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DOI: https://doi.org/10.23670/IRJ.2017.66.012 Мороз Т.П.1, Федотов Д.М.2, Грибанов А.В.3
Младший научный сотрудник института медико-биологических исследований, 2 кандидат медицинских наук, доцент кафедры гигиены и медицинской экологии, магистрант Высшей школы
естественных наук и технологий, 3 доктор медицинских наук, профессор, главный научный сотрудник института медико-биологических исследований, 1,2,3Северный (Арктический) федеральный университет имени М.В. Ломоносова, Архангельск, 2Северный государственный медицинский университет Исследование проводилось при финансовой поддержке Российского государственного регионального научного фонда и Администрации Архангельской области в рамках регионального конкурса «Русский Север: история, современность, перспективы». 17-16-29003 «Ухудшение постурального контроля с возрастом как фактор снижения качества жизни
людей в циркумполярных условиях» ХАРАКТЕРИСТИКА ПОСТУРАЛЬНОГО БАЛАНСА У ЖЕНЩИН 55-64 ЛЕТ
Аннотация
Целью нашей работы явилась оценка качества ходьбы у женщин 55-59 лет при сравнении с женщинами 60-64 лет. В исследовании приняли участие 80 женщин в возрасте 55-64 лет. Данная выборка была разделена на 2 подгруппы: (1) женщины в возрасте 55-59 лет (W55-59, n = 36) и (2) женщины в возрасте 60-64 лет (W60-64, n = 44). Оценка параметров ходьбы производилась при помощи компьютерного стабилометрического комплекса «Balance Manager». Были проведены следующие тесты: «Простая ходьба», «Быстрый разворот» и «Шаг-перешагивание». В тесте «Простая ходьба» отмечается статистически значимое снижение длины шага (p = 0,04) у женщин W60-64 по сравнению с W55-59. Так же было обнаружено значимое увеличение времени разворота влево (p = 0,02) в тесте «Быстрый разворот» у группы женщин W60-64 по сравнению с W55-59. При анализе теста «Шаг-перешагивание» было обнаружено, что в группе женщин W60-64 время движения (справа) (p = 0,05) было выше по сравнению с W55-59. По результатам оценки качества ходьбы, установлено, что уровень сложно- координационных движений и сложных двигательных актов был выше в группе W55-59 по сравнению с W60-64. Группа женщин W60-64 продемонстрировала снижение длины шага и более продолжительное время выполнения разворотов, что может рассматриваться как один из признаков старения и стать причиной снижения координации в будущем.
Ключевые слова: Мобильность, постуральный баланс, старение, женщины.
Moroz T.P.1, Fedotov D.M.2, Gribanov A.V.3
Junior Researcher, Institute of Biomedical Research, 2PhD, Associate Professor of the Department of Hygiene and Medical Ecology, Master student of Higher School of Natural Sciences and Technology, 3 Doctor of Medical Sciences, Professor, Chief researcher, Institute of Biomedical Research, 1,2,3Northern (Arctic) Federal University, Arkhangelsk, 2Northern State Medical University The study was carried out with the financial support of the Russian State Regional Scientific Fund and the Administration of the Arkhangelsk Region within the regional contest "Russian North: history, modernity, prospects", project No. 17-1629003 "Deterioration ofpostural control with aging as a factor of reducing the quality of life ofpeople in circumpolar
conditions"
POSTURAL BALANCE CHARACTERISTIC IN WOMEN AGED 55-64 YEARS
Abstract.
The aim of the recent study was to evaluate gait performance in women aged 55-59 years in comparison with women aged 60-64 years. A total 80 healthy, community-dwelling women aged 55-64 yrs. participated in this study. They were divided into 2 subgroups: (1) women aged 55-59 years (W55-59, n=36) and (2) women aged 60-64 years (W60-64, n=44). The walking performance was assessed by computer stabilometric complex «Balance Manager». The following tests were carried out: Walk Across, Step-Quick Turn and Step Up and Over. WA test showed statistically significant shorter step length (p = 0.04) in W60-64 compared to W55-59. It was revealed statistically significant longer time (left) (p = 0.02) in SQT test in W60-64 compared to W55-59. While analyzing SUO test found that in W60-64 the movement time (right) (p = 0.05) was longer compared to W55-59. Based on the evaluation of walk it is established that the level of hard-coordination and complex motor acts was higher in W55-59 compared to W60-64. Thus, we concluded that spatiotemporal characteristics of walk in middle-aged women were changed with age. The older group of women (W60-64) demonstrated a reduction in step length and prolonged execution turn time, which might be a cause for decreasing of coordination with aging. Keywords: mobility, postural balance, ageing, women.
