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Kuzmik A, Boltz M, Resnick B, Drazich BF, Galvin JE. Gender, Pain, and Function Associated With Physical Activity After Hospitalization in Persons Living With Dementia. Alzheimer Dis Assoc Disord 2023; 37:357-362. [PMID: 37738286 PMCID: PMC10841226 DOI: 10.1097/wad.0000000000000583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/04/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND The purpose of this study was to identify factors that are associated with physical activity after hospitalization in persons living with dementia. METHODS Multiple linear regressions were conducted to test factors associated with objective activity levels (sedentary, low, moderate, and vigorous) among 244 patients living with dementia from a randomized controlled trial. RESULTS Within 48 hours of hospital discharge, time in sedentary behavior was associated with increased pain (β=0.164, P =0.015). Time in low activity was associated with less pain (β=-0.130, P =0.049) and higher physical function (β=0.300, P =<0.001). Time in moderate activity was associated with increased physical function (β=0.190, P =0.008) and male gender (β=0.155, P =0.016). No significant associations of potential factors were found with time in vigorous activity. CONCLUSIONS Our findings suggest that managing or reducing pain, encouraging individual functional level, and gender could influence time spent in physical activity after acute hospitalization in persons living with dementia.
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Affiliation(s)
- Ashley Kuzmik
- Ross and Nese College of Nursing, Pennsylvania State University, University Park, PA
| | - Marie Boltz
- Ross and Nese College of Nursing, Pennsylvania State University, University Park, PA
| | | | | | - James E Galvin
- Comprehensive Center for Brain Health, Miller School of Medicine, University of Miami, Boca Raton, FL
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Lopez P, Fitzgerald DB, McVeigh JA, Badiei A, Muruganandan S, Newton RU, Straker L, Lee YCG, Peddle-McIntyre CJ. Associations of physical activity and quality of life in parapneumonic effusion patients. ERJ Open Res 2023; 9:00209-2023. [PMID: 37753285 PMCID: PMC10518875 DOI: 10.1183/23120541.00209-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/17/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Little is known about activity behaviours and quality of life (QoL) of patients with parapneumonic pleural effusions (PPE) after hospital discharge. This study is a secondary analysis of a randomised trial (dexamethasone versus placebo) for hospitalised patients with PPE. We: 1) described the patients' activity behaviour patterns and QoL measured at discharge and at 30 days post-discharge; and 2) examined the association between activity behaviours and QoL scores. Methods Activity behaviour (7-day accelerometry; Actigraph GT3X+) and QoL (Medical Outcomes Study Short-Form 36) were assessed. Repeated measures analysis of covariance controlling for baseline values and a series of linear regression models were undertaken. Results 36 out of 53 eligible participants completed accelerometry assessments. Despite modest increases in light physical activity (+7.5%) and some domains of QoL (>2 points) from discharge to 30 days post-discharge, patients had persistently high levels of sedentary behaviour (>65% of waking wear time) and poor QoL (≤50 out of 100 points) irrespective of treatment group (p=0.135-0.903). Increasing moderate-to-vigorous physical activity was associated with higher scores on most QoL domains (p=0.006-0.037). Linear regression indicates that a clinically important difference of 5 points in physical composite QoL score can be achieved by reallocating 16.1 min·day-1 of sedentary time to moderate-to-vigorous physical activity. Conclusion Patients with PPE had low levels of physical activity and QoL at discharge and 30 days post-discharge irrespective of treatment. Moderate-to-vigorous physical activity participation was associated with higher QoL scores. Increasing moderate-to-vigorous physical activity following discharge from the hospital may be associated with improvements in QoL.
