Gait Speed Research Articles

Exploring the Influence of BMI on Gait Metrics: A Comprehensive Analysis of Spatiotemporal Parameters and Stability Indicators

Background: Gait analysis is a vital tool for evaluating overall health and predicting outcomes such as mortality and cognitive decline. This study explores how normal and obese BMI categories impact gait dynamics, addressing gaps in understanding the effect of body composition on specific gait parameters. Research Question: The primary objective is to investigate differences in spatiotemporal gait parameters—specifically, gait speed, step length, cadence, and double support time—between normal and obese BMI groups to understand the effects of obesity on gait. Methods: This observational case-control study analyzed spatiotemporal gait metrics from 163 participants, using inertial measurement units (IMUs) to collect data on various gait parameters. Statistical analyses explored the relationship between BMI categories and these metrics. Results: No significant differences were found in gait speed, cadence, stride duration, or double support time between the normal and obese groups. However, significant differences were identified in age, hypertension prevalence, balance problems, and the incidence of falls, emphasizing the complex effects of obesity on factors influencing gait stability. Significance: This study contributes to our understanding of obesity’s impact on gait by highlighting the need to consider associated health and stability parameters. These findings prompt a re-evaluation of how BMI is integrated into clinical gait assessments and emphasize the necessity for personalized healthcare strategies. This research highlights the importance of future studies with larger, more diverse populations and a wider array of biomechanical measures to dissect the relationship between BMI, body composition, and gait dynamics.

Forget About Memory: Disentangling the Amnestic Syndrome in Idiopathic Normal Pressure Hydrocephalus.

Idiopathic normal pressure hydrocephalus (iNPH) can present with both episodic amnestic syndrome and biomarkers of Alzheimer's disease (AD) pathology. To examine the associations between amnestic syndrome and cerebrospinal fluid (CSF) AD biomarkers in iNPH and the CSF tap test response in iNPH patients with amnestic syndrome. We used the Free and Cued Selective Reminding Test to divide iNPH into amnestic and non-amnestic patients. We compared their clinical, biological, and radiological characteristics and examined the reversibility of gait spatiotemporal parameters and neuropsychological performances after a CSF tap test. Univariate and multiple linear regression models examined the association between memory performance and clinical-biological characteristics. Sixty-two non-amnestic patients (mean age 77.0±7.0 years, 38.7% female) and thirty-eight amnestic patients (mean age 77.0±5.9 years, 36.8% female) presented similar levels of AD biomarkers and clinical-radiological profiles. Global cognition and education levels were lower in the amnestic iNPH group. We found no association between AD biomarkers and memory performances (total tau: β= -4.50; 95% CI [-11.96;2.96]; p = 0.236; amyloid-β (1-42): β= 8.60, 95% CI [-6.30;23.50]; p = 0.240). At baseline, amnestic iNPH patients performed worse on executive functions, attention, and gait speed but improved similarly to the non-amnestic iNPH patients after the tap test. In our clinical sample of iNPH patients, we confirm the lack of specificity of the amnestic profile for predicting AD pathology. Clinicians should not preclude amnestic iNPH patients from undergoing an invasive procedure of CSF derivation.

Reliability and Validity of the Rate of Force Development for Quadriceps in Older Patients with Cardiovascular Disease

Background/Objectives: The rate of force development (RFD), which is the change in force over a period of time during muscle contraction, quantifies rapid muscle contractions. RFD may serve as a measure of physical rehabilitation in patients with cardiovascular disease (CVD); however, its reliability and validity in older patients remain unclear. This study examined the reliability and validity of quadricep RFD in older patients with CVD. Methods: This prospective study enrolled 30 outpatients undergoing cardiac rehabilitation (median age, 77 years) and 30 inpatients hospitalized for CVD (median age, 76 years). The quadricep RFD values at three time points (RFD50, 0–50 ms; RFD100, 0–100 ms; and RFD200, 0–200 ms) were calculated from the slope of the force–time curve. Physical performance was assessed using the Short Physical Performance Battery (SPPB). Intra- and inter-rater correlation coefficients were assessed for outpatients. The correlation coefficients between RFD values and physical performance indicators were assessed separately for outpatients and inpatients. Results: The intraclass correlation coefficients (1,1) and (2,1) for RFD50, RFD100, and RFD200 were 0.742, 0.893, and 0.873 and 0.810, 0.918, and 0.930, respectively. The correlation coefficients for SPPB with RFD50, RFD100, and RFD200 were 0.553, 0.547, and 0.597 (all p < 0.05), respectively, for inpatients; similar moderate correlations were observed for gait speed and the chair stand test. Conclusions: The test–retest reliability of the RFD was excellent in older patients with CVD. The RFD was positively correlated with physical function indicators, suggesting its validity as a measure of physical rehabilitation.

