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Single Limb Stance Times: A Descriptive Meta-Analysis of Data From Individuals at Least 60 Years of Age

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  • Physical Therapy Consultants

Abstract and Figures

This meta-analysis was conducted to derive normative reference values for single limb stance (SLS) with the eyes opened. The initial analysis involving 22 studies and 3484 participants (60-99 years) identified a mean SLS time of 15.7 seconds. As the studies did not provide homogeneous data, further analysis focused on 3 age groups (60-69, 70-79, and 80-99 years). Data from these individual age groups were homogeneous. Mean SLS times for the groups were 27.0, 17.2, and 8.5 seconds, respectively. These times and the lower limits of the confidence intervals associated with them offer useful estimates of normal SLS times to which the SLS times of tested individuals can be compared.
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Topics in Geriatric Rehabilitation
Vol. 22, No. 1, pp. 70–77
c
2006 Lippincott Williams & Wilkins, Inc.
Single Limb Stance Times
A Descriptive Meta-Analysis of Data
From Individuals at Least 60 Years
of Age
Richard W. Bohannon, PT, EdD, NCS, FAHA
This meta-analysis was conducted to derive normative reference values for single limb stance
(SLS) with the eyes opened. The initial analysis involving 22 studies and 3484 participants (60–
99 years) identified a mean SLS time of 15.7 seconds. As the studies did not provide homo-
geneous data, further analysis focused on 3 age groups (60–69, 70–79, and 80–99 years). Data
from these individual age groups were homogeneous. Mean SLS times for the groups were 27.0,
17.2, and 8.5 seconds, respectively. These times and the lower limits of the confidence inter-
vals associated with them offer useful estimates of normal SLS times to which the SLS times of
tested individuals can be compared. Key words: aging,balance,measurement,normative
reference values
TESTS AND MEASURES of balance are a
fundamental component of clinicians’ ex-
amination of patients with a variety of dis-
eases and disorders.1Although there are nu-
merous options for quantifying standing bal-
ance, the time an individual can stand on one
lower limb (ie, single limb stance [SLS] or
unipedal balance) has been used widely, ei-
ther alone or as part of a larger test battery.
Wolfson et al described SLS time as “one of
the most challenging gauges of stability while
standing on a narrow area of support” and
averred it to be “the most frequently used
measure of balance in physical training stud-
ies involving older adults.”
2The reliability of
From the School of Allied Health, University of
Connecticut, Storrs, Conn; and Physical Therapy
Consultants, West Hartford, Conn.
I am grateful to the following individuals who provided
clarifying information or data related to their studies:
Jasminka Ilich-Ernst, PhD; Fredric D. Wolinsky, PhD;
Robert Bulbulian, PhD; and Vasilios I. Kalapotharakos,
PhD.
Corresponding author: Richard W. Bohannon, PT, EdD,
NCS, FAHA, School of Allied Health, University of Con-
necticut, 358 Mansfield Rd, U-2101, Storrs, CT 06269
(e-mail: richard.bohannon@uconn.edu).
the test has not received much attention,3–5
but its validity has been demonstrated by its
relationship with other important variables
such as gait performance,6,7fall status,8,9self-
sufficiency in instrumental activities of daily
living,10,11 and frailty.10,11 Several investiga-
tors have suggested 5 seconds as a criterion
standard for SLS times.9,11,12 Others have re-
ported values for SLS times that were intended
to be, or might be used as, normative refer-
ence values.13–29 An examination of the stud-
ies reporting these times shows considerable
variability in the measurement specifics re-
ported as well as the times described. The pur-
pose of this project therefore was to exam-
ine these studies and employ meta-analysis to
better typify normal balance of elders as de-
scribed by SLS times (with eyes opened).
METHODS
The identification of relevant studies
involved electronic searches of MEDLINE
(1966–2005), CINAHL (1982–2005), and
EMBASE (1995–2005). The searches were
limited to works that involved human partic-
ipants and were published in English. The
70
lwwj201-13 January 23, 2006 22:14 Char Count= 0
SINGLE LIMB STANCE TIMES
last search was conducted in July of 2005.
The terms unipedal, one, single, leg, stand,
stance, and balance were used in appropriate
combinations in the searches. Articles with
abstracts suggesting them to be relevant were
retrieved. Reference lists of these articles
were checked for other potentially relevant
articles, which were in turn retrieved. All re-
trieved articles were examined for fulfillment
of 2 inclusion criteria: reporting of means
and standard deviations for SLS times (with
eyes opened) and testing of participants who
were aged 60 years and older. Studies and
data were excluded if focused on individuals
known to have balance-limiting pathologies
(eg, stroke) or problems (eg, falling).
Retained articles were abstracted for infor-
mation on participants, test specifics, and SLS
times. Abstracted information was then tab-
ulated and entered into a Statistical Package
for the Social Sciences (SPSS) database. As
multiple SLS times were sometimes reported
for the same participants (eg, left and right,
with and without shoes), only the best SLS
time for any group (eg, 75–79 years, nondom-
inant side, shoes on) was entered into the
database.
All analyses were conducted via SPSS (Ver-
sion 11.0) for Windows and the meta-analytic
syntax for SPSS posted by Wilson.30 Specifi-
cally used were a meta-analysis analog to the 1-
way analysis of variance (METAF.SPS) and a de-
scriptive meta-analysis (MEANES.SPS) for any
type of effect size.
RESULTS
Twenty-two studies were included in the
analysis (Table 1). Thirteen involved American
participants, 2 involved Swedish participants,
and 1 each involved Chinese, Polish, Japanese,
Australian, Korean, and Greek participants.
Data used were based on one (preferred/self-
selected, dominant or nondominant side) or
both lower limbs. Depending on the study,
testing was performed with shoes on, off,
or under both the conditions. The maximum
time allowed for the test was often not stated.
