Functional Capacity Of Individuals Research Articles

Quality of life and associated factors in patients with chronic Chagas disease.

To evaluate the quality of life (QoL) of patients with Chagas disease (CD) and the association between QoL domains and several clinical, socioeconomic and lifestyle characteristics of this population. Cross-sectional observational study conducted from March 2014 to March 2017 including a total of 361 outpatients followed at Evandro Chagas National Institute of Infectious Disease, Brazil. QoL was assessed using the Portuguese shorter version of the original WHO Quality of Life questionnaire (WHOQOL-BREF). Information about clinical CD presentation, presence of comorbidities, functional class, previous benznidazole treatment, socioeconomic profile and lifestyle was also obtained. Environment and physical domains presented the worst QoL scores, while the social relationship domain presented the highest score. Multivariate regression analysis demonstrated that variables independently associated with QoL were functional class, sex, clinical presentation of CD, sleep duration, schooling, physical activity level, smoking, income per capita and residents by domicile. The low socioeconomic status and the physical limitations imposed by the disease presented an important impact on the QoL reduction among CD patients, especially on environment and physical domains. Strategies to improve QoL among CD patients should be tailored and consider many different variables to maximise improvements not only of patients' physical but also of their mental health.

DUCHENNE MUSCULAR DYSTROPHY - PHYSIOTHERAPY: P.316Utility of ACTIVE workspace volume as a clinically meaningful measure of functional capacity in individuals with neuromuscular disease

ACTIVE, a custom video game, uses a skeletal tracking algorithm to quantify the worskpace volume (WSV) with which a person can interact by reaching and leaning in three dimensions to squish spiders or dig for jewels. ACTIVE evaluates a combination of upper-extremity and proximal muscle function, making it an ideal tool to identify and track impairment across a spectrum of abilities in individuals with neuromuscular disease. This study explored the validity and functional relevance of ACTIVE across a variety of neuromuscular disorders and its ability to measure change as a result of treatment. Three hundred and thirty five individuals with neuromuscular disease including Duchenne muscular dystrophy (n=119), Becker muscular dystrophy (n=41), limb girdle muscular dystrophies (n=113) performed ACTIVE, other traditional assessments of upper extremity and lower extremity function, and self- and parent-reports of function as appropriate at regularly scheduled clinic visits. ACTIVE demonstrated validity by significantly correlating to disease-specific validated outcome measures (Rho= 0.5 - 0.9, p<0.001). ACTIVE also reduced the ceiling and floor effects when compared to traditional scales as ACTIVE measures function on a continuous scale. We explored the minimum clinically important difference in ACTIVE score, drew comparisons to patient reports of function for individual activities of daily living (ADL), and formulated minimal WSV requirements for each ADL. Additionally, ACTIVE was responsive to intervention in a sub-cohort of the DMD group that performed ACTIVE pre and post steroid initiation. ACTIVE is able to quantify functional abilities in patients across ages and diagnoses on a single continuous scale and is responsive to intervention in neuromuscular disease.

Efeito do atendimento em grupo na qualidade de vida e capacidade funcional de pacientes após AVC

INTRODUÇÃO: O Acidente Vascular Cerebral (AVC) é considerado a segunda doença mais incapacitante do mundo, podendo causar diversas sequelas. Nesse sentido, o atendimento fisioterapêutico em grupo se configura como uma estratégia promissora e viável dentro do processo de reabilitação dos indivíduos acometidos. OBJETIVO: Avaliar o nível de qualidade de vida e capacidade funcional antes e após uma intervenção fisioterapêutica em grupo em pacientes com sequelas de AVC. MÉTODOS: Trata-se de uma análise retrospectiva de prontuários, realizada a partir da coleta de dados referentes à capacidade funcional (Índice de Barthel Modificado), e qualidade de vida (EQVE-AVE) de pacientes vítimas de AVC que realizaram um protocolo de atendimento fisioterapêutico em um ambulatório entre setembro de 2016 até agosto de 2017. RESULTADOS: 27 prontuários atenderam aos critérios estabelecidos. No que tange aos resultados referentes à capacidade funcional dos indivíduos, foi possível notar diferença significativa nos itens de: Alimentação; higiene pessoal; banho; vestir-se, além do score total do Índice de Barthel Modificado. Observou-se também melhora significativa em aspectos referentes a qualidade de vida nos seguintes itens: Energia; linguagem; mobilidade; memória/concentração, além do score total da escala de avaliação EQVE-AVE. CONCLUSÃO: Identificou-se melhora no nível de qualidade de vida e capacidade funcional de indivíduos que sofreram AVC após realização de um protocolo de atendimento fisioterapêutico em grupo em um ambulatório.

