Physical Performance Outcomes Research Articles

The Relationship between Physical Activity and Physical Performance and Cognitive Abilities in the Chinese Elderly

PURPOSE: Decreased physical and cognitive ability have become seriously problematic in aging. Studies seldom describe the relationship between physical activity (PA), physical performance and cognitive abilities, most of which by measuring only one or two specific abilities using questionnaires. The study was thus designed to examine the relationship between PA and physical performance and multiple cognitive abilities in the Chinese elderly. METHODS: The design was a cross-sectional study. 148 people aged 65.15±7.79 were included from Guangxi Province in southern China. PA was measured by the Physical Activity Scale for the Elderly (PASE, Cronbach’s ɑ=0.752; Test-retest reliability=0.980). Physical performance included coordination and lower limb strength, functional walking ability and the balance ability. Cognitive abilities were measured by computer-based tests, including simple reaction time and executive function (stroop task and shifting task). The association between PA and the outcomes were examined using correlation matrix and linear regression. RESULTS: 1) The average time spent on physical activity was 1.8h/d; 2) High levels of PA significantly associated with better gait speed (B=-0.67, p<0.05), 30-s chair-stand test (B=0.72, p<0.05) and reaction abilities (B=0.89, p<0.05); 3) The gait speed significantly correlated with the accuracy of stroop task (r = 0.23, p = .018) and shifting task (r = 0.21, p = 0.023), grip strength significantly correlated with the accuracy and the reaction time of the stroop task(r = 0.19, p = 0.04 & r = 0.19, p = 0.04). However, other physical performance outcomes had no significant correlation with the cognitive abilities. CONCLUSIONS: More physically active residents scored higher on physical performance outcomes. Positive associations were found between physical performance, executive function and reaction ability.

The Experience of Chemotherapy-Induced Peripheral Neuropathy Among Childhood Cancer Survivors

As the number of childhood cancer survivors (CCS) is increasing, it is imperative to understand the late effects of childhood cancer therapy to optimize their health and quality of life. Chemotherapy-induced peripheral neuropathy (CIPN) is an unpleasant effect of chemotherapy that affects the peripheral nervous system. This qualitative study uses narrative analysis with a phenomenological influence to understand the lived experience of CIPN among five CCS utilizing photo-elicitation. The lived experience of CIPN is characterized by "a condition of disconnection" with three subthemes: (1) disconnection between mind and body, (2) disconnection between anticipated potential and reality, and (3) disconnection between survivors and support. The condition of disconnection leads to a variety of negative physical and emotional performance outcomes. These findings support the need for refined clinical strategies for identifying this underappreciated condition and further development of interventions to "rebuild the connections" that CCS are lacking.

The effects of 8weeks of inspiratory muscle training on the balance of healthy older adults: a randomized, double-blind, placebo-controlled study.

To examine the effects of 8‐week unsupervised, home‐based inspiratory muscle training (IMT) on the balance and physical performance of healthy older adults. Fifty‐nine participants (74 ± 6 years) were assigned randomly in a double‐blinded fashion to either IMT or sham‐IMT, using a pressure threshold loading device. The IMT group performed 30‐breath twice daily at ~50% of maximal inspiratory pressure (MIP). The sham‐IMT group performed 60‐breaths once daily at ~15% MIP; training was home‐based and unsupervised, with adherence self‐reported through training diaries. Respiratory outcomes were assessed pre‐ and postintervention, including forced vital capacity, forced expiratory volume, peak inspiratory flow rate (PIFR), MIP, and inspiratory peak power. Balance and physical performance outcomes were measured using the shortened version of the Balance Evaluation System test (mini‐BEST), Biodex® postural stability test, timed up and go, five sit‐to‐stand, isometric “sit‐up” and Biering–Sørensen tests. Between‐group effects were examined using two‐way repeated measures ANOVA, with Bonferroni correction. After 8‐week, the IMT group demonstrated greater improvements (P ≤ 0.05) in: PIFR (IMT = 0.9 ± 0.3 L sec−1; sham‐IMT = 0.3 L sec−1); mini‐BEST (IMT = 3.7 ± 1.3; sham‐IMT = 0.5 ± 0.9) and Biering–Sørensen (IMT = 62.9 ± 6.4 sec; sham‐IMT = 24.3 ± 1.4 sec) tests. The authors concluded that twice daily unsupervised, home‐based IMT is feasible and enhances inspiratory muscle function and balance for community‐dwelling older adults.

