Non-invasive neuromodulation in reducing the risk of falls and fear of falling in community-dwelling older adults: systematic review.

Introduction: Neuromodulation is a non-invasive technique that allows for the modulation of cortical excitability and can produce changes in neuronal plasticity. Its application has recently been associated with the improvement of the motor pattern in older adults individuals with sequelae from neurological conditions. Objective: To highlight the effects of non-invasive neuromodulation on the risk of falls and fear of falling in community-dwelling older adults. Methods: Systematic review conducted in accordance with the items of the Cochrane Handbook for Systematic Reviews of Interventions. Searches were carried out in electronic databases: CENTRAL, Clinical Trials, LILACS, PEDro, PubMed, Web of Science, between 13/06/2020 and 20/09/2023, including all indexed texts without language and publication date restrictions, randomized controlled clinical trials, which presented as their main outcome non-invasive neuromodulation for reducing the fear of falling and risk of falls in the older adults, regardless of gender. Results: An extensive search identified 9 eligible studies for qualitative synthesis from 8,168 potential articles. Rigorous filtering through automated tools, title/abstract screening, and full-text evaluation ensured a focused and relevant selection for further analysis. Most studies (80%) used transcranial direct current electrical stimulation as an intervention, over the motor cortex or cerebellum area, with anodal current and monopolar electrode placement. The intensity ranged from 1.2 mA to 2 mA, with a duration of 20 min (80%). The profile of the research participants was predominantly individuals over 65 years old (80%), with a high risk of falls (60%) and a minority reporting a fear of falling (40%). The outcomes were favorable for the use of neuromodulation for the risk of falls in the older adults, through improvements in static and dynamic balance. Conclusion: The results may have limited applicability to direct outcomes related to the risk of falls, in addition to evidence regarding the difference or lack thereof in applicability between genders, fallers and non-fallers, as well as older adults individuals with low and high fear of falling. Systematic review registration: The protocol for this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) to obtain the identification of ongoing research (ID: 222429).

Associação entre antropometria, atividade física e funcionalidade de adultas e idosas / Relationship between anthropometry, physical activity, and functionality of female adults and elderly women

Analisar a associação entre o desempenho físico, a idade, as variáveis antropométricas e a condição de atividade física em mulheres adultas e idosas fisicamente ativas. Estudo transversal, analítico com 152 mulheres, entre 49 e 84 anos, participantes do programa Universidade Aberta à Terceira Idade avaliadas por meio da idade, variáveis antropométricas, Mini Exame do Estado Mental, Força de Preensão Manual, Teste de Sentar e Levantar do Solo e Cadeira e Questionário Internacional de Atividade Física. As mulheres apresentaram idade média de 67,4 anos, foram classificadas em 44,4% eutróficas, 41,7% sobrepeso e 13,9% abaixo do peso, 65,1% ativas e 34,9% insuficientemente ativas. Houve correlação negativa fraca nos valores do Teste Sentar e Levantar do solo quando comparado a idade e ao Índice de Massa Corporal (p < 0001). Observou-se correlação fraca entre o Teste Sentar e Levantar do solo e a Força de Preensão Manual. A Força de Preensão Manual apresentou correlação com a altura (p < 0,001). Os testes de força indireta nas mulheres adultas e idosas fisicamente ativas foram fracamente associados, além disso, observou-se correlação fraca entre a força muscular global e capacidade físico-funcional, avaliados pelos testes supracitados, com a idade e o IMC, em que maior idade e maior IMC foram correlacionado a menor força e desempenho físico.

The aim of this study is to analyze the relationship between physical performance, age, anthropometric variables, and the condition of physical activity in female adults and physically active elderly women. This was a cross-sectional, analytical study with 152 women, between 49 and 84 years old, participants of the Open University for the Elderly program, evaluated through age, anthropometric variables, Mini Mental State Examination, Handgrip Strength, Sit-to-Stand Test from the Ground and Chair, and International Physical Activity Questionnaire. Participants' mean age was 67.4 years, were classified as 44.4% eutrophic, 41.7% overweight and 13.9% underweight, 65.1% active and 34.9% insufficiently active. There was a weak negative correlation between the values from the Sit-to-Stand Test from the Ground when compared to age and Body Mass Index (p < 0.001). A weak correlation was observed between the Sit-to-Stand Test from the Ground and the Handgrip Strength. Handgrip strength was correlated with height (p < 0.001). Indirect strength tests in female adults and physically active elderly women were weakly related. Moreover, there was a weak correlation between global muscle strength and physical-functional capability, evaluated by the aforementioned tests, with age and BMI, in which greater age and higher BMI were correlated with lower strength and physical performance.