Gait analysis in the early stage of Parkinson's disease with a machine learning approach.

Gait disorder is a prominent motor symptom in Parkinson's disease (PD), objective and quantitative assessment of gait is essential for diagnosing and treating PD, particularly in its early stage. This study utilized a non-contact gait assessment system to investigate gait characteristics between individuals with PD and healthy controls, with a focus on early-stage PD. Additionally, we trained two machine learning models to differentiate early-stage PD patients from controls and to predict MDS-UPDRS III score. Early-stage PD patients demonstrated reduced stride length, decreased gait speed, slower stride and swing speeds, extended turning time, and reduced cadence compared to controls. Our model, after an integrated analysis of gait parameters, accurately identified early-stage PD patients. Moreover, the model indicated that gait parameters could predict the MDS-UPDRS III score using a machine learning regression approach. The non-contact gait assessment system facilitates the objective and quantitative evaluation of gait disorder in PD patients, effectively distinguishing those in the early stage from healthy individuals. The system holds significant potential for the early detection of PD. It also harnesses gait parameters for a reasoned prediction of the MDS-UPDRS III score, thereby quantifying disease severity. Overall, gait assessment is a valuable method for the early identification and ongoing monitoring of PD.

An intensified trans-sectoral nutritional intervention in malnourished patients with chronic pancreatitis improves diseases prognosis and identifies potential biomarkers of nutritional status.

Malnutrition is a common complication in chronic pancreatitis and associated with reduced quality of life and life expectancy. Nutritional support is considered mandatory in malnourished patients with chronic pancreatitis but there is only scarce evidence on optimal treatment modalities and the efficacy of nutrition therapy. Here, we investigated the feasibility and efficacy of an intensified nutritional intervention in malnourished patients with chronic pancreatitis and aimed to identify suitable indicators for monitoring nutritional status. We performed a single-arm feasibility study, in which malnourished patients with chronic pancreatitis received an intensified trans-sectoral nutritional intervention for 6 months. Multimodal treatment comprised face-to-face dietary counseling, oral nutritional supplementation, and a complementary telephone-based nutrition and exercise coaching. Patients underwent follow-up examinations after 28, 90, and 180 days, when we assessed changes in anthropometric and body composition measures, muscle function, Chronic Pancreatitis Prognosis Score (COPPS), as well as blood parameters and intestinal microbiota composition. Eleven out of 73 patients initially screened for study participation were enrolled in the trial of which 9 subjects (age (mean ± SD): 56.2 (±14.8) years; male: 67%; alcoholic etiology: 44%) underwent the complete intervention. Patients gained a median of 5.3 kg (8.6%) body weight, including 1.6 kg skeletal muscle mass, and significantly increased gait speed (p < 0.001). Ameliorated nutritional status and muscle function were associated with increased blood levels of IGF-1 and cholinesterase as well as altered gut microbiota composition on the phyla and genera level. Moreover, significant improvements in COPPS indicated reduced disease severity after 90 and 180 days. Malnourished patients with chronic pancreatitis benefit from intensified nutritional therapy. Besides ameliorated nutritional status, a multimodal intervention can improve muscle function as well disease prognosis. Future studies are needed to prove superiority to standard-of-care and to validate potential biomarkers for prospective monitoring of nutritional status. https://clinicaltrials.gov/study/NCT04476056, NCT04476056.

Outpatient Physiotherapy for Immune Mediated Necrotizing Myositis With a Positive Outcome: Must Pathology Equal Dysfunction? A Case Report

BACKGROUND: Necrotizing Myositis (NM) is a rare autoimmune systemic condition leading to skeletal muscle destruction visualized on Magnetic Resonance Imaging (MRI). The prognosis is severe progressive muscle weakness leading to functional mobility decline. This case study described outpatient physiotherapy management of NM, not hitherto reported, and the unanticipated outcomes given the diagnosis and MRI findings. CASE PRESENTATION: A 77-year-old female was diagnosed with NM, confirmed on MRI significant for abnormal T2 signal in all muscular compartments of both lower extremities, after 4 months of progressive limb weakness had prevented her from walking independently. Outpatient physiotherapy began 10 months after diagnosis. Examination revealed spinal and peripheral joint hypomobility, lower limb weakness (1 repetition, 30s sit to stand-30STS), functional limitation (14/80, Lower Extremity Functional Scale-LEFS), and slow gait with rollator. The physiotherapy diagnosis was that musculoskeletal impairments contributed to movement dysfunction, leading to 18 manual therapy and exercise treatments over 19 weeks. OUTCOMES AND FOLLOW-UP: Strength (8 repetition 30STS) and function (49/80 LEFS) improved beyond minimal clinical important differences and gait speed at discharge approximated age-sex-matched normal. DISCUSSION: For this NM case, strength and function improved despite confirmed muscle necrosis and prognosis of progressive muscle degradation after addressing modifiable musculoskeletal impairments.

