400-m Walk Time Research Articles

Noninvasive assessment of glymphatic dysfunction in idiopathic normal pressure hydrocephalus with diffusion tensor imaging.

Diffusion tensor imaging (DTI) along the perivascular space (ALPS) (DTI-ALPS)-by calculating the ALPS index, a ratio accentuating water diffusion in the perivascular space-has been proposed as a noninvasive, indirect MRI method for assessing glymphatic function. The main aim of this study was to investigate whether DTI-ALPS would reveal glymphatic dysfunction in idiopathic normal pressure hydrocephalus (iNPH) and whether the ALPS index was associated with disease severity. Thirty iNPH patients (13 men; median age 77 years) and 27 healthy controls (10 men; median age 73 years) underwent MRI and clinical assessment with the Timed Up and Go test (TUG) and Mini-Mental State Examination (MMSE); only the patients were evaluated with the Hellström iNPH scale. MRI data were analyzed with the DTI-ALPS method and Radscale screening tool. iNPH patients showed significantly lower mean ALPS index scores compared with healthy controls (median [interquartile range] 1.09 [1.00-1.15] vs 1.49 [1.36-1.59], p < 0.001). Female healthy controls showed significantly higher ALPS index scores than males in both hemispheres (e.g., right hemisphere 1.62 [1.47-1.67] vs 1.33 [1.14-1.41], p = 0.001). This sex difference was not seen in iNPH patients. The authors found a moderate exponential correlation between mean ALPS index score and motor function as measured with time required to complete TUG (r = -0.644, p < 0.001), number of steps to complete TUG (r = -0.571, p < 0.001), 10-m walk time (r = -0.637, p < 0.001), and 10-m walk steps (r = -0.588, p < 0.001). The authors also found a positive linear correlation between mean ALPS index score and MMSE score (r = 0.416, p = 0.001). Simple linear regression showed a significant effect of diagnosis (B = -0.39, p < 0.001, R2 = 0.459), female sex (B = 0.232, p = 0.002, R2 = 0.157), and Evans index (B = -4.151, p < 0.001, R2 = 0.559) on ALPS index. Multiple linear regression, including diagnosis, sex, and Evans index score, showed a higher predictive value (R2 = 0.626) than analysis of each of these factors alone. The ALPS index, which was significantly decreased in iNPH patients, could serve as a marker of disease severity, both clinically and in terms of neuroimaging. However, it is important to consider the significant influence of biological sex and ventriculomegaly on the ALPS index, which raises the question of whether the ALPS index solely reflects glymphatic function or if it also encompasses other types of injury. Future studies are needed to address potential confounding factors and further validate the ALPS method.

Changes in strength-related outcomes following velocity-monitored resistance training with 10 % and 20 % velocity loss in older adults

We compared the effects of velocity-monitored resistance training with an intra-set velocity loss (i.e., the decrement in repetition velocity over the set) of 10 % vs. 20 % on strength-related outcomes in older adults. We randomly assigned eighteen older adults to a velocity loss group of 10 % (n = 10; 78 ± 12 years) or 20 % (n = 8; 73 ± 10 years) to perform a 10-week training program. The primary outcomes were the one-repetition maximum (1RM) and the average mean velocity against absolute loads associated with loads <60 % 1RM (MVlow) and ≥ 60 % 1RM (MVhigh) in the leg and chest press exercises, assessed at pre-, mid- (week 5), and post-test. Secondary outcomes included handgrip strength, 1-kg medicine ball throw distance, 10-m walking time, and five-repetition sit-to-stand time. No differences between groups were found in any outcome at any time (p > 0.05). Both groups improved the 1RM leg press from pre- to mid- and post-test and the MVlow and MVhigh from pre- to mid-test (p < 0.05). No group improved the 1RM chest press (p > 0.05), but both increased the MVlow from pre- to mid-test (p < 0.05). Furthermore, both groups improved the sit-to-stand time, while only the 20 % velocity loss group significantly improved handgrip strength and 10-m walking time (p < 0.05). The results showed that both velocity losses improved leg press strength and velocity, chest press velocity, and sit-to-stand time in older adults, although a 10 % velocity loss was more efficient as it required less volume (i.e., total repetitions) than 20 %. Nevertheless, the latter seems required to optimize handgrip strength and 10-m walking time in older people.

