Lower Extremity Physical Function Research Articles

Effects of whole-body vibration training on lower extremity muscle strength and physical function in elderly patients with sarcopenia

ABSTRACT Objectives To investigate the feasibility and benefits of WBV training in enhancing muscle strength and physical performance in older inpatients with sarcopenia. Methods We included 40 patients with sarcopenia (mean age 85 years; age range 80~90 years) and randomly separated into the WBV group or control (CON) group. The WBV group underwent 8 weeks of conventional rehabilitation training combined with WBV, whereas the CON group received 8 weeks of conventional rehabilitation training alone. The primary outcome was maximal isometric muscle strength. The secondary outcomes were the time-up-and-go test (TUGT), the five-times sit-to-stand test (FTSST), the 6-m gait speed test, and the Morse Fall Scale (MFS). Results After an 8-week intervention, only the quadriceps and tibialis anterior muscles in the CON group showed substantial gains in strength. In the WBV group, significant increases were observed in iliopsoas (P<0.05), quadriceps (P<0.01), hamstring(P<0.01), and tibialis anterior muscle (P<0.01) respectively. For all physical performance assessments, improvements were observed in both CON and WBV groups (P<0.05), the improvement in the WBC group was greater than the CON group (P<0.05). However, there was no significant difference in fall risk between the two groups (P>0.05). Conclusion This result highlights a eight weeks of whole-body vibration training can increase the lower-limb muscular strength and physical performance of older inpatients with sarcopenia.

Global knee function rating more strongly influences adolescent athletes that sustain a sports-related surgical ACL re-injury or contralateral ACL injury.

This study evaluated differences between adolescent athletes who sustained a surgical anterior cruciate ligament (ACL) re-injury, or contralateral ACL injury following return to sports bridge programme participation (Group 1) compared to those that did not (Group 2). At 19.9 ± 7 years of age, 198 athletes participated in this study. Groups were compared for time postsurgery, preprogramme and postprogramme Knee Outcome Survey Sports Activity Scale (KOS-SAS) and global rating of knee function (GRKF) during sports activities, postprogramme lower extremity physical function test performance and perceived sports performance compared to preinjury level. By 6.0 ± 3.2 years postsurgery, 11 (5.6%) sustained another ACL injury. Group 1 was younger (17.3 ± 1.7 years vs. 20.1 ± 6.8 years, p < 0.001). Postprogramme re-evaluation revealed that Group 1 had a greater GRKF compared to their programme initiation GRKF than Group 2 (32.6 ± 38 vs. 20.0 ± 23, p = 0.04). Group 1 also had a greater mean preprogramme to postprogramme GRKF change than Group 2 (51.3 ± 31 vs. 35.5 ± 21, p = 0.02) (effect size = 0.73). More Group 1 subjects also had a GRKF difference that exceeded the overall mean than Group 2 (p = 0.04). Group 1 had moderately strong relationships between preprogramme and postprogramme GRKF score change and the postprogramme GRKF score (r = 0.65, p = 0.04) and between preprogramme and postprogramme KOS-SAS score change and postprogramme GRKF score (r = 0.60, p = 0.04). Global rating scores had a stronger influence among adolescent athletes that sustained either surgical ACL re-injury or contralateral ACL injury. Since group physical function and neuromuscular control factors were similar, clinicians need to increase their awareness and understanding of other factors that may influence surgical ACL re-injury or contralateral ACL injury risk. Level III, retrospective cohort study.

Outcomes of the LEAP feasibility trial-A low-threshold, exercise programme with protein supplementation to target frailty and poor physical functioning in people experiencing homelessness and addiction issues.

