STUDY ELIGIBILITY CRITERIA

Randomized controlled trials of exercise interventions for older adults ≥ 65 years, that provided quantitative data (mean/SD) on preferred gait speed at baseline and post-intervention, as a primary or secondary outcome measure in the published article were included. Studies were excluded when the PEDro score was ≤4, or if participants were selected for a specific neurological or neurodegenerative disease, Chronic Obstructive Pulmonary Disease, cardiovascular disease, recent lower limb fractures, lower limb joint replacements, or severe cognitive impairments. The meta-effect is presented in Forest plots with 95 % confidence

STUDY APPRAISAL AND SYNTHESIS METHODS

intervals and random weights assigned to each trial. Homogeneity and risk of publication bias were assessed.

RESULTS

Twenty-five studies were analysed in this meta-analysis. Data from six types or combinations of exercise interventions were pooled into sub-analyses. First, there is a significant positive meta-effect of resistance training progressed to 70-80 % of 1RM on preferred gait speed of 0.13 [CI 95 % 0.09-0.16] m/s. The difference between intervention- and control groups shows a substantial meaningful change (>0.1 m/s). Secondly, a significant positive meta-effect of interventions with a rhythmic component on preferred gait speed of 0.07 [CI 95 % 0.03-0.10] m/s was found. Thirdly, there is a small significant positive meta-effect of progressive resistance training, combined with balance-, and endurance training of 0.05 [CI 95 % 0.00-0.09] m/s. The other sub-analyses show non-significant small positive meta-affects.

CONCLUSIONS

Progressive resistance training with high intensities, is the most effective exercise modality for improving preferred gait speed. Sufficient muscle strength seems an important condition for improving preferred gait speed. The addition of balance-, and/or endurance training does not contribute to the significant positive effects of progressive resistance training. A promising component is exercise with a rhythmic component. Keeping time to music or rhythm possibly trains higher cognitive functions that are important for gait.

LIMITATIONS

The focus of the present meta-analysis was at avoiding as much heterogeneity in exercise interventions. However heterogeneity in the research populations could not be completely avoided, there are probably differences in health status within different studies.

Gait characteristics associated with walking speed decline in older adults: results from the Baltimore Longitudinal Study of Aging

BACKGROUND

Understanding the mechanisms that contribute to walking speed decline can provide needed insight for developing targeted interventions to reduce the rate and likelihood of decline.

OBJECTIVE

Examine the association between gait characteristics and walking speed decline in older adults.

METHODS

Participants in the Baltimore Longitudinal Study of Aging aged 60 to 89 were evaluated in the gait laboratory which used a three dimensional motion capture system and force platforms to assess cadence, stride length, stride width, percent of gait cycle in double stance, anterior-posterior mechanical work expenditure (MWE), and medial-lateral MWE. Usual walking speed was assessed over 6 m at baseline and follow-up. Gait characteristics associated with meaningful decline (decline≥0.05 m/s/y) in walking speed were evaluated by logistic regression adjusted for age, sex, race, height, weight, initial walking speed and follow-up time.

RESULTS

Among 362 participants, the average age was 72.4 (SD=8.1) years, 51% were female, 27% were black and 23% were identified has having meaningful decline in usual walking speed with an average follow-up time of 3.2 (1.1) years. In the fully adjusted model, faster cadence [ORadj=0.65, 95% CI (0.43,0.97)] and longer strides [ORadj=0.87, 95% CI (0.83,0.91)] were associated with lower odds of decline. However age [ORadj=1.04, 95% CI (0.99,1.10)] was not associated with decline when controlling for gait characteristics and other demographics.

CONCLUSION

A sizable proportion of healthy older adults experienced walking speed decline over an average of 3 years. Longer stride and faster cadence were protective against meaningful decline in usual walking speed.

