Impact of spinal imbalance and back muscle strength on locomotive syndrome in community-living elderly people

How global spine sagittal alignment and spinal degeneration affect locomotive syndrome risk in the elderly

BACKGROUND

The aim of this study was to delineate the features of the locomotive syndrome (LS) risk stage in the elderly population, encompassing global spine sagittal alignment, visible spinal degenerative changes on plain radiographs, muscle strength, physical capabilities, and low back pain (LBP).

METHODS

The study enrolled 232 subjects, evaluated using plain radiographs. The evaluation included measurements of lumbar lordosis (LLA), thoracic kyphosis (TKA), spinal inclination (SIA) angles, and sagittal vertical axis. Assessments included lumbar osteophyte formation (LOF) and lumbar disc height (LDH) to examine spinal degenerative changes. LS evaluation used the locomotive syndrome risk test based on LS risk criteria, classifying participants into no risk, stage 1 LS, and stage 2 LS groups. Using a visual analogue scale (VAS), we investigated the prevalence of low back pain (LBP) and assessed physical performances across these groups.

RESULTS

There were 132 participants with no LS risk, 71 with stage 1 LS risk, and 29 with stage 2 LS risk. As LS risk increased, LBP prevalence and VAS scores rose, physical abilities, and back muscle strength decreased. TKA showed no variation across groups, while LLA decreased with advancing LS risk stage. Except for L1-L2 and L5-S1, lumbar disc height (LDH) decreased with higher LS risk stages. LOF occurrence increased notably with higher LS risk stages. Spinal inclination angle (SIA) significantly increased with advancing LS risk stages.

CONCLUSION

Participants diagnosed with LS exhibited an increased incidence of spinal degeneration, reduced LLA, and global spinal imbalance characterized by anterior spinal inclination.

Exploring age-related changes in motor function: insights from the peak decline found in Koji Awareness screening test

The KOJI AWARENESS (KA) screening test assesses motor function in humans. We aimed to analyze the correlation between age and KA screening scores and to identify the specific age at which a significant decline occurs. A total of 793 healthy participants (234 females) were interviewed for basic information on age and sex and completed the KA screening test. In addition to calculating the total score from the KA test, the scores were calculated for the neck-scapula-upper extremity-complex (NSU), trunk, and lower extremity (LE) segments. Spearman's rank correlation coefficient was used to assess the validity of the test. Additionally, Bayesian linear regression was employed to estimate the change point in KA scores, facilitating the identification of a critical age associated with a notable decline in motor function. KA screening total and separate body segment scores were negatively correlated with age in both gender (for female and male, KA total score, ρ = - 0.443, ρ = - 0.344; NSU segment, ρ = - 0.431, ρ = - 0.427; trunk segment, ρ = - 0.210, ρ = - 0.473; LE segment: ρ = - 0.43, ρ = - 0.507). Furthermore, a change-point analysis using linear regression analysis showed that KA screening total scores declined sharply at the age of 49.1(95% credible interval: 37.503, 68.366). The result show that total KA scores decrease - 0.196 (95% credible interval: - 0.335,  - 0.049) for every 1 year of age increase, and for ages over 49.1, total KA scores additionally decrease - 0.255 (95% credible interval: - 0.485, - 0.054) for every 1 year of age increase. In the NSU segment, females showed a more rapid decline than males from the age of 50 years. KA screening test total scores declined sharply at the age of 49.1. These results may be useful in setting treatment goals, exercise, and lifestyle programs for age-related decline in motor function.

Relationship among Osteoporosis, Sarcopenia, Locomotive Syndrome, and Spinal Kyphosis in Older Individuals Living in a Local Mountain Area

STUDY DESIGN

Cross-sectional cohort study.

PURPOSE

This study investigated the relationship among osteoporosis, sarcopenia, locomotive syndrome, and spinal kyphosis in older individuals living in a mountain area.

OVERVIEW OF LITERATURE

Kyphosis greatly reduces the quality of life of older individuals. Osteoporosis and sarcopenia are kyphosiscausing factors.

METHODS

This cross-sectional study included 361 individuals aged ≥65 years (mean age, 75.0 years) living in a local mountain area and underwent medical check-ups from 2014 to 2018. The survey items included kyphosis index, body mass index, back pain prevalence, back pain Visual Analog Scale score, Oswestry Disability Index, walking speed, grip strength, skeletal mass index, osteoporosis (% young adult mean [YAM]), LOCOMO 5 score, and presence of sarcopenia (Asian Working Group for Sarcopenia). The participants were divided into the N (kyphosis index: <12; n=229, 63.4%), M (kyphosis index: 12-15; n=99, 27.4%), and K (kyphosis index: ≥15; n=33, 9.2%) groups. p -values of <0.05 were considered statistically significant. An association factor of kyphosis (kyphosis index: ≥15) was investigated with logistic regression analysis.

RESULTS

Age and LOCOMO 5 scores were significantly higher (p <0.05) and %YAM and walking speed were significantly lower (p <0.05) in the K group than in the M and N groups. Other survey items showed significant differences. Only %YAM (odds ratio, 0.20; 95% confidence interval, 0.04-0.96) was an independent factor associated with a kyphosis index of ≥15.

CONCLUSIONS

Decreased muscle mass and muscle strength would be related to kyphosis; however, no such relations were noted. Bone loss was significantly related to kyphosis. Osteoporosis-induced decrease in vertebral body height is present in the background. Sarcopenia and locomotive syndrome were not related to kyphosis, whereas decreased bone density was independently associated with kyphosis in older individuals living in a mountain area.

Can the measurement of Locomo Age improve motivation for exercise in fitness club users?

AIM

In 2022, the Japanese Orthopaedic Association developed "Locomo Age," which can be used to measure mobility. The potential effects of measuring Locomo Age on motivation to exercise are yet to be explored. This study aimed to determine whether the measurement of Locomo Age improved motivation for exercise.

METHODS

In total, 90 fitness club users (17 men and 73 women) were enrolled in the study. The participants performed the locomotive syndrome risk test. These results were entered on a smartphone website, and their Locomo Age was automatically calculated. Questionnaires about impressions of Locomo Age and changes in motivation for exercise after measuring Locomo Age were surveyed.

RESULTS

The mean Locomo Age of the participants was 84.4 ± 8.5 years, which was significantly higher than their actual age (75.9 ± 7.2 years, P < 0.001). Questionnaires showed that 55 participants (61.1%) felt that their Locomo Age was higher than expected; 42 participants (46.7%) had increased motivation for exercise, and only two participants (2.2%) had decreased motivation. The rate of improvement in motivation for exercise was higher in the group of participants who reported having an older Locomo Age than they expected compared with that of the group with a Locomo Age that was the same as they expected (P < 0.05).

