The effects of toe grip training on physical performance and cognitive function of nursing home residents

A 3 month nutrition and exercise program improved hallux strength among senior daycare center users in Korea: a cluster randomized controlled trial

Introduction

With a growing aging population, the focus on the health and well-being of older adults, especially in preventing falls, becomes crucial. This 3 month study, initiated in July 2022, aimed to assess the impact of a nutrition and exercise program in senior daycare centers in Chuncheon, South Korea.

Methods

A 3 month study, beginning in July 2022, included 204 older adults from 10 senior daycare centers in Chuncheon, South Korea. Randomly assigned to intervention or control groups, the intervention involved nutrition, daily toe exercises, or both. Control centers received interventions post-measurements. Pre- and post-intervention analyses used paired t-tests and multiple linear regression, assessing metrics like toe grip strength for significance. While 204 were initially enrolled, the analysis included 151 participants due to dropouts.

Results

Participants, with a mean age of 83.3 years (43.1% aged ≥ 85 years), exhibited mild to moderate cognitive impairment and multiple chronic illnesses. Health data indicated that 37.3% were obese, and the average BMI was 24.0 kg/m2. Both the intervention and control groups showed significant improvements in toe grip strength post-intervention. Specifically, the exercise-only and combined exercise-nutrition groups demonstrated significant differences in hallux strength compared to the control group after adjusting for age and gender.

Conclusion

The study showed that a basic nutrition and exercise program increased toe strength in older adults with chronic diseases, including mild cognitive impairments. This intervention holds potential to prevent muscle strength decline and reduce fall risks in older individuals. As the first of its kind in Korean senior daycare centers, it emphasizes the need for future research and standardized programs for senior daycare users.

Development of a frailty prevention program including nutrition and exercise interventions for older adults in senior daycare centers in South Korea using a mixed methods research design

BACKGROUND/OBJECTIVES

The growing aging population has led to an increased utilization of senior daycare centers. This study was conducted to design a program to enhance the health of older adults in senior daycare centers in Chuncheon City, South Korea.

SUBJECTS/METHODS

The study explored the health conditions and dietary patterns of older adults in senior daycare centers. Participants included staff and older adults from senior daycare centers in Chuncheon City. A mixed methods research design was used to obtain both qualitative and quantitative data. Qualitative insights were obtained through in-depth interviews with 26 staff members and older adults, coupled with observations made at 10 senior daycare centers. The quantitative component comprised structured questionnaires and physical measurements of 204 older adults at these centers.

RESULTS

Many of the older adults relied on the meals provided by the center due to their limited cooking abilities. Dental health issues and dysphagia were common. Interviews highlighted the budgetary constraints of the centers in providing wholesome meals and the need for government support to alleviate meal expenses and enhance quality. A structured survey of older adults showed that the average age was 83.3 yrs, with an average of 2 chronic conditions per participant. Frailty analysis of the participants revealed that 56.2% were prefrail and 32.0% were frail. Almost half of the participants (47.0%) used dentures. Based on these findings, a preventive intervention program was proposed, addressing the specific needs and challenges of older adults while promoting overall well-being and preventing frailty.

CONCLUSION

Tailored health promotion strategies are crucial in senior daycare centers. Recommended interventions include staff nutrition education, improved dietary plans, and cost-effective strength training programs. These interventions aim to reduce frailty and enhance the quality of life of older adults in the community via interventions in daycare centers.

Foot Problems and Their Associations with Toe Grip Strength and Walking Speed in Community-Dwelling Older Individuals Using Day Services: A Cross-Sectional Study

Foot disorders in older individuals compromise balance and contribute to postural and gait instabilities, causing a decrease in the activities of daily living and quality of life. In this cross-sectional study, we analyzed the foot-related data of 160 frail older participants who attended day service centers in A prefecture in Japan to determine the prevalence of foot problems and their associations with toe grip strength and walking speed in frail older people. Multiple regression analysis was used to identify foot-related variables that correlated with toe grip strength and walking speed. The prevalence rates of skin dryness (Support level 88.2%, Care level 85.2% for men; Support level 84.9%, Care level 93% for women) and suspected and existing fungal infections in nails (Support level 94.1%, Care level 92.6% for men; Support level 98.1%, Care level 95.2% for women) were high in both sexes regardless of the level of care required. Furthermore, in both sexes, the prevalence rates of toe and arch deformities were significantly increased in the people who required care. Regression analysis revealed that some right-sided foot-related problems were significantly associated with right toe grip strength and walking speed. The decrease in toe grip strength was significantly associated with walking speed. Our study provides evidence that some specific conditions were associated with toe grip force and walking speed. This finding can contribute to future strategies to protect foot health in community-dwelling older individuals.

Relationship between fall history and toe grip strength in older adults with knee osteoarthritis in Japan: A cross-sectional study

BACKGROUND

Knee osteoarthritis (KOA), one of the most common musculoskeletal diseases in older adults, is associated with a high incidence of falls. Similarly, toe grip strength (TGS) is associated with a history of falls in older adults; however, the relationship between TGS and falls in older adults with KOA who are at risk of falling is not known. Therefore, this study aimed to determine if TGS is associated with a history of falls in older adults with KOA.

