Weight-bearing Training Research Articles

Rehabilitation effect of standing bed combined with early anti-gravity running table training on ankle fracture

To explore the clinical effect of standing bed combined with early anti-gravity running table training in the healing and functional recovery of anterior rotation external rotation ankle fractures. Fifty-two patients with ankle fractures of degree III or degree IV of PER admitted to Pingle Orthopaedic and Traumatology Hospital of Shenzhen City between September 2021 and January 2023 were selected for observation, and they were divided into 26 cases in each group according to the method of randomised numerical table into the control group and the observation group. The patients in the control group started the routine rehabilitation treatment on the 1st day after operation, and in the 0–2 weeks after operation, the affected limb was elevated and ankle pump training was carried out; in the 3–6 weeks after operation, joint mobility training, strength training and soft tissue release were carried out; and in the 6–8 weeks after operation, weight-bearing training was increased. The observation group added standing bed training on the 7th postoperative day and anti-gravity running table training on the 28th postoperative day on the basis of the treatment protocol of the control group. Bone density, ankle mobility and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores, pain, ankle mobility and swelling evaluations were compared between the 2 groups before and after 8 weeks of treatment, and the quality scores of bone scabs were compared between the 2 groups after 4 weeks of treatment. There was no statistical significance in the comparison of the items between the two groups before treatment (all P > 0.05), and the difference in the bone scab quality score was not statistically significant after 4 weeks of treatment (P > 0.05), and after 8 weeks of treatment, the bone scab quality score, bone mineral density and AOFAS scores, pain, ankle mobility, and evaluations were higher than those of the control group (all P < 0.05), and there was no significant difference in the degree of swelling (P > 0.05). Standing bed combined with early anti-gravity running table training applied to postoperative patients with PER III or IV degree ankle fracture can reduce the degree of pain and improve the ankle joint function.

Weight bearing training alleviates muscle atrophy and pyroptosis of middle-aged rats.

Age-related muscle atrophy and adipose accumulation begin to occur in young and middle-aged individuals, and exercise at an early age improves body composition. Pyroptosis may play an essential role in age-related low-grade inflammation. This study aimed to explore the alleviation of muscle atrophy by weight-bearing training with increasing age via inhibition of pyroptosis. Ninety 8-month-old male SD rats were randomly divided into three groups: (1) normal baseline group (N group, n = 10), sacrificed after adaptive feeding; control group (C group, n = 40); and weight-bearing running group (R group, n = 40). Blood samples, adipose tissue (AT), and extensor digitorum longus (EDL) were collected after 8, 16, 24, and 32-weeks intervention. The body weight, muscle mass, fat mass, plasma lipid, AT wet weight, adipocyte cross-sectional area (CSA), and apoptosis rates of AT and EDL were increased, while the muscle mass, wet weight, and fiber CSA of EDL were decreased by aging, which were reversed by exercise. Weight-bearing training promoted protein synthesis in EDL, inhibited protein degradation in EDL, and expression of pyroptotic key proteins in EDL and AT in rats. Weight-bearing training improves body composition and alleviates age-related muscle atrophy in rats, and its mechanism may be related to the inhibition of pyroptosis in the EDL and AT and the improvement of muscle protein metabolism.

The Effect of the Hip Flexion Angle in Osteonecrosis of the Femoral Head Based on China-Japan Friendship Hospital Classification - A Finite Element Study.

