"Going Backward": Effects of age and fatigue on posterior-directed falls in Parkinson disease.

BACKGROUND: Nearly half of persons with Parkinson disease (PD) report fatigue as a factor in their fall history. However, it is unknown whether these self-reported falls are caused by a sensation of fatigue or performance fatigue. OBJECTIVE: We sought to investigate the influences of performance fatigue and age on postural control in persons with PD. METHODS: Individuals with PD (n = 14) underwent postural control assessments before (T0) and immediately after (T1) fatiguing exercise. Biomechanical data were gathered on participants completing a treadmill-induced, posterior-directed fall. Performance fatigue was produced using lower extremity resistance exercise on an isokinetic ergometer. Repeated measures ANCOVAs were used with age as a covariate to determine the effects of performance fatigue on biomechanical variables. RESULTS: After adjustment for age, there was a statistically significant difference in peak center of pressure (COP) latency during the support phase of recovery. Pairwise comparisons demonstrated a decrease in peak ankle displacement from T0 to T1. Age was also found to be significantly related to reaction time and peak knee displacement while participants were fatigued. CONCLUSIONS: The decreased peak COP latency, along with decreased ankle angular displacement, suggest that persons with PD adopt a stiffening strategy in response to backward directed falls. Postural stiffening is not uncommon in persons with PD and could be a risk factor for falls. Older individuals with PD demonstrate slower mobility scores and decreased reaction times in the setting of fatigue, suggesting a combined effect of the aging and fatigue processes.

Reproducibility and responsiveness of gait initiation in Parkinson's disease.

Persons with Parkinson's disease (PD) have significant impairments in functional mobility, including the ability to initiate gait. Three-dimensional analysis of kinetic and kinematic outcomes has become one of the most powerful tools in evaluating abnormalities in gait initiation for persons with PD. Surprisingly however, the psychometric properties of spatial and temporal measures of gait initiation for persons with PD have not been established using force-platforms. The purposes of this study were to determine the reliability of kinetic and kinematic measures of gait initiation and to identify the minimal detectable change of these measures in persons with PD during On and Off medication conditions. Sixteen participants with idiopathic PD performed a series of 3 repeated trials of gait initiation by starting from a quiet stance position on 2 AMTI OR-6 force platforms, and walking forward across the floor following a signal from the investigators. Testing was performed first in the Off medication condition, after which participants took their medication and waited 60 min before repeating the gait initiation assessments. Relative test-retest reliability was good-to-excellent for most outcome measures (range 0.417-0.960). Bland-Altman analysis revealed no systematic variance in the majority of outcome measures when tested in distinct medication conditions (On vs. Off medication). Most outcome measures required low-to-moderate amounts of change (<50%) to indicate true change in individual participants. These results suggest that spatial and temporal measures of gait initiation using force-platforms are highly reliable and responsive to changes in performance for persons with PD, regardless of whether individuals are optimally medicated.

Aging-related limit of exercise efficacy on motor decline.

Identifying lifestyle strategies and allied neurobiological mechanisms that reduce aging-related motor impairment is imperative, given the accelerating number of retirees and increased life expectancy. A physically active lifestyle prior to old age can reduce risk of debilitating motor decline. However, if exercise is initiated after motor decline has begun in the lifespan, it is unknown if aging itself may impose a limit on exercise efficacy to decelerate further aging-related motor decline. In Brown-Norway/Fischer 344 F1 hybrid (BNF) rats, locomotor activity begins to decrease in middle age (12-18 months). One mechanism of aging-related motor decline may be decreased expression of GDNF family receptor, GFRα-1, which is decreased in substantia nigra (SN) between 12 and 30 months old. Moderate exercise, beginning at 18 months old, increases nigral GFRα-1 and tyrosine hydroxylase (TH) expression within 2 months. In aged rats, replenishing aging-related loss of GFRα-1 in SN increases TH in SN alone and locomotor activity. A moderate exercise regimen was initiated in sedentary male BNF rats in a longitudinal study to evaluate if exercise could attenuate aging-related motor decline when initiated at two different ages in the latter half of the lifespan (18 or 24 months old). Motor decline was reversed in the 18-, but not 24-month-old, cohort. However, exercise efficacy in the 18-month-old group was reduced as the rats reached 27 months old. GFRα-1 expression was not increased in either cohort. These studies suggest exercise can decelerate motor decline when begun in the latter half of the lifespan, but its efficacy may be limited by age of initiation. Decreased plasticity of GFRα-1 expression following exercise may limit its efficacy to reverse motor decline.

Resistance training for activity limitations in older adults with skeletal muscle function deficits: a systematic review.

Human aging results in a variety of changes to skeletal muscle. Sarcopenia is the age-associated loss of muscle mass and is one of the main contributors to musculoskeletal impairments in the elderly. Previous research has demonstrated that resistance training can attenuate skeletal muscle function deficits in older adults, however few articles have focused on the effects of resistance training on functional mobility. The purpose of this systematic review was to 1) present the current state of literature regarding the effects of resistance training on functional mobility outcomes for older adults with skeletal muscle function deficits and 2) provide clinicians with practical guidelines that can be used with seniors during resistance training, or to encourage exercise. We set forth evidence that resistance training can attenuate age-related changes in functional mobility, including improvements in gait speed, static and dynamic balance, and fall risk reduction. Older adults should be encouraged to participate in progressive resistance training activities, and should be admonished to move along a continuum of exercise from immobility, toward the recommended daily amounts of activity.

