Effects of dual-task resistance exercise on cognition, mood, depression, functional fitness, and activities of daily living in older adults with cognitive impairment: a single-blinded, randomized controlled trial

BACKGROUND

Regular exercise is emphasized for the improvement of functional capacity and independence of older adults. This study aimed to compare the effects of a dual-task resistance exercise program and resistance exercise on cognition, mood, depression, physical function, and activities of daily living (ADL) in older adults with cognitive impairment.

METHODS

A total of 44 older adults participated in the study. Participants were randomly allocated to an experimental group (n = 22) performing a dual-task resistance exercise program for cognitive function improvement and a control group (n = 22) performing a resistance exercise program. Both groups performed the exercise for 40 min per session, three times a week, for 6 weeks (18 sessions). Cognition, mood, depression, functional fitness, and ADL were quantified before and after the intervention using the Mini-Mental State Examination (MMSE), profile of mood states (POMS), geriatric depression scale (GDS), senior fitness test (SFT), and Korean version of ADL, respectively.

RESULTS

There was a significant time and group interaction on the MMSE (p = 0.044). There were no significant time and group interactions in the POMS, GDS, SFT, or ADL. Cognitive function (p < 0.001), mood (p < 0.001), depression (p < 0.001), functional fitness (p < 0.001), and ADL (p < 0.001) significantly improved after dual-task resistance exercise, and cognitive function (p < 0.001), mood (p < 0.001), depression (p < 0.001), functional fitness (p < 0.001), and ADL (p < 0.001) significantly improved after resistance exercise.

CONCLUSIONS

Dual-task resistance exercise is more effective than resistance exercise in improving cognitive function in older adults with cognitive impairment. Both dual-task resistance exercise and resistance exercise improves mood, depression, functional fitness, and ADL after the intervention. We propose using dual-task resistance exercises for cognitive and physical health management in the older adults with cognitive impairment.

TRIAL REGISTRATION

This study was registered with the Clinical Research Information Service (WHO International Clinical Trials Registry Platform) (Registration ID, KCT0005389; Registration date, 09/09/2020).

C-Mill Virtual Reality/Augmented Reality Treadmill Training for Reducing Risk of Fall in the Elderly: A Randomized Controlled Trial

Objective: Falling is considered one of the major problems that may affect the elderly, leading to multiple health issues. Walking adaptability to environmental demands is essential for safe walking in the elderly. The aim of this study was to evaluate the efficacy of virtual reality (VR)/augmented reality (AR) treadmill training on balance performance and the risk of falls in the elderly. Materials and Methods: Sixty Saudi elderly individuals of both genders, aged between 60 and 70 years, participated in the study. The participants were categorized into two groups: the experimental and the control groups. Both groups received 1 hour of training: 30 minutes of conventional exercises and 30 minutes of gait training on the C-Mill VR/AR treadmill. The experimental group used the C-Mill treadmill with VR and AR games therapy. The control group had gait training on the C-Mill treadmill without VR and AR. The training for both groups was conducted for 6 successive weeks/three times a week. The changes in the scores of the following variables were recorded at baseline, after 6 weeks of training, and 4 weeks after the completion of training. These variables involved the time needed for completing the Timed Up and Go (TUG) test, overall stability indices of the Fall Risk (FR) test and Limit of Stability (LOS) test evaluated using the Biodex Balance System (BBS), and the time required for completing the LOS test. Results: Both groups demonstrated significant improvement in all measured variables immediately post-training, and this improvement persisted for 4 weeks after completing the training. The experimental group exhibited greater improvement in the recorded values of all measured variables compared with the control group following the training. Conclusions: This study concluded that C-Mill VR/AR treadmill training is effective in improving balance control and reducing the fall risk in the elderly.

Diagnostic Criteria and Measurement Techniques of Sarcopenia: A Critical Evaluation of the Up-to-Date Evidence

Sarcopenia, a geriatric syndrome characterized by progressive skeletal muscle mass and function decline, poses a significant health risk among the elderly, contributing to frailty, falls, hospitalization, loss of independence and mortality. The prevalence of sarcopenia varies significantly based on various factors, such as living status, demographics, measurement techniques and diagnostic criteria. Although the overall prevalence is reported at 10% in individuals aged 60 and above, disparities exist across settings, with higher rates in nursing homes and hospitals. Additionally, the differences in prevalence between Asian and non-Asian countries highlight the impact of cultural and ethnic factors, and variations in diagnostic criteria, cut-off values and assessment methods contribute to the observed heterogeneity in reported rates. This review outlines diverse diagnostic criteria and several measurement techniques supporting decision making in clinical practice. Moreover, it facilitates the selection of appropriate tools to assess sarcopenia, emphasizing its multifactorial nature. Various scientific groups, including the European Working Group of Sarcopenia in Older People (EWGSOP), the International Working Group on Sarcopenia (IWGS), the Asian Working Group on Sarcopenia (AWGS), the American Foundation for the National Institutes of Health (FNIH) and the Sarcopenia Definition and Outcomes Consortium (SDOC), have published consensus papers outlining diverse definitions of sarcopenia. The choice of diagnostic criteria should be aligned with the specific objectives of the study or clinical practice, considering the characteristics of the study population and available resources.

Effects of individually optimized rocker midsoles and self-adjusting insoles on plantar pressure in persons with diabetes mellitus and loss of protective sensation

INTRODUCTION

Rocker shoes and insoles reduce peak pressure (PP) in persons with diabetes (DM) and loss of protective sensation (LOPS). However, they are handmade, leading to inconsistent effectiveness. If foot structure changes over time, high PP-locations also change. To address this, individualized algorithm based 3D-printed rockers and self-adjusting pressure-reducing insoles are applied.

METHODS

PP across seven foot regions was analyzed in 21 persons with DM and LOPS. Regions with PP < 200 kPa were considered not at risk (RnoR); regions with PP ≥ 200 kPa at risk (RaR). The aim was to offload RaR, while remaining PP < 200 kPa in RnoR.

RESULTS

Individualized rockers and self-adjusting insoles combined successfully reduce PP < 200 kPa (on average 24 % - 48 %) in all feet with toes, central and lateral forefoot identified as RaR. Same intervention reduces PP in 68 % of the feet with medial forefoot identified as RaR. With the heel as RaR, no intervention reduces PP successfully in all feet.

CONCLUSIONS

Individualized 3D-printed rockers combined with self-adjusting insoles reduce PP (< 200 kPa) in toes, central and lateral forefoot, but not in heels. Alternative insoles with medial arch support, heel cup and compliant midsole materials might enhance success rate across entire foot.

Improving Older Adults' Functional Health Using the Progressive Stay Strong, Stay Healthy Program

This study assessed the Stay Strong, Stay Healthy (SSSH) level two resistance training program in 406 older adults (69.3 ± 8.1 years). SSSH included 10 exercises completed during 60 minute sessions, which were offered twice weekly for eight weeks. 30-second sit-to-stand (30STS), timed-up-and-go (TUG), flexibility, and balance poses were completed pre/post-SSSH. Paired t-tests with Bonferroni corrections showed the whole group improved 30STS, TUG, flexibility, and total balance scores over time (p < .001). Repeated measures analyses of variance showed both geography and age groups improved 30STS, TUG, flexibility, and total balance scores over time (all time effects p ≤ .039). Independent t-tests showed rural participants improved to a similar or greater absolute extent than their urban neighbors for nearly all measures and all age groups improved to a similar absolute magnitude over time. This study demonstrates SSSH level two improves physical function in older adults and these benefits are similar across geography and age groups.

A study of the discriminative properties of the Six-Spot Step Test in older adults at risk of falling and those not at risk

OBJECTIVE

To investigate the discriminative properties of the Six-Spot Step Test in older adults with self-reported balance problems.

METHODS

Seventy-five older adults aged ≥65 years completed the Six-Spot Step Test and the Timed "Up and Go" test. A Mini-BESTest score of ≤19 was used as a cutoff for defining the risk of falling, and a receiver operating characteristics curve was generated to determine relevant cutoff scores.

RESULTS

An overall accuracy of 85% for the Six-Spot Step Test and 88% for the Timed "Up and Go" test were found. The probability of ruling out people at risk of falling increased with a test score shorter than 8.0 and 7.3 seconds on the Six-Spot Step Test and the Timed "Up and Go" test, respectively. Maximizing the total true positive and true negative test results generated a cutoff score of 8.8 seconds (accuracy 79%) and 8.3 seconds (accuracy 80%) for the Six-Spot Step Test and the Timed "Up and Go" test, respectively.

CONCLUSIONS

The Six-Spot Step Test, which challenges the ability to adapt to more complex tasks during walking, discriminates accurately between older adults at risk of falling and those not at risk. Results as low as eight seconds qualify for fall-preventive interventions.

