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

Relationship between sit-to-stand movements and physical function in healthy older adults: Testing duration power and displacement velocities for A 30-second chair-rise test

BACKGROUND

Standard assessment of physical function commonly involves evaluation of gait speed, balance, duration of repetitive sit-to-stand movements using the 5-times chair-rise test (CRT-5), and handgrip strength (HGS). However, reports involving longer versions of stand-alone sit-to-stand tests to evaluate functional fitness in older adults are hard to find in literature.

PURPOSE

To investigate the strength of within-group relationships between duration, power and velocity using a 30-s chair-rise test (CRT-30) and physical performance, and to assess between-group differences in these relationships, in a large cohort of older adults.

METHODS

Study participants (n = 73; age-range: 28-93 years; females: 50 males: 23) performed a longer protocol (CRT-30) at maximum voluntary speed. Chair-rise power (CRP), sit-to-stand (concentric) and stand-to-sit (eccentric) velocities were measured during trials. Anthropometric, Short Physical Performance Battery (SPPB) and HGS data collected with CRT-30 variables were analyzed in participants divided into three subsets (<50, 50-70 & >70 years).

RESULTS

Between-group differences significantly varied between CRT-30 measurements. CRT-30 duration, power and velocities demonstrated strong within-group correlations with SPPB and HGS measures, especially in the >70-year age-group (p < 0.01). CRT-30 and physical performance variables also showed significant between-group differences, especially for the >70 years age group.

CONCLUSION

CRT variables such as duration, power, sit-to-stand and stand-to-sit velocities exhibit stronger relationships with markers of physical function, especially in older adults.

Multimodal respiratory muscle training and Tai Chi intervention with healthy older adults: A double-blind randomised placebo control trial

BACKGROUND

The World Health Organization reported that one of the major challenges for all countries in the next few years will be the development of preventive approaches to care for older adults. After COVID-19, multimodal interventions have been created to enhance older health, especially targeting respiratory muscles (e.g., inspiratory muscle training [IMT]). The following research aims to explore the combination of two interventions (IMT and Tai Chi) using a randomised, double-blind placebo approach.

METHODS

A total of 30 participants were recruited from the local community in Derby (UK) and underwent an experimental (IMT + Tai Chi) or placebo (sham-IMT + Tai Chi) training protocol. Measurements of balance (i.e., mini-BEST), inspiratory muscle strength (i.e., Maximal Inspiratory Pressure) and mobility (i.e., 6 Minutes Walking Test) were collected at baseline and after 8 weeks.

RESULTS

The results show that a combination of IMT and Tai Chi significantly improves dynamic balance (P < 0.01) and mobility (P < 0.05) when compared to Tai Chi alone, with an additional positive correlation between balance, mobility and inspiratory muscle strength (P < 0.05).

CONCLUSION

The manuscript is the first to report the combined effects of IMT and Tai Chi in older adults following rigorous methods. The results highlight the relationship between inspiratory muscle and balance, as the results demonstrate a potential link between metaboreflex and balance control, fostering multimodal practices for healthy ageing interventions.

Resistance exercise combined with protein supplementation for skeletal muscle mass in people with pancreatic cancer undergoing neoadjuvant chemotherapy: Study protocol for the REBUILD trial

BACKGROUND

Pancreatic cancer patients' prognosis may be limited by two conditions, cachexia and sarcopenia. Resistance exercise and protein supplementation are safe non-pharmacological strategies that may increase or preserve skeletal muscle mass within this population. Therefore, the primary aim of this study is to examine the feasibility of a home-based virtually supervised resistance exercise intervention, with or without protein supplementation in pancreatic cancer patients initiating neoadjuvant chemotherapy. This intervention may also maintain skeletal muscle mass and improve plasma biomarkers associated with muscle tissue wasting, physical function and psychological measures.

METHODS

We aim to recruit 45 patients with locally advanced pancreatic cancer initiating neoadjuvant chemotherapy. Patients will be randomized to receive either Resistance Exercise (RE) (n = 15), Resistance Exercise and Protein Supplementation (RE + PS) (n = 15), or Attention Control (AC) (n = 15). Patients randomized to RE or RE + PS will receive 16-weeks of home-based virtually supervised resistance exercise. The AC will receive a 16-week stretching program. Primary and secondary outcomes will be measured at baseline and after 16 weeks during study visits.

DISCUSSION

The REBUILD trial is the first randomized controlled trial that combines resistance exercise with daily protein supplementation during neoadjuvant chemotherapy in pancreatic cancer patients. Our novel home-based virtually supervised exercise intervention seeks to mitigate barriers to participation in this vulnerable population. Furthermore, results of this trial will address important research gaps associated with pancreatic cancer-related cachexia, a condition closely connected with poor prognosis and mortality.

Smartphone delivered social media-based rehabilitation for people with COPD in Thar Desert, India: A feasibility study

BACKGROUND

Pulmonary telerehabilitation offers an accessible and cost-effective therapy option for patients with chronic respiratory diseases. In the Thar Desert, home to 16.6 million people with a population density of 83 persons per square kilometre, transportation barriers to tertiary care increase the demand for telerehabilitation services.

OBJECTIVE

To assess the feasibility of smartphone and social media-based rehabilitation for COPD patients in the Thar Desert, India.

METHODS

COPD patients were recruited from a tertiary hospital's outpatient department. Rehabilitation videos in Hindi were provided through smartphones via social media. Key assessments included the COPD Assessment Test (CAT), EQ-5D-3L, mMRC dyspnoea scale, 6-minute walk test and 30-second sit-to-stand test at baseline and 8 weeks. Usability, acceptability and adherence were measured using the System Usability Scale (SUS) and Technology Acceptance Model (TAM) at 8 weeks, with follow-up on exercise adherence after 1 year.

RESULTS

Of the 54 COPD patients assessed, 45 were recruited (mean age 64.18, 86.7% male). Statistically significant improvements (P < 0.05) were observed in mMRC, EQ-5D-3L, CAT and 6-minute walk test scores. High acceptability was noted, with a mean SUS score of 81.5/100 and TAM score of 93.93/128. After 8 weeks, 75.5% of participants were exercising, with 58% maintaining routines 1 year later.

CONCLUSION

Smartphone-based pulmonary telerehabilitation is feasible for COPD patients in the Thar Desert, demonstrating high acceptability even in low-literacy populations. Further trials in diverse settings are recommended.

Longitudinal trajectories of disability index and associated factors in Chinese older adults

BACKGROUND

As the global population ages, understanding the trajectories of disability in older adults is crucial for improving health outcomes and quality of life. This study aimed to identify patterns of disability index trajectories and associated factors influencing these trajectories in older adults.

METHODS

A total of 3,227 older adults aged 60 years and older were recruited from four waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018). We used group-based trajectory model to jointly estimate trajectories of disability index and attrition probability, while assessing baseline factors associated with the trajectory membership.

RESULTS

Our findings revealed four distinct trajectories of disability index: slightly limited-gradual deterioration (n = 1661, 51.5%), fluctuating change (n = 588, 18.2%), slightly limited-substantial deterioration (n = 397, 12.3%), and stable severely limited (n = 581, 18.0%). Women, unmarried, lower educational level, living in rural areas, no pension, comorbidity, poor self-rated health, a history of falls, short sleep duration, inadequate social activity, weakness, slowness, and poor chair standing were significantly associated with a higher probability of being in poorer disability index trajectories.

CONCLUSIONS

This study highlights the heterogeneity of disability index trajectories in older adults and the multifaceted factors that influence them. Our findings underscore the importance of targeting early prevention or intervention based on the determinants of these trajectories to individual needs to maintain or delay the rate of deterioration of disability in older adults.

3D Mitochondrial Structure in Aging Human Skeletal Muscle: Insights Into MFN-2-Mediated Changes

Age-related skeletal muscle atrophy, known as sarcopenia, is characterized by loss of muscle mass, strength, endurance, and oxidative capacity. Although exercise has been shown to mitigate sarcopenia, the underlying governing mechanisms are poorly understood. Mitochondrial dysfunction is implicated in aging and sarcopenia; however, few studies explore how mitochondrial structure contributes to this dysfunction. In this study, we sought to understand how aging impacts mitochondrial three-dimensional (3D) structure and its regulators in skeletal muscle. We hypothesized that aging leads to remodeling of mitochondrial 3D architecture permissive to dysfunction and is ameliorated by exercise. Using serial block-face scanning electron microscopy (SBF-SEM) and Amira software, mitochondrial 3D reconstructions from patient biopsies were generated and analyzed. Across five human cohorts, we correlate differences in magnetic resonance imaging, mitochondria 3D structure, exercise parameters, and plasma immune markers between young (under 50 years) and old (over 50 years) individuals. We found that mitochondria are less spherical and more complex, indicating age-related declines in contact site capacity. Additionally, aged samples showed a larger volume phenotype in both female and male humans, indicating potential mitochondrial swelling. Concomitantly, muscle area, exercise capacity, and mitochondrial dynamic proteins showed age-related losses. Exercise stimulation restored mitofusin 2 (MFN2), one such of these mitochondrial dynamic proteins, which we show is required for the integrity of mitochondrial structure. Furthermore, we show that this pathway is evolutionarily conserved, as Marf, the MFN2 ortholog in Drosophila, knockdown alters mitochondrial morphology and leads to the downregulation of genes regulating mitochondrial processes. Our results define age-related structural changes in mitochondria and further suggest that exercise may mitigate age-related structural decline through modulation of mitofusin 2.

