The effect of a 12-week combined exercise intervention program on physical performance and gait kinematics in community-dwelling elderly women.

This study aimed to determine if combined exercise intervention improves physical performance and gait joint-kinematics including the joint angle and dynamic range of motion (ROM) related to the risk of falling in community-dwelling elderly women. A 12-week combined exercise intervention program with extra emphasis on balance, muscle strength, and walking ability was designed to improve physical performance and gait. Twenty participants attended approximately two-hour exercise sessions twice weekly for 12 weeks. Participants underwent a physical performance battery, including static balance, sit and reach, whole body reaction time, 10 m obstacle walk, 10 m maximal walk, 30-second chair stand, to determine a physical performance score, and received quantitative gait kinematics measurements at baseline and in 12 weeks. Significant lower extremity strength improvement 13.5% (p<.001) was observed, which was accompanied by significant decreases in time of the 10 m obstacle walk (p<.05) and whole body reaction time (p<.001) in this study. However, no significant differences were seen for static balance and flexibility from baseline. For gait kinematics, in the mid-swing phase, knee and hip joint angle changed toward flexion (p<.01, p<.05, respectively). Ankle dynamic ROM significantly increased (p<.05) following exercise intervention. The plantar flexion angle of the ankle in the toe-off phase was increased significantly (p<.01). However, other gait parameters were not significantly different from baseline. These findings from the present investigation provide evidence of significant improvements in physical performance related to the risk factors of falling and safe gait strategy with a combined exercise intervention program in community-dwelling elderly women. The results suggest this exercise intervention could be an effective approach to ameliorate the risk factors for falls and to promote safer locomotion in elderly community-dwelling women.

[1]  L. Puggaard Effects of training on functional performance in 65, 75 and 85 year‐old women: Experiences deriving from community based studies in Odense, Denmark , 2003, Scandinavian journal of medicine & science in sports.

[2]  Daisuke Koizumi,et al.  Effects of combined sensory and muscular training on balance in Japanese older adults. , 2004, Preventive medicine.

[3]  Jennifer A. Boxer,et al.  Effect of a gentle Iyengar yoga program on gait in the elderly: an exploratory study. , 2005, Archives of physical medicine and rehabilitation.

[4]  J. Judge,et al.  Balance improvements in older women: effects of exercise training. , 1993, Physical therapy.

[5]  D. Edwards,et al.  Effects of a three-year exercise program on motor function and cognitive processing speed in older women. , 1991, Research quarterly for exercise and sport.

[6]  D. Kiel,et al.  Self-paced resistance training and walking exercise in community-dwelling older adults: effects on neuromotor performance. , 1997, The journals of gerontology. Series A, Biological sciences and medical sciences.

[7]  W. Beam,et al.  A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. , 1999, Research quarterly for exercise and sport.

[8]  W. Berg,et al.  Circumstances and consequences of falls in independent community-dwelling older adults. , 1997, Age and ageing.

[9]  A. Hicks,et al.  Training for muscle power in older adults: effects on functional abilities. , 2003, Canadian journal of applied physiology = Revue canadienne de physiologie appliquee.

[10]  R. Barrett,et al.  Swing phase mechanics of healthy young and elderly men. , 2001, Human movement science.

[11]  B. Hurley Age, gender, and muscular strength. , 1995, The journals of gerontology. Series A, Biological sciences and medical sciences.

[12]  D G Lloyd,et al.  The effect of exercise on gait patterns in older women: a randomized controlled trial. , 1996, The journals of gerontology. Series A, Biological sciences and medical sciences.

[13]  Lester M. Wolfson,et al.  The Relationship of Knee and Ankle Weakness to Falls in Nursing Home Residents: An Isokinetic Study , 1987, Journal of the American Geriatrics Society.

[14]  M. Brown,et al.  Effects of a low intensity exercise program on selected physical performance characteristics of 60- to 71- year olds , 1991, Aging.

