Journal of Electromyography and Kinesiology 21 (2011) 512–518

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Journal of Electromyography and Kinesiology

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Mini-trampoline exercise related to mechanisms of dynamic stability improves

the ability to regain balance in elderly
Fernando Amâncio Aragão a,c, Kiros Karamanidis b, Marco Aurélio Vaz c, Adamantios Arampatzis d,e,⇑
a
Department of Physical Therapy, Balance and Movement Research Laboratory, State University of West of Paraná, Brazil
b
Institute of Biomechanics and Orthopedics, German Sport University Cologne, Germany
c
Exercise Research Laboratory, Federal University of Rio Grande do Sul, Brazil
d
Department of Training and Movement Sciences, Humboldt University Berlin, Germany
e
Centre of Sport Science and Sport Medicine Berlin (CSSB), Germany

a r t i c l e i n f o a b s t r a c t

Article history: Falls have been described by several studies as the major cause of hip and femur fractures among the
Received 28 August 2010 elderly. Therefore, interventions to reduce fall risks, improve dynamic stability and the falling recovery
Received in revised form 8 January 2011 strategies in the elderly population are highly relevant. This study aimed at investigating the effects of
Accepted 9 January 2011
a 14-week mini-trampoline exercise intervention regarding the mechanisms of dynamic stability on
elderly balance ability during sudden forward falls. Twenty-two elderly subjects participated on mini-
trampoline training and 12 subjects were taken as controls. The subjects of the experimental group were
Keywords:
Training
evaluated before and after the 14-week trampoline training (exercised group), whereas control subjects
Dynamic stability were evaluated twice in the forward fall task with a three-month interval. The applied exercise interven-
Muscle strength tion increased the plantarflexors muscle strength (10%) as well as the ability to regain balance during
Falls the forward falls (35%). The 14-week mini-trampoline training intervention increased elderly abilities
Aging to recover balance during forward falls; the improvement was attributed to the higher rate of hip
moment generation.
Ó 2011 Elsevier Ltd. All rights reserved.

1. Introduction
Falls have been described as the major cause of hip and femur
fractures among the elderly population (Masud and Morris,
2001). Thirty percent of elderly over 65 years of age fall at least
once a year, and about half of these persist with recurrent fall
events (Tinetti and Speechley, 1989), not rarely resulting in death
due to the complications that follow-up after these falls (Kannus
et al., 2005). In the event of stability loss, balance recovery to a sta-
ble upright stance position is usually obtained by taking one or
more steps (Maki et al., 2003). Most of the falls occurrences happen
when stability is lost in the forward direction (Blake et al., 1988).
Elderly are less able than young adults to recover balance through
stepping, apparently due to reductions in both step length and
speed (Karamanidis et al., 2008; Thelen et al., 1997; Wojcik et al.,
2001).
The mechanisms that determine the stepping reactions to re-
store a stable upright stance position following balance loss have
not been fully determined (Hsiao-Wecksler and Robinovitch,
1999). Based on the equations of motion of the inverted pendulum
⇑ Corresponding author at: Department of Training and Movement Sciences,
Humboldt University Berlin, Germany.
E-mail address: a.arampatzis@hu-berlin.de (A. Arampatzis).
model (Hof, 2008; Hof et al., 2005) as well as on the equations of a
multi segment model (Hof, 2007), there are three mechanisms
from a mechanical point of view by which the stability may be
maintained after a postural perturbation: (a) by increasing the base
of support (BS), (b) by counter-rotating segments around the cen-
tre of mass (CM) and (c) by applying an external force other than
the ground reaction force (i.e. grasping). Those mechanisms are
responsible for maintaining dynamic stability after unpredicted
instability and should be the most important components to be fo-
cused in exercise interventions targeting at dynamic stability
improvement and fall prevention. Exercise programs with strong
dynamic component have been found to be an effective way to im-
prove dynamic stability in old age (Campbell et al., 1999; Lord
et al., 2003), however, as far as we know, no intervention was
planned and carried out exploring the three mechanisms responsi-
ble for dynamic stability (Hof, 2007, 2008; Hof et al., 2005) after a
perturbation, what could contribute to determine more effective
interventions to prevent falls in the elderly.
Karamanidis et al. (2008) reported that the effective use of
mechanisms responsible for dynamic stability related to muscle
strength and tendon stiffness of the lower extremities muscle–ten-
don-units. Despite the lack of conclusive studies, the exercise on
mini-trampoline may require high demands of the muscles of the
lower extremities (Crowther et al., 2007; Heitkamp et al., 2001).

