Publications by authors named "Mirjam Pijnappels"

90 Publications

Determinants of instrumented sedentary and physical activity behavior in geriatric rehabilitation inpatients: RESORT.

Exp Gerontol 2021 10 21;154:111524. Epub 2021 Aug 21.

Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Movement Sciences, the Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, 300 Grattan Street, Parkville, 3050, Victoria, Australia; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore. Electronic address:

Background: Physical inactivity in hospitalized older adults is highly prevalent and associated with detrimental health outcomes. Understanding its determinants is important for prognosis and tailoring interventions in geriatric rehabilitation inpatients.

Methods: Within the REStORing health of acutely unwell adulTs (RESORT) observational, longitudinal cohort, geriatric rehabilitation inpatients wore an inertial sensor (ActivPAL4) for one week to objectively assess instrumented sedentary behavior (i-SB) and physical activity (i-PA). Determinants were grouped in five geriatric domains: morbidity, cognition/psychology, physical performance, functional performance, and nutritional status. Their association with i-SB (mean sitting, lying, non-upright time) and i-PA (mean number of steps, sit-to-stand transitions and upright time) quintiles were examined using multivariate ordinal logistic regression analyses with Bonferroni correction (p < 0.006).

Results: A total of 145 inpatients were included (mean age 83.0, SD 7.7 years; 55.9% females). More comorbidities were associated with a lower daily number of steps (OR:0.91, 95%CI: 0.86-0.96) and lower upright time (OR:0.93, 95%CI: 0.88-0.98). Depressive symptoms (higher Hospital Anxiety and Depression Scale score) were associated with higher non-upright time (OR: 1.12, 95%CI: 1.03-1.21) and lower upright time (OR: 0.89, 95%CI: 0.83-0.96). Better physical performance (higher Functional Ambulation Classification, gait speed, and Short Physical Performance Battery score) was associated with lower i-SB measures (OR range: 0.07-0.78, p < 0.0005) and higher i-PA measures (OR range: 1.35-19.50, p < 0.0005). Higher functional performance (Katz index of Activities of Daily Living score) was associated with lower i-SB measures (OR range: 0.61-0.69, p ≤ 0.003) and higher i-PA measures (OR range: 1.60-3.64, p < 0.0005). Being malnourished was associated with lower i-PA measures (OR range: 0.29-0.32, p ≤ 0.004).

Conclusions: Worse morbidity, depressive symptoms, worse physical and functional performance, and worse nutritional status were associated with higher i-SB and lower i-PA. These determinants should be taken into account while designing and promoting multidisciplinary physical activity interventions.
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http://dx.doi.org/10.1016/j.exger.2021.111524DOI Listing
October 2021

Rapid Inhibition Accuracy and Leg Strength Are Required for Community-Dwelling Older People to Recover Balance From Induced Trips and Slips: An Experimental Prospective Study.

J Geriatr Phys Ther 2021 Jul 26. Epub 2021 Jul 26.

Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, New South Wales, Australia. UNSW Medicine, Sydney, New South Wales, Australia. Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands. Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor.

Background And Purpose: Falls can result in bone fractures and disability, presenting a serious threat to quality of life and independence in older adults. The majority of falls in community-living older adults occur while walking and are often caused by trips and slips. The study aimed to identify the specific sensorimotor and psychological factors required for older adults to recover balance from trips and slips.

Methods: Forty-one older adults aged 65 to 87 years were assessed on sensorimotor (knee extension strength, proprioception, postural sway, and edge contrast sensitivity), reaction (simple reaction time, stepping, and catching reaction inhibition), and psychological (general anxiety and concern about falling) measures. Using a harness system, participants walked at 90% of their usual pace on a 10-m walkway that could induce trips and slips in concealed and changeable locations. Post-perturbation responses resulting in more than 30% of body weight being recorded by the harness system were defined as falls. Poisson regressions were used to test associations between the sensorimotor, reaction, and psychological measures and number of falls.

Results: Fifty-one falls occurred in 25 of 41 participants. Poisson regression revealed body mass index, lower-limb proprioception, knee extension strength, rapid inhibition accuracy, concern about falling, and anxiety were significantly associated with the rate of falls. Other measures including postural sway were not statistically significant. Using stepwise Poisson regression analyses, normalized knee extension strength (rate ratio [RR]: 0.68, 95% confidence interval [CI]: 0.47-0.98), and rapid inhibition accuracy (RR: 0.64, 95% CI: 0.46-0.87) were independently associated with falls.

Conclusion: Our findings suggest rapid inhibition accuracy and adequate leg strength are required for older adults to recover balance from trips and slips. The mechanisms for balance recovery during daily life activities are likely different from those for static balance, suggesting the need for task-specific assessments and interventions for fall prevention in older adults.
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http://dx.doi.org/10.1519/JPT.0000000000000312DOI Listing
July 2021

The short- and long-term temporal relation between falls and concern about falling in older adults without a recent history of falling.

PLoS One 2021 9;16(7):e0253374. Epub 2021 Jul 9.

Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Background And Aim: The reciprocal relation between falling and concern about falling is complex and not well understood. We aimed to determine whether concern about falling increases after a fall and whether concern about falling increases the odds of future falls in community-dwelling older adults without a recent fall history.

Methods: We selected 118 community-dwelling older adults (mean age: 71.4 (SD: 5.3) years) without a self-reported history of falling, one year prior to baseline assessment, from the one-year VIBE cohort for analyses. On a monthly basis, we recorded concern about falling (using the Falls Efficacy Scale-International, FES-I), as well as the occurrence of falls (through questionnaires and telephone calls). We determined 1) whether falling predicts an increase in concern about falling and 2) whether a high concern about falling is predictive of falling. Standard linear (fixed-effects) regression and mixed effects regression analyses were performed over long-term, i.e. one year, and short-term, i.e. one-month, intervals, respectively and were adjusted for gender, age and physical activity (quantified as the average total walking duration per day). Analyses were performed separately for all reported falls and for injurious falls only.

Results: High concern about falling at baseline did not predict falls over the course of one year, nor over the course of one month. Furthermore, falls in between baseline assessment and one year thereafter did not predict increased concern about falling from baseline to one year later, independent of whether all falls or only injurious falls were considered. However, falls, either all or injurious only, happening somewhere over the course of a one-month interval, significantly predicted small increases in concern about falling (1.49 FES-I points, 95% CI [0.74, 2.25], p<0.001 for all falls; 2.60 FES-I points, 95% CI [1.55, 3.64], p<0.001 for injurious falls) from the start to the end of that one-month interval.

Conclusion: Older adults without a recent history of falling seem to be resilient against developing concern about falling after having fallen, resulting in a short-term temporary effect of falling on concern about falling. Furthermore, we found no evidence that a high concern about falling predicts future falls over a one-month or a one-year follow-up period, suggesting that concern is not a primary cause for falls in older adults without a recent history of falling.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253374PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270453PMC
July 2021

The (cost-)effectiveness of an implemented fall prevention intervention on falls and fall-related injuries among community-dwelling older adults with an increased risk of falls: protocol for the in balance randomized controlled trial.

