Age-related relative increases in electromyography activity and torque according to the maximal capacity during upright standing

Influence of complexity of the task and the level of physical activity in the association between the muscular function and posture of older adults

INTRODUCTION

Postural control involves the coordination of muscle synergies of lower limb for the performance of postural strategies. However, the relationship between muscle function and postural control of older adults with different levels of physical activity has not yet been fully elucidated. The aim of this study was to analyze the influence of muscle function of lower limb on postural control in tasks with disturbance in the visual and somatosensory systems of older adults with different levels of physical activity.

METHODS

61 older adults participated in this study. The assessment of postural control was performed using posturography in tasks with visual and somatosensory systems disturbance. To assess peak torque and mean power of the lower limb, an isokinetic dynamometer was used. A regression test was performed to investigate the association between muscle function and posture. The regression model was adjusted for the level of physical activity.

RESULTS

The complexity of the task and level of physical activity influenced the association between muscle function and postural control. The conditions that involved simultaneous disturbance in the visual and somatosensory systems were the ones that showed the greatest combination of associations, regardless of the stance type.

CONCLUSION

The ability to produce ankle and hip muscle power seems to be crucial for the postural control of the older adults in tasks that involve reducing the base of support associated with disturbances in the visual and somatosensory system. Physical activity programs for older adults should include strength and power training for the ankle, knee, and hip muscles, with emphasis on hip abductors.

Knee Angle Estimation from Surface EMG during Walking Using Attention-Based Deep Recurrent Neural Networks: Feasibility and Initial Demonstration in Cerebral Palsy

Accurately estimating knee joint angle during walking from surface electromyography (sEMG) signals can enable more natural control of wearable robotics like exoskeletons. However, challenges exist due to variability across individuals and sessions. This study evaluates an attention-based deep recurrent neural network combining gated recurrent units (GRUs) and an attention mechanism (AM) for knee angle estimation. Three experiments were conducted. First, the GRU-AM model was tested on four healthy adolescents, demonstrating improved estimation compared to GRU alone. A sensitivity analysis revealed that the key contributing muscles were the knee flexor and extensors, highlighting the ability of the AM to focus on the most salient inputs. Second, transfer learning was shown by pretraining the model on an open source dataset before additional training and testing on the four adolescents. Third, the model was progressively adapted over three sessions for one child with cerebral palsy (CP). The GRU-AM model demonstrated robust knee angle estimation across participants with healthy participants (mean RMSE 7 degrees) and participants with CP (RMSE 37 degrees). Further, estimation accuracy improved by 14 degrees on average across successive sessions of walking in the child with CP. These results demonstrate the feasibility of using attention-based deep networks for joint angle estimation in adolescents and clinical populations and support their further development for deployment in wearable robotics.

Neuromechanical characterization of the abductor hallucis and its potential role in upright postural control

There is growing evidence to support a role for the abductor hallucis (AH) in standing balance control; however, functional properties of the muscle that may provide more insight into AH's specific contribution to upright posture have yet to be characterized. This study was conducted to quantify functional neuromechanical properties of the AH and correlate the measures with standing balance variables. We quantified strength and voluntary activation during maximal voluntary isometric contractions of the great toe abductor in nine (3 females and 6 males) healthy, young participants. During electrically evoked twitch and tetanic contractions, we measured great toe abduction peak force and constructed a force-frequency curve. We also evaluated peak abduction force, contraction time (CT), half-relaxation time (HRT), rate of force development (RFD), and relaxation rate (RR) from twitch contractions evoked using doublet stimuli. Strength, VA, CT, HRT, RFD, and RR were correlated to centre of pressure standard deviation (COP SD) and velocity (COP VEL) variables of the traditional COP trace and its rambling and trembling components during single-legged stance. AH twitch properties (e.g., CT: 169.8 ± 32.3 ms; HRT: 124.1 ± 29.2 ms) and force-frequency curve were similar to other slow contractile muscles. Contractile speed related negatively with COP VEL, suggesting AH may be appropriate for slow, prolonged tasks such as ongoing postural balance control. Correlation coefficient outcomes for all variables were similar between rambling and trembling components. Our results provide further evidence for the importance of AH neuromechanical function for standing balance control, at least during a challenging single-legged posture.

Anticipatory postural control in adaptation of goal-directed lower extremity movements

Skilled football players can adapt their kicking movements depending on external environments. Predictive postural control movements, known as anticipatory postural adjustments (APAs), are needed preceding kicking movements to precisely control them while maintaining a standing posture only with the support leg. We aimed to clarify APAs of the support leg in the process of adaptation of goal-directed movements with the lower limb. Participants replicated ball-kicking movements such that they reached a cursor, representing a kicking-foot position towards a forward target while standing with the support leg. APAs were observed as the centre of pressure of the support leg shifted approximately 300 ms in advance of the onset of movement of the kicking foot. When the cursor trajectory of the kicking foot was visually rotated during the task, the kicking-foot movement was gradually modified to reach the target, indicating adaptation to the novel visuomotor environment. Interestingly, APAs in the mediolateral direction were also altered following the change in kicking-foot movements. Additionally, the APAs modified more slowly than the kicking-foot movements. These results suggest that flexible changes in predictive postural control might support the adaptation of goal-directed movements of the lower limb.

Training Postural Balance Control with Pelvic Force Field at the Boundary of Stability

This study characterizes the effects of a postural training program on balance and muscle control strategies in a virtual reality (VR) environment. The Robotic Upright Stand Trainer (RobUST), which applies perturbative forces on the trunk and assistive forces on the pelvis, was used to deliver perturbation-based balance training (PBT) in a sample of 10 healthy participants. The VR task consisted of catching, aiming, and throwing a ball at a target. All participants received trunk perturbations during the VR task with forces tailored to the participant's maximum tolerance. A subgroup of these participants additionally received assistive forces at the pelvis during training. Postural kinematics were calculated before and after RobUST training, including (i) maximum perturbation force tolerated, (ii) center of pressure (COP) and pelvic excursions, (iii) postural muscle activations (EMG), and (iv) postural control strategies (the ankle and hip strategies). We observed an improvement in the maximum perturbation force and postural stability area in both groups and decreases in muscle activity. The behavior of the two groups differed for perturbations in the posterior direction where the unassisted group moved towards greater use of the hip strategy. In addition, the assisted group changed towards a lower margin of stability and higher pelvic excursion. We show that training with force assistance leads to a reactive balance strategy that permits pelvic excursion but that is efficient at restoring balance from displaced positions while training without assistance leads to reactive balance strategies that restrain pelvic excursion. Patient populations can benefit from a platform that encourages greater use of their range of motion.