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Affiliation(s)
- Pedro Lopez
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
- Joint first authors
| | - Deirdre B. Fitzgerald
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
- Joint first authors
| | - Joanne A. McVeigh
- Curtin School of Allied Health, Curtin University, Perth, Australia
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Arash Badiei
- Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia
- Adelaide Medical School, Faculty of Health and Medical Science, University of Adelaide, Adelaide, Australia
| | | | - Robert U. Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Leon Straker
- Curtin School of Allied Health, Curtin University, Perth, Australia
- enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Yun Chor Gary Lee
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Medical School, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
- Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
- Joint senior authors
| | - Carolyn J. Peddle-McIntyre
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
- Joint senior authors
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Reidy PT, Borack MS, Dickinson JM, Carroll CC, Burd NA, Drummond MJ, Fry CS, Lambert BS, Gundermann DM, Glynn EL, Markofski MM, Timmerman KL, Moro T, Volpi E, Trappe S, Trappe TA, Harber MP, Rasmussen BB. Postabsorptive muscle protein synthesis is higher in outpatients as compared to inpatients. Am J Physiol Endocrinol Metab 2023; 325:E113-E118. [PMID: 37315157 PMCID: PMC10393319 DOI: 10.1152/ajpendo.00144.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/16/2023]
Abstract
Several factors affect muscle protein synthesis (MPS) in the postabsorptive state. Extreme physical inactivity (e.g., bedrest) may reduce basal MPS, whereas walking may augment basal MPS. We hypothesized that outpatients would have a higher postabsorptive MPS than inpatients. To test this hypothesis, we conducted a retrospective analysis. We compared 152 outpatient participants who arrived at the research site the morning of the MPS assessment with 350 Inpatient participants who had an overnight stay in the hospital unit before the MPS assessment the following morning. We used stable isotopic methods and collected vastus lateralis biopsies ∼2 to 3 h apart to assess mixed MPS. MPS was ∼12% higher (P < 0.05) for outpatients than inpatients. Within a subset of participants, we discovered that after instruction to limit activity, outpatients (n = 13) took 800 to 900 steps in the morning to arrive at the unit, seven times more steps than inpatients (n = 12). We concluded that an overnight stay in the hospital as an inpatient is characterized by reduced morning activity and causes a slight but significant reduction in MPS compared with participants studied as outpatients. Researchers should be aware of physical activity status when designing and interpreting MPS results.NEW & NOTEWORTHY The postabsorptive muscle protein synthesis rate is lower in the morning after an overnight inpatient hospital stay compared with an outpatient visit. Although only a minimal amount of steps was conducted by outpatients (∼900), this was enough to increase postabsorptive muscle protein synthesis rate.
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Affiliation(s)
- Paul T Reidy
- Center for Metabolic Health, University of Texas Medical Branch, Galveston, Texas, United States
- Department of Kinesiology, Nutrition and Health, Miami University, Oxford, Ohio, United States
| | - Michael S Borack
- Center for Metabolic Health, University of Texas Medical Branch, Galveston, Texas, United States
| | - Jared M Dickinson
- Center for Metabolic Health, University of Texas Medical Branch, Galveston, Texas, United States
| | - Chad C Carroll
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Nicholas A Burd
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Micah J Drummond
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, Utah, United States
- Molecular Medicine Program, University of Utah, Salt Lake City, Utah, United States
| | - Christopher S Fry
- Center for Metabolic Health, University of Texas Medical Branch, Galveston, Texas, United States
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, United States
| | - Bradley S Lambert
- Center for Metabolic Health, University of Texas Medical Branch, Galveston, Texas, United States
| | - David M Gundermann
- Center for Metabolic Health, University of Texas Medical Branch, Galveston, Texas, United States
| | - Erin L Glynn
- Center for Metabolic Health, University of Texas Medical Branch, Galveston, Texas, United States
| | - Melissa M Markofski
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, United States
| | - Kyle L Timmerman
- Department of Internal Medicine/Geriatrics, University of Texas Medical Branch, Galveston, Texas, United States
| | - Tatiana Moro
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, United States
| | - Elena Volpi
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, United States
- Department of Internal Medicine/Geriatrics, University of Texas Medical Branch, Galveston, Texas, United States
| | - Scott Trappe
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Todd A Trappe
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Matthew P Harber
- Human Performance Laboratory, Ball State University, Muncie, Indiana, United States
| | - Blake B Rasmussen
- Center for Metabolic Health, University of Texas Medical Branch, Galveston, Texas, United States
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, United States
- Department of Biochemistry & Molecular Biology, University of Texas Medical Branch, Galveston, Texas, United States
