Ground Reaction Force in Sit-to-stand Movement Reflects Lower Limb Muscle Strength and Power in Community-dwelling Older Adults

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.

Relationship between Acceleration in a Sit-To-Stand Movement and Physical Function in Older Adults

Acceleration parameters in sit-to-stand (STS) movements are useful for measuring lower-limb function in older adults. The purpose of this study was to examine the relationship between acceleration in STS movements and physical function and the test-retest reliability of acceleration parameters in older adults. We performed cross-sectional analyses on 244 older adults including 107 men (mean age: 77.4 ± 4.7) and 137 women (mean age: 75.6 ± 5.3). Four acceleration parameters were measured in STS movements: maximum acceleration (MA), maximum velocity (MV), maximum power (MP), and stand-up time (ST). Good intraclass correlation coefficients (ICC > 0.70) were observed for all parameters. For the acceleration parameters, MA, MV, and MP were relatively strongly associated with the 5-time STS test (men: r = -0.36~-0.47; women: r = -0.37~-0.45) and the timed up and go test (men: r = -0.39~0.47, women: r = -0.43~-0.51): MP was also strongly associated with grip strength (men: r = 0.48, women: r = 0.43). All acceleration parameters were poorer in participants reporting mobility limitations than in those reporting no mobility limitations. These findings support the usefulness of sensor-based STS measurement. The system is expected to be useful in various settings where care prevention is addressed.

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.

The effects of anterior and posterior ankle-foot orthoses on sit-to-stand transfer performance in stroke patients

BACKGROUND

Nonarticulated and low-temperature thermoplastic ankle-foot orthoses (AFOs) have a semirigid design and are effective in improving the postural control mechanism (PCM) in individuals with poststroke hemiparesis. AFOs with an anterior leaf (AAFOs) are more often prescribed than are AFOs with a posterior leaf (PAFOs); however, the effects of AAFOs on the PCM during sit-to-stand transfer (STST) have not been explored.

RESEARCH QUESTIONS

Do AAFOs and PAFOs change the PCM differently during STST?

METHODS

A cross-sectional quasi-experimental design was adopted in this study. Fourteen individuals with poststroke hemiparesis (10 men and 4 women, aged between 38 and 71 years, stroke onset between 1 and 17 months) performed STST with shoes only, an AAFO with shoes, or a PAFO with shoes. Vertical ground reaction force (VGRF) and center-of-pressure (CoP) coordinates were collected using a pressure mat to calculate PCM parameters. A single-factor repeated measures analysis of variance was performed to answer the research question.

RESULTS

(1) The weight-bearing percentage of the paretic leg was significantly lower when the participants wore a PAFO (p = 0.018) than when they wore an AAFO (p = 0.019) during the first 5 and 5-10 s after rising. (2) A small rate of change of the VGRF increment (dF/dT) was detected when participants wore AFOs, particularly AAFO. (3) The maximum mediolateral displacement of the CoP when standing up was significantly different among the three conditions (p = 0.012).

SIGNIFICANCE

For patients with poststroke hemiparesis, AAFO and PAFOs change the PCM during STST performance. Only AAFO improved the PCM possibly because of the rigidity and clearance of the heel region, which provide somatic sensory feedback. Therefore, rehabilitation professionals should educate hemiplegic patients who use AAFOs or PAFOs to perform dynamic daily tasks slowly for their safety.

Impaired Modulation of Motor and Functional Performance in Patients after Total Knee Arthroplasty: A Prospective Observational Study

