Reliability and minimal detectable change of the Short Physical Performance Battery in older adults with mild cognitive impairment.

OBJECTIVES: Reliability of the Short Physical Performance Battery (SPPB) are rarely examined among older adults with mild cognitive impairment (MCI). This study aimed to investigate the test-retest reliability and minimal detectable change (MDC) of the SPPB in older adults with MCI. METHODS: Participants included 100 older adults with MCI. The SPPB was assessed with the first 2 assessments separated by a 20-min interval and the third separated by a 1-week interval. The intraclass correlation coefficient (ICC) and MDC values were estimated. RESULTS: The intraday ICC was 0.73 for the SPPB score, 0.90 for the 4-m walk time (4mwt), and 0.95 for the 5-times chair stand time (5cst); the corresponding interday ICC values were 0.76, 0.89, and 0.91, respectively. The MDC values ranged from 1.1 to 1.2 for the SPPB score, from 0.77 to 0.80 s for the 4mwt, and from 1.32 to 1.77 for the 5cst. CONCLUSIONS: The SPPB had satisfactory reliability among older adults with MCI. The test-retest reliability of the SPPB is sufficient (>0.7) for group comparisons. Moreover, the test-retest reliability for the 4mwt and 5cst subscale performances is acceptable (> 0.9) for individual-level measurements over time.

Taiwanese reference values for the Short Physical Performance Battery in community-dwelling older adults.

OBJECTIVES: To establish reference values for SPPB score as well as test performances among Taiwanese community-dwelling older adults. METHODS: Participants included 847 older adults. The total scores and three subtest scores for the SPPB and the registered time to complete the walk and five-repetition sit-to-stand (STS) tests were determined and compared between sex and age (65-74, 75-84, and ≥85 years) groups. RESULTS: The mean SPPB total score was 10.9 in women and 10.5 in men. SPPB scores did not differ by sex, regardless of age group. However, the walk test (p = .030) and STS test (p = .008) timings were longer for men than for women in the 65-74-year-old group. The ≥85-year-old men achieved a lower balance score than did the 65-74-year-old men (p = .027). CONCLUSIONS: Population-specific SPPB reference values contribute to assessments of physical function and facilitate cross-cultural comparisons of physical performance.

Effectiveness of a home-based, family caregiver-administered manual massage intervention in managing dementia symptoms and reducing caregiver stress: A randomized, controlled clinical trial.

OBJECTIVES: To investigate the effectiveness of family caregiver-administered home-based manual massages in managing dementia symptoms and reducing caregiver stress. METHODS: Thirty-eight pairs of participants-patients with dementia and their family caregivers-were randomly allocated to the experimental or the control group. The caregivers underwent 3-h-long massage training. Subsequently, the patients received a 30-min-long, home-based massage from their caregivers thrice a week for 8 consecutive weeks. The Cornell Scale for Depression in Dementia (CSDD), Cohen-Mansfield Agitation Inventory (CMAI), and Perceived Stress Scale (PSS) were assessed before and after the interventions. RESULTS: After intervention, the experimental group exhibited significant improvements in CSDD and CMAI scores compared with the scores of the control group (all p < .001). Furthermore, the experimental group obtained more favorable PSS scores than did the control group (p = .013). CONCLUSIONS: Family caregiver-administered home-based massage therapy is recommended for managing dementia symptoms and reducing caregiver stress.

Classification of Plank Techniques Using Wearable Sensors.

The plank is a common core-stability exercise. Developing a wearable inertial sensor system for distinguishing between acceptable and aberrant plank techniques and detecting specific deviations from acceptable plank techniques can enhance performance and prevent injury. The purpose of this study was to develop an inertial measurement unit (IMU)-based plank technique quantification system. Nineteen healthy volunteers (age: 20.5 ± 0.8 years, BMI: 22.9 ± 1.4 kg/m2) performed the standard plank technique and six deviations with five IMUs positioned on the occiput, cervical spine, thoracic spine, sacrum, and right radius to record movements. The random forest method was employed to perform the classification. The proposed binary tree classification model achieved an accuracy of more than 86%. The average sensitivities were higher than 90%, and the specificities were higher than 91%, except for one deviation (83%). These results suggest that the five IMU-based systems can classify the plank technique as acceptable or aberrant with good accuracy, high sensitivity, and acceptable specificity, which has significant implications in monitoring plank biomechanics and enabling coaching practice.

