6-min Walk Research Articles

Effectiveness of rehabilitation in hospitalized hemodialysis patients as compared with rehabilitation in hospitalized patientsnot on hemodialysis: a retrospective cohort study.

The effectiveness of rehabilitation aimed at improving the activities of daily living and physical functions may differ between hospitalized patients undergoing hemodialysis (HD) and not undergoing HD (non-HD). The aim of the present study was to compare the outcomes of rehabilitation between hospitalized HD and non-HD patients. This was a retrospective cohort study of inpatients who underwent rehabilitation. We measured the rehabilitation time (min/day), length of hospital stay (days), and the Barthel index (BI). In addition, at the time of admission and discharge, grip strength, isometric knee extension strength, 10m walking speed, timed up and go test, and short physical performance battery were examined. The outcomes were then compared between the HD and non-HD groups. This study was made up of 902 patients (non-HD group: 765, HD group: 137). Our analysis revealed a lower rehabilitation time [43.3 (0.6) vs. 38.8 (1.2) min/day] and longer hospital stay [48.5 (0.5) vs. 58.1 (2.3) days] in the HD group as compared with the non-HD group (p < 0.05). In addition, the 10m walking speed [0.75 (0.02) vs. 0.66 (0.03) m/s], timed up and go test [20.8 (0.7) vs. 24.3 (1.0) sec], and short physical performance battery [6.3 (0.6) vs. 4.7 (0.6) points] at discharge were also significantly lower in the HD group as compared with the non-HD group (p < 0.05). Rehabilitation efforts for HD patients need to be improved by securing more time for inpatient rehabilitation and promoting mobility function improvement for these patients.

Relative efficacy of prehabilitation interventions and their components: systematic review with network and component network meta-analyses of randomised controlled trials

ObjectiveTo estimate the relative efficacy of individual and combinations of prehabilitation components (exercise, nutrition, cognitive, and psychosocial) on critical outcomes of postoperative complications, length of stay, health related quality of...

Dose–response relationship between sedentary time and anxiety and the moderating effect of a 10-min walk: a cross-sectional study

BackgroundThe effectiveness and generalisability of conventional anxiety treatment programmes is low across the population, and it is important to explore the research evidence for preventing and improving anxiety from a physical activity perspective. This study examined sedentary activity’s impact on anxiety, its dose–response relationship, and the interactive effects of 10-min walks and sedentary duration on anxiety.MethodsA total of 28,977 individuals were chosen from the Chinese Psychological and Behavioural Study of the Population (PBICR) 2022. Binary logistic regression analyzed the association between sedentary time and anxiety and the interaction effect of daily 10-min walks and sedentary time on anxiety. Restricted cubic spline model explored the dose–response relationship between sedentary time and anxiety risk.ResultsParticipants who were sedentary for > 6 h had a 25.1% increased risk of anxiety (OR = 1.251). Among those sedentary for > 6 h, each additional hour of sedentary time increased the risk of anxiety by 4.3%. However, for participants sedentary for ≤ 6 h, sedentary time did not increase the risk of anxiety. A non-linear J-shaped relationship between sedentary time and the risk of anxiety (non-linear trend p < 0.001). Among individuals who were sedentary for > 6 h, those who walked more than 10 min on ≤ 5 days per week had a 67.1% increased risk of anxiety (OR = 1.671), whereas those who walked more than 10 min on > 5 days per week experienced a 19% decreased risk of anxiety (OR = 0.810). For individuals sedentary for ≤ 6 h, each additional day of walking for > 10 min reduced the risk of anxiety by 9.8%. Among those sedentary for > 6 h, each additional day of walking for > 10 min reduced the risk of anxiety by 10.3%.ConclusionsA non-linear J-shaped relationship between sedentary time and anxiety risk. Walking for more than 10 min was associated with fewer negative effects of sedentary activity on anxiety. It is recommended that future empirical studies with a higher level of evidence be conducted to further confirm the effect of 10-min walking days on anxiety risk through empirical studies and to use specialized wearable devices to improve the accuracy of the measurements. By further exploring the effects of sedentary time and 10-min walking days on anxiety risk, the most effective treatment programs based on physical activity interventions can be established to reduce the prevalence of anxiety in the whole population.

