Association between ground reaction force in sit-to-stand motion and falls in community-dwelling older Japanese individuals

The relationship between acceleration in sit-to-stand and falls in community-dwelling older adults: cross-sectional study

[Purpose] This study aimed to determine the relationship between acceleration parameters in the sit-to-stand (STS) movement and falls, and the strength of the association between acceleration in STS movements and falls in older adults. [Participants and Methods] In total, 330 older adults were included. Four acceleration parameters were measured in STS movement: maximum acceleration (MA), velocity (MV), power (MP), and stand-up time (ST). For the conventional STS tests, 5 times STS test (5xSTS) and ground reaction force (maximal rate of force development per body weight: RFD/w, peak reaction force per body weight: F/w, chair-rise time: T) were measured. Poisson regression analysis adjusted for confounding factors was used. [Results] In the model adjusted for confounders, significant associations were observed among MV (Prevalence ratio (PR): 0.75; 95% confidence interval (CI): 0.58-0.98), MP (PR: 0.67; 95% Cl: 0.68-0.93), RFD/w (PR: 0.70; 95% Cl: 0.56-0.87), and T (PR: 1.14; 95% Cl: 1.05-1.24). [Conclusion] Among the acceleration parameters, MP was most strongly associated with falls and was considered the most useful parameter for evaluation. In addition, comparisons with the conventional chair rise tests suggested that MP was stronger than the 5xSTS test and may be equally related to the RFD/w.

A Simple Device for Measuring Sit-to-Stand Movements and Cardio-Metabolic Diseases: A Cross-Sectional Study in a Health Check-Up Population Over 20 Years Old

Introduction Several studies have reported the usefulness of measuring lower limb muscle strength through the motion of standing up using a reaction force measuring device positioned on the ground. There is inadequate information on the association between cardiovascular disease risk factors and ground reaction force (GRF) during standing up. Therefore, this study estimated the association between GRF by sit-to-stand movements and cardiovascular disease risk factors in a health check-up population. Methods This cross-sectional study included 1,182 healthy participants without chronic diseases who underwent periodic health check-ups from August 2019 to December 2020. The study included individuals aged ≥20 years who underwent a standing test from an initial seated position in a chair. A sit-to-stand force analyzer was used to measure GRF, and health status information was collected at enrollment. The relationships between blood test data and each measurement obtained from GRF measurements (forth/body mass (F/M), rate of forth development/body mass (RFD/M), and stable time) were parsed according to sex using linear regression analysis coordinated by age. GRF measurements and their relationships with cardiovascular disease risk factors were assessed using logistic regression analysis, adjusted for age and sex. Results A total of 1,182 participants was included in this study, with male participants accounting for 61.5%. The study participants had a median age of 57.0 years (IQR: 47.0-63.0). After adjusting for age, F/M was positively associated with high-density lipoprotein cholesterol in male (β=22.59, p<0.001) and female participants (β=20.35, p=0.011) and negatively associated with plasma glucose in male (β=-16.25, p=0.008) and female participants (β=-18.78, p=0.028). Stable time (time required to be stabilize after standing up movement) was positively associated with hemoglobin A1c levels in male (β=0.55, p=0.001) and female participants (β=0.56, p=0.036). Logistic regression analysis adjusted by age and sex showed that a lower F/M ratio was associated with hypertension, hyperlipidemia, and diabetes mellitus (adjusted odds ratio (aOR) =1.60, p=0.01; aOR=1.75, p=0.001; and aOR=2.23, p=0.002, respectively). Lower RFD/M was associated with hyperlipidemia and diabetes mellitus (aOR=1.46, p=0.013 and aOR=1.63, p=0.045, respectively). A shorter stable time was associated with diabetes mellitus (aOR=0.39, p<0.001). Conclusions These findings suggest that lower limb function impairment, as assessed via standing-up movements using a GRF-measuring device, may relate to cardiovascular disease. Further research is needed to confirm this association.