The Effects of Pilates Exercise Training Combined with Walking on Cardiorespiratory Fitness, Functional Capacity, and Disease Activity in Patients with Non-Radiologically Confirmed Axial Spondylitis

The objective of the study was to examine the effects of Pilates exercise training combined with walking on cardiorespiratory fitness, functional capacity, and disease activity in patients with non-radiologically confirmed axial spondylitis (nr-axSpA). Thirty patients with nr-axSpA (seven women (90%), with a mean age of 46.07 ± 10.48 years old and C-reactive protein (CRP) 2.26 ± 2.14 mg/L) were randomly divided into two groups: A (n1 = 15 patients) and B (n2 = 15 patients). Group A followed a 6-month home-based Pilates exercise training program, while Group B remained untrained until the end of the study. A cardiopulmonary exercise test (CPET), timed up and go test (TUG), five times sit-to-stand test (5×STS), sit-and-reach test (SR), back scratch test for the right (BSR) and the left arm (BSL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Ankylosing Spondylitis Disease Activity Score (ASDAS) were applied to all patients, both at the beginning and at the end of the study. After 6 months, Group A showed higher values in exercise time by 37.41% (p = 0.001), higher peak oxygen uptake (VO2peak) by 25.41% (p = 0.01), a higher ratio between oxygen uptake and maximum heart rate (VO2/HRmax) by 14.83% (p = 0.04), and higher SR by 18.70% (p = 0.007), while lower values were observed in TUG by 24.32% (p = 0.001), 5×STS by 12.13% (p = 0.001), BASDAI score by 20.00% (p = 0.04) and ASDAS score by 23.41% (p = 0.03), compared to Group B. Furthermore, linear regression analysis showed a positive correlation in Group A between BASDAI and 5×STS (r = 0.584, p = 0.02), BASDAI and TUG (r = 0.538, p = 0.03), and ASDAS and 5×STS (r = 0.538, p = 0.03), while a negative correlation was found between BASDAI and VO2peak (r = -0.782, p < 0.001), ASDAS and SR (r = -0.548, p = 0.03), and ASDAS and VO2peak (r = -0.659, p = 0.008). To sum up, cardiorespiratory fitness, functional capacity, and disease activity improved after a long-term Pilates exercise training program in patients with nr-axSpA.

Convergent validity and inter-rater reliability of a lower-limb multimodal physical function assessment in community-dwelling older adults

Introduction: Lower-limb physical function declines with age and contributes to a greater difficulty in performing activities of daily living. Existing assessments of lower-limb function assess one dimension of movement in isolation or are not time-efficient, which discourages their use in community and clinical settings. We aimed to address these limitations by assessing the inter-rater reliability and convergent validity of a new multimodal functional lower-limb assessment (FLA). Methods: FLA consists of five major functional movement tasks (rising from a chair, walking gait, stair ascending/descending, obstacle avoidance, and descending to a chair) performed consecutively. A total of 48 community-dwelling older adults (32 female participants; age: 71 ± 6 years) completed the FLA as well as timed up-and-go, 30-s sit-to-stand, and 6-min walk tests. Results: Slower FLA time was correlated with a slower timed up-and-go test (ρ = 0.70), less sit-to-stand repetitions (ρ = -0.65), and a shorter distance in the 6-min walk test (ρ = -0.69; all, p < 0.001). Assessments by two raters were not different (12.28 ± 3.86 s versus 12.29 ± 3.83 s, p = 0.98; inter-rater reliability ρ = 0.993, p < 0.001) and were statistically equivalent (via equivalence testing). Multiple regression and relative weights analyses demonstrated that FLA times were most predicted by the timed up-and-go performance [adjusted R ² = 0.75; p < 0.001; raw weight 0.42 (95% CI: 0.27, 0.53)]. Discussion: Our findings document the high inter-rater reliability and moderate-strong convergent validity of the FLA. These findings warrant further investigation into the predictive validity of the FLA for its use as an assessment of lower-limb physical function among community-dwelling older adults.

Pragmatic multicentre stepped-wedge cluster randomised trial to investigate the effectiveness of community-based falls prevention programme for older adults with falls risk in Singapore: a protocol paper

INTRODUCTION

Falls are an important public health issue with consequences that include injuries, quality of life reduction and high healthcare costs. Studies show that falls prevention strategies are effective in reducing falls rate among community-dwelling older adults. However, the evaluation for effectiveness was usually done in a controlled setting with homogeneous population, and thus may not be generalisable to a wider population. This study aims to evaluate the impact of community falls prevention programmes with group-based strength and balance exercises, on falls risk and health outcomes for older adults with falls risk in Singapore.

METHODS AND ANALYSIS

This is a pragmatic closed cohort stepped-wedge cluster randomised trial design study, which involves sequential crossover of clusters from the waitlist control condition to the intervention condition, with the sequence of crossover randomly determined. The intervention will be sequentially rolled out to 12 clusters (a minimum of 5 participants/cluster), over 6 time periods with 8-week intervals in Central and North regions of Singapore. The primary analysis will be conducted under the intention-to-treat principle. A general linear mixed model or generalised estimating equation analysis appropriate for a multilevel longitudinal study incorporating an appropriate error distribution and link function will be used. Markov model will be developed to estimate the incremental cost per quality-adjusted life years and incremental cost per fall prevented from the implementation of falls prevention strategies from a societal perspective. Conditional on there being clinically relevant differences in short-term outcomes, we will implement simulation modelling to project the long-term divergence in trajectories for outcomes and costs using the Markov model.

ETHICS AND DISSEMINATION

Ethics approval has been obtained. Results will be disseminated in publications and other relevant platforms.

TRIAL REGISTRATION NUMBER

NCT04788251.

Musculoskeletal Fitness for Identifying Low Physical Function in Older Women

AIMS

This cross-sectional study aimed to analyze the relevance of musculoskeletal fitness for identifying low physical functioning in community-dwelling older women.

METHODS

Sixty-six older women (73.62 ± 8.23 yrs old) performed a musculoskeletal fitness assessment of the upper and lower limbs. A handheld dynamometer was used to evaluate upper-limb muscle strength through a handgrip (HG) test. Lower-limb power and force were assessed from a two-leg countermovement vertical jump (VJ) on a ground reaction force platform. Physical functioning was assessed subjectively using the Composite Physical Function (CPF) questionnaire and objectively by daily step count measured by accelerometry and gait speed/agility assessed by the 8-Foot Up-and-Go (TUG) test. Logistic regressions and ROC curves were carried out to define odds ratios and ideal cutoff values for discriminatory variables.

RESULTS

VJ power showed the ability to identify low physical functioning when evaluated through the CPF (14 W/kg, 1011 W), gait speed/agility (15 W/kg, 800 W), or daily accumulated steps (17 W/kg). Considering that VJ power was normalized for body mass, the increase of 1 W/kg corresponds to a decrease of 21%, 19%, or 16% in the chance of low physical functioning when expressed by these variables, respectively. HG strength and VJ force did not show a capacity to identify low physical functioning.

CONCLUSIONS

The results suggest that VJ power is the only marker of low physical functioning when considering the three benchmarks: perception of physical ability, capacity for mobility, and daily mobility.

Structural equation model of the relationship between functional ability, mental health, and quality of life in older adults living alone

Aims

Living alone, a reality in an increasing number of older adults recently, is a risk factor for low quality of life. This study identified the predictors of quality of life in older adults living alone based on mental health and the International Classification of Functioning, Disability, and Health.

Methods

This secondary data analysis used information from the 2018 Assessing the Requirements of Customized Health Care and Daily Living Support Services survey (N = 1,022), collected from adults aged ≥ 65 living alone in Siheung City, South Korea, from August to October 2018. The exogenous variables were body functions (hand grip strength, timed “up and go” test score, and body mass index), daily living activities (Korean Instrumental Activities of the Daily Living Scale), social activity participation (social activity engagement, neighbor contacts, and family contacts), and participation in economic activity (frequency). The endogenous variables were mental health (Geriatric Depression Scale Short Form—Korean Version and UCLA Loneliness Scale) and quality of life (EuroQoL-5 Dimension-3 Level and EuroQoL-Visual Analog Scale).

Results

After modifying the hypothetical model, which had failed to satisfy the recommended fitness level, the (modified) model had good fitness indices Q (CMIN / df) 2.90, GFI 1, AGFI 1, RMSEA 0.04, CFI 0.90 and PCFI 0.53. Of the nine pathways of the modified model, five were statistically significant. Quality of life was affected by body functions, daily living activities, social activity participation, and mental health. These variables explained 68.2% of the factors affecting quality of life.