Skeletal Muscle Function Deficits in the Elderly: Current Perspectives on Resistance Training.

A variety of changes in skeletal muscle occur with aging. Sarcopenia is the age-associated loss of muscle mass and is one of the main contributors to musculoskeletal impairments in the elderly. Traditional definitions of sarcopenia focused on the size of human skeletal muscle. However, increasing evidence in older adults suggests that low muscle mass is associated with weakness, and weakness is strongly associated with function and disability. In recent years a global trend has shifted toward more encompassing definitions for the loss of muscle mass which include decreases in physical function. This review focuses on skeletal muscle function deficits in the elderly and how these age-associated deficits can be ameliorated by resistance training. We set forth evidence that skeletal muscle deficits arise from changes within the muscle, including reduced fiber size, decreased satellite cell and fiber numbers, and decreased expression of myosin heavy chain (MHC) isoform IIa. Finally, we provide recommendations for clinical geriatric practice regarding how resistance training can attenuate the increase in age-associated skeletal muscle function deficits. Practitioners should consider encouraging patients who are reluctant to exercise to move along a continuum of activity between "no acticity" on one end and "recommended daily amounts" on the other.

The Effects of Performance Fatigability on Postural Control and Rehabilitation in the Older Patient.

Fatigue is common in older adults and has a significant effect on quality of life. Despite the high prevalence of fatigue in older individuals, several aspects are poorly understood. It is important to differentiate subjective fatigue complaints from fatigability of motor performance because the two are independent constructs with potentially distinct consequences on mobility. Performance fatigability is the magnitude of change in a performance criterion over a given time of task performance. Performance fatigability is a compulsory element of any strength training program, yet strength training is an important component of rehabilitation programs for older adults. The consequences of fatigability for older adults suggest that acute exercise of various types may result in acute impairments in postural control. The effects of performance fatigability on postural control in older adults are evaluated here to aid the rehabilitation clinician in making recommendations for evaluation of fall risks and exercise prescription.

Effects of age and acute muscle fatigue on reactive postural control in healthy adults.

BACKGROUND: Falls can cause moderate to severe injuries such as hip fractures and head trauma in older adults. While declines in muscle strength and sensory function contribute to increased falls in older adults, skeletal muscle fatigue is often overlooked as an additional contributor to fall risk. The purpose of this investigation was to examine the effects of acute lower extremity muscle fatigue and age on reactive postural control in healthy adults. METHODS: A sample of 16 individuals participated in this study (8 healthy older adults and 8 healthy young persons). Whole body kinematic and kinetic data were collected during anterior and posterior reproducible fall tests before (T0) and immediately after (T1) eccentric muscle fatiguing exercise, as well as after 15-min (T15) and 30-min (T30) of rest. FINDINGS: Lower extremity joint kinematics of the stepping limb during the support (landing) phase of the anterior fall were significantly altered by the presence of acute muscle fatigue. Step velocity was significantly decreased during the anterior falls. Statistically significant main effects of age were found for step length in both fall directions. Effect sizes for all outcomes were small. No statistically significant interaction effects were found. INTERPRETATION: Muscle fatigue has a measurable effect on lower extremity joint kinematics during simulated falls. These alterations appear to resolve within 15 min of recovery. The above deficits, coupled with a reduced step length, may help explain the increased fall risk in older adults.

Acute effects of muscle fatigue on anticipatory and reactive postural control in older individuals: a systematic review of the evidence.

BACKGROUND: Falls are the leading cause of traumatic brain injury and fractures and the No. 1 cause of emergency department visits by older adults. Although declines in muscle strength and sensory function contribute to increased falls in older adults, skeletal muscle fatigue is often overlooked as an additional contributor to fall risk. In an effort to increase awareness of the detrimental effects of skeletal muscle fatigue on postural control, we sought to systematically review research studies examining this issue. PURPOSE: The specific purpose of this review was to provide a detailed assessment of how anticipatory and reactive postural control tasks are influenced by acute muscle fatigue in healthy older individuals. METHODS: An extensive search was performed using the CINAHL, Scopus, PubMed, SPORTDiscus, and AgeLine databases for the period from inception of each database to June 2013. This systematic review used standardized search criteria and quality assessments via the American Academy for Cerebral Palsy and Developmental Medicine Methodology to Develop Systematic Reviews of Treatment Interventions (2008 version, revision 1.2, AACPDM, Milwaukee, Wisconsin). RESULTS: A total of 334 citations were found. Six studies were selected for inclusion, whereas 328 studies were excluded from the analytical review. The majority of articles (5 of 6) utilized reactive postural control paradigms. All studies incorporated extrinsic measures of muscle fatigue, such as declines in maximal voluntary contraction or available active range of motion. The most common biomechanical postural control task outcomes were spatial measures, temporal measures, and end-points of lower extremity joint kinetics. CONCLUSION: On the basis of systematic review of relevant literature, it appears that muscle fatigue induces clear deteriorations in reactive postural control. A paucity of high-quality studies examining anticipatory postural control supports the need for further research in this area. These results should serve to heighten awareness regarding the potential negative effects of acute muscle fatigue on postural control and support the examination of muscle endurance training as a fall risk intervention in future studies.