Defining Clinically Meaningful Cut Points for Leg Power Impairment Using Physical Performance in Older Adults: A Secondary Analysis From Boston RISE

OBJECTIVE

To identify clinically meaningful thresholds of leg power impairment identified by the stair climb power test (SCPT).

DESIGN

Cross-sectional analysis using the baseline data from an observational cohort study.

SETTING

The Boston Rehabilitative Impairment Study of the Elderly.

PARTICIPANTS

Community-dwelling older adults (N=413).

MAIN OUTCOME MEASURES

SCPT and the Short Physical Performance Battery (SPPB).

RESULTS

Using the receiver operating characteristic curves and Youden's J statistics, the optimal threshold for the SCPT associated with mobility limitation as defined by an SPPB score ≤9 was 3.07 Watts/kg for men with a sensitivity of 74%, a specificity of 73% and, an area under the curve (AUC) value of 0.78. For women, the optimal threshold was 2.59 Watts/kg with a sensitivity of 83%, a specificity of 69%, and an AUC value of 0.81. The classification and regression tree sensitivity analysis demonstrated similar thresholds, 2.88 Watts/kg and 2.53 Watts/kg for men and women, respectively.

CONCLUSIONS

The study identified clinically meaningful thresholds of impairment for the SCPT for mobility limited older primary care patients. These thresholds may be used to inform rehabilitation care to improve functional mobility of older adults and should be validated in larger more representative clinical trials.

Classical Ballet for Women Aged Over 50 Years: Investigating Balance, Strength, and Range of Motion

Background: Regular exercise can mitigate the loss of strength, balance, and flexibility that contribute to age-related decline in physical function and mobility. However, traditional exercise interventions often report poor adherence rates. There is growing interest in classical ballet as an enjoyable exercise modality for adults in middle to late age. Classical ballet requires muscular strength, coordination, and flexibility. The current study investigated a classical ballet intervention on the balance, physical function, and range of motion of women aged over 50 years. Methods: Twenty-two healthy female participants (aged 56.2 (4.5) years (mean (SD)) completed a 10-week ballet intervention. Results: This single-arm study showed significant improvements (p<.05) in lower limb strength (measured by 5 times sit-to-stand and forward leap) and high adherence rates (95% adherence for participants who completed the intervention). No adverse events were reported. Improvements in balance were reported in the left leg only (as measured by center of pressure ellipse area in the parallel retiré condition). Conclusions: These results allude to the positive effects of ballet training on strength and balance in adults aged 50 years and over. High adherence rates suggest that ballet training was enjoyed and may thus be a long-term exercise modality for this population. Although this study was a single-arm design, it suggests promising results for future research wishing to evaluate the effectiveness of classical ballet training using randomized controlled trial designs.

The Effectiveness of Dance Interventions on Psychological and Cognitive Health Outcomes Compared with Other Forms of Physical Activity: A Systematic Review with Meta-analysis

BACKGROUND

Physical activity is known to improve psychological and cognitive outcomes. Learning dance sequences may challenge cognition, partnered or group dance may benefit social interactions, and the artistic aspect may improve psychological wellbeing. Dance is an equally effective form of physical activity compared with other structured physical activities to improve physical health, but it is unclear how effective dance could be for psychological and cognitive outcome measures.

OBJECTIVE

To systematically review the literature on the effectiveness of structured dance interventions, compared with structured exercise programmes, on psychological and cognitive outcomes across the lifespan.

METHODS

Eight databases were searched from earliest records to July 2022. Studies investigating a dance intervention lasting ≥ 4 weeks, including psychological and/or cognitive health outcomes, and having a structured exercise comparison group were included. Screening and data extraction were performed by two independent reviewers at all stages. All reviewer disagreements were resolved by the primary author. Where appropriate, meta-analysis was performed, or an effect size estimate generated.

RESULTS

Of 21,737 records identified, 27 studies met the inclusion criteria. Total sample size of included studies was 1392 (944 females, 418 males, 30 unreported). Dance was equally as effective as other physical activity interventions in improving quality of life for people with Parkinson's disease [mean difference 3.09; 95% confidence interval (CI) - 2.13 to 8.30; p = 0.25], reducing anxiety (standardised mean difference 2.26; 95% CI - 2.37 to 6.90; p = 0.34), and improving depressive symptoms (standardised mean difference 0.78; 95% CI - 0.92 to 2.48; p = 0.37). Preliminary evidence found dance to be superior to other physical activity interventions to improve motivation, aspects of memory, and social cognition and to reduce distress. Preliminary evidence found dance to be inferior to other physical activity interventions to improve stress, self-efficacy and language fluency.

CONCLUSION

Undertaking structured dance of any genre is generally equally and occasionally more effective than other types of structured exercise for improving a range of psychological and cognitive outcomes.

TRIAL REGISTRATION

PROSPERO: CRD42018099637.

Association of potato consumption with calcified atherosclerotic plaques in the coronary arteries: The NHLBI Family Heart Study

BACKGROUND AND AIMS

While the association of potato consumption with risk factors for coronary artery disease has been inconsistent, no data are available in the literature on the influence of potato consumption on subclinical disease. Thus, we sought to examine whether baked/mashed potato consumption is associated with calcified atherosclerotic plaques in the coronary arteries.

METHODS AND RESULTS

In a cross-sectional design, we studied 2208 participants of the NHLBI Family Heart Study. These subjects were selected based on their elevated cardiovascular disease risk compared to the general population. Potato consumption was assessed by a semi-quantitative food frequency questionnaire. We defined prevalent CAC using an Agatston score of at least 100 and fitted generalized estimating equations to calculate prevalence odds ratios of CAC. Mean age at initial clinic visit was 58.2 years and 55% were female. Median consumption of potatoes was 2-4/week. There was no statistically significant association between frequency of potato consumption and prevalent CAC: odds ratios (95% CI) for CAC were 1.0 (reference), 0.85 (0.56-1.30), 0.85 (0.58-1.26), and 0.95 (0.60-1.53) among subjects reporting potato consumption of <1/week, 1/week, 2-4/week, and 5+/week, respectively (p for linear trend 0.83), adjusting for age, sex, BMI, smoking, exercise, diabetes, hypertension, total calories, prevalent coronary heart disease, income, education, and daily red meat intake.

CONCLUSIONS

We found no significant association between baked/mashed potato consumption and CAC in older adults.

STUDY REGISTRATION NUMBER

NCT00005136. Study registration date: 5/25/2000.

Veteran's Attitudes and Knowledge of End-of-Life Care: A Pilot Study Using a Mixed Methods Approach

Veterans make up a quarter of the deaths in the United States (US). However, little is known about their knowledge and preferences about end-of-life care and pain management. Given this, we were interested in how veterans' military experiences impact their end-of-life experiences and attitudes. Our exploratory study addressed the knowledge and perceptions of hospice and pain management at the end of life. The quantitative aspect was a survey using descriptive statistics that used a small (n = 14) subgroup from a randomly selected sample in the continental US. A small population-based sample (N = 123) used a blended sampling frame of randomly selected validated cell phone and landline numbers. The qualitative aspect examined eight targeted interviews of urban dwelling older veterans over age 60 residing in Northeast Ohio to get a deeper understanding of their knowledge and attitudes toward end-of-life care. Our findings suggest that veterans did not understand the difference between hospice and palliative care and expressed concerns regarding pain medication use at the end of life. Future research examining the concept of stoicism at the end of life among veterans and educational interventions are needed.

Changes in Mild Neurocognitive Disorder Status in Mobility Limited Older Primary Care Patients: Implications for Rehabilitative Care

OBJECTIVE

The aim of the study is to identify potential rehabilitative treatment targets associated with participants' annual cognitive status.

DESIGN

A cohort study patients with self-reported mobility limitation who completed neuropsychological, physical performance testing, and questionnaires at baseline to 2-year follow-up were categorized into three groups (persistently cognitively normal, nonpersistent mild neurocognitive disorder, and persistently mild neurocognitive disorder) based on their annual cognitive status using baseline, years 1 and 2 performance on Hopkins Verbal Learning, Trail Making, and Digit Symbol Substitution Tests. Repeated measures multinomial regression analysis was used to examine the differences between groups and associated characteristics.

RESULTS

Study included 349 participants (mean age, 76 ± 7) with 57% of participants were persistently cognitively normal, 16% persistently mild neurocognitive disorder, and 27% nonpersistent mild neurocognitive disorder over 2 yrs of follow-up. Faster gait speed (relative risk reduction, 0.64-0.89) was associated with risk reduction and increase in depressive symptoms (relative risk reduction, 1.09-1.12) was associated with greater risk of being classified into the nonpersistent or persistently mild neurocognitive disorder compared with persistently cognitively normal.

CONCLUSIONS

Variability across cognitive status over time was observed. Gait speed and depressive symptoms were modifiable risk factors associated with nonpersistent and persistent mild neurocognitive disorder status. This study reinforces the potential benefit of multifaceted rehabilitation for preventing and treating older adults with mobility and/or cognitive problems.

