Resistive Exercise for Arthritic Cartilage Health (REACH): a randomized double-blind, sham-exercise controlled trial

Nanodevices for deep cartilage penetration

Osteoarthritis (OA) is a degenerative joint disease and is the main cause of chronic pain and functional disability in adults. Articular cartilage is a hydrated soft tissue that is composed of normally quiescent chondrocytes at a low density, a dense network of collagen fibrils with a pore size of 60-200 nm, and aggrecan proteoglycans with high-density negative charge. Although certain drugs, nucleic acids, and proteins have the potential to slow the progression of OA and restore the joints, these treatments have not been clinically applied owing to the lack of an effective delivery system capable of breaking through the cartilage barrier. Recently, the development of nanotechnology for delivery systems renders new ideas and treatment methods viable in overcoming the limited penetration. In this review, we focus on current research on such applications of nanotechnology, including exosomes, protein-based cationic nanocarriers, cationic liposomes/solid lipid nanoparticles, amino acid-based nanocarriers, polyamide derivatives-based nanocarriers, manganese dioxide, and carbon nanotubes. Exosomes are the smallest known nanoscale extracellular vesicles, and they can quickly deliver nucleic acids or proteins to the required depth. Through electrostatic interactions, nanocarriers with appropriate balance in cationic property and particle size have a strong ability to penetrate cartilage. Although substantial preclinical evidence has been obtained, further optimization is necessary for clinical transformation. STATEMENT OF SIGNIFICANCE: The dense cartilage matrix with high-negative charge was associated with reduced therapeutic effect in osteoarthritis patients with deep pathological changes. However, a systematic review in nanodevices for deep cartilage penetration is still lacking. Current approaches to assure penetration of nanosystems into the depth of cartilage were reviewed, including nanoscale extracellular vesicles from different cell lines and nanocarriers with appropriate balance in cationic property and size particle. Moreover, nanodevices entering clinical trials and further optimization were also discussed, providing important guiding significance to future research.

A recommended exercise program appropriate for patients with knee osteoarthritis: A systematic review and meta-analysis

Background: Knee osteoarthritis (KOA) is a common degenerative disease. Recommended first-line management includes exercise. However, there is still no standard recommendation for the appropriate exercise program for patients with KOA.

Purpose: This study aims to compare the effects of a land-based exercise program with high vs. uncertain compliance with recommendations among people with KOA in pain, function, and stiffness.

Methods: From January 2000 to January 2022, PubMed, EBSCO, Sport-discuss, Medline, and Web of Science were searched. A comprehensive review of meta-analyses of land-based exercise programs with exercise prescriptions was done in symptomatic individuals with KOA. The Cochrane Collaboration’s standards were followed for study selection, eligibility criteria, data extraction, and statistics, and the Cochrane Collaboration’s tool was used to assess the risk of bias. Review Manager 5 software was used to extract the baseline mean and follow-up values, as well as the accompanying standard deviation, to calculate the standardized mean difference (SMD). In meta-analyses, SMD was calculated for pain outcomes, self-reported physical function, and stiffness. The effects of the outcomes on the subgroups of studies were compared. A fixed- or random-effects model was used in group research studies with comparable outcomes.

Results: There were 15 studies with a total of 1,436 participants. Compliance with the ACSM recommendations was categorized as “high” in five cases and “uncertain” in nine others. The SMD for pain was −0.31 (95% CI −0.47, −0.14) in the subgroup with a high ACSM compliance ratio and −0.55 (95% CI −0.69, −0.41) in the subgroup with uncertain ACSM compliance. For physical function, in the high-compliance group, the SMD was −0.21 (95% CI −0.38, −0.05), while in the uncertain-compliance group, it was −0.61 (95 % CI −0.82, −0.40). The SMD was −0.40 (95 % CI −0.61, −0.19) for stiffness and high compliance with ACSM. The SMD was −0.29 (95% CI −0.66, 0.07) for study interventions with uncertain compliance.

Conclusion: The results showed that the land-based training program significantly improved pain, physical function, and stiffness in KOA patients compared to controls. Exercise interventions with high adherence to ACSM recommendations differed significantly only in stiffness measures compared with the uncertain-compliance group.

Clinical Trial Registration:https://www.crd.york.ac.uk/prospero/#recordDetails, identifier PROSPERO (ID CRD42022311660)

Comparison of the knee joint reaction force between individuals with and without acute anterior cruciate ligament rupture during walking

Background

Anterior cruciate ligament plays a significant role in knee joint stability. It is claimed that the incidence of knee osteoarthritis increases in individuals with anterior cruciate ligament (ACL) rupture. The aim of this study was to evaluate the knee joints reaction force in ACL rupture group compared to normal subjects.

Method

Fifteen patients with acute ACL rupture and 15 healthy subjects participated in this study. The ground reaction force (GRF) and kinematic data were collected at a sampling rate of 120 Hz during level-ground walking. Spatiotemporal parameters, joint angles, muscle forces and moments, and joint reaction force (JRF) of lower extremity were analyzed by OpenSIM software.

