Impact of step width on trunk motion and gait adaptation in elderly women with knee osteoarthritis.

BACKGROUND: Step width during walking can provide important information about aging and pathology. Although knee osteoarthritis (OA) is a common disease in elderly women, little is known about how different step widths influence gait parameters in patients with knee OA. OBJECTIVE: To address this, we investigated the differences between narrower and wider step width on the center of mass (CoM) and gait biomechanics of elderly women with knee OA. METHODS: Gait and CoM data were measured using a three-dimensional motion capture system and anthropometric data were acquired via standing full-limb radiography. Thirty elderly women with knee OA were divided into two groups depending on the average step width value (0.16 m). Specifically, the narrower step width group included those with a below average step width (n= 15) and the wider step width group included those with an above average step width (n= 15). The differences between the two groups were analyzed using an independentt-test. RESULTS: Walking speed, step length, knee and ankle sagittal excursion, and medial-lateral CoM range were significantly greater in the narrower group. In contrast, the medial-lateral CoM velocity, medial-lateral ground reaction force (GRF), and foot progression angle were significantly higher in wider group. The external knee adduction moment, vertical GRF, and vertical CoM did not differ between the groups. CONCLUSIONS: Our data indicate that step width in women with knee OA is associated with trunk motion and gait patterns. People with a narrower step might improve their gait function by increasing trunk frontal control to maintain gait stability. In contrast, in those with a wider step, greater toe out angle and shorter step length might be a compensatory adaptation to reduce knee loading.

The difference in the relationship of spinal sagittal alignment between individuals with flat lumbar and normal lordosis posture based on global and regional angles.

BACKGROUND: According to previous studies, the relationship between lumbar lordosis and thoracic kyphosis or that between pelvic parameters and thoracic kyphosis have been inconsistent. OBJECTIVE: The purpose of this study was to investigate spinal sagittal alignment and its relationship to global and regional lumbar and thoracic angles, pelvic and sway angles, and C7-S1 distance measurements, followed by a detailed subgroup analysis using an inertial measurement unit system. METHODS: A total of 51 asymptomatic volunteers stood in a comfortable posture with inertial measurement units attached to the T1, T7, T12, L3, and S2 vertebrae. T1, T7, T12, L3, and S2 sagittal angles were acquired during standing posture using the Eulerian angle coordinate system. All angles are reported as the mean of three 5-s measurements. Following the measurement of lumbar lordosis angles (T12 relative S2), participants were divided into the flat lumbar and normal lordosis groups. RESULTS: There were different correlation patterns between groups because of spinal sagittal imbalance, which was greater in the flat lumbar group than in the normal lordosis group. In addition, sacral inclination proved the ideal parameter to evaluate reciprocal balance in lumbar lordosis, showing a stronger correlation with lower than with upper lumbar lordosis. T1 was the key element in assessing thoracic kyphosis, which showed a stronger correlation with upper than with lower thoracic kyphosis. CONCLUSION: We suggest that when assessing posture, it is necessary to identify the global and regional angles and it is useful to classify spinal sagittal alignment into subgroups according to lumbar lordosis and evaluate the groups separately.

Assessing the effects of sway-back posture on global and regional spinal sagittal angles using inertial measurement units.

BACKGROUND: Sway-back posture in the sagittal profile is a commonly adopted poor standing posture. Although the terms, definitions, and adverse health problems of sway-back posture are widely used clinically, few studies have quantified sway-back posture. OBJECTIVE: To investigate spinal sagittal alignment in sway-back posture while standing based on global and regional angles using inertial measurement units (IMUs). METHODS: This cross-sectional study recruited 30 asymptomatic young adults. After measuring the sway angle while standing, the participants were divided into sway-back and non-sway-back groups (normal thoracic group). Each participant stood in a comfortable posture for 5 seconds with IMUs at the T1, T7, T12, L3, and S2 levels. Then, we measured the global and regional lumbar and thoracic angles and sacral inclination in the standing position. RESULTS: Although there was no difference in the global lumbar angle, there was a difference in regional lumbar angles between the two groups. The normal thoracic group had balanced lumbar lordosis between the upper and lower lordotic arcs, whereas the sway back group tended to have a flat upper lumbar angle and increased lower lumbar angle. CONCLUSION: It is useful to assess the global and regional angles in the spinal sagittal assessment of individuals with sway-back posture.

Differences in regional and global lumbar angle during slumped sitting and upright sitting among global three subgroups.

