, Volume 35, Issue 5, pp 1905–1915 | Cite as

Exercise of mechanisms of dynamic stability improves the stability state after an unexpected gait perturbation in elderly

  • Stefanie Bierbaum
  • Andreas Peper
  • Adamantios ArampatzisEmail author


Unexpected changes during gait challenge elderly individuals to a greater degree than young adults. However, the adaptive potential of elderly seems to be retained, and therefore, the training of the mechanisms of dynamic stability as well as muscle strength training may improve the dynamic stability after unexpected perturbations. Thirty-eight subjects (65–75 years) participated in the study, divided into two experimental groups (stability training group, ST, n = 14 and mixed training group, MT, n = 14) and a control group (CG, n = 10). Both experimental groups performed exercises which focused on the mechanisms of dynamic stability. Additionally, the MT group executed a training to improve muscle strength. Session volume and duration were equal for both groups (14 weeks, twice a week, ~1.5 h per session). Pre- and post-intervention, subjects performed a gait protocol with an induced unexpected perturbation. Post-intervention, the margin of stability was significantly increased after the unexpected perturbation in the ST group, indicating an improvement in stability state (pre, −30.3 ± 5.9 cm; post, −24.1 ± 5.2 cm). Further, both intervention groups increased their base of support after the intervention to regain balance after gait perturbation, whereas only the ST group showed a statistically significant improvement (STpre, 90.9 ± 6.6 cm, STpost, 98.2 ± 8.5 cm; MTpre, 91.4 ± 6.2 cm; MTpost, 97.9 ± 12.7 cm). The CG showed no differences between pre- and post-measurements. The exercise of the mechanisms of dynamic stability led to a better application of these mechanisms after an unexpected perturbation during gait. We suggest that the repeated exercise of the mechanisms of dynamic stability contributes to significant improvements in postural stability. Additional strength training for healthy elderly individuals, however, shows no further effect on the ability to recover balance after unexpected perturbations during gait.


Dynamic stability Intervention Unexpected perturbation Aging Recovery performance 


