Relationship between test methodology and mean velocity in timed walk tests: a review

[Prevalence of frailty in a population aged 70 and older who pay a visit to health center and its detection in primary care]

INTRODUCTION

The detection of frailty in the elderly is key to preventing disability. The main objective of this study is to find out the proportion of frail people in subjects aged 70 and over who attend a health center in A Coruña (Spain).

METHODS

Cross-sectional study, carried out from August 2020 to April 2021. Consecutive selection of patients ≥70 years, with Barthel ≥90, who accessed the health center.

DEPENDENT VARIABLES

Short Physical Performance Battery (SPPB), Get Up and Go (TUG) and Gait Speed (MV); independent: gender, age, number of falls in the last year, number of drugs used chronically, and Charlson index.

RESULTS

The sample was 114 people. The proportion of frail people is 16.7% (95% CI 10.94-24.57) with the SPPB, 28.6% in those aged 80 and over; and 36.8% using VM. The risk of frailty increases by at least 4.1% for each year of age after 70. Being a woman multiplies the risk by at least 1.5. The concordance between frailty according to the SPPB and MV is 46.8% (95% CI 30.85-62.77).

CONCLUSIONS

The prevalence of frailty in independent people for basic ADL who attend a health center is at least 10.94%. Both the SPPB and the MV are feasible and useful methods in primary care.

Cortical activation and brain network efficiency during dual tasks: An fNIRS study

OBJECTIVE

Dual task (DT) is a commonly used paradigm indicative of executive functions. Brain activities during DT walking is usually measured by portable functional near infrared spectroscopy (fNIRS). Previous studies focused on cortical activation in prefrontal cortex and overlooked other brain regions such as sensorimotor cortices. This study is aimed at investigating the modulations of cortical activation and brain network efficiency in multiple brain regions from single to dual tasks with different complexities and their relationships with DT performance.

METHODS

Forty-two healthy adults [12 males; mean age: 27.7 (SD=6.5) years] participated in this study. Participants performed behavioral tasks with portable fNIRS simultaneous recording. There were three parts of behavioral tasks: cognitive tasks while standing (serial subtraction of 3's and 7's), walking alone and DT (walk while subtraction, including serial subtraction of 3's and 7's). Cognitive cost, walking cost and cost sum (i.e., sum of cognitive and walking costs) were calculated for DT. Cortical activation, local and global network efficiency were calculated for each task.

RESULTS

The cognitive cost was greater and the walking cost was less during DT with subtraction 3's compared with 7's (P's = 0.032 and 0.019, respectively). Cortical activation and network efficiency were differentially modulated among single and dual tasks (P's < 0.05). Prefrontal activation during DT was positively correlated with DT costs, while network efficiency was negatively correlated with DT costs (P's < 0.05).

CONCLUSIONS

Our results revealed prefrontal over-activation and reduced network efficiency in individuals with poor DT performance. Our findings suggest that reduced network efficiency could be a possible mechanism contributing to poor DT performance, which is accompanied by compensatory prefrontal over-activation.

Correlates of Gait Speed Among Older Adults From 6 Countries: Findings From the COSMIC Collaboration

BACKGROUND

Few studies have compared gait speed and its correlates among different ethnogeographic regions. The goals of this study were to describe usual and rapid gait speed, and identify their correlates across Australian, Asian, and African countries.

METHODS

We used data from 6 population-based cohorts of adults aged 65+ from 6 countries and 3 continents (N = 6 472), with samples ranging from 231 to 1 913. All cohorts are members of the Cohort Studies of Memory in an International Consortium collaboration. We investigated whether clinical (body mass index [BMI], hypertension, stroke, apolipoprotein status), psychological (cognition, mood, general health), and behavioral factors (smoking, drinking, physical activity) correlated with usual (N = 4 cohorts) and rapid gait speed (N = 3 cohorts) similarly across cohorts. Regression models were controlled for age, sex, and education, and were sex-stratified.

RESULTS

Age- and sex-standardized usual gait speed means ranged from 0.61 to 1.06 m/s and rapid gait speed means ranged from 1.16 to 1.64 m/s. Lower BMI and better cognitive function consistently correlated with faster gait speed in all cohorts. Less consistently, not having hypertension and greater physical activity engagement were associated with faster gait speed. Associations with mood, smoking, and drinking were largely nonsignificant. These patterns were not attenuated by demographics. There was limited evidence that the associations differed by sex, except physical activity, where the greater intensity was associated with usual gait among men but not women.

CONCLUSIONS

This study is among the first to describe the usual and rapid gait speeds across older adults in Africa, Asia, and Australia.

A New Approach to Individualize Physical Activity Interventions for Individuals With Dementia: Cluster Analysis Based on Physical and Cognitive Performance

BACKGROUND AND PURPOSE

Physical activity (PA) can have a beneficial effect on cognitive and physical performance in individuals with dementia (IWD), including those residing in nursing homes. However, PA interventions in nursing homes are usually delivered using a group setting, which may limit the effectiveness of the intervention due to the heterogenous nature of IWD. Therefore, the purpose of this study was to identify clusters based on cognitive and physical performance values, which could be used to improve individualization of PA interventions.

METHODS

Based on the cognitive and physical performance variables of 230 IWD, a cluster analysis was conducted. Global cognition (Mini-Mental State Examination), mobility (6-Meter Walking Test), balance (Frailty and Injuries: Cooperative Studies of Intervention Techniques-subtest-4), and strength and function of lower extremities (30-Second Chair-Stand Test) were assessed, and values were used to perform a hierarchical cluster analysis with Ward's method. Differences in physical and cognitive performance as well as other secondary outcomes (age, sex, body mass index, use of walking aids, diagnosis and etiology of dementia, number of medications, and Cumulative Illness Rating Scale) were tested using 1-factorial analyses of variance.

RESULTS AND DISCUSSION

Out of 230 data sets, 3-cluster solutions were identified with similar cluster sizes of 73 to 79. The silhouette coefficients for all calculated clusters ranged between 0.15 and 0.34. The cluster solutions were discussed in the context of cognitive and physical functions as well as training modalities and opportunities. The 4-cluster solution appears to be best suited for providing or developing an individualized PA intervention.

CONCLUSIONS

The identified clusters of the 4-cluster solution may be used in future research to improve individualization of dementia-specific PA interventions. By assigning IWD to these clusters, more homogenous groups with regard to cognitive and physical performance can be formed. This allows for more individualized PA interventions and may result in a higher effectiveness, particularly in nursing homes. Our findings are relevant for therapists and nursing staff who design or deliver PA interventions in nursing homes or similar settings.

A Tablet-Based App to Support Nursing Home Staff in Delivering an Individualized Cognitive and Physical Exercise Program for Individuals With Dementia: Mixed Methods Usability Study

BACKGROUND

The promotion of physical activity in individuals with dementia living in nursing homes is crucial for preserving physical and cognitive functions and the associated quality of life. Nevertheless, the implementation of physical activity programs in this setting is challenging, as the time and expertise of nursing home staff are limited. This situation was further exacerbated by the COVID-19 pandemic. Mobile health apps may be a sustainable approach to overcome these challenges in the long term. Therefore, the Individualized Cognitive and Physical Exercise-App (the InCoPE-App) was developed to support nursing home staff in delivering and implementing tailored cognitive and physical exercise training for individuals with dementia.

OBJECTIVE

This study aims to assess the usability of the InCoPE-App in terms of user performance and user perception in a laboratory setting using a mixed methods approach.

METHODS

Nursing home staff were encouraged to perform 5 basic tasks within the InCoPE-App. Their thoughts while using the app were captured by implementing a think aloud protocol. Then, participants completed the System Usability Scale questionnaire. The think aloud transcripts were qualitatively evaluated to unveil usability issues. All identified issues were rated in terms of their necessity to be fixed. Task completion (ie, success rate and time) and perceived usability were evaluated descriptively.

RESULTS

A total of 14 nursing home employees (mean age 53.7, SD 10.6 years; n=13, 93% women) participated in the study. The perceived usability of the InCoPE-App, as assessed by the System Usability Scale questionnaire, can be rated as "good." The main usability issues concerned navigation logic and comprehensibility of app content.

CONCLUSIONS

The InCoPE-App is a user-friendly app that enables nursing home staff to deliver and implement cognitive and physical exercise training for individuals with dementia in nursing homes. The InCoPE-App can be used with little training, even by people aged ≥50 years, who may have low digital literacy. To achieve sustainable use and high user satisfaction of the InCoPE-App in the long term, it should be implemented and evaluated in a field study.

Functional training improves peak oxygen consumption and quality of life of individuals with heart failure: a randomized clinical trial

BACKGROUND

Functional training may be an effective non-pharmacological therapy for heart failure (HF). This study aimed to compare the effects of functional training with strength training on peak VO₂ and quality of life in individuals with HF.

