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Sadeh S, Gobert D, Shen KH, Foroughi F, Hsiao HY. Biomechanical and neuromuscular control characteristics of sit-to-stand transfer in young and older adults: A systematic review with implications for balance regulation mechanisms. Clin Biomech (Bristol, Avon) 2023; 109:106068. [PMID: 37639862 DOI: 10.1016/j.clinbiomech.2023.106068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/24/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Falls are major health concerns in older adults. Sit-to-stand transfer is an important functional movement that can predict falling risk in older adults. Aging-associated declines in neuromechanical control of movement may negatively impact sit-to-stand performance. This systematic review aims to summarize differences in neuromechanical characteristics of younger vs. older adults that likely affect balance regulation during sit-to-stand. METHODS Five databases (Academic search complete, MEDLINE, APA PsycInfo, Pubmed, and SPORTDiscus) were systematically searched from January 1985 through March 2023. Three reviewers assessed the quality of methodology, study design, results, and risk of bias using the Appraisal tool for Cross-Sectional Studies. Studies reported neuromuscular and biomechanical characteristics during sit-to-stand in young versus older adults were included. FINDINGS Seventeen studies (343 older and 225 younger adults) were included. Compared to younger adults, older adults showed slower sit-to-stand time, higher trunk flexion, postural sway, agonist-antagonist muscle co-activation of the ankle and knee muscles, and lower ankle dorsiflexion torque. Lower magnitude and rate of vertical ground reaction force development and lower vertical momentum during rising were observed with aging during fast-speed sit-to-stand. There was heterogeneity among studies on sit-to-stand speed, foot position, use of arms, and seat height adjustability. INTERPRETATIONS Higher trunk angular displacement and velocity accompanied by higher anterior momentum, likely to compensate for knee extensor muscle weaknesses, may lead to higher postural sway upon standing and therefore require higher knee and ankle muscle co-activation to maintain balance stability. Thus, additional attention to trunk control strategies is needed during clinical evaluations.
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Affiliation(s)
- Soroosh Sadeh
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA.
| | - Denise Gobert
- Department of Physical Therapy, Texas State University, Round Rock, TX, USA.
| | - Keng-Hung Shen
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA.
| | - Forouzan Foroughi
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA.
| | - Hao-Yuan Hsiao
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA.
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Benefits of Virtual Reality Program and Motor Imagery Training on Balance and Fall Efficacy in Isolated Older Adults: A Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111545. [PMID: 36363502 PMCID: PMC9692723 DOI: 10.3390/medicina58111545] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
Abstract
Background and Objectives: for isolated older adults, alternative training indoors to maintain balance is essential; however, related studies are lacking. To improve the balance of isolated older adults and reduce their fear of falling, we aimed to examine the balance−keeping effect of a virtual reality (VR) program and motor imagery training (MIT) and propose training that could improve physical activity among older adults. Methods: a total of 34 older adults admitted to a convalescent hospital were assessed. VR (n = 12) and MIT (n = 10) groups completed their assigned intervention in six weeks, whereas the control group (CG) (n = 12) did not. The follow−up was performed after two weeks. Results: in group × time interactions, body center movement area, open and closed eyes balance scores, and fall efficacy were significantly different (p < 0.05). In contrast with the VR group, the MIT group did not show a significant difference in the open or closed eyes balance scores depending on the period. However, there was a significant difference between the MIT group and CG in the open eyes balance score post-test (d = 1.13, 95% confidence interval, 0.40−12.33). Conclusions: we propose VR and MIT as training methods to prevent physical weakness in isolated older adults.
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Wagner PP, Foesser D, Chapurlat R, Szulc P. Risk Factors for the Incident Decline of Physical Performance in Older Men: The Prospective Strambo Study. Calcif Tissue Int 2022; 110:428-440. [PMID: 34718830 DOI: 10.1007/s00223-021-00926-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/17/2021] [Indexed: 11/25/2022]
Abstract
Risk factors of physical performance decline in older men remain uncertain. We assessed risk factors of incident physical performance deterioration in older men followed up prospectively. In a cohort of 821 men aged 60-87, physical performance was assessed by four tests (five chair stands, standing with closed eyes, forward and backward tandem walk) at baseline, 4 and 8 years. Various predictive biological measurements were performed at baseline. Serum creatinine/ cystatin C (Cr/CysC) ratio was used as an index of muscle mass. In multivariate models, higher age, higher fat mass index (FMI = fat mass/height2), low physical activity, prior stroke and fracture were associated with poor physical performance at baseline. Higher age, low physical activity, low calcium intake, prior non-vertebral fractures, low apparent free testosterone concentration and poor health status were associated with higher risk of loss to follow-up. Low grip strength, Parkinson's disease and stroke were associated with higher risk of incident inability to do five chair stands. Low Cr/CysC ratio and high FMI were associated with high risk of incident inability to perform forward and backward tandem walk. Sarcopenic obesity (co-occurrence of lower tertile of Cr/CysC and upper tertile of FMI) was associated with higher risk of incident inability to perform forward (OR = 3.31, 95% CI 1.88-5.84, p < 0.001) and backward tandem walk and of incident inability to perform more than one test (OR = 5.82, 95% CI 1.29-26.27, p < 0.001). In conclusion, sarcopenic obesity and poor health are associated with higher risk of incident severe decline of physical performance.
