Martial arts fall training to prevent hip fractures in the elderly

Influence of the Backward Fall Technique on the Transverse Linear Acceleration of the Head during the Fall

BACKGROUND

The formation of large accelerations on the head and cervical spine during a backward fall is particularly dangerous due to the possibility of affecting the central nervous system (CNS). It may eventually lead to serious injuries and even death. This research aimed to determine the effect of the backward fall technique on the linear acceleration of the head in the transverse plane in students practicing various sports disciplines.

METHODS

The study involved 41 students divided into two study groups. Group A consisted of 19 martial arts practitioners who, during the study, performed falls using the side aligning of the body technique. Group B consisted of 22 handball players who, during the study, performed falls using the technique performed in a way similar to a gymnastic backward roll. A rotating training simulator (RTS) was used to force falls, and a Wiva^® Science apparatus was used to assess acceleration.

RESULTS

The greatest differences in backward fall acceleration were found between the groups during the buttocks' contact with the ground. Larger changes in head acceleration were noted in group B.

CONCLUSIONS

The lower changes in head acceleration obtained in physical education students falling with a lateral body position compared to students training handball indicate their lower susceptibility to head, cervical spine, and pelvis injuries when falling backwards as caused by horizontal force.

Judo-based exercise programs to improve health outcomes in middle-aged and older adults with no judo experience: A scoping review

The practice of judo appears to impact positively on physical performance, muscle strength and flexibility in older people, while also benefiting bone mineral density in middle-aged adults. This scoping review aimed to map the range, scope and type of relevant studies conducted to examine the safety, feasibility and effects of judo interventions on various health-related outcomes designed for middle-aged and older adults (≥45 years) with no previous experience in judo. Six databases as well as gray literature were searched using a developed search strategy. Two independent reviewers screened the titles and abstracts, as well as full-texts of relevant articles using data extraction tools developed for the purpose of this study. Fifteen original studies were included, comprising 648 participants (mean age 45-77.8 years). All 15 studies reported significant positive results of ≥1 health-related outcome. Quality of life and bone mineral density seemed to improve only after longer interventions (≥9 or ≥12 months, respectively), while results regarding fear of falling and physical activity levels were mixed. Five studies showed improvements in fear of falling while four studies reported no change. Similarly, two studies showed improvements in physical activity, while another study showed no change. Five studies reported on safety and deemed their intervention to be safe (no adverse events), with two studies confirming feasibility. Findings suggest that judo interventions can positively impact health-related outcomes in middle-aged and older adults. However, studies had small sample sizes and more research is needed to confirm these findings. Geriatr Gerontol Int 2023; 23: 163-178.

Protective responses of older adults for avoiding injury during falls: evidence from video capture of real-life falls in long-term care

BACKGROUND

falls are common in older adults, and any fall from standing height onto a rigid surface has the potential to cause a serious brain injury or bone fracture. Safe strategies for falling in humans have traditionally been difficult to study.

OBJECTIVE

to determine whether specific 'safe landing' strategies (body rotation during descent, and upper limb bracing) separate injurious and non-injurious falls in seniors.

DESIGN

observational cohort study.

SETTING

two long-term care homes in Vancouver BC.

METHODS

videos of 2,388 falls experienced by 658 participants (mean age 84.0 years; SD 8.1) were analysed with a structured questionnaire. General estimating equations were used to examine how safe landing strategies associated with documented injuries.

RESULTS

injuries occurred in 38% of falls, and 4% of falls caused injuries treated in hospitals. 32% of injuries were to the head. Rotation during descent was common and protective against injury. In 43% of falls initially directed forward, participants rotated to land sideways, which reduced their odds for head injury 2-fold. Upper limb bracing was used in 58% of falls, but rather than protective, bracing was associated with an increased odds for injury, possibly because it occurred more often in the demanding scenario of forward landings.

CONCLUSIONS

the risk for injury during falls in long-term care was reduced by rotation during descent, but not by upper limb bracing. Our results expand our understanding of human postural responses to falls, and point towards novel strategies to prevent fall-related injuries.