Muscle strengthening in individuals with Amyotrophic Lateral Sclerosis: a systematic review with meta-analyses

Despite the observed benefits of properly prescribed exercises for people with Amyotrophic Lateral Sclerosis (ALS), the scarcity of studies and lack of consensus on the effects of muscle-strengthening exercises on this population has a negative impact on their rehabilitation. This study aimed to evaluate the effects of muscle-strengthening interventions in individuals with ALS. This systematic review of intervention studies included clinical trials that performed non-respiratory muscle strengthening in people with ALS compared to non-strengthening interventions, usual care, or placebo. Such studies were obtained from the MEDLINE, EMBASE, Cochrane Library, SPORTDiscus, and Physiotherapy Evidence Database databases, with no language or publication date restrictions. The outcomes considered were peripheral muscle strength, functionality, fatigue, and adverse events. The Physiotherapy Evidence Database scale was used to analyze the risk of bias, while the Grading of Recommendations Assessment, Development and Evaluation system was used to evaluate the quality of the evidence. Searches were conducted in October 2023 and eight studies were included, totaling 296 individuals. Seven of the eight studies showed superiority of the experimental intervention over the control, but this was not supported in the meta-analyses. Small sample size and high heterogeneity in the primary studies contributed significantly to the low quality of the evidence. There was no evidence of the superiority of interventions for muscle strengthening compared to interventions not aimed at strengthening, usual care, or placebo in terms of the outcomes analyzed immediately after the intervention. The quality of the evidence ranged from low to very low. Five of the studies evaluated adverse events, without reporting serious events. Interventions for muscle strengthening did not prove to be more effective when compared to the control group in the short term nor seem to produce serious adverse events. The low quality of the evidence indicates the need for studies with greater methodological rigor in this population, to more assertively assess the impacts of this intervention over the short, medium, and long term.

"The effect of aerobic exercise on bone formation and resorption markers and the quality of life tests in postmenopausal osteopenic patients"

The aim of the current study was to examine the effects of light- to moderate intensity aerobic exercise on bone mineral density (BMD) in postmenopausal osteopenic women by using bone formation and resorption markers. In the current study, P1NP and CTX levels increased in both the exercise and the control group. The aim of the current study was to examine the effects of light- to moderate-intensity aerobic exercise on bone mineral density (BMD) in postmenopausal osteopenic women by using rapidly responsive bone formation and resorption markers.

PURPOSE

In this prospective, randomized, controlled, single-blind clinical study, women aged 45-65 years with BMD T scores between - 1 and - 2.5 measured by double X-ray absorptiometry (DXA) were included after evaluation of exclusion criteria and the women were divided into 2 groups: aerobic exercise group and control group (exercise, n = 25; control, n = 25). At baseline and at the 12-week follow-up, the serum levels of bone formation and resorption biomarkers, including procollagen type 1 N-terminal propeptide (P1NP), cross-linked C-telopeptide of type I collagen (CTX), osteocalcin, oxidative markers such as malondialdehyde, nonbone-specific total alkaline phosphatase, 25(OH)D3, and parathyroid hormone (PTH), were examined in all patients.

RESULTS

A statistically significant increase in P1NP and CTX levels was noted in both the exercise and control groups at the 12-week evaluation compared to baseline (p > 0.05). Although there was no significant change in osteocalcin levels in the control group (p > 0.05), a statistically significant increase was observed in the exercise group (p < 0.05). In the exercise group, no significant changes were observed in bone formation or resorption markers, including P1NP, CTX, osteocalcin, and total ALP, or in oxidative stress markers, such as malondialdehyde, compared to those in the control group (p > 0.05).

CONCLUSION

In conclusion, the current study revealed that regular walking exercise of light to moderate intensity significantly contributes to improvements in pain, walking speed, balance, lower extremity dynamic balance, and activities of daily living in postmenopausal women with osteopenia compared to inactive individuals.

TRIAL REGISTRATION

Clinical Trial Number NCT06866561.

Effects of low-frequency vibration training on walking ability and body composition among older adults: a randomized controlled trial

Background

As life expectancy rises, age-related decline in mobility and physical function poses challenges for older adults. While traditional exercise can help, limitations and injury risks persist. This study explores low-frequency vibration training as a potential alternative to improve walking ability and body composition in older adults.

Methods

A lottery was used to randomly assign 50 participants (mean age 80.08 years) to either a vibration group (n = 25, 10 males, 15 females) or a control group (n = 25, 11 males, 14 females). While the control group continued their regular daily schedule, the vibration group completed 8 weeks of low-frequency vibration training (frequency: 4-13 Hz; amplitude: two mm), three sessions per week, with each session lasting 20-30 minutes. The walk ability was assessed using the 30-second Chair Stand Test (30-s CST), Timed Up and Go (TUG), and six-meter (six m) walk speed, while body composition was measured via body mass index (BMI), body fat percentage, and waist circumference (WC), hip circumference (HC), and waist-to-hip ratio (WHR).

Results

Low-frequency vibration training significantly increased walking speed in the six m walk speed (F (1,36) = 4.50, p = 0.04, η p 2 = 0.11) and TUG (z =  - 2.72, p = 0.007), compared with the control group. Observed improvements on the 30-s CST were not statistically significant (F (1,36) = 0.05, p = 0.81, η p 2 = 0.002). In the WC, the effect of time (F (1,36) = 7.19, p = 0.01, η p 2 = 0.16) was significant. The main effect of the group for HC (F (1,36) = 0.06, p = 0.80, η p 2 = 0.002) and WHR (F (1,36) = 2.00, p = 0.16, η p 2 = 0.05) were not significant, but the interaction effects for HC (F (1,36) = 6.37, p = 0.01, η p 2 = 0.15) and WHR (F (1,36) = 9.08, p = 0.005, η p 2 = 0.20) were significant. However, the intervention showed no statistically significant effects on BMI and body fat percentage.

Conclusion

Low-frequency vibration training significantly enhanced walking speed and WHR in older adults. This low-intensity intervention is especially beneficial for those with exercise limitations or a high risk of injury. Although its effects on BMI and body fat percentage were limited, the study offers valuable insights for developing personalized vibration training programs.

The efficacy of high-intensity laser and short-wave diathermy both combined with exercises in patients with knee osteoarthritis: a randomized comparative study

The present study aimed to investigate the effects of high-intensity laser therapy and short-wave diathermy, both with exercise, on pain, physical function, and quality of life in patients with knee osteoarthritis and compare the efficacy of these modalities. This head-to-head randomized study included sixty patients diagnosed with primary knee osteoarthritis (OA) according to the American College of Rheumatology (ACR) criteria and radiologically evaluated as Kellgren-Lawrence stages 2 and 3 bilateral OA patients were divided into two groups according to the therapy: high-intensity laser (HILT) with exercise (n = 30) and short-wave diathermy (SWD) with exercise (n = 30) in which patients treated for 2 weeks (5 days a week for a total of 10 sessions). Visual Analogue Scale (VAS), The Western Ontario and McMaster Universities Arthritis Index (WOMAC), Timed Up and Go, Stair Climb, 30-s chair-stand, 40-meter Fast-paced Walk, and Short Form Survey (SF-36) tests were performed before and after treatments. Compared to pretreatment, HILT + exercise therapy improved all the test results, while SWD + exercise therapy also improved test scores except for the 30-s chair-stand and 40-meter Fast-paced Walk tests. When HILT + exercise therapy was compared with SWD + exercise therapy, HILT treatment was more effective in all tests except the Stair Climb and 40-meter Fast-paced Walk tests. Although the treatments applied with exercise were effective in both groups, HILT was more effective than SWD in terms of pain, physical, functional, and quality of life. HILT was recommended in the treatment plan of patients with stage 2-3 knee osteoarthritis.

Stair climb muscle power is associated with gait speed, sit-to-stand performance, patient-reported outcomes and objective measures of mechanical muscle function in individuals with knee osteoarthritis - secondary analysis from an RCT

BACKGROUND

Mechanically measured leg extensor muscle power (LEP) predicts functional performance, patient-reported outcomes (PROMs) and mechanical muscle function in patients with knee osteoarthritis (OA). The stair climb test (SCT) have been used to assess LEP in clinical populations, but the relationship between SCT derived LEP and functional- and self-reported outcome measures in patients with knee-OA remains unknown.

OBJECTIVES

To investigate the relationship between LEP derived from SCT, and patient-reported outcomes (PROMs), functional performance, knee extensor muscle strength (MVIC), rate of force development (RFD) and Nottingham LEP in individuals with knee-OA.

DESIGN

Cross-sectional study.

METHOD

SCT power was obtained in 96 knee-OA patients (age 56.9 ± 7.7 yr. males n = 47, females n = 49). The dependent variable was SCT power, while independent variables included 4 × 10 m fast-paced walk (4x10m-FWT), sit-to-stand (STS), STS power, KOOS, Oxford Knee Score (OKS), LEP, MVIC, and RFD.

RESULTS

There were strong correlations (r = 0.72-0.80, p < 0.01) between SCT power and 4x10m-FWT and STS. There were weak-to-moderate correlations (r = 0.22-0.42, p < 0.05) between SCT power versus OKS and all KOOS subscales. Moderate correlations were observed between SCT power and Nottingham LEP, MVIC, and RFD (r = 0.53-0.64, p < 0.01).

CONCLUSIONS

SCT power correlates positively with functional performance, PROMs and mechanical lower limb muscle function in male and female individuals with knee-OA.

Comparative effectiveness of Tuina therapy versus manual physical therapy for knee osteoarthritis: a randomized controlled trial

BACKGROUND

Tuina therapy (Tuina) is commonly utilized for managing knee osteoarthritis (KOA), yet the available evidence is limited. This study aimed to evaluate the effectiveness of Tuina compared to widely accepted manual physical therapy (mPT) for patients with KOA.

METHODS

Between Oct 2019 and Oct 2021, patients with KOA (Kellgren-Lawrence score II or III) were randomly assigned in a 1:1 ratio to receive Tuina or mPT, with eight 20-min sessions over 3 weeks. Assessments were performed at baseline, week 4, 8, and 16. The primary outcome was the change of total Western Ontario and McMaster University Osteoarthritis Index (WOMAC) from baseline to week 4. Secondary outcomes included WOMAC subscales, knee pain measures, performance-based tests, quality-of-life measures, and safety assessments. Patients, evaluators, and statisticians were blinded to treatment group assignment. All main analyses were by intention-to-treat.

