Effects of Paraplegia Fitness Integrated Training on Physical Function and Exercise Self-Efficacy and Adherence Among Individuals With Spinal Cord Injury.

OBJECTIVE: To determine the effects of the Paraplegia Fitness Integrated Training (PARAFiT) program, which is an integrated graded physical exercise and health education program for individuals with spinal cord injury (SCI). METHODS: This nonrandomized single-blind study included 44 participants, who were assigned to either an intervention (PARAFiT) group or an active control (conventional physiotherapy) group. The intervention group underwent the PARAFiT program (8 weeks), which consisted of circuit-based interval training, progressive upper limb resistance training, and health education sessions. During the unsupervised period, the intervention group continuously underwent health education program once a month for 2 months (8 weeks). Repeated-measures analysis of variance was used for the analysis. RESULTS: The intervention group presented with a higher level of physical activity than did the control group; however, the difference was not significant (p=0.36). Additionally, the intervention group presented with better exercise self-efficacy and cardiorespiratory fitness and stronger bilateral shoulder muscle and handgrip than did the control group (all p<0.05). Exercise adherence was higher in the intervention group than in the control group during both the supervised (80% vs. 75%) and unsupervised (40% vs. 20%) periods. CONCLUSION: The PARAFiT program enhanced the level of physical activity, exercise self-efficacy, physical fitness, and exercise adherence among the patients with SCI. Future studies should incorporate guidelines for home-based exercises and regular monitoring to promote long-term adherence to exercise and physical activity among individuals with SCI.

Effects of patient education on the quality of life of patients with type 2 diabetes mellitus: A scoping review.

Introduction: Patient education is an integral component of diabetes mellitus care. The emergence of different methods and characteristics of patient education has led to varying outcomes of quality of life (QoL). Herein, we systematically searched for published studies reporting patient education and its methods and characteristics for improving the QoL of patients with type 2 diabetes mellitus (T2DM). Method: In this scoping review, eligible studies from six databases (PubMed, Scopus, Cochrane Library, Springer Link, Science Direct and Google Scholar) were identified. The keywords used in the search strategies were as follows: health education, health promotion, patient education, diabetes care, QoL, diabetes mellitus and type 2 diabetes mellitus. Two reviewers independently screened all references and full-text articles retrieved to identify articles eligible for inclusion. Results: A total of 203 articles were identified in the initial search. Of them, 166 were excluded after screening the titles and abstracts. Further full-text screening led to the subsequent removal of 22 articles, leaving 15 articles eligible for data extraction. Conclusion: There is a broad array of methods of patient education for improving the QoL of patients with T2DM. Self-management education with supplementary supervision and monitoring effectively improves QoL. Future studies must emphasise the application of holistic education covering psychological distress, diet plan, and physical health.

Home-Based Physical Activity in Patients With Type 2 Diabetes Mellitus: A Scoping Review.

To promote optimal healthcare delivery in type 2 diabetes mellitus (T2DM) following the outbreak of coronavirus disease 2019, adopting home-based physical activity (PA) is being seriously considered. Therefore, this study aims to outline the characteristics of exercise protocols for home-based PA and the challenges and limitations in implementing home-based PA in patients with T2DM. This scoping review was carried out by identifying eligible studies in six different databases (Scopus, Cochrane Library, SpringerLink, ProQuest, Science Direct, and Google Scholar). The keywords used in the search strategies were: home-based physical activity, home-based exercise therapy, home-based physical exercise, home-based exercise, home-based exercise training, diabetes mellitus, and T2DM. Two reviewers independently screened all full-text articles to find articles that met the eligibility requirements. A total of 443 articles were identified in the search. Approximately 342 articles were excluded by screening titles and abstracts, which led to the selection of 44 articles relevant to the current study. Further screening of the full-text led to the subsequent removal of 34 other articles, leading to 10 studies that were eligible for data extraction. This review suggested that the exercise protocols for home-based PA include resistance exercise using free weight and own body weight with a frequency of two to three sessions per week at moderate intensity, along with aerobic exercise (particularly walking) with a frequency of three to five times per week at moderate intensity. A combination of resistance and aerobic exercise showed more significant benefits of PA in patients with T2DM. More studies regarding home-based PA in T2DM patients with metabolic disorders are warranted.

