Physical Resilience Research Articles

The relationship between pre-surgery self-rated health and changes in functional and mental health in older adults: insights from a prospective observational study

BackgroundElective surgeries are among the most common health stressors in later life and put a significant risk at functional and mental health, making them an important target of research into healthy aging and physical resilience. Large-scale longitudinal research mostly conducted in non-clinical samples provided support of the predictive value of self-rated health (SRH) for both functional and mental health. Thus, SRH may have the potential to predict favorable adaptation processes after significant health stressors, that is, physical resilience. So far, a study examining the interplay between SRH, functional and mental health and their relative importance for health changes in the context of health stressors was missing. The present study aimed at addressing this gap.MethodsWe used prospective data of 1,580 inpatients (794 complete cases) aged 70 years or older of the PAWEL study, collected between October 2017 and May 2019 in Germany. Our analyses were based on SRH, functional health (Barthel Index) and self-reported mental health problems (PHQ-4) before and 12 months after major elective surgery. To examine changes and interrelationships in these health indicators, bivariate latent change score (BLCS) models were applied.ResultsOur analyses provided evidence for improvements of SRH, functional and mental health from pre-to-post surgery. BLCS models based on complete cases and the total sample pointed to a complex interplay of SRH, functional health and mental health with bidirectional coupling effects. Better pre-surgery SRH was associated with improvements in functional and mental health, and better pre-surgery functional health and mental health were associated with improvements in SRH from pre-to-post surgery. Effects of pre-surgery SRH on changes in functional health were smaller than those of functional health on changes in SRH.ConclusionsMeaningful changes of SRH, functional and mental health and their interplay could be depicted for the first time in a clinical setting. Our findings provide preliminary support for SRH as a physical resilience factor being associated with improvements in other health indicators after health stressors. Longitudinal studies with more timepoints are needed to fully understand the predictive value of SRH for multidimensional health.Trial registrationPAWEL study, German Clinical Trials Register, number DRKS00013311. Registered 10 November 2017 – Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013311.

Ageing and physical resilience after health stressors.

The objectives of this article are to introduce a conceptual framework for physical resilience in the context of ageing and to discuss key elements and challenges in the design of studies of physical resilience after health stressors. Advancing age is associated with increasing exposure to multiple stressors and declining capacity to respond to health stressors. Resilience is defined broadly as the ability to resist or recover well from the adverse effects of a health stressor. In ageing-related study designs of physical resilience after a health stressor, this dynamic resilience response can be observed as changes in repeated measures of function or health status in various domains important to older adults. Methodologic issues in selecting the study population, defining the stressor, covariates, outcomes, and analytic strategies are highlighted in the context of an ongoing prospective cohort study of physical resilience after total knee replacement surgery. The article concludes with approaches to intervention development to optimize resilience.

COVIDsmart: A Digital Health Initiative for Remote Data Collection and Study of COVID's Impact on the State of Virginia.

The COVID-19 pandemic has affected people's lives beyond severe and long-term physical health symptoms. Social distancing and quarantine have led to adverse mental health outcomes. In addition, COVID-induced economic setbacks have likely exacerbated the psychological distress affecting broader aspects of physical and mental well-being. Remote digital health studies can provide information about the pandemic's socioeconomic, mental, and physical impact. COVIDsmart was a collaborative effort to deploy a complex digital health research study to understand the impact of the pandemic on diverse populations. Here we describe how digital tools were used to capture the effects of the pandemic on the overall wellbeing of diverse communities across large geographical areas within the state of Virginia. The objective of this paper is to describe the digital recruitment strategies and data collection tools applied in the COVIDsmart study and share preliminary study results. COVIDsmart conducted digital recruitment, eConsent, and survey collection through a HIPAA compliant digital health platform. This is alternative to traditional in-person recruitment and onboarding method used for studies. Participants in Virginia were actively recruited over three months utilizing widespread digital marketing strategies. Six months of data were collected remotely on participant demographics, COVID-19 clinical parameters, health perceptions, mental and physical health, resilience, vaccination status, education/work functioning, social/family functioning, and economic impact. Data were collected using validated questionnaires or surveys reviewed by an expert panel that were completed in a cyclical fashion. To retain high level of engagement throughout the study, participants were incentivized to stay enrolled and complete more surveys to further their chances of receiving monthly gift card drawing and/or one of multiple grand prizes. Virtual recruitment demonstrated relatively high rates of interest in Virginia (N=3,737), and 782 have consented to participate in the study (21.1%). The most successful recruitment technique was the effective use of newsletters/emails (41.4%). The primary reason for contributing as a study participant was advancing research (79.9%), followed by the need to give back to their community (64.8%). Incentives only reported as a reason among 21% of the consented participants. Overall, the primary reason for contributing as a study participant was attributed to altruism at 88.6%. The COVID-19 pandemic has accelerated the need for digital transformation in research. COVIDsmart is a statewide prospective cohort to study the impact of COVID-19 on Virginians' social, physical, and mental health. The study design, project management, and collaborative efforts across multi-disciplinary groups led to the development of effective digital recruitment, enrollment, and data collection strategies to evaluate the pandemic effects on a large, diverse population. These findings may inform effective recruitment techniques across diverse communities and participants' interest in remote digital health studies.

