Risk-of-falling related outcomes improved in community-dwelling older adults after a 6-week sideways walking intervention: a feasibility and pilot study

Effect of Comprehensive Balance Modulating Strategies on Physical Performance Among the Elderly in Care Home Settings in Southern India

Purpose Globally, the proportion of the elderly population is rising. Age-related physical performance impairments are more common and affect quality of life. This study aimed to investigate the impact of a new exercise regimen called Comprehensive Balance-Modulating Strategies (CBMS) on the physical performance of older adults living in care home settings. Methods Forty-eight functionally independent elderly individuals were randomized into two groups: group A received the CBMS programme for eight weeks, and group B received routine medical care. The Short Physical Performance Battery (SPPB) and the Four Square Step Test (FSST) were outcome measures. Outcomes were measured at baseline, immediately after the intervention, and eight weeks after the intervention. Results The mean and standard deviation of subjects' ages in both groups were 72.46 (8.28) and 68.12 (6.95), respectively. The CBMS programme significantly improved physical performance among the intervention group (p = <0.0001). Conclusion The present study found that CBMS was effective in improving physical performance among institutionalized elderly. Large-scale clinical trials and research exploring the effect of CBMS among community-dwelling elderly individuals are recommended.

Exercise with a wearable hip-assist robot improved physical function and walking efficiency in older adults

Wearable assistive robotics has emerged as a promising technology to supplement or replace motor functions and to retrain people recovering from an injury or living with reduced mobility. We developed delayed output feedback control for a wearable hip-assistive robot, the EX1, to provide gait assistance. Our purpose in this study was to investigate the effects of long-term exercise with EX1 on gait, physical function, and cardiopulmonary metabolic energy efficiency in elderly people. This study used parallel experimental (exercise with EX1) and control groups (exercise without EX1). A total of 60 community-dwelling elderly persons participated in 18 exercise intervention sessions during 6 weeks, and all participants were assessed at 5 time points: before exercise, after 9 exercise sessions, after 18 sessions, and 1 month and 3 months after the last session. The spatiotemporal gait parameters, kinematics, kinetics, and muscle strength of the trunk and lower extremities improved more after exercise with EX1 than in that without EX1. Furthermore, the effort of muscles over the trunk and lower extremities throughout the total gait cycle (100%) significantly decreased after exercise with EX1. The net metabolic energy costs during walking significantly improved, and functional assessment scores improved more in the experimental group than in the control group. Our findings provide evidence supporting the application of EX1 in physical activity and gait exercise is effective to improve age-related declines in gait, physical function, and cardiopulmonary metabolic efficiency among older adults.

Fall history in older adults impacts acceleration profiles after a near collision with a moving pedestrian hazard

BACKGROUND

Environmental hazards (e.g., pedestrian traffic) cause falls and testing environment impacts gait in older adults. However, most fall risk evaluations do not assess real-world moving hazard avoidance.

AIMS

This study examined the effect of fall history in older adults on acceleration profiles before, during, and after a near collision with a moving hazard, in laboratory and real-world settings.

METHODS

Older adults with (n = 14) and without a fall history (n = 15) performed a collision avoidance walking task with a sudden moving hazard in real-world and laboratory settings. Gait acceleration and video data of participants' first-person views were recorded. Four mixed effects multilevel models analyzed the magnitude and variability of mean and peak anteroposterior and mediolateral acceleration while walking before, during, and after the moving hazard in both environments.

RESULTS

In the real-world environment, older adults without a fall history increased their mean anteroposterior acceleration after the moving hazard (p = 0.046), but those with a fall history did not (p > 0.05). Older adults without a fall history exhibited more intersubject variability than those with a fall history in mean (p < 0.001) and peak anteroposterior (p = 0.015) acceleration across environments and epochs. Older adults without a fall history exhibited a slower peak mediolateral reaction during the moving hazard (p = 0.014) than those with a fall history.

CONCLUSIONS

These results suggest that compared to older adults with a fall history, older adults without a fall history are more adaptable and able to respond last-minute to unexpected hazards. Older adults with a fall history exhibited more homogenous responses.

