Silvia Gonçalves Ricci Neri

Do virtual reality games improve mobility skills and balance measurements in community-dwelling older adults? Systematic review and meta-analysis

Objective: To summarize evidence on the effectiveness of virtual reality games and conventional therapy or no-intervention for fall prevention in the elderly. Data sources: An electronic data search (last searched December 2016) was performed on 10 databases (Web of Science, EMBASE, PUBMED, CINAHL, LILACS, SPORTDiscus, Cochrane Library, Scopus, SciELO, PEDro) and retained only randomized controlled trials. Review method: Sample characteristics and intervention parameters were compared, focusing on clinical homogeneity of demographic characteristics, type/duration of interventions, outcomes (balance, reaction time, mobility, lower limb strength and fear of falling) and low risk of bias. Based on homogeneity, a meta-analysis was considered. Two independent reviewers assessed the risk of bias. Results: A total of 28 studies met the inclusion criteria and were appraised (n: 1121 elderly participants). We found that virtual reality games presented positive effects on balance and fear of falling compared with no-intervention. Virtual reality games were also superior to conventional interventions for balance improvements and fear of falling. The six studies included in the meta-analysis demonstrated that virtual reality games significantly improved mobility and balance after 3–6 and 8–12 weeks of intervention when compared with no-intervention. The risk of bias revealed that less than one-third of the studies correctly described the random sequence generation and allocation concealment procedures. Conclusion: Our review suggests positive clinical effects of virtual reality games for balance and mobility improvements compared with no-treatment and conventional interventions. However, owing to the high risk of bias and large variability of intervention protocols, the evidence remains inconclusive and further research is warranted.

Muscle quality is associated with dynamic balance, fear of falling, and falls in older women

HighlightsNumerous scientists use the term “muscle quality” to refer to the relationship between muscle strength and muscle volume.The aim of the present study was to investigate the association between muscle quality and falls‐related traits in older women.Muscle quality was linked to negative outcomes in older women, in particular, falls‐related risk factors.Muscle quality may be a useful supplement to other muscular indices in the evaluation of risk of falls.

The association between body adiposity measures, postural balance, fear of falling, and fall risk in older community-dwelling women

Background and Purpose: Recent investigations demonstrate an association between obesity and the propensity of older adults to fall. The aim of this study was to investigate the association between body adiposity measures, postural balance, fear of falling, and risk of falls in older women. Methods: One hundred forty-seven volunteers took part in this cross-sectional study. Participants underwent body composition assessment using dual-energy x-ray absorptiometry and had body mass index, waist circumference (WC), and body adiposity index measured. Postural balance was assessed using a force platform, while fear of falling and risk of falls were, respectively, evaluated by the Falls Efficacy Scale—International and the QuickScreen Clinical Falls Risk Assessment. Results and Discussion: All adiposity measures were correlated to at least 1 postural stability parameter and to fear of falling (ρ= 0.163, P < .05 to r = 0.337, P < .001); however, WC was the index most strongly correlated to risk of falls (ρ= 0.325; P < .001). When obesity was classified using WC, it was observed that compared with nonobese individuals (n = 51), obese individuals (n = 96) exhibited greater center of pressure displacement in the anteroposterior and mediolateral axes, especially during conditions with feet apart (P < .05). The obese group also exhibited an increased fear of falling (28.04 vs 24.59; P = .002) and had a higher proportion of individuals with increased fall risk (72% vs 35%; P < .001). Conclusion: In summary, adiposity measures are associated with risk of falls in older women, which might be mediated by reduced postural balance and increased fear of falling. Among these indices, WC, an easy and low-cost assessment, demonstrated the strongest association with falls-related outcomes.

Obesity is associated with reduced postural control in community-dwelling older adults: a systematic review

Abstract Purpose: To summarise evidence from observational studies that examined the impact of obesity on Centre of Pressure (CoP) sway during quiet standing in community-dwelling older adults. Methods: An electronic data search (last searched April 2017) was performed on six databases (MEDLine, Web of Science, CINAHL, PsycINFO, Scopus and LILACS). Details of the study design, participants’ characteristics, obesity classification criteria, postural control conditions, CoP sway parameters and risk of bias were extracted by two independent reviewers. Results: Of 265 studies reviewed, four met the inclusion criteria and were appraised. Common to all the included studies was a negative effect of obesity on CoP sway parameters, especially at anteroposterior and mediolateral ranges. Of note, these findings were observed in a wide variety of quiet stance conditions, with significance more evident when vision was restricted. The risk of bias revealed that most studies’ samples were not representative of the entire population. Conclusions: The present systematic review suggests that obesity is associated with reduced static postural control in community-dwelling older adults. However, due to the risk of bias and the large variability of protocols used to measure CoP sway, the evidence remains inconclusive. Future longitudinal studies are needed to confirm the findings.

