Physical activity components associated with gait parameters in community-dwelling older adults.

OBJECTIVE: To investigate the association between components of physical activity and spatiotemporal gait parameters in community-dwelling older adults. METHODS: Cross-sectional study with 134 independent community-dwelling older adults. A questionnaire was applied to obtain information related to the components of physical activity (frequency, duration, modality, and history of physical activity in the life course) and the GAITRite System was used to quantify gait parameters. Three MANOVA models adjusted for potential confounders were conducted to identify associations between components of physical activity (predictors) and gait performance (outcome). RESULTS: Higher weekly frequency but not daily hours of physical activity and sports practice (tennis, boxing, football, volleyball, and tai chi) were significantly associated with better gait performance, specifically gait speed and stride length. CONCLUSION: Understanding the most effective components of physical activity to maintain functional capacity and independence in community-dwelling older adults, allowing for active aging, is essential for formulating more effective strategies.

Association between vertebral fragility fractures, muscle strength and physical performance: A cross-sectional study.

BACKGROUND: Few studies have investigated the association between vertebral fragility fractures and lower limb muscle strength and physical performance in women with low bone mass. OBJECTIVES: To explore whether the presence of vertebral fracture is independently associated with poor physical performance and decreased lower limb muscle strength. To understand whether lower limb muscle strength is associated with physical performance in women with vertebral fracture. METHODS: Older women with low bone mass were divided into 2 groups: no vertebral fracture (NF) and presence of vertebral fragility fracture (VFF). Physical performance was evaluated using the Five Times Sit to Stand (5TSS) test, the Timed Up and Go (TUG) test and a 5m walk test (5MWT). Lower limb muscle strength was assessed using an isokinetic dynamometer. RESULTS: We included 94 women with low bone mass (mean age 71.6 [SD 5.7] years, time since menopause 24.4 [7.1] years, mean BMI 27.5 [5.1] kgm-2). VFF was only associated with low peak hip abductor torque (p = 0.001) after adjustments. In the VFF group (n= 47), each 1 Nmkg-1 increase: in knee extensor torque was associated with improved 5MWT (p = 0.005), TUG (p = 0.002) and 5TSS (p = 0.005) performances; in knee flexor torque was associated with improved 5MWT speed (p = 0.003) and TUG time (p = 0.006); in hip abductor torque was associated with improved 5MWT speed (p = 0.003); and in hip extensor torque with improved TUG time (p = 0.046). CONCLUSION: VFF was associated with reduced hip abductor strength in older women. However, the number of vertebral fractures influenced the association. Additionally, lower limb muscle strength was associated with physical performance, regardless of the clinical characteristics of the fractures. Therefore, strength and power training programs for the lower limbs could improve physical performance.

Diagnostic accuracy of the five times stand-to-sit test for the screening of global muscle weakness in community-dwelling older women.

BACKGROUND: Although the 5 times stand-to-sit test (5TSST) is indicated for screening for muscle weakness in older adults, its validity is based only on the correlation with quadriceps muscle strength or with the muscle strength of a few muscle groups of the lower limbs. Thus, the objective of the present study was to verify whether in independent older women, the 5TSST can really estimate global muscle strength, considering the sum of muscle strength of the trunk, hip, knee and ankle, which are important for functional activities. METHODS: 119 independent older women participated in this cross-sectional study, undergoing the 5TSST and an isometric muscle strength assessment of the trunk, hip, knee and ankle, using an isokinetic dynamometer. The accuracy of the 5TSST for the discrimination of older women with reduced global muscle strength was evaluated by the ROC curve. RESULTS: The ROC curve showed that the 5TSST may discriminate older women with reduced global muscle strength with moderate accuracy (AUC = 0.783; 95 % CI = 0.681-0.886; p < 0.001). The 5TSST score with the best accuracy (sensitivity: 80.0 % and specificity: 61.8 %) to evaluate global muscle strength was 11.64 s. CONCLUSION: 5TSST can be used to identify reduced global muscle strength in independent older women, standing out as an accessible tool for the screening of muscle weakness.