[15]  J. Judge,et al.  Exercise to improve gait velocity in older persons. , 1993, Archives of physical medicine and rehabilitation.

[16]  John Doucette,et al.  Risk Factors for Serious Injury During Falls by Older Persons in the Community , 1995 .

[17]  Gustaf Bucht,et al.  A 1-year combined weight-bearing training program is beneficial for bone mineral density and neuromuscular function in older women , 2005, Osteoporosis International.

[18]  E H Wagner,et al.  The effect of strength and endurance training on gait, balance, fall risk, and health services use in community-living older adults. , 1997, The journals of gerontology. Series A, Biological sciences and medical sciences.

[19]  S. Owen,et al.  Effect of intense strength training on standing balance, walking speed, and sit-to-stand performance in older adults. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[20]  M. Rogers,et al.  Methods to assess and improve the physical parameters associated with fall risk in older adults. , 2003, Preventive medicine.

[21]  D. Winter Foot trajectory in human gait: a precise and multifactorial motor control task. , 1992, Physical therapy.

[22]  T. Hortobágyi,et al.  Age causes a redistribution of joint torques and powers during gait. , 2000, Journal of applied physiology.

[23]  M. Whitehurst Reaction Time Unchanged in Older Women following Aerobic Training , 1991, Perceptual and motor skills.

[24]  M. Tinetti,et al.  Risk factors for falls among elderly persons living in the community. , 1988, The New England journal of medicine.

[25]  Warwick L. Spinks,et al.  Exercise, Mobility and Aging , 2000, Sports medicine.

[26]  H. Engels,et al.  Effects of Low-Impact, Moderate-Intensity Exercise Training with and without Wrist Weights on Functional Capacities and Mood States in Older Adults , 1998, Gerontology.

[27]  R. Brand,et al.  The biomechanics and motor control of human gait: Normal, elderly, and pathological , 1992 .

[28]  Kenneth Meijer,et al.  The effect of age and joint angle on the proportionality of extensor and flexor strength at the knee joint. , 2004, The journals of gerontology. Series A, Biological sciences and medical sciences.

[29]  S. Õunpuu,et al.  Step length reductions in advanced age: the role of ankle and hip kinetics. , 1996, The journals of gerontology. Series A, Biological sciences and medical sciences.

[30]  L. Sauvage,et al.  A CLINICAL TRIAL OF STRENGTHENING AND AEROBIC EXERCISE TO IMPROVE GAIT AND BALANCE IN ELDERLY MALE NURSING HOME RESIDENTS , 1992, American journal of physical medicine & rehabilitation.

[31]  N. Beyer,et al.  Exercise and injury prevention in older people , 2003, Scandinavian journal of medicine & science in sports.

[32]  M. Pollock,et al.  Effect of aerobic and resistance training on fractionated reaction time and speed of movement. , 1990, Journal of gerontology.

[33]  F. Zajac,et al.  Contributions of the individual ankle plantar flexors to support, forward progression and swing initiation during walking. , 2001, Journal of biomechanics.

[34]  A. Patla,et al.  Visual control of limb trajectory over obstacles during locomotion: effect of obstacle height and width , 1993 .

[35]  M. Nevitt,et al.  Risk Factors for Falls and for Serious Injuries on Falling Among Older Japanese Women In Hawaii , 1999, Journal of the American Geriatrics Society.

[36]  S R Lord,et al.  Choice stepping reaction time: a composite measure of falls risk in older people. , 2001, The journals of gerontology. Series A, Biological sciences and medical sciences.

[37]  Satoru Ebihara,et al.  Differential gait kinematics between fallers and non‐fallers in community‐dwelling elderly people , 2005 .

[38]  J. Collins,et al.  Biomechanical gait alterations independent of speed in the healthy elderly: evidence for specific limiting impairments. , 1998, Archives of physical medicine and rehabilitation.

[39]  D. Kerrigan,et al.  Effect of a hip flexor-stretching program on gait in the elderly. , 2003, Archives of physical medicine and rehabilitation.