Etiology and modification of gait instability in older adults: a randomized controlled trial of exercise

Abstract

Increased gait instability is common in older adults, even in the absence of overt disease. The goal of the present study was to quantitatively investigate the factors that contribute to gait instability and its potential reversibility in functionally impaired older adults. We studied 67 older men and women with functional impairment before and after they participated in a randomized placebo-controlled, 6-mo multimodal exercise trial. We found that 1) gait instability is multifactorial; 2) stride time variability is strongly associated with functional status and performance-based measures of function that have previously been shown to predict significant clinical outcomes such as morbidity and nursing home admission; 3) neuropsychological status and health-related quality of life play important, independent roles in gait instability; and 4) improvement in physiological capacity is associated with reduced gait instability. Although the etiology of gait instability in older persons with mild-moderate functional impairment is multifactorial, interventions designed to reduce gait instability may be effective in bringing about a more consistent and more stable walking pattern.

Relação da pressão plantar e amplitude de movimento de membros inferiores com o risco de quedas em idosas

“…However, the importance of evaluating muscular strength and endurance, once weakness and limitation of ROM in LL would be associated with alterations of walking pattern, as well as with difficulty of balance 21,32 , should be considered.…”

Gait dynamics, fractals and falls: Finding meaning in the stride-to-stride fluctuations of human walking

“…We have also noted how a metronome reduces gait variability in patients with Parkinson's disease, while it alters (becoming more abnormal) the fractal scaling index. Randomized control trials in older adults and in patients with osteoarthritis have shown that the regulation of gait dynamics, variability as well as other measures such as non-stationary indices, are responsive to resistance training (Hausdorff, Nelson et al, 2001) and that improvement in physiologic capacity (e.g., muscle strength) is associated with reduced gait instability. These findings also demonstrate that while measures of variability are sensitive markers of fall risk, they are also sensitive to physiologic function and amenable to change with the appropriate intervention.…”

“…Simplified block diagram depicting some of the factors that contribute to gait stability and fall risk. Adapted from Hausdorff, Nelson et al (2001). Example of the effects of MPH (MPH) on stride time variability during usual walking in a child with ADHD.…”

Statistical quantifiers of memory for an analysis of human brain and neuro-system diseases

“…Despite its welldeveloped experimental methods this field still lacks good and reliable theoretical quantitative indicators for human gait disorders. Interesting results in this field have been derived before by Hausdorff et al [13][14][15][16][17][18][19][20][21]. They studied the dynamical changes of human gait, connected with various diseases [13][14][15][16], the increasing instability of gait in elderly people [13,[16][17][18], presence of long-range correlations in stride interval fluctuations [19,20], stride-to-stride variability and its temporal organization in children [21].…”