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Salihu AT, Hill KD, Jaberzadeh S. Age and Type of Task-Based Impact of Mental Fatigue on Balance: Systematic Review and Meta-Analysis. J Mot Behav 2024; 56:373-391. [PMID: 38189442 DOI: 10.1080/00222895.2023.2299706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
The role of cognition in balance control suggests that mental fatigue may negatively affect balance. However, cognitive involvement in balance control varies with the type or difficulty of the balance task and age. Steady-state balance tasks, such as quiet standing, are well-learned tasks executed automatically through reflex activities controlled by the brainstem and spinal cord. In contrast, novel, and challenging balance tasks, such as proactively controlling balance while walking over rugged terrain or reacting to unexpected external perturbations, may require cognitive processing. Furthermore, individuals with preexisting balance impairments due to aging or pathology may rely on cognitive processes to control balance in most circumstances. This systematic review and meta-analysis investigated the effect of mental fatigue on different types of balance control tasks in young and older adults. A literature search was conducted in seven electronic databases and 12 studies met eligibility criteria. The results indicated that mental fatigue had a negative impact on both proactive (under increased cognitive load) and reactive balance in young adults. In older adults, mental fatigue affected steady-state and proactive balance. Therefore, mentally fatigued older individuals may be at increased risk of a loss of balance during steady-state balance task compared to their younger counterparts.
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Affiliation(s)
- Abubakar Tijjani Salihu
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Shapour Jaberzadeh
- Monash Neuromodulation Research Unit, Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
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Alenazi AM, Alanazi MF, Elnaggar RK, Alshehri MM, Alqahtani BA, Alhowimel AS, Alhwoaimel NA, Alanazi AD, Alotaibi MA, Almutairi SM, Alghamdi MS, Bindawas SM. Prevalence and risk factors for falls among community-dwelling adults in Riyadh area. PeerJ 2023; 11:e16478. [PMID: 38077414 PMCID: PMC10710170 DOI: 10.7717/peerj.16478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Objectives This study aimed to assess fall prevalence, identify related risk factors, and establish cut-off scores for fall risk measures among community-dwelling adults in Riyadh region of Saudi Arabia. Methods A cross-sectional study was conducted in community, Riyadh city, Saudi Arabia. A sample of 276 Saudi citizens aged ≥40 years who were able to read and write in Arabic. Fall history and number of falls in the past 12 months were determined via self-reports. Variables assessed included demographic information, self-reported chronic diseases, depressive symptoms, and back pain severity. Results Participants were classified as either fallers (n = 28, 10.14%) or non-fallers. Fallers were more likely to have arthritis (odds ratio [OR]: 7.60, p = 0.001), back pain (OR: 5.22, p = 0.002), and higher depressive symptom scores (OR: 1.09, p = 0.013) than non-fallers. The number of reported falls was significantly associated with an elevated body mass index (incidence rate ratio [IRR]: 1.09, p = 0.045), arthritis (IRR: 8.74, p < 0.001), back pain (IRR: 4.08, p = 0.005), neurological diseases (IRR: 13.75, p < 0.007), and depressive symptoms (IRR: 1.08, p = 0.005). Cut-off scores predictive of falls associated with back pain and depressive symptoms were 1.5 (sensitivity: 0.61; specificity: 0.79; area under the curve [AUC]: 0.70) and 11.5 score (sensitivity: 0.57; specificity: 0.76; AUC: 0.66), respectively. Conclusions The prevalence of falls was relatively low among the individuals considered in this study. Chronic conditions, back pain severity, and depressive symptoms were determined to be associated with falls among community-dwelling individuals in Saudi Arabia.