CONCLUSIONS

The measurement of Locomo Age improved the motivation for exercise. This result remained true even when the Locomo Age was higher than expected, as it did not decrease the participants' motivation. Locomo Age allows for the comprehension of participants' mobility without medical knowledge. Geriatr Gerontol Int 2023; ••: ••-••.

Locomotive Syndrome and Lumbar Spine Disease: A Systematic Review

Locomotive syndrome (LS) is defined based on the Loco-Check, 25-question Geriatric Locomotive Function Scale (GLFS-25), 5-question Geriatric Locomotive Function Scale (GLFS-5), Stand-Up Test, Two-Step Test, or a total assessment (i.e., positive for one or more of the GLFS-25, Stand-Up Test, and Two-Step Test). Lumbar spine disease has been reported to be one of the most common musculoskeletal disorders leading to LS. We therefore conducted a systematic review via PubMed, Google Scholar, Cochrane Library, Web of Science, and MEDLINE, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 26 studies were considered to be eligible for inclusion in this systematic review. The GLFS-25 showed an association with low back pain, sagittal spinopelvic malalignment, and lumbar spinal stenosis but not vertebral fracture. The GLFS-5 showed an association with low back pain and lumbar spinal stenosis. The Loco-Check and Two-Step Test showed an association with low back pain, sagittal spinopelvic malalignment, and lumbar spinal stenosis. The Stand-Up Test showed no association with lumbar spinal stenosis. The total assessment showed an association with low back pain and lumbar spinal stenosis. Furthermore, the GLFS-25, Two-Step Test, and total assessment were improved by spinal surgery for lumbar spinal stenosis. The current evidence concerning the relationship between LS and lumbar spine disease still seems insufficient, so further investigations are required on this topic.

Relationship of frequency of participation in a physical checkup and physical fitness in middle-aged and elderly people: the Yakumo study

An annual physical checkup is provided as part of the long-term Yakumo study. The checkup is voluntary and there is variation in the frequency of participation. The aim of this study was to examine relationship of physical fitness with frequency of participation in this checkup. The subjects had all attended at least one annual physical checkup from 2006 to 2018. Data from 1,804 initial checkups were used for analysis. At the checkups, age, gender, height, weight, body mass index (BMI), and bone mineral density (BMD) were recorded, and physical activity was measured. The average number of physical checkups per participant for 13 years was 2.4 (1-13). Daily exercise habits were found to be significantly associated with higher participation in physical checkups. Furthermore, between groups with low (1-5 times; <90th percentile of participants) and high (≥6 times) participation, weight and BMI were significantly higher, and BMD, grip strength, 10-m gait time, back muscle strength, and two-step test were all significantly lower in the group with lower frequency of participation in the checkup. In conclusions, our results show that frequency of participation in a voluntary annual physical checkup is significantly associated with physical fitness in middle-aged and elderly people.

Risk Factors for Neuropathic Pain in Middle-Aged and Elderly People: A Five-Year Longitudinal Cohort in the Yakumo Study

OBJECTIVE

To determine the risk factors for new neuropathic pain (NeP) after five years in healthy middle-aged and elderly volunteers.

DESIGN

Prospective longitudinal cohort study (Yakumo study).

SETTING

Clinical evaluation in a health checkup.

SUBJECTS

A total of 366 people (male N = 146, female N = 220, average age = 63.5 years) who did not have NeP in 2013 were examined.

METHODS

NeP was diagnosed based on a painDETECT questionnaire score ≥13. Body mass index (BMI), comorbidity, low back pain (LBP), sciatica, physical ability, grip and back muscle strength, osteoporosis, sarcopenia, frailty, spinal alignment, and quality of life (QOL) with the SF36 in 2013 were compared between NeP(+) and NeP(-) subjects in 2018 using multivariate logistic regression analysis.

RESULTS

The NeP(+) rate in 2018 was 5.2%, with no significant differences in age and gender. NeP(+) subjects had significantly lower BMI, severe sciatica, poor gait ability, higher rates of osteoporosis and sarcopenia, greater lumbar kyphosis and spinal inclination, and poorer mental health in 2013. Poor gait ability (odds ratio [OR] = 8.05), low BMI (OR = 2.31), lumbar kyphosis (OR = 1.38), low percentage of the young adult mean (OR = 1.15), and low mental QOL (OR = 1.06) were identified as significant and independent risk factors for new NeP after five years.

CONCLUSIONS

This longitudinal cohort study identified five independent risk factors for development of new NeP after five years, with related factors of spinal inclination, sarcopenia, and sciatica. New NeP may be prevented by intervention or treatment of these factors at an early stage in relatively healthy middle-aged and elderly people.

Overcoming locomotive syndrome: The Yakumo Study

OBJECTIVES

Improvement of life expectancy is increasingly important with the aging of society. The aim of the study was to compare physical performance in elderly people in two 3-year periods (2001-2003) and (2016-2018).

METHODS

The participants were healthy Japanese elderly adults who attended public health check-ups in Yakumo. Results for 10 m gait time, two-step test, back muscle strength, and grip strength were examined prospectively for participants in 2001-2003 (Group A: n = 488) and 2016-2018 (Group B: n = 309) by gender and age (65-74 and 75-84 years).

RESULTS

There were significant differences between Groups A and B for 10 m gait time (age 65-74: male: 5.6 vs. 5.2 s, female: 6.3 vs. 5.5 s; age 75-84: male: 6.1 vs. 5.5 s, female: 6.7 vs. 5.8 s; all p < .05) and two-step test (age 65-74: male: 1.41 vs. 1.48, female: 1.35 vs. 1.44; age 75-84: male: 1.32 vs. 1.41, female: 1.30 vs. 1.38; all p < .05), but not for back muscle strength or grip strength.

CONCLUSION

Our results suggest a phenomenon of 'overcoming locomotive syndrome', in which physical performance changed by aging, including motor functions such as 10 m gait time and two-step test, has improved in the current population compared with a similar population from 15 years ago.

Relationship between tongue pressure and back muscle strength in healthy elderly individuals

BACKGROUND

Aging is associated with a decrease in muscle mass and strength in swallowing muscles, as well as in whole-body muscles. A decrease in tongue pressure (TP) is related with whole-body function, and the trunk, including abdominal and back muscles, forms the core of the body. However, the direct relationship between TP and trunk muscle strength remains unclear.

AIMS

To clarify the association between back muscle strength, an indicator of trunk muscle strength, and TP in healthy elderly individuals.

METHODS

In all, 112 healthy community-dwelling individuals aged ≥ 60 years (men: 35, median age 74.0; women: 77, median age 69.0) were included. Body mass index (BMI), TP, and back muscle strength (BMS) were measured. Tooth loss pattern was evaluated by the Eichner classification. Participants were divided into two groups based on the median of the BMS and classified into three groups based on the Eichner index (Eichner A, B, and C). The effects of BMS and occlusal support on TP were analyzed.

