Effects of stretching exercise on walking performance and balance in older adults: A systematic review and meta-analysis

This systematic review aimed to analyse the literature on the effects of stretching exercise as a strategy to improve walking performance and balance in older adults. A literature search was performed in five databases up to October 2023 for randomized clinical trials addressing the effects of stretching exercise programs in older adults. The methodological quality was evaluated through the PEDro scale. A total of 29 studies were included. Methodological quality was good in 16 publications and fair in 13 investigations. Improvements on balance and walking ability following stretching programs were reported in different studies. The meta-analysis pooling 139 participants from 6 studies showed that stretching interventions increased gait speed in comparison with control groups that were not assigned to any exercise programs (standardized mean difference=0.56; 95 % confidence interval: 0.21, 0.90; I-squared = 0 %, p=0.520). These findings indicate potential benefits of stretching exercises to enhance walking ability in older adult population.

The effect of a home-based exercise program on gait characteristics in an individual with Parkinson's disease over a one-year period: A case study

BACKGROUND

The COVID-19 pandemic has placed a restriction on physiotherapy clinical visits for supervised exercise. It is important that individuals with Parkinson's Disease (PD) continue an exercise regime at home during the pandemic and also in normal situations.

OBJECTIVE

The purpose of this study was to explore the case history of an individual with PD who used a developed home-based exercise programme for one year during the COVID-19 pandemic.

METHODS

A 67 year-old married woman was diagnosed with PD stage 2.5 on the modified Hoehn and Yahr (HY) scale. Gait characteristics and the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor scores were assessed at baseline, 10 weeks, and 12 months. The home-based exercise program included breathing exercises, posture correction, stretching exercises, rotation of the axial segments, balance training, and task-specific gait training.

RESULTS

After 12 months, her MDS-UPDRS motor scores decreased when compared to baseline and 10 weeks, and gait characteristics at 12 months showed an increase in the degree of foot rotation, step length, cadence, and gait speed when compared to baseline and 10 weeks.

CONCLUSION

This case study showed that improvements in MDS-UPDRS and gait characteristics can continue over a 12 month period as a result of a home-based exercise programme. Therefore, home-based exercise programs should be encouraged with weekly monitoring, especially in individuals with gait disorders which show deterioration.

The effects of rhythmic exercise using PNF patterns on gait variables in normal adults

BACKGROUND

Maintaining gait stability is an important factor for preventing falls of normal adults. Thus, it is necessary to conduct research on gait variables in normal adults.

OBJECTIVE

In this study, we conducted research on the effect of rhythmic exercise using proprioceptive neuromuscular facilitation (PNF) patterns on gait variables in normal adults.

METHODS

Thirty-two subjects were divided into two groups, the training and control groups, with 16 subjects in each group. We measured various gait variables step time difference (STD), step length difference (SLD), single support difference (SSD), stance phase difference (STPD) and swing phase difference (SWPD) for the pre-test and post-test in each group.

RESULTS

As a result of paired t-tests on various gait variables (STD, SLD, SSD, STPD, SWPD) of the training and control group, the training group showed significance in SLD, STPD and STD and the control group had no significance in all items.

CONCLUSIONS

In this study, which verified the effect of rhythmic exercise using the PNF patterns on the gait variables of normal adults, there was statistical significance in SLD, STPD, and STD showing that dynamic exercise using the PNF pattern is helpful in improving the walking ability of normal adults.

Acute and Chronic Effects of Supervised Flexibility Training in Older Adults: A Comparison of Two Different Conditioning Programs

Flexibility training is a fundamental biological process that improves the quality of life of the elderly by improving the ranges of motion of joints, postural balance and locomotion, and thus reducing the risk of falling. Two different training programs were assessed acutely and after 12 weeks by means of the sit-and-reach test. Thirty-one healthy older adults were randomly divided into three groups: the Experiment I group (Exp) performed strength and static stretching exercises; the Experiment II group performed dynamic and static stretching exercises; and participants assigned to the control group maintained a sedentary lifestyle for the entire period of the study. Flexibility acutely increased in Exp I by the first (ΔT0 = 7.63 ± 1.26%; ES = 0.36; p = 0.002) and second testing sessions (ΔT1 = 3.74 ± 0.91%; ES = 0.20; p = 0.002). Similarly, it increased in Exp II significantly by the first (ΔT0 = 14.21 ± 3.42%; ES = 0.20; p = 0.011) and second testing sessions (ΔT1 = 9.63 ± 4.29%; ES = 0.13; p = 0.005). Flexibility significantly increased over the 12 weeks of training in Exp I (ΔT0 - T1 = 9.03 ± 3.14%; ES = 0.41; p = 0.020) and Exp II (ΔT0 - T1 = 22.96 ± 9.87%; ES = 0.35; p = 0.005). The acute and chronic differences between the two groups were not significant (p > 0.05). These results suggest the effectiveness of different exercise typologies in improving the flexibility of the posterior muscular chains in older adults. Therefore, the selection of a program to optimize training interventions could be based on the physical characteristics of the participants.