People experiencing homelessness are more likely to experience poor health with physical functioning deficits and frailty commonly reported. It is not well known how strategies to target physical functioning deficits and frailty work in practice in this group. The primary aim of this study was to explore the feasibility of an exercise intervention with protein supplementation to target physical functioning and frailty in people experiencing homelessness evaluated by recruitment and retention rates, adherence to the exercise sessions and protein supplement, adverse effects, programme feedback and characteristics of non-returners, sporadic and frequent attenders. The secondary aim was to evaluate changes in effectiveness outcomes of grip strength, muscle mass, lower extremity physical function, pain, frailty, and risk of malnutrition. This prospective single-arm study evaluated the feasibility of a 16-week rolling, low-threshold, 'drop-in' once weekly exercise programme with protein supplementation. The main recruitment site was a day-service centre for people who are homeless. Feasibility was assessed by the recruitment and retention rates, adherence to the exercise sessions and protein supplement as well as adverse effects, programme feedback and evaluation of characteristics of non-returners, sporadic (≤50% of available sessions) and frequent attenders (≥50% of available sessions). Effectiveness outcomes included pain (Visual Analogue Scale), physical functioning and performance (hand-grip dynamometry, limb circumference, the Short Physical Performance Battery), frailty (SHARE-FI and Clinical Frailty Scale) and nutritional status (Mini Nutritional Assessment). Thirty-one participants were recruited mean (SD) age 45(16) years. There was a recruitment rate of a median (IQR) of 2(1-3) new participants per week. The retention rate was 45% (n = 14) to the main recruitment site. Adherence to the exercise sessions and nutritional intervention was 90% and 100% respectively. Three adverse events were recorded during 74 interventions over the 16-week programme. The acceptability of the programme was highlighted in participant feedback. Characteristics of frequent returners (≥50%) were older age, female, more stably housed and more stable in addiction. The programme did not induce any changes in effectiveness outcomes. The feasibility of this programme was demonstrated. Overall, the programme was well received with higher retention rates in older participants, females, those more stably housed and those stable in addiction. A higher powered, more intense programme is needed to demonstrate programme effectiveness.

Omega-3 polyunsaturated fatty acids in sarcopenia management: A network meta-analysis of randomized controlled trials.

Sarcopenia frequently occurs with aging and leads to major adverse impacts on activities of daily living and quality of life in elderly individuals. Omega-3 polyunsaturated fatty acid (omega-3 PUFAs) supplements are considered promising therapeutic agents for sarcopenia management; however, the evidence remains inconsistent. We reviewed randomized controlled trials (RCTs) about omega-3 PUFA supplementation in patients with sarcopenia or in those at high risk for sarcopenia. Network meta-analysis (NMA) procedures were conducted using a frequentist model. The primary outcomes were (1) upper-extremity muscle strength and (2) lower-extremity physical function. The NMA of 16 RCTs showed that the high-dose (more than 2.5g/day omega-3 PUFAs) group yielded the greatest improvement in both upper-extremity muscle strength and lower-extremity physical function [compared to placebo/standard care groups, standardized mean difference (SMD)=1.68, 95% confidence interval (95%CI)=0.03-3.33, and SMD=0.73, 95%CI=0.16-1.30, respectively], and the effects were reaffirmed in subgroup analyses of placebo-controlled RCTs or those excluding concurrent resistance training programs. None of the investigated omega-3 PUFAs supplementation was associated with significantly increased skeletal muscle mass, fat mass, or overall body weight. Our findings provide a basis for future large-scale RCTs to investigate the dose effects and clinical application of omega-3 PUFA supplementation in sarcopenia management. TRIAL REGISTRATION: The current study was approved by the Institutional Review Board of the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (TSGHIRB No. B-109-29) and registered in PROSPERO (CRD42022347161).

Segmental extracellular-to-intracellular water resistance ratio and physical function in older adults

ObjectivesThis study aimed to investigate the association between whole-body (WB), arm, and leg extracellular-to-intracellular water resistance (Recw/Ricw) ratios and various physical functions of each segment and muscle mass using segmental multifrequency bioelectrical impedance analysis. MethodsIn total, 988 community-dwelling older adults were included in the analysis. Physical function was assessed using hand grip, 5-repetition sit-to-stand, 5-m habitual walk, Timed Up and Go, and single-leg balance with eyes open tests. Each segmental Recw/Ricw ratio and muscle mass were assessed at 5 and 250 kHz resistances using a segmental multifrequency bioelectrical impedance analysis device. Pearson's correlation between the segmental Recw/Ricw ratio and muscle mass and physical function was calculated, and the difference in correlation coefficients was tested using Bonferroni correction. Multiple linear regression analysis was conducted using physical function as the dependent variable and the segmental Recw/Ricw ratio as the independent variable, adjusting for sex, age, body mass index, and segmental muscle mass. ResultsWB and leg Recw/Ricw ratios were significantly positively correlated with good hand grip performance, gait speed, mobility, balance, and standing power (p < 0.05), after adjusting for sex, age, body mass index, and muscle mass. Furthermore, the leg Recw/Ricw ratio was positively associated with lower extremity physical function compared with WB and arm Recw/Ricw ratios and muscle mass (p < 0.01). Conversely, WB muscle mass was more strongly related to grip strength than WB, arm, and leg Recw/Ricw ratios (p < 0.01). ConclusionsThe Recw/Ricw ratio is useful for identifying older adults with worse physical function. The Recw/Ricw ratio allows for easy and timely screening of older adults with worse physical function in clinical settings.

