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Alshehre YM, Almutairi SM. Prevalence of falls among adult mothers in Saudi Arabia: a cross-sectional study. BMC Womens Health 2023; 23:587. [PMID: 37946121 PMCID: PMC10636813 DOI: 10.1186/s12905-023-02760-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The prevalence of falls among mothers (18-49 years old) in Saudi Arabia has been overlooked and understudied. Therefore, the study aimed to identify the 1-year prevalence, rate of falls, and consequent injuries among mothers in Saudi Arabia. METHODS In this cross-sectional study, a self-administered online questionnaire, including sociodemographic data and questions related to the history of falls and consequent injuries during the past 12 months, was disseminated through social media in Saudi Arabia. RESULTS A convenience sample of 986 mothers were voluntarily recruited for this study with a median age of 33 years and an interquartile range of 10 years. The 1-year prevalence of falls among mothers was 14.1 % (n = 139), and 52.5 % (n = 73/139) of the fallers experienced more than one fall. Among mothers who had experienced a fall, 25.4 % (n = 33/139) experienced a fall incident during pregnancy. The reported consequences of falls were pain in 37.4 % (n = 52/139), muscle and ligament injuries in 7.2 % (n = 10/139), and fractures in 2.2 % (n = 3/139) of participants. The study's findings indicate that asthma and high cholesterol level predicts the risk of falls in mothers. CONCLUSIONS According to our convenience sampling, 14.1% of mothers had experienced one or more falls in the past 12 months. The increased prevalence of falls among this age group of women supports the idea that falls are not only an issue for the older adult population, but fall prevention strategies for this age range are also needed.
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Affiliation(s)
- Yousef M Alshehre
- Department of Physiotherapy, Faculty of Applied Medical Sciences, University of Tabuk, 71491 University of Tabuk, Tabuk, 47713, Saudi Arabia.
| | - Sattam M Almutairi
- Physiotherapy Department, College of Medical Rehabilitation Science, Qassim University, Buraydah, Saudi Arabia
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Obesity Is Associated With Gait Alterations and Gait Asymmetry in Older Adults. Motor Control 2023; 27:6-19. [PMID: 35393368 DOI: 10.1123/mc.2021-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The prevalence of obesity (OB) has increased in the older adult (OA) population. However, it is not quite clear whether OB exaggerates gait instability and leads to a higher risk of falls in OAs. The first goal of this study was to investigate whether OB is associated with gait alterations and gait asymmetry in OAs. The second goal of this study was to examine relationships between various OB measures with gait measures and gait symmetry measures in OAs. METHODS A total of 30 OAs were included and categorized according to their body mass index (BMI) values into groups of persons with normal weight (NW), overweight (OW), and OB. Participants were required to complete an anthropometric assessment, a body composition assessment, and overground walking tests. RESULTS The group with OB had shorter swing phase, longer stance phase, and shorter single support phase than the NW group. Increased body weight, BMI, visceral adipose tissue mass, and android fat had correlations with shorter swing phase, longer stance phase, and shorter single support phase. Increased body weight and BMI had significantly positive correlations with symmetry index of knee range of motion. CONCLUSIONS OB may impair gait automation capacity in OAs. Both body weight and BMI remain good measures in terms of establishing correlations with gait stability in OAs. However, the amount of fat mass surrounding the abdomen could be vital to interpreting the alterations in the gait of OAs with obesity.
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Bohrer RCD, Lodovico A, Duysens J, Rodacki ALF. Multifactorial assessment of older adults able and unable to recover balance during a laboratory-induced trip. Curr Aging Sci 2022; 15:172-179. [PMID: 35114929 DOI: 10.2174/1874609815666220202123523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/03/2021] [Accepted: 11/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Older adults are prone to falls, and identifying fallers and non-fallers from a set of fall-related variables is essential while establishing effective preventive programs. AIMS This study aimed to analyze if a set of parameters (i.e., strength, functional status, dynamic balance, gait, and obesity-related anthropometric measures) differ between older adults able and unable to recover from an induced trip. OBJECTIVE To analyze predictors among older adults able and unable to identify fallers and non-fallers. METHODS Thirty healthy old adults were tripped once during the mid-swing phase of the gait. The trip outcome was used as a criterion to assign participants to a recovery (REC; n=21; 71.2±5.7 years; 70.9±12.8 kg; 1.60±0.09 m) or a non-recovery group (NREC; n=9; 69.4±6.8 years; 85.7±11.8 kg; 1.59±0.08 m). The spatiotemporal gait parameters, functional mobility, dynamic balance, and isokinetic muscular function were measured. RESULTS The NREC presented larger BMI (33.6±2.7 vs. 27.5±3.4 kg.m-2; p<0.05); greater time for the initiation phase on the voluntary step execution test (197.0±27.9vs. 171.7±31.3s; p<0.05); lower plantarflexor (0.41±0.15 vs. 0.59±0.18 N.m; p<0.05), dorsiflexor (0.18±0.05 vs. 0.24±0.07 N.m; p<0.05), knee extensor (1.03±0.28 vs. 1.33±0.24 N.m; p<0.05) and knee flexor peak torques (0.50±0.15 vs. 0.64±0.13 N.m; p<0.05); and greater time up and go (8.0±0.8 vs. 7.4±0.7s). CONCLUSIONS The results showed that it is possible to identify fall risk components based on several fall-related parameters using a laboratory-induced trip as the outcome variable.
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Affiliation(s)
- Roberta Castilhos Detanico Bohrer
- Federal University of Paraná, Department of Physical Education, Rua Coronel Heráclito dos Santos, 100, Jardim das Américas, 81530-000, Curitiba, Paraná - Brazil
| | - Angélica Lodovico
- Federal University of Paraná, Department of Physical Education, Rua Coronel Heráclito dos Santos, 100, Jardim das Américas, 81530-000, Curitiba, Paraná - Brazil
- Inspirar Faculty, Rua João Tschannerl, 880, Jardim Schaffer -, 80820-010 Curitiba, Paraná - Brazil
| | - Jacques Duysens
- University of Leuven, Faculty of Movement and Rehabilitation Sciences, Tervuursevest 101, 3001 Heverlee - Belgium
| | - André Luiz Felix Rodacki
- Federal University of Paraná, Department of Physical Education, Rua Coronel Heráclito dos Santos, 100, Jardim das Américas, 81530-000, Curitiba, Paraná - Brazil
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Van Hulten V, Rasmussen N, Driessen JHM, Burden AM, Kvist A, van den Bergh JP. Fracture Patterns in Type 1 and Type 2 Diabetes Mellitus: A Narrative Review of Recent Literature. Curr Osteoporos Rep 2021; 19:644-655. [PMID: 34931295 PMCID: PMC8716348 DOI: 10.1007/s11914-021-00715-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW In this narrative review, we have summarized the literature on fracture risk in T1DM and T2DM with a special focus on fracture site, time patterns, glucose-lowering drugs, and micro- and macrovascular complications. RECENT FINDINGS T1DM and T2DM were associated with an overall increased fracture risk, with preferent locations at the hip, vertebrae, humerus, and ankle in T1DM and at the hip, vertebrae, and likely humerus, distal forearm, and foot in T2DM. Fracture risk was higher with longer diabetes duration and the presence of micro- and macrovascular complications. In T2DM, fracture risk was higher with use of insulin, sulfonylurea, and thiazolidinediones and lower with metformin use. The increased fracture risk in T1DM and T2DM concerns specific fracture sites, and is higher in subjects with longer diabetes duration, vascular complications, and in T2DM with the use of specific glucose-lowering medication.
