6-min Walk Research Articles

The role of maximal inspiratory pressure on functional performance in adults with heart failure.

Exercise intolerance is common among adults with heart failure (HF) and is a strong prognostic indicator. We examined maximal inspiratory pressure (MIP) as an indicator of maximal and submaximal exercise capacity in older HF patients. Fifty-one patients age≥50years with HF underwent MIP testing via the PrO2 device. Peak oxygen uptake (VO2), 6min walk distance (6MWD), 30s sit-to-stand test (STS), gait speed (GS), grip strength and lower extremity muscle strength [one-repetition maximum (1RM)] were measured. Correlation and exploratory multiple regression analyses investigated relationships between MIP, left ventricular ejection fraction (LVEF), age, body mass index (BMI) and physical function. MIP was then stratified by median (64cm H2O), and endpoints were compared between median groups. The median age was 69years [interquartile range (IQR): 66-73], and the median LVEF was 36.5% (IQR: 30%-45%). Regression identified MIP as an independent predictor for grip strength, 6MWD, 1RM weight and 30s STS after adjustment for age, BMI and LVEF. MIP greater than the median (n=25) independently predicted and reflected greater peak VO2 [14.2 (12.8-18.1) vs. 11.5 (9.7-13.0) mL/kg/min; P=0.0007] as well as 6MWD, 1RM, 30s STS and GS (all P<0.05). The analysis demonstrates that MIP is a novel biometric for exercise tolerance in adults with HF. Assessments of MIP are safe and convenient, with the potential to enhance routine HF surveillance and provide novel biometrics to guide HF therapeutics.

Which Variables Are Associated with the Magnitude of the Physical Fitness Response in Older Adults? An Analysis of Their Development and Influence.

Regular physical exercise has proven to be an effective strategy for enhancing the health and well-being of older adults. However, there are still gaps in our understanding of the impacts of exercise on older adults with different health conditions, as well as in the customization of training programs according to individual capabilities. This study aimed to analyze the variables that influence the response of physical capabilities in older adults, considering their development over the aging process, with the goal of assisting professionals in creating personalized training programs. To achieve this, we conducted a cohort study involving 562 previously inactive adults and older adults who underwent anthropometric assessments, blood pressure measurements, and comprehensive physical tests. These assessments were conducted before and after a 14-week training program. Results indicated no significant variations in variables such as waist circumference (p = 0.0455, effect size = 0.10), body mass index (p = 0.0215, effect size = 0.15), systolic (p < 0.0001, effect size = 0.35) and diastolic blood pressure (p < 0.0001, effect size = 0.25) pre- and post-intervention. Strength tests, agility, the 6 min walk test (6MWT), and the back scratch test (BS) showed significant improvements post-intervention, with p-values all below 0.0001 and effect sizes ranging from 0.30 to 0.50. Multiple linear regression analyses revealed that lower initial values in physical capabilities were associated with more significant improvements during training (R2 = 0.73, p < 0.001). These results underscore that individualized guidance in training can lead to clinically meaningful improvements in physical performance and health among older adults, with effect sizes indicating moderate-to-large benefits (effect size range = 0.30 to 0.50). Therefore, personalized training programs are essential to maximize health benefits in this population.

Characterization and natural history of patients with LMNA-related dilated cardiomyopathy in the phase 3 REALM-DCM trial.

