Clemens Becker

• Professor
• Head of Department at University of Heidelberg Germany

The amount of walking that people with chronic obstructive pulmonary disease (COPD) do is reduced. However, data on their manner of walking ( i.e. , gait) is still lacking. We characterised real-world gait in COPD by assessing levels and distributions of gait parameters, and comparing them across COPD severity, and with healthy peers. 549 people wi...

Background/Objectives: The burden of disease caused by fragility fractures, and hip fractures in particular, is significant both from a personal and a societal perspective. Digital technologies such as wearable devices now allow a real-world assessment of walking and physical mobility, describing temporal and spatial measures. Built on a transparen...

Background The inability to appropriately react to balance perturbations is a common cause of falls. Perturbation-based balance training (PBT) is especially beneficial for improving reactive balance and shows high potential for fall prevention. However, its dose–response relationship, feasibility, and acceptability remain to be determined among ol...

Zusammenfassung Die postakute stationäre Geriatrische Rehabilitation ist eine wirksame Therapieform für ältere Patienten mit funktionellen Defiziten durch chronische Dekonditionierung oder akuter Erkrankung. Durch das Rehabilitationsstärkungsgesetz und die aktualisierte Reha-Richtlinie soll die Anmeldung zur Geriatrischen Rehabilitation erleichtert...

Zusammenfassung Die vorhersehbaren demographischen Veränderungen haben endlich zu einem proaktiven gesundheitspolitischen Diskurs in Deutschland geführt. Durch die Verabschiedung der Krankenhausstrukturreform werden überfällige Veränderungen angestoßen, die einen Teil der Probleme adressieren. Benötigt wird jedoch ein systemischer Ansatz, der vor a...

Background Orthogeriatric co-management (OGCM) has been proposed as care model for geriatric patients with fragility fractures. However, its impact on nursing home (NH) admissions following non-hip fractures is unclear. This study aims to assess the association between OGCM and the probability of NH admissions within 6 months in older patients with...

Highlights What are the main findings? Clinical lower limb assessments (both subjective and objective) were more discriminative in differentiating between the four PFF recovery groups in older adults. Older adults in the acute proximal femoral fracture recovery group demonstrated lower physical activity intensity compared to those in later recovery...

Disability overcomes mortality burden in older adults with hip fracture, expanding unhealthy lifespan. Building comprehensive assessment, pre-fracture functional status and 30-day post-surgical recovery are the most powerful predictors of 5-years survival. A tool supporting estimation of long-term survival may optimize the appropriate delivery of t...

Purpose Current evidence on the use of eHealth in geriatric rehabilitation is limited. This aim of this study was to achieve international consensus on three key eHealth-related topics in geriatric rehabilitation: the use, domains, and scientific evaluation of eHealth. Additionally, we developed a model that provides insight into the use of eHealth...

Wearable and lightweight devices facilitate real-world physical activity (PA) assessments. MX metrics, as a cut-point-free parameter, evaluate acceleration above which the most active X minutes are accumulated. It provides insights into the intensity of PA over specific durations. This study evaluated the association of MX metrics and clinical test...

The L-test is a performance-based measure to assess balance and mobility. Currently, the primary outcome from this test is the time required to finish it. In this study we present the instrumented L-test (iL-test), an L-test wherein mobility is evaluated by means of a wearable inertial sensor worn at the lower back. We analyzed data from 113 people...

Walking is crucial for active and healthy ageing, but changes with age and in the presence of chronic conditions. In the field of chronic obstructive pulmonary disease (COPD) – a highly prevalent chronic condition at older ages - extensive research has been done on physical activity limitation, but little is known about the patterns of walking duri...

Hip fracture is the most frequent non-intentional injury of older persons leading to hospital admission in North America and Europe. Hip fracture rehabilitation follows the overall goal to get older persons back on their feet and mobile again, up to the point of functional and mobility-related independence in everyday life. This primary outcome, ho...

BACKGROUND Recent technological advances in wearable devices offer new potential for measuring mobility in real-world contexts. Mobilise-D has validated digital mobility outcomes to provide novel outcomes and endpoints in clinical research of four different long-term health conditions (Parkinson’s disease (PD), Multiple Sclerosis (MS), Chronic Obst...

Background Recent technological advances in wearable devices offer new potential for measuring mobility in real-world contexts. Mobilise-D has validated digital mobility outcomes to provide novel outcomes and end points in clinical research of 4 different long-term health conditions (Parkinson disease, multiple sclerosis, chronic obstructive pulmon...

