Dynamical Properties of Postural Control in Obese Community-Dwelling Older Adults †

Assessing fall risk in osteoporosis patients: a comparative study of age-matched fallers and nonfallers

This study aimed to investigate sway parameters and physical activity level of the age/gender-matched older adults with osteoporosis faller and nonfaller patients. By examining these factors, our objective was to understand how these faller and nonfaller groups with osteoporosis differed particularly in terms of balance capabilities and their impact on physical activity levels. We recruited 24 patients with osteoporosis: 12 who reported a fall within a year before recruitment (fallers) and 12 without falls (nonfallers). Given the close association between biochemical markers of musculoskeletal health such as serum calcium, parathyroid hormone (PTH), Vitamin D, and renal function, we compared these markers in both groups. As a result, elderly individuals with osteoporosis and with a history of falls within the preceding year indicated significantly higher sway velocity (P = 0.012*), sway area (P < 0.001*), and sway path length (P = 0.012*). Furthermore, fallers had significantly lower calcium (P = 0.02*) and Parathyroid hormone (PTH) (P = 0.02*), as well as higher Alkaline Phosphatase (ALP) (P = 0.02*) as compared to nonfallers despite similar vitamin D and creatinine levels. In conclusion, diminished biochemical factors in the osteoporosis faller group could possibly cause postural instability resulting in lower physical activity levels in the osteoporosis fall group and increasing the risk of falls.

The usefulness of Integrative Neuromuscular Training to counteract obesity: a narrative review

BACKGROUND AND OBJECTIVE

The association between physical activity and diet has a valuable impact in weight status management to counteract obesity. In this context, within different training strategies (i.e., endurance, resistance training, concurrent training, agility training) the Integrative Neuromuscular Training (INT) represents a structured training mode focused on global human movement pattern development with the aim to enhance motor control, mobility and stability. In this narrative review we aimed to discuss the feasibility of INT interventions on physical fitness and body composition outcomes in individuals with obesity.

SUBJECTS

Medline/PubMed, EMBASE, Web of Science, Google Scholar including were searched before 1st February 2023 without restrictions on publication year.

METHODS

Two researchers extracted data from published trials. Randomized controlled trials or clinical trials, Body Mass Index of children and adolescents at the 95% percentile or greater, and for adults to be above 30 kg/m2, detailed intervention description, randomization process and allocation into an experimental or a control group, trials must have been written in English, were included.

RESULTS

We included a total of 19 studies complying with the inclusion criteria for the review process. There is evidence that INT promotes positive adaptations in fitness levels in both younger and older participants with concomitant ameliorations during a shorter, medium and longer time period. Moreover, cardiorespiratory fitness, muscular strength, balance, postural control and body composition reached significant remarkable improvements following a specific intervention based on INT principles compared to other training mode. However, Body Mass Index, fat mass percentage and waist circumference showed similar changes overtime.

CONCLUSIONS

Taken together, these findings support the effectiveness of INT in ameliorating physical fitness (i.e., health-related and skill related components) without negative changes in body composition. Nevertheless, fitness coaches and therapists may consider this training modality a feasible option when prescribing physical exercise in outpatients with obesity.

Assessment of gait and posture characteristics using a smartphone wearable system for persons with osteoporosis with and without falls

We used smartphone technology to differentiate the gait characteristics of older adults with osteoporosis with falls from those without falls. We assessed gait mannerism and obtained activities of daily living (ADLs) with wearable sensor systems (smartphones and inertial measurement units [IMUs]) to identify fall-risk characteristics. We recruited 49 persons with osteoporosis: 14 who had a fall within a year before recruitment and 35 without falls. IMU sensor signals were sampled at 50 Hz using a customized smartphone app (Lockhart Monitor) attached at the pelvic region. Longitudinal data was collected using MoveMonitor+ (DynaPort) IMU over three consecutive days. Given the close association between serum calcium, albumin, PTH, Vitamin D, and musculoskeletal health, we compared these markers in individuals with history of falls as compared to nonfallers. For the biochemical parameters fall group had significantly lower calcium (P = 0.01*) and albumin (P = 0.05*) and higher parathyroid hormone levels (P = 0.002**) than nonfall group. In addition, persons with falls had higher sway area (P = 0.031*), lower dynamic stability (P < 0.001***), gait velocity (P = 0.012*), and were less able to perform ADLs (P = 0.002**). Thus, persons with osteoporosis with a history of falls can be differentiated by using dynamic real-time measurements that can be easily captured by a smartphone app, thus avoiding traditional postural sway and gait measures that require individuals to be tested in a laboratory setting.

