Search Results (102)

Background and Objectives: Parkinson’s disease (PD) is a progressive neurodegenerative disorder in which gait and balance disturbances substantially increase the risk of falls and loss of independence. Pharmacological treatment alleviates several motor symptoms but has limited effects on postural instability. Backward walking (BW), a demanding locomotor task, has recently been investigated as both an assessment tool and a rehabilitation strategy in PD. The purpose of this focused systematic review is to analyse the benefits and limitations of retro walking in relation to the gait parameters and balance control of PD patients. Materials and Methods: A structured literature search (2015–2025) was conducted across multiple databases in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Eligibility criteria, screening procedures, and qualitative synthesis methods were predefined. Nine studies (including two randomized controlled trials) met the inclusion criteria. Methodological quality was assessed using PEDro and ROBINS-I tools, and the certainty of evidence was evaluated using GRADE. Results: The research results indicate within-group improvements in balance and gait parameters following BW training. Some of the included studies also suggest that BW may be a sensitive marker of balance deficits and fall risk. However, the evidence is limited by small sample sizes, heterogeneity of interventions, and a predominance of non-randomized designs. Conclusions: Current evidence regarding BW in PD remains preliminary. While BW may be considered as a supplementary component of rehabilitation, its specific efficacy cannot be clearly distinguished from general exercise effects. Further high-quality randomized controlled trials with standardized protocols and long-term follow-up are required. Full article

Chronological age incompletely captures neurodegenerative burden and functional vulnerability in multiple sclerosis (MS). Brain-predicted age difference (Brain-PAD; predicted minus chronological age) provides an MRI-derived index of accelerated brain aging, but links to mobility and real-world behavior remain unclear. Forty-three adults with MS completed structural MRI, mobility testing, and six months of free-living physical activity monitoring. Brain age was estimated using PyBrainAge applied to FreeSurfer-derived cortical thickness and subcortical volumes. Hierarchical regressions tested whether Brain-PAD explained additional variance in mobility (Mini-BESTest total and subscores; forward/backward walking velocity) and moderate-to-vigorous physical activity (MVPA) beyond age and disability (PDDS). Predicted brain age exceeded chronological age (Brain-PAD = 8.4 ± 11.1 years; p < 0.001). After accounting for age and PDDS, Brain-PAD explained additional variance in Mini-BESTest total (ΔR² = 0.05, p = 0.042) and anticipatory control (ΔR² = 0.08, p = 0.034), with a trend for sensory orientation. Brain-PAD was not associated with walking velocity beyond PDDS. Higher Brain-PAD was associated with lower MVPA (β = −0.91, p = 0.005) and explained additional variance (ΔR² = 0.19). Brain-PAD is elevated in MS and relates to balance control and real-world physical activity beyond age and disability, highlighting its potential to identify functional vulnerability. Full article

Objective: The present study aimed to compare muscle thickness and physical performance in different functional tests predicting falls between older adults with low and high fall risk. Methods: Seventy-one community-dwelling older women (74.5 ± 8.5 years old) volunteered for this study. The Berg Balance Scale (BBS) was used to stratify the sample as low and high risk for fall (BBS cutoff = ≥ 50 points). The performance in the Timed Up and Go Test (TUGT), 5-repetition sit-to-stand test (5xSST), 3 m walk test (3mWT), and 3 m backward walk test (3mBWT) was assessed. The elbow flexor and knee extensor muscle thickness were obtained by ultrasound (USD). A linear mixed model analysis was used to determine between-group differences in functional mobility and muscle thickness, and Bayesian analysis was applied to check the probability to replicate the same results (i.e., the magnitude of the evidence). Results: The low-fall-risk group exhibited significantly better performance only in 3mWT (mean difference = 0.84 s [95% CI: 0.40 to 1.29 s]; p = 0.001) and 3mBWT (mean difference = 1.54 s [95% CI: 0.21 to 2.85 s]; p = 0.024). The Bayes Factor (BF) for performance on the 3mWT and 3mBWT shows that the low-fall-risk group has a probability of 98.7% (BF10 = 77.3) and 99.7% (BF10 = 368), respectively, of performing better than the high-fall-risk group. Conclusions: Based on inferential and Bayesian analysis, the performance in 3mWT and that in 3mBWT were classified as very strong to excellent instruments, respectively, for differentiating older women with high fall risk. Full article

