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Journal of Neuroengineering and... Nov 2021Physical training (PT, e.g., Tai Chi and strength training) has been demonstrated to improve balance control and prevent falls. Recently, exergame intervention (EI) has... (Meta-Analysis)
Meta-Analysis Review
Comparison between the effects of exergame intervention and traditional physical training on improving balance and fall prevention in healthy older adults: a systematic review and meta-analysis.
OBJECTIVE
Physical training (PT, e.g., Tai Chi and strength training) has been demonstrated to improve balance control and prevent falls. Recently, exergame intervention (EI) has emerged to prevent falls by enhancing both physical and cognitive functions in older adults. Therefore, we aim to quantitatively assess and compare the effects of PT and EI on the performance of balance control and fall prevention in healthy older adults via meta-analysis.
METHODS
A search strategy based on the PICOS principle was used to find the publication in the databases of PubMed, EMBASE, Web of Science, Cochrane Library, and MEDLINE. The quality and risk of bias in the studies were independently assessed by two researchers.
RESULTS
Twenty studies consisting of 845 participants were included. Results suggested that as compared to PT, EI induced greater improvement in postural control (sway path length, SMD = - 0.66, 95% CI - 0.91 to - 0.41, P < 0.001, I = 0%; sway speed, SMD = - 0.49, 95% CI - 0.71 to - 0.27, P < 0.001, I = 42%) and dynamic balance (SMD = - 0.19, 95% CI - 0.35 to - 0.03, P = 0.02, I = 0%) in healthy older adults. The EI with 90-119 min/week for more than 8-week significantly reduced falls. Subgroup analyses revealed that exergames, which were designed by the two principles of repeatedly performing diversified tasks and gradually increase the difficulty of the task, induced significant effects in improving balance control and falls prevention respectively (P = 0.03, P = 0.009). In addition, intervention that combines EI and PT induced significant improvement in postural control (P = 0.003).
CONCLUSION
The exergame intervention, especially the combination of EI and PT, is a promising strategy to improve balance control and reduce falls in healthy older adults. Future studies with rigorous design, larger sample size, and follow-up assessments are needed to further assess the effectiveness of diverse exergame interventions in fall prevention and to quantify the "dose-effect" relationship, as well as the carry-over effect of such intervention, which will ultimately help optimize the rehabilitative strategies to improve balance control and prevent falls.
Topics: Aged; Exercise; Exergaming; Humans; Postural Balance; Resistance Training
PubMed: 34819097
DOI: 10.1186/s12984-021-00917-0 -
International Journal of Environmental... Oct 2022Constraint-induced movement therapy (CIMT) has been delivered in the stroke population to improve lower-extremity functions. However, its efficacy on prime components of... (Meta-Analysis)
Meta-Analysis Review
Constraint-induced movement therapy (CIMT) has been delivered in the stroke population to improve lower-extremity functions. However, its efficacy on prime components of functional ambulation, such as gait speed, balance, and cardiovascular outcomes, is ambiguous. The present review aims to delineate the effect of various lower-extremity CIMT (LECIMT) protocols on gait speed, balance, and cardiovascular outcomes. Material and methods: The databases used to collect relevant articles were EBSCO, PubMed, PEDro, Science Direct, Scopus, MEDLINE, CINAHL, and Web of Science. For this analysis, clinical trials involving stroke populations in different stages of recovery, >18 years old, and treated with LECIMT were considered. Only ten studies were included in this review, as they fulfilled the inclusion criteria. The effect of CIMT on gait speed and balance outcomes was accomplished using a random or fixed-effect model. CIMT, when compared to controlled interventions, showed superior or similar effects. The effect of LECIMT on gait speed and balance were non-significant, with mean differences (SMDs) of 0.13 and 4.94 and at 95% confidence intervals (Cis) of (-0.18-0.44) and (-2.48-12.37), respectively. In this meta-analysis, we observed that despite the fact that several trials claimed the efficacy of LECIMT in improving lower-extremity functions, gait speed and balance did not demonstrate a significant effect size favoring LECIMT. Therefore, CIMT treatment protocols should consider the patient's functional requirements, cardinal principles of CIMT, and cardiorespiratory parameters.
Topics: Adolescent; Humans; Physical Therapy Modalities; Stroke; Stroke Rehabilitation; Walking; Walking Speed
PubMed: 36232103
DOI: 10.3390/ijerph191912809 -
Journal of Sport and Health Science Jul 2022The biomechanics of the trunk and lower limbs during walking and running gait are frequently assessed in individuals with low back pain (LBP). Despite substantial... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The biomechanics of the trunk and lower limbs during walking and running gait are frequently assessed in individuals with low back pain (LBP). Despite substantial research, it is still unclear whether consistent and generalizable changes in walking or running gait occur in association with LBP. The purpose of this systematic review was to identify whether there are differences in biomechanics during walking and running gait in individuals with acute and persistent LBP compared with back-healthy controls.