SV, John EB. Evaluation of surgical skill using machine learning with optimal wearable sensor locations

Evaluation of surgical skills during minimally invasive surgeries is needed when recruiting new surgeons. Although surgeons’ differentiation by skill level is highly complex, performance in specific clinical tasks such as pegboard transfer and knot tying could be determined using wearable EMG and accelerometer sensors. A wireless wearable platform has made it feasible to collect movement and muscle activation signals for quick skill evaluation during surgical tasks. However, it is challenging since the placement of multiple wireless wearable sensors may interfere with their performance in the assessment. This study utilizes machine learning techniques to identify optimal muscles and features critical for accurate skill evaluation. This study enrolled a total of twenty-six surgeons of different skill levels: novice (n = 11), intermediaries (n = 12), and experts (n = 3). Twelve wireless wearable sensors consisting of surface EMGs and accelerometers were placed bilaterally on bicep brachii, tricep brachii, anterior deltoid, flexor carpi ulnaris (FCU), extensor carpi ulnaris (ECU), and thenar eminence (TE) muscles to assess muscle activations and movement variability profiles. We found features related to movement complexity such as approximate entropy, sample entropy, and multiscale entropy played a critical role in skill level identification. We found that skill level was classified with highest accuracy by i) ECU for Random Forest Classifier (RFC), ii) deltoid for Support Vector Machines (SVM) and iii) biceps for Naïve Bayes Classifier with classification accuracies 61%, 57% and 47%. We found RFC classifier performed best with highest classification accuracy when muscles are combined i) ECU and deltoid (58%), ii) ECU and biceps (53%), and iii) ECU, biceps and deltoid (52%). Our findings suggest that quick surgical skill evaluation is possible using wearables sensors, and features from ECU, deltoid, and biceps muscles contribute an important role in surgical skill evaluation.

Predictive Validity of Motor Fitness and Flexibility Tests in Adults and Older Adults: A Systematic Review

Motor fitness and flexibility have been linked to several health issues. We aimed to investigate the predictive validity of motor fitness and flexibility tests in relation to health outcomes in adults and older adults. Web of Science and PubMed databases were screened for studies published from inception to November 2020. Two authors systematically searched, evaluated, and extracted data from identified original studies and systematic reviews/meta-analysis. Three levels of evidence were constructed: strong, moderate, and limited/inconclusive evidence. In total, 1182 studies were identified, and 70 studies and 6 systematic reviews/meta-analysis were summarized. Strong evidence indicated that (i) slower gait speed predicts falls and institutionalization/hospitalization in adults over 60 years old, cognitive decline/impairment over 55 years old, mobility disability over 50 years old, disability in instrumental activities of daily living (IADL) over 54 years old, cardiovascular disease risk over 45 years old, and all-cause mortality over 35 years old; (ii) impaired balance predicts falls and disability in IADL/mobility disability in adults over 40 years old and all-cause mortality over 53 years old; (iii) worse timed up&go test (TUG) predicts falls and fear of falling over 40 years old. Evidence supports that slower gait speed, impaired balance, and worse TUG performance are significantly associated with an increased risk of adverse health outcomes in adults.

Effects of a Randomized Home-Based Quality of Movement Protocol on Function, Posture and Strength in Outpatients with Obesity

