Physical Performance Test Score Research Articles

Association between reduced physical performance measures and short-term consequences after major emergency abdominal surgery: a prospective cohort study

BackgroundMajor emergency abdominal surgery is associated with high morbidity with outcomes worse than for similar elective surgery, including complicated physical recovery, increased need for rehabilitation, and prolonged hospitalisation.PurposeTo investigate whether low physical performance test scores were associated with an increased risk of postoperative complications, and, furthermore, to investigate the feasibility of postoperative performance tests in patients undergoing major emergency abdominal surgery. We hypothesize that patients with low performance test scores suffer more postoperative complications.MethodsThe study is a prospective observational cohort study including all patients who underwent major abdominal surgery at the Department of Surgery at Zealand University Hospital between 1st March 2017 and 31st January 2019. Patients were evaluated with De Morton Mobility Index (DEMMI) score, hand grip strength, and 30-s chair-stand test.ResultsThe study included 488 patients (median age 69, 50.6% male). Physiotherapeutic evaluation including physical performance tests with DEMMI and hand grip strength in the immediate postoperative period were feasible in up to 68% of patients undergoing major emergency abdominal surgery. The 30-s chair-stand test was less viable in this population; only 21% of the patients could complete the 30-s chair-stand test during the postoperative period. In logistic regression models low DEMMI score (< 40) and ASA classification and low hand grip strength (< 20 kg for women, < 30 kg for men were independent risk factors for the development of postoperative severe complications Clavien–Dindo (CD) grade ≥ 3.ConclusionsIn patients undergoing major emergency surgery low performance test scores (DEMMI and hand grip strength), were independently associated with the development of significant postoperative complications CD ≥ 3.

Age-Related Reference Intervals for Physical Performance Test Outcomes Relevant to Male Youth Middle Eastern Football Players.

To develop age-specific reference intervals for physical performance test outcomes relevant to male youth Middle Eastern football players. We analyzed mixed-longitudinal data (observations range: 1751-1943 assessments) from a sample of 441 male youth outfield football players (chronological age range: 11.7-18.4y) as part of the Qatar Football Association and Aspire Academy development program over 14 competitive seasons. Semiparametric generalized additive models for location, scale, and shape estimated age-specific reference centiles for 10-m sprinting, 40-m sprinting, countermovement jump height, and maximal aerobic speed variables. The estimated reference intervals indicated that the distribution of the physical performance test scores increased monotonically and nonlinearly with advancing chronological age for sprinting and countermovement jump outcome measures, reaching a plateau after 16years common to each of these performance variables. The maximal aerobic speed median score increased substantially until ∼14.5years, with the nonlinear trend flattening off toward relatively older chronological ages. We developed age-related reference intervals for physical performance test outcomes relevant to youth Qatari football players. Country-wide age-specific reference intervals can assist in the longitudinal tracking of the individual players' progress over time against benchmark values derived from the reference population.

Prospective sarcopenia outcomes associated with physical performance in individuals aged 55 years and over in Malaysia.

While the potential of physical performance tests as screening tools for sarcopenia is evident, limited information on relevant reference values for sarcopenia detection. In this study, we aimed to establish the prospective relationship between physical performance tests, including time up and go (TUG), functional reach (FR), gait speed (GS), and hand grip strength (HGS) with five-year sarcopenia risk and to determine suitable cut-off values for screening activities. This was a prospective study utilizing data from the Malaysian Elders Longitudinal Research (MELoR) study, which involved community-dwelling older adults aged 55 years and above at recruitment. Baseline (2013-2015) and wave 3 (2019) data were analyzed. Sarcopenia risk was determined using the strength, assistance walking, rising from a chair, climbing stairs, and falls (SARC-F) tool, with SARC-F ≥ 4 indicating sarcopenia. Baseline physical performance test scores were dichotomized using ROC-determined cut-offs. Data were available from 774 participants with mean age of 68.13 (SD = 7.13) years, 56.7% women. Cut-offs values for reduced GS, TUG, FR, and HGS were: <0.7 m/s (72.9% sensitivity and 53% specificity), >11.5 s (74.2%; 57.2%), <22.5 cm (73%; 54.2%) and HGS male <22 kg (70.0%; 26.7%) and female <17 kg (70.0%; 20.3%) respectively. Except for FR = 1.76 (1.01-3.06), GS = 2.29 (1.29-4.06), and TUG = 1.77 (1.00-3.13) were associated with increased sarcopenia risk after adjustments for baseline demographics and sarcopenia. The defined cut-off values may be useful for the early detection of five-year sarcopenia risk in clinical and community settings. Despite HGS being a commonly used test to assess strength capacity in older adults, we advocate alternative strength measures, such as the sit-to-stand test, to be included in the assessment. Future studies should incorporate imaging modalities in the classification of sarcopenia to corroborate current study findings.