Physical Activity is Associated with Walking Capacity in Persons with Multiple Sclerosis

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system which affects 1 in 1000 persons in the United States. MS results in functional limitations, including impairments in walking capacity, balance, and increases in overall fatigue, leading to decreased physical activity. However, the potential associations between physical activity, walking ability and functional capacity are not clear in this population. PURPOSE: To evaluate the association between physical activity, walking ability and functional capacity in individuals with MS. METHODS: Fifty-eight individuals with MS between the ages of 18-70 (Male = 15, 47 ± 12 years, BMI = 28.8 ± 6.5, EDSS = 0-4) performed a maximal incremental cycle test to assess peak aerobic capacity (VO2 peak). Subjects completed a timed 25-foot walk test (T25FW), 6 minute walk test (6MW), and wore an accelerometer for one week to determine physical activity. Moderate / vigorous physical activity (MVPA) was defined as >1722 counts per minute. RESULTS: MVPA was correlated with 6MW, T25FW and VO2peak (p<0.05, Table 1). In stepwise regression analyses, MVPA was a stronger predictor of T25FW (β: –0.44, p<0.01) and 6MW (β: 0.48, p<0.01) than VO2peak (β: –0.29, p=0.03; β: 0.32, p<0.01). CONCLUSION: Although both MVPA and VO2 peak provide unique contributions to the prediction of 6MW and T25FW, MVPA is a stronger predictor. These results suggest that improving both physical activity and cardiovascular fitness may improve walking ability in persons with MS.Table: No title available.

Effects of Pulmonary Rehabilitation on Respiratory Muscle Strength and Functional Capacity of Individuals with Chronic Obstructive Pulmonary Disease: Case Report

Chronic obstructive pulmonary disease is a common preventable and treatable disease characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. The objective of this study was to evaluate the effects of a pulmonary rehabilitation program on respiratory muscle strength and functional capacity of individuals with chronic obstructive pulmonary disease. An elderly male patient participated in the pulmonary rehabilitation program and was evaluated before and after intervention. This program consisted of four phases: stretching, aerobic exercises, resistance training and relaxation. The physical activities were provided three times a week on alternate days, for 4 months, totaling 48 sessions. The results obtained after the rehabilitation program showed improvement in the physical functional capacity of the patient measured by the six-minute walk test (Pre=480; Post=540m). The maximal inspiratory pressure values increased (Pre=-60; Post=-120cmH2O) whereas the maximal expiratory pressure values remained the same (Pre=50; Post=50cmH2O). Therefore, the respiratory rehabilitation program has improved functional capacity and inspiratory muscle strength.

Correlation between Exercise Stress Test and Echocardiographic Parameters in Elderly Individuals

Abstract Background: Maximum oxygen consumption (VO2 max) in healthy individuals decreases approximately 10% per decade of life, and such decrease is more pronounced after the seventh decade. Objectives: To assess functional capacity of individuals aged 75 years or older, submitted to ergometric test and transthoracic echocardiogram exam, by means of metabolic equivalent (MET) and VO2 max measurements. Methods: A total of 381 patients (205 women; 79 ± 3.7 years) were evaluated. Exclusion criteria were: presence of left ventricular (LV) systolic [...]

