A Clustering-Based Approach to Functional and Biomechanical Parameters Recorded with a Pair of Smart Eyeglasses in Older Adults in Order to Determine Physical Performance Groups.

Falls and frailty status are often associated with a decline in physical capacity and multifactorial assessment is highly recommended. Based on the functional and biomechanical parameters measured during clinical tests with an accelerometer integrated into smart eyeglasses, the purpose was to characterize a population of older adults through an unsupervised analysis into different physical performance groups. A total of 84 participants (25 men and 59 women) over the age of sixty-five (age: 74.17 ± 5.80 years; height: 165.70 ± 8.22 cm; body mass: 68.93 ± 13.55 kg) performed a 30 s Sit-to-Stand test, a six-minute walking test (6MWT), and a 3 m Timed Up and Go (TUG) test. The acceleration data measured from the eyeglasses were processed to obtain six parameters: the number of Sit-to-Stands, the maximal vertical acceleration values during Sit-to-Stand movements, step duration and length, and the duration of the TUG test. The total walking distance covered during the 6MWT was also retained. After supervised analyses comparison (i.e., ANOVAs), only one of the parameters (i.e., step length) differed between faller groups and no parameters differed between frail and pre-frail participants. In contrast, unsupervised analysis (i.e., clustering algorithm based on K-means) categorized the population into three distinct physical performance groups (i.e., low, intermediate, and high). All the measured parameters discriminated the low- and high-performance groups. Four of the measured parameters differentiated the three groups. In addition, the low-performance group had a higher proportion of frail participants. These results are promising for monitoring activities in older adults to prevent the decline of physical capacities.

Effects of muscular and mental fatigue on spatiotemporal gait parameters in dual task walking in young, non-frail and frail older adults.

BACKGROUND: Dual-task (DT) walking is of great interest in clinical evaluation to evaluate frailty or cognitive declines in older adults. Frail older adults are known to adopt different walking strategy to overcome fatigue. However, no studies evaluated the effect of muscular or mental fatigue on dual-task walking strategy and the difference between frail and non-frail older adults. AIMS: Evaluate the effect of mental and muscular fatigue on spatio-temporal parameters in dual-task walking in young, non-frail and frail older adults. METHODS: 59 participants divided into 20 young (Y) (24.9 ± 3 years old), 20 non-frail (NF) (75.8 ± 4.9 years old) and 19 frail older adults (F) (81 ± 4.7 years old) performed single-task (ST) walking, single-task cognitive (serial subtraction of 3), and dual-task (subtraction + walking) for 1 min at their fast pace. Gait speed, step length, step length variability, stance and swing phase time, single and double support time, cadence, gait speed variability were recorded in single- and dual-task walking. The dual-task effect (DTE) was calculated as ((DT - ST)/ST) × 100). Generalized linear mixed models (GLMM) were used to compare the effects of mental and muscular fatigue on gait and cognitive variables between the groups. RESULTS: The DTE walking parameters were worse in F compared to NF or Y but no significant effect of fatigue were highlighted except for swing time and single support time DTEs. CONCLUSIONS: The results were mitigated but a clear difference in dual-task spatio-temporal parameters was found between F and NF which brings hope into the capacity of DT to better reveal frailty.

Applying the UTAUT2 Model to Smart Eyeglasses to Detect and Prevent Falls Among Older Adults and Examination of Associations With Fall-Related Functional Physical Capacities: Survey Study.