Conclusions

By highlighting the role of mental health, this model provides a useful framework for improving the quality of life of older adults who live alone and function at various levels in the community. Focusing on advancing mental health through body functions, daily living activities, and social activity participation can improve quality of life.

Risk of Falls in HIV-Infected Patients on Antiretroviral Therapy and Its Associated Factors

Purpose

Methods

Results

Conclusion

Do the dual-task "8-foot up and go" tests provide additional predictive value for early detection of cognitive decline in community-dwelling older women?

BACKGROUND

The 8-Foot Up and Go (8UG) test is a widely used mobility assessment. Some dual-task mobility assessments have been developed to help detect cognitive decline.

AIMS

This study developed a dual-task version of 8UG test to investigate the dual-task 8UG performance and to evaluate the ability of dual-task 8UG test in detecting cognitive decline.

METHODS

A total of 101 eligible community-dwelling women aged 60-74 years were grouped into the mild cognitive impairment group (MCI, n = 49) and the non-cognitive impairment group (NCI, n = 52). The 8UG tests under single-task (ST), manual dual-task (MT), and cognitive dual-task (CT) conditions were performed respectively. The dual-task cost (DTC) and the correct response rate (CRR) were calculated to quantify the dual-task interference.

RESULTS

Participants spent more time in performing the 8UG test under dual-task conditions. No differences were observed between NCI and MCI groups for 8UG parameters under ST and MT conditions (p > 0.05). When executing CT, significant differences were found in the number of correct answers and CRR (p < 0.05). CRR showed the strongest ability to predict MCI with a cut-off point of 0.50 (71.2% sensitivity and 61.2% specificity).

DISCUSSION

Both manual and cognitive dual-task were found to interfere with the 8UG performance. CRR with cutoff point of 0.50 could be a potential predictor of MCI in community-dwelling older women.

CONCLUSIONS

The CRR of the cognitive dual-task 8UG test could be recommended as a potential predictor for the early detection of MCI in community-dwelling older women.

Association between Domains of the Clinical-Functional Vulnerability Index and Falls History in Older Adults: A Cross-Sectional Study

Objectives: The study aimed to determine which domains, sets, and isolated or combined questions of the Clinical-Functional Vulnerability Index (CFVI-20) are associated with falls history in older adults. Methods: Instruments used were the CFVI-20 assessment and reported falls during the last year. The receiver operating characteristics (ROC) curves identified the performance of the CFVI-20 domains and questions in identifying older adults with and without falls history, while logistic regression identified relevant questions to identify fall history. Results: This study included 1725 individuals (71.9 ± 7.3 years). The area under the curve (AUC) between the CFVI-20 and fall history was 0.69. The mobility domain presented the largest AUC (0.71; p < 0.01), and most isolated domains showed low AUCs (0.51 to 0.58). Isolated questions were limited to identifying fallers. The regression analysis identified 7 questions of the CFVI-20 with falls. Conclusions: The CFVI-20 general score identified older adults with a fall history. When considered in isolation, most domains were limited to identifying falls, except for the mobility domain. Combining the CFVI-20 questions enabled identification of fallers.

How Well Do Low Population-Specific Values for Muscle Parameters Associate with Indices of Poor Physical Health? Cross-Sectional Data from the Geelong Osteoporosis Study

We aimed to examine associations between skeletal muscle deficits and indices of poor health. Cut-points for skeletal muscle deficits were derived using data from the Geelong Osteoporosis Study and definitions from the revised European Consensus on Definition and Diagnosis and the Foundation for the National Institutes of Health. Participants (n = 665; 323 women) aged 60–96 year had handgrip strength measured by dynamometry and appendicular lean mass by whole-body dual-energy X-ray absorptiometry. Physical performance was assessed using the Timed Up and Go test. Sex-specific cut-points were equivalent to two standard deviations below the mean young reference range from the Geelong Osteoporosis Study. Indices of poor health included fractures, falls, and hospitalisations. Low trauma fractures since age 50 year (excluding skull, face, digits) were self-reported and confirmed using radiological reports. Falls (≥1 in the past 12 months) and hospitalisations (past month) were self-reported. Logistic regression models (age- and sex-adjusted) were used to examine associations. Receiver Operating Characteristic curves were applied to determine optimal cut-points for handgrip strength, Timed Up and Go, appendicular lean mass/height2, and appendicular lean mass/body mass index that discriminated poor health outcomes. There were 48 participants (6.9%) with hospitalisations, 94 (13.4%) with fractures, and 177 (25.3%) with at least one fall (≥1). For all cut-points, low handgrip strength was consistently associated with falls. There was little evidence to support an association between low appendicular lean mass, using any cut-point, and indices of poor health. Optimal cut-offs for predicting falls (≥1) were: handgrip strength 17.5 kg for women and 33.5 kg for men; Timed Up and Go 8.6 s for women and 9.9 s for men; appendicular lean mass/height2 6.2 kg/m2 for women and 7.46 kg/m2 for men; and appendicular lean mass/body mass index 0.6 m2 for women and 0.9 m2 for men. In conclusion, muscle strength and function performed better than lean mass to indicate poor health. These findings add to the growing evidence base to inform decisions regarding the selection of skeletal muscle parameters and their optimal cut-points for identifying sarcopenia.

Effectiveness and Acceptability of e- and m-Health Interventions to Promote Physical Activity and Prevent Falls in Nursing Homes—A Systematic Review

Age-related decreases in physical activity (PA) and a decline in physical functioning lead to increased fall risk. As falls are a major cause of accidental deaths and hospitalization in older adults, PA promotion and fall prevention are important measures, especially in nursing homes (NH). With advances in information and communication technology, e- and m-health solutions have been developed to positively influence various health-related factors. To date, only little research exists on the implementation of these technologies to promote health in NH. Therefore, the objective of this systematic review was to provide an overview of the effectiveness, acceptability, and feasibility of e- and m-health interventions aimed at promoting PA and preventing falls in NH. Additionally, the effectiveness of such interventions regarding the secondary outcomes physical function, cognitive function, neuropsychiatric symptoms, and psychosocial status was examined. A systematic literature search was performed in five databases and studies published until 15 November 2021, were considered for inclusion. All studies that examined the effectiveness and/or the acceptability and feasibility of e- or m-health interventions in promoting PA and preventing falls in NH, without restriction on language or date of publication, were included in the final synthesis. Of the 1,358 records retrieved, 28 studies were included in this systematic review. Twenty-four studies contained digital exergaming as an intervention or as a part of the intervention, the four additional studies on e-health interventions only examined a small number of outcomes. No m-health intervention study was identified. Data synthesis indicates that exergaming may be effective in reducing the number of falls and fall risk in NH residents. Several significant improvements were also reported regarding secondary outcomes albeit not consistent across studies. No conclusion can be drawn about the effects of exergaming and other e-health interventions on PA, as data is scarce. E-health interventions were mostly reported as feasible and well accepted by NH residents. However, these findings may not be applicable to NH residents with advanced physical and/or cognitive impairments, since they were excluded in many studies. Therefore, more research examining other digital solutions besides exergaming to promote PA in this specific population is critical.

Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42021289488

Sections of the Brief-Balance Evaluation Systems Test Relevant for Discriminating Fast Versus Slow Walking Speeds in Community-Dwelling Older Women

BACKGROUND AND PURPOSE

Walking speed can be used to identify characteristics of frailty in older adults. It has a strong positive correlation with balance abilities. The Brief-Balance Evaluation Systems Test (Brief-BESTest) was developed to assess functions of the 6 balance control systems in a short time. However, for community-dwelling older adults, the relationship between walking speed and the Brief-BESTest needs to be clarified. Even the cutoff scores for each Brief-BESTest section should be indicated for physical therapists to effectively evaluate balance deficits. Our objective was to establish cutoff scores for individual Brief-BESTest sections, determine fast or slow walkers in community-dwelling older adults, and investigate the relationship between balance control systems and walking speed.

METHODS

In a cross-sectional study involving 55 participants 77 years and older, the Brief-BESTest was evaluated after grouping the participants based on their walking speeds in public community centers. We compared the age, history of falls, handgrip strength, quadriceps strength, appendicular skeletal muscle mass index, comfortable walking speeds, and the Brief-BESTest scores between the fast- and slow-walking groups by using the independent t test, Fisher exact test, or Mann-Whitney U test. We also determined the receiver operating characteristic curves, and calculated the cutoff, area under the curve (AUC), sensitivity, and specificity of each section.

RESULTS

All sections of the Brief-BESTest, except Section 1 (Biomechanical Constraints) were able to differentiate between fast and slow walkers in community-dwelling older women. Section VI (Stability in Gait) showed the highest AUC (0.83) and the cutoff score for the fast- and slow-walker groups was 3.0 points (sensitivity = 0.85, specificity = 0.81). Sections III, IV, and V (Anticipatory, Reactive, and Sensory Orientation, respectively) had moderate AUC (0.71-0.72). Sections I and II (Stability Limits) showed weak correlations with the walking speed.

