The influence of fear of falling on the control of upright stance across the lifespan.

BACKGROUND: Standing at height, and subsequent changes in emotional state (e.g., fear of falling), lead to robust alterations in balance in adults. However, little is known about how height-induced postural threat affects balance performance in children. Children may lack the cognitive capability necessary to inhibit the processing of threat and fear-related stimuli, and as a result, may show more marked (and perhaps detrimental) changes in postural control compared to adults. This work explored the emotional and balance responses to standing at height in children, and compared responses to young and older adults. METHODS: Children (age: 9.7 ± 0.8 years, n = 38), young adults (age: 21.8 ± 4.0 years, n = 45) and older adults (age: 73.3 ± 5.0 years, n = 15) stood in bipedal stance in two conditions: at ground level and 80 cm above ground. Centre of pressure (COP) amplitude (RMS), frequency (MPF) and complexity (sample entropy) were calculated to infer postural performance and strategy. Emotional responses were quantified by assessing balance confidence, fear of falling and perceived instability. RESULTS: Young and older adults demonstrated a postural adaptation characterised by increased frequency and decreased amplitude of the COP, in conjunction with increased COP complexity (sample entropy). In contrast, children demonstrated opposite patterns of changes: they exhibited an increase in COP amplitude and decrease in both frequency and complexity when standing at height. SIGNIFICANCE: Children and adults adopted different postural control strategies when standing at height. Whilst young and older adults exhibited a potentially protective "stiffening" response to a height-induced threat, children demonstrated a potentially maladaptive and ineffective postural adaptation strategy. These observations expand upon existing postural threat related research in adults, providing important new insight into understanding how children respond to standing in a hazardous situation.

Effects of free versus restricted arm movements on postural control in normal and modified sensory conditions in young and older adults.

The purpose of this study was to explore the effects of arm movements on postural control when standing under different sensory conditions in healthy young and older adults. Fifteen young (mean ± SD age; 21.3 ± 4.2 years) and 15 older (mean ± SD age; 73.3 ± 5.0 years) adults completed the modified Romberg test, which uses four task manipulations (i.e. eyes open and eyes closed on a firm and foam surface) to compromise the fidelity of sensory feedback mechanisms. Each participant completed the tasks under two arm movement conditions: restricted and free arm movements. Centre of pressure (COP) range and frequency were calculated to characterise postural performance and strategy, respectively. Older adults showed greater COP range with restricted compared to free arm movements during all modified sensory conditions, with these effects most prominent in the medio-lateral (ML) plane (all p < .05, Cohen's d = 0.69-1.61). Compared to the free arm movement condition, there was an increase in ML displacement and frequency when arm movements were restricted during only the most challenging (i.e. vestibular dominant) task in young adults (all p < .05, d = 0.645-0.83). Finally, main age effects for the arm restriction cost (p < .05) indicates a greater reliance on an upper body strategy in older compared to young adults, independent of sensory availability/accuracy. These findings indicate that older adults compensate for the loss of accuracy in sensory input by increasing reliance on upper body movement strategies.

Exploring how arm movement moderates the effect of task difficulty on balance performance in young and older adults.

Emerging evidence highlights that arm movements exert a substantial and functionally relevant contribution on quiet standing balance control in young adults. Ageing is associated with "non-functional" compensatory postural control strategies (i.e., lower limb co-contraction), which in turn, may increase the reliance on an upper body strategy to control upright stance. Thus, the primary purpose of this study was to compare the effects of free versus restricted arm movements on balance performance in young and older adults, during tasks of different difficulty. Fifteen young (mean ± SD age; 21.3 ± 4.2 years) and fifteen older (mean ± SD age; 73.3 ± 5.0 years) adults performed bipedal, semi-tandem and tandem balance tasks under two arm position conditions: restricted arm movements and free arm movements. Centre of pressure (COP) amplitude and frequency were calculated as indices of postural performance and strategy, respectively. Especially in older adults, restriction of arm movement resulted in increased sway amplitude and frequency, which was primarily observed for the mediolateral direction. Further, increasing balance task difficulty raised the arm restriction cost (ARC; a new measure to quantify free vs. restricted arm movement differences in postural control) that was more prominent in older adults. These findings indicate the ARC provides a measure of reliance on the upper body for balance control and that arm movement is important for postural control in older adults, especially during tasks of greater difficulty.