RESULTS

Of the 140 patients allocated to Tuina or mPT, 127 completed the treatment. There was significant intervention × time interaction observed in the WOMAC-total (F(2, 266) = 3.87, P = 0.02), there was no statistically significant between groups at week 4 (between-group difference: -1.00, 95%CI: -5.33 to 3.33, P = 0.79, Bonferroni correction). By week 8, Tuina showed significantly consistent improvement compared to mPT (between-group difference: -4.33, 95%CI: -8.34 to -0.31, P = 0.03, Bonferroni correction), whereas there were no statistically significant differences between groups at week 16 (between-group difference: 0.74, 95%CI: -3.67 to 5.15, P = 0.37, Bonferroni correction). Most secondary outcomes showed no significant between-group differences, except for the Timed Up and Go Test Time favoring mPT (0.94, 95%CI: 0.03 to 1.85, P = 0.04). No serious adverse events occurred. One patient in the mPT group took the medication and no patients received other therapies for KOA.

CONCLUSIONS

Tuina produced beneficial effectiveness similar to mPT in treating KOA.

TRIAL REGISTRATION

NCT03966248, Registered on 29/05/2019, ClinicalTrials.gov.

Analysis of potential categories of quality of life of transcatheter aortic valve replacement patients and discussion of their influencing factors

BACKGROUND

The prevalence of aortic valve stenosis is on the rise, primarily due to an aging population. Transcatheter Aortic Valve Replacement (TAVR) has emerged as an effective treatment option, especially for patients at high surgical risk. However, the variation in post-TAVR quality of life across patient groups warrants further examination to understand the contributing factors.

OBJECTIVE

This study aims to evaluate the quality of life in patients post-TAVR, characterize distinct patient group profiles, and identify key factors that influence their quality of life.

METHODS

From July 2023 to September 2024, 215 TAVR patients were recruited via convenience sampling. Data on sociodemographics and quality of life were gathered using the TAVR-specific quality of life scale. Latent variable growth modeling helped identify quality of life categories and predict influencing factors.

RESULTS

Three categories of TAVR patients were identified based on quality of life: the "High quality of life-high health status" group, the "Medium quality of life-intermediate health" group, and the "Low quality of life-low health status" group. Logistic regression analysis revealed that sleep quality, self-efficacy, and performance on the 30-s chair sit-to-stand test were significant predictors of quality of life.

CONCLUSION

There is considerable variability in the quality of life among TAVR patients. Tailored health management strategies based on specific patient profiles can potentially improve outcomes in these populations.

The Detrimental Effects of Mental Fatigue on Cognitive and Physical Performance in Older Adults Are Accentuated by Age and Attenuated by Habitual Physical Activity

OBJECTIVE

Our research objectives were to evaluate the extent to which cognitive and physical performance in older adults, when fresh, and when fatigued vary with age and habitual physical activity.

METHODS

We employed experimental study designs, with between- (Study 1: age: 51-64 and 65-80 years and Study 2: habitual physical activity: active and sedentary) and within-participants factors (Study 1: test: before cognitive task and after cognitive task and Study 2: session: fatigue and control and test: before and after cognitive task). In testing sessions, participants performed exercise (6-min walk, 30-s sit stand, and 30-s arm curl) and cognitive (response inhibition and vigilance) tasks before and after a 20-min demanding cognitive task (time load dual back [TLDB] task). In Study 2, participants completed a paced breathing task (control session) as well as the TLDB (fatigue session). Ratings of mental fatigue and exercise-related perceived exertion were obtained.

RESULTS

The 20-min TLDB task elicited a state of mental fatigue. Cognitive and physical performance was worse after than before the TLDB task. These impairments in performance were moderated by age (Study 1) and habitual physical activity (Study 2).

CONCLUSION

The deleterious effects of mental fatigue on cognitive and physical performance were accentuated by aging and attenuated by habitual physical activity.

IMPLICATIONS

Cognitive and/or physical training could mitigate the negative effects of mental fatigue on performance in older adults.

Effects of Oral Amino Acid Supplementation on Physical Activity, Systemic Inflammation, and Quality of Life in Adult Patients with Cystic Fibrosis: A Single-Center, Randomized, Double-Blind, Placebo-Controlled Pilot Study

Background/Objective: Cystic Fibrosis (CF) is a common, life-threatening genetic disorder that leads to progressive lung function decline, respiratory failure, and premature death. Musculoskeletal complications, affecting both peripheral and respiratory muscles, are major concerns in CF patients. Inflammatory cytokines seem to be responsible for the activation of the molecular pathways involved in the imbalance between protein synthesis and catabolism, with consequent loss of muscle mass and function. This study aims to assess the effects of amino acid supplements on functional status, muscle mass and strength, inflammation, and quality of life in adult CF patients. Methods: We conducted a randomized, double-blind, placebo-controlled pilot trial with 60 adult CF patients, aged 18 or older. Participants were randomly assigned to receive either amino acid supplementation or a placebo for 4 weeks. Physical function tests and self-assessment questionnaires on quality of life, global health, and sleep status, as well as blood samples to measure pro-inflammatory cytokines, were performed at baseline and after the treatment period. Results: The amino acid supplementation group showed a significant improvement in self-perceived physical performance and health status. Interleukin-6 serum levels were significantly reduced in this group compared to those who received the placebo (p = 0.042). Conclusions: Amino acid supplementation in adult CF patients improves self-perception of health status and may reduce systemic inflammation, significantly decreasing serum levels of Interleukin-6. This suggests potential benefits for the overall well-being of CF patients and a reduction in their inflammatory status.

The Influence of Aging on Hip Abductor Muscle Torque, Power, Velocity and the Association With Lower Limb Physical Function

BACKGROUND AND PURPOSE

Muscle strength, power, and mass decline with aging, leading to functional loss highly correlated with balance and falls in older adults. Lower limb muscle function is critical for fall prevention in older adults, and hip abductor force and rapid force development have been shown to be important during stepping tasks. However, it remains unclear whether hip abductor muscle function changes with aging. Therefore, the primary aim of this study was to compare maximum torque, submaximal power, and submaximal velocity of hip abductor muscles, as well as hip abductor strength and power clinical assessments, between young and older adults. The secondary aim was to investigate whether there is a relationship between the clinical assessments and hip abduction maximum torque, submaximal power, and submaximal velocity in young and older adults.

METHODS

The volunteers young (n = 20, 26.5 ± 3.9) and older (n = 20, 71.9 ± 5.3) adults performed a hip abduction estimated 1-repetition maximum (e1RM) and submaximal tests (40%, 60%, and 70% of e1RM) and clinical assessments (stair climb power test and the 30-second chair stand test).

RESULTS

Older adults exhibited a statistically significant decline in hip abduction torque, power, and velocity, accompanied by lower scores in clinical assessments in comparison to young adults. However, young adults did not exhibit any significant associations between clinical assessments and hip abduction maximum torque, power, and velocity, whereas older adults demonstrated strong correlations (r ≥ 0.52, P ≤ .02).

DISCUSSION

Older adults have a significant reduction in their ability to produce hip abduction torque, power, and velocity, as well as poor performance in clinical assessments compared to young adults. The declines in hip abductor maximum torque, power, and velocity with aging may be related to functional performance, as shown by the significant correlations between these variables and clinical assessments in older adults.

CONCLUSION

Health care professionals should consider declines in the ability to generate muscle force rapidly, given its significance to lower limb function and overall physical capabilities.

Applying both the 30-s and the 5-repetition sit-to-stand tests captures dissimilar groups and a broader spectrum of physical abilities in mobility-limited older individuals: results from the BIOFRAIL study

PURPOSE

We aimed to assess differences among older patients demonstrating low STS performance in the 30 s-STS and/or the 5r-STS.

METHODS

30 s-STS and 5r-STS were used to assess lower limb muscle strength and function in older adults. Analysis involved 376 patients (≥ 65 years) from a geriatric outpatient clinic for fall assessment.

RESULTS

The mean age of patients was 79.8 (± 6.1) years (67% female). In total, 40.6% had low STS performance with 9.3% presenting only low 30 s-STS, 9.8% only low 5r-STS, and 21.5% low STS performance in both tests. Patients with low STS performance in both tests had lower gait speed, were more often frail, and had more prior falls compared to patients with low STS performance in one test only.

CONCLUSION

The two STS tests are not interchangeable, and the use of both STS tests capture a wider range of physical abilities in mobility-limited older adults.

CLINICAL TRIAL REGISTRATION

NCT05795556.

Discordance between self-report and performance-based outcomes: Contribution of psychosocial factors

The purpose of this study was to examine the role of psychosocial factors in the discordance between perceived and observed physical disability in patients with osteoarthritis of the hip or knee joint. This was a cross-sectional study of patients seen for consideration of joint arthroplasty surgery. Patients completed a psychosocial outcome measure, a patient self-reported functional scale, and two performance-based tests. Data of 121 patients, mean age, 67 (8), 81 (67%) females were used for analysis. The fear avoidance and positive affect domains had the strongest association with the discordance between the self-report and both performance outcome measures. Age, gender, and severity of osteoarthritis were associated with discordance in relation to walking. Fear avoidance beliefs and positive affect play important roles in perception of pain and function. Age, gender, and severity of arthritis should be taken into consideration for a more holistic approach to arthritis care.

Nutritional intake as a determinant of high-speed resistance and multicomponent training efficacy on strength in older women at risk of sarcopenia. A randomized clinical trial

BACKGROUND AND AIM

Despite advances in research on training and nutritional supplementation, it is largely unknown how micronutrient intake modulates the response to training in older adults. This study investigates the relationship between nutrient intake and response to training in older women at risk of sarcopenia.

METHODS

A randomized clinical trial with two parallel groups (high-speed resistance training (H-RT) and multicomponent training (MT)) was conducted over a 32-week intervention involving 80 older women at risk of sarcopenia (mean age: 77.36 ± 6.71 years). A food frequency questionnaire was administered to assess whether nutrient intake influenced strength outcomes measured by the Five Times Sit-to-Stand Test (5STS) and other functional variables.

RESULTS

Significant improvements in the five times sit to stand test (5STS) were observed in both groups post-intervention (p < 0.001), with no significant differences between them (p = 0.127), suggesting comparable effectiveness. In both groups, lower levels of vitamin B12 (H-RT: rp = -0.52; MT: rp = -0.50) and vitamin D (H-RT: rp = -0.55; MT: rp = -0.69) were associated with worse 5STS performance. Additionally, in the H-RT group, lower levels of vitamin E (rp = -0.36), magnesium (rp = -0.48), iron (rp = -0.43), and potassium (rp = -0.47) were also correlated with poorer performance.

