Predictive Validity of Motor Fitness and Flexibility Tests in Adults and Older Adults: A Systematic Review

Motor fitness and flexibility have been linked to several health issues. We aimed to investigate the predictive validity of motor fitness and flexibility tests in relation to health outcomes in adults and older adults. Web of Science and PubMed databases were screened for studies published from inception to November 2020. Two authors systematically searched, evaluated, and extracted data from identified original studies and systematic reviews/meta-analysis. Three levels of evidence were constructed: strong, moderate, and limited/inconclusive evidence. In total, 1182 studies were identified, and 70 studies and 6 systematic reviews/meta-analysis were summarized. Strong evidence indicated that (i) slower gait speed predicts falls and institutionalization/hospitalization in adults over 60 years old, cognitive decline/impairment over 55 years old, mobility disability over 50 years old, disability in instrumental activities of daily living (IADL) over 54 years old, cardiovascular disease risk over 45 years old, and all-cause mortality over 35 years old; (ii) impaired balance predicts falls and disability in IADL/mobility disability in adults over 40 years old and all-cause mortality over 53 years old; (iii) worse timed up&go test (TUG) predicts falls and fear of falling over 40 years old. Evidence supports that slower gait speed, impaired balance, and worse TUG performance are significantly associated with an increased risk of adverse health outcomes in adults.

Neuromusculoskeletal Health in Pediatric Obesity: Incorporating Evidence into Clinical Examination

Purpose of Review The study aims to highlight the clinical importance of assessing and managing neuromusculoskeletal health in pediatric obesity and to support translation of evidence into practice. Recent Findings A growing evidence base suggests that children with obesity experience neuromusculoskeletal impairments and physical complications including increased pain, reduced muscle strength, impaired balance and motor skill, gait deviations, postural malalignment, greater fatigue, and potentially reduced flexibility and sub-optimal bone health. Such evidence supports the need to screen, assess, and optimize neuromusculoskeletal health as part of pediatric obesity management. Summary The likelihood of children with obesity experiencing neuromusculoskeletal impairments is high and can impact the way a child moves, and their interest or capacity to engage in physical activity and exercise. Barriers to movement should be minimized to promote optimal development of the neuromusculoskeletal system and to support engagement in sufficient physical activity for weight management. Healthcare professionals should screen for neuromusculoskeletal impairments as well as personalize interventions and modify standardized exercise interventions to optimize obesity treatment. Further research should explore whether neuromusculoskeletal impairments influence the success of obesity treatment or whether they improve following obesity treatment.

Development of an exercise programme for balance abilities in people with multiple sclerosis: a development of concept study using Rasch analysis

Background People with multiple sclerosis (PwMS) frequently have impaired balance from an early stage of the disease. Balance difficulties can be divided into categories; although, to date, these lack scientific foundation. Impaired balance in PwMS can be addressed using specific and challenging exercises. Such exercises should provide an optimal challenge point; however, the difficulty of balance exercises is often unknown, making it difficult to target the exercises to an individual’s abilities. The aims of this study were: to develop an exercise programme for PwMS relating the exercises to the balance problem categories; to establish the order of difficulty of exercises in each category and; to evaluate the content and structural validity of the exercise programme. Methods A “construct map” approach was used to design and develop an exercise programme for PwMS. Potentially relevant balance exercises were identified, then a framework was set up, comprising four dimensions (subsequently reduced to three dimensions) of balance exercises. The relevance, comprehensibility, and comprehensiveness of the exercise programme were rated by 13 physiotherapists, who also linked 19 key exercises to balance categories. A total of 65 PwMS performed the 19 balance exercises, rated their difficulty and commented on the relevance and comprehensibility of each exercise. A Rasch model was used to evaluate the relative difficulty of the exercises. To assess fit of the data to the Rasch model a rating scale model was used, which is a unidimensional latent trait model for polytomous item responses. Results Evaluation by the physiotherapists and PwMS indicated that the content validity of the exercise programme was adequate. Rasch analysis showed that the latent trait “balance exercises in PwMS” comprised three subdimensions (“stable BOS”, “sway” and “step and walk”). The 19 balance exercises showed adequate fit to the respective dimensions. The difficulties of the balance exercises were adequate to cover the ability spectrum of the PwMS. Conclusion A balance exercise programme for PwMS comprising three dimensions of balance exercises was developed. Difficulty estimates have been established for each of the exercises, which can be used for targeted balance training. Content and structural validity of the programme was adequate.