Effects of arm movement strategies on emotional state and balance control during height-induced postural threat in young adults.

BACKGROUND: It is firmly established that postural threat seems to lead to an increased reliance on an ankle control ('stiffening') strategy. However, little is known about how postural threat affects performance in challenging tasks that require the use of upper body postural control strategies for stability. It is logical to assume that in such conditions, being able to utilise an upper body strategy may reduce the reliance on such ankle stiffening strategy. RESEARCH QUESTION: The objective of this study was to determine how arm movement influences balance control during a challenging balance task performed under conditions of postural threat. METHODS: Thirty young adults (mean ± SD age; 22.0 ± 4.0 years) balanced in tandem stance whilst standing at both ground-level (no threat) and 0.8 m above ground (threat). In both conditions, participants performed the task under two different arm positions: restricted arm movements and free arm movements. Postural sway amplitude and frequency were calculated to infer postural stiffening response. Self-reported emotional responses were quantified by assessing balance confidence, fear of falling, perceived stability, and conscious balance processing. RESULTS: Independent of arm movements, postural threat evoked an increase in fear of falling and conscious balance processing, and reductions in balance confidence and perceived stability. These threat-related changes in emotional state were further amplified when arm movements were restricted. Whilst significant increases in sway frequency during threat were observed in both arm conditions, reductions in sway amplitude were only observed during the restricted arm movement condition. SIGNIFICANCE: We propose that these responses likely reflect a fear-related cautious strategy intended to reduce the postural destabilisation associated with individuals being unable to use their arms to counter any destabilisation, as would normally be the case in daily life.

[Effects of Complex Versus Block Strength Training on the Athletic Performance of Elite Youth Soccer Players]. / Einfluss eines Komplex- versus blockweisen Krafttrainings auf sportmotorische Leistungen von Nachwuchsleistungsfußballern.

BACKGROUND: Muscle strength and speed are important determinants of soccer performance. It has previously been shown that complex training (CT, combination of strength and plyometric exercises within a single training session) is effective to enhance strength and speed performance in athletes. However, it is unresolved whether CT is more effective than conventional strength training that is delivered in one single block (BT) to increase proxies of athletic performance. Thus, the aim of the present study was to investigate the effects of CT versus BT on measures of muscle strength/power, speed, and agility in elite youth soccer players. METHODS: Eighteen male elite youth soccer players conducted six weeks (2 sessions/week, 30 min. each) of progressive CT (n = 10, age: 18.5 ± 2.2 years) or BT (n = 8, age: 18.1 ± 1.6 years) in addition to their regular soccer training (approx. 6 sessions/week, 60-90 min. each). Before and after training, tests were conducted for the assessment of strength (one-repetition maximum [1RM] squat), power (countermovement jump [CMJ]), speed (30-m linear sprint), and agility (T test). Non-parametric analyses were used to calculate differences within (Wilcoxon test) and between (Mann-Whitney-U test) groups. RESULTS: Both CT and BT proved to be safe (i.e. no training-related, but six match-related injuries reported) and feasible (i.e. attendance rate of ≥ 80% in both groups) training regimens when implemented in addition to regular soccer training. The statistical analysis revealed significant improvements from pre-training to post-training tests for the CT group in 1 RM squat (p = 0.043) and CMJ height (p = 0.046). For the BT-group, significantly enhanced sprint times were observed over 5 m (p = 0.039) and 10 m (p = 0.026). Furthermore, both groups significantly improved their t test time (CT: p = 0.046; BT: p = 0.027). However, group comparisons (CT vs. BT) over time (post-training minus pre-training test) did not show any significant differences. CONCLUSION: Six weeks of CT and BT resulted in significant improvements in proxies of athletic performance. Yet CT did not produce any additional effects compared to BT. Future research is needed to examine whether the observed test-specific changes, i.e. improvements in strength/power for the CT-group and improvements in speed for the BT-group, are due to the applied configuration of strength, plyometric, and sprint exercises or if they rather indicate a general training response.

Neuromuscular and athletic performance following core strength training in elite youth soccer: Role of instability.