Fall impacts from standing show equivalence between experts in stage combat landing strategy and naïve participants after training

BACKGROUND: Slips, trips, and falls are the second leading cause of non-fatal injuries in workplace in the United States. A stage combat landing strategy is used in the theatre arts to reduce the risk of fall-induced injury, and may be a viable approach among some working populations. OBJECTIVE: The goal of this study was to compare fall impact characteristics between experts in stage combat landing strategy and naïve participants after four training sessions of stage combat landing strategy training. METHODS: Forward and backward falls from standing were induced by releasing participants from static leans. Participants fell onto a foam mat, and impact force was measured using force platforms under the mat. A statistical equivalence test was used to determine if impact characteristics between groups were similar. RESULTS: Results indicated equivalence between groups in peak impact force during backward but not forward falls. Equivalence between groups in impact time suggested a mechanism by which equivalence in peak impact force as achieve. CONCLUSIONS: Four training sessions was sufficient for naïve participants to exhibit fall impact characteristics similar to experts in an anecdotally-effective landing strategy, and support further study. To our knowledge, this was the first study to investigate training for a landing strategy involving stepping after losses of balance from standing.

Influence of the Backward Fall Technique on the Sagittal Linear Acceleration of the Head during a Fall

(1) Background: This research aimed to determine the effect of the backward fall technique on the sagittal linear acceleration of the head in students training in different sports. (2) Methods: The study involved 41 students divided into two study groups. Group A included 19 students training in martial arts who practised falls with side aligning of the body. Group B included 22 handball players who practised falls performed in a way similar to a gymnastic backward roll. A rotating training simulator (RTS) was used to force falls, and Wiva ^® Science apparatus was used to assess acceleration. (3) Results: Significant changes in head acceleration were only obtained between immediate fall tests (IFTs) and forced fall tests (FFTs) in group B. Significant differences were noted between groups for the IFT and FFT. Greater changes in head acceleration were noted in group B. (4) Conclusions: Smaller changes in head acceleration in group A students indicate a lower susceptibility to head, pelvic and cervical spine injuries in falls performed backward with side aligning of the body. This technique in group A limited the differences in head acceleration between IFTs and FFTs. Negative acceleration values obtained in group B confirmed that the head may suffer a moment of force, tilting it backwards, but then forward when the buttocks hit the ground.

Accuracy of Kinovea software in estimating body segment movements during falls captured on standard video: Effects of fall direction, camera perspective and video calibration technique

Falls are a major cause of unintentional injuries. Understanding the movements of the body during falls is important to the design of fall prevention and management strategies, including exercise programs, mobility aids, fall detectors, protective gear, and safer environments. Video footage of real-life falls is increasingly available, and may be used with digitization software to extract kinematic features of falls. We examined the validity of this approach by conducting laboratory falling experiments, and comparing linear and angular positions and velocities measured from 3D motion capture to estimates from Kinovea 2D digitization software based on standard surveillance video (30 Hz, 640x480 pixels). We also examined how Kinovea accuracy depended on fall direction, camera angle, filtering cut-off frequency, and calibration technique. For a camera oriented perpendicular to the plane of the fall (90 degrees), Kinovea position data filtered at 10 Hz, and video calibration using a 2D grid, mean root mean square errors were 0.050 m or 9% of the signal amplitude and 0.22 m/s (7%) for vertical position and velocity, and 0.035 m (6%) and 0.16 m/s (7%) for horizontal position and velocity. Errors in angular measures averaged over 2-fold higher in sideways than forward or backward falls, due to out-of-plane movement of the knees and elbows. Errors in horizontal velocity were 2.5-fold higher for a 30 than 90 degree camera angle, and 1.6-fold higher for calibration using participants’ height (1D) instead of a 2D grid. When compared to 10 Hz, filtering at 3 Hz caused velocity errors to increase 1.4-fold. Our results demonstrate that Kinovea can be applied to 30 Hz video to measure linear positions and velocities to within 9% accuracy. Lower accuracy was observed for angular kinematics of the upper and lower limb in sideways falls, and for horizontal measures from 30 degree cameras or 1D height-based calibration.