When stated however the most frequent time
was 30 seconds (10 studies). Times of 60 sec-
onds (3 studies) and 45 seconds (2 studies)
were also stated. The number of trials was of-
ten not stated but ranged from 1 to 5 when
indicated. In studies where more than a sin-
gle trial was used, the measurement used was
often not stipulated. When designated, it was
either the best/maximum time or the average
time.
Depending on the multiple factors, the
criterion SLS times were variable (Table 1),
but mean times ranged from 4.3 to 57.7 sec-
onds. The results of the meta-analyses are pre-
sented in Table 2. Analysis using data from
all 3484 participants of the 22 studies ana-
lyzed revealed a mean SLS time of 15.7 sec-
onds for individuals aged between 60 and 99
years. The descriptive meta-analysis showed
that the data of the different studies were not
homogeneous (Q=95.41, P<.0001). When
data from the 13 studies whose 1867 partic-
ipants could be divided into 3 age groups
(60–69, 70–79, and 80–99 years) were com-
pared using the analysis of variance, a sig-
nificant between-group difference was noted
(Q=12.44, P=.0020). The overall mean for
these data was 17.8 seconds. The data from
the studies contributing to each individual age
group were homogeneous (Q=1.46–7.80,
P.8562). The mean times for the age groups
were 27.0, 17.2, and 8.5 seconds, respectively.
DISCUSSION
The results of this meta-analysis provide
an estimate of normal SLS times (with eyes
opened) for healthy elders. Based as they
are on the consolidation of data from multi-
ple sources, the normative reference values
are derived from a larger sample of elders
than was tested in any one study. They there-
fore probably provide a more precise estimate
than would be available otherwise.
The meta-analysis confirmed the well-
established relationship between age and bal-
ance. That is, balance diminishes as age
increases.31 Consequently, it is best that
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BOHANNON
Table 1. Summary of studies reporting single leg stance times for apparently healthy elders
Study Participants Test specifics Times, s
Wolinsky et al3261 African American men
and women (60–65 y)
Limb: self-selected
Shoes: not stated
Maximum time: 30 s
Trials: not stated
Measurement: not stated
15.1 ±11.6
Iverson et al18 54 American men (60–90
y), noninstitutionalized,
independent in ADL, walk
without assistive device
Limb: both
Shoes: on
Maximum time: 30 s
Trials: 3
Measurement: not stated
15.9 ±11.5 (right, first)
16.9 ±12.2 (left, first)
20.7 ±10.5 (right, best)
21.9 ±10.2 (left, best)
Bohannon
et al13
61 American men and
women (60–79 y), no
vertigo or neurologic or
orthopaedic dysfunction
of the trunk or lower
extremities
Limb: both
Shoes: off
Maximum time: 30 s
Trials: 5
Measurement: mean of best
time for both limbs
14.2 ±9.3 (70--79 y)
22.5 ±8.6 (60--69 y)
Lin et al22 765 Chinese men and
women (65 y), no
disability in ADL
Limb: either
Shoes: not stated
Maximum time: none
Trials: not stated
Measurement: not stated
9.7 ±12.7
Jedrychowski
et al19
559 Polish men (65–89 y),
healthy, independent, and
active lives, excluded if
residents of homes for
elderly and long-stay
geriatric wards
Limb: both
Shoes: not stated
Maximum time: not stated
Trials: not stated
Measurement: mean of times
for both limbs
17.3 ±17.9 (80--89 y)
22.3 ±24.8 (75--79 y)
31.6 ±36.9 (70--74 y)
57.7 ±58.0 (65--69 y)
Briggs et al471 American women
(60–86 y), healthy,
independent in ADL, able
to walk without assistive
device, excluded if
serious musculoskeletal
or neurologic problems
Limb: both
Shoes: off and on
Maximum time: 45 s
Trials: 3
Measurement: best time for
each limb
9.7 ±10.4 (75–79 y,
dominant, shoes off)
10.2 ±12.2 (80–86 y,
nondominant, shoes on)
10.6 ±11.3 (80–86 y,
dominant, shoes on)
10.8 ±11.8 (75–79 y,
dominant, shoes on)
10.8 ±12.9 (75–79 y,
nondominant, shoes off)
12.0 ±12.9 (75--79 y,
nondominant, shoes
on)
12.3 ±11.5 (80--86 y,
dominant, shoes off)
13.0 ±13.9 (80–86 y,
nondominant, shoes off)
18.6 ±14.8 (70–74 y,
dominant, shoes on)
19.6 ±16.6 (70–74 y,
nondominant, shoes on)
(Continues)
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SINGLE LIMB STANCE TIMES
Table 1. Summary of studies reporting single leg stance times for apparently healthy elders
(Continued)
Study Participants Test specifics Times, s
19.8 ±18.0 (70–74 y,
nondominant, shoes off)
20.1 ±16.0 (70--74 y,
dominant, shoes off)
23.9 ±18.6 (65–69 y,
nondominant, shoes on)
23.9 ±18.6 (65–69 y,
nondominant, shoes on)
24.3 ±16.8 (65–69 y,
dominant, shoes on)
25.7 ±18.6 (65–69 y,
nondominant, shoes off)
28.3 ±17.9 (65--69 y,
dominant, shoes off)
34.1 ±14.0 (60–64 y,
nondominant, shoes on)
37.8 ±13.9 (60–64 y,
nondominant, shoes off)
38.1 ±13.0 (60–64 y,
dominant, shoes off)
38.5 ±11.6 (60--64 y,
dominant, shoes on)
Rudisill and
Toole24
60 American men and
women (60–79 y), most
