Buichi Tanaka

Fear of falling is associated with prolonged anticipatory postural adjustment during gait initiation under dual-task conditions in older adults

Little is known about dynamic balance control under dual-task conditions in older adults with fear of falling (FoF). The purpose of this study was to examine the effect of FoF on anticipatory postural adjustment (APA) during gait initiation under dual-task conditions in older adults. Fifty-seven elderly volunteers (age, 79.2 [6.8] years) from the community participated in this study. Each participant was categorised into either the Fear (n=24) or No-fear (n=33) group on the basis of the presence or absence of FoF. Under single- and dual-task conditions, centre of pressure (COP) data were collected while the participants performed gait initiation trials from a starting position on a force platform. We also performed a 10-m walking test (WT), a timed up & go test (TUG), and a functional reach test (FR). The reaction and APA phases were measured from the COP data. The results showed that under the dual-task condition, the Fear group had significantly longer APA phases than the No-fear group, although no significant differences were observed between the 2 groups in the reaction and APA phases under the single-task condition and in any clinical measurements (WT, TUG, and FR). Our findings suggest that specific deficits in balance control occur in subjects with FoF during gait initiation while dual tasking, even if their physical functions are comparable to subjects without FoF.

DUAL-TASK WALK IS A RELIABLE PREDICTOR OF FALLS IN ROBUST ELDERLY ADULTS

National Institute on Aging (NIA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIA or the National Institutes of Health. Dr. Markland received support through a Veterans Health Administration Career Development Award. Author Contributions: Alayne D. Markland: study concept and design, data analysis, interpretation of data, and manuscript preparation. Patricia S. Goode, Kathryn L. Burgio, and Holly E. Richter: study concept and design, interpretation of data, and critical review of the manuscript. David T. Redden: study concept and design, data analysis, interpretation of data, and critical review of the manuscript. Patricia S. Baker and Richard M. Allman: study concept and design, acquisition of subjects and data, interpretation of data, and critical review of the manuscript. Sponsor’s Role: The sponsors had no active role in the design, methods, subject recruitment, data collection, analysis, or manuscript preparation.

Effects of Balance Training on Muscle Coactivation During Postural Control in Older Adults: A Randomized Controlled Trial

BACKGROUND Recently, several studies have reported age-associated increases in muscle coactivation during postural control. A rigid posture induced by strong muscle coactivation reduces the degree of freedom to be organized by the postural control system. The purpose of this study was to clarify the effect of balance training on muscle coactivation during postural control in older adults. METHODS Forty-eight subjects were randomized into an intervention (mean age: 81.0 ± 6.9 years) and a control group (mean age: 81.6 ± 6.4 years). The control group did not receive any intervention. Postural control ability (postural sway during quiet standing, functional reach, and functional stability boundary) was assessed before and after the intervention. A cocontraction index was measured during the postural control tasks to assess muscle coactivation. RESULTS Cocontraction index values in the intervention group significantly decreased following the intervention phase for functional reach (p < .0125). Cocontraction index values had a tendency to decrease during functional stability boundary for forward and quiet standing tasks. Functional improvements were observed in some of the tasks after the intervention, that is, functional reach, functional stability boundary for forward, one-leg stance, and timed up and go (p < .05). CONCLUSIONS Our study raised the possibility that balance training for older adults was associated with decreases in muscle coactivation during postural control. Postural control exercise could potentially lead older adults to develop more efficient postural control strategies without increasing muscle coactivation. Further research is needed to clarify in greater detail the effects of changes in muscle coactivation.

Trail-Walking Exercise and Fall Risk Factors in Community-Dwelling Older Adults: Preliminary Results of a Randomized Controlled Trial

OBJECTIVES: To evaluate the effects of a trail‐walking exercise (TWE) program on the rate of falls in community‐dwelling older adults.

Effects of fear of falling on muscular coactivation during walking

Background and aims: Increased fear of falling is associated with greater muscular coactivation during standing postural control. Excessive muscular coactivation reduces the performance of agonist muscles. Although several recent studies have observed increased muscular coactivation during walking in older adults, little is known about the relationship between fear of falling and muscular coactivation during walking. The purpose of this study was to compare muscular coactivation during walking between older adults with fear of falling and older adults without fear of falling. Methods: Thirty-eight healthy older adults (82.3±6.8 years) participated in this study. Walking speed and step length were measured. Electromyography (EMG) data were collected from the tibialis anterior and soleus during walking to calculate the co-contraction index (CI). Subjects were divided into those with fear of falling and those without fear of falling, on the basis of a modified Falls Efficacy Scale (FES). Stepwise multiple regression analysis was used, with CI as the dependent variable, and fear of falling, experience of falling (during the past year), walking speed, step length, and age as independent variables. Results: Mean values of CI during walking, walking speed, and step length were 51.9±11.7%, 0.90±0.40 m/s, and 0.43±0.11 m, respectively. Eight subjects (21.1%) had fallen within the past year, and 19 subjects (50.0%) had fear of falling. All subjects without fear of falling had FES scores of 10 (maximum score). Subjects with fear of falling had a median FES score of 17 (interquartile range, 13 to 25). Stepwise multiple regression analysis revealed that fear of falling remained significantly associated with CI (ps<0.01): CIs for subjects with fear and those without fear were 59.5±12.2% and 46.7±8.5%, respectively. Conclusion: Individuals with a fear of falling have increased muscular co-activation at the ankle joint during walking, at least in a certain subgroup of older adults. Further research is needed to clarify negative and positive effects of muscular coactivation during walking in fearful subjects.

