The association of dietary antioxidants and the inflammatory potential of the diet with poor physical function and disability in older Australian men: the Concord Health and Ageing in Men Project

Our objective was to evaluate the association of antioxidant intake and the inflammatory potential of the diet with functional decline in older men. A diet history questionnaire was used to collect dietary intake data from men aged ≥ 75 years (n 794) participating in the Concord Health and Aging in Men Project cohort study. Intake of vitamins A, C, E and Zn were compared with the Australian Nutrient Reference Values to determine adequacy. The Energy-adjusted Dietary Inflammatory Index (E-DIITM) was used to assess the inflammatory potential of the diet. Physical performance data were collected via handgrip strength and walking speed tests, and activities of daily living (ADL) and instrumental activities of daily living (IADL) questionnaires, at baseline and 3-year follow-up (n 616). Logistic regression analysis was used to identify associations between diet and incident poor physical function and disability. Both poor antioxidant intake and high E-DII scores at baseline were significantly associated with poor grip strength and ADL disability at 3-year follow-up. No significant associations with walking speed or IADL disability were observed. Individual micronutrient analysis revealed a significant association between the lowest two quartiles of vitamin C intake and poor grip strength. The lowest quartiles of intake for vitamins A, C, E and Zn were significantly associated with incident ADL disability. The study observed that poor antioxidant and anti-inflammatory food intake were associated with odds of developing disability and declining muscle strength in older men. Further interventional research is necessary to clarify the causality of these associations.

Assessment of myosteatosis and functionality in pretreatment gynecological cancer patients

PURPOSE

We aimed to investigate the relationship between pretreatment gynecologic cancer survival and the physical function of patients with myosteatosis. Understanding this relationship prior to treatment would help healthcare providers identify and refer patients with poor muscle quality to an exercise program prior to treatment.

METHODS

We conducted a cross-sectional analysis of 73 GC patients. Physical function was quantified using handgrip strength and an adapted version of the Senior Fitness Test (aerobic endurance not included). The EORTC QLC-C30 was used to evaluate general health quality. Myosteatosis (values below the median muscle radiodensity), muscle mass, and adipose tissue variables were calculated from the computed tomography (CT) scan at the third lumbar vertebra using specific software.

RESULTS

Seventy patients (50.9 ± 15.2) were included; 41.5% had stage III or IV disease, and 61.4% had cervical cancer. The myosteatosis group was 11.9 years older and showed reduced functioning compared to the normal-radiodensity group. Age and Timed Up and Go (TUG) test results were shown to be the most reliable predictors of muscle radiodensity in pretreatment gynecological patients according to multivariate regression analysis (R2 = 0.314).

CONCLUSION

Gynecological healthcare professionals should be aware that prompt exercise programs might be especially beneficial for older patients with reduced TUG performance to preserve muscle function and quality.

Cross-sectional associations between patterns and composition of upright and stepping events with physical function: insights from The Maastricht Study

INTRODUCTION

Age-related declines in physical functioning have significant implications for health in later life. Physical activity (PA) volume is associated with physical function, but the importance of the pattern in which PA is accumulated is unclear. This study investigates associations between accelerometer-determined daily PA patterns, including composition and temporal distribution (burstiness) of upright and stepping events, with physical function.

METHODS

Data was from participants who wore an activPAL3 accelerometer as part of The Maastricht Study. Exposures included a suite of metrics describing the composition and the temporal distribution (burstiness) of upright and sedentary behaviour. Physical function outcomes included the six-minute walk test (6MWT), timed chair-stand test (TCST), grip strength (GS), and SF-36 physical functioning sub-scale (SF-36pf). Multivariable linear regression models were used to assess associations, adjusting for covariates including overall PA volume (daily step count).

RESULTS

Participants(n = 6085) had 6 or 7 days of valid data. Upright and stepping event metrics were associated with physical function outcomes, even after adjusting PA volume. Higher sedentary burstiness was associated with better function (6MWT, TCST, and SF-36pf), as was duration and step volume of stepping events (6MWT, TCST, GS, and SF-36pf), step-weighted cadence (6MWT, TCST, and SF-36pf). Number of stepping events was associated with poorer function (6MWT, GS, and SF-36pf), as was upright event burstiness (SF-36pf). Associations varied according to sex.

CONCLUSION

Our study reveals that diverse patterns of physical activity accumulation exhibit distinct associations with various measures of physical function, irrespective of the overall volume. Subsequent investigations should employ longitudinal and experimental studies to examine how changing patterns of physical activity may affect physical function, and other health outcomes.

Effect of prebiotic fiber on physical function and gut microbiota in adults, mostly women, with knee osteoarthritis and obesity: a randomized controlled trial

PURPOSE

Obesity is a primary risk factor for knee osteoarthritis (OA). Prebiotics enhance beneficial gut microbes and can reduce body fat and inflammation. Our objective was to examine if a 6-month prebiotic intervention improved physical function in adults with knee osteoarthritis and obesity. We also measured knee pain, body composition, quality of life, gut microbiota, inflammatory markers, and serum metabolomics.