1050-6411/$ - see front matter Ó 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jelekin.2011.01.003
 F.A. Aragão et al. / Journal of Electromyography and Kinesiology 21 (2011) 512–518
Therefore we can argue that mini-trampoline exercise in old adults
would be an adequate training stimulus increasing muscle
strength.
However, mini-trampoline exercises consist of a multi compo-
nent approach which are likely to affect many other physical fac-
tors other than strength, such as body stability, muscle
coordinative responses, joint movement amplitudes and spatial
integration. New unfamiliar training exercises are initially associ-
ated with some inefficient accompanying movements. These ef-
fects are suppressed by facilitations, and the movement patterns
become more efficient through neural adaptation expressed by
improvement in intramuscular and intermuscular coordination.
In this direction Heitkamp et al. (2001) showed that a balance
training circuit including the mini-trampoline station improved
not only balance and strength but also was effective in the equal-
ization of muscular imbalances between the two limbs. In contrast,
no studies were done to identify specific contributions brought by
mini-trampoline exercise as a different training model approach,
such interventions still need further elucidation.
Nonetheless, we can hypothesize that a pre-planned exercise
protocol on mini-trampoline involving the mechanisms by which
the stability may be maintained after a postural perturbation
might additionally improve the effectiveness of elderly people to
use these mechanisms increasing the ability to regain balance after
a perturbation. Therefore, the objective of the current study was to
investigate the effects of a 14-week mini-trampoline exercise
intervention including the mechanism responsible for dynamic
stability on the ability of elderly participants to regain balance
after an induced forward fall.
2. Methods
2.1. Experimental design
Twenty-one elderly subjects, five males and 16 females
(67 ± 4 years) participated on a mini-trampoline training after
signing an informed consent form. The experiment was approved
by the ethics commission of the German Sport University Cologne.
Subjects with orthopedic or neurologic disabilities and that were
using any prescribed medication which could direct influence abil-
ity to perform balance tests were excluded from the study. Twelve
additional elderly subjects, seven males and five females
(68 ± 3 years) were selected as a control group. These subjects
did not engage in any regular physical activity for 3 months and
were subjected to the same procedures as the training group ex-
cept for the 14-week trampoline training.
The ability of the participants to regain balance after a perturba-
tion has been examined using the simulated forward fall condition
(Madigan and Lloyd, 2005; Wojcik et al., 1999). The experimental
design of the forward fall task has been previously described
(Karamanidis and Arampatzis, 2007). Briefly, subjects were re-
leased suddenly without warning from a fixed forward-inclined
position. The participants were initially maintained in an inclined
forward posture by a horizontal inextensible cable, attached at
one end of the belt worn by the subjects around the pelvis and
at the other end to a custom-built pneumatic release system. Sub-
jects were instructed and encouraged to restore balance by taking
a single step after forward fall was initiated. All participants wore a
full trunk safety harness suspended for an overhead track that al-
lowed all forward and lateral motions and prevented contact of
any body part other than the feet with the ground. The angle of
the forward lean was controlled adjusting the lean control cable
length until the load cell attached to the cable indicated that it sup-
ported a specified percentage of the subject’s body weight (BW).
Before starting the tasks, three ‘‘practice’’ trials at 10 ± 3% BW were
513
performed at which the time of release was known to the subjects,
