Fast Walk Test Research Articles

Associations between changes in leg extensor muscle power and physical function after supervised exercise in patients with hip osteoarthritis. Secondary analysis from the hip booster trial

ObjectiveTo investigate associations between changes in leg extensor muscle power of the affected limb (ΔLEP) and changes in physical function after 12 weeks of progressive resistance training (PRT) or neuromuscular exercise (NEMEX) in patients with hip osteoarthritis. DesignSecondary analyses of a randomized controlled trial. From 160 participants enrolled in the clinical trial and cluster randomized to PRT (n ​= ​82) or NEMEX (n ​= ​78), a total of 147 (92%) had complete follow-up data and were included in the analyses. Simple linear and multivariate linear regression models estimated the crude and adjusted associations between ΔLEP normalized to body weight (watt/kg) and changes in performance-based and patient-reported measures of physical function. ResultsAdjusted estimates [95% confidence intervals] showed associations between ΔLEP (watt/kg) and changes in 30-s chair stand test (β: 2.34 [1.33; 3.35], R2: 0.13), 9-step timed stair climb test (β: −1.47 [-2.09; −0.85], R2: 0.38), 40-m fast paced walking test (β: −2.20 [-3.30; −1.11], R2: 0.09), Activities of Daily Life function (β: 8.63 [3.16; 14.10], R2: 0.23) and Sport and Recreation function (β: 10.57 [2.32; 18.82], R2: 0.21) subscales from the Hip disability and Osteoarthritis Outcomes Score. Group allocation to PRT did not lead to greater regression coefficients than in NEMEX. ConclusionsChanges in leg extensor muscle power after supervised exercise are consistently associated with changes in physical function across performance-based and patient-reported measures in patients with hip osteoarthritis. These associations seem to be independent of allocation to PRT or NEMEX.

Effect of prebiotic fiber on physical function and gut microbiota in adults, mostly women, with knee osteoarthritis and obesity: a randomized controlled trial.

Obesity is a primary risk factor for knee osteoarthritis (OA). Prebiotics enhance beneficial gut microbes and can reduce body fat and inflammation. Our objective was to examine if a 6-month prebiotic intervention improved physical function in adults with knee osteoarthritis and obesity. We also measured knee pain, body composition, quality of life, gut microbiota, inflammatory markers, and serum metabolomics. Adults (n = 54, mostly women) with co-morbid obesity (BMI > 30kg/m2) and unilateral/bilateral knee OA were randomly assigned to prebiotic (oligofructose-enriched inulin; 16g/day; n = 31) or isocaloric placebo (maltodextrin; n = 21) for 6months. Performance based-tests, knee pain, quality of life, serum metabolomics and inflammatory markers, and fecal microbiota and short-chain fatty acids were assessed. Significant between group differences were detected for the change in timed-up-and-go test, 40m fast paced walk test, and hand grip strength test from baseline that favored prebiotic over placebo. Prebiotic also reduced trunk fat mass (kg) at 6months and trunk fat (%) at 3months compared to placebo. There was a trend (p = 0.059) for reduced knee pain at 6months with prebiotic versus placebo. In gut microbiota analysis, a total of 37 amplicon sequence variants differed between groups. Bifidobacterium abundance was positively correlated with distance walked in the 6-min walk test and hand grip strength. At 6months, there was a significant separation of serum metabolites between groups with upregulation of phenylalanine and tyrosine metabolism with prebiotic. Prebiotics may hold promise for conservative management of knee osteoarthritis in adults with obesity and larger trials are warranted. Clinicaltrials.gov/study/NCT04172688.

Vertical locomotion improves horizontal locomotion: effects of climbing on gait and other mobility aspects in Parkinson’s disease. A secondary analysis from a randomized controlled trial

BackgroundIn the Climb Up! Head Up! trial, we showed that sport climbing reduces bradykinesia, tremor, and rigidity in mildly to moderately affected participants with Parkinson’s disease. This secondary analysis aimed to evaluate the effects of sport climbing on gait and functional mobility in this cohort.MethodsClimb Up! Head Up! was a 1:1 randomized controlled trial. Forty-eight PD participants (Hoehn and Yahr stage 2–3) either participated in a 12-week, 90-min-per-week sport climbing course (intervention group) or were engaged in regular unsupervised physical activity (control group). Relevant outcome measures for this analysis were extracted from six inertial measurement units placed on the extremities, chest, and lower back, that were worn during supervised gait and functional mobility assessments before and after the intervention. Assessments included normal and fast walking, dual-tasking walking, Timed Up and Go test, Instrumented Stand and Walk test, and Five Times Sit to Stand test.ResultsCompared to baseline, climbing improved gait speed during normal walking by 0.09 m/s (p = 0.005) and during fast walking by 0.1 m/s. Climbing also reduced the time spent in the stance phase during fast walking by 0.03 s. Climbing improved the walking speed in the 7-m- Timed Up and Go test by 0.1 m/s (p < 0.001) and the turning speed by 0.39 s (p = 0.052), the speed in the Instrumented Stand and Walk test by 0.1 m/s (p < 0.001), and the speed in the Five Times Sit to Stand test by 2.5 s (p = 0.014). There was no effect of sport climbing on gait speed or gait variables during dual-task walking.ConclusionsSport climbing improves gait speed during normal and fast walking, as well as functional mobility in people with Parkinson’s disease.Trial registration This study was registered within the U.S. National Library of Medicine (No: NCT04569981, date of registration September 30th, 2020)