Relationship between preoperative and discharge evaluations in patients receiving around-the-knee osteotomy.

[Purpose] This study aimed to determine the relationship between preoperative and discharge assessments in patients undergoing around-the-knee osteotomy. [Participants and Methods] We enrolled patients admitted to our hospital who underwent around-the-knee osteotomy. We measured knee joint range of motion, pain numeric rating scale, pain catastrophizing scale, hospital anxiety and depression scale, and 10-m walk time were measured preoperatively and before discharge. Pre-post comparisons and correlation testing were performed. [Results] A total of 18 patients were analyzed. Resting and exercise pain numeric rating scale, knee flexion and extension range of motion, and pain catastrophizing scale were significantly better during discharge. A significant correlation was observed between the preoperative pain catastrophizing scale total score and 10-m walking time, knee flexion and extension range of motion, pain catastrophizing scale total score, and hospital anxiety and depression scale-depression subscale preoperatively. [Conclusion] Appropriate postoperative rehabilitation after around-the-knee osteotomy improved physical function and cognitive/psychological evaluation at discharge. The correlation between the preoperative pain catastrophizing scale total score and 10-m walking time at discharge suggests that the prolonged walking pain that occurred preoperatively may have affected the cognitive and psychological evaluation of pain.

The mediation roles of intermuscular fat and inflammation in muscle mitochondrial associations with cognition and mobility.

Mitochondrial dysfunction may contribute to brain and muscle health through inflammation or fat infiltration in the muscle, both of which are associated with cognitive function and mobility. We aimed to examine the association between skeletal muscle mitochondrial function and cognitive and mobility outcomes and tested the mediation effect of inflammation or fat infiltration. We analysed data from 596 Baltimore Longitudinal Study of Aging participants who had concurrent data on skeletal muscle oxidative capacity and cognitive and mobility measures of interest (mean age: 66.1, 55% women, 24% Black). Skeletal muscle oxidative capacity was assessed as post-exercise recovery rate (kPCr) via P31 MR spectroscopy. Fat infiltration was measured as intermuscular fat (IMF) via CT scan and was available for 541 participants. Inflammation markers [IL-6, C-reactive protein (CRP), total white blood cell (WBC), neutrophil count, erythrocyte sedimentation rate (ESR), or albumin] were available in 594 participants. We examined the association of kPCr and cognitive and mobility measures using linear regression and tested the mediation effect of IMF or inflammation using the mediation package in R. Models were adjusted for demographics and PCr depletion. kPCr and IMF were both significantly associated with specific cognitive domains (DSST, TMA-A, and pegboard dominant hand performance) and mobility (usual gait speed, HABCPPB, 400m walk time) (all P<0.05). IMF significantly mediated the relationship between kPCr and these cognitive and mobility measures (all P<0.05, proportion mediated 13.1% to 27%). Total WBC, neutrophil count, and ESR, but not IL-6 or CRP, also mediated at least one of the cognitive and mobility outcomes (all P<0.05, proportion mediated 9.4% to 15.3%). Skeletal muscle mitochondrial function is associated with cognitive performance involving psychomotor speed. Muscle fat infiltration and specific inflammation markers mediate the relationship between muscle mitochondrial function and cognitive and mobility outcomes. Future studies are needed to confirm these associations longitudinally and to understand their mechanistic underpinnings.

Application of Knee Robotic Orthosis to Improve the Walking Performance of People with Post-Polio Syndrome