familiarizing them with the experimental protocol. A trial was de-
fined as a single-step behavior if only one step was taken or if the
anterior displacement of the second step (contralateral limb) did
not exceed the anterior displacement of the recovery limb (visual
control of the kinematic data). A multiple-step behavior was de-
fined when the subject took a second step of the recovery limb
of any kind or when the subject took a contralateral step whose
anterior displacement exceeded that of the recovery limb.
During the task the forward lean angle was adjusted to start
from approximately 8–10% BW. Once the subject was able to suc-
cessfully perform the task with a single step throughout three at-
tempts, the lean inclination angle was increased based on the
subject’s resistance force applied to the cable that was progres-
sively increased by 2–3% of BW. The task was performed until
the subject could not manage to maintain a single step after the
forward release, requiring a multiple step behavior to recover
stability.
2.2. Measurement of recovery mechanics
At the beginning of each trial, the subject stood barefoot on a
force plate (60 cm  90 cm, Kistler, Winterhur, Switzerland). The
first step always landed on a second force plate (60 cm  90 cm,
Kistler, Winterhur, Switzerland) mounted in front of the initial
force plate. The ground reaction forces were collected at a sam-
pling rate of 1080 Hz. To determine the onset of release, the pneu-
matic release system triggered a TTL signal at the instant of release
which was simultaneously captured as an analogue signal by a Vi-
con motion capture system (1080 Hz, Model 624, Vicon, Oxford,
UK). Kinematic data were recorded with 14 Vicon cameras operat-
ing at 120 Hz. Twenty-one reflective markers (diameter of 14 mm)
were used to track the body kinematics. The markers were placed
to define the head, trunk, left and right forearm, left and right arm,
left and right thigh, pelvis, left and right lower leg and left and right
foot, as follows: four marker head strap, one marker on the spinous
process of C7 vertebra and bilateral markers at shoulder acromion,
umeral lateral epicondilus, ulnar styloid process, anterior superior
iliac spine, femoral trochanter, femoral lateral epicondyle, lateral
malleolus of tibia and between the head of the 1st metatarsal
and the toe proximal falange. A body model was used to calculate
knee and hip joint angles, the parameters of dynamic stability and
the resultant joint moments through inverse dynamics. The data
provided by Zatsiorsky and Seluyanov (1983) was used to calculate
masses and moments of inertia of the body segments.
For each trial, three time points were defined: (A) subjects re-
lease (determined by the analogue signal that the Vicon motion
capture system received from the pneumatic release system); (B)
touchdown of the recovery limb (determined by the ground reac-
tion force data – threshold level 20 N); and (C) first minimum knee
joint angle of the recovery limb after touchdown. Time point (C)
indicated termination of downwards motion of the body (where
vertical CM velocity is zero). Further, recovery step task was di-
vided into two phases, based on the identified time points
(Fig. 1): (1) phase until touchdown (defined from subject’s release
until touchdown of the recovery limb) and (2) main stance phase
(defined from touchdown until the first minimum knee angle of
the recovery limb).
To recognize the state of the dynamic stability during the for-
ward falls we used the ‘‘extrapolated center of mass’’ concept for-
mulated by Hof et al. (2005) (Fig. 1). The concept is based on the
inverted pendulum model of balance during a dynamic situation
(i.e. CM has an initial horizontal velocity). In a static situation
(i.e. CM velocity zero) the condition for balance requires the verti-
cal projection of the CM to be within the base of support. However
during dynamical situations this condition is not sufficient and the
514 F.A. Aragão et al. / Journal of Electromyography and Kinesiology 21 (2011) 512–518