Olfaction and Mobility in Older Adults

Decreased mobility is a hallmark of aging. Olfactory dysfunction is common in older adults and may be associated with declines in mobility. To determine whether poor olfaction was associated with faster declines in mobility in older adults. This cohort study included 2500 participants from the Health, Aging, and Body Composition Study. Participants completed the Brief Smell Identification Test during the year 3 clinical visit (1999-2000) and were followed for up to 7 years. A data analysis was conducted between January and July 2023. Olfaction was defined as good (test score, 11-12), moderate (9-10), hyposmia (7-8), or anosmia (0-6). Mobility was measured using the 20-m usual and fast walking tests in clinical visit years 3 to 6, 8, and 10 and the 400-m fast walking test in years 4, 6, 8, and 10. The primary analyses included 2500 participants (1292 women [51.7%]; 1208 men [48.3%]; 960 Black [38.4%] and 1540 White [61.6%] individuals; mean [SD] age, 75.6 [2.8] years). Multivariate-adjusted analyses showed that poor olfaction was associated with slower walking speed at baseline and a faster decline over time. Taking the 20-m usual walking test as an example, compared with participants with good olfaction, the speed at baseline was 0.027 (95% CI, 0-0.053) m/s slower for those with hyposmia and 0.034 (95% CI, 0.005-0.062) m/s slower for those with anosmia. Longitudinally, the annual decline was 0.004 (95% CI, 0.002-0.007) m/s/year faster for those with hyposmia and 0.01 (95% CI, 0.007-0.013) m/s/year faster for those with anosmia. Similar results were obtained for the 20-m and 400-m fast walking tests. Further, compared with participants with good olfaction, the odds of being unable to do the 400-m test were 2.02 (95% CI, 1.17-3.48) times higher for those with anosmia at the year 8 visit and 2.73 (95% CI, 1.40-5.35) times higher at year 10. Multiple sensitivity and subgroup analyses supported the robustness and generalizability of the findings. The results of this cohort study suggest that poor olfaction is associated with a faster decline in mobility in older adults. Future studies should investigate underlying mechanisms and potential health implications.

Investigation of the Validity and Reliability of Two Smart Bands Selected That Count Steps at Different Walking Speed

Whether activity monitor smart wristbands that have become widespread can accurately estimate the step count while walking is a matter of curiosity. The current study aims to analyze the validity and reliability of step count (SC) estimation at normal walking and fast walking pace under controlled conditions of two selected smart wristbands of the leading wearable device vendors, Xiaomi (Mi4) and Huawei (H4). Twenty healthy adult male and twenty healthy adult female were included in the study and analyzed separately. The mean age of male and female participants was 22.25 and 21.62 years, with BMI values of 24.22 kg/m2 and 21.42 kg/m2, respectively. The above-ground walking protocol consisted of four separate five-minute tests: Normal Walking Test, Normal Walking Retest, Fast Walking Test, and Fast Walking Retest. In the study, the analyses were performed by using activity monitor measurements and criterion measurements (the number of steps determined from video recordings), compatibility of test-retest measurement values, error indicators (MPE and MAPE), Intraclass Correlation Coefficients (ICC), and Bland-Altman limits of agreement. According to the current study results, it was revealed that the MAPE values recorded for Mi4 and H4 smart wristbands for both normal and fast walking pace in male and female participants were &amp;lt;5%, which was deemed excellent. According to all analyses, the H4 device was found to be valid and reliable, but according to ICC and Pearson Correlation analyses, the Mi4 device was not found to be valid and reliable at fast walking pace.

