A 30-s chair-stand test as a measure of lower body strength in community-residing older adults

Clinical usefulness of indoor life-space assessment in community-dwelling older adults certified as needing support or care

PURPOSE

This study aimed to develop a questionnaire to evaluate indoor life-space mobility and assess its validity in community-dwelling older adults certified as needing support or care.

METHODS

The participants included 37 community-dwelling older adults undergoing home-visit rehabilitation (mean age: 78.5±7.0 years). We developed a questionnaire to assess the degree of indoor life-space mobility (home-based life-space assessment (Hb-LSA)), evaluating the functional status (life-space assessment (LSA), time spent away from bed, functional independence measure (FIM), bedside mobility scale (BMS)), physical function (hand grip power (HGP), 30-second chair stand (CS-30), one-leg standing (OLS)) and cognitive status (mental status questionnaire (MSQ)).

RESULTS

The average Hb-LSA score was 56.3±24.3 (minimum 4 to maximum 102.5). The test-retest reliability was high (intraclass correlation coefficients: (1, 1)=0.986, (1, 2)=0.993). The Hb-LSA scores were significantly associated with the LSA (r=0.897), time spent away from bed (r=0.497), FIM (r=0.786), BMS (r=0.720), HGP (r=0.388), CS-30 (r=0.541) and OLS (r=0.455). There were no significant associations between the Hb-LSA scores and the FIM cognitive subscores (r=0.180) or MSQ scores (r=-0.240). The Hb-LSA scores were significantly higher among the participants able to move independently indoors (75.8±18.8 points) than in those who required help to move (45.7±20.2 points).

CONCLUSIONS

The Hb-LSA is a useful, reliable and valid tool for assessing the degree of indoor physical mobility in the life-space. The Hb-LSA score is related to the degree of independence of indoor mobility.

Community-based recreational football: a novel approach to promote physical activity and quality of life in prostate cancer survivors

As the number of cancer survivors continues to increase, there is an increasing focus on management of the long-term consequences of cancer including health promotion and prevention of co-morbidity. Prostate cancer is the most frequent type of cancer type in men and causes increased risk of heart disease, diabetes and osteoporosis. Epidemiological evidence points to a positive effect of regular physical activity on all-cause and prostate cancer mortality and current clinical evidence supports the use of exercise in cancer rehabilitation. However, the external validity of existing exercise studies is limited and the majority of prostate cancer survivors remain sedentary. Hence, novel approaches to evaluate and promote physical activity are warranted. This paper presents the rationale behind the delivery and evaluation of community-based recreational football offered in existing football clubs under the Danish Football Association to promote quality of life and physical activity adherence in prostate cancer survivors. The RE-AIM framework will be applied to evaluate the impact of the intervention including outcomes both at the individual and organizational level. By introducing community-based sport environments, the study offers a novel approach in the strive towards sustained physical activity adherence and accessibility in prostate cancer survivors.

A study of the inter-rater reliability of a test battery for use in patients after total hip replacement

Objective:

To assess the within-day inter-rater reliability of a test battery of functional performance, muscle strength and leg extension power on total hip replacement patients.

Design:

A test–retest design was used.

Setting:

Orthopaedic department at a Regional Hospital in Denmark.

Subjects:

Two convenience samples of 20 total hip replacement patients were included.

Intervention:

The tests were performed three months after total hip replacement. Two raters performed test and re-test, with two hours rest in-between.

Main measures:

The test battery included: sit-to-stand performance, 20-metre maximum walking speed, stair climb performance, isometric muscle strength (hip abduction/flexion), and leg extension power. Absolute reliability was assessed with Bland Altman plots, standard error of measurement (SEM), and minimal detectable change. Relative reliability was assessed with intra-class correlation coefficient.

Results:

Systematic differences between testers were seen in tests of walking speed (0.32 seconds p = 0.03) and stair climb performance (0.18 seconds p = 0.003). In per cent of the grand mean, the standard error of measurement was 3%–10%, indicating the measurement error on a group level, and the minimal detectable change was 10%–27%, indicating the measurement error on an individual level. The intra-class correlation coefficients were above 0.80 in all tests (range 0.83–0.95).

Conclusions:

The tests showed acceptable relative and absolute inter-rater reliability on a group level, but not on an individual level (except from test of walking speed and stair climb performance). Systematic differences between testers were considered clinically irrelevant (0.3 and 0.2 seconds).

Feasibility of a combined aerobic and strength training program and its effects on cognitive and physical function in institutionalized dementia patients. A pilot study

Objectives

We examined the feasibility of a combined aerobic and strength training program in institutionalized dementia patients and studied the effects on cognitive and physical function.

Methods

Thirty-three patients with dementia, recruited from one nursing home, participated in this non-randomized pilot study (25 women; age = 85.2±4.9 years; Mini Mental State Examination = 16.8±4.0). In phase 1 of the study, seventeen patients in the Exercise group (EG) received a combined aerobic and strength training program for six weeks, five times per week, 30 minutes per session, in an individually supervised format and successfully concluded the pre and posttests. In phase 2 of the study, sixteen patients in the Social group (SG) received social visits at the same frequency, duration, and format and successfully concluded the pre and posttests.

Results

Indices of feasibility showed that the recruitment and adherence rate, respectively were 46.2% and 86.3%. All EG patients completed the exercise program according to protocol without adverse events. After the six-week program, no significant differences on cognitive function tests were found between the EG and SG. There was a moderate effect size in favor for the EG for the Visual Memory Span Forward; a visual attention test. There were significant differences between groups in favor for the EG with moderate to large effects for the physical tests Walking Speed (p = .003), Six-Minute Walk Test (p = .031), and isometric quadriceps strength (p = .012).

Conclusions

The present pilot study showed that it is feasible to conduct a combined aerobic and strength training program in institutionalized patients with dementia. The selective cognitive visual attention improvements and more robust changes in motor function in favor of EG vs. SG could serve as a basis for large randomized clinical trials.

Trial Registration

trialregister.nl 1230

Social class differences in physical functions in middle-aged men and women

OBJECTIVE

The objective of the present study is to analyze gender differences and social class gradients in physical functions; and to study whether the social class gradients in physical functions in midlife differed between men and women.

METHOD

This study used traditionally used physical performance tests and we added several tests of vigorous physical functioning (trunk muscle strength and power and sagittal flexibility). We measured reaction time, one-legged balance, sagittal flexibility, jump height, chair rise ability, trunk muscle- and handgrip strength in 5,412 participants aged 50 to 60 years (68.5% men).

RESULTS

We found gender differences and social class gradients for all physical performance tests. We did not find an interaction between social class and gender, indicating that the social gradient in physical functions did not differ between men and women.

DISCUSSION

Including measures of vigorous physical functioning may add to the existing knowledge on development of functional limitation and poorer functional health later in life.

Identifying balance and fall risk in community-dwelling older women: the effect of executive function on postural control

PURPOSE

The mechanisms linking cognition, balance function, and fall risk among older adults are not fully understood. An evaluation of the effect of cognition on balance tests commonly used in clinical practice to assess community-dwelling older adults could enhance the identification of at-risk individuals. The study aimed to determine (1) the association between cognition and clinical tests of balance and (2) the relationship between executive function (EF) and balance under single- and dual-task testing.