METHODS
A search was conducted in PubMed, CINAHL, SPORTDiscus, and PsycINFO in June 2019 and was repeated in December 2020. Studies were included if they reported biomechanical characteristics of individuals with and without LBP during steady-state or perturbed walking and running. Biomechanical data included spatiotemporal, kinematic, kinetic, and electromyography variables. The reporting quality and potential for bias of each study was assessed. Data were pooled where possible to compare the standardized mean differences (SMD) between back pain and back-healthy control groups.
RESULTS
Ninety-seven studies were included and reviewed. Two studies investigated acute pain and the rest investigated persistent pain. Nine studies investigated running gait. Of the studies, 20% had high reporting quality/low risk of bias. In comparison with back-healthy controls, individuals with persistent LBP walked slower (SMD = -0.59, 95% confidence interval (95%CI): -0.77 to -0.42)) and with shorter stride length (SMD = -0.38, 95%CI: -0.60 to -0.16). There were no differences in the amplitude of motion in the thoracic or lumbar spine, pelvis, or hips in individuals with LBP. During walking, coordination of motion between the thorax and the lumbar spine/pelvis was significantly more in-phase in the persistent LBP groups (SMD = -0.60, 95%CI: -0.90 to -0.30), and individuals with persistent LBP exhibited greater amplitude of activation in the paraspinal muscles (SMD = 0.52, 95%CI: 0.23-0.80). There were no consistent differences in running biomechanics between groups.
CONCLUSION
There is moderate-to-strong evidence that individuals with persistent LBP demonstrate differences in walking gait compared to back-healthy controls.
Topics: Biomechanical Phenomena; Gait; Humans; Low Back Pain; Running; Walking
PubMed: 35151908
DOI: 10.1016/j.jshs.2022.02.001 -
Journal of Sports Science & Medicine Sep 2023Static stretching can increase the range of motion of a joint. Muscle-tendon unit stiffness (MTS) is potentially one of the main factors that influences the change in... (Meta-Analysis)
Meta-Analysis Review
Static stretching can increase the range of motion of a joint. Muscle-tendon unit stiffness (MTS) is potentially one of the main factors that influences the change in the range of motion after static stretching. However, to date, the effects of acute and long-term static stretching on MTS are not well understood. The purpose of this meta-analysis was to investigate the effects of acute and long-term static stretching training on MTS, in young healthy participants. PubMed, Web of Science, and EBSCO published before January 6, 2023, were searched and finally, 17 papers were included in the meta-analysis. Main meta-analysis was performed with a random-effect model and subgroup analyses, which included comparisons of sex (male vs. mixed sex and female) and muscle (hamstrings vs. plantar flexors) were also performed. Furthermore, a meta-regression was conducted to examine the effect of total stretching duration on MTS. For acute static stretching, the result of the meta-analysis showed a moderate decrease in MTS (effect size = -0.772, Z = -2.374, 95% confidence interval = -1.409 - -0.325, p = 0.018, I = 79.098). For long-term static stretching, there is no significant change in MTS (effect size = -0.608, Z = -1.761, 95% CI = -1.284 - 0.069, p = 0.078, I = 83.061). Subgroup analyses revealed no significant differences between sex (long-term, p = 0.209) or muscle (acute, p =0.295; long-term, p = 0.427). Moreover, there was a significant relationship between total stretching duration and MTS in acute static stretching (p = 0.011, R2 = 0.28), but not in long-term stretching (p = 0.085, R < 0.01). Whilst MTS decreased after acute static stretching, only a tendency of a decrease was seen after long-term stretching.