Physical Function Tests Are Potential Tools to Identify Low Physical Resilience in Women after Breast Cancer Treatment

Background: This study sought to investigate whether different physical function tests (objective measures of physical performance) may identify a low physical resilience in breast cancer survivors (BCS). Methods: This analytical cross-sectional study evaluated 146 BCS and 69 age-matched women without breast cancer history. The different times after the end of treatment were used as criteria for group division. Participants were divided into four groups: control (CT: n = 69–women without breast cancer history); <1.0 years after the end of treatment (<1 YAT: n = 60); 1–3.9 years after the end of treatment (1–3.9 YAT: n = 45); and ≥4 years after the end of treatment (>4 YAT: n = 41). Physical function was evaluated by 4 m walk test (4-MWT), five-times-sit-to-stand test (FTSST), timed up and go test (TUG), and short physical performance battery (SPPB). Age, menopausal status, smoking, number of medications, level of physical activity, body mass index, and muscle strength were used as confounding variables in ANCOVA. Results: All groups that underwent cancer treatment (<1 YAT, 1–3.9 YAT and ≥4 YAT) had lower physical performance (p < 0.001) identified by 4 MWT, TUG, and FTSST when compared to the CT group. For the SPPB, the <1 YAT and ≥4 YAT groups had lower performance (p = 0.005) when compared to the CT. Conclusions: The different physical function tests can be used to identify a low physical resilience in BCS.

Positive Self-perceptions of Aging Increase Physical Resilience to Facilitate Social Re-engagement of Older Adults Who Fall: Analysis Based on Health and Retirement Study Data

ObjectiveTo determine whether self-perceptions of aging (SPAs) predict physical resilience after a fall and whether SPA and physical resilience affect subsequent social engagement in older adults with a fall. DesignProspective cohort study. SettingGeneral community. ParticipantsOlder adults who reported a fall within 2 years after baseline data collection (N=1707, mean age 72.9 years, 60.9% women). Main Outcome MeasurePhysical resilience indicates the ability to resist or recover from functional decline from a stressor. The change in frailty status from directly after the fall to up to 2 years of follow-up was used to generate 4 physical resilience phenotypes. Social engagement was dichotomized based on the presence at 1 of the 5 social activities at least once a month. The 8-item Attitudes Toward Own Aging Scale was used to assess SPA at baseline. Multinomial logistic regression and nonlinear mediation analysis were used. ResultsPositive prefall SPA predicted more resilient phenotypes after a fall. Both positive SPA and physical resilience affected subsequent social engagement. Physical resilience partially mediated the association between SPA and social re-engagement (mediated percentage of 14.5%, P=.004). This mediation effect was fully driven by those with previous falls. ConclusionPositive SPA promotes physical resilience in older adults with a fall, both of which affect subsequent social engagement. Physical resilience partially mediated the effect of SPA on social engagement but only for previous fallers. Multidimensional recovery incorporating psychological, physiological, and social aspects should be stressed in the rehabilitation of older adults who fall.