Physical performance tasks were linked to the PROMIS physical function metric in patients undergoing hemodialysis

ObjectivesTo investigate whether a multi-item performance outcome measure, the physical performance test (PPT), can be calibrated to a common scale with patient-reported outcome measures, using the Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) metric. Study Design and SettingWe analyzed baseline data (N = 1,113) from the CONVINCE study, an international trial in end-stage kidney disease patients comparing high-dose hemodiafiltration with high-flux hemodialysis. Assumptions of item response theory (IRT) modelling were investigated for the combined set of the nine-item PPT and a four-item PROMIS PF short form (PROMIS-PF4a). We applied unidimensional IRT linking for calibrating the PPT to the PROMIS PF metric. ResultsAlthough some evidence for multidimensionality was found, classical test statistics (Cronbach's Alpha = 0.93), Mokken (Loevinger's H = 0.50), and bifactor analysis (explained common variance = 0.65) indicated that PPT and PROMIS-PF4a items can be used to assess a common PF construct. On the group level, the agreement between PROMIS-PF4a and linked PPT scores was stable across several subsamples. On the individual level, scores differed considerably. ConclusionWe found preliminary evidence that the PPT can be linked to the PROMIS PF metric in hemodialysis patients, enabling group comparisons across patient-reported outcome and performance outcome measures. Alternative linking methods should be applied in future studies using a more comprehensive PROMIS PF item set.

Comparaison de la valeur prédictive d’un test de performance physique standardisé à celle du phénotype de fragilité selon Fried pour les événements indésirables chez les octogénaires

The population of adults aged 80 years and older is heterogenous with some being robust and others having a higher risk for adverse events. This study compares the predictive value of two tools used to identify older adults who are at higher risk for adverse outcomes: frailty phenotype according to Fried and a standardized physical performance test. The BELFRAIL population-based cohort of 567 community-dwelling adults aged 80 years and older living in Belgium. Fried frailty phenotype and physical performance test (gait, chair stand, standing balance tests and putting on and off a cardigan). The predictive value of the two tools in predicting mortality (up to 5.1 ± 0.25 years), hospitalization (3.0 ± 0.25 years) and decline in activities of daily living (after 1.7 ± 0.21 years) was compared using reclassification statistics and decision curve analysis. Frail participants according to Fried phenotype and those in the lowest quartile of the physical performance test score had higher risk for mortality and hospitalization. Harrell C and area under operator curve were similar (< 0.70). Reclassification statistics and net benefit in decision curve analysis showed no significant difference between the two tools in identifying higher risk for mortality, hospitalization and functional decline. In a cohort of community-dwelling adults 80 years and older a standardized physical performance test was as good as the Fried frailty phenotype in identifying higher risk for adverse outcomes.

Lifestyle Intervention Strategy to Treat Diabetes in Older Adults: A Randomized Controlled Trial.

Lifestyle intervention is recommended as first-line treatment of diabetes at all ages; however, little is known about the efficacy of lifestyle intervention in older adults with diabetes. We aimed to determine whether lifestyle intervention would improve glycemic control and age-relevant outcomes in older adults with diabetes and comorbidities. A total of 100 older adults with diabetes were randomly assigned to 1-year intensive lifestyle intervention (ILI) (diet and exercise at a facility transitioned into community-fitness centers and homes) or healthy lifestyle (HL) group. The primary outcome was change in HbA1c. Secondary outcomes included glucoregulation, body composition, physical function, and quality of life. Changes between groups were analyzed with mixed-model repeated-measures ANCOVA following the intention-to-treat principle. HbA1c improved more in the ILI than the HL group (mean ± SE -0.8 ± 0.1 vs. 0.1 ± 0.1%), associated with improved insulin sensitivity (1.2 ± 0.2 vs. -0.4 ± 0.2) and disposition (26.0 ± 8.9 vs. -13.0 ± 8.4 109 min-1) indices (between-group P < 0.001 to 0.04). Body weight and visceral fat decreased more in the ILI than HL group (-8.4 ± 0.6 vs. -0.3 ± 0.6 kg, P < 0.001, and -261 ± 29 vs. -30 ± 27 cm3, P < 0.001, respectively). Physical Performance Test score increased more in the ILI than HL group (2.9 ± 0.6 vs. -0.1 ± 0.4, P < 0.001) as did VO2peak (2.2 ± 0.3 vs. -1.2 ± 0.2 mL/kg/min, P < 0.001). Strength, gait, and 36-Item Short Form Survey (SF-36) Physical Component Summary score also improved more in the ILI group (all P < 0.001). Total insulin dose decreased in the ILI group by 19.8 ± 4.4 units/day. Adverse events included increased episodes of mild hypoglycemia in the ILI group. A lifestyle intervention strategy is highly successful in improving metabolic and functional health of older adults with diabetes.