OBJECTIVE: The purpose of this study was to investigate differences in regional lumbar lordosis (RLL) and global lumbar lordosis (GLL) angle during slumped sitting and upright sitting among three global subgroups. METHODS: A total of 48 young asymptomatic volunteers stood in a comfortable posture, sat upright, and sat in a slumped position for 5 seconds, with inertial measurement units attached to the T10, L3, and S2 vertebrae. According to standing measurement, the participants were categorized into flat-back (GLL < 20∘), normal lordosis (20∘⩽ GLL < 30∘), and hyper-lordosis (30∘⩽ GLL < 40∘) groups. RESULTS: Both the GLL and RLL in the flat-back group were reduced lumbar lordosis in the upright sitting posture and increased lumbar kyphosis in the slumped sitting postures compared to the other groups (p< 0.05), but the range of motion during the transition from upright sitting to slumped sitting was lower than that of the normal and hyper-lordosis groups (p< 0.05). GLL in standing was a moderate correlation with GLL and RLL during upright sitting (p< 0.05). However, there was a strong correlation between GLL and RLL kinematics during upright and slumped sitting (p< 0.05). CONCLUSIONS: Flat-back posture is a potential source of low back pain during both upright and slumped sitting compared to the normal and hyper-lordosis groups. Posture measurements in a standing and sitting position conducted to assess lordosis should consider the relationship between GLL and RLL.

The effects of differences on sagittal kinematics and muscle coordination during step up and step down in patients with spinal stenosis.

BACKGROUND AND OBJECTIVE: Lumbar spinal stenosis (LSS) is a common spinal disorder that causes patients to assume a forward-trunk posture. Spinal alignment affects swing limb angles and stance limb muscle activities. Therefore, we investigated the effects of differences in step up (SU) and step down (SD) tasks on the kinematics of the trunk and swing limb as well as stance limb muscle coordination in patients with LSS. METHODS: Nine elderly female patients diagnosed with LSS were recruited for this study. The sagittal kinematics of the trunk and swing limb and isolated contraction ratio of the gluteus medius (GMed) and vastus lateralis (VL) during SU and SD tasks were measured using a motion analysis system and surface electromyography system. RESULTS: Thoracic (17.71∘± 7.77∘) and spine angles (13.64∘± 11.34∘) as well as swing hip (48.48∘± 12.76∘) and pelvic angles (7.52∘± 10.33∘) were significantly greater during SU than SD (10.14∘± 8.41∘, 10.03∘± 11.03∘, 29.42∘± 10.57∘, 3.21∘± 10.11∘, all P< 0.05, respectively). The isolated contraction ratio of the GMed of the stance limb (34.12% ± 13.28%) was significantly higher during SU than during SD (26.65% ± 10.02%), whereas that of the VL of the stance limb (65.88% ± 13.28%) was significantly lower during SU than during SD (73.35% ± 10.02%, P= 0.011 for both comparisons). CONCLUSIONS: Patients with LSS demonstrated trunk compensatory mechanisms to address swing hip and knee angles. Trunk position affected pelvic limb muscle coordination in the standing support limb. These findings demonstrate that SD are more challenging than SU for patients with LSS, possibly due to reduced ability to generate adequate leg extensor muscular output to safely control the motion of the body's center of mass. Therefore, trunk positions must be considered when patients with LSS undergo rehabilitation programs, particularly those involving SD or descending stairs, so that healthcare professionals can better assist patients with LSS. In addition, this study provides a background for further studies.

Inter-tester Reliability of Lumbar Lordosis Posture Classification Using a Novel Screening Device.

OBJECTIVE: The purpose of this study was to investigate the inter-tester reliability of lumbar lordosis posture using a novel screening device. METHODS: A total of 33 healthy young male participants participated in the study. Two examiners measured the regional upper and lower lumbar lordosis angles of the participants in the standing position using a flexible ruler. The bent flexible ruler maintained a fixed shape and was transferred to a protractor for angle measurement. Two examiners classified each participant into one of 4 lumbar spine categories and measured the upper and lower regional lumbar lordosis angles. RESULTS: The agreement level between the 2 examiners in assessing healthy participants was 87.9%. The calculated kappa coefficient was 0.79 (95% CI = 0.86-0.97), reflecting a substantial level of agreement. CONCLUSION: Our results suggest that our novel screening device for assessing upper and lower lumbar angles showed good inter-tester reliability in posture classification. Our findings may be useful for health care professionals for managing sagittal lumbar posture in asymptomatic younger individuals; however, more testing is still needed.