BMC Geriatr 2021 06 23;21(1):381. Epub 2021 Jun 23.

Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.

Background: Falls and fall-related injuries among older adults are a serious threat to the quality of life and result in high healthcare and societal costs. Despite evidence that falls can be prevented by fall prevention programmes, practical barriers may challenge the implementation of these programmes. In this study, we will investigate the effectiveness and cost-effectiveness of In Balance, a fourteen-week, low-cost group fall prevention intervention, that is widely implemented in community-dwelling older adults with an increased fall risk in the Netherlands. Moreover, we will be the first to include cost-effectiveness for this intervention. Based on previous evidence of the In Balance intervention in pre-frail older adults, we expect this intervention to be (cost-)effective after implementation-related adjustments on the target population and duration of the intervention.

Methods: This study is a single-blinded, multicenter randomized controlled trial. The target sample will consist of 256 community-dwelling non-frail and pre-frail adults of 65 years or older with an increased risk of falls. The intervention group receives the In Balance intervention as it is currently widely implemented in Dutch healthcare, which includes an educational component and physical exercises. The physical exercises are based on Tai Chi principles and focus on balance and strength. The control group receives general written physical activity recommendations. Primary outcomes are the number of falls and fall-related injuries over 12 months follow-up. Secondary outcomes consist of physical performance measures, physical activity, confidence, health status, quality of life, process evaluation and societal costs. Mixed model analyses will be conducted for both primary and secondary outcomes and will be stratified for non-frail and pre-frail adults.

Discussion: This trial will provide insight into the clinical and societal impact of an implemented Dutch fall prevention intervention and will have major benefits for older adults, society and health insurance companies. In addition, results of this study will inform healthcare professionals and policy makers about timely and (cost-)effective prevention of falls in older adults.

Trial Registration: Netherlands Trial Register: NL9248 (registered February 13, 2021).
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http://dx.doi.org/10.1186/s12877-021-02334-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8220122PMC
June 2021

Patients' perceived walking abilities, daily-life gait behavior and gait quality before and 3 months after total knee arthroplasty.

Arch Orthop Trauma Surg 2021 May 6. Epub 2021 May 6.

Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 9, 1081 BT, Amsterdam, The Netherlands.

Introduction: Functional outcome and patients' daily-life activities after total knee arthroplasty are becoming more important with a younger and more active patient population. In addition to patient-reported outcome measures (PROMs), trunk-based accelerometry has shown to be a promising method for evaluating gait function after total knee arthroplasty. The aim of this study was to evaluate daily-life perceived walking abilities, gait behavior and gait quality before and 3 months after total knee arthroplasty, using PROMs and trunk-based accelerometry.

Materials And Methods: A cohort of 38 patients completed questionnaires including the Oxford Knee Score and modified Gait Efficacy Scale before and 3 months after primary unilateral total knee arthroplasty. At both time points, they wore a tri-axial accelerometer at the lower back for seven consecutive days and nights. Gait behavior was calculated using gait quantity and walking speed, and multiple gait quality parameters were calculated.

Results: Significant improvements were seen after 3 months in the Oxford Knee Score [median (interquartile range) 29 (10) vs 39 (8), p < 0.001] and modified Gait Efficacy Scale [median (interquartile range) 67 (24) vs 79 (25), p = 0.001]. No significant changes were observed in gait behavior (quantity and speed) or gait quality variables.

Conclusions: In contrast to the significant improvements in patients' perception of their walking abilities and PROMs, patients did not show improvements in gait behavior and gait quality. This implies that after 3 months patients' perceived functional abilities after total knee arthroplasty do not necessarily represent their actual daily-life quantity and quality of gait, and that more focus is needed on postoperative rehabilitation to improve gait and functional behavior.
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http://dx.doi.org/10.1007/s00402-021-03915-yDOI Listing
May 2021

Sensitivity to Change and Responsiveness of the Original and the Shortened Version of the Community Balance and Mobility Scale for Young Seniors.

Arch Phys Med Rehabil 2021 Apr 29. Epub 2021 Apr 29.

Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany. Electronic address:

Objective: To examine sensitivity to change and responsiveness of the Community Balance and Mobility Scale (CBM) and shortened CBM (s-CBM).

Design: Secondary analysis using data of a randomized controlled trial.

Setting: General community.

Participants: Young community-dwelling seniors aged 61-70 years (N=134; mean age, 66.2±2.5y).

Interventions: Participants underwent 12 months of exercise intervention.

Main Outcome Measures: CBM and s-CBM. Sensitivity to change was assessed using standardized response mean (SRM) and paired t tests as appropriate. Responsiveness was assessed using 2 minimal important difference (MID) estimates. Analyses were conducted for the full sample and for the subgroups "high-balance" and "low-balance," divided by median split.

Results: Inferential statistics revealed a significant CBM (P<.001) and s-CBM (P<.001) improvement within the full sample and the subgroups (high-balance: P=.001, P=.019; low-balance: P<.001, P<.001). CBM and s-CBM were moderately sensitive to change (SRM, 0.48 vs 0.38) within the full sample. In the high-balance subgroup, moderate SRM values (0.70) were found for the CBM and small values for the s-CBM (0.29). In the low-balance subgroup, moderate SRM values were found for the CBM (0.67) and high values for the s-CBM (0.80). For the full sample, CBM and s-CBM exceeded the lower but not the higher MID value. In the high-balance subgroup, the CBM exceeded both MID values, but the s-CBM exceeded only the lower. In the low-balance subgroup, CBM and s-CBM exceeded both MID values.

Conclusions: The CBM is a suitable tool to detect intervention-related changes of balance and mobility in young, high-performing seniors. Both versions of the CBM scale show good sensitivity to change and responsiveness, particularly in young seniors with low balance.
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http://dx.doi.org/10.1016/j.apmr.2021.03.036DOI Listing
April 2021

Robustness of In-Laboratory and Daily-Life Gait Speed Measures over One Year in High Functioning 61- to 70-Year-Old Adults.

Gerontology 2021 Mar 22:1-10. Epub 2021 Mar 22.

Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands,

Introduction: Gait speed is a simple and safe measure with strong predictive value for negative health outcomes in clinical practice, yet in-laboratory gait speed seems not representative for daily-life gait speed. This study aimed to investigate the interrelation between and robustness of in-laboratory and daily-life gait speed measures over 12 months in 61- to 70-year-old adults.

Methods: Gait speed was assessed in laboratory through standardized stopwatch tests and in daily life by 7 days of trunk accelerometry in the PreventIT cohort, at baseline, and after 6 and 12 months. The interrelation was investigated using Pearson's correlations between gait speed measures at each time point. For robustness, changes over time and variance components were assessed by ANOVA and measurement agreement over time by Bland-Altman analyses.

