Walking on a Balance Beam as a New Measure of Dynamic Balance to Predict Falls in Older Adults and Patients with Neurological Conditions.

BACKGROUND: Beam walking is a new test to estimate dynamic balance. We characterized dynamic balance measured by the distance walked on beams of different widths in five age groups of healthy adults (20, 30, 40, 50, 60 years) and individuals with neurological conditions (i.e., Parkinson, multiple sclerosis, stroke, age: 66.9 years) and determined if beam walking distance predicted prospective falls over 12 months. METHODS: Individuals with (n = 97) and without neurological conditions (n = 99, healthy adults, age 20-60) participated in this prospective longitudinal study. Falls analyses over 12 months were conducted. The summed distance walked under single (walking only) and dual-task conditions (walking and serial subtraction by 7 between 300 to 900) on three beams (4, 8, and 12-cm wide) was used in the analyses. Additional functional tests comprised grip strength and the Short Physical Performance Battery. RESULTS: Beam walking distance was unaffected on the 12-cm-wide beam in the healthy adult groups. The distance walked on the 8-cm-wide beam decreased by 0.34 m in the 20-year-old group. This reduction was ~ 3 × greater, 1.1 m, in the 60-year-old group. In patients, beam walking distances decreased sharply by 0.8 m on the 8 versus 12 cm beam and by additional 1.6 m on the 4 versus 8 cm beam. Beam walking distance under single and dual-task conditions was linearly but weakly associated with age (R2 = 0.21 for single task, R2 = 0.27 for dual-task). Age, disease, and beam width affected distance walked on the beam. Beam walking distance predicted future falls in the combined population of healthy adults and patients with neurological conditions. Based on receiver operating characteristic curve analyses using data from the entire study population, walking ~ 8.0 of the 12 m maximum on low-lying beams predicted future fallers with reasonable accuracy. CONCLUSION: Balance beam walking is a new but worthwhile measure of dynamic balance to predict falls in the combined population of healthy adults and patients with neurological conditions. Future studies are needed to evaluate the predictive capability of beam walking separately in more homogenous populations. Clinical Trial Registration Number NCT03532984.

Blood flow restriction reduces the increases in cardiorespiratory responses and subjective burden without inhibiting muscular activity during cycling at ventilatory threshold in healthy males.

Low-intensity endurance exercise with blood flow restriction (KAATSU) is under consideration for use in cardiac rehabilitation. However, the physiological responses to such exercise have not yet been fully characterized. In an initial effort in healthy males (n = 11, age: 26.3±4.6 y), we compared the physiological responses to low-intensity endurance exercise with and without a thigh KAATSU. Participants performed maximal graded exercise testing using a cycle ergometer with or without KAATSU. We examined responses to cycling exercise at ventilatory threshold (VT) in heart rate (HR), oxygen consumption (VO2), dyspnea, ratings of perceived exertion (RPE), blood pressure (BP), and rectus femoris activation. Participants reached VT at a lower mechanical load, HR, VO2, dyspnea, and double product (HR×systolic BP) with KAATSU vs. no-KAATSU. At VT, RPE, and rectus femoris activity did not differ between the two conditions. These results suggest that KAATSU reduced exercise intensity to reach VT and the physiological responses to exercise at VT without changes in knee extensor muscle activation. Results from this pilot study in healthy males suggest that KAATSU aerobic exercise at VT intensity has the potential to be an effective and low-burden adjuvant to cycling in cardiac rehabilitation.

Effects of Motor-Cognitive Dual-Task Standing Balance Exergaming Training on Healthy Older Adults' Standing Balance and Walking Performance.

Objective: This study examined the effects of motor-cognitive dual-task exergaming standing balance training on healthy older adults' static, dynamic, and walking balance. Methods: Twenty-four adults older than 70 years (control group: n = 9, males = 6, balance training group: n = 15, males = 8) completed the experiment. Dual-tasking standing balance training comprised the accurate control of a ping-pong ball on a tray held with both hands, while standing on one leg (analog training) and three modules of Wii Fit™ exergaming (digital training). The duration of balance training was ∼15 minutes per day, 2 days per week for 8 weeks, in total 16 sessions. We measured one-leg standing time, functional reach distance, walking balance evaluated by the distance walked on a narrow beam (4-cm long, 4-cm wide, and 2-cm high) with single and dual tasking, habitual and maximal walking speed, and muscle strength of the hip extensor, hip abductor, hip adductor, knee extensor, and plantarflexor muscle groups in the right leg at baseline and after 8 weeks. Results: Control group decreased, but balance training group increased one-leg standing time. Only the balance training group improved functional reach distance and hip and knee extensor strength. There was no change in walking speed and walking balance in either group. In the balance training group, changes in maximal speed correlated with changes in dual-tasking walking balance and changes in one-leg standing time correlated with changes in single-tasking walking balance. Conclusion: These results suggest that 16 sessions of motor-cognitive dual-task standing exergaming balance training substantially improved healthy older adults' static and dynamic balance and leg muscle strength but failed to improve walking speed and walking balance. Balance exercises specific to walking balance need to be included in balance training to improve walking balance.

