Walking Obstacle Research Articles

Performance of Children with Mental Retardation with and without Down’s Syndrome on Standardized Walking Obstacle Course

Objective: To compare the performance of children with mental retardation with and without Down’s syndrome on Standardised Walking Obstacle Course. Method: A prospective comparative study consisted of 30 participants between the age group of 6-14 years. These participants were divided into 2 groups Mentally retarded with Down’s syndrome and Mentally retarded without Down’s syndrome. Standardised Walking Obstacle Course Test (SWOC) is used to measure stability and speed during gait in terms of time, number of steps, number of stumbles and number of steps off the path for each participant Paired , Unpaired t test and ANOVA were used for data analysis. Results: The time taken and the number of steps off the path was significantly more (p<0.01) in children with Down’s syndrome as compared to children without Down’s syndrome. The number of steps and the number of stumbles was also more (p<0.01) in children with Down’s syndrome as compared to children without Down’s syndrome.

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±7.2years). 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.

Effects of Constraint-Induced Movement Therapy on Gait, Balance, and Functional Locomotor Mobility

This study reports the secondary effects of a constraint-induced movement therapy (CIMT) protocol on spatial temporal parameters of gait, balance, and functional locomotor mobility in children with cerebral palsy. Sixteen children (4-12 years old) participated in a 3-week CIMT program. Participants were tested on the first and last day of the CIMT program using the Standardized Walking Obstacle Course (SWOC), the Pediatric Balance Scale (PBS) and the GAITRite Gold system (CIR Systems, Inc, Havertown, Pennsylvania). Wilcoxon signed rank tests were used on all pre- and posttests. Only the spatial temporal parameters of cadence and velocity differed significantly, with 12 subjects displaying a faster cadence (P = .02) and 10 subjects displaying a faster velocity (P = .05). In this pilot study, CIMT was found to promote changes in 2 spatial temporal parameters of gait. However, no changes were noted in the participant's measures on the SWOC and PBS.

Challenging Gait Conditions Predict 1-Year Decline in Gait Speed in Older Adults With Apparently Normal Gait

Mobility often is tested under a low challenge condition (ie, over a straight, uncluttered path), which often fails to identify early mobility difficulty. Tests of walking during challenging conditions may uncover mobility difficulty that is not identified with usual gait testing. The purpose of this study was to determine whether gait during challenging conditions predicts decline in gait speed over 1 year in older people with apparently normal gait (ie, gait speed of ≥1.0 m/s). This was a prospective cohort study. /b> Seventy-one older adults (mean age=75.9 years) with a usual gait speed of ≥1.0 m/s participated. Gait was tested at baseline under 4 challenging conditions: (1) narrow walk (15 cm wide), (2) stepping over obstacles (15.24 cm [6 in] and 30.48 cm [12 in]), (3) simple walking while talking (WWT), and (4) complex WWT. Usual gait speed was recorded over a 4-m course at baseline and 1 year later. A 1-year change in gait speed was calculated, and participants were classified as declined (decreased ≥0.10 m/s, n=18), stable (changed <0.10 m/s, n=43), or improved (increased ≥0.10 m/s, n=10). Analysis of variance was used to compare challenging condition cost (usual--challenging condition gait speed difference) among the 3 groups. Participants who declined in the ensuing year had a greater narrow walk and obstacle walk cost than those who were stable or who improved in gait speed (narrow walk cost=0.43 versus 0.33 versus 0.22 m/s and obstacle walk cost=0.35 versus 0.26 versus 0.13 m/s). Simple and complex WWT cost did not differ among the groups. The participants who declined in gait speed over time walked the fastest, and those who improved walked the slowest at baseline; thus, the potential contribution of regression to the mean to the findings should not be overlooked. In older adults with apparently normal gait, the assessment of gait during challenging conditions appears to uncover mobility difficulty that is not identified by usual gait testing.