Topics: Female; Male; Humans; Muscle Stretching Exercises; Tendons; Muscles; Hamstring Muscles
PubMed: 37711702
DOI: 10.52082/jssm.2023.465 -
Neuroscience and Biobehavioral Reviews Jul 2023The difficulty in assessing FOG and the variety of existing cues, hamper to determine which cueing modality should be applied and which FOG-related aspect should be... (Meta-Analysis)
Meta-Analysis Review
The difficulty in assessing FOG and the variety of existing cues, hamper to determine which cueing modality should be applied and which FOG-related aspect should be targeted to reach personalized treatments for FOG. This systematic review aimed to highlight: i) whether cues could reduce FOG and improve FOG-related gait parameters, ii) which cues are the most effective, iii) whether medication state (ON-OFF) affects cues-related results. Thirty-three repeated measure design studies assessing cueing effectiveness were included and subdivided according to gait tasks (gait initiation, walking, turning) and to the medication state. Main results reveal that: preparatory phase of gait initiation benefit from visual and auditory cues; spatio-temporal parameters (e.g., step and stride length) are improved by visual cues during walking; turning time and step time variability are reduced by applying auditory and visual cues. Some findings on the potential benefits of cueing on FOG and FOG gait-related parameters were found. Questions remain about which are the best behavioral strategies according to FOG features and PD clinical characteristics.
Topics: Humans; Parkinson Disease; Cues; Gait Disorders, Neurologic; Gait; Walking
PubMed: 37086934
DOI: 10.1016/j.neubiorev.2023.105189 -
Sports Medicine (Auckland, N.Z.) May 2017Plyometric training is an effective method to prevent knee injuries in female athletes; however, the effects of plyometric training on jump performance in female... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Plyometric training is an effective method to prevent knee injuries in female athletes; however, the effects of plyometric training on jump performance in female athletes is unclear.
OBJECTIVE
The aim of this systematic review and meta-analysis was to determine the effectiveness of plyometric training on vertical jump (VJ) performance of amateur, collegiate and elite female athletes.
METHODS
Six electronic databases were searched (PubMed, MEDLINE, ERIC, Google Scholar, SCIndex and ScienceDirect). The included studies were coded for the following criteria: training status, training modality and type of outcome measures. The methodological quality of each study was assessed using the physiotherapy evidence database (PEDro) scale. The effects of plyometric training on VJ performance were based on the following standardised pre-post testing effect size (ES) thresholds: trivial (<0.20), small (0.21-0.60), moderate (0.61-1.20), large (1.21-2.00), very large (2.01-4.00) and extremely large (>4.00).
RESULTS
A total of 16 studies met the inclusion criteria. The meta-analysis revealed that plyometric training had a most likely moderate effect on countermovement jump (CMJ) height performance (ES = 1.09; 95 % confidence interval [CI] 0.57-1.61; I = 75.60 %). Plyometric training interventions of less than 10 weeks in duration had a most likely small effect on CMJ height performance (ES = 0.58; 95 % CI 0.25-0.91). In contrast, plyometric training durations greater than 10 weeks had a most likely large effect on CMJ height (ES = 1.87; 95 % CI 0.73-3.01). The effect of plyometric training on concentric-only squat jump (SJ) height was likely small (ES = 0.44; 95 % CI -0.09 to 0.97). Similar effects were observed on SJ height after 6 weeks of plyometric training in amateur (ES = 0.35) and young (ES = 0.49) athletes, respectively. The effect of plyometric training on CMJ height with the arm swing was likely large (ES = 1.31; 95 % CI -0.04 to 2.65). The largest plyometric training effects were observed in drop jump (DJ) height performance (ES = 3.59; 95 % CI -3.04 to 10.23). Most likely extremely large plyometric training effects on DJ height performance (ES = 7.07; 95 % CI 4.71-9.43) were observed following 12 weeks of plyometric training. In contrast, a possibly small positive training effect (ES = 0.30; 95 % CI -0.63 to 1.23) was observed following 6 weeks of plyometric training.
CONCLUSION
Plyometric training is an effective form of training to improve VJ performance (e.g. CMJ, SJ and DJ) in female athletes. The benefits of plyometric training on VJ performance are greater for interventions of longer duration (≥10 weeks).
Topics: Athletes; Athletic Performance; Exercise; Female; Humans; Isometric Contraction; Leg; Movement; Muscle Strength; Physical Education and Training; Plyometric Exercise; Track and Field
PubMed: 27704484
DOI: 10.1007/s40279-016-0634-6 -
International Journal of Sports Medicine Apr 2022Training-intensity distribution (TID) is considered the key factor to optimize performance in endurance sports. This systematic review aimed to: I) characterize the TID...
