Rising from the floor in older adults

Reproducibility and concordance of functional autonomy tests in older adult women: a comparative study of face-to-face and virtual assessments

Introduction

The literature does not explore functional assessments carried out remotely and in older women in virtual environments.

Objective

This study analyzed the reproducibility and agreement in applying functional autonomy tests face to face (FF) and virtually (V).

Methods

A single evaluator carried out two evaluations. The following tests were performed: walking 10 m, rising from the sitting position (RSP), rising from the ventral decubitus position (RVDP), and sitting and rising from a chair and walking around the house (SRCW).

Results

No significant changes were identified between V and FF (p > 0.05 for all). No significant changes were identified between tests considering FF and V conditions (p > 0.05 for all). The highest value for the intraclass correlation coefficient was <0.0001 for the SRCW (CL, r = 0.98 CI95%: 0.969-0.990 and ICC, r = 0.99 CI95%: 0.984-0.995), and the lowest was <0.0001 for the RSP (CL, r = 0.91 CI95%: 0.853-0.954 and ICC, r = 0.95 CI95%: 0.921-0.976). Regarding agreement between tests, a variation was found between the lowest value of 0.07 ± 0.74 BIAS for the RVDP and the highest value of 0.32 ± 1.89 BIAS for the SRCW.

Conclusion

The tests used in the present study showed good reproducibility and agreement in older people when carried out face to face and virtually.

Caffeine Responsiveness Before and After Pilates Training in Healthy Older Adults

Objective

The study aimed to assess responsiveness to the effects of acute caffeine intake after 8 weeks of Pilates intervention in healthy older adults.

Methods

Fifteen healthy older adults performed physical performance regarding daily practice, strength, and balance tests after ingestion of acute 5 mg/kg of caffeine or placebo before and after Pilates training.

Results

The caffeine intake reduced, regardless of Pilates training, the time in 10-m walk test (before placebo vs caffeine, 6.48 ± 0.70 vs 6.51 ± 0.82 seconds; after placebo vs caffeine, 5.84 ± 0.70 vs 5.48 ± 0.61 seconds; P = .008; ηp 2 = 0.404) and timed up and go test (before placebo vs caffeine, 26.30 ± 1.82 vs 24.37 ± 2.12 seconds; after placebo vs caffeine, 22.96 ± 2.36 vs 22.49 ± 2.27 seconds; P = .002; ηp 2 = 0.517) compared with the placebo. Participants were not less responsive to caffeine intake in the 10-m walk test (ΔPre vs ΔPost, -0.33 ± 0.66 vs -0.36 ± 0.53 seconds; P = .888), but they were less responsive for the timed up and go test (ΔPre vs ΔPost, -1.92 ± 2.06 vs -0.47 ± 1.15 seconds; P = 0.030) after Pilates intervention. There were no differences for the sit-to-stand test, rising from the floor, dress and undress T-shirt, handgrip strength, and balance variables.

Conclusion

Although the caffeine improved on the 10-m walk test and timed up and go test performance, healthy older adults were less responsive to caffeine after Pilates training only for performance on the timed up and go test.

Functional vs. dual-task training effects on trunk muscle function and functional fitness in older women with and without chronic low back pain: A randomized clinical trial

INTRODUCTION

Non-specific chronic low back pain (CLBP) predominantly affects women aged 40-80 years. Physical exercise is a primary treatment form, with functional training (FT) and dual-task training (DT) emerging as potential modalities due to their distinct characteristics. However, limited information exists regarding the effects of these exercise modalities on CLBP.

OBJECTIVE

To compare the FT and DT effects on trunk function and functional fitness in CLBP older women.

METHODOLOGY

This was a randomized clinical trial with two training groups (FT and DT) and CLBP and non-CLBP individuals. We assessed the trunk stability, maximum isometric strength, endurance of trunk muscles, and functional fitness before and after 16 weeks of training RESULTS: We found only time effects for circular stability and instability (p <.001), flexors (p =.006), and extensors endurance (p <.001). For the lateral flexors, there was an average reduction of 17.3 units in lateral flexor endurance in the FT compared to the DT in CLBP individuals. For the strength of the flexor, CLBP individuals exhibited an increase of 69.3 units compared to non-CLBP. For the strength of extensors, CLBP individuals showed a decrease of 75.1 units compared to non-CLBP individuals. We identified a time effect for all functional fitness measures (p <.050) CONCLUSION: FT and DT increase trunk stability, maximum isometric strength, and endurance of trunk muscles, besides the functional fitness of CLBP older women SIGNIFICANCE: Professionals can choose either training type, as there are no differences in the initial 16 weeks of intervention.

Dual-task training is as effective as functional training on the functional fitness of older women: a randomized clinical trial

BACKGROUND

The interest in approaches that improve older individuals' functional fitness and autonomy is increasing. However, the effects of dual-task training on older women's functional fitness and the comparison with the functional training approach are unclear. Therefore, we compared dual-task and functional training on the functional fitness of older women and the effects of three months of detraining.

METHODS

Sixty-one women performed 16 weeks of dual-task training or functional training. The functional fitness was measured pre-, post-training, and post-detraining, based on the ability to put on and take off a t-shirt, evaluating the mobility of the upper limb, standing-up from the prone position measuring the global functionality, five times sit-to-stand test to assess the lower limbs muscle power, timed up and go to measure the dynamic balance and agility, gallon-jug shelf-transfer to evaluate the global functionality emphasizing the upper limbs and 10 m walk test to analyze the gait ability.

RESULTS

Dual-task training and functional training generally provided significant small to moderate magnitude performance increases in the put on and take off a t-shirt (dual-task training: d = 0.35 / functional training: d = 0.49), five times sit-to-stand test (dual-task training: d = 0.41 / functional training: d = 0.77), timed up and go (dual-task training: d = 0.34 / functional training: d = 0.78), and gallon-jug shelf-transfer (dual-task training: d = 0.76 / functional training: d = 0.82). Only the functional training improved the 10 m walk test (d = 0.32; p = 0.013), and both groups did not change the standing-up from the prone position performance. After the detraining period, both groups kept the adaptations for the gallon-jug shelf-transfer and five times sit-to-stand test. At the same time, only the dual-task training maintained the adaptations for the put on and take off a t-shirt and the functional training for the timed up and go.

CONCLUSION

Sixteen weeks of dual-task and functional training are similarly effective in improving older women's functional fitness, maintaining their benefits even after three months of detraining.

TRIAL REGISTRATION

RBR-10ny848z ( https://ensaiosclinicos.gov.br/rg/RBR-10ny848z ).

Test-retest reliability of Latin American Group for Maturity (GDLAM) protocol in older women

Functional autonomy (FA) is a critical factor in determining the quality of life of older adults (OA), especially in the case of older women (OW), as they face a decline in FA in their later years of life. FA should be assessed early, using valid, reliable, and low-cost tests. This study evaluated the test-retest reliability of GDLAM and GDLAM autonomy index (GI) in OW. Thirty-nine OW (71.2 ± 6.50 years) participated in the study. A repeated measures design was used to compare the interday test-retest reliability of the five GDLAM tests (seconds) and the GI (points). The five tests represent activities of daily living, such as dressing or wandering around the house, while the GI provides a weighting of the results of the five tests. The analysis consisted of the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and coefficient of variation (CV). A CV ≤ 10% and an ICC ≥ 0.80 were considered acceptable reliability, whereas a CV ≤ 5% and an ICC ≥ 0.90 were considered high reliability. The outcome of the five tests, represented by the GI, showed high interday test-retest reliability (CV = 6.00% and ICC = 0.91). The results of this study demonstrate that the five tests of the GDLAM protocol and the GI have high interday test-retest reliability and good interday reproducibility. From a practical point of view, the GDLAM protocol allows the assessment of FA of community-dwelling OW, providing background for early diagnosis and, with it, the possibility of developing an individualized physical exercise prescription.