Effect of Blood Flow Restriction on Gait and Mobility in Older Adults: A Systematic Review and Meta-Analysis.

Older adults demonstrate gait impairments that increase their risk for falls. These age-related mobility impairments are in part due to declines in muscle mass and strength. High-intensity exercise can improve muscle strength and mobility but may not be tolerable for older adults due to musculoskeletal injury and pain. Blood flow restriction (BFR) with lower-intensity exercise offers a strategy that may be more tolerable for older adults, but whether BFR improves gait and mobility in older adults is unclear. The purpose of this systematic review and meta-analysis was to determine the effect of BFR on gait and mobility in healthy older adults. PubMed, Embase, Cochrane Library, and CINAHL were systematically searched for articles utilizing BFR in older adults. Articles were included if adults were over 60 years, did not have chronic health conditions, had undergone randomized controlled trials, and presented objectively measured gait outcomes. The search identified 1501 studies, of which 9 were included in the systematic review and 8 studies in the meta-analysis. Outcome measures included the Timed Up and Go (TUG), 6-Minute Walk Test (6MWT), 400 m walk test, Short Physical Performance Battery (SPPB), and 10 m walk test. Meta-analyses found improvements in the TUG (mean difference (MD) = -0.71; 95% CI = -1.05, -0.37; p < 0.001) and SPPB (MD = -0.94; 95% CI = -1.48, -0.39; p < 0.001) in BFR compared to no BFR. There were no differences in gait speed (MD = 0.59; 95% CI = -0.22, 1.41; p = 0.16). BFR may be effective for gait and mobility tasks over shorter distances. Clinicians may consider incorporating BFR to improve mobility and gait function in older adults.

Associations between dual-task walking and cognitive impairment in people attending a cognitive diagnostic clinic.

Dual-task walking performance is an early marker of dementia. However, there is uncertainty about which measure of the dual-task test is a better marker. The objective of this study was to determine which dual-task measure best differentiates between normal cognition, mild cognitive impairment (MCI) and dementia. Participants (n = 116) were aged ≥60 years attending a cognitive clinic in Melbourne, Australia. Single- and dual-task gait speed were obtained using a 16 metre distance and stopwatch. The cognitive task involved reciting alternate letters of the alphabet sitting and walking. Dual-task interference in gait and cognition was calculated as: single-task-dual-task/single task × 100 and summed to obtain total interference. Multiple linear regression was used to determine differences in single and dual-task measures between those with no cognitive impairment (n = 11), MCI (n = 54) and dementia (n = 51). The mean age of the sample was 76.9 (SD 6.4) years and 48.3% (n = 56) were female. Compared to those with dementia: (a) those with MCI had a higher dual-task letter rate and lower cognitive and total interference (all indicate better performance) (p < .05) and (b) those with no cognitive impairment had a higher single- and dual-task letter rate (both indicate better performance) (p < .05). There were no differences between those with no cognitive impairment and those with MCI (all p > .05). In a cognitive clinic, measurement during dual-task walking differentiated those with dementia from those with MCI or no cognitive impairment. However, differences appear to be driven by performance on the cognitive, rather than the gait task.

Performance of SARC-F and SARC-CalF scores to predict risk of mortality in hemodialysis patients: a cohort study

This study aimed to evaluate the association between the questionnaires SARC-F and SARC-CalF with risk of mortality in patients undergoing hemodialysis (HD). A cohort study, with patients on HD age ≥ 18 years, both sex, between June 2019 and April 2023. Body composition (anthropometry and bioelectrical impedance), muscle functional (handgrip strength and gait speed), screening of sarcopenia using the SARC-F and SARC-CalF, nutritional status and laboratory data were assessed. Follow-up for mortality up to 47 months. The sample consisted of 243 participants and the prevalence of risk of sarcopenia using SARC-F and SARC-CalF were 30% and 45%, respectively; 65 died for all reasons and three patients were censored due to transplantation. Multivariate analysis identified SARC-CalF as predictor of mortality in HD patients [hazard ratio 1.96; 95% CI (1.01–3.79); p = 0.04]. The survival analysis showed that there was a significant difference in the survival curves among the groups stratified by SARC-F and SARC-CalF for log-rank test. A higher specificity was found for SARC-CalF than SARC-F (80% vs. 77%) in receiver operating characteristic (ROC) curve. Both questionnaires were associated with anthropometric, parameters of body composition, physical measurements, and SARC-CalF was predictor of risk for mortality in HD patients.