Commentary on “Predictors of Standardized Walking Obstacle Course Outcome Measures in Children With and Without Developmental Disabilities”

Commentary on “Predictors of Standardized Walking Obstacle Course Outcome Measures in Children With and Without Developmental Disabilities”

Predictors of Standardized Walking Obstacle Course Outcome Measures in Children With and Without Developmental Disabilities

This study was designed to determine which characteristics of children predict measures on the Standardized Walking Obstacle Course (SWOC). SWOC testing was performed under 3 conditions: (1) walk, (2) walk with a tray, and (3) walk wearing shaded glasses. Trials consisted of standing up, walking the course in 1 direction, and sitting down. Children (n = 440) completed 2 trials per condition. Trial measures included time, and numbers of steps, stumbles, and steps off the path. Relationships were evaluated using Chi-square analyses and significant predictors were determined by multiple logistic regression analyses. Sensitivity and specificity were calculated to determine the accuracy of disability as a predictor. Age, weight, and disability were the strongest predictors (P < .05). Increased age and weight predicted shorter time and fewest steps. Disability predicts longer time and most steps. The SWOC is appropriate to screen children for disabilities in functional ambulation.

Adiposity and Physical Activity Influence Physical Function and Fatigue in Older Women

Both physical activity and adiposity have been associated with functional performance and fatigue in the elderly; however, the relative impact of each is not established. PURPOSE: The aim of this study was to examine the independent contributions of physical activity and adiposity on physical function and fatigue in older community-dwelling women (N = 43; 69.7±6.1 yr). METHODS: Assessments included physical performance via 7-m obstacle walk (7-OB), chair stand (CHAIR) and 6 min walk (WALK); general, physical and mental fatigue via the Multidimensional Fatigue Inventory (MFI); physical activity by weekly pedometer count (STEPS); and adiposity (%Fat) by DXA. RESULTS: As expected, an inverse relationship existed between STEPS and %Fat (r=-0.38, p=0.01) and greater STEPS improved 7-OB, CHAIR and WALK performance (r range=0.42 to 0.51, p<0.01). Greater adiposity was associated with poorer 7-OB (r=0.43, p=0.004) and WALK (r=0.52, p<0.001) performance. Similarly, greater %Fat was associated with higher general fatigue (r=0.30, p=0.049) and mental fatigue (r=0.31, p=0.045) but not physical fatigue (p=0.43). STEPS were related to general fatigue (r=-0.32, p=0.04) but not physical or mental fatigue (p>0.05). Hierarchical multiple regression analyses were conducted to determine the independent contribution of %Fat and STEPS to 7-OB, WALK and general fatigue. Greater adiposity (b=0.32) and fewer STEPS (b=-0.31) were associated with poorer 7-OB (R2=0.27, p=0.002) and WALK performance (R2=0.37, p<0.001; b=-0.36 and 0.38, respectively). However, only %Fat (b=0.30) was an independent positive predictor of fatigue (p=0.049, R2=0.09). CONCLUSIONS: Physical function performance is influenced by adiposity and habitual physical activity; however, adiposity is the primary predictor of general fatigue in older women.

Effects Of Aquatic Exercise Training Using Water-resistance Equipment In Elderly

PURPOSE: To prevent falls in Japan, both gait and resistance training of the lower extremities are recommended. However, resistance training for the elderly induces muscle damage. Recently, aquatic exercise using water buoyancy and resistance have commonly been performed by the elderly. We have now produced new water-resistance equipment. The purpose of the present study was to evaluate the efficacy of aquatic exercise training using the new equipment for the elderly. METHODS: Subjects were divided into two groups a resistance group of twelve subjects (using water-resistance equipment) and a non-resistance group of eight subjects (without the equipment). The aquatic exercise training was 90 min, three times per week for 8 weeks, and mostly consisted of walking. All subjects underwent anthropometric measurements, physical performance testing and profile of mood states (POMS). RESULTS: Significant improvements were observed in muscle strength in plantar flexion (resistance group; 32.3±6.8®43.8±6.5 p<0.001, non-resistance group; 40.4±6.7®48.1±9.6 p<0.05) and the timed up & go test (TUG) (resistance group; 5.9±0.7®5.2±0.5 p<0.001, non-resistance group; 5.8±0.4®5.4±0.7 p<0.001) in both groups. Additionally, 10-m obstacle walking (p<0.05) and 5-m maximum walking speed (p<0.01) and length with eye open (p<0.05) were significantly improved in the resistance group than non-resistance group. Also, a low negative correlation was found between the degree of change in TUG and POMS (tension and anxiety) scores (p<0.05, r=-0.621) in the resistance group. As it became easier to maintain posture, stand, and move, tension and anxiety in everyday life were alleviated with improvement of strength of the lower extremities and balance function. CONCLUSIONS: The present aquatic exercise training using water-resistance equipment may be used by the elderly to improve balance and walking ability, which are associated with the prevention of falls.

