Effect of gender, age, and anthropometry on axial and appendicular muscle strength

Fall risk in patient with dysplastic hip osteoarthritis

PURPOSE

Patients with dysplastic hip osteo arthritis (DHOA) often have a spinopelvic imbalance, and they are more likely to experience falls. This study aimed to evaluate the risk factors for falls in patients with DHOA, including spinopelvic parameters.

METHODS

In this cross-sectional study, a total of 103 patients with DHOA were included from 2019 to 2021. Fall risk was evaluated using the Fall Risk Index 5 items version (FRI-5). Demographics, functional outcomes, and spinopelvic parameters were compared between the high-risk group (FRI-5 ≥ 6) and the low-risk group (FRI-5 < 6). Multivariate analysis was performed using factors with significant differences in univariate analysis.

RESULTS

High-risk and low-risk groups comprised 54 and 49 patients, respectively. Females were significantly more common in the high-risk group than in the low-risk group. The Harris Hip Score was significantly lower in the high-risk group than in the low-risk group (p = 0.02). Pelvic incidence, tilt, and obliquity were significantly higher in the high-risk group than in the low-risk group (p < 0.01). In multivariate analysis, female sex (odds ratio [OR]: 3.76, 95% confidence interval [CI]: 1.11-12.64, p = 0.03), pelvic obliquity (OR: 1.36, 95% CI: 1.09-1.71, p < 0.01), and Harris hip score (OR: 0.96, 95% CI: 0.93-0.99, p = 0.02) were identified as risk factors.

CONCLUSION

Female sex, pelvic obliquity, and low Harris hip score were associated with an increased risk of falls among patients with DHOA.

Anterior knee pain as a potential risk factor for falls in older adults: insights from the osteoarthritis initiative data

BACKGROUND

Knee joint pain has been demonstrated to be a separate risk factor for falling. A common pain site in the knee, anterior knee pain(AKP), is believed to be associated with early knee osteoarthritis (KOA).This study investigated the relationship between falls and AKP in people with or at risk for KOA.

METHODS

Four years of follow-up data from the Osteoarthritis Initiative cohort trial, a large-scale, multicenter observational investigation, were analyzed in this study. A patellar quadriceps tenderness/tendinitis knee exam was performed to evaluate AKP. Falls were self-reported. The associations between falls (recurrent falls: ≥2 falls/year; any falls: ≥1 fall(s)/year) and AKP were analyzed using the generalized estimation equation of repeated logistic regression and adjusted for confounding variables.

RESULTS

The study analyzed data from 3,318 participants, split into two groups: those with AKP (720 participants) and those without AKP (2,598 participants). The primary outcome of the study, which focused on repeated falls, revealed that participants with AKP were 1.27 times more likely to experience repeated falls compared to those without AKP (95% CI: 1.07-1.52, P = 0.007). However, when considering any falls experienced by an individual as an additional outcome, it is important to note that our findings did not indicate a significant predictive effect of AKP on any falls investigated. Sensitivity analyses, which excluded knee arthroplasty cases, yielded consistent results with the aforementioned findings.

CONCLUSIONS

Older adults with AKP experience a higher frequency of falls compared to those without AKP in individuals diagnosed with KOA or at a high risk of developing KOA.

A machine learning approach to identify important variables for distinguishing between fallers and non-fallers in older women

Falls are a significant ongoing public health concern for older adults. At present, few studies have concurrently explored the influence of multiple measures when seeking to determine which variables are most predictive of fall risks. As such, this cross-sectional study aimed to identify those functional variables (i.e. balance, gait and clinical measures) and physical characteristics (i.e. strength and body composition) that could best distinguish between older female fallers and non-fallers, using a machine learning approach. Overall, 60 community-dwelling older women (≥65 years), retrospectively classified as fallers (n = 21) or non-fallers (n = 39), attended three data collection sessions. Data (281 variables) collected from tests in five separate domains (balance, gait, clinical measures, strength and body composition) were analysed using random forest (RF) and leave-one-variable-out partial least squares correlation analysis (LOVO PLSCA) to assess variable importance. The strongest discriminators from each domain were then aggregated into a multi-domain dataset, and RF, LOVO PLSCA, and logistic regression models were constructed to identify the important variables in distinguishing between fallers and non-fallers. These models were used to classify participants as either fallers or non-fallers, with their performance evaluated using receiver operating characteristic (ROC) analysis. The study found that it is possible to classify fallers and non-fallers with a high degree of accuracy (e.g. logistic regression: sensitivity = 90%; specificity = 87%; AUC = 0.92; leave-one-out cross-validation accuracy = 63%) using a combination of 18 variables from four domains, with the gait and strength domains being particularly informative for screening programmes aimed at assessing falls risk.

Could kyphotic posture disturb body balance in young healthy population?

BACKGROUND

Kyphosis is roughly a slight forward curvature of the spine. A slight kyphosis or posterior curvature is normal throughout the human body and is present in every individual. Hyperkyphotic is a kyphotic angle greater than 40° commonly measured on a lateral X-ray measured by the Cobb method between C7 and T12. Postural instability and loss of balance can result from shifting the center of mass beyond the support base's limits. Studies are showing that kyphotic posture affects the center of gravity and affects falls in the elderly, but there are limited studies on the effect of balance in young individuals.

OBJECTIVES

the correlation between the balance and thoracic kyphosis angle has been investigated.

METHODS

Forty-three healthy individuals over the age of 18 participated in the study. Participants who met the criteria were split into two groups based on their kyphosis angle. For measuring thoracic kyphosis, Flexi Curve is used. Objective evaluation of static balance was made with NeuroCom Balance Manager® static posturography device.

RESULTS

In terms of mean difference, there was no significant difference between the kyphotic and control groups in the balance measures, and there was no correlation between the kyphosis angle and balance measures, according to statistical analysis.

CONCLUSION

According to our study, no significant relationship was found between body balance and thoracic kyphosis in the young population.

Handgrip as a measure of muscle strength and its physiological dependence on therapeutic variables: A randomized case

Clinical and medical data findings have traditionally been more representative of male than female subjects, and when combined, have not clearly differentiated between the groups. In this study there were no research questions initially contemplated, as the data were obtained from an educational setting, where participants completed tasks as part of a pedagogical program of preparation. The nature of the post-hoc analysis renders the study as a hypothesis-generating type rather than a hypothesis-testing one. It began as a cross-sectional quantitative analysis of performance on a task to explore the relationship between hand grip and three independent physiological variables. The data collected from all subjects were randomized since the total group of participants contained a disproportionate number of females as compared to males, this being a result of a demographic predominance of female students in a program of teacher preparation. Graphical analysis with the slope taken as a measure of hand grip dependence on three independent variables, and the correlation value used as a measure of association between variables yielded discernible differences. The grip strength dependence on the hand size as well as the wrist thickness show consistently significant differences for females only, with t test of significance (p < .001), and large effect size differences based on Cohen's d values of 3.08 and 1.92, respectively. The significance of the finding that female grip strength depends the most on wrist thickness has implications for rehabilitative and therapeutic settings.

Handgrip Strength Features in Rheumatoid Arthritis Patients Assessed Using an Innovative Cylindrical-Shaped Device: Relationships With Demographic, Anthropometric and Clinical Variables

To investigate the relationship between handgrip strength (HGs) features, evaluated with an innovative cylindrical-shaped grip device, and demographic, anthropometric and clinical variables, in patients with rheumatoid arthritis (RA). Consecutive RA patients were prospectively enrolled for this cross-sectional study. For each patient were collected demographic, anthropometric, clinical data related to disease activity. HGs was assessed in terms of area under the force–time curve (AUC-FeT), peak grip force and time to reach the curve plateau. The correlations between the variables were studied with the Spearman’s rho correlation coefficient. The receiver operating characteristic (ROC) curve analysis was used to test the discriminant accuracy of HGs features in identifying patients in moderate/high disease activity. A multivariate analysis was performed to estimate the contribution of covariates on the AUC-FeT. A significant correlation was found among AUC-FeT, age, Simplified Disease Activity Index (SDAI), Ultrasound-Clinical Arthritis Activity (US-CLARA) (all at p < 0.0001), and body mass index (BMI) (p = 0.0001). Any correlation was found between HGs and radiographic damage. The discriminatory power of AUC-FeT was good [area under-ROC curve = 0.810 (95% CI 0.746–0.864)]. Variables significantly associated with AUC-FeT in multivariate analysis were age (p = 0.0006), BMI (p = 0.012), gender (p = 0.004), SDAI (p = 0.047) and US-CLARA (p = 0.023). HGs is negatively influenced by demographic (gender and age), anthropometric (BMI), and disease activity variables (SDAI and US-CLARA). These findings highlight the role of HGs in RA patients' functional impairment and disability.

