Effects of regular walking on postural stability in the elderly

Difference in postural stability between STarT Back Tool subgroups of patients with low back pain under conditions of sensory deprivation and cognitive load

Objective

We explored differences in postural stability between subgroups of patients with low back pain (LBP) and varying risk levels for developing chronicity measured using the Subgroups for Targeted Treatment (STarT) Back Tool.

Methods

This was a cross-sectional, single-session, double-blind experimental study among 65 participants who had LBP for more than 14 days. Postural stability was assessed by measuring the center of pressure (COP) range, displacement area, and velocity in anterior–posterior and mediolateral directions under four sensory and cognitive conditions: (i) eyes open and counting forward, (ii) eyes closed and counting forward, (iii) eyes closed and counting forward in multiples of seven, and (iv) eyes closed and counting backward in multiples of seven. The participants were stratified into low-/medium- (n = 53) and high-risk (n = 9) subgroups.

Results

There were no significant between-group differences among patients with LBP stratified as having a low/medium or high risk of chronicity in postural stability and sensory and cognitive conditions.

Conclusions

Impaired postural stability is important to consider when treating patients with LBP. However, we found that these impairments were not strongly aggravated in groups with a higher risk of chronicity, as measured using the STarT Back Tool.

Influence of Walking as Physiological Training to Improve Respiratory Parameters in the Elderly Population

Walking as physiological training is reported to be an effective activity in order to beneficially influence and slow the onset of aging in healthy elderly people. However, insufficient evidence exists on how walking influences lung function in seniors. In our study, we aim to evaluate the effect of different types of walking on lung function in healthy seniors. The PubMed, Web of Science, Scopus and EBSCO Essentials databases were searched, while the methodological quality was assessed by the RoB2 tool. A total of seven studies (RCTs) published between 2002-2022 that met the eligibility criteria were analysed in this review. All participants were older adults without any specific associated disease, aged 60 and above. The interventions included structured physical activity; a high/moderate exercise program; long-term regular walking; walking as a part of functional movement training; walking sideways, backward and forward as a part of aerobic training; fast walking; Stepper walking; walking on a treadmill combined with incentive spirometry; and Nordic walking. Overall, most of the mentioned types of walking led to improved lung function in healthy elderly subjects. However, the prescribed Stepper walking program did not improve lung function in healthy seniors.

Objectively Measured Physical Activity Is Associated with Static Balance in Young Adults

Purpose: Regular physical activity (PA) strengthens muscles and improves balance and coordination of human body. The aim of this study was to examine whether objectively measured physical activity (PA) and sedentary behaviors were related to static balance in young men and women. Design and setting: Cross-sectional community study. Participants: 86 healthy adults (50% women) aged 21.26 ± 2.11 years. Method: PA variables, including moderate-to-vigorous PA (MVPA), light PA (LPA), sedentary time (SED), and sedentary breaks, were measured by accelerometers on wrist (ActiGraph WGT3X-BT). The static balance was tested in the bipedal stance with eyes open or closed. The movement of the center of pressure, including total sway path length (SP), sway velocity (SV), and sway area (SA), was recorded with a three-dimensional force platform (Kistler 9287CA). The associations between PA (MVPA/LPA/SED/sedentary breaks) and static balance (SP/SV/SA) were analyzed using mixed linear regression analyses, with adjustments for condition (eyes open/closed), sex, age, body mass index (BMI), total device wearing time, and PA*condition. Data were analyzed with SPSS 24.0. Results: Better performance was observed in eyes-open condition (p < 0.05). MVPA was negatively associated with SA (p = 0.030), and SED was positively associated with SA after adjustments, respectively (p = 0.0004). No significance was found in the association of light PA, SED, or sedentary breaks with other static balance variables, respectively (p > 0.05). Conclusion: Increasing MVPA and less SED are associated with lower sway area measured by force platform, indicating more PA may related to better static balance in young adults.

Dual-Task Conditions on Static Postural Control in Older Adults: A Systematic Review and Meta-Analysis

Dual-task (DT) consists of the performance of two tasks simultaneously. An index of DT difficulty has been linked to decreased postural control. Because a wide range of DT is employed, this study aimed to evaluate its effects in static balance in older adults. PubMed, Web of Science, and Scopus were screened, and the secondary tasks were grouped as manual, reaction time, discrimination and decision making, mental tracking, verbal fluency, working memory, or "other" tasks. A total of 66 studies have been included. The meta-analysis was conducted on 28 effects and showed a significant mean effect size of d = 0.24 (p = .02, SE = 0.10; confidence interval [0.04, 0.44]), indicating a worsening in stability during DT. In conclusion, postural control was worsened by the Stroop test and the arithmetic tasks improved it. The results do not underpin any conclusive statement on the impact of DT, and a standard operating procedure was created.

Kinematics of Suryanamaskar Using Three-Dimensional Motion Capture

Background:

Suryanamaskar, a composite yogasana consisting of a sequence of 12-consecutive poses, producing a balance between flexion and extension is known to have positive health benefits for obesity and physical fitness management, upper limb muscle endurance, and body flexibility. However, limited information is available on biomechanical demands of Suryanamaskar, i.e., kinematic and kinetic.

