title: The effect of a foot gymnastic exercise programme on gait performance in older adults: a randomised controlled trial.
abstract: BACKGROUND
  Aged-related loss of ankle dorsiflexion range of motion (ROM) and toe plantarflexor strength play an important role in gait performance. Further, conventional strength, balance and gait training can significantly improve the lower extremity muscle power and functional abilities of older individuals. It remains unclear, however, whether training effects can be enhanced by augmenting ankle ROM and toe plantarflexor strength complementary to training.
  
  
  OBJECTIVE
  This study investigated the effect of physical exercise combined with foot gymnastics on the gait performance in older adults.
  
  
  METHODS
  Fifty-six independent living, older adults aged 66-91 years were randomly assigned to either foot gymnastics group (FG; n = 28) or training group (TG; n = 28). Further, 14 subjects were integrated as a control group (CG; n = 14) (no exercise). The FG and TG completed the same training program consisting of aerobic exercises, progressive resistance strength training and stretching exercises twice per week for 12 weeks, whereas the FG performed additional foot gymnastic exercises at the end of the training session and a 10-min foot gymnastics home-program daily. Assessments included the Falls Efficacy Scale - International (FES-I), Expanded Timed Get-up-and-Go test (ETGUG), gait analysis and muscle power measurements of the knee and ankle joint at pre- and post-training. Results. No significant change in FES-I score occurred in either group. The FG showed a significant improvement of ankle ROM. There were significant time x group interactions in walking speed, step length, in several muscle power measurements and in ETGUG. The positive effects of gait parameters ranged between 1 and 11% and between 2 and 12%, of muscle power between 14 and 34% and 14 and 46% and of ETGUG were 10 and 8% for the FG and TG, respectively. The FG and TG did not differ significantly in their improvements. The CG showed a trend to deteriorations between 0 and -6% for gait parameters, between -4 and -14% for muscle power and 0% for ETGUG.
  
  
  CONCLUSIONS
  The results of this study provide evidence of significant improvements in gait performance, muscle power and ETGUG after a conventional training program in independent living, older adults. However, there is no additional effect on physical performance after foot gymnastic exercises.
authors.affiliation: Institute of Human Movement Sciences and Sport, ETH, Zurich, Switzerland. antonia.hartmann@move.biol.ethz.ch
authors.forename: Antonia
authors.initials: A
authors.lastname: Hartmann
authors.forename: Kurt
authors.initials: K
authors.lastname: Murer
authors.forename: Rob A
authors.initials: RA
authors.lastname: de Bie
authors.forename: Eling D
authors.initials: ED
authors.lastname: de Bruin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000843:Ankle Joint / Q000502:physiology*; D005081:Exercise Therapy; D005260:Female; D005528:Foot / Q000502:physiology*; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D053580:Muscle Strength; D052580:Muscle Stretching Exercises; D016059:Range of Motion, Articular