Brief Lower Body Functional Performance Questionnaire (Brief-LBFPQ) for independent older adults / Breve Questionário de Desempenho Funcional dos Membros Inferiores (Brief-LBFPQ) para idosos independentes

Abstract Introduction The literature still lacks evidence about patient-reported outcome measures to fast screen the reduced physical performance of the lower body in older adults to be applied in any clinical setting as primary health care or without specific instruments in prevention campaigns, or even easy to be applied by phone. Objective: To develop a brief questionnaire to screen the lower body functional performance in community-dwelling older adults and to validate this new questionnaire with objective clinical tests. Methods A convenience sampling of 221 community-dwelling older adults was included in this cross-sectional study. The validity between Brief-LBFPQ and objective tests such as gait speed, Timed-Up and Go test (TUG), 5-Time Stand-to-Sit test (5TSST), and step test were assessed by multinominal logistic regression. Internal consistency was determined using Cronbach's alpha and Test-retest reliability was determined using intraclass correlation coefficient (ICC) for numeral scale and Cohen's Kappa for ordinal scale. Results Brief-LBFPQ was significantly associated with objective tests. All eight items from Brief-LBFPQ presented an absolute agreement with ICCs values above 0.7. Kappa values of Brief-LBFPQ items ranged from 0.6 to 0.83, showing substantial agreement and perfect agreement. Conclusion Brief-LBFPQ could be very useful in general clinic settings as it provides earlier screening of functional impairment in independent older adults, and consequently may allow an earlier intervention approach.

Resumo Introdução A literatura ainda carece de evidências acerca de instrumentos de autorrelato para o rastreio rápido do prejuízo no desempenho físico dos membros inferiores em idosos, que possam ser aplicados em qualquer ambiente clínico, como na Atenção Básica à Saúde, e que não requeiram nenhum ins-trumento específico para campanhas de prevenção, ou mesmo de fácil aplicação por contato telefônico. Objetivo Desenvolver um breve questionário para triagem do desempenho funcional dos membros inferiores em idosos da comunidade e validar este novo questionário com testes clínicos objetivos. Métodos Uma amostra de conveniência de 221 idosos da comunidade foi incluída neste estudo transversal. A validade entre o Brief-LBFPQ e os testes objetivos como velocidade da marcha, Timed-Up and Go (TUG), teste de levantar e sentar 5 vezes (TLS5x) e teste do degrau foi avaliada pela regressão logística multinominal. A consistência interna foi determinada pelo alfa de Cronbach e a confiabilidade teste-reteste foi determinada pelo coeficiente de correlação intraclasse (CCI) para a escala numérica e o Kappa de Cohen para a escala ordinal. Resultados O Brief-LBFPQ foi significativamente associado aos testes objetivos. Todos os oito itens do Brief-LBFPQ apresentaram concordância absoluta com valores de CCI acima de 0,7. Os valores de Kappa dos itens do Brief-LBFPQ variaram de 0,6 a 0,83, mostrando concordância substancial e concordância perfeita. Conclusão O Brief-LBFPQ pode ser muito útil em diferentes ambientes clínicos, pois permite uma triagem precoce do comprometimento funcional em idosos independentes e, consequentemente, pode permitir uma abordagem de intervenção mais precoce.

Rate of Torque Development and Torque Steadiness of the Lower Limb and Future Falls Among Community-Dwelling Older Adults Without Previous Falls: A Longitudinal 1-Year Study.

The objective was to investigate the association between rate of torque development (RTD) and torque steadiness (TS) of the lower limb and the occurrence of prospective falls in community-dwelling older adults without falls in the previous year. One hundred older adults performed the tests to obtain the RTD and TS of the hip, knee, and ankle. New episodes of falls were monitored through telephone contact for a prospective period of 12 months. The association of RTD and TS with the occurrence of prospective falls was verified by multiple logistic regression adjusted for confounding variables. There was no association between RTD of hip, knee, and ankle and prospective falls. Only the TS at 50% of the peak torque of the hip flexors was associated with the occurrence of future falls (p = .023). Identifying modifiable risk factors for the first fall in older adults is essential for the development of adequate prevention programs.