Release TD KJAmin 2.3. Mini-trampoline training intervention

160
stable
Uxmax The training intervention was applied in the training group for
140
14 weeks, twice a week, during 90-min sessions. Training sessions
120 were always prepared in small training groups of 4–7 subjects.
XCM Each session had a 10-min warm up and at least three pause inter-
100 PxCM vals depending on subject’s requirements. To participate in the
(cm)

80 training all subjects were instructed to check up their health con-

dition and additionally have medical doctor consent to participate
60 in a regular sport activity of moderate intensity on mini-
40 trampolines.
toeproj. The mini-trampoline training was always attended by an expe-
20 rienced physical therapist and should follow criteria such as: re-
spect everyone’s physical capacities; increase exercises
0
difficulties once the subjects could practice, learn and adapt; fol-
0 150 300 450 600 750 900
(ms) low an exercise philosophy where the mechanisms responsible
for dynamic stability were included and focus on sessions that re-
Fig. 1. Representation curves of a stable recovery during the forward fall task. quired both a dynamic training and were attractive to the subjects
Anteroposterior boundary of the base of support (Ux max), horizontal component of where they could socialize and enjoy.
the projection of the toe from the recovery limb to the ground (toeProj.), horizontal
Therefore, the exercises in the sessions were created concen-
component of the vertical projection of the centre of mass to the ground (PxCM) and
the extrapolated centre of mass (XCM) during the recovery task of a single step. The trating on movements where the participants should react with
zero value in the vertical axis represents the initial position (before release) of the counter rotation of segments and stimulating fast and large step
horizontal component of the vertical projection of the toe from the recovery limb to reactions, training the increase in the base of support in order to
the ground. TD, touchdown; KJAmin, first minimum at the knee joint angle of the adapt to the mini-trampoline unstable surface and regain stability.
recovery limb after TD.
Table 1 brings an overview of some basic movements performed
during the training intervention in relation to the stability mecha-
nisms required.
The basic exercise movements performed on the sessions (see
velocity of the CM has to be accounted for (Hof et al., 2005). Hof
Table 1) had diverse additional derivations along the intervention
et al. (2005) introduced the ‘‘extrapolated center of mass’’ a quan-
period, incorporating to the basic movement new challenging
tity which includes the position of CM, the velocity of CM and the
and attractive conditions ranging from the inclusion of several
eigen frequency of the inverted pendulum. For a dynamic situation
types of group games to circuit tasks and individual exercises. In
the system is stable if the extrapolated CM (i.e. extrapolated CM
addition, to create complex activities, different kinds of assistance
trajectory in the direction of its velocity) is within the base of sup-
equipments were used such as balls (i.e. therapeutic balls, tennis
port. The margin of stability in the anteroposterior direction was
calculated as follows:
Table 1
bx ¼ U xmax  X CM Examples of exercise movements and the stability mechanisms involved.

where bx is the margin of stability in the anteroposterior direc- Basic exercise performed on the mini-trampoline Included
mechanism
tion, Uxmax is the anterior boundary of the base of support and
XCM is the extrapolated CM in the anteroposterior direction Hopping on place 1, 2
  Hopping with rotation 1, 2
VxCM
X CM ¼ PxCM þ p ffiffiffiffiffi . PxCM is the horizontal (anteroposterior) Hopping opening and closing legs (adduction and 1
g=l
abduction)
component of the vertical projection of the CM to the ground, Hopping with alternate front and back leg movements 1
VxCM is the horizontal (anteroposterior) CM velocity, g is acceler- Front and back jumps with both feet joined 2
ation of gravity, and l is the distance between CM and centre of Front and back jumps with both feet joined with rotation 2
Lateral jumps with both feet joined with rotation 2
ankle joint in the sagittal plane. Postural stability is maintained in One foot jump 2
circumstances where the position of the extrapolated CM is with- One foot jump with front and back displacement 2
in the base of support (positive values of margin of stability), Quiet stand with one foot support 2
while stability is lost in cases where the extrapolated CM passes Quiet stand with feet in line (one just behind the other) 2
Jump into different mini-trampolines 1, 2
the anterior boundary of the base of support during stance phase
Association of different jump patterns with ball throwing 1, 2
(negative values of margin of stability). Hopping and playing tennis with rackets 1, 2
The margin of stability at release is directly related to the sub- Hopping and control an air balloon with the hand 1, 2
ject leaning angle and was determined in the anteroposterior Walk over different trampolines controlling the air balloon 1, 2
direction because after a forward fall both the extrapolated CM Kick a ball while hopping 1, 2
Quiet stance with closed eyes 2
and the base of support shifts in the anterior direction. The reaction Running over several trampolines 1, 2
time was defined as the time from moment of release to the mo- Running on place 1, 2
ment the midpoint of the foot exceeded an acceleration of 1.5 m/s2. Upright stance, explore the maximal CM projection (body 2
At the time of release, the forward lean angle determines a clear inclination) with no change in the BS.
Simulation of big step reactions between two mini- 1
unstable position (negative values of margin of stability), that was
trampolines
increasing once the subject was able to regain balance with a single Hopping among different mini-trampolines inclinations 1, 2
step. The capacity to regain balance after the induced forward fall Hopping among different mini-trampoline heights 1, 2
was evaluated during the fall, concerning the most negative mar-
Description of basic exercises performed on mini-trampoline during the period of
gin of stability the subjects had at the time of release in which they the intervention with regard to the dynamic stability mechanism involved. The
were able to regain balance (positive values of margin of stability) numbers indicate the main mechanism involved in the exercise execution
at touchdown. (1 = increase in BS; 2 = counter rotation of segments).
 F.A. Aragão et al. / Journal of Electromyography and Kinesiology 21 (2011) 512–518 515