Effect of visual condition and physical activity on the plantar pressure distribution in adult and older women / Efeito do sistema visual e atividade física na distribuição da pressão plantar em mulheres adultas e idosas

Abstract The aging process causes changes in the physical and functional conditions, as well as in the foot structure and function. This study aimed to analyze the plantar pressure variation with respect to visual information and physical activity in adult and older women. This was a cross-sectional study that included 142 women (mean age of 67.8 years). Participants responded the anamnesis questionnaire, Mini Mental State Examination, and International Physical Activity Questionnaire. Plantar pressure was assessed using computerized baropodometry. Weight distribution was observed in semitandem positions for the right foot forward and then the left foot forward . Data analysis showed that foot type had no correlation with age (p = 0.37 right foot; p = 0.93 left foot) or level of physical activity (p = 0.28 right foot; p = 0.96 left foot). Moreover, plantar pressure variation showed no significant relationship with age (R2 = 0.2; p = 0.6). In conclusion, plantar pressure variation is not associated with the morphological foot type in women analyzed, as the visual condition did not generate plantar pressure variations when compared to its effect on the classification of plantar arches. Furthermore, level of physical activity was not associated with plantar pressure variation .

Resumo O processo de envelhecimento acarreta alterações nas condições físico-funcionais e na estrutura e função do pé. O objetivo do estudo foi analisar a variação da pressão plantar quanto a informação visual e atividade física em mulheres adultas e idosas. Estudo transversal, com uma amostra de 142 mulheres (média de idade de 67,8 anos). As mulheres responderam ao questionário de anamnese, Mini Exame do Estado Mental (MEEM) e o Questionário Internacional de Atividade Física (IPAQ). O exame da pressão plantar foi realizado pela baropodometria computadorizada. A distribuição da pressão plantar foi observada na posição semitandem com o pé direito na frente e com o pé esquerdo à frente. O tipo de pé não teve relação com a variação da pressão plantar, idade (p = 0,37 pé direito e p = 0,93 pé esquerdo) ou atividade física (p = 0,28 pé direito e p = 0,96 pé esquerdo). A variação da pressão plantar também não mostrou relação significativa com idade (R2 = 0,2 e p = 0,6). Conclui-se que a variação da pressão plantar não está associada com o tipo morfológico do pé das mulheres analisadas, pois a condição visual não gerou variação da pressão plantar quando comparada ao seu efeito na classificação dos arcos plantares. O nível de atividade física não apresentou relação na variação da pressão plantar.

Comparação entre instrumentos de avaliação do equilíbrio em mulheres adultas e idosas da comunidade / Comparison between balance assessment instruments for adult and elderly women in the community

Objetivo: Comparar dois instrumentos de avaliação do equilíbrio, BESTest e Baropodometria, em mulheres da comunidade e verificar a influência da idade, comorbidades e visão no equilíbrio. Método: Estudo tranversal, analítico, realizado com mulheres adultas (50 a 64 anos) e idosas (a partir dos 65 anos). O equilíbrio foi avaliado por uma plataforma baropodométrica e com o Balance Evaluation Systems Test (BESTest). Aplicou-se teste T, Anova, Bonferroni e Regressão Linear utilizando o Software SPSS 23.0, adotando-se p<0,05. Resultados: Participaram 156 mulheres sendo 54 adultas (59 anos ± 3,93) e 102 idosas (71 anos ± 4,8). O BESTest verificou que as mulheres adultas apresentaram melhor desempenho (p<0,01) em relação à idosas nas categorias restrições biomecânicas, transições e antecipações, orientação sensorial, estabilidade de marcha e escore total. Houve relação entre o BESTest e o autorrelato de doenças no grupo de idosas nas categorias restrições biomecânicas, transições/antecipações e escore total (p<0,01). A baropodometria identificou alteração do deslocamento latero-lateral com olhos fechados entre os grupos (p=0,01), sendo que, as idosas apresentaram pior desempenho. Todavia, as ferramentas supracitadas apresentaram pouca relação entre si, tendo sua associação variando entre 5 e 11%. Conclusão: O BESTest e a baropometria foram capazes de detectar diferenças entre o equilíbrio de mulheres adultas e idosas, porém apresentam baixa associação entre si. Sugere-se que sejam adotadas como avaliações complementares e não substituíveis na prática clínica do fisioterapeuta.

Objective: To compare two balance assessment instruments, BESTest and Baropodometry, in community women and to verify the influence of age, comorbidities and vision on balance. Method: Cross-sectional, analytical study conducted with adult women (50 to 64 years old) and elderly women (65 years old and older). Balance was assessed by a baropodometric platform and the Balance Evaluation Systems Test (BESTest). T test, Anova, Bonferroni and Linear Regression were applied using the SPSS 23.0 software, adopting p <0.05. Results: 156 women participated in the study, 54 adults (59 years ± 3.93) and 102 elderly women (71 years ± 4.8). BESTest found that adult women performed better (p <0.01) than older women in the categories biomechanical restrictions, transitions and anticipations, sensory orientation, gait stability and total score. There was a relationship between BESTest and disease self-report in the elderly group in the biomechanical restrictions, transitions / anticipations and total score categories (p <0.01). Baropodometry identified altered lateral-lateral displacement with eyes closed between the groups (p = 0.01), and the elderly presented worse performance. However, the aforementioned tools had little relation to each other, and their association ranged from 5 to 11%. Conclusion: BESTest and baropometry were effective in detecting differences between the balance of adult and elderly women but had a low association with each other. It is suggested that they be adopted as complementary and not substitutable evaluations in the physiotherapist's clinical practice.