Prediction of cadet basic training physical performance outcomes

BackgroundEntry to the United States Military Academy requires submission of scores on the Cadet Fitness Assessment. The cadet fitness assessment consists of push‐ups, crunches, kneeling basketball throw, shuttle run, and 1‐mile run. Upon arrival for Cadet Basic Training, cadets are assessed on the components of the Army Physical Fitness Test; push‐ups, sit‐ups and a 2‐mile run. Additionally all cadets are assessed on a swim test. Records of stress‐fractures incurred during Cadet Basic Training are also retained.ObjectiveTo apply supervised and unsupervised machine learning to describe Cadet Basic Training and Cadet Fitness Assessment data compiled from the graduating classes of 2012 to 2021.MethodsSimple data‐analysis plots, linear regression models, and unsupervised k‐means cluster analysis were developed to predict Cadet Basic Training performance. Models were generated to identify the relationship between body mass index (BMI), age and gender on 2‐mile run performance to replicate past Army results.ResultsA total N=8886 (82% male) cadets were retained for analysis. The relationship between 2‐mile run performance and BMI was weak (R2=0.07), with age, BMI, and gender representing significant predictors (p&lt;0.01). Similar results were found for all performance outcomes except pull‐ups. The relationship between pull‐up performance and BMI was stronger (R2=0.47). The cluster analysis revealed four clusters. One cluster was identified to poor 2‐mile run performance while a second cluster was identified with poor swim, push‐up, and sit‐up performance. Scatterplots did not indicate any relationship between cluster assignments and BMI.ConclusionsBMI and even waist circumference may be poor predictors of performance on military physical fitness test outcomes. Machine learning could offer more precision for identifying poor performers early and provide novel opportunities for remediation.Support or Funding InformationNoneThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Objective physical activity and physical performance in middle-aged and older adults.

Older adults may have difficulty meeting the Physical Activity (PA) Guidelines. A favorable balance between PA and sedentary time (SED) is an important determinant of physical performance in older adults. Our objective was to explore associations of PA/SED with physical performance across mid-older age in adults without overt mobility disability. Framingham Offspring Study participants free of mobility disability with accelerometry and physical performance data (gait speed, chair stand time, and handgrip strength), were studied in cross-sectional analysis (n = 1352). We regressed physical performance on PA level, measured using steps, moderate to vigorous (MV)PA and SED. We stratified by age groups, adjusted for covariates, and modelled MVPA and SED separately and together as predictors. Only 38% of adults 50-64 years and 15% of adults ≥75 years met the PA Guidelines (i.e., 150 min MVPA per week). Individuals achieving at least 5 min/day of MVPA had 0.062 ± 0.013 m/s greater gait speed and better chair stands and handgrip strength (in women) than those with <5 min/day of MVPA (p < 0.01) across mid-older age. SED was associated with poorer performance on gait speed and chair stand tests, but results were not significant after adjusting for MVPA (p > 0.05). For adults ≥75 years, every 5000 more steps/day related to ~0.045 m/s greater gait speed (p = 0.006). Our cross-sectional study demonstrated that, across mid-older adulthood, MVPA related to better physical performance, but in adults ≥75 years, total steps walked associated with better gait speed. These data warrant future research on the impact of PA on physical performance and health outcomes in older age.

A Scoping Review of Physical Performance Outcome Measures Used in Exercise Interventions for Older Adults With Alzheimer Disease and Related Dementias.