ABSTRACT Introduction Poliomyelitis has been considered a statutory notifiable infectious disease in Hong Kong since 1948. Approximately 15% to 80% of patients suffer from post-polio syndrome (PPS) with an increased risk of falling and chronic pain. Most of them relied on the use of knee lock-type orthoses as aids. This study aimed to evaluate the effect of using a custom-fit knee robotic orthosis on their gait performance. Materials and Methods A case series report was used for this study on a group of individuals suffering from chronic PPS who used orthoses and had a history of falling. A knee robotic orthosis was custom-fit for eight sessions of walking practice. Assessments included laboratory gait analysis, functional measures, and subjective ratings of exertional level. Pain responses were recorded to evaluate the effect of using the knee robotic orthosis on participants’ gait performance. Results Five participants completed the study in using the knee robotic orthosis. All achieved reduction in shoulder tilting and trunk swaying movement on walking at the anterior-posterior and the medial-lateral direction. A total of 80% of the study participants achieved reduction in trunk rotation movement, lower-limb circumduction, and hip hiking movement on the affected side on walking. All study participants were able to demonstrate improvement in their gait symmetry after using the knee robotic orthosis as reflected by the symmetric index improvement of kinematics. The rate of perceived exertion and the visual analog scale of pain in all study participants were reported lower when they used the knee robotic orthosis. However, the 10-m walking time achieved was longer. Conclusions The knee robotic orthosis had a positive effect on remediating the abnormal kinematics of PPS patients using conventional lock-knee orthosis after eight sessions of training practice. Reduction in the limping gait pattern and improvement in gait symmetry was achieved in using a knee robotic orthosis for walking. The chronic pain response and the physical exertional level on walking were also reduced. However, the walking speed achieved was slower. Clinical Relevance The application of the knee robotic orthosis for walking assist is new to most of the PPS patients. The positive outcomes achieved merit further research for future clinical practice.

Minimally invasive surgery supercapsular percutaneously-assisted total hip (SuperPath) arthroplasty.

The benefits of minimally invasive surgical techniques in total hip arthroplasty (THA) are well known, but concerns about applying SuperPATH in patients with secondary OA of acetabular dysplasia do not have been reported. We aim to evaluate whether SuperPATH is applicable to secondary OA, furthermore, to quantify the recovery of lower extremity function. 30 patients with secondary OA admitted for THA applying SuperPATH were investigated. Clinical Japanese Orthopaedic Association (JOA) Score and radiographical evaluation were performed. Following was examined pre- and early post-operatively; pain level, blood tests, TUG and 10-M walking time for lower limb recovery. Preoperative radiographic measurements revealed an average Sharp angle of 46.2 ± 2.8 degrees and CE angle of 19.4 ± 7.3 degrees. 29 THAs had Crowe Type I and 1 THA had Crowe Type II. JOA score improved from 48.8 preoperatively to 91.5 at 2 months postoperatively. The perioperative pain assessment (VAS) averaged 7.0±1.5 preoperatively, 4.6±2.6 on the first postoperative day, then decreased gradually to 1.2±1.4 at 2 weeks. Blood data showed that creatine kinase, myoglobin, and CRP were significantly elevated on the day after surgery, but they normalized at 2 weeks postoperatively. Both TUG and 10M walking time showed slightly higher values at 1 week postoperatively compared to preoperatively but recovered to the same level as preoperatively at 2 weeks after surgery. Our data suggests that SuperPATH approach to THA for dysplastic OA was applicable to mildly dysplastic OA and achieved an early recovery of lower limb function.

Gait training with a wearable powered robot during stroke rehabilitation: a randomized parallel-group trial

BackgroundWe have developed a wearable rehabilitation robot, “curara®,” and examined its immediate effect in patients with spinocerebellar degeneration and stroke, but its rehabilitative effect has not been clarified. The purpose of this study was to examine the effect of this device on gait training in stroke patients.MethodsForty stroke patients were enrolled in this study. The participants were divided randomly into two groups (groups A and B). The participants assigned to group A received RAGT with curara® type 4, whereas those in group B received conventional therapist-assisted gait training. The clinical trial period was 15 days. The participants performed 10 sessions of gait training (5 times per week) each lasting 30 ± 5 min per day. The 10-m walking time (10mWT), and 6-minute walking distance (6MWD) were evaluated as the main outcomes. Timed up and go and Berg Balance Scale (BBS) were also examined. Gait parameters (stride duration and length, standard deviation of stride duration and length, cadence, ratio of the stance/swing phases, minimum/maximum knee joint angle, and minimum/maximum hip joint angle) were measured using a RehaGait®. The items other than BBS were measured on days 0, 7, and 14, whereas BBS was measured on days 0 and 14. The improvement rate was calculated as the difference of values between days 14 and 0 divided by the value on day 0. The improvement rates of the 10mWT and 6MWD were set as the main outcomes.ResultsThe data of 35 participants were analyzed. There was no significant difference in the main outcomes between both groups at the end of gait training. As for intragroup changes, gait speed, stride length, stride duration, and cadence were improved significantly between days 0 and 14 in each group. When examining the interaction effect between the day of measurement and group, stride duration (p = 0.006) and cadence (p = 0.012) were more significantly improved in group A than in group B.ConclusionsThis novel wearable powered robot may have the potential to improve gait speed of individuals in stroke rehabilitation.Trial registrationJapan Registry of Clinical Trials (jRCTs032180163). Registered on February 22, 2019; https://jrct.niph.go.jp/en-latest-detail/jRCTs032180163.UMIN Clinical Trials Registry (UMIN000034237)Registered on September 22, 2018; https://center6.umin.ac.jp/cgi-open-bin/icdr/ctr_view.cgi?recptno=R000038939.

