Piloting the effectiveness of the Workout on Wheels Internet Intervention (WOWii) program among individuals with mobility disabilities

BACKGROUND

Doing any amount of moderate-to-vigorous physical activity yields health benefits. Individuals with mobility disabilities are among the least physically active Americans and limited evidence indicates effective strategies to promote physical activity among this group.

OBJECTIVE

Examine whether a 16-week virtual intervention program (Workout on Wheels internet intervention, WOWii) increases exercise engagement among mobility impaired individuals.

METHODS

Participants recruited through community organizations that provide services to individuals with disabilities. The WOWii program is comprised of 3 core components: 16 weeks of virtual intervention delivery and access to the WOWii website; staff and peer support; an exercise package that included an activity tracker and heart rate monitor, pedal exerciser, and therabands.

RESULTS

Ten people enrolled. Participants demonstrated good program engagement, attending an average of 14.1 ± 2.1 of the 16 virtual meetings and completing an average of 10.6 ± 5.6 weekly activities. Exercise data revealed that participants increased their time spent in aerobic exercise from an average of two days a week performing 32 ± 22 min during week one to an average of five days a week doing 127 ± 143 min in the final WOWii week. Only half continued to exercise over the two months once WOWii virtual meetings ended.

CONCLUSIONS

WOWii program delivery successfully promoted increased exercise participation for people with mobility disabilities over the 16 intervention weeks. Future studies should investigate approaches to promote exercise maintenance beyond program delivery.

Cardiovascular disease, muscle function, and long-term falls risk: The Perth Longitudinal Study of Ageing Women

BACKGROUND

A few cross-sectional studies have highlighted inconsistent associations between cardiovascular disease (CVD) and musculoskeletal conditions. We sought to investigate the relationship between clinical CVD including subtypes, compromised muscle function, as well as incident self-reported and injurious falls in older women.

MATERIALS AND METHODS

1431 community-dwelling older women (mean age ± SD; 75.2 ± 2.7 years) were included in over 14.5 years of a prospective study, the Perth Longitudinal Study of Ageing in Women. CVD (up to 18-years prior to the baseline visit) and injurious fall hospitalizations over 14.5 years were obtained from linked health records. Self-reported falls for five years were obtained via a written adverse event diary posted every four months. Timed-Up-and-Go (TUG) test and hand grip strength were used to assess mobility and muscle strength, respectively. Mobility impairment was defined as TUG performance >10.2 sec and muscle weakness characterized as grip strength <22 kg.

RESULTS

Over 5-years, 411 (28.7%) women reported a falls, while 567 (39.6%) were hospitalized due to an injurious fall over 14.5 years. Prior CVD events were associated with 32% (HR 1.32 95%CI, 1.06-1.64) and 29% (HR 1.29 95%CI, 1.07-1.56) increased risk of self-reported and injurious falls, respectively, in multivariable-adjusted models. When considering subtypes of CVD, only cerebrovascular disease was related to self-reported (HR 1.77; 95%CI, 1.15-2.72) and injurious falls requiring hospitalization (HR 1.51; 95%CI, 1.00-2.27). CVD was also associated with cross-sectional and prospective mobility impairments. However, no evidence for such relationships was observed for muscle weakness.

CONCLUSIONS

Prevalent CVD events, particularly cerebrovascular disease, are related to an increased risk of long-term falls. These findings highlight the need to recognize increased falls risk in patients with CVD. Further, there is a need to understand whether incorporating prevalent CVD into falls screening tools improves risk stratification or affects model calibration.