CONCLUSIONS

The results indicate that improvements in strength are related to micronutrient sufficiency rather than macronutrient sufficiency. Deficiencies in vitamin D and B12 negatively impacted muscle strength gains in both H-RT and MT, while vitamin E, potassium, magnesium, and iron influenced H-RT outcomes. The lesser effect of micronutrient deficiencies on MT suggests it may be more suitable for individuals with mild deficiencies, as it requires fewer specific nutrients for muscle strength.

REGISTRATION

The study is registered at ClinicalTrials.gov under the identifier NCT05870046.

Physical activity targeting patients admitted to a psychiatric hospital- a mixed method feasibility study

BACKGROUND

Physical activity (PA) shows positive effects on mental illness. PA and the use of municipal rehabilitation after discharge from psychiatric hospitalisation are inconsistent. The aim of this study was to evaluate the feasibility and acceptability of an intervention consisting of structured PA during hospitalisation and the use of a personalised physical activity plan and referral for municipal rehabilitation after discharge.

METHODS

A mixed-method design was used to explore the feasibility and acceptability of the intervention. Changes in health-related quality of life and physical function were measured using a six-minute walk test, a 30-second sit-to-stand test, handgrip strength, and patient reported outcomes (SF-36 and the Patient Specific Functional Scale [PSFS]). Qualitative results were further explored through semi-structured telephone interviews with twelve participants three weeks after discharge.

RESULTS

Twenty-six participants completed the intervention (median age: 46 years old; female: 57.7%). Improvements were seen in the PSFS. For SF-36, overall improvements were observed in the subscales physical function, well-being, and social function. Participants adhered to 61.5% of the scheduled physical activity sessions, 88% received a personalised physical activity plan, and 57% received municipal rehabilitation. The clinical provider played an important role in terms of motivation, structure, and knowledge about physical activity.

CONCLUSION

Physical activity during hospitalisation, a personalised physical activity plan, and municipal rehabilitation was feasible for persons with mental illness. Positive changes were observed in the following self-reported outcomes: Quality of life, physical function, and social function, and participants reported moderate to good acceptance of the intervention.

Internet-Based Psycho-Physical Exercise Intervention Program in Mild-to-Moderate Depression: The Study Protocol of the SONRIE Randomized Controlled Trial

The COVID-19 pandemic has intensified depression due to isolation and reduced physical activity, highlighting the need for accessible remote treatments. The SONRIE study evaluates the effectiveness of a 12-week online intervention combining physical exercise and internet-based cognitive-behavioral therapy on depressive symptoms in adults with mild-to-moderate depression. This randomized controlled trial involved 80 adults aged 25-65 years diagnosed with depression according to the ICD-10 criteria. Participants were randomized to an experimental group receiving the combined online intervention or to a control group receiving standard care. The primary outcome was the change in depression severity, assessed by the Beck Depression Inventory, with outcomes measured at baseline, immediately post-intervention, and after an 8-week follow-up phase. Statistical analyses include analysis of covariance to compare group changes over time, with effect sizes quantifying the intervention's impact. The SONRIE study demonstrates a promising online approach for treating depression, with potential implications for clinical practice and public health strategies.

Relationship between epicardial adipose tissue thickness and sedentary time, physical activity level, and physical performance in patients with hypertension

Epicardial adipose tissue is associated with the development of cardiovascular disease and its increase is positively correlated with blood pressure elevation in hypertensive individuals. In the literature, being physically active has been shown to be effective in the treatment of hypertension and reduction of epicardial adipose tissue thickness. The aim of this study was to evaluate the relationship between epicardial adipose tissue thickness and sedentary time, physical activity level and physical performance in patients with hypertension. The physical and demographic characteristics of the 40 patients with hypertension were collected with sociodemographic form. Waist/hip circumference was measured with tape measure and epicardial adipose tissue thickness with echocardiography device. Physical activity levels and sedentary time were recorded via IPAQ-7. Physical performance was determined using the 30-s sit-and-stand test. There was a moderate negative correlation between epicardial adipose tissue thickness and IPAQ-7 score (rho: -0.568 p < 0.001) and a high negative correlation between epicardial adipose tissue thickness and sit-and-stand test score (rho: -0.794 p < 0.001). There was no relationship between epicardial adipose tissue thickness and daily sitting time, BMI, or hip circumference. There was moderate positive correlation between epicardial adipose tissue thickness and age (rho: 0.504 p: 0.001) and low positive correlation between waist circumference (rho: 0.322 p < 0.05).This study demonstrated that the epicardial adipose tissue thickness was negatively associated with activity and performance in hypertensive patients, but not with daily sitting time. These results underscore the importance of physical activity in the management and prevention of chronic diseases.

Thirty-second chair stand test in older adults with chronic health conditions is associated with lower limb oxygen extraction capacity

BACKGROUND

The 30-s chair stand test (CS-30) is a well-known measure of muscle strength in older adults. However, factors other than muscle strength may also be involved in older adults with chronic health conditions who require support and care in daily living.

PURPOSE

To test the hypothesis that the CS-30 in older adults with chronic health conditions is associated with lower limb muscle oxygen extraction capacity.

METHODS

Twenty-seven older adults with chronic health conditions (those who needed support and care in daily living because of stroke, musculoskeletal disease, etc.) were recruited. Tissue and percutaneous oxygen saturations of the right vastus lateralis muscle were measured during CS-30 measurements, and muscle oxygen extraction rate (MOER) was calculated. Knee extension strength, skeletal muscle mass index (SMI), and phase angle (PhA) were measured. In a multiple regression analysis with CS-30 as the dependent variable, results were calculated for model 1 with SMI, PhA, and ΔMOER as independent variables and model 2 with knee extension muscle strength added to model 1.

RESULTS

Phase angle (model 1, β = 0.46, p = .014; model 2, β = 0.46, p = .016) and ΔMOER (model 1, β = 0.39, p = .032; model 2, β = 0.40, p = .039) were significantly associated in both models. Adjusted R2 was 0.26 (Model 1) and 0.23 (Model 2).

CONCLUSION

The CS-30 in older adults with chronic health conditions may be related to muscle oxygen extraction capacity. This indicates that CS-30 also considers lower limb endurance assessment in this population.

Cross-sectional assessment of the Tinetti performance-oriented mobility tool for screening physical frailty syndrome in older adults

BACKGROUND

Physical-functional fitness (PFF) assessments have become crucial tools for identifying physical frailty syndrome (PFS) in older adults, helping guide preventive and interventional strategies.

PURPOSE

This study aimed to evaluate the predictive value of performance-based PFF tests for detecting PFS among community-dwelling older adults in Tehran, Iran. Additionally, it sought to compare PFF variables between PFS groups to assess the applicability of these tests as practical screening tools in clinical and community settings.

METHODS

Data were collected from 161 participants (91 males, 56.5%; 70 females, 43.5%), including sociodemographic, anthropometric, medical history, PFF, and PFS assessments.

RESULTS

Frail participants exhibited significantly lower scores in various PFF tests, including the Tinetti balance, walking, and total score components, physical activity levels (PAL), mean hand grip strength (MGS), 30-s arm curl (30 s-AC), 30 s-chair stand (30 s-CS), Standing Stork Balance (SSB), and back stretch (BST) tests (p < 0.001). Frail individuals also had lower levels of education, shorter stature, and higher BMI compared to non-frail/pre-frail participants, highlighting broader vulnerabilities. Logistic regression analyses showed that all PFF tests, including Tinetti balance and walking components, MGS, 30 s-AC, 30 s-CS, were significant protective factors against FS. However, ROC curve analysis revealed optimal cutoff points for PFS identification, with PAL and MGS demonstrating the highest sensitivity and specificity for predicting PFS. The all components of Tinetti scale also proved to be strong predictors of FS.

CONCLUSION

Our findings demonstrate that, regardless of age, sex, education level, stature, and fall incidence, PFF assessments remain critical for identifying older adults at risk for PFS. The study highlights the predictive strength of key variables, such as PAL, MGS, and the Tinetti-POMA components, offering novel insights into the role of these tests in improving PFS screening accuracy. These results underscore the importance of integrating PFF assessments into routine clinical and community-based health evaluations, enabling early detection and timely interventions to promote healthier aging trajectories.

Changes in fatigue after first-ever ischemic stroke and their associations with changes in physical fitness, body composition, and physical activity

OBJECTIVES

The objectives of the present study were 1) to describe changes in fatigue from 3 to 12 months post-stroke and compare different patterns of fatigue changes with respect to concurrent changes in physical fitness, body composition, and activity levels, and 2) to explore whether changes in fatigue are associated with changes in physical fitness, body composition, and physical activity levels in patients recovering from first-ever ischemic stroke.

MATERIALS AND METHODS

In this longitudinal observational study, we assessed 72 patients (mean age 62 years, 36 % females) at 3 and 12 months after first-ever ischemic stroke. Fatigue was measured with the 7-item Fatigue Severity Scale. Physical fitness, body composition and physical activity were assessed using cardiopulmonary exercise testing, physical function tests, Dual-energy X-ray Absorptiometry, and accelerometers.

RESULTS

Fatigue levels was stable between 3 and 12 months post-stroke in 44 (61 %) patients, decreased in 14 (19 %), and increased in another 14 (19 %). Patients with increased fatigue levels showed a greater decrease in cardiorespiratory fitness, as measured directly by peak oxygen uptake, compared to those with decreased fatigue. Robust regression analysis, adjusted for age and sex, indicated that each kilogram of lean body mass gained from 3 to 12 months post-stroke was significantly associated with a 0.3-point reduction in fatigue during the same timeframe (B= -0.32; 95 %CI [-0.51, -0.12]).

CONCLUSION

There was considerable individual variation in changes to fatigue, physical fitness, body composition, and physical activity levels between 3 and 12 months following a first-ever ischemic stroke. Increased fatigue was linked to a greater concurrent decline in cardiorespiratory fitness, while lean body mass was associated with decreases in fatigue.

The impacts of a mHealth platform-enabled lifestyle-integrated multicomponent exercise program on reversing pre-frailty in community-dwelling older adults: A randomized controlled trial

BACKGROUND

Multicomponent exercise has robust evidence supporting their effectiveness in preventing pre-frailty/frailty. However, a generalizable model for managing frailty through exercise in real-world settings is still not well defined. A promising approach is to incorporate exercise into daily life. We have developed a lifestyle-integrated multicomponent exercise program supported by a mHealth platform. The objective of this research was to assess its effectiveness and elucidate its potential mechanisms for reversing pre-frailty in community-dwelling older adults.

METHODS

In this prospective, two-arm parallel randomized controlled trial, 134 pre-frail older adult were enrolled from the Fujian Prospective Ageing Cohort. Participants were randomly assigned to either the intervention group (integrating multicomponent exercise into daily life through a mHealth platform) or control group (health education). The primary outcome was the proportion of participants exhibiting pre-frailty after a 6-month intervention. Secondary outcomes included changes in functional fitness, body composition, bone mineral density, physical activity, and sedentary behavior.

RESULT

Of the 134 participants, 52 (77 %) from the intervention group and 54 (81 %) from the control group completed the study. After 6 months, the proportion of pre-frailty was significantly lower in the intervention group compared to the control group (32.8 % vs 98.5 %, P < .001). Improvements were observed in all five frailty components, except for unintentional weight loss. The intervention group also demonstrated significant enhancement in functional fitness, bone mineral density, and body composition (P < .05). Additionally, the intervention group experienced a decrease in sedentary time and an increase in light physical activity, although there was no statistically significant difference in moderate-to-vigorous physical activity.

CONCLUSION

The lifestyle-integrated multicomponent exercise program, facilitated through a mHealth platform, shows promising beneficial effects on reversing pre-frailty, improving functional fitness and body composition, and decreasing sedentary behavior in community-dwelling older adults.

Gonarthrosis related changes in quadriceps muscle architecture and physical function outcomes in women

This study aimed to assess the effects of gonarthrosis on quadriceps muscle architecture and fatigue, physical function, and postural balance in women compared with healthy controls. Eighty-one females diagnosed with gonarthrosis (n = 40) and healthy control group (n = 41) aged between 47 and 77 years participated in the study. After demographic data were collected, right and left rectus femoris (RF), vastus intermedius (VI), vastus lateralis (VL) thicknesses and RF pennation angle (PA) were determined using a 2D real-time ultrasound device (USG). RF and VI depths and RF cross-sectional area (CSA) were obtained using ultrasound with the probe positioned in a transverse orientation to the muscle. In addition, the participants underwent the timed up and go test (TUG), 30-sec sit-and-up test (SU30s), and completed the Fatigue Severity Scale (FSS). The relationship between functional tests and right and left quadriceps muscle architecture parameters was also analyzed. In our study, the right CSA (p < .001, t=- 8.609, ES = 1.92), left VL (p = .020, t= - 2.365, ES = 0.052), and left CSA (p < .001, t=- 10.164, ES = 2.26) were significantly higher in the healthy group. Conversely, TUG (p < .001, t = 4.882, ES = 1.08) and FSS (p < .001, t = 10.362, ES = 2.29) were significantly higher in the gonarthrosis group, while SU30s values were higher in the control group (p < .001, t = - 12.262, ES = 2.73). Additionally, a negative correlation was observed between SU30s and CSA, whereas TUG and FSS showed a positive correlation with CSA (p < .001). According to the results of our study, some morphological losses were observed in the quadriceps muscle architecture of participants with gonarthrosis. Decreases in CSA affect functional performance. Determination of quadriceps muscle architecture in patients with gonarthrosis can be used to predict functional loss.

Rehabilitation after bone marrow transplant compared with usual care to improve patient outcomes (REBOOT): protocol for a randomised controlled trial

BACKGROUND

Haematological cancer affects more than 1.3 million people around the world annually and accounted for almost 800,000 deaths globally in 2020. The number of patients with these cancers undergoing bone marrow transplant is increasing. Of note, this intensive treatment is associated with complex and multifactorial side effects, often impacting nutritional status, physical functioning and overall health-related quality of life. The primary aim of this study is to investigate the effectiveness of an eight-week multidisciplinary rehabilitation intervention compared with usual care on the physical function domain of the European Organisation for the Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30 version 3) in patients with haematological cancer following bone marrow transplant.

METHODS

This is a multisite, pragmatic two-arm parallel-group, randomised controlled trial (RCT) with stratified randomisation, powered for superiority, recruiting 170 participants at 30 days following either allogeneic or autologous bone marrow transplant (ACTRN12622001071718). Recruitment sites include three Australian university affiliated teaching hospitals. Participants are eligible if aged ≥ 18 years, treated for haematological cancer with allogeneic or autologous bone marrow transplant and can walk independently. The intervention group will receive eight weeks of twice weekly telehealth-based exercise classes, an initial and follow up dietetics consult, post exercise protein supplements, and a home-based physical activity program, all with embedded behaviour change strategies. The primary outcome is patient reported physical function measured using the EORTC QLQ-C30 version 3. Secondary outcomes include other domains of the EORTC QLQ-C30, fatigue, physical function, physical activity levels, frailty, body composition, sarcopenia and nutrition assessment. We will also undertake a health economic analysis alongside the trial and a process evaluation exploring intervention fidelity, causal mechanisms as well as contextual influences through qualitative enquiry.

DISCUSSION

The REBOOT trial will add RCT-evidence from a rigorously conducted, statistically powered multi-site trial to existing limited knowledge on the effects of multi-disciplinary rehabilitation for people with haematological cancer. If effectiveness is supported, then implementation of rehabilitation into care pathways for people having bone marrow transplant can be considered.

TRIAL REGISTRATION

ACTRN12622001071718 prospectively registered 03/08/2022, last updated 08/03/2024.

A Smartphone-Based Timed Up and Go Test Self-Assessment for Older Adults: Validity and Reliability Study

Background

The Timed Up and Go test (TUG) is recommended as an evidence-based tool for measuring physical capacity. Instrumented TUG (iTUG) approaches expand classical supervised clinical applications offering the potential of self-assessment for older adults.

Objective

This study aimed to evaluate the concurrent validity and test-retest reliability of a smartphone-based TUG self-assessment "up&go app."

Methods

A total of 52 community-dwelling older adults (>67 years old) were recruited. A validated and medically certified system attached with a belt at the lower back was used as a reference system to validate the "up&go app" algorithm. The participants repeated the TUG 5 times wearing, a smartphone with the "up&go app" in their front trouser pocket and an inertial sensor to test the concurrent validity. A subsample of 37 participants repeated the "up&go app" measurement 2 weeks later to examine the test-retest reliability.

Results

The correlation between the "up&go app" and the reference measurement was r=0.99 for the total test duration and r=0.97 for the 5 single repetitions. Agreement between the 5 repetitions was intraclass correlation coefficient (ICC)=0.9 (0.84-0.94). Leaving out the first repetition, the agreement was ICC=0.95 (0.92-0.97). Test-retest agreement had an ICC=0.79 (0.53-0.9).

Conclusions

The duration of 5 repetitions of the TUG test, measured with the pocket-worn "up&go app," was very consistent with the results of a lower-back sensor system, indicating excellent concurrent validity. Participants walked slower in the first round than in the other 4 repetitions within a test run. Test-retest reliability was also excellent. The "up&go app" provides a useful smartphone-based approach to measure 5 repetitions of the TUG. The app could be used by older adults as a self-screening and monitoring tool of physical capacity at home and thereby help to early identify functional limitations and take interventions when necessary.

Characteristics of Evidenced-Based Falls Prevention Program Completers and Non-Completers and Difference in Outcomes

Evidenced-based community falls prevention programs can reduce falls in older adults. We sought to (1) describe the characteristics of program participants who met completion criteria by receiving the full program dose (completers) versus those who did not (non-completers), and (2) determine the differences in outcomes (falls, fear of falling and physical function) between the two groups. Data from ten programs from 2014-2019 were evaluated. Completers were older and reported more fear of falling and lower perceived health at baseline. A higher proportion of completers had reduced falls, decreased fear of falling, and were more likely to take actions to reduce fall risk. Both groups improved in physical function with no evidence of a difference between groups. While completers gained a greater benefit, both groups demonstrated a fall risk reduction. A larger loss of non-completers to follow-up may have impacted results. Targeting programs for individuals may improve completion rates.

Examining dose-response of an outdoor walk group program in the Getting Older Adults Outdoors (GO-OUT) trial

OBJECTIVE

The Getting Older Adults Outdoors (GO-OUT) randomized trial showed that a 10-week outdoor walk group (OWG) program was not superior to 10 weekly phone reminders in increasing physical and mental health; however, OWG attendance varied. This study examined whether dose-response relationships existed between OWG attendance and improvement in physical and mental health among older adults with mobility limitations.

METHODS

We analyzed data from 76 OWG participants with pre- and post-intervention scores on at least one of seven measures of health outcomes (walking endurance, comfortable and fast walking speed, balance, lower extremity strength, walking self-efficacy, and emotional well-being). Participants were classified as attending 0-9, 10-15, and 16-20 OWG sessions based on attendance tertiles. We adjusted for participant sex and study site in regression analyses.

RESULTS

Among the 76 participants, mean age was 74.9 ± 6.6 years and 72% were female. Compared to those attending 0-9 OWG sessions, participants attending 16-20 sessions exhibited a 56.3-meter greater improvement in walking endurance (95% CI: 17.3, 95.4, p = 0.005); 0.15-meter/second greater improvement in comfortable walking speed (95% CI: 0.01, 0.29, p = 0.034); and 0.18-meter/second greater improvement in fast walking speed (95% CI: 0.03, 0.34, p = 0.020). Higher attendance was associated with greater odds of improvement in comfortable walking speed (OR = 7.1; 95% CI: 1.1, 57.8, p = 0.047) and fast walking speed (OR = 10.1, 95% CI: 1.8, 72.0, p = 0.014). No significant dose-response relationships for the remaining outcomes were observed.

CONCLUSIONS

Higher attendance in a park-based, supervised, task-oriented and progressive OWG program is associated with greater improvement in walking endurance and walking speed among older adults with mobility limitations. Attendance likely impacted walking capacity and not balance, lower extremity strength, walking self-efficacy or emotional well-being due to task-specificity of training. This study highlights the importance of attendance when designing and implementing OWG programs to enhance walking endurance and speed among older adults.

Respiratory muscle training reduces painful swallowing and opioid use during radiation therapy for head and neck cancer: a matched pair analysis

BACKGROUND

Patients with head and neck cancer (HNC) receiving radiation therapy (RT) are at increased risk for symptoms of oral mucositis (OM), opioid use, and declines in physical function, outcomes that contribute to increased morbidity and mortality. The study objective was to determine the effects of respiratory muscle training (RMT) on OM and opioid use, as well as functional performance in patients with HNC receiving RT with or without concurrent chemotherapy (CCRT).

METHODS

Patients aged ≥ 18 years of age with stage I to IV HNC being treated with RT or CCRT receiving a home-based respiratory muscle training (RMT) (n = 20) were compared to a 5:1 matched historical group (n = 100) who did not receive RMT. RMT was delivered using the commercially available Power Lung AireStream device (Houston, TX) via a standardized home-based inspiratory and expiratory muscle-training program requiring ~ 20-30 min/day, five days per week, with a progressively increasing workload. Primary endpoints collected from all patients included changes in OM symptoms and use of opioids for pain control following start of RT. Secondary outcomes collected on RMT patients included respiratory muscle strength and functional performance (Six-Minute Walk Test, 6MWT; Short Physical Performance Battery, SPPB). All measures were assessed before and within 1-2 weeks following a standard 7-week RT regimen.

RESULTS

RMT reduced the impact of self-reported swallowing soreness (p = 0.032), eating soreness (p = 0.036), and opioid use (p = 0.015). RMT maintained inspiratory muscle strength (+ 0.6 ± 18 cmH2O, p = 0.87), expiratory muscle strength (+ 0.7 ± 12.7 cmH2O, p = 0.197), and improved the 6MWT (+ 20 ± 39.9 m, p = 0.025), with no change in the SPPB total score (p = 0.262).

CONCLUSIONS

RMT is a low-cost intervention that is easy to perform among patients undergoing RT/RTCC for HNC and is likely to reduce OM pain/symptoms and opioid, as well as to preserve respiratory muscle strength and physical function during cancer treatment.

TRIAL REGISTRATION

Not applicable. This was a matched retrospective cohort study not registered as it was a nonrandomized trial with a historical control group.

Quercetin ingestion alters motor unit behavior and enhances improvement in muscle strength following resistance training in older adults: a randomized, double-blind, controlled trial

BACKGROUND

During resistance training, quercetin ingestion can enhance motor unit (MU) with a higher recruitment threshold in older adults.

OBJECTIVE

We investigated the effects of daily quercetin glucoside ingestion on chronic adaptations in muscle strength and MU behavior following resistance training in healthy older adults.

METHODS

Twenty-six older adults were randomly allocated to two groups that completed 6-week resistance training intervention with the ingestion of either placebo (PLA) or quercetin glycosides (QUE) at 200 mg/day. Maximal voluntary force (MVF) during isometric knee extension, muscle mass, and MU firing behavior during ramp task at 70%MVF were measured before (PRE) and after (POST) intervention.

RESULTS

In both groups, knee extensor MVF was significantly increased (both p < 0.001), and the improvement in QUE (115.1 ± 11.0%) was greater than in PLA (105.3 ± 4.8%) (p < 0.001) by the Mann-Whitney test. Muscle mass was not changed from PRE to POST in PLA or QUE (p > 0.050). At POST, firing rates of Mus with relatively moderate (recruited between 20 and 40%MVF) or higher (recruited between 20 and 40%MVF) recruitment thresholds were higher in QUE than PLA (p < 0.050). There was a significant correlation between %change in MVF and %change in firing rates of MUs with a relatively higher recruitment threshold from PRE to POST (p = 0.018, r = 0.642).

CONCLUSIONS

These results suggest that the adaptations of MUs with higher recruitment thresholds explain the greater improvement in muscle strength associated with QUE ingestion.

CLINICAL TRIAL REGISTRY

UMIN000053019 ( https://rctportal.niph.go.jp/detail/um?trial_id=UMIN000053019 ).

Cognitive Impairment Before Cardiac Surgery: A Prospective Single-Center Observational Analysis

Background/Objectives: We aimed at evaluating the prevalence of cognitive impairment before cardiac surgery, its associated risk factors, and the diagnostic performance of cognitive tests. Methods: This prospective, single-center observational study included patients aged 50 years or older with coronary artery and/or valvular heart disease waiting for cardiac surgery. Patients underwent a cognitive and physical assessment before cardiac surgery. The cognitive assessment included eight tests exploring different cognitive domains and two questions exploring subjective cognitive complaints. Physical assessment included functional capacity and physical activity level. Cognitive tests with adjusted scores below 1.5 or more standard deviations from cognitively unimpaired subjects were considered abnormal. Cognitive impairment was defined as two or more abnormal cognitive tests. Results: We identified objective cognitive impairment in 41 out of 134 patients (31%). Interestingly, 66% of patients with objective cognitive impairment did not report any complaints. Moreover, similar complaints were reported among patients with and without objective cognitive impairment. The combination of Phonetic Fluency Test, Trail Making Test B, Digit Modalities Test, and the digit span forwards from the Wechsler Adult Intelligence Scale yielded the best diagnostic accuracy (AUC: 0.88; 95 CI: 0.82-0.93). Finally, cognitive impairment was associated with a worse Sit-To-Stand performance. Conclusions: Objective cognitive impairment before cardiac surgery is prevalent but subjective cognitive complaints are unreliable. We propose a combination of four cognitive tests with an efficient diagnostic profile to enhance its clinical applicability.

Age-related differences across the adult lifespan: a comparison of six field assessments of physical function

BACKGROUND

Age-related declines in physical capabilities often result from decreased lower-limb muscle strength and power, which are measurable through field tests. Various tests can detect functional declines in older adults, but their responsiveness to age-related differences is less understood in those without substantial impairments. Therefore, this study evaluated and compared the ability of field tests to detect age-related changes in physical and muscle function across adulthood.

METHODS

304 participants (52% female; 19-85 years) completed six field tests: handgrip strength (HGS), maximal gait speed (MGS) over a 10-m course, 5-repetition sit-to-stand power (STSP), timed up and go (TUG), countermovement jump (CMJ), and stair climbing power (SCP). Segmented regression analysis determined the relationship between age and field test performance, and identified the age at which the rate of decline increased. A multilevel linear mixed model compared decline rates between tests.

RESULTS

Before 60 years, SCP and CMJ were responsive to age-related differences (-0.70 to -0.81%/year, p < 0.05), whereas TUG and STSP (lower age-related decline, -0.18% to -0.52%/year, p < 0.05) and HGS and MGS (no significant age-related decline) exhibited lower responsiveness. After 60, most tests (except the STSP) demonstrated increased responsiveness to age-related differences, although these differences remain most pronounced in SCP and CMJ (-1.61 to -1.75%/year, p < 0.05).

CONCLUSIONS

These findings imply that most field tests are responsive to age-related declines in physical and/or muscle function after 60. In younger age groups, field tests that evaluate lower-limb power and have minimal ceiling effects, such as SCP and CMJ, should be prioritized.

The effect of prehabilitation for older patients awaiting total hip replacement. A randomized controlled trial with long-term follow up

BACKGROUND

Prehabilitation involving a planned exercise program before surgery is proposed to improve rehabilitation and postoperative outcomes. However, the current evidence on the efficacy of prehabilitation for patients awaiting total hip replacement is conflicting. The aim of this study was to evaluate efficacy of preoperative exercises and education (AktivA®) for adults 70 years or older awaiting total hip replacement.

METHODS

In a two-armed randomized controlled trial we recruited 98 participants aged 70 years or older with a Harris Hip Score less than 60 awaiting elective primary total hip replacement. Participants were recruited at three hospitals in Norway between 2019 and 2022. Participants were randomly assigned to prehabilitation or usual care. The prehabilitation group received a tailored exercise program for 6-12 weeks in addition to patient education. Gait speed, the primary outcome, was measured by the 40 m Fast-Paced Walk Test. Secondary outcomes included performance-based tests (Chair Stand Test, Timed Up & Go Test, 6-Minute Walk Test, Stair Climb Test) and patient-reported outcomes (Hip Disability and Osteoarthritis Outcome Score (HOOS) and EQ-5D). Outcomes were assessed at baseline, post intervention, and further 6 weeks, 3-, 6-, and 12 months post-surgery.

RESULTS

For the primary outcome gait speed at the primary endpoint (3 months post-surgery), no significant between-group differences were observed. However, post-intervention (before surgery), we found a significant improvement in favor of prehabilitation for both gait speed (0.15 m/s, 95% CI 0.02-0.28) and the HOOS quality of life subscale (11.93, 95% CI 3.38-20.48). No other significant differences were found at any post-surgery follow-up for these outcomes. For other secondary outcomes, there were no between-group differences at any point of assessment. Both groups showed improvement across all outcomes 3-12 months after surgery.

CONCLUSIONS

The AktivA®program, used as a prehabilitation intervention during a period of 6-12 weeks before total hip replacement did not improve gait speed or any other post-operative outcomes compared to usual care. Both groups demonstrated significant improvement in gait speed and performed well relative to Western reference values 12 months post-surgery. Thus, replacing painful hip joints through total joint replacement seems to outweigh the efficacy of prehabilitation.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03602105-initial release: 06/06/2018.

Effects of a physical therapist-driven individualized hybrid model of the exercise component of cardiac rehabilitation on patient outcomes: a prospective single group, time-series design

PURPOSE

The aim of this prospective single group, time-series study was to determine the feasibility, adherence, and effectiveness of an individualized physical therapist (PT)-driven hybrid model of the exercise component of cardiac rehabilitation (CR) that uses a novel intensity-recovery progression protocol (IRPP) and cardiac testing template (CTT) to assess achieved heart rate (HR) intensity, HR recovery, and intensity-recovery total to guide treatment.

METHODS

Assessment of a questionnaire, treadmill 6-min walk (6MW), 1-min sit-to-stand (1STS), 1-min step, and 1-min agility square tests were assessed on 100 participants. Compared to traditional CR the 36-visit 1:1 hybrid model was individualized using the IRPP program and CTT.