BACKGROUND: As people age, their physical capacities (eg, walking and balance) decline and the risk of falling rises. Yet, classic fall detection devices are poorly accepted by older adults. Because they often wear eyeglasses as they go about their daily activities, daily monitoring to detect and prevent falls with smart eyeglasses might be more easily accepted. OBJECTIVE: On the basis of the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2), this study evaluated (1) the acceptability of smart eyeglasses for the detection and prevention of falls by older adults and (2) the associations with selected fall-related functional physical capacities. METHODS: A total of 142 volunteer older adults (mean age 74.9 years, SD 6.5 years) completed the UTAUT2 questionnaire adapted for smart eyeglasses and then performed several physical tests: a unipodal balance test with eyes open and closed, a 10-m walk test, and a 6-minute walk test. An unsupervised analysis classified the participants into physical performance groups. Multivariate ANOVAs were performed to identify differences in acceptability constructs according to the performance group. RESULTS: The UTAUT2 questionnaire adapted for eyeglasses presented good psychometric properties. Performance expectancy (ß=.21, P=.005), social influence (ß=.18, P=.007), facilitating conditions (ß=.17, P=.04), and habit (ß=.40, P<.001) were significant contributors to the behavioral intention to use smart eyeglasses (R²=0.73). The unsupervised analysis based on fall-related functional physical capacities created 3 groups of physical performance: low, intermediate, and high. Effort expectancy in the low performance group (mean 3.99, SD 1.46) was lower than that in the other 2 groups (ie, intermediate: mean 4.68, SD 1.23; high: mean 5.09, SD 1.41). Facilitating conditions in the high performance group (mean 5.39, SD 1.39) were higher than those in the other 2 groups (ie, low: mean 4.31, SD 1.68; intermediate: mean 4.66, SD 1.51). CONCLUSIONS: To our knowledge, this study is the first to examine the acceptability of smart eyeglasses in the context of fall detection and prevention in older adults and to associate acceptability with fall-related functional physical capacities. The older adults with higher physical performances, and possibly lower risks of falling, reported greater acceptability of smart eyeglasses for fall prevention and detection than their counterparts exhibiting low physical performances.

Validation of 3D Knee Kinematics during Gait on Treadmill with an Instrumented Knee Brace.

To test a novel instrumented knee brace intended for use as a rehabilitation system, based on inertial measurement units (IMU) to monitor home-based exercises, the device was compared to the gold standard of motion analysis. The purpose was to validate a new calibration method through functional tasks and assessed the value of adding magnetometers for motion analysis. Thirteen healthy young adults performed a 60-second gait test at a comfortable walking speed on a treadmill. Knee kinematics were captured simultaneously, using the instrumented knee brace and an optoelectronic camera system (OCS). The intraclass correlation coefficient (ICC) showed excellent reliability for the three axes of rotation with and without magnetometers, with values ranging between 0.900 and 0.972. Pearson's r coefficient showed good to excellent correlation for the three axes, with the root mean square error (RMSE) under 3° with the IMUs and slightly higher with the magnetometers. The instrumented knee brace obtained certain clinical parameters, as did the OCS. The instrumented knee brace seems to be a valid tool to assess ambulatory knee kinematics, with an RMSE of <3°, which is sufficient for clinical interpretations. Indeed, this portable system can obtain certain clinical parameters just as well as the gold standard of motion analysis. However, the addition of magnetometers showed no significant advantage in terms of enhancing accuracy.

How fiber dynamics of plantarflexor and dorsiflexor muscles based on EMG-driven approach can explain the metabolic cost at different gait speeds.

PURPOSE: The aim of this study was to investigate the fiber dynamics of plantarflexor and dorsiflexor muscles and their association with the net metabolic rate (NCw). METHODS: Metabolic, kinematic, kinetic, and electromyography measurements were made on seven young subjects while they walked on a force-plate instrumented treadmill at 1.00, 1.20, 1.40, 1.60, and 1.8 m/s for 1:30 min. The net metabolic rate was computed, and a one degree-of freedom EMG-driven approach was used to extract the force generation ability (Fability), and active force-length (fAL) and force-velocity (fV) multiplier of each muscle. A one-way (speeds) repeated measures ANOVA was performed for each muscle and a multiple linear regression model was used to explain NCw. RESULTS: Fability was significantly affected by gait speed for the GasMed and the SOL muscles. The decrease of Fability for the SOL and the GasMed was accompanied by a decrease in the force-velocity multiplier. The peak muscle force for the SOL increased for the lowest speed compared to the higher speed, and for the TibAnt increased at high speed compared to low speed. In addition, Fability fAL, and fV of the SOL predicted over 58% of NCw and FMax of the TibAnt accounts for 39.9% of the variance in NCw. CONCLUSION: The increase of NCw with gait speed over the preferred walking speed can be partially explained by the decreasing capacity of the SOL muscle to produce muscle force and more specifically by the force-velocity relationship and an increase in muscle force for the TibAnt.

