57 Physical Activity Improvement in Elderly Hospitalised Patients at the Royal London: Exercise as Part of A Multimodal Intervention

Introduction

Approximately 65% of elderly patients admitted to hospital experience some level of deconditioning during their stay. This can lead to longer length of stays, premature admissions to care homes and loss of function whilst in hospital (British Geriatrics Society). There is evidence that exercise can be safe and effective in reversing functional decline in this population. However, there is limited evidence into the effectiveness and feasibility of running a multi modal exercise intervention (eg. Dance and Exercise) on a busy elderly care ward in the UK.

Method

An 8-week inpatient programme consisting of a 60-minute exercise classes once a week and/or 60-minute dance class once a week started on the Older Person’s Wards at the Royal London. Primary outcome measures included: 5 x Sit To Stands (5xSTS) and Falls Efficacy Scale International (FES-I). Secondary measures; Rockwood score, Barthel Index, Elderly Mobility Score (EMS), Mood, 4AT and handgrip strength. Patient satisfaction scores were also recorded.

Results

23 patients were included in the analysis, 3 patients attended the dance class, 14 attended the exercise class and 5 attended both. In total 37 sessions were completed. The average score for all outcome measures improved except one after 8 weeks. The 5xSTS times improved by an average of 7.7 seconds and the FES-I score dropped by 3.9. The Barthel score increased by 5 points. Handgrip strength increased by 2.3 kg and 57% improved on their EMS. Mood improved from 5.4/10 to 6.0/10 and 4AT from 2.7 to 1.7. Overall, 70% of participants reported enjoying the classes and 90% said they would re-attend.

Conclusion

A multifactorial intervention including seated dance and exercise sessions showed significant improvements in mobility, fear of falling, cognition and functional tasks. Further work will look into the impact on length of stay and readmissions inpatient to hospital.

19th International Meeting on Frankia and Actinorhizal Plants

It has been 40 years since the first meeting dedicated to Frankia and actinorhizal plants, which was held at Petersham, Massachusetts (reported in Torrey and Tjepkema, 1979). Since then biennial meetings have been organised and held in different venues around the globe (Table 1). The most recent meeting, the "19th International Meeting on Frankia and Actinorhizal Plants", organised in Hammamet, Tunisia from 17th to 19th of March, 2018, gathered scientists from Algeria, Argentina, Belgium, China, Egypt, France, India, Portugal, Senegal, Sweden, UK, USA and Tunisia. The event was a stimulating opportunity for active researchers to share many advances since the previous meeting held in Montpellier, France (Franche et al. 2016) and to discuss new perspectives in this research field.

Effects of juglone concentration on growth in vitro ofFrankia ArI3 andRhizobium japonicum strain 71

Nitrogen-fixing nurse crops and cocrops of plant species nodulated byFrankia andRhizobium have been used to promote the growth of black walnut trees. Although walnut is known to inhibit the growth of certain associated plants due to its allelopathic derivative juglone (5-hydroxy-1,4-napthoquinone), juglone inhibition of symbiotic, nitrogen-fixing soil microorganisms had not been investigated. This research revealed that a concentration of 10(-3) M juglone absolutely inhibited the growth in vitro of aFrankia isolate from root nodules of red alder and ofRhizobium japonicum strain 71. Lesser concentrations of juglone inhibited the growth of these bacteria relative to the controls. The more-rapidly growingRhizobium strain exhibited slight growth at 10(-4) M juglone concentration, whereasFrankia growth was completely inhibited. Considering both the susceptibility of the host plant and nitrogen-fixing endophyte to the allelochemical juglone, caution should be exercised in selecting nitrogen-fixing plants as nurse crops for black walnut.

Nodular symbionts ofShepherdia,Alnus, andMyricafrom a sand dune ecosystem: trends in occurrence of soilborneFrankiagenotypes

A successional sand dune system along the Lake Michigan shoreline was chosen to study the impact of edaphic factors, vegetation cover, and topographic position on Frankia strain distribution and infectivity. On this site, three actinorhizal species, Myrica gale L., Alnus incana (L.) Moench subsp. rugosa (Du Roi) Clausen, and Shepherdia canadensis (L.) Nutt., grew in different communities. Soil samples were collected on plots devoid of actinorhizal plants and serially diluted to inoculate the three native host plants in a greenhouse study. Strains present in the nodules formed were then genetically characterized using PCR-RFLP of the 16S–23S intergenic spacer (IGS). An additional study site was included to estimate the impact of the sympatric presence of the three host species on soil infectivity and strain diversity. On this second site, soils used as inocula were collected in the rhizosphere of M. gale and S. canadensis. The M. gale and A. incana nodular strains belonged to an homogeneous cluster, whereas the S. cana densis nodular strains were separated into two distinct genetic clusters, irrespective of edaphic conditions and proximity to the host's root systems. A χ2analysis conducted on Shepherdia-infective strains showed the dominance of two distinct genotypes, with one of them being specific to newly formed dunes lacking plant cover and the other specific to older, stable dunes with dense vegetative cover.Key words: Frankia, Myrica, Shepherdia, Alnus, IGS 16S–23S, sand dunes.