Quasi-experimental pilot study to improve mobility and balance in recurrently falling nursing home residents by voluntary non-targeted side-stepping exercise intervention

BACKGROUND

Side-stepping is a potential exercise program to reduce fall risk in community-dwelling adults in their seventies, but it has never been tested in nursing home residents. This was a pilot quasi-experimental study to examine the feasibility and potential mobility and balance benefits of an intervention based on voluntary non-targeted side-stepping exercises in nursing home residents who fall recurrently.

METHODS

Twenty-two participants were recruited and non-randomly assigned to an intervention group ([Formula: see text]11, side-stepping exercises, STEP) participating in an 8-week protocol and to a control group ([Formula: see text]11, usual physiotherapy care, CTRL). They were clinically assessed at 4-time points: baseline, after 4 and 8 weeks, and after a 4-week follow-up period (usual physiotherapy care). Statistical differences between time points were assessed with a Friedman repeated measures ANOVA on ranks or a one-way repeated measures ANOVA.

RESULTS

Compared to baseline, significant benefits were observed in the STEP group at 8 weeks for the Timed Up and Go ([Formula: see text]0.020) and 6-minute walking test ([Formula: see text]0.001) as well as for the Berg Balance Scale ([Formula: see text]0.041) and Mini motor test ([Formula: see text]0.026). At follow-up, the Tinetti Performance Oriented Mobility Assessment and Berg Balance Scale significantly worsened in the STEP group ([Formula: see text]0.009 and [Formula: see text]0.001, respectively). No significant differences were found between the groups at the same time points.

CONCLUSIONS

Our intervention was feasible and improved mobility and balance after almost 8 weeks. Studies with larger samples and randomized control trials are needed to consolidate our preliminary observations and confirm the deterioration of some tests when side-stepping exercises are discontinued.

TRIAL REGISTRATION

Identifier: ISRCTN13584053. Retrospectively registered 01/09/2022.

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

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

Resistance Circuit Training or Walking Training: Which Program Improves Muscle Strength and Functional Autonomy More in Older Women?

To evaluate the effects of two programs (resistance and walking training) on the functional autonomy and muscle strength (isometric and dynamic) of older women, 67 subjects were divided randomly into three groups: resistance training (RTG; Mean = 64.70 ± 6.74 years), walking (WG, Mean = 65.56 ± 7.82 years), and control (CG; Mean = 64.81 ± 4.34). The experimental groups underwent a 16-week intervention. Muscle strength (isometric and dynamic) and functional autonomy were assessed. The subjects participating in the RTG showed improvements in the comparison pre to post-test in the maximal forces of upper limb (MULS) (Δ% = 49.48%; p = 0.001) and lower limb (MLLS) (Δ% = 56.70%; p = 0.001), isometric biceps forces (BIS) (Δ% = 30.13%; p = 0.001) and quadriceps forces (QIS) (Δ% = 65.92%; p = 0.001), and in the general index (GI) of functional autonomy (Δ% = −18.32%; p = 0.002). The WG improved in all functional autonomy tests, except for the standing up from prone position test (SVDP). In strength tests, the WG obtained improvements only in the QIS (Δ% = 41.80%; p = 0.001) and MLLS (Δ% = 49.13%; p = 0.001) tests. The RTG obtained better results (p < 0.05) when compared to the WG and CG. The results allow us to infer that resistance exercise programs are more effective in increasing strength and functional autonomy, a fact that may mitigate the deleterious effects on health of aging.

Impact of walking states, self-reported daily walking amount and age on the gait of older adults measured with a smart-phone app: a pilot study

BACKGROUND

Smartphones provide a cost-effective avenue for gait assessment among older adults in the community. The purpose of this study is to explore the impact of walking state, self-reported daily walking amount, and age on gait quality, using a smartphone application.

METHODS

One hundred older adult individuals from North China, aged 73.0 ± 7.7 years, voluntarily participated in this study. They performed three walking tests: normal walking, fast walking, and visually impaired walking. Three-dimensional acceleration data for gait were obtained using the smartphone app Pocket Gait. This study used multivariate analysis of variance (MANOVA) to explore the effects of the walking state, self-reported daily walking amount, and age on the step frequency, root mean square (RMS) acceleration, step time variability, regularity, and symmetry.

RESULTS

The walking state, self-reported daily walking amount, and age had statistically significant effects on gait quality. Compared with normal walking, the step frequency, RMS acceleration, variability, and regularity were greater in the fast-walking state, and simulated visually impaired walking did not significantly affect gait quality. Relatively older individuals had a significant decline in gait quality compared to (relatively) younger older adult individuals. Compared with older adults who walked less than 1 km a day, older adults who walked more had better gait quality.