Results: Included were 189 participants (median age 67 years [interquartile range: 64-68], 52.2% females). In-laboratory and daily-life gait speed measures showed low correlations (Pearson's r = 0.045-0.455) at each time point. Moreover, both in-laboratory and daily-life gait speed measures appeared robust over time, with comparable and smaller within-subject than between-subject variance (range 0.001-0.095 m/s and 0.032-0.397 m/s, respectively) and minimal differences between measurements over time (Bland-Altman) with wide limits of agreement (standard deviation of mean difference range: 0.12-0.34 m/s).

Discussion/conclusion: In-laboratory and daily-life gait speed measures show robust assessments of gait speed over 12 months and are distinct constructs in this population of high-functioning adults. This suggests that (a combination of) both measures may have added value in predicting health outcomes.
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http://dx.doi.org/10.1159/000514150DOI Listing
March 2021

Development of a Balance Recovery Performance Measure for Gait Perturbation Training Based on the Center of Pressure.

Front Sports Act Living 2021 15;3:617430. Epub 2021 Feb 15.

Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.

The availability of instrumented treadmills that can apply unexpected perturbations during walking has made gait perturbation training more popular in clinical practice. To quantify and monitor balance recovery while training, easy to use measures are needed and may be based on integrated force plate data. Therefore, we aimed to quantify and evaluate different implementations of the recovery performance measure based on center of pressure data. Recovery performance was calculated based on differences in center of pressure trajectories between unperturbed walking and balance recovery after a perturbation. Five methodological choices leading to 36 different implementations were evaluated. Test-retest reliability, effect sizes, and concurrent validity were evaluated against trunk velocity measures. Differences in measures of (dis-)similarity, time normalization and reference data affected reliability, sensitivity and validity and none of the performance measure implementations based on center of pressure trajectories was superior on all criteria. Measures assessing perturbation effects on trunk velocities provided more reliable and sensitive recovery outcomes. Different implementations of the recovery performance measure can be chosen dependent on constraints imposed in the clinical setting. Quantifying recovery performance based on center of pressure data is possible and may be suitable to monitor improvement in recovery performance after gait perturbations in specific clinical setups. Validity of performance measures in general requires further attention.
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http://dx.doi.org/10.3389/fspor.2021.617430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7917114PMC
February 2021

The Role of Foot-Loading Factors and Their Associations with Ulcer Development and Ulcer Healing in People with Diabetes: A Systematic Review.

J Clin Med 2020 Nov 7;9(11). Epub 2020 Nov 7.

Department of Rehabilitation Medicine, Amsterdam Movement Sciences, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.

We aimed to comprehensively and systematically review studies associating key foot-loading factors (i.e., plantar pressure, weight-bearing activity, adherence or a combination thereof) with ulcer development and ulcer healing in people with diabetes. A systematic literature search was performed in PubMed and EMBASE. We included studies if barefoot or in-shoe plantar pressure, weight-bearing activity or footwear or device adherence was measured and associated with either ulcer development or ulcer healing in people with diabetes. Out of 1954 records, 36 studies were included and qualitatively analyzed. We found low to moderate quality evidence that lower barefoot plantar pressure and higher footwear and device adherence associate with lower risk of ulcer development and shorter healing times. For the other foot-loading factors, we found low quality evidence with limited or contradictory results. For combined measures of foot-loading factors, we found low quality evidence suggesting that lower cumulative plantar tissue stress is associated with lower risk of ulcer development and higher ulcer healing incidence. We conclude that evidence for barefoot plantar pressure and adherence in association with ulcer outcome is present, but is limited for the other foot-loading factors. More comprehensive investigation in particularly the combination of foot-loading factors may improve the evidence and targeting preventative treatment.
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http://dx.doi.org/10.3390/jcm9113591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694972PMC
November 2020

Association between Daily-Life Gait Quality Characteristics and Physiological Fall Risk in Older People.

Sensors (Basel) 2020 Sep 29;20(19). Epub 2020 Sep 29.

Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.

Gait quality characteristics obtained from accelerometry during daily life are predictive of falls in older people but it is unclear how they relate to fall risk. Our aim was to test whether these gait quality characteristics are associated with the severity of fall risk. We collected one week of trunk accelerometry data from 279 older people (aged 65-95 years; 69.5% female). We used linear regression to investigate the association between six daily-life gait quality characteristics and categorized physiological fall risk (QuickScreen). Logarithmic rate of divergence in the vertical (VT) and anteroposterior (AP) direction were significantly associated with the level of fall risk after correction for walking speed (both < 0.01). Sample entropy in VT and the mediolateral direction and the gait quality composite were not significantly associated with the level of fall risk. We found significant differences between the high fall risk group and the very low- and low-risk groups, the moderate- and very low-risk and the moderate and low-risk groups for logarithmic rate of divergence in VT and AP (all ≤ 0.01). We conclude that logarithmic rate of divergence in VT and AP are associated with fall risk, making them feasible to assess the physiological fall risk in older people.
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http://dx.doi.org/10.3390/s20195580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7582484PMC
September 2020

The influence of postural threat on strategy selection in a stepping-down paradigm.

Sci Rep 2020 07 2;10(1):10815. Epub 2020 Jul 2.

Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.

To walk safely in their environment, people need to select adequate movement strategies during gait. In situations that are perceived as more threatening, older adults adopt more cautious strategies. For individuals with excessive fear, selecting adequate strategies might be troubling. We investigated how a postural threat affects the selection of strategies within and between older adults by using a stepping-down paradigm. In twenty-four older adults we determined the height at which they switched in stepping-down strategies from a less demanding but more balance threatening heel landing to a more demanding yet safer toe landing. We expected that this switching height would be lower in the high (0.78 m elevation) compared to low threat (floor level) condition. Furthermore, we investigated if older adults, for which the postural threat evoked an increase in the perceived fear, presented a different stepping down strategy due to the postural threat. Our results indicated that the postural threat changed older adults' strategies selection towards a more conservative toe landing. Hence, despite the additional effort, older adults prefer more cautious strategies during a postural threat. No effects of perceived fear on strategy selection between individuals were observed, potentially due to relatively small differences in fear among participants.
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http://dx.doi.org/10.1038/s41598-020-66352-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7331803PMC
July 2020

The association of basic and challenging motor capacity with mobility performance and falls in young seniors.

Arch Gerontol Geriatr 2020 Sep - Oct;90:104134. Epub 2020 Jun 6.

Network Aging Research, Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany; Department of Clinical Gerontology and Rehabilitation, Robert Bosch Hospital Stuttgart, Auerbachstr. 110, 70376, Stuttgart, Germany; Institute of Sports and Sports Sciences, Heidelberg University, Im Neuenheimer Feld 700, 69120, Heidelberg, Germany. Electronic address:

Background: Understanding the association between motor capacity (MC) (what people can do in a standardized environment), mobility performance (MP) (what people actually do in real-life) and falls is important for early detection of and counteracting on functional decline, particularly in the rapidly growing population of young seniors. Therefore, this study aims to 1) explore the association between MC and MP, and between MC and falls, and 2) investigate whether challenging MC measures are better associated with MP and falls than basic MC measures.

