The effects of an active-assisted stretching program on functional performance in elderly persons: a pilot study

Static Stretch Training versus Foam Rolling Training Effects on Range of Motion: A Systematic Review and Meta-Analysis

BACKGROUND

Long-term static stretching as well as foam rolling training can increase a joint's range of motion (ROM). However, to date, it is not clear which method is the most effective for increasing ROM.

OBJECTIVE

The purpose of this systematic review and meta-analysis was to compare the effects of static stretching and foam rolling training on ROM.

METHODS

The literature search was performed in PubMed, Scopus, and Web of Science to find the eligible studies. Eighty-five studies (72 on static stretching; and 13 on foam rolling) were found to be eligible with 204 effect sizes (ESs). For the main analyses, a random-effect meta-analysis was applied. To assess the difference between static stretching and foam rolling, subgroup analyses with a mixed-effect model were applied. Moderating variables were sex, total intervention duration, and weeks of intervention.

RESULTS

Static stretch (ES =  - 1.006; p < 0.001), as well as foam rolling training (ES =  - 0.729; p = 0.001), can increase joint ROM with a moderate magnitude compared with a control condition. However, we did not detect a significant difference between the two conditions in the subgroup analysis (p = 0.228). When the intervention duration was ≤ 4 weeks, however, a significant change in ROM was shown following static stretching (ES =  - 1.436; p < 0.001), but not following foam rolling (ES =  - 0.229; p = 0.248). Thus, a subgroup analysis indicated a significant favorable effect with static stretching for increasing ROM compared with foam rolling (p < 0.001) over a shorter term (≤ 4 weeks). Other moderator analyses showed no significant difference between static stretch and foam rolling training on ROM.

CONCLUSIONS

According to the results, both static stretching and foam rolling training can be similarly recommended to increase joint ROM, unless the training is scheduled for ≤ 4 weeks, in which case static stretching demonstrates a significant advantage. More studies are needed with a high-volume foam rolling training approach as well as foam rolling training in exclusively female participants.

Synergistic Effects of Cognitive Training and Physical Exercise on Dual-Task Performance in Older Adults

BACKGROUND

Studies report benefits of physical exercise and cognitive training to enhance cognition in older adults. However, most studies did not compare these interventions to appropriate active controls. Moreover, physical exercise and cognitive training seem to involve different mechanisms of brain plasticity, suggesting a potential synergistic effect on cognition.

OBJECTIVE

This study investigated the synergistic effect of cognitive training and aerobic/resistance physical exercise on dual-task performance in older adults. Intervention effects were compared to active controls for both the cognitive and the exercise domain.

METHOD

Eighty-seven older adults completed one of 4 different combinations of interventions, in which computer lessons was active control for cognitive training and stretching/toning exercise control for aerobic/resistance training: (a) cognitive dual-task training and aerobic/resistance training (COG+/AER+), (b) computer lessons and aerobic/resistance training (COG-/AER+), (c) cognitive dual-task training and stretching/toning exercises (COG+/AER-), and (d) computer lessons and stretching/toning exercises (COG-/AER-). The primary outcome was performance in an untrained transfer dual task. Stepwise backward removal regression analyses were used to predict pre- versus post-test changes in groups that have completed the dual-task training, aerobic/resistance or both interventions.

RESULTS

Participation in AER+ did not predict improvement in any dual-task outcomes. Participation in COG+ predicted reduction in dual-task cost and participation in COG+/AER+ predicted reduction in task-set cost.

DISCUSSION

Results suggest that the combination of cognitive and physical training protocols exerted a synergistic effect on task-set cost which reflects the cost of maintaining multiple response alternatives, whereas cognitive training specifically improved dual-task cost, which reflects the ability of synchronizing concurrent tasks.

