Health-related predictors of falls and fractures in women over 40.

SUMMARY: A longitudinal study of women aged 40-80 predicted single falls from a previous fall history and deficient vestibular integration. Multiple falls were predicted by a fall history, low activity levels, more medical conditions and deficient vestibular integration. Low bone mineral density, more medical conditions and fall history predicted fractures. INTRODUCTION: The purpose of this study was to identify potentially modifiable health-related factors predicting falls and fractures, focussing on women over 40. METHODS: Four hundred and forty-nine women aged 40-80 years from the Longitudinal Assessment of Women study participated. Demographic information (age, BMI, medications, medical conditions and activity level), balance assessments (including timed up & go and modified clinical test for sensory interaction of balance) and measurements of bone mineral density and body composition were collected in 2001; fall and fracture data were gathered in 2003, 2005, 2007, 2008 and 2010 to determine incidence. RESULTS: Multinomial logistic regression revealed that single falls could be predicted by a history of previous falls (OR 3.08) and being unsteady in bipedal stance on foam with eyes closed (OR 1.99). Multiple falls were predicted by a history of falls at baseline (OR 4.69), low levels of activity (OR 2.17), greater number of medical conditions (OR 1.12) and being unsteady in bipedal stance on foam with eyes closed (OR 4.21). Low bone mineral density (OR 3.13), greater number of medical conditions (OR 1.32) and a history of falls (OR 3.04) were predictive of fractures. CONCLUSIONS: Poor health, decreased balance, and inactivity are predictive of falls and low bone mineral density, low activity level and poor health predictive fractures. Results suggest failing the balance test bipedal stance on foam with eyes closed in the presence of low activity and poor health is a valid quick screening tool for detecting potential fallers for referral for in-depth balance assessment and intervention.

Is the Wii Fit a new-generation tool for improving balance, health and well-being? A pilot study.

BACKGROUND: The Nintendo Wii Fit is a new product that is purported to improve balance, strength, flexibility, fitness and general well-being. Currently, there are no controlled trials published to support such claims. AIM: The aim of this research was to determine the feasibility of Wii Fit in improving balance, strength, flexibility and fitness for healthy women aged between 30 and 60 years. METHOD: Ten women aged 30-58 years were recruited to the study. Intervention involved a 30-min session, twice weekly for 10 weeks. The manufacturer's pre-programmed Wii Fit regime determined for age and physical ability was followed. All women were assessed before and after the 10 weeks' intervention. Demographic information collected included age, weight, and self-reported information related to habitual physical activity, regular medication, hormone replacement therapy and well-being. Balance measures included the modified Clinical Test for Sensory Integration of Balance, reaction time and unilateral stance with velocity of sway recorded. Clinical measures of balance and mobility included the Step Test, the timed Up & Go test (TUG) and the TUG(cognitive). Somatosensory testing included touch, vibration and knee-joint re-positioning ability; ankle flexibility and the muscle strengths of quadriceps, hip abductors and adductors were also measured. Cardiovascular fitness was measured using a 6-min walk test. RESULTS: Balance (unilateral stance, eyes open (p < 0.05) and lower limb muscle strength (p < 0.05) showed significant improvement but changes in touch, vibration, proprioception, cardiovascular endurance, mobility, weight change, activity level and well-being were not significant. CONCLUSION: Activity fostered by Wii Fit showed an immediate effect on balance and strength that needs confirmation by statistically powered studies.

Falling is not just for older women: support for pre-emptive prevention intervention before 60.