The effect of high-fiber diet based on gut microbiota in patients with chronic heart failure.

Objective: This research explored the effect of high-fiber diet based on gut microbiota on chronic heart failure (HF) patients. Methods: Chronic HF patients, who had undergone a dietary survey indicating a daily dietary fiber intake of less than 15g/d were divided into the control and study groups (n = 50). In addition to conventional heart failure treatment, the study group received dietary guidance, while the control group did not receive any dietary guidance and maintained their usual low-fiber dietary habits. After one year intervention, the daily dietary fiber intake, abundance of gut microbiota, plasma trimethylamine N-oxide (TMAO), albumin (ALB), prealbumin (PA), transferrin (TF), C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8), left ventricular ejection fraction (LVEF), left ventricular end-diastolic index (LVEDVI), and left ventricular end-systolic volume index (LVESVI), Barthel index (BI), and 6 min walking distance (6 MWD) were compared. Results: After intervention, in both groups, the daily dietary fiber intake increased, abundance of Firmicutes, Proteobacteria, Actinobacteria, Fusobacteria decreased and that of Bacteroides increased; the plasma TMAO decreased; serum ALB, PA, and TF levels increased; serum CRP, TNF-α, IL-6, and IL-8 levels decreased, and the change was greater in the study group; LVEF elevated, LVEDVI and LVESVI reduced, and the differences between both groups were not significant; BI and 6 MWD elevated, and the study group was higher than the control group. Conclusion: High-fiber diet positively regulates the composition of gut microbiota, nutritional status and microinflammatory level in chronic HF patients, thereby improving patients' quality of life.

Gender Differences Are a Leading Factor in 5-Year Survival of Patients with Idiopathic Pulmonary Fibrosis over Antifibrotic Therapy Reduction.

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive lung disease with a median survival of 3-5 years. Antifibrotic therapies like pirfenidone and nintedanib slow progression, but the outcomes vary. Gender may influence disease presentation, progression, and response to treatment. This study evaluates the impact of gender on the 5-year survival, pharmacological management, and clinical outcomes of patients with IPF. A retrospective cohort study of 254 IPF patients was conducted, with 164 (131 males:33 females) having complete data. Patients underwent spirometry, DLCO, and 6 min walk tests. Data on comorbidities, smoking, antifibrotic therapy type, dosage adjustments, and adverse events were collected. We used Kaplan-Meier survival curves and logistic regression to assess gender-related differences in outcomes. Men had worse lung function at diagnosis (FVC 74.9 ± 18.5 vs. 87.2 ± 20.1% of pred.; p < 0.001) and a higher smoking prevalence (74% vs. 30%; p < 0.001). Women had better survival (51.2 vs. 40.8 ± 19.2 months; p = 0.005) despite more frequent biopsy use (36% vs. 17%; p = 0.013). Women tolerated longer therapy better (p = 0.001). No differences were found between patients receiving reduced antifibrotic dosing and those receiving full dosing. Gender has a significant impact on IPF outcomes, with women demonstrating better survival and tolerance to long-term therapy. In contrast, reducing antifibrotic treatment does not appear to significantly affect survival outcomes. These findings underscore the need for future research on gender-specific management approaches.

Assessing walking speed in persons with a lower-limb amputation: Test-retest reliability of the 10-m walk test.

Preferred walking speed (PWS), maximal walking speed (MWS), and walking speed reserve (WSR)-the difference between MWS and PWS-can be easily obtained from the 10-m walk test (10MWT) to assess walking ability and function. However, their test-retest reliability has not been determined in persons with unilateral lower-limb amputation (LLA). To determine the reliability of the PWS, MWS, and WSR obtained from the 10MWT in persons with LLA. Test-retest with a 48- to 120-h interval between test days. Test-retest relative and absolute reliability was assessed by the intraclass correlation coefficient (ICC) and the %change in mean (%CM) and coefficient of variation (CV), respectively. Preferred walking speed showed excellent reliability between day 1 (familiarization day) and day 2 (ICC = 0.97; %CM = -1.8; CV = 7.7) and a significant speed increase from day 2 to day 3 (ICC = 0.96; %CM = 8.5, p < 0.003; CV = 7.4). Maximal walking speed showed excellent reliability between day 1 and day 2 (ICC = 0.94; %CM = 2.9; CV = 8.3) and between day 2 and day 3 (ICC = 0.94; %CM = 1.8; CV = 8.6). Overall, WSR was poorly reliable between day 1 and day 2 (ICC = 0.65; %CM = 39.2; CV = 39.2) and between day 2 and day 3 (ICC = 0.74; %CM = 30.0; CV = 30.0). Preferred walking speed obtained from a single 10MWT and MWS obtained after a 10MWT familiarization day are reliable walking speed measures for persons with LLA with similar characteristics to those of our sample. Nonetheless, it is critical that both PWS and MWS are obtained after a 10MWT familiarization to obtain a reliable WSR.

