BJMB
Brazilian Journal of Motor Behavior
Special issue:
Manipulation of sensory information on postural control performance
of children, young and older adults
Meereis-Lemos et al.
2024
VOL.18
https://doi.org/10.20338/bjmb.v18i1.410
1 of 7
Postural control performance of active and inactive older adults during manipulation of
sensory information tests: a cross-sectional study
ESTELE C. W. M. LEMOS
1
| CLARISSA S. TEIXEIRA
2
| RAFAELA O. MACHADO
3
| GABRIEL I. PRANKE
4
| LUIZ F. C.
LEMOS
4
| CARLOS B. MOTA
4
1
Universidade Federal do Espirito Santo, Vitória, ES, Brazil
2
Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
3
Pontifica Universidade Católica do Paraná, Curitiba, PR, Brazil
4
Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
Correspondence to: Estele Caroline Welter Meereis Lemos
Universidade Federal do Espirito Santo, ES, Brazil
ORCID 0000-0001-7827-1829
email: estelefisio@gmail.com
https://doi.org/10.20338/bjmb.v18i1.410
HIGHLIGHTS
This study compared the postural balance of active and
inactive elderly women in situations involving
manipulation of sensory systems.
• This study corroborates the literature on the importance
of physical exercise practice as a preventive strategy to
reduce the occurrence of falls.
Active elderly present reduced dependence of visual
inputs and improved somatosensory afferences when
compared to inactive elderly.
Active elderly present higher COP average
displacement speed than inactive elderly.
ABBREVIATIONS
ADL Activities of daily living
ap Anteroposterior
CNS Central nervous system
COP Center of pressure
COPap COP displacement in the ap direction
COPml COP displacement in the ml direction
COPvel COP avarage displacement speed
Fap Ground reaction force ap component
FLP Foam-laser Dynamic Posturography method
Fml Ground reaction force ml component
Fv Ground reaction force vertical component
h Distance from the surface to the geometric
center of the platform
Map Moment about the anteroposterior axis
ml Mediolateral
Mml Moment about the mediolateral axis
MMSE Mini Mental State Examination
TOS Sensory Organization Test
PUBLICATION DATA
Received 18 12 2023
Accepted 13 04 2024
Published 22 06 2024
BACKGROUND: Inactivity during the aging process negatively influences postural control.
AIM: The aim of the present study is to evaluate the postural balance of active and inactive
elderly women in situations involving manipulation of sensory systems.
METHOD: The study included 20 elderly women (10 active and 10 inactive) with a mean age
of 63.45 ± 2.37 years, who underwent postural balance assessment using a force platform in
the six conditions of the Sensory Organization Test. For comparison between groups, the
Student's t-test and Mann-Witney test were used. Statistically significant differences were
observed between the groups for the three balance variables analyzed: Center of pressure
displacement in the anteroposterior direction (COPap), in the mediolateral direction (COPml)
and average speed (COPvel).
RESULTS: In situations in which the somatosensory system was not disturbed, as Sensory
Organization Test (TOS) I, II and III, it was observed that active elderly women presented
smaller COPap and COPml than inactive, however, in tests in which the somatosensory
system was disturbed, due to the addition of a cushion between the platform and the
individual's feet (TOS IV, V and VI), this difference was not observed. Furthermore, active
elderly present higher COP displacement average speed than inactive elderly in almost all
sensory tests (TOS I, III IV, V and VI).
CONCLUSION: It can be concluded that active elderly presented reduced dependence of
visual inputs and improved somatosensory afferences when compared to inactive elderly and
that active elderly presented higher COP average displacement speed than inactive elderly.
KEYWORDS: Postural balance | Elderly | Physical exercise
INTRODUCTION
Aging is characterized as a progressive and natural process with constant changes, biologically, functionally and structurally
1
.
It is a process that can alter the neuromuscular, somatosensory, vestibular and visual systems
2
, which can influence postural stability,
BJMB
Brazilian Journal of Motor Behavior
Meereis-Lemos et al.
2024
VOL.18
https://doi.org/10.20338/bjmb.v18i1.410
2 of 7
Special issue:
Manipulation of sensory information on postural control
performance of children, young and older adults
generating deficits in the postural control system
3
.