METHODS

A randomized, parallel-design and examiner-blinded controlled clinical trial with concealed allocation, intention-to-treat and per-protocol analyses. Twenty-seven participants with chronic HF were randomly allocated to functional or strength training group, to perform a 12-week physical training, three times per week, totalizing 36 sessions. Primary outcomes were the difference on peak VO₂ and quality of life assessed by cardiopulmonary exercise testing and Minnesota Living with Heart Failure Questionnaire, respectively. Secondary outcomes included functionality assessed by the Duke Activity Status Index and gait speed test, peripheral and inspiratory muscular strength, assessed by hand grip and manovacuometry testing, respectively, endothelial function by brachial artery flow-mediated dilation, and lean body mass by arm muscle circumference.

RESULTS

Participants were aged 60 ± 7 years, with left ventricular ejection fraction 29 ± 8.5%. The functional and strength training groups showed the following results, respectively: peak VO₂ increased by 1.4 ± 3.2 (16.9 ± 2.9 to 18.6 ± 4.8 mL.kg^-1.min^-1; p time = 0.011) and 1.5 ± 2.5 mL.kg^-1.min^-1 (16.8 ± 4.0 to 18.6 ± 5.5 mL.kg^-1.min^-1; p time = 0.011), and quality of life score decreased by 14 ± 15 (25.8 ± 14.8 to 10.3 ± 7.8 points; p time = 0.001) and 12 ± 28 points (33.8 ± 23.8 to 19.0 ± 15.1 points; p time = 0.001), but no difference was observed between groups (peak VO₂: p interaction = 0.921 and quality of life: p interaction = 0.921). The functional and strength training increased the activity status index by 6.5 ± 12 and 5.2 ± 13 points (p time = 0.001), respectively, and gait speed by 0.2 ± 0.3 m/s (p  time = 0.002) in both groups.

CONCLUSIONS

Functional and strength training are equally effective in improving peak VO₂, quality of life, and functionality in individuals with HF. These findings suggest that functional training may be a promising and innovative exercise-based strategy to treat HF.

TRIAL REGISTRATION

NCT03321682. Registered date: 26/10/2017.

Specialized Care Resources for Diagnosis and Management of Patients Who Have Suffered Falls: Results of a National Survey in Geriatric Units

INTRODUCTION

Clinical guidelines recommend comprehensive multifactorial assessment and intervention to prevent falls and fractures in older populations.

METHODS

A descriptive study was conducted by the Falls Study Group of the Spanish Geriatric Medicine Society (SEMEG) to outline which types of healthcare-specific resources were assigned for fall assessment in Spanish geriatric departments. A self-reported seven-item questionnaire was delivered from February 2019 to February 2020. Where geriatric medicine departments were not available, we tried to contact geriatricians working in those areas.

RESULTS

Information was obtained regarding 91 participant centers from 15 autonomous communities, 35.1% being from Catalonia and 20.8% from Madrid. A total of 21.6% reported a multidisciplinary falls unit, half of them in geriatric day hospitals. Half of them reported fall assessment as part of a general geriatric assessment in general geriatric outpatient clinics (49.5%) and, in 74.7% of cases, the assessment was based on functional tests. A total of 18.7% reported the use of biomechanical tools, such as posturography, gait-rides or accelerometers, for gait and balance analysis, and 5.5% used dual X-ray absorptiometry. A total of 34% reported research activity focused on falls or related areas. Regarding intervention strategies, 59% reported in-hospital exercise programs focused on gait and balance improvement and 79% were aware of community programs or the pathways to refer patients to these resources.

CONCLUSIONS

This study provides a necessary starting point for a future deep analysis. Although this study was carried out in Spain, it highlights the need to improve public health in the field of fall prevention, as well as the need, when implementing public health measures, to verify that these measures are implemented homogeneously throughout the territory. Therefore, although this analysis was at the local level, it could be useful for other countries to reproduce the model.

Normative values for grip strength, gait speed, timed up and go, single leg balance, and chair rise derived from the Canadian longitudinal study on ageing

BACKGROUND

decreased muscle strength and physical function often precede disability, nursing home admission, home care use and mortality in older adults. Normative values for commonly used physical performance-based tests are not widely available for older adults but are required for clinicians and researchers to easily identify individuals with low performance.

OBJECTIVE

to develop normative values for grip strength, gait speed, timed up and go, single-leg balance and five-repetition chair rise tests in a large population-based sample of Canadians aged 45-85 years.

METHODS

baseline data (2011-2015) from the Canadian Longitudinal Study on Ageing was used to estimate age- and sex-specific normative values for each of the physical tests. Participants were without disability or mobility limitation (no assistance with activities of daily living or use of mobility devices).

RESULTS

of the 25,470 participants eligible for the analyses 48.6% (n = 12,369) were female with a mean age of 58.6 ± 9.5 years. Sex-specific 5th, 10th, 20th, 50th, 80th, 90th and 95th percentile values for each physical performance-based test were estimated. Cross-validation (n = 100 repetitions) with a 30% holdout sample was used to evaluate model fit.

CONCLUSIONS

the normative values developed in this paper can be used in clinical and research settings to identify individuals with low performance relative to their peers of the same age and sex. Interventions targeting these at-risk individuals including physical activity can prevent or delay mobility disability and the resulting cascade of increasing care requirements, health care costs and mortality.

Effects of Neuromuscular Training on Physical Performance in Older People: A Systematic Review

This systematic review aimed to assess the available evidence on the effects of neuromuscular training on physical performance in older adults. A literature search was conducted across four databases (Psychology and Behavioral (EBSCO), Scopus, Web of Science and PubMed). The PRISMA guidelines were followed. The PEDro scale and Cochrane risk of bias tool were used to assess the quality of and risk of bias in the studies, respectively. The protocol was registered in PROSPERO (code: CRD42022319239). The outcomes were muscle strength, cardiorespiratory fitness, postural balance and gait speed. From 610 records initially found, 10 were finally included in the systematic review, involving 354 older people with a mean age of 67.3 years. Nine of them reported significant changes in at least one variable related to physical performance in the intervention compared to the control groups. The neuromuscular training caused significant improvements in postural balance, flexibility, cardiorespiratory fitness, strength power of the upper and lower limbs and autonomy. The available evidence indicates that neuromuscular training has a positive effect on some variables of physical performance, especially in postural balance; however, the methodological quality and certainty of the evidence in the available literature are limited. Therefore, a greater number of high-quality studies are required to draw definitive conclusions.

The association between low cognitive reserve and subjective memory complaints in functionally independent older women

BACKGROUND

Several factors have been found to defend against pathologic cognitive decline in aging (i.e., cognitive reserve [CR]); however, other factors, including subjective memory complaints (SMC) and decreased functionality are considered early indicators of underlying neurocognitive dysfunction. Despite these known associations, the relationship between the presence of CR and SMC remains equivocal. This study sought to determine the relationship between objectively measured CR and SMC in a sample of functionally independent older women.

METHODS

This cross-sectional study recruited women aged ≥60 years who attended fitness or continuing education programs at the University for Seniors in Mexico City. Participants underwent a battery of physical and cognitive evaluations, including the Cognitive Reserve Questionnaire (CRQ), and were asked probing questions used to identify the presence of SMC.

RESULTS

The 269 participants had a median age of 69 years; most were single (40.5 %), lived alone (32.7 %), retired (58.2 %), well-educated (≥12 years of education), and functionally independent (89.2 %). 62 % scored "high" on the CRQ, while 9.3 % scored "low". After adjusting for multiple covariates, an independent association between CRQ score and the probability to have SMC was found (adjusted OR = 0.87, 95% CI 0.80-0.95, p-value = 0.002).

CONCLUSIONS

This study identified a relationship between low CR and the presence of SMC, independently of the cognitive function and motoric marker of muscle strength (i.e., low gait speed and handgrip strength) in functionally independent older women over 60y. This relationship remains independent of other variables such as age, symptoms of depression and instrumented activities of daily living.

Comparison of manual and automated measures of walking speed: Distance and pace matter

BACKGROUND

Walking speed (WS) represents a global marker of individual health and provides a simple and objective measure of motor performances for use in clinical and research settings. WS is most often measured over relatively short distances at usual (UWS) or fast (FWS) pace, using manual (e.g., stopwatch) or automated methods (e.g., photoelectric cells). As the time needed to walk over these distances is very short, we hypothesized that measurement error related to manual compared to automated WS measures is more pronounced for shorter distances and FWS and investigated the reliability and agreement of WS in a subsample of the Constances cohort at two paces and over two distances.

METHODS

We recruited 100 community-dwelling participants (50 % women) aged 45-70y (mean = 56.1y). WS was measured manually (stopwatches) and using photoelectric cells, at two paces (UWS/FWS) and over two distances (3 m/5 m). Agreement was examined using Bland and Altman plots and intraclass correlation coefficients (ICC).

RESULTS

Participants were on average 169.8 cm tall, and their mean body mass index was 25.4 kg/m². Agreement between manual stopwatches and photoelectric cells was excellent (ICCs between 0.92 and 0.97), but it was lower for smaller distances, with significantly lower ICCs over 3 m compared to 5 m both for UWS (difference_ICC = -0.04) and FWS (difference_ICC = -0.05). Bias of manual measures was constant for UWS and increased with increasing FWS. There were inter-rater effects, with better agreement for UWS and 5 m compared to FWS and 3 m.

