Higher Physical Functioning Research Articles

Baseline characteristics of breast and gynecological cancer patients enrolled in the trial of a multidisciplinary survivorship care model in an Asian national ambulatory cancer center.

37 Background: Accessible Cancer Care to Enable Support for Cancer Survivors (ACCESS) is a multidisciplinary survivorship care model launched at the National Cancer Centre Singapore (NCCS) in 2019. ACCESS employs routine distress and problem screening to triage cancer patients with varying care needs and complexities for tailored care. Here, we described the study design to evaluate ACCESS, and reported the baseline characteristics of our study cohort to characterize the profile of prospective target recipients of the new care model. Methods: A cluster randomized controlled trial was initiated to assess the effectiveness of ACCESS on quality of life and symptom burden, with each cluster unit defined at the oncologist level. Clusters were randomized in a 1:1 ratio to receive ACCESS or usual care. Eligible patients were ≥21 years, newly diagnosed with breast or gynecological cancer, and receiving follow-up care in NCCS. Patients were followed up for one year and patient-reported outcomes were collected every three months using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Rotterdam Symptom Checklist. Results: By May 2021, 91 patients and 89 patients in the usual care and ACCESS arm were recruited, respectively. Both groups (usual care vs. ACCESS) had comparable mean age (56.2±10.9 vs. 56.2±10.7, P = 0.998) and racial composition (P = 0.760). Employment status was similar in both arms (48.4% vs. 56.2% employed, P = 0.293) and most patients were covered by health insurance (89.8% vs. 88.1%, P = 0.920). At baseline, patients in both arms had comparable mean quality of life scores (65.1±19.8 vs. 66.9±17.6, P = 0.51) and reported high physical, role, emotional, cognitive, and social functioning levels (all mean scores > 70). No statistically significant differences in physical symptom and psychological distress levels were observed. Prevalent symptoms reported included fatigue (82.4% vs. 71.9%), pain (68.1% vs. 55.1%), and insomnia (57.1% vs. 55.1%). Almost half of the cohort reported financial difficulties (45.1% vs. 46.1%). Conclusions: Comparable baseline characteristics suggested the absence of systematic differences in care needs and demand among patients cared by different oncologists. Despite high functioning statuses at baseline, participants reported impaired quality of life with active physical and financial problems. These results support our hypothesis that routine screening would be valuable to identify such problems promptly for management via standardized care pathways. Results from this ongoing trial will determine the effectiveness of ACCESS on quality of life and functional recovery through treatment and survivorship. Clinical trial information: NCT04014309.

OS10.5.A BrainWear: Longitudinal, objective assessment of physical activity in 42 HGG patients

Abstract BACKGROUND In patients with High Grade Glioma (HGG), QoL and physical function decline with progressive disease (PD). Objective assessment of physical functioning is challenging as patients spend most of their time away from the hospital. Wearable technology allows measurement of objective, continuous activity data in a non-obtrusive manner. BrainWear is a phase II feasibility study, collecting longitudinal physical activity (PA) data from patients with primary and secondary brain tumours. MATERIAL AND METHODS All agreed to wear an Axivity AX3 triaxial accelerometer and completed the EORTC QLQ C30 and BN20, the Montreal Cognitive Assessment (MoCA) and Multidimensional fatigue inventory (MFI) questionnaires. Accelerometers were changed at 14-day intervals, and PRO questionnaires completed at pre-specified study intervals. Age-sex matched controls were identified from the UK Biobank 7-day accelerometer study. Raw accelerometer data was processed using UK Biobank accelerometer software and inclusion of high-quality wear time selected as ≥72 hours of data in a 7-day data collection and data in each 1-hour period of a 24-hour cycle over multiple days. We analysed variation in activity by patient demographics and treatment days. The wilcoxin-signed rank test was used to compare participant activity between radiotherapy treatment days and non-treatment days, mixed effects models were used to evaluate longitudinal changes in activity and we used k-means clustering to characterise clusters of PA behaviours. RESULTS We have collected 3458 days of accelerometer data from 42 HGG patients with a median age of 59, 80% of which has been classified as high quality. Patients >60 years spend more time doing moderate activity compared to those <60 years (52 vs 33 minutes/day, p=0.012), and there are significant differences in mean vector magnitude (17.12 vs 16.85 mg, p=0.013) and walking (91 vs 72 minutes/day) between radiotherapy and non-radiotherapy days. In patients having a 6-week RT course, time spent in daily moderate activity falls 4-fold between week 1 and the second week after RT completion (70 minutes to 16 minutes/day). Comparing HGG patients to healthy controls shows a significant difference in time spent across all activities (p<0.05). K-means clustering analysis shows three distinct clusters, with 87% of HGG patients falling into the very inactive or moderately active groups. CONCLUSION Digital remote health monitoring is feasible and acceptable with 80% of data classified as high-quality wear-time suggesting good patient adherence. Triaxial accelerometer data collection captures objective evidence of a significant reduction in moderate daily activity at the time of expected peak RT side-effects and patients walk almost 30% less on non-RT treatment days. HGG patients show significantly lower levels of activity compared to matched healthy controls.