Associations of Lower-Limb Phase Angle with Locomotion and Motor Function in Japanese Community-Dwelling Older Adults

Whole-body phase angle (PhA) is associated with motor function and geriatric diseases. However, it was unclear which parts of the upper- or lower-limb PhA were involved. This study investigated the differences in the PhA of the upper and lower extremities and their relationships with frailty, locomotive syndrome indices, and motor function in community-dwelling older adult participants. This study was a cross-sectional observational study. In 69 community-dwelling older adults, the PhA at each measurement site (whole body, upper limbs, and lower limbs), motor function, Kihon Checklist (KCL), and 25-Geriatric Locomotive Function Scale (GLFS-25) were measured. This study examined differences in each PhA and its relationship with motor function and geriatric diseases. Multiple regression analysis was performed using GLFS-25 as the dependent variable and sex and lower-limb PhA as independent variables. In this cohort (mean age: 72.3 ± 5.7 years; 18 males and 51 females), lower-limb PhA was significantly lower than upper-limb PhA. Unlike other PhAs, lower-limb PhA was related to grip strength, TUG, F/w, and GLFS-25. Multiple regression analysis showed that the lower-limb PhA was independently related to GLFS-25. Cellular health of the lower extremity is associated with gait, standing function, and indicators of locomotive syndrome.

Association between physical performance during sit-to-stand motion and frailty in older adults with cardiometabolic diseases: a cross-sectional, longitudinal study

BACKGROUND

Although physical performance tests of the lower extremities are used to assess sarcopenia and frailty, little is known about the mechanisms by which the parameters of ground reaction force (GRF) measured during sit-to-stand motion affect the frailty status in older adults. We aimed to examine the association between GRF parameters during sit-to-stand motion and the incidence of frailty in older adults.

METHODS

This longitudinal study evaluated 319 outpatients aged ≥ 65 years with cardiometabolic diseases. The GRF parameters were measured using a motor function analyzer, in which the power, speed, and balance scores were calculated. Frailty was diagnosed using the modified version of the Cardiovascular Health Study (mCHS) and the Kihon Checklist (KCL). The independent associations between scores and frailty indices were assessed using multivariate binomial logistic regression analyses. Cox regression analysis was used to examine whether power and speed scores were associated with the incidence of frailty after adjusting for covariates.

RESULTS

Logistic regression analyses adjusted for covariates showed that the power and speed scores were associated with frailty according to the mCHS criteria (power: OR = 0.37, 95% CI = 0.22-0.63; speed: OR = 0.64, 95% CI = 0.52-0.79) and KCL criteria (power: OR = 0.40, 95% CI = 0.26-0.62; speed: OR = 0.81, 95% CI = 0.69-0.96) at baseline. Receiver operating characteristic analyses revealed that the area under the curve values of power and speed scores for discriminating mCHS-defined frailty were 0.72 and 0.73. The Cox regression analysis showed that the speed score predicted the incidence of mCHS-defined (HR = 0.45, 95% CI = 0.22-0.92, P = 0.029) and KCL-defined (HR = 0.77, 95% CI = 0.60-0.99, P = 0.039) frailty, whereas the power score was associated with the incidence of KCL-defined frailty (HR = 0.72, 95% CI = 0.55-0.95, P = 0.02) after adjusting for covariates.

CONCLUSIONS

The speed and power scores measured during sit-to-stand motion are predictive of frailty in older adults with cardiometabolic disease. Therefore, the GRF parameters measured during sit-to-stand motion could be an important indicator of frailty. Further studies are necessary to examine whether the GRF parameters can be improved by exercise or whether the changes in these parameters are associated with the improvement of frailty status.

Comparison of toe pressure strength in the standing position and toe grip strength in association with the presence of assistance in standing up: a cross-sectional study in community-dwelling older adults

PURPOSE

We believe that toe pressure strength in the standing position, which is closer to the actual movement, is more associated with standing up in the older adults than the conventional toe grip strength. Therefore, the purpose of this study is to examine the association between toe pressure strength in the standing position and the presence of assistance in standing up in the older adults.

