Walking Sessions Research Articles

Acute effects of voluntary breathing patterns on postural control during walking.

Breathing and postural control is reported to be both neuromuscularly and mechanically interdependent. To date, the effects of voluntary abdominal and thoracic breathing (VAB and VTB) on the EMG activity of muscles involved in both respiratory and postural functions, as well as gait biomechanics related to these breathing patterns, have not been investigated in young, healthy adults. The aim of the study was to evaluate the EMG responses of neck and trunk muscles, as well as the kinematic, stability, and kinetic parameters of gait induced by VAB and VTB compared to involuntary breathing (INB). Twenty-four healthy, physically active participants (12 men and 12 females) were required to complete three two-minute walking sessions on an instrumented treadmill (e.g. devices with capacitive sensors embedded beneath the running belt) at 5.0kmh-1, first with INB and then alternatively with VAB and VTB. A respiratory inductive plethysmography unit was used to provide real-time visual feedback of the breathing pattern performed by each participant. The EMG activity of the sternocleidomastoid (SCM), upper trapezius (UT), thoracic and lumbar erector spinae (TES and LES), as well as spatiotemporal (step width, stride length, stride time, stance phase, swing phase, and cadence), stability (anteroposterior and mediolateral center of pressure trajectory), and dynamic gait parameters (vertical ground reaction forces, vGRF) were recorded during each testing condition. Our findings revealed that both voluntary breathing patterns significantly affected the EMG activity of the SCM (p<0.01) and UT (p<0.05), with the activity between these muscles, as expressed by the SCM:UT ratio, being more balanced during VAB (0.94) and VTB (1.05) compared to INB (0.73). Additionally, VAB walking led to a narrower step width (p<0.01) and reduced vGRF over the forefoot (p<0.01) compared to INB walking. Neither VAB nor VTB influenced the activation levels of the LES and TES, nor did they affect other spatiotemporal, stability, or dynamic gait parameters (p>0.05). Our findings suggest that certain gait parameters (e.g. step width, forefoot vGRFs) are primarily influenced by VAB compared to INB, likely due to the more balanced activation of the SCM and UT muscles. This balanced activation may enhance head stability and control during walking, thereby contributing to improved postural control.

Altered cortical activation patterns in post-stroke patients during walking with two-channel functional electrical stimulation: a functional near-infrared spectroscopy observational study.

Restoration of independent walking ability is the primary objective of stroke rehabilitation; however, not all patients achieve this goal due to diverse impairments in the paretic lower limb and compensatory mechanisms that lead to an asymmetrical and mechanically inefficient gait. This investigation aimed to examine alterations in cortical activation in post-stroke patients while walking with a wearable two-channel functional electrical stimulation (FES) in comparison to walking without FES. This observational study was conducted to discern distinct activation patterns in 19 stroke patients during sessions with and without FES, while using functional near-infrared spectroscopy (fNIRS) to monitor changes in blood oxygen levels. Our findings revealed only a significant reduction in ΔOxy-Hb in the contralesional pre-motor cortex (z = -2.803, p = 0.005) during the FES-on walking sessions compared to the FES-off sessions. Furthermore, all regions in the FES-on session exhibited lower ΔOxy-Hb. Conversely, no significant differences were observed in ΔDeoxy-Hb. Moreover, a significant correlation was found between decrease in cPMC and the reduced cost time of walking under FES-on condition. The fNIRS analysis revealed diminished activation in the contralesional pre-motor cortex when walking with FES, implying that FES may facilitate a more automatic gait pattern while reducing a patient's reliance on contralesional cortical resources. The findings of this study lay the groundwork for long-term neural rehabilitation.