The aim of this study was to determine the effects of two different home-based training interventions on functional parameters and body composition in obese patients. Sixty-four obese patients were recruited at the IRCCS Istituto Auxologico Italiano and randomly assigned into a movement quality group (MQ) and a conventional training group (CT). In the MQ, the training protocol combined various stimuli based on whole-body movement patterns, mobility, motor control and diaphragmatic breathing. The CT included traditional bodyweight resistance-training exercises. All patients were tested for movement efficiency (Functional Movement Screen, FMS), postural control (Modified Balance Error Scoring System, M-BESS), breathing pattern (Total Faulty Breathing Scale, TFBS), muscular strength (Handgrip Strength Test, HST and Five Repetition Sit to Stand, FRSTS) and body composition (Waist Circumference, WC, Body Mass Index, BMI, Body fat mass percentage, Fat Mass) before and after a 6-week period of training. Significant interactions and main effects of time (p < 0.0001) were found in MQ compared to CT in the FMS, M-BESS and TFBS parameters, while muscular strength (HST, FRSTS) and body composition parameters improved similarly in both groups with a main effect of time (p < 0.05). These findings suggest that a 6-week movement quality training is effective in ameliorating postural control and movement efficiency with similar improvements in muscular strength and body composition compared with a mere traditional home-based training. Fitness coaches and practitioners might consider the MQ intervention as a valuable alternative to conventional training when treating obesity.

Prediction of fall risk among community-dwelling older adults using a wearable system

Falls are among the most common cause of decreased mobility and independence in older adults and rank as one of the most severe public health problems with frequent fatal consequences. In the present study, gait characteristics from 171 community-dwelling older adults were evaluated to determine their predictive ability for future falls using a wearable system. Participants wore a wearable sensor (inertial measurement unit, IMU) affixed to the sternum and performed a 10-m walking test. Measures of gait variability, complexity, and smoothness were extracted from each participant, and prospective fall incidence was evaluated over the following 6-months. Gait parameters were refined to better represent features for a random forest classifier for the fall-risk classification utilizing three experiments. The results show that the best-trained model for faller classification used both linear and nonlinear gait parameters and achieved an overall 81.6 ± 0.7% accuracy, 86.7 ± 0.5% sensitivity, 80.3 ± 0.2% specificity in the blind test. These findings augment the wearable sensor's potential as an ambulatory fall risk identification tool in community-dwelling settings. Furthermore, they highlight the importance of gait features that rely less on event detection methods, and more on time series analysis techniques. Fall prevention is a critical component in older individuals’ healthcare, and simple models based on gait-related tasks and a wearable IMU sensor can determine the risk of future falls.

Relation of Physical Activity Level to Postural Balance in Obese and Overweight Spanish Adult Males: A Cross-Sectional Study

The aim of this study was to analyze the influence of physical activity level on postural control in obese and overweight Spanish adult males. Forty-three males aged between 25 and 60 years old were included. Anthropometric, body composition, and physical activity variables were assessed, and postural control was evaluated using the Sensory Organization Test. No correlation was found between the level of physical activity and postural control, assessed by the Sensory Organization Test within the whole sample. However, within the group with a higher total fat mass percentage, non-sedentary individuals presented improved scores on the somatosensory organization test when compared to sedentary individuals (96.9 ± 1.8 vs. 95.4 ± 1.2; p < 0.05) and poorer scores on the composite equilibrium score (73.4 ± 7.2 vs. 79.2 ± 6.9; p < 0.05). The altered integration of somatosensory inputs most likely affects the tuning, sequencing, and execution of balance strategies in sedentary men with a high total fat mass percentage.

Isokinetic Muscle Strength and Postural Sway of Recreationally Active Older Adults vs. Master Road Runners

Trunk muscle strength and control is an important prerequisite for everyday activities among elderly people decreasing the predisposition to falls. High levels of physical exercise performed by older athletes could offer benefits to core/trunk muscle strength and postural control compared with recreational physical activities and among elderly people with lower levels of physical activity. The present study aimed to compare trunk muscle strength and postural control of older running athletes vs. older physically active adults. Participants were master road runners (RUN, n = 15, six women, 64.3 ± 3.6 years) and physically active elderly (control group, CON, n = 15, six women, 65.4 ± 5.0 years) people that were submitted to the evaluations: esthesiometer, posturography (force plate), and isokinetic test (Biodex dynamometer) of trunk muscle extension and flexion. RUN presented higher values for relative peak torque of trunk extensor muscles at 60°/s (p = 0.046) and 180°/s (p = 0.007) and relative average power during trunk extension at 60°/s (p = 0.008) and 180°/s (p = 0.004) compared to CON. CON had a higher medial-lateral oscillation speed of the center of pressure in the stable condition with eyes closed (p = 0.004) compared to RUN. RUN presented higher isokinetic torque of extensor trunk muscles and better postural control than CON. This supposedly could help with postural control and balance and contribute to the prevention of falls among the elderly. The practice of running systematically by master athletes may partially explained our findings.

