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Background: Dynamic balance keeps the vertical projection of the center of mass within the base of support while walking. Dynamic balance tests are used to predict the risks of falls and eventual falls. The psychometric properties of most dynamic balance tests are unsatisfactory and do not comprise an actual loss of balance while walking. Objectives: Using beam walking distance as a measure of dynamic balance, the BEAM consortium will determine the psychometric properties, lifespan and patient reference values, the relationship with selected “dynamic balance tests,” and the accuracy of beam walking distance to predict falls. Methods: This cross-sectional observational study will examine healthy adults in 7 decades (n = 432) at 4 centers. Center 5 will examine patients (n = 100) diagnosed with Parkinson’s disease, multiple sclerosis, stroke, and balance disorders. In test 1, all participants will be measured for demographics, medical history, muscle strength, gait, static balance, dynamic balance using beam walking under single (beam walking only) and dual task conditions (beam walking while concurrently performing an arithmetic task), and several cognitive functions. Patients and healthy participants age 50 years or older will be additionally measured for fear of falling, history of falls, miniBESTest, functional reach on a force platform, timed up and go, and reactive balance. All participants age 50 years or older will be recalled to report fear of falling and fall history 6 and 12 months after test 1. In test 2, seven to ten days after test 1, healthy young adults and age 50 years or older (n = 40) will be retested for reliability of beam walking performance. Conclusion: We expect to find that beam walking performance vis-à-vis the traditionally used balance outcomes predicts more accurately fall risks and falls. Clinical Trial Registration Number: NCT03532984.
Background Balance training (BT) has been used for the promotion of balance and sports-related skills as well as for prevention and rehabilitation of lower extremity sport injuries. However, evidence-based dose-response relationships in BT parameters have not yet been established.
Objective The objective of this systematic literature review and meta-analysis was to determine dose-response relationships in BT parameters that lead to improvements in balance in young healthy adults with different training status.
Data Sources A computerized systematic literature search was performed in the electronic databases PubMed, Web of Knowledge, and SPORTDiscus from January 1984 up to May 2014 to capture all articles related to BT in young healthy adults.
Study Eligibility Criteria A systematic approach was used to evaluate the 596 articles identified for initial review. Only randomized controlled studies were included if they investigated BT in young healthy adults (16-40 years) and tested at least one behavioral balance performance outcome. In total, 25 studies met the inclusion criteria for review.
Study Appraisal and Synthesis Methods Studies were evaluated using the physiotherapy evidence database (PEDro) scale. Within-subject effect sizes (ESdw) and between-subject effect sizes (ESdb) were calculated. The included studies were coded for the following criteria: training status (elite athletes, sub-elite athletes, recreational athletes, untrained subjects), training modalities (training period, frequency, volume, etc.), and balance outcome (test for the assessment of steady-state, proactive, and reactive balance).
Results Mean ESdb demonstrated that BT is an effective means to improve steady-state (ESdb = 0.73) and proactive balance (ESdb = 0.92) in healthy young adults. Studies including elite athletes showed the largest effects (ESdb = 1.29) on measures of steady-state balance as compared with studies analyzing sub-elite athletes (ESdb = 0.32), recreational athletes (ESdb = 0.69), and untrained subjects (ESdb = 0.82). Our analyses regarding dose-response relationships in BT revealed that a training period of 11-12 weeks (ESdb = 1.09), a training frequency of three (mean ESdb = 0.72) or six (single ESdb = 1.84) sessions per week, at least 16-19 training sessions in total (ESdb = 1.12), a duration of 11-15 min for a single training session (ESdb = 1.11), four exercises per training session (ESdb = 1.29), two sets per exercise (ESdb = 1.63), and a duration of 21-40 s for a single BT exercise (ESdb = 1.06) is most effective in improving measures of steady-state balance. Due to a small number of studies, dose-response relationships of BT for measures of proactive and reactive balance could not be qualified.
Limitations The present findings must be interpreted with caution because it is difficult to separate the impact of a single training modality (e.g., training frequency) from that of the others. Moreover, the quality of the included studies was rather limited, with a mean PEDro score of 5.
Conclusions Our detailed analyses revealed effective BT parameters for the improvement of steady-state balance. Thus, practitioners and coaches are advised to consult the identified dose-response relationships of this systematic literature review and meta-analysis to implement effective BT protocols in clinical and sports-related contexts. However, further research of high methodological quality is needed to (1) determine dose-response relationships of BT for measures of proactive and reactive balance, (2) define effective sequencing protocols in BT (e.g., BT before or after a regular training session), (3) discern the effects of detraining, and (4) develop a feasible and effective method to regulate training intensity in BT.