Prediction of Reduced Gait Speed Using 5-Time Sit-to-Stand Test in Healthy Older Adults.

OBJECTIVES: To determine the accuracy of the 5-time stand-to-sit (5TSTS) test for the identification of older adults with reduced gait speed. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: A total of 559 community-dwelling older adults were included in the study, divided into groups of women (n = 465) and men (n = 94). METHODS: 5TSTS and gait speed were assessed. Multiple linear regression analysis with adjustment was performed in order to determine the association between 5TSTS and gait speed, followed by the receiver operating characteristic (ROC) curve for the identification of the usefulness of 5TSTS to discriminate older adults with reduced gait speed. Based on the ROC curve, we identified the area under the curve, the sensitivity, specificity, and cutoff points of the 5TSST. Statistical analyses were made using the SPSS software (version 25.0), and a significance level of 5% (P ≤ .05) was adopted. RESULTS: The 5TSTS showed correlation with gait speed. Additionally, 5TSTS was able to discriminate reduced gait speed with moderate accuracy (P < .05; AUC between 0.7 and 0.8). For women, the cutoff scores for 5TSTS to identify gait speed <0.8 m/s was 14.15 seconds; for gait speed <1.0 m/s, it was 12.67 seconds. For men, the cutoff scores for 5TSTS to identify gait speed <0.8 m/s was 14.67 seconds, and for gait speed <1.0 m/s, it was 13.63 seconds. CONCLUSION AND IMPLICATIONS: The 5TSTS is clinically useful and can be an alternative assessment for discriminating community-dwelling older adults with reduced gait speed, when the gait evaluation is not feasible. The study also suggests different cutoff values for 5TSTS considering the gait speeds <0.8 and <1.0 m/s for older women and men, respectively.

Trunk muscle function and anterior and posterior limits of stability in community-dwelling older adults.

BACKGROUND: Understanding of the influence of trunk muscles on the older adult's limit of stability (LOS) is important for clinical practice. OBJECTIVE: To compare the anterior and posterior LOS and the flexor and extensor trunk muscle function; verify the association of trunk muscles and LOS, and the association of LOS and the previous falls of community-dwelling older adults. METHODS: Sample characterization data, trunk muscle function (peak torque - PT and torque steadiness - TS), LOS and previous falls (6 months) were collected from 79 older people. Comparisons were made between the variables of the anterior/posterior LOS (Reaction time, Movement velocity, Maximum excursion, Directional control), between trunk extensors/flexors muscle function and between TS at 10% and at 50%. Associations were made between the anterior/posterior LOS and the number of previous falls and between LOS and trunk muscle function. RESULTS: The posterior LOS was worse than the anterior LOS, except for the reaction time. The flexor muscles obtained a lower PT, but better performance in TS. The TS at 10% of the trunk extensor was associated with the posterior directional control (p = 0.032). There was no association between trunk muscle function and the anterior LOS, or between previous falls and LOS. CONCLUSIONS: The older adults presented worse performance in the posterior LOS and worse TS in the trunk extensor muscles, although the trunk extensor muscles presented a higher PT. Although no association between LOS and previous falls, the better the TS at 10% of the trunk extensors, better posterior directional control.

Hip muscle strength, dynamic balance and functional capacity of community-dwelling older adults aged 60 and older: A cross-sectional study.

The objective of the present study was to evaluate the association of hip muscle strength, dynamic balance and functional capacity in the older adults aged 60 to 79 years and older adults aged 80 years and older. A total of 191 community-dwelling older adults participated in this study. Isometric muscle strength was quantified as the peak torque (PT), measured using an isokinetic dynamometer. Functional capacity was determined by the forward step test (ST) and the dynamic balance by the tandem gait (TG) test. The hip flexor, extensor, abductor and adductor PT in the older adults aged 60 to 79 years had a positive influence on the execution of the step test (p < 0.05). The peak adductor torque did not show a significant association with tandem gait (p = 0.649). In older adults aged 80 years and older, the peak adductor torque was the only one that showed an association with the performance of the ST (p = 0.001) and TG (p = 0.024) tests. The hip adductors may have a higher contribution in adults aged 80 years and older during the execution of clinical tests. These findings are relevant to clinical practice as they can help in the development of appropriate physical exercise programs targeting older adults of different age groups.