Plantar pressure distribution during running in early childhood

INTRODUCTION Plantar loads represent a reliable estimation of the mechanical efficiency of movement. The aim of this study was to describe and compare plantar pressure measures during running in children 4-6 years of age. METHODS Twenty-eight children were divided into three groups (4, 5 6 year-olds). Plantar pressure during running at self-selected speed was recorded using an Emed-AT platform (Novel). Contact area, peak pressure, relative maximum force, and relative contact time were analyzed under five different plantar regions. Foot length and dynamic plantar arch index were calculated. The MANOVA and Bonferroni post-hoc were used to compare groups. Level of significance was set at p < 0.05. RESULTS BMI and arch index did not differ between the age groups. When compared to the younger groups, 6-year-old children produced higher loads of peak pressure (p < 0.01) and maximum force (p < 0.01), larger contact area (p < 0.01) and longer contact time (p < 0.05) under most foot regions, except for maximum force under the midfoot (p < 0.05). CONCLUSIONS Foot structure and plantar loads during running seem to be still developing in 6-year-olds. These children present different values of peak pressure, maximum force, contact time, and contact area than 4 and 5-year-olds, with higher values in the forefoot and lower values in the midfoot.INTRODUCTION Plantar loads represent a reliable estimation of the mechanical efficiency of movement. The aim of this study was to describe and compare plantar pressure measures during running in children 4-6 years of age. METHODS Twenty-eight children were divided into three groups (4, 5 6 year-olds). Plantar pressure during running at self-selected speed was recorded using an Emed-AT platform (Novel). Contact area, peak pressure, relative maximum force, and relative contact time were analyzed under five different plantar regions. Foot length and dynamic plantar arch index were calculated. The MANOVA and Bonferroni post-hoc were used to compare groups. Level of significance was set at p < 0.05. RESULTS BMI and arch index did not differ between the age groups. When compared to the younger groups, 6-year-old children produced higher loads of peak pressure (p < 0.01) and maximum force (p < 0.01), larger contact area (p < 0.01) and longer contact time (p < 0.05) under most foot regions, except for maximum force under the midfoot (p < 0.05). CONCLUSIONS Foot structure and plantar loads during running seem to be still developing in 6-year-olds. These children present different values of peak pressure, maximum force, contact time, and contact area than 4 and 5-year-olds, with higher values in the forefoot and lower values in the midfoot.

Childhood obesity is associated with altered plantar pressure distribution during running

BACKGROUND Obesity is associated with higher foot loading during walking. The impact of this condition on running, however, has yet to be elucidated. RESEARCH QUESTION The purpose of this study was to examine the association between childhood obesity and plantar pressure distribution during running. METHODS Forty-two volunteers aged 5-10 years took part in this cross-sectional study. Body mass index (BMI) was assessed for obesity classification. Peak plantar pressure was evaluated during running at self-selected speed using an Emed AT-4 pressure platform. RESULTS AND SIGNIFICANCE BMI was correlated to peak pressure at whole foot (r = 0.340; p = .027), midfoot (r = 0.550; p < .001) and forefoot (r = 0.454; p = .003). Regarding other baropodometric parameters, obese children generated more forces during running compared to their leaner counterparts (all p < .050), except at the hallux. Also, obese children had a larger contact area under all the foot regions (all p < .050). These findings provide evidence that childhood obesity is associated with increased plantar pressure during running at self-selected speeds and support the concept that obese children are at higher risk of developing foot discomfort and pain.