RESULTS

In the low BMS group, there was a significant difference in TP between the Eichner B and Eichner C (p = 0.017) groups. However, in the high BMS group, occlusal support did not affect TP. Moreover, the explanatory factors for TP were BMS (β = 0.373, p = 0.001) and the Eichner index (β = 0.190, p = 0.036).

CONCLUSIONS

TP was correlated more with BMS than aging and occlusal support in healthy elderly individuals. This study indicated that the clinical evaluation of the whole body is important when assessing oral and swallowing function.

Influence of Global Spine Sagittal Balance and Spinal Degenerative Changes on Locomotive Syndrome Risk in a Middle-Age and Elderly Community-Living Population

Purpose

The aim of this study was to describe the characteristics of each locomotive syndrome (LS) risk stage, including global spine sagittal alignment, spinal degenerative changes evident on plain radiographs, low back pain (LBP), muscle strength, and physical ability in middle-aged and elderly people in a health checkup.

Methods

This study included 211 healthy Japanese volunteers (89 men and 122 women; mean age, 64.0 years) who underwent assessment with both radiographs and Spinal Mouse. Spinal sagittal parameters included thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), sagittal vertical axis, and spinal inclination angle (SIA). Lumbar disc height (LDH) and lumbar osteophyte formation (LOF) at each level were evaluated as the spinal degenerative changes. The LS assessment comprised three tests: stand-up test, two-step test, and 25-question Geriatric Locomotive Function Scale (GLFS-25). The subjects were divided into three groups (no risk, stage 1 LS, or stage 2 LS) according to LS risk test criteria. The prevalence of LBP was investigated with a visual analogue scale (VAS), and physical performances were also compared among the groups.

Results

Of the participants, 122 had no risk of LS, 56 had stage 1 LS risk, and 29 had stage 2 LS risk. With increasing LS risk stage, the prevalence of and VAS score for LBP increased significantly, and back muscle strength and physical abilities decreased significantly. The TKA did not differ among the three groups. The LLA decreased gradually with LS risk stage (P = 0.0001). At each level except L1–L2 and L5–S1, LDH decreased gradually with LS risk stage. The prevalence of LOF increased significantly with increasing LS risk stage. The SIA increased significantly with LS risk stage (P = 0.0167).

Conclusions

Participants with LS had higher prevalence of spinal degeneration, small LLA, and global spinal imbalance by anterior spinal inclination.

Differences of lumbopelvic sagittal parameters among community-dwelling middle-age and elderly individuals: Relations with locomotor physical function

This study aims to establish radiographic parameters of lumbopelvic sagittal alignment, gender related differences, and age-related changes in a middle-aged community, to investigate whether age-related changes of lumbopelvic alignment reflect the risk of locomotive syndrome (LS). This study included 448 healthy Japanese volunteers who attended a basic health checkup supported by the local government. The subjects (184 males and 264 females, mean age: 62.7 years) were grouped according to their age by decade. Sagittal lumbopelvic parameters were collected by lateral spine radiographs including lumbar lordosis (L1-S1, LL), lower lumbar lordosis (L4-S1, LLL), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). The three tests (stand-up test, two-step test, and 25-question geriatric locomotive function scale [GLFS-25]) composing the LS risk test were performed. LL was significantly lower in males than in the females. A significant decrease of LL and LLL was observed from 60 s to 70 s in the females. PI did not markedly change with aging in either gender but was lower in males. A remarkable increase of PT was seen from 60 s to 70 s in the females. SS did not markedly change with aging and was lower in males in all decades. The prevalence of LS risk in males and females increased gradually with age and was greater in females in any decade. 70 s females with LS risk had significantly lower LL and higher PT compared to them without LS risk. Radiographic parameters of lumbopelvic sagittal alignment were established in community-dwelling middle-age and elderly individuals.

Musculoskeletal Factors and Geriatric Syndromes Related to the Absence of Musculoskeletal Degenerative Disease in Elderly People Aged over 70 Years

Purpose

To investigate factors with a significant relationship with the absence of musculoskeletal disease (MSD: osteoporosis, knee osteoarthritis (K-OA), and lumbar spondylosis (L-OA)) in elderly people ≥70 years old.

Methods

The subjects were 279 people (134 males, 145 females, mean age: 75.2 years) who attended an annual health checkup and were prospectively included in the study. Osteoporosis was defined as %YAM ≤70%, K-OA as Kellgren–Lawrence grade ≥2, and L-OA as osteophytes of Nathan class ≥3. Subjects were divided into those with (group D) and without (group N) any MSD. Clinical variables including locomotive syndrome (LS), frailty, sarcopenia, and QOL (SF-36) were compared between the groups.

Results

There was no significant difference in age or gender between group N (n = 54) and group D (n = 225). Lower BMI and pain, including neuropathic pain; greater back muscle strength, physical ability, and balance with eyes closed; larger lumbar lordosis, sacral inclination, and lumbar ROM; and smaller spinal inclination were found in group N. The rates of LS and sarcopenia were significantly lower and QOL was significantly higher in group N.

Conclusions

This study firstly revealed the significant musculoskeletal factors and geriatric syndromes related to an absence of MSD, which may form the basis of interventions to improve QOL in elderly people ≥70 years old.

Locomotive Syndrome Stage 1 Predicts Significant Worsening of Future Motor Performance: The Prospective Yakumo Study

Purpose

Aging of society has increased the need for prolongation of a healthy lifespan through maintenance of physical function. Prediction of future physical function may be possible by screening for stage 1 locomotive syndrome (LS). In this prospective study, we examined the influence of LS stage 1 at baseline (2011) on physical performance after 5 years (2016) in a community-dwelling cohort.

Methods

The participants were elderly adults aged >40 years who attended public health checkups as part of the Yakumo Study. LS screening in 2011 and 2016 was performed using the 25-question geriatric locomotive function scale (GLFS-25), the stand-up test, and the two-step test. LS of stage 1 or 2 was defined if the participant met the criteria in any of the three tests. Participants not meeting LS criteria were defined as the no risk group. Physical performance tests (10 m gait time, back muscle strength, 3 m TUG, and maximum stride) were also performed in 2011 and 2016.

Results

A total of 113 subjects (49 males, 64 females; average age 65.0 years) were followed from 2011 to 2016. At baseline, 73 (65%) had no risk, 29 (25%) had stage 1 LS, and 11 (10%) had stage 2 LS. Five years later, 51 (45%) had no risk, 45 (40%) had stage 1 LS, and 17 (15%) had stage 2 LS. Of the 73 subjects with no risk at baseline, 23 (32%) had stage 1 LS and 1 (1%) had stage 2 LS after 5 years. The baseline stage 1 LS group had significantly worse physical performance after 5 years, compared to the baseline no risk group (p < 0.05).