Accuracy of the step test to evaluate lower limb muscle strength in community-dwelling older women.

OBJECTIVE: to investigate the accuracy of the step test (ST) to evaluate total lower limb muscle strength (LLMS) in older women. DESIGN: observational cross-sectional study. METHODS: 119 community-dwelling older women were submitted to the ST and LLMS evaluation (isometric peak torque of eight muscle groups of the dominant lower limb). The capacity of the ST to discriminate older women with reduced LLMS was measured using ROC curve, followed by the posttest probability (PoTP) calculation. RESULTS: a ST score of 0.24 cm per cm of participant's height presents a sensitivity of 63.3%, specificity of 77%; enhances the PoTP from 48% to 72% for positive test and decreases the PoTP from 48% to 31% for negative test. CONCLUSION: the ST may complement the clinical screening of reduced LLMS in older women, given that it is a simple and quick low-cost test and allows the evaluation of each lower limb separately.

Relationship Between Lower Limb Muscle Strength and Future Falls Among Community-Dwelling Older Adults With No History of Falls: A Prospective 1-Year Study.

Objective: To investigate whether lower limb muscle strength could be a risk factor for the first fall among nonfaller community-dwelling older adults. Method: Hip, knee, and ankle peak torque (PT) was measured with an isokinetic dynamometer in 101 older adults with no history of falls in the previous year. Next, the authors followed up the participants on a monthly basis by telephone contact to determine the occurrence of fall episodes over a period of 1 year. Multivariate logistic regression adjusted for confounding variables was applied to assess the relationship between falls and lower limb PT. Results: there was no association between lower limb PT and future falls (p > .05). Conclusion: Based on these results, it is important to identify other factors that predispose older adults with no history of falls to falling for the first time, so that early and effective preventive strategies may be elaborated.

What is the best clinical assessment tool for identification of adults aged ≥80 years at high risk of falls?

OBJECTIVES: To assess the Balance Evaluation Systems Test (BESTest), Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go (TUG) test and gait speed to determine which is the most appropriate test for identification of adults aged ≥80 years at higher risk of falls, and to investigate the clinical usefulness of the combination of such tests by cumulative post-test probability (PoTP) for predicting the risk of falls. DESIGN: Longitudinal prospective study. PARTICIPANTS: Ninety-eight older adults (aged 80-102 years). INTERVENTIONS: Older adults were submitted to the clinical tests and followed-up in order to record the occurrence of falls. The capacity of the clinical tests to detect which older adults are at higher risk of falls was measured using the receiver operating characteristic curve, followed by calculation of PoTP for predicting the risk of falls. RESULTS: The BESTest and the Mini-BESTest demonstrated the best PoTP for predicting the risk of falls for a positive test (70%), followed by the TUG test (66%) and gait speed (63%). When performed in combination, a positive result on the TUG test, gait speed and Mini-BESTest increased the probability of older adults falling within the next 6months from 50% to 89%; a negative result on these three tests decreased the probability of older adults falling within the next 6months from 50% to 3%. CONCLUSION: The combination of TUG test, gait speed and Mini-BESTest provided the best approach. If all three tests are positive, there is an 89% chance of identifying an older person at risk of falling. If all three tests are negative, there would only be a 3% chance of obtaining a false-negative result.

The effect of unilateral muscle fatigue of hip abductor muscles on balance and functional capacity in community-dwelling older women.

