Spinal movement and performance of a standing reach task in participants with and without Parkinson disease.

BACKGROUND AND PURPOSE: Evidence suggests that individuals with early and mid-stage Parkinson disease (PD) have diminished range of motion (ROM). Spinal ROM influences the ability to function. In this investigation, the authors examined available spinal ROM, segmental excursions (the ROM used) during reaching, and their relationships in community-dwelling adults with and without PD. SUBJECTS: The subjects were 16 volunteers with PD (modified Hoehn and Yahr stages 1.5-3) and 32 participants without PD who were matched for age, body mass index, and sex. METHODS: Range of motion of the extremities was measured using a goniometer, and ROM of the spine was measured using the functional axial rotation (FAR) test, a measure of unrestricted cervico-thoracic-lumbar rotation in the seated position. Motion during reaching was determined using 3-dimensional motion analysis. Group differences were determined using multivariable analysis of variance followed by analysis of variance. Contributions to total reaching distance of segmental excursions (eg, thoracic rotation, thoracic lateral flexion) were determined using forward stepwise regression. RESULTS: Subjects with PD as compared with subjects without PD had less ROM (FAR of 98.2 degrees versus 110.3 degrees, shoulder flexion of 151.9 degrees versus 160.1 degrees) and less forward reaching (29.5 cm versus 34.0 cm). Lateral trunk flexion and total rotation relative to the ground contributed to reaching, with the regression model explaining 36% of the variance. DISCUSSION AND CONCLUSION: These results contribute to the growing body of evidence demonstrating that spinal ROM is impaired early in PD.

The relative effect of Alzheimer's disease and related dementias, disability, and comorbidities on cost of care for elderly persons.

OBJECTIVES: Our primary objectives were (a) to determine the relative impact of Alzheimer's disease and related dementias (ADRD), disability, and common comorbid health conditions on the cost of caring for community-dwelling elderly person and (b) to determine whether ADRD serves as an effect modifier for the effect of disability and common comorbidities on costs. METHODS: Participants were drawn from community respondents to the 1994 National Long Term Care Survey. The authors compared total cost of caring for persons without ADRD with that of those who had moderate and severe ADRD. Using regression analysis, the author identified the adjusted effect of ADRD, limitations in activities of daily living (ADLs), and common comorbidities on total costs. RESULTS: Persons with severe ADRD had higher median total costs ($10,234) than did persons with moderate ADRD ($4,318) and those without ADRD ($2,268, p <.001). However, disability measured by ADL limitations was a more important predictor of total cost than was ADRD status in both stratified and multivariate analyses. Comorbidities such as heart attack, stroke, and chronic obstructive pulmonary disease also increased costs. Severe ADRD was an effect modifier for ADL limitations, increasing the positive impact of disability on total costs among persons with severe ADRD, but not for comorbidities. DISCUSSION: Disability, severe ADRD, and comorbidity all had independent effects that increased total costs. Thus, any risk adjustment procedure should account for disability and comorbidity and not just ADRD status.

Longitudinal evaluation of economic and physical impact of Parkinson's disease.

The cost of parkinsonism and Parkinson's disease (PD) is largely unknown although clinical experience suggests that the impact of this disease is substantial. Longitudinal data is presented for health status, disease symptoms, functional status, and financial costs for 70 participants with PD or parkinsonism. The sample was dichotomized into those rating their health as excellent, good, or very good ('good health') and those rating their health as fair or poor ('poor health'). The 'poor health' group were significantly more disabled at baseline. Symptoms increased between year 1 and 3 with greatest increases in fatigue, pain, and depression for the 'good health' group. At year 1, total direct cost/capita was about dollars 5000/year for both groups; indirect costs were dollars 5000 for the 'good health' group and dollars 15,000/year for the 'poor health' group. By year 3, total expenditures increased over 25% for the 'good health' group and nearly doubled for the 'poor health' group, while percent costs that were compensated declined for groups. Out of pocket, expenses were as high as dollars 3000/year for the 'poor health' group by year 3. Through analysis of the broad impact of PD, including non-neurological symptoms and economic ramifications, it is possible to better appreciate the impact of this chronic condition on overall quality of life.

Spinal flexibility and balance control among community-dwelling adults with and without Parkinson's disease.