LMNA-related dilated cardiomyopathy (DCM) is a rare disease with an incompletely defined phenotype. The phase 3 REALM-DCM trial evaluated a potential disease-modifying therapy for LMNA-related DCM but was terminated due to futility without safety concern. This study utilized pooled data from REALM-DCM to descriptively characterize the phenotype and progression of LMNA-related DCM in a contemporary cohort of patients using common heart failure (HF) measures. REALM-DCM enrolled patients with stable LMNA-related DCM, an implanted cardioverter defibrillator or cardiac resynchronization therapy defibrillator, and New York Heart Association (NYHA) Class II/III HF symptoms. Between 2018 and 2022, 77 patients took part in REALM-DCM. The median patient age was 53years (range: 23-72), and 57% were male. Overall, 88% of patients had a pathogenic or likely pathogenic LMNA variant, and 12% had a variant of uncertain significance with a concordant phenotype. Among patients with confirmed sequencing, 55% had a missense variant. Atrial fibrillation was present in 60% of patients; 79% of all patients had NYHA Class II and 21% had NYHA Class III HF symptoms at baseline. Median (range) left ventricular ejection fraction (LVEF), 6min walk test (6MWT) distance, Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) score and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration at baseline were 42% (23-62), 403m (173-481), 67 (18-97) and 866pg/mL (57-5248), respectively. LVEF, 6MWT distance and KCCQ-OS score were numerically lower in patients who had NYHA Class III versus II symptoms at baseline (LVEF: 38% vs. 43%; 6MWT distance: 326 vs. 413m; and KCCQ-OS score: 43 vs. 70), whereas NT-proBNP concentration was higher (1216 vs. 799pg/mL). Median follow-up was 73weeks (range: 0.4-218; 73 in NYHA Class II and 75 in NYHA Class III). Patients displayed variable change from baseline in 6MWT, KCCQ-OS and NT-proBNP values during follow-up. Overall, 25% of patients experienced ventricular tachycardia, and 8% had ventricular fibrillation. Ten (13%) patients met the composite endpoint of worsening HF (adjudicated HF-related hospitalization or urgent care visit) or all-cause death; six had NYHA Class II and four had NYHA Class III at baseline. All-cause mortality occurred in 6 (8%) patients; three had NYHA Class II and three had NYHA Class III symptoms at baseline. Findings confirm the significant morbidity and mortality associated with LMNA-related DCM despite the standard of care management. Typical measures of HF, including 6MWT distance, KCCQ-OS score and NT-proBNP concentration, were variable but correlated with NYHA class. An unmet treatment need remains among patients with LMNA-related DCM. NCT03439514.

Understanding Kinesiophobia: Predictors and Influence on Early Functional Outcomes in Patients with Total Knee Arthroplasty.

This observational study aimed to identify predictors of kinesiophobia and examine its correlation with early functional outcomes in TKA recipients. On the first and fifth postoperative days (POD1 and POD5), we evaluated pain using the International Pain Outcomes Questionnaire (IPO-Q) and created multidimensional pain composite scores (PCSs). The Total Pain Composite Score (PCStotal) assesses the overall impact of pain, taking into account outcomes of pain intensity, pain-related interference with function, and emotions and side effects. Functional status on POD 5 was determined by the Barthel index, 6 min walking test, and knee range of motion. Kinesiophobia was assessed on POD5 using the Tampa Scale for Kinesiophobia (TSK). Among 75 TKA patients, 27% exhibited kinesiophobia. The final regression model highlighted PCStotal on POD5 (OR = 6.2, CI = 1.9-19.9), PCStotal (OR = 2.1, CI = 1.2-3.8) on POD1, and the intensity of chronic pain before surgery (OR = 1.4, CI = 1.1-2.1) as significant kinesiophobia predictors. On POD5, those with kinesiophobia showed increased dependency, slower gait, and poorer knee extension recovery. This study emphasizes the need to identify and address kinesiophobia in TKA patients for better functional outcomes and recovery. Additionally, it is vital to assess different domains of pain, not just pain intensity, as it can lead to kinesiophobia development.

Cerebellar Metabolic Connectivity during Treadmill Walking before and after Unilateral Dopamine Depletion in Rats.

Compensatory changes in brain connectivity keep motor symptoms mild in prodromal Parkinson's disease. Studying compensation in patients is hampered by the steady progression of the disease and a lack of individual baseline controls. Furthermore, combining fMRI with walking is intricate. We therefore used a seed-based metabolic connectivity analysis based on 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) uptake in a unilateral 6-OHDA rat model. At baseline and in the chronic phase 6-7 months after lesion, rats received an intraperitoneal injection of [18F]FDG and spent 50 min walking on a horizontal treadmill, followed by a brain PET-scan under anesthesia. High activity was found in the cerebellar anterior vermis in both conditions. At baseline, the anterior vermis showed hardly any stable connections to the rest of the brain. The (future) ipsilesional cerebellar hemisphere was not particularly active during walking but was extensively connected to many brain areas. After unilateral dopamine depletion, rats still walked normally without obvious impairments. The ipsilesional cerebellar hemisphere increased its activity, but narrowed its connections down to the vestibulocerebellum, probably aiding lateral stability. The anterior vermis established a network involving the motor cortex, hippocampus and thalamus. Adding those regions to the vermis network of (previously) automatic control of locomotion suggests that after unilateral dopamine depletion considerable conscious and cognitive effort has to be provided to achieve stable walking.