METHODS

Ninety-five community-dwelling older adults (82 ± 8 years old, 72% female) were included in this study. The patients were evaluated based on their need for assistance in standing up. Physical functions, including toe pressure strength in the standing position, toe grip strength, hand grip strength, knee extension strength, one-leg standing time with eyes open, and maximal walking speed, were measured.

RESULTS

When compared with and without assistance to stand up, the group requiring assistance had weaker toe pressure strength in the standing position than the group without assistance (p = 0.015, ES = 0.53). After adjusting for confounding factors, the final model revealed that toe pressure strength in the standing position was associated with the use of assistance in standing up (odds ratio 0.94 [0.88-0.99, p = 0.025]).

CONCLUSION

Toe pressure strength in the standing position was associated with the use of assistance in standing up in older adults. Improving toe pressure strength in the standing position may facilitate the ability of older adults to stand up.

Evaluation of Sit-to-Stand Movement in Older Adults with Locomotive Syndrome Using the Nintendo Wii Balance Board

Standing up from a chair is a mechanically demanding daily motion, and its biomechanics represent motor performance. In older adults with locomotive syndrome (LS), sit-to-stand (STS) movement with adequate postural control is essential to prevent falls. This study evaluated the characteristics of dynamic balance during STS movement on older adults with LS. A total of 116 participants aged ≥65 years were divided into Non-LS, LS stage 1, and LS stage 2 groups using the LS risk test. The participants were instructed to stand on the Nintendo Wii Balance Board as quickly as possible, and the STS movement was quantified using the vertical ground reaction force (VGRF) and center of pressure (CoP). The STS score, which represented dynamic balance, was significantly different among the groups (p < 0.001). The rate of VGRF development was significantly lower in the LS stages 1 and 2 than in the Non-LS group (p < 0.001). On the other hand, the total distance of the CoP path did not differ among the groups (p = 0.211). These findings indicated a reduction of postural control in older adults with LS. The STS score emphasized the importance of balance training to prevent falls in older adults with LS.

Effects of Chinese fitness dancing on lower limb strength and fall risk in middle‐aged and older women: A cross‐sectional study

This study sought to identify the effect of Chinese fitness dancing on lower limb strength and fall risk in middle-aged and older women. The MicroFET3 portable muscle strength tester, the FreeStep test system, and tests to evaluate fall risk were used to measure the maximum muscle strength, fall risk index, and static balance ability of extensor muscle groups in the lower limbs. Compared with the irregular exercise group, the maximum muscle strength of extensor muscle groups in the lower limb, five sit-to-stand test timings, fall risk index, static balance ability, and lower limb flexibility did not improve significantly in the 1-year regular exercise group (p > 0.01). However, these indicators were significantly improved in the 10-year regular exercise group compared with the 1-year regular exercise group (p < 0.01). Long-term regular participation in Chinese fitness dancing significantly increased muscle strength in the lower limbs and effectively lowered the fall risk index in middle-aged and older women. Thus, long-term regular participation in Chinese fitness dancing can be used as a preventive measure to increase muscle strength in the lower limbs and reduce the risk of falls in middle-aged and older women.

Effects and optimal dosage of resistance training on strength, functional capacity, balance, general health perception, and fatigue in people with multiple sclerosis: a systematic review and meta-analysis

PURPOSE

To analyze the effectiveness of resistance training programs (RTP) on strength, functional capacity, balance, general health perception, and fatigue for people with Multiple Sclerosis (MS) and to determine the most effective dose of RTP in this population.

METHODS

Studies examining the effect of RTP on strength, functional capacity, balance, general health perception, and fatigue in MS patients were included. 44 studies were included. The meta-analysis, subgroup analysis and meta-regression methods were used to calculate the mean difference and standardized mean difference.

RESULTS

Significant group differences were observed in knee extensor (p = 0.01) and flexor (p < 0.001), but not in 1-repetition maximum. Regarding functional capacity and balance, differences between groups, in favour of the RTP group, were found in the Timed Up and Go Test (p = 0.001), walking endurance, (p = 0.02) gait speed (p = 0.02) and balance (p = 0.02). No significant differences between groups were observed in fatigue or general health perception. The results regarding the optimal dose are inconsistent.

CONCLUSIONS

RTP improves strength, functional capacity, balance, and fatigue in people with MS. Registration: (PROSPERO): CRD42020182781Implications for rehabilitationResistance training is a valid strategy to improve isometric strength and functional capacity in MS patients.RTP using long durations (more than 6 weeks), high intensity (more than 80% 1-RM) and two-day weekly training frequency may be a correct stimulus to improve strength, functional capacity, balance, and fatigue in people with MS.Trainers and rehabilitators should consider these indicators in order to maximize muscular and functional adaptations in this population.

Development of a screening formula for sarcopenia using ground reaction force during sit-to-stand motion

BACKGROUND

Ground reaction force during sit-to-stand motion is related to lower extremity strength, and such measurements indicating weak muscle strength, may be linked to sarcopenia. We aimed to examine and describe the relationship between sarcopenia and ground reaction force during sit-to-stand motion to develop a diagnostic tool.

RESEARCH QUESTION

Can ground reaction force during sit-to-stand motion help detect sarcopenia?

METHODS

This study included 627 community-dwelling older adults who were divided into non-sarcopenia and sarcopenia groups to compare ground reaction force parameters. A sit-to-stand force analyzer was used to measure the ground reaction force, power, and time between the minimum and maximum ground reaction force. We assessed the association between sarcopenia and each ground reaction force parameter. Receiver operating characteristic curve analysis was performed with sarcopenia as the dependent variable and ground reaction force-related measurements as independent variables. The probability of predicting sarcopenia was calculated using multiple logistic regression analysis, with sex and age as independent variables, and another receiver operating characteristic analysis was performed using the probability value.

RESULTS

Ground reaction force parameters related to strength and power were lower in the sarcopenia group than in the non-sarcopenia group. Furthermore, we were able to develop a formula to detect sarcopenia using the maximum ground reaction force (area under the curve; 0.906 [95% CI 0.858-0.954] for men and 0.858 [0.808-0.908] for women). The sensitivity and specificity of sarcopenia detection using this formula were 89.7% and 80.5%, respectively, for men and 95.0% and 60.9%, respectively, for women.

SIGNIFICANCE

Ground reaction force during sit-to-stand motion may reflect low skeletal muscle strength associated with sarcopenia. We were able to develop a method for sarcopenia detection by analyzing the sit-to-stand force required in only one or two sit-to-stand motions, even though it does not measure the skeletal muscle mass directly.

Factors influencing gait speed in community-dwelling older women: A Bayesian approach

BACKGROUND

Human gait is a complex task resulting from the interaction of sensory perception, muscle force output, and sensory-motor integration, which declines with the aging process and impacts gait speed in older women.

RESEARCH QUESTION

What are the separate and combined impacts of sensory-motor factors on gait speed of older women?

METHODS

Sixty healthy older women (69.3 ± 5.9 years) volunteered for this study. A previous screening using Pearson's correlation selected variables significantly correlated with gait speed: age, plantar tactile perception, lower limb explosive force, and mean velocity (MV) of the center of pressure (CoP). Simple and multivariate regression models were performed with selected variables. The magnitude of evidence was obtained using Bayesian inference, determining posterior probabilities based on our data.

RESULTS

Gait speed was negatively correlated with age and positively correlated with plantar tactile perception, MV (Romberg index), and lower limb explosive force. The coefficient of determination (R²) varied between 0.06 for plantar tactile perception and 0.22 for explosive force (p < 0.05). The multivariate model, including age, MV (Romberg index), and lower limb explosive force, explained 44% (R² = 0.44) of the variance in gait speed, with a small standard error of estimate (0.14 m/s). Bayesian inference confirmed the good posterior probability of the model.

SIGNIFICANCE

Age, plantar tactile perception, MV (Romberg index), and lower limb explosive force impact gait speed, whereas the combination of the first three factors has an excellent posterior probability of predicting or affecting gait speed.