EXPLORING THE IMPACT OF ATTENDANCE IN AN OUTDOOR WALKING PROGRAM ON HEALTH IN OLDER ADULTS WITH MOBILITY LIMITATIONS

Abstract Walking in an outdoor environment offers numerous health benefits for older adults with mobility limitations. Effects may vary, however, depending on the level of attendance. This study aimed to investigate whether a dose-response relationship existed between attendance in an outdoor walk group (OWG) program and improvement in health outcomes among older adults with mobility limitations. We analyzed data from a randomized controlled trial conducted across four cities in Canada and focused specifically on community-dwelling older adults assigned to a 10-week OWG program (n=79, age=74.7±6.6 years, 72% female). Participants were categorized into three groups based on attendance tertiles, with the first, second, and third tertiles corresponding to attending 0–9, 10–15, and 16–20 outdoor walking sessions in total. Outcomes were operationalized as change in scores on measures of walking endurance, comfortable and fast gait speed, balance, lower extremity strength, walking self-confidence, and emotional well-being pre- to post-intervention. Results from multiple linear regression models showed that, compared to those who attended 0–9 OWG sessions, participants who attended 16–20 sessions exhibited a 52.7-meter greater improvement in walking endurance (95% CI:12.3, 93.1); 0.15-meter/second greater improvement in comfortable gait speed (95% CI:0.00, 0.29); and 0.17-meter/second greater improvement in fast gait speed (95% CI:0.02, 0.33), after adjusting for sex and study site. No significant dose-response relationships for balance, lower extremity strength, walking self-confidence, and emotional well-being were observed. The role of attendance highlighted in this study provides critical information relevant to the design and implementation of outdoor walking interventions aimed at improving health among older adults.

An Outdoor Walking Program for Immigrant Muslim Older Adults: A Community-Based Participatory Intervention.

To explore Muslim immigrant older adults' experiences of a modified community-based outdoor walking program and identify factors that facilitate or hinder program acceptance and participation. An exploratory qualitative description single-group pilot study was designed and implemented in three phases: (1) pre-intervention focus group interviews; (2) intervention implementation with tracking of physical activity levels using personal activity monitors; and (3) postintervention individual interviews. Participants were recruited using a convenience sampling strategy in a mosque in Edmonton, Canada, in June 2019. After focus group discussions with participants, walking sessions were conducted for 10 weeks in a local accessible park with required amenities such as benches and restrooms. A fitness instructor delivered the weekly program that was followed by individual semistructured interviews to explore participants' satisfaction and program acceptance. Content analysis was used for qualitative data and sociodemographic, health and physical activity level (via step counts) data was documented for all participants. Thirteen participants with a mean age of 66.9 years completed the program. The majority of participants led a sedentary lifestyle. Participants identified three motivators that increased program satisfaction, which were socialising with peers, having a fitness instructor, and using Fitbit activity trackers. Difficulties with transportation and lack of appropriate educational components were areas for improvement that could enhance acceptability of the program. This study suggests that early incorporation of older immigrants' preferences increases acceptance of physical activity programs. Nurses' engaging in healthy lifestyle support for older immigrants can identify the influences on positive uptake of physical activity programs in this population. Immigrant Muslim older adults lack access to evidence-based physical activity programming that meets their cultural and religious preferences. This study provides some insights into ways to engage this population in similar programs. Community-dwelling older adults who participated in this study completed focus groups and interviews and engaged in the 10-week pilot intervention. Their input informed the modifications to the intervention.

Engagement in a virtual group-based walking intervention for persons with schizophrenia: a qualitative study

BackgroundExercise is beneficial for persons with schizophrenia; however, high dropout rates limit the impact of interventions. Virtual exercise programs have the potential to improve engagement; however, few intervention studies of virtual programs have been conducted in this population.MethodsThis study examined qualitative data from 15 adults with schizophrenia who participated in a pilot randomized controlled trial of Virtual PACE-Life, a live, video-delivered group walking intervention guided by self-determination theory. Interviews elicited feedback on the intervention, barriers and facilitators to engagement, recommendations for intervention refinement, and preferences for exercise programming modality. Rapid qualitative analysis was used to explore similarities and differences between completers (i.e., those that attended ≥ 50% of virtual walking sessions; n = 9) and non-completers (i.e., those that attended < 50% of virtual walking sessions; n = 6).ResultsBoth groups viewed Virtual PACE-Life positively but found the virtual exercise sessions challenging and inadequate for facilitating social interaction. Work obligations impacted completers’ attendance whereas technological issues and forgetting impacted non-completers’ attendance at virtual walking sessions. Completers preferred virtual exercise programs and non-completers preferred in-person exercise programs.ConclusionsThese findings suggest that future virtual group-based walking programs should prioritize enhancing the social aspect, offering scheduling choices, and regularly assessing the perceived difficulty of exercise sessions. These modifications not only have the potential to improve intervention engagement but they also may increase participant autonomy and relatedness, core components of self-determination theory.

