Subjective Physical Functioning Research Articles

Abstract B068: Physical function and fitness of African American prostate cancer survivors at baseline of Men Moving Forward, a lifestyle intervention program

Abstract Background: Prostate cancer (PC) is the most commonly diagnosed cancer in American men with 1 in 8 men diagnosed in their lifetime. African American men have the highest rates of incidence and mortality for PC in the USA, due to a myriad of socio-biological factors. Fortunately, given advances in screening and treatment options the survival rate of PC is high with a 97% 5-year survival rate. However, PC treatments can cause muscle atrophy and reduced physical functioning and quality of life (QoL). Physical function and strength can serve as proxy measurements for cellular aging, longevity, and QoL. Handgrip is related to overall strength, upper limb function, bone mineral density, and mortality. Sit-to-stand measures leg strength and endurance and is used to evaluate fall risk. The 6-minute walk test (6MW) is used to assess aerobic capacity. Men Moving Forward (MMF) is one of the first community-based lifestyle programs developed with and for African American Prostate Cancer Survivors (AAPCS). This study examines objective and subjective physical function of MMF participants at baseline. Methods: MMF is a randomized, wait-list control trial with a 16-week group-based lifestyle intervention focused on physical activity, nutrition and QoL, led by local health coaches. Participants complete physical assessments and surveys at baseline, post-intervention and 12 months. Physical assessments consist of a blood draw, DXA scan, anthropometric measurements, handgrip strength, 30-second sit-to-stand, and 6MW (added with second cohort). Participants also answer surveys on their health and physical function. Pearson’s correlation was used to assess linear correlation between fitness measures and self-reported physical function. Results: At baseline, 100 AAPCS completed both the physical assessment and survey. Participants had a mean age of 65.8 ± 7.26 years, 49% were married/living with a partner, 47.6% were retired, and education levels varied. Top comorbidities include hypertension, obesity, diabetes, and hypercholesterolemia. Mean hand grip scores were 39.8 ± 7.5kg for right and 38.4 ± 7.7kg for left. Handgrip scores 28.2-44.0kg for men aged 64-69 are considered normal. Mean sit-to-stand (n=96) was 12.2 ± 4.3 reps in 30 seconds. Since 6MW was added later in the study, 68 men completed with a mean score of 0.42 ± 0.10 km. Normal ranges for men aged 65-69 is 15 reps for sit-to-stand and 0.572km for 6MW. 50% of participants rated their overall health as “good”, 21% as “very good”, and 20% as “fair” on a five-point Likert scale. PROMIS physical function measures had an average of 50.3 ± 7.3 for men at baseline. PROMIS physical function was weakly correlated with 6MW and sit-to-stand with r = 0.34, p-value=0.004 and r = 0.27, p- value=0.009, respectively. Conclusion: Data reflect the value of supporting AAPCS in lifestyle changes to improve physical function. Few efforts have addressed lifestyle among AAPCS, despite high prostate cancer burden. Future reports will examine the efficacy of MMF in improving physical function, overall health, and QoL. Citation Format: Margaret Y. Tovar, Iwalola Awoyinka, Patricia Sheean, Paula Papanek, Toni Uhrich, Sandra Contreras, Meheret Gebreegziabher, Estefania Alonso, Jayme Ewens, Shannon Reed, Diana Navarro Suarez, Kathleen O'Connell, Kathryn Flynn, Kathryn Bylow, Deepak Kilari, Melinda Stolley. Physical function and fitness of African American prostate cancer survivors at baseline of Men Moving Forward, a lifestyle intervention program [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B068.

Bodily sensations and quality of life in adolescents with non-cardiac chest pain: a comparative study for the undetermined part of a frequent health problem.

Chest pain in adolescents represents a considerable burden for health services and is rarely associated with cardiac disease. Since chest pain could be related to psychosocial factors there is a need for exploring the relationships among stressful situations, drug consumption, suicidal behaviors, accompanying bodily symptoms and health-related quality of life in adolescents with non-cardiac chest pain. In this study, we assessed these determinants in 108 adolescents with non-cardiac chest pain (NCCP) and a control group of 77 patients using a structured interview applied to the patients presented to the cardiology outpatient clinics of Tepecik Training and Research Hospital, İzmir, Türkiye, between 30 October 2018 and 30 June 2019. After the interview, the adolescents were given a self-administered pediatric quality of life inventory and the body sensations questionnaire for assessing aspects of fear. Adolescents with NCCP expressed more panic associated bodily symptoms and reported worse subjective physical, academic, and emotional functioning in addition to more suicidal ideation. NCCP could be accepted as a warning sign of an underlying psychosocial problem and requires a more interdisciplinary collaborative care by pediatricians, psychologists, and psychiatrists.

Association between subjective physical function and occurrence of new fractures in older adults: A retrospective cohort study.