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Karkauskiene E, Tully MA, Dudoniene V, Giné-Garriga M, Escribà-Salvans A, Font-Jutglà C, Jerez-Roig J. Effectiveness of Interventions for Reducing Sedentary Behaviour in Older Adults Living in Long-Term Care Facilities: A Protocol for a Systematic Review. Healthcare (Basel) 2023; 11:1976. [PMID: 37510417 PMCID: PMC10379966 DOI: 10.3390/healthcare11141976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/22/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Background. Sedentary behaviour (SB) is an important risk factor for several health-related outcomes. The prevalence of SB is alarmingly high in older adults, who spend on average 9.4 h being sedentary each day, making them the most sedentary of all age groups. Objectives. The primary objective of this review is to assess the impact of interventions aimed at reducing SB in older adults (aged 60 years and older) living in long-term care facilities (LTCFs). The research question for this systematic review is as follows: in older people living in LTCFs, do interventions aimed at reducing SB, compared to usual care, result in a decrease in SB daily time or a reduction in the length of prolonged and uninterrupted sitting bouts? Data sources. Only peer-reviewed articles will be included in this systematic review, articles will be identified using the PICO method in seven different databases. Participants and interventions. Any primary intervention study (including randomized controlled trials, non-randomized controlled trials, and cohort studies) with the aim to reduce SB daily time or shorten the length of prolonged and uninterrupted sitting bouts in older adults living in LTCFs will be included. After searching databases, abstracts of the studies will be screened, and, after retrieving full text articles, data extraction will be conducted by two independent reviewers. Study appraisal and synthesis methods. The review will adhere to PRISMA reporting guidelines. Risk of bias (RoB) will be assessed using ROBINS-I or the RoB 2.0 tool and will be discussed with a third reviewer. The data will be grouped according to study design, with separate analysis for randomised and non-randomised designs. Results. The primary outcomes will be SB or time spent sedentary, assessed before and after the intervention. For the outcomes with the same measurement units, the pooled mean differences will be calculated. Standardised mean differences will be calculated for the outcomes with different measurement units. The data not suitable in numbers will be synthesised narratively. The strength of evidence of the outcomes will be assessed using GRADE assessment. If the data are suitable for quantitative analysis, we plan to use the Revman software to conduct a meta-analysis. Conclusions and implications of key findings. This protocol can serve as a valuable resource for other researchers interested in conducting similar systematic reviews or meta-analyses in the field of SB and older adult health.
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Affiliation(s)
- Erika Karkauskiene
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, 44221 Kaunas, Lithuania
| | - Mark A Tully
- School of Medicine, Faculty of Life and Health Sciences, Ulster University, Londonderry BT48 7JL, UK
| | - Vilma Dudoniene
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, 44221 Kaunas, Lithuania
| | - Maria Giné-Garriga
- Blanquerna Faculty of Psychology, Education and Sport Sciences, Ramon Llull University, 08022 Barcelona, Spain
- Blanquerna Faculty of Health Sciences, Ramon Llull University, 08022 Barcelona, Spain
| | - Anna Escribà-Salvans
- Department of Social Sciences and Community Health, Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia, 08500 Vic, Spain
| | - Cristina Font-Jutglà
- Department of Social Sciences and Community Health, Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia, 08500 Vic, Spain
| | - Javier Jerez-Roig
- Department of Health Promotion and Rehabilitation, Lithuanian Sports University, 44221 Kaunas, Lithuania
- Department of Social Sciences and Community Health, Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia, 08500 Vic, Spain
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Jang JH, Kim T, Yeo HJ, Cho WH, Min KH, Oh JY, Hong SB, Baek AR, Lee HK, Kim C, Chang Y, Park HK, Lee HB, Bae S, Moon JY, Yoo KH, Gil HI, Shin B, Jeon K, Cho WH, Min KH, Oh JY, Hong SB, Baek AR, Lee HK, Kim C, Chang Y, Park HK, Lee HB, Bae S, Moon JY, Yoo KH, Gil HI, Shin B, Jeon K. Impact of nutrition and physical activity on outcomes of hospital-acquired pneumonia. Sci Rep 2022; 12:15605. [PMID: 36114344 PMCID: PMC9481870 DOI: 10.1038/s41598-022-19793-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 09/05/2022] [Indexed: 11/09/2022] Open
Abstract
Frailty is an important risk factor for adverse health-related outcomes. It is classified into several phenotypes according to nutritional state and physical activity. In this context, we investigated whether frailty phenotypes were related to clinical outcome of hospital-acquired pneumonia (HAP). During the study period, a total of 526 patients were screened for HAP and 480 of whom were analyzed. The patients were divided into four groups according to physical inactivity and malnutrition: nutritional frailty (Geriatric Nutritional Risk Index [GNRI] < 82 and Clinical Frailty Scale [CFS] ≥ 4), malnutrition (GNRI < 82 and CFS < 4), physical frailty (GNRI ≥ 82 and CFS ≥ 4), and normal (GNRI ≥ 82 and CFS < 4). Among the phenotypes, physical frailty without malnutrition was the most common (39.4%), followed by nutritional frailty (30.2%), normal (20.6%), and malnutrition (9.8%). There was a significant difference in hospital survival and home discharge among the four phenotypes (p = 0.009), and the nutritional frailty group had the poorest in-hospital survival and home discharge (64.8% and 34.6%, respectively). In conclusion, there were differences in clinical outcomes according to the four phenotypes of HAP. Assessment of frailty phenotypes during hospitalization may improve outcomes through adequate nutrition and rehabilitation treatment of patients with HAP.