1306-P: Body-Worn Motion Sensors Detect Gait Deficits in People with Impaired Fasting Glucose Who Have Normal 400-Meter Walk Time

Background: Gait is increasingly recognized as a marker of general health status. Abnormal gait characteristics have been observed in people with diabetes, but it is unclear if subtle changes in specific gait characteristics can be found in people with impaired fasting glucose (IFG), who are not yet classified as diabetic (prediabetic). Aim: The aim of this study was to investigate if digital gait measures discriminate people with IFG from healthy control subjects (HC) who have a normal 400-meter walk time. Methods: One-hundred and eight people with IFG (mean age: 71.20 years) and 63 healthy control participants (mean age: 70.40 years) wore 6 inertial sensors (Opals by APDM, a Clario Company) while performing a 400-meter fast walk test. In total, 56 measures were derived from the 400-meter walk test, including time to complete the test. Analysis of Covariance (ANCOVA) was used to investigate the differences between the prediabetic and healthy control groups while adjusting for body mass index (BMI) as a covariate. Results: After controlling for BMI as a covariate, 9 out of 55 gait measures were significantly different (p&amp;lt;10-4) between IFG and HC groups. Step duration, cadence, and turn velocity were the most discriminative measures. In contrast, there was no significant difference between groups for stopwatch timed for 400-meter walk test. Conclusion: Specific gait measures using body-worn sensors could be abnormal in people with IFG, even when stop watch time for the 400-meter walk test is normal. Thus, digital gait measures show promise to be used as endpoints for clinical trials in people with prediabetes. Disclosure V.V.Shah: Employee; APDM Wearable Technologies, A Clario Company. P.Carlson-kuhta: None. K.Sowalsky: Employee; Clario. M.Mancini: Consultant; Clario. F.B.Horak: Employee; APDM Precision Motion, division of Clario. Funding National Institutes of Health (5IK2CX000729-05)

Effect of an Integrated Physiotherapy Protocol on Knee Osteoarthritis Patients: A Preliminary Study

Exercise therapy can potentially relieve symptoms and improve functional status of the knee osteoarthritis population. Despite the proved practical benefits, there is no standard, comprehensive physiotherapeutic protocol available targeting the physical and physiological impairment cluster associated with disease. Osteoarthritis is a whole joint disease, affecting joint cartilage, ligaments, menisci and joint associated muscles, from variable pathophysiological processes. Hence, there is a need to develop a physiotherapy protocol to address the multi-structural physical, physiological and functional impairments associated with the disease. The objective of the present study is to evaluate the efficacy of designed, therapist supervised, patient education, progressive resistance exercises, passive stretching exercises, soft tissue manipulation, muscle energy technique, Maitland mobilization, aerobic exercise, and neuromuscular training physiotherapy protocol on pain, disability, balance, and physical functional performance in knee osteoarthritis patients. The preliminary study was conducted on a (n = 60) sample of convenience. The samples were randomly allocated into two study groups, intervention, and control group. The control group was advised on a basic home program. On the other hand, the treatment of the intervention group was designed with a therapist supervised Physiotherapy Protocol. The outcome variables studied were the Visual Analogue Scale, Modified WOMAC Scale, Timed Up and Go Test, Functional Reach Test, 40 m Fast Paced Walk Test, Stair Climb Test, 30 s Chair Stand Test. The results of the study revealed a significant improvement among most of the studied outcome measures in the intervention group, hence the designed supervised physiotherapy protocol was found effective in relieving multiple physiological impairments associated with this whole joint disease.

Clinical advantages of gradually reducing radius versus multi-radius total knee arthroplasty: a noninferiority randomized trial

BackgroundThe rationale for gradually reducing radius (GR) femoral component aims to prevent flexion instability by gradually change the center of femoral rotation, unlike a discrete change by the multi-radius (MR) which is more common for most of total knee arthroplasties (TKA). However, no strong evidence has been reported the clinical significance of the GR design.MethodsThis patient-blinded, parallel, non-inferiority trial conducted in September 2020. Patients with knee osteoarthritis consented for cruciate retaining TKA were randomly allocated to a GR or MR group. Primary outcome measures were knee functions at postoperative 6 and 12 months using the Knee injury and Osteoarthritis Outcome Score (KOOS). Secondary outcome measures were performance-based tests (30-s chair stand test, 40-m fast paced walk test, and 3-m timed up and go test), and knee motions.ResultsSixty patients were enrolled and randomized; GR (n = 30) and MR (n = 30) group. The changes of KOOS at 6 and 12 months from baseline showed clinical meaningful for both GR and MR group. At 6 and 12 months postoperatively, there was no significant difference between both groups in all KOOS subscales. The length of stay was not different between GR and MR group (5.93 ± 1.44 vs 6.17 ± 1.86 days, p = 0.59). Patients on both groups presented similar performance-based tests. However, the improvement in degrees of knee motion for the GR group was significantly greater than the MR group (34.67 ± 12.52 vs 23.67 ± 12.59, p = 0.001).ConclusionGR was noninferiority to MR for the functional outcomes and performances after TKA.The GR femoral component gave more knee motions than did the MR prostheses.Level of evidenceLevel I, therapeutic study.