METHODS

Adults (n = 54, mostly women) with co-morbid obesity (BMI > 30 kg/m2) and unilateral/bilateral knee OA were randomly assigned to prebiotic (oligofructose-enriched inulin; 16 g/day; n = 31) or isocaloric placebo (maltodextrin; n = 21) for 6 months. Performance based-tests, knee pain, quality of life, serum metabolomics and inflammatory markers, and fecal microbiota and short-chain fatty acids were assessed.

RESULTS

Significant between group differences were detected for the change in timed-up-and-go test, 40 m fast paced walk test, and hand grip strength test from baseline that favored prebiotic over placebo. Prebiotic also reduced trunk fat mass (kg) at 6 months and trunk fat (%) at 3 months compared to placebo. There was a trend (p = 0.059) for reduced knee pain at 6 months with prebiotic versus placebo. In gut microbiota analysis, a total of 37 amplicon sequence variants differed between groups. Bifidobacterium abundance was positively correlated with distance walked in the 6-min walk test and hand grip strength. At 6 months, there was a significant separation of serum metabolites between groups with upregulation of phenylalanine and tyrosine metabolism with prebiotic.

CONCLUSION

Prebiotics may hold promise for conservative management of knee osteoarthritis in adults with obesity and larger trials are warranted.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov/study/NCT04172688.

The association of depressive symptoms with handgrip strength and gait speed in community-dwelling older adults: data from the baseline phase of Birjand Longitudinal Aging Study

BACKGROUND

Depression is a multifaceted condition with a high prevalence and burden to society. Handgrip strength (HGS) and gait speed (GS) are indices of physical health, which is linked to mental health. Previous studies have shown heterogeneity among countries in the association of physical parameters and depression. In this study, we aimed to investigate the association of HGS and GS with depressive symptoms in older adults.

METHODS

This is a cross-sectional study analyzing data from the Birjand Longitudinal Aging Study, a cohort of community-dwelling older adults (≥ 60 years old). Depressive symptoms were assessed by the nine-item Patient Health Questionnaire. HGS was measured with a hand dynamometer in a sitting position, and GS was estimated by a 15-foot walk test at usual pace.

RESULTS

Compared to participants in the first quartile, those in the second quartile of HGS had significantly lower odds of suffering from depressive symptoms, while GS was not significantly associated with depressive symptoms. A higher HGS was associated with a lower risk of moderate depressive symptoms, while a higher GS was related to a lower risk of moderately severe and severe symptoms.

CONCLUSIONS

Our findings suggest that older people residing in Birjand, Iran with a moderate HGS are less likely to suffer from depressive symptoms than those with lower HGS.

Associations of Neurological Biomarkers in Serum With Gait Measures: The Cardiovascular Health Study

BACKGROUND

Gait impairment leads to increased mobility decline and may have neurological contributions. This study explores how neurological biomarkers are related to gait in older adults.

METHODS

We studied participants in the Cardiovascular Health Study, a population-based cohort of older Americans, who underwent a serum biomarker assessment from samples collected in 1996-1997 for neurofilament light chain (NfL), glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase L1, and total tau (n = 1 959, mean age = 78.0 years, 60.8% female). In a subsample (n = 380), cross-sectional associations with quantitative gait measures were explored. This subsample was assessed on a mat for gait speed, step length, double support time, step time, step length variability, and step time variability. Gait speed was also measured over a 15-ft walkway annually from 1996-1997 to 1998-1999 for longitudinal analyses. Linear regression models assessed cross-sectional associations of biomarkers with gait measures, whereas mixed effects models assessed longitudinal gait speed change from baseline to 1998-1999.

RESULTS

Neurofilament light chain was significantly associated with annual gait speed decline (standardized β = -0.64 m/s, 95% CI: [-1.23, -0.06]) after adjustment for demographic and health factors. Among gait mat-assessed phenotypes, NfL was also cross-sectionally associated with gait speed (β = 0.001 m/s [0.0003, 0.002]) but not with other gait measures. None of the remaining biomarkers were significantly related to gait in either longitudinal or cross-sectional analyses.

CONCLUSIONS

Higher NfL levels were related to greater annual gait speed decline. Gait speed decline may be related to axonal degeneration. The clinical utility of NfL should be explored.