Evaluating the effect of upper-body morbidity on quality of life following primary breast cancer treatment: a systematic review and meta-analysis

PURPOSE

Improvements in breast cancer management continue to increase survival and life expectancy after treatment. Yet the adverse effects of treatment may persist long term, threatening physical, psychological, and social wellbeing, leading to impaired quality of life (QOL). Upper-body morbidity (UBM) such as pain, lymphoedema, restricted shoulder range of motion (ROM), and impaired function are widely reported after breast cancer treatment, but evidence demonstrating its impact on QOL is inconsistent. Therefore, the aim of the study was to conduct a systematic review and meta-analysis evaluating the effect of UBM on QOL following primary breast cancer treatment.

METHODS

The study was prospectively registered on PROSPERO (CRD42020203445). CINAHL, Embase, Emcare, PsycInfo, PubMed/Medline, and SPORTDiscus databases were searched for studies reporting QOL in individuals with and without UBM following primary breast cancer treatment. Primary analysis determined the standardised mean difference (SMD) in physical, psychological, and social wellbeing scores between UBM + /UBM - groups. Secondary analyses identified differences in QOL scores between groups, according to questionnaire.

RESULTS

Fifty-eight studies were included, with 39 conducive to meta-analysis. Types of UBM included pain, lymphoedema, restricted shoulder ROM, impaired upper-body function, and upper-body symptoms. UBM + groups reported poorer physical (SMD =  - 0.99; 95%CI =  - 1.26, - 0.71; p < 0.00001), psychological (SMD =  - 0.43; 95%CI =  - 0.60, - 0.27; p < 0.00001), and social wellbeing (SMD =  - 0.62; 95%CI =  - 0.83, - 0.40; p < 0.00001) than UBM - groups. Secondary analyses according to questionnaire showed that UBM + groups rated their QOL poorer or at equal to, UBM - groups across all domains.

CONCLUSIONS

Findings demonstrate the significant, negative impact of UBM on QOL, pervading physical, psychological, and social domains.

IMPLICATIONS FOR CANCER SURVIVORS

Efforts to assess and minimise the multidimensional impact of UBM are warranted to mitigate impaired QOL after breast cancer.

Mild Neurocognitive Disorder, Social Engagement, and Falls Among Older Primary Care Patients

OBJECTIVES

(1) To estimate the association between social engagement (SE) and falls; (2) To examine the relation between mild neurocognitive disorder (MNCD) and falls by different levels of SE.

DESIGN

We performed a secondary data analysis using prospective cohort study design.

SETTING

Primary care.

PARTICIPANTS

A total of 425 older adult primary care patients at risk for mobility decline (N=425). As previously reported, at baseline, 42% of participants exhibit MNCD.

MAIN OUTCOME MEASURES

The outcome variable was the number of falls during 2 years of follow-up. Exposure variables at baseline included (1) MNCD identified using a cut-off of 1.5 SD below the age-adjusted mean on at least 2 measures within a cognitive performance battery and (2) SE, which was assessed using the social component of the Late-Life Function and Disability Instrument. High SE was defined as having a score ≥ median value (≥49 out of 100). All models were adjusted for age, sex, education, marital status, comorbidities, and pain status.

RESULTS

Over 2 years of follow-up, 48% of participants fell at least once. MNCD was associated with a higher rate of falls, adjusting for the covariates (Incidence Rate Ratio=1.6, 95% confidence interval: 1.1-2.3). There was no significant association between MNCD and the rate of falls among people with high SE. In participants with low SE (having a score less than 49.5 out 100), MNCD was associated with a higher rate of falls as compared with participants with no neurocognitive disorder (No-NCD).

CONCLUSIONS

Among participants with low SE, MNCD was associated with a higher rate of falls, but not among participants with high SE. The findings suggest that high SE may be protective against falls among older primary care patients with MNCD.

Ballet after breast cancer: investigating the feasibility and acceptability of a novel 16-week classical ballet intervention for breast cancer survivors

Purpose

The “Ballet after breast cancer” study sought to investigate the feasibility and acceptability of a 16-week classical ballet intervention for breast cancer survivors, delivered face-to-face and/or online.

Methods

Breast cancer survivors were recruited to take part in 2 × 1-h ballet classes per week for 16 weeks. Primary outcomes of feasibility and acceptability were assessed according to rates of enrolment and attendance and participant feedback via questionnaire. Secondary outcomes included quality of life (QOL), upper-body disability, shoulder range of motion (ROM), muscular strength, aerobic capacity, and physical activity levels. Associations between rate of attendance and changes in secondary measures were explored.

Results

Thirty-one participants (62% of eligible individuals) enrolled in the program. Twenty-nine women commenced the intervention [53.3 ± 10.8 years (Mean ± SD)], attending 77.6% [67.6, 87.5] (Mean [95% CI]) of sessions. Based on these rates of enrolment and attendance, and participant feedback, the program was deemed feasible and acceptable to participants. Significant improvements in shoulder ROM and reductions in sedentary behaviour were achieved. Participants also reported improvements in physical capacity and psychological, social, and cognitive wellbeing.

Conclusions

The “Ballet after breast cancer” program, delivered face-to-face and/or online, was feasible and acceptable to breast cancer survivors. Improvements in shoulder ROM achieved doing ballet were pertinent given the adverse effects of upper-body morbidity on breast cancer survivor QOL. Improvements in physical activity behaviour and perceived benefits to wellbeing also support the use of ballet to mitigate QOL impairment after treatment.

Implications for cancer survivors

The physical demands and the fun, creative, and social characteristics of ballet promote improvement across multiple domains of health and wellbeing. Ballet shows promise as an activity to improve QOL and increase long-term engagement in health-promoting physical activity after breast cancer.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-022-07420-9.

Forest regeneration within Earth system models: current process representations and ways forward

Earth system models must predict forest responses to global change in order to simulate future global climate, hydrology, and ecosystem dynamics. These models are increasingly adopting vegetation demographic approaches that explicitly represent tree growth, mortality, and recruitment, enabling advances in the projection of forest vulnerability and resilience, as well as evaluation with field data. To date, simulation of regeneration processes has received far less attention than simulation of processes that affect growth and mortality, in spite of their critical role maintaining forest structure, facilitating turnover in forest composition over space and time, enabling recovery from disturbance, and regulating climate-driven range shifts. Our critical review of regeneration process representations within current Earth system vegetation demographic models reveals the need to improve parameter values and algorithms for reproductive allocation, dispersal, seed survival and germination, environmental filtering in the seedling layer, and tree regeneration strategies adapted to wind, fire, and anthropogenic disturbance regimes. These improvements require synthesis of existing data, specific field data-collection protocols, and novel model algorithms compatible with global-scale simulations. Vegetation demographic models offer the opportunity to more fully integrate ecological understanding into Earth system prediction; regeneration processes need to be a critical part of the effort.

30-day Mortality Following COVID-19 and Influenza Hospitalization Among US Veterans Aged 65 and Older

Background

COVID‐19 and influenza are important sources of morbidity and mortality among older adults. Understanding how outcomes differ for older adults hospitalized with either infection is important for improving care. We compared outcomes from infection with COVID‐19 and influenza among hospitalized older adults.

Methods

We conducted a retrospective study of 30‐day mortality among veterans aged 65+ hospitalized with COVID‐19 from March 1, 2020–December 31, 2020 or with influenza A/B from September 1, 2017 to August 31, 2019 in Veterans Affairs Health Care System (VAHCS). COVID‐19 infection was determined by a positive PCR test and influenza by tests used in the VA system. Frailty was defined by the claims‐based Veterans Affairs Frailty Index (VA‐FI). Logistic regressions of mortality on frailty, age, and infection were adjusted for multiple confounders.

Results

A total of 15,474 veterans were admitted with COVID‐19 and 7867 with influenza. Mean (SD) ages were 76.1 (7.8) and 75.8 (8.3) years, 97.7% and 97.4% were male, and 66.9% and 76.4% were white in the COVID‐19 and influenza cohorts respectively. Crude 30‐day mortality (95% CI) was 18.9% (18.3%–19.5%) for COVID‐19 and 4.3% (3.8%–4.7%) for influenza.

Combining cohorts, the odds ratio for 30‐day mortality from COVID‐19 (versus influenza) was 6.61 (5.74–7.65). There was a statistically significant interaction between infection with COVID‐19 and frailty, but there was no significant interaction between COVID‐19 and age.

Separating cohorts, greater 30‐day mortality was significantly associated with older age (p: COVID‐19: <0.001, Influenza: <0.001) and for frail compared with robust individuals (p for trend: COVID‐19: <0.001, Influenza: <0.001).

Conclusion

Mortality from COVID‐19 exceeded that from influenza among hospitalized older adults. However, odds of mortality were higher at every level of frailty among those admitted with influenza compared to COVID‐19. Prevention will remain key to reducing mortality from viral illnesses among older adults.

Trajectories of Frailty in the 5 Years Prior to Death Among U.S. Veterans Born 1927-1934

BACKGROUND

Electronic frailty indices (eFIs) are increasingly used to identify patients at risk for morbidity and mortality. Whether eFIs capture the spectrum of frailty change, including decline, stability, and improvement, is unknown.

METHODS

In a nationwide retrospective birth cohort of U.S. Veterans, a validated eFI, including 31 health deficits, was calculated annually using medical record and insurance claims data (2002-2012). K-means clustering was used to assign patients into frailty trajectories measured 5 years prior to death.