Lumbar Movement Dysfunction Based on Movement Control Impairment Classification System in Those Who Do and Do Not Develop Transient Low Back Pain During Prolonged Sitting.

OBJECTIVE: Long-term sitting triggers movement-related disorders. We used a movement control impairment (MCI) system to investigate lumbar movement dysfunction in those who did and did not develop transient low back pain (LBP) during prolonged sitting. METHODS: Twelve patients who did and did not develop transient LBP during sitting for 2 hours were enrolled. We tested the movement control abilities of the 2 groups using 6 MCI tests (12 test items). RESULTS: The mean MCI test score in the transient LBP developer group was significantly higher than that in the LBP non-developer group (P = .03). Lumbar flexion movement control as the backward rocking test was significantly more common in the transient LBP developer than in the LBP non-developer group (P < .027). Pelvic shifting and asymmetry during side-bending of the trunk were evident in both groups (all P > .05). However, pelvic shifting during side-bending of the trunk was evident only in the LBP group (33%; P = .093). CONCLUSION: The group exhibiting transient LBP had higher positive MCI test scores and exhibited more asymmetry than the other group. Even the non-LBP group exhibited poor lumbar flexion and rotation. Therefore, subjects with subclinical dysfunction caused by prolonged sitting may require homogenous subgroups classification for the early detection of mechanical risk factors and health and functional interventions.

The Intertester Reliability of a Modified Movement System Impairment Classification System Used to Evaluate Individuals With Prolonged Sitting: A Preliminary Study.

OBJECTIVE: Prolonged sitting while working at a computer leads to poor sitting postures, which can aggravate low back pain in many individuals. We examined the intertester reliability of using the modified musculoskeletal impairment schema for classifying participants sitting at computers for prolonged times. METHODS: Fifty participants were examined independently by each therapist using a test-retest design. Each therapist assigned an musculoskeletal impairment classification upon completion of the examination. The agreement percentages and the kappa coefficient were used to evaluate intertester reliability in classifying participants with prolonged sitting. RESULTS: The percentage agreement between the 2 examiners for participants who maintained the sitting posture for prolonged times was 84%. The calculated kappa coefficient was 0.73, reflecting a substantial level of agreement. CONCLUSIONS: The present findings provide some evidence to support the classification of individuals who sit at computers for prolonged times and participants with rotation with flexion pattern would need to manage asymmetry pattern in a subclinical group.

The effect of sagittal hip angle on lumbar and hip coordination and pelvic posterior shift during forward bending.

PURPOSE: The purpose of this study was to investigate the effects of dynamic sagittal hip angle on lumbar and hip coordination and pelvic posterior shift during forward bending. METHODS: A total of 44 asymptomatic younger female volunteers were recruited to this study. Following measurement of trunk forward bending, participants were divided into three groups based on hip flexion angle: group 1, < 30°; group 2, ≥ 30° and < 50°; and group 3, ≥ 50°. Lumbar spine and hip coordination and pelvic backward shift were recorded during trunk forward bending using a three-dimensional ultrasonic motion analysis system. RESULTS: Pelvic and total angles increased with hip angle (group 3 > group 2 > group 1; p = 0.003 and p < 0.001, respectively), whereas lumbar/hip and pelvic/hip angle ratios decreased significantly (p < 0.001). The degree of pelvic posterior shift increased to a limited extent, whereas the pelvic posterior shift/hip angle ratio decreased significantly (p < 0.05). CONCLUSIONS: Asymptomatic subjects with limited hip flexion showed reduced total pelvic anterior rotation and greater relative proportion of pelvic motion than insufficient hip motion. These subjects tended to increase the pelvic posterior shift/hip angle ratio during trunk forward bending, possibly increasing passive tension by elongating the hamstring muscles to increase hip motion. The results of this study provide information that will improve the assessment of lumbar spine and hip coordination patterns and facilitate movement strategies by determining the specific requirements of individuals. These slides can be retrieved under Electronic Supplementary Material.

Inertial Measurement Unit-based Evaluation of Global and Regional Lumbar Spine and Pelvis Alignment in Standing Individuals With a Flat Lumbar Posture.