Development and validation of a clinical prediction rule for walking independence in hospitalized older adults with a vertebral compression fracture.

No reports on factors or Clinical prediction rules (CPRs) associated with walking independence among patients with vertebral compression fractures (VCFs) are available. Evidence regarding epidemiological walking independence rates is also sparse. Here, we sought to (i) obtain epidemiological data on the probability of inpatients with VCFs achieving walking independence, and (ii) develop and validate a CPR to determine walking independence in hospitalized patients with VCFs. We conducted a retrospective cross-sectional observational study of patients aged ≥60years who were hospitalized for VCF at four hospitals in Japan in 2019-2022. The outcome was walking independence at discharge. We performed a binomial logistic regression analysis to assess predictors of walking independence. Five independent variables were entered: age, American Society of Anesthesiologists physical status, cognitive function, Berg Balance Scale (BBS), and 10-m walking test. Among the independent variables that were significant, we converted the continuous variables to binary data by calculating cut-off values and then created the CPR. The area under the curve (AUC) was calculated as the measure of the CPR's diagnostic accuracy, and internal validation was conducted by bootstrapping. Of the 240 patients, 188 (78.3%) achieved walking independence. Cognitive function and the BBS score (with a cut-off of 45 points) were identified as significant predictors. We created a CPR using these two items (0-2 points). The CPR's AUC was 0.92 (0.874-0.967), and internal validation by bootstrapping yielded a mean AUC of 0.919 with a slope of 0.965. The walking independence rate of patients with a VCF during hospitalization was 78.3%, with cognitive function and BBS being predictors. The developed CPR performed well enough to retrospectively predict walking independence in VCF patients. The BBS cut-off value and the CPR may serve as useful indicators for clinicians to predict VCF patients' walking independence.

Multiple sclerosis and spasticity: the role of anaesthetic nerve blocks on rectus femoris muscle. When should stiff knee be treated with botulinum toxin?

To compare the effect of rectus femoris diagnostic motor nerve blocks (DNB) with anaesthetics and rectus femoris muscle botulinum toxin (BoNT-A) injection in multiple sclerosis patients with unilateral stiff-knee gait. Prospective observational study Subjects/Patients: Multiple sclerosis patients in stable condition. Patients underwent evaluation before and 1 hour after the anaesthetic block, and 1 month after the botulinum injection. Assessment included a 10-m walking test, a 6-minute walking test, a timed-up-and-go (TUG) test, and a Baseline Expanded Disability Status Scale (EDSS). Post-DNB and post-BoNT-A satisfaction was measured with the global assessment of efficacy scale. Fourteen patients with unilateral stiff-knee gait due to multiple sclerosis underwent a DNB, among whom 13 received botulinum injections in the rectus femoris muscle after a satisfying test result. Positive post-DNB results correlated with significant functional improvements after BoNT-A. Higher EDSS and longer time from diagnosis correlated with poorer post-DNB and post-BoNT-A absolute outcomes. DNB showed predictive value for BoNT-A outcomes, especially in the case of worse functional status. It effectively predicted endurance and walking speed improvement, while TUG showed greater improvement after botulinum. In cases of uncertain therapeutic benefit, nerve blocks may provide a valuable diagnostic support, particularly in patients with lower functional status.

Efficacy of exercise with the hybrid assistive limb lumbar type on physical function in mobility-limited older adults: A 5-week randomized controlled trial