A behavioral mechanism of how increases in leg strength improve old adults' gait speed

We examined a behavioral mechanism of how increases in leg strength improve healthy old adults’ gait speed. Leg press strength training improved maximal leg press load 40% (p = 0.001) and isometric strength in 5 group of leg muscles 32% (p = 0.001) in a randomly allocated intervention group of healthy old adults (age 74, n = 15) but not in no-exercise control group (age 74, n = 8). Gait speed increased similarly in the training (9.9%) and control (8.6%) groups (time main effect, p = 0.001). However, in the training group only, in line with the concept of biomechanical plasticity of aging gait, hip extensors and ankle plantarflexors became the only significant predictors of self-selected and maximal gait speed. The study provides the first behavioral evidence regarding a mechanism of how increases in leg strength improve healthy old adults’ gait speed.

Effects of Short-Term Training of Community-Dwelling Elderly with Modular Interactive Tiles

Objective: The objective of this study is to test for the increased mobility, agility, balancing, and general fitness of community-dwelling elderly individuals as a result of short-term training involving playing with modular interactive tiles (Entertainment Robotics, Odense, Denmark) at two community activity centers for the elderly. Three different tests from the Senior Fitness Test were used in order to test a variety of health parameters of the community-dwelling elderly, including those parameters related to fall prevention. Materials and Methods: Eighteen community-dwelling elderly individuals (63-95 years of age; mean, 83.2 years of age) were assessed in one intervention group without the use of a control group. The intervention group performed nine group sessions (1-1.5 hours each) of playful training with the modular interactive tiles over a 12-week period in two community activity centers for the elderly. Data were collected using pre-tests and post-tests of the 6-Minute Walk Test (6MWT), the 8-foot Timed Up & Go Test (TUG), and the Chair-Stand Test (CS). Data were analyzed for statistically significant differences and increases of means. Results: The 6MWT, TUG, and CS measurements showed statistically significant differences and increases of means between the pre-tests and post-tests with the 6MWT (P<0.001) (means difference, 22.4 percent), TUG (P<0.001) (means difference, 15 percent), and CS (P<0.002) (means difference, 14 percent). Fifty-six percent of the elderly progressed from one health risk level to a better level, according to the three tests. Conclusions: Statistically significant increases in scores were found across all tests, suggesting an improvement of many different health parameters for the elderly. Well-established research has shown the relationship between such test scores and fall incidents, balancing, mobility, agility, etc. This significant improvement in the health status of the elderly is obtained in as few as nine training sessions over a 12-week period of "playing" exergames with the modular interactive tiles.

Test-retest reliability of the GAITRite walkway system for the spatio-temporal gait parameters while dual-tasking in post-stroke patients

PURPOSE

To examine the test-retest reliability of spatio-temporal gait parameters during performance of single- and dual-tasking in post-stroke patients.

METHOD

This study was conducted using a single-group repeated-measures design, involving a baseline measurement session and a follow-up session two days later. Forty-three chronic stroke patients (>6 months) participated in this study. Spatio-temporal gait parameters under the single- and dual-task conditions at a self-selected comfortable gait speed were measured using the GAITRite walkway system. Intraclass correlation coefficients [ICC(2,1)] were calculated for determination of reliability between sessions. The level of agreement between the two sessions was determined using Bland-Altman 95% limits of the agreement plots.

RESULTS

In all gait parameters, a significant difference was observed between the single- and dual-task conditions (p < 0.05). For the single condition, ICC (95% CI) was very good for all measures, ranging from 0.98 to 0.99 (0.97-0.99). In addition, for the dual-task condition, ICC (95% CI) was good to very good for all measures, ranging from 0.69 to 0.90 (0.49-0.99).

CONCLUSIONS

The results of current study demonstrated that the test-retest reliability of the GAITRite system for measurement of spatio-temporal gait parameters under single- and dual-task conditions was good to very good. Therefore, we suggest that measurement of spatio-temporal gait parameters under a dual-task condition using the GAITRite system would be useful for clinical assessment in post-stroke patients.

IMPLICATIONS FOR REHABILITATION

Improvement of walking ability provides opportunities for stroke patients to participate in the community. Our finding, additional cognitive tasks can interfere with the independently basic activities of daily living in stroke patients, may provide basic information for use in development of rehabilitation programs for stroke patients. Spatio-temporal gait parameters under the dual-task condition measured using the GAITRite system may be useful for clinical assessment in post-stroke patients.

