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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 3  |  Issue : 2  |  Page : 94-97

Correlation of lumbar core strength with functional mobility in community-dwelling elderly adults


Department of Physiotherapy, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India

Date of Submission03-May-2021
Date of Decision06-Oct-2021
Date of Acceptance29-Nov-2021
Date of Web Publication12-Jan-2022

Correspondence Address:
Dr. Danielle Malcolm DSouza
Sarla Garden, Vakola, Santacruz East, Mumbai - 400 055, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijptr.ijptr_35_21

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  Abstract 


Context: Aging results in changes in individual cells and organs of the body which consequently result in changes in function and appearance. These changes imply a negative influence on functional performance interfering with activities of daily living. The core muscles form an important mechanical linkage providing proximal stability and distal mobility. With age, due to fat infiltration, the core muscle strength is found to decrease.
Aims: The study aimed to find if a correlation exists between core muscle strength and functional mobility in community-dwelling elderly individuals.
Settings and Design: The study was an analytical cross-sectional study conducted in an urban setup in Pune.
Subjects and Methods: A total of 103 community-dwelling elderly individuals were assessed for lumbar core strength using the Supine test of Pressure biofeedback and functional mobility using the timed up and go (TUG) test as well as the functional reach test (FRT).
Statistical Analysis Used: Spearman correlation test was used in this study.
Results: The study showed a significant correlation between core strength and TUG test as well as with the FRT scores (r[TUG] = −0.75, r[FRT] = 0.72).
Conclusions: Individuals with a stronger core require lesser duration to complete the TUG test, and can reach a greater distance in the FRT.

Keywords: Core strength, elderly, functional mobility


How to cite this article:
DSouza DM, Kulkarni VN. Correlation of lumbar core strength with functional mobility in community-dwelling elderly adults. Indian J Phys Ther Res 2021;3:94-7

How to cite this URL:
DSouza DM, Kulkarni VN. Correlation of lumbar core strength with functional mobility in community-dwelling elderly adults. Indian J Phys Ther Res [serial online] 2021 [cited 2022 Jan 25];3:94-7. Available from: https://www.ijptr.org/text.asp?2021/3/2/94/335663




  Introduction Top


The transversus abdominis, internal and external obliques, quadratus lumborum, erector spinae, and multifidus muscles are all part of the “Core” region, which is delimited by the abdominal wall, pelvis, lower back, and diaphragm.[1],[2] The spine and pelvis are supported during movement by the action of these muscles contracting together on the incompressible contents of the abdominal cavity.[3] The core muscles thus act as a mechanical linkage providing proximal stability and enhancing distal mobility and the endurance of these muscles plays a very important role in spinal stability during prolonged physical activity and thus protects from the risk of injury.[4],[5],[6]

Individual cells and organs in the body undergo changes as they age, resulting in changes in function and appearance. These alterations have a deleterious impact on functional performance, interfering with daily activities such as stair climbing and descending.[7] Furthermore, in older individuals, the chances of visual, vestibular, and sensory affection are doubled due to the degenerative changes occurring in these systems which affect the functional performance thus making them susceptible to an increased risk of fall.[8],[9],[10] There is also evidence that as people age, their core muscles lose strength and endurance as a result of increased fat infiltration.[11]

Conventionally, balance and lower extremity resistance training were used to counter age-related impairments.[12] However, while resistance training improves strength, the benefits of strength do not translate well to improvements in functional tasks, activities of daily living, or the risk of falling.[13] Further, among older adults, there exists an association between limb impairments and both mobility and balance as compared to the effect of trunk impairments such as decreased core muscle strength and endurance on the same.[14],[15] In the light of the existing research carried out in this area and keeping in view the lacunae that have not received due attention, the purpose of this study was to analyze the correlation of core strength with functional mobility among community-dwelling elderly individuals.


