Continuous Scale Physical Functional Performance Research Articles

Assessing lower extremity loading during activities of daily living using continuous-scale physical functional performance 10 and wireless sensor insoles: a comparative study between younger and older adults

PurposeThis study aims to investigate the lower extremity loading during activities of daily living (ADLs) using the Continuous Scale of Physical Functional Performance (CS-PFP 10) test and wireless sensor insoles in healthy volunteers.MethodsIn this study, 42 participants were recruited, consisting of 21 healthy older adults (mean age 69.6 ± 4.6 years) and 21 younger healthy adults (mean age 23.6 ± 1.8 years). The performance of the subjects during ADLs was assessed using the CS-PFP 10 test, which comprised 10 tasks. The lower extremity loading was measured using wireless sensor insoles (OpenGo, Moticon, Munich, Germany) during the CS-PFP 10 test, which enabled the measurement of ground reaction forces, including the mean and maximum total forces during the stance phase, expressed in units of body weight (BW).ResultsThe total CS-PFP 10 score was significantly lower in older participants compared to the younger group (mean total score of 57.1 ± 9.0 compared to 78.2 ± 5.4, respectively). No significant differences in the mean total forces were found between older and young participants. The highest maximum total forces were observed during the tasks ‘endurance walk’ (young: 1.97 ± 0.34 BW, old: 1.70 ± 0.43 BW) and ‘climbing stairs’ (young: 1.65 ± 0.36 BW, old: 1.52 ± 0.28 BW). Only in the endurance walk, older participants showed a significantly higher maximum total force (p < 0.001).ConclusionThe use of wireless sensor insoles in a laboratory setting can effectively measure the load on the lower extremities during ADLs. These findings could offer valuable insights for developing tailored recommendations for patients with partial weight-bearing restrictions.

FUNCTIONAL IMPROVEMENTS MEASURED BY THE CONTINUOUS-SCALE PHYSICAL FUNCTIONAL PERFORMANCE TEST IN A UNILATERAL TRANSFEMORAL AMPUTEE FOLLOWING SOUND SIDE KNEE ARTHROPLASTY: A CASE STUDY

Osteoarthritis is common in the sound limb of persons with a transfemoral amputation (TFA) due to gait abnormalities and increased load on the knee when ambulating with or without aprosthesis. Commonly, a sound-limb total knee arthroplasty (TKA) is required to decrease pain and improve physical function. This case report discusses physical functional outcomes in a person with a TFA following sound limb TKA as measured by the Continuous-Scale Physical Functional Performance Test 10 (CS-PFP 10). A patient with a right TFA underwent a left TKA to improve functional performance. The purpose of this case was to quantify functional changes measured by the CS-PFP 10 at one week pre-TKA and one, three, six, twelve, and eighteen months post-TKA. Skilled standard care physical therapy was immediately implemented post-TKA, which included therapeutic interventions and electrotherapeutic modalities. Additionally, a whole-body high-intensity strengthening program was introduced at eighteen weeks post-operative (post-op) as an adjunct to return the patient to his prior level of function as a CrossFit® athlete.All five CS-PFP 10 domains demonstrated continuous improvement, while the rate of perceived exertion decreased. At one week post-op, the patient’s CS-PFP 10 score indicated an increased likelihood of functional dependence. However, by eighteen months, the patient achieved a total CS-PFP 10 score in the 75 to 90 range, indicating independent function likely. The CS-PFP 10 is a valid instrument to measure improvement in activities of daily living (ADL) in specified functional domains and overall function. Following this patient post-operatively through rehabilitation, the CS-PFP 10 revealed objective improvements demonstrating that sound limb total joint arthroplasty and physical therapy can greatly improve function. These interventions are a viable course of treatment in the presence of contralateral functional impairment in patients with TFA.The CS-PFP 10 is a valid instrument to accurately measure improvements in ADLs in specified functional domains and overall function in the patient population with a TFA followingsound limb TKA.

