Weight bearing exercise can elicit similar peak muscle activation as medium–high intensity resistance exercise in elderly women

Purpose: To assess whether stepping-based weight bearing exercise (WBE) can elicit peak activation of upper leg muscles similar to resistance exercise (RE) at an intensity required to induce strength gains in elderly women. Methods: Muscular activation of several upper leg muscles was measured during RE and WBE in a cohort of 19 healthy elderly women (69.3 ± 3.4 years). WBE consisted of forward and lateral stepping with step heights of 10, 20 and 30 cm. Muscular activation was compared to 60% of one-repetition maximum (1-RM) of congruent RE. Results: Peak activation during WBE was higher than RE at 60% 1-RM during forward and lateral stepping in vastus lateralis starting at 20 cm (p = 0.049 and p = 0.001), and biceps femoris at 30 cm step height (p = 0.024 and p = 0.030). Gluteus maximus peak activation matched RE at 60% 1-RM at 20 and 30 cm step height regardless of step direction (p ≥ 0.077). Peak activation of the rectus femoris and gluteus medius matched RE activation at 60% 1-RM during lateral stepping at 30 cm (p = 0.355 and p = 0.243, respectively) but not during forward stepping. WBE did not induce similar activation as RE in the semitendinosus. Conclusion: In WBE, most upper leg muscles were recruited at an equal or higher intensity than in RE at 60% 1-RM. Lateral stepping at 30 cm step height showed the highest training potential of all WBE’s applied

Calcium and Vitamin D Supplementation in Men

Calcium and vitamin D supplements reverse secondary hyperparathyroidism and are widely prescribed to prevent osteoporotic fractures, with proven antifracture efficacy when targeted to individuals with documented insufficiencies. Men who should particularly be considered for calcium and vitamin D supplements include elderly or institutionalized individuals, patients with documented osteoporosis on antiresorptive or anabolic medication, and individuals receiving glucocorticoids. Benefits are most apparent when a daily dose of 1000–1200 mg calcium is complemented with 800 IU vitamin D. Compliance is the key to optimizing clinical efficacy. While (conventionally dosed) vitamin D has not been associated with safety concerns, recent meta-analytic data have provided evidence to suggest that calcium supplements (without coadministered vitamin D) may potentially be associated with cardiovascular risks

Concurrent Validity of Four Activity Monitors in Older Adults

Sedentary behaviour (SB) and physical activity (PA) have been shown to be independent modulators of healthy ageing. We thus investigated the impact of activity monitor placement on the accuracy of detecting SB and PA in older adults, as well as a novel random forest algorithm trained on data from older persons. Four monitor types (ActiGraph wGT3X-BT, ActivPAL3c VT, GENEActiv Original, and DynaPort MM+) were simultaneously worn on five anatomical sites during ten different activities by a sample of twenty older adults (70.0 (12.0) years; 10 women). The results indicated that collecting metabolic equivalent (MET) data for 60 s provided the most representative results, minimising variability. In addition, thigh-worn monitors, including ActivPAL, Random Forest, and Sedentary Sphere—Thigh, exhibited superior performance in classifying SB, with balanced accuracies ≥ 94.2%. Other monitors, such as ActiGraph, DynaPort MM+, and GENEActiv Sedentary Sphere—Wrist, demonstrated lower performance. ActivPAL and GENEActiv Random Forest outperformed other monitors in participant-specific balanced accuracies for SB classification. Only thigh-worn monitors achieved acceptable overall balanced accuracies (≥80.0%) for SB, standing, and medium-to-vigorous PA classifications. In conclusion, it is advisable to position accelerometers on the thigh, collect MET data for ≥60 s, and ideally utilise population-specific trained algorithms

Bench stepping with incremental heights improves muscle volume, strength and functional performance in older women