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Affiliation(s)
- Aqeel M. Alenazi
- Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Riyadh, Saudi Arabia
| | - Maram F. Alanazi
- Occupational Therapy, Sydney University, Sydney, New South Wales, Australia
| | - Ragab K. Elnaggar
- Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Riyadh, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Cairo University, Cairo, Giza, Egypt
| | | | - Bader A. Alqahtani
- Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Riyadh, Saudi Arabia
| | - Ahmed S. Alhowimel
- Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Riyadh, Saudi Arabia
| | - Norah A. Alhwoaimel
- Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Riyadh, Saudi Arabia
| | - Ahmad D. Alanazi
- Department of Rehabilitation Science, Majmaah University, Majmaah, Riyadh, Saudi Arabia
| | - Mazyad A. Alotaibi
- Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Riyadh, Saudi Arabia
| | - Sattam M. Almutairi
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah, Qassim, Saudi Arabia
| | - Mohammed S. Alghamdi
- Department of Medical Rehabilitation Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Saad M. Bindawas
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
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Wang M, Wu F, Callisaya ML, Jones G, Winzenberg TM. Longitudinal associations of objectively measured physical activity and sedentary time with leg muscle strength, balance and falls in middle-aged women. Eur J Sport Sci 2023; 23:2240-2250. [PMID: 37272369 DOI: 10.1080/17461391.2023.2222096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We examined the longitudinal associations of accelerometer-measured physical activity and sedentary time with leg muscle strength (LMS), balance, and falls in middle-aged women. This was a 5-year cohort study among 308 women aged 36-56 years. We used linear mixed-effects models to examine associations of baseline and change in accelerometer-measured sedentary time, light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) with baseline and 5-year change in LMS and balance (timed up and go test [TUG], functional reach test [FRT], lateral reach test [LRT], and step test [ST]), and negative binomial/Poisson and log-binomial regression as appropriate to assess associations with falls after 5-year follow-up. Greater baseline MVPA was associated with better baseline LMS (β = 4.65 kg/SD, 95% CI: 1.37, 7.93) and TUG (β = -0.09 s/SD, 95% CI: -0.18, -0.01) but not with change in them over 5 years. Baseline MVPA was not associated with FRT at baseline but associated with a greater decrease in FRT (β = -0.87 cm/SD, 95% CI: -1.57, -0.17). Increased MVPA over 5 years was associated with less deterioration in FRT (β = 0.88 cm/SD, 95% CI: 0.14, 1.61). Increased sedentary time over 5 years was associated with a larger decrease in FRT (β = -0.82 cm/SD, 95% CI: -1.58, -0.07). Higher baseline LPA was associated with higher falls risk (IRR = 1.27, 95% CI: 1.02, 1.57). Higher baseline MVPA may benefit LMS and balance, while increasing MVPA in the medium term has little effect on change in these outcomes in mid-life. Detrimental association of LPA with falls may be due to greater exposures to environmental hazards.HighlightsOur study for the first time examined the longitudinal associations of objectively measured physical activity and sedentary time with leg muscle strength, balance and falls in middle-aged women.Higher baseline moderate-to-vigorous physical activity (MVPA) may be beneficial for muscle strength and balance at baseline but increasing MVPA in the medium term has little effect on change in LMS or balance outcomes in middle-aged women.Higher baseline light physical activity (LPA) was associated with an increased risk of falls.The detrimental association of LPA with falls may be due to a greater exposure to environmental hazards in midlife, which needs to be clarified in future research.
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Affiliation(s)
- Mengmeng Wang
- School of Public Health, Anhui Medical University, Hefei, People's Republic of China
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Peninsula Clinical School, Central Clinical School, Monash University, Clayton, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Tania M Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
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Kazanski ME, Cusumano JP, Dingwell JB. Rethinking margin of stability: Incorporating step-to-step regulation to resolve the paradox. J Biomech 2022; 144:111334. [PMID: 36244320 PMCID: PMC10474615 DOI: 10.1016/j.jbiomech.2022.111334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/04/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022]
Abstract
Derived from inverted pendulum dynamics, mediolateral Margin of Stability (MoSML) is a mechanically-grounded measure of instantaneous frontal-plane stability. However, average MoSML measures yield paradoxical results. Gait pathologies or perturbations often induce larger (supposedly "more stable") average MoSML, despite clearly destabilizing factors. However, people do not walk "on average" - they walk (and sometimes lose balance) one step at a time. We assert the paradox arises because averaging MoSML discards crucial step-to-step dynamics. We present a framework unifying the inverted pendulum with Goal-Equivalent Manifold (GEM) analyses. We identify in the pendulum's center-of-mass dynamics constant-MoSML manifolds, including one candidate "stability GEM" signifying the goal to maintain some constant MoSML∗. We used this framework to assess step-to-step MoSML dynamics of humans walking in destabilizing environments. While goal-relevant deviations were readily corrected, people did not exploit equifinality by allowing deviations to persist along this GEM. Thus, maintaining a constant MoSML∗ is inconsistent with observed step-to-step fluctuations in center-of-mass states. Conversely, the extent to which participants regulated fluctuations in mediolateral foot placements strongly predicted their regulation of center-of-mass fluctuations. Thus, center-of-mass dynamics may arise indirectly as a consequence of regulating mediolateral foot placements. To help resolve the paradox caused by averaging MoSML, we present a new statistic, Probability of Instability (PoIL), used here to predict lateral instability likelihood. Participants exhibited increased PoIL when destabilized (p = 9.45 × 10-34), despite exhibiting larger ("more stable") average MoSML (p = 1.70 × 10-15). Thus, PoIL correctly captured people's increased risk of losing lateral balance, whereas average MoSML did not. PoIL also helps explain why people's average MoSML increased in destabilizing contexts.
