The Aging Male

ISSN: 1368-5538 (Print) 1473-0790 (Online) Journal homepage: www.tandfonline.com/journals/itam20

Age-related changes in musculoskeletal function,

balance and mobility measures in men aged 30–80
years

Melissa Nolan, Jennifer Nitz, Nancy Low Choy & Sara Illing

To cite this article: Melissa Nolan, Jennifer Nitz, Nancy Low Choy & Sara Illing (2010) Age-
related changes in musculoskeletal function, balance and mobility measures in men aged
30–80 years, The Aging Male, 13:3, 194-201, DOI: 10.3109/13685531003657818

To link to this article: https://doi.org/10.3109/13685531003657818

Published online: 04 May 2010.

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The Aging Male, September 2010; 13(3): 194–201

Age-related changes in musculoskeletal function, balance and mobility

measures in men aged 30–80 years

MELISSA NOLAN1, JENNIFER NITZ2, NANCY LOW CHOY3, & SARA ILLING4
1
Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane,
Australia, 2Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland,
Brisbane, Australia, 3Physiotherapy Department, Faculty of Health Sciences and Medicine, Bond University, Queensland,
Australia, and 4Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland,
Brisbane, Australia

(Received 25 November 2009; revised 3 January 2010; accepted 12 January 2010)

Abstract
Objectives. This study aimed to establish age-related changes in musculoskeletal function, balance and mobility measures in
men.
Design. An observational, cross-sectional cohort study was undertaken.
Methods. One hundred six healthy, community-ambulant men (30–80 years) participated in this study. Recruitment of a
convenience sample continued until a minimum of 20 men represented each decade between 30 and 80 years. Demographics
(age, height, weight), health and current activity level were recorded. Balance and mobility were measured using the timed up
and go test, the step test, functional and lateral reach. Reaction time was determined from limits of stability test. Leg muscle
strength was measured with a spring gauge (kg), and ankle flexibility was measured using goniometry.
Results. Balance, mobility and most strength measures were reduced by the 60s while ankle flexibility declined by the 70s
(p 5 0.01). Reaction times increased by the 60s (p 5 0.01).
Conclusion. This study of men demonstrated reduced musculoskeletal function, balance and mobility generally by the 60s.
These results provide health professionals with normal performance levels to use as therapeutic goals as well as identify
musculoskeletal factors associated with reducing balance and mobility. Hence, these results inform clinicians and policy
makers for the establishment of pre-emptive interventions to promote healthier ageing.

Keywords: Men, aging, functional balance, strength, mobility

men. Much of the available literature focuses on

Introduction
women [6,7], unidentified gender groups [8] or on
Balance is a complex skill requiring the interaction of either young or elderly men [5] leaving gaps in the
dynamic sensorimotor processes while postural stabi- knowledge of the middle decades of life for men. This
lity, dynamic balance and mobility tasks are under- is most evident when functional performance mea-
taken [1]. As people age there is a general sures other than gait are considered [9] and further
deterioration in a number of aspects of the muscu- research in this area is thus required.
loskeletal system which may reduce the ability to Regaining motor function and safe mobility is a
balance and mobilise, and these impairments have major rehabilitation goal for physiotherapists and their
been identified as being a major risk factor for falls patients recovering from injury and illness. Phy-
[2,3]. Older men have shown a similar pattern of ‘falls’ siotherapists set rehabilitation goals and use a variety
history to women [4], although few specific studies of of clinical measures to determine outcomes for
men have been undertaken [5]. While it is likely that a dynamic balance and safe mobility. These measures
range of sensorimotor factors may be associated with include the timed up and go (TUG) test [10], step test
reduced balance and performances on motor tasks in (ST) [11], functional reach (FR) [12] and lateral
middle aged, as well as older men, it is not known reach (LR) [13]. The TUG is a test of functional
when balance and mobility start to decline in men. mobility that requires the subject to move from sitting
The sensorimotor risk factors associated with earlier to standing, walk 3 m, turn walk back to the chair and
changes in balance have also not been documented for sit down again as quickly as they safely can whilst