There is growing evidence that exercise interventions can mitigate functional decline and reduce fall risk in older adults with Alzheimer disease and related dementias (ADRD). Although physical performance outcome measures have been successfully used in older adults without cognitive impairment, additional research is needed regarding their use with individuals who have ADRD, and who may have difficulty following instructions regarding performance of these measures. The purpose of this scoping review was to identify commonly used physical performance outcome measures, for exercise interventions, that are responsive and reliable in older adults with ADRD. Ultimately, we aimed to provide recommendations regarding the use of outcome measures for individuals with ADRD across several domains of physical performance. A scoping review was conducted to broadly assess physical performance outcome measures used in exercise interventions for older adults with ADRD. Exercise intervention studies that included at least 1 measure of physical performance were included. All physical performance outcome measures were abstracted, coded, and categorized into 5 domains of physical performance: fitness, functional mobility, gait, balance, and strength. Criteria for recommendations were based on (1) the frequency of use, (2) responsiveness, and (3) reliability. Frequency was determined by the number of studies that used the outcome measure per physical performance domain. Responsiveness was assessed via calculated effect size of the outcome measures across studies within physical performance domains. Reliability was evaluated via published studies of psychometric properties. A total of 20 physical performance outcome measures were extracted from 48 articles that met study inclusion criteria. The most frequently used outcome measures were the 6-minute walk test, Timed Up and Go, repeated chair stand tests, short-distance gait speed, the Berg Balance Scale, and isometric strength measures. These outcome measures demonstrated a small, medium, or large effect in at least 50% of the exercise intervention studies. Good to excellent reliability was reported in samples of older adults with mild to moderate dementia. Fitness, functional mobility, gait, balance, and strength represent important domains of physical performance for older adults. The 6-minute walk test, Timed Up and Go, repeated chair stand tests, short-distance gait speed, Berg Balance Scale, and isometric strength are recommended as commonly used and reliable physical performance outcome measures for exercise interventions in older adults with mild to moderate ADRD. Further research is needed on optimal measures for individuals with severe ADRD. The results of this review will aid clinicians and researchers in selecting reliable measures to evaluate physical performance outcomes in response to exercise interventions in older adults with ADRD.

Mental Fatigue in Football: Is it Time to Shift the Goalposts? An Evaluation of the Current Methodology.

Research in football for a long time has focused on the physical nature of fatigue as opposed to its mental aspects. However, since 2016, six original articles have investigated the effects of induced mental fatigue in football on isolated physical, skill and decision-making performance tests, along with physical, technical and tactical performance outcomes in small-sided games. Whilst these studies have overall shown a negative impact of mental fatigue on task performance, this current opinion aims to critically examine the methodological approach to this problem, most notably the lack of ecological validity when inducing mental fatigue and the present approach to measuring mental fatigue using visual analogue scales (VAS). It is suggested that future research on mental fatigue in football may benefit from the use of surveys/interviews to understand the true cognitive demands of elite football players. Additionally, future research should aim to reduce the reliance on using VAS to measure mental fatigue as results from this tool may be confounded by several response biases. In conclusion, this article highlights the need for mentally fatiguing tasks that adequately represent football-associated mental fatigue and assessments of mental fatigue that minimise the confounding effect of response bias.

The effect of training interventions on physical performance, quality of life, and fatigue in patients receiving breast cancer treatment: a systematic review.

The primary purpose of this systematic review is to structure the available evidence concerning physical exercise programs and their effects on (1) physical performance outcomes, (2) experienced fatigue, and (3) quality of life (QoL) in patients during the initial treatment for breast cancer. A systematic literature search, based upon the PRISMA guideline, up to January 1, 2018, was performed using four databases (Web of Science, Cochrane Library for Clinical Trials, PubMed, and Medline). Inclusion criteria were as follows: (1) adults > 18years; (2) patients with breast cancer undergoing initial treatment; (3) interventions with the aim to influence the patient's physical activity, QoL, or fatigue; (4) randomized controlled trials (RCTs) of all ages. The selected studies were scored for methodological quality, and data concerning physical performance, QoL, and fatigue were extracted. Twenty-eight RCTs were included. Different treatment modalities during initial treatment were identified (radiation therapy, chemotherapy, and combination therapy), as well as different types of physical training interventions (cardiovascular endurance exercise, strengthening programs, or a combination of both). Therefore, the results were clustered with regard to the above-mentioned grouping; extracting every relevant outcome related to physical performance (6 MWT or VO2peak; grip/muscle strength), QoL (questionnaires), and fatigue (questionnaires). Different training programs (endurance, resistance, or a combination of both) were found. These programs were applied during different phases of initial treatment. Some programs were supervised while others were home based. Overall, most training interventions provided an improvement in physical performance and a decrease in perceived fatigue. QoL was the outcome variable least susceptible to improvement. Different types of exercise programs are available for rehabilitation purposes of breast cancer patients during adjuvant therapy. Overall resistance training or resistance training in combination with CV endurance training provides the best results, especially on physical performance and perceived fatigue.

Validation of a Claims-Based Frailty Index Against Physical Performance and Adverse Health Outcomes in the Health and Retirement Study.