Improvements in gait characteristics after intensive resistance and functional training in people with dementia: a randomised controlled trial

BACKGROUND

Preventing and rehabilitating gait disorders in people with dementia during early disease stage is of high importance for staying independent and ambulating safely. However, the evidence gathered in randomized controlled trials (RCTs) on the effectiveness of exercise training for improving spatio-temporal gait parameters in people with dementia is scarce. The aim of the present study was to determine whether a specific, standardized training regimen can improve gait characteristics in people with dementia.

METHODS

Sixty-one individuals (mean age: 81.9 years) with confirmed mild to moderate stage dementia took part in a 3-month double-blinded outpatient RCT. Subjects in the intervention group (IG) received supervised, progressive resistance and functional group training for 3 months (2 times per week for two hours) specifically developed for people with dementia. Subjects in the control group (CG) conducted a low-intensity motor placebo activity program. Gait characteristics were measured before and after the intervention period using a computerized gait analysis system (GAITRite®).

RESULTS

Adherence to the intervention was excellent, averaging 91.9% in the IG and 94.4% in the CG. The exercise training significantly improved gait speed (P < 0.001), cadence (P = 0.002), stride length (P = 0.008), stride time (P = 0.001), and double support (P = 0.001) in the IG compared to the CG. Effect sizes were large for all gait parameters that improved significantly (Cohen's d: 0.80-1.27). No improvements were found for step width (P = 0.999), step time variability (P = 0.425) and Walk-Ratio (P = 0.554). Interestingly, low baseline motor status, but not cognitive status, predicted positive training response (relative change in gait speed from baseline).

CONCLUSION

The intensive, dementia-adjusted training was feasible and improved clinically meaningful gait variables in people with dementia. The exercise program may represent a model for preventing and rehabilitating gait deficits in the target group. Further research is required for improving specific gait characteristics such as gait variability in people with dementia.

TRIAL REGISTRATION

ISRCTN49243245.

The effectiveness of a combined exercise intervention on physical fitness factors related to falls in community-dwelling older adults

This study aimed to evaluate the effectiveness of an innovative exercise program on muscle strength, balance, and gait kinematics in elderly community-dwellers. The exercise program included strength and balance training and the 8-form Tai Chi Chuan. The measurements were carried out at baseline and 12 weeks, and consisted of four physical performance tests, joint isokinetic strength tests, and three-dimensional gait analysis. Fifty-six community-dwelling older adults aged 60–80 years old were randomly assigned to an intervention or control group. After 12 weeks, the intervention group showed a 17.6% improvement in the timed up and go test, accompanied by a 54.7% increase in the 30-second chair stand test score. Significant increases in the score of star excursion balance tests, and the strength of the extensor and flexor muscles at knee and ankle joints were also observed. In addition, the intervention group walked at a faster speed with a longer step length, shorter support phase, and a greater sagittal plane range of motion at the hip and ankle joints. No statistical improvements were seen in the control group. This study provided an effective, evidence-based falls prevention program that can be implemented in community settings to improve physical fitness and reduce fall risks among community-dwelling older adults. The star excursion balance test could be a sensitive measure of physical performance for fall risk assessment in older people.

Pulmonary rehabilitation improves long-term outcomes in interstitial lung disease: a prospective cohort study

BACKGROUND

Pulmonary rehabilitation improves outcomes in patients with interstitial lung disease (ILD), however it is unclear whether these effects are long lasting and which patients benefit most.

METHODS

Patients with ILD were recruited into this prospective cohort study from three pulmonary rehabilitation programs. Patients completed functional assessments (6-minute walk distance (6MWD), and 4-meter walk time) and surveys (quality of life, dyspnea, depression, and physical activity) before rehabilitation, after rehabilitation, and at six months. Changes from baseline were compared using a paired t-test. Independent predictors of change in 6MWD and quality of life were determined using multivariate analysis.