Effects of manual massage given by family caregivers for patients with dementia: A preliminary investigation.

OBJECTIVES: To explore the effects of a 10-week manual massage intervention given by caregivers of patients with dementia on the behavioral and psychological symptoms of dementia (BPSD) and caregiver burden. METHODS: Twelve pairs of participants-patients with dementia and their family caregivers-were recruited. Before the intervention, caregivers received a four-hour full body manual massage training course. Thereafter, the caregivers gave a 30-min massage to the patients once a week for a 10-week period. The Cornell Scale for Depression in Dementia, Cohen-Mansfield Agitation Inventory, and Zarit Burden Scale were administered pre- and post-intervention. RESULTS: Total scores on all questionnaires significantly decreased after the intervention (p < .05). Moreover, two subscale scores of the Cornell Scale for Depression in Dementia-behavioral disturbance and physical signs-reduced significantly (p < .05). CONCLUSIONS: This study provides preliminary evidence on the benefits of manual massage given by caregivers for the management of BPSD and caregiver burden.

Assessment of Low Back Pain: Reliability and Minimal Detectable Change of the Brief Pain Inventory.

IMPORTANCE: The Brief Pain Inventory (BPI) is one of the most widely used measures to assess pain and related impacts among patients with low back pain (LBP). However, its test-retest reliability and minimal detectable change (MDC) have rarely been examined in patients with LBP, interfering with its utility. OBJECTIVE: To investigate the test-retest reliability and MDC of the BPI among patients with LBP. DESIGN: Repeated assessments design with a 1-wk interval. SETTING: Department of Physical Medicine and Rehabilitation in a hospital in Taiwan. PARTICIPANTS: Fifty-four patients with stable LBP conditions. OUTCOMES AND MEASURES: The BPI has two subscales-Intensity and Interference-that assess pain intensity and pain interference, respectively. Their test-retest reliability was examined using the intraclass correlation coefficient (ICC), and MDCs were calculated. RESULTS: The ICCs of the Intensity and Interference subscales were .62 and .76, respectively. The MDC values for the two subscales were 2.57 and 2.34, respectively. For the four Intensity items, the average-pain score had a higher ICC (.60) than scores on the other items (worst, least, and current pain, which had ICCs of about .40). CONCLUSIONS AND RELEVANCE: The results suggest that although the BPI is a commonly used measure of pain intensity and pain interference among patients with LBP, caution should be exercised in interpreting the Intensity subscale score and its item scores. What This Article Adds: The BPI is widely used to assess pain and related impacts on daily occupation and functioning among patients with LBP. This study provides information regarding its test-retest reliability. Moreover, the MDC values provide clinicians and researchers with the thresholds for determining real improvement (beyond random measurement error).

Impacts of tai chi exercise on functional fitness in community-dwelling older adults with mild degenerative knee osteoarthritis: a randomized controlled clinical trial.