Low-Intensity Resistance Training with Moderate Blood Flow Restriction Appears Safe and Increases Skeletal Muscle Strength and Size in Cardiovascular Surgery Patients: A Pilot Study.

We examined the safety and the effects of low-intensity resistance training (RT) with moderate blood flow restriction (KAATSU RT) on muscle strength and size in patients early after cardiac surgery. Cardiac patients (age 69.6 ± 12.6 years, n = 21, M = 18) were randomly assigned to the control (n = 10) and the KAATSU RT group (n = 11). All patients had received a standard aerobic cardiac rehabilitation program. The KAATSU RT group additionally executed low-intensity leg extension and leg press exercises with moderate blood flow restriction twice a week for 3 months. RT-intensity and volume were increased gradually. We evaluated the anterior mid-thigh thickness (MTH), skeletal muscle mass index (SMI), handgrip strength, knee extensor strength, and walking speed at baseline, 5-7 days after cardiac surgery, and after 3 months. A physician monitored the electrocardiogram, rate of perceived exertion, and the color of the lower limbs during KAATSU RT. Creatine phosphokinase (CPK) and D-dimer were measured at baseline and after 3 months. There were no side effects during KAATSU RT. CPK and D-dimer were normal after 3 months. MTH, SMI, walking speed, and knee extensor strength increased after 3 months with KAATSU RT compared with baseline. Relatively low vs. high physical functioning patients tended to increase physical function more after 3 months with KAATSU RT. Low-intensity KAATSU RT as an adjuvant to standard cardiac rehabilitation can safely increase skeletal muscle strength and size in cardiovascular surgery patients.

Synthesis and characterization of 4'-C-guanidinomethyl-2'-O-methyl-modified RNA oligomers.

This study investigated the synthesis and properties of 4'-C-guanidinomethyl-2'-O-methyluridine and RNAs containing the analog. Thermal and thermodynamic stabilities of double-stranded RNAs (dsRNAs) containing the nucleoside analog were examined. It was found that although the analog decreased the thermal and thermodynamic stabilities of dsRNA, it had base-discrimination ability. The 4'-C-guanidinomethyl modification increased stability of RNAs in a buffer containing serum. Furthermore, small interference RNAs incorporating one analog at the passenger strand still preserved their RNA interference activities. It was suggested that the 4'-guanidinomethyl modification significantly improved cell membrane permeability of RNA. Thus, 4'-C-guanidinomethyl-2'-O-methyl analogs may be useful in improving the properties of therapeutic siRNA molecules.

Blood Flow Restriction Increases the Neural Activation of the Knee Extensors During Very Low-Intensity Leg Extension Exercise in Cardiovascular Patients: A Pilot Study.

Blood flow restriction (BFR) has the potential to augment muscle activation, which underlies strengthening and hypertrophic effects of exercise on skeletal muscle. We quantified the effects of BFR on muscle activation in the rectus femoris (RF), the vastus lateralis (VL), and the vastus medialis (VM) in concentric and eccentric contraction phases of low-intensity (10% and 20% of one repetition maximum) leg extension in seven cardiovascular patients who performed leg extension in four conditions: at 10% and 20% intensities with and without BFR. Each condition consisted of three sets of 30 trials with 30 s of rest between sets and 5 min of rest between conditions. Electromyographic activity (EMG) from RF, VL, and VM for 30 repetitions was divided into blocks of 10 trials and averaged for each block in each muscle. At 10% intensity, BFR increased EMG of all muscles across the three blocks in both concentric and eccentric contraction phases. At 20% intensity, EMG activity in response to BFR tended to not to increase further than what it was at 10% intensity. We concluded that very low 10% intensity exercise with BFR may maximize the benefits of BFR on muscle activation and minimize exercise burden on cardiovascular patients.

Beam Walking to Assess Dynamic Balance in Health and Disease: A Protocol for the "BEAM" Multicenter Observational Study.