CONCLUSIONS

Both distance and pace have an influence on the reliability of WS measures using manual timing methods. Our findings also suggest the presence of rater effects and better agreement for 5 m and UWS. These findings are helpful for the design of studies that include manual measures of WS, especially FWS, in order to reduce measurement error and suggest that longer distances are preferable.

Accuracy and comparison of sensor-based gait speed estimations under standardized and daily life conditions in children undergoing rehabilitation

Background

Gait speed is a widely used outcome measure to assess the walking abilities of children undergoing rehabilitation. It is routinely determined during a walking test under standardized conditions, but it remains unclear whether these outcomes reflect the children's performance in daily life. An ankle-worn inertial sensor provides a usable opportunity to measure gait speed in the children's habitual environment. However, sensor-based gait speed estimations need to be accurate to allow for comparison of the children's gait speed between a test situation and daily life. Hence, the first aim of this study was to determine the measurement error of a novel algorithm that estimates gait speed based on data of a single ankle-worn inertial sensor in children undergoing rehabilitation. The second aim of this study was to compare the children’s gait speed between standardized and daily life conditions.

Methods

Twenty-four children with walking impairments completed four walking tests at different speeds (standardized condition) and were monitored for one hour during leisure or school time (daily life condition). We determined accuracy by comparing sensor-based gait speed estimations with a reference method in both conditions. Eventually, we compared individual gait speeds between the two conditions.

Results

The measurement error was 0.01 ± 0.07 m/s under the standardized and 0.04 ± 0.06 m/s under the daily life condition. Besides, the majority of children did not use the same speed during the test situation as in daily life.

Conclusion

This study demonstrates an accurate method to measure children's gait speed during standardized walking tests and in the children's habitual environment after rehabilitation. It only requires a single ankle sensor, which potentially increases wearing time and data quality of measurements in daily life. We recommend placing the sensor on the less affected side, unless the child wears one orthosis. In this latter case, the sensor should be placed on the side with the orthosis. Moreover, this study showed that most children did not use the same speed in the two conditions, which encourages the use of wearable inertial sensors to assess the children's walking performance in their habitual environment following rehabilitation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12984-022-01079-3.

Preventing frailty with the support of a home-monitoring and communication platform among older adults-a study protocol for a randomised-controlled pilot study in Sweden

Background

POSITIVE (i.e. maintaining and imPrOving the intrinSIc capaciTy Involving primary care and caregiVErs) is a new intervention program consisting of home-monitoring equipment and a communication platform to support treatment of frailty symptoms initially in primary care and prevent disability in older adults.

Methods

The primary objectives are to estimate the potential efficacy of the POSITIVE system on improving frailty in at least one point in Fried’s criteria and five points in Frailty Trait Scale. The secondary objectives are to (A) assess the recruitment, retention, drop-out rates, compliance with the intervention and the intervention mechanisms of impact; (B) evaluate the usability and acceptance of the POSITIVE system, and to get estimations on; (C) the potential efficacy of the intervention on improving the participants’ physical performance, cognitive functions, mood, independency level in activities in daily living, the impact on quality of life and number of falls during the follow-up period; (D) the impact on the caregiver quality of life and caregiver burden; and (E) on the consumption of health care resources, participants’ perception of health and level of care received, and healthcare professionals’ workload and satisfaction.

A randomised controlled, assessor-blinded pilot study design recruiting from a primary care centre in Stockholm Region will be conducted. Fifty older adults identified as pre-frail or frail will be randomised into a control or an intervention group. Both groups will receive a medical review, nutritional recommendations and Vivifrail physical exercise program. The intervention group will receive the POSITIVE-system including a tablet, the POSITIVE application and portable measurement devices. The participants receiving the POSITIVE program will be monitored remotely by a primary care nurse during a 6-month follow-up. Data will be collected at baseline, 3 and 6 months into the intervention though the platform, standardised assessments and surveys. A process evaluation as per Medical Research Council guidance will be conducted after the 6-month follow-up period.

Discussion

The implications of the study are to provide estimations on the potential efficacy of the POSITIVE system in improving frailty among older adults and to provide relevant data to inform powered studies of potential efficacy and effectiveness, as well as to inform about the feasibility of the current study design.

Trial registration

ClinicalTrials.gov. Registration number: NCT04592146. October 19, 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-01147-4.

Measurement Properties of Remotely or Self-Administered Lower Extremity Mobility Performance Measures in Adults: A Systematic Review

OBJECTIVE

For individuals who face barriers to care assessment, there is a need for remote administration or self-administration of physical performance measures that assess mobility to determine current functional status and to monitor and predict future changes in functional status. The primary purpose of this review is to evaluate the available measurement properties of scores for remotely or self-administered lower extremity mobility performance measures in adults. This review also outlines the test procedures and population suitability of these measures.

METHODS

Data sources were Ovid MEDLINE, Ovid Embase, EBSCOhost CINAHL, Ovid AMED, and Cochrane CENTRAL-which were searched from inception to January 26, 2021-and the reference lists of relevant studies. Two individuals independently screened studies that assessed at least 1 prespecified measurement property of scores for a remote and/or self-administered lower extremity physical performance measure assessing mobility in an adult population. Two individuals independently extracted data on study characteristics, measurement properties, feasibility, and interpretability using piloted extraction forms. The COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) Risk of Bias tool was used to assess methodological quality. Data were qualitatively summarized, and results were compared against COSMIN's criteria for good measurement properties. Level of evidence was determined using COSMIN's modified GRADE approach.

RESULTS

Fourteen studies detailing 19 outcome measures were included. Many studies displayed "sufficient" measurement properties based on COSMIN's criteria; however, risk of bias for most of the included studies was rated adequate or doubtful.

CONCLUSION

Clinicians and researchers can consider the measurement properties of scores and feasibility of different approaches presented in this review when determining how to assess or monitor mobility in adult populations.

IMPACT

Assessing mobility via remote or self-administered physical performance measures in adult populations appears to be feasible using a variety of methods including simple tools (chair, stopwatch), videoconferencing, and smartphone applications. This strategy may be particularly valuable for self-management of chronic conditions and decreasing barriers to accessing care.

Exercise and physical performance in older adults with sarcopenic obesity: A systematic review

Background

Sarcopenic obesity is characterized by low muscle mass and high body fat; prevalence increases with age, particularly after age 65 years. For this systematic literature review we searched scientific databases for studies on exercise interventions for improving physical performance in adults with sarcopenic obesity; also, we identified potential gaps in clinical practice guidelines that need to be addressed.

Methods

We followed the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The databases were searched for studies published through November 2021 that measured physical performance in adults with sarcopenic obesity.

Results

Most of the studies applied a strength training protocol in which improvement was noted post-treatment on the Time Chair Rise (TCR), 30-s Chair Stand, and Single Leg Stance (SLS) tests. Discrepancies between the studies were observed when resistance training was combined with or without elastic bands or electromyostimulation, as measured with the Short Physical Performance Battery (SPPB), Physical Performance Test (PPT), Gait Speed, and Timed Up & Go (TUG) test. Post-intervention SPPB, PPT, and gait speed scores showed an increase or maintenance of performance, while TUG test scores were higher according to one study but lower according to another.

Conclusions

Engagement in physical exercise, and resistance training in particular, can improve or maintain physical performance in adults with sarcopenic obesity. Study samples should include more men. A future area of focus should be the impact of different types of training (aerobic, power training, combined modalities). Finally, studies with longer intervention periods and follow-up periods are needed to gain a better understanding of the effectiveness of exercise on physical function in adults with sarcopenic obesity.

ICT-Based Individualized Training of Institutionalized Individuals With Dementia. Evaluation of Usability and Trends Toward the Effectiveness of the InCoPE-App

Physical activity interventions can alleviate the course of disease for individuals with dementia (IWD) who have been extraordinarily affected by the COVID-19 pandemic. Information and Communication Technology (ICT) provides new opportunities not only to mitigate negative effects of the pandemic but also to sustainably improve everyday life of IWD in nursing homes. The aim of the present study was to evaluate the ICT-based InCoPE-App, which was used to assess physical and cognitive performance and deliver individualized exercise for IWD, with regard to 1) user experience of nursing assistants, and 2) trends toward the effectiveness of the intervention on physical and cognitive performance of IWD. An 18-week individualized multidomain intervention (2 × 60 min/session) was delivered to an intervention group (IG; n = 10, mean age 88.4 ± 5.6, 70% female) by nursing assistants (n = 10, mean age 56.1 ± 10.4, 90% female) using the InCoPE-App. A control group (CG; n = 3, mean age 87.3 ± 3.5, 100% female) received conventional treatment. User experience was assessed among nursing assistants by different questionnaires, i.e., PSSUQ and ISONORM 9241/110-S for usability, and AttrakDiff2 for pragmatic (PQ), hedonic quality-identity and stimulation (HQI and HQS), and attractiveness (ATT). Trends toward the effectiveness of the intervention were assessed using MMSE (global cognitive function), FICSIT-4 (balance), 6MWT and TUG (mobility), and m30CST (function of lower limbs). Usability of the InCoPE-App was rated as high by nursing assistants (mean ± SD; overall PSSUQ 2.11 ± 0.75; overall ISONORM 9241/110-S 1.90 ± 0.88; ATT 1.86 ± 1.01; PQ 1.79 ± 1.03; HQI 1.8 ± 0.79; and HQS 1.37 ± 0.69). Dropout was high in the total sample (36.7%). Trends toward the effectiveness were observed within IG in nine IWD who showed positive or neutral trends in at least two physical performance outcomes. Seven participants had positive or neutral trends in the FICSIT-4, seven participants in m30CST, and four and seven participants in 6MWT and TUG, respectively. In conclusion, the InCoPE-App has good nursing assistant-rated usability, whereas training effects and intervention adherence were rather low most likely due to COVID-19 restrictions. Single-subject research revealed more positive than negative trends in IG of IWD. Further research is needed to evaluate feasibility, suitability, and effectiveness of the InCoPE-App.