Density and Urban Resilience, Cross-Section Analysis in an Iranian Metropolis Context

While there is a large body of research on sustainable development and urban resilience, the interaction between urban densification and urban resilience remains understudied. This study aims to investigate several facets of urban resilience and densification before analyzing their mutual relationship. Focusing on ecological, social, economic, and physical elements of urban resilience on the one hand and population density, residential density, built-up area ratio (BAR), and parcel density on the other, a combination of spatial and quantitative methodologies is applied. Our empirical investigation revealed that the spatial distribution of all resilience indicators is varied. In other words, the cumulative form of urban resilience indicators has a different significance than the individual version. Similarly, different types of density have varying orientations and degrees of connection with measures of resilience that should be evaluated in empirical investigations. In addition, our research revealed that density has a stronger relationship with social and physical resilience than with ecological and economic resilience. The findings drawn from this research have the potential to inform the design of secure, resilient cities across a range of spatial dimensions.

Regional-scale assessment of soil functions and resilience indicators: Accounting for change of support to estimate primary soil properties and their uncertainty

Researchers and stakeholders are increasingly interested in evaluating soil functions and their relationships with soil physical resilience to prevent and mitigate natural and anthropogenic threats. This study aims to assess the effect of changing spatial support on estimating primary soil properties that are then used to map compound indicators of soil functions. The specific objectives are to determine the epistemic uncertainty associated with the estimates and assess the impact of accounting for the change-of-support when scaling up from the point- to the block-resolution.The study area is the southern Italian region of Campania, which is renowned for its high-quality agricultural and dairy products but is increasingly subject to soil disturbance and degradation. Seven primary soil properties (sand and clay contents, oven-dry soil bulk density, calcium carbonate, rock fragment, soil organic matter, and pH) were estimated over 75-m × 75-m blocks by jointly analyzing more than 3,000 point-based soil measurements with gridded terrain attributes by using multi-collocated block cokriging. Two compound soil indicators were then assessed from the maps of these soil properties: 1) the soil organic carbon stock (SOCS) in the entire region of Campania, and 2) the recharge transit time in the Sele alluvial plain where information about the mean annual depth to groundwater is available.The change-of-support proved to affect the total variance and the assessment of the extremes in the probability distributions of the primary soil variables. Our results emphasize that negative consequences occur when the change-of-support problem, upscaling in particular, is overlooked as happens when analyzing environmental data, especially for planning purposes and in the case of environmental risk assessment.

Too much is too little: Estimating the optimal physical activity level for a healthy mental state.

Although physical activity and exercise are generally thought to have favorable effects on mental health, excessive physical activity may have unfavorable effects. In this study, the associations between physical activity and the states of mental health with U-shaped dose-response curves were hypothesized, and the ranges of physical activity resulting in optimal effects on mental health were investigated. A cross-sectional survey was conducted on 1,237 adult volunteers in 2017 and 2018. Of these volunteers, 526 participants validly answered the self-administered questionnaires asking about physical activity, depression, anxiety, resilience, insomnia vulnerability, and life events. A comparison of mental health measures by physical activity levels and quadratic equation model regressions were performed. No significant linear associations between physical activity levels and mental health measurements were observed; however, the U-shaped, quadratic equation models indicated a significance. The following levels of physical activity per week optimized the mental health measurements values of the participants: 6,953 MET-minutes and 25.70 h for depression, 5,277 MET-minutes and 21.60 h for state anxiety, 5,678 MET-minutes and 22.58 h for trait anxiety, 25.41 h for resilience, and 9,152 MET-minutes and 31.17 h for insomnia vulnerability. Physical activities in the optimal range were associated with more favorable mental health measurements. Physical activities that were too much or too long and outside of the optimal range were associated with less favorable mental health measurements.