  Subjects and Methods Top


This was an analytical cross-sectional study conducted at the Physiotherapy Outpatient Department of a Hospital in Pune over a period of 2 months after approval from the Institutional Ethics Committee. A total of 150 participants were screened of which 103 individuals were included in the study by purposive sampling technique.

The purpose of the study was explained and written informed consent was obtained from the participants. Community-dwelling elderly individuals aged 60 years and above, with a body mass index (BMI) between 18.5 and 30 and those ambulating independently according to Functional Ambulation Classification Grade 6 were included in the study. Forty-seven elderly individuals with musculoskeletal impairments (in the past 1 year), those who previously reported neurological disease affecting balance, cognitive impairment, and spinal pathologies were excluded from the study. Each participant participated in a single testing session. Data were obtained from the participants and then recorded.

Core muscle strength

The strength of the lumbar core muscles was measured using a pressure biofeedback equipment. The participant was asked to lie down in a crook position with 70°–90° of knee flexion, with the pressure biofeedback unit (folded into thirds) positioned beneath the lumbar lordosis and inflated to a baseline pressure of 40 mmHg. The participant was instructed to hollow the abdominal muscles so as to draw the umbilicus up and in, increasing the pressure on the cuff and hold the pressure steady for 10 s. Increase in pressure was recorded.[16],[17] The subject was given a practice trial.

Functional mobility

Timed up and go test

The patient was made to sit in a chair without arms with the back supported. On the command “go,” the patient was instructed to rise from the chair, walk 3 m at a comfortable pace, turn, walk back to the chair and sit down. Timing was recorded at the instruction “go” and stopped when the patient was seated. The patient was given one practice trial that was not included in the score.[18]

Functional reach test

The patient was instructed to stand next to but not touching the wall and position the arm that was closer to the wall at 90° of shoulder flexion with a closed fist. The starting position of the third metacarpal head on the yardstick was recorded and the patient was instructed to reach as forward as he could without taking a step. The location of the third metacarpal on the yardstick was recorded again. Scores were determined by assessing the difference between the start and end position of the third metacarpal. Three trials were given and the average was noted.[19]

Statistical analysis

The obtained data were recorded in Microsoft Excel (2007) and a master chart was prepared including the participant's demographic data. Data were analyzed using the IBM SPSS Software (version 25, SPSS Inc., Chicago, Illinois. U. S.). Descriptive analysis of the data was done. As the data did not pass the Shapiro–Wilk test for normality, Spearman's test was used to assess the correlation between the variables.


  Results Top


The present study was conducted in an urban set up on 103 community-dwelling elderly individuals aged 60 years and above with a mean age of 62 ± 3.162 years and a mean BMI of 25.92 ± 2.871. The mean core strength of the participants was 43.3 ± 2.03 mm Hg. The mean scores for the timed up and go (TUG) test and the functional reach test (FRT) were 9.96 ± 1.13 s and 10.63 ± 2.98 inches, respectively [Table 1].
Table 1: Descriptive statistics

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[Graph 1] shows rs= −0.75, n = 103, indicating a significant negative correlation between the variables, such that the higher the core strength, the lesser the duration required by the subject to complete the TUG test.



[Graph 2] shows rs = 0.72, n = 103, indicating a significant positive correlation between the variables, such that the higher the core strength, the greater the functional reach distance performed by the subject.




  Discussion Top


The purpose of this study was to investigate the correlation between lumbar core strength and functional mobility in community-dwelling elderly people.

A significant negative correlation was found between the core muscle strength and the scores of the TUG test while a significant positive correlation was found to exist between the core muscle strength and the FRT scores in community-dwelling elderly individuals. This implies that higher the core strength of an individual, lesser the duration required to complete the TUG test, and greater the functional reach distance implying that individuals with better core strength are more functionally mobile.

