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Tabira K, Oguma Y, Yoshihara S, Shibuya M, Nakamura M, Doihara N, Hirata A, Manabe T. Digital Peer-Supported App Intervention to Promote Physical Activity Among Community-Dwelling Older Adults: Nonrandomized Controlled Trial. JMIR Aging 2024; 7:e56184. [PMID: 38814686 PMCID: PMC11176879 DOI: 10.2196/56184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/05/2024] [Accepted: 04/16/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND The use of mobile apps has promoted physical activity levels. Recently, with an increasing number of older adults accessing the internet, app-based interventions may be feasible in older populations. Peer support-based interventions have become a common method for promoting health-related behavior change. To our knowledge, the feasibility of using digital peer support apps (DPSAs) to increase physical activity among older adults and its impact on physical activity and physical function have not been investigated. OBJECTIVE This study aims to assess the feasibility of using DPSAs in older adults and to assess changes in physical activity and physical function in DPSA users. METHODS We conducted a nonrandomized controlled trial of older adults aged ≥65 years. We recruited participants for 2 distinct 12-week programs designed to increase physical activity. Participants could choose between an intervention group (app program and exercise instruction) or a control group (exercise instruction only). DPSA creates a group chat for up to 5 people with a common goal, and participants anonymously post to each other in the group. Once a day, participants posted a set of their step counts, photos, and comments on a group chat box. The intervention group used the DPSA after receiving 2 face-to-face lectures on its use. The participants were characterized using questionnaires, accelerometers, and physical function assessments. The feasibility of the DPSA was assessed using retention and adherence rates. Physical activity was assessed using accelerometers to measure the daily step count, light intensity physical activity, moderate to vigorous intensity physical activity (MVPA), and sedentary behavior. Physical function was assessed using grip strength and the 30-second chair-stand test. RESULTS The participants in the intervention group were more frequent users of apps, were more familiar with information and communication technology, and had a higher baseline physical activity level. The retention and adherence rates for the DPSA intervention were 88% (36/41) and 87.7%, respectively, indicating good feasibility. Participants in the intervention group increased their step count by at least 1000 steps and their MVPA by at least 10 minutes using the DPSA. There was a significant difference in the interaction between groups and intervention time points in the daily step count and MVPA (step count, P=.04; duration of MVPA, P=.02). The DPSA increased physical activity, especially in older adults with low baseline physical activity levels. CONCLUSIONS The feasibility of DPSA was found to be good, with the intervention group showing increases in daily steps and MVPA. The effects of DPSA on step count, physical activity, and physical function in older adults with low baseline physical activity should be investigated using randomized controlled trials.
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Affiliation(s)
- Kento Tabira
- Graduate School of Health Management, Keio University, Kanagawa, Japan
- Sports Medicine Research Center, Keio University, Kanagawa, Japan
| | - Yuko Oguma
- Graduate School of Health Management, Keio University, Kanagawa, Japan
- Sports Medicine Research Center, Keio University, Kanagawa, Japan
| | - Shota Yoshihara
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
- A10 Lab Inc, Tokyo, Japan
| | | | - Manabu Nakamura
- Graduate School of Health Management, Keio University, Kanagawa, Japan
- Sports Medicine Research Center, Keio University, Kanagawa, Japan
| | - Natsue Doihara
- Sports Medicine Research Center, Keio University, Kanagawa, Japan
| | - Akihiro Hirata
- Graduate School of Health Management, Keio University, Kanagawa, Japan
- Sports Medicine Research Center, Keio University, Kanagawa, Japan
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Tomoki Manabe
- Graduate School of Health Management, Keio University, Kanagawa, Japan
- Sports Medicine Research Center, Keio University, Kanagawa, Japan
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Herbst AC, Coleman MC, Macon EL, Brokman A, Stromberg AJ, Harris PA, Adams AA. Retirement risk factors, exercise management and muscle mass in US senior horses. Equine Vet J 2024; 56:522-534. [PMID: 37341387 DOI: 10.1111/evj.13958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 05/05/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Information on the management and health of US senior horses (≥15 years of age) is currently limited. OBJECTIVES Provide information on (1) primary use of US senior horses, (2) reasons and risk factors for horse retirement, (3) exercise management, (4) prevalence of low muscle mass and (5) risk factors for, and owner-perceived consequences of, low muscle mass. STUDY DESIGN Online survey. METHODS Survey responses from 2717 owners of U.S.-resident senior horses (≥15 years of age) were analysed descriptively and inferentially, using ordered and binomial logistic regression, ANOVA and the Kruskal-Wallis test. RESULTS The most frequently reported primary uses were pleasure riding/driving (38.5%) and full retirement (39.8%). Most horses (61.5%) were retired between 15 and 24 years of age, with health problems being the main reason. Age, female sex, Thoroughbred breed and various medical conditions were identified as risk factors for retirement. In working horses (i.e., those not retired or semi-retired), exercise intensity was negatively associated with age. The owner-reported prevalence of low muscle mass in all horses was 17.2% (95%CI = 15.7-18.7). In those affected by low muscle mass, the ability to work and welfare-related aspects were commonly perceived to be impaired. Increasing age, sex (gelding), pituitary pars intermedia dysfunction, osteoarthritis, laminitis and primary use (retired and semi-retired vs. use for competition) were identified as risk factors for owner-reported low muscle mass. MAIN LIMITATIONS Potential response, recall and sampling bias. Causal relationships cannot be established. CONCLUSIONS Although structured exercise into old age may provide health benefits (as seen in elderly people), a large proportion of horses were fully retired in the current study. Senior horses were mainly retired for health problems and characterising these problems may aid in extending their work/active life. Low muscle mass was perceived to affect horses' welfare and ability to work, and identification of prevention and treatment strategies is therefore warranted.
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Affiliation(s)
- Alisa C Herbst
- M. H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, Kentucky, USA
| | - Michelle C Coleman
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Erica L Macon
- M. H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, Kentucky, USA
| | - Aviv Brokman
- Department of Statistics, University of Kentucky, Lexington, Kentucky, USA
| | - Arnold J Stromberg
- Department of Statistics, University of Kentucky, Lexington, Kentucky, USA
| | - Pat A Harris
- Equine Studies Group, Waltham Petcare Science Institute, Leicestershire, UK
| | - Amanda A Adams
- MARS EQUESTRIAN™ Research Fellow, M. H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, Kentucky, USA
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Gavrila Laic RA, Firouzi M, Claeys R, Bautmans I, Swinnen E, Beckwée D. A State-of-the-Art of Exoskeletons in Line with the WHO's Vision on Healthy Aging: From Rehabilitation of Intrinsic Capacities to Augmentation of Functional Abilities. SENSORS (BASEL, SWITZERLAND) 2024; 24:2230. [PMID: 38610440 PMCID: PMC11014060 DOI: 10.3390/s24072230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024]
Abstract
The global aging population faces significant health challenges, including an increasing vulnerability to disability due to natural aging processes. Wearable lower limb exoskeletons (LLEs) have emerged as a promising solution to enhance physical function in older individuals. This systematic review synthesizes the use of LLEs in alignment with the WHO's healthy aging vision, examining their impact on intrinsic capacities and functional abilities. We conducted a comprehensive literature search in six databases, yielding 36 relevant articles covering older adults (65+) with various health conditions, including sarcopenia, stroke, Parkinson's Disease, osteoarthritis, and more. The interventions, spanning one to forty sessions, utilized a range of LLE technologies such as Ekso®, HAL®, Stride Management Assist®, Honda Walking Assist®, Lokomat®, Walkbot®, Healbot®, Keeogo Rehab®, EX1®, overground wearable exoskeletons, Eksoband®, powered ankle-foot orthoses, HAL® lumbar type, Human Body Posturizer®, Gait Enhancing and Motivation System®, soft robotic suits, and active pelvis orthoses. The findings revealed substantial positive outcomes across diverse health conditions. LLE training led to improvements in key performance indicators, such as the 10 Meter Walk Test, Five Times Sit-to-Stand test, Timed Up and Go test, and more. Additionally, enhancements were observed in gait quality, joint mobility, muscle strength, and balance. These improvements were accompanied by reductions in sedentary behavior, pain perception, muscle exertion, and metabolic cost while walking. While longer intervention durations can aid in the rehabilitation of intrinsic capacities, even the instantaneous augmentation of functional abilities can be observed in a single session. In summary, this review demonstrates consistent and significant enhancements in critical parameters across a broad spectrum of health conditions following LLE interventions in older adults. These findings underscore the potential of LLE in promoting healthy aging and enhancing the well-being of older adults.
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Affiliation(s)
- Rebeca Alejandra Gavrila Laic
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Jette, Belgium; (R.A.G.L.); (M.F.); (R.C.); (D.B.)
| | - Mahyar Firouzi
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Jette, Belgium; (R.A.G.L.); (M.F.); (R.C.); (D.B.)
- Brain, Body and Cognition Research Group, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Elsene, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Pleinlaan 2, 1050 Elsene, Belgium
- Brubotics (Human Robotics Research Center), Vrije Universiteit Brussel, Pleinlaan 2, 1050 Elsene, Belgium
| | - Reinhard Claeys
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Jette, Belgium; (R.A.G.L.); (M.F.); (R.C.); (D.B.)
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Pleinlaan 2, 1050 Elsene, Belgium
- Brubotics (Human Robotics Research Center), Vrije Universiteit Brussel, Pleinlaan 2, 1050 Elsene, Belgium
| | - Ivan Bautmans
- FRIA, Frailty in Ageing, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium;
| | - Eva Swinnen
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Jette, Belgium; (R.A.G.L.); (M.F.); (R.C.); (D.B.)
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Pleinlaan 2, 1050 Elsene, Belgium
- Brubotics (Human Robotics Research Center), Vrije Universiteit Brussel, Pleinlaan 2, 1050 Elsene, Belgium
| | - David Beckwée
- Rehabilitation Research, Department of Physiotherapy, Human Physiology and Anatomy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Jette, Belgium; (R.A.G.L.); (M.F.); (R.C.); (D.B.)
- Brubotics (Human Robotics Research Center), Vrije Universiteit Brussel, Pleinlaan 2, 1050 Elsene, Belgium
- FRIA, Frailty in Ageing, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium;
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Shuman V, Brach JS, Bean JF, Freburger JK. Prevalence and Predictors of Ambulatory Care Physicians' Documentation of Mobility Limitations in Older Adults. Arch Phys Med Rehabil 2023; 104:719-727. [PMID: 36731767 PMCID: PMC10164109 DOI: 10.1016/j.apmr.2022.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine how often physicians document mobility limitations in visits with older adults, and which patient, physician, and practice characteristics associate with documented mobility limitations. DESIGN We completed a cross-sectional analysis of National Ambulatory Medical Care Surveys, years 2012-2016. Multivariate analyses were conducted to identify patient, physician, and practice-level factors associated with mobility limitation documentation. SETTING Ambulatory care visits. PARTICIPANTS We analyzed visits with adults 65 years and older. Final sample size represented 1.3 billion weighted visits. INTERVENTION Not applicable. MAIN OUTCOME MEASURE We defined the presence/absence of a mobility limitation by whether any International Classification of Diseases (ICD)-9 or ICD-10 code related to mobility limitations, injury codes, or the patient's "reasons for visit" were documented in the visits. RESULTS The overall prevalence of mobility limitation documentation was 2.4%. The most common codes were falls-related. Patient-level factors more likely to be associated with mobility limitation documentation were visits by individuals over 85 years of age, relative to 65-69 years, (odds ratio 2.32, 95% confidence interval 1.76-3.07]; with a comorbid diagnosis of arthritis (odds ratio 1.35, 1.18-2.01); and with a comorbid diagnosis of cerebrovascular disease (odds ratio 1.60, 1.13-2.26). Patient-level factors less likely to be associated with mobility limitation documentation were visits by men (odds ratio 0.80, 0.64-0.99); individuals with a cancer diagnosis (odds ratio 0.76, 0.58-0.99); and by individuals seeking care for a chronic problem (relative to a new problem [odds ratio 0.36, 0.29-0.44]). Physician-level factors associated with an increased likelihood of mobility limitation documentation were visits to neurologists (odds ratios 4.48, 2.41-8.32) and orthopedists (odds ratio 2.67, 1.49-4.79) compared with primary care physicians. At the practice-level, mobility documentation varied based on the percentage of practice revenue from Medicare. CONCLUSIONS Mobility limitations are under-documented and may be primarily captured when changes in function are overt.
