Effects of self-management exercise group participation in community-dwelling older adults.

BACKGROUND: The effects of physical fitness and age on motor function in older adults who continue to exercise remain unclear. This study aimed to examine the effects of participation in self-management exercise groups in adults aged ≥65 years. METHODS: The motor functions of 372 citizens who participated in a self-management exercise group for 1 year were examined. The motor functions were assessed by measuring grip strength, five-repetition sit-to-stand test, 5-m fastest walking time (walking time) and timed up and go test. The participants were grouped according to their baseline grip strength (low or high grip strength groups). The baseline parameters were compared to those assessed 1 year after group participation. In addition, the rates of long-term care/support need certification were examined at 2-year follow-up. RESULTS: In the low grip strength group aged ≥75 years, the grip strength of men, and grip strength and five-repetition sit-to-stand test results of women improved after 1 year. In the high grip strength group, the five-repetition sit-to-stand and timed up and go test results of men aged 65-74 years and five-repetition sit-to-stand test results of men aged ≥75 years improved. Among women in the high grip strength group, grip strength, five-repetition sit-to-stand test, walking time, and timed up and go test results improved in the participants aged 65-74 and ≥ 75 years. The number of new long-term care/support need certifications was comparable in both groups. CONCLUSIONS: Participation in self-management exercise groups led to maintaining or improving physical fitness among community-dwelling-older adults. Furthermore, higher baseline grip strength was associated with improvements in many motor functions; therefore, participation in self-management exercise groups before the onset of functional decline is desirable.

Relationship between foot morphology, muscle strength, and physical performance test in women aged 65 years and older: a cross-sectional study.

BACKGROUND: Hallux valgus is a foot deformity that may affect gait, thus increasing the risk of falls among older people. We investigated the relationship between foot morphology, muscle strength, and physical performance. METHODS: In this study, community-dwelling older people aged ≥65 years were included. A three-dimensional footprint automatic measurement apparatus was used to measure the hallux valgus angle, arch height ratio, and heel-floor angle. Furthermore, the toe flexor strength and ankle plantar flexion strength were measured. Physical performance tests included the five-repetition sit-to-stand test, one-leg standing time, maximal step length, functional reach test, and 5-m fastest walking time (walking time). The relationship between the hallux valgus angle and foot morphology and muscle strength was examined. In addition, factors affecting physical performance testing were assessed. Two-group comparisons, correlation, and multiple comparisons were used for statistical analyses. RESULTS: Of the 133 women (age 77.7 ± 6.2 years), 57 had hallux valgus and 76 had no hallux valgus. There was a significant difference in the arch height ratio and heel-floor angle between women with and without hallux valgus (p < 0.001). A correlation was found between the hallux valgus angle and the heel-floor angle (r = 0.468, p < 0.001) and arch height ratio (r = - 0.337, p < 0.001), respectively. Multiple regression analysis showed that the hallux valgus angle was related to functional reach (ß = - 0.162, p = 0.042), and toe flexor strength was related to five-repetition sit-to-stand (ß = - 0.182, p = 0.036), maximal step length (ß = 0.328, p < 0.001), and walking time (ß = - 0.219, p = 0.006). CONCLUSIONS: A relationship was found between the hallux valgus angle, arch height rate, and inward inclination angle of the calcaneus. Functional reach was predicted based on the hallux valgus angle, whereas the five-repetition sit-to-stand, maximal step length, and walking time were predicted based on toe flexor strength. Hallux valgus predicted not only the forefoot but also the foot morphology and was related to physical performance. From the perspective of motor function and fall prevention, efforts should be made to better understand and prevent the onset and progression of hallux valgus.

Association Between Toe Flexor Strength and Activity Levels in Community-Dwelling Japanese Older Women.

This study aimed to explore the relationship between toe flexor strength and the daily activity levels in 56 Japanese older women aged between 70 and 88 years. The activity levels were measured as the average number of steps/day using a pedometer and the life space assessment (LSA) scores. The Mann-Whitney U test was used to compare toe flexor muscle strength and the LSA scores between those with fewer than and more than 6,000 steps/day. Spearman's correlation coefficient was used to investigate the relationship between toe grip strength according to age and each variable. The LSA scores were significantly higher in the group with >6,000 steps/day (ß = 0.188, p < .05). A correlation was found between the number of steps/day and toe flexor strength (r = .424, ß = 0.419, p < .05) and the LSA scores (r = .417, ß = 0.435, p < .05) in the participants in their 80s. Increasing the number of steps/day may benefit women in their 80s.