Results

The hip, knee and ankle joints reaction force at loading response and push-off intervals of the stance phase during walking was significantly higher in individuals with ACL rupture compared to healthy controls (p value < 0.05). Walking velocity (p value < 0.001), knee (p value = 0.065) and ankle (p value = 0.001) range of motion in the sagittal plane were significantly lower in the patients with ACL rupture compared to healthy subjects. The mean value of vertical GRF in the mid-stance, the peak of the hip adduction moment in loading response and push-off phases, the hip abductor, knee flexor and vastus intermedius part of quadriceps muscle forces were significantly higher compared to healthy subjects (p < 0.05) while vastus medialis and vastus lateralis produced significantly lower force (p < 0.001).

Conclusions

Based on results of this study, lower limb JRF was higher in those with ACL rupture compared to healthy subjects may be due to the compensatory mechanisms used by this group of subjects. An increase in knee JRF in patients with ACL rupture may be the reason for the high incidence of knee OA.

Improvised use of a digital tool for social interaction in a Norwegian care facility during the COVID-19 pandemic: an exploratory study

Background

Digital tools for social communication have been deployed in care facilities during the COVID-19 pandemic to facilitate social connectedness between older people and their next of kin in a safe manner. This study explores how and why health care professionals facilitate the ad hoc and prompt use of a technology for social communication, known as KOMP, in care facilities in western Norway to promote communication and social engagement among residents and their next of kin during the crisis.

Methods

To investigate the perspectives and practices of health care professionals, we conducted focus groups, individual interviews, and participant observation in public short- and long-term care facilities in western Norway. An explorative investigation with inductive content analysis was applied to analyse interview transcripts and fieldnotes from participant observation.

Results

The resulting qualitative data reveal that prompt implementation of interactive technology to cope with social distancing during the pandemic added new routines to the staff workload. Using this interactive technology entailed new forms of collaborative work among residents, next of kin, health care professionals and technology facilitators. Additionally, the staff articulated a sense of responsibility towards using KOMP as a meaningful and practical tool for social communication in an extraordinary period of reduced social contact.

Conclusions

Improvised implementation of KOMP as an interactive technology shapes work routines, introduces new tasks and creates additional responsibilities. Despite creative efforts by health care staff, however, using KOMP remains constrained by the physical and cognitive abilities of its users. We suggest that health care managers ask a deceptively simple question when introducing novel technologies in health care contexts, namely: what kind of invisible work do these devices entail?

The Efficacy of Brief School-Based Exercise Programs in Improving Pubertal Bone Mass and Physical Fitness: A Randomized Controlled Trial

PURPOSE

To examine the effects of three types of school-based exercises on bone health and physical fitness function in Chinese boys and girls.

METHODS

One hundred and seventy-four Chinese boys and girls were randomly assigned into four groups: (1) sham exercise (ShEx); (2) high-impact exercise (HiEx); (3) high-impact exercise with various directions (HiExVi); and (4) high-intensity interval exercise (HiInEx). Speed of sound (SOS) and physical fitness parameters were determined before and after six-month intervention.

RESULTS

At the end of six-month intervention, participants in all groups show an increment of SOS compared with the baseline (p < 0.05), and the changes were higher in HiEx (mean: 38.878 m/s, 95% CI: 32.885~44.872, p = 0.001) and HiExVi groups (49.317 m/s, 42.737~55.897, p < 0.001) compared with ShEx group (20.049 m/s, 13.751~26.346). Six-month exercise training generated a reduction of percent of body fat (PBF) and waist-hip ratio (WHR) (p < 0.05). The decrease of PBF was greater in HiExVi (-1.222%, -1.820~-0.624, p = 0.012) and HiInEx groups (-1.395%, -1.809~-0.982, p = 0.003), whereas the reduction of WHR was larger in HiEx (-0.026, -0.039~-0.014, p = 0.009), HiExVi (-0.024, -0.036~-0.012, p = 0.021), and HiInEx groups (-0.035, -0.046~-0.024, p < 0.001) compared with ShEx group. Balance function (BLF), vital capacity (VC), standing long jump (SLJ), and sit up (SU) increased in all intervention groups (p < 0.05). The BLF increased in HiEx (6.332 s, 4.136~8.528, p = 0.001), HiExVi (10.489 s, 8.934~12.045, p < 0.001), and HiInEx groups (9.103 s, 7.430~10.776, p < 0.001) showed a greater change than that of ShEx group (1.727 s, 0.684~2.770). The increment of VC (273.049 mL, 199.510~346.587, p < 0.001) and SU (2.537 times/min, 0.639~4.435, p = 0.017) was higher in HiInEx group, whereas the accrual in SLJ was larger in HiExVi (7.488 cm, 4.936~10.040, p = 0.007) compared with ShEx group (58.902 mL, 7.990~109.814; -0.463 times/min, -2.003~1.077; 1.488 cm, -0.654~3.630).