Reduced arm swing frequently occurs in older adults and is associated with declined gait performance. Experimental studies have demonstrated that restricting arm swing decreases stride length and walking speed, whereas deliberately increasing arm swing can improve these gait parameters. This study evaluated whether a wearable haptic feedback system could effectively increase arm-swing amplitude and assess its effects on spatiotemporal gait outcomes during overground walking. Using a within-subject repeated-measures design, twelve community-dwelling older adults (6 males/6 females; $75.8\pm 6.5$ years) completed three no-feedback conditions (Baseline, Exaggerated, Fast) and six feedback conditions varying Direction (Forward, Backward, Combined) and target Magnitude (+100%, +200% of the Baseline). The arm-swing angle was estimated in real time from upper-arm inertial measurement unit (IMU) sensors; targets were defined for peak Forward flexion and/or peak Backward extension, and vibrotactile cues were delivered when the corresponding peak failed to reach the target. The arm range of motion (ROM) increased significantly across conditions, with the largest increase during Feedback (+229%), exceeding Exaggerated (+120%) and Fast (+64%) (all $p<0.001$). Walking speed and stride length also increased during Feedback relative to the Baseline ($p<0.001$). Within feedback conditions, the arm ROM showed independent main effects of the Direction and Magnitude, whereas gait outcomes were primarily influenced by Direction. Arm-swing symmetry was largely preserved, with the smallest variability during Feedback. These findings support the feasibility of vibrotactile feedback to enhance arm swing and improve gait outcomes in older adults. Full article

Background: Age-related cognitive decline is linked to reduced gait complexity and higher fall risk. Traditional linear gait measures may miss subtle motor-cognitive deficits in older adults with dementia. This study examined whether an 8-week motor-cognitive exercise program could improve gait adaptability in institutionalized older adults with cognitive impairment. Gait complexity, measured using Sample Entropy, was the primary outcome. Methods: Forty-two institutionalized older adults completed follow-up assessments, including 26 with cognitive impairment and 16 controls. Gait was assessed during normal walking (single-task) and while performing cognitive tasks (dual-task), such as naming animals or counting backward. Inertial sensors recorded stride intervals, and Sample Entropy was calculated to evaluate gait regularity and adaptability, (gait complexity). The intervention included 24 structured sessions combining physical and cognitive exercises targeting balance, coordination, and executive function. Non-parametric tests (Wilcoxon) were used, with Bonferroni correction for multiple comparisons. Results: Participants with cognitive impairment showed increased gait complexity, especially during dual-task walking. Significant improvements were found in both limbs under dual-task conditions (left: p = 0.015, effect size = 0.34; right: p = 0.030, effect size = 0.31). During single-task walking, a significant improvement was observed in the left limb (p = 0.006, effect size = 0.39). Conclusions: Motor-cognitive exercise may enhance non-linear gait complexity in institutionalized older adults with cognitive impairment. The use of dual-task training in rehabilitation and highlight the value of entropy-based gait assessment for detecting subtle functional changes. However, the lack of a randomized non-exercising cognitive impairment control group limits definitive conclusions about causality. Full article

Background/Objectives: Motor coordination is the essential ability that influences children’s overall physical development and their ability to engage in various activities. The development of motor skills and coordination continues for several years, as it is a gradual process that extends beyond the early stages of walking. The study aimed to describe the differences in genders and physical activity levels using the Body Coordination Test for Children (KTK) test battery to assess motor coordination in kindergarten children. Methods: The sample consisted of 814 participants, including both sexes (aged 5.57 ± 0.49 years). Participants were divided into two groups according to their involvement in physical activity (OPA) or physical inactivity (NO OPA). OPA had to have a minimum of 2 days per week of additional organized training/lessons with at least 60 min. Results: The results show significant gender differences in walking backwards; girls outperformed boys with a statistically significant mean difference of −3.11 (p = 0.01; 95% CI: −4.57 to −1.64). Similarly, for total motor quotient (MQ), girls scored higher than boys, with a significant mean difference of −4.92 (p = 0.01; 95% CI: −7.85 to −1.99). The results revealed that the OPA group consistently outperformed the NO OPA group across all subtests, with significant differences in Total MQ (p = 0.01). Conclusions: Our study results indicated that physically active children demonstrated better motor coordination in comparison to their inactive peers. This suggests that regular physical activity positively influences motor coordination development in children. Full article