Conclusions

This longitudinal study showed that stage 1 LS screening is important for prevention of motor dysfunction in middle-aged and elderly people.

Relationships between Spinal Sarcopenia and Spinal Sagittal Balance in Older Women

Background

Spinal sarcopenia is receiving renewed attention as a cause of spinal sagittal imbalance. However, the relationships between spinal sarcopenia and spinal sagittal balance (SSB) have not been thoroughly investigated. We evaluated the relationships between SSB parameters and sarcopenic indices with lumbar paraspinal muscle (LPM) quantity and strength in healthy older adults.

Methods

Twenty-four healthy community-dwelling older women were enrolled. Demographic variables, conventional sarcopenic indices, isometric back muscle strength, and SSB parameters, as well as results of functional examinations and lumbar spine computed tomography scan with LPM cross-sectional area (CSA) and density assessments, were examined. The independent effect on the sum of the total LPM CSA was determined using multivariable regression analysis adjusted for age, appendicular skeletal muscle mass, gait speed, handgrip strength, back extensor strength, and pelvic tilt (PT) angle.

Results

PT angle was significantly correlated with the sum of the total LPM CSA and mean LPM density (r=-0.502, p=0.015 and r=0.504, p=0.014, respectively). Furthermore, PT angle was an independent factor for the sum of the total LPM CSA (β=-0.610, p=0.021) in the multivariate regression models (R²=0.320).

Conclusion

Our data suggest that PT angle was significantly correlated with LPM CSA in healthy older women. To our knowledge, this is the first report to investigate the relationships of sarcopenic indices and spinal muscle degeneration with SSB.

Increase in lumbar kyphosis and spinal inclination, declining back muscle strength, and sarcopenia are risk factors for onset of GERD: a 5-year prospective longitudinal cohort study

PURPOSE

The objective was to identify risk factors for new development of gastroesophageal reflux disease (GERD) 5 years later in a prospective longitudinal cohort study.

METHODS

A total of 178 subjects (male 72, female 106, mean age 68 years) without GERD in 2013 were examined for GERD in 2018. A Frequency Scale for Symptoms of GERD score ≥ 8 was used for diagnosis of GERD. Body mass index, spinal alignment, muscle strength, physical ability, number of oral drugs per day, sarcopenia, and frailty determined in 2013 and 2018 were compared between the GERD(+) and GERD(-) groups in 2018. Aggravation of lumbar kyphosis and spinal inclination from 2013 to 2018 was defined as a change of ≥ 5° or ≥ 10°, and weakening of back muscle strength as a change of ≥ 10 kg. QOL (SF-36) was also examined.

RESULTS

Of the 178 subjects, 38 (21%) were diagnosed as GERD(+) in 2018. Sarcopenia in 2018 was significantly related to a GERD(+) status (p < 0.05). The GERD(+) group had significantly higher rates of changes of lumbar kyphosis ≥ 5° (p < 0.005) and ≥ 10° (p < 0.0001), of spinal inclination ≥ 5° (p < 0.0001), and of decreased back muscle strength ≥ 10 kg (p < 0.05). SF-36 were also significantly worse in the GERD(+) group (p < 0.05).

CONCLUSIONS

This prospective longitudinal study firstly demonstrated that lumbar kyphotic change, aggravation of spinal inclination, decreased back muscle strength, and sarcopenia are significant risk factors for new development of GERD. Management and prevention of these factors may contribute to reduction of GERD symptoms and increased QOL in middle-aged and elderly people. These slides can be retrieved under Electronic Supplementary Material.

The decreasing phase angles of the entire body and trunk during bioelectrical impedance analysis are related to locomotive syndrome

BACKGROUND

The phase angle (measured via bioelectrical impedance analysis [BIA]) is an indicator of cell membrane function and used for prognostic evaluation of diseases. Locomotive syndrome (LS) has been advocated in the evaluation of physical ability. This study aimed to determine the relationship between LS and the phase angle as well as muscle mass, muscular strength, and motor function.

METHODS

In this prospective cohort study, 541 patients undergoing a health checkup participated. All participants were assessed using a 25-question geriatric locomotive function scale for the diagnosis of LS, phase angle, and muscle mass measurements via BIA. Grip strength, back muscle strength, and 3-m timed-up-and-go (TUG) test measurements were used as physical performance tests. Patients were divided into non-LS and LS groups, and their characteristics were compared. We assessed whether the phase angle was related to LS, whether it could be a risk factor in multivariate analysis, and the most important part of the phase angle.

RESULTS

Age, the whole body phase angle, grip strength, back muscle strength, and TUG test result were significantly different between the two groups. Logistic regression analysis revealed that the whole body phase angle and TUG test result were risk factors of LS. Based on the subanalysis targeting specific phase angles, the trunk phase angle was a significant important factor for LS.

CONCLUSION

The phase angle was significantly related to LS, and the decreased phase angle was a significant risk factor of LS together with the TUG test result. Furthermore, in subgroup analysis, the phase angle of the trunk was a significant important factor of LS. BIA can be performed conveniently, and it has been widely used for health checkups and in clinical practice. Focusing on the phase angle in BIA may be additionally helpful for the early detection and early intervention of LS.

Features of trunk muscle weakness in patients with ankylosing spondylitis: A cross-sectional study

BACKGROUND

Ankylosing spondylitis (AS) is an inflammatory autoimmune disorder that manifested with sacroiliitis at its early stage and developed extensive inflammation with syndesmophytes of the lumbar, thoracic and cervical spines at its later stage. In the present study, we characterized the trunk isometric strength in patients with AS with different disease severity, defined by the radiological images.

METHODS

In a cross-sectional study conducted in a university-affiliated hospital, thirty-eight male AS patients (23 in the early AS group whose radiological findings showed no syndesmophyte, Modified Stoke Ankylosing Spinal Score (m-SASSS <3); and 15 in the syndesmophyte group, m-SASSS ≥24), and 22 healthy controls were recruited. All subjects received assessments of maximum isometric strength of trunk flexor and extensor muscles at a variety of trunk postures measured by an isokinetic device.

RESULTS

Under all examined trunk postures, the syndesmophyte AS patient group had the lowest isometric trunk muscle strength among the three groups. The flexion/extension ratio, defined by the ratio between isometric trunk flexor and extensor strengths, was highest among the three groups.

CONCLUSIONS

Trunk muscle strength significantly decreases in patients with syndesmophyte AS. The decrease of trunk muscle is inhomogeneous, which is more profound in extensor than in flexor muscles.