The Stroke Upper and Lower Extremity Physical Function Measures Were Supported for Score Reliability, Validity, and Administration Efficiency for Patients Poststroke.

The aims of this study were to (1) evaluate the suitability of newly developed items for calibration into 2 item banks for stroke upper extremity (SUE) and stroke lower extremity (SLE) physical function patient-reported outcome measures (PROMs) and (2) assess score reliability and validity and PROM administration efficiency based on computerized adaptive testing (CAT). A retrospective longitudinal study involving patients poststroke who were treated in outpatient rehabilitation clinics responded to 28 and 25 region-specific candidate items addressing tasks related to upper or lower extremity physical function, respectively. Item response theory model assumptions of unidimensionality, local independence, item fit, and presence of differential item functioning were evaluated. CAT-generated scores were assessed for reliability, validity, and administration efficiency, and 10-item short forms were assessed for reliability. Cohorts consisted of 2017 patients with stroke involving the upper extremity and 2107 patients with stroke involving the lower extremity (mean age [SD]: SUE = 62 [14] and SLE = 63 [14]; range = 14-89). Two solutions (SUE: 28-item; SLE: 24-item) supported unidimensionality and fit to the item response theory model, with reliability estimates >0.93 for all administration modes. No items demonstrated differential item functioning. Scores discriminated among multiple patient groups in clinically logical ways, with better outcomes observed for patients who were younger, were male, had less chronicity, and had fewer comorbidities. The SUE and SLE, respectively, had 1% and 0.3% floor effects and 4.3% and 1.1% ceiling effects. Change score effect sizes were 0.5 (SUE) and 0.6 (SLE). Simulated CAT scores required an average of 6 (SUE) and 5.6 (SLE) items (median = 5). The stroke upper extremity and stroke lower extremity PROM scores were reliable, valid, and efficient and had moderate change effect sizes for assessing physical function as perceived by patients poststroke with upper and lower extremity impairments. Scores had negligible floor and acceptable ceiling effects. Based on these results, the stroke PROMs are suitable for research and routine clinical practice. As item response theory-based measures, these PROMs support clinical practice guideline recommendations for the use of outcome measures in neurologic physical therapy and the administration of condition-specific functional questions with low response burden for patients. The 10-item short forms offer a feasible alternative administration mode when CAT administration is not available.

Weight Loss and Exercise Effects on Rate of Torque Development and Physical Function in Overweight Older Women.

Exercise training (EX) and weight loss (WL) improve lower extremity physical function (LEPF) in older overweight women; however, effects on rate of torque development (RTD) are unknown. This study aimed to determine the effects of WL + EX or WL alone on RTD, and relatedly LEPF, in overweight older women. Leg strength was assessed using isokinetic dynamometry, and RTD was calculated (RTD200 = RTD at 200ms, RTDPeak = peak RTD, T2P = time to 1st peak). LEPF was determined via clinical functional tasks. Women (n = 44, 69.1 ± 3.6years, 30.6 ± 4.3kg/m2) completed a 6-month trial in EX + WL or WL groups with similar weight loss (-9.8 ± 4.2%, p > .95). EX + WL had greater improvements in (a) most LEPF tasks (p < .001) and (b) RTD200, compared with WL (36% vs. -16%, p = .031); no other RTD parameters differed. Changes in RTD parameters and LEPF were not related (all p > .05). RTD is responsive to EX but is not associated with LEPF in older women.