Fear of movement and competence frustration mediate the relationship between pain catastrophising and physical function in people living with axSpA: an online cross-sectional survey

The objective of this study is to examine the contribution of pain catastrophising to Axial Spondyloarthritis (axSpA) patient's physical function and to test the mediating role of fear of movement, and uniquely, the contribution of competence frustration to the fear-avoidance model. Participants (N = 98, 70% female, M age = 45.62, SD 12.16) completed an online survey (December 2020-May 2021) distributed in the United Kingdom via the National Axial Spondyloarthritis Society (n ≈ 3500; NASS, 2019). The PROCESS SPSS macro was used to test three mediation models using percentile bootstrap 95% confidence intervals (PBCI). A significant indirect effect on the relationship between pain and physical function via fear of movement (β = 0.10, 95% PBCI = 0.030-0.183) was observed (Model 1). Model 2 showed the relationship between pain catastrophising and physical function to be significantly mediated by fear of movement (β = 0.16, 95% PBCI = 0.005-0.322). Finally, Model 3 showed a significant indirect effect on the relationship between pain catastrophising and physical function via competence frustration (β = 0.15, 95% PBCI = 0.014-0.309) but not through fear of movement (β = 0.062, 95% PBCI = - 0.134 to 0.248). To our knowledge, this is the first study to examine and demonstrate the unique contribution of competence need frustration to the Fear-avoidance model in people that live with axSpA. Identifying modifiable factors that contribute to disease outcomes such as physical function can improve the care and quality of life for people living with a disease currently without a cure.

Virtual reality exergames for improving physical function, cognition and depression among older nursing home residents: A systematic review and meta-analysis

OBJECTIVE

To explore the effectiveness of virtual reality (VR) exergames on physical function, cognition and depression among older nursing home residents.

METHODS

A systematic review and meta-analysis were conducted. The PubMed, Ovid, Embase, Cochrane, CINAHL, and Web of Science databases were searched for relevant studies from inception until June 1, 2023. The reviewers independently completed the study selection, data extraction and quality assessment. Subgroup analyses were conducted to explore the sources of between-study heterogeneity and to determine whether participant or intervention characteristics influenced effect sizes.

RESULTS

Eighteen studies met the inclusion criteria and were selected for qualitative and quantitative synthesis. The overall methodological quality was relatively high, and the overall evidence grade was moderate. VR exergames had a large effect on physical function, including mobility [SMD=-0.66, P < 0.001], balance [SMD=0.95, P < 0.001], and lower limb strength [SMD=0.53, P = 0.0009]; and a moderate effect on cognition [SMD=0.48, P = 0.02] and depression [SMD=-0.72, P = 0.03]. Subgroup analyses revealed that a training frequency of 2 sessions per week and coordinating with physiotherapists yielded greater improvements in mobility (P = 0.009; P = 0.0001). VR exergames had especially beneficial effects on balance for physically fit participants (P = 0.03) and on cognition for participants with cognitive impairment (P = 0.01). Additionally, regarding the improvement of depression, commercial VR exergames were superior to self-made systems (P = 0.03).

CONCLUSION

VR exergames can provide a positive impact on physical function, cognition and depression among older nursing home residents. The study also demonstrated the different benefits of exergames between participants who were physically fit and those with cognitive impairment, which is considered as an innovative, cost-efficient and sustainable approach. Specifically, commercial VR exergame programs with a frequency of 2 sessions per week and coordinating with physiotherapists may be the most appropriate and effective option.

What are the differences in the recovery of physical function and clinical score between patients with steroid-related osteonecrosis of the femoral head and hip osteoarthritis undergoing total hip arthroplasty? A propensity score-matched study

PURPOSE

Steroid-related osteonecrosis of the femoral head (ONFH), arising from steroid administration for underlying diseases, represents a unique pathology for total hip arthroplasty (THA) and typically affects a younger demographic compared to osteoarthritis (OA). Given the significant age-related differences, this study aims to employ propensity score matching to align patient backgrounds between these two diseases and compare physical function. Additionally, our objective is to scrutinize the patterns of clinical score recovery over the course of one year following THA.

METHODS

Using propensity score matching, 29 patients each with steroid-related ONFH and OA were selected. Muscle strength (hip abductor and knee extensor) were assessed before and after THA. Additionally, recovery of the Harris Hip Score (HHS) and Oxford Hip Score (OHS) up to one year postoperatively was analyzed.

RESULTS

The steroid-related ONFH group exhibited gender bias and significantly younger age compared to the OA group. Propensity score matching achieved balanced patient backgrounds. Physical function showed trends of lower hip abduction and knee extensor strength on the operative side in the steroid-related ONFH group. Notably, nonoperative knee extensor strength decreased significantly after matching. HHS and OHS were poor in steroid-related ONFH up to three months postoperatively but recovered after six months.

CONCLUSIONS

Patients with steroid-related ONFH experience positive outcomes in clinical score following THA. Propensity score matching effectively identified muscle weakness on both operative and nonoperative sides, highlighting its utility in comparative analyses.

Protein intake and its relationship with frailty in chronic kidney disease

INTRODUCTION

Patients with chronic kidney disease (CKD) are susceptible to frailty because of a range of nutrition-related factors. While protein restriction is commonly advised to preserve kidney function in patients with CKD, insufficient protein intake could potentially exacerbate frailty risk. This study aimed to elucidate the relationship between frailty and protein intake in patients with CKD.

