Evaluation of Gait Characteristics in Subjects With Locomotive Syndrome Using the Wearable Gait Sensors

Background: Locomotive syndrome (LS) is a condition where a person requires nursing care services due to problems with locomotive abilities and musculoskeletal systems. Individuals with LS have a reduced walking speed compared to those without LS. However, differences in lower-limb kinematics and during walking between individuals with and without LS are not fully understood. The purpose of this study is to clarify the characteristics of gait kinematics using wearable sensors for individuals with LS.Methods: We assessed 125 people aged 65 years and older who utilized a public health promotion facility. The participants were grouped into Non-LS, LS-stage 1, LS-stage 2 (large number indicate worse locomotive ability) based on 25-question Geriatric Locomotive Function Scale (GLFS-25). Spatiotemporal parameters and lower-limb kinematics during 10-m walking test were analyzed by 7-inertia-sensors based motion analysis system. Peak joint angles during stance and swing phase as well as gait speed, cadence and step length were compared among all groups.Results: The number of each LS stage was 69, 33, 23 for Non-LS, LS-stage 1, LS-stage 2, respectively. LS-stage2 group showed significantly smaller peak hip extension angle, hip flexion angle and knee flexion angle than Non-LS group (hip extension: Non-LS: 9.5 ± 5.3°, LS-stage 2: 4.2 ± 8.2°, P = 0.002; hip flexion: No-LS: 34.2 ± 8.8°, LS-stage 2: 28.5 ± 9.5°, P = 0.026; knee flexion: Non-LS: 65.2 ± 18.7°, LS-stage 2: 50.6 ± 18.5°, P = 0.005). LS-stage 1 and LS-stage 2 groups showed significantly slower gait speed than Non-LS group (Non-LS 1.3 ± 0.2 m/s, LS-stage1 1.2 ± 0.2 m/s, LS-stage2 1.1 ± 0.2 m/s, P < 0.001).Conclusions: LS-stage2 group showed significantly different lower-limb kinematics compared with Non-LS group including smaller hip extension, hip flexion and knee flexion. The intervention based on these kinematic characteristics measured by wearable sensors would be useful to improve the locomotive ability for individuals classified LS-stage2.

Effects of nutritional intervention by feeding high-protein foods containing BCAA for improving locomotive syndrome: Randomized Controlled Trial

[Purpose] Exercise guidance is an effective measure against locomotive syndrome. Appropriate nutritional management is also considered necessary in order to maintain the motor function. This study is the first exploratory and prospective research on the effects of exercise guidance and feeding high-protein foods in order to improve locomotive syndrome, in elderly people. [Method] We conducted a survey regarding five items related to locomotorium on the basic checklist prepared by the Japanese Ministry of Health, among men and women in their 60s and over living in Miyazaki Prefecture. Participation was solicited from those who responded “applicable” to three or more items, with those who gave their consent assigned to a food + exercise intervention group (EF group), an exercise intervention group (EX group), and a control group (C group) for research. Motor function surveys such as interviews, questionnaire, and locomotive syndrome risk test were conducted at the start of the study and three months later. The EX and EF groups were instructed to carry out locomotion training, while the EF group was asked to ingest one bag of high-protein test food daily immediately following exercise. The participants carried an activity meter and kept a record of their life in a diary during the study period. The EX and EF groups were encouraged to make recordings in a diary and carry an activity meter, while also getting a regular telephone contact once a week. [Results] An improvement in the motor function was observed in the EX and EF group compared to the C group via Locomotive syndrome risk testing. While the muscle mass decreased significantly during the study period in the C and EX group, no significant change was observed in limbs/trunk muscle mass in the EF group. [Conclusion] The locomotion training improved the results of the Locomotive syndrome risk testing. Although muscle mass decreased with exercise guidance alone, muscle mass loss was suppressed by feeding high-protein foods in addition to exercise. We conclude that feeding high-protein foods is useful for improving motor function and maintaining muscle mass, in addition to exercise guidance, as a measure against locomotive syndrome in elderly.

Locomotive Syndrome Associated With Daily Moderate to Vigorous Physical Activity in Community‐dwelling Older Adults: A Cross-sectional Analysis

Background: Locomotive syndrome (LS) is associated with weakness and loss of function in the musculoskeletal organs. To evaluate the association between LS and daily physical activities (PA) in community-dwelling older adults using a three-axis accelerometer. Methods: This cross-sectional study included healthy 80 older adults (40 men and 40 women; age: 60-79 years). Three functional tests, the two-step test, the stand-up test, and the 25-question geriatric locomotive function scale (GLFS) were used to assess the risk of LS. Maximal isometric muscle strengths of the knee extensors were examined, and the weight bearing index (knee extension strength/body weight) was calculated. Habitual daily PA was evaluated using a three-axis wrist accelerometer. Results: Of the 80 participants, 41 (51.3%) fulfilled the diagnostic criteria for LS (including a two-step test score < 1.3, difficulty with one-leg standing from 40 cm in the stand-up test, and a 25-question GLFS score ≥ 7) We found that step count and time spent performing moderate to vigorous PA (MVPA) were significantly higher in women participants without LS compared to those with LS (p = 0.01); no significant difference was found in men. Logistic regression analyses indicated a longer time spent performing MVPA (> 47.26 min/day) was associated with a lower risk of LS compared to only performing for 21.11 min/day. Conclusions: Our data showed that daily MVPA using a three-axis accelerometer was associated with LS in community-dwelling older adult women, but not in men.