A 10-week judo-based exercise programme improves physical functions such as balance, strength and falling techniques in working age adults

BACKGROUND

Falls and fall-related injuries are major threats not only for older adults but also for younger age groups such as working-age adults. It has been shown that it is possible to reduce the risk of falls and fall-related injuries, to some extent. However, interventions aiming at reducing both the risk of falls and mitigating fall-related injuries through teaching safe falling techniques are still sparsely investigated. The aim with this study was to investigate the effect of a 10-week workplace-based judo inspired exercise programme (Judo4Balance). The measures in the study include physical functions, fall-related self-efficacy and safe falling techniques.

METHODS

A total of 142 working-age adults participated in this non-randomised controlled study. The participants were allocated to the Judo4Balance group (n = 79), or to a waiting list control group (n = 63). The mean age was 47 years (18-68). The recruitment period was from May 2018 to October 2019. A total of 128 participants were included in the analysis. Logistic Regression models were used to analyse the outcomes: physical function, balance and fall-related self-efficacy as well as falling techniques (backwards and forwards).

RESULTS

At the 10-week follow-up, the results displayed significant differences between the two groups in all measurements, except for the fall-related self-efficacy with OR = 1.8. Techniques for falling forwards and backwards displayed the highest OR = 124.1 and OR = 98.9. Physical function and balance showed OR = 3.3 and OR = 6.4.

CONCLUSIONS

This exercise programme under study displayed significant differences in strength, balance and safe falling techniques between the groups. It is suggested that these functions, which were studied here, can effectively be trained in working-age adults by using the Judo4Balace exercise programme. Thus, it may be beneficial to further investigate and include training in proper falling techniques when designing fall prevention exercise programmes. Furthermore, it may be a novel way of addressing fall-related injuries, which are of utmost importance to prevent in near future.

TRIAL REGISTRATION

NCT04294342 . Registered 4 March 2020 - The Impact of Specifically Adapted Judo-based Training Program on Risk Factors for Falls Among Adults - Full Text View - ClinicalTrials.gov.

Utilization of Safe Fall Landing Strategies in Physical Therapist Management of Geriatric Populations: A Case Report

OBJECTIVE

Safe fall landing strategies (SFLS) have shown promise to decrease injury during falls but have been examined primarily in young, healthy populations. There is emerging evidence to suggest SFLS can be safe and effective for a geriatric population; however, this intervention has not been examined in a clinical physical therapist practice setting. This case study seeks to determine how SFLS can be incorporated into a physical therapy program with a geriatric population.

METHODS (CASE DESCRIPTION)

A 77-year-old woman reported imbalance and inability to return to her previous active lifestyle. Multiple SFLS were implemented during the course of physical therapist management. Controlled fall heights were gradually progressed over the course of therapy.

RESULTS

Gains in Patient Specific Functional Scale score (initial score = 2.5, discharge score = 8), static balance, and ability to perform floor-to-waist lifting were seen following physical therapist intervention that included SFLS. The patient was able to perform a back fall and a front fall from a standing position and reported no adverse side effects throughout the course of physical therapist care.

CONCLUSION

This case report demonstrates how SFLS were safely and pragmatically progressed for 1 patient in a clinical physical therapy setting. SFLS may have the potential to improve patient outcomes and even decrease the risks associated with falls, though further evaluation is needed.

IMPACT

This case report introduces SFLS as an emerging intervention in the clinical physical therapist practice setting. This case report should encourage future research needed to assess the effectiveness and safety of this treatment strategy in physical therapy.

Evaluating a Novel Multifactorial Falls Prevention Activity Programme for Community-Dwelling Older People After Stroke: A Mixed-Method Feasibility Study

Purpose

The overall purpose of this study was to explore participants’ and physiotherapists’ experiences regarding the acceptability, implementation, and practicality of a novel group-based multifactorial falls prevention activity programme for community-dwelling older people after stroke. Specifically, the purpose was to explore if and how participating could impact on the participants’ health-related quality of life (HRQoL) in terms of their daily lived experience regarding physical, mental, emotional and social well-being. A secondary purpose was to explore whether participating in the programme could positively influence participants’ balance, strength, falls efficacy, mobility and motor impairment of the trunk.