The relationship between muscle quality and incidence of falls in older community-dwelling women: An 18-month follow-up study

Introduction: Important components that might mediate the relationship between aging and falls are reduced muscle strength and mass. Although muscle‐related phenotypes have been linked to falls in older people, the role of muscle quality has yet to be examined. Aim: To investigate the relationship between muscle quality and incidence of falls over an 18‐month follow‐up in older community‐dwelling women. Methods: A total of 167 women (68.1 ± 6.2 years) underwent quadriceps isometric peak torque and thigh‐muscle thickness assessments using isokinetic dynamometer and ultrasound, respectively. Muscle quality was considered as the ratio between maximal strength and muscle thickness. Participants were tracked by phone calls for ascertainment of falls during the follow‐up period. Cox proportional regressions and X2 tests were performed, with statistical significance set at P < 0.05. Results: A total of 139 volunteers were successful tracked over the follow‐up period. The overall incidence of fall was 23.4% (95% CI: 16.5–31.0). Rate of fallers among individuals with low‐muscle quality (57.7%) was higher than in those with normal muscle quality (15.3%) (X2 = 21.132; P < 0.001). The proportion of multiple fallers was also significantly higher (X2 = 11.029; P < 0.001) among volunteers with low‐muscle quality when compared to those with normal muscle quality (14.8% and 3.6%, respectively). The presence of low‐muscle quality was associated with a significantly greater risk of falls over the follow‐up (hazard ratio: 4.619; 95% CI: 2.302–9.269). Conclusion: Low‐muscle quality is associated with a higher incidence of falls in older women. These findings provide support for the concept that muscle quality is a clinically meaningful assessment among older people. HighlightsMuscle quality is a clinically meaningful assessment in the prediction of falls in older people.Muscle quality may serve as supplement to other muscle‐related assessments in the prediction of falls in older people.Muscle quality is independently associated with higher incidence of falls in older community‐dwelling women.

Stages of sarcopenia and the incidence of falls in older women: A prospective study

The purpose of the present study was to assess the association between different stages of sarcopenia and the incidence of falls over 18 months in older community-dwelling women. 246 women (68.1 ± 6.2 years) underwent body composition using dual-energy x-ray absorptiometry, knee extensors isokinetic peak torque, and Timed Up-and-Go assessments. The stages of sarcopenia were classified according to the European Working Group on Sarcopenia in Older People. Volunteers were classified into four groups as follows: nonsarcopenia, presarcopenia, sarcopenia, and severe sarcopenia. Participants were tracked by phone calls for ascertainment of falls during a follow-up period of 18 months. Cox proportional regressions were conducted. A total of 195 women were followed over the 18-month period. Proportions of each sarcopenia stage were 6.7%, 13.8%, and 12.8% for presarcopenia, sarcopenia, and severe sarcopenia, respectively. The proportion of fallers progressively increased according to the severity of sarcopenia, with 15.4%, 40.7%, and 72% for presarcopenia, sarcopenia, and severe sarcopenia, respectively (X2 = 30.637; p < 0.001). Severe sarcopenia was consistently associated with a higher risk of falls (hazard ratio: 3.843; 95% CI: 1.816-8.131), even after adjustments for age, body mass index, physical activity level, regular use of four or more medications, reduced peripheral sensation, presence of two or more chronic diseases, and history of lower-limbs pain. It is concluded that severe sarcopenia is independently associated with higher incidence of falls in older women. These results provide support for the concept that sarcopenia staging has clinical implications and might be an useful supplement to other routine falls risk assessment tools.

Session Perceived Exertion Following Traditional and Circuit Resistance Exercise Methods in Older Hypertensive Women

This study compared session ratings of perceived exertion (SRPE) between traditional multiple-set (TR) and circuit (CI) resistance exercise methods in treated hypertensive women. Fourteen volunteers (69.9 ± 5.6 years) performed two training sessions (TR and CI) in a random order, with the same number of sets, exercises, and loads. SRPE was obtained 30 minutes following each session using Foster’s scale. OMNI-resistance exercise scale (OMNI-RES) measures were subsequently taken. Foster’s SRPE was not significantly different between sessions (3.8 ± 0.9 TR vs. 3.4 ± 1.0 CI; p = .125), but OMNI-RES values were significantly higher following TR than following CI (5.2 ± 1.3 vs. 4.6 ± 1.5; p = .033). Total session duration was longer for TR (29.3 ± 1.2 vs. 20.0 ± 0.9 minutes; p < .001). Using moderate loads, the CI method did not elicit higher SRPE when compared with TR. Conversely, significantly lower OMNI-RES values follow CI. These results will be useful for prescribing exercise regimens for older hypertensive women.