METHODS

Participants (24 women, mean age of 76.18 [SD 16.45] years) completed six clinical balance tests, four cognitive tests, and two measures of physical function.

RESULTS

Poor balance function was associated with poor performance on cognitive testing of EF. In addition, the association with EF was strongest under the dual-task timed up-and-go (TUG) test and the Fullerton Advanced Balance Scale. Measures of global cognition were associated only with the dual-task performance of the TUG. Postural sway measured with the Standing Balance Test, under single- or dual-task test conditions, was not associated with cognition.

CONCLUSIONS

Decreased EF was associated with worse performance on functional measures of balance. The relationship between EF and balance was more pronounced with dual-task testing using a complex cognitive task combined with the TUG.

Impact of body mass index on the relationship between muscle quality and physical function in older women

OBJECTIVES

To investigate the impact of body mass index (BMI) (normal weight, overweight, obese) on the relationship between muscle quality (MQ) and physical function in community-dwelling older women.

DESIGN

Cross-sectional study.

SETTING

University research laboratory.

PARTICIPANTS

Community-dwelling older women (n = 94, 73.6 ± 5.4 y) stratified by BMI (normal weight: 20.0-24.9 kg/m2; overweight: 25.0-29.9 kg/m2; obese: ≥ 30.0 kg/m2).

MEASUREMENTS

Body mass index using height and weight, leg extension power via the Nottingham power rig, body composition using dual-energy X-ray absorptiometry, and physical function (6-minute walk, 8-foot up-and-go, 30-second chair stand). Muscle quality was defined as leg power (watts) normalized for lower-body mineral-free lean mass (kg).

RESULTS

Following adjustments for covariates, muscle quality was significantly higher in women of normal BMI compared to overweight (10.0 ± 0.4 vs. 8.7 ± 0.4 watts/kg, p = 0.03). Muscle quality was a significant predictor of performance on the 6-minute walk and 8-foot up-and-go in normal and overweight women (all p < 0.05) and performance on the 30-second chair stand in normal and obese women (both p < 0.05). Body mass index did not significantly impact the association between MQ and physical function (all p > 0.05).

CONCLUSIONS

Muscle quality varies by BMI, yet the relationship to physical function is not significantly different across BMI groups. The results imply that interventions that increase MQ in older women may improve physical function, regardless of BMI.

The efficacy of tourniquet assisted total knee arthroplasty on patient-reported and performance-based physical function: a randomized controlled trial protocol

BACKGROUND

Surgical treatment of osteoarthritis with total knee arthroplasty (TKA) usually takes place in a complete bloodless field using a tourniquet. However, doing the surgery without a tourniquet may reduce muscle damage, post-surgery pain and led to improved functional rehabilitation and mobilization.

METHODS/DESIGN

A prospective, blinded, parallel-group, controlled superiority trial, with balanced randomization [1:1]. Patients aged 50 or older eligible for primary TKA for osteoarthritis will be consecutively recruited from Department of Orthopedic Surgery and Traumatology, Odense University Hospital, Denmark. A total of 80 patients will be randomly allocated to TKA with or without tourniquet application providing 40 patients for each of the two treatment arms. The tourniquet assisted TKA group will have an automatic, micro-processor-based pneumatic tourniquet inflated around the thigh during surgery. The non-tourniquet assisted TKA group will have surgery performed without application of a tourniquet. The primary aim is to compare tourniquet assisted to non-tourniquet assisted TKA on patient-reported physical function (KOOS-ADL). The secondary aim is to compare post-surgery pain, function in sports and recreation, quality of life, and performance-based physical function. The explorative outcomes include; use of pain medication, single-fiber muscle damage, and changes in mechanical muscle function. The primary endpoint will be at 3-months following surgical treatment, and the time-point for analysis of the primary outcome. However, follow-up will continue up to 1 year, and provide medium-term results. The treatment effect (difference in KOOS-ADL) will be analyzed using a random effects regression model, crude and adjusted results will be reported, if needed. Analyses will be based on the intention-to-treat (ITT). Subsequent per-protocol analysis may be necessary in the event of a substantial number of patients (> 15%) being lost during follow-up. The number needed to treat (NNT) for a positive effect of treatment (>10 points on KOOS-ADL) will be reported.

DISCUSSION

This is the first randomized clinical trial comparing the efficacy of tourniquet assisted TKA on patient-reported physical function supported by a range of performance-based secondary outcome measures. As such it will provide high quality evidence that may help determine whether tourniquet should be used in future TKA procedures in patients with osteoarthritis of the knee.

TRIAL REGISTRATION

ClinicalTrials NCT01891266.

Physical performance is associated with working memory in older people with mild to severe cognitive impairment

BACKGROUND

Physical performances and cognition are positively related in cognitively healthy people. The aim of this study was to examine whether physical performances are related to specific cognitive functioning in older people with mild to severe cognitive impairment.

METHODS

This cross-sectional study included 134 people with a mild to severe cognitive impairment (mean age 82 years). Multiple linear regression was performed, after controlling for covariates and the level of global cognition, with the performances on mobility, strength, aerobic fitness, and balance as predictors and working memory and episodic memory as dependent variables.

RESULTS

The full models explain 49-57% of the variance in working memory and 40-43% of episodic memory. Strength, aerobic fitness, and balance are significantly associated with working memory, explaining 3-7% of its variance, irrespective of the severity of the cognitive impairment. Physical performance is not related to episodic memory in older people with mild to severe cognitive impairment.

CONCLUSIONS

Physical performance is associated with working memory in older people with cognitive impairment. Future studies should investigate whether physical exercise for increased physical performance can improve cognitive functioning. This trial is registered with ClinicalTrials.gov NTR1482.

Peak hip and knee joint moments during a sit-to-stand movement are invariant to the change of seat height within the range of low to normal seat height

BACKGROUND

Previous studies have consistently reported that decreasing seat height increases the peak hip and knee joint moments; however, these findings may not apply to biomechanical changes at very low seat heights. The purpose of this study, therefore, was to examine the effect of a large range of seat heights on peak joint moments of the lower limb during a sit-to-stand (STS) movement.

METHODS

Eight healthy young subjects participated in this experiment. Each subject was instructed to stand up from six seat heights (10, 20, 30, 40, 50 and 60 cm). Joint moments were calculated with an inverse dynamics method. The sum of the hip and knee joint moments was used as the index to indicate the mechanical load of the STS movement. The effect of seat height on the mechanical load was examined with both analytical and experimental approaches.

RESULTS

Through the analytical approach, it was revealed that the mechanical load of STS movements from low and normal seat heights (10 to 40 cm) always reaches its peak at or near the posture in which the thigh is horizontally positioned. This finding indicates that the peak value is invariant between the low and normal seat heights. Similar results were also found in the experimental approach. There were few significant differences in the peak mechanical load and the peak hip and knee joint moments between the low and normal seat heights, while they differed significantly between the low and high seat heights.

