Lumbar extensor fatigue and circumferential ankle pressure impair ankle joint motion sense

Diaphragmatic breathing exercises in recovery from fatigue-induced changes in spinal mobility and postural stability: a study protocol

Prolonged periods of sitting at work can increase trunk muscle fatigue from the continuous contraction of deep trunk muscles. Insufficient activity of these muscles can decrease muscular support to the spine and increases stress on its passive structures. This can lead to reduced spinal mobility and impaired postural stability. It may also stimulate nociceptor activity leading to pain. However, frequently used recovery modalities such as muscle strengthening and stretching exercises, can be time-consuming, impractical, and difficult to implement in the workplace. Diaphragmatic breathing exercises, which increase the activity of the deep trunk muscles by raising intra-abdominal pressure, seem to be a suitable alternative. However, little is known as to what extent diaphragmatic breathing exercises contribute to the reduction of fatigue induced by prolonged sitting. This paper presents a study protocol that aims to investigate the acute effect of diaphragmatic breathing exercises on recovery of fatigue-induced changes in spinal mobility and postural stability in sedentary middle-aged adults at risk of developing non-specific low back pain. Twenty sedentary adults aged between 25 and 44 years will perform Abt's fatigue protocol, followed by 1) active recovery using diaphragmatic breathing exercises and 2) passive recovery in the form of lying on the bed, respectively. There will be 1 week of rest in-between. Pre-fatigue, post-fatigue, and after the active and passive recovery, spinal mobility and postural stability will be evaluated using the spinal mouse device and a posturography system, respectively. The electromyography will be used to determine the muscle-fatigue conditions. We hypothesize that active recovery in a form of diaphragmatic breathing exercises would be more effective in restoring spinal mobility and postural stability followed by the fatigue of back and hamstring muscles compared to passive recovery in sedentary adults. Increasing core and respiratory muscle strength via these exercises could be beneficial for overall mobility and stability of the spine. Reducing compressive stress on the passive structures of the spine may be also beneficial for lowering low back pain. Therefore, we believe that diaphragmatic breathing exercises have the possibility to be incorporated into the workplace and contribute to better back health in sedentary middle-aged adults. Clinical Trial Registration: [https://www.irct.ir/trial/67015], identifier [IRCT20221126056606N1].

Physiological Mechanisms of Exercise and Its Effects on Postural Sway: Does Sport Make a Difference?

While the effect of a variety of exercises on postural balance control has been extensively studied, less attention has been paid to those requiring sport-specific skills. Therefore there is a need to analyze the literature and elucidate changes in postural balance control after exercises performed in conditions close to a particular sport. This scoping review aims (i) To map the literature that addresses postural sway aspects of acute responses to general and sport-specific exercises and their underlying physiological mechanisms, and (ii) To identify gaps in the existing literature and propose future research on this topic. The main literature search conducted on MEDLINE, Web of Science, Scopus, PubMed, and Cochrane Library databases was completed by SpringerLink, Elsevier, and Google Scholar. A total of 60 articles met the inclusion criteria. Findings identified that among a variety of studies evaluating the effects of exercise on postural balance control, only few of them were conducted under sport-specific conditions (i.e., while shooting in biathlon or pentathlon, and after simulated or match-induced protocols in combat and team sports). Therefore, more research is still needed to address this gap in the literature and aim research at investigation of postural sway response to sport-specific exercises. Further analysis of the literature showed that the type, intensity and duration of exercise play a key role in increased postural sway. Whole body and localized muscular fatigue of the trunk, neck and lower limbs is considered to be a main factor responsible for the magnitude of balance impairment in an initial phase of recovery and speed of its readjustment to a pre-exercise level. Other likely factors affecting postural stability are hyperventilation and deterioration of sensorimotor functions, though some contribution of muscle damage, dehydration, hyperthermia or dizziness cannot be excluded. A better understanding of the physiological mechanisms of balance impairment after exercises performed under simulated fatigue induced protocol, close to conditions specific to a particular sport, has implications for designing smart exercise programs tailored to individual needs to improve athlete performance with high demands on postural stability and/or decrease their risk of injuries.