The Athlete's Foot and Ankle: Osteochondral Lesion of the Talus

Osteochondral lesions of the talus (OLTs) are common injuries among athletes who experience acute ankle sprains, chronic ankle instability, or ankle fracture. Such lesions often cause athletes lasting pain and disability that can limit their participation in sport. It is unclear which of these lesions will become symptomatic, however those with persistent symptoms may be indicated for operative management given the limited ability of cartilage to regenerate. In the case of the athlete, an expectation of high physical function must factor into this decision-making alongside the postoperative recovery period. This article will briefly describe the wide range of surgical options available for treating OLTs and their respective indications. It will go on to elaborate on the author's preferred operative techniques for athletic patients and their associated outcomes. For small lesions, the author favors arthroscopic treatment involving debridement and placement of an extracellular matrix mixed with bone marrow aspirate concentrate. For larger or cystic lesions, osteochondral autograft transplantation is typically preferred.

Using machine learning to examine associations between the built environment and physical function: A feasibility study.

Linking geospatial neighbourhood design characteristics to health and behavioural data from population-representative cohorts is limited by data availability and difficulty collecting information on environmental characteristics (e.g. greenery, building setbacks, dwelling structure). As an alternative, this study examined the feasibility of Generative Adversarial Networks (GANs) - machine learning - to measure neighbourhood design using 'street view' and aerial imagery to explore the relationship between the built environment and physical function. This study included 3102 adults aged 45 years and older clustered in 200 neighbourhoods in 2016 from the How Areas in Brisbane Influence Health and Activity (HABITAT) project in Brisbane, Australia. Exposure data were Google Street View and Google Maps images from within the 200 neighbourhoods, and outcome data were self-reported physical function using the PF-10 (a subset of the SF-36). Physical function scores were aggregated to the neighbourhood level, and the highest and lowest 20 neighbourhoods respectively were used in analysis. We found that the aerial imagery retrieved was unable to be used to adequately train the model, meaning that aerial imagery failed to produce meaningful results. Of the street view images, n=56,330 images were downloaded and used to train the GAN model. Model outputs included augmented street view images between neighbourhoods classed as having high function and low function residents. The GAN model detected differences in neighbourhood design characteristics between neighbourhoods classed as high and low physical function at the aggregate level. Specifically, differences were identified in urban greenery (including tree heights) and dwelling structure (e.g. building height). This study provides important lessons for future work in this field, especially related to the uniqueness, diversity and amount of imagery required for successful applications of deep learning methods.

Emotional, Social, and Existential Loneliness Before and During the COVID-19 Pandemic: Prevalence and Risk Factors Among Dutch Older Adults.

ObjectivesThe coronavirus disease 2019 pandemic, with its accompanying isolation measures, has led to increasing loneliness among older adults. In this study, we examine whether the increased level of loneliness observed in the Netherlands persisted into the fall of 2020, whether there were differences in emotional, social, and existential loneliness, and whether the presence of well-known risk factors for loneliness also led to further increases in loneliness during the pandemic.MethodsData were obtained from the Longitudinal Aging Study Amsterdam, with observations of 404 community-dwelling older adults aged 74–96 years from 2019 and fall 2020.ResultsLoneliness increased between 2019 and 2020, and the increase was particularly high for emotional loneliness (partial η 2 = 0.19). Having a partner and a high mastery and good physical functioning before the pandemic provided some protection against an increase in loneliness.DiscussionLoneliness increased for almost all older people. Targeted policies can reduce the negative impact of vulnerabilities. Efforts to combat loneliness during the pandemic should focus not only on groups traditionally considered vulnerable, such as socially isolated people, but also on older adults with a partner and who have daily contact with others.