Determination of the Predictors with the Greatest Influence on Walking in the Elderly

Background and Objectives: Previous studies have revealed that independent variables (lower extremity strength, postural control ability, and body composition) influence gait performance and variability, but the difference in the relative influence between these variables is unclear. Hence, this study determines the variable that is the most influential predictor of gait performance and variability among potential independent variables in the elderly. Materials and Methods: Seventy-eight subjects aged ≥60 years participated. For each subject, the gait variables and lower extremity muscle strength were measured using an accelerometer worn on both feet during a 6-minute walk and a manual force sensor, respectively. The static balance ability was measured through two force plates, and the body composition was measured by applying bioelectrical impedance analysis. Linear regression analyses were performed stepwise to determine whether these variables affect gait performance and variability. Results: After adjusting for sex and gait performance, the ankle strength, body fat mass, mean velocity in the medial-lateral direction, ankle plantar flexion strength, and girth were predictors of gait speed dorsiflexion, gait performance, swing width of the gait performance, walking speed, and gait variability, respectively. Conclusions: Overall, gait performance in the elderly is related to muscle strength, postural control, and body composition in a complex manner, but gait variability appears to be more closely related to ankle muscle strength. This study provides further evidence that muscle strength is important in motor function and stability.

Can a targeted home-based exercise programme improve turning characteristics in individuals with Parkinson's disease?

BACKGROUND

Turns are often cited as a difficult task for individuals with Parkinson's disease and often lead to falls, however targeted exercise interventions may help to reduce this problem. This study examined the effects of a 10-week home-based exercise program focusing on turns which may be an exercise approach for improving mobility and reducing falls in individuals with Parkinson's disease.

METHODS

Turning and stepping characteristics were recorded using Inertial Measurement Units while participants performed a 180° standing turn. Eye movements were measured using a BlueGain electrooculography system. Clinical outcomes were assessed using the Movement Disorders Society-Unified Parkinson's Disease Rating Scale, Functional axial rotation-physical score and the Falls Efficacy Scale International.

FINDINGS

Twenty individuals with Parkinson's disease were matched by severity using the Modified Hoehn and Yahr scale and were randomly allocated to an exercise (n = 10) or control group (n = 10). Significant improvements were seen after 10 weeks in the exercise group only for; onset latency of body segments, step size, number of fast phase eye movements, the Movement Disorders Society-Unified Parkinson's Disease Rating Scale in motor and rigidity scores, Functional axial rotation-physical score and the Falls Efficacy Scale International.

INTERPRETATION

These results indicate that the home-based exercise programme targeting turning characteristics had positive effects on turning performance and clinical outcomes associated with falls in individuals with Parkinson's disease. These preliminary results support the notion that targeted home-based exercises may provide an effective intervention in this population.

Gait Parameters of Older Adults according to Their Fall History and Functional Capacity While Walking at Different Speeds

INTRODUCTION

It is believed that functional capacity and fall history are factors capable of influencing the gait parameters of older adults. Thus, the objective of this study was to verify whether gait parameters of community-dwelling older adults differ according to their functional capacity and fall history when walking at self-selected walking speed (SSWS) and fast walking speed (FWS) using principal component analysis (PCA).

METHODS

Two hundred ninety-five participants (82.3% women and 17.7% men) were allocated in four groups according to their fall history and functional capacity: non-fallers with higher functional capacity (NFHFC, n = 94; 69.3 ± 5.5 years), non-fallers with lower functional capacity (NFLFC, n = 114; 72.0 ± 8.1 years), fallers with higher functional capacity (FHFC, n = 29; 70.0 ± 6.0 years), and fallers with lower functional capacity (FLFC, n = 58; 72.5 ± 8.2 years). Fall history, anthropometric data, functional capacity by short physical performance battery and mobility by Timed Up and Go (TUG), and spatiotemporal gait parameters were evaluated.

RESULTS

Data analysis indicated that FLFC presented the lowest scores, especially in the Five Times Sit-to-Stand Test and TUG. The PCA showed that the first principal component (PC1) explained the most substantial amount of the data variability in both walking speeds (SSWS and FWS), predominantly including temporal parameters. PC2 composed by spatial outcomes (stride and step length and walking speed) showed the highest effect size. PC1 and PC2 were able to differentiate functional status, regardless of fall history.

CONCLUSIONS

Functional capacity showed great importance when analyzing gait parameters at different walking speeds (SSWS and FWS), regardless of fall history. Older adults with high functional capacity demonstrate better performance during gait. Besides, spatiotemporal parameters are the main factors explaining gait variability, both in SSWS and FWS.

Is Stretching Exercise An Adequate Control Group in Clinical Trials Aimed at Improving Physical Fitness and Function of Older Adults? A Systematic Review and Meta-Analysis

This study aimed to determine if stretching exercise can be implemented as an adequate control therapy in exercise randomized controlled trials aimed at improving physical fitness and physical function in older adults. Five electronic databases were systematically searched for randomized controlled trials focused in the physical fitness and function of older adults using stretching exercise as control group. The methodological quality was assessed and a meta-analysis was carried out. Sixteen studies were included, 13 in the meta-analysis. The methodological quality ranged from fair to good. The meta-analysis only in the controls resulted in significant improvements in different functional parameters related to walking, balance, knee flexion strength, or global physical function. The interventions, compared with the controls, significantly improved balance and knee strength parameters. Stretching exercise as control therapy in older people can lead to beneficial effects and could influence the interpretation of the effect size in the intervention groups.