CONCLUSIONS

This study concluded that, while the peak mechanical load and the peak hip and knee joint moments increase inversely to seat height within the range of high to normal seat height (60 to 40 cm), they are invariant to the change of seat height within the range of low to normal seat height (10 to 40 cm). These findings are useful for the design of chair, the improvement in the evaluation standard of minimum sit-to-stand height tests and the development of new muscular strength test.

Health-related physical fitness measures: reference values and reference equations for use in clinical practice

OBJECTIVE

To provide reference values and reference equations for frequently used clinical field tests of health-related physical fitness for use in clinical practice.

DESIGN

Cross-sectional design.

SETTING

General community.

PARTICIPANTS

Convenience sample of volunteers (N=370) between 18 and 90 years of age were recruited from a wide range of settings (ie, work sites, schools, community centers for older adults) and different geographic locations (ie, urban, suburban, rural) in southeastern Norway.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The participants conducted 5 clinical field tests (6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, fingertip-to-floor test).

RESULTS

The results of the field tests showed that performance remained unchanged until approximately 50 years of age; after that, performance deteriorated with increasing age. Grip strength (79%), meters walked in 6 minutes (60%), and seconds used on the stair test (59%) could be well predicted by age, sex, height, and weight in participants ≥50 years of age, whereas the performance on all tests was less well predicted in participants <50 years of age.

CONCLUSIONS

The reference values and reference equations provided in this study may increase the applicability and interpretability of the 6-minute walk test, stair test, 30-second sit-to-stand test, handgrip test, and fingertip-to-floor test in clinical practice.

Measuring health-related physical fitness in physiotherapy practice: reliability, validity, and feasibility of clinical field tests and a patient-reported measure

STUDY DESIGN

A cross-sectional study with a test-retest design.

OBJECTIVES

To assess measurement properties of the physical fitness questionnaire, the 6-minute walk test, the stair test, the hand-grip test, the 30-second sit-to-stand test, and the fingertip-to-floor test in patients with various musculoskeletal conditions (MSCs).

BACKGROUND

Patients suffering from MSCs tend to be more deconditioned and less physically active than healthy people. Physiotherapists should, therefore, focus on health-related physical fitness in addition to their patients' specific MSCs to offer optimal treatment. To enable good decision making, a core set of feasible measures with acceptable measurement properties is needed.

METHODS

Eighty-one patients with MSCs (57.6 ± 14.2 years of age) were recruited from outpatient physiotherapy clinics. Relative reliability was analyzed with intraclass correlation coefficient model 2,1, and absolute reliability with standard error of measurement and smallest detectable change. Construct validity was assessed with a priori hypotheses. Time spent and assistance needed to accomplish the measures were used to assess feasibility.

RESULTS

The 6-minute walk test, the hand-grip test, and the physical fitness questionnaire showed acceptable reliability (49 m, 4 kg, and 2 points, respectively) and construct validity. The stair test showed acceptable reliability (8 seconds) but not validity. The 30-second sit-to-stand test showed acceptable validity but not reliability (4 sit-to-stands), whereas the fingertip-to-floor test showed neither acceptable reliability (9 cm) nor validity.

CONCLUSION

The 6-minute walk test, the hand-grip test, and the physical fitness questionnaire can be recommended as a core set of reliable and valid measures to assess health-related physical fitness in patients with various MSCs.

Short-term strength training improves muscle quality and functional capacity of elderly women

To assess effects of a short-term strength training (ST) program on muscle quality (MQ) and functional capacity, 36 sedentary elderly women (age = 66.0 ± 8 year, height = 159.1 ± 9.2 cm, body mass = 68.3 ± 12.1 kg, body fat = 37.0 ± 4.2 %) were randomly divided into an experimental group (EG; n = 19) or a control group (CG; n = 17). The EG performed two to three sets of 12-15 repeats of leg press, knee extension, and knee flexion exercises, 2 days/week for 6 weeks. Before and after training, lower body one repetition maximum (1RM), functional performance tests, quadriceps femoris muscle thickness (MT), and muscle quality (MQ) (1RM and quadriceps MT quotient) were assessed. After training, only the EG showed significant improvements in 1RM (p < 0.05), 30-s sit-to-stand (p < 0.001), and 8 foot up-and-go (p < 0.001). In addition, only in the EG, significant increases in all quadriceps femoris MT measurements (vastus lateralis, vastus medialis, vastus intermedius, and rectus femoris) (p ≤ 0.05), and MQ (p < 0.001) were demonstrated. No changes were observed in the CG. Furthermore, there were significant associations between individual changes in MQ and corresponding changes in 30-s sit-to-stand (r = 0.62, p < 0.001), and 8 foot up-and-go (r = -0.71, p < 0.001). In conclusion, a ST program of only 6 weeks was sufficient to enhance MQ of the knee extensors in elderly women, which resulted in beneficial changes in functional capacity.

Subgroups associated with lower physical fitness in older adults with ID: results of the HA-ID study

Although physical fitness is generally very low in older adults with intellectual disabilities (ID), levels may differ across subgroups. It is important to identify which subgroups need to be targeted specifically in physical activity and fitness interventions and reference values. Physical fitness was measured with box-and-block-test, response-time-test, Berg-balance-scale, walking speed, grip strength, 30s-chair-stand, 10 m incremental-shuttle-walking test and the extended modified-back-saver-sit-and-reach-test in a large sample of older adults with ID (n=1050), and subgroups associated with lower physical fitness levels were identified applying multivariate linear regression analyses. Both fixed personal characteristics such as being older, being female, having more severe ID and having Down syndrome and modifiable or preventable factors such as physical activity levels, mobility impairments and a need of more intensive care, are independently associated with lower levels of multiple physical fitness components. This first study identifies subgroups of older adults with ID which require adapted reference values, and subgroups that need to be specifically targeted in fitness promotion programs.

Patients with musculoskeletal conditions do less vigorous physical activity and have poorer physical fitness than population controls: a cross-sectional study

OBJECTIVES

To compare physical activity and physical fitness in patients with various musculoskeletal conditions receiving physiotherapy in primary care with population controls.

DESIGN

Cross-sectional.

PARTICIPANTS

One hundred and sixty-seven patients with musculoskeletal conditions receiving physiotherapy in primary care and 313 population controls from various settings and geographical areas.

MAIN OUTCOME MEASURES

Physical activity was measured with the International Physical Activity Questionnaire short-form (IPAQ-sf) and reported in metabolic equivalents (METs). The 6-minute walk test and 30-second sit-to-stand test reflected cardiorespiratory endurance and muscular strength, respectively.

RESULTS

Differences in physical activity between the groups were explored using the Mann-Whitney U-test. The patient group reported significantly less vigorous activity compared with the control group {median 0 [interquartile range (IQR) 0 to 960] vs median 240 [IQR 0 to 1440] MET minutes/week, respectively)} (P=0.001). A similar proportion of patients (68%) and controls (75%) reached the recommended level of health-enhancing physical activity (P=0.11). Linear regression analyses adjusted for age, body mass index and gender showed significantly poorer fitness in the patient group compared with the control group, reflected by the 6-minute walk test and the 30-second sit-to-stand test {mean difference 69m [95% confidence interval (CI) 52 to 85; P≤0.001] and six repetitions [95% CI 5 to 7; P≤0.001], respectively}.