Smart Eyeglasses: A Valid and Reliable Device to Assess Spatiotemporal Parameters during Gait.

The study aims to determine the validity and reproducibility of step duration and step length parameters measured during walking in healthy participants using an accelerometer embedded in smart eyeglasses. Twenty young volunteers participated in two identical sessions comprising a 30 s gait assessment performed at three different treadmill speeds under two conditions (i.e., with and without a cervical collar). Spatiotemporal parameters (i.e., step duration and step length normalized by the lower limb length) were obtained with both the accelerometer embedded in smart eyeglasses and an optoelectronic system. The relative intra- and inter-session reliability of step duration and step length computed from the vertical acceleration data were excellent for all experimental conditions. An excellent absolute reliability was observed for the eyeglasses for all conditions and concurrent validity between systems was observed. An accelerometer incorporated in smart eyeglasses is accurate to measure step duration and step length during gait.

Sit-To-Stand Movement Evaluated Using an Inertial Measurement Unit Embedded in Smart Glasses-A Validation Study.

Wearable sensors have recently been used to evaluate biomechanical parameters of everyday movements, but few have been located at the head level. This study investigated the relative and absolute reliability (intra- and inter-session) and concurrent validity of an inertial measurement unit (IMU) embedded in smart eyeglasses during sit-to-stand (STS) movements for the measurement of maximal acceleration of the head. Reliability and concurrent validity were investigated in nineteen young and healthy participants by comparing the acceleration values of the glasses' IMU to an optoelectronic system. Sit-to-stand movements were performed in laboratory conditions using standardized tests. Participants wore the smart glasses and completed two testing sessions with STS movements performed at two speeds (slow and comfortable) under two different conditions (with and without a cervical collar). Both the vertical and anteroposterior acceleration values were collected and analyzed. The use of the cervical collar did not significantly influence the results obtained. The relative reliability intra- and inter-session was good to excellent (i.e., intraclass correlation coefficients were between 0.78 and 0.91) and excellent absolute reliability (i.e., standard error of the measurement lower than 10% of the average test or retest value) was observed for the glasses, especially for the vertical axis. Whatever the testing sessions in all conditions, significant correlations (p < 0.001) were found for the acceleration values recorded either in the vertical axis and in the anteroposterior axis between the glasses and the optoelectronic system. Concurrent validity between the glasses and the optoelectronic system was observed. Our observations indicate that the IMU embedded in smart glasses is accurate to measure vertical acceleration during STS movements. Further studies should investigate the use of these smart glasses to assess the STS movement in unstandardized settings (i.e., clinical and/or home) and to report vertical acceleration values in an elderly population of fallers and non-fallers.

Ankle Sprains Risk Factors in a Sample of French Firefighters: A Preliminary Prospective Study.

CONTEXT: Firefighters participating in mandatory physical exercise sessions are exposed to a high risk of ankle sprain injury. Although both physiological and psychological risk factors have been identified, few prospective studies considered the complex interaction of these factors in firefighters. OBJECTIVE: To prospectively determine whether intrinsic physical risk factors and work-related environments predict ankle sprains occurring during on-duty physical exercise in firefighters during an 8-month follow-up period. DESIGN: Prospective. SETTING: Fire Department and Rescue Service. PARTICIPANTS: Thirty-nine firefighters were selected based on convenience sampling. INTERVENTION: Participants performed physical tests and completed questionnaires. MAIN OUTCOME MEASURES: Lower Quarter Y-Balance Test, Weight-Bearing Lunge Test, anthropometric measures, postural stability, chronic ankle instability (Cumberland Ankle Instability Tool) scores, previous injuries, and perceived psychosocial work environment (Copenhagen Psychosocial Questionnaire [COPSOQ]). RESULTS: During the follow-up, 9 firefighters sustained an injury. Lower Quarter Y-Balance Test and Weight-Bearing Lunge Test performances, Cumberland Ankle Instability Tool scores, history of previous ankle sprain, and specific dimensions of the COPSOQ significantly differed between injured and uninjured firefighters. Lower-limbs asymmetries of the Lower Quarter Y-Balance Test (ie, anterior, posteromedial, and posterolateral directions) and the Weight-Bearing Lunge Test were predictors of ankle sprains. CONCLUSIONS: These findings originally provide evidence that intrinsic factors mainly contribute to ankle sprains, although psychosocial work environment assessment could also characterize firefighters at risk.