Effects of stretching exercises on human gait: a systematic review and meta-analysis

Background: Stretching is commonly used in physical therapy as a rehabilitation tool to improve range of motion and motor function. However, is stretching an efficient method to improve gait, and if so, for which patient category? Methods: A systematic review of randomized and non-randomized controlled trials with meta-analysis was conducted using relevant databases. Every patient category and every type of stretching programs were included without multicomponent programs. Data were meta-analysed where possible. Estimates of effect sizes (reported as standard mean difference (SMD)) with their respective 95% confidence interval (95% CI) were reported for each outcome. The PEDro scale was used for the quality assessment. Results: Twelve studies were included in the analysis. Stretching improved gait performance as assessed by walking speed and stride length only in a study with a frail elderly population, with small effect sizes (both SMD= 0.49; 95% CI: 0.03, 0.96; PEDro score: 3/10). The total distance and the continuous walking distance of the six-minute walking test were also improved only in a study in an elderly population who had symptomatic peripheral artery disease, with large effect sizes (SMD= 1.56; 95% CI: 0.66, 2.45 and SMD= 3.05; 95% CI: 1.86, 4.23, respectively; PEDro score: 5/10). The results were conflicting in healthy older adults or no benefit was found for most of the performance, spatiotemporal, kinetic and angular related variables. Only one study (PEDro score: 6/10) showed improvements in stance phase duration (SMD=-1.92; 95% CI: -3.04, -0.81), swing phase duration (SMD=1.92; 95 CI: 0.81, 3.04), double support phase duration (SMD= -1.69; 95% CI: -2.76, -0.62) and step length (SMD=1.37; 95% CI: 0.36, 2.38) with large effect sizes. Conclusions: There is no strong evidence supporting the beneficial effect of using stretching to improve gait. Further randomized controlled trials are needed to understand the impact of stretching on human gait.

Effects of stretching exercises on human gait: a systematic review and meta-analysis

Background: Stretching is commonly used in physical therapy as a rehabilitation tool to improve range of motion and motor function. However, is stretching an efficient method to improve gait, and if so, for which patient category? Methods: A systematic review of randomized and non-randomized controlled trials with meta-analysis was conducted using relevant databases. Every patient category and every type of stretching programs were included without multicomponent programs. Data were meta-analysed where possible. Estimates of effect sizes (reported as standard mean difference (SMD)) with their respective 95% confidence interval (95% CI) were reported for each outcome. The PEDro scale was used for the quality assessment. Results: Twelve studies were included in the analysis. Stretching improved gait performance as assessed by walking speed and stride length only in a study with a frail elderly population, with small effect sizes (both SMD= 0.49; 95% CI: 0.03, 0.96; PEDro score: 3/10). The total distance and the continuous walking distance of the six-minute walking test were also improved only in a study in an elderly population who had symptomatic peripheral artery disease, with large effect sizes (SMD= 1.56; 95% CI: 0.66, 2.45 and SMD= 3.05; 95% CI: 1.86, 4.23, respectively; PEDro score: 5/10). The results were conflicting in healthy older adults or no benefit was found for most of the performance, spatiotemporal, kinetic and angular related variables. Only one study (PEDro score: 6/10) showed improvements in stance phase duration (SMD=-1.92; 95% CI: -3.04, -0.81), swing phase duration (SMD=1.92; 95 CI: 0.81, 3.04), double support phase duration (SMD= -1.69; 95% CI: -2.76, -0.62) and step length (SMD=1.37; 95% CI: 0.36, 2.38) with large effect sizes. Conclusions: There is no strong evidence supporting the beneficial effect of using stretching to improve gait. Further randomized controlled trials are needed to understand the impact of stretching on human gait.

Gait Characteristics Based on Shoe-Type Inertial Measurement Units in Healthy Young Adults during Treadmill Walking

This study investigated the gait characteristics of healthy young adults using shoe-type inertial measurement units (IMU) during treadmill walking. A total of 1478 participants were tested. Principal component analyses (PCA) were conducted to determine which principal components (PC_s) best defined the characteristics of healthy young adults. A non-hierarchical cluster analysis was conducted to evaluate the essential gait ability, according to the results of the PC₁ score. One-way repeated analysis of variance with the Bonferroni correction was used to compare gait performances in the cluster groups. PCA outcomes indicated 76.9% variance for PC₁–PC₆, where PC₁ (gait variability (GV): 18.5%), PC₂ (pace: 17.8%), PC₃ (rhythm and phase: 13.9%), and PC₄ (bilateral coordination: 11.2%) were the gait-related factors. All of the pace, rhythm, GV, and variables for bilateral coordination classified the gait ability in the cluster groups. We suggest that the treadmill walking task may be reliable to evaluate the gait performances, which may provide insight into understanding the decline of gait ability. The presented results are considered meaningful for understanding the gait patterns of healthy adults and may prove useful as reference outcomes for future gait analyses.

Combined Resistance and Stretching Exercise Training Benefits Stair Descent Biomechanics in Older Adults

Introduction

Stair descent is a physically demanding activity of daily life and common risk for falls. Age-related deteriorations in ankle joint capacities make stair descent particularly challenging for older adults in built environments, where larger rise steps are encountered. Exercise training may allow older adults to safely cope with the high biomechanical demands of stair descent. However, little is known about the demands of increased rise stairs for older adults, nor the impact of exercise.

Aim

We investigated whether the effects of lower-limb resistance training would alter joint kinetics and movement strategies for older adults when descending standard rise, and increased rise stairs.

Methods

Fifteen older adults descended a four-step stair adjusted to standard rise (170 mm), and increased rise (255 mm) on separate visits. Between these two visits, randomly allocated participants underwent 16 weeks of either: resistance exercise training (n = 8) or habitual activity (n = 7). Kinetic data were measured from step-mounted force plates, and kinematic data from motion-capture cameras. Training involved twice-weekly sessions of lower-limb resistance exercises (three sets of ∼8 repetitions at ∼80% three-repetition maximum), and static plantarflexor stretching (three, 45 s holds per leg).