The alteration in the mechanical environment of the necrotic area is the primary cause of the collapse observed in osteonecrosis of the femoral head (ONFH). This study aims to evaluate the biomechanical implications of the China-Japan Friendship Hospital (CJFH) classification system and hip flexion angles on the necrotic area in ONFH using finite element analysis (FEA). The goal is to provide valuable guidance for hip preservation treatments and serve as a reference for clinical diagnosis and therapeutic interventions. Hip tomography CT scan data from a healthy volunteer was used to create a 3D model of the left hip. The model was preprocessed and imported into Solidworks 2018, based on the CJFH classification. Material parameters and boundary conditions were applied to each fractal model in ANSYS 21.0. Von Mises stresses were calculated, and maximum deformation values were obtained to evaluate the biomechanical effects of the load on the necrotic area and post-necrotic femur, as well as assess each fractal model's collapse risk. (1) At the same hip flexion angle, maximum deformation followed this order: M Type < C Type < L Type. The L3 type necrotic area experienced the most significant deformation at 0, 60, and 110° angles (1.121, 1.7913, and 1.8239 mm respectively). (2) Under the same CJFH classification, maximum deformation values increased with hip flexion angle (0 < 60 < 110°), suggesting a higher risk of collapse at larger angles. (3) Von Mises stress results showed that the maximum stress was not located in the necrotic area but near the inner and outer edge of the femoral neck, indicating decreased stiffness and strength of the subchondral bone after osteonecrosis. The study found that femoral head collapse risk was higher when the necrotic area was located in the lateral column under the same stress load and flexion angle. Mechanical properties of the necrotic area changed, resulting in decreased bone strength and stiffness. Large-angle hip flexion is more likely to cause excessive deformation of the necrotic area; thus, ONFH patients should reduce or avoid large-angle hip flexion during weight-bearing training in rehabilitation activities.

Novel Noninvasive Spinal Neuromodulation Strategy Facilitates Recovery of Stepping after Motor Complete Paraplegia.

It has been suggested that neuroplasticity-promoting neuromodulation can restore sensory-motor pathways after spinal cord injury (SCI), reactivating the dormant locomotor neuronal circuitry. We introduce a neuro-rehabilitative approach that leverages locomotor training with multi-segmental spinal cord transcutaneous electrical stimulation (scTS). We hypothesized that scTS neuromodulates spinal networks, complementing the neuroplastic effects of locomotor training, result in a functional progression toward recovery of locomotion. We conducted a case-study to test this approach on a 27-year-old male classified as AIS A with chronic SCI. The training regimen included task-driven non-weight-bearing training (1 month) followed by weight-bearing training (2 months). Training was paired with multi-level continuous and phase-dependent scTS targeting function-specific motor pools. Results suggest a convergence of cross-lesional networks, improving kinematics during voluntary non-weight-bearing locomotor-like stepping. After weight-bearing training, coordination during stepping improved, suggesting an important role of afferent feedback in further improvement of voluntary control and reorganization of the sensory-motor brain-spinal connectome.

RE-FRACTURE AS IMPACT OF RIGID IMPLANT AND BONE OSTEOPOROSIS: A CASE REPORT

Background: The increasing life expectancy of the world population associated with osteopenia and osteoporosis leads to low-energy fractures, especially in the lower limb. The overture of locking plates has widened the area of close fracture fixation, and it is essential to justify and optimize their usage. This study aims to report the potential postoperative re-fracture after implant removal and as a consequence of bone osteoporosis.Case report: We present a re-fracture of proximal femur case in 60 years old female after a trivial fall into her right femur. This patient underwent a removal implant surgery a week before in the same spot where she fell. The open surgery was made with the same incision, and we do the Open Reduction Internal Fixation for her. Discussion: The major design of the fixation tool is to secure the fracture with less effect on native axial load stress from the whole bone. Stress shielding caused due to firm bone-implant results in its resorption. The bone degradation underneath gives rise to the plate's collapse, resulting in repeated bone breakage. Early discharge, continued weight-bearing training for proximal femur fractures were associated with speedy improvement in daily activities. The photodynamic polymer liquid was the latest technology for bone stabilization.Conclusion: Rigid bone plates can cause stress shielding, and when the implants are removed, re-fracture easily happens. Therefore, discharge of patients quickly for weight-bearing training in proximal femur fractures was encouraged to promote better healing.

MSTN is an important myokine for weight-bearing training to attenuate bone loss in ovariectomized rats.

