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.

Preliminary Assessment of Muscle Activity and Muscle Characteristics during Training with Powered Robotic Exoskeleton: A Repeated-Measures Study

A variety of robotic exoskeletons have been developed for patients with spinal cord injuries. However, the optimal training method and period for using a robotic exoskeleton have been uncertain until now. The purpose of this study is to determine the minimum training period for using a robotic exoskeleton with minimal muscle activity by investigating the changes in muscle activity and muscle characteristics of healthy adults during robotic exoskeleton training. A total of 16 people participated in the study. The robotic exoskeleton locomotion training consisted of three 50-min sessions a week for 7 weeks. The assessment consisted of sitting, standing, wide standing, sit-to-stand, and stand-to-sit where muscle activity and muscle characteristics were measured during each motion. All measurements were performed in the first session and every five sessions. Participants showed decreased muscle activity up to 10 sessions of training in the standing position, and 15 sessions in sit-to-stand and stand-to-sit motions. Upper extremity muscles showed decreased muscle activity, tone, stiffness, and logarithmic decrement up to the 15th session. The study results show that at least 15 training sessions are required to use the robotic exoskeleton with minimal load on the musculoskeletal system, and longer training is required for patients with spinal cord injury.

Comparative trial of the effects of continuous locomotion training provided at pharmacies: a pilot study

Background While the world’s population is growing older, healthy life expectancy is not increasing. The Japanese Orthopedic Association proposed the concept of ‘locomotive syndrome,’ manifested as a decline in mobility functions, and introduced a short test battery for assessing the risk of this syndrome. The test battery includes the ‘stand-up test,’ ‘two-step test,’ and ‘25-question Geriatric Locomotive Function Scale’ (25-question GLFS). The purpose of locomotion training is to improve and sustain standing and gait functions. However, the place where locomotion training can be provided and followed up has not been decided upon. Therefore, a study was conducted to explore the effect of locomotive syndrome improvement by continuous locomotion training provided at community pharmacies. The objective of this study was to evaluate the effect of pharmacists’ instructions and follow-up on the compliance and effectiveness of locomotion training. Methods The inclusion criteria were 1) age ≥ 65 years and 2) decline in mobility functions. Guidance on how to perform locomotion training was provided by a pharmacist at the pharmacy. The participants performed locomotion training at home. They were tested and instructed at the pharmacy once a month for 3 months. The main outcome measures were test battery results and the percentage of number of days participants who were able to do the training at home. Results Eleven participants were analysed. The minimum implementation percentage was 78%. Improvements were observed in 25-question GLFS, muscle strength, and standing time on one leg. Three participants no longer showed a noticeable decline in mobility function. Conclusion Continuous locomotion training provided at pharmacies could contribute to locomotive syndrome prevention. Trial registration This study was registered with the University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; identification No. UMIN000027963. Registered 28 June 2017).

Forward and Retro Locomotion Training on Anthropometrical Body Compositions and Aerobic Performance

Background Forward and retro locomotion on a treadmill is a common tool for lower extremity rehabilitation in the clinical setting. The purpose of this study was to evaluate effect on anthropometrical body composition adaptations and aerobic performance during forward and retro locomotion training on a treadmill at 10-degree inclinations. Methods A convenience sample of 30 healthy male subjects with mean age of 20.93±2.54 years, participated in the study. Subjects were divided into 2 groups, Forward Locomotion Group (FLG) and Retro Locomotion Group (RLG) (n=15) and performed forward and retro locomotion training on a treadmill at 10-degree inclination respectively for duration of 6 weeks. Study outcomes such as aerobic performance and anthropometrical body composition were measured at pre and post intervention phases. Results Although both FLG and RLG training improved aerobic performance significantly. However, RLG reported a significant improvement as compared to FLG in the above parameters. Whereas, anthropometrical body composition changes are not found to be significant even after 6 weeks of intervention in both groups. Conclusion Both the forward and retro locomotion training improved aerobic performance but not the body composition variables, also retro locomotion training was more effective than forward locomotion in improving aerobic performance.

Possible Improvement of the Sagittal Spinopelvic Alignment and Balance through “Locomotion Training” Exercises in Patients with “Locomotive Syndrome”: A Literature Review

On the basis of rapid population aging, in 2007, the Japanese Orthopaedic Association (JOA) proposed a new disease concept “locomotive syndrome” as a degenerative condition of reduced mobility due to the impairment of the musculoskeletal system. Worsened locomotive components, which consist of bones, joints, and intervertebral discs, and muscles and nerves, can lead to symptoms such as pain, limited range of motion, malalignment, impaired balance, and difficulty in walking, ultimately resulting in the requirement of nursing care. “Locomotive syndrome” has gained increased interest in Japan but still not worldwide. Hence, in this brief review, we summarize an updated definition, assessment, and management of “locomotive syndrome”. The JOA recommends “locomotion training” exercise intervention to be effective in maintaining motor function that comprises two simple exercises—squatting and single-leg standing. However, the extent to which exercises affect “locomotive syndrome” is unknown. Here, we further report hypothesis-generating patient cases who presented the improved sagittal spinopelvic alignment in standing radiographs and postural stability in piezoelectric force-plate measurements through our 6-month “locomotion training” outpatient rehabilitation program. It is noteworthy that “locomotion training” facilitated these improvements despite the presence of specific disorders including thoracic kyphosis and symptomatic lumbar spinal canal stenosis. This raises the need for further investigations to clarify effects of “locomotion training” exercises on the spinal alignment, global balance, and quality of life in patients with “locomotive syndrome”.