CONCLUSION

The brief school-based exercises were effective in improving schoolchildren's health, but they showed different effects, with HiEx mostly improving bone health, HiInEx largely benefiting physical fitness function, and HiExVi enhancing both bone and physical fitness.

[Possibilities and limits of conservative treatment for osteoarthritis : Sport advice, training therapy, orthotics and cartilage therapeutics]

Hintergrund

Arthrose – die Degeneration von Gelenken – ist ein weit verbreitetes Problem durch alle Bevölkerungsschichten, das im zunehmenden Alter vermehrt auftritt und die häufigste Ursache für mobilitätseinschränkende Schmerzen am Bewegungsapparat ist. Etwa 70–80 % der über 70-Jährigen zeigen Zeichen einer Gelenksdegeneration. Insgesamt sind bis zu 25 % der Gesamtbevölkerung davon betroffen, aufgrund der generellen Alterung der Bevölkerung mit steigender Tendenz. Die Inzidenz der Arthrose steigt aber schon ab dem 40 Lebensjahr, wobei besonders posttraumatische und sekundäre Arthroseformen zum Tragen kommen.

Anspruch

Der Wunsch nach hoher Mobilität und Sport zieht sich als Phänomen ebenfalls durch alle Altersgruppe. Dies ist mit hohen Gelenkbelastungen verbunden und stellt damit eine große Herausforderung an vor allem früh degenerativ veränderte Gelenksstrukturen dar. In diesem Zusammenhang ist der orthopädisch tätige Arzt gefordert, die Belastbarkeit von geschädigten Gelenken abzuschätzen und so früh wie möglich präventive Schritte sowie gegebenenfalls konservative Therapien einzuleiten, um die Progression der Arthrose zu verhindern und damit den eventuell notwendigen Gelenkersatz möglichst weit nach hinten zu schieben.

Internal and Imagined External Foci of Attention Do Not Influence Pirouette Performance in Ballet Dancers

Ballet dancers need to constantly improve their performance. Several studies show that an internal focus (on body movements) leads to inferior motor performance relative to an external focus of attention (on the movement effects), but the majority of dancers usually adopt an internal focus. It is not clear if the benefits of an external focus are relevant for form-based tasks performed in a ballet. Purpose: Test whether an imagined external focus of attention can improve ballet dancers' performance of a form-based task, the en dehors double pirouette (EDDP). Method: 23 experienced amateurs and 17 professional dancers between 18 and 35 years old performed three EDDP under each of three attentional focus instruction conditions (No Focus, Internal, Imagined External). Order of presentation of Internal and Imagined External focus instructions was blocked and balanced across participants. Movement quality was assessed by three experts with a customized observational scale. Movement kinematics were measured by the angle of inclination of the trunk and inclination of the rotation axis with respect to the global vertical during the EDDP. Results: Movement quality and trunk inclination were significantly different between amateurs and professionals, but the rotation axis inclination was not. No quantitative or qualitative effects of focus were found for the performance of the EDDP across focus conditions. Conclusions: There appears to be no differential effects of using an internal or imagined external focus on the immediate performance of the EDDP for amateur and professional ballet dancers. Personal and task factors might account for the lack of effects.

Uptake and use of a minimum data set (MDS) for older people living and dying in care homes in England: a realist review protocol

INTRODUCTION

Care homes provide nursing and social care for older people who can no longer live independently at home. In the UK, there is no consistent approach to how information about residents' medical history, care needs and preferences are collected and shared. This limits opportunities to understand the care home population, have a systematic approach to assessment and documentation of care, identifiy care home residents at risk of deterioration and review care. Countries with standardised approaches to residents' assessment, care planning and review (eg, minimum data sets (MDS)) use the data to understand the care home population, guide resource allocation, monitor services delivery and for research. The aim of this realist review is to develop a theory-driven understanding of how care home staff implement and use MDS to plan and deliver care of individual residents.

METHODS AND ANALYSIS

A realist review will be conducted in three research stages.Stage 1 will scope the literature and develop candidate programme theories of what ensures effective uptake and sustained implementation of an MDS.Stage2 will test and refine these theories through further iterative searches of the evidence from the literature to establish how effective uptake of an MDS can be achieved.Stage 3 will consult with relevant stakeholders to test or refine the programme theory (theories) of how an MDS works at the resident level of care for different stakeholders and in what circumstances. Data synthesis will use realist logic to align data from each eligible article with possible context-mechanism-outcome configurations or specific elements that answer the research questions.

ETHICS AND DISSEMINATION

The University of Hertfordshire Ethics Committee has approved this study (HSK/SF/UH/04169). Findings will be disseminated through briefings with stakeholders, conference presentations, a national consultation on the use of an MDS in UK long-term care settings, publications in peer-reviewed journals and in print and social media publications accessible to residents, relatives and care home staff.