balls, soccer balls and medicine balls), balloons, sticks, rackets and post = 77.6 ± 12.6 kg; exercised: pre = 76.7 ± 13.3 kg, post = 76.8 ±
elastic bands always with the subjects training on the mini-tram- 13.2 kg). No difference was found in the knee extensors maximal
polines that were positioned either in series or in parallel set-ups. isometric voluntary contraction in the exercised group: pre
The training was accomplished with different types of mini- 168.6 ± 40.8 Nm; post = 171.7 ± 39.8 Nm (P > 0.05); however, the
trampolines, four 90 cm spring steel trampolines model TrimilinÒ ankle plantarflexors moment increased after the 14-week mini-
Med (30–110 kg load capacity; Heymans GmbH and CO., trampoline training: pre = 141.9 ± 28.2 Nm; post = 155 ± 32.5 Nm
Dünzelbach, Germany) and five 120 cm highly elastic mini-trampo- (P 6 0.05).
lines with single-rubber rope-suspension model Trimilin Swing Margin of stability at release for the exercised group showed
(10–100 kg load capacity; Heymans GmbH and CO., Dünzelbach, significant (P 6 0.05) lower values after the intervention; exercised
Germany). group: pre = 14.1 ± 4.3 cm; post = 19.1 ± 5.1 cm; control group:
To examine muscle strength potential of the knee-extensor and pre = 17.4 ± 7.8 cm; post = 18.6 ± 8.0 cm, demonstrating a bet-
ankle plantarflexor Muscle Tendon Units (MTU), the participants of ter ability of the participants to regain balance after the induced
the exercised group performed maximal isometric voluntary ankle falls (i.e. they were able to recover from a lesser margin of stability
plantarflexion and knee extension contractions on a dynamometer or a more inclined position). The control group did not show signif-
(Biodex Medical Systems. Inc., Shirley, NY, USA) before and after icant difference in the margin of stability at release between the
the intervention. The maximal isometric voluntary contractions pre–post comparisons, indicating no performance improvements
(MIVC) were filmed by 13 Vicon cameras operating at 120 Hz to in the simulated forward falls after the 14 weeks. No differences
calculate the kinematics of the joint angles during contractions. were found for the control as well as for the exercised group in
The method for calculating the resultant joint moments has been the components of dynamic stability at touchdown when compar-
previously described in detailed (Arampatzis et al., 2004, 2005). In ison was made between pre- and post-exercise measurements
resume, the resultant joint moment explores at which angle occurs (P > 0.05) (Table 2). The experimental group demonstrated faster
the MIVC peak. Based on torque–angle relation curve, the subjects recovery steps during the phase until touchdown due to a decrease
perform the MIVC’s in three angles around the optimal joint angle in the duration until touchdown after the intervention (Table 2).
(ankle angle: 85°, knee angle 120°). This means for ankle plantar- The reaction time as well as the maximum hip flexion moment
flexors 90°, 85° and 80° (90° ankle angle: foot vertical to tibia) and for of the recovery limb during the phase until touchdown did not
knee extensors 125°, 120° and 115° (180° knee angle: full extended show any differences (P > 0.05) before and after the intervention
knee). The calculation of the resultant joint moments takes into con- in the experimental group (Table 2). However, the time until the
sideration the misalignments of the joint axis related to the dyna- maximum of the hip flexion moment decreased and the rate of
mometer that occur during MIVC and also due to the seat and hip moment generation during the phase until touchdown in-
tissue compliances. In addition, the effect of moments arising from creased significantly (P 6 0.05) after the intervention in the exper-
antagonistic muscles during the ankle plantarflexion and knee imental group (Table 2 and Fig. 2). The control group did not show