Introduction: Walking impairment is an important risk factor for falls, hospitalisations and mortality. Yet, guidelines still have to be defined for obtaining valid and reliable walking activity (e.g., number of steps per day) and gait (e.g., walking speed) parameters in the real world. Objectives: i) identify the minimal daily wearing time during...

Background The main focus of rehabilitation following hip fracture is to regain mobility. Objectives To estimate the progression of real-world mobility the first year after hip fracture using digital mobility outcomes. Design An exploratory, prospective cohort study with pooled data from four previously conducted clinical trials. Setting and Sub...

BACKGROUND Algorithms estimating real-world digital mobility outcomes (DMOs) are increasingly validated in healthy adults and various disease cohorts. However, their accuracy and reliability in older adults after hip fractures, who often walk slowly for short durations, is underexplored. OBJECTIVE The objective of this study was to examine DMO acc...

Background Algorithms estimating real-world digital mobility outcomes (DMOs) are increasingly validated in healthy adults and various disease cohorts. However, their accuracy and reliability in older adults after hip fracture, who often walk slowly for short durations, is underexplored. Objective This study examined DMO accuracy and reliability in...

Background The Timed Up and Go test (TUG) is recommended as an evidence-based tool for measuring physical capacity. Instrumented TUG (iTUG) approaches expand classical supervised clinical applications offering the potential of self-assessment for older adults. Objective This study aimed to evaluate the concurrent validity and test-retest reliabili...

Objective This study investigated the effectiveness of supramaximal high-intensity interval training (supramaximal HIT) on muscle capacities and physical function compared to moderate-intensity training (MIT) for older adults. Methods Sixty-eight older adults (66–79 years, 56% women), not engaged in regular exercise, were randomised to 3 months of...

Introduction The ability to respond effectively to external perturbations is crucial for avoiding falls. The Stepping Threshold Test (STT) has been developed to assess this reactive balance, but its ability to discriminate between fallers and non-fallers is still unsubstantiated. This study aimed to evaluate the discriminant validity of the STT in...

Peoples' walking efficiency declines as they grow older, posing constraints on mobility, and affecting independence and quality of life. Although wearable assistive technologies are recognized as a potential solution for age-related movement challenges, few have proven effective for older adults, predominantly within controlled laboratory experimen...

Purpose Walking is crucial for active and healthy ageing, but it changes with age and in the presence of diverse health conditions, such as non-communicable diseases. In the field of the chronic lung disease COPD (chronic obstructive pulmonary disease), extensive research has been done on physical activity limitation, but little is known about the...

Falls pose a significant health risk, particularly for older people and those with specific medical conditions. Therefore, timely fall detection is crucial for preventing fall-related complications. Existing fall detection methods often have high false alarm or false negative rates, and many rely on handcrafted features. Additionally, most approach...

Progressive gait impairment is common among aging adults. Remote phenotyping of gait during daily living has the potential to quantify gait alterations and evaluate the effects of interventions that may prevent disability in the aging population. Here, we developed ElderNet, a self-supervised learning model for gait detection from wrist-worn accele...

Background Vertebral and pelvic fractures are associated with a significant burden of negative health and psychosocial outcomes. The number of vertebral and pelvic fractures is increasing in an aging society. Vertebral and pelvic fractures are increasingly significant injuries for individuals and society. However, few epidemiological studies have e...

Hintergrund Im Alter gilt die mangelnde Fähigkeit, selbständig vom Boden aufzustehen, als Risikofaktor für zukünftige Stürze und den Schweregrad sturzbedingter Verletzungen. Mit der Backward-Chaining-Methode (BCM) kann diese Fähigkeit verbessert werden. Ziel In einer Machbarkeitsstudie wurde der Einsatz der BCM bei älteren Patient*innen mit sturzbe...

Introduction Sex differences are commonly reported for hip fracture incidence rates and recovery. Current knowledge about mobility recovery after hip fracture involves clinical assessments of physical capacity or patient-reported outcomes. Information on mobility performance during daily life is missing but relevant to evaluate patients’ recovery....

Background Orthogeriatric co-management (OGCM) addresses the special needs of geriatric fracture patients. Most of the research on OGCM focused on hip fractures while results concerning other severe fractures are rare. We conducted a health-economic evaluation of OGCM for pelvic and vertebral fractures. Methods In this retrospective cohort study,...

Orthogeriatric co-management (OGCM) describes a collaboration of orthopedic surgeons and geriatricians for the treatment of fragility fractures in geriatric patients. While its cost-effectiveness for hip fractures has been widely investigated, research focusing on fractures of the upper extremities is lacking. Thus, we conducted a health economic e...