Physical fatigue (PF) negatively affects postural control, resulting in impaired balance performance in young and older adults. Similar effects on postural control can be observed for mental fatigue (MF) mainly in older adults. Controversial results exist for young adults. There is a void in the literature on the effects of fatigue on balance and cortical activity. Therefore, this study aimed to examine the acute effects of PF and MF on postural sway and cortical activity. Fifteen healthy young adults aged 28 ± 3 years participated in this study. MF and PF protocols comprising of an all-out repeated sit-to-stand task and a computer-based attention network test, respectively, were applied in random order. Pre and post fatigue, cortical activity and postural sway (i.e., center of pressure displacements [CoPd], velocity [CoPv], and CoP variability [CV CoPd, CV CoPv]) were tested during a challenging bipedal balance board task. Absolute spectral power was calculated for theta (4–7.5 Hz), alpha-2 (10.5–12.5 Hz), beta-1 (13–18 Hz), and beta-2 (18.5–25 Hz) in frontal, central, and parietal regions of interest (ROI) and baseline-normalized. Inference statistics revealed a significant time-by-fatigue interaction for CoPd (p = 0.009, d = 0.39, Δ 9.2%) and CoPv (p = 0.009, d = 0.36, Δ 9.2%), and a significant main effect of time for CoP variability (CV CoPd: p = 0.001, d = 0.84; CV CoPv: p = 0.05, d = 0.62). Post hoc analyses showed a significant increase in CoPd (p = 0.002, d = 1.03) and CoPv (p = 0.003, d = 1.03) following PF but not MF. For cortical activity, a significant time-by-fatigue interaction was found for relative alpha-2 power in parietal (p < 0.001, d = 0.06) areas. Post hoc tests indicated larger alpha-2 power increases after PF (p < 0.001, d = 1.69, Δ 3.9%) compared to MF (p = 0.001, d = 1.03, Δ 2.5%). In addition, changes in parietal alpha-2 power and measures of postural sway did not correlate significantly, irrespective of the applied fatigue protocol. No significant changes were found for the other frequency bands, irrespective of the fatigue protocol and ROI under investigation. Thus, the applied PF protocol resulted in increased postural sway (CoPd and CoPv) and CoP variability accompanied by enhanced alpha-2 power in the parietal ROI while MF led to increased CoP variability and alpha-2 power in our sample of young adults. Potential underlying cortical mechanisms responsible for the greater increase in parietal alpha-2 power after PF were discussed but could not be clearly identified as cause. Therefore, further future research is needed to decipher alternative interpretations.
Physical fatigue (PF) negatively affects postural control, resulting in impaired balance performance in young and older adults. Similar effects on postural control can be observed for mental fatigue (MF) mainly in older adults. Controversial results exist for young adults. There is a void in the literature on the effects of fatigue on balance and cortical activity. Therefore, this study aimed to examine the acute effects of PF and MF on postural sway and cortical activity. Fifteen healthy young adults aged 28 ± 3 years participated in this study. MF and PF protocols comprising of an all-out repeated sit-to-stand task and a computer-based attention network test, respectively, were applied in random order. Pre and post fatigue, cortical activity and postural sway (i.e., center of pressure displacements [CoPd], velocity [CoPv], and CoP variability [CV CoPd, CV CoPv]) were tested during a challenging bipedal balance board task. Absolute spectral power was calculated for theta (4–7.5 Hz), alpha-2 (10.5–12.5 Hz), beta-1 (13–18 Hz), and beta-2 (18.5–25 Hz) in frontal, central, and parietal regions of interest (ROI) and baseline-normalized. Inference statistics revealed a significant time-by-fatigue interaction for CoPd (p = 0.009, d = 0.39, Δ 9.2%) and CoPv (p = 0.009, d = 0.36, Δ 9.2%), and a significant main effect of time for CoP variability (CV CoPd: p = 0.001, d = 0.84; CV CoPv: p = 0.05, d = 0.62). Post hoc analyses showed a significant increase in CoPd (p = 0.002, d = 1.03) and CoPv (p = 0.003, d = 1.03) following PF but not MF. For cortical activity, a significant time-by-fatigue interaction was found for relative alpha-2 power in parietal (p < 0.001, d = 0.06) areas. Post hoc tests indicated larger alpha-2 power increases after PF (p < 0.001, d = 1.69, Δ 3.9%) compared to MF (p = 0.001, d = 1.03, Δ 2.5%). In addition, changes in parietal alpha-2 power and measures of postural sway did not correlate significantly, irrespective of the applied fatigue protocol. No significant changes were found for the other frequency bands, irrespective of the fatigue protocol and ROI under investigation. Thus, the applied PF protocol resulted in increased postural sway (CoPd and CoPv) and CoP variability accompanied by enhanced alpha-2 power in the parietal ROI while MF led to increased CoP variability and alpha-2 power in our sample of young adults. Potential underlying cortical mechanisms responsible for the greater increase in parietal alpha-2 power after PF were discussed but could not be clearly identified as cause. Therefore, further future research is needed to decipher alternative interpretations.