In this context, it is known that balance is a complex function that requires the integration of the somatosensory, visual and
vestibular systems, and the organization of this information by the central nervous system (CNS), which will generate neuromuscular
responses
4,5
. In this way, it can directly impact the activities of daily living (ADL) of the elderly
3,6,7
. In the literature, there are studies that
emphasize that these progressive changes delay the feedback of information, affecting postural control and consequently increasing the
risk of falls
8,9
.
Falls occur when the individual loses control of their center of gravity and there is insufficient recovery of balance
10
. In this way,
they are characterized as any type of unintentional displacement to a level lower than the level before, with the inability to correct in a
timely manner, even if a fall to the ground does not occur
11
.
The causes of the increased risk of falls in the elderly can be multifactorial and subdivided into intrinsic, extrinsic and behavioral
factors
12
. Thus, it becomes a serious public health issue related to the age of individuals over 60 years old, as it has consequences such
as increased risk of subsequent falls, hospital readmission, functional decline, mortality, fear of falling again and social isolation
8,13
.
The practice of physical activity acts as an essential factor in maintaining functional fitness and postural balance, reducing the
negative effects caused by the aging process, even delaying some restrictions regarding the performance of ADLs, prolonging the active
life span of this population as well as reducing the rate of falls in the elderly population
14,15,16
.
Studies have shown that physical inactivity harms the systems that act in postural control
17,18
as well as that with the practice of
physical activity there is an improvement in functional, coordinative and neuromotor capacity
19
. Furthermore, there are indicators that
show that exercises improves postural and neuromotor stability, such as a decrease in the total speed of the trajectory and area of sway
in the anteroposterior direction with eyes open and closed and bipedal support
17,20
. However, it is still necessary to investigate which
sensory systems physical exercise influences the most, so strategies and interventions can be proposed in order to focus on the system
in question.
The amplitude and speed of body sway in the mediolateral and anteroposterior directions are frequently investigated COP
variables
9,21-23
and are used to predict the risk of falls in the elderly
24-26
in addition to the sensory organization test, through assessment
by Foam- laser Dynamic Posturography (FLP) method, which analyzes the relative contribution of the somatosensory, visual and
vestibular systems to the individual's body stability, indicating the system responsible for instability, it is possible to infer that the use of
the aforementioned tests can concomitantly bring interesting information about the means these systems contribute to postural control.
In this context, the aim of the present study was to evaluate the postural balance of active and inactive elderly women in
situations involving manipulation sensorial to analyzes the relative contribution of sensory systems. Assessments of the visual,
somatosensory and vestibular systems were carried out with eyes open and closed, with an unstable and stable surfaces and with and
without a mobile cabin.
METHODS
This is a cross-sectional study, approved by the Ethics and Research Committee of the Federal University of Santa Maria
(CAAE 010.0.243.000-08), in accordance with the standards established in Resolution 466/12 of the National Health Council on
research involving human beings.
Participants
The study included 20 elderly women who met the inclusion criteria: aged between 60 and 80 years, scoring above 26 points
on the Mini Mental State Examination (MMSE), complying with the Informed Consent Form. The sample selection was for convenience,
and for the group of active elderly women, elderly women who practice water aerobics at the Federal University of Santa Maria (UFSM)
were invited, and those who performed physical exercises at a frequency equal to or greater than 150 minutes per week in the last three
months
27
were included. For the group of inactive elderly women, elderly women were invited from a long-term care institution for elderly
people living in Santa Maria-RS who had not performed physical exercise for 150 minutes per week in the last three months28.
Individuals who had known neurological disease, acute orthopedic trauma, severe visual impairment and/or used medications capable of
influencing the tests were excluded from the study.
To calculate the sample size, G*Power software version 3.1.9.2 was used, in which an α = 0.05 was adopted, a power of 90%.
Of the variables to be investigated in the present study, the results found in the study by Meereis et al.
16
, referring to the amplitude of
COP displacement in the mediolateral direction during the Sensory Organization Test (TOS 1) were used to support the sample
calculation. Thus, the effect size was 1.42, therefore the minimum "n" of 10 individuals in each group was adopted.
BJMB
Brazilian Journal of Motor Behavior
Meereis-Lemos et al.