Systemic Lupus, Metabolic Syndrome, Cardiac Disease, and Peripheral Artery Disease

Systemic Lupus, Metabolic Syndrome, Cardiac Disease, and Peripheral Artery Disease

Self-reported life-space mobility in the first year after ischemic stroke: longitudinal findings from the MOBITEC-Stroke project

BackgroundLife-space mobility is defined as the size of the area in which a person moves about within a specified period of time. Our study aimed to characterize life-space mobility, identify factors associated with its course, and detect typical trajectories in the first year after ischemic stroke.MethodsMOBITEC-Stroke (ISRCTN85999967; 13/08/2020) was a cohort study with assessments performed 3, 6, 9 and 12 months after stroke onset. We applied linear mixed effects models (LMMs) with life-space mobility (Life-Space Assessment; LSA) as outcome and time point, sex, age, pre-stroke mobility limitation, stroke severity (National Institutes of Health Stroke Scale; NIHSS), modified Rankin Scale, comorbidities, neighborhood characteristics, availability of a car, Falls Efficacy Scale-International (FES-I), and lower extremity physical function (log-transformed timed up-and-go; TUG) as independent variables. We elucidated typical trajectories of LSA by latent class growth analysis (LCGA) and performed univariate tests for differences between classes.ResultsIn 59 participants (mean age 71.6, SD 10.0 years; 33.9% women), mean LSA at 3 months was 69.3 (SD 27.3). LMMs revealed evidence (p ≤ 0.05) that pre-stroke mobility limitation, NIHSS, comorbidities, and FES-I were independently associated with the course of LSA; there was no evidence for a significant effect of time point. LCGA revealed three classes: “low stable”, “average stable”, and “high increasing”. Classes differed with regard to LSA starting value, pre-stroke mobility limitation, FES-I, and log-transformed TUG time.ConclusionRoutinely assessing LSA starting value, pre-stroke mobility limitation, and FES-I may help clinicians identify patients at increased risk of failure to improve LSA.

Physical function across the lifespan in adults with multiple sclerosis: An application of the Short Physical Performance Battery.

Multiple sclerosis (MS) typically has its onset in early and middle adulthood, but the population is steadily becoming more dominated by older adults. One of the primary consequences of both MS and aging involves declines of lower extremity physical function and mobility. This cross-sectional study compared physical function status based on Short Physical Performance Battery (SPPB) summary and component scores between persons with MS and healthy controls across 6 age groups. We further examined associations between SPPB summary scores and component scores as well as associations between summary scores and measures of physical and cognitive function for identifying the strongest correlates of SPPB summary scores. The study involved secondary analysis of cross-sectional data from multiple studies. Ambulatory adults with MS who were relapse-free for the last 30 days were recruited, and controls were recruited based on similar criteria to adults with MS except without the diagnosis of MS or relapses. The sample of 345 persons with MS and 174 controls completed questionnaires regarding demographic and clinical information and underwent assessments of physical and cognitive function including the SPPB, 6-Minute Walk, Timed 25-Foot Walk, Symbol Digit Modalities Test, California Verbal Learning Test-Second Edition, and Brief Visuospatial Memory Test-Revised. The two-way ANOVA indicated a main effect of MS status (F(5,500)=34.74, p<.01, η2=0.065), a main effect of age (F(1,500)=3.88, p<.01, η2=0.037), and no MS status by age interaction (F(5,500)=1.20, p=.31, η2=0.012) on SPPB scores. The bivariate correlation analysis indicated that summary SPPB scores were associated with component SPPB scores in the overall samples of persons with MS (rs=0.71 to 0.83) and controls (rs=0.42 to 0.91) as well as within most age groups of MS (rs=0.63 to 0.91) and controls (rs=0.34 to 1.00). The associations between SPPB scores and physical function outcomes were larger in the sample of persons with MS (rs=-0.72 to 0.76) than controls (rs=-0.47 to 0.48). SPPB scores were further significantly associated with scores on cognitive outcomes in persons with MS (rs=0.31 to 0.43), whereas these associations were weaker in controls (rs=0.09 to 0.32). Overall, the associations between SPPB scores and physical function outcomes were stronger than the associations between SPPB scores and cognitive function outcomes. Overall, MS status and aging have additive effects on physical function, and the summary SPPB score may be driven by a specific component within each age group. SPPB scores may be driven more by mobility rather than cognition, and are consistent with cognitive-motor coupling in MS. The novelty of this study provides evidence of worsening physical function based on the application of the SPPB and its scores across the lifespan in persons with MS and controls, and this has important implications particularly given the increasing prevalence of older adults with MS.

A study to explore the role of a low threshold, fitness focussed physical rehabilitation intervention with protein supplementation to target physical function and frailty in people with problematic substance use and homelessness: protocol for a single-arm feasibility cohort study.

