Ann Rehabil Med.  2018 Feb;42(1):113-119. 10.5535/arm.2018.42.1.113.

Association Between Asymmetry in Knee Extension Strength and Balance in a Community-Dwelling Elderly Population: A Cross-Sectional Analysis

Affiliations
  • 1Department of Rehabilitation Medicine, Kyung Hee University Hospital, Seoul, Korea. rememberme85@naver.com
  • 2Department of Rehabilitation Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
  • 3Department of Family Medicine, Kyung Hee University Hospital, Seoul, Korea.

Abstract


OBJECTIVE
To evaluate the association between balance function and asymmetry of knee extension strength in an elderly Korean population.
METHODS
The strength of the knee extensors in each leg was measured in 306 community-dwelling elderly subjects (age, 76.70±4.85 years) and 25 young healthy subjects (age, 34.23±8.93 years). Based on the difference in strength of both legs, the elderly subjects were divided into symmetric (n=128) and asymmetric (n=178) strength groups using an asymmetry cutoff 20%. We determined the postural control ability of the subjects using InBody posturography, Berg Balance Scale (BBS), Timed Up and Go test (TUG) and Short Physical Performance Battery (SPPB). The sway index (SI) of the subjects in four positions was assessed using posturography.
RESULTS
The group with asymmetric strength presented a significantly higher SI than the group with symmetric strength, in the normal position with eyes open and eyes open on pillows. In the normal position with the eyes closed and in postures with the eyes closed on pillows, the statistical analysis revealed no significant differences between the two groups. The three tests for physical performance (BBS, TUG, and SPPB) show no statistically significant difference between the two groups.
CONCLUSION
The asymmetric strength group showed a significantly lower balance than the group with symmetric strength based on several posturographic parameters. Ambulatory elderly individuals with asymmetry in knee extension strength, showed deficits in balance control even in normal clinical tests.

Keyword

Elderly; Postural asymmetry factor; Postural balance; Accidental falls

MeSH Terms

Accidental Falls
Aged*
Cross-Sectional Studies*
Healthy Volunteers
Humans
Knee*
Leg
Postural Balance
Posture

Figure

  • Fig. 1 Posturography and posture settings. (A) The force plate of the InBody posturography is composed of four plates, and each force plate measures the perpendicular pressure of the anterior and posterior feet. (B) The subjects removed their shoes, placed their feet on the plates, and stood in a comfortable position.


Reference

1. Steffen TM, Hacker TA, Mollinger L. Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther. 2002; 82:128–137. PMID: 11856064.
2. Grisso JA, Kelsey JL, O'Brien LA, Miles CG, Sidney S, Maislin G, et al. Risk factors for hip fracture in men. Hip Fracture Study Group. Am J Epidemiol. 1997; 145:786–793. PMID: 9143208.
3. Carabello RJ, Reid KF, Clark DJ, Phillips EM, Fielding RA. Lower extremity strength and power asymmetry assessment in healthy and mobility-limited populations: reliability and association with physical functioning. Aging Clin Exp Res. 2010; 22:324–329. PMID: 19940556.
Article
4. Laroche DP, Cook SB, Mackala K. Strength asymmetry increases gait asymmetry and variability in older women. Med Sci Sports Exerc. 2012; 44:2172–2181. PMID: 22617401.
Article
5. Nakao H, Yoshikawa T, Mimura T, Hara T, Nishimoto K, Fujimoto S. Influence of lower-extremity muscle force, muscle mass and asymmetry in knee extension force on gait ability in community-dwelling elderly women. J Phys Ther Sci. 2006; 18:73–79.
Article
6. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000; 80:896–903. PMID: 10960937.
7. Kim HS, Yun DH, Yoo SD, Kim DH, Jeong YS, Yun JS, et al. Balance control and knee osteoarthritis severity. Ann Rehabil Med. 2011; 35:701–709. PMID: 22506194.
Article
8. Perry MC, Carville SF, Smith IC, Rutherford OM, Newham DJ. Strength, power output and symmetry of leg muscles: effect of age and history of falling. Eur J Appl Physiol. 2007; 100:553–561. PMID: 16847676.
Article
9. Skelton DA, Kennedy J, Rutherford OM. Explosive power and asymmetry in leg muscle function in frequent fallers and non-fallers aged over 65. Age Ageing. 2002; 31:119–125. PMID: 11937474.
Article
10. Guralnik JM, Seeman TE, Tinetti ME, Nevitt MC, Berkman LF. Validation and use of performance measures of functioning in a non-disabled older population: MacArthur studies of successful aging. Aging (Milano). 1994; 6:410–419. PMID: 7748914.
Article
11. Ostir GV, Volpato S, Fried LP, Chaves P, Guralnik JM. Women's Health and Aging Study. Reliability and sensitivity to change assessed for a summary measure of lower body function: results from the Women's Health and Aging Study. J Clin Epidemiol. 2002; 55:916–921. PMID: 12393080.
12. Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006; 54:743–749. PMID: 16696738.
Article
13. Quadri P, Tettamanti M, Bernasconi S, Trento F, Loew F. Lower limb function as predictor of falls and loss of mobility with social repercussions one year after discharge among elderly inpatients. Aging Clin Exp Res. 2005; 17:82–89. PMID: 15977454.
Article
14. Gardner MM, Robertson MC, Campbell AJ. Exercise in preventing falls and fall related injuries in older people: a review of randomised controlled trials. Br J Sports Med. 2000; 34:7–17. PMID: 10690444.
Article
15. Barnett A, Smith B, Lord SR, Williams M, Baumand A. Community-based group exercise improves balance and reduces falls in at-risk older people: a randomized controlled trial. Age Ageing. 2003; 32:407–414. PMID: 12851185.
16. Hytonen M, Pyykko I, Aalto H, Starck J. Postural control and age. Acta Otolaryngol. 1993; 113:119–122. PMID: 8475724.
17. Lanshammar K, Ribom EL. Differences in muscle strength in dominant and non-dominant leg in females aged 20-39 years: a population-based study. Phys Ther Sport. 2011; 12:76–79. PMID: 21496769.
18. Suetta C, Aagaard P, Magnusson SP, Andersen LL, Sipila S, Rosted A, et al. Muscle size, neuromuscular activation, and rapid force characteristics in elderly men and women: effects of unilateral long-term disuse due to hip-osteoarthritis. J Appl Physiol (1985). 2007; 102:942–948. PMID: 17122381.
Article
19. Portegijs E, Sipila S, Pajala S, Lamb SE, Alen M, Kaprio J, et al. Asymmetrical lower extremity power deficit as a risk factor for injurious falls in healthy older women. J Am Geriatr Soc. 2006; 54:551–553. PMID: 16551335.
Article
Full Text Links
  • ARM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr