Clinical Biomechanics 25 (2010) 450–454

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Clinical Biomechanics
journal homepage: www.elsevier.com/locate/clinbiomech

Peak torque and rate of torque development in elderly with and without
fall history q
Paulo Cesar Barauce Bento a, Gleber Pereira b, Carlos Ugrinowitsch c, André Luiz Felix Rodacki a,*
a
Centro de Estudos do Comportamento Motor, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
b
Nucleus of Biological and Health Science, Positivo University, Curitiba, Paraná, Brazil
c
Escola de Educação Física e Esporte, Universidade de São Paulo, São Paulo, São Paulo, Brazil

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

Article history: Background: Falls are one of the greatest concerns among the elderly. A number of studies have described
Received 10 August 2009 peak torque as one of the best fall-related predictor. No studies have comprehensively focused on the rate
Accepted 10 February 2010 of torque development of the lower limb muscles among elderly fallers. Then, the aim of this study was to
determine the relationship between muscle peak torque and rate of torque development of the lower
limb joints in elderly with and without fall history. It was also aimed to determine whether these param-
Keywords: eters of muscle performance (i.e., peak torque and rate of torque development) are related to the number
Risk of falls
of falls.
Rate of torque development
Fallers
Methods: Thirty-one women volunteered to participate in the study and were assigned in one of the
groups according to the number of falls over the 12 months that preceded the present. Then, participants
with no fall history (GI; n = 13; 67.6[7.5] years-old), one fall (GII; n = 8; 66.0[4.9] years-old) and two or
more falls (GIII; n = 10; 67.8[8.8] years-old) performed a number of lower limb maximal isometric volun-
tary contractions from which peak torque and rate of torque development were quantified.
Findings: Primary outcomes indicated no peak torque differences between experimental groups in any
lower limb joint. The rate of torque development of the knee flexor muscles observed in the non-fallers
(GI) was greater than that observed in the fallers (P < 0.05) and had a significant relationship with the
number of falls (P < 0.05).
Interpretation: The greater knee flexor muscles’ rate of torque development found in the non-fallers in
comparison to the fallers indicated that the ability of the elderly to rapidly reorganise the arrangement
of the lower limb may play a significant role in allowing the elderly to recover balance after a trip. Thus,
training stimulus aimed to improve the rate of torque development may be more beneficial to prevent
falls among the elderly than other training stimulus, which are not specifically designed to improve
the ability to rapidly produce large amounts of torque.
Ó 2010 Published by Elsevier Ltd.

1. Introduction fractures occur as a consequence of falls and prospective data indi-

Falls are a relatively common event among elderly people and
are one of the major public health concerns with respect to mor-
bidity, mortality and health service costs. Approximately 30% of
individuals aged 65 or older fall at least once a year with a 50%
reoccurrence rate within the same time period (Masud and Morris,
2001). The proportion of falls increases up to 40% in elderly aged
75 years or older (Tinetti et al., 1988). Ninety percent of the hip
q slow or at moderate speeds, which may not constitute an optimal
We certify that no party having a direct interest in the results of the research
supporting this article has or will confer a benefit on us or on any organization with
which we are associated.
* Corresponding author. Address: Universidade Federal do Paraná, Departamento
de Educação Física, Rua Coração de Maria, 92, Jardim Botânico, Curitiba-PR, CEP
80215-370, Brazil.
E-mail address: rodacki@ufpr.br (A.L.F. Rodacki).
cates that 33% of the women and 17% of the men will suffer a hip
fracture after 90 years of age (Hayes et al., 1996).
Declines in neuromuscular function of the lower limbs have
been identified as a major risk factor for falls among elderly.
Strength training has been considered as an attractive strategy to
reduce the risk of falls because it attenuates the decline in the neu-
romuscular function (Fiatarone et al., 1994; Larsson et al., 1979;
Moreland et al., 2004; Persch et al., 2009; Skelton et al., 1994).
However, strength training requires moving a heavy resistance at
stimulus to decrease response time to avoid a fall after tripping
(van den Bogert et al., 2002). Therefore, falls may be more related
to the ability to produce power than torque, as the later increases
the muscle ability to generate torque rapidly, decreasing the re-
sponse time after tripping (Thelen et al., 1996).