Active Videogaming Interventions in Adults with Neuromuscular Conditions: A Scoping Review

This review synthesized active videogaming (AVG) intervention literature over a 10-year period (2010-2020) for people with neuromuscular conditions (18-64 years of age), examining interventions that aimed to improve health and secondary conditions, physical activity, and outcomes quality of life (QOL). Systematic searches yielded 40 eligible studies. The major groups were multiple sclerosis (40%) and stroke (33%), and the study participants had mostly mild-to-moderate disability who were able to play games in a standing position. Research designs primarily involved randomized controlled trials (65%) and pre/post-trial design without a control group (28%). The majority of interventions used commercial off-the-shelf gaming systems, such as Nintendo Wii and Microsoft Kinect. Studies reported significant improvements in health outcomes, specifically in balance (n = 30/36), mobility (n = 24/27), and cardiorespiratory fitness (n = 6/8). Positive changes were also seen in secondary conditions (n = 8/12), physical activity (n = 3/4), and QOL outcomes (n = 8/16). AVG research for people with neuromuscular conditions has grown in both quantity and quality but several gaps remain. Study findings provide a roadmap for future AVG trials on understudied populations, and highlight technology and targeted outcomes as drivers of future intervention research.

Is the presence of home entrance steps associated with community participation of people with mobility impairments?

BACKGROUND

Little is known about how home entrances are related to community participation for people with mobility impairments.

OBJECTIVE

This investigation explored how the need to navigate steps at the entrance of a home affects the community participation levels of people with mobility impairments.

METHODS

This survey study used pre-measure data collected from three different samples. Participants were adults living independently in the community aged 18-94 years old who self-reported having a mobility impairment. Measures included the Brief Community Engagement Questionnaire to examine potential differential effects on the number of non-discretionary trips people make into the community (e.g., getting groceries, medications) versus the number of discretionary activities (e.g., socializing outside the home) people reported over seven days.

RESULTS

People with mobility impairments were less likely to report a stepped entrance than people without MI, but when the entrance they use the most had steps they reported significantly higher exertion to use the entrance. The presence of steps had no effect on non-discretionary trips (p = .74), but was associated with 49% (p < .01) fewer discretionary activities reported by people with mobility impairment relative to those without MI.

CONCLUSION

Steps at the home entrance of people with mobility impairment may be an important mediating factor in their level of participation. When researchers and practitioners evaluate interventions that aim to increase community participation of people with mobility impairment, they should control for the presence of steps at their home entrance.

Associations Between Smoking Status and Physical and Mental Health-Related Quality of Life Among Individuals With Mobility Impairments

BACKGROUND

In the general population, quitting smoking is associated with improved health-related quality of life (QoL), but this association has not been examined in smokers with chronic mobility impairments (MIs).

PURPOSE

We examined associations between smoking status and health-related QoL over 6 months, and whether relationships are moderated by depression and MI severity.

METHODS

This is a secondary analysis of a smoking cessation induction trial among smokers with MIs (n = 241, 56% female, 36% Black) assessed at baseline, and 4 and 6 months after. Participants were grouped into "Smokers" (smoking at 4 and 6 months), "Abstainers" (quit at 4 and 6 months), "Relapsers" (relapsed at 6 months), and "Late-quitters" (quit at 6 months). Physical and mental health-related QoL was assessed with the Short-Form Health Survey. Depression was defined as scores ≥10 on the Patient Health Questionnaire, and MI severity by the use of skilled care for personal needs. Data were analyzed with linear mixed models.

RESULTS

Aggregating across time, among nondepressed participants, compared with "Smokers," the "Abstainer," and "Late-quitter" groups improved their physical health scores. "Late-quitters" also improved compared with "Relapsers." Among the total sample, compared with "Smokers," "Abstainers" showed improvements in mental health scores overtime, whereas "Relapsers" improved their score at 4 months, and "Late-quitters" improved at 6 months.

CONCLUSIONS

Quitting smoking is associated with improvements in physical health-related QoL regardless of the severity of MI but only among those without depression at baseline. For mental health-related QoL, associations with quitting smoking were independent of baseline depression and severity of MI.