2024
VOL.18
https://doi.org/10.20338/bjmb.v18i1.410
3 of 7
Special issue:
Manipulation of sensory information on postural control
performance of children, young and older adults
Procedures
The research was carried out in the biomechanics laboratory of the Center for Physical Education and Sports (CEFD) at UFSM.
First, an anamnesis and assessment of the level of physical activity
27
and MMSE were carried out to identify cognitive function. Soon
after, anthropometric data such as body mass and height were collected using a scale and a Welmy stadiometer, respectively.
The group was composed of 10 active elderly women and 10 inactive elderly women, with similar anthropometric
characteristics, illustrated in table 1.
Table 1. Anthropometric Characteristics.
Active Elderly
n= 10
Inactive Elderly
n=10
Mean ± SD
Mean ± SD
T-Test
Mann-Whitney Test
Age (years)
61,35 ± 2,80
62,95 ± 2,87
0,183
Height (m)
1,53 ± 0,12
1,54 ± 0,05
0,932
Mass (kg)
73,42 ± 7,03
75,34 ± 7,55
0,516
BMI (kg/cm²)
29,56 ± 5,67
31,50 ± 3,63
0,585
n= number of individuals in the group; BMI = body mass index; p-value = probability value in Student's t test, indicates a statistically
significant difference if p < 0.05.
The assessment of postural control was carried out using a force platform (OR6-6, Advanced Mechanical Technology
Incorporation, USA), during sensory manipulation, which was carried out through the sensory organization test (TOS), using
posturography dynamics validated by Castagno
28
. For the evaluation, each participant was positioned the force platform in a one
cabin, two meters high.
Individuals were asked to remain standing barefoot on the platform during the six conditions following sensory organization test
(TOS), with feet positioned hip-width apart for 30 seconds after the individual was stabilized. The support base was marked on each
individual's first attempt on graph paper so that the positioning of the lower limbs could be repeated in all conditions. For unstable support
surface conditions, an AIREX® Balance Pad (Airex AG, Inc.) flexible foam cushion was added on the platform with dimensions of 50 cm
long, 50 cm wide and 10 cm thick and density, calculated by indications Patel
29
, of 80 kg/m³.
Hereinafter the six conditions of the sensory organization test are presented:
TOS I) Individual with eyes open and fixed horizontally, stable support surface (feet supported on the force platform),
fixed visual cabin. This test evaluates the visual, somatosensory and vestibular systems.
TOS II) Individual with eyes closed, stable support surface. Assessment of the somatosensory and vestibular systems.
TOS III) Eyes open, stable foot support surface, oscillating visual cabin, 10 seconds manually tilted forward and 10
seconds to return to the starting position. It evaluates the somatosensory, vestibular and, above all, visual systems.
TOS IV) Eyes open, fixed visual cabin, unstable support surface (with the addition of a foam cushion between the
person's feet and the platform). It mainly evaluates the somatosensory system.
TOS V) Eyes closed, fixed visual cabin, unstable support surface. This test evaluates the somatosensory and vestibular
systems under overload conditions.
TOS VI) Eyes open, unstable support surface with oscillating visual cabin. Assessment of the somatosensory, visual and
vestibular systems.
Three attempts were made in each condition, with a 1-min interval between them, totaling 18 attempts. The order of tests was
randomized for each participant. The displacement of the center of force overtime results in a trajectory which is related to the movement
of the center of mass
21
and, therefore, related with postural control. The COP position is calculated each time:
COPap = (Mml h . Fap) / Fv
COPml = (Map h . Fml) / Fv
Where COPap denotes center of pressure displacement in the anteroposterior direction; COPml denotes center of pressure
displacement in the mediolateral direction; Map denotes moment about the anteroposterior axis; Mml denotes moment about the
mediolateral axis; Fap: ground reaction force anteroposterior component; Fml denotes ground reaction force mediolateral component; Fv
denotes ground reaction force vertical component, h denotes distance from the surface to the geometric center of the platform.
BJMB
Brazilian Journal of Motor Behavior
Meereis-Lemos et al.