Long-Term Efficacy of Treatment Effects After a Kyphosis Exercise and Posture Training Intervention in Older Community-Dwelling Adults: A Cohort Study

BACKGROUND AND PURPOSE

Treatments that prevent worsening kyphosis are important due to the progressive nature of kyphosis with aging. We assessed long-term efficacy of treatment effects after a short-term kyphosis exercise and posture training intervention in a cohort study among older adults with hyperkyphosis, and investigated whether long-term treatment effects differ among males and females.

METHODS

In the original kyphosis intervention, 112 older adults enrolled in a waitlist design randomized controlled trial. One hundred three participants, mean age 70.0 (5.7) years and kyphosis 52.0° (7.4°), completed a twice weekly, 3-month, group exercise and posture training intervention, and were eligible to enroll in the follow-up study. We compared (1) change in outcomes pre-/postintervention to change postintervention over the follow-up period, (2) change in outcomes pre-/postintervention and postintervention to follow-up, stratified by sex, and (3) long-term change postintervention to follow-up in males and females. Primary outcome was change in kyphometer-measured thoracic kyphosis. Secondary outcomes were change in lumbar lordosis, objective measures of physical function, self-reported measures of physical activity, and health-related quality of life (HRQoL).

RESULTS AND DISCUSSION

Forty-three participants, 42% of the eligible cohort, returned for follow-up, a mean 3.0 (0.7) years after completing the original intervention. Participants (27 females and 16 males) were 73.8 (6.1) years old, with mean kyphosis 48.9° (11.9°) at follow-up. Kyphosis declined -1.5° (95% confidence interval [CI]: -3.9° to 1.0°) postintervention to follow-up and this was no different than change pre-/postintervention, P = .173. Lordosis improved 8.9° (95% CI: 6.2° to 11.6°), more than change pre-/postintervention, P < .001. Gait speed measure of physical function increased 0.08 (95% CI: 0.02 to 0.14) m/s, Physical Activity Scale for the Elderly (PASE) measure of physical activity increased 4 (95% CI: -16 to 24) points, and Patient-Reported Outcomes Measurement Information System (PROMIS) mental health T-score measure of HRQoL increased 1.1 (95% CI: -1.0 to 3.1) points, but these improvements were not significantly more than change pre-/postintervention, P > .050. Other measures of physical function (modified Physical Performance Test [PPT], Timed Up and Go, and 6-minute walk) and HRQoL (Scoliosis Research Society [SRS-30] self-image and PROMIS physical function and physical health) declined at follow-up, significantly more than change pre/postintervention, P ≤ .050. Comparing change in outcomes pre-/postintervention and postintervention to follow-up, stratified by sex, both males and females increased lordosis, and decreased modified PPT and 6-minute walk measures of physical function, P < .050. Males and females differed in long-term change postintervention to follow-up. Time loaded standing and PASE improved in females compared with males, P = .008 and P = .092, respectively, and PROMIS mental health, physical health, and physical function declined in females compared with males, P = .073, P = .025, and P = .005, respectively.

CONCLUSIONS

In our follow-up study, a mean of 3.0 (0.07) years after a 3-month kyphosis exercise and posture training intervention, kyphosis maintained and did not progress as expected with age. There was long-term improvement in lordosis. Compared with treatment effects from the short-term intervention, gait speed maintained equally well in males and females, while trunk endurance improved in females. Further investigation of long-term benefits of a short-term kyphosis exercise and posture training intervention is warranted.

Age-Related Changes in Concentric and Eccentric Isokinetic Peak Torque of the Trunk Muscles in Healthy Older Versus Younger Men

This study investigated age-related changes in trunk muscle function in healthy men and the moderating effect of physical activity. Twelve older (67.3 ± 6.0 years) and 12 younger (24.7 ± 3.1 years) men performed isokinetic trunk flexion and extension tests across a range of angular velocities (15°/s-180°/s) and contractile modes (concentric and eccentric). For concentric trunk extension, mixed-effects analysis of covariance revealed a significant interaction between Angular velocity × Age group (p = .026) controlling for physical activity. Follow-up univariate analysis of covariance revealed that the younger group produced significantly greater peak torque for all concentric extension conditions. Eccentric trunk strength was somewhat preserved in the older group. Age-related changes in trunk strength were independent of physical activity. The normal loss of trunk muscle strength in older age is muscle- and contractile-mode specific. These findings provide guidance for effective intervention strategies to offset adverse health outcomes related to trunk strength loss in older adults.

The relationships between isometric muscle strength and respiratory functions of the Turkish National Paralympic Goalball Team

Goalball is a unique sport for only blind and visually disabled people to prevent physical inactivity and its harmful consequences. Determining the profile of physical fitness parameters and their relationship is crucial for all sports discipline. The purpose of the study is to determine the characteristics and the relationship between isometric muscle strength and respiratory functions. A total of 14 (10 female, four male athletes) goalball athletes were included in the study. Upper-extremity, lower-extremity and trunk isometric muscle strength and pulmonary function tests measurements were performed to the athletes on two different days. The relationship between parameters was evaluated by Spearman correlation test. Strength and pulmonary function parameters were higher in male athletes (P<0.05). A medium/strong/very strong correlation was found between respiratory function and upper extremity isometric muscle strength (r=0.529–0.917, P<0.05). A moderate/strong correlation was found between lower extremity isometric muscle strength and respiratory function (r=0.534–0.867, P<0.05). A moderate correlation was found between trunk isometric muscle strength and respiratory function (r=0.538–0.640, P<0.05). It was seen that respiratory functions were associated with upper-lower extremity and trunk muscle strength. With this result, the idea arises that strength exercises can affect the improvement of respiratory function in individuals with disabilities, which is very important for both overall health and sports performance.

Adapting Fitness Age Calculations to Suit a Modern North American Female Population, Regardless of Age, Race, or Ability Level

Objectives: Fitness Age (FA) has been reported in Japan and South Korea as one way to assess an individual’s overall health. To date, this method has not been used in North America. The objective of the current study was to assess the applicability of existing Fitness Age calculations for North American women. Methods: Thirty-seven North American working women aged 18 to 67 years completed a fitness test battery, as described by previous studies. The fitness test results were used with published regression equations to estimate each woman’s FA which was subsequently adjusted to correct for biases in the data. Results: The data from the fitness tests were similar to those presented in the previously published literature with the exception of grip strength, trunk flexion, and body fat percentage which differed significantly compared to the populations assessed previously. These population differences appear to have impacted the applicability of the published methods for this population. Discussion: Because the FA estimates must be corrected according to a theoretical “ideal” to address population biases before they can be used, the authors propose using the deviation from this theoretical ideal rather than raw FA in future aging studies, as this is where the interesting inter-personal differences lay.