Materials and Methods

This was an exploratory mixed-method Phase I feasibility study. A convenience sample of five older community-dwelling people after stroke participated in a novel eight-week multifactorial activity programme which included falls education, a mix of individually tailored and group-based strength and balance exercises, exploring limits of stability and safe landing techniques and a social element. Qualitative data from post-intervention interview transcripts with the participants and the physiotherapists who delivered the programme were thematically analysed using both deductive and inductive approaches to explore the participants’ and therapists’ experiences with the programme. Quantitative outcomes included balance, strength, falls efficacy, mobility and motor impairment of the trunk.

Results

The programme was deemed feasible in terms of acceptability, implementation and practicality by the participants as well as the physiotherapists delivering the programme. The overarching theme regarding HRQoL identified that participating in the programme was perceived to empower the participants living with stroke and positively influenced their daily physical, mental, emotional and social well-being. Participant outcomes showed a change in the direction of improvements in balance, strength, mobility, motor impairment of the trunk and reduced concerns about falling. Subjectively, participants only reported perceived improvements in balance and strength.

Conclusion

Running a novel multifactorial falls prevention activity programme for older community-dwelling people after stroke was feasible. Participating in the programme helped participants to perceive improved balance, strength and empower them to make meaningful changes, improving their daily lived experiences. A future fully powered study could build on these results to investigate physical improvements, prevention of falls and improvements to domains of HRQoOL.

The association between anterior femoroacetabular impingement and femoral neck fractures: An observational study

The impact between acetabulum and femoral neck is another possible mechanism of femoral neck fracture.Direct trauma of the greater trochanter may not be able to fully explain the mechanism underlying femoral neck fracture. In this study, we sought to investigate whether anterior femoroacetabular impingement are associated with femoral neck fractures.A total of 36 patients with femoral neck fracture who had undergone total hip arthroplasty or hemiarthroplasty were included in this study. These patients were divided into 2 groups: labrum tear group and normal labrum group. Patients' age, gender, body mass index, muscle injury, injury pattern, trauma severity, femoral head-neck offset, femoral head-neck ratio, Cam deformity alpha angle, acetabular anteversion, femoral head diameter, acetabular index, cortical index, hip axis length, and neck stem angle were recorded and analyzed. SPSS 18.0 software was used for statistical analyses.According to intraoperative findings, 22 patients exhibited a labrum tear. Magnetic resonance imaging examination revealed bone contusion on the anterolateral margin of the acetabulum with muscle damage surrounding the hip. Among 14 cases without a labrum tear, no bone contusion and obvious muscle injury were found on the anterolateral margin of the acetabulum. Notably, muscle injury, injury pattern, trauma severity and femoral head-neck offset differed significantly (P < .05) between labrum tear and normal labrum groups.Previous studies have focused more on direct lateral trauma. In this study, the impact between acetabulum and femoral neck is another possible mechanism besides lateral impact. Specifically, the abnormal anatomy of the hip, such as femoral head-neck offset, may promote the fracturing process.

Effects of Judo Training on Bones: A Systematic Literature Review

Ciaccioni, S, Condello, G, Guidotti, F, and Capranica, L. Effects of judo training on bones: a systematic literature review. J Strength Cond Res 33(10): 2882-2896, 2019-The aim of this study was to provide a systematic literature review on the osteogenic effects of judo (PROSPERO: CRD42016041803). The online search was conducted according to the inclusion criteria: observational studies and clinical/interventional trials in English from inception to June 2016; bone health, bone mineral density (BMD), diameters, impact force, and bone turnover marker (BTM) outcomes. Thirty-four studies were included and graded for their methodological quality ("fair" quality: 79.4%). The most used assessment method (44.1%) was X-ray absorptiometry. A positive association between judo and bone health/status emerged. Findings support site-specific BMD accrual in children, adolescents, adult athletes, and in premenopausal and postmenopausal female practitioners. Bone turnover markers revealed a hypermetabolic status in high-level judo athletes. The osteogenic stimuli of judo seem to protect athletes from alterations in bone metabolic balance due to weight loss cycling. Sexual dimorphism was found between judoka in bone diameters and mass, and significant differences in bone breadths emerged between elite and nonelite judokas. The fall techniques reduced bone impact force and velocity with respect to "natural" fall. Further longitudinal, cross-sectional, and interventional researches are required. This article provides useful information on bone for health sport scientists, coaches, and practitioners, stimulating future research lines on judo. In particular, coaches and physical trainers should consider introducing judo fall techniques in their training plans to prevent fall-related injuries, especially relevant in the older population. Conversely, coaches are urged to carefully control weight cycling dietary habits of their athletes, which can produce serious metabolic responses on bones.