The Late-Stage Elderly Questionnaire has been incorporated into health assessments for older adults in Japan, encompassing three self-administered questions on subjective physical function: subjective gait speed decline, recent fall history, and exercise habits. Nevertheless, its efficacy in predicting new fracture occurrences remains uncertain. This retrospective cohort study utilized Japan's DeSC database, a large commercially available claims database. Participants were older adults aged ≥75 years and provided complete responses to the Late-Stage Elderly Questionnaire at health check-ups. We performed two Cox regression analyses for new fractures based on the responses to the three questions (Model 1) and on age, sex, and responses to the three questions (Model 2). The predictive abilities of the 1-year occurrence of new fractures were compared between the two models. Of 11 683 eligible older adults, 927 (7.93%) experienced new fractures. Model 1 revealed significant associations between new fractures and subjective gait speed decline (hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.40-1.89), recent fall history (HR, 2.03; 95% CI, 1.77-2.33), and absence of exercise habits (HR, 1.29; 95% CI, 1.13-1.47). Model 2 demonstrated superior predictive ability (area under the curve, 0.677; 95% CI, 0.659-0.695) compared with Model 1 (area under the curve, 0.633; 95% CI, 0.614-0.652), with a net reclassification improvement of 0.383 (95% CI, 0.317-0.449). Three subjective physical well-being factors were significantly associated with new fracture development in older adults. These results suggest that the three-question assessment may be a valuable screening tool for identifying new fractures. Geriatr Gerontol Int 2024; 24: 337-343.

Changes in Health-Related Quality of Life, Pain and Functional Parameters in People with Hemophilia and People with Osteoarthritis - a Comparative Follow-up of Physiotherapeutic Training (Physio-FUN Study)

Background: Spontaneous joint bleeding is common in people with hemophilia (PWH). These bleeds lead to reduced physical activity and thus to a weakening of the musculature. Common sequelae of this are synovitis and cartilage damage. In the long term, secondary osteoarthritis, so-called hemophilic arthropathy, occurs with changes and progressive destruction of joint structures (Lafeber et al., 2008). Hemophilic arthropathy is age-independent and can lead to severe movement restrictions and significant limitations in health-related quality of life (HRQoL) of affected PWH (Varaklioti et al., 2018). To prevent advanced stages of arthropathy not only regular assessment of musculoskeletal status and early detection of symptoms, but also daily rehabilitation exercises at home, and implementation of appropriate physiotherapy and medical training are important (Bossard et al., 2008). Home exercises and manual therapy can be used without causing bleeding or pain to improve pain, HRQoL and functionality (Tat et al., 2021). The primary aim of the Physio-FUN study was to assess the subjective (Hemophilia Exercise Project Test-Questionnaire [HEP-Test-Q]) and objective physical functioning (Hemophilia Joint Health Score [HJHS]) during the course of 1-year applied physiotherapy comparing PWH with arthropathy and patients with osteoarthritis (PWO). Methods: In this prospevtive, controlled monocentric cohort study it was planned to enroll 20 adult PWH A or B compared to 20 gender-matched adult PWO without a bleeding disorder. Patients with a blood pressure ≥ 180/110 mmHg were excluded. A positive ethical approval for the study was obtained by the Ethics Committee North Rhine, Germany. After informed consent had been obtained, the study participants underwent examinations based on clinician-reported outcomes (ClinRO) and performance outcomes (PerfO) and completed different patient-reported outcomes (PROs). ClinROs included ultrasound, functional movement screen (FMS) and the collection of anthropometric and clinical data; PerfOs included cardiopulmonary performance, 6-minute walk test (6MWT), blood pressure measurement before and after 6MWT, joint mobility (neutral-zero method) and Functional Movement Screen (FMS) to evaluate movement pattern quality; PROs included the assessment of sociodemographic data, HRQoL (SF-12), Physical Activity Questions (EPIC - Simple Index), pain sensation scale (SES) and Borg Rating of Perceived Exertion (RPE) measuring physical activity intensity level. All patients took part in regular physiotherapy (once a week) at the ARZD as prescribed by a physician. During the study, PWH continued to receive their usual hemophilia treatment regimen without study-related changes. Over a period of 12 months, ClinROs, PerfOs and PROs were collected repeatedly on a quarterly basis. Each patient was supposed to participate in 5 measure points (baseline, every 12 weeks over a one-year period). Ultrasound examinations were performed at baseline and at the conclusion at MZP5 in all patients. Results: At baseline 17 PWH (mean age 43.29±13.1 years) and 12 PWO (mean age 61.42±8.5 years) were enrolled; most PWH had HA (88.2%) were severely affected (58.8%) and 6/17 had a knee endoprosthesis. 88.2% of PWH had a disabled card (most with a disability degree of ≥ 80) compared to 45.5% of PWO (most with a disability degree of 50). PWH had a significant worse orthopaedic joint status ( p<.002) and subjective physical functioning ( p<.001) compared to PWO; PWH had a mean HJHS of 26.76±18.0 vs. 11.0±5.7 and a mean HEP-Test-Q of 48.12±16.4 vs. 67.08±9.1. PWO reported highest impairments in the domain ‘mobility’, while PWH suffered mainly under reduced ‘endurance’. With respect to their age, height and weight most of the PWH were below the predicted lower limit of the 6MWD compared to the PWO who all were above the lower limit of the 6MWD. No difference was found between the groups regarding FMS (11.34±3.8) and RPE before (11.5±3.3) after 6MWT (11.5±3.3). Conclusions: Our study took place during the Corona pandemic and was quite time consuming for the participants, resulting in a failure to reach the desired number of cases and lead to a high drop-out rate over the duration of the project. Although PWH were significantly younger than PWO, they had a significantly worse subjective (HEP-Test-Q) and objective physical functioning (HJHS).