Review of Current Spinal Robotic Orthoses

Osteoporotic spine fractures (OSF) are common sequelae of osteoporosis. OSF are directly correlated with increasing age and incidence of osteoporosis. OSF are treated conservatively or surgically. Associated acute pain, chronic disabilities, and progressive deformities are well documented. Conservative measures include a combination of initial bed rest, analgesia, early physiotherapy, and a spinal brace (orthosis), with the aim for early rehabilitation to prevent complications of immobile state. Spinal bracing is commonly used for symptomatic management of OSF. While traditional spinal braces aim to maintain the neutral spinal alignment and reduce the axial loading on the fractured vertebrae, they are well known for complications including discomfort with reduced compliance, atrophy of paraspinal muscles, and restriction of chest expansion leading to chest infections. Exoskeletons have been developed to passively assist and actively augment human movements with different types of actuators. Flexible, versatile spinal exoskeletons are designed to better support the spine. As new technologies enable the development of motorized wearable exoskeletons, several types have been introduced into the medical field application. We have provided a thorough review of the current spinal robotic technologies in this paper. The shortcomings in the current spinal exoskeletons were identified. Their limitations on the use for patients with OSF with potential improvement strategies were discussed. With our current knowledge of spinal orthosis for conservatively managed OSF, a semi-rigid backpack style thoracolumbar spinal robotic orthosis will reduce spinal bone stress and improve back muscle support. This will lead to back pain reduction, improved posture, and overall mobility. Early mobilization is an important part of management of patients with OSF as it reduces the chance of developing complications related to their immobile state for patients with OSF, which will be helpful for their recovery.

The effect of age, prolonged seated work and sex on posture and perceived effort during a lifting task

The purpose of this investigation was to determine the effect of prolonged seated work, lift task, age and sex on normalized lumbar angles, thoracic angles, perceived effort and duration of lifts. A total of 17 young and 17 mature participants were recruited with an average (standard deviation) age of 23.8 (5.0) years and 63.7 (3.9) years, respectively. Participants completed 3 different floor to knuckle lifts before and following 90 min of seated work. The lifts included; (i) 7 kg symmetrical, (ii) 4.5 kg symmetrical and (iii) 4.5 kg asymmetrical. Prolonged seated work and age interacted to affect normalized peak lumbar angles (p = 0.0469) where older adults adopted 56(15)% flexion after seated work compared to 67(16)% among younger adults. Older adults took significantly longer to complete the lifting tasks compared to younger adults while age did not affect perceived effort across lifting tasks. Older workers may require age specific interventions given age specific responses.

Relationship Between Age at Adult Height and Knee Mechanics During a Drop Vertical Jump in Men

Background:

Anterior cruciate ligament (ACL) injuries are relatively common among younger athletes, with significant physical, psychological, and financial consequences. Research has largely focused on female athletes by identifying specific risk factors for an ACL injury, including variation in pubertal growth timing. There is less known about risk factors in males, and little is known about the effects of pubertal development on ACL injury risk in men.

Purpose/Hypothesis:

The purpose of this study was to analyze the relationship between an indicator of pubertal growth timing (age at adult height) and biomechanical risk for ACL injuries in men. We hypothesized that earlier age at adult height is correlated with riskier landing biomechanics during a drop vertical jump (DVJ) in men.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 21 recreationally active male students (age range, 20-33 years) were included. Participants completed a questionnaire on age at adult height and limb dominance, and anthropometric measurements were taken. There were 6 DVJ tests performed, with participants landing on a force plate while digital cameras recorded kinematic data from retroreflective markers placed according to the Helen Hayes marker system. Primary outcomes were sagittal and frontal plane knee kinematics and kinetics during contact. Data were analyzed using Pearson product-moment correlation.

Results:

In both limbs, age at achieving adult height was significantly negatively correlated with knee flexion/extension angle at toe-off (dominant: r = –0.79, P < .01; nondominant: r = –0.74, P < .01) and with peak flexion (dominant: r = –0.63, P < .01; nondominant: r = –0.70, P < .01) and extension (dominant: r = –0.66, P < .01; nondominant: r = –0.56, P = .01) angles during contact. In the nondominant limb, age at adult height was significantly negatively correlated with varus/valgus angle at initial contact (r = –0.43; P = .05) and toe-off (r = –0.44; P = .04) and was positively correlated with peak varus moment during contact (r = 0.42; P = .06). Age at adult height was also positively correlated with peak vertical ground-reaction force (r = 0.58; P < .01).

Conclusion:

Later age at adult height was correlated with riskier landing profiles in this study. This suggests that males with later or longer pubertal growth may have increased mechanical risk for ACL injuries. A better understanding of the effects of pubertal growth on landing biomechanics can improve the early identification of male athletes at greater risk for injuries.

Changes in the Static Balance of Older Women Participating in Regular Nordic Walking Sessions and Nordic Walking Combined with Cognitive Training

Regular Nordic walking (NW) improves physical fitness, including the ability to maintain balance, in older adults. However, little is known about whether complementing the exercise programme with cognitive training (CT) contributes to increased effects. The aim of the study was to determine and compare the effect of regular NW and NW combined with CT on the ability to maintain static balance in older adults. The study examined 61 women aged 64 to 93 years living in adult day care centres. Twenty people participated in a three-month programme combining NW and CT (group NW + CT), 20 people participated only in NW classes (group NW), and 21 people were a control group (group C). The Romberg balance test, Fullerton Functional Fitness Test, and Attention and Perceptivity Test were used. After the programme, an increase in the time of maintaining the balance (with eyes open on the left and right legs) was observed in groups NW + CT and NW, with no such changes found in group C. This increase was greater in group NW + CT. Increased agility and strength of the hand were predictors of improving the ability to maintain balance. Regular NW improved the ability to maintain balance with eyes open in female residents of adult day care centres.

Feasibility and Reliability of Functional Muscle Tests in Lung Transplant Recipients

Supplemental digital content is available in the text.

Objective

This study investigates the feasibility, reliability, and correlations of recommended functional tests in lung transplant recipients shortly after surgery.

Design

This is an observational study.

Methods

Fifty patients (28 females) performed well-standardized maximum isometric back extension in a sitting position, handgrip strength, and Biering-Sørensen endurance tests shortly before discharge from the acute hospital, shortly thereafter, and 2 mos later after subacute rehabilitation.

Results

Back extension testing was well feasible, but only two thirds of the patients could perform the Biering-Sørensen test at baseline and they experienced a greater number of minor but no major adverse events. Absolute reliability measures and the intraclass correlation coefficients were excellent for the strength (0.97–0.98 [0.95–0.99]) and good for the endurance tests (0.69 [0.26–0.87]). Handgrip revealed high correlation with back strength (≥0.75) but not with Biering-Sørensen scores.

Conclusions

Well-controlled maximum back strength testing is feasible and reliable, and the scores are highly correlated with grip strength in lung transplant recipients shortly before hospital discharge. The Biering-Sørensen test should be limited to patients without dominant weakness and/or fear. Future research should investigate whether grip instead of back extension strength can safely be used for proper exercise prescription.

The effect of age on in-vivo spine stiffness, postures and discomfort responses during prolonged sitting exposures

Many industrialised working populations are ageing and prolonged sitting exposures are prevalent across occupational sectors. The purpose of this work was to determine the effect of age and sex on passive spine stiffness, postures and discomfort in response to seated work. A total of 34 participants were recruited, with 17 older adults with an average age of (standard deviation) 63.7 (±3.9) years and 17 younger adults aged 23.8 (±5.0) years. Participants were asked to sit continuously for 90 min while typing. Baseline passive spine stiffness was higher in older adults at 40% flexion compared to younger adults (p = .0233). Older adults sat in less normalised flexion, at 33.4% (±16.4) compared to 60.9% (±20.2) in the younger group (p = .0003). Discomfort was higher among older adults in the neck, right shoulder and middle back regions (p < .0086). An understanding of age-specific responses to workplace exposures is essential to determine whether age-specific interventions are warranted.   Practitioner summary: Older adults had higher passive spine stiffness and sat with less flexion during prolonged sitting. Discomfort was higher among older adults and occurred earlier in the simulation compared to younger participants, indicating that interventions, such as walking breaks may need to be implemented earlier during sitting for aged workers.

Soft Tissue and Bony Injuries Attributed to the Practice of Yoga: A Biomechanical Analysis and Implications for Management

OBJECTIVE

To analyze injuries that were directly associated with yoga practice and identify specific poses that should be avoided in patients with osteopenia or osteoporosis.

