Exercise Right Week Q&A with Dr Kim van Schooten and Dr Yoshi Okubo
NeuRA researchers are stepping up their research with the introduction of a new perturbation treadmill aimed at preventing falls and improving balance.
What is a perturbation treadmill?
A perturbation treadmill is a treadmill, like those in the gym, but with two belts instead of one. We can control the speed of each belt independently. Each foot is placed on a different belt, which allows us to make one leg go faster than the other. Many researchers use this to study how people learn to walk with their legs at different speeds (motor learning and retention), but we are mainly interested in using this to study how people respond to perturbation, which is a disturbance of motion, or the state of equilibrium. We will temporarily speed up or slow down one leg, which will feel like a trip or slip to the person walking on the treadmill. The treadmill can also move sideways, allowing us to study how people respond to a loss of balance.
How will it help reduce falls and improve mobility?
Simply put, whether someone experiences a fall depends on whether they lose their balance and if they are able to recover.
Using the treadmill, we can determine how likely someone is to lose their balance by increasing the difficulty of the perturbations. We can also study how people respond once they lose their balance. By comparing people that were very stable and recovered successfully to people that had more difficulty with staying upright, we can identify sensorimotor or neuropsychological functions, such as reaction time or muscle strength, that are important to maintaining balance and preventing falls.
A better understanding of how people prevent falls will help us improve interventions. Our hope is that this work will lead to more individualised approaches. Currently, most fall prevention interventions take a “one-size-fits-all” approach. This works well on a group level but may be suboptimal for individuals. Identification of mechanisms that limit balance on an individual level, and interventions tailored to these factors, may allow for a leap in the effectiveness of fall prevention.
We will also use the perturbation treadmill to provide novel interventions. Research in the US has shown that a single training session of walking with perturbations, reduced the number of falls experienced by older people during a year follow up by 50 per cent. Our own study showed a 60 per cent reduction of in-lab falls due to slips and trips. This reduction in falls is quite large compared to reductions of 29 per cent seen with traditional fall prevention programs, which is why we are exploring the use of the perturbation treadmill to train older people and people with balance impairments. Compared to a perturbation walkway, a perturbation treadmill has an advantage, in that it can be used in gyms and clinics with limited space.
Why is exercise so important?
Exercise is essential for improving and maintaining our cognitive and physical abilities. It also has beneficial effects on our mental health. However, as we age, we tend to become less active. A recent study suggests that globally 31 per cent of adults, and 40-60 per cent of people aged 60-and-over, are physically inactive. Our own study showed that after the age of 50, the duration of daily walks reduces by about 15 per cent each decade. This is unfortunate because physical activity and exercise can actually slow down the ageing process.
- The World Health Organization’s recommendation for physical activity is to accumulate at least 150 minutes of moderate-intensity physical activity, 75 minutes of vigorous-intensity physical activity, or an equivalent combination of the two, each week. They further add that muscle-strengthening activities should be done for the major muscle groups two or more days a week. This recommendation is relevant for all adults, including those 65 and over.
- People do not have to go to the gym every day to be physically active. Swimming, gardening or brisk walking can all contribute to achieving your activity goal.
Keep in mind that exercise can be task specific. If the aim is to prevent falls and improve balance, engaging in sufficiently challenging balance exercise for 120 minutes per week seems to be most efficient. Together with Associate Professor Kim Delbaere, we are testing a home-based exercise program, called StandingTall Plus to encourage people to perform balance exercises at home.
To learn more about this program and to get involved in the study visit: https://www.neura.edu.au/clinical-trial/standingtall-plus/
About the researchers:
Dr Kim van Schooten: Dr van Schooten is a postdoctoral fellow at NeuRA and conjoint senior lecturer at UNSW Medicine. her research focuses on why older people fall more often than younger people, and with more severe consequences, by examining age-related changes in balance and mobility. She studies how people maintain and recover their balance during daily-life activities, to improve our understanding of why falls occur and to reveal targets for the prevention of mobility impairments and falls.
Dr Yoshiro Okubo: Dr Okubo is also a postdoctoral fellow at NeuRA and conjoint lecturer at UNSW Medicine. A unique feature of his study is their novel walkway that can induce real trips and slips to participants who are secured in a full-body safety harness. Using this system, Dr Okubo has been investigating exercise programs that directly train the ability to respond to environmental hazards and prevent falls in older people and those with neurological conditions.