8068 Beneficial Effects of a Personalized Exercise Program for Patients with Cushing's Disease and Acromegaly After Biochemical Control

Abstract Disclosure: E. Valassi: None. L. Martel-Duguech: None. H. Bascuñana: None. V. Priego-Corredor: None. J. Viñals-Ribé: None. O. González-Viñuela: None. T. Caparrós-Pons: None. S.M. Webb: None. Background: Patients with Cushing’s disease (CD) in remission and controlled acromegaly (ACRO) present with residual metabolic derangements, muscle dysfunction, and poor quality of life (QoL). Although exercise is known to exert positive effects on psychophysical health in several conditions, evidence demonstrating its potential benefits in pituitary diseases is scanty. Main hypothesis: A personalized program of combined (aerobic and resistance training) exercise lasting 12 weeks improves cardiometabolic parameters, body composition, physical performance and QoL in patients with CD in remission and controlled ACRO. Methodology: Ten female patients with CD in remission [mean (±SD) age, 59±4 years, mean (±SD) BMI, 35±2 Kg/m2, median (IQR) duration of remission, 5(4) years] and 10 male patients with controlled ACRO [mean (±SD) age, 53±9 years, mean (±SD) BMI, 27±4 Kg/m2, median (IQR) duration of control, 6(3) years] underwent a 12-week, structured, personalized program of combined aerobic and resistance exercise, under the supervision of professional trainers. We evaluated the following parameters at baseline and within 72 hours after the completion of the exercise program: blood pressure (BP), BMI, waist and neck circumferences; physical performance (gait speed, hand grip strength, 30-Second Chair Stand; Timed “Up and Go”); lumbar and femoral bone mineral density (BMD) and body composition, using dual x-ray absorptiometry (DXA); muscle thickness (cm) at the middle and distal third of rectus femoris (RF) and vastus intermedius (VI) on both sides, using muscle ultrasound scans in the transverse plane (Philips Affiniti 70; The Netherlands); quality of life (QoL), using the questionnaires CushingQoL in CD patients and AcroQoL in ACRO patients. Major results: After completion of the exercise program, CD patients had lower diastolic BP and waist circumference as compared with baseline (p&amp;lt;0.05). Physical performance globally improved (p&amp;lt;0.01 for all function tests). Femoral BMD was higher, percentage of lean mass increased while trunk fat decreased (p&amp;lt;0.01). RF and VI muscle thickness was greater at both the middle and distal third on the right side (p&amp;lt;0.01), and at the distal third on the left as compared with baseline (p&amp;lt;0.05). ACRO patients had a lower systolic BP as compared with baseline. Gait speed and hand grip strength increased while performance on the 30-Second Chair Stand improved (p&amp;lt;0.05). Muscle thickness at the middle third of the right RF was greater as compared with baseline (p&amp;lt;0.05). QoL was unchanged in both CS and ACRO patients at the end of the program. Conclusions: A customized exercise program promotes beneficial cardiometabolic and muscle changes in patients with CD and ACRO and, therefore, should be offered in a specialized pituitary clinic, within an integrated multidisciplinary team approach. Study financed by ISCIII research project number FIS PI21/01223 Presentation: 6/1/2024

6427 Impact of Adrenalectomy On Frailty And Muscle Function In Patients With Mild Autonomous Cortisol Secretion: A Prospective Longitudinal Study

Abstract Disclosure: J. Saini: None. V. Fell: None. B. Atkinson: None. S. Achenbach: None. I. Bancos: None. Background: Patients with mild autonomous cortisol secretion (MACS) have a higher prevalence of frailty and reduced muscle strength as compared to patients with nonfunctioning adrenal adenomas or subjects without adrenal disorders. Objective: To determine the impact of adrenalectomy on frailty and parameters of functional strength in patients with MACS. Methods: We conducted a single-center prospective longitudinal study of adults with MACS scheduled for adrenalectomy and referent subjects evaluated between 2018 and 2023. MACS was defined as serum cortisol&amp;gt;1.8 mcg/dL after 1 mg dexamethasone suppression test in patients with adrenal adenomas and no features of overt hypercortisolism. Referent subjects were included if they had abdominal imaging and had no adrenal disorders. Patients and referent subjects had a baseline and a follow-up evaluation at least 10 months later. Differences were assessed using paired t-tests for (1) Frailty Index (FI)--calculated using a questionnaire containing 47 variables on comorbidities, symptoms, and daily living activities (frailty defined as FI&amp;gt;0.25) (2) physical function assessed using handgrip strength (Jamar Plus digital hand dynamometer), timed up-and-go test (time taken to rise from a chair, walk to and from 3 m, and sit down), gait speed, 6-minute walk test, and (3) Advanced Glycation End (AGE) Product (using AGE reader). Results: We evaluated 41 patients before and after adrenalectomy, and 31 referent subjects at baseline and follow-up visit, at a similar interval (median 1.6, IQR 1.2-2.0 vs 1.5 years, IQR 1.0-2.2, P=0.759). While sex distributions were no different between the 2 groups (women, 66% vs 84%, P=0.086), patients with MACS were older than the referent group (median age 57.3, IQR 48.8-66.9 vs 49.0, IQR 41.7-57.9 years, P=0.005). Post-adrenalectomy, FI decreased by a mean of 0.057 (SD 0.08), P&amp;lt;0.001 in patients, and remained unchanged in the referent group. AGE decreased in patients by 0.148 (SD 0.45), P=0.04 but not in referent subjects (-0.047, SD 0.242, P=0.5). Patients demonstrated no improvement in parameters of muscle strength: gait speed (mean change 0.305 m/s, P=0.453), 6-minute walk test (mean change 16.4 meters, P=0.201), dominant (mean Z score change -0.055, P=0.72) and nondominant (mean Z score change -0.199, P=0.192) hand grip muscle strength. At follow-up, both patients (mean change 1.897 seconds, P&amp;lt;0.001) and referent subjects (mean change=1.475 seconds, P&amp;lt;0.001) demonstrated a deterioration on the timed up-and-go test. Conclusions: While no improvement was seen in the parameters of muscle strength, adrenalectomy improved the frailty index in patients with MACS. In addition, AGE, a biomarker associated with cardiovascular morbidity, decreased after adrenalectomy, suggesting a beneficial cardiovascular impact of MACS reversal. Presentation: 6/1/2024