A Standing Low-frequency Vibration Exercise Device for Improving Balance in Community-dwelling Older Adults: A Single-blind Randomized Controlled Trial.

This study aimed to compare the effects of the standing low-frequency vibration exercise device (SLVED) and walking training on balance ability on an unstable surface in community-dwelling elderly people. Thirty-eight older adults were randomly allocated to the SLVED sessions: the intervention group (n = 19), and the walking sessions: the control group (n = 19). Each group session lasted 20 min and was performed twice a week for 12 weeks. Standing balance was assessed by the change in center-of-gravity sway of the participant standing on foam rubber with eyes open (EO) and eyes closed (EC). The primary outcome measures were the root mean square (RMS) values of the center of foot pressure in the mediolateral and anteroposterior directions and the RMS area. Secondary outcome measures were the results of the 10-m walking time test (10 MWT), five-times sit-to-stand (5T-STS) test, and timed up-and-go (TUG) test. Analysis of variance showed a significant group × time interaction for the TUG test. Significant improvements were observed in Y-RMS for EO condition; RMS, X-RMS, Y-RMS, and RMS area for EC condition; and 10 MWT, 5T-STS test, and TUG test for the main effect of the time factor. SLVED for intervention in community-dwelling older adults showed a greater improvement than walking training in the TUG test. In addition, SLVED improved the Y-RMS for the EO condition on foam rubber; RMS, X-RMS, Y-RMS, and RMS area for the EC condition on foam rubber in standing balance; and the 10 MWT and 5T-STS test, suggesting that it has similar effects to walking training.

Long-term Effects of Plantar Plate Therapy for Subtalar Joint Valgus Type for One Case Osteoarthritis of the Knee

There are many research reports showing that the effect of plantar plate on medial knee OA is effective in the short term, but there are few reports that it is effective for a long period of 6 months or longer. Also although there are many studies on plantar plate in the varus type of the subtalar joint, there are few studies in the valgus type of the subtalar joint. In this study, we investigated the long-term effect of wearing a plantar plate that guides the subtalar joint to a neutral position in patients with the subtalar joint valgus type. The case is an elderly female diagnosed with bilateral knee osteoarthritis. The case is an elderly female diagnosed with bilateral knee osteoarthritis. X-ray evaluation was right III, left III in KL grade.The plantar plate was evaluated by comparing the 10 m maximum effort walking time and pain evaluation VAS, the total consumption and the number of steps in one week without and immediately after wearing the plantar plate. In order to examine the long-term effects, functional evaluation was performed 3 months, 6 months, and 12 months after the installation of the plantar plate.As a result, 10m walking time and walking pain improved, suggesting improvement in long-term walking ability after 3 months, 6 months, and 12 months. In addition, SF36.v2, a health-related QOL evaluation scale, total consumption, and number of steps improved, and a weight loss effect was obtained. Based on the above, it is suggested that the manufactured plantar plate is effective for a long period of time. I thought For cases in which the subtalar joint is valgus, a plantar plate that induces varus to the subtalar joint is more suitable than a lateral wedge-shaped plantar plate that induces valgus to the subtalar joint.