Abstract 073: Physical Function And Subsequent Risk Of Cardiovascular Events In Older Adults: The Atherosclerosis Risk In Communities (ARIC) Study

Background: Reduced physical function, an exemplary phenotype of aging, has been associated with cardiovascular disease (CVD). However, few studies have comprehensively investigated the association of physical function with risk of incident and recurrent CVD in community-dwelling older adults. Methods: Physical function, evaluated with the Short Performance Physical Battery (SPPB), was assessed in the ARIC study at visit 5 (2011-2013) among 5548 participants (mean age 75±5 years, female 58%, black 22%). The SPPB score was categorized into low (0-6), intermediate (7-9), and high (10-12) physical function. We assessed the associations of SPPB categories with composite and individual outcomes of coronary heart disease (CHD), stroke, or heart failure (HF) using Cox proportional hazards models adjusting for potential confounders. We also evaluated improvement in c-statistics by adding SPPB to covariates. Results: During a median follow-up of 6.2 years, there were 821 composite events (329 CHD, 226 stroke, and 467 HF cases). Compared to high SPPB score, low and intermediate SPPB score were robustly associated with higher risk of the composite CVD outcome (hazard ratio [HR] 1.59 [95% CI 1.29-1.95] and 1.32 [1.12-1.56], respectively) (Table). These associations were largely consistent between participants with and without a history of CVD at baseline. Among individual outcomes, low SPPB score showed the highest HR for stroke, whereas intermediate SPPB score was only significantly associated with HF. The addition of SPPB significantly improved c-statistic for composite outcome (Δc-statistic 0.006 [95% CI 0.002-0.009]), and the improvement was especially evident in participants without history of CVD (Δc-statistic 0.013 [0.003-0.023]). Conclusions: Lower physical function was robustly associated with the risk of CVD and improved its prediction beyond established predictors in older adults. Clinicians should pay attention to physical function when managing CVD risk in older adults.

Long-term quality of life and nutritional results after laparoscopic sentinel node navigation surgery versus laparoscopic standard gastrectomy for early gastric cancer: Secondary outcomes of a multicenter, randomized phase 3 trial (SENORITA).

4054 Background: Laparoscopic sentinel node navigation surgery (LSNNS) has been suggested as an alternative to laparoscopic standard gastrectomy (LSG) in early gastric cancer patients to improve long-term quality of life (QOL) and nutritional outcomes. Here, we present 3-year results of patient-reported quality of life (QOL) and nutrition, secondary endpoints of SENORITA trial. Methods: SENORITA is a prospective multicenter randomized phase 3 trial. Patients diagnosed with early gastric cancer of 3 cm or less were randomly allocated (1:1) to LSNNS for stomach preservation or LSG. The primary endpoint was 3-year disease-free survival. In this study, we analyzed QOL assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and EORTC stomach module (STO22) and nutritional parameters at 3, 12, 24, and 36 months after surgery. Linear mixed model analyses was used to evaluate differences between the two groups. This trial is registered with ClinicalTrials.gov, NCT01804998. Results: From March 2013 to March 2017, a total of 580 patients were randomly assigned and 527 patients were included in the modified intention-to-treat analysis population (258 in LSNNS and 269 in LSG group). QOL questionnaires were available for 99.4% of patients at baseline and then for 92.2%, 83.2%, 72.8%, and 66.9% at 3, 12, 24, and 36 months after surgery, respectively. The LSNNS group had higher physical function score than the LSG group at all time points (p = 0.002). However, there were no significant differences in other scales of EORTC QLQ-C30. Regarding EORTC QLQ-STO22, pain, eating restriction, anxiety, and taste scores were lower (better QOL) at all time points in the LSNNS group than in the LSG group (p = 0.002, < 0.001, < 0.001, and < 0.001, respectively). The summary score of EORTC QLQ-STO22 was also higher in the LSNNS group representing better QOL (p < 0.001). Body mass index, hemoglobin and total protein were significantly higher in the LSNNS group compared with the LSG group. Conclusions: The LSNNS group had better physical function and less symptoms, including pain, eating restriction, anxiety, and taste change compared with the LSG group. Moreover, the nutritional parameters were better maintained in the LSNNS group than in the LSG group. These findings showed benefits of stomach preserving surgery in LSNNS and can be used to help decision making about treatment for patients with early gastric cancer. Clinical trial information: NCT01804998.

Association of changes of pro-inflammatory markers with physical function in women with breast cancer receiving chemotherapy.