Submaximal levels of effort are required for the performance of the most common daily tasks. Inaccuracy in modulating motor outputs during submaximal tasks has been reported as indicator of safety during daily activities in subjects with lower limb musculoskeletal disorders. The study is aimed at investigating performance modulation ability during motor and functional tasks in patients after total knee arthroplasty (TKA). Sixteen patients with end-stage osteoarthritis undergoing TKA and twenty age-matched healthy participants performed isokinetic knee extension, sit-to-stand, and walking tasks at three levels of self-estimated effort (100%, 50%, and 25%) the day before (T0) and 4 days after surgery (T1). Maximum performance in terms of peak torque (PT—knee extension), overshoot (OS—sit-to-stand), and walking speed was evaluated. Subsequently, relative error (RE) between target and observed performance was computed for the submaximal tasks (RE_50% and RE_25%). Our results showed a decline of maximum performance after surgery, which resulted lower in patients compared to healthy subjects. RE_50% and RE_25% for knee extension (involved limb) (p < 0.001) and RE_25% for sit-to-stand (p < 0.001) increased from pre- to postsurgery. At T0, knee extension RE_25% and walking RE_50% and RE_25% were higher in patients. At T1, RE_50% and RE_25% were higher in patients for knee extension (involved limb), sit-to-stand, and walking. In conclusion, the ability to modulate motor and functional performance decreased after TKA and resulted impaired when compared to healthy age-matched subjects. Based on relationship between ability to modulate motor outputs and risk of falling, the role of modulation ability as indicator of readiness for discharge and safe return to daily activities deserves further investigations in patients in early phase after TKA.

The Effect of Convergence Gamification Training in Community-Dwelling Older People: A Multicenter, Randomized Controlled Trial

OBJECTIVES

It is necessary to improve the health of older adults through exercise, but there is no concrete way to implement it or an environment in which they can exercise continuously. Our objective was to confirm the safety and efficacy of information technology (IT) convergence gamification exercise equipment for older adults. We tried to demonstrate equivalence to conventional exercise by comparing the functional improvement.

DESIGN

Randomized controlled trial, with 8-week-long IT convergence exercises 3 times a week vs conventional exercise.

SETTING AND PARTICIPANTS

40 community-dwelling participants aged 60-85 years.

METHOD

Participants were randomly divided into a conventional exercise group (group 1) and an IT convergence exercise group (group 2). Both groups were trained for 8 weeks, and functional assessment was performed before training (pre-evaluation), after training, and after 4 weeks of rest.

RESULTS

There were functional improvements in both groups. A comparison of the differences in the functional assessment between pre-evaluation and after 8 weeks of training yielded the following results. In group 1, the mean Five Times Sit to Stand Test-30 seconds was scored as 3.60 ± 2.56 (P < .015); Five Times Sit to Stand Test-5 times, -1.75 ± 2.04 s (P < .015); Berg Balance Scale, 1.05 ± 1.39 (P < .015); Timed Up-and-Go test, -0.64 ± 0.64 s (P < .015); and 10-m Walking Test, -0.35 ± 0.47 s (P < .015). And in group 2, the mean Five Times Sit to Stand Test-30 seconds (s) was scored as 3.70 ± 2.62 (P < .015), Five Times Sit to Stand Test-5 times, -1.65 ± 1.59 s (P < .015); Berg Balance Scale, 1.05 ± 1.00 (P < .015); Timed Up-and-Go test, -0.93 ± 0.68 s (P < .015); 10-m Walking Test, -0.41 ± 0.489 s (P < .015); Chair Sit and Reach test, 2.23 ± 3.19 cm (P < .015); and Korean version of the Falls Efficacy Scale-International, -1.05 ± 1.43 (P < .015).

CONCLUSION AND IMPLICATIONS

The results of this study suggest that the IT convergence gamification exercise equipment such as balpro110 has exercise effects similar to conventional exercise and also has advantages as an alternative to exercise for older adults in the next generation.

Clinical features contributing to the sit-to-stand transfer in people with Parkinson’s disease: a systematic review

Introduction

The aim of this systematic review is to present the existing literature on the clinical motor, and non-motor factors contributing to sit-to-stand transfer in individuals with Parkinson's disease.

Data synthesis

Five databases (PubMed, PEDro, Cochrane, SCOPUS, and Ovid) were searched for literature on the contributing factors to sit-to-stand performance in Parkinson's disease. A quality check of these observational studies was done using the 'strengthening the reporting of observational studies in epidemiology' (STROBE) statement and the tool of the 'National Heart, Lung, and Blood Institute' (NHLBI). Descriptive and quantitative data were extracted and compiled, and a meta-analysis was performed to compute the standardised mean difference.