Relationship between foot morphology and toe muscle strength in female university students.

[Purpose] The purpose was to clarify the relationship between foot morphology and toe muscle strength in female university students. [Participants and Methods] Data from 103 female university students (age, 20.4 ± 1.6 years) on height, body weight, pain in the foot and toes, heel height (cm) of shoes worn in everyday life, and the number of times (per week) shoes with heels ≥3 cm were worn were collected. The hallux valgus angle and medial longitudinal arch height ratio of the foot were measured, and toe muscle strength was evaluated according to the strength of the toe flexor and abductor hallucis muscles. [Results] Arch height ratio was significantly lower with hallux valgus angle ≥16°. In the 206 feet, a very weak negative correlation was found between hallux valgus angle and arch height ratio. In 150 feet with hallux valgus angle <16°, a very weak correlation was found between toe flexor strength and arch height ratio. [Conclusion] Body mass index was within the normal range, and the period of wearing high-heeled shoes was short; these factors have no effect on hallux valgus angle. Hallux valgus may be prevented by increasing toe flexor strength to prevent downward movement of the navicular and first cuneiform bones.

Differences in walking and running parameters in elementary school students with and without backpacks.

BACKGROUND: Backpack syndrome (BS) is a term used to describe symptoms such as shoulder and back pain that are believed to be caused by carrying a backpack. Few studies have investigated the changes in walking and running parameters with and without backpacks. OBJECTIVE: The present study aimed to investigate the differences in walking and running parameters with and without backpacks in primary school children with and without BS. METHODS: This cross-sectional study included 51 children (average age 9.3 years, 6- 12 years). Two questions were asked beforehand: whether the respondents had shoulder or back pain when going to school and present; those who answered that they had pain in both cases were defined as the BS group, while the others were the control group. Walking and running at comfortable speeds and walking and running with a 6 kg backpack on their backs were measured. RESULTS: During walking, there were main effects for speed, cadence, and strike angle with and without the backpack, but no interactions were identified for any of the parameters. In running, however, there were main effects for speed, stride length, strike angle, and lift-off angle, and an interaction effect was observed for speed and stride length. CONCLUSIONS: During walking, carrying a 6 kg backpack increased cadence and walking speed. During running, carrying a backpack caused a decrease in stride length and running speed in the BS group, whereas there was no change in the control group, suggesting that the control and BS groups may respond differently.

Characteristics of hindfoot morphology and ankle range of motion in young women with hallux valgus.

BACKGROUND: Hallux valgus occurs more frequently in women as they age; therefore, it is beneficial to prevent hallux valgus in younger women. The purpose of this study was to clarify the characteristics of hindfoot morphology and the range of motion of the ankle joint with hallux valgus in young women. METHODS: The participants were 140 young women (mean age 18.8 ± 0.6 years). A three-dimensional footprint automatic measurement apparatus was used to measure the hallux valgus angle in the standing position and the arch-height ratio and heel-floor angle (HFA) in the standing and chair-sitting positions. The amount of change in foot morphology owing to differences in posture was calculated. The range of motion of the ankle joint dorsiflexion, plantarflexion, inversion, and eversion was measured. Participants were classified into two groups according to the presence of hallux valgus. Statistical analysis was used to compare hindfoot morphology and range of motion between the two groups, and the correlation between foot morphology and range of motion was investigated depending on the presence of hallux valgus. RESULTS: With hallux valgus, the HFA tilted inwards (p = 0.010), and the change in the arch-height ratio due to the difference in posture was large (p = 0.021). There was no difference in the range of motion of the ankle joints with or without hallux valgus. In women with hallux valgus, the amount of change in arch height and HFA was correlated with the range of motion of eversion (r = 0.391, p = 0.027; r = -0.362, p = 0.042). CONCLUSIONS: With hallux valgus, the hindfoot pronated, and the arch height decreased from sitting to standing. Furthermore, the amount of change in the hindfoot and midfoot due to posture was related to the range of motion of eversion.