PATIENTS AND METHODS

We retrospectively reviewed the medical records of patients with injuries that were primarily caused by yoga. Patients were seen from January 1, 2006, through December 31, 2018. Injuries were categorized into 3 groups: (1) soft tissue injury, (2) axial nonbony injury, and (3) bony injury. Patients underwent evaluation and were counseled to modify exercise activity.

RESULTS

We identified 89 patients for inclusion in the study. Within the soft tissue group, 66 patients (74.2%) had mechanical myofascial pain due to overuse. Rotator cuff injury was seen in 6 (6.7%), and trochanteric bursopathy was observed in 1 (1.1%). In the axial group, exacerbation of pain in degenerative joint disease (46 patients [51.7%]) and facet arthropathy (n=34 [38.2%]) were observed. Radiculopathy was seen in 5 patients (5.6%). Within the bony injury category, kyphoscoliosis was seen on imaging in 15 patients (16.9%). Spondylolisthesis was present in 15 patients (16.9%). Anterior wedging was seen in 16 (18.0%), and compression fractures were present in 13 (14.6%). The poses that were most commonly identified as causing the injuries involved hyperflexion and hyperextension of the spine. We correlated the kinesiologic effect of such exercises on specific musculoskeletal structures.

CONCLUSION

Yoga potentially has many benefits, but care must be taken when performing positions with extreme spinal flexion and extension. Patients with osteopenia or osteoporosis may have higher risk of compression fractures or deformities and would benefit from avoiding extreme spinal flexion. Physicians should consider this risk when discussing yoga as exercise.

Only one patient out of five achieves symmetrical knee function 6 months after primary anterior cruciate ligament reconstruction

PURPOSE

To assess the percentage of patients achieving symmetrical knee function 6 months after primary anterior cruciate ligament (ACL) reconstruction (ACLR) and to identify factors affecting its achievement, in a large cohort.

METHODS

Data were extracted from our clinic database. Patients who underwent primary ACLR from 2000 to 2015 and were assessed with the isokinetic quadriceps and hamstring muscles strength tests and single-leg-hop test at the 6-month follow-up were included in the study. Demographic data, information on the graft used, cartilage injuries and concomitant meniscal surgery were reviewed. Patients who reached a limb symmetry index (LSI) of ≥ 90% in all three tests were considered to have achieved symmetrical knee function. A multivariate logistic regression analysis was used to determine whether patient age, gender, time from injury to surgery, pre-injury Tegner activity level, graft type, cartilage injury and the presence of medial meniscus (MM) or lateral meniscus (LM) resection or repair were factors associated with the achievement of symmetrical knee function 6 months after primary ACLR.

RESULTS

A total of 4093 patients (54.3% males) with a mean age of 28.3 ± 10.7 years were included. Data from all three tests were available for 3541 patients. The proportion of patients that achieved a LSI of ≥ 90% was 35.7%, 47.3% and 67.9% for isokinetic quadriceps muscle strength, hamstring muscles strength and the single-leg-hop test, respectively. A total of 693 patients (19.6%) achieved symmetrical knee function, reaching a LSI of ≥ 90% in all three tests. Older age (≥ 30 years) (OR, 0.50; 95% CI 0.41-0.61; P < 0.001), MM resection (OR, 0.75; 95% CI 0.57-0.98; P = 0.03) and MM repair (OR, 0.63; 95% CI 0.40-0.98; P = 0.04) reduced the odds, whereas the use of hamstring tendon (HT) autograft (OR, 2.28; 95% CI 1.51-3.45; P < 0.001) over bone-patellar tendon-bone (BPTB) autograft increased the odds of achieving symmetrical knee function.

CONCLUSION

Only 19.6% of the patients achieved symmetrical knee function 6 months after primary ACLR. Age ≥ 30 years, MM resection and MM repair reduced the chance, whereas the use of HT autograft over BPTB autograft increased the chance of achieving symmetrical knee function 6 months after primary ACLR. This study shows that most of the patients are yet to regain symmetrical knee function 6 months after primary ACLR and, moreover, it identifies several factors affecting its achievement in a large cohort. The results of this study should be used to counsel patients about their expected functional recovery and to optimize rehabilitation and maximize knee function after ACLR.

LEVEL OF EVIDENCE

III.

Low self-reported sports activity before stroke predicts poor one-year-functional outcome after first-ever ischemic stroke in a population-based stroke register

Background

Physical activity (PA) is associated with lower risk of stroke. We tested the hypothesis that lack of pre-stroke PA is an independent predictor of poor outcome after first-ever ischemic stroke.

Methods

We assessed recent self-reported PA and other potential predictors for loss of functional independence - modified Rankin Scale (mRS) > 2 - one year after first-ever ischemic stroke in 1370 patients registered between 2006 and 2010 in the Ludwigshafen Stroke Study, a population-based stroke registry.

Results

After 1 year, 717 (52.3%) of patients lost their independence including 251 patients (18.3%) who had died. In multivariate logistic regression analysis lack of regular PA prior to stroke (Odds Ratio (OR) 1.7, Confidence Interval (CI) 1.1–2.5), independently predicted poor outcome together with higher age (65–74: OR 1.7; CI 1.1–2.8, 75–84 years: OR 3.3; CI 2.1–5.3; ≥85 years OR 14.5; CI 7.4–28.5), female sex (OR 1.5; CI 1.1–2.1), diabetes mellitus (OR 1.8; CI 1.3–2.5), stroke severity (OR 1.2; CI 1.1–1.2), probable atherothrombotic stroke etiology (OR 1.8; CI 1.1–2.8) and high leukocyte count (> 9.000/mm³; OR 1.4; CI 1.0–1.9) at admission. Subclassifying unknown stroke etiology, embolic stroke of unknown source (ESUS; n = 40, OR 2.2; CI 0.9–5.5) tended to be associated with loss of independence.

Conclusion

In addition to previously reported factors, lack of PA prior to stroke as potential indicator of worse physical condition, high leukocyte count at admission as indicator of the inflammatory response and probable atherothrombotic stroke etiology might be independent predictors for non-functional independence in first-ever ischemic stroke.

Relationship between core stability and dynamic balance in women with postmenopausal osteoporosis

Objectives

The aim of this study was to investigate the relationship between core stability and dynamic balance in women with postmenopausal osteoporosis.

Patients and methods

A total of 100 females (mean age 59.9±7.5 years; range, 42 to 73 years) with postmenopausal osteoporosis between January 2016 and June 2016 were included in this study. All patients were evaluated for dynamic balance with the Star Excursion Balance Test (SEBT) and for core stability with trunk flexion, extension, and Side Bridge Test (SBT).

Results

There was a significant correlation between age and the reach directions of anterior (A), posteromedial (PM), and posterolateral (PL) of the right limb (p<0.001, p=0.009, p=0.012) and the reach directions of A and PM of the left limb (p<0.001, p=0.004). There was no correlation between the lumbar spine, femoral neck, and total hip Bone Mineral Density (BMD) and the reach directions of SEBT (p>0.05). There was a significant correlation between the trunk flexion test results and the reach directions of A, PM, and PL of the right limb (p=0.005, p=0.001, p=0.002), (r=0.277, r=0.333, r=0.308) and the reach directions of A, PM, and PL of the left limb (p=0.008, p=0.016, p=0.005), (r=0.265, r=0.239, r=0.276). There was a significant correlation between the SBT results and the reach directions of A, PM, and PL of the right limb (p<0.001, p<0.001, p=0.005), (r=0.423, r=0.366, r=0.281) and the reach directions of A, PM, and PL of the left limb (p<0.001, p<0.001, p=0.001), (r=0.418, r=0.356, r=0.316). There was a significant correlation between the trunk extension test results and the reach directions of A, PM, and PL of the right limb (p<0.001, p<0.001, p=0.006), (r=0.383, r=0.471, r=0.276) and the reach directions of A, PM, and PL of the left limb (p<0.001, p<0.001, p=0.003) (r=0.407, r=0.401, r=0.297).

Conclusion

Our study results showed that age and core stability were associated with dynamic balance in women with postmenopausal osteoporosis.