Background: Backward walking (BW) has been proven to reduce the external knee adduction moment (EKAM) and knee adduction angular impulse (KAAI) during gait in healthy subjects, but its effects in individuals with knee osteoarthritis (OA) remain unknown. This study aimed to investigate the effects of self-selected speed BW on the EKAM, KAAI, and external knee flexion moment (EKFM) in individuals with medial knee OA. Methods: Thirty-two participants with medial knee OA underwent a three-dimensional gait analysis across three randomized conditions: (1) self-selected speed forward walking (FW), (2) self-selected speed BW, and (3) speed-controlled forward walking (SCFW) (for each individual, the SCFW speed was controlled within a range of 95% to 105% of BW speed). For each condition, the first peak of EKAM, second peak of EKAM, first peak of EKFM, and the KAAI were determined. One-way repeated measures ANOVA and multiple pairwise comparisons were performed to compare peaks of EKAM, peak of EKFM, and the KAAI between conditions. Results: BW significantly reduced the first peak of EKAM and the KAAI in comparison with FW and SCFW (p < 0.001). Both BW and SCFW showed a significantly reduced first peak of EKFM in comparison with FW (p < 0.001). However, BW did not reduce the second peak of EKAM when compared with FW or SCFW (p > 0.05). Conclusions: BW can significantly reduce the first peak of EKAM and the KAAI in comparison with FW and SCFW in individuals with medial knee OA. Full article

Background: The severity of foot disability in children with cerebral palsy (CP) should be examined with both objective and subjective assessment tools. This cross-sectional study investigated the effect of foot-ankle function on physical performance in CP with spastic equinus deformity. Methods: A cross-sectional prospective study was performed on 61 children with CP. Participants were evaluated by the Gross Motor Function Classification System (GMFCS), Oxford Ankle FootQuestionnaire for Children (OxAFQ-C), Timed Up andGo Test (TUG), singleleg stance test (SLST), 3-Meter BackwardWalk Test (3MBWT), and Functional Reach Test. Results: The mean ± SD age of the children with CP (28 girls and 33 boys) included in the study was 11.3 ± 4.4 years. Individuals with higher foot-ankle function had better TUG, 3MBWT, and SLST performances (P < 0.005). The OxAFQ-C physical scale was moderately correlated with TUG (r = −0.474) and SLST (right extremity–eyes open) (r = 0.386) (P < 0.01). In addition, there was a low significant correlation between 3MBWT, SLST (right extremity– eyes closed), SLST (left extremity–eyes open), and SLST (left extremity–eyes closed) with the OxAFQ-C physical scale (P < 0.05). The OxAFQ-C school and play scale had a moderate-to-weak correlation coefficient (r = 0.257–0.439) with all of the physical performance tests (P < 0.05). In addition, there were moderate and low correlations of the OxAFQ-C emotional scale with TUG (r = −0.495) and 3MBWT (r = −0.298). Conclusions: These results show that foot-ankle performance influenced physical performance in time-based physical tasks but not in better performance-based physical conditions. It was concluded that foot-ankle condition was most strongly associated with sit-to-stand and walking performance. Full article

Background/Objectives: Obesity in adolescence is associated with a deterioration in cognitive functions, with significant implications for psychophysical well-being and academic performance. Recent studies highlight the importance of integrated interventions that combine nutrition education and physical activity to promote the overall health of students. The present study aims to evaluate the efficacy of an integrated intervention based on nutritional education and conscious body movement in improving cognitive functions, perceived well-being and nutritional knowledge in lower secondary school students with indicators of overweight and obesity. Methods: A quasi-experimental design with randomization at the class level was adopted, involving 60 students divided into an experimental group and control group. The intervention was divided into twelve weeks of activities, divided between nutritional education modules and physical activity courses. Standardized tests for the assessment of cognitive functions (Digit Span Forward, Digit Span Backward, Stroop Test, Trail Making Test B), motor tests (6-Minute Walk Test, Sit and Reach Test) and a food knowledge questionnaire were administered before and after the intervention. Results: The experimental group showed significant improvements compared to the control group in all cognitive, motor, and nutritional knowledge measures, indicating the effectiveness of the integrated intervention in promoting cognitive and physical well-being. Conclusions: The findings support the role of school as a generative environment of integrated well-being, suggesting the need to develop and implement curricular programs that integrate nutrition education and physical activity to counteract the negative effects of obesity on cognitive function in adolescents. Full article