Differences in toe flexor strength and foot morphology between wheelchair dependent and ambulant older people in long-term care: a cross-sectional study.

BACKGROUND: Hallux valgus, lesser toe deformity, and muscle weakness of the toe flexors contribute to falls in older people. This study aimed to examine the differences in toe flexor strength and foot morphology in older people requiring long-term care due to changes in the way they mobilize in everyday life. METHODS: This study included 84 people aged ≥70 years without motor paralysis who underwent rehabilitation. They were divided into those who could mobilize without a wheelchair (walking group, n = 54) and those who used a wheelchair to mobilize (wheelchair group, n = 30). The presence or absence of diseases was confirmed, and hand grip strength, toe flexor strength, and foot morphology using the foot printer were measured. The presence of diseases, hand grip strength, toe flexor strength, and foot morphology were compared between the two groups. Multiple logistic analysis was performed with wheelchair dependence as the dichotomous outcome variable, and the percentages of each strength measure observed in the wheelchair group to the average hand grip and toe flexor strength measures in the walking group were compared. RESULTS: No significant between-group difference in foot morphology was found. The factors related to the differences in ways of ambulating in daily life were history of fracture, heart disease, and toe flexor strength. After comparing the muscle strength of the wheelchair group with the mean values of the walking group, we found that the toe flexor strength was significantly lower than the hand grip strength. CONCLUSIONS: Older people who used a wheelchair to mobilize have significantly less toe flexor strength than those who do not despite no significant difference in foot morphology. Use of a wheelchair is associated with a reduction in toe flexor strength.

Analgesia by Sacral Surface Electrical Stimulation for Primary Dysmenorrhoea.

OBJECTIVE: To evaluate the effects of analgesia by sacral surface electrical stimulation on lower abdominal pain in women with primary dysmenorrhoea. DESIGN: Explorative study. PARTICIPANTS: Eleven female university students, who regularly experience difficulty in their university work due to menstrual pain, or who use analgesics for more than one day each month, were recruited. METHODS: Sacral surface electrical stimulation, 5 Hz for 15 min, was performed after the onset of menstruation. Electrodes were placed on the skin, directly above the second and fourth sacral foramina. Visual analogue scale and degree of pain (calculated by using a low current to assess pain) were determined before and after electrical stimulation. RESULTS: Visual analogue scale score and degree of pain decreased significantly immediately after electrical stimulation (p < 0.001). A correlation was observed between visual analogue scale score and degree of pain before and after electrical stimulation (r=0.516, p <0.001). No side-effects were observed in any participant. CONCLUSION: Sacral surface electrical stimulation may provide immediate pain relief in women with dysmenorrhoea and lower abdominal pain.

Correlation between functional ability, toe flexor strength, and plantar pressure of hallux valgus in young female adults: a cross-sectional study.

BACKGROUND: The prevalence of hallux valgus (HV) increases with age in females. Several studies have investigated the relationship between foot problems, including HV, and falls in older individuals. This study aimed to examine whether HV causes a decline in functional activity in young females and also evaluate the relationship between HV angle, functional activity, toe flexor strength, and plantar pressure. METHODS: We assessed 94 females (mean age, 19.6 ± 1.3 years; mean body mass index, 21.2 ± 2.0 kg/m2) not currently receiving treatment for lower limb disease. HV angle was determined using their footprint. Functional reach (FR) and maximum step length (MSL), toe flexor strength, and plantar pressure were measured. Plantar pressure was measured during walking. We also calculated FR and the pressure in eight regions (first toe, second through fifth toes, first metatarsal, second through fourth metatarsals, fifth metatarsal, midfoot, medial heel, and lateral heel). RESULTS: There were 39 and 55 participants in the HV and no HV groups, respectively. FR and MSL did not differ significantly between the HV and no HV groups. Toe flexor strength was significantly different between the HV and no HV groups (26.69 ± 9.68 vs. 32.19 ± 8.55, respectively) (p = 0.002, ß = 0.206). During walking, plantar pressure was significantly lower in the second through fifth toes in the HV group (p = 0.005, ß = 0.187). During FR, plantar pressure was significantly greater in the first metatarsal in the HV group (p = 0.016, ß = 0.338). HV angle was negatively correlated with toe flexor strength (r = - 0.315, p = 0.002, ß = 0.121) and plantar pressure during walking in the second through fifth toes (r = - 0.362, p < 0.001, ß = 0.047), and positively correlated with plantar pressure during FR in the first metatarsal (r = 0.308, p = 0.002, ß = 0.137). Toe flexor strength was negatively correlated with plantar pressure during FR in the second through fourth metatarsals (r = - 0.318, p = 0.002, ß = 0.115), and there was a positive correlation with MSL (r = 0.330, p = 0.001, ß = 0.092). CONCLUSIONS: This study confirmed that HV reduces toe flexor strength and affects forefoot pressure during walking and FR in young females. Moreover, the toe flexor strength affects MSL. Efforts to prevent the onset and deterioration of HV from a young age might help reduce the risk of falling when older.

