Minimal power required to ascend a flight of stairs versus actual power measured with body-fixed sensors in adults aged 19-85 years.

A good stair-climbing (SC) ability is crucial for independent living in older adults. A simple formula that estimates the mean power needed to ascend a flight of stairs in a predetermined time (i.e., total ascent duration) is easy to implement in practice, but lacks information on actual power values generated per step. The latter is possible with body-fixed sensors. This study aimed at comparing both methodologies and investigating their sensitivity to detect age-related differences. 318 participants (162 ♀; age 19-85 years) were tested on a 6-step staircase and two methodologies were used to estimate mean SC power: (1) a body-fixed sensor with automated detection of power production per step, and (2) a mathematic equation based on timed ascent duration, body mass and stair height. SC power was 210.4 W lower with formula compared to sensor, lower in women versus men and in older versus young adults (p < 0.001). The difference in SC power between sensor and formula was greater in individuals with better performance (i.e., men and young adults) (p < 0.001), indicating a ceiling effect of the formula in well-functioning and younger individuals. Likewise, ICC's between both methodologies showed poor reliability in people aged <65 years (0.087-0.363) and moderate to good reliability in people aged ≥65 years (0.453-0.780). To conclude, participants with better SC performance are able to largely overshoot the minimal power required to ascend the stairs in a certain duration. This makes the sensor more sensitive to identify early age-related differences compared to the formula.

Older adults' lower-limb muscle power production throughout a full flight of stairs: Reliability and comparison between different stair models.

Lower-limb muscle power should be closely monitored to prevent age-related functional ability declines. Stair-climbing (SC) power is a functionally relevant measurement of lower-limb muscle power. Body-fixed sensors can measure power production throughout the different steps of a flight of stairs to assess different aspects of performance. This study investigated: 1) power production throughout a full flight of stairs; 2) if staircases with less or more steps can provide similar information; and 3) test-retest reliability of SC power. 116 community-dwelling older adults (57 women) ascended three staircases as fast as possible: 12, 6 and 3 steps. Mean vertical power production per step was collected and analyzed using a commercial body-fixed sensor and software. Three phases were found in SC power production: 1) an acceleration phase, i.e., the power produced in step 1 (P1); 2) a phase where the highest performance (Pmax) is reached and; 3) a fatiguing phase with power loss (Ploss; only measurable on 12-step staircase). Mean power (Pmean) over the different steps was also evaluated. P1 did not differ between staircases (all p>0.05), whereas Pmax and Pmean were higher with increasing number of steps (p = 0.073 -p<0.001). P1, Pmax and Pmean were strongly correlated between staircases (r = 0.71-0.95, p<0.05). and showed good to excellent reliability (ICC = 0.66-0.95, p<0.05). Ploss showed poor reliability. To conclude, measurements of SC power production (P1, Pmax and Pmean) with a single sensor on the lower back are reliable across different staircases. A small, transportable, 3-step staircase can be used for measuring power production in clinical practices with no access to regular staircases. However, absolute values are dependent on the number of steps, indicating that measurements to track performance changes over time should always be done using an identical stair model.

Sensor- and equation-based sit-to-stand power: The effect of age and functional limitations.

Estimating lower-limb muscle power during sit-to-stand (STS) tests is feasible for large-scale implementation. This study investigated 1) whether age, functional limitations and sex have an influence on the movement strategy and power production during STS; and 2) potential differences between STS power estimated with either a simple equation or a sensor. Five-repetition STS data of 649 subjects (♂352 ♀297) aged 19 to 93 years were included. Subjects were divided in different age groups and levels of functioning. A body-fixed sensor measured (sub)durations, trunk movement (flexion/extension) and STS muscle power (Psensor). Additionally, mean STS muscle power was calculated by a mathematic equation (Alcazar et al., 2018b)Results revealed that 1) older subjects and women showed greater trunk flexion before standing up than younger subjects and men, respectively (both p < 0.001); 2) well-functioning adults seemed to have the tendency to not extend the trunk fully during the sit-to-stand transition (mean difference extension - flexion range = -15.3° to -13.1°, p < 0.001); 3) mobility-limited older adults spent more time in the static sitting and standing positions than their well-functioning counterparts (all p < 0.001); 4) STS power decreased with age and was lower in women and in limited-functioning subjects compared to men and well-functioning subjects, respectively (p < 0.05); 5) Pformula was highly related to Psensor (ICC = 0.902, p < 0.001); and 6) Pformula demonstrated higher values than Psensor in well-functioning adults [mean difference = -0.31 W/kg and -0.22 W/kg for men and women, respectively (p < 0.001)], but not among limited-functioning older adults. To conclude, this study showed that age and functional limitations have an influence on the movement strategy during a 5-repetition STS test. Differences in movement strategy can affect the comparison between Pformula and Psensor. In well-functioning older adults, Pformula was slightly higher than Psensor, which might be related to an incomplete extension in the sit-to-stand transition.

Association of Sit-to-Stand Capacity and Free-Living Performance Using Thigh-Worn Accelerometers among 60- to 90-Yr-Old Adults.

PURPOSE: Five times sit-to-stand (STS) test is commonly used as a clinical assessment of lower-extremity functional ability, but its association with free-living performance has not been studied. Therefore, we investigated the association between laboratory-based STS capacity and free-living STS performance using accelerometry. The results were stratified according to age and functional ability groups. METHODS: This cross-sectional study included 497 participants (63% women) 60-90 yr old from three independent studies. A thigh-worn triaxial accelerometer was used to estimate angular velocity in maximal laboratory-based STS capacity and in free-living STS transitions over 3-7 d of continuous monitoring. Functional ability was assessed with short physical performance battery. RESULTS: Laboratory-based STS capacity was moderately associated with the free-living mean and maximal STS performance ( r = 0.52-0.65, P < 0.01). Angular velocity was lower in older compared with younger and in low- versus high-functioning groups, in both capacity and free-living STS variables (all P < 0.05). Overall, angular velocity was higher in capacity compared with free-living STS performance. The STS reserve (test capacity - free-living maximal performance) was larger in younger and in high-functioning groups compared with older and low-functioning groups (all P < 0.05). CONCLUSIONS: Laboratory-based STS capacity and free-living performance were found to be associated. However, capacity and performance are not interchangeable but rather provide complementary information. Older and low-functioning individuals seemed to perform free-living STS movements at a higher percentage of their maximal capacity compared with younger and high-functioning individuals. Therefore, we postulate that low capacity may limit free-living performance.