BACKGROUND: One area of research that requires further elaboration is the relationship between impairments and functional limitations. By identifying specific contributors to functional limitations, it may be possible to establish intervention strategies, including exercise approaches, that can delay or ameliorate decline in function. The association between impaired spinal flexibility and functional limitations has not been studied in depth. The purposes of this study were to determine (a) the associations between spinal flexibility and functional limitations; (b) the relative contribution of spinal flexibility to specific functional limitations; and (c) how disease state (Parkinson's disease [PD] vs no PD) modified these relationships. METHODS: Participants included 251 community-dwelling adults, 56 of whom were with diagnosed PD and 195 were without PD or other specific disorders. Measures included spinal flexibility (i.e., functional axial rotation [FAR]) and configuration (i.e., thoracic kyphosis and lumbar lordosis), functional limitations (i.e., functional reach, supine-to-stand time, 10-m walk, and 360 degrees turn). RESULTS: Canonical correlation (Can R) demonstrated significant associations between spinal measures and functional limitations (Can R = .488, p = .0001). After controlling for age, gender, race, body mass index, comorbidity, confidence, and depression, a multivariate regression model demonstrated that spinal flexibility contributed significantly to functional reach (R2 = .334 for the overall model, p = .0001). Based on the parameter estimate of 0.026, the results prediet that FAR accounts for a 4.6-inch difference in reach distance between the least and most flexible of the participants. In addition, there were significant differences between almost all measurements for the PD compared with the non-PD participants. CONCLUSION: Results clearly implicate spinal flexibility as a contributor to functional reach, a measure of functional limitation and an established measure of balance control. Further work is needed to determine the extent to which spinal flexibility can be improved and the effect of that improvement on balance.

An application of generalizability theory to study a physical performance measure in Parkinson's disease.

Clinicians and researchers frequently quantify impairments and functional ability to monitor patient's symptoms and progress. For some patients, such as those with Parkinson's disease (PD), symptoms can fluctuate from day to day, making reliable measurement difficult. Multiple measures then may be required to obtain reliable data. Decisions must be made, balancing the optimum measurement schedule to obtain "good reliability" against burden to the patient. This investigation demonstrates the use of Generalizability Theory in determining the testing schedule when designing an experiment involving patients with known fluctuations of symptoms. In this investigation we use "Functional Axial Rotation" (FAR), a measure of spinal flexibility, to illustrate the use of Generalizability Theory for designing an experiment using participants who have PD. Measurements of FAR were taken on 13 participants, aged 60 or older, who were in early and mid-stages of PD. Three measurements were obtained on each of two consecutive days, and repeated on two consecutive days a week later, giving a total of 12 measures of FAR for each individual. Four sources of variation (subject, week, day and trial) were employed to estimate the reliability of FAR under several designs. Assuming different schedules of measures across weeks, days and trials, the estimated reliability of FAR for four measurements is in the range of 0.75 to 0.83, and for eight measurements in the range of 0.82 to 0.86. We discuss the use of this type of analysis in the determination of the optimum measurement design for experiments involving subjects with known fluctuations.

Timed loaded standing: a measure of combined trunk and arm endurance suitable for people with vertebral osteoporosis.

Chronic back tiredness or fatigue is a common complaint of people who have a history of osteoporotic vertebral fracture. Trunk muscle endurance has not been studied in people with vertebral osteoporosis, partly due to the lack of assessment tools. We developed a measure of combined trunk and arm endurance suitable for people with vertebral osteoporosis, timed loaded standing (TLS). TLS measures the time a person can stand while holding a two-pound dumbbell in each hand with the arms at 90 degrees of shoulder flexion and the elbows extended. Intraclass correlation coefficients (ICCs) for same day inter-trial and six to ten day test-retest reliability were 0.89 (lower bound 95% confidence interval [LB 95% CI] 0.79) and 0.84 (LB 95% CI 0.68), respectively, in a sample of 21 older women with no known osteoporosis. In 127 women with vertebral fractures, the ICC for same day inter-trial reliability was 0.81 (LB 95% CI 0.75). In a sub-sample of 30 of these women with vertebral fractures, the six to ten day test-retest reliability was 0.85 (LB 95% CI 0.75). Moderately strong and statistically significant (p < or = 0.05) correlations were found between TLS and sixteen of eighteen measures of physical impairment and function. Functional reach distance, gait velocity, MOS-36 Physical Function Subscale, shoulder flexion strength, and six minute walk distance were most strongly associated with TLS time. Women with vertebral fractures who endorsed having back tiredness when standing and working with the arms in front of the body, sitting to rest because of back tiredness or pain, and planning rest periods because of back tiredness or pain had significantly lower TLS times. TLS is a simple, safe physical performance measure of combined trunk and arm endurance that demonstrates acceptable reliability (inter-trial and test- retest) and concurrent validity.