Weight-bearing training, as one of resistance exercises, is beneficial to bone health. Myostatin (MSTN) is a negative regulator of skeletal muscle growth and development. Animals lacking MSTN show increased bone mineral density (BMD). The aim of this study was to investigate the preventive effect of weight-bearing training on bone loss in ovariectomized rats and whether it was related to MSTN. In this study, the rats were randomly assigned to three group: Sham-ovariectomized (Sham), ovariectomized (OVX), ovariectomized and weight-bearing training (OWT). The rats in the OWT group ran at 20-m/min bearing with 35% of their body weight for 6days/week. After 10weeks, compared with the OVX group, weight-bearing training increased the BMD of total femur and trabecular bone by 8.13% and 57.44%, respectively. The OVX-induced destruction of bone microarchitecture including the thickness and number of trabeculae and bone volume fraction was all significantly improved (9.26%, 47.68%, 63.03%) in the OWT group. The OVX-induced degradation of bone mechanical properties was significantly enhanced in the OWT group (maximum load increased by 35.46%, stiffness increased by 89.19%, energy absorption increased by 53.4%; elastic modulus increased by 26.3%). Ten-week weight-bearing training also significantly upregulated the mRNA and protein expression of Wnt1 and β-catenin, which is crucial in bone development. Compared with the Sham group, MSTN in serum and muscle increased in the OVX group, but it decreased in the OWT group compared with the OVX group. Its receptor ActRIIB and downstream molecules Smad2/3 in the OVX group were downregulated in bone by weight-bearing training. The results indicated that MSTN is an important myokine for weight-bearing training to attenuate bone loss in ovariectomized rats.

Impact of home-based squat training with two-depths on lower limb muscle parameters and physical functional tests in older adults

This study investigated the effect of home-based shallow and deep squat trainings on knee extension peak torque, muscle thickness, one-repetition maximum (1RM) leg press, and physical function in older individuals. Sixteen participants were randomly assigned to the shallow squat group (SS group; age, 71.0 ± 4.0 years) or deep squat group (DS group, age; 68.6 ± 3.6 years). Chairs of 40-cm height and chairs with a cushion of 20-cm height (60-cm in total) were used as the depth targets for squats, with participants instructed to sink until their hip touched the chair and cushion. Participants performed four sets of squats per day (35 repetitions per set), three days per week, for 12 weeks at their home. Knee extension peak torque, muscle thickness of quadriceps femoris (e.g., vastus lateralis, rectus femoris, and vastus intermedius), and physical function were measured at weeks 0 (baseline), 4, 8, and 12. Maximal isometric knee extension peak torque, muscle thickness, and walking speed did not change significantly over the 12-week training period in either group (P > 0.05). However, compared with the baseline, there was significant improvement in the results of 30-s sit-to-stand repetition tests after weeks 8 and 12 in both groups (P < 0.05). Additionally, 1RM leg press results were significantly improved after weeks 4 and 12 in the DS group, and weeks 4, 8, and 12 in the SS group (P < 0.05). Results indicate that home-based weight-bearing squat training improves lower limb function in older adults, as well as performance in physical functional tests related to activities of daily living. Moreover, such training benefits older adults regardless of whether squats are shallow or deep.

Biodex© training post-stroke for postural stability in the upper trunk: A pilot study.

BackgroundStroke affects upper trunk postural stability and upper limb function in approximately 85% of stroke survivors. Upper trunk postural stability is essential for functioning of the upper limb and is a prerequisite for hand function. The rehabilitation of the upper limb and upper trunk post-stroke remains a challenge because of poor recovery of motor and sensory function.ObjectivesTo determine the effect of Biodex© upper limb weight-bearing training on upper trunk postural stability in patients post-stroke.MethodA longitudinal randomised control pilot trial with single blinding was undertaken to assess postural stability on the Biodex© at baseline and 1-month post-baseline. In addition to standard rehabilitative care, upper limb weight-bearing training on the Biodex© was added for participants in the experimental group. Descriptive data analysis and the Mann–Whitney test for group comparisons were done using STATA (p < 0.05).ResultsFifteen participants took part, seven in the control and eight in the experimental group, with an overall median age of 55 years. At baseline there were statistically significant lower scores in the experimental group on overall (p = 0.02) and anterior/posterior (p = 0.009) stability level 6 (moderately unstable base of support) in the upper trunk postural stability scores. No statistically significant improvements were noted between groups on any of the Biodex© stability levels at 1-month post-baseline testing (p > 0.05).ConclusionUpper limb weight-bearing training with the addition of Biodex© training did not result in improvements in upper trunk postural stability.Clinical implicationsThe findings suggest that exercising on a moderately unstable base of support may improve upper trunk postural stability in patients post-stroke. The addition of Biodex© training to standard rehabilitative care for retraining and exercising upper trunk postural control in a weight-bearing position does not lead to better outcomes than standard care.