CONCLUSIONS

The walking state, self-reported daily walking amount, and age have a significant effect on the gait quality of older adults. Walking with pigmented sunglasses can be used as a training intervention to improve gait performance. Older adult people who walk less than 1 km/day have worse gait quality compared with their counterparts.

Association between daily activities and fall in older adults: an analysis of longitudinal ageing study in India (2017-18)

Background

Declining functionality affects an individual’s musculoskeletal integrity increasing the risk of fall and disability. Individuals with severe functional limitations are 5 times more likely to experience a fall. Thus, this paper investigated the association between functional decline and falls in older adults.

Methods

This study uses secondary data from the Longitudinal Aging Study in India (2017–18). A total of 31,477 people over the age of 60 are included in the study. Descriptive statistics and bivariate analysis were performed to determine the association between activities of daily living (ADL), instrumental activities of daily living (IADL) and fall. Adjusted odds ratio was used to determine the association of ADL and IADL with fall while controlling for age, gender, balance and gait impairments.

Results

The study reported 6352 fall episodes in 3270 participants aged 60 and above, over a period of 2 years. More than 30% of participants reported difficulty in ADL and IADL. Age and gender adjusted odds of fall were higher in participants with difficulty in more than 4 ADLs (AOR:1.32; CI:1.08 – 1.67) and in more than 2 IADL (AOR: 1.39; CI:1.02 – 1.89). Similarly, the odds of fall were higher for difficulty in ADL (AOR:1.31; CI:1.11 – 1.73) and IADL (AOR of 1.18; CI:1.07 – 1.29) controlling for gait and balance impairment. Difficulty in pushing-pulling objects (AOR: 1.30; CI: 1.15 – 1.46 & AOR: 1.40; CI: 1.21–1.61) and getting up from the chair (AOR: 1.12; CI:1.01–1.26 & AOR: 1.27; CI: 0.99 – 1.26) was significantly associated with fall when adjusted for age, gender and balance and gait parameters.

Conclusions

This study provides the new insights into the association of fall and risk of functional decline, especially difficulty in pushing and pulling objects and getting up from a chair, can be incorporated in the primary screening of fall risk assessment.

Effect of baduanjin on the fall and balance function in middle-aged and elderly people: A protocol for systematic review and meta-analysis

BACKGROUND

The risk of fall seriously affects the health and quality of life of the middle-aged and elderly people, especially the injury and disability caused by fall of the middle-aged and elderly people, which imposes a huge burden on family and social medical care. Baduanjin exercise may be an effective intervention to enhance the muscle strength and stability of lower limbs, improve the balance ability and gait of middle-aged and elderly people, reduce the incidence of falls, improve the quality of life, and promote the health of middle-aged and elderly people. The aim of this study is to summarize evidence and systematically review the efficacy and safety of Baduanjin on the fall and balance function in middle-aged and elderly people.

METHODS

We conducted a systematic search of English and Chinese RCTs in the following 8 electronic databases: PubMed, EMBASE, Web of Science, The Cochrane Library, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure (CNKI), Chinese Science and Technology Periodical Database (VIP), Wanfang Database, from their respective dates of inception to July 2021. Other resources will be searched if necessary. The primary outcome is the fall rate in middle-aged and elderly people and the secondary outcomes include the Single-Leg Standing (SLS) Test, Berg Balance Scale (BBS), Timed Up and Go (TUG) Test. The study selection, data extraction, risk of bias, data synthesis and analysis, reporting biases, and the quality of evidence will be independently conducted by 2 reviewers who use the EndNote X9 software, Cochrane handbook assessment tool, RevMan 5.3 software, a funnel plot and GRADE system.

RESULTS

This study will evaluate the effect of Baduanjin on falls and balance function of middle-aged and elderly people from multiple outcome evaluation indicators such as fall rate, and provide high-quality evidence.

CONCLUSION

This study will provide evidence for whether Baduanjin has an effect on falls and balance function in middle-aged and elderly people.

ETHICS AND DISSEMINATION

Ethics approval is not required for systematic review, since it does not infringe on personal interests. The results will be submitted to peer-review journals or disseminated at scientific conferences.