Feasibility and effects of a chair-based yoga program for adults with neurodisability

Purpose: This study focuses on exploring the feasibility and the effects of practicing chair-based yoga for 10 weeks on health-related quality of life (HRQoL) and interoceptive body awareness (BA) in adults with neurodisability and moderate to severe physical dependence.Materials and Methods: A pre- and post-testing control group design was followed. Participants were 34 service users at a rehabilitation center. The intervention group (IG, n = 17, 53% men, mean age of 48.6 ± 11.4 years) took part in the 10-week chair-based yoga program. The control group (CG, n = 17, 53% men, mean age of 53.1 ± 11.0 years) received usual care. The outcome measures were feasibility (recruitment rate, attrition, completion rate, adherence, participation, safety and tolerability), HRQoL (WHOQoL-BREF questionnaire), and BA (the Multidimensional Assessment of Interoceptive Awareness, MAIA). Participants in the IG completed a questionnaire to measure their personal experience of participating in the program.Results and Conclusions: This study provides implications for a 10-week chair-based yoga program as a feasible, well-tolerated, and safe intervention, reinforced by the participants' retrospective judgment. Compared to the CG, the program produced statistically significant improvements over BA, such as subscales of MAIA Noticing (p = .031, Hedges g_s = 0.76), Emotional Awareness (p < .001, Hedges g_s = 1.68), and Trusting (p = .036, Hedges g_s = 0.74), but not HRQoL, for the IG. Chair-based yoga programs could be a rehabilitation strategy in the socio-health care of a varied population with physical mobility impairments leading to wheelchair use.Implications for RehabilitationA 10-week chair-based yoga intervention was shown to be a feasible, well-tolerated, and safe therapy which allowed people of varying abilities to participate equitable.Chair-based yoga can help people with moderate to severe physical dependence due to neurodisability to improve their interoceptive body awareness.Chair-based yoga does not have a significant impact on the health-related quality of life of this sample of participants.

Disparities in mental health, social support and coping among individuals with mobility impairment

BACKGROUND

CDC estimated that 19.4 million (7.8%) US adults are living with mobility impairment, who are unable to walk a quarter mile. Individuals with physical disability reported greater depression and, in some cases, insufficient social support.

OBJECTIVES

This study explores the extent of disparities in psychological health, social support, and coping mechanisms among those with mobility impairment as compared to those without such impairment, and the longitudinal effect of onset of mobility impairment on subsequent psychosocial health and coping.

METHODS

Individuals with mobility impairment were matched to controls from a nationally representative sample, using the propensity score method. The final sample included 345 matched pairs. Regression models with robust standard errors were used to assess disparities in outcomes by mobility status. Autoregressive models were used to assess the longitudinal effect of the onset of mobility limitation on these outcomes.

RESULTS

Those with impaired mobility fared significantly higher on negative affect (p < .05) and pessimism (p < .05), and significantly lower on life satisfaction (p < .05) and positive affect (p = .001). In terms of coping, they showed disparities in health locus of control (self) (p < .05), planning (p < .05), active coping (p < .05), and problem-focused coping (p < .05), as compared to those without mobility limitation. The onset of mobility impairment had significant effects in similar psychological and coping domains.

CONCLUSION

Our work revealed a piece of reality of individuals living with mobility impairment and will inform designing effective interventions to mitigate psychosocial health disparities in this population.

Noncardiac-Related Morbidity, Mobility Limitation, and Outcomes in Older Adults With Heart Failure

BACKGROUND

To examine the individual and combined associations of noncardiac-related conditions and mobility limitation with morbidity and mortality in adults with heart failure (HF).

METHODS

We conducted a retrospective cohort study in a large, diverse group of adults with HF from five U.S. integrated healthcare delivery systems. We characterized patients with respect to the presence of noncardiac conditions (<3 vs ≥3) and/or mobility impairment (defined by the use/nonuse of a wheelchair, cane, or walker), categorizing them into four subgroups. Outcomes included all-cause death and hospitalizations for HF or any cause.

