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      The effects of 8 weeks of inspiratory muscle training on the balance of healthy older adults: a randomized, double‐blind, placebo‐controlled study

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          Abstract

          To examine the effects of 8‐week unsupervised, home‐based inspiratory muscle training ( IMT) on the balance and physical performance of healthy older adults. Fifty‐nine participants (74 ± 6 years) were assigned randomly in a double‐blinded fashion to either IMT or sham‐ IMT, using a pressure threshold loading device. The IMT group performed 30‐breath twice daily at ~50% of maximal inspiratory pressure ( MIP). The sham‐ IMT group performed 60‐breaths once daily at ~15% MIP; training was home‐based and unsupervised, with adherence self‐reported through training diaries. Respiratory outcomes were assessed pre‐ and postintervention, including forced vital capacity, forced expiratory volume, peak inspiratory flow rate ( PIFR), MIP, and inspiratory peak power. Balance and physical performance outcomes were measured using the shortened version of the Balance Evaluation System test (mini‐ BEST), Biodex ® postural stability test, timed up and go, five sit‐to‐stand, isometric “sit‐up” and Biering–Sørensen tests. Between‐group effects were examined using two‐way repeated measures ANOVA, with Bonferroni correction. After 8‐week, the IMT group demonstrated greater improvements ( P ≤ 0.05) in: PIFR ( IMT = 0.9 ± 0.3 L sec −1; sham‐ IMT = 0.3 L sec −1); mini‐ BEST ( IMT = 3.7 ± 1.3; sham‐ IMT = 0.5 ± 0.9) and Biering–Sørensen ( IMT = 62.9 ± 6.4 sec; sham‐ IMT = 24.3 ± 1.4 sec) tests. The authors concluded that twice daily unsupervised, home‐based IMT is feasible and enhances inspiratory muscle function and balance for community‐dwelling older adults.

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          Sit-to-stand performance depends on sensation, speed, balance, and psychological status in addition to strength in older people.

          Sit-to-stand (STS) performance is often used as a measure of lower-limb strength in older people and those with significant weakness. However, the findings of recent studies suggest that performance in this test is also influenced by factors associated with balance and mobility. We conducted a study to determine whether sensorimotor, balance, and psychological factors in addition to lower-limb strength predict sit-to-stand performance in older people. Six hundred and sixty nine community-dwelling men and women aged 75-93 years (mean age 78.9, SD = 4.1) underwent quantitative tests of strength, vision, peripheral sensation, reaction time, balance, health status, and sit-to-stand performance. Many physiological and psychological factors were significantly associated with sit-to-stand times in univariate analyses. Multiple regression analysis revealed that visual contrast sensitivity, lower limb proprioception, peripheral tactile sensitivity, reaction time involving a foot-press response, sway with eyes open on a foam rubber mat, body weight, and scores on the Short-Form 12 Health Status Questionnaire pain, anxiety, and vitality scales in addition to knee extension, knee flexion, and ankle dorsiflexion strength were significant and independent predictors of STS performance. Of these measures, quadriceps strength had the highest beta weight, indicating it was the most important variable in explaining the variance in STS times. However, the remaining measures accounted for more than half the explained variance in STS times. The final regression model explained 34.9% of the variance in STS times (multiple R =.59). The findings indicate that, in community-dwelling older people, STS performance is influenced by multiple physiological and psychological processes and represents a particular transfer skill, rather than a proxy measure of lower limb strength.
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            Endurance times for low back stabilization exercises: clinical targets for testing and training from a normal database.

            To establish isometric endurance holding times, as well as ratios between torso extensors, flexors, and lateral flexors (stabilizers), for clinical assessment and rehabilitation targets. Simple measurement of endurance times in four tests performed in random order by a healthy cohort. To measure reliability, a subsample also performed the tests again 8 weeks later. University laboratory. Seventy-five young healthy subjects (31 men, 44 women). Women had longer endurance times than men for torso extension, but not for torso flexion or for the "side bridge" exercise, which challenges the lateral flexors (stabilizers). Men could sustain the "side bridge" for 65% of their extensor time and 99% of their flexion time, whereas women could sustain the "side bridge" for only 39% of their extensor time and 79% of their flexion time. The tests proved reliable, with reliability coefficients of >.97 for the repeated tests on 5 consecutive days and again 8 weeks later. Healthy young men and women possess different endurance profiles for the spine stabilizing musculature. Given the growing support for quantification of endurance, these data of endurance times and their ratios between extensor, flexor, and lateral flexor groups in healthy normal subjects are useful for patient evaluation and for providing clinical training targets.
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              The importance of trunk muscle strength for balance, functional performance, and fall prevention in seniors: a systematic review.

