Effect of a supervised hip flexor stretching program on gait in elderly individuals.

OBJECTIVE: To determine whether a 10-week supervised hip flexor stretching program in healthy elderly subjects would increase peak hip extension, stride length and gait speed and reduce anterior pelvic tilt during walking. DESIGN: A double-blinded, randomized, controlled trial. SETTING: Pre- and posttreatment assessments were performed in a gait laboratory, whereas stretching exercises were performed outside of the laboratory, usually in the subject's home. PARTICIPANTS: Eighty-two healthy elderly individuals, with 39 subjects in the control group and 43 subjects in the treatment group. INTERVENTION: The treatment group completed a 10-week, twice-daily hip flexor stretching program, which was supervised twice weekly by a rehabilitation clinician. The control group completed a 10-week shoulder abductor stretching program. MAIN OUTCOME MEASUREMENTS: Passive hip extension range of motion, dynamic peak hip extension, peak anterior pelvic tilt, stride length, and gait speed during walking. RESULTS: The treatment group showed significant improvements in passive hip extension range of motion (P = .007). Subjects in the treatment group who presented with limited preassessment peak hip extension during walking had increased stride length (P = .019) and peak hip extension (P = .012), and decreased anterior pelvic tilt (P = .006) during walking, whereas subjects in the control group showed only decreased anterior pelvic tilt (P = .013). CONCLUSIONS: The 10-week supervised hip flexor stretching program was effective in increasing stride length and peak hip extension during walking in elderly adults who had limited preintervention hip extension during walking. These results support the use of a simple stretching program for elderly individuals in counteracting age-related decline in gait function.

Effect of a supervised hip flexor stretching program on gait in frail elderly patients.

OBJECTIVE: To determine whether a 10-week supervised hip flexor stretching program in frail elderly subjects would increase peak hip extension, stride length, and gait speed and reduce anterior pelvic tilt during comfortable and fast-paced walking. DESIGN: A double-blinded, randomized, controlled trial. SETTING: Pre- and post-treatment assessments were performed in a gait laboratory and stretching exercises were performed outside of the laboratory, usually in the subjects' place of residence. PARTICIPANTS: Seventy-four frail elderly individuals, with 41 subjects in the control group and 33 subjects in the treatment group. INTERVENTION: The treatment group completed a 10-week twice-daily hip flexor stretching program that was supervised twice weekly by a rehabilitation clinician. The control group completed a 10-week shoulder abductor stretching program. MAIN OUTCOME MEASUREMENTS: Dynamic peak hip extension and peak anterior pelvic tilt, stride length, and gait speed while walking at a comfortable pace and a fast pace, as well as passive hip extension range of motion. RESULTS: The treatment group showed significant increases in walking speed and stride length after the intervention but showed no significant changes in peak hip extension or anterior pelvic tilt during comfortable and fast-paced walking. The treatment group also showed significantly increased passive hip extension range of motion. CONCLUSIONS: These results indicate that a simple stretching program is effective in improving some measures of age-related decline in gait function in frail elderly patients. The lack of consistent improvements in walking kinematics is attributed to the presence of multiple disabilities and limitations present in the frail subjects.

A three-dimensional kinematic and kinetic comparison of overground and treadmill walking in healthy elderly subjects.

BACKGROUND: Instrumented treadmills offer a number of advantages for the biomechanical analysis of elderly gait, yet it is unclear how closely treadmill gait approximates overground gait. Although studies have indicated that the kinematics and kinetics of overground and treadmill gait are very similar in young adults, it still needs to be determined whether data collected in elderly adults during treadmill walking can be generalized to overground gait. The purpose of this study, therefore, was to compare the three-dimensional kinematics and kinetics of treadmill gait to overground gait in a group of healthy elderly subjects. METHODS: Three-dimensional kinematic and kinetic data for 18 healthy, nondisabled elderly subjects, age 65-81 years, were collected for speed-matched overground and treadmill walking conditions. FINDINGS: Overall, the kinematics and kinetics of gait during treadmill and overground walking in the elderly had very similar patterns. However, during treadmill walking elderly subjects showed greater cadence, smaller stride length and stride time as well as reductions in the majority of joint angles, moments and powers when compared to overground walking. INTERPRETATION: The large increase in cadence suggests that an effective method of acclimation to treadmill walking still needs to be determined. Because of the differences, we believe that in order for instrumented treadmills to become a suitable tool for research and training purposes in healthy elderly, subjects must be adequately acclimated to the treadmill.