Association between locomotive syndrome and blood parameters in Japanese middle-aged and elderly individuals: a cross-sectional study

Background

Locomotive syndrome (LS) is associated with weakness and loss of function in the musculoskeletal organs. We aimed to determine the association between LS components and blood parameters in middle-aged and elderly individuals.

Methods

We included 223 middle-aged and elderly individuals in this study (104 men and 119 women; age: 40–85 years). All participants were asked to fast for at least 3 h before the venous blood samples were obtained and the hemoglobin, total protein, glycated hemoglobin (HbA1c), growth hormone, albumin and lipid profile were measured. Three functional tests, the stand-up test, the two-step test, and the 25-question geriatric locomotive function scale (GLFS) were used to assess the risk of LS. Walking speed was assessed by the 10-m walking test. Maximal isometric muscle strengths of the knee extensors were examined, and the weight bearing index (knee extension strength/body weight) was calculated. To assess an independent association between blood parameters and LS, the area under the receiver operating characteristic curve analysis (area under the curve, sensitivity, and specificity) and a binary logistic regression analysis were performed with adjustment for age.

Results

Of the 223 subjects, 119 (53.3%) fulfilled the diagnostic criteria for LS (including a two-step test score < 1.3, difficulty with one-leg standing from 40 cm in the stand-up test, and a 25-question GLFS score ≥ 7). Increased levels of HbA1c were significant risk factors for LS with an OR of 2.62 (OR_95%CI = 1.43–4.80), as determined by a logistic regression analysis. Additionally, dehydroepiandrosterone-sulfate (DHEA-S) levels were significant only in the male subjects (OR = 0.992 [OR_95%CI = 0.986–0.998]), at a threshold of 88 (AUC; 0.70, sensitivity; 79.6%, specificity; 49.1%). Moreover, 101 of 223 participants (41 men, 60 women) were analyzed for serum albumin levels, with a prevalence of LS at 55.4%, indicating that low levels of albumin were significant risk factors for LS (OR = 0.148 [OR_95%CI = 0.023–0.954], p = 0.0445).

Conclusions

These results suggest that higher HbA1c and lower albumin are associated with the prevalence of LS in Japanese middle-aged and elderly individuals. Furthermore, low DHEA-S levels may be useful screening tools for LS in men.

Effects of a progressive walking program on the risk of developing locomotive syndrome in elderly Japanese people: a single-arm trial

[Purpose] This study aimed to identify the efficacy of a progressive walking program on the risk of developing locomotive syndrome among untrained elderly Japanese people. [Participants and Methods] Twenty-four untrained elderly individuals (68 ± 4 years) completed a 17-week progressive walking program. The stand-up, two-step tests and the 25-question geriatric locomotive function scale were used to assess the risk of locomotive syndrome at baseline, the 8-week midpoint (2 months), and the 17-week endpoint (4 months). Maximal isometric muscle strength of the knee extensors and flexors were measured using a dynamometer with the hip joint angle at 90° of flexion and physical function (the 30-s sit-to-stand, sit-up, 10-meter walk, and grip strength) were evaluated. [Results] The 4-month walking program significantly improved the two-step test and geriatric locomotive function scale scores. This may be attributable to the improvement in knee flexor strength and physical function. [Conclusion] A 4-month program of progressive walking effectively lowered the risk of developing locomotive syndrome in elderly Japanese people by improving knee flexor muscle strength and physical function.

Relationship between locomotive syndrome and body composition among community-dwelling middle-age and elderly individuals in Japan: The Yakumo study

OBJECTIVES

Locomotive syndrome (LS) is a condition requiring nursing care for musculoskeletal disorders. Our aim was to evaluate the correlation between body composition, measured by bioelectrical impedance analysis (BIA), and LS, measured using the 25-question Geriatric Locomotive Functional Scale (GLFS-25).

METHODS

We enrolled 286 individuals who were undergoing regular health follow-up. All individuals completed the GLFS-25, body composition analysis by BIA, and five physical performance tests related to LS: timed up-and-go test, 10-m gait time, maximum stride length, back strength, and grip strength. Measured variables and demographic data were compared between individuals with and without LS.

RESULTS

The extracellular water ratio, the extracellular water/total body water (ECW/TBW) ratio differentiated the LS and non-LS groups (p=.005), with all physical function measures being lower among individuals with a high, compared to low, ECW/TBW ratio. The risk ratio for LS among individuals with a high ECW/TBW ratio was 2.31, with an odds ratio of 2.67.

CONCLUSION

The ECW/TBW ratio is predictive of LS. Based on our results, we propose that BIA should routinely be performed, with follow-up and intervention, as needed, for individuals with a high ECW/TBW ratio, as they are at risk for developing LS.

The utility of 25-question Geriatric Locomotive Function Scale for evaluating functional ability and disease activity in Japanese rheumatoid arthritis patients: A cross-sectional study using NinJa database

OBJECTIVES

To investigate the distribution of 25-question Geriatric Locomotive Function Scale (GLFS-25) scores in Japanese rheumatoid arthritis (RA) patients and evaluate relationships with clinical variables.

METHODS

Among 15,115 patients registered in the NinJa database for fiscal year 2015, 1710 with complete GLFS-25 and disease activity score-28 (DAS28) data were analyzed. Correlations between GLFS-25 score and clinical variables were assessed by Spearman coefficients. Mean GLFS-25 scores were compared among DAS28 groups (<2.6, 2.6-3.1, 3.2-5.0, ≥5.1) using the Kruskal-Wallis test. To evaluate the performance of the GLFS-25 and Health Assessment Questionnaire Disability Index (HAQ-DI) for predicting DAS28 ≥ 3.2 (moderate/high disease activity), receiver operator characteristic (ROC) curves were constructed.

RESULTS

GLFS-25 score was significantly correlated with age, disease duration, DAS28, and HAQ-DI. GLFS-25 score increased in parallel with DAS28. The proportion of patients with locomotive syndrome stage 2 also increased with DAS28. Area under the curve values for HAQ-DI and GLFS-25 score were 0.739 and 0.768, respectively. At a GLFS-25 positive cutoff score ≥16, sensitivity was 0.716 and specificity was 0.661 for predicting DAS28 ≥ 3.2.

CONCLUSION

This study documents the GLFS-25 score distribution in Japanese RA patients and demonstrates that GLFS-25 is a useful measure for evaluating functional ability in RA.

The impact of musculoskeletal diseases on the presence of locomotive syndrome

OBJECTIVES

We assessed the impact of musculoskeletal diseases, depressive mental state, and hypertension on locomotive syndrome, a condition of reduced mobility requiring nursing care. Since locomotive syndrome is a major public health issue that needs attention, its relationship with functional inconvenience in performing daily activities was also investigated.