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Affiliation(s)
- Valerie Shuman
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA.
| | - Jennifer S Brach
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA
| | - Jonathan F Bean
- New England Geriatric Research and Education Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA; Department of PM&R, Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Janet K Freburger
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA
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Weiss SM, Castelo M, Liu B, Norris M. Virtual fall program assessment for frail Canadian community-dwelling older adults: Examining equitable accessibility. Digit Health 2023; 9:20552076231178410. [PMID: 37312948 PMCID: PMC10259118 DOI: 10.1177/20552076231178410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 05/10/2023] [Indexed: 06/15/2023] Open
Abstract
Objective In response to COVID-19, the fall prevention program (FPP) at Sunnybrook Health Sciences Centre was modified to be delivered virtually. We compared patient populations assessed for the FPP virtually versus in-person to explore equitable accessibility. Methods A retrospective chart review was performed. All patients assessed virtually from the beginning of the COVID-19 pandemic until the end of abstraction (April 25, 2022) were compared to a historic sample of patients assessed in-person beginning in January 2019. Demographics, measures of frailty, co-morbidity, and cognition were abstracted. Wilcoxon Rank Sum tests and Fisher's Exact tests were used for continuous and categorical variables, respectively. Results Thirty patients were assessed virtually and compared to 30 in-person historic controls. Median age was 80 years (interquartile range 75-85), 82% were female, 70% were university educated, the median Clinical Frailty Score was 5 out of 9, and 87% used >5 medications. Once normalized, frailty scores showed no difference (p = 0.446). The virtual cohort showed significantly higher outdoor walking aid use (p = 0.015), reduced accuracy with clock drawing (p = 0.020), and nonsignificant trends toward using >10 medications, requiring assistance with >3 instrumental activities of daily living (IADLs), and higher treatment attendance. No significant differences were seen for time-to-treat (p = 0.423). Conclusion Patients assessed virtually were similarly frail as the in-person controls but had increased use of walking aids, medications, IADL assistance, and cognitive impairment. In a Canadian context, frail and high socioeconomic status older adults continued to access treatment through virtual FPP assessments during the COVID-19 pandemic highlighting both the benefits of virtual care and potential inequity.
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Affiliation(s)
- Sophie M. Weiss
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Matthew Castelo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Barbara Liu
- Division of Geriatric Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
- Division of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mireille Norris
- Division of Geriatric Medicine, University of Toronto Temerty Faculty of Medicine, Toronto, ON, Canada
- Division of Geriatric Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Jayaraman C, Embry KR, Mummidisetty CK, Moon Y, Giffhorn M, Prokup S, Lim B, Lee J, Lee Y, Lee M, Jayaraman A. Modular hip exoskeleton improves walking function and reduces sedentary time in community-dwelling older adults. J Neuroeng Rehabil 2022; 19:144. [PMID: 36585676 PMCID: PMC9801566 DOI: 10.1186/s12984-022-01121-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 12/16/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite the benefits of physical activity for healthy physical and cognitive aging, 35% of adults over the age of 75 in the United States are inactive. Robotic exoskeleton-based exercise studies have shown benefits in improving walking function, but most are conducted in clinical settings with a neurologically impaired population. Emerging technology is starting to enable easy-to-use, lightweight, wearable robots, but their impact in the otherwise healthy older adult population remains mostly unknown. For the first time, this study investigates the feasibility and efficacy of using a lightweight, modular hip exoskeleton for in-community gait training in the older adult population to improve walking function. METHODS Twelve adults over the age of 65 were enrolled in a gait training intervention involving twelve 30-min sessions using the Gait Enhancing and Motivating System for Hip in their own senior living community. RESULTS Performance-based outcome measures suggest clinically significant improvements in balance, gait speed, and endurance following the exoskeleton training, and the device was safe and well tolerated. Gait speed below 1.0 m/s is an indicator of fall risk, and two out of the four participants below this threshold increased their self-selected gait speed over 1.0 m/s after intervention. Time spent in sedentary behavior also decreased significantly. CONCLUSIONS This intervention resulted in greater improvements in speed and endurance than traditional exercise programs, in significantly less time. Together, our results demonstrated that exoskeleton-based gait training is an effective intervention and novel approach to encouraging older adults to exercise and reduce sedentary time, while improving walking function. Future work will focus on whether the device can be used independently long-term by older adults as an everyday exercise and community-use personal mobility device. Trial registration This study was retrospectively registered with ClinicalTrials.gov (ID: NCT05197127).
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Affiliation(s)
- Chandrasekaran Jayaraman
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA
| | - Kyle R. Embry
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Departments of Physical Medicine and Rehabilitation, Medical Social Sciences and Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL USA
| | - Chaithanya K. Mummidisetty
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA
| | - Yaejin Moon
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA
| | - Matt Giffhorn
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA
| | - Sara Prokup
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA
| | | | - Jusuk Lee
- grid.266102.10000 0001 2297 6811Department of Radiology, University of California, San Francisco, USA
| | | | - Minhyung Lee
- grid.419666.a0000 0001 1945 5898Samsung Electronics Co, Suwon, South Korea
| | - Arun Jayaraman
- grid.280535.90000 0004 0388 0584Max Näder Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Departments of Physical Medicine and Rehabilitation, Medical Social Sciences and Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL USA
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Lee SH, Lee HJ, Kim K, Lee BH, Kim YH. Effect of Exercise Using an Exoskeletal Hip-Assist Robot on Physical Function and Walking Efficiency in Older Adults. J Pers Med 2022; 12:jpm12122077. [PMID: 36556297 PMCID: PMC9781024 DOI: 10.3390/jpm12122077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Robotic technology has developed rapidly in recent years, and several robotic devices have been applied to improve physical, sensory, intellectual, psychological, and social functioning in the elderly and people with disabilities. In this study, we investigated the effects of EX1-assisted exercise in various environments on physical function, muscle strength, and walking efficiency in older adults. We designated four experimental conditions and randomly assigned participants to one of four groups: A (overground walking without an EX1), B (overground walking using the resistance mode of EX1), C (stair ascent using the assistance mode of EX1), and Group D (inclined treadmill walking using the assistance mode of EX1). A total of 60 community-dwelling elderly persons participated in 10 exercise intervention sessions for 4 weeks, and all participants were assessed before and after the exercise intervention. Physical function was measured by the 10-meter walk test for self-selected velocity (10MWT-SSV), short physical performance battery (SPPB), Berg balance scale (BBS), timed up and go (TUG), functional reach test (FRT), geriatric depression scale-short form (GDS-SF), and muscle strength of trunk and lower extremity. Cardiopulmonary metabolic energy efficiency was measured using a portable telemetric gas analyzer system. A significant increase in the 10MWT-SSV and TUG test was observed in groups B, C, and D. A statistically significant improvement in the SPPB and FRT was seen only in group D, and GDS-SF scores decreased significantly after exercise with an EX1 in groups B and D. Trunk and lower limb muscle strength increased more in the groups that exercised with EX1 assistance than those without an EX1, particularly in group B. The net metabolic energy costs and energy expenditure measurement during walking significantly improved in exercise groups C and D. The findings in this study support the application of the EX1 to physical activity and exercise to improve age-related changes in physical function, muscle strength, and walking efficiency among older adults. In addition, personalized exercise programs using different modes and training environments with an EX1 can enhance physical performance and walking efficiency in the elderly.
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Affiliation(s)
- Su-Hyun Lee
- Center for Prevention and Rehabilitation, Samsung Medical Center, Department of Physical and Rehabilitation Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Hwang-Jae Lee
- Robot Business Team, Samsung Electronics, Suwon 16499, Republic of Korea
| | - Kyungrock Kim
- GEMS Lab, Samsung Research, Samsung Electronics, Seoul 06765, Republic of Korea
| | - Byoung-Hee Lee
- Department of Physical Therapy, Sahmyook University, Seoul 01795, Republic of Korea
| | - Yun-Hee Kim
- Center for Prevention and Rehabilitation, Samsung Medical Center, Department of Physical and Rehabilitation Medicine, Heart Vascular Stroke Institute, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Republic of Korea
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul 06351, Republic of Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06351, Republic of Korea
- Correspondence: or ; Tel.: +82-2-3410-2824
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Harris R, Brach JS, Moye J, Ogawa E, Ward R, Halasz I, Bean J. The Live Long Walk Strong Rehabilitation Program Study: Design and Methods. Arch Rehabil Res Clin Transl 2022; 4:100205. [PMID: 36123980 PMCID: PMC9482036 DOI: 10.1016/j.arrct.2022.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To identify attributes targeted by rehabilitative treatment within which improvements lead to short- and long-term changes in mobility. Maintaining independence in mobility is important to many older adults and is associated with critical outcomes such as aging in place, morbidity, and mortality. Design The Live Long Walk Strong rehabilitation study is a phase 2 single-blind, randomized controlled trial. Setting Veterans Affairs Boston Healthcare System, outpatient physical therapy. Participants 198 community-dwelling middle- and older-aged veterans (aged 50 years and older) will be recruited from primary care practices (N=198). Interventions Comparing a moderate-vigorous intensity physical therapy program of 10 sessions with a waitlist control group. Main Outcome Measure The primary outcome measure is gait speed. Secondary outcomes include leg strength and power, trunk muscle endurance, gait smoothness, and exercise self-efficacy. Results Outcomes will be assessed within 2 weeks of intervention completion, at 8 weeks postintervention, and at 16 weeks postintervention. Two-sample t tests will compare mean change in gait speed and target attributes (leg power, trunk muscle endurance, gait smoothness, and exercise self-efficacy) between treatment and control groups. Paired t tests will examine within-person change at subsequent follow-up visits. Multivariable regression analyses will evaluate relationships between dependent and independent variables and potential mediation adjusting for relevant covariates. Conclusions Results of this study are expected to advance and refine the design of Live Long Walk Strong rehabilitative care and demonstrate its proof of concept and efficacy.