METHODS

The study participants, older adults with KOA scheduled to undergo unilateral total knee arthroplasty (TKA), were divided into two groups: non-fall (n = 256) and fall groups (n = 74). Descriptive data, fall-related assessments, modified Fall Efficacy Scale (mFES), radiographic data, pain, and physical function including TGS were evaluated. The assessment was conducted on the day before performing TKA. Mann-Whitney and chi-squared tests were performed to compare the two groups. Multiple logistic regression analysis was performed to determine the association of each outcome with the presence or absence of falls.

RESULTS

Mann-Whitney U test revealed that the fall group had statistically significantly lower height, TGS on the affected and unaffected sides, and mFES. Multiple logistic regression analysis revealed that the incidence of fall history is associated with TGS on the affected side; the weaker the affected TGS of the KOA, the more likely the individual is to fall.

CONCLUSIONS

Our results indicate that TGS on the affected side is related to a history of falls in older adults with KOA. The significance of evaluating TGS among patients with KOA in routine clinical practice was demonstrated.

Rehabilitation in the long-term care insurance domain: a scoping review

PURPOSE

Since the enactment of the long-term care insurance (LTCI) act in 2000, the number of LTCI users has increased annually. However, evidence regarding what is being carried out as rehabilitation treatment under LTCI is lacking. In this study, a scoping review was performed to bridge this knowledge gap.

METHODS

Articles related to rehabilitation in connection with LTCI published between April 2000 and November 2020 were searched for in PubMed, CINAHL, CENTRAL (Cochrane Central Register of Controlled Trials), Ichushi Web Ver.5, and CiNii and randomized controlled trials (RCTs) of rehabilitation provided under LTCI were examined.

RESULTS

Of the 15,572 publications identified, 15 RCTs, including rehabilitation treatment by physiatrists and therapists, met the eligibility criteria of our review and were included. The rehabilitation trials in the 15 RCTs varied and included balance training, exercise therapy, cognitive tasks, and activities such as singing and dancing. The results allowed us to focus on three categories: fall prevention, dementia, and theory and tools interventions related to occupational therapy practice.

CONCLUSION

The focal points of attention in the rehabilitation treatment of LTCI were identified. However, the physical function, quality of life, and activities of daily living (ADL) of those who "need support" vary from person to person. Therefore, the consolidation of evidence on rehabilitation treatment of LTCI must be continued.

Effects of Insole with Toe-Grip Bar on Barefoot Balance and Walking Function in Patients with Parkinson's Disease: A Randomized Controlled Trial

The maintenance and improvement of balance and walking function in patients with Parkinson’s disease (PD) is essential. Toe dysfunction in patients with PD is related to balance and walking. Recently, insoles have been developed to improve toe function, but their effects on the physical functions of patients with PD remain unclear. In this randomized controlled study, we investigated the effects of insoles with a toe-grip bar on balance and walking function in such patients. Twenty-nine patients with PD in Hoehn and Yahr stages II−IV were randomly assigned to an intervention or control group. Patients in the intervention and control groups wore shoes having insoles with and without a toe-grip bar for 4 weeks, respectively. The center of gravity sway of standing posture (total trajectory length, envelope area, and maximum anterior−posterior center of pressure [AP-COP] distance) and walking parameters at normal and fast speeds were measured pre- and post-intervention in the rehabilitation room. All measurements were performed with the participants being barefoot. The maximum AP-COP distance and step length of the fast-walking condition were significantly improved in the intervention compared to the control group (p < 0.05). Thus, insoles with a toe-grip bar may improve balance and walking function in patients with PD.

Physical and Motor Fitness Tests for Older Adults Living in Nursing Homes: A Systematic Review

This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives.

The effect of interventions anticipated to improve plantar intrinsic foot muscle strength on fall-related dynamic function in adults: a systematic review

Background

The plantar intrinsic foot muscles (PIFMs) have a role in dynamic functions, such as balance and propulsion, which are vital to walking. These muscles atrophy in older adults and therefore this population, which is at high risk to falling, may benefit from strengthening these muscles in order to improve or retain their gait performance. Therefore, the aim was to provide insight in the evidence for the effect of interventions anticipated to improve PIFM strength on dynamic balance control and foot function during gait in adults.

Methods

A systematic literature search was performed in five electronic databases. The eligibility of peer-reviewed papers, published between January 1, 2010 and July 8, 2020, reporting controlled trials and pre-post interventional studies was assessed by two reviewers independently. Results from moderate- and high-quality studies were extracted for data synthesis by summarizing the standardized mean differences (SMD). The GRADE approach was used to assess the certainty of evidence.

Results

Screening of 9199 records resulted in the inclusion of 11 articles of which five were included for data synthesis. Included studies were mainly performed in younger populations. Low-certainty evidence revealed the beneficial effect of PIFM strengthening exercises on vertical ground reaction force (SMD: − 0.31-0.37). Very low-certainty evidence showed that PIFM strength training improved the performance on dynamic balance testing (SMD: 0.41–1.43). There was no evidence for the effect of PIFM strengthening exercises on medial longitudinal foot arch kinematics.

