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Published in: Archives of Orthopaedic and Trauma Surgery 2/2017

Open Access 01-02-2017 | Orthopaedic Surgery

Modified step aerobics training and neuromuscular function in osteoporotic patients: a randomized controlled pilot study

Authors: Martin Behrens, Karoline Müller, Jill-Isabel Kilb, Lennart Schleese, Philipp K. E. Herlyn, Sven Bruhn, Thomas Mittlmeier, Hans-Christof Schober, Dagmar-C. Fischer

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 2/2017

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Abstract

Background

Training programs directed to improve neuromuscular and musculoskeletal function of the legs are scarce with respect to older osteoporotic patients. We hypothesized that a modified step aerobics training program might be suitable for this purpose and performed a randomized controlled pilot study to assess the feasibility of conducting a large study. Here we report on the training-related effects on neuromuscular function of the plantar flexors.

Patients and methods

Twenty-seven patients with an age of at least 65 years were enrolled and randomized into control and intervention group. The latter received supervised modified step aerobics training (twice weekly, 1 h per session) over a period of 6 months. At baseline, and after 3 and 6 months neuromuscular function of the plantar flexors, i.e., isometric maximum voluntary torque, rate of torque development and twitch torque parameters were determined in detail in all patients of both groups.

Results

Twenty-seven patients (median age 75 years; range 66–84 years) were randomized (control group n = 14; intervention group n = 13). After 3 and 6 months of training, maximum voluntary contraction strength in the intervention group was significantly higher by 7.7 Nm (9.1%; 95% CI 3.3–12.2 Nm, P < 0.01) and 12.4 Nm (14.8%; 95% CI 6.4–18.5 Nm, P < 0.01) compared to controls. These changes were most probably due to neural and muscular adaptations.