Influence of Concurrent Exercise Training on Ankle Muscle Activation during Static and Proactive Postural Control on Older Adults with Sarcopenic Obesity: A Multicenter, Randomized, and Controlled Trial

Sarcopenic obesity (SO), characterized by age-related muscle loss and excess body fat, significantly impairs postural control. However, limited research has explored the effects of concurrent exercise training on neuromuscular strategies during postural control in older adults with SO. The study enrolled 50 older adults with SO, split into an intervention group (IG, n = 25, mean age = 76.1 ± 3.5 years; mean BMI = 34.4 ± 4.0 kg/m2) and a control group (CG, n = 25, mean age = 75.9 ± 5.4 years; mean BMI = 32.9 ± 2.3 kg/m2). Participants in the IG were engaged in 60-min Total Mobility Plus Program (TMP) sessions three times a week for four months, while the CG maintained their typical daily activities. Standardized evaluations were conducted both before and after the intervention. These assessments included the Romberg and Timed Up and Go (TUG) tests, as well as the measurement of Center of Pressure (CoP) displacements parameters under various conditions. Additionally, ankle muscle activities were quantified during postural control evaluations and maximal voluntary contractions of plantar and dorsal flexors. Post-intervention results revealed a significant reduction of the standing time measured in the Romberg (-15.6%, p < 0.005) and TUG (-34.6%, p < 0.05) tests. Additionally, CoP area and velocity were notably reduced in various conditions (p < 0.05). Postural control improvements were associated with an increase of strength (p < 0.05) and decrease of ankle muscle activation (p < 0.05). These findings highlight the reversibility of neuromuscular system alterations associated with the synergistic effects of sarcopenia and obesity, emphasizing the trainability of postural control regulation within this population. By incorporating these insights into clinical practice and public health strategies, it seems possible to optimize the health and well-being of older adults with SO.

Attention-Based Deep Recurrent Neural Network to Estimate Knee Angle During Walking from Lower-Limb EMG

Accurate prediction of joint angle during walking from surface electromyography (sEMG) offers the potential to infer movement intention and therefore represents a potentially useful approach for adaptive control of wearable robotics. Here, we present the use of a recurrent neural network (RNN) with gated recurrent units (GRUs) and an attention mechanism to estimate knee angle during overground walking from sEMG and its initial offline validation in healthy adolescents. Our results show that the attention mechanism improved estimation accuracy by focusing on the most relevant parts of the input dataset within each time window, particularly muscles active during knee excursion. Sensitivity analysis revealed knee extensor and flexor muscles to be most salient in accurately estimating joint angle. Additionally, we demonstrate the ability of the GRU-RNN approach to accurately estimate knee angle during overground walking in a child with cerebral palsy (CP) in the presence of exoskeleton knee extension assistance. Collectively, our findings establish the initial feasibility of using this approach to estimate user movement from sEMG, which is particularly important for developing robotic exoskeletons for children with neuromuscular disorders such as CP.

Age-specific biomechanical challenges and engagement in dynamic balance training with robotic or virtual real-time visual feedback

Challenging balance training that targets age-related neuromuscular and motor coordination deficits is needed for effective fall prevention therapy. Goal-directed training can provide intrinsically motivating balance activities but may not equally challenge balance for all age groups. Therefore, the purpose of this research was to quantify age-specific effects of dynamic balance training with real-time visual feedback. Kinematics, muscle activity, and user perceptions were collected for forty healthy adults (20 younger, 18-39 years; 20 older, 58-74 years), who performed a single balance training session with or without real-time visual feedback. Feedback involved controlling either a physical mobile robot or screen-based virtual ball through a course with standing tilt motions from an instrumented wobble board. Dynamic balance training was more challenging for older compared to younger adults, as measured by significantly higher dorsiflexor and knee extensor muscle activity and ankle co-contractions (50%-80%, p<0.05). Older participants also performed more motion while training without feedback compared to younger adults (22%-65%, p<0.05). Robotic and virtual real-time visual feedback elicited similar biomechanical adaptations in older adults, reducing motions to similar levels as younger adults and increasing ankle co-contractions (p<0.05). Despite higher muscular demand, perceived physical exertion and high enjoyment levels (Intrinsic Motivation Inventory >0.80) were consistent across groups. However, robotic visual feedback may be more challenging than virtual feedback based on more frequent balance corrections, lower perceived competence, and lower game scores for older compared to younger adults. These findings collectively support the feedback system's potential to provide engaging and challenging at-home balance training across the lifespan.

A two-stage disto-proximal braking modality to interrupt gait initiation in healthy adults

The purpose of this investigation was to determine the effect of unexpected gait termination in able-bodied participants during gait initiation on spatiotemporal and stance limb biomechanical parameters. Twenty-one healthy adults took part in this study and were divided into two groups based on the natural anterior or posterior incline of their trunk. Each participant performed 15 random trials of gait initiation: 10 trials with a Go signal and 5 with Go-&-Stop signals. Spatiotemporal parameters were assessed between the Go signal and the first heel contact. Ankle, knee, and hip joint moments were calculated in the sagittal plane. Free moment and impulse were also calculated for the stance limb. Spatiotemporal parameters were not influenced by the mean trunk inclination (p > 0.05), but participants with a forwardly-inclined trunk presented higher hip extension moments (p < 0.05). Unexpected stopping required smaller ankle and knee moments compared to the Go condition (p < 0.05). The hip extension moments appeared to be independent of gait initiation conditions (p > 0.05). The capacity of able-bodied people to interrupt their gait initiation relied on a two-stage disto-proximal braking modality involving explosive motor patterns at the ankle and hip joints. Such a pattern could be altered in vulnerable people, and further studies are needed to investigate this. This study determined a clinical method applicable as a functional protocol to assess and improve the postural control of people suffering from a lack of motor modulation during crucial transient tasks. Such tasks are essential in activities of daily living.

Does 8-Week Resistance Training with Slow Movement Cadenced by Pilates Breathing Affect Muscle Strength and Balance of Older Adults? An Age-Matched Controlled Trial

This study investigated the balance and dorsiflexion strength of older adults after eight weeks of resistance training, with the exercise velocity cadenced by the Pilates breathing technique and the volume modulated by the session duration. Forty-four older adults were divided into two groups: resistance training (TR; n = 22) and resistance training with the Pilates breathing technique cadencing all exercises (TR + P; n = 22), both during eight weeks. The total exercising volume was controlled by time of execution (50 min/session). The dorsiflexion strength and balance were assessed. The RT group showed higher dorsiflexion strength after the protocol: Right (RT = 29.1 ± 7.7 vs. RT + P = 22.9 ± 5.2, p = 0.001) and Left (RT = 29.5 ± 6.9 vs. RT + P = 24.0 ± 5.2, p = 0.001). All balance parameters were improved in RT + P group compared to its own baseline: Path Length (cm) (pre = 71.0 ± 14.3 vs. post = 59.7 ± 14.3, p = 0.003); Sway Velocity (cm/s) (pre = 3.6 ± 0.7; post = 2.9 ± 0.7; p = 0.001); Sway Area (cm2) (pre = 8.9 ± 5.3 vs. post = 5.7 ± 2.1, p = 0.003); Excursion Medio Lateral (cm) (pre = 3.0 ± 0.7 vs. post = 2.6 ± 0.5 cm, p = 0.002); and Excursion AP (cm) (pre = 3.6 ± 1.4 vs. post = 2.8 ± 0.7 cm, p = 0.010). Resistance training using slower velocity movement cadenced by Pilates breathing technique produced balance improvements compared to baseline (moderate to large effect sizes), but no between-group effect was observed at the end of the protocol. The dorsiflexion strength was higher in the RT group compared to RT + P group.

Relationship between hip abductor strength, rate of torque development scaling factor and medio-lateral stability in older adults

BACKGROUND

Recently, the rate of torque development scaling factor (RTD-SF) has been proposed as a useful tool that could contribute to a more comprehensive insight into muscular capacity. While lower RTD-SF is associated with ageing and certain neuromuscular diseases, it remains unknown whether this novel measure is associated with the postural control in the older adults.