A busy day has minimal effect on factors associated with falls in older people: An ecological randomised crossover trial

Fatigue is a common complaint in older people. Laboratory-induced muscle fatigue has been found to affect physical functions in older populations but these protocols are rigorous and are unlikely to accurately reflect daily activities. This study used an ecological approach to determine the effects of a busy day on self-reported fatigue and fall-related measures of physical and cognitive function in older people. Fifty community-dwelling adult volunteers, aged 60-88 (mean 73) years participated in this randomised crossover trial. Participants undertook assessments of balance, strength, gait, mobility, cognitive function and self-reported fatigue, before and after a planned rest day and a planned busy day (randomly allocated) at least one week apart. Participants wore an activity monitor on both the rest and busy days. On average, participants undertook twice as many steps and 2.5 times more minutes of activity on the busy, compared with the rest day. Participants had a significant increase in self-reported fatigue on the afternoon of the busy day and no change on the rest day. Repeated measures ANOVAs found no significant day (rest/busy) × time (am/pm) interaction effects, except for the timed up and go test of mobility, resulting from relatively improved mobility performance over the rest day, compared with the busy day. This study showed few effects of a busy day on physical and cognitive performance tests associated with falls in older people.

Walking-Induced Fatigue Leads to Increased Falls Risk in Older Adults

BACKGROUND

For older adults, falls are a serious health problem, with more than 30% of people older than 65 suffering a fall at least once a year. One element often overlooked in the assessment of falls is whether a person's balance, walking ability, and overall falls risk is affected by performing activities of daily living such as walking.

OBJECTIVE

This study assessed the immediate impact of incline walking at a moderate pace on falls risk, leg strength, reaction time, gait, and balance in 75 healthy adults from 30 to 79 years of age. Subjects were subdivided into 5 equal groups based on their age (group 1, 30-39 years; group 2, 40-49 years; group 3, 50-59 years; group 4, 60-69 years; group 5, 70-79 years).

METHODS

Each person's falls risk (using the Physiological Profile Assessment), simple reaction time, leg strength, walking ability, and standing balance were assessed before and after a period of incline walking on an automated treadmill. The walking task consisted of three 5-minute trials at a faster than preferred pace. Fatigue during walking was elicited by increasing the treadmill incline in increments of 2° (from level) every minute to a maximum of 8°.

RESULTS

As predicted, significant age-related differences were observed before the walking activity. In general, increasing age was associated with declines in gait speed, lower limb strength, slower reaction times, and increases in overall falls risk. Following the treadmill task, older adults exhibited increased sway (path length 60-69 years; 10.2 ± 0.7 to 12.1 ± 0.7 cm: 70-79 years; 12.8 ± 1.1 to 15.1 ± 0.8 cm), slower reaction times (70-79 years; 256 ± 6 to 287 ± 8 ms), and declines in lower limb strength (60-69 years; 36 ± 2 to 31 ± 1 kg: 70-79 years; 32.3 ± 2 to 27 ± 1 kg). However, a significant increase in overall falls risk (pre; 0.51 ± 0.17: post; 1.01 ± 0.18) was only seen in the oldest group (70-79 years). For all other persons (30-69 years), changes resulting from the treadmill-walking task did not lead to a significant increase in falls risk.

CONCLUSIONS

As most falls occur when an individual is moving and/or fatigued, assessing functional properties related to balance, gait, strength, and falls risk in older adults both at rest and following activity may provide additional insight.

Effects of lumbar extensor fatigue and surface inclination on postural control during quiet stance

A number of work environments require workers to perform tasks on inclined surfaces. Such tasks, along with muscle fatigue, can impair postural control and increase falling risks. The objective of this study was to determine the effects of surface inclination angle, standing direction, and lumbar extensor fatigue on postural control during quiet standing. A group of 16 young, healthy participants were tested while standing on inclined surfaces before and after lumbar extensor fatigue (induced by repetitive isotonic exercise). Three inclination angles (0°, 18° and 26°) and three standing directions (uphill, downhill, and lateral facing) were examined. Postural control was assessed using several measures derived from center-of-pressure time series and subjectively perceived stability. Significant main and interactive effects of inclination angle and standing direction were found for all dependent measures. The adverse effects of standing on inclined surfaces were found to differ between the three standing directions. In general, dose-response relationships with inclination angle were evident, particularly in the lateral-facing direction. Fatigue-related effects differed between conditions, suggesting that the adverse effect of lumbar extensor fatigue on postural control depend on inclination angle and standing direction. These findings may facilitate the development of fall prevention interventions for work involving inclined surfaces.

Consequences of lower extremity and trunk muscle fatigue on balance and functional tasks in older people: a systematic literature review

Background

Muscle fatigue reduces muscle strength and balance control in young people. It is not clear whether fatigue resistance seen in older persons leads to different effects. In order to understand whether muscle fatigue may increase fall risk in older persons, a systematic literature review aimed to summarize knowledge on the effects of lower extremity and trunk muscle fatigue on balance and functional tasks in older people was performed.