Background: People who are homeless are more likely to experience poor mental health and addiction as well as suffering from non-communicable diseases. There is evidence of frailty and accelerated physical ageing among people experiencing homelessness. Appropriate physical rehabilitation and nutritional supplementation strategies can stabilise or reverse frailty and general physical decline, but it is not known how this type of intervention would work in practice in this population. Aim: To evaluate the feasibility and preliminary efficacy of a low threshold physical rehabilitation intervention with protein supplementation to target physical functioning and frailty in people with problematic substance use who are experiencing homelessness. Methods: The intervention will consist of a 12-week low threshold rehabilitation programme with protein supplementation. Participants will be service users of the Ballyfermot Advance Project, a day services centre for people with addiction issues and experiencing homelessness. Primary outcomes will be feasibility including numbers recruited, retention of participants and number of repeat visits. Any adverse events will be recorded. Secondary outcomes will be strength and muscular mass, physical performance and lower extremity physical function, pain, frailty and nutritional status. Discussion: An immediate impact may be simply a distraction from difficult circumstances and potentially an improvement of physical health of participants, which can be a conduit for the emergence of other positive behaviours and recovery. Longer term, this study will generate preliminary data on which to inform the design of a definitive randomised controlled trial of physical rehabilitation and protein supplementation, if indicated. Ethics and dissemination: Ethical approval was granted by the Faculty of Health Sciences Research Ethics Committee in TCD. Study findings will be disseminated through publication into an international peer-reviewed journal and presented at national and international conferences.

Association Between Contrast Sensitivity and Physical Function in Cognitively Healthy Older Adults: The Brain Networks and Mobility Function Study.

To evaluate whether contrast sensitivity is associated with lower extremity physical function in cognitively intact older adults. Cross-sectional analysis of the relationship of binocular and worse eye log contrast sensitivity (LCS) to expanded Short Physical Performance Battery (eSPPB) and its components (gait speed, narrow walking speed, chair stand pace, and balance) in 192 cognitively healthy older adults. The association of LCS with postural sway and gait was also tested with tasks that further challenged functional reserve. Mean age was 76.4 years with 56% identifying as female and over 98.5% having good corrected visual acuity. Lower LCS was significantly associated with worse performance on the eSPPB, 4-M gait speed, narrow walking speed, and balance time in unadjusted and adjusted models. The relationship between worse eye LCS and larger postural sway was 3 times greater on a foam surface (beta 1.07, 95% CI [0.35, 1.80]) than a firm surface (beta 0.35, 95% CI [0.05, 0.65]), and both were robust to adjustment for confounders; similar findings were observed with binocular LCS. Lower binocular LCS had a greater decremental effect on gait velocity during the fast pace (beta -0.58, 95% CI [-0.90, -0.27]) than the usual pace (Beta -0.39 [-0.63, -0.15]) gait task. These findings suggest that cognitively unimpaired older adults without significant visual acuity impairment can have subtle preclinical deficits in contrast sensitivity and physical function that could place them at risk of mobility and balance issues. Future studies should determine whether this subset of older adults may benefit from targeted intervention to prevent disability.

Associations of the Short Physical Performance Battery (SPPB) with Adverse Health Outcomes in Older Adults: A 14-Year Follow-Up from the English Longitudinal Study of Ageing (ELSA)

The Short Physical Performance Battery (SPPB) is an objective tool for evaluating three domains (balance, repeated chair stands, and gait speed) of lower extremity physical function in older age. It is unclear how the associations between SPPB scores and health outcomes persist over time. The aim of this 14-year cohort study was to investigate associations between SPPB scores and health outcomes among participants aged 60+ years in the English Longitudinal Study of Ageing (ELSA). The exposures were SPPB scores (total and domain-specific) at baseline (Wave 2). The outcomes were mobility impairments, difficulties in performing basic activities of daily living (ADL) or instrumental activities of daily living (IADL), and falls, measured at seven subsequent timepoints (Waves 3 to 9). The analyses involved linear and logistic multilevel regressions. After adjusting for potential confounders, a one-point increase in the total SPPB score was associated with a 0.13 (95% CI: -0.16, -0.10) decrease in mobility impairment, a 0.06 (-0.08, -0.05) decrease in ADL disabilities, a 0.06 (-0.07, -0.04) decrease in IADL disabilities, and 8% (0.90, 0.95) lower odds of falling (averaged across all follow-ups). Associations between the SPPB domains and health outcomes were more varied. The SPPB may be a useful measure for identifying older adults at a high risk of adverse outcomes.