Declined Physical Function And Cortical Activation In Older Adults During Cs-pfp10 Compared To Young Adults

PURPOSE: To examine electrocortical activation during the Continuous Scale Physical Function Performance 10 (CS-PFP10) task in older adults compared to young adults. METHODS: Twenty older (OLD; 75.40 ± 7.32 yrs, 70.33 ± 18.23 kg, 162.87 ± 7.55 cm) and twenty healthy young (YOUNG; 19.88 ± 1.72 yrs, 66.52 ± 14.22 kg, 167.50 ± 10.22 cm) adults volunteered. The prefrontal (Fz), primary motor (Cz), somatosensory (Pz), and visual (Oz) theta (4-8 Hz) and alpha-2 (10-12 Hz) electrocortical activations (μV2/Hz) using a mobile electroencephalograph (EEG) were quantified during the CS-PFP10. Independent t-tests were used to analyze electrocortical activation and PF score differences between groups. RESULTS: The OLD had lower Fz, Cz, and Oz theta powers (Fz: 38.18 ± 3.26 vs. 41.88 ± 2.35, p < .001; Cz: 38.09 ± 4.20 vs. 40.79 ± 1.69, p = .002; Oz: 37.65 ± 3.36 vs. 41.61 ± 2.39, p < .001), alpha-2 powers (Fz: 36.64 ± 3.61 vs. 39.38 ± 2.68, p = .002; Cz: 36.97 ± 4.34 vs. 40.79 ± 3.41, p = .02; Oz:35.94 ± 3.74 vs. 38.34 ± 2.80, p = .007) and PF score (50.05 ± 14.20 vs. 65.33 ± 14.50, p < .001) compared to the YOUNG during the CS-PFP10 tasks. CONCLUSIONS: Our findings reveal that less frontal, motor, and visual theta and alpha-2 power and PF scores in the OLD compared to the YOUNG. While less prefrontal, motor, and visual theta powers are thought to be declined goal-directed attention/decision-making ability, motor performance, and visual input accordingly, less alpha-2 power in these cortices are suggested as enhanced behavioral neural processing associated with visuospatial attention. This may indicate that older adults have different motor control strategy compared to young adults. As visuospatial predominant neural processing can result in some delay in motor control, our findings may explain why elderly population is prone to fall risk during daily living tasks.

Body Composition, Strength And Physical Function In Short- And Long-term Breast Cancer Survivors

Previous data have found that breast cancer survivors (BCS) have poorer body composition, strength, and physical function compared to age and weight matched controls. Whether these changes improve over time after treatment remains uncertain. PURPOSE: To compare body composition, strength, and physical function between short-term (ST; <4 years; n=17; age=57±9 yrs) and long-term (LT; >4 years; n=24; age=62±7 yrs) BCS. METHODS: Body composition [lean mass (LM), fat mass (FM)] was assessed using dual-energy X-ray absorptiometry. Lower body strength was assessed using the Biodex leg extension/flexion system at 60 ° isometric knee extension. Upper body strength was assessed using one repetition maximum chest press. Physical function was measured using the continuous-scale physical function performance test. Independent t-tests were used to compare ST and LT-BCS. Significance was accepted at p ≤ 0.05. RESULTS: Time since treatment completion was 1.8±1.0 yrs for ST and 11.8±6.9 yrs for LT. There were no differences in body weight, LM, FM, and upper and lower body strength between groups. Total physical function (ST:64±14; LT:73±11 U) and the functional domains for endurance (ST:66±15; LT:75±12 U) and balance (ST:65±15; LT:75±12 U) were significantly lower in ST-BCS. CONCLUSION: Our findings indicate that without exercise, body composition and strength do not improve whereas physical function improves over time following treatment. Funding: ACSM Doctoral Student Grant; NSCA Doctoral Graduate Student Research Grant.

Performance and Reproducibility of the Continuous Scale Physical Functional Performance 10 Test in Patients With Chronic Obstructive Pulmonary Disease: A CONTROLLED CROSS-SECTIONAL STUDY.