The Effectiveness and Safety Analysis of Duloxetine in Treating Comorbid Depression in Parkinson's Disease: A Retrospective Study.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by both motor and non-motor symptoms, including depression, which significantly impacts the quality of life of affected individuals. This study aims to investigate the real-world effectiveness and safety of duloxetine in treating comorbid depression in patients with Parkinson's disease and to compare its outcomes with traditional treatment approaches. This study included adult patients diagnosed with Parkinson's disease combined with depression from December 2020 to December 2023. Based on the use of duloxetine, the cohort was divided into a traditional treatment group and a duloxetine group (traditional treatment combined with duloxetine). Patients with incomplete medical records, concurrent antidepressant therapy, or major psychiatric or neurological disorders were excluded. Retrospective data, including demographic information, treatment adherence, and various assessment scores, were collected from medical records by trained research staff. In total, 106 patients were analyzed, with 50 patients receiving traditional treatment and 56 patients receiving duloxetine. The duloxetine group exhibited significantly lower scores than the traditional treatment group in the Unified PD Rating Scale (p = 0.015), Hamilton Depression Rating Scale (p = 0.013), Beck Depression Inventory (p = 0.031), Parkinson's disease Questionnaire-39 (p = 0.006), and Clinical Global Impression-Improvement (p < 0.001) scores. In motor function assessment, the duloxetine group demonstrated improvements in kinetic tremor scores (p = 0.017), gait speed (p < 0.001), Timed Up and Go Test performance (p < 0.001), dyskinesia severity (p = 0.017), and rigidity (p = 0.019) compared to the traditional treatment group. Additionally, the duloxetine group exhibited better cognitive function across various assessments, including the Symbol Digit Modalities Test (p = 0.024), Stroop Color-Word Test (p = 0.048), and Montreal Cognitive Assessment (p = 0.024). Duloxetine is associated with superior efficacy in improving motor and non-motor symptoms, overall clinical status, and cognitive function. These findings support the potential utility of duloxetine as a comprehensive treatment option for comorbid depression in Parkinson's disease.