InCoPE-App: Study protocol to examine usability and effectiveness of an individualized, tablet-based multidomain exercise program for institutionalized people with dementia delivered by nursing assistants. (Preprint)

Background

The COVID-19 pandemic has had drastic consequences on everyday life in nursing homes. Limited personnel resources and modified hygiene and safety measures (eg, no external exercise instructors, no group settings) have often led to interrupted physical exercise treatments. As a consequence, people with dementia benefiting from individualized exercise programs are affected by the pandemic’s impact.

Objective

Our goal is to develop an easily applicable mobile application (Individualized Cognitive and Physical Exercise [InCoPE] app) allowing nursing assistants to test cognitive function and physical performance and subsequently train people with dementia through a multidomain, individualized exercise program.

Methods

We will evaluate the usability and effectiveness of the InCoPE-App by applying a mixed method design. Nursing assistants will use the InCoPE-App for 18 weeks to assess the cognitive function and physical performance of 44 people with dementia every 3 weeks and apply the individualized exercise program. We will record overall usability using questionnaires (eg, Post-Study System Usability and ISONORM 9241/10), log events, and interviews. Perceived hedonic and pragmatic quality will be assessed using the AttrakDiff questionnaire. Effectiveness will be evaluated by considering changes in quality of life as well as cognitive function and physical performance between before and after the program.

Results

Enrollment into the study will be completed in the first half of 2022. We expect an improvement in the quality of life of people with dementia accompanied by improvements in cognitive function and physical performance. The usability of the InCoPE-App is expected to be rated well by nursing assistants.

Conclusions

To date, there is no scientifically evaluated app available that enables nursing assistants without expertise in sports science to deliver an individualized exercise program among people with dementia. A highly usable and effective InCoPE-App allows nursing assistants to test cognitive function and physical performance of people with dementia and, based thereon, select and deliver an appropriate individualized exercise program based on the cognitive and physical status of an individual, even in times of a pandemic.

Trial Registration

German Register of Clinical Trials DRKS00024069; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024069

International Registered Report Identifier (IRRID)

DERR1-10.2196/36247

Effects of a 16-Week Multimodal Exercise Program on Physical Performance in Individuals With Dementia: A Multicenter Randomized Controlled Trial

BACKGROUND AND PURPOSE

Dementia affects physical as well as cognitive performance. In individuals with dementia (IWD), decline in physical performance increases with disease progression and is associated with higher functional dependence and decreased quality of life. It is paramount to examine factors that potentially preserve physical performance in IWD, particularly in light of conflicting findings on the effectiveness of physical activity interventions on physical performance of IWD, mainly due to limited number of high-quality studies, large heterogeneity in methods used, or insufficient reporting of methods. The aim of this study was to investigate the effects of a 16-week multimodal exercise program (MEP) combining physical and cognitive tasks on physical performance in IWD, and to identify individual characteristics of MEP responders.

METHODS

A multicenter randomized controlled trial with assessment methods identified by an expert panel was conducted. We included 319 IWD of mild to moderate severity, older than 65 years, who underwent a standardized MEP specifically designed for IWD. At baseline and immediately after the MEP, we assessed physical performance (ie, mobility, balance, and strength) and function of lower extremities (primary outcomes). Potential effects of the MEP on physical performance were identified using 2-factor analyses of variance with repeated measurements within 2 samples (ie, intention-to-treat and per-protocol sample). Additionally, we compared characteristics related to physical performance between positive, non-, and negative responders.

RESULTS AND DISCUSSION

Neither analysis procedure revealed statistically significant time×group effects. However, 28% to 40% of participants were positive responders with regard to balance, and strength and function of lower extremities; and these persons had statistically significant lower baseline performance in the corresponding assessments.

CONCLUSIONS

This randomized controlled trial revealed no overall effects of the MEP on physical performance, probably due to high heterogeneity of the study sample. Findings in responder analysis showed that IWD with lower physical performance at baseline tended to benefit more than those with higher baseline performance. Thus, a higher degree of individualization of the MEP depending on baseline performance on IWD may improve overall MEP effectiveness.

Concurrent impact of bilateral multiple joint functional electrical stimulation and treadmill walking on gait and spasticity in post-stroke survivors: a pilot study

Background: Stroke causes multi-joint gait deficits, so a major objective of post-stroke rehabilitation is to regain normal gait function. Design and Setting: A case series completed at a neuroscience institute. Aim: The aim of the study was to determine the concurrent impact of functional electrical stimulation (FES) during treadmill walking on gait speed, knee extensors spasticity and ankle plantar flexors spasticity in post-stroke survivors. Participants: Six post-stroke survivors with altered gait patterns and ankle plantar flexors spasticity (4 = male; age 56.8 ± 4.8 years; Body Mass Index (BMI) 26.2 ± 4.3; since onset of stroke: 30.8 ± 10.4 months; side of hemiplegia [L/R]: 3:3) were recruited. Intervention: Nine treatment sessions using FES bilaterally while walking on a treadmill. Main Outcome Measures: Primary outcome measures included the Modified Modified Ashworth Scale (MMAS), Timed Up and Go test (TUG), 10-m walking test, gait speed, and Functional ambulation category (FAC). Secondary outcome measures included the Step Length Test (SLT), and active range of motion (ROM) of the affected ankle and the knee. Measurements were taken at baseline (T0), at the end of last treatment (T1), and 1 month after the final treatment session (T2). Results: The TUG, 10-m walking test, gait speed, FAC, active ROM, and SLT all significantly improved following treatment (P< .05), while ankle plantar flexors spasticity (P = .135), and knee extensors spasticity (P = .368) did not show any significant decrease. Conclusions: A short duration of bilateral FES in conjugation with treadmill walking contributed to significant improvement in gait speed, functional mobility, functional ambulation, range of motion and step length in post-stroke survivors. In contrast, no significant decreases were identified in the spasticity of the ankle plantar flexors and knee extensors muscles.

How do we define and measure sarcopenia? A meta-analysis of observational studies

OBJECTIVE

this study aimed to investigate how sarcopenia has been defined and measured in the literature reporting its prevalence, and how different definitions and measurement tools can affect prevalence estimates.

DESIGN

systematic review and meta-analysis.

SETTING AND PARTICIPANTS

community-dwelling older people.

METHODS

meta-analysis of data collected from observational studies. We performed an electronic search in five databases to identify studies reporting the prevalence of sarcopenia. We used descriptive statistics to present data pertaining sarcopenia definition and measurement tools, and the quality-effects model for meta-analysis of pooled prevalence.

RESULTS

we found seven different operational definitions for sarcopenia and a variety of tools applied to assess the sarcopenic markers; muscle mass, muscle strength and physical performance. The prevalence of sarcopenia varied between the definitions with general estimates ranging from 5% based on the European Working Group on Sarcopenia in Older People (EWGSOP1) criterion to 17% with the International Working Group on Sarcopenia. According to the tool used to assess muscle mass, strength and physical performance, prevalence values also varied within definitions extending from 1 to 7%, 1 to 12% and 0 to 22%, respectively.

CONCLUSION AND IMPLICATIONS

the criteria used to define sarcopenia, as well as the measurement tools applied to assess sarcopenic markers have influence in the prevalence of sarcopenia. The establishment of a unique definition for sarcopenia, the use of methods that guarantee an accurate evaluation of muscle mass and the standardisation of measurement tools are necessary to allow a proper diagnosis and comparison of sarcopenia prevalence among populations.

The Paradoxical Effect of Living Alone on Cognitive Reserve and Mild Cognitive Impairment among Women Aged 60+ in Mexico City

An elderly person who lives alone must often be autonomous and self-sufficient in daily living activities. We explored if living alone and marital status were associated with mild cognitive impairment and low cognitive reserve in a sample of Mexican women aged 60+ attending continuing education courses using a cross-sectional design. Objective cognitive functions were assessed using the MMSE and Blessed Dementia Scale. We administered the Cognitive Reserve Questionnaire. Independence skills were assessed with the Katz index and Lawton index. Multivariate logistic regression analysis was used. We recruited 269 participants (x¯ = 69.0 ± 5.8 years). Single, widowed, separated, and divorced women comprised 73% of the participants. A third lived alone and 84% had completed high school. Mild cognitive deficit was observed among 24.5–29.0%; the upper range for cognitive reserve was 61.7%. Living alone versus living with someone was associated with cognitive impairment (OR = 0.51, p = 0.04) and with low to medium cognitive reserve (OR = 0.51, p = 0.02) after adjusting for confounding variables. Living alone was an independent factor associated with a lower probability of displaying mild cognitive impairment and a higher probability of displaying high cognitive reserve. Women living alone in this study had a more robust cognitive framework and had built their own support networks.