Longitudinal Assessment of Balance Using Virtual Reality in Patients Receiving Potentially Neurotoxic Adjuvant Chemotherapy

PurposeChemotherapy-induced peripheral neuropathy (CIPN) commonly affects people treated for cancer, with functional consequences of impaired balance and falls. Virtual reality technology (VR) may be able to assess balance, identifying patients at increased risk of falls. We aimed to assess the impact of neurotoxic chemotherapy on balance and falls risk using VR, and explore whether changes in balance threshold were associated with falls or validated CIPN measures. MethodsWe conducted a prospective, longitudinal cohort study at two Australian oncology centres. Eligible participants were commencing adjuvant chemotherapy containing a taxane for breast cancer, or oxaliplatin for colon cancer. Excluded: insufficient English to complete assessments, VR intolerance, or pre-existing balance disorder. VR balance threshold was recorded at baseline, intervals during chemotherapy, and 3- and 6-months after chemotherapy completion. Additional measures: 1) clinician-graded peripheral sensory neuropathy (Common Terminology Criteria for Adverse Events), 2) Total Neuropathy Score-clinical, 3) patient-reported neuropathy, 4) ‘Timed Up-and-Go’ test, 5) participant-reported falls/near-falls. ResultsOf 34 participants consented, 24 (71%) had breast cancer and 10 (29%) had colon cancer. Compared to baseline, balance threshold worsened in 10/28 (36%) evaluable participants assessed at the end-of-chemotherapy; this persisted in 7/22 (32%) at 6 months. CIPN affected 86% at end of chemotherapy, and 73% at 6-months post-chemotherapy . Falls/near-falls were reported by 12/34 (35%), and associated with impaired balance (p = 0.002). ConclusionVR balance assessment warrants further investigation as a surrogate method to objectively identify patients at risk of falls from CIPN, however was no better at diagnosing CIPN than existing tools. Trial Registration: N/A

Relationship between Ankle Range of Motion (ROM), Muscle Strength, Balance, and Fall Risk in Postmenopausal Women: A Pilot Study

Menopause is an age-dependent physiological condition associated with a natural decline in estrogen levels, which causes a progressive decrease in muscle mass and strength, and bone density. Estrogen deficiency occurring during menopause will affect both the gynecological area and the whole body which will directly act on skeletal muscle through estrogen receptors. Although various factors are associated with falls in menopausal women, impaired balance and mobility have been consistently identified as the main risk factors. Identification of the factors associated with balance and fall risk may enable therapists to design treatments to help reduce the risk of falls and the consequences. Since the impact of impaired balance and fall risk among postmenopausal women is undefined. The purpose of this study was to assess the relationship between ankle range of motion and muscle strength with balance and fall risk in post-menopausal women. The ankle ROM and muscle strength were examined by using a universal goniometer and push-pull hand-held dynamometer respectively; the balance was assessed by Y balance test (YBT) and fall risk was measured by Fall Efficacy Scale International (FES-I). Karl Pearson correlation coefficient was used to find the relationship between ankle ROM, ankle strength, balance, and fall risk among postmenopausal women which showed a low positive correlation between the ankle ROM and YBT whereas a moderate positive correlation between the ankle strength and YBT which was statistically significant. The correlation between FES-I and ankle ROM and ankle strength were high and moderate respectively which was also statistically significant. Keywords: Postmenopausal women, ankle range of motion, ankle strength, balance, fall risk, YBT

Inducing Body Weight Supported Postural Perturbations during Gait and Balance Exercises to Improve Balance after Stroke: A Pilot Study (Preprint)

BACKGROUND Impaired balance-regulation after stroke put patients and therapists at risk for injury during rehabilitation. Body-weight-support systems (BWSSs) minimize this risk and allow patients to safely practice balance activities during therapy. Treadmill based balance perturbation systems with BWSSs are known to improve balance in patients with age or disease related impairments. However, these stationary systems are unable accommodate complex exercises requiring more freedom of movement. OBJECTIVE To evaluate the effect of a new balance perturbation module, which is directly integrated to a track-mounted BWSS, has on impaired balance secondary to acute stroke. METHODS This unblinded quasi-randomized controlled pilot study took place in a rehabilitation focused long-term acute care hospital. Participants were recruited from stroke rehabilitation inpatients with an admission Berg Balance Scale (BBS) score of 21/56 or greater. Over a two-week period, consented participants completed eight BWSS or BWSS with perturbation (BWSS-P) treatment sessions; study activities were incorporated into regular treatment so as to not disrupt their care. While both groups conducted the same balance and gait activities during their treatment sessions, the BWSS-P sessions included lateral and anterior/posterior resistive or assistive balance perturbations. Pre- and post-intervention BBS and Activities-Specific Balance-Confidence (ABC) assessments were the primary outcome measures collected. Institutional BBS data from fiscal-year 2018, prior to installation of the track mounted BWSS, was used as a historical standard-of-care (SOC) baseline. RESULTS Improved post-intervention BBS and ABC assessment scores showed all participants benefited from therapy (p<0.05). The BBS percent-change of the BWSS-P [mean(SD)n] [66.95%(43.78%)14] and BWSS control [53.29%(24.13%)15] were greater than the SOC group [28.31%(17.25%)30] (p<0.05), with no difference between BWSS groups (p=0.6669); ABC percent score-changes were also similar (p>0.800). CONCLUSIONS Both BWSS groups demonstrated similar BBS and ABC score improvements, indicating balance perturbations are not detrimental to post-acute stroke rehabilitation and are safe to use. This data provides strong rationale for conducting a larger follow-up study to further assess if this new perturbation system provides additional benefit to the rehabilitation of gait and balance impairments following stroke. CLINICALTRIAL ClinicalTrials.gov [NCT04919161]