562 Background: Chemotherapy adversely affects the immune system and physical function. Inflammation is independently associated with functional decline. Compared to the individual cytokines [e.g., interleukin-6 (IL-6)], the pro-inflammatory index, IL-6/IL-10 ratio, is a better predictor of poor outcomes and mortality in many diseases. Other markers of inflammation such as soluble tumor necrosis factor (sTNFR) I, and sTNFRII have also been shown to be predictive of poor outcomes. We have previously reported a significant increase in sTNFRI/II with chemotherapy in patients with breast cancer. However, it is not yet understood if chemotherapy-related changes to inflammatory makers is associated with physical function after treatment. In this study, we assessed the relationship between changes of pro-inflammatory markers during chemotherapy with physical function after completing chemotherapy. Methods: This was a secondary analysis of a large nationwide cohort study in women with stage I-III breast cancer (NCT01382082). Serum levels of IL6, IL10, sTNFRI, and sTNFRII were measured ≤7 days before chemotherapy (T1) and ≤1 month after chemotherapy (T2), and the IL6/IL10 ratio was calculated. Absolute changes (T2-T1) of sTNFR-I and sTNFRII (reported in pg/mL) and the IL6/IL10 ratio were calculated. Physical function was measured by the Functional Assessment of Cancer Therapy: General – physical well being (FACT-PWB) at T1 and T2 and contains 7-items, each using a 5-point rating scale ranging from 0 (Not at all) to 4 (Very much), with a total score ranging from 0-28; higher scores represent higher physical function. ANOVA was used to compare means of FACT-PWD scores and mean changes of pro-inflammatory markers. Multivariate linear regressions were used to determine if increased pro-inflammatory markers were associated with lower FACT-PWD at T2, controlling for baseline FACT-PWD, age, race, education, and marital status. Results: We included 580 patients (mean age=53 years, range 22-81). Physical function significantly and clinically declined from T1-T2 (mean=22.2, SE=0.23 vs mean=19.4, SE=0.25; p<0.001). From T1-T2, there was a significant increase in IL6/IL10 (average change = 0.32, SE=0.09; p=0.004). A greater increase in pro-inflammatory markers from T1 to T2 was associated with lower FACT-PWD score at T2; sTNFRI (β=-3.92, SE=1.4), sTNFRII (β=-14.9, SE=7.1), and IL6/IL10 (β=-0.17, SE=0.06); all p<0.05. Conclusions: Serum pro-inflammatory markers increased from pre-chemotherapy to post-chemotherapy in patients with breast cancer. Greater increases in pro-inflammatory markers are associated with lower physical function within one month of the completion of chemotherapy. Pro-inflammatory markers; sTNFRI, sTNFRII, and IL6/IL10, may serve as useful biomarkers to help identify patients at risk of reduced physical function after chemotherapy.

Resilience and associated characteristics in adults with spina bifida.

To measure resilience and identify associated demographic and clinical factors in individuals with spina bifida. An anonymous survey was distributed via Facebook advertising to individuals with congenital urological conditions. Respondents 18years or older with spina bifida were included in this study. Resilience was measured with the 10-item Connor-Davidson Resilience Scale. Mean resilience levels in the study population and a US general population sample were compared with Student's t-test. Multiple linear regression assessed demographic and clinical factors associated with resilience. The mean resilience score for participants (n=195; 49 males, 146 females; mean age 40y 2mo [SD 12y 7mo] range 18-74y) was 27.2 (SD 7.5), which differed from a mean of 31.8 (SD 5.4) for a US general population sample (p<0.01). Multiple linear regression demonstrated significant positive associations between resilience and older age (p=0.04), prior urological surgeries (p=0.03), higher household education (p<0.01), and higher physical function (p<0.01). Resilience in individuals with spina bifida is moderately poor, relative to the general population, and is associated with certain demographic and clinical factors. As a modifiable construct with positive effects on quality of life, psychological well-being, and health-related behaviors, resilience is a promising target for intervention in individuals with spina bifida. What this paper adds Resilience in individuals with spina bifida is moderately poor. Resilience is lower in individuals with spina bifida than the general population. Resilience is associated with age, household education, physical function, and urological surgery.