METHODS

This cross-sectional study enrolled patients with CKD stage 3-5. Frailty and prefrailty were assessed using the Japanese version of the Cardiovascular Health Study (J-CHS) criteria. To estimate dietary protein intake, Maroni's formula based on 24-h urine collection was used. The potential association between frailty/pre-frailty and protein intake was investigated using a logistic regression analysis.

RESULTS

Ninety-seven individuals with CKD were included in the study, with a median age of 73.0 years (interquartile range: 67.0, 82.0). Among them, 34 were women (35.1%), and the estimated glomerular filtration rate (eGFR) was 36.3 mL/min/1.73 m2 (interquartile range: 26.9, 44.1). Frailty and pre-frailty were identified in 13.4% and 55.7% of participants, respectively. Comparing the groups, protein intake in the frailty/pre-frailty group (0.83 g/kgBW/day [0.72, 0.93]) was lower than that in the robust group (0.89 g/kgBW/day [0.84, 1.19], p = 0.002). Upon logistic regression analysis, protein intake exhibited an independent association with frailty/pre-frailty (odds ratio: 0.72, 95% confidence interval: 0.59-0.89, p = 0.003).

CONCLUSION

Reduced protein intake in patients with CKD is associated with frailty and pre-frailty. It is advisable to ensure that patients with CKD who are at risk of frailty consume an adequate amount of protein.

Association of 'Tortoise' and 'Hare' movement behavior patterns with cardiometabolic health, body composition, and functional fitness in older adults

We investigated the association of movement behavior patterns with cardiometabolic health, body composition, and functional fitness in older adults. A total of 242 older adults participated of this cross-sectional study. Sedentary time, light physical activity (LPA) and moderate-vigorous physical activity (MVPA), steps/day, and step cadence were assessed by accelerometry. The movement behavior patterns were derived by principal component analysis. Cardiometabolic health was defined by a metabolic syndrome score (cMetS). Body composition was determined by appendicular lean mass/body mass index (ALM/BMI). Functional fitness was assessed by a composite z-score from the Senior Fitness Test battery. Two patterns were identified: 'Tortoise' (low sedentary time, high LPA and steps/day) and 'Hare' (high MVPA, steps/day, and step cadence). 'Tortoise' and 'Hare' were associated with better cMetS. 'Hare' was positively associated with ALM/BMI and Functional Fitness. While 'Tortoise' and 'Hare' were associated with better cMetS, only 'Hare' was associated with better ALM/BMI and functional fitness.

Effects of different sizes of ambient particulate matter and household fuel use on physical function: National cohort study in China

BACKGROUND

Impact of outdoor and household air pollution on physical function remains unelucidated. This study examined the influence of various ambient particulate sizes (PM1, PM2.5, and PM10) and household fuel usage on physical function.

METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011 and 2015 were utilized. The physical functional score was computed by summing scores from four tests: grip strength, gait speed, chair stand test, and balance. Multivariate linear and linear mixed-effects models were used to explore the separate and combined effects of PM1, PM2.5, PM10 and household fuel use on physical function in the cross-sectional and longitudinal analyses, respectively, and to further observe the effects of fuel cleanup on physical function in the context of air pollution exposure.

RESULTS

Both cross-sectional and longitudinal analyses revealed negative correlations between PM1 (β = -0.044; 95% CI: -0.084, -0.004), PM2.5 (β = -0.024; 95% CI: -0.046, -0.001), PM10 (β = -0.041; 95% CI: -0.054, -0.029), and physical function, with a more pronounced impact observed for fine particulate matter (PM1). Cleaner fuel use was associated with enhanced physical function compared to solid fuels (β = 0.143; 95% CI: 0.070, 0.216). The presence of air pollutants and use of solid fuels had a negative impact on physical function, while cleaner fuel usage mitigated the adverse effects of air pollutants, particularly in areas with high exposure.

CONCLUSION

This study underscores the singular and combined detrimental effects of air pollutants and solid fuel usage on physical function. Addressing fine particulate matter, specifically PM1, and prioritizing efforts to improve household fuel cleanliness in regions with elevated air pollution levels are crucial for preventing physical disability.

Functional decline in older breast cancer survivors treated with and without chemotherapy and non-cancer controls: results from the Hurria Older PatiEnts (HOPE) prospective study

PURPOSE

This study aimed to assess whether physical functional decline in older women with early-stage breast cancer is driven by cancer, chemotherapy, or a combination of both.

METHODS

We prospectively sampled three groups of women aged ≥ 65: 444 with early-stage breast cancer receiving chemotherapy (BC Chemo), 98 with early-stage breast cancer not receiving chemotherapy (BC Control), and 100 non-cancer controls (NC Control). Physical function was assessed at two timepoints (T1 [baseline] and T2 [3, 4, or 6 months]) using the Physical Functioning Subscale (PF-10) of the RAND 36-item Short Form. The primary endpoint was the change in PF-10 scores from T1 to T2, analyzed continuously and dichotomously (Yes/No, with "yes" indicating a PF-10 decline > 10 points, i.e., a substantial and clinically meaningful difference).