Conclusion

It is worthwhile to investigate efficacy of this training program in a large randomized trial. However, a detailed neuromuscular assessment appears feasible only in a subset of participants.
Literature
3.
go back to reference Novotny SA, Warren GL, Hamrick MW (2015) Aging and the muscle-bone relationship. Physiology (Bethesda) 30(1):8–16 Novotny SA, Warren GL, Hamrick MW (2015) Aging and the muscle-bone relationship. Physiology (Bethesda) 30(1):8–16
4.
go back to reference Lord SR, Ward JA, Williams P, Anstey KJ (1994) Physiological factors associated with falls in older community-dwelling women. J Am Geriatr Soc 42(10):1110–1117CrossRefPubMed Lord SR, Ward JA, Williams P, Anstey KJ (1994) Physiological factors associated with falls in older community-dwelling women. J Am Geriatr Soc 42(10):1110–1117CrossRefPubMed
5.
go back to reference Skelton DA, Greig CA, Davies JM, Young A (1994) Strength, power and related functional ability of healthy people aged 65–89 years. Age Ageing 23(5):371–377CrossRefPubMed Skelton DA, Greig CA, Davies JM, Young A (1994) Strength, power and related functional ability of healthy people aged 65–89 years. Age Ageing 23(5):371–377CrossRefPubMed
7.
go back to reference Kannus P, Sievanen H, Palvanen M, Jarvinen T, Parkkari J (2005) Prevention of falls and consequent injuries in elderly people. Lancet 366(9500):1885–1893CrossRefPubMed Kannus P, Sievanen H, Palvanen M, Jarvinen T, Parkkari J (2005) Prevention of falls and consequent injuries in elderly people. Lancet 366(9500):1885–1893CrossRefPubMed
9.
go back to reference Stolzenberg N, Belavy DL, Rawer R, Felsenberg D (2013) Vibration or balance training on neuromuscular performance in osteopenic women. Int J Sports Med 34(11):956–962CrossRefPubMed Stolzenberg N, Belavy DL, Rawer R, Felsenberg D (2013) Vibration or balance training on neuromuscular performance in osteopenic women. Int J Sports Med 34(11):956–962CrossRefPubMed
10.
go back to reference Madureira MM, Takayama L, Gallinaro AL, Caparbo VF, Costa RA, Pereira RM (2007) Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial. Osteoporos Int 18(4):419–425CrossRefPubMed Madureira MM, Takayama L, Gallinaro AL, Caparbo VF, Costa RA, Pereira RM (2007) Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: a randomized controlled trial. Osteoporos Int 18(4):419–425CrossRefPubMed
11.
go back to reference Kemmler W, von Stengel S, Engelke K, Haberle L, Kalender WA (2010) Exercise effects on bone mineral density, falls, coronary risk factors, and health care costs in older women: the randomized controlled senior fitness and prevention (SEFIP) study. Arch Intern Med 170(2):179–185CrossRefPubMed Kemmler W, von Stengel S, Engelke K, Haberle L, Kalender WA (2010) Exercise effects on bone mineral density, falls, coronary risk factors, and health care costs in older women: the randomized controlled senior fitness and prevention (SEFIP) study. Arch Intern Med 170(2):179–185CrossRefPubMed
12.
go back to reference Yamazaki S, Ichimura S, Iwamoto J, Takeda T, Toyama Y (2004) Effect of walking exercise on bone metabolism in postmenopausal women with osteopenia/osteoporosis. J Bone Miner Metab 22(5):500–508CrossRefPubMed Yamazaki S, Ichimura S, Iwamoto J, Takeda T, Toyama Y (2004) Effect of walking exercise on bone metabolism in postmenopausal women with osteopenia/osteoporosis. J Bone Miner Metab 22(5):500–508CrossRefPubMed
13.
go back to reference Tagliaferri C, Wittrant Y, Davicco MJ, Walrand S, Coxam V (2015) Muscle and bone, two interconnected tissues. Ageing Res Rev 21:55–70CrossRefPubMed Tagliaferri C, Wittrant Y, Davicco MJ, Walrand S, Coxam V (2015) Muscle and bone, two interconnected tissues. Ageing Res Rev 21:55–70CrossRefPubMed
14.
go back to reference Martyn-St James M, Carroll S (2009) A meta-analysis of impact exercise on postmenopausal bone loss: the case for mixed loading exercise programmes. Br J Sports Med 43(12):898–908CrossRefPubMed Martyn-St James M, Carroll S (2009) A meta-analysis of impact exercise on postmenopausal bone loss: the case for mixed loading exercise programmes. Br J Sports Med 43(12):898–908CrossRefPubMed
15.