CONCLUSIONS

Three sections (III, anticipatory postural adjustments; IV, reactive postural responses; and VI, stability in gait) could differentiate between fast and slow walkers. Section VI was a particularly important balance function measurement that differentiated the walking speed with the highest accuracy. Therefore, it should be a primary focus when physical therapists treat community-dwelling older adults.

Associations between physical activity levels with nutritional status, physical fitness and biochemical indicators in older adults

BACKGROUND & AIMS

A sedentary lifestyle is one of the major health concerns of all societies that is associated by an increased risk of cardiovascular diseases. In this regard, we compared the anthropometric parameters, physical fitness (PF), lipid profile, and nutritional status of older adults with different levels of physical activity (PA).

METHODS

In this cross sectional study, 220 older people (age: 67.39 ± 2.08 yrs) according to their PA levels had been categorized at high (n = 72), moderate (78) and low (n = 70) PA groups. The International Physical Activity Questionnaires and food frequency questionnaire has been used to determine the PA and nutritional status, respectively. Waist and hip circumference, height, weight, and body mass index of subjects were measured and calculated. Both lower and upper body strength, flexibility, static and dynamic balance, and endurance performance factors were used to determine the level of PF. To assess blood biochemical factors, subjects were asked to visit the laboratory after 12 h of fasting.

RESULTS

The results showed waist circumference, hip circumference, and body fat percent were significantly lower in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). Upper body strength, lower body strength, static balance, dynamic balance flexibility and endurance were significantly better in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). Moreover, triglyceride was significantly lower in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). According to the post hoc results, high-density lipoprotein, low-density lipoprotein and fasting glucose were significantly better in the high PA group compared to the low PA group in both males and females (P ≤ 0.05). All participants regardless PA levels showed insufficient consumption of zinc, calcium, vitamin E, and vitamin D (P ≤ 0.05). On the other hand, carbohydrate, sodium, iron, vitamin C and niacin intake significantly above recommended dietary allowance (P ≤ 0.05).

CONCLUSIONS

The results of the current work showed that a higher level of PA improved anthropometric indicators, PF, and lipid profile in Iranian older adults. Moreover, older nutrition should be monitor to maintain their physical health and to prevent them from developing chronic diseases and their malnutrition complications.

Reliability and Diagnostic Accuracy of Commonly Used Performance Tests Relative to Fall History in Older Persons: A Systematic Review

Background/Objectives

Early detection of fall risk is crucial for targeted fall prevention and rehabilitation. This systematic review facilitates decision-making concerning the optimal choice for a suitable fall risk assessment test for older persons in four different settings. This systematic review provides an overview of reliability and diagnostic accuracy (sensitivity [SE], specificity, likelihood ratios, and post-test probabilities) of commonly used performance measures to assess older persons' fall risk.

Methods

Two reviewers independently screened titles, abstracts, and full texts of all articles identified through a systematic search on the PubMed, Embase, CINAHL, and Web of Science databases. The methodological quality was critically appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the COSMIN risk of bias tool. Due to a setting-dependent fall risk, four relevant settings were selected for the analyses: 1) community dwelling, 2) nursing home, 3) hospital, and 4) the combined setting of hospitalized and community-dwelling persons.

Results

Recommendations for diagnostic accuracy can be made for the specific settings: setting 1) mini-balance evaluation system test, timed up and go test with fast speed (TUG FAST), cognitive TUG FAST, functional reach test, and fast gait speed; 2) TUG at usual speed; 3) none of the included tests; and 4) some hip muscle strength and hand grip strength tests might be recommended.

Conclusion

The review's results are applicable for use in clinical practice, both on a population and on an individual level for patients and caregivers. Most measures' reliability is sufficient. However, the included tests' discriminative ability is not optimal for clinical use in relevant settings. The low sample sizes of most of the included studies and a limited amount of studies in all but the community-dwelling setting hinder us from making strong recommendations.

Physical Fitness among Community-Dwelling Older Women with and without Risk of Falling-The Taipei Study, Taiwan

The purposes of this study were to compare the differences in physical fitness between community-dwelling older women fallers and non-fallers, with and without a risk of falling, and to investigate the relation between physical fitness and falling risk factors. This study was a secondary data analysis from a community- and exercise-based fall-prevention program. Baseline assessments pertaining to body weight and height, self-reported chronic diseases, the 12-item fall risk questionnaire (FRQ), senior fitness test, single-leg stand test, and handgrip strength test were extracted. Participants (n = 264) were classified into fallers and non-fallers, and sub-classified according to the risk of falling (FRQ ≥4 and <4). While controlling for the effect of age, body mass index (BMI), and multimorbidity, one-way analysis of covariance indicated that older women with a risk of falling showed poorer performances of the 8-foot up-and-go, 2-min step and 30-s chair stand compared with those without a risk of falling, regardless of the history of falls. Additionally, weaker grip strength was found in non-fallers with falling risk. Some significant, but low-to-moderate, correlations were found between physical fitness tests and fall risk factors in the FRQ, particularly in gait/balance problem and leg muscle weakness. Proactive efforts are encouraged to screen and manage deterioration in the identified physical fitness.

Is functional fitness performance a useful predictor of risk of falls among community-dwelling older adults?

Background

Falls among older adults are a serious public health problem. Many studies indicate that positive functional fitness performance decreases the risk of falls. A limited amount of previous study has investigated the association between broad functional fitness and the fall risk. This study examines the associations between functional fitness and the risk of falling among community-dwelling older adults.

Methods

Three waves of cross-sectional data were collected from 2017 to 2019 in Taipei City, Taiwan. Six hundred sixty-five participants aged ≥65 years were randomly recruited from 12 districts of Taipei. Eight functional fitness tests (i.e., back scratch, chair-sit and-reach, 8-ft up-and-go, 30-s sit-to-stand, 30-s arm curl, 30-s single-leg stance, 2-min step, and hand grip strength tests) were performed to record the physical performance of older subjects. A Chinese version of the fall-risk questionnaire (FRQ) was used to calculate the fall risk scores. Linear regression and logistic regression were utilized to estimate the relationships of each functional fitness and fall risk.

Result

The results showed that 37.45% of older adults had a high risk of falling. It was found for each functional fitness that performance was linearly associated with the risk of falling. Moreover, older adults with low-performance levels in all functional fitness except back-scratching were more likely to have a higher risk of falling.

Conclusions

Our study indicated that functional fitness performance appears to provide valid predictive guidance for reducing the risk of falling among the older population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-021-00608-1.

Rest-activity daily rhythm and physical activity levels after hip and knee joint replacement: the role of actigraphy in orthopedic clinical practice

Elective hip and knee joint replacement for osteoarthritis are cost-effective surgical procedures requiring specific rehabilitation programs. Actigraphy is widely used in both research and clinical practice to study activity patterns with great accuracy and validity but it has never been utilized in orthopedic patients. Therefore, the aim of this study was to objectively assess, through actigraphy, physical activity (PA) levels and rest-activity daily rhythm (RAR) in patients undergoing hip or knee joint replacement and hospitalized for ten days after surgery. Twenty subjects (11 males and 9 females; age: 62.68 ± 10.39 years old; BMI: 29.03 ± 3.92 kg/m²) wore the Actiwatch 2 actigraph (Philips Respironics, Portland, OR) to record both PA levels and RAR for 11 consecutive days and data on subjective scores of pain, by a visual analog scale (VAS), and functional and clinical scores were collected. The following time-points were considered for the statistical analysis: pre-surgery (PRE), the first (POST1), the fourth (POST4) and the tenth (POST10) day after surgery. RAR were processed with the population mean cosinor to describe the rhythm's characteristics (acrophase, amplitude and MESOR) while data on actigraphy-based PA, VAS, and functional clinical scores were compared among PRE, POST1, POST4 and POST 10 with the RM-ANOVA or the non-parametric Friedman test. The day after surgery the subjects had a flattened RAR compared to the other conditions: lower values were detected in POST1 compared to both PRE, POST4 and POST10 for MESOR (p < .0001; η²_p = .71, large) and amplitude (p < .0001; η²_p = .63, large) while RAR's acrophase (p < .0001; η²_p = .61, large) was delayed in PRE (16:45) compared to POST1 (12:42), POST4 (14:38), and POST10 (14:38). PA levels were significantly lower at POST 1 (76.7 ± 33.4) compared to PRE (192.3 ± 91.5; p < .0001 and ES: 1.68, large), POST4 (137.9 ± 45.9; p < .0001 and ES: 1.54, large), and POST10 (131.2 ± 54.3; p < .0001 and ES: 1.21, large) whereas VAS and functional clinical values significantly improved at POST10. Hip and knee joint replacement negatively influenced RAR and PA the first day after surgery but a progressive improvement in the circadian pattern of rest-activity cycle, PA levels, VAS and functional ability was recorded from POST4 to POST10. Actigraphy has the ability to collect real-life data without interfering with clinical practice and give clinicians a new measure of performance that is currently not available. This tool could allow to identify patients with disrupted circadian rhythm and reduced PA in the peri-operative period in orthopedic surgery, and timely intervene on these subjects with personalized rehabilitative intervention.