The Indirect Effects of Right Wing Authoritarianism and Ambivalent Sexism in Cadets' Opinions on the Fairness of RMC's Physical Performance Test

In an effort to create an inclusive culture, the Canadian Armed Forces (CAF) has been attempting to eradicate sexism within its ranks (Scoppio, 2019). Despite these efforts, female soldiers continue to face discrimination in the CAF. At the Royal Military College of Canada (RMC), cadets must complete a physical performance test (PPT), in which male and female cadets are scored differently according to sex due to biological differences. Evidence shows that the separate marking scheme creates a divide between the sexes, as female cadets feel that their PPT scores are taken less seriously than male cadets and male cadets denigrate the PPT scores obtained by female cadets (Scoppio, 2019). Right wing authoritarianism (RWA), ambivalent sexism (AS), and its two subscales, benevolent sexism (BS) and hostile sexism (HS) may help explain attitudes regarding gender fairness of PPT scores. Results from a sample of 169 cadets' revealed that the relationship between RWA and BS and RWA and AS do not significantly predict opinions on the PPT and the indirect effects were not significant. However, the indirect effects between RWA, HS, and attitudes regarding the PPT were significant.

Effects of a 3-Week Inpatient Multidisciplinary Body Weight Reduction Program on Body Composition and Physical Capabilities in Adolescents and Adults With Obesity.

BackgroundThe aim of the present study was to examine the short-term changes in body composition and physical capabilities in subjects with obesity during a multidisciplinary inpatient body weight reduction program (BWRP).MethodsOne hundred thirty-nine adolescents (56 boys and 83 girls; BMI: 37.1 ± 6.5 kg/m2; Fat Mass, FM: 45.3 ± 7.2%) and 71 adults (27 males and 44 females; BMI: 44 ± 4.7 kg/m2; FM: 51.4 ± 4.7%) followed a 3-week inpatient BWRP consisting of regular physical activity, moderate energy restriction, nutritional education and psychological counseling. Before (T0) and after the end of the BWRP (T21), body composition was assessed with an impedancemeter, lower limb muscle power with Margaria Stair Climbing Test (SCT), lower limb functionality with Short Physical Performance Battery (SPPB), and the capacity of performing activity of daily living (ADL) with Physical Performance Test (PPT).ResultsAt T21, obese adolescents showed a 4% reduction in body mass (BM) (p < 0.001), associated with a FM reduction in boys (−10%) and girls (−6%) (p < 0.001) and with a 3% reduction in fat-free mass (FFM) recorded only in boys (p = 0.013). Obese adults showed a 5% BM reduction (p < 0.001), associated with a 2% FFM and 9% FM reduction (p < 0.001) in males, and 7% FM reduction in females (p < 0.001). Regarding physical capabilities, at T21 in obese adolescents, PPT score increased by 4% (p < 0.001), SCT decreased by −5% (boys) and −7% (girls) (p < 0.001), while SPPB score did not change significantly. In obese adults at T21, PPT score increased by 9% (p < 0.001), SCT decreased by −16% (p < 0.001) only in females, and SPPB score increased by 7% (males) and 10% (females) (p < 0.01).ConclusionIn conclusion, moderate energy restriction and regular physical activity determine a 4-5% BM reduction during a 3-week inpatient BWRP, improve physical capabilities and induce beneficial changes in body composition in adolescents and adults with obesity.Trial registrationThis study was approved by the Ethical Committee of the Istituto Auxologico Italiano (Milan, Italy; research code: 01C124; acronym: PRORIPONATFIS). Registered 11 November 2020 - Retrospectively registered.