Correspondence: Dr. Jenny Nitz, Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia QLD 4072,
Brisbane, Australia. Tel: þ61-733652791. Fax: þ61-733651622. E-mail: j.nitz@shrs.uq.edu.au
ISSN 1368-5538 print/ISSN 1473-0790 online Ó 2010 Informa UK Ltd.
DOI: 10.3109/13685531003657818
 Balance in men 30–80 years 195

being timed. The ST measures anticipatory control of changes likely to be associated with the pre-clinical
dynamic balance while the subject balances on one leg period of change. The outcomes from 20 subjects in
as they place the other foot on and off a step as quickly each decade would subsequently enable power
as they can in 15 s. The number of completed steps is calculations to be determined, and thus inform
recorded. The function and LR tests measure the subject numbers for a larger study if indicated.
anticipatory control of balance as the subject reaches Inclusion criteria required the men to be aged
in a forwards or lateral direction to their limit of between 30 and 80 years of age, to be community-
stability. The distance reached in the forwards or dwelling and ambulatory without an aid and able to
lateral direction is recorded thus providing informa- give informed consent.
tion regarding the ability to control internal perturba- Exclusion criteria included a diagnosed pathol-
tion of centre of mass. These measurements are used ogy that could account for changes in postural
in a range of settings and to monitor outcomes for a stability. Thus, men were excluded if they had
variety of different pathologies and age groups. While neurologic disorders, dizziness, uncorrected vision,
normative values for women have been established, diabetes mellitus, peripheral vascular disease that
Isles et al. [6] demonstrated that a linear reduction in required active management or surgical interven-
performance of the TUG, ST, FR and LR was tion, or other major musculoskeletal dysfunction,
apparent with age for women. Duncan et al. [12] cognitive impairment or dementia. Men taking
included small numbers of men in their cross- medication for psychiatric disorders, depression
sectional study of FR, but not all decades were and anxiety were excluded from the study, as an
included. The current study will fill this gap by association of such medication with falls has been
performing an across decade study of men to establish demonstrated [14].
normative data for functional balance measures Prior to collecting any data all participants gave
including the TUG, ST, FR and LR. informed written consent in accordance with the
Identification of change in musculoskeletal FR and requirements of the Declaration of Helsinki and
clinical balance and mobility measures for community institutional ethics committee. The test session
dwelling men between 30 and 80 years will allow commenced with a face-to-face interview and the
identification of deterioration in balance and likely measurement of height and weight. Personal in-
musculoskeletal contributors when these first present formation including name, age, past medical his-
in younger decades. With this knowledge earlier tory, past surgical history, number of prescribed
interventions can be delivered that target specific medications, falls history [6], activity level [15] and
impairments to decrease risk of falls as men age [6]. limb dominance were sought from each participant.
Thus, this study will report balance, reaction time, These variables need to be included in this study as
strength and ankle flexibility data for age decade an influence on balance performance may occur
cohorts between 30 and 80 years. A concurrent study [16].
of stability and sensory system function will complete
the data set for the participants and be separately
Outcome measures
reported.
The primary aim of this study was to determine Reliable and valid balance and mobility measures
changes to functional balance and mobility measures, were undertaken using established protocols. A series
reaction times, leg muscle strength and ankle flex- of strength and flexibility measures were also under-
ibility as men age. The hypothesis being tested is that taken in no specific order.
men will show a significant decline in balance and The TUG, ST FR and LR were applied using the
musculoskeletal function by the 60s. protocol described previously [6].
The limits of stability (LOS) test (a test option of
the Balance MasterTM Neurocom6 Database Sys-
Methods
tem, Neurocom Clamacas, Oregon) was used to
The design was a cross-sectional cohort study. identify reaction time in this study. The LOS test
Subjects were recruited through convenience provides a laboratory measure of the capacity of the
sampling using word of mouth, information e-mails, subject to control their balance when responding to
notices and flyers on university and public notice an external cue that demands they lean and shift their
boards and included members of the public, uni- centre of mass in a predetermined direction towards
versity students and family members to promote the a target depicted on a computer screen. Clark et al.
study and seek volunteers. Recruitment continued [17] demonstrated that the LOS test was a reliable
until a minimum of 20 men represented each decade dynamic balance test when administered to commu-
from the 30s to the 70s. nity-dwelling older adults. Subjects stood unsup-
The power calculations provided by the study on ported on the force plates, with close supervision by
women [6] suggested that about 20 subjects per the investigator to ensure safe execution of the test.
decade would be required, although more may be Standard instructions provided by the manufacturer
required across the mid-life decades if the study was regarding application of this test were followed. The
to have appropriate power to detect more subtle LOS have been quantified by measuring the mean
196 M. Nolan et al.

position of the centre of pressure during the sus-

tained weight shift task [17]. Measures automatically
recorded by the programme included reaction time
(time between the stimulus to move and actual
response movement), velocity of movement and
excursion of movement in the forwards, right, back
and left directions. Only the reaction time scores
were extracted for use in this study.
Quadriceps, hip abductor and adductor muscle
strength testing was undertaken using a spring gauge
following the procedure described by Low Choy
et al. [7]. Ankle dorsiflexion range of motion was
measured (left and right) using the protocol de-
scribed by Nitz and Low Choy [18].