A Comparison of Health-Related Quality of Life, Pain and Functional Parameters between People with Hemophilia and People with Osteoarthritis - Preliminary Results of the Physio-FUN Study

Background: Spontaneous joint bleeding is common in people with hemophilia (PWH) leading to reduced physical activity and weakening of the musculature. Common sequelae of this are synovitis and cartilage damage. Following, secondary osteoarthritis, so-called hemophilic arthropathy, occurs with changes and progressive destruction of joint structures (Lafeber et al., 2008). Hemophilic arthropathy can lead to severe movement restrictions and significant limitations in health-related quality of life (HRQoL) (Varaklioti et al., 2018). To prevent advanced stages of arthropathy not only regular assessment of musculoskeletal status and early detection of symptoms, but also daily rehabilitation exercises at home, and implementation of appropriate physiotherapy and medical training are important (Bossard et al., 2008). Home exercises and manual therapy can be used without causing bleeding or pain to improve pain, HRQoL and functionality (Tat et al., 2021). The primary aim of the Physio-FUN study was to assess subjective (HEP-Test-Q]) and objective physical functioning (HJHS]) during the course of 1-year applied physiotherapy comparing PWH with arthropathy and patients with osteoarthritis (PWO). Methods: In this prospective, controlled monocentric cohort study it was planned to enroll 20 adult PWH A or B compared to 20 matched adult PWO without a bleeding disorder. Patients with a blood pressure ≥ 180/110 mmHg were excluded. A positive ethical approval for the study was obtained by the Ethics Committee North Rhine, Germany. After informed consent had been obtained, the study participants underwent examinations and completed questionnaires for Clinical Outcome Assessments (COAs) (see table 1); clinical, anthropometric and socio-demographic data were collected. All patients took part in regular physiotherapy (once a week) at the ARZD as prescribed by a physician. During the study, PWH continued to receive their usual hemophilia treatment regimen without study-related changes. Over a period of 12 months, Clinical Outcome Assessment (COAs) were collected repeatedly on a quarterly basis. Each patient was supposed to participate in 5 measure points (baseline, every 12 weeks over a one-year period). Ultrasound examinations were performed at baseline and at the conclusion at MZP5 in all patients. Results: At baseline 17 PWH (mean age 43.29±13.1 years) and 12 PWO (mean age 61.42±8.5 years) were enrolled; most PWH had HA (88.2%), were severely affected (58.8%), had a target joint (52.6%) and 6/17 had a knee endoprosthesis. 88.2% of PWH had a disabled card (most with a disability degree of ≥ 80) compared to 45.5% of PWO (most with a disability degree of 50). PWH had a significant worse orthopaedic joint status ( p<.003) and subjective physical functioning ( p<.001) compared to PWO; PWH had a mean HJHS of 26.76±18.0 vs. 11.0±5.7 and a mean HEP-Test-Q of 48.12±16.4 vs. 67.08±9.1. PWO reported highest impairments in the HEP-Test-Q domain ‘mobility’, while PWH suffered mainly under reduced ‘endurance’. The NNM showed a significant impairment in the mobility of the left ( p<.001) and right ( p<.013) ankle, 58.3% PWO had no impairments compared to 58.9-76.5% of PWH with moderate-severe impairments. This was confirmed by the ultrasound showing a worse progression of their disease ( p<.001) compared to PWO (mean HEAD-US 11.41±6.5 vs. 3.75±3.3). PWH had a worse HRQoL ( p<.001) (mean PCS of 37.51±8.3 vs. 49.45±7.2) and reported a significant higher ( p<.001) emotional distress due to pain (mean SES affective 30.0±12.8, SES sensory 20.94±6.2 vs. SES affective 16.75±2.6, SES sensory 12.08±2.5). Compared to PWO, PWH had a significant lower PAL-value ( p<.045) describing the level of physical activity over the period of 24 hours, most had a sedentary job (87.5% vs. 50%). Most of the PWH were below the predicted lower limit of the 6MWD compared to the PWO who all were above the lower limit. No difference was found between the groups regarding FMS and RPE before and after 6MWT and in the MCS. Conclusions: Although PWH were significantly younger than PWO, they had a significantly worse subjective and objective physical functioning; in addition they had a worse HRQoL, HEAD-US, NNM, PAL and a higher pain experience. Our study took place during the Corona pandemic and was quite time consuming for the participants, resulting in a failure to reach the desired number of cases and led to a high drop-out rate over the duration of the project.

Comorbid pain and falls among Chinese older adults: the association, healthcare utilization and the role of subjective and objective physical functioning

BackgroundPain and falls are significant disabling health conditions which cause substantial economic burdens on older adults and their families. Physical functioning (both subjective and objective) might play a significant role in older adults’ pain and falls. In this study we aimed to examine: (1) the relationship between pain and falls among Chinese older adults; (2) pain-fall status (i.e., comorbid pain-fall, pain-only, fall-only, and neither-pain-nor-fall) in relation to healthcare utilization; and (3) whether physical functioning measured either subjectively or objectively would contribute differently to the pain intensity and to the occurrence of falls.MethodsWe used a nationally-representative sample of older adults from the 2011–2012 baseline survey of the China Health and Retirement Longitudinal Study (N = 4,461, aged 60–95 years). Logistic, linear, and negative binomial models adjusted for demographic variables were used in the analysis.ResultsOverall, 36% of older adults reported pain, 20% had fall occurrences, and 11% had comorbid pain and falls. Pain intensity was significantly associated with falls. Individuals in groups of pain-only, fall-only, and comorbid pain-fall reported significantly higher healthcare utilization, that is, more frequent inpatient care and doctor visits than those in the neither-pain-nor-fall group. Subjective, not objective, physical functioning was associated with pain and falls.ConclusionPain and falls are significantly associated with each other, and both can lead to increased healthcare utilization. Compared to objective physical functioning, subjective physical functioning is more likely to correlate with pain and falls, suggesting that self-reported physical status should be considered when designing pain-fall preventive strategies.

