The purpose of this study was to investigate the effects of multicomponent training program, designed to improve the torque around the ankle joint performing high-speed movement execution, on healthy older adults. Participants were balanced by torque around the ankle joint and randomly allocated to either exercise (n = 12, 69.7 ± 4.8 years, 74.6 ± 16.8 kg, 1.63 ± 0.10 m) or control group (CG) (n = 14, 70.86 ± 6.48 years; 73.5 ± 13.4 kg, 1.56 ± 0.05 m). The exercise group (EG) performed a multicomponent training of resistance, agility, and coordination exercises, focusing on the plantar flexor muscles during 12 weeks (3 days per week). Outcome measures were torque (plantar flexion and extension), reactive capacity (Step test), and functional mobility (gait and timed up and go [TUG] test). The training program was induced to increase peak torque of extensor muscles around the ankle joint to EG (Δ = 50%; d = 1.59) compared to the CG. Such improvement was converted to reactive capacity improvements considering the decrease in the execution time of the Swing phase and in the Total time of the Step test (Δ = 19%; d = 0.93, Δ = 14%; d = 1.02, respectively). Gains in functional mobility were verified by the increase of the walking speed (Δ = 15%; d = 1.37) and by the smaller time of execution of TUG test (Δ = 17%; d = 1.73) in the EG. Therefore, the multicomponent training was effective to reduce or to reverse muscular age-related declines, which are associated with functional capacity and reduction of fall risk in older adults.
Get full access to this article
View all access options for this article.
References
1.
FasanoA, PlotnikM, BoveF, BerardelliA. The neurobiology of falls. Neurol Sci, 2012; 33:1215–1223.
2.
MadiganM, RosenblattNJ, GrabinerMD. Obesity as a factor contributing to falls by older adults. Curr Obes Rep, 2014; 3:348–354.
3.
ShorrRI, MionLC, ChandlerAM, RosenblattLC, LynchD, KesslerLA. Improving the capture of fall events in hospitals: Combining a service for evaluating inpatient falls with an incident report system. J Am Geriatr Soc, 2008; 56:701–704.
4.
Carande-KulisV, StevensJA, FlorenceCS, BeattieBL, AriasI. A cost–benefit analysis of three older adult fall prevention interventions. J Saf Res, 2015; 52:65–70.
5.
GrabinerMD, FeuerbachJW, JahnigenDW. Measures of paraspinal muscle performance do not predict initial trunk kinematics after tripping. J Biomech, 1996; 29:735–744.
6.
VandervoortAA. Aging of the human neuromuscular system. Muscle Nerve, 2002; 25:17–25.
7.
KannusP, SievänenH, PalvanenM, JärvinenT, ParkkariJ. Prevention of falls and consequent injuries in elderly people. Lancet, 2005; 366:1885–1893.
8.
ChouCH, HwangCL, WuYT. Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: A meta-analysis. Arch Phys Med Rehabil, 2012; 93:237–244.
9.
LaRocheDP, CreminKA, GreenleafB, CroceRV. Rapid torque development in older female fallers and nonfallers: A comparison across lower-extremity muscles. J Electromyogr Kinesiol, 2010; 20:482–488.
10.
LinSI, WoollacottM. Association between sensorimotor function and functional and reactive balance control in the elderly. Age Ageing, 2005; 34:358–363.
11.
MelzerI, OddssonLI. The effect of a cognitive task on voluntary step execution in healthy elderly and young individuals. J Am Geriatr Soc, 2004; 52:1255–1262.
12.
MadiganML, LloydEM. Age and stepping limb performance differences during a single-step recovery from a forward fall. J Gerontol A Biol Sci Med Sci, 2005; 60:481–485.
13.
MonacoV, RinaldiLA, MacrìG, MiceraS. During walking elders increase efforts at proximal joints and keep low kinetics at the ankle. Clin Biomech, 2009; 24:493–498.
14.
JudgeJO, DavisBR, ÕunpuuS. Step length reductions in advanced age: The role of ankle and hip kinetics. J Gerontol A Biol Sci Med Sci, 1996; 51:M303–M312.
15.
BeijersbergenC, GranacherU, VandervoortA, DeVitaP, HortobágyiT. The biomechanical mechanism of how strength and power training improves walking speed in old adults remains unknown. Ageing Res Rev, 2013; 12:618–627.
16.
DeVitaP, HortobagyiT. Age causes a redistribution of joint torques and powers during gait. J Appl Physiol, 2000; 88:1804–1811.
17.
WebberSC, PorterMM. Effects of ankle power training on movement time in mobility-impaired older women. Med Sci Sports Exerc, 2010; 42:1233–1240.
18.
FujiwaraK, ToyamaH, AsaiH, YaguchiC, IreiM, NakaM, et al.Effects of regular heel-raise training aimed at the soleus muscle on dynamic balance associated with arm movement in elderly women. J Strength Cond Res, 2011; 25:2605–2615.
19.
NagaiK, InoueT, YamadaY, TateuchiH, IkezoeT, IchihashiN, et al.Effects of toe and ankle training in older people: A cross-over study. Geriatr Gerontol Int, 2011; 11:246–255.
20.
ArampatzisA, PeperA, BierbaumS. Exercise of mechanisms for dynamic stability control increases stability performance in the elderly. J Biomech, 2011; 44:52–58.
21.
