{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:12:26Z","timestamp":1787008346142,"version":"build-2736575974"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2019,10,3]],"date-time":"2019-10-03T00:00:00Z","timestamp":1570060800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research Grants Council of the Hong Kong Special Administrative Region, China","award":["27608815"],"award-info":[{"award-number":["27608815"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This study evaluated the effect of attentional focus instructions on movement efficiency during a level-ground walking task in older adults with and without a history of falls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>One hundred and thirty-four community-dwelling older adults were categorised into older fallers (OF) (n = 37) and older non-fallers (ONF) (n = 97). Each participant was instructed to walk at a self-selected pace along a 6 m walkway under three attentional focus conditions (i.e. internal, goal-directed and control) for a total of nine trials. Average muscle activity indices of lower limb co-contractions were measured using surface electromyography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both shank and thigh muscle co-contractions were higher in OF than in ONF in all three conditions. OF also demonstrated higher shank muscle co-contraction under the internal relative to the goal-directed condition, with no such change observed in ONF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite no significant between-group differences in functional balance and balance confidence, relative walking inefficiencies were observed in OF compared with ONF. This finding demonstrates the debilitating consequences of falling that can occur with relative independence from various physiological or psychological factors that are commonly associated with falling and used to rationalise behavioural change. We also provide evidence that OF are more susceptible to conditions that provoke them to allocate attention internally. Therefore, in clinical contexts (e.g. gait rehabilitation), verbal instructions that refer to body movements (internal focus) might serve to compromise movement efficiency in older adults with a history of falls. Such changes will, theoretically, lessen the ability to react efficiently to changing environments experienced in daily life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ageing\/afz113","type":"journal-article","created":{"date-parts":[[2019,8,9]],"date-time":"2019-08-09T07:18:17Z","timestamp":1565335097000},"page":"811-816","source":"Crossref","is-referenced-by-count":19,"title":["The role of attentional focus on walking efficiency among older fallers and non-fallers"],"prefix":"10.1093","volume":"48","author":[{"given":"Toby C T","family":"Mak","sequence":"first","affiliation":[{"name":"School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William R","family":"Young","sequence":"additional","affiliation":[{"name":"Institute of Environment, Health and Societies, Brunel University London, UK"},{"name":"Department of Clinical Sciences, Brunel University London, UK"},{"name":"College of Life and Environmental Sciences, University of Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wing-Kai","family":"Lam","sequence":"additional","affiliation":[{"name":"Li Ning Sports Science Research Center, Li Ning (China) Sports Goods Co. Ltd, Beijing, China"},{"name":"Department of Kinesiology, Shenyang Sport University, Shenyang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andy C Y","family":"Tse","sequence":"additional","affiliation":[{"name":"Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomson W L","family":"Wong","sequence":"additional","affiliation":[{"name":"School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,10,3]]},"reference":[{"key":"2019102510393386200_ref1","doi-asserted-by":"crossref","first-page":"1304","DOI":"10.1093\/gerona\/60.10.1304","article-title":"Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older","volume":"60","author":"Montero-Odasso","year":"2005","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2019102510393386200_ref2","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1093\/gerona\/glr008","article-title":"Association between muscle activation and metabolic cost of walking in young and old adults","volume":"66","author":"Hortob\u00e1gyi","year":"2011","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2019102510393386200_ref3","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1016\/S0003-9993(00)90101-1","article-title":"Kinetic alterations independent of walking speed in elderly fallers","volume":"81","author":"Kerrigan","year":"2000","journal-title":"Arch Phys Med Rehabil"},{"key":"2019102510393386200_ref4","doi-asserted-by":"crossref","DOI":"10.5040\/9781492596844","volume-title":"Attention and Motor Skill Learning","author":"Wulf","year":"2007"},{"key":"2019102510393386200_ref5","doi-asserted-by":"publisher","first-page":"450","DOI":"10.3200\/JMBR.36.4.450-459","article-title":"EMG activity as a function of the performer\u2019s focus of attention","volume":"36","author":"Vance","year":"2004","journal-title":"J Mot Behav"},{"key":"2019102510393386200_ref6","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1016\/j.brainresbull.2005.06.035","article-title":"Increased movement accuracy and reduced EMG activity as the result of adopting an external focus of attention","volume":"67","author":"Zachry","year":"2005","journal-title":"Brain Res Bull"},{"key":"2019102510393386200_ref7","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1016\/j.humov.2009.11.008","article-title":"Increased jump height and reduced EMG activity with an external focus","volume":"29","author":"Wulf","year":"2010","journal-title":"Hum Mov Sci"},{"key":"2019102510393386200_ref8","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/S0966-6362(03)00005-5","article-title":"Surface electromyography analysis for variable gait","volume":"18","author":"Roetenberg","year":"2003","journal-title":"Gait Posture"},{"key":"2019102510393386200_ref9","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1016\/j.gaitpost.2008.12.007","article-title":"Interaction between age and gait velocity in the amplitude and timing of antagonist muscle coactivation","volume":"29","author":"Hortob\u00e1gyi","year":"2009","journal-title":"Gait Posture"},{"key":"2019102510393386200_ref10","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1016\/j.clinbiomech.2013.01.004","article-title":"Association between energy cost of walking, muscle activation, and biomechanical parameters in older female fallers and non-fallers","volume":"28","author":"Marques","year":"2013","journal-title":"Clin Biomech"},{"key":"2019102510393386200_ref11","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1177\/1545968307313510","article-title":"Reinvestment and falls in community-dwelling older adults","volume":"22","author":"Wong","year":"2008","journal-title":"Neurorehabil Neural Repair"},{"key":"2019102510393386200_ref12","first-page":"25","article-title":"Reliability and validity of the Cantonese version of mini-mental state examination\u2014A preliminary study. 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