BACKGROUND: Dynamic balance keeps the vertical projection of the center of mass within the base of support while walking. Dynamic balance tests are used to predict the risks of falls and eventual falls. The psychometric properties of most dynamic balance tests are unsatisfactory and do not comprise an actual loss of balance while walking. OBJECTIVES: Using beam walking distance as a measure of dynamic balance, the BEAM consortium will determine the psychometric properties, lifespan and patient reference values, the relationship with selected "dynamic balance tests," and the accuracy of beam walking distance to predict falls. METHODS: This cross-sectional observational study will examine healthy adults in 7 decades (n = 432) at 4 centers. Center 5 will examine patients (n = 100) diagnosed with Parkinson's disease, multiple sclerosis, stroke, and balance disorders. In test 1, all participants will be measured for demographics, medical history, muscle strength, gait, static balance, dynamic balance using beam walking under single (beam walking only) and dual task conditions (beam walking while concurrently performing an arithmetic task), and several cognitive functions. Patients and healthy participants age 50 years or older will be additionally measured for fear of falling, history of falls, miniBESTest, functional reach on a force platform, timed up and go, and reactive balance. All participants age 50 years or older will be recalled to report fear of falling and fall history 6 and 12 months after test 1. In test 2, seven to ten days after test 1, healthy young adults and age 50 years or older (n = 40) will be retested for reliability of beam walking performance. CONCLUSION: We expect to find that beam walking performance vis-à-vis the traditionally used balance outcomes predicts more accurately fall risks and falls. CLINICAL TRIAL REGISTRATION NUMBER: NCT03532984.

Cognitive dual-tasking augments age-differences in dynamic balance quantified by beam walking distance: A pilot study.

There is currently no test to directly and easily measure dynamic balance during walking in old adults. We examined the idea that distance of beam walking with and without cognitive dual-tasking could detect age differences in dynamic balance. Healthy old (n = 16, 71.2 y) and young (n = 20, 22.0 y) volunteers walked 3 times on 4-m long beams first without (single-tasking) then with a calculation task (dual-tasking) in order of decreasing beam width (12, 8, 4 cm). There was a Group (old, young) by Beam width (4, 8, 12 cm) by Task (single-, dual-tasking) interaction (F = 4.0, p = 0.026) for beam walking distance (primary outcome). Beam walking distance decreased similarly with decreasing beam width while single-tasking (12 cm: 3.88 m, 8 cm: 3.62 m, 4 cm: 2.49 m) and dual-tasking (12 cm: 3.87 m, 8 cm: 3.76 m, 4 cm: 2.59 m) in young adults. Beam walking distance decreased substantially and most on the narrowest beam while single-tasking (12 cm: 3.85 m, 8 cm: 3.72 m, 4 cm: 1.46 m) but decreased even more on the two narrowest beams during dual-tasking (12 cm 3.91 m, 8 cm: 2.63 m, 4 cm: 0.66 m) in old adults. Video analyses revealed that step length decreased in young while both step number and step length decreased in old adults. Beam width but not dual-tasking affected young adults' beam walking distance whereas both beam width and dual-tasking affected substantially and interactively old adults' beam walking distance and velocity. The results suggest that, if validated and cognitive performance also quantified, beam walking distance and walking velocity in single- and dual-tasking conditions could be a diagnostic tool of walking balance and cognitive impairment in aging.

Lower extremity power training improves healthy old adults' gait biomechanics.

PURPOSE: Age-related slowing of gait speed predicts many clinical conditions in later life. We examined the kinematic and kinetic mechanisms of how lower extremity power training increases healthy old adults' gait speed. METHODS: We randomly allocated old adults to a training (age 74.3 y, 9 males, 6 females) and a control group (age 73.6 y, 3 males, 4 females) and compared the biomechanics of habitual and fast gait before and after 16 sessions (8 weeks) of lower extremity power training. RESULTS: Training increased maximal leg press load by ∼40% (P < 0.05) and maximal voluntary force in five groups of leg muscles by ∼32% (P < 0.05) in the training group. Training vs. control tended to increase habitual (10.8 vs. 7.6%) and fast gait speed (17.6 vs. 9.0%; all P < 0.05) more. In the training group only, these increases in gait speed correlated with increases in stride length (habitual: r2 = 0.84, fast: r2 = 0.89). Training made old adults' gait more erect: hip and knee extension increased in the stance phase of gait. Training increased ankle joint positive work by 3.3 J (control: -0.4 J, Group by Time interaction: P < 0.05), which correlated r2 = 0.58 and r2 = 0.67 with increases in habitual and fast gait speed without changes in hip and knee joint powers. CONCLUSION: Increases in leg muscle power increased healthy old adults' gait speed through correlated increases in stride length and ankle plantarflexor work generation.