Methodological Considerations on the Relationship Between the 1,500-m Rowing Ergometer Performance and Vertical Jump in National-Level Adolescent Rowers.

Maciejewski, H, Rahmani, A, Chorin, F, Lardy, J, Samozino, P, and Ratel, S. Methodological considerations on the relationship between the 1,500-m rowing ergometer performance and vertical jump in national-level adolescent rowers. J Strength Cond Res 33(11): 3000-3007, 2019-The purpose of this study was to investigate whether 3 different approaches for evaluating squat jump performance were correlated with rowing ergometer performance in elite adolescent rowers. Fourteen young male competitive rowers (15.3 ± 0.6 years), who took part in the French rowing national championships, performed a 1,500-m all-out rowing ergometer performance (P1500) and a squat jump (SJ) test. The performance in SJ was determined by calculating the jump height (HSJ in cm), a jump index (ISJ = HSJ·body mass·gravity, in J), and the mean power output (PSJ in W) from the Samozino et al.'s method. Furthermore, allometric modeling procedures were used to consider the importance of body mass (BM) in the relationships between P1500 and jump scores. P1500 was significantly correlated with HSJ (r = 0.29, p ≤ 0.05), ISJ (r = 0.72, p < 0.0001), and PSJ (r = 0.86, p < 0.0001). Furthermore, BM explained at least 96% of the relationships between SJ and rowing performances. However, the similarity between both allometric exponents for PSJ and P1500 (1.15 and 1.04, respectively) indicates that BM could influence jump and rowing ergometer performances at the same rate, and that PSJ could be the best correlate of P1500. Therefore, the calculation of power seems to be more relevant than HSJ and ISJ to (a) evaluate jump performance and (b) infer the capacity of adolescent rowers to perform 1,500-m all-out rowing ergometer performance, irrespective of their body mass. This could help coaches to improve their training program and potentially identify talented young rowers.

Relationship between Force-Velocity Profiles and 1,500-m Ergometer Performance in Young Rowers.

Rowing races require developing high level of force and power output at high contraction velocity. This study determined the force-velocity and power-velocity (F-P-V) profiles of lower and upper limbs of adolescent rowers and their relationships with a 1,500-m rowing ergometer performance. The power developed during the 1,500-m (P1500) was evaluated in fourteen national-level male rowers (age: 15.3±0.6 yrs). F-P-V profiles were assessed during bench pull (BP) and squat jump (SJ) exercises. The theoretical maximal values of force (F0), velocity (V0), power output (Pmax) and the F-V relationship slope (S FV ) were determined. The body mass (BM) influence on these relationships was considered using an allometric approach. F0 was 720±144 and 2146±405 N, V0 was 1.8±0.1 and 1.8±0.3 m·s-1, Pmax was 333±83 and 968±204 W and SFV was -391±54 and -1,200±260 N·s·m-1 for BP and SJ, respectively. Upper and lower limb F0 and Pmax were significantly related. P1500 was significantly (P<0.05) correlated to V0-BP, F0-BP, SFV-BP, Pmax-BP, F0-SJ and Pmax-SJ (r²=0.29 to 0.79). BM accounted for more than 90% of these relationships. Rowers' F-P-V profiles reflect adaptations to chronic rowing practice. F-P-V profiles and rowing performance correlations suggest that BP and SJ exercises are relevant to evaluate young rowers' explosive abilities.

