Effects of the Mobility-Fit Physical Activity Program on Strength and Mobility in Older Adults in Assisted Living: A Feasibility Study

Physical activity programs focusing on fall prevention often overlook upper-limb strength, which is important for transferring, balance recovery, and arresting a fall. We developed and evaluated a physical activity program, Mobility-Fit for older adults in Assisted Living (AL) that includes upper-limb strengthening, agility, coordination, and balance exercises. Thirty participants (85 ± 6 years) were recruited from two AL facilities; 15 were assigned to Mobility-Fit (three times/week, 45 min/session for 12 weeks) and 15 maintained usual care. Twenty-two participants (11 in each group) completed the study. We compared outcome changes between groups and interviewed participants and staff to explore the effectiveness and feasibility of the program. Among participants who attended Mobility-Fit, knee extension strength increased by 6%, reaction time decreased by 16%, and five-time sit-to-stand duration decreased by 15%. Conversely, participants in the usual care group had a 6% decrease in handgrip strength. Changes of these outcomes were significantly different between two groups (p < 0.05). Participants enjoyed the program and staff suggested some changes to improve attendance. Our results indicate that Mobility-Fit is feasible to deliver and beneficial for older adults in AL and may guide future clinical trials to evaluate the effectiveness of upper limb strengthening on safe mobility of older adults in care facilities

Effects of methods of descending stairs forwards versus backwards on knee joint force in patients with osteoarthritis of the knee: a clinical controlled study

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to investigate the kinetic characteristics of compensatory backward descending movement performed by patients with osteoarthritis of the knee.</p> <p>Methods</p> <p>Using a three-dimensional motion analysis system, we investigated lower extremity joint angles, joint moments, joint force of the support leg in forward and backward descending movements on stairs, and joint force of the leading leg at landing in 7 female patients with osteoarthritis of the knee.</p> <p>Results</p> <p>Compared with the forward descending movement, knee joint angle, joint moment and joint force of the support leg all decreased in the backward descending movement. Joint force of the leading leg at landing was also reduced in the backward descending movement. In addition, we confirmed that the center of body mass was mainly controlled by the knee and ankle joints in the forward descending movement, and by the hip joint in the backward descending movement.</p> <p>Conclusions</p> <p>Since it has been reported that knee flexion angle and extensor muscle strength are decreased in patients with osteoarthritis of the knee, we believe that backward descending movement is an effective method to use the hip joint to compensate forthese functional defects. In addition, due to the decreased knee joint force both in the leading and support legs in backward descending movement, the effectiveness of compensatory motion for pain control and knee joint protection was also suggested.</p

A multiscale model to predict current absolute risk of femoral fracture in a postmenopausal population

Osteoporotic hip fractures are a major healthcare problem. Fall severity and bone strength are important risk factors of hip fracture. This study aims to obtain a mechanistic explanation for fracture risk in dependence of these risk factors. A novel modelling approach is developed that combines models at different scales to overcome the challenge of a large space–time domain of interest and considers the variability of impact forces between potential falls in a subject. The multiscale model and its component models are verified with respect to numerical approximations made therein, the propagation of measurement uncertainties of model inputs is quantified, and model predictions are validated against experimental and clinical data. The main results are model predicted absolute risk of current fracture (ARF0) that ranged from 1.93 to 81.6% (median 36.1%) for subjects in a retrospective cohort of 98 postmenopausal British women (49 fracture cases and 49 controls); ARF0 was computed up to a precision of 1.92 percentage points (pp) due to numerical approximations made in the model; ARF0 possessed an uncertainty of 4.00 pp due to uncertainties in measuring model inputs; ARF0 classified observed fracture status in the above cohort with AUC = 0.852 (95% CI 0.753–0.918), 77.6% specificity (95% CI 63.4–86.5%) and 81.6% sensitivity (95% CI 68.3–91.1%). These results demonstrate that ARF0 can be computed using the model with sufficient precision to distinguish between subjects and that the novel mechanism of fracture risk determination based on fall dynamics, hip impact and bone strength can be considered validated