Cross-sectional studies revealed that inclusion of unstable elements in core-strengthening exercises produced increases in trunk muscle activity and thus potential extra stimuli to induce more pronounced performance enhancements in youth athletes. Thus, the purpose of the study was to investigate changes in neuromuscular and athletic performance following core strength training performed on unstable (CSTU) compared with stable surfaces (CSTS) in youth soccer players. Thirty-nine male elite soccer players (age: 17 ± 1 years) were assigned to two groups performing a progressive core strength-training program for 9 weeks (2-3 times/week) in addition to regular in-season soccer training. CSTS group conducted core exercises on stable (i.e., floor, bench) and CSTU group on unstable (e.g., Thera-Band® Stability Trainer, Togu© Swiss ball) surfaces. Measurements included tests for assessing trunk muscle strength/activation, countermovement jump height, sprint time, agility time, and kicking performance. Statistical analysis revealed significant main effects of test (pre vs post) for trunk extensor strength (5%, P < 0.05, d = 0.86), 10-20-m sprint time (3%, P < 0.05, d = 2.56), and kicking performance (1%, P < 0.01, d = 1.28). No significant Group × test interactions were observed for any variable. In conclusion, trunk muscle strength, sprint, and kicking performance improved following CSTU and CSTS when conducted in combination with regular soccer training.

The Role of Instability with Plyometric Training in Sub-elite Adolescent Soccer Players.

The purpose of this study was to investigate the effects of plyometric training on stable (SPT) vs. highly unstable surfaces (IPT) on athletic performance in adolescent soccer players. 24 male sub-elite soccer players (age: 15±1 years) were assigned to 2 groups performing plyometric training for 8 weeks (2 sessions/week, 90 min each). The SPT group conducted plyometrics on stable and the IPT group on unstable surfaces. Tests included jump performance (countermovement jump [CMJ] height, drop jump [DJ] height, DJ performance index), sprint time, agility and balance. Statistical analysis revealed significant main effects of time for CMJ height (p<0.01, f=1.44), DJ height (p<0.01, f=0.62), DJ performance index (p<0.05, f=0.60), 0-10-m sprint time (p<0.05, f=0.58), agility (p<0.01, f=1.15) and balance (p<0.05, 0.46≤f≤1.36). Additionally, a Training group×Time interaction was found for CMJ height (p<0.01, f=0.66) in favor of the SPT group. Following 8 weeks of training, similar improvements in speed, agility and balance were observed in the IPT and SPT groups. However, the performance of IPT appears to be less effective for increasing CMJ height compared to SPT. It is thus recommended that coaches use SPT if the goal is to improve jump performance.

Sex-specific effects of surface instability on drop jump and landing biomechanics.

This study investigated sex-specific effects of surface instability on kinetics and lower extremity kinematics during drop jumping and landing. Ground reaction forces as well as knee valgus and flexion angles were tested in 14 males (age: 23±2 years) and 14 females (age: 24±3 years) when jumping and landing on stable and unstable surfaces. Jump height was found to be significantly lower (9%, p<0.001) when drop jumps were performed on unstable vs. stable surface. Significantly higher peak ground reaction forces were observed when jumping was performed on unstable versus stable surfaces (5%, p=0.022). Regarding frontal plane kinematics during jumping and landing, knee valgus angles were higher on unstable compared to stable surfaces (19-32%, p<0.05). Additionally, at the onset of ground contact during landings, females showed higher knee valgus angles than males (222%, p=0.027). Sagittal plane kinematics indicated significantly smaller knee flexion angles (6-35%, p<0.05) when jumping and landing on unstable vs. stable surfaces. During drop jumps and landings, women showed smaller knee flexion angles at ground contact compared to men (27-33%, p<0.05). These findings imply that knee motion strategies were modified by surface instability and sex during drop jumps and landings.

[Effects of complex training on strength and speed performance in athletes: a systematic review. Effects of complex training on athletic performance]. / Effekte von Komplextraining auf Kraft- und Schnelligkeitsleistungen bei Sportlern: Ein systematischer Überblick. Effekte von Komplextraining auf sportliche Leistungen.