Age-Related Differences in Head Impact during Experimentally Induced Sideways Falls

Purpose

To examine head impact incidence and head acceleration during experimentally induced falls as a function of age.

Methods

15 young adults (21.2±2.7) and 10 older adults (61.9±4.3 years) underwent 6 experimentally induced sideways falls. Participants fell sideways onto a 20cm crash pad. The number of head impacts was tabulated from video recordings and head acceleration was calculated from motion capture data. A total of 147 falls were analyzed.

Results

The young group underwent 88 falls, in which 11.4% resulted in head impact. The older group underwent 59 falls, in which 34.5% resulted in head impact. A proportion analysis revealed older adults had a significantly greater proportion of head impacts than young adults (X²(1) = 11.445, p = 0.001). A two-way ANOVA only revealed a main effect of head impact on acceleration (F(1,142) = 54.342, p<0.001).

Conclusion

The older adults experienced a greater proportion of head impacts during sideways falls. Head impact resulted in greater head acceleration compared to no head impact. Collectively, this data highlights the possibility that age-related neuromuscular changes to head control may result in elevated risk of fall-related TBIs. Future research examining mechanisms underlying increases in fall-related head impact is warranted.

Preliminary investigation of teaching older adults the tuck-and-roll strategy: Can older adults learn to fall with reduced impact severity

Falls are common and potentially disastrous for older adults. A novel approach that could augment current fall prevention procedures is to teach older adults movement strategies to reduce the risk of injury. The purpose of the study was to determine whether older adults can learn a movement strategy ("tuck-and-roll") that reduces fall impact severity. Learning was quantified with short-term acquisition, bilateral transfer and 1-week-retention. 14 healthy older individuals participated (63.9 ± 5.6 years) in the investigation. Participants were randomly assigned into either training group (n = 7) or active control group (n = 7). All participants performed standardized sideway falls at baseline, immediately post intervention and 1-week-retention tests. During the falling assessments, kinetic and kinematic impact severity parameters were measured. The results for short-term learning revealed that the training group showed greater reduction in hip impact force (33% reduction) than the control group (16% reduction). Furthermore, there was partial bilateral transfer effect and 1-week retention observed in the training group. The observations provide preliminary evidence that teaching tuck-and-roll strategy to older adults has potential effect. The observations provide preliminary evidence that older adults might reduce impact severity utilizing tuck-and-roll strategy during unpredictably-timed sideway falls.

Walking with perturbations: a guide for biped humans and robots

This paper provides an update on the neural control of bipedal walking in relation to bioinspired models and robots. It is argued that most current models or robots are based on the construct of a symmetrical central pattern generator (CPG). However, new evidence suggests that CPG functioning is basically asymmetrical with its flexor half linked more tightly to the rhythm generator. The stability of bipedal gait, which is an important problem for robots and biological systems, is also addressed. While it is not possible to determine how biological biped systems guarantee stability, robot solutions can be useful to propose new hypotheses for biology. In the second part of this review, the focus is on gait perturbations, which is an important topic in robotics in view of the frequent falls of robots when faced with perturbations. From the human physiology it is known that the initial reaction often consists of a brief interruption followed by an adequate response. For instance, the successful recovery from a trip is achieved using some basic reactions (termed elevating and lowering strategies), that depend on the phase of the step cycle of the trip occurrence. Reactions to stepping unexpectedly in a hole depend on comparing expected and real feedback. Implementation of these ideas in models and robotics starts to emerge, with the most advanced robots being able to learn how to fall safely and how to deal with complicated disturbances such as provided by walking on a split-belt.

Exercise Frequency and Fracture Risk in Older Adults-How Often Is Enough?