According to Barbosa et al., with the onset of aging the functional capacity of older individual's declines, thus affecting both static and dynamic balance, in turn resulting in an increased risk of falls.[20] It was stated by Brittenham et al. that 60% of the mass of one's body is in the trunk and thus all movements of the extremities either originate or are coupled through the trunk.[21] This is supported by Hodges et al., who found that the co-contraction of the deeper layer of transversus abdominis and multifidus muscle groups occur prior to any movement of the limbs and believe that this neuromuscular pre-activation is critical in stabilizing the spine prior to any movement. This further suggests that during any activity in the limbs, core muscles are active before the prime movers of the limbs. Furthermore, the structure of the spine is more unstable than that of the other bones.[22] This explains why the role of the deep muscles is particularly important for spinal stabilization which is supported by a study performed by Nishad et al. in which the participants when given an intervention program comprising of core strengthening for 6 weeks showed improved TUG and FRT scores.[23]

The current study is also supported by Fujiwara et al., according to whom, there is loss in reflex ability as well as muscle strength in the rectus abdominis, transversus abdominis, and external oblique muscles which affects the functional activities of daily living (ADL) for people over 60 years of age.[24]

TUG test incorporates multiple activities including sit-to-stand, walking a short distance, changing direction during walking which alters the base of support while in the FRT, the patient is asked to reach as forward as he can without stepping forward thus again moving the center of gravity out of the base of support. As seen previously, optimal core stability helps maintain the center of gravity within the altered base of support and this could be a reason for individuals with good core strength having better TUG and FRT scores. In addition, according to the kinetic chain theory, core stability is the ability to control the position and motion of the trunk and pelvis relative to the extremities to allow for optimal force production dissipation and transfer to the extremities during movement.[25] As everyday activities require coordination between the upper and lower extremities, the core muscles act as a mechanical linkage providing proximal stability to enhance distal mobility. However, in the current study, purposive sampling design was used hence the results cannot be generalized to the whole population of community-dwelling elderly individuals. A further research can be carried out on a larger cohort, in order to obtain results that can be generalized to the whole population and the correlation between the variables can be studied after the administration of an intervention program.


  Conclusions Top


The present study concluded that a strong correlation of core strength with functional mobility exists among community-dwelling elderly individuals and thus more emphasis should be given to core strengthening in clinical practice to improve balance and mobility and reduce the risk of falls in elderly individuals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Guskiewiez K. Regaining postural stability and balance. In: William E. Prentice, editor. Rehabilitation Techniques for Sports Medicine and Athletic Training Prentice. 5th ed. New York: McGraw Hill; 2011. p. 145--170.  Back to cited text no. 1
    
2.
Arokoski JP, Valta T, Airaksinen O, Kankaanpää M. Back and abdominal muscle function during stabilization exercises. Arch Phys Med Rehabil 2001;82:1089-98.  Back to cited text no. 2
    
3.
Richardson C, Hodges P, Hides J. Therapeutic Exercise for Lumbopelvic Stabilisation. 2nd ed. London: Churchill Livingstone; 2004. p. 60-71.  Back to cited text no. 3
    
4.
Fredericson M, Moore T. Muscular balance, core stability, and injury prevention for middle- and long-distance runners. Phys Med Rehabil Clin N Am 2005;16:669-89.  Back to cited text no. 4
    
5.
Granata KP, Slota GP, Wilson SE. Influence of fatigue in neuromuscular control of spinal stability. Hum Factors 2004;46:81-91.  Back to cited text no. 5
    
6.
Sato K, Mokha M. Does core strength training influence running kinetics, lower-extremity stability, and 5000-M performance in runners? J Strength Cond Res 2009;23:133-40.  Back to cited text no. 6
    
7.
Emilio EJ, Hita-Contreras F, Jiménez-Lara PM, Latorre-Román P, Martínez-Amat A. The association of flexibility, balance, and lumbar strength with balance ability: Risk of falls in older adults. J Sports Sci Med 2014;13:349-57.  Back to cited text no. 7
    
8.
Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: Validation of an instrument. Can J Public Health 1992;83 Suppl 2:S7-11.  Back to cited text no. 8
    