2024
VOL.18
https://doi.org/10.20338/bjmb.v18i1.410
4 of 7
Special issue:
Manipulation of sensory information on postural control
performance of children, young and older adults
The variables analyzed were center of pressure displacement in the anteroposterior direction (COPap), in the mediolateral
direction (COPml) and center of pressure average displacement speed (COPvel). The frequency used to acquire data from the force
platform (forces and moments) was 100 Hz. The raw data from the platform were filtered by a 4th order Butterworth low-pass filter at a
frequency of 10 Hz, thus eliminating possible interference from the environment.
Statistical Analyses
For statistical analysis, SPSS Software (Statistical Package for the Social Science) version 13.0 for Windows was used. To
analyze the distribution of data, the Shapiro-Wilk test was performed. Then, the Student's t test was performed for data with normal
distribution and the Mann-Witney test for data with non-normal distribution for comparison between groups. For all tests, a significance
level of 5% was used.
RESULTS
The results of the study are described below. Table 2 illustrates the behavior of COPap, COPml and COPvel during the
execution of the six sensory organization tests.
Table 2. Balance test statistical data
Active Elderly
n= 10
Inactive Elderly
n=10
Mean ± SD
Mean ± SD
T-Test
Mann-Whitney Test
TOS I
COPap (cm)
1,27 ± 0,69
2,74 ± 0,94
< 0,01*
COPml (cm)
0,59 ± 0,30
1,70 ± 0,69
< 0,01*
COPvel (cm/s)
3,22 ± 1,70
1,26 ± 0,28
< 0,01*
TOS II
COPap (cm)
1,78 ± 0,74
2,59 ± 0,83
0,02*
COPml (cm)
1,00 ± 0,60
1,31 ± 0,51
< 0,01*
COPvel (cm/s)
3,58 ± 1,44
1,40 ± 0,42
0,11
TOS III
COPap (cm)
2,38 ± 1,26
3,74 ± 1,21
0,03*
COPml (cm)
0,94 ± 0,57
2,22 ± 1,04
< 0,01*
COPvel (cm/s)
3,43 ± 1,09
1,76 ± 0,64
< 0,01*
TOS IV
COPap (cm)
2,14 ± 0,61
3,32 ± 1,77
0,03*
COPml (cm)
1,24 ± 0,37
2,60 ± 2,49
0,10
COPvel (cm/s)
3,64 ± 1,47
1,70 ± 0,72
< 0,01*
TOS V
COPap (cm)
3,54 ± 1,16
4,70 ± 1,69
0,05
COPml (cm)
1,97 ± 1,00
2,20 ± 0,86
0,35
COPvel (cm/s)
4,19 ± 1,30
2,23 ± 0,67
< 0,01*
TOS VI
COPap (cm)
6,83 ± 5,75
6,41 ± 1,83
0,37
COPml (cm)
3,37 ± 4,75
3,13 ± 1,11
0,26
COPvel (cm/s)
5,38 ± 2,56
2,69 ± 0,96
< 0,01*
COPap = displacement of the center of pressure in the anteroposterior direction; COPml = displacement of the center of pressure in the
medio-lateral direction, VM = Average velocity of COP displacement. * < 0.05.
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DISCUSSION
Active elderly women demonstrated less postural sway, which infers better postural control and a lower risk of falls then
inactive elderly women. By specifically analyzing the COP sway amplitude in different TOS conditions on a stable support surface, that is,
TOS I, II and III, statistically significant differences were found for all postural balance variables analyzed. Indicating the contribution of
the sensory systems responsible for postural balance without manipulating the somatosensory system.,
In relation to TOS I, a situation in which information from the visual, vestibular and somatosensory systems were present, the
COP displacement amplitude was significantly smaller in the group of active elderly women for both COPap and COPml, inferring that
exercise promotes better postural control, corroborating other studies
16,22
. Similarly, in TOS II and TOS III, when visual information is
suppressed and respectively manipulated, the COPap and COPml displacement values from active elderly were lower than inactive.
Elderly people generally depend more on visual inputs, and the results of this study indicated that active subjects presented better
postural performance and managed sensory conflicting situations in a better way when compared to inactive subjects. Given this, it can
be inferred that exercise can mitigate the risk of falls in situations where vision is compromised, such as, in situations of low vision or low
light, circumstances which generate greater postural instability for the elderly
31
.