BACKGROUND: Degenerative osteoarthritis (OA) often leads to pain and stiffness of the affected joints, which may affect the physical performance and decrease the quality of life of people with degenerative knee OA. Compared to traditional exercise, tai chi is a safe exercise with slow movements which can facilitate physical functioning and psychological well being, and might be suitable for improving the physical activities of older adults with knee OA. Therefore, this study investigated the impacts of tai chi exercise on the functional fitness of community-dwelling older adults with degenerative knee OA. METHODS: Sixty-eight community-dwelling older adults with knee OA were recruited from the local community to participate in this randomized controlled clinical trial. All subjects were randomly assigned to either an TCE group that practiced tai chi exercise (TCE) (n = 36) or a control group (CON) (n = 32) that received regular health education programs twice per week for 12 weeks. Outcome measurements were determined using functional fitness tests before and after the intervention, including a 30-s chair stand (number of repeats), 30-s arm-curl (number of repeats), 2-min step (number of steps), chair sit-and-reach (reaching distance, cm), back-scratch flexibility (distance between hands, cm), single-leg stand (time, s), functional reach (reaching distance, cm), 8-foot up-and-go (time, s), and 10-m walk tests (time, s). Pre-post comparisons of functional fitness were analyzed using the ANCOVA test with SPSS software version 18.0. RESULTS: Results revealed that participants' functional fitness in the TCE group had significantly higher adjusted mean post-tests scores than that in the CON group after the intervention, including the 8-foot up-and-go (s) (mean difference [MD]=-2.92 [-3.93, -1.91], p = 2.39*10- 7), 30-s arm curl (MD = 4.75 (2.76, 6.73), p = 1.11*10- 5), 2-min step (MD = 36.94 [23.53, 50.36], p = 7.08*10- 7), 30-s chair stand (MD = 4.66 [2.97, 6.36], p = 6.96*10- 7), functional-reach (MD = 5.86 [3.52, 8.20], p = 4.72*10- 6), single-leg stand with eyes closed (MD = 3.44 [1.92, 4.97], p = 2.74*10- 5), chair sit-and-reach (MD = 3.93 [1.72, 6.15], p = 0.001), and single-leg stand with eyes opened (MD = 17.07 [6.29, 27.85], p = 0.002), with large effect sizes (η²=0.14 ~ 0.34). CONCLUSIONS: Community-dwelling older adults with knee OA in the TCE group had better functional fitness performances after the 12-week tai chi intervention than those receiving only health education.

Acute Effects of Squats Using Elastic Bands on Postactivation Potentiation.

ABSTRACT: Peng, H-T, Zhan, D-W, Song, C-Y, Chen, Z-R, Gu, C-Y, Wang, I-L, and Wang, L-I. Acute effects of squats using elastic bands on postactivation potentiation. J Strength Cond Res 35(12): 3334-3340, 2021-The study aimed to investigate the acute effects of squats using elastic bands at different resistance and recovery time points on postactivation potentiation (PAP). Fifteen male collegiate physical education students volunteered to participate in the study. Subjects were assigned to 6 experimental visits, which consisted of repeated factors that were 2 resistance squats (3 repetition maximum [RM] and 5RM) with elastic bands as intervention and 3 performance tests (countermovement jumps [CMJs], 20-m sprints, and change of direction [COD]). The performance test was measured before the resistance squat (pre-test) and at 15 seconds, 4 minutes, and 8 minutes after the resistance squat (post-tests) on each visit. An AMTI force plate and a set of Optojump sensors were used to obtain ground reaction force data during the CMJs and during the 20-m sprints and COD test, respectively. Repeated-measures two-way analyses of variance were performed for the resistance squats and recovery time points for each dependent variable. The 20-m sprint and COD test times at the 4-minute recovery time point after 3RM and 5RM resistance squatting were shorter than the pre-test values (p < 0.05). The rates of force development at the 4- and 8-minute recovery time points after 5RM resistance squatting were higher than the corresponding pre-test values (p < 0.05). All test performance variables significantly decreased at the 15-second recovery time point (p < 0.05). The use of elastic bands in 3RM and 5RM resistance squatting as a warm-up activity may positively affect PAP to improve sprinting, COD ability, and jump explosiveness at the 4-minute recovery time point.

Effects of Relative Drop Heights of Drop Jump Biomechanics in Male Volleyball Players.

Previous cross-sectional studies have reported that higher drop heights do not always result in improved performance, and may increase injury risk during drop jumps (DJ). The purpose of this study was to analyze the kinematics and kinetics during the DJ in order to determine the relative drop height that maximize performance without exposing the lower extremity joints to unnecessary loads. Twenty male Division I college volleyball players volunteered. Data were collected using 11 infrared cameras and two force platforms. Participants performed three maximal effort countermovement jumps (CMJ). Subsequently, 50, 75, 100, 125, and 150% CMJ height (CMJH) was used to scale their relative drop height for three DJ trials per height. There was a significant increase in the landing phase impulse when the drop height exceeded 100%CMJH (p<0.05). At 125% and 150%CMJH, the negative work of knee and ankle significantly increased. The incoming velocity, kinetic energy, landing depth, maximum ground reaction force, landing impulse and power absorption of knee and ankle all increased with drop height (p<0.05). DJ height and reactive strength index following the drop landing were not statistically different between any of the drop heights (p>0.05). 50% to 100%CMJH may be the appropriate individual relative drop height for the DJ.

