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The Functional Movement Screen and Active Older Clients
By Joshua S. Lovato, MS and Len Kravitz, PhD

Study Reviewed:
Mitchell, U.H., Johnson, A.W., Vehrs, P.R. et al. (2016). Performance on the functional movement screen in older active adults, Journal of Sport and Health Science, 5, 119-125.

The Functional Movement Screen (FMS TM) is a movement analysis protocol that has been designed to help evaluate a person's readiness to perform in physical activity and exercise. The inexpensive, easily administered screen evaluates functional movement patterns essential for normal bodily movement and has been used for a wide variety of populations including rehabilitation to athletic performance. The FMS is not intended to identify orthopedic problems, but rather to recognize limitations in asymmetries in persons in respect to basic movement patterns. The screen consists of seven functional movement test items, which have been described elsewhere (Cook et al. 2006a, 2006b) and including the following:
1. Overhead deep squat: to assess bilateral, symmetrical and functional mobility of hips, knees and ankles
2. Hurdle step: to assess bilateral functional mobility and stability of hips, knees and ankles
3. In-line lunge: to assess hip and ankle mobility and stability, quadriceps flexibility, and knee stability
4. Shoulder mobility: to assess bilateral shoulder range of motion, combining internal rotation with adduction and external rotation with abduction
5. Active straight leg raise: to assess active hamstring and gastroc-soleus flexibility while maintaining a stable pelvis and active extension of the opposite leg
6. Trunk stability push-up: to assess trunk stability in the sagittal plane while a symmetrical upper-extremity motion is performed
7. Rotary stability: to assess multi-plane trunk stability during a combined upper and lower extremity motion

Typical fitness assessments examine the number of repetitions performed or the weight that is lifted, where in contrast the FMS attempts to identify imbalances in stability and mobility during fundamental movement patterns.

Functional limitations and asymmetries develop over time due to aging, poor flexibility, weak muscles, neurological disorders and poor posture (Mitchell et al., 2016). Mitchell and colleagues note if untreated, some of these irregularities can lead to a long-term disability or functional limitation. Although the FMS has been utilized in college athletics, professional sport, military, firefighters, and martial arts, Mitchell et al. chose to evaluate it's application for an aging population, since there is no research with this tool in this population.

Study Participants
The participants in the study were recruited from a Health Fair that was held in conjunction with the 2012 annual World Senior Games (Mitchell et al., 2016). There were ninety-seven men (n=53) and women (n=44) between the ages of 52-83 years old with an average age of 65.7 years. Participants average BMI was 25.8 ± 4.2 (kg/m2), which would be considered over weight for a younger population, but healthy for this population (Vorvick, L.J. 2016). All participants filled out a pre-participation questionnaire that answered questions about their nutrition habits, sleep patterns and current medications. In addition, the participants completed an activity questionnaire to quantify their current level of physical activity.

Study Methods
The seven FMS tests were completed under the guidance of a trained FMS instructor as well as being video-recorded. Each test was compared by two raters and in cases of inconsistent scoring the video was used to find consensus. Scores of the FMS were scored 0-3 with a score of 3 being given for correct completion of the movement without compensation; a 2 was given if compensation occurred, or faulty form or poor alignment; a 1 was given if the movement was incomplete; and a 0 score meant the participant perceived pain during the movement.

Study Results
The results of the study show that as a person ages, her/his FMS score also decreases. This result signifies, with this population sample of older adults, that with aging, participants were also experiencing some functional limitations. The oldest participants had the lowest FMS scores. However, Mitchell and colleagues explain this was anticipated. Factors such as neuromuscular coordination, balance, flexibility and core strength, which the FMS assesses, tend to decline as a person ages. The researchers note that muscle strength has been shown to decreases about 1% to 2% per year (starting at age 65) and similarly, power decreases at a rate of 3.5% per year (Skelton et al., 1994).