Effectiveness of a 3-month antifalling program in the mobility, balance confidence, and muscle performance of older adults.

This study determined the effectiveness of a 3-month group-based multicomponent exercise program in the mobility, balance confidence, and muscle performance of older adults. A total of 40 participants (mean age=70.60±6.25 years completed pre- and posttest clinical intervention measures of mobility using the Timed Up and Go (TUG) test, balance confidence using the Activities-specific Balance Confidence scale, upper limb strength (handgrip dynamometer), and lower limb function (30-sec chair rise test). Data were analyzed using paired t-test and based on TUG criteria for risk of fall (low- and high-risk groups). Significant improvements were found in all measures (All P<0.05) following the 3-month program. Measures according to the risk of fall categories were also significantly improved (P<0.01), except the left handgrip strength (P>0.05). The low-risk group showed a higher improvement in mobility (14.87% vs. 11.74%), balance confidence (34.21% vs. 26.08%), and lower limb function (96.87% vs. 21.20%) but was not significantly different from the high-risk group (P>0.05). A group-based multicomponent exercise program benefited the physical functions of older adults at low- or high risk of falls.

Dual-Tasking Effects on Gait and Turning Performance of Stroke Survivors with Diabetic Peripheral Neuropathy.

BACKGROUND: Stroke survivors depend on the unaffected leg during walking and standing. The presence of diabetic peripheral neuropathy (DPN) affecting both legs may further affect the postural balance and gait instability and increase the risk for falls in such patients. Thus, this study was conducted to investigate the effect of dual taskings on the gait and turning performance of stroke survivors with DPN. METHODS: Forty stroke survivors were recruited (20 with DPN and 20 without DPN) in this cross-sectional study design. Instrumented timed up and go (iTUG) tests were conducted in three different tasking conditions (single task, dual motor and dual cognitive). APDM® Mobility Lab system was used to capture the gait parameters during the iTUG tests. A two-way mixed analysis of variance was used to determine the main effects of gait performance on three taskings during the iTUG test. RESULTS: Spatiotemporal gait parameters and turning performance (turning time and turning step times) were more affected by the tasking conditions in stroke survivors with DPN compared to those without DPN (P < 0.05). CONCLUSION: Stroke survivors with DPN had difficulty walking while turning and performing a secondary task simultaneously.

Relationship between anthropometric characteristics and aerobic fitness among Malaysian men and women.

This cross-sectional study evaluated the relationships between anthropometric and aerobic fitness (rate of perceived exertion [RPE] and predicted maximal oxygen uptake [VO2max]) among 228 participants (age: 23.78±4.42 years). RPE and predicted VO2max were determined during the cycle ergometer exercise test. Data were also obtained for height, weight, body mass index (BMI), hip and waist (WC) circumferences. Data analysis revealed VO2max is correlated with WC (r=-0.571), weight (r=-0.521), waist-to-height ratio (WHtR) (r=-0.516), waist-to-hip ratio (WHR) (r=-0.487), and BMI (r=-0.47) in men, while, in women with WC (r=-0.581), weight (r=-0.571), WHtR (r=-0.545), BMI (r=-0.545), WHR (r=-0.473), and height (r=-0.287) (all P<0.05). Regression analysis showed WC was a significant predictor for VO2max in men and women (r 2=32.6% vs. 33.7%). The receiver operating characteristic curve of WC showed 0.786 and 0.831 for men and women, respectively. WC or abdominal obesity is the strongest predictor for VO2max, which is an indicator of aerobic fitness in Malaysian adults.

The effectiveness of patient education in improving pain, disability and quality of life among older people with low back pain: A systematic review.

OBJECTIVES: This study aimed to gain an overview of patient education and the effects of patient education for older people with low back pain (LBP). METHODS: The search strategies were performed via EBSCO MEDLINE, EBSCO CINAHL, Science Direct, PubMed, and PEDro databases from 2006 to 2016. The keywords "patient education", "low back pain", "elderly", "older adults", "older persons" and "older people" were used during the literature search. Boolean operators were used to expand or limit the searching scope and manual exclusion was performed to choose articles eligible for this study. RESULTS: A total of 2799 articles were retrieved but only five articles were related with patient education for older people with LBP. Findings suggest that patient education for older people may differ in terms of its contents such as health education, self-management, video education, and postural education. The high methodological quality of the studies revealed that patient education showed improvement in terms of pain, disability and quality of life among older people with LBP. CONCLUSIONS: Patient education improved pain and had positive effects on disability and quality of life among older people with LBP. However, due to the limited number of RCTs more studies are needed to provide evidence for its effectiveness.