Aims:

The present study aimed to explore the kinematics of spine, upper, and lower extremity during Suryanamaskar to enhance greater understanding of Suryanamaskar required for safe and precise prescription in the management of musculoskeletal disorders.

Methods:

Three-dimensional motion capture of Suryanamaskar was performed on 10 healthy trained yoga practitioners with 12-camera Vicon System (Oxford Metrics Group, UK) at a sampling frequency of 100 Hz using 39 retro-reflective markers. Data were processed using plug-in-gait model. Analog data were filtered at 10Hz. Joint angles of the spine, upper, and lower extremities during 12-subsequent poses were computed within Vicon Nexus.

Results:

Joint motion was largely symmetrical in all poses except pose 4 and 9. The spine moved through a range of 58° flexion to 44° extension. In the lower quadrant, hip moved from 134° flexion to 15° extension, knee flexed to a maximum of 140°, and 3° hyperextension. Ankle moved in a closed kinematic chain through 40° dorsiflexion to 10° plantarflexion. In the upper quadrant, maximum neck extension was76°, shoulder moved through the overhead extension of 183°–56° flexion, elbow through 22°–116° flexion, and wrist from 85° to 3° wrist extension.

Conclusions:

Alternating wide range of transition between flexion and extension during Suryanamaskar holds potential to increase the mobility of almost all body joints, with stretch on anterior and posterior soft tissues and challenge postural balance mechanisms through a varying base of support.

Daily Bicycling in Older Adults May be Effective to Reduce Fall Risks-A Case-Control Study

Older adults gain many health benefits from riding bicycles regularly. We aimed to explore whether older persons who ride bicycles regularly have better balance than controls. Balance control and voluntary stepping were assessed in 20 older adults aged 65-85 years who live in an agricultural community village and who ride bicycles regularly, and 30 age- and gender-matched nonbicycle riders (NBR). Self-reported function and fear of fall were also assessed. Bicycle riders (BR) showed significantly better balance, faster voluntary stepping, and better self-reported advanced lower-extremity function compared with NBR. The results might suggest that bicycling regularly preserves balance control and speed of voluntary stepping in older adults because bicycling might maintain specific balance coordination patterns. The results should be treated with caution as bicycle riders were older adults who selected an active lifestyle (i.e., bicycling as well as living in an agricultural village) that may bias the results.

Racial Differences in Neighborhood Perceptions and their Influences on Physical Activity among Urban Older Women

Background

Proper levels of physical activity (PA) are important to healthy aging. Little is known about racial differences in influences of neighborhood perceptions (NP) on PA and use of neighborhood resources among community-dwelling older women.

Materials and methods

In 2014 and 2015, 49 white and 44 black women of age 65 and older living in Washington, DC were queried about their PA, NP, use of neighborhood resources and sociodemographic characteristics. They wore an accelerometer and a Global Positioning System device concurrently for 7 consecutive days. Data were analyzed by race.

Results

Compared to Whites, Blacks had lower NP scores (71% positive vs. 77%, p = 0.01), lower mean daily step counts (mean (SD): 3256 (1918) vs. 5457 (2989), p < 0.001), and lower frequencies of all exercise activities combined (19.7 (8.7) vs. 25.2 (11.8) per week, p = 0.01). For both Whites and Blacks, better NPs were associated with more frequent PA both at (p = 0.05) and away from home (p = 0.01). However, better NPs were associated with higher frequencies of exercise activities, moderate-to-high intensity activities, and utilitarian walking for Whites but not Blacks (p < 0.05 for race-perception interaction terms).

Conclusions

In an urban setting, older Black women were more likely than older White women to have poor NPs, less PA, and weaker or no association of positive NPs with higher levels of certain PAs. Such substantial racial differences warrant further investigation and consideration in health promotion programs.

One session of high-intensity interval training (HIIT) every 5 days, improves muscle power but not static balance in lifelong sedentary ageing men: A randomized controlled trial

BACKGROUND

Declining muscle power during advancing age predicts falls and loss of independence. High-intensity interval training (HIIT) may improve muscle power, but remains largely unstudied in ageing participants.

METHODS

This randomized controlled trial (RCT) investigated the efficacy of a low-frequency HIIT (LfHIIT) intervention on peak muscle power (peak power output [PPO]), body composition, and balance in lifelong sedentary but otherwise healthy males.

METHODS

Thirty-three lifelong sedentary ageing men were randomly assigned to either intervention (INT; n = 22, age 62.3 ± 4.1 years) or control (n = 11, age 61.6 ± 5.0 years) who were both assessed at 3 distinct measurement points (phase A), after 6 weeks of conditioning exercise (phase B), and after 6 weeks of HIIT once every 5 days in INT (phase C), where control remained inactive throughout the study.

RESULTS

Static balance remained unaffected, and both absolute and relative PPO were not different between groups at phases A or B, but increased significantly in INT after LfHIIT (P < 0.01). Lean body mass displayed a significant interaction (P < 0.01) due to an increase in INT between phases B and C (P < 0.05).

CONCLUSIONS

6 weeks of LfHIIT exercise feasible and effective method to induce clinically relevant improvements in absolute and relative PPO, but does not improve static balance in sedentary ageing men.

