Aging-related changes in neuromuscular control strategies and their influence on postural stability

Altered neuromuscular strategies are suggested to contribute to age-related decreases in postural stability. Current approaches tend to overlook global (whole body) neuromuscular postural control strategies, potentially due to methodological constraints or residual influence from a longstanding, but outdated, biomechanical view in which postural sway is represented by a single-jointed inverted pendulum. In this study, we investigate age-related differences in postural strategies during upright static balance maintenance by assessing global neuromuscular control. We collected simultaneous posturography and electromyography (EMG) data from young (18-35 years, n = 32) and older (65-85 years, n = 33) participants while they stood upright on a force plate or on foam pads thereon, with eyes open or closed. Postural instability was assessed by the standard deviation and velocity of the center of pressure. EMG sensors recorded the activity of thirty muscles (15 on each hemibody). Co-contraction across all muscle pairs was measured with Falconer's co-contraction index (CCI), and muscle synergy with non-negative matrix factorization. The older group possessed increased global co-contraction intensity, marked by more frequent use of a knee extensor synergy, and was more unstable than the younger group. Notably, advancing age modulated the variability of co-contraction intensity, where the oldest individuals consistently adopted a pure co-contraction strategy marked by the highest CCI values and lowest variability. Age-corrected correlations revealed that knee extensor CCI values were significantly related to postural instability. Taken together, global co-contraction appears to be a signature of elderly postural strategy and age-related instability may be directly related to the extent of knee extensor co-contraction. These results stress the importance of zooming out from classical agonist-antagonist muscle pair investigations in the endeavor to understand elderly postural control strategy.