Psychological Assessment of Cross-Cultural Mission Candidates in Australasia

This study surveyed psychological assessment practice for cross-cultural mission candidates in Australasia. It hypothesized that there would be a difference in knowledge about assessments between mission chief executive officers (CEOs), member care specialists, and psychological assessors. Sixty-nine mission organization staff and nine independent assessors responded to an online survey about psychological assessment, compliance with Australian legislation and government recommendations, and the use of psychometric tests. The results suggested that pre-field psychological assessments were a vital part of member care. Assessors were more likely to report organizations struggled to apply the results to candidate selection, that assessments were used to screen out people with mental illness, and were looking for different key attributes in candidates compared with organizations. The key areas that were identified as being important to assess were strong interpersonal skills, physical and psychological resilience, and contentment with current relationship status. The study also identified several systemic problems in relation to the focus of assessments, payment, measurement, and whether reports complied with law and government recommendations, and previous recommendations in the mission literature. This study suggested a need for a more standardized purposeful approach to conducting pre-field psychological assessments for cross-cultural mission candidates.

Physical activity is a potential measure of physical resilience in older adults receiving hemodialysis.

Physical resilience, or the ability to recover after a physical stressor, declines with aging. Efforts to preserve physical resilience in the older dialysis population are critically needed; however, validated, patient-centered measures that are sensitive to change are also needed. Our objective was to assess accelerometer-derived step count variability, or a measure of intra-individual variation in physical activity, as a potential measure of physical resilience among older adults receiving hemodialysis. Community-dwelling ambulatory older adults receiving in-center hemodialysis were prospectively enrolled. Participants wore wrist accelerometers during daytime hours on both dialysis and non-dialysis days up to 14 days, and the feasibility of accelerometer use was assessed from wear time. We used accelerometer data to compute step counts in 4-hour blocks and step count variability. Physical function was assessed with the Short Physical Performance Battery (SPPB which includes gait speed test), grip strength, activities of daily living (ADLs) instruments, and life space mobility. We assessed interval fatigue (subjective rating from 0 to 10) on dialysis and non-dialysis days and self-reported recovery time. We assessed the correlations of step count variability with measures of physical function and step count and interval fatigue. Of 37 enrolled participants, 29 had sufficient accelerometer data for analyses. Among the 29 participants, mean (SD) age was 70.6(4.8) years, and 55% (n=16) were male and 72% (n=21) were Black race. Participants were largely sedentary with median (Q1-Q3) self-reported total kilocalories per week of 200 (36-552). Step count variability was positively correlated with measures of physical function: SPPB (r=0.50, p<0.05), gait speed (r=0.59, p<0.05), handgrip strength (r=0.71, p<0.05), Instrumental ADLs (r=0.44, p<0.05) and life space mobility (r=0.54, p<0.05).There was a weak inverse correlation between post-dialysis step counts (4-hour blocks after a dialysis session) and post-dialysis interval fatigue [r=-0.19 (n=102, p=0.06). Physical activity assessment via accelerometer is feasible for older adults receiving hemodialysis. Step count variability correlated with physical function, so it may be a novel measure of physical resilience. Further studies are needed to validate this measure.

The Physical Resilience Instrument for Older Adults (PRIFOR) in Surgical Inpatients: Further Evidence for Its Factor Structure and Validity.

The Physical Resilience Instrument for Older Adults (PRIFOR) is a questionnaire for assessing physical resilience in older adults suffering from acute health stressors. Prior psychometric evidence of the PRIFOR showed that it has good criterion-related validity, known-group validity, predictive validity, and internal consistency. However, it is unclear whether the PRIFOR can be replicated in older adults suffering after surgical treatment. This study aimed at evaluating whether the three-factor structure of the PRIFOR can be replicated in older adults suffering after surgical treatment. Moreover, the concurrent validity of the PRIFOR was examined using the association between the PRIFOR and measures of depression, cognition, activities of daily living, and frailty. A longitudinal study was adopted in a tertiary-care medical center in Taiwan. A total of 207 patients aged 65 years old and older who underwent surgery and if they were able to communicate independently. The PRIFOR, the 5-item Geriatric Depression Scale, the Short Portable Mental Status Questionnaire, the Katz Index of Independence in Activities of Daily Living and Clinical Frailty Scale were all assessed after surgery. The three-factor structure (positive thinking, cope and adjust lifestyle, and belief and hopeful mindset) was supported by the CFA results in the present sample. In addition, the PRIFOR showed good concurrent validity with depression (r = -0.470 to -0.542), cognition (r = 0.358 to 0.409), activities of daily living (r = 0.209 to 0.310), and frailty (r =-0.161 to -0.237). The PRIFOR can be recommended to measure physical resilience in older adults suffering after surgical treatment. For the adequate estimation of older adults' level of physical resilience postoperatively and to guide the implementation of individualized interventions, it is important to provide appropriate care for older adults to recover after surgery.