Methods: Basic (habitual gait speed, Timed Up-and-Go) and challenging (fast gait speed, Community Balance & Mobility Scale) MC measures were performed in 169 young seniors (61-70 years). MP was assessed using one-week sensor-monitoring including time being sedentary, light active, and at least moderately active. Falls in the previous six months were reported. Associations and discriminative ability were calculated using correlation, regression and receiver operating curve analysis.

Results: Mean age was 66.4 (SD 2.4) years (50.6 % women). Small to moderate associations (r = 0.06-0.31; p < .001-.461) were found between MC, MP and falls. Challenging MC measures showed closer associations with MP and falls (r = 0.10-0.31; p < .001-.461) compared to basic (r = 0.06-0.22; p = .012-.181), remained significant in three out of four regression models explaining 2.5-8.6 % of the variance, and showed highest discriminative ability (area under the curve = 0.59-0.70) in all analyses.

Conclusions: Challenging MC measures are closer associated with mobility performance and falls as compared to basic MC measures in young seniors. This indicates the importance of applying challenging motor capacity assessments in young seniors. On the same note, small to moderate associations imply a need for an assessment of both MC and MP in order to capture the best possible MC and the actual daily-life MP in young seniors.
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http://dx.doi.org/10.1016/j.archger.2020.104134DOI Listing
December 2020

Perturbation-based gait training to improve daily life gait stability in older adults at risk of falling: protocol for the REACT randomized controlled trial.

BMC Geriatr 2020 05 7;20(1):167. Epub 2020 May 7.

Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.

Background: The European population is rapidly ageing. There is an urgent need for innovative solutions to reduce fall risk in older adults. Perturbation-based gait training is a promising new method to improve reactive balance responses. Whereas positive effects on task-specific dynamic balance recovery during gait have been shown in clinical or laboratory settings, translation of these effects to daily life gait function and fall risk is limited. We aim to evaluate the effect of a 4-week perturbation-based treadmill training on daily-life dynamic gait stability, assessed with inertial sensor data. Secondary outcomes are balance recovery performance, clinical balance and gait assessment scores, the amount of physical activity in daily life and falls incidence during 6 months follow-up.

Methods: The study is a monocenter assessor-blinded randomized controlled trial. The target study sample consists of 70 older adults of 65 years and older, living in the community and with an elevated risk of falling. A block-randomization to avoid seasonal effects will be used to allocate the participants into two groups. The experimental group receives a 4-week, two times per week perturbation-based gait training programme on a treadmill, with simulated slips and trips, in combination with cognitive dual tasks. The control group receives a 4-week, two times per week treadmill training programme under cognitive dual-task conditions without perturbations. Participants will be assessed at baseline and after the 4-weeks intervention period on their daily-life gait stability by wearing an inertial sensor on the lower back for seven consecutive days. In addition, clinical balance and gait assessments as well as questionnaires on falls- and gait-efficacy will be taken. Daily life falls will be followed up over 6 months by a fall calendar.

Discussion: Whereas perturbation-based training has shown positive effects in improving balance recovery strategies and in reducing laboratory falls, this study will contribute to investigate the translation of perturbation-based treadmill training effects in a clinical setting towards improving daily life gait stability and reducing fall risk and falls.

Trial Registration: NTR7703 / NL66322.028.18, Registered: January 8, 2019; Enrolment of the first participant April 8, 2019.
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http://dx.doi.org/10.1186/s12877-020-01566-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203817PMC
May 2020

Instrumented measures of sedentary behaviour and physical activity are associated with mortality in community-dwelling older adults: A systematic review, meta-analysis and meta-regression analysis.

Ageing Res Rev 2020 08 30;61:101061. Epub 2020 Apr 30.

Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands; Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, 300 Grattan Street, Parkville, Victoria 3050, Melbourne, Australia. Electronic address:

Background: Sedentary behaviour (SB) and physical activity (PA) can be objectively assessed with inertial sensors to describe bodily movement. Higher SB and lower PA is associated with higher chronological age and negative health outcomes. This study aimed to quantify the association between instrumented measures of SB (i-SB) and PA (i-PA) and mortality in community-dwelling older adults, to subsequently compare the quantitative effect sizes and to determine the dose-response relationships.

Methods: An electronic search in six databases from inception to 27th of June 2019 was conducted. All articles reporting on i-SB or i-PA and mortality in community-dwelling older adults aged 60 years or older were considered eligible. A meta-analysis was conducted for the association between i-SB and i-PA and mortality expressed in Hazard Ratios (HR) and 95% Confidence Intervals (95% CI). A meta-regression analysis was performed to determine the dose-response relationship between i-SB and steps per day and mortality.

Results: Twelve prospective articles representing eleven cohorts, reporting data of 38,141 participants were included. In total 2502 (6.4%) participants died during follow-up (2.0 to 9.8 years). Comparing the most sedentary with the least sedentary groups of participants resulted in a pooled HR of 2.44 (95% CI 1.82-3.25). Comparing the least active with the most active groups of participants resulted in a pooled HR of 1.93 (95% CI 1.39-2.69); 2.66 (95% CI 2.11-3.35); 3.43 (95% CI 2.61-4.52), and 3.09 (95% CI 2.33-4.11) for light, moderate-to-vigorous-, total PA and steps per day, respectively. Meta-regression analyses showed clear dose-response relationships between i-SB and steps per day and mortality risk.

Conclusion: Both i-SB and i-PA are significantly associated with mortality in community-dwelling older adults, showing the largest effect size for total physical activity. Dose-response relationships could be observed for i-SB and steps per day.
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http://dx.doi.org/10.1016/j.arr.2020.101061DOI Listing
August 2020

Distinct Trajectories of Individual Physical Performance Measures Across 9 Years in 60- to 70-Year-Old Adults.

J Gerontol A Biol Sci Med Sci 2020 09;75(10):1951-1959

Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands.

Background: Physical performance is an important factor for successful aging. This study aimed to identify distinct trajectories of multiple physical performance measures over 9 years in individuals aged 60-70 years and to evaluate their characteristics and the overlap between measures.

Methods: Four physical performance measures were assessed in 440 participants of the Longitudinal Aging Study Amsterdam: tandem stand, gait speed, chair stand, and handgrip strength. Gender-specific latent class models were conducted to obtain distinct trajectories and their degree of overlap.

Results: Mean age at baseline was 67.9 (SD 1.7) years for males and 68.0 (SD 1.7) years for females. The optimal number of trajectories differed across measures. For tandem stand, no distinct trajectories were found (all 179 males, 198 females). For gait speed, three trajectories were identified, dependent on baseline speed: high-stable (47 males, 27 females), intermediate-stable (132 males, 130 females), and low-declining performance (6 males, 48 females). Two trajectories were identified for the chair stand: a stable (168 males, 150 females) and declining trajectory (10 males, 38 females). For handgrip strength, three declining trajectories were identified differing in baseline performance: high (55 males, 75 females), intermediate (111 males, 118 females), and low (17 males, 10 females). Overall, 11.9% of males and 5.7% of females were classified in similar trajectories across measures.