BackgroundSarcopenia and frailty often worsen in older adults because of declines in activities of daily living and social connections that are associated with chronic diseases and traumatic injuries such as falls and fractures. Exercise intervention for sarcopenia can take >3 months to improve muscle mass, muscle strength, and walking speed. Thus, a specialized intervention system for shorter periods of time is needed. In this study, we aimed to evaluate the short-term efficacy of an exercise program using the wearable cyborg Hybrid Assistive Limb (HAL) lumbar type in physical function in mobility-limited older adults who do not require transition to long-term care. MethodsThis randomized, single-blind, parallel-group study involved 79 community-dwelling older adults with physical frailty or locomotive syndrome assigned to an intervention group (n = 40) with the HAL lumbar type exercise program or a control group (n = 39) without the exercise program. The intervention group underwent trunk training (including trunk and hip flexion, standing and sitting from a single sitting position, and squats) and gait training (treadmill and parallel bars) twice a week for 5 weeks while wearing the HAL lumbar type. The 10-m usual and maximum walking speeds, Timed Up and Go test results, 5-times chair-standing test results, 5-question Geriatric Locomotive Function Scale (GLFS-5) scores, body-fat percentage, and muscle mass were measured before and after the intervention and analyzed using the intention-to-treat method. ResultsThe intervention (23 % male; mean age, 74.7 ± 4.7 years) and control (21 % male; mean age, 75.1 ± 4.1 years) groups did not differ significantly in baseline characteristics. Seventy-seven participants completed the program; two withdrew for personal reasons. The mean difference (standard error) between the groups for the primary outcome (usual walking speed) was 0.35 (0.04) m/s; the time-by-group interaction was significant (p < 0.001). Secondary outcomes (maximum walking speed, Timed Up and Go test results, 5-times chair-standing test results, and GLFS-5 scores) significantly improved in the intervention group. Body composition was unchanged in both groups. ConclusionsA 5-week exercise program using the HAL lumbar type is a promising option for community-dwelling older adults with limited mobility who do not require nursing care, resulting in clinically meaningful improvements in most physical functions within a short period.

MHealth devices demonstrate validity and reliability in detecting steps in chronic stroke survivors who rely on assistive devices

PurposeTo assess the concurrent validity and reliability of five mHealth devices (STEPZ, Health, Pacer, Google Fit, and Fitbit Inc.®) in counting steps among individuals with chronic stroke using assistive devices (AD). Our primary objective was to identify significant variations in step counts between AD users and non-users. MethodsIn a cross-sectional study, individuals performed a 2-min walking test while carrying two smartphones (Android OS and iOS) equipped with four different applications (STEPZ, Health, Pacer, and Google Fit), alongside a Fitbit Inc.® device. A visual video recording served as criterion-standard measure for step counting. Each participant completed four walking trials. Two proficient researchers conducted data collection in a controlled environment at a single day. ResultsTwenty-four individuals were included. The devices were valid for individuals in individuals with chronic stroke who used AD (0.52 ≤ r ≥ 0.89), except for Health (iOS). There is no agreement between the criterion-standard and Health (iOS), and all other devices showed adequate reliability (0.107 ≤ CCI [2, 1] ≥ 0.701). There was no difference in stepping counting when the individuals used or not the AD. ConclusionsHealth for iOS is neither valid nor reliable for individuals with chronic stroke who are AD users. There is no difference in step counting were when the individuals with chronic stroke are users or non-users of AD.

Effects of Baduanjin Exercise on lung function and 6 min walk in COPD patients: a systematic review and meta-analysis

COPD is a public health problem of global concern, which seriously affects the quality of life of patients and is also the third leading cause of death from non-communicable diseases. To investigate the effect of Ba duan jin exercise on lung function and the results of a 6-min walking trial in patients with stable COPD. Literature databases such as Web of Science, Embase, PubMed, Cochrane Library, Chinese Biomedical Literature (CBM), CNKI, Wanfang Data and VIP were searched by computer, the search period is up to January 2024. Literature screening, quality evaluation and data extraction were carried out independently by two researchers. And use RevMan 5.3 software and StataMP 18 (64-bit) software to process the relevant outcome indicators. A total of 16 RCT studies with 1184 patients were included. The meta-analysis results showed that compared with the control group, Ba Duan Jin exercise could improve FEV1 (MD = 0.29, 95% CI (0.20, 0.37), P < 0.0001), FEV1/FVC (%) (MD = 3.86, 95% CI (2.24, 5.47), P < 0.00001), and 6-min walking distance (MD = 45.41, 95% CI (33.93, 56.89), P < 0.00001) in stable COPD patients. The results of subgroup analysis based on the duration of the intervention cycle, research quality, and intervention frequency showed that periodic Ba Duan Jin exercise can significantly improve the relevant lung function levels to varying degrees. At the same time, the intervention effect of Ba Duan Jin exercise during the implementation process is also affected by the duration of the exercise cycle, exercise frequency, and the completion of the exercise plan. Ba Duan Jin exercise has a positive improvement effect on lung function and 6-min walking distance in stable COPD patients. In the process of exercise implementation, attention should be paid to cultivating exercise habits, stabilizing and improving attendance rates, and strictly implementing training techniques to achieve the best clinical outcomes for these patients.