Strategies for increasing gait speed in patients with hip osteoarthritis: their clinical significance and effects on hip loading

BackgroundChanges in gait speed are required in various situations and can be achieved by changing stride length, cadence, or both. Differences in strategies for increasing gait speed may have different effects on hip joint and physical function. The purpose of this study was to determine the effects of strategies for increasing gait speed on hip pain, physical function, and changes in hip loading during gait in patients with hip osteoarthritis (OA). We hypothesized that patients who increase gait speed mainly by increasing cadence would have lesser hip pain, a higher physical function, and a lower rate of increase in hip moments with increasing gait speed.MethodsForty-seven patients with secondary hip OA (age, 48.3 ± 11.0 years) were included. Gait speed, stride length, cadence, and peak and impulse of the hip moments were measured during gait at self-selected normal and fast gait speeds. The patients were classified as types S (with mainly increasing stride length, n = 11 [23.4%]), C (with mainly increasing cadence, n = 23 [48.9%]), and SC (with increasing stride length and cadence, n = 13 [27.7%]) according to whether they used changes in stride length and/or cadence to transition from normal to fast gait. Hip pain, physical function, and hip moment changes during gait were compared between types.ResultsThe physical function was higher in types C (38.0 ± 8.8, P = 0.018) and SC (40.6 ± 8.5, P = 0.015) than in type S (28.2 ± 7.8), even after adjustment for age and minimum joint space width. Hip pain was not significantly different between types. The robustness of these results was confirmed with sensitivity analysis. The rates of increases in peak external hip adduction (P = 0.003) and internal rotation moments (P = 0.009) were lower in type C than in type SC.ConclusionsType C tended to suppress the increase in hip moments during fast gait. Types C and SC, which included increased cadence, maintained higher physical function levels than type S. Encouraging the use of cadence-increasing strategy may be useful for reducing hip loading and maintaining physical function in patients with hip OA.

Estimating the effect of health assessments on mortality, physical functioning and health care utilisation for women aged 75 years and older

Health assessments have potential to improve health of older people. This study compares long-term health care utilisation, physical functioning, and mortality for women aged 75 years or over who have had a health assessment and those who have not. Prospective data on health service use, physical functioning, and deaths among a large cohort of women born 1921-26 were analysed. Propensity score matching was used to produce comparable groups of women according to whether they had a health assessment or not. The study population included 6128 (67.3%) women who had an assessment, and 2971 (32.7%) women who had no assessment. Propensity matching produced 2101 pairs. Women who had an assessment had more use of other health services, longer survival, and were more likely to survive with high physical functioning compared to women with no assessment. Among women who had good baseline physcial functioning scores, women who had an assessment had significantly lower odds of poor outcomes at 1000 days follow-up compared to women who had no assessment (OR: 0.67, 95%CI: 0.52, 0.85). This large observational study shows the real-world potential for assessments to improve health outcomes for older women. However, they also increased health service use. This increased healthcare is likely to be an important mechanism in improving the women's health outcomes.

The Impact of Health literacy on Health Outcomes in Cancer Patients Attending Inpatient Rehabilitation

Health literacy (HL) entails people's knowledge, motivation, and competences to access, understand, appraise, and apply health information. Lower HL is associated with poorer psychosocial health. However, there are no studies so far evaluating the impact of HL within oncological rehabilitation in Germany. Therefore, we explored HL in cancer patients in inpatient rehabilitation and its association with rehabilitation outcome. We conducted a secondary data analysis of a questionnaire survey with 449 cancer patients (breast, prostate, and colon cancer) at 3 measurement occasions (end of rehabilitation, 3- and 9 months follow-up). We assessed HL with the European Health Literacy Survey (HLS-EU-Q6). We evaluated rehabilitation outcomes by measuring fear of progression (FoP-Q-SF), need for psychosocial support, physical functioning and global quality of life (EORTC-QLQ-C30), and the work ability index (WAI). To explore the impact of HL on rehabilitation outcome, we used multiple regression analyses controlling for other factors. At the end of rehabilitation, up to 56% of the patients reported difficulties in HL dimensions. Better HL was significantly associated with lower fear of progression (β=- 0,33) and need for psychosocial support (OR=0,28), higher physical functioning (β=0,22), higher global health status (β=0,23), and higher work ability (β=0,21). Longitudinal analyses showed that improvement in HL was significantly accompanied by improvements in all rehabilitation outcomes (0,18 ≤ β ≤ 0,24). HL is a relevant factor within cancer rehabilitation. More than half of the patients showed problematic HL at discharge. Furthermore, HL is a predictor of psychosocial, somatic, and work-related rehabilitation outcomes up to 9 months. Effective strategies to support patients in dealing with health information are essential and should be promoted within rehabilitation.