Effects of Graded Exercises Integrated with Education on Physical Fitness, Exercise SelfEfficacy, and Activity Levels in People with Spinal Cord Injury: A Quasi-Experimental Study Protocol.

Study Design: A quasi-experimental single-blinded study. Purpose: To investigate the effects of 'graded exercise integrated with education' on physical fitness, exercise self-efficacy (ESE), and physical activity (PA) levels among subacute and chronic wheelchair-dependent paraplegia patients. Overview of Literature: Most of the chronic spinal cord injury (SCI) patients had low physical fitness due to a sedentary lifestyle and lack of ESE after discharge from a rehabilitation program. Education may encourage them to engage with exercise to regain and maintain their physical fitness. However, there is a lack of research to support the effects of exercise integrated with education after an SCI. Methods: A total of 44 participants will be assigned to either the experimental group (graded exercise integrated with education) or active control (conventional physical therapy). The experimental group will receive graded strength and aerobic exercise training according to their progression criteria. They will attend an education program during and after the rehabilitation program. The control group will only receive conventional physical therapy during their in-rehabilitation program. This study will be conducted during a period of 16 weeks, consisting of 8 weeks of in-rehabilitation and 8 weeks post-rehabilitation. Statistical analysis will be performed using the IBM SPSS ver. 21.0 (IBM Corp., Armonk, NY, USA) at a significance level of p≤0.05. Results: The primary outcome measures will be upper-limb isokinetic strength, isometric grip strength, and cardiorespiratory fitness. The secondary outcomes will be ESE and PA levels. Conclusions: An intervention that combines exercise training and education may be warranted to enhance the physical fitness, ESE, and PA levels in SCI patients. This trial was registered with ClinicalTrials.gov (NCT03420170).

Regression equations to estimate the 2-min walk distance in an adult Asian population aged 40-75 years.

BACKGROUND AND OBJECTIVE: There is increased use of the 2-min walk test (2MWT) to assess functional exercise capacity. However, the distance achieved during this test may be difficult to interpret in the absence of reference values from a local population. Regression equations to estimate the 2-min walk distance (2MWD) only exist for American and Brazilian populations. The objective of this study was to develop regression equations to estimate the 2MWD in Malaysian adults who were free from major health problems. METHODS: Eighty-seven adults (43 males; mean ± SD age: 57.1 ± 9.6 years) performed two 2MWT using a standardized protocol. Heart rate (HR) was recorded every 30 s during the test. Stepwise multiple regression analysis was performed using age, gender, height, weight and change in HR (ΔHR) as independent variables, and better of the two 2MWD as the dependent variable. A second regression equation, without ΔHR, was planned if ΔHR was retained as one of the predictors of the 2MWD in the first equation. RESULTS: The better of the two 2MWD was 200 ± 34 m. Males walked 33 ± 6 m further than females (P < 0.001). The two regression equations were 196 - 1.1 × age, years + 1.0 × ΔHR, bpm + 31.2 × gender (R2 = 0.73) and 279 - 1.7 × age, years + 35.9 × gender (R2 = 0.47) with females = 0 and males = 1. CONCLUSION: The equations derived in this study may facilitate the interpretation of the 2MWD in clinical populations in Malaysia, as well as in countries with similar cultural backgrounds to Malaysia.

Effects of Kinesio® Taping on Dynamic Balance Following Fatigue: a Randomized Controlled Trial.

The objective of the study was to determine the effects of Kinesio taping (KT) in inhibiting fatigue and preserving dynamic balance. Male recreational athletes were recruited to participate in this study. Participants were blinded from the group assignment and divided into four groups (Group A; KT and fatigue, Group B; no tape and fatigue, Group C; KT and no fatigue and Group D; no tape and no fatigue) using sequentially opaque, sealed envelopes. Pre and post measurements of Modified Star Excursion Balance Test (SEBT) composite score and normalized reach distance were used to measure dynamic balance. Adapted Functional Agility Short Term Fatigue Protocol (FAST-FP) was used to induce fatigue. KT was applied to rectus femoris, biceps femoris and medial gastrocnemius of the dominant leg. There was a significant change in the SEBT composite score between groups over time (p<0.05) and in time effect (p<0.05). The main effect comparing the SEBT composite score between the group was not significant (p=0.16). Group A (90.10±9.40) and Group B (86.14±10.50) attained lower mean for SEBT composite score compared to Group C (97.30±10.83) and Group D (98.13±9.47) suggests that fatigue have a diminishing effect on dynamic balance. KT application inhibit the effects of fatigue and preserved lateral and posterior direction of SEBT. KT application may lower the risk for injuries in the lateral and posterior directions following fatigue induction.