Data analysis Figure 1. Flowchart showing stages in study protocol and the
number of participants at each stage.
All data analyses were performed using SPSS for
windows version 16 (SPSS Inc., Chicago, IL). Data
were inspected for outliers. Descriptive statistics were of falls and activity level), significant age-related
used to present demographic, health and activity data, changes were identified for the balance and mobility
along with the measures of clinical balance and measures along with reaction time, strength and
mobility, reaction time, strength and flexibility. A flexibility measures (p 5 0.01).
multivariate analysis was used to determine main An age-related decline occurred in the TUG test
effects of age group, demographics, health factors and (Figure 2A). The peak performance was present in
activity level on musculoskeletal balance and mobility the 30s, with a significant reduction in the time taken
measures. A series of univariate analyses was used to to perform the test by the 60s (p ¼ 0.000, 95% CI:
establish age-related changes in balance measures 71.86 to 70.58) and a further trending reduction
(TUG, ST, FR and LF), reaction times, strength by the 70s (p ¼ 0.020, 95% CI: 71.41 to 70.12).
measures and flexibility. Age category was entered as The reduction in the number of completed steps
the main factor, with height, weight, co-morbidities, performed in each age decade for the ST also
number of prescribed medications, activity level and declined (Figure 2B). The peak performance was in
falls history included as covariates [7]. Post hoc the 30s, except for the 7.5 cm step on the right leg,
analyses of the least significant differences were used which peaked in the 40s. While a trending reduction
to identify the age decade when a significant reduc- occurred by the 50s for the right ST using the 7.5 cm
tion in balance and mobility, reaction times, strength block (p ¼ 0.044, 95% CI: 0.08–5.31), a significant
and flexibility occurred. To protect against Type 1 reduction presented by the 60s irrespective of the
errors the p-value was lowered to p 5 0.01 [7]. As a height of the block or the leg used for the test (7.5 cm
result, the p-values between 0.05 and 0.01 were block: Left p ¼ 0.000, 95% CI: 2.23–7.22; Right
reported as a strong trend when the differences p ¼ 0.002, 95% CI: 1.68–6.98; 15 cm block: Left
between age categories were considered. p ¼ 0.000, 95% CI: 1.95–6.51; Right p ¼ 0.000, 95%
CI: 1.92–6.63).
There was also an age-related decline in reaching
Results
distance for FR and LR (Figure 2C). The distance
A total of 113 men were recruited for the study. Of reached in both FR and LR was greatest in the 30s. A
these 106 (93%) met the inclusion criteria, com- significant reduction in forwards reaching distance
pleted the tests and were included in the analysis (no was apparent by the 50s on the left (p ¼ 0.004, 95%
outliers within 2 SD). Participants represented five CI: 1.75–8.94), while a trending reduction was
age cohorts: 30–39 (n ¼ 22); 40–49 (n ¼ 20); 50–59 revealed by the 50s on the right (p ¼ 0.027, 95%
(n ¼ 21); 60–69 (n ¼ 22) and 70–79 (n ¼ 21). Figure CI: 0.46–7.67), with this becoming significant by the
1 shows the recruitment and study flow. 60s (p ¼ 0.000, 95% CI: 3.92–11.04). A further
Participant characteristics are presented in Table I. trending reduction was evident by the 70s on both
Table II shows the mean scores and standard errors sides (Left: p ¼ 0.013, 95% CI: 78.17 to 70.99;
for each decade cohort for all clinical measures of Right: p ¼ 0.012, 95% CI: 1.02–8.23). For the LR
balance and mobility and reaction times while test, a significant reduction in distance reached
Table III includes data for strength, and flexibility. presented by the 60s on the left (p ¼ 0.009, 95%
ANOVA yielded a main effect of age group for all CI: 1.26–8.62), and as a trending reduction on the
measures investigated (p 5 0.05). Even with adjust- right side (p ¼ 0.012, 95% CI: 1.10–8.59). The reach
ments for six variables (height, weight, number of distance was significantly reduced by the 70s on both
medical conditions, number of medications, number sides.
 Balance in men 30–80 years 197

Table I. Demographics, health factors, activity level and falls history of the study cohort.

Height (cm) Weight (kg) Median (range)

Upper Lower Upper Lower Co-morbidities Number of Activity Number

Age decades Mean (SD) bound bound Mean (SD) bound bound (n) medications (n) level (1–6) of falls (n)