Conclusions: Trajectories of physical performance were heterogeneous, but showed similar patterns for males and females. Little overlap between measures was shown, suggesting different mechanisms for decline. This study emphasizes the use of multiple domains to assess physical performance.
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http://dx.doi.org/10.1093/gerona/glaa045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7518554PMC
September 2020

Quality of Daily-Life Gait: Novel Outcome for Trials that Focus on Balance, Mobility, and Falls.

Sensors (Basel) 2019 Oct 11;19(20). Epub 2019 Oct 11.

Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences, 1081BT Amsterdam, The Netherlands.

Technological advances in inertial sensors allow for monitoring of daily-life gait characteristics as a proxy for fall risk. The quality of daily-life gait could serve as a valuable outcome for intervention trials, but the uptake of these measures relies on their power to detect relevant changes in fall risk. We collected daily-life gait characteristics in 163 older people (aged 77.5 ± 7.5, 107♀) over two measurement weeks that were two weeks apart. We present variance estimates of daily-life gait characteristics that are sensitive to fall risk and estimate the number of participants required to obtain sufficient statistical power for repeated comparisons. The provided data allows for power analyses for studies using daily-life gait quality as outcome. Our results show that the number of participants required (i.e., 8 to 343 depending on the anticipated effect size and between-measurements correlation) is similar to that generally used in fall prevention trials. We propose that the quality of daily-life gait is a promising outcome for intervention studies that focus on improving balance and mobility and reducing falls.
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http://dx.doi.org/10.3390/s19204388DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832726PMC
October 2019

Creating and Validating a Shortened Version of the Community Balance and Mobility Scale for Application in People Who Are 61 to 70 Years of Age.

Phys Ther 2020 01;100(1):180-191

Network Aging Research, and Institute of Sports and Sports Sciences, Heidelberg University.

Background: The Community Balance and Mobility Scale (CBM) has been shown to be reliable and valid for detecting subtle balance and mobility deficits in people who are 61 to 70 years of age. However, item redundancy and assessment time call for a shortened version.

Objective: The objective was to create and validate a shortened version of the CBM (s-CBM) without detectable loss of psychometric properties.

Design: This was a cross-sectional study.

Methods: Exploratory factor analysis with data from 189 young seniors (aged 61-70 years; mean [SD] age = 66.3 [2.5] years) was used to create the s-CBM. Sixty-one young seniors (aged 61-70 years; mean [SD] age = 66.5 [2.6] years) were recruited to assess construct validity (Pearson correlation coefficient) by comparing the CBM versions with Fullerton Advance Balance Scale, Timed Up-and-Go, habitual and fast gait speed, 8 Level Balance Scale, 3-m tandem walk, and 30-second chair stand test. Internal consistency (Cronbach α), ceiling effects, and discriminant validity (area under the curve [AUC]) between fallers and nonfallers, and self-reported high and low function (Late-Life Function and Disability Index) and balance confidence (Activities-Specific Balance Confidence Scale), respectively, were calculated.

Results: The s-CBM, consisting of 4 items, correlated excellently with the CBM (r = 0.97). Correlations between s-CBM and other assessments (r = 0.07-0.72), and CBM and other assessments (r = 0.06-0.80) were statistically comparable in 90% of the correlations. Cronbach α was .84 for the s-CBM, and .87 for the CBM. No CBM-version showed ceiling effects. Discriminative ability of the s-CBM was statistically comparable with the CBM (AUC = 0.66-0.75 vs AUC = 0.65-0.79).

Limitations: Longitudinal studies with larger samples should confirm the results and assess the responsiveness for detecting changes over time.

Conclusions: The psychometric properties of the s-CBM were similar to those of the CBM. The s-CBM can be recommended as a valid and quick balance and mobility assessment in young seniors.
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http://dx.doi.org/10.1093/ptj/pzz132DOI Listing
January 2020

Development of a clinical prediction model for the onset of functional decline in people aged 65-75 years: pooled analysis of four European cohort studies.

BMC Geriatr 2019 06 27;19(1):179. Epub 2019 Jun 27.

Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.

Background: Identifying those people at increased risk of early functional decline in activities of daily living (ADL) is essential for initiating preventive interventions. The aim of this study is to develop and validate a clinical prediction model for onset of functional decline in ADL in three years of follow-up in older people of 65-75 years old.

Methods: Four population-based cohort studies were pooled for the analysis: ActiFE-ULM (Germany), ELSA (United Kingdom), InCHIANTI (Italy), LASA (Netherlands). Included participants were 65-75 years old at baseline and reported no limitations in functional ability in ADL at baseline. Functional decline was assessed with two items on basic ADL and three items on instrumental ADL. Participants who reported at least some limitations at three-year follow-up on any of the five items were classified as experiencing functional decline. Multiple logistic regression analysis was used to develop a prediction model, with subsequent bootstrapping for optimism-correction. We applied internal-external cross-validation by alternating the data from the four cohort studies to assess the discrimination and calibration across the cohorts.

Results: Two thousand five hundred sixty community-dwelling people were included in the analyses (mean age 69.7 ± 3.0 years old, 47.4% female) of whom 572 (22.3%) reported functional decline at three-year follow-up. The final prediction model included 10 out of 22 predictors: age, handgrip strength, gait speed, five-repeated chair stands time (non-linear association), body mass index, cardiovascular disease, diabetes, chronic obstructive pulmonary disease, arthritis, and depressive symptoms. The optimism-corrected model showed good discrimination with a C statistic of 0.72. The calibration intercept was 0.06 and the calibration slope was 1.05. Internal-external cross-validation showed consistent performance of the model across the four cohorts.

Conclusions: Based on pooled cohort data analyses we were able to show that the onset of functional decline in ADL in three years in older people aged 65-75 years can be predicted by specific physical performance measures, age, body mass index, presence of depressive symptoms, and chronic conditions. The prediction model showed good discrimination and calibration, which remained stable across the four cohorts, supporting external validity of our findings.
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http://dx.doi.org/10.1186/s12877-019-1192-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6595632PMC
June 2019

Effects of Ankle Muscle Fatigue and Visual Behavior on Postural Sway in Young Adults.

Front Physiol 2019 5;10:643. Epub 2019 Jun 5.

Laboratory of Information, Vision and Action (LIVIA), Graduate Program in Movement Science, Department of Physical Education, São Paulo State University (UNESP), São Paulo, Brazil.