PROSPERO REGISTRATION NUMBER

CRD42020171323; this review protocol is registered on the International Prospective Register of Systematic Reviews.

Association of care workers' job satisfaction and global happiness with change of functional performance of severely disabled elderly residents in nursing homes: a cohort and questionnaire study in Japan

OBJECTIVES

There is growing concern regarding quality of work life (QWL) among care staff in nursing homes. However, little is known about the impact of QWL on nursing home residents' functional performance. Recent literature suggests that job satisfaction and happiness of healthcare workers reflect their perceived QWL and impact the quality of their care. This study examined the association between job satisfaction and global happiness with change in functional performance of severely disabled elderly residents in nursing homes.

DESIGN

A retrospective cohort study of nursing home residents combined with a questionnaire survey of their care staff.

SETTING

Eighteen nursing homes in Japan.

PARTICIPANTS

Data were collected from 1000 residents with a required care level of 3-5 and from 412 care staff in nursing homes between October 2017 and March 2018.

OUTCOMES AND EXPLANATORY VARIABLES

Functional performance was structurally assessed with ICF (International Classification of Functioning, Disability and Health) staging, composed of 52 items concerning activities of daily life, cognitive function and social participation, at baseline and 6 months later. Deterioration and improvement of functional performance were dichotomously defined as such change in any of the items. QWL of care staff was evaluated with a questionnaire including questions about job satisfaction and global happiness.

RESULTS

Functional performance deteriorated and improved in 23.0% and 12.7% of residents, respectively. Global happiness of care staff was associated with lower probability of residents' deterioration (adjusted OR, 0.61; CI 0.44 to 0.84). There was no significant correlation between job satisfaction or happiness of care staff and improvement of residents' functional performance.

CONCLUSION

These results suggest that QWL of care staff is associated with changes in functional performance of elderly people with severe disabilities in nursing homes.

Perspective of Dose and Response for Individualized Physical Exercise and Training Prescription

Physical interventions are used to increase physical (sports) performance and considered as effective low-cost strategies in the fields of healthcare, disease or injury prevention, and medical treatment. In general, a considerable amount of evidence buttress the application of physical interventions in various fields as it has been demonstrated to contribute to the maintenance and recovery of physical performance, cognitive function, and overall state of health. To implement physical interventions effectively, it is essential to provide an appropriate exercise and training prescription. Exercise and training prescription are key for "dose" specification and for the individualization (personalizing) of physical exercise and training, precisely adjusted and controlled like medication. Since the physiological response to physical interventions is demonstrably individual and dependent on many influencing factors, individualization is an emerging approach aiming to maximize the efficiency of an intervention by accounting for the interindividual heterogeneity. The present brief viewpoint article aims to distinguish and to redefine between the terms dose and response in order to improve the understanding of practitioners, the methodology of study protocols, and to relate future findings to the actual biological (interindividual) variability of acute and chronic responses.

The Contribution of Functional Magnetic Resonance Imaging to the Understanding of the Effects of Acute Physical Exercise on Cognition

The fact that a single bout of acute physical exercise has a positive impact on cognition is well-established in the literature, but the neural correlates that underlie these cognitive improvements are not well understood. Here, the use of neuroimaging techniques, such as functional magnetic resonance imaging (fMRI), offers great potential, which is just starting to be recognized. This review aims at providing an overview of those studies that used fMRI to investigate the effects of acute physical exercises on cerebral hemodynamics and cognition. To this end, a systematic literature survey was conducted by two independent reviewers across five electronic databases. The search returned 668 studies, of which 14 studies met the inclusion criteria and were analyzed in this systematic review. Although the findings of the reviewed studies suggest that acute physical exercise (e.g., cycling) leads to profound changes in functional brain activation, the small number of available studies and the great variability in the study protocols limits the conclusions that can be drawn with certainty. In order to overcome these limitations, new, more well-designed trials are needed that (i) use a more rigorous study design, (ii) apply more sophisticated filter methods in fMRI data analysis, (iii) describe the applied processing steps of fMRI data analysis in more detail, and (iv) provide a more precise exercise prescription.

Potentially inappropriate prescribing in dementia: a state-of-the-art review since 2007

OBJECTIVES

Dementia frequently occurs alongside comorbidities. Coexisting conditions are often managed with multiple medications, leading to increased risk of potentially inappropriate medication and adverse drug reactions. We aimed to estimate prevalence of, and identify factors reported to be associated with, potentially inappropriate prescribing (PIP) for older individuals diagnosed with dementia.

DESIGN

We used a state-of-the-art review approach, selecting papers written in English and published from 2007 to January 2018. Publications were retrieved from Scopus and Web of Science databases. Inclusion criteria included a formal diagnosis of dementia, a formal classification of PIP and reported prevalence of PIP as an outcome. Random effects models were used to provide a pooled estimate of prevalence of PIP. The Appraisal tool for Cross-Sectional Studies (AXIS tool) was used to assess bias in the included studies.