To compare the performances of patients with chronic obstructive pulmonary disease (COPD) and healthy individuals on the Continuous Scale Physical Functional Performance 10 (PFP10) test and, second, to test the reproducibility of the PFP10 test in these participants. In a prospective, cross-sectional study, 28 patients with COPD (67 ± 9 y, FEV1: 44.3 ± 16.9% pred) and 12 healthy volunteers (healthy group) matched by age, body mass index, and sex were included. The participants performed 2 PFP10 tests 5 d apart. Main outcome measure was performance on the PFP10 test and included total score, score for specific domains, and total time to perform the PFP10 test. The functional performance of patients with COPD was worse than that of the healthy group on PFP10 total scores (43.9 ± 12.6 vs 63.5 ± 9.4, respectively; P < .001; effect size: 1.78) and time to complete the tasks (207.9 ± 36.1 sec vs 153.2 ± 12.1 sec, respectively; P < .001, effect size: 2.27). In addition, the COPD group had significantly worse performance in the domains of upper-body strength, lower-body strength, balance and coordination, and endurance. The test was highly reproducible (ICC: 0.98; 95% CI, 0.96-0.99 for both groups), and the mean difference (upper and lower limits of agreement) of the total scores was -3 (-9 to 3). The PFP10 test is a suitable and reproducible test for determining decreases in the functional performance of patients with COPD compared with healthy individuals.

Body Composition, IGF1 Status, and Physical Functionality in Nonagenarians: Implications for Osteosarcopenia

ObjectivesBody composition alterations occur during aging. The purpose of the present analysis was to explore the functional consequences of the overlap of sarcopenia and osteoporosis, and the potential role of insulin-like growth factor 1 (IGF1) in their development in the oldest old. Setting and ParticipantsEighty-seven nonagenarians from the Louisiana Healthy Aging Study were included. MeasuresThe definition of sarcopenia was based on appendicular lean mass (ALM). Osteoporosis was diagnosed based on bone mineral density (BMD) T score. Four phenotypes were compared: (1) healthy body composition, that is, nonosteoporotic nonsarcopenic (CO, control group), (2) osteoporotic (O, low BMD T score), (3) sarcopenic (S, low ALM), and (4) osteosarcopenic (OS, low BMD T score and low ALM). Sex- and age-specific IGF1–Standard Deviation Scores (SDS) were calculated. The Continuous Scale–Physical Functional Performance (CS-PFP) test was performed. ResultsIn OS men, IGF1-SDS values (−0.61 ±0.37 vs −0.04 ± 0.52, P = .02) were lower than those in CO males (control group), whereas IGF1-SDS were similar in the 4 body composition phenotypes in women. In men only, ALM was positively associated with IGF1-SDS values (P = .01) independent of age and C-reactive protein concentration. Regarding bone health, we found no association between IGF1-SDS values and BMD. IGF1-SDS was not associated with functional performance (CS-PFP) in men and women. Conclusions/ImplicationsIGF1 sensitivity in skeletal muscle and bone may differ by sex in the oldest old. IGF1 status did not appear to affect physical functionality. Determinants and clinical and functional characteristics of osteosarcopenia need to be further investigated in order to define conclusive diagnostic criteria.

Prolonged acute care and post-acute care admission and recovery of physical function in survivors of acute respiratory failure: a secondary analysis of a randomized controlled trial