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Heinzmann J, Baumgartner C, Liechti FD. Goal-Directed Mobility of Medical Inpatients-A Mini Review of the Literature. Front Med (Lausanne) 2022; 9:878031. [PMID: 35665320 PMCID: PMC9158316 DOI: 10.3389/fmed.2022.878031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background Inpatients spend most of their hospitalization in bed, which can lead to negative physical, social, and psychological outcomes, especially in the geriatric population. Goal-directed mobilization involves setting mobility goals with patients and care teams working together toward achieving these goals. Methods Three different platforms (SCOPUS, Ovid Medline, PubMed) were searched. Search terms included "goal-directed," "goal-attainment" or "goal-setting," and "inpatient" or "hospitalization" and "mobility" or "mobilization." Articles were included if mobility goals were set in acutely hospitalized adults. Studies were excluded if only covering specific illness or surgery. Results One Hundred Seventy three articles were screened for inclusion by two independent reviewers. In the final analysis, 13 articles (5 randomized controlled trials, 2 Post-hoc analyses, 3 quality-improvement projects, 1 pre-post two group analysis, 1 comment and 1 study protocol) were assessed. Goal-directed mobilization improved mobility-related outcomes, i.e., level of mobilization, activity, daily walking time and functional independence. Readmissions, quality of life, discharge disposition and muscle weakness were not significantly altered and there was conflicting evidence regarding length of stay and activities of daily living. Conclusion There is a lack of evidence of goal-directed mobilization on relevant outcomes due to the low number of studies in the field and the study design used. Further research on goal-directed mobility should use standardized mobility protocols and measurements to assess mobility and the effects of goal-directed mobility more accurately and include broader patient populations.
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Affiliation(s)
- Jeannelle Heinzmann
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christine Baumgartner
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabian D Liechti
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Prevett C, Moncion K, Phillips S, Richardson J, Tang A. The role of resistance training in mitigating risk for mobility disability in community-dwelling older adults: a systematic review and meta-analysis. Arch Phys Med Rehabil 2022; 103:2023-2035. [PMID: 35504310 DOI: 10.1016/j.apmr.2022.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/15/2022] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the effects of community-based resistance training (RT) on physical function for older adults with mobility disability. DATA SOURCES Four databases (PEDro, MedLine, Ovid, CINAHL and Web of Science) were searched from inception to February 2, 2021. STUDY SELECTION Randomized controlled trials that examined community-based RT for improving physical function in community-dwelling older adults were included. DATA EXTRACTION Two reviewers independently conducted title and abstract screening, full-text evaluation, data extraction, and risk of bias quality assessment. DATA SYNTHESIS Twenty-four studies (3,656 participants, age range 63-83 years) were included. RT programs ranged from 10 weeks to 18 months in duration. RT was more effective than control in improving 6MWT distance (n=638; mean difference (MD) 16.1 meters; 95% CI 12.27-19.94, p<0.0001), lower extremity strength (n=785; standard MD 2.01; 95% CI 1.27-2.75, p<0.0001) and usual gait speed (n= 2,106; MD 0.05 meters/second, 95% CI 0.03-0.07, p<0.001). In sensitivity analyses, benefits were maintained when studies with a high risk of bias were excluded. There was no effect of RT on fast gait speed or Short Physical Performance Battery score compared to control. CONCLUSIONS RT improves walking distance, lower extremity strength, and usual gait speed in older adults with mobility disability. Improvements in physical function could increase independence in activities of daily living for this at-risk population.
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Affiliation(s)
- Christina Prevett
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada, L8S 1C7
| | - Kevin Moncion
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada, L8S 1C7
| | - Stuart Phillips
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada, L8S 1C7
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada, L8S 1C7
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada, L8S 1C7.