Effects of Dynamic Stretching with Different Loads on Hip Joint Range of Motion in the Elderly

The purpose of this study was to investigate the immediate and sustained effects of static stretching (SS), dynamic stretching (DS) with no-load (DSNL), DS with a light load (DSLL, 0.25 kg), and DS with a heavy load (DSHL, 0.5 kg) on the hip joint range of motion (ROM). Sixteen participants (63.2 ± 7.13 years) were randomly assigned to perform SS, DSNL, DSLL, and DSHL exercises. The ROM for passive flexion and extension of the right hip joint was measured at pretest, as well as immediately after and at 60 min after completing the exercise. Additionally, the ROM of hip flexion and extension during the stretching exercise was evaluated by kinematic analysis of video-captured images. Passive ROM measurements reveals that the hip flexion ROM was higher after DSNL than after DSLL and DSHL at both time points (DSNL vs. DSLL, DSHL: 0 min: 7.0% vs. -1.8%, -3.9%; 60 min: 7.8% vs. -2.1%, -1.4%, p < 0.05), as well as higher than after SS at 60 min after exercise (DSNL vs. SS: 7.8% vs. 1.0%, p < 0.05). Compared to SS, all types of DS demonstrated a more sustained effect of ROM improvement at 60 min (DSNL, DSLL, DSHL vs. SS: 8.0%, 5.6%, 7.0% vs. 1.6%, p < 0.05). These results suggest that all DS modes can effectively improve hip extension ROM in the elderly. DSNL may be the most effective exercise for improving hip flexion ROM, providing sustained effect for over 60 min.

Does Combined Physical and Cognitive Training Improve Dual-Task Balance and Gait Outcomes in Sedentary Older Adults?

Everyday activities like walking and talking can put an older adult at risk for a fall if they have difficulty dividing their attention between motor and cognitive tasks. Training studies have demonstrated that both cognitive and physical training regimens can improve motor and cognitive task performance. Few studies have examined the benefits of combined training (cognitive and physical) and whether or not this type of combined training would transfer to walking or balancing dual-tasks. This study examines the dual-task benefits of combined training in a sample of sedentary older adults. Seventy-two older adults (≥60 years) were randomly assigned to one of four training groups: Aerobic + Cognitive training (CT), Aerobic + Computer lessons (CL), Stretch + CT and Stretch + CL. It was expected that the Aerobic + CT group would demonstrate the largest benefits and that the active placebo control (Stretch + CL) would show the least benefits after training. Walking and standing balance were paired with an auditory n-back with two levels of difficulty (0- and 1-back). Dual-task walking and balance were assessed with: walk speed (m/s), cognitive accuracy (% correct) and several mediolateral sway measures for pre- to post-test improvements. All groups demonstrated improvements in walk speed from pre- (M = 1.33 m/s) to post-test (M = 1.42 m/s, p < 0.001) and in accuracy from pre- (M = 97.57%) to post-test (M = 98.57%, p = 0.005).They also increased their walk speed in the more difficult 1-back (M = 1.38 m/s) in comparison to the 0-back (M = 1.36 m/s, p < 0.001) but reduced their accuracy in the 1-back (M = 96.39%) in comparison to the 0-back (M = 99.92%, p < 0.001). Three out of the five mediolateral sway variables (Peak, SD, RMS) demonstrated significant reductions in sway from pre to post test (p-values < 0.05). With the exception of a group difference between Aerobic + CT and Stretch + CT in accuracy, there were no significant group differences after training. Results suggest that there can be dual-task benefits from training but that in this sedentary sample Aerobic + CT training was not more beneficial than other types of combined training.

Effects of combined physical and cognitive training on fitness and neuropsychological outcomes in healthy older adults

PURPOSE

Physical exercise and cognitive training have been shown to enhance cognition among older adults. However, few studies have looked at the potential synergetic effects of combining physical and cognitive training in a single study. Prior trials on combined training have led to interesting yet equivocal results. The aim of this study was to examine the effects of combined physical and cognitive interventions on physical fitness and neuropsychological performance in healthy older adults.

METHODS

Seventy-six participants were randomly assigned to one of four training combinations using a 2×2 factorial design. The physical intervention was a mixed aerobic and resistance training program, and the cognitive intervention was a dual-task (DT) training program. Stretching and toning exercises and computer lessons were used as active control conditions. Physical and cognitive measures were collected pre- and postintervention.

RESULTS

All groups showed equivalent improvements in measures of functional mobility. The aerobic-strength condition led to larger effect size in lower body strength, independently of cognitive training. All groups showed improved speed of processing and inhibition abilities, but only participants who took part in the DT training, independently of physical training, showed increased task-switching abilities. The level of functional mobility after intervention was significantly associated with task-switching abilities.

CONCLUSION

Combined training did not yield synergetic effects. However, DT training did lead to transfer effects on executive performance in neuropsychological tests. Both aerobic-resistance training and stretching-toning exercises can improve functional mobility in older adults.