Study results showed that as BMI increased (i.e., towards overweight and obesity) there was also a decrease in FMS score. This is very helpful to personal trainers. This widely used tool indicates that functional movement patterns, utilized daily for activities of daily life are undesirably affected with an increase in body weight. Those individuals whose BMI were the highest had the lowest FMS scores. Mitchell et al. highlight that excess weight affects an older person's balance, flexibility, mobility and stability. The researchers propose that these results suggest that a reduction body weight, in an overweight/obese individual, as a person ages may likely increase their enjoyment of quality fundamental movement patterns. Traditionally, as fitness professionals we tend to focus on the deleterious health consequences of obesity in aging populations. These results shine even a new light on another concern, functional movement limitations as an outcome due to creeping obesity and aging.

Those participants with decreased physical activity also showed a lower FMS score. Mitchell et al. (2016) highlight that a lack of physical activity will negatively influence a person's stability, balance, neuromuscular control and proprioception. Once again, an important message to trainers to encourage their older clients to keep moving.
In regards to sex differences, Mitchell and fellow researchers (2016) note that there were no overall differences observed in this population. However, differences did occur in specific FMS measures. For instance, the women scored higher than the men on flexibility and mobility. Contrariwise, the men scored better on the push-up test, a measure of upper body strength and stability.

Perhaps the most worrying finding of the study is the researchers observed a high prevalence of asymmetries in strength and flexibility in 55 of the 97 participants. Mitchell et al. (2016) note that research shows there is a correlation between leg strength asymmetry and falling in older adults. Asymmetries may lead to long-term disability and dsysfuntion (Mitchell et al). The bilateral assessments in shoulder mobility showed the most frequent asymmetry. The researchers explain that a shoulder hypermobility or hypomobility can ultimately impact an elder person's ability to self-care and complete occupational activities. Another area of asymmetry noted was with core stability. Asymmetrical core strength, which may be a factor of a number of neural and muscle tissue contributions, places the spine at risk and thus may jeopardize a person for balance, postural control and basic functional movement (Mitchell et al., 2016).

Summary Thoughts
The FMS assessment attempts to pinpoint functional deficits related to mobility, stability and proprioceptive weaknesses. Its purpose is to be a part of a pre-participation physical assessment to identify deficits not observed with traditional fitness and health-related screening tools. From the results of this study, the FMS appears to be a most useful tool in the assessment of functional fitness for active elder adults. In addition, the tool clearly identified some meaningful concerns with functional movement ability that may occur with aging, increase in body weight and a decrease in physical activity. One special observation of this study is the correlation between leg strength asymmetry and falling in older adults. If personal trainers are able to identify such a discrepancy early, they may be able to successfully incorporate an individualized fall-prevention program for an active, older client. The FMS is a useful assessment tool for personal trainers working with active elder populations.

Joshu S. Lovato, M.S. has a combined Masters degree in Exercise Science and Sport Administration from the University of New Mexico (Albuquerque). He is a corrective exercise specialist who enjoys working with clinical populations and athletes.

Len Kravitz, PhD, CSCS is the program coordinator of exercise science and a researcher at the University of New Mexico, where he received the Outstanding Teacher of the Year award. In addition to being a 2016 inductee into the National Fitness Hall of Fame, Len was awarded the 2016 CanFitPro Specialty Presenter Award.

Additional References:
Cook, G., Burton, L., Hoogenboom, B. J. (2006a). Pre-participation screening: The Use of fundamental movements as an assessment of function-part 1, North American Journal of Sports Physical Therapy,1(2), 62-72.

Cook, G., Burton, L., Hoogenboom, B. J. (2006b). Pre-participation screening: The Use of fundamental movements as an assessment of function-part 2, North American Journal of Sports Physical Therapy, 1(3), 132-139.

Skelton, D.A., Greig, C.A., Davies, J.M., & Young, A. (1994). Strength, power and related functional ability of healthy people aged 65-89 years. Age Ageing, 23(5), 371-377.

Vorvick, L.J. (2016). Body mass index. U.S. National Library of Medicine
Accessed: June 19, 2017