Aim: Task-specific exercises such as bench stepping can improve functional ability and reduce falling incidents in older adults. However, such exercises are often not optimized to improve muscle volume and force-velocity characteristics. This study determined the effects of a 12-week stepping program using incremental step heights (STEEP), on muscle volume, strength, power, functional ability and balance performance in older women. Methods: Forty-five community-dwelling women (69y ± 4) were randomly assigned to the STEEP group or a non-training CONTROL group. Training intensity was primarily determined by step height, while training volume remained equal. Thigh muscle volume (CT-scan), force-velocity characteristics of the knee extensors (Biodex dynamometer) and functional ability (Short Physical Performance Battery, timed stair ascent, 10-m walk test and countermovement jump height) were determined pre- and post-intervention. In addition, 3D trunk accelerations were recorded at the lower back to assess balance during the Short Physical Performance Battery balance tests. Results: Two-way ANOVA showed that the STEEP program increased thigh muscle volume, knee extensor isometric peak torque, dynamic peak power, unloaded rate of velocity development and improved performance on all functional tests to a greater extent than CONTROL (p <.05), except the countermovement jump. No improvements were found for peak velocity and balance performance (p >.05). Conclusion: Our results indicate that bench step training with incremental step heights simultaneously improves functional ability, thigh muscle volume and force-velocity characteristics of the knee extensors in older women

Otago Exercises Monitoring for Older Adults by a Single IMU and Hierarchical Machine Learning Models

Otago Exercise Program (OEP) is a rehabilitation program for older adults to improve frailty, sarcopenia, and balance. Accurate monitoring of patient involvement in OEP is challenging, as self-reports (diaries) are often unreliable. With the development of wearable sensors, Human Activity Recognition (HAR) systems using wearable sensors have revolutionized healthcare. However, their usage for OEP still shows limited performance. The objective of this study is to build an unobtrusive and accurate system to monitor OEP for older adults. Data was collected from older adults wearing a single waist-mounted Inertial Measurement Unit (IMU). Two datasets were collected, one in a laboratory setting, and one at the homes of the patients. A hierarchical system is proposed with two stages: 1) using a deep learning model to recognize whether the patients are performing OEP or activities of daily life (ADLs) using a 10-minute sliding window; 2) based on stage 1, using a 6-second sliding window to recognize the OEP sub-classes performed. The results showed that in stage 1, OEP could be recognized with window-wise f1-scores over 0.95 and Intersection-over-Union (IoU) f1-scores over 0.85 for both datasets. In stage 2, for the home scenario, four activities could be recognized with f1-scores over 0.8: ankle plantarflexors, abdominal muscles, knee bends, and sit-to-stand. The results showed the potential of monitoring the compliance of OEP using a single IMU in daily life. Also, some OEP sub-classes are possible to be recognized for further analysis.Comment: 10 page

DS-MS-TCN: Otago Exercises Recognition with a Dual-Scale Multi-Stage Temporal Convolutional Network

The Otago Exercise Program (OEP) represents a crucial rehabilitation initiative tailored for older adults, aimed at enhancing balance and strength. Despite previous efforts utilizing wearable sensors for OEP recognition, existing studies have exhibited limitations in terms of accuracy and robustness. This study addresses these limitations by employing a single waist-mounted Inertial Measurement Unit (IMU) to recognize OEP exercises among community-dwelling older adults in their daily lives. A cohort of 36 older adults participated in laboratory settings, supplemented by an additional 7 older adults recruited for at-home assessments. The study proposes a Dual-Scale Multi-Stage Temporal Convolutional Network (DS-MS-TCN) designed for two-level sequence-to-sequence classification, incorporating them in one loss function. In the first stage, the model focuses on recognizing each repetition of the exercises (micro labels). Subsequent stages extend the recognition to encompass the complete range of exercises (macro labels). The DS-MS-TCN model surpasses existing state-of-the-art deep learning models, achieving f1-scores exceeding 80% and Intersection over Union (IoU) f1-scores surpassing 60% for all four exercises evaluated. Notably, the model outperforms the prior study utilizing the sliding window technique, eliminating the need for post-processing stages and window size tuning. To our knowledge, we are the first to present a novel perspective on enhancing Human Activity Recognition (HAR) systems through the recognition of each repetition of activities

Where to Step? Contributions of Stance Leg Muscle Spindle Afference to Planning of Mediolateral Foot Placement for Balance Control in Young and Old Adults