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Affiliation(s)
- V Van Hulten
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | | | - J H M Driessen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - A M Burden
- Department of Chemistry and Applied Biosciences, Institute for Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - A Kvist
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Chemistry and Applied Biosciences, Institute for Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
- Department of Endocrinology and Metabolism, Molecular Endocrinology & Stem Cell Research Unit (KMEB), Odense University Hospital, Odense, Denmark
| | - J P van den Bergh
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands.
- Department of Internal Medicine, Subdivision of Endocrinology, VieCuri Medical Center, Venlo, The Netherlands.
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Tamini S, Cicolini S, Porcu A, Seddone A, Ryan-Wenger N, Sartorio A. Use of a Pediatric Obesity Fall-risk Scale (POFS) in 301 hospitalized obese children and adolescents. J SPEC PEDIATR NURS 2021; 26:e12335. [PMID: 33792145 DOI: 10.1111/jspn.12335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/26/2021] [Accepted: 03/18/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Falls are a significant safety risk in hospitalized patients, but little evidence regarding their significance in obese children are available to date. Aim of the study was to determine whether the Pediatric Obesity Fall-risk Scale (POFS) is able to discriminate between hospitalized obese pediatric patients at high or low risk of falling, to evaluate its sensitivity and specificity and to analyze if the risk factors considered were actually related to the falling event. DESIGN AND METHODS The sample consisted of 301 children and adolescents hospitalized for a body weight reduction program. In this 12-month study, 14.6% of patients experienced a fall during hospitalization, the fall rate per 1000 patient days being 5.33 for the first and 4.36 for the second 6-month of the year. The components of the POFS included chronological age, history of falls, body mass index standard deviation score (BMI-SDS), and the ability to maintain equilibrium. RESULTS No differences were observed between fallers and nonfallers as far as BMI and BMI-SDS are concerned. Compared with patients who did not fall, those who fell were significantly younger and shorter and their weights were lower. The POFS identified 85 patients with high and 216 with low falling risk, the two subgroups being comparable for BMI and BMI-SDS. Compared with patients with low fall-risk, those with high fall-risk were significantly younger and shorter and their weights were lower. The sensitivity of the POFS was 61.4%, while the specificity was 77.4%. The positive predictive value of the POFS was 31.8%, while the negative predictive value was 92.1%. The analyses of each POFS component did not show significant differences between fallers and non-fallers in terms of BMI-SDS and equilibrium test. Compared with patients who did not fall, those who fell were significantly younger, experienced a fall during the 3 months prior the admission in hospital and their total POFS score was higher. PRACTICE IMPLICATIONS Preventing falls in hospitalized obese pediatric patients is challenging due to the markedly increased risk of this population and specific fall-risk assessment tools are required to early identify patients who needs more care, attention, and specific nursing/medical interventions.
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Affiliation(s)
- Sofia Tamini
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
| | - Sabrina Cicolini
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
| | - Anna Porcu
- Nursing Service, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
| | - Angela Seddone
- Nursing Service, Istituto Auxologico Italiano, IRCCS, Verbania, Italy.,Division of Auxology and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
| | - Nancy Ryan-Wenger
- Department of Pediatrics, The Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Alessandro Sartorio
- Experimental Laboratory for Auxo-Endocrinological Research, Istituto Auxologico Italiano, IRCCS, Verbania, Italy.,Division of Auxology and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, Verbania, Italy
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Exploring the association between measures of obesity and measures of trip-induced fall risk among older adults. Arch Phys Med Rehabil 2021; 102:2362-2368. [PMID: 34343524 DOI: 10.1016/j.apmr.2021.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/23/2021] [Accepted: 06/01/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Explore the association between measures of obesity and measures of trip-induced fall risk among community-dwelling older adults. DESIGN Case-control SETTING: Gait laboratory PARTICIPANTS: Voluntary sample of 55 community-dwelling older adults (≥65 years of age) with body mass index (BMI) of 18.84-44.68 kg/m2. INTERVENTIONS Not applicable MAIN OUTCOMES MEASURES: Measures of obesity included six anthropometry-based measures (BMI; thigh, hip and waist circumferences; ratio of waist-to-hip circumference; and index of central obesity) and four DEXA-based measures (percent trunk, leg and total fat; and fat mass index). Measures of risk of tripping during overground walking included median and interquartile range of toe clearance, and area under the swing phase toe trajectory. Measures of trip recovery after a laboratory-induced trip included trunk angle and angular velocity at ground contact of the first recovery step, anteroposterior distance from stepping foot to center of mass at the same instant, and step time of the first recovery step. RESULTS Risk of tripping was associated with waist-to-hip ratio and thigh circumference. After grouping participants by waist-to-hip ratio, those with high ratios (≥0.9 cm for males and ≥0.85 cm for females) exhibited significantly greater variability in toe clearance. Trip recovery was associated with hip circumference, thigh circumference, fat mass index, and total fat. After grouping participants by fat mass index, those with high indices (>9 kg/m2 for males and >13 kg/m2 for females) exhibited less favorable trunk kinematics following a laboratory-induced trip (Cohen's d=0.84). CONCLUSION Waist-to-hip ratio and fat mass index may more closely relate to trip-induced fall risk than BMI among community-dwelling older adults.