30–39 (n ¼ 22) 179.95 (6.02) 177.08 182.42 83.91 (12.63) 78.31 89.51 0.00 (0–3) 0.00 (0–2) 4.00 (1–6) –
40–49 (n ¼ 20) 179.20 (7.37) 175.75 182.65 92.74 (10.23) 87.95 97.53 0.50 (0–1) 0.00 (0–4) 4.00 (1–6) –
50–59 (n ¼ 21) 178.02 (6.65) 175.00 181.05 87.95 (14.92) 81.16 94.74 1.00 (0–3) 0.00 (0–5) 4.00 (2–6) 0.00 (0–2)
60–69 (n ¼ 22) 175.23 (7.60) 171.86 178.59 85.36 (11.92) 80.08 90.65 1.50 (0–4) 2.00 (0–6) 3.00 (1–6) 0.00 (0–1)
70–79 (n ¼ 21) 175.86 (7.03) 172.66 179.06 82.52 (11.67) 77.21 87.84 1.00 (0–5) 2.00 (0–6) 3.00 (2–6) 0.00 (0–3)

An age-related increase in reaction times was would present by the 60s in men. These data also
identified (Figure 2D). Reaction time in all direc- represent the first systematic approach to assessing
tions was fastest in the 30s. Reaction time in the age-related changes in performances of functional
forward direction slowed by the 60s (p ¼ 0.029, 95% motor tasks and in so doing provide pilot normative
CI: 70.29 to 70.16) and was significantly reduced values for men aged between 30 and 80 years for the
by the 70s. The reaction times in the backward TUG, ST, FR and LR. In addition, age decade
direction however, were significantly slower by the values for reaction times during the LOS test,
60s (p ¼ 0.002, 95% CI: 70.34 to 70.07). Reaction strength of specific leg muscles and ankle flexibility
time to the left was significantly slower by the 60s were identified, providing additional information for
(p ¼ 0.001, 95% CI: 70.35 to 70.08), with a further these modalities.
trending reduction presenting by the 70s (p ¼ 0.047, The TUG results of this study support the
95% CI: 70.27 to 70.00). Reaction time to the available normative data from a number of studies
right however, was only significantly reduced by the that focussed on the older age decades [10,19,20]. A
70s (p ¼ 0.000, 95% CI: 70.57 to 70.30). significantly longer time taken to perform the test was
Figure 3A demonstrates the age-related changes in evident in the 60s, with a further trending decline in
muscle strength, with peak force identified in the 30s performance present by the 70s. Overall, our mean
for all but one muscle group tested (left hip data for the TUG test scores are on the lower (faster)
abductors). Compared with the 30s, the left and right end of the range of data reported from previous
quadriceps muscle group revealed a significant studies for independently functioning older adults
reduction in strength by the 60s (Left: p ¼ 0.001, [10,21]. This could be due to the characteristics of
95% CI: 3.12–11.01; Right: p ¼ 0.004, 95% CI: 2.12– our convenience sample, with only active, commu-
10.67) and a further significant reduction in strength nity-dwelling men without identifiable pathology
by the 70s (Left: p ¼ 0.000, 95% CI: 3.99–11.97; included in our study. Our results reveal faster times
Right: p ¼ 0.001, 95% CI: 3.25–11.90). For the right than the findings of Podsiadlo and Richardson [10],
hip abductor muscles, a strong trending reduction which is not surprising as people with neurological
occurred by the 60s (p ¼ 0.012, 95% CI: 0.95–7.37), dysfunction and various musculoskeletal conditions
with a further strong trending reduction in strength were included in their study cohort.
presenting by the 70s on the left and right (Left: The results of this study demonstrated that
p ¼ 0.011, 95% CI: 0.97–7.40; Right: p ¼ 0.013, 95% irrespective of the height of the step, a significant
CI: 0.90–7.40). For the left and right hip adductor decline in ST performance was evident by the 60s.
muscles a trending reduction in strength was present These findings show that the ST is a discriminative
by the 60s, respectively (Left: p ¼ 0.043, 95% CI: clinical test with better performances by men
0.12–7.65; Right: p ¼ 0.016, 95% CI: 0.84–8.05), younger than 60, and that men in their 60s perform
with a further trending reduction on both sides better than those in their 70s. Overall, our mean data
evident by the 70s (Left: p ¼ 0.010, 95% CI: 1.22– reported for the ST, irrespective of the height of the
8.74; Right: p ¼ 0.010, 95% CI: 1.15–8.35). step is higher than that reported in a study conducted
Figure 3B depicts the decrease in ankle range of by Hill et al. [11] who examined the performance of
motion that presented with advancing age. Peak 41 healthy older adults, of which men represented
ankle range of motion was evident in the 30s, with a 44% of the cohort. A possible reason for this
strong trending loss in range presenting by the 70s difference is explained by the fact that only older
for both the left (p ¼ 0.026, 95% CI: 0.61–9.19) and adults were studied (mean age 72.5), and it has been
right ankles (p ¼ 0.023, 95% CI: 0.75–9.78). demonstrated that with age, performance on the ST
declines [6]. Despite the higher mean scores in our
study, our findings generally concur with those of
Discussion
Hill et al. [11], where it was demonstrated that
The findings of this study supported the hypothesis irrespective of the height of the step, ST performance
that reduced balance and musculoskeletal function using the right foot was slightly better in comparison
 Table II. Normative data for clinical balance measures and reaction times. 198

