Effects of Caffeine Ingestion on Human Standing Balance: A Systematic Review of Placebo-Controlled Trials.

Caffeine ingestion may influence balance control via numerous mechanisms. Although previously investigated using various study designs and methods, here we aimed to create the first evidence-based consensus regarding the effects of caffeine on the control of upright stance via systematic review (PROSPERO registration CRD42021226939). Embase, PubMed/MEDLINE, SPORTDiscus and Web of Science databases were searched on 27 January 2021 to identify placebo-controlled trials investigating caffeine-induced changes in human standing balance. Reference lists of eligible studies were also searched. Overall, nine studies involving a total of 290 participants were included. All studies were moderate to strong in quality according to the QualSyst tool. Balance-related outcome measures were collected across a range of different participant ages, stances and sensory conditions. The results show that younger participants' balance was generally unaffected by caffeine ingestion. However, a significant balance impairment was observed following caffeine ingestion in all studies involving older participants (average age >65 years). Our results therefore suggest an age-dependent effect of caffeine ingestion on human standing. Further research into this effect is warranted as only one study has directly compared younger and older adults. Nonetheless, an important implication of our findings is that caffeine ingestion may increase fall risk in older adults. Furthermore, based on our findings, caffeine ingestion should be considered as a potential confounding factor when assessing human standing balance, particularly in older adults.

Ingestion of Sodium Bicarbonate (NaHCO3) Following a Fatiguing Bout of Exercise Accelerates Postexercise Acid-Base Balance Recovery and Improves Subsequent High-Intensity Cycling Time to Exhaustion.

This study evaluated the ingestion of sodium bicarbonate (NaHCO3) on postexercise acid-base balance recovery kinetics and subsequent high-intensity cycling time to exhaustion. In a counterbalanced, crossover design, nine healthy and active males (age: 23 ± 2 years, height: 179 ± 5 cm, body mass: 74 ± 9 kg, peak mean minute power (Wpeak) 256 ± 45 W, peak oxygen uptake (V̇O2peak) 46 ± 8 ml.kg-1.min-1) performed a graded incremental exercise test, two familiarization and two experimental trials. Experimental trials consisted of cycling to volitional exhaustion (TLIM1) at 100% WPEAK on two occasions (TLIM1 and TLIM2) interspersed by a 90 min passive recovery period. Using a double-blind approach, 30 min into a 90 min recovery period participants ingested either 0.3 g.kg-1 body mass sodium bicarbonate (NaHCO3) or a placebo (PLA) containing 0.1 g.kg-1 body mass sodium chloride (NaCl) mixed with 4 ml.kg-1 tap water and 1 ml.kg-1 orange squash. The mean differences between TLIM2 and TLIM1 was larger for PLA compared with NaHCO3 (-53 ± 53 vs. -20 ± 48 s; p = .008, d = 0.7, CI =-0.3, 1.6), indicating superior subsequent exercise time to exhaustion following NaHCO3. Blood lactate [Bla-] was similar between treatments post TLIM1, but greater for NaHCO3 post TLIM2 and 5 min post TLIM2. Ingestion of NaHCO3 induced marked increases (p < .01) in both blood pH (+0.07 ± 0.02, d = 2.6, CI = 1.2, 3.7) and bicarbonate ion concentration [HCO3-] (+6.8 ± 1.6 mmo.l-1, d = 3.4, CI = 1.8, 4.7) compared with the PLA treatment, before TLIM2. It is likely both the acceleration of recovery, and the marked increases of acid-base after TLIM1 contributed to greater TLIM2 performance compared with the PLA condition.

Mechanisms of interpersonal sway synchrony and stability.

Here we explain the neural and mechanical mechanisms responsible for synchronizing sway and improving postural control during physical contact with another standing person. Postural control processes were modelled using an inverted pendulum under continuous feedback control. Interpersonal interactions were simulated either by coupling the sensory feedback loops or by physically coupling the pendulums with a damped spring. These simulations precisely recreated the timing and magnitude of sway interactions observed empirically. Effects of firmly grasping another person's shoulder were explained entirely by the mechanical linkage. This contrasted with light touch and/or visual contact, which were explained by a sensory weighting phenomenon; each person's estimate of upright was based on a weighted combination of veridical sensory feedback combined with a small contribution from their partner. Under these circumstances, the model predicted reductions in sway even without the need to distinguish between self and partner motion. Our findings explain the seemingly paradoxical observation that touching a swaying person can improve postural control.