OBJECTIVE: This study aimed to report falls and identify factors that might predict a fall in women aged between 40 and 80 years and thus provide evidence of earlier falls and need for morbidity preventive intervention. DESIGN AND PARTICIPANTS: A prospective cohort study design over 5 years. Personal demographic data of age, co-morbidities, number of prescribed medications, falls, activity level and living situation were obtained at face-to-face interview. Height, weight, body mass index and postural stability were measured in participating women living independently in the community. RESULTS: Women were categorized into age decade cohorts, with 463 remaining at the year 5 assessment. At baseline, 8% of the women in their forties, 14% in their fifties, 25% in their sixties and 40% in their seventies had fallen in the previous 12 months. Over the 5-year study period, 21% of women in their forties and fifties, 31% of women in their sixties and 47% in their seventies had fallen. Multiple fallers mostly comprised women in their sixties and seventies. Parametric modeling and the classification tree approach revealed age and number of co-morbidities to be most predictive of a fall. Women < 60 years old had an increased risk of a fall by 8% and women > 60 years an increased risk of a fall by 35% with every additional co-morbidity. Stability and other demographics were not predictive of falling. CONCLUSIONS: For women over 40 years old, the number of co-morbidities increased the risk of a fall. The falls risk escalated with additional co-morbidities if they were over 60 years. Preventive program participation to maintain good health beginning by the forties appears vital to prevent falls.

Positive effects of exercise on falls and fracture risk in osteopenic women.

UNLABELLED: Exercise may affect osteopenic women at risk of falls and fractures. A workstation approach to exercise was evaluated in a randomised study of 98 women. The intervention group improved in measures of balance, strength and bone density. This study supports a preventative exercise approach that aims to reduce risk factors for fractures and falls, in women already at risk, through balance training and weight-bearing activity. INTRODUCTION: The objective of this study was to determine the effects of a workstation balance training and weight-bearing exercise program on balance, strength and bone mineral density (BMD) in osteopenic women. A single-blinded randomised controlled trial (RCT) was undertaken for 20 weeks with measurements at baseline and completion. MATERIALS AND METHODS: Ninety-eight (98) community-dwelling osteopenic women aged 41-78 years were recruited through the North Brisbane electoral roll. Subjects were randomised via computer-generated random numbers lists into either a control (receiving no intervention), or exercise group (two one-hour exercise sessions per week for 20 weeks with a trained physiotherapist). Assessments at baseline and post-intervention included balance testing (five measures), strength testing (quadriceps, hip adductors / abductors / external rotators and trunk extensors), and DXA scans (proximal femur and lumbar spine). Baseline assessment showed no significant differences between groups for all demographics and measures except for subjects taking osteoporosis medication. The percentage differences between pre- and post-intervention measurements were examined for group effect by ANOVA using an intention-to-treat protocol. RESULTS: Ninety-eight women (mean age 62.01 years, SD 8.9 years) enrolled in the study. The mean number of classes attended for the 42 participants in the exercise group who completed the program was 28.2 of a possible 40 classes (71%). At the completion of the trial the intervention group showed markedly significant better performances in balance (unilateral and bilateral stance sway measures, lateral reach, timed up and go and step test) (p < 0.05) with strong positive training effects reflecting improvements of between 10% to 71%. Similarly there were gains in strength of the hip muscles (abductors, adductors, and external rotators), quadriceps and trunk extensors with training effects between 9% and 23%. CONCLUSIONS: Specific workstation exercises can significantly improve balance and strength in osteopenic women. This type of training may also positively influence bone density although further study is required with intervention over a longer period. A preventative exercise program may reduce the risk of falls and fractures in osteopenic women already at risk.

Changes in activity level in women aged 40-80 years.

OBJECTIVES: The purpose of this study was to report habitual physical activity levels in women and document the change in level of activity and factors affecting this change over a 5-year period. METHODS: A 5-year prospective cohort design was used. Women aged 40-80 years, living independently in the community, were recruited via the electoral role. The effects were investigated, first, of age, activity level, history of falls, number of co-morbidities and medications, body mass index and stability at baseline on change in activity level and, second, change in these demographics on activity level over the study period. RESULTS: Data from 459 women who completed our study are reported. Only activity level and body mass index at baseline significantly affected change in activity level (p<0.000). Change in activity level was not influenced by change in demographics over the study period. The forties and fifties cohorts accounted for the baseline body mass index effect on activity change (p<0.04). In the forties cohort, number of medical conditions at base line (p<0.03) and, in the sixties cohort, increase in number of medical conditions (p=0.011) affected activity level change. CONCLUSIONS: Activity level at baseline and body mass index in younger women were most likely to affect change over time. Being unsteady or having already fallen did not stimulate change.