Effects of aquatic exercise training using water-resistance equipment in elderly

To prevent falls in Japan, both gait and resistance training of the lower extremities are recommended. However, resistance training for the elderly induces muscle damage. Recently, aquatic exercise using water buoyancy and resistance have commonly been performed by the elderly. We have now produced new water-resistance equipment. The purpose of the present study was to evaluate the efficacy of aquatic exercise training using the new equipment for the elderly. Subjects were divided into two groups: a resistance group of 12 subjects (using water-resistance equipment) and a non-resistance group of eight subjects (without the equipment). The aquatic exercise training was 90 min, three times per week for 8 weeks, and mostly consisted of walking. All subjects underwent anthropometric measurements, physical performance testing, and profile of mood states (POMS). Significant improvements were observed in muscle strength in plantar flexion, and the timed up and go test (TUG) in both groups. Additionally, 10-m obstacle walking and 5-m maximum walking speed and length with eye-open were significantly improved in the resistance group. Also, a low negative correlation was found between the degree of change in TUG and POMS (tension and anxiety) scores in the resistance group. As it became easier to maintain posture, stand, and move, tension and anxiety in everyday life were alleviated with improvement of strength of the lower extremities and balance function. The present aquatic exercise training using water-resistance equipment may be used by the elderly to improve balance and walking ability, which are associated with the prevention of falls.

Impact of Training Modality on Strength and Physical Function in Older Adults

Background: The importance of maintaining strength in older adults is well documented and various training modalities have been recommended; however, the effectiveness of various interventions with high translation to public health practice has not been completely characterized. Additionally, the interrelations among mode, strength, and lower extremity physical function (LEPF) changes in older adults warrant further investigation. Purpose: The primary aims were to examine the effectiveness of cardiovascular endurance training (CVE) compared with balance and flexibility training (FLEX) and to explore the relationship of muscle strength to LEPF. Methods: Fifty-five adults (69.1 ± 5.6 years, 35 female) were randomly assigned to 10 months of CVE or FLEX. Knee extension and flexion at 60 and 120°·s^–1 were measured using an isokinetic dynamometer. LEPF was measured using a battery of tasks. The CVE group exercised using treadmills, cycles, and elliptical trainers. The FLEX group participated in a group exercise class that incorporated flexibility and balance activities. Results: The CVE training group significantly improved peak oxygen consumption by 6% (p = 0.03), while the FLEX training group showed no change (p = 0.47). Participants significantly improved peak torque at both speeds and muscle actions by 21–65% (p ≤ 0.05), with no group effect (p > 0.05). Both groups also significantly improved performance on all LEPF tasks included in this study (4–7%, p ≤ 0.05). Significant correlations (all p = 0.00) were found between improvements in strength and improvements in LEPF including timed walk and peak torque extension and flexion at 60°·s^–1 (r = 0.40 and 0.27, respectively), obstacle walk and peak torque extension and flexion at 60 and 120°·s^–1 (r range 0.27–0.40), and stair ascent and peak torque extension at 120°·s^–1 (r = 0.37). Conclusions: Sedentary older adults achieve similar improvements in strength and LEPF with either CVE or FLEX training with the latter being related to improvements in leg strength.