METHODS

We conducted a cross-sectional study using an Internet panel survey, comprising 747 persons aged 30-90 years. Demographics, personal medical history, and daily activity data were assessed. The 25-question Geriatric Locomotive Function Scale was used to diagnose locomotive syndrome. Stepwise linear regression analysis and logistic regression analysis were conducted to evaluate the association between locomotive syndrome, musculoskeletal diseases, and functional inconvenience.

RESULTS

Aging, osteoporosis, and low back pain significantly increased the risk of locomotive syndrome, followed by knee osteoarthritis and lumbar spinal stenosis. Locomotive syndrome was significantly related to depressive mental state and hypertension, and led to functional inconvenience in Seiza sitting, cleaning, shopping, and strolling.

CONCLUSION

Locomotive syndrome was associated with functional inconvenience in performing common daily activities involving the lower extremities and spine. Osteoporosis and aging were significantly associated with locomotive syndrome. The risk of locomotive syndrome may be decreased by treating comorbid osteoporosis and instituting exercise and diet-related modifications.

Age-related reduction of trunk muscle torque and prevalence of trunk sarcopenia in community-dwelling elderly: Validity of a portable trunk muscle torque measurement instrument and its application to a large sample cohort study

Trunk muscle weakness and imbalance are risk factors for postural instability, low back pain, and poor postoperative outcomes. The association between trunk muscle strength and aging is poorly understood, and establishing normal reference values is difficult. We aimed to establish the validity of a novel portable trunk muscle torque measurement instrument (PTMI). We then estimated reference data for healthy young adults and elucidated age-related weakness in trunk muscle strength. Twenty-four university students were enrolled to validate values for PTMI, and 816 volunteers from the general population who were recruited to the Iwaki Health Promotion Project were included to estimate reference data for trunk muscle strength. Trunk flexion and extension torque were measured with PTMI and KinCom, and interclass correlation coefficients (ICC) were estimated to evaluate the reliability of PTMI values. Furthermore, from the young adult reference, the age-related reduction in trunk muscle torque and the prevalence of sarcopenia among age-sex groups were estimated. The ICC in flexion and extension torque were 0.807 (p<0.001) and 0.789 (p<0.001), respectively. The prevalence of sarcopenia increased with age, and the prevalence due to flexion torque was double that of extension torque. Flexion torque decreased significantly after 60 years of age, and extension torque decreased after 70 years of age. In males over age 80, trunk muscle torque decreased to 49.1% in flexion and 63.5% in extension. In females over age 80, trunk muscle torque decreased to 60.7% in flexion and 68.4% in extension. The validity of PTMI was confirmed by correlation with KinCom. PTMI produced reference data for healthy young adults, and demonstrated age-related reduction in trunk muscle torque. Trunk sarcopenia progressed with aging, and the loss of flexion torque began earlier than extension torque. At age 80, trunk muscle torque had decreased 60% compared with healthy young adults.

Lifestyle factors are significantly associated with the locomotive syndrome: a cross-sectional study

Background

The Japanese Orthopedic Association first proposed the concept of “locomotive syndrome” in 2007. It refers to circumstances in which elderly people need nursing care services or are at high risk of requiring such services within a short time. Recently, the public health burden of providing nursing care for elderly individuals has increased. Therefore, locomotive syndrome, and the means of preventing it, are a major public health focus in Japan. The purpose of this study was to investigate the relationships of lifestyle factors, such as smoking, alcohol consumption, sleep duration, and dental health, with locomotive syndrome.

Methods

We conducted a cross-sectional study using an internet panel survey. The participants comprised 747 individuals aged 30–90 years. Factors related to demographics (age, sex), general health (number of teeth, presence of periodontal disease), and lifestyle (smoking, alcohol consumption, sleep duration) were assessed. We also used the 25-question Geriatric Locomotive Function Scale to determine whether each participant had locomotive syndrome. Multivariate analysis was conducted using logistic regression to investigate the independent relationships between locomotive syndrome and lifestyle factors after adjusting for sex and age.

Results

A greater proportion of women (17.7%) than men (11.2%) had locomotive syndrome (p < 0.05). Participants aged ≥65 years showed significantly higher percentages (men: 21.4%, women: 75.7%) of locomotive syndrome compared with those aged <65 years (p < 0.05). Logistic regression analysis revealed that older age (≥ 65 years), sex, current smoking status, number of existing teeth, and presence of periodontal disease were associated with locomotive syndrome, whereas sleep duration was not. The frequency of alcohol consumption, except for daily drinking, was also associated with locomotive syndrome.

Conclusion

Our study indicates that lifestyle factors, such as smoking and number of existing teeth, may partly affect the prevalence of locomotive syndrome. Hence, lifestyle modifications, such as improving oral hygiene and promoting cessation of smoking, are important means to reduce the risk of locomotive syndrome and should be promoted by public health staff.

Staged decrease of physical ability on the locomotive syndrome risk test is related to neuropathic pain, nociceptive pain, shoulder complaints, and quality of life in middle-aged and elderly people - The utility of the locomotive syndrome risk test

OBJECTIVES

A locomotive syndrome (LS) risk test for evaluation of physical ability is recently proposed. The objective of this study is to evaluate the utility of this test by examining physical ability, neuropathic pain, nociceptive pain, shoulder complaints, and quality of life (QOL).

METHODS

A prospective cohort study was conducted in 523 subjects (240 males, 283 females; mean age: 63.3 years) at a health checkup. Data collected using visual analog scales (VAS) for shoulder pain, low back pain, sciatica, and knee pain, neuropathic pain, shoulder complaint, body mass index (BMI), osteoporosis, and SF-36 were compared among three LS risk stages.

RESULTS

Subjects in LS risk stage 1 (24%) had significantly more osteoporosis, slower gait speed, weaker muscle strength and higher VAS, with no difference in age and BMI compared to those with no LS risk (50%). Subjects in stage 2 (26%) had significantly poorer results for all items. Shoulder complaint, neuropathic pain and QOL differed significantly among all three groups and worsened with decline in mobility on the LS risk test.

CONCLUSIONS

LS risk test is easy and useful screening tool for evaluation of mobility and for screening for pain and complaint associated with activity of daily living and QOL.

Locomotive syndrome is associated with body composition and cardiometabolic disorders in elderly Japanese women

Background

A concept referred to as locomotive syndrome (LS) was proposed by the Japanese Orthopaedic Association in order to help identify middle-aged and older adults who may be at high risk of requiring healthcare services because of problems associated with locomotion. Cardiometabolic disorders, including obesity, hypertension, diabetes, and dyslipidemia, have a high prevalence worldwide. The purpose of this study was to determine the associations between LS and both body composition and cardiometabolic disorders.