The impact of intrinsic capacity and physical resilience on health outcomes: a case report

Justification and objective: The physiological changes that accompany human aging increase the risk of disease and care dependence. To meet the health needs of older adults, care must go beyond diagnosing specific diseases and assess the impact of these conditions on functional capacity. The concepts of intrinsic capacity and physical resilience aim to explain the trajectory of various health outcomes in older adults. The case presented below illustrates the positive impact of intrinsic capacity, together with external resources, on the prognosis of an older patient during a catastrophic health event. Case description: A 91-year-old widower was diagnosed with severe dehydration, delirium, pneumonia, and a grade IV pressure injury after lying in his home for 6 days. He remained hospitalized for 87 days and was discharged with almost complete recovery of his functional capacity. Discussion: The main point of this case is the positive health outcome experienced by a nonagenarian patient given the severity of the events. From the perspective of intrinsic capacity, he was functionally independent, had good sensory function, excellent cognition and vitality, and his psychological status was positive. He is currently progressing towards complete functional recovery.

Validity and Reliability of the Preference for and Tolerance of the Intensity of Exercise Questionnaire among Chinese College Students

The rising prevalence of physical inactivity is in all age groups (e.g., in college students) a major public health issue as not meeting the recommended minimum amount of regular physical activity is linked to adverse health events. Vice versa, there is mounting evidence that achieving the recommended amount of regular physical activity is a vital element to prevent chronic diseases, but there is often an insufficient adherence to planned and structured forms of physical activity (i.e., physical exercises). In this context, there is a large body of evidence indicating that exercise adherence is, among other factors, influenced by exercise-related affective responses. The Preference for and Tolerance of the Intensity of Exercise Questionnaire (PRETIE-Q) has been developed to measure these affective responses (e.g., to specific exercise intensities). So far, no validated Chinese version of the PRETIE-Q has been available in the literature. To address this gap in literature, the present study developed and validated a Chinese version of the PRETIE-Q in a large sample of Chinese college students. Data from a total of 1117 college students were collected for analyses concerning factorial validity and construct validity. The re-test reliability was established using a sample of 150 randomly selected participants. In addition, the level of regular physical activity (PA), cardiorespiratory fitness (CRF), and resilience were used to examine possible links with two domains (preference and tolerance) of the PRETIE-Q. Our results showed that a Chinese version of the PRETIE-Q has a good fit and reliability (Cronbach’s α of 0.72 to 0.85 for preference and tolerance, respectively; ICC: r = 0.72 of preference and r = 0.67 of tolerance; fit indices: χ2 = 21.612, df = 19, p > 0.05, TLI = 0.997, CFI = 0.998, RMSEA = 0.016, SRMR = 0.024). Secondly, positive associations of intensity-tolerance with PA, CRF, and resilience were observed. In summary, this study indicates that the Chinese version of the PRETIE-Q has sound psychometric properties and can be used in Chinese college students. The adapted version of the PRETIE-Q paves the way for further research on exercise-related affective responses in Chinese-speaking samples, although the generalizability of our findings needs to be established for other cohorts such as adolescents and older people with and without chronic diseases.

Abstract A034: Health-related quality of life among African American prostate cancer survivors enrolled in a lifestyle intervention program