Validity of the Osteoarthritis Research Society International (OARSI) recommended performance-based tests of physical function in individuals with symptomatic Kellgren and Lawrence grade 0–2 knee osteoarthritis

BackgroundPerformance-based physical tests have been widely used as objective assessments for individuals with knee osteoarthritis (KOA), and the core set of tests recommended by the Osteoarthritis Research Society International (OARSI) aims to provide reliable, valid, feasible and standardized measures for clinical application. However, few studies have documented their validity in roentgenographically mild KOA. Our goal was to test the validity of five performance-based tests in symptomatic KOA patients with X-ray findings of Kellgren and Lawrence (K-L) grade 0–2.MethodsWe recruited a convenience sample of thirty KOA patients from outpatient clinics and 30 age- and sex-matched asymptomatic controls from the community. They performed five OARSI-recommended physical tests and the KOA group answered the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. The tests included the 9-step stair-climbing test (9 s-SCT), timed up and go (TUG) test, 30-second chair-stand test (30sCST), 40-m fast walking-test (40MFPW) and 6-minute walking test (6MWT). The discriminant validity of these physical tests were assessed by comparisons between the KOA and control groups, receiver operating curve and multivariate logistic regression analysis. The convergent/divergent validity was assessed by correlation between the physical tests results and the three subscale scores of the WOMAC in the KOA group.ResultsThe KOA group had significantly worse performance than the control group. The percentage of difference was the largest in the 9 s-SCT (57.2%) and TUG tests (38.4%). Meanwhile, Cohen’s d was above 1.2 for the TUG test and 6MWT (1.2 ~ 2.0), and between 0.8 and 1.2 for the other tests. The areas under the curve to discriminate the two groups were mostly excellent to outstanding, except for the 30sCST. Convergent validity was documented with a moderate correlation between the 9 s-SCT and the physical function (WOMAC-PF) subscale scores (Spearman’s ρ = 0.60).ConclusionsThe OARSI recommended core set was generally highly discriminative between people with K-L grade 0–2 KOA and their controls, but convergent/divergent validity was observed only in the 9 s-SCT. Further studies are required to evaluate the responsiveness of these tests and understand the discordance of physical performance and self-reported measures.

Associations between Muscle-Tendon Morphology and Functional Movements Capacity, Flexibility, and Balance in Older Women.

Loss of functional movement capacity in older adults is related to adverse changes in musculotendinous morphology, but this relationship is poorly understood. This study examined the associations between musculotendinous morphology and functional movements, flexibility, and balance ability. Ninety-nine older women (66.6 ± 4.6 years, body mass index 23.5 ± 3.3 kg∙m−2) were recruited from Chonburi Province, Thailand. During one 90-min visit, muscle ultrasound imaging of vastus lateralis, biceps femoris, and medial gastrocnemius muscles, and tendon ultrasonography of the Achilles tendon and patellar tendon were performed. Measures were also obtained for the straight leg raise, passive dorsiflexion, balance, and functional tests (Five Times Sit to Stand (5TSTS), Timed Up and Go (TUG), 10-Meter Fast Walk Test (10-MFWT), and 6-Minute Walk Test (6-MWT)). The results specify that functional movement performance correlates most strongly with medial gastrocnemius muscle thickness (5TSTS (r = −0.26), TUG (r = −0.44), 10-MFWT (r = 0.41), and 6-MWT (r = 0.48) all p < 0.05) and that vastus lateralis muscle thickness and medial gastrocnemius muscle thickness correlate positively with balance ability (r = 0.24, 0.34; p < 0.05) and negatively with fear of falling. It appears that muscle mass, rather than other morphological parameters, such as muscle quality or fascicle length, is the main factor affecting the susceptibility of older women to frailty.

Effect of power training on locomotion capacities in children with cerebral palsy with GMFCS level III–IV

Purpose Power training (PT) is a promising training modality to improve functional abilities in children with cerebral palsy (CP). This study aimed to implement PT in an adapted school and to assess its effect on locomotion capacities in children with Gross Motor Function Classification System (GMFCS) level III–IV. Materials and methods Nine children with CP (GMFCS level III–IV) were trained three times/week for 12 weeks. The training sessions took place during the 50-minute physical activity classes and included high intensity exercise. The outcome measures were the performance on the 10-meter comfortable and fast walking tests, the 50-meter sprint test (50M-ST), and the energy expenditure index (EEI). Results Participants spent 12 ± 7 and 7 ± 9 min per session at an intensity superior to 40% and 60% of the heart rate reserve, respectively. Performance in the 10-meter walking test (13.5 ± 7.8 to 9.9 ± 4.6 s, p < 0.05), the 10-meter fast walking test (8.8 ± 3.1 to 7.0 ± 3.2 s, p < 0.05), the 6-minute walking exercise (199.0 ± 48.6 to 316.6 ± 107.2 m, p < 0.05), and in 50M-ST (53.8 ± 29.5 to 42.3 ± 16.2 s, p < 0.05) increased after training. The EEI was reduced after training (p = 0.01), resulting in a more efficient gait. Conclusions PT was successfully implemented in children with CP with GMFCS level III–IV. Results suggest that PT increases walking capacities. Implications for rehabilitation Power training (PT) is feasible with children with bilateral cerebral palsy with GMFCS level III and IV. Physical education course in specialist school is a valuable environment to implement PT in children with poor gross motor function. Power training results in locomotion capacities improvement.