Introduction
Studies of gait biomechanics are becoming increasingly important in gerontology and geriatrics, as it allows predicting the degree of deterioration of the mobility and the risk of falls in patients [4, P. 976-981], [8, P. 151-156]. In addition, the identification of the age characteristics of gait in the elderly makes it possible to foresee the medical and social needs of aging [2, P. 835-839], [5, P. 1415-1420]. Of particular importance are the gains for living in the North, in the region of uncomfortable climatic living conditions, which place high demands on functional systems of the human body [9, P. 751-758].
The aim of the recent study was to evaluate walking performance in women aged 55-59 years in comparison with women aged 60-64 years.
Materials and methods
Eighty healthy community-dwelling women volunteered to participate in this study. According to age, they were divided into 2 subgroups: (1) women aged 55-59 years (W55-59, n=36) and (2) women aged 60-64 years (W60-64, n=44). Exclusion
criteria of this study were: inability to walk independently, being registered at the mental hospital, stroke at anamnesis and neuro-degenerative diseases.
The walking performance was assessed by computer stabilometric complex «Balance Manager». The following tests were conducted:
Walk Across (WA). The WA test quantifies characteristics of gait while walking on the force plate. The measured parameters of this test are: step width, step length and speed.
Step-Quick Turn (SQT). The SQT test gives an assessment of turn performance characteristics while patient takes two forward steps, quickly turns 180° and returns to the starting point. The measured parameters are: turn time and sway velocity.
Step Up and Over (SUO). The SUO test gives an assessment of motor control characteristics while patient steps up onto a barrier with one foot, lifting the body through an takes standing position over the barrier, swings the other foot over the b arrier, and then lowers the body to land the swing leg on the force plate. The measured parameters are: lift up index (force to rise), movement time and impact index (control of impact force descending onto the swing leg).
Statistical analysis was held with program "SPSS 20.0". Standard statistical methods were used for calculation of mean and standard deviation of the mean (±SD). For 100% we have taken the results of W55-59 (the red line). Relatively to this line we have put the results of W60-64 (the blue line) (Fig. 1, 2). Differences between subjects were examined using a Student t-test. Statistical significance was accepted at p<0.05.
Results
Fig. 1 - Mean characteristics of Step-Quick Turn (SQT) and Walk Across (WA) tests parameters in women aged 55-64 yrs (%
from W55-59, taken as 100%)
Note:* p<0.05 compared to W60-64.
Fig. 2 - Characteristics of Step Up and Over (SUO) test parameters in women aged 55-64 yrs (% from W55-59, taken as
100%)
Note: *p<0.05 compared to W60-64.
No significant differences between measured groups were suggested in step width and speed in WA test and in sway left and right in the SQT test (fig. 1). WA test showed statistically significant shorter step length (p = 0.04) in W60-64 compared to W55-59. We revealed statistically significant longer time (left) (p = 0.02) and no difference in time (right) in SQT test in W60-64 compared to W55-59. While analyzing SUO test found that in W60-64 the movement time (right) (p = 0.05) was longer compared to W55-59. No significant differences between other measured parameters in SUO test were suggested (fig. 2).
Discussion
The results of the „Walk Across" test demonstrated a reduced step length (p = 0,04) and speed during the walk, and an increased in the step width in W60-64 compared to W55-59. This necessitates increasing time to support on two legs compared to standing on one leg while walking. It can also be due to the fear of loss of balance with aging, which is especially important in winter in Northern regions. Step length can be shortened (consciously or unconsciously) to reduce the walking speed, which helps to minimize the displacement of the center of gravity in decreasing of its control [1, P. 643-645].