Reference values for performance test outcomes relevant to English female soccer players

The purpose of this study was to present reference standards for physical performance test outcomes relevant to elite female soccer players. We analysed mixed-longitudinal data (n = 1715 observations) from a sample of 479 elite youth and senior players as part of the English Football Association’s national development programme (age range: 12.7 to 36.0 years). Semi-parametric generalized additive models for location, scale and shape (GAMLSS) estimated age-related reference centiles for 5-m sprinting, 30-m sprinting, countermovement jump (CMJ) height, and Yo-Yo Intermittent Recovery Test Level 1 (Yo-Yo IR1) performance. The estimated reference centiles indicated that the median of the distribution of physical performance test scores varied non-linearly with advancing chronological age, improving until around 25 years for each performance variable. These are the first reference ranges for performance test outcomes in elite English female soccer players. These data can assist practitioners when interpreting physical test performance outcomes to track an individual’s progress over time and support decision making regarding player recruitment and development.

Comparison Between the Physical Performance Test and the Clinical Frailty Score in Adult Patients With Chronic Kidney Disease Treated by Haemodialysis.

Elderly patients with chronic kidney disease treated by haemodialysis are at increased risk of malnutrition and cachexia, becoming frail, with associated greater mortality. The physical performance test (PPT), using nine tasks to assess multiple domains of physical function is robust and reproducible, but time consuming, whereas the clinical frailty score (CFS) is more rapid. We compared the results from independent blinded observers in 22 haemodialysis patients, 16 (72.7%) male, mean age 65 ± 12.5 years. The PPT and CFS scores were highly correlated (r = −0.88, p < .001), with a high level of agreement (kappa score 0.91) for classifying patients as frail. Both scores were strongly associated with serum creatinine (PPT r=0.76, CFS r=−0.86, p < .001), hand grip strength (PPT r = 0.68, p = .001 CFS r = 0.64, p = .002), lean body mass index (PPT r = 0.50, p = .02, CFS r = −0.46, p = .038). We found that the CFS performed favourably compared to the PPT for haemodialysis patients in identifying and screening patients for frailty.

Skeletal muscle mitochondrial DNA copy number and mitochondrial DNA deletion mutation frequency as predictors of physical performance in older men and women.

Mitochondrial DNA (mtDNA) quality and quantity relate to two hallmarks of aging-genomic instability and mitochondrial dysfunction. Physical performance relies on mitochondrial integrity and declines with age, yet the interactions between mtDNA quantity, quality, and physical performance are unclear. Using a validated digital PCR assay specific for mtDNA deletions, we tested the hypothesis that skeletal muscle mtDNA deletion mutation frequency (i.e., a measure of mtDNA quality) or mtDNA copy number predicts physical performance in older adults. Total DNA was isolated from vastus lateralis muscle biopsies and used to quantitate mtDNA copy number and mtDNA deletion frequency by digital PCR. The biopsies were obtained from a cross-sectional cohort of 53 adults aged 50 to 86 years. Before the biopsy procedure, physical performance measurements were collected, including VO2max, modified physical performance test score, 6-min walk distance, gait speed, grip strength, and total lean and leg mass. Linear regression models were used to evaluate the relationships between age, sex, and the outcomes. We found that mtDNA deletion mutation frequency increased exponentially with advancing age. On average from ages 50 to 86, deletion frequency increased from 0.008 to 0.15%, an 18-fold increase. Females may have lower deletion frequencies than males at older ages. We also measured declines in VO2max and mtDNA copy number with age in both sexes. The mtDNA deletion frequency measured from single skeletal muscle biopsies predicted 13.3% of the variation in VO2max. Copy number explained 22.6% of the variation in mtDNA deletion frequency and 10.4% of the lean mass variation. We found predictive relationships between age, mtDNA deletion mutation frequency, mtDNA copy number, and physical performance. These data are consistent with a role for mitochondrial function and genome integrity in maintaining physical performance with age. Analyses of mtDNA quality and quantity in larger cohorts and longitudinal studies could extend our understanding of the importance of mitochondrial DNA in human aging and longevity.