30–39 (n ¼ 22) 40–49 (n ¼ 20) 50–59 (n ¼ 21) 60–69 (n ¼ 22) 70–79 (n ¼ 21)

Upper Lower Upper Lower Upper Lower Upper Lower Upper Lower
Measure Mean (SD) bound bound Mean (SD) bound bound Mean (SD) bound bound Mean (SD) bound bound Mean (SD) bound bound

Balance
TUG 5.01 (0.6) 5.31 4.70 4.98 (0.9) 5.42 4.55 5.48 (0.7) 5.82 5.15 6.23 (1.3) 6.84 5.62 7.00 (1.3) 7.63 6.37
Step test (Left), 7.5 cm 21.86 (4.3) 23.79 19.94 21.30 (4.6) 23.46 19.14 19.76 (2.9) 21.10 18.43 17.14 (4.5) 19.15 15.12 16.00 (4.1) 17.90 14.10
M. Nolan et al.

Step test (Right), 7.5 cm 22.45 (3.9) 24.22 20.69 21.65 (5.0) 24.02 19.28 19.76 (2.9) 21.13 18.40 17.32 (5.1) 19.58 15.06 16.14 (4.1) 18.02 14.26
Step test (Left), 15 cm 21.14 (4.0) 22.95 19.32 20.75 (3.9) 22.60 18.90 19.81 (2.9) 21.14 18.48 16.91 (4.2) 18.79 15.03 15.38 (3.6) 17.05 13.71
Step test (Right), 15 cm 21.64 (4.2) 23.50 19.77 21.05 (3.7) 22.78 19.32 20.10 (2.9) 21.42 18.77 17.36 (4.7) 19.47 15.26 15.48 (3.8) 17.21 13.75
Functional reach (Left) 40.46 (6.1) 43.17 37.75 40.32 (5.1) 42.73 37.90 35.11 (5.5) 37.63 32.60 33.93 (6.0) 36.60 31.27 29.35 (6.6) 32.40 26.30
Functional reach (Right) 40.80 (6.0) 43.46 38.14 39.39 (5.1) 41.83 36.96 36.73 (5.9) 39.45 34.00 33.32 (5.9) 35.95 30.68 28.69 (6.5) 31.65 25.72
Lateral reach (Left) 30.19 (6.2) 32.95 27.44 27.12 (6.3) 30.08 24.16 27.13 (6.0) 29.89 24.37 26.67 (6.6) 29.60 23.74 21.73 (5.0) 24.03 19.42
Lateral reach (Right) 30.75 (5.5) 33.21 28.29 27.67 (6.4) 30.69 24.66 28.35 (6.1) 31.13 25.57 27.04 (7.1) 30.22 23.86 22.19 (5.5) 24.70 19.69
Reaction time (s)
Forwards 0.63 (0.2) 0.72 0.54 0.68 (0.1) 0.75 0.61 0.71 (0.2) 0.81 0.60 0.78 (0.1) 0.87 0.70 0.99 (0.3) 1.14 0.85
Backwards 0.47 (0.0) 0.51 0.42 0.61 (0.2) 0.72 0.51 0.58 (0.1) 0.66 0.49 0.68 (0.1) 0.75 0.60 0.70 (0.3) 0.86 0.53
Left 0.49 (0.1) 0.54 0.44 0.56 (0.1) 0.64 0.48 0.61 (0.1) 0.68 0.54 0.71 (0.2) 0.83 0.60 0.85 (0.3) 1.00 0.70
Right 0.51 (0.1) 0.56 0.46 0.60 (0.1) 0.68 0.51 0.63 (0.1) 0.70 0.55 0.63 (0.1) 0.70 0.56 0.95 (0.3) 1.12 0.77

Table III. Normative data for muscle strength and flexibility.

30–39 (n ¼ 22) 40–49 (n ¼ 20) 50–59 (n ¼ 21) 60–69 (n ¼ 22) 70–79 (n ¼ 21)

Upper Lower Upper Lower Upper Lower Upper Lower Upper Lower
Measure Mean (SD) Bound Bound Mean (SD) Bound Bound Mean (SD) Bound Bound Mean (SD) Bound Bound Mean (SD) Bound Bound

Muscle strength (Nm)