Association of Dietary Quality, Inflammatory Markers, and Physical Functioning among Older Female Cancer Survivors

One area within geriatric oncology that is understudied and undertreated is the dietary quality of older cancer survivors. Most older adults with cancer experience nutritional deficits due to their age and cancer treatment. Research has shown the impact of competing comorbidities, polypharmacy, and decline in functional and cognitive status on older adults’ nutritional needs. This study sought to examine the diet quality of older female cancer survivors, and its association with inflammatory markers and physical functioning. Participants completed surveys online, by mail, or phone. Additional participant information was obtained through medical records. Descriptive statistics, Pearson’s correlations, forward linear regressions were used to analyze these data. Older female cancer survivors (≥65) that had completed their initial cancer treatment in the past 5 years were recruited through cancer clinic visits and medical records. The study was conducted from November 2018 through January 2020. Self-reported physical functioning (RAND-36), diet quality (DHQ-II, HEI-2015), and BMI were obtained from surveys. Participant diagnosis, comorbidities, and inflammatory marker (c-reactive protein (CRP)) were obtained through electronic medical records; albumin was collected as a marker correlated with inflammation. The average age of participants (n = 171) was 73.6 ± 8.4 years. Mean physical functioning score was 60 ± 24 out of 100. Mean total HEI scores were 66.39 + 10.0 out of 100. Positive correlations were observed between total HEI scores and physical functioning, self-rated health, albumin, education, and income. Negative correlations were observed between physical functioning and BMI, self-rated health, albumin, and age. Regressions indicated that individuals who had higher HEI scores were more likely to report higher physical functioning (β = 0.38, P < 0.001). Identifying dietary quality and markers to overall assess inflammation is pertinent to improve the long-term health of cancer survivors. The strong correlations between physical function, HEI, and albumin demonstrates the relationship albumin has with inflammation and its subtle impact it can have on older cancer survivors. Along with CRP, serum albumin should be interpreted in the context of the patient’s overall health. Future larger cohort studies of older cancer survivors with longitudinal measurements are warranted.

Resilience and Psychobiological Response to Stress in Older People: The Mediating Role of Coping Strategies.

Resilience, the ability to overcome adversity and face stressful demands and experiences, has been strongly associated with successful aging, a low risk of diseases and high mental and physical functioning. This relationship could be based on adaptive coping behaviors, but more research is needed to gain knowledge about the strategies employed to confront social stress. Thus, we aimed to investigate the role of the use of active or passive coping strategies by resilient people in dealing with stressful situations. For this purpose, we measured resilience, coping strategies, and perceived stress in 66 healthy older adults (31 men and 35 women) between 56 and 75 years old who were exposed to stress (Trier Social Stress Test, TSST) or a control situation. The stress response was analyzed at endocrine (cortisol) and psychological (anxiety) levels. In the stress condition, moderated mediation analysis showed a conditional indirect effect of resilience on cortisol reactivity through active coping. However, passive coping strategies did not mediate the resilience-cortisol relationship. In addition, neither active nor passive coping mediated the relationship between resilience and the anxiety response. These results suggest that resilience is associated with active coping strategies, which in turn could explain, at least in part, individual differences in the cortisol response to a psychosocial laboratory stressor. These factors may prevent the development of stress-related pathologies associated with aging and facilitate healthy and satisfactory aging.

Low-Intensity Resistance Training with Moderate Blood Flow Restriction Appears Safe and Increases Skeletal Muscle Strength and Size in Cardiovascular Surgery Patients: A Pilot Study.

We examined the safety and the effects of low-intensity resistance training (RT) with moderate blood flow restriction (KAATSU RT) on muscle strength and size in patients early after cardiac surgery. Cardiac patients (age 69.6 ± 12.6 years, n = 21, M = 18) were randomly assigned to the control (n = 10) and the KAATSU RT group (n = 11). All patients had received a standard aerobic cardiac rehabilitation program. The KAATSU RT group additionally executed low-intensity leg extension and leg press exercises with moderate blood flow restriction twice a week for 3 months. RT-intensity and volume were increased gradually. We evaluated the anterior mid-thigh thickness (MTH), skeletal muscle mass index (SMI), handgrip strength, knee extensor strength, and walking speed at baseline, 5–7 days after cardiac surgery, and after 3 months. A physician monitored the electrocardiogram, rate of perceived exertion, and the color of the lower limbs during KAATSU RT. Creatine phosphokinase (CPK) and D-dimer were measured at baseline and after 3 months. There were no side effects during KAATSU RT. CPK and D-dimer were normal after 3 months. MTH, SMI, walking speed, and knee extensor strength increased after 3 months with KAATSU RT compared with baseline. Relatively low vs. high physical functioning patients tended to increase physical function more after 3 months with KAATSU RT. Low-intensity KAATSU RT as an adjuvant to standard cardiac rehabilitation can safely increase skeletal muscle strength and size in cardiovascular surgery patients.

