Declarations of Interest: Mike Roys is an independent consultant working as a sole trader under the name of Rise and Going Consultancy. There is no conflict of interest with how this study was run nor the outcome measures reported. No other competing interests exist.
Older people have an increased risk of falling during locomotion, with falls on stairs being particularly common and dangerous. Step going (i.e., the horizontal distance between two consecutive step edges) defines the base of support available for foot placement on stairs, as with smaller going, the user's ability to balance on the steps may become problematic. Here we quantified how stair negotiation in older participants changes between four goings (175, 225, 275, and 325 mm) and compared stair negotiation with and without a walking approach. Twenty-one younger (29 ± 6 years) and 20 older (74 ± 4 years) participants negotiated a 7-step experimental stair. Motion capture and step-embedded force platform data were collected. Handrail use was also monitored. From the motion capture data, body velocity, trunk orientation, foot clearance and foot overhang were quantified. For all participants, as stair going decreased, gait velocity (ascent p A = 0.033, descent p D = 0.003) and horizontal step clearance decreased (p A = 0.001), while trunk rotation (p D = 0.002) and foot overhang increased (p A,D < 0.001). Compared to the younger group, older participants used the handrail more, were slower across all conditions (p A < 0.001, p D = 0.001) and their foot clearance tended to be smaller. With a walking approach, the older group (Group x Start interaction) showed a larger trunk rotation (p A = 0.011, p D = 0.015), and smaller lead foot horizontal (p A = 0.046) and vertical clearances (p D = 0.039) compared to the younger group. A regression analysis to determine the predictors of foot clearance and amount of overhang showed that physical activity was a common predictor for both age groups. In addition, for the older group, medications and fear of falling were found to predict stair performance for most goings, while sway during single-legged standing was the most common predictor for the younger group. Older participants adapted to smaller goings by using the handrails and reducing gait velocity. The predictors of performance suggest that motor and fall risk assessment is complex and multifactorial. The results shown here are consistent with the recommendation that larger going and pausing before negotiating stairs may improve stair safety, especially for older users.
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Introduction Stair descent is a physically demanding activity of daily life and common risk for falls. Age-related deteriorations in ankle joint capacities make stair descent particularly challenging for older adults in built environments, where larger rise steps are encountered. Exercise training may allow older adults to safely cope with the high biomechanical demands of stair descent. However, little is known about the demands of increased rise stairs for older adults, nor the impact of exercise. Aim We investigated whether the effects of lower-limb resistance training would alter joint kinetics and movement strategies for older adults when descending standard rise, and increased rise stairs. Methods Fifteen older adults descended a four-step stair adjusted to standard rise (170 mm), and increased rise (255 mm) on separate visits. Between these two visits, randomly allocated participants underwent 16 weeks of either: resistance exercise training ( n = 8) or habitual activity ( n = 7). Kinetic data were measured from step-mounted force plates, and kinematic data from motion-capture cameras. Training involved twice-weekly sessions of lower-limb resistance exercises (three sets of ∼8 repetitions at ∼80% three-repetition maximum), and static plantarflexor stretching (three, 45 s holds per leg). Results Standard stairs – Peak ankle joint moments increased ( p < 0.002) and knee joint moments decreased ( p < 0.01) during descent after exercise training. Peak centre of pressure-centre of mass (CoP-CoM) separations increased in posterior ( p = 0.005) and medio-lateral directions ( p = 0.04) after exercise training. Exercise training did not affect CoM descent velocity or acceleration. Increased rise stairs – Required greater ankle, knee, and hip moments ( p < 0.001), peak downward CoM velocity and acceleration ( p = 0.0001), and anterior-posterior CoP-CoM separation ( p = 0.0001), but lower medial-lateral CoP-CoM separation ( p < 0.05), when compared to standard stair descent. Exercise training did not affect joint kinetics or movement strategies. Discussion Exercise training increased the maximum joint ROM, strength and force production of the ankle, and enabled a greater ankle joint moment to be produced in single-leg support (lowering phase) during standard stair descent. Descending increased rise stairs raised the task demand; exercise training could not overcome this. Future research should prioritize the ankle joint in stair descent, particularly targeting plantarflexor torque development across stairs of varying riser heights.
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