BACKGROUND: Post-activation potentiation (PAP) can elicit acute performance enhancements in variables of strength, power, and speed. However, it is unresolved whether the frequent integration of PAP eliciting conditioning activities in training (i. e., complex training) results in long-term adaptations. In this regard, it is of interest to know whether complex training results in larger performance enhancements as compared to more traditional and isolated training regimens (e. g., resistance training). Thus, this systematic literature review summarises the current state of the art regarding the effects of complex training on measures of strength, power, and speed in recreational, subelite, and elite athletes. Further, it provides information on training volume and intensities that proved to be effective. METHODS: Our literature search included the electronic databases Pubmed, SportDiscus, and Web of Science (1995 to September 2013). In total, 17 studies met the inclusionary criteria for review. Ten studies examined alternating complex training and 7 studies sequenced complex training. RESULTS: Our findings indicated small to large effects for both alternating complex training (countermovement jump height: + 7.4 % [ESd = -0.43]; squat jump height: + 9.8 % [ESd = -0.66]; sprint time: -2.4 % [ESd = 0.63]) and sequenced complex training (countermovement jump height: + 6.0 % [ESd = -0.83]; squat jump height: + 11.9 % [ESd  = -0.97], sprint time: -0.7 % [ESd = 0.52]) in measures of power and speed. As compared to more traditional training regimens, alternating and sequenced complex training showed only small effects in measures of strength, power, and speed. A more detailed analysis of alternating complex training revealed larger effects in countermovement jump height in recreational athletes (+ 9.7 % [ESd = -0.57]) as compared to subelite and elite athletes (+ 2.7 % [ESd = -0.15]). Based on the relevant and currently available literature, missing data (e. g., time for rest interval) and diverse information regarding training volume and intensity do not allow us to establish evidence-based dose-response relations for complex training. CONCLUSION: Complex training represents an effective training regimen for athletes if the goal is to enhance strength, power, and speed. Studies with high methodological quality have to be conducted in the future to elucidate whether complex training is less, similar, or even more effective compared to more traditional training regimens. Finally, it should be clarified whether alternated and/or sequenced conditioning activities implemented in complex training actually elicit acute PAP effects.

[Assessment and training of strength and balance for fall prevention in the elderly: recommendations of an interdisciplinary expert panel]. / Diagnostik und Training von Kraft und Gleichgewicht zur Sturzprävention im Alter: Empfehlungen eines interdisziplinären Expertengremiums.

The proportion of elderly people in societies of western industrialized countries is continuously rising. Biologic aging induces deficits in balance and muscle strength/power in old age, which is responsible for an increased prevalence of falls. Therefore, nationwide and easy-to-administer fall prevention programs have to be developed in order to contribute to the autonomy and quality of life in old age and to help reduce the financial burden on the public health care system due to the treatment of fall-related injuries. This narrative (qualitative) literature review deals with a) the reasons for an increased prevalence of falls in old age, b) important clinical tests for fall-risk assessment, and c) evidence-based intervention/training programs for fall prevention in old age. The findings of this literature review are based on a cost-free practice guide that is available to the public (via the internet) and that was created by an expert panel (i.e., geriatricians, exercise scientists, physiotherapists, geriatric therapists). The present review provides the scientific foundation of the practice guide.

[Acute effects of postactivation potentiation on strength and speed performance in athletes]. / Akute Effekte der Postaktivierungspotenzierung auf Kraft- und Schnelligkeitsleistungen bei Sportlern.

BACKGROUND: The contractile history of a muscle or a muscle group can result in an acute enhancement of subsequent muscle force output. This phenomenon is referred to as postactivation potentiation (PAP) and it was frequently substantiated in original research manuscripts, systematic literature reviews, and meta-analyses. However, there is a lack in the literature regarding precise dose-response relations. This literature review describes the main determinants of PAP effects and additionally presents the state of the art regarding the acute effects of PAP protocols on measures of strength, power, and speed in subelite and elite athletes of different sport disciplines. Furthermore, an attempt is made to demonstrate evidence-based information concerning the design of effective PAP protocols. METHODS: Our literature search included the electronic databases Pubmed, SportDiscus, and Google Scholar (1995-March 2013). In total, 23 studies met the inclusionary criteria for review. RESULTS: Findings from our literature review indicate that various conditioning activities produce acute PAP effects in subelite and particularly elite athletes. More specifically, conditioning activities that are characterised by multiple sets, moderate to high intensities (60-84 % of the one repetition maximum), and rest intervals of 7-10 min. following the conditioning activity have the potential to induce short-term improvements in muscle force output and sports performance. CONCLUSION: It is recommended that subelite and particularly elite athletes from strength, power, and speed disciplines apply specifically tailored conditioning activities during the acute preparation process for competition to induce performance enhancing PAP effects.