Medial-lateral postural stability in community-dwelling women over 40 years of age.

OBJECTIVE: To document the change in medial-lateral balance in women aged between 40 and 80 years. DESIGN: A cross-sectional study of six measures of medial-lateral balance was undertaken. SETTING: The Betty Byrne Henderson Centre for Women and Ageing, Royal Women's Hospital, Australia. SUBJECTS: Five hundred and three community-dwelling women between 40 and 80 years of age were randomly recruited from a large metropolitan region with 366 subjects admitted after applying exclusion criteria. MEASUREMENTS: The clinical measurements included the lateral reach and step tests while laboratory measurements were gathered from the Balance Master software programs for unilateral stance and limits of stability. RESULTS: A significant decline in all measures (p < 0.02) was evident between the forties and sixties age decade cohorts. The clinical step test showed a significant (p < 0.001) decline between the forties and fifties groups. A significant correlation was shown between step test and unilateral stance (p < 0.001) and movement velocity, reaction time and end-point excursion centre of gravity (COG) on the limits of stability test (p < 0.001). CONCLUSIONS: This new evidence demonstrates that there is a significant decline in medial-lateral balance in women that occurs between their forties and sixties. Suggestions for further study were made.

A longitudinal physical profile assessment of skeletal muscle manifestations in myotonic dystrophy.

OBJECTIVES: To develop an assessment that describes the skeletal muscle manifestations in myotonic dystrophy subjects and then use it to quantify the presentation of skeletal muscle disability and to show change over time. DESIGN: A quantified skeletal muscle assessment was developed and applied three times over a two-year period at intervals around 12 months. Thirty-six subjects with myotonic dystrophy and 20 subjects without neuromuscular disability were evaluated. The assessment comprised manual muscle testing of five pairs of muscles, measuring neck flexor strength with a strain gauge, respiratory function tests, power and lateral pinch grip strength, all tests of impairment. Assessment of the ability to move from sitting to standing and fasten buttons tested disability. RESULTS: Results from subjects with myotonic dystrophy were compared to the normal data. The subjects with myotonic dystrophy were significantly weaker in proximal upper limb muscles, quadriceps, tibialis anterior muscles and neck flexor muscles as well as power and lateral pinch grips. There was also significant reduction in forced expiratory volume at one second (FEV1) and forced vital capacity (FVC). Significant disability was seen in the myotonics in moving from sitting to standing and in fastening buttons. Over the two-year study period proximal upper limb and lower limb muscle strength, FVC and sit-to-stand ability declined significantly. Power grip declined but lateral pinch grip and FEV1 improved significantly. Button fastening ability improved significantly. CONCLUSION: The test developed was shown to be reliable and sensitive to the change in skeletal muscle manifestations in subjects with myotonic dystrophy who were shown to be significantly weaker than normal subjects.

Wheelchair design for people with neuromuscular disability.

The observation that wheelchairs often failed to provide the mobility and support needed by patients with neuromuscular disability facilitated this study. Three groups of subjects with multiple sclerosis, spinal cord injury and muscular dystrophy were examined to determine their various disabilities and anthropometric measurement. These were then compared with wheelchair dimensions in an endeavour to determine whether the problem was wheelchair design or poor prescription. An evaluation of wheelchair use was also included. Results showed that several wheelchair dimensions including seat depth, arm rest height, backrest height and lack of contour support failed to match the sample population, indicating the need for greater care in selection of wheelchairs for patients with neuromuscular disabilities in addition to the need for design revision.

The Use of EMG Biofeedback in Quadriceps Strengthening Exercise for Rheumatoid Arthritis Patients: A Clinical Trial.

A clinical trial involving rheumatoid arthritis patients hospitalized due to an exacerbation of their disease, was initiated in order to determine whether EMG biofeedback when used in conjunction with isometric exercise enhanced quadriceps strengthening. The parameters of muscle bulk, strength and motor unit activity were measured before, during and after the trial to determine any improvements occurring. Results showed that in predominantly elderly patients there was no significant increase in quadriceps strengthening when EMG biofeed-back was used. Further, for subjects under 45 years of age, EMG biofeedback was not shown to effect significant improvement.