Effects of adiposity on postural control and cognition in older adults

BACKGROUND

Understanding the impacts of increased adiposity on postural control and cognitive deficits in adults is critical for health practitioners in recommending or prescribing effective weight loss regimens. Despite prior work in this area, the knowledge of increased adiposity impacts on postural control and cognitive deficits in older adults (OAs) is still limited.

RESEARCH QUESTION

The purposes of the current study were: (a) to assess the relationship between postural measures and adiposity measures by using regression model analyses and, (b) to examine the impacts of increased adiposity and age on cognitive performance.

METHODS

A total of thirty (30) individuals aged 60+ years participated in the study. Participants were classified into three groups based upon their BMI scores at the onset of the study. The normal weight (NW) (BMI: 18.5-24.9 kg/m²), the overweight (OW) (BMI: 25-29.9 kg/m²), and the obese (OB) groups (BMI: 30-40 kg/m²) each had five females and five males. Participants were required to perform two test sessions: (1) anthropometry assessment and body composition scanning; and (2) evaluation of plantar tactile function, postural control, and cognitive function.

RESULTS

Overall, our findings indicate that increased adiposity in OAs is associated with declines in both cognitive function and postural control.

SIGNIFICANCE

Our data also indicate that measures such as BMI and abdominal fat mass amounts/ratios offer the best insight to the impact of adiposity on cognitive function and postural control measures. However, further work is still needed to clarify the mechanistic links between adiposity and cognitive-postural deficits.

Static balance assessment in patients with severe osteoarthritis of the knee

BACKGROUND

Pain related to severe knee osteoarthritis may lead to static balance disorders. Patients with severe knee arthrosis with arthroplasty indication should be aware of the postoperative rehabilitation menu because their balance ability has decreased.

METHODS

The study involved 33 patients with unilateral severe osteoarthritis (the study group) and 33 healthy subjects (the control group). We conducted the measurements of static balance with the CQStab2P platform. Functional disability was assessed using the Knee Society Score (KSS).

RESULTS

In the study group, balance distribution asymmetry between lower limbs was higher. Patients unloaded the painful joints due to pain and knee instability. We observed statistically significant differences both with eyes open and with eyes closed only for balance symmetry. The study group had mean results of 53.9 (±19.1 SD) points in the KSS scales and 52.1 (±24.1) in the KSS function. There were statistically significant positive correlations regarding KSS and body height (0.270; P < 0.05), and negative correlations for body mass index (0.329; P < 0.01). In measurements with open eyes, patients' KSS correlated with mean amplitude of sways (-0,227; P < 0.01) and max anteroposterior (-0.279; P < 0.01). In measurements with eyes closed, KSS function correlated with number of sways in the sagittal plane (0.331; P < 0.01).

CONCLUSIONS

Patients with severe osteoarthritis suffered from balance disorders regarding limbs' asymmetrical loading both under visual control and without visual control.

Diagnostic Balance Tests for Assessing Risk of Falls and Distinguishing Older Adult Fallers and Non-Fallers: A Systematic Review with Meta-Analysis

Falls are a major cause of injury and morbidity in older adults. To reduce the incidence of falls, a systematic assessment of the risk of falling is of paramount importance. The purpose of this systematic review was to provide a comprehensive comparison of the diagnostic balance tests used to predict falls and for distinguishing older adults with and without a history of falls. We conducted a systematic review of the studies in which instrumented (force plate body sway assessment) or other non-instrumented balance tests were used. We analyzed the data from 19 prospective and 48 retrospective/case-control studies. Among the non-instrumented tests, the single-leg stance test appears to be the most promising for discrimination between fallers and non-fallers. In terms of body sway measures, the center-of-pressure area was most consistently associated with falls. No evidence was found for increased benefit of the body sway test when cognitive tasks were added, or the vision was eliminated. While our analyses are limited due to the unbalanced representation of different test and outcome measures across studies, we can recommend the single-leg test for the assessment of the risk of falling, and the measurements of body sway for a more comprehensive assessment.