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Bai C, Wanigatunga AA, Saldana S, Casanova R, Manini TM, Mardini MT. Are Machine Learning Models on Wrist Accelerometry Robust against Differences in Physical Performance among Older Adults? SENSORS (BASEL, SWITZERLAND) 2022; 22:3061. [PMID: 35459045 PMCID: PMC9032589 DOI: 10.3390/s22083061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/01/2022] [Accepted: 04/13/2022] [Indexed: 06/14/2023]
Abstract
Sufficient physical activity (PA) reduces the risk of a myriad of diseases and preserves physical capabilities in later life. While there have been significant achievements in mapping accelerations to real-life movements using machine learning (ML), errors continue to be common, particularly for wrist-worn devices. It remains unknown whether ML models are robust for estimating age-related loss of physical function. In this study, we evaluated the performance of ML models (XGBoost and LASSO) to estimate the hallmark measures of PA in low physical performance (LPP) and high physical performance (HPP) groups. Our models were built to recognize PA types and intensities, identify each individual activity, and estimate energy expenditure (EE) using wrist-worn accelerometer data (33 activities per participant) from a large sample of participants (n = 247, 57% females, aged 60+ years). Results indicated that the ML models were accurate in recognizing PA by type and intensity while also estimating EE accurately. However, the models built to recognize individual activities were less robust. Across all tasks, XGBoost outperformed LASSO. XGBoost obtained F1-Scores for sedentary (0.932 ± 0.005), locomotion (0.946 ± 0.003), lifestyle (0.927 ± 0.006), and strength flexibility exercise (0.915 ± 0.017) activity type recognition tasks. The F1-Scores for recognizing low, light, and moderate activity intensity were (0.932 ± 0.005), (0.840 ± 0.004), and (0.869 ± 0.005), respectively. The root mean square error for EE estimation was 0.836 ± 0.059 METs. There was no evidence showing that splitting the participants into the LPP and HPP groups improved the models’ performance on estimating the hallmark measures of physical activities. In conclusion, using features derived from wrist-worn accelerometer data, machine learning models can accurately recognize PA types and intensities and estimate EE for older adults with high and low physical function.
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Affiliation(s)
- Chen Bai
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA; (T.M.M.); (M.T.M.)
| | - Amal A. Wanigatunga
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Santiago Saldana
- Department of Biostatistics and Data Science, School of Medicine, Wake Forest University, Winston-Salem, NC 27101, USA; (S.S.); (R.C.)
| | - Ramon Casanova
- Department of Biostatistics and Data Science, School of Medicine, Wake Forest University, Winston-Salem, NC 27101, USA; (S.S.); (R.C.)
| | - Todd M. Manini
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA; (T.M.M.); (M.T.M.)
| | - Mamoun T. Mardini
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL 32610, USA; (T.M.M.); (M.T.M.)
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Alexander NB, Phillips K, Wagner-Felkey J, Chan CL, Hogikyan R, Sciaky A, Cigolle C. Team VA Video Connect (VVC) to optimize mobility and physical activity in post-hospital discharge older veterans: baseline assessment. BMC Geriatr 2021; 21:502. [PMID: 34551725 PMCID: PMC8456191 DOI: 10.1186/s12877-021-02454-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background Telehealth is increasingly used for rehabilitation and exercise but few studies include older adult participants with comorbidities and impairment, particularly cognitive. Using Veterans Administration Video Connect (VVC), the aim of the present study is to present the screening, recruitment, baseline assessment, and initial telehealth utilization of post-hospital discharge Veterans in a VVC home-telehealth based program to enhance mobility and physical activity. Methods Older adult Veterans (n = 45, mean age 73), recently discharged from the hospital with physical therapy goals, were VVC-assessed in self-report and performance-based measures, using test adaptations as necessary, by a clinical pharmacy specialist and social worker team. Results Basic and instrumental ADL disabilities were common as were low mobility (Short Portable Performance Battery) and physical activity levels (measured by actigraphy). Half had Montreal Cognitive Assessment (MoCA) scores in the mild cognitive impairment range (< 24). Over 2/3 of the participants used VA-supplied tablets. While half of the Veterans were fully successful in VVC, 1/3 of these and an additional group with at least one failed connection requested in-person visits for assistance. One-quarter had no VVC success and sought help for tablet troubleshooting, and half of these eventually “gave up” trying to connect; difficulty with using the computer and physical impairment (particularly dexterity) were described prominently in this group. On the other hand, Veterans with at least mild cognitive impairment (based on MoCA scores) were present in all connectivity groups and most of these used caregiver support to facilitate VVC. Conclusions Disabled older post-hospital discharged Veterans with physical therapy goals can be VVC-assessed and enrolled into a mobility/physical activity intervention. A substantial proportion required technical support, including in-person support for many. Yet, VVC seems feasible in those with mild cognitive impairment, assuming the presence of an able caregiver. Modifications of assessment tools were needed for the VVC interface, and while appearing feasible, will require further study. Trial registration ClinicalTrials.gov NCT 04045054 05/08/2019.