BACKGROUND: Hip abductor muscles are important for the maintenance of postural stability, mainly on the mediolateral direction and unipodal support conditions. The objective of the present study was to evaluate the effect of unilateral induced fatigue of hip abductor muscles on balance and functional capacity of older women. METHODS: The study included physically independent women aged 60-75 years. We assessed static balance with the single limb stance test (SLS) and evaluated functional capacity with the maximum gait speed (MGS) and step test (ST). We ran the protocol of hip abductor muscle fatigue with a Biodex isokinetic dynamometer. Assessment of balance and functional capacity happened before and after the muscle fatigue protocol. We applied the t-test for repeated measures to determine whether unilateral hip abductor muscle fatigue influences the performance in the tests (SLS, MGS and ST). RESULTS: The protocol of hip abductor muscle fatigue negatively affected all three evaluated tasks: SLS (p = 0.000), ST (p = 0.000) and MGS (p = 0.000). However, the single limb stance test was the most task affected (effect size = 0.51, pre- and post-fatigue difference = 28.1 %). CONCLUSION: After the unilateral muscle fatigue of hip abductors, we observed the worst performance on clinical tests, mainly regarding the SLS test, which shows the involvement of hip abductors during usual motor tasks. However, the small magnitude of the limitation of functional tests (MGS and ST) suggests the presence of postural compensations.

Diagnostic Accuracy of Clinical Tests for the Indirect Assessment of Hip Abductor Muscle Strength in Community-Dwelling Older Women.

OBJECTIVE: The objective of this study was to determine the accuracy of 3 clinical tests (lateral step [LS], tandem gait [TG], and single-leg stance [SS]) in identifying older women with reduced hip abductor muscle strength and to determine the post-test probability of each test and of their combination in changing the certainty of diagnosis. METHODS: In this cross-sectional study, a total of 123 older women received clinical testing to obtain the variables LS height, time for TG execution, percentage of errors in TG, and time of permanence on SS and were tested for isometric hip abductor peak torque using an isokinetic dynamometer. Only the dominant lower limb was evaluated. Multiple linear regression analysis with adjustment was performed to determine the association among variables, followed by the receiver operating characteristic curve to identify clinical variables that can discriminate older women with reduced abductor muscle strength. Post-test probability was then calculated based on the receiver operating characteristic curve data. RESULTS: Although the 4 clinical variables showed correlation with abductor peak torque, only LS and TG time were able to discriminate reduced abductor muscle strength with low accuracy (area under the curve was between 0.5 and 0.7). However, the combination of LS and TG time increased post-test probability from 47% (prevalence of weakness in the population) to 76% when both tests were positive and reduced it from 47% to 18% when both tests were negative. CONCLUSION: The combination of the LS test and TG time is useful for the indirect assessment of hip abductor strength in community-dwelling older women. IMPACT: Hip abductor muscle strength is extremely important for function in older women. This study presents clinicians with simple, fast, and inexpensive methods for assessing hip abductor muscle strength.

Risk factors for future falls among community-dwelling older adults without a fall in the previous year: A prospective one-year longitudinal study.

INTRODUCTION: One of the main risk factor for falls is a history of falls itself. Henceforth, preventing a fall is an important strategy for the prevention of new ones. The objective of the present study was to determine whether personal self-perception questions and functional tests might represent risk factors for a fall during the year following a year without any falls among independent community-dwelling older adults, considering a period of 12 prospective months. METHODS: A total of 101 community-dwelling older adults without a fall in the previous year underwent an initial evaluation (sample characterization, self-perception questionnaire and functional tests) and monthly monitoring of prospective fall episodes by telephone contact. We determined the association between the occurrence of prospective falls (dependent variable) and personal questions and functional tests (independent variables) with multiple binary logistic regression adjusted for confounding variables. RESULTS: Only age (p = 0.005) and self-perception of general health (p = 0.019) showed association with the occurrence of prospective falls. CONCLUSION: Our results showed that the only factors bearing an association with the occurrence of prospective falls were age and general health self-perception, which demonstrates the importance of administrating self-perception measures in clinical practice or in epidemiological studies for the prevention of a fall during the year following a year without any falls in older adults.