Benefits of Thai Yoga on physical mobility and lower limb muscle strength in overweight/obese older women: A randomized controlled pilot trial

BACKGROUND AND PURPOSE

Although Thai Yoga (TY) is reported to improve health-related fitness for the elderly, no study has yet carried out the effect of TY Program on physical mobility and lower-limb muscle strength in overweight/obese older women.

MATERIALS AND METHODS

In a randomized controlled pilot design, twenty-two sedentary women with a BMI ≥ 23 kg/m², aged 62 ± 1 years were randomly assigned to either a TY group for 60 min, 3 times a week or to a "no exercise" control (CON) group. Sit and reach (SRT), functional reach (FRT) and 30-s chair stand (CST-30), 8-foot up and go (8UGT), 6-min walk (6MWT)) and lower-limb muscle strength were measured at the beginning, 4, and 8 weeks.

RESULTS

At week 4, a significant between groups was obtained in CST-30, 8UGT, and 6MWT. At week 8, FRT, 8UGT, 6MWT and knee flexor and extensor muscle strength were improved in the TY over the CON. Significant improvement was found in all variables within the TY, but no change was observed in the CON.

CONCLUSION

An 8-week TY program appears to provide beneficial improvements in physical mobility in overweight/obese older women.

Family Orchards and Health-Related Quality of Life in the Elderly. A Protocol for a Study in Las Hurdes (Spain) Based on an Ethnographic Approach

Demographic evolution is resulting on an aged population increment in Spain. This growth has been more relevant in rural areas, where the population has traditionally lived under hard socio-economic conditions and leveraging the natural resources such as food from family orchards to survive. Studies that have investigated the possibilities and uses of these traditional family orchards today in relation to health-related quality of life in the elderly are scarce. Based on a previous ethnography, this mixed research aims to describe a protocol that will evaluate the effects of the use of traditional family orchards as a daily resource on fitness and quality of life of the elderly population in Las Hurdes (Spain). Body composition, fitness, mental health, health-related quality of life, and activity-related behaviors of participants will be assessed. The outcomes of this study might enable us to design further tailored physical exercise-based interventions using family orchards as an adequate resource to improve the health-related quality of life and fitness of the elderly in rural areas. In addition, the study detailed here might also be applied to other similar rural areas in Spain and worldwide.

The Effects of a Walking Intervention on Gait Parameters in Older Adults Residing in Long-Term Care: A Randomized Controlled Trial

OBJECTIVES

We examined the effects of a walking intervention in older adults residing in long-term care (LTC) homes on gait velocity (primary outcome), and stride length, cadence and heel-to-heel base of support (secondary outcomes) compared to those in an interpersonal interaction control group and a care-as-usual control group at 16-weeks post-intervention.

METHODS

These previously unpublished gait data were collected as part of a larger prospective, randomized, three group study. One hundred and sixty-eight participants residing in 12 LTC homes were randomized into: a) a walking group (n=57) - 1:1 supervised, individualized, progressive, 30 minutes, five times a week walking program for 16 weeks; b) an interpersonal interaction group (n=55) - stationary 1:1 conversation time with research personnel; and, c) a care-as-usual control group (n=56). Gait was assessed at baseline and 16-weeks post-intervention using the GAITRite® computerized system. One-way Analysis of Covariance (ANCOVA), controlling for age, sex, cognitive status and baseline gait parameter (velocity, stride length, cadence, heel-to-heel base of support) was used to examine differences among groups for velocity, stride length, cadence, and heel-to-heel base of support at 16-weeks post-intervention.

RESULTS

Ninety-one participants with available data were included in this analysis: walking group (n=31/57, mean age=82.77±6.75 years); interpersonal interaction group (n=31/55, mean age=82.74±9.27 years); care-as-usual control group (n=29/56, mean age=85.40±8.78 years). ANCOVA showed a significant difference in the mean gait velocity at 16-weeks post-intervention [F(2, 84) =6.99, p=0.0006); η2 (95%CI)=0.16 (0.02, 0.27)]. Post hoc comparisons using Sidak test showed that the estimated marginal mean (EMM) for velocity for the walking group [EMM (SE), 0.51m/s (0.03)] was significantly higher compared to the interpersonal interaction group [EMM (SE), 0.38m/s (0.03); t(83)=3.15, p=0.007] and the care-as-usual control group [EMM (SE), 0.38m/s (0.03)]; t(83)=3.32, p=0.004]. No significant difference was observed between groups for stride length, cadence or heel-to-heel base of support.

CONCLUSION

LTC residents with limited physical functioning showed significant improvement in gait velocity but not in stride length, cadence or heel-to-heel base of support after a 16-week walking intervention.

Stand Up Now: A Sedentary Behavior Intervention in Older Adults of Moderate to Low Physical Function

OBJECTIVES

To examine the efficacy of an the intervention Stand Up Now (SUN) to reduce sedentary behavior (SB) and improve physical function and mobility.

METHODS

SUN included two groups: (a) focused on reducing total SB (SUNSL) and (b) focused on increasing sit-to-stand (STS) transitions (SUNSTS). The participants (N = 71; Mage = 87 ± 7 years) had 12 weekly health coaching sessions. SB, physical function, and mobility were measured at the baseline, 6, and 12 weeks via the activPAL, Short Physical Performance Battery, and the 8-foot up and go, respectively. Linear mixed models examined the outcome variables over time.

RESULTS

Both groups decreased sedentary time (1.3 ± 0.3 hr, p < .001), increased standing time (0.5 ± 0.2 hr, p < .02), and improved physical function (1.5 ± 0.4 points, p < .001) from the baseline to 6 weeks, and they maintained it at 12 weeks. SUNSTS increased STS transitions (5.4 ± 4.1, p < .001), while SUNSL had no changes (0.5 ± 3.1, p > .9). There were no changes in mobility for either group (0.5 ± 1.5 s, p > .05).

DISCUSSION

SUN demonstrates the efficacy to improve SB and physical function in older adults.

Aquatic exercise improves functional capacity, perceptual aspects, and quality of life in older adults with musculoskeletal disorders and risk of falling: A randomized controlled trial

BACKGROUND

This study aimed to determine the effects of an aquatic training program on functional capacity, perceptual aspects, and quality of life (QoL) performed by older adults with musculoskeletal disorders (MSDs) and moderate/high risk of falls.

METHODS

This randomized controlled trial included 120 older adults assigned to aquatic exercises (AG; n = 60; 70.62 ± 6.04 years) and a control group (CG; n = 60; 71.86 ± 6.95 years). The risk of falls, perceptual aspects (fall risk awareness and pain), functional capacity (lower and upper body strength, lower and upper body flexibility, functional mobility, and balance) and QoL were assessed at baseline and after the experimental protocol. The AG performed 16 weeks of aquatic exercises (twice per week, 45 min.session^-1) with lower and upper body strength, stretching, and balance exercises. Exercise intensity was controlled using the rate of perceived exertion (12-16 on the Borg scale [6-20 points]) and heart rate (progressing from 40% to 60% of the heart-rate reserve).

RESULTS

The training program improved the lower (mean difference [95% CI]: 2.7 [2.0 to 3.3]) and upper body strength (3.5 [2.6 to 4.5]), lower (4.6 [3.4 to 5.8]) and upper body flexibility (6.5 [4.3 to 8.6]), functional mobility (-2.5 [-2.9 to -1.9]), and balance (11.2 [10.6 to 11.9]); reduced pain perception (-3.2 [-3.7 to -2.8]); increased the fall risk awareness (9.5 [8.8 to 10.1]) and QoL perception (5.6 to 22.6 [4.6 to 25.1]).

CONCLUSIONS

The water-based program may be used as a preventive approach for the older adults with MSDs and at risk of falling to improve physical and usual perceptual aspects (QoL and pain) and fall risk awareness.