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Association between body mass index and falls in community-dwelling men and women: a prospective, multinational study in the Survey of Health, Ageing and Retirement in Europe (SHARE). Eur Geriatr Med 2021; 12:837-849. [PMID: 33817765 DOI: 10.1007/s41999-021-00485-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/11/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the longitudinal associations between body mass index (BMI) categories and falls risk in men and women. METHODS Prospective cohort study using data from 50,041 community-dwelling adults aged ≥ 50 years assessed in Wave 6 and 7 in the cross-national Survey of Health, Ageing and Retirement in Europe (SHARE). Socio-demographic and clinical factors were assessed at baseline (Wave 6). Functional impairment was defined by any limitations in activities of daily living (ADL) or instrumental ADL (IADL). Participants were classified as underweight, normal weight, overweight or obese at baseline. At 2-year follow-up (Wave 7), falls in the previous six months were recorded. The longitudinal associations between BMI categories and falls were analysed by binary logistic regression models; odds ratios (OR) and 95% confidence intervals (CI) were calculated. All analyses were adjusted for socio-demographic and clinical factors. Furthermore, analyses were stratified by sex, age and functional impairment. RESULTS Mean age was 67.0 years (range 50-102); 28,132 participants were women; 4057 (8.1%) participants reported falls at follow-up. Participants had an increased falls risk [OR (95% CI)] if they were underweight [1.41 (1.06-1.88), p = 0.017] or obese [1.20 (1.09-1.32), p < 0.001] compared to those with normal weight. The association of underweight and obesity with increased falls risk was consistent in participants aged ≥ 65 years. In participants with functional impairment, underweight was associated with higher falls risk [1.61 (1.09-2.40), p = 0.018], while obesity was not. CONCLUSION A U-shaped relationship between BMI and falls risk was found in community-dwelling adults.
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Hermenegildo-López Y, Sandoval-Insausti H, Donat-Vargas C, Banegas JR, Rodríguez-Artalejo F, Guallar-Castillón P. General and central obesity operate differently as predictors of falls requiring medical care in older women: a population-based cohort study in Spain. Age Ageing 2021; 50:213-219. [PMID: 32857126 DOI: 10.1093/ageing/afaa164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES to examine the association of general and abdominal obesity with falls, falls requiring medical care and falls with fractures in older women. DESIGN a population-based prospective cohort of 1,185 women aged ≥60 in Spain, followed up from 2008 to 2010 through 2012. MEASURES weight, height and waist circumference were measured at baseline using standardised techniques. Participants were classified according to body mass index as normal weight (<25), overweight (25-29.9) and general obesity (≥30). Abdominal obesity was defined as waist circumference >88 cm. In 2012, participants reported the falls experienced in the previous year. Logistic regression models were mutually adjusted for general and abdominal obesity and for main confounders. RESULTS in this cohort of older women, a total of 336 women experienced falls, 168 of them had falls requiring medical care and 64 falls with fractures. For falls, no association was found with general obesity nor abdominal obesity. However, compared with normal weight, overweight women had a decreased risk for falls requiring medical care [odds ratio (OR) 0.57; 95% confidence interval (CI) 0.34-0.94] and for falls with fractures (OR 0.27; 95% CI 0.12-0.63). The corresponding values for general obesity were 0.44 (0.24-0.81) and 0.30 (0.11-0.82). Abdominal obesity was positively associated with falls requiring medical care (OR 1.82; 95% CI 1.12-2.94) and falls with fractures (OR 2.75; 95% CI 1.18-6.44). CONCLUSIONS in older women, general obesity may protect from falls requiring medical care and falls with fractures. On the contrary, abdominal obesity increased the risk of suffering from types of falls.
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Affiliation(s)
- Ygor Hermenegildo-López
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- Transfusion Center of the Community of Madrid, Madrid, Spain
| | - Helena Sandoval-Insausti
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Carolina Donat-Vargas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Jose Ramón Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Pilar Guallar-Castillón
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid-IdiPaz, CIBERESP (CIBER of Epidemiology and Public Health), Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD, USA
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Abstract
The population worldwide is aging and prevalence of obesity in this population is increasing. The range of consequences that effect these at-risk patients include increased risk of falls, fractures, reduced quality of life, and cognitive decline. This article describes the epidemiology of obesity, risks and benefits of weight loss, and importance of treating obesity to help promote healthy aging. Health care professionals should encourage older adults with obesity to implement healthy lifestyle behaviors including exercise and diet routine. Treating obesity in older adults mitigates the significant public health crisis, and reduces health care utilization and risk of long-term adverse events.
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Affiliation(s)
- Meredith N Roderka
- Section of Weight & Wellness, Department of Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Sadhana Puri
- Geisel School of Medicine, 1 Rope Ferry Road, Hanover, NH 03755, USA
| | - John A Batsis
- Section of Weight & Wellness, Department of Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA; Geisel School of Medicine, 1 Rope Ferry Road, Hanover, NH 03755, USA; The Dartmouth Institute for Health & Clinical Practice, 1 Medical Center Drive, Lebanon, NH 03756, USA; Dartmouth Centers for Health and Aging Hitchcock Loop Road, Lebanon, NH 03766, USA; Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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Batsis JA, Petersen CL, Crow RS, Cook SB, Stevens CJ, Seo LM, Brooks E, Mackenzie TA. Weight change and risk of the foundation of National Institute of Health Sarcopenia-defined low lean mass: Data from the National Health and Nutrition examination surveys 1999-2004. Clin Nutr 2020; 39:2463-2470. [PMID: 31727381 PMCID: PMC7196520 DOI: 10.1016/j.clnu.2019.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 09/16/2019] [Accepted: 10/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Self-reported weight change may lead to adverse outcomes. We evaluated weight change with cutpoints of low lean mass (LLM) in older adults. METHODS Of 4984 subjects ≥60 years from NHANES 1999-2004, we applied LLM cutoffs of appendicular lean mass (ALM):body mass index (BMI) males<0.789, females<0.512. Self-reported weight was assessed at time of survey, and questions asked participants their weight one and 10 years earlier, and at age 25. Weight changes were categorized as greater/less/none than 5%. Logistic regression assessed weight change (gain, loss, no change) on LLM, after adjustment. RESULTS Of 4984 participants (56.5% female), mean age and BMI were 71.1 years and 28.2 kg/m2. Mean ALM was 19.7 kg. In those with LLM, 13.5% and 16.3% gained/lost weight in the past year, while 48.9% and 19.4% gained/lost weight in the past decade. Compared to weight at age 25, 85.2 and 6.1% of LLM participants gained and lost ≥5% of their weight, respectively. Weight gain over the past year was associated with a higher risk of LLM (OR 1.35 [0.99,1.87]) compared to weight loss ≥5% over the past year (0.89 [0.70,1.12]). Weight gain (≥5%) over 10-years was associated with a higher risk of LLM (OR 2.03 [1.66, 2.49]) while weight loss (≥5%) was associated with a lower risk (OR 0.98 [0.76,1.28]). Results were robust compared to weight at 25 years (gain OR 2.37 [1.76,3.20]; loss OR 0.95 [0.65,1.39]). CONCLUSION Self-reported weight gain suggests an increased risk of LLM. Future studies need to verify the relationship with physical function.