PREDICTORS OF 400M WALKING TIME: THE STUDY OF MUSCLE MOBILITY AND AGING (SOMMA)

Abstract Longer 400m walking time has been strongly associated with overall mortality and many other aging-related outcomes in prior studies. Inability to walk 400m defines ‘mobility disability’. We assessed characteristics that might contribute to 400m walking time in SOMMA, a cohort of 879 men and women over age 70. We excluded people with a gait speed &amp;lt; 0.6 m/s. The analysis included 49 factors representing several domains: muscle mass and strength, body composition, oxygen delivery, muscle mitochondrial ATP generation, fitness by cardiopulmonary exercise testing (VO2 peak), fatigability by questionnaire, usual physical activity, depressed mood, cognitive performance, lower extremity pain, lower extremity sensation, smoking, wealth and income, and general health. We used both elastic net and forward step-wise regression to generate multivariate models. Factors associated with longer (worse) walking time in both elastic net and forward step-wise regression models were: *weaker leg power, *fatigue during treadmill testing, *higher BMI, *greater self-reported fatigability, *worse performance on the timed DSST test, *fewer hours spent walking, *taking more medications, *older age, *poorer fitness (VO2peak), *more joint stiffness, *smoking, and *reduced peripheral sensation. These results indicate that 400m walk time is influenced by numerous factors. Some are also associated with overall mortality and aging outcomes and therefore they might underlie the prognostic value of the 400m walk. Additionally, some of the predictors could be improved, such as leg strength, cardiopulmonary fitness, more time walking, quitting smoking, and treatment of joint stiffness, perhaps reducing the risk of mobility disability.

Associations between biomarkers of cellular senescence and physical function in humans: observations from the lifestyle interventions for elders (LIFE) study

Cellular senescence is a plausible mediator of age-associated declines in physical performance. To test this premise, we examined cross-sectional associations between circulating components of the senescence-associated secretory phenotype (SASP) and measures of physical function and muscle strength in 1377 older adults. We showed significant associations between multiple SASP proteins and the short physical performance battery (SPPB), its subcomponents (gait speed, balance, chair rise time), and 400-m walk time. Activin A, ICAM1, MMP7, VEGFA, and eotaxin showed strong associations based on gradient boost machine learning (GBM), and, when combined with other proteins, effectively identified participants at the greatest risk for mobility disability (SPPB score le 7). Senescence biomarkers were also associated with lower grip strength, and GBM identified PARC, ADAMTS13, and RANTES as top candidates in females, and MMP2, SOST, and MCP1 in males. These findings highlight an association between senescence biomarkers and physical performance in older adults. ClinicalTrials.gov Identifier: NCT01072500.

Most Falls of Active Elderly People are not Caused by Decreases in Physical Function

Several healthy, community-dwelling elderly people who live independently experience falls. However, their falls are not always attributed to decreased physical function. We aimed to examine the cause of falls in active elderly people. They were divided into fallers (n = 49) and non-fallers (n = 170) based on their fall experience during the previous year. The subjects participated in the following tests: transferring velocity during the sit-to-stand, one-leg stand time, functional reach, 10-m maximal walking time, muscle strength (foot grip, ankle plantar flexion, hip flexion, knee extension strength), systemic reaction time, agility stepping, and maximal side step length after completing the ADL questionnaire, fall risk assessment sheet, fall risk profile from Demura et al, and life-space assessment sheet. No significant differences were observed in physical functions, which were the basis of fall prevention (muscle strength, balance, and gait) and fall avoidance (systemic reactions, agility stepping, and maximal side step length) between both groups. A significant difference was observed in the ADL score but not between both fall risk scores, and the Life-Space Assessment scores. Moreover, no significant differences were observed between the high risk ratio for falls and nursing care based on each questionnaire. In conclusion, the differences in physical function and fall risk factors between the fallers and non-fallers in active, independent elderly people living in the community were not observed. The cause of these falls (22.4%) was not attributed to physical function decreases or other fall risk factors. These may mainly depend on accidents resulting from high activity.

A Comparative Study of Ultrasound-Guided Continuous Adductor Canal Block With Ultrasound-Guided Continuous Femoral Nerve Block in Unilateral Total Knee Arthroplasty for Limb Mobilization and Analgesic Efficacy.