RESEARCH QUESTION

Are hip abductor muscle strength, RTD and RTD-SF associated with responses to external postural perturbations in medio-lateral direction in older adults?

METHODS

Twenty healthy older adults (14 females, 6 males) were assessed for hip abductor muscle strength, RTD and RTD-SF, using a custom-built dynamometer. Perturbations were applied at waist level (4 perturbation intensities, 15 repetitions each) using a wire-pull paradigm, with centre-of-pressure (CoP) being recorded with force plates. For each condition (i.e. perturbation intensity), medio-lateral displacement and velocity of the CoP were computed. For both parameters, within-individual variation (representing consistency of the responses), expressed by the standard deviation (SD) of CoP parameters was also considered. Pearson correlation coefficients were computed between parameters of hip muscle capacity and CoP responses and SD values of CoP responses.

RESULTS

RTD-SF was moderately positively related to the consistency of the responses of both CoP displacement and velocity (r = 0.53-0.56; p = 0.011-0.016) at the lowest level of the perturbation magnitude (15 N). No other statistically significant relationships were found (all r < 0.35).

SIGNIFICANCE

RTD-SF could play a role in preserving postural balance in older adults when low-intensity perturbations are applied. RTD-SF is a novel outcome measure that could represent an important alternative clinical tool to traditional strength assessments. It could represent a supplementary tool to assess the risk of falls, however, several limitations and ambiguities need to be resolved by future research before it can be utilized in practice.

Effects of Concurrent and Terminal Visual Feedback on Ankle Co-Contraction in Older Adults during Standing Balance

This preliminary investigation studied the effects of concurrent and terminal visual feedback during a standing balance task on ankle co-contraction, which was accomplished via surface electromyography of an agonist–antagonist muscle pair (medial gastrocnemius and tibialis anterior muscles). Two complementary mathematical definitions of co-contraction indices captured changes in ankle muscle recruitment and modulation strategies. Nineteen healthy older adults received both feedback types in a randomized order. Following an analysis of co-contraction index reliability as a function of surface electromyography normalization technique, linear mixed-effects regression analyses revealed participants learned or utilized different ankle co-contraction recruitment (i.e., relative muscle pair activity magnitudes) and modulation (i.e., absolute muscle pair activity magnitudes) strategies depending on feedback type and following the cessation of feedback use. Ankle co-contraction modulation increased when concurrent feedback was used and significantly decreased when concurrent feedback was removed. Ankle co-contraction recruitment and modulation did not significantly change when terminal feedback was used or when it was removed. Neither ankle co-contraction recruitment nor modulation was significantly different when concurrent feedback was used compared to when terminal feedback was used. The changes in ankle co-contraction recruitment and modulation were significantly different when concurrent feedback was removed as compared to when terminal feedback was removed. Finally, this study found a significant interaction between feedback type, removal of feedback, and order of use of feedback type. These results have implications for the design of balance training technologies using visual feedback.

Methods and Strategies for Reconditioning Motor Output and Postural Balance in Frail Older Subjects Prone to Falls

In frail older subjects, the motor output of the antigravity muscles is fundamental in resisting falls. These muscles undergo accelerated involutions when they are inactive and the risk of falling increases during leisure and domestic physical activity. In order to reduce their risk of falling, frail older subjects limit their physical activities/exercises. The problem is that the less they exercise, the less they are able to exercise and the greater the risk in exercising. Hence, a vicious circle sets up and the antigravity muscles inevitably continue to deteriorate. This vicious circle must be broken by starting a reconditioning program based on developing the strength of antigravity muscles (especially lower-limb muscles). To begin with, for each increase in muscle strength, postural balance is improved. Once this increase reaches the threshold beyond which postural balance no longer improves, it seems appropriate to implement exercises aimed at concomitantly improving motor output and postural balance in order to counteract or even reverse the involution process of the postural balance system. Methods and strategies toward this end are proposed in this present communication. However, the transfer effects between strength increase and postural balance ability are not yet totally known and future research should evaluate the relationship between muscle strength and postural balance throughout rehabilitation programs (i.e., program follow-ups) in frail older subjects in order to advance knowledge of this relationship.

Does Interrupting Prolonged Sitting With 10- or 20-Min Standing Attenuate Postprandial Glycemia and Blood Pressure in Middle-Aged and Older Adults With Type 2 Diabetes?

We carried out three types of 2-hr experimental sessions with middle-aged and older adults with Type 2 diabetes in order to examine the acute effect of interrupting prolonged sitting with varying periods of standing on postprandial glycemia and blood pressure (BP): (a) prolonged sitting after breakfast; (b) standing for 10 min, 30 min after breakfast; and (c) standing for 20 min, 30 min after breakfast. Glucose and BP were assessed before and after breakfast. A generalized linear model revealed no significant differences for the incremental area under the curve of glucose between standing for 10 min, 30 min after breakfast, versus prolonged sitting after breakfast (β = -4.5 mg/dl/2 hr, 95% CI [-17.3, 8.4]) and standing for 20 min, 30 min after breakfast, versus prolonged sitting after breakfast (β = 0.9 mg/dl/2 hr, 95% CI [-11.9, 13.7]). There was no difference in area under the curve of systolic and diastolic BP among the sessions. Interrupting prolonged sitting time with 10 or 20 min of standing 30 min after breakfast does not attenuate postprandial glycemia or BP in middle-aged and older adults with Type 2 diabetes.

Age does not affect the relationship between muscle activation and joint work during incline and decline walking

Older compared with younger adults walk with different configurations of mechanical joint work and greater muscle activation but it is unclear if age, walking speed, and slope would each affect the relationship between muscle activation and net joint work. We hypothesized that a unit increase in positive but not negative net joint work requires greater muscle activation in older compared with younger adults. Healthy younger (age: 22.1 yrs, n = 19) and older adults (age: 69.8 yrs, n = 16) ascended and descended a 7° ramp at slow (~1.20 m/s) and moderate (~1.50 m/s) walking speeds while lower-extremity marker positions, electromyography, and ground reaction force data were collected. Compared to younger adults, older adults took 11% (incline) and 8% (decline) shorter strides, and performed 21% less positive ankle plantarflexor work (incline) and 19% less negative knee extensor work (decline) (all p < .05). However, age did not affect (all p > .05) the regression coefficients between the muscle activation integral and positive hip extensor or ankle plantarflexor work during ascent, nor between that and negative knee extensor or ankle dorsiflexor work during descent. With increased walking speed, muscle activation tended to increase in younger but changed little in older adults across ascent (10 ± 12% vs. -1.0 ± 10%) and descent (3.6 ± 10.2% vs. -2.6 ± 7.7%) (p = .006, r = 0.47). Age does not affect the relationship between muscle activation and net joint work during incline and decline walking at freely-chosen step lengths. The electromechanical cost of joint work production does not underlie the age-related reconfiguration of joint work during walking.