0268-0033/$ - see front matter Ó 2010 Published by Elsevier Ltd.

doi:10.1016/j.clinbiomech.2010.02.002
 P.C.B. Bento et al. / Clinical Biomechanics 25 (2010) 450–454
Power training has been proposed as a promising stimulus for
improving elderly functionality because high speed movements
can improve motor-unit firing rate, synchronization, muscle acti-
vation level and decrease activation threshold more than strength
training (Cutsem et al., 1998; Miszko et al., 2003), which may be
critical to increase response time. Thus, it seems that the ability
of the elderly to produce torque rapidly may be more specific than
strength training. In fact, fallers are less powerful than non-fallers
during a leg extension test (Perry et al., 2007; Skelton et al., 2002).
Thus, it is important to determine whether fallers and non-fallers
can be differentiated based on measurements of lower limb joints
torque magnitude (i.e., joint peak torques) and how quickly these
torques are developed (i.e., the rate of torque development) (Robi-
novitch et al., 2002).
Therefore, the aim of the present study was to compare muscle
peak torque and rate of torque development of the lower limb
joints in elderly with and without fall history. It was also aimed
to determine whether these parameters of muscle performance
(i.e., peak torque and rate of torque development) are related to
the number of falls. The understanding of the factors that influence
falls are relevant for several health professionals involved in the
conduction of exercises specifically designed for elderly subjects.
2. Methods
Thirty-one women from the local community volunteered to
participate on the study. The inclusion criteria were: aged
60 years-old or above, not participating in any physical activity
program in the last 6 months, free from orthopaedic, balance and
other health problems that could affect gait. All procedures were
approved by the University Ethics Committee and participants
signed an informed consent form before participation.
Participants attended to one laboratory session and answered a
customised questionnaire before performing a number of lower
limb maximal strength tests (see below). The questionnaire was
designed to identify whether participants experienced a fall during
the last 12 months and the circumstances participants felt. A fall
was defined as unintentionally coming to rest on the ground, floor,
or other lower level, whether or not it produced an injury (Buchner
et al., 1997). According to the responses, participants were divided
in three groups: no fall history (GI; n = 13), one fall (GII; n = 8) and
two or more falls (GIII; n = 10) (Table 1). a one-way ANOVA re-
vealed no differences in the physical characteristics between
groups (P > 0.05).
Participants performed a series of lower limb maximal isomet-
ric contraction tests. Hip, knee, and, ankle flexion and extension
maximal voluntary isometric torques were assessed in a recum-
bent posture with the joints positioned at approximately 90o (Pers-
ch et al., 2009). The proximal segments were firmly secured and
stabilized by a velcrum strap. Hip abduction and adduction tests
were performed with the participants in a standing posture and
the experimenters ensured that they did not use additional move-
ments in order to improve performance. The order of the tests fol-
lowed a reversed balanced order between participants, i.e., the
order followed by one participant was followed in a reversed order
Table 1
Mean (SD) physical characteristics of the participants of the non-fallers (GI), one fall
(GII), and two or more falls (GIII) in the last 12 months.
GI (n = 13) GII (n = 08) GIII (n = 10)
Age (years-old) 67.6 (7.5) 66.0 (4.9) 67.8 (8.8)
Body mass (kg) 73.5 (16.1) 73.3 (4.4) 75.8 (12.0)
Stature (cm) 157.9 (12.0) 157.5 (4.1) 157.1 (7.4)
BMI (m2 kg 1) 29.1 (3.9) 29.5 (3.0) 30.6 (2.1)
451
by the next one, irrespective of the experimental group. For in-
stance, one participant was tested using a proximal-to-distal order
and the next one was tested in a distal-to-proximal order in which
each pair of agonist/antagonist pairs were tested in sequence, due
to set up constraints (i.e., the table and load cell position were
changed for each test). It was assumed that no learning effect oc-
curred in this approach which was conveniently applied to reduce
collection session time.
Force–time traces were determined with a load cell (Model
CZC500, Kratos, São Paulo, Brazil) firmly attached to an adjustable
pole that permitted aligning the line of pull perpendicularly to the
tested (dominant) segment. An adjustable cuff was used to secure
the cable to the participant’s segment. The perpendicular distance
between the load cell and the joint centre was determined and
used to calculate net joint torques. Fig. 1 provides a schematic rep-
resentation of the torque testing procedures. Participants were al-
lowed three to five trials to get familiarized with the test demands.