go back to reference Stacoff A, Diezi C, Luder G, Stussi E, Kramers-de Quervain IA (2005) Ground reaction forces on stairs: effects of stair inclination and age. Gait Posture 21(1):24–38CrossRefPubMed Stacoff A, Diezi C, Luder G, Stussi E, Kramers-de Quervain IA (2005) Ground reaction forces on stairs: effects of stair inclination and age. Gait Posture 21(1):24–38CrossRefPubMed
16.
go back to reference Hallage T, Krause MP, Haile L, Miculis CP, Nagle EF, Reis RS, Da Silva SG (2010) The effects of 12 weeks of step aerobics training on functional fitness of elderly women. J Strength Cond Res 24(8):2261–2266CrossRefPubMed Hallage T, Krause MP, Haile L, Miculis CP, Nagle EF, Reis RS, Da Silva SG (2010) The effects of 12 weeks of step aerobics training on functional fitness of elderly women. J Strength Cond Res 24(8):2261–2266CrossRefPubMed
17.
go back to reference Chien MY, Wu YT, Hsu AT, Yang RS, Lai JS (2000) Efficacy of a 24-week aerobic exercise program for osteopenic postmenopausal women. Calcif Tissue Int 67(6):443–448CrossRefPubMed Chien MY, Wu YT, Hsu AT, Yang RS, Lai JS (2000) Efficacy of a 24-week aerobic exercise program for osteopenic postmenopausal women. Calcif Tissue Int 67(6):443–448CrossRefPubMed
18.
go back to reference Clary S, Barnes C, Bemben D, Knehans A, Bemben M (2006) Effects of ballates, step aerobics, and walking on balance in women aged 50–75 years. J Sports Sci Med 5(3):390–399PubMedPubMedCentral Clary S, Barnes C, Bemben D, Knehans A, Bemben M (2006) Effects of ballates, step aerobics, and walking on balance in women aged 50–75 years. J Sports Sci Med 5(3):390–399PubMedPubMedCentral
19.
go back to reference Nnodim JO, Strasburg D, Nabozny M, Nyquist L, Galecki A, Chen S, Alexander NB (2006) Dynamic balance and stepping versus tai chi training to improve balance and stepping in at-risk older adults. J Am Geriatr Soc 54(12):1825–1831CrossRefPubMed Nnodim JO, Strasburg D, Nabozny M, Nyquist L, Galecki A, Chen S, Alexander NB (2006) Dynamic balance and stepping versus tai chi training to improve balance and stepping in at-risk older adults. J Am Geriatr Soc 54(12):1825–1831CrossRefPubMed
20.
go back to reference Gianoudis J, Bailey CA, Sanders KM, Nowson CA, Hill K, Ebeling PR, Daly RM (2012) Osteo-cise: strong bones for life: protocol for a community-based randomised controlled trial of a multi-modal exercise and osteoporosis education program for older adults at risk of falls and fractures. BMC Musculoskelet Disord 13:78CrossRefPubMedPubMedCentral Gianoudis J, Bailey CA, Sanders KM, Nowson CA, Hill K, Ebeling PR, Daly RM (2012) Osteo-cise: strong bones for life: protocol for a community-based randomised controlled trial of a multi-modal exercise and osteoporosis education program for older adults at risk of falls and fractures. BMC Musculoskelet Disord 13:78CrossRefPubMedPubMedCentral
21.
go back to reference Gianoudis J, Bailey CA, Ebeling PR, Nowson CA, Sanders KM, Hill K, Daly RM (2014) Effects of a targeted multimodal exercise program incorporating high-speed power training on falls and fracture risk factors in older adults: a community-based randomized controlled trial. J Bone Miner Res 29(1):182–191CrossRefPubMed Gianoudis J, Bailey CA, Ebeling PR, Nowson CA, Sanders KM, Hill K, Daly RM (2014) Effects of a targeted multimodal exercise program incorporating high-speed power training on falls and fracture risk factors in older adults: a community-based randomized controlled trial. J Bone Miner Res 29(1):182–191CrossRefPubMed
22.
go back to reference Bentley DJ, Newell J, Bishop D (2007) Incremental exercise test design and analysis: implications for performance diagnostics in endurance athletes. Sports Med 37(7):575–586CrossRefPubMed Bentley DJ, Newell J, Bishop D (2007) Incremental exercise test design and analysis: implications for performance diagnostics in endurance athletes. Sports Med 37(7):575–586CrossRefPubMed
23.
go back to reference DVO (2011) DVO guideline 2009 for prevention, diagnosis and therapy of osteoporosis in adults. Osteologie 20:55–74 DVO (2011) DVO guideline 2009 for prevention, diagnosis and therapy of osteoporosis in adults. Osteologie 20:55–74
24.