Differences Between Bimodal and Unimodal Force-time Curves During Countermovement Jump.

This study aimed to explore the biomechanical differences between single and double peak ground reaction force-time curves during the countermovement jump with respect to kinematics, kinetics, and coordination of the lower extremities. Twenty-five college students were stratified into a single peak curve group and a double peak curve group. Eight infrared cameras and two force platforms were synchronized to collect the data. Independent t-tests were performed with groups for each dependent kinematic, kinetic and time of the joint extensor concentric contraction variable. Repeated one-way analysis of variance measurements were performed for the time of the ankle, knee and hip extensor concentric contraction in each group. The double peak curve was associated with larger jump height, reactive strength index modified, rate of force development, impulse, hip, knee and ankle flexion, extension angular displacement, and hip and knee moments (p<0.05). The double peak curve group revealed a better hip, knee and ankle (proximal to distal) timing of extensor concentric contractions sequence of the lower extremities during the countermovement jump (p<0.05). The double peak curve group exhibited a more effective countermovement jump movement with respect to biomechanics compared to the single peak curve group.

Effects of Femoral Rotational Taping on Dynamic Postural Stability in Female Patients With Patellofemoral Pain.

OBJECTIVE: To investigate the effects of femoral rotational taping on task performance, dynamic postural control, and pain during the Star Excursion Balance Test (SEBT) in patients with patellofemoral pain (PFP) compared to healthy controls. DESIGN: Case-control study, pretest-posttest. SETTING: Laboratory. PARTICIPANTS: Twenty-four female participants (16 with PFP, 8 controls). INTERVENTIONS: Participants in both the PFP and control groups performed SEBT with no taping, sham taping, and femoral rotational taping. MAIN OUTCOME MEASURES: The maximum anterior excursion distance, 3-dimensional hip and knee kinematics of the stance leg, and pain score (VAS) during SEBT were recorded. The coefficients of variance (CV) of kinematic data gathered from electromagnetic sensors on pelvis and femur were calculated to represent segmental stability. RESULTS: When performing the SEBT in the anterior direction, application of femoral rotational taping increased maximum excursion distance (65.57% vs 66.15% leg length, P = 0.027), decreased hip adduction excursion (47.6 vs 32.1 degrees, P = 0.010), and pain (3.34 vs 2.38, P = 0.040) in the PFP group. Femoral rotational taping also improved the medial-lateral (7.1 vs 4.6, P = 0.015) and proximal-distal stability (7.5 vs 4.5, P = 0.020) of the pelvis, and medial-lateral stability (7.2 vs 6.1, P = 0.009) of the femur. CONCLUSIONS: The results support the use of femoral rotational taping for improving dynamic postural control and reducing pain during SEBT. CLINICAL RELEVANCE: Femoral rotational taping could be used in the management of young female patients with PFP.

Optimum Drop Jump Height in Division III Athletes: Under 75% of Vertical Jump Height.

Our purpose was to evaluate the vertical ground reaction force, impulse, moments and powers of hip, knee and ankle joints, contact time, and jump height when performing a drop jump from different drop heights based on the percentage of a performer's maximum vertical jump height (MVJH). Fifteen male Division III athletes participated voluntarily. Eleven synchronized cameras and two force platforms were used to collect data. One-way repeated-measures analysis of variance tests were used to examine the differences between drop heights. The maximum hip, knee and ankle power absorption during 125%MVJH and 150%MVJH were greater than those during 75%MVJH. The impulse during landing at 100%MVJH, 125%MVJH and 150%MVJH were greater than 75%MVJH. The vertical ground reaction force during 150%MVJH was greater than 50%MVJH, 75%MVJH and 100%MVJH. Drop height below 75%MVJH had the most merits for increasing joint power output while having a lower impact force, impulse and joint power absorption. Drop height of 150%MVJH may not be desirable as a high-intensity stimulus due to the much greater impact force, increasing the risk of injury, without increasing jump height performance.