Evaluation of the Glittre-ADL test as an instrument for classifying functional capacity of individuals with cardiovascular diseases

BackgroundThe assessment of functional capacity in individuals with cardiovascular disease is closely related to lower limb function. The Glittre-ADL test is a global test to evaluate this patients. ObjectiveWe aimed to verify whether the Glittre-ADL test discriminates functional status while evaluating individuals with cardiovascular disease. MethodsA total of 42 participants were evaluated using the Glittre-ADL test Incremental Shuttle Walking Test (shuttle test), Human Activity Profile, and Duke Activity Status Index. Data from the shuttle test, Human Activity Profile, and DASI were divided into tertiles for statistical analysis. The time required to complete the Glittre-ADL test was compared among tertiles of the shuttle test, Duke Activity Status Index and Human Activity Profile using analysis of variance. ResultsThere were significant differences between the tertiles of the shuttle test. Tertile 1 was different from tertiles 2 (mean difference, 47.63; 95% CI, 19.86–75.39) and 3 (mean difference, 67.15; 95% CI, 41.25–93.05). For the Duke Activity Status Index there were significant between-group differences. Tertile 1 was different from tertiles 2 (mean difference, 42.45; 95% CI, 8.82–76.09) and 3 (mean difference, 43.56; 95% CI, 13.68–73.44). For the Human Activity Profile there were significant between-group differences. Tertile 3 was different from tertiles 1 (mean difference, 51.46; 95% CI, 21.27–81.64) and 2 (mean difference, 33.01; 95% CI, 3.52–62.51). ConclusionThe Glittre-ADL test is able to discriminate the functional status in individuals with cardiovascular disease, most of whom have hypertension. The Glittre-ADL test was sensitive to discriminate more functionally affected individuals.

Self-rated health and functional capacity in individuals reporting overlapping symptoms of gastroesophageal reflux disease, functional dyspepsia and irritable bowel syndrome - a population based study

BackgroundGastroesophageal reflux disease (GERD), functional dyspepsia (FD) and irritable bowel syndrome (IBS) are common functional gastrointestinal conditions with a significant impact on daily life. The objectives were to analyse general self-rated health and self-reported functional capacity in adults meeting the criteria for GERD, FD and IBS, respectively, and in individuals who meet the criteria for more than one of the conditions.MethodsA nationwide study of 100,000 individuals aged 20 years and above, randomly selected in the general Danish population. A web-based questionnaire survey formed the basis of this study. Questions regarding FD and IBS were extracted from the ROME III adult questionnaire. Questions regarding GERD were developed based on the Montreal definition. Self-rated health and functional capacity was measured by single global questions.ResultsRespondents meeting the criteria for either GERD, FD or IBS have significantly higher odds of reporting poor self-rated health and impaired functional capacity compared to individuals not experiencing these functional gastrointestinal conditions. Furthermore, respondents with overlapping gastrointestinal (GI) symptom complexes have significantly higher odds of reporting poor self-rated health and impaired functional capacity compared to respondents with symptoms compatible with only one of the symptom complexes.ConclusionsThis study demonstrates that individuals experiencing symptoms of GERD, FD or IBS report poor self-rated health as well as impaired functional capacity. The impact on self-rated health and functional capacity is highest among individuals experiencing overlapping symptoms of GERD, FD and IBS.

Effects of Anteroposterior Talus Mobilization on Range of Motion, Pain, and Functional Capacity in Participants With Subacute and Chronic Ankle Injuries: A Controlled Trial