RESULTS

The bibliographic search yielded 221 citations, with 12 studies meeting the inclusion criteria. The estimates of PIP prevalence for people living with dementia ranged from 14% to 64%. Prevalence was 31% (95% CI 9 to 52) in the community, and 42% (95% CI 30 to 55) in nursing/care homes. PIP included prescribing likely related to dementia (eg, hypnotics and sedative and cholinesterase inhibitors) and prescribing related to treatment of comorbidities (eg, cardiovascular drugs and non-steroidal anti-inflammatory medication). Higher levels of comorbidity were associated with increased risk of PIP; however, only one study investigated associations with specific comorbidities of dementia.

CONCLUSION

PIP remains a significant issue in healthcare management for people living with dementia. Higher levels of comorbidity are associated with increased prevalence of PIP, but the specific conditions driving this increase remain unknown. Further work is necessary to investigate PIP related to the presence of common comorbidities in patients living with dementia.

Considerations of the Principles of Resistance Training in Exercise Studies for the Management of Knee Osteoarthritis: A Systematic Review

OBJECTIVE

To evaluate the methodologic quality of resistance training interventions for the management of knee osteoarthritis.

DATA SOURCES

A search of the literature for studies published up to August 10, 2015, was performed on MEDLINE (OVID platform), PubMed, Embase, and Physiotherapy Evidence Database databases. Search terms associated with osteoarthritis, knee, and muscle resistance exercise were used.

STUDY SELECTION

Studies were included in the review if they were published in the English language and met the following criteria: (1) muscle resistance training was the primary intervention; (2) randomized controlled trial design; (3) treatment arms included at least a muscle conditioning intervention and a nonexercise group; and (4) participants had osteoarthritis of the knee. Studies using preoperative (joint replacement) interventions with only postoperative outcomes were excluded. The search yielded 1574 results. The inclusion criteria were met by 34 studies.

DATA EXTRACTION

Two reviewers independently screened the articles for eligibility. Critical appraisal of the methodology was assessed according to the principles of resistance training and separately for the reporting of adherence using a specially designed scoring system. A rating for each article was assigned.

DATA SYNTHESIS

There were 34 studies that described a strength training focus of the intervention; however, the principles of resistance training were inconsistently applied and inadequately reported across all. Methods for adherence monitoring were incorporated into the design of 28 of the studies, but only 13 reported sufficient detail to estimate average dose of exercise.

CONCLUSIONS

These findings affect the interpretation of the efficacy of muscle resistance exercise in the management of knee osteoarthritis. Clinicians and health care professionals cannot be confident whether nonsignificant findings are because of the lack of efficacy of muscle resistance interventions, or occur through limitations in treatment prescription and patient adherence. Future research that seeks to evaluate the effects of muscle strength training interventions on symptoms of osteoarthritis should be properly designed and adherence diligently reported.

Exercise Benefits for Chronic Low Back Pain in Overweight and Obese Individuals

Overweight and obese individuals with chronic low back pain (LBP) struggle with the combined physical challenges of physical activity and pain interference during daily life; perceived disability increases, pain symptoms worsen, and performance of functional tasks and quality of life (QOL) decline. Consistent participation in exercise programs positively affects several factors including musculoskeletal pain, perceptions of disability due to pain, functional ability, QOL, and body composition. It is not yet clear, however, what differential effects occur among different easily accessible exercise modalities in the overweight-obese population with chronic LBP. This narrative review synopsizes available randomized and controlled, or controlled and comparative, studies of easily accessible exercise programs on pain severity, QOL, and other outcomes, such as physical function or body composition change, in overweight-obese persons with chronic LBP. We identified 16 studies (N = 1,351) of various exercise programs (aerobic exercise [AX], resistance exercise [RX], aquatic exercise [AQU], and yoga-Pilates) that measured efficacy on LBP symptoms, and at least one other outcome such as perceived disability, QOL, physical function, and body composition. RX, AQU, and Pilates exercise programs demonstrated the greatest effects on pain reduction, perceived disability, QOL, and other health components. The highest adherence rate occurred with RX and AQU exercise programs, indicating that these types of programs may provide a greater overall impact on relevant outcomes for overweight-obese LBP patients.

LEVEL OF EVIDENCE

V.

Graded Resistance Exercise And Type 2 Diabetes in Older adults (The GREAT2DO study): methods and baseline cohort characteristics of a randomized controlled trial

Background

Type 2 diabetes (T2D) is projected to affect 439 million people by 2030. Medical management focuses on controlling blood glucose levels pharmacologically in a disease that is closely related to lifestyle factors such as diet and inactivity. Physical activity guidelines include aerobic exercise at intensities or volumes potentially unreachable for older adults limited by many co-morbidities. We aim to show for the first time the efficacy of a novel exercise modality, power training (high-velocity, high-intensity progressive resistance training or PRT), in older adults with T2D as a means for improving glycemic control and targeting many associated metabolic and physiological outcomes.