Testosterone Replacement Therapy Added to Intensive Lifestyle Intervention in Older Men With Obesity and Hypogonadism

Obesity and hypogonadism additively contribute to frailty in older men; however, appropriate treatment remains controversial. Determine whether testosterone replacement augments the effect of lifestyle therapy on physical function in older men with obesity and hypogonadism. Randomized, double-blind, placebo-controlled trial. VA Medical Center. 83 older (age ≥65 years) men with obesity (body mass index ≥30 kg/m2) and persistently low am testosterone (<10.4 nmol/L) associated with frailty. Participants were randomized to lifestyle therapy (weight management and exercise training) plus either testosterone (LT+Test) or placebo (LT+Pbo) for 6 months. Primary outcome was change in Physical Performance Test (PPT) score. Secondary outcomes included other frailty measures, body composition, hip bone mineral density (BMD), physical functions, hematocrit, prostate specific antigen (PSA), and sex hormones. PPT score increased similarly in LT+Test and LT+Pbo group (17% vs. 16%; P = 0.58). VO2peak increased more in LT+Test than LT+Pbo (23% vs. 16%; P = 0.03). Despite similar -9% weight loss, lean body mass and thigh muscle volume decreased less in LT+Test than LT+Pbo (-2% vs. -3%; P = 0.01 and -2% vs -4%; P = 0.04). Hip BMD was preserved in LT+Test compared with LT+Pbo (0.5% vs -1.1%; P = 0.003). Strength increased similarly in LT+Test and LT+Pbo (23% vs 22%; P = 0.94). Hematocrit but not PSA increased more in LT+Test than LT+Pbo (5% vs 1%; P < 0.001). Testosterone levels increased more in LT+Test than LT+Pbo (167% vs 27%; P < 0.001). In older, obese hypogonadal men, adding testosterone for 6 months to lifestyle therapy does not further improve overall physical function. However, our findings suggest that testosterone may attenuate the weight loss-induced reduction in muscle mass and hip BMD and may further improve aerobic capacity.

OR02-05 Effect of Testosterone Replacement Therapy Added to Intensive Lifestyle Intervention on Cognitive Functions in Frail, Older Veterans with Hypogonadism and Obesity: A Randomized Clinical Trial

Background: Both hypogonadism and obesity are common in older men which might additively exacerbate their age-related decline in cognitive functions. We tested the hypothesis that the addition of testosterone replacement therapy to intensive lifestyle intervention would enhance the benefits of intensive lifestyle intervention on cognition in older men with hypogonadism and obesity. Methods: Eighty-three older (age≥65 years) male veterans with obesity (BMI≥30 kg/m2) and evidence of persistently low AM testosterone (<300 ng/dl) associated with frailty (modified Physical Performance Test score <31) were randomized to six months of: 1) lifestyle therapy (diet-induced weight loss and supervised aerobic and resistance exercise training) + testosterone replacement therapy (LT+Test) or 2) lifestyle therapy + placebo (LT+Pbo). In this secondary analyses, outcomes were changes in cognition as assessed through comprehensive cognitive test battery (Modified Mini-Mental State Exam, Word Fluency Test, Trail Making Test Parts A and B Rey Auditory Verbal Learning Test, Stroop Color and Word Test, and Symbol Digit Modalities Test). We used z scores of changes in the cognitive tests to assess changes in attention, memory, executive function, language, global, and composite cognitive functions in response to the lifestyle and hormonal interventions. Results: After 6 months, body weight decreased similarly in the LT+Test group and LT+Pbo group (decrease of 9.7 kg vs. 10.3 kg, respectively; P=0.91) whereas testosterone levels increased more in the LT+Test than in the LT+Pbo group (increase of 324 ng/dl vs 88 ng/dl, respectively; P<0.001). Memory z-score increased more in the LT+Test group than in the LT+Pbo group (0.73 vs. 0.39, respectively; P=0.03). Moreover, attention z-score increased more in the LT+Test group than in the LT+Pbo group (0.89 vs. 0.38, respectively; P=0.01). On the other hand, changes in executive function z-score, language z-score, and global z-score did not significantly differ between the LT+Test group and LT+Pbo group (0.45 vs 0.37, 0.34 vs 0.07, and 0.55 vs 0.29, respectively; P=0.13 to 0.56). More importantly, the composite cognitive z-score obtained by averaging all z-scores from each domain increased more in the LT+Test group than in the LT+Pbo group (0.56 vs 0.27; P=0.003). Conclusion: These findings suggest that in the specific population of older men with hypogonadism and obesity associated with frailty, testosterone replacement therapy can augment the positive effects on cognition from intensive lifestyle intervention by diet-induced weight loss and combined aerobic and resistance exercise.