Floor-to-Stand Performance Among People Following Stroke

OBJECTIVES

Studies have examined floor-to-stand performance in varied adult populations both quantitatively and qualitatively. Despite an elevated risk of falls and inability to independently return to stand after a fall, few have examined the ability to stand from the floor in patients recovering from stroke. There were 2 objectives of the study: to identify the relationships between floor-to-stand performance using a timed supine-to-stand test (TSS) and physical performance measures of gait, balance, and balance confidence among persons in the subacute phase after stroke; and to analyze descriptive strategies used in the completion of the TSS.

METHODS

A cross-sectional design was implemented. Fifty-eight adults (mean age = 59.2 [standard deviation (SD) = 13.9] years; 34 [58.6%] men) who were in the subacute phase after ischemic or hemorrhagic stroke and who could stand from the floor with no more than supervision completed the TSS and physical performance assessments.

RESULTS

The median time to complete the TSS in our sample was 13.0 (interquartile range = 15.5) seconds. TSS time was significantly correlated with physical performance tests, including the Timed "Up & Go" Test (ρ = 0.70), gait speed (ρ = -0.67), Dynamic Gait Index (ρ = -0.52), and Activities-Specific Balance Confidence Scale (ρ = -0.43). Thirty-two percent of the variance in TSS time was attributed to Timed "Up & Go" Test time and the use of the quadruped position to transition to standing. Participants who used a gait device were more likely to use a chair during rise to stand.

CONCLUSION

The TSS demonstrates concurrent validity with physical performance measures.

IMPACT

Findings serve to improve functional mobility examination after stroke and to formulate effective treatment interventions to improve floor-to-stand performance.

Effects of combined muscle power and endurance training with different volumes on functional and hemodynamic parameters in previously trained older adults

BACKGROUND

To promote optimal neuromuscular and cardiovascular gains in older adults, it seems crucial to investigate the effects of different combined training volumes in this population. Thus, the present study aimed to compare the effects of combined muscle power training (MPT) and endurance training (ET) with different volumes on functional and hemodynamic parameters in previously trained older adults.

METHODS

Twenty-five older adults were randomly assigned to either the lower-volume group (LVG; n = 13) or the higher-volume group (HVG; n = 12). In the LVG, participants performed 1 set of 6 repetitions for each exercise, followed by 10 min of walking exercise. In the HVG, participants performed 2 sets of 6 repetitions for each exercise, followed by 20 min of walking exercise. Lift from the ventral decubitus position (LPDV), timed up-and-go (TUG), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were assessed before and after 8 weeks.

RESULTS

Significant increases in LPDV test occurred in both groups after 8 weeks (p < 0.05). Additionally, significant improvements in TUG performance occurred in both groups from week 0 to week 8 (p < 0.05). However, no significant changes were observed between groups in functional parameters (p > 0.05). SBP and DBP remain unchanged (p > 0.05) in both groups over the experimental period.

CONCLUSIONS

These findings indicate that lower-volume and higher-volume of combined MPT and ET promoted improvements in functional parameters. This study has an important practical application, as it indicates that regardless of the volume (lower or higher), comparable improvements are observed in functional parameters in previously trained older adults.

Novel Metrics for Assessing Mobility During Ground-Standing Transitions

INTRODUCTION

Transitioning between the ground and standing is a required activity for many professions including skilled trades, law enforcement, and military service. However, available assessments are limited and focus primarily on quality of movement. Thus, we developed two novel assessments of functional mobility specific for ground-to-standing transitions: Stand-Prone-Standx2 (SPS2) and Stand-Kneel-Standx2 (SKS2-L/R) tests. The purpose of this study was to determine the psychometrics of these two new measures in able-bodied (AB) service members and in service members with unilateral lower extremity injury (LEI).

MATERIALS AND METHODS

A total of 57 AB service members and 31 service members with a traumatic unilateral LEI wearing a custom carbon-fiber ankle-foot orthosis participated in this study. In total, 36 AB and 18 LEI participants returned for a second session to assess intersession reliability. Intraclass correlation coefficients were calculated for intersession and inter-rater comparisons (two-way random model for consistency and single measure). Additionally, performance was compared between legs and groups.

RESULTS

The SPS2 and SKS2 assessments demonstrated excellent inter-rater and intersession reliability in both the AB and LEI groups with all intraclass correlation coefficient values greater than 0.8. Further, the tests were responsive to deficits associated with LEI, with the LEI group having significantly longer times on all assessments compared to the AB group.

CONCLUSIONS

The SPS2 and SKS2 performance measures were found to have excellent inter-rater and intersession reliability in both AB participants and participants with LEI. Further, participants with LEI performed significantly slower than the AB participants. Excellent reliability and responsiveness to deficits associated with LEI support the use of the SPS2 and SKS2 to assess mobility in individuals with LEI. Transitions between the ground and standing occur in many occupational and daily tasks. These reliable performance measures that assess ground-to-stand transitions can be applied widely, in many populations beyond highly functioning service members with LEI.

Factors associated with unrecovered falls among older adults

This cross-sectional exploratory study investigated factors associated with unrecovered falls among older patients with a history of falls in the previous year participating in a clinical trial on fall prevention by asking them about their inability to get up independently after the fall. Participants' sociodemographic, clinical, functional (ADL/IADL, TUG, chair-stand test, hand grip, risk of falling) and fall location were investigated. We conducted a multivariate regression analysis adjusted for covariates to identify the main factors associated with unrecovered falls. Out of 715 participants (mean age: 73.4 years; 86% women), 51.6% (95% IC; 47.9 - 55.3%) experienced unrecovered falls. Depressive symptoms, ADL/IADL limitation, mobility limitation, undernutrition, and outdoor falls were associated with unrecovered falls. While assessing the risk of falling, professionals should consider preventive strategies and preparedness procedures for those who are more likely to experience unrecovered falls, such as training to get up from the floor, alarms, and support services.

Resistance Circuit Training or Walking Training: Which Program Improves Muscle Strength and Functional Autonomy More in Older Women?

To evaluate the effects of two programs (resistance and walking training) on the functional autonomy and muscle strength (isometric and dynamic) of older women, 67 subjects were divided randomly into three groups: resistance training (RTG; Mean = 64.70 ± 6.74 years), walking (WG, Mean = 65.56 ± 7.82 years), and control (CG; Mean = 64.81 ± 4.34). The experimental groups underwent a 16-week intervention. Muscle strength (isometric and dynamic) and functional autonomy were assessed. The subjects participating in the RTG showed improvements in the comparison pre to post-test in the maximal forces of upper limb (MULS) (Δ% = 49.48%; p = 0.001) and lower limb (MLLS) (Δ% = 56.70%; p = 0.001), isometric biceps forces (BIS) (Δ% = 30.13%; p = 0.001) and quadriceps forces (QIS) (Δ% = 65.92%; p = 0.001), and in the general index (GI) of functional autonomy (Δ% = −18.32%; p = 0.002). The WG improved in all functional autonomy tests, except for the standing up from prone position test (SVDP). In strength tests, the WG obtained improvements only in the QIS (Δ% = 41.80%; p = 0.001) and MLLS (Δ% = 49.13%; p = 0.001) tests. The RTG obtained better results (p < 0.05) when compared to the WG and CG. The results allow us to infer that resistance exercise programs are more effective in increasing strength and functional autonomy, a fact that may mitigate the deleterious effects on health of aging.

Therapy options for those affected by a long lie after a fall: a scoping review

BACKGROUND

After a fall, more than half of older people living alone are unable to get up or get help independently. Fall-related recumbency makes affected individuals aware of functional status limitations and increased vulnerability. Patient-centered therapy is needed to manage physical, psychological, and social needs. This review summarizes the current evidence on care options for the special patient population.

METHODS

The scoping review used the six-step framework proposed by Arksey and O´Malley and was conducted in accordance with the modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework for scoping reviews. The literature searches were conducted in five databases and ten online archives. Articles were screened, assessed and selected using defined inclusion and exclusion criteria. Articles were included if they were published in either German or English and related to the care of long lies. Thematic synthesis was based on the literature review.

