Elsevier

Archives of Gerontology and Geriatrics

Volume 55, Issue 2, September–October 2012, Pages 480-485
Archives of Gerontology and Geriatrics

Postural balance and physical activity in daily life (PADL) in physically independent older adults with different levels of aerobic exercise capacity

https://doi.org/10.1016/j.archger.2012.04.009Get rights and content

Abstract

Balance impairs with aging and may cause mobility limitations and functional decline. We aimed to evaluate postural balance and PADL in physically independent older adults with different levels of exercise capacity. One hundred fifty seven physically independent individuals, aged 60 years or older were evaluated. Postural balance assessment was performed during one-legged stance test using a force-platform and maximum exercise capacity with the incremental shuttle walking test (ISWT). PADL was assessed subjectively by the modified Baecke questionnaire and objectively using a pedometer. Based on the performance achieved in the ISWT, according to the percentage of the predicted value, the older adults were separated into 3 groups: low performance group (LP group, ISWT < 80% predicted, n = 32, 19 women), normal performance group (NP group, 80  ISWT  100% predicted, n = 30, 22 women) and high performance group (HP group, ISWT > 100% predicted, n = 95, 67 women). The HP group showed better postural balance when compared to LP groups (p < 0.001) and also higher levels of PADL measured with pedometer (p < 0.001). There was a modest correlation (r = 0.45) between exercise capacity and PADL in the LP group and a weak correlation between exercise capacity and balance (r = −28) in the HP group. Physically independent older adults with more preserved exercise capacity have better postural balance and higher levels of PADL in comparison to those older adults who show a poorer condition in terms of exercise capacity.

Introduction

The most important physiological changes that occur during the aging process (Fleg et al., 2005) are the decline in both muscle strength and aerobic capacity. There is a decrease at the rate of approximately 1% per year of maximum aerobic capacity after senescence (Dehn & Bruce, 1972). Although age itself is thought to contribute to this decline, the reduction in vigorous physical activity (Ogawa et al., 1992) and muscle mass (Rosen, Sorkin, Goldberg, Hagberg, & Katzel, 1998) associated with aging exacerbate the process. These physiologic decrements in maximal strength and cardiopulmonary fitness probably contribute to weakness and loss of independence in daily life function (Dutta, 1997). As the older adults often use the limit of their capacity to fulfill the activities of daily life (Hortobagyi, Mizelle, Beam, & DeVita, 2003), the determination of the physical remnants is very important to make clinical decision (Bautmans, Lambert, & Mets, 2004).

As laboratory assessment is not widely available and may be expensive, field tests such as the ISWT have become increasingly popular to assess maximal exercise capacity (Probst et al., 2012). The ISWT is commonly used for assessing exercise capacity in patients with cardiopulmonary diseases, but is still little explored for evaluation of healthy individuals. Probst et al. (2012) assessed exercise capacity of a group of healthy subjects 18–83 years and developed a reference equation for predicting ISWT for this population. Another recent study evaluated a group of health individuals between 40 and 60 years by using the ISWT and correlated it with balance measures (Spagnuolo, Jurgensen, Iwama, & Dourado, 2010).

Balance is another function that often becomes impaired with aging (Corriveau et al., 2000, Horak et al., 1989, Hughes et al., 1996). Balance involves several control systems, including motor control mechanisms and sensory integrative processes (visual, vestibular, and proprioceptive), which undergo significant changes with age (Stelmach et al., 1989, Woollacott and Shumway-Cook, 1990).

Few studies have investigated the relationship between exercise capacity and balance and the results are controversial. Spagnuolo et al. (2010) observed that there is a close relationship between the performance achieved on the ISWT and balance evaluated by the Berg balance scale in individuals between 40 and 84 years (r = 0.61). In contrast, Hughes et al. (1996), when studying frail elderly without apparent disease living in the community, found no correlation between postural balance and functional performance assessed with the 6-min walking test.

Regarding the level of PADL, previous studies have shown a link between the relatively sedentary status of older adults population and poor balance performance (Gauchard et al., 2003, Prioli et al., 2005), which suggests that this effect may be reversed through increased physical activity (Onambélé et al., 2008). Studies in adult populations show that there is an inverse association between age and number of steps accumulated per day (Tudor-Locke et al., 2004, Tudor-Locke et al., 2009). Physical activity levels decline significantly with age (Westerterp & Meijer, 2001), and nearly 60% of older people without disabilities are insufficiently active or overtly inactive (Brown, Yore, Ham, & Macera, 2005). Epidemiological studies have shown that self-reported levels of physical activity in older adults are associated with performance in mobility tasks (Rantanen et al., 1999) and independence in activities of daily living (LaCroix, Guralnik, Berkman, Wallace, & Satterfield, 1993). Morie et al. (2010) found that older men with high levels of PADL showed better aerobic capacity compared to less active individuals. However, the inverse relationship cannot be affirmed.

Hence, considering that there are still gaps regarding the interaction between postural balance and physical performance in the older adults, the aim of this study was to evaluate postural balance and physical activity level in daily life in physically independent older adults with different levels of aerobic exercise capacity.

Section snippets

Design and subjects

A cross-sectional study was conducted from September 2009 to December 2010. The convenience sample consisted of older adults who participated on an interdisciplinary project (EELO Project – study on aging and longevity). The EELO Project is a thematic project developed at Universidade Norte do Paraná (UNOPAR) which aimed to evaluate the socio-demographic factors and indicators of health conditions of older adults in Londrina, a city of Northern Paraná, Brazil. Information can be found at //www2.unopar.br/sites/eelo/

Results

The characteristics of subjects are described in Table 1. There were the same number of elderly on the LP and NP group and a higher number of older adults on the HP group. The groups were similar regarding gender and BMI, but in terms of age, the older adults on the LP group were older than the others. All referred comorbidities were grouped into categories depending on the affected system and those reported most frequently are described in Table 2. The comparison of the performance

Discussion

This study showed that physically independent older adults with more preserved exercise capacity have better postural balance and higher levels of PADL.

Regarding the performance in the ISWT and the one-leg stance test, it was found that subjects who showed greater distance (HP group) were also those with the highest stability during the balance test. This may be related to the fact that walking and standing in one leg require an ability to stand in unilateral weight bearing. The relationship

Conclusion

In summary, physically independent older adults with more preserved exercise capacity have better postural balance and higher levels of PADL in comparison to those who show a poorer condition in terms of exercise capacity. However, the absence of correlations between exercise capacity and measures of balance and PADL suggests that despite the ability of exercise to be a contributing factor it cannot be considered a determining factor of balance and PADL.

Conflict of interest

None.

Funding source

RAS and VSP are supported by Fundação Nacional de Desenvolvimento do Ensino Superior Particular (FUNADESP, Brazil).

Acknowledgments

The authors would like to thank the university students who helped with the data collection of the study. We are also grateful to all professors from the Centre of Research in Health Sciences, who contributed to the development of the study.

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