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Affiliation(s)
- John A Batsis
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States; The Dartmouth Institute for Health Policy, Lebanon, NH, United States.
| | - Curtis L Petersen
- The Dartmouth Institute for Health Policy, Lebanon, NH, United States
| | - Rebecca S Crow
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Summer B Cook
- Department of Kinesiology, University of New Hampshire, Durham, NH, United States
| | | | - Lillian M Seo
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Emma Brooks
- Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
| | - Todd A Mackenzie
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States; Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States; The Dartmouth Institute for Health Policy, Lebanon, NH, United States
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Kioh SH, Mat S, Kamaruzzaman SB, Ibrahim F, Mokhtar MS, Hairi NN, Cumming RG, Myint PK, Tan MP. Does Lower Lean Body Mass Mediate the Relationship Between Falls and Higher Body Mass Index in Asian Older Persons? J Aging Phys Act 2020; 28:426-433. [PMID: 31756717 DOI: 10.1123/japa.2019-0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/23/2019] [Accepted: 09/23/2019] [Indexed: 11/18/2022]
Abstract
The current evidence on the relationship between a higher body mass index (BMI) and falls in older adults is conflicting. This study, therefore, evaluated the relationship between BMI and falls and explored underlying mechanisms for this relationship. Data from 1,340 individuals from the Malaysian Elders Longitudinal Research study, obtained through home-based computer-assisted interviews and followed by hospital-based health checks, were utilized. A history of the presence of falls in the previous 12 months was obtained. The presence of at least one fall in the past 12 months was associated with a higher BMI (odds ratio = 1.03, 95% confidence interval [1.01, 1.06]). The relationship between a higher BMI and falls was, however, attenuated by a lower percentage of lean body mass, which accounted for 69% of the total effect of BMI on the risk of falls. Future studies should now investigate this aforementioned relationship prospectively.
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Rosenblatt NJ, Girgis C, Avalos M, Fleischer AE, Crews RT. The Role of the Podiatrist in Assessing and Reducing Fall Risk: An Updated Review. Clin Podiatr Med Surg 2020; 37:327-369. [PMID: 32146988 DOI: 10.1016/j.cpm.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Falls present a tremendous challenge to health care systems. This article reviews the literature from the previous 5 years (2014-2019) in terms of methods to assess fall risk and potential steps that can be taken to reduce fall risk for patients visiting podiatric clinics. With regard to assessing fall risk, we discuss the role of a thorough medical history and podiatric assessments of foot problems and deformities that can be performed in the clinic. With regard to fall prevention we consider the role of shoe modification, exercise, pain relief, surgical interventions, and referrals.
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Affiliation(s)
- Noah J Rosenblatt
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA.
| | - Christopher Girgis
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Marco Avalos
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Adam E Fleischer
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
| | - Ryan T Crews
- Dr. William M. Scholl College of Podiatric Medicine's Center for Lower Extremity Ambulatory Research (CLEAR), 3333 Green Bay Road, North Chicago, IL 60064, USA
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Lee EJ, Lee SA, Soh Y, Kim Y, Won CW, Chon J. Association between asymmetry in lower extremity lean mass and functional mobility in older adults living in the community: Results from the Korean Frailty and Aging Cohort Study. Medicine (Baltimore) 2019; 98:e17882. [PMID: 31702661 PMCID: PMC6855585 DOI: 10.1097/md.0000000000017882] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The asymmetry in lower extremity strength is known to be related to the functional mobility in older adults living in the community. However, little is known about the association between lower extremity lean mass asymmetry and functional mobility in this patient group. Hence, this study aimed to determine whether asymmetry in lower extremity muscle mass has a significant relationship with functional mobility in older adults living in the community.This cross-sectional study analyzed the pre-existing data from the Korean Frailty and Aging Cohort Study. A total of 435 older people (aged 70-84 years) were divided into the following groups according to their Limb Asymmetry Index (LAsI): low, intermediate, and high asymmetric groups. LAsI is calculated using lower extremity lean mass, and comparisons between groups were conducted. The participants were also further divided into better and worse mobility groups based on their physical performance test results (Timed Up and Go and Short Physical Performance Battery), and comparisons between groups were conducted. Comparisons between fallers and non-fallers were also conducted. In addition, this study investigated the factors that had a significant effect on gait speed and fall experience within the past year among older adults living in the community.The LAsI was significantly associated with gait speed in older adults living in the community. Older adults in the highest tertile of the LAsI had a slower gait speed than those in the lowest tertile of the LAsI. However, no significant difference was observed in the LAsI between the better mobility group and worse mobility group. Moreover, the LAsI was not a significant predictor of falls.Asymmetry in lower extremity lean mass was significantly associated with gait speed in older adults living in the community.
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Affiliation(s)
- Eun Jeong Lee
- Department of Rehabilitation Medicine, Kyung Hee University Medical Center
| | - Seung Ah Lee
- Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong
| | - Yunsoo Soh
- Department of Rehabilitation Medicine, Kyung Hee University Medical Center
| | - Yong Kim
- Department of Rehabilitation Medicine, Kyung Hee University Medical Center
| | - Chang Won Won
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, South Korea
| | - Jinmann Chon
- Department of Rehabilitation Medicine, Kyung Hee University Medical Center
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Waters DL, Qualls CR, Cesari M, Rolland Y, Vlietstra L, Vellas B. Relationship of Incident Falls with Balance Deficits and Body Composition in Male and Female Community-Dwelling Elders. J Nutr Health Aging 2019; 23:9-13. [PMID: 30569062 DOI: 10.1007/s12603-018-1087-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Sarcopenia and obesity are reported risk factors for falls, although the data are not consistent and most studies do not make sex comparisons. We investigated whether falls were associated with balance, gait, and body composition, and whether these relationships are sex-specific. DESIGN Secondary analysis of 4-year follow-up data from of the New Mexico Aging Process Study. SETTING Albuquerque, New Mexico. PARTICIPANTS 307 participants (M, n=122, 75.8 yr. SD5.5; F, n=183, 74.6yr SD6.1). MEASUREMENTS Gait and balance were assessed annually using the Tinetti test. Lean body mass (LBM), appendicular skeletal muscle mass (ASM), fat free mass (FFM), total fat mass (FM) were assessed annually by DXA. Falls were assessed using bimonthly falls calendars. Hazard ratios (HR) for 2-point worsening in gait and balance score and falls were calculated by Cox proportional hazard for men and women. RESULTS Baseline balance deficits, and not body composition, represented the strongest predictor of falls. For the total balance score, the variables with significant sex interactions were ASM (Male-HR 1.02 95%CI 0.60-1.73; Female-HR 1.92 95%CI 1.05-3.52, p=0.03) and FFM (Male-HR 1.04 95%CI 0.64-1.70; Female-HR 1.91 95%CI 1.12-3.24, p=0.04), after adjustment for age, sarcopenia and physical activity. The body composition relationship with balance deficits was U-shaped with the strongest predictors being low LBM in males and high FM in females. CONCLUSIONS Specific body composition components and balance deficits are risk factors for falls following sex-specific patterns. Sex differences need to be explored and considered in interventions for worsening balance and falls prevention.