9.
Hurvitz EA, Richardson JK, Werner RA, Ruhl AM, Dixon MR. Unipedal stance testing as an indicator of fall risk among older outpatients. Arch Phys Med Rehabil 2000;81:587-91.  Back to cited text no. 9
    
10.
Vellas BJ, Wayne SJ, Romero L, Baumgartner RN, Rubenstein LZ, Garry PJ. One-leg balance is an important predictor of injurious falls in older persons. J Am Geriatr Soc 1997;45:735-8.  Back to cited text no. 10
    
11.
Hicks GE, Simonsick EM, Harris TB, Newman AB, Weiner DK, Nevitt MA, et al. Cross-sectional associations between trunk muscle composition, back pain, and physical function in the health, aging and body composition study. J Gerontol A Biol Sci Med Sci 2005;60:882-7.  Back to cited text no. 11
    
12.
Granacher U, Zahner L, Golhofer A. Strength, power, and postural control in seniors: Considerations for functional adaptations and for fall prevention. Eur J Sport Sci 2008;8:325-40.  Back to cited text no. 12
    
13.
Orr R, Raymond J, Fiatarone Singh M. Efficacy of progressive resistance training on balance performance in older adults: A systematic review of randomized controlled trials. Sports Med 2008;38:317-43.  Back to cited text no. 13
    
14.
Mayson DJ, Kiely DK, LaRose SI, Bean JF. Leg strength or velocity of movement: Which is more influential on the balance of mobility limited elders? Am J Phys Med Rehabil 2008;87:969-76.  Back to cited text no. 14
    
15.
Visser M, Goodpaster BH, Kritchevsky SB, Newman AB, Nevitt M, Rubin SM, et al. Muscle mass, muscle strength, and muscle fat infiltration as predictors of incident mobility limitations in well-functioning older persons. J Gerontol A Biol Sci Med Sci 2005;60:324-33.  Back to cited text no. 15
    
16.
Kisner C, Colby LA. Therapeutic Exercise Foundations and Techniques. 4th ed. New Delhi, India: Jaypee Borthers Medical Publishers (P) LTD.; 2002. p. 591-633, 638-76.  Back to cited text no. 16
    
17.
Richardson C, Hodges P, Hides J. Therapeutic Exercise for Lumbopelvic Stabilisation. 2nd ed. London: Churchill Livingstone; 2004. p. 191-2.  Back to cited text no. 17
    
18.
Wrisley DM, Kumar NA. Functional gait assessment: Concurrent, discriminative, and predictive validity in community-dwelling older adults. Phys Ther 2010;90:761-73.  Back to cited text no. 18
    
19.
Weiner DK, Duncan PW, Chandler J, Studenski SA. Functional reach: A marker of physical frailty. J Am Geriatr Soc 1992;40:203-7.  Back to cited text no. 19
    
20.
Barbosa AR, Santarém JM, Filho WJ, Marucci Mde F. Effects of resistance training on the sit-and-reach test in elderly women. J Strength Cond Res 2002;16:14-8.  Back to cited text no. 20
    
21.
Brittenham D, Brittenham G. Stronger Abs and Back. Champaign, IL: Human Kinetics; 1997.  Back to cited text no. 21
    
22.
Hodges PW, Richardson CA. Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine (Phila Pa 1976) 1996;21:2640-50.  Back to cited text no. 22
    
23.
Nishad AM, Nizar AK. Randomised controlled trial of core strength training in older adults: Effects on functional mobility. Sch Acad J Biosci 2015;3:19-25.  Back to cited text no. 23
    
24.
Fujiwara T, Hara Y, Chino N. Expiratory function in complete tetraplegics: Study of spirometry, maximal expiratory pressure, and muscle activity of pectoralis major and latissimus dorsi muscles. Am J Phys Med Rehabil 1999;78:464-9.  Back to cited text no. 24
    
25.
Kibler WB, Press J, Sciascia A. The role of core stability in athletic function. Sports Med 2006;36:189-98.  Back to cited text no. 25
    



 
 
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