Moment-to-moment cascades: Infants' real-time locomotor posture structures opportunities for joint object play with caregivers.

Developmental cascades-the view that development in one domain can induce change in another-provide unique flexibility for researchers to examine relations among multiple behaviors. Research using this theoretical framework has demonstrated that changes in infant locomotor development are met with concomitant changes in infants' interactions with objects and caregivers. However, little is known about how infants' real-time locomotor actions organize these larger associations across developmental time. This study mapped the progression of one potential moment-to-moment cascade pathway linking changes in infant locomotion, access to objects and caregivers, and joint object play. We observed 30 infant-caregiver dyads during three monthly sessions across the transition to walking (Minfant age = 11.98 months, range = 8.74-14.86) and examined whether and how infants' real-time locomotor actions shaped the unfolding of the cascade. Infants moved more frequently in supported upright postures (i.e., cruising, supported walking) compared to crawling at the prewalking session and compared to walking at walk onset. However, infants preferred to walk after spending 1 month as walkers. Regardless of how they moved, infants regularly encountered objects and caregivers during everyday exploration. But there was an effect of locomotor posture on joint object play. Specifically, dyads were most likely to engage in object play after supported upright bouts at the prewalking and walk onset sessions, but at the final walking session, they were most likely to do so after walking bouts. Taken together, this in-depth examination of moment-to-moment cascades highlights the contributions of the many timescales that drive developmental processes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The association of mental health with physical activity and its dimensions in Chinese adults: A cross-sectional study.

Selecting the most efficient type of physical activity that improves mental health can assist in choosing appropriate interventions. Hence, the objective of this study was to evaluate the associations between physical activity and its various aspects, including weekly physical activity, weekly walking and exercise sessions, and the frequency of walking and exercise per week, with the mental health of Chinese adults. This cross-sectional study was carried out in Hangzhou (2023) involving 512 adults aged 18 and 64. Each participant received a self-completed questionnaire comprising three sections. The initial section focused on gathering basic information about the participants, such as gender, age, annual income, and marital status. The second section consisted of the 12-item General Health Questionnaire (GHQ-12), which aimed to evaluate the mental health status of the participants. Lastly, the third section included the International Physical Activity Questionnaire-Short Version (IPAQ-SV), which assessed the metabolic equivalent (MET) of activities like walking, moderate-intensity exercises, and high-intensity exercises. The study found that mental health problems affected 25.74% of adults, while physical inactivity was prevalent in 49.63% of adults. The statistical model was highly significant (F = 25.143, p < 0.001), suggesting that at least one predictor has a significant impact on mental health. The model accounted for 39% of the variance in mental health, with all variables showing predictive value. Notably, the number of walking days per week emerged as the most influential predictor of mental health (β = -0.392), followed by level of weekly physical activity in MET, the number of exercise training sessions per week, weekly exercise training in MET, and weekly walking in MET (β = -0.312, -0.301, -0.212, and -0.202, respectively). Adults can allocate more days per week to walking and their usual physical activity to improve their mental health.