BackgroundTotal knee joint replacement surgery is associated with severe postoperative pain and is amenable to regional anesthesia techniques for pain control. Femoral nerve block (FNB) provides effective analgesia after total knee arthroplasty (TKA) but has been associated with delayed ambulation due to quadriceps muscle weakness. Adductor canal block (ACB) may be a promising alternative, with less effect on the quadriceps muscle and comparable analgesic efficacy. We evaluated the effectiveness, safety, and patient satisfaction of continuous ACB augmented with infiltration between the popliteal artery and capsule of the knee (iPACK) block and compared them with those of continuous FNB amplified with iPACK block in preventing postoperative pain among patients undergoing unilateral total knee replacement (TKR) surgeries.MethodologyAccording to a computer-generated sequence from September 2019 to June 2020, 50 American Society of Anesthesiologists grades I-III patients aged between 35 and 75 years who underwent unilateral TKR surgery were randomized into two equal groups, namely, ACB and FNB. The Timed Up and Go (TUG) and 10-minute walk tests were used to detect early ambulation (impact on quadriceps muscle). The secondary goal was to evaluate and compare opioid consumption and analgesic efficacy between the groups measured using a numeric rating scale (NRS). The demographic characteristics, technical difficulty, efficiency, safety, and comfort were compared between the two groups.ResultsDuring the postoperative period, patients in the ACB group could perform all TUG tests significantly faster than those in the FNB group. The mean get-up time in the ACB group was 39.08 ± 5.53 seconds, whereas that in the FNB group was 44.92 ± 7.10 seconds (p < 0.01). The 3-m walk time was 123.16 ± 15.90 seconds in the ACB group and 134.68 ± 13.13 seconds in the FNB group (p < 0.01). The 10-m walk time was 221.24 ± 18.82 seconds in the ACB group and 245.24 ± 21.68 seconds in the FNB group (p < 0.001). No significant difference was observed in NRS scores between the groups after the first 24 hours. The number of opioids available for consumption in both groups was equivalent.ConclusionsACB when augmented with an iPACK block is a good alternative to FNB for unilateral TKR surgeries. ACB may promote early ambulation without a reduction in analgesia when compared with FNB.

Immediate effects of neuromuscular joint-facilitation bridging exercises on walking ability and balance function in stroke patients.

[Purpose] This study aimed to examine the immediate effects of a pelvic neuromuscular joint-facilitation intervention on the walking and balance ability of patients with hemiplegia caused by cerebrovascular accidents. [Participants and Methods] A total of 15 patients with hemiplegia caused by cerebrovascular accidents underwent a neuromuscular joint-facilitation lumbar-pattern intervention (intervention group), a bridge exercise (bridge intervention group), or a neuromuscular joint-facilitation bridge intervention (neuromuscular joint-facilitation bridge group). Each intervention was randomly administered at 7-day intervals. Measurement items included the timed up-and-go test, functional reach test, 10-m maximum walking speed test, and load in the standing position. Measurements were taken before and after the intervention in each group. [Results] The timed up-and-go test result was significantly shorter in the neuromuscular joint-facilitation intervention group. Timed up-and-go test results, functional reach, 10-m walking time, and standing load (non-paralyzed side) significantly improved in the neuromuscular joint-facilitation bridge group. [Conclusion] The neuromuscular joint-facilitation bridge intervention was immediately effective in patients with hemiplegia caused by cerebrovascular accidents and improved their walking and balance ability.

Effects of Repeated Co-Injections of Corticosteroids and Hyaluronic Acid on Knee Osteoarthritis: A Prospective, Double-Blind Randomized Controlled Trial

BackgroundWe compared the effects of repeated co-injections of corticosteroids plus hyaluronic acid (HA) with the effects of HA injections alone in patients with knee osteoarthritis. MethodsA double-blind randomized controlled trial was conducted between October 2016 and July 2017 at a medical center. Patients (n = 57) who fulfilled the clinical and radiographic criteria for knee osteoarthritis established by the American College of Rheumatology with a Kellgren-Lawrence score of 2 or 3 were included. They were assigned to either the HA group (n = 29) or corticosteroids plus HA group (n = 28), and injections were administered under ultrasound guidance once a week for 3 consecutive weeks. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were the primary outcomes. Physical functional performance (10-m fast walking and chair-rising time) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were secondary outcomes. The assessment was performed prior to injections, 1 week, and 1, 3, and 6 months after injections. Data were analyzed through repeated-measures analysis of covariance. ResultsBoth groups experienced decreased pain and improved physical function and physical functional performance over time. We found significant group × time interaction effects favoring the corticosteroids plus HA group in WOMAC-pain (P = .005) and physical function (P = .005), chair-rising time (P = .032), and KOOS-pain (P = .001). ConclusionsRepeated co-injections of corticosteroids plus HA more effectively decreased pain and improved physical function and physical functional performance than injections of HA alone from 1 week through 6 months posttreatment.