active in recreational or
fitness activity
Limb: either
Shoes: not stated
Maximum time: not stated
Trials: 3
Measurement: not stated
11.1 ±12.2 (70--79 y,
women)
14.5 ±14.2 (70--79 y,
men)
17.1 ±16.4 (60--69 y,
men)
20.5 ±12.3 (60--69 y,
women)
MacRae et al894 American men and
women (60–89 y), living
independently in the
community, walk without
assistance
Limb: self-selected
Shoes: bare feet
Maximum time: 30 s
Trials: 2 after 1 practice trial
Measurement: best time
17.2 ±11.9
Gehlsen et al26 30 American men and
women (71.3 ±4.4 y), no
history of falls
Limb: not stated
Shoes: not stated
Maximum time: not stated
Trials: not stated
Measurement: not stated
18.7 ±10.1
Kinugasa et al6495 Japanese men and
women (65–89 y)
Limb: preferred
Shoes: not stated
Maximum time: 60 s
Trials: not stated
Measurement: not stated
38.6 ±22.5
(Continues)
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Table 1. Summary of studies reporting single leg stance times for apparently healthy elders
(Continued)
Study Participants Test specifics Times, s
Hill et al27 96 Australian women (>70
y), community dwelling,
independent in domestic
ADL, walk without
assistive device, regularly
going outdoors, no falls in
previous year
Limb: both
Shoes: not stated
Maximum time: 30 s
Trials: not stated
Measurement: not stated
9.2 ±5.6 (80+y, right)
11.4 ±8.4 (80+y, left)
18.2 ±10.2 (75–79 y, left)
18.7 ±10.0 (75--79 y,
right)
19.8 ±8.7 (70–74 y, left)
21.9 ±8.3 (70--74 y,
right)
Kim et al28 253 Korean women (65–84
y), participants in adult
education programs
Limb: preferred
Shoes: not stated
Maximum time: not stated
Trials: 3
Measurement: not stated
4.2 ±4.5 (80--84 y)
6.9 ±9.7 (75--79 y)
9.4 ±10.2 (70--74 y)
13.7 ±14.8 (65--69 y)
Wiksten et al25 26 American women (>60
y), healthy, nondisabled,
excluded if had
conditions that might
limit balance or muscle
performance
Limb: both
Shoes: off (bare foot)
Maximum time: 45 s
Trials: 3
Measurement: best time of
each limb
33.0 ±14.4 (dominant)
33.3 ±16.0
(nondominant)
Netz and
Argov23
252 Israeli men and women
(60–89 y), independent,
community dwelling
Limb: both Shoes: not stated
Maximum time: 60 s
Trials: 2
Measurement: best time of
each limb
7.1 ±13.3 (80–89 y, left)
7.7 ±13.2 (80--89 y,
right)
16.0 ±17.6 (70–79 y, left)
18.4 ±19.5 (70--79 y,
right)
22.5 ±20.6 (60–69 y, left)
26.4 ±22.2 (60--69 y,
right)
Wolfson et al277 American men and
women (75 y),
excluded if unable to
walk 8 m without
assistance, diagnosed
with neurologic disease
affecting mobility, taking
balance- or strength-
impairing medications
Limb: not stated
Shoes: off (bare foot)
Maximum time: 30 s
Trials: 2
Measurement: best time
5.4 ±0.9
9.1 ±2.3
10.4 ±2.5
12.2 ±2.7
El-Kashlan
et al15
30 American men and
women (60–79 y),
excluded if had vestibular
or health problems
contributing to
disequilibrium
Limb: both
Shoes: not stated
Maximum time: 30 s
Trials: 3
Measurement: mean of 3
17.5 ±10.5 (70–79 y, left)
18.2 ±10.0 (70--79 y,
right)
25.8 ±6.2 (60–69 y, left)
27.1 ±6.4 (60--69 y,
right)
Bulbulian and
Hargan14
56 American men and
women (60–80 y), no
medical, pathological, or
pharmacological factors
affecting balance
Limb: dominant
Shoes: on (gym)
Maximum time: 60 s
Trials: not stated
Measurement: not stated
42.8 ±20.4 (60--69 y)
35.6 ±23.0 (70--79 y)
(Continues)
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SINGLE LIMB STANCE TIMES
Table 1. Summary of studies reporting single leg stance times for apparently healthy elders
(Continued)
Study Participants Test specifics Times, s
Greendale
et al16
59 American men and
women (>60 y), excluded
if had pain limiting
function or injurious falls,
used assistive devices
Limb: not stated
Shoes: not stated
Maximum time: not stated
Trials: not stated
Measurement: not stated
15.9 ±1.5
Gustafson
et al17
17 Swedish men and
women (73–80 y),
healthy, active
Limb: both
Shoes: off (bare foot)
Maximum time: 30 s
Trials: not stated
Measurement: best
20.9 ±11.6
Kronhed et al21 30 Swedish men and
women (70–75 y),
healthy, community
dwelling, walked safely
without aids
Limb: both
Shoes: off (bare foot)
Maximum time: 30 s
Trials: 3
Measurement: best
12.0 ±11.0 (right)
16.0 ±12 (left)
20.0 ±10.0 (left)
21.0 ±10.0 (right)
Kalapotharakos
et al20
33 Greek men and women
(60–74 y), inactive but
without limitations in
ADL
Limb: nondominant
Shoes: off
Maximum time: no limit
Trials: 3
Measurement: best
28.5 ±10.0 (70--74 y,
men)
47.2 ±18.5 (60--69 y,
women)
48.0 ±15.0 (60--69 y,
men)
Lindsey et al29 105 American women
(60–88 y)
Limb: both
Shoes: not stated
Maximum time: 30 s
Trials: 1 after 1 practice trial
Measurement: best
28.1 ±5.3 (60--69 y)
16.6 ±10.7 (70--79 y)
16.8 ±13.2 (80--89 y)
ADL indicates activities of daily living.
Times used in meta-analysis are set in bold.
judgments as to the normality of SLS perfor-
mance be based on the 3 age groups (60–69,
70–79, and 80–99 years) presented in Table 2.