RESULTS

Adherence was 35% (timely) and 44% (overall) completion. The per-protocol analysis (PPA) and intent-to-treat (ITT) analysis suggest significant improvement in objective assessments baseline to visit 15 (PPA = 11 of 14) (ITT = 13 of 14), baseline to visit 30 (PPA = 12 of 14) (ITT = 12 of 14) and visit 15 to visit 30 (PPA = 9 of 14) (ITT = 10 of 14). Improvement beyond the minimal clinically important difference (MCID) was 94.3% in the 6MW and 91.4% in the 1STS.

CONCLUSIONS

The PT-driven IRPP program was feasible in terms of adherence and safety, showing significant improvement in a majority of assessments. Analysis of HR using the CTT may help clinical decision making for progression in CR.

Factors associated with aspects of functioning one year after hospitalization due to COVID-19

ObjectiveTo identify factors, present at 3 months after COVID-19 that are associated with the level of functioning 1 year after hospitalization.DesignMulticenter prospective observational study.SettingRegion Västra Götaland Sweden.ParticipantsPatients ≥ 18 years of age who were followed regarding body functions and activities 3 months and 1 year after discharge from a hospitalization for COVID-19.Main measuresPatient-reported outcome measures at 3 months and 1 year, a clinical follow-up at 1 year, and clinical information retrieved from medical charts.ResultsIn total 169 participants were included in the analysis, including 113 males (67%). The mean patient age was 66 (standard deviation (SD) 13, range 21-95). One year after hospitalization, 50 (34%) participants were under the normative value for forced vital capacity and 57 (39%) were under normative value for forced expiratory volume in 1 second. The mean walking distance was 441 m (SD 118 m) in the 6-minute walking test, and 62 (40%) patients reported mobility problems. Older age, female sex, and more self-reported symptoms of physical fatigue were significantly associated with lower levels of functioning 1 year after COVID-19. The initial severity of COVID-19 did not significantly influence functioning at 1 year.ConclusionPreviously hospitalized individuals with respiratory difficulties 1 year after COVID-19 may present acceptable lung function on spirometry but be close to their maximal functional performance. The findings highlight the need for in-depth assessments to identify rehabilitation needs.

Holistic Patient-Centered Outcomes in Post-Acute Kidney Injury Care: Physical, Emotional, Cognitive, and Social Outcomes

Acute kidney injury can lead to severe short- and long-term consequences. The majority of acute kidney injury outcome studies have focused on mortality and kidney-related outcomes, with very few studies considering the importance of a holistic approach to post-acute kidney injury care. In this review, we focus on the physical, emotional, cognitive, and social outcomes following acute kidney injury that may affect patients' quality of life, aiming to highlight the importance of assessing and managing patients both during their hospitalization as well as posthospital discharge. We conclude with specific key recommendations to ensure that health care providers consider all aspects of care for patients with acute kidney injury, and we advocate for a concerted effort to develop post-acute kidney injury care strategies that embrace a holistic approach, ensuring comprehensive care for acute kidney injury survivors.

Factors Affecting Life-Space Mobility of Home-Care Older Adults Receiving Home-Visit Rehabilitation Using Path Analysis: A Cross-Sectional Multicenter Study

AIM

 Life-space mobility (LSM) limitations are a significant concern associated with facility admission, mortality, and quality of life in older adults. Home-visit rehabilitation (HR) users are particularly vulnerable to LSM restrictions, making its maintenance and improvement a priority in this population. This study aimed to assess LSM using the life-space assessment (LSA) and expand existing conceptual models for independent community-dwelling older adults in Japan. Additionally, we analyzed factors influencing LSM in HR users.

METHODS

 This multicenter cross-sectional study included 105 HR users, comprising 56 men (53.3%) and 49 women (46.7%); mean age 78.5 ± 7.7 years, from urban and rural areas between August 2020 and October 2022. Motor function (grip strength, 30-second chair stand test, CS-30), psychological factors (Self-Efficacy Scale on Going out among community-dwelling Elderly, SEGE), activities of daily living (ADL) ability (functional independence measure, FIM), instrumental ADL (IADL) ability (Frenchay Activities Index, FAI), and environmental factors (home and communication environment, living alone, and day service use frequency), which have been reported in previous studies, were collected for parameters related to LSA. Path analysis examined associations between these factors and LSA.

RESULTS

 LSA revealed direct effects on FAI (β = 0.344), FIM-motor score (β = 0.261), living alone (β = -0.196), and day service use frequency (β = 0.184). Indirect effects were observed in CS-30 (β = 0.220), SEGE (β = 0.085), and sex (β = -0.087). The model demonstrated good fit (goodness-of-fit index, GFI, 0.956; adjusted GFI, 0.910; comparative fit index, 1.000; root mean square error of approximation, 0.000).

CONCLUSION

 ADL, IADL, and environmental factors directly affect LSA in home-care older adults using HR, while motor function, psychological factors, and sex have indirect effects. These findings highlight the importance of considering these relationships when designing rehabilitation strategies to support LSM. Future research should examine broader populations, additional variables, and longitudinal data to refine interventions for HR users.

Sarcopenia is associated with survival in patients awaiting kidney transplant

BACKGROUND

The relationship of sarcopenia to frailty and other survival determinants in patients waitlisted for kidney transplant is not well characterized. Our goal was to evaluate the relationship of muscle area to functional and frailty metrics and its impact on survival in patients waitlisted for kidney transplant.

METHODS

Among 303 consecutively listed transplant candidates, 172 had a computed scan within 3 months of frailty and biochemical testing that permitted muscle area evaluation. Third lumbar level psoas muscle indices (total bilateral psoas area/height2) were calculated. Testing included frailty metrics, treadmill and pedometer ability, troponin, and brain natriuretic peptide levels. Associations between muscle area, demographic, biochemical, and frailty measures were analyzed. Log-rank test was used to evaluate waitlist survival on the basis of muscle area, and multivariate Cox proportional hazards modeling was used to evaluate factors independently associated with survival.

RESULTS

Demographic factors associated with third lumbar level psoas muscle indices include male sex (P < .001), race (P = .02), age (P = .004), and body mass index (P < .0001). Grip strength, treadmill ability, and Sit-Stands positively correlated with third lumbar level psoas muscle indices (P < .01). Brain natriuretic peptide and Up and Go negatively correlated with third lumbar level psoas muscle indices (P < .01). Survival was significantly associated with third lumbar level psoas muscle indices (P = 0.02). Treadmill ability, Sit-Stands, Up and Go, race and muscle area were most closely associated with waitlist survival on multivariate modeling.

CONCLUSION

Sarcopenia as assessed with muscle area measurements is independently associated with kidney waitlist survival. Functional ability and muscle area may be overlapping, but noncongruent, determinants of waitlist outcomes and may need to be individually assessed to create the most predictive survival model.

To compare the effect and durability of the effect of corrective exercise and manual therapy focused on the back versus hip on disability, function, pressure pain, pain map, health and psychological status of the elderly with chronic back and hip pain: protocol for a randomised controlled trial

This paper presents a protocol for a randomised control trial to compare the effect and durability of the effect of corrective exercise, and manual therapy focused on the back versus hip versus back and hip on disability, function, pressure pain threshold, pressure pain mapping, health and psychological status of the elderly with chronic back and hip pain. A total of 75 elderly participants will be assigned randomly into three groups, including back-focused exercises (n=25), hip-focused exercises (n=25) and back-focused and hip-focused exercises (n=25). Primary outcomes (disability and function) and secondary outcomes (pressure pain threshold, pressure pain mapping, health status and psychological factors) will be evaluated before, immediately after and 6 months after the 8 week exercise intervention. The data will be analysed using a general linear model repeated measures analysis of variance including both within and between factors (three groups*three times) with Bonferroni adjustments used as a post-hoc test at a significant level of 0.05. This trial will demonstrate whether back versus hip versus back-focused and hip-focused manual therapy can better improve the disability, function, pressure pain threshold, pressure pain mapping, health and psychological status of the elderly with chronic back and hip pain. If successful, this study's findings and information will potentially have implications for addressing back and hip pain in the elderly population by an alternative multidisciplinary approach. Trial registration number: IRCT20220911055941N1.

Cognitive Priming During Warmup Enhances Sport and Exercise Performance: A Goldilocks Effect

Background: Mental fatigue can impair sport, exercise and cognitive performance. Warmup activities can improve performance when the individual is rested. However, their effectiveness when the individual is fatigued has yet to be established. The research objectives were to evaluate the effects of physical and combined physical plus cognitive warmup activities on subsequent sport, exercise, and cognitive performance when rested and fatigued by sleep restriction in athletes (Study 1) and older adults (Study 2). Methods: In Study 1, 31 padel players completed a padel performance test and Stroop task after physical and combined warmups when rested and fatigued by sleep deprivation. In Study 2, 32 older adults completed sit-stand, arm curl, walking, Stroop, and psychomotor vigilance tests after no warmup, physical warmup, and combined warmup when rested and fatigued by sleep deprivation. In both studies, combined warmups intermixed short-, medium-, or long-duration cognitive tasks between physical warmup activities. Mental fatigue was measured using visual analog scale ratings. Results: In both studies, sleep deprivation increased mental fatigue and impaired performance. In Study 1, relative to a physical warmup, padel and Stroop performance were improved by combined warmups (with short-to-medium cognitive tasks) when rested and fatigued. In Study 2, relative to no warmup, sit-stand, arm curl, walking, Stroop, and reaction time performance were improved by physical and combined warmups (with short-to-medium cognitive tasks) when rested and fatigued. Conclusions: The negative effects of sleep deprivation on sport, exercise, and cognitive performance were best mitigated by combined warmups with short-to-medium cognitive tasks. Combined warmups are effective countermeasures against the deleterious effects of mental fatigue on performance.

Examining recovery trajectories of physical function, activity performance, cognitive and psychological functions, and health related quality of life in COVID-19 patients treated in ICU: a Swedish prospective cohort study

PURPOSE

To investigate the recovery trajectories of physical function, activity performance, cognitive and psychological functions, and health related quality of life, as well as potential interaction effects, in individuals with COVID-19 treated in an intensive care unit (ICU).