Ankle muscle fatigue has been shown to increase body sway. In addition, body sway in quiet upright standing is reduced when saccadic eye movements are performed. The purpose of this study was to investigate the effects of visual information manipulation on postural control during ankle muscle fatigue in young adults. Twenty young adults performed: (1) two 60-s trials in quiet bipedal standing with eyes open, eyes closed, and while performing saccadic eye movements; (2) maximum voluntary isometric contractions in a leg press device, custom-made to test ankle plantar flexion force; (3) a calf raise exercise on top of a step to induce ankle muscle fatigue; and (4) a repetition of items 1 and 2. Postural sway parameters were compared with two-way ANOVAs (vision condition × fatigue;  < 0.05). Ankle muscle fatigue increased anterior-posterior and medial-lateral displacement and RMS of sway, as well as sway area. Saccadic eye movements reduced anterior-posterior displacement and RMS of sway and area of sway compared to eyes open and eyes closed conditions. Both saccadic eye movements and eyes closed increased the frequency of AP sway compared to the eyes open condition. Finally, anterior-posterior displacement, anterior-posterior RMS, and both anterior-posterior and medial-lateral sway frequency were affected by an interaction of fatigue and vision condition. Without muscle fatigue, closing the eyes increased anterior-posterior displacement and RMS of sway, compared to eyes open, while during muscle fatigue closing the eyes closed reduced anterior-posterior displacement and had no significant effect on anterior-posterior RMS. In conclusion, body sway was increased after induction of ankle muscle fatigue. Saccadic eye movements consistently reduced postural sway in fatigued and unfatigued conditions. Surprisingly, closing the eyes increased sway in the unfatigued condition but reduced sway in the fatigued condition.
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http://dx.doi.org/10.3389/fphys.2019.00643DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560149PMC
June 2019

Lack of Knowledge Contrasts the Willingness to Counteract Sarcopenia Among Community-Dwelling Adults.

J Aging Health 2020 Aug-Sep;32(7-8):787-794. Epub 2019 Jun 3.

Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands.

Sarcopenia is highly prevalent in older adults. Knowledge among community-dwelling adults is important for effective prevention and treatment of sarcopenia. This study aims to assess current knowledge about sarcopenia, investigate willingness for treatment and prevention, and awareness of muscle health. Participants who attended health educational events completed a questionnaire on knowledge about sarcopenia. Self-perceived muscle health was assessed by visual analog scale. Objective muscle measures included muscle mass, handgrip strength, and gait speed. Included participants were 197 (median aged 67.9 years [interquartile range = 57.0-75.1]). Eighteen participants (9%) reported to know what sarcopenia is. Participants' self-perceived muscle health showed a low correlation with all objective muscle measures. 76% were willing, in case of sarcopenia diagnosis, to start treatment and 71% were willing to prevent sarcopenia. Knowledge about sarcopenia is limited while participants were willing to start treatment and prevention. Strategies to increase knowledge among community-dwelling adults are needed.
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http://dx.doi.org/10.1177/0898264319852840DOI Listing
April 2021

The Adapted Lifestyle-Integrated Functional Exercise Program for Preventing Functional Decline in Young Seniors: Development and Initial Evaluation.

Gerontology 2019 21;65(4):362-374. Epub 2019 May 21.

School of Health Sciences, University of Manchester, Manchester, United Kingdom.

Background: The Lifestyle-integrated Functional Exercise (LiFE) program is an intervention integrating balance and strength activities into daily life, effective at reducing falls in at-risk people ≥70 years. There is potential for LiFE to be adapted to young seniors in order to prevent age-related functional decline.

Objective: We aimed to (1) develop an intervention by adapting Lifestyle-integrated Functional Exercise (aLiFE) to be more challenging and suitable for preventing functional decline in young seniors in their 60s and (2) perform an initial feasibility evaluation of the program. Pre-post changes in balance, mobility, and physical activity (PA) were also explored.

Methods: Based on a conceptual framework, a multidisciplinary expert group developed an initial aLiFE version, including activities for improving strength, neuromotor performances, and PA. Proof-of-concept was evaluated in a 4-week pre-post intervention study measuring (1) feasibility including adherence, frequency of practice, adverse events, acceptability (i.e., perceived helpfulness, adaptability, level of difficulty of single activities), and safety, and (2) changes in balance/mobility (Community Balance and Mobility Scale) and PA (1 week activity monitoring). The program was refined based on the study results.

Results: To test the initial aLiFE version, 31 young seniors were enrolled and 30 completed the study (mean age 66.4 ± 2.7 years, 60% women). Of a maximum possible 16 activities, participants implemented on average 12.1 ± 1.8 activities during the intervention, corresponding to mean adherence of 76%. Implemented activities were practiced 3.6-6.1 days/week and 1.8-7.8 times/day, depending on the activity type. One noninjurious fall occurred during practice, although the participant continued the intervention. The majority found the activities helpful, adaptable to individual lifestyle, appropriately difficult, and safe. CMBS score increased with medium effect size (d = 0.72, p = 0.001). Increase in daily walking time (d = 0.36) and decrease in sedentary time (d = -0.10) were nonsignificant. Refinements included further increasing the task challenge of some strength activities and defining the most preferred activities in the trainer's manual to facilitate uptake of the program.

Conclusion: aLiFE has the potential to engage young seniors in regular lifestyle-integrated activities. Effectiveness needs to be evaluated in a randomized controlled trial.
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http://dx.doi.org/10.1159/000499962DOI Listing
February 2020

Protocol for the PreventIT feasibility randomised controlled trial of a lifestyle-integrated exercise intervention in young older adults.

BMJ Open 2019 03 20;9(3):e023526. Epub 2019 Mar 20.

Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

Introduction: The European population is rapidly ageing. In order to handle substantial future challenges in the healthcare system, we need to shift focus from treatment towards health promotion. The PreventIT project has adapted the Lifestyle-integrated Exercise (LiFE) programme and developed an intervention for healthy young older adults at risk of accelerated functional decline. The intervention targets balance, muscle strength and physical activity, and is delivered either via a smartphone application (enhanced LiFE, eLiFE) or by use of paper manuals (adapted LiFE, aLiFE).

Methods And Analysis: The PreventIT study is a multicentre, three-armed feasibility randomised controlled trial, comparing eLiFE and aLiFE against a control group that receives international guidelines of physical activity. It is performed in three European cities in Norway, Germany, and The Netherlands. The primary objective is to assess the feasibility and usability of the interventions, and to assess changes in daily life function as measured by the Late-Life Function and Disability Instrument scale and a physical behaviour complexity metric. Participants are assessed at baseline, after the 6 months intervention period and at 1 year after randomisation. Men and women between 61 and 70 years of age are randomly drawn from regional registries and respondents screened for risk of functional decline to recruit and randomise 180 participants (60 participants per study arm).

Ethics And Dissemination: Ethical approval was received at all three trial sites. Baseline results are intended to be published by late 2018, with final study findings expected in early 2019. Subgroup and further in-depth analyses will subsequently be published.

Trial Registration Number: NCT03065088; Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2018-023526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527989PMC
March 2019

Gait speed assessed by a 4-m walk test is not representative of daily-life gait speed in community-dwelling adults.

Maturitas 2019 Mar 7;121:28-34. Epub 2018 Dec 7.

Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, the Netherlands. Electronic address:

Objectives: Standardized tests of gait speed are regarded as being of clinical value, but they are typically performed under optimal conditions, and may not reflect daily-life gait behavior. The aim of this study was to compare 4-m gait speed to the distribution of daily-life gait speed.

Study Design: The cross-sectional Grey Power cohort included 254 community-dwelling participants aged 18 years or more.