Comparison Between Water Aerobics and Deep-Water Running on Middle-Aged Adults' Anthropometric, Hemodynamic and Functional Outcomes.

Head-out aquatic training, using modalities such as water-aerobics/hydrogymnastics (HYD) and deep-water running (DWR), has been effective in improving the physical, metabolic and cognitive health of middle-aged adults. However, direct comparisons between these modalities are lacking. The aim of this study was to compare the effects of water aerobics and deep-water running on anthropometric, functional and hemodynamic outcomes in adults and older adults. An uncontrolled pragmatic trial (RBR-2txw8zy) was conducted with participants aged 30 to 80, allocated to HYD and DWR groups. The intervention consisted of 12 weeks of progressive aerobic training with weekly undulating periodization (2× week), divided into three mesocycles (4, 5, and 3 weeks), each lasting 50 min. Intensity was prescribed using the Rate of Perceived Effort (RPE), ranging from RPE 11 to 17. Outcomes assessed included the 30 s chair stand, 30 s arm curl, Timed-Up-and-Go usual (TUG-u) and maximum (TUG-m), 6 min walking test (6MWT), body mass, waist circumference, blood pressure and resting heart rate-HRrest. The analysis was conducted using generalized estimating equations, with per-protocol (PP) and intention-to-treat (ITT) analyses. The study included 104 participants (HYD: n = 63, mean age 59 years, 54 women; DWR: n = 41, mean age 53 years, 33 women). ITT analysis showed improvements in waist circumference, waist-to-height ratio, and TUG-m in the HYD group, and a reduction in HRrest in the DWR group. Both modalities showed significant improvements in the 30 s chair stand, 30 s arm curl, 6MWT, waist circumference, and waist-to-height ratio in the PP analysis. Both modalities promoted functional improvements and favorable changes in anthropometric evaluations, with DWR showing a greater reduction in HRrest.

Cerebral Metabolic Rate of Oxygen and Accelerometry-Based Fatigability in Community-Dwelling Older Adults.

Alterations in energy metabolism may drive fatigue in older age, but prior research primarily focused on skeletal muscle energetics without assessing other systems, and utilized self-reported measures of fatigue. We tested the association between energy metabolism in the brain and an objective measure of fatigability in the Study of Muscle, Mobility and Aging (N=119, age 76.8±4.0 years, 59.7% women). Total brain cerebral metabolic rate of oxygen (CMRO 2 ) was measured using arterial spin labeling and T 2 -relaxation under spin tagging MRI protocols. Accelerometry-based fatigability status during a fast-paced 400m walk was determined using the Pittsburgh Fatigability Index (PPFI, higher=worse). Confounders included skeletal muscle energetics, measured in vivo using spectroscopy and ex vivo using respirometry, cardiorespiratory fitness (VO 2 peak), weight, medication count, and multimorbidity. Multivariable logistic regression models were used to estimate the association (odds ratio (OR)) of CMRO 2 with PPFI>0 compared to the referent group PPFI=0. Models were first adjusted for age and sex, and further adjusted for confounders. In this sample, 41.2% had PPFI>0 (median 3.3% [0.4-8.0%]). CMRO 2 was positively associated with PPFI>0 (age and sex adjusted OR=1.61, 95% CI: 1.06, 2.45, p=0.03); adjustment for confounders attenuated the association. The positive association of brain energetics and fatigability warrants further study in older adults.

The Importance of Dose Escalation in the Treatment of Pulmonary Arterial Hypertension with Treprostinil.