BIOMECHANICAL CHARACTERISTICS IN YOGA SIRSASANA

The aim of this study was to understand how to process Yoga headstand and the difference between genders in headstand. Twelve skilled participates were recruited in this study (Males 34.1 [Formula: see text] 3.3 years, [Formula: see text]; Females 36.5 [Formula: see text] 3.9 years, [Formula: see text]). The 10 camera Vicon motion capture system, Kistler force plate, and Medilogic pressure mat were used synchronously to record the movement, ground reaction force, and pressure distribution during headstand. The Mann–Whitney U test and Friedman test ([Formula: see text]) was applied to assess the statistics. The trunk, hip, knee, and ankle joint angles were [Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text], respectively, in all subjects. The pressure distribution was 38 [Formula: see text] 19%, 29 [Formula: see text] 12%, and 33 [Formula: see text] 9% on subjects’ heads, right elbows, and left elbows, respectively. The COP trajectory was 31.2 [Formula: see text] 17.4[Formula: see text]cm and surface area was 5.3 [Formula: see text] 1.4[Formula: see text]cm2. No significant differences were found in joint angles, overall force distribution, and COP trajectory and surface area between genders. Both males and females distribute body weight to the supports of head and elbows equally and kept the body straight and erect on the ground during Yoga headstand.

The Role of Trunk Musculature in Osteoporotic Vertebral Fractures: Implications for Prediction, Prevention, and Management

This review examines the current evidence for associations between vertebral fractures (VFx), the most common type of fracture in older adults, and trunk muscles, which are intimately tied to spinal loading and function. Individuals with prevalent VFxs have more fat infiltration in the trunk muscles, lower trunk extension strength, and altered muscle activation patterns. However, no longitudinal studies have examined whether assessment of trunk muscle can contribute to prediction of fracture risk. A few studies report that exercise interventions targeting the trunk muscles can reduce the risk of VFx, improve trunk strength and endurance in patients who have had a VFx, and reduce the risk of falling, a common cause of VFx, but the quality of evidence is low. Trunk muscles likely have an important role to play in prediction, prevention, and management of VFx, but additional longitudinal studies and randomized controlled trials are needed to clarify this role.

What is the effect of spino-pelvic sagittal parameters and back muscles on osteoporotic vertebral fracture?

STUDY DESIGN

Case control study.

PURPOSE

To examine the effect of spino-pelvic sagittal parameters and back muscles on osteoporotic vertebral fracture.

OVERVIEW OF LITERATURE

Low bone mass is not the only important component of the risk on osteoporotic vertebral fracture; many other risk factors also contribute to skeletal fragility.

METHODS

Seventy-two patients who had a lateral radiograph of the whole spine, magnetic resonance imaging of the lumbar spine, and bone densitometry, were enrolled. The spino-pelvic sagittal parameters (pelvic incidence, pelvic tilt [PT], sacral slope, thoracic kyphosis, lumbar lordosis), age, lumbar bone mineral density, and amount of back muscle around the lumbar spine were analyzed.

RESULTS

There was higher sagittal imbalance of the spine in the vertebral fracture group (p=0.011). In spinopelvic parameters, the average of PT was 22.13° in vertebral fracture group and 13.70° in the non-fracture group (p=0.002). The amount of lower back extensor muscle in the vertebral fracture group was 2,170 mm(2), which was lower than the non-fracture group (3,040 mm(2), p=0.001). Multiple logistic regression analysis for the risk of osteoporotic vertebral fracture was significant in lumbar bone mineral density (odds ratio [OR], 0.313; 95% confidence interval [CI], 0.139-0.706, p=0.005) and the muscle ratio of extensor back muscle (OR, 0.902; 95% CI, 0.826-0.984; p=0.020).

CONCLUSIONS

These results suggest that osteoporotic vertebral fracture could be developed easily by weakness of extensor back muscle in sagittal imbalance of the spine with high pelvic tilt.

Sex differences in the association of fasting and postchallenge glucose levels with grip strength among older adults: the Rancho Bernardo Study

OBJECTIVE

Persons with diabetes have accelerated muscle loss. The association of fasting and postchallenge glucose levels per se to grip strength, a clinical marker of poor physical function, and potential sex differences in this relationship has not been previously described.

DESIGN

Longitudinal cohort.

SETTING

USA.

PARTICIPANTS

Participants were community-dwelling older adults (mean age 71.3 years) without self-reported diabetes and/or use of diabetes medication with glucose measured at baseline (1992-1996).

MEASUREMENTS

Fasting plasma glucose (FPG) was measured in 1019 women and 636 men. Two-hour glucose (2HG) levels after a 75 g oral glucose tolerance test were also available (women, n=870; men, n=559). Dominant hand grip strength was assessed using a hand-held dynamometer at 3.0±1.6 visits over a median 7.0 years. Mixed linear models examined the association of baseline glucose levels with grip strength, accounting for repeated visits, and adjusting for covariates.

RESULTS

Sex-specific FPG quartiles were associated with unadjusted differences in grip strength among women (p=0.03) but not men (p=0.50). However, in men, adjusting for age, education, height, weight, peripheral neuropathy, physical activity, and comorbidities, each SD (SD=17 mg/dL) higher FPG was associated with persistently lower grip strength (-0.44±0.22 kg, p=0.049); 2HG (SD=50 mg/dL) was unrelated to grip strength (-0.39±0.25 kg, p=0.13). In women, neither FPG (SD=16 mg/dL) nor 2HG (SD=45 mg/dL) was associated with grip strength (0.02±0.12 kg, p=0.90; and -0.20±0.14 kg, p=0.14; respectively) after adjustment. The rate of change in grip strength did not differ across FPG or 2HG quartiles in either sex.

CONCLUSIONS

In age-adjusted analyses, elevated fasting glucose levels are associated with persistently lower grip strength in older men, but not women. Future studies are needed to elucidate reasons for these sex differences and may provide further insight into accelerated loss of muscle function as a complication of diabetes in older adults.

Force Capacity of Back Extensor Muscles in Healthy Males: Effects of Age and Recovery Time

To judge a person’s maximum trunk extension performance as either age-appropriate or deconditioned is challenging. The current study aimed at determining age and anthropometrically adjusted maximum voluntary contraction (MVC) of back extensors considering the number and recovery time between trials. Thirty-one younger (20–30 years) and 33 older (50–60 years) healthy males performed five repetitions of maximal isometric trunk extensions in an upright standing position with randomized recovery times ranging between one to five minutes at one minute intervals. Torque values were normalized according to the individual’s upper body mass resulting in upper body torque ratios (UBTR). To evaluate the impact of age, recovery time, and fatigue on UBTR we applied a linear mixed-effects model. Based on surface EMG data muscular fatigue could be excluded for both groups. For all MVC trials, UBTR levels differed significantly between age groups (range of mean values: younger: 2.26–2.28, older: 1.78–1.87, effect size: 1.00) but were independent from recovery time. However, the older males tended to exert higher UBTR values after shorter recovery periods. The study provides normative values of anthropometrically and age-group adjusted maximum back extensor forces. For the investigated groups, only two MVC trials with a recovery time of about one minute seem appropriate.

Age-related changes in trunk neuromuscular activation patterns during a controlled functional transfer task include amplitude and temporal synergies

While healthy aging is associated with physiological changes that can impair control of trunk motion, few studies examine how spinal muscle responses change with increasing age. This study examined whether older (over 65 years) compared to younger (20-45 years) adults had higher overall amplitude and altered temporal recruitment patterns of trunk musculature when performing a functional transfer task. Surface electromyograms from twelve bilateral trunk muscle (24) sites were analyzed using principal component analysis, extracting amplitude and temporal features (PCs) from electromyographic waveforms. Two PCs explained 96% of the waveform variance. Three factor ANOVA models tested main effects (group, muscle and reach) and interactions for PC scores. Significant (p<.0125) group interactions were found for all PC scores. Post hoc analysis revealed that relative to younger adults, older adults recruited higher agonist and antagonistic activity, demonstrated continuous activation levels in specific muscle sites despite changing external moments, and had altered temporal synergies within abdominal and back musculature. In summary both older and younger adults recruit highly organized activation patterns in response to changing external moments. Differences in temporal trunk musculature recruitment patterns suggest that older adults experience different dynamic spinal stiffness and loading compared to younger adults during a functional lifting task.