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Affiliation(s)
- D L Waters
- Debra Waters, Department of Medicine / School of Physiotherapy, University of Otago PO Box 56, Dunedin 9054, New Zealand, , +64 3 479 7222
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15
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Celinskis D, Grabiner MD, Honeycutt CF. Bilateral early activity in the hip flexors associated with falls in stroke survivors: Preliminary evidence from laboratory-induced falls. Clin Neurophysiol 2018; 129:258-264. [PMID: 29223103 PMCID: PMC5747263 DOI: 10.1016/j.clinph.2017.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 10/11/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Falls are the most common and expensive medical complication following stroke. Hypermetric reflexes have been suggested to impact post-stroke balance but no study has evaluated reflex amplitudes under real conditions of falls in this population. Our objective was to quantify the early reflexive responses during falls induced in the laboratory. METHODS Sixteen stroke survivors were exposed to posteriorly directed treadmill perturbations that required a forward step to maintain a balance. Perturbations differed in terms of treadmill translation displacement, velocity, and acceleration. EMG amplitudes were compared between Fall/Recovery trials, as well as Fallers/Non-Fallers at two different time windows: 50-75 and 75-100 ms. RESULTS Sixteen of 86 trials resulted in falls by nine subjects (Fallers). While no differences were found between 50 and 75 ms, EMG amplitude in the paretic rectus femoris muscle was larger between 75 and 100 ms during Fall trials. Further, a bilateral increase in RF activity was seen in Fallers but not Non-Fallers. Interestingly, the bilateral increase was related to perturbation intensity (larger EMG activity with larger perturbations) in Fallers, but again not in Non-Fallers. CONCLUSIONS Heightened early recovery hip flexor activity between 75 and 100 ms is associated with falls and Fallers post-stroke. SIGNIFICANCE Though requiring replication and expanded subject pools, these preliminary results reflect a possible clinically meaningful relationship between heightened reflexive responses and fall risk. Future work should evaluate the underlying mechanisms driving these heightened reflexes (e.g. stretch, startle) such that future rehabilitation techniques can address this abnormal response.
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Affiliation(s)
- Dmitrijs Celinskis
- School of Biological and Health Systems Engineering, Arizona State University, USA
| | - Mark D Grabiner
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, USA
| | - Claire F Honeycutt
- School of Biological and Health Systems Engineering, Arizona State University, USA.
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16
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White AM, Tooth LR, Peeters GMEEG. Fall Risk Factors in Mid-Age Women: The Australian Longitudinal Study on Women's Health. Am J Prev Med 2018; 54:51-63. [PMID: 29254554 DOI: 10.1016/j.amepre.2017.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/06/2017] [Accepted: 10/10/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In contrast to older adults, little is known about risk factors for falls in adults aged 50-64 years, despite a high prevalence of falls in this age group. The aim was to identify risk factors for falls in mid-age women and explore how associations change with age. METHODS Data were analyzed in 2016 from women aged 50-55 years in 2001 (born 1946-1951) in the Australian Longitudinal Study on Women's Health. The predictor variables were health-related factors (measured 2001, 2004, 2007, 2010) and the outcome was falls in the past 12 months (measured 2004, 2007, 2010, 2013). Prospective associations between predictor variables and falls measured 3 years later were analyzed using logistic regression with complete data for 4,629, 7,096, 5,911, and 5,774 participants. RESULTS In surveys, 20.5% (2004), 30.7% (2007), 30.5% (2010), and 26.6% (2013) of women reported a fall in the previous 12 months. In the univariable models, most factors were associated with falls 3 years later. In the multivariable models, higher odds of falling were found for overweight and obese women compared with healthy weight women at all survey intervals (OR range, 1.15-1.43). Impaired vision (OR range, 1.25-1.35) and poor physical functioning (OR range, 1.24-1.66) were associated with falls at three survey intervals. Depression (OR range, 1.31-1.42), leaking urine (OR range, 1.25-1.49), stiff/painful joints (OR range, 1.26-1.62), severe tiredness (OR range, 1.29-1.49), osteoporosis (OR range, 1.25-1.52), and hormone replacement therapy (OR range, 0.69-0.79) were associated with falls at two survey intervals. There was no obvious age-related increase or decrease in the number of statistically significant associations. CONCLUSIONS Identified fall risk factors varied over time, highlighting that falling involves a complex interplay of risk factors in mid-age women.
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Affiliation(s)
- Anthea M White
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Leigh R Tooth
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - G M E E Geeske Peeters
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia; Global Brain Health Institute, University of California, San Francisco and Trinity College Dublin, San Francisco, California, Dublin, Ireland.
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Choi WJ, Robinovitch SN, Ross SA, Phan J, Cipriani D. Effect of neck flexor muscle activation on impact velocity of the head during backward falls in young adults. Clin Biomech (Bristol, Avon) 2017; 49:28-33. [PMID: 28843128 DOI: 10.1016/j.clinbiomech.2017.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 07/12/2017] [Accepted: 08/15/2017] [Indexed: 02/07/2023]
Abstract
Falls are a common cause of traumatic brain injuries (TBI) across the lifespan. A proposed but untested hypothesis is that neck muscle activation influences impact severity and risk for TBI during a fall. We conducted backward falling experiments to test whether activation of the neck flexor muscles facilitates the avoidance of head impact, and reduces impact velocity if the head contacts the ground. Young adults (n=8) fell from standing onto a 30cm thick gymnastics mat while wearing a helmet. Participants were instructed to fall backward and (a) prevent their head from impacting the mat ("no head impact" trials); (b) allow their head to impact the mat, but with minimal impact severity ("soft impact" trials); and (c) allow their head to impact the mat, while inhibiting efforts to reduce impact severity ("hard impact" trials). Trial type associated with peak magnitude of electromyographic activity of the sternocleidomastoid (SCM) muscles (p<0.017), and with the vertical and horizontal velocity of the head at impact (p<0.001). Peak SCM activations, expressed as percent maximal voluntary isometric contraction (%MVIC), averaged 75.3, 67.5, and 44.5%MVIC in "no head impact", "soft impact", and "hard impact" trials, respectively. When compared to "soft impact" trials, vertical impact velocities in "hard impact" trials averaged 87% greater (3.23 versus 1.73m/s) and horizontal velocities averaged 83% greater (2.74 versus 1.50m/s). For every 10% increase in SCM %MVIC, vertical impact velocity decreased 0.24m/s and horizontal velocity decreased 0.22m/s. We conclude that SCM activation contributes to the prevention and modulation of head impact severity during backward falls.