Background: Treprostinil, which is administered via continuous subcutaneous or intravenous infusion, is a medication applied in the treatment of pulmonary arterial hypertension (PAH). The dose of treprostinil is adjusted on an individual basis for each patient. A number of factors determine how well patients respond to treatment. Objectives: The aim of this study was to identify factors that may influence the clinical response to the dose of treprostinil at 3 months after the start of therapy. Methods: The factors influencing treatment response were analyzed in consecutive PAH patients who started receiving treprostinil treatment. The treatment efficacy was assessed as improvement in 6 min walk distance (6MWD) and WHO functional class (WHO FC), a reduction in N-terminal prohormone of brain natriuretic peptide (NTproBNP), and the percentage of patients achieving low-risk status after 12 months of treatment. Results: A total of 83 patients were included in this analysis. Classification of patients according to the tertiles of treprostinil dose achieved at 3 months after drug inclusion shows that after 12 months of follow-up, the median WHO FC in the highest dose group was lower than that in the intermediate dose group (WHO FC II vs. WHO FC III, p = 0.005), the median NTproBNP was lower (922 pg/mL, vs. 1686 pg/mL, p = 0.036) and 6MWD was longer (300 m vs. 510 m, p = 0.015). The French Noninvasive Criteria (NIFC) scale score was higher (2 vs. 0, p = 0.008), and the Reveal scale score was lower (5.0 vs. 8.5, p = 0.034). In the group of patients who exceeded a dose of 19.8 ng/kg/min within 3 months, an improvement in 6MWD was observed significantly more often after one year of therapy, and they were more likely to show an increase in NIFC scale scores after one year of therapy than the group of patients who received the lower dose (65% vs. 30%, p = 0.02). In the group of patients younger than 50 years of age, a statistically significant correlation was observed between the dose of treprostinil achieved after three months of treatment and the parameters assessed after 12 months of treatment, including WHO FC, 6MWD, and NIFC prognostic scale scores (all p < 0.05). Conclusions: The clinical effect of treatment is critically dependent on the rapid escalation of the treprostinil dose during the first three months of treatment.

Echocardiography of the right heart in pulmonary arterial hypertension: insights from the ULTRA RIGHT VALUE study.

Outcome in pulmonary arterial hypertension (PAH) is determined by right ventricular (RV) function adaptation to increased afterload. Echocardiography is easily available to assist bedside evaluation of the RV. However, no agreement exists about the feasibility and most relevant measurements. We therefore examined the feasibility, quality, and clinical correlations of standard echocardiographic variables in the evaluation of PAH. The present multicentric study collected echocardiographic examinations with centralized reading in 401 patients with prevalent PAH. Clinical variables, as World Health Organization (WHO) functional class (FC), 6 min walk distance (6MWD), brain natriuretic peptide (BNP)/NT-proBNP, invasive haemodynamics, the European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines-derived four-strata score, and the United States Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL) 2.0 score, were also collected. Echocardiographic measurements showed variable degrees of dilation of the right heart as assessed by right atrial and RV areas, altered indices of systolic function such as tricuspid annular plane systolic excursion (TAPSE), fractional area change, or 2D strain, and derived estimates of RV to pulmonary artery (PA) coupling by referring these measurements to systolic PA pressure (sPAP). All these measurements were feasible. All measurements of right heart dimensions and function, particularly TAPSE/sPAP, were correlated with WHO-FC, 6MWD, BNP/NT-proBNP, invasive haemodynamics, and ESC/ERS and REVEAL 2.0 scores. The present quality-controlled data from a network of PAH referral centres offer the background needed for further evaluation of the added value of echocardiography to currently recommended risk assessments in PAH.

Acupuncture and Kinesitherapy Improve Physical Activity More than Kinesitherapy Alone in Patients with Acute Decompensated Chronic Heart Failure with Reduced Ejection Fraction Who Are Already on Optimal Drug Therapy: A Randomized, Sham-Controlled, Double-Blind Clinical Study.