Results

Standard stairs – Peak ankle joint moments increased (p < 0.002) and knee joint moments decreased (p < 0.01) during descent after exercise training. Peak centre of pressure-centre of mass (CoP-CoM) separations increased in posterior (p = 0.005) and medio-lateral directions (p = 0.04) after exercise training. Exercise training did not affect CoM descent velocity or acceleration. Increased rise stairs – Required greater ankle, knee, and hip moments (p < 0.001), peak downward CoM velocity and acceleration (p = 0.0001), and anterior-posterior CoP-CoM separation (p = 0.0001), but lower medial-lateral CoP-CoM separation (p < 0.05), when compared to standard stair descent. Exercise training did not affect joint kinetics or movement strategies.

Discussion

Exercise training increased the maximum joint ROM, strength and force production of the ankle, and enabled a greater ankle joint moment to be produced in single-leg support (lowering phase) during standard stair descent. Descending increased rise stairs raised the task demand; exercise training could not overcome this. Future research should prioritize the ankle joint in stair descent, particularly targeting plantarflexor torque development across stairs of varying riser heights.

Long-Term Effects of a Soft Robotic Suit on Gait Characteristics in Healthy Elderly Persons

As a walking assistive device for elderly persons, one of the major aims should be to improve and rehabilitate gait characteristics after long-term repeated use of the device. However, most of the existing research on walking assistive devices only emphasize their immediate effects, and there is limited research indicating the long-term effects. To address this gap, this paper experimentally validates the effects of our soft wearable robotic suit on gait characteristics of elderly persons after repeated use of the device for six weeks. Experimental results on four elderly subjects (age = 74.8 ± 5.0 year) show that, after six weeks of gait rehabilitation training by the robotic suit, the gait characteristics of the subjects were improved, leading to an increased walk ratio with an average of 9.8% compared with the initial state. The results of this research will benefit the potential use of the robotic suit in gait training and rehabilitation for elderly persons and also will be useful to the establishment of practical guidelines that maximize the training and rehabilitation effectiveness of the robotic suit.

A associação entre capacidade física e probabilidade de internação hospitalar em idosos que vivem na comunidade

RESUMO O crescimento da população idosa exige reorganização política, econômica e social, em especial na área da saúde, devido ao impacto sobre esta. A avaliação da Probabilidade de Internação Hospitalar (PIH) é usada como indicador da condição de saúde do idoso. Entretanto, variáveis de capacidade física (CF) ainda não foram associadas com a PIH. Analisou-se a associação entre CF e a PIH de idosos. O estudo realizado foi epidemiológico, transversal e analítico. A seleção da amostra ocorreu de forma aleatória em uma das Equipes de Saúde da Família no bairro Passo d’Areia, no município de Porto Alegre, sendo avaliados 317 idosos com idade ≥ 65 anos. A CF foi avaliada por testes de força de membros superiores e inferiores, flexibilidade e equilíbrio. A PIH foi avaliada pelo instrumento de triagem rápida de Boult. Para análise estatística, a PIH foi ajustada em dois grupos: baixa-média e média alta-alta (MAA) e realizada a análise multivariada de regressão de Poisson. O nível de significância adotado foi de p ≤ 0,05. Nos resultados encontrados, as variáveis físicas que permaneceram associadas à PIH-MAA foram a força de membros inferiores (RP = 1,78; IC 95% = 1,04 - 3,04) e flexibilidade (RP = 2,13; IC 95% = 1,28 - 3,56). Houve associação negativa entre os baixos níveis de força de membro inferior e de flexibilidade com PIH-MAA. A prevalência da PIH-MAA entre indivíduos com força alterada para membros inferiores foi 78% maior em relação àqueles com força normal e 113% entre aqueles com alteração de flexibilidade.

Interventions for the prevention and treatment of disability due to acquired joint contractures in older people: a systematic review

Background

acquired joint contractures have significant effects on quality of life and functioning.

Objective

to determine the effects of interventions to prevent and treat disabilities in older people with acquired joint contractures.

Methods

systematic search (last 8/2016) via Cochrane Library, PubMed, EMBASE, PEDro, CINAHL, trial registries, reference lists of retrieved articles and scientific congress pamphlets. Controlled and randomised controlled trials in English or German comparing an intervention with another intervention or standard care were included. Two independent researchers performed the selection of publications, data extraction and critical appraisal.

Results

seventeen studies with 992 participants met the inclusion criteria: 16 randomised controlled trials and 1 controlled trial (nursing homes = 4, community settings = 13). The methodological quality of the studies varied. Splints were examined in four studies, stretching exercises in nine studies, and ultrasound, passive movement therapy, bed-positioning and group exercise were each examined in one study. Studies on splints revealed inconclusive results regarding joint mobility or spasticity. Five of seven studies that assessed active stretching programmes for healthy older people reported statistically significant effects on joint mobility in favour of the intervention. Pain, quality of life, activity limitations and participation restrictions were rarely assessed.

Conclusion

the evidence for the effectiveness of interventions to prevent and treat disability due to joint contractures is weak, particularly for established nursing interventions such as positioning and passive movement. Better understanding is required regarding the delivery of interventions, such as their intensity and duration. In addition to functional issues, activities and social participation should also be studied as outcomes.

To dance or not to dance? A comparison of balance, physical fitness and quality of life in older Irish set dancers and age-matched controls

OBJECTIVE

The objective of this study is to determine if older adults regularly participating in Irish set dancing have superior balance, physical fitness and quality of life compared to age-matched controls.

STUDY DESIGN

This study used a community-based, observational cross-sectional design.

METHODS

Regular set dancers (n = 39) and age-matched controls (n = 33) were recruited. Participants were assessed using the physical activity scale for the elderly (physical activity levels), mini-BESTest (balance) and senior fitness test (battery of functional fitness tests). Quality of life was also assessed using the EuroQol EQ visual analogue scale.