Then, three maximal trials were performed and that with the high-
est peak torque was used for further analysis. Participants were in-
structed to produce torque as fast and hard as possible and sustain
the contraction for a short period (approximately 2–3 s). The use of
short periods of contraction was deemed important to minimise fa-
tigue effects. Intervals of 1 min were introduced between efforts.
The peak torque was continually monitored during the session
and trials in which a torque variation greater than 10% of the mean
peak torque were repeated. In general, participants achieved the
standard with three trials, but in some cases one extra trial was
allowed.
The force–time signals were sampled with a frequency of
1000 Hz, amplified (Kratos, model IK-1C, São Paulo, Brazil) and
converted to digital signals with the aid of a 16 bit A/D card (Na-
tional Instruments, model NI USB 6218, USA) and finally stored
on a personal computer. Raw torque data was low pass filter with
a Butterworth second order recursive filter set at 20 Hz. Peak tor-
que was determined as the highest torque value obtained after
the onset of the voluntary contraction. The rate of torque develop-
ment was calculated using a customised routine (Matlab 6.0Ó,
USA) and defined as the slope of the force–time curve from 20%
to 80% of the peak torque values. The coefficient of determination
was calculated to assess the fitting of the regression equations
(R2 = 0.98).
3. Statistical approach
Descriptive statistics (mean and standard deviation) were per-
formed to characterise the participants. The Kolmogorof–Smirnoff
test was applied and confirmed data normality. A number of one-
way ANOVAs were performed to compare the results between
groups. Bonferroni post hoc test was used for multiple compari-
sons purpose. In addition, a multiple regression equation (stepwise
method) was performed to identify the variables that were corre-
lated with the number of falls. The coefficient of significance was
set at P < 0.05 and all statistical procedures calculated using the
16.0 SPSS statistical package (USA).
4. Results
Fig. 2 shows peak torques and rates of torque development. No
differences were found between groups on peak torque and rate of
F P torque development (P > 0.05) in any joint of the lower limbs, ex-
0.29 0.74 cept the knee flexors, which showed larger (P < 0.05) rate of force
0.24 0.78 development in the non-fallers than in the other two groups of fal-
0.04 0.96
lers. No differences were found in peak knee flexor torque between
1.24 0.29
the fallers, irrespective of the number of falls (P > 0.05).
452 P.C.B. Bento et al. / Clinical Biomechanics 25 (2010) 450–454
Dorsiflexion
Knee Extensors
Hip Extensors
Hip Adductors
Fig. 1. Schematic representation of the position of the line of pull and participants’ position during the Peak torque and rate of torque development tests.
Regarding the multiple regression analysis, only the rate of tor-
que development of the knee flexor muscles entered the model
(P = 0.02). However, this variable shared a small portion of the total
variance of the factors that affect the number of falls (r2 = 0.13).
5. Discussion
The main finding of the present study was that peak torque and
rate of torque development in fallers and non-fallers did not differ,
except the knee flexor muscles which showed greater rate of tor-
que development in the non-fallers group, irrespective of the num-
ber of falls.
Increasing the ability to produce muscle strength has been sug-
gested as one of the fundamental components of exercise programs
to prevent the functional decline and to decrease the risk of fall
(Persch et al., 2009; Province et al., 1995) throughout the aging
Plantiflexion
Knee Flexors
Hip Flexors
Hip Abductors
process. For instance, fallers have been reported to present reduced
knee (Aniansson et al., 1983; Fugl-Meyer et al., 1980; Persch et al.,
2009) and ankle (Thelen et al., 1996; Whipple et al., 1987; Wolfson
et al., 1995) isokinetic peak torques, irrespective of the testing
speed. However, isometric strength assessments do not seem to
detect differences in peak torque between fallers and non-fallers.
Indeed, Skelton et al. (2002), Laroche et al. (2009) and the present
study did not report differences in peak knee extension and flexion
torques between fallers and non-fallers. On the other hand, Perry
et al. (2007) reported differences in isometric peak torque for the
hamstrings, plantar flexors, and dorsiflexor muscles between fal-
lers and non-fallers. The difference between Perry’s findings and
the present study may be related to discrepancies in participants’
age as they used an older population (75.9 vs. 67.1 years-old).
The importance of producing muscle force rapidly (i.e., rate of
torque development) to fall prevention has been described by oth-
ers. Bean et al. (2002) and Sayers et al. (2005) reported that con-
 P.C.B. Bento et al. / Clinical Biomechanics 25 (2010) 450–454 453