Abstract Background: Prostate cancer (PC) is the most diagnosed non-skin cancer among men in the United States, with African American (AA) men experiencing the highest incidence of all racial/ethnic groups. Screening and treatment advances for PC have resulted in men living years beyond their diagnosis; however, side effects of PC treatments can impact health-related quality of life (QoL). African American PC survivors (AAPCS) may be at increased risk of experiencing lower QoL. Lifestyle interventions show potential for improving QoL through changes in health behavior and symptom improvement, yet few have focused on AAPCS. This study explores QoL of AAPCS enrolled in Men Moving Forward (MMF), a randomized trial to improve body composition through lifestyle change. Methods: Baseline data from 83 AAPCS enrolled in MMF were used in analysis. Participants completed Patient-Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests for physical function, anxiety, depression, fatigue, sleep disturbance, social function, and pain intensity. Standardized T scores (U.S. general population mean = 50, SD =10) were generated for all domains except pain intensity (0-10), and summary scores for physical and mental health were generated. A higher score reflects more of a construct being measured. Thus, for symptoms, scores above the mean are worse, while for functioning domains, scores below the mean are worse. Summary scores for physical and mental QoL were also calculated. Questionnaires related to physical activity, self-efficacy, perceived stress, social support, and resilience were also collected. We compare sample means to published norms of U.S. PC survivors, considering a difference of 3 points (1/3 SD) as clinically meaningful. Multiple linear regression analyses were used to examine factors associated with physical and mental health summary scores. Results: AAPCS scores were similar to the U.S. PCS means for depression (45.6 vs 45.4), fatigue (47.9 vs 47.3), sleep disturbance (48.4 vs 48.2), and physical function (50.4 vs 50.2). AAPCS scores were worse than the U.S. PCS means for anxiety (49.4 vs 45.9) and social participation (51.2 vs 55.1). The average mental health summary score for AAPCS was better than the U.S. general population (53.4 vs 50), while the physical health summary score was similar (51.4 vs 50). Perceived stress (p&amp;lt;0.000) was negatively associated with mental health. Comorbidities (p=0.002) were negatively associated with physical health, while physical activity (p=0.034) was positively associated with physical health. Conclusions: Our sample of AAPCS was similar to U.S. PCS except for worse anxiety and social function. We also found that factors that could be impacted by a lifestyle intervention were associated with physical and mental health. Future work will examine additional correlates and explore the impact of the MMF lifestyle intervention on changes in QoL. Citation Format: Iwalola Awoyinka, Kathryn E. Flynn, Anjishnu Banerjee, Alexis Visotcky, Sophia Aboagye, Margaret Tovar, Deepak Kilari, Kathryn A. Bylow, Paula Papanek, Patricia M. Sheean, Melinda R. Stolley. Health-related quality of life among African American prostate cancer survivors enrolled in a lifestyle intervention program [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A034.

The Importance of Patient Resilience on Outcomes Following Foot and Ankle Orthopaedic Surgery

Category: Other; Ankle Introduction/ Purpose: Recovery from orthopedic surgery requires a degree of both physical and mental resilience during recovery and rehabilitation. The brief resilience scale (BRS) is a validated and reliable 6-item screening tool that measures resilience as the ability to bounce back or recover from stress. BRS can provide unique and important information about patients coping with health-related stressors. To date, there is little evidence describing the use of BRS as a pre-operative benchmark to evaluate outcomes following foot and ankle orthopedic injuries and procedures. We aim to determine how patient resilience, as measured with BRS, may predict the impact of orthopedic conditions and recovery from foot and ankle surgery. Methods: All patients undergoing foot and ankle orthopedic surgery at a single institution were enrolled in U-COSMOS, a HIPAA-compliant, automated outcomes data repository. All patients undergoing surgery completed BRS pre-operatively. We used a BRS cutoff of &lt; 3 (lower resilience, LR), 3-3.9 (intermediate resilience, IR), and &gt;=4 (high resilience, HR) to create three cohorts. Patients also completed a PROMIS Physical Function (PF) Computer Adaptive Test (CAT), PROMISE Pain Interference (PI) CAT, PROMISE Depression (D) CAT, and Global Health (GH) Short Form pre-operatively as well as 3-, 6-, 12-, and 24- months post-operatively, as applicable. Patients with a minimum follow-up of 180 days were included for analysis, and the longest available follow-up was used. Differences in outcomes between the three BRS groups were determined non-parametrically using a Kruskal–Wallis one-way analysis of variance. Results: A total of 586 patients were included for analysis, with an average follow-up of 389 days. The patients were categorized as low resilience (n=44), intermediate resilience (n=229), and high resilience (n=323). Patients in the high resilience cohort had significantly higher PF and lower PI and Depression scores both pre-operatively (p &lt; 0.05 for all) and post-operatively (p &lt; 0.001 for all). The greatest disparity was found in depression where low resilience patients were greater than 1 SD worse than high resilience patients (Figure 1). Similar trends are observed for physical and mental global health. In addition to having higher absolute baseline and follow-up scores, the change of PF and PI is also significantly higher for high resilience patients (p = 0.02). Conclusion: Patients with high pre-operative resilience demonstrate better pre-operative physical function and pain interference scores compared to lower resilience patients and show greater improvement at 12 months post-op. We also found that lower BRS scores are associated with decreased pre- and post-operative mental health outcomes, including PROMIS Depression. Further analysis of the role of BRS in pre-operative assessment will help guide shared treatment decision-making. Identifying interventions for patients with low resilience will likely lead to improve surgical outcomes.