RESULTS

Baseline PF-10 scores were similar across all groups. The BC Chemo group experienced a significant decline at T2, with a median change in PF-10 of -5 (interquartile range [IQR], -20, 0), while BC Control and NC Control groups showed a median change of 0 (IQR, -5, 5; p < 0.001). Over 30% of BC Chemo participants had a substantial decline in PF-10 vs. 8% in the BC Control and 5% in the NC Control groups (p < 0.001).

CONCLUSION

In this cohort of older adults with early-stage breast cancer, the combination of breast cancer and chemotherapy contributes to accelerated functional decline. Our findings reinforce the need to develop interventions aimed at preserving physical function, particularly during and after chemotherapy.

IMPLICATIONS FOR CANCER SURVIVORS

The high prevalence of accelerated functional decline in older women undergoing breast cancer chemotherapy underscores the urgency to develop interventions aimed at preserving physical function and improving health outcomes.

CLINICAL TRIAL

NCT01472094, Hurria Older PatiEnts (HOPE) with Breast Cancer Study.

Effects of Exercise Training on Muscle Mass and Physical Function in Patients with Hepatocellular Carcinoma After Diagnosis: A Systematic Review

BACKGROUND AND AIMS

Decreased muscle mass and physical function are common complications in hepatocellular carcinoma (HCC) patients who are associated with increased morbidity and mortality. Thus, there have been targeted efforts to prevent and/or improve both by enrolling these patients in exercise training programs. We performed a systematic review to evaluate the effects of exercise training on muscle mass and physical function in people with HCC after diagnosis.

METHODS

A systematic literature search was conducted using the Medline, Base, PubMed, Cochrane and Scopus, and trial registries, through April 2023 for studies that assessed the effects of an exercise training program in adults with HCC. The primary outcomes were muscle mass and physical function. To assess the risk of bias, we used the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project.

RESULTS

Eight studies met inclusion criteria, comprising a total of 809 participants. Interventions included aerobic exercise training, resistance exercise training, balance and flexibility training, or home-based exercise training. Four studies showed statistically significant improvements in at least one muscular outcome. Three studies showed a maintenance of muscular outcomes, and one study showed a decrease in muscle mass. Four articles showed statistically improvements in at least one physical fitness variable, and two showed a maintenance of physical function variable.

CONCLUSION

Together, the results suggest that patients may benefit from physical exercise training after treatment to improve muscle mass and physical function.

Study protocol - assessing parkrun for walking rehabilitation for people living with, and beyond, cancer: acceptability, adherence, social support and physical function

INTRODUCTION

Due to a variety of barriers, the majority of cancer survivors do not do enough physical activity to meet current recommendations. This study will assess the feasibility of participation in parkrun walk-run events as a novel mode of community rehabilitation exercise.

METHODS

This protocol describes a single-arm intervention study with participants acting as their own controls. The study accepts adults diagnosed with any type of cancer, undergoing treatment or in remission. Participants must be able to walk and have medical clearance to exercise. A sample of 100 participants will be recruited across the Sunshine Coast over two years. Data will be collected over 9-months at 4 time points: Baseline (T1); after 4-weeks of usual daily activities and cancer management prior to parkrun participation(T2); after a 6-month parkrun intervention (T3); at 2-month follow-up (T4). The primary objectives are to assess the acceptability of, and adherence to, parkrun as rehabilitation exercise. Secondary outcomes include wellness, health-related quality of life, anxiety, depression, mood, physical function, parkrun metrics, dietary intake, and diet and exercise behaviour.

CONCLUSION

This study will be the first to examine the long-term effects of parkrun as a cancer rehabilitation modality with regard to physical function, psychosocial outcomes and dietary intake.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry ACTRN12623000473662 registered 09/05/2023.Approved by UniSC Human Research Ethics Committee (A221828) and the UK parkrun Research Board. Original protocol. Authors SB, RB, HHW, MM, YK.

Square-stepping exercise in older inpatients in early geriatric rehabilitation. A randomized controlled pilot study

BACKGROUND

Preservation of mobility and fall prevention have a high priority in geriatric rehabilitation. Square-Stepping Exercise (SSE) as an evaluated and standardized program has been proven to be an effective training for older people in the community setting to reduce falls and improve subjectively perceived health status. This randomized controlled trial (RCT), for the first time, examines SSE in the context of inpatient early geriatric rehabilitation compared to conventional physiotherapy (cPT).