A claims-based frailty index (CFI) was developed based on a deficit-accumulation approach using self-reported health information. This study aimed to independently validate the CFI against physical performance and adverse health outcomes. This retrospective cohort study included 3,642 community-dwelling older adults who had at least 1 health care encounter in the year prior to assessments of physical performance in the 2008 Health and Retirement Study wave. A CFI was estimated from Medicare claims data in the past year. Gait speed, grip strength, and the 2-year risk of death, institutionalization, disability, hospitalization, and prolonged (>30 days) skilled nursing facility (SNF) stay were evaluated for CFI categories (robust: <0.15, prefrail: 0.15-0.24, mildly frail: 0.25-0.34, moderate-to-severely frail: ≥0.35). The prevalence of robust, prefrail, mildly frail, and moderate-to-severely frail state was 52.7%, 38.0%, 7.1%, and 2.2%, respectively. Individuals with higher CFI had lower mean gait speed (moderate-to-severely frail vs robust: 0.39 vs 0.78 m/s) and weaker grip strength (19.8 vs 28.5 kg). Higher CFI was associated with death (moderate-to-severely frail vs robust: 46% vs 7%), institutionalization (21% vs 5%), activity of daily living disability (33% vs 9%), instrumental activity of daily living disability (100% vs 22%), hospitalization (79% vs 23%), and prolonged SNF stay (17% vs 2%). The odds ratios per 1-SD (=0.07) difference in CFI were 1.46-2.06 for these outcomes, which remained statistically significant after adjustment for age, sex, and a comorbidity index. The CFI is useful to identify individuals with poor physical function and at greater risks of adverse health outcomes in Medicare data.

Threshold of Energy Deficit and Lower-Body Performance Declines in Military Personnel: A Meta-Regression.

Negative energy balance (EB) is common during military operations, diminishing body mass and physical performance. However, the magnitude of negative EB where performance would still be maintained is not well defined. Our objective was to explore relationships between EB and physical performance during military operations and define an acceptable negative EB threshold where performance may be maintained. A systematic search was performed for studies that measured EB and physical performance during military training. A total of 632 articles and technical reports were screened. Lower-body power and strength were the most common performance tests across investigations and were used as physical performance outcomes. Data were extracted from nine eligible studies containing 15 independent subgroups. Meta-regression assessed changes in performance in relation to study duration (days), average daily EB, and total EB (daily EB × duration). Changes in physical performance were not associated with average daily EB or training duration. Total EB was associated with changes in lower-body power (r2 = 0.764, P < 0.001) and strength (r2 = 0.836, P < 0.001) independently and combined (r2 = 0.454, P = 0.002). Predictive equations generated from the meta-regression indicated that, for a zero to small (2%) decline in performance, total EB should be limited to - 5686 to - 19,109kcal, for an entire operation, whereas total EB of - 39,243 to - 59,377kcal will result in moderate (7%) to large (10%) declines in performance. These data demonstrated that greater total negative EB is associated with declines in lower-body performance during military operations.

Effects of Combined Strength and Endurance Training on Physical Performance and Biomarkers of Healthy Young Women.

Kyröläinen, H, Hackney, AC, Salminen, R, Repola, J, Häkkinen, K, and Haimi, J. Effects of combined strength and endurance training on physical performance and biomarkers of healthy young women. J Strength Cond Res 32(6): 1554-1561, 2018-Cardiovascular fitness has decreased and obesity has increased in young adults worldwide during the last 10 years. Therefore, there is an urgent need to find out optimal exercise training programs for improving physical performance and health outcomes, especially among sedentary women. Subjects were 25- to 30-year-old women with a very low physical activity, and 65% of them were overweight (body mass index > 25). They performed endurance and strength training 3 times a week for 9 weeks. Independent strength training and instructed endurance training by indoor cycling were prescribed. Measurements were performed before, in the middle, and after the training period. No nutritional guidelines were given to the subjects. The 9-week training period led to an 8.5% increase in estimated maximal oxygen uptake. Maximal isometric strength of the leg and arm extensors as well as trunk flexors and extensors increased by 28.9, 7.8, 27.2, and 16.1%, respectively. Total cholesterol values lowered by 7.6%, and high-density lipoprotein increased by 8.8%, whereas low-density lipoprotein, hemoglobin, serum glucose, and triglyceride remained unchanged. Serum cortisol increased by 22.7%, but no changes in plasma testosterone, estradiol, or sex hormone binding globulin were observed. The skeletal muscle mass increased by 0.8% without other changes in body composition. Our results indicated that only 27 combined endurance and strength training sessions in 9 weeks improved maximal endurance and strength capacity as well as some health outcomes. Thus, combined strength and endurance training itself can induce significant health benefits without the necessity of changes in dietary habits.