RESULTS

Fifty-four patients were recruited (22 with idiopathic pulmonary fibrosis), 50 patients (93%) completed the rehabilitation program, and 39 returned for six-month follow-up. 6MWD improved 57.6 m immediately after rehabilitation (95% confidence interval (CI) 40.2-75.1 m, p < 0.0005), and remained 49.8 m above baseline at six months (95%CI 15.0-84.6 m, p = 0.005). The majority of patients achieved the minimum clinically important difference for quality of life (51%), dyspnea (65%), and depression score (52%) immediately after rehabilitation, and improvements were still significant at 6-month follow-up for quality of life, depression, and physical activity. A low baseline 6MWD was the only independent predictor of improvement in 6MWD during rehabilitation (r = -0.49, p < 0.0005). Change in 6MWD was an independent predictor of change in quality of life (r = -0.36, p = 0.01).

CONCLUSIONS

Pulmonary rehabilitation improved multiple short- and long-term outcomes in patients with ILD. While all patients appear to benefit, ILD patients with a low baseline 6MWD had greater benefit from rehabilitation.

CLINICAL TRIALS REGISTRATION NUMBER

NCT01055730 (clinicaltrials.gov).

Zebrafish (Danio rerio) as a model for the study of aging and exercise: physical ability and trainability decrease with age

A rapidly aging global population has motivated the development and use of models for human aging. Studies on aging have shown parallels between zebrafish and humans at the internal organization level; however, few parallels have been studied at the whole-organism level. Furthermore, the effectiveness of exercise as a method to mitigate the effects of aging has not been studied in zebrafish. We investigated the effects of aging and intermittent exercise on swimming performance, kinematics and behavior. Young, middle-aged and old zebrafish (20-29, 36-48 and 60-71% of average lifespan, respectively) were exercised to exhaustion in endurance and sprint swimming tests once a week for four weeks. Both endurance and sprint performance decreased with increased age. Swimming performance improved with exercise training in young and middle-aged zebrafish, but not in old zebrafish. Tail-beat amplitude, which is akin to stride length in humans, increased for all age groups with training. Zebrafish turning frequency, which is an indicator of routine activity, decreased with age but showed no change with exercise. In sum, our results show that zebrafish exhibit a decline in whole-organism performance and trainability with age. These findings closely resemble the senescence-related declines in physical ability experienced by humans and mammalian aging models and therefore support the use of zebrafish as a model for human exercise and aging.

Effects of exercise on dual-task ability and balance in older adults: a systematic review

The interest in research on exercise and physical activity effects on dual-task performance has grown rapidly in the last decade due to the aging global population. Most of the available literature is focused on exercise benefits for the risk of falls, attention, and gait-speed; however, there is a lack of evidence reporting the exercise effects on balance in healthy older adults during dual-task performance. The objective of this study was to critically review the existing evidence of a potential relationship between exercise and improvement of static and dynamic balance during dual-task in healthy older adults and secondary outcomes in other physical and cognitive indices. A systematic search using online databases was used to source articles. Inclusion criteria included articles classified as randomized controlled trials (RCT), controlled trials (CT) and uncontrolled trials (UT). Moreover, the studies had to include an exercise or physical activity protocol in the intervention. Eight studies met the eligibility criteria and included 6 RCTs, 1 CT, and 1 UT. Several limitations were identified, mainly focused on the lack of a common and standardized method to evaluate the balance during the dual-task performance. Additionally, exercise protocols were extensively different, and generally lacked reporting measures. Preliminary findings show that the current body of evidence does not support that exercises used in these interventions entail clear and noteworthy benefits on static or dynamic balance improvements during dual-task performance. Innovative measures and exercise programs may need to be developed before efficacious screening and treatment strategies can be used in clinical settings.

