22/09/2024
A plantar intrinsic foot muscles exercise program for older adults to improve mobility related outcomes 🦶
👉 Among fall prevention interventions, those involving a functional exercise program aimed at improving mobility (i.e., gait, balance, coordination and functional task training (https://pubmed.ncbi.nlm.nih.gov/21586143/) seem to be most effective, reducing the rate of falls by 23% (https://pubmed.ncbi.nlm.nih.gov/31792067/).
👉 Functional exercise programs, including fall preventive exercise interventions, are established without noticeable understanding of the plantar intrinsic foot muscles (PIFMs), while there are indications that these muscles have a role in fall related aspects of mobility. The PIFMs stabilize and stiffen the foot (https://pubmed.ncbi.nlm.nih.gov/32446178/, https://pubmed.ncbi.nlm.nih.gov/24478287/) and consequently contribute to balance and propulsive gait (https://pubmed.ncbi.nlm.nih.gov/30655349/, https://pubmed.ncbi.nlm.nih.gov/21864955/). Weakness of the PIFMs in older adults may thus have a detrimental effect on mobility and fall risk. Indeed, it was found that toe flexor weakness predicts falling in older adults (https://pubmed.ncbi.nlm.nih.gov/19751956/, https://pubmed.ncbi.nlm.nih.gov/34979512/).
📘 Therefore, Willemse and colleagues (https://pubmed.ncbi.nlm.nih.gov/39033125/) developed a PIFM strengthening exercises. The training consists of both isolated and functional foot exercises, of which the intensity gradually increases based on the participant’s progression, to be executed 5 days a week for 12 weeks (1 x supervised session, 4 x self-training/week).
📷 The figure below shows exercises included in the training, together with the number of repetitions, the contraction time and pose for the easiest intensity level of the training.
👉 At the onset of the training, each participant starts the exercises at the easiest level. When the participant perceives the exercise without any difficulty for 5 consecutive training sessions and the trainer scores maximum motor performance using a 3-point scale, modified from Fraser and Hertel (https://pubmed.ncbi.nlm.nih.gov/29364026/), , the trainer sets the level of intensity to the next level (s. comments for the corresponding exercise progressions)..
Motor performance is scored as:
0️⃣ : no movement or position cannot be maintained
1️⃣ : exercise can be partially completed or with difficulty or compensation
2️⃣ : exercise can be completed with typical performance
👉 In an upcoming RCT, the authors intend to investigate the effect of this PIFM strengthening training on mobility related outcome variables (maximum gait speed (primary outcome measure), capacity and strength of the plantar intrinsic foot muscles, foot and ankle biomechanics during gait, and various other fall risk-related variables) in older adults.
👉 The most recent systematic review found low-certainty evidence that PIFM strengthening exercises improve foot function during gait and very low-certainty evidence for its favorable effect on dynamic balance control (https://pubmed.ncbi.nlm.nih.gov/35057831/).
💡So, don`t forget PIFM exercises to improve gait, balance control and possibly fall prevention in older adults!