Eligibility criteria included community-dwelling men and women previously diagnosed with T2D who met the current definition of metabolic syndrome according to the International Diabetes Federation. Participants were randomized to a fully supervised power training intervention or sham exercise control group for 12 months. Intervention group participants performed whole body machine-based power training at 80%1RM, 3 days per week. The control group undertook the same volume of non-progressive, low-intensity training. Participants were assessed at baseline, 6 months and 12 months and followed for a further 5 years, during which time participants were advised to exercise at moderate-high intensity. Glycemic control (HbA1c) and insulin resistance as measured by the homeostatic model assessment 2 (HOMA2-IR) were the primary outcomes of the trial. Outcome assessors were blinded to group assignment and participants were blinded to the investigators’ hypothesis regarding the most effective intervention.

Results

We recruited 103 participants (48.5 % women, 71.6 ± 5.6 years). Participants had 5.1 ± 1.8 chronic diseases, had been diagnosed with T2D for 8 ± 6 years and had a body mass index (BMI) of 31.6 ± 4.0 kg/m². Fasting glucose and insulin were 7.3 ± 2.4 mmol/L and 10.6 ± 6.3 mU/L, respectively. HbA1c was 54 ± 12 mmol/mol. Eighty-six participants completed the 12-month assessment and follow-up is ongoing. This cohort had a lower-than-expected dropout (n = 14, 14 %) over the 12-month intervention period.

Conclusions

Power training may be a feasible adjunctive therapy for improving glycemic control for the growing epidemic of T2D in older adults.

Trial registration

Australian and New Zealand Clinical Trials Registry ACTRN12606000436572 (24 September 2006).

Rapid repetitive passive movement promotes knee proprioception in the elderly

Joint proprioception plays an important role in the generation of coordinated movements, maintenance of normal body posture, body conditioning, motor learning, and relearning. Previous studies have demonstrated that proprioceptive function of the elderly can be enhanced via specific exercises; however, not all of the elderly can actively and safely participate in physical activities. The purpose of this study was to evaluate the effects of rapid repetitive passive movement in an average velocity of 90°/s on knee proprioception in the elderly. A repeated-measure design was employed. Two age groups (12 young/12 elderly) were intervened with repetitive passive movements of 60 repetitions to the knee joint via two machines (isokinetic dynamometer/self-designed machine) in separate days. Changes in proprioception were evaluated via joint active repositioning and kinesthesia, both before and after the intervention. The results revealed that all subjects demonstrated good test–retest reliabilities on proprioceptive measurements. For the active repositioning and kinesthesia, significant statistical main effects were found for group and time, but not for machine. No statistical interactions were revealed. Despite of age-related proprioceptive declines, elderly subjects could benefit from rapid repetitive passive movements. This indicates that repetitive passive movement may be an alternative to physical activity for those who are home-bound, in a sedentary lifestyle, or with other health conditions that may limit their abilities to actively maintain or strengthen joint proprioception.

Preliminary evidence that low ankle-brachial index is associated with reduced bilateral hip extensor strength and functional mobility in peripheral arterial disease

OBJECTIVE

Peripheral arterial disease (PAD) has been associated with skeletal muscle pathology, including atrophy of the affected muscles. In addition, oxidative metabolism is impaired, muscle function is reduced, and gait and mobility are restricted. We hypothesized that greater severity of symptomatic PAD would be associated with lower levels of muscle mass, strength, and endurance, and that these musculoskeletal abnormalities in turn would impair functional performance and walking ability in patients with PAD.

METHODS

We assessed 22 persons with intermittent claudication from PAD in this cross-sectional pilot study. Outcome assessments included initial claudication distance and absolute claudication distance via treadmill protocols and outcomes from the 6-minute walk (6MW). Secondary outcomes included one repetition maximum strength/endurance testing of hip extensors, hip abductors, quadriceps, hamstrings, plantar flexors, pectoral, and upper back muscle groups, as well as performance-based tests of function. Univariate and stepwise multiple regression models were constructed to evaluate relationships and are presented.

RESULTS

Twenty-two participants (63.6% male; mean [standard deviation] age, 73.6 [8.2] years; range, 55-85 years) were studied. Mean (standard deviation) resting ankle-brachial index (ABI) was 0.54 ([0.13]; range, 0.28-0.82), and participants ranged from having mild claudication to rest pain. Lower resting ABI was significantly associated with reduced bilateral hip extensor strength (r = 0.54; P = .007) and reduced whole body strength (r = 0.32; P = .05). In addition, lower ABI was associated with a shorter distance to first stop during the 6MW (r = 0.38; P = .05) and poorer single leg balance (r = 0.44; P = .03). Reduced bilateral hip extensor strength was also significantly associated with functional outcomes, including reduced 6MW distance to first stop (r = 0.74; P = .001), reduced 6MW distance (r = 0.75; P < .001), and reduced total short physical performance battery score (worse function; r = 0.75; P = .003).