RESULTS

Among 114,553 adults diagnosed with HF (mean age: 73 years old, 46% women), compared with <3 noncardiac conditions/no mobility limitation, adjusted hazard ratios (HR) for all-cause death among those with <3 noncardiac conditions/mobility limitation, ≥3 noncardiac conditions/no mobility limitation, ≥3 noncardiac conditions/mobility limitation (vs) were 1.40 (95% CI, 1.31-1.51), 1.72 (95% CI, 1.69-1.75), and 1.93 (95% CI, 1.85-2.01), respectively. We did not observe an increased risk of any-cause or HF-related hospitalization related to the presence of mobility limitation among those with a greater burden of noncardiac multimorbidity. Consistent findings regarding mortality were observed within groups defined according to age, gender, and HF type (preserved, reduced, mid-range ejection fraction), with the most prominent impact of mobility limitation in those <65 years of age.

CONCLUSIONS

There is an additive association of mobility limitation, beyond the burden of noncardiac multimorbidity, on mortality for patients with HF, and especially prominent in younger patients.

Long-Term Exposure to Anticholinergic and Sedative Medications and Cognitive and Physical Function in Later Life

BACKGROUND

Anticholinergic and sedative medications are frequently prescribed to older individuals. These medications are associated with short-term cognitive and physical impairment, but less is known about long-term associations. We therefore examined whether over 20 years cumulative exposure to these medications was related to poorer cognitive and physical functioning.

METHODS

Older adult participants of the Longitudinal Aging Study Amsterdam (LASA) were followed from 1992 to 2012. On seven measurement occasions, cumulative exposure to anticholinergic and sedative medications was quantified with the drug burden index (DBI), a linear additive pharmacological dose-response model. Cognitive functioning was assessed with the Mini-Mental State Examination (MMSE), Alphabet Coding Task (ACT, three trials), Auditory Verbal Learning Test (AVLT, learning and retention condition), and Raven Colored Progressive Matrices (RCPM, two trials). Physical functioning was assessed with the Walking Test (WT), Cardigan Test (CT), Chair Stands Test (CST), Balance Test (BT), and self-reported Functional Independence (FI). Data were analyzed with linear mixed models adjusted for age, education, sex, living with a partner, BMI, depressive symptoms, comorbidities (cardiovascular disease, diabetes, cancer, COPD, osteoarthritis, CNS diseases), and prescribed medications.

RESULTS

Longitudinal associations were found of the DBI with poorer cognitive functioning (less items correct on the three ACT trials, AVLT learning condition, and the two RCPM trials) and with poorer physical functioning (longer completion time on the CT, CST, and lower self-reported FI).

CONCLUSIONS

This longitudinal analysis of data collected over 20 years, showed that higher long-term cumulative exposure to anticholinergic and sedative medications was associated with poorer cognitive and physical functioning.

The Enabling Reduction of Low-Grade Inflammation in Seniors (ENRGISE) Pilot Study: Screening Methods and Recruitment Results

BACKGROUND

The Enabling Reduction of Low-grade Inflammation in Seniors (ENRGISE) Pilot Study is a multicenter randomized clinical trial examining the feasibility of testing whether omega-3 fish oil (ω-3) and the angiotensin receptor blocker losartan alone or in combination can reduce inflammation and improve walking speed in older adults with mobility impairment. We describe recruitment methods and results.

METHODS

Eligible participants were 70 years and older, had elevated interleukin-6 levels (2.5-30 pg/mL) and mobility impairment.

RESULTS

Of those who responded to recruitment, 83% responded to mailings. A total of 5,424 telephone screens were completed; of these, 2,011 (37.1%) were eligible for further screening. The most common reasons for ineligibility at the telephone screens were lack of mobility impairment or use of angiotensin receptor blockers or angiotensin-converting enzyme inhibitors (n=1.789). Of the 1,305 initial screening visits, 1,087 participants had slow gait speed (<1 m/s). Of these, 701 (64%) had elevated interleukin-6 and were eligible for second screening visits. Of the 582 second screening visits, 335 (57.6%) were eligible to be randomized. A total of 289 participants (96% of goal) were randomized: 180 in the ω-3 stratum (240% of goal); 43 in the losartan (57% of goal), and 66 in the combination (44% of goal). The telephone screen and first screening visit to randomization ratio was 19 to 1 and 4.5 to 1, respectively. The estimated cost of recruitment per randomized participant was $1,782.