Results

Thirteen studies were selected; a majority of them provided a high-to-moderate level of evidence. Ten were cross-sectional, while the other three were case–control studies. Collectively, individuals with Parkinson's disease had a prolonged transfer time than those of age-matched healthy peers, particularly from peak horizontal velocity phase to seat-off phase, implying bradykinesia. A reduction in peak and rate to peak joint torques was also related to the decreased pace and stability of the sit-to-stand movement in individuals with Parkinson's disease. Additionally, they demonstrated exaggerated trunk flexion as a postural stabilisation strategy, allowing them to maintain and manoeuvre the relative positions of their centre of mass through the transitional phase of the transfer.

Conclusion

As per the existing literature, an alteration in strength, overall body bradykinesia, balance, posture, as well as cognition may result in an impaired sit-to-stand transfer in individuals with Parkinson's disease.

Segmental contribution to whole-body angular momentum during stepping in healthy young and old adults

Recent evidence suggests that during volitional stepping older adults control whole-body angular momentum (H) less effectively than younger adults, which may impose a greater challenge for balance control during this task in the elderly. This study investigated the influence of aging on the segment angular momenta and their contributions to H during stepping. Eighteen old and 15 young healthy adults were instructed to perform a series of stepping at two speed conditions: preferred and as fast as possible. Full-body kinematics were recorded to compute angular momenta of the trunk, arms and legs and their contributions to total absolute H on the entire stepping movement. Results indicated that older adults exhibited larger angular momenta of the trunk and legs in the sagittal plane, which contributed to a higher sagittal plane H range during stepping compared to young adults. Results also revealed that older adults had a greater trunk contribution and lower leg contribution to total absolute H in the sagittal plane compared to young adults, even though there was no difference in the other two planes. These results stress that age-related changes in H control during stepping arise as a result of changes in trunk and leg rotational dynamics.

Individuals with gluteal tendon repair display similar hip biomechanics to those of a healthy cohort during a sit-to-stand task

BACKGROUND

Gluteal-tendon repair (GTR) is reported to be effective for relieving pain and improving clinical function in patients with gluteal-tendon tears. The sit-to-stand (STS) task is an important activity of daily living and is often used to assess functional capacity in clinical populations. Understanding if and how STS performance is altered in individuals with gluteal tendon repair may be an effective marker of GTR outcomes as well as a possible therapeutic target for post-operative rehabilitation.

RESEARCH QUESTION

Do biomechanical parameters during STS differ between age- and sex-matched participants with and without gluteal-tendon repair?

METHODS

27 participants with a GTR and 29 healthy participants performed the STS task. Data were acquired using the three-dimensional motion capture system and forceplates. Outcomes of interest were task duration, rate of force development, trunk, pelvis, and hip joint angles, moments and powers. Differences were assessed using Generalised linear multivariate models and statistical parametric mapping.

RESULTS

GTR patients performed the STS movement significantly slower (1.4+/- 0.40 s) compared to controls (1.1+/ -0.2 s) with a significantly lower rate of force development (35.1+/- 5.7 N/kg/ms vs 30.3+/- 8.5 N/kg/ms). There were no group differences for hip, pelvis, or trunk angle over the movement cycle or for maximal or minimal values. Furthermore, there were no significant differences detected in hip joint kinetics. However, there appeared to be substantial between-subject variability indicating different patient-specific movements patterns.

SIGNIFICANCE

Individuals with a GTR performed the STS task about 20 % slower than healthy controls with a lower rate of force development. The individual variations indicate that participants likely employed different movement strategies to achieve STS. While the lack of differences between groups could suggest that GTR helps restore function and corrects the proposed underlying aetiology, it is possible that the STS task was not sufficiently challenging to discriminate between groups.

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.

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

OBJECTIVES

Ground reaction force (GRF) during sit-to-stand motion is associated with lower extremity strength and balance function. The relationship between GRF and experience of falls has been reported; however, there are no reports on whether GRF can predict the incidence of future falls. We aimed to evaluate the ability of GRF to predict falls and compare GRF with existing predictors.