The age groups contain fewer participants,
Table 2. Summary of meta-analysis of single limb stance times
Total Seconds balanced, Homogeneity,
Age category, y Studies/groups (n) sample (N) mean (95% CI) Q(P)
60–99 22/49 3484 15.7 (12.6–18.7) 95.41 (.0001)
60–69, 70–79, 80–99 13/37 1867 17.8 (14.1–21.6) 12.44 (.0020)
60–69 11/14 851 27.0 (20.4–33.7) 7.80 (.8562)
70–79 12/17 870 17.2 (11.6–22.8) 4.91 (.9962)
80–99 6/6 146 8.5 (1.0–16.1) 1.46 (.9178)
CI indicates confidence interval.
but their data are homogeneous and the lower
limits of their confidence intervals do provide
a standard below which an individual’s per-
formance can be considered less than normal.
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The standards for 60- to 69-year-olds (20.4 sec-
onds) and 70- to 79-year-olds (11.6 seconds)
surpass the 5-second test duration used by
Vellas et al9and described as crucial by
Jonsson et al.12 The criterion standard for
80- to 99-year-olds (1.0 second) is less than
5 seconds.
This study had several limitations. First, the
consolidated sample for the oldest age group
(80–99 years) was not particularly large (n=
146). Second, many potentially relevant deter-
minants of balance (other than age) could not
be addressed. In some cases, information was
not specified (eg, shoes on or off). In other
cases, there were too few studies in which a
condition was present to warrant subgroup
analysis. Finally, the meta-analysis employed
the best SLS performance data reported for
the participants of an included study. Grant-
ing that some consistent rule for selection was
necessary, selection of the best performance
data may have resulted in higher SLS values
(means and lower limit of confidence interval)
than would have been obtained otherwise. At-
tenuating this possibility is the use of maxi-
mum times (eg, 30 seconds), which some in-
dividuals, particularly those who are younger,
may be able to exceed. While the cessation of
timing after a limited period adds to the prac-
ticality of the test, it also leads to a ceiling ef-
fect that can result in the underestimation of
average performance.
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... Functional Gait Assessment. The Functional Gait Assessment is a reliable (Wrisley et al., 2004) and valid (Bohannon, 2006) measure of balance. The assessment consists of 10 tasks in which subjects walk along a 6.0 m long by 0.3048 m wide walkway under a variety of different circumstances: at normal, fast, and slow speeds; with vertical and horizontal head turns; with their eyes closed; over obstacles; in tandem, backward, and up/ down stairs. ...
Article
Motor functioning in persons with serious mental illness (SMI) is not well studied. We assessed motor functioning in people with SMI (n = 15) vs. adults with obesity (n = 15) and healthy controls (n = 15). Motor skills were assessed using balance and coordination tests. Motor planning and performance were assessed in Obstacle and Metronome Walking Tasks. The SMI group scored lower on balance and coordination tests (all ps < 0.001), and took longer steps when approaching obstacles (all ps < 0.001), but had unimpaired motor performance on the Metronome Walking Task. In obesity, excess body mass impairs motor skills, which adversely impacts motor performance. In persons with SMI, motor performance was unimpaired, with cognitive and neuroanatomical abnormalities likely underlying balance, coordination, and motor skill challenges.
... The one-legged balance test is one of the most commonly used balance tests and is widely considered to be cost-effective and feasible in both clinical and research settings (Bohannon, 2006;Jonsson et al., 2004;Mancini and Horak, 2010;Michikawa et al., 2009;Springer et al., 2007). Proponents of the test suggest that it should be implemented into primary care to help identify individuals at higher risk of falling and other poor health outcomes (Kozinc et al., 2020;Michikawa et al., 2009;Nickelston, 2014), emphasising a clear need to systematically review and synthesise the evidence on one-legged balance performance and fall risk. ...
Article
Objective The aim of this systematic review was to synthesise all published evidence on associations between one-legged balance performance and falls. Methods Medline, EMBASE, CINAHL and Web of Science were systematically searched (to January 2021) to identify peer-reviewed, English language journal articles examining the association between one-legged balance performance and falls in community-dwelling adults. Results Of 4 310 records screened, 55 papers were included (n=36 954 participants). There was considerable heterogeneity between studies including differences in study characteristics, ascertainment of balance and falls, and analytical approaches. A meta-analysis of the time that individuals could maintain the one-legged balance position indicated that fallers had worse balance times than non-fallers (standardised mean difference: -0.29(95%CI:-0.38,-0.20) in cross-sectional analyses; -0.19(-0.28,-0.09) in longitudinal analyses), although there was no difference in the pooled median difference. Due to between-study heterogeneity, regression estimates between balance and fall outcomes could not be synthesised. Where assessed, prognostic accuracy indicators suggested that one-legged balance was a poor discriminator of fall risk; for example, 5 of 7 studies demonstrated poor prognostic accuracy (Area Under the Curve <0.6), with most studies demonstrating poor sensitivity. Conclusions This systematic review identified 55 papers that examined associations between balance and fall risk, the majority in older aged adults. However, the evidence was commonly of low quality and results were inconsistent. This contradicts previous perceptions of one-legged balance as a useful fall risk tool and highlights crucial gaps that must be addressed in order to translate such assessments to clinical settings.
... Muscle strength was assessed using a grip force test with a JAMAR dynamometer [29]. Stability was tested by a single limb stance test (eyes closed), which is easy to perform and widely used to assess static balance [30]. This test was initially completed with eyes open to prevent injury and anticipate any patient's inability to perform the test with eyes closed. ...