Methods

Studies were identified with searches of the PUBMED and SCOPUS data bases.

Papers describing effects of lower extremity or trunk muscle fatigue protocols on balance or functional tasks in older people were included. Studies were compared with regards to study population characteristics, fatigue protocol, and balance and functional task outcomes.

Results

Seven out of 266 studies met the inclusion criteria. Primary findings were: fatigue via resistance exercises to lower limb and trunk muscles induces postural instability during quiet standing; induced hip, knee and ankle muscle fatigue impairs functional reach, reduces the speed and power of sit-to-stand repetitions, and produces less stable and more variable walking patterns; effects of age on degree of fatigue and rate of recovery from fatigue are inconsistent across studies, with these disparities likely due to differences in the fatigue protocols, study populations and outcome measures.

Conclusion

Taken together, the findings suggest that balance and functional task performance are impaired with fatigue. Future studies should assess whether fatigue is related to increased risk of falling and whether exercise interventions may decrease fatigue effects.

Effects of localized muscle fatigue on recovery from a postural perturbation without stepping

Several investigations have demonstrated that localized muscle fatigue (LMF) causes an increase in postural sway measures during quiet stance. Since many falls are likely the result of a postural perturbation, this study investigated the effects of LMF on balance recovery from sagittal plane postural perturbations. Thirty-two participants (16 young, 16 older) were tested. Postural perturbations were administered with ballistic pendulums before and after exercises to fatigue the lumbar extensors and plantar flexors. Measures of balance recovery were based on the center of pressure (COP) and center of mass (COM) trajectories and the maximum perturbation that could be withstood without stepping. A covariate analysis that included initial conditions at the time of the perturbation was also performed. The results demonstrated changes in the COM trajectory that were consistent with an LMF-induced decrement in the ability to recover from the perturbations without stepping. Interpretation of the COP trajectory was presented in light of the COM and indicated a modified postural control strategy following LMF.

Re-weighting of somatosensory inputs from the foot and the ankle for controlling posture during quiet standing following trunk extensor muscles fatigue

The present study focused on the effects of trunk extensor muscles fatigue on postural control during quiet standing under different somatosensory conditions from the foot and the ankle. With this aim, 20 young healthy adults were asked to stand as immobile as possible in two conditions of No fatigue and Fatigue of trunk extensor muscles. In Experiment 1 (n = 10), somatosensation from the foot and the ankle was degraded by standing on a foam surface. In Experiment 2 (n = 10), somatosensation from the foot and ankle was facilitated through the increased cutaneous feedback at the foot and ankle provided by strips of athletic tape applied across both ankle joints. The centre of foot pressure displacements (CoP) were recorded using a force platform. The results showed that (1) trunk extensor muscles fatigue increased CoP displacements under normal somatosensatory conditions (Experiment 1 and Experiment 2), (2) this destabilizing effect was exacerbated when somatosensation from the foot and the ankle was degraded (Experiment 1), and (3) this destabilizing effect was mitigated when somatosensation from the foot and the ankle was facilitated (Experiment 2). Altogether, the present findings evidenced re-weighting of sensory cues for controlling posture during quiet standing following trunk extensor muscles fatigue by increasing the reliance on the somatosensory inputs from the foot and the ankle. This could have implications in clinical and rehabilitative areas.

Postural sway and joint kinematics during quiet standing are affected by lumbar extensor fatigue

The purpose of this study was to investigate changes in postural sway and strategy elicited by lumbar extensor muscle fatigue. Specifically, changes in center of mass (COM), center of pressure (COP), and joint kinematics during quiet standing were determined, as well as selected cross correlations between these variables that are indicative of movement strategy. Twelve healthy male participants stood quietly both before and after exercises that fatigued the lumbar extensors. Whole-body movement and ground reaction force data were recorded and used to calculate mean body posture and variability of COM, COP, and joint kinematics during quiet standing. Three main findings emerged. First, participants adopted a slight forward lean post-fatigue as evidenced by an anterior shift of the COM and COP. Second, post-fatigue increases in joint angle variability were observed at multiple joints including joints distal to the fatigued musculature. Despite these increases, anterior-posterior (AP) ankle angle correlated well with AP COM position, suggesting the body still behaved similar to an inverted pendulum. Third, global measures of sway based on COM and COP were not necessarily indicative of changes in individual joint kinematics. Thus, in trying to advance our understanding of how localized fatigue affects movement patterns and the postural control system, it appears that joint kinematics and/or multivariate measures of postural sway are necessary.