RESULTS

The search yielded 1047 hits, of which 19 research papers were included. Two themes were identified: (1) acute therapy, focused on prolonged recumbency and pronounced physical effects; and (2) preventive therapy, which examined standing up training, technical aids, and social control systems in the context of fall management.

CONCLUSIONS

There are a limited number of interventions that relate to the patient population. The interventions are predominantly presented independently, so there is a lack of structuring of the interventions in the form of a treatment pathway. In addition to pooling professional expertise and an interprofessional approach, it is important to continue inpatient treatment in the home setting, even though the effectiveness of interventions in a home setting has hardly been verified thus far. The solution for a missing treatment process is first of all a planned, interprofessional and intersectoral approach in therapy.

Impact of an individual personalised rehabilitation program on mobility performance in older-old people

BACKGROUND

Studies have shown benefits of exercise interventions on preferred and fast gait speed in healthy older adults, but the impact of a personalised rehabilitation program targeting a large cohort of non-disabled older-old adults has rarely been examined.

AIMS

The purpose was to determine whether personalised intervention-related improvements in gait and mobility performance in older-old adults were dependent on cognitive status and/or history of falls.

METHODS

Based on a pre-post design, 483 older-old persons (mean age: 83.3 ± 5.1 years) were followed during a personalised rehabilitation program over a period of 7 weeks, with twice-weekly sessions (45 min each). Gait speed in four conditions (preferred, fast, and under two dual-task conditions), static postural sway, Timed Up and Go test, Five Times Sit to Stand test, the ability to rise from the floor, and handgrip strength test were assessed.

RESULTS

Using a pre-post analysis of covariance, a significant increase in preferred gait speed (+ 20.1%), fast gait speed (+ 15.8%), and dual-task speed while counting (+ 13.4%) was observed after the rehabilitation, regardless of the baseline cognitive status and fall history. Similar improvements in TUG and maximal handgrip force were observed, with a significant reduction of performance time (-19.5%) or an increase of handgrip strength (+ 6.2%).

DISCUSSION

Results suggest the effectiveness of personalised intervention to improve a battery of physical performance measures in older-old adults, even for the frailest participants.

CONCLUSION

Implementing a personalised intervention for targeting the high-risk older-old adults in priority is critical regarding the clinically meaningful change in gait speed.

Functional Autonomy Evaluation Levels in Middle-Aged and Older Spanish Women: On Behalf of the Healthy-Age Network

Aging is associated with a progressive loss of functional capacity that affects the health and quality of life of middle-aged and older people. The purpose of this study was to report functional autonomy evaluation levels in middle-aged and older women in the Spanish context. A total of 709 middle-aged and older women, between 50 and 90 years old, were selected to participate in the study. The sample was divided by age category every five years. The functional autonomy levels were determined by the Latin American Group for Maturity (GDLAM) protocol and we developed a classification pattern for middle-aged and older women living in Spain. The GDLAM Index (GI) was then calculated to assess functional autonomy. The classification of the tests and the GI followed the percentile rank (P) Very Good (p < 0.15), Good (p 0.16–p 0.50), Regular (p 0.51–p 0.85), and Poor (p > 0.85). It was considered that the lower the value found for the percentile, the better the result. The GDLAM protocol showed strong reliability with intraclass correlation coefficient (ICC) values greater than 0.92 in all tests. It is observed that all variables of the GDLAM protocol presented a positive and significant correlation with age (p < 0.001). The Roc Curve showed that GI values higher than 26 (CI95% = 0.97–1.00; p < 0.001) and 32 (CI95% = 0.98–1.00; p < 0.001) for middle-aged and elderly women, respectively, can predict and indicate low functional autonomy. The normative values hereby provided will enable evaluation and adequate interpretation of Spanish middle-aged and older women’s functional autonomy.

Effect of testosterone supplementation on sarcopenic components in middle-aged and elderly men: A systematic review and meta-analysis

The aim of this study was to conduct a systematic review of the literature of randomized controlled trials on the effect of testosterone (T) supplementation compared to the placebo group or lower dose on sarcopenic components (muscle mass, strength and physical performance) in middle-aged and elderly men. Major electronic databases were searched for articles published on or before December 2019. Studies including individuals with age ≥ 40 years and which described the effect of T supplementation on sarcopenic components were found eligible (11 studies). Outcomes were calculated as the difference in means between the experimental and control/placebo groups, and data were presented as effect size with 95% confidence limits (95%CI). The meta-analysis was performed using a random effects model. Regarding lean body mass (LBM), eight studies evaluated the effect of T supplementation on this outcome, of these, seven reported gains after the intervention period. Our meta-analysis showed a beneficial effect on LBM of 2.54 kg (95% CI, 1.27 to 3.80) (p < 0.001). In muscle strength (MS), seven included studies evaluated the handgrip strength (HGS) and just one reported gain after the intervention period, but the meta-analysis showed an increase for HGS of 1.58 kgf (95%CI, 0.17 to 3.0) (p = 0.03). The second outcome for MS was leg strength (LS), where nine studies were included and five demonstrated gains in this parameter after the intervention period. In the meta-analysis, two out of three tests showed an effect on LS: T supplementation increase the leg press strength in 91.23 N (95%CI, 0.23 to 182.22) (p = 0.05) and leg extension in 144.10 N (95%CI, 44.21 to 244.00) (p < 0.01). In physical performance, four studies evaluated this outcome, with three of them showing positive effects in this parameter. In the meta-analysis, only two studies that reported the same assessment test (Physical Performance Test) were included, but no effect of T supplementation on this parameter was found. It can be concluded that T supplementation influences sarcopenic components in middle-aged and older men, because is associated with increased in muscle mass and strength in addition to physical performance.

Assessment in the Supine-To-Stand Task and Functional Health from Youth to Old Age: A Systematic Review

Performance in the supine-to-stand (STS) task is an important functional and health marker throughout life, but the evaluation methods and some correlates can impact it. This article aims to examine the studies that assessed the performance of the STS task of young people, adults and the elderly. Evidence of the association between the STS task and body weight status, musculoskeletal fitness and physical activity was investigated, and a general protocol was proposed. MEDLINE/Pubmed and Web of Science databases were accessed for searching studies measuring the STS task directly; identification, objective, design, sample, protocols and results data were extracted; the risk of bias was assessed (PROSPERO CRD42017055693). From 13,155 studies, 37 were included, and all demonstrated a low to moderate risk of bias. The STS task was applied in all world, but the protocols varied across studies, and they lacked detail; robust evidence demonstrating the association between STS task and musculoskeletal fitness was found; there was limited research examining body weight status, physical activity and the STS task performance. In conclusion, the STS task seems to be a universal tool to track motor functional competence and musculoskeletal fitness throughout life for clinical or research purposes.

The Relationship Between Performance of Sit-To-Stand From a Chair and Getting Down and Up From the Floor in Community-Dwelling Older Adults

BACKGROUND AND PURPOSE

The ability to perform sit-to-stand from a chair and getting down and up from the floor, or the ability to safely perform a floor transfer are important transitional activities for independent living. The sit-to-stand maneuver is frequently performed by community-dwelling older adults and is routinely evaluated as a part of geriatric physical therapy assessment. Conversely, a floor transfer is rarely performed by older adults or addressed by clinicians, even when working with frail patients who live alone and are at high risk for falls. Accordingly, the specific aim of this cross-sectional study was to determine the concurrent, predictive, and discriminant validity of the five times sit-to-stand (5xSTS) test against 3-point floor transfer performance.

METHODS

A total of 46 community-dwelling adults, ages 65-96 years, were recruited using a stratified sampling technique based on self-reported levels of floor transfer ability: independent (n = 16); assisted (n = 15); and dependent (n = 15). Forty-five of the 46 participated in the data collection process. Participants were first assessed for the 5xSTS test and were categorized based on performance as unable to perform (n = 14), poor performance (>13.6 seconds), or good performance (≤13.6 seconds). Participants then performed the 3-point floor transfer test and were classified based on results as independent (n = 18), assisted (n = 10), or dependent (n = 17). Spearman correlations were calculated to assess the concurrent validity for the 5xSTS testing procedure against 3-point floor transfer performance. The Kruskal-Wallis test was used to: 1) determine the discriminant validity of 5xSTS test outcome performance among groups that differ in 3-point floor transfer test performance; and 2) examine the significance level of the socio-demographic data.