Spinal-flexibility-plus-aerobic versus aerobic-only training: effect of a randomized clinical trial on function in at-risk older adults.

BACKGROUND: As exercise is associated with favorable health outcomes, impaired older adults may benefit from specialized exercise interventions to achieve gains in function. The purpose of this study was to determine the added benefit of a spinal flexibility-plus-aerobic exercise intervention versus aerobic-only exercise on function among community-dwelling elders. METHODS: We employed a randomized clinical trial consisting of 3 months of supervised exercise followed by 6 months of home-based exercise with telephone follow-up. A total of 210 impaired males and females over age 64 enrolled in this study. Of these, 134 were randomly assigned to either spinal flexibility-plus-aerobic exercise or aerobic-only exercise, with 116 individuals completing the study. Primary outcomes obtained at baseline, after 3 months of supervised exercise, and after 6 months of home-based exercise included: axial rotation, maximal oxygen uptake (VO2max); functional reach, timed-bed-mobility; and the Physical Function Scale (PhysFunction) of the Medical Outcomes Study SF-36. RESULTS: Differences between the two interventions were minimal. Overall change scores for both groups combined indicated significant improvement for: axial rotation (p=.001), VO2max (p=.0001), and PhysFunction (p=.0016). Secondary improvements were noted for overall health (p=.0025) and reduced symptoms (p=.0008). Differences between groups were significant only for VO2max (p=.0014) at 3 months with the aerobic-only group improving twice as much in aerobic capacity as the spinal flexibility-plus-aerobic group. Repeated measures indicated both groups improved during the supervised portion of the intervention but tended to return toward baseline following the home-based portion of the trial. CONCLUSIONS: Gains in physical functioning and perceived overall health are obtained with moderate aerobic exercise. No differential improvements were noted for the spinal flexibility-plus-aerobic intervention.

Reliability of physical performance tests in four different randomized clinical trials.

OBJECTIVES: (1) To assess the test-retest reliability of physical performance tests in subject groups with different levels of impairment and disability, and (2) to assess the stability of these tests over different time intervals. DESIGN: Test-retest, repeated measures reliability design. SETTING: (1) A university's center for aging and research center, (2) a continuing care retirement community, and (3) an extended care and rehabilitation center at a Veterans Affairs medical center. SUBJECTS: Twenty-four community-dwelling elders, 15 community-dwelling elders with Parkinson disease, 12 older women with vertebral osteoporosis and compression fractures, and 14 elderly nursing home residents. MEASURES: Lower extremity isometric strength (ankle dorsiflexion, hip abduction), spinal configuration (thoracic kyphosis, lumbar lordosis), lumbosacral motion (flexion, extension), and timed measures of the ability to get in and to get out of bed at a usual pace. RESULTS: Most of the within-group intraclass correlation coefficients (ICCs) were good to excellent (.70 to .97). Overall, ICCs for all groups combined were between .70 and .96, and no decrement in reliability was noted after controlling for group membership. In addition, no decrement in the ICC was observed for short (1 day) vs. longer (1 week) intervals of testing. CONCLUSIONS: These performance-based measures may be used reliably across a wider range of testing environments and elderly populations than has been reported.

Quality of life and Parkinson's disease.

BACKGROUND: People with Parkinson's disease (PD) have a progressive loss of function eventually leading to severe disability. Although PD would be expected to have a profound impact on an individual's psychosocial health, there is relatively limited research on its psychosocial effect. The purposes of this study were (a) to examine the relationships between physical disability, depression, and control beliefs and quality of life in people with PD and (b) to characterize how these psychosocial variables differ by stage of disease. METHODS: Eighty-six individuals from five stages based on clinical disability, ages 51-87, were interviewed. Established instruments were used to measure physical disability, depression, and control beliefs. Quality of life (QOL) was rated on a 5-point Likert scale. RESULTS: A multivariable regression model including physical disability, stage of disease, depression, mastery, and health locus of control predicted QOL (R2 = 0.48), with mastery as the only significant predictor (p = .0001). There were significant differences by PD stage for all variables (p < .05). CONCLUSIONS: Mastery predicted quality of life in individuals with PD even when depression and physical disability were included in the model. Differences in psychosocial variables by stage of PD suggest that the psychosocial profile of PD patients may change as the disease progresses.