6612 Both Overt And Mild Hypercortisolism Accelerate Biological Aging

Abstract Disclosure: K. Yu: None. J. Saini: None. J.N. Farr: None. F. Vanessa: None. S. Khosla: None. I. Bancos: Advisory Board Member; Self; AstraZeneca, Adrenas, Neurocrine, Spruce, Recordati, Xeris, Novo Nordisk, HRA Pharmaceuticals, Sparrow, Diurnal, Corcept. Research Investigator; Self; HRA Pharmaceuticals, Recordati. Importance: Patients with both mild autonomous cortisol secretion (MACS) and overt Cushing syndrome (CS) demonstrated high prevalence of aging-related morbidity and an increased mortality. Objective: To determine whether p16INK4a in T cell, a cell cycle enzyme that associated with chronological aging and cell senescence, is associated with hypercortisolism and hypercortisolism-related comorbidities. Design, Setting, and Participants: In this single-center cross-sectional study, we prospectively recruited consecutive patients with hypercortisolism between July 1, 2020 and August 24 2022. Patients were included if they were diagnosed with Cushing syndrome (CS) or mild autonomous cortisol secretion (MACS). Age- (± 2 years) and sex-matched referent subjects without known adrenal disorders were included if abdominal imaging was available. Participants on exogenous glucocorticoids within 3 months prior were excluded. Exposure: Presence of hypercortisolism (MACS and CS). Main Outcomes and Measures: Primary outcomes included p16INK4a, advanced glycation end products (AGE) reader result, Frailty Index score, frailty (defined as frailty index&amp;gt;0.31), and physical performances in patients and matched referents at index date. Secondary outcomes included correlation between biological age markers, hormonal workup and the risk of comorbidities. p16INK4a expression analysis was adjusted for age, sex, smoking, and alcohol use for all analyses except for associations with CVD and frailty. Results: Of 85 patients (87% women, mean age 53 years), 51 (60%) had MACS (34 had matched referents), 34 (40%) had overt CS (16 had matched referents). Patients with CS demonstrated a median 1.9-fold higher p16INK4a expression (P&amp;lt;.001), and patients with MACS showed a median of 1.70-fold p16INK4a expression (P=.013), when compared to referent subjects. Age- and sex-adjusted p16INK4a expression was associated with frailty index score (r=0.23, P=.035), time-up-and-go test (r=0.28, P=.048), gait speed (r=-0.36, P=.035), but not with AGE reader result, 6-minute walk test, or hand grip measurement. The p16INK4a expression was associated with history of cardiovascular disease (age-adjusted odds ratio (aOR)=3.70, 95% confidence interval (CI), 1.20-11.43) and frailty (aOR=2.27, 95%CI, 1.04-4.98). Conclusion and relevance: We demonstrated evidence of cell senescence in both patients with CS and patients with MACS. Further studies need to determine the impact of surgical, cortisol-lowering, and senolytic medical therapies in MACS on cell senescence and associated aging-related comorbidities. Presentation: 6/1/2024

Blood flow modulation to improve motor and neurophysiological outcomes in individuals with stroke: a scoping review.

Ischemic Conditioning (IC) is a procedure involving brief periods of occlusion followed by reperfusion in stationary limbs. Blood Flow Restriction with Exercise (BFR-E) is a technique comprising blood flow restriction during aerobic or resistance exercise. Both IC and BFR-E are Blood Flow Modulation (BFM) strategies that have shown promise across various health domains and are clinically relevant for stroke rehabilitation. Despite their potential benefits, our knowledge on the application and efficacy of either intervention in stroke is limited. This scoping review aims to synthesize the existing literature on the impact of IC and BFR-E on motor and neurophysiological outcomes in individuals post-stroke. Evidence from five studies displayed enhancements in paretic leg strength, gait speed, and paretic leg fatiguability after IC. Additionally, BFR-E led to improvements in clinical performance, gait parameters, and serum lactate levels. While trends toward motor function improvement were observed post-intervention, statistically significant differences were limited. Neurophysiological changes showed inconclusive results. Our review suggests that IC and BFR-E are promising clinical approaches in stroke, however high-quality studies focusing on neurophysiological mechanisms are required to establish the efficacy and underlying mechanisms of both in stroke. Recommendations regarding future directions and clinical utility are provided.

12571 Ultrasonography Is A Potential Cost-effective Tool To Evaluate Muscle Impairment In Patients With Controlled Cushing’S Disease And Acromegaly

Abstract Disclosure: L. Martel-Duguech: None. H. Bascuñana: None. S. Webb: None. E. Valassi: None. Myopathy is a frequent feature in patients with Cushing’s syndrome (CS) and in patients with acromegaly (ACRO) long-term after biochemical control is achieved. Although ultrasonography (US) is an easy and cost-effective tool to evaluate muscle impairment in the clinical setting, its usefulness in patients with “controlled” ACRO end CS patients has not been established The aim of our study was to evaluate muscle structure using US and assess the correlation between US parameters, muscle function and quality of life (QoL). We included 36 female patients with CS [mean (±SD) age, 50±12 years; mean (±SD) BMI, 26.7±3.8] and 36 age- and BMI-matched healthy women. Mean (±SD) duration of remission was 132±87 months. We also included 36 patients with ACRO [20 females and 16 males, mean (±SD) age, 53±9 years, BMI 27±4 Kg/m2 and duration of control 92±58 months], and 36 age, gender and BMI-matched controls. We obtained transverse ultrasound images of the rectus femoris and assessed muscle intensity at both the midpoint (QmitR) and the distal third (QtercR), between the anterior inferior iliac spine and the proximal end of the patella. We scored muscle intensity using the Heckmatt’s rating scale and classified our findings as follows: 1-normal, 2-mildy increased muscle echoes with normal bone reflection, 3-moderately increased muscle echoes with reduced bone, 4-severely increased muscle echoes with absent bone reflection. We found that mean US intensity score was increased in patients with CS (QmitR p&amp;lt;0.001) and in patients with ACRO (QmitR p&amp;lt;0.05; QtercR p&amp;lt;0.001) vs. the controls, suggesting more impaired muscle architecture in the former, likely due to fibrosis/fatty infiltration. We also measured muscle function using the following tests: gait speed velocity (GS), timed up and go (TUG) and 30-second chair stand. QoL was assessed using both generic (SF-36) and disease-specific (CushingQoL and AcroQoL) questionnaires. US parameters, QoL and muscle function were correlated; in CS patients, higher QtercR was associated with slower GS (r=-0.421, p=0.041) and lower scores in social dimensions on CushingQoL ( friends/family , r=-0.510, p=0.013; and work/study, r=-0.523, p=0.010) . In ACRO patients, higher QmedR was associated with slower GS (r=-0.382, p=0.031) and decreased TUG (r=-0.497, p=0.004) and 30-second chair stand (r=-0.444, p=0.011) in all patients. Higher QmedR was also associated with lower score in physical function (ρ=-0.734, p=0.024), vitality (ρ=-0.728, p=0.026), and AcroQoL total score (ρ=-0.725, p=0.027), in male patients only. Conclusion: muscle US architectural parameters are impaired in “controlled” CS and ACRO patients, and are correlated with muscle function and QoL in both groups of patients. US may be a useful technique to identify, in a clinical setting, those CS and ACRO patients showing residual myopathy. This work was supported by PI17/00749 and PI21/01223 and FEDER funds Presentation: 6/3/2024