extension efforts on the resultant joint moment were taken into ac- any significant differences in all above mentioned parameters (Ta-
count using the method also described previously (Mademli et al., ble 2 and Fig. 2).
2004). Therefore, in the following text maximal knee and ankle joint In both groups we analyzed only the trials with the lower mar-
moments refers to the maximal joint moment values where the ef- gin of stability at release (i.e. the maximal inclined position) in
fect of the joint axis alteration relative to the dynamometer axis,
gravitational effects and the effect of antagonist moment on the Table 2
measured moment were taken into account. Reaction time, duration from release to touchdown, dynamic stability parameters at
touchdown and resultant hip joint moment parameters in the phase from release to
touchdown.
2.4. Statistics Control (n = 12) Exercised (n = 21)
Pre Post Pre Post
A paired t-test for dependent samples was used to identify pos-
sible differences within groups on the anthropometrical, muscle Reaction time (ms) 145 ± 34 132 ± 21 123 ± 31 119 ± 20
Duration until TD (ms) 491 ± 44 481 ± 42 494 ± 50 475 ± 44*
strength, in temporal and kinetic data of the components of the dy- Boundary BS (cm) 93.8 ± 12.3 95.8 ± 16.7 95.7 ± 6.9 98.7 ± 10.9
namic stability (anterior boundary of the base of support, position Extrapolated CM (cm) 88.2 ± 13.2 90.0 ± 17.5 91.2 ± 8.3 95.6 ± 11.0
of the extrapolated CM, horizontal component of the projection of Projection CM (cm) 53.9 ± 10.5 55.2 ± 12.8 52.8 ± 6.1 56.4 ± 8.2
the CM to the ground, horizontal CM velocity, minimum knee an- Horizontal VCM (m/s) 1.20 ± 0.19 1.20 ± 0.21 1.30 ± 0.14 1.34 ± 0.13
pffiffiffiffiffiffiffi
Term g=l (s1) 3.49 ± 0.16 3.46 ± 0.13 3.40 ± 0.06 3.42 ± 0.06
gle, duration from releasep toffiffiffiffiffiffi
touchdown,
ffi push-off force of the sup-
Margin of stability at 5.7 ± 5.2 5.8 ± 4.4 4.4 ± 3.9 3.1 ± 3.8
port limb and the term g=l) and on the margin of stability at
TD (cm)
release, at touchdown and at the end of the main stance phase. Max hip moment 1.31 ± 0.29 1.26 ± 0.25 1.25 ± 0.23 1.28 ± 0.26
In addition, an unpaired t-test for independent samples was car- (Nm/kg)
ried out to verify differences between groups (comparison of the Time to max hip 230 ± 42 218 ± 43 225 ± 37 195 ± 35*
moment (ms)
Post/Pre ratio) for all dynamic stability variables as well as to
Rate h moment 4.9 ± 1.0 4.9 ± 1.3 4.9 ± 1.7 5.6 ± 1.7*
examine differences between groups at the beginning of the exper- generation
iment. The level of significance for all statistical comparisons was (Nm/kg*s)
set at P 6 0.05.
Mean ± SD of reaction time, duration until touchdown (duration until TD), rate in
the increase of base of support from release to touchdown (rate of BS increase),
anterior boundary of the base of support (boundary BS), position of the extrapolated
3. Results
centre of mass (extrapolated CM), horizontal component of the projection of the
centre of mass to the ground (projection
pffiffiffiffiffiffiffi CM), horizontal velocity of the centre of
The trained group had a smaller reaction time at the beginning mass (horizontal VCM) and term g=l (g: acceleration of gravity; l: distance between
of the study compared to the control group (trained = 123 ± 21 ms, the centre of mass and centre of the ankle joint) at the instant of touchdown;
margin of stability at touchdown (margin of stability at TD), maximal hip moment
control = 145 ± 34 ms; P 6 0.05). There were no differences be-
(max hip moment), time to achieve the maximal hip moment (time to max hip
tween groups concerning all other variables at the beginning of moment), rate of hip moment generation (rate h moment generation).
the study. No differences (P > 0.05) were found between pre and *
Statistically significant differences between pre and post training measurements
post body mass measurements (control: pre = 77.9 ± 13.2 kg, for exercised group.
516 F.A. Aragão et al. / Journal of Electromyography and Kinesiology 21 (2011) 512–518