Treadmill gait speeds correlate with physical activity counts measured by cell phone accelerometers

A number of important health-related outcomes are directly related to a person's ability to maintain normal gait speed. We hypothesize that cellular telephones may be repurposed to measure this important behavior in a noninvasive, continuous, precise, and inexpensive manner. The purpose of this study was to determine if physical activity (PA) counts collected by cell phone accelerometers could measure treadmill gait speeds. We also assessed how cell phone placement influenced treadmill gait speed measures. Participants included 55 young, middle-aged, and older community-dwelling men and women. We placed cell phones as a pendant around the neck, and on the left and right wrist, hip, and ankle. Subjects then completed an individualized treadmill protocol, alternating 1 min rest periods with 5 min of walking at different speeds (0.3-11.3 km/h; 0.2-7 mi/h). No persons were asked to walk at speeds faster than what they would achieve during day-to-day life. PA counts were calculated from all sensor locations. We built linear mixed statistical models of PA counts predicted by treadmill speeds ranging from 0.8 to 6.4 km/h (0.5-4 mi/h) while accounting for subject age, weight, and gender. We solved linear regression equations for treadmill gait speed, expressed as a function of PA counts, age, weight, and gender. At all locations, cell phone PA counts were strongly associated with treadmill gait speed. Cell phones worn at the hip yielded the best predictive model. We conclude that in both men and women, cell phone derived activity counts strongly correlate with treadmill gait speed over a wide range of subject ages and weights.

Neuromuscular Responses to Platform Perturbations in Power-Versus Endurance-Trained Athletes

The purpose was to assess differences in postural response characteristics between two groups of elite athletes having power or endurance training. Participants were all men and included power- ( M age = 21 yr., SD = 3, n = 12) and endurance-trained ( M age = 22, SD = 3, n = 12) athletes. Muscle response characteristics and center of pressure measures were recorded during recovery from Fast (10 cm at 80 cm/sec.) and Slow (10 cm at 20 cm/sec.) horizontal platform perturbations. In response to Fast perturbations, power-trained athletes responded with significantly shorter times to stabilize the center of pressure, shorter muscle-contraction onset times, and larger muscle response amplitudes than endurance-trained athletes. This suggests power-trained athletes are more effective than endurance-trained athletes in responding to balance threats such as slips and trips in daily life and that power training should be studied to improve balance control of balance-impaired populations.

Maintaining functionality in later years: a review of nutrition and physical activity interventions in postmenopausal women

Independence and quality of life of postmenopausal women are influenced by functional status. Nutrition and physical activity impact functional changes through changes in body composition. The article presents a narrative review of the literature to identify interventions that improve the functionality of community-dwelling postmenopausal women. The authors used the Evidence Analysis Approach developed by the American Dietetic Association to appraise current research. Strong evidence does exist that interventions that incorporate both physical activity and nutrition can improve physical function of older women. However, research focusing on functional status and quality of life, in addition to nutrition and exercise, is extremely limited.

Correlation between two physical activity programs in the gait of sedentary elderly subjects

ABSTRACT Objectives: To assess the effect of exercise on gait using two different programs: a group of aerobic exercises (Group A, n = 18) and a group of flexibility and balance exercises (Group B, n = 19). Methods: A casualized controlled study, in which each sample controlled itself, was undertaken. The sample comprised 37 male and female subjects, aged from 60 to 90 years, from the outpatient clinic of the Geriatrics Unit of Hospital das Clínicas of Faculdade de Medicina of Universidade de São Paulo; the patients were sedentary and had not exercised regularly during the past six months. Results: Improvement of gait was seen mainly in the group that did specific exercises. Conclusion: The results of this study underline the importance of physical exercises in sedentary elderly subjects, but show the need for programming the exercises towards specific goals, which can optimize the results of this tool of health promotion for the elderly.

Gait Disorders and Falls

Since approximately 30% of persons over the age of 65 fall each year, prevention of falls is a very important topic. Gait disorders and diminished ability to walk safely are associated with an increased risk of falling. In older adults, falls commonly lead to injuries, institutionalization, and early death. The resultant decline in activities of daily living further contributes to loss of mobility and independence. Gait analysis using the dual-task paradigm (e.g., walking and carrying a cup of tea) offers a sensible tool for detecting older persons prone to falling. Changes in gait patterns due to simultaneously performing a secondary attention-demanding task are interpreted as interference by competing demands for attentional resources in gait control. Exercise interventions such as Jaques-Dalcroze eurhythmics address these attentional properties and aim to decrease such interference. To fully stress physical capacities in older adults, not only does automaticity of walking have to be trained, but also simultaneous performance of additional tasks. Exercise interventions for fall prevention should focus on developing basic skeletal muscle strength as a prerequisite to training gait automaticity in dual or multiple task situations. Recommendations for further research center on new approaches to combine exercises with additional tasks to improve gait and functionality in older adults.