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Affiliation(s)
- Meghan E Kazanski
- Department of Kinesiology, Pennsylvania State University, University Park, PA 16802, USA.
| | - Joseph P Cusumano
- Department of Engineering Science & Mechanics, Pennsylvania State University, University Park, PA 16802, USA
| | - Jonathan B Dingwell
- Department of Kinesiology, Pennsylvania State University, University Park, PA 16802, USA
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Arphorn S, Ishimaru T, Lertvarayut T, Kiatkitroj K, Theppitak C, Manothum A, Hara K. Risk factors for occupational falls among middle-aged and elderly farm workers in Nan province, Thailand. J Agromedicine 2022; 27:402-408. [DOI: 10.1080/1059924x.2022.2040071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sara Arphorn
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Center of Excellence on Environmental Health and Toxicology, Bangkok, Thailand
| | - Tomohiro Ishimaru
- Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Teepapipat Lertvarayut
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Public Health, Faculty of Physical Education, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Kanpitcha Kiatkitroj
- Department of Occupational Health and Safety, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Program of Occupational Health and Safety, Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
| | - Chalermsiri Theppitak
- Institute of Public Health, Suranaree University of Technology, Nakhon Ratchasima, Thailand
| | - Aniruth Manothum
- Faculty of Industrial Technology, Lampang Rajabhat University, Lampang, Thailand
| | - Kunio Hara
- Department of Occupational Safety and Health Management, School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu, Japan
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Pettersson B, Bajraktari S, Skelton DA, Zingmark M, Rosendahl E, Lundin-Olsson L, Sandlund M. Recruitment strategies and reach of a digital fall-prevention intervention for community-dwelling older adults. Digit Health 2022; 8:20552076221126050. [PMID: 36118253 PMCID: PMC9478742 DOI: 10.1177/20552076221126050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background To have an impact on the population's health, preventive interventions have
to reach a large proportion of the intended population. Digital solutions
show potential for providing wider access to fall preventive exercise.
However, there is a lack of knowledge about how to reach the target group.
The aim of this study was to describe the recruitment process used in the
Safe Step randomised controlled trial and the characteristics of the
participants reached. Methods Several recruitment methods, both digital and non-digital, were adopted to
reach the intended sample size. Sociodemographic parameters from the
baseline questionnaire were used to describe participant characteristics.
The characteristics were also compared to a representative sample of older
adults in the Swedish population. Results In total, 1628 older adults were recruited. Social media proved to be the
most successful recruitment strategy, through which 76% of the participants
were recruited. The participants reached had a mean age of 75.9 years, lived
in both urban and rural locations, were already frequent users of the
Internet and applications (smartphone/tablet) (79.9%), had higher education
(71.9%), and a large proportion were women (79.4%). In comparison with the
general population participants in the Safe Step study were more highly
educated (p < 0.001), women in the study more frequently
lived alone (p < 0.001) and men more often reported
poorer self-rated health (p = 0.04). Within the study, men
reported a faster deteriorating balance (p = 0.003) and
more prescribed medication (p < 0.001) than women. Conclusion Recruitment via social media is a useful strategy for reaching older adults,
especially women and frequent users of the Internet, for a fully
self-managed and digital fall prevention exercise intervention. This study
underlines that a range of interventions must be available to attract and
suit older adults with different functional statuses and digital skills.