CONCLUSIONS

Our results suggest the existence of a causal pathway from a reduction in ABI to muscle atrophy and weakness, to whole body disability represented by claudication outcomes and performance-based tests of functional mobility in an older cohort with symptomatic PAD. Longitudinal outcomes from this study and future trials are required to investigate the effects of an anabolic intervention targeting the muscles involved in mobility and activities of daily living and whether an increase in muscle strength will improve symptoms of claudication and lead to improvements in other functional outcomes in patients with PAD.

The effect of adding whole-body vibration to squat training on the functional performance and self-report of disease status in elderly patients with knee osteoarthritis: a randomized, controlled clinical study

OBJECTIVES

The study objectives were to evaluate the effects of adding whole-body vibration to squat training on functional performance and self-report of disease in elderly individuals with knee osteoarthritis (OA).

DESIGN

This was a prospective, randomized trial in which selected variables were evaluated at three periods: 3 weeks prior to the training, immediately prior, and after the end of the training.

SUBJECTS

Twenty-three (23) elderly subjects were evaluated using four functional performance tests: Berg Balance Scale (BBS), Timed Get Up and Go Test (TGUG), Chair Stand Test (CST), and 6-Minute Walk Test (6MWT), and a self-report of the status of disease (WOMAC).

INTERVENTIONS

The intervention lasted for 12 weeks, 3 times per week. The participants were randomized into two groups: (1) squat training with whole-body vibration, and (2) squat training without vibration.

RESULTS

Although there was no statistical difference in functional performance and self-report of disease status between the groups, performance in all the functional tests and in all the domains of WOMAC improved in the vibration group compared to their initial status. In the exercise group, performance improved only two tests (BBS and 6MWT), and there was a reduction in self-reported pain (WOMAC) compared to their initial status.

CONCLUSIONS

Although the addition of whole-body vibration to squat training failed to result in a significant improvement in functional performance and self-reported status of knee osteoarthritis in the elderly, the intragroup results suggest that whole-body vibration may represent a feasible and effective way of improving the functionality and self-perception of disease status in older adults with knee OA.

Lower limb muscle strengthening does not change frontal plane moments in women with knee osteoarthritis: A randomized controlled trial

BACKGROUND

Osteoarthritis is a common musculo-skeletal problem accompanied with muscle weakness. Muscle weakness may be readily improved by resistance training. Greater muscle strength has been associated with a lower knee joint loading rate.

METHODS

We conducted a single-blind randomized controlled trial of 54 female patients with osteoarthritis in at least one knee, according to the American College of Rheumatology clinical criteria. Patients were randomized into a 6-month high intensity progressive resistance training or a sham-exercise program. The primary outcomes were first peak knee and hip adduction moment measured using three-dimensional gait analysis at self-selected habitual and maximal speeds. Secondary outcomes were sagittal plane knee and hip moments, peak muscle strength, gait speed, and self-reported knee osteoarthritis symptoms measured by the Western Ontario and McMaster Osteoarthritis Index (WOMAC).

FINDINGS

Six months of high intensity resistance training did not change the first peak knee or hip adduction moment at either habitual or maximum walking speeds (P>0.413) compared to the sham-exercise. However, the second peak hip adduction moment (P=0.025) and WOMAC pain score (P<0.001) were reduced significantly in both groups over time, but there was no group effect. The changes in the second peak hip adduction moment were inversely related to the changes in the WOMAC pain score (r=-0.394, P=0.009).

INTERPRETATIONS

Muscle strength training in women with osteoarthritis, while effective for reducing osteoarthritis symptoms, appeared to operate through mechanisms other than improved knee or hip joint loading, as paradoxically, improved symptoms were related to decreases of hip adduction moment in late stance.

Progressive resistance training and dynamic alignment in osteoarthritis: A single-blind randomised controlled trial

BACKGROUND

we hypothesised that high intensity progressive resistance training would improve lower limb dynamic alignment and function (lower knee adduction moment, increased muscle strength, and fewer knee osteoarthritis symptoms).

METHODS

women (n=54) with osteoarthritis in at least one knee were randomised into a 6-month resistance training or a sham-exercise program. The primary outcomes were dynamic shank and knee adduction angles and knee adduction moment of the most symptomatic knee measured with quantitative gait analysis. Secondary outcomes were muscle strength, gait speed, and osteoarthritis symptoms.

FINDINGS

dynamic alignment and knee adduction moment did not change over time or between groups. Muscle strength improved in both groups over time, but significantly more in the resistance training group (P=0.002). By contrast, gait velocity and pain improved over time (P ≤ 0.009) in both groups. Improvements in shank adduction angle were related to improvements in self-reported disability (r=0.381, P=0.015), but not to changes in muscle strength, gait velocity, or pain (all P>0.05).