The effect of intra-articular extended-release triamcinolone acetonide on OARSI-recommended physical performance measures in adults with bilateral symptomatic knee osteoarthritis

ObjectiveWhile the effect of triamcinolone acetonide extended-release (TA-ER) on reducing knee osteoarthritis (OA) pain has been reported, the effects on physical performance are incompletely understood. This open label clinical trial systematically evaluated the effects of intra-articular TA-ER on physical performance, self-reported function, and quality of life in participants with bilateral symptomatic knee OA 6, 12 (primary) and 24 weeks following bilateral injection of TA-ER (32 ​mg). MethodsSeventy participants were enrolled (61.4% women; age 64.0 ​± ​11.7; BMI 31.8 ​± ​5.7 ​kg/m2). Physical performance was measured by 30-s chair stand test, 40 ​m fast paced walk test (FPWT), and stair negotiation test at baseline and each follow-up visit. Physical function and quality of life (QOL) were measured with the Knee Injury and Osteoarthritis Outcome Score (KOOS-PS) and pain was measured with numeric rating scale (NRS). ResultsIn comparison with baseline, self-reported pain, function, and quality of life were improved at each follow-up through 24 weeks and the number of chair-stands significantly improved following treatment by (mean ​± ​SE) 1.9 ​± ​0.6 ​at 6-week (p ​= ​0.0048) and by 1.8 ​± ​0.5 ​at 12-week follow-up (p ​= ​0.0011) but was not statistically significant at 24-week follow-up (0.6 ​± ​0.6; p ​= ​0.4711). Stair negotiation times were 7.2 ​± ​3.7, 7.1 ​± ​3.8, and 5.4 ​± ​4.0 ​s lower at the three respective follow-up timepoints, although these changes did not reach statistical significance (p ​= ​0.0530, p ​= ​0.0599, and p ​= ​0.1793 respectively). The 40m-FPWT time did not significantly improve. ConclusionThese data indicate improvement in chair stand performance through 12 weeks post-injection and sustained improvement in participant-reported physical function through 24-week follow-up in adults with bilateral painful knee OA treated with TA-ER.

Influence of pain quality on physical performance in subjects with osteoarthritis of knee

Objectives Neuropathic pain features are frequently observed in subjects with knee osteoarthritis, which reduces their physical performance. This study was done to compare the physical performance between the subjects with neuropathic and nociceptive pain features. In addition, to assess the relationship between pain quality and physical performance in subjects with osteoarthritis of the knee. Methods Eighty subjects, ranging from 40 − 70 years of both genders with symptomatic and radiologically verified unilateral knee osteoarthritis (OA) were included for the study. Before having them in the study, all the subjects completed baseline interviews and demographic data. The subjects were categorized under neuropathic and nociceptive groups using Pain Detect Questionnaire (PDQ). One-time measurement of pain intensity, isometric strength of Quadriceps & hamstrings, and knee joint range of motion were assessed in both groups. Physical performance was measured using Osteoarthritis Research Society International recommended physical performance tests for knee osteoarthritis (40 m Fast Paced Walk Test, 6 min walk test, 30 s chair stand test, Timed up and Go Test, Stair Climb Test) and OA knee-related disability using Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. Results Of the eighty subjects, forty subjects were included in the neuropathic group (44%), forty in the nociceptive group based on PDQ. Physical performance (p < 0.05) was significantly reduced in the neuropathic group. There existed a weak negative correlation between pain quality and variables measured (p < 0.05). Conclusion Physical performance was significantly reduced in OA knee subjects with neuropathic pain features. There is a negative correlation between pain quality and most of the physical performance variables.