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Affiliation(s)
- Neil B Alexander
- VA Ann Arbor Healthcare System Geriatric Research, Education and Clinical Center (GRECC), 2215 Fuller Road, MI, 48105, Ann Arbor, USA. .,Division of Geriatric and Palliative Medicine, Department of Internal Medicine, Ann Arbor, USA.
| | - Kristin Phillips
- VA Ann Arbor Healthcare System Geriatric Research, Education and Clinical Center (GRECC), 2215 Fuller Road, MI, 48105, Ann Arbor, USA
| | - Joleen Wagner-Felkey
- VA Ann Arbor Healthcare System Geriatric Research, Education and Clinical Center (GRECC), 2215 Fuller Road, MI, 48105, Ann Arbor, USA
| | - Chiao-Li Chan
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, Ann Arbor, USA
| | - Robert Hogikyan
- VA Ann Arbor Healthcare System Geriatric Research, Education and Clinical Center (GRECC), 2215 Fuller Road, MI, 48105, Ann Arbor, USA
| | - Alexandra Sciaky
- VA Ann Arbor Healthcare System Geriatric Research, Education and Clinical Center (GRECC), 2215 Fuller Road, MI, 48105, Ann Arbor, USA
| | - Christine Cigolle
- VA Ann Arbor Healthcare System Geriatric Research, Education and Clinical Center (GRECC), 2215 Fuller Road, MI, 48105, Ann Arbor, USA.,Division of Geriatric and Palliative Medicine, Department of Internal Medicine, Ann Arbor, USA.,Department of Family Medicine, University of Michigan, Ann Arbor, USA
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10
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Choi HG, Yeom HA, Lee MA, Ra JR. A structural equation modeling approach to understanding physical function of terminal cancer patients. Support Care Cancer 2021; 30:1149-1158. [PMID: 34435210 DOI: 10.1007/s00520-021-06444-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/15/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Understanding the activities of daily living (ADL) of cancer patients at the end-of-life stage may help healthcare providers develop interventions for preserving physical function and enhance patient's dignity in an everyday care context. This study aims to develop and test a causal effect model of physical function in terminal cancer patients. METHODS A total of 238 participants were recruited from two hospitals in South Korea. The data were collected using a structured questionnaire including demographics, visual analogue scale for pain, Functional Assessment of Chronic Illness Therapy-Fatigue, and Katz index of independence in ADL. The collected data were analyzed using SPSS WIN 25.0 and AMOS 23.0 programs for structural equation modeling procedures. RESULTS Most participants were aged 65 years or older (65.5%), male (53.8%), and inpatients (74.4%). The most common primary cancer site was gastrointestinal tract (44.1%). Physical function of the participants was positively influenced by regular exercise and negatively influenced by hospitalization, fatigue, and pain, explaining 35.1% of the variance. In this study, regular exercise improved participants' ADL level directly and indirectly either by reducing fatigue or decreasing fatigue through controlling pain. Pain did not affect ADL directly but decreased ADL level indirectly through fatigue as a mediator. CONCLUSION ADL was positively influenced by regular exercise and was negatively influenced by hospitalization, fatigue, and pain. Based on these results, in order to minimizing the problems of physical function in terminal cancer patients, interventions that reduce pain and fatigue and provide regular exercise are required.
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Affiliation(s)
- Han-Gyo Choi
- College of Nursing, The Catholic University of Korea, Seoul, South Korea
| | - Hye-Ah Yeom
- College of Nursing, The Catholic University of Korea, Seoul, South Korea.
| | - Myung Ah Lee
- Division of Medical Oncology, Department of Internal Medicine, Cancer Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jeong-Ran Ra
- Hospice & Palliative Care Team, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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11
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Van Jacobs A, Coltman A, Gomez-Perez SL, Bienia B, Sclamberg JS, Peterson SJ. Prevalence of low computed tomography-measured skeletal muscle index and handgrip strength in a general medical population. Nutr Clin Pract 2021; 37:102-109. [PMID: 33930219 DOI: 10.1002/ncp.10660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Sarcopenia is defined as the loss of muscle mass and function and has been associated with worsened outcomes, including disability and mortality. The aim of this study was to describe the prevalence of sarcopenia in patients who had an abdominal computed tomography (CT) scan completed within 7 days of hospital admission. METHODS A retrospective study was conducted. Adult patients admitted to either the general medical or surgical floor were included. Muscle function was assessed using handgrip strength (HGS, kg), completed within the first 48 hours of admission. Skeletal muscle index (SMI, kg/m2 ) at the third lumber region was calculated among patients who had an abdominal CT scan completed within 7 days of admission. Sarcopenia was identified by the combination of low SMI and HGS. The primary outcome was the percentage of patients diagnosed with sarcopenia. RESULTS A total of 1318 patients were admitted; 11% (n = 141) had an abdominal CT scan completed within 7 days of admission. Only race and prevalence of malnutrition were different between patients who did and did not have a CT completed. The overall prevalence of sarcopenia was 13% (n = 18/141). Additionally, 39% of the sample was at risk for sarcopenia, with either low SMI (n = 13/141) or low HGS (n = 42/141). CONCLUSIONS Overall prevalence of sarcopenia was low, but more than one-third of patients had either low SMI or low HGS. Minimal differences were observed between patients who did and did not have an abdominal CT scan completed upon admission.