Good maintenance of physical benefits in a 12-month exercise and nutritional intervention by voluntary, home-based exercise: a 6-month follow-up of a randomized controlled trial

We assessed the maintenance of physical benefits in a 12-month exercise and nutritional intervention in postmenopausal women (55-75 years of age) after 6-month postintervention follow-up by voluntary, home-based exercise, and examined whether physical factors responded differently to high or low exercise frequency during the 6-month postintervention period. Forty-five women completed the 12-month intervention program, followed by 6-month cessation of intervention, and were compared with 19 matched controls. Twenty-one of the former exercisers reported that they continued exercise training at least 30 min at least 3 days/week (high-frequency exerciser, HFE), while the remaining 24 former exercisers reported that they had done exercise training at least 30 min twice per week or less during the postintervention follow-up (low-frequency exerciser, LFE). The following items were measured at baseline, 12, and 18 months: bone strength, CS-30 test, 10-m obstacle walk, whole-body reaction time, one-leg stance, and grip strength. After 6-month postintervention follow-up, the beneficial effect on bone was not fully maintained. These benefits in physical performance obtained in the 12-month intervention program, except one-leg stance, were fully maintained for 6 months by voluntary, home-based exercise. The gained benefit in one-leg stance was not fully maintained; LFE showed a significant decrease over the 6-month postintervention follow-up period, suggesting that continued exercise training of at least 30 min at least 3 days/week is required to maintain the balance benefit. These findings suggest that a continued exercise program of voluntary, home-based exercise may be effective to maintain the physical benefits of exercise intervention that may lower fracture risk in later life.

Evaluation of Visual and Auditory Feedback in Virtual Obstacle Walking

This paper describes evaluation experiments for visual and auditory feedback in a virtual obstacle walking scenario. Two studies with healthy subjects were carried out using the actuated gait orthosis Lokomat. Controlled factors for the visual feedback experiment were three different perspectives and 2D/3D vision. In the auditory feedback experiment, controlled factors were rhythmic distance feedback and gradual foot clearance feedback. For the visual and auditory feedback experiments, outcome was assessed with task-specific performance parameters and questionnaires. Results for visual feedback indicate that the chosen side perspective is superior to behind and ego perspectives. It is also shown that 3D vision does not reduce the number of obstacle hits compared to 2D vision. Furthermore, it is demonstrated that adding continuous auditory feedback made subjects walk faster compared to the exclusive use of visual feedback. Subjects rated auditory distance feedback as more helpful than auditory foot clearance feedback. Therefore, we suggest using side perspective and auditory feedback on obstacle distance.

보행 시 장애물 높이에 따른 정상 성인의 족저압 분포 연구

본 연구는 장애물을 넘는 동안 장애물의 높이 변화가 보행 시 족저압에 미치는 영향을 알아보기 위해 실시하였으며 이를 위해 족저 최고 족저압과 최대 힘, 압력 중심의 이동 경로를 중심으로 자료를 수집하여 분석하였다. 근골격계에 문제가 없는 열여섯 명의 건강한 젊은 성인이 이 연구에 참여하여 맨발로 각각 평지, 10cm, 20cm 그리고 30cm의 장애물을 넘는 동안 입각기 발의 족저 최고 족저압과 최대 힘, 압력중심 이동경로를 측정하였다. 측정은 Tekscan사의 Footmat system을 이용하였으며, 대상자의 발을 일곱 개의 영역(두 개의 발가락 영역, 세 개의 전족부 영역, 한 개의 중족부와 후족부 영역)으로 나누어 수집한 자료를 일원배치분산분석을 이용하여 분석하였다. 본 연구를 통해 높이가 다른 여러 가지 장애물을 넘을 때, 입각기 동안 족저의 영역별 최고 족저압과 최대 힘은 발가락부위에서 유의하게 증가하는 것을 알 수 있었고 후족부위에서는 감소하였다. 그리고 장애물의 높이가 높아질수록 압력중심 이동경로가 짧아지면서 전족부에서 외전하는 경향을 볼 수 있었다. 따라서 본 연구에서는 장애물 보행 시 장애물의 높이가 발의 구조와 기능에 영향을 미친다는 것을 확인할 수 있었다. The purpose of this study was to investigate the effect of different obstacle heights on the plantar foot pressure during obstacle crossing. Sixteen healthy adults who had no musculoskeletal disorders were instructed to perform unobstructed level walking and to step over obstacles corto 10cm, 20cm, 30cm. Plantar foot forces and pressures were recorded by the Footmat system(Tekscan, Boston, USA) during level and obstacle walking with barefoot. Plantar foot surface was defined as seven regions for pressure measurement; two toe regions, three forefoot regions, one midfoot region, one heel region. One-way ANOVA was used to compare each region data of foot according to various heights. The results indicated that there are significant differences on peak pressure and maximal forces regarding each region at stance phase. As height of obstacle became high, the pathway of COP had a tendency to be short and abducted. Plantar pressure of foot could be changed by obstacle height and these findings demonstrated that obstacle with different height have an effect on structure and function of the foot.