Classification Model to Discriminate People with and without Pain in the Lower Back and Lower Limb using Symmetry Data

Background Multiple factors are associated with lower back and lower limb (LB &amp; LL) pain, such as impaired muscle strength, balance, endurance, and motor control, and altered movement patterns. Symmetry of motion, strength and balance are goals for rehabilitation in patients with LB &amp; LL pain. When classifying patients before or during on- and offline assessment, it is necessary that an easy to use functional test be available for clinicians. Purpose To establish a classification tree model for discriminating people with and without LB &amp; LL pain during walking using symmetry values from side plank endurance test, hip abductor strength test, one-leg standing time tests and walking tests. Study design Cross-sectional study Methods A total of 100 subjects with and without LB &amp; LL pain during walking participated. We measured the side plank endurance time, hip abductor strength and one-leg standing time with eyes open and closed, and the sagittal and frontal head angles at comfortable and fast walking speeds using a wearable wireless earbud sensor and calculated the symmetry index (SI) for each test. Classification and regression tree analysis with 10-fold cross validation was used to develop the classification model. Results The classification tree had 83% accuracy for discriminating people with and without LB &amp; LL pain during walking. The most important factor for classification was the SI of the one-leg standing time with eyes closed; the second-most important factor was the SI of the frontal head angle during fast walking. Conclusions The present classification model can differentiate people with and without LB &amp; LL pain during walking based on symmetry data acquired during functional tests, such as one-leg standing time with the eyes closed and fast walking test using the wearable device. Based on the present results, clinicians can classify patients before and during on- and offline assessments using cutoff values of the SI of the one-leg standing test with eyes closed of 63.88%, and of frontal head motion during a fast-walking test of 63.31%.

Remotely monitored cardiac rehabilitation based on a walking test during the COVID-19 pandemic

Funding AcknowledgementsType of funding sources: Public Institution(s). Main funding source(s): This research was funded by the Ministry of Health, Czech Republic; conceptual development of research organization (FNBr, 65269705).BackgroundSince the beginning of 2020, the SARS-CoV-2 pandemic, causing COVID-19, has been affected worldwide. During the first and second waves of the COVID-19 pandemic, health care provision was significantly reduced or interrupted as a precaution. In particular quarantine and social isolation, public health preventive measures of the SARS-CoV-2 pandemic have been found to be associated with worsening cardiovascular risk factors. CR exercise programs have also been affected by these restrictions" effects, and stress testing was attenuated due to concerns about the spread of the disease through the potential transfer of aerosol particles. Therefore, in many centers or specialized clinics, CR programs have been partially interrupted.PurposeThe purpose of our research was to propose the possibility of an alternative approach, namely remotely monitored CR, which takes into account the recommendations for COVID-19 quarantine in cardiac patients. We assumed that through the remotely monitored CR based on a walking test, we would conduct an effective alternative intervention to improve cardiorespiratory fitness.MethodsFrom October to December 2020, we performed an 8-week study of remotely monitored CR in cardiac patients with low to moderate cardiovascular risk. The intervention was based on the principles of II. phase of CR and consisted of regular physical exercise and teleconsultations in the home-based setting. Patients were instructed to perform regular physical exercise 3 - 5 times a week, for a minimum of 30 minutes, to control the intensity on an HR monitor at the target zone determined by calculation based on the 200-meter fast-walk test (200MFWT) result. Besides, patients were instructed that the physical exercise intensity was consistent with the rate of perceived exertion rating between "somewhat hard" to "hard" (12 - 14). The study physiotherapist was a remote trainer who telemonitored patients and gave them telephone feedback once every two weeks.ResultsThe study completed ten patients. All patients were post-cardiac revascularization with recommended medication, including beta-blockers. The average age was 60.5 ± 8.8 years. The statistical analysis showed significantly improved cardiorespiratory fitness by reducing the 200MFWT time from 116.8 ± 7.2 seconds to 105.0 ± 5.8 seconds (p = 0.005). The above performance improvement was achieved without a statistically significant change in HRmax at the end of 200MFW. No physical activity-related adverse events were reported throughout the intervention.Conclusion(s): Our study supports the effectiveness of remotely monitored CR, which can address limited access during the COVID-19 pandemic. Research evidence suggests that CR based on a walking test and telemonitoring via an HR monitor can effectively increase cardiorespiratory fitness in cardiac patients with low to moderate cardiovascular risk.

Cardiac Rehabilitation Based on the Walking Test and Telerehabilitation Improved Cardiorespiratory Fitness in People Diagnosed with Coronary Heart Disease during the COVID-19 Pandemic.

This study investigated an alternative home-based cardiac telerehabilitation model in consideration of the recommendations for the COVID-19 quarantine of people diagnosed with coronary heart disease (CHD). We hypothesized that using a 200 m fast walking test (200 mFWT) and telerehabilitation would create an effective alternative cardiac rehabilitation (CR) intervention that could improve cardiorespiratory fitness. Participants (n = 19, mean age 60.4 ± 9.6) of the 8-week intervention performed regular physical exercise at the target heart rate zone determined by calculations based on the 200 mFWT results. In our study, the participants were supervised using telerehabilitation. A total of 84% of participants completed the 8-week intervention. No adverse events were reported during telerehabilitation. The study participants noted a significant improvement (p < 0.001) in cardiorespiratory fitness expressed by an 8% reduction in the walking test time (Δ 8.8 ± 5.9 s). Home-based telerehabilitation based on 200 mFWT effectively increased the cardiorespiratory fitness in people with CHD with a low to moderate cardiovascular risk. This was a novel approach in CR during the COVID-19 pandemic. As research in this area is justified, this paper may serve as an alternative method of providing healthcare during the COVID-19 pandemic and as a basis for further upcoming randomized controlled trials.