Effects of a 16-week multimodal exercise program on activities of daily living in institutionalized individuals with dementia

We aimed to examine the effects of a 16-week multimodal exercise program (MEP) on activities of daily living (ADL) in individuals with dementia (IWD). Furthermore, we investigated the participants’ individual response to the MEP and whether baseline cognitive and motor performance explain ADL performance. We conducted a multicenter randomized controlled trial (RCT) involving 319 participants aged ≥ 65 years with mild to moderate dementia. ADL were assessed at baseline and after the 16-week intervention using the Barthel Index (BI), the Erlangen Test of Activities of Daily Living (E-ADL) and the 7‑item Physical Performance Test (PPT-7). We additionally assessed cognitive and motor performance using standardized and validated assessments. Intervention effects were examined through two-factor analysis of variance with repeated measurements applying a per protocol and an intention-to-treat analysis. We compared baseline cognitive and motor performance between positive-responders (positive-R), non-responders (non-R), and negative-responders (negative-R) and examined cognitive and motor performance as potential cofounders of ADL by conducting multiple regression analyses. There were no significant time×group effects on ADL. Between 20 and 32% of participants responded positively to the intervention, i.e., improved ADL performance from baseline to follow-up. Positive-R had worse baseline motor performance compared to non-R. Cognitive and motor performance explained up to 51.4% of variance in ADL. The MEP had no significant overall effect on ADL in IWD. This may be related to insufficient exercise intensity. However, our results indicate that the response to the MEP depends on individual prerequisites which should thus be considered in further research on individual exercise approaches.

Standardized gait speed ratio in elderly patients with heart failure

Aims

Although aging is strongly associated with both heart failure and a decline in gait speed, a definition of slowness incorporating an age‐related decline has yet to be developed. We aimed to define an event‐driven cut‐off for the relative decline in gait speed against age‐adjusted reference values derived from the general population and evaluate its prognostic implications.

Methods and results

Standardized gait speed (SGS) was defined as the median gait speed stratified by age, sex, and height in 3777 elderly (age ≥ 65 years) individuals without a history of cardiovascular diseases (Tokyo Metropolitan Institute of Gerontology‐Longitudinal Interdisciplinary Study on Aging: general population cohort). The mortality event‐driven optimal cut‐off of the SGS ratio (actual gait speed divided by the respective SGS) was defined using FRAGILE‐HF cohort data and externally validated using Kitasato cohort data, comprising 1301 and 1247 hospitalized elderly patients with heart failure, respectively. Using FRAGILE‐HF data, the optimal SGS ratio cut‐off was determined as 0.527. In the Kitasato cohort, SGS ratio < 0.527 was associated with a higher 1 year [hazard ratio (HR): 1.70, 95% confidence interval (CI): 1.07–2.72, P = 0.024] and long‐term (HR: 1.46, 95% CI: 1.05–2.02, P = 0.024) mortality rate, independent of pre‐existing covariates.

Conclusions

Gait speed was significantly declined in patients with heart failure, even after taking age and sex‐related decline into account. A SGS ratio of 0.527 is a validated cut‐off for slowness independently associated with mortality in patients with heart failure age ≥65.

Peripheral Neuropathy: An Important Contributor To Physical Limitation And Morbidity In Stage 3-4 Chronic Kidney Disease

BACKGROUND

Impaired physical function drives adverse outcomes in chronic kidney disease (CKD). Peripheral neuropathy is highly prevalent in CKD, though its contribution to physical function in CKD patients is unknown. This study examined the relationships between neuropathy, walking speed and quality of life (QoL) in CKD.

METHODS

This was a prospective observational study investigating neuropathy in CKD patients with an eGFR 15-60ml/kg/min-1. A total of 109 patients were consecutively recruited. The presence and severity of neuropathy was determined using the Total Neuropathy Score (TNS). Walking speed was assessed at both usual and maximal speed, and QoL was assessed using the SF-36 questionnaire.

RESULTS

Peripheral neuropathy was highly prevalent: 40% demonstrated mild neuropathy and 37% had moderate-severe neuropathy. Increasing neuropathy severity was the primary predictor of reduced walking speed (R2=-0.41, p<0.001) and remained so after multivariable analysis adjustment for diabetes. This association was evident for both usual and maximal walking speeds. Neuropathy correlated significantly with low scores on multiple domains of SF-36 including physical function (r=-0.570, p<0.001). Subanalysis according diabetic status revealed a high prevalence of neuropathy both with-and-without diabetes; relationships to walking speed remained evident in subgroup analysis. However, those with diabetes demonstrated greater severity of neuropathy, slower walking speed and lower scores in QoL.

CONCLUSIONS

Moderate to severe peripheral neuropathy was common in stage 3-4 CKD, associated with reduced walking speed independent of diabetes status and was correlated with patient reported QoL. This suggests that neuropathy is an important contributor to declining physical function in CKD irrespective of diabetes status. Targeted diagnosis and management of peripheral neuropathy during CKD progression may improve functional outcomes and QoL.

Development, Validity, and Reliability of a Novel Walking Speed Measurement Device: the GaitBox

BACKGROUND

Gait speed is an important measure of health status for older adults and individuals with neurological conditions. Literature reports that measurements made by people are not as accurate as automatic timers.

RESEARCH QUESTION

Is the GaitBox (GB), a device to measure walking speed (WS) automatically and accurately, a valid approach to walking speed measurement in a clinical setting?

METHODS

Two prospective validation studies were completed comparing the GB to human timers (HT) and the Sprint Timing System (STS). Subjects were recruited from convenience samples of healthy older adults (S1, N = 35, 72.4 + 7.4 years of age) and individuals with Spinal Cord Injury (SCI), Traumatic Brain Injury (TBI), or unknown / no diagnosis (S2, N = 44, 35.3 + 13.5 years of age). Subjects completed 4 timed walks. The GB, HT, and STS simultaneously measured WS across a 4 m or 10 m course. Protocol followed an adapted version of the NIH Walk Test. Subjects were instructed to walk at a normal pace. Validity and reliability were determined using Pearson correlations, absolute mean differences, Intraclass Correlation Coefficients (ICC's) and Bland-Altman plots.

RESULTS

WS measured in both studies demonstrated strong correlations between GB and STS (r = 0.98-0.99, p < 0.0001), excellent test-retest reliability GB ICC's (0.93-0.94), no systematic bias, and good precision. In S1 and S2, ICC's between GB and STS were excellent at 0.91 and 0.93, respectively.

SIGNIFICANCE

Considering the increased use of WS as a clinically relevant measure of mobility, functional decline, and recovery, accurate measurement of WS are important. These studies show the GB is a valid and reliable measurement tool within various populations completing the 4 m and 10 m walk tests at a usual speed. Additional populations and walking distances should be evaluated further. Due to its accuracy, the GaitBox is a valid alternative to HT in the clinic setting.

The effect of different test protocols and walking distances on gait speed in older persons

Background and aims

Walking is the core physical activity of older persons. The assessment of walking capacity is increasingly important for clinical purposes and clinical research. Differences between assessment tools and protocols for short walks to obtain gait characteristics can be responsible for changes, e.g., in gait speed from 0.1 to 0.2 m/s. The purpose of this study was to generate further knowledge for the harmonization and/or standardization of short walk-test protocols for assessing gait characteristics under supervised conditions.

Methods

For this cross-sectional study, 150 community-dwelling older adults (mean age 80.5 ± 4.5 years) were recruited. Participants performed eight walks differing in the distance (8-versus 4-m), static versus dynamic trials and comparing different test speed instructions (usual versus maximal) on an electronic walkway.

Results

A meaningful significant difference in mean usual gait speed was documented comparing the 4-m dynamic and static test protocol (0.12 m/s; p = 0.001). For the same comparison over an 8-m distance (dynamic versus static) and for the comparison between usual gait speed over 4-and 8-m, the differences in gait speed were smaller, but still statistically significant (p = 0.001).

Conclusions

Gait speed was faster, if the test protocol did not include a static start or stop. The differences were greater for a shorter walking distance. This aspect should be considered for the comparison of study results and is particularly relevant for systematic reviews and meta-analyses.

Distinct Trajectories of Individual Physical Performance Measures Across 9 Years in 60- to 70-Year-Old Adults

Background

Physical performance is an important factor for successful aging. This study aimed to identify distinct trajectories of multiple physical performance measures over 9 years in individuals aged 60–70 years and to evaluate their characteristics and the overlap between measures.

Methods

Four physical performance measures were assessed in 440 participants of the Longitudinal Aging Study Amsterdam: tandem stand, gait speed, chair stand, and handgrip strength. Gender-specific latent class models were conducted to obtain distinct trajectories and their degree of overlap.