Kinematic characterization of standing reach: comparison of younger vs. older subjects.

OBJECTIVE: To characterize typical spinal motions that occur during standing reach and to describe differences in spinal motions and center of pressure displacements during reach between younger and older healthy adults. DESIGN: Exploratory, cross sectional investigation utilizing video motion and biomechanics force platform analysis. BACKGROUND: Standing reach provides a means for assessing both arm function and balance control in the context of a common functional activity. The interaction between age-related declines in spinal mobility and the spinal motion occurring during reach is poorly understood. The characterization of spinal motions during task performance for healthy subjects of different age groups is an important first step for understanding the relationship between impairments and physical performance in disabled populations. METHODS: Thirty-four subjects ages 20-36 and 33 subjects ages 60-76 participated. Video motion and force plate analysis were used to characterize spinal motion and center of pressure displacements during the functional reach test for younger and older subjects. RESULTS: Spinal motion during standing reach was characterized by forward trunk flexion, lateral trunk flexion, thoracolumbar rotation, and lower body rotation. Younger and older subjects differed (P = 0.05) in the amount of forward trunk flexion and thoracolumbar rotation which occurred but not lower body rotation. Younger subjects displaced their center of pressure further forward (P = 0.0001) and through a greater percentage of their initial base of support (P = 0.0001) than older subjects. CONCLUSION: This study provides the first multiplanar characterization of spinal motion used during standing reach. Significant differences for a number of variables existed between younger and older subjects.

Exercise to improve spinal flexibility and function for people with Parkinson's disease: a randomized, controlled trial.

OBJECTIVES: The effectiveness of an exercise intervention for people in early and midstage Parkinson's disease (stages 2 and 3 of Hoehn and Yahr) in improving spinal flexibility and physical performance in a sample of community-dwelling older people is described. DESIGN AND SETTING: Fifty-one men and women, aged 55-84 years, identified through advertisement, local support groups, and local neurologists were enrolled into a randomized, controlled trial. Subjects were assigned randomly to an intervention or a usual care arm (i.e., no specific exercise). Of the original 51 participants, 46 completed the randomized, controlled trial. Participants in the exercise arm (n = 23) received individual instruction three times per week for 10 weeks. Participants in the usual care arm (n = 23) were "wait listed" for intervention. MEASUREMENTS: Changes over 10 weeks in spinal flexibility (i.e., functional axial rotation) and physical performance (i.e., functional reach, timed supine to stand) were the primary outcome measures. RESULTS: MANOVA conducted for the three primary outcome variables demonstrated significant differences (P < or = .05) between the two groups. Further analysis using ANOVA demonstrated significant differences between groups in functional axial rotation and functional reach for the intervention compared with the control group. There was no significant difference in supine to sit time. CONCLUSION: Study results demonstrate that improvements in axial mobility and physical performance can be achieved with a 10-week exercise program for people in the early and midstages of PD.

The burden of Parkinson's disease on society, family, and the individual.

OBJECTIVE: To examine the burden of Parkinson's Disease (PD) on society, family, and the individual. SETTING: In-home interviews in Central North Carolina. DESIGN: A cross-sectional, descriptive study. PARTICIPANTS: A total of 109 people with PD. MEASURES: Standard instruments used to assess income, health status, health-related costs, and household activities. SAMPLE: The sample was weighted toward individuals who were within the first 5 years of post-PD diagnosis. RESULTS: The total per capita societal burden was approximately $6000 per year, the greatest single element of which was compensation for earnings loss for those less than age 65. Government insurance covered 85% of our sample. The largest components of family burden were the burden of providing informal caregiving and that of earnings loss. Spouses providing informal care did so a mean of 22 hours per week. Compared with a random sample of older people, our respondents spent much less time on house and yard work. CONCLUSION: The direct costs of the disease reflect a small portion of the burden. The hidden costs, in the form of lost wages, informal care, and changing roles are substantial. Their magnitude is even more important when we consider that the family generally lives on a fixed income, and the caregiver is an older aged spouse. Medical practitioners will best be able to intervene if they look holistically at the patient with this disease. When treating symptoms themselves, practitioners need to be aware of the high level of pain, fatigue, and depression associated with PD, even in the early stages. The results demonstrate clearly that family relationships are affected early, indicating the importance of providing early referrals to services such as home health, social workers/counseling, and well as PD support groups.