RESULTS

There were 214 250 veterans born between 1927 and 1934 (mean [SD] age at death = 79.4 [2.8] years, 99.2% male, 90.3% White) with an annual eFI in the 5 years before death. Nine frailty trajectories were identified. Those starting at nonfrail or prefrail had 2 stable trajectories (nonfrail to prefrail, n = 29 786 and stable prefrail, n = 28 499) and 2 rapidly increasing trajectories (prefrail to moderately frail, n = 28 244 and prefrail to severely frail, n = 22 596). Those who were mildly frail at baseline included 1 gradually increasing trajectory (mildly to moderately frail, n = 33 806) and 1 rapidly increasing trajectory (mildly to severely frail, n = 15 253). Trajectories that started at moderately or severely frail included 2 gradually increasing trajectories (moderately to severely frail, n = 27 662 and progressing severely frail, n = 14 478) and 1 recovering trajectory (moderately frail to mildly frail, n = 13 926).

CONCLUSIONS

Nine frailty trajectories, including 1 recovering trajectory, were identified in this cohort of older U.S. Veterans. Future work is needed to understand whether prevention and treatment strategies can improve frailty trajectories and contribute to compression of morbidity toward the end of life.

Exercise for affect and enjoyment in overweight or obese males: a comparison of high-intensity interval training and moderate-intensity continuous training

High-intensity interval training (HIIT) is effective for generating positive cardiovascular health and fitness benefits. This study compared HIIT and moderate-intensity continuous training (MICT) for affective state and enjoyment in sedentary males with overweight or obesity.Twenty-eight participants performed stationary cycling for 6 weeks × 3 sessions/week. Participants were randomly allocated to HIIT (N=16) (10 × 1-minute intervals at ~90% peak heart rate) or MICT (N=12) (30 minutes at 65-75% peak heart rate). Affective state changes were assessed after 6-weeks training. Enjoyment and acute change in affect were assessed after individual training sessions.HIIT participants reported improved positive affect following 6 weeks training (∆ 3.6 ± 4.6, p = 0.007, effect size d = 0.70), without corresponding improvement in negative affect (p = 0.48, d = -0.19). MICT did not induce any improvement in positive affect (p = 0.56, d = 0.16) or negative affect (p = 0.23, d = -0.41). Enjoyment ratings were comparable for both exercise formats (HIIT: 4.4 ± 0.4 on a 7-point scale; MICT: 4.3 ± 0.3; p = 0.70, d = 0.15).Six weeks of HIIT induced improvement in positive affect in sedentary participants with overweight or obesity. Enjoyment of training was only slightly above neutral levels for both training formats.What's already known about this topic? Exercise training can improve general affect however the optimal exercise characteristics for improving affect are unclear.Studies assessing the relative enjoyment of HIIT in comparison to MICT have largely been equivocal to date.What does this study add? HIIT can improve affective state in males with overweight or obesity.Six weeks of stationary cycling HIIT were rated as only mildly enjoyable, comparable to ratings for MICT.

Evaluating the Feasibility and Effects of a Short-Term Task Specific Power Training With and Without Cognitive Training Among Older Adults With Slow Gait Speed: A Pilot Study

Objective:

To investigate the feasibility and efficacy of short-term functional power training and further examine whether the addition of cognitive training targeting sustained attention and inhibitory control would augment the effect on the outcomes.

Design:

Randomized pilot study.

Setting:

Clinical research facility.

Participants:

Community-dwelling primary care patients (N=25) aged >65 years with mobility limitation within the VA Boston Healthcare System.

Interventions:

Participants were randomly assigned to either functional power training (n=14) or functional power+cognitive training (n=11), offered 3 times a week for 6 weeks. Session durations were either 70 minutes (functional power+cognitive training) or 40 minutes (functional power training).

Main Outcome Measures:

We evaluated feasibility (dropouts, attendance), mobility performance (Short Physical Performance Battery [SPPB]), leg power [stair climb test]), dynamic balance [figure-of-8], and gait characteristics [gait speed, stance time, step width, swing time, step length, variabilities under single-task and dual-task conditions]). Nonparametric analyses were used to compare overall pre-post changes and between-group differences.

Results:

Of the 39 veterans screened, 25 were randomized and enrolled. Twenty-one men with a mean age 76±7 years completed the study; 86% were white. Participants had a mean SPPB score of 8.3±1.6 out of 12. For those completing the study, overall attendance was 79%. Among all participants, clinically relevant and/or statistically significant median change in mobility performance (∆1 point), leg power (∆25.0W), dynamic balance (∆-1.1s), and gait characteristics (gait speed [∆0.08s, ∆0.09s], step length [∆1.9cm, ∆3.8cm], and stance time [∆-0.02s, ∆-0.05s] under single- and dual-task, respectively) were observed after 6 weeks of training. There were no statistically significant group differences in dropouts, attendance rate, or any of the outcomes based on cognitive training status.

Conclusions:

Short-term functional power training with or without a cognitive training led to clinically meaningful improvements in mobility performance, leg power, dynamic balance, and gait characteristics. These findings add to the body of evidence supporting the benefits of functional power training on clinically relevant outcomes. Additional cognitive training did not have an added effect on the study outcomes from our study. Further research is needed.

Racial and Ethnic Disparities in U.S. Veteran Health Characteristics

Racial/ethnic health disparities persist among veterans despite comparable access and quality of care. We describe racial/ethnic differences in self-reported health characteristics among 437,413 men and women (mean age (SD) = 64.5 (12.6), 91% men, 79% White) within the Million Veteran Program. The Cochran-Mantel-Haenszel test and linear mixed models were used to compare age-standardized frequencies and means across race/ethnicity groups, stratified by gender. Black, Hispanic, and Other race men and women reported worse self-rated health, greater VA healthcare utilization, and more combat exposure than Whites. Compared to White men, Black and Other men reported more circulatory, musculoskeletal, mental health, and infectious disease conditions while Hispanic men reported fewer circulatory and more mental health, infectious disease, kidney, and neurological conditions. Compared to White women, Black women reported more circulatory and infectious disease conditions and Other women reported more infectious disease conditions. Smoking rates were higher among Black men, but lower for other minority groups compared to Whites. Minority groups were less likely to drink alcohol and had lower physical fitness than Whites. By identifying differences in burden of various health conditions and risk factors across different racial/ethnic groups, our findings can inform future studies and ultimately interventions addressing disparities.

The Short Physical Performance Battery (SPPB): A Quick and Useful Tool for Fall Risk Stratification Among Older Primary Care Patients

OBJECTIVES

Evaluate fall risk with the Short Physical Performance Battery (SPPB) and examine its application within the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool advocated by the Centers for Disease Control and Prevention.

DESIGN

Prospective longitudinal cohort study.

SETTING AND PARTICIPANTS

417 community-dwelling adults aged ≥65 years at risk for mobility decline, recruited from 9 primary care practices.

METHODS

The SPPB, a 3-part performance-based test (gait time, chair stand, and balance), was assessed at baseline. Previously established cutpoints were used to categorize participant scores into 3 groups: low, middle, and best performers. Self-reported falls were assessed in-person at baseline and via phone interviews quarterly for 4 years. Multivariable negative binomial regression models were used to evaluate the relationship of the SPPB and each of its 3 components with fall rates over 1 and 4 years of follow-up. Additional analysis were stratified by fall risk screen status (+/-) based on self-reported fall history and balance self-efficacy using an adapted STEADI model.

RESULTS

Participants had median age 76 years (interquartile range 70-82) and were 67.2% female with mean baseline SPPB 8.7 ± 2.3. Poor performance on the SPPB and on each of its 3 components independently predicted higher fall risk in the first year. After 4 years, the low total baseline SPPB [rate ratio (RR) 1.53, confidence interval (CI) 1.09-2.17] and gait time performances (RR 1.61, CI 1.07-2.41) predicted higher fall risk. After stratifying the sample according to the STEADI model, we observed the highest 1-year fall risk among those with a (+) fall risk screen who also scored lowest on the SPPB.

CONCLUSIONS AND IMPLICATIONS

The SPPB is a performance measure with clinical utility for fall risk stratification over 1 and 4 years of follow-up among older adults. It shows promise as a complement to the STEADI guidelines, but its full benefits should be confirmed within a larger study.

Interrelated Neuromuscular and Clinical Risk Factors That Contribute to Falls

BACKGROUND

Neuromuscular and clinical factors contribute to falls among older adults, yet the interrelated nature of these factors is not well understood. We investigated the relationships between these factors and how they contribute to falls, which may help optimize fall risk assessment and prevention.

METHODS

A total of 365 primary care patients (age = 77 ± 7, 67% female) were included from the Boston Rehabilitative Impairment Study of the Elderly. Neuromuscular measures included leg strength and leg velocity, trunk extensor endurance, and knee range of motion. Clinical measures included memory, executive function, depressive symptoms, pain, sensory loss, vision, comorbidity, physical activity, mobility self-efficacy, and psychiatric medication. Factor analysis was used to evaluate clustering of factors. Negative binomial regression assessed the relationship of factors with three-year fall rate. Interactions were tested to examine whether clinical factors modified the relationship between neuromuscular factors and falls.

RESULTS

Three factors emerged: (i) neuromuscular factors, pain, and self-efficacy; (ii) memory; and (iii) executive function. Having three neuromuscular impairments predicted higher fall rate (incidence rate ratio [95% confidence interval]: 3.39 [1.82-6.32]) but was attenuated by memory (1.69 [1.10-2.61]), mobility self-efficacy (0.99 [0.98-0.99]), psychiatric medication use (1.54 [1.10-2.14]), and pain (1.13 [1.04-1.23]). Pain modified the relationship between neuromuscular impairment burden (number of neuromuscular impairments) and falls. Having three neuromuscular impairments was associated with a higher fall rate in patients with high levels of pain (5.73 [2.46-13.34]) but not among those with low pain.