Effects of Shoes That Can Be Tightened Using Wire and Dial on the Dynamic Balance Following Ankle Muscle Fatigue: A Crossover Study

Ankle muscle fatigue causes joint instability and increased postural sway, which triggers imbalance, leading to injury. The purpose of this study was to investigate the immediate effects of wearing shoes that can be tightened using wire and dial (SWD) compared to being barefoot and wearing lace shoes of the slip-on type (LSS) on the dynamic balance of the ankle after muscle fatigue. Twenty-two healthy individuals were enrolled in this study. Muscle fatigue in the ankle was induced using Biodex, an isokinetic equipment. The participants were randomly allocated to the barefoot, LSS, and SWD groups, and the dynamic balance immediately after inducing muscle fatigue in each participant was measured using BIORescue, the Y-Balance test, and the side-hop test. The results showed that after inducing ankle muscle fatigue, wearing SWD leads to a more significant increase in dynamic balance than barefoot and wearing LSS (p < 0.05). Hence, to improve the dynamic balance of the ankle after muscle fatigue, wearing SWD is suggested as it allows the tightening of the ankle and dorsum of the foot using the wire and dial.

Brain connectivity during simulated balance in older adults with and without Parkinson's disease

Individuals with Parkinson's disease often experience postural instability, a debilitating and largely treatment-resistant symptom. A better understanding of the neural substrates contributing to postural instability could lead to more effective treatments. Constraints of current functional neuroimaging techniques, such as the horizontal orientation of most MRI scanners (forcing participants to lie supine), complicates investigating cortical and subcortical activation patterns and connectivity networks involved in healthy and parkinsonian balance control. In this cross-sectional study, we utilized a newly-validated MRI-compatible balance simulator (based on an inverted pendulum) that enabled participants to perform balance-relevant tasks while supine in the scanner. We utilized functional MRI to explore effective connectivity underlying static and dynamic balance control in healthy older adults (n = 17) and individuals with Parkinson's disease while on medication (n = 17). Participants performed four tasks within the scanner with eyes closed: resting, proprioceptive tracking of passive ankle movement, static balancing of the simulator, and dynamic responses to random perturbations of the simulator. All analyses were done in the participant's native space without spatial transformation to a common template. Effective connectivity between 57 regions of interest was computed using a Bayesian Network learning approach with false discovery rate set to 5%. The first 12 principal components of the connection weights, binomial logistic regression, and cross-validation were used to create 4 separate models: contrasting static balancing vs {rest, proprioception} and dynamic balancing vs {rest, proprioception} for both controls and individuals with Parkinson's disease. In order to directly compare relevant connections between controls and individuals with Parkinson's disease, we used connections relevant for predicting a task in either controls or individuals with Parkinson's disease in logistic regression with Least Absolute Shrinkage and Selection Operator regularization. During dynamic balancing, we observed decreased connectivity between different motor areas and increased connectivity from the brainstem to several cortical and subcortical areas in controls, while individuals with Parkinson's disease showed increased connectivity associated with motor and parietal areas, and decreased connectivity from brainstem to other subcortical areas. No significant models were found for static balancing in either group. Our results support the notion that dynamic balance control in individuals with Parkinson's disease relies more on cortical motor areas compared to healthy older adults, who show a preference of subcortical control during dynamic balancing.

Preserving Mobility in Older Adults with Physical Frailty and Sarcopenia: Opportunities, Challenges, and Recommendations for Physical Activity Interventions

One of the most widely conserved hallmarks of aging is a decline in functional capabilities. Mobility loss is particularly burdensome due to its association with negative health outcomes, loss of independence and disability, and the heavy impact on quality of life. Recently, a new condition, physical frailty and sarcopenia, has been proposed to define a critical stage in the disabling cascade. Physical frailty and sarcopenia are characterized by weakness, slowness, and reduced muscle mass, yet with preserved ability to move independently. One of the strategies that have shown some benefits in combatting mobility loss and its consequences for older adults is physical activity. Here, we describe the opportunities and challenges for the development of physical activity interventions in people with physical frailty and sarcopenia. The aim of this article is to review age-related physio(patho)logical changes that impact mobility in old age and to provide recommendations and procedures in accordance with the available literature.

Acute Effects of Single- Versus Double-Leg Postactivation Potentiation on Postural Balance of Older Women: An Age-Matched Controlled Study

AIMS

To compare the postactivation potentiation effects of isometric contraction until failure in double- and single-leg tasks on older women's balance.

METHODS

The one-legged balance test was performed before and immediately after a rise-to-toes task until the task failure. Older women were divided into two groups: a group performed the task with double leg (n = 43) and the other group with single-leg support (n = 55).

RESULTS

The single-leg group showed slower velocity of sway post rise-to-toes task (pre = 4.02 ± 1; post = 3.78 ± 1.15 m/s; p = .04) without differences for the center of pressure path length (pre = 79 ± 21; post = 75 ± 23 cm; p = .08). In the double-leg group, faster velocity of sway (pre = 4 ± 1.22; post = 4.25 ± 1.13; p = .03) and increased center of pressure path length (pre = 80 ± 24; post = 85 ± 23 cm; p = .03) were observed after the task.

CONCLUSIONS

The single-leg group showed improved balance outcomes due to postactivation potentiation, while the double-leg group showed worsened balance consistent with muscle fatigue.

Immediate Effect of Balance Taping Using Kinesiology Tape on Dynamic and Static Balance after Ankle Muscle Fatigue

The objective of this study was to investigate whether ankle balance taping (ABT) applied after muscle fatigue-inducing exercise can cause immediate improvements in dynamic and static balance. A total of 31 adults (16 males and 15 females) met the inclusion criteria. The experiment was designed using a single-blinded, randomized controlled trial. Changes in static and dynamic balance were measured before and after inducing muscle fatigue in the ankles and after ABT or ankle placebo taping (APT). After ankle muscle fatigue-inducing exercise, both the ABT and APT groups showed significant increases in surface area ellipses in the static state with eyes open (p < 0.05), and significant increases in surface area ellipses in the static and dynamic states with eyes closed (both p < 0.05). After taping of the fatigued ankle, surface area ellipses decreased significantly when eyes were open and closed in the static and dynamic states, but only in the ABT group (p < 0.05). Static balance was significantly different between groups (eyes open, 36.2 ± 86; eyes closed, 22.9 ± 46.7). Dynamic balance was significantly different between groups (eyes open, 68.6 ± 152.1; eyes closed, 235.8 ± 317.6). ABT may help prevent ankle injuries in individuals who experience muscle fatigue around the ankles after sports and daily activities.

Could Ankle Muscle Activation be Used as a Simple Measure of Balance Exercise Intensity?

Few, if any, studies have reported the effects of intensity of balance exercise for balance training and rehabilitation. The aim of the present study was to find a relative measure of intensity of balance exercise. On this basis, we analysed ankle muscle activation in the sagittal plane with increasing difficulty for a one leg stance on a T-board. Ten adults (7 men, 24.1 ± 3.5 years; 3 women, 30.6 ± 5.8 years) performed 3 trials on a T-board within 6 randomly assigned stability levels. T-board swaying velocities in the sagittal plane were manipulated to attain different stability levels (conditions). Concurrently, angular distance of the T-board and active balance time (i.e., percentage of a total time balancing) under each condition were measured. Surface electromyography from the tibialis anterior, gastrocnemius and soleus were monitored during one leg stance. The surface electromyography amplitude in the time domain was quantified using the root-mean-square values. Significant effect of stability levels on angular distance (F_5,45 = 3.4; p = 0.01) and velocity of the T-board (F_5,45 = 4.6; p = 0.002) were obtained. Active balance time decreased by ∼15% (p = 0.001) from the maximal to the minimal stability conditions. The graded level of balance board stability conditions did not generate significantly higher root-mean-square values in any muscles and hence could not be used as a relative measure of intensity of balance exercise. These findings imply that there could be a plateau in difficulty of balance exercise for enhancement of ankle muscle activity.