ASSESSING PHYSICAL FUNCTION AND MENTAL HEALTH AMONG OLDER PERSONS IN PRISON

Abstract As the number of older incarcerated persons grows, evaluating changes in their physical and mental health over time may be important for appropriate planning and needs assessment. Based on findings from the Aging Inmates’ Suicidal Ideation and Depression Study (Aging INSIDE), we will provide recommendations for assessing both objective and subjective physical function in older incarcerated persons. We will also discuss our experiences with assessing depression and suicidal ideation in this population and describe how the processes for collecting data needed to be modified during the COVID-19 pandemic. Those attending this session will learn about the pros and cons of using face-to-face assessments and mailed surveys to assess physical function and mental health among older persons in the prison setting and will learn how these outcomes may differ between those who have a life sentence versus those expecting to be released from incarceration in late life.

Monitoring of Patient-Reported Outcomes in Patients with Bleeding Disorders to Assure Quality of Care: Results from a Single Outpatient Haemophilia Treatment Centre in Germany

Background: By collecting certain treatment data during patient's care and comparing these data over time, reliable findings are obtained on whether and at which points there is a need for improvement. Due to the complexity and high risk of complications in the treatment of blood coagulation disorders, an interdisciplinary care of patients is needed to ensure a high-quality and efficient therapy. The Coagulation Treatment Centre rhein-ruhr (GZRR) follows a holistic treatment concept providing cross-sectoral care through interdisciplinary cooperation. This approach is intended also to improve patients' treatment satisfaction (TS), physical functioning (PF) and health-related quality of life (HRQoL). The aim was to evaluate TS, PF and HRQoL in patients treated at the GZRR. Methods: Since 2019 patients > 5 years attending the routine visits at the GZRR completed validated and standardised patient-reported outcomes (PROs) at each visit. Patients > 12 years filled in the generic SF-36 for the assessment of HRQoL, haemophilia-specific HRQoL is assessed with the Haem-A-QoL (adults) or age-related versions of the Haemo-QoL (kids) questionnaires. For the evaluation of TS and PF haemophilia- and age-group specific questionnaires were administered (Hemo-SatA+P, HEP-Test-Q). Results: 177 patients (range 6-80 years) with bleeding disorders were enrolled, among them 55.9% had haemophilia (Haemophilia A, n=88; Haemophilia B, n=11) and 44.1% had VWD; 57.1% were severely affected. Sixty-eight were children (39%) with a mean age of 11.44±3.4 years and BMI of 18.82±3.7; 109 were adults with a mean age of 38.79±16.7 years and BMI of 25.72±5.5. Patients were relatively satisfied with their treatment, adults reported highest impairments in the domain 'burden', while parents were mainly dissatisfied concerning 'ease & convenience'. Children (C) reported a significantly better (p<.0001) subjective physical functioning compared to adults (A). Both age groups showed highest impairments in the domain 'endurance' (MC=70.69±20.3 vs. MA=51.48±25.4). Patients reported good HRQoL in the Mental Component Score of the SF-36 50.07±11.1 and showed some impairments in the Physical Component Score 45.26±11.9; significant difference were found between children and adults in all subdomains of the SF-36. Conclusions: These findings demonstrate that the interdisciplinary approach leads to good results in PROs. Based on the findings direct short-term interventions could be administered to solve minor issues. Follow-up data could prove that this kind of quality-of-care assurance helps not only to improve the clinical situation of patients, but also their PRO.

Examining Sensory-motor Training Versus Impairment-based Training on Pain and Function in Subjects With Knee Osteoarthritis

Purpose: Osteoarthritis is a degenerative joint disease affecting synovial joints and damages joints due to stresses caused by an abnormality in any of the synovial joint tissues, including articular cartilage and subchondral bone, ligaments, menisci, periarticular muscles, peripheral nerves, and synovium. To compare the effect of sensory-motor training versus impairment-based training on pain and physical function in subjects with knee osteoarthritis. Methods: Simple random sampling was used to divide 30 subjects aged 50 and 70 years who met the inclusion and exclusion criteria into two groups (n=15). Group A received sensory-motor training, while Group B received impairment-based training. Before the treatment, the subjects walked for 10 minutes to warm up. For three weeks, each group was treated three times per week. Pre-test; post-test outcomes are noted, the visual analog scale (VAS) was used to assess pain, and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) was used to assess physical function. Results: Comparing the post-test pain (VAS) scores between groups showed that the mean±SD of posttest pain (VAS) score in the sensory-motor training group was 2.707±1.01. The mean±SD in the impairment-based training group was almost the same, at 2.29±1.13. It was statistically significant at the 5% level. Similarly, the mean±SD of the posttest function (WOMAC) score in the sensory-motor training group was 16.55±6.92. Conclusion: Sensory-motor training is superior to impairment-based training on pain and physical function in subjects with knee osteoarthritis.

Tai Chi Improves Brain Functional Connectivity and Plasma Lysophosphatidylcholines in Postmenopausal Women With Knee Osteoarthritis: An Exploratory Pilot Study.

