Effects of an adapted physical activity program in a group of elderly subjects with flexed posture: clinical and instrumental assessment
From: J Neuroeng Rehabil. 2008 Nov 25;5(1):32 [Epub ahead of print]
Posture is not static but is a dynamic process represented by alignment of the body’s anatomical units in relationship to one another at any given time. Posture can be influenced by multiple factors. These factors can be static, as in the anatomical makeup of an individual, or dynamic, related to neuromuscular systems. The flexed posturing that often develops places the center of gravity closer to their limit of stability.
Flexed posture commonly increases with age and is related to musculoskeletal impairment and reduced physical performance. A double-blind, two-arm, randomized 3-month clinical trial was conducted for 3 months in order to evaluate the effects of an Adapted Physical Activity program for flexed posture on the postural alignment and the physical performance of the elderly.
Participants were randomly divided into two groups: one followed an Adapted Physical Activity program for flexed posture inspired to the Sinaki proposal and the other one completed a non-specific physical activity protocol for the elderly. A multidimensional clinical assessment was performed at baseline and at 3 months including anthropometric data, clinical profile, measures of musculoskeletal impairment and disability. The instrumental assessment of posture was realized using a stereophotogrammetric system and a specific biomechanical model designed to describe the reciprocal position of the body segments on the sagittal plane in a upright posture.
In both groups exercise sessions began with 10 minutes’ warm-up and ended with 10 minutes’ cool-down.
1. In a sitting position with hands behind the head, deep-breathing-in exercise combined with pushing elbows backwards. Then back to the initial position (10 repetitions).
2. In a sitting position with slightly flexed elbows, deep-breathing-in exercise combined with shoulder extension and adduction, and neck extension. Then back to the initial position (10 repetitions).
3. In a sitting position with arms along the sides, deep-breathing-in exercise combined with shoulder elevation. Then back to the initial position (10 repetitions).
4. In a sitting position with hands on thighs, deep-breathing-in exercise combined with shoulder abduction rotating palms upwards (10 repetitions).
5. In a sitting position holding a stick in two hands, deep-breathing-in exercise combined with raising the stick (8 repetitions).
6. In a sitting position with arms along the sides, lateral bending of the trunk while trying to touch the floor with fingers from one side to the other (8 repetitions).
7. In a standing position in front of a wall, arms overhead wall slides combined with neck extension (8 repetitions).
8. In a standing position with back touching the wall, starting from 90° shoulders abduction and 90° elbows flexion, complete shoulder abduction and elbow extension bringing hands over head (8 repetitions).
9. In a standing position with forearms on table, alternate hip extension (10 repetitions).
10. Supine with hip and knee flexion, and feet on the floor, anterior pelvic tilt while strengthening abdominal and glutei muscles (10 repetitions).
The non-specific physical activity protocol for the elderly adopted in Group NSPA consisted of global posture exercises through a floor training with the use of exercise balls for increasing joint mobility, muscle strength and flexibility.
The Adapted Physical Activity program determined a significant improvement in several key parameters of the multidimensional assessment in comparison to the non-specific protocol: decreased occiput-to-wall distance, higher greater lower limb range of motion of lower limbs, better flexibility of pectoralis, hamstrings and hip flexor muscles, increased spine extensors muscles strength. The stereophotogrammetric analysis revealed a reduction of compensative postural adaptations to flexed posture characterized by diminishing of reduced protrusion of the head and ankle dorsiflexion in the participants of the specific program.
The Adapted Physical Activity program for flexed posture significantly improved postural alignment and musculoskeletal impairment of the elderly. The stereophotogrammetric evaluation of posture was useful to measure the global postural alignment and especially to analyze the possible compensatory strategies at the head and lower limbs in flexed posture.