CONCLUSIONS

Neuromuscular impairment burden was strongly associated with fall rate in older adults with pain. These factors should be considered together during fall risk assessment, post fall assessment, and prevention.

The Association of Pain Phenotype with Neuromuscular Impairments and Mobility Limitations Among Older Primary Care Patients: A Secondary Analysis of the Boston Rehabilitative Impairment Study of the Elderly

BACKGROUND

Clarifying the relationship between pain phenotypes and physical function in older adults may enhance screening and treatment for functional decline in primary care settings.

OBJECTIVE

To investigate the association of more severe pain phenotypes with neuromuscular impairments or mobility limitations among older community-dwelling primary care patients.

DESIGN

Cross-sectional analysis.

SETTING

The Boston Rehabilitative Impairment Study of the Elderly.

PARTICIPANTS

Adults aged 65 years or older.

METHODS

We counted the number of musculoskeletal pain locations (none, single site, multisite, or widespread) using the McGill Pain Questionnaire and identified pain intensity tertiles using the Brief Pain Inventory. Neuromuscular attributes (trunk extensor muscle endurance, and leg speed, strength, strength asymmetry, and range of motion) and mobility (Short Physical Performance Battery [SPPB]) were assessed with performance-based measures. Additionally, self-reported mobility was measured on the Late Life Function and Disability Instrument (LLFDI). For neuromuscular attributes and LLFDI, scores in the lowest tertile indicated neuromuscular impairment or mobility limitations, respectively. For SPPB, a score <7 (of 12) indicated severe mobility limitations.

RESULTS

Among 430 participants (mean age = 77) most were female (68%), white (83%), and had either multisite (50%) or widespread (14%) pain. After adjusting for baseline characteristics, widespread pain (compared to none) was associated with slow leg speed (adjusted odds ratio, 95% confidence interval: aOR = 2.33, 1.03-5.27), limited ankle range of motion (aOR = 2.15, 1.03-4.47) and mobility limitations on LLFDI (aOR = 3.85, 1.81-8.19). Being in the highest pain intensity tertile, versus lowest tertile, was associated with poor trunk extensor muscle endurance (aOR = 2.49, 1.41-4.39), limited ankle range of motion (aOR = 2.15, 1.25-3.71), and mobility limitations on SPPB (aOR = 2.56, 1.45-4.52), and LLFDI (aOR = 4.70, 2.63-8.40).

CONCLUSIONS

Among ambulatory, older primary care patients, more severe pain phenotypes are associated with neuromuscular impairments identified on physical testing and mobility limitations on validated measures.

Association between Diet Quality and Frailty Prevalence in the Physicians' Health Study

OBJECTIVES

Limited data suggest that a healthy diet is associated with a lower risk of frailty. We sought to assess the relationship between three measures of diet quality and frailty among male physicians.

DESIGN

Cross-sectional analysis of a cohort study.

SETTING

Physicians' Health Study.

PARTICIPANTS

A total of 9861 initially healthy US men, aged 60 years or older, who provided data on frailty status and dietary habits.

MEASUREMENTS

A cumulative deficit frailty index (FI) was calculated using 33 variables encompassing domains of comorbidity, functional status, mood, general health, social isolation, and change in weight. Diet quality was measured using the Alternative Healthy Eating Index (aHEI), Mediterranean Diet Score (MDS), and Dietary Approaches to Stop Hypertension (DASH).

RESULTS

The FI identified 38% of physicians as non-frail, 44% as pre-frail, and 18% as frail. Multinomial logistic regression models adjusted for age, smoking status, and energy intake showed that compared with the lowest aHEI quintiles, those in the highest quintiles had lower odds of frailty and pre-frailty compared with non-frailty (odds ratio [OR] for frailty = .47; 95% confidence interval [CI] = .39-.58; for pre-frailty: OR = .75; CI = .65-.87). Exercise did not modify this association (P interaction >.1). Similar relationships were observed for DASH and MDS quintiles with frailty and pre-frailty. Restricted cubic splines showed an inverse dose-response relationship of diet quality scores with odds of frailty and pre-frailty.

CONCLUSION

Cross-sectional data show an inverse dose-response relationship of diet quality with pre-frailty and frailty. Future longitudinal studies are needed to investigate whether healthier diet is a modifiable risk factor for frailty. ClinicalTrials.gov identifier: NCT00000500. J Am Geriatr Soc 68:770-776, 2020.

Milk polar lipids modulate lipid metabolism, gut permeability, and systemic inflammation in high-fat-fed C57BL/6J ob/ob mice, a model of severe obesity

Dynamic interactions between lipid metabolism, gut permeability, and systemic inflammation remain unclear in the context of obesity. Milk polar lipids, lipids derived from the milk fat globule membrane, could positively affect the aforementioned obesity-related endpoints. This study aimed to test the hypotheses that milk polar lipids will reduce gut permeability, systemic inflammation, and liver lipid levels, and differentially affect the hepatic expression of genes associated with fatty acid synthesis and cholesterol regulation in preexisting obesity. We fed 3 groups of C57BL/6J ob/ob mice (n = 6 per group) for 2 wk: (1) a modified AIN-93G diet (CO) with 34% fat by energy; (2) CO with milk gangliosides (GG) at 0.2 g/kg of diet; and (3) CO with milk phospholipids (PL) at 10 g/kg of diet. The GG and PL were provided as semi-purified concentrates and replaced 2.0% and 7.2% of dietary fat by energy. The GG and PL did not affect total food intake, weight gain, fasting glucose, or gut permeability. The PL decreased liver mass and the mesenteric fat depot compared with the CO. The GG increased tight junction protein occludin in colon mucosa compared with the CO. The GG and PL decreased tight junction protein zonula occludens-1 in jejunum mucosa compared with the CO. Plasma endotoxin increased during the study but was unaffected by the treatments. Compared with the CO and GG, the PL increased plasma sphingomyelin and plasma IL-6. The GG and PL differentially regulated genes associated with lipid metabolism in the liver compared with the CO. Regarding general effects on lipid metabolism, the GG and PL decreased lipid levels in the liver and the mesenteric depot, and increased lipid levels in the plasma. Diet consumption decreased significantly when the ob/ob mice were kept in metabolic cages, which were not big enough and resulted in unwanted animal deaths. Future studies may keep this in mind and use better metabolic equipment for ob/ob mice. In conclusion, dietary milk polar lipids may have limited beneficial effects on gut barrier integrity, systemic inflammation, and lipid metabolism in the context of severe obesity.

Meaningful Change Estimates for the Late-Life Function and Disability Instrument in Older Adults

BACKGROUND

The Late-Life Function and Disability Instrument (LLFDI) is a well-validated and frequently used patient-reported outcome for older adults. The aim of this study was to estimate the minimal clinically important difference (MCID) of the LLFDI-Function Component (LLFDI-FC) and its subscales among community-dwelling older adults with mobility limitations.

METHODS

We performed a secondary analysis of the Boston Rehabilitative Impairment Study of the Elderly, a longitudinal cohort study of older adults with mobility limitations residing in the community. The MCID for each LLFDI-FC scale over 1 year of follow-up was estimated using both anchor- and distribution-based methods, including mean change scores on a patient-reported global rating of change in function scale, the standard error of measurement (SEM), and the minimal detectable change with 90% confidence (MDC90).

RESULTS

Data from 320 older adults were used in the analysis (mean age 76 years, 69% female, mean of four chronic conditions). Meaningful change estimates for "small change" based on the global rating of change and SEM were 2, 3, 4, and 4 points for the LLFDI-FC overall function scale and basic lower-extremity, advanced lower-extremity, and upper-extremity subscales, respectively. Estimates for "substantial change" based on the global rating of change and minimal detectable change with 90% confidence were 5, 6, 9, and 10 points for the overall function scale and basic lower-extremity, advanced lower-extremity, and upper-extremity subscales, respectively.

CONCLUSION

This study provides the first MCID estimates for the LLFDI-FC, a widely used patient-reported measure of function. These values can be used to interpret the outcomes of longitudinal investigations of functional status in similar populations of community-dwelling older adults.

The Relationship Between Cognitive Impairment and Upper Extremity Function in Older Primary Care Patients

BACKGROUND

Individuals with mild cognitive impairment (MCI), often a precursor to dementia, experience limitations in completing daily activities. These limitations are particularly important to understand, as they predict risk for dementia. Relations between functional changes and both cognitive decline and upper extremity motor impairments have been reported, but the contribution of motor function to relations between cognitive function and functional independence remains poorly understood. We examined the relationship between cognition and upper extremity activities, and whether this relation was mediated by motor function.

METHODS

A total of 430 community-dwelling primary care patients aged at least 65 years from the Boston Rehabilitative Impairment Study of the Elderly completed self-report measures of upper extremity function, tests of neuromuscular attributes to measure motor function (reaction time, pronosupination of the hands), and neuropsychological measures. Participants were classified based on cognitive performance into groups: MCI and without MCI, with MCI further classified by cognitive subtype. Regression and mediation analyses examined group differences and relations between cognitive function, upper extremity function, and neuromuscular attributes.