              The aging process results in a number of functional (e.g., deficits in balance and strength/power performance), neural (e.g., loss of sensory/motor neurons), muscular (e.g., atrophy of type-II muscle fibers in particular), and bone-related (e.g., osteoporosis) deteriorations. Traditionally, balance and/or lower extremity resistance training were used to mitigate these age-related deficits. However, the effects of resistance training are limited and poorly translate into improvements in balance, functional tasks, activities of daily living, and fall rates. Thus, it is necessary to develop and design new intervention programs that are specifically tailored to counteract age-related weaknesses. Recent studies indicate that measures of trunk muscle strength (TMS) are associated with variables of static/dynamic balance, functional performance, and falls (i.e., occurrence, fear, rate, and/or risk of falls). Further, there is preliminary evidence in the literature that core strength training (CST) and Pilates exercise training (PET) have a positive influence on measures of strength, balance, functional performance, and falls in older adults. The objectives of this systematic literature review are: (a) to report potential associations between TMS/trunk muscle composition and balance, functional performance, and falls in old adults, and (b) to describe and discuss the effects of CST/PET on measures of TMS, balance, functional performance, and falls in seniors. A systematic approach was employed to capture all articles related to TMS/trunk muscle composition, balance, functional performance, and falls in seniors that were identified using the electronic databases PubMed and Web of Science (1972 to February 2013). A systematic approach was used to evaluate the 582 articles identified for initial review. Cross-sectional (i.e., relationship) or longitudinal (i.e., intervention) studies were included if they investigated TMS and an outcome-related measure of balance, functional performance, and/or falls. In total, 20 studies met the inclusionary criteria for review. Longitudinal studies were evaluated using the Physiotherapy Evidence Database (PEDro) scale. Effect sizes (ES) were calculated whenever possible. For ease of discussion, the 20 articles were separated into three groups [i.e., cross-sectional (n = 6), CST (n = 9), PET (n = 5)]. The cross-sectional studies reported small-to-medium correlations between TMS/trunk muscle composition and balance, functional performance, and falls in older adults. Further, CST and/or PET proved to be feasible exercise programs for seniors with high-adherence rates. Age-related deficits in measures of TMS, balance, functional performance, and falls can be mitigated by CST (mean strength gain = 30 %, mean effect size = 0.99; mean balance/functional performance gain = 23 %, mean ES = 0.88) and by PET (mean strength gain = 12 %, mean ES = 0.52; mean balance/functional performance gain = 18 %, mean ES = 0.71). Given that the mean PEDro quality score did not reach the predetermined cut-off of ≥6 for the intervention studies, there is a need for more high-quality studies to explicitly identify the relevance of CST and PET to the elderly population. Core strength training and/or PET can be used as an adjunct or even alternative to traditional balance and/or resistance training programs for old adults. Further, CST and PET are easy to administer in a group setting or in individual fall preventive or rehabilitative intervention programs because little equipment and space is needed to perform such exercises.
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                Author and article information

                Contributors
                fferraro@bournemouth.ac.uk
                Journal
                Physiol Rep
                Physiol Rep
                10.1002/(ISSN)2051-817X
                PHY2
                physreports
                Physiological Reports
                John Wiley and Sons Inc. (Hoboken )
                2051-817X
                09 May 2019
                May 2019
                : 7
                : 9 ( doiID: 10.1002/phy2.2019.7.issue-9 )
                : e14076
                Affiliations
                [ 1 ] Department of Human Sciences and Public Health Bournemouth University Bournemouth United Kingdom
                [ 2 ] School of Health Sciences University of Southampton Southampton United Kingdom
                [ 3 ] Orthopaedic Research Institute Bournemouth University Bournemouth United Kingdom
                Author notes
                [*] [* ] Correspondence

                Francesco V. Ferraro, Department of Human Sciences and Public Health, Bournemouth University, Royal London House, Christchurch Road, Bournemouth BH1 3LT, United Kingdom.

                Tel: +44 (0)1202 964207

                E‐mail: fferraro@ 123456bournemouth.ac.uk

                Author information
                https://orcid.org/0000-0002-4902-7760
                Article
                PHY214076
                10.14814/phy2.14076
                6509064
                31074198
                d6264ea7-d95b-40cd-bad8-9aed01694d9d
                © 2019 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 07 January 2019
                : 28 March 2019
                : 02 April 2019
                Page count
                Figures: 2, Tables: 4, Pages: 12, Words: 8061
                Funding
                Funded by: Bournemouth University
                Categories
                Ageing and Degeneration
                Endurance and Performance
                Skeletal Muscle
                Muscle Structure and Function
                Control of Breathing
                Original Research
                Original Research
                Custom metadata
                2.0
                phy214076
                May 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.2.1 mode:remove_FC converted:09.05.2019

                breathing exercise,falls prevention,frail elderly,mini‐best,postural balance

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