Exercise of Dynamic Stability in the Presence of Perturbations Elicit Fast Improvements of Simulated Fall Recovery and Strength in Older Adults: A Randomized Controlled Trial.

Sebastian Bohm,Adamantios Arampatzis,Martin Mandla-Liebsch,Falk Mersmann

doi:10.3389/fspor.2020.00052

Abstract

Age-related impairments of reactive motor responses to postural threats and reduced muscular capacities of the legs are key factors for the higher risk of falling in older people. It has been evidenced that a training of dynamic stability in the presence of perturbations has the potential to improve these deficits. However, the time course of training effects during such interventions is poorly understood. The purpose of this parallel-group study was to investigate the temporal adaptation dynamics of the balance recovery performance and leg strength during a dynamic stability training. Forty-two healthy older adults (65–85 years) were randomly assigned to a training (n = 27, analyzed n = 18) or control group (n = 15, n = 14). The training was conducted in a group setting for 6 weeks (3×/week, 45 min). The exercises focused on the mechanism of stability control (i.e., modulation of the base of support and segment counter-rotations around the center of mass) during standing, stepping, and jumping on unstable surfaces with a high balance intensity. Before, after 3 and after 6 weeks, the maximum plantar flexion moment and the knee extension moment were assessed. The recovery performance was evaluated by a simulated forward fall (lean-and-release test) and the margin of stability concept. The margin of stability at release decreased significantly after 3 weeks of training (34%, effect size g = 0.79), which indicates fast improvements of balance recovery performance. The margin of stability further decreased after week 6 (53%, g = 1.21), yet the difference between weeks 3 and 6 was not significant. Furthermore, the training led to significant increases in the plantar flexion moment after weeks 3 (12%, g = 0.72) and 6 (13%, g = 0.75) with no significant difference between weeks. For the knee extension moment, a significant increase was found only after week 6 (11%, g = 1.07). The control group did not show any significant changes. This study provides evidence that a challenging training of dynamic stability in the presence of perturbations can improve balance recovery performance and leg strength of older adults already after a few weeks. Therefore, short-term training interventions using this paradigm may be an effective strategy for fall prevention in the elderly population, particularly when intervention time is limited.

Highlights

The increased risk of falling and associated injuries in older adults (Rubenstein, 2006) makes falls a major source of morbidity and mortality (Rubenstein, 2006; Marks, 2011; Alamgir et al, 2012) in a globally senescent population
The ability to respond to sudden perturbations and postural threats as the cause of a fall event strongly relies on the successful application of general mechanisms responsible for the dynamic stability control (Bierbaum et al, 2010), i.e., increase in the base of support and counter-rotating segments around the center of mass (CoM) (Hof, 2007)
We investigated the initial time course of adaptive responses to a challenging training of the dynamic stability in the presence of perturbations, considering the effects on balance recovery performance and lower limb strength capacities of older adults

Summary

Introduction

The increased risk of falling and associated injuries in older adults (Rubenstein, 2006) makes falls a major source of morbidity and mortality (Rubenstein, 2006; Marks, 2011; Alamgir et al, 2012) in a globally senescent population. The ability to respond to sudden perturbations and postural threats as the cause of a fall event strongly relies on the successful application of general mechanisms responsible for the dynamic stability control (Bierbaum et al, 2010), i.e., increase in the base of support and counter-rotating segments around the center of mass (CoM) (Hof, 2007) The application of these control mechanisms of the neuromotor system (including perception, signal processing, and motor control) is not actively exercised during classical strength training and likely requires a different intervention approach that focuses on balance recovery performance (Sherrington et al, 2019). Adaptations of neural control are different after balance compared to strength training (Beck et al, 2007; Gruber et al, 2007; Taube et al, 2007)

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