CONCLUSION

Recruitment for ω-3 exceeded goals, but goals for the losartan and combination strata were not met due to the high proportion of participants taking angiotensin receptor blockers or angiotensin-converting enzyme inhibitors.

Preference-based measures of health-related quality of life in congenital mobility impairment: a systematic review of validity and responsiveness

INTRODUCTION

Mobility impairment is the leading cause of disability in the UK. Individuals with congenital mobility impairments have unique experiences of health, quality of life and adaptation. Preference-based outcomes measures are often used to help inform decisions about healthcare funding and prioritisation, however the applicability and accuracy of these measures in the context of congenital mobility impairment is unclear. Inaccurate outcome measures could potentially affect the care provided to these patient groups. The aim of this systematic review was to examine the performance of preference-based outcome measures for the measurement of utility values in various forms of congenital mobility impairment.

METHODS

Ten databases were searched, including Science Direct, CINAHL and PubMed. Screening of reference lists and hand-searching were also undertaken. Descriptive and narrative syntheses were conducted to combine and analyse the various findings. Results were grouped by condition. Outcome measure performance indicators were adapted from COSMIN guidance and were grouped into three broad categories: validity, responsiveness and reliability. Screening, data extraction and quality appraisal were carried out by two independent reviewers.

RESULTS

A total of 31 studies were considered eligible for inclusion in the systematic review. The vast majority of studies related to either cerebral palsy, spina bifida or childhood hydrocephalus. Other relevant conditions included muscular dystrophy, spinal muscular atrophy and congenital clubfoot. The most commonly used preference-based outcome measure was the HUI3. Reporting of performance properties predominantly centred around construct validity, through known group analyses and assessment of convergent validity between comparable measures and different types of respondents. A small number of studies assessed responsiveness, but assessment of reliability was not reported. Increased clinical severity appears to be associated with decreased utility outcomes in congenital mobility impairment, particularly in terms of gross motor function in cerebral palsy and lesion level in spina bifida. However, preference-based measures exhibit limited correlation with various other condition-specific and clinically relevant outcome measures.

CONCLUSION

Preference-based measures exhibit important issues and discrepancies relating to validity and responsiveness in the context of congenital mobility impairment, thus care must be taken when utilising these measures in conditions associated with congenital mobility impairments.

Evaluating functional electrical stimulation (FES) cycling on cardiovascular, musculoskeletal and functional outcomes in adults with multiple sclerosis and mobility impairment: A systematic review

BACKGROUND

People with Multiple Sclerosis (PwMS) are at an increased risk of diseases associated with low levels of physical activity (PA). Deconditioning may lead to an acceleration in the development of secondary complications from MS, impairing physical function and exacerbating disease progression. Functional Electrical Stimulation (FES) Cycling may provide a suitable lower limb exercise intervention for PwMS with mobility impairment. The effects of FES cycling on cardiovascular, musculoskeletal and functional outcomes for PwMS with mobility impairment are yet to be investigated to date.

OBJECTIVE

The objective of this review was to systematically examine the outcomes of PwMS with mobility impairment following FES cycling intervention.

METHODS

A systematic search of four electronic databases (MEDLINE, Web of Science, CINAHL and PEDro) from their inception to 8th January 2019 was performed. Inclusion criteria was (1) include human participants with definite diagnosis of MS (2) participants had to be aged 18 years or older (3) include participants with mobility impairment (determined as an average participant EDSS ≥ 6.0) (4) evaluate FES cycling as an intervention study.

RESULTS

Initial searches found 1163 studies. 9 of which met the full inclusion criteria: 5 pre-post studies with no control group, 2 randomised controlled trials (RCTs), 1 retrospective study and 1 case study. Two studies had the same participant group and intervention but reported different outcomes. Outcome data was available for n = =76 unique participants, with n = =82 completing a FES cycling intervention. Of the n = =4 papers with clear dropout rates, pooled dropout rate was 25.81%. Two papers reported non-significant improvements in aerobic capacity following a FES cycling intervention. Four papers reported no change in lower limb strength and two papers reported significant reductions in spasticity post training. Four studies failed to provide information regarding adverse events with the other studies reporting n = =10 adverse events across 36 participants.