Novel Mat Exergaming to Improve the Physical Performance, Cognitive Function, and Dual-Task Walking and Decrease the Fall Risk of Community-Dwelling Older Adults

Physical exercise and cognitive training were previously demonstrated to improve the physical functioning and decrease the incidence of falls for older adults. This study aimed to utilize an interactive exergame mat system to develop a novel cognitive–physical training program and explore the training effects on physical performance, cognitive function, dual-task walking (DTW), and fall risk compared to the control condition. In this quasi-experimental non-randomized controlled intervention study, 110 community-dwelling older adults participated. The exercise group (n = 56; mean age, 70.7 ± 4.6 years) performed ladder-type, three-by-three grid-type, and circle-type mat exergames with simultaneous cognitive–physical training (EMAT), while the control group (n = 54; mean age, 72.0 ± 5.7 years) underwent a multicomponent exercise intervention focused on physical and cognitive training. A 2 h training session was completed weekly for 3 months. Functional fitness (including upper- and lower-extremity strength and flexibility, grasp strength, aerobic endurance, static balance, dynamic balance and agility), a foot tapping test (FTT), the Montreal Cognitive Assessment (MoCA), DTW, and a fall risk questionnaire (FRQ) were assessed before and after the interventions. The EMAT program enhanced upper-extremity strength, lower-extremity strength and flexibility, aerobic endurance, and dynamic balance and agility; improved DTW and FTT performances; and decreased FRQ score. EMAT also showed a significant advantage over control in terms of lower-extremity strength and flexibility, aerobic endurance, dynamic balance and agility, and FRQ score (all P < 0.05). The current study provides evidence of the effects of a novel mat exergaming program on physical and cognitive performance. EMAT effectively reduced the fall risk and increased the dual-task ability of walking, factors that are important in fall prevention for community-dwelling older adults.

Contextual sensory integration training via head mounted display for individuals with vestibular disorders: a feasibility study

Purpose: Virtual reality (VR) interventions can simulate real-world sensory environments. The purpose of this study was to test the feasibility of a novel VR application (app) developed for a Head Mounted Display (HMD) to target dizziness, imbalance and sensory integration in a functional context for patients with vestibular disorders. Here we describe the design of the app as well as self-reported and functional outcomes in vestibular patients before and after participating in vestibular rehabilitation using the app.Material and methods: Our app includes a virtual street, airport, subway or a park. The clinician controls the visual and auditory load including several levels of direction, amount and speed of virtual pedestrians. Clinicians enrolled 28 patients with central (mild-traumatic brain injury [mTBI] or vestibular migraine) and peripheral vestibular disorders. We recorded the Simulator Sickness Questionnaire, Visual Vertigo Analogue Scale (VVAS), Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence Scale (ABC), 8-foot up and go (8FUG) and Four-Step Square Test (FSST) before and after the intervention.Results: Within the 15 patients who completed the study, 12 with peripheral hypofunction showed significant improvements on the VVAS (p = 0.02), DHI (p = 0.008) and ABC (p = 0.02) and a small significant improvement on the FSST (p = 0.015). Within-session changes in symptoms were minimal. Two patients with mTBI showed important improvements, but one patient with vestibular migraine, did not.Conclusion: HMD training within increasingly complex immersive environments appears to be a promising adjunct modality for vestibular rehabilitation. Future controlled studies are needed to establish effectiveness.IMPLICATIONS FOR REHABILITATIONVirtual Reality allows for gradual introduction of complex semi-real visual environments.Within VR training patients can re-learn to maintain balance when presented with a sensory conflict in a safe environment.Head Mounted Display training appears to be a promising adjunct modality for vestibular rehabilitation.Portability and affordability of the hardware and software enhance the potential clinical outreach.

Effects of A "Modified" Otago Exercise Program on the Functional Abilities and Social Participation of Older Adults Living in the Community-The AGA@4life Model

Strength and balance exercises form part of multifactorial programs to reduce the risk of falling and promote active ageing. The aim of this study was to evaluate the effect of a strength and balance exercise program, adapted from the traditional Otago Exercise Program (OTAGO) into a technological system. A non-randomized experimental study enrolled 34 participants (83.24 ± 6.89 years) from a daycare center in Portugal, who were distributed into an intervention group (IG; 18 participants) and a control group (CG; 16 participants). The IG underwent a "modified" OTAGO incorporated in a technological system using pressure and inertial sensors, feedback, and Exergames for 8 weeks, 3 times a week. The CG continued their regular activities. Outcome measures were evaluated at baseline and after 8 weeks of intervention. After the program, differences were observed between the groups in handgrip strength (p = 0.03), step test (p = 0.03), 4stage balance test "modified" (p < 0.001) and activities and participation profile related to mobility (PAPM) (p < 0.001). The IG showed positive results in the self-efficacy for exercise (p = 0.03), PAPM (p = 0.00) and all functional tests, except for timed up and go (p = 0.35). No significant changes were observed in the CG. The results support this intervention program as a good exercise solution to improve functional abilities, social participation, and self-efficacy, reducing the risk of falling.

Cost-Effectiveness of "Tele-Square Step Exercise" for Falls Prevention in Fibromyalgia Patients: A Study Protocol

Background: Women with fibromyalgia (FM) have 2.5 falls per year compared to the 0.5 falls in people without FM. This fact poses a significant health expense. Square Stepping Exercise (SSE) is a balance training system that has been shown to be effective in preventing falls in the elderly. However, there are neither studies in people with FM nor studies that apply SSE through video-conferencing (Tele-SSE). The objectives of this project are 1) to investigate the applicability, safety, decrease in the number of falls, and incremental cost-effectiveness ratio of prevention of falls program through Tele-SSE in women with FM, and 2) to study the transfer of obtained results to the public and private socio-health economy of Extremadura. Methods/Design: A randomized controlled trial with experimental (Tele-SSE) and control (usual treatment) groups will be carried out. The application of Tele-SSE will be performed for 12 months (three times per week) and one additional follow-up month after the intervention. A focus group including agents to identify key points to transfer the findings to the public and private sectors in Extremadura. One-hundred and eighteen women with FM will be recruited and randomly distributed into the two groups: Experimental (Tele-SSE; n = 59) and control group (Usual care; n = 59). Primary outcome measures will be: 1) Applicability; 2) safety; 3) annual number of falls; and 4) incremental cost-effectiveness ratio. Secondary outcomes will be: 1) Balance; 2) fear of falling; 3) socio-demographic and clinical information; 4) body composition; 5) physical fitness; 6) physical activity and sedentary behavior; 7) quality of life-related to health, mental health, and positive health; 8) pain; 9) disability level; 10) cognitive aspects; and 11) depressive symptoms. Regarding the focus group, the acceptability of the Tele-SSE will be evaluated in social-sanitary agents and will include Tele-SSE in their services offer. A statistical analysis will be carried out by treatment intention and protocol. In addition, a cost-effectiveness analysis from the perspective of the health system will be performed. Discussion: This project aims to improve the efficiency and equity of physical therapy services based on tele-exercise in preventing falls in people with FM. Furthermore, orientations will be given in order to transfer the obtained findings into the social-sanitary system and market.

Rate of Force Development as a Predictor of Mobility in Community-dwelling Older Adults

BACKGROUND AND PURPOSE

Rate of force development (RFD) is influential, and possibly more influential than other muscular performance parameters, for mobility in older adults. However, only a few studies have investigated this matter, and this has not been examined for the plantar flexors (PFs). The purpose of this study was to examine the contribution of PF RFD and other common tests of muscular performance to Up-and-Go (UG) performance and walking speed (WS) in older adults.

METHODS

Twenty-six (19 females) healthy, community-dwelling older adults (73.7 ± 4.9 years) were recruited from a senior citizen center for this observational study. Handgrip strength, UG performance, as well as preferred and maximal WS were obtained. Time taken to complete 5-chair rises and the number of chair rises completed in 30 seconds were recorded. Rate of force development of the PFs was obtained during a rapid, bilateral calf raise performed on a force plate. Hierarchical multiple linear regression was used to identify significant predictors, after adjusting for physical activity level and body mass index, of mobility (ie, UG, preferred and maximal WS).

RESULTS AND DISCUSSION

No muscular performance variables correlated with preferred WS. Rate of force development (adjusted R2 = 0.356; P = .008) and handgrip strength (adjusted R2 = 0.293; P = .026) were the only predictors of maximal WS and accounted for a 21.7% and 16.1% change in R2, respectively, after accounting for physical activity level and body mass index. Rate of force development was the only predictor of UG performance (adjusted R2 = 0.212; P = .006) and accounted for a 29.2% change in R2 after adjustment variables were applied.

CONCLUSIONS

Compared to common assessments of muscular performance, such as handgrip strength and chair rise performance, PF RFD was a greater predictor of mobility in older adults. These findings, in conjunction with recent reports, indicate that the assessment of RFD likely complements strength testing, thereby enabling a more robust assessment of functional decline in older adults.