Measures of shoulder protraction and thoracolumbar rotation.

Physical therapists need objective measures that can be used reliably with a variety of subject groups to document upper quadrant function. Two aspects of upper quadrant motion, shoulder protraction and thoracolumbar rotation, are assessed routinely in clinical practice, but no standard measurement techniques have been reported. We hypothesized that there would be significant differences, by age and state of health, for both shoulder protraction and thoracolumbar rotation. The purposes of this study were: 1) to develop measurement approaches for shoulder protraction and thoracolumbar rotation; 2) to determine if there are significant differences in these motions for four subject groups: healthy young, healthy elders, functionally limited elders, and people with Parkinson's disease; and 3) to describe between-rater and within-rater reliability for these measures. Fifty-five subjects participated in this investigation. All subjects were rated by a physical therapist and two research assistants. Using an analysis of variance followed by Scheffe's post hoc analysis, significant differences were demonstrated between the groups. Between-rater and within-rater reliability ranged from ICCs of 0.54 to 0.95. Clinicians can use these measures to quantify aspects of upper quadrant function treated routinely in physical therapy practice. These measures also have applicability for researchers.

Reliability of impairment and physical performance measures for persons with Parkinson's disease.

BACKGROUND AND PURPOSE: Parkinson's disease (PD) is characterized by rigidity, postural instability, bradykinesia, and tremor, as well as other musculoskeletal impairments and functional limitations. The purpose of this investigation was to determine the reliability and stability of measures of impairments and physical performance for people in the early and middle stages of PD, Subjects. Thirteen men and 2 women in Hoehn and Yahr stages 2 and 3 of PD participated. Their mean age was 74.5 years (SD = 5.7, range = 64-84). METHODS: Thirteen impairment-level variables and 8 physical performance variables were measured. Measurements were taken on two consecutive days and again a week later on the corresponding two consecutive days. Reliability and stability were assessed using analysis of variance and intraclass correlation coefficients (ICCs). RESULTS: Test-retest reliability (ICCs) of variables ranged from .69 (hamstring muscle length) to .97 (lumbar flexion). Intraclass correlation coefficients were .85 or greater for 10 of the variables. CONCLUSIONS AND DISCUSSION: The results suggest that in the early and middle stages of PD, many of the measures of impairment and physical performance are relatively stable.

The relative importance of strength and balance in chair rise by functionally impaired older individuals.

OBJECTIVE: The ability to stand independently and safely from the seated position is essential for independent function. This investigation determined the relative contributions of measures of lower extremity strength and measures of balance control in explaining the performance characteristics of sitting-to-standing. Variables analyzed included those related to success of the activity (e.g., time to rise, lowest chair height) and to biomechanical characteristics of performance (e.g., how fast specific body segments moved). SETTING: Durham Veteran's Affairs Medical Center motion analysis laboratory. DESIGN: Cross-sectional correlational study. PARTICIPANTS: Fifty-eight men and women aged 66 to 96 (mean = 77) with functional limitations. MEASUREMENTS: Predictor variables were lower extremity strength (isometric) and balance (functional reach and sway). The outcome variable, chair rise performance, was quantified by: lowest successful chair height (chairs at 33 to 58 cm); time to rise; maximum hip flexion angular velocity; and the maximum horizontal and vertical velocities of the motion of the body center of mass (COM). Covariates were lower extremity range of motion and sensory status. RESULTS: With bivariate analysis, lower extremity strength demonstrated relationships with the lowest chair height (r = -0.639) and maximum vertical velocity of the COM (r = .389); functional reach was associated with three variables (lowest chair height r = .374; time to rise r = .297; and maximum horizontal velocity of the COM r = .251). Using a multivariate regression analysis (including lower extremity strength, functional reach, sensory loss, and lower extremity range of motion), the model accounted for 47% of the variance in lowest chair height; lower extremity strength was the only significant predictor (P < .001). The model also accounted for 20% of the variance in maximum horizontal velocity of the COM; lower extremity strength was a significant predictor (P = .006). CONCLUSIONS: Lower extremity strength and balance control both play a role in performance of chair rise; lower extremity strength is the stronger predictor of success for functionally impaired older adults.