Observed Physical Function Is Associated With Better Cognition Among Elderly Adults: The Adventist Health Study-2.

Lifestyle factors may individually protect against the development of mild cognitive impairment. We investigate the relationships between both self-reported physical activity and measured physical function with cognition in a population of elderly adults, more than half of whom follow vegetarian dietary patterns. Otherwise healthy adults (n = 127, mean age 74.9 ± 7.9 years, 61.3% current vegetarians) were assessed using a comprehensive neuropsychological battery. A principal components analysis derived processing speed, executive function, and memory/language factors. Participants reported current levels of vigorous physical activity on questionnaires, and physical function and mobility were measured with the Physical Performance Test (PPT) and Timed Up and Go (TUG) Test. Generalized linear models estimated β coefficients for cross-sectional associations between cognitive factors and indicators of physical abilities and self-reported physical activity. Better physical function indicated by PPT was associated with higher scores on the processing speed factor (β = 0.21 SDs for each 4.4-point increase in PPT score; p = 0.02). Faster TUG times were also associated with higher processing speed factor scores (β = 0.21 SDs increase for each 2.8 second less TUG time; p = 0.02). Self-reported levels of vigorous physical activity were not associated with any area of cognitive function; the association between PPT, TUG and processing speed was independent of physical activity. Associations between PPT and TUG and processing speed were stronger among participants who followed vegetarian dietary patterns. Better physical function may have an effect on cognition in a context of healthy lifestyles.

Influences of Resistance Training on Physical Function in Older, Obese Men and Women With Sarcopenia.

Sarcopenic obesity is associated with disability, gait problems, and falls. Activities of daily living such as walking and climbing stairs are physically difficult or impossible for the individual with severe obesity. These aspects also limit participation in recreational activities or exercise programs. However, good muscle function is crucial to maintain functional independence. The objective of this study was to investigate the influence of resistance training on physical function in older, obese persons with sarcopenia. The study was conducted in a pre-test/post-test design with 2 intervention groups. The participants were physically inactive and obese older adults (≥65 years, BMI ≥ 30 kg/m), without severe diseases. They were divided into a group with sarcopenia (SAR, n = 28) and a group with no or presarcopenia (NSAR, n = 20). The intervention consisted of progressive resistance training, undertaken twice a week for 16 weeks, increasing to 80% to 85% of maximum strength with 3 sets of 8 to 12 repetitions. Sarcopenia was assessed using the Short Physical Performance Battery (SPPB), hand-grip strength, and skeletal muscle mass index (SMI). In addition, the modified Physical Performance Test (PPT) and the Functional Reach Test were used for determining physical function. After training, participants in the SAR group were able to significantly increase their performance in hand-grip strength (by 9%), gait speed (by 5%), SPPB score (by 13%), and modified PPT score (by 11%). In SPPB and modified PPT, they could reach the values of the NSAR group's baseline performance. The NSAR group participants were also able to improve their already good performance at baseline in the 2 tests of physical function after training (SPPB score by 10%, modified PPT score by 7%). However, the participants of both groups could not increase the results of the SMI and the Functional Reach Test. The participants of both groups improved their physical performance in several parameters after training. The results also showed that older, obese adults with sarcopenia benefitted from resistance training. The increase in muscle function can support them having a life with functional independence, and this can help reduce the risk of disability and falls.

Sex differences in response to targeted kyphosis specific exercise and posture training in community-dwelling older adults: a randomized controlled trial