A Japanese Stretching Intervention Can Modify Lumbar Lordosis Curvature.

STUDY DESIGN: Eighteen healthy male adults were assigned to either an intervention or control group. OBJECTIVES: Isogai dynamic therapy (IDT) is one of Japanese stretching interventions and has been practiced for over 70 years. However, its scientific quantitative evidence remains unestablished. The objective of this study was to determine whether IDT could modify lumbar curvature in healthy young adults compared with stretching exercises used currently in clinical practice. SUMMARY OF BACKGROUND DATA: None of previous studies have provided data that conventional stretching interventions could modify spinal curvatures. However, this study provides the first evidence that a specific form of a Japanese stretching intervention can acutely modify the spinal curvatures. METHODS: We compared the effects of IDT, a Japanese stretching intervention (n=9 males), with a conventional stretching routine (n=9 males) used widely in clinics to modify pelvic tilt and lumbar lordosis (LL) angle. We measured thoracic kyphosis (TK) and LL angles 3 times during erect standing using the Spinal Mouse before and after each intervention. IDT consisted of: (1) hip joint correction, (2) pelvic tilt correction, (3) lumbar alignment correction, and (4) squat exercise stretch. The control group performed hamstring stretches while (1) standing and (2) sitting. RESULTS: IDT increased LL angle to 25.1 degrees (±5.9) from 21.2 degrees (±6.9) (P=0.047) without changing TK angle (pretest: 36.8 degrees [±6.9]; posttest: 36.1 degrees [±6.5]) (P=0.572). The control group showed no changes in TK (P=0.819) and LL angles (P=0.744). CONCLUSIONS: IDT can thus be effective for increasing LL angle, hence anterior pelvic tilt. Such modifications could ameliorate low back pain and improve mobility in old adults with an unfavorable pelvic position.

A behavioral mechanism of how increases in leg strength improve old adults' gait speed.

We examined a behavioral mechanism of how increases in leg strength improve healthy old adults' gait speed. Leg press strength training improved maximal leg press load 40% (p = 0.001) and isometric strength in 5 group of leg muscles 32% (p = 0.001) in a randomly allocated intervention group of healthy old adults (age 74, n = 15) but not in no-exercise control group (age 74, n = 8). Gait speed increased similarly in the training (9.9%) and control (8.6%) groups (time main effect, p = 0.001). However, in the training group only, in line with the concept of biomechanical plasticity of aging gait, hip extensors and ankle plantarflexors became the only significant predictors of self-selected and maximal gait speed. The study provides the first behavioral evidence regarding a mechanism of how increases in leg strength improve healthy old adults' gait speed.

Lumbar lordosis angle (LLA) and leg strength predict walking ability in elderly males.

There is an association between gait performance and spinal alignment in elderly females but it is unclear if this association is gender-dependent and postural changes would also predict gait performance in healthy elderly males. We measured thoracic kyphosis angle (TKA), LLA as indices of spinal alignment and maximal walking speed (WS), timed up and go test (TUG), 10-m obstacle walking time, and 6-min walk distance as indices of gait performance in healthy old males (n=124, age 73.0 ± 7.2 years). Knee extensor strength and one-leg standing time with eyes open were measures of physical function. The LLA but not TKA correlated with performance in each of the 4 gait test. Multiple-regression analyses showed that only the combination of knee extensor strength and LLA accounted for significant variation in gait performance. While previous studies showed that spinal alignment is associated with gait performance in elderly women, in healthy elderly males both functional (leg strength) and structural (spinal alignment) factors contribute to gait performance.

Limb oxygenation during the cold pressor test in spinal cord-injured humans.

OBJECTIVE: To investigate changes in tissue oxygenation in the arm and leg during the cold pressor test in humans with spinal cord injury (SCI). METHODS: Subjects with SCI at cervical 6 (n=7) and subjects with SCI at thoracic 5 or thoracic 6 (n=5) experienced 3-min cold water immersion of the foot and subsequent 10-min recovery. Changes in tissue oxygenation and blood pressure were determined. Tissue oxygenation was assessed by hemoglobin/myoglobin concentration (Hb/MbO2) measured using near-infrared spectroscopy. RESULTS: Mean arterial blood pressures increased significantly by 15±9 and 6±6 mmHg during cold water immersion in the cervical and thoracic SCI groups, respectively (P<0.001). Hb/MbO2 in the arm decreased significantly by 23±15 µM cm during cold water immersion only in the cervical SCI group (P<0.001), whereas Hb/MbO2 in the leg decreased significantly by 82±56 µM cm during cold water immersion only in the thoracic SCI group (P<0.001). INTERPRETATION: Afferent activity coming from below the lesion due to cold stimuli would reflexively enhance sympathetic activity in both the arm and leg in individuals with cervical SCI but only in the leg in individuals with thoracic SCI. A decrease in tissue oxygenation might have been caused by sympathetic vasoconstriction. The reduction of tissue oxygenation in the arm was marked in individuals with cervical SCI, suggesting differential control of arm oxygenation and leg oxygenation in the region below SCI.