Article
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Purpose Hematologic patients have a poorer health-related quality of life due to the disease and its treatments. Non-pharmacological interventions represent an opportunity in tertiary cancer prevention to manage persistent symptoms and support patients in their return to active daily living. This interventional study aimed to evaluate the feasibility of a program combining physical exercise (PE) and heart rate variability biofeedback (HRVB) in hematologic patients. Method Hematologic patients in remission within 6 months participated in a 12-week rehabilitation program including 24 supervised sessions of PE associated with 10 supervised sessions of HRVB and daily home-based practice of paced breathing. We assessed patient adherence, fatigue, physical function, and heart rate variability. Results Twenty patients were included, 17 completed the protocol and 3 dropped out due to disease progression or time constraints; no adverse events or incidents were reported. Participation rates were 85% for PE and 98% for HRVB-supervised sessions. Significant improvements of physical capacity (6-min walk test, p < 0.001; 50-foot walk test, p < 0.001), muscle strength (grip force test, p < 0.01), and flexibility (toe-touch test, p < 0.001; back scratch test, p < 0.05) were measured. Coherence ratio (p < 0.001) and low-frequency spectral density of HRV signal (p < 0.003) increased significantly, suggesting improved autonomic function. Fatigue, static balance, and other time and frequency indicators of HRV were not improved (all p > 0.05). Conclusion A rehabilitation program combining PE and HRVB is feasible in hematologic patients and effective on physical function. Further research with a larger sample size is needed to investigate effectiveness on patients’ autonomic functions and their impacts on symptomatology.
... The SLS test is a static balance test that records the time a participant can support the test on one leg without assistance. The SLS was performed three times with a pause between repetitions, and the best value was recorded [39]. The SLS test is a valid test in COPD that can indicate fall risk in COPD [40]. ...
Article
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Purpose This study aims to assess the effect of inspiratory muscle training (IMT) combined with endurance training (ET) on balance in patients with chronic obstructive pulmonary disease (COPD). Methods We studied 32 male patients (62 ± 6 years) with moderate to very severe COPD. They were randomly assigned to an experimental group (IMT+ET) n = 16 or a control group (ET) n = 16 with similar characteristics. The evaluations were carried out at inclusion and after eight weeks of the training period. Functional balance was assessed by the Berg Balance Scale (BBS), the Timed-up and Go (TUG), the Single Leg Stance test (SLS), and the Activities-specific Balance Confidence (ABC) scale. The strength of the inspiratory muscles (PI max ) was assessed by maximal inspiratory mouth pressure. Functional exercise performance was assessed by the 6 minutes walking test (6MWT). IMT program consists in performing two daily sets of 30 inspirations with 50% of PI max increased by 10% every two weeks. ET program consists in performing 30 min treadmill exercise at 60% to 80% of the average speed achieved during the 6MWT three days per week. Results After the training period, the experimental group demonstrated greater improvements in BBS (IMT+ET vs. ET; p = 0.019), and in ABC (IMT+ET vs. ET; p = 0.014). However, no significant differences between groups were observed for TUG, SLS, and 6MWT. There was a significant difference between groups in PI max (IMT+ET vs. ET; p = 0.030). Significant moderate correlations were obtained between ΔPI max and ΔBBS for both groups (IMT+ET: r = 0.624, p = 0.010; ET r = 0.550, p = 0.027) as well as for ΔABC but only in the experimental group (IMT+ET: r = 0.550, p = 0.027). Conclusion Compared to ET alone, the results suggest that IMT combined with ET enhances inspiratory muscle function and functional balance according to BBS and ABC in patients with COPD. We suggest that inspiratory muscle training might be introduced as additional training to pulmonary rehabilitation programs aimed at improving balance in COPD patients. Trial registration The trial registry name: Clinical Trials; Registration number: NCT04084405 ; URL: https://clinicaltrials.gov/ct2/show/NCT04084405 .
... The balance will be measured using the bilateral single-leg stance test. 66 The participants will stand and be asked to lift a foot and hold the position for a maximum of 60 s, then to do the same exercise on the other foot (duration held in equilibrium, 2 times 60 s). ...
Article
Introduction: Despite safety and benefits of physical activity during treatment of localised breast cancer, successful exercise strategies remain to be determined. The primary objective of the 'dispositif connecté', that is, connected device in English trial is to evaluate the efficacy of two 6-month exercise interventions, either single or combined, concomitant to adjuvant treatments, on the physical activity level of patients with breast cancer, compared with usual care: an exercise programme using a connected device (activity tracker, smartphone application, website) and a therapeutic patient education intervention. Secondary objectives are to evaluate adherence to interventions, their impact at 6 and 12 months, representations and acceptability of interventions, and to assess the cost-effectiveness of the interventions using quality-adjusted life-years. Methods and analysis: This is a 2×2 factorial, multicentre, phase III randomised controlled trial. The study population (with written informed consent) will consist of 432 women diagnosed with primary localised invasive breast carcinoma and eligible for adjuvant chemotherapy, hormonotherapy and/or radiotherapy. They will be randomly allocated between one of four arms: (1) web-based connected device (evolving target number of daily steps and an individualised, semisupervised, adaptive programme of two walking and one muscle strengthening sessions per week in autonomy), (2) therapeutic patient education (one educational diagnosis, two collective educational sessions, one evaluation), (3) combination of both interventions and (4) control. All participants will receive the international physical activity recommendations. Assessments (baseline, 6 and 12 months) will include physical fitness tests, anthropometrics measures, body composition (CT scan, bioelectrical impedance), self-administered questionnaires (physical activity profile (Recent Physical Activity Questionnaire), quality of life (European Organization for Research and Treatment of Cancer Quality-Of-Life Questionnaire-30, EQ-5D-5L), fatigue (Piper Fatigue Scale-12), social deprivation (Evaluation of Deprivation and Inequalities in Health Examination Centres), lifestyle, physical activity barriers, occupational status) and biological parameters (blood draw). Ethics and dissemination: This study was reviewed and approved by the French Ethics Committee. The findings will be disseminated to the scientific and medical community via publications in peer-reviewed journals and conference presentations. Trial registration number: NCT03529383; Pre-results.
... Thus, the included women are most likely not representative of the female population at this age. Furthermore, when comparing the risk of fracture associated with short OLST observed in this study with results from other studies, it should be noted that there could be procedural differences between studies in how the OLST results were obtained [60], e.g., using different number of attempts, using the average of both legs, or a single maximum value. ...