Changes in Fat Mass have a Greater Impact on Physical Function in Elderly Women than Changes in Lean Mass

Although lean mass is associated with physical function in older adults, the impact of changes in fat mass (FM) and lean soft tissue (LST) is not well characterized. PURPOSE: To determine the impact of changes in FM and LST on lower extremity physical function (LEPF) in community-dwelling elderly women over two years. METHODS: Elderly women (67.6±6.0 yrs, N = 197) were assessed for body composition via dual-energy X-ray absorptiometry and their LEPF was evaluated with a) stair ascend (ST-UP) and b) descend (ST-DN), c) 7 m walk (7M-W), d) 7 m obstacle walk (7M-OBW), and e) chair rise, walk and return (UP&GO). Average Z-score from all tests was used to estimate overall LEPF. RESULTS: Losers (n=60, lost >3% FM), Maintainers (n=62, ±3% FM), and Gainers (n=75, gained >3% FM) did not differ at baseline in LEPF or in body composition except in LST (42.5±6.2, 45.4±6.2, 43.7±5.6 kg, respectively, p=0.03). Over the 2 years, as expected, the Losers reduced and the Gainers increased in weight (-4.6±3.4, 2.6±2.4 kg, respectively), FM (-3.2±2.3, 2.5±1.4 kg, respectively), and body fat percentage (-2.3±2.2, 1.9±1.2 %, respectively, all p<0.01) and the Losers decreased in LST (-1.2±1.7 kg, p<0.01); however, the Maintainers had very small but significant losses of weight (-0.6±1.6 kg) and LST (-0.4±1.3 kg, both p=0.01) and gain in body fat percentage (0.2±0.7 %, p=0.01) with no change in fat mass (0.0±0.5 kg, p=0.97). Losers improved 5.2% in 7M-W (p<0.01), 4.0% in 7M-OBW (p=0.02), and 5.5% in UP&GO (p<0.01), and Maintainers improved 3.4% in ST-UP (p=0.03) and 5.9% in ST-DN (p<0.01), whereas Gainers decreased in overall LEPF (0.11±0.82 to -0.06±0.87 Z, p=0.01). Controlling for LST at baseline, 7M-W (p=0.01), UP&GO (p<0.01) and LEPF (p=0.04) interacted with participant grouping; Losers improved in performance but Maintainers or Gainers did not change or decreased slightly. No time by group interactions (all p>0.05) were found when the sample was split on two-year loss (>3%), maintenance (±3%), or gain (>3%) in LST. CONCLUSION: Changes in FM have more impact on LEPF than changes in LST among relatively healthy community dwelling older women. Lifestyle interventions to reduce FM may improve physical performance and reduce risk for disability in older women. Support: NIH RO1-AG020118, UIUC Research Board

地域高齢者における筋肉量の評価方法について

The purpose of this study was to determine the best way to indicate muscle mass of community-dwelling elderly men and women. We recruited 398 elderly men and women (age range, 61-96, years) who use a community center and live in a metropolitan suburb. We measured appendicular and whole body muscle mass by using bioelectrical impedance analysis and analyzed our results in relation to indicators of physical function. We assessed muscle mass with no adjustment, adjustment by body mass, and adjustment by body height. In men, appendicular muscle mass adjusted by body mass correlated significantly with 10-m obstacle walking time, and whole body muscle mass adjusted by body mass correlated significantly with all indicators physical function except five chair stands and maximum walking speed. In women, appendicular and whole body muscle mass adjusted by body mass correlated significantly with all indicators of physical function. However, appendicular and whole body muscle mass adjusted by body height were unrelated to indicators of physical function. Only whole body muscle mass adjusted by body mass was related to physical function in both men and women. This finding suggests that whole body muscle mass adjusted by body mass is the best indicator of muscle mass in community-dwelling elderly persons.