Rhythmic stepping exercise under cognitive conditions improves fall risk factors in community-dwelling older adults: Preliminary results of a cluster-randomized controlled trial

Objective: The purpose of this pilot trial was to evaluate whether a 24-week program of rhythmic stepping exercise (RSE) would be effective in improving physical function and reducing fear of falling in older adults. Participants: Four units (n = 52) randomized into an RSE group (two units, n = 25) and a non-rhythmic stepping exercise (NRSE) group (two units, n = 27) participated in a pilot cluster randomized controlled trial. Methods: Each exercise group received 60 min group training sessions once a week for 24 weeks. Measurement was based on the difference in physical functions between the RSE and NRSE groups. Results: Significant differences were observed between the two groups for locomotive function with significant group × time interaction. Relative risk was calculated as 2.778 (95% CI: 1.030–7.492) for fear of falling for participants in the NRSE group compared with patients in the RSE group (p = 0.037). Conclusions: The results of this pilot trial suggest that the RSE program is more effective in improving locomotive function and fear of falling.

Effects of a DVD-Based Seated Dual-Task Stepping Exercise on the Fall Risk Factors Among Community-Dwelling Elderly Adults

OBJECTIVE The purpose of this randomized control trial study was to evaluate the effectiveness of a digital video disc (DVD)-based seated dual-task (DT) stepping exercise to improve the DT walking capability in elderly people. In the DT exercise, participants were asked to perform a verbal fluency task while stepping as quickly as possible. METHODS Eight clusters (n=93) randomized into a DVD group (4 clusters, n=48) and a nonexercise control group (4 clusters, n=45) participated in this trial. In the DVD group, participants received 20 min of group training twice a week for 24 weeks. The exercise class used an exercise DVD that included a 15-min basic exercise and a 5-min DT exercise. No exercise program was prescribed for the control group. The measurements were based on the difference in physical function, including DT walking, between the DVD and control groups. In the DT walking test, participants walked individually at a comfortable speed while carrying a ball on a tray. The relative DT lag was calculated by using simple walking as the comparison condition. The Timed Up and Go test and the 5-chair stand test were also performed. RESULTS The median relative adherence to the study was 87.5% (25th-75th percentile, 83.3%-95.8%) in the DVD group. The outcome measurements, including the DT walking time and DT time lag (p<0.05), among participants in the DVD group were significantly improved. However, other outcome measurements were not significantly different between the two groups (p>0.05). CONCLUSION The current study reports the effectiveness of a DVD-based exercise for the improvement of the DT walking capability. A larger study is needed to confirm the present results. Study of a Web-based exercise regime would be valuable to identify the most effective exercise for prevention of falls and fall-related fractures.

Seated stepping exercise in a dual-task condition improves ambulatory function with a secondary task: a randomized controlled trial

Background and aims: A close relationship exists between dual-task (DT)-related gait changes and the risk of falling in the elderly. However, the impact of DT training on the incidence of falls in the elderly remains unclear. We aimed to evaluate the effects of a seated stepping exercise in DT conditions to improve walking ability in community-dwelling elderly. Methods: This was a randomized controlled trial (RCT) in community-dwelling elderly in Japan. Fifty-three participants were randomly assigned to a DT group (stepping exercise in DT conditions, n=26) and a single-task (ST) group (stepping exercise in ST conditions, n=27). All participants received 50 min group training sessions, once a week for 24 weeks. Outcome measures were based on differences in walking ability in single-task (ST), cognitive-task (CT), and manual-task (MT) conditions between DT and ST groups. Results: Participants in the DT group showed significantly greater improvement in outcome measures, including 10-m gait speed, walking cadence, and cost during cognitive and manual tasks. The number of enumerated figures during CT, as well as the numbers of steps taken and of enumerated figures during stepping with MT demonstrated significant Group × Time interactions (p<0.05). Conclusions: This RCT suggests that the seated stepping exercise is more effective at improving ambulatory function in DT conditions than in ST conditions.

Effect of resistance training on physical performance and fear of falling in elderly with different levels of physical well-being.

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Complex obstacle negotiation exercise can prevent falls in community-dwelling elderly Japanese aged 75 years and older

Objectives:  The aim of the present study was to evaluate whether a complex course obstacle negotiation exercise (CC), a 24‐week exercise program, can reduce falls and fractures in older adults, as compared with a simple course obstacle negotiation exercise (SC).