Article
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In women of ages 75–80 years, a low one leg standing time (OLST) was associated with an increased risk of incident fractures, independently of bone mineral density and clinical risk factors. OLST contributed substantially to fracture probability, indicating that the test should be considered when evaluating fracture risk in older women.IntroductionPhysical function and risk of falls are important risk factors for fracture. A few previous studies have suggested that a one leg standing time (OLST) less than 10 s predicts fracture risk, but the impact of OLST, in addition to known clinical risk factors, for fracture probability is unknown. The aim of this study was to determine the independent contribution of OLST to fracture probability in older women.Methods The Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone Fractures (SUPERB) is a prospective population-based study of 3028 women 75–80 years old, recruited from the greater Gothenburg area in Sweden. At baseline, information on risk factors was collected using questionnaires, bone mineral density was measured with dual-energy X-ray absorptiometry (DXA), and OLST was performed.ResultsDuring a median follow-up of 3.6 years (IQR 1.5 years), X-ray-verified incident fractures were identified using health records. OLST was available in 2405 women. OLST less than 10 s was associated with an increased risk for incident hip fracture (Hazard Ratio (HR) 3.02, 95% Confidence Interval (CI) [1.49–6.10]), major osteoporotic fracture (HR 95% CI 1.76 [1.34–1.46]), and nonvertebral fracture (HR 95% CI 1.61 [1.26–2.05]) in Cox regression analyses adjusted for age, height, and weight. Depending on BMD, the 4-year fracture probability increased by a factor of 1.3 to 1.5 in a 75-year-old woman with a low OLST (<10 s).ConclusionA low OLST has a substantial impact on fracture probability and should be considered when evaluating fracture risk in older women.
... It measured the time that the patient was able to balance on one leg. The patient chose a leg to stand on (whichever he/she felt more comfortable with), flexed the opposite knee allowing the foot to clear the floor, and balanced on one leg [25]. ...
Article
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Resting hypoxemia is the most severe stage of Chronic Obstructive Pulmonary Disease (COPD). Due to their impairments during the exacerbation, these patients are limited to traditional exercise rehabilitation and are excluded from the majority of the studies. The aim of this study was to assess the feasibility and the efficacy of two exercise programs in Acute Exacerbation of COPD (AECOPD) patients with resting hypoxemia. In this randomized clinical trial, patients hospitalized due to an acute exacerbation of COPD with hypoxemia at rest were included. Patients were randomly assigned into three groups. A Control Group (pharmacological treatment), a Global Exercise Group (GEG), and a Functional Electrostimulation Group (FEG). Patients were treated during the hospitalization period. The main outcomes were lower limb strength (assessed by a dynamometer), balance (assessed by the one leg standing balance test), health related quality of life (assessed by the EQ-5D), adverse events and adherence. At the end of the intervention, there were significant differences in all the variables in favour of the experimental groups (p < 0.05). We concluded that conducting an exercise program is feasible and improves lower limb strength, balance, and health related quality of life in AECOPD patients with resting hypoxemia.
... Protocols for the single-leg stance test vary considerably in the literature with tests sometimes allowing use of either leg or the preferred leg, from one to five trials, and scores recorded as the mean or maximum value of all trials, or the last of two trials (36,38 A c c e p t e d M a n u s c r i p t 16 The ICC reflects the proportion of between-participant variance on the total variance (23). In our study, the major variances for the PBMs with poor reliability in some of the age-stratified analyses are from error (57% to 72%). ...
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BACKGROUND The aim of this study was to determine the relative and absolute reliabilities of five key performance-based measures of physical function in the Canadian Longitudinal Study on Aging (CLSA). METHODS An age-stratified sub-sample of 147 participants from the CLSA who were undergoing their 3-year data collection visit participated in two repeat visits (within one week). Participants underwent tests of grip strength, 4-metre gait speed, Timed Up and Go (TUG), chair-rise and single-leg stance (left, right, mean, maximum). Intra-class correlation coefficients (ICC), standard error of measurement (SEM) and minimal detectable change (MDC) values were calculated. RESULTS The relative reliability for grip strength was excellent (ICC = 0.95); the TUG and single-leg stance tests had good reliability (ICC = 0.80 or 0.78-0.82, respectively); gait speed and the chair-rise test had moderate reliability (ICC=0.64 for both) for participants overall. For participants between 50 and 64 years, TUG and gait speed had poor reliabilities (ICC = 0.38 or 0.33, respectively). For participants aged 75+ years, the single-leg stance had poor reliability (ICC=0.30-0.39). The MDC90 was about 6 kg for grip strength, 2.3 seconds for TUG, 0.2 metres/second for gait speed, 5.2 seconds for chair-rise, and ranged from 22.8 to 26.2 seconds for the single-leg stance. CONCLUSIONS Among community-dwelling Canadians >50 years old, the reliabilities of the CLSA measures were moderate to excellent. The TUG and gait speed in the youngest age group, and the single-leg stance in oldest age group, showed poor reliability. MDC values can be used to interpret changes over time.
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Background: Little is known about how HIV affects walking biomechanics, or about associations between HIV-related gait deviations, functional performance and self-reported outcomes. This paper reports on gait biomechanics and -variability in people with HIV (PWH), and associations with clinical tests, self-reported function and falls. Methods: A cross-sectional study tested consecutively-sampled PWH (n=50) and HIV-seronegative participants (SNP, n=50). Participants underwent three-dimensional gait analysis, performed clinical tests (short walk- and single leg stance tests with and without dual tasking, chair-rise tests and a physical performance battery), and completed questionnaires about function and falls. Between-group comparisons were done using analysis of covariance. Linear correlations between gait variability, clinical tests and patient-reported outcomes were established. Results: PWH and SNP had comparable median ages (PWH 36.6 [IQR 32.0–45.6], SNP 31.1 [23.2–45.1]). Compared with SNP, PWH walked slower (adjusted mean difference [MD]=-0.2 m/s, 95% CI=-0.3; -0.1) with greater variability (adjusted MD=14.7, 95% CI=9.9; 19.5). Moreover, PWH were slower in five-times sit-to-stand (5STS) performance (adjusted MD=1.9 seconds, 95% CI=1.00; 2.9). Significant deviations in hip kinematics (increased flexion; adjusted MDs=2.4°–2.8°, P=.012–.016), and knee kinematics (reduced flexion; adjusted MDs=2.3°–3.7°, P=.007–.027) were found in PWH during dual task walking. PWH’s 5STS moderately correlated with larger gait variability (usual pace r=-0.5; dual task r=-0.6), poorer self-reported mobility- (r=0.4) and self-care function (r=0.5), and fear of falling (P=.003). Conclusions: PWH presented with biomechanical deviations suggestive of a slowed and variable gait, especially under cognitive challenges. Five-times STS may be useful to screen for gait deviations in PWH.