RESULTS

When controlling for between-group differences in levels of physical activity (ANCOVA analysis), the dancers had significantly better balance, functional capacity and quality of life (all P < 0.05) compared to controls. No differences between the groups were observed in other measures of functional fitness.

CONCLUSION

The findings of this study suggest regular participation in set dancing is associated with health benefits for older adults. These results may inform future studies prospectively examining the role of set dancing for falls prevention, emotional well-being and cognitive function in community-dwelling older adults.

Review of safety and mobility issues among older pedestrians

Although old people make up an extremely vulnerable road-user group, older pedestrians' difficulties have been studied less extensively than those of older drivers, and more knowledge of this issue is still required. The present paper reviews current knowledge of older-adult problems with the main components of pedestrian activity, i.e., walking and obstacle negotiation, wayfinding, and road crossing. Compared to younger ones, old pedestrians exhibit declining walking skills, with a walking speed decrease, less stable balance, less efficient wayfinding strategies, and a greater number of unsafe road crossing behaviors. These difficulties are linked to age-related changes in sensorial, cognitive, physical, and self-perception abilities. It is now known that visual impairment, physical frailty, and attention deficits have a major negative impact on older pedestrians' safety and mobility, whereas the roles of self-evaluation and self-regulation are still poorly understood. All these elements must be taken into consideration, not only in developing effective safety interventions targeting older pedestrians, but also in designing roads and cars. Recent initiatives are presented here and some recommendations are proposed.

Outcome measures in older persons with acquired joint contractures: a systematic review and content analysis using the ICF (International Classification of Functioning, Disability and Health) as a reference

Background

Joint contractures are a common health problem in older persons with significant impact on activities of daily living. We aimed to retrieve outcome measures applied in studies on older persons with joint contractures and to identify and categorise the concepts contained in these outcome measures using the ICF (International Classification of Functioning, Disability and Health) as a reference.

Methods

Electronic searches of Medline, EMBASE, CINAHL, Pedro and the Cochrane Library were conducted (1/2002-8/2012). We included studies in the geriatric rehabilitation and nursing home settings with participants aged ≥ 65 years and with acquired joint contractures. Two independent reviewers extracted the outcome measures and transferred them to concepts using predefined conceptual frameworks. Concepts were subsequently linked to the ICF categories.

Results

From the 1057 abstracts retrieved, 60 studies met the inclusion criteria. We identified 52 single outcome measures and 24 standardised assessment instruments. A total of 1353 concepts were revealed from the outcome measures; 96.2 % could be linked to 50 ICF categories in the 2nd level; 3.8 % were not categorised. Fourteen of the 50 categories (28 %) belonged to the component Body Functions, 4 (8 %) to the component Body Structures, 26 (52 %) to the component Activities and Participation, and 6 (12 %) to the component Environmental Factors.

Conclusions

The ICF is a valuable reference for identifying and quantifying the concepts of outcome measures on joint contractures in older people. The revealed ICF categories remain to be validated in populations with joint contractures in terms of clinical relevance and personal impact.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0213-6) contains supplementary material, which is available to authorized users.

Acute effects of stretching exercise on the soleus muscle of female aged rats

It has been shown that stretching exercises can improve the flexibility and independence of the elderly. However, although these exercises commonly constitute training programs, the morphological adaptations induced by stretching exercises in aged skeletal muscle are still unclear.

OBJECTIVE

To assess the acute effects of passive mechanical static stretching on the morphology, sarcomerogenesis and modulation of important components of the extracellular matrix of the soleus muscle of aged female rats.

METHODS

Fifteen old female rats with 26 months were divided into two groups: stretching (n=8, SG) and control (n=7, CG): The stretching protocol consisted of 4 repetitions each of 1 min with 30s interval between sets. Stretching was performed on the left soleus muscle, 3 times a week for 1 week. After three sessions, the rats were anesthetized to remove the left soleus muscle, and then euthanized. The following analyses were carried out: muscle fiber cross-sectional area and serial sarcomere number; immunohistochemistry for the quantification of collagen I, III and TGFβ-1.

RESULTS

a decrease in muscle fiber cross-sectional area of the SG was observed when compared to the CG (p=0.0001, Kruskal-Wallis); the percentage of type I collagen was significantly lower in the SG when compared to the CG (p=0.01, Kruskal-Wallis), as well as the percentage of TGFβ-1 (p=0.04, Kruskal-Wallis); collagen III was significantly higher in the SG than in the CG (7.06±6.88% vs 4.92±5.30%, p=0.01, Kruskal-Wallis).

CONCLUSION

Although the acute stretching induced muscle hypotrophy, an antifibrotic action was detected.

The relevance of stretch intensity and position-a systematic review

Stretching exercises to increase the range of motion (ROM) of joints have been used by sports coaches and medical professionals for improving performance and rehabilitation. The ability of connective and muscular tissues to change their architecture in response to stretching is important for their proper function, repair, and performance. Given the dearth of relevant data in the literature, this review examined two key elements of stretching: stretch intensity and stretch position; and their significance to ROM, delayed onset muscle soreness (DOMS), and inflammation in different populations. A search of three databases, Pub-Med, Google Scholar, and Cochrane Reviews, identified 152 articles, which were subsequently categorized into four groups: athletes (24), clinical (29), elderly (12), and general population (87). The use of different populations facilitated a wider examination of the stretching components and their effects. All 152 articles incorporated information regarding duration, frequency and stretch position, whereas only 79 referred to the intensity of stretching and 22 of these 79 studies were deemed high quality. It appears that the intensity of stretching is relatively under-researched, and the importance of body position and its influence on stretch intensity, is largely unknown. In conclusion, this review has highlighted areas for future research, including stretch intensity and position and their effect on musculo-tendinous tissue, in relation to the sensation of pain, delayed onset muscle soreness, inflammation, as well as muscle health and performance.

