Mauri Kallinen

Effects of Resistance Training on Lower-Extremity Impairments in Older People With Hip Fracture

OBJECTIVE To study the effects of resistance training on muscle strength parameters, mobility, and balance. DESIGN Randomized controlled trial. SETTING Research laboratory and senior gym. PARTICIPANTS Population-based sample of eligible 60- to 85-year-old community-dwelling men and women 0.5 to 7.0 years after hip fracture. Forty-six people had no contraindications and were willing to participate in the exercise trial. INTERVENTION Twelve-week intensive progressive strength-power training (n=24), aiming to reduce asymmetric deficit in leg muscle strength and power, or no intervention (n=22). MAIN OUTCOME MEASURES Isometric knee extension torque (KET) and leg extension power (LEP) measured in the weaker and stronger leg and the asymmetric deficit ([weak/sum both legs]x100%), 10-m walking speed, dynamic balance test, and self-reported outdoor mobility. RESULTS KET increased in both legs (P<.021), LEP tended to increase in the weaker leg (P=.071), and asymmetric LEP deficit decreased (P=.010) after training compared with the control group. LEP of the stronger leg, asymmetric KET deficit, walking speed, and balance performance were not significantly affected by training. Self-reported ability to walk outdoors improved after training. The compliance to the training was over 90%, and few adverse events (n=4; mainly musculoskeletal) were likely to be caused by the training. CONCLUSIONS Intensive resistance training is feasible for people with a hip fracture and improved muscle strength and power. More intensive training especially for the weaker leg may be needed to obtain more marked effects on asymmetric deficit, mobility, and balance. Also, the timing and duration of training program should be considered. (ISRCTN identifier ISRCTN34271567.)

Customer‐oriented counseling for physical activity in older people: study protocol and selected baseline results of a randomized‐controlled trial (ISRCTN 07330512)

The objective of this study is to describe the rationale, design and selected baseline results of a 2‐year randomized‐controlled trial (RCT) on the effects of physical activity counseling in community‐living older people.

Long-term Effect of Physical Activity Counseling on Mobility Limitation Among Older People: A Randomized Controlled Study

BACKGROUND Physical activity counseling increases physical activity among older people, but its effectiveness on mobility, that is, maintaining the ability to move independently, is unknown. We studied the effect of physical activity counseling on mobility among older people and evaluated whether counseling-induced benefits persist after cessation of the intervention. METHODS In a 2-year, single-blinded, randomized controlled study, 632 sedentary participants aged 75-81 years were randomly assigned into the intervention (n = 318) or control (n = 314) group. The intervention group received a single individualized physical activity counseling session with a supportive telephone contact every 4 months for 2 years. The outcome measures-perceived difficulty in advanced (walking 2 km) and basic (walking 0.5 km) mobility-were gathered semiannually during the intervention and the 1.5-year postintervention follow-up. RESULTS The proportion of participants with difficulties in advanced mobility at the beginning and end of the intervention was 34% and 38%, respectively, in the intervention group. In the control group, the corresponding proportions were 32% and 45%. The treatment effect was significant at the 2-year follow-up (odds ratio [OR] 0.84, 95% confidence interval [CI]: 0.70-0.99; p = .04) and remained significant 1.5 years postintervention (OR 0.82, 95% CI: 0.68-0.99; p = .04). The effect on basic mobility postintervention was parallel but nonsignificant (OR 0.87, CI: 0.69-1.09; p = .22). CONCLUSIONS Among older people, a single individualized physical activity counseling session with a supportive phone contact every 4 months for 2 years had a positive effect on mobility, an important factor for maintaining independence in the community in old age.

Factors affecting the increased risk of physical inactivity among older people with depressive symptoms

The purpose of this study was to investigate the association between depressive symptoms and physical inactivity, and whether motives for and barriers to exercise explain the potential association between depressive symptoms and physical inactivity in older people. The design of the study was cross‐sectional. The study population comprised 645 people born between 1922 and 1928 who were residents in a city‐center area of Jyväskylä in central Finland. Depressive symptoms were assessed using Center for the Epidemiologic Studies Depression Scale, physical activity using Grimbys (1986) validated scale, and motives for and barriers to exercise using a questionnaire and mobility limitation with a test of walking time over 10 m. The results demonstrated that the risk of physical inactivity was more than twofold among persons with depressive symptoms compared with non‐depressed people. A higher prevalence of perceived barriers to physical activity, such as poor health, fear and negative experiences, together with lack of knowledge, explained part of the increased risk of physical inactivity among those with depressive symptoms while differences in motives for physical activity did not have a material effect. Adjustment for walking time over 10 m attenuated the increased risk of inactivity further. When planning exercise promotion programs, finding ways to overcome fear and negative experiences and providing information may help to increase physical activity among people with depressive symptoms. Additionally, difficulties caused by poor mobility should not be ignored.