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Affiliation(s)
- Beatrice Pettersson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Saranda Bajraktari
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Magnus Zingmark
- Municipality of Östersund, Health and Social Care Administration, Östersund, Sweden
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Erik Rosendahl
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Lillemor Lundin-Olsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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Rathnayake N, Lekamwasam S. Prevalence and factors associated with recurrent falls among middle-aged community-dwelling women. J Frailty Sarcopenia Falls 2021; 6:92-97. [PMID: 34557608 PMCID: PMC8419846 DOI: 10.22540/jfsf-06-092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 11/03/2022] Open
Abstract
Objective This community-based study evaluated the prevalence and associated risk factors of recurrent falls among middle-aged community-dwelling women in Southern-Sri Lanka. Methods Randomly selected 285 middle-aged women (40-60years, Mean±SD;51.7±6.1years) participated. History of falls within the previous 12-months was inquired and those who reported two or more falls within 6-month period were considered as recurrent fallers. Age, menopausal status, weight (kg), height (m), waist-circumference (WC, cm), appendicular-skeletal-muscle-mass (ASMM, kg by DXA), hand-grip-strength (HGS, kg) and gait-speed (GS, m/s) were evaluated. Body-mass-index (BMI, kg/m2) and relative-ASMM-index (RSMI, kg/m2) were calculated. Results The prevalence of recurrent falls was 13% (95%CI; 9.4%-17.5%) (n=37). Recurrent falls were higher among postmenopausal women compared to premenopausal women, older middle-aged women (51-60years) compared to young middle-aged women (40-50years), those with low RSMI compared to normal RSMI, low HGS compared to normal HGS and low GS compared to normal GS (p<0.01). BMI and WC did not show significant associations with recurrent falls. Risk factors associated with recurrent falls were age (OR;7.41, 95%CI; 1.23-44.43, p=0.02), RSMI (OR;3.21, 95%CI; 1.00-10.32, p=0.04) and HGS (OR;3.19, 95%CI; 1.26-8.09, p=0.01). Conclusions The prevalence of falls among middle-aged women was considerably high. Falls were associated with advanced age, low muscle mass and muscle strength.
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Affiliation(s)
- Nirmala Rathnayake
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Sri Lanka
| | - Sarath Lekamwasam
- Population Health Research Centre, Department of Medicine, Faculty of Medicine, University of Ruhuna, Sri Lanka
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Wang M, Wu F, Callisaya ML, Jones G, Winzenberg TM. Neither leg muscle strength nor balance are associated with the incidence of falls in middle-aged women: A 5-year population-based prospective study. J Gerontol A Biol Sci Med Sci 2021; 76:e187-e193. [PMID: 33929494 DOI: 10.1093/gerona/glab122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Muscle strength and balance are major modifiable factors of falls in older adults, but their associations with falls in middle-aged adults are under investigated. We aimed to examine the association of baseline and change in leg muscle strength (LMS) and balance with the incidence of falls in a cohort of middle-aged women. METHODS This was a five-year follow-up of a population-based sample of 273 women aged 36-57 years at baseline (2011-2012). Data on LMS (by dynamometer) and balance (timed up and go test [TUG], step test [ST], functional reach test [FRT], and lateral reach test [LRT]) were obtained at baseline and five years later (2017-2018). After five years, falls were recorded monthly for one year by questionnaire (2017-2019). Negative binomial/Poisson and log binomial regressions were used as appropriate to assess associations of baseline and change in LMS and balance with any falls, injurious falls and multiple falls. RESULTS Over one-year, 115 participants (42%) reported at least one fall. Neither baseline nor 5-year change in LMS and balance measures were associated with the risk of any falls, injurious falls, or multiple falls five years later, with or without adjusting for confounders at baseline (incidence rate ratio/relative risk ranging from 0.85 to 1.19, 0.90 to 1.20, and 0.82 to 1.36, respectively; P>0.05 for all). CONCLUSIONS Baseline or change in LMS and balance measures are not associated with incident falls among middle-aged women. The contributions of environmental and other intrinsic factors such as chronic conditions and gait/mobility problems need to be investigated.
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Affiliation(s)
- Mengmeng Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Michele L Callisaya
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Tania M Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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