The importance of objectively measuring functional tests in complement to self-report assessments in patients with knee osteoarthritis

BackgroundOsteoarthritis (OA) is a chronic degenerative disease which can result in chronic pain, loss of joint function and consequently decline in quality of life. Research questionA variety of instruments that measure the different dimensions of health status in patients with OA are available. However, despite the fact that WOMAC and other questionnaires and scales may provide additional understanding regarding the patient’s condition, some studies have reported discrepancies between patients’ perceptions and their actual ability to perform the task. The aim of the present study was investigate the physical capabilities with the function domain of WOMAC. MethodsThis study has a cross-sectional design including patients diagnosed with moderate to severe knee OA (i.e., grades II, III and IV) according to the Kellgren-Lawrence. These patients were submitted to the battery of functional tests recommended by the OARSI group (30-second chair stand test, 40 m fast paced walking test, Stair climb test, timed “Up and Go”, and Six-minute walking test) and filled the WOMAC. Pearson’s correlation and multiple linear regression was applied. ResultsA total of 153 patients were included. A significant and weak correlation was observed between WOMAC and the 40-meter walking test, TUG, stair-climbing test, and the 6MWT. In addition, 30-second chair stand test demonstrated a significant and moderate correlation (r=-0.503). The multiple regression analysis results indicated that only 30-second chair stand test was a significant (p = 0.001) predictor of WOMAC. This result remains significant even after adjusting for age, BMI, total muscle mass, and number of knees affected SignificanceThe 30-second chair stand test is associated with the WOMAC function domain. There is no correlation of this domain with any other functional tests, emphasizing the importance of including other tests for a global evaluation.

A tool to improve functional outcome assessment of a multimodal program for patients with chronic low back pain: A study on walk tests (at comfortable and fast speed).

Tools for functional assessment of chronic low back pain (LBP) are lacking. To determine the correlations and the responsiveness of the 400 m comfortable walk test (400 mCWT) and the 200 m fast-walk test (200 mFWT) in the functional assessment of a multimodal program. One hundred and twenty-seven participants (68 females) with LBP and with or without radicular pain completed a Quebec Back Pain Disability Scale, a Sorensen test, a Shirado test, a 400 mCWT and a 200 mFWT, at baseline and at the end of the program. No significant side effect was reported during walk tests. Walking speed was significantly increased after the program (0.18 ± 0.15 m.s-1 for the 400 mCWT and 0.17 ± 0.17 m.s-1 for the 200 mFWT). Clinical parameters were also significantly improved (82.02 ± 83.1 seconds for the Shirado, 92.1 ± 100.1 seconds for the Sorensen, -14.0 ± 12.9 for the Quebec scale). A significant relationship was found between the increase in walking speed for the two walk tests and the improvement of the Quebec scale. The gait speed improvement was close to the minimal clinically important change (95% confidence interval: 0.14-0.22) determined from the Quebec scale threshold (minimum detectable change). Both 400 mCWT and 200 mFWT are correlated with functional parameters and are responsive for the functional assessment of LBP.

Prospective Evaluation of Changes in Pain Levels, Quality of Life and Functionality After Low Dose Radiotherapy for Epicondylitis, Plantar Fasciitis, and Finger Osteoarthritis.

Background: The objective benefits of low dose radiotherapy (LDRT) for non-malignant joint disorders are controversial. This study evaluated changes in pain, quality of life (QoL) and function after LDRT for epicondylitis, plantar fasciitis, and finger osteoarthritis.Materials and Methods: Patients over 40 years old with epicondylitis, plantar fasciitis, and finger osteoarthritis were had pain following at least 6 months of conservative therapy. Patients received 0.5 Gy LDRT twice weekly for 4 weeks repeated once after 8 weeks in patients who failed to achieve complete pain relief. Patients assessed their pain according to the visual analog scale. Handgrip strength was measured with an isometric dynamometer and the fast self-paced walking test was used in patients with plantar fasciitis. QoL was evaluated according to the EQ-5D and HAQ-DI questionnaires.Results: Outcomes for 157 patients (204 sites) were documented at 2, 6, and 12 months after last LDRT. Pain reduction at rest (p < 0.001), during activity (p < 0.001) and increase in handgrip strength (extension p < 0.001, flexion p = 0.002) were highly significant for patients with lateral epicondylitis. Patients with medial epicondylitis reported pain relief at rest (p = 0.041) and during activity (p = 0.041) and significant increase in handgrip strength (p = 0.022). Patients with plantar fasciitis reported pain reduction at rest (p < 0.001), during activity (p < 0.001) and faster walking times (p < 0.001). A trend toward improved QoL was observed. Patients with finger osteoarthritis reported significant pain relief during activity (p < 0.001) and a gain in handgrip strength (p = 0.004), with a trend to both pain relief at rest (p = 0.056) and stronger pinch grip (p = 0.099).Conclusions: LDRT achieved significant pain relief at rest and during activity and a corresponding objective improvement in handgrip strength in patients with epicondylitis. Pain relief at rest, during activity and improvement in walking time were demonstrated in patients with plantar fasciitis. LDRT achieved pain relief during activity, and handgrip strength was improved in patients with finger osteoarthritis. No significant effect was seen on quality of life measures for these conditions. The observed benefits were maintained 12 months after LDRT for all 3 indications and we recommend this low cost, safe intervention for patients over 40 who have failed prior conservative therapy.