Design of a low-cost force insoles to estimate ground reaction forces during human gait

This paper proposes a low-cost electronic system for estimating ground reaction forces (GRF) during human gait. The device consists of one master node and two slave nodes. The master node sends instructions to slave nodes that sample and store data from two force insoles located at the participant’s feet. These insoles are equipped with 14 piezo-resistive FlexiForce A301 sensors (FSR). The slave nodes are attached to the ankles and feet of each participant. Subsequently, the start command is transmitted through the master node, which is connected to the USB port of a personal computer (PC). Once the walking session is completed, the information obtained by the slave nodes can be downloaded by accessing the access point generated by these devices through Wi-Fi communication. The GRF estimation system was validated with force platforms (BTS Bioengineering P6000, Italy), giving on average a fit measure equal to 68.71%±4.80% in dynamic situations. Future versions of this device are expected to increase this fit by using machine learning models.

HbA1c and Liver Fat After 16 Weeks of Fasted versus Fed Exercise Training in Adults With Type 2 Diabetes.

Exercise-nutrient timing is of interest for people with type 2 diabetes (T2D) as a potential method to optimize glycemic control. However, the optimal nutritional environment for exercise is not well understood over the long term. The Fasted Exercise for Type 2 Diabetes (FED) Trial compared 16 wk of fasted versus postprandial morning exercise on glycated hemoglobin (HbA1c) and liver proton density fat fraction (PDFF). Twenty adults with T2D were recruited and randomized to complete exercise after an overnight fast versus after their morning meal. Participants walked three mornings per week, progressing to 180 min·wk -1 over 16 wk. Groups were balanced with five males and five females each. Sixteen participants completed the trial (8 in each group, 50% female). Age, HbA1c, and PDFF were 59.8 ± 9.0 yr, 7.2 ± 0.7%, and 9.3 ± 4.1%, respectively. On average, both groups completed 98% of their walking sessions but there was no change in HbA1c (-0.2%, P = 0.588). However, one participant from each group had changes in their glucose-lowering medication during the trial, and when excluded, the fasted training group had greater improvements in HbA1c compared with the postprandial group (-0.3% vs 0.0%, P = 0.033). There was no difference in changes in liver PDFF between groups (-1.6% vs 0.3%, P = 0.221) but visceral fat and intramuscular fat decreased to a greater extent after fasted exercise. Although our study had a small sample size, it suggests that exercise after an overnight fast can have high adherence and represents an option for people with T2D to improve longer-term indicators of glycemia and ectopic fat depots.

A THREE MONTHS YOGA PROGRAM ON COGNITIVE VARIABLES OF DEMENTIA RISK PARTICIPANTS: A PILOT STUDY

Background: Dementia refers to symptoms that affect memory, thinking, orientation, judgment, speech, and social abilities significantly enough to interfere with daily activities. Dementia is the second most prevalent disease worldwide. Materials &amp; Methods: A total of thirty individuals, with an average age of 52.4 years (± 7.68 years), were enrolled and then assigned at random to either the yoga group (average age 50.9 years ± 7.23 years) or the control group (average age 52.2 years ± 7.73 years). For a duration of three months, the control group participated in brisk walking sessions lasting thirty minutes five days a week, whereas the yoga group endured sixty-minute yoga sessions five days a week. Before and after the three-month intervention period for both groups, working memory was evaluated using the N back task, and executive function was examined using the Trail Making Test (TMT). Results: A significant difference was observed in all four parameters of N back test in yoga group as compared to the control group (P &lt; 0.05) after 12 weeks [ H1( P = 0.01), E1( P = 0.009), H2 (P = 0.0007), E2 ( P = 0.006 ]. There was improvement in the Trail Making Test, but did not observe the significant difference in the yoga group as compared to the control group ( P &gt; 0.05), [ A ( P = 0.096), B ( P = 0.569)]. Conclusion: The result of this pilot study suggests that yoga practices for dementia risk participants improves the Hit score of the N back test and reduces errors, similarly this improves the executive functions of the brain. Larger studies are needed to confirm these findings.

Perturbation-based balance training of older adults and effects on physiological, cognitive and sociopsychological factors: a secondary analysis from a randomised controlled trial with 12-month follow-up

BackgroundPerturbation-based balance training (PBT) has shown promising, although diverging, fall-preventive effects; however, the effects on important physical, cognitive and sociopsychological factors are currently unknown. The study aimed to evaluate these...