Kinesiophobia, Pain, Muscle Functions, and Functional Performances among Older Persons with Low Back Pain.

OBJECTIVES: This study aims (1) to determine the association between kinesiophobia and pain, muscle functions, and functional performances and (2) to determine whether kinesiophobia predicts pain, muscle functions, and functional performance among older persons with low back pain (LBP). METHODS: This is a correlational study, involving 63 institutionalized older persons (age = 70.98 ± 7.90 years) diagnosed with LBP. Anthropometric characteristics (BMI) and functional performances (lower limb function, balance and mobility, and hand grip strength) were measured. Muscle strength (abdominal and back muscle strength) was assessed using the Baseline® Mechanical Push/Pull Dynamometer, while muscle control (transverse abdominus and multifidus) was measured by using the Pressure Biofeedback Unit. The pain intensity and the level of kinesiophobia were measured using Numerical Rating Scale and Tampa Scale of Kinesiophobia, respectively. Data were analyzed using Pearson's correlation coefficients and multivariate linear regressions. RESULTS: No significant correlations were found between kinesiophobia and pain and muscle functions (all p > 0.05). Kinesiophobia was significantly correlated with mobility and balance (p = 0.038, r = 0.263). Regressions analysis showed that kinesiophobia was a significant predictor of mobility and balance (p = 0.038). CONCLUSION: We can conclude that kinesiophobia predicted mobility and balance in older persons with LBP. Kinesiophobia should be continuously assessed in clinical settings to recognize the obstacles that may affect patient's compliance towards a rehabilitation program in older persons with LBP.

The Effect of Diabetic Peripheral Neuropathy on Ground Reaction Forces during Straight Walking in Stroke Survivors.

Purpose. The aim of this present study was to investigate the ground reaction forces (GRFs) alterations in stroke survivors with diabetic peripheral neuropathy (DPN). Methods. Ten stroke survivors with DPN, 10 stroke survivors without DPN, and 10 healthy controls with matched body weight between groups participated in this case-control cross-sectional study. Three-dimensional GRFs (anterior-posterior, medial-lateral, and vertical) were collected at a comfortable walking speed using the Nexus Vicon motion analysis system and force plate. The Kruskal-Wallis test was used to analyze GRFs parameters. Results. We found significant alterations of medial-lateral forces of the nonparetic side and vertical forces of the paretic side in stroke survivors with DPN compared to stroke survivors without DPN and healthy controls. In addition, there were smaller braking and lower propulsion peak in anterior-posterior forces, smaller magnitude of medial-lateral forces, and lower first and second peak of vertical forces in stroke survivors with DPN compared to stroke survivors without DPN and healthy controls. Conclusion. The study findings identified that GRFs were affected in stroke survivors with DPN on both the paretic and the nonparetic sides. Further investigations are warranted to explore the impact of DPN on the kinematics and muscle activity related to the gait performance in stroke survivors with DPN.

Axial Segmental Coordination During Turning: Effects of Stroke and Attentional Loadings.

Attentional loadings deteriorate straight walking performance for individuals poststroke, but its effects on turning while walking remain to be determined. Here we compared turning kinematics under three attentional loading conditions (single, dual-motor, and dual-cognitive task) between stroke survivors and healthy controls. Nine chronic stroke survivors and 10 healthy controls performed the Timed Upand- Go test while their full-body kinematics were recorded. Onset times of yaw rotation of the head, thorax and pelvis segments and head anticipation distance were used to quantify turning coordination. Results showed that stroke survivors reoriented their body segments much earlier than the controls, but they preserved the similar segmental reorientation sequence under the single-task condition. For the healthy controls, attentional loading led to an earlier axial segment reorientation, but the reorientation sequence was preserved. In contrast, the dual-cognitive task condition led to a disrupted reorientation sequence in stroke. The results indicate that turning coordination was altered in individuals poststroke, especially under the dual-task interference.