It was found that in the group of women aged 60-64 years turn time left in the „Step-Quick Turn" test was significantly longer (p = 0,02) compared to women aged 55-59 years. Prolonged turn time to 180° may indicate insufficient vestibular function, elements of bradykinesia or pathology of the musculoskeletal system. No significant differences in other measured parameters emerged in this test between measured groups, and therefore we can conclude that the results of the older group were lower compared to the younger group. The results may indicate a gradual weakening of the musculoskeletal system with aging. We have found that older women have a reduction in the speed of adaptation to complex motor acts.
Analysis of the "Step Quick Turn" test indicated a decrease in adaptive abilities to complex motor acts in W60-64 compared to W55-59. Neurophysiological mechanisms of complex motor acts in the elderly is one of the development factors of fall syndrome. Changes in the parameters of this test in the elderly may also be due to a reduction in visual and vestibular information in balance control, dysfunction of the musculoskeletal system. H.J. Lee and S. Choi-Kwon [10, P. 1132 - 1135] noticed that vestibular changes in people aged 60 years and older were accompanied by a decrease in the quality of life and increase their level of anxiety.
In the „Step Up and Over" test significant differences were observed in the movement time right (p = 0,05) in W60-64 compared to W55-59. Increase in the execution time in older women of motion can be due to stiffness in joints, bradykinesia, balance disorder or attempt to avoid discomfort [4, P. 976-981], [6, P. 365-371], [9, P. 751-758].
N. Beyer et al [3, P. 300-309] noted that rehabilitation programs aimed at preserving the dynamic components of postural control, including patients with postural instability, have a positive impact on reducing the risk of falls and subsequent preservation of mobility. Using the tests "Walk Across", "Step-Quick Turn" in the diagnosis of walk parameters will be useful for predicting the risk of falls and reduction of mobility, as well as for evaluation and correction of quality rehabilitation programs related to postural control changes. Moreover, conducting of sport and recreational activities aimed at preserving the ability to complex motor acts in women 65 years and older, will have a positive impact on mobility, social independence, and also decrease risk of further falls. Thus, it has a positive impact on the duration and quality of life in elderly women [6, P. 365371], [7, P. 12], [11, P. 44-52], [12, P. 166-170].
Conclusion
In both groups, the average test parameters were within normal limits. Based on the evaluation of walk it is established that the level of hard-coordination and complex motor acts was higher in W55-59 compared to W60-64.
Thus, we concluded that spatiotemporal characteristics in middle-aged women were changed with age. The older group of women (W60-64) demonstrated a reduction in step length and prolonged execution turn time, which might be a cause for decreasing of coordination with aging.
Список литературы / References
1. Hausdorff J.M. Balance and gait in older adults with systemic hypertension / J.M. Hausdorff, T. Herman, R. Baltadjieva and others // The American journal of cardiology. - 2003 - Vol. 91, №5. - P.643-645.
2. Baloh R.W. A longitudinal study of gait and balance dysfunction in normal older people / R.W. Baloh, S.H. Ying, K.M Jacobson // Archives of Neurology. - 2003. -Vol. 60, № 6. - P. 835-839.
3. Beyer N. Old women with a recent fall history show improved muscle strength and function sustained for six months after finishing training / N. Beyer, L. Simonsen, J. Bulow and others // Aging clinical and experimental research. - 2007. -Vol. 19, № 4. - P. 300-309.
4. Camicioli R. Balance in the healthy elderly: posturography and clinical assessment / R. Camicioli, V.P. Panzer, J. Kaye // Archives of neurology. - 1997. - Vol. 54, № 8. - P. 976-981.
5. Campbell A.J. Examination by logistic regression modelling of the variables which increase the relative risk of elderly women falling compared to elderly men / A.J. Campbell, G.F. Spears, M.J. Borrie // Journal of clinical epidemiology. - 1991. - Vol. 43, № 12. - P. 1415-1420.
6. Carbonneau E. Effects of age and lean direction on the threshold of single-step balance recovery in younger, middle-aged and older adults. / E. Carbonneau, C. Smeesters // Gait and posture. - 2014. - Vol. 39, № 1. - P. 365-371.