In situations of TOS IV, V and VI when an unstable support surface is added, hindering the action of the somatosensory
system, the active elderly women obtained statistically significant lower values only in one of six variables (COPap on TOS IV). From this
result, it can be observed that when somatosensory inputs were distorted, the sway amplitude of the two groups was similar. This finding
corroborates other studys
32
meaning that physical exercise improves somatosensory afferences, since it indicates that the active elderly
group depend of undisturbed somatosensory inputs to present better balance control than inactive group.
Regarding COPvel, it can be observed that active elderly women presented statistically significant higher COP displacement
speed in most tests (TOS I, TOS III, TOS IV, TOS V, TOS VI), differently from other studies that compared active and inactive elderly
women
22,36
. However, the present study suggests that active elderly women are able to make postural adjustments more quickly,
ensuring the maintenance of postural control, demonstrating that the central nervous system was able to change the trajectory of sway
quickly in order to ensure that balance was not threatened. This is important, since the ability to make postural adjustments necessary for
adequate postural control is reduced with aging, especially in complex tasks
9,37
.
Several authors have found a relationship between better postural control and physical exercise
16,33,34
, showing that losses
related to postural control are related not only to the aging process, but also to physical inactivity, thus, the practice of physical exercises
is capable to improve the balance of inactive elderly women. In relation to this, Patti and collaborators
35
, state that the practice of
physical exercises favors the improvement of the conditions for receiving sensory information from the vestibular, visual and
somatosensory systems and also activates the antigravity muscles, in addition to limiting the loss of muscle mass and strength, which is
reinforced by the results of the present study.
This study as any cross-sectional analysis has certain limitation. The group of inactive elderly woman was institutionalized, so
some characteristics arising from institutionalization can provide to these elderly more inactivity than living in community. However, the
influence of institutionalization on elderly physical activity wasn’t the aim of this study.
Despite the limitations, the present study reinforces that postural control is influenced by the practice of physical exercise and
active elderly women have a smaller COP displacement compared to inactive elderly women
9,38,39
. This reinforces the idea that the lower
postural control and consequent higher risk of falls among inactive elderly women may not only be due to the aging process, but also to
factors related to physical inactivity
18,40
.
CONCLUSION
This study corroborates the literature on the importance of practicing physical exercise as a preventive strategy to reduce the
occurrence of falls because (a) it demonstrates that active elderly present reduced dependence of visual inputs when compared to
inactive elderly; (b) somatosensory afferences were improved and (c) higher COP average displacement speed can reflect the ability to
make postural adjustments more quickly in order to maintain a postural control.
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https://doi.org/10.20338/bjmb.v18i1.410
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performance of children, young and older adults
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Editor-in-chief: Dr Fabio Augusto Barbieri - São Paulo State University (UNESP), Bauru, SP, Brazil.
Associate editors: Dr José Angelo Barela - São Paulo State University (UNESP), Rio Claro, SP, Brazil; Dr Natalia Madalena Rinaldi - Federal University of Espírito Santo
(UFES), Vitória, ES, Brazil; Dr Renato de Moraes University of São Paulo (USP), Ribeirão Preto, SP, Brazil.
Guest editors: Dr Paula Favaro Polastri Zago - São Paulo State University (UNESP), Bauru, SP, Brazil; Dr Daniela de Godoi Jacomassi Federal University of São Carlos
(UFSCAR), São Carlos, SP, Brazil.
Copyright:© 2024 Lemos, Teixeira, Machado, Pranke, Lemos and Mota and BJMB. This is an open-access article distributed under the terms of the Creative Commons
Attribution-Non Commercial-No Derivatives 4.0 International License which permits unrestricted use, distribution, and reproduction in any medium, provided the original
author and source are credited.
Funding: Nothing to declare.
Competing interests: The authors have declared that no competing interests exist.
DOI: https://doi.org/10.20338/bjmb.v18i1.410
Citation: Meereis-Lemos ECW, Teixeira CS, Machado RO, Pranke GI, Lemos LFC, Mota CB. (2024). Postural control performance of active and inactive older adults
during manipulation of sensory information tests: a cross-sectional study. Brazilian Journal of Motor Behavior, 18(1):e410.