Quadriceps (Left) 67.81 (6.9) 70.99 64.78 64.16 (8.3) 68.07 60.25 63.44 (10.0) 68.03 58.84 57.50 (11.4) 62.57 52.44 45.78 (20.1) 50.71 40.84
Quadriceps (Right) 67.55 (8.27) 71.22 63.88 64.85 (7.7) 68.49 61.21 63.79 (10.05) 68.37 59.21 58.15 (12.4) 63.65 52.65 47.01 (12.8) 52.87 41.15
Hip abductors (Left) 62.90 (17.0) 70.46 55.33 65.25 (17.4) 73.42 57.09 65.10 (16.0) 72.40 57.80 55.67 (15.0) 62.36 48.98 43.35 (11.9) 48.78 37.91
Hip abductors (Right) 66.54 (15.4) 73.39 59.69 65.99 (18.6) 74.73 57.26 67.25 (16.6) 74.81 59.68 54.30 (14.2) 60.60 47.99 42.08 (13.8) 48.37 35.80
Hip adductors (Left) 64.00 (19.8) 72.80 55.20 63.50 (20.2) 72.98 54.02 69.38 (19.8) 78.42 60.34 57.96 (16.1) 65.14 50.77 43.30 (14.6) 49.98 36.63
Hip adductors (Right) 65.48 (19.6) 74.17 56.87 64.94 (19.9) 74.30 55.59 68.56 (17.7) 76.63 60.49 55.50 (14.5) 61.94 49.05 41.53 (15.0) 48.39 34.66
Flexibility (8)
Ankle ROM (Left) 47.53 (5.4) 49.96 45.11 43.70 (7.6) 47.26 40.14 45.18 (8.6) 49.10 41.25 45.85 (7.0) 48.97 42.73 42.63(6.4) 45.56 39.71
Ankle ROM (Right) 47.64(8.4) 51.38 43.91 45.12(7.1) 48.48 41.77 48.51(8.7) 52.47 44.54 46.98(5.5) 49.44 44.52 42.38(7.0) 45.59 39.16
 Balance in men 30–80 years 199

Figure 2. (A) TUG test results across age decades. (B) Number of steps in 15 s for age decades. (C) Functional and lateral reaching distances
for age decades. (D) Reactions times for age decades using the LOS test. *Trend (p 5 0.05), **Significant (p 5 0.01), ***Significant
(p 5 0.001).

Figure 3. (A) Age-related changes in muscle strength. (B) Age-related changes in ankle range of motion. *Trend (p 5 0.05), **Significant
(p 5 0.01), ***Significant (p 5 0.001).

to the left foot. An effect of dominance may have 60s. A further trending reduction was evident by the
been responsible for the different scores between the 70s on both sides. The earlier and more rapid decline
left and right legs, as approximately 98% of the in left FR could be explained by the fact that
subjects tested were right leg dominant (skill leg), approximately 98% of the subjects were right hand
and their left leg was their nominated preferred leg dominant, with right upper limb activity and practice
for stance. Thus an effect of habitual loading may likely to help preserve the functional capacity of
have preserved left leg stance, however, future studies reach. Further investigation of this observation is
are required to substantiate this claim. required.
The outcomes of the FR test of this study LR scores generated by this study support the
reinforced the findings of Duncan et al. [12] and current literature reporting an age-related decline in
demonstrated an age-related decline in FR distance LR distance with advancing age [13]. The results of
in older men. The mean FR scores for our study were the LR test provided evidence of a significant
slightly higher than those reported in a study reduction in distance reached by the 60s on the left,
conducted by Wernick-Robinson et al. [22]. Their with only a trending reduction present on the right
smaller sample of 13 healthy older adults but of for this decade. Again, the effect of right hand
mixed gender probably accounts for the shorter reach dominance could account for the preservation of
distances reported. The findings for the FR test of function evident on the right. Further investigation of
our study demonstrated that there was a significant this observation is warranted as it differs from the
decline in left FR by the 50s and in right FR by the earlier study of older women by Brauer et al. [13]
200 M. Nolan et al.