Quadriceps Rate of Torque Development and Disability in Persons With Tibiofemoral Osteoarthritis.

Background Declines in the ability to rapidly generate quadriceps muscle torque may underlie disability in individuals with tibiofemoral osteoarthritis. Objective To determine whether quadriceps rate of torque development (RTD) predicts self-reported disability and physical performance outcomes in individuals with tibiofemoral osteoarthritis. Methods This controlled laboratory, cross-sectional study assessed quadriceps strength and RTD in 76 individuals (55% female; mean ± SD age, 61.83 ± 7.11 years) with symptomatic and radiographic tibiofemoral osteoarthritis. Early (0-50 milliseconds), late (100-200 milliseconds), and overall peak RTDs were quantified in the symptomatic (involved) and contralateral limbs and used to calculate bilateral average values. Disability was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function subscale and 3 physical performance tests, including the (1) 20-m fast-paced walk, (2) 30-second chair stand, and (3) timed stair climb. Separate univariate regression models were used to determine the unique associations among measures of quadriceps RTD, WOMAC function score, and physical performance outcomes after accounting for quadriceps strength (change in R2). Results Greater involved-side late RTD and greater bilateral average early RTD were associated with faster walking (change in R2 = 0.05, P = .013 and change in R2 = 0.05, P = .043, respectively). Greater bilateral average late RTD was associated with faster walking (change in R2 = 0.20, P<.001) and faster stair climb (change in R2 = 0.11, P = .001). No quadriceps RTD variable was significantly associated with WOMAC function score (change in R2 range, <0.01-0.017). Conclusion Involved-limb quadriceps RTD was weakly associated with physical performance outcomes, but not self-reported disability, in individuals with tibiofemoral osteoarthritis. Bilateral average quadriceps RTD was moderately associated with walking speed. Level of Evidence Prognosis, level 2b. J Orthop Sports Phys Ther 2018;48(9):694-703. Epub 22 May 2018. doi:10.2519/jospt.2018.7898.

Body Composition Measures Associate with Physical Performance but not Disability in Individuals with Knee Osteoarthritis

Higher body mass index (BMI) is associated with more disability in individuals with knee osteoarthritis (KOA); however, BMI does not always provide accurate information about body composition, which may be a better predictor of disability in these patients. PURPOSE: Determine the associations between body composition and self-reported disability (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] function) and physical performance (20m fast-paced walk, chair-stand, stair-climb) after accounting for BMI in individuals with KOA. METHODS: Body mass and height were objectively measured, and percent fat (%FM) and lean mass (%LM) were determined using dual energy x-ray absorptiometry on 47 adults with radiographically defined KOA (Kellgren-Lawrence grade 2-4; 30% male; 60.2±8.3 yrs; BMI = 29.5±3.8 kg/m2). The WOMAC function subscale, 20m fast-paced walk (WALK), chair-stand (CHAIR), and stair-climb (STAIR) were completed on the same day. Separate linear regression analyses were conducted to determine the unique variance in WOMAC and each physical performance test explained individually by %FM and %LM after accounting for BMI ([INCREMENT]R2). Regression models accounted for sex and K-L grade, as both have been reported to associate with disability or body composition in individuals with KOA. RESULTS: Higher %FM significantly associated with better physical performance after accounting for BMI (WALK: [INCREMENT]R2 = 0.10, p = 0.03; CHAIR: [INCREMENT]R2 = 0.16, p = 0.01; STAIR: [INCREMENT]R2 = 0.13, p = 0.02). Higher %LM significantly associated with better chair-stand performance but not 20m fast-paced walk or stair-climb tests (WALK: [INCREMENT]R2 = 0.04, p = 0.17; CHAIR: [INCREMENT]R2 = 0.09, p = 0.04; STAIR: [INCREMENT]R2 = 0.08, p = 0.07). Neither %FM ([INCREMENT]R2 = 0.004, p = 0.70) nor %LM ([INCREMENT]R2 = 0.001, p = 0.84) associated with WOMAC after accounting for BMI. BMI did not explain a significant amount of variance in WOMAC or physical performance outcomes (R2 range = 0.004 - 0.07, p > 0.05) as part of any regression model. CONCLUSIONS: Lower %FM and higher %LM associated with better physical performance but not WOMAC. BMI did not significantly associate with WOMAC or physical performance. Future interventions should seek to increase %LM and decrease %FM, rather than focusing on overall reduction in BMI to improve physical performance. Supported by: NIH NIAMS 1R21AR067560-01.