ObjectiveThe purpose of this study was to measure the acute (1 session) and chronic effects (6 sessions) and the follow-up (2 weeks) of anteroposterior articular mobilization of the talus, grade III of Maitland, on the dorsiflexion range of motion (ROM), pain, and functional capacity of individuals with subacute and chronic traumatic injuries of the ankle. MethodsThirty-eight volunteers, men and women, with a mean age of 40.8 years, with subacute and chronic ankle injuries participated. The volunteers were blinded to the study purpose and were allocated into the experimental group (EG) or sham group (SG). Dorsiflexion ROM, pain, and functional capacity were measured using the universal goniometer, visual analog scale, and Foot and Ankle Ability Measure, respectively. Measurements were taken on 4 different occasions: (1) baseline, (2) after the first session, (3) after the sixth session, and (4) at follow-up. Articular anteroposterior mobilization of the talus grade III of Maitland was applied to the EG, whereas manual contact was applied to the SG. Three series of 30 seconds each with a 30-second rest interval between the series were conducted. ResultsSignificant increases in ankle dorsiflexion ROM were observed only for the EG after the first (EG: 9.5 ± 1.1; SG: 7.6 ± 1.1) and sixth (EG: 12.8 ± 1.2; SG: 8.4 ± 1.2) sessions and were maintained at follow-up (EG: 13.2 ± 1.1; SG: 9.3 ± 1.3). Decreases in pain and improvements in functional capacity (FC) were identified for both groups after the first and sixth sessions (Pain, EG: 1.3 ± 0.5; SG: 1.8 ± 0.6 and EG: 0.7 ± 0.3; SG: 0.7 ± 0.3; FC, EG: 64.6 ± 3.5; SG: 67.4 ± 4.4 and EG: 79.9 ± 3.3; SG: 86.2 ± 3.3) and remained at follow-up (Pain, EG: 0.3 ± 0.2; SG: 0.5 ± 0.3; FC, EG: 86.8 ± 2.7; SG: 89.8 ± 3.7). ConclusionArticular grade III mobilization improved ankle dorsiflexion ROM, when compared with the SG. Changes in pain and functional capacity were similar in both groups.

Relationships between self-reported and performance-based measures of functional capacity in individuals with chronic stroke.

[Purpose] The aim of this study was to investigate the associations between self-reported and valid performance-based measures of functional capacity in individuals with chronic stroke. [Subjects and Methods] Self-reported measures of functional capacity of 31 individuals with chronic stroke were assessed by the Duke Activity Status Index scores, whereas performance-based measures were assessed by the distance covered (in meters) and oxygen consumption (relative oxygen consumption, in ml·kg−1·min−1) during the six-minute walking test. [Results] The subjects had a mean age of 58.6±13 years and a mean time since the onset of stroke of 28.3±15.1 months. They had a mean Duke Activity Status Index of 27.3±14.4, mean distance covered of 325.2±140.2 m, and mean relative oxygen consumption of 9.6±2.3 ml·kg−1·min−1. Significant, positive, and moderate to good correlation coefficients were found between the Duke Activity Status Index scores and the distance covered during the six-minute walking test (r=0.68). Significant, positive, and fair associations were also found between the Duke Activity Status Index scores and relative oxygen consumption values obtained during the six-minute walking test (r=0.45). [Conclusion] The findings of the present study support the clinical use of the Duke Activity Status Index as a tool to assist in clinical evaluations of functional capacity of individuals with chronic stroke.

POSTOPERATIVE EFFECT OF PHYSICAL THERAPY RELATED TO FUNCTIONAL CAPACITY AND RESPIRATORY MUSCLE STRENGTH IN PATIENTS SUBMITTED TO BARIATRIC SURGERY.

ABSTRACTBackground: Respiratory physiotherapy plays an important role preventing complications in bariatric surgery. Aim: To assess the effects of out-patient physiotherapy during post-operative period through respiratory pressures and functional capacity in individuals submitted to bariatric surgery. Method: A prospective longitudinal and controlled study was done in adults with body mass index (BMI) equal or greater than 40 kg/m², who have been submitted to bariatric surgery. They were divided into two groups: intervention-group, who performed out-patient physiotherapy twice a week, from thirty to sixty days after surgery; and the control-group, who only followed home instructions. Both groups were evaluated before surgery and sixty days after surgery through manovacuometry, six-minute walk test and the Borg Scale of perceived exertion. Results:Twenty participants were included the intervention-group and twenty-three in the control-group. Both groups had significant and similar weight loss after surgery. The manovacuometry presented no differences comparing pre- and post-surgery and in the comparison between the groups. The result of the six-minute walk test for the intervention-group increased by 10.1% in the post-operative period in relation to pre-. The Borg scale of perceived exertion in the intervention-group in pre-surgery decreased by 13.5% in the post-surgery compared to pre-surgery. In the control-group there was no difference comparing pre- and post-operative values, as in the comparison with the intervention-group. Conclusion: The low-intensity exercise program, carried out between the 30th and the 60th day after bariatric surgery provided better functional capacity; did not change respiratory muscle strength; and improved the perceived exertion rate.