Efeito agudo do alongamento na marcha de idosas em terreno inclinado

Introdução O envelhecimento causa modificações musculares que influenciam negativamente a capacidade funcional dos idosos na locomoção, em especial durante a transposição de superfícies inclinadas. Essas mudanças geram redução da performance, diminuindo a mobilidade e aumentando o risco de queda na execução de tal tarefa. Os exercícios de alongamento podem reduzir a influência de dessas degenerações, preservando a capacidade muscular e a mobilidade. Objetivo O objetivo deste estudo foi avaliar a atuação do efeito agudo de uma sessão de exercícios de alongamento sobre a marcha de idosas durante a locomoção em uma rampa. Materiais e métodos Doze mulheres idosas, saudáveis e independentes, caminharam subindo e descendo uma rampa com inclinação de 10%. A análise cinemática (2D) e eletromiográfica foi realizada durante uma única sessão experimental, imediatamente antes (PRÉ) e após (PÓS) a realização de um exercício de alongamento estático dos flexores do quadril. Resultados O exercício de alongamento gerou aumento da amplitude (PRÉ 52,3 ± 18,30; PÓS 63,6 ± 16,90) e velocidade (PRÉ 195,8 ± 31,20/s; PÓS 241,8 ± 29,80/s) do quadril, assim como redução do tempo de ativação do tibial anterior (PRÉ TAFIN1 29,7 ± 6,7%; TAFIN2 100,0 ± 0,0%; PÓS TAFIN1 23,3 ± 7,4%; TAFIN2 87,7 ± 3,4%) e do bíceps femoral (PRÉ 45,0 ± 5,4%; PÓS 36,1 ± 10,4%) na subida na rampa. Na descida ocorreu aumento na velocidade da marcha (PRÉ 0,95 ± 0,18 m.s-1; PÓS 1,01 ± 0,22 m.s-1) e tamanho do passo (PRÉ 1,02 ± 0,15 m; PÓS 1,08 ± 0,18 m). Conclusão Os exercícios utilizados foram capazes de alterar de forma significativa os parâmetros avaliados, permitindo uma marcha mais veloz e reduzindo a ativação muscular. Estudos longitudinais são necessários para que os resultados aqui encontrados de forma temporária possam ser confirmados de forma permanente.

Interventions to maintain mobility: What works?

Mobility, in broad terms, includes everything from the ability to move within your immediate environment (e.g., get out of bed) to the ability to drive across the country. Mobility is essential to maintaining independence and wellbeing, particularly for older adults. This is highlighted by the large number of interventions developed for older adults with the goal of maintaining such mobility. The current paper reviews the state of the science with respect to mobility interventions. Inclusion criteria for the review were: (1) articles must have been peer-reviewed; (2) interventions were evaluated in a randomized controlled trial (RCT); (3) studies included a mobility outcome such as lifespace, driving, or walking ability; (4) studies included a sample of healthy community-dwelling older adults (e.g., not investigations of disease conditions); and (5) studies must have reported enough empirical data and detail such that results could potentially be replicated. Three main types of interventions were identified: cognitive training, educational interventions, and exercise interventions. A detailed summary and evaluation of each type of intervention, and the current evidence regarding its effectiveness in maintaining mobility, are discussed. Several interventions show clear evidence of effectiveness, and thus are prime areas for translation of results to the older population. Needs and issues for future intervention research are also detailed.

Força muscular e qualidade de vida em idosas

OBJETIVO: Verificar o efeito do treinamento físico sobre os níveis de força e a qualidade de vida, considerando capacidade funcional, limitações físicas, dor, estado geral de saúde, vitalidade e variáveis de relação social em idosas institucionalizadas. MÉTODOS: Participaram do estudo 36 idosas com 60 ou mais anos de idade, recrutadas no Serviço Social do Comércio (SESC), na cidade de São Luís-MA, compondo dois grupos: sedentário (n=16) e treinamento (n=20). Determinou-se a força muscular isométrica máxima dos extensores da coluna lombar e joelho, flexores de cotovelo e abdutores dos ombros, com o uso do dinamômetro NPRO2000. Aplicou-se questionário SF-36 para avaliação da qualidade de vida. O treinamento ocorreu em sessões, duas vezes por semana, de 60 minutos, por 12 semanas. A intensidade foi estabelecida pela zona de repetições máximas (três a quatro séries; 8 a 12 repetições) e a ordem dos exercícios foi modificada a cada quatro semanas. Estatisticamente, foi utilizado o teste t Student do programa SPSS 10.0. RESULTADOS: O grupo sedentário não alcançou valor significativo nas variáveis estudadas; o grupo treinamento atingiu escores significativos de ganho de força, nos extensores do joelho (p=0,0032; 30,23%) e extensores da coluna lombar (p=0,0207; 12,33%). A avaliação da qualidade de vida apresentou-se significativa, com aumento percentual nos domínios da capacidade funcional (p=0,0092; 11,05%), estado geral de saúde (p=0,0075; 14,17%), vitalidade (p=0,0015; 15,38%) e saúde mental (p=0,0154; 9,64%). CONCLUSÃO: O treinamento de força proposto promoveu aumento significativo na força muscular, repercutindo na melhoria da qualidade de vida nos domínios capacidade funcional, estado geral de saúde, vitalidade e saúde mental.