Accelerometry for evaluation of gait pattern in healthy soccer athletes

An accelerometer system was used to measure the characteristics of the motion of 133 healthy male soccer athletes in a 30-s walking test and the data obtained were analysed using the gait evaluation differential entropy method (GEDEM). GEDEM processes gait acceleration data and calculates an index that provides a quantitative evaluation of a subject's gait, at low cost and with negligible effect on the subject. The GEDEM index was not significantly correlated with age, body weight, body mass index, or the number of years of active training. The GEDEM value for the anterior-posterior axis showed a small negative statistically significant correlation with height and the vertical axis was moderately and statistically significantly positively correlated with the time spent training per week. The triaxial accelerometry system described here is easy for subjects and testers to use, and enables measurements to be made on the sports field to evaluate an athlete's musculoskeletal condition with respect to gait stability.

Relação da aptidão muscular e amplitude articular, por faixa etária, na marcha do idoso

RESUMO INTRODUÇÃO: Com o aumento da longevidade, estudos realizados com pessoas idosas vêm despertando cada vez mais o interesse de pesquisadores de diversas áreas. É preciso compreender e analisar as mudanças relacionadas com o processo de envelhecimento e, através do esclarecimento destas, propiciar uma melhor qualidade de vida. Este estudo teve por objetivo identificar a associação das variáveis da aptidão muscular, amplitude e cadência de passos com a faixa etária. Materiais e métodos: A amostra foi constituída por 30 mulheres com idade acima de 65 anos, participantes dos grupos de convivência da Secretaria de Assistência Social do município de Ijuí/RS. Foram estudadas as seguintes variáveis: amplitude e cadência do passo, resistência muscular localizada de membros inferiores, flexibilidade de tronco, quadril, joelho e tornozelo e força muscular de membros inferiores. Respectivamente, essas variáveis foram avaliadas pelos seguintes métodos: distância e tempo percorrido, marcha estacionária de dois minutos, goniometria e pressão dos membros inferiores sobre a balança. As variáveis foram comparadas nas diferentes faixas etárias. RESULTADOS: Os resultados obtidos com a pesquisa foram: quanto à flexão de tronco, a média geral obtida da amostra foi de 90,67 (± 8,27) graus. Em relação à flexão de quadril, a média obtida foi de 105,83 (±9,83) graus; na extensão do quadril, a média foi de 9,47(±0,81). Na análise da flexibilidade do joelho, observou-se que a média geral para o movimento de flexão foi de 111,17 (±10,31) graus; no movimento de extensão, a média foi de 0,87 (±1,59) graus. Na plantiflexão, a média geral da amplitude articular foi de 21,50 (±6,03) graus. Quando analisada a resistência muscular localizada, a média geral do desempenho foi de 70,87 (±20,24) repetições No desempenho dos sujeitos quanto à força muscular de membros inferiores, a média geral do membro inferior direito foi de 15,06 (±4,20), e membro inferior esquerdo, 15,67 (±6,86). Quanto a amplitude e cadência do passo, a média total da amplitude do passo entre os sujeitos é de 0,56 (± 0,14) cm; já na cadência de passo, a média geral é 1,49 (± 0,27) passo/segundos. CONCLUSÃO: A análise dos dados sugere que há associação entre as variáveis da aptidão muscular com a faixa etária, sendo que estas têm forte influência sobre a marcha. Com o avanço da idade, a cadência de passos tende a aumentar e a amplitude, a diminuir.

WITHDRAWN: Interventions for preventing falls in elderly people

BACKGROUND

Approximately 30 per cent of people over 65 years of age and living in the community fall each year; the number is higher in institutions. Although less than one fall in 10 results in a fracture, a fifth of fall incidents require medical attention.

OBJECTIVES

To assess the effects of interventions designed to reduce the incidence of falls in elderly people (living in the community, or in institutional or hospital care).