Stable gait requires active control of the mediolateral (ML) kinematics of the body center of mass (CoM) and the base of support (BoS) in relation to each other. Stance leg hip abductor (HA) muscle spindle afference may be used to guide contralateral swing foot placement and adequately position the BoS in relation to the CoM. We studied the role of HA spindle afference in control of ML gait stability in young and older adults by means of muscle vibration. Healthy young (n = 12) and older (age &gt; 65 years, n = 18) adults walked on a treadmill at their preferred speed. In unperturbed trials, individual linear models using each subject’s body CoM position and velocity at mid-swing as inputs accurately predicted foot placement at the end of the swing phase in the young [mean R2 = 0.73 (SD 0.11)], but less so in the older adults [mean R2 = 0.60 (SD 0.14)]. In vibration trials, HA afference was perturbed either left or right by vibration (90 Hz) in a random selection of 40% of the stance phases. After vibrated stance phases, but not after unvibrated stance phases in the same trials, the foot was placed significantly more inward than predicted by individual models for unperturbed gait. The effect of vibration was stronger in young adults, suggesting that older adults rely less on HA spindle afference. These results show that HA spindle afference in the stance phase of gait contributes to the control of subsequent ML foot placement in relation to the kinematics of the CoM, to stabilize gait in the ML direction and that this pocess is impaired in older adults

Adaptations to Postural Perturbations in Patients With Freezing of Gait

Introduction: Freezing of gait (FOG) is a powerful determinant of falls in Parkinson's disease (PD). Automatic postural reactions serve as a protective strategy to prevent falling after perturbations. However, differences in automatic postural reactions between patients with and without FOG in response to perturbation are at present unclear. Therefore, the present study aimed to compare the response patterns and neuromuscular control between PD patients with and without FOG and healthy controls (HCs) after postural perturbations.Methods: 28 PD patients (15 FOG+, 13 FOG−) and 22 HCs were included. Participants stood on a moveable platform while random perturbations were imposed. The first anterior platform translation was retained for analysis. Center of pressure (CoP) and center of mass (CoM) trajectories and trunk, knee and ankle angles were compared between the three groups using the Statistical Parametric Mapping technique, allowing to capture changes in time. In addition, muscle activation of lower leg muscles was measured using EMG.Results: At baseline, FOG+ stood with more trunk flexion than HCs (p = 0.005), a result not found in FOG−. Following a perturbation, FOG+ reacted with increased trunk extension (p = 0.004) in comparison to HCs, a pattern not observed in FOG−. The CoM showed greater backward displacement in FOG− and FOG+ (p = 0.008, p = 0.027). Both FOG+ and FOG− showed increased co-activation of agonist and antagonist muscles compared to HCs (p = 0.010), with no differences between FOG+ and FOG−.Conclusions: Automatic postural reactions after a sudden perturbation are similar between PD subgroups with and without FOG but different from HCs. Reactive postural control, largely regulated by brain stem centers, seems to be modulated by different mechanisms than those governing freezing of gait. Greater differences in initial stance position, enhanced by joint stiffening, could however underlie maladaptive postural responses and increase susceptibility for balance loss in FOG+ compared to FOG−

How reliable are knee kinematics and kinetics during side-cutting manoeuvres?

INTRODUCTION: Side-cutting tasks are commonly used in dynamic assessment of ACL injury risk, but only limited information is available concerning the reliability of knee loading parameters. The aim of this study was to investigate the reliability of side-cutting data with additional focus on modelling approaches and task execution variables. METHODS: Each subject (n=8) attended six testing sessions conducted by two observers. Kinematic and kinetic data of 45° side-cutting tasks was collected. Inter-trial, inter-session, inter-observer variability and observer/trial ratios were calculated at every time-point of normalised stance, for data derived from two modelling approaches. Variation in task execution variables was regressed against that of temporal profiles of relevant knee data using one-dimensional statistical parametric mapping. RESULTS: Variability in knee kinematics was consistently low across the time-series waveform (≤5°), but knee kinetic variability was high (31.8, 24.1 and 16.9Nm for sagittal, frontal and transverse planes, respectively) in the weight acceptance phase of the side-cutting task. Calculations conveyed consistently moderate-to-good measurement reliability. Inverse kinematic modelling reduced the variability in sagittal (∼6Nm) and frontal planes (∼10Nm) compared to direct kinematic modelling. Variation in task execution variables did not explain any knee data variability. CONCLUSION: Side-cutting data appears to be reliably measured, however high knee moment variability exhibited in all planes, particularly in the early stance phase, suggests cautious interpretation towards ACL injury mechanics. Such variability may be inherent to the dynamic nature of the side-cutting task or experimental issues not yet known