Validation and Establishment of an Interval-Level Measure of the Balance Assessment in Sitting and Standing Positions in Patients With Stroke.

OBJECTIVE: To validate the psychometric properties of the Balance Assessment in Sitting and Standing Positions, including validity (unidimensionality and concurrent validity), reliability (Rasch reliability), and responsiveness (compared with the Postural Assessment Scale for Stroke Patients [PASS]) and to transform the Balance Assessment in Sitting and Standing Positions from an ordinal-level measure into an interval-level measure. DESIGN: Retrospective cross-sectional study. SETTING: Medical records from a medical center. PARTICIPANTS: Patients with stroke (N=1193). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The 4-item Balance Assessment in Sitting and Standing Positions was used, assessing static sitting balance, dynamic sitting balance, static standing balance, and dynamic standing balance. RESULTS: Data of 1193 patients with stroke were included for Rasch analysis. The 4 items of the Balance Assessment in Sitting and Standing Positions constituted a unidimensional construct (infit/outfit mean square, .75-1.05), had good concurrent validity (r=.70-.90), and had sufficient Rasch reliability (.93). The Balance Assessment in Sitting and Standing Positions had large responsiveness (effect size, 1.20; standardized response mean, 1.51) and was comparable with the PASS (effect size, .90; standardized response mean, 1.32). CONCLUSIONS: The Balance Assessment in Sitting and Standing Positions has sound psychometric properties. The transformed-Rasch scores of the Balance Assessment in Sitting and Standing Positions can be used to identify patients' balance function and detect patients' changes.

Effect of leg press training on patellar realignment in patients with patellofemoral pain.

[Purpose] The purpose of this study was to investigate the effect of leg press and leg press with hip adduction exercise training on patellar alignment and pain in patients with patellofemoral pain (PFP). [Subjects and Methods] Seventeen patients participated in this study. Eight weeks of leg press or leg press with hip adduction training, including progressive lower-limb weight-training and stretching, was given. Patellar alignment (tilt and displacement) and pain measurements were conducted before and after leg press or leg press with hip adduction training. Patellar tilt angle and the bisect offset index were measured on axial computed tomography scans of the fully extended knee position with the quadriceps relaxed and contracted. Pain was assessed by using a 10-cm visual analog scale. [Results] No differences were found in patellar tilt and displacement with the quadriceps either relaxed or contracted after leg press and leg press with hip adduction. However, significant pain reduction was evident in both leg press and leg press with hip adduction. [Conclusion] The results indicated that patellar realignment does not appear to mediate pain alleviation. Furthermore, hip adduction in addition to leg press training had no additive beneficial effect on patellar realignment or pain reduction.

Effects of attaching elastic bands to the waist and heels on drop jumps.

This study aimed to investigate the effects of the external load of elastic bands attached to the waist and heels to enhance the pre-activation of leg extensor muscles on drop jumps (DJs). Twelve male college athletes volunteered for this study. Eight cameras and two force platforms were used to collect data. Each subject performed DJs with elastic band loads of 0% and 20% body weight (BW) attached to the waist and heels during the airborne and landing phases from 40- and 50-cm drop heights. Repeated measures of two-way analysis of variance were performed with two loads of the elastic bands and two heights of the platform for each dependent biomechanical variable. Jump height, reactive strength index, leg stiffness, hip, knee flexion, and ankle plantarflexion angles at the initial foot contact and ankle dorsiflexion range of motion (ROM) significantly increased with 20% BW loads. The peak ground reaction force of impact, eccentric work, and hip flexion range of motion significantly decreased with 20% BW loads. The use of the elastic bands as accentuated loading during the airborne and landing phases of DJs can induce pre-activation of the joint extensors of the lower extremity to achieve stretch-shortening cycle benefits and performance and reduce the ground impact for the lower extremity. HighlightsAttaching elastic bands to the waist and heels enables the following during drop jumps.The joint extensors of the lower extremities act as a counterbalance to the pull from the elastic bands.The performance of the drop jump was improved.The ground impact was reduced.