Background The main focus of rehabilitation following hip fracture is to regain mobility. Objectives To estimate the progression of real-world mobility the first year after hip fracture using digital mobility outcomes. Design An exploratory, prospective cohort study with pooled data from four previously conducted clinical trials. Setting and Sub...

Background In Germany, geriatricians deliver acute geriatric care during acute hospital stay and post-acute rehabilitation after transfer to a rehabilitation clinic. The rate patients receive acute geriatric care (AGC) or are transferred to post-acute rehabilitation (TPR) differs between hospitals. This study analyses the association between the tw...

Background Wrist-worn inertial sensors are used in digital health for evaluating mobility in real-world environments. Preceding the estimation of spatiotemporal gait parameters within long-term recordings, gait detection is an important step to identify regions of interest where gait occurs, which requires robust algorithms due to the complexity of...

Digitized assessments have a considerable potential to guide clinicial decision making and monitor progress and disease trajectories. The Timed Up and Go test (TUG) has been long established for assessment in geriatric medicine and instrumented versions (iTUG) have been developed and validated. This scoping review includes studies that applied the...

Progressive gait impairment is common in aging adults. Remote phenotyping of gait during daily living has the potential to quantify gait alterations and evaluate the effects of interventions that may prevent disability in the aging population. Here, we developed ElderNet, a self-supervised learning model for gait detection from wrist-worn accelerom...

This study aimed to validate a wearable device's walking speed estimation pipeline, considering complexity, speed, and walking bout duration. The goal was to provide recommendations on the use of wearable devices for real-world mobility analysis. Participants with Parkinson's Disease, Multiple Sclerosis, Proximal Femoral Fracture, Chronic Obstructi...

Background Fall prevention is important for healthy ageing, but the economic impact of fall prevention are scarcely investigated. A recent cost-effectiveness analysis compared a group-delivered Lifestyle-integrated Functional Exercise Program (gLiFE) with an individually-delivered program (LiFE) in community-dwelling people (aged ≥ 70 years) at ris...

Zusammenfassung Die Bedeutung der Wirbelkörperfrakturen, die zu einer Krankenhauseinweisung führen nimmt zu. Dieser Anstieg ist nicht nur demographisch bedingt. Die Fallzahlen der LWK-, BWK- und HWK Frakturen sind altersadjustiert in den letzten 15 Jahren um weit mehr als 100% angestiegen. Ein ähnlicher Anstieg wird auch für die Beckenfrakturen beo...

This study aimed to validate a wearable device’s walking speed estimation pipeline, considering complexity, speed, and walking bout duration. The goal was to provide recommendations on the use of wearable devices for real-world mobility analysis. Participants with Parkinson’s Disease, Multiple Sclerosis, Proximal Femoral Fracture, Chronic Obstructi...

In Germany, different models of orthogeriatric co-management have been implemented in certified geriatric trauma centers. So far, it is not clear how the different models are implemented and what influence the certification has on the structures and processes within the centers. The present study examined the extent of cooperation between surgery a...

After a hip fracture, rehabilitation starts with the primary aim to get older persons back on their feet and mobile again. Multidisciplinary hospital treatment is suggested as the first essential step for optimization of care immediately after the fracture, followed by subacute exercise interventions to further improve mobility. However, reported o...

As people grow older, their walking efficiency declines, posing constraints on mobility and affecting independence and overall life quality. While wearable assistive technologies are recognized as a potential solution for age-related movement challenges, few have proven effective for older adults, predominantly within controlled laboratory experime...

Orthogeriatric co-management (OGCM) may provide benefits for geriatric fragility fracture patients in terms of more frequent osteoporosis treatment and fewer re-fractures. Yet, we did not find higher costs in OGCM hospitals for re-fractures or antiosteoporotic medication for most fracture sites within 12 months, although antiosteoporotic medication...

Introduction The clinical assessment of mobility, and walking specifically, is still mainly based on functional tests that lack ecological validity. Thanks to inertial measurement units (IMUs), gait analysis is shifting to unsupervised monitoring in naturalistic and unconstrained settings. However, the extraction of clinically relevant gait paramet...

Few older adults regain their pre-fracture mobility after a hip fracture. Intervention studies evaluating effects on gait typically use short clinical tests or in-lab parameters that are often limited to gait speed only. Measurements of mobility in daily life settings exist and should be considered to a greater extent than today. Less than half of...

Background: To reduce falls and their consequences, evidence-based and consensus-based recommendations are needed for risk stratification, screening, assessment, and fall prevention as well as treatment. In 2020, the Federal Falls Prevention Initiative (BIS) published recommendations for physical training for falls prevention as a group or individ...