Evaluating the level of access and equity of the bus rapid transit (BRT) system: The case of Dar-Es-Salaam, Tanzania

Bus Rapid Transit (BRT) systems have witnessed significant growth worldwide, particularly in rapidly urbanizing cities in the developing world, often implemented through public-private partnerships to foster economic growth. However, the success of such ambitions relies on ensuring equitable transit access for all residents, including those living with poverty or other social disadvantages. The purpose of this study is to explore transit access, coverage, and equity of the BRT system in Dar-es-Salaam, Tanzania using infrastructure-based measures of proximity to transit stations and stops. In particular, the equitable distribution of transit access patterns is explored in relation to neighborhood socio-economic strata in the catchment areas within a 30-min walking distance. The study's findings reveal notable disparities in the level of access among various socio-economic strata, with the least deprived population benefiting the most from the Dar-es-Salaam BRT system. As more BRT phases are implemented, there is a continuous increase in the Multidimensional Poverty Index (MPI) within the areas not covered by the BRT system. This suggests that access improvements predominantly favor the wealthier population rather than effectively addressing the needs of the impoverished population. To enhance access and achieve more equitable outcomes, it is crucial to implement targeted strategies and measures. These may include improved integration of the BRT with a feeder system, continuous improvement of Non-Motorized Transport (NMT) facilities, and the promotion of equitable transit-oriented development along the BRT corridor. These initiatives play a vital role in ensuring that vulnerable populations, especially the poor, have access to and can benefit from the BRT services.

Feasibility of prehabilitation for patients awaiting total knee arthroplasty; a pilot study

ObjectiveTo examine the feasibility of conducting a preoperative home-based prehabilitation program for total knee arthroplasty patients at risk for delayed in-hospital recovery, and to explore the pre- and postoperative impact of this program. DesignA retrospective cohort study with matched controls, enabling subgroup analyses. SettingHome-based. SubjectsPatients awaiting primary unilateral total knee arthroplasty between 2019 and 2020, were compared with matched historic cases from 2016 to 2017. Matching criteria were scoring ≤17 points on the De Morton Mobility Index and >12.5 s on the timed-up-and-go test. InterventionSupervised home-based prehabilitation program versus no prehabilitation. OutcomesFeasibility, determined by recruitment rate, adherence, and safety of the program. Preoperative impact, assessed for the intervention group by differences in mean values for aerobic capacity, muscle strength and functional mobility between the first and last sessions. Postoperative impact was defined as the time needed to achieve in-hospital independence of physical function and was measured by the differences in mean values between the intervention and control groups. ResultsRecruitment rate was 71 %; adherence and drop-out rates were 88 % and 12 % respectively. No adverse events were reported. Preoperatively, the intervention group showed significant improvements in aerobic capacity on the 2-min walking test (84.29 m–98.06 m; p = 0.007) and 2-min step test (40.35 steps to 52.95 steps; p = 0.014), muscle strength on the 30 s chair stand test (7.3 stands to 10.1 stands; p = 0.002), and functional mobility as seen in the timed-up-and-go-test (19.52 s–15.85 s; p = 0.031). Postoperatively, the intervention group achieved in-hospital independence of physical function earlier (mean rank 16.11) than the control group (mean rank 24.89; p=<0.01). ConclusionsIt is feasible to conduct a prehabilitation program 4–6 weeks preoperatively, for high-risk patients awaiting total knee arthroplasty. Additionally, the program appears to have a positive impact on physical fitness both pre- and postoperatively.

Availability of Observational Pain Assessment Tools in Hospitalized Patients with Osteoporotic Vertebral Fractures.