Association between the trunk muscle function performance and the presence of vertebral fracture in older women with low bone mass.

BACKGROUND: Despite the clinical importance, it has remained unclear which changes in the trunk muscle function parameters are more associated with the presence of vertebral fracture (VF). AIMS: The aim of this study was to verify the association between the trunk muscle function performance and the presence of VF in older women with low bone mass. The secondary aim was to evaluate the correlation between trunk muscle function and both fall history and muscle mass. METHODS: This cross-sectional study was composed by 94 women over 60 years within value of T-Score lumbar spine BMD <- 1.0 DP. Multidimensional evaluations were performed: appendicular skeletal muscle mass index (ASMI) was determined by the total body DEXA; the radiographic evaluations measured the degree of thoracic kyphosis and classification of VF. The trunk muscle function parameters, such as peak torque (PT), rate of torque development (RTD) and torque steadiness (TS) were evaluated by isokinetic dynamometer. The trunk muscle endurance was evaluated by the timed loaded standing test. The adjusted multivariate logistic regression model and multivariate linear regression were performed to verify the association between the variables studied. RESULTS: The results showed that the trunk muscle function parameter with greater association with the presence of VF is TS extensors (OR = 1.70; p < 0.001). The other two significant muscle parameters were: RTD30 flexors (OR = 0.31; p = 0.033) and PT extensors (OR = 0.13; p = 0.009). No statistical association was found between the presence of VF and the ASMI and trunk muscle endurance. No correlation between trunk muscle function and fall history was observed. There was a weak correlation between ASMI and extensor PT (R2 = 0.21; p = 0.027) and extensor RTD30 (R2 = 0.21; p = 0.026). CONCLUSIONS: This study demonstrated that deficit in trunk muscle function has shown a strong association with the presence of VF, highlighting issues heretofore unexplored regarding the association between VF with muscle power and motor control.

Use of the BESTest and the Mini-BESTest for Fall Risk Prediction in Community-Dwelling Older Adults Between 60 and 102 Years of Age.

BACKGROUND AND PURPOSE: Reference values for the Balance Evaluation Systems Test (BESTest) and the Mini-Balance Evaluation Systems Test (Mini-BESTest) need to be established to predict falls in older adults during every stage of aging. The purpose of this study was to determine the cutoff scores for the BESTest and the Mini-BESTest for community-dwelling older adults in order to predict fall risk. METHODS: A total of 264 older adults, of both sexes, between the ages of 60 and 102 years, were divided into 4 groups according to age range. After evaluation, participants received telephone follow-up for 6 months to record the number of fall episodes. To define the reference values of the tests in relation to fall risk prediction, a receiver operating characteristic curve was drawn to identify the area under the curve and the sensitivity and specificity of the tests. Statistical analyses were done using SPSS (Version 16.0-SPSS Inc) with a significance level of 5% (P ≤ .05). RESULTS: The cutoff scores to identify older adults with fall risk according to the BESTest and the Mini-BESTest in the different age groups were 99 and 25 points, respectively, for people 60 to 69 years of age, 92 and 23 points for the age group of 70 to 79 years, 85 and 22 points for people 80 to 89 years of age, and 74 and 17 points for people 90 years of age or older. CONCLUSION: The BESTest and the Mini-BESTest are good tools for predicting fall risk in the 6 months following an initial evaluation in community-dwelling Brazilian older adults. The study also determined that cutoff values vary for different age groups.