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Affiliation(s)
- Philippe Paul Wagner
- INSERM UMR1033, University of Lyon, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France
| | - Dominique Foesser
- INSERM UMR1033, University of Lyon, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France
| | - Roland Chapurlat
- INSERM UMR1033, University of Lyon, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France
- Department of Rheumatology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France
| | - Pawel Szulc
- INSERM UMR1033, University of Lyon, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France.
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Wagner PP, Whittier DE, Foesser D, Boyd SK, Chapurlat R, Szulc P. Bone Microarchitecture Decline and Risk of Fall and Fracture in Men With Poor Physical Performance-The STRAMBO Study. J Clin Endocrinol Metab 2021; 106:e5180-e5194. [PMID: 34251437 DOI: 10.1210/clinem/dgab506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Indexed: 01/06/2023]
Abstract
CONTEXT High fracture risk in individuals with low muscle strength is attributed to high risk of falls. OBJECTIVE This work aims to study the association of muscle mass and physical performance with bone microarchitecture decline and risk of fall and nonvertebral fracture in men. METHODS A prospective, 8-year follow-up of a cohort was conducted among the general population. A total of 821 volunteer men aged 60 and older participated. Hip areal bone mineral density (aBMD) and appendicular lean mass (ALM) were assessed at baseline by dual x-ray absorptiometry. Lower-limb relative ALM (RALM-LL) is ALM-LL/(leg length)2. The physical performance score reflects the ability to perform chair stands and static and dynamic balance. Bone microarchitecture was assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT) at baseline and after 4 and 8 years. Statistical analyses were adjusted for shared risk factors. Outcome measurements included the rate of change in the HR-pQCT indices, incident falls, and fractures. RESULTS Cortical bone loss and estimated bone strength decline were faster in men with low vs normal RALM-LL (failure load: -0.74 ± 0.09 vs -0.43 ± 0.10%/year; P < .005). Differences were similar between men with poor and those with normal physical performance (failure load: -1.12 ± 0.09 vs -0.40 ± 0.05%/year; P < .001). Differences were similar between men having poor performance and low RALM-LL and men having normal RALM-LL and performance (failure load: -1.40 ± 0.17 vs -0.47 ± 0.03%/year; P < .001). Men with poor physical performance had a higher risk of fall (hazard ratio [HR] = 3.52; 95% CI, 1.57-7.90, P < .05) and fracture (HR = 2.68; 95% CI, 1.08-6.66, P < .05). CONCLUSION Rapid decline of bone microarchitecture and estimated strength in men with poor physical performance and low RALM-LL may contribute to higher fracture risk.
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Affiliation(s)
| | - Danielle E Whittier
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta T2N 4Z6, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Steven K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta T2N 4Z6, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Roland Chapurlat
- INSERM UMR1033, Université de Lyon, Lyon, France
- Department of Rheumatology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Pawel Szulc
- INSERM UMR1033, Université de Lyon, Lyon, France
- Department of Rheumatology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
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Atrsaei A, Paraschiv-Ionescu A, Krief H, Henchoz Y, Santos-Eggimann B, Büla C, Aminian K. Instrumented 5-Time Sit-To-Stand Test: Parameters Predicting Serious Falls beyond the Duration of the Test. Gerontology 2021; 68:587-600. [PMID: 34535599 DOI: 10.1159/000518389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Falls are a major cause of injuries in older adults. To evaluate the risk of falls in older adults, clinical assessments such as the 5-time sit-to-stand (5xSTS) test can be performed. The development of inertial measurement units (IMUs) has provided the possibility of a more in-depth analysis of the movements' biomechanical characteristics during this test. The goal of the present study was to investigate whether an instrumented 5xSTS test provides additional information to predict multiple or serious falls compared to the conventional stopwatch-based method. METHODS Data from 458 community-dwelling older adults were analyzed. The participants were equipped with an IMU on the trunk to extract temporal, kinematic, kinetic, and smoothness movement parameters in addition to the total duration of the test by the stopwatch. RESULTS The total duration of the test obtained by the IMU and the stopwatch was in excellent agreement (Pearson's correlation coefficient: 0.99), while the total duration obtained by the IMU was systematically 0.52 s longer than the stopwatch. In multivariable analyses that adjusted for potential confounders, fallers had slower vertical velocity, reduced vertical acceleration, lower vertical power, and lower vertical jerk than nonfallers. In contrast, the total duration of the test measured by either the IMU or the stopwatch did not differ between the 2 groups. CONCLUSIONS An instrumented 5xSTS test provides additional information that better discriminates among older adults those at risk of multiple or serious falls than the conventional stopwatch-based assessment.