Fall Risk and Balance Confidence in Patients With Diabetic Peripheral Neuropathy: An Observational Study

OBJECTIVE

Individuals with diabetic peripheral neuropathy (DPN) have functional deficits that increase their risk of falling. However, psychological aspects such as loss of confidence in undertaking activities could also contribute to this risk. We examined correlations between balance confidence and fall risk among individuals with DPN.

METHODS

This was a cross-sectional study of 146 individuals with DPN. Elevated fall risk was determined by timed up-and-go test with standard cut-off time of 13.5 seconds, and balance confidence was measured by 16-item Activities Specific Balance Confidence scale. Functional parameters assessed included functional reach, body sway velocity during quiet standing and muscle strength at ankle and toe.

RESULTS

Twenty percent of the DPN patients were at increased risk of falls. Every unit increase in balance confidence was associated with 9% (95% confidence interval: 0.88, 0.95; p<0.001) reduced odds of falling, after adjusting for socio-demographic, health and functional characteristics. No other functional parameters had significant associations with fall risk in adjusted analyses.

CONCLUSIONS

Psychological factors like balance confidence appear to be more important for fall risk among DPN patients, compared to objective functional performance. Interventions targeting balance confidence may be beneficial in reducing the risk of falls in this population.

Mobility Improvements are Found in Older Veterans After 6-Months of Gerofit Regardless of BMI Classification

Veterans represent a unique population of older adults as they are more likely to self-report disability and be overweight or obese compared to the general population. We sought to compare changes in mobility function across the obesity spectrum in older Veterans participating in six-months of Gerofit, a clinical exercise program. 270 Veterans completed baseline, three, and six-month functional assessment and were divided post-hoc into groups: normal weight, overweight, and obese. Physical function assessment included: ten-meter walk time, six-minute walk distance, 30-second chair stands, and eight-foot up-and-go time. No significant weight x time interactions were found for any measure. However, significant (P<0.02) improvements were found for all mobility measures from baseline to three-months and maintained at six-months. Six-months of participation in Gerofit, if enacted nationwide, appears to be one way to improve mobility and function in older Veterans at high risk for disability regardless of weight status.

Association between asymmetry in lower extremity lean mass and functional mobility in older adults living in the community: Results from the Korean Frailty and Aging Cohort Study

The asymmetry in lower extremity strength is known to be related to the functional mobility in older adults living in the community. However, little is known about the association between lower extremity lean mass asymmetry and functional mobility in this patient group. Hence, this study aimed to determine whether asymmetry in lower extremity muscle mass has a significant relationship with functional mobility in older adults living in the community.This cross-sectional study analyzed the pre-existing data from the Korean Frailty and Aging Cohort Study. A total of 435 older people (aged 70-84 years) were divided into the following groups according to their Limb Asymmetry Index (LAsI): low, intermediate, and high asymmetric groups. LAsI is calculated using lower extremity lean mass, and comparisons between groups were conducted. The participants were also further divided into better and worse mobility groups based on their physical performance test results (Timed Up and Go and Short Physical Performance Battery), and comparisons between groups were conducted. Comparisons between fallers and non-fallers were also conducted. In addition, this study investigated the factors that had a significant effect on gait speed and fall experience within the past year among older adults living in the community.The LAsI was significantly associated with gait speed in older adults living in the community. Older adults in the highest tertile of the LAsI had a slower gait speed than those in the lowest tertile of the LAsI. However, no significant difference was observed in the LAsI between the better mobility group and worse mobility group. Moreover, the LAsI was not a significant predictor of falls.Asymmetry in lower extremity lean mass was significantly associated with gait speed in older adults living in the community.

Predictors of instrumental activities of daily living in community-dwelling older adults

Psychiatric mental health clinicians often rely on proxy and self-report evaluations to determine the cognitive function of older adults however, performance measures have greater accuracy and predictive ability for everyday function. This study tested physical and cognitive predictors of functional abilities in fifty-one community residing older adults. We administered a computerized battery of executive function tasks, a performance-based measure of instrumental activities of daily living (IADL), and three physical function measures (grip strength, 30-second Chair Stand Test, and 8-foot Up and Go). Regression models assessed the associations of three components of executive function (updating, shifting, and inhibition) with IADLs and physical functions. Updating was a significant predictor of the Medications and Financial DAFS scores and of grip strength. Shifting also predicted grip strength. In conclusion, different executive functions predict different domains of IADL functioning. Working memory was a robust predictor of IADL functioning in older adults, especially medication management skills.

Despite Active Public Health Campaigns, Death from Falls Increased 30% in the Past Decade: Is Ageism Part of the Barrier to Self-Awareness?

Public health messaging campaigns stating that falls are bad and can be prevented are not effective, as evidenced by a 30% increase in death from falls over the past decade. A first approach is to use measures of balance to show the magnitude of the problem. Second, the role of ageism as a barrier to required behavioral change should be addressed. Third, explanations should be provided regarding why mobility and balance have changed. As a counter to ageism, pros and cons for specific interventions and how these maximize momentum and mobility should be discussed.

Active Video Games for Improving Physical Performance Measures in Older People: A Meta-analysis

Background and Purpose:

Participation in regular physical activity is associated with better physical function in older people (>65 years); however, older people are the least active of all age groups. Exercise-based active video games (AVGs) offer an alternative to traditional exercise programs aimed at maintaining or enhancing physical performance measures in older people. This review systematically evaluated whether AVGs could improve measures of physical performance in older people. Secondary measures of safety, game appeal, and usability were also considered.

Methods:

Electronic databases were searched for randomized controlled trials published up to April 2015. Included were trials with 2 or more arms that evaluated the effect of AVGs on outcome measures of physical performance in older people.

Results:

Eighteen randomized controlled trials (n = 765) were included. Most trials limited inclusion to healthy community-dwelling older people. With the exception of 1 trial, all AVG programs were supervised. Using meta-analyses, AVGs were found to be more effective than conventional exercise (mean difference [MD], 4.33; 95% confidence intervals [CIs], 2.93-5.73) or no intervention (MD, 0.73; 95% CI, 0.17-1.29) for improving Berg Balance scores in community-dwelling older people. Active video games were also more effective than control for improving 30-second sit-to-stand scores (MD, 3.99; 95% CI, 1.92-6.05). No significant differences in Timed Up and Go scores were found when AVGs were compared with no intervention or with conventional exercise.

Conclusions:

Active video games can improve measures of mobility and balance in older people when used either on their own or as part of an exercise program. It is not yet clear whether AVGs are equally suitable for older people with significant cognitive impairments or balance or mobility limitations. Given the positive findings to date, consideration could be given to further development of age-appropriate AVGs for use by older people with balance or mobility limitations.

8-Foot-Up-and-Go Test is Associated with Hospitalizations and Mortality in Idiopathic Pulmonary Fibrosis: A Prospective Pilot Study

PURPOSE

To assess the prognostic value of the 8-foot-up-and-go test (8-FUGT) in pilot cohort of patients with idiopathic pulmonary fibrosis (IPF).

METHODS

Thirty-four patients with IPF (68 ± 8 years) underwent 8-FUGT at baseline and were followed for up to 40 months. Receiver operating characteristics and age-adjusted Cox hazard ratios (HR) were analyzed for 8-FUGT, hospitalizations, and mortality. Correlation coefficients were determined between 8-FUGT and other exercise tests.

RESULTS

8-FUGT ≥ 6.9 s was found to be associated with hospitalization (sensitivity = 77%, specificity = 76%, p = 0.03) and mortality (sensitivity = 91%, specificity = 70% p = 0.008) in patients with IPF. Categorical models demonstrated that 8-FUGT ≥ 6.9 s was associated with 14.1- (p < 0.001) and 55.4-fold (p = 0.001) increased risks for hospitalization and mortality, respectively. In continuous models, for every 1-s slower performance in the 8-FUGT there were 54% [HR = 1.54, 95% CI (1.11-2.15) p = 0.01] increased risk for hospitalization and 94% [HR = 1.94, 95% CI (1.26-2.99) p = 0.003] increased risk for mortality. 8-FUGT was inversely related to 6-min walk distance (r = - 0.61), peak oxygen consumption (r = - 0.58), and peak work rate (r = - 0.72), all p < 0.001.

CONCLUSIONS

The 8-FUGT was strongly associated with hospitalizations and mortality in patients with IPF, as well as correlated with established prognostic markers. These novel findings suggest a prognostic value of the 8-FUGT for risk stratification, referral to pulmonary rehabilitation, and considering listing for lung transplantation. 8-FUGT is an inexpensive and practical tool that has prospective for implementation in clinical and research settings in IPF. Future prospective studies should evaluate the effect of changes in 8-FUGT on clinical outcomes.

TRIAL REGISTRATION

NCT01499745, Clinicaltrials.gov.