Sit to stand in elderly fallers vs non-fallers: new insights from force platform and electromyography data.

BACKGROUND: The sit-to-stand movement requires balance control and coordination between the trunk and lower limbs. For these reasons, it is commonly used in clinics for evaluating lower limb muscle function in the elderly. The aim of the present study was to point out re levant biomechanical and neurophysiological sit-to-stand parameters allowing comparison between elderly fallers and non-fallers. METHODS: Ten elderly fallers and thirty non-fallers performed sit-to-stand movements. Sit-to-stand mechanical (maximal and mean force, impulse) and temporal parameters were measured in the vertical and anteroposterior axes using force platforms. Activity of rectus femoris, vastus lateralis, and gastrocnemius lateralis muscles was bilaterally recorded by surface electromyography. RESULTS: Time to realize sit-to-stand movements was significantly longer in elderly fallers compared to non-fallers (p < 0.05). In the same way, maximal vertical force and mean posterior force applied on force platform were significantly lower (p < 0.05) in fallers than in non-fallers individual. At muscular activity level, results showed a main statistical difference in gastrocnemius lateralis muscle activity patterns between faller and non-faller groups. CONCLUSION: Vertical and anteroposterior data from force platform, and gastrocnemius lateralis muscle activity determined during sit-to-stand movement are the most relevant parameters to differentiate fallers and non-fallers. Moreover, these factors highlight different strategies to rise from a chair between faller and non-faller group, suggesting that fallers would constantly adjust their control balance during the sit-to-stand movement.

The 1,500-m Rowing Performance is Highly Dependent on Modified Wingate Anaerobic Test Performance in National-Level Adolescent Rowers.

PURPOSE: The aim of the current study was to determine whether the anaerobic performance assessed by a modified Wingate test could account for the 1,500-m rowing ergometer performance in young competitive rowers. METHODS: Fourteen national-level adolescent rowers performed on a rowing ergometer i) a 30-s allout exercise (i.e., modified Wingate test) and ii) a 1,500-m all-out exercise (i.e., rowing performance). For each of these two exercises, the mean power output was considered as the main performance criterion (PWIN and P1500, respectively). RESULTS: PWIN was correlated to P1500 (r2 = .83, p < .0001, ß = 100%). Furthermore, the estimated total muscle mass was correlated to PWIN and P1500 (r2 = .72 and r2 = .83, p < .0001, ß = 100%, respectively). The allometric scaling also indicated that total muscle mass accounts 62% for the relationship between PWIN and P1500. CONCLUSION: Our results highlight the importance of considering the contribution of total muscle mass and anaerobic energy pathways to 1,500-m rowing performance in competitive adolescent rowers. Therefore, the modified Wingate test could be used by rowing coaches to potentially identify talented young rowers.

Determination of reliable force platform parameters and number of trial to evaluate sit-to-stand movement.

BACKGROUND: Sit-to-stand (STS) movement is useful for evaluating lower limb muscle function, especially from force platforms. Nevertheless, due to a lack of standardization of the STS movement (e.g., position, subject's instructions, etc.), it is difficult to compare results obtained in previous studies. AIMS: The aim of the present study was to determine the most relevant condition, parameters, and number of trial to perform STS movements. METHODS: In this study, STS mechanical (maximal and mean force, impulse) and temporal parameters were measured in the vertical, medio-lateral and antero-posterior axes using a force platform. Five STS conditions (i.e., with or without armrests, variation of the height of the chair and the movement speed) were analyzed to evaluate repeatability of different standardized procedures. RESULTS: Most of the mechanical and temporal parameters were influenced by the STS condition (p < 0.05). Regarding vertical axis, results showed a strong to perfect repeatability for all parameters (0.72 < ICC < 0.9) for only one condition: STS performed as rapidly as possible with a 90° knee angle when seated, without using armrests. Regardless conditions of performance, our results also showed that the most repeatable parameters were mean and peak force in medio-lateral axis, and the impulse measured in the three directions. Three trials should be performed to reach high repeatability. CONCLUSION: Our results suggest that the fast condition, with a 90° knee joint angle, with arms crossed over the chest, is the most reliable condition to evaluate performance during STS movement.