Background and Objectives: Osteoporotic vertebral fractures in older patients cause lower back pain and abnormal posture, resulting in impaired activities of daily living (ADLs). Assessing pain using self-reported assessment tools is difficult, especially in patients with moderate-to-severe cognitive impairment. Recently, observational assessment tools have been used when self-reported ones were difficult to administer. No studies have reported the usefulness of observational assessment tools in patients with acute-phase orthopedic disorders without complication. This study aimed to examine the availability of observational tools for pain assessment in patients with lumbar vertebral fractures. Materials and Methods: Patients admitted to our hospital with acute-phase vertebral fractures were enrolled in this prospective observational study. Pain was assessed using Japanese versions of the Abbey pain scale and Doloplus-2 observational assessment tools, and the Numerical Rating Scale, a self-reported assessment tool. To compare the pain assessment tool, we examined whether each tool correlated with ADLs and ambulatory status. ADLs were assessed using the Barthel Index. Ambulatory status was assessed using the Functional Ambulation Categories and the 10-m walking test. Results: Similar to the Numerical Rating Scale scores, assessments with the Abbey pain scale and Doloplus-2 showed significant decreases in scores over time. A significant positive correlation was observed between the self-reported and observational assessment tools. Each pain assessment tool was significantly negatively correlated with ADLs and ambulatory status. Conclusions: When self-reported assessment with the Numerical Rating Scale is difficult for patients with cognitive impairment, pain can be estimated using the Abbey pain scale and Doloplus-2 observational assessment tools.

Rationale and design of the multi organ inflammation with serial testing study: a comprehensive assessment of functional and structural abnormalities in patients with recovered COVID-19.

Short-term clinical outcomes from SARS-CoV-2 infection are generally favorable. However, 15-20% of patients report persistent symptoms of at least 12 weeks duration, often referred to as long COVID. Population studies have also demonstrated an increased risk of incident diabetes and cardiovascular disease at 12 months following infection. While imaging studies have identified multi-organ injury patterns in patients with recovered COVID-19, their respective contributions to the disability and morbidity of long COVID is unclear. A multicenter, observational study of 215 vaccine-naïve patients with clinically recovered COVID-19, studied at 3-6 months following infection, and 133 healthy volunteers without prior SARS-CoV-2 infection. Patients with recovered COVID-19 were screened for long COVID related symptoms and their impact on daily living. Multi-organ, multi-parametric magnetic resonance imaging (MRI) and circulating biomarkers were acquired to document sub-clinical organ pathology. All participants underwent pulmonary function, aerobic endurance (6 min walk test), cognition testing and olfaction assessment. Clinical outcomes were collected up to 1 year from infection. The primary objective of this study is to identify associations between organ injury and disability in patients with long-COVID symptoms in comparison to controls. As a secondary objective, imaging and circulating biomarkers with the potential to exacerbate cardiovascular health were characterized. Long-term sequelae of COVID-19 are common and can result in significant disability and cardiometabolic disease. The overall goal of this project is to identify novel targets for the treatment of long COVID including mitigating the risk of incident cardiovascular disease. clinicaltrials.gov (MOIST late cross-sectional study; NCT04525404).

Impacts of a Prescribed Physical Activity Program for People with Chronic Diseases Living in Community Settings in France.

Sedentary behavior and physical inactivity are modifiable risk factors at the forefront of prevention and health promotion strategies. The health benefits of physical activity (PA) have been widely demonstrated in chronic diseases and have led to the prescription of adapted PA. To date, French scientific data are insufficient to evaluate the effectiveness of prescribing adapted PA. This study aimed (1) to evaluate the effectiveness of a community-based program and (2) to identify patient characteristics at inclusion that could be associated with improved post-program anthropometric data. Our sample was composed of 113 participants with a chronic disease (83.18% women) with a mean age of 55.4 ± 13.9 years. Participants benefited from an 8-week adapted PA program. All participants were evaluated at the beginning and end of the program by anthropometric measurements, a subjective measure of the level of PA and a measure of physical condition. Almost 86% of the participants were overweight and two-thirds were obese. Statistical analyses showed a significant improvement in physical condition, expressed by a better cardiorespiratory endurance (up to +14% for a 2 min walk test; MT0 = 78.1 m vs. MT1 = 89 m; p < 0.001 with a 2 min walk test), improved flexibility (+12.5%; MT0 = 2.4 vs. MT1 = 2.7; p < 0.001), and increased muscle strength in the lower limbs (+22.7%; MT0 = 11.9 vs. MT1 = 14.6; p < 0.001). The level of physical activity increased significantly for all participants (57.52% of inactive individuals at T0 vs. 5.31% at T1; p = 0.004). Correlational analyses revealed that the decrease in BMI and weight throughout the program correlated positively with age (r = 0.252 and p = 0.007, and r = 0.247 and p = 0.008, respectively) and negatively with BMI from baseline (r = -0.271; p = 0.004). The key points of this community-based PA program are the following: (1) It improves participants' physical condition. (2) It improves anthropometric parameters. (3) It modifies physical activity behavior. Furthermore, in the context of the program set up specifically for this purpose, it would appear that elderly and overweight people are more likely to exhibit beneficial effects on anthropometric parameters than younger participants or those with a high level of obesity. However, these results need to be confirmed by a long-term evaluation of the effectiveness of such devices.