Nutrition and Emotional Health Education: The Use of Emotional Intelligence and a Plant-Based Diet to Reduce Cardiometabolic Risk.

For individuals living with chronic conditions like diabetes mellitus and obesity, there is a need for sustainable behavioral strategies and physiologic tools. These tools support identifying and addressing barriers to healthy eating, reducing body mass index (BMI), and building increased physical resilience in real time. To evaluate whether a 12-week learning management system designed to combine nutritional intervention with education and coaching on improving emotional intelligence (EI) could alter cardiometabolic outcomes. This pre-post prospective study enrolled 37 adult volunteers with BMI greater than 25 to participate in a 12-week learning management system. Primary (BMI, systolic blood pressure, diastolic blood pressure, low-density lipoprotein [LDL], high-density lipoprotein, and fasting glucose levels) and secondary self-reported outcomes were assessed at baseline, 12weeks, and 6months after enrollment using Short Form-36, Emotional Quotient Inventory (EQi), and Whole Health Index (WHI). Linear mixed-effects regression models with random effect were used to estimate changes in primary and secondary outcomes. We adjusted for multiple testing using Holm step-down method. BMI and LDL were the only primary endpoints lower at program completion and 6-month follow-up compared to baseline levels (-1.63 and -17.77mg/dL, respectively; P < .001). Secondary outcomes showing statistically significant improvement from baseline to 6-month follow-up included energy/fatigue (Short Form-36), self-regard (EQi), decision-making (EQi), impulse control (EQi), stress management (EQi), Whole Brain - Form A (WHI), Whole Food - Form C (WHI), and Whole Body - Form D (WHI). This study provides preliminary evidence that lifestyle programs combining nutritional interventions and EI can have a significant impact on BMI and LDL. Our study highlights the potential importance of both nutrition and EI in programs targeting diet and lifestyle modification.

Reserve and resilience in CKD: concept introduction and baseline results from the Physical REsilience Prediction in Advanced REnal Disease (PREPARED) study

BackgroundThe purpose of this manuscript is to introduce reserve and resilience as novel concepts in chronic kidney disease (CKD) research and present baseline data from a unique prospective cohort study designed to characterize recovery from functional decline after a health event.MethodsThe Physical REsilience Prediction in Advanced REnal Disease (PREPARED) study recruited a national, prospective cohort of Veterans ≥70 years old with an estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m2, prior nephrology care, and at high risk for hospitalization. Electronic health record data were paired with telephone surveys. Self-reported measures of reserve included physical, psychological, and cognitive capacity and environmental resources. We calculated counts (frequencies) and medians (25th, 75th percentiles) for baseline measures of reserve. The study’s longitudinal follow-up of physical function every 8 weeks or following an acute care encounter, which will be used to define resilience, is ongoing.ResultsParticipants had a median (25th, 75th percentile) age of 76.3 (72.8, 81.4) years and eGFR of 23.4 (18.2, 28.8) ml/min/1.73 m2; 23.3% were Black, and 97.4% were male, 91.6% had hypertension, 67.4% had diabetes mellitus, 46.0% had coronary heart disease, and 39.8% had heart failure. Baseline measures of physical, psychological, and cognitive domains showed low reserve on average, but with wide ranges.ConclusionsDespite similar levels of kidney function, older adults participating in PREPARED had a wide range of measures of reserve in other health domains. Non-renal measures of reserve may be important indicators of capacity of CKD patients to recover after acute care encounters.