Objective: A pre/post pilot study was designed to investigate neurobiological mechanisms and plasma metabolites in an 8-week Tai-Chi (TC) group intervention in subjects with knee osteoarthritis.Methods: Twelve postmenopausal women underwent Tai-Chi group exercise for 8 weeks (60 min/session, three times/week). Outcomes were measured before and after Tai Chi intervention including pain intensity (VAS), Brief Pain Inventory (BPI), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), plasma metabolites (amino acids and lipids), as well as resting-state functional magnetic resonance imaging (rs-fMRI, 10 min, eyes open), diffusion tensor imaging (DTI, 12 min), and structural MRI (4.5 min) in a subgroup. Clinical data was analyzed using paired t-tests; plasma metabolites were analyzed using Wilcoxon signed-rank tests; and rs-fMRI data were analyzed using seed-based correlations of the left and right amygdala in a two-level mixed-effects model (FSL software). Correlations between amygdala-medial prefrontal cortex (mPFC) connectivity and corresponding changes in clinical outcomes were examined. DTI connectivity of each amygdala was modeled using a Bayesian approach and probabilistic tractography. The associations between neurobiological effects and pain/physical function were examined.Results: Significant pre/post changes were observed with reduced knee pain (VAS with most pain: p = 0.018; WOMAC-pain: p = 0.021; BPI with worst level: p = 0.018) and stiffness (WOMAC-stiffness, p = 0.020), that likely contributed to improved physical function (WOMAC-physical function: p = 0.018) with TC. Moderate to large effect sizes pre/post increase in rs-fMRI connectivity were observed between bilateral mPFC and the amygdala seed regions (i.e., left: d = 0.988, p = 0.355; right: d = 0.600, p = 0.282). Increased DTI connectivity was observed between bilateral mPFC and left amygdala (d = 0.720, p = 0.156). There were moderate-high correlations (r = 0.28–0.60) between TC-associated pre-post changes in amygdala-mPFC functional connectivity and pain/physical function improvement. Significantly higher levels of lysophosphatidylcholines were observed after TC but lower levels of some essential amino acids. Amino acid levels (alanine, lysine, and methionine) were lower after 8 weeks of TC and many of the lipid metabolites were higher after TC. Further, plasma non-HDL cholesterol levels were lower after TC.Conclusion: This pilot study showed moderate to large effect sizes, suggesting an important role that cortico-amygdala interactions related to TC have on pain and physical function in subjects with knee osteoarthritis pain. Metabolite analyses revealed a metabolic shift of higher lyso-lipids and lower amino acids that might suggest greater fatty acid catabolism, protein turnover and changes in lipid redistribution in response to TC exercise. The results also support therapeutic strategies aimed at strengthening functional and structural connectivity between the mPFC and the amygdala. Controlled clinical trials are warranted to confirm these observed preliminary effects.

Effect of Exercise on Secondary Sarcopenia: A Comprehensive Literature Review.

Simple SummarySarcopenia is an inevitable component of aging. It is officially recognized as a muscle disease with an ICD-10-MC diagnosis code that can be used to bill for care in some countries. Sarcopenia can be classified into primary or age-related sarcopenia and secondary sarcopenia. The condition is referred to as secondary sarcopenia when any other comorbidities are present in conjunction with aging. Secondary sarcopenia is more prevalent than primary sarcopenia and requires special attention. Exercise interventions may help in our understanding and prevention of sarcopenia with a specific morbidity Glomerular filtration rate that exercise improves muscle mass, quality or physical function in elderly subjects with cancer, type 2 diabetes, kidney diseases and lung diseases. In this review, we summarize recent research that has studied the impact of exercise on patients with secondary sarcopenia, specifically those with one comorbid condition. We did not discover any exercise intervention specifically for subjects with secondary sarcopenia (with one comorbidity). Even though there is a strong argument for using exercise to improve muscle mass, quality or physical function in subjects with cancer, type 2 diabetes, kidney diseases, lung diseases and many more, very few studies have reported baseline sarcopenia assessments. Based on the trials summarized in this review, we may propose but not conclude that resistance, aerobic, balance training or even walking can be useful in subjects with secondary sarcopenia with only one comorbidity due to the limited number of trials. This review is significant because it reveals the need for broad-ranging research initiatives involving secondary sarcopenic patients and highlights a large secondary sarcopenia research gap.Background: Sarcopenia has been recognized as an inevitable part of aging. However, its severity and the age at which it begins cannot be predicted by age alone. The condition can be categorized into primary or age-related sarcopenia and secondary sarcopenia. Sarcopenia is diagnosed as primary when there are no other specific causes. However, secondary sarcopenia occurs if other factors, including malignancy or organ failure, are evident in addition to aging. The prevalence of secondary sarcopenia is far greater than that of primary sarcopenia and requires special attention. To date, nutrition and exercise have proven to be the best methods to combat this disease. The impact of exercise on subjects suffering from sarcopenia with a specific morbidity is worthy of examination for understanding and prevention. The purpose of this review, therefore, is to summarize recent research that has investigated the impact of exercise in patients with secondary sarcopenia, specifically with one comorbidity. Methods: Pubmed, Web of Science, Embase and Medline databases were searched comprehensively with no date limit for randomized controlled trials. The literature was specifically searched for clinical trials in which subjects were sarcopenic with only one comorbidity participating in an exercise intervention. The most visible comorbidities identified and used in the search were lung disease, kidney disease, heart disease, type 2 diabetes, cancer, neurological diseases, osteoporosis and arthritis. Results: A total of 1752 studies were identified that matched the keywords. After removing duplicates, there were 1317 articles remaining. We extracted 98 articles for full screening. Finally, we included 21 relevant papers that were used in this review. Conclusion: Despite a strong rationale for using exercise to improve muscle mass, quality or physical function in subjects with cancer, type 2 diabetes, kidney disease, lung disease and many more, baseline sarcopenia evaluation has been reported in very few trials. The limited number of studies does not allow us to conclude that exercise can improve sarcopenia in patients with other comorbidities. This review highlights the necessity for wide-ranging research initiatives involving secondary sarcopenic patients.

