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

Abstract

BackgroundTurning 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. ObjectivesTo 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. DesignCross-sectional design. SettingVillage community center. ParticipantsTwenty community-dwelling elderly women capable of independent walking were enrolled in the study. MethodsParticipants 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 MeasurementsDifferences 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. ResultsDuring 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). ConclusionsWe 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 EvidenceIV