INTERPRETATIONS

although muscle strength improved significantly more in the PRT group, the hypothesised reduction in knee adduction moment, shank and knee adduction angles were not evident after either exercise modality. However, improvements in disability and shank adduction angle were significantly directly related. Initial alignment should be used to stratify this population into separate groups when designing future trials and alternative modes of training investigated to potentially enhance beneficial alterations in knee alignment.

The relationship between knee adduction moment and cartilage and meniscus morphology in women with osteoarthritis

OBJECTIVE

The aim of this cross-sectional study is to investigate the relationship between knee adduction moment and knee adduction angular impulse and meniscus, cartilage and bone morphology in women with knee osteoarthritis (OA).

METHOD

Forty-five women aged >40 years with OA in at least one knee, according to American College of Rheumatology clinical criteria were studied. The knee joint loading was assessed by three-dimensional motion analysis system during gait. Three Tesla magnetic resonance imaging (MRI) with a coronal T2-weighted spin echo sequence was used for evaluating meniscus pathology, and a coronal T1-weighted gradient echo sequence for quantifying cartilage morphology and bone surface size. Cartilage thickness, denuded area and subchondral area in the femorotibial joint was measured using custom software.

RESULTS

A higher peak knee adduction moment was observed in participants with medial compared to those with lateral tears (2.92+/-1.06 vs -0.46+/-1.7, P<0.001). Participants with a higher knee adduction moment displayed a larger medial meniscus extrusion (r=0.532, P<0.001) and a lower medial meniscus height (r=-0.395, P=0.010). The inverse relationship was observed for the lateral meniscus. A higher knee adduction moment was also associated with a higher ratio of the medial to lateral tibial subchondral bone area (r=0.270, P=0.035). By contrast, cartilage thickness and denuded areas in the femur and tibia were not related to the knee adduction moment. Similar results were found for the relationship between knee adduction angular impulse and meniscus, cartilage and bone morphology.

CONCLUSIONS

Dynamic knee joint loading is significantly related to meniscus pathology and bone size, but not to cartilage thickness in women with OA.

Does land-based exercise reduce pain and disability associated with hip osteoarthritis? A meta-analysis of randomized controlled trials

OBJECTIVE

To determine if clinical guidelines recommending therapeutic exercise for people with hip osteoarthritis (OA) are supported by rigorous scientific evidence.

METHODS

A meta-analysis of randomized controlled trials (RCTs) recruiting people with hip OA and comparing some form of land-based exercise program (as opposed to exercises conducted in the water) with a non-exercise group in terms of hip pain and/or self-reported physical function.

RESULTS

Thirty-two RCTs were identified, but only five met the inclusion criteria. Only one of the five included RCTs restricted recruitment to people with hip OA, the other four RCTs also recruiting participants with knee OA. The five included studies provided data on 204 and 187 hip OA participants for pain and physical function, respectively. Combining the results of the five included RCTs using a fixed-effects model demonstrated a small treatment effect for pain (standardized mean difference (SMD) -0.38; 95% confidence interval (CI) -0.67 to -0.09). No significant benefit in terms of improved self-reported physical function was detected (SMD -0.02; 95% CI -0.31 to 0.28).

CONCLUSION

Currently there is only silver level evidence (one small RCT) supporting the benefit of land-based therapeutic exercise for people with symptomatic hip OA in terms of reduced pain and improved physical function. The limited number and small sample size of the included RCTs restricts the confidence that can be attributed to these results.

Prior hospitalization and the risk of heart attack in older adults: a 12-year prospective study of Medicare beneficiaries

BACKGROUND

We investigated whether prior hospitalization was a risk factor for heart attacks among older adults in the survey on Assets and Health Dynamics among the Oldest Old.

METHODS

Baseline (1993-1994) interview data were linked to 1993-2005 Medicare claims for 5,511 self-respondents aged 70 years and older and not enrolled in managed Medicare. Primary hospital International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 410.xx discharge codes identified postbaseline hospitalizations for acute myocardial infarctions (AMIs). Participants were censored at death or postbaseline managed Medicare enrollment. Traditional risk factors and other covariates were included. Recent postbaseline non-AMI hospitalizations (ie, prior hospitalizations) were indicated by a time-dependent marker, and sensitivity analyses identified their peak effect.

RESULTS

The total number of person-years of surveillance was 44,740 with a mean of 8.1 (median = 9.1) per person. Overall, 483 participants (8.8%) suffered postbaseline heart attacks, with 423 participants (7.7%) having their first-ever AMI. As expected, significant traditional risk factors were sex (men); race (whites); marital status (never being married); education (noncollege); geography (living in the South); and reporting a baseline history of angina, arthritis, diabetes, and heart disease. Risk factors were similar for both any postbaseline and first-ever postbaseline AMI analyses. The time-dependent recent non-AMI hospitalization marker did not alter the effects of the traditional risk factors but increased AMI risk by 366% (adjusted hazards ratio = 4.66, p < .0001). Discussion. Our results suggest that some small percentage (<3%) of heart attacks among older adults might be prevented if effective short-term postdischarge planning and monitoring interventions were developed and implemented.