Obesity is associated with reduced cardiorespiratory fitness and altered metabolic responses. However, the acute effects of forward and backward locomotion training in individuals with a body mass index (BMI) ≥ 30 remain underexplored. This study investigated this population’s cardiorespiratory, metabolic–perceptual, and muscle electromyography (EMG) responses to forward and backward locomotion at different speeds. Twenty-eight male participants were divided into four seven-member groups, following a randomized crossover design with a Latin Square-like counterbalancing approach. Participants completed four 10 min walking conditions (3 km/h forward, 3 km/h backward, 4 km/h forward, and 4 km/h backward) on separate days, with cardiorespiratory parameters (e.g., VO₂, VCO₂, and heart rate), metabolic responses (e.g., lactate and energy expenditure), and lower-limb muscle EMG activity measured. Statistical analysis using two-way repeated measures (MANOVA) revealed significant direction effects (p < 0.05) on VO₂, VCO₂, heart rate, energy expenditure, Borg RPE, final lactate, and the EMG activity of quadriceps, hamstrings, and tibialis anterior, but not on pre-lactate or soleus activity (p > 0.05). These findings provide valuable insights for optimizing exercise programs in obese individuals, supporting tailored movement strategies to enhance physiological outcomes. Full article

Cognitive–motor integration is the coordination of cognitive and motor processes; it is commonly impaired among people living with dementia (PWD) and may be improved through exercise. This pilot randomized controlled trial (1:1) aimed to determine the effect of 6 months of exercise on cognitive–motor integration compared to usual care in n = 42 PWD at two residential care facilities. Participants completed single- and dual-task standing (30 s of standing while counting backward by 1 s), walking (4 m walk while naming words), and timed-up-and-go (TUG) tests (TUG with a category task), measured using APDM inertial sensors at baseline and 6 months (age = 82 years, 35% female, Montreal Cognitive Assessment = 10.2 ± 5.9, NCT05488951). The adapted Otago Exercise Program involved 60 min of lower-body strength and balance exercises and walking 3x/week for 6 months. Usual care involved regular social activities and healthcare appointments. Exercise provoked increased single-task stride length and increased dual-task TUG turn velocity compared to usual care (p < 0.05). Usual care may reduce the ability to appropriately select cautious gait, as the usual care group exhibited faster dual-task gait speed at 6 months compared to the OEP plus usual care (p < 0.05), which was faster than their single-task gait speed. Our results support implementing the OEP to improve cognitive–motor integration in PWD. Full article

Despite significant progress in fall detection systems, many of the proposed algorithms remain difficult to implement in real-world applications. A common limitation is the lack of location awareness, especially in outdoor scenarios where accurately determining the fall location is crucial for a timely emergency response. Moreover, the complexity of many existing algorithms poses a challenge for deployment on edge devices, such as wearable systems, which are constrained by limited computational resources and battery life. As a result, these solutions are often impractical for long-term, continuous use in practical settings. To address the aforementioned issues, we developed a portable, wearable device that integrates a microcontroller (MCU), an inertial sensor, and a chip module featuring Global Positioning System (GPS) and Narrowband Internet of Things (NB-IoT) technologies. A low-complexity algorithm based on a finite-state machine was employed to detect fall events, enabling the module to meet the requirements for long-term outdoor use. The proposed algorithm is capable of filtering out eight types of daily activities—running, walking, sitting, ascending stairs, descending stairs, stepping, jumping, and rapid sitting—while detecting four types of falls: forward, backward, left, and right. In case a fall event is detected, the device immediately transmits a fall alert and GPS coordinates to a designated server via NB-IoT. The server then forwards the alert to a specified communication application. Experimental tests demonstrated the system’s effectiveness in outdoor environments. A total of 6750 samples were collected from fifteen test participants, including 6000 daily activity samples and 750 fall events. The system achieved an average sensitivity of 97.9%, an average specificity of 99.9%, and an overall accuracy of 99.7%. The implementation of this system provides enhanced safety assurance for elderly individuals during outdoor activities. Full article