CONCLUSIONS

Patients with various long-term musculoskeletal conditions receiving physiotherapy in primary care had significantly poorer physical fitness and reported less vigorous physical activity compared with population controls.

The effectiveness of a combined exercise intervention on physical fitness factors related to falls in community-dwelling older adults

This study aimed to evaluate the effectiveness of an innovative exercise program on muscle strength, balance, and gait kinematics in elderly community-dwellers. The exercise program included strength and balance training and the 8-form Tai Chi Chuan. The measurements were carried out at baseline and 12 weeks, and consisted of four physical performance tests, joint isokinetic strength tests, and three-dimensional gait analysis. Fifty-six community-dwelling older adults aged 60–80 years old were randomly assigned to an intervention or control group. After 12 weeks, the intervention group showed a 17.6% improvement in the timed up and go test, accompanied by a 54.7% increase in the 30-second chair stand test score. Significant increases in the score of star excursion balance tests, and the strength of the extensor and flexor muscles at knee and ankle joints were also observed. In addition, the intervention group walked at a faster speed with a longer step length, shorter support phase, and a greater sagittal plane range of motion at the hip and ankle joints. No statistical improvements were seen in the control group. This study provided an effective, evidence-based falls prevention program that can be implemented in community settings to improve physical fitness and reduce fall risks among community-dwelling older adults. The star excursion balance test could be a sensitive measure of physical performance for fall risk assessment in older people.

The Relationship of Knee-Extensor Strength and Rate of Torque Development to Sit-to-Stand Performance in Older Adults

PURPOSE

To investigate the association of knee-extensor strength and power to performance in the 30-second sit-to-stand test (30sSTS) in healthy older adults.

METHOD

In a cross-sectional study of 29 healthy older adults aged 60-82 years (12 male, 17 female), hierarchical regression was used to determine the relationship of knee-extensor concentric and eccentric strength, peak rate of torque development (peak RTD) using isokinetic dynamometry, and momentum variables with the number of sit-to-stand repetitions completed in 30 seconds (30sSTSreps).

RESULTS

Concentric (180°/s) and eccentric (90°/s) knee-extensor strength were significant independent predictors of 30sSTSreps after controlling for physical activity level, height and weight (adjusted R (2)=0.425, p=0.004; adjusted R (2)=0.427, p=0.004 respectively), as was concentric (90°/s) knee-extensor peak RTD (adjusted R (2)=0.424, p=0.004). Peak linear vertical momentum (PLVM) (adjusted R (2)=0.615, p<0.001) accounted for 36% of the variance.

CONCLUSIONS

Generation of PLVM is an important predictor of 30sSTSreps; knee-extensor concentric and eccentric strength and power are associated with improved performance in this common functional task. Focusing on these parameters in exercise interventions may improve functional performance and give insight into specific factors related to success on the test.

Effects of substituting a portion of standard physiotherapy time with virtual reality games among community-dwelling stroke survivors

BACKGROUND

Evidence indicates that the continuation of therapy among community-dwelling stroke survivors improves physical function. Community rehabilitation programmes often face limitations in terms of resources. It is imperative to include new motivational interventions to encourage some level of non-clinician management. The aim of this study was to determine whether there were any changes in physical function and activities of daily living when substituting a portion of the standard physiotherapy time with virtual reality games among community-dwelling stroke survivors.

METHODS

In this controlled trial, the experimental group received 30 minutes of virtual reality balance games in addition to 90 minutes of standard physiotherapy. The control group continued with their two hours of routine standard physiotherapy. Both groups received 12 therapy sessions: two-hour sessions twice per week for six continuous weeks. Changes in physical function, activities of daily living and balance ability were assessed using the Timed Up and Go test, 30-second Sit to Stand test, Timed Ten-Metre Walk test, Six-Minute Walk test and the Barthel Index, and static balance was assessed using a probalance board.

RESULTS

Twenty-eight participants completed post-intervention assessments. The results showed a significant within-subject effect on the Timed Up and Go test: F (1, 26) = 5.83, p = 0.02; and the 30-second Sit to Stand test; F (1, 26) = 13.50, p = 0.001. The between-subject effect was not significant (p > 0.05) for any of the outcome measurements.

CONCLUSION

Substituting a portion of the standard physiotherapy time with virtual reality games was equally effective in maintaining physical function outcomes and activities of daily living among community-dwelling stroke survivors.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trials Register, ACTRN12613000478718.

Effects of recreational soccer in men with prostate cancer undergoing androgen deprivation therapy: study protocol for the 'FC Prostate' randomized controlled trial

BACKGROUND

Androgen deprivation therapy (ADT) is a cornerstone in the treatment of advanced prostate cancer. Adverse musculoskeletal and cardiovascular effects of ADT are widely reported and investigations into the potential of exercise to ameliorate the effects of treatment are warranted. The 'Football Club (FC) Prostate' study is a randomized trial comparing the effects of soccer training with standard treatment approaches on body composition, cardiovascular function, physical function parameters, glucose tolerance, bone health, and patient-reported outcomes in men undergoing ADT for prostate cancer.

METHODS/DESIGN

Using a single-center randomized controlled design, 80 men with histologically confirmed locally advanced or disseminated prostate cancer undergoing ADT for 6 months or more at The Copenhagen University Hospital will be enrolled on this trial. After baseline assessments eligible participants will be randomly assigned to a soccer training group or a control group receiving usual care. The soccer intervention will consist of 12 weeks of training 2-3 times/week for 45-60 min after which the assessment protocol will be repeated. Soccer training will then continue bi-weekly for an additional 20 weeks at the end of which all measures will be repeated to allow for additional analyses of long-term effects. The primary endpoint is changes in lean body mass from baseline to 12 weeks assessed by dual X-ray absorptiometry scan. Secondary endpoints include changes of cardiovascular, metabolic, and physical function parameters, as well as markers of bone metabolism and patient-reported outcomes.

DISCUSSION

The FC Prostate trial will assess the safety and efficacy of a novel soccer-training approach to cancer rehabilitation on a number of clinically important health outcomes in men with advanced prostate cancer during ADT. The results may pave the way for innovative, community-based interventions in the approach to treating prostate cancer.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01711892.