Release TD END Release TD END

2 2
Flexion Pre Flexion Pre
Post Post
1 1
Hip (Nm/kg)

Hip (Nm/kg)
0 0

-1 -1

-2 -2
Extension Extension
0 200 400 600 800 0 200 400 600 800
Time (ms) Time (ms)

Fig. 2. Mean and SE curves of the sagittal plane joint moments (internal) of the hip joints of the recovery leg from release until 800 ms, before and after the intervention (left:
control group, right: exercised group). TD: touchdown, END: end of the main phase.

Table 3 1.8
Dynamic stability parameters at the end of the main stance phase, duration of the Control
main stance phase and ground reaction force parameters within the main stance
phase. 1.6
* Exercised

Ratio (post/pre values)

Control (n = 12) Exercised (n = 21)
Pre Post Pre Post 1.4 *
Boundary BS (cm) 94.7 ± 12.5 97.2 ± 17.3 96.4 ± 6,7 99.7 ± 10.9
Extrapolated CM (cm) 84.6 ± 11.5 84.8 ± 16.5 88.2 ± 8.7 91.6 ± 10.1
Projection CM (cm) 64.7 ± 10.6 64.8 ± 13.4 63.4 ± 5.3 66.6 ± 8.8 1.2
Horizontal VCM (m/s) 0.7 ± 0.18 0.64 ± 0.20 0.85 ± 0.25 0.86 ± 0.22
pffiffiffiffiffiffiffi
Term g=l (s1) 3.5 ± 0.17 3.5 ± 0.14 3.4 ± 0.06 3.4 ± 0.06
Margin of stabilityend 0.10 ± 0.06 0.12 ± 0.06 0.08 ± 0.05 0.08 ± 0.05 1.0
(m)
Duration main stance 155 ± 63 157 ± 60 138 ± 56 128 ± 40
phase (ms) 0.8
Average forceVertical 12.2 ± 2.6 12.5 ± 2.4 12.4 ± 2.4 14.0 ± 2.8* bx release RMG-hip
(N/kg)
Average forceHorizontal 4.2 ± 2.0 4.4 ± 1.6 4.0 ± 1.2 4.7 ± 1.5* Fig. 3. Ratio (post to pre-intervention values) of the margin of stability at release
(N/kg) (bx release) and rate of hip moment generation (RMG-hip), in the phase until
touchdown. ⁄ Statistically significant differences between exercised and control
Mean (SD) of the anterior boundary of base of support (boundary BS), position of groups.
the extrapolated centre of mass (extrapolated CM), horizontal component of the
projection of the centre of mass (projection
pffiffiffiffiffiffiffi CM), horizontal velocity of the centre of
mass (horizontal VCM) and the term g=l (g: acceleration of gravity; l: distance
jects improved their ability to regain balance during a sudden for-
between the centre of mass and the centre of the ankle joint); margin of stability in ward fall. The participants were able to regain balance from a more
the end of the main stance phase (margin of stabilityend), duration of the main inclined position (i.e. more negative values in the margin of stabil-
stance phase, normalized average vertical ground reaction force of the recovery leg ity at release) after the intervention.
(average forceVertical), normalized average horizontal ground reaction force of the
Comparing mean values of margin of stability at release before
recovery leg (average forceHorizontal), within the main stance phase.
*
Statistically significant differences between pre and post training measurements and after the mini-trampoline training, the exercised group
for exercised group. showed an improvement of about 35%, while the control group
did not show statistical differences. Moreover, the between groups
which the stability after the induced falls has been regained. There- statistics indicate an improvement in dynamic stability of the
fore, the components of dynamic stability in the end of the main trained group (by higher ratio values Post/Pre of margin of stability
stance did not show any differences in the pre–post comparisons at release) related to control and, in parallel, the trained subjects
in both groups (Table 3). showed after the intervention an increase of about 10% in muscle
The comparison between groups showed that the trained group strength of the triceps surae muscles.
had significant higher ratio (Post/Pre) values for the variables margin The components of dynamic stability at touchdown (base of
of stability at release (trained = 1.39 ± 0.061; control = 1.07 ± 0045; support, extrapolated CM, projection
pffiffiffiffiffiffiffi of CM to the ground, horizon-
P 6 0.05); and hip joint moment generation (trained = 1.17 ± 0.18; tal CM velocity and the term g=l), did not show differences be-
control = 1.01 ± 0.27; P 6 0.05) while comparing to the control tween pre and post measurements for both control and exercised
group (Fig. 3). No other variables of the dynamic stability showed groups. Nevertheless, the experimental group was able to achieve
differences while comparing the two groups. similar BS values in shorter time from release to touchdown; this
determined a faster recovery step during the phase until touch-
4. Discussion down after the training and showed an important improvement
in using the mechanism of dynamic stability (i.e. increase of base
In this study we investigated whether a 14-week mini-trampo- of support). Although the maximal hip flexion moment in the
line training intervention, based on exercises that involve the phase until touchdown contributes significantly to the ability in
mechanisms by which stability is maintained, contributes to recovering balance after a forward fall (Wojcik et al., 2001;