Fear of Falling Contributing to Cautious Gait Pattern in Women Exposed to a Fictional Disturbing Factor: A Non-randomized Clinical Trial.

Objective: This study aimed to investigate the gait pattern of elderly women with and without fall-history, with high and low fear of falling, when exposed to a disturbing factor. Materials and Methods: Forty-nine elderly women without cognitive impairment agreed to participate. Participants were divided into four groups, considering the history of falls and fear of falling. Three-dimensional gait analysis was performed to assess gait kinematics before and after exposure to the fictional disturbing factor (psychological and non-motor agent). Results: After being exposed to the perturbation, all showed shorter step length, stride length and slower walking speed. Those without fall-history and with high fear of falling showed greater changes and lower Gait Profile Score. Conclusion: The gait changes shown in the presence of a fear-of-falling causing agent led to a cautious gait pattern in an attempt to increase protection. However, those changes increased fall-risk, boosted by fear of falling. Clinical Trial Registration: www.residentialclinics.gov.br, identifier: RBR-35xhj5.

Foot-ground clearance characteristics in women: A comparison across different ages.

BACKGROUND: Tripping is a common event leading to falls amongst elderly. Minimum foot clearance (MFC) is a critical swing phase control factor associated with tripping and falls. RESEARCH QUESTION: Are there differences in MFC characteristics among three age groups of women and are there association between MFC and lower limb kinematics? METHODS: Cross-sectional observational study. Three-dimensional gait analysis of 55 healthy women. ANOVA was used to compare (p<0.05) MFC characteristics among young, middle-aged and elderly groups. Multiple Linear Regression Analysis was used to test prediction over MFC. RESULTS: Elderly women walked slower, with lower MFC and lower maximum foot velocity during swing (MFV) than young and middle-aged women. There were more hip flexion and less ankle dorsiflexion during MFC among elderly. There is a strong positive relationship between dorsiflexion and MFC. And ankle dorsiflexion was the most predictive variable over MFC. SIGNIFICANCE: Elderly women walk slower with lower MFC value and less ankle dorsiflexion than gender-matched young controls. Increased hip flexion may represent a gait adaptation to avoid tripping. Gait speed had no effect on those findings.

Relação da força muscular com equilíbrio estático em idosos - comparação entre pilates e multimodalidades

Resumo Objetivo: Comparar o efeito do pilates e de multimodalidades sobre a força muscular e o equilíbrio em idosas. Metodologia: Estudo transversal do tipo caso-controle, feito em Goiânia-GO, com 62 idosas, divididas em dois grupos: multimodalidades e pilates. Avaliaram-se a força de preensão manual (FPM) e o equilíbrio por meio da estabilometria. Resultados: O pilates contribuiu para maior FPM, bem como demonstrou menor superfície da elipse, o que implica melhor equilíbrio. Porém, não houve relação nem predição da FPM sobre o equilíbrio em ambos os grupos. Conclusão: O pilates promoveu maior ganho de força muscular e equilíbrio estático, entretanto, apesar de a força muscular ser a variável com melhor resultado, essa não mostrou relação com o equilíbrio.

Abstract Objective: To compare the effect of pilates and multimodalities on muscle strength and balance in the elderly. Methodology: Cross-sectional case-control study, conducted in Goiânia-GO, with 62 elderly women, divided into two groups: Multimodalities and pilates. The manual gripping force (FPM) and the balance were evaluated by Stabilometry. Results: The pilates contributed to higher FPM as well, demonstrated lower ellipse surface, which implies in better balance. However, there was no relationship or prediction of MPF on balance in both groups. Conclusion: pilates promoted greater gains in muscle strength and static balance. However, although muscle strength was the variable with the best result, it did not show a relationship with balance.

Resumen Objetivo: Comparar el efecto de pilates y multimodalidades sobre la fuerza muscular y el equilibrio en mujeres de edad avanzada. Métodos: Estudio transversal del tipo estudio de casos y controles en Goiânia-GO, con 62 mujeres de edad avanzada, divididas en dos grupos: multimodalidades y pilates. Se evaluó la fuerza de prensión manual y el equilibrio por medio de la estabilometría. Resultados: El pilates contribuyó a mayor fuerza de prensión manual y, como se ha demostrado, superficie inferior de la elipse, lo que implica un mejor equilibrio. Sin embargo, no se demostró ninguna relación o predicción de fuerza de prensión manual en el equilibrio en ambos grupos. Conclusión: El pilates promueve mayores ganancias en la fuerza muscular y el equilibrio estático. Sin embargo, a pesar de que la fuerza muscular es variable con mejores resultados, esto no se relaciona con el equilibrio.