RESULTS

Moderate to strong positive correlations were found between the 3-point floor transfer test and the categorical performance outcomes of the 5xSTS test (rho ranged from 0.67 to 0.88, p < .001). A strong negative correlation was found between 5xSTS scores and the 3-point floor transfer test (rho = 0.86, p < .001). There was moderate sensitivity (71%) and strong specificity (93%) for the 5xSTS test to predict floor transfer performance. The outcomes of 5xSTS performance differed significantly among 3-point floor transfer performance outcome groups. Older adults who were unable to perform 5xSTS test were also dependent in floor transfer performance. In contrast, older adults who demonstrated good performance in the 5xSTS test were independent in floor transfer performance (p ≤ 0.012).

CONCLUSION

Floor transfer is a highly important safety maneuver for older adults, although it is rarely performed and assessed. This study documents that the 5xSTS test displays concurrent, predictive, and discriminative validity properties, making it a potentially useful initial screening tool to predict floor transfer ability. Failure to complete the 5xSTS test may also be a reliable indicator of floor transfer performance dependency among community-dwelling older adults.

Impact of the backward chaining method on physical and psychological outcome measures in older adults at risk of falling: a systematic review

BACKGROUND

Being unable to "get up from the floor" is a risk factor and predictor of serious fall-related injuries in older age; however, floor-rise training (FRT) is not widely used. The backward chaining method (BCM) is a success-oriented, step-by-step form of FRT. This systematic review aimed to evaluate the impact of BCM on physical and psychological outcome measures, and its clinical application.

METHODS

Studies were identified through systematic searching of five databases. Criteria for inclusion were: use of BCM as a treatment method, outcome measures related to falls, and participants aged 60 + years. Study quality was evaluated using the Mixed Methods Appraisal Tool and PEDro scale, if applicable.

RESULTS

Seven studies with a total of 446 participants (mean age 82.4 ± 5.3 years) were identified. Emerging evidence shows that BCM significantly improves the ability to get up unassisted from the floor, as well as mobility with reduced fall incidence in older people. Furthermore, it can potentially reduce fear of falling. Reporting on feasibility and acceptance of BCM was limited. Study quality varied widely.

CONCLUSIONS

BCM provides a promising intervention in fall-related recovery strategies for older adults and is most effective when offered to older adults at risk of falling. Considering the small number of included studies and the varying methodological quality, these findings should be evaluated accordingly. The growing evidence regarding the benefits of BCM, yet the lack of adoption into standard care, highlights the need for further research and clinical application of this intervention approach.

Impact of an ambulatory physical activity program on balance and motor abilities of retirees: a prospective study

BACKGROUND

Given the public health problem generated by posture and gait disorders, a preventive approach is essential.

OBJECTIVE

We investigated the impact of an ambulatory physical activity program (APAP) on the motor skills of retirees.

METHOD

Retirees ≥60 years were recruited in this prospective study. The APAP was supported by a French regional health insurance plan. Between inclusion (T0) and 12 weeks (T1), subjects participated in an APAP (1 h/wk) that included strengthening muscular exercises, balance work, joint flexibility exercises, one-leg-balance test (OLB), stimulation of the foot arch and rise-from-the-floor (RFF). Timed-up-and-go test (TUG) duration, gait speed (GS), OLB duration and RFF success were compared between T1 and T0.

RESULTS

Two hundred subjects (86% women) were enrolled; mean age was 73.8 years (45.5% ≥75 years). TUG durations (s) were lower at T1 than at T0 (8.98 and 9.64; P < .0001). The GS (m/s) and OLB durations (s) were higher at T1 than at T0 (1.26 vs 1.12 for GS, 16.16 vs 13.02 for OLB; P < .0001). The rate of participants who successfully completed RFF was higher at T1 (94%) than at T0 (76%) (P < .0001). After the APAP, TUG duration was reduced in 64.5% of cases, the GS improved in 73% of cases, OLB duration increased in 50% of cases and RFF became possible in 18.5% of cases (all P < .0001).

CONCLUSION

Physical activity programs are effective for improving motor performance, even in older adults. Retirees must be encouraged to do regular physical activity to prevent or slow the functional decline associated with ageing, and to improve their overall quality of life.

Reliability and Validity of the Floor Transfer Test as a Measure of Readiness for Independent Living Among Older Adults

BACKGROUND AND PURPOSE

The ability to get up from the floor after a fall is a basic skill required for functional independence. Consequently, the inability to safely get down to and up from the floor or to perform a floor transfer (FT) may indicate decreased mobility and/or increased frailty. A reliable and valid test of FT ability is a critical part of the clinical decision-making process. The FT test is a simple, performance-based test that can be administered quickly and easily to determine a patient's ability to safely and successfully get down and up from the floor using any movement strategy and without time restriction. The primary purpose of this cross-sectional study was to determine the intrarater reliability and validity of the FT test as a practical alternative to several widely used yet time-consuming measures of physical disability, frailty, and functional mobility.

METHODS

A total of 61 community-dwelling older adults (65-96 years of age) participated in the study, divided into 2 separate subsamples: intrarater reliability was studied with 15 participants, while concurrent validity was studied with the remaining 46 participants. In both subsamples, the participants were stratified on the basis of the self-reported levels of FT ability as independent, assisted, and dependent. Intrarater reliability was assessed on 2 separate occasions and scores were analyzed by intraclass correlation coefficient and κ statistics. Concurrent validity of the FT test was assessed against the self-reported FT ability questionnaire, Physical Functioning Scale, Phenotype of Physical Frailty, and the Short Physical Performance Battery. Known-groups validity was tested by determining whether the FT test distinguished between (1) community-dwelling older adults with physical disabilities versus those without physical disabilities; and (2) community-dwelling older adults who were functionally dependent versus those who were independent. Participants were also categorized on the basis of FT test outcome as independent, assisted, or dependent. The Spearman correlation coefficients were calculated to examine the strength of the relationships between the FT test and physical status measures. The Kruskal-Wallis test was used to determine whether the FT test significantly discriminated between groups as categorized by the Physical Functioning Scale and Short Physical Performance Battery, and to examine the significance level of the sociodemographic data across the 3 FT test outcome groups.

RESULTS

The intrarater reliabilities of the measures were good (0.73-1.00). There were statistically positive and strong correlations between the FT test and all physical status measures (ρ ranged from 0.86 to 0.93, P < .001). Older adults who passed the FT test were collectively categorized as those without physical disabilities and functionally independent, whereas older adults who failed the FT test were categorized as those with physical disabilities and functionally dependent (P < .001).

CONCLUSION

The FT test is a reliable and valid measure for screening for physical disability, frailty, and functional mobility. It can determine which older adults have physical disabilities and/or functional dependence and hence may be useful in assessing readiness for independent living. Inclusion of the FT test at initial evaluation may reveal the presence of these conditions and address the safety of older adults in the community.

INBED: A Highly Specialized System for Bed-Exit-Detection and Fall Prevention on a Geriatric Ward

OBJECTIVE

In geriatric institutions, the risk of falling of patients is very high and frequently leads to fractures of the femoral neck, which can result in serious consequences and medical costs. With regard to the current numbers of elderly people, the need for smart solutions for the prevention of falls in clinical environments as well as in everyday life has been evolving.

METHODS

Hence, in this paper, we present the Inexpensive Node for bed-exit Detection (INBED), a comprehensive, favourable signaling system for bed-exit detection and fall prevention, to support the clinical efforts in terms of fall reduction. The tough requirements for such a system in clinical environments were gathered in close cooperation with geriatricians.