OBJECTIVE: The purpose of this study was to investigate the global and regional lumbar spine and pelvis postural alignment in standing individuals with a flat lumbar posture using an inertial measurement unit (IMU) system. METHODS: A total of 80 symptomatic young volunteers (25 men and 55 women in their early 20s) were recruited at Inje University in Gimhae, South Korea for this study. Participants stood in a comfortable posture for 5 seconds with IMUs on the T10, L3, and S2 level. Participants were then categorized into 3 groups according to the global lumbar lordosis (GLL) angle (T10-S2): <20°, 20° ≤ GLL angle < 30°, and 30° ≤ GLL angle < 40°. We compared the GLL and regional lumbar lordosis (RLL) angles among the 3 groups. RESULTS: As GLL increased, RLL angles (upper, P = .001; lower, P < .001) tended to increase, whereas the sacrum angle decreased (P < .001). A stepwise regression model showed that the sacrum angle was the single best predictor of GLL in standing participants. Based on IMU measurements, participants with GLL <20° are considered representative of participants with a flat lumbar posture. CONCLUSION: Posture measurements in a standing position conducted to assess lordosis should consider the relationship between GLL and RLL rather than GLL or RLL alone. We found that S2 was the best predictor of GLL.

Stepping over an obstacle in patients with lumbar spinal stenosis: Trunk and lower extremities of kinematic and muscle activation normalized by double limb support. A preliminary study.

BACKGROUND: Patients with LSS tend to adopt a flexed lumbar posture and trunk position, particularly when stepping over an obstacle, as this activity alters the biomechanical demands placed on the trunk and lower extremities. OBJECTIVE: To investigate the effects of lumbar spinal stenosis (LSS) on patients' trunk and lower-extremity kinematics, and on activities involving the gluteus medius (GMed) and vastus lateralis (VL). METHODS: All participants (9 older adult patients with LSS and 11 control subjects) were required to negotiate an obstacle while walking. Trunk and lower-extremity kinematic data and GMed and VL activities were recorded using a synchronized 3D motion capture system and surface electromyography. RESULTS: The thoracic (12.01∘± 8.82∘ and 16.45∘± 10.80∘) and spinal (9.92∘± 14.03∘ and 5.99∘± 15.94∘) flexion angles of the leading and trailing swing limbs were higher, and the pelvic anterior tilting angle (2.37∘± 7.76∘ and 10.38∘± 8.07∘) was lower in the LSS group than in the control group (p< 0.05). With the exception of toe-off and normalized GMed activities in the contralateral leading limb (p> 0.05), all GMed (256.73 ± 112.22%, 174.00 ± 75.79%, and 270.57 ± 114.45%, respectively) and VL (208.98 ± 124.81%, 182.97 ± 93.23%, 283.91 ± 154.71%, and 394.42 ± 108.94%, respectively) activities of the contralateral leading and trailing swing limb (heel-strike and toe-off normalized activities) were significantly higher in the LSS group than in the control group (p< 0.05). CONCLUSIONS: Patients with LSS exhibited trunk-flexed postures when stepping over an obstacle, and these trunk alignments placed higher demands on the GMed and VL activities normalized by double-limb support during joint loading in the single-leg stance. These findings support clinical recommendations for regulating the physical activity of obstacle negotiation that may be beneficial in the management of patients with LSS.

The effects of a posterior superior iliac spine support device on upper trunk acceleration during gait in individuals with flat lumbar back posture.

BACKGROUND: The orientation of the pelvis is of particular importance to the sagittal curve of the spine and has geometric relationships with the top of the spine and lumbar lordosis. Changes in spinal shape or disruptions of sagittal balance in the spine, such as a flattened lumbar spine, have significant negative effects. OBJECTIVE: The aim of this study was to investigate the effects of the posterior superior iliac spine support device (PSD) on upper trunk acceleration during gait in individuals with flat lumbar back posture. METHODS: In total, 10 young male subjects with reduced lumbar lordosis (global lumbar lordosis angle (T10-S2): <-20∘) were recruited for this study. Participants walked 7 m with and without wearing a PSD at a self-selected speed while fitted with an accelerometer attached over the T7 spinous process. RESULTS: The normalized AP acceleration of T7 with PSD (40.57 ± 11.22%) was significantly higher than those without PSD (37.10 ± 10.46%, p= 0.035). CONCLUSIONS: We found that wearing the PSD immediately improved pelvic physiological movement during walking in individuals with lumbar flat back posture. Our findings may help healthcare professionals manage flat back posture in asymptomatic younger individuals.

Strategy on navigating obstacle in patients with lumbar spinal stenosis: Relationship among trunk and pelvic movement, swing toe clearance, and muscle coordination of the stance limb.