PURPOSE OF REVIEW

Due to older people's low sports participation rates, exercise frequency may be the most critical component for designing exercise protocols that address fracture risk. The aims of the present article were to review and summarize the independent effect of exercise frequency (ExFreq) on the main determinants of fracture prevention, i.e., bone strength, fall frequency, and fall impact in older adults.

RECENT FINDINGS

Evidence collected last year suggests that there is a critical dose of ExFreq that just affects bone (i.e., BMD). Corresponding data for fall-related fracture risk are still sparse and inconsistent, however. The minimum effective dose (MED) of ExFreq that just favorably affects BMD at the lumbar spine and femoral neck has been found to vary between 2.1 and 2.5 sessions/week. Although this MED cannot necessarily be generalized to other cohorts, we speculate that this "critical exercise frequency" might not significantly vary among adult cohorts.

Sideways fall-induced impact force and its effect on hip fracture risk: a review

Osteoporotic hip fracture, mostly induced in falls among the elderly, is a major health burden over the world. The impact force applied to the hip is an important factor in determining the risk of hip fracture. However, biomechanical researches have yielded conflicting conclusions about whether the fall-induced impact force can be accurately predicted by the available models. It also has been debated whether or not the effect of impact force has been considered appropriately in hip fracture risk assessment tools. This study aimed to provide a state-of-the-art review of the available methods for predicting the impact force, investigate their strengths/limitations, and suggest further improvements in modeling of human body falling.

METHODS

We divided the effective parameters on impact force to two categories: (1) the parameters that can be determined subject-specifically and (2) the parameters that may significantly vary from fall to fall for an individual and cannot be considered subject-specifically.

RESULTS

The parameters in the first category can be investigated in human body fall experiments. Video capture of real-life falls was reported as a valuable method to investigate the parameters in the second category that significantly affect the impact force and cannot be determined in human body fall experiments.

CONCLUSIONS

The analysis of the gathered data revealed that there is a need to develop modified biomechanical models for more accurate prediction of the impact force and appropriately adopt them in hip fracture risk assessment tools in order to achieve a better precision in identifying high-risk patients. Graphical abstract Impact force to the hip induced in sideways falls is affected by many parameters and may remarkably vary from subject to subject.

Falling upward with Parkinson's disease

Falls can injure, even kill. No one with Parkinson’s disease (PD) wants to fall by accident. However, the potential nastiness of falls does not preclude a more nuanced understanding of the personal meaning that falls can have. Rather than view falls as a problem to fear and manage solely by preventing and repairing harm, people with PD and those who care for them may recast falls as a mixed blessing. Falls may be a resource, skill, and catalyst for personal growth. We discuss how falls may give rise to opportunities in interrelated domains: capabilities, credo, character, creativity, chronemics, and connectedness. Clinicians could incorporate a positive focus across these domains to help people with PD to ‘fall upward’ in the sense of flourish.

[Practice of martial arts and bone mineral density in adolescents of both sexes]

OBJECTIVE

The purpose of this study was to analyze the relationship between martial arts practice (judo, karate and kung-fu) and bone mineral density in adolescents.

METHODS

The study was composed of 138 (48 martial arts practitioners and 90 non-practitioners) adolescents of both sexes, with an average age of 12.6 years. Bone mineral density was measured using Dual-Energy X-ray Absorptiometry in arms, legs, spine, trunk, pelvis and total. Weekly training load and previous time of engagement in the sport modality were reported by the coach. Partial correlation tested the association between weekly training load and bone mineral density, controlled by sex, chronological age, previous practice and somatic maturation. Analysis of covariance was used to compare bone mineral density values according to control and martial arts groups, controlled by sex, chronological age, previous practice and somatic maturation. Significant relationships between bone mineral density and muscle mass were inserted into a multivariate model and the slopes of the models were compared using the Student t test (control versus martial art).

RESULTS

Adolescents engaged in judo practice presented higher values of bone mineral density than the control individuals (p-value=0.042; Medium Effect size [Eta-squared=0.063]), while the relationship between quantity of weekly training and bone mineral density was significant among adolescents engaged in judo (arms [r=0.308] and legs [r=0.223]) and kung-fu (arms [r=0.248] and spine [r=0.228]).