Training-intensity distribution (TID) is considered the key factor to optimize performance in endurance sports. This systematic review aimed to: I) characterize the TID typically used by middle-and long-distance runners; II) compare the effect of different types of TID on endurance performance and its physiological determinants; III) determine the extent to which different TID quantification methods can calculate same TID outcomes from a given training program. The keywords and search strategy identified 20 articles in the research databases. These articles demonstrated differences in the quantification of the different training-intensity zones among quantification methods (i. e. session-rating of perceived exertion, heart rate, blood lactate, race pace, and running speed). The studies that used greater volumes of low-intensity training such as those characterized by pyramidal and polarized TID approaches, reported greater improvements in endurance performance than those which used a threshold TID. Thus, it seems that the combination of high-volume at low-intensity (≥ 70% of overall training volume) and low-volume at threshold and high-intensity interval training (≤ 30%) is necessary to optimize endurance training adaptations in middle-and long-distance runners. Moreover, monitoring training via multiple mechanisms that systematically encompasses objective and subjective TID quantification methods can help coaches/researches to make better decisions.
Topics: Endurance Training; High-Intensity Interval Training; Humans; Oxygen Consumption; Physical Endurance; Running
PubMed: 34749417
DOI: 10.1055/a-1559-3623 -
The Cochrane Database of Systematic... Jul 2017Delayed motor development may occur in children with Down syndrome, cerebral palsy, general developmental delay or children born preterm. It limits the child's... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Delayed motor development may occur in children with Down syndrome, cerebral palsy, general developmental delay or children born preterm. It limits the child's exploration of the environment and can hinder cognitive and social-emotional development. Literature suggests that task-specific training, such as locomotor treadmill training, facilitates motor development.
OBJECTIVES
To assess the effectiveness of treadmill interventions on locomotor development in children with delayed ambulation or in pre-ambulatory children (or both), who are under six years of age and who are at risk for neuromotor delay.
SEARCH METHODS
In May 2017, we searched CENTRAL, MEDLINE, Embase, six other databases and a number of trials registers. We also searched the reference lists of relevant studies and systematic reviews.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) and quasi-RCTs that evaluated the effect of treadmill intervention in the target population.
DATA COLLECTION AND ANALYSIS
Four authors independently extracted the data. Outcome parameters were structured according to the International Classification of Functioning, Disability and Health model.
MAIN RESULTS
This is an update of a Cochrane review from 2011, which included five trials. This update includes seven studies on treadmill intervention in 175 children: 104 were allocated to treadmill groups, and 71 were controls. The studies varied in population (children with Down syndrome, cerebral palsy, developmental delay or at moderate risk for neuromotor delay); comparison type (treadmill versus no treadmill; treadmill with versus without orthoses; high- versus low-intensity training); study duration, and assessed outcomes. Due to the diversity of the studies, only data from five studies were used in meta-analyses for five outcomes: age of independent walking onset, overall gross motor function, gross motor function related to standing and walking, and gait velocity. GRADE assessments of quality of the evidence ranged from high to very low.The effects of treadmill intervention on independent walking onset compared to no treadmill intervention was population dependent, but showed no overall effect (mean difference (MD) -2.08, 95% confidence intervals (CI) -5.38 to 1.22, 2 studies, 58 children; moderate-quality evidence): 30 children with Down syndrome benefited from treadmill training (MD -4.00, 95% CI -6.96 to -1.04), but 28 children at moderate risk of developmental delay did not (MD -0.60, 95% CI -2.34 to 1.14). We found no evidence regarding walking onset in two studies that compared treadmill intervention with and without orthotics in 17 children (MD 0.10, 95% CI -5.96 to 6.16), and high- versus low-intensity treadmill interventions in 30 children with Down syndrome (MD -2.13, 95% -4.96 to 0.70).Treadmill intervention did not improve overall gross motor function (MD 0.88, 95% CI -4.54 to 6.30, 2 studies, 36 children; moderate-quality evidence) or gross motor skills related to standing (MD 5.41, 95% CI -1.64 to 12.43, 2 studies, 32 children; low-quality evidence), and had a negligible improvement in gross motor skills related to walking (MD 4.51, 95% CI 0.29 to 8.73, 2 studies, 32 children; low-quality evidence). It led to improved walking skills in 20 ambulatory children with developmental delay (MD 7.60, 95% CI 0.88 to 14.32, 1 study) and favourable gross motor skills in 12 children with cerebral palsy (MD 8.00, 95% CI 3.18 to 12.82). A study which compared treadmill intervention with and without orthotics in 17 children with Down syndrome suggested that adding orthotics might hinder overall gross motor progress (MD -8.40, 95% CI -14.55 to -2.25).Overall, treadmill intervention showed a very small increase in walking speed compared to no treadmill intervention (MD 0.23, 95% CI 0.08 to 0.37, 2 studies, 32 children; high-quality evidence). Treadmill intervention increased walking speed in 20 ambulatory children with developmental delay (MD 0.25, 95% CI 0.08 to 0.42), but not in 12 children with cerebral palsy (MD 0.18, 95% CI -0.09 to 0.45).