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Affiliation(s)
- W J Choi
- Injury Prevention and Biomechanics Laboratory, Department of Physical Therapy, Yonsei University, Wonju, Kangwon-do, South Korea.
| | - S N Robinovitch
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - S A Ross
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - J Phan
- Department of Physical Therapy, Chapman University, Irvine, CA, USA
| | - D Cipriani
- Department of Physical Therapy, Center for Graduate Studies, West Coast University, Los Angeles, CA, USA
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18
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Kim JC, Chon J, Kim HS, Lee JH, Yoo SD, Kim DH, Lee SA, Han YJ, Lee HS, Lee BY, Soh YS, Won CW. The Association Between Fall History and Physical Performance Tests in the Community-Dwelling Elderly: A Cross-Sectional Analysis. Ann Rehabil Med 2017; 41:239-247. [PMID: 28503457 PMCID: PMC5426269 DOI: 10.5535/arm.2017.41.2.239] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/24/2016] [Indexed: 11/05/2022] Open
Abstract
Objective To evaluate the association between baseline characteristics, three physical performance tests and fall history in a sample of the elderly from Korean population. Methods A total of 307 participants (mean age, 76.70±4.85 years) were categorized into one of two groups, i.e., fallers and non-fallers. Fifty-two participants who had reported falling unexpectedly at least once in the previous 12 months were assigned to the fallers group. Physical performance tests included Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), Timed Up and Go test. The differences between the two study groups were compared and we analyzed the correlations between fall histories and physical performance tests. Results SPPB demonstrated a significant association with fall history. Although the BBS total scores did not show statistical significance, two dynamic balance test items of BBS (B12 and B13) showed a significant association among fallers. Conclusion This study suggests that SPPB and two dynamic balance test items of the BBS can be used in screening for risk of falls in an ambulatory elderly population.
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Affiliation(s)
- Jin Chul Kim
- Department of Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Jinmann Chon
- Department of Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Hee Sang Kim
- Department of Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Jong Ha Lee
- Department of Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Seung Don Yoo
- Department of Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Dong Hwan Kim
- Department of Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Seung Ah Lee
- Department of Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Yoo Jin Han
- Department of Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Hyun Seok Lee
- Department of Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Bae Youl Lee
- Department of Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Yun Soo Soh
- Department of Rehabilitation Medicine, Kyung Hee University Medical Center, Seoul, Korea
| | - Chang Won Won
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Korea
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19
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Handrigan GA, Maltais N, Gagné M, Lamontagne P, Hamel D, Teasdale N, Hue O, Corbeil P, Brown JP, Jean S. Sex-specific association between obesity and self-reported falls and injuries among community-dwelling Canadians aged 65 years and older. Osteoporos Int 2017; 28:483-494. [PMID: 27562568 DOI: 10.1007/s00198-016-3745-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 08/15/2016] [Indexed: 01/13/2023]
Abstract
UNLABELLED This study investigated the relationship between body mass index (BMI) and falls among community-dwelling elderly. Results indicate that obesity is associated with increased falls and there appears to be a sex-specific difference with obese men at higher risk of falling. Obesity is identified as a risk factor for falls in men. INTRODUCTION The prevalence of falls, fall-related injuries, and obesity has increased over the last decade. The objectives of this study were to investigate sex-specific association and dose-response relationship between BMI and falls (and related injuries) among community-dwelling elderly. METHODS Our study sample consisted of 15,860 adults aged 65 years or older (6399 men and 9461 women) from the 2008-2009 Canadian Community Health Survey-Healthy Aging (CCHS-HA). Falls, fall-related injuries, and BMI measures were self-reported. For both sex, dose-response curves presenting the relationship between BMI, falls, and fall-related injuries were first examined. Thereafter, multivariate logistic regression analyses were also performed to investigate these relationships after adjustment for potentially confounding variables. RESULTS Of women, 21.7 % reported a fall and 16.9 % of men. The dose-response relationship between BMI and prevalence of falls showed that underweight and obese individuals reported falling more than normal and overweight individuals; this being more apparent in men than women. Finally, the dose relationship between BMI and prevalence of fall-related injuries showed that only obese men seem more likely to have sustained a fall-related injury. Results from the multivariate analysis showed that obesity in men was significantly associated with higher odds of falling odds ratio (OR) 1.33 (1.04-1.70) and was not significantly associated with higher odds of fall-related injuries OR 1.10 (0.66-1.84) over a 12-month period compared to normal weight men. For women, obesity was not significantly associated with higher fall prevalence OR 0.99 (0.79-1.25) and fall-related injuries OR 0.71 (0.51-1.00). CONCLUSION Obesity is associated with self-reported falls, and there appears to be a sex-specific difference in elderly persons.
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Affiliation(s)
- G A Handrigan
- School of Kinesiology and Leisure, Université de Moncton, Moncton, NB, Canada.
| | - N Maltais
- School of Kinesiology and Leisure, Université de Moncton, Moncton, NB, Canada
| | - M Gagné
- Institut National Santé Publique Québec, Québec, QC, Canada
| | - P Lamontagne
- Institut National Santé Publique Québec, Québec, QC, Canada
| | - D Hamel
- Institut National Santé Publique Québec, Québec, QC, Canada
| | - N Teasdale
- Department of Kinesiology, Université Laval, Québec, QC, Canada
| | - O Hue
- Department of Science of Physical Activity, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - P Corbeil
- Department of Kinesiology, Université Laval, Québec, QC, Canada
| | - J P Brown
- Department of Medicine, Université Laval, Québec, QC, Canada
| | - S Jean
- Institut National Santé Publique Québec, Québec, QC, Canada
- Department of Medicine, Université Laval, Québec, QC, Canada
- Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
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20
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Ylitalo KR, Karvonen-Gutierrez CA. Body mass index, falls, and injurious falls among U.S. adults: Findings from the 2014 Behavioral Risk Factor Surveillance System. Prev Med 2016; 91:217-223. [PMID: 27575319 DOI: 10.1016/j.ypmed.2016.08.044] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 12/25/2022]
Abstract
Falls are an important health concern because they are associated with loss of independence and disability, particularly among women. We determined the age- and sex-specific prevalence of injurious falls among adults in the United States and examined the impact of obesity on fall risk. Self-reported falls, injurious falls, and health histories were obtained from 280,035 adults aged 45-79years in the 2014 Behavioral Risk Factor Surveillance System. Body mass index was categorized as underweight (<18.5kg/m2), normal weight (18.5-24.9kg/m2), overweight 25-29.9kg/m2), class I obesity (30.0-34.9kg/m2), or class II/III obesity (≥35.0kg/m2) based on self-reported height and weight. Data were analyzed using weighted age- and sex-specific prevalence rates and Poisson regression. Overall, 11.0% reported ≥1 injurious fall in the previous 12months. Mid-life women 55-59years reported the highest prevalence of injurious falls (15.4%). Among mid-life women, overweight was associated with injurious falls (RR=1.17; 95% CI: 1.08, 1.28), but overweight was not associated with falling among other age-sex groups. Class II/III obesity was associated with injurious falls among all age-sex groups. After considering the mediators like health conditions (depression, cardiovascular disease, diabetes, arthritis) and behaviors (physical activity, sleep), the association of class II/III obesity and injurious fall risk persisted only among mid-life women (RR=1.23; 95% CI: 1.12, 1.36). Not only are mid-life women at high risk for falls, but the class II/III obesity is a risk factor for injurious falls. Targeting mid-life women for fall and injury prevention is an important aim for practitioners, particularly given unique correlates of falling for this group.