Association of body mass index with physical function and health-related quality of life in adults with arthritis

Arthritis and obesity, both highly prevalent, contribute greatly to the burden of disability in US adults. We examined whether body mass index (BMI) was associated with physical function and health-related quality of life (HRQOL) measures among adults with arthritis and other rheumatic conditions. We assessed objectively measured BMI and physical functioning (six-minute walk, chair stand, seated reach, walking velocity, hand grip) and self-reported HRQOL (depression, stiffness, pain, fatigue, disability, quality of life-mental, and quality of life, physical) were assessed. Self-reported age, gender, race, physical activity, and arthritis medication use (covariates) were also assessed. Unadjusted and adjusted linear regression models examined the association between BMI and objective measures of functioning and self-reported measures of HRQOL. BMI was significantly associated with all functional (Ps ≤ 0.007) and HRQOL measures (Ps ≤ 0.03) in the unadjusted models. Associations between BMI and all functional measures (Ps ≤ 0.001) and most HRQOL measures remained significant in the adjusted models (Ps ≤ 0.05); depression and quality of life, physical, were not significant. The present analysis of a range of HRQOL and objective measures of physical function demonstrates the debilitating effects of the combination of overweight and arthritis and other rheumatic conditions. Future research should focus on developing effective group and self-management programs for weight loss for people with arthritis and other rheumatic conditions (registered on clinicaltrials.gov: NCT01172327).

Fit and Strong! Plus: design of a comparative effectiveness evaluation of a weight management program for older adults with osteoarthritis

Osteoarthritis (OA) is the most common chronic condition and principal cause of disability among older adults. The current obesity epidemic has contributed to this high prevalence rate. Fortunately both OA symptoms and obesity can be ameliorated through lifestyle modifications. Physical activity (PA) combined with weight management improves physical function among obese persons with knee OA but evidence-based interventions that combine PA and weight management are limited for this population. This paper describes a comparative effectiveness trial testing an evidence-based PA program for adults with lower extremity (LE) OA, Fit and Strong!, against an enhanced version that also addresses weight management based on the evidence-based Obesity Reduction Black Intervention Trial (ORBIT). Adult participants (n=400) with LE OA, age 60+, overweight/obese, and not meeting PA requirements of ≥ 150 min per week, are randomized to one of the two programs. Both 8-week interventions meet 3 times per week and include 60 min of strength, flexibility, and aerobic exercise instruction followed by 30 min of education/group discussion. The Fit and Strong! education sessions focus on using PA to manage OA; whereas Fit and Strong! Plus addresses PA and weight loss management strategies. Maintenance of behavior change is reinforced in both groups during months 3-24 through telephone calls and mailed newsletters. Outcomes are assessed at baseline, and 2, 6, 12, 18, and 24 months. Primary outcomes are dietary change at 2 months followed by weight loss at 6 months that is maintained at 24 months. Secondary outcomes assess PA, physical performance, and anxiety/depression.

Muscle strength and physical activity are associated with self-rated health in an adult Danish population

OBJECTIVE

To describe associations of muscle strength, physical activity and self-rated health.

METHOD

Isometric muscle strength by maximal handgrip strength (HGS) or muscle strength by 30s repeated chair stand test (30s-CS) was combined with leisure time physical activity. Using logistic regression odds ratio was calculated for good self-rated health according to the combined associations among 16,539 participants (59.7% women), mean age 51.9 (SD: 13.8) years, from a cross-sectional study in Denmark 2007-2008.

RESULTS

Good self-rated health was positively associated with higher levels of physical activity and greater muscle strength. Regarding HGS the highest OR for good self-rated health was in the moderate/vigorous physically active participants with high HGS (OR=6.84, 95% CI: 4.85-9.65 and OR=7.34, 95% CI: 5.42-9.96 for men and women, respectively). Similarly the highest OR for good self-rated health was in the moderate/vigorous physically active participants with high scores in the 30s-CS test (6.06, 95% CI: 4.32-8.50 and 13.38, 95% CI: 9.59-18.67 for men and women, respectively). The reference groups were sedentary participants with low strength (HGS or 30s-CS).

CONCLUSION

The combined score for physical activity level with either HGS or 30s-CS was strongly positively associated with self-related health.

The effects of a physical exercise programme after radical cystectomy for urinary bladder cancer. A pilot randomized controlled trial

OBJECTIVE

Assessment of feasibility and effects of an exercise training programme in patients following cystectomy due to urinary bladder cancer.

DESIGN

Single-blind, pilot, randomized controlled trial.

SETTING

University hospital, Sweden.

SUBJECTS

Eighteen patients (64-78 years), of 89 suitable, cystectomized due to urinary bladder cancer, were randomized after hospital discharge to intervention or control.

INTERVENTIONS

The 12-week exercise programme included group exercise training twice a week and daily walks. The control group received only standardized information at discharge.

MAIN OUTCOME MEASURES

Trial eligibility and compliance to inclusion were registered. Assessments of functional capacity, balance, lower body strength and health-related quality of life (HRQoL) with SF-36.

RESULTS

Out of 122 patients 89 were eligible, but 64 did not want to participate/were not invited. Twenty-five patients were included, but 7 dropped out before randomization. Eighteen patients were randomized to intervention or control. Thirteen patients completed the training period. The intervention group increased walking distance more than the control group, 109 m (75-177) compared to 62 m (36-119) (P = 0.013), and role physical domain in SF-36 more than the control group (P = 0.031). Ten patients were evaluated one year postoperatively. The intervention group had continued increasing walking distance, 20 m (19-36), whereas the control group had shortened the distance -15.5 m (-43 to -5) (P = 0.010).

CONCLUSIONS

A 12-week group exercise training programme was not feasible for most cystectomy patients. However, functional capacity and the role-physical domain in HRQoL increased in the short and long term for patients in the intervention group compared with controls.

Sustaining Transfers through Affordable Research Translation (START): study protocol to assess knowledge translation interventions in continuing care settings

Background

Bridging the research-practice gap is an important research focus in continuing care facilities, because the population of older adults (aged 65 years and over) requiring continuing care services is the fastest growing demographic among countries in the Organisation for Economic Co-operation and Development (OECD). Unlicensed practitioners, known as health care aides, provide the majority of care for residents living in continuing care facilities. However, little research examines how to sustain health care aide behavior change following initial adoption of current research evidence.

Methods/Design

We will conduct a phase III, multicentre, cluster randomized controlled trial (RCT) using a stratified 2 × 2 additive factorial design, including an embedded process evaluation, in 24 supportive living facilities within the health zone of Edmonton, AB, Canada. We will determine which combination of frequency and intensity of reminders most effectively sustains the completion of the sit-to-stand activity by health care aides with residents. Frequency refers to how often a reminder is implemented; intensity refers to whether a reminder is social or paper-based. We will compare monthly reminders with reminders implemented every 3 months, and we will compare low intensity, paper-based reminders and high intensity reminders provided by a health care aide peer.

Using interviews, questionnaires, and observations, Sustaining Transfers through Affordable Research Translation (START) will evaluate the processes that inhibit or promote the mobility innovation’s sustainability among health care aides in daily practice. We will examine how the reminders are implemented and perceived by health care aides and licensed practical nurses, as well as how health care aides providing peer reminders are identified, received by their peers, and supported by their supervisors.

Discussion

START will connect up-to-date innovation research with the practice of health care aides providing direct care to a growing population of older Albertans. The project’s reach extends to both supportive living and long-term care settings. Furthermore, START has the potential to introduce and sustain a broad range of innovations in various care areas, such as dementia care, wound care, and pain management – domains where the uptake and sustainability of innovations also encounter significant challenges. By identifying the optimal frequency and intensity of knowledge translation interventions, we hope to enable continuing care organizations to efficiently integrate care innovations into the day-to-day care of residents.