CONCLUSION

Findings suggest FES cycle training may reduce CVD risk alongside trends for a reduction in spasticity post training, however the low quality of the literature precludes any definitive conclusions. FES cycle training appears to be well tolerated in PwMS with mobility impairment, with no serious adverse events.

Mobility impairments and geographic variation in vulnerability to household food insecurity

Studies indicate an association between disability and higher rates of household food insecurity (HFI). Geographic variation in this relationship has not been explored despite the potential influence of economic and political contexts, including costs of living and disability social assistance. This study examines the association between mobility impairment and HFI within and across Canada considering the possible role of population composition, contextual, and collective influences. Using data from 217,094 adults from the 2007/08, 2009/10, 2013/14, and 2015/16 Canadian Community Health Survey, multivariate logistic regression models examined associations between mobility impairment and HFI controlling for socio-demographic factors and geography of residence (i.e., province, region, and urban/rural status). Subsequent analysis of 14,353 surveyed adults with mobility impairments was conducted to examine geographic and socio-demographic factors associated with HFI in this population. Adults with mobility impairments had elevated odds of HFI of 3.85 (95% CI: 3.49-4.24), when adjusting for age, sex, and geography of residence and 2.11 (95% CI: 1.89-2.35) adjusting for additional socio-demographic characteristics. Across Canada, mobility impaired adults experienced greater odds of HFI. Significantly lower odds of HFI were found for mobility impaired adults living in Newfoundland, Alberta, and Saskatchewan compared to Ontario when adjusting for age and sex, and in Quebec when controlling for additional socio-demographic factors. Socioeconomic factors and age accounted for most variation in HFI in this population, suggesting the importance of poverty reduction strategies that reduce vulnerability to HFI across the population.

Tailoring Assessments and Prescription in Cardiac Rehabilitation for Older Adults: The Relevance of Geriatric Domains

Older adults have distinctive health challenges that are relevant to the prevention and treatment of cardiovascular diseases and are potentially modifiable by cardiac rehabilitation. Cardiac rehabilitation in older adults provides opportunity to assess sarcopenia, obesity, osteoporosis, frailty, falls risk, arthritis, cognition, special senses, self-efficacy, depression, social support, polypharmacy, and nutritional adequacy. Therefore, broadening standard assessments to include these domains can help detect modifiable vulnerabilities and inform therapeutic priorities.

'Timed up and go' and brain atrophy: a preliminary MRI study to assess functional mobility performance in multiple sclerosis

Motor and cognitive disabilities are related to brain atrophy in multiple sclerosis (MS). 'Timed up and go' (TUG) has been recently tested in MS as functional mobility test, as it is able to evaluate ambulation/coordination-related tasks, as well as cognitive function related to mobility. The objective of this study is to evaluate the relationship between brain volumes and TUG performances. Inclusion criteria were a diagnosis of MS and the ability to walk at least 20 m. TUG was performed using a wearable inertial sensor. Times and velocities of TUG sub-phases were calculated by processing trunk acceleration data. Patients underwent to a brain MRI, and volumes of whole brain, white matter (WM), grey matter (GM), and cortical GM (C) were estimated with SIENAX. Sixty patients were enrolled. Mean age was 41.5 ± 11.6 years and mean EDSS 2.3 ± 1.2. Total TUG duration was correlated to lower WM (ρ = 0.358, p = 0.005) and GM (ρ = 0.309, p = 0.017) volumes. A stronger association with lower GM volume was observed for intermediate (ρ = 0.427, p = 0.001) and final turning (ρ = 0.390, p = 0.002). TUG is a useful tool in a clinical setting as it can not only evaluate patients' disability in terms of impaired functional mobility, but also estimate pathological features, such as grey atrophy.