Results

Mean age at baseline was 67.9 (SD 1.7) years for males and 68.0 (SD 1.7) years for females. The optimal number of trajectories differed across measures. For tandem stand, no distinct trajectories were found (all 179 males, 198 females). For gait speed, three trajectories were identified, dependent on baseline speed: high-stable (47 males, 27 females), intermediate-stable (132 males, 130 females), and low-declining performance (6 males, 48 females). Two trajectories were identified for the chair stand: a stable (168 males, 150 females) and declining trajectory (10 males, 38 females). For handgrip strength, three declining trajectories were identified differing in baseline performance: high (55 males, 75 females), intermediate (111 males, 118 females), and low (17 males, 10 females). Overall, 11.9% of males and 5.7% of females were classified in similar trajectories across measures.

Conclusions

Trajectories of physical performance were heterogeneous, but showed similar patterns for males and females. Little overlap between measures was shown, suggesting different mechanisms for decline. This study emphasizes the use of multiple domains to assess physical performance.

Predictors of falls in patients during the first year after total hip arthroplasty: A prospective cohort study

BACKGROUND AND PURPOSE

Since falls after total hip arthroplasty (THA) cause severe complications such as dislocation and fractures around the femoral stem, it is important to investigate what factors predict of falls. Thus, investigating predictors of falls in patients waiting for THA would be valuable as it lead to more strategic interventions to prevent these problems. The purpose of this study was to evaluate the predictors of falls in patients during the first year after THA.

METHODS

This is a prospective cohort study. A total of 157 patients who underwent THA for unilateral hip osteoarthritis were analyzed. The incidence of falls during the first year after THA was monitored, and patients were classified into a "faller" and "non-faller" group. The following factors were compared between the two groups: demographic data (age, sex, body mass index, leg length discrepancy, length of hospital stay, and history of falling), preoperative hip abductor muscle strength, functional performance (single leg stance and maximum walking speed), pain during walking, and physical activity.

RESULTS

On multivariate logistic regression analysis, preoperative hip abductor muscle strength on the affected side and a history of falling were predictors of falls during the first year after THA. On subsequent receiver operating characteristic curve analysis, preoperative hip abductor muscle strength on the affected side was retained as a significant predictor, with a cut-off strength of 0.46 Nm/kg differentiating the faller and non-faller groups with a specificity of 73.6%, specificity of 50.0%, and area under the curve of 70.2%.

CONCLUSIONS

Finding from the present study suggested that clinicians should focus on low preoperative hip abductor muscle strength on the affected side and a history of falling to prevent falls during the first year after THA.

Methods of 10-Meter Walk Test and Repercussions for Reliability Obtained in Typically Developing Children

Introduction

Research and clinical settings use the 10-meter walk test (10MWT) to measure locomotor capacity with considerable methodological diversity. Comparison between healthy and disabled children is frequent; however, the reproducibility of 10MWT using different methods is unknown.

Objectives

This study analysed intrasubject, test-retest reliability, and agreement of four methods of 10MWT, exploring the influence of pace, acceleration-deceleration phases, and anthropometric measurements when calculating mean velocity.

Methods

This cross-sectional study evaluated 120 typical children, both sexes, aged 6, 8, 10, and 12 (n = 30 for each age). The mean times and velocities of the path (10 m) and middle path (6 m) obtained at a self-selected and fast pace were analysed. Initial assessment and another after seven days recorded three measurements per method (sV6 = self-selected pace and 6 m; sV10 = self-selected pace and 10 m; fV6 = fast pace and 6 m; fV10 = fast pace and 10 m). Interclass correlation coefficient (ICC), multiple regression, and Snedecor-F test (5% significance level) were used.

Results

The fV10 method had high intrasubject reliability for all tested ages (0.70 < ICC > 0.89); sV10 exhibited high intrasubject reliability for ages 6, 8, and 12 (0.70 < ICC > 0.89) and moderate for age 10 (0.50 < ICC < 0.69).Test-retest reliability at sV6 and fV6 did not reach high ICC in any tested ages. The test-retest reliability at sV10 and fV10 was moderate for ages 6, 8, and 12 (0.50 < ICC > 0.69) and poor for age 10 (0.25 < ICC > 0.49). There was no agreement between methods: sV6 versus sV10 (mean difference = 0.91 m/s; SEM = 0.036); fV6 versus fV10 (mean difference = 1.70; SEM = 0.046). The fV6 method versus fV10 overestimated the velocity (bias = 1.70 m/s).

Conclusions

For typical children, the method that ensured the highest intrasubject reliability used fast pace and 10 m. Moreover, test-retest reliability increased when adopting 10 m at both self-selected and fast pace. The methods were not equivalent but were related, and those that did not compute the entire pathway overestimated the results.

Using force data to self-pace an instrumented treadmill and measure self-selected walking speed

BACKGROUND

Self-selected speed is an important functional index of walking. A self-pacing controller that reliably matches walking speed without additional hardware can be useful for measuring self-selected speed in a treadmill-based laboratory.

METHODS

We adapted a previously proposed self-pacing controller for force-instrumented treadmills and validated its use for measuring self-selected speeds. We first evaluated the controller's estimation of subject speed and position from the force-plates by comparing it to those from motion capture data. We then compared five tests of self-selected speed. Ten healthy adults completed a standard 10-meter walk test, a 150-meter walk test, a commonly used manual treadmill speed selection test, a two-minute self-paced treadmill test, and a 150-meter self-paced treadmill test. In each case, subjects were instructed to walk at or select their comfortable speed. We also assessed the time taken for a trial and a survey on comfort and ease of choosing a speed in all the tests.

RESULTS

The self-pacing algorithm estimated subject speed and position accurately, with root mean square differences compared to motion capture of 0.023 m s -1 and 0.014 m, respectively. Self-selected speeds from both self-paced treadmill tests correlated well with those from the 10-meter walk test (R>0.93,p<1×10-13). Subjects walked slower on average in the self-paced treadmill tests (1.23±0.27 ms-1) than in the 10-meter walk test (1.32±0.18 ms-1) but the speed differences within subjects were consistent. These correlations and walking speeds are comparable to those from the manual treadmill speed selection test (R=0.89,p=3×10-11;1.18±0.24 ms-1). Comfort and ease of speed selection were similar in the self-paced tests and the manual speed selection test, but the self-paced tests required only about a third of the time to complete. Our results demonstrate that these self-paced treadmill tests can be a strong alternative to the commonly used manual treadmill speed selection test.

CONCLUSIONS

The self-paced force-instrumented treadmill well adapts to subject walking speed and reliably measures self-selected walking speeds. We provide the self-pacing software to facilitate use by gait researchers and clinicians.

Effects of starting position, distance and ending point in a walking speed test among older adults

AIMS

This study examined the effects of the starting position, distance and ending point on walking speed in older adults with both the usual and maximum walking speeds.

METHODS

In total, 101 older community-dwellers aged between 60 and 74 years were included in this cross-sectional study. Participants were instructed to walk two distances (i.e., 10 and 25 m) at usual and maximum speeds twice. The paired t-test was used to examine the effects of starting positions (static start vs. dynamic start) and ending points (known vs. unknown ending point) on walking speed. Analysis of variance was used to explore walking speed differences among 4, 6, 8, 10, 15, 20 and 25 m walking tests.

RESULTS

Differences in walking speed between static start and dynamic start became larger with a decrease in the walking distance (Cohen's d: 4 m > 6 m > 10 m), and differences were larger in tests at the maximum walking speed (Cohen's d = 0.28-0.85) compared with those at usual walking speed (Cohen's d = 0.21-0.67). The walking speed increased with distance, but no significant changes were found among 10, 15, 20 and 25 m tests at the usual speed. Trivial speed differences were observed in walking speed between known (mean = 1.23-1.82 m/s) and unknown ending points (mean = 1.27-1.86 m/s; Cohen's d < 0.20).

CONCLUSIONS

Test parameters, particularly the starting position and walk distance, do influence walking speed measured in the short-distance walking speed test among older adults. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2020; ••: ••-••.

Comparison of multidimensional frailty score, grip strength, and gait speed in older surgical patients

BACKGROUND

Frail older adults are at increased risk of post-operative morbidity compared with robust counterparts. Simple methods testing frailty such as grip strength or gait speed have shown promising results for predicting post-operative outcome, but there is a debate regarding the most appropriate and precise frailty assessment method. We compared the predictive value of multidimensional frailty score (MFS) with grip strength, gait speed, or conventional risk stratification tool for predicting post-operative complications in older surgical patients.

METHODS

From January 2016 to June 2017, 648 older surgical patients (age ≥ 65 years) were included for analysis. MFS was calculated based on the preoperative comprehensive geriatric assessment. Grip strength and gait speed were measured before surgery. The primary outcome was a composite of post-operative complications (e.g. pneumonia, urinary tract infection, delirium, acute pulmonary thromboembolism, and unplanned intensive care unit admission). The secondary outcome was the 6 month all-cause mortality.

RESULTS

Among 648 patients (mean age 76.6 ± 5.4 years, 52.8% female), 66 (10.2%) patients experienced post-operative complications, and the 6 month mortality was 3.9% (n = 25). Grip strength, gait speed, MFS, and American Society of Anesthesiologists (ASA) classification could predict post-operative complication but only MFS (hazard ratio = 1.581, 95% confidence interval 1.276-1.959, P < 0.001) could predict 6 month mortality after adjustment. MFS (C-index = 0.750) had a superior prognostic utility compared with age (0.638, P = 0.008), grip strength (0.566, P < 0.001), and ASA classification (0.649, P = 0.004). MFS improved the predictive value on age [C-index of 0.638 (age) vs. 0.758 (age + MFS), P < 0.001] and ASA classification [C-index of 0.649 (ASA) vs. 0.765 (ASA + MFS), P < 0.001] for post-operative complication; however, gait speed or grip strength did not provide additional prognostic value in both age and ASA.