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Affiliation(s)
- Kelly R Ylitalo
- College of Health and Human Sciences, Baylor University, Waco, TX, United States.
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21
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Garman CR, Nussbaum MA, Franck CT, Madigan ML. A Pilot Study Exploring Obesity-Related Differences in Fall Rate and Kinematic Response Resulting From a Laboratory-Induced Trip. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/21577323.2016.1198732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Christina R. Garman
- Department of Biomedical Engineering, Marquette University, Milwaukee, WI, USA
| | - Maury A. Nussbaum
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA
| | | | - Michael L. Madigan
- Department of Biomedical Engineering, Texas A&M University, 5045 Emerging Technologies Building, College Station, TX 77843, USA
- Department of Mechanical Engineering, Texas A&M University, College Station, TX, USA
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22
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Rowbotham SK, Blau S. The circumstances and characteristics of fatal falls in Victoria, Australia: a descriptive study. AUST J FORENSIC SCI 2016. [DOI: 10.1080/00450618.2016.1194472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Samantha K. Rowbotham
- Department of Forensic Medicine, Monash University, Southbank, Victoria 3006, Australia
| | - Soren Blau
- Department of Forensic Medicine, Monash University, Southbank, Victoria 3006, Australia
- Victorian Institute of Forensic Medicine, Southbank, Victoria 3006, Australia
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23
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Knee osteoarthritis negatively affects the recovery step following large forward-directed postural perturbations. J Biomech 2016; 49:1128-1133. [PMID: 26947035 DOI: 10.1016/j.jbiomech.2016.02.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 02/16/2016] [Accepted: 02/21/2016] [Indexed: 12/12/2022]
Abstract
The reasons for higher fall risk of people with osteoarthritis (OA) compared to people without OA are not known. It is possible that following a loss of balance OA may negatively affect the recovery stepping response. Stepping responses have not been reported for people with knee OA. Here, we compared recovery step kinematics following laboratory-induced trip and following a large treadmill-delivered perturbation simulating a trip between a group of women with and without self-reported knee OA. We hypothesized that knee OA would significantly impair recovery step kinematics compared to those of a control group. Following the laboratory-induced trip, step length and trunk flexion velocity at recovery step completion of women with OA were significantly impaired and more so for the women who fell. Following the treadmill-delivered perturbation, the recovery step kinematics of women with OA were not significantly impaired. For both perturbations, the women who fell had significantly impaired recovery step kinematics compared to those who did not fall, regardless of OA. The results are consistent with previous work on healthy middle aged and older women and suggest that the same biomechanical risk factors for trip-related falls are shared by middle age and older women regardless of the presence of knee OA. The results support the need to determine whether training protocols which have been shown to improve recovery step kinematics and reduce prospective falls by healthy older women can have similar outcomes for people with knee OA.
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Rosenblatt NJ, Bauer A, Rotter D, Grabiner MD. Active dorsiflexing prostheses may reduce trip-related fall risk in people with transtibial amputation. ACTA ACUST UNITED AC 2015; 51:1229-42. [PMID: 25625226 DOI: 10.1682/jrrd.2014.01.0031] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 06/02/2014] [Indexed: 11/05/2022]
Abstract
People with amputation are at increased risk of falling compared with age-matched, nondisabled individuals. This may partly reflect amputation-related changes to minimum toe clearance (MTC) that could increase the incidence of trips and fall risk. This study determined the contribution of an active dorsiflexing prosthesis to MTC. We hypothesized that regardless of speed or incline the active dorsiflexion qualities of the ProprioFoot would significantly increase MTC and decrease the likelihood of tripping. Eight people with transtibial amputation walked on a treadmill with their current foot at two grades and three velocities, then repeated the protocol after 4 wk of accommodation with the ProprioFoot. A mixed-model, repeated-measures analysis of variance was used to compare MTC. Curves representing the likelihood of tripping were derived from the MTC distributions and a multiple regression was used to determine the relative contributions of hip, knee, and ankle angles to MTC. Regardless of condition, MTC was approximately 70% larger with the ProprioFoot (p < 0.001) and the likelihood of tripping was reduced. Regression analysis revealed that MTC with the ProprioFoot was sensitive to all three angles, with sensitivity of hip and ankle being greater. Overall, the ProprioFoot may increase user safety by decreasing the likelihood of tripping and thus the pursuant likelihood of a fall.
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Affiliation(s)
- Noah J Rosenblatt
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL
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25
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Mitchell RJ, Lord SR, Harvey LA, Close JCT. Associations between obesity and overweight and fall risk, health status and quality of life in older people. Aust N Z J Public Health 2015; 38:13-8. [PMID: 24494939 DOI: 10.1111/1753-6405.12152] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 07/01/2013] [Accepted: 09/01/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To determine whether overweight and obese individuals have higher reported fall and fall injury risk than individuals of healthy weight, and to examine the influence of BMI on health, quality of life and lifestyle characteristics of fallers. METHODS A representative sample of community-based individuals aged 65 years and older in New South Wales was surveyed regarding their history of falls, height, weight, lifestyle and general health within a 12-month period. RESULTS Obese individuals had a 31% higher risk of having fallen, but no higher risk of a fall-related injury compared to healthy-weight individuals. Obese fallers also had a 57% higher risk of believing nothing could be done to prevent falls; a 41% higher risk of using four or more medications; a 30% higher risk of experiencing moderate or extreme pain or discomfort; were 26% less likely have walked for two or more hours in the last week; and were less likely to think they were doing enough physical activity. CONCLUSIONS Older obese individuals have an increased risk of falls and obese fallers have a higher prevalence of pain and inactivity than fallers of a healthy weight. IMPLICATIONS A decrease in sedentary lifestyle and regular weight-bearing exercise may reduce fall risk in older obese individuals.