Measuring the health-related quality of life of children with impaired mobility: examining correlation and agreement between children and parent proxies

Objective

The objective of this research project was to evaluate the validity of proxy health-related quality of life measures in the context of paediatric mobility impairment. Accurate health-related quality of life data is essential for quality-adjusted life year calculation; a key outcome in economic evaluation. Thirteen child-parent dyads (13 children with mobility impairments, 13 parent proxies) were asked to complete a range of outcome measures (EQ-5D-Y, VAS and HUI2/3) relating to the child’s health. The relationship between respondent outcomes was examined using tests of respondent type effect (Wilcoxon signed-rank), correlation (Spearman’s rank-order) and agreement (Bland–Altman plots).

Results

Parent proxies significantly undervalued the health-related quality of life of their mobility-impaired children: children rated their health-related quality of life higher than their parents by proxy on all measures. The VAS had the highest overall mean score for children and proxies (79.50 [SD = 15.01] and 75.77 [SD = 14.70] respectively). Child and proxy results were significantly different (p < 0.05) for all measures besides the VAS (p = 0.138). Strong correlation and acceptable agreement were observed for equivalent child/proxy VAS and HUI measures. The EQ-5D-Y exhibited the least agreement between children and proxies. Sufficient association between child/proxy VAS and HUI measures indicated a degree of interchangeability.

The effect of exercise training in adults with multiple sclerosis with severe mobility disability: A systematic review and future research directions

INTRODUCTION

There is evidence for the benefits of exercise training in persons with multiple sclerosis (MS). However, these benefits have primarily been established in individuals with mild-to-moderate disability (i.e., Expanded Disability Status Scale [EDSS] scores 1.0-5.5), rather than among those with significant mobility impairment. Further, the approaches to exercise training that have been effective in persons with mild-to-moderate MS disability may not be physically accessible for individuals with mobility limitations. Therefore, there is a demand for an evidence-base on the benefits of physically accessible exercise training approaches for managing disability in people with MS with mobility impairment.

OBJECTIVE

To conduct a systematic review of the current literature pertaining to exercise training in individuals with multiple sclerosis (MS) with severe mobility disability.

METHODS

Four electronic databases (PubMed, EMBASE, OvidMEDLINE, and PsychINFO) were searched for relevant articles published up until October 2016. The review focused on English-language studies that examined the effect of exercise training in people with MS with severe mobility disability, characterized as the need for assistance in ambulation or EDSS score ≥ 6.0. The inclusion criteria involved full-text articles that: (i) included participants with a diagnosis of MS; (ii) included primarily participants with a reported EDSS score ≥ 6.0 and/or definitively described disability consistent with this level of neurological impairment; and (iii) implemented a prospective, structured exercise intervention. Data were analyzed using a descriptive approach and summarized by exercise training modality (conventional or adapted exercise training), and by outcome (disability, physical fitness, physical function, and symptoms and participation).

RESULTS

Initially, 1164 articles were identified and after removal of duplicates, 530 articles remained. In total, 512 articles did not meet the inclusion criteria. 19 articles were included in the final review. Five studies examined conventional exercise training (aerobic and resistance training), and thirteen studies examined adapted exercise modalities including body-weight support treadmill training (BWSTT), total-body recumbent stepper training (TBRST), and electrical stimulation cycling (ESAC). Outcomes related to mobility, fatigue, and quality of life (QOL) were most frequently reported. Two of five studies examining conventional resistance exercise training reported significant improvements in physical fitness, physical function, and/or symptomatic and participatory outcomes. Nine of 13 studies examining adapted exercise training reported significant improvements in disability, physical fitness, physical function, and/or symptomatic and participatory outcomes.

CONCLUSIONS

There is limited, but promising evidence for the benefits of exercise training in persons with MS with severe mobility disability. Considering the lack of effective therapeutic strategies for managing long-term disability accumulation, exercise training could be considered as an alternative approach. Further research is necessary to optimize the prescription and efficacy of exercise training for adults with MS with severe mobility disability.