RESULTS

The conceptional efforts led to a multi-component system with a core wearable device, attached to the patients, to detect several types of movements such as rising, restlessness and-in the worst case-falling. Occurring events are forwarded to the nursing staff immediately by using a modular, self-organizing and dependable wireless infrastructure. Both, the hardware and software of the entire INBED system as well as the particular design process are discussed in detail. Moreover, a trail test of the system is presented.

CONCLUSIONS

The INBED system can help to relieve the nursing staff significantly while the personal freedom of movement and the privacy of patients is increased compared to similar systems.

Comparison of range of motion during movement from supine to sitting position in healthy young and elderly participants

[Purpose] The purpose of this study was to compare the range of motion (ROM) during supine-to-sitting position (StSP) movement between healthy young and elderly participants to understand age-related tendencies, which is beneficial for the assessment and treatment of frail elderly. [Participants and Methods] The participants were 14 healthy young males (age, 19–24 years) and 16 healthy elderly individuals (8 males and 8 females; age, 65–74 years). Rising movement was performed 5 times freely at a comfortable speed. [Results] The joint angles during StSP movements in right shoulder abduction, extension of both shoulder joints, right elbow flexion, trunk extension, and adduction of both hip joints were significantly larger, whereas neck flexion, trunk flexion, and left hip joint abduction were significantly smaller in the healthy elderly participants than in the healthy young participants. All joint movements were earlier in the elderly participants than in the healthy young participants. [Conclusion] The results of this study suggest that focusing on how to use both upper limbs is important, in addition to the neck and trunk, when evaluating StSP movement. Similarly, to encourage independence during StSP movement, the elbow extensors must be strengthened.

Are interventions effective in improving the ability of older adults to rise from the floor independently? A mixed method systematic review

Purpose: To review available evidence on older people's ability to get up off the floor independently and determine the effectiveness of interventions to improve older adults' ability to rise from the floor.Materials and methods: Seven databases were searched between January 1975 and June 2018. Eligibility criteria included: people aged ≥60; interventions to improve strength/function including ability to get up off the floor (for intervention studies); comparison groups (for randomized and nonrandomized controlled trials); outcome: quantitative or qualitative evaluation of ability to get up off the floor. Selection of the studies was undertaken in three stages: (1) titles and abstracts were scanned by one reviewer, (2) full abstract screening by one reviewer, and (3) articles read in full by two reviewers. Results of all articles are summarized and randomized controlled trials (RCT) (where possible) were analyzed by meta-analysis to determine intervention effectiveness.Results: Forty-one studies met inclusion criteria. For each of the RCTs that utilized resistance training and/or teaching the skill, a reduction in time to get up off the floor were reported. However, meta-analyses of all RCT interventions indicated no significant change in time for older people to get up off the floor independently with intervention (MD: -0.43[-1.38, 0.51]). Sub-analyses of interventions utilizing resistance training showed an improvement trending towards significance (MD: -0.81[-1.72, 0.09]). Heterogeneity between studies was high, therefore results should be viewed with some caution.Conclusions: Resistance training interventions may improve older people's ability to rise from the floor unassisted. However, knowledge of specific techniques to get up and the effect of simply practicing the task of getting off the floor need to be further explored.Implication for rehabilitationOne in three older people living in the community fall each yearOne aspect of falling that is often overlooked is whether the older person can get themselves up off the floor independently or do they have to wait for assistance.Interventions that include resistance training may help the older person to be able to get up by themselves.

Examining the Feasibility of Supine-to-Stand as a Measure of Functional Motor Competence

A person’s ability to rise from the floor to a standing position is seen as a precursor for establishing and maintaining bipedal independence. It also is an important primer for the development of other fundamental movement skills and is associated with functional capacity in later life. Thus, the potential importance of developing this movement capability early in life and understanding how it may relate to global function (i.e., motor competence [MC]) across the lifespan may be underestimated. Therefore, this study examined the validity of supine-to-stand test (STS) as a developmental measure of functional MC across childhood into young adulthood using a pre-longitudinal screen approach and examining associations between movement components. STS time also provided a secondary measure of developmental validity in addition to an examination of the concurrent validity of STS against developmentally valid measures of MC (i.e., throwing, kicking, hopping, and standing long jump) in these age groups. Overall, results indicated that cross-sectional data “curves” for the STS components generally fit Roberton’s hypothetical model curves. STS time demonstrated weak to moderate (r = −.28 to −.64) correlations to MC product measures across all age groups indicating that STS time can be considered a valid and reliable measure of MC across childhood into young adulthood.

Characteristics of Older Adults Who Are Unable to Perform a Floor Transfer: Considerations for Clinical Decision-Making

BACKGROUND AND PURPOSE

The ability to get down to and up from the floor or to perform a floor transfer (FT) is a vital and useful skill for older adults at risk of falling. Little is known about the health-related factors that separate older adults who can perform FT independently from those who cannot. Therefore, the specific aims of this cross-sectional study are to (1) describe and compare health-related factors among older adults who were independent, assisted, or dependent in FT performance; and (2) establish the parallel reliability between self-reported and actual performance of FT.

METHODS

A total of 46 community-dwelling adults ages 65 to 96 years were recruited using a stratified sampling technique based on self-reported levels of FT ability: independent (n = 15), assisted (n = 15), or dependent (n = 15). Participants were asked to perform the actual FT test and were categorized according to test result as independent (n = 18), assisted (n = 10), or dependent (n = 17). Sociodemographic and health-related factors of participants were separated into the 3 FT test outcome groups. The Kruskal-Wallis test was used to compare these factors across the 3 FT test outcome groups. The quadratic-weighted κ coefficient was calculated to determine the agreement between self-reported FT ability and FT test performance.

RESULTS

Significant differences were observed among the FT test outcome groups based on all sociodemographic and health-related factors (P < .05). Older adults who were dependent in FT were older and dependent in instrumental activities of daily living (IADL, 100%). Also, this group required some type of help during basic activities of daily living (ADL, 35.3%), which reflected a homebound status and the need for caregiver support, including the use of 2-handed assistive devices during ambulation. More than half the participants in this category had fallen at least once in the past 6 months. Conversely, older adults who were independent in FT were younger and living independently in the community (83.3%). The parallel reliability between the self-reported FT ability and actual FT test performance was 0.92 (95% confidence interval, 0.88-0.97).

CONCLUSION

Sociodemographic and health-related factors were significantly different among older adults who demonstrated varying abilities on the FT test. This study has shown that the self-reported FT ability and actual FT test performance represented reliable alternative forms to assess the ability to transfer from a standing to a supine position on the floor and then back to an erect position. Evaluation of FT ability and/or performance is recommended as a standard component of geriatric functional assessment to make more informed clinical decision in providing effective physical therapy interventions.

Testosterone Replacement, Muscle Strength, and Physical Function

Muscle strength and physical function decrease in older men, as do testosterone levels. Nonetheless, the effects of testosterone replacement therapy on muscle strength and physical function remain inconclusive and equivocal. We conducted a rapid systematic review, the results of which showed that testosterone replacement does not affect muscle strength (measured by hand grip strength and leg muscle strength), although it may increase physical function (measured by the 6-minute walk test, Physical Activity Scale for the Elderly score, and other physical performance tests). However, most of the studies were conducted in the United States or Europe and did not include participants from Asian or other ethnic backgrounds; therefore, further studies are needed to evaluate the effects of testosterone replacement in a broader population.

The Role of Physical Activity on Mood State and Functional Skills of Elderly Women

Introduction:

Ageing is associated with several physical, psychological and behavioral changes. These changes are closely related with global health and functional capacity in the elderly. Mood disturbances are common among the elderly and may significantly increase apathy, resulting in decreased habitual physical activity levels.

Materials and Methods:

The purpose of this cross-sectional study was to evaluate the mood state and functional motor capacities of elderly women engaged in a public physical activity program in Brazil and compare them with physically inactive elderly. Thirty elderly women were included in the study and categorized into two groups: physically active group, composed of participants enrolled on a public physical activity program (n = 16, 69±5 years) and physically inactive group (n = 14, 68±4 years). Total mood disturbance was assessed using the Profile of Mood States, whereas functional motor capacity was evaluated with the Sitting and Rising test. Independent t test and Mann-Whitney U] were used to compare groups.