Aftereffects of prolonged Achilles tendon vibration on postural control are reduced in older adults

AIM

To assess the change in the contribution of proprioceptive signal from leg muscles in postural control with ageing.

METHODS

Fifteen young (~23 yr) and fifteen older adults (~68 yr) participated in Experiment 1, which consisted of recording the mean position of the centre of pressure (CoP), CoP path length, CoP velocity, and the amplitude of the Hoffmann (H) reflex and maximal M wave (M_MAX) in the soleus muscle during upright standing, before and after 1 h of bilateral Achilles tendon vibration applied in seated posture. Eight young (~24 yr) and eight older adults (~67 yr) participated in Experiment 2 consisting of recording H-reflex and M_MAX in seated posture before and after the 1-h vibration procedure used in Experiment 1.

RESULTS

Immediately after the 1-h vibration, the mean CoP position shifted forward in both groups (p < 0.05), with a greater magnitude of change (% pre-vibration) in young [mean(SD); 74(41)%] than older adults [44(40)%; p < 0.05]. The CoP path length and velocity only increased in young adults after vibration (p < 0.05). The H-reflex amplitude decreased only in young adults after vibration [before: 35(12); after: 16(13)% M_max, p < 0.05] during upright standing (Experiment 1), whereas it decreased similarly (p > 0.05) in young [before: 47(12)% M_max; after: 28(17)% M_max] and older adults [before: 34(13)% M_max; after: 21(14)% M_max] in seated posture (Experiment 2).

CONCLUSION

Prolonged Achilles tendon vibrations lead to lesser postural perturbation in older than in young adults, supporting the assumption of a decreased reliance on leg muscle proprioception in postural control with ageing.

The role of posturography on the initial stage of sports training

One of the main directions in the wrestlers training on the initial stage of sports training is the formation of the wrestler’s motion coordination abilities. Equilibrium function and anthropometric data including wrestler’s gender have essential differences in connection both with the child’s biological specialities and choosen athletic discipline special aspects. This research is focused on comparsion of variations in kinetic postural control affected by the lassitude among young athletes and non-athletes. 16 girl childs - freestyle wrestlers participates in this research. They are on initial stage of sports training. The control group consisted of 14 girl childs irrelevant to sports. There was made a hypothesis that the wrestlers lassitude can be measured subjectively (with the Borg scale) and objectively (with the stabilometrics), and that the wrestlers will better control their body position than the girls irrelevant to sports. Tecnobody Pro-Kin stabilometric platform was used to measure postural balance. There was determined statistically significant positive relationship of the investigated parameters changes between groups. As a result of the research we can make a conclusion that the offered method can provide reliable data concerning wrestler’s lassitude level. Analogues data are received with the rating of perceived exertion by Borg’s scale. As the result we can conclude that the offered postural balance research method is valid for the wrestler’s lassitude rating and can be used as a component of the complex athletes control system.

sEMG Activation of the Flexor Muscles in the Foot during Balance Tasks by Young and Older Women: A Pilot Study

OBJECTIVE

In this publication, we suggest that young adults and seniors use various defense mechanisms to counteract loss of balance. One of the hypotheses is the change in the coordination of antagonistic muscle groups, especially within the ankles. In this study, we tried to determine if there is a relationship between the condition from resilient, to pre-frail, to frail and the ability to maintain balance during free standing and balance tasks. The aim of the study was to define the importance of muscle activity in the ankle joint, dorsal flexor of the foot for the following: tibialis anterior (TA), plantar flexor of the foot gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and peroneus longus (PER), during balance tasks with eyes open (EO) and closed (EC). We hypothesized that there are differences in the activity and co-activation of the tested muscles in young and older women, which may indicate an increased risk of falls and walking disorders.

MATERIALS AND METHODS

A group of 20 women qualified for the study. The group was divided into two subgroups, young (G1) and elderly women (G2). The aim of the study was to define the importance of muscle activity in the ankle joint, dorsal flexor of the foot for the following: tibialis anterior (TA), plantar flexor of the foot gastrocnemius medialis (GM), gastrocnemius lateralis (GL), and peroneus longus (PER), during balance tasks with eyes open (EO) and closed (EC).

RESULTS

In this study, we observed significant differences between groups in the maximum and mean values of electromyography activity (EMG) activation of the examined muscles on different types of surfaces and with open and closed eyes. Older women generated higher values of EMG activation in all muscles except the gastrocnemius medialis muscle. The results were significant for co-activation at rest for muscles as follows: tibialis anterior and gastrocnemius medialis with eyes closed (p = 0.01) and peroneus and gastrocnemius lateralis at rest with eyes open (p = 0.03), eyes closed (p = 0.04), and on a foam (p = 0.02). The sEMG amplitude of the tested muscles means that agonist muscle activity changed relative to antagonistic muscle activity.

CONCLUSIONS

Activation of sEMG and coordination of ankle muscles during balance tasks change with age. It can be hypothesized that assessment of balance during free standing and equivalent tasks can predict the state of frailty, after taking into account other physiological variables that are believed to affect balance control.

Age-Related Adaptations of Lower Limb Intersegmental Coordination During Walking

Lower-limb intersegmental coordination is a complex component of human walking. Aging may result in impairments of motor control and coordination contributing to the decline in mobility inducing loss of autonomy. Investigating intersegmental coordination could therefore provide insights into age-related changes in neuromuscular control of gait. However, it is unknown whether the age-related declines in gait performance relates to intersegmental coordination. The aim of this study was to evaluate the impact of aging on the coordination of lower limb kinematics and kinetics during walking at a conformable speed. We then assessed the body kinematics and kinetics from gait analyses of 84 volunteers from 25 to 85 years old when walking was performed at their self-selected speeds. Principal Component Analysis (PCA) was used to assess lower-limb intersegmental coordination and to evaluate the planar covariation of the Shank-Thigh and Foot-Shank segments. Ankle and knee stiffness were also estimated. Age-related effects on planar covariation parameters was evaluated using multiple linear regressions (i.e., without a priori age group determination) adjusted to normalized self-selected gait velocity. Colinearity between parameters was assessed using a variation inflation factor (VIF) and those with a VIF < 5 were entered in the analysis. Normalized gait velocity significantly decreased with aging (r = −0.24; P = 0.028). Planar covariation of inter-segmental coordination was consistent across age (99.3 ± 0.24% of explained variance of PCA). Significant relationships were found between age and intersegmental foot-shank coordination, range of motion of the ankle, maximal power of the knee, and the ankle. Lower-limb coordination was modified with age, particularly the coordination between foot, and shank. Such modifications may influence the ankle motion and thus, ankle power. This observation may explain the decrease in the ankle plantar flexor strength mainly reported in the literature. We therefore hypothesize that this modification of coordination constitutes a neuromuscular adaptation of gait control accompanying a loss of ankle strength and amplitude by increasing the knee power in order to maintain gait efficiency. We propose that foot-shank coordination might represent a valid outcome measure to estimate the efficacy of rehabilitative strategies and to evaluate their efficiency in restoring lower-limb synergies during walking.