Changes in plantar load distribution in legally blind subjects

We investigated the impact of visual impairment on balance control. We measured the center of pressure (COP) between the two feet and plantar surface pressures on each foot in 18 normal-sighted participants and compared their data with measures from 18 legally blind participants, either acquired or congenital. Pressures were measured in open- and closed-eye conditions using a baropodometric resistive plate. In the eyes-open condition, there were no differences between the sighted and legally blind groups in COP displacement. However, participants with visual loss had significantly increased pressures in two metatarsal regions (M1 and M2 zones) of the plantar surface in both viewing conditions (p < 0.05). The differences in pressure measures between the normally sighted and legally blind groups could be attributed mainly to the subgroup of subjects with acquired impairment. Our findings suggest that subjects with visual impairment present increased metatarsal pressures (i.e. forefoot), not yet associated to anterior displacement of COP or impaired balance control.

Using augmented reality technology for balance training in the older adults: a feasibility pilot study

Background Impaired balance leading to falls is common in the older adults, and there is strong evidence that balance training reduces falls and increases independence. Reduced resources in health care will result in fewer people getting help with rehabilitation training. In this regard, the new technology augmented reality (AR) could be helpful. With AR, the older adults can receive help with instructions and get feedback on their progression in balance training. The purpose of this pilot study was to examine the feasibility of using AR-based visual-interactive tools in balance training of the older adults. Methods Seven older adults (66–88 years old) with impaired balance trained under supervision of a physiotherapist twice a week for six weeks using AR-based visual-interactive guidance, which was facilitated through a Microsoft HoloLens holographic display. Afterwards, participants and physiotherapists were interviewed about the new technology and their experience of the training. Also, fear of falling and balance ability were measured before and after training. Results Five participants experienced the new technology as positive in terms of increased motivation and feedback. Experiences were mixed regarding the physical and technical aspects of the HoloLens and the design of the HoloLens application. Participants also described issues that needed to be further improved, for example, the training program was difficult and monotonous. Further, the HoloLens hardware was felt to be heavy, the application’s menu was difficult to control with different hand manoeuvres, and the calibration took a long time. Suggestions for improvements were described. Results of the balance tests and self-assessment instruments indicated no improvements in balance performance after AR training. Conclusions The study showed that training with the new technology is, to some extent, feasible for the older adults, but needs further development. Also, the technology seemed to stimulate increased motivation, which is a prerequisite for adherence to training. However, the new technology and training requires further development and testing in a larger context.

Impact of supine versus upright exercise on muscle deoxygenation heterogeneity during ramp incremental cycling is site specific

Purpose We tested the hypothesis that incremental ramp cycling exercise performed in the supine position (S) would be associated with an increased reliance on muscle deoxygenation (deoxy[heme]) in the deep and superficial vastus lateralis (VLd and VLs, respectively) and the superficial rectus femoris (RFs) when compared to the upright position (U). Methods 11 healthy men completed ramp incremental exercise tests in S and U. Pulmonary $$\dot{V}$$ V ˙ O2 was measured breath-by-breath; deoxy[heme] was determined via time-resolved near-infrared spectroscopy in the VLd, VLs and RFs. Results Supine exercise increased the overall change in deoxy[heme] from baseline to maximal exercise in the VLs (S: 38 ± 23 vs. U: 26 ± 15 μM, P < 0.001) and RFs (S: 36 ± 21 vs. U: 25 ± 15 μM, P < 0.001), but not in the VLd (S: 32 ± 23 vs. U: 29 ± 26 μM, P > 0.05). Conclusions The present study supports that the impaired balance between O2 delivery and O2 utilization observed during supine exercise is a regional phenomenon within superficial muscles. Thus, deep muscle defended its O2 delivery/utilization balance against the supine-induced reductions in perfusion pressure. The differential responses of these muscle regions may be explained by a regional heterogeneity of vascular and metabolic control properties, perhaps related to fiber type composition.