HIP ABD
HIP ADU
300 150 50
HIP FLEX KNE FLE DORSI
HIP EXT KNE EXT PLANTI
40
Torque(N•m)

Torque (N•m)

Torque(N•m)
200 100
30

20
100 50
10

0 0 0
0 1 2 0 1 2 0 1 2
Groups Groups Groups
Rate of torque development (N •m•s )

Rate of torque development (N •m•s )

Rate of torque development (N •m•s )
HIP ABD
HIP ADU
3 1.5
HIP FLEX KNE FLE 0.5 DORSI
HIP EXT KNE EXT PLANTI
0.4
2 1.0
0.3
*
0.2
1 0.5
0.1

0 0.0 0.0
0 1 2 0 1 2 0 1 2
Groups Groups Groups

Fig. 2. Peak torque and rate of torque development around the hip, knee and ankle joints of elderly participants with no falls (0), one fall (1) and two or more falls (2) in the
last 12 months.

traction velocity was a stronger predictor of performance on lower on the maximum speeds with which the lower extremity could
intensity functional tasks than muscle strength. This argument is in be moved, rather than on the sensory or motor programming pro-
line with those proposed by Cuoco et al. (2004) that walking tasks cesses involved in response initiation.
are more dependent on speed than strength. Probably, the rate of The natural age-related losses in the neuromuscular system
torque development influences more the ability of the subjects to may explain the increased risk of falls among the elderly. A number
recover balance and avoid a fall after tripping than the maximum of studies (Erim et al., 1999; Lockhart and Kim, 2006; Thelen et al.,
force capability (i.e., peak torque), as evidenced here. For instance, 1996) have consistently reported great reductions in the number
elderly non-fallers have higher knee extensors rate of torque devel- and area of fast-twitch muscle fibres in comparison to the slow-
opment than fallers (Perry et al., 2007; Pijnappels et al., 2008). Lar- twitch muscle fibres in elderly. Thus, the reduced ability to rapidly
oche et al. (2009) reported no differences in rate of torque develop torque seems to be a typical characteristic in the elderly.
development (RTD) between fallers and non-fallers. The reason The present study confirms previous ones that have reported this
for such difference is probably the lack of familiarization trials. In decline is more pronounced in the older subjects with a fall history
our experience, elderly need to learn how to perform fast isometric than non-fallers. Probably, age-related changes in muscle activa-
contractions because the RTD is highly variable between trials. Fur- tion rate (Lockhart and Kim, 2006) may have an important implica-
thermore, they calculated RTD over a 200 ms interval. Some indi- tion in the ability to recover from a trip and avoid a fall as most
viduals may have reached peak torque at the end of this time actions have to be explosive and ballistic nature to avoid it. It
interval, which greatly decreases RTD values. Calculating RTD from should be noted that peak torque magnitude (i.e., ability to gener-
20% to 80% of the peak torque values guarantees that the RTD is ate large amounts of force) was not as relevant as the rate of torque
calculated in a steep region of the torque curve. development among fallers. Indeed, Pavol et al. (2002) showed that
The sequence of actions after tripping may help to unravel the weak and strongest older adults were similar with respect to the
importance of the rate of torque development to prevent falls. Trip- risk of a trip. However, high muscle strength increases the risk of
ping usually occurs during single support, in the middle of the fall during-step or elevating response fall, while decreased strength
swing phase, producing loss of balance. After tripping, the body’s may represent a risk of an after-step fall (Pavol et al., 2002).
centre of mass moves forward, passing the base of support, causing Therefore, it seems that improving the ability of the knee flexor