Ability of Heart Rate Recovery and Gait Kinetics in a Single Wearable to Predict Frailty: Quasiexperimental Pilot Study.

Aging is a risk factor for falls, frailty, and disability. The utility of wearables to screen for physical performance and frailty at the population level is an emerging research area. To date, there is a limited number of devices that can measure frailty and physical performance simultaneously. The aim of this study is to evaluate the accuracy and validity of a continuous digital monitoring wearable device incorporating gait mechanics and heart rate recovery measurements for detecting frailty, poor physical performance, and falls risk in older adults at risk of falls. This is a substudy of 156 community-dwelling older adults ≥60 years old with falls or near falls in the past 12 months who were recruited for a fall prevention intervention study. Of the original participants, 22 participants agreed to wear wearables on their ankles. An interview questionnaire involving demographics, cognition, frailty (FRAIL), and physical function questions as well as the Falls Risk for Older People in the Community (FROP-Com) was administered. Physical performance comprised gait speed, timed up and go (TUG), and the Short Physical Performance Battery (SPPB) test. A gait analyzer was used to measure gait mechanics and steps (FRAIL-functional: fatigue, resistance, and aerobic), and a heart rate analyzer was used to measure heart rate recovery (FRAIL-nonfunctional: weight loss and chronic illness). The participants' mean age was 74.6 years. Of the 22 participants, 9 (41%) were robust, 10 (46%) were prefrail, and 3 (14%) were frail. In addition, 8 of 22 (36%) had at least one fall in the past year. Participants had a mean gait speed of 0.8 m/s, a mean SPPB score of 8.9, and mean TUG time of 13.8 seconds. The sensitivity, specificity, and area under the curve (AUC) for the gait analyzer against the functional domains were 1.00, 0.84, and 0.92, respectively, for SPPB (balance and gait); 0.38, 0.89, and 0.64, respectively, for FRAIL-functional; 0.45, 0.91, and 0.68, respectively, for FROP-Com; 0.60, 1.00, and 0.80, respectively, for gait speed; and 1.00, 0.94, and 0.97, respectively, for TUG. The heart rate analyzer demonstrated superior validity for the nonfunctional components of frailty, with a sensitivity of 1.00, specificity of 0.73, and AUC of 0.83. Agreement between the gait and heart rate analyzers and the functional components of the FRAIL scale, gait speed, and FROP-Com was significant. In addition, there was significant agreement between the heart rate analyzer and the nonfunctional components of the FRAIL scale. The gait and heart rate analyzers could be used in a screening test for frailty and falls in community-dwelling older adults but require further improvement and validation at the population level.

Low serum Metrnl levels are associated with increased risk of sarcopenia in the older adults.