Relationship of self-reported and performance-based visual function with performance-based measures of physical function: the Health ABC study.

To assess the relationship between self-reported and performance-based visual impairment (VI) and lower extremity physical function. Cross-sectional analysis of 2219 Health ABC participants who completed vision testing and the Short Physical Performance Battery (SPPB). Linear regression models used either self-reported (weighted visual function question (VFQ) score)) or performance-based (visual acuity (VA), log contrast sensitivity (LCS), Frisby stereoacuity (SA)) to predict SPPB or its components-gait speed, chair stands, or standing balance-with and without covariate adjustment. Mean age was 73.5 years (range 69-80); 52.4% were female and 37.4% African American. All VI measures were strongly associated with SPPB in unadjusted and adjusted models (p<0.001). A self-reported VFQ score 1 standard deviation lower than the mean (mean 87.8 out of 100) demonstrated a -0.241(95% CI:-0.325, -0.156) adjusted difference in SPPB. After controlling for covariates, VA of <20/40 (41%) demonstrated a -0.496(-0.660, -0.331) lower SPPB score while SA score>85 arcsec (30%) had a -0.449(-0.627, -0.271) adjusted SPPB score versus those with better visual function. LCS<1.55 (28.6%) was associated with a -0.759(-0.938, -0.579) lower and LCS≤1.30 (8%) with a -1.216(-1.515, -0.918) lower adjusted SPPB score relative to better LCS. In a final multivariable model containing multiple vision measures, LCS remained independently associated with SPPB and all components, while SA remained associated with balance (all p<0.05). Both self-reported and performance-based VI are strongly associated with poor lower extremity physical function. These findings may identify a subgroup of older adults with co-existing visual and physical dysfunction who may benefit from targeted screening and intervention to prevent disability.

Physical Functional Impairment and the Risk of Incident Mild Cognitive Impairment in an Observational Study of World Trade Center Responders.

Posttraumatic stress disorder (PTSD) has been linked to increased risk of cognitive dysfunction and physical functional impairment (PFI). The objective of this prospective cohort study was to examine whether PFI was associated with increased risk of incident mild cognitive impairment (MCI) among World Trade Center (WTC) responders with PTSD. We hypothesized that responders with PTSD would have an elevated risk of incident MCI and that PFI would mediate this increase. We examined responder participants in the WTC Aging Study whose baseline physical assessments were completed by May 2016-April 2017 and were followed up at least once before December 2019. Those without complete demographic, medical, or behavioral data were excluded. PFI was assessed using measures of upper body strength (maximal handgrip strength [HGS]) and lower extremity physical functioning (Short Physical Performance Battery). PTSD was rated using a diagnostic interview and symptom checklist; MCI and dementia were assessed using the Montreal Cognitive Assessment and diagnosed using the National Institute on Aging-Alzheimer's Association criteria. Group differences and longitudinal comparisons were examined. Cox proportional hazards models were evaluated from time to incident MCI and conversion to dementia. A mediation analysis examined whether PFI mediated associations between PTSD and MCI. Within the sample of 2,687 WTC responders, 324 (12.06%, 95% CI = [10.83-13.29]) had lower extremity PFI. Responders with lower extremity PFI were older, had lower education and higher body mass, and were at a higher risk of pulmonary embolisms and PTSD. Responders with lower extremity PFI demonstrated lower baseline cognition and had increased hazards of MCI (multivariable-adjusted hazards ratio [aHR] = 1.55 [95% CI 1.21-1.98]); those with MCI converted to dementia more rapidly than those without PFI (2.73 [1.38-5.39] p = 0.004). In addition, each standard deviation decrease in HGS was associated with increased hazards of developing MCI (aHR = 1.35 [95% CI 1.10-1.66]). A mediation model suggested PFI played an intermediary role in the relationship between PTSD and MCI. WTC responders with PFI demonstrated worse cognitive and behavioral outcomes, and PFI played an intermediary role in the relationship between PTSD and incident MCI, suggesting that PFI may be an early indicator of MCI in responders with PTSD. Regular monitoring of PFI should be considered among PTSD populations.

Sedentary Behavior and Lower-Extremity Physical Function across the Lifespan of Adults with Multiple Sclerosis.