RESULTS

MCI participants demonstrated poorer neuromuscular attributes and self-reported upper extremity function, and neuromuscular attributes significantly mediated positive relations between cognitive status and self-reported upper extremity function. Poorer self-reported upper extremity function was most prominent for groups with executive dysfunction.

CONCLUSIONS

Together with previous research, results suggest that the relationship between cognitive function, motor function, and functional activities is not confined to mobility tasks but universally related to body systems and functional activities. These findings inform new approaches for dementia risk screening and rehabilitative care.

Neuromuscular Attributes Associated With Lower Extremity Mobility Among Community-Dwelling Older Adults

BACKGROUND

The Short Physical Performance Battery (SPPB) is advocated as a screening tool in geriatric care for predicting future disability. We aimed to identify the leg neuromuscular attributes to be targeted in rehabilitative care among older adults with poor SPPB scores.

METHODS

Boston Rehabilitative Impairment Study of the Elderly (Boston RISE) participants (n = 430) underwent assessment of neuromuscular attributes (leg strength, leg velocity, trunk extensor endurance, knee flexion range of motion [ROM], ankle ROM, and foot sensation). Linear regression models examined association between each neuromuscular attribute and SPPB, adjusting for age, race, gender, comorbidity, body mass index, depression, cognition, and other neuromuscular attributes.

RESULTS

Participants with 1 SD unit higher leg strength, leg velocity, and trunk extensor endurance had 0.52, 0.30, and 0.52 points higher SPPB total score. Participants with ankle ROM impairment and foot sensory loss had 0.43 and 0.57 lower SPPB total score compared with those without these. Leg strength and trunk extensor endurance were associated with balance; leg velocity, trunk extensor endurance, and ankle ROM were associated with gait speed; and strength, trunk extensor endurance, knee ROM, and feet sensation were associated with chair stand score. Neuromuscular attributes, along with covariates, explained 40.4% of the variance in the total SPPB score, a substantial increase over the 22.7% variance explained by covariates alone.

CONCLUSIONS

Neuromuscular attributes affect mobility performance in older patients as measured by the SPPB. Specific impairments are associated with poor performance in specific component scores. Assessment of the SPPB components and rehabilitation of associated impairments may help improve the functional performance among older adults.

The Association Between Social Engagement, Mild Cognitive Impairment, and Falls Among Older Primary Care Patients

OBJECTIVES

To examine associations between mild cognitive impairment (MCI) and falls among primary care patients, and to investigate whether social engagement (SE) modifies these associations.

DESIGN

Cross sectional analysis using baseline data from an observational cohort study.

SETTING

Primary care.

PARTICIPANTS

Community-dwelling older adults (N=430) at risk of mobility decline with a mean age of 76.6 years (range 65-96y).

MAIN OUTCOME MEASURES

The number of falls in the past year was reported at the baseline interview. MCI was identified using a cutoff of 1.5 SD below the age-adjusted mean on at least 2 of the standardized cognitive performance tests. SE (eg, keeping in touch with friends and family, volunteering, participating social activities…) was assessed with the Late Life Function and Disability Instrument, and required a score above the median value 49.5 out of 100.

RESULTS

MCI was present among 42% of participants and 42% reported at least 1 fall in the preceding year. Using generalized estimating equations, MCI was associated with a 77% greater rate of falls (P<.05). There was a statistically significant interaction between SE and MCI on the rate of falls (P<.01), such that at a high level of SE, MCI was not statistically associated with falls (P=.83). In participants with lower levels of SE, MCI is associated with 1.3 times greater rate of falls (P<.01).

CONCLUSIONS

While MCI is associated with a greater risk for falls, higher levels of SE may play a protective role.

The Effectiveness of Dance Interventions on Physical Health Outcomes Compared to Other Forms of Physical Activity: A Systematic Review and Meta-Analysis

BACKGROUND

Physical inactivity is one of the key global health challenges as it is associated with adverse effects related to ageing, weight control, physical function, longevity, and quality of life. Dancing is a form of physical activity associated with health benefits across the lifespan, even at amateur levels of participation. However, it is unclear whether dance interventions are equally as effective as other forms of physical activity.

OBJECTIVE

The aim was to systematically review the literature on the effectiveness of structured dance interventions, in comparison to structured exercise programmes, on physical health outcome measures.

METHODS

Seven databases were searched from earliest records to 4 August 2017. Studies investigating dance interventions lasting > 4 weeks that included physical health outcomes and had a structured exercise comparison group were included in the study. Screening and data extraction were performed by two reviewers, with all disagreements resolved by the primary author. Where appropriate, meta-analysis was performed or an effect size estimate generated.

RESULTS

Of 11,434 studies identified, 28 (total sample size 1276 participants) met the inclusion criteria. A variety of dance genres and structured exercise interventions were compared. Meta-analyses showed dance interventions significantly improved body composition, blood biomarkers, and musculoskeletal function. The effect of either intervention on cardiovascular function and self-perceived mobility was equivalent.

CONCLUSION

Undertaking structured dance of any genre is equally and occasionally more effective than other types of structured exercise for improving a range of health outcome measures. Health practitioners can recommend structured dance as a safe and effective exercise alternative.

Which Neuromuscular Attributes Are Associated With Changes in Mobility Among Community-Dwelling Older Adults With Symptomatic Lumbar Spinal Stenosis?

OBJECTIVES

To identify neuromuscular attributes associated with mobility and changes in mobility over 2 years of follow-up among patients with and without symptomatic lumbar spinal stenosis (SLSS).

DESIGN

Secondary analysis of a longitudinal cohort study.

SETTING

Outpatient rehabilitation center.

PARTICIPANTS

Community-dwelling older adults ≥65 years with self-reported mobility limitations (N=430). SLSS was determined using self-reported symptoms of neurogenic claudication and imaging-detected lumbar spinal stenosis.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Basic and advanced mobility as measured by the Late-Life Function and Disability Instrument (LLFDI).

RESULTS

Among 430 community-dwelling older adults, 54 (13%) patients met criteria for SLSS, while 246 (57%) did not. On average LLFDI basic and advanced mobility scores decreased significantly from baseline through year 2 for participants with SLSS (basic: P=.04, 95% CI 0.18, 5.21; advanced P=.03, 95% CI 0.39, 7.84). Trunk extensor muscle endurance (trunk endurance) and leg strength were associated with baseline basic mobility (R2=0.27, P<.001) while leg strength and knee flexion range of motion (ROM) were associated with baseline advanced mobility among participants with SLSS (R2=0.47, P<.001). Among participants without SLSS trunk endurance, leg strength and ankle ROM were associated with baseline basic mobility (R2=0.38, P<.001), while trunk endurance, leg strength, leg strength asymmetry, and knee flexion ROM were associated with advanced mobility (R2=0.20, P<.001). Trunk endurance and leg strength were associated with change in basic mobility (R2=0.29, P<.001), while trunk endurance and knee flexion ROM were associated with change in advanced mobility (R2=0.42, P<.001) among participants with SLSS. Among participants without SLSS trunk endurance, leg strength, knee flexion ROM, and ankle ROM were associated with change in basic mobility (R2=0.22, P<.001), while trunk endurance, leg strength, and knee flexion ROM were associated with change in advanced mobility (R2=0.36, P<.001).

CONCLUSIONS

Patients with SLSS experience greater impairment in the neuromuscular attributes: trunk endurance, leg strength, leg strength asymmetry, knee flexion and extension ROM, and ankle ROM compared to patients without SLSS. Differences exist in the neuromuscular attributes associated with mobility at baseline and decline in mobility over 2 years of follow-up for patients with and without SLSS. These findings may help guide rehabilitative care approaches for patients with SLSS.

Comparison of lower limb stiffness between male and female dancers and athletes during drop jump landings

Repetition of jumps in dance and sport training poses a potential injury risk; however, non-contact landing injuries are more common in athletes than dancers. This study aimed to compare the lower limb stiffness characteristics of dancers and athletes during drop landings to investigate possible mechanisms of impact-related injuries. Kinematics and kinetics were recorded as 39 elite modern and ballet dancers (19 men and 20 women) and 40 college-level team sport athletes (20 men and 20 women) performed single-legged drop landings from a 30-cm platform. Vertical leg stiffness and joint stiffness of the hip, knee, and ankle were calculated using a spring-mass model. Stiffness data, joint kinematics, and moments were compared with a group-by-sex 2-way analysis of variance. Multiple linear regression was used to assess the relative contribution of hip and knee and ankle joint stiffness to variance in overall vertical leg stiffness for dancers and athletes. Dancers had lower leg (P < 0.001), knee joint (P = 0.034), and ankle joint stiffness (P = 0.043) than athletes. This was facilitated by lower knee joint moments (P = 0.012) and greater knee (P = 0.029) and ankle joint (P = 0.048) range of motion in dancers. Males had higher leg (P < 0.001) and ankle joint stiffness (P < 0.001) than females. This occurred through lower ankle range of motion (P < 0.001) and greater ankle moment (P = 0.022) compared to females. Male and female dancers demonstrated reduced lower limb stiffness compared to athletes, indicating a more pliable landing technique. Dance training techniques could potentially inform approaches to injury prevention in athletes.

Bone mineral density in pre-professional female ballet dancers: A systematic review and meta-analysis

OBJECTIVES

To quantitatively compare bone mineral density (BMD) outcomes between pre-professional female adolescent ballet dancers and control populations.

