|Year : 2021 | Volume
| Issue : 2 | Page : 94-97
Correlation of lumbar core strength with functional mobility in community-dwelling elderly adults
Danielle Malcolm DSouza, Vivek N Kulkarni
Department of Physiotherapy, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
|Date of Submission||03-May-2021|
|Date of Decision||06-Oct-2021|
|Date of Acceptance||29-Nov-2021|
|Date of Web Publication||12-Jan-2022|
Dr. Danielle Malcolm DSouza
Sarla Garden, Vakola, Santacruz East, Mumbai - 400 055, Maharashtra
Source of Support: None, Conflict of Interest: None
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|| |
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., The spine and pelvis are supported during movement by the action of these muscles contracting together on the incompressible contents of the abdominal cavity. 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.,,
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. 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.,, There is also evidence that as people age, their core muscles lose strength and endurance as a result of increased fat infiltration.
Conventionally, balance and lower extremity resistance training were used to counter age-related impairments. 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. 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., 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|| |
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., The subject was given a practice trial.
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.
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.
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|| |
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].
[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|| |
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. 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. 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. 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.
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.
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. 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|| |
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
Conflicts of interest
There are no conflicts of interest.
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