What’s the BEST Way for Mobility-Impaired Adults to Exercise?
Preventing falls among older adults is a health-care crisis of economic, quality of life (QoL) and morbidity dimensions. With nearly 60% of those over 65 reporting limited mobility and the high rates of falling in this group, exercise researchers are attempting to discern what type of programming is optimal.
A European group compared high-intensity Exergaming (ExG), which engages players to respond to stimuli quickly, in an explosive manner while maintaining balance and spatial orientation with multi-sensory stimuli, vs 60 minutes of cycling (Cyc) at moderate intensity after a warm-up of low-intensity walking drills. Each group did 25 1-hr supervised sessions, 5 d/wk for 5 weeks after thorough assessments of mobility.
Exercise intensity was kept similar in terms of heart rates and perceived exertion. Improvements in the general health-related QoL survey SF-36 and the WOMAC (an index of mobility impairment) were statistically similar, though the ExG did perform better overall.
Body mass reductions were also similar, as were depression-scale and 6-meter walk test scores. However, balance and Schwab-England Activities of Daily Living scores were significantly higher post-intervention among the ExG subjects than the Cyc and controls.
In conclusion, the authors acknowledged that general exercise, such as cycling, improves some elements of life for those with mobility impairments. But multi-dimensional training that demands rapid, multi-directional responses to a variety of stimuli may be preferred for overall balance and mobility improvements.
MSSE Sept. 2019
Bi-Lateral Improvements from Uni-Lateral Gait Re-Training
Running injuries are so prevalent that many shoe designs, running techniques, training modalities and protocols have been studied and modified to reduce them. Lately, gait retraining has taken hold in the therapeutic community with the idea that reducing tibial shock (TS), through which ground contact forces traverse to the knees, hips and low back, could alter the trajectory of an individual’s risk of injury.
So a study was done to see if providing biofeedback to a runner running on a treadmill at his or her preferred pace (vs one the researchers imposed) using neurophysiological principles would impact peak TS in the untrained limb. So what are those principles?
Few runners are perfectly symmetrical with TS varying as much as 30% or more. Knowing that the “left hemisphere of the brain may be more responsive to dynamic control of movement” and the right side “may be more sensitive with spatial, visual-motor, or kinematic feedback”, 13 recreational runners were trained 8 times over a 2 week period targeting only the right leg with biofeedback. The hypothesis was that this would translate to left leg reductions in TS as well at both preferred and at a 10% reduced speed.
Though slightly less reduction in left-side TS occurred at both speeds, this type of gait retraining, with focus on the right side, worked well. The point is, think of hitting the ground softly with the right leg to help both.
MSSE Sept. 2019
Reported in the Cleveland Clinic’s Arthritis Advisor (Dec. 2019), since surgery is riskier in overweight and obese patients, it’s often recommended they lose weight before major procedures. A JBJS study determined that those who lost 20 or more pounds within 3 months prior to knee replacement surgery spent one less day in the hospital and were 76% less likely to stay in the hospital for 4 or more days.
A report in the National Osteoporosis Foundation (Aug. 2019) called attention to the dangers of osteoporotic fractures (OPF) in those 65 or older. Women had a 79% higher rate of fractures than men with hip fractures being the most detrimental. Forty percent of OPF required hospitalization, overall, while 90% of hip fractures did. Combined, these kinds of events are responsible for more hospitalizations than heart attacks, strokes and breast cancer. Furthermore, nearly 20% of those who suffer an OPF died within a year; hip fractures tend to be the most fatal. Arthritis Advisor Dec. 2019
Investigators at Brigham and Women’s Hospital assessed a representative sample of 1,500 subjects from their larger pool of over 25,000 in the VITAL study to see if vitamin D and omega-3 supplements reduced systemic inflammation. Systemic inflammation is associated with aging and obesity and linked with many diseases including heart, diabetes, osteoporosis, some cancers and neurodegenerative ones like Alzheimer’s. They found that those who took D and fish oil supplements did not have lower levels of inflammation. In fact, D is associated – not caused – with increased levels of on inflammatory marker, IL-6. The only ones who got anti-inflammation benefits were those who ate low levels of fish. So eat fish. Health Canal Nov. 13, 2019