Impact Of Training Modality On Strength And Physical Function Improvement In Older Adults

The importance of maintaining strength in older adults is well documented and several training modes have been recommended; however, the effectiveness of each has not been completely characterized. Specifically, the interrelationships among mode, strength adaptations, and lower extremity physical function (LEPF) warrant further investigation. PURPOSE: The primary aims of this study were to 1) examine the effectiveness of cardiovascular (CV) to balance, flexibility, and functional strength (BAL) training on strength and LEPF and 2) explore the measure of muscle function most highly related to LEPF. METHODS: Forty-eight community-dwelling older adults (mean age 69.0 ±5.4 yrs, 31 female) were randomly assigned to 10-months of CV or BAL training. Muscle function, specifically knee extension and flexion at 120 deg/sec, was measured using an isokinetic dynamometer. LEPF was measured using a battery of tasks including stair ascent and descent, timed up-and-go, walk, and obstacle walk. Lower extremity mineral free lean mass (MFLM) was assessed using DXA. The CV group exercised using a variety of cardiovascular modes including treadmills, cycles, ellipticals, and a stair climber. The BAL group participated in a group exercise class that incorporated a wide variety of exercises for flexibility, balance, and functional strength, all completed at a low aerobic intensity level. RESULTS: Participants significantly improved peak torque and average power in combined leg extension and flexion (36.1% and 86.4%, respectively, p<0.05), with no group effect (p=0.34 and 0.72, respectively). Both groups also significantly improved performance on all LEPF tasks (3.5 to 7.7%, p<0.05) except timed up-and-go which declined (−5.8%, p<0.05), with a strong trend for CV improving more than BAL for walk (p=0.052), stair ascent (p=0.052), and timed up-and-go (p=0.063). Post intervention, LEPF performance was most highly correlated to average extension/flexion power normalized by leg MFLM (r = 0.48 to 0.68, p < 0.05). CONCLUSIONS: Previously sedentary older adults may achieve improvements in strength and LEPF with either CV or BAL training and these improvements are most closely related to average leg extension/flexion power normalized by leg MFLM.

Comparison Between the C-leg® Microprocessor-Controlled Prosthetic Knee and Non-Microprocessor Control Prosthetic Knees

This study investigated energy expenditure and obstacle course negotiation between the C-leg and various non-microprocessor control (NMC) prosthetic knees and compared a quality of life survey (SF-36v2) of use of the C-leg to national norms. Thirteen subjects with unilateral limb loss (12 with trans-femoral and one with a knee disarticulation amputation) participated in the study. The mean age was 46 years, range 30-75. Energy expenditure using both the NMC and C-leg prostheses was measured at self-selected typical and fast walking paces on a motorized treadmill. Subjects were also asked to walk through a standardized walking obstacle course carrying a 4.5 kg (10 lb) basket and with hands free. Finally, the SF-36v2 was completed for subjects while using the C-leg. Statistically significant differences were found in oxygen consumption between prostheses at both typical and fast paces with the C-leg showing decreased values. Use of the C-leg resulted in a statistically significant decrease in the number of steps and time to complete the obstacle course. Scores on a quality of life index for subjects using the C-leg were above the mean for norms for limitation in the use of an arm or leg, equal to the mean for the general United States population for the physical component score and were above this mean for the mental component score. Based on oxygen consumption and obstacle course findings, the C-leg when compared to the NMC prostheses may provide increased functional mobility and ease of performance in the home and community environment. Questionnaire results suggest a minimal quality of life impairment when using a C-leg for this cohort of individuals with amputation.