Comparison of the long-term effectiveness of progressive neuromuscular facilitation and continuous passive motion therapies after total knee arthroplasty

[Purpose] The aim of this longitudinal study was to examine the long term functional effectiveness of proprioceptive neuromuscular facilitation (PNF) after total knee arthroplasty. [Subjects and Methods] We included 30 patients and they were randomly assigned to two groups. In addition to the standard rehabilitation program the PNF group received proprioceptive neuromuscular facilitation therapy and the CPM group received continuous passive motion therapy. The outcome measures included range of motion using a goniometer, pain scores using a numeric pain rating scale, days to reach functional benchmarks, the Beck depression scale and isokinetic torque and isometric strength measurements. [Results] There were no significant differences between the two groups in terms of baseline demographic data, clinical findings and length of stay. Days to reach range of motion benchmarks were similar in the two groups. Pain at the 8th week was slightly higher in the PNF group. With the exception of walking with a walker, days to reach functional benchmarks were statistically significantly fewer in patients of the PNF group despite similar isokinetic measurements. Administration of PNF resulted in earlier functional gains in patients after total knee arthroplasty. These functional accomplishments were more pronounced in the PNF group despite it having isokinetic torque measurements similar to those of the CPM group. [Conclusion] PNF techniques can positively affect functional outcomes over the long term.

The relevance of stretch intensity and position-a systematic review

Stretching exercises to increase the range of motion (ROM) of joints have been used by sports coaches and medical professionals for improving performance and rehabilitation. The ability of connective and muscular tissues to change their architecture in response to stretching is important for their proper function, repair, and performance. Given the dearth of relevant data in the literature, this review examined two key elements of stretching: stretch intensity and stretch position; and their significance to ROM, delayed onset muscle soreness (DOMS), and inflammation in different populations. A search of three databases, Pub-Med, Google Scholar, and Cochrane Reviews, identified 152 articles, which were subsequently categorized into four groups: athletes (24), clinical (29), elderly (12), and general population (87). The use of different populations facilitated a wider examination of the stretching components and their effects. All 152 articles incorporated information regarding duration, frequency and stretch position, whereas only 79 referred to the intensity of stretching and 22 of these 79 studies were deemed high quality. It appears that the intensity of stretching is relatively under-researched, and the importance of body position and its influence on stretch intensity, is largely unknown. In conclusion, this review has highlighted areas for future research, including stretch intensity and position and their effect on musculo-tendinous tissue, in relation to the sensation of pain, delayed onset muscle soreness, inflammation, as well as muscle health and performance.

The comparison of spinal curves and hip and ankle range of motions between old and young persons

BACKGROUND

Falls have been strongly associated with decreased physical activity and impaired mobility. Reduced range of motion, as a consequence of muscle stiffness, has been indicated to assume a positive relationship to fall incidence. Also clinical observations suggest that maintaining the normal spinal curves is associated with the prevention of spinal, knee and hip disorders. Thus, the aim of this study was to compare hip and ankle range of motions and thoracic and lumbar curves between young and old persons Methods: Using a nonprobability sampling 30 elderly persons at average of 68.14 ±4.03 years of age and 30 young people (age 23.37 ± 2.31 years) through a case - control design participated in the study. Maximal hip extension and ankle dorsiflexion range of motions were measured by a standard goniometer. Thoracic and lumbar curvatures were measured by a flexible ruler in both groups. Independent t test were used to statistically analyze differences between groups.

RESULTS

Compared with the young group, the elderly group had decreased hip extension and ankle dorsiflexion motions (p<0.01). The result of independent t test showed that the mean of lumbar curve was higher in young group (31.29± 6.37) than elderly subjects (27.93±8.11) ,however, no significant difference was found between two groups (p=0.08). The result also showed increasing thoracic curvature with aging (young group=34.43±13.27, old group= 36.19±8.97), however, no significant difference was found between two groups

CONCLUSION

Findings suggest decreased ankle and hip joint range of motions should be considered in rehabilitation of elderly people.