Lung Function Reserve and Physical Function in Healthy Older Adults: Findings from BLSA

Forced Expiratory Volume in 1-second (FEV1) that falls below the lower limit of normal (LLN) is a well-established correlate of functional limitation and disability. However, less is known about the functional implications of gradations of lung function above the LLN. We examined the cross-sectional association between gradations of healthy lung function and usual gait speed, reported walking ability, and fast 400m walk performance in 750 persons (50.7% men) aged 55-95 free from respiratory disease and mobility limitations, participating in the Baltimore Longitudinal Study of Aging (BLSA). The 2012 Global Lung Initiative (GLI) reference equations were used to calculate FEV1 Z-scores, with healthy lung function categorized as follows: -1.6 < Z ≤ -1.0 (pre-clinical), -1.0 < Z ≤ -0.3 (low normal), -0.3 < Z ≤ 0.3 (normal), 0.3 < Z ≤ 1.0 (high-normal), and Z > 1.0 (high). Associations between gradations of healthy lung function and physical function were evaluated using multivariate linear regression, adjusting for age, sex, height, weight, and waist circumference. Compared to the ‘pre-clinical’ category, the difference in 400m walk time was 0.71 (p>.05), -6.60 (p>.05), -12.21 (p<0.05), and -15.52 (p<0.01) seconds for the ‘low normal’, ‘normal’, ‘high-normal’, and ‘high’ categories, respectively. No associations between gradations of healthy lung function and normal gait speed or walking ability were found (p>0.05). Higher levels of lung function reserve are associated with better 400m walking performance, thus efforts to promote and/or reduce loss of lung function reserve may help individuals maintain high functional capacity in later life.

Association Between Arterial Stiffness and Fatigability in Well-Functioning Older Adults

The association between vascular health measured by arterial stiffness and fatigability, a marker of future mobility decline, is unknown. We examined 1210 men (47.7%) and women from the Baltimore Longitudinal Study of Aging, mean age 66.6 ± 13.9 years. Perceived fatigability was assessed after a 5-minute, treadmill walk using Borg rating (range 6-20). Arterial stiffness was determined by carotid femoral pulse wave velocity (PWV). In linear regression analyses fatigability and PWV were associated in men (Beta/P-value) (0.160/0.001) and women (0.136/0.008). Adjustment for mean arterial and pulse pressure attenuated the association in women (0.104/0.050) but not men (0.160/0.001). The association was significant among those with slower usual and rapid gait speeds, longer 400m walk time and slower repeated chair stands pace (all p<0.05). Arterial stiffness is associated with a greater proneness to fatigue especially in older adults exhibiting poorer mobility. The underlying mechanisms appear to differ between men and women.

Detecting a Novel Walking-Based Performance Fatigability Marker With Accelerometry in Older Adults

Walking-based performance fatigability measures (e.g., lap-time difference) may not adequately capture performance deterioration as self-pacing is a common compensatory strategy in those with low activity tolerance. To overcome this limitation, we developed a new approach with accelerometry (ActiGraph GT3X+, sampling=80 Hz, non-dominant wrist) during fast-paced 400m-walk (N=57, age=78.7±5.7 years, women=53%). Cadence (steps/second) was estimated using raw accelerometer data (R “ADEPT”). Penalized regression splines (R “mgcv”) were used to estimate the individual-level smoothed cadence trajectories. “Time-to-slow-down” was defined as first time-point where the full confidence interval of change in cadence<0. Five participants were censored at stopping time (not slowdown or complete walk). Median “time-to-slow-down” was 1.86 minutes (IQR=0.98-2.73, range=0.57-6.25). Participants with longer “time-to-slow-down” had slower starting cadence, longer 400m-walk time, and greater perceived fatigability (Pittsburgh Fatigability Scale), p’s<0.05 (linear regression). Our preliminary findings revealed that detecting accelerometry-based performance fatigability/deterioration in older adults is feasible and needs to account for initial pace.