CONCLUSIONS

Different modalities of martial arts are related to higher bone mineral density in different body regions among adolescents.

Long-Term Exercise and Bone Mineral Density Changes in Postmenopausal Women--Are There Periods of Reduced Effectiveness?

There is increasing evidence that physical exercise can prevent fractures in postmenopausal women. However, even with careful adaptation of the exercise program to subjects' changing bone, health, and fitness status, effectivity may still decrease over the time. This could be specifically the case where the limitations of higher age collide with the specification of the exercise program. Thus, the aim of this study was to monitor bone mineral density (BMD) changes over a 16-year period of supervised exercise. Our hypothesis was that BMD differences at lumbar spine (LS) and femoral neck (FN) between exercisers (EG) and nontraining controls (CG) increased throughout the intervention with significant differences for each of the four 4-year observation periods. Sixty-seven (EG, n = 39 versus CG, n = 28) initially early-postmenopausal osteopenic women of the Erlangen Fitness and Osteoporosis Prevention Study (EFOPS) with complete BMD data sets for baseline (1998) and 4-, 8-, 12-, and 16-year follow-up were included in the analysis. The exercise protocol initially focused on a high-intensity strategy that addressed bone but increasingly shifted to a more comprehensive intervention. LS-BMD differences between the EG and CG continuously increased (year 4: 2.4% (95%- Confidence Interval 1.0% to 3.8%), year 8: 3.1% (1.6% to 4.7%), year 12: 3.9% (1.9% to 5.8), year 16: 4.5% (2.5% to 6.6%). Correspondingly, rising differences for FN-BMD (0.9% (-0.2% to 2.1%) versus 1.9% (0.4% to 3.3%) versus 2.0% (0.5% to 3.8%) versus 3.0% (1.0% to 5.0%)) were observed. However, in contrast to our hypothesis, group differences within the four 4-year periods were not consistently significant (LS, p = 0.001 to 0.097; FN, p = 0.026 to 0.673); further, BMD kinetics among the groups varied between LS and FN. Of particular importance, significant differences (p ≤ 0.030) for both regions were still found in the final period. We conclude that exercise-even when adapted for subjects' decreasing bone, health, and fitness status-is consistently effective in favorably affecting BMD in (initially) early-postmenopausal osteopenic women without any leveling-off effect after 16 years of exercise.

Development and Process Evaluation of a 5-Week Exercise Program to Prevent Falls in People after Stroke: The FALLS Program

Falls are a common complication after stroke, with balance and gait deficits being the most important risk factors. Taking into account the specific needs and capacities of people with stroke, we developed the FALLS program (FALL prevention after Stroke), based on the “Nijmegen falls prevention program” (a proven-effective 5-week exercise program designed for community-dwelling elderly people). The program was tested in twelve community-dwelling persons with stroke, and a process evaluation was conducted with patients, trainers, health care professionals, and managers. The FALLS program was considered suitable and feasible by people with stroke in the study and relevant health care professionals, and recommendations for implementation in clinical practice have been suggested.

Physical activity and hip fracture disability: a review

Objective. The present paper examines pertinent literature sources published in the peer-reviewed English language between 1980 and November 1, 2010 concerning hip fractures. The aim was to highlight potential intervention points to offset the risk of incurring a hip fracture and its attendant disability. Methods. An in-depth search of the literature using the key terms: disability, epidemiology, hip fracture, prevention, and risk factors was conducted, along with data from the author's research base detailing the disability associated with selected hip fracture cases. All articles that dealt with these key topics were reviewed, and relevant data were tabulated and analyzed. Results. Hip fractures remain an important but potentially preventable public health problem. Among the many related remediable risk factors, low physical activity levels are especially important. Related determinants of suboptimal neuromuscular function also contribute significantly to hip fracture disability. Conclusion. Physical activity participation can help to reduce the prevalence and excess disability of hip fractures and should be encouraged.

Effect of adapted karate training on quality of life and body balance in 50-year-old men

BACKGROUND

Aging is associated with a decrease in physical skills, sometimes accompanied by a change in quality of life (QOL). Long-term martial arts practice has been proposed as an avenue to counter these deleterious effects. The general purpose of this pilot study was to identify the effects of an adapted karate training program on QOL, depression, and motor skills in 50-year-old men.