METHODS

Data were collected in a general hospital in the department of acute geriatric care at admission and discharge. Fifty-eight inpatients were randomized to control (CG, n = 29) or intervention groups (IG, n = 29). CG received usual care with cPT five days per week during their hospital stay. For the IG SSE replaced cPT for at least six sessions, alternating with cPT. Physical function was measured with the Short Physical Performance Battery (SPPB) and Timed "Up & Go" (TUG). Gait speed was measured over a distance of 10 m. In a subgroup (n = 17) spatiotemporal gait parameters were analyzed via a GAITRite® system.

RESULTS

Both the SPPB total score improved significantly (p =  < 0.001) from baseline to discharge in both groups, as did the TUG (p < 0.001). In the SPPB Chair Rise both groups improved with a significant group difference in favor of the IG (p = 0.031). For both groups gait characteristics improved: Gait speed (p =  < 0.001), walk ratio (p = 0.011), step length (p =  < 0.001), stride length (p =  < 0.001) and double support (p = 0.009). For step length at maximum gait speed (p = 0.054) and stride length at maximum gait speed (p = 0.060) a trend in favor of the IG was visible.

CONCLUSIONS

SSE in combination with a reduced number of sessions of cPT is as effective as cPT for inpatients in early geriatric rehabilitation to increase physical function and gait characteristics. In the Chair Rise test SSE appears to be superior. These results highlight that SSE is effective, and may serve as an additional component for cPT for older adults requiring geriatric acute care.

TRIAL REGISTRATION

DRKS00026191.

Establishing the Reliability of The Step Test Evaluation of Performance on Stairs (STEPS) in Multiple Sclerosis

OBJECTIVE

To establish the inter- and intra-rater reliability of The Step Test Evaluation of Performance on Stairs (STEPS) for people with multiple sclerosis (PwMS) and examine its relation to clinical mobility measures, cognition, and activity levels.

DESIGN AND SETTING

STEPS performance was rated by 3 raters at the initial visit. Two raters observed the STEPS performance via videotape at the initial visit and then 1 week later. Participants also completed in lab clinical mobility tests and cognitive assessments at their initial visit. Activity levels were tracked for the subsequent 6 months.

PARTICIPANTS

In total, 23 people with relapsing-remitting MS (N=23).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE(S)

Intraclass correlation coefficients (ICCs) were used to assess intra-rater and inter-rater reliability, while correlation analyses compared STEPS performance with cognition, clinical mobility assessments, and activity levels. The inter-rater reliability analysis among the 3 raters included scoring from only the initial evaluation. For the intra-rater reliability, 2 raters viewed and rated the videotaped session for each of the participants and then repeated the same process 1 week later.

RESULTS

Total STEPS scores demonstrated excellent agreement by ICC for inter- (ICC=0.97) and intra-rater reliability (ICC>0.95) and significant correlations with established clinical mobility assessments in PwMS. Better performance on STEPS was associated with information processing speed and prospective activity levels in PwMS.

CONCLUSIONS

Stair ambulation is a challenging task, integral for mobility and independence, therefore, having a sensitive and valid reliable assessment of stair performance is critical for PwMS. The STEPS assessment is a quick, easily administered, reliable, and valid tool for assessing stair ambulation in PwMS.

Sex differences in osteoarthritis prevalence, pain perception, physical function and therapeutics

OBJECTIVE

Women have a higher prevalence of osteoarthritis (OA) and worse clinical courses than men. However, the underlying factors and therapeutic outcomes of these sex-specific differences are incompletely researched. This review examines the current state of knowledge regarding sex differences in OA prevalence, risk factors, pain severity, functional outcomes, and use and response to therapeutics.

METHODS

PubMed database was used with the title keyword combinations "{gender OR sex} AND osteoarthritis" plus additional manual search of the included papers for pertinent references, yielding 212 references. Additional references were added and 343 that were reviewed for appropriateness.

RESULTS

Globally, women account for 60% of people with osteoarthritis with a greater difference after age 40. The higher risk for women may be due to differences in joint anatomy, alignment, muscle strength, hormonal influences, obesity, and/or genetics. At the same radiographic severity, women have greater pain severity than men, which may be explained by biologically distinct pain pathways, differential activation of central pain pathways, differences in pain sensitivity, perception, reporting, and coping strategies. Women have greater limitations of physical function and performance than men independent of BMI, OA severity, injury history, amount of weekly exercise. Women also have greater use of analgesic medications than men but less use of arthroplasty and poorer prognosis after surgical interventions.

CONCLUSIONS

The recognition of sex differences in OA manifestations and management could guide tailoring of sex-specific treatment protocols, and analysis of sex as a biological variable in future research would enhance development of precision medicine.