Effect of different types of exercise on bone mineral density in postmenopausal women: A systematic review and meta-analysis

AbstractPostmenopausal women face a high risk of bone loss. Exercise has a beneficial effect to prevent bone deterioration in elderly women. This study was conducted to investigate the effect of different types of exercise on bone mineral density at the lumbar spine and femoral neck in postmenopausal women.This review followed the guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered in advance in the International prospective register of systematic reviews (PROSPERO) (ID: CRD42018095097). Literature searches with no language restriction were conducted through PubMed, Scopus, Web of Science, Cochrane, Science Direct, Eric, ProQuest, and Primo up to March 1 2019 using related MeSH terms and key words. Controlled trials with ≥ 6 months intervention duration among postmenopausal women that comprised at least one exercise and one control group were included in this study. Meta-analyses were performed using random-effects models and effect sizes calculated using the standardised mean difference (SMD). Seven categories of exercise were classified and used in sub-group analyses. P-values &lt; 0.05 were considered statistically significant.Seventy-five studies were included, assessing the bone mineral density of 5300 (range of mean age: 50–79) postmenopausal women who performed exercise or control protocols. Interventions ranged from six to 30 months and the most common exercise frequency was three sessions per week. The majority of studies employed multicomponent exercise interventions. Results of the meta-analyses showed a significant effect (SMD = 0.37, 95%-CI: 0.25–0.50) for lumbar spine and femoral neck (SMD = 0.33, 0.23–0.43) (all P &lt; 0.0001).Sub-group analysis revealed large heterogeneity and no significant differences in exercise categories at the lumbar spine (P = 0.36) and femoral neck (P = 0.43). However, weight-bearing exercise + jumping + resistance training exhibited the largest effect (SMD = 0.71, 0.33–1.10) at the lumbar spine. Moreover, non-weight-bearing combined + resistance exercise revealed the largest effect (SMD = 0.68, 0.16–1.19) at the femoral neck. Contrary to our expectation, jumping alone indicated a greater decrease in bone mineral density compared to the control group at both the lumbar spine (−0.07, −0.46–0.32) and femoral neck (−0.12, −0.62–0.37).In conclusion, the current study provided a positive small effect of exercise on bone mineral density at the lumbar spine and femoral neck. Findings from sub-group analyses suggest larger benefits in multicomponent interventions that include weight-bearing and resistance training exercises compared to them as a single mode of exercise. Unequal numbers of studies were found for each category (e. g. jumping: two trials; dynamic resistance training: 15 trials), affecting the comparison between them. Therefore, findings should be interpreted with caution; they are not yet generalizable to specific types of exercise.

Proper mechanical stress promotes femoral head recovery from steroid-induced osteonecrosis in rats through the OPG/RANK/RANKL system

BackgroundLong-term use of steroid may lead to osteonecrosis of the femoral head (ONFH). Mechanical stress may help bone formation and remodeling. This study aimed to probe the role of mechanical stress in the femoral head recovery in rats.MethodsRat models with ONFH were induced by steroid. Rats were subjected to different levels of mechanical stress (weight-bearing training), and then the morphology and bone density of femoral head of rats were measured. The mRNA and protein levels of the OPG/RANK/RANKL axis in rat femoral head were assessed. Gain- and loss-of function experiments of OPG were performed to identify its role in femoral head recovery following stress implement. The ex vivo cells were extracted and the effects of stress and OPG on osteogenesis in vitro were explored.ResultsSteroid-induced ONFH rats showed decreased bone density and increased bone spaces, as well as necrotic cell colonies and many cavities in the cortical bones and trabeculars. Proper mechanical stress or upregulation of OPG led to decreased RANK/RANKL expression and promoted femoral head recovery from steroid-induced osteonecrosis. However, excessive mechanical stress might impose too much load on the femurs thus leading even retard femoral head recovery process. In addition, the in vitro experimental results supported that proper stress and overexpression of OPG increased the osteogenesis of ex vivo cells of femoral head.ConclusionThis study provided evidence that proper mechanical stress promoted femoral head recovery from steroid-induced osteonecrosis through the OPG/RANK/RANKL system, while overload might inhibit the recovery process. This study may offer novel insights for ONFH treatment.