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Affiliation(s)
- Arash Atrsaei
- Laboratory of Movement Analysis and Measurement (LMAM), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Anisoara Paraschiv-Ionescu
- Laboratory of Movement Analysis and Measurement (LMAM), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Helene Krief
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Yves Henchoz
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Brigitte Santos-Eggimann
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement (LMAM), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Kováčiková Z, Sarvestan J, Zemková E. Age-related differences in stair descent balance control: Are women more prone to falls than men? PLoS One 2021; 16:e0244990. [PMID: 33411803 PMCID: PMC7790224 DOI: 10.1371/journal.pone.0244990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/18/2020] [Indexed: 12/03/2022] Open
Abstract
Stair descent is one of the most common forms of daily locomotion and concurrently one of the most challenging and hazardous daily activities performed by older adults. Thus, sufficient attention should be devoted to this locomotion and to the factors that affect it. This study investigates gender and age-related differences in balance control during and after stair descent on a foam mat. Forty-seven older adults (70% women) and 38 young adults (58% women) performed a descent from one step onto a foam mat. Anteroposterior (AP) and mediolateral (ML) centre of pressure velocity (CoP) and standard deviation of the CoP sway were investigated during stair descent and restabilization. A two-way analysis of variance (ANOVA) revealed the main effects of age for the first 5 s of restabilization. Older women exhibited significantly higher values of CoP sway and velocity in both directions compared to the younger individuals (CoP SDAP5, 55%; CoP SDML5, 30%; CoP VAP5, 106%; CoP VML5, 75%). Men achieved significantly higher values of CoP sway and velocity only in the AP direction compared to their younger counterparts (CoP SDAP5, 50% and CoP VAP5, 79%). These findings suggest that with advancing age, men are at higher risk of forward falls, whereas women are at higher risk of forward and sideways falls.
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Affiliation(s)
- Zuzana Kováčiková
- Faculty of Physical Culture, Department of Natural Sciences in Kinanthropology, Palacký University Olomouc, Olomouc, Czech Republic
- * E-mail:
| | - Javad Sarvestan
- Faculty of Physical Culture, Department of Natural Sciences in Kinanthropology, Palacký University Olomouc, Olomouc, Czech Republic
| | - Erika Zemková
- Faculty of Physical Education and Sports, Department of Biological and Medical Sciences, Comenius University in Bratislava, Bratislava, Slovakia
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Quijoux F, Vienne-Jumeau A, Bertin-Hugault F, Zawieja P, Lefèvre M, Vidal PP, Ricard D. Center of pressure displacement characteristics differentiate fall risk in older people: A systematic review with meta-analysis. Ageing Res Rev 2020; 62:101117. [PMID: 32565327 DOI: 10.1016/j.arr.2020.101117] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/07/2020] [Accepted: 06/15/2020] [Indexed: 12/31/2022]
Abstract
Falling is the second most prevalent cause of accidental death in the world. Currently available clinical tests to assess balance in older people are insufficiently sensitive to screen for fall risk in this population. Laboratory tests that record the center of pressure (COP) trajectory could overcome this problem but despite their widespread use, the choice of COP trajectory features for use as a biomarker of fall risk lacks consensus. This systematic review and meta-analysis aimed at identifying the best COP characteristics to predict risk of falling in older adults. More than 4000 articles were screened; 44 (7176 older adults) were included in this study. Several COP parameters emerged as good indices to discriminate fallers from non-fallers. From sensitivity analysis, Sway area per unit time, anteroposterior mean velocity, and radial mean velocity were the best traditional features. In this study, identification of older people with a high fall risk was demonstrated using quiet-standing recordings. Such screening would also be useful for routine follow-up of balance changes in older fallers in clinical practice.