improvement of dynamic stability performance in elderly subjects. Hsiao-Wecksler and Robinovitch, 2007; Mademli et al., 2008) our
We found that after the training intervention the exercised sub- study did not find differences in peak hip moment after training.
 F.A. Aragão et al. / Journal of Electromyography and Kinesiology 21 (2011) 512–518
Instead, a similar hip moment was achieved earlier in the forward
fall which determined a higher rate of hip moment generation after
the intervention. This increase in the rate of hip moment genera-
tion seems to be the most important reason for the improvement
of the mechanism of dynamic stability and determined the faster
recovery step in the trained group after the mini-trampoline exer-
cises. Quicker steps are, indeed, a common and effective recovery
strategy in young adults. Hsiao-Wecksler and Robinovitch (2007),
found that at a given step length, young adults were able to recover
balance from larger inclined angles compared to elderly
(Hsiao-Wecksler and Robinovitch, 2007) due to their quicker steps.
In addition, an increase in the maximal isometric voluntary con-
traction moment of the ankle plantarflexors muscles was found
after training. Early studies indicate that in the primary phase of
a tripping recovery reaction the support limb generates a large an-
kle plantarflexion moment in order to bring the appropriate push-
off force that provides the necessary stability for the adequate step
positioning of the recovery limb (Pijnappels et al., 2005). The
events detected on the phase until touchdown lead to conse-
quences on the parameters calculated in the main stance phase.
The maintenance of stability from a more inclined position (i.e.
with a lesser margin of stability) at release required higher ground
reaction forces (horizontal and vertical) in the main stance phase
acting as breaks of the movement.
Many studies have suggested that training exercises could help
old adults to improve stability during a perturbation, compensat-
ing aging related deficiencies; however, most of them are based
on strength training programs (Hess and Woollacott, 2005;
Pijnappels et al., 2008; Wolfson et al., 1995). As far as we know,
this is the first time an intervention was developed focusing on
training the enhancement of the mechanisms by which dynamic
stability is maintained and the mini-trampoline was an effective
tool to be used on those training interventions.
In conclusion, our findings show evidence that a 14-week mini-
trampoline training intervention increased the ability of old adults to
recover balance during forward falls. The increased ability was associ-
ated to a higher rate of hip moment generation after the perturbation.
Acknowledgements
The authors would like to thank: CAPES and DAAD (F.A.A.); FINEP
and CNPq (M.A.V.) and Heymans Trimilin for the mini-trampolines.
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Fernando Amâncio Aragão received the B.Sc. degree
in Physical Therapy (1999) from São Paulo State
University (UNESP, Brazil), Completed his M.Sc.
degree in Neuroscience (2002) at Federal University
of São Paulo (UNIFESP, Brazil) and his Ph.D. in Human
Movement Sciences (2009) at Federal University of
Rio Grande do Sul (UFRGS, Brazil). He is currently
Professor of the Physical Therapy Department in
State University of West of Paraná (UNIOESTE, Brazil)
where he works with neurological and geriatric
rehabilitation. His research interests include adapta-
tions of gait and postural control due to ageing and
following neurological diseases.
Kiros Karamanidis, received his Ph.D. at the German
Sport University of Cologne in 2006. His main
research interests are in the field of adaptation of
aging muscles and its effect on gait mechanics
focusing on the prevention of falls in the elderly.
518 F.A. Aragão et al. / Journal of Electromyography and Kinesiology 21 (2011) 512–518
Marco Aurélio Vaz is Associate Professor and coor-
dinator of the Neuromuscular Plasticity Department
of the Exercise Research Laboratory at the Federal
University of Rio Grande do Sul. Among his research
interests are the neuromuscular plasticity due to
different models of increased and reduced use. His
research work concentrates on neuromuscular
adaptation to training, artificial electrical stimula-
tion, osteoarthritis, muscle inhibition, immobiliza-
tion, aging and spasticity, as well as muscle fatigue
and muscle damage.
Adamantios Arampatzis is Professor and chair of the
Department Training- and Movement Sciences at the
Humboldt-University of Berlin. Among his research
interests are the plasticity of the musculoskeletal
system to exercise and the influence of the neuro-
muscular capacity of the human system on motor
task behaviour during daily and sport activities. His
research work concentrates on muscle–tendon unit
adaptation, neuromuscular control of locomotion,
dynamic stability and joint mechanics.