Background/Objectives: It is unknown how early exercise therapy combined with acupuncture (AP) affects the speed of recovery in patients suffering from heart failure with reduced ejection fraction (HFrEF) who are hospitalized due to worsening HF. Methods: A prospective, sham-procedure-controlled, double-blind, randomized clinical trial with three patient groups was conducted. The study included patients with HFrEF who were hospitalized for worsening HF. After initial stabilization, patients were randomly assigned to three groups, the controls (C) treated with optimal drug therapy (ODT); E1 received ODT with kinesitherapy, and sham AP; E2 received ODT, kinesitherapy, and needle AP aiming to enhance compensation. Improvement in physical activity was measured by the modified Barthel index (A test), 2 or 6 min walking tests, an endurance walking test, and decrease of blood brain natriuretic peptide (BNP). Results: A total of 120 patients completed the study. The average age was 74 years, 73.3% were male, median EF was 32%, and 83.3% were New York Heart Association (NYHA) Class III. After the fifth day of therapy, the E2 group showed the greatest improvement in the A test compared to other groups (p = 0.022). After 5 days, 80%, 50%, and 10% achieved an A test score of 30 or higher, demonstrating functional independence, (p < 0.01) in the E2, E1, and C groups, respectively. At hospital discharge, the E2 group showed significantly better walking endurance compared to the E1 and C groups (p < 0.001). At discharge, BNP decreased significantly more in both E groups, compared to the C group. Conclusions: Short-term early rehabilitation with AP and kinesitherapy significantly improves the functional status of HFrEF decompensated patients when compared to kinesitherapy alone and ODT.

Comparison of Functional Electrical Stimulation Cycle vs. Conservative Rehabilitation on Functional Status and Muscle Features in Stroke Patients

Background Functional Electrical Stimulation (FES) Cycle is used in the rehabilitation of stroke. Objective The aim of this study is to investigate the effects of CR and FES cycle therapy on the functional status and muscle features in stroke patients Methods The 1st Group(n = 15) received only CR for 6 weeks, and the 2nd Group(n = 15) received FES cycle 3 days a week for 4 weeks in addition to the CR treatment. Brunnstrom recovery staging(BRS), Fugl-Meyer lower extremity evaluation(FME); Berg Balance Scale(BBS), Functional Ambulation Classification(FAC), Barthel Index(BI), Fatigue Severity Scale(FSS), 6 min walk test(6mWT), knee extensor and knee flexor muscle strengths(KEMS, KFMS) in both groups were assessed before and after treatment(6th week). Pennate angle(PA) and rectus femoris muscle thickness(RFT) were measured. Results Significant improvement was detected in BBS, FAS, BI, FME, 6mWT, KEMS, RFT scores after intra-group treatment compared to before treatment in both groups. Only the 2nd Group showed a significant difference in KFMS, FSS, BRS lower extremity, PA values after treatment compared to before. No significant superiority of the groups over each other was detected. Conclusions CR and FES Cycle contribute to the improvement of the functional status of the patients, but their superiority over each other was not observed.

Effects of Real-Life Motor Complexity on Walking and Mobility in Trained and Sedentary Adolescents With Intellectual Disabilities: A Motor Dual-Task Investigation.

Adolescents with intellectual disabilities (ID) often encounter challenges in walking and mobility due to cognitive and motor impairments. This study aimed to investigate the impact of real-life motor complexity on walking and mobility in this population, particularly focusing on dual-task scenarios. Twenty-four adolescents with ID, divided into trained and sedentary groups, participated in the study. Participants completed the Timed Up and Go Test and the 10-m walk test under various conditions, including holding a water glass, carrying a tray with 2 glasses of water, introducing background noise, and encountering unexpected obstacles. Both groups significantly exhibited increased completion times (P < .001) in the Timed Up and Go Test and 10-m walk test with each added level of difficulty. The trained group demonstrated significantly superior performance (P < .05), only in the single task and holding a water glass. However, the difference between groups diminished as the challenges increased. In conclusion, real-life motor dual-tasking scenarios significantly impact walking and mobility in adolescents with ID. Physical activity may improve mobility and walking, particularly under less challenging conditions. Incorporating real-life challenges into motor dual-task training programs can enhance adaptability and reduce the risk of falls and injuries, ultimately improving the quality of life for individuals with ID.

The Impact of Photobiomodulation Therapy on Swelling Reduction and Recovery Enhancement in Total Knee Arthroplasty: A Randomized Clinical Trial.