the fall. The only way to prevent a fall is through a fast recovery muscles to rapidly control the arrangement of the lower segments
step of the swing leg to support the body weight. However, the is a relevant strategy to prevent falls. Experimental studies de-
individual should reduce the moment of inertia of the swinging signed to improve the rate of torque development of the knee flex-
leg to increase the whole segment angular acceleration. A high rate or muscles are required to test whether such improvements are
of torque development of the knee flexor muscles may produce a effective to ameliorate the ability to recover balance and to reduce
fast knee flexion movement, which reduces the radius of gyration the risk of falls. According to the sequence of actions that occur
and, consequently, the segment’s moment of inertia. The findings during a trip, the rate of torque development of the hip flexor mus-
of Thelen et al. (1997), corroborate with this idea. They showed cles may be also relevant to avoid a fall after tripping because rais-
that the age-related decline in balance recovery largely depends ing the lower segment is required to enlarge the clearance of the
454 P.C.B. Bento et al. / Clinical Biomechanics 25 (2010) 450–454
disturbed segment with respect to the ground. However, no signif-
icant effect was found. It must be emphasized that we are not dis-
carding the importance of the knee extensor or hip flexor muscles
while recovering from a trip, as rapid actions around these joints
play an important role and determine the ability to safely set the
foot on the ground and avoid a fall.
The present study has a number of limitations. First, the partic-
ipants were relatively young in their mid 1960–1970s and are not
as prone to fall as older individuals. Second, our sample was
formed by healthy and non-institutionalized individuals, who are
also less prone to fall. Third, the number of participants that expe-
rienced a fall is relatively small due to difficulties to include/iden-
tify individuals that fell in the last 12 months. In addition, the
circumstances of the falls were not fully investigated because some
of them may have occurred in adverse conditions (e.g., slippery
conditions). Finally, further examination of muscle activation rate
and magnitude is required in individuals with a fall history to
determine whether muscle recruitment strategy plays a significant
role while recovering from a trip and avoiding a fall.
6. Conclusion
The present study showed that the rate of torque development
was found to be a specific fall-related determinant among elderly
subjects rather than peak torque magnitude, which was found
not to be a strong predictor of falls. These findings are in agreement
with other studies that have proposed exercises designed to devel-
op muscle power (i.e., with fast muscle contraction) as to be more
specific and beneficial to reduce the risk of falls than exercises indi-
cated to improve strength training. Improving the knee flexor mus-
cles rate of torque development may be an additional relevant
strategy to reduce the risk of falls because it may allow a rapid con-
trol of the lower limb arrangement and recover balance after a trip.
The sequence of actions that must be performed after tripping indi-
cates that the rate of torque development of the knee flexor mus-
cles may act as an additional preventive factor, which must be
included in training routines in conjunction with other lower limb
muscles that are well known as to be closely related to the risk of
falls among elderly (e.g., knee extensor muscles). Other experimen-
tal studies are required to confirm whether improved rate of tor-
que development of the knee flexor muscles is able to offer a
protective effect and reduce the risk of fall.
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