  1. Arampatzis A, Karamanidis K, De Monte D, Stafilidis S, Morey-Klapsing G, Brüggemann GP (2004) Differences between measured and resultant joint moments during voluntary and artificially elicited isometric knee extension contractions. Clin Biomech 19(3):277–283CrossRefGoogle Scholar
  2. Arampatzis A, Morey-Klapsing G, Karamanidis K, De Monte G, Stafilidis S, Brüggemann GP (2005) Differences between measured and resultant joint moments during isometric contractions at the ankle joint. J Biomech 38(4):885–892CrossRefGoogle Scholar
  3. Arampatzis A, Karamanidis K, Mademli L (2008) Deficits in the way to achieve balance related to mechanisms of dynamic stability control in the elderly. J Biomech 41(8):1754–1761CrossRefGoogle Scholar
  4. Arampatzis A, Peper A, Bierbaum S (2011) Exercise of mechanisms for dynamic stability control increases stability performance in the elderly. J Biomech 44(1):52–58CrossRefGoogle Scholar
  5. Bhatt T, Wening JD, Pai YC (2006) Adaptive control of gait stability in reducing slip-related backward loss of balance. Exp Brain Res 170(1):61–73CrossRefGoogle Scholar
  6. Bierbaum S, Peper A, Karamanidis K, Arampatzis A (2010) Adaptational responses in dynamic stability during disturbed walking in the elderly. J Biomech 43(12):2362–2368CrossRefGoogle Scholar
  7. Bierbaum S, Peper A, Karamanidis K, Arampatzis A (2011) Adaptive feedback potential in dynamic stability during disturbed walking in the elderly. J Biomech 44(10):1921–1926CrossRefGoogle Scholar
  8. Blake AJ, Morgan K, Bendall MJ, Dallosso H, Ebrahim SB, Arie TH, Fentem PH, Bassey EJ (1988) Falls by elderly people at home: prevalence and associated factors. Age Ageing 17(6):365–372CrossRefGoogle Scholar
  9. Bohannon RW, Andrews AW (2011) Normal walking speed: a descriptive meta-analysis. Physiotherapy 97(3):182–189CrossRefGoogle Scholar
  10. Chandler JM, Duncan PW, Kochersberger G, Studenski S (1998) Is lower extremity strength gain associated with improvement in physical performance and disability in frail, community-dwelling elders? Arch Phys Med Rehabil 79(1):24–30CrossRefGoogle Scholar
  11. Chodzko-Zajko WJ, Proctor DN, Fiatorone Singh MA et al (2009) American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 41(7):1510–1530CrossRefGoogle Scholar
  12. Dempster WT, Gabel WC, Felts WJ (1959) The anthropometry of the manual work space for the seated subject. Am J Phys Anthropol 17:289–317CrossRefGoogle Scholar
  13. Etman A, Wijlhuizen GJ, van Heuvelen MJ, Chorus A, Hopman-Rock M (2012) Falls incidence underestimates the risk of fall-related injuries in older age groups: a comparison with the FARE (Falls risk by Exposure). Age Ageing 41(12):190–195CrossRefGoogle Scholar
  14. Feder G, Cryer C, Donovan S, Carter Y et al (2000) Guidelines for the prevention of falls in people over 65. Brit Med J 321(7267):1007–1011CrossRefGoogle Scholar
  15. Floyer-Lea A, Matthews PM (2004) Changing brain networks for visuomotor control with increased movement automaticity. J Neurophysiol 92:2405–2412CrossRefGoogle Scholar
  16. Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH (2010) Interventions for preventing falls in older people living in the community (Review). Cochrane Database Syst Rev 15(2):CD000340Google Scholar
  17. Grabiner MD, Owings TM, Pavol MJ (2005) Lower extremity strength plays only a small role in determining the maximum recoverable lean angle in older adults. J Gerontol A Biol Sci Med Sci 60(11):M1447–M1450CrossRefGoogle Scholar
  18. Granacher U, Gruber M, Strass D, Gollhofer A (2007) The impact of sensorimotor training in elderly men on maximal and explosive force production capacity. Dtsch Z Sportmed 58(12):446–451Google Scholar
  19. Granacher U, Muehlbauer T, Zahner L, Gollhofer A, Kressig RW (2011) Comparison of traditional and recent approaches in the promotion of balance and strength in older adults. Sports Med 41(5):377–400CrossRefGoogle Scholar
  20. Heiden TL, Sanderson DJ, Inglis JT, Siegmund GP (2006) Adaptations to normal human gait on potentially slippery surfaces: the effects of awareness and prior slip experience. Gait Posture 24(2):237–246CrossRefGoogle Scholar
  21. Heinrich S, Weigelt I, Rapp K, Becker C, Rissmann U, König HH (2012) Sturz- und Frakturprävention auf der Grundlage des Nationalen Expertenstandards Sturzprophylaxe. Z Gerontol Geriatr 45:128–137CrossRefGoogle Scholar
  22. Hof AL, Gazendam MGJ, Sinke WE (2005) The condition for dynamic stability. J Biomech 38(1):1–8CrossRefGoogle Scholar
  23. Horak FB (2006) Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing 35(suppl 2):ii7–ii11CrossRefGoogle Scholar
  24. Hortobágyi T, Zheng D, Weidner M, Lambert NJ, Westbrook S, Houmard JA (1995) The influence of aging on muscle strength and muscle fiber characteristics with special reference to eccentric strength. J Gerontol A Biol Sci Med Sci 50(6):B399–B406CrossRefGoogle Scholar
  25. Hsiao-Wecksler ET, Robinovitch SN (2007) The effect of step length on young and elderly women’s ability to recover balance. Clin Biomech 22(5):574–580CrossRefGoogle Scholar