Fast-velocity resistance training improves force development and mobility in Multiple Sclerosis

This study aimed to analyze the benefits of a lower-limb fast-velocity concentric resistance training on rate of force development, mobility, and quality of life in people with Multiple Sclerosis. A randomized controlled trial was conducted in 30 people with Multiple Sclerosis, who were randomly assigned to either an experimental (n=18) or a control (n=12) group. The experimental group carried out 10-weeks of fast-velocity concentric resistance training, while the control group did not perform any intervention. Early and late rate of force development during knee extension in both legs, sit-to-stand and Timed Up and Go tests and quality life questionnaire were evaluated before and after intervention. The training program evoked an increase in early rate of force development in experimental group (0-30; Rightleg: 63.9%, p<0.001;ES=-1.4; Leftleg: 52.7%, p<0.001;ES=-1.0) compared to control group (showed modest increases). Furthermore, experimental group improved mobility after training (Sit-to-stand: 22.2%, p<0.001;ES=1.0; Timed Up and Go Test: 10.1%, p<0.001;ES=1.1) and increased the perception of quality of life after training, while control showed no changes. The fast-velocity concentric resistance training has the potential to improve early rate of force development and mobility after 10-weeks of training. In addition, the increase in self-perceived quality of life following this training modality demonstrates promising results in the Multiple Sclerosis population.

Change in subjective health status among frail older Japanese people owing to the coronavirus disease pandemic and characteristics of their responses

Aim

The coronavirus disease 2019 (COVID‐19) pandemic remains a major global public health issue, and it has led to restrictions in physical and social activities among community‐dwelling people, including frail older adults. This study aimed to determine the impact of the pandemic on the subjective health status and characteristics of community‐dwelling frail older adults by assessing their knowledge of infection, behaviors and negative psychological response.

Methods

During October 2019, 720 older adults participated in “The Otassha Study.” A year after the COVID‐19 outbreak, between June 29 and July 31, 2020, a health status questionnaire, comprising questions concerning knowledge about infection, behaviors and psychological responses during the pandemic, was sent to all participants of the health examination in 2019. Respondents were divided into the robust and frail groups, and their responses were compared.

Results

Although the self‐reported health status of the older adults in both groups was worse in 2020 than in 2019, differences were not observed in the degree of deterioration between the groups. Those in the frail group had fewer resources of information related to COVID‐19 and had fewer coping behaviors for health maintenance compared with the robust group.

Conclusion

Information gathering and actions aimed at health maintenance tended to be weaker among older adults with frailty, although the influence of COVID‐19 on subjective health status did not differ significantly between robust and frail adults. Therefore, robust and frail older adults may need to adopt different countermeasures to prevent worse health during this pandemic. Geriatr Gerontol Int 2021; 21: 1053–1059.

Chair sit-to-stand performance is associated with diagnostic features of sarcopenia in older men and women

BACKGROUND

Standing from a chair is a fundamental activity of daily living, and it can be applied to assess the physical function, especially in older individuals.

AIM

The aim of this study was to elucidate the characteristics of mechanical and temporal parameters during chair stand based on the relationship with skeletal muscle and physical functional parameters in older men and women.

METHODS

Eighty older men and women participated in this study. We measured four parameters of chair stand performance: ground reaction force (GRF), rate of force development (RFD), and chair rise time (CRT) were calculated from the foot-floor force data; sit-to-stand (STS) was also assessed by measuring the time needed to complete 10 chair stand repetitions. The muscle thickness (MT) and echo intensity, as indexes of muscle size and quality, respectively, were measured using axial B-mode ultrasound images from quadriceps femoris. The gait speed and handgrip strength were measured as physical functional parameters.

RESULTS

Partial correlation was used to determine the association of chair stand performance with MT, echo intensity, and physical parameters while considering the height, body mass, and age. GRF, RFD, and STS were significantly correlated with MT (r = 0.35, 0.26, and -0.49), gait speed (r = 0.32, 0.31, and -0.67), and handgrip strength (r = 0.57, 0.59, and -0.49). As the result of regression analysis, MT, gait speed, and handgrip strength were estimated by GRF and STS.

CONCLUSION

These results suggest that chair stand performance is useful as it reflects the muscle size and physical functions in older individuals.