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Affiliation(s)
- Rebekah Harris
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA
| | - Jennifer S. Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer Moye
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Harvard Medical School, Cambridge, MA
| | - Elisa Ogawa
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA
| | - Rachel Ward
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA
- Massachusetts Veterans Epidemiology and Research Information Center, VA Boston Healthcare System, Boston, MA
| | - Ildiko Halasz
- Department of Medicine, VA Boston Healthcare System, Boston, MA
| | - Jonathan Bean
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA
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Forte P, Monteiro AM. The Physical Activity and Exercise as Key Role Topic in Sports Medicine for Old People Quality of Life. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060797. [PMID: 35744060 PMCID: PMC9229455 DOI: 10.3390/medicina58060797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022]
Affiliation(s)
- Pedro Forte
- Department of Sports, Higher Institute of Educational Sciences of the Douro (ISCE Douro), 4560-708 Penafiel, Portugal
- Department of Sport Sciences and Physical Education, Instituto Politécnico de Bragança (IPB), 5300-253 Braganza, Portugal;
- Research Center in Sports Sciences, Health and Human Development (CIDESD), 6201-001 Covilha, Portugal
- CI-ISCE, ISCE Douro, 4560-708 Penafiel, Portugal
- Correspondence:
| | - António M. Monteiro
- Department of Sport Sciences and Physical Education, Instituto Politécnico de Bragança (IPB), 5300-253 Braganza, Portugal;
- Research Center in Sports Sciences, Health and Human Development (CIDESD), 6201-001 Covilha, Portugal
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10
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Bamonti PM, Moye J, Harris R, Kallmi S, Kelly CA, Middleton A, Bean JF. Development of a Coaching Protocol to Enhance Self-efficacy Within Outpatient Physical Therapy. Arch Rehabil Res Clin Transl 2022; 4:100198. [PMID: 35756988 PMCID: PMC9214325 DOI: 10.1016/j.arrct.2022.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To describe the development of the Specific, Measurable, Action-Oriented, Realistic, and Timed (SMART) Coaching Protocol to increase exercise self-efficacy in middle-aged and older adults participating in Live Long Walk Strong (LLWS) Rehabilitation Program. LLWS Rehabilitation Program is an innovative physical therapist (PT) delivered outpatient intervention for middle- and older-aged adults with slow gait speed. Design Phase II randomized controlled trial (RCT) with masked outcome assessment. We applied the Knowledge to Action Framework to develop and implement the LLWS SMART Coaching Protocol within an RCT for the LLWS Rehabilitation Program. Data will be collected at baseline and post intervention at 2, 8 and 16 weeks. Setting Outpatient; VA Boston Healthcare System. Participants Community-dwelling veterans (N=198) (older than 50 years) with slow gait speed (<1.0 m/s). Interventions Participants will be randomized to the LLWS Rehabilitation Program, an 8-week (10-session) PT-delivered intervention, or wait-list control group. Each study visit will introduce a new SMART Coaching module focused on goal setting, exercise adherence, and addressing internal and external barriers to meeting exercise goals. Main Outcome Measures Primary outcome is gait speed and secondary outcome is the Self-Efficacy for Exercise Scale. Conclusions Incorporating cognitive behavioral tools in physical therapy intervention research is critical for targeting motivational processes needed for exercise behavior change.
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Key Words
- Exercise
- LLWS, Live Long Walk Strong
- PT, physical therapist
- Physical therapy modalities
- RCT, randomized controlled trial
- Rehabilitation
- SCT, social cognitive theory
- SMART, Specific, Measurable, Action-Oriented, Realistic, and Timed
- SPPB, Short Physical Performance Battery
- VA, Veterans Affairs
- Walking speed.
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Affiliation(s)
- Patricia M. Bamonti
- VA Boston Healthcare System, Research Service, Boston, MA
- Harvard Medical School, Department of Psychiatry, Boston, MA
| | - Jennifer Moye
- Harvard Medical School, Department of Psychiatry, Boston, MA
- VA Boston Healthcare System, New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA
| | - Rebekah Harris
- VA Boston Healthcare System, New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA
| | - Selmi Kallmi
- VA Boston Healthcare System, Mental Health Division, Brockton, MA
| | - Catherine A. Kelly
- VA Boston Healthcare System, New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA
| | - Addie Middleton
- VA Boston Healthcare System, New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA
| | - Jonathan F. Bean
- VA Boston Healthcare System, New England Geriatric Research Education and Clinical Center (GRECC), Boston, MA
- Harvard Medical School, Department of Physical Medicine & Rehabilitation, Boston MA
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11
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Multisensory Exercise Improves Balance in People with Balance Disorders: A Systematic Review. Curr Med Sci 2021; 41:635-648. [PMID: 34403086 DOI: 10.1007/s11596-021-2417-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine the effect of multisensory exercise on balance disorders. METHODS PubMed, Scopus and Web of Science were searched to identify eligible studies published before January 1, 2020. Eligible studies included randomized control trials (RCTs), non-randomized studies, case-control studies, and cohort studies. The methodological quality of the included studies was evaluated using JBI Critical Appraisal Checklists for RCTs and for Quasi-Experimental Studies by two researchers independently. A narrative synthesis of intervention characteristics and health-related outcomes was performed. RESULTS A total of 11 non-randomized studies and 9 RCTs were eligible, including 667 participants. The results supported our assumption that multisensory exercise improved balance in people with balance disorders. All of the 20 studies were believed to be of high or moderate quality. CONCLUSION Our study confirmed that multisensory exercise was effective in improving balance in people with balance disorders. Multisensory exercises could lower the risk of fall and enhance confidence level to improve the quality of life. Further research is needed to investigate the optimal strategy of multisensory exercises and explore the underlying neural and molecular mechanisms of balance improvement brought by multisensory exercises.
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12
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Ditchburn JL, van Schaik P, Dixon J, MacSween A, Martin D. The effects of exergaming on pain, postural control, technology acceptance and flow experience in older people with chronic musculoskeletal pain: a randomised controlled trial. BMC Sports Sci Med Rehabil 2020; 12:63. [PMID: 33062284 PMCID: PMC7547415 DOI: 10.1186/s13102-020-00211-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 10/01/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Older people with chronic musculoskeletal pain are at risk of falls. This study aimed to investigate the effects of exergaming on pain and postural control in older people with chronic musculoskeletal pain. Secondary outcomes were technology acceptance, flow experience, perceived physical exertion, expended mental effort and heart rate. METHODS Fifty four older adults (age: 71 ± 5 years) with chronic musculoskeletal pain were randomised into 2 groups. Group 1 received exergaming training using the Interactive Rehabilitation and Exercise System (IREX®). Group 2 undertook traditional gym-based exercise (TGB). Both groups completed twice weekly 40-min exercise sessions for 6 weeks. Perceived pain was measured using a numeric pain rating scale and the Multidimensional Affect and Pain Survey questionnaire. Postural control was measured as sway using a Kistler™ force platform. Technology acceptance was measured with the Unified Theory of Acceptance and Use of Technology questionnaire and flow experience with the Flow State Scale. Physiological measures of perceived physical exertion, expended mental effort and heart rate were recorded during all sessions. RESULTS The exergaming group demonstrated significant reductions in pain intensity and thermal pain including a near significant approach in physical engagement in comparison to TGB group. Although no intervention effects on postural control were found, the exergaming group showed significant improvements in three sway measures (AP SD, ML SD and AP range) over time whereas significant improvements in ML range were found in the TGB group. Relating to technology acceptance, significant intervention effects on social influence and behavioural intention were found in the TGB group instead, although both groups demonstrated increases of acceptance over time. Regarding flow experience, concentration at task was significantly influenced in the TGB group and significant increases in flow variables over time were observed in both groups. Significant increases over time in perceived physical exertion and expended mental effort were found in both groups. CONCLUSION Our findings support the potential of exergaming to alleviate pain and improve balance in older people with chronic musculoskeletal pain. Both forms of exercise are acceptable, intrinsically motivating and show evidence of benefit to older people with chronic musculoskeletal pain. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04029285 (retrospectively registered, July 23, 2019).
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Affiliation(s)
- Jae-Llane Ditchburn
- Institute of Science, Natural Resources and Outdoor Studies, University of Cumbria, Fusehill Street, Carlisle, Cumbria, CA1 2HH UK
| | - Paul van Schaik
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
| | - John Dixon
- School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BX UK
| | - Alasdair MacSween
- School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BX UK
| | - Denis Martin
- School of Health and Life Sciences, Teesside University, Middlesbrough, TS1 3BX UK
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13
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Cardiac Rehabilitation Is Associated With Improved Physical Function in Frail Older Adults With Cardiovascular Disease. J Cardiopulm Rehabil Prev 2020; 40:310-318. [PMID: 32804797 DOI: 10.1097/hcr.0000000000000537] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Frailty is highly prevalent among older adults with cardiovascular disease (CVD) and is associated with greater than 2-fold risk for morbidity and mortality, independent of age and comorbidities. Many candidates are not referred to cardiac rehabilitation (CR) under the assumption that they are too frail to benefit. We hypothesized that CR is associated with similar benefits for frail adults as for intermediate-frail and nonfrail adults. METHODS Retrospective analysis of CVD patients who completed a phase II CR program. Patients classified as frail by meeting ≥2 frailty criteria and intermediate-frail by meeting 1 criterion, including 6-min walk distance (6MWD) <300 m, gait speed ≤0.65 m/sec or 0.76 m/sec normalized to height and sex, tandem stand <10 sec, Timed Up & Go (TUG) <15 sec, and weak hand grip strength per Fried criteria. Changes within and between groups were compared before and after completion of CR. RESULTS We evaluated 243 patients; 75 were classified as frail, 70 as intermediate-frail, and 98 as nonfrail. Each group improved in all measures of frailty except for tandem stand. There were no significant differences in pre- to post-CR measures for 6MWD, gait speed, tandem stand, or hand grip strength between groups. Frail patients showed greater improvement in TUG than the other groups (P = .007). CONCLUSION Among frail patients, CR was associated with improvements in multiple domains of physical function. Gains achieved by frail adults were similar to or greater than those achieved by intermediate-frail and nonfrail patients. These data provide strong rationale for referring all eligible patients to CR, including frail patients. Those who are most physically impaired may derive gains that have proportionally greater ramifications.
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14
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German version of the outcome expectations for exercise scale-2 : Psychometric properties in geriatric patients after hip or pelvic fractures with fear of falling. Z Gerontol Geriatr 2020; 54:582-589. [PMID: 32623492 DOI: 10.1007/s00391-020-01753-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/14/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Physical exercise is associated with many health benefits. Especially for older adults it is challenging to achieve an appropriate adherence to exercise programs. The outcome expectations for exercise scale 2 (OEE-2) is a 13-item self-report questionnaire to assess negative and positive exercise outcome expectations in older adults. The aim of this study was to translate the OEE‑2 into German and to assess the psychometric properties of this version. METHODS The OEE‑2 was translated from English into German including a forward and backward translation process. Psychometric properties were assessed in 115 patients with hip/pelvic fractures (76% female, mean age 82.5 years) and fear of falling during geriatric inpatient rehabilitation. RESULTS Principal component analyses could confirm a two-factor solution (positive/negative OEE) that explained 58% of the total variance, with an overall internal reliability of α = 0.89. Cronbach's α for the 9‑item positive OEE subscale was 0.89, for the 4‑item negative OEE subscale 0.79. The two subscales were correlated with rs = 0.49. Correlations of the OEE total score were highest with the perceived ability to manage falls, prefracture leisure time activities and prior training history (rs = 0.35-0.41). CONCLUSION These results revealed good internal reliability and construct validity of the German version of the OEE‑2. The instrument is valid for measuring physical exercise outcome expectations in older, German-speaking patients with hip or pelvic fractures and fear of falling.