DESIGN

Systematic review and meta-analysis.

METHODS

Six electronic databases and relevant journals were systematically searched up to August 2017. Included articles examined BMD in adolescent females undergoing pre-professional ballet training and healthy age-matched controls with an available English full text. Dancers were aged 15-19 years and trained in ballet at least 10h per week. BMD data were analysed via standardized mean difference to account for differences in reporting methods RESULTS: From 3984 potential articles, 8 cross-sectional studies were accepted for inclusion, which compared 293 dancers (16.9±0.8 years) to 333 controls (16.9±0.9 years). No data were available from longitudinal studies. Dancers displayed lower BMD at the radius and higher BMD at the femoral neck, femoral trochanter and Ward's triangle. No significant differences were observed in the lumbar spine or tibia. The overall study quality was low and heterogeneity was present in some analyses.

CONCLUSIONS

This meta-analysis indicates that there may be a site-specific osteogenic effect of pre-professional classical ballet training in adolescent females, with a notable and concerning finding of reduced upper limb BMD compared to age-matched controls. Longitudinal cohort studies are required to confirm the effects of pre-professional ballet training on BMD during adolescence.

Accuracy of step count measured by physical activity monitors: The effect of gait speed and anatomical placement site

INTRODUCTION

Consumer-based physical activity monitors (PAMs) are becoming increasingly popular, with multiple global organisations recommending physical activity levels that equate to 10,000 steps per day for optimal health. We therefore aimed to compare the step count of five PAMs to a visual step count to identify the most accurate monitors at varying gait speeds, along with the optimal anatomical placement site.

METHODS

Participants completed 3min on a treadmill for five speeds (5.0km/h, 6.5km/h, 8.0km/h, 10km/h, 12km/h). An Actigraph wGT3XBT-BT was placed on the waist and wrist, a FitBit One on the waist, and a Fitbit Flex, Fitbit Charge HR and Jawbone UP24 on both wrists. A video of participant's lower limbs was recorded for visual count. Analyses of variance (ANOVAs) were conducted to examine the effects of gait speed and device placement site on step count accuracy.

RESULTS

Thirty-one participants (mean age 24.3±5.2yrs) took part. Step count error ranged from 41.3±13.8% for the wrist-worn Actigraph to only 0.04±4.3% and -0.3±4.0% for the waist-worn Fitbit One and Actigraph, respectively. Across all gait speeds, waist-worn devices achieved better accuracy than those on the wrist (p<0.001). The Jawbone was the most accurate wrist-worn consumer-based device at slower speeds (p=0.026), with the Fitbit Flex, and Fitbit Charge HR increasing in accuracy to match the Jawbone at higher speeds.

CONCLUSION

The accuracy and reliability of consumer-based PAMs and the Actigraph is affected by anatomical placement site and walking speed. The Fitbit One and Actigraph on the waist were the strongest performers across all speeds.

The effects of high-intensity interval training vs. moderate-intensity continuous training on body composition in overweight and obese adults: a systematic review and meta-analysis

OBJECTIVE

The objective of this study is to compare the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) for improvements in body composition in overweight and obese adults.

METHODS

Trials comparing HIIT and MICT in overweight or obese participants aged 18-45 years were included. Direct measures (e.g. whole-body fat mass) and indirect measures (e.g. waist circumference) were examined.

RESULTS

From 1,334 articles initially screened, 13 were included. Studies averaged 10 weeks × 3 sessions per week training. Both HIIT and MICT elicited significant (p < 0.05) reductions in whole-body fat mass and waist circumference. There were no significant differences between HIIT and MICT for any body composition measure, but HIIT required ~40% less training time commitment. Running training displayed large effects on whole-body fat mass for both HIIT and MICT (standardized mean difference -0.82 and -0.85, respectively), but cycling training did not induce fat loss.

CONCLUSIONS

Short-term moderate-intensity to high-intensity exercise training can induce modest body composition improvements in overweight and obese individuals without accompanying body-weight changes. HIIT and MICT show similar effectiveness across all body composition measures suggesting that HIIT may be a time-efficient component of weight management programs.

Consumer sensory evaluation and chemical composition of beef gluteus medius and triceps brachii steaks from cattle finished on forage or concentrate diets

The objective of this study was to assess the impact of cattle finishing diet and muscle type on meat quality. Consumer sensory response, proximate composition, Warner-Bratzler shear force (WBSF), fatty acid composition, and volatile compounds were assessed from the gluteus medius (GM) and triceps brachii (TB) muscles of cattle ( = 6 per diet) which were grain-finished (USUGrain) on conventional feedlot or 2 forage diets, a perennial legume, birdsfoot trefoil-finished (USUBFT; ), and grass-finished (USUGrass; ). Diet had an interacting effect with muscle for all sensory attributes ( ≤ 0.002), except aroma and flavor ( ≥ 0.078). In forage-finished beef, tenderness, fattiness, overall liking, and WBSF tenderness of GM was greater ( < 0.05) than TB, whereas for USUGrain, the tenderness, fattiness, overall liking, and WBSF tenderness of both muscles were similar ( > 0.05) but the juiciness of TB was more liked than USUGrain GM ( < 0.05). The juiciness of forage-finished beef did not differ ( > 0.05) between GM and TB. Lower ( < 0.05) intramuscular fat (IMF) percent was determined for USUGrass beef in comparison with USUGrain beef. The IMF percent of USUBFT beef was similar ( > 0.05) to both USUGrass and USUGrain beef. However, IMF percent was not impacted by muscle type ( = 0.092). The ratio of -6:-3 fatty acids was affected by muscle dependent on diet ( = 0.016). The ratio of -6:-3 fatty acids was affected by the interaction of muscle × diet ( = 0.016). Between forage diets (USUGrass and USUBFT), -6:-3 ratios were similar ( > 0.05) between GM and TB, whereas within USUGrain, the GM was greater ( < 0.05) than the TB. Cumulative MUFA was greater ( < 0.05) in USUGrain compared with both USUGrass and USUBFT, which were similar ( > 0.05). Strecker aldehydes, ketones, pyrazines, and methional were affected ( ≤ 0.036) by muscle and found to have a greater concentration in GM compared with TB. Overall, consumers determined that USUGrain GM and TB had similar ( > 0.05) quality ratings. However, within forage-finished beef, the GM was perceived more frequently ( < 0.05) to be of premium quality and the forage-finished TB was more frequently ( < 0.05) rated as having unsatisfactory quality. These findings were in agreement with ratings of tenderness and overall liking. Therefore, in the context of our consumer group grilled GM and TB steaks, grain-finished beef provided more uniform quality and eating experience compared with forage-finished beef.

Interventions to improve fundamental motor skills in pre-school aged children: A systematic review and meta-analysis

OBJECTIVES

Mastery in -fundamental motor skills (FMS) is associated with increased physical activity (PA) in school-aged children; however, there is limited research on pre-schoolers (3-5 years). We aimed to evaluate interventions for improving FMS as well as PA.

DESIGN/METHODS

A search of electronic databases was conducted for controlled trials using PA interventions with FMS as outcomes in healthy pre-schoolers. Standardised mean difference (SMD), 95% confidence intervals and publication bias were calculated for each outcome using Revman 5.3.

RESULTS

Twenty trials met inclusion criteria. In total, 4255 pre-schoolers were analysed with 854 completing a FMS intervention. Studies were categorised into three groups (i) Teacher-Led (TL)(n=13); (ii) Child-Centred (CC)(n=6) and (iii) Parent-Led (PL)(n=1). Mean age was 4.3±0.4 years, with equal gender distribution. Interventions ran for 21±17 weeks, 3±1 times per week for 35±17 minutes. TL interventions significantly improved overall FMS (SMD=0.14[0.06, 0.21]; p=0.0003), object control (SMD=0.47[0.15, 0.80]; p= 0.004), and locomotor skills (SMD=0.44[0.16, 0.73]; p=0.002), whereas CC interventions were not significant. There was a small, non-significant reduction in sedentary time (SMD=-0.35[-0.80, 0.10]; p= 0.12), and a large non-significant increase in PA (SMD=0.79[-0.83, 2.41]; p=0.34).

CONCLUSION

PA interventions improve FMS in pre-schoolers; however, due to limited research, more study is needed on CC interventions. Targeting FMS development in pre-schoolers may promote higher PA levels and reduce sedentary time, however more study is needed.

A Novel Approach to Identifying Trajectories of Mobility Change in Older Adults

Objectives

To validate trajectories of late-life mobility change using a novel approach designed to overcome the constraints of modest sample size and few follow-up time points.

Methods

Using clinical reasoning and distribution-based methodology, we identified trajectories of mobility change (Late Life Function and Disability Instrument) across 2 years in 391 participants age ≥65 years from a prospective cohort study designed to identify modifiable impairments predictive of mobility in late-life. We validated our approach using model fit indices and comparing baseline mobility-related factors between trajectories.

Results

Model fit indices confirmed that the optimal number of trajectories were between 4 and 6. Mobility-related factors varied across trajectories with the most unfavorable values in poor mobility trajectories and the most favorable in high mobility trajectories. These factors included leg strength, trunk extension endurance, knee flexion range of motion, limb velocity, physical performance measures, and the number and prevalence of medical conditions including osteoarthritis and back pain.