Age-related changes in leg proprioception: implications for postural control

In addition to being a prerequisite for many activities of daily living, the ability to maintain steady upright standing is a relevant model to study sensorimotor integrative function. Upright standing requires managing multimodal sensory inputs to produce finely tuned motor output that can be adjusted to accommodate changes in standing conditions and environment. The sensory information used for postural control mainly arises from the vestibular system of the inner ear, vision, and proprioception. Proprioception (sense of body position and movement) encompasses signals from mechanoreceptors (proprioceptors) located in muscles, tendons, and joint capsules. There is general agreement that proprioception signals from leg muscles provide the primary source of information for postural control. This is because of their exquisite sensitivity to detect body sway during unperturbed upright standing that mainly results from variations in leg muscle length induced by rotations around the ankle joint. However, aging is associated with alterations of muscle spindles and their neural pathways, which induce a decrease in the sensitivity, acuity, and integration of the proprioceptive signal. These alterations promote changes in postural control that reduce its efficiency and thereby may have deleterious consequences for the functional independence of an individual. This narrative review provides an overview of how aging alters the proprioceptive signal from the legs and presents compelling evidence that these changes modify the neural control of upright standing.

Evaluation of foot position and orientation as manipulated variables to control external knee adduction moments in leg extension training

BACKGROUND AND OBJECTIVE

Effective leg extension training at a leg press requires high forces, which need to be controlled to avoid training-induced damage. In order to avoid high external knee adduction moments, which are one reason for unphysiological loadings on knee joint structures, both training movements and the whole reaction force vector need to be observed. In this study, the applicability of lateral and medial changes in foot orientation and position as possible manipulated variables to control external knee adduction moments is investigated. As secondary parameters both the medio-lateral position of the center of pressure and the frontal-plane orientation of the reaction force vector are analyzed.

METHODS

Knee adduction moments are estimated using a dynamic model of the musculoskeletal system together with the measured reaction force vector and the motion of the subject by solving the inverse kinematic and dynamic problem. Six different foot conditions with varying positions and orientations of the foot in a static leg press are evaluated and compared to a neutral foot position.

RESULTS

Both lateral and medial wedges under the foot and medial and lateral shifts of the foot can influence external knee adduction moments in the presented study with six healthy subjects. Different effects are observed with the varying conditions: the pose of the leg is changed and the direction and center of pressure of the reaction force vector is influenced. Each effect results in a different direction or center of pressure of the reaction force vector.

CONCLUSIONS

The results allow the conclusion that foot position and orientation can be used as manipulated variables in a control loop to actively control knee adduction moments in leg extension training.

Selective effect of static stretching, concentric contractions, and a balance task on ankle force sense

Proper ankle motor control is critical for balance in the human body during functional activities such as standing, walking, and running. Different exercise modalities are often performed during the same training session where earlier activities may influence later ones. The purpose of the current study was to determine the acute effects of different exercise modalities on ankle force sense. Seventeen subjects performed four different intervention protocols (static stretching, balance task, concentric contractions, and control) in random order. Each session comprised measurements before and after the intervention protocol of the force sense of the ankle plantar flexors (PF) and dorsal flexors (DF) at 10% and 30% of maximal voluntary isometric contraction (MVC). Absolute errors (AE) were calculated separately for each force level and muscle group. An overall PF error (PF-SUM = PF at 10%MVC + PF at 30%MVC), DF error (DF-SUM = DF at 10%MVC + DF at 30%MVC) and ankle error (PF-DF-SUM = PF-SUM + DF-SUM) were also calculated. The main effect of time generally revealed that ankle force sense was significantly reduced after static stretching (PF-DF-SUM: Pre: 6.11±2.17 Nm, Post: 8.03±3.28 Nm; p < 0.05), but no significant differences were observed for the concentric contractions (PF-DF-SUM: Pre: 6.01±1.97 Nm, Post: 6.50±2.28 Nm) and the balance task (PF-DF-SUM: Pre: 5.25±1.97 Nm, Post: 5.50±1.26 Nm). The only significant interaction was observed for the PF-DF-SUM (F = 4.48, p = 0.008) due to greater error scores after stretching (+31.4%) compared to the concentric (+8.2%), balance (+4.8%), and control (-3.5%) conditions. Based on these results, static stretching should not be performed before activities that require a high ankle force sense such as balance, coordination, and precision tasks.

Electromyographic study of hip muscles involved in total hip arthroplasty: Surprising results using the direct anterior minimally invasive approach

BACKGROUND

The functional and clinical benefit of minimally invasive total hip arthroplasty (THA) is well-known, but the literature reports impaired gait and posture parameters as compared to the general population, especially following use of the anterior minimally invasive approach, which has more severe impact on posture than the posterior approach. The reasons for this impairment, however, remain unexplained. We therefore conducted a surface electromyography (sEMG) study of the hip muscles liable to be affected by arthroplasty surgery: gluteus maximus (GMax), gluteus medius (GMed), tensor fasciae latae (TFL), and sartorius (S). The study addressed the following questions: (1) Is bipodal and unipodal GMed activity greater following anterior THA than in asymptomatic subjects? (2) Is a single manual test sufficient to assess maximal voluntary contraction (MVC) in hip abductors (GMax, GMed, TFL) and flexors (TFL, S)?

HYPOTHESIS

Bipodal and unipodal GMed activity is greater following anterior THA than in asymptomatic subjects.

METHOD

Eleven patients with anterior THA and 11 asymptomatic subjects, matched for age, gender and body-mass index, were included. Subjects underwent 3 postural tests: bipodal, eyes closed (BEC), unipodal on the operated side (UOP), and unipodal on the non-operated side (UnOP), with unipodal results averaged between both sides in the asymptomatic subjects. Data were recorded from 4-channel EMG and a force plate. EMG test activity was normalized as a ratio of MVC activity.

RESULTS

Postural parameters (mean center of pressure displacement speed) were poorer and sEMG activity higher in anterior THA than asymptomatic subjects (p<0.005). On the BEC test, GMax and GMed activity was higher on both operated and non-operated sides than in asymptomatic controls (respectively, 0.15±0.12 and 0.12±0.6 versus 0.07±0.06 for GMax, and 0.13±0.08 and 0.13±0.08 versus 0.08±0.05 for GMed; p<0.05). On unipodal tests, both UOP and UnOP GMed activities were higher than in controls (respectively, 0.51±0.3 and 0.48±0.27 versus 0.28±0.13; p<0.04); GMax and TFL activities were higher than in controls only on the UOP tests (respectively, 0.49±0.43 versus 0.24±0.18, and 0.23±0.17 versus 0.12±0.16; p<0.05).

DISCUSSION

sEMG activity in the hip abductors, which are the main stabilizing muscles for the pelvis, is increased following anterior THA, in parallel with impaired postural parameters. This finding may be due to intraoperative TFL and S neuromuscular spindle lesion. The present preliminary study is to be followed up by a comparison of all 3 common minimally invasive approaches (anterior, anterolateral and posterior) using the same study protocol.

LEVEL OF EVIDENCE

III, prospective case-control study.