The Effect of Ankle Joint Mobilization with Movement Weight Bearing Training On ROM, Balance Ability and Gait Velocity in Hemiplegic Patients

Objective: The purpose of this study was to investigate the effects of ankle range of motion(ROM), balance ability, and gait velocity of the ankle flexion when the joint Mobilization with Movement was applied. Method: Ankle joint ROM, balance ability(BBS), and gait velocity were examined before and after application. Result: In the experimental group, ROM of dorsiflexion and eversion increased significantly, the balance ability improved, and the gait velocity increased more than the control group(p<.05). Conclusion: Through this study, In addition to the symptoms of central nervous system damage in hemiplegic patients, it can be used as an effective treatment for reducing the limit of motion of the ankle due to secondary musculoskeletal problems and improving balance ability and gait velocity.

Comparison of Functional Capability, Flexibility, Strength and Quality of Life in Aged Women Engaged in Resistance Exercise, Weight-Bearing Training or Hydro-Gymnastics

Comparison of Functional Capability, Flexibility, Strength and Quality of Life in Aged Women Engaged in Resistance Exercise, Weight-Bearing Training or Hydro-Gymnastics

Effects of treadmill training on microvascular remodeling in the rat after spinal cord injury.

The morphological characteristics of skeletal muscles innervated caudal to a spinal cord injury (SCI) undergo dramatic phenotypic and microvascular changes. Female Sprague-Dawley rats received a severe contusion at thoracic level 9/10 and were randomly assigned to locomotor training, epidural stimulation, or a combination of the treatment groups (CB). Fiber type composition and capillary distribution were assessed in phenotypically distinct compartments of the tibialis anterior. Spinal cord injury induced a shift in type II fiber phenotype from oxidative to glycolytic (P < 0.05) as well as capillary loss within the oxidative core and glycolytic cortex; the CB treatment best maintained capillary supply within both compartments. The angiogenic response of CB training improved capillary distribution across the muscle; capillary distribution became spatially more homogeneous and mean capillary supply area decreased, potentially improving oxygenation. There is an important role for weight-bearing training in maintaining the oxidative phenotype of muscle after SCI. Muscle Nerve 59:370-379, 2019.

PO-071 Effects of Resistance Training of Different Loads on Gastrocnemius Protein, IGF-I and TNF-α in Aging Rats

Objective To observe the effects of different load resistance training on skeletal muscle dystrophy in aging rats by observing the expression of protein and protein of IGF-I and TNF-α in aging rats after 8 weeks of different load resistance training. The resistance training delays the theoretical basis for anti-skeletal muscle aging.&#x0D; Methods 40 aging SD rats (18 months old) were randomly divided into a quiet control group, a non-weight-bearing exercise group, 30% of the largest negative recombination, 50% of the largest negative recombination, and 70% of the largest negative recombination. The sports group carried the treadmill movement with the tail load, the slope was 35°, the running speed was 15m/min, the rest was 30s every 15s, the rest was 3min after four cycles, and the three groups were one cycle. The cycle was intermittent for 10 minutes, and the exercise frequency was the next day for 8 weeks. After 8 weeks, the rat gastrocnemius muscle was taken. The protein content of the gastrocnemius muscle was determined by Coomassie brilliant blue method. The contents of IGF-I and TNF-α in the gastrocnemius muscle were determined by enzyme-linked immunosorbent assay.&#x0D; Results After 1.8 weeks of different load resistance exercise, compared with the quiet control group, the skeletal muscle protein content of each exercise group increased, among which 50% of the largest negative recombination and 70% of the largest negative recombination was the most significant (P&lt;0.01). Compared with 70% of the largest negative recombination, the 50% maximum negative recombination content was relatively high (P&lt;0.05);&#x0D; &#x0D; After 8 weeks of different load resistance exercise, compared with the quiet control group, the content of IGF-I in the gastrocnemius of each exercise group was higher than that of the quiet control group, and there was a very significant difference (P&lt;0.01), and 50%. The highest negative recombination and 70% of the largest negative recombination content is the highest;&#x0D; After 8 weeks of different load resistance exercise, compared with the quiet control group, the TNF-α content in the gastrocnemius muscle of the rats in each resistance exercise group increased slightly, and the increase of only 50% of the largest negative recombination was statistically significant (P&lt;0.05), although there were differences between the exercise groups, there was no statistical significance (P&gt;0.05).&#x0D; &#x0D; Conclusions 50% of the maximum weight-bearing resistance training can effectively increase the skeletal muscle muscle protein content of aging SD rats, and it is related to up-regulation of IGF-I factor and down-regulation of TNF-α factor expression by resistance training.