The cost effectiveness of personalized dietary advice to increase protein intake in older adults with lower habitual protein intake: a randomized controlled trial

PurposeTo examine the cost effectiveness of dietary advice to increase protein intake on 6-month change in physical functioning among older adults.MethodsIn this multicenter randomized controlled trial, 276 community-dwelling older adults with a habitual protein intake < 1.0 g/kg adjusted body weight (aBW)/d were randomly assigned to either Intervention 1; advice to increase protein intake to ≥ 1.2 g/kg aBW/d (PROT, n = 96), Intervention 2; similar advice and in addition advice to consume protein (en)rich(ed) foods within half an hour after usual physical activity (PROT + TIMING, n = 89), or continue the habitual diet with no advice (CON, n = 91). Primary outcome was 6-month change in 400-m walk time. Secondary outcomes were 6-month change in physical performance, leg extension strength, grip strength, body composition, self-reported mobility limitations and quality of life. We evaluated cost effectiveness from a societal perspective.ResultsCompared to CON, a positive effect on walk time was observed for PROT; – 12.4 s (95%CI, – 21.8 to – 2.9), and for PROT + TIMING; – 4.9 s (95%CI, – 14.5 to 4.7). Leg extension strength significantly increased in PROT (+ 32.6 N (95%CI, 10.6–54.5)) and PROT + TIMING (+ 24.3 N (95%CI, 0.2–48.5)) compared to CON. No significant intervention effects were observed for the other secondary outcomes. From a societal perspective, PROT was cost effective compared to CON.ConclusionDietary advice to increase protein intake to ≥ 1.2 g/kg aBW/d improved 400-m walk time and leg strength among older adults with a lower habitual protein intake. From a societal perspective, PROT was considered cost-effective compared to CON. These findings support the need for re-evaluating the protein RDA of 0.8 g/kg BW/d for older adults.Trial registrationThe trial has been registered at ClinicalTrials.gov (NCT03712306). Date of registration: October 2018. Registry name: The (Cost) Effectiveness of Increasing Protein Intake on Physical Functioning in Older Adults. Trial Identifier: NCT03712306.

Gait training with a wearable curara\xae robot for cerebellar ataxia: a single-arm study

BackgroundAtaxic gait is one of the most common and disabling symptoms in people with degenerative cerebellar ataxia. Intensive and well-coordinated inpatient rehabilitation improves ataxic gait. In addition to therapist-assisted gait training, robot-assisted gait training has been used for several neurological disorders; however, only a small number of trials have been conducted for degenerative cerebellar ataxia. We aimed to validate the rehabilitative effects of a wearable “curara®” robot developed in a single-arm study of people with degenerative cerebellar ataxia.MethodsTwenty participants with spinocerebellar ataxia or multiple system atrophy with predominant cerebellar ataxia were enrolled. The clinical trial duration was 15 days. We used a curara® type 4 wearable robot for gait training. We measured the following items at days 0, 7, and 14: Scale for the Assessment and Rating of Ataxia, 10-m walking time (10 mWT), 6-min walking distance (6 mWD), and timed up and go test. Gait parameters (i.e., stride duration and length, standard deviation of stride duration and length, cadence, ratio of the stance and swing phases, minimum and maximum knee joint angles, and minimum and maximum hip joint angles) were obtained using a RehaGait®. On days 1–6 and 8–13, the participants were instructed to conduct gait training for 30 ± 5 min with curara®. We calculated the improvement rate as the difference of values between days 14 and 0 divided by the value on day 0. Differences in the gait parameters were analyzed using a generalized linear mixed model with Bonferroni’s correction.ResultsData from 18 participants were analyzed. The mean improvement rate of the 10 mWT and 6 mWD was 19.0% and 29.0%, respectively. All gait parameters, except the standard deviation of stride duration and length, improved on day 14.ConclusionsTwo-week RAGT with curara® has rehabilitative effects on gait function comparable to those of therapist-assisted training. Although the long-term effects after a month of RAGT with curara® are unclear, curara® is an effective tool for gait training of people with degenerative ataxia.Trial registration jRCT, jRCTs032180164. Registered: 27 February 2019; retrospectively registered. https://jrct.niph.go.jp/en-latest-detail/jRCTs032180164.