Gender and Age Differences in Levels, Types and Locations of Physical Activity among Older Adults Living in Car-Dependent Neighborhoods

BACKGROUND

A thorough understanding of gender differences in physical activity is critical to effective promotion of active living in older adults.

OBJECTIVES

To examine gender and age differences in levels, types and locations of physical activity.

DESIGN

Cross-sectional observation.

SETTING

Car-dependent urban and rural neighborhoods in Worcester County, Massachusetts, USA.

PARTICIPANTS

111 men and 103 women aged 65 years and older.

MEASUREMENTS

From 2012 to 2014, participants were queried on type, frequency and location of physical activity. Participants wore an accelerometer for 7 consecutive days.

RESULTS

Compared to women, men had a higher mean daily step count (mean (SD) 4385 (2122) men vs. 3671(1723) women, p=0.008). Men reported higher frequencies of any physical activity and moderate-to-vigorous physical activity, and a lower frequency of physical activity inside the home. Mean daily step counts and frequency of physical activity outside the home decreased progressively with age for both men and women. Women had a sharper decline in frequencies of self-reported physical activity. Men had a significant decrease in utilitarian walking, which women did not (p=0.07). Among participants who reported participation in any physical activity (n=190), more women indicated exercising indoors more often (59% vs. 44%, p=0.04). The three most commonly cited locations for physical activity away from home for both genders were streets or sidewalks, shopping malls, and membership-only facilities (e.g., YMCA or YWCA). The most common types of physical activity, performed at least once in a typical month, with over 40% of both genders reporting, included light housework, brisk walking, leisurely walking, and stretching.

CONCLUSION

Levels, types and location preferences of physical activity differed substantially by gender. Levels of physical activity decreased progressively with age, with greater decline among women. Consideration of these gender differences is necessary to improve the effectiveness of active living promotion programs among older adults.

Tai Chi Can Improve Postural Stability as Measured by Resistance to Perturbation Related to Upper Limb Movement among Healthy Older Adults

Purpose. The aim of the study was to examine the effects of Tai Chi (TC) training on postural control when upright standing was perturbed by upper limb movement. Methods. Three groups, TC, Brisk walk (BW), and sedentary (SE), of thirty-six participants aged from 65 to 75 years were recruited from local community centers. Participants performed static balance task (quiet standing for 30 s with eyes open and closed) and fitting task (two different reaching distances X three different opening sizes to fit objects through). During tasks, the COP data was recorded while standing on the force plate. Criteria measures calculated from COP data were the maximum displacement in anterior-posterior (AP) and medial-lateral (ML) directions, the 95% confidence ellipse area (95% area), and the mean velocity. Results. No significant effect was observed in the static balance task. For fitting tasks, the group effect was observed in all directions on COP 95% area (p < 0.05) and the TC group showed reduced area. The tests of subject contrasts showed significant trends for reaching different distances and fitting different openings conditions in all directions, the 95% area, and the mean velocity (p < 0.05). Conclusion. Compared to the other two groups, long-term TC exercise helps in reducing the effects of upper body perturbation as measured by posture sway.

The Relationship Between Pedometer-Determined Ambulatory Activity and Balance Variables Within an Older Adult Population

The purpose of this investigation was to determine the differences between gender, physical activity level, and balance in an older adult population. A secondary purpose was to examine the relationship between pedometer-determined ambulatory activity and balance. Forty-six older adults aged 73.7 ± 6.2 years participated in the study. Participants completed the Fullerton Advanced Balance (FAB) Scale and completed a 2-week daily step recording to determine average steps taken per day. Low-level activity participants (<5,000 steps/day) were significantly different from the high-level activity participants (>7,500 steps/day) in weight, age, and the number of medications reported. Males performed better than females on the two-footed jump test and reactive postural test FAB assessments. High-level activity participants performed significantly better than low-level activity participants on all FAB assessments except stand with feet together and eyes closed, reach forward to object, and walk with head turns.

Effects of age and acute muscle fatigue on reactive postural control in healthy adults

BACKGROUND

Falls can cause moderate to severe injuries such as hip fractures and head trauma in older adults. While declines in muscle strength and sensory function contribute to increased falls in older adults, skeletal muscle fatigue is often overlooked as an additional contributor to fall risk. The purpose of this investigation was to examine the effects of acute lower extremity muscle fatigue and age on reactive postural control in healthy adults.

METHODS

A sample of 16 individuals participated in this study (8 healthy older adults and 8 healthy young persons). Whole body kinematic and kinetic data were collected during anterior and posterior reproducible fall tests before (T0) and immediately after (T1) eccentric muscle fatiguing exercise, as well as after 15-min (T15) and 30-min (T30) of rest.

FINDINGS

Lower extremity joint kinematics of the stepping limb during the support (landing) phase of the anterior fall were significantly altered by the presence of acute muscle fatigue. Step velocity was significantly decreased during the anterior falls. Statistically significant main effects of age were found for step length in both fall directions. Effect sizes for all outcomes were small. No statistically significant interaction effects were found.

INTERPRETATION

Muscle fatigue has a measurable effect on lower extremity joint kinematics during simulated falls. These alterations appear to resolve within 15 min of recovery. The above deficits, coupled with a reduced step length, may help explain the increased fall risk in older adults.

