The Effect of Ageing on the Standing Up Movement Analysed using the Capacity, Reserve, Movement Objectives, and Compensation (CaReMoOC) Framework

Abstract

In healthy ageing, capacity declines in the neural, muscular, and skeletal systems, and each system decline has its effect on the execution of complex motor tasks. This decline in capacity can result in the inability to stand up (sit-to-stand, sit-to-walk), which is a key movement for independence. The mechanisms leading to mobility limitations or inabilities are complex, overlapping, and interdependent and the complementary fields of biomechanics, motor control, and physiology need to be combined to understand these mechanisms. The aim of this review is to provide an overview of the current knowledge of age-related compensation in standing up and to consider the limitations of these results when analysing standing up in daily life using the Capacity, Reserve, Movement Objectives, and Compensation (CaReMoOC) framework that combines biomechanics, motor control, and physiology. A literature search was performed in the search engine Scopus, using the keywords and their synonyms: strateg*(approach, technique, way) AND, sit-to-walk OR sit-to-stand OR rise (raise, arise, stand, stand-up) AND chair (seat). Inclusion criteria were: biomechanics or motor control on sit-to-stand or sit-to-walk in healthy and/or frail adults (<60y) and elderly (>60y), and/or osteoarthritis patients as a specific case of ageing related decline. The review shows that movement compensations in standing up manifest as changes in planned trajectory (Compensation by Selection) and in muscle recruitment (Compensation by Reorganisation). However, as most studies in the literature typically use standardized experimental protocols where movement compensation is restricted, these studies cannot be directly translated to functional tasks, such as the mobility of the elderly in their homes, communities, and clinic. Compensation must be included in future studies in order to facilitate clinical translation. Specifically, future studies in the standing up task should 1) determine the effect of varying arm use strategies (e.g., armrests, knees, chair, cane) on trunk and both lower limb and upper limb joint loading, 2) analyse control strategies in elderly people, 3) determine the biomechanical implications of asymmetry, and 4) incorporate assessments of age-related physical and neural decline as well as changes in psychological priorities.