Beneficial Exercises for Cancer-Related Fatigue among Women with Breast Cancer: A Systematic Review and Network Meta-Analysis.

Cancer-related fatigue (CRF) is the most common cause of physical powerlessness in women with breast cancer (BC). The practice of continuous effective exercise is beneficial with respect to reducing CRF. To explore exercise efficacy and respective ranks with respect to reducing CRF in women with BC within the inter-treatment and post-treatment periods. Throughout this systematic review and network meta-analysis, articles published from 2000 to March 2022 were included. Article searches were conducted on the MEDLINE, Embase, CINAHL, and CENTRAL databases. Adult women with BC and different exercise programs were compared with those involved in regular care as a control during or after treatment. In addition, randomized controlled trials (RCT) were also included. A risk-of-bias assessment, with the revised Cochrane risk-of-bias tool regarding RCT and probability-based ranking, was established based on the surface under the cumulative rank (SUCRA) method via network meta-analysis. a total of 5747 women with BC followed seven exercise interventions. Yoga (SMD = -0.54, 95% CI [-0.86, -0.22]) was ranked first (94.5%), with significant effects in respect of mitigating CRF, followed by resistance exercise (66.2%), and aerobic resistance (63.3%), while Qigong ranked last (22.2%) among the 36 RCT in inter-treatment. Aerobic resistance exercise (SMD = -0.52, 95% CI [-0.98, -0.07]) induced significant effects in respect of mitigating CRF in the 38 RCTs in the post-treatment period. Yoga, aerobic yoga, and aerobic resistance exercise ranked as the top three (75.5%, 75.0%, and 72.4%, respectively), whereas relaxation ranked last (38.8%) in the post-treatment period. Yoga, aerobic resistance, and aerobic yoga are recommended for the purposes of inter- and post-treatment exercise to reduce CRF in women with BC by enhancing their physical resilience and long-term quality of life.

A SIMPLIFIED APPROACH FOR CLASSIFYING PHYSICAL RESILIENCE AMONG OLDER ADULTS: THE HEALTH ABC STUDY

Abstract Physical resilience is an emerging concept within the context of aging and geriatric medicine, and we previously developed and validated one such measure based on the mismatch between persons’ frailty level and comorbidity burden. We sought to develop a simplified version for classifying physical resilience. We also examined the agreement between the simplified version and the original approach and evaluated its predictive validity. We included 2,457 older adults from the Health, Aging, and Body Composition Study. We constructed a simplified version for quantifying physical resilience based on the comorbidity burden and level of frailty (score: 0-10). Participants were grouped by the number of diseases and classified into three groups—adapters, expected agers, and premature frailers—based on the mean and SD of frailty score (less than, within, or above one standard deviation of the mean). The Cohen’s kappa between the novel resilience classification and the original approach was 0.70, and the percentage of absolute agreement was 85.4%. We observed a steep increase in years of healthy and able life from premature frailers to adapters in the simplified resilience classifications. We developed a simplified version for quantifying physical resilience in a cohort of initially well-functioning older Black and White adults. The agreement between the simplified version and the original approach is high. Adapters had a longer healthy lifespan than expected agers and premature frailers. This user-friendly measure could help assess patients’ physical resilience in clinical settings.

METABOLIC SYNDROME, GLUCOSE INTOLERANCE, AND PHYSICAL RESILIENCE

Abstract When confronted with a major physical stressor, some older adults are able to recover to baseline with minimal changes, while others undergo irreversible declines. The ability to adapt and recover well from physical stress is called physical resilience and may be impeded by altered glucose-insulin dynamics. Among 55 participants in the pilot phase of the Study of Physical Resilience IN Geriatrics(SPRING), we examined associations between metabolic syndrome and/or diabetes status to physical resiliency recovery parameters after the clinical stressors total knee replacement and bone marrow transplant. These parameters included health outcomes, functional recovery, and pain in the weeks after the intervention. Additionally, we hypothesized that less resilient individuals would have abnormal glucose and insulin responses to a 75-gram oral glucose tolerance test at 0, 30, 60, 120 minutes and tested this in a subset (n=40) without known diabetes. Exploratory analyses of this pilot study will be presented during this session.