Quadriceps weakness preferentially predicts detrimental gait compensations among common impairments after total knee arthroplasty.

Patients with total knee arthroplasty (TKA) have large deficits in physical performance in comparison to their healthy age-matched peers. Limb asymmetry stemming from less relative load borne by the surgical limb during daily mobility is associated with diminished performance and worsens with greater mobility demands. How common targets of postoperative care, such as muscle weakness, lower limb extension power, residual knee pain, and poor balance confidence can influence asymmetrical limb loading remains unclear. Forty-six patients with unilateral TKA underwent testing of impairments and motion analysis during 10° decline walking at 3 and 6 months postoperatively. At 3 months, only quadriceps femoris strength asymmetry was found to be significantly related to both total support moment (MT ) (β = 0.431; p < 0.001) and knee extensor moment (MK ) (β = 0.493; p < 0.001) asymmetry. Again at 6 months, only quadriceps strength asymmetry was related to MT (β = 0.432; p < 0.001) and MK (β = 0.534; p < 0.001) asymmetry. Quadriceps strength significantly improved over time in both limbs, however, deficits between limbs remained. Persistent quadriceps weakness is a key factor associated with walking compensation patterns that are limiting the capacity for greater physical performance of patients with TKA. The pronounced asymmetry in limb and knee loading at 3 months remains unchanged until at least 6 months after surgery, and its association with quadriceps strength asymmetry does not substantially change over time. While other factors may also prompt gait compensations, emphasis on improved quadriceps strength should be a focus of efforts to resolve gait compensations and enhance physical performance outcomes. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2355-2363, 2018.

Yoga for Persons With HIV-Related Distal Sensory Polyneuropathy: A Case Series

Purpose: Distal sensory polyneuropathy (DSP) is the most common neurologic complication of human immunodeficiency virus (HIV) disease. DSP-related symptoms have been associated with disability, reduced quality of life (QOL), and impaired function. Yoga has been shown to improve mental and physical status in people with chronic diseases. We assessed feasibility and measured the effect of a 4-week integrative yoga program in 3 persons with HIV-related DSP in the lower extremities. Case Description: Of 22 patients with DSP scheduled to attend an HIV pain clinic over 6 months, 3 enrolled in and completed the yoga program. Inclusion criteria were diagnosis of HIV disease and DSP in the feet, controlled HIV disease status, average foot pain of at least 4/10 on a numerical scale, sensory symptoms in the lower extremity, and an established regimen of pharmacologic pain management. The age range of participants was 56 to 64 years. Time since HIV disease diagnosis ranged from 15 to 30 years; time with DSP ranged from 7 to 15 years. A battery of QOL, function, disability, pain, and physical performance outcomes was measured at baseline, after the yoga intervention, and at 4-week follow-up. Outcomes: Overall attendance rate at the yoga classes was 88%. No adverse events occurred, and participants were highly satisfied with the program. Pain-related QOL and some gait parameters improved in all cases. It appeared that pain-related QOL improved without concurrent reduction in perceived pain severity or interference. Other outcomes, such a walking endurance, balance, and function, improved in some cases, but changes were inconsistent between individuals. No cases demonstrated improvement in vibration sensation or leg strength, nor reduction in self-reported disability. Conclusions: Although recruitment challenges led to concern regarding feasibility of this intervention, the program appeared to be safe and viewed favorably by the participants. There were inconsistent outcomes between individual participants; however, all experienced improved pain-related QOL and improvement in some gait characteristics. Yoga may be a viable nonpharmaceutical approach to the management of HIV-related DSP, but further research is needed to assess effectiveness, identify optimal format and dosage, and determine characteristics of potential responders.

Can a single session of motor imagery promote motor learning of locomotion in older adults? A randomized controlled trial.