Conclusions

Our findings support the validity of this approach and may facilitate the investigation of a broader scope of research questions within aging populations of varied sizes and traits.

Concentration and ratio of essential fatty acids influences the inflammatory response in lipopolysaccharide challenged mice

The goal of this study was to evaluate the role of both the % of dietary, 18-carbon PUFA (2.5%, 5% and 10%) and the n-6:n-3 ratio (1:1, 10:1 and 20:1) on the acute inflammatory response. Mice were fed diets for 8 weeks and injected intraperitoneally with LPS to induce acute inflammation. After 24h mice were sacrificed and plasma cytokines measured. Diets significantly affected the erythrocyte PUFA composition and the effect of PUFA ratio was more prominent than of PUFA concentration. The % dietary PUFA affected feed efficiency (p<0.05) and there was a PUFA×ratio interaction with body fat (p<0.01). In mice fed high %kcal from PUFA, those given a low n-6:n-3 ratio had more body fat than those fed a high ratio. Of the twelve cytokines measured, eleven were significantly affected by the % PUFA (p<0.05), whereas five were affected by the ratio (p<0.05). For seven cytokines, there was a significant PUFA×ratio interaction according to a two way ANOVA (p<0.05). These data indicate that dietary polyunsaturated fatty acids can affect LPS induced-inflammation.

Effect of Pain and Mild Cognitive Impairment on Mobility

OBJECTIVES

To examine the effect of pain and mild cognitive impairment (MCI)-together and separately-on performance-based and self-reported mobility outcomes in older adults in primary care with mild to moderate self-reported mobility limitations.

DESIGN

Cross-sectional analysis.

SETTING

Academic community outpatient clinic.

PARTICIPANTS

Individuals aged 65 and older in primary care enrolled in the Boston Rehabilitative Impairment Study in the Elderly who were at risk of mobility decline (N=430).

MEASUREMENTS

Participants with an average score greater than three on the Brief Pain Inventory (BPI) were defined as having pain. MCI was defined using age-adjusted scores on a neuropsychological battery. Multivariable linear regression models assessed associations between pain and MCI, together and separately, and mobility performance (habitual gait speed, Short Physical Performance Battery), and self-reports of function and disability in various day-to-day activities (Late Life Function and Disability Instrument).

RESULTS

The prevalence of pain was 34% and of MCI was 42%; 17% had pain only, 25% had MCI only, 17% had pain and MCI, and 41% had neither. Participants with pain and MCI performed significantly worse than all others on all mobility outcomes (P<.001). Participants with MCI only or pain only also performed significantly worse on all mobility outcomes than those with neither (P<.001).

CONCLUSION

Mild to moderate pain and MCI were independently associated with poor mobility, and the presence of both comorbidities was associated with the poorest status. Primary care practitioners who encounter older adults in need of mobility rehabilitation should consider screening them for pain and MCI to better inform subsequent therapeutic interventions.

Legume finishing provides beef with positive human dietary fatty acid ratios and consumer preference comparable with grain-finished beef

Consumer liking, proximate composition, pH, Warner-Bratzler shear force, fatty acid composition, and volatile compounds were determined from the LM (longissimus thoracis) of cattle ( = 6 per diet) finished on conventional feedlot (USUGrain), legume, and grass forage diets. Forage diets included a condensed tannin-containing perennial legume, birdsfoot trefoil (; USUBFT), and a grass, meadow brome ( Rehmann; USUGrass). Moreover, representative retail forage (USDA Certified Organic Grass-fed [OrgGrass]) and conventional beef (USDA Choice, Grain-fed; ChGrain) were investigated ( = 6 per retail type). The ChGrain had the greatest ( < 0.05) intramuscular fat (IMF) percentage followed by USUGrain, the IMF percentage of which was greater ( < 0.05) than that of USUGrass and OrgGrass. The IMF content of USUBFT was similar ( > 0.05) to that of both USUGrain and USUGrass. Both grain-finished beef treatments were rated greater ( < 0.05) for flavor, tenderness, fattiness, juiciness, and overall liking compared with USUGrass and OrgGrass. Consumer liking of USUBFT beef tenderness, fattiness, and overall liking were comparable ( > 0.05) with that of USUGrain and ChGrain. Flavor liking was rated greatest ( < 0.05) for USUGrain and ChGrain, and that of USUBFT was intermediate ( > 0.05) to those of ChGrain, USUGrass, and OrgGrass. Cumulative SFA and MUFA concentrations were greatest ( < 0.05) in ChGrain and USUGrain, whereas USUGrass and OrgGrass had lower ( < 0.05) concentrations. Concentrations of cumulative SFA and MUFA in USUBFT were intermediate and similar ( > 0.05) to those of USUGrain and USUGrass. Each forage-finished beef treatment, USUGrass, OrgGrass, and USUBFT, had lower ( < 0.001) ratios of -6:-3 fatty acids. Hexanal was the most numerically abundant volatile compound. The concentration of hexanal increased with increasing concentrations of total PUFA. Among all the lipid degradation products (aldehydes, alcohols, furans, carboxylic acids, and ketones) measured in this study, there was an overall trend toward greater quantities in grain-finished products, lower quantities in USUGrass and OrgGrass, and intermediate quantities in USUBFT. This trend was in agreement with IMF content, fatty acid concentrations, and sensory attributes. These results suggest an opportunity for a birdsfoot trefoil finishing program, which results in beef comparable in sensory quality with grain-finished beef but with reduced -6 and SFA, similar to grass-finished beef.

In vivo markers of inflammatory response in recent-onset schizophrenia: a combined study using [(11)C]DPA-713 PET and analysis of CSF and plasma

Several lines of evidence suggest aberrant immune response in schizophrenia, including elevated levels of cytokines. These cytokines are thought to be produced by activated microglia, the innate immune cells of the central nervous system. However, increase in translocator protein 18 kDa (TSPO), a marker of activated glia, has not been found in patients with chronic schizophrenia using second-generation radiotracers and positron emission tomography (PET)-based neuroimaging. In this study we focused on patients with recent onset of schizophrenia (within 5 years of diagnosis). Quantified levels of TSPO in the cortical and subcortical brain regions using the PET-based radiotracer [(11)C]DPA-713 were compared between the patients and healthy controls. Markers of inflammation, including interleukin 6 (IL-6), were assessed in the plasma and cerebrospinal fluid (CSF) in these participants. We observed no significant change in the binding of [(11)C]DPA-713 to TSPO in 12 patients with recent onset of schizophrenia compared with 14 controls. Nevertheless, the patients with recent onset of schizophrenia showed a significant increase in IL-6 in both plasma (P<0.001) and CSF (P=0.02). The CSF levels of IL-6 were significantly correlated with the levels of IL-6 in plasma within the total study population (P<0.001) and in patients with recent onset of schizophrenia alone (P=0.03). Our results suggest that increased levels of IL-6 may occur in the absence of changed TSPO PET signal in the brains of medicated patients with recent onset of schizophrenia. Future development of PET-based radiotracers targeting alternative markers of glial activation and immune response may be needed to capture the inflammatory signature present in the brains of patients with early-stage disease.

Neuromuscular Impairments Contributing to Persistently Poor and Declining Lower-Extremity Mobility Among Older Adults: New Findings Informing Geriatric Rehabilitation

OBJECTIVE

To identify neuromuscular impairments most predictive of unfavorable mobility outcomes in late life.

DESIGN

Longitudinal cohort study.

SETTING

Research clinic.

PARTICIPANTS

Community-dwelling primary care patients aged ≥65 years (N=391) with self-reported mobility modifications, randomly selected from a research registry.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Categories of decline in and persistently poor mobility across baseline, 1 and 2 years of follow-up in the Lower-Extremity Function scales of the Late-Life Function and Disability Instrument. The following categories of impairment were assessed as potential predictors of mobility change: strength (leg strength), speed of movement (leg velocity, reaction time, rapid leg coordination), range of motion (ROM) (knee flexion/knee extension/ankle ROM), asymmetry (asymmetry of leg strength and knee flexion/extension ROM measures), and trunk stability (trunk extensor endurance, kyphosis).

RESULTS

The largest effect sizes were found for baseline weaker leg strength (odds ratio [95% confidence interval]: 3.45 [1.72-6.95]), trunk extensor endurance (2.98 [1.56-5.70]), and slower leg velocity (2.35 [1.21-4.58]) predicting a greater likelihood of persistently poor function over 2 years. Baseline weaker leg strength, trunk extensor endurance, and restricted knee flexion motion also predicted a greater likelihood of decline in function (1.72 [1.10-2.70], 1.83 [1.13-2.95], and 2.03 [1.24-3.35], respectively).

CONCLUSIONS

Older adults exhibiting poor mobility may be prime candidates for rehabilitation focused on improving these impairments. These findings lay the groundwork for developing interventions aimed at optimizing rehabilitative care and disability prevention, and highlight the importance of both well-recognized (leg strength) and novel impairments (leg velocity, trunk extensor muscle endurance).

Health Characteristics, Neuromuscular Attributes, and Mobility Among Primary Care Patients With Symptomatic Lumbar Spinal Stenosis: A Secondary Analysis

BACKGROUND AND PURPOSE

Mobility problems are common among older adults. Symptomatic lumbar spinal stenosis (SLSS) is a major contributor to mobility limitations among older primary care patients. In comparison with older primary care patients with mobility problems but without SLSS, it is unclear how mobility problems differ in older primary care patients with SLSS. The purpose of this study was to compare health characteristics, neuromuscular attributes, and mobility status in a sample of older primary care patients with and without SLSS who were at risk for mobility decline. We hypothesized that patients with SLSS will manifest poorer health and greater severity of neuromuscular impairments and mobility limitations.