Mitochondrial function in skeletal muscle of patients with protracted critical illness and ICU-acquired weakness.

BackgroundMitochondrial damage occurs in the acute phase of critical illness, followed by activation of mitochondrial biogenesis in survivors. It has been hypothesized that bioenergetics failure of skeletal muscle may contribute to the development of ICU-acquired weakness. The aim of the present study was to determine whether mitochondrial dysfunction persists until protracted phase of critical illness.MethodsIn this single-centre controlled-cohort ex vivo proof-of-concept pilot study, we obtained vastus lateralis biopsies from ventilated patients with ICU-acquired weakness (n = 8) and from age and sex-matched metabolically healthy controls (n = 8). Mitochondrial functional indices were measured in cytosolic context by high-resolution respirometry in tissue homogenates, activities of respiratory complexes by spectrophotometry and individual functional capacities were correlated with concentrations of electron transport chain key subunits from respiratory complexes II, III, IV and V measured by western blot.ResultsThe ability of aerobic ATP synthesis (OXPHOS) was reduced to ~54 % in ICU patients (p<0.01), in correlation with the depletion of complexes III (~38 % of control, p = 0.02) and IV (~26 % of controls, p<0.01) and without signs of mitochondrial uncoupling. When mitochondrial functional indices were adjusted to citrate synthase activity, OXPHOS and the activity of complexes I and IV were not different, whilst the activities of complexes II and III were increased in ICU patients 3-fold (p<0.01) respectively 2-fold (p<0.01).ConclusionsCompared to healthy controls, in ICU patients we have demonstrated a ~50 % reduction of the ability of skeletal muscle to synthetize ATP in mitochondria. We found a depletion of complex III and IV concentrations and relative increases in functional capacities of complex II and glycerol-3-phosphate dehydrogenase/complex III.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-1160-x) contains supplementary material, which is available to authorized users.

Evaluation of functional capacity in individuals with signs and symptoms of musculoskeletal disease: results of the BRAZCO population study (Brazilian COPCORD Study).

The disability caused by the musculoskeletal signs and symptoms affects the quality of life of a population, especially that related to health. The objective of this study is to evaluate the functional capacity of individuals of the Brazilian population who presented musculoskeletal signs and symptoms (MSK-S). The prevalence of MSK-S was evaluated in 5000 individuals (>15 years) in 16 capitals from the five regions of Brazil using the COPCORD Core Questionnaire. Those individuals (n = 2494) that experienced MSK-S and referred some level of disability at the time of the interview were invited to complete the Health Assessment Questionnaire-Disability Index (HAQ-DI). The HAQ-DI scores were compared among regions, and subgroups according to gender, age and type of activity. Three hundred ninety-four (7.9 %) participants reported disability at the time of the interview. The average score of HAQ-DI was 1.09 (SD = 0.71), and the Brazilian region with the highest level of disability was the North region. Among individuals without history of trauma, the disability was higher when the duration of MSK-S was longer. Disability was shown to worsen with increasing age, and the group with 25-34 years showed the lowest scores. Females showed worse functional capacity scores compared to males (p = 0.002). Individuals showed higher degrees of difficulty or were incapable of performing the activities walking, reaching, usual activities and dressing. MSK-S reduce the functional capacity of individuals of the Brazilian general population. The reduction in functional capacity was mainly observed in individuals with chronic musculoskeletal complaints not due to trauma, as well as in female gender and in advancing age.

Does the heel-rise test explain functional capacity in venous insufficiency?