Methods

The study participants were 165 healthy adult Japanese women volunteers living in rural areas. LS was defined as a score ≥16 on the 25-question Geriatric Locomotive Function Scale (GLFS-25). Height, body weight, body fat percentage, body mass index (BMI), and bone status were measured. Bone status was evaluated by quantitative ultrasound (i.e., the speed of sound [SOS] of the calcaneus) and was expressed as the percent of Young Adult Mean of the SOS (%YAM). Comorbid conditions of hypertension, hyperlipidemia, and diabetes were assessed using self-report questionnaires.

Results

Twenty-nine participants (17.6 %) were classed as having LS. The LS group was older, shorter, and had a higher body fat percentage, a higher BMI, and lower bone status than the non-LS group. Multiple logistic regression analysis showed that participants with a BMI ≥23.5 kg/m² had a significantly higher risk for LS than those with a BMI <23.5 kg/m² (odds ratio [OR] = 3.78, p < 0.01). Furthermore, GLFS-25 scores were higher in participants with than those without hypertension, diabetes, or obesity, and significantly increased with the number of present disorders.

Conclusions

These findings suggest that BMI may be a useful screening tool for LS. Furthermore, because hypertension and diabetes were associated with LS, the prevention of these disorders accompanied by weight management may help protect against LS.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0339-6) contains supplementary material, which is available to authorized users.

Effects of an adapted physical activity program on psychophysical health in elderly women

Background

Several studies have shown the positive effects of adapted physical activity (APA) on physical and mental health (MH) during the lifetime. The aim of this study was to assess the effectiveness of a specific APA intervention program in the improvement of the health-related quality of life (QOL) and functional condition of spine in elderly women.

Methods

Thirty women were recruited from a senior center and randomly assigned to two groups: control group (CG; age: 69.69±7.94 years, height: 1.57±0.06 m, weight: 68.42±8.18 kg, body mass index [BMI]: 27.88±2.81) and trained group (TG; age: 68.35±6.04 years, height: 1.55±0.05 m, weight: 64.78±10.16 kg, BMI: 26.98±3.07). The APA program was conducted for 8 weeks, with two training sessions/week. CG did not perform any physical activity during the study. Spinal angles were evaluated by SpinalMouse^® (Idiag, Volkerswill, Switzerland); health-related QOL was evaluated by SF-36 Health Survey, which assesses physical component summary (PCS-36), mental component summary (MCS-36), and eight subscales: physical functioning, role-physical, bodily pain, general health perception, role-emotional, social functioning, vitality, and MH. All measures were recorded before and after the experimental period.

Results

In TG, compared to CG, the two-way analysis of variance with repeated measures with Bonferroni post hoc test showed a relevant improvement in lumbar spinal angle (°) and in SF-36 outcomes after the intervention period. We showed a significant increase in physical functioning, bodily pain, and MH subscales and in PCS-36 and MCS-36 scores in TG compared to CG. In particular, from baseline to posttest, we found that in TG, the PCS-36 and MCS-36 scores increased by 13.20% and 11.64%, respectively.

Conclusion

We believe that an 8-week APA intervention program is able to improve psychophysical heath in elderly people. During the aging process, a dynamic lifestyle, including regular physical activity, is a crucial factor for public and health care systems to improve QOL and physical fitness in aging people.

Locomotive syndrome presents a risk for falls and fractures in the elderly Japanese population

“Locomotive syndrome” is used to designate the condition of individuals with musculoskeletal disease who are highly likely to require nursing care. This article reviews screening, prevalence, causal and related factors, and the relationship between locomotive syndrome and falls and fractures in older adults with this syndrome. A few self-administered questionnaire tools are available to assess individuals for locomotive syndrome. Additionally, screening methods, including a physical functioning assessment, are appropriate for detailed discrimination of locomotive syndrome. The prevalence of locomotive syndrome is significantly higher in women than in men, and tends to increase markedly from 70 years of age. More severe locomotive syndrome is related to knee pain, osteoporosis, sarcopenia, and lumbar disease. The incidence of falling in locomotive syndrome is higher than the incidence for the older population in general. Locomotive training including squats and a unipedal standing exercise has been recommending to prevent locomotive syndrome. This training improves muscle strength and balance function for older people who have a risk for locomotive syndrome.

Lumbar spondylosis, lumbar spinal stenosis, knee pain, back muscle strength are associated with the locomotive syndrome: Rural population study in Japan

OBJECTIVES

To comprehensively investigate the clinical and physical factors associating with locomotive syndrome (Loc-S); the locomotorium-disability for daily life.

METHODS

647 volunteers participated (247 males, 400 females, Age: 58.4 ± 11.0, BMI: 22.5 ± 3.3). Three self-assessment questionnaires were administered: 1) "25-question Geriatric Locomotive Function Scale" (GFLS-25) for evaluating Loc-S (GLFS-25 ≥ 16 defined as Loc-S); 2) "diagnostic support tool for LSS" (LSS-DST) for evaluating the prevalence of lumbar spinal stenosis (LSS); 3) Knee injury and Osteoarthritis Outcome Score (KOOS). Plain radiographs of the bilateral knees and lumbar spine were evaluated, and the severity of lumbar spondylosis (LS) and knee osteoarthritis (KOA) defined by Kellgren-Lawrence grade. Bone status was evaluated by using the osteo-sono assessment index (OSI) at the calcaneus. Isometric muscle strength of trunk and leg (Nm/kg, both extension and flexion) were evaluated. Linear regression analysis was performed to elucidate the factors concerned with GFLS-25 including age, sex, and BMI.

RESULTS

Thirty-nine subjects (6.0%, 13 males, 26 females) were defined as having Loc-S. Single regression model showed that age, height, BMI, skeletal muscle mass, OSI, LSS, KOOS, the severity of LS and KOA, and trunk- and leg-muscle strength were correlated with the degree of GLFS-25. Stepwise multiple regression model showed that sex, height, LSS, KOOS, the severity of LS, and back muscle strength were significantly correlated with that of GLFS-25.

CONCLUSION

In this cross-sectional study, pain status associated with LSS and knee joint, structural severity for LS, and back muscle strength primarily affected the degree of GFLS-25. For managing Loc-S, we must pay more intensive attention to these factors.

Gait variability analysed using an accelerometer is associated with locomotive syndrome among the general elderly population: The GAINA study

BACKGROUND

Gait variability analysed using an accelerometer provides a unique measurement of locomotive dysfunction in patients with musculoskeletal disease or in frail elderly subjects. Therefore, assessing gait variability may become a clinical screening method for the locomotive syndrome. The purpose of this study was to investigate whether gait variability analysed using an accelerometer was associated with locomotive syndrome in the general elderly population.