The role of strength in rising from a chair in the functionally impaired elderly.

Rising from a chair is a task essential for independent living. Many elderly persons have difficult with this task. Previous studies have drawn conflicting conclusions as to the role of strength in limiting the ability to rise from a chair. The purpose of this study is to determine the role of knee extensor strength in rising from a chair in the functionally impaired elderly. It is hypothesized that knee extensor strength limits the minimum chair height from which a subject can rise in the functionally impaired elderly, but not in the young. Studying both young healthy adults and functionally impaired elderly showed that required joint moment increased monotonically with decreasing chair height. Further, the elderly used significantly more of their available strength to rise from any chair height, and their mean required knee moment was 97% of the available strength when rising from the lowest chair height from which they could successfully rise. These data suggest that strength is a limiting factor in determining the minimum chair height from which the functionally impaired elderly may rise.

Chair rise strategy in the functionally impaired elderly.

Many elderly people have difficulty with the common functional activity of rising from a chair. Previous work has identified different strategies that are used to assist the young, the healthy elderly, and the functionally impaired elderly subjects in this activity. For the young and the healthy elderly, modification of these strategies with decreased chair height has been examined. This study examined the changes in chair rise strategy in 18 moderately functionally impaired elderly as the difficulty with rising was increased. The results show that the functionally impaired elderly, when rising from their lowest successful chair compared to a chair of knee height, significantly increase peak hip flexion velocity (11 degrees/sec, p < 0.01) and time to rise (1.25 sec, p < 0.01), and significantly decreased their mean center of mass/base of support (COM/BOS) separation at lift-off (1.96 cm, p < 0.05). These alterations in strategy suggest that while the functionally impaired elderly attempt to increase their momentum in rising by increasing their hip flexion velocity, they simultaneously attempt to increase their stability by taking more time to rise and shortening the distance between their COM/BOS at lift-off. These changes suggest a more conservative strategy with increased difficulty, resulting in decreased success in rising from a chair.

Sit to stand from progressively lower seat heights -- alterations in angular velocity.

This study investigates the influence of chair height on the dynamics of sit-to-stand for two age groups. Eleven young (25-36 years) and 10 older (61-79 years) adults participated. Subjects rose from chairs set at four heights relative to knee height. Motion was quantified using a bilateral active-marker-based motion analysis system. Subjects appeared to increase trunk flexion angular velocity to overcome mechanical difficulties of decreasing chair heights. This variable showed a main effect for chair height (P = 0.0001). Time at which knee, hip, and trunk extension angular velocity were attained each demonstrated a chair by age interaction effect (P<0.05). Synchrony of body segment maximum extension angular velocities was altered for the older subjects at the lowest chair heights, suggesting that older individuals begin to change their performance as the task becomes more demanding. RELEVANCE:--Sitting to standing is one of the essential physical tasks used frequently throughout the day. Clinicians are frequently called upon to improve chair rise performance for those with functional limitations. Efforts are likely to be most successful if clinicians understand how healthy individuals accommodate to changing conditions (such as changing chair height) and use that information to interpret the performance of those with impairments and functional limitations.

Relationships between mobility of axial structures and physical performance.

BACKGROUND AND PURPOSE: Many day-to-day activities require bending and twisting motions of the spine (axial mobility). Because little is known about the relationship between axial mobility and physical performance, this investigation explored these relationships. SUBJECTS: Thirty-one men and 26 women, aged 20 to 91 years (chi=58.4, SD=24.4), participated. METHODS: Subjects were assigned to one of three age groups: 20 to 40 years, 60 to 74 years, or 75 years and older. Five sets of variables were identified and measured: cervical, lumbar, sagittal configuration (ie, kyphosis, lordosis), combined spinal motion, and physical performance. RESULTS: A multivariate analysis of variance revealed age effects for all sets of variables; a post hoc analysis of variance revealed age effects for all variables within the sets. Canonical correlations, controlling for age, demonstrated associations between the cervical and combined spinal motion sets of variables and between the combined spinal motion and physical performance sets of variables. CONCLUSION AND DISCUSSION: This investigation demonstrated an age effect for selected measures of axial mobility, sagittal configuration, and physical performance thought to depend on axial motion. Controlling for age, the results also demonstrated associations between measures of axial mobility and physical performance.