Postural control and balance in a cohort of healthy people living in Europe: An observational study

In the past 20 years, posturography has been widely used in the medical field. This observational study aimed to report the values derived from posturography of a wide set of healthy subjects from various European countries using a plantar pressure platform and a standardized method of measurement.A random cluster sampling of 914 healthy subjects aged between 7.0 and 85.99 years, stratified by age, was carried out. To provide percentile values of our cohort, data were processed to obtain 3 curves corresponding to the following percentiles: 25th, 50th, 75th, and the interquartile range. Distance-weighted least squares method was used to represent the percentile on appropriate graphs.In our sample, the balance to improve with age, up to approximately 45 years, but the trend to reverse with older age. The data show that the oscillations on the sagittal plane (y-mean) change with advancing age. Young people had more retro-podalic support than older people; the balance shifted forward in elderly people.As the study included a relatively large quantity of data collected using a standardized protocol, these results could be used as normative values of posturography for similar populations. On the basis of this data, correct diagnostic clues will be available to clinicians and professionals in the field. However, further studies are needed to confirm our findings.

Does hip joint positioning affect maximal voluntary contraction in the gluteus maximus, gluteus medius, tensor fasciae latae and sartorius muscles?

BACKGROUND

Minimally invasive total hip arthroplasty (THA) is presumed to provide functional and clinical benefits, whereas in fact the literature reveals that gait and posturographic parameters following THA do not recover values found in the general population. There is a significant disturbance of postural sway in THA patients, regardless of the surgical approach, although with some differences between approaches compared to controls: the anterior and anterolateral minimally invasive approaches seem to be more disruptive of postural parameters than the posterior approach. Electromyographic (EMG) study of the hip muscles involved in surgery [gluteus maximus (GMax), gluteus medius (GMed), tensor fasciae latae (TFL), and sartorius (S)] could shed light, the relevant literature involves discordant methodologies. We developed a methodology to assess EMG activity during maximal voluntary contraction (MVC) of the GMax, GMed, TFL and sartorius muscles as a reference for normalization. A prospective study aimed to assess whether hip joint positioning and the learning curve on an MVC test affect the EMG signal during a maximal voluntary contraction.

HYPOTHESIS

Hip positioning and the learning curve on an MVC test affect EMG signal during MVC of GMax, GMed, TFL and S.

METHODS

Thirty young asymptomatic subjects participated in the study. Each performed 8 hip muscle MVCs in various joint positions recorded with surface EMG sensors. Each MVC was performed 3 times in 1 week, with the same schedule every day, controlling for activity levels in the preceding 24h. EMG activity during MVC was expressed as a ratio of EMG activity during unipedal stance. Non-parametric tests were applied.

RESULTS

Statistical analysis showed no difference according to hip position for abductors or flexors in assessing EMG signal during MVC over the 3 sessions. Hip abductors showed no difference between abduction in lateral decubitus with hip straight versus hip flexed: GMax (19.8±13.7 vs. 14.5±7.8, P=0.78), GMed (13.4±9.0 vs. 9.9±6.6, P=0.21) and TFL (69.5±61.7 vs. 65.9±51.3, P=0.50). Flexors showed no difference between hip flexion/abduction/lateral rotation performed in supine or sitting position: TFL (70.6±45.9 vs. 61.6±45.8, P=0.22) and S (101.1±67.9 vs. 72.6±44.6, P=0.21). The most effective tests to assess EMG signal during MVC were for the hip abductors: hip abduction performed in lateral decubitus (36.7% for GMax, 76.7% for GMed), and for hip flexors: hip flexion/abduction/lateral rotation performed in supine decubitus (50% for TFL, 76.7% for S).

DISCUSSION

The study hypothesis was not confirmed, since hip joint positioning and the learning curve on an MVC test did not affect EMG signal during MVC of GMax, GMed, TFL and S muscles. Therefore, a single session and one specific test is enough to assess MVC in hip abductors (abduction in lateral decubitus) and flexors (hip flexion/abduction/lateral rotation in supine position). This method could be applied to assess muscle function after THA, and particularly to compare different approaches.

LEVEL OF EVIDENCE

III, case-matched study.

Relationship between Muscle Function, Muscle Typology and Postural Performance According to Different Postural Conditions in Young and Older Adults

Although motor output of the postural function clearly influences postural performance in young and older subjects, no relationship has been formally established between them. However, the relationship between lower-extremity muscle strength/power and postural performance is often pointed out, especially in older subjects. In fact, the influence of motor output may vary according to the postural condition considered (e.g., static, dynamic, challenging, disturbing). In static postural condition, there may be a relationship between lower-extremity muscle strength and postural performance when the value of muscle strength is below a certain threshold in older subjects. Above this threshold of muscle strength, this relationship may disappear. In dynamic postural condition, lower-extremity muscle power could facilitate compensatory postural actions, limiting induced body imbalance likely to generate falls in older subjects. In young subjects, there could be a relationship between very early rapid torque of the leg extensor muscles and postural performance. In the case of postural reaction to (external) perturbations, a high percentage of type II muscle fibers could be associated with the ability to react quickly to postural perturbations in young subjects, while it may enable a reduction in the risk of falls in older subjects. In practice, in older subjects, muscle strength and/or power training contributes to reducing the risk of falls, as well as slowing down the involution of muscle typology regarding type II muscle fibers.

Effect of calf-raise training on rapid force production and balance ability in elderly men

This study examined whether home-based, high-speed calf-raise training changes the rate of torque development (RTD) during plantar flexion contractions and balance performance in elderly men. Thirty-four healthy elderly men (73 ± 5 yr) were randomly assigned to a training or control group (n = 17 in each group). The subjects in the training group completed 8 wk (3 times/wk) of home-based bilateral calf-raise training using body mass. Before and after the intervention, RTD during plantar flexion contractions and center-of-pressure (COP) displacement during single-leg standing were measured. Surface electromyographic amplitude of the triceps surae and tibialis anterior during the strength and single-leg standing was measured. Clinical magnitude-based inferences were used to interpret the training effect, with the smallest worthwhile effect assumed to be 0.2 of the baseline SD. The peak RTD increased 21% (90% confidence limits, ±19%) relative to the control group, which was accompanied by corresponding changes of the medial gastrocnemius (MG) and soleus (SOL) activations. The effect on COP displacement was possibly trivial (0%, ±13%), whereas substantial reduction in the MG (-19%, ±15%) and SOL (-25%, ±13%) activations during standing was observed. Our findings indicate that calf-raise training at home, performed without special equipment or venue, induces a substantial increase in the plantar flexors' rapid force-generating capability and triceps surae activations. Although the training effect on standing balance performance was not substantial, observed changes in the triceps surae activations during standing are expected to contribute to future balance performance improvement.NEW & NOTEWORTHY Calf-raise training with the intent to move rapidly, without special equipment or venue, induces an improvement of explosive plantar flexion force, which is attributable to neuromuscular rather than musculotendinous adaptations. Although the training effect on balance performance was trivial, we found a sign of improvement (i.e., neuromuscular adaptations during standing). In conclusion, functional neuromuscular capacity can be enhanced by home-based calf-raise exercise in elderly men, which may protect against mobility loss with aging.