Trial registration

ClinicalTrials.gov, NCT01746459

Cancer-related fatigue in breast cancer patients after surgery: a multicomponent model using partial least squares-path modeling

OBJECTIVE

The aim of this study is to examine factors contributing to cancer-related fatigue (CRF) in breast cancer patients who have undergone surgery.

METHODS

Sixty women (mean age: 50.0) completed self-rated questionnaires assessing components of CRF, muscular and cognitive functions. Also, physiological and subjective data were gathered. Data were analyzed using partial least squares variance-based structural equation modeling in order to examine factors contributing to CRF after breast surgery.

RESULTS

The tested model was robust in terms of its measurement quality (reliability and validity). According to the structural model results, emotional distress (β = 0.59; p < 0.001), pain (β = 0.23; p < 0.05), and altered vigilance (β = 0.30; p < 0.05) were associated with CRF, accounting for 61% of the explained variance. Also, emotional distress (β = 0.41; p < 0.05) and pain (β = 0.40; p < 0.05) were related to low physical function and accounted for 41% of the explained variance. However, the relationship between low physical function and CRF was weak and nonsignificant (β = 0.01; p > 0.05).

CONCLUSION

Emotional distress, altered vigilance capacity, and pain are associated with CRF in postsurgical breast cancer. In addition, emotional distress and pain are related to diminished physical function, which, in turn, has no significant impact on CRF. The current model should be examined in subsequent phases of the treatment (chemotherapy and/or radiotherapy) when side effects are more pronounced and may lead to increased intensity of CRF and low physical function.

Optimizing the mobility of residents with dementia: a pilot study promoting healthcare aide uptake of a simple mobility innovation in diverse nursing home settings

BACKGROUND

Almost 90 percent of nursing home residents have some type of mobility limitation. Many spend most of their waking hours lying in bed or sitting. Such inactivity can negatively affect residents' health and general well-being. This pilot study aimed to assess (1) the effect of the sit-to-stand activity on mobility outcomes of nursing home residents, (2) the effect of an audit-and-feedback intervention on uptake of the sit-to-stand activity by healthcare aides, and (3) the contextual factors influencing uptake of the sit-to-stand activity by healthcare aides.

METHODS

This quasi-experimental pilot study was conducted in two nursing homes in western Canada. Twenty-six residents with dementia completed the sit-to-stand activity with 56 healthcare aides during daily care; separately, 71 healthcare aides completed a research use and context survey. Preliminary mobility feedback was presented to healthcare aides in one site. Resident mobility was measured using the 30-second sit-to-stand test. Healthcare aide uptake of the activity was measured using documentation flowsheets and a survey-based measure. Context was measured using the Alberta Context Tool. Mobility and uptake outcomes were analyzed over time and by site with analysis of covariance. Spearman and Pearson correlations were used to correlate context data with research use.

RESULTS

Residents who more frequently completed the sit-to-stand activity were more likely to maintain or improve mobility compared with those who completed it less frequently (F=4.46; p=0.046, after adjustment for age). Uptake for one site was significantly different from the other (t-score=2.67; p=0.01, after adjustment for resident covariates). The audit-and-feedback intervention was associated with increased uptake of the activity from pre-intervention to post-intervention (t-score=-2.48; p=0.02). More context domains correlated significantly with aides' use of conceptual research and information sources in one site than the other.

CONCLUSIONS

The sit-to-stand activity is a promising means to maintain or improve transfer ability of nursing home residents with dementia. In the nursing home with initially weak uptake, strengthened uptake followed an audit-and-feedback intervention. Activity participation was higher in the site with stronger correlations between context and measured research use. Results are sufficiently promising to warrant proceeding with a full clinical trial.

Patient Activation through Counseling and Exercise--Acute Leukemia (PACE-AL)--a randomized controlled trial

BACKGROUND

Patients with acute leukemia experience a substantial symptom burden and are at risk of developing infections throughout the course of repeated cycles of intensive chemotherapy. Physical activity in recent years has been a strategy for rehabilitation in cancer patients to remedy disease and treatment related symptoms and side effects. To date, there are no clinical practice exercise guidelines for patients with acute leukemia undergoing induction and consolidation chemotherapy. A randomized controlled trial is needed to determine if patients with acute leukemia can benefit by a structured and supervised counseling and exercise program.

METHODS/DESIGN

This paper presents the study protocol: Patient Activation through Counseling and Exercise--Acute Leukemia (PACE-AL) trial, a two center, randomized controlled trial of 70 patients with acute leukemia (35 patients/study arm) following induction chemotherapy in the outpatient setting. Eligible patients will be randomized to usual care or to the 12 week exercise and counseling program. The intervention includes 3 hours + 30 minutes per week of supervised and structured aerobic training (moderate to high intensity 70-80%) on an ergometer cycle, strength exercises using hand weights and relaxation exercise. Individual health counseling sessions include a self directed home walk program with a step counter. The primary endpoint is functional performance/exercise capacity (6 minute walk distance). The secondary endpoints are submaximal VO₂ max test, sit to stand and bicep curl test, physical activity levels, patient reported outcomes (quality of life, anxiety and depression, symptom prevalence, intensity and interference). Evaluation of clinical outcomes will be explored including incidence of infection, hospitalization days, body mass index, time to recurrence and survival. Qualitative exploration of patients' health behavior and experiences.

DISCUSSION

PACE-AL will provide evidence of the effect of exercise and health promotion counseling on functional and physical capacity, the symptom burden and quality of life in patients with acute leukemia during out patient management. The results will inform clinical practice exercise guidelines and rehabilitation programs for patients undergoing treatment for acute leukemia. Optimizing the treatment and care pathway may ease the transition for patients from illness to the resumption of everyday activities.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01404520.

Does progressive resistance strength training as additional training have any measured effect on functional outcomes in older hospitalized patients? A single-blinded randomized controlled trial

OBJECTIVE

To evaluate the effect of progressive resistance strength training as additional training measured on functional outcomes in older hospitalized patients.

DESIGN

A single-blinded randomized controlled trial.

SETTING

Department of Geriatric Rehabilitation in university hospital.

PARTICIPANTS

A sample of 71 patients were successively included and randomized either to the treatment group (TG) (n = 36) or the control group (CG) (n = 35). Fifteen participants dropped out (TG n = 7; CG n = 8), leaving 56 participants with a mean age of 79 (SD 7).

INTERVENTION

Participants in the treatment group were treated in groups with progressive resistance strength training in addition to standard care. Progressive resistance strength training of the lower extremities was performed in three sets of 12-15 repetitions, intensity 60-70% of one repetition maximum, in four 50-minute sessions per week.

MAIN MEASURES

The effect was evaluated by timed up & go test, 30-second chair-stand test, 10-m walk test, three tasks (transfer, walking, stairs) of the Barthel Index, and use of walking aids.