Acute effects of muscle fatigue on anticipatory and reactive postural control in older individuals: a systematic review of the evidence

BACKGROUND

Falls are the leading cause of traumatic brain injury and fractures and the No. 1 cause of emergency department visits by older adults. Although declines in muscle strength and sensory function contribute to increased falls in older adults, skeletal muscle fatigue is often overlooked as an additional contributor to fall risk. In an effort to increase awareness of the detrimental effects of skeletal muscle fatigue on postural control, we sought to systematically review research studies examining this issue.

PURPOSE

The specific purpose of this review was to provide a detailed assessment of how anticipatory and reactive postural control tasks are influenced by acute muscle fatigue in healthy older individuals.

METHODS

An extensive search was performed using the CINAHL, Scopus, PubMed, SPORTDiscus, and AgeLine databases for the period from inception of each database to June 2013. This systematic review used standardized search criteria and quality assessments via the American Academy for Cerebral Palsy and Developmental Medicine Methodology to Develop Systematic Reviews of Treatment Interventions (2008 version, revision 1.2, AACPDM, Milwaukee, Wisconsin).

RESULTS

A total of 334 citations were found. Six studies were selected for inclusion, whereas 328 studies were excluded from the analytical review. The majority of articles (5 of 6) utilized reactive postural control paradigms. All studies incorporated extrinsic measures of muscle fatigue, such as declines in maximal voluntary contraction or available active range of motion. The most common biomechanical postural control task outcomes were spatial measures, temporal measures, and end-points of lower extremity joint kinetics.

CONCLUSION

On the basis of systematic review of relevant literature, it appears that muscle fatigue induces clear deteriorations in reactive postural control. A paucity of high-quality studies examining anticipatory postural control supports the need for further research in this area. These results should serve to heighten awareness regarding the potential negative effects of acute muscle fatigue on postural control and support the examination of muscle endurance training as a fall risk intervention in future studies.

Variations in Community Prevalence and Determinants of Recreational and Utilitarian Walking in Older Age

Background. Regular walking is critical to maintaining health in older age. We examined influences of individual and community factors on walking habits in older adults. Methods. We analyzed walking habits among participants of a prospective cohort study of 745 community-dwelling men and women, mainly aged 70 years or older. We estimated community variations in utilitarian and recreational walking, and examined whether the variations were attributable to community differences in individual and environmental factors. Results. Prevalence of recreational walking was relatively uniform while prevalence of utilitarian walking varied across the 16 communities in the study area. Both types of walking were associated with individual health and physical abilities. However, utilitarian walking was also strongly associated with several measures of neighborhood socioeconomic status and access to amenities while recreational walking was not. Conclusions. Utilitarian walking is strongly influenced by neighborhood environment, but intrinsic factors may be more important for recreational walking. Communities with the highest overall walking prevalence were those with the most utilitarian walkers. Public health promotion of regular walking should take this into account.

Late Isometric Assessment of Hip Abductor Muscle and Its Relationship with Functional Tests in Elderly Women Undergoing Replacement of Unilateral Hip Joint

OBJECTIVE

The aim of this study was to evaluate the recovery of muscle strength and measure autonomy 3 yrs after hip replacement surgery in a sample of patients.

DESIGN

Seventy-eight female patients (70.7 ± 6.3 yrs old) operated on for hip replacement were evaluated. They underwent evaluation tests for hip abductor muscle strength on the healthy and operated limb using strength curves obtained with isometric assessments. Autonomy was evaluated with a rating scale Western Ontario and McMaster Universities Arthritis Index (WOMAC), Harris and MOS 36-Item Short-Form Health Survey (SF-36) and functional assessment (Timed 'Up and Go' test).

RESULTS

Three years after surgery, a muscle strength deficit was still noticeable on the operated limb compared with the healthy limb ranging from 9% at 5 degrees of adduction to 12% at 0 degree of abduction. The strength curves obtained on the operated side maintained the same descending trend as the healthy side. The authors found no significant correlations between the patient-reported functional measures and the hip abductor strength deficit. The Timed Up and Go test was moderately correlated with the muscle strength deficit. The association between the deficit and the Timed Up and Go test was statistically significant.

CONCLUSIONS

The evaluation of muscle strength and functional tests are more useful than the rating scales in patients 3 yrs after surgery. The strength curves are useful to have different levels of information and describe joint function.

Comparison of static postural stability in exercising and non-exercising women during the perinatal period

BACKGROUND

The purpose of the study was to determine whether women who exercised during and after pregnancy had better static postural stability compared to those who did not exercise.

MATERIAL AND METHODS

Posturographic tests were performed in 31 women at 34-39 weeks gestation, and again at 6-10 weeks postpartum. The center of pressure mean velocity (with directional subcomponents) and sway area were computed from 30-s quiet standing trials on a stationary force plate with eyes open or closed. The women were surveyed about their lifestyle and physical activity in the perinatal period. Based on the survey, 12 of the women were assigned as regular exercisers and 19 as non-exercisers. A Mann-Whitney U test was used to compare data of the exercisers and the non-exercisers in their advanced pregnancy and again at 2 months postpartum.

RESULTS

Postural sway measures were not significantly different between the exercisers and the non-exercisers in advanced pregnancy and at 2 months postpartum (p>0.05).