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Affiliation(s)
- Amanda Van Jacobs
- Department of Food and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Sandra L Gomez-Perez
- Department of Clinical Nutrition, College of Health Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Benjamin Bienia
- Department of Radiology, Amita Health, Hinsdale, Illinois, USA
| | - Joy S Sclamberg
- Diagnostic Radiology Residency Program, Department of Diagnostic Radiology and Nuclear Medicine, Rush Medical College, Rush University Medical Center, Chicago, Illinois, USA
| | - Sarah J Peterson
- Department of Clinical Nutrition, College of Health Sciences, Rush University Medical Center, Chicago, Illinois, USA
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12
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Conijn D, van Bodegom-Vos L, Volker WG, Mertens B, Vermeulen HM, Huurman V, van Schaik J, Vliet Vlieland T, Meesters J. A multicomponent intervention to decrease sedentary time during hospitalization: a quasi-experimental pilot study. Clin Rehabil 2020; 34:901-915. [PMID: 32476455 PMCID: PMC7472834 DOI: 10.1177/0269215520920662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The aim of this study was to evaluate the feasibility and preliminary effects of a multicomponent intervention to decrease sedentary time during and shortly after hospitalization. Design: This is a quasi-experimental pilot study comparing outcomes in patients admitted before and after the implementation of the intervention. Setting: The study was conducted in a university hospital. Subjects: Participants were adult patients undergoing elective organ transplantation or vascular surgery. Interventions: In the control phase, patients received usual care, whereas in the intervention phase, patients also received a multicomponent intervention to decrease sedentary time. The intervention comprised eight elements: paper and digital information, an exercise movie, an activity planner, a pedometer and Fitbit Flex™, a personal activity coach and an individualized digital training program. Measures: Measures of feasiblity were the self-reported use of the intervention components (yes/no) and satisfaction (low–high = 0–10). Main outcome measure was the median % of sedentary time measured by an accelerometer worn during hospitalization and 7–14 days thereafter. Results: A total of 42 controls (mean age = 59 years, 62% male) and 52 intervention patients (58 years, 52%) were included. The exercise movie, paper information and Fitbit Flex were the three most frequently used components, with highest satisfaction scores for the fitbit, paper information, exercise movie and digital training. Median sedentary time decreased from 99.6% to 95.7% and 99.3% to 91.0% between Days 1 and 6 in patients admitted in the control and intervention phases, respectively. The difference at Day 6 reached statistical significance (difference = 41 min/day, P = 0.01). No differences were seen after discharge. Conclusion: Implementing a multicomponent intervention to reduce sedentary time appeared feasible and may be effective during but not directly after hospitalization.
