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jkeogh38
02-27-2007, 01:19 PM
Hi all subscribers.

Attached is my original question and the replies I received from Biomech-L, Sportscience and Supertraining List members. Thanks to all of the following individuals for replying:

Thanks

Justin




Original Question
Hi

I am currently replying to the comments of some reviewers on a grant
application and am searching for some information on what is considered
the gold standard for the assessment of muscular strength and functional
ability in older adults. In regards to functional ability, I mean the
ability to stand, walk, get out of a chair, climb stairs etc for older
adults. Are there in fact any gold standards for these aspects of
function?

In the grant application we wrote, we were looking at using isoinertial
(1RM or 3RM) strength tests e.g. squat, lat pulldown and bench press as
they give an indication of strength in different movement patterns and
require various muscle groups as agonists. However, i get the impression
that the reviewer thinks we should use isokinetic tests. I am aware of
the issues with isokientic testing especially when used with an
isoinertial training program, but is there a definitive paper that
addresses these shortcomings of isokinetic tests? Also, any issues with
using a 3RM vs a 1RM? How valid is such an approach?

In regards to assessing functional ability in older adults, there are
lots of tests that we could use. Are there any more "gold standard"
approaches to assessing functional ability than tests such as the timed
up and go, sit to stand, walking speed, 15 sec step test etc? Is the
gold standard always such a field-based test? I have looked at using
questionnaires and wil be using some that assess various domains of
quality of life, but one reviewer also thinks that approach has issues.

I look forward to your replies.

Thanks

Justin


Replies
Hi Justin,

I can understand your dilemma. In terms of function field tests, Runge
(2006) and Rittweger (2004) have used the Leonardo force plate which
with extra cost come with a chair to measure force & power of the timed
up and go. Additionally (as you may be aware) the force plate has
capability to measure right and left leg differences in countermovement
jump and is an accepted "gold standard test" of the lower limb.

This may be of some help,

Kind regards

Darryl


I'm not sure of a gold standard, but I do know that a professor at my former institution does a lot of research in the area of functional ability in older adults. If you don't get much help from the list, she might be of some assistance. She is presently an Assistant Professor in Kinesiology at the University of Georgia, Athens, Georgia, USA. Her name is Elaine Cress and email is mecress@uga.edu.

Good luck and best regards

____________________________
Jonathan E. Wingo, Ph.D.
Postdoctoral Research Fellow
Institute for Exercise and Environmental Medicine
PresbyterianHospital of Dallas
7232 Greenville Ave.
Dallas, TX 75231
Phone: 214-345-5356
Fax: 214-345-4618
JonathanWingo@texashealth.org



Dear Justin,

I got your letter through Ellen Freiberger in Erlangen. We are working
together within an EU-project called EUNAAPA, European Network for
Action on Ageing and Physical Activity, where we are in the process of
gathering information about instruments in use in 18 European
countries. I am a so called "work package leader" for this, and here I
send
you the questionnaire that is in use right now. A lot of instruments
are mentioned there, but of course it is not complete. In the next
phase, we will write reviews on instruments regarding the two big
fields physical activity and function.

I think that there is a lack of "gold standards" for different groups
of elderly persons, from those who are in very good health to
multideseased, very frail persons, but maybe we will get a better
picture through the review work.

Kind regards,
Kerstin


Kerstin Frändin, senior lecturer
Karolinska Institutet
Department of Neurobiology, Caring Sciences and Society
Division of Physiotherapy
231 00, SE 141 83 Huddinge
Sweden

Telephone:+46-31-687 57 18, mobile phone: +46 709 28 05 77
E-mail: kerstin.frandin@ki.se



It's a good question and I thank you for making the connection on this one, Lucy! Didn't know your whereabouts and I hope that all is going well in the bustling city of Hong Kong. An opportunity came up about 4 years ago for me to visit Roger and Rhonda when they were at the Polytech physio school there - you're in an amazing place!