Association of dietary intake with joint space narrowing and osteophytosis at the knee in Japanese men and women: the ROAD study

OBJECTIVE

The objective of the present study is to identify dietary nutrients associated with joint space narrowing (JSN) and osteophytosis at the knee in a population-based cohort of the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study.

METHODS

From the baseline survey of the ROAD study, 827 participants (305 men and 522 women) in a rural cohort were analyzed. Dietary nutrient intakes for the last month were assessed by a self-administered brief diet history questionnaire. Minimum joint space width (mJSW) and osteophyte area (OPA) in the medial compartment of the knee were measured using a knee osteoarthritis (OA) computer-aided diagnostic system.

RESULTS

In men, there were no associations of dietary nutrient intakes with mJSW or OPA. In women, vitamins K, B1, B2, B6, and C were associated with mJSW after adjustment for age, body mass index, and total energy (p < 0.05). Vitamins E, K, B1, B2, niacin, and B6 were significantly associated with OPA (p < 0.05) in women. Vitamins K, B and C may have a protective role against knee OA in women and might lead to disease-modifying treatments.

CONCLUSIONS

The present study revealed that low dietary intake of vitamins K, B, and C are associated with JSN and osteophytosis in women.

ISSLS Prize winner: Mechanical influences in progressive intervertebral disc degeneration

STUDY DESIGN

Mechanical study on cadaver motion segments.

OBJECTIVE

To determine whether high gradients of compressive stress within the intervertebral disc are associated with progressive disc degeneration.

SUMMARY OF BACKGROUND DATA

Mechanical loading can initiate disc degeneration but may be unimportant in disease progression, because degenerative changes cause the disc to be increasingly "stress-shielded" by the neural arch. However, the most typical feature of advanced disc degeneration (delamination and collapse of the annulus) may not depend on absolute values of compressive stress but on gradients of compressive stress that act to shear annulus lamellae.

METHODS

A total of 191 motion segments (T7-T8 to L5-S1) were dissected from 42 cadavers aged 19 to 92 years. Each was subjected to approximately 1 kN compression, while intradiscal stresses were measured by pulling a pressure transducer along the disc's midsagittal diameter. "Stress gradients" in the annulus were quantified as the average rate of increase in compressive stress (MPa/mm) between the nucleus and the region of maximum stress in the anterior or posterior annulus. Measurements were repeated before and after creep loading and in simulated flexed and erect postures. Disc degeneration was assessed macroscopically on a scale of 1 to 4.

RESULTS

As grade of disc degeneration increased from 2 to 4, nucleus pressure decreased by an average 68%, and maximum compressive stress in the annulus decreased by 48% to 64%, depending on location and posture. In contrast, stress gradients in the annulus increased by an average 75% in the anterior annulus (in flexed posture) and by 108% in the posterior annulus (in erect posture). Spearman rank correlation showed that these increases were statistically significant.

CONCLUSION

Despite stress-shielding by the neural arch, gradients of compressive stress increase with increasing grade of disc degeneration. Stress gradients act to shear adjacent lamellae and can explain progressive annulus delamination and collapse.

LEVEL OF EVIDENCE

N/A.

Association of physical activities of daily living with the incidence of certified need of care in the long-term care insurance system of Japan: the ROAD study

BACKGROUND

The present study aimed to investigate association of physical activities of daily living with the incidence of certified need of care in the national long-term care insurance (LTCI) system in elderly Japanese population-based cohorts.

METHODS

Of the 3,040 participants in the baseline examination, we enrolled 1,773 (699 men, 1,074 women) aged 65 years or older who were not certified as in need of care-level elderly at baseline. Participants were followed during an average of 4.0 years for incident certification of need of care in the LTCI system. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used assess function. Associated factors in the baseline examination with the occurrence were determined by multivariate Cox proportional hazards regression analysis. Receiver operating characteristic curve analysis was performed to evaluate cut-off values for discriminating between the occurrence and the non-occurrence group.

RESULTS

All 17 items in the WOMAC function domain were significantly associated with the occurrence of certified need of care in the overall population. Cut-off values of the WOMAC function score that maximized the sum of sensitivity and specificity were around 4-6 in the overall population, in men, and in women. Multivariate Cox hazards regression analysis revealed that a WOMAC function score ≥4 was significantly associated with occurrence with the highest hazard ratio (HR) for occurrence after adjusting for confounders in the overall population (HR [95 % confidence interval (CI)] 2.54 [1.76-3.67]) and in women [HR (95 % CI) 3.13 (1.95-5.02)]. A WOMAC function score ≥5 was significantly associated with the highest HR for occurrence in men [HR (95 % CI) 1.88 (1.03-3.43)].

CONCLUSIONS

Physical dysfunction in daily living is a predictor of the occurrence of certified need of care. Elderly men with a WOMAC function score ≥5 and women with a score ≥4 should undergo early intervention programs to prevent subsequent deterioration.

Degree of thoracic kyphosis and peak torque of trunk flexors and extensors among healthy women

OBJECTIVE

The aim of this study was to analyze the effects of aging on the degree of thoracic kyphosis and peak torque of the trunk flexor and extensor muscles among women without a densitometric diagnosis of osteoporosis.

METHODS

Thirty women were selected to make up three groups: young women (n = 10; 24.60 ± 2.27 years of age); adults (n = 10; 43.50 ± 2.88); and elderly women (n = 10; 62.40 ± 2.67). Bone mineral density (BMD), degree of thoracic kyphosis and peak torque of the trunk flexors and extensors were evaluated. Differences between the groups were evaluated using the Kruskal-Wallis ANOVA and Mann-Whitney U tests. Pearson's correlation coefficient was used to assess correlations between the variables. The significance level was taken to be 5% (p ≤ 0.05).

RESULTS

The elderly group presented a greater degree of thoracic kyphosis (p = 0.009) and lower peak torque of the trunk flexors and extensors than the young group. The adult group presented lower peak torque of the trunk than the young group. A negative correlation was observed between age and peak torque of the trunk flexors and extensors (p ≤ 0.001), and a positive correlation between age and the degree of thoracic kyphosis (r = 0.58; p ≤ 0.001). The elderly group presented higher values for the eccentric/concentric ratio of the peak torque for flexors (p = 0.03) and extensors (p = 0.02).

CONCLUSION

This study suggests that physiological aging may be associated with a greater degree of thoracic kyphosis and lower muscle strength of the trunk flexors and extensors. Moreover, the elderly women showed a relative capacity for preservation of eccentric strength.

The influence of fat infiltration of back extensor muscles on osteoporotic vertebral fractures

Study Design

Retrospective study.

Purpose

To investigate the influence of fat infiltration at low back extensor muscles on osteoporotic vertebral fracture.

Overview of Literature

In persons with stronger back muscles, the risk of osteoporotic vertebral fractures will likely be lower than in those persons with weaker back muscles. However, the degree of influence of fat infiltration of the back extensor muscle on osteoporotic vertebral fracture remains controversial.

Methods

Two hundred and thirty-seven patients who had undergone lumbar spine magnetic resonance imaging and bone mineral density (BMD) were enrolled in this study. The amount of low back extensor muscle was determined using the pseudocoloring technique on an axial view of the L3 level. The patients were divided into two groups: osteoporotic vertebral fracture group (group A) and non-fracture group (group B). The amount of low back extensor muscle is compared with BMD, degenerative change of disc, osteophyte grade of facet joint and promontory angle to reveal the association between these factors.

Results

A negative correlation is found between age and the amount of low back extensor muscle (p=0.001). The amount of low back extensor muscle in group A and group B was 60.3%±14.5% and 64.2%±9.3% respectively, thus showing a significantly smaller amount of low back extensor muscle in the osteoporotic vertebral fracture group (p=0.015).