AragaoFA, KaramanidisK, VazMA, ArampatzisA. Mini-trampoline exercise related to mechanisms of dynamic stability improves the ability to regain balance in elderly. J Electromyogr Kinesiol, 2011; 21:512–518.
22.
de VreedePL, SamsonMM, van MeeterenNL, van der BomJG, DuursmaSA, VerhaarHJ. Functional tasks exercise versus resistance exercise to improve daily function in older women: A feasibility study. Arch Phys Med Rehabil, 2004; 85:1952–1961.
23.
LittbrandH, Lundin-OlssonL, GustafsonY, RosendahlE. The effect of a high-intensity functional exercise program on activities of daily living: A randomized controlled trial in residential care facilities. J Am Geriatr Soc, 2009; 57:1741–1749.
24.
MarshAP, MillerME, RejeskiWJ, HuttonSL, KritchevskySB. Lower extremity muscle function after strength or power training in older adults. J Aging Phys Act, 2009; 17:416–443.
25.
WallersteinLF, TricoliV, BarrosoR, RodackiAL, RussoL, AiharaAY, et al.Effects of strength and power training on neuromuscular variables in older adults. J Aging Phys Act, 2012; 20:171–185.
26.
BohannonRW. Reference values for the timed up and go test: A descriptive meta-analysis. J Geriatr Phys Ther, 2006; 29:64–68.
27.
PerschLN, UgrinowitschC, PereiraG, RodackiAL. Strength training improves fall-related gait kinematics in the elderly: A randomized controlled trial. Clin Biomech (Bristol, Avon), 2009; 24:819–825.
28.
MelzerI, ShtilmanI, RosenblattN, OddssonLI. Reliability of voluntary step execution behavior under single and dual task conditions. Journal of neuroengineering and rehabilitation, 2007; 4:16.
29.
PodsiadloD, RichardsonS. The timed “Up & Go”: A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc, 1991; 39:142–148.
30.
BorgG. Borg's Perceived Exertion and Pain Scales. Champaign: Human Kinetics, 1998.
31.
NakagawaS, CuthillIC. Effect size, confidence interval and statistical significance: A practical guide for biologists. Biol Rev, 2007; 82:591–605.
32.
CohenJ. Statistical Power Analysis for the Behavioral Sciences. New York: Psychology Press, 1988.
33.
GianoudisJ, BaileyCA, EbelingPR, NowsonCA, SandersKM, HillK, et al.Effects of a targeted multimodal exercise program incorporating high-speed power training on falls and fracture risk factors in older adults: A community-based randomized controlled trial. J Bone Mineral Res, 2014; 29:182–191.
34.
BeanJF, KielyDK, LaRoseS, O'neillE, GoldsteinR, FronteraWR. Increased velocity exercise specific to task training versus the National Institute on Aging's strength training program: Changes in limb power and mobility. J Gerontol A Biomed Sci Med Sci, 2009; 64:983–991.
35.
SkeltonDA, KennedyJ, RutherfordOM. Explosive power and asymmetry in leg muscle function in frequent fallers and non-fallers aged over 65. Age Ageing, 2002; 31:119–125.
36.
PijnappelsM, BobbertMF, van DieenJH. Push-off reactions in recovery after tripping discriminate young subjects, older non-fallers and older fallers. Gait Posture, 2005; 21:388–394.
37.
MakiBE, McIlroyWE. Control of rapid limb movements for balance recovery: Age-related changes and implications for fall prevention. Age Ageing, 2006; 35Suppl 2:ii12–ii8.
38.
MelzerI, KrasovskyT, OddssonLI, LiebermannDG. Age-related differences in lower-limb force-time relation during the push-off in rapid voluntary stepping. Clin Biomech (Bristol, Avon), 2010; 25:989–994.
39.
LipfertSW, GüntherM, RenjewskiD, SeyfarthA. Impulsive ankle push-off powers leg swing in human walking. J Exp Biol, 2014; 217:1218–1228.
40.
KerriganDC, ToddMK, Della CroceU, LipsitzLA, CollinsJJ. Biomechanical gait alterations independent of speed in the healthy elderly: Evidence for specific limiting impairments. Arch Phys Med Rehabil, 1998; 79:317–322.
41.
SiegelKL, KeppleTM, StanhopeSJ. Joint moment control of mechanical energy flow during normal gait. Gait Posture, 2004; 19:69–75.
42.
StudenskiS, PereraS, PatelK, RosanoC, FaulknerK, InzitariM, et al.Gait speed and survival in older adults. JAMA, 2011; 305:50–58.
43.
BischoffHA, StähelinHB, MonschAU, IversenMD, WeyhA, Von DechendM, et al.Identifying a cut-off point for normal mobility: A comparison of the timed “up and go” test in community-dwelling and institutionalised elderly women. Age Ageing, 2003; 32:315–320.
44.
HortobágyiT, MizelleC, BeamS, DeVitaP. Old adults perform activities of daily living near their maximal capabilities. J Gerontol A Biol Sci Med Sci, 2003; 58:M453–M460.
45.
IwamotoJ, SuzukiH, TanakaK, KumakuboT, HirabayashiH, MiyazakiY, et al.Preventative effect of exercise against falls in the elderly: A randomized controlled trial. Osteoporosis Int, 2009; 20:1233–1240.
46.
Reed-JonesRJ, DorgoS, HitchingsMK, BaderJO. Vision and agility training in community dwelling older adults: Incorporating visual training into programs for fall prevention. Gait Posture, 2012; 35:585–589.