go back to reference Lips P, Leplege A (2000) Ost WPQLI: development and validation of a quality of life questionnaire for patients with vertebral fractures: Qualeffo-41. Qual Life Res 9(6):763–766CrossRef Lips P, Leplege A (2000) Ost WPQLI: development and validation of a quality of life questionnaire for patients with vertebral fractures: Qualeffo-41. Qual Life Res 9(6):763–766CrossRef
25.
go back to reference Dias N, Kempen GIJM, Todd CJ, Beyer N, Freiberger E, Piot-Ziegler C, Yardley L, Hauer K (2006) The German version of the falls Efficacy Scale-International Version (FES-I). Z Gerontol Geriatr 39(4):297–300CrossRefPubMed Dias N, Kempen GIJM, Todd CJ, Beyer N, Freiberger E, Piot-Ziegler C, Yardley L, Hauer K (2006) The German version of the falls Efficacy Scale-International Version (FES-I). Z Gerontol Geriatr 39(4):297–300CrossRefPubMed
26.
go back to reference Folland JP, Wakamatsu T, Fimland MS (2008) The influence of maximal isometric activity on twitch and H-reflex potentiation, and quadriceps femoris performance. Eur J Appl Physiol 104(4):739–748CrossRefPubMed Folland JP, Wakamatsu T, Fimland MS (2008) The influence of maximal isometric activity on twitch and H-reflex potentiation, and quadriceps femoris performance. Eur J Appl Physiol 104(4):739–748CrossRefPubMed
27.
go back to reference Behrens M, Weippert M, Wassermann F, Bader R, Bruhn S, Mau-Moeller A (2015) Neuromuscular function and fatigue resistance of the plantar flexors following short-term cycling endurance training. Front Physiol 6:145CrossRefPubMedPubMedCentral Behrens M, Weippert M, Wassermann F, Bader R, Bruhn S, Mau-Moeller A (2015) Neuromuscular function and fatigue resistance of the plantar flexors following short-term cycling endurance training. Front Physiol 6:145CrossRefPubMedPubMedCentral
28.
go back to reference Ekblom MM (2010) Improvements in dynamic plantar flexor strength after resistance training are associated with increased voluntary activation and V-to-M ratio. J Appl Physiol (1985) 109(1):19–26CrossRef Ekblom MM (2010) Improvements in dynamic plantar flexor strength after resistance training are associated with increased voluntary activation and V-to-M ratio. J Appl Physiol (1985) 109(1):19–26CrossRef
29.
go back to reference Solstad GM, Fimland MS, Helgerud J, Iversen VM, Hoff J (2011) Test-retest reliability of v-wave responses in the soleus and gastrocnemius medialis. J Clin Neurophysiol 28(2):217–221CrossRefPubMed Solstad GM, Fimland MS, Helgerud J, Iversen VM, Hoff J (2011) Test-retest reliability of v-wave responses in the soleus and gastrocnemius medialis. J Clin Neurophysiol 28(2):217–221CrossRefPubMed
30.
go back to reference Tillin NA, Jimenez-Reyes P, Pain MT, Folland JP (2010) Neuromuscular performance of explosive power athletes versus untrained individuals. Med Sci Sports Exerc 42(4):781–790CrossRefPubMed Tillin NA, Jimenez-Reyes P, Pain MT, Folland JP (2010) Neuromuscular performance of explosive power athletes versus untrained individuals. Med Sci Sports Exerc 42(4):781–790CrossRefPubMed
31.
go back to reference Zehr EP (2002) Considerations for use of the Hoffmann reflex in exercise studies. Eur J Appl Physiol 86(6):455–468CrossRefPubMed Zehr EP (2002) Considerations for use of the Hoffmann reflex in exercise studies. Eur J Appl Physiol 86(6):455–468CrossRefPubMed
32.
go back to reference Aagaard P, Simonsen EB, Andersen JL, Magnusson P, Dyhre-Poulsen P (2002) Neural adaptation to resistance training: changes in evoked V-wave and H-reflex responses. J Appl Physiol (1985) 92(6):2309–2318CrossRef Aagaard P, Simonsen EB, Andersen JL, Magnusson P, Dyhre-Poulsen P (2002) Neural adaptation to resistance training: changes in evoked V-wave and H-reflex responses. J Appl Physiol (1985) 92(6):2309–2318CrossRef
33.
34.
go back to reference Barbat-Artigas S, Rolland Y, Cesari M, Abellan van Kan G, Vellas B, Aubertin-Leheudre M (2013) Clinical relevance of different muscle strength indexes and functional impairment in women aged 75 years and older. J Gerontol A Biol Sci Med Sci 68(7):811–819CrossRefPubMed Barbat-Artigas S, Rolland Y, Cesari M, Abellan van Kan G, Vellas B, Aubertin-Leheudre M (2013) Clinical relevance of different muscle strength indexes and functional impairment in women aged 75 years and older. J Gerontol A Biol Sci Med Sci 68(7):811–819CrossRefPubMed