Longitudinal comparison of low- and high-velocity resistance training in relation to body composition and functional fitness of older adults

BACKGROUND

Functional mobility disability affects more than one in five adults over 70 years and increases to 80% by 90 years. While negative changes in mobility are multifactorial, deleterious body composition changes contribute significantly. Resistance training alters the negative trajectory of physical function as well as increases lean mass among older adults. Recently, high-velocity (HV) resistance training has been indicated as an effective intervention to increase lean mass and functional performance.

AIMS

The present investigation compared body composition, physical function, and muscular strength changes between HV and LV resistance training programs.

METHODS

Participants > 65 years (n = 53) were randomly assigned to LV, HV, or active control (AC) group and participated in their respective intervention for 48 weeks.

RESULTS

Analysis of covariance revealed no significant body composition changes over time between groups (p > 0.05). Eight-foot up-and-go performance improved in the HV and AC groups (p < 0.05) with no change in the LV group (p > 0.05) over time. Muscular strength increased in both the LV and HV groups within the first 24 weeks, while only in the LV group, muscular strength continued to increase from 24 to 48 weeks (p < 0.05).

DISCUSSION

Resistance training appears to be an effective intervention for improving aspects of physical function and muscular strength; however, no significant changes in body composition were observed over the 48-week intervention.

CONCLUSION

Findings from the current investigation support use of resistance training for improving physical function among community-dwelling older adults.

Joint moments' contributions to vertically accelerate the center of mass during stair ambulation in the elderly: An induced acceleration approach

Falls are a serious problem faced by the elderly. Older adults report mostly to fall while performing locomotor activities, especially the ones requiring stair negotiation. During these tasks, older adults, when compared with young adults, seem to redistribute their lower limb joint moments. This may indicate that older adults use a different strategy to accelerate the body upward during these tasks. The purposes of this study were to quantify the contributions of each lower limb joint moment to vertically accelerate the center of mass during stair ascent and descent, in a sample of community-dwelling older adults, and to verify if those contributions were correlated with age and functional fitness level. A joint moment induced acceleration analysis was performed in 29 older adults while ascending and descending stairs at their preferred speed. Agreeing with previous studies, during both tasks, the ankle plantarflexor and the knee extensor joint moments were the main contributors to support the body. Although having a smaller contribution to vertically accelerate the body, during stair descent, the hip joint moment contribution was related with the balance score. Further, older adults, when compared with the results reported previously for young adults, seem to use more their knee extensor moment than the ankle plantarflexor moment to support the body when the COM downward velocity is increasing. By contributing for a better understanding of stair negotiation in community dwelling older adults, this study may help to support the design of interventions aiming at fall prevention and/or mobility enhancement within this population.

Predicting chemotherapy toxicity in older adults: Comparing the predictive value of the CARG Toxicity Score with oncologists' estimates of toxicity based on clinical judgement

AIM

The Cancer and Aging Research Group's (CARG) Toxicity Score was designed to predict grade ≥3 chemotherapy-related toxicity in adults aged ≥65 yrs. commencing chemotherapy for a solid organ cancer. We aimed to evaluate the CARG Score and compare it to oncologists' estimates for predicting severe chemotherapy toxicity in older adults.

METHODS

Patients aged ≥65 yrs. starting chemotherapy for a solid organ cancer had their CARG Score (range 0-23) calculated. Their treating oncologist, blinded to these results, independently estimated each patient's risk of severe chemotherapy toxicity (0-100%). Toxicities were captured prospectively. The predictive value of the CARG Score and oncologists' estimates was estimated using logistic regression and in terms of Area Under the Receiver Operating Characteristic curve (AU-ROC).

RESULTS

126 patients from ten oncologists at two sites participated. The median age was 72 yrs. (range 65-84). The median CARG Score was 7 (range 0-17); the median oncologist estimate of risk was 30% (range 3-80%), and these measures were not correlated (r = -0.01). 64 patients (52%) experienced grade ≥ 3 toxicity. Rates of severe toxicity in low-, intermediate-, and high-risk groups by CARG Score were 58%, 47%, and 58% respectively, and 63%, 44%, and 67% by oncologist estimate. Severe chemotherapy toxicity was not predicted by the CARG Score (OR 1.04, 95%CI 0.92-1.18, p = .54, AU-ROC 0.52), or oncologists' estimates (OR 1.00, 95%CI 0.98-1.02, p = .82, AU-ROC 0.52).

CONCLUSION

Neither the CARG Score, nor oncologists' estimates based on clinical judgement, predicted severe chemotherapy-related toxicity in our population of older adults with cancer. Methods to improve risk prediction are needed.

Multifactorial Screening Tool for Determining Fall Risk in Community-Dwelling Adults Aged 50 Years or Over (FallSensing): Protocol for a Prospective Study

Background

Falls are a major health problem among older adults. The risk of falling can be increased by polypharmacy, vision impairment, high blood pressure, environmental home hazards, fear of falling, and changes in the function of musculoskeletal and sensory systems that are associated with aging. Moreover, individuals who experienced previous falls are at higher risk. Nevertheless, falls can be prevented by screening for known risk factors.

Objective

The objective of our study was to develop a multifactorial, instrumented, screening tool for fall risk, according to the key risk factors for falls, among Portuguese community-dwelling adults aged 50 years or over and to prospectively validate a risk prediction model for the risk of falling.

Methods

This prospective study, following a convenience sample method, will recruit community-dwelling adults aged 50 years or over, who stand and walk independently with or without walking aids in parish councils, physical therapy clinics, senior’s universities, and other facilities in different regions of continental Portugal. The FallSensing screening tool is a technological solution for fall risk screening that includes software, a pressure platform, and 2 inertial sensors. The screening includes questions about demographic and anthropometric data, health and lifestyle behaviors, a detailed explanation about procedures to accomplish 6 functional tests (grip strength, Timed Up and Go, 30 seconds sit to stand, step test, 4-Stage Balance test “modified,” and 10-meter walking speed), 3 questionnaires concerning environmental home hazards, and an activity and participation profile related to mobility and self-efficacy for exercise.

Results

The enrollment began in June 2016 and we anticipate study completion by the end of 2018.

Conclusions

The FallSensing screening tool is a multifactorial and evidence-based assessment which identifies factors that contribute to fall risk. Establishing a risk prediction model will allow preventive strategies to be implemented, potentially decreasing fall rate.

Registered Report Identifier

RR1-10.2196/10304

Validity of the 8-Foot Up and Go, Timed Up and Go, and Activities-Specific Balance Confidence Scale in older adults with and without cognitive impairment

The purpose of this study was to determine whether (1) mild cognitive impairment (MCI) alters the validity of the Timed Up and Go (TUG), the 8-Foot Up and Go (8UG), or the Activities-Specific Balance Confidence (ABC) scale in the identification of fallers and nonfallers and (2) there were differences in the concurrent validity between the TUG and ABC when compared with the 8UG and ABC in those with and without MCI.. The classification of MCI was based on a score of <26 points on the Montreal Cognitive Assessment. For the 62 participants enrolled, excellent correlations were demonstrated in pairwise comparisons between the outcome measures (on a continuous scale). Based on frequently cited cutpoints, the sensitivity of the TUG was only 20% with a specificity of 94.6% and the sensitivity of the 8UG was 64% with a specificity of 75.7%. The TUG identified fallers at significantly different rates than the 8UG and the ABC (p < 0.05). For this reason, the 8UG is recommended as a more appropriate outcome measure for identifying fall risk in community-dwelling older adults. Fall history was found as the only significant predictor of test outcome for the TUG, 8UG, and ABC, indicating that MCI is not a significant determinant of test performance.

Effects of a Community-Based Exercise Program on Older Adults’ Physical Function, Activities of Daily Living, and Exercise Self-Efficacy: Feeling Fit Club

Community-based exercise programs have demonstrated feasibility, yet many lack controlled studies examining their efficacy. This study examined the efficacy of a community-based exercise program, using a controlled design. Participants ( N = 262, Mage = 74.0 years, SD = 8.4) were women (77%) and men recruited from senior centers served by the county Area Agency on Aging. Intervention participants ( n = 133) were newly enrolled in classes. Controls ( n = 129) were recruited from matched sites not offering classes. Validated measures of physical function, exercise self-efficacy, balance, and activities of daily living (ADL) confidence were administered at baseline and 3 months. Significant improvements in upper and lower body strength, aerobic endurance, mobility, exercise self-efficacy, and balance were found in the exercisers but not controls. No changes in ADL confidence occurred in exercisers, while significant decreases occurred in controls. Findings support the efficacy of the county-wide program. Building an evidence base for community-delivered programs should provide impetus for increased dissemination through state and national agencies thereby increasing program impact.