Comparing Psychometric Properties of GLFS-5 With GLFS-25 for Screening Locomotive Syndrome in Community-dwelling Iranian Older People

Objectives: Locomotive syndrome refers to reduced mobility due to impairment of locomotive organs. Because of the importance of screening locomotive syndrome among older people, this article is focused on psychometric characteristics of Geriatric Locomotive Function Scale (GLFS)-5 and comparing it with GLFS-25 in Iranian older adults Methods: This research was conducted on 320 older Iranian people. Validity and reliability of the GLFS-5 were examined and confirmed using Content Validity Index (CVI), factor analysis, correlation coefficient with the European Quality of Life Scale-5 Dimension (EQ-5D) questionnaire, the Cronbach α value for internal consistency, and intraclass correlation and Receiver Operating Characteristic (ROC) technique to determine the cutoff score for the locomotive syndrome. Results: In phase 1 of the study, 250 Iranian older people ≥60 years were analyzed. The factor analysis showed that the GLFS-25 is a multi-dimensional scale (Activities of Daily Livings [ADLs] and Quality of Life [QoL], pain, social relationship, and psychological status), and GLFS-5 is a one-dimensional scale (the ability to perform daily activities). The Cronbach α values for GLFS-25 and GLFS-5 were 0.93 and 0.84, respectively. As for association between the GLFS-25 and GLFS-5 with EQ-5D and Visual Analogue Scale (VAS) (health self-perceived), the Pearson correlation coefficients were 0.85 and -0.72 for GLFS-25 (P=0.01) and 0.82 and -0.67 for GLFS-5 (P=0.01), respectively. The cutoff scores to identify locomotive syndrome for the GLFS-25 and GLFS-5 were 16 and 4, respectively. Discussion: Considering the good validity and reliability properties of the GLFS-5 compared to GLFS-25 and the more convenient use of this short version of the GLFS, its application is highly recommended for community-based screening of locomotive syndrome in Iranian older people.

Factors Related to Locomotive Syndrome in School-Aged Children in Okazaki: A Cross-Sectional Study

The relationship of locomotive syndrome with other physical characteristics and lifestyle habits in children has not been fully elucidated. The aim of this study was to assess the prevalence of children’s locomotive syndrome, and to determine its relationship with the above-mentioned factors. This was a cross-sectional study of 285 elementary school children who volunteered to participate in a medical checkup for physical function. Data was collected via medical examination, clinical measurements, and questionnaires. A multivariable logistic regression model was used to determine the relationship (odds ratios; ORs) of participants’ characteristics, physical functions, and other outcomes determined by questionnaire on locomotive syndrome. The following factors were related to locomotive syndrome: older age (OR = 1.421, 95% confidence interval [CI] [1.039, 1.945]), male sex (OR = 4.011, 95% CI [2.189, 7.347]), and more time spent watching television per day (OR = 1.281, 95% CI [1.001, 1.640]). These results may assist in the encouragement of children to perform appropriate physical activities and avoid unhealthy lifestyle habits, reducing the occurrence of locomotive syndrome.

Factors associated with mobility decrease leading to disability: a cross-sectional nationwide study in Japan, with results from 8681 adults aged 20-89 years

Background Mobility decrease leading to disability can gradually develop during early life, however, its related factors are not well clarified. Therefore, we investigate the related factors of mobility decrease at various levels, using nationwide data in Japan. Methods In total, 8681 independent community dwellers aged 20-89 years were analysed (average age, 51.6 years; 58.5% women). Three stages of mobility decrease were based on the locomotive syndrome risk test: Stage 1, emerging; Stage 2, progressing; Stage 3, progressed to restrict social engagement. Age was analysed using a simple quadratic function model. Results The prevalence of Stages 1-3 was 31.6% (n = 2746), 5.8% (n = 504), and 3.2% (n = 278), respectively. On the multivariable logistic regression, increased age in participants aged ≥40 years (stage 1: odds ratio[OR] 1.05-1.20, stage 2: OR 1.04-1.22, stage 3: OR 1.05-1.22), female (stage 1: OR 2.28, 95% confidence interval [CI] 1.99-2.61, stage 2: OR 2.40, 95% CI 1.77-3.25, stage 3: OR 1.80, 95% CI 1.19-2.72), overweight status (stage 1: OR 1.56, 95% CI 1.34-1.82, stage 2: OR 3.19, 95% CI 2.38-4.27, stage 3: OR 2.87, 95% CI 1.90-4.32), hypertension (stage 1: OR 1.20, 95% CI 1.01-1.41, stage 2: OR 1.99, 95% CI 1.49-2.64, stage 3: OR 2.10, 95% CI 1.44-3.05), and diabetes mellitus (stage 1: OR 1.62, 95% CI 1.17-2.24, stage 2: OR 1.57, 95% CI 0.93-2.66, stage 3: OR 2.10, 95% CI 1.13-3.90) were positively associated. The frequency of physical activity/sports, even a few per month, was inversely associated with all stages (stage 1: OR 0.59-0.72, stage 2: OR 0.50-0.67, stage 3: 0.36-0.53). A one-year increase in age had a stronger impact on mobility decrease in older adults than in younger ones. Increased age in participants aged < 40 years and smoking were associated with Stage 1, while intake of various foods was inversely associated with Stages 1 and 2. Conclusion Increased age (< 40 years) was associated with emerging mobility decrease, while that (≥ 40 years) was associated with any levels of mobility decrease. Female, lifestyle habits, including physical activities and overweight status, were associated with mobility decrease at every level.