BACKGROUND AND OBJECTIVE: Lumbar spinal stenosis (LSS) is a common spinal disorder that causes patients to assume a forward-trunk posture. Spinal alignment affects gait, muscle activity, and trunk-pelvis-limb coordination because the lumbar spine and muscles interact to allow load transfer between the lower back and pelvis during sagittal trunk movement. Therefore, we investigated the relationships among trunk and pelvic movement, swing toe clearance, and muscle coordination (isolated contraction ratios) of the stance limb during obstacle-crossing by patients with LSS. METHODS: Ten patients with LSS and ten control subjects were enrolled. All navigated an obstacle during walking. Kinematic data from the trunk and lower extremities were monitored using a three-dimensional motion analysis system. In addition, we measured the isolated contraction ratios of the gluteus medius (GMed) and vastus lateralis (VL) using surface electromyography. RESULTS: The normalized lead limb distance was significantly lower in the LSS group than in controls. The spine flexion angle when the swinging limb toe was above the obstacle was higher, but the pelvic anterior tilting angle was lower, in the LSS group. LSS patients also had a significantly lower isolated contraction ratio of the GMed in the trailing stance limb but a significantly higher VL. CONCLUSIONS: Patients with LSS adapted a poor posture and their thoracic and spinal regions were hyperflexed with restricted pelvic obliquity. This created an inefficient gait, a shorter leading limb step, and less stable muscle coordination in the stance limb. Our findings may help healthcare professionals manage patients with LSS.

Effects of lengthwise postural taping for lumbar spine rotation with flexion syndrome: a case report.

[Purpose] This study investigated the effects of lengthwise postural taping on a patient having lumbar spine rotation with flexion syndrome during prolonged periods of sitting. [Subject and Methods] The subject was a 22-year-old woman who had developed transient low back pain in the lumbo-pelvic region. The subject was asked to sit in a chair during 30 minutes of computer work under three conditions: no taping, extensive lumbo-pelvic region taping, and lengthwise lumbo-pelvic region taping. The center of force and mean peak gluteal pressure were measured using a TekScan system. [Results] With extensive taping, the AP center of force progressively decreased after 10, 20, and 30 min, while the ML center of force differed only slightly by time point. With lengthwise taping, the ML and AP center of force decreased after 20 min. [Conclusion] These findings suggest that lengthwise taping is a useful method for patients having lumbar rotation with flexion syndrome to prevent slumped sitting posture and excessive pressure on the gluteal muscles.

Effects of task velocity and center of mass acceleration during Y-Balance Test in elderly females with good and poor visual acuity.

[Purpose] To explore the effects of good binocular visual acuity (BVA) compared to poor BVA, reach distance, task velocity, and center of mass (COM) acceleration were evaluated in elderly females performing the Y-Balance Test (YBT) using a cross-sectional design. [Subjects and Methods] A total of 13 participants had BVA of ≥0.4 log of the minimum angle of resolution (logMAR) (poor BVA group), and the other 13 had BVA of ≤0.3 logMAR (good BVA group). An accelerometer was attached over participants' L3 spinous process, and they then performed the YBT. [Results] The normalized reach distances in the three directions among the good BVA group were longer than those among the poor BVA group. The task velocity in the good BVA group was significantly higher, whereas COM acceleration in the A direction was significantly lower compared with the poor BVA group. [Conclusion] Visual status must be considered when older adult individuals undergo physical therapy and functional training to ensure that healthcare professionals can better assist older adult women.

Difference in trunk stability during semicircular turns with and without a bag in elderly women.

BACKGROUND: Direction changes while walking are more likely to cause a hip fracture than is falling while walking in a straight line. Trunk stability is an important contributor to safe and effective walking, and arm movements influence trunk movement while walking. However, the difference in the trunk stability during semicircular turns performed by elderly women with a light bag has not been examined. OBJECTIVE: To investigate the effects of carrying a bag on trunk stability during semicircular turns in elderly women. METHODS: We enrolled 15 community-dwelling elderly women capable of independent walking. Participants walked with and without a bag at a self-selected speed along a marked path, which included semicircular turns, while fitted with an accelerometer attached over the L3 spinous process. RESULTS: Gait velocity was faster during semicircular turning with a bag versus without a bag. The normalized medial-lateral center of mass acceleration was lower during semicircular turning with a bag versus without a bag. CONCLUSIONS: We suggest that a light additional arm load and increased arm swing contributes to trunk stability and efficient walking during semicircular turning by elderly women.