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15
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Ward RE, Quach L, Welch SA, Leveille SG, Leritz E, Bean JF. Interrelated Neuromuscular and Clinical Risk Factors That Contribute to Falls. J Gerontol A Biol Sci Med Sci 2020; 74:1526-1532. [PMID: 30721929 DOI: 10.1093/gerona/glz030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 01/29/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Neuromuscular and clinical factors contribute to falls among older adults, yet the interrelated nature of these factors is not well understood. We investigated the relationships between these factors and how they contribute to falls, which may help optimize fall risk assessment and prevention. METHODS A total of 365 primary care patients (age = 77 ± 7, 67% female) were included from the Boston Rehabilitative Impairment Study of the Elderly. Neuromuscular measures included leg strength and leg velocity, trunk extensor endurance, and knee range of motion. Clinical measures included memory, executive function, depressive symptoms, pain, sensory loss, vision, comorbidity, physical activity, mobility self-efficacy, and psychiatric medication. Factor analysis was used to evaluate clustering of factors. Negative binomial regression assessed the relationship of factors with three-year fall rate. Interactions were tested to examine whether clinical factors modified the relationship between neuromuscular factors and falls. RESULTS Three factors emerged: (i) neuromuscular factors, pain, and self-efficacy; (ii) memory; and (iii) executive function. Having three neuromuscular impairments predicted higher fall rate (incidence rate ratio [95% confidence interval]: 3.39 [1.82-6.32]) but was attenuated by memory (1.69 [1.10-2.61]), mobility self-efficacy (0.99 [0.98-0.99]), psychiatric medication use (1.54 [1.10-2.14]), and pain (1.13 [1.04-1.23]). Pain modified the relationship between neuromuscular impairment burden (number of neuromuscular impairments) and falls. Having three neuromuscular impairments was associated with a higher fall rate in patients with high levels of pain (5.73 [2.46-13.34]) but not among those with low pain. CONCLUSIONS Neuromuscular impairment burden was strongly associated with fall rate in older adults with pain. These factors should be considered together during fall risk assessment, post fall assessment, and prevention.
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Affiliation(s)
- Rachel E Ward
- New England Geriatric Research and Education Clinical Center (GRECC), VA Boston Healthcare System, Massachusetts.,Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.,Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Lien Quach
- New England Geriatric Research and Education Clinical Center (GRECC), VA Boston Healthcare System, Massachusetts.,Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts.,Spaulding Rehabilitation Hospital, Boston, Massachusetts.,Department of Gerontology, University of Massachusetts, Boston, Massachusetts
| | - Sarah A Welch
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Suzanne G Leveille
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Elizabeth Leritz
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Massachusetts
| | - Jonathan F Bean
- New England Geriatric Research and Education Clinical Center (GRECC), VA Boston Healthcare System, Massachusetts.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.,Spaulding Rehabilitation Hospital, Boston, Massachusetts
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16
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The Impact of Street Space Perception Factors on Elderly Health in High-Density Cities in Macau—Analysis Based on Street View Images and Deep Learning Technology. SUSTAINABILITY 2020. [DOI: 10.3390/su12051799] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The urban space environment has been proven to be related to the health of the elderly. However, as a high-density city, Macau’s limited urban space must cope with the growing population and the arrival of an aging society. In the existing studies, less attention has been paid to Macau, especially the relationship between Macanese elderly and urban space. This study uses Baidu Street View (BSV) on the Macau Peninsula and conducts field surveys to obtain street view data to evaluate the openness, greenness, interface coverage, and road area ratio of street space and its association with the physical and mental health of the elderly and social health. The results show that the data truly reflect the overall street space conditions on the Macau Peninsula. The street openness, greenery rate, and interface enclosure are all related to the elderly in various evaluations in areas with a higher population dependency index and aging index. Human space perception is related to health gain, and road area ratio is weaker than other indicators. The research results have certain policy implications and have practical significance for city managers and designers.
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17
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Orange ST, Marshall P, Madden LA, Vince RV. Short-Term Training and Detraining Effects of Supervised vs. Unsupervised Resistance Exercise in Aging Adults. J Strength Cond Res 2019. [PMID: 29528961 DOI: 10.1519/jsc.0000000000002536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Orange, ST, Marshall, P, Madden, LA, and Vince, RV. Short-term training and detraining effects of supervised vs. unsupervised resistance exercise in aging adults. J Strength Cond Res 33(10): 2733-2742, 2019-This study compared the effects of a 4-week supervised (SUP) resistance training program and unsupervised (UNSUP) resistance training program followed by 12 weeks of detraining (DET). Thirty-six healthy aging adults (age: 53.6 ± 3.6 years; body mass index: 28.3 ± 5.1 kg·m) were randomly allocated to an SUP group (n = 17) or a UNSUP group (n = 19). Participants completed 3 training sessions per week using resistance bands and body weight movements. Measures of physical performance were administered at baseline, at the end of the training program, and after the DET period. Function was assessed with the 6-minute walk test (6MWT), timed up-and-go (TUG), 30-second chair sit-to-stand (STS), stair-climb test (SCT), 40-m fast-paced walk test (FPWT) and sit-and-reach test (SRT), whereas the isometric midthigh pull (IMTP) and hand grip test were used to measure muscle strength. After training, improvements in performance were found in the 6MWT, TUG, 30-second chair STS, SCT, FPWT, SRT, and IMTP (p ≤ 0.05), with no significant differences between groups (p > 0.05). In addition, most of the training-induced improvements remained significantly above baseline values after the DET period (p ≤ 0.05). No significant between-group differences were observed after training or DET (p > 0.05). Four weeks of either SUP or UNSUP resistance training is sufficient to substantially improve muscle strength and function in aging adults, and these gains are largely preserved after prescribed exercise cessation. Home-based resistance training seems to be a practical and effective alternative to traditional SUP programs that may help circumvent many barriers to physical activity in aging adults.
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Affiliation(s)
- Samuel T Orange
- Sport, Health and Exercise Science, School of Life Sciences, University of Hull, Hull, United Kingdom
| | - Phil Marshall
- Sport, Health and Exercise Science, School of Life Sciences, University of Hull, Hull, United Kingdom
| | - Leigh A Madden
- Center of Biomedical Research, School of Life Sciences, University of Hull, Hull, United Kingdom
| | - Rebecca V Vince
- Sport, Health and Exercise Science, School of Life Sciences, University of Hull, Hull, United Kingdom
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18
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Van Dyck D, Herman K, Poppe L, Crombez G, De Bourdeaudhuij I, Gheysen F. Results of MyPlan 2.0 on Physical Activity in Older Belgian Adults: Randomized Controlled Trial. J Med Internet Res 2019; 21:e13219. [PMID: 31593541 PMCID: PMC6803893 DOI: 10.2196/13219] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 05/15/2019] [Accepted: 07/09/2019] [Indexed: 12/24/2022] Open
Abstract
Background The beneficial effects of physical activity (PA) for older adults are well known. However, few older adults reach the health guideline of 150 min per week of moderate-to-vigorous PA (MVPA). Electronic health (eHealth) interventions are effective in increasing PA levels in older adults in the short term but, rarely, intermediate-term effects after a period without the support of a website or an app have been examined. Furthermore, current theory-based interventions focus mainly on preintentional determinants, although postintentional determinants should also be included to increase the likelihood of successful behavior change. Objective This study aimed to investigate the effect of the theory-based eHealth intervention, MyPlan 2.0, focusing on pre- and postintentional determinants on both accelerometer-based and self-reported PA levels in older Belgian adults in the short and intermediate term. Methods This study was a randomized controlled trial with three data collection points: baseline (N=72), post (five weeks after baseline; N=65), and follow-up (three months after baseline; N=65). The study took place in Ghent, and older adults (aged ≥65 years) were recruited through a combination of random and convenience sampling. At all the time points, participants were visited by the research team. Self-reported domain-specific PA was assessed using the International Physical Activity Questionnaire, and accelerometers were used to objectively assess PA. Participants in the intervention group got access to the eHealth intervention, MyPlan 2.0, and used it independently for five consecutive weeks after baseline. MyPlan 2.0 was based on the self-regulatory theory and focused on both pre- and postintentional processes to increase PA. Multilevel mixed-models repeated measures analyses were performed in R (R Foundation for Statistical Computing). Results Significant (borderline) positive intervention effects were found for accelerometer-based MVPA (baseline−follow-up: intervention group +5 min per day and control group −5 min per day; P=.07) and for accelerometer-based total PA (baseline−post: intervention group +20 min per day and control group −24 min per day; P=.05). MyPlan 2.0 was also effective in increasing self-reported PA, mainly in the intermediate term. A positive intermediate-term intervention effect was found for leisure-time vigorous PA (P=.02), moderate household-related PA (P=.01), and moderate PA in the garden (P=.04). Negative intermediate-term intervention effects were found for leisure-time moderate PA (P=.01) and cycling for transport (P=.07). Conclusions The findings suggest that theory-based eHealth interventions focusing on pre- and postintentional determinants have the potential for behavior change in older adults. If future studies including larger samples and long-term follow-up can confirm and clarify these findings, researchers and practitioners should be encouraged to use a self-regulation perspective for eHealth intervention development. Trial Registration Clinicaltrials.gov NCT03194334; https://clinicaltrials.gov/ct2/show/NCT03783611.
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Affiliation(s)
- Delfien Van Dyck
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Research Foundation - Flanders, Brussels, Belgium
| | - Karel Herman
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Louise Poppe
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Research Foundation - Flanders, Brussels, Belgium
| | - Geert Crombez
- Department of Experimental Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Educational Policy, Ghent University, Ghent, Belgium
| | - Freja Gheysen
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Research and Valorisation, Vives University of Applied Sciences, Kortrijk, Belgium
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19
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The Effect of Exercise on Glucoregulatory Hormones: A Countermeasure to Human Aging: Insights from a Comprehensive Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101709. [PMID: 31096708 PMCID: PMC6572009 DOI: 10.3390/ijerph16101709] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/25/2019] [Accepted: 05/11/2019] [Indexed: 11/17/2022]
Abstract
Hormones are secreted in a circadian rhythm, but also follow larger-scale timetables, such as monthly (hormones of the menstrual cycle), seasonal (i.e., winter, summer), and, ultimately, lifespan-related patterns. Several contexts modulate their secretion, such as genetics, lifestyle, environment, diet, and exercise. They play significant roles in human physiology, influencing growth of muscle, bone, and regulating metabolism. Exercise training alters hormone secretion, depending on the frequency, duration, intensity, and mode of training which has an impact on the magnitude of the secretion. However, there remains ambiguity over the effects of exercise training on certain hormones such as glucoregulatory hormones in aging adults. With advancing age, there are many alterations with the endocrine system, which may ultimately alter human physiology. Some recent studies have reported an anti-aging effect of exercise training on the endocrine system and especially cortisol, growth hormone and insulin. As such, this review examines the effects of endurance, interval, resistance and combined training on hormones (i.e., at rest and after) exercise in older individuals. We summarize the influence of age on glucoregulatory hormones, the influence of exercise training, and where possible, examine masters' athletes' endocrinological profile.