Diversity and specificity of Frankia strains in nodules of sympatric Myrica gale, Alnus incana, and Shepherdia canadensis determined by rrs gene polymorphism

The identity of Frankia strains from nodules of Myrica gale, Alnus incana subsp. rugosa, and Shepherdia canadensis was determined for a natural stand on a lake shore sand dune in Wisconsin, where the three actinorhizal plant species were growing in close proximity, and from two additional stands with M. gale as the sole actinorhizal component. Unisolated strains were compared by their 16S ribosomal DNA (rDNA) restriction patterns using a direct PCR amplification protocol on nodules. Phylogenetic relationships among nodular Frankia strains were analyzed by comparing complete 16S rDNA sequences of study and reference strains. Where the three actinorhizal species occurred together, each host species was nodulated by a different phylogenetic group of Frankia strains. M. gale strains from all three sites belonged to an Alnus-Casuarina group, closely related to Frankia alni representative strains, and were low in diversity for a host genus considered promiscuous with respect to Frankia microsymbiont genotype. Frankia strains from A. incana nodules were also within the Alnus-Casuarina cluster, distinct from Frankia strains of M. gale nodules at the mixed actinorhizal site but not from Frankia strains from two M. gale nodules at a second site in Wisconsin. Frankia strains from nodules of S. canadensis belonged to a divergent subset of a cluster of Elaeagnaceae-infective strains and exhibited a high degree of diversity. The three closely related local Frankia populations in Myrica nodules could be distinguished from one another using our approach. In addition to geographic separation and host selectivity for Frankia microsymbionts, edaphic factors such as soil moisture and organic matter content, which varied among locales, may account for differences in Frankia populations found in Myrica nodules.

Co-evolution between Frankia populations and host plants in the family Casuarinaceae and consequent patterns of global dispersal

Symbioses between the root nodule-forming, nitrogen-fixing actinomycete Frankia and its angiospermous host plants are important in the nitrogen economies of numerous terrestrial ecosystems. Molecular characterization of Frankia strains using polymerase chain reaction/restriction fragment length polymorphism (PCR/RFLP) analyses of the 16S rRNA-ITS gene and of the nifD-nifK spacer was conducted directly on root nodules collected worldwide from Casuarina and Allocasuarina trees. In their native habitats in Australia, host species contained seven distinctive sets of Frankia in seven different molecular phylogenetic groups. Where Casuarina and Allocasuarina trees are newly planted outside Australia, they do not normally nodulate unless Frankia is introduced with the host seedling. Nodules from Casuarina trees introduced outside Australia over the last two centuries were found to contain Frankia from only one of the seven phylogenetic groups associated with the host genus Casuarina in Australia. The phylogenetic group of Frankia found in Casuarina and Allocasuarina trees introduced outside Australia is the only group that has yielded isolates in pure culture, suggesting a greater ability to survive independently of a host. Furthermore, the Frankia species in this group are able to nodulate a wider range of host species than those in the other six groups. In baiting studies, Casuarina spp. are compatible with more Frankia microsymbiont groups than Allocasuarina host spp. adapted to drier soil conditions, and C. equisetifolia has broader microsymbiont compatibility than other Casuarina spp. Some Frankia associated with the nodular rhizosphere and rhizoplan, but not with the nodular tissue, of Australian hosts were able to nodulate cosmopolitan Myrica plants that have broad microsymbiont compatibility and, hence, are a potential host of Casuarinaceae-infective Frankia outside the hosts' native range. The results are consistent with the idea that Frankia symbiotic promiscuity and ease of isolation on organic substrates, suggesting saprophytic potential, are associated with increased microsymbiont ability to disperse and adapt to diverse new environments, and that both genetics and environment determine a host's nodular microsymbiont.

Induction of Pseudoactinorhizae by the Plant Pathogen Agrobacterium rhizogenes

Infection of Elaeagnus angustifolia cotyledonary wounds by Agrobacterium rhizogenes strain NCPPB 2659 resulted in the formation of pseudoactinorhizae on roots differentiated from callus. These pseudoactinorhizal root nodules were anatomically indistinguishable from the actinorhizae induced by the plant's microsymbiont Frankia. This unusual hairy root phenotype provides support for the concept that the genetic program for actinorhiza morphogenesis resides in the plant's genome.