METHODS

This prospective observational cohort study enrolled 456 community-dwelling older adults living in Itabashi ward who participated in health check-ups in 2016 and 2017. Participants' physical and cognitive functions were assessed, and the maximum GRF (F), F/weight (F/W), rate of force development (RFD), RFD/W (RFD/weight), and time taken to stand up were evaluated. The following year, participants were asked to report the number of falls during the year. Cox proportional hazards regression was conducted to analyze the relationship between the lowest quintile of each GRF parameter as a predictive factor for falling and assess the annual incidence of falls.

RESULTS

Twenty-three participants reported having two or more falls in the previous year. Of all GRF parameters evaluated, only F/W was lower in the fallers than in the non-fallers. After adjusting for sex, age, lifestyle, and comorbidities, F/W was associated with falls in 1 year, and the lowest F/W group had higher risks of falls than the highest F/W group (hazard ratio 2.72, 95 % confidence interval 1.11-6.68). Other measures were not associated with falls.

CONCLUSIONS

GRF during the sit-to-stand motion might predict the incidence of future falls.

Sit-to-Stand Kinetics and Correlates of Performance in Young and Older Males

PURPOSE

To compare sit-to-stand (STS) kinetics in young (YM) and older (OM) males and determine correlates of STS performance.

METHODS

YM (n = 15, age = 20.7 ± 2.2 yrs) and OM (n = 15, age = 71.6 ± 3.9 yrs) performed a single STS task as quickly as possible on a force plate and the vertical ground reaction force (VGRF) signal was analyzed. Peak VGRF, as well as peak (100 ms rolling average), early (minimum VGRF to 50% peak VGRF), late (50% peak VGRF to peak VGRF), and overall (minimum VGRF to peak VGRF) rate of force development (RFD) were calculated. Power (absolute and relative) and velocity parameters as well as rate of electromyography rise (RER) were also obtained.

RESULTS

STS time, average power, early RFD, and lower limb lean mass were similar between groups (p > 0.05). All other power, velocity, RFD, and RER measures were lower in OM (p < 0.05; d = 0.41-2.19). Peak VGRF and all RFD measures, except late RFD, were strongly correlated with STS performance in OM, while peak VGRF and peak RFD were only moderately correlated with performance in YM.

CONCLUSIONS

Most kinetic variables, except absolute average power, were diminished in OM, and there was a preferential decrease in late RFD compared to early RFD. Peak VGRF and RFD exhibited stronger correlations with STS time and power in OM compared to YM, and early RFD appears to be more influential for STS performance than late RFD. These findings may be useful for practitioners/clinicians involved in designing interventions aimed at optimizing STS performance in older adults.

The relationship between ground reaction force in sit-to-stand movement and lower extremity function in community-dwelling Japanese older adults using long-term care insurance services

[Purpose] The purpose of this study was to investigate which of the four chair-rising methods has low-load and the highest success rate, and whether the GRF parameters in that method are useful for measuring lower extremity function among physically frail Japanese older adults. [Subjects and Methods] Fifty-two individuals participated in this study. The participants voluntarily attempted four types of Sit-to-stand test (one variation without and three variations with the use of their arms). The following parameters were measured: peak reaction force (F/w), two force development rate parameters (RFD1.25/w, RFD8.75/w) and two time-related parameters (T1, T2). Three additional commonly employed clinical tests (One-leg balance with eyes open, Timed up and go and 5-meter walk test) were also conducted. [Results] “Hands on a chair” chair-rising method produced the highest success rate among the four methods. All parameters were highly reliable between testing occasions. T2 showed strongly significant associations with Timed up and go and 5-meter walk test in males. RFD8.75/w showed significant associations with Timed up and go and 5-meter walk test in females. [Conclusion] Ground reaction force parameters in the Sit-to-stand test are a reliable and useful method for assessment of lower extremity function in physically frail Japanese older adults.