BJMB

Brazilian Journal of Motor Behavior

Special issue:

“Control of Gait and Posture: a tribute to Professor Lilian T. B.

Gobbi”

Magalhães et al.

2023

VOL.17

N.4

https://doi.org/10.20338/bjmb.v17i4.363

134 of 145

Fear of falling is associated with gait parameters during obstacle avoidance with

different physical characteristics in older adults

GABRIELA V. MAGALHÃES

| JULIANA A. SILVA

| MILENA RAZUK

| NATALIA M. RINALDI

Laboratório de Análise Biomecânica do Movimento (Bio.Mov), Centro de Educação Física e Desportos, Universidade Federal do Espírito Santo, Vitória, ES, Brasil

Correspondence to:!Natalia Madalena Rinaldi, Laboratório de Análise Biomecânica do Movimento (Bio.Mov), Centro de Educação Física e Desportos, Universidade

Federal do Espírito Santo. Avenida Fernando Ferrari, 514, Goiabeiras, Vitória, ES, Brasil.

email: natalia.rinaldi@ufes.br

https://doi.org/10.20338/bjmb.v17i4.363

HIGHLIGHTS

• Physical characteristic of the obstacle is not associated

with FOF in older adults.

• FOF is associated to walking through and to obstacle

avoidance.

• The obstacle avoidance phase is more associated with

FOF than the approach phase.

ABBREVIATIONS

CoM Center of mass

FES-I Fall Efficacy Scale-International

FO Walking with a Fragile obstacle

FOF Fear of falling

FOHD Horizontal distance foot-obstacle

FOHD_LL Horizontal distance foot-obstacle for the

leading limb

FOHD_TL Horizontal distance foot-obstacle for the

trailing limb

FOVD_LL Vertical distance foot-obstacle for the

leading limb

FOVD _TL Vertical distance foot-obstacle for the

trailing limb

Mini-BESTest!Mini-Balance Evaluation Systems Test

MMSE Mini-Mental State Examination

OFHD Horizontal distance obstacle-foot

OFHD_LL Horizontal distance obstacle-foot for the

leading limb

OFHD_TL Horizontal distance obstacle-foot for the

trailing limb

RSTRIDE Right stride

LSTRIDE Left stride

SO Walking with a Solid obstacle

STEP_DST Double support time

STEP_DUR Step duration

STEP_LEN Step length

STEP_VEL Step velocity

STEP_WID Step width

STEPO Step during the obstacle avoidance

STEPO_DUR Step duration!during avoidance

STEPO_LEN Step length!during avoidance

STEPO_VEL Step velocity!during avoidance

STEPO_WID Step width!during avoidance

WT Walking Through

PUBLICATION DATA

Received 03 05 2023

Accepted 19 06 2023

Published 20 06 2023

BACKGROUND: Fear of falling (FOF) is related to worse locomotor performance, is a

predictor of decline in functionality, and predisposes falls in older adults. It is necessary to

investigate how FOF influences locomotor parameters during walking and in obstacle

avoidance in older adults.

AIM: To investigate the relationship between FOF and the locomotor variables during walking

through and obstacle avoidance with different physical characteristics.

METHOD: 22 older adults participated in this study and were invited to perform three tasks: 1)

Walking Through; 2) Walking with a solid obstacle and 3) Walking with a fragile obstacle.

RESULTS: Correlations were found between FOF and following variables: 1) Walking

Through: step velocity (r=-0.640, p=0.003), width (r=0.641, p=0.003), double support time

(r=0.523, p=0.022); 2) Solid obstacle: step velocity (r=-0.666, p=0.002), length (r=-0.758,

p<0.001), foot-obstacle horizontal distance (r=-0.479, p=0.038), right stride velocity (r=-0.534,

p=0.019), length (r=-0.522, p=0.022), left stride velocity (r=-0.551, p=0.014), left stride

duration (r=0.561, p=0.012); 3) Fragilid obstacle: step velocity (r=-0.629, p=0.004), length (r=-

0.556, p=0.014), foot-obstacle distance (r=-0.540, p=0.017), obstacle-foot distance (r=-0.492,

p=0.032), right stride velocity (r=-0.583, p=0.009), length (r=-0.498, p=0.030), left stride

velocity (r=-0.574, p=0.010), length (r=-0.462, p=0.047), width (r=-0.514, p=0.024), right stride

duration (r=0.479, p=0.038), left stride duration (r=0.646, p=0.003).

INTERPRETATION: The characteristics of the obstacle did not influence the older adults FOF

during walking through and obstacle avoidance. Although they adopt predictive and reactive

compensatory adaptations in an attempt to make the task safer, these adaptations actually

make the task more dangerous and increase the risk of stumbling and falling.

KEYWORDS: Aging | Locomotion | Dual task

BJMB! ! ! ! ! ! ! ! !

Brazilian(Journal(of(Motor(Behavior(

(

Magalhães et al.