Localised application of vibration improves passive knee extension in women with apparent reduced hamstring extensibility: a randomised trial

QUESTION

Does the localised application of vibration over the hamstrings improve hamstring extensibility?

DESIGN

Randomised controlled trial with concealed allocation, intention-to-treat analysis, and assessor blinding.

PARTICIPANTS

30 non-athletic females (aged 18-22 yrs) with limited hamstring extensibility bilaterally.

INTERVENTION

The experimental group received 3 sessions of localised application of vibration per week for 8 weeks. At each session, 3 sets of vibration were applied over the left and right hamstring muscles. The control group continued their usual daily activities. Both groups were asked to perform no specific exercises during the 8-week intervention period.

OUTCOME MEASURES

Hamstring muscle extensibility was measured bilaterally at baseline and at the end of the 8-week intervention period by measuring passive knee extension in supine with 90 deg of hip flexion.

RESULTS

At baseline, the mean lack of knee extension was 27 deg (SD 9) in the experimental group and 24 deg (SD 8) in the control group. At 8 weeks, this had changed to 13 deg (SD 5) in the experimental group and 23 deg (SD 9) in the control group. This was a significant treatment effect: mean between-group difference of 13 deg (95% CI 11 to 16).

CONCLUSION

An 8-week regimen of localised application of vibration over the hamstring muscles significantly reduces knee extension lack in women with reduced range on the passive knee extension test.

Flexibility training and functional ability in older adults: a systematic review

Background. As indicated in a recent systematic review relating to Canada's Physical Activity Guidelines for Older Adults, exercise interventions in older adults can maintain or improve functional abilities. Less is known about the role of flexibility in the maintenance or improvement of functional abilities, and there currently does not exist a synthesis of the literature supporting a consensus on flexibility training prescription. Purpose. To systematically review the effects of flexibility-specific training interventions on measures of functional outcomes in healthy older adults over the age of 65 years. Methods. Five electronic databases were searched for intervention studies involving concepts related to aging, flexibility, functional outcomes, and training interventions. After evaluating the articles for relevance, 22 studies were considered. Results. The results suggested that while flexibility-specific interventions may have effects on range of motion (ROM) outcomes, there is conflicting information regarding both the relationship between flexibility interventions and functional outcomes or daily functioning. Conclusions. Due to the wide range of intervention protocols, body parts studied, and functional measurements, conclusive recommendations regarding flexibility training for older adults or the validity of flexibility training interventions as supplements to other forms of exercise, or as significant positive influences on functional ability, require further investigation.

The Effects of a Water-Based Exercise Program on Strength and Functionality of Older Adults

Objective:

To analyze the effects of a water-based exercise program on peak torque (PT) and rate of torque development (RTD) during maximal voluntary ballistic isometric contractions of the lower limb muscles and the performance of a number of functional tests in the elderly.

Method:

Thirty-seven elderly were randomly assigned to water-based training (3 d/wk for 12 wk) or a control group. Extensor and flexor PT and RTD of the ankle, knee, and hip joints and functional tests were evaluated before and after training.

Results:

PT increased after training for the hip flexors (18%) and extensors (40%) and the plantar-flexor (42%) muscles in the water-based group. RTD increased after training for the hip-extensor (10%), knee-extensor (11%), and ankle plantar-flexor (27%) muscles in the water-based group. Functional tests also improved after training in the water-based group (p< .05).

Conclusion:

The water-based program improved PT and RTD and functional performance in the elderly.

Análise da marcha no plano inclinado e declinado de adultas e idosas com diferentes volumes de atividades semanais

A marcha é um dos mais naturais movimentos humanos, porém com o envelhecimento, sua eficiência vai se reduzindo, principalmente durante a transposição de superfícies inclinadas, onde o risco de acidentes aumenta. OBJETIVO: Avaliar as diferenças do padrão da marcha de indivíduos idosos ativos (ATI) e sedentários (SED) em relação aos indivíduos adultos (ADU) durante a locomoção em um terreno inclinado (rampa). MÉTODOS: Quarenta e cinco indivíduos (15 ADU, 15 ATI e 15 SED) caminharam, subindo e descendo uma rampa com 10% de inclinação. A análise cinemática (Vicon MX-13) e cinética (Plataforma de Força AMTI) de variáveis relacionadas com a marcha foi realizada. RESULTADOS: Foram identificadas reduções na amplitude e potência do impulso ao redor do tornozelo dos indivíduos SED e ATI em comparação aos ADU durante a subida da rampa. Na descida, as principais diferenças entre o grupo ADU e os grupos SED e ATI foram com relação à velocidade de deslocamento, provavelmente por limitações musculares de ordem elástica, principalmente ao redor do quadril. CONCLUSÃO: Aparentemente, o nível de atividades físicas não influenciou a marcha dos SED e ATI; entretanto, uma limitação do IPAQ de conseguir classificar adequadamente diferentes níveis de atividades físicas pode ter influenciado o resultado. Futuros estudos longitudinais nos quais os indivíduos são submetidos a diferentes volumes de atividades físicas diárias são necessários para que os resultados aqui encontrados possam ser confirmados.

Exercise for improving balance in older people

BACKGROUND

In older adults, diminished balance is associated with reduced physical functioning and an increased risk of falling. This is an update of a Cochrane review first published in 2007.

OBJECTIVES

To examine the effects of exercise interventions on balance in older people, aged 60 and over, living in the community or in institutional care.

SEARCH METHODS

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL (The Cochrane Library 2011, Issue 1), MEDLINE and EMBASE (to February 2011).