An exploratory qualitative investigation of psychosocial determinants of parental decisions to support sport participation for youth with a mobility impairment

INTRODUCTION

Parents of youth with a mobility impairment (MI) have an important influence on their children's sport participation. The current study consists of an exploratory qualitative investigation of the relevance of HAPA for understanding parental support behaviours for youth with MI's sport participation.

METHODS

Parents of youth athletes (Mage=11.10; SD=2.77) and non-athletes (Mage=11.50; SD=3.84) participated in semi-structured interviews with question development guided by the Health Action Process Approach (HAPA).

RESULTS

Constructs from HAPA were expressed as relevant to parental decisions, with differing subthemes emerging based upon parental group (i.e. parents of non-athletes or parents of athletes). Other constructs that emerged included barriers, facilitators, and resources.

DISCUSSION

Constructs from the motivational phase of HAPA were relevant for parents of athletes and non-athletes, while the volitional phase demonstrated utility for understanding the views of parents of athletes. Differences between the patterns of responses of both groups were apparent in how the constructs were expressed. Findings identify key areas for research, as well as practical applications. For example, future programs can target parental positions on specific HAPA constructs (e.g. risk perceptions) where differences were found between both groups of parents in order to promote parental decisions that support their children's sport participation.

Built environment attributes related to GPS measured active trips in mid-life and older adults with mobility disabilities

BACKGROUND

Understanding factors which may promote walking in mid-life and older adults with mobility impairments is key given the association between physical activity and positive health outcomes.

OBJECTIVE

To examine the relationship between active trips and objective measures of the home neighborhood built environment.

METHODS

Global positioning systems (GPS) data collected on 28 adults age 50+ with mobility disabilities were analyzed for active trips from home. Objective and geographic information systems (GIS) derived measures included Walk Score, population density, street connectivity, crime rates, and slope within the home neighborhood. For this cross-sectional observational study, we conducted mean comparisons between participants who took active trips from home and those who did not for the objective measures. Effect sizes were calculated to assess the magnitude of group differences.

RESULTS

Nine participants (32%) took active trips from home. Walking in the home neighborhood was significantly associated with GIS derived measures (Walk Score, population density, and street density; effect sizes 0.9-1.2). Participants who used the home neighborhood for active trips had less slope within 1 km of home but the difference was not significant (73.5 m ± 22 vs. 100.8 m ± 38.1, p = 0.06, d = 0.8). There were no statistically significant differences in mean scores for crime rates between those with active trips from home and those without.

CONCLUSIONS

The findings provide preliminary evidence that more walkable environments promote active mobility among mid-life and older adults with mobility disabilities. The data suggest that this population can and does use active transportation modes when the built environment is supportive.

Hip flexion weakness is associated with impaired mobility in oculopharyngeal muscular dystrophy: a retrospective study with implications for trial design

Oculopharyngeal muscular dystrophy (OPMD) is a rare myopathy for which validated outcome measures are lacking, posing a barrier to clinical trials. Our goal was to identify factors associated with impaired mobility in OPMD in order to guide development of surrogate endpoints in future clinical trials. One hundred forty-four individuals with OPMD were included in this retrospective, single-center study. We made novel use of parametric time-to-event analysis to model age at initial use of assistive device for ambulation. We hypothesized that limb weakness and other markers of disease severity are associated with earlier use of assistive devices. 23.6% of individuals (34/144) progressed to use of assistive devices (mean age 66.0 ± 9.6 y). Earlier age at assistive device was associated with hip flexion Medical Research Council grade ≤3 (p <0.0001), earlier disease onset (p <0.0001), and lack of blepharoptosis surgery (p = 0.011). Markers of dysphagia severity were not associated with earlier progression to assistive devices. Our study is the first to show a statistical association between hip flexion weakness and impaired mobility in OPMD, indicating that hip flexion strength could be explored as a surrogate endpoint for use in clinical trials. Since severity of disease features may be discordant within individuals, composite outcome measures are warranted.