Abstract

Objective: This study aims to investigate how the use of a walking stick affects lower limb muscle strength and gait performance in elderly individuals.

Participants: The research subjects were elderly residents aged 55 and above from indigenous tribes in Taitung, Taiwan.

Design: The subjects participated in a 12-week walking stick program, conducted twice per week, with each session lasting 120 minutes. Data were collected before and after the intervention, utilizing assessments of lower limb muscle strength, dynamic balance, and gait analysis.

Measurements: A sample t-test was conducted to compare pre- and post-test data.

Results: The results indicated a significant improvement trend in lower limb muscle strength, dynamic balance, and gait performance following the intervention. These findings suggest that elderly individuals can enhance lower limb strength and improve walking performance through progressive sit-to-stand exercises.

Conclusions: Increasing stride length and maintaining continuous walking may contribute to delaying the aging process.

Keywords: Chair sit, Dynamic Balance

Background

Aging leads to the gradual deterioration of organ function, resulting in reduced physical ability, impaired balance, decreased vision, and muscle weakness. Physiological changes can significantly impact activities of daily life. Decline in lower limb muscle strength can cause instability and increased fall risk due to unsteady gait. Previous fall experiences often instill fear and reduce confidence in walking, leading many elderly individuals to adopt a sedentary lifestyle or rely on mobility aides to minimize fall risks. A sedentary lifestyle exacerbates physical decline, with muscle deterioration being a primary contributor to disability among the elderly [1]. Excessive sedentary behavior is associated with increased all-cause mortality and reduced life expectancy [2]. Reduced physical activity accelerates functional decline, further heightening the risk of falls. Therefore, strengthening balance and lower limb muscle training is crucial for maintaining gait stability and walking speed [3,4].

Elderly individuals typically prioritize balance over speed during walking, resulting in slower walking speed, reduced step frequency, shorter step length, and prolonged double support phases to enhance stability and mitigate fall risk [5]. Identifying high-risk elderly individuals through gait assessments and providing fall prevention education and exercise programs are key strategies for reducing fall incidence [6]. A. Shumway-Cook et al., [7]. It is also said that elderly people with unstable gait usually have poor lower limb muscle strength and flexibility. There is a high correlation between balance and gait. From this we can see that the better the dynamic balance ability, the more stable the center of gravity transfer will be, the larger the stride or the faster the step frequency can be, and the better the gait of the elderly will be [8].

Nordic walking, which involves the use of walking poles, has gained popularity due to its ability to redistribute body weight across four points of support, thereby reducing strain on the spine, lower limb joints, and lumbar region [9,10]. Whether standing, walking, running, etc., you need good balance [11]. Therefore, it greatly improves the sense of security and balance of the elderly and reduces the risk of falling while walking.

Compared to conventional walking aids, walking sticks promotes better posture, balance, and gait stability. Research indicates that long-term Nordic walking training improves upper and lower limb strength, endurance, cardiopulmonary function, flexibility, balance, walking distance, and gait stability [12].

While Nordic walking benefits elderly individuals with relatively intact mobility, its applicability to frail or mobility-impaired individuals remains uncertain. Because walking requires standing on both feet for a long time, it is more difficult for people with lower limb weakness and sub-healthy people. This study explores the effectiveness of a modified bamboo walking sticks program, as promoted by Dr. Guo Jian in Taiwan [13]. Unlike Nordic walking, which may be unsuitable for frail elderly individuals, this program focuses on stationary training movements utilizing two poles to create a safe closed kinetic chain exercise pattern. This approach is particularly beneficial for elderly individuals with mobility impairments or chronic conditions. The study aims to assess the impact of a 12-week walking sticks intervention on lower limb strength, dynamic balance, and gait performance.

Purpose

This study examines the effects of a 12-week walking sticks exercise program on lower limb strength, dynamic balance, and gait performance in elderly individuals aged 55 and above from two indigenous tribes in Taitung, Taiwan. Participants attended one 120-minute session per week throughout the study period.

Methods

Participants

The subjects of this study are the elders from Taitung aboriginal tribes who have been registered at the Cultural Health Center. According to regulations, the senior citizen of a tribe is 55 years old or above. Selected 2 tribes for course intervention, totaling 42 people. Following the 12-week intervention, 31 participants (21females and 10males) completed both Paired Samples T-Test. The mean age was 75.87 ± 8.89 years, with the following age distribution: 55-59 years (n=2), 60-64 years (n=1), 65-69 years (n=4), 70-74 years (n=6), 75- 79 years (n=7), and 80+ years (n=11). (Table.1)

Table 1: Add basic information of research subjects

Research Instruments

1. Lower Limb Assessment: 30-second sit-to-stand test (lower limb muscle strength) 2.44-meter timed up-and-go test (dynamic balance).

2. Gait analysis: Based on the gait phase definitions outlined by A. Khard et al., [14]. Four gait parameters were recorded: walking speed, stride length, stride frequency, and step length.

Results

1. Effects on Lower Limb Muscle Strength

Post-test results showed significant improvements in both the 30-second sit-to-stand test and the 2.44-meter timed up-and-go test (p< .05)(Table.2), indicating enhanced lower limb muscle strength following the 12-week intervention. These findings align with previous studies [15-17]. Confirming the effectiveness of walking sticks in strengthening lower limbs.

The results of this study confirmed that lower limb training, whether continuous walking or partial lower limb training on a chair, Although most current studies use Nordic walking as an example, most elderly people in Taiwan are in sub-health conditions, so using a cane is a good training method in the early stages.

Table 2: Lower limb muscle strength before and after test results

2. Effects on Gait Performance

Post-test results demonstrated significant improvements in walking speed, stride length, and step length (p< .05)( Table.3), Only the stride frequency is not significant. These findings are partially consistent with previous studies [8,18-21].

After 12 weeks of brisk walking training, there was a significant improvement in stride length and walking speed. Although stride frequency remained stable, participants exhibited improved walking speed and stride length, indicating enhanced mobility without an increase in step frequency. Although there was no significant difference in stride frequency, the elderly showed better walking speed and stride length at the same stride frequency. It has been shown that elderly people who have used walking sticks for 12 weeks have better mobility.

Table 3: Gait test results before and after

Conclusion

1. The walking sticks Intervention with walking sticks can significantly improve the lower limb muscle strength and dynamic balance ability of the elderly.

2. The intervention of walking sticks exercise improved the walking speed, stride length and step length of the elderly; There was no improvement in stride frequency.

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