title: Effects of toe and ankle training in older people: a cross-over study.
abstract: OBJECTIVE
  Maintenance of physical function in the elderly is important. Previous studies have focused mainly on training-center-based interventions, accompanied by training staff or equipped with training machinery. The purpose of this study was to investigate the effects of toe and ankle training for the elderly.
  
  
  METHODS
  The four facilities were divided into two groups that received the intervention in 8-week shifts. An exercise program, focused mainly on ankle, foot and toe function, was conducted with the subject in a sitting position. Muscle strength, physical function, fear of falling and health-related quality of life were assessed at the beginning of the study and at the end of each 8-week phase. Because subjects were not randomized, significant intergroup differences were present in some baseline measurements. Therefore, the study was conducted with a cross-over design, and ancova was included with the baseline value as an independent covariate.
  
  
  RESULTS
  A significant improvement was found in quadriceps strength, functional reach, stepping in sitting and Euro Qol EQ5D score, together with a possible improvement in toe flexor strength.
  
  
  CONCLUSIONS
  These results suggest that a training program carried out with the subject in a sitting position and focused mainly on ankle, foot and toe functions is effective in improving some aspects of motor function in the elderly. This approach may help elderly individuals maintain their activity level without increasing risks.
authors.affiliation: Human Health Sciences, Graduate School of Medicine Kyoto University, Kyoto, Japan. k.nagai@ky2.ecs.kyoto-u.ac.jp
authors.forename: Koutatsu
authors.initials: K
authors.lastname: Nagai
authors.forename: Takuya
authors.initials: T
authors.lastname: Inoue
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Yamada
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Tateuchi
authors.forename: Tome
authors.initials: T
authors.lastname: Ikezoe
authors.forename: Noriaki
authors.initials: N
authors.lastname: Ichihashi
authors.forename: Tadao
authors.initials: T
authors.lastname: Tsuboyama
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000369:Aged, 80 and over; D000843:Ankle Joint; D018592:Cross-Over Studies; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D053580:Muscle Strength; D009735:Nursing Homes; D004856:Postural Balance; D011187:Posture; D014034:Toes