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Affiliation(s)
- Rebecca J Mitchell
- Falls and Injury Prevention Group, Neuroscience Research Australia, University of New South Wales
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Osteosarcopenic obesity and fall prevention strategies. Maturitas 2015; 80:126-32. [DOI: 10.1016/j.maturitas.2014.11.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 11/18/2014] [Indexed: 12/24/2022]
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Lix LM, Leslie WD. Untangling the causality knot: another tool for clinical researchers. J Bone Miner Res 2014; 29:2323-6. [PMID: 25330027 DOI: 10.1002/jbmr.2369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Lisa M Lix
- Department of Medicine, University of Manitoba, Winnipeg, Canada
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Mitchell RJ, Lord SR, Harvey LA, Close JCT. Obesity and falls in older people: mediating effects of disease, sedentary behavior, mood, pain and medication use. Arch Gerontol Geriatr 2014; 60:52-8. [PMID: 25307955 DOI: 10.1016/j.archger.2014.09.006] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 07/03/2014] [Accepted: 09/15/2014] [Indexed: 11/28/2022]
Abstract
Obesity has been associated with an increased risk of falls among older people. However, it is not certain whether factors commonly associated with falls and/or obesity mediate this risk. This research examines whether specific diseases, sedentary behavior, mood, pain, and medication use mediate the association between obesity and falls. A representative sample of community-living individuals aged 65+ years in New South Wales (NSW), Australia were surveyed regarding their experience of falls, height, weight, lifestyle and general health within a 12 month period. Intervening variable effects were examined using Freedman and Schatzkin's difference in coefficients tests and regression analyses were used to estimate relative risks. Obesity was associated with a 25% higher risk (95%confidence interval (CI) 1.11-1.41; p<0.0003) of having fallen in the previous 12 months compared to non-obese individuals. The strongest mediators of the association between obesity and falls were sleeping tablets (t=-5.452; p<0.0001), sitting for more than 8h per day on weekdays (t=5.178; p<0.0001), heart disease/angina (t=3.526; p<0.0001), anti-depressant use (t=3.102; p=0.002), moderate/extreme anxiety or depression (t=3.038; p=0.002), and diabetes (t=3.032; p=0.002). Sedentary behavior, chronic health conditions and medication use were identified as mediators for the association between obesity and falls in community living older people. Interventions aimed at weight reduction and increased activity may have benefits not only for fall prevention, but also for the mediating health, mood and lifestyle factors identified here.
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Affiliation(s)
- Rebecca J Mitchell
- Falls and Injury Prevention Group, Neuroscience Research Australia, University of New South Wales, Australia.
| | - Stephen R Lord
- Falls and Balance Group, Neuroscience Research Australia, University of New South Wales, Australia
| | - Lara A Harvey
- Falls and Injury Prevention Group, Neuroscience Research Australia, University of New South Wales, Australia
| | - Jacqueline C T Close
- Falls and Injury Prevention Group, Neuroscience Research Australia, University of New South Wales, Australia; Prince of Wales Clinical School, University of New South Wales, Australia
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Abstract
The growth of the worldwide population of older adults presents significant challenges, many inter-related, that range from the health of individuals to the health of national economies. In the US, more than one-third of older adults may be obese, a condition that may independently increase the risk for mobility impairment, fall-related injury and, possibly, costs of post-injury treatment and care. The effectiveness of conventional exercise-based fall prevention programs is significant but smaller than both the annual rate of falling of older adults and rate of growth of this population, who are at greatest risk for injurious falls. The anthropometric and functional consequences of obesity may impose limitations on the ability to perform compensatory stepping responses following large postural disturbances. The focus of this paper is the potential of task-specific training to improve compensatory stepping responses and reduce falls by obese people given the individual-specific anthropometric and functional consequences of obesity.
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Affiliation(s)
- Michael Madigan
- Department of Engineering Science and Mechanics, Virginia Tech, 326 Norris Hall, MC 0219, Blacksburg, VA, 24061, USA.
| | - Noah J Rosenblatt
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 W. Taylor Street, Room 650, Chicago, IL, 60612, USA.
| | - Mark D Grabiner
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 W. Taylor Street, Room 648, Chicago, IL, 60612, USA.
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Sheehan KJ, O'Connell MDL, Cunningham C, Crosby L, Kenny RA. The relationship between increased body mass index and frailty on falls in community dwelling older adults. BMC Geriatr 2013; 13:132. [PMID: 24313947 PMCID: PMC4029500 DOI: 10.1186/1471-2318-13-132] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 11/26/2013] [Indexed: 11/17/2022] Open
Abstract
Background The global population is becoming older and more overweight. The inter-relationship between frailty and falls is often seen in the older adult and is associated with poor health outcomes. Little is known about this relationship for those with excess body mass. This study aimed to assess the relationships between BMI, frailty and falls. Methods Frailty, body mass index, clinical and demographic characteristics were assessed at baseline for 606 community dwelling adults aged 60 years and older. Falls were assessed prospectively with a semi-structured telephone interview two years later. Results An increase in BMI contributed significantly to the identification of frail (Odds Ratio: 4.4; 95% Confidence Interval: 1.4, 13.6) older adults. A total of 346 falls by 148 participants were reported at follow up. Those with an increased BMI were significantly less likely to have experienced a fall between baseline and follow up assessments (p = 0.03). Despite these opposing trends a BMI greater than or equal to 30.0 kg.m2 did not alter the relationship between falls and frailty for the current cohort. Conclusions This is the first study to assess the falls-frailty relationship for those with an increased BMI. Obesity was found to be protective against falling but not specifically in frail older adults.
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Affiliation(s)
- Katie J Sheehan
- Technology Research for Independent Living (TRIL), St,James's Hospital, Dublin, Ireland.
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Teasdale N, Simoneau M, Corbeil P, Handrigan G, Tremblay A, Hue O. Obesity Alters Balance and Movement Control. Curr Obes Rep 2013. [DOI: 10.1007/s13679-013-0057-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Hoops ML, Rosenblatt NJ, Hurt CP, Crenshaw J, Grabiner MD. Does lower extremity osteoarthritis exacerbate risk factors for falls in older adults? ACTA ACUST UNITED AC 2013. [PMID: 23181533 DOI: 10.2217/whe.12.53] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The risk of falling reportedly increases almost 2.5-times in those with lower extremity osteoarthritis (OA(LE)) compared with age-matched controls. However, the mechanisms underlying the increased risk are not clear. The risk factors for falls in people with OA(LE) found in the literature are mostly the same as the risk factors for people without OA(LE). It is hypothesized that risk factors for falls are exacerbated by OA(LE), such that these individuals are more likely to become dynamically unstable and, once this has occurred, are less able to perform an appropriate compensatory stepping response compared with people without OA(LE). To the extent that this is true, task-specific training targeting the compensatory step, which decreases falls in middle-aged and older women, should be effective for people with OA(LE). The purpose of the present review is to provide the rationale for the above hypothesis. Furthermore, the present authors present evidence that the fall risk of people with OA(LE) could be efficiently and effectively reduced using task-specific training previously shown to reduce falls in middle aged and older women.
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Affiliation(s)
- Mackenzie L Hoops
- Department of Kinesiology & Nutrition, University of Illinois at Chicago, 1919 W Taylor Street, Chicago, IL, USA.
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