One outcome of aging with multiple sclerosis (MS) involves the decline in physical function, including compromised balance, reduced walking speed, and lower-extremity strength. Sedentary behavior, the other end of the activity continuum, may be targeted for improvements in physical function among adults with MS, but less is known about the relationship between sedentary behavior and physical function with increasing age in MS. This study examined the associations between device-measured volume and pattern of sedentary behavior and physical function based on SPPB (Short Physical Performance Battery) of ambulatory persons with MS across the lifespan. We categorized participants (N = 216) into young (20–39 years), middle-aged (40–59 years), and older (60–79 years) age groups. Participants completed the SPPB during a single visit to the laboratory and wore an accelerometer for a 7-day period. The one-way analysis of variance indicated no differences in volume and pattern of sedentary behavior among the three age groups, except for average sedentary bout length. Spearman bivariate correlations indicated that pattern, but not volume, of sedentary behavior was associated with physical function in young, middle-aged, and older adults, and the magnitude of these associations varied by age group. Future interventions may reduce and break up prolonged periods of sedentary behavior for improvements in physical function and possibly other consequences in persons with MS.

Power, Strength, And Physical Function: A Prospective Study Examining All-cause Mortality

Functional capacity has traditionally been the primary fitness characteristic studied when examining mortality. With the advent of a variety of muscle strengthening protocols becoming more popular since the turn of the century, the potential role of muscular strength and physical function is now being examined in respect to mortality. PURPOSE: Examine the associations between lower extremity muscular power, muscular strength, physical function and all-cause mortality in a nationally representative sample over U.S adults. METHODS: The study sample (2,631) included participants (≥50 years of age) from the 1999-2002 National Health and Nutrition Examination Survey. The primary independent variables in this study included: time to peak force in seconds (TPFs); peak force in newtons (strength)(PF-N); time to complete a 20-foot walk in seconds(TTCWs). Weighted quartiles (Q) of TPFs, PF-N, and TTCWs were created. The primary dependent variable in this study was all-cause mortality. Cox-proportional hazard models were used for all analyses, adjusting for age, gender, race-ethnicity, education, self-reported smoking, cardiovascular disease, stroke, chronic obstructive pulmonary disease, hypertension, self-reported diabetes, and waist circumference. Quartile 1 (Q1) served as the referent group for analysis with PF-N. Quartile 4 (Q4) served as the reference groups for analyses with TPFs and TTCWs. RESULTS: A dose-response relationship was found for quartiles of increasing PF-N ([Q2: 0.59, 95% CI 0.52-0.68], [Q3: HR 0.48, 95% CI 0.37-0.60], and [Q4: HR 0.32, 95% CI 0.23-0.46]) and decreasing TTCWs ([Q3: HR 0.64, 95% CI 0.53-0.76]), [Q2: HR 0.58, 95% CI 0.46-0.74], [Q1: 0.35, 95% CI 0.26-0.47]). No significant associations were found for TPFs. CONCLUSIONS:Greater PF-N and lower TTCWs time were associated with significantly lower risk for all-cause mortality. Future research should examine the role of upper and lower extremity muscular strength and physical function in predicting all-cause and disease specific mortality.

Weight Loss And Exercise Effects On Torque Development And Physical Function In Overweight Older Women

PURPOSE: Obesity negatively impacts lower extremity physical function [LEPF] and is associated with loss of independent living in part due to reduced muscle quality and capacity, especially in older women. Concurrent exercise/physical activity and weight loss interventions have been shown to improve LEPF. However, the inclusion of power modulations, specifically rate of torque development [RTD] parameters in response to these interventions has not been investigated. The aim of this study was to determine the effects of weight loss, with or without exercise training, on RTD parameters and their potential impact on LEPF in overweight physically inactive older women. METHODS: This project involved a secondary data analysis from a 6-month parent project that involved weight loss involving different dietary regimens with or without exercise. Overweight inactive postmenopausal women (n = 44, 69.1 ± 3.6 yrs; 30.6 ± 4.3 kg/m2) completed the trial within two groups: 1) exercise and weight loss [EX+WL; (N = 30)] and weight loss alone [WL; (N = 14)]. Knee flexor and extensor strength and power were assessed via a maximum voluntary contraction [MVIC] using an isokinetic dynamometry with RTD parameters [RTD200 = RTD at 200 ms, RTDPeak = Peak RTD and T2P = Time to 1st Peak]. LEPF was assessed via 6-min walk, 8-ft up and go, and 30-s chair stand. RESULTS: Weight loss was similar in the groups (-7.1 ± 4.1 kg; -9.8 ± 4.2%, p > 0.95) whereas EX+WL had greater improvements in most LEPF tasks (p < 0.001). EX+WL had a greater increase in RTD200 Flexion compared with WL (36% vs. -16%, p = 0.031), with no other differences in RTD parameters observed. No significant regression models were observed predicting change in LEPF performance from changes in RTD parameters (all p > 0.05). CONCLUSIONS: These findings suggest weight loss, which incorporates exercise training, can improve LEPF and rate of torque development in overweight/obese physically inactive older women, yet these improvements do not appear to transfer to improvements in physical function task performance