Effects of Community-Based Physical-Cognitive Training, Health Education, and Reablement among Rural Community-Dwelling Older Adults with Mobility Deficits.

Reablement services are approaches for maintaining and improving the functional independence of older adults. Previous reablement studies were conducted in a home environment. Due to the limited evidence on the effects of multicomponent interventions and reablement in a community-based context, this study aimed to develop and evaluate the effect of community-based physical-cognitive training, health education, and reablement (PCHER) among rural community-dwelling older adults with mobility deficits. The trial was conducted in rural areas of New Taipei City, Taiwan. Older adults with mild to moderate mobility deficits were recruited from six adult daycare centers, and a cluster assignment was applied in a counterbalanced order. The experimental group (n = 16) received a PCHER intervention, comprising 1.5 h of group courses and 1 h of individualized reablement training, while the control group (n = 12) underwent PCHE intervention, comprising 1.5 h of group courses and 1 h of placebo treatment. A 2.5-h training session was completed weekly for 10 weeks. The outcome measures contained the de Morton Mobility Index (DEMMI), the Saint Louis University Mental Status (SLUMS) Examination, the Barthel Index (BI), the Short Physical Performance Battery (SPPB), and the Canadian Occupational Performance Measure (COPM). The PCHER significantly improved the DEMMI, SLUMS, BI, SPPB, and COPM (all p < 0.05), with medium-to-large effect sizes. PCHER also showed an advantage over PCHE in terms of the SPPB (p = 0.02). This study verified that combining individualized reablement with group-based multicomponent training was superior to group courses alone in enhancing the functional abilities of community-dwelling older adults with mobility deficits.

Physical Fitness among Community-Dwelling Older Women with and without Risk of Falling-The Taipei Study, Taiwan.

The purposes of this study were to compare the differences in physical fitness between community-dwelling older women fallers and non-fallers, with and without a risk of falling, and to investigate the relation between physical fitness and falling risk factors. This study was a secondary data analysis from a community- and exercise-based fall-prevention program. Baseline assessments pertaining to body weight and height, self-reported chronic diseases, the 12-item fall risk questionnaire (FRQ), senior fitness test, single-leg stand test, and handgrip strength test were extracted. Participants (n = 264) were classified into fallers and non-fallers, and sub-classified according to the risk of falling (FRQ ≥4 and <4). While controlling for the effect of age, body mass index (BMI), and multimorbidity, one-way analysis of covariance indicated that older women with a risk of falling showed poorer performances of the 8-foot up-and-go, 2-min step and 30-s chair stand compared with those without a risk of falling, regardless of the history of falls. Additionally, weaker grip strength was found in non-fallers with falling risk. Some significant, but low-to-moderate, correlations were found between physical fitness tests and fall risk factors in the FRQ, particularly in gait/balance problem and leg muscle weakness. Proactive efforts are encouraged to screen and manage deterioration in the identified physical fitness.

Effects of Arch Support Insoles on Single- and Dual-Task Gait Performance Among Community-Dwelling Older Adults.

PURPOSE: To explore the immediate and prolonged effects of arch support insoles on single- and dual-task gait performance among community-dwelling older adults. METHODS: Twenty women performed single- and dual-task walking for 10 m at self-selected comfortable and fast paces while performing serial subtractions (cognitive interference) or carrying a tray (motor interference). Spatiotemporal gait parameters were measured and compared with measurements without arch support immediately after the insertion of the insoles and at 1-week follow-up. RESULTS: Some effects were noted, with small-to-medium effect sizes. During comfortable-paced single-task walking, stride length and walk ratio (step length/cadence) increased after arch support use. During comfortable-paced motor dual-task walking, arch support use increased cadence, stride length, and speed and decreased dual-task costs (DTCs) on cadence and speed. During fast-paced motor dual-task walking, cadence increased and the DTC on cadence decreased after arch support use at the 1-week follow-up. During comfortable-paced cognitive dual-task walking, cadence increased and the walk ratio decreased following arch support use. At the 1-week follow-up, DTCs on cadence reduced, but those on stride length and speed increased. During fast-paced cognitive dual-task walking, the speed and stride length demonstrated immediate decreases followed by increases at the 1-week follow-up. CONCLUSION: The study results indicate that the use of arch support improves single- and motor dual-task gait performance, which may contribute to gait and balance training in older adults.