where limb dominance did not appear to influence stability and function, by demonstrating that there
lateral LOS as no significant difference between the was a delay in gluteus medius activation with
sides was reported. advancing age, and this, in conjunction with other
The reaction time results from the LOS test in this measures was predictive of prospective fallers. For
study revealed that a gradual increase in reaction the left and right hip adductors in our study, trending
time occurred across the mid-life period, with a reductions in strength were present by the 60s, with
significant increase in time to react to a stimulus further trending declines evident by the 70s. This
presenting by the 60s. A further trending increase in study demonstrated that weakness in quadriceps, hip
time to react was evident by the 70s in the forwards abductors and hip adductors is definitive by the 70s,
direction. Significantly slower reaction times were with evidence of earlier reductions in muscle strength
evident in the backwards and left directions in the by the 60s for the quadriceps and hip abductors. The
60s, with a significant increase in reaction time results support the need to target men in the 50- to
present in the right direction in the 70s. While these 70-year age period pre-emptively with interventions
results of this study concur with those of Lord et al. to address the decline in muscle strength that
[16], a different method of testing reaction time was presents with advancing age. The need for pre-
used. In that study [16], a manual switch was used emptive interventions has also been propounded for
with the subject reacting to a stimulus while seated women in the 40–60 year age range [7]. The results
using a hand and foot switch. In the current study of this study also support the critical need for
however, the reaction times were calculated from the strengthening programmes to target muscles con-
speed of response to a stimulus in standing during trolling the medio-lateral plane of movement – the
the LOS test [17]. Irrespective of the test used, hip abductor and adductor muscles – in conjunction
slower reaction times were evident for men in their with the quadriceps muscles, more associated with
60s and 70s. An efficient reaction time should enable the control of movement in the anterior-posterior
an individual to perform well on clinical balance plane [7].
tests, reinforcing the strong linkage between reaction The findings of this study support earlier reports of
time and balance. In accordance with Woollacott reduced ankle range of motion with age in men [28].
[23], our study showed that with age, older adults Loss of ankle joint flexibility may be associated with
demonstrated a longer reaction time, which together functional impairment, predisposing older adults to
with a poor response strategy (activation of proximal falls, however further investigation is necessary to
muscles prior to their distal muscles) could add to determine any association between ankle dorsiflexion
the risk of falls in older adults. Future studies are range, and how this loss of range may contribute to
needed to examine reaction times and neuro-motor falls [18]. Adequate ankle range of motion further
response selection concurrently, as efficient reaction ensures that safe and functional capacity to walk,
times require both attributes. Currently, there is a negotiate stairs and rise from a chair is achieved [18].
shortage of literature linking these elements which There were several limitations of this study. With
reinforces the need for further studies in this area. only approximately 20 men recruited in each age
Our study confirmed that a gradual reduction in decade cohort, it may have been difficult to detect
quadriceps strength presented in men with a sig- earlier changes particularly when multiple variables
nificant reduction in strength evident by the 60s and were entered into the model of analyses. In addition,
further reductions in quadriceps strength in the 70s. a sample of convenience was used to form the subject
These findings provide support for earlier studies pool, which could have influenced our results. A
[24,25] and concur with Borges [26], who showed further weakness of the design was the use of semi-
that an age-related decline in quadriceps strength random test order of testing (tests carried out in no
occurred in men between 60 and 70 years of age. specific order) as opposed to formal randomisation of
While the current study demonstrated a similar tests. Future studies could also examine the relation-
pattern in men, the initial decline in strength was a ship between balance, reaction time, strength and
little later than the reported studies of women [7]. flexibility measures and the measures of balance and
The reduction in hip abductor strength was mobility to determine which elements have more
significantly reduced by the 60s in the right leg, with impact on motor performances.
a further trending reduction in strength presenting by Despite these limitations, this study confirmed a
the 70s. On the left however, the reduction in decline in musculoskeletal function, balance and
strength was not evident until the 70s. This may mobility with age, which was generally definitive by
reflect an effect of leg dominance as approximately the 60s. These reported changes occur before
98% of the subjects tested were right leg dominant attention is usually focussed on the testing of balance
(skill leg), and their left leg was their nominated or underlying causes, or any consideration given to
preferred leg for stance. Thus an effect of habitual pre-emptive strategies to maintain or improve bal-
loading may have had a positive effect on left leg ance performance and motor function [6]. Thus, it is
strength and this observation warrants further in- important to test and report the associations between
vestigation. Brauer et al. [27] investigated the presenting musculoskeletal function and balance and
importance of hip abductor muscle strength to mobility to strengthen the call for pre-emptive
 Balance in men 30–80 years 201