Balance confidence and functional balance in relation to falls in older persons with hip fracture history

Purpose: To investigate whether self‐assessed balance confidence and functional balance are associated with falls in older persons with hip fracture history. Methods: This study is a part of a larger study on functional capacity and exercise rehabilitation in hip fracture patients. Seventy‐nine patients, operated at the local hospital for collum or trochanter fracture within one‐half to 7 years, participated in the laboratory measurements. Balance confidence was assessed with Activities‐specific Balance Confidence scale (ABC) and functional balance using the Berg Balance Scale (BBS). According to self‐reported number of falls during the previous 6 months participants were classified as those with falls vs. no falls; recurrent falls (3 or more falls) vs. occasional/no falls (< 3 falls); indoor falls vs. no indoor falls; outdoor falls vs. no outdoor falls. The relationships between ABC, BBS, and fall status were tested by logistic regression. Results: Lower BBS score was associated with all falls during previous 6 months (OR 0.929, 95% CI 0.875–0.987). Lower ABC score was associated with recurrent falling (OR 0.974, 0.952–0.998), as well as lower BBS score (OR 0.876, 0.797–0.962). Additionally, lower ABC and lower BBS scores were related to indoor falls (ABC OR 0.975, 0.957–0.993; BBS OR 0.913, 0.852–0.978). Participants with outdoor falls did not differ from those with no outdoor falls in ABC scores or BBS. Conclusions: Self‐assessed balance confidence and functional balance are related to prevalence of recurrent and indoor falls in older hip fracture patients. Therefore use of Activities‐specific Balance Confidence scale and Berg Balance Scale might be reasoned to expand in evaluating the probability for falls among at‐risk elders.

Neck semispinalis capitis muscle size in sitting and prone positions measured by real-time ultrasonography

Objective: To examine the reliability of measurements of semispinalis capitis muscle (SECM) cross-sectional area (CSA) in prone and sitting positions, and to compare the muscle size in these two positions. Design: Semispinalis capitis CSA was measured twice a day on two successive days with a real-time ultrasound apparatus. Subjects: Eighteen males (aged 19–34 years) and 28 females (aged 19–34 years) were studied for the reliability test. Seven males and 12 females were randomly selected to compare SECM size in sitting and prone positions. Results: The intraclass correlation coefficient (ICC) for repeatability measurements was r = 0.98 for the two positions. The correlation of the CSA in sitting and in prone positions was r = 0.93 (p <0.01). There were no significant differences between CSA, linear dimensions and shape ratio of SECM in the two positions. Conclusions: In this study SECM ultrasonography appeared to be an accurate method in both positions, and position as such had no significant effects on the SECM cross-sectional size. Such accuracy allows neck muscle evaluation in clinical diagnosis and in follow-up studies during neck rehabilitation programmes.

Postural Balance and Self-Reported Balance Confidence in Older Adults with a Hip Fracture History

Background: Balance dysfunction and loss of balance confidence have been associated with functional limitations and loss of independency in daily tasks. This study examined various aspects of postural balance and balance confidence between older adults with a hip fracture history and their non-fractured counterparts. A comprehensive assessment of balance capacity in older adults with a hip fracture history may help to identify aspects of postural balance that play an important role in the mobility recovery and the avoidance of further falls. Methods: The present study comprised 79 community-dwelling older adults with a hip fracture history and 31 non-fractured subjects of the same age, who participated in balance tests including both force platform measures and functional balance testing (Berg Balance Scale, BBS). In addition, balance confidence was assessed with the Activities-Specific Balance Confidence (ABC) scale. Results: Persons with a hip fracture history had a markedly poorer balance control and were significantly less confident maintaining their balance during daily activities compared to the controls. Sixty percent of the subjects in the hip fracture group versus 87% of the non-fracture group (χ2 test, p = 0.003) were able to perform the semi-tandem standing with their eyes closed. Significantly lower scores in the BBS (hip fracture group 46.3 vs. non-fracture group 52.9) and ABC (hip fracture group 59.4 vs. non-fracture group 77.5%) tests were found among the hip fracture subjects compared to the controls. In addition, the performance time in the lateral weight-shifting task (hip fracture group 13.4 vs. non-fracture group 8.4 s) was significantly slower compared to the controls. Conclusions: Balance impairments along with the loss of balance confidence are persistent problems among community-dwelling older adults with a history of hip fracture and may contribute to mobility limitations and the risk of falling. These areas of function and behaviour in older adults with a hip fracture history should be taken into consideration when planning effective, well-targeted rehabilitation programs.

Physical inactivity and pain in older men and women with hip fracture history.