  26. Hunter GR, McCarthy JP, Bamman MM (2004) Effects of resistance training on older adults. Sports Med 34(5):248–329CrossRefGoogle Scholar
  27. Karamanidis K, Arampatzis A (2007) Age-related degeneration in leg-extensor muscle–tendon units decreases recovery performance after a forward fall: compensation with running experience. Eur J Appl Physiol 99(1):73–85CrossRefGoogle Scholar
  28. Karamanidis K, Arampatzis A, Mademli L (2008) Age-related deficit in dynamic stability control after forward falls is affected by muscle strength and tendon stiffness. J Electromyogr Kinesiol 18(6):980–989CrossRefGoogle Scholar
  29. Latham NK, Bennett DA, Stretton CM, Anderson CS (2004) Systematic review of progressive resistance strength training in older adults. J Gerontol A Biol Sci Med Sci 59(1):48–61CrossRefGoogle Scholar
  30. Lord SR, Ward JA, Williams P, Anstey KJ (1993) An epidemiological study of falls in older community-dwelling women: the Randwick falls and fractures study. Aust J Public Health 17(3):240–245CrossRefGoogle Scholar
  31. Mademli L, Arampatzis A, Karamanidis K (2008) Dynamic stability control in forward falls: postural corrections after muscle fatigue in young and older adults. Eur J ApplPhysiol 103(3):295–306Google Scholar
  32. Maki BE, McIlroy WE (1997) The role of limb movements in maintaining upright stance: the “change-in-support” strategy. Phys Ther 77(5):488–507Google Scholar
  33. Marigold DS, Patla AE (2002) Strategies for dynamic stability during locomotion on a slippery surface: effects of prior experience and knowledge. J Neurophysiol 88(1):339–353Google Scholar
  34. Moreland JD, Richardson JA, Goldsmith CH, Clase CM (2004) Muscle weakness and falls in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 52(7):1121–1129CrossRefGoogle Scholar
  35. Pai YC, Patton J (1997) Center of mass velocity-position predictions for balance control. J Biomech 30(4):347–354Google Scholar
  36. Pijnappels M, Bobbert MF, van Dieen JH (2004) Contribution of the support limb in control of angular momentum after tripping. J Biomech 37:1811–1818CrossRefGoogle Scholar
  37. Pijnappels M, Bobbert MF, van Dieen JH (2005) Push-off reactions in recovery after tripping discriminate young subjects, older non-fallers and older fallers. Gait Posture 21(4):388–394CrossRefGoogle Scholar
  38. Puttemans V, Wenderoth N, Swinnen SP (2005) Changes in brain activation during the acquisition of a multifrequency bimanual coordination task: from the cognitive stage to advanced levels of automaticity. J Neurosci 25(17):4270–4278CrossRefGoogle Scholar
  39. Robinovitch SN, Helle B, Lui A, Cortez J (2002) Effect of strength and speed of torque development on balance recovery with the ankle strategy. J Neurophysiol 88(2):613–620Google Scholar
  40. Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 35(suppl 2):ii37–ii41CrossRefGoogle Scholar
  41. Schubert M, Beck S, Taube W, Amtage F, Faist M, Gruber M (2008) Balance training and ballistic strength training are associated with task-specific corticospinal adaptations. Eur J Neurosci 27:2007–2018CrossRefGoogle Scholar
  42. Sherrington C, Whitney JC, Lord SR, Herbert RD, Cumming RG, Close JCT (2008) Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc 56(12):2234–2243CrossRefGoogle Scholar
  43. Shumway-Cook A, Woollacott M (2006) Motor control—translating research into clinical practice. 3rd edition, Lippincott Williams & Wilkins.Google Scholar
  44. Taube W, Gruber M, Beck S, Faist M, Gollhofer A, Schubert M (2007) Cortical and spinal adaptations induced by balance training: correlation between stance stability and corticospinal activation. Acta Physiol (Oxford) 189(4):347–358CrossRefGoogle Scholar
  45. Thelen DG, Wojcik LA, Schultz AB, Ashton-Miller JA, Alexander NB (1997) Age differences in using a rapid step to regain balance during a forward fall. J Gerontol A Biol Sci Med Sci 52(1):M8–M13CrossRefGoogle Scholar
  46. Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319(26):1701–1707CrossRefGoogle Scholar
  47. Tseng SC, Stanhope SJ, Morton SM (2009) Impaired reactive stepping adjustments in older adults. J Gerontol A Biol Sci Med Sci 64(7):807–815CrossRefGoogle Scholar
  48. Wojcik LA, Thelen DG, Schultz AB, Ashton-Miller JA, Alexander NB (2001) Age and gender differences in peak lower extremity joint torques and ranges of motion used during single-step balance recovery from a forward fall. J Biomech 34(1):67–73CrossRefGoogle Scholar
  49. Woltring HJ (1986) A FORTRAN package for generalized, cross-validatory spline smoothing and differentiation. Adv Engineering Software 8:104–113CrossRefGoogle Scholar

Copyright information

© American Aging Association 2012

Authors and Affiliations

  • Stefanie Bierbaum
    • 1
    • 2
  • Andreas Peper
    • 1
  • Adamantios Arampatzis
    • 1
    • 3
    Email author
  1. 1.Department of Training and Movement SciencesHumboldt-University BerlinBerlinGermany
  2. 2.Motor Performance and Cognition LaboratoryUniversity of StuttgartStuttgartGermany
  3. 3.Center of Sports Science and Sports Medicine BerlinBerlinGermany

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