Results:

The physically active group had lower total mood disturbance (p=0.02), confusion (p<0.01), tension (p<0.01), hostility (p=0.05) and fatigue (p=0.01) compared to the physically inactive group. There were no group differences regarding vigor, depression and sitting and rising performance (p>0.05).

Conclusion:

Lack of difference in functional motor capacity between the physically active and inactive elderly may be explained by the absence of exercise systematization in these programs.

Comparing the effects of two distinct eccentric modalities to traditional resistance training in resistance trained, higher functioning older adults

BACKGROUND

The effects of eccentric resistance exercise are of interest in the older adult cohort, but to our knowledge, there is no research on the relative effects of different eccentric modalities on a range of outcomes in higher functioning, resistance trained older adults.

METHODS

33 resistance-trained older adults (aged 67±4.5years) were randomized into one of three supervised training groups: traditional (TRE), eccentric only (ERE) or eccentrically biased resistance exercise (EBRE) on a 45°, plate-loaded leg press machine. Participants trained twice per week with maximal strength, functional capacity, body composition and blood biomarkers measured before and after the eight-week intervention.

RESULTS

Both eccentric and concentric strength, and important functional tasks for independent living significantly improved independent of group. Body composition and blood biomarkers were found to significantly improve in the EBRE group only however, no statistical differences were found between groups.

CONCLUSION

Compared to traditional resistance training, the two eccentric modalities investigated here were equally effective for improvements in maximum muscular strength, functional capacity, body composition and metabolic biomarkers. When training the resistance trained older adult, very heavy isoinertial external loads (at least 70% of one repetition maximum) are effective irrespective of contraction mode. With heavy strength training, resistance trained older adults can continue to expect improvements in health and function.

The sitting and rising test for assessing people with chronic stroke

[Purpose] To investigate the inter-rater and test-retest reliability of the sitting-rising test (SRT), the correlations of sitting-rising test scores with measures of strength, balance, community integration and quality of life, as well as the cut-off score which best discriminates people with chronic stroke from healthy older adults were investigated. [Subjects and Methods] Subjects with chronic stroke (n=30) and healthy older adults (n=30) were recruited. The study had a cross-sectional design, and was carried out in a university rehabilitation laboratory. Sitting-rising test performance was scored on two occasions. Other measurements included ankle dorsiflexor and plantarflexor strength, the Fugl-Meyer assessment, the Berg Balance Scale, the timed up and go test, the five times sit-to-stand test, the limits of stability test, and measures of quality of health and community integration. [Results] Sitting-rising test scores demonstrated good to excellent inter-rater and test-retest reliabilities (ICC=0.679 to 0.967). Sitting-rising test scores correlated significantly with ankle strength, but not with other test results. The sitting-rising test showed good sensitivity and specificity. A cut-off score of 7.8 best distinguished healthy older adults from stroke subjects. [Conclusions] The sitting-rising test is a reliable and sensitive test for assessing the quality of sitting and rising movements. Further studies with a larger sample are required to investigate the test’s validity.

Rationale for Strengthening Muscle to Prevent Falls and Fractures: A Review of the Evidence

Falls represent a major public health problem in older people, predominantly due to the resulting injuries which lead to progressive disability, immobilization and resulting comorbidities, dependency, institutionalization, and death. Reduced muscle strength and power have been consistently identified as risk factors for falls and related injuries, and it is likely these associations result from the central role played by reduced muscle strength and power in poor balance recovery. In addition, muscle strength and power are involved with protective responses that reduce the risk of an injury if a fall occurs. Progressive resistance training (PRT) is the standard way to increase muscle strength and power, and this training forms one of the main components of fall prevention exercise interventions. However, PRT has rarely been implemented in routine practice due to multiple challenges inherent to frail older people. The ongoing development of drugs expected to increase muscle power offers a new opportunity to reduce the risk of falls and fall-related injuries. The intent here is not to replace exercise training with drugs but rather to offer a pharmacologic alternative when exercise is not possible or contraindicated. The target population would be those most likely to benefit from this mechanism of action, i.e., weak older people without major causes for falls independent of muscle weakness. Provided such a tailored strategy was followed, a muscle anabolic may address this major unmet need.

Model development to study strategies of younger and older adults getting up from the floor

BACKGROUND

Long lies after a fall remain a public health challenge. Many successful fall prevention programmes have been developed but only few of them include recovery strategies after a fall. Once better understood, such movement strategies could be implemented into training interventions.

AIMS

A model of motion sequences describing successful movement strategies for rising from the floor in different age groups was developed. Possible risk factors for poor rising performance such as flexibility and muscle power were evaluated.

METHODS

Fourteen younger subjects between 20 and 50 years of age and 10 healthy older subjects (60+ years) were included. Movement strategies and key components of different rising sequences were determined from video analyses. The temporal parameters of transfers and number of components within the motion sequences were calculated. Possible explanatory variables for differences in rising performance were assessed (leg extension power, flexibility of the knee- and hip joints).

RESULTS

Seven different components were identified for the lie-to-stand-walk transfer, labelled as lying, initiation, positioning, supporting, elevation, or stabilisation component followed by standing and/or walking. Median time to rise was significantly longer in older subjects (older 5.7s vs. younger 3.7s; p < 0.001), and leg extension power (left p = 0.002, right p = 0.013) and knee flexibility (left p = 0.019, right p = 0.025) were significantly lower. The number of components for rising was correlated with hip flexibility (r = 0.514) and maximal power (r = 0.582). The time to rise was correlated with minimal goniometric knee angle of the less flexible leg (r = 0.527) and maximal leg extension power (r = 0.725).

CONCLUSIONS

A motion sequence model containing seven different components identified by individual key-frames could be established. Age-related differences in rising strategies and performance were identified.

The movement patterns used to rise from a supine position by children with developmental delay and age-related differences in these

The purposes of this study were to determine (1) movement patterns and strategies of children with mild to moderate developmental delay (DD) used to rise up and how they differ from those used by age-matched children with typical development (TD), (2) whether the movement patterns differ with age in children with DD, and (3) to determine the developmental sequences for the UE, AX and LE in children with DD and whether they are different from those used by children with TD. Sixty six children with TD and 31 children with DD aged two to six years were recruited. Peabody Developmental Motor Scale II (PDMS-2) was used to determine the motor performance level. The participants were recorded during rising for at least five repetitions. Two trained pediatric physical therapists viewed each video recording and classified the movement patterns of the upper extremities (UE), trunk/axial (AX) and lower extremities (LE) regions using descriptive categories developed by previous researchers. The DD and TD groups were further divided into four subgroups each using a one-year interval. The percentage of occurrence of the each UE, AX and LE movement was determined and compared across subgroups, and between each age-matched pair of TD and DD groups. The results demonstrated that the participants in the TD group clearly followed the proposed developmental sequence and the children with DD followed the developmental sequences but with different maturation speeds and greater variability, especially at the age of three to five years. The most common movement patterns used by the children in each of the DD subgroups were at least one developmental categorical pattern behind those used by the age-matched children with TD before five years old, except for the LE region. In the DD group, the movement patterns had moderate to high correlation with the child's motor performance level, indicating that the children with better motor performances used more developmentally advanced patterns in comparison with those with lower scores. However, besides motor maturity, numerous other intrinsic/extrinsic factors may affect the child's performance of this task. The information obtained in this study would assist therapists when working with the children with DD, so that they can provide individualized treatment rather than guiding all such children toward a single, mature pattern.