CONCLUSIONS

Individually performed physical activity during the perinatal period did not affect pregnant/postpartum women's postural stability characteristics of quiet standing.

Effects of exercise on ankle proprioception in adult women during 16 weeks of training and eight weeks of detraining

This study evaluates the effects of training and detraining on ankle proprioception in terms of kinesthesia in adult women. Sixty participants were randomly assigned to three groups. Tai Chi and Brisk Walking Groups went through a 16-week training period followed by an eight-week detraining period. The ankle plantar-flexion, dorsal-flexion, inversion, and eversion kinesthesia were measured every four weeks. The ankle kinesthesia in plantar/dorsal flexion of both exercise groups decreased, but the Tai Chi Group decreased more and sooner than the Brisk Walking Group. The training effects of Tai Chi exercise were retained but diminished during the detraining. The training effects of Brisk Walking exercise were not retained. The kinesthesia of ankle inversion and eversion remained unchanged after training. The results suggest that Tai Chi exercise is more effective in training ankle proprioception in plantar and dorsal flexion and in retaining the training effects compared with Brisk Walking exercise.

Leisure activity participation as predictor of quality of life in Korean urban-dwelling elderly

This study investigated participation in leisure activities in urban-dwelling elderly persons in Korea and its role in predicting quality of life. The participated activities over a 48-hour period were recorded by each participant, and amount of participated time for each activity was calculated. Correlational analysis examined the relationship between the degree of participation in domains of leisure activity and quality of life. Multiple regression analysis was conducted to determine which leisure activity participation predicted quality of life. The results indicated that the participants spent the most time in "use of media". Quality of life showed a positive correlation with "use of media", "sports and outdoor leisure activity" and "hobby and other leisure activity". The results of hierarchical multiple regression analysis found that use of media, "religious activity", sports and outdoor leisure activity and hobby and other leisure activity significantly predicted quality of life after controlling for the effects of demographic variables. Of these variables, hobby and other leisure activity was the strongest predictor of quality of life. The results will augment treatment planning and activity management in enhancing quality of life by allied health professionals, especially occupational therapists. The findings are limited in that the sample consisted of urban-dwelling elderly primarily with a religious affiliation. It is recommended that a cross-cultural investigation using standard assessment measures be conducted to validate whether there is indeed similarities in time use and leisure activity participation in the elderly in different cultures.

A randomized controlled trial of an automated exercise coach for older adults

OBJECTIVES

To compare the efficacy of a computer-based physical activity program (Embodied Conversational Agent-ECA) with that of a pedometer control condition in sedentary older adults.

DESIGN

Single-blind block-randomized controlled trial stratified according to clinic site and health literacy status.

SETTING

Three urban ambulatory care practices at Boston Medical Center between April 2009 and September 2011.

PARTICIPANTS

Older adults (N = 263; mean age 71.3; 61% female; 63% African American; 51% high school diploma or less).

INTERVENTION

ECA participants were provided with portable tablet computers with touch screens to use for 2 months and were directed to connect their pedometers to the computer using a data cable and interact with a computer-animated virtual exercise coach daily to discuss walking and to set walking goals. Intervention participants were then given the opportunity to interact with the ECA in a kiosk in their clinic waiting room for the following 10 months. Control participants were given a control pedometer intervention that only tracked step counts for an equivalent period of time. Intervention participants were also provided with pedometers.

MEASUREMENTS

The primary outcome was average daily step count for the 30 days before the 12-month interview. Secondary outcomes were average daily step count for the 30 days before the 2-month interview. Outcomes were also stratified according to health literacy level.

RESULTS

ECA participants walked significantly more steps than control participants at 2 months (adjusted mean 4,041 vs 3,499 steps/day, P = .01), but this effect waned by 12 months (3,861 vs 3,383, P = .09). For participants with adequate health literacy, those in the ECA group walked significantly more than controls at both 2 months (P = .03) and 12 months (P = .02), while those with inadequate health literacy failed to show significant differences between treatment groups at either time point. Intervention participants were highly satisfied with the program.

CONCLUSION

An automated exercise promotion system deployed from outpatient clinics increased walking among older adults over the short-term. Effective methods for long-term maintenance of behavior change are needed.

Risk factors of falls in community dwelling active elderly

OBJECTIVE

To search for measures to describe and relate to accidental falls in community dwelling elderly.

METHOD

A EuroQol EQ-5D questionnaire based on a patient's otoneurological case history provided a general health related quality of life measure, a fall history for the last 3 months and force platform measures for 96 active elderly from a pensioner organization.

RESULTS

On average, the elderly experienced 0.3 falls over the preceding three months. A fall was seen to cause a significant deterioration in the quality of life and vertigo and caused fear of falling. The postural instability correlated with falls. Vertigo was present among 42% and was most commonly characterized as episodic and rotatory in factorial analysis items relating to vertigo correlated to falls and balance complaints. Four factors were identified and three of these correlated with falls. Vestibular failure correlated to a fall occurring when a person was rising up; Movement intolerance correlated with falls due to slips and trips, and Near-syncope factor correlated to falls for other reasons. In posturography, the variable measuring critical time describing the memory based "closed loop" control of postural stability carried a risk for accidental fall with an odds ratio of 6. The variable measuring zero crossing velocity showed a high rate of velocity change around the neutral position of stance.