Plantar Pressure Distribution among Older Persons with Different Types of Foot and Its Correlation with Functional Reach Distance.

Background. Changes in biomechanical structures of human foot are common in the older person, which may lead to alteration of foot type and plantar pressure distribution. We aimed to examine how foot type affects the plantar pressure distribution and to determine the relationship between plantar pressure distribution and functional reach distance in older persons. Methods. Fifty community-dwelling older persons (age: 69.98 ± 5.84) were categorized into three groups based on the Foot Posture Index. The plantar pressure (max⁡P) and contact area were analyzed using Footscan® RSScan platform. The Kruskal-Wallis test was used to compare the plantar pressure between foot types and Spearman's correlation coefficient was used to correlate plantar pressure with the functional reach distance. Results. There were significant differences of max⁡P in the forefoot area across all foot types. The post hoc analysis found significantly lower max⁡P in the pronated foot compared to the supinated foot. A high linear rank correlation was found between functional reach distance and max⁡P of the rearfoot region of the supinated foot. Conclusions. These findings suggested that types of the foot affect the plantar maximal pressure in older persons with functional reach distance showing some associations.

Muscle Functions and Functional Performance among Older Persons with and without Low Back Pain.

This study aims to compare muscle functions and functional performances between older persons with and without low back pain (LBP) and to determine the association between muscle functions and functional performances. This is a cross-sectional study, involving 95 older persons (age = 70.27 ± 7.26 years). Anthropometric characteristics, muscle functions, and functional performances were measured. Data were analyzed using ANOVA, Pearson's correlation, and multiple linear regression. The functional performances showed no significant differences (females LBP versus non-LBP, males LBP versus non-LBP) (p < 0.05). For muscle functions, significant differences were found (females LBP versus non-LBP) for abdominal muscle strength (p = 0.006) and back muscle strength (p = 0.07). In the LBP group, significant correlations were found between back and abdominal muscle strength and hand grip strength (r = 0.377 and r = 0.396, resp.), multifidus control and lower limb function (r = 0.363) in females, and back muscle strength and lower limb function (r = 0.393) in males (all p < 0.05). Regression analysis showed that abdominal and back muscle strengths were significant predictors of hand grip strength (p = 0.041 and p = 0.049, resp.), and multifidus control was a significant predictor of lower limb function in females (p = 0.047). This study demonstrates that older women with LBP exhibit poorer muscle functions compared to older women without LBP.

Postural Control and Gait Performance in the Diabetic Peripheral Neuropathy: A Systematic Review.

Purpose. The aim of this paper is to review the published studies on the characteristics of impairments in the postural control and gait performance in diabetic peripheral neuropathy (DPN). Methods. A review was performed by obtaining publication of all papers reporting on the postural control and gait performance in DPN from Google Scholar, Ovid, SAGE, Springerlink, Science Direct (SD), EBSCO Discovery Service, and Web of Science databases. The keywords used for searching were "postural control," "balance," "gait performance," "diabetes mellitus," and "diabetic peripheral neuropathy." Results. Total of 4,337 studies were hit in the search. 1,524 studies were screened on their titles and citations. Then, 79 studies were screened on their abstract. Only 38 studies were eligible to be selected: 17 studies on postural control and 21 studies on the gait performance. Most previous researches were found to have strong evidence of postural control impairments and noticeable gait deficits in DPN. Deterioration of somatosensory, visual, and vestibular systems with the pathologic condition of diabetes on cognitive impairment causes further instability of postural and gait performance in DPN. Conclusions. Postural instability and gait imbalance in DPN may contribute to high risk of fall incidence, especially in the geriatric population. Thus, further works are crucial to highlight this fact in the hospital based and community adults.

Effectiveness of Strengthening Exercises for the Elderly with Low Back Pain to Improve Symptoms and Functions: A Systematic Review.