Comparação de dois tratamentos fisioterapêuticos na redução da dor e aumento da autonomia funcional de idosos com gonartrose

Objetivo: Comparar o tratamento da terapia manual, associada ao ultrassom, com o tratamento da cinesioterapia convencional, associada ao laser de arseneto de galium (AsGa), na redução da dor e no aumento da autonomia funcional em idosos com gonartrose. Métodos: Estudo clínico, de delineamento quase-experimental. A amostra foi dividida aleatoriamente em dois grupos: grupo experimental 1 (GE1; n=44; idade=68±7,64 anos; índice de massa corporal: 26,77±4,74Kg/m2) - idosos com gonartrose submetidos ao tratamento fisioterapêutico com terapia manual e ultrassom; e grupo experimental 2 (GE2; n=20; idade=70±5,49 anos; índice de massa corporal: 27,11±4,63Kg/m 2 ) - idosos com gonartrose submetidos ao tratamento fisioterápico com cinesioterapia convencional e laserterapia. Foram analisados a autonomia funcional (protocolo do Grupo de Desenvolvimento Latino-Americano para a Maturidade - GDLAM) e o quadro álgico (escala CR10 de Borg). Ambos os GEs participaram de sessões de treinamento com duração de 45 minutos, duas vezes semanais, durante oito semanas consecutivas. O nível de significância foi de p<0,05. Resultados: Observou-se melhora da autonomia funcional pela redução significativa do índice de GDLAM (p<0,001) tanto no GE1 (Δ=16,14) quanto no GE2 (Δ=9,32). Semelhantemente, houve diminuição significativa (p<0,001) do nível de dor tanto no GE1 (Δ=5,09) quanto no GE2 (Δ=7,1). O poder do experimento foi de 98%. Conclusão: Infere-se, assim, que ambos os tratamentos sugeridos neste estudo são eficazes no aumento da autonomia funcional e na redução do quadro álgico de idosos com gonartrose.

The intra- and inter-rater reliability of component analysis of rise from supine in the children with typical development and developmental delay

The purpose of this study was to determine the intra- and inter-rater reliability of classifying the movement patterns of rising from supine to stand in the children with typical development (TD) and mild to moderate developmental delay (DD). Sixty-eight children with TD and 20 children with DD aged 2 through 6 years were videotaped during rising. Two trained pediatric physical therapists independently viewed each videotape and classified the movement patterns of upper extremities (UE), trunk/axial (AX) and lower extremities (LE) regions using descriptive categories developed by previous researchers. Kappa statistic and average percentage of agreement were calculated to determine reliability. The average agreement rate of intra-rater ranged from 90% to 97% in TD group for three regions, and 79% to 89% in DD group; the agreement rate between raters ranged from 82% to 95% in TD group for three regions, and 71% to 87% in DD group. Using kappa statistic guidelines, high intra- and inter-rater reliabilities (k>0.81) were found in TD group, except inter-rater reliability for LE. Substantial intra- and inter-reliabilities (0.61<k<0.81) were found in DD group. As comparing the reliabilities of three regions, the lowest intra- and inter-rater reliabilities were found at the LE region in both groups. As taking age into consideration and dividing each group into subgroups by 2-year interval, in DD group, the intra-rater reliabilities were higher in younger participants (aged 2-4 years), except for the LE region, but the results of inter-rater reliabilities were variable. For the children with TD, the levels of inter-rater reliability increased for the UE region and decreased for LE region in older age, but the results for these two regions were reverse for the children with DD. The findings of this study suggested that the complexities and difficulties affecting reliabilities in classifying the movement patterns of rising were related to developmental capability, age and body region. In order to improve intra- and inter-rater reliabilities, extra training is needed in examining the children with DD, particularly for the UE and LE regions.

Ability to sit and rise from the floor as a predictor of all-cause mortality

BACKGROUND

While cardiorespiratory fitness is strongly related to survival, there are limited data regarding musculoskeletal fitness indicators. Our aim was to evaluate the association between the ability to sit and rise from the floor and all-cause mortality.

DESIGN

Retrospective cohort.

METHODS

2002 adults aged 51-80 years (68% men) performed a sitting-rising test (SRT) to and from the floor, which was scored from 0 to 5, with one point being subtracted from 5 for each support used (hand/knee). Final SRT score, varying from 0 to 10, was obtained by adding sitting and rising scores and stratified in four categories for analysis: 0-3; 3.5-5.5, 6-7.5, and 8-10.

RESULTS

Median follow up was 6.3 years and there were 159 deaths (7.9%). Lower SRT scores were associated with higher mortality (p < 0.001). A continuous trend for longer survival was reflected by multivariate-adjusted (age, sex, body mass index) hazard ratios of 5.44 (95% CI 3.1-9.5), 3.44 (95% CI 2.0-5.9), and 1.84 (95% CI 1.1-3.0) (p < 0.001) from lower to higher SRT scores. Each unit increase in SRT score conferred a 21% improvement in survival.

CONCLUSIONS

Musculoskeletal fitness, as assessed by SRT, was a significant predictor of mortality in 51-80-year-old subjects. Application of a simple and safe assessment tool such as SRT, which is influenced by muscular strength and flexibility, in general health examinations could add relevant information regarding functional capabilities and outcomes in non-hospitalized adults.

The effect of ballroom dance on balance and functional autonomy among the isolated elderly

The aim of the present study was to analyze the influence of a ballroom dancing program on the functional autonomy and physical balance of institutionalized elderly individuals. The study enrolled 75 sedentary elderly subjects from long-term institutions who were randomly divided into a ballroom dance program group (EG; n=39) and a control group (CG; n=36). The protocol of the Latin American Group for Maturity (GDLAM) was used to evaluate functional autonomy. Physical balance was analyzed using a stabilometer and posture meter platforms. The level of significance in statistical tests was set at p<0.05. Regarding the physical balance evaluation, only the members of the EG achieved a significant reduction in weight (Δ=-0.98 kg) following the experiment, both in the intragroup (p=0.002) and in the intergroup analysis (p=0.012). In the evaluation of functional autonomy, only the EG showed a significant reduction in the execution time of all the tests and in the GDLAM index: GI (Δ=-6.99), both in the intragroup (p<0.001) and in the intergroup analysis (p=0.011). Thus, it can be inferred that sedentary elderly individuals who are residents of long-term institutions can improve their functional autonomy and balance with a ballroom dance program.

Flexibility, functional autonomy and quality of life (QoL) in elderly yoga practitioners

The aim of this study was to assess the levels of flexibility, functional autonomy and QoL in elderly yoga practitioners. The subjects were divided into a yoga group (YG; n = 52; age = 66.79 ± 3.30 years; BMI = 24.77 ± 3.18) and control group (CG; n = 31; age = 69.33 ± 4.84 years; BMI = 24.32 ± 3.71) and submitted to flexibility tests through goniometry, the LADEG autonomy protocol and QoL, using the WHOQOL-Old questionnaire. Repeated measures ANOVA showed increases in articular range of motion in shoulder abduction (Δ%SA = 14.11%; p = 0.0001), horizontal shoulder extension (Δ%HSE = 33.90%; p = 0.0001), lumbar spine flexion (Δ%LSF = 50.74%; p = 0.0001), hip flexion (Δ%HF = 35.75%; p = 0.0001), hip extension (Δ%HE = 10.93%; p = 0.021) and knee flexion (Δ%KF = 3.90%; p = 0.001) and in the GDLAM autonomy index (Δ%AI = -13.67%; p = 0.0001) in the YG compared to the CG. The Mann-Whitney test revealed increases in QoL scores in Facet 1 (Δ%Fac1 = 9.04%; p=0.043), Facet 5 (Δ%Fac5 = 51.06%; p = 0.0001) and in overall QoL (Δ%OqoL = 8.13%; p = 0.046) in the YG compared to the CG. The remaining variables showed no significant intergroup modifications. Thus, the study suggests that the regular practice of yoga may lead to improved range of motion in the performance of activities of daily living in elderly women.