Purpose Walking is crucial for an active and healthy ageing, but it changes with age and in the presence of diverse health conditions, such as non-communicable diseases and injuries. So far, conceptual frameworks of walking have not included the impact of these conditions and individuals’ lived experiences on their walking. Thus, we aimed to identi...

Hintergrund und Zielsetzung Das Lifestyle-integrated-Functional-Exercise(LiFE)-Programm ermöglicht eine Steigerung der körperlichen Aktivität. Bisher ist unklar, wie sich das Aktivitätsmuster hinsichtlich der Dauer der Gehepisoden ändert. Ziel der Arbeit Die Veränderungen der kurzen bzw. langen Gehepisoden innerhalb von 6 Monaten sollen untersucht...

Zusammenfassung Stürze sind der wichtigste Risikofaktor für Frakturen im Alter. Epidemiologische Studien haben viele Risikofaktoren für Stürze identifiziert, die durch strukturiertes körperliches Training beeinflussbar sind. Dieser Artikel beschreibt die Evidenz zu Inhalten, Methoden und Belastungsdosierung eines körperlichen Trainings zur Vermeidu...

Introduction Perturbation-based balance training (PBT) targets the mechanism of falls (eg, slipping, tripping) to specifically train the recovery actions needed to avoid a fall. This task-specific training has shown great promise as an effective and efficient intervention for fall prevention in older adults. However, knowledge about the dose–respon...

Background Gait characteristics are important risk factors for falls, hospitalisations, and mortality in older adults, but the impact of COPD on gait performance remains unclear. We aimed to identify differences in gait characteristics between adults with COPD and healthy age-matched controls during (1) laboratory tests that included complex moveme...

BACKGROUND Wrist worn inertial sensors are used in digital health for evaluating mobility in real-world environments. Preceding the estimation of spatio-temporal gait parameters within continuous long-term recordings, gait detection is an important step to identify regions of interest where gait occurs, which requires robust algorithms due to the c...

Thousands of Apps offer guidance on exercise, and consumer electronics such as wristbands or smartphones increasingly offer tools to measure physical activity and mobility. The promised analysis goes far beyond step counting. In sharp contrast, the evidence of mobile gait analysis based on these mass products is rare at best. Seemingly trivial tech...

Background Although digital mobility outcomes (DMOs) can be readily calculated from real-world data collected with wearable devices and ad-hoc algorithms, technical validation is still required. The aim of this paper is to comparatively assess and validate DMOs estimated using real-world gait data from six different cohorts, focusing on gait sequen...

Background: Falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Objective: To synthesize evidence-based and expert consensus-based 2022 world guidelines for the management and prevention of...

Zusammenfassung Die Definition von relevanten Trainingszielen und deren weitgehend individualisierte Allokation zu Gruppen unterschiedlicher Anforderungen sollte der erste Schritt einer jeden Trainingsstrategie zur optimierten Trainingsplanung und sicheren Trainingsdurchführung sein. Die Festlegung der Trainingsziele im Bereich der Frakturprophylax...

Zusammenfassung Trainingsprotokolle zur Frakturprophylaxe müssen eine Vielzahl von trainingswissenschaftlichen, logistischen und finanziellen Rahmenbedingungen berücksichtigen, um die erwünschte Effektivität und Anwendbarkeit im Einzel- oder Gruppentraining zu gewährleisten. Basierend auf dem individuellen Risikoprofil ist eine Zuordnung von dedizi...

Background Estimation of walking speed from wearable devices requires combining a set of algorithms in a single analytical pipeline. The aim of this study was to validate a pipeline for walking speed estimation and assess its performance across different factors (complexity, speed, and walking bout duration) to make recommendations on the use and v...

Background: Knowledge about the causal factors leading to falls is still limited, and fall prevention interventions urgently need to be more effective to limit the otherwise increasing burden caused by falls in older people. To identify individual fall risk, it is important to understand the complex interplay of fall-related factors. Although fall...

The aim of the present systematic review and meta-analysis was to determine the effects of exercise on low-trauma overall and major osteoporotic fractures in adults. Our systematic search of six literature databases according to the PRISMA guideline was conducted up to May 22, 2021, and included controlled clinical exercise trials with (a) individu...

Introduction: Accurately assessing people’s gait, especially in real-world conditions and in case of impaired mobility, is still a challenge due to intrinsic and extrinsic factors resulting in gait complexity. To improve the estimation of gait-related digital mobility outcomes (DMOs) in real-world scenarios, this study presents a wearable multi-sen...