Conclusions

This review revealed at best low-certainty evidence that PIFM strengthening exercises improve foot function during gait and very low-certainty evidence for its favorable effect on dynamic balance control. There is a need for high-quality studies that aim to investigate the effect of functional PIFM strengthening exercises in large samples of older adults. The outcome measures should be related to both fall risk and the role of the PIFMs such as propulsive forces and balance during locomotion in addition to PIFM strength measures.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13047-021-00509-0.

The effect of group-based Otago exercise program on fear of falling and physical function among older adults living in nursing homes: A pilot trial

This pilot trial explored the feasibility of group-based Otago exercise program (OEP) and its impact on fear of falling (FOF) and physical function among Chinese older adults living in nursing homes. The intervention group received group-based OEP for 12 weeks, while the control group received routine care. The modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE), timed Up and Go test (TUG), four-stage Balance test (FSBT), and 30 seconds sit-to-stand test (30s-SST) were used. After twelve weeks, we found that the intervention group had better outcomes than the control group in mSAFFE, TUG, FSBT and 30s-SST (p<0.05). Also, we compared the pretest-posttest results within the two groups, respectively. We found that, within the intervention group, the outcomes of mSAFFE, TUG, FSBT, and 30s-SST become significantly better after twelve weeks, but within the control group, the outcomes of TUG, FSBT, and 30s-SST become significantly worse. Our findings demonstrated that a group-based OEP was feasible and acceptability among Chinese older adults living in nursing homes and the group-based OEP could improve FOF and physical function among those older adults.

The correlation between toe flexor strength and performance-based measures of physical fitness in the elderly

[Purpose] To examine the correlation between toe flexor strength (TFS) and physical fitness performance measurements and their gender differences in the elderly. [Participants and Methods] Japanese males (n=50) and females (n=121), aged 65–88 years, participated in this study. We measured TFS, handgrip strength (HGS), knee extensor strength (KES), sit-and-reach distance (SR), and functional reach (FR). [Results] The female participants had significantly lower TFS, KES, and HGS than the male participants; however, the female participants had a significantly higher SR than that the male participants. FR was not significantly different between males and females. In males, TFS was significantly correlated with HGS, KES, SR, and FR. In females, TFS had correlations with HGS, KES, and FR; however, no correlation with SR was found. We could observe these correlations even after adjustment for age and body weight. [Conclusion] Elderly male had higher TFS than elderly females. In addition, TFS was correlated with all the physical fitness measurements in the male participants and all the measurements except for SR in the female participants. Gender and aging may explain the inconsistent results between SR and other physical fitness performance measurements.

Acute Response of Toe-Spread-Out Exercise on Medial Longitudinal Arch Height and Balance

OBJECTIVES This study was to determine the acute response of the toe-spread-out exercise(TSE) on the medial longitudinal arch height(MLAH) and the static and dynamic balance.METHODS Twenty-four healthy young males and females were randomly assigned to the exercise group(n=12) or to the control group(n=12). The exercise group performed 40 repetitions of TSE while the control group had a rest on the chair. Before and after the exercise or rest, MLAH was measured while standing. One-leg standing test was conducted on the force plate with eyes closed and open. The total distance of the center of pressure (COP) was calculated to assess the static balance. Y-balance test was performed; and the anterior, and medial/lateral posterior reach distances were measured to assess the dynamic balance.RESULTS There was an interaction between group and time for the MLAH (p<.001), and the MLAH in the exercise group increased after the exercise (2.03±1.01 mm; t=-6.930, p<.001). There was an interaction between group and time for the anterior reach distance during the Y-balance test (p=.023), and the distance in the exercise group showed a strong tendency to increase after the exercise (t=-2.104, p=.059). No interaction was found for the total distance of the COP.CONCLUSIONS The 40 repetitions of TSE increased MLAH and showed a positive effect on dynamic balance in healthy young males and females. These results suggest that TSE can be useful as a new exercise method to improve the foot arch structure and function. Further research with the longer duration of TSE training for various populations is warranted.

Effects of Long-Term Use of Insoles with a Toe-Grip Bar on the Balance, Walking, and Running of Preschool Children: A Randomized Controlled Trial

This randomized controlled study is aimed at investigating the effects of long-term use of insoles with a toe-grip bar on the balance, walking, and running of preschool children. Fifty-two preschool children were randomly assigned to an intervention group or control group. Children included in the intervention group wore shoes with insoles that had a toe-grip bar, and those in the control group wore shoes with regular insoles without a toe-grip bar for 4 weeks while they were at school. The center of gravity sway (total trajectory length and envelope area), walking parameters (walking speed, cadence, stride length, step length, stance time, and swing time), and time to run 25 m were measured before and after the intervention. The 25 m running time of the intervention group was significantly improved after the intervention (F = 5.66; p < 0.05). This study suggests that insoles with a toe-grip bar may contribute to improvements in the running of preschool children.