CONCLUSION

Vertigo and poor postural stability were the major reasons for falls in the active elderly. In ageing, postural control is shifted towards open loop control (visual, proprioception, exteroception and vestibular) instead of closed loop control and is a factor that contributes to a fall.

Effect of moderate physical exercise on postural control among 65-74 years old men

The aim of this study was to assess the changes in the postural control (PC) during quiet stance among elderly men with fatigue induced by moderate exercise, and to assess the relationships between changes in PC and somatic indices (body mass index (BMI), waist to hip ratio (WHR)), load during exercise, and post-exercise blood lactate (BL) concentration. The study involved 17 elderly men (68.4±2.9 years of age, ranging between 65 and 74 years). Mean velocity of the center of pressure (COP) displacements was measured using a force plate both before and after fatigue induced by a cycle ergometer exercise. Following physical exercise, the mean velocity of the COP and its components, both in the sagittal and frontal plane, increased significantly. It was found that increasing BMI was associated with increasing exercise-induced changes in the mean velocity of the frontal plane. Additionally, BL level was positively correlated with changes in the mean velocity of the sagittal plane. Higher post-exercise values of the mean velocity of the COP may suggest a temporary increase in the risk of falls. Therefore, it seems advisable to caution the elderly men in regards to the increased risk of falling following exercise. Analysis showed that the changes in the PC as indicated by the increase in the COP displacements velocity may be related to the level of fatigue (as indicated by BL). Moreover, elderly men possessing a higher BMI may exhibit a tendency toward the greater increase in the postural sway after exercise-induced fatigue.

Strategies of stepping over obstacles: The effects of long-term exercise in older adults

BACKGROUND

Stepping over obstacles challenges stability and is a leading cause of falls in older adult populations. As walking and Tai Chi (TC) exercise have been suggested practices for older adults for fall prevention, the purpose of this study was to evaluate the obstacle-crossing strategies of long-term TC practitioners and exercise walkers.

METHODS

Thirty healthy older women (average age: 65.7 years) with either TC (n=15) experience (average experience: 8.2 years) or walking exercise (n=15; average experience: 8.8 years) participated in this study. We used three trial conditions: (1) normal walking, (2) crossing a 15cm (20% of leg length) obstacle, and (3) crossing a 23cm (30% of leg length) to assess obstacle-crossing strategy. Sagittal plane obstacle-crossing kinematic parameters and plantar pressures were used to evaluate the obstaclecrossing strategy. A MANOVA assessed differences between groups.

RESULTS

Individuals with a TC background crossed the obstacle significantly faster with a significantly longer step relative to the exercise walkers. Plantar pressure profiles between the two groups also differed. Exercise walkers showed greater plantar pressure in the forefoot; TC practitioners demonstrated greater medial heel plantar pressure during obstacle-crossing.

CONCLUSIONS

Our results suggest that obstacle-crossing strategies were affected by the type of longterm exercise. The strategies each group used had important attributes that affect stability during obstacle-crossing. Future studies are needed to understand how obstacle-crossing strategies are adopted and how exercise may influence the strategy used.

Cardiovascular and coordination training differentially improve cognitive performance and neural processing in older adults

Recent studies revealed a positive influence of physical activity on cognitive functioning in older adults. Studies that investigate the behavioral and neurophysiological effects of type and long term duration of physical training, however, are missing. We performed a 12-month longitudinal study to investigate the effects of cardiovascular and coordination training (control group: relaxation and stretching) on cognitive functions (executive control and perceptual speed) in older adults. We analyzed data of 44 participants aged 62–79 years. Participants were trained three times a week for 12 months. Their physical and cognitive performance was tested prior to training, and after 6 and 12 months. Changes in brain activation patterns were investigated using functional MRI. On the behavioral level, both experimental groups improved in executive functioning and perceptual speed but with differential effects on speed and accuracy. In line with the behavioral findings, neurophysiological results for executive control also revealed changes (increases and reductions) in brain activity for both interventions in frontal, parietal, and sensorimotor cortical areas. In contrast to the behavioral findings, neurophysiological changes were linear without indication of a plateau. In both intervention groups, prefrontal areas showed decreased activation after 6 and 12 months when performing an executive control task, as compared to the control group, indicating more efficient information processing. Furthermore, cardiovascular training was associated with an increased activation of the sensorimotor network, whereas coordination training was associated with increased activation in the visual–spatial network. Our data suggest that besides cardiovascular training also other types of physical activity improve cognition of older adults. The mechanisms, however, that underlie the performance changes seem to differ depending on the intervention.

Investigating Walking Environments in and around Assisted Living Facilities: A Facility Visit Study

Objective:

This study explores assisted living residents' walking behaviors, locations where residents prefer to walk, and walking environments in and around assisted living facilities.

Background:

Regular walking is beneficial to older adults' physical and psychological health. Yet frail older residents in assisted living are usually too sedentary to achieve these benefits. The physical environment plays an important role in promoting physical activity. However, there is little research exploring this relationship in assisted living settings.

Methods:

The researcher visited 34 assisted living facilities in a major Texas city. Methods included walk-through observation with the Assisted Living Facility Walking Environment Checklist, and interviews with administrators by open- and close-ended questions. The data from 26 facilities were analyzed using descriptive statistics (for quantitative data) and content analysis (for qualitative data).