[Muscle activation during therapeutic climbing exercises]. / Analyse der Muskelaktivität therapeutischer Kletterübungen.

BACKGROUND: Therapeutic climbing exercises are employed for the treatment of shoulder- and knee-joint injuries. However, there is a void in the literature regarding muscle activation levels during the performance of these exercises. Thus, the purpose of this study was to investigate differences in muscle activation during therapeutic climbing exercises depending on the degree of task difficulty. PARTICIPANTS/MATERIAL AND METHODS: A sample of 10 healthy subjects (sex: 4 females, 6 males; age: 27 ± 3 years; climbing experience: 5 ± 3 years) performed three shoulder girdle (i. e., wide shoulder pull, narrow shoulder pull, shoulder row) and two leg extensor (i. e., ascending frontal, ascending sidewards) exercises. Electromyographic (EMG) data were recorded on the right side for eleven muscles and then normalised using the maximum voluntary contractions for each muscle. RESULTS: With increasing task difficulty, muscle activity in all but one muscle (i. e., m. trapezius ascendens) increased significantly for the three shoulder girdle exercises. For the two leg extensor exercises, an increase in task difficulty produced a tendency towards yet not significantly higher muscle activity. CONCLUSION: Shoulder row was the most effective therapeutic climbing exercise in the ability to activate muscles while showing the highest EMG signals. The absence of significant differences in muscle activity between the two leg extensor exercises indicates their equivalent use for muscle activation during therapy.

Effects of climbing on core strength and mobility in adults.

The objective of this study was to examine the impact of an indoor climbing training and detraining program on core/handgrip strength and trunk mobility in men and women. 28 young sedentary adults participated in this study and were assigned to an intervention (30±3 years) or a control (29±2 years) group. The intervention group participated in 8 weeks (2 times/week) of indoor climbing training, followed by 8 weeks of detraining. Tests included the measurement of maximal isometric strength (MIS) of the trunk flexors/extensors, the assessment of trunk mobility in the sagittal (SAP) and the coronal (CRP) plane as well as testing of handgrip strength. After training, significant improvements were observed in MIS of the trunk flexors/extensors (~19-22%, all p<0.01), in trunk mobility in SAP/CRP (~14-19%, all p<0.01), and in handgrip strength (~5%, p<0.01). During detraining, MIS (~12-13%, all p<0.01) and trunk mobility (~7-10%, all p<0.01) deteriorated significantly, whereas handgrip strength remained. This indoor climbing training program conducted in sedentary adults proved to be feasible (i. e., attendance rate of 89.4%) and effective. It is suggested that indoor climbing should be permanently conducted to maintain the observed improvements in core muscle strength and trunk mobility.

Balance training and multi-task performance in seniors.

Age-related impairment in gait patterns when simultaneously performing cognitive (CI) and/or motor (MI) interference tasks are associated with an increased risk of falling in seniors. The objective of this study was to investigate the impact of balance training (BT) on walking performance with and without concurrently performing a CI and/or MI task in seniors. Twenty healthy women (n=14) and men (n=6) were assigned to either an intervention (n=11, age 71.9+/-4.8 yrs) or a control group (n=9, age 74.9+/-6.3 yrs). The intervention group conducted a six week BT (3/week). Pre and post tests included the assessment of stride-to-stride variability during single (walking), dual (CI or MI+walking), and triple (CI+MI+walking) task walking on an instrumented walkway. BT resulted in statistically significant reductions in stride time variability under single (p=0.02, Delta34.8%) but not dual or triple-task walking. Significant improvements in the MI task (p=0.05, Delta39.1%), but not in the CI task were found while walking. Findings showed that improved performance during single-task walking did not transfer to walking under dual or triple-task conditions suggesting multi-task BT as an alternative training modality. Improvement of the secondary motor but not cognitive task may indicate the need for the involvement of motor and particularly cognitive tasks during BT.