The effect of weight bearing alignment training on anterior pelvic tilt in children with cerebral palsy

Objective To evaluate the effect of weight-bearing alignment training (WBAT) in correcting anterior pelvic tilt in children with cerebral palsy. Methods Twenty-seven children with cerebral palsy and anterior pelvic tilt were recruited and randomly assigned to a WBAT group, a strengthening group and a standing group, each of 9. In addition to routine medication and rehabilitation training, the 3 groups received WBAT, strengthening training or standing training respectively for 20 minutes a day, 5 times a week for 4 weeks. Before and immediately after the treatment, the subjects′ anterior superior iliac spine-posterior superior iliac spine angles (ASIS-PSIS angles) were assessed along with their anterior-posterior angles (A-P angles) and distances in a 1-minute walk test. Results The WBAT group showed significant improvement in their average ASIS-PSIS angle (to 18.61±3.13°), A-P angle (to 23.31±3.81°) and the distance in the 1-minute walk test after the treatment. The standing group had significant progress in improving their A-P angles (to 24.48±4.33°), and the strengthening group had significant improvement in the distance walked in the 1-minute walk test. The average improvements in the ASIS-PSIS angle and walk distance in the WBAT group were significantly better than in the other 2 groups. Conclusion WBAT is superior to strengthening and standing training in improving the ASIS-PSIS angle, A-P angle and walking ability of children with cerebral palsy and anterior pelvic tilt. Key words: Alignment; Posture; Cerebral palsy; Pelvic tilt; Weight-bearing alignment training

F146. Effect of transcranial direct current stimulation on gait of stroke patients

Introduction Stroke is the most leading cause to functional disability and gait problems. The purpose of this study was to determine the effect of transcranial direct current stimulation on selected gait kinematics in stroke patients. Methods Thirty male stroke patients participated in this study. The patients were assigned randomly into two equal groups (study and control). Patients in the study group received Anodal tDCS in addition to selected physical therapy program for stroke patients. Patients in the control group received selected physical therapy program only including: strengthening exercises, stretching exercises, weight bearing, balance exercises and gait training. The Outcome Measures: Biodex gait trainer 2 TM was used to assess selected gait kinematics (step cycle, walking speed) before and after four weeks training period (end of treatment) for both groups. Results There was a statistically significant increase in walking speed and step cycle in both group. The improvement in gait parameters post treatment was significantly higher in the study group compared to the control group Conclusion Transcranial direct current stimulation is effective in improving selected gait kinematics in stroke patients when added to the selected physical therapy program.

COMplex Fracture Orthopedic Rehabilitation (COMFORT) - Real-time visual biofeedback on weight bearing versus standard training methods in the treatment of proximal femur fractures in the elderly: study protocol for a multicenter randomized controlled trial