METHODS

This is a secondary analysis of the Boston Rehabilitative Study of the Elderly (Boston RISE). Fifty community-dwelling primary care patients aged 65 years or older at risk for mobility decline met inclusion criteria. SLSS was determined on the basis of computerized tomography (CT) scan and self-reported symptoms characteristic of neurogenic claudication. Outcome measures included health characteristics, neuromuscular attributes (trunk endurance, limb strength, limb speed, limb strength asymmetry, ankle range of motion [ROM], knee ROM, kyphosis, sensory loss), and mobility (Late-Life Function and Disability Instrument: basic and advanced lower extremity function subscales, 400-meter walk test, habitual gait speed, and Short Physical Performance Battery score). Health characteristics were collected at a baseline assessment. Neuromuscular attributes and mobility status were measured at the annual visit closest to conducting the CT scan.

RESULTS AND DISCUSSION

Five participants met criteria for having SLSS. Differences are reported in medians and interquartile ranges. Participants with SLSS reported more global pain, a greater number of comorbid conditions [SLSS: 7.0 (2.0) vs no-SLSS: 4.0 (2.0), P < .001], and experienced greater limitation in knee ROM [SLSS: 115.0° (8.0°) vs no-SLSS: 126.0° (10.0°), P = .04] and advanced lower extremity function than those without SLSS.A limitation of this study was its small sample size and therefore inability to detect potential differences across additional measures of neuromuscular attributes and mobility. Despite the limitation, the differences in mobility for participants with SLSS may support physical therapists in designing interventions for older adults with SLSS. Participants with SLSS manifested greater mobility limitations that exceeded meaningful thresholds across all performance-based and self-reported measures. In addition, our study identified that differences in mobility extended beyond not just walking capacity but also across a variety of tasks that make up mobility for those with and without SLSS.

CONCLUSION

Among older primary care patients who are at risk for mobility decline, patients with SLSS had greater pain, higher levels of comorbidity, greater limitation in knee ROM, and greater limitations in mobility that surpassed meaningful thresholds. These findings can be useful when prioritizing interventions that target mobility for patients with SLSS.

Mobility-Related Consequences of Reduced Lower-Extremity Peripheral Nerve Function with Age: A Systematic Review

The objective of this study is to systematically review the relationship between lower-extremity peripheral nerve function and mobility in older adults. The National Library of Medicine (PubMed) was searched on March 23, 2015 with no limits on publication dates. One reviewer selected original research studies of older adults (≥65 years) that assessed the relationship between lower-extremity peripheral nerve function and mobility-related outcomes. Participants, study design and methods of assessing peripheral nerve impairment were evaluated and results were reported and synthesized. Eight articles were identified, including 6 cross-sectional and 2 longitudinal studies. These articles investigated 6 elderly cohorts (4 from the U.S. and 2 from Italy): 3 community-dwelling (including 1 with only disabled women and 1 without mobility limitations at baseline), 1 with both community-dwelling and institutionalized residents, 1 from a range of residential locations, and 1 of patients with peripheral arterial disease. Mean ages ranged from 71-82 years. Nerve function was assessed by vibration threshold (n=2); sensory measures and clinical signs and symptoms of neuropathy (n=2); motor nerve conduction (n=1); and a combination of both sensory measures and motor nerve conduction (n=3). Each study found that worse peripheral nerve function was related to poor mobility, although relationships varied based on the nerve function measure and mobility domain assessed. Six studies found that the association between nerve function and mobility persisted despite adjustment for diabetes. Evidence suggests that peripheral nerve function impairment at various levels of severity is related to poor mobility independent of diabetes. Relationships varied depending on peripheral nerve measure, which may be particularly important when investigating specific biological mechanisms. Future research needs to identify risk factors for peripheral nerve decline beyond diabetes, especially those common in late-life and modifiable. Interventions to preserve nerve function should be investigated with regard to their effect on postponing or preventing disability in older adults.

Leg and Trunk Impairments Predict Participation in Life Roles in Older Adults: Results From Boston RISE

BACKGROUND

The physical impairments that affect participation in life roles among older adults have not been identified. Using the International Classification of Functioning Disability and Health as a conceptual framework, we aimed to determine the leg and trunk impairments that predict participation over 2 years, both directly and indirectly through mediation by changes in activities.

METHODS

We analyzed 2 years of data from the Boston Rehabilitative Impairment Study of the Elderly, a cohort study of 430 primary care patients with self-reported mobility limitation (mean age 77 years; 68% female; average of four chronic conditions). Frequency of and limitations in participation were examined using the Late-Life Disability Instrument. Baseline physical impairments included: leg strength, leg speed of movement, knee range of motion (ROM), ankle ROM, leg strength asymmetry, kyphosis, and trunk extensor endurance. Structural equation modeling with latent growth curve analysis was used to identify the impairments that predicted participation at year 2, mediated by changes in activities. Models were adjusted for baseline participation, age, and gender.

RESULTS

Leg speed and ankle ROM directly influenced participation in life roles during follow-up (βdirect = 1.39-4.53 and 4.70, respectively). Additionally, ankle ROM and trunk extensor endurance contributed indirectly to participation score at follow-up via effects on changes in activities (βindirect = -1.06 to -4.24 and 1.01 to 4.18, respectively).

CONCLUSIONS

Leg speed, ankle ROM, and trunk extensor endurance are key physical impairments predicting participation in life roles in older adults. These results have implications for the development of exercise interventions to enhance participation.

How Should Disability Be Measured in Older Adults? An Analysis from the Boston Rehabilitative Impairment Study of the Elderly

OBJECTIVES

To determine and compare the predictive validity and responsiveness of the Late-Life Function and Disability Instrument (LLFDI) frequency and limitation dimensions in assessing two critical dimensions of disability: frequency of and limitations in performance of major life roles.

DESIGN

Secondary analysis of 2-year follow-up data from the Boston Rehabilitative Impairment Study of the Elderly.

SETTING

Primary care.

PARTICIPANTS

Community-dwelling older adults (≥65) (n = 430) at risk of mobility decline.

MEASUREMENTS

The LLFDI frequency and limitation dimensions, self-rated health, hospitalizations, and emergency department (ED) visits over 2 years. Responsiveness measures included effect size (ES) estimates and minimal detectable change (MDC) scores.

RESULTS

The LLFDI frequency dimension predicted low self-rated health (odds ratio (OR) = 0.51, P < .001), hospitalizations (OR = 0.68, P < .001), and ED visits (OR = 0.73, P = .003) over 2 years, whereas the limitation dimension did not. The absolute ES was 0.63 for the frequency dimension and 0.81 for the limitation dimension. The proportion of subjects with a decline greater than or equal to the MDC was 10.6% for the frequency dimension and 14.2% for the limitation dimension. For participants who improved greater than or equal to the MDC, the proportion was 1.7% for the frequency dimension and 15.3% for the limitation dimension.

CONCLUSION

Frequency of participation in major life roles was a better predictor of adverse outcomes than perceived limitations, although limitations appeared to be more responsive to meaningful change. These results can be used to guide the selection of the most appropriate metric for measuring disability in geriatric research.

Functional performance as a predictor of injurious falls in older adults

OBJECTIVES

To determine whether a performance battery and its components aid in predicting injurious falls.

DESIGN

Longitudinal analysis; prospective cohort study.

SETTING

Clinical site.

PARTICIPANTS

Boston-area community-dwelling adults (N = 755; mean age ± SD 78.1 ± 5.4, 64.1% female, 77.6% white).

MEASUREMENTS

Baseline functional performance was determined according to the Short Physical Performance Battery (SPPB), measuring balance, gait speed, and five repeated chair stands. Fall history (past year) and efficacy in performing 10 daily activities without falling were assessed. Falls were assessed using a daily calendar over 4 years. Injurious falls were defined as resulting in fractures, sprains, dislocations, pulled or torn muscles, ligaments, or tendons or seeking medical attention.

RESULTS

Poorest chair stand performance (≥16.7 seconds) was associated with greater hazard of injurious falls than in all other chair stand performance groups (hazard ratio (HR) = 1.96, 95% confidence interval (CI) = 1.18-3.26 for ≥ 16.7 vs. 13.7-16.6 seconds; HR = 1.65, 95% CI = 1.07-2.55 for ≥ 16.7 vs. 11.2-13.6 seconds, HR = 1.60, 95% CI = 1.03-2.48 for ≥ 16.7 vs. <11.2 seconds). SPPB did not predict injurious falls. Fall history predicted injurious falls (HR = 1.82, 95% CI = 1.39-2.39); falls efficacy did not. Fall history and a slow chair stand (<16.7 seconds) had a 2-year cumulative incidence rate of an injurious fall of 46% (95% CI = 0.34-0.58), nearly the combined rate of a positive fall history (0.29, 95% CI = 0.25-0.34) and a slow chair stand alone (0.21, 95% CI = 0.13-0.30).

CONCLUSION

An easily administered chair stand test may be sufficient for evaluating performance as part of a risk stratification strategy for injurious falls.