METHODS

This prospective cohort study included patients with confirmed COVID-19 infection, treated in an ICU. Clinical assessments and self-ratings of functioning, disability and health were performed > 1 month and > 12 months after discharge from hospital.

RESULTS

Among the 65 included individuals (mean age 56.6, SD 11) significant improvements in physical and psychological function were observed over time, although not reaching population norms. Cognition remained unchanged (MoCA median 27, IQR 4). At the 12-month follow-up, physical limitations in activity (RAND-36) were found to be associated with dyspnea (mMRC-Dyspnea), mental and physical fatigue (MFI-20), and walking endurance (6-minute walk test) (r2 0.509 p < 0.001). Role limitations due to physical health (RAND-36) was found to be associated with physical and mental fatigue (MFI-20) and pain (r2 0.530 p < 0.001).

CONCLUSION

Despite improvements in functioning and health in this group of predominantly younger age recovery did not reach population norms. These results highlight persistent impairments and activity limitations that may necessitate long-term healthcare interventions.

Impact of a 10-Week Aqua Fitness Intervention on Physical Fitness and Psychosocial Measures in Inactive Healthy Adult Women

Background/objectives: Previous studies on aquatic exercises have primarily focused on either physical fitness or psychological outcomes. This study examines the effects of a structured 10-week aqua fitness program on physical fitness and psychosocial outcomes in healthy adult women. Additionally, a 4-week training cessation period was incorporated to assess the sustainability of any observed physical fitness benefits. Methods: A total of 32 female participants (mean age 51.28 ± 9.12 years) with prior aqua aerobics experience engaged in supervised aqua fitness sessions, conducted three times per week (~55 min/session) at moderate intensity (RPE = 12, on a 6-20 scale). The physical fitness outcomes assessed included dominant hand grip strength, lower limb muscle endurance, dynamic balance, mobility, and upper and lower limb flexibility. The psychosocial outcomes included subjective well-being and social inclusion. Results: The results demonstrate significant improvements in dynamic balance (ES = 0.85) and lower limb flexibility (ES = 0.73 and 0.65 for the two limbs, respectively), with smaller yet notable gains observed in other physical fitness outcomes (ES = from 0.20 to 0.48). On the contrary, only a marginal improvement was detected in a single domain of subjective well-being (environmental domain, ES = 0.35) and no changes were observed across the seven domains of social inclusion. Importantly, all physical fitness gains were maintained during the 4-week training cessation period, with lower limb flexibility showing additional improvements. Conclusions: These findings underscore the effectiveness of supervised aqua fitness programs in enhancing physical fitness in middle-aged women, while their impact on psychosocial outcomes appears limited in this population.

Effect of a tailor-made hydrotherapy on physical functions in patients after unilateral unicompartmental knee arthroplasty-A feasibility study

INTRODUCTION

Unicompartmental knee arthroplasty (UKA) is one of the treatment options for patients whose osteoarthritis involves one out of the 3 compartments. Patients who underwent UKA benefited from shorter hospital stays, better range of motion, and lower risk of postoperative complications compared with patients who underwent total knee arthroplasty (TKA). Hydrotherapy is being introduced complementary to conventional postoperative rehabilitation programs. No report on the use of hydrotherapy evaluating physical functions on patients who underwent UKA leads us to carry out the present study. This is a feasibility study to investigate the effects of hydrotherapy on physical functions in patients after primary unilateral UKA.

METHODS

A retrospective cohort study recruited 68 patients who underwent primary unilateral UKA. Nineteen patients were allocated to the hydrotherapy group and 49 patients were in the convention group. Patients in the hydrotherapy group received hydrotherapy and conventional physiotherapy, and the convention group was given conventional physiotherapy only. The primary outcome was Knee Society Function Score (KFS) measured before surgery, six months, and one year after UKA. Self-reported walking tolerance, Timed Up and Go Test (TUGT), and 30-s Chair Stand Test (30CST) were conducted before and after the completion of rehabilitation. Pain and range of motion were also covered.

RESULTS

Hydrotherapy group showed significantly higher KFS at 6 months (P = 0.038) and one year (P = 0.030) after operation. Range of motion flexion and extension in the hydrotherapy group were significantly improved at postoperative 4 weeks and the last session of rehabilitation. Self-reported walking tolerance in the hydrotherapy group was significantly longer at the last session (P = 0.011). No significant difference was found in TUGT, 30CST, and pain between the two groups after rehabilitation. In both groups, all outcomes were significantly better as compared to preoperative findings.

CONCLUSION

Patients who underwent UKA after hydrotherapy complementary to conventional physiotherapy showed significant improvements in functions, range of motion, and time to tolerating walking before rest. Pain, mobility, balance, leg strength, and endurance were comparable between the two groups. Combination of hydrotherapy with conventional postoperative physiotherapy rehabilitation yielded even better outcomes than conventional physiotherapy alone. Further research with advanced study design, larger sample size and longer follow-up periods for patients who underwent UKA is recommended.

TRIAL REGISTRATION

NCT06459960, retrospectively registered on 13.06.2024 (ClinicalTrials.gov).

Discriminative ability of instrumented cognitive-motor assessments to distinguish fallers from non-fallers

In older populations, sensitive fall risk assessment tools are important to timely intervene and prevent falls. Instrumented assessments have shown to be superior to standardized fall risk assessments such as the Timed Up and Go Test (TUG) and should capture both motor and cognitive functions. Therefore, the aim was to test novel instrumented assessments with and without a cognitive component. One hundred thirty-seven older adults aged 73.1 ± 7.3 years, 38 categorized as fallers and 99 as non-fallers, conducted five instrumented assessments on the Dividat Senso, a pressure sensitive stepping platform, and three standardized geriatric assessments (TUG, TUG-dual task, 30-s Sit-to-Stand Test (STS)). T-tests were applied to compare the test performance of fallers versus non-fallers. Furthermore, logistic regression analyses and area under the curve (AUC) analyses were performed. Statistically significant differences between fallers and non-fallers were found in the Go/No-Go test (p = .001, d = .72), the TUG (p = .014, d = .48), and the STS (p = .008, d = .51). Only the Go/No-Go test contributed significantly to all regression models. Significant AUC values were found for the Reaction Time Test (RTT) (AUC = .628, p = .023), Go/No-Go (AUC = .673, p = .002), TUG (AUC = .642, p = .012), and STS (AUC = .690, p = .001). The Go/No-Go test measuring inhibition showed the best discriminative ability suggesting added value of instrumented assessments with a cognitive component for clinical fall risk assessment in relatively healthy older adults. The study should be extended with a frailer population, in which TUG and the other instrumented assessments are possibly good predictors as well.

Accelerometer-measured physical activity patterns in daily life and their association with factors of sedentary behavior in people with epilepsy

OBJECTIVES

Being physically active is important, but people with epilepsy (PWE) tend to have a sedentary lifestyle. There is limited evidence about physical activity patterns in PWE using objective measures. The aims of this study were: (1) to examine the physical activity patterns of PWE, (2) compare activity patterns between PWE in terms of drug-resistant epilepsy and medically controlled epilepsy with age- and sex-matched healthy controls; and (3) explore the association between physical activity patterns and body function and structure, activity and participation, and quality of life of PWE.

METHODS

Seventy-three PWE and 74 healthy controls were enrolled. Physical activity data were collected prospectively over a 7-day period using a SenseWear Arm Band. Body function and structure in PWE were evaluated using the Fatigue Severity Scale, 30-second Chair Stand (30CST), Biodex-Fall Risk, Generalized Anxiety Disorder, Beck Depression Inventory, Pittsburg Sleep Quality Index, and Montreal Cognitive Assessment (MoCA). Activity and participation in PWE were measured using Activities-specific Balance Confidence, Timed Up and Go Test, Six-Minute Walk Test, and Tinetti-Balance and Tinetti-Gait. The quality of life of PWE was evaluated using the Quality of Life in Epilepsy Inventory-31.

RESULTS

PWE took fewer steps per day and were sedentary for more time compared with healthy controls (7826 vs. 10,564 steps, P = 0.01; 534 min/day vs. 463 min/day, P < 0.001), especially PWE with drug-resistant epilepsy. 30CST, MoCA, and Biodex-Fall Risk were associated with sedentary behavior, with Biodex-Fall Risk explaining 7.2 % of the variance.

CONCLUSIONS

PWE demonstrated lower physical activity levels compared with healthy individuals, especially those with drug-resistant epilepsy. Our study highlights the need to tailor strategies including postural stability exercises for the enhancement of physical activity levels in PWE.

Performance-Based Outcome Measures After Hip or Knee Arthroplasty: A Systematic Review and Content Analysis Using the International Classification of Functioning, Disability and Health (ICF)

RATIONAL

One of the important considerations to select the appropriate outcome measures is determining if the tool is relevant to patients. Despite the availability of various performance-based tests to objectively assess function, it is unknown which performance-based tests best capture important aspects of function after hip or knee arthroplasty.

AIMS AND OBJECTIVES

Our systematic review aimed to identify the existing performance-based tests used in hip or knee arthroplasty and link the activity component of each test to the modified International Classification of Functioning, Disability and Health (ICF) core set for osteoarthritis (OA).

METHOD

We searched four databases from inception until April 2024. A performance-based test was included if an individual performs one or more activities, evaluated by an assessor and resulted in a numerical value. Two reviewers independently screened and extracted data and assessed the included performance-based tests.

RESULTS

From 449 studies included in this review, we identified 28 performance-based tests which covered 15 categories of OA core set activity and participation. The categories of d4500:walking short distances, d4104:standing and d4103:sitting were the most frequently used, employed in 14, 10 and 10 performance-based tests, respectively. However, 34 categories of activity and participation were not found in any performance-based tests. A-test ('A' like Activity or Assessment) had the widest coverage covering 10 out of 49 core set categories. Four performance tests covered four activity and participation categories, one covered three categories, 10 covered two categories and 12 covered one category.

CONCLUSION

Our ICF-based content analysis revealed that the existing performance-based tests covered certain OA core set activity and participation categories, but overlooked multiple categories. This analysis can serve as a guide for researchers and clinicians in selecting suitable performance-based tests or a battery of tests to assess function following hip or knee arthroplasty.