Preferred step frequency minimizes veering during natural human walking.

In the absence of visual information, humans cannot maintain a straight walking path. We examined the hypothesis that step frequency during walking affects the magnitude of veering in healthy adults. Subject walked at a preferred (1.77 ± 0.18 Hz), low (0.8 × preferred, 1.41 ± 0.15 Hz), and high (1.2× preferred, 2.13 ± 0.20 Hz) step frequency with and without a blindfold. We compared the absolute differences between estimated and measured points of crossing a target line after 16 m of forward walking at the three step frequencies. There was no significant difference in veering when subjects walked at the different frequencies without a blindfold. However, the magnitude of veering was the smallest at the preferred (mean ± SE=91.6 ± 33.6 cm) compared with the low (204.3 ± 43.0 cm) and high (112.7 ± 34.0 cm) frequency gaits with a blindfold. Thus, walking at a preferred step frequency minimizes veering, which occurs in the absence of visual information. This phenomenon may be associated with the previously reported minimization of movement variability, energy cost, and attentional demand while walking at a preferred step frequency.

Contraction history produces task-specific variations in spinal excitability in healthy human soleus muscle.

INTRODUCTION: In human movements muscles lengthen and then shorten, or occasionally shorten and then lengthen, but it is unclear whether the nature of neural activation of the initial phase influences the neural state of the subsequent phase. We examined whether contraction history modulates spinal excitability in the healthy human soleus muscle. METHODS: Subjects performed six blocks of 10 repetitions of four muscle actions consisting of specific combinations of passive shortening (PAS), and passive lengthening (PAL), shortening contraction (SHO), and lengthening contraction (LEN); that is: (1) SHO+PAL; (2) PAS+LEN; (3) PAS+PAL; and (4) SHO+LEN. RESULTS: Compared with baseline, the H-reflex increased in the block of 300-400 s after SHO+PAL and decreased in the block of 0-100 s after PAS+LEN and SHO+LEN. CONCLUSIONS: Our results suggest that spinal excitability is potentiated during a muscle action preceded by muscle shortening, but it becomes depressed during a muscle action preceded by muscle lengthening.

Asymmetrical modulation of corticospinal excitability in the contracting and resting contralateral wrist flexors during unilateral shortening, lengthening and isometric contractions.

Unilateral isometric muscle contractions increase motor-evoked potentials (MEPs) produced by transcranial magnetic stimulation not only in the contracting muscle but also in the resting contralateral homologous muscle. Corticospinal excitability in the M1 contralateral to the contracting muscle changes depending on the type of muscle contraction. Here, we investigated the possibility that corticospinal excitability in M1 ipsilateral to the contracting muscle is modulated in a contraction-type-dependent manner. To this end, we evaluated MEPs in the resting left flexor carpi radialis (FCR) during unilateral shortening, lengthening, and isometric muscle contractions of the right wrist flexors at 10, 20, and 30% of maximal isometric contraction force. To compare the effects of different unilateral contractions on MEPs between the contracting and resting sides, MEPs in the right FCR were recorded on two separate days. In a separate experiment, we investigated the contraction specificity of the crossed effect at the spinal level by recording H-reflexes from the resting left FCR during contraction of the right wrist flexors. The results showed that MEPs in the contracting right FCR were the smallest during lengthening contraction. By contrast, MEPs in the resting left FCR were the largest during lengthening contraction, whereas the H-reflex was similar in the resting left FCR during the three types of muscle contraction. These results suggest that different types of unilateral muscle contraction asymmetrically modulate MEP size in the resting contralateral homologous muscle and in the contracting muscle and that this regulation occurs at the supraspinal level.

Unusual blood pressure response during standing therapy in tetraplegic man.

We report a case of an individual with cervical spinal cord injury who showed a unique blood pressure response during passive standing and passive walking-like leg movement, i.e., hypertension with standing and hypotension with leg movement.

Hypoventilation during passive leg movement in spinal cord-injured humans.

We examined ventilatory response during passive walking-like exercise in the standing posture in complete spinal cord-injured humans and found that ventilatory equivalent for O(2) uptake, which would be related to the sensation of breathlessness, was lower during passive exercise than during quiet standing.