SELECTION CRITERIA

Randomised controlled studies testing the effects of exercise interventions on balance in older people. The primary outcomes of the review were clinical measures of balance.

DATA COLLECTION AND ANALYSIS

Pairs of review authors independently assessed risk of bias and extracted data from studies. Data were pooled where appropriate.

MAIN RESULTS

This update included 94 studies (62 new) with 9,917 participants. Most participants were women living in their own home.Most trials were judged at unclear risk of selection bias, generally reflecting inadequate reporting of the randomisation methods, but at high risk of performance bias relating to lack of participant blinding, which is largely unavoidable for these trials. Most studies only reported outcome up to the end of the exercise programme.There were eight categories of exercise programmes. These are listed below together with primary measures of balance for which there was some evidence of a statistically significant effect at the end of the exercise programme. Some trials tested more than one type of exercise. Crucially, the evidence for each outcome was generally from only a few of the trials for each exercise category. 1. Gait, balance, co-ordination and functional tasks (19 studies of which 10 provided primary outcome data): Timed Up & Go test (mean difference (MD) -0.82 s; 95% CI -1.56 to -0.08 s, 114 participants, 4 studies); walking speed (standardised mean difference (SMD) 0.43; 95% CI 0.11 to 0.75, 156 participants, 4 studies), and the Berg Balance Scale (MD 3.48 points; 95% CI 2.01 to 4.95 points, 145 participants, 4 studies).2. Strengthening exercise (including resistance or power training) (21 studies of which 11 provided primary outcome data): Timed Up & Go Test (MD -4.30 s; 95% CI -7.60 to -1.00 s, 71 participants, 3 studies); standing on one leg for as long as possible with eyes closed (MD 1.64 s; 95% CI 0.97 to 2.31 s, 120 participants, 3 studies); and walking speed (SMD 0.25; 95% CI 0.05 to 0.46, 375 participants, 8 studies).3. 3D (3 dimensional) exercise (including Tai Chi, qi gong, dance, yoga) (15 studies of which seven provided primary outcome data): Timed Up & Go Test (MD -1.30 s; 95% CI -2.40 to -0.20 s, 44 participants, 1 study); standing on one leg for as long as possible with eyes open (MD 9.60 s; 95% CI 6.64 to 12.56 s, 47 participants, 1 study), and with eyes closed (MD 2.21 s; 95% CI 0.69 to 3.73 s, 48 participants, 1 study); and the Berg Balance Scale (MD 1.06 points; 95% CI 0.37 to 1.76 points, 150 participants, 2 studies).4. General physical activity (walking) (seven studies of which five provided primary outcome data). 5. General physical activity (cycling) (one study which provided data for walking speed). 6. Computerised balance training using visual feedback (two studies, neither of which provided primary outcome data). 7. Vibration platform used as intervention (three studies of which one provided primary outcome data).8. Multiple exercise types (combinations of the above) (43 studies of which 29 provided data for one or more primary outcomes): Timed Up & Go Test (MD -1.63 s; 95% CI -2.28 to -0.98 s, 635 participants, 12 studies); standing on one leg for as long as possible with eyes open (MD 5.03 s; 95% CI 1.19 to 8.87 s, 545 participants, 9 studies), and with eyes closed ((MD 1.60 s; 95% CI -0.01 to 3.20 s, 176 participants, 2 studies); walking speed (SMD 0.04; 95% CI -0.10 to 0.17, 818 participants, 15 studies); and the Berg Balance Scale ((MD 1.84 points; 95% CI 0.71 to 2.97 points, 80 participants, 2 studies).Few adverse events were reported but most studies did not monitor or report adverse events.In general, the more effective programmes ran three times a week for three months and involved dynamic exercise in standing.

AUTHORS' CONCLUSIONS

There is weak evidence that some types of exercise (gait, balance, co-ordination and functional tasks; strengthening exercise; 3D exercise and multiple exercise types) are moderately effective, immediately post intervention, in improving clinical balance outcomes in older people. Such interventions are probably safe. There is either no or insufficient evidence to draw any conclusions for general physical activity (walking or cycling) and exercise involving computerised balance programmes or vibration plates. Further high methodological quality research using core outcome measures and adequate surveillance is required.

Physical activity status and gender differences in community-dwelling older adults with chronic diseases

BACKGROUND

Physical activity trends have a negative correlation between age and level of activity. Older adults with chronic diseases because of a preponderance of health problems often have difficulty achieving recommended physical activity levels. Lower levels of physical activity among older women have also been reported. Therefore, knowledge that could help tailor interventions to motivate groups at risk (such as older women with chronic diseases) is an important area of study.

PURPOSE

This study was designed to explore physical activity levels and gender-based differences in older adults with chronic diseases in a district in Taipei.

METHODS

This study used a cross-sectional survey design. A total of 206 community-dwelling elders were recruited and asked to complete two questionnaires during face-to-face interviews. The first questionnaire gathered data on sociodemographics and health status, and the second, a modified Community Healthy Activities Model Program for Seniors, was a physical activities questionnaire and gathered data on participants' physical activity habits.

RESULTS

Results found that 54.4% of participants achieved the recommended energy expenditure level of 1000 kcal/week during leisure-time physical activity. Female participants were found less likely to meet the recommended leisure-time physical activity guidelines than their male counterparts. Age significantly predicted caloric expenditure during leisure-time physical activity for female participants, and self-reported health status significantly predicted caloric expenditure during leisure-time physical activity for male participants.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Results demonstrated different physical activity levels in older men and women, with predictive factors of caloric expenditure during leisure-time physical activity also different between genders. Therefore, interventions promoting physical activity should take these differences into account.