Main Outcome Measures: Pearson's correlations were used to compare gait speed assessed using a timed 4-m walk test at preferred pace, and daily-life gait speed obtained from tri-axial lower-back accelerometer data over seven consecutive days.

Results: Participants (median age 66.7 years [IQR 59.4-72.5], 65.7% female) had a mean 4-m gait speed of 1.43 m/s (SD 0.21), and a mean 50th percentile of daily-life gait speed of 0.90 m/s (SD 0.23). Ninety-six percent had a bimodal distribution of daily-life gait speed, with a mean 1st peak of 0.61 m/s (SD 0.15) and 2nd peak of 1.26 m/s (SD 0.23). The percentile of the daily-life distribution that corresponded best with the individual 4-m gait speed had a median value of 91.2 (IQR 75.4-98.6). The 4-m gait speed was very weakly correlated to the 1st and 2nd peak (r = 0.005, p = 0.936 and r=0.181, p = 0.004), and the daily-life gait speed percentiles (range: 1st percentile r = 0.076, p = 0.230 to 99th percentile r = 0.399, p < 0.001; 50th percentile r = 0.132, p = 0.036).

Conclusions: The 4-m gait speed is only weakly related to daily-life gait speed. Clinicians and researchers should consider that 4-m gait speed and daily-life gait speed represent two different constructs.
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http://dx.doi.org/10.1016/j.maturitas.2018.12.008DOI Listing
March 2019

Comparison of Standard Clinical and Instrumented Physical Performance Tests in Discriminating Functional Status of High-Functioning People Aged 61⁻70 Years Old.

Sensors (Basel) 2019 Jan 22;19(3). Epub 2019 Jan 22.

Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 BT Amsterdam, The Netherlands.

Assessment of physical performance by standard clinical tests such as the 30-sec Chair Stand (30CST) and the Timed Up and Go (TUG) may allow early detection of functional decline, even in high-functioning populations, and facilitate preventive interventions. Inertial sensors are emerging to obtain instrumented measures that can provide subtle details regarding the quality of the movement while performing such tests. We compared standard clinical with instrumented measures of physical performance in their ability to distinguish between high and very high functional status, stratified by the Late-Life Function and Disability Instrument (LLFDI). We assessed 160 participants from the PreventIT study (66.3 ± 2.4 years, 87 females, median LLFDI 72.31, range: 44.33⁻100) performing the 30CST and TUG while a smartphone was attached to their lower back. The number of 30CST repetitions and the stopwatch-based TUG duration were recorded. Instrumented features were computed from the smartphone embedded inertial sensors. Four logistic regression models were fitted and the Areas Under the Receiver Operating Curve (AUC) were calculated and compared using the DeLong test. Standard clinical and instrumented measures of 30CST both showed equal moderate discriminative ability of 0.68 (95%CI 0.60⁻0.76), = 0.97. Similarly, for TUG: AUC was 0.68 (95%CI 0.60⁻0.77) and 0.65 (95%CI 0.56⁻0.73), respectively, = 0.26. In conclusion, both clinical and instrumented measures, recorded through a smartphone, can discriminate early functional decline in healthy adults aged 61⁻70 years.
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http://dx.doi.org/10.3390/s19030449DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387343PMC
January 2019

Predictors of metabolic syndrome in community-dwelling older adults.

PLoS One 2018 31;13(10):e0206424. Epub 2018 Oct 31.

Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.

Objectives: The metabolic syndrome has been associated with a variety of individual variables, including demographics, lifestyle, clinical measures and physical performance. We aimed to identify independent predictors of the prevalence and incidence of metabolic syndrome in a large cohort of older adults.

Methods: The Longitudinal Aging Study Amsterdam is a prospective cohort including community-dwelling adults aged 55-85 years. Metabolic syndrome was defined according to criteria of the National Cholesterol Education Program Adult Treatment Panel III. The incidence of metabolic syndrome was calculated over a period of three years. Stepwise backward logistic regression analyses were used to identify predictors, including variables for demographics, lifestyle, clinical measures and physical performance, both in a cross-sectional cohort (n = 1292) and a longitudinal sub-cohort (n = 218).

Results: Prevalence and incidence of metabolic syndrome were 37% (n = 479) and 30% (n = 66), respectively. Cross-sectionally, heart disease (OR: 1.91, 95% CI: 1.37-2.65), peripheral artery disease (OR: 2.13, 95% CI: 1.32-3.42), diabetes (OR: 4.74, 95% CI: 2.65-8.48), cerebrovascular accident (OR: 1.92, 95% CI: 1.09-3.37), and a higher Body Mass Index (OR: 1.32, 95% CI: 1.26-1.38) were significant independent predictors of metabolic syndrome. Longitudinally, Body Mass Index (OR: 1.16, 95% CI: 1.05-1.27) was an independent predictor of metabolic syndrome.

Conclusion: Four age related diseases and a higher Body Mass Index were the only predictors of metabolic syndrome in the cross-sectional cohort, despite the large variety of variables included in the multivariable analysis. In the longitudinal sub-cohort, a higher Body Mass Index was predictive of developing metabolic syndrome.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206424PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6209297PMC
April 2019

Do Older Adults Select Appropriate Motor Strategies in a Stepping-Down Paradigm?

Front Physiol 2018 12;9:1419. Epub 2018 Oct 12.

Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.

Selecting motor strategies in daily life tasks requires a perception of the task requirements as well as of one's own physical abilities. Age-related cognitive and physical changes may affect these perceptions. This might entail that some older adults select inappropriate movement strategies when confronted with daily-life motor tasks, which could lead to balance loss or falls. We investigated whether older adults select motor strategies in accordance with their actual physical ability. Twenty-one older adults were subjected to a stepping down paradigm, in which full-body kinematics of selected and reactive behavior were recorded. Stepping down from a curb can be done with either (1) a relatively low effort but more balance threatening heel landing, or (2) a more controlled but more demanding toe landing. The probability of selecting a toe landing grows with an increase in curb height. We determined the curb height at which participants switched from heel to toe landing during expected stepping down over different heights as an indicator of their perceived ability. During an unexpected step down trial, participants encountered a step down of 0.1 m earlier than expected, because part of the walkway was removed and covered by a black cloth. We evaluated participants' actual physical ability from the reactive behavior, with performance defined as the reduction in kinetic energy between the peak value after landing and the onset of the next step. To unravel whether the selected motor strategies corresponded with actual physical ability, the ability to recover from the unexpected step down was correlated to the height at which the participants switched movement strategy. The switching height was not correlated to the ability to recover from an unexpected step down (ρ = 0.034, = 0.877). This finding suggests that older adults do not select their movement strategy in stepping down based on their actual abilities, or have an imprecise perception of their actual abilities. Future research should evaluate whether inappropriate motor strategy selection in a stepping down paradigm can explain accidental falls in older adults.
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http://dx.doi.org/10.3389/fphys.2018.01419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6194179PMC
October 2018

Catch the ruler: concurrent validity and test-retest reliability of the ReacStick measures of reaction time and inhibitory executive function in older people.

Aging Clin Exp Res 2019 Aug 9;31(8):1147-1154. Epub 2018 Oct 9.