BackgroundHyperkyphosis, an excessive anterior curvature in the thoracic spine, is associated with reduced health status in older adults. Hyperkyphosis is highly prevalent, more common in older women than men. There is no standard intervention to reduce age-related hyperkyphosis. Sex differences in response to a kyphosis-specific exercise intervention are not known.MethodsWe conducted a randomized controlled trial of a targeted kyphosis-specific exercise and postural training program on the primary outcome Cobb angle of kyphosis, and investigated whether the magnitude of change differed between men and women. One hundred twelve participants aged ≥60 years with kyphosis ≥40° were enrolled and randomized to exercise or waitlist control, and 101 participants had analyzable baseline and follow-up radiographs for Cobb angle measurements. A group intervention including 10 participants per group was delivered by a physical therapist, 1-h, twice a week for 3-months. Controls were placed on a waitlist for 3 months before receiving a delayed intervention. Primary outcome was change from baseline to 3-months in Cobb angle measured from standing lateral spine radiographs. Secondary outcomes included change over 3-months in kyphometer-measured kyphosis, physical function and quality of life. Groups were combined for analysis after both received the intervention, and sex differences in response to the intervention were tested with ANOVA.ResultsParticipants (60 women, 41 men) were 70.0 (SD = 5.7) years old with mean Cobb angle 55.9 (SD = 12.2) degrees at baseline. The active group had higher baseline modified Physical Performance Test scores than control, p = 0.03. Men had greater baseline kyphometer-measured kyphosis, p = 0.09, and higher bone mineral density (BMD), spine strength, more vertebral fractures and diffuse idiopathic skeletal hyperostosis (DISH) than women, p ≤ 0.01. There was no statistically significant difference between groups in change in Cobb at 3-months, p = 0.09, however change in kyphometer-measured kyphosis differed by 4.8 (95% CI:-6.8,-2.7) degrees, p < 0.001, favoring the active group. There were no differences between men and women in change in either kyphosis measurement after intervention, p > 0.1.ConclusionsA 3-month targeted spine strengthening exercise and posture training program reduced kyphometer-measured, but not radiographic-measured kyphosis. Despite sex differences in baseline kyphosis, BMD, spine strength, fractures and DISH, sex did not affect treatment response.Trial registrationClinicalTrials.gov Identifier: NCT01766674.

Aerobic or Resistance Exercise, or Both, in Dieting Obese Older Adults

BackgroundObesity causes frailty in older adults; however, weight loss might accelerate age-related loss of muscle and bone mass and resultant sarcopenia and osteopenia.MethodsIn this clinical trial involving 160 obese older adults, we evaluated the effectiveness of several exercise modes in reversing frailty and preventing reduction in muscle and bone mass induced by weight loss. Participants were randomly assigned to a weight-management program plus one of three exercise programs — aerobic training, resistance training, or combined aerobic and resistance training — or to a control group (no weight-management or exercise program). The primary outcome was the change in Physical Performance Test score from baseline to 6 months (scores range from 0 to 36 points; higher scores indicate better performance). Secondary outcomes included changes in other frailty measures, body composition, bone mineral density, and physical functions.ResultsA total of 141 participants completed the study. The Physical Performance Test score increased more in the combination group than in the aerobic and resistance groups (27.9 to 33.4 points [21% increase] vs. 29.3 to 33.2 points [14% increase] and 28.8 to 32.7 points [14% increase], respectively; P=0.01 and P=0.02 after Bonferroni correction); the scores increased more in all exercise groups than in the control group (P<0.001 for between-group comparisons). Peak oxygen consumption (milliliters per kilogram of body weight per minute) increased more in the combination and aerobic groups (17.2 to 20.3 [17% increase] and 17.6 to 20.9 [18% increase], respectively) than in the resistance group (17.0 to 18.3 [8% increase]) (P<0.001 for both comparisons). Strength increased more in the combination and resistance groups (272 to 320 kg [18% increase] and 288 to 337 kg [19% increase], respectively) than in the aerobic group (265 to 270 kg [4% increase]) (P<0.001 for both comparisons). Body weight decreased by 9% in all exercise groups but did not change significantly in the control group. Lean mass decreased less in the combination and resistance groups than in the aerobic group (56.5 to 54.8 kg [3% decrease] and 58.1 to 57.1 kg [2% decrease], respectively, vs. 55.0 to 52.3 kg [5% decrease]), as did bone mineral density at the total hip (grams per square centimeter; 1.010 to 0.996 [1% decrease] and 1.047 to 1.041 [0.5% decrease], respectively, vs. 1.018 to 0.991 [3% decrease]) (P<0.05 for all comparisons). Exercise-related adverse events included musculoskeletal injuries.ConclusionsOf the methods tested, weight loss plus combined aerobic and resistance exercise was the most effective in improving functional status of obese older adults. (Funded by the National Institutes of Health; LITOE ClinicalTrials.gov number, NCT01065636.)