Conclusions

Fat infiltration of low back extensor muscle was increased in osteoporotic vertebral fracture patients. Therefore, fat infiltration of low back extensor muscle in an elderly person may be a risk factor of osteoporotic vertebral fracture.

Is kyphosis related to mobility, balance, and disability?

OBJECTIVE

The aim of this study was to determine the association of increased kyphosis with declines in mobility, balance, and disability among community-living older adults.

DESIGN

The 18-mo follow-up visit data from 2006 to 2009 for 620 participants from the population-based Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly Boston Study of older adults was used. Cross-sectional multivariable regression analyses were performed to assess the relationship between kyphosis (measured using the kyphosis index) and measures of mobility performance (Short Physical Performance Battery), balance (Berg Balance Scale score), and disability (self-reported difficulty walking a quarter of a mile or climbing a flight of stairs). The authors then evaluated the men and the women separately. Adjustment variables included demographic factors (age, sex, race, and education), body mass index, self-rated health, comorbidities (heart disease, diabetes, stroke, and depressive symptoms), back pain, knee pain, and falls self-efficacy.

RESULTS

After full adjustment, greater kyphosis index was associated with lower Short Physical Performance Battery scores (adjusted β = -0.08, P = 0.01) but not with lower Berg Balance Scale (adjusted β = -0.09, P = 0.23) or self-reported disability (adjusted β = 1.00; 95% confidence interval, 0.93-1.06) scores. In sex-specific analyses, kyphosis index was associated with only the Short Physical Performance Battery in the women.

CONCLUSIONS

Greater kyphosis is associated with poorer mobility performance but not with poorer balance or self-reported disability. This association with the Short Physical Performance Battery was observed only among the women. Mechanisms by which increased kyphosis influences physical performance should be explored prospectively.

Muscle strength and its relationship with skeletal muscle mass indices as determined by segmental bio-impedance analysis

PURPOSE

Despite increasing interest in bio-impedance analysis (BIA) for estimation of segmental skeletal muscle mass (SMM), published results have not been entirely convincing. Furthermore, a better understanding of the relationship between muscle strength and SMM will be useful in interpreting outcomes of physical/training interventions particularly in groups with diverse body sizes (e.g. men vs women). This study aimed to measure SMM in the upper body (upper extremity and torso), to determine its correlation with muscle strength and to examine the effects of gender on muscle strength-muscle mass relationship.

METHODS

Segmental (upper extremity and torso) SMM and muscle strength in five distinct shoulder planes (forward flexion, abduction in scapular plane, abduction in coronal plane, internal and external rotation) were measured in 45 healthy participants (22 males, 23 females) with mean age 30.3 years. Statistical analysis included independent t tests, Pearson correlation, and multiple regression analysis.

RESULTS

Men and women differed significantly in body mass (BMI: 25.9 ± 4.3 vs 23 ± 3.6) and SMM (p < 0.01). A strong relationship correlation was found between the five shoulder strength measurements and upper extremity SMM (r = 0.66-0.80, p < 0.01), which was not affected by gender. There was a significant gender difference (p < 0.01) in absolute shoulder strength, but not after normalisation to the SMM.

CONCLUSION

BIA-estimated SMM of upper extremity and torso was highly correlated with upper extremity (shoulder) strength independent of gender. SMM may, therefore, be useful for the normalisation of muscle strength allowing size-independent comparisons of muscle strength in individuals with diverse physical characteristics.

Decline in lumbar extensor muscle strength the older adults: correlation with age, gender and spine morphology

BACKGROUND

Muscle morphology, age and gender may be determinants of muscle strength in older adults. However, very few research studies have directly examined such correlation in the ageing spine. The aim of the study was to examine the correlation between lumbar extensor muscle strength, its muscle fibre angles, thoracolumbar curvature, age and gender in the older and younger adults.

METHODS

Muscle fibre angles of lumbar extensor muscles, thoracolumbar curvature and lumbar extensor muscle strength were examined in 26 young (mean age 27.9, SD 5.2) and 26 older (mean age 72.1, SD 5.9) participants. Pearson's correlation was employed to determine the association among lumbar extensor muscle fibre angle, thoracolumbar curvature, age, gender and lumbar extensor muscle strength. Multiple stepwise linear regression analysis was used to identify significant determinants of lumbar extensor muscle strength.

RESULTS

The results demonstrated a significant correlation between lumbar extensor muscle strength, muscle fibre angle, age and gender. In the step wise regression analysis, both gender and age were identified as the most robust determinant for lumbar extensor muscle strength in older adults. However, gender was the only determinant of muscle strength in the young.

CONCLUSION

These results suggest that the decline in the lumbar extensor muscle strength in older adults was more dependent on age when compared to younger adults.

Vertebral compression fractures: a review of current management and multimodal therapy

Vertebral compression fractures are a prevalent disease affecting osteoporotic patients. When symptomatic, they cause significant pain and loss of function and have a high public health impact. In this paper we outline the diagnosis and management of these patients, with evidence-based review of treatment outcomes for the various therapeutic options. Diagnosis involves a clinical history focusing on the nature of the patient’s pain as well as various imaging studies. Management is multimodal in nature and starts with conservative therapy consisting of analgesic medication, medication for osteoporosis, physical therapy, and bracing. Patients who are refractory to conservative management may be candidates for vertebral augmentation through either vertebroplasty or kyphoplasty.

Association of dietary intake with joint space narrowing and osteophytosis at the knee in Japanese men and women: the ROAD study

OBJECTIVE: The objective of the present study is to identify dietary nutrients associated with joint space narrowing (JSN) and osteophytosis at the knee in a population-based cohort of the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study. METHODS: From the baseline survey of the ROAD study, 827 participants (305 men and 522 women) in a rural cohort were analyzed. Dietary nutrient intakes for the last month were assessed by a self-administered brief diet history questionnaire. Minimum joint space width (mJSW) and osteophyte area (OPA) in the medial compartment of the knee were measured using a knee osteoarthritis (OA) computer-aided diagnostic system. RESULTS: In men, there were no associations of dietary nutrient intakes with mJSW or OPA. In women, vitamins K, B1, B2, B6, and C were associated with mJSW after adjustment for age, body mass index, and total energy (p < 0.05). Vitamins E, K, B1, B2, niacin, and B6 were significantly associated with OPA (p < 0.05) in women. Vitamins K, B and C may have a protective role against knee OA in women and might lead to disease-modifying treatments. CONCLUSIONS: The present study revealed that low dietary intake of vitamins K, B, and C are associated with JSN and osteophytosis in women.

Promoção da saúde e prevenção de incapacidades funcionais dos idosos na estratégia de saúde da família: a contribuição da fisioterapia

A procura de idosos por serviços de saúde costuma ocorrer quando estes são acometidos por limitações importantes e/ou necessitam de assistência devido à redução da força muscular e a incapacidades funcionais. Tal momento é fundamental para que profissionais da saúde, particularmente fisioterapeutas, amenizem o enfraquecimento muscular e reduzam as incapacidades e dependências. O presente artigo expõe ações de promoção da saúde e prevenção das incapacidades funcionais na terceira idade para que as equipes de saúde da família possam estimular os idosos a mudarem seus hábitos e viverem suas vidas com melhor qualidade. Espera contribuir para a incorporação das práticas fisioterapêuticas entre as equipes de saúde.

Physical performance, bone and joint diseases, and incidence of falls in Japanese men and women: a longitudinal cohort study

SUMMARY

This study examined whether physical performance and bone and joint diseases were risk factors for falls in 745 men and 1,470 women from the Research on Osteoarthritis/osteoporosis Against Disability (ROAD) study (mean, 69.7 years). Slower walking speed was a risk factor for falls in men and women. Knee pain was a risk factor for falls in women.

INTRODUCTION

The objective of the present study was to clarify the incidence of falls by sex and age and to determine whether physical performance and bone and joint diseases are risk factors for falls in men and women using a large-scale population-based cohort of the ROAD.