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20
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Chen SC, Ding SB, Xie BC, Tian H, Lu CY. Are aquatic exercises efficacious in postmenopausal women with knee osteoarthritis? A meta-analysis of randomized controlled trials. J Sports Med Phys Fitness 2019; 59:1763-1770. [PMID: 31062542 DOI: 10.23736/s0022-4707.19.09596-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION To assess the effects of aquatic exercise in postmenopausal women with knee osteoarthritis using an up-to-date meta-analysis. EVIDENCE ACQUISITION PubMed, Cochrane Library, Embase, Scopus, Web of Science, Google Scholar, the China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Database (CBM), VIP and Wanfang database were searched systematically for randomized controlled trials (RCTs) published until July 2018. The RCTs included comparing the efficacy of aquatic exercise vs. control in postmenopausal women with knee osteoarthritis, the primary outcomes were assessed by the Western Ontario McMaster University Osteoarthritis Index (WOMAC) and the Knee injury and Osteoarthritis Outcome Score (KOOS). EVIDENCE SYNTHESIS Six RCTs comprising 432 participants. This meta-analysis revealed that aquatic exercise could significantly relieve the symptom of postmenopausal women with knee osteoarthritis. But there was no significant difference between aquatic exercise program and control group for the improvement of pain, stiffness, function outcomes, sport, activities of daily living and quality of life. CONCLUSIONS Contrary to prior reviews, our analysis demonstrated that aquatic exercise has no positive impact on pain physical function, stiffness, activities of daily living, sport and quality of life in elderly women with knee osteoarthritis. However, aquatic exercise could improve the symptoms of knee osteoarthritis. Further investigation is needed because of limited available data.
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Affiliation(s)
- Shi-Chun Chen
- Department of Pharmacology, Guangdong Medical University, Dongguan, China
| | - Shao-Bo Ding
- Department of Pharmacy, Dongguan People's Hospital, Dongguan, China
| | - Bao-Cheng Xie
- Department of Pharmacology, Guangdong Medical University, Dongguan, China
| | - Hao Tian
- Department of Pharmacology, Guangdong Medical University, Dongguan, China
| | - Cheng-Yu Lu
- Department of Pharmacology, Guangdong Medical University, Dongguan, China -
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Benedetti MG, Furlini G, Zati A, Letizia Mauro G. The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4840531. [PMID: 30671455 PMCID: PMC6323511 DOI: 10.1155/2018/4840531] [Citation(s) in RCA: 191] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/28/2018] [Accepted: 12/04/2018] [Indexed: 01/13/2023]
Abstract
Physical exercise is considered an effective means to stimulate bone osteogenesis in osteoporotic patients. The authors reviewed the current literature to define the most appropriate features of exercise for increasing bone density in osteoporotic patients. Two types emerged: (1) weight-bearing aerobic exercises, i.e., walking, stair climbing, jogging, and Tai Chi. Walking alone did not appear to improve bone mass; however it is able to limit its progressive loss. In fact, in order for the weight-bearing exercises to be effective, they must reach the mechanical intensity useful to determine an important ground reaction force. (2) Strength and resistance exercises: these are carried out with loading (lifting weights) or without (swimming, cycling). For this type of exercise to be effective a joint reaction force superior to common daily activity with sensitive muscle strengthening must be determined. These exercises appear extremely site-specific, able to increase muscle mass and BMD only in the stimulated body regions. Other suggested protocols are multicomponent exercises and whole body vibration. Multicomponent exercises consist of a combination of different methods (aerobics, strengthening, progressive resistance, balancing, and dancing) aimed at increasing or preserving bone mass. These exercises seem particularly indicated in deteriorating elderly patients, often not able to perform exercises of pure reinforcement. However, for these protocols to be effective they must always contain a proportion of strengthening and resistance exercises. Given the variability of the protocols and outcome measures, the results of these methods are difficult to quantify. Training with whole body vibration (WBV): these exercises are performed with dedicated devices, and while it seems they have effect on enhancing muscle strength, controversial findings on improvement of BMD were reported. WBV seems to provide good results, especially in improving balance and reducing the risk of falling; in this, WBV appears more efficient than simply walking. Nevertheless, contraindications typical of senility should be taken into account.
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Affiliation(s)
- Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giulia Furlini
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Zati
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
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Belfiore P, Miele A, Gallè F, Liguori G. Adapted physical activity and stroke: a systematic review. J Sports Med Phys Fitness 2018; 58:1867-1875. [DOI: 10.23736/s0022-4707.17.07749-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Self-Paced Cycling Improves Cognition on Institutionalized Older Adults Without Known Cognitive Impairment: A 15-Month Randomized Controlled Trial. J Aging Phys Act 2018; 26:614-623. [DOI: 10.1123/japa.2017-0135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aimed at identifying the effects of self-paced cycling on the cognitive and functional status and fall risk on institutionalized older adults without cognitive impairment. A total of 39 individuals were randomly assigned to an exercise group or to a control group. The exercise group participants cycled at their self-selected intensity at least for 15 min daily during 15 months. The control group participants performed recreational activities. The Mini-Mental State Examination, Fuld object memory evaluation, and symbol digit modality test were used for cognitive assessments. The Katz index, the timed “Up & Go” test, and the World Health Organization questionnaire were used to assess functional independence, mobility, and fall risk. Significant improvements were observed in the exercise group for global cognition and attention, visual scanning, and processing speed. Long-term self-paced cycling training seems to have a protective effect on cognitive status and attention, visual scanning, and processing speed in older institutionalized individuals.
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Effects of physical exercise in older adults with reduced physical capacity: meta-analysis of resistance exercise and multimodal exercise. Int J Rehabil Res 2018; 40:303-314. [PMID: 29023317 DOI: 10.1097/mrr.0000000000000249] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Older adults with reduced physical capacity are at greater risk of progression to care dependency. Progressive resistance strength exercise and multimodal exercise have been studied to restore reduced physical capacity. To summarize the best evidence of the two exercise regimes, this meta-analysis study appraised randomized-controlled trials from published systematic reviews. Medline, Embase, and the Cochrane Database of Systematic Review and Cochrane Central Register of Controlled Clinical Trials were searched for relevant systematic reviews. Two reviewers independently screened the relevant systematic reviews to identify eligible trials, assessed trial methodological quality, and extracted data. RevMan 5.3 software was used to analyze data on muscle strength, physical functioning, activities of daily living, and falls. Twenty-three eligible trials were identified from 22 systematic reviews. The mean age of the trial participants was 75 years or older. Almost all multimodal exercise trials included muscle strengthening exercise and balance exercise. Progressive resistance exercise is effective in improving muscle strength of the lower extremity and static standing balance. Multimodal exercise is effective in improving muscle strength of the lower extremity, dynamic standing balance, gait speed, and chair stand. In addition, multimodal exercise is effective in reducing falls. Neither type of exercise was effective in improving activities of daily living. For older adults with reduced physical capacity, multimodal exercise appears to have a broad effect on improving muscle strength, balance, and physical functioning of the lower extremity, and reducing falls relative to progressive resistance exercise alone.
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Effects of Structured Exercise Interventions for Older Adults Hospitalized With Acute Medical Illness: A Systematic Review. J Aging Phys Act 2018; 26:284-303. [PMID: 28605230 DOI: 10.1123/japa.2016-0372] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This review examined effects of structured exercise (aerobic walking, with or without complementary modes of exercise) on cardiorespiratory measures, mobility, functional status, healthcare utilization, and quality of life in older adults (≥60 years) hospitalized for acute medical illness. Inclusion required exercise protocol, at least one patient-level or utilization outcome, and at least one physical assessment point during hospitalization or within 1 month of intervention. MEDLINE, Embase, and CINAHL databases were searched for studies published from 2000 to March 2015. Qualitative synthesis of 12 articles, reporting on 11 randomized controlled trials (RCTs) and quasi-experimental trials described a heterogeneous set of exercise programs and reported mixed results across outcome categories. Methodological quality was independently assessed by two reviewers using the Cochrane Collaboration Risk of Bias tool. Larger, well-designed RCTs are needed, incorporating measurement of premorbid function, randomization with intention-to-treat analysis, examination of a targeted intervention with predefined intensity, and reported adherence and attrition.
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26
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Maritz CA, Silbernagel KG. A Prospective Cohort Study on the Effect of a Balance Training Program, Including Calf Muscle Strengthening, in Community-Dwelling Older Adults. J Geriatr Phys Ther 2018; 39:125-31. [PMID: 26288238 DOI: 10.1519/jpt.0000000000000059] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Falls are the number 1 cause of injury, fractures, and death among the older population. In fact, one-third of adults older than 60 years will experience 1 or more falls annually. Factors including inactivity and decreased mobility are associated with overall declines in strength, balance, and functional mobility in older adults. PURPOSE The purpose of this study was to evaluate the effect of a balance training program, including calf muscle strengthening, in community-dwelling older adults and to evaluate how calf muscle strength correlates with risk factors for falls. METHODS Community-dwelling older adults from a local senior center were invited to participate in a 5-week (10 sessions), 1-on-1, balance training program, which included calf muscle strengthening. All the participants were evaluated before and after the intervention. The outcome measures were static balance, unilateral heel-rise test, Timed Up and Go test (TUG), the 30-second Chair Stand Test (30-sCST), and the Activity Balance Confidence Scale. RESULTS Twenty-eight participants (6 males and 22 females) mean (standard deviation) age of 78 years were included in the study and completed the baseline evaluation. Eight participants did not complete the study. Static balance with eyes closed, heel rise, TUG, 30-sCST, and the Activity Balance Confidence Scale improved significantly (P < .05) following treatment compared with the baseline evaluation. The heel-rise ability correlated significantly (P < .05) with TUG (r = -0.484 to -0.528) and 30-sCST (r = 0.501-0.595). Sixty-three percent of the participants performed 10 reps or less of the unilateral heel rise on the right side and 60% on the left side. None of the participants who performed 10 reps or more of the unilateral heel rise had a high risk of falls based on the TUG. CONCLUSIONS A balance training program that includes calf muscle strengthening performed twice a week for 5 weeks resulted in significant improvements in calf muscle strength, functional performance and balance, as well as a significant improvement in balance confidence. The results from this study identify the importance unilateral calf muscle strength has to falls risk among older adults.
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Affiliation(s)
- Carol A Maritz
- Department of Physical Therapy, Samson College of Health Sciences, University of the Sciences, Philadelphia, Pennsylvania
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Cardiac Aging – Benefits of Exercise, Nrf2 Activation and Antioxidant Signaling. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 999:231-255. [DOI: 10.1007/978-981-10-4307-9_13] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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28
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Evaluation of an Outpatient Rehabilitative Program to Address Mobility Limitations Among Older Adults. Am J Phys Med Rehabil 2017; 96:600-606. [PMID: 28079616 PMCID: PMC5510704 DOI: 10.1097/phm.0000000000000682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental digital content is available in the text. Live Long Walk Strong is a clinical demonstration program for community-dwelling older patients. It was designed to be consistent with current fall prevention guidelines and reimbursed under the Medicare model. Patients were screened within primary care and referred to a physiatrist followed by systematic assessment and treatment within an outpatient rehabilitative care setting. The treatment included behavioral modification, fall prevention education, community/home exercise integration, and exercise targeting strength, power, flexibility, balance, and endurance. Treatment duration and frequency varied with each patient based on baseline presentation, clinical judgment, and patient preference. Program feasibility and preliminary effectiveness were evaluated by assessing participation and changes in physical performance, respectively. There were 266 patients referred to the program, and 147 were willing to participate. Of these, 116 patients completed all scheduled visits (10.8 ± 3.9 visits). The noncompleters (n = 31) had a higher rate of falls in the previous 6 months and lower baseline Short Physical Performance Battery composite score. At the completion of care, the adjusted mean change in Short Physical Performance Battery was 1.66 units, surpassing a large clinically meaningful threshold (1 unit). The Live Long Walk Strong program appears to be feasible to implement and demonstrates preliminary effectiveness in enhancing mobility among older adults.