Objective. To determine the effect of strengthening exercises for older people with low back pain (LBP). Methods. This study is a systematic review of experimental study which evaluated the evidence regarding exercises for older people with LBP by using EBSCO Academic Search Premier, EBSCO EconLit, Science Direct, PUBMED, and PEDro from 2006 to 2016. Search strategy for each database was conducted by using keywords such as "low back pain", "older people", and "strengthening exercise". Boolean operators were used to combine keywords and manual exclusion was conducted to verify studies which met the inclusion criteria. The articles reviewed were evaluated and critically appraised by using PEDro scale and SPSS version 20 was used to analyze the data. Results. Three articles were found regarding strengthening exercise for older people with LBP whereas one study was conducted on multicomponent exercise. The mean, standard deviation, and variance of the PEDro score of all the studies were 5.67, 2.33, and 1.528, respectively. Overall, the qualities of all studies reviewed were fair. Two articles showed significant results when compared to control group (p < 0.05). Conclusions. Strengthening exercise is a beneficial treatment for older people with LBP in reducing pain intensity, disability, and improved functional performances.

Range of motion, muscle length, and balance performance in older adults with normal, pronated, and supinated feet.

[Purpose] To compare the lower limb joint range of motion and muscle length between different types of foot posture, and determine the correlation of range of motion and muscle length with balance performance. [Subjects and Methods] Ninety individuals (age, 65.2±4.6 years) were assessed using the Foot Posture Index to determine their type of foot (Normal [0 to +5], pronated [+6 to +9], and supinated [-1 to -4]; n=30 per group). The range of motion (goniometer), muscle length (goniometer and tape measure), and balance performance (functional reach test and four square step test) were measured for each participant. Data were analyzed using the Kruskal-Wallis test and Spearman's rank-order correlation. [Results] No significant differences were found in range of motion, muscle length, and balance performance among different types of foot posture, except for right and left ankle dorsiflexion range of motion. Balance performance was significantly correlated with selected muscle length and range of motion, especially in the supinated foot. [Conclusion] Range of motion and muscle length of the lower limb may be associated with balance performance in older adults with foot deformities. These findings may guide physiotherapists in choosing intervention based on specific assessments for older adults with foot deformity.

Effects of a Behavioral and Exercise Program on Depression and Quality of Life in Community-Dwelling Older Adults: A Controlled, Quasi-Experimental Study.

Sedentary behavior and low participation in exercise among older adults can lead to depression and low quality of life (QOL). The current study investigated the effects of behavioral and exercise programs on depression severity and QOL among Malaysian community-dwelling older adults. A controlled, quasi-experimental, pre-posttest design was used. A total of 63 participants were divided into three groups: (a) exercise and behavior group (EBG), (b) exercise only group (EG), and (c) control group (CG). Results showed a significant difference in depression among groups (F(2,58) = 33.49, p < 0.01, η(2) = 0.54; mean, EBG < EG < CG) and in physical (F(2,58) = 5.33, p < 0.01, η(2)= 0.16; mean, EBG > EG > CG) and mental (F(2,58) = 4.08, p < 0.01, η(2) = 0.12; mean, EBG > CG > EG) scores of QOL. A combination of behavioral and exercise programs has superior effects on depression and QOL of older adults. [Journal of Gerontological Nursing, 42(2), 45-54.].

Mobility and Balance and Their Correlation with Physiological Factors in Elderly with Different Foot Postures.

This study determines (1) the correlation between mobility and balance performances with physiological factors and (2) the relationship between foot postures with anthropometric characteristics and lower limb characteristics among elderly with neutral, pronated, and supinated foot. A cross-sectional observational study was conducted in community-dwelling elderly (age: 69.86 ± 5.62 years). Participants were grouped into neutral (n = 16), pronated (n = 14), and supinated (n = 14) foot based on the foot posture index classification. Anthropometric data (height, weight, and BMI), lower limb strength (5-STS) and endurance (30 s chair rise test), mobility (TUG), and balance (FSST) were determined. Data were analyzed using Spearman's correlation coefficient. Body weight was negatively and moderately correlated (r(s) = -0.552, P < 0.05) with mobility in supinated foot; moderate-to-high positive linear rank correlation was found between lower limb strength and mobility (r(s) = 0.551 to 0.804, P < 0.05) for pronated and neutral foot. Lower limb endurance was negatively and linearly correlated with mobility in pronated (r(s) = -0.699) and neutral (r(s) = -0.573) foot. No correlation was observed in balance performance with physiological factors in any of the foot postures. We can conclude that muscle function may be the most important feature to make movement possible in older persons regardless of the type of foot postures.