BackgroundThe proportion of survivors of acute respiratory failure is growing; yet, many do not regain full function and require prolonged admission in an acute or post-acute care facility. Little is known about their trajectory of functional recovery. We sought to determine whether prolonged admission influenced the trajectory of physical function recovery and whether patient age modified the recuperation rate.MethodsWe performed a secondary analysis of a randomized clinical trial of intensive physical therapy for patients with acute respiratory failure requiring mechanical ventilation for ≥4 days. The primary outcome was Continuous Scale Physical Functional Performance, short form (CS-PFP-10), score. Predictor variables included prolonged admission in an acute or post-acute care facility at 1 month, time, and patient age. To determine whether the association between admission and functional outcome varied over time, a multivariable mixed effects linear regression model was fit using an interaction between prolonged admission and time with a primary outcome of total CS-PFP-10 score.ResultsOf the 89 patients included, 56% (50 of 89) required prolonged admission. At 1 month, patients who remained admitted had CS-PFP-10 scores that were 20.1 (CI 10.4–29.8) points lower (p < 0.0001) than patients who were discharged to home. However, there was no difference in the rate at which physical function improved from 3 to 6 months for patients who required prolonged admission compared with those who returned home (p = 0.24 for interaction between prolonged admission and time). Adjusted for age, Acute Physiology and Chronic Health Evaluation II score, and sex, both groups had CS-PFP-10 scores that were 8.2 (CI 4.5–12.0) points higher at 6 months than at 3 months (p < 0.0001). For each additional year in patient age, CS-PFP-10 recovered 0.36 points slower (95% CI 0.12–0.61; p = 0.004).ConclusionsPatients who require prolonged admission after acute respiratory failure have significantly lower physical functional performance than patients who return home. However, the rates of physical functional recovery between the two groups do not differ. The majority of survivors do not recover sufficiently to achieve functional independence by 6 months. Older age negatively influences the trajectory of functional recovery.Trial registrationClinicalTrials.gov, NCT01058421. Registered on 26 January 2010.

Validity of the German Version of the Continuous-Scale Physical Functional Performance 10 Test.

Background The Continuous-Scale Physical Functional Performance 10 Test (CS-PFP 10) quantitatively assesses physical functional performance in older adults who have a broad range of physical functional ability. This study assessed the validity and reliability of the CS-PFP 10 German version. Methods Forward-translations and backtranslations as well as cultural adaptions of the test were conducted. Participants were German-speaking Swiss community-dwelling adults aged 64 and older. Concurrent validity was assessed using Pearson correlation coefficients between CS-PFP 10 and gait velocity, Timed Up and Go Test, hand grip strength, SF-36 physical function domain, and Freiburger Physical Activity Questionnaire. Internal consistency was calculated by Cronbach's alpha. Results Backtranslation and cultural adaptions were accepted by the CS-PFP 10 developer. CS-PFP 10 total score and subscores (upper body strength, upper body flexibility, lower body strength, balance and coordination, and endurance) correlated significantly with all measures of physical function tested. Internal consistency was high (Cronbach's alpha 0.95–0.98). Conclusion The CS-PFP 10 German version is valid and reliable for measuring physical functional performance in German-speaking Swiss community-dwelling older adults. Quantifying physical function is essential for clinical practice and research and provides meaningful insight into physical functional performance of older adults. This trial is registered with ClinicalTrials.gov NCT01539200.

Comparative Analysis of High-Velocity Versus Low-Velocity Exercise on Outcomes After Total Knee Arthroplasty: A Randomized Clinical Trial.