Background: Total knee arthroplasty (TKA) is commonly performed for severe osteoarthritis but often results in significant postoperative swelling and discomfort, impacting early rehabilitation. Photobiomodulation therapy (PBMT), utilizing low-level laser therapy (LLLT), has emerged as a potential adjunctive treatment to alleviate these symptoms. Methods: In this single-center, nonblinded prospective randomized clinical trial, conducted from May to July 2024, 30 patients undergoing primary TKA were enrolled and divided into two groups. Fifteen patients formed the control group receiving standard postoperative care, while the intervention group consisted of another 15 patients who received additional PBMT from the first to the fifth postoperative day (POD). The swelling was assessed using bioimpedance analysis, which offers a noninvasive, safe, and efficient method for assessing postoperative swelling by measuring tissue impedance, and functional outcomes were measured using the 2-min walk test (2MWT) and active range of motion (aROM). The study was registered with ClinicalTrials.gov (NCT06426251). Results: The PBMT group demonstrated significantly lower impedance, reactance, and phase angle ratios by POD6, suggesting reduced swelling compared to the control group. In the 2MWT, the PBMT group achieved a longer walking distance of 27 m, compared to 16 m in the control group. However, there were no significant differences in aROM or Visual Analogue Scale (VAS) pain scores between the groups. Conclusions: The findings indicate that PBMT effectively reduces postoperative swelling and enhances early mobility post-TKA. These benefits suggest that PBMT can be a valuable addition to conventional postoperative care, potentially accelerating functional recovery, and reducing rehabilitation time.

Exercise Training in Heart Failure: Current Evidence and Future Directions.

Heart Failure (HF) is a prevalent condition which places a substantial burden on healthcare systems worldwide. Medical management implemented with exercise training (ET) plays a role in prognostic and functional capacity improvement. The aim of this review is to determine the effect of exercise training (ET) on HFpEF and HFrEF patients as well as exercise modality recommendations in frail and sarcopenic subpopulations. Pharmacological therapy structures the cornerstone of management in HF reduced ejection fraction (HFrEF) and aids improved survival rates. Mortality reduction with pharmacological treatments in HF preserved ejection fraction (HFpEF) are yet to be established. Cardiac rehabilitation (CR) and ET can play an important role in both HFrEF and HFpEF. Preliminary findings suggest that CR significantly improves functional capacity, exercise duration, and quality of life. ET has shown beneficial effects on peak oxygen consumption (pVO2) and 6 min walk test distance in HFrEF and HFpEF patients, as well as a reduction in hospitalisation and mortality rates; however, the limited scope of larger trials reporting on this underscores the need for further research. ET also has been shown to have beneficial effects on depression and anxiety levels. High-intensity training (HIT) and moderate continuous training (MCT) have both shown benefits, while resistance exercise training and ventilatory assistance may also be beneficial. ET adherence rates are higher when enrolled to a supervised programme, but prescription rates remain low worldwide. Larger robust trials are required to determine ET's effects on HF, as well as the most efficacious and personalised exercise prescriptions in HF subtypes.

Enhancing gait mechanics: The effectiveness of a novel walking aid.

A walking support orthosis known as the e-foot®, a rubber orthotic worn from the hip to the forefoot to enhance joint flexibility and movement, has been developed to assist elderly people and individuals with walking impairments. Despite its widespread acceptance and positive reception in some care settings, the precise impact of this device on gait dynamics remains unexplored. This study aims to bridge this gap by comparing the walking speeds of healthy volunteers using the e-foot® against their normal walking speeds. Furthermore, it seeks to elucidate the biomechanical alterations induced by the e-foot® on their gait patterns. In this intervention study, 51 healthy volunteers underwent a 10-m walk test, both with and without the e-foot®, to measure its effect on walking speed. Gait changes were biomechanically compared by analyzing marker positions and accelerations of the lower extremities during the walk tests. The e-foot® orthotic device significantly improved walking times for both men and women in the 10-m walk test. Biomechanical testing showed a consistent trend of higher marker positions of the knees, heels, and toes when participants were using the e-foot®. Additionally, marker acceleration during the first half of the swing phase was greater with the e-foot®, indicating a faster gait initiation. The e-foot® increased the walking speed of healthy volunteers. Also, there were changes to knee, heel and toe positions during gait, and comparative increase in acceleration was recorded in these three parts during swinging gait.

Exploring Medium- and Long-Term Respiratory and Functional Sequelae in Young Adults Post-COVID-19.