Results:

The results indicate that (a) residents were walking both indoors and outdoors for exercise or other purposes (e.g., going to destinations); (b) assisted living facility planning and design details—such as neighborhood sidewalk conditions, facility site selection, availability of seating, walking path configuration (e.g., looped/nonlooped path), amount of shading along the path, presence of handrails, existence of signage, etc.—may influence residents' walking behaviors; and (c) current assisted living facilities need improvement in all aspects to make their environments more walkable for residents.

Conclusion:

Findings of the study provide recommendations for assisted living facilities to improve the walkability of environments and to create environmental interventions to promote regular walking among their residents. This study also implies several directions for future research.

The influence of fear of falling on gait and balance in older people

BACKGROUND

fear of falling (FoF) has great impact on functioning and quality of life of older people, but its effects on gait and balance are largely unknown.

METHODS

we examined FoF in 100 participants aged >or=75 years, using the Activities-specific Balance Confidence scale. Participants with a mean score <67% were assigned to the FoF group. We quantified gait and balance during walking at the preferred velocity with and without a cognitive dual task (arithmetic task and verbal fluency), using an electronic walkway (Gaitrite) and a trunk accelerometer (SwayStar). Primary outcome measures were gait velocity, stride-length and stride-time variability, as well as mediolateral angular displacement and velocity.

RESULTS

gait velocity was significantly lower (P < 0.05) and stride-length and stride-time variability were significantly higher (P < 0.05) in the FoF group. However, after standardisation for gait velocity, differences became non-significant. Mediolateral angular displacement and velocity were not associated with FoF. We found no difference between the FoF and no-FoF group with respect to the dual-task effect on gait and balance variables.

CONCLUSIONS

the lower gait velocity in the FoF group may be a useful adaptation to optimise balance, rather than a sign of decreased balance control. The ability to attend to a secondary task during walking is not influenced by FoF.

Effect of a Sand or Firm-Surface Walking Program on Health, Strength, and Fitness in Women 60–75 Years Old

The effects of 8 wk of soft-sand (n= 19) and firm-surface walking (n= 19) on blood lipids, submaximal fitness (8-min walk at 4.5 km/hr), and leg strength in elderly (60+ yr), sedentary women were studied. Significant main time effects (p< .005) were found for blood lipids. The surface interaction effect for high-density lipoprotein approached significance (p= .052), with a tendency for higher levels in the sand group postintervention (p= .06). Neither group reported significant differences across time for submaximal oxygen consumption (p= .223), but a greater percentage reduction in heart-rate response to the 8-min walk was reported in the sand group (p= .016). Knee strength did not change in either group, whereas hip strength significantly improved in both groups (p= .0001), with larger effect sizes reported in the sand group. Overall, both groups showed improvements in blood lipids, fitness, and strength, with strength changes being slightly higher in the sand-walking group.

Effect of a community-based Argentine tango dance program on functional balance and confidence in older adults

Tango-dancing and walking programs are compared in nondemented seniors at risk for falls. Fallers (N = 30) age 62-91 were randomly assigned to a 10-wk (40 hr, 2 hr 2x/wk) tango class or walk group. The Activities-specific Balance Confidence (ABC) scale, sit-to-stand scores, and normal and fast walk were measured pre-, post-, and 1 month postintervention. Two-way repeated-measures ANOVAs indicated a significant main effect (p < .01) for time on all measures. Group and interaction effects for ABC led to improvement only in tango because of high baseline mean for the walk group. Clinical improvements measured using Established Populations for Epidemiologic Studies of the Elderly scoring were greater for the tango group. From these preliminary results it is suggested that although both interventions are effective activities for increasing strength and walk speed, tango might result in greater improvements than walking in balance skills and in walking speed in the 10-wk intervention. The study needs to be repeated with a greater sample size to determine the effectiveness of walking on fear of falling.

Postural stability and physical performance in social dancers

This cross-sectional study examined the benefits of social dancing on postural stability and physical performance in dancers aged 50 years or more. Walking speed, lower limb reaction time and low back flexibility were measured in 202 social dancers and 202 community-dwelling comparison subjects aged 50-87 years. The results showed that dancers who were older than 60 years had better postural stability and faster leg reaction times, whilst dancers aged 50-59 showed only better flexibility, when compared with the controls. Male dancers had greater low back flexibility and leg reaction time compared to controls. In contrast, female dancers had superior performance only for leg reaction time when compared with controls. The results indicate that social dancing is associated with enhanced postural stability and physical performance in older adults.

Do spike insoles enhance postural stability and plantar-surface cutaneous sensitivity in the elderly?