Introduction Individuals with chronic venous insufficiency (CVI) have muscle pump dysfunction and reduced functionality. However, studies are inconsistent in proving whether a particular test can assess muscle functional capacity. Therefore, the aim of this study was to evaluate whether the heel-rise test (HRT) is able to explain functional capacity in patients with CVI. Materials and methods Subjects with CVI aged between 20 and 59 years old were selected for this study. All participants were classified by means of the Clinical Anatomy Etiology Pathophysiology Classification of Chronic Venous Disease (CEAP). The HRT and the shuttle walk test (SWT) were performed. Descriptive statistics, Spearman correlation, linear models and regression variance analysis (one-way ANOVA) were used for data analysis. Significance was set at alpha ≤ 5%. Results 79 subjects were included in the study (38.79 ± 1.34 years). The HRT was able to explain functional capacity only in individuals aged between 50-59 years (R2 = 0.60, p = 0.0001). The heel-rise test was not sensitive to detect differences between the CEAP classes analyzed (p &gt; 0.05). Conclusion The HRT was able to explain functional capacity in individuals aged between 50-59 years, and it can be applied in clinical practice for the functional evaluation of patients with CVI with mild severity in this age range.

Avaliação do impacto do processo de envelhecimento sobre a capacidade funcional de adultos mais velhos fisicamente ativos

Objetivos: Verificar o impacto do processo de envelhecimento sobre a capacidade funcional de adultos mais velhos, fisicamente ativos. Métodos: Vinte e quatro indivíduos com idade acima de 50 anos, fisicamente ativos, realizaram dois testes ergométricos (TE) máximos, cujo intervalo variou entre dois e dez anos (média de 4,013,74 anos). As variáveis analisadas nos dois TEs foram: consumo de oxigênio no pico do esforço (VO2pico), frequência cardíaca pico (FCpico) e índice de massa corporal (IMC). Resultados: Não foi observada diferença estatisticamente significativa nos valores de VO2pico, FCpico e IMC entre o primeiro e o segundo TE, com intervalo médio entre eles de aproximadamente quatro anos. Além disso, não foi identificada nenhuma associação entre o VO2pico e a idade (p&gt;0,05). Conclusão: A capacidade funcional de indivíduos com mais de 50 anos, que se exercitavam regularmente, foi mantida em detrimento ao processo de envelhecimento.

Analysis of Risk Factors Sociodemographic for the Functional Dependence of Adults with Spinal Cord Injury

Objective: To evaluate the odds ratio of risk factors of sociodemographic and functional capacity of adults with spinal cord injury. Methods: Analytical, cross-sectional, quantitative study accomplished with a group of 47 people with spinal cord injury in hospitals and 27 in the household. The data were collected through a structured instrument composed of independent variables related to epidemiological and clinical data on spinal cord injury and dependent variables corresponding to the scale of the Barthel Index (BI). The data were analysed with the two-tailed chi-square or Fisher’s exact tests using the Statistical Package for the Social Sciences version 20.0 (SPSS Inc., USA). Odds ratio (OR) and 95% confidence intervals (CI) were used as an estimate of the risk. The level of significance was set at a p value ≤0.05. Results: It was found that males (OR = 4.804, p = 0.041), the education less than ten years (OR = 3.000, p = 0.036), the hospital care (OR = 5.250, p = 0.002) and injury time less than six months (OR = 5.250, p = 0.002) are sociodemographic factors that are associated with the functional capacity of individuals with spinal cord injury. Moreover, the total dependence (p < 0.001) and severe dependence (p = 0.019) are associated with quadricplegia. It was found that males (p = 0.041), the education less than ten years (p = 0.036), attention to hospital health (p = 0.002) and minor injury time less than six months (p = 0.002) are sociode-mographic factors associated with functional capacity of subjects. Conclusion: As a result, it was found that knowing the epidemiological and clinical factors of people with spinal cord injury is relevant to plan the nursing care. In other words, knowing the epidemiological and clinical factors of people with spinal cord injury is relevant to achieve the functional independence of these people, and it was demonstrated that the social determinants of health are interrelated and interdependent of chronic health conditions, as evidenced by the Care Model for Chronic Conditions.