PurposeTo investigate the influence of a single session of locomotor-based motor imagery training on motor learning and physical performance.Patients and methodsThirty independent adults aged >65 years took part in the randomized controlled trial. The study was conducted within an exercise science laboratory. Participants were randomly divided into three groups following baseline locomotor testing: motor imagery training, physical training, and control groups. The motor imagery training group completed 20 imagined repetitions of a locomotor task, the physical training group completed 20 physical repetitions of a locomotor task, and the control group spent 25 minutes playing mentally stimulating games on an iPad. Imagined and physical performance times were measured for each training repetition. Gait speed (preferred and fast), timed-up-and-go, gait variability and the time to complete an obstacle course were completed before and after the single training session.ResultsMotor learning occurred in both the motor imagery training and physical training groups. Motor imagery training led to refinements in motor planning resulting in imagined movements better matching the physically performed movement at the end of training. Motor imagery and physical training also promoted improvements in some locomotion outcomes as demonstrated by medium to large effect size improvements after training for fast gait speed and timed-up-and-go. There were no training effects on gait variability.ConclusionA single session of motor imagery training promoted motor learning of locomotion in independent older adults. Motor imagery training of a specific locomotor task also had a positive transfer effect on related physical locomotor performance outcomes.

Impacts of persistent general and site‐specific pain on activities of daily living and physical performance: A prospective analysis of the English Longitudinal Study of Ageing

Pain is an increasingly common phenomenon as people age; pain over a long period can result in limited functioning. The present study investigated the impacts of general and multisite-specific pain on activities of daily living and physical performance among older adults. Data were analyzed from the English Longitudinal Study of Ageing, a representative sample of the population aged ≥50 years. Face-to-face interview and nurse records were used from waves 2-6 (2004-2012) for analyses. General and site-specific pain (back, hip and knee) were measured biennially between 2004 and 2008 (n = 5010). Impaired activity of daily living and physical performance measures (chair rise and grip strength) between 2008 and 2012 were aggregated across assessments as outcomes. Multinomial logistic regressions were used for the former and linear regression for the latter, adjusting for potential covariates. General pain (moderate-to-severe) was prevalent, with close to one-quarter of participants reporting pain at least twice during the follow-up period. Multisite pain reports were strong predictors of subsequent limited activities of daily living (adjusted odds ratio range 1.86-3.97 for back and hip, 2.04-4.19 for back and knee, and 2.08-5.16 for hip and knee). Persistent pain was also strongly associated with worse physical performance outcomes. Our data confirm the longitudinal impacts of persistent pain among older adults. The findings highlight the value of monitoring and management of both general and site-specific pain in order to promote sustained independence at older ages. Geriatr Gerontol Int 2018; 18: 1051-1057.

Impact of Visceral Obesity and Sarcopenia on Short-Term Outcomes After Colorectal Cancer Surgery.

With the increased prevalence of obesity and sarcopenia, those patients with both visceral obesity and sarcopenia were at higher risk of adverse outcomes. The aim of this study was to ascertain the combined impact of visceral obesity and sarcopenia on short-term outcomes in patients undergoing colorectal cancer surgery. We conducted a prospective study from July 2014 to February 2017. Patients' demographic, clinical characteristics, physical performance, and postoperative short-term outcomes were collected. Patients were classified into four groups according to the presence of sarcopenia or visceral obesity. Clinical variables were compared. Univariate and multivariate analyses evaluating the risk factors for postoperative complications were performed. A total of 376 patients were included; 50.8 and 24.5% of the patients were identified as having "visceral obesity" and "sarcopenia," respectively. Patients with sarcopenia and visceral obesity had the highest incidence of total, surgical, and medical complications. Patients with sarcopenia or/and visceral obesity all had longer hospital stays and higher hospitalization costs. Age ≥ 65years, visceral obesity, and sarcopenia were independent risk factors for total complications. Rectal cancer and visceral obesity were independent risk factors for surgical complications. Age ≥ 65years and sarcopenia were independent risk factors for medical complications. Laparoscopy-assisted operation was a protective factor for total and medical complications. Patients with both visceral obesity and sarcopenia had a higher complication rate after colorectal cancer surgery. Age ≥ 65years, visceral obesity, and sarcopenia were independent risk factors for total complications. Laparoscopy-assisted operation was a protective factor.

Do Pain Coping and Pain Beliefs Associate With Outcome Measures Before Knee Arthroplasty in Patients Who Catastrophize About Pain? A Cross-sectional Analysis From a Randomized Clinical Trial.