2023

VOL.17

N.4

https://doi.org/10.20338/bjmb.v17i4.363

135 of 145

Special issue:

“Control of Gait and Posture: a tribute to Professor Lilian T. B. Gobbi”

INTRODUCTION

Aging is a continuous and irreversible physiological process sometimes associated with reduced functional capacity of the older

adults

, decline of the sensory system

, and postural control mechanisms

. Thus, slower or diminished anticipatory and compensatory

responses occur during gait, especially in complex tasks, such as, obstacle avoidance

and locomotion on unstable surfaces

Thus, older adults have lower velocity and step width and longer duration

associated with gait variability

. These changes

become more evident as the task complexity increases, which lead to more obstacles to avoid

, leading to reductions in velocity and

length and an increase in step width

. These changes are attempts to make gait safe and are caused by the fear of falling (FOF)

;

however, it restricts the control and adjustment of movement

, thus increasing the risk of falling.

FOF is a psychological factor related to worse gait performance

and a predictor of decline in functionality

, as it restricts

daily activities and reduces the level of physical activity of the older adults, leading to a lower quality of life

. These factors increase the

fear of falling

in individuals after the first fall

, making them more susceptible to new episodes

, as well as in individuals who have

never fallen

. Studies

12,16

have identified that FOF may be present in older adults regardless of the actual occurrence of a fall. Yet,

these older adults present insecurity in avoiding falls

and restrict their activities

17,18

, which further reduces functional capacity,

increases fear, and generates a vicious cycle

Considering that most falls occur during gait associated with activities with support on one limb, such as obstacle avoidance, it

is not totally clear how the fear of falling influences the avoidance movement and the reactive mechanisms that aim to prepare for the

task and reduce postural changes

. Studies

4,20,21

investigated gait parameters during obstacle avoidance with a single obstacle, as well

as manipulation of the height of obstacles

22,23,24

. However, there are few studies

25,26

on obstacle avoidance with different physical

characteristics. Yet, there is also a gap about how FOF affects the spatiotemporal parameters of gait during obstacle avoidance with

different physical characteristics. Therefore, this study aimed to investigate the relationship between FOF and the spatiotemporal

variables during walking through and obstacle avoidance with different physical characteristics. It is expected that: a) during the fragile

obstacle avoidance, FOF presents more correlations with locomotor parameters of older adults when compared with the solid obstacle

avoidance without the perception of fragility; b) FOF presents correlations with variables of walking through, in which the greater the FOF,

the slower, longer and unstable the walk; c) for both obstacle avoidance conditions, the avoidance phase presents more correlations with

FOF compared to the approach phase, and d) for the approach and obstacle avoidance phases of both obstacles, there are important

correlations between Fall Efficacy Scale-International (FES-I) and variables that identify changes and adaptations of gait that are

influenced by FOF. It is expected that the higher the FOF, the closer the foot approaches the obstacle and the slower and longer the walk

becomes, leading to more risk of stumbling.

METHODS

Participants

The study included 22 right-handed older adults with independent gait without the use of walking aids and able to perform the

experimental protocol. Participants were excluded if they had cognitive (< 24 points in the Mini-Mental State Examination - MMSE) or

neurological impairment, vestibular dysfunction, and/or if they were unable to walk without assistance. After agreeing to participate in the

study, individuals signed an informed consent form.

Procedures

The study was conducted at the Laboratory of Biomechanical Analysis of Movement (Bio.Mov) of the Center for Physical

Education and Sports at the Federal University of Espírito Santo (CEFD/UFES) and was approved by the Ethics Committee on Research

of the Federal University of Espírito Santo (CAAE: 88258218.8.0000.5542). Initially, anamnesis was performed to verify the general

health status of the participants and anthropometric measurements (height and body mass) were taken to calculate the Body Mass Index.

The MMSE was applied for cognitive screening. Then, the Falls Questionnaire was administered to investigate the presence of a history

of falls in the last 12 months and their characteristics. To determine and to evaluate the participants’ FOF was used the FES-I. In this

scale, the older adults quantify the fear of falling in “I am not worried” (1 point), “a little worried” (2 points), “moderately worried” (3 points)

and “very worried” (4 points) 16 activities presented regarding the fear of falling while performing them. Thus, a score greater than or

equal to 23 points suggests an association with the sporadic occurrence of falls, and a score greater than or equal to 31 points suggests

a recurrent occurrence of falls

. For a better characterization of the sample the Mini-Balance Evaluation Systems Test (Mini-BESTest)

and the Modified Baecke Questionnaire for older adults were used

. The Mini-BESTest was used to assess balance. This has a

maximum score of 28 points, and the higher the score, the better the balance of the older adults28. The Modified Baecke Questionnaire

for older adults was used to verify the level of physical activity. This evaluates occupational, sports and leisure activities. A score equal to

or less than 9.11 points indicates a low level of physical activity, between 9.12 and 16.17 points indicates a moderate level of physical