The results suggest that the plasticity of the AT in response to short-term mechanical loading may be age dependent and that the AT length-tension properties of middle-aged runners may be more vulnerable to change following running compared to younger athletes. However, the observed AT changes in the middle-aged runners dissipated within 20-28 h post-run, suggesting that a tendon viscoelastic recovery mechanism may occur in vivo.

Stair falls, especially during stair descent, are a major problem for older people. Stair fall risk has typically been assessed by quantifying mean differences between subject groups (e.g. older vs. younger individuals) for a number of biomechanical parameters individually indicative of risk, e.g., a reduced foot clearance with respect to the stair edge, which increases the chances of a trip. This approach neglects that individuals within a particular group may also exhibit other concurrent conservative strategies that could reduce the overall risk for a fall, e.g. a decreased variance in foot clearance. The purpose of the present study was to establish a multivariate approach that characterises the overall stepping behaviour of an individual. Twenty-five younger adults (age: 24.5±3.3 y) and 70 older adults (age: 71.1±4.1 y) descended a custom-built instrumented seven-step staircase at their self-selected pace in a step-over-step manner without using the handrails. Measured biomechanical parameters included: 1) Maximal centre of mass angular acceleration, 2) Foot clearance, 3) Proportion of foot length in contact with stair, 4) Required coefficient of friction, 5) Cadence, 6) Variance of these parameters. As a conventional analysis, a one-way ANOVA followed by Bonferroni post-hoc testing was used to identify differences between younger adults, older fallers and non-fallers. To examine differences in overall biomechanical stair descent behaviours between individuals, k-means clustering was used. The conventional grouping approach showed an effect of age and fall history on several single risk factors. The multivariate approach identified four clusters. Three clusters differed from the overall mean by showing both risky and conservative strategies on the biomechanical outcome measures, whereas the fourth cluster did not display any particularly risky or conservative strategies. In contrast to the conventional approach, the multivariate approach showed the stepping behaviours identified did not contain only older adults or previous fallers. This highlights the limited predictive power for stair fall risk of approaches based on single-parameter comparisons between predetermined groups. Establishing the predictive power of the current approach for future stair falls in older people is imperative for its implementation as a falls prevention tool.

Background Stair falls are a major health problem for older people, but presently there are no specific screening tools for stair fall prediction. The purpose of the present study was to investigate whether stair fallers could be differentiated from non-fallers by biomechanical risk factors or physical/psychological parameters and to establish the biomechanical stepping profile posing the greatest risk for a stair fall. Methods Eighty-seven older adults (age: 72.1±5.2 y) negotiated an instrumented seven-step staircase and performed a range of physical/psychological tasks. K-means clustering was used to profile the overall stair negotiation behaviour with biomechanical parameters indicative of fall risk as input. Falls and events of balance perturbation (combined “hazardous events”) were then monitored during a 12-month follow-up. Cox-regression analysis was performed to examine if physical/psychological parameters or biomechanical outcome measures could predict future hazardous events. Kaplan-Meier survival curves were obtained to identify the stepping strategy posing a risk for a hazardous event. Results Physical/psychological parameters did not predict hazardous events and the commonly used Fall Risk Assessment Tool (FRAT) classified only 1/17 stair fallers at risk for a fall. Single biomechanical risk factors could not predict hazardous events on stairs either. On the contrary, two particular clusters identified by the stepping profiling method in stair ascent were linked with hazardous events. Conclusion This highlights the potential of the stepping profiling method to predict stair fall risk in older adults against the limited predictability of single parameter approaches currently used as screening tools.

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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.

Reductions in muscular power output and performance during multi-joint motor tasks with aging have often been associated with muscle weakness. This study aimed to examine if matching younger and middle-aged adults for triceps surae (TS) muscle strength and tendon stiffness eliminates age-related differences in muscular power production during drop jump. The maximal ankle plantar flexion moment and gastrocnemius medialis tendon stiffness of 29 middle-aged (40–67 years) and 26 younger (18–30 years) healthy physically active male adults were assessed during isometric voluntary ankle plantar flexion contractions using simultaneous dynamometry and ultrasonography. The elongation of the tendon during the loading phase was assessed by digitizing the myotendinous junction of the gastrocnemius medialis muscle. Eight younger (23 ± 3 years) and eight middle-aged (54 ± 7 years) adults from the larger subject pool were matched for TS muscle strength and tendon stiffness (plantar flexion moment young: 3.1 ± 0.4 Nm/kg; middle-aged: 3.2 ± 0.5 Nm/kg; tendon stiffness: 553 ± 97 vs. 572 ± 100 N/mm) and then performed series of drop jumps from different box heights (13, 23, 33, and 39 cm) onto a force plate (sampling frequency 1000 Hz). The matched young and middle-aged adults showed similar drop jump heights for all conditions (from lowest to highest box height: 18.0 ± 3.7 vs. 19.7 ± 4.8 cm; 22.6 ± 4.2 vs. 22.9 ± 4.9 cm; 24.8 ± 3.8 vs. 23.5 ± 4.9 cm; 25.2 ± 6.2 vs. 22.7 ± 5.0 cm). However, middle-aged adults showed longer ground contact times (on average 36%), lower vertical ground reaction forces (36%) and hence lower average mechanical power (from lowest to highest box height: 2266 ± 563 vs. 1498 ± 545 W; 3563 ± 774 vs. 2222 ± 320 W; 4360 ± 658 vs. 2475 ± 528 W; 5008 ± 919 vs. 3034 ± 435 W) independent of box height. Further, leg stiffness was lower (48%) in middle-aged compared to younger adults for all jumping conditions and we found significant correlations between average mechanical power and leg stiffness (0.70 ≤ r ≤ 0.83; p < 0.01). Thus, while jumping performance appears to be unaffected when leg extensor muscle strength and tendon stiffness are maintained, the reduced muscular power output during lower limb multi-joint tasks seen with aging may be due to age-related changes in motor task execution strategy rather than due to muscle weakness.

Supplemental Digital Content is available in the textPresent evaluation methods in adult spinal deformity fail to assess functional impairments. Therefore, this study introduced a valid and reliable clinical scale, the Function Assessment scale for Spinal Deformity. By measuring function and balance, this scale can increase our insights on the impact of spinal deformity on functioning.

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