Cancer history and physical function in patients with cardiovascular disease

Both cancer and cardiovascular disease (CVD) cause skeletal muscle mass loss, thereby increasing the likelihood of a poor prognosis. We investigated the association between cancer history and physical function and their combined association with prognosis in patients with CVD. We retrospectively reviewed 3,796 patients with CVD (median age: 70 years; interquartile range [IQR]: 61-77 years) who had undergone physical function tests (gait speed and 6-minute walk distance [6MWD]) at discharge. We performed multiple linear regression analyses to assess potential associations between cancer history and physical function. Moreover, Kaplan-Meier curves and Cox regression analyses were used to evaluate prognostic associations in four groups of patients categorized by the absence or presence of cancer history and of high or low physical function. Multiple regression analyses showed that cancer history was significantly and independently associated with a lower gait speed and 6MWD performance. A total of 610 deaths occurred during the follow-up period (median: 3.1 years; IQR: 1.4-5.4 years). The coexistence of low physical function and cancer history in patients with CVD was associated with a significantly higher mortality risk, even after adjusting for covariates (cancer history/low gait speed, hazard ratio [HR]: 1.93, P < 0.001; and cancer history/low 6MWD, HR: 1.61, P = 0.002). Cancer history is associated with low physical function in patients with CVD, and the combination of both factors is associated with a poor prognosis.

Deficits in force production during multifinger tasks demarcate cognitive dysfunction

BACKGROUND

The multifinger force deficit (MFFD) is the decline in force generated by each finger as the number of fingers contributing to an action is increased. It has been shown to associate with cognitive status.

AIMS

The aim was to establish whether a particularly challenging form of multifinger grip dynamometry, that provides minimal tactile feedback via cutaneous receptors and requires active compensation for reaction forces, will yield an MFFD that is more sensitive to cognitive status.

METHODS

Associations between measures of motor function, and cognitive status (Montreal Cognitive Assessment [MoCA]) and latent components of cognitive function (derived from 11 tests using principal component analysis), were estimated cross-sectionally using generalized partial rank correlations. The participants (n  =  62) were community dwelling, aged 65-87.

RESULTS

Approximately half the participants were unable to complete the dynamometry task successfully. Cognitive status demarcated individuals who could perform the task from those who could not. Among those who complied with the task requirements, the MFFD was negatively correlated with MoCA scores-those with the highest MoCA scores tended to exhibit the smallest deficits, and vice versa. There were corresponding associations with latent components of cognitive function.

DISCUSSION

The results support the view that neurodegenerative processes that are a feature of normal and pathological aging exert corresponding effects on expressions of motor coordination-in multifinger tasks, and cognitive sufficiency, due to their dependence on shared neural systems.

CONCLUSIONS

The outcomes add weight to the assertion that deficits in force production during multifinger tasks are sensitive to cognitive dysfunction.

Arm cycle ergometry in critically ill patients: A systematic review

BACKGROUND

Intensive care unit (ICU) survivors face functional limitations due to ICU-acquired weakness. Arm cycle ergometry (ACE) introduced in the ICU may improve physical function. To our knowledge, there is limited evidence on the effectiveness of ACE and physical function outcomes in critically ill patients.

OBJECTIVE

The objective of this systematic review was to examine the impact of ICU-based ACE on physical function, safety, and other clinical outcomes.

REVIEW METHOD USED

Systematic Review.

DATA SOURCES

A search of seven databases was conducted from the inception to January 1, 2023: Medline Ahead of Print, Ovid MEDLINE(R), Allied and Complementary Medicine Database (AMED), Embase, Cochrane Central, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature (CINAHL).

REVIEW METHODS

We included two arm studies of critically ill adults admitted to the ICU who received ACE and any comparator for our primary outcome, physical function. Our secondary outcomes included severe events. We included safety studies with or without a comparator group. Screening, data abstraction, and risk-of-bias assessments were completed independently, in duplicate. We used the Grading of Recommendations, Assessment, Development, and Evaluation approach to assess the overall certainty of evidence.

RESULTS

We screened 651 citations and included eight studies that enrolled 183 patients. Due to heterogeneity, meta-analysis was not performed. For our primary outcome, one randomised controlled trial found significant improvements in physical function, measured by the Barthel Index with ACE, whereas a nonrandomised study showed no difference. Out of the six studies reporting safety, none reported any severe safety events. The overall certainty of evidence was very low.

CONCLUSION

ACE initiated in the ICU is a likely safe intervention. Based on the limited ACE studies and heterogeneity between studies, further research with more rigorous studies evaluating important outcomes for patients is needed.

Associations of Skeletal Muscle Mass, Muscle Fat Infiltration, Mitochondrial Energetics, and Cardiorespiratory Fitness With Liver Fat Among Older Adults

BACKGROUND

Muscle mass loss may be associated with liver fat accumulation, yet scientific consensus is lacking and evidence in older adults is scant. It is unclear which muscle characteristics might contribute to this association in older adults.

METHODS

We associated comprehensive muscle-related phenotypes including muscle mass normalized to body weight (D3-creatine dilution), muscle fat infiltration (magnetic resonance imaging), carbohydrate-supported muscle mitochondrial maximal oxidative phosphorylation (respirometry), and cardiorespiratory fitness (VO2 peak) with liver fat among older adults. Linear regression models adjusted for age, gender, technician (respirometry only), daily minutes of moderate-to-vigorous physical activity, and prediabetes/diabetes status tested main effects and interactions of each independent variable with waist circumference (high: women-≥88 cm, men-≥102 cm) and gender.