Unraveling stroke gait deviations with movement analytics, more than meets the eye: a case control study.

This study aimed to identify and quantify the kinematic and kinetic gait deviations in post-stroke hemiplegic patients with matched healthy controls using Statistical Parametric Mapping (SPM). Fifteen chronic stroke patients [4 females, 11 males; age 53.7 (standard deviation 12.2) years; body mass 65.4 (10.4) kg; standing height 168.5 (9.6) cm] and 15 matched healthy controls [4 females, 11 males; age 52.9 (11.7) years; body weight 66.5 (10.7) years; standing height 168.3 (8.8) cm] were recruited. In a 10-m walking task, joint angles, ground reaction forces (GRF), and joint moments were collected, analyzed, and compared using SPM for an entire gait cycle. Generally, when comparing the stroke patients' affected (hemiplegic) and less-affected (contralateral) limbs with the control group, SPM identified significant differences in the late stance phase and early swing phase in the joint angles and moments in bilateral limbs (all p < 0.005). In addition, the vertical and anteroposterior components of GRF were significantly different in various periods of the stance phase (all p < 0.005), while the mediolateral component showed no differences between the two groups. SPM was able to detect abnormal gait patterns in both the affected and less-affected limbs of stroke patients with significant differences when compared with matched controls. The findings draw attention to significant quantifiable gait deviations in the less-affected post-stroke limb with the potential impact to inform gait retraining strategies for clinicians and physiotherapists.

Exploration of the Impact of Built Environment Factors on Morning and Evening Peak Ridership at Urban Rail Transit Stations: A Case Study of Changsha, China

&lt;div&gt;To identify the influences of various built environment factors on ridership at urban rail transit stations, a case study was conducted on the Changsha Metro. First, spatial and temporal distributions of the station-level AM peak and PM peak boarding ridership are analyzed. The Moran’s I test indicates that both of them show significant spatial correlations. Then, the pedestrian catchment area of each metro station is delineated using the Thiessen polygon method with an 800-m radius. The built environment factors within each pedestrian catchment area, involving population and employment, land use, accessibility, and station attributes, are collected. Finally, the mixed geographically weighted regression models are constructed to quantitatively identify the effects of these built environment factors on the AM and PM peak ridership, respectively. The estimation results indicate that population density and employment density have significant but opposite influences on the AM and PM peak ridership, which can be attributed to the opposite travel directions of commuters in the AM and PM peak. The recreational facility density, road density, and 10-min walking accessibility could significantly positively affect the PM peak ridership, and their influences vary greatly over space. Besides, the operating time of stations significantly positively affects both the AM and PM peak ridership, transfer stations have significantly larger PM peak ridership and terminal stations have significantly larger AM peak ridership. The findings are expected to provide new insights for agencies to formulate appropriate measures to improve the ridership of urban rail transit.&lt;/div&gt;

Mesenchymal stromal cells to treat patients with non-ischaemic heart failure: Results from SCIENCE II pilot study.