Flexibility training and functional ability in older adults: a systematic review

Background. As indicated in a recent systematic review relating to Canada's Physical Activity Guidelines for Older Adults, exercise interventions in older adults can maintain or improve functional abilities. Less is known about the role of flexibility in the maintenance or improvement of functional abilities, and there currently does not exist a synthesis of the literature supporting a consensus on flexibility training prescription. Purpose. To systematically review the effects of flexibility-specific training interventions on measures of functional outcomes in healthy older adults over the age of 65 years. Methods. Five electronic databases were searched for intervention studies involving concepts related to aging, flexibility, functional outcomes, and training interventions. After evaluating the articles for relevance, 22 studies were considered. Results. The results suggested that while flexibility-specific interventions may have effects on range of motion (ROM) outcomes, there is conflicting information regarding both the relationship between flexibility interventions and functional outcomes or daily functioning. Conclusions. Due to the wide range of intervention protocols, body parts studied, and functional measurements, conclusive recommendations regarding flexibility training for older adults or the validity of flexibility training interventions as supplements to other forms of exercise, or as significant positive influences on functional ability, require further investigation.

The modified total body rotation test: a rapid, reliable assessment of physical function in older adults

OBJECTIVES

To describe a quick, modified measure of total body rotation with performance rankings for elderly persons and to highlight the importance of total body rotational ability for overall physical performance.

DESIGN

Scores were collected during the same testing session and were compared with other measures using a Pearson correlation.

SETTING

Community-based senior centers.

PARTICIPANTS

One hundred forty-five participants aged 79.6±7.2 were recruited using flyers distributed at health fairs, senior centers, and lifelong learning programs.

MEASUREMENTS

The modified total body rotation test (MTBR), the back-scratch test, the modified sit-and-reach test, the 30-second chair-stand test, the Short Physical Performance Battery, and the short version of the Continuous-Scale Physical Functional Performance Test.

RESULTS

The MBTR significantly correlated to all standard measures of physical performance. Norms are reported for all participants, and reliability analyses were conducted using data from 18 participants. Data were divided into quintiles to create cutoffs for physical performance rankings that can be used when reporting results to the general public.

CONCLUSION

Many evaluations measure isolated components of physical performance, but few examine whole body movements that allow all components necessary for independence and function to work in harmony as needed considering the task and the individual's movement strategy. The current study offers the MTBR as a quick, easy, and cost-effective evaluation method to quantify the degree of impairment or injury and the rate of improvement with treatment or training.

Feasibility of a multidimensional home-based exercise programme for the elderly with structured support given by the general practitioner's surgery: study protocol of a single arm trial preparing an RCT [ISRCTN58562962]

Background

Physical activity programmes can help to prevent functional decline in the elderly. Until now, such programmes use to target either on healthy community-dwelling seniors or on elderly living in special residences or care institutions. Sedentary or frail people, however, are difficult to reach when they live in their own homes. The general practitioner's (GP) practice offers a unique opportunity to acquire these people for participation in activity programmes. We conceptualised a multidimensional home-based exercise programme that shall be delivered to the target group through cooperation between GPs and exercise therapists. In order to prepare a randomised controlled trial (RCT), a feasibility study is being conducted.

Methods

The study is designed as a single arm interventional trial. We plan to recruit 90 patients aged 70 years and above through their GPs. The intervention lasts 12 weeks and consists of physical activity counselling, a home-exercise programme, and exercise consultations provided by an exercise therapist in the GP's practice and via telephone. The exercise programme consists of two main components: 1. a combination of home-exercises to improve strength, flexibility and balance, 2. walking for exercise to improve aerobic capacity. Primary outcome measures are: appraisal by GP, undesirable events, drop-outs, adherence. Secondary outcome measures are: effects (a. motor tests: timed-up-and-go, chair rising, grip strength, tandem stand, tandem walk, sit-and-reach; b. telephone interview: PRISCUS-Physical Activity Questionnaire, Short Form-8 Health Survey, three month recall of frequency of falls, Falls Efficacy Scale), appraisal by participant, exercise performance, focus group discussion. Data analyses will focus on: 1. decision-making concerning the conduction of a RCT, 2. estimation of the effects of the programme, detection of shortcomings and identification of subgroups with contrary results, 3. feedback to participants and to GPs.

Conclusion

A new cooperation between GPs and exercise therapists to approach community-dwelling seniors and to deliver a home-exercise programme is object of research with regard to feasibility and acceptance. In case of success, an RCT should examine the effects of the programme. A future implementation within primary medical care may take advantage from the flexibility of the programme.

Trial registration

Current Controlled Trials ISRCTN58562962.