Sex-Specific Variations in Glycated Hemoglobin Responses to Structured Exercise in Type 2 Diabetes: Healthcare Implications of Walking and Strength Training on Glycemic Control.

Type 2 diabetes mellitus (T2DM) affects one in ten individuals in the United States, with rates expected to rise significantly. This novel study aimed to evaluate the impact of a structured exercise program on glycated hemoglobin (HbA1c) levels among males and females with T2DM, and to compare the effects of different volumes of combined aerobic and resistance exercise. A total of 67 adult participants with T2DM were randomly assigned to two groups: Group 1 (exercise classes and walking sessions) and Group 2 (exercise classes only). After 10 weeks, 39 participants completed the intervention and 34 had complete HbA1c records. Results indicated a significant improvement in HbA1c levels overall, with males exhibiting a greater decrease compared to females. Minimal baseline differences were observed between the walking and non-walking groups and improvements in HbA1c were noted in both groups with no significant differences. These findings suggested potential sex-specific differences in response to structured exercise programs. The study highlighted the importance of tailored exercise interventions in healthcare while managing T2DM. Further research is necessary to optimize exercise prescriptions and evaluate long-term benefits, but the current evidence supports structured exercise as a valuable component of comprehensive diabetes care. This research underscores the need for personalized approaches in exercise regimens, contributing to the growing body of knowledge on sex-specific responses to T2DM interventions.

The Association of Genetic Markers Involved in Muscle Performance Responding to Lactate Levels during Physical Exercise Therapy by Nordic Walking in Patients with Long COVID Syndrome: A Nonrandomized Controlled Pilot Study.

Several genetic markers have shown associations with muscle performance and physical abilities, but the response to exercise therapy is still unknown. The aim of this study was to test the response of patients with long COVID through an aerobic physical therapy strategy by the Nordic walking program and how several genetic polymorphisms involved in muscle performance influence physical capabilities. Using a nonrandomized controlled pilot study, 29 patients who previously suffered from COVID-19 (long COVID = 13, COVID-19 = 16) performed a Nordic walking exercise therapy program for 12 sessions. The influence of the ACE (rs4646994), ACTN3 (rs1815739), AMPD1 (rs17602729), CKM (rs8111989), and MLCK (rs2849757 and rs2700352) polymorphisms, genotyped by using single nucleotide primer extension (SNPE) in lactic acid concentration was established with a three-way ANOVA (group × genotype × sessions). For ACE polymorphism, the main effect was lactic acid (p = 0.019). In ACTN3 polymorphism, there were no main effects of lactic acid, group, or genotype. However, the posthoc analysis revealed that, in comparison with nonlong COVID, long COVID increased lactic acid concentrations in Nordic walking sessions in CT and TT genotypes (all p < 0.05). For AMPD1 polymorphism, there were main effects of lactic acid, group, or genotype and lactic acid × genotype or lactic acid × group × genotype interactions (all p < 0.05). The posthoc analysis revealed that, in comparison with nonlong COVID, long COVID increased lactic acid concentrations in Nordic walking sessions in CC and CT genotypes (all p < 0.05). Physical therapy strategy through Nordic walking enhanced physical capabilities during aerobic exercise in post-COVID19 patients with different genotypes in ACTN3 c.1729C>T and AMPD1 c.34C>T polymorphisms. These findings suggest that individuals who reported long COVID who presumably exercised less beforehand appeared to be less able to exercise, based on lactate levels, and the effect of aerobic physical exercise enhanced physical capabilities conditioned by several genetic markers in long COVID patients.

Aerobic Exercise in the Aquatic Environment Suppresses the Plasma Renin Activity in Individuals with Type 2 Diabetes: A Secondary Analysis of a Randomized Clinical Trial.