The arch support insoles show benefits to people with flatfoot on stance time, cadence, plantar pressure and contact area.

BACKGROUND: Pes planus (flatfoot) is a common deformity characterized by the midfoot arch collapses during walking. As the midfoot is responsible for shock absorption, persons with flatfoot experience increased risk of injuries such as thumb valgus, tendinitis, plantar fasciitis, metatarsal pain, knee pain, lower-back pain with prolonged uphill, downhill, and level walking, depriving them of the physical and mental health benefits of walking as an exercise. METHODS: Fifteen female college students with flatfoot were recruited. A wireless plantar-pressure system was used to measure the stance time, cadence, plantar pressure, and contact area. Parameters were compared between wearing flat and arch-support insoles using a two-way repeated measures ANOVA with on an incline, decline, and level surface, respectively. The significance level α was set to 0.05. The effect size (ES) was calculated as a measure of the practical relevance of the significance using Cohen's d. RESULTS: On the level surface, the stance time in the arch-support insole was significantly shorter than in the flat insole (p<0.05; ES = 0.48). The peak pressure of the big toe in the arch-support insole was significantly greater than in the flat insole on the uphill (p<0.05; ES = 0.53) and level surfaces (p<0.05; ES = 0.71). The peak pressure of the metatarsals 2-4 and the contact area of the midfoot in the arch-support insole were significantly greater than in the flat insole on all surfaces (all p< 0.05). CONCLUSIONS: These results imply that wearing an arch-support insole provides benefits in the shortened stance time and generation of propulsion force to the big toe while walking on uphill and level surfaces and to the metatarsals 2-4 while walking on the level surface. More evenly distributed contact areas across the midfoot may help absorb shock during uphill, downhill and level walking.

Novel Mat Exergaming to Improve the Physical Performance, Cognitive Function, and Dual-Task Walking and Decrease the Fall Risk of Community-Dwelling Older Adults.

Physical exercise and cognitive training were previously demonstrated to improve the physical functioning and decrease the incidence of falls for older adults. This study aimed to utilize an interactive exergame mat system to develop a novel cognitive-physical training program and explore the training effects on physical performance, cognitive function, dual-task walking (DTW), and fall risk compared to the control condition. In this quasi-experimental non-randomized controlled intervention study, 110 community-dwelling older adults participated. The exercise group (n = 56; mean age, 70.7 ± 4.6 years) performed ladder-type, three-by-three grid-type, and circle-type mat exergames with simultaneous cognitive-physical training (EMAT), while the control group (n = 54; mean age, 72.0 ± 5.7 years) underwent a multicomponent exercise intervention focused on physical and cognitive training. A 2 h training session was completed weekly for 3 months. Functional fitness (including upper- and lower-extremity strength and flexibility, grasp strength, aerobic endurance, static balance, dynamic balance and agility), a foot tapping test (FTT), the Montreal Cognitive Assessment (MoCA), DTW, and a fall risk questionnaire (FRQ) were assessed before and after the interventions. The EMAT program enhanced upper-extremity strength, lower-extremity strength and flexibility, aerobic endurance, and dynamic balance and agility; improved DTW and FTT performances; and decreased FRQ score. EMAT also showed a significant advantage over control in terms of lower-extremity strength and flexibility, aerobic endurance, dynamic balance and agility, and FRQ score (all P < 0.05). The current study provides evidence of the effects of a novel mat exergaming program on physical and cognitive performance. EMAT effectively reduced the fall risk and increased the dual-task ability of walking, factors that are important in fall prevention for community-dwelling older adults.