Effects of COMT genotype on cognitive ability and functional capacity in individuals with schizophrenia

Cognitive and functional impairments are core features of schizophrenia. This study examined the catechol-O-methyltransferase (COMT) genotype and its relationship to cognition and functional capacity in 188 individuals with schizophrenia or schizoaffective disorder. We found that in a dose–response fashion, individuals with more Met alleles performed significantly better on tests of learning/memory and abstraction. The effects of COMT genotype on cognition were modest, explaining about 3% of the variance in learning/memory and abstraction. Larger studies will be needed to examine the relationships between COMT and other genes and cognitive performance and everyday functioning.

Neurocognitive predictors of performance‐based functional capacity in bipolar disorder

Neurocognitive impairment can predict functional capacity in individuals with bipolar disorder, though little research has examined whether different neurocognitive domains impact specific types of tasks. This study examined the relationship between several neurocognitive variables and the UCSD Performance-Based Skills Assessment (UPSA; Patterson etal., 2011) to identify the domains and tests that best predict the performance across the subscales. Forty-seven euthymic participants who were diagnosed with either Bipolar I or Bipolar II were recruited and assessed on a battery of neuropsychological measures and the UPSA. Correlational and regression analyses were run to identify neurocognitive predictors of UPSA subscales. Per the literature, verbal learning and memory and executive function composites were first examined. Verbal learning and memory predicted the Communication subscale and Total score variables above and beyond the estimated FSIQ and symptom rating scales. In a secondary exploratory analysis, the Benton Judgment of Line Orientation subtest predicted the Finance subscale while the California Verbal Learning Test predicted the UPSA total score. Verbal learning and memory emerged as the strongest predictor of functional capacity, suggesting that this domain should be investigated in future mediational and longitudinal studies with the UPSA.

Community-based Exercise Programs as a Strategy to Optimize Function in Chronic Disease

Chronic diseases are the leading cause of death and disability worldwide. Preliminary evidence suggests that community-based exercise (CBE) improves functional capacity (FC) and health-related quality of life (HRQL). To describe the structure and delivery of CBE programs for chronic disease populations and compare their impact on FC and HRQL to standard care. Randomized trials examining CBE programs for individuals with stroke, chronic obstructive pulmonary disease, osteoarthritis, diabetes, and cardiovascular disease were identified. Quality was assessed using the Cochrane risk of bias tool. Meta-analyses were conducted using Review Manager 5.1. The protocol was registered on PROSPERO (CRD42012002786). Sixteen studies (2198 individuals, mean age 66.8±4.9 y) were included to describe program structures, which were comparable in their design and components, irrespective of the chronic disease. Aerobic exercise and resistance training were the primary interventions in 85% of studies. Nine studies were included in the meta-analysis. The weighted mean difference for FC, evaluated using the 6-minute walk test, was 41.7 m (95% confidence interval [CI], 20.5-62.8). The standardized mean difference for all FC measures was 0.18 (95% CI, 0.05-0.3). The standardized mean difference for the physical component of HRQL measures was 0.21 (95% CI, 0.05-0.4) and 0.38 (95% CI, 0.04-0.7) for the total score. CBE programs across chronic disease populations have similar structures. These programs appear superior to standard care with respect to optimizing FC and HRQL in individuals with osteoarthritis; however, the effect beyond this population is unknown. Long-term sustainability of these programs remains to be established.

Managing the working body: active ageing and limits to the ‘flexible’ firm

ABSTRACTWorkforce ageing is considered in the context of four Australian employing organisations which are each in the process of change. In these organisations, perceptions regarding the relationship between the declining body and productivity led to a depreciation of the value of older workers and their consignment to less productive edges of organisations. While this was viewed as benefiting older workers, it was also acknowledged that workforce ageing will place severe constraints on the use of such practices, already regarded with suspicion by operational managers responsible for cost containment. Policies which aim to restrain biological and psychological decline, by supporting individual functional capacity and health, workplace design and ergonomics and developing the work community are advocated.