Does Locomotive Syndrome, Associated with Sarcopenia or otherwise, Influence Quality of Life in Individuals Aged over 80 years? Third Wave of the LOCOMOV Project

Introduction: Locomotion is a determinant of intrinsic capacity ofolder people and can be limited by dysfunction in locomotory organs,characterizing Locomotive Syndrome (LoS). Knowledge on locomotiveproblems and sarcopenia, and their interface with quality of life, in theoldest old in the literature is scarce.Objective: To evaluate the correlation between LoS and sarcopenia andtheir influence on quality of life in oldest old.Methods: A cross-sectional study of an observational, descriptive andanalytical epidemiological survey in independent older adults aged 80and over from São Paulo, Brazil and who participated in the third waveof the LOCOMOV Project, was carried out. Sociodemographic data,comorbidities, functioning in activities of daily living, physical functioning,quality of life, and presence of sarcopenia and LoS were assessed. Thestatistical analyses included the Test-for-Comparing-Two-Proportions,Pearson's Correlation Coefficient, the chi-Square test and Student´s t-test.Results: Thirty oldest old with a mean age of 89.1 years were evaluated.The prevalence of LoS was high (53.3%) and correlated significantly withchronic pain (p-value 0.024), worse performance on the SPPB and Gaitspeed (p-value <0.001). Sarcopenia was not correlated with LoS, but worsequality of life on the physical domain was significantly associated with LoS(p-value <0.001) regardless of the presence of sarcopenia.Conclusions: LoS was highly prevalent among the oldest old studied andnegatively impacted their quality of life, regardless of the presence ofsarcopenia.

Associations between locomotive and non-locomotive physical activity and physical performance in older community-dwelling females with and without locomotive syndrome: a cross-sectional study

Background Locomotive syndrome (LS) is a condition of reduced mobility due to a disorder of the locomotive system. Increasing moderate to vigorous physical activity (MVPA) has been recommended to prevent LS. However, to increase daily MVPA is difficult for older people with LS. The MVPA consists of not only locomotive activities such as walking but also non-locomotive activities such as household activities. The aim of this study was to examine the associations between locomotive/non-locomotive MVPA and physical performance in older females with and without LS. Methods Participants of this cross-sectional study were 143 older community-dwelling Japanese females. The participants were divided into two groups based on the results of the stand-up test: the normal group (NL) (n = 86) and the LS group (n = 57). Both the locomotive and non-locomotive PA seperately measured with its intensity. The intensity of physical activity (PA) was calculated as METs and classified as sedentary behavior (SB 1–1.5 metabolic equivalent tasks (METs)), low-intensity physical activity (LPA 1.6–2.9 METs), and MVPA (≥ 3 METs). For example, locomotive LPA is slow walking speed of 54 m/min, and locomotive MVPA is walking speed of 67 m/min. While non-locomotive LPA is office work and cooking, non-locomotive MVPA is housecleaning. Physical function was evaluated by handgrip strength, walking speed, and 2-step test. Results Walking speed, hand-grip strength, 2-step test, daily step counts, and all PA measurements were not significantly different between two groups. In the LS, locomotive MVPA (r = 0.293, p < 0.05) and total MVPA (r = 0.299, p < 0.05) was significantly correlated with walking speed, but not in the NL. Conclusions Walking speed was positively correlated with locomotive MVPA and total MVPA in the LS group, but not in NL group. This result suggests that slow walking speed in older people with LS occur in connection with lower locomotive MVPA and total MVPA.

Locomotive syndrome: a new view of fragility in older age

Locomotive syndrome is a geriatric syndrome that corresponds to the model of autonomy loss and the emergence of addictions due to pathology of the musculoskeletal system with a heavy medical and social burden. Combination of musculoskeletal system diseases, including osteoarthritis, osteoporosis, dorsopathy, sarcopenia, neuropathy, together with impaired physical functioning are the clinical characteristics of locomotive syndrome. Only comprehensive programs, including pain treatment, the risk of osteoporetic fractures, prevention of falls, correction of sarcopenia, physical training, psychotherapeutic methods, etc., can increase the mobility of patients with locomotive syndrome and help reduce addictions in older age.