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Piano L, Geri T, Testa M. Raising and stabilization phase of the sit-to-stand movement better discriminate healthy elderly adults from young subjects: a pilot cross-sectional study. Arch Physiother 2020; 10:7. [PMID: 32318274 PMCID: PMC7161000 DOI: 10.1186/s40945-020-00078-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background The sit-to-stand (STS) test is usually included in the clinical assessment of balance and its instrumented analysis may support clinicians in objectively assessing the risk of falling. The aim of the present study was to assess if kinetic parameters of STS collected using a force platform, with particular focus on the raising and stabilization phase, could discriminate between young and older adults. Methods Twenty-four adults (age ranging from 18 to 65 years old) and 28 elderly adults (older than 65 years old) performed STS on a force platform. Data on ground reaction forces, sway, displacement and velocity of the center of pressure were gathered during the raising and the stabilization phases. Results elderly subjects showed significant greater global sway (146.97 vs 119.85; p < 0.05) and a higher velocity (vs 40.03 vs 34.35 mm/s; p < 0.05) of execution of STS. Between-group comparisons highlighted a greater postural sway in the raising phase (21.63 vs 13.58; p < 0.001) and a doubled sway during the stabilization phase (12.38 vs 4.98; p < 0.001). Conclusions The analysis of STS performed on a force platform provides further information about the age-specific pattern of STS execution. The stabilization phase of STS seems to be the more challenging for functional independent older adults and should be considered during balance assessment.Further studies are needed to confirm findings and improve generalizability of this study.
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Affiliation(s)
- Leonardo Piano
- Unit of Rehabilitation and Functional Recovery, Casa di Cura "La Residenza", via Roma 1, 12050, Rodello, CN Italy
| | - Tommaso Geri
- 2Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, via Magliotto 2, 17100 Savona, Italy
| | - Marco Testa
- 2Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, via Magliotto 2, 17100 Savona, Italy
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Ferraro FV, Gavin JP, Wainwright T, McConnell A. The effects of 8 weeks of inspiratory muscle training on the balance of healthy older adults: a randomized, double-blind, placebo-controlled study. Physiol Rep 2019; 7:e14076. [PMID: 31074198 PMCID: PMC6509064 DOI: 10.14814/phy2.14076] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 12/21/2022] Open
Abstract
To examine the effects of 8-week unsupervised, home-based inspiratory muscle training (IMT) on the balance and physical performance of healthy older adults. Fifty-nine participants (74 ± 6 years) were assigned randomly in a double-blinded fashion to either IMT or sham-IMT, using a pressure threshold loading device. The IMT group performed 30-breath twice daily at ~50% of maximal inspiratory pressure (MIP). The sham-IMT group performed 60-breaths once daily at ~15% MIP; training was home-based and unsupervised, with adherence self-reported through training diaries. Respiratory outcomes were assessed pre- and postintervention, including forced vital capacity, forced expiratory volume, peak inspiratory flow rate (PIFR), MIP, and inspiratory peak power. Balance and physical performance outcomes were measured using the shortened version of the Balance Evaluation System test (mini-BEST), Biodex® postural stability test, timed up and go, five sit-to-stand, isometric "sit-up" and Biering-Sørensen tests. Between-group effects were examined using two-way repeated measures ANOVA, with Bonferroni correction. After 8-week, the IMT group demonstrated greater improvements (P ≤ 0.05) in: PIFR (IMT = 0.9 ± 0.3 L sec-1 ; sham-IMT = 0.3 L sec-1 ); mini-BEST (IMT = 3.7 ± 1.3; sham-IMT = 0.5 ± 0.9) and Biering-Sørensen (IMT = 62.9 ± 6.4 sec; sham-IMT = 24.3 ± 1.4 sec) tests. The authors concluded that twice daily unsupervised, home-based IMT is feasible and enhances inspiratory muscle function and balance for community-dwelling older adults.
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Affiliation(s)
- Francesco V. Ferraro
- Department of Human Sciences and Public HealthBournemouth UniversityBournemouthUnited Kingdom
| | - James P. Gavin
- School of Health SciencesUniversity of SouthamptonSouthamptonUnited Kingdom
| | - Tom Wainwright
- Department of Human Sciences and Public HealthBournemouth UniversityBournemouthUnited Kingdom
- Orthopaedic Research InstituteBournemouth UniversityBournemouthUnited Kingdom
| | - Alison McConnell
- Department of Human Sciences and Public HealthBournemouth UniversityBournemouthUnited Kingdom
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