Background and Objectives: Long COVID-19 syndrome may cause difficulties in functionality during daily life in young people. Our objective was to investigate the respiratory and functional sequelae in young adults with asymptomatic or mild COVID-19 compared with healthy peers 3-6 months and 6-12 months after COVID-19 infection. Materials and Methods: Participants aged 18-25 who had COVID-19 within the last 3-6 months (Post-COVID Group 1, n = 25) and 6-12 months (Post-COVID Group 2, n = 25) and age-gender-matched healthy controls (n = 25) were included in this study. Respiratory functions and muscle strength were measured. Physical function was assessed with 6 min walking test (6MWT) and an Incremental Shuttle Walk Test (ISWT). The 1 min sit-to-stand test (1-MSTST) and hand grip strength (HGS) were used to assess muscle performance. Fatigue and dyspnea severity were questioned. Results: The FVC%pred (p = 0.023) and MEP (p = 0.034) were higher, and 1-MSTST repetitions were lower in Post-COVID Group-1 compared to Post-COVID Group-2 (p = 0.029). The PEF%pred (p = 0.025), MEP (p = 0.001), and ISWT distance were lower in Post-COVID Group-2 compared to healthy controls. The number of 1-MSTST repetitions and 6MWT distance were lower in Post-COVID Group-1 (p = 0.003, p = 0.001) and Post-COVID Group-2 (p = 0.003, p = 0.017) than in healthy controls. Exercise-induced blood lactate change during the ISWT, HGS, fatigue, and dyspnea were not significantly different between post-COVID groups and healthy controls. Conclusions: Young adults who pass asymptomatic or mild SARS-CoV-2 infection exhibit a decline in FVC%pred, PEF%pred, lower extremity muscle performance, and physical function within 3-6 months. In addition, the deterioration in respiratory and physical functions becomes apparent within 6-12 months.

Moderate-To-Vigorous Physical Activity Independent of Stationary Time Is Associated With Better Functional Outcomes Over Four-Years in Individuals With or at Risk of Knee Osteoarthritis.

Osteoarthritis is a progressive joint disease that causes pain and disability, impairing physical function. Moderate-to-vigorous physical activity (MVPA) is recommended for knee osteoarthritis, while stationary time, independent of activity, may negatively impact health outcomes. We hypothesised that individuals with the highest MVPA and lowest stationary time would have better long-term function compared to those with the lowest MVPA and highest stationary time, as well as those with high levels of both MVPA and stationary time. Data included 442 participants, with an average age of 66-years and 190-females from the Osteoarthritis Initiative who wore accelerometers to assess MVPA and stationary time. Participants were grouped into tertiles of MVPA and stationary time normalised to total accelerometer wear time. The three groups were: highest activity, lowest stationary (HALS), highest activity, highest stationary (HAHS), and lowest activity, highest stationary (LAHS). Gait speed, the 400m walk test, and five-time repeated chair stand were assessed at baseline and four-year follow-up. Compared to the LAHS group, the HALS and HAHS groups had better performance in gait speed p<0.001, d=0.96-1.06, 400m walk time p<0.001, d=1.21-1.36, and five-time repeated chair stand p<0.001, d=0.54-0.81 at baseline and four-year follow-up. No differences were found between the HALS and HAHS groups at either timepoint. Higher levels of MVPA were associated with better lower-limb functional outcomes in individuals with or at risk of knee osteoarthritis. Higher levels of stationary time do not negatively influence functional performance as long as higher numbers of MVPA levels (∼30min/day) are achieved.

Muscle power is associated with higher levels of walking capacity and self-reported gait performance and physical activity in individuals with cerebral palsy.

