Do older adults present altered pelvic and trunk movement pattern during gait? A systematic review with meta-analysis and GRADE recommendations.

BACKGROUND: Cognitive, sensory, and biomechanical factors may affect gait of older adults. Among biomechanical factors, reduced pelvis and trunk range of motion (ROM) were associated with slower gait speed, shorter step length, and increased susceptibility to fall in older adults. OBJECTIVE: To systematically review the studies that compared trunk and pelvic movement during gait among adults and older adults. METHODS: Electronic search was conducted on MEDLINE, EMBASE, and Cinahl from inception until May 2020. Studies that compared trunk and/or pelvis kinematics during gait between adults and older adults were included. The following data were extracted from studies: gait speed, walking surface, and pelvis trunk ROM during gait in the three planes of motion. Meta-analyses were calculated for slow, comfortable, and fast gait speeds using random effects models. GRADE determined the strength of evidence. RESULTS: Twelve studies were included in this review. There was moderate-quality evidence that older adults have reduced pelvic rotation ROM at comfortable speed (SMD = -0.90 [-1.35, -0.45]) and high-quality evidence that older adults also have reduced pelvic rotation ROM at fast walking speed (SMD = -1.55 [-3.43, -0.33]). In addition, there was low-quality evidence that older adults have reduced trunk rotation at fast walking speed (SMD = -0.63 [-1.23, -0.03]). There were no differences for pelvic and trunk movement in the sagittal and frontal planes. CONCLUSION: There is low to high quality of evidence that older adults walk with less pelvic rotation ROM in comfortable and fast walking speeds, and less trunk rotation ROM during fast walking speed.

Pressões respiratórias m¨¢ximas e capacidade funcional em idosas assintom¨¢ticas / Respiratory pressures and functional capacity in asymptomatic elderly

Introdução: Durante o processo de envelhecimento, os músculos respiratórios apresentam redução de força, o que pode afetar a performance ventilatória durante o exercício e comprometer a capacidade funcional dos idosos. Objetivo: Avaliar a relação entre a força dos músculos respiratórios (evidenciada pelas pressões respiratórias máximas) e a capacidade funcional de idosas assintomáticas. Métodos: Trinta e nove idosas sedentárias e não-tabagistas (70,4 mais ou menos 3,1 anos) participaram do estudo. Estas voluntárias tiveram pressão inspiratória máxima (PImáx), pressão expiratória máxima (PEmáx) e teste de caminhada de seis minutos (TC6min) registrados para avaliar a força muscular respiratória e capacidade funcional. Os dados foram analisados pelo coeficiente de Correlação de Pearson (r). O nível de significância (μ) preestabelecido foi de 5%. Resultados: A análise descritiva dos dados (média mais ou menos desvio-padrão) mostrou valores de PImáx = 55,6 mais ou menos 21,0 cmH2O e PEmáx = 71,3 mais ou menos 22,0 cmH2O. A distância média percorrida no teste de caminhada foi de 443,5 mais ou menos 49,6 m. Os valores dos coeficientes de Correlação de Pearson entre a distância percorrida e a PImáx e PEmáx foram, respectivamente: r = 0,44 (p = 0,005) e r = 0,27 (p= 0,11). Conclusões: a capacidade funcional das idosas apresentou correlação positiva apenas com a força dos músculos inspiratórios, sugerindo relação entre estas variáveis. Desta forma, a inclusão do treinamento da musculatura inspiratória nos programas de treinamento físico de idosos poderá contribuir para a melhoria da capacidade funcional.

Introduction: Throughout the aging process, the respiratory muscles show reduction on its strength which may affect the ventilator performance during exercise and undertake the functional capacity of the elderly. Objective: to evaluate the relation between the strength of the respiratory muscles (given by the maximal respiratory pressures) and the functional capacity of healthy elderly. Methods: Thirty nine sedentary and non-smoking ladies (70,4 more or less 3,1 years) took part on the study. These volunteers had maximal inspiratory pressure (PImáx), maximal expiratory pressure (PEmáx) and a six-minute walk test (6MWT) recorded to evaluate their respiratory muscular function and functional capacity. The data were analyzed using the Coefficient from the Pearson Correlation (r). The pre established significance (μ) level was of 5%. Results: The descriptive data analysis (mean more or less the standard deviation) have shown values of PImáx = 55, 6 more or less 21, 0 cmH2O e PEmáx = 71, 3 more or less 22,0 cmH2O. The covered distance on the walking test was of 443, 5 more or less 49, 6 m. The values of the coefficients from the Pearson Correlation (r) between the covered distance and the PImáx e PEmáx were respectively: r = 0, 44 (p = 0,005) and r = 0, 27 (p = 0, 11). Conclusions: the functional capacity of the elderly showed positive correlation with the strength of the inspiratory muscles only suggesting relationship between these variables. So, the use of inspiratory muscle training in exercise training programs could contribute to improve the elderly functional capacity.