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Park J, Kwon Y, Park H. Effects of 24-Week Aerobic and Resistance Training on Carotid Artery Intima-Media Thickness and Flow Velocity in Elderly Women with Sarcopenic Obesity. J Atheroscler Thromb 2017; 24:1117-1124. [PMID: 28674320 PMCID: PMC5684477 DOI: 10.5551/jat.39065] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aim: Sarcopenic obesity (SO) is closely associated with cardiovascular disease (CVD) in elderly women. Increases in body fat and decreases in muscle mass are closely associated with increased carotid intima-media thickness (CIMT). The aim of this study was to examine the influence of a 24-week aerobic and resistance training program on carotid parameters in SO. Methods: Fifty elderly women (74.1 ± 6.1 years) with SO were randomly divided into an exercise group and a control group. The exercise group performed combined exercise over 24 weeks, consisting of resistance and aerobic training for 50–80 min, 5 times a week. Carotid variables were measured using B-mode ultrasound. The differences in the carotid variables and the relative changes between baseline and after 24 weeks were evaluated. Results: In the analysis of variance (ANOVA) results, CIMT (p = 0.013), systolic flow velocity (p = 0.007), diastolic flow velocity (p = 0.006), and wall shear rate (p = 0.010) showed significant interactions. In paired t-test results of the exercise group, CIMT significantly decreased (p < 0.01) and systolic flow velocity (p < 0.01), diastolic flow velocity (p < 0.001), and wall shear rate (p < 0.05) significantly increased after 24 weeks. Conclusion: The 24-week combined exercise effectively decreased CIMT and increased carotid flow velocity and wall shear ratio. Therefore, combined exercise is thought to contribute to the improvement of the risk of CVD in elderly women with SO.
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Affiliation(s)
- Jinkee Park
- Department of Sport Rehabilitation, Dong Ju College, Busan
| | - Yoochan Kwon
- Institute of Taekwondo for Health and Culture, Dong-A University.,Department of Taekwondo, Dong-A University
| | - Hyuntea Park
- Department of Health Care & Science, Dong-A University.,Institute of Convergence Bio-Health, Dong-A University
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30
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Public Open Space Development for Elderly People by Using the DANP-V Model to Establish Continuous Improvement Strategies towards a Sustainable and Healthy Aging Society. SUSTAINABILITY 2017. [DOI: 10.3390/su9030420] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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31
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Narasimhan M, Rajasekaran NS. Exercise, Nrf2 and Antioxidant Signaling in Cardiac Aging. Front Physiol 2016; 7:241. [PMID: 27378947 PMCID: PMC4911351 DOI: 10.3389/fphys.2016.00241] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 06/03/2016] [Indexed: 12/16/2022] Open
Abstract
Aging is represented by a progressive decline in cellular functions. The age-related deformities in cardiac behaviors are the loss of cardiac myocytes through apoptosis or programmed cell death. Oxidative stress (OS) and its deleterious consequence contribute to age-related mechanical remodeling, reduced regenerative capacity, and apoptosis in cardiac tissue. The pathogenesis of OS in the elderly can predispose the heart to other cardiac complications such as atherosclerosis, hypertension, ischemic heart disease, cardiac myopathy, and so on. At the molecular level, oxidant-induced activation of Nrf2 (Nuclear erythroid-2-p45-related factor-2), a transcription factor, regulates several genes containing AREs (Antioxidant Response Element) and bring the respective translates to counteract the reactive radicals and establish homeostasis. Myriad of Nrf2 gene knockout studies in various organs such as lung, liver, kidney, brain, etc. have shown that dysregulation of Nrf2 severely affects the oxidant/ROS sensitivity and predispose the system to several pathological changes with aberrant cellular lesions. On the other hand, its gain of function chemical interventions exhibited oxidant stress resistance and cytoprotection. However, thus far, only a few investigations have shown the potential role of Nrf2 and its non-pharmacological induction in cardiac aging. Therefore, here we review the involvement of Nrf2 signaling along with its responses and ramifications on the cascade of OS under acute exercise stress (AES), moderate exercise training (MET), and endurance exercise stress (EES) conditions in the aging heart.
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Affiliation(s)
- Madhusudhanan Narasimhan
- Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center Lubbock, TX, USA
| | - Namakkal S Rajasekaran
- Cardiac Aging and Redox Signaling Laboratory, Center for Free Radical Biology, Division of Molecular and Cellular Pathology, Department of Pathology, University of Alabama at BirminghamBirmingham, AL, USA; Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of MedicineSalt Lake City, UT, USA; Department of Exercise Physiology, College of Health, University of Utah School of MedicineSalt Lake City, UT, USA
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32
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Christiani Y, Byles JE, Tavener M, Dugdale P. Exploring the implementation of poslansia, Indonesia's community-based health programme for older people. Australas J Ageing 2016; 35:E11-6. [PMID: 27198005 DOI: 10.1111/ajag.12305] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To explore the implementation of poslansia, a community-based integrated health service implemented across Indonesia to improve the health status of older people through health promotion and disease prevention. METHODS Data analysis of 307 poslansia surveyed in the 4th wave of Indonesia Family Life Survey (IFLS-4). We examined the services provided in the programme, resources and perceived problems. RESULTS The services provided by poslansia focused mostly on risk factor screening and treatment for minor illness, and less on health promotion activities. Lack of support from community health centres, no permanent place for holding poslansia and lack of participant interest in joining the programme were associated with fewer services provided in the programme (P < 0.05). CONCLUSION The findings indicate existing support from the community, community health centres and related institutions for poslansia is not adequate for optimal service function. Health awareness among the older population should also be increased for programme sustainability.
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Affiliation(s)
- Yodi Christiani
- Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute (HMRI), University of Newcastle, Callaghan, New South Wales, Australia.
| | - Julie E Byles
- Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute (HMRI), University of Newcastle, Callaghan, New South Wales, Australia
| | - Meredith Tavener
- Priority Research Centre for Generational Health and Ageing, Hunter Medical Research Institute (HMRI), University of Newcastle, Callaghan, New South Wales, Australia
| | - Paul Dugdale
- Centre for Health Stewardship, Australian National University, Canberra, Australia
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Ward RE, Beauchamp MK, Latham NK, Leveille SG, Percac-Lima S, Kurlinski L, Ni P, Goldstein R, Jette AM, Bean JF. Neuromuscular Impairments Contributing to Persistently Poor and Declining Lower-Extremity Mobility Among Older Adults: New Findings Informing Geriatric Rehabilitation. Arch Phys Med Rehabil 2016; 97:1316-22. [PMID: 27056644 DOI: 10.1016/j.apmr.2016.03.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/07/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To identify neuromuscular impairments most predictive of unfavorable mobility outcomes in late life. DESIGN Longitudinal cohort study. SETTING Research clinic. PARTICIPANTS Community-dwelling primary care patients aged ≥65 years (N=391) with self-reported mobility modifications, randomly selected from a research registry. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Categories of decline in and persistently poor mobility across baseline, 1 and 2 years of follow-up in the Lower-Extremity Function scales of the Late-Life Function and Disability Instrument. The following categories of impairment were assessed as potential predictors of mobility change: strength (leg strength), speed of movement (leg velocity, reaction time, rapid leg coordination), range of motion (ROM) (knee flexion/knee extension/ankle ROM), asymmetry (asymmetry of leg strength and knee flexion/extension ROM measures), and trunk stability (trunk extensor endurance, kyphosis). RESULTS The largest effect sizes were found for baseline weaker leg strength (odds ratio [95% confidence interval]: 3.45 [1.72-6.95]), trunk extensor endurance (2.98 [1.56-5.70]), and slower leg velocity (2.35 [1.21-4.58]) predicting a greater likelihood of persistently poor function over 2 years. Baseline weaker leg strength, trunk extensor endurance, and restricted knee flexion motion also predicted a greater likelihood of decline in function (1.72 [1.10-2.70], 1.83 [1.13-2.95], and 2.03 [1.24-3.35], respectively). CONCLUSIONS Older adults exhibiting poor mobility may be prime candidates for rehabilitation focused on improving these impairments. These findings lay the groundwork for developing interventions aimed at optimizing rehabilitative care and disability prevention, and highlight the importance of both well-recognized (leg strength) and novel impairments (leg velocity, trunk extensor muscle endurance).
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Affiliation(s)
- Rachel E Ward
- New England Geriatric Research Education and Clinical Center, Boston Veterans Affairs Healthcare System, Boston, MA; Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Cambridge, MA.
| | - Marla K Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Nancy K Latham
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA
| | - Suzanne G Leveille
- Harvard Medical School, Boston, MA; College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA
| | - Sanja Percac-Lima
- Harvard Medical School, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - Laura Kurlinski
- Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Cambridge, MA
| | - Pengsheng Ni
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA
| | - Richard Goldstein
- Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Cambridge, MA
| | - Alan M Jette
- Health and Disability Research Institute, Boston University School of Public Health, Boston, MA
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, Boston Veterans Affairs Healthcare System, Boston, MA; Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, Cambridge, MA
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Pedersen MM, Petersen J, Beyer N, Damkjær L, Bandholm T. Supervised progressive cross-continuum strength training compared with usual care in older medical patients: study protocol for a randomized controlled trial (the STAND-Cph trial). Trials 2016; 17:176. [PMID: 27039381 PMCID: PMC4818542 DOI: 10.1186/s13063-016-1309-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 03/22/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Hospitalization in older adults is characterized by physical inactivity and a risk of losing function and independence. Systematic strength training can improve muscle strength and functional performance in older adults. Few studies have examined the effect of a program initiated during hospitalization and continued after discharge. We conducted a feasibility study prior to this trial and found a progression model for loaded sit-to-stands feasible in older medical patients. This study aims to determine whether a simple supervised strength training program for the lower extremities (based on the model), combined with post-training protein supplementation initiated during hospitalization and continued at home for 4 weeks, is superior to usual care on change in mobility 4 weeks after discharge in older medical patients. METHODS Eighty older medical patients (65 years or older) acutely admitted from their own homes will be included in this randomized, controlled, parallel-group, investigator-blinded, superiority trial. After baseline assessments patients will be randomized to (1) intervention: progressive strength training during hospitalization and after discharge (home-based), or (2) control: usual care. Shortly after discharge, 4 weeks after discharge (primary end point) and 6 months after discharge patients will be assessed in their own homes. The intervention encompasses strength training consisting of two lower extremity exercises (sit-to-stand and heel raise) daily during hospitalization and three times per week for 4 weeks after discharge. Both exercises follow pre-defined models for progression and will be performed for three sets of 8-12 repetitions maximum in each training session. Thereafter, the patient will be asked to consume a protein supplement given orally containing 18 g milk-based protein. The primary outcome will be change in the de Morton Mobility Index score from baseline to 4 weeks after discharge. Secondary outcomes will be 24-h mobility level, isometric knee extension strength, the 30-sec sit-to-stand test, habitual gait speed, hand-grip strength, and Activities of Daily Living. DISCUSSION We chose to investigate the effect of a minimal time-consuming treatment approach, i.e. two well-performed strength training exercises combined with protein supplementation, to facilitate implementation in a busy clinical care setting, given a positive trial outcome. TRIAL REGISTRATION ClinicalTrials.gov: NCT01964482 .