Obesity is associated with postural balance on unstable surfaces but not with fear of falling in older adults

BACKGROUND

There are inconsistent findings regarding the relationship between body mass index (BMI), fear of falling and body balance, especially on unstable surfaces.

OBJECTIVES

To investigate whether obesity is associated with worse postural balance and fear of falling in older adults.

METHODS

A cross-sectional study was conducted with 201 older adults, classified as normal weight, overweight, or obese according to BMI. Postural balance was evaluated on stable and unstable surfaces on the Biodex Balance System platform under three visual conditions: with and without visual feedback and with eyes closed. Fear of falling was identified by a dichotomous question and the Falls Efficacy Scale. These data were compared between groups and included in adjusted multiple linear regression analysis.

RESULTS

The study showed no significant differences (p > 0.05) in body oscillations on a stable surface between the three groups. On an unstable surface, the obese older adults exhibited body oscillations from 0.61° [95% CI 0.07, 1.30] to 1.63° [95% CI 0.84, 2.41] greater than those with normal weight in the three visual conditions. The obese older adults also displayed larger mediolateral oscillations with visual feedback (mean difference: 0.50° [95% CI 0.01, 0.98]) as well as greater global oscillations without visual feedback (mean difference of 0.82° [95% CI 0.18, 1.81]) and with progressive instability (mean difference: 0.80° [95% CI 0.05, 1.66]) than the overweight older adults. BMI explained from 6 to 12% of body swings investigated on unstable surface. Obesity was not associated with fear of falling.

CONCLUSION

Obesity was associated with reduced postural stability on unstable surfaces but not with fear of falling in older adults.

Mini-Logger- A Wearable Inertial Measurement Unit (IMU) for Postural Sway Analysis

Postural instability assessment is an important tool in fall risk analysis and for timely intervention of falls to reduce or prevent fall injuries. Traditionally fall risk is measured though postural sway assessment and is collected through forceplates by mapping Center of Pressure (COP) excursions or using motion analysis camera system for marker sway trajectories. However, both of these systems are expensive and lack portability to their usage in clinical environments. In this study, we developed a novel wearable low-cost MEMS inertial sensor and validated its usage for human postural sway assessment in standing posture with eyes open/closed, vibration/no vibration, and proprioception /low proprioception conditions. The two objectives of this study were: 1) To develop and validate an Inertial Measurement Unit (IMU) for sway analysis 2) To determine the feasibility of the system in detecting human postural imbalances such as reduced proprioception or presence of stochastic resonance induced through subthreshold vibrations on the feet. The novel IMU was tested for sway against infra-red marker on a specialized platform with 4-degrees of freedom. Many parameters of postural sway such as sway velocity, Root Mean Square (RMS), and sway path length could successfully detect subtle postural changes due to varying proprioceptive and sub-threshold vibration conditions. We found agreement in sway signal determinism from the two methods.Clinical Relevance- This wearable sensor technology has potential to determine balance in reliable, easy and accurate way in clinical environments.

Relationship Between Obesity and Balance in the Community-Dwelling Elderly Population: A Cross-Sectional Analysis

INTRODUCTION

Although there are similar characteristics between obese individuals and fall-susceptible population, little is known about relationships between body weight and risk factors for fall, particularly in the elderly population. The aim of this study was to determine whether body mass index-based obesity is associated with decreased balance and whether instability has relationships with the main risk factors for falls.

METHODS

A total of 317 participants were categorized based on their body mass index. Clinical balance assessments were performed using the Berg Balance Scale, Timed Up and Go test, and Short Physical Performance Battery. The knee extensor strength of each individual was measured using a dynamometer. Total sway distance was calculated on InBody posturography in four conditions.

RESULTS

The results of three clinical balance assessment tools showed significant correlation with body mass index. The obese group showed decreased isokinetic knee extensor muscle strength and had a higher total sway distance than the normal weight group.

CONCLUSIONS

The elderly population with obesity exhibits poor balance performing ability, and it is associated with the decreased strength of the lower limbs and impaired postural stability. The logistic regression analysis of our study showed that body mass index-based obesity can be regarded as a fall risk.