Neuroscience Research Australia, University of New South Wales, Sydney, Australia.

Background: Reduced cognitive function, particularly executive function (EF), is associated with an increased risk of falling in older people. We evaluated the utility of the ReacStick test, a clinical test of reaction time, and inhibitory EF developed, for young athletes, for fall-risk assessment in older people.

Aims: To evaluate the psychometric properties of ReacStick measures of reaction time and executive functioning in healthy community-dwelling older people.

Methods: 140 participants (aged 77 ± 5 years) underwent testing. Two test conditions-simple and inhibitory go/no-go-provided measures of reaction time, recognition load (difference in reaction time between conditions), and go/no-go accuracy. Concurrent validity was evaluated against the conventional tests of reaction time and EF (simple hand reaction time, trail-making test, and Stroop colour test). Discriminant ability was determined for fall-risk factors (age, gender, physiological profile assessment, and fall history). Test-retest reliability after 1 week was evaluated in 30 participants.

Results: ReacStick reaction time correlated with tests of reaction time and EF, recognition load correlated with inhibitory EF, and go accuracy correlated with reaction time and inhibitory EF. No-go accuracy was not significantly correlated with any of the reaction time and EF tests. Test-retest reliability was good-to-excellent (ICC > 0.6) for all the outcomes. ReacStick reaction time discriminated between groups based on age, recognition load between genders, and no-go accuracy between retrospective fallers and non-fallers.

Discussion: An unavoidable time pressure may result in complementary information to the traditional measures.

Conclusions: The ReacStick is a reliable test of reaction time and inhibitory EF in older people and could have value for fall-risk assessment.
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http://dx.doi.org/10.1007/s40520-018-1050-6DOI Listing
August 2019

Where to Step? Contributions of Stance Leg Muscle Spindle Afference to Planning of Mediolateral Foot Placement for Balance Control in Young and Old Adults.

Front Physiol 2018 21;9:1134. Epub 2018 Aug 21.

Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands.

Stable gait requires active control of the mediolateral (ML) kinematics of the body center of mass (CoM) and the base of support (BoS) in relation to each other. Stance leg hip abductor (HA) muscle spindle afference may be used to guide contralateral swing foot placement and adequately position the BoS in relation to the CoM. We studied the role of HA spindle afference in control of ML gait stability in young and older adults by means of muscle vibration. Healthy young ( = 12) and older (age > 65 years, = 18) adults walked on a treadmill at their preferred speed. In unperturbed trials, individual linear models using each subject's body CoM position and velocity at mid-swing as inputs accurately predicted foot placement at the end of the swing phase in the young [mean = 0.73 ( 0.11)], but less so in the older adults [mean = 0.60 ( 0.14)]. In vibration trials, HA afference was perturbed either left or right by vibration (90 Hz) in a random selection of 40% of the stance phases. After vibrated stance phases, but not after unvibrated stance phases in the same trials, the foot was placed significantly more inward than predicted by individual models for unperturbed gait. The effect of vibration was stronger in young adults, suggesting that older adults rely less on HA spindle afference. These results show that HA spindle afference in the stance phase of gait contributes to the control of subsequent ML foot placement in relation to the kinematics of the CoM, to stabilize gait in the ML direction and that this pocess is impaired in older adults.
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http://dx.doi.org/10.3389/fphys.2018.01134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6110888PMC
August 2018

The association between age and accelerometry-derived types of habitual daily activity: an observational study over the adult life span in the Netherlands.

BMC Public Health 2018 07 4;18(1):824. Epub 2018 Jul 4.

McRoberts BV, The Hague, The Netherlands.

Background: Advances in sensor technology allow for objective and high-resolution monitoring of physical activity and sedentary behaviour. Novel epidemiological data is required to provide feedback on an individual's habitual daily activity in comparison to peers and might eventually lead to refined physical activity guidelines.

Methods: We merged data of 762 people between 18 and 99 years of age, who all wore a DynaPort MoveMonitor accelerometer on their lower back during 1 week in daily-life, to provide insight into habitual types and durations of daily activities, and examine the association between age and physical activity and sedentary behaviour.

Results: We found associations between age and almost all activity outcomes. These associations suggested that physical activity declines and sedentary behaviour increases from the age of 50. We further describe an association with gender, with men walking more often in fewer but longer bouts and having fewer, longer bouts of sitting and standing.

Conclusions: These data provide a valuable reference and may call for more age- and gender-specific activity interventions.
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http://dx.doi.org/10.1186/s12889-018-5719-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031182PMC
July 2018

Concurrent validity and reliability of the Community Balance and Mobility scale in young-older adults.

BMC Geriatr 2018 07 3;18(1):156. Epub 2018 Jul 3.

Network Aging Research (NAR), Heidelberg University, Bergheimer Straße 20, DE-69115, Heidelberg, Germany.

Background: With the growing number of young-older adults (baby-boomers), there is an increasing demand for assessment tools specific for this population, which are able to detect subtle balance and mobility deficits. Various balance and mobility tests already exist, but suffer from ceiling effects in higher functioning older adults. A reliable and valid challenging balance and mobility test is critical to determine a young-older adult's balance and mobility performance and to timely initiate preventive interventions. The aim was to evaluate the concurrent validity, inter- and intrarater reliability, internal consistency, and ceiling effects of a challenging balance and mobility scale, the Community Balance and Mobility Scale (CBM), in young-older adults aged 60 to 70 years.

Methods: Fifty-one participants aged 66.4 ± 2.7 years (range, 60-70 years) were assessed with the CBM. The Fullerton Advanced Balance scale (FAB), 3-Meter Tandem Walk (3MTW), 8-level balance scale, Timed-Up-and-Go (TUG), and 7-m habitual gait speed were used to estimate concurrent validity, examined by Spearman correlation coefficient (ρ). Inter- and intrarater reliability were calculated as Intra-class-correlations (ICC), and internal consistency by Cronbach alpha and item-total correlations (ρ). Ceiling effects were determined by obtaining the percentage of participants reaching the highest possible score.

Results: The CBM significantly correlated with the FAB (ρ = 0.75; p < .001), 3MTW errors (ρ = - 0.61; p < .001), 3MTW time (ρ = - 0.35; p = .05), the 8-level balance scale (ρ = 0.35; p < .05), the TUG (ρ = - 0.42; p < .01), and 7-m habitual gait speed (ρ = 0.46, p < .001). Inter- (ICC = 0.97), intrarater reliability (ICC = 1.00) were excellent, and internal consistency (α = 0.88; ρ = 0.28-0.81) was good to satisfactory. The CBM did not show ceiling effects in contrast to other scales.

Conclusions: Concurrent validity of the CBM was good when compared to the FAB and moderate to good when compared to other measures of balance and mobility. Based on this study, the CBM can be recommended to measure balance and mobility performance in the specific population of young-older adults.

Trial Registration: Trial number: ISRCTN37750605 . (Registered on 21/04/2016).
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http://dx.doi.org/10.1186/s12877-018-0845-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031142PMC
July 2018
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