interventions. Due to the incidence and consequence 11. Hill KD, Bernhardt J, McGann AM, Maltese D, Berkovits D.
of falls in the community among older adults, A new test of dynamic standing balance for stroke patients:
reliability, validity and comparison with healthy elderly.
screening methods identifying individuals who pre- Physiother Can 1996;48:257–262.
sent with an increased falls risk is required in order to 12. Duncan PW, Studenski S, Chandler J. Functional reach: a
refer men who may benefit from interventions new clinical measure of balance. J Gerontol 1990;47:M93–
designed to improve balance and decrease falls and M98.
13. Brauer S, Burns Y, Galley P. Lateral reach: a new
risks for falls with age [7]. The areas where decline in
clinical measure of medio-lateral balance. Phys Res Int
the musculoskeletal components of balance were 1999;4:81–88.
identified in our study suggest that pre-emptive 14. Leipzig M, Cumming R, Tinnetti M. Drugs and falls in older
exercise programmes should include strengthening people: a systematic review and meta-analysis: I. Psychtropic
exercises for all lower limb muscle groups as well as Drugs. JAGS 1999;47:30–39.
specific balance training that challenges anticipatory 15. Hirvensalo M, Rantanen T, Heikkinen E. Mobility difficulties
and physical activity as predictors of mortality and loss of
balance control particularly at LOS and includes independence in the community-living older population.
unstable supporting surfaces. JAGS 2000;48:493–498.
16. Lord SR, Menz HB, Tiedemann A. A Physiological profile
Declaration of interest: The authors report no approach to falls risk assessment and prevention. Phys Ther
conflict of interest. The authors alone are responsible 2003;83:237–252.
17. Clark S, Rose DJ, Fujimoto K. Generalizability of the limits of
for the conduct and writing of the paper. stability test in the evaluation of dynamic balance among older
adults. Arch Phys Med Rehabil 1997;78:1078–1084.
References 18. Nitz JC, Low Choy NL. The relationship between ankle
dorsiflexion range, falls and activity level in women aged 40 to
1. Horak FB. Postural orientation and equilibrium: what do we 80 years. N Z J Phys 2004;32:121–125.
need to know about neural control of balance to prevent falls? 19. Shumway-Cook A, Brauer S, Woollacott M. Predicting the
Age Ageing 2006;35(Suppl 2):ii7–ii11. probability for falls in community-dwelling older adults using
2. Lord SR, Lloyd D, Sek Keung LI. Sensori-motor function, the timed up and go test. Phys Ther 2000;80:896–903.
gait patterns and falls in community-dwelling women. Age 20. Steffen TM, Hacker TA, Millinger L. Age and gender-related
Ageing 1996;25:292–299. test performance in community-dwelling elderly people: six-
3. Lord SR, Rogers MW, Howland A, Fitzpatrick R. Lateral minute walk test, berg balance scale, timed up and go test and
stability, sensorimotor function and falls in older people. JAGS gait speeds. Phys Ther 2002;82:128–137.
1999;47:1077–1081. 21. Hughes C, Osman C, Woods AK. Relationship among
4. Morris M, Osborne D, Hill K, Kendig H, Lundgren- performance on stair ambulation, functional reach and
Lindquist B, Browning C, et al. Predisposing factors for Timed Up and Go tests in older adults. Issues Ageing
occasional and multiple falls in older Australians who live a 1998;21:18–22.
home. Aust J Phys 2004;50:153–159. 22. Wernick-Robinson M, Krebs D, Giorgetti MM. Functional
5. Iverson BD, Gossman MR, Shaddeau S, Tuner ME. Balance reach: does it really measure dynamic balance. Arch Phys Med
performance, force production and activity levels in non- Rehabil 1999;80:262–269.
institutionalised men 60 to 90 years of age. Phys Ther 23. Woollacott MA. Systems contributing to balance disorders in
1990;70:348–355. older adults. J Gerontol Med Sci 2000;55A:M424–M428.
6. Isles RC, Low Choy NL, Steer M, Nitz JC. Normal values 24. Danneskiold-Samsoe B, Kofod V, Munter J, Grimby G,
of balance tests in women aged 20–80. JAGS 2004;52:1367– Schnohr P, Jensen G. Muscle strength and functional capacity
1372. in 78–81 year old men and women. Eur J Appl Physiol
7. Low Choy NL, Brauer SG, Nitz JC. Age-related changes in 1984;52:310–314.
strength and somatosenstaion during midlife rationale for 25. Hughes VA, Frontera WR, Wood M. Longitudinal muscle
targeted preventive intervention programs. Ann N Y Acad Sci strength changes in older adults: Influence of muscle mass,
2007;1114:180–193. physical activity and health. J Gerontol A – Biol Sci Med Sci
8. Hurley M, Rees J, Newham D. Quadriceps function, 2001;56A:209–217.
proprioceptive acuity and functional performance in healthy 26. Borges O. Isometric and isokinetic knee extension and flexion
young, middle-aged and elderly subjects. Age Ageing torque in men and women aged 20–70. Scand J Rehbil Med
1998;27:55–67. 1989; 21:45–53.
9. Bohannon RW. Comfortable and maximum walking speed of 27. Brauer S, Burns Y, Galley P. A prospective study of laboratory
adults aged 20–79 years: reference values and determinants. and clinical measures of postural stability to predict commu-
Age Ageing 1997;26:15–19. nity dwelling fallers. J Gerontol Med Sci 2000;55A:M467–
10. Podsiadlo D, Richardson S. The timed ‘Up and Go’: a test M476.
of basic functional mobility for frail persons. JAGS 1991;39:142– 28. Vandervoort A. Ankle mobility and postural stability. Phy-
148. siotherapy Theory and Practice 1999;15:91–103.