Background There is evidence that physical exercise training (PET) conducted at the workplace is effective in improving physical fitness and thus health. However, there is no current systematic review available that provides high-level evidence regarding the effects of PET on physical fitness in the workforce. Objectives To quantify sex-, age-, and occupation type-specific effects of PET on physical fitness and to characterize dose-response relationships of PET modalities that could maximize gains in physical fitness in the working population. Data Sources A computerized systematic literature search was conducted in the databases PubMed and Cochrane Library (2000-2019) to identify articles related to PET in workers. Study Eligibility Criteria Only randomized controlled trials with a passive control group were included if they investigated the effects of PET programs in workers and tested at least one fitness measure. Study Appraisal and Synthesis Methods Weighted mean standardised mean differences (SMDwm) were calculated using random effects models. A multivariate random effects meta-regression was computed to explain the influence of key training modalities (e.g., training frequency, session duration, intensity) on the effectiveness of PET on measures of physical fitness. Further, subgroup univariate analyses were computed for each training modality. Additionally, methodological quality of the included studies was rated with the help of the Physiotherapy Evidence Database (PEDro) Scale. Results Overall, 3423 workers aged 30-56 years participated in 17 studies (19 articles) that were eligible for inclusion. Methodological quality of the included studies was moderate with a median PEDro score of 6. Our analyses revealed significant, small-sized effects of PET on cardiorespiratory fitness (CRF), muscular endurance, and muscle power (0.29 <= SMDwm <= 0.48). Medium effects were found for CRF and muscular endurance in younger workers (<= 45 years) (SMDwm = 0.71) and white-collar workers (SMDwm = 0.60), respectively. Multivariate random effects meta-regression for CRF revealed that none of the examined training modalities predicted the effects of PET on CRF (R-2 = 0). Independently computed subgroup analyses showed significant PET effects on CRF when conducted for 9-12 weeks (SMDwm = 0.31) and for 17-20 weeks (SMDwm = 0.74). Conclusions PET effects on physical fitness in healthy workers are moderated by age (CRF) and occupation type (muscular endurance). Further, independently computed subgroup analyses indicated that the training period of the PET programs may play an important role in improving CRF in workers.
Background: Walking speed decreases in old age. Even though old adults regularly participate in exercise interventions, we do not know how the intervention-induced changes in physical abilities produce faster walking. The Potsdam Gait Study (POGS) will examine the effects of 10 weeks of power training and detraining on leg muscle power and, for the first time, on complete gait biomechanics, including joint kinematics, kinetics, and muscle activation in old adults with moderate mobility disability. Methods/Design: POGS is a randomized controlled trial with two arms, each crossed over, without blinding. Arm 1 starts with a 10-week control period to assess the reliability of the tests and is then crossed over to complete 25-30 training sessions over 10 weeks. Arm 2 completes 25-30 exercise sessions over 10 weeks, followed by a 10-week follow-up (detraining) period. The exercise program is designed to improve lower extremity muscle power. Main outcome measures are: muscle power, gait speed, and gait biomechanics measured at baseline and after 10 weeks of training and 10 weeks of detraining. Discussion: It is expected that power training will increase leg muscle power measured by the weight lifted and by dynamometry, and these increased abilities become expressed in joint powers measured during gait. Such favorably modified powers will underlie the increase in step length, leading ultimately to a faster walking speed. POGS will increase our basic understanding of the biomechanical mechanisms of how power training improves gait speed in old adults with moderate levels of mobility disabilities. (C) 2016 S. Karger AG, Basel
Objectives The objective of this systematic review and meta-analysis was to quantify the effectiveness of supervised vs. unsupervised balance and/or resistance training programs on measures of balance and muscle strength/ power in healthy older adults. In addition, the impact of supervision on training-induced adaptive processes was evaluated in the form of dose-response relationships by analyzing randomized controlled trials that compared supervised with unsupervised trials. Data Sources A computerized systematic literature search was performed in the electronic databases PubMed, Web of Science, and SportDiscus to detect articles examining the role of supervision in balance and/or resistance training in older adults. Study Eligibility Criteria The initially identified 6041 articles were systematically screened. Studies were included if they examined balance and/or resistance training in adults aged >= 65 years with no relevant diseases and registered at least one behavioral balance (e.g., time during single leg stance) and/or muscle strength/ power outcome (e.g., time for 5-Times-Chair-Rise-Test). Finally, 11 studies were eligible for inclusion in this meta-analysis. Study Appraisal Weighted mean standardized mean differences between subjects (SMDbs) of supervised vs. unsupervised balance/resistance training studies were calculated. The included studies were coded for the following variables: number of participants, sex, age, number and type of interventions, type of balance/strength tests, and change (%) from pre- to post-intervention values. Additionally, we coded training according to the following modalities: period, frequency, volume, modalities of supervision (i.e., number of supervised/unsupervised sessions within the supervised or unsupervised training groups, respectively). Heterogeneity was computed using I 2 and chi(2) statistics. The methodological quality of the included studies was evaluated using the Physiotherapy Evidence Database scale. Results Our analyses revealed that in older adults, supervised balance/resistance training was superior compared with unsupervised balance/resistance training in improving measures of static steady-state balance (mean SMDbs = 0.28, p = 0.39), dynamic steady-state balance (mean SMDbs = 0.35, p = 0.02), proactive balance (mean SMDbs = 0.24, p = 0.05), balance test batteries (mean SMDbs = 0.53, p = 0.02), and measures of muscle strength/power (mean SMDbs = 0.51, p = 0.04). Regarding the examined dose-response relationships, our analyses showed that a number of 10-29 additional supervised sessions in the supervised training groups compared with the unsupervised training groups resulted in the largest effects for static steady-state balance (mean SMDbs = 0.35), dynamic steady-state balance (mean SMDbs = 0.37), and muscle strength/power (mean SMDbs = 1.12). Further, >= 30 additional supervised sessions in the supervised training groups were needed to produce the largest effects on proactive balance (mean SMDbs = 0.30) and balance test batteries (mean SMDbs = 0.77). Effects in favor of supervised programs were larger for studies that did not include any supervised sessions in their unsupervised programs (mean SMDbs: 0.28-1.24) compared with studies that implemented a few supervised sessions in their unsupervised programs (e.g., three supervised sessions throughout the entire intervention program; SMDbs: -0.06 to 0.41). Limitations The present findings have to be interpreted with caution because of the low number of eligible studies and the moderate methodological quality of the included studies, which is indicated by a median Physiotherapy Evidence Database scale score of 5. Furthermore, we indirectly compared dose-response relationships across studies and not from single controlled studies. Conclusions Our analyses suggest that supervised balance and/or resistance training improved measures of balance and muscle strength/power to a greater extent than unsupervised programs in older adults. Owing to the small number of available studies, we were unable to establish a clear dose-response relationship with regard to the impact of supervision. However, the positive effects of supervised training are particularly prominent when compared with completely unsupervised training programs. It is therefore recommended to include supervised sessions (i.e., two out of three sessions/week) in balance/resistance training programs to effectively improve balance and muscle strength/power in older adults.
Background: Habitual walking speed predicts many clinical conditions later in life, but it declines with age. However, which particular exercise intervention can minimize the age-related gait speed loss is unclear.
Purpose: Our objective was to determine the effects of strength, power, coordination, and multimodal exercise training on healthy old adults' habitual and fast gait speed.
Methods: We performed a computerized systematic literature search in PubMed and Web of Knowledge from January 1984 up to December 2014. Search terms included 'Resistance training', 'power training', 'coordination training', 'multimodal training', and 'gait speed (outcome term). Inclusion criteria were articles available in full text, publication period over past 30 years, human species, journal articles, clinical trials, randomized controlled trials, English as publication language, and subject age C65 years. The methodological quality of all eligible intervention studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. We computed weighted average standardized mean differences of the intervention-induced adaptations in gait speed using a random-effects model and tested for overall and individual intervention effects relative to no-exercise controls.
Results: A total of 42 studies (mean PEDro score of 5.0 +/- 1.2) were included in the analyses (2495 healthy old adults; age 74.2 years [64.4-82.7]; body mass 69.9 +/- 4.9 kg, height 1.64 +/- 0.05 m, body mass index 26.4 +/- 1.9 kg/m(2), and gait speed 1.22 +/- 0.18 m/s). The search identified only one power training study, therefore the subsequent analyses focused only on the effects of resistance, coordination, and multimodal training on gait speed. The three types of intervention improved gait speed in the three experimental groups combined (n = 1297) by 0.10 m/s (+/- 0.12) or 8.4 % (+/- 9.7), with a large effect size (ES) of 0.84. Resistance (24 studies; n = 613; 0.11 m/s; 9.3 %; ES: 0.84), coordination (eight studies, n = 198; 0.09 m/s; 7.6 %; ES: 0.76), and multimodal training (19 studies; n = 486; 0.09 m/s; 8.4 %, ES: 0.86) increased gait speed statistically and similarly.
Conclusions: Commonly used exercise interventions can functionally and clinically increase habitual and fast gait speed and help slow the loss of gait speed or delay its onset.