So with regards to the grant reviews, Justin - sounds like you are dealing with the basic issue of neural specificity of training. Utilization of outcome measures for strength and physical function that mirror the movement patterns of your resistance exercise program (or vice versa) does provide the most chance of showing significant increases, especially in a task such as rising from a chair in which dynamic quads strength is a key factor. However, to my knowledge there are no gold standards, a deficiency which in turn gives the reviewer's personal opinion more weight that it should! If a copy is available to you, there is some relevant information in the Jessie Jones/Debbie Rose 2005 book: Physical Activity Instruction of Older Adults. Champaign, Illinois: Human Kinetics, including a chapter on assessment from Gareth Jones, Tom Overend and myself. In that we made some reference to ACSM's Guidelines on Exercise Testing and Prescription.

Cheers and best wishes,
Tony.
Anthony A. Vandervoort, Ph.D., Professor, Faculty of Health Sciences; Senior Associate Dean, Faculty of Graduate Studies, The University of Western Ontario.

Hi Justin. I am forwarding your question to a colleague of mine at
the Univ. of Florida - i.e., Todd Manini. Todd has done a fair amount
of work in this area (including his doctoral dissertation)...lots of
functional testing with older adults...maybe he'll have an answer to
your question about gold standards for functional tests.

Kind regards,
Dwight


Dwight J. The'
Ph.D. Student
Exercise Science & Science Education
SyracuseUniversity


Hi Justin,

I'm trying to catch up on my Supertraining reading and I saw your post on assessing older adults.

The link I'm sending you is for the Senior Fitness Test Kit (Human Kinetics) by Rikli and Jones. It contains norms for community-dwelling older adults in various decades of age in several functional fitness areas. They presented the info at one of the ACSM Health and Fitness Summits I attended a few years back and I know they've published findings in peer-reviewed literature, but I can't remember where at the moment (I'm sure you can find it with an appropriate search engine).

http://www.humankinetics.com/products/showproduct.cfm?isbn=0736067191

I hope this helps--please let me know if it does!

Teresa Merrick, M.A. (PhD student),
ACSM HFI, NSCA CPT/CSCS, NASM CPT
Bellevue, NE


Justin,

The FIM has worked well for many older adults (also there is reliability data in published rehabilitation literature). For lower extremity specifically you can use the LEM.

FIM (functional independence measure) and LEM (lower extremity measure), I am using both on my current research with elderly hip and pelvic fracture subjects to supplement the biomechanical data. Hope that helps.

Janet Kneiss, MS PT
Graduate student
Universityof Rochester


Pax!

I expect that you have got replies pointing out that the Berg Balance
Scale is more or less the "gold standard" for functional tests for
elderly. I am myself involved in designing a test battery in a project
which aims at assessing the fall risk among elderly (n = 100+). Browsing
the litterature on the subject the BBS obviously has a wide support.
Concering force measurements we use only MVC isometric tests in our case
-- warming up + 3 reps and taking the best result. The purpose is to
identify cases with *abnormal* weakness (e.g. quadriceps) for which
isometric MVC is simple and safe.

BTW I am also associated with the www.hurlabs.com which makes a legext
device which circumvents some of the problems with the isokinetic
devices. Here the load is preset and the subject makes a maximal effort
--> as fast as possible.

Regards Frank Borg
U of Jyväskylä, Chydenius Institute


Justin Keogh PhD
Senior Lecturer
Division of Sport and Recreation
Institute of Sport and Recreation Research New Zealand
AUT University
Private Bag 92006
Auckland 1142
New Zealand
Room AH221I

Phone: 64-9-921-9999 ext 7617
Mobile: 027 344 1642
Fax: 64-9-921-9960
email: justin.keogh@aut.ac.nz
http://www.aut.ac.nz/schools/sport_and_recreation/our_staff/
http://www.isrrnz.ac.nz/