Influence of Obesity and Impact of a Physical Activity Program on Postural Control and Functional and Physical Capacities in Institutionalized Older Adults: A Pilot Study

Objective: To evaluate the role of obesity in the effects of physical activity (PA) on postural control and functional and physical capacities in the older adults and to assess the effectiveness of a PA program on these capacities. Methods: Six obese (age = 78.8 [3.7] y; body mass index > 30 kg/m2), 7 overweight (age = 80.9 [2.8] y; 25 < body mass index < 30 kg/m2), and 6 normal weight (age = 80.8 [5.7] y; body mass index < 25 kg/m2) older adults performed the time up and go test, the 6-minute walk test, and the Tinetti test. Static and dynamic (forward leaning) postural control tests were also assessed. All these tests were similarly assessed 4 months later, during which only the obese group and overweight group participated in a PA program. Results: Before PA, results of the time up and go test, 6-minute walk test, Tinetti test, quiet standing, and forward lean tests revealed that physical capacities and static and dynamic postural control were impaired in the obese group when compared to the normal weight group. After PA, results of quiet standing, physical and functional tests were improved for obese group. Conclusions: Obesity is an additional constraint to age-related postural control and functional and physical capacities deteriorations. Nevertheless, a PA program is effective in improving balance and functional capacities in obese older adults.

Deleterious Effects of Higher Body Mass Index on Subjective and Objective Measures of Chemotherapy-Induced Peripheral Neuropathy in Cancer Survivors

CONTEXT

Recent, albeit, limited evidence suggests that body mass index (BMI) may be a modifiable risk factor to reduce the deleterious effects of chemotherapy-induced peripheral neuropathy (CIPN) in cancer survivors.

OBJECTIVES

To evaluate for differences in demographic, clinical, pain, sensation, and balance characteristics among three BMI groups. We hypothesized that as BMI increased, survivors would report higher pain intensity scores and have significant decrements in measures of sensation and balance.

METHODS

A total of 416 survivors with CIPN were evaluated using subjective and objective measures of CIPN. Survivors were divided into three BMI groups (i.e., normal weight, overweight, and obese). Differences among the BMI groups were evaluated using parametric and nonparametric statistics.

RESULTS

Of the 416 survivors, 45.4% were normal weight, 32.5% were overweight, and 22.1% were obese. Compared with the normal-weight group, survivors in the other two groups had lower functional status scores, a higher comorbidity burden, higher pain intensity scores, and higher interference scores. In addition, compared with the normal-weight group, survivors in the other two BMI groups had significantly worse balance scores.

CONCLUSION

Our findings support the hypothesis that as BMI increased, pain sensation and balance characteristics worsened. Our findings suggest that nutritional counseling as well as exercise and weight management programs in survivors with CIPN may improve these clinically important problems.

Walking and postural balance in adults with severe short stature due to isolated GH deficiency

OBJECTIVES

Walking and postural balance are extremely important to obtain food and to work. Both are critical for quality of life and ability to survive. While walking reflects musculoskeletal and cardiopulmonary systems, postural balance depends on body size, muscle tone, visual, vestibular and nervous systems. Since GH and IGF-I act on all these systems, we decided to study those parameters in a cohort of individuals with severe short stature due to untreated isolated GH deficiency (IGHD) caused by a mutation in the GHRH receptor gene. These IGHD subjects, despite reduction in muscle mass, are very active and have normal longevity.

METHODS

In a cross-sectional study, we assessed walking (by a 6-min walk test), postural balance (by force platform) and fall risk (by the 'Timed Up and Go' test) in 31 IGHD and 40 matched health controls.

RESULTS

The percentage of the walked distance measured in relation to the predicted one was similar in groups, but higher in IGHD, when corrected by the leg length. Absolute postural balance data showed similar velocity of unipodal support in the two groups, and better values, with open and closed eyes and unipodal support, in IGHD, but these differences became non-significant when corrected for height and lower-limb length. The time in 'Timed Up and Go' test was higher in IGHD cohort, but still below the cut-off value for fall risk.

CONCLUSION

IGHD subjects exhibit satisfactory walking and postural balance, without increase in fall risk.