RESULTS

Significant improvements in the 10-m walk test (P < 0.01) and Barthel Index (walking) (P = 0.01) were demonstrated within the treatment group but not in the control group. Both groups had significant improvements in timed up & go, 30-second chair-stand (modified) and Barthel Index (transfer and walking). No significant difference was found between groups except for the Barthel Index (stairs) (P = 0.05). Analysis by the mixed-effects model showed that the treatment group improved more than the control group in all outcome variables.

CONCLUSION

The results indicate that for older hospitalized patients progressive resistance strength training as additional training may have an effect compared to standard care, but no statistically significant effects were demonstrated when measured by functional outcomes.

Testing a two step nursing intervention focused on decreasing rehospitalizations and nursing home admission post discharge from acute care

Older adults are at high risk of readmission on discharge from the Acute Medical and Emergency Department (ED). This study examines the effect of a two-stage nursing assessment and intervention to address older adults' uncompensated problems and thus intend to prevent readmission and functional decline. A randomized controlled study was conducted. Included were 271 patients aged 70 and over admitted to an ED. A brief standardized nursing assessment and intervention was carried out after discharge and at follow-up. No effect was found on readmission to hospital, admission to nursing home, or death but the intervention group was less likely to be at risk of depression after 180 days. Whether this method can be recommended needs further study as well as knowledge is needed as to the organization and to reveal older adults' experiences on follow-up after ED stay.

Physical functioning, perceived disability, and depressive symptoms in adults with arthritis

This study investigated how physical functioning and perceived disability are related to depressive symptoms in adults with arthritis (n = 401). Participants self-reported depressive symptoms and disability. Objective measures of physical functioning included the 30-second chair stand test, 6-minute walk test, gait speed, balance, grip strength, and the seated reach test. Separate quantile regression models tested associations between each functional measure and depressive symptoms, controlling for age, gender, race, BMI, self-reported health status, and arthritis medication use. The association between perceived disability and depressive symptoms was also tested. Participants averaged 56.3 ± 10.7 years; 85.8% were women; 64.3% were white. Lower distance in the 6-minute walk test, fewer chair stands, slower gait speed, and greater perceived disability were associated with greater depressive symptoms in unadjusted models (Ps < 0.05). Fewer chair stands and greater perceived disability were associated with more depressive symptoms in adjusted models (Ps < 0.05). Balance, grip strength, and seated reach were not related to depressive symptoms. The perception of being disabled was more strongly associated with depressive symptoms than reduced physical functioning. To reduce the risk of depression in arthritic populations, it may be critical to not only address physical symptoms but also to emphasize coping skills and arthritis self-efficacy.

Força de membros inferiores como indicador de incapacidade funcional em idosos

O propósito deste estudo foi discriminar a quantidade de repetições no teste sentar e levantar da cadeira na estimativa da incapacidade funcional. Estudo epidemiológico de corte transversal com amostra probabilística de 622 indivíduos, idade > 60 anos. A capacidade funcional autopercebida foi analisada como variável dicotômica: ausência de dependência versus dependência na realização de atividade básicas (ABVD) e instrumentais da vida diária (AIVD). Aplicou-se o teste sentar e levantar da cadeira durante 30 segundos (número de repetições máximas) para avaliar a força de membros inferiores. O teste mostrou-se como discriminador da incapacidade funcional devido os valores apresentados pelas áreas sob as curvas ROC serem >0,60. O ponto de corte para determinar a incapacidade funcional nas ABVD foi < 10 repetições (homens) e < 9 repetições (mulheres); nas AIVD < 14 repetições (homens) e < 10 repetições (mulheres). A força de membros inferiores pode ser utilizada como preditor da incapacidade funcional nas ABVD e AIVD.

Population-based reference values for the 1-min sit-to-stand test

OBJECTIVES

To determine reference values for the 1-min sit-to-stand (STS) test in an adult population.

METHODS

Cross-sectional study nested within a nationwide health promotion campaign in Switzerland. Adults performed the STS test and completed questions on demographics and health behavior.

RESULTS

6,926 out of 7,753 (89.3 %) adults were able to complete the STS test. The median number of repetitions ranged from 50/min (25-75th percentile 41-57/min) in young men and 47/min (39-55/min) in young women aged 20-24 years to 30/min (25-37/min) in older men and 27/min (22-30/min) in older women aged 75-79 years.

CONCLUSIONS

The reference values support the interpretation of 1-min STS test performance and identification of subjects with decreased lower body muscular strength and endurance.

The influence of sprint interval training on body composition, physical and metabolic fitness in adolescents and young adults with intellectual disability: a randomized controlled trial

OBJECTIVE

In this study we evaluated the effect of sprint interval training on metabolic and physical fitness in adolescents and young adults with intellectual disabilities when compared with continuous aerobic training and no training (control).

METHODS

Fifty-four persons with intellectual disabilities (age: 17 (3.0), body mass index: 27.7 (3.7), intelligence quotient: 59 (8.6)) were matched based on age, gender and intelligence quotient between sprint interval training (n = 17), continuous aerobic training (n = 15) and control (n = 14). Sprint interval training was composed of three blocks of 10 minutes at ventilatory threshold (blocks 1 and 3: 10 sprint bouts of 15 seconds, followed by 45 seconds relative rest; block 2: continuous training) twice a week for 15 weeks. Continuous aerobic training was composed of three blocks of 10 minutes continuous training. After eight weeks, intensity was increased to 110% of ventilatory threshold. The control group did not participate in supervised exercise training. Before and after the training period, body composition, physical and metabolic fitness were evaluated.

RESULTS

Sprint interval training showed a significant positive evolution for waist circumference, fat%, systolic blood pressure, lipid profile, fasting insulin, homeostasis model assessment of insulin resistance, peak VO2, peak Watt, ventilatory threshold, 6-minute walk distance and muscle fatigue resistance when compared with no training (P < 0.01). The sprint interval training group demonstrated significant improvements for fat%, systolic blood pressure, low-density lipoprotein, fasting insulin, peak VO2 and peak power and ventilatory threshold (P < 0.01) when compared with continuous aerobic training.

CONCLUSION

In this study we could observe that sprint interval training has stronger beneficial effects on body composition, physical fitness and metabolic fitness compared with control. Compared with continuous aerobic training, sprint interval training seems to result in better outcome.

An evaluation of the 30-s chair stand test in older adults: frailty detection based on kinematic parameters from a single inertial unit

BACKGROUND

A growing interest in frailty syndrome exists because it is regarded as a major predictor of co-morbidities and mortality in older populations. Nevertheless, frailty assessment has been controversial, particularly when identifying this syndrome in a community setting. Performance tests such as the 30-second chair stand test (30-s CST) are a cornerstone for detecting early declines in functional independence. Additionally, recent advances in body-fixed sensors have enhanced the sensors' ability to automatically and accurately evaluate kinematic parameters related to a specific movement performance. The purpose of this study is to use this new technology to obtain kinematic parameters that can identify frailty in an aged population through the performance the 30-s CST.