Knee osteoarthritis outcomes in patients with severe obesity following bariatric surgery or total knee arthroplasty: the swift trial

Purpose: High body mass index (BMI, kg/m2) is a modifiable risk factor that has been associated with the development and progression of osteoarthritis (OA) and knee pain. The gold standard for the treatment of end stage knee OA remains total knee arthroplasty (TKA), though patients with morbid obesity (BMI≥40 kg/m2) are increasingly required to lose weight prior to TKA due to increased surgical risk and a higher rate of complications. Conservative weight-loss approaches often fail to help patients lose the recommended weight prior to TKA, potentially making them ineligible for surgery. Recent studies have shown that patients who undergo bariatric surgery experience short-term improvements in knee functionality and decreased pain, either obviating the need for arthroplasty - or at least improving the success of subsequent total knee replacements. Here we present interim data from the trial entitled “Surgical Weight-loss to Improve Functional Status Trajectories following arthroplasty for painful knee osteoarthritis”. This current multi-center, prospective study compares pain and functional outcomes in patients receiving bariatric surgery prior to TKA versus obese patients who go straight to TKA. Methods: We recruited patients with BMI ≥40 kg/m2 and painful knee OA who met the indications for TKA from the bariatrics, orthopedics and rheumatology clinics at the four hospital centers. Patients with a BMI >35 kg/m2 were also recruited if they had a qualifying comorbid condition including obstructive sleep apnea, diabetes, hypertension or hyperlipidemia. Patients were assigned to the bariatric (BAR) or TKA (TKA) arms based on surgical choice (goal n=150 for each arm), with all bariatric patients having anatomy-altering sleeve gastrectomy or gastric bypass, and not laparoscopic gastric banding. At baseline and several time points after surgery (see figure), we documented height, weight, the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog pain (VAS) scales, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and had patients perform functional assessments (Timed-Up and Go, 30-second Chair Stand and 40-meter fast paced walk test). We targeted minimum detectable change (MDC) in outcomes for the VAS for knee pain (33% reduction), Timed Up and Go (decrease by 2 seconds), 30-second Chair Stand (increase by 2 reps), 40-meter fast paced walk (increase by 0.16 m/s), WOMAC score (16% reduction), and the KOOS pain score (10-point improvement). Using a logistic regression to adjust for age and baseline BMI, we compared the percentage of patients in the two arms who achieve an MDC for the various outcomes. Results: For the current analysis, 20 bariatric surgery patients and 22 TKA patients completed their 6-month follow-up visits. Each subcohort had a similar sex distribution (15% vs 14%, p=0.999) but the bariatric group was younger (53 vs 61 years old, p=0.0045) and had a higher baseline BMI (47.1 vs 40.9, p=0.0009). Many bariatric patients achieved significant improvement in knee pain and function as evidenced by the MDC in the various tests, though the percent with MDC consistently tended to be higher in the TKA cohort. These MDC benchmarks included the 30-second Chair Stand (TKA 60% vs BAR 29%, p=0.085), KOOS pain score (TKA 89% vs BAR 65%, p=0.130), the Visual Analog Pain Scale (TKA 50% vs BAR 34%, p=0.390), Timed Up and Go (TKA 45% vs BAR 21%, p=0.205), the 40-meter fast paced walk (TKA 61% vs BAR 42%, p=0.319), and the WOMAC (TKA 81% vs BAR 59%, p=0.225). Many of the bariatric patients have had subsequent arthroplasty, but not enough time has passed to report levels of improvement. Conclusions: In morbidly obese patients who are eligible for TKA, bariatric surgery may result in modest improvements in knee pain and function when compared to TKA at 6 months post operatively. In addition to potentially altering the need for and timing of TKA, surgical weight loss may result in improved TKA outcomes. This study was supported by the Investigator Initiated Study Program of Ethicon-Endo Surgery, Inc. (Grant Number: 14-621).