Pain-coping strategies and appraisals are responses to the pain experience. They can influence patient-reported and physical performance outcome measures in a variety of disorders, but the associations between a comprehensive profile of pain-coping responses and preoperative pain/function and physical performance measures in patients scheduled for knee arthroplasty have not been examined. Patients with moderate to high pain catastrophizing (a pain appraisal approach associated with an exaggerated focus on the threat value of pain) may represent an excellent study population in which to address this knowledge gap. We asked the following questions among patients with high levels of pain catastrophizing who were scheduled for TKA: (1) Do maladaptive pain responses correlate with worse self-reported pain intensity and function and physical performance? (2) Do adaptive pain-coping responses show the opposite pattern? As an exploratory hypothesis, we also asked: (3) Do maladaptive responses show more consistent associations with measures of pain, function, and performance as compared with adaptive responses? A total of 384 persons identified with moderate to high levels of pain catastrophizing and who consented to have knee arthroplasty were recruited. The sample was 67% (257 of 384) women and the mean age was 63 years. Subjects were consented between 1 and 8 weeks before scheduled surgery. All subjects completed the WOMAC pain and function scales in addition to a comprehensive profile of pain coping and appraisal measures and psychologic health measures. Subjects also completed the Short Physical Performance Battery and the 6-minute walk test. For the current study, all measures were obtained at a single point in time at the preoperative visit with no followup. Multilevel multivariate multiple regression was used to test the hypotheses and potential confounders were adjusted for in the models. Maladaptive pain responses were associated with worse preoperative pain and function measures. For example, the maladaptive pain-coping strategy of guarding and the pain catastrophizing appraisal measures were associated with WOMAC pain scores such that higher guarding scores (β = 0.12, p = 0.007) and higher pain catastrophizing (β = 0.31, p < 0.001) were associated with worse WOMAC pain; no adaptive responses were associated with better WOMAC pain or physical performance scores. Maladaptive responses were also more consistently associated with worse self-reported and performance-based measure scores (six of 16 associations were significant in the hypothesized direction), whereas adaptive responses did not associate with better scores (zero of 16 scores were significant in the hypothesized direction). The maladaptive responses of guarding, resting, and pain catastrophizing were associated with worse scores on preoperative pain and performance measures. These are pain-related responses surgeons should consider when assessing patients before knee arthroplasty. TKA candidates found to have these pain responses may be targets for treatments that may improve postoperative outcome given that these responses are modifiable. Future intervention-based research should target this trio of maladaptive pain responses to determine if intervention leads to improvements in postsurgical health outcomes. Level I, prognostic study.

Pilot Randomized Controlled Trial of a Home Vegetable Gardening Intervention among Older Cancer Survivors Shows Feasibility, Satisfaction, and Promise in Improving Vegetable and Fruit Consumption, Reassurance of Worth, and the Trajectory of Central Adiposity

BackgroundHolistic approaches are sought to improve lifestyle behaviors and health of cancer survivors long term. ObjectiveOur aim was to explore whether a home-based vegetable gardening intervention is feasible and whether it improves diet and other health-related outcomes among older cancer survivors. DesignWe conducted a feasibility trial in which cancer survivors were randomized to receive a year-long gardening intervention immediately or to a wait-list control arm. Home visits at baseline and 1 year assessed physical performance, anthropometric indices, behavioral and psychosocial outcomes, and biomarkers. Participants/settingParticipants included 46 older (aged 60+ years) survivors of locoregionally staged cancers across Alabama from 2014 to 2016. Forty-two completed 1-year follow-up. InterventionCooperative extension master gardeners delivered guidance to establish three seasonal vegetable gardens at survivors’ homes. Plants, seeds, and gardening supplies were provided. OutcomesPrimary outcomes were feasibility targets of 80% accrual and retention, and an absence of serious adverse events; other outcomes were secondary and explored potential benefits. Statistical analysesBaseline to follow-up changes were assessed within and between arms using paired t, McNemar’s, and χ2 tests. ResultsThis trial proved to be safe and demonstrated 91.3% retention; 70% of intervention participants rated their experience as “excellent,” and 85% would “do it again.” Data suggest significantly increased reassurance of worth (+0.49 vs −0.45) and attenuated increases in waist circumference (+2.30 cm vs +7.96 cm) in the gardening vs control arms (P=0.02). Vegetable and fruit consumption increased by approximately 1 serving/day within the gardening arm from baseline to follow-up (mean [standard error]=1.34 [1.2] to 2.25 [1.9] servings/day; P=0.02)] compared to controls (1.22 [1.1] to 1.12 [0.7]; P=0.77; between-arm P=0.06). ConclusionsThe home vegetable gardening intervention among older cancer survivors was feasible and suggested improvements in vegetable and fruit consumption and reassurance of worth; data also suggest attenuated increases in waist circumference. Continued study of vegetable gardening interventions is warranted to improve health, health behaviors, and well-being of older cancer survivors.