Autonomia funcional de idosas praticantes de Pilates

O objetivo foi avaliar o efeito do método Pilates na autonomia funcional de idosas. Foram selecionadas 52 voluntárias, submetidas à avaliação geral e ao protocolo de avaliação da autonomia funcional do Grupo Latino-Americano de Desenvolvimento para Maturidade (GDLAM), que consiste em cinco testes (caminhada de 10 m, levantar-se da posição sentada, levantar-se da cadeira e locomover-se pela casa, levantar-se da posição de decúbito ventral e vestire tirar uma camiseta); em seguida, foram divididas em dois grupos: grupo Pilates (GP, n=27; idade 66,9±5,3 anos) e grupo controle (GC, n=25; idade 65,2±3,9 anos). O GP foi submetido a uma série de dez exercícios de Pilates, por oito semanas, duas vezes por semana. Os dois grupos foram reavaliados após esse período. O nível de significância considerado foi de p?0,05. O GP obteve resultados significativamente melhores em todos os testes e no índice geral do GDLAM (p=0,035) após a intervenção. O GC obteve escore significativamente melhor (p=0,042) apenas no teste de caminhada de 10 m, tendo mantido sua classificação inicial de funcionalidade regular. Comparando-se os escores dos grupos após a intervenção, encontraram-se diferenças significativas em favor do GP, inclusive no índice GDLAM (p<0,05), tendo este passado da classificação de regular a bom. A prática do método Pilates gerou pois melhora significativa do desempenho funcional das idosas estudadas.

Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels, low bone mass, and physical frailty

OBJECTIVES

To investigate the effects of testosterone supplementation on bone, body composition, muscle, physical function, and safety in older men.

DESIGN

Double-blind, randomized, placebo-controlled trial.

SETTING

A major medical institution.

PARTICIPANTS

One hundred thirty-one men (mean age 77.1 +/- 7.6) with low testosterone, history of fracture, or bone mineral density (BMD) T-score less than -2.0 and frailty.

INTERVENTION

Participants received 5 mg/d of testosterone or placebo for 12 to 24 months; all received calcium (1500 mg/d diet and supplement) and cholecalciferol (1,000 IU/d).

MEASUREMENTS

BMD of hip, lumbar spine, and mid-radius; body composition; sex hormones, calcium-regulating hormones; bone turnover markers; strength; physical performance; and safety parameters.

RESULTS

Ninety-nine men (75.6%) completed 12 months, and 62 (47.3%) completed end therapy (mean 23 months; range 16-24 months for 62 who completed therapy). Study adherence was 54%, with 40% of subjects maintaining 70% or greater adherence. Testosterone and bioavailable testosterone levels at 12 months were 583 ng/dL and 157 ng/dL, respectively, in the treatment group. BMD on testosterone increased 1.4% at the femoral neck and 3.2% at the lumbar spine (P=.005) and decreased 1.3% at the mid-radius (P<.001). There was an increase in lean mass and a decrease in fat mass in the testosterone group but no differences in strength or physical performance. There were no differences in safety parameters.

CONCLUSION

Older, frail men receiving testosterone replacement increased testosterone levels and had favorable changes in body composition, modest changes in axial BMD, and no substantial changes in physical function.

Nível de atividade física, autonomia funcional e qualidade de vida em idosas ativas e sedentárias

INTRODUÇÃO: O envelhecimento é um processo contínuo durante o qual ocorre declínio progressivo de todos os processos fisiológicos. OBJETIVO: O objetivo do presente estudo foi analisar os níveis de atividade física, autonomia funcional e qualidade de vida em idosas ativas e sedentárias. MÉTODO: A amostra foi constituída de 30 mulheres (15 sedentárias e 15 ativas), com idade igual ou superior a 60 anos. Para determinar o nível de atividade física, utilizou-se a versão do Questionário Baecke Modificado para Idosos; e a autonomia funcional foi avaliada pela bateria de testes do Grupo de Desenvolvimento Latino-Americano para a Maturidade (GDLAM); e a qualidade de vida, por meio do questionário WHOQOL-OLD. O tratamento estatístico foi composto por análise descritiva e inferencial. Os dados foram analisados pelo SPSS®, versão 13.0. O nível de significância e erro estatístico considerado foi de 5% (p < 0,05). RESULTADOS E DISCUSSÃO: Pela análise dos resultados pôde-se observar que os níveis de atividade física encontrados nas idosas ativas foi maior que os das sedentárias, repercutindo nos melhores resultados apresentados nos testes de autonomia funcional, apesar de ambas serem classificadas com IG fraco. Em relação à qualidade de vida, constatamos não haver associação a melhores níveis quando comparamos ambos os grupos. CONSIDERAÇÕES FINAIS Recomenda-se que seja realizada uma intervenção por meio de um programa de treinamento de físico mais intenso, envolvendo maior quantidade de indivíduos mais bem condicionados para melhor verificar as possíveis alterações das variáveis do estudo realizado.

Effects of transdermal testosterone on bone and muscle in older men with low bioavailable testosterone levels, low bone mass, and physical frailty

OBJECTIVES

To investigate the effects of testosterone supplementation on bone, body composition, muscle, physical function, and safety in older men.

DESIGN

Double-blind, randomized, placebo-controlled trial.

SETTING

A major medical institution.

PARTICIPANTS

One hundred thirty-one men (mean age 77.1 +/- 7.6) with low testosterone, history of fracture, or bone mineral density (BMD) T-score less than -2.0 and frailty.

INTERVENTION

Participants received 5 mg/d of testosterone or placebo for 12 to 24 months; all received calcium (1500 mg/d diet and supplement) and cholecalciferol (1,000 IU/d).

MEASUREMENTS

BMD of hip, lumbar spine, and mid-radius; body composition; sex hormones, calcium-regulating hormones; bone turnover markers; strength; physical performance; and safety parameters.

RESULTS

Ninety-nine men (75.6%) completed 12 months, and 62 (47.3%) completed end therapy (mean 23 months; range 16-24 months for 62 who completed therapy). Study adherence was 54%, with 40% of subjects maintaining 70% or greater adherence. Testosterone and bioavailable testosterone levels at 12 months were 583 ng/dL and 157 ng/dL, respectively, in the treatment group. BMD on testosterone increased 1.4% at the femoral neck and 3.2% at the lumbar spine (P=.005) and decreased 1.3% at the mid-radius (P<.001). There was an increase in lean mass and a decrease in fat mass in the testosterone group but no differences in strength or physical performance. There were no differences in safety parameters.

CONCLUSION

Older, frail men receiving testosterone replacement increased testosterone levels and had favorable changes in body composition, modest changes in axial BMD, and no substantial changes in physical function.

Efeitos de um programa de caminhada sob os níveis de autonomia funcional de idosas monitoradas pelo programa saúde da família

OBJETIVO: verificar os efeitos de um programa de caminhada sobre os níveis de autonomia funcional de idosas participantes do Programa Saúde da Família. MÉTODOS: Para este estudo experimental, a amostra foi aleatoriamente dividida em: grupo experimental (GE; n=58, idade:67±6 anos) e grupo controle (GC; n=40; idade:70±6 anos). Todas eram fisicamente ativas, porém sem um rigor na regularidade do programa de atividade física. A autonomia funcional foi avaliada pela bateria de testes do Grupo de Desenvolvimento Latino-Americano para a Maturidade (GDLAM), composta de: caminhar 10m (C10m), levantar-se da posição sentada (LPS), levantar-se da posição de decúbito ventral (LPDV), levantar-se da cadeira e locomover-se pela a casa (LCLC) e o teste de vestir e tirar uma camiseta (VTC). Esses testes resultam no índice de GDLAM (IG). O programa de intervenção foi realizado em frequência semanal de três vezes, com intensidade que variava entre 55% a 75% da frequência cardíaca máxima. RESULTADOS: Na análise intragrupos, pôde-se observar melhora significativa no GE, em todos os testes do GDLAM e no IG (Δ=-4,13; p=0,0001); entretanto, o GC obteve uma piora significativa em todos os testes do GDLAM e no IG (Δ=+0,05; p=0,0001). Na comparação intergrupos, o GE mostrou-se superior ao GC em todos os testes (p<0,05) e no IG (Δ=-8,23; p=0,0001). CONCLUSÕES: Pode-se inferir que o GE, após ter se submetido à atividade de caminhada regular e controlada, obteve melhora do nível de autonomia funcional, quando comparado ao inicial e ao do GC. Número de registro clínico: NCT00981734.