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Affiliation(s)
- Mette Merete Pedersen
- Optimed, Clinical Research Centre and Physical Medicine Research-Copenhagen (PMR-C), Department of Physiotherapy, Copenhagen University Hospital, Hvidovre, Denmark.
| | - Janne Petersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.,Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nina Beyer
- Musculoskeletal Rehabilitation Research Unit, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Damkjær
- Department of Rehabilitation, Copenhagen Municipality Health Administration, Copenhagen, Denmark
| | - Thomas Bandholm
- Optimed, Clinical Research Centre and Physical Medicine Research-Copenhagen (PMR-C), Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
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Task-Oriented Exercise to Reduce Activities of Daily Living Disability in Vulnerable Older Adults: A Feasibility Study of the 3-Step Workout for Life. J Aging Phys Act 2015; 24:384-92. [PMID: 26583695 DOI: 10.1123/japa.2015-0070] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The purpose of this feasibility study was to evaluate the 3-Step Workout for Life program, a 10-week exercise program that included moderate-intensity muscle strength training followed by task-oriented training. Fourteen participants completed the program (mean age = 73 years; SD = 6.83). The Box and Block test (Z = -2.24, p = .03) and the 30-s chair stand test (Z = -2.21, p = .03) indicate improved physical functioning of the upper and lower extremities. More importantly, results of the function component from the Late-Life Function and Disability Instrument (Z = -2.04, p = .04) and motor skills scale from the Assessment of Motor and Process Skills (Z = -2.97, p = .003) indicate subjective and objective improvements on performing activities of daily living. Supplementing moderate-intensity muscle strength exercise with task-oriented training components is feasible. Preliminary data support the effectiveness of 3-Step Workout for Life in reducing late-life disability.
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Kuss K, Laekeman M. Aktivierende Physiotherapie bei chronischen Schmerzen älterer Patienten. Schmerz 2015; 29:402-10. [DOI: 10.1007/s00482-015-0037-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Knee Extensor Power Relates to Mobility Performance in People With Knee Osteoarthritis: Cross-Sectional Analysis. Phys Ther 2015; 95:989-95. [PMID: 25655881 PMCID: PMC4498146 DOI: 10.2522/ptj.20140360] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/28/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Quadriceps femoris muscle strengthening is a common rehabilitation exercise for knee osteoarthritis (OA). More information is needed to determine whether targeting muscle power is a useful adjunct to strengthening for people with knee OA. OBJECTIVE The purpose of this study was to identify the predictive ability of knee extensor strength and knee extensor power in the performance of physical tasks in adults with knee OA. DESIGN This study used a cross-sectional design. METHODS Fifty-five participants with clinical knee OA were included (43 women; mean [SD] age=60.9 [6.9] years). Dependent variables were: timed stair ascent, timed stair descent, and the Six-Minute Walk Test (6MWT). Independent variables were: peak knee extensor strength and mean peak knee extensor power. Covariates were: age, body mass index, and self-efficacy. Multiple regression analyses were run for each dependent variable with just covariates, then a second model including strength, and then a third model including power. The R(2) values were compared between models. RESULTS Power explained greater variance than strength in all models. Over and above the covariates, power explained an additional 6% of the variance in the 6MWT, increasing the R(2) value from .33 to .39; 8% in the stair ascent test, increasing the R(2) value from .52 to .60; and 3% in the stair descent test, increasing the R(2) value from .44 to .47. LIMITATIONS The sample demonstrated very good mobility and muscle function scores and may not be indicative of those with severe knee OA. CONCLUSIONS In adults with knee OA, knee extensor power was a stronger determinant of walking and stair performance when compared with knee extensor strength. Clinicians should consider these results when advising patients on exercise to maintain or improve mobility.
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Loh DA, Hairi NN, Choo WY, Mohd Hairi F, Peramalah D, Kandiben S, Lee PL, Gani N, Madzlan MF, Abd Hamid MAI, Akram Z, Chu AS, Bulgiba A, Cumming RG. MultiComponent Exercise and theRApeutic lifeStyle (CERgAS) intervention to improve physical performance and maintain independent living among urban poor older people--a cluster randomised controlled trial. BMC Geriatr 2015; 15:8. [PMID: 25887235 PMCID: PMC4334409 DOI: 10.1186/s12877-015-0002-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/20/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The ability of older people to function independently is crucial as physical disability and functional limitation have profound impacts on health. Interventions that either delay the onset of frailty or attenuate its severity potentially have cascading benefits for older people, their families and society. This study aims to develop and evaluate the effectiveness of a multiComponent Exercise and theRApeutic lifeStyle (CERgAS) intervention program targeted at improving physical performance and maintaining independent living as compared to general health education among older people in an urban poor setting in Malaysia. METHODS This cluster randomised controlled trial will be a 6-week community-based intervention programme for older people aged 60 years and above from urban poor settings. A minimum of 164 eligible participants will be recruited from 8 clusters (low-cost public subsidised flats) and randomised to the intervention and control arm. This study will be underpinned by the Health Belief Model with an emphasis towards self-efficacy. The intervention will comprise multicomponent group exercise sessions, nutrition education, oral care education and on-going support and counselling. These will be complemented with a kit containing practical tips on exercise, nutrition and oral care after each session. Data will be collected over four time points; at baseline, immediately post-intervention, 3-months and 6-months follow-up. DISCUSSION Findings from this trial will potentially provide valuable evidence to improve physical function and maintain independence among older people from low-resource settings. This will inform health policies and identify locally acceptable strategies to promote healthy aging, prevent and delay functional decline among older Malaysian adults. TRIAL REGISTRATION ISRCTN22749696.
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Affiliation(s)
- Debbie Ann Loh
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Noran Naqiah Hairi
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Wan Yuen Choo
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Farizah Mohd Hairi
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Devi Peramalah
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Shathanapriya Kandiben
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Pek Ling Lee
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Norlissa Gani
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Mohamed Faris Madzlan
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Mohd Alif Idham Abd Hamid
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Zohaib Akram
- Department of Oral Pathology, Oral Medicine and Periodontology, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia.
| | - Ai Sean Chu
- Fitness First Malaysia, Menara MBF, Jalan Sultan Ismail, Kuala Lumpur, Malaysia.
| | - Awang Bulgiba
- Julius Centre University of Malaya, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Robert G Cumming
- Centre for Education and Research on Ageing, Concord Hospital, Concord, NSW, Australia. .,Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
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STROLLO S, CASEROTTI P, WARD R, GLYNN N, GOODPASTER B, STROTMEYER E. A review of the relationship between leg power and selected chronic disease in older adults. J Nutr Health Aging 2015; 19:240-8. [PMID: 25651453 PMCID: PMC4840887 DOI: 10.1007/s12603-014-0528-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This review investigates the relationship between leg muscle power and the chronic conditions of osteoarthritis, diabetes mellitus, and cardiovascular disease among older adults. Current literature assessing the impact of chronic disease on leg power has not yet been comprehensively characterized. Importantly, individuals with these conditions have shown improved leg power with training. METHODS A search was performed using PubMed to identify original studies published in English from January 1998 to August 2013. Leg power studies, among older adults ≥ 50 years of age, which assessed associations with osteoarthritis, diabetes mellitus, and/or cardiovascular disease were selected. Studies concerning post-surgery rehabilitation, case studies, and articles that did not measure primary results were excluded. RESULTS Sixteen studies met inclusion criteria, addressing osteoarthritis (n=5), diabetes mellitus (n=5), and cardiovascular disease (n=6). Studies generally supported associations of lower leg power among older adults with chronic disease, although small sample sizes, cross-sectional data, homogenous populations, varied disease definitions, and inconsistent leg power methods limited conclusions. CONCLUSIONS Studies suggest that osteoarthritis, diabetes mellitus, and cardiovascular disease are associated with lower leg power compared to older adults without these conditions. These studies are limited, however, by the heterogeneity in study populations and a lack of standardized measurements of leg power. Future larger studies of more diverse older adults with well-defined chronic disease using standard measures of leg power and interventions to improve leg power in these older adults with chronic disease are needed.
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Affiliation(s)
- S.E. STROLLO
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - P. CASEROTTI
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - R.E. WARD
- Health and Disability Research Institute, Boston University, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - N.W. GLYNN
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - B.H. GOODPASTER
- Sanford Burnham Medical Research Institute, Orlando, FL, USA
| | - E.S. STROTMEYER
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
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Systematic review of functional training on muscle strength, physical functioning, and activities of daily living in older adults. Eur Rev Aging Phys Act 2014. [DOI: 10.1007/s11556-014-0144-1] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Leung AYM, Cheung MKT, Tse MA, Shum WC, Lancaster BJ, Lam CLK. Walking in the high-rise city: a Health Enhancement and Pedometer-determined Ambulatory (HEPA) program in Hong Kong. Clin Interv Aging 2014; 9:1343-52. [PMID: 25170259 PMCID: PMC4144928 DOI: 10.2147/cia.s66351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Due to the lack of good infrastructure in the public estates, many older adults in urban areas are sedentary. The Health Enhancement and Pedometer-Determined Ambulatory (HEPA) program was developed to assist older adults with diabetes and/or hypertension to acquire walking exercise habits and to build social support, while engaged in regular physical activity. This study aimed to describe the HEPA program and to report changes in participants’ walking capacity and body strength after 10-week walking sessions. A pre- and postintervention design was used. Pedometers were used to measure the number of steps taken per day before and after the 10-week intervention. Upper and lower body strength, lower body flexibility, and quality of life were assessed. A total of 205 older adults completed the program and all health assessments. After the 10-week intervention, the average number of steps per day increased by 36%, from 6,591 to 8,934. Lower body strength, upper body strength, and aerobic fitness increased significantly after 10 weeks, along with improvement in the 12-item Short Form Health Survey (SF™-12) physical and mental health component summary scores. A social support network was built in the neighborhood, and the local environment was utilized to make walking possible and enjoyable.
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Affiliation(s)
- Angela Y M Leung
- School of Nursing, University of Hong Kong, People's Republic of China ; Research Centre on Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, University of Hong Kong, People's Republic of China
| | - Mike K T Cheung
- Centre on Research and Advocacy, Hong Kong Society for Rehabilitation, University of Hong Kong, People's Republic of China
| | - Michael A Tse
- Institute of Human Performance, University of Hong Kong, People's Republic of China
| | - Wai Chuen Shum
- Sheng Kung Hui Holy Carpenter Church Social Services, Hong Kong Special Administrative Region, People's Republic of China
| | - B J Lancaster
- School of Nursing, University of Hong Kong, People's Republic of China ; School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Cindy L K Lam
- Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
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Hurley MV, Dudziec M, Kennedy B, Anderson L, Jackson I, Koskela S, Gallagher W, Jones F. Increasing the health, activity and participation levels of people attending day centres. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.7.310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michael V Hurley
- Professor of Rehabilitation Sciences at the School of Rehabilitation Sciences, Faculty of Health, Social Care and Education, St Georges University of London and Kingston University
| | - Magdalena Dudziec
- Researcher at the School of Rehabilitation Sciences, Faculty of Health, Social Care and Education, St Georges University of London and Kingston University
| | - Bernadette Kennedy
- Head of the Integrated Falls and Bone Health Service, St George's Healthcare NHS Trust
| | - Liezl Anderson
- Senior Occupational Therapist at the Integrated Falls and Bone Health Service, St George's Healthcare NHS Trust
| | - Iris Jackson
- Consultant Practitioner at Wandsworth Council Adult Social Services
| | - Sian Koskela
- Research Associate at the School of Rehabilitation Sciences, Faculty of Health, Social Care and Education, St Georges University of London and Kingston University
| | - William Gallagher
- Service Manager at Randall Close Resource Centre, Leonard Cheshire Disability
| | - Fiona Jones
- Professor of Rehabilitation Research at the School of Rehabilitation Sciences, Faculty of Health, Social Care and Education, St Georges University of London and Kingston University, London, UK
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Kim ER, Kang MH, Kim YG, Oh JS. Effects of a Home Exercise Program on the Self-report Disability Index and Gait Parameters in Patients with Lumbar Spinal Stenosis. J Phys Ther Sci 2014; 26:305-7. [PMID: 24648654 PMCID: PMC3944311 DOI: 10.1589/jpts.26.305] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 09/22/2013] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The present study was performed to identify the effect of a home exercise
program on the self-reported disability index and gait parameters in patients with lumbar
spinal stenosis (LSS). [Methods] Fifteen patients with LSS were enrolled in this study and
were trained in a 4-week home exercise program (40 min/day). All patients were evaluated
with three self-reported disability indices (Oswestry Disability Index, Roland-Morris
Disability Questionnaire, and Spinal Stenosis Scale), and gait parameters were assessed
using a GAITRite system before and after the home exercise program. [Results] Patients
with LSS showed significant decreases in the self-reported questionnaire scores and pain
intensity after the home exercise program. However, the gait parameters did not
significantly change. [Conclusion] These findings suggest that home exercise programs can
improve self-reported questionnaire scores and decrease pain in patients with LSS.