To compare the acute effects of aquatic walking/running versus dry-land walking/running on blood glucose and plasma renin activity (PRA) in individuals with type 2 diabetes, participants with type 2 diabetes performed deep-water or dry-land walking and/or running sessions in a swimming pool or on an athletics track, respectively. Both sessions comprised seven blocks of 3 min at 85-90% of the heart rate deflection point (HRDP), interspersed with 2 min at <85% HRDP, totaling 35 min, with a 48 h interval between sessions. PRA and blood glucose were assessed before and immediately after the sessions. Generalized estimation equations were used to verify the session effects, with the Bonferroni post hoc test, considering the significance level as 0.05. Twelve individuals (53.2 ± 8.9 years) diagnosed with type 2 diabetes for 6.3 ± 6.34 years participated in the study. A reduction in PRA was found only after the aquatic session (-7.75 ng/mL/h; -69%; p: 0.034), while both aquatic and dry-land sessions similarly reduced the blood glucose levels (aquatic: -38 mg/dL, -21%; dry-land: -26 mg/dL, -14%; time effect, p = 0.007). Despite yielding similar glycemic reductions as dry-land walking/running, aquatic walking/running led to an expressive decrease in PRA among individuals with type 2 diabetes.

Implementation of a unilateral hip flexion exosuit to aid paretic limb advancement during inpatient gait retraining for individuals post-stroke: a feasibility study

BackgroundDuring inpatient rehabilitation, physical therapists (PTs) often need to manually advance patients’ limbs, adding physical burden to PTs and impacting gait retraining quality. Different electromechanical devices alleviate this burden by assisting a patient’s limb advancement and supporting their body weight. However, they are less ideal for neuromuscular engagement when patients no longer need body weight support but continue to require assistance with limb advancement as they recover. The objective of this study was to determine the feasibility of using a hip flexion exosuit to aid paretic limb advancement during inpatient rehabilitation post-stroke.MethodsFourteen individuals post-stroke received three to seven 1-hour walking sessions with the exosuit over one to two weeks in addition to standard care of inpatient rehabilitation. The exosuit assistance was either triggered by PTs or based on gait events detected by body-worn sensors. We evaluated clinical (distance, speed) and spatiotemporal (cadence, stride length, swing time symmetry) gait measures with and without exosuit assistance during 2-minute and 10-meter walk tests. Sessions were grouped by the assistance required from the PTs (limb advancement and balance support, balance support only, or none) without exosuit assistance.ResultsPTs successfully operated the exosuit in 97% of sessions, of which 70% assistance timing was PT-triggered to accommodate atypical gait. Exosuit assistance eliminated the need for manual limb advancement from PTs. In sessions with participants requiring limb advancement and balance support, the average distance and cadence during 2-minute walk test increased with exosuit assistance by 2.2 ± 3.1 m and 3.4 ± 1.9 steps/min, respectively (p < 0.017). In sessions with participants requiring balance support only, the average speed during 10-meter walk test increased with exosuit by 0.07 ± 0.12 m/s (p = 0.042). Clinical and spatiotemporal measures of independent ambulators were similar with and without exosuit (p > 0.339).ConclusionsWe incorporated a unilateral hip flexion exosuit into inpatient stroke rehabilitation in individuals with varying levels of impairments. The exosuit assistance removed the burden of manual limb advancement from the PTs and resulted in improved gait measures in some conditions. Future work will understand how to optimize controller and assistance profiles for this population.

Implementation and evaluation of a community-based mindful walking randomized controlled trial to sustain cognitive health in older African Americans at risk for dementia