SEARCH STRATEGY

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (January 2003), Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to 2003 Week 19), CINAHL (1982 to April 2003), The National Research Register, Issue 2, 2003, Current Controlled Trials (www.controlled-trials.com accessed 11 July 2003) and reference lists of articles. No language restrictions were applied. Further trials were identified by contact with researchers in the field.

SELECTION CRITERIA

Randomised trials of interventions designed to minimise the effect of, or exposure to, risk factors for falling in elderly people. Main outcomes of interest were the number of fallers, or falls. Trials reporting only intermediate outcomes were excluded.

DATA COLLECTION AND ANALYSIS

Two reviewers independently assessed trial quality and extracted data. Data were pooled using the fixed effect model where appropriate.

MAIN RESULTS

Sixty two trials involving 21,668 people were included.Interventions likely to be beneficial:Multidisciplinary, multifactorial, health/environmental risk factor screening/intervention programmes in the community both for an unselected population of older people (4 trials, 1651 participants, pooled RR 0.73, 95%CI 0.63 to 0.85), and for older people with a history of falling or selected because of known risk factors (5 trials, 1176 participants, pooled RR 0.86, 95%CI 0.76 to 0.98), and in residential care facilities (1 trial, 439 participants, cluster-adjusted incidence rate ratio 0.60, 95%CI 0.50 to 0.73) A programme of muscle strengthening and balance retraining, individually prescribed at home by a trained health professional (3 trials, 566 participants, pooled relative risk (RR) 0.80, 95% confidence interval (95%CI) 0.66 to 0.98) Home hazard assessment and modification that is professionally prescribed for older people with a history of falling (3 trials, 374 participants, RR 0.66, 95% CI 0.54 to 0.81) Withdrawal of psychotropic medication (1 trial, 93 participants, relative hazard 0.34, 95%CI 0.16 to 0.74) Cardiac pacing for fallers with cardioinhibitory carotid sinus hypersensitivity (1 trial, 175 participants, WMD -5.20, 95%CI -9.40 to -1.00) A 15 week Tai Chi group exercise intervention (1 trial, 200 participants, risk ratio 0.51, 95%CI 0.36 to 0.73). Interventions of unknown effectiveness:Group-delivered exercise interventions (9 trials, 1387 participants) Individual lower limb strength training (1 trial, 222 participants) Nutritional supplementation (1 trial, 46 participants) Vitamin D supplementation, with or without calcium (3 trials, 461 participants) Home hazard modification in association with advice on optimising medication (1 trial, 658 participants), or in association with an education package on exercise and reducing fall risk (1 trial, 3182 participants) Pharmacological therapy (raubasine-dihydroergocristine, 1 trial, 95 participants) Interventions using a cognitive/behavioural approach alone (2 trials, 145 participants) Home hazard modification for older people without a history of falling (1 trial, 530 participants) Hormone replacement therapy (1 trial, 116 participants) Correction of visual deficiency (1 trial, 276 participants).Interventions unlikely to be beneficial:Brisk walking in women with an upper limb fracture in the previous two years (1 trial, 165 participants).

AUTHORS' CONCLUSIONS

Interventions to prevent falls that are likely to be effective are now available; less is known about their effectiveness in preventing fall-related injuries. Costs per fall prevented have been established for four of the interventions and careful economic modelling in the context of the local healthcare system is important. Some potential interventions are of unknown effectiveness and further research is indicated.

THE EFFECT OF PHYSICAL TRAINING ON THE LOCOMOTOR APPARATUS IN ELDERLY PEOPLE

Physiological changes taking place on the locomotive apparatus as a result of aging, such as muscular mass loss, body balance loss, reduced bone mass and osteoarthrosis cause limitations to the daily activities of elderly people, compromising their quality of life and making them weaker and dependent. Aged people who regularly practice physical activities have a higher level of functional independence and a better quality of life than the sedentary ones. This article addresses the key physiological changes with aging and provides a review of current literature about the effects of physical exercises on the locomotive apparatus of elderly individuals, specifying the best ways to prescribe physical exercises to this age group.