Recomendações para prescrição de dispositivos auxiliares da marcha em idosos / Recommendations for prescribing walking aids in older adults

O uso de um dispositivo auxiliar da marcha (DAM), como bengala ou andador, pode auxiliar os idosos na realização de suas atividades diárias, mantendo-os funcionalmente independentes e relativamente ativos. Porém, a utilização inadequada, o mau estado e as dimensões incorretas do dispositivo, assim como erros na prescrição do tipo de dispositivo podem aumentar o risco de quedas nos idosos usuários de DAM. Diante da falta de recomendações quanto à sua prescrição, o objetivo desse artigo é discorrer sobre os pré-requisitos para a prescrição de cada dispositivo (bengala e andador), de acordo com a nossa experiência adquirida na Área de Fisioterapia em Gerontologia, no Centro de Reabilitação (CER) do Hospital das Clínicas de Ribeirão Preto, considerando as evidências científicas disponíveis até o momento. Assim, com a difusão das informações contidas nesse artigo para os profissionais da saúde que prestam assistência a idosos, espera-se aprimorar a prática de prescrição do DAM e de educação do idoso, de seus familiares e cuidadores, a fim de que sejam alcançados os benefícios do uso de um DAM e prevenidos os possíveis eventos adversos, como as quedas.

The use of a walking aid device (WAD), such as a cane or walker, can assist older adults in performing their daily activities, keeping them functionally independent and relatively active. However, improper use, poor condition and incorrect dimensions of the device, as well as errors in prescribing the type of device may increase the risk of falls in older people who use a WAD. Given the lack of recommendations on its prescription, the purpose of this article is to discuss the requirements for the prescription of each device (cane and walker), according to our experience obtained in the area of ​​Gerontology Physiotherapy in the Rehabilitation Center (CER) of the Hospital das Clínicas de Ribeirão Preto, considering the scientific evidence available at the moment. Thus, by disseminating the information contained in this article to health professionals who provide care to older people, it is expected to improve the practice of prescribing WAD and educating the older adults, their families and caregivers, in order to achieve the benefits of use a WAD and prevent possible adverse events such as falls.

Medo de quedas e força muscular do quadril em idosos independentes da comunidade / Miedo a caerse y fuerza muscular de cadera en ancianos independientes de la comunidad / Fear of falling and hip muscular strength in independent older adults of the community

RESUMO O medo de quedas pode fazer com que o idoso desenvolva estratégias que alteram o equilíbrio semiestático e dinâmico, predispondo-o a um risco aumentado de cair. A função muscular dos abdutores e adutores de quadril tem importante papel na manutenção da estabilidade postural. Entretanto, não se sabe se idosos com medo de cair apresentam maior comprometimento na função muscular do quadril. Assim, o objetivo foi comparar o pico de torque (PT) isométrico dos músculos abdutores e adutores de quadril entre idosos com e sem medo de quedas. Os participantes foram divididos em dois grupos: com (n=81) e sem (n=81) medo de quedas. O PT dos abdutores e adutores de quadril foi obtido com dinamômetro isocinético (System 4 Pro, Biodex, Nova York, EUA). A comparação do PT dos grupos foi realizada por meio de modelo linear geral univariado, ajustado pelas covariáveis idade, sexo, índice de massa corporal, nível de atividade física e histórico de quedas, utilizando o software SPSS 17.0, com nível de significância de 5%. Não houve diferença do PT abdutor e adutor do quadril entre os grupos após análise univariada com ajustamento. Observou-se que idosos com medo de quedas não apresentam prejuízos na função muscular dos estabilizadores de quadril quando comparados a idosos sem medo de quedas.

RESUMEN El miedo a caerse puede hacer que los ancianos desarrollen estrategias de alteración del equilibrio semiestático y dinámico, predisponiéndolos a un mayor riesgo de caídas. La función muscular de los abductores y de los aductores de cadera juega un papel importante en el mantenimiento de la estabilidad postural. Sin embargo, no se sabe si los ancianos con miedo a caerse tienen un mayor deterioro en la función muscular de la cadera. Por lo tanto, el objetivo fue comparar el torque máximo (TM) isométrico de los músculos abductores y aductores de cadera entre los ancianos con miedo y sin miedo a caerse. Los participantes se dividieron en dos grupos: con miedo a caerse (n=81) y sin (n=81) miedo a caerse. El TM de los abductores y aductores de cadera se obtuvo mediante la utilización del dinamómetro isocinético (System 4 Pro, Biodex, Nueva York, EE.UU.). La comparación del TM de los grupos se realizó mediante un modelo lineal general univariado, ajustado por covariables edad, género, índice de masa corporal, nivel de actividad física e historial de caídas, utilizando el software SPSS 17.0, con nivel de significancia del 5%. No hubo diferencias entre el TM del abductor y del aductor de cadera entre los grupos tras el análisis univariado con ajuste. Se observó que los ancianos con miedo a caerse no presentaron daños en la función muscular de los estabilizadores de la cadera en comparación con los ancianos sin miedo a caerse.