METHODS

A total of 745 men and 1,470 women were analyzed in the present study (mean age, 68.5 years). A questionnaire assessed the number of falls during 3 years of follow-up. Grip strength and walking speed were measured at baseline. Knee and lumbar spine radiographs were read by Kellgren-Lawrence (KL) grade; radiographic knee osteoarthritis and lumbar spondylosis were defined as KL = 3 or 4. Knee and lower back pain were estimated by an interview.

RESULTS

During a mean follow-up of 3 years, 141 (18.9 %) men and 362 (24.6 %) women reported at least one fall. Slower walking speed was a risk factor for falls in men (0.1 m/s decrease; odds ratio [OR], 1.15; 95 % confidence interval [CI], 1.09-1.23) and women (0.1 m/s decrease; OR, 1.05; 95 % CI, 1.01-1.10). Knee pain was also a risk factor for falls (OR, 1.38; 95 % CI, 1.03-1.84) in women, but lower back pain was not.

CONCLUSION

We examined the incidence and risk factors for falls in men and women. Slower walking speed was a risk factor for falls in men and women. Knee pain was a risk factor for falls in women.

Risk factors for falls in a longitudinal population-based cohort study of Japanese men and women: the ROAD Study

The objective of this study was to clarify the associations of physical performance and bone and joint diseases with single and multiple falls in Japanese men and women using a population-based longitudinal cohort study known as Research on Osteoarthritis/osteoporosis Against Disability (ROAD). A total of 452 men and 896 women were analyzed in the present study (mean age, 63.9 years). A questionnaire was used to assess the number of falls during the 3-year follow-up. Grip strength, 6-m walking time, and chair stand time were measured at baseline. Knee osteoarthritis (OA) and lumbar spondylosis were defined as Kellgren Lawrence=2, 3 or 4. Vertebral fracture (VFx) was assessed with the Japanese Society of Bone and Mineral Research criteria. Osteoporosis was defined by bone mineral density using dual energy X-ray absorptiometry based on World Health Organization criteria. Knee and lower back pain were estimated by an interview. During a 3-year follow-up, 79 (17.4%) men and 216 (24.1%) women reported at least one fall, and 54 (11.9%) men and 111 (12.4%) women reported multiple falls. Knee pain was a risk factor for multiple falls in women, but not in men. VFx tended to be associated with multiple falls in women, but not in men. A longer 6-m walking time was a risk factor for multiple falls in women, whereas a longer chair stand time was a risk factor for multiple falls in men. We found gender differences in risk factors for falls.

Mid- to long-term factors influencing functional status of people affected by lower-limb amputation associated with hemiparesis due to stroke

PURPOSE

In people with lower-limb amputation and hemiparesis, prognostic factors of rehabilitation outcomes were investigated at hospital discharge. This study aims to identify which factors influence functional outcomes at mid- to long-term follow-up.

METHODS

Follow-up observational study on forty-four people (68 ± 9 years old) with unilateral amputation for vascular disease, temporally preceding or following hemiparesis due to stroke (26 patients prior amputation; 18 patients prior stroke), was performed. Barthel Index (BI) and Locomotor Capabilities Index (LCI) scores were recorded at discharge from the rehabilitation hospital and 3.4 years later. Use of the prosthesis was also recorded.

RESULTS

At the follow-up, BI and LCI scores had significantly decreased (10 and 13%, respectively). Contralaterality of the impairment was the main prognostic factor for reduced functional status (p = 0.025) and prosthesis abandonment (p = 0.028, OR = 4.4), especially for women (OR = 8). Severity of hemiparesis affected the BI score (p < 0.01) and level of amputation the LCI score (p < 0.01).

CONCLUSIONS

At the light of the observed decrement of functional status after discharge, particular attention should be paid to the patients more exposed to the risk of worsening and/or prosthesis abandon, such as women with contralateral impairment. The results of this study may assist rehabilitation teams in performing a more specific and effective long-term rehabilitative interventions.

Patterns and correlates of grip strength change with age in Afro-Caribbean men

BACKGROUND

muscle strength is essential for physical functions and an indicator of morbidity and mortality in older adults. Among the factors associated with muscle strength loss with age, ethnicity has been shown to play an important role.

OBJECTIVE

to examine the patterns and correlates of muscle strength change with age in a population-based cohort of middle-aged and older Afro-Caribbean men.

METHODS

handgrip strength and body composition were measured in 1,710 Afro-Caribbean men. Data were also collected for demographic variables, medical history and lifestyle behaviours.

RESULTS

the age range of the study population was 29-89 years. Grip strength increased below age 50 years, and decreased after age 50 years over 4.5-year follow-up. The average loss in grip strength was 2.2% (0.49% per year) for ages 50 years or older and 3.8% (0.64% per year) for ages 65 years or older. The significant independent predictors of grip strength loss included older age, a greater body mass index, lower initial arm lean mass and greater loss of arm lean mass.

CONCLUSION

Afro-Caribbean men experience a significant decline in muscle strength with advanced age. The major independent factors associated with strength loss were similar to other ethnic groups, including age, body weight and lean mass.

Yoga spinal flexion positions and vertebral compression fracture in osteopenia or osteoporosis of spine: case series

OBJECTIVE

The objective of this report is to raise awareness of the effect of strenuous yoga flexion exercises on osteopenic or osteoporotic spines. We previously described subjects with known osteoporosis in whom vertebral compression fractures (VCFs) developed after spinal flexion exercise (SFE) and recommended that SFEs not be prescribed in patients with spinal osteoporosis.

METHODS

This report describes 3 healthy persons with low bone mass and yoga-induced pain or fracture.

RESULTS

All 3 patients had osteopenia, were in good health and pain-free, and had started yoga exercises to improve their musculoskeletal health. New pain and fracture areas occurred after participation in yoga flexion exercises.

CONCLUSIONS

The development of pain and complications with some flexion yoga positions in the patients with osteopenia leads to concern that fracture risk would increase even further in osteoporosis. Although exercise has been shown to be effective for improving bone mineral density and decreasing fracture risk, our subjects had development of VCFs and neck and back pain with yoga exercises. This finding suggests that factors other than bone mass should be considered for exercise counseling in patients with bone loss. The increased torque pressure applied to vertebral bodies during SFEs may be a risk. Exercise is effective and important for treatment of osteopenia and osteoporosis and should be prescribed for patients with vertebral bone loss. Some yoga positions can contribute to extreme strain on spines with bone loss. Assessment of fracture risk in older persons performing SFEs and other high-impact exercises is an important clinical consideration.

The effect of resistance training on muscle strength and physical function in older, postmenopausal breast cancer survivors: a randomized controlled trial

INTRODUCTION

Older breast cancer survivors (BCS) report more falls and functional limitations than women with no cancer history. Exercise training could reduce risk factors for future falls and disability.

METHODS

We conducted a randomized, controlled trial in 106 early-stage, postmenopausal BCS who were ≥50 years old at diagnosis and post-treatment. Women were randomly assigned to a 1-year resistance + impact exercise program or a stretching placebo program. Endpoints were one repetition maximum bench press and leg press strength, timed five chair stands, 4 m usual walk speed, timed stance tests, handgrip strength, self-report physical function, and fatigue. We also examined the influence of age, adjuvant hormone therapy use, and exercise adherence on study outcomes.

RESULTS

Women in the resistance + impact training program significantly improved maximal leg (p <0 .02) and bench (p <0 .02) press strength compared to the stretching group. Women who attended 50% or more of prescribed resistance training sessions had significantly better changes in maximal strength measures compared to less adherent women.

CONCLUSIONS

Resistance + impact exercise is superior to stretching at improving maximal muscle strength and exercise adherence contributes to the degree of improvement.

IMPLICATIONS FOR CANCER SURVIVORS

Older BCS can safely engage in resistance exercise that improves lower and upper body strength, thereby reducing a risk factor for falls and future disability. However, the ability of resistance training to shift other indices of fall and disability risk, i.e., balance and function, is unclear. Strategies to promote adherence to resistance training could lead to greater improvements in strength.