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Affiliation(s)
- D Conijn
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - L van Bodegom-Vos
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - W G Volker
- Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague/Leiden, The Netherlands
| | - Bja Mertens
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - H M Vermeulen
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands
| | - Val Huurman
- Department of Transplantation Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - J van Schaik
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Tpm Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands.,Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague/Leiden, The Netherlands
| | - Jjl Meesters
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, The Netherlands.,Department for Innovation, Quality + Research, Basalt Rehabilitation Center, The Hague/Leiden, The Netherlands
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13
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Chen YS, Cai YX, Kang XR, Zhou ZH, Qi X, Ying CT, Zhang YP, Tao J. Predicting the risk of sarcopenia in elderly patients with patellar fracture: development and assessment of a new predictive nomogram. PeerJ 2020; 8:e8793. [PMID: 32328345 PMCID: PMC7166043 DOI: 10.7717/peerj.8793] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 02/25/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose To develop a risk prediction model for postoperative sarcopenia in elderly patients with patellar fractures in China. Patients and methods We conducted a community survey of patients aged ≥55 years who underwent surgery for patellar fractures between January 2013 and October 2018, through telephone interviews, community visits, and outpatient follow-up. We established a predictive model for assessing the risk of sarcopenia after patellar fractures. We developed the prediction model by combining multivariate logistic regression analysis with the least absolute shrinkage model and selection operator regression (lasso analysis) as well as the Support Vector Machine (SVM) algorithm. The predictive quality and clinical utility of the predictive model were determined using C-index, calibration plots, and decision curve analysis. We also conducted internal sampling methods for qualitative assessment. Result We recruited 137 participants (53 male; mean age, 65.7 years). Various risk factors were assessed, and low body mass index and advanced age were identified as the most important risk factor (P < 0.05). The prediction rate of the model was good (C-index: 0.88; 95% CI [0.80552–0.95448]), with a satisfactory correction effect. The C index is 0.97 in the validation queue and 0.894 in the entire cohort. Decision curve analysis suggested good clinical practicability. Conclusion Our prediction model shows promise as a cost-effective tool for predicting the risk of postoperative sarcopenia in elderly patients based on the following: advanced age, low body mass index, diabetes, less outdoor exercise, no postoperative rehabilitation, different surgical methods, diabetes, open fracture, and removal of internal fixation.
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Affiliation(s)
- Yi-Sheng Chen
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan-Xian Cai
- Department of Plastic Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xue-Ran Kang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Ear Institute, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Translational Medicine on Ear and Nose diseases, Shanghai, China
| | - Zi-Hui Zhou
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Qi
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen-Ting Ying
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun-Peng Zhang
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Tao
- Department of Orthopedics, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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14
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Turunen KM, Aaltonen-Määttä L, Törmäkangas T, Rantalainen T, Portegijs E, Keikkala S, Kinnunen ML, Finni T, Sipilä S, Nikander R. Effects of an individually targeted multicomponent counseling and home-based rehabilitation program on physical activity and mobility in community-dwelling older people after discharge from hospital: a randomized controlled trial. Clin Rehabil 2020; 34:491-503. [PMID: 31964174 DOI: 10.1177/0269215519901155] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate the effects of multicomponent rehabilitation on physical activity, sedentary behavior, and mobility in older people recently discharged from hospital. DESIGN Randomized controlled trial. SETTING Home and community. PARTICIPANTS Community-dwelling people aged ⩾60 years recovering from a lower limb or back musculoskeletal injury, surgery, or disorder were recruited from local health center hospitals and randomly assigned into an intervention (n = 59) or a control (standard care, n = 58) group. INTERVENTION The six-month intervention consisted of a motivational interview, goal attainment process, guidance for safe walking, a progressive home exercise program, physical activity counseling, and standard care. MEASUREMENTS Physical activity and sedentary time were assessed using an accelerometer and a single question. Mobility was evaluated with the Short Physical Performance Battery, self-reported use of a walking aid, and ability to negotiate stairs and walk outdoors. Intervention effects were analyzed with generalized estimating equations. RESULTS Daily physical activity was 127 ± 78 minutes/day and 121 ± 70 at baseline and 167 ± 81 and 164 ± 72 at six months in the intervention and control group, respectively; mean difference of 3.4 minutes (95% confidence interval (CI) = -20.3 to 27.1). In addition, no significant between-group differences were shown in physical performance. CONCLUSION The rehabilitation program was not superior to standard care for increasing physical activity or improving physical performance. Mobility-limited older people who had recently returned home from hospital would have needed a longer and more frequently monitored comprehensive geriatric intervention.
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Affiliation(s)
- Katri M Turunen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Laura Aaltonen-Määttä
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Klinik Healthcare Solutions Oy, Helsinki, Finland
| | - Timo Törmäkangas
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Timo Rantalainen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Erja Portegijs
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Sirkka Keikkala
- Finland Health Centre Hospital, Health Centre of Jyväskylä Cooperation Area, City of Jyväskylä, Finland
| | - Marja-Liisa Kinnunen
- Finland Health Centre Hospital, Health Centre of Jyväskylä Cooperation Area, City of Jyväskylä, Finland.,Central Hospital of Central Finland, Jyväskylä, Finland.,Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Taija Finni
- Neuromuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Sarianna Sipilä
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Riku Nikander
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Central Hospital of Central Finland, Jyväskylä, Finland.,GeroCenter Foundation for Aging Research and Development, Jyväskylä, Finland
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