Hip fracture patients often suffer from pain for several months after surgery. This may lead to physical inactivity and subsequent mobility limitation and disability. The purpose of this study was to investigate the association between severe musculoskeletal pain and the level of physical activity in older people with a history of hip fracture. Data were collected from 60- to 85-year-old (n = 78) community-dwelling people, 0.7–7.5 years after hip fracture. Physical activity was assessed with the Yale Physical Activity Survey (YPAS). According to the YPAS summary index distribution, the participants were divided into the physically inactive and physically active groups. Musculoskeletal pain in the lower back, hip or knee region was assessed by the Visual Analog Scale. Pain was defined as severe pain if the subject rated the pain 66 mm or over (upper third of the scale) in at least one of the relevant body regions in the lower body. Thirty-three subjects (42%) experienced severe pain in the lower body, of whom 23 (70%) reported severe pain in the operated hip. Twenty-three patients (30%) used pain medication prescribed by a physician. The level of musculoskeletal pain was significantly higher in the physically inactive (62%) than in the physically active (31%) group (p = 0.011). Logistic regression analysis showed that people with severe pain had over three times (OR: 3.5, 95% CI: 1.30–9.39) the risk for physical inactivity compared to those with less or no pain. Multivariate adjustments for balance confidence, time since fracture, number of chronic diseases and type of surgery did not materially change the estimate (OR: 3.0, 95% CI: 1.00–9.30). Pain is an important associated factor of physical inactivity in older people with a hip fracture history. Pain management may be important in restoring and sustaining the level of physical activity after hip fracture. Further prospective and experimental studies are, however, needed to explore the causality between pain and physical activity as well as the role of pain management and physical activity interventions in preventing mobility limitation and disability among older people recovering from hip fracture.

Promoting mobility after hip fracture (ProMo): study protocol and selected baseline results of a year-long randomized controlled trial among community-dwelling older people.

BackgroundTo cope at their homes, community-dwelling older people surviving a hip fracture need a sufficient amount of functional ability and mobility. There is a lack of evidence on the best practices supporting recovery after hip fracture. The purpose of this article is to describe the design, intervention and demographic baseline results of a study investigating the effects of a rehabilitation program aiming to restore mobility and functional capacity among community-dwelling participants after hip fracture.Methods/DesignPopulation-based sample of over 60-year-old community-dwelling men and women operated for hip fracture (n = 81, mean age 79 years, 78% were women) participated in this study and were randomly allocated into control (Standard Care) and ProMo intervention groups on average 10 weeks post fracture and 6 weeks after discharged to home. Standard Care included written home exercise program with 5-7 exercises for lower limbs. Of all participants, 12 got a referral to physiotherapy. After discharged to home, only 50% adhered to Standard Care. None of the participants were followed-up for Standard Care or mobility recovery. ProMo-intervention included Standard Care and a year-long program including evaluation/modification of environmental hazards, guidance for safe walking, pain management, progressive home exercise program and physical activity counseling. Measurements included a comprehensive battery of laboratory tests and self-report on mobility limitation, disability, physical functional capacity and health as well as assessments for the key prerequisites for mobility, disability and functional capacity. All assessments were performed blinded at the research laboratory. No significant differences were observed between intervention and control groups in any of the demographic variables.DiscussionTen weeks post hip fracture only half of the participants were compliant to Standard Care. No follow-up for Standard Care or mobility recovery occurred. There is a need for rehabilitation and follow-up for mobility recovery after hip fracture. However, the effectiveness of the ProMo program can only be assessed at the end of the study.Trial registrationCurrent Controlled Trials ISRCTN53680197

Health-related quality of life and physical activity in persons at high risk for type 2 diabetes

Purpose. The aim of this study was to compare the health-related quality of life (HRQOL) of persons at risk for type 2 diabetes to that of the Finnish general population. In addition, the associations between physical activity and HRQOL at-risk persons were studied. Methods. One hundred thirty-two at-risk persons were recruited from health care centres in Central Finland. Participants filled out questionnaires including demographic characteristics, HRQOL (SF-36), frequency of vigorous physical activity (≤2 times a week, once a week, less than once a week) and comorbidities. Results. HRQOL of at-risk persons differed significantly from that of the Finnish population in four of the eight dimensions of SF-36. Compared with reference values of the general population, the values of at-risk persons were worse for general health and pain, but better for mental health and role limitation (emotional) dimensions. Among at-risk persons those physically more active had less depressiveness and lower body weight. HRQOL decreased linearly with decreasing physical activity in all dimensions. Conclusions. People with elevated risk for type 2 DM have reduced HRQOL in general health and body pain dimensions, but mental health and emotional role dimensions were better compared with that of the population. Among at-risk persons, the benefits of physical activity on HRQOL were seen in all HRQOL dimensions. Regular exercise and body weight control may improve subjective health and reduce risk for type 2 DM and its consequences.