This study assessed the concurrent validity and test–retest-reliability of the Apple Health app on iPhone for measuring gait parameters in different age groups. Twenty-seven children, 28 adults and 28 seniors equipped with an iPhone completed a 6-min walk test (6MWT). Gait speed (GS), step length (SL), and double support time (DST) were extracted f...

BACKGROUND Knowledge about the causal factors leading to falls is still limited, and fall prevention interventions urgently need to be more effective to limit the otherwise increasing burden caused by falls in older people. To identify individual fall risk, it is important to understand the complex interplay of fall-related factors. Although fall e...

BACKGROUND Older adults are at increased risk of developing health disorders and functional decline. A comprehen-sive geriatric assessment (CGA) to identify early signs of negative trajectories has enormous potential for patients, society and health care system. However, due to time constraints and considerable effort physicians rarely conduct the...

Background Older adults are at increased risk of developing health disorders and functional decline. However, owing to time constraints and considerable effort, physicians rarely conduct comprehensive assessments to detect early signs of negative trajectories. If designed properly, digital technologies could identify health risks already at a precl...

Background This study aimed to explore the acceptability of a wearable device for remotely measuring mobility in the Mobilise-D technical validation study (TVS), and to explore the acceptability of using digital tools to monitor health. Methods Participants ( N = 106) in the TVS wore a waist-worn device (McRoberts Dynaport MM + ) for one week. Fol...

Background: the individually delivered Lifestyle-integrated Functional Exercise (LiFE) was shown to improve physical activity (PA) and reduce fall incidence, however being rather resource-consuming due to one-to-one delivery. A potentially less resource-intensive group format (gLiFE) was developed and compared against the original program, consider...

With an ageing global population and an increasing focus on aging in place, the number of people in need of geriatric rehabilitation (GR) is rapidly increasing. As current GR practice is very heterogenous, cross-country comparisons could allow us to learn from each other and optimise the effectiveness of GR. However, international GR research comes...

Accurately assessing people's gait, especially in real-world conditions and in case of impaired mobility, is still a challenge due to intrinsic and extrinsic factors resulting in gait complexity. To improve the estimation of gait-related digital mobility outcomes (DMOs) in real-world scenarios, this study presents a wearable multi-sensor system (IN...

Background: walking is crucial for an active and healthy ageing, but the perspectives of individuals living with walking impairment are still poorly understood. Objectives: to identify and synthesise evidence describing walking as experienced by adults living with mobility-impairing health conditions and to propose an empirical conceptual framew...

Background The ability to walk is an important indicator of general health and mobility deficits have wide-ranging economic implications. We undertook a systematic review to elucidate the impact of walking parameters on health care costs. Methods Publications reporting on associations between health care costs and walking parameters were identifi...

Background Measuring mobility in daily life entails dealing with confounding factors arising from multiple sources, including pathological characteristics, patient specific walking strategies, environment/context, and purpose of the task. The primary aim of this study is to propose and validate a protocol for simulating real-world gait accounting f...

Background falls are common in older adults, and any fall from standing height onto a rigid surface has the potential to cause a serious brain injury or bone fracture. Safe strategies for falling in humans have traditionally been difficult to study. Objective to determine whether specific ‘safe landing’ strategies (body rotation during descent, an...

Coronavirus disease 2019 (COVID-19) poses a threat to the health and independence of older people in particular. In this article we elaborate on the content and importance of post-acute COVID-19 geriatric rehabilitation from a European perspective. We explain the geriatric rehabilitation paradox and how this can and should be solved. We also presen...

Background Physiotherapy and occupational therapy are currently described using the duration of treatment (days or weeks), the frequency of therapy sessions (on a daily or 3–5 days per week basis) and considering the duration of a session (e.g., 30 or 45 min). The content is often poorly defined and the intensity is rarely reported. Using digital t...

Background: Perceived benefits of intervention programs from a participant perspective can be examined by assessing their willingness to pay (WTP). Aiming to support decision-makers in their decision to implement a fall prevention program, this study examined (1) the WTP for a group-based and an individually delivered fall prevention program, (2)...

Aufgrund der gegenwärtigen demographischen Entwicklung wird dem Erhalt der Funktionalität des älteren Patienten in den nächsten Jahren sowohl aus individueller als auch aus gesellschaftlicher Perspektive eine hohe Bedeutung zukommen. Das geriatrische Syndrom der Sarkopenie, welches den altersassoziierten Abbau von Muskelkraft und Muskelmasse bezeic...