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Affiliation(s)
- Eui-Ryong Kim
- Department of Rehabilitation Science, Graduate School, Inje University, Republic of Korea
| | - Min-Hyeok Kang
- Department of Rehabilitation Science, Graduate School, Inje University, Republic of Korea
| | - Yang-Gon Kim
- Department of Physical Therapy, Graduate School, Inje University, Republic of Korea
| | - Jae-Seop Oh
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Republic of Korea
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Manson J, Rotondi M, Jamnik V, Ardern C, Tamim H. Effect of tai chi on musculoskeletal health-related fitness and self-reported physical health changes in low income, multiple ethnicity mid to older adults. BMC Geriatr 2013; 13:114. [PMID: 24160867 PMCID: PMC3870959 DOI: 10.1186/1471-2318-13-114] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 09/19/2013] [Indexed: 11/16/2022] Open
Abstract
Background Tai Chi (TC) has proven to be effective at improving musculoskeletal fitness by increasing upper and lower body strength, low back flexibility and overall physical health. The objectives of this study were to examine changes in musculoskeletal health-related fitness and self-reported physical health after a 16 week TC program in a low income multiple ethnicity mid to older adult population. Methods Two hundred and nine ethnically diverse mid to older community dwelling Canadian adults residing in low income neighbourhoods were enrolled in a 16 week Yang style TC program. Body Mass Index and select musculoskeletal fitness measures including upper and lower body strength, low back flexibility and self-reported physical health measured by SF 36 were collected pre and post the TC program. Determinants of health such as age, sex, marital status, education, income, ethnicity of origin, multi-morbidity conditions, weekly physical activity, previous TC experience as well as program adherence were examined as possible musculoskeletal health-related fitness change predictors. Results Using paired sample t-tests significant improvements were found in both upper and lower body strength, low back flexibility, and the SF 36 physical health scores (p < 0.05). Based on multiple linear regression analyses, no common health determinants explained a significant portion of the variation in percent changes of the musculoskeletal fitness and SF 36 measures. Conclusions These results reveal that TC has the potential of having a beneficial influence on musculoskeletal health-related fitness and self-reported physical health in a mid to older low socioeconomic, ethnically diverse sample.
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Affiliation(s)
- James Manson
- York University, 341 Bethune College, 4700 Keele Street, M3J 1P3 North York, Ontario, Canada.
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Johnson JA, McIlroy WE, Roy E, Papaioannou A, Thabane L, Giangregorio L. Feasibility study of walking for exercise in individuals living in assisted living settings. J Geriatr Phys Ther 2013; 36:175-81. [PMID: 23459236 PMCID: PMC5096924 DOI: 10.1519/jpt.0b013e318282d2d3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Decreased physical activity levels are an increasing concern, specifically for the aging population. Older adults (>65 years) are able to achieve health benefits from participating in a regular exercise program based on studies done in younger community-dwelling older adults. There is less research investigating the efficacy of exercise for improving physical function among the older adult population in assisted living settings. This study investigated using a treadmill with a harness system, to engage older adults in aerobic exercise. The primary objective of the study was to assess the feasibility of a large trial by evaluating the recruitment and short-term retention rate of older adults with limited mobility. Secondary objectives were to determine whether older adults could achieve the frequency, intensity, and duration of aerobic exercise recommended by the American College of Sports Medicine. METHODS A feasibility study of residents of an assisted living facility who had care needs ranging from retirement home to palliative care. The feasibility of recruitment and retention was determined by recording the number of older adults who consented to participate in treadmill walking for 3 weeks, declined treadmill participation including reasons why, and completed the 6 treadmill sessions. All participating residents completed a baseline assessment, including a medical chart review, and had the choice to walk on the treadmill or not. To determine whether participants could achieve what is recommended in physical activity guidelines, exercise, frequency, intensity, and duration achieved after the final treadmill sessions were reported. RESULTS Among eligible residents, 30% consented to participate in the study. There were no significant differences between treadmill participants and those who chose not to walk on the treadmill. The average compliance to treadmill sessions was 94.4% ± 10.8%. Treadmill participants achieved an average intensity of 50.3% heart rate reserve (SD = 30.2%) and an average frequency of 3 sessions in 1 week. Average duration of the final session was 14 minutes 53 seconds ± 6 minutes 43 seconds. CONCLUSION This study provides preliminary evidence that it is feasible to recruit and retain older adults in assisted living facilities to participate in a short-term treadmill walking study; however, it may be difficult to recruit a large number of individuals. Treadmill participants were able to achieve the American College of Sports Medicine's recommended intensity and frequency for aerobic exercise. For older adults in assisted living settings to achieve 20 minutes a day, they may need more than 3 weeks of progression or multiple sessions per day.
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Affiliation(s)
- Jenna A. Johnson
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - William E. McIlroy
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Eric Roy
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Alexandra Papaioannou
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Centre for Evaluation of Medicines, St Joseph’s Healthcare, Hamilton, Ontario, Canada
| | - Lora Giangregorio
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
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Bean JF, Latham NK, Holt N, Kurlinksi L, Ni P, Leveille S, Percac-Lima S, Jette A. Which neuromuscular attributes are most associated with mobility among older primary care patients? Arch Phys Med Rehabil 2013; 94:2381-2388. [PMID: 23973445 DOI: 10.1016/j.apmr.2013.07.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 07/31/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the neuromuscular attributes that are associated with self-reported mobility status among older primary care patients. DESIGN Cohort study. SETTING Metropolitan-based health care system. PARTICIPANTS Community-dwelling primary care patients aged ≥65 years (N=430), with self-reported modification of mobility tasks resulting from underlying health conditions. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Basic and Advanced Lower Extremity Function as measured by the Late Life Function and Disability Instrument. RESULTS We constructed multivariable linear regression models evaluating both outcomes. For Basic Lower Extremity Function, leg strength, leg velocity, trunk extensor muscle endurance, and ankle range of motion (ROM) were statistically significant predictors (P<.001, R(2)=.21). For Advanced Lower Extremity Function, leg strength, leg strength asymmetry, leg velocity, trunk extensor muscle endurance, and knee flexion ROM were statistically significant predictors (P<.001, R(2)=.39). Sensitivity analyses conducted using multiple imputations to account for missing data confirmed these findings. CONCLUSIONS This analysis highlights the relevance and importance of 5 categories of neuromuscular attributes: strength, speed of movement, ROM, asymmetry, and trunk stability. It identifies novel attributes (leg velocity and trunk extensor muscle endurance) relevant to mobility and highlights that impairment profiles vary by the level of mobility assessed. These findings will inform the design of more thorough and potentially more effective disability prevention strategies.
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Affiliation(s)
| | | | - Nicole Holt
- Spaulding Rehabilitation Hospital, Boston, MA
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Comparative analysis of speed's impact on muscle demands during partial body weight support motor-assisted elliptical training. Gait Posture 2013; 39:314-20. [PMID: 23973354 DOI: 10.1016/j.gaitpost.2013.07.120] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 07/10/2013] [Accepted: 07/26/2013] [Indexed: 02/02/2023]
Abstract
Individuals with walking limitations often experience challenges engaging in functionally relevant exercise. An adapted elliptical trainer (motor to assist pedal movement, integrated body weight harness, ramps/stairs, and grab rails) has been developed to help individuals with physical disabilities and chronic conditions regain/retain walking capacity and fitness. However, limited published studies are available to guide therapeutic interventions. This repeated measures study examined the influence of motor-assisted elliptical training speed on lower extremity muscle demands at four body weight support (BWS) levels commonly used therapeutically for walking. Electromyography (EMG) and pedal trajectory data were recorded as ten individuals without known disability used the motor-assisted elliptical trainer at three speeds [20,40, 60 revolutions per minute (RPM)] during each BWS level (0%, 20%, 40%, 60%). Overall, the EMG activity (peak, mean, duration) in key stabilizer muscles (i.e., gluteus medius, gluteus maximus, vastus lateralis, medial gastrocnemius and soleus) recorded at 60 RPM exceeded those at 40 RPM, which were higher than values at 20 RPM in all but three situations (gluteus medius mean at 0% BWS, vastus lateralis mean at 20% BWS, soleus duration at 40% BWS); however, these differences did not always achieve statistical significance. Slower motor-assisted speeds can be used to accommodate weakness of gluteus medius, gluteus maximus, vastus lateralis, medial gastrocnemius and soleus. As strength improves, training at faster motor-assisted speeds may provide a means to progressively challenge key lower extremity stabilizers.
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Utilization of aerobic exercise in adult neurological rehabilitation by physical therapists in Canada. J Neurol Phys Ther 2013; 37:20-6. [PMID: 23389387 DOI: 10.1097/npt.0b013e318282975c] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE Although aerobic exercise (AE) has been shown to improve aerobic capacity and reduce morbidity in neurological populations, its application is challenging. The purpose of this study was to survey Canadian physical therapists practicing in adult neurorehabilitation regarding the use of AE in clinical practice. METHODS Members of the Neurosciences Division of the Canadian Physiotherapy Association were invited to participate in a Web-based survey. RESULTS Response rate was 36% (N = 155) with every Canadian province represented. The majority of respondents were females in full-time practice for more than 15 years. The majority (88%) agreed/strongly agreed with the following: "AE should be incorporated into treatment programs of patients with neurological conditions." Although 77% prescribed AE, barriers to use included patient concerns (cardiac status, cognitive/perceptual deficits, fatigue) and operations (lack of staff, time, screening tools). The most commonly used screening tools were health records and patient responses to exercise and the least common was exercise stress tests. Overground walking and cycle ergometry were the most frequently used AE modes, and general response to exercise and patient feedback were most frequently used for determining exercise intensity and monitoring AE. DISCUSSION AND CONCLUSIONS Respondents clearly recognized the importance of AE in neurorehabilitation. Barriers to application of AE and limitations in the use of appropriate screening and training procedures need to be addressed to advance clinical utilization of AE in neurological practice. Understanding current patterns of utilization of AE is important for the development of professional education initiatives and clinical guidelines for best practices in AE for neurological populations. Video Abstract available (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A40) for more insights from the authors.
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