BackgroundProximal femur fractures are a common injury after low energy trauma in the elderly. Most rehabilitation programs are based on restoring mobility and early resumption of weight-bearing. However, therapy compliance is low in patients following lower extremity fractures. Moreover, little is known about the relevance of gait parameters and how to steer the rehabilitation after proximal femur fractures in the elderly. Therefore, the aim of this prospective, randomized controlled trial is to gain insight in gait parameters and evaluate if real-time visual biofeedback can improve therapy compliance after proximal femur fractures in the elderly.MethodsThis is a two-arm, parallel-design, prospective, randomized controlled trial. Inclusion criteria are age ≥ 60 years, a proximal femur fracture following low energy trauma, and unrestricted-weight bearing. Exclusion criteria are cognitive impairment and limited mobility before trauma. Participants are randomized into either the control group, which receives care as usual, or the intervention group, which receives real-time visual biofeedback about weight-bearing during gait in addition to care as usual. Spatiotemporal gait parameters will be measured in 94 participants per group during a 30-m walk with an ambulatory biofeedback system (SensiStep). The progress of rehabilitation will be evaluated by the primary outcome parameters maximum peak load and step duration in relation to the discharge date. Secondary outcome parameters include other spatiotemporal gait parameters in relation to discharge date. Furthermore, the gait parameters will be related to three validated clinical tests: Elderly Mobility Scale; Functional Ambulation Categories; and Visual Analogue Scale. The primary hypothesis is that participants in the intervention group will show improved and faster rehabilitation compared to the control group.DiscussionThe first aim of this multicenter trial is to investigate the normal gait patterns after proximal femur fractures in the elderly. The use of biofeedback systems during rehabilitation after proximal femur fractures in the elderly is promising; therefore, the second aim is to investigate the effect of real-time visual biofeedback on gait after proximal femur fractures in the elderly. This could lead to improved outcome. In addition, analysis of the population may indicate characteristics of subgroups that benefit from feedback, making a differentiated approach in rehabilitation strategy possible.Trial registrationTrialRegister.nl, NTR6794. Registered on 31 October 2017.

Effects of multicomponent training on lean and bone mass in postmenopausal and older women: a systematic review.

The purpose of this systematic review was to update and examine to what extent multicomponent training interventions could improve lean and bone mass at different anatomical regions of the body in postmenopausal and older women. A computerized literature search was performed in the following online databases: PubMed MEDLINE, Cochrane, and Web of Knowledge. The search was performed to include articles up until February 2017. The methodological quality of selected studies was evaluated using the Cochrane risk of bias tool. Fifteen studies met the inclusion criteria. Studies examining the effects of combined training methods in postmenopausal and older women showed contrasting results, possibly due to the wide range of the participants' age, the evaluation of different regions, and the varying characteristics of the training methods between studies. Overall, it appears that exercise modes that combine resistance, weight-bearing training, and impact-aerobic activities can increase or prevent muscle and skeletal mass loss during the ageing process in women. Further studies are needed to identify the optimal multicomponent training protocols, specifically the training loads that will improve lean and bone mass at different anatomical locations, in postmenopausal and older women.

Resistance training using a novel robotic walker for over-ground gait rehabilitation: a preliminary study on healthy subjects.

Strength training is an aspect of gait rehabilitation, which complements balance control and weight-bearing training. However, conventional strength training does not show positive gait outcomes, due to lack of task specificity. Therefore, the aims of this study were to investigate the effects of a resistance force applied at the center of mass (CoM) and to investigate whether this exercise can be used for effective task-specific gait training. Using a novel robotic walker, a consistent resistive force was applied to the CoM of subjects in the posterior direction. Eleven healthy subjects were instructed to walk under five walking conditions with increasing forces, based on each subject's body weight (BW), at 0, 2.5, 5, 7.5, and 10% BW. Joint kinematics and mean amplitude and frequency of electromyography signals from nine major muscles were measured. The application of resistance resulted in significantly increased flexion angles at ankle, knee, and hip joints. A large amount of motor unit activation with lower firing rates was found at knee and hip joints, indicating that this type of resistance training can improve muscular strength and endurance in a task-specific manner. The long-term effects of the resistance training on neurologically challenged patients will be investigated in the future.

Physical Therapy Interventions and Bone Health: A Short Commentary

Risk of osteoporosis is increasing in normal population due to inactivity, dietary eating habits, and sedentary life styles, low calcium intake, less exposure to sun light and hormonal changes. Physical therapy interventions, weight bearing training, jumping intervention in childhood and adolescence, modified step aerobics training, balance training, strength training and water based exercise can be used for treatment and prevention of osteoporosis.