CONCLUSIONS

Multidimensional frailty score based on preoperative comprehensive geriatric assessment showed better utility than age, grip strength, gait speed, or ASA classification for predicting post-operative complication and 6 month mortality. MFS also showed incremental predictive ability for post-operative complications with the addition of age and ASA classification. Accordingly, MFS is superior to grip strength or gait speed for predicting complications among older surgical patients.

The importance of physical fitness for the relationship of BDNF with obesity measures in young normal-weight adults

Aims

Brain derived neurotrophic factor (BDNF) is essential for cognitive function. It is also found in non-neuronal tissues with various regulatory actions, including metabolic. Physical fitness (PF) is associated with improved synthesis and secretion of BDNF and reduced obesity. However, the importance of PF for the relationship of BDNF with obesity has not been investigated. This study aims at examining the relationship of PF with BDNF and obesity in 174 young (age = 25.30 ± 9.2 years) healthy adults.

Main methods

Serum BDNF was evaluated using ELISA while obesity was determined using body weight (BW), BMI, and waist circumference (WC). Six minute walk distance (6MWD) test was used to estimate PF.

Key findings

Serum BDNF was greater (p = 0.000) in the participants with high (Hi6MWD) versus low (Lw6MWD) PF group. Additionally, 6MWD explained 6.8% of serum BDNF. Obesity measures were greater (p < 0.05) in the participants with low versus high BDNF. In regression analyses, serum BDNF explained 4.7% of BW (p = 0.004), 3.8% of BMI (p = 0.011), and 6.2% of WC (p = 0.001). However, when the participants were divided into Hi6MWD and Lw6MWD, BDNF explained 8.2% of BW (p = 0.009), 6.0% of BMI (p = 0.03), and 7.0% of WC (p = 0.013), only in the Hi6MWD, but not in the Lw6MWD (p > 0.05) groups.

Significance

The finding confirms the relationship of BDNF with obesity. Additionally, it further suggests the importance of PF level to this relationship among young adults. Future studies are needed to confirm these findings.

Comparison of measurement protocols to estimate preferred walking speed between sites

BACKGROUND

Walking speed influences a variety of typical outcome measures in gait analysis. Many researchers use a participant's preferred walking speed (PWS) during gait analysis with a goal of trying to capture how a participant would typically walk. However, the best practices for estimating PWS and the impact of laboratory size and walk distance are still unclear.

RESEARCH QUESTION

Is measured PWS consistent across different distances and between two laboratory sites?

METHODS

Participants walked overground at a "comfortable speed" for six different conditions with either dynamic (4, 6, 10, and 400 m) or static (4 and 10 m) starts and stops at two different data collection sites. Repeated measures ANOVA with Bonferroni corrections were used to test for differences between conditions and sites.

RESULTS

Participants walked significantly faster in the 4, 6, and 10 m dynamic conditions than in the 400 m condition. On average, participants walked slower in the static trials than the dynamic trials of the same distance. There was a significant interaction of lab and condition and so results were examined within each lab. Across both labs, we found that the 4 and 10 m dynamic conditions were not different than the 6 m dynamic condition at both sites, while other tests did not provide consistent results at both sites.

SIGNIFICANCE

We recommend researchers use a 6 m distance with acceleration and deceleration zones to reliably test for PWS across different laboratories. Given some of the differences found between conditions that varied by site, we also emphasize the need to report the test environment and methods used to estimate PWS in all future studies so that the methods can be replicated between studies.

The Association Between Gait Speed and Cognitive Status in Community-Dwelling Older People: A Systematic Review and Meta-analysis

BACKGROUND

Gait speed and cognitive performance tend to decline with age. A better understanding of the dynamics of the association between gait speed and cognitive status may identify preclinical markers and improve diagnostic assessments. The objective was to quantify the association between gait speed and cognitive status in later life.

METHODS

A systematic search was undertaken of relevant databases for original articles published prior to June 2017, measuring the association between gait speed and cognition cross-sectionally or longitudinally among the community-dwelling population. A meta-analysis pooled results of the mean difference between concurrent measures of gait speed in the normal cognition group compared to non-normal cognition groups.

RESULTS

Thirty-six studies were selected, providing data from 29,520 participants. The majority of studies reported a significant association between slower gait speed and worse cognitive function in older people. Results of the meta-analysis of 27 studies showed that, compared to normal controls, clinically meaningful reductions in gait speed ranged from 0.11 m/s in those with cognitive impairment, to 0.20 m/s in those with mild dementia, and to 0.41 m/s in those with moderate dementia.

CONCLUSION

The strength of evidence for an association between gait speed and cognition was demonstrated by the number and consistency of results, as well as quality of the studies. Identification of diagnostic markers of motor-cognitive risk has led to increasing interest in the effects of interventions for prevention of gait speed loss and cognitive decline in aging.

Normal-Appearing White Matter Integrity Is a Predictor of Outcome After Ischemic Stroke

Background and Purpose- The aim of the present study was to evaluate the relationship between normal-appearing white matter (NAWM) integrity and postischemic stroke recovery in 4 main domains including cognition, mood, gait, and dependency. Methods- A prospective study was conducted, including patients diagnosed for an ischemic supratentorial stroke on a 3T brain MRI performed 24 to 72 hours after symptom onset. Clinical assessment 1 year after stroke included a Montreal Cognitive Assessment, an Isaacs set test, a Zazzo cancelation task, a Hospital Anxiety and Depression scale, a 10-meter walking test, and a modified Rankin Scale (mRS). Diffusion tensor imaging parameters in the NAWM were computed using FMRIB (Functional Magnetic Resonance Imaging of the Brain) Diffusion Toolbox. The relationships between mean NAWM diffusion tensor imaging parameters and the clinical scores were assessed using linear and ordinal regression analyses, including the volumes of white matter hyperintensities, gray matter, and ischemic stroke as radiological covariates. Results- Two hundred seven subjects were included (66±13 years old; 67% men; median National Institutes of Health Stroke Scale score, 3; interquartile range, 2-6). In the models including only radiological variables, NAWM fractional anisotropy was associated with the mRS and the cognitive scores. After adjusting for demographic confounders, NAWM fractional anisotropy remained a significant predictor of mRS (β=-0.24; P=0.04). Additional path analysis showed that NAWM fractional anisotropy had a direct effect on mRS (β=-0.241; P=0.001) and a less important indirect effect mediating white matter hyperintensity burden. Similar results were found with mean diffusivity, axial diffusivity, and radial diffusivity. In further subgroup analyses, a relationship between NAWM integrity in widespread white matter tracts, mRS, and Isaacs set test was found in right hemispheric strokes. Conclusions- NAWM diffusion tensor imaging parameters measured early after an ischemic stroke are independent predictors of functional outcome and may be additional markers to include in studies evaluating poststroke recovery.

Role of Frailty on Risk Stratification in Cardiac Surgery and Procedures

The number of older people candidates for interventional cardiology, such as PCI but especially for transcatheter aortic valve implantation (TAVI) , would increase in the future. Generically, the surgical risk, the amount of complications in the perioperative period, mortality and severe disability remain significantly higher in the elderly than in younger. For this reason it's important to determine the indication for surgical intervention, using tools able to predict not only the classics outcome (length of stay, mortality), but also those more specifically geriatrics, correlate to frailty: delirium, cognitive deterioration, risk of institutionalization and decline in functional status. The majority of the most used surgical risks scores are often specialist-oriented and many variables are not considered. The need of a multidimensional diagnostic process, focused on detect frailty, in order to program a coordinated and integrated plan for treatment and long term follow up, led to the development of a specific geriatric tool: the Comprehensive Geriatric Assessment (CGA). The CGA has the aim to improve the prognostic ability of the current risk scores to capture short long term mortality and disability, and helping to resolve a crucial issue providing solid clinical indications to help physician in the definition of on interventional approach as futile. This tool will likely optimize the selection of TAVI older candidates could have the maximal benefit from the procedure.

The Copenhagen Sarcopenia Study: lean mass, strength, power, and physical function in a Danish cohort aged 20-93 years

BACKGROUND

Despite no international consensus on the diagnostic criteria for sarcopenia, low lean mass, muscle strength, and physical function are important risk factors for disability, frailty, and mortality in older individuals, as well as in a wide range of patients with muscle loss. Here, we provide a population-based reference material of total and regional lean body mass, muscle strength/power parameters, and physical function in a healthy cohort of Danish men and women across the lifespan.

METHODS

Volunteers aged 20-93 years from the Copenhagen City Heart Study were invited to establish a Danish reference material (Copenhagen Sarcopenia Study) on lean mass characteristics [appendicular lean mass (ALM), iDXA, GE Lunar], muscle function [handgrip strength (HGS), Jamar dynamometer and leg extension power (LEP), Nottingham Power Rig], and physical function [30 s sit-to-stand test (STS), 10-m maximal and habitual gait speed (GS)].