Allogeneic stem cell therapy is more logistically suitable compared with autologous cell therapy for large-scale patient treatment. We aim to investigate the clinical safety and efficacy profile of the allogeneic adipose tissue derived mesenchymal stromal cell product (CSCC_ASC) as an add-on therapy in patients with chronic non-ischaemic heart failure with reduced left ventricular ejection fraction (HFrEF)<40%. This is a single-centre investigator-initiated randomized phase I/II study with direct intra-myocardial injections of 100 million allogeneic CSCC_ASC. A total of 30 HFrEF patients with New York Heart Association (NYHA) class ≥II despite optimal anticongestive heart failure medication and plasma NT-proBNP>300pg/mL (>35pmol/L) were included and randomized 2:1 to CSCC_ASC or standard care. The primary endpoint left ventricular end systolic volume (LVESV) and other echo related parameters were analysed by an investigator blinded for treatment allocation. No difference in serious adverse events was observed between groups. LVESV decreased significantly from baseline to 6months follow-up in the ASC group (153.7±53.2mL and 128.7±45.6mL, P<0.001) and remained unchanged in the standard care group (180.4±39.4mL and 186.7±48.9mL, P=0.652). There was a significant difference between the groups in LVESV change (31.3±11.0mL, P=0.009). The difference from baseline to follow-up between the two groups in left ventricular end diastolic volume (LVEDV) was 18.7±12.4mL, P=0.146 and in left ventricular ejection fraction (LVEF) -7.8±2.1%, P=0.001. Considering the baseline values of LVESV, LVEDV and LVEF as covariates, the difference between groups for change from baseline to follow-up resulted in a P-value of 0.056, 0.076, and 0.738, respectively. NYHA class and self-reported health did also improve significantly in the ASC group compared with the standard care group (0.7±0.2, P=0.001 and -12.8±5.3, P=0.025; respectively). There was no difference in NT-proBNP (-371±455pmol/L, P=0.422) or in 6min walk test (12±31m, P=0.695) between groups. Intramyocardial injections of allogeneic CSCC_ASC in patients with chronic non-ischaemic HFrEF was safe and improved LVESV, LVEF, NYHA class, and self-reported health compared with standard care group.

Early heart rate recovery after a 6-min walking test in patients after percutaneous aortic valve implantation coresponds with clinical benefits

Abstract Background Time-appropriate return to a resting heart rate (HR) after cessation of exercise is a marker for predicting outcomes in patients with heart failure (HF). We aimed to evaluate the prognostic value of HR recovery in functional improvement in patients with severe aortic stenosis after percutaneous aortic valve implantation (TAVI). Methods 6 min walk test (6MWT) was performed in 93 individuals before TAVI and in 3 months follow up. The change in walking distance was measured. We analyzed also the differences between baseline HR, HR at the end of the test, and HR at the 1st, 2nd and 3rd minute of recovery. Results After 3 months the distance of 6MWT in TAVI patients improved by 39±63 m and reached a total of 322±117 m. The differences between HR after 2 min of recovery and baseline HR in pre-TAVI after a 6MWT was the only significant predictor of waking distance improvement during follow-up in multiple linear regression model. Conclusions Our study showes that changes of HR recovery after a 6MWT may be a helpful and easy parameter to assess improvement in exercise capacity after TAVI. This simple method can also help to identify patients in whom no significant benefit in functional improvement can be expected despite successful valve implantation.Demographics

Personalized care in dilated cardiomyopathy: Rationale and study design of the activeDCM trial.

Dilated cardiomyopathy (DCM) is a leading cause of heart failure, particularly in younger individuals. Low physical strength is a global risk factor for cardiovascular mortality, and physical activity and a healthy lifestyle have been shown to improve outcomes in patients with heart failure. However, inappropriate exercise may increase the risk of arrhythmias in certain individuals with DCM. The determinants for predicting individual risks in this setting are poorly understood, and clinicians are hesitant to recommend sports for cardiomyopathy patients. The activeDCM trial aims to assess the safety and efficacy of a personalized exercise and activity programme for individuals with DCM. The activeDCM trial is a prospective, randomized, interventional trial with a 12month follow-up. Three hundred patients, aged 18-75years with DCM, left ventricular ejection fraction (LVEF)≤50% and New York Heart Association (NYHA) classes I-III, will be enrolled. The intervention includes a personalized exercise and activity programme. The primary outcome is the increase in peak oxygen uptake (VO2max, mL/kg/min) from baseline to 12months. Secondary endpoints include adherence to personalized activity programmes, freedom from clinically relevant arrhythmia, unplanned hospitalization for heart failure and changes in NYHA class, quality of life scores, 6min walk distance, muscular strength, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin T (hsTnT) levels and cardiac function. Advanced research questions include high-density phenome and omics analysis combined with digital biomarkers derived from Apple Watch devices. The activeDCM trial will provide valuable insights into the safety and efficacy of personalized exercise training in DCM patients, inform clinical practice and contribute to the development of heart failure management programmes. The study will generate data on the impact of exercise on various aspects of cardiovascular disease, including genetic, metabolic, phenotypic and longitudinal aspects, facilitating the development of future digital tools and strategies, including the incorporation of smart wearable devices.