The prevalence of car dependence and sedentary lifestyles has created concern in the transportation and health sectors. Walking is the most popular and practical kind of exercise that can significantly enhance health. In Chile, more than half of older adults have health issues and almost 72% of the elderly population never engages in physical activity. This study aims to investigate the relationship between older adults’ walking behavior and the built environment along the streets and parks in Santiago’s middle-income neighborhoods. Six medium-income central and pericentral neighborhoods of Santiago were selected. The average number of older persons who walk along the paths and two modified audit forms were used to measure walking behavior and built environment features, respectively. Both correlation analysis and backward regression were used to examine the associations. While elements like the existence of bus stops, pedestrian streets, and general cleanliness contribute to the enhanced number of older adults who walk along street segments, the presence of insecurity signs was found to be negatively associated with the number of older adults who walk in the neighborhood parks. Furthermore, complexity and mystery showed a negative association with the number of older adults in the neighborhood parks. Urban policymakers might use these findings to encourage older adults to walk more in Santiago’s medium-income neighborhoods. Full article

In the aging population, imbalance leading to falls is of critical concern; thus, it is imperative to determine and quantify neuromuscular changes because of rehabilitative balance training. (1) Background: Previous studies that have examined changes in balance due to rehabilitative training placed a focus on clinical measures (i.e., behavioral, kinetic, and kinematic outputs); however, irregularities due to abnormalities of underlying neural origin were unrevealed by the aforementioned measures. (2) Methods: Examining muscle activity was used to determine strategies pre- and post-six weeks of balance training in twenty-three healthy older adults (69.5 ± 5.7 years old) and five survivors of stroke (66.4 ± 9.48 years old). Surface electromyographic (sEMG) signals were recorded from eight of the lower limb muscles while participants performed forward walking (FW), forward tandem walking (FT-W), backward walking (BW), and backward tandem walking (BT-W) tasks. The sEMG data were then conditioned and muscle synergies were extracted using non-negative matrix factorization (NNMF). (3) Results: It was observed that muscle synergies and activation patterns changed for pre- versus post-balance training in older adults (i.e., healthy individuals and those who had suffered from stroke). (4) Conclusions: From our findings, it was indicative that muscle activation and muscle synergies could be used to quantify and inform rehabilitative balance training in older adults. Full article

Background: The early detection of fall risk in older adults is crucial for prevention. This study assessed the 3-Meter Backward Walk Test (3m-BWT) as a predictor of falls. Methods: A retrospective observational case–control study was conducted with 483 community-dwelling participants (mean age 76.3 ± 6.5 years), including 101 individuals with a history of falls in the previous 12 months. A standardized battery of functional assessments was applied. Results: Significant differences were observed between fallers and non-fallers across all functional variables (p < 0.001), with fallers demonstrating slower performance on the 3m-BWT (6.8 ± 3.4 s vs. 5.1 ± 1.3 s). The 3m-BWT showed moderate correlations with Short Physical Performance Battery, 5-repetition Sit-to-Stand, gait speed, and 4-Square Step Test, and a moderate-to-strong correlation with Timed Up-and-Go (r = 0.632), even after adjusting for age, sex, and BMI. Although the 3m-BWT exhibited superior discriminative ability compared to other tests (AUC = 0.655), its predictive power in isolation remains limited. The optimal cut-off point was identified at 5.5 s (sensitivity: 59.5%; specificity: 68.6%), while a threshold of <3.5 s yielded high sensitivity (98%) but low specificity, supporting its use in fall risk screening. Conclusions: These findings support the integration of the 3m-BWT as a complementary tool within comprehensive geriatric assessments, particularly in contexts requiring high sensitivity. Given the multifactorial nature of falls, combining the 3m-BWT with other clinical evaluations and fall history is recommended to enhance risk stratification and inform preventive strategies. Full article