Subjective and objective assessments are associated for physical function but not cognitive function in community-dwelling stroke survivors

Purpose To investigate the relation between subjectively and objectively assessed cognitive and physical functioning among community-dwelling stroke survivors, and to examine the association of stroke severity with subjectively and objectively assessed cognitive and physical impairments. Materials and methods Secondary data analysis was conducted with 127 community-dwelling stroke survivors. For cognitive functioning, objective measures included the NIH Toolbox Cognition Battery and the Executive Function Performance Test; subjective measures included the Quality of Life in Neurological Disorders Applied Cognition. Objective and subjective physical functioning was measured by the NIH Toolbox 2-Minute Walk Test and the Patient-Reported Outcomes Measurement Information System Physical Function, respectively. Results A positive correlation was observed between subjective and objective physical functioning, whereas the correlation between subjective and objective cognitive functioning was nonsignificant. Stroke severity was associated with objective cognitive impairment and objective and subjective physical impairment, but not subjective cognitive impairment. Conclusions The lack of association between objective and subjective cognitive functioning challenges the conventional assumption that perceived functioning reflects actual performance. We recommend using both objective and subjective measures to accurately identify cognitive and physical impairment following stroke. Implications for Rehabilitation Subjective cognitive functioning is not associated with objective cognitive functioning, suggesting that solely relying on stroke patients’ reports is inadequate and may inaccurately estimate patients’ actual deficits. Both objective and subjective measures should be used to accurately identify cognitive and physical impairment following stroke. Practitioners should be cognizant of stroke patients’ behavioral signs associated with underlying cognitive problems that warrant further evaluation.

The Relation Between Subjective and Objective Assessment of Cognitive and Physical Functioning in Community-Dwelling Stroke Survivors

<h3>Research Objectives</h3> To investigate the relation between subjectively and objectively assessed cognitive and physical functioning among community-dwelling stroke survivors, and to examine the association of stroke severity with subjectively and objectively assessed cognitive and physical impairments. <h3>Design</h3> Secondary data analysis of a cross-sectional, multi-site study. <h3>Setting</h3> Community. <h3>Participants</h3> One hundred twenty-seven community-dwelling stroke survivors (mean age 57.4; 48.8% female) who were at least one year after discharge from rehabilitation. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Objective cognitive functioning measured by the NIH Toolbox Cognition Battery and the Executive Function Performance Test (EFPT). Subjective cognitive functioning measured by the Quality of Life in Neurological Disorders (Neuro-QoL) Applied Cognition. Objective and subjective physical functioning measured by the NIH Toolbox 2-Minute Walk Test and the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, respectively. <h3>Results</h3> A strong positive correlation was found between subjective and objective physical functioning (r = 0.52; P < 0.001), whereas the association between subjective and objective cognitive functioning was nonsignificant. Compared to moderate stroke survivors, mild stroke survivors had lower odds for objective cognitive impairment (total cognition: odds ratio [OR] = 0.28, 95% confidence interval [CI] = 0.12 to 0.64; fluid cognition: OR = 0.34, 95% CI = 0.14 to 0.81; functional cognition: OR = 0.22, 95% CI = 0.08 to 0.61), objective physical impairment (OR = 0.27, 95% CI = 0.08 to 0.86), and subjective physical impairment (OR = 0.37, 95% CI = 0.15 to 0.93). However, no significant association was found between stroke severity and subjective cognitive impairment. <h3>Conclusions</h3> The discordance between objective and subjective cognitive functioning contradicts the conventional assumption that perceived functioning reflects actual performance. Our findings suggest that unique information may be captured in each approach and that they are not interchangeable. As such, incorporating both objective and subjective measures into routine assessment is recommended for clinicians to comprehensively characterize and early identify post-stroke cognitive and physical impairments, enhancing the recognition and management of functional consequences of stroke by clinicians as well as stroke survivors and caregivers. <h3>Author(s) Disclosures</h3> None disclosed.

Relationship of subjective and objective sleep measures with physical performance in advanced-stage lung cancer patients

Advanced lung cancer patients suffer from deteriorated physical function, which negatively impacts physical and psychological health. As little is known about sleep and physical function in this population, this study aimed to examine the association between subjective and objective sleep parameters and physical function among them. 164 advanced lung cancer patients were included. Objective sleep was measured by actigraphy (measured on non-dominant wrist for 72 h), and subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Performance-based physical function was measured by Timed Up and Go Test (TUGT), 6-Minute Walk Test (6MWT), Sit-to-Stand Test, and One-leg Standing Test. Univariable and multivariable regression analyses were employed to examine the association between sleep and physical function. Total sleep time (TST) was significantly associated with the 6MWT (β = 0.259; 95% CI 0.120, 0.398; P < 0.001), TUGT (β = − 0.012; 95% CI = − 0.017, − 0.008; P < 0.001) and Sit-to-Stand Test (β = 0.027; 95% CI = 0.018, 0.035; P < 0.001) after adjustment for multiple covariates. PSQI global score was only significantly associated with TUGT (β = 0.140; 95% CI = 0.000, 0.280; P = 0.050) after adjustment for multiple covariates. Shorter sleep duration significantly predicted poorer physical performance in advanced lung cancer patients, and more attention is required for those with less than 4.3 h of sleep on average.Trial registration: ClinicalTrials.gov, NCT03482323. Registered 29 March 2018, https://clinicaltrials.gov/ct2/show/NCT03482323; ClinicalTrials.gov, NCT04119778. Registered 8 October 2019, https://clinicaltrials.gov/ct2/show/NCT04119778.