Differences in gait velocity and trunk acceleration during semicircular turning gait with and without bag in females of very advanced age.

[Purpose] Gait velocity and trunk acceleration during semicircular turning gait with and without carrying a hand-held bag were compared in females of very advanced age. [Subjects and Methods] Ten female volunteers of very advanced age who could walk independently were recruited for this study. Gait velocity and trunk acceleration were measured using an accelerometer during semicircular turning gait with and without carrying a hand-held bag. [Results] Gait velocity during semicircular turning gait was greater with the bag than without the bag. [Conclusions] Trunk stability during semicircular turning gait was higher when the subjects carried a bag. Additional arm load could be considered during gait training in females of very advanced age.

The effects of gait time and trunk acceleration ratio during stair climbing in old-old adult females.

[Purpose] This study investigated the effects of gait time and trunk acceleration ratio in old-old adult females during stair climbing. [Subjects and Methods] Twenty-five older adult females who were able to walk independently volunteered for this study and were categorized into two age groups (older adults or old-old adults). Gait time and trunk acceleration ratio were measured using an accelerometer during stair climbing. [Results] Gait time and trunk acceleration ratio when climbing stairs were significantly higher in the old-old age group than in the older adults group. [Conclusions] These findings suggest that old-old females have decreased upper trunk control. In addition, gait time and the trunk acceleration ratio during stair climbing are useful clinical markers for predicting function and balance control ability in old-old elderly populations.

Comparison of trunk acceleration ratios during stair negotiation in old-old females.

[Purpose] This study compared trunk acceleration ratios in old-old adult females during stair negotiation. [Subjects and Methods] Twelve old-old adult females who could walk independently volunteered for this study. This study measured gait time and trunk acceleration ratios using an accelerometer during ascending and descending stairs [Results] The trunk acceleration ratio when descending stairs was significantly higher than that when ascending stairs. [Conclusion] These findings suggest that old-old females have greater deterioration of upper trunk control function for descending than for ascending stairs, regardless of task time. In addition, the trunk acceleration ratio during stair negotiation is a useful clinical marker to predict function and balance control ability in old-old females.

Effects of Balance Control Through Trunk Movement During Square and Semicircular Turns on Gait Velocity, Center of Mass Acceleration, and Energy Expenditure in Older Adults.

BACKGROUND: Turning during ambulation is a common movement in everyday life, but complex and challenging for older adults. Balance control through trunk movement provides a stable platform during walking, thus it is an essential component of safe and efficient turning during walking in elderly individuals. OBJECTIVES: To investigate the effects of balance control during square turning (ST) and semicircular turning (SCT) on gait velocity, center of mass (COM) acceleration, and energy expenditure in elderly women. DESIGN: Cross-sectional design. SETTING: Village community center. PARTICIPANTS: Twenty community-dwelling elderly women capable of independent walking were enrolled in the study. METHODS: Participants walked at a self-selected speed along a marked path that included 2 types of turns (the path was divided into 3 segments: straight, turning, and straight return), while fitted with an accelerometer attached over the L3 spinous process. MAIN OUTCOME MEASUREMENTS: Differences in gait velocity, normalized COM acceleration, and energy expenditure were analyzed using paired t-tests for comparisons between ST and SCT tasks and using a one-way repeated-measures analysis of variance for within tasks. RESULTS: During the ST task, which was characterized by the use of a less-stable balance maintenance strategy, gait velocity and vertical COM acceleration were lower (P < .05), whereas greater medial-lateral COM acceleration (P < .05) and energy expenditure (P < .001) were observed during turning and return straight stages compared with the SCT task. For both tasks, velocity during turning stage was the slowest, among the 3 stages, the straight stage was the fastest (P < .05). For the SCT task, the anterior-posterior COM acceleration during the straight stage was significantly higher than during the turning stage, and the vertical COM acceleration during the straight stage was significantly lower than during the return-straight stage (P < .05). In both tasks, the energy expenditure of the turning stage was significantly higher than in the straight and return straight stage (P ≤ .001), and in the return straight stage was higher than the straight stage-only ST task (P < .05). CONCLUSIONS: We suggest that elderly individuals participate in balance and gait training using a variety of turns, including turns requiring medial-lateral and vertical COM balance control, to prevent falls and to improve energy efficiency of walking. LEVEL OF EVIDENCE: IV.