Postural threat differentially affects the feedforward and feedback components of the vestibular-evoked balance response.

Circumstances may render the consequence of falling quite severe, thus maximising the motivation to control postural sway. This commonly occurs when exposed to height and may result from the interaction of many factors, including fear, arousal, sensory information and perception. Here, we examined human vestibular-evoked balance responses during exposure to a highly threatening postural context. Nine subjects stood with eyes closed on a narrow walkway elevated 3.85 m above ground level. This evoked an altered psycho-physiological state, demonstrated by a twofold increase in skin conductance. Balance responses were then evoked by galvanic vestibular stimulation. The sway response, which comprised a whole-body lean in the direction of the edge of the walkway, was significantly and substantially attenuated after ~800 ms. This demonstrates that a strong reason to modify the balance control strategy was created and subjects were highly motivated to minimise sway. Despite this, the initial response remained unchanged. This suggests little effect on the feedforward settings of the nervous system responsible for coupling pure vestibular input to functional motor output. The much stronger, later effect can be attributed to an integration of balance-relevant sensory feedback once the body was in motion. These results demonstrate that the feedforward and feedback components of a vestibular-evoked balance response are differently affected by postural threat. Although a fear of falling has previously been linked with instability and even falling itself, our findings suggest that this relationship is not attributable to changes in the feedforward vestibular control of balance.

Dynamic transformation of vestibular signals for orientation.

The same pattern of vestibular afferent feedback may signify a loss of balance or a change in body orientation, depending upon the initial head posture. To resolve this ambiguity and generate an appropriate motor response, the CNS must transform vestibular information from a head-centred reference frame into relevant motor coordinates. But what if the reference frame is continuously moving? Here, we ask if this neural transformation process is continuously updated during a voluntary change in head posture. Galvanic vestibular stimulation (GVS) was used to induce a sensation of head roll motion in blindfolded subjects marching on the spot. When head orientation was fixed, this caused unconscious turning behaviour that was maximal during neck flexion, minimal with the head level and reversed direction with neck extension. Subjects were then asked to produce a continuous voluntary change in head pitch, while GVS was applied. As the neck moved from full flexion into extension, turn velocity was continuously modulated and even reversed direction, reflecting the pattern observed during the head-fixed condition. Hence, an identical vestibular input resulted in motor output which was dynamically modulated by changes in head pitch. However, response magnitude was significantly reduced, suggesting possible suppression of vestibular input during voluntary head movement. Nevertheless, these results show that the CNS continuously reinterprets vestibular exafference to account for ongoing voluntary changes in head posture. This may explain why the head can be moved freely without losing the sense of balance and orientation.

Postural reorientation does not cause the locomotor after-effect following rotary locomotion.

After a period of stepping on a rotating platform, blindfolded subjects demonstrate a tendency to unconsciously turn when stepping in place, an after-effect known as podokinetic after-rotation (PKAR). Recent studies have also reported a change in postural orientation following the adaptive period and have suggested that this is causally related to PKAR. Here, we assess changes in trunk orientation following platform adaptation and determine their relationship to PKAR. Specifically, we determine whether a reorganized standing posture causes PKAR. Ten subjects stepped on a platform rotating at 60°/s for 10 min, with a cadence of 100 steps/min. Following adaptation, a significant PKAR response was seen, with a mean yaw rotation velocity of 6.0 ± 2.2°/s. In addition to this dynamic after-effect, there was a significant twist of the trunk with respect to the feet when standing still (6.9° ± 4.5°; mean ± SD), confirming the presence of a postural reorientation after-effect. However, the magnitudes of the two after-effects did not correlate (r = 0.06, p = 0.87). Furthermore, in a second experiment, a prolonged passive twist of the trunk was used to induce postural reorientation. However, in this case, PKAR was not induced. These results demonstrate that PKAR is not an automatic consequence of reorganized standing posture.