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Background Cognitive integration of sensory input and motor output plays an important role in balance. Despite this, it is not clear if specific cognitive processes are associated with balance and how these associations change with age. We examined longitudinal associations of word memory, verbal fluency, search speed and reading ability with repeated measures of one-legged balance performance. Methods Up to 2934 participants in the MRC National Survey of Health and Development, a British birth cohort study, were included. At age 53, word memory, verbal fluency, search speed and reading ability were assessed. One-legged balance times (eyes closed) were measured at ages 53, 60-64 and 69 years. Associations between each cognitive measure and balance time were assessed using random-effects models. Adjustments were made for sex, death, attrition, height, body mass index, health conditions, health behaviours, education, and occupational class. Results In sex-adjusted models, one SD higher scores in word memory, search speed and verbal fluency were associated with 14.1% (95%CI: 11.3,16.8), 7.2% (4.4,9.9) and 10.3% (7.5,13.0) better balance times at age 53, respectively. Higher reading scores were associated with better balance, although this association plateaued. Associations were partially attenuated in mutually-adjusted models and effect sizes were smaller at ages 60-64 and 69. In fully-adjusted models, associations were largely explained by education, although remained for word memory and search speed. Conclusions Higher cognitive performance across all measures was independently associated with better balance performance in midlife. Identification of individual cognitive mechanisms involved in balance could lead to opportunities for targeted interventions in midlife.
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This study investigated whether 184 volunteers from 20 to 79 years of age could perform eight timed balance tests and examined the relationship between test performance and age. All subjects were able to balance with their feet together and eyes closed for 30 seconds. The ability to balance on the right and left legs did not differ significantly. Subjects over 60 years of age were unable to balance on one leg, particularly when their eyes were closed, for as long a period as younger subjects. The Pearson product-moment and Spearman correlations of age and duration of one-legged balance were −.65 and −.71 (eyes opened) and −.79 and −.75 (eyes closed). The findings suggest that when timed balance tests are performed as a part of a patient's neurologic examination, the results should be interpreted in light of the patient's age. Information is provided to assist in this interpretation.
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Although published studies have indicated the effectiveness of strength exercise for improving muscle strength and functional and neuromotor performance in older adults, there is limited evidence concerning the effects and the intensity of a resistance exercise programme. This study aimed to evaluate the effects of a 12-week high- and moderate-resistance exercise programme on functional and neuromotor performance in healthy, inactive older adults. In total, 33 sedentary people (aged 60–74years) were assigned to one of three groups: control; high resistance exercise; and moderate resistance exercise. All three groups were evaluated in the pre- and post-exercise period using the 6-minute walk test, whole body reaction time and one leg stance time. After the exercise period, both resistance exercise groups significantly improved their lower body strength, functional performance (as measured by the 6-minute walk test), whole body reaction time and one leg stance time. Functional and neuromotor performance improved similarly for both high- and moderate-resistance exercise after the training period. The high-resistance exercise was more effective in increasing the lower body strength than moderate-resistance exercise. Results suggest that functional and neuromotor performance can be significantly improved with both high- and moderate-resistance exercise protocols.
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Physical therapists are encouraged to use the Guide to Physical Therapist Practice (Guide) in their practice. The purpose of this study was to determine whether and how pediatric physical therapists (PTs) use the Guide. A nationwide electronic survey was sent to pediatric physical therapists. Four hundred seventy-five members returned the survey yielding a 9.6% response rate. Respondents reported that they practice consistently with the Guide's patient/client management model but that they do not find the Guide useful. Respondents made recommendations for a future edition of the Guide. Pediatric PTs value the Guide as a reference, resource, and teaching tool. When the Guide is revised, the following should be considered: pediatric content, format, and utility of the Guide; educational needs of pediatric PTs about the Guide; and how stakeholders and PTs with other specialties view and use the Guide.
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The goal of this study was to identify methods for characterizing high-functioning older adults living in the community. The subjects were 495 older adults from the Longitudinal Interdisciplinary Study on Aging conducted by the Tokyo Metropolitan Institute of Gerontology. Physical performance measures included grip strength, walking at preferred and maximum speeds, one-leg standing with eyes open, and finger tapping rate. Performance scores were created by summing each categorical score. Consistent differences were found among age groups and genders. Scores were lower in subjects who had stroke or diabetes than in those without these conditions. These results suggest that physical performance measures have both discriminant validity and construct validity, which make them useful methods for characterizing high-functioning older persons.
Article
This study evaluated a balance-training program's influence in healthy older adults. Fifteen community-dwelling participants aged 70-75 years were randomized to an exercise group, and 15 gender-and age-matched participants, to a control group. The 9-week training program comprised ordinary-life balance, vestibular-habituation, and ball exercises and station training. Clinical balance tests were conducted before and after training. Tests that showed significant improvement in the exercise group after the intervention included standing on the fight leg with eyes closed, standing on the right leg and the left leg while turning the head and walking 30 m. Significant between-group differences were found at posttest. A significant decrease was seen in the control group in the walking-forward test, and this change was significantly different between groups. The study indicates that balance performance in healthy older adults might be improved by balance training including exercises that stimulate multiple sensory systems and their central integration.