Progressive multi-component home-based physical therapy for deconditioned older adults following acute hospitalization: a pilot randomized controlled trial

Objective: To determine whether a progressive multicomponent physical therapy intervention in the home setting can improve functional mobility for deconditioned older adults following acute hospitalization. Design: Randomized controlled trial. Setting: Patient homes in the Denver, CO, metropolitan area. Participants: A total of 22 homebound older adults age 65 and older (mean ± SD; 85.4 ±7.83); 12 were randomized to intervention group and 10 to the control group. Intervention: The progressive multicomponent intervention consisted of home-based progressive strength, mobility and activities of daily living training. The control group consisted of usual care rehabilitation. Measurements: A 4-meter walking speed, modified Physical Performance Test, Short Physical Performance Battery, 6-minute walk test. Results: At the 60-day time point, the progressive multicomponent intervention group had significantly greater improvements in walking speed (mean change: 0.36 m/s vs. 0.14 m/s, p = 0.04), modified physical performance test (mean change: 6.18 vs. 0.98, p = 0.02) and Short Physical Performance Battery scores (mean change: 2.94 vs. 0.38, p = 0.02) compared with the usual care group. The progressive multicomponent intervention group also had a trend towards significant improvement in the 6-minute walk test at 60 days (mean change: 119.65 m vs. 19.28 m; p = 0.07). No adverse events associated with intervention were recorded. Conclusions: The progressive multicomponent intervention improved patient functional mobility following acute hospitalization more than usual care. Results from this study support the safety and feasibility of conducting a larger randomized controlled trial of progressive multicomponent intervention in this population. A more definitive study would require 150 patients to verify these conclusions given the effect sizes observed.

The effect of the rehabilitation program on balance, gait, physical performance and trunk rotation in Parkinson's disease.

BackgroundParkinson’s disease (PD) is a progressive, neurodegenerative disease which leads to postural and gait disorders, limitation in mobility, activities of daily living and disability.AimsThe aim of the study is to assess the effects of the rehabilitation program on balance, gait, motor performance and trunk rotations in PD patients.MethodsSixty-four patients with 1.5–3.0 stage PD in the Hoehn and Yahr scale were randomly allocated to rehabilitation and control groups. Sixty-one patients completed the study. Patients were assessed three times, at month intervals. Between the first and second assessments, the rehabilitation group participated in a rehabilitation training program focused on mobility, balance and gait exercises, consisting of 28 sessions. Balance was assessed with tandem stance and the Pastor test (shoulder tug). Gait was assessed with a 10 m walk at preferred speed and 360° turn. Motor performance was evaluated by means of the Physical Performance Test (PPT) and timed motor activities. The trunk rotations were measured in the lumbar and thoraco-lumbar spine with a tape measure.ResultsThe rehabilitation group significantly improved (p < 0.05) in balance and gait outcomes, PPT score, timed activities and trunk rotations both in comparison to the control group and baseline results. The positive effects of the exercise program maintained for at least 1 month.ConclusionThe 4-week rehabilitation training program focused on mobility, balance and gait exercises improved balance, gait, physical performance and trunk rotations in patients with PD.

Noctural Enuresis as a Risk Factor for Falls in Older Community Dwelling Women with Urinary Incontinence

We determined the association of urinary symptoms with fall risk andphysical limitations in older community dwelling women with urinary incontinence. We performed an in-depth assessment of daytime and nighttime urinary symptoms, fall risk, physical function, physical performance tests and mental function in older community dwelling women with urinary incontinence who had not sought care for urinary symptoms. All assessments were performed in participant homes. We used univariable and multivariable linear regression to examine the relationship of urinary symptoms to fall risk,physical function and physical performance. Of 37 women with a mean ± SD age of 74 ± 8.4 years who had urinary incontinence 48% were at high risk for falls. Nocturnal enuresis was reported by 50% of the women. Increased fall risk was associated with increasing frequency of nocturnal enuresis (p = 0.04), worse lower limb function (p <0.001), worse upper limb function (p <0.0001) and worse performance on a composite physical performance test of strength, gait and balance (p = 0.02). Women with nocturnal enuresis had significantly lower physical performance test scores than women without nocturnal enuresis (median 7, range 0 to 11 vs 9, range 1 to 12, p = 0.04). In a multivariable regression model including age, nocturnal enuresis episodes and physical function only physical function was associated with an increased fall risk (p <0.0001). Nocturnal enuresis is common in older community dwelling women with urinary incontinence. It may serve as a marker of fall risk even in women who do not seek care for urinary symptoms. Interventions targeting upper andlower body physical function could potentially decrease the risk of falls in older women with urinary incontinence.