High-velocity (HV) exercise is defined as performing a concentric muscle contraction as fast as possible, or in 1 second or less. Low-velocity (LV) exercise is defined as using 2 seconds to complete the contraction. A comparison of HV to LV exercise performed by community dwelling older adults indicates that HV exercise produces greater gains in power and scores for the 8-ft up-and-go, 30-seond chair stand, and continuous scale physical function performance tests. The effectiveness of HV strengthening exercises has not been identified for individuals who undergo total knee arthroplasty (TKA). The purpose of this research study was to compare the effects of a 6-week exercise program, using either LV or HV contractions, on functional performance, gait, and pain of individuals who have undergone TKA. Adults aged 60 to 89 years with a mean (standard deviation) age of 71.2 (6.8) years who underwent TKA an average of 15 days prior were randomly assigned to an HV exercise (n = 19) or LV exercise (n = 19) training group. The training program lasted for 12 sessions, over 6 to 7 weeks. The primary outcome was functional performance rated with the 6-Minute Walk Test. Secondary measures were the stair climb test, Timed Up and Go test, gait velocity, gait deviations measured with the Gait Abnormality Rating Scale, and pain via a visual analog scale. A 2×2 mixed model analysis of variance (group × time) was used for all outcomes. Comparison between LV and HV groups for posttest gait velocity and Gait Abnormality Rating Scale used independent t test and Mann-Whitney U test, respectively. At baseline no differences between groups were noted for sex, age, and height. The LV group weighed more and had more comorbid conditions. Spearman's ρ demonstrated that the greater comorbidities of the LV group correlated with a slower stair climb test at baseline. At posttest both groups exhibited significantly improved scores for all outcome measurements except the visual analog scale for pain. The HV group, but not the LV group, reported a significant decrease in pain at the end of the 6-week training program. Both HV and LV progressive exercises equally improve functional performance. Only the HV group reported significantly decreased pain at posttest.

A Randomized Trial of an Intensive Physical Therapy Program for Patients with Acute Respiratory Failure.

Early physical therapy (PT) interventions may benefit patients with acute respiratory failure by preventing or attenuating neuromuscular weakness. However, the optimal dosage of these interventions is currently unknown. To determine whether an intensive PT program significantly improves long-term physical functional performance compared with a standard-of-care PT program. Patients who required mechanical ventilation for at least 4 days were eligible. Enrolled patients were randomized to receive PT for up to 4 weeks delivered in an intensive or standard-of-care manner. Physical functional performance was assessed at 1, 3, and 6 months in survivors who were not currently in an acute or long-term care facility. The primary outcome was the Continuous Scale Physical Functional Performance Test short form (CS-PFP-10) score at 1 month. A total of 120 patients were enrolled from five hospitals. Patients in the intensive PT group received 12.4 ± 6.5 sessions for a total of 408 ± 261 minutes compared with only 6.1 ± 3.8 sessions for 86 ± 63 minutes in the standard-of-care group (P < 0.001 for both analyses). Physical function assessments were available for 86% of patients at 1 month, for 76% at 3 months, and for 60% at 6 months. In both groups, physical function was reduced yet significantly improved over time between 1, 3, and 6 months. When we compared the two interventions, we found no differences in the total CS-PFP-10 scores at all three time points (P = 0.73, 0.29, and 0.43, respectively) or in the total CS-PFP-10 score trajectory (P = 0.71). An intensive PT program did not improve long-term physical functional performance compared with a standard-of-care program. Clinical trial registered with www.clinicaltrials.gov (NCT01058421).

The Effects of Resistance Training on Physical Function and Quality of Life in Breast Cancer Survivors.

Breast cancer survivors (BCS) exhibit decreased physical function and quality of life (QOL) following cancer treatments. Resistance training (RT) may elicit positive changes in physical and mental well-being. This study assessed 27 BCS, pre-and post-intervention (six months) on the following variables: muscular strength (via one repetition maximum (1RM) of chest press and leg extension), physical function (via the Continuous Scale-Physical Functional Performance test) and QOL (via the Short Form-36 survey). RT consisted of two days/week of ten exercises including two sets of 8–12 repetitions at 52%–69% of their 1RM. A repeated measures analysis of variance revealed BCS significantly (p < 0.05) increased upper (71 ± 22 to 89 ± 22 kg) and lower body (74 ± 18 to 93 ± 24 kg) strength, total physical function (65.5 ± 12.1 to 73.6 ± 12.2 units) and the subcomponents of physical function: upper body strength (63.5 ± 16.3 to 71.2 ± 16.8 units), lower body strength (58.5 ± 14.9 to 68.6 ± 16.3 units), balance and coordination (66.5 ± 12.2 to 74.6 ± 11.6 units), and endurance (67.2 ± 12.0 to 75.0 ± 11.6 units). No changes were observed over time for subjective measures of physical function and QOL. Results showed RT could be an effective means to improve objective physical function in BCS. Further research is needed to clarify the effects of RT on subjective physical function and QOL.