Association of Physical Activity and Physical Functioning Phenotypes With Fall Risk Among Women.

Objective: Physical activity (PA) may slow aging-related declines in physical functioning (PF), but the relationship of PA and falls is not well understood. This study examined the association of PA and PF with falls. Methods: The Study of Women's Health Across the Nation participants (n = 1597; age: 65.1years ± 2.7) reported PF and PA in 2012-2013 and falls in 2016-2017. Four phenotypes were identified: high PA-high PF, high PA-low PF, low PA-high PF, and low PA-low PF. Results: One-third (29.3%) reported ≥1 fall. Women with low PA-low PF (RR = 1.32; 95% CI: 1.06, 1.66) and with high PA-low PF (RR = 1.37; 95% CI: 1.07, 1.74) were more likely to fall than high PA-high PF. Over time, women with worsening PF had increased fall risk (RR = 1.43; 95% CI: 1.17, 1.74), but women who increased PA did not. Discussion: Poor PF increases the risk of falls, regardless of PA. However, increasing PA does not necessarily increase fall risk, reinforcing the importance of PA engagement.

The Association of Muscle Mass Measured by D3-Creatine Dilution Method With Dual-Energy X-Ray Absorptiometry and Physical Function in Postmenopausal Women.

The D3-creatine (D3Cr) dilution method provides a direct measure of skeletal muscle. The aim of this study was to compare the association of D3Cr muscle mass with lean body mass (LBM) measured by dual-energy x-ray absorptiometry (DXA) and examine its relation with physical function in postmenopausal women. Seventy-four community-dwelling women (mean age 82.3 ± 5.4) participated in this pilot study from the Buffalo, New York clinical site of the Women's Health Initiative (WHI). Participants attended a clinic visit which included anthropometric measures, blood draw, DXA scan, measures of physical function, and initiated the D3Cr protocol. Physical function was evaluated using hand grip strength, short physical performance battery (SPPB), and RAND-36 physical function scale. Descriptive statistics and logistic regression models were used to examine the associations of D3Cr muscle mass with functional outcomes. D3-creatine muscle mass was moderately correlated with DXA LBM (r = 0.50) and DXA appendicular lean mass (ALM) (r = 0.50). Individuals with high D3Cr muscle mass (%) had higher physical function compared to individuals with low muscle mass (%), indicated by high scores on SPPB (odds ratio [OR] = 5.24; 95% confidence interval [CI]: 1.40, 19.58). We observed stronger relationships between high D3Cr and physical function than either DXA LBM (OR = 3.40; 95% CI: 0.88, 13.11) or DXA ALM (OR = 4.15; 95% CI: 1.10, 15.68) and physical function. Our findings provide strong preliminary data for the associations of D3Cr muscle mass with measures of physical function in older women. These findings support and extend prior work on D3Cr muscle mass in older men.

Quality of Life in Patients with Cerebral Venous Sinus Thrombosis: A Study on Physical, Psychological, and Social Status of Patients in Long-term.

Cerebral venous sinus thrombosis (CVST) causes significant problems for patients in the working age and may therefore negatively affect their quality of life (QOL). In the present study, we sought to evaluate the QOL and its predictors in subjects with CVST. This observational, prospective study investigated several outcomes of 56 CVST patients after thrombosis onset. Demographic characteristics, medical history, neurological signs and symptoms during hospitalization, and the employment status of the patients were retrospectively collected. Stroke-related functional scales, including the modified Rankin Scale (mRS) and Barthel Index (BI) were employed. For physical and mental aspects of the QOL, we used the validated Persian version of the Stroke Specific Quality of Life (SS-QOL) scale. The physical and functional outcomes in the long-term were promising according to mRS and BI tools, as well as the improved rate of return to work. Mental domains of the SS-QOL, such as energy and personality represented the lowest scores. According to the multiple linear regression analysis, lower mRS score, and longer time interval between CVST onset and interview were associated with higher physical function of the patients while their better mental function was correlated with lower mRS score and thrombosis in merely one cerebral venous. CVST patients experience an acceptable alleviation of the primary physical disabilities, while residual symptoms, mostly in psychologic/mental domains, impair their QOL.