[Prehabilitation through physical activity in oncology]. / Préhabilitation par l'activité physique en oncologie.

It has now been established that preoperative physical activity plays an essential role in minimizing postoperative complications. Patients who have undergone physical preparation recover their preoperative abilities more quickly. However, only about a third of those with access to such preparation report an improvement in their physical abilities. The modalities of intervention and follow-up, such as the training load and the generic format of the proposed sessions, seem to hinder patient participation in these programs, thus explaining the mixed results. In this context, it seems necessary to individualize prehabilitation in order to improve the functional capacities of people in this phase or in the phase of accelerated recovery after treatment or surgery.

La préhabilitation, un nouveau parcours préopératoire pour améliorer la condition des patients.

The maintenance and optimization of functional capacities before, during, and after treatment are major challenges for frailty persons as cancer's patients. It is now known that physical activity in prehabilitation plays a crucial role in limiting, among other things, post-operative complications. The benefits have already been demonstrated in various studies, including a decrease in hospitalization duration, an increase in cardiorespiratory endurance, improvement in quality of life, and better fatigue management. It is observed that patients who undergo prehabilitation are those who recover their preoperative capacities the fastest. However, it is estimated that only one-third of patients with access to prehabilitation improve their physical capacities.

Assessing muscle quality as a key predictor to differentiate fallers from non-fallers in older adults.

BACKGROUND: Falling is an important public health issue because of its prevalence and severe consequences. Evaluating muscle performance is important when assessing fall risk. The study aimed to identify factors [namely muscle capacity (strength, quality, and power) and spatio-temporal gait attributes] that best discriminate between fallers and non-fallers in older adults. The hypothesis is that muscle quality, defined as the ratio of muscle strength to muscle mass, is the best predictor of fall risk. METHODS: 184 patients were included, 81% (n = 150) were women and the mean age was 73.6 ± 6.83 years. We compared body composition, mean grip strength, spatio-temporal parameters, and muscle capacity of fallers and non-fallers. Muscle quality was calculated as the ratio of maximum strength to fat-free mass. Mean handgrip and power were also controlled by fat-free mass. We performed univariate analysis, logistic regression, and ROC curves. RESULTS: The falling patients had lower muscle quality, muscle mass-controlled power, and mean weighted handgrip than the non-faller. Results showing that lower muscle quality increases fall risk (effect size = 0.891). Logistic regression confirmed muscle quality as a significant predictor (p < .001, OR = 0.82, CI [0.74; 0.89]). ROC curves demonstrated muscle quality as the most predictive factor of falling (AUC = 0.794). CONCLUSION: This retrospective study showed that muscle quality is the best predictor of fall risk, above spatial and temporal gait parameters. Our results underscore muscle quality as a clinically meaningful assessment and may be a useful complement to other assessments for fall prevention in the aging population.

Age-related effects on absolute and relative isokinetic knee extensor strength in community-dwelling older men and women at a French geriatric day hospital.