METHODS

Eighteen adults with a mean age of 54 years, as well as sixteen pre-frail and thirteen frail patients with mean ages of 78 and 85 years, respectively, performed the 30-s CST while their trunk movements were measured by a sensor-unit at vertebra L3. Sit-stand-sit cycles were determined using both acceleration and orientation information to detect failed attempts. Movement-related phases (i.e. impulse, stand-up, and sit-down) were differentiated based on seat off and seat on events. Finally, the kinematic parameters of the impulse, stand-up and sit-down phases were obtained to identify potential differences across the three frailty groups.

RESULTS

For the stand-up and sit-down phases, velocity peaks and "modified impulse" parameters clearly differentiated subjects with different frailty levels (p < 0.001). The trunk orientation range during the impulse phase was also able to classify a subject according to his frail syndrome (p < 0.001). Furthermore, these parameters derived from the inertial units (IUs) are sensitive enough to detect frailty differences not registered by the number of completed cycles which is the standard test outcome.

CONCLUSIONS

This study shows that IUs can enhance the information gained from tests currently used in clinical practice, such as the 30-s CST. Parameters such as velocity peaks, impulse, and orientation range are able to differentiate between adults and older populations with different frailty levels. This study indicates that early frailty detection could be possible in clinical environments, and the subsequent interventions to correct these disabilities could be prescribed before further degradation occurs.

OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis

OBJECTIVES

To recommend a consensus-derived set of performance-based tests of physical function for use in people diagnosed with hip or knee osteoarthritis (OA) or following joint replacement.

METHODS

An international, multidisciplinary expert advisory group was established to guide the study. Potential tests for consideration in the recommended set were identified via a survey of selected experts and through a systematic review of the measurement properties for performance-based tests. A multi-phase, consensus-based approach was used to prioritize and select performance-based tests by applying decision analysis methodology (1000Minds software) via online decision surveys. The recommended tests were chosen based on available measurement-property evidence, feasibility of the tests, scoring methods and expert consensus.

RESULTS

Consensus incorporated the opinions of 138 experienced clinicians and researchers from 16 countries. The five tests recommended by the advisory group and endorsed by Osteoarthritis Research Society International (OARSI) were the 30-s chair-stand test, 40 m fast-paced walk test, a stair-climb test, timed up-and-go test and 6-min walk test. The first three were recommended as the minimal core set of performance-based tests for hip or knee OA.

CONCLUSION

The OARSI recommended set of performance-based tests of physical function represents the tests of typical activities relevant to individuals diagnosed with hip or knee OA and following joint replacements. These tests are complementary to patient-reported measures and are recommended as prospective outcome measures in future OA research and to assist decision-making in clinical practice. Further research should be directed to expanding the measurement-property evidence of the recommended tests.

Early adaptations to eccentric and high-velocity training on strength and functional performance in community-dwelling older adults

The authors examined whether an eccentric training program or a high-velocity training program was more beneficial in regards to function and strength. Nineteen community-dwelling older adults, between the ages of 65 and 89 years, from a local senior center participated in the 8-week exercise program. All participants were randomly assigned to either an eccentric or a high-velocity training group. A doubly multivariate analysis of variance with 1 between-subjects factor and repeated measures was used to examine group and time differences. This analysis revealed that no differences existed between the groups (p > 0.05). However, there were within-group differences for both the high-velocity and the eccentric groups. For both groups, walking speed, 8-ft up-and-go time, chair stand, leg extension strength, leg curl strength, and leg press strength increased from preintervention to postintervention (p < 0.05). This suggests that a high-velocity training program provides similar results as an eccentric training program but with less total work. The eccentric training group trained at a higher percentage of their 1RM and tested with higher loads, which may suggest that a longer exercise program would show the eccentric training group to be stronger and more functional. Fitness practitioners dealing with an older adult population should focus on training with all types of training velocities. Not only are these types of training modalities safe for this population but they also can improve their ability to perform activities of daily living.

Physical performance in recently aged adults after 6 weeks traditional Thai dance: a randomized controlled trial

Background

Exercise has been shown to be effective in cardiovascular endurance in the elderly. We studied the effect of Thai dancing on physical performance of Thai elderly.

Methods

This was an open-labeled, randomized intervention study. The Thai dancing group exercised for 40 minutes three times a week for 6 weeks. Physical performance ability was the primary outcome, including a 6-minute walk test (6MWT), five-times sit-to-stand (FTSST), and a sit-and-reach test measured before and after 6 weeks of intervention.

Results

There were 42 subjects enrolled in the study, and 38 female subjects completed (20 in Thai dance group, 18 controls), with an average age of 65.8 ± 5.1 years. The Thai dance group had significantly better physical performance in all measurements at the end of the study. The 6MWT was longer (416.7 ± 58.7 versus 345.7 ± 55.1 m; P = 0.011), FTSST was quicker (10.2 ± 1.5 versus 14.4 ± 3.3 seconds; P < 0.001), and flexibility was higher (14.9 ± 3.5 versus 11.1 ± 5.7 cm; P = 0.002) in the Thai dance group than the control group.

Conclusion

Thai dance can improve physical performance in recently aged (elderly) female adults.

Resveratrol blunts the positive effects of exercise training on cardiovascular health in aged men

Ageing is thought to be associated with decreased vascular function partly due to oxidative stress. Resveratrol is a polyphenol, which in animal studies has been shown to decrease atherosclerosis, and improve cardiovascular health and physical capacity, in part through its effects on Sirtuin 1 signalling and through an improved antioxidant capacity. We tested the hypothesis that resveratrol supplementation enhances training-induced improvements in cardiovascular health parameters in aged men. Twenty-seven healthy physically inactive aged men (age: 65 ± 1 years; body mass index: 25.4 ± 0.7 kg m(-2); mean arterial pressure (MAP): 95.8 ± 2.2 mmHg; maximal oxygen uptake: 2488 ± 72 ml O2 min(-1)) were randomized into 8 weeks of either daily intake of either 250 mg trans-resveratrol (n = 14) or of placebo (n = 13) concomitant with high-intensity exercise training. Exercise training led to a 45% greater (P < 0.05) increase in maximal oxygen uptake in the placebo group than in the resveratrol group and to a decrease in MAP in the placebo group only (-4.8 ± 1.7 mmHg; P < 0.05). The interstitial level of vasodilator prostacyclin was lower in the resveratrol than in the placebo group after training (980 ± 90 vs. 1174 ± 121 pg ml(-1); P < 0.02) and muscle thromboxane synthase was higher in the resveratrol group after training (P < 0.05). Resveratrol administration also abolished the positive effects of exercise on low-density lipoprotein, total cholesterol/high-density lipoprotein ratio and triglyceride concentrations in blood (P < 0.05). Resveratrol did not alter the effect of exercise training on the atherosclerosis marker vascular cell adhesion molecule 1 (VCAM-1). Sirtuin 1 protein levels were not affected by resveratrol supplementation. These findings indicate that, whereas exercise training effectively improves several cardiovascular health parameters in aged men, concomitant resveratrol supplementation can blunt these effects.