35.
go back to reference Hopkins DR, Murrah B, Hoeger WW, Rhodes RC (1990) Effect of low-impact aerobic dance on the functional fitness of elderly women. Gerontologist 30(2):189–192CrossRefPubMed Hopkins DR, Murrah B, Hoeger WW, Rhodes RC (1990) Effect of low-impact aerobic dance on the functional fitness of elderly women. Gerontologist 30(2):189–192CrossRefPubMed
36.
go back to reference Shigematsu R, Chang M, Yabushita N, Sakai T, Nakagaichi M, Nho H, Tanaka K (2002) Dance-based aerobic exercise may improve indices of falling risk in older women. Age Ageing 31(4):261–266CrossRefPubMed Shigematsu R, Chang M, Yabushita N, Sakai T, Nakagaichi M, Nho H, Tanaka K (2002) Dance-based aerobic exercise may improve indices of falling risk in older women. Age Ageing 31(4):261–266CrossRefPubMed
37.
go back to reference Hakkinen K, Alen M, Kallinen M, Newton RU, Kraemer WJ (2000) Neuromuscular adaptation during prolonged strength training, detraining and re-strength-training in middle-aged and elderly people. Eur J Appl Physiol 83(1):51–62CrossRefPubMed Hakkinen K, Alen M, Kallinen M, Newton RU, Kraemer WJ (2000) Neuromuscular adaptation during prolonged strength training, detraining and re-strength-training in middle-aged and elderly people. Eur J Appl Physiol 83(1):51–62CrossRefPubMed
38.
go back to reference Nielsen J, Kagamihara Y (1992) The regulation of disynaptic reciprocal Ia inhibition during co-contraction of antagonistic muscles in man. J Physiol 456:373–391CrossRefPubMedPubMedCentral Nielsen J, Kagamihara Y (1992) The regulation of disynaptic reciprocal Ia inhibition during co-contraction of antagonistic muscles in man. J Physiol 456:373–391CrossRefPubMedPubMedCentral
39.
go back to reference Andriacchi TP, Andersson GB, Fermier RW, Stern D, Galante JO (1980) A study of lower-limb mechanics during stair-climbing. J Bone Joint Surg Am 62(5):749–757CrossRefPubMed Andriacchi TP, Andersson GB, Fermier RW, Stern D, Galante JO (1980) A study of lower-limb mechanics during stair-climbing. J Bone Joint Surg Am 62(5):749–757CrossRefPubMed
40.
go back to reference Ryan ED, Thompson BJ, Herda TJ, Sobolewski EJ, Costa PB, Walter AA, Cramer JT (2011) The relationship between passive stiffness and evoked twitch properties: the influence of muscle CSA normalization. Physiol Meas 32:677–686CrossRefPubMed Ryan ED, Thompson BJ, Herda TJ, Sobolewski EJ, Costa PB, Walter AA, Cramer JT (2011) The relationship between passive stiffness and evoked twitch properties: the influence of muscle CSA normalization. Physiol Meas 32:677–686CrossRefPubMed
41.
go back to reference Andersen LL, Aagaard P (2006) Influence of maximal muscle strength and intrinsic muscle contractile properties on contractile rate of force development. Eur J Appl Physiol 96(1):46–52CrossRefPubMed Andersen LL, Aagaard P (2006) Influence of maximal muscle strength and intrinsic muscle contractile properties on contractile rate of force development. Eur J Appl Physiol 96(1):46–52CrossRefPubMed
42.
go back to reference Bojsen-Møller J, Magnusson SP, Rasmussen LR, Kjaer M, Aagaard P (2005) Muscle performance during maximal isometric and dynamic contractions is influenced by the stiffness of the tendinous structures. J Appl Physiol (1985) 99(3):986–994CrossRef Bojsen-Møller J, Magnusson SP, Rasmussen LR, Kjaer M, Aagaard P (2005) Muscle performance during maximal isometric and dynamic contractions is influenced by the stiffness of the tendinous structures. J Appl Physiol (1985) 99(3):986–994CrossRef
Metadata
Title
Modified step aerobics training and neuromuscular function in osteoporotic patients: a randomized controlled pilot study
Authors
Martin Behrens
Karoline Müller
Jill-Isabel Kilb
Lennart Schleese
Philipp K. E. Herlyn
Sven Bruhn
Thomas Mittlmeier
Hans-Christof Schober
Dagmar-C. Fischer
Publication date
01-02-2017
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 2/2017
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-016-2607-5

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