Association between rapid force production by the plantar flexors and balance performance in elderly men and women

Plantar flexion strength and balance ability are considered to be crucial for avoiding falls. However, no clear relationship has been established between these two factors in elderly population. This study aimed to examine the association between plantar flexion strength and balance performance in elderly men and women. Forty-three men and 35 women aged over 65 years performed isometric plantar flexion as fast and hard as possible. From the time-torque curve, the rate of torque development in time intervals of 30, 50, 100, 150, and 200 ms from the onset of contraction was determined and normalized to peak torque. In addition, the center of pressure displacement during single-leg standing was calculated and normalized to height. When the data were collapsed over sexes, the normalized rate of torque development was negatively correlated with the normalized center of pressure displacement, except for the time interval of 200 ms. By sex, regardless of the time interval, there was a negative correlation between the normalized rate of torque development and the normalized center of pressure displacement in the elderly men but not in the elderly women. No correlation was seen between the peak torque and normalized center of pressure displacement in either pooled or separated data. The findings suggest that the capability of rapid force production rather than maximal force production of the plantar flexion is important for balance ability in elderly men, but this capability may not be relevant in elderly women.

Leg and trunk muscle coordination and postural sway during increasingly difficult standing balance tasks in young and older adults

Ageing impairs body balance and increases older adults' fall risk. Balance training can improve intrinsic fall risk factors. However, age comparisons of muscle activity responses during balance tasks are lacking. This study investigated relative muscle activity, muscle coordination and postural sway during various recommended static balance training tasks. Muscle activity (%MVC), amplitude ratios (AR) and co-activity (CAI) were determined during standing tasks for 30s (1: double limb stance on a foam surface, eyes open; 2: double limb stance on firm ground, eyes closed; 3: double limb stance, feet in step position on a foam surface, eyes open; 4: double limb stance, feet in step position on firm ground, eyes closed; 5: single limb stance on firm ground, eyes open) in 20 healthy young adults (24±2 y) and 20 older adults (73±6 y). Surface electromyography (SEMG) was applied (SENIAM guidelines) to ankle (tibialis anterior, soleus, medial gastrocnemius, peroneus longus) and thigh (vastus lateralis, vastus medialis, biceps femoris, semitendinosus) muscles (non-dominant leg). Electrodes over trunk (multifidus and internal oblique) muscles were applied bilaterally. Two- to six-fold higher levels of relative muscle activity were found in older adults for ankle (0.0002<p<0.001), thigh (0.0008<p<0.075) and trunk (0.001<p<0.036) muscles. Co-activation was elevated in young adults for the trunk (0.001<p<0.031) and in older adults for the ankle (0.009<p<0.03). Age-group differences were observed for muscle coordination patterns during all stance conditions at the ankle (0.06<ηp(2)<0.28) and the trunk (0.14<ηp(2)<0.23). Older adults had higher electrophysiological costs for all stance conditions. Muscle coordination showed inverse activity patterns at the ankle and trunk. Optimal balance and strength training programs should take into account age-specific alterations in muscle activity.

Neuromuscular function in different stages of sarcopenia

This study applied the screening tool developed by the European Working Group on Sarcopenia in Older People (EWGSOP) on seniors aged over 65years and concurrently tested various laboratory-based indices of neuromuscular function. Twenty-four healthy and independent living older adults (9 men, 15 women) with a mean age of 79.1±5.8years participated. Based on gait speed, handgrip strength and muscle mass all subjects were categorized into one of the three conceptual sarcopenia stages (pre-sarcopenia, sarcopenia, severe sarcopenia). Maximal strength of dorsiflexors in the left leg was measured and voluntary activation was assessed by the interpolated twitch technique. In addition, isometric evoked contractile properties were recorded. Skeletal muscle mass was assessed by ultrasound from nine sites. There were roughly equal number of subjects in each sarcopenic category, and age was not different among the 3 groups. There were no differences in handgrip strength and skeletal muscle mass index among the 3 groups. Gait speed was significantly slower (p<0.01) in the severe sarcopenic subjects compared to the pre-sarcopenic group. With no differences in voluntary activation among the groups, the maximal voluntary contractions (MVCs) for severe sarcopenic subjects were 29% lower (p=0.02) and with 19% slower (p=0.02) voluntary rates of torque development (RTD) compared to sarcopenic subjects. Furthermore, the severe group was 34% lower (p=0.04) with 36% slower (p=0.02) RTD compared to pre-sarcopenic subjects. Peak twitch tension was 54% lower (p<0.01) in the severe group compared with the pre-sarcopenic group. Maximal twitch RTD were 40% (p=0.03) slower for the severe group compared to the sarcopenia group, and 51% slower (p=0.03) compared with the pre-sarcopenia group, but when normalized to peak torques there were no statistical differences. The laboratory tests found neuromuscular differences among the 3 groups which generally supported the classification scheme and helped to illustrate some key factors that could explain differences in functional capacities. These initial findings support the assumption that this categorization is relevant for identifying older adults with different neuromuscular properties. However, further studies are needed to provide more insight into the specific neuromuscular changes in the three sarcopenia stages, and how these changes relate to functional capacity. Such studies could ultimately contribute to identifying optimal interventions to improve neuromuscular functioning.

Joint positioning sense, perceived force level and two-point discrimination tests of young and active elderly adults

Background:

Changes in the proprioceptive system are associated with aging. Proprioception is important to maintaining and/or recovering balance and to reducing the risk of falls.

Objective:

To compare the performance of young and active elderly adults in three proprioceptive tests.

Method:

Twenty-one active elderly participants (66.9±5.5 years) and 21 healthy young participants (24.6±3.9 years) were evaluated in the following tests: perception of position of the ankle and hip joints, perceived force level of the ankle joint, and two-point discrimination of the sole of the foot.

Results:

No differences (p>0.05) were found between groups for the joint position and perceived force level. On the other hand, the elderly participants showed lower sensitivity in the two-point discrimination (higher threshold) when compared to the young participants (p < 0.01).

Conclusion:

Except for the cutaneous plantar sensitivity, the active elderly participants had maintained proprioception. Their physical activity status may explain similarities between groups for the joint position sense and perceived force level, however it may not be sufficient to prevent sensory degeneration with aging.

Neuromuscular electrical stimulation leads to physiological gains enhancing postural balance in the pre-frail elderly

Physiological aging leads to a progressive weakening of muscles and tendons, thereby disturbing the ability to control postural balance and consequently increasing exposure to the risks of falls. Here, we introduce a simple and easy-to-use neuromuscular electrical stimulation (NMES) training paradigm designed to alleviate the postural control deficit in the elderly, the first hallmarks of which present as functional impairment. Nine pre-frail older women living in a long-term care facility performed 4 weeks of NMES training on their plantarflexor muscles, and seven nontrained, non-frail older women living at home participated in this study as controls. Participants were asked to perform maximal voluntary contractions (MVC) during isometric plantarflexion in a lying position. Musculo-tendinous (MT) stiffness was assessed before and after the NMES training by measuring the displacement of the MT junction and related tendon force during MVC. In a standing position, the limit of stability (LoS) performance was determined through the maximal forward displacement of the center of foot pressure, and related postural sway parameters were computed around the LoS time gap, a high force requiring task. The NMES training induced an increase in MVC, MT stiffness, and LoS. It significantly changed the dynamics of postural balance as a function of the tendon property changes. The study outcomes, together with a multivariate analysis of investigated variables, highlighted the benefits of NMES as a potential tool in combating neuromuscular weakening in the elderly. The presented training-based strategy is valuable in alleviating some of the adverse functional consequences of aging by directly acting on intrinsic biomechanical and muscular properties whose improvements are immediately transferable into a functional context.