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The purpose of this study was to investigate activity fitness of daily living of elderly women in Korea. The subjects were 253 elderly women ranging in age from 65 to 84 years. Twenty items related to the activity fitness of daily living were measured. The Pearson's correlation coefficients between the performance test items and age were significant (P<0.05) and the score of all items remarkably decreased with advancing age. In order to extract activity fitness of daily living, the principal component analysis was applied to the 20×20 correlation matrix. The first principal component was interpreted as fundamental activity fitness (FAF) of daily living. The results of the comparison clearly indicated that the 75-79 and 80-84 age groups were inferior in FAF of daily living. Furthermore, in order to analyze the factorial structure of these elderly women, extracted factors were rotated with normal varimax criterion. The activity fitness (AF) of daily living were categorized to 7 factors : muscular strength and movement of the whole body, flexibility, balance, coordination of upper limbs, agility of upper and lower limbs, endurance, and reaction time. Results of the comparison of AF factors showed that a decline with advancing age was significant for muscular strength and movement of the whole body. The prediction equations of FAF were developed using multiple regression analyses. Results indicated that 8 selected items from 7 factors were significant predictors of the dependent variable FAF. Equally clarified was that 3 of our 8 items could be excluded, while still yielding comparable precision in predicting FAF. On the basis of all our analyses and considering the practicability of the measurement, we recommend the equation FAFS=1.504 X1-0.838 X2-0.489 X3-0.363 X4-0.686 X5 +68.71, with an R=0.850; where FAFS= fundamental activity fitness score, X1=arm curl, X2=walking around two chairs in a figure 8, X3= one foot tapping in a sitting position, X4=sit and reach, X5carrying beans using chopsticks, which can predict FAF with high precision in elderly Korean women.
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In our hospital in 1989 a series of 30 healthy elderly people participated in a study to evaluate the effect of physical training on improving balance. Thereafter, the majority of the people in thi ...
Article
***Note: Figures may be missing from this format of the document Abstract: Aging is associated with decreases in strength and muscle mass. In addition, the ability to maintain balance decreases with age. Few studies have examined the relationship between isokinetic muscle performance and balance performance. It was the purpose of this study to determine if there is a relationship between muscle and balance performance, and to discover how this relationship is affected by age. Fifty-five healthy females were recruited from two different age groups, 28 females who were 18-30 years of age {mean age = 22.9 years ( ± 3.4), height = 163.5 cm (±6.5), weight = 64.8 kg (± 15.7)) and 26 females who were > 60 years of age {mean age = 68.1 years (+ 4.8), height = 159.7 cm (± 10.0), weight = 68.0 kg (± 11.4)1. Concentric and eccentric isokinetic muscle performance for the hip, knee, and ankle was measured using the KinCom isokinetic dynamometer. Balance performance was measured using the sharpened Romberg and one-legged stance tests. Younger subjects performed significantly better than older subjects on all muscle and balance performance variables (P = 0.05 to P = 0.0001), except the sharpened Romberg test with the eyes open. The older group exhibited significant relationships between balance and muscle performance measures (r — 0.10 to r — 0.57). In the older group, hip muscle performance was shown to correlate significantly better with balance performance than knee or ankle muscle performance. Also noted was a significantly greater relationship between muscle performance and balance performance with the eyes closed in the older group, as compared to the younger group. This is the first study known to thoroughly examine the relationship between muscle and balance performance. The presence of significant relationships warrants further examination. It is recommended that this relationship be examined in a broad spectrum of young, old, healthy and disabled populations.
Article
Evaluate the clinical utility of several simple measures of static and dynamic equilibrium in human subjects. In particular, one proposed clinical measure, the Clinical Test of Sensory Integration and Balance (CTSIB) was compared with dynamic posturography for the measurement of postural control capabilities. Cross-sectional study of normal subjects and prospective observational study of the same performance measures in vestibular disorder patients. Academic tertiary care referral center. Data were collected for all test measures from a group of normal subjects (ages, 20 to 79 years), as well as for a group of patients undergoing treatment for vestibular dysfunction. Data suggest that several semiquantitative clinical tests of static and dynamic equilibrium can be helpful in evaluating and monitoring patients with chronic vestibular dysfunction. The CTSIB results seem to correlate well with dynamic posturography, suggesting that this measure may be useful in identifying patients with abnormal postural control. Formal dynamic posturography testing appears to be more sensitive in detecting abnormal postural control and more exact in defining the specific pattern of dysfunction. Simple clinical measures of static and dynamic equilibrium can reliably distinguish vestibular disorder patients from normal subjects. Dynamic posturography continues to play an important role in the functional evaluation and management of vestibular disorder patients.
Article
Falls are a leading cause of fatal and nonfatal injuries among the elderly. Accurate determination of risk factors associated with falls in older adults is necessary, not only for individual patient management, but also for the development of fall prevention programs. The purpose of this study was to evaluate the effectiveness of clinical measures, such as the one-legged stance test (OLST), sit-to-stand test (STST), manual muscle tests (MMT), and response speed in predicting faller status in community-dwelling older adults (N = 94, age 60-89 years). The variables assessed were single-leg standing (as measured by OLST), STST, and MMT of 12 different muscle groups (hip flexors, hip abductors, hip adductors, knee flexors, knee extensors, ankle dorsiflexors, ankle plantarflexors, shoulder flexors, shoulder abductors, elbow flexors, elbow extensors, and finger flexors), and speed of response (as measured by a visual hand reaction and movement time task). Of the 94 older adults assessed, 28 (29.7%) reported at least one fall within the previous year. The discriminant analysis revealed that there were six variables that significantly discriminated between fallers and nonfallers. These variables included MMT of the ankle dorsiflexors, knee flexors, hip abductors, and knee extensors, as well as time on the OLST and the STST. The results indicate that simple clinical measures of musculoskeletal function can discriminate fallers from nonfallers in community-dwelling older adults. J Orthop Sports Phys Ther 1992;16(3):123-128.