RESULTS

Among older adults aged 75 (interquartile range: 73, 79 years; 59.8% women), muscle mass and liver fat were not associated overall (N = 362) but were positively associated among participants with a high waist circumference (β: 25.2; 95% confidence intervals [95% CI]: 11.7, 40.4; p = .0002; N = 160). Muscle fat infiltration and liver fat were positively associated (β: 15.2; 95% CI: 6.8, 24.3; p = .0003; N = 378). Carbohydrate-supported maximum oxidative phosphorylation (before adjustment) and VO2 peak (after adjustment; β: -12.9; 95% CI: -20.3, -4.8; p = .003; N = 361) were inversely associated with liver fat; adjustment attenuated the estimate for maximum oxidative phosphorylation although the point estimate remained negative (β: -4.0; 95% CI: -11.6, 4.2; p = .32; N = 321).

CONCLUSIONS

Skeletal muscle-related characteristics are metabolically relevant factors linked to liver fat in older adults. Future research should confirm our results to determine whether trials targeting mechanisms common to liver and muscle fat accumulation are warranted.

The effects of different exercise types on cognitive and physical functions in dementia patients: A randomized comparative study

PURPOSE

The physical and cognitive effects of aerobic exercise on dementia have been extensively studied. Further investigation of other types of exercise with different physiological effects is still needed. This study aimed to determine cognitive and physical effects of 6-week aerobic, balance, and combined (aerobic-balance) exercise programs on dementia.

MATERIALS AND METHODS

A total of 31 mild to moderate dementia patients aged 65-90 years were divided into three exercise groups. Before and after the 6-week exercise program, mental rotation, spatial orientation, visual memory, and mental status were assessed for cognitive functions, while fall risk, reaction time, lower limb strength, and frailty were assessed for physical functions. Comprehensive cognitive and physical assessments were performed to provide a holistic approach to dementia.

RESULTS

When post-exercise values were compared with pre-exercise values, only frailty decreased significantly in the aerobic exercise group (p = 0.017). After exercise program in balance and combined exercise groups, mental rotation (p = 0.005, p = 0.032), spatial orientation (p = 0.020, p = 0.035), mental status (p = 0.007, p = 0.014), and lower extremity strength (p = 0. 010, p = 0.005) increased significantly, while fall risk (p = 0.005, p = 0.005), reaction time (p = 0.028, p = 0.016), and frailty (p = 0.020, p = 0.009) decreased significantly. Moreover, in contrast to combined and aerobic exercise, improvement in visual memory was also observed in the balance exercise group (p = 0.016).

CONCLUSIONS

These findings suggest that balance and combined exercises may have broader effects on dementia than aerobic exercise. It emphasizes the importance of designing exercise programs for dementia patients, considering the cognitive and physical deficits of the patients, and creating a multidimensional treatment approach.

Remotely delivered exercise to older rural cancer survivors: a randomized controlled pilot trial

PURPOSE

The study aimed to determine the feasibility of remotely delivered exercise (tele-exercise) for older, rural cancer survivors and to explore the effects of tele-exercise on physical function, physical activity, and patient-reported outcomes.

METHODS

Participants were rural cancer survivors age ≥ 60 years (79% female; mean age 70.4 ± 5.7) randomly assigned to the remotely delivered EnhanceFitness (tele-EF) exercise program, inclusive of aerobic, strength, and balance training and led by American Council on Exercise certified instructors for 1 h, 3 days/week for 16 weeks (n = 20) or to a waitlist control group (n = 19). We assessed feasibility, physical function, accelerometer-measured physical activity, and patient-reported outcomes at baseline and post intervention.

RESULTS

Among those screened as eligible, 44 (64%) consented to participate with 39 randomized after completing baseline measures. Attrition was equivalent between groups (n = 1, each) with 95% completing the study. The median class attendance rate was 86.9% (interquartile range: 79-94%). Compared to controls, tele-EF participants had statistically significant improvement in the five-time sit-to-stand test (- 3.4 vs. - 1.1 s, p = 0.03, effect size = 0.44), mean daily light physical activity (+ 38.5 vs 0.5 min, p = 0.03, effect size = 0.72) and step counts (+ 1977 vs. 33, p = 0.01, effect size = 0.96). There were no changes in self-efficacy for exercise, fatigue, or sleep disturbance between groups.

CONCLUSIONS

Findings indicate that tele-EF is feasible in older, rural cancer survivors and results in positive changes in physical function and physical activity.

IMPLICATIONS FOR CANCER SURVIVORS

Tele-EF addresses common barriers to exercise for older, rural cancer survivors, including limited accessible opportunities for professional instruction and supervision.