ABSTRACT The fear of falling can cause older adults to develop strategies that alter the semi-static and dynamic balance, predisposing them to increased risk of falling. The muscular function of abductors and adductors plays an important role in maintaining postural stability. However, it is unknown whether older people with fear of falling have greater impairment in hip muscular function. Thus, the objective was to compare the isometric peak torque (PT) of hip abductor and adductor muscles among older adults with and without fear of falling. Participants were divided into two groups: with (n=81) and without (n=81) fear of falling. The PT of hip abductors and adductors was obtained with isokinetic dynamometer (System 4 Pro, Biodex, New York, USA). The PT groups were compared using general linear model univariate, adjusted for covariates age, sex, body mass index, physical activity level and history of falls, using the SPSS 17.0 software, with a significance level of 5%. No difference was found between the PT of hip abductor and adductor and the groups after univariate analysis with adjustment. We observed that older people with fear of falling have no muscle function loss of the hip stabilizers when compared with subjects without fear of falling.

Relationship between grip strength and global muscle strength in community-dwelling older people.

There are still conflicting results regarding the association between grip and global muscle strength in older people. Therefore, the objective of the present study was to determine the association between grip strength and global muscle strength, as well as between grip strength and individual trunk, hip, knee and ankle muscle strengths. METHODS: Grip strength was assessed using a manual dynamometer, and trunk, hip, knee and ankle muscle strength with an isokinetic dynamometer, in order to obtain the global muscle strength variable, in 150 older men and women from the community. The association between grip and global muscle strength and between grip strength and the strength of each muscle group was determined through the Pearson correlation test, followed by multivariate linear regression adjusted for sex, age, body mass index, level of physical activity and number of comorbidities. RESULTS: A positive significant association was found between grip strength and global muscle strength in older people (r = 0.690; ß = 10.07; p < 0.001; R2 = 0.604), even after adjustment. There was also a low to moderate association between all the muscle groups and grip strength. However, when the model was adjusted, the relationship between grip strength and ankle dorsiflexor peak torque lost significance (p = 0.924). CONCLUSION: Grip strength can represent global muscle strength in younger older people in the community, even when confounding variables are considered in the statistical model. However, grip strength does not eliminate the need for specific assessment of different muscle groups, when indicated.

Contribution of hip abductor-adductor muscles on static and dynamic balance of community-dwelling older adults.

BACKGROUND: The previous studies have investigated causes of and risk factors for falls and impairment of functional capability in older adults. However, the biomechanical factors involved in functional performance and postural control, and the contribution of hip muscles, are still unknown. AIMS: The aim of the present study was to verify the association between the muscle function of hip abductors and adductors and static and dynamic balance, in a narrow base of support, in community-dwelling older adults. METHODS: Eighty-one older adults, including both women and men, were evaluated. Tandem gait and single-leg stance were used to assess static and dynamic balance, and an isokinetic dynamometer was used to analyze muscle function (peak torque and rate of torque development according to body weight). Data were analyzed by a multivariate linear regression test without adjustment and with adjustment using two models: adjustment I (sex) and adjustment II (age). RESULTS: There was a statistically significant association between peak torque of abductor in single-leg stance and tandem gait speed. The PT of hip adductors contributed to static balance performance, in a narrow base of support from the unadjusted data and from the adjusted data by sex. CONCLUSION: The findings of the present study are relevant, because if deficits in balance and functionality in older adults can be linked to a decline in maximum muscle strength of hip abductors, this parameter can be treated to maintain independence in older adults for as long as possible.