The Effect of a 12-week Combined Exercise Intervention Program on Physical Performance and Gait Kinematics in Community-dwelling Elderly Women

This study aimed to determine if combined exercise intervention improves physical performance and gait joint-kinematics including the joint angle and dynamic range of motion (ROM) related to the risk of falling in community-dwelling elderly women. A 12-week combined exercise intervention program with extra emphasis on balance, muscle strength, and walking ability was designed to improve physical performance and gait. Twenty participants attended approximately two-hour exercise sessions twice weekly for 12 weeks. Participants underwent a physical performance battery, including static balance, sit and reach, whole body reaction time, 10 m obstacle walk, 10 m maximal walk, 30-second chair stand, to determine a physical performance score, and received quantitative gait kinematics measurements at baseline and in 12 weeks. Significant lower extremity strength improvement 13.5% (p<.001) was observed, which was accompanied by significant decreases in time of the 10 m obstacle walk (p<.05) and whole body reaction time (p<.001) in this study. However, no significant differences were seen for static balance and flexibility from baseline. For gait kinematics, in the mid-swing phase, knee and hip joint angle changed toward flexion (p<.01, p<.05, respectively). Ankle dynamic ROM significantly increased (p<.05) following exercise intervention. The plantar flexion angle of the ankle in the toe-off phase was increased significantly (p<.01). However, other gait parameters were not significantly different from baseline. These findings from the present investigation provide evidence of significant improvements in physical performance related to the risk factors of falling and safe gait strategy with a combined exercise intervention program in community-dwelling elderly women. The results suggest this exercise intervention could be an effective approach to ameliorate the risk factors for falls and to promote safer locomotion in elderly community-dwelling women.

Effects of Exercise and Nutritional Intervention to Improve Physical Factors Associated with Fracture Risk in Middle-aged and Older Women

This 1-year intervention study was designed to examine the effects of exercise and nutritional intervention on the improvement of physical factors associated with fracture risk in middle-aged and older women. One hundred twenty-six women aged 55-75 years were divided into one of 3 groups: an exercise group, an exercise and nutrition group, and a control group. Nutritional intervention was designed to encourage women to obtain sufficient daily protein (65g or over) and calcium intake (600mg or over). The setting was center-based and home-based exercise. Measurements were bone stiffness, one-leg stance, whole body reaction time, grip strength, 10m obstacle walk and 30-second chair stand. Results show that exercise intervention can significantly improve physical ability in older women with regard to one-leg stance, whole body reaction time, 10m obstacle walk and 30-second chair stand, suggesting that older women are able to ameliorate fall risk factors by exercise intervention. The exercise and nutrition group had success in modifying bone loss when compared with the exercise group, suggesting that multimodal intervention that includes exercise and nutrition targeted at correcting bone loss should be recommended. The results suggest that exercise and nutritional intervention may be an effective approach to fracture prevention in middle-aged and older women.

Influence of Lower-extremity Muscle Force, Muscle Mass and Asymmetry in Knee Extension Force on Gait Ability in Community-dwelling Elderly Women

The purpose of this study was to examine the influence of muscle mass/power of the lower-extremities, including asymmetry in knee extension force, on gait ability of Japanese community-dwelling elderly women. The study population comprised 30 women aged 65-89 years. The parameters examined were activities of daily living, physical performance, functional capacity, isometric muscle forces of knee extension and flexion measured by a dynamometer, and muscle mass measured by bioelectrical impedance analysis. Asymmetry in knee extension force was calculated from rate of difference between the right and the left knee extension forces. One leg balance with eyes open, 6-minute walking distance (6MD) and knee extension force decreased, while 10-m obstacle walking time and asymmetry in knee extension force increased with age. Gait ability including 6MD and 10-m obstacle walking time correlated with asymmetry in knee extension force, which also exhibited correlations with one leg balance with eyes open and knee extension force. The results of the present study indicate that on increase in asymmetry in knee extension force as well as a decrease in lower-extremity muscle force might accelerate the loss of gait ability, while the improvement of asymmetry in knee extension force might be beneficial to self-supporting life in elderly individuals.