The purpose of this study was to investigate the relationships between a Power Leg Press test (PLP) with walking capacity and self-reported performance and participation in individuals with Cerebral Palsy (CP), and to compare the strength of the associations between two power tests (PLP and isokinetic (IsoK)) with walking capacity. Ambulatory individuals with CP (n = 33; age 17.89 ± 7.52 years) performed five inclined power leg presses at 40%-50% of their 1-repetition maximum "as fast as possible". A linear position transducer was attached to the weight bar, and the displacement, total load, and angle of the sled were used to calculate peak power for each trial. Isokinetic knee extensor power was measured at 60 deg/sec. Walking capacity was measured using the 10-m walk test fast (FS) and self-selected (SS) speeds and the 1-min walk test (1MWT). Self-reported performance and participation measures were the Activities Scale for Kids-performance (ASKp), Patient-Reported Outcomes Measurement Information System (PROMIS®), and the Gait Outcomes Assessment List (GOAL). Pearson's correlation coefficients determined relationships between power measures with walking capacity and self-report measures (α < 0.05). PLP and IsoK power were significantly correlated to SS (r = 0.361, r = 0.376), FS (r = 0.511, r = 0.485), and 1MWT (r = 0.583. r = 0.443), respectively (p < 0.05). There was no significant difference between the strength of the associations between walking capacity and each test of power (PLP and Isok) (p > 0.05). PLP power was significantly correlated to composite scores on the ASKp (r = 0.690) and GOAL (r = 0.577) and to four components of the PROMIS, including physical function (r = 0.588) (p < 0.01). The Gait and Mobility subscale of the GOAL (r = 0.705) and the Locomotion (r = 0.636), Transfers (r = 0.547), and Standing (r = 0.521) subscales of the ASKp had strong relationships to peak power produced during the PLP test (p < 0.01). PLP power was significantly correlated with walking capacity and self-reported walking performance and mobility-based participation in ambulatory individuals with CP. Higher movement velocities associated with the PLP test may explain the significant associations of power with faster gait speeds. Self-reported mobility performance and physical activity also showed moderate to strong relationships with lower extremity power. Overall, these results suggest a strong link between decreased muscle power generation and walking limitations in individuals with CP.

Appetite Regulation in Response to Acute Exercise among Weight-Loss Treatment Responders vs Nonresponders: A Pilot Study

ABSTRACT Introduction The reason for weight-loss heterogeneity in response to lifestyle interventions is not clear. Important regulators of food intake and energy expenditure include peripheral hormonal signals from insulin, glucagon-like peptide 1 (GLP-1), leptin, and ghrelin. Herein, we examine the hormonal regulators of appetite and satiety following a high-volume bout of moderate-to-vigorous intensity exercise in responders and nonresponders to a 6-month, digitally delivered, weight-loss lifestyle intervention. Methods Young adults (27.7 ± 3.7 yr; 11 female, 1 male) characterized as responders (n = 7; lost 3% of their initial body weight) and nonresponders (n = 5) participated in a 60-min treadmill exercise challenge, consisting of three 15-min intervals at 80% of peak oxygen consumption (V̇O2peak), with 5 min of walking at 50% V̇O2peak between intervals. Blood samples were obtained prior to and immediately after exercise and 30 and 60 min after exercise during seated recovery for determination of plasma glucose, insulin, GLP-1active, leptin, and acylated ghrelin. Univariate analyses (mean ± standard deviation) and Cohen’s d described between-group differences in hormone responses to exercise. Results Glucose and leptin responses during the exercise challenge and recovery were similar for nonresponders and responders; however, nonresponders had higher insulin concentrations post-exercise compared to responders (9.8 ± 3.5 μU·mL−1 vs 6.2 ± 2.2 μU·mL−1 at 30 min (d = 1.23); 9.4 ± 1.8 μU·mL−1 vs 6.3 ± 2.1 μU·mL−1 at 60 min (d = 1.54)). Concentrations of GLP-1active also appeared higher in nonresponders compared to responders following exercise (12.2 ± 2.8 pmol·L−1 vs 9.3 ± 1.1 pmol·L−1 (d = 1.36)), but this difference disappeared after 30 min of recovery. Ghrelin levels were lower in the nonresponders following exercise (308 ± 27 pg·mL−1 vs 494 ± 98 pg·mL−1 (d = −2.58)) and remained so over the recovery period (287.4 ± 12.3 pg·mL−1 vs 392.1 ± 47.2 pg·mL−1 at 30 min (d = −3.08); 313.0 ± 39.8 pg·mL−1 vs 393.9 ± 60.8 pg·mL−1 at 60 min (d = −1.21)). Conclusions These findings support potential appetite hormonal differences in the heterogenous weight-loss response to lifestyle therapy. A better understanding of how exercise affects appetite regulation in young adults with overweight and obesity could help with precision care.