7. LaFont C. Falls, Gait and Balance Disorders in the Elderly: From Successful Aging to Frailty / C. LaFont, A. Baroni, M. Allard and others // Facts and Research in Gerontology. - New York: Springer Publishing Company. - 1996. - 185 p.
8. Грибанов А.В. Возрастные особенности качества жизни у женщин пожилого и старческого возраста с постуральной стабильностью / А.В. Грибанов, А.В. Демин, Т.П. Мороз // Врач - аспирант. - 2014. - №4.1 (65). - С. 151-156.
9. Lee H.J. Quality of life and the related factors in patients with dizziness / Lee H.J., Choi-Kwon S. // Journal of Korean Academy of Nursing. - Vol. 39, № 5. - P. 751-758.
10. Ostchega Y. The prevalence of functional limitations and disability in older persons in the US: data from the National Health and Nutrition Examination Survey III. / Y. Ostchega, T.B. Harris, R. Hirsch, and others // Journal of the American Geriatrics Society. - 2000. - Vol. 48, № 9. - P. 1132 - 1135.
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Список литературы на английском языке / References in English
1. Hausdorff J.M. Balance and gait in older adults with systemic hypertension / J.M. Hausdorff, T. Herman, R. Baltadjieva and others // The American journal of cardiology. - 2003 - Vol. 91, №5. - P.643-645.
2. Baloh R.W. A longitudinal study of gait and balance dysfunction in normal older people / R.W. Baloh, S.H. Ying, K.M Jacobson // Archives of Neurology. - 2003. -Vol. 60, № 6. - P. 835-839.
3. Beyer N. Old women with a recent fall history show improved muscle strength and function sustained for six months after finishing training / N. Beyer, L. Simonsen, J. Bulow and others // Aging clinical and experimental research. - 2007. -Vol. 19, № 4. - P. 300-309.
4. Camicioli R. Balance in the healthy elderly: posturography and clinical assessment / R. Camicioli, V.P. Panzer, J. Kaye // Archives of neurology. - 1997. - Vol. 54, № 8. - P. 976-981.
5. Campbell A.J. Examination by logistic regression modelling of the variables which increase the relative risk of elderly women falling compared to elderly men / A.J. Campbell, G.F. Spears, M.J. Borrie // Journal of clinical epidemiology. - 1991. - Vol. 43, № 12. - P. 1415-1420.
6. Carbonneau E. Effects of age and lean direction on the threshold of single-step balance recovery in younger, middle-aged and older adults. / E. Carbonneau, C. Smeesters // Gait and posture. - 2014. - Vol. 39, № 1. - P. 365-371.
7. LaFont C. Falls, Gait and Balance Disorders in the Elderly: From Successful Aging to Frailty / C. LaFont, A. Baroni, M. Allard and others // Facts and Research in Gerontology. - New York: Springer Publishing Company. - 1996. - 185 p.
8. Gribanov A.V. Vozrastnye osobennosti kachestva zhizni u zhenshhin pozhilogo i starcheskogo vozrasta s postural'noj stabil'nost'ju [Aged features of quality of life in women elderly and senile age with postural instability] / A.V. Gribanov, A.V. Dyomin, T.P. Moroz // Vrach - aspirant [Postgraduate - Doctor]. - 2014. - № 4. - P. 151-156. [in Russian].
9. Lee H.J. Quality of life and the related factors in patients with dizziness / Lee H.J., Choi-Kwon S. // Journal of Korean Academy of Nursing. - Vol. 39, № 5. - P. 751-758.
10. Ostchega Y. The prevalence of functional limitations and disability in older persons in the US: data from the National Health and Nutrition Examination Survey III. / Y. Ostchega, T.B. Harris, R. Hirsch, and others // Journal of the American Geriatrics Society. - 2000. - Vol. 48, № 9. - P. 1132 - 1135.
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12. Gudkov A.B. Osobennosti postural'nogo balansa u muzhchin pozhilogo i starcheskogo vozrasta s sindromom straha padenija [Peculiarities of postural balance among elderly men with fear of falling syndrome] / A.B. Gudkov, A.V. Dyomin // Uspehi gerontologii [Advances in Gerontology]. - 2012. - Т. 25. № 1. - С. 166-170. [in Russian].