METHODS

A total of 273 residents were screened after a yearly medical check-up, and of these, 223 subjects (mean age, 73.6 ± 8.3 years) met the eligibility criteria. Demographic information, body function and structure measurements (bone mass, grip strength, muscle mass, and postural alignment), and gait parameters were assessed. Gait variability analysis was based on acceleration using a wireless tri-axial accelerometer attached to the 3rd lumbar vertebra process by a trunk belt. Autocorrelation coefficients were used to represent gait variability in three directions: vertical, mediolateral, and anteroposterior. The subjects were classified as either having or not having the locomotive syndrome based on the 5-question Geriatric Locomotive Function Scale.

RESULTS

Of the 223 subjects, 41 (18.3%) had the locomotive syndrome. Autocorrelation coefficients in three directions were lower in the subjects with locomotive syndrome. Using multivariate logistic regression analysis with adjustment factors, of the autocorrelation coefficients only gait variability in the vertical axis remained a significant independent associated with the locomotive syndrome.

CONCLUSION

This finding suggested that gait variability based on evaluation of autocorrelation coefficients in the vertical axis measured using an accelerometer has the potential to become a screening method for the locomotive syndrome in the general elderly population.

Spinal sagittal balance substantially influences locomotive syndrome and physical performance in community-living middle-aged and elderly women

OBJECTIVES

Spinal sagittal imbalance has been well known risk factor of decreased quality of life in the field of adult spinal deformity. However, the impact of spinal sagittal balance on locomotive syndrome and physical performance in community-living elderly has not yet been clarified. The present study investigated the influence of spinal sagittal alignment on locomotive syndrome (LS) and physical performance in community-living middle-aged and elderly women.

METHODS

A total of 125 women between the age of 40-88 years (mean 66.2 ± 9.7 years) who completed the questionnaires, spinal mouse test, physical examination and physical performance tests in Yakumo study were enrolled in this study. Participants answered the 25-Question Geriatric Locomotive Function Scale (GLFS-25), the visual analog scale (VAS) for low back pain (LBP), knee pain. LS was defined as having a score of >16 points on the GLFS-25. Using spinal mouse, spinal inclination angle (SIA), thoracic kyphosis angle (TKA), lumbar lordosis angle (LLA), sacral slope angle (SSA), thoracic spinal range of motion (TSROM), lumbar spinal range of motion (LSROM) were measured. Timed-up-and-go test (TUG), one-leg standing time with eyes open (OLS), and maximum stride, back muscle strength were also measured. The relationship between spinal sagittal parameters and GLFS-25, VAS and physical performance tests were analyzed.

RESULTS

26 people were diagnosed as LS and 99 were diagnosed as non-LS. LBP and knee pain were greater, physical performance tests were poorer, SIA were greater, LLA were smaller in LS group compared to non-LS group even after adjustment by age. SIA significantly correlated with GLFS-25, TUG, OLS and maximum stride even after adjustment by age. The cutoff value of SIA for locomotive syndrome was 6°. People with a SIA of 6° or greater were grouped as "Inclined" and people with a SIA of less than 6° were grouped as "Non-inclined". 21 people were "Inclined" and 104 were "Non-inclined". Odds ratio to fall in LS of Inclined group compared to Non-inclined group is 5.0. GLFS-25 were significantly higher, VAS for LBP were greater, TUG, OLS and maximum stride were poorer in Inclined group compared to Non-inclined group even after adjustment by age.

CONCLUSIONS

The present study demonstrated that spinal sagittal balance influences the LS and physical performance in community-living middle-aged and elderly women. SIA is a useful spinal parameter to evaluate the risk of LS, and its cutoff value is 6°.

Changes in spinal range of motion after a flexibility training program in elderly women

BACKGROUND

Aging-related reduced spinal mobility can interfere with the execution of important functional skills and activities in elderly women. Although several studies have shown positive outcomes in response to spinal flexibility training programs, little is known about the management of sets and repetitions in training protocols. The purpose of this study was to investigate the effects of an 8-week specific and standardized flexibility training program on the range of spinal motion in elderly women.

METHODS

PARTICIPANTS WERE RECRUITED IN A SENIOR CENTER OF PALERMO AND RANDOMLY ASSIGNED IN TWO GROUPS: trained group (TG) and control group (CG), which included 19 and 18 women, respectively. TG was trained for 8 weeks at two sessions/week. In particular, every session included three phases: warm up (~10 minutes), central period (~50 minutes), and cool down (~10 minutes). CG did not perform any physical activity during the experimental period. Spinal ranges of motion (ROM) were measured from neutral standing position to maximum bending position and from neutral standing position to maximum extension position before and after the experimental period, using a SpinalMouse® device (Idiag, Volkerswill, Switzerland).

RESULTS

After the training period, TG showed an increase in spinal inclination by 16.4% (P<0.05), in sacral/hip ROM by 29.2% (P<0.05), and in thoracic ROM by 22.5% (P>0.05) compared with CG from maximum extension position to maximum bending position. We did not observe any significant difference in TG's lumbar ROM compared with CG after the training period (P>0.05).

CONCLUSION

We found that an 8-week flexibility training program improved ROMs of the spine in elderly women. The training protocol appeared to be practicable for active elderly people with autonomy and the capability for self-care.

Impact of low back pain, knee pain, and timed up-and-go test on quality of life in community-living people

BACKGROUND

The Japanese Orthopaedic Association (JOA) has proposed the term "locomotive syndrome" (LS) to designate a condition in people from high-risk groups with musculoskeletal disease who are highly likely to require nursing care at some point. This syndrome is caused by weakening of the musculoskeletal organs such as bone, joint, and muscle. The current study investigated factors that influence quality of life (QOL) loss caused by LS, which builds upon our previous study showing that LS affects individuals' QOL.

METHODS

We enrolled 386 subjects >50 years old. Sex, age, body mass index and bone mineral density, plus physical function tests of grip strength, back muscle strength, maximum stride, 10-m gait time, functional reach (cm), timed up-and-go test (TUG) (s) and one-leg standing time (s), and the visual analogue scale assessments for leg numbness and knee, low back and leg pain were selected as independent variables in a multiple regression model for the JOA Back Pain Evaluation Questionnaire (JOABPEQ), the Short Form-36 (SF-36), and the Roland Morris Disability Questionnaire (RDQ) scores.

RESULTS

Low back pain contributed significantly to all JOABPEQ scores. Knee pain and TUG contributed significantly to 4/5 and 3/5 of the JOABPEQ scores, respectively. Age, TUG, knee pain, and low back pain contributed significantly to the RDQ and the physical component summary of the SF-36.

CONCLUSIONS

Low back and knee pain proved to be significant contributors to individuals' QOL. TUG might be the most valuable function test for effectively evaluating an individual's QOL.