AUTHORS' CONCLUSIONS
This update of the review from 2011 provides additional evidence of the efficacy of treadmill intervention for certain groups of children up to six years of age, but power to find significant results still remains limited. The current findings indicate that treadmill intervention may accelerate the development of independent walking in children with Down syndrome and may accelerate motor skill attainment in children with cerebral palsy and general developmental delay. Future research should first confirm these findings with larger and better designed studies, especially for infants with cerebral palsy and developmental delay. Once efficacy is established, research should examine the optimal dosage of treadmill intervention in these populations.
Topics: Body Weight; Cerebral Palsy; Child Development; Child, Preschool; Dependent Ambulation; Down Syndrome; Exercise Movement Techniques; Humans; Infant; Locomotion; Motor Skills; Motor Skills Disorders; Randomized Controlled Trials as Topic; Walking
PubMed: 28755534
DOI: 10.1002/14651858.CD009242.pub3 -
Scandinavian Journal of Medicine &... Feb 2023The Achilles tendon (AT) can be exposed to considerable stress during athletic activities and is often subject to pathologies such as tendinopathies. When designing a... (Review)
Review
The Achilles tendon (AT) can be exposed to considerable stress during athletic activities and is often subject to pathologies such as tendinopathies. When designing a prevention or rehabilitation protocol, mechanical loading is a key factor to consider. This implies being able to accurately determine the load applied to the AT when performing exercises that stress this tendon. A systematic review was performed to synthesize the load borne by the AT during exercises/activities. Three databases (Pubmed, Embase and Cochrane) were searched for articles up to May 2021, and only the studies assessing the AT load in newtons relative to body-weight (BW) on humans during activities or exercises were included. Most of the 11 included studies assessed AT load when running or walking (N = 10), and only three tested exercises were usually performed during rehabilitation. The load on the tendon ranged from 2.7 to 3.95 BW when walking, from 4.15 to 7.71 BW when running, and from 0.41 to 7.3 BW according to the strengthening exercise performed. From the collected data, a progression of exercises progressively loading the Achilles tendon, as well as the possible connections with walking and running activities, could be defined. However, the trends highlighted in the relationship between tendon loading and walking or running speeds present some inconsistencies. Further research is still needed to clarify them, but also to complete the data set in healthy and injured people.
Topics: Humans; Achilles Tendon; Exercise; Walking; Running; Exercise Therapy
PubMed: 36278501
DOI: 10.1111/sms.14242 -
Sensors (Basel, Switzerland) Dec 2022Motor, gait and balance disorders reduce functional capabilities for activities of daily living in children with cerebral palsy (CP). Robot-assisted gait therapy (RAGT)... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Motor, gait and balance disorders reduce functional capabilities for activities of daily living in children with cerebral palsy (CP). Robot-assisted gait therapy (RAGT) is being used to complement conventional therapy (CT) or treadmill therapy (TT) in CP rehabilitation. The aim of this systematic review is to assess the effect of RAGT on gait, balance and functional independence in CP children, in comparison to CT or TT.
METHODS
We have conducted a systematic review with meta-analysis. A search in PubMed Medline, Web of Science, Scopus, CINAHL, PEDro and SciELO has been conducted for articles published until October 2022. Controlled clinical trials (CCT), in which RAGT was compared to TT or CT and assessed gait speed, step and stride length, width step, walking distance, cadence, standing ability, walking, running and jumping ability, gross motor function and functional independence in children with CP, have been included. Methodological quality was assessed with the PEDro scale and the pooled effect was calculated with Cohen's Standardized Mean Difference (SMD) and its 95% Confidence Interval (95% CI).
RESULTS
A total of 15 CCTs have been included, providing data from 413 participants, with an averaged methodological quality of 5.73 ± 1.1 points in PEDro. The main findings of this review are that RAGT shows better results than CT in the post-intervention assessment for gait speed (SMD 0.56; 95% CI 0.03 to 1.1), walking distance (SMD 2; 95% CI 0.36 to 3.65) and walking, running and jumping ability (SMD 0.63; 95% CI 0.12 to 1.14).
CONCLUSIONS
This study shows that the effect of RAGT is superior to CT on gait speed, walking distance and walking, running and jumping ability in post-intervention, although no differences were found between RAGT and TT or CT for the remaining variables.
Topics: Humans; Child; Robotics; Cerebral Palsy; Activities of Daily Living; Gait; Walking; Exercise Therapy
PubMed: 36560281
DOI: 10.3390/s22249910