Physical functional capacity in idiopathic pulmonary fibrosis: performance characteristics of the continuous-scale physical function performance test

Background: Physical functional capacity is impaired in idiopathic pulmonary fibrosis (IPF). There is no tool to measure this key clinical outcome. The continuous-scale physical function performance (CS-PFP) test is one that assesses activities of daily living, but it has never been used in IPF. Methods: We determined internal consistency of the CS-PFP. We used correlations to assess the strength of association between CS-PFP scores and various parameters of IPF severity, and compared the CS-PFP scores between patients with IPF and published values from a healthy control group. Results: Sixteen subjects completed the test and retest. Test-retest reliability (0.84, p = 0.003) and internal consistency (Cronbach’s α = 0.91) were excellent. Subjects with IPF had significantly worse CS-PFP scores than controls (46.0 ± 11.1 vs 58.7 ± 12.5, p = 0.001). In IPF, the CS-PFP scores correlated moderately to very strongly with several disease severity variables. Conclusion: The CS-PFP is a reliable and valid tool in IPF.

Exploring the Relationship Between Activity and Physical Participation in Older Adults With Parkinson's Disease

Purpose: To examine the association between activity and physical participation in older adults with Parkinson's disease (PD) and those without PD. Methods: Participants were 190 volunteers with PD (n = 74) and without PD (n = 116) between 50 and 94 years. They completed the Continuous Scale Physical Functional Performance 10-item test and the Community Healthy Activities Model Program for Seniors physical activity questionnaire for older adults as measures of activity and participation, respectively. Conclusions: Associations between participation and activity were small to moderate for adults with PD and small for those without PD. Participants with PD also had significantly lower activity scores than participants without PD. Older adults with PD are more limited in activity and are approaching a point where activity limitations also constrain participation.

Determinants of Objectively Measured Physical Functional Performance in Early to Mid-stage Parkinson Disease

Parkinson disease (PD) may lead to functional limitations through both motor and nonmotor symptoms. Although patients with advanced disease have well-documented and profound functional limitations, less is known about the determinants of function in early to mid-stage disease where interventions may be more likely to benefit and preserve function. The objective of the current study was to identify motor, cognitive, and gait determinants of physical functional performance in patients with early to mid-stage PD. This was a secondary analysis of cross-sectional baseline data from a randomized clinical trial of exercise. The study was performed at a tertiary academic medical center. The study included 121 patients with early to mid-stage PD. Our functional performance outcomes included the following: the Continuous Scale Physical Functional Performance Test (CS-PFP; primary outcome); the Timed Up and Go test (TUG); and Section 2 (Activities of Daily Living) of the Unified Parkinson's Disease Rating Scale (UPDRS). Explanatory variables included measures of disease severity, motor function, cognitive function, balance, and gait. Stepwise linear regression models were used to determine correlations between explanatory variables and outcome measures. In our regression models, the CS-PFP significantly correlated with walking endurance (Six-Minute Walk Test; r(2)= 0.12, P< .0001), turning ability (360° Turn Test; r(2)= 0.03, P= .002), attention (Brief Test of Attention; r(2)= 0.01, P= .03), overall cognitive status (Mini-Mental State Examination; r(2)= 0.01, P= .04), and bradykinesia (timed tapping; r(2)= 0.02, P= .02). The TUG significantly correlated with walking speed (5-Meter Walk Test; r(2)= 0.33, P< .0001), stride length (r(2)= 0.25, P< .0001), turning ability (360° turn, r(2)= 0.05, P= .0003), and attention (r(2)= 0.016, P= .03). Section 2 of the UPDRS was significantly correlated with endurance (r(2)= 0.09, P< .0001), turning ability (r(2)= 0.03, P= .001), and attention (r(2)= 0.01, P= .03). Gait, motor, and cognitive function all contribute to objectively measured global functional ability in mild to moderate PD. Subjectively measured functional activity outcomes may underestimate the impact of both motor and nonmotor symptoms.