Balance problems are often related to a loss of plantar-sensitivity in elderly people. The purpose of this study was to explore the contribution of plantar cutaneous inputs induced by a spike support surface to the control of stance. Nineteen elderly (mean age 69.0 years, range 62-80) and 19 young adults (mean age 25.9 years, range 21-32) were instructed to stand (standing session) or to walk (walking session) for 5 min with sandals equipped with spike insoles (spike condition). Both sessions also involved a no spike condition in which participants stood or walked for 5 min without these insoles (no spike condition). In all conditions, postural responses were assessed during unperturbed stance and were performed (1) immediately after putting the spike or the no spike insoles, and (2) 5 min after standing or walking with them. Sway parameters, such as centre of foot pressure mean location, surface area, mean speed, root mean square and median frequency on the antero-posterior and medio-lateral axes, were calculated. As postural performances are often related to plantar-surface sensitivity, cutaneous sensitivity threshold was also evaluated with Semmes-Weinstein monofilaments. Although no immediate effect of the spike insoles was found, results indicated that standing or walking for 5 min with sandals equipped with spike insoles led to a significant improvement of quiet standing in the elderly. Balance improvement was also observed in young adults. The results provided evidence that wearing sandals with spike insoles can contribute, at least temporarily, to the improvement of unperturbed stance in elderly people with relatively intact plantar cutaneous sensation. Further research is needed to assess the effects of longer and discontinuous stimulations with spike insoles on postural control.

Biomechanics of Tai Chi: a review

Tai Chi Chuan is a favourite form of exercise throughout the world and has drawn increasing research interest from international scientists. Biomechanical research into Tai Chi has grown substantially and has provided evidence of the beneficial effects of Tai Chi exercise on health, fitness, and prevention of falls. This paper reviews studies that have explored the biomechanical aspects of Tai Chi, such as balance, kinematics, kinetics, strength, and neuromuscular activities.

The duration and plantar pressure distribution during one-leg stance in Tai Chi exercise

BACKGROUND

Tai Chi exercise improved the balance control and muscle strength of the lower extremities. The aim of this study is to quantify the one-leg stance duration and plantar pressure distribution during the one-leg stance in Tai Chi and to try to elaborate on its probable effects on the ability to balance on one leg.

METHODS

Sixteen experienced Tai Chi practitioners participated in this study. The Novel Pedar-X insole system was used to record the plantar forces during the execution of a set of 42-form Tai Chi movements and during normal walking. The one-leg stance duration and plantar pressure distribution during the one-leg stance were analyzed.

FINDINGS

In Tai Chi exercise, the total duration spent in the one-leg stance was less (p<0.05), the duration of each one-leg stance was longer (p<0.01) and the medial-lateral displacement of the centre of pressure was greater (p<0.05) than during normal walking. The peak pressure and pressure-time integral of the second and third metatarsal heads and the fourth and fifth metatarsal heads were significantly greater (p<0.05) than those of other plantar regions during the one-leg stance in normal walking, whereas the peak pressure and pressure-time integral of the first metatarsal head and the great toe were significantly greater (p<0.05) than those of other plantar regions during the one-leg stance in Tai Chi exercise.

INTERPRETATION

The longer duration of each one-leg stance and the plantar pressure distribution characteristics during the one-leg stance in Tai Chi exercise may be associated with an improved ability to balance on one leg. The findings may provide useful information toward the development of strengthening programs, strategies for the prevention of falls, and the promotion of a physically active lifestyle.

Performance-oriented mobility assessment (POMA) balance score indicates need for assistive device

PURPOSE

To determine (1) if older adults using an assistive device (AD) score lower on the Performance-Oriented Mobility Assessment (POMA) balance subscale (B-subscale) than individuals not using an AD; and (2) if a cut-score of 12 would indicate the need to use an AD.

METHODS

Elderly persons (n = 82, mean age = 82.1 years) were surveyed about AD use, health status, activity level and fall history. A one-time assessment of balance was conducted using the B-subscale. The 'arising task' was repeated to evaluate performance on the sit-to-stand task without using hands.

RESULTS

A significant difference in B-subscale scores was observed between the two groups (AD; no AD), (P < 0.001). AD use was associated with lower activity level and health status. A cut-score of 12 points indicated device use (P = 0.000). The repeated 'arising task' demonstrated that 76.8% performed the task without using hands for support.

CONCLUSION

Older adults using an AD will score lower on the B-subscale and report lower activity level and health status. A score of less than 12 on the B-subscale is indicative of AD need. Older adults who use an AD and self-report a falls history will score lower on the B-subscale than individuals using an AD and no reported history of falls.

Plantar Pressure Distribution During Tai Chi Exercise

OBJECTIVES

To describe and quantify the plantar pressure distribution characteristics during Tai Chi exercise and to explain the beneficial effect of Tai Chi on balance control and muscle strength when compared with normal walking.

DESIGN

Description and within-subject design.

SETTING

A biomechanics laboratory.

PARTICIPANTS

Sixteen experienced Tai Chi practitioners.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Pressure-time integral, ground reaction force, and displacement of center of pressure (COP).

RESULTS

During Tai Chi movements, the loading of the first metatarsal head and the great toe were significantly greater than in other regions (P<.05). The ground reaction forces varied between the Tai Chi movements and normal walking. Compared with normal walking, the locations of the COP in the Tai Chi movements were significantly more medial and posterior at initial contact (P<.05), and were significantly more medial and anterior at the end of contact with the ground (P<.05). The displacements of the COP were significantly wider (P<.05) in the mediolateral direction in the forward, backward, and sideways Tai Chi movements. The displacement was significantly larger (P<.05) in the anteroposterior direction in the forward movement.

CONCLUSIONS

The plantar pressure characteristics of Tai Chi movements found in this study may be one of the important factors that Tai Chi exercise improves balance control and muscle strength.