Seasonal changes in nodular nitrogenase activity of Alnus glutinosa and Elaeagnus angustifolia

Root nodule development, and seasonal patterns of nodular nitrogenase and hydrogenase activities were determined for 5- to 8-year old black alder (Alnus glutinosa (L.) Gaertn.) and Russian olive (Elaeagnus angustifolia L.) interplanted with black walnut (Juglans nigra L.) on bottomland and upland sites in central Illinois, USA. Black alder produced nodules at both sites, but Russian olive did so only at the bottomland site. Nodular nitrogenase activity was detectable in both species over a 220-day period. Maximum, midday rates of nitrogenase activity (acetylene reduction) of 15 to 20 micromoles C(2)H(4) per g dry nodule per hour were maintained by black alder for approximately 150 days at both the upland and bottomland sites. Near maximum rates of nodular nitrogenase activity were maintained for a similar period by Russian olive at the lowland site, although specific nitrogenase activity was approximately 25% lower than in black alder owing to a larger proportion of necrotic nodular tissue in Russian olive. In both species, nitrogenase activity increased exponentially with temperature between 10 degrees C and 20 to 25 degrees C. No net hydrogen evolution by nodules of either species was detected at any time during the assay period, indicating efficient hydrogenase systems were operating under the conditions of the field assay. Height of black walnut interplanted with nodulated black alder and Russian olive was greater than that of black walnut grown in pure stands.

Autumnal changes of sulfur fractions and the ratio of organic sulfur to total nitrogen in leaves and adjacent bark of eastern cottonwood, white basswood and actinorhizal black alder

Autumnal changes in organic-S, sulfate-S, total-S and the ratios of organic-S to total-N and sulfate-S to organic-S were followed in leaves and adjacent bark of actinorhizal (Frankia-nodulated) black alder (Alnus glutinosa (L.) Gaertn.) and eastern cottonwood (Populus deltoides Bartr. ex Marsh.) trees growing on a minespoil site high in extractable soil sulfate, and in black alder and white basswood (Tilia heterophylla Venten.) trees growing on a prairie-derived soil in Illinois. Organic-S concentrations decreased significantly (P < 0.05) during autumn only in foliage of trees growing on the prairie-derived soil where losses of leaf organic-S were 65% for black alder and 100% for white basswood. Leaf sulfate concentrations were relatively stable throughout autumn in white basswood growing on prairie-derived soil and in black alder at both sites. Sulfate-S concentrations in leaves were significantly (P < 0.05) higher in trees at the minespoil site than in trees growing in the prairie-derived soil (5.1 mg g(-1) for the minespoil site and 1.2 mg g(-1) for the prairie-derived soil), and in the non-actinorhizal species during late summer. During the autumn, the ratio of organic-S to total-N doubled in leaves of eastern cottonwood at the minespoil site, but in black alder and white basswood growing on the prarie-derived soil, it decreased by 60 and 74%, respectively. Organic-S concentrations in bark increased more during autumn in species unable to fix atmospheric N(2), than in black alder. The results suggest that patterns of autumnal translocation of leaf S can be site-dependent and that leaf S and leaf N are, at least in part, translocated independently in the fall. Black alder and eastern cottonwood seemed to incorporate sulfate-S readily into organic substances in leaves when grown in soils with a high sulfate content.

Leaf photosynthetic characteristics of seedlings of actinorhizal Alnus spp. and Elaeagnus spp

Single leaf photosynthetic characteristics of Alnus glutinosa, A. incana, A. rubra, Elaeagnus angustifolia, and E. umbellata seedlings conditioned to ambient sunlight in a glasshouse were assessed. Light saturation occurred between 930 and 1400 μmol m(-2)s(-1) PAR for all species. Maximum rates of net photosynthesis (Pn) measured at 25°C ranged from 12.8 to 17.3 μmol CO2m(-2)s(-1) and rates of dark respiration ranged from 0.74 to 0.95 μmol CO2m(-2)s(-1). These values of leaf photosynthetic variables are typical of early to midsuccessional species. The rate of Pn measured at optimal temperature (20°C) and 530μmol m(-2)s(-1) PAR was significantly (p<0.01) correlated with leaf nitrogen concentration (r=0.69) and negatively correlated with the mean area of a leaf (r=-0.64). We suggest that the high leaf nitrogen concentration and rate of Pn observed for Elaeagnus umbellata and to a lesser degree for E. angustifolia are genetic adaptations related to their crown architecture.