Successful Aging: A Comprehensive Outcome Using Latent Profile Analysis

Understanding “successful aging” is a primary goal of gerontology and adult development researchers that has been motivated by rapid the increases in life expectancy over the last 100 years. Successful aging, as it is understood by Rowe and Kahn, is conceptualized multidimensionally in terms of limited disease and disability, high physical, mental and cognitive functioning, and active engagement with life. “Success” in all three domains reflects the idealized manifestation of “successful aging.” Nevertheless, research on successful aging typically focuses on only one or two aspects of the model – most commonly physical disease or disability. The overall goal of this research is to advance understanding and subsequent attempts to promote holistic successful aging. Specifically, using key metrics from each domain of successful aging from the Midlife Development in the United States (MIDUS), this study characterizes distinct profiles of successful aging, and it describes the distribution of these profiles in the adult population. Results indicate 3 profiles. These are labeled as Successfully Aged, Somewhat Successfully Aged, and Least Successfully Aged. Approximately 82.1% of the population (mean age=50.5) is classified as Successfully Aged, whereas the remainder are classified in the Somewhat Successfully Aged (12.2%), and Least Successfully Aged (5.6%), respectively. As expected, those who were classified as Successfully Aged had the highest cognitive scores, sense of well-being, and self-rated health; and had the lowest number of age-related physical disabilities (i.e. cancer, stroke, osteoporosis, etc.) and mental health conditions (depression, anxiety disorder, and panic disorder). This outcome can be applied to multiple predictors.

Smoking, Obesity, and Disability Benefits or Litigation Are Not Associated with Clinically Important Reductions in Physical Functioning After Intramedullary Nailing of Tibial Shaft Fractures: A Retrospective Cohort Study.

Forty percent of long bone fractures involve the tibia. These fractures are associated with prolonged recovery and may adversely affect patients' long-term physical functioning; however, there is limited evidence to inform what factors influence functional recovery in this patient population. In a secondary analysis of a previous randomized trial, we asked: What fracture-related, demographic, social, or rehabilitative factors were associated with physical function 1 year after reamed intramedullary nailing of open or closed tibial shaft fractures? This is a secondary (retrospective) analysis of a prior randomized trial (Trial to Re-evaluate Ultrasound in the Treatment of Tibial Fractures; TRUST trial). In the TRUST trial, 501 patients with unilateral open or closed tibial shaft fractures were randomized to self-administer daily low-intensity pulsed ultrasound or use a sham device, of which 15% (73 of 501) were not followed for 1 year due to early study termination as a result of futility (no difference between active and sham interventions). Of the remaining patients, 70% (299 of 428) provided full data. All fractures were fixed using reamed (298 of 299) or unreamed (1 of 299) intramedullary nailing. Thus, we excluded the sole fracture fixed using unreamed intramedullary nailing. The co-primary study outcomes of the TRUST trial were time to radiographic healing and SF-36 physical component summary (SF-36 PCS) scores at 1-year. SF-36 PCS scores range from 0 to 100, with higher scores being better, and the minimum clinically important difference (MCID) is 5 points. In this secondary analysis, based on clinical and biological rationale, we selected factors that may be associated with physical functioning as measured by SF-36 PCS scores. All selected factors were inserted simultaneously into a multivariate linear regression analysis. After adjusting for potentially confounding factors, such as age, gender, and injury severity, we found that no factor showed an association that exceeded the MCID for physical functioning 1 year after intramedullary nailing for tibial shaft fractures. The independent variables associated with lower physical functioning were current smoking status (mean difference -3.0 [95% confidence interval -5 to -0.5]; p = 0.02), BMI > 30 kg/m2 (mean difference -3.0 [95% CI -5.0 to -0.3]; p = 0.03), and receipt of disability benefits or involvement in litigation, or plans to be (mean difference -3.0 [95% CI -5.0 to -1]; p = 0.007). Patients who were employed (mean difference 4.6 [95% CI 2.0 to 7]; p < 0.001) and those who were advised by their surgeon to partially or fully bear weight postoperatively (mean difference 2.0 [95% CI 0.1 to 4.0]; p = 0.04) were associated with higher physical functioning. Age, gender, fracture severity, and receipt of early physical therapy were not associated with physical functioning at 1-year following surgical fixation. Among patients with tibial fractures, none of the factors we analyzed, including smoking status, receipt of disability benefits or involvement in litigation, or BMI, showed an association with physical functioning that exceeded the MCID. Level III, therapeutic study.