The Effect of an 8-Week Tai Chi Exercise Program on Physical Functional Performance in Middle-Aged Women

The purpose of this study was to determine the effectiveness of an 8-week Tai Chi Chih exercise program on physical functional performance (PFP) among women aged 45 to 65 years. A quasi-experimental design with a nonequivalent comparison group was used. Forty-one healthy inactive women were assigned to either an intervention group (n = 19) or a comparison group (n = 19). A 60-min Tai Chi Chih exercise class was conducted twice a week for 8 weeks. PFP was measured at baseline and postintervention using the Continuous Scale Physical Functional Performance-10 (CS-PFP 10). Between-group differences were analyzed using one-way analysis of covariance (ANCOVA). After participating in the 8-week program, intervention group participants showed greater improvement in the CS-PFP measures (p < .05, η(2) > .06). However, the comparison group had little changes. The findings from this study suggest that participation in an 8-week Tai Chi Chih exercise program can improve PFP in healthy, community-dwelling middle-aged women.

Effects of Class IV Laser Therapy on Fibromyalgia Impact and Function in Women with Fibromyalgia

This study evaluated the effects of Class IV laser therapy on pain, Fibromyalgia (FM) impact, and physical function in women diagnosed with FM. The study was a double-blind, randomized control trial. Testing was completed at the university and Rheumatologist office and treatment was completed at a chiropractic clinic. Thirty-eight (38) women (52±11 years; mean±standard deviation) with FM were randomly assigned to one of two treatment groups, laser heat therapy (LHT; n=20) or sham heat therapy (SHT; n=18). Both groups received treatment twice a week for 4 weeks. Treatment consisted of application of LHT or SHT over seven tender points located across the neck, shoulders, and back. Treatment was blinded to women and was administered by a chiropractic physician for 7 minutes. Participants were evaluated before and after treatment for number and sensitivity of tender points, completed the FM Impact Questionnaire (FIQ) and the pain question of the FIQ, and were measured for function using the continuous scale physical functional performance (CS-PFP) test. Data were evaluated using repeated-measures analysis of variance with significance accepted at p≤0.05. There were significant interactions for pain measured by the FIQ (LHT: 7.1±2.3 to 6.2±2.1 units; SHT: 5.8±1.3 to 6.1±1.4 units) and for upper body flexibility measured by the CS-PFP (LHT: 71±17 to 78±12 units; SHT: 77±12 to 77±11 units) with the LHT improving significantly compared to SHT. There was a time effect for the measure of FM impact measured by the FIQ, indicating that FM impact significantly improved from pre- to post-treatment in LHT (63±20 to 57±18 units), while no change was observed in the SHT (57±11 to 55±12 units). This study provides evidence that LHT may be a beneficial modality for women with FM in order to improve pain and upper body range of motion, ultimately reducing the impact of FM.

Impact of Peak Oxygen Uptake and Muscular Fitness on the Performance of Activities of Daily Living in Patients With Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a progressively debilitating disease, which, over time, may compromise patient ability to perform activities of daily living (ADL). The purpose of this study was to examine the relationships between selected parameters of physical fitness and performance of ADL in COPD patients. A convenience sample of 23 COPD patients (11 men and 12 women, age 6869 years) was studied at the conclusion of an exercise rehabilitation program. Patients were assessed using the Continuous Scale Physical Functional Performance 10 Test (PFP-10) battery, chest press, leg press, and a symptom limited graded exercise test. The PFP-10 global score was 54 ± 12, and 11 patients fell below a global score of 57, which has been established as the threshold for independence. Peak oxygen uptake (VO(2peak)) was 20 ± 4 mL·kg(-1)·min(-1), the forced expiratory volume in 1 second/forced expiratory volume ratio was 0.58 ± 0.12, grip strength was 61 ± 16 kg (both hands), and chest press and leg press were 4 ± 3 and 12 ± 7 kg/kg body weight, respectively. The associations between the PFP-10 VO(2peak) and leg press were modest (r = 0.501, P = .014; and r = 0.547, P = .008) as was grip strength (r = 0.418, P = .047). There was no association between the PFP-10 and forced expiratory volume, forced expiratory volume in 1 second/forced vital capacity, or chest press (r = -20.040, P = .856; r = 20.212, P = .330; and r = 0.120, P = .595), respectively. The results of this investigation suggest that lower body strength is important in optimizing ADL performance in COPD patients.