PURPOSE: Isokinetic knee extensor strength is poorly evaluated in geriatric day hospitals (GDHs), despite its potential functional significance compared to grip strength. This study aimed to investigate age-related effects on absolute and relative isokinetic knee extensor peak torque (KEPT) data in community-dwelling older GDH patients. METHODS: A total of 472 French GDH patients (179 men and 293 women, aged 75-94 years) participated in this study. Absolute and relative KEPT were measured at six distinct angular velocities between 0.52 and 3.14 rad/s. In addition, comfortable gait speed and grip strength were assessed. Participants were stratified by sex and age using 5-year intervals. One-way ANOVAs were used to examine age-related effects on KEPT values. Multiple linear regression models were employed to investigate the associations between gait speed and both mean KEPT values and grip strength, with separate models conducted on absolute and relative values. RESULTS: The recruited GDH patients presented lower absolute and relative KEPT values in comparison with established reference values for healthy community-dwelling older individuals, with men being consistently stronger than women. Notably, there was a significant decline in both absolute and relative KEPT values beyond the age of 85 for both sexes. Importantly, the multiple linear regression analyses conducted revealed a significant positive relationship between gait speed and mean KEPT values, surpassing the association with grip strength. CONCLUSIONS: These findings underscore the clinical importance of assessing isokinetic knee extensor strength in community-dwelling older GDH patients, particularly for tailoring personalized physical activity interventions.

Effects of age, sex, frailty and falls on cognitive and motor performance during dual-task walking in older adults.

BACKGROUND: Dual-task (DT) walking is of great interest in clinical evaluation to evaluate the risk of falling or cognitive declines in older adults. However, it appears necessary to investigate deeply the confounding factors to better understand their impact on dual-task performance. OBJECTIVE: To evaluate the effect of age, sex, falls and frailty on cognitive and motor parameters in dual-task walking. SUBJECTS: 66 older participants (mean age = 75.5 ± 6.3; mean height = 165.8 ± 8.4 cm; mean weight = 68.4 ± 14 kgs) were split into groups based on their age, sex, fall and frailty status. METHODS: Participants performed single-task walking, single-task cognitive (serial subtraction of 3), and dual-task walking (subtraction + walking) for 1 min at their fast pace. Gait speed, step length, step length variability, stance and swing phase time, single and double support, cadence, step time variability and gait speed variability were recorded in single- and dual-task walking and used to calculate the dual-task effect (DTE) as ((DT - ST) / ST) ∗ 100). The cognitive score (DTEcog) was calculated as the number of correct responses minus errors. Generalized linear mixed models (GLMM) were used to compare the effects of falls, frailty, age and sex on gait and cognitive variables. RESULTS: The interaction frailty*sex and frailty*age were the major effect on the DTEs. Specifically, the DTE was higher in women than men and in the frail group compared to non-frail. CONCLUSIONS: The present findings provide a better understanding on the confounding factors explaining the behavior in DT that could be used to develop more effective dual-task clinical programs for community-living older adults.

Effects of individualized lower limb isokinetic strengthening in clinical rehabilitation of older post-stroke patients: A retrospective study.

OBJECTIVE: Muscle weakness in the lower limbs is a motor consequence of stroke that causes functional impairment. The aim of this study was to assess the effectiveness of an individualized isokinetic strengthening programme, using the moment-velocity profile, on functional recovery during post-stroke rehabilitation of older patients. A further objective was to describe the effects of the individualized isokinetic strengthening on muscular parameters. DESIGN: Retrospective study. PATIENTS: Older post-stroke patients. METHODS: Using the Barthel Index, functional abilities in basic daily tasks were assessed and retrospectively analysed for 88 patients in a post-stroke rehabilitation unit. Of these, 44 patients received conventional rehabilitation (conventional group) and 44 received individualized isokinetic strengthening in addition to conventional rehabilitation (isokinetic group). A 2-Group (isokinetic, conventional) × 2-Time (before, after intervention) repeated measures analysis of variance (ANOVA) was conducted. For muscular parameters, Student t-tests and Wilcoxon tests were performed. RESULTS: The Barthel Index score increased more in the isokinetic group (61.59 ± 26.34 to 88.18 ± 12.16) than in the conventional group (61.70 ± 26.5 to 76.93 ± 18.12). A significant Time × Group interaction was found (F(1,86) = 5.95, p = 0.02). In the isokinetic group all muscular parameters improved. CONCLUSION: This retrospective clinical study suggests that lower limb isokinetic strengthening, individualized using the moment-velocity profile, is clinically efficient for functional recovery during post-stroke rehabilitation of older patients. Intragroup effects of isokinetic strengthening also suggest benefits for muscular parameters.