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Acute Effects of Muscle Fatigue on Anticipatory and Reactive Postural Control in Older Individuals: A Systematic Review of the Evidence

Papa, Evan V. PT, DPT, PhD, MA1; Garg, Hina PT, MS2; Dibble, Leland E. PT, PhD, ATC2

Journal of Geriatric Physical Therapy: January/March 2015 - Volume 38 - Issue 1 - p 40–48
doi: 10.1519/JPT.0000000000000026
Systematic Reviews

Background: Falls are the leading cause of traumatic brain injury and fractures and the No. 1 cause of emergency department visits by older adults. Although declines in muscle strength and sensory function contribute to increased falls in older adults, skeletal muscle fatigue is often overlooked as an additional contributor to fall risk. In an effort to increase awareness of the detrimental effects of skeletal muscle fatigue on postural control, we sought to systematically review research studies examining this issue.

Purpose: The specific purpose of this review was to provide a detailed assessment of how anticipatory and reactive postural control tasks are influenced by acute muscle fatigue in healthy older individuals.

Methods: An extensive search was performed using the CINAHL, Scopus, PubMed, SPORTDiscus, and AgeLine databases for the period from inception of each database to June 2013. This systematic review used standardized search criteria and quality assessments via the American Academy for Cerebral Palsy and Developmental Medicine Methodology to Develop Systematic Reviews of Treatment Interventions (2008 version, revision 1.2, AACPDM, Milwaukee, Wisconsin).

Results: A total of 334 citations were found. Six studies were selected for inclusion, whereas 328 studies were excluded from the analytical review. The majority of articles (5 of 6) utilized reactive postural control paradigms. All studies incorporated extrinsic measures of muscle fatigue, such as declines in maximal voluntary contraction or available active range of motion. The most common biomechanical postural control task outcomes were spatial measures, temporal measures, and end-points of lower extremity joint kinetics.

Conclusion: On the basis of systematic review of relevant literature, it appears that muscle fatigue induces clear deteriorations in reactive postural control. A paucity of high-quality studies examining anticipatory postural control supports the need for further research in this area. These results should serve to heighten awareness regarding the potential negative effects of acute muscle fatigue on postural control and support the examination of muscle endurance training as a fall risk intervention in future studies.

1Department of Physical Therapy, University of North Texas Health Science Center, Fort Worth.

2Department of Physical Therapy, University of Utah, Salt Lake City.

Address correspondence to: Evan V. Papa, DPT, PhD, MA, Department of Physical Therapy, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, MET 533, Fort Worth, TX 76107 (

Conflicts of interest and source of funding: none declared.

Richard Bohannon was the Decision Editor.

Copyright © 2015 the Section on Geriatrics of the American Physical Therapy Association
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