METHODS AND DESIGN

Fifteen 50-year-old men were enrolled in a one-year prospective experiment. Participants practiced adapted karate training for 90 minutes three times a week. Testing sessions, involving completion of the MOS 36-item Short Form Health Survey (SF36) and Beck Depression Inventory, as well as motor and effort evaluation, were done at baseline, and six and 12 months.

RESULTS

Compared with baseline, participants had better Beck Depression Inventory scores after one year of karate training (P < 0.01) and better perception of their physical health (P < 0.01), but not on the mental dimension (P < 0.49). They also improved their reaction time scores for the nondominant hand and sway parameters in the eyes-closed position (P < 0.01).

CONCLUSION

Regular long-term karate practice had favorable effects on mood, perception of physical health confirmed by better postural control, and improved performance on objective physical testing. Adapted karate training would be an interesting option for maintaining physical activity in aging.

Could martial arts fall training be safe for persons with osteoporosis?: a feasibility study

Background

Osteoporosis is a well-established risk factor for fall-related hip fractures. Training fall arrest strategies, such as martial arts (MA) fall techniques, might be useful to prevent hip fractures in persons with osteoporosis, provided that the training itself is safe. This study was conducted to determine whether MA fall training would be safe for persons with osteoporosis extrapolated from the data of young adults and using stringent safety criteria.

Methods

Young adults performed sideways and forward MA falls from a kneeling position on both a judo mat and a mattress as well as from a standing position on a mattress. Hip impact forces and kinematic data were collected. For each condition, the highest hip impact force was compared with two safety criteria based on the femoral fracture load and the use of a hip protector.

Results

The highest hip impact force during the various fall conditions ranged between 1426 N and 3132 N. Sideways falls from a kneeling and standing position met the safety criteria if performed on the mattress (max 1426 N and 2012 N, respectively) but not if the falls from a kneeling position were performed on the judo mat (max 2219 N). Forward falls only met the safety criteria if performed from a kneeling position on the mattress (max 2006 N). Hence, forward falls from kneeling position on a judo mat (max 2474 N) and forward falls from standing position on the mattress (max 3132 N) did not meet both safety criteria.

Conclusions

Based on the data of young adults and safety criteria, the MA fall training was expected to be safe for persons with osteoporosis if appropriate safety measures are taken: during the training persons with osteoporosis should wear hip protectors that could attenuate the maximum hip impact force by at least 65%, perform the fall exercises on a thick mattress, and avoid forward fall exercises from a standing position. Hence, a modified MA fall training might be useful to reduce hip fracture risk in persons with osteoporosis.

Age differences in energy absorption in the upper extremity during a descent movement: implications for arresting a fall

BACKGROUND

Falls are the number one cause of unintentional injury in older adults. The protective response of "breaking the fall" with the outstretched hand is often essential for avoiding injury to the hip and head. In this study, we compared the ability of young and older women to absorb the impact energy of a fall in the outstretched arms.

METHODS

Twenty young (mean age = 21 years) and 20 older (M = 78 years) women were instructed to slowly lower their body weight, similar to the descent phase of a push-up, from body lean angles ranging from 15 degrees to 90 degrees . Measures were acquired of peak upper extremity energy absorption, arm deflection, and hand contact force.

RESULTS

On average, older women were able to absorb 45% less energy in the dominant arm than young women (1.7 +/- 0.5% vs 3.1 +/- 0.4% of their body weight x body height; p < .001). These results suggest that, even when both arms participate equally, the average energy content of a forward fall exceeds by 5-fold the average energy that our older participants could absorb and exceeds by 2.7-fold the average energy that young participants could absorb.

CONCLUSIONS

During a descent movement that simulates fall arrest, the energy-absorbing capacity of the upper extremities in older women is nearly half that of young women. Absorbing the full energy of a fall in the upper extremities is a challenging task even for healthy young women. Strengthening of upper extremity muscles should enhance this ability and presumably reduce the risk for injury to the hip and head during a fall.