Correction to: Correlation between functional ability, toe flexor strength, and plantar pressure of hallux valgus in young female adults: a cross-sectional study.

An amendment to this paper has been published and can be accessed via the original article.

Foot Characteristics and Falls among Community-dwelling Independent Elderly Women Who Can Walk Outdoors.

OBJECTIVE: We examined the toe flexor strength, foot morphology, and falls in community-dwelling elderly women who could walk outdoors independently without aids. METHODS: The presence or absence of falls in 1 year, the toe flexor strength, and foot morphology were recorded in 70 women. Hallux valgus was defined as a first phalangeal angle ≥16°. Falls were compared based on the presence or absence of hallux valgus using the chi-squared test. The toe flexor strength, arch height ratio (medial longitudinal arch), and spread ratio (lateral arch) were compared using the Mann-Whitney U-test according to the presence or absence of hallux valgus. Spearman's correlation coefficient was used to compare toe flexor strength and foot morphology. RESULTS: No difference in the fall rate was noted between those with hallux valgus on at least one foot and those without hallux valgus. No difference in toe flexor strength was noted between feet with and without hallux valgus. Correlations were found between the hallux valgus angle and the arch height (r=-0.228, P<0.01) and spread ratios (r=0.494, P<0.001). CONCLUSIONS: Among community-dwelling elderly women who can walk independently outdoors without aids, the presence or absence of hallux valgus does not affect the incidence of falls. The lack of correlation between toe flexor strength and foot morphology may support this conclusion.

Effects and indications of sacral surface therapeutic electrical stimulation in refractory urinary incontinence.

OBJECTIVE: To describe the effects and indications of sacral surface therapeutic electrical stimulation (SS-TES) for refractory urinary incontinence. DESIGN: Evaluation before and after therapy. SETTING: On clinical site and at nursing home. SUBJECTS: Seven neurogenic bladder, five unstable bladder and six nocturia cases were investigated. Twelve were outpatients and six were residents. INTERVENTIONS: Surface electrodes were placed at the posterior sacral foramens of S2 and S4. Stimulation conditions were duration 0.3 ms, frequency 20 Hz and maximum intensity. The stimulation was continued for 15 min twice daily for over one month. MAIN OUTCOME MEASURES: Therapeutic effects were evaluated on the basis of voiding charts as subjective findings and urodynamic study as objective findings before and after therapy. RESULTS: Subjective findings showed incontinence frequency significantly decreased from 2.3 +/- 1.4 times/day before therapy to 1.3 +/- 2.0 times/day after therapy (p < 0.01); 55.5% of patients were improved or greatly improved. Objective findings showed that maximum vesical capacity (MVC) significantly increased from 208.2 +/- 94.5 ml before therapy to 282.1 +/- 66.8 ml (p < 0.001). Uninhibited contraction significantly decreased from 40.4 +/- 31.4 cmH2O before therapy to 25.7 +/- 23.9 cmH2O (p < 0.01); 44% of patients were improved or greatly improved. This therapy was effective in particular for cases whose MVC was small before applying SS-TES. CONCLUSION: SS-TES was effective in some patients with refractory urinary incontinence.