Objective and subjective physical function in allogeneic hematopoietic stem cell transplant recipients.

We conducted a prospective study of adult allogeneic hematopoietic cell transplantation (HCT) recipients to assess pre- and post-HCT physical function. Baseline measurements included a wrist actigraphy, a 6 min walk test (6MWT), an international physical activity questionnaire (IPAQ), and a Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) as well as serial post-HCT assessments of 6MWT, IPAQ, and FACT-BMT. Forty-seven patients were evaluable for functionality assessments, with a median follow-up of 54.5 months for surviving recipients. No patients demonstrated vigorous or very vigorous activity at any time during monitoring by wrist actigraphy; patients spent a median of 6 h daily sedentary. Self-reported activity via the IPAQ showed 36%, 43%, and 21% of subjects reporting light, moderate, and vigorous activity prior to HCT, respectively. Post-HCT 6MWTs on day +30 demonstrated the greatest association with subsequent survival and non-relapse mortality. A decline in 6MWT distance over time also demonstrated worsened overall survival. This study shows the feasibility of fitness assessments and the ability to risk stratify for subsequent mortality, particularly using the 6MWT on the day +30 single time point assessment and change scores from baseline to day +30 post HCT. These pilot findings suggest important targets for future study.

Effect of Virtual Reality Gait Training on Participation in Survivors of Subacute Stroke: A Randomized Controlled Trial.

ObjectiveAfter stroke, people experience difficulties with walking that lead to restrictions in participation in daily life. The purpose of this study was to examine the effect of virtual reality gait training (VRT) compared to non–virtual reality gait training (non-VRT) on participation in community-living people after stroke.MethodsIn this assessor-blinded, randomized controlled trial with 2 parallel groups, people were included between 2 weeks and 6 months after stroke and randomly assigned to the VRT group or non-VRT group. Participants assigned to the VRT group received training on the Gait Real-time Analysis Interactive Lab (GRAIL), and participants assigned to the non-VRT group received treadmill training and functional gait exercises without virtual reality. Both training interventions consisted of 12 30-minute sessions during 6 weeks. The primary outcome was participation measured with the restrictions subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) 3 months postintervention. Secondary outcomes included subjective physical functioning, functional mobility, walking ability, dynamic balance, walking activity, fatigue, anxiety and depression, falls efficacy, and quality of life.ResultsTwenty-eight participants were randomly assigned to the VRT group and 27 to the non-VRT group, of whom 25 and 22 attended 75% or more of the training sessions, respectively. No significant differences between the groups were found over time for the USER-P restrictions subscale (1.23; 95% CI = −0.76 to 3.23) or secondary outcome measures. Patients’ experiences with VRT were positive, and no serious adverse events were related to the interventions.ConclusionsThe effect of VRT was not statistically different from non-VRT in improving participation in community-living people after stroke.ImpactAlthough outcomes were not statistically different, treadmill-based VRT was a safe and well-tolerated intervention that was positively rated by people after stroke. VR training might, therefore, be a valuable addition to stroke rehabilitation.Lay SummaryVRT is feasible and was positively experienced by people after stroke. However, VRT was not more effective than non-VRT for improving walking ability and participation after stroke.

NONİNVAZİV MEKANİK VENTİLASYON DESTEĞİ OLAN VE OLMAYAN AKUT SOLUNUM YETMEZLİĞİNDE FONKSİYONEL BAĞIMSIZLIK VE KAS KUVVETİ

Purpose: Development of muscle weakness is common in the course of acute respiratory failure (ARF). This study aimed to compare muscle strength and physical function in subjects with ARF undergoing noninvasive mechanical ventilation (NIV) added to standard medical treatment (SMT) and SMT only in the intensive care unit. Methods: Thirty-two subjects with ARF (19 NIV and 13 SMT) were included. Subject characteristics were recorded. Peripheral muscle strength was measured using the Medical Research Council Scale (MRC) and handgrip strength. Functional independence was evaluated using the Barthel Index (BI). Results: In the NIV group, proximal muscle strength (shoulder abduction) was significantly lower than distal limb strength (wrist extension) (p=0.030). In both groups, proximal lower limb strength (hip flexion) was also significantly lower than distal limb strength (ankle dorsiflexion) (p=0.002). The BI total score was significantly lower in the NIV group than that of the SMT group (p=0.016). The BI score was significantly related to the MRC sum score (r=0.633) and handgrip strength (r=0.629, p&amp;lt;0.05). Conclusion: Functional independence and proximal muscle strength compared to distal adversely affected in patients undergoing NIV for ARF. Weakness or functional limitations may prevent patients from functioning adequately in rehabilitation practices in intensive care.

Longitudinal association between mental health and future antibiotic prescriptions in healthy adults: Results from the LOHAS.