Red cell distribution width, anemia, and lower-extremity physical function among rural-dwelling older adults

BackgroundElevated red cell distribution width (RDW) has been associated with degenerative conditions in aging.AimsWe aimed to evaluate the associations of RDW and anemia with lower-extremity physical function among rural-dwelling older adults.MethodsThis population-based cross-sectional study included 5093 rural residents (age ≥ 60 years, 57.3% women) who participated in the MIND-China Study in Shandong. Data were collected via face-to-face interviews, clinical examinations, and laboratory tests. RDW was categorized according to quartiles and the lower-extremity physical function was assessed using the Short Physical Performance Battery (SPPB),ResultsMultiple linear regression analyses suggested that the fourth quartile of RDW (vs. first quartile) was associated with lower SPPB summary score (β-coefficient – 0.38; 95% CI – 0.58 to – 0.18) and lower scores in balance test (– 0.09; – 0.17 to – 0.01), chair stand test (– 0.17; – 0.27 to – 0.07), and walking speed test (– 0.12; – 0.19 to − 0.05). Anemia was associated with a multiple-adjusted β-coefficient of – 0.34 (– 0.52 to – 0.16) for SPPB summary score. Stratified analysis by anemia showed that there was a linear association between RDW and SPPB in individuals without anemia but a J-shaped association in individuals with anemia.DiscussionThis large-scale population-based study revealed the associations of high RDW and anemia with poor lower-extremity physical function among rural-dwelling Chinese older adults. These findings suggest that an elevated RDW might be a biochemical marker for poor lower-extremity physical function among older adults.ConclusionsAnemia and an elevated RDW are associated with poor performance in lower-extremity physical function among rural-dwelling Chinese older adults.

Effects of home-based leg heat therapy on walking performance in patients with symptomatic peripheral artery disease: a pilot randomized trial.

Few noninvasive therapies currently exist to improve functional capacity in people with lower extremity peripheral artery disease (PAD). The goal of the present study was to test the hypothesis that unsupervised, home-based leg heat therapy (HT) using water-circulating trousers perfused with warm water would improve walking performance in patients with PAD. Patients with symptomatic PAD were randomized into either leg HT (n = 18) or a sham treatment (n = 16). Patients were provided with water-circulating trousers and a portable pump and were asked to apply the therapy daily (7 days/wk, 90 min/session) for 8 wk. The primary study outcome was the change from baseline in 6-min walk distance at 8-wk follow-up. Secondary outcomes included the claudication onset-time, peak walking time, peak pulmonary oxygen consumption and peak blood pressure during a graded treadmill test, resting blood pressure, the ankle-brachial index, postocclusive reactive hyperemia in the calf, cutaneous microvascular reactivity, and perceived quality of life. Of the 34 participants randomized, 29 completed the 8-wk follow-up. The change in 6-min walk distance at the 8-wk follow-up was significantly higher (P = 0.029) in the group exposed to HT than in the sham-treated group (Sham: median: -0.9; 25%, 75% percentiles: -5.8, 14.3; HT: median: 21.3; 25%, 75% percentiles: 10.1, 42.4, P = 0.029). There were no significant differences in secondary outcomes between the HT and sham group at 8-wk follow-up. The results of this pilot study indicate that unsupervised, home-based leg HT is safe, well-tolerated, and elicits a clinically meaningful improvement in walking tolerance in patients with symptomatic PAD.NEW & NOTEWORTHY This is the first sham-controlled trial to examine the effects of home-based leg heat therapy (HT) on walking performance in patients with peripheral artery disease (PAD). We demonstrate that unsupervised HT using water-circulating trousers is safe, well-tolerated, and elicits meaningful changes in walking ability in patients with symptomatic PAD. This home-based treatment option is practical, painless, and may be a feasible adjunctive therapy to counteract the decline in lower extremity physical function in patients with PAD.