Sarcopenia is a geriatric syndrome characterized by progressive loss of muscle mass and function. Meteorin-like (Metrnl) is a secretory protein that has protective effects on skeletal muscle injury. However, the association of Metrnl level with sarcopenia remains unclear. A total of 772 community-dwelling older adults (median age = 76years), comprising 409 males and 363 females, from both urban and rural areas were enrolled. Serum Metrnl was measured by enzyme-linked immunosorbent assay. Appendicular skeletal muscle mass index (ASMI), grip strength, and gait speed were measured for the assessment of sarcopenia. We found that serum Metrnl levels were lower in patients with sarcopenia [median (IQR) = 180.1 (151.3-220.3) pg/mL] than older adults without sarcopenia [211.9 (163.2-270.0) pg/mL, P < 0.001]. Receiver-operating characteristic curve analysis showed that the optimal cut-off value of serum Metrnl level that predicted sarcopenia was 197.2pg/mL with a sensitivity of 59.2% and a specificity of 63.8% (AUC = 0.63, 95% CI = 0.59-0.67, P < 0.001). Multivariate logistic regression analyses showed that lower serum Metrnl level (< 197.2pg/mL) was significantly associated with increased risk of sarcopenia (adjusted OR = 2.358, 2.36, 95% CI = 1.528-3.685, P < 0.001). Moreover, serum Metrnl concentration was positively correlated with the components of sarcopenia including ASMI (r = 0.135, P < 0.001), grip strength (r = 0.102, P = 0.005), and gait speed (r = 0.106, P = 0.003). Taken together, our findings demonstrate that low serum Metrnl level is correlated with increased risk of sarcopenia in the older adults.

Frailty, Body Composition, and Glycemic Control in Older Adults with Type 2 Diabetes.

The relationship between frailty and glycemic control in older adults with diabetes remains uncertain, mainly due to the fact that previous studies have not accounted for measures of body composition. In older adults with diabetes, we examined the association between three types of frailty measures and glycemic control, while accounting for fat-free mass (FFM) and waist circumference (WC). Eighty older adults (age ≥65, 27 women and 53 men, mean age 80.5±0.6 years) had gait speed, Cardiovascular Health Study Index (CHSI), Rockwood Clinical Frailty Scale (RCFS), and glycosylated hemoglobin (HgA1C) measured. HgA1C showed a negative association only with CHSI (standardized β=-0.255±0.120, p=0.038), but no association with gait speed or the RCFS. Even after accounting for FFM and WC, we demonstrated a negative association between glycated hemoglobin and increasing frailty in older adults with diabetes.

Gait speed in older adults: exploring the impact of functional, physical and social factors

Purpose: With age there is a neuromuscular and cognitive decline that impacts on functional ability. One of the most characteristic and easily recognisable signs of this decline is a decrease in usual gait speed. For older adults, gait speed is a non-invasive indicator of health and functional status and is regarded as a vital sign. As it predicts various conditions later in life, measuring usual walking speed is crucial in the clinical setting. Therefore, analysing and determining the association between walking speed and the impact of functional and socio-economic variables may facilitate the prevention of associated health problems and the maintenance of physical function in older adults. This study aims to identify the key factors that influence walking speed in older adults, as well as to examine the influence of socio-economic status on walking speed. Methods: A total of 1253 older adults (89.5% women) with a mean age of 78.1 ± 5.8 voluntarily participated in this descriptive cross-sectional study, which examines the results of functional capacity tests and socioeconomic data in older adults. To assess physical function, SPPB tests (chair stand test, balance tests, gait speed test), manual grip strength, muscle quality index, and power were conducted, in addition to measuring body composition and socioeconomic status. Results: The final regression model showed that gait speed was significantly partially explained (R2=0.35; p&lt;0.01) by the socioeconomic environment, age, balance, and relative power. At the same time, belonging to a higher socio-economic environment is linked to lower relative power (p&lt;0.01; η2=0.07). Conclusions: Exploring the factors that affect walking speed in older adults, this study highlights that age, relative power and balance are significant determinants. These clinical markers provide crucial information for designing personalized and effective interventions to promote healthy aging. Keywords: Frailty, gait speed, elderly, relative power, socioeconomic status.

Analysis of Spatiotemporal Gait Variables before and after Unilateral Total Knee Arthroplasty

This study aimed (a) to evaluate the spatiotemporal gait variables of total knee arthroplasty (TKA) before (pre-) and after the procedure (post-), and (b) to investigate the influence of the surgical side on these variables. Twenty-one volunteers (13 females and 8 males) participated, undergoing assessments pre-surgery and nine to 12 months post-surgery. Clinical tests indicated significant reductions in knee pain and improvements in active and passive extension post-surgery. TKA resulted in decreased pain, extension deficits, and functional assessments, with lower scores on the WOMAC questionnaire. A gait analysis showed post-surgery improvements in gait speed (5.8%), cycle time (−4.8%), step time (4.4%), double limb support time (−11.1%), step (4.4%) and stride (6.3%) lengths, and step (5.1%) and stride (5.0%) cadences. Comparisons between surgical side and limb dominance indicated significant differences in gait speed, stance, swing and step times, double limb support time, step and stride lengths, and step cadence. The non-dominant limb demonstrated greater improvements across most parameters compared to the dominant limb. These findings emphasize the importance of considering the limb dominance of patients with knee osteoarthritis when evaluating post-TKA function. These conclusions can be helpful for personalized rehabilitation programs, allowing tailored interventions for individuals undergoing knee surgery.