Physical performance and risk of hip fractures in older men

The aim of these analyses was to describe the association between physical performance and risk of hip fractures in older men. Performance on five physical function exams (leg power, grip strength, usual walking pace, narrow walk balance test, and five repeated chair stands) was assessed in 5902 men >or=65 yr of age. Performance (time to complete or strength) was analyzed as quartiles, with an additional category for unable to complete the measure, in proportional hazards models. Follow-up averaged 5.3 yr; 77 incident hip fractures were confirmed by physician review of radiology reports. Poor physical performance was associated with an increased risk of hip fracture. In particular, repeated chair stand performance was strongly related to hip fracture risk. Men unable to complete this exam were much more likely to experience a hip fracture than men in the fastest quartile of this test (multivariate hazard ratio [MHR]: 8.15; 95% CI: 2.65, 25.03). Men with the worst performance (weakest/slowest quartile or unable) on at least three exams had an increased risk of hip fracture compared with men with higher functioning (MHR: 3.14, 95% CI: 1.46, 6.73). Nearly two thirds of the hip fractures (N = 49, 64%) occurred in men with poor performance on at least three exams. Poor physical function is independently associated with an increased risk of hip fracture in older men. The repeated chair stands exam should be considered in clinical settings for evaluation of hip fracture risk. Concurrent poor performance on multiple physical function exams is associated with an increased risk of hip fractures.

Linking stability to demographics, strength and sensory system function in women over 40 to support pre-emptive preventive intervention

OBJECTIVE

To investigate differences in demographics, strength and sensory system function of 254 women aged 40-80 years categorized as stable, unsteady or unstable using simple balance tests.

METHOD

Demographics (age, height, weight, medications, co-morbidities, falls history, activity level), measures of quadriceps, hip abductor and adductor strength, somatosensory, visual and vestibular function were recorded. Subjects were categorized as stable (completed all trials), unsteady (failed one/two trials) or unstable (failed all trials) after three 10-s trials of bilateral stance (foam surface, eyes closed (EC)) and one-leg stance (firm surface, eyes open (EO)), and the results were compared.

RESULTS

Both balance tasks identified women in their fifties as unstable ( approximately 9%), with 60% of these women failing both tasks. More women were unsteady or unstable on foam EC (27%) than in one-leg stance EO (20%). Unsteady and unstable categories of women were older, reported more co-morbidities and medications and less activity than stable women. The women categorized as unstable in either test recorded weaker hip muscles, higher vibration thresholds, greater joint positioning error, reduced edge contrast sensitivity, low-contrast visual acuity and reduced dynamic visual acuity than the stable categories (p < 0.01). The two tests detected differences in characteristics of unstable women, with those failing one-leg stance EO being heavier, and those failing foam EC having weaker quadriceps.

CONCLUSION

These data link instability in women from the fifties to multiple demographic and sensorimotor factors associated with increased risk of falls, thus supporting use of balance tests in primary-care settings to assist referral for diagnostic assessment and pre-emptive interventions.

Effect of combined exercise training on bone, body balance, and gait ability: a randomized controlled study in community-dwelling elderly women

The purpose of this study was to investigate whether a 48-week multicomponent exercise program could improve the risk factors for fall and hip fracture. Fifty elderly women 65-70 years of age participated. These participants were divided into an exercise group (25 subjects) that attended an exercise program and a control group (25 subjects) that did not. The exercise program included stretching for 9 min, strength training for 10 min followed by 23 min of weight-bearing exercise at an intensity above 65%-75% of the maximal heart rate, and 18 min of balance and posture correction training. The program was conducted three times per week for 48 weeks. The 10-m maximal walk time, maximal step length, and eyes-open-one-legged-stand time in the exercise group improved significantly (P < 0.05). Concerning deoxypyridinoline, the exercise group achieved a significant improvement (P < 0.05) after the 48 weeks. Bone mineral density (BMD) of the femoral neck and trochanter in the exercise group was significantly increased after the exercise program; also body sway was significantly improved (P < 0.05). In conclusion, a multi-component exercise program with weight-bearing exercise at a moderate intensity and gait training may be effective in offsetting a decline in BMD and improving aggravation of bone resorption in this population. In addition, this program has a positive effect on postural stability and gait ability.