RESULTS

A total of 1305 participants [729 women (age: 56.4 ± 18.9 years, height: 1.66 ± 0.01 m, body mass index: 24.6 ± 4.3 kg/m² and 576 men, age: 57.0 ± 17.5 years, height: 1.80 ± 0.07 m, body mass index: 26.0 ± 3.9 kg/m² ] completed all measurements and were included in the present analysis. Lean mass characteristics (TLM, ALM, and ALM/h² ) decreased with increasing age in both men and women (P < 0.001). Men demonstrated larger absolute and relative total ALM and higher HGS and LEP compared with women at all age intervals (P < 0.001). HGS and LEP decreased progressively with age in both men and women (P < 0.01); 30 s STS performance, habitual GS, and maximal GS decreased at an accellerated rate of decline with increasing age in both men and women (P < 0.001). Habitual GS was reduced in men and women aged ≥70 years, while maximal GS was reduced from the age of ≥60 years compared with young adults (P < 0.001). Regardless of sex, 30 s STS was reduced from the age of ≥50 years compared with the young reference group (P < 0.001) CONCLUSIONS: While the power-based measurements (LEP and 30 s STS) started to decline already at age +50 years, less power-based parameters (GS and HGS) and lean mass characteristics (TLM, ALM, and ALM/h² ) remained unaltered until after the age of +70 years. Notably, the cut-off thresholds derived in the present study differed from earlier reference data, which underlines the importance of obtaining updated and local reference materials.

The Role of Mitochondrial DNA Variation in Age-Related Decline in Gait Speed Among Older Men Living With Human Immunodeficiency Virus

Background

Age-related gait speed decline is accelerated in men with human immunodeficiency virus (HIV). Mitochondrial genetic variation is associated with frailty and mortality in the general population and may provide insight into mechanisms of functional decline in people aging with HIV.

Methods

Gait speed was assessed semiannually in the Multicenter AIDS Cohort Study. Mitochondrial DNA (mtDNA) haplogroups were extracted from genome-wide genotyping data, classifying men aged ≥50 years into 5 groups: mtDNA haplogroup H, J, T, Uk, and other. Differences in gait speed by haplogroups were assessed as rate of gait speed decline per year, probability of slow gait speed (<1.0 m/s), and hazard of slow gait using multivariable linear mixed-effects models, mixed-effects logistic regression models, and the Andersen-Gill model, controlling for hepatitis C virus infection, previous AIDS diagnosis, thymidine analogues exposure, education, body composition, smoking, and peripheral neuropathy. Age was further controlled for in the mixed-effects logistic regression models.

Results

A total of 455 HIV-positive white men aged ≥50 years contributed 3283 person-years of follow-up. Among them, 70% had achieved HIV viral suppression. In fully adjusted models, individuals with haplogroup J had more rapid decline in gait speed (adjusted slopes, 0.018 m/s/year vs 0.011 m/s/year, pinteraction = 0.012) and increased risk of developing slow gait (adjusted odds ratio, 2.97; 95% confidence interval, 1.24-7.08) compared to those with other haplogroups.

Conclusions

Among older, HIV-infected men, mtDNA haplogroup J was an independent risk factor for more rapid age-related gait speed decline.

Tester and testing procedure influence clinically determined gait speed

BACKGROUND

There is a clinical need to be able to reliably detect meaningful changes (0.1 to 0.2 m/s) in usual gait speed (UGS) considering reduced gait speed is associated with morbidity and mortality.

RESEARCH QUESTION

What is the impact of tester on UGS assessment, and the influence of test repetition (trial 1 vs. 2), timing method (manual stopwatch vs. automated timing), and starting condition (stationary vs. dynamic start) on the ability to detect changes in UGS and fast gait speed (FGS)?

METHODS

UGS and FGS was assessed in 725 participants on a 8-m course with infrared timing gates positioned at 0, 2, 4 and 6 m. Testing was performed by one of 13 testers trained by a single researcher. Time to walk 4-m from a stationary start (i.e. from 0-m to 4-m) was measured manually using a stopwatch and automatically via the timing gates at 0-m and 4-m. Time taken to walk 4-m with a dynamic start was measured during the same trial by recording the time to walk between the timing gates at 2-m and 6-m (i.e. after 2-m acceleration).

RESULTS

Testers differed for UGS measured using manual vs. automated timing (p = 0.02), with five and two testers recording slower and faster UGS using manual timing, respectively. 95% limits of agreement for trial 1 vs. 2, manual vs. automated timing, and dynamic vs. stationary start ranged from ±0.15 m/s to ±0.20 m/s, coinciding with the range for a clinically meaningful change. Limits of agreement for FGS were larger ranging from ±0.26 m/s to ±0.35 m/s.

SIGNIFICANCE

Repeat testing of UGS should performed by the same tester or using an automated timing method to control for tester effects. Test protocol should remain constant both between and within participants as protocol deviations may result in detection of an artificial clinically meaningful change.

Comparison of the use of a manual stopwatch and an automatic instrument for measuring 4-m gait speed at the usual walking pace with different starting protocols in older adults

PURPOSE

This study compared manual stopwatch-based and automatic instrument-based measurements for gait speed (GS) obtained from the individual's usual walking pace using a 4-m walking test with different starting protocols in healthy older adults.

METHODS

One hundred fifty-three healthy older adults aged ≥ 65 years (57 men, 96 women) participated. GS was measured using both a stopwatch and automatic timer with or without 2-m acceleration and deceleration phases. In the GS measurement using the stopwatch, the first tester stood in the middle of the timing zone (MS1) while the second walked beside the participants from the beginning line to the ending line (MS2).

RESULTS

In the manual method, MS1 and MS2 showed similar GS for both standing and moving starts. There was no significant difference in GS measured between with the manual stopwatch and with the automatic timer in standing start. However, in the moving start protocol, GS measured with the manual stopwatch was significantly faster, by 0.05 m/s in MS1 (p < 0.001) and 0.04 m/s in MS2 (p < 0.001) compared to the timed GS with the automatic timer. GS measured manually using a moving start was significantly faster than that measured manually using a standing start (MS1, 0.06 m/s, 5.0%, p < 0.001; MS2, 0.08 m/s, 6.8%, p < 0.001); however, there was no difference between the start protocols when automatic measurements were performed (p = 0.135).

CONCLUSIONS

The starting protocol (starting and moving start) affected the usual 4-m GS when measured using a manual stopwatch. Therefore, we suggest that careful evaluation to measure GS for functional assessment of older adults using the moving start with a manual stopwatch.

Home-Based Gait Speed Assessment: Normative Data and Racial/Ethnic Correlates Among Older Adults

OBJECTIVES

To determine home-based gait speed performance and its associations with sociodemographic and health-related factors among older adults.

DESIGN

Cross-sectional analysis of a nationally representative US population sample.

SETTING AND PARTICIPANTS

Homes of Health and Retirement Study (HRS) participants.

METHODS

Walk test data measured at home over 2.5 m were aggregated for 6983 individuals, aged ≥65 years (mean age 74.8 ± 6.9 years, 54.2% women), from the 2006 and 2008 HRS waves. Means for gait speed at normal pace were determined for demographic and clinical groupings; association of gait speed with demographic, socioeconomic status, and health factors were examined. Four-year mortality was predicted from baseline slow gait status defined using demographic-based cutoff scores as well as commonly recommended cutoff scores (100 or 60 cm/s).

RESULTS

Home-based gait speed (cm/s) means were lower for female than male (9.6% difference), older than younger (18.0% difference), African American than white (20.5% difference), and Hispanic than Non-Hispanic (10.3% difference) participants. Differences by age group, race, and ethnicity remained significant within sexes (P < .001). Lower speed was associated with African American race and all health problems; higher speed was associated with higher socioeconomic status and alcohol consumption. Four-year mortality was predicted by slow gait status. Predictive validity was, in general, higher for slow gait cutoff scores defined by demographic characteristics.

CONCLUSIONS AND IMPLICATIONS

Mean gait speed measured at home differs among older (aged ≥65 years) US resident population groups defined by sex, age, race, ethnicity, health status, and combinations of these factors, and predicts 4-year mortality when substantially slower than group-based norms. These findings may assist researchers and clinicians in determining normal and abnormal gait performance in older adults in community settings.

A Systematic Review of Thirty-One Assessment Tests to Evaluate Mobility in Older Adults

Assessments of gait, balance, and transfer in elderly people play a valuable role in maintaining healthy aging and preventing a decline in mobility. Several evaluation tools have been proposed; however, clinicians should select the most accurate ones wisely, based on numerous criteria. This systematic review aims to identify all applicable elderly mobility assessment tests and show their measurement properties with as much detail as possible. Initially, a broad search was performed. Articles were screened based on their titles and abstracts, and only studies published in English were considered. Based on our inclusion and exclusion criteria, 31 assessment tests evaluating the mobility of healthy elderly people were found. Then, further searches were completed to identify the measurement properties of each test. These characteristics include the origin and year of establishment, several practicality factors, and validity. The analysis of our outcomes illustrates the similarities and differences between the identified tests.