To investigate the association of mental health and subjective physical functioning with future antibiotic prescriptions. Prospective cohort study. A rural town in Japan. Participants who completed the baseline survey (2008-2010) of the Locomotive Syndrome and Health Outcomes in the Aizu Cohort Study (LOHAS) were recruited. Participants were limited to those without comorbidities according to the Charlson comorbidity index. Participants using antibiotics at baseline were excluded. Mental health and physical functioning were assessed using the Mental Health and Physical Functioning domains of the Short-Form 12 Health Survey, and depressive symptoms were assessed using the Mental Health Inventories at baseline. The main outcome was antibiotic prescriptions found in claims data during 1 year after the baseline survey. A total of 967 participants were included in the analysis, and 151 (15.6%) participants with at least one missing variable for the confounding factors were excluded, leaving 816 participants for the primary analysis. Among the 816 participants, 65 (8.0%) were newly prescribed at least one antibiotic during the 1-year follow-up period. The most frequently prescribed antibiotics were third-generation cephalosporins (44 prescriptions; 35.5%), macrolides (28 prescriptions; 22.6%), and quinolones (23 prescriptions; 18.6%). A multivariable logistic regression analysis showed an association between higher mental health scores and future antibiotic prescriptions (adjusted odds ratio [AOR], 1.40 per 1 standard deviation [SD] increase; 95% confidence interval [CI], 1.03-1.90), whereas no significant relationship was observed between Physical Functioning scores and future antibiotic prescriptions (AOR, 0.95 per 1 SD increase; 95% CI, 0.75-1.22). During the secondary analysis, adults with depressive symptoms were less likely to be prescribed antibiotics (AOR, 0.27; 95% CI, 0.11-0.70). Better mental health was associated with increased future antibiotic prescriptions for healthy community-dwelling Japanese adults, suggesting that mentally healthier adults could be a target population for reducing antimicrobial use.

THU0634-HPR KNEE EXTENSOR MUSCLE STEADINESS IN RELATION TO MAXIMAL TORQUE AND PHYSICAL FUNCTIONING IN PATIENTS WITH KNEE OSTEOARTHRITIS

Background:Osteoarthritis (OA) of the knee is characterized by knee pain and limitations in daily activities. Muscle weakness is associated with these characteristics, quantified as maximal voluntary muscle torque (MVT). The quality of muscle contraction is presented by fluctuations observed on a torque-time curve and the extent of these fluctuations is referred to as muscle steadiness. Whether muscle steadiness is associated with maximal muscle torque and consequently with pain and activity limitations is unknown.Objectives:To determine the association of knee extensor muscle steadiness with MVT and to explore the association of muscle steadiness with physical functioning in subjects with knee OA.Methods:Baseline data of 172 patients out of 177 patients with knee OA, who participated in the VIDEX trial (trial registration number, NL47786.048.14), were used for this study. Maximal voluntary knee extension torque (MVT) was assessed using an isokinetic dynamometer. Torque-time curve data were processed into (i) coefficient of magnitude of torque variance (CV) in percentage (%), (ii) frequency of torque variance as peak power frequency (PPF) in Hertz (Hz) and (iii) MVT in Newton meters (Nm). Physical functioning was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, the Get-Up &amp; Go (GUG) test, the 6-minute walk test (6MWT) and the Stair climb up &amp; down test. Correlation and Regression analyses were performed to determine associations. Sex, age, BMI, KL-grade, knee alignment and pain were considered as potential confounders.Results:Lower CV and PPF, reflecting better muscle steadiness, were significantly associated (p&lt; 0.01 and p&lt;0.05, respectively) with higher MVT, but associations were weak. Regression analyses showed a significant association of lower CV with better physical functioning on the WOMAC (p&lt;0.05), also after correction for relevant confounders. The association with WOMAC was confounded by pain, but not by sex, age and BMI. No associations of CV with the GUG test, the 6MWT and the Stair climb up &amp; down test were found. PPF was not significantly associated with physical functioning.Conclusion:This is the first explorative study of muscle steadiness in relation to physical functioning in knee OA patients. Muscle steadiness is, to some extent, related to better physical functioning, but this is not consistent across all measures of physical functioning in this study. There seems to be some relationship, but it is weak and needs further exploration. No previous studies comparing clinical scores to muscle steadiness in knee OA were found to compare our results. Studies on muscle steadiness are needed to improve our understanding on this aspect of muscle torque.

Timeline of functional recovery after hip fracture in seniors aged 65 and older: a prospective observational analysis.

Hip fractures are a major cause of loss of function among seniors. We assessed the timeline of objective and subjective functional recovery after hip fracture. We conducted a prospective observational secondary analysis of a 1-year clinical trial on vitamin D and home exercise treatment and complications after hip fracture among 173 patients age ≥ 65years (mean age 84years; 79.2% women; 77.4% community-dwelling) conducted from January 2005 through December 2007. Lower extremity function (Timed Up and Go test (TUG), knee extensor and flexor strength) and grip strength was assessed at baseline and at 6 and 12months follow-up. Subjective physical functioning was assessed using the SF-36 questionnaire also at 3 and 9months follow-up. Multivariable-adjusted repeated-measures models were used to assess the timeline of functional recovery in the total population and in subgroups of patients. Lower extremity function including TUG (- 61.1%), knee extensor (+ 17.6%), and knee flexor (+ 11.6%) strength improved significantly in the first 6months (P < 0.001). However, between 6 and 12months, there was no further significant improvement for any of the functional tests. Grip strength decreased from baseline to 6months (- 7.9%; P < 0.001) and from 6 to 12months (- 10.8%; P < 0.001). Subjective physical functioning improved from 3 to 9months (+ 15.2%, P < 0.001), but no longer thereafter. Functional recovery after hip fracture may be largely complete in the first 6months for objective functional tests, whereas may extend up to 9months for subjective recovery, with oldest-old, female, institutionalized, and cognitively impaired patients recovering most poorly. NCT00133640.