Clinician's Commentary on Wilhelm et al.(1.).

Clinician's Commentary on Wilhelm et al.(1.).

A combined aerobic and resistance exercise program improves physical functional performance in patients with heart failure: a pilot study.

Recent guidelines for exercise in patients with heart failure (HF) recommended aerobic and resistance exercise as being safe and effective; however, the clinical and functional significance of these combined training modalities has not been established. In this pilot study, combined aerobic and resistance training was hypothesized to improve physical function, muscle strength, and health-related quality of life (HRQOL) compared with an attention control wait list (ACWL). The 10-item Continuous Scale Physical Functional Performance Test (CS-PFP10), which simulates common household chores; muscle strength (handgrip and knee extension); and HRQOL (Kansas City Cardiomyopathy Questionnaire) were evaluated at baseline (T1) and at 12 weeks (T2). The home-based moderate-intensity walking and resistance training program was performed 5 days a week. Twenty-four New York Heart Association class II to III HF patients (mean [SD] age, 60 [10] years; mean [SD] left ventricular ejection fraction, 25% [9%]) were randomized to a combined aerobic and resistance exercise program or to an ACWL group. Of the total group, 58% were New York Heart Association class III HF patients, 50% were white, and 50% were female. The CS-PFP10 total scores were significantly increased in the exercise group, from 45 (18) to 56 (16). The Kansas City Cardiomyopathy Questionnaire overall summary score was significantly improved (P < .001) at T2 in the exercise intervention group compared with the ACWL group. Participants provided the home-based, combined aerobic and resistance exercise program had significantly improved physical function, muscle strength, symptom severity, and HRQOL compared with the ACWL group. The findings of this study must be interpreted cautiously owing to the limitations of a small sample, data collection from a single center, and differences between control and interventions groups at baseline. A combined aerobic and resistance exercise approach may improve physical function in stable HF patients, but further study in a larger, more diverse population is recommended. However, in this study, the CS-PFP10 instrument demonstrated its ability to identify functional health status in HF patients and thus warrants further testing in a larger sample for possible use in clinical practice.

Performance-based physical function in older community-dwelling persons: a systematic review of instruments

Identification of older persons at risk for the loss of independence, onset of (co)-morbidity or functional limitations through screening/assessment is of interest for the public health-care system. To date several different measurement instruments for overall physical function are frequently used in practice, but little information about their psychometric properties is available. Objectives and Our aim was to assess instruments with an overall score related to functional status and/or physical performance on content and psychometric properties. Electronic databases (Medline, EMBASE, AMED, Cochrane Library and CINAHL) were searched, using MeSH terms and relevant keywords. Studies, published in English, were included if their primary or secondary purpose was to evaluate the measurement properties of measurement instruments for overall physical function in community-dwelling older persons aged 60 years and older. Reliability, validity, responsiveness and practicability were evaluated, adhering to a specified protocol. In total 78 articles describing 12 different functional assessment instruments were included and data extracted. Seven instruments, including their modified versions, were evaluated for reliability. Nine instruments, including their modified versions, were evaluated with regard to validity. In conclusion, the Short Physical Performance Battery can be recommended most highly in terms of validity, reliability and responsiveness, followed by the Physical Performance Test and Continuous Scale Physical Functional Performance.