BackgroundWith an increasing proportion of older adults and the associated risk of Alzheimer’s Disease and Related Dementias (ADRD) around the globe, there is an urgent need to engage in ADRD risk reduction efforts. African American (AA) older adults in the U.S. are disproportionally impacted by ADRD compared to other races and ethnicities. Mindful walking integrates two potentially protective factors of ADRD by elevating mindfulness and physical activity (i.e., walking), resulting in a synergistic behavioral strategy that is feasible and safe for older adults. However, the efficacy of applying this intervention for cognitive health outcomes has not been evaluated using experimental designs.MethodsThis paper documents the goal and protocol of a community-based, mindful walking randomized controlled trial to examine the short- and longer-term efficacy on cognitive and other health-related outcomes in ADRD at-risk AA older adults. The study outcomes include various brain health determinants, including cognitive function, quality of life, psychological well-being, physical activity, mindfulness, sleep, and overall health status. In addition, the estimated costs of program implementation are also collected throughout the study period. This study will recruit 114 older adults (ages 60+ years) with elevated ADRD risk from the Midlands region of South Carolina. Older adults are randomly assigned to participate in 24 sessions of outdoor mindful walking over three months or a delayed mindful walking group (n=57 in each group). Participants in both groups follow identical measurement protocols at baseline, after 12 weeks, after 18 weeks, and after 24 weeks from baseline. The outcome measures are administered in the lab and in everyday settings. Costs per participant are calculated using micro-costing methods. The eliciting participant costs for mindful walking engagement with expected results are reported using the payer and the societal perspectives.DiscussionThis study will generate evidence regarding the efficacy of mindful walking on sustaining cognitive health in vulnerable older adults. The results can inform future large-scale effectiveness trials to support our study findings. If successful, this mindful walking program can be scaled up as a low-cost and viable lifestyle strategy to promote healthy cognitive aging in diverse older adult populations, including those at greatest risk.Trial registrationClinicalTrials.gov number NCT06085196 (retrospectively registered on 10/08/2023).

Knee Angle Estimation from Surface EMG during Walking Using Attention-Based Deep Recurrent Neural Networks: Feasibility and Initial Demonstration in Cerebral Palsy.

Accurately estimating knee joint angle during walking from surface electromyography (sEMG) signals can enable more natural control of wearable robotics like exoskeletons. However, challenges exist due to variability across individuals and sessions. This study evaluates an attention-based deep recurrent neural network combining gated recurrent units (GRUs) and an attention mechanism (AM) for knee angle estimation. Three experiments were conducted. First, the GRU-AM model was tested on four healthy adolescents, demonstrating improved estimation compared to GRU alone. A sensitivity analysis revealed that the key contributing muscles were the knee flexor and extensors, highlighting the ability of the AM to focus on the most salient inputs. Second, transfer learning was shown by pretraining the model on an open source dataset before additional training and testing on the four adolescents. Third, the model was progressively adapted over three sessions for one child with cerebral palsy (CP). The GRU-AM model demonstrated robust knee angle estimation across participants with healthy participants (mean RMSE 7 degrees) and participants with CP (RMSE 37 degrees). Further, estimation accuracy improved by 14 degrees on average across successive sessions of walking in the child with CP. These results demonstrate the feasibility of using attention-based deep networks for joint angle estimation in adolescents and clinical populations and support their further development for deployment in wearable robotics.

'Walk Buds': A walking intervention to increase physical activity, physical fitness, and emotional wellbeing, in 9-13 year old children with intellectual disabilities. Results of a clustered randomised feasibility trial.

Children with intellectual disability are less physically active and more sedentary than typically developing peers. To date no studies have tested the feasibility of a school-based walking intervention for children with Intellectual Disability. A clustered randomised controlled trial (cRCT), with an embedded process evaluation, was used to test the feasibility of a school-based walking intervention. Eight schools (n = 161 pupils aged 9-13 years) were randomised into either an intervention arm or an 'exercise as usual' arm. Measures included physical activity, physical fitness and emotional wellbeing. Baseline and 3-month follow-up data were collected. The 'Walk Buds' intervention was found to be acceptable to teaching staff and pupils, with an uptake rate of the walking sessions offered of 84%. A number of challenges were experienced, relating to the COVID-19 pandemic, and difficulties collecting accelerometer data. Barriers, facilitators and required changes identified through the mixed methods process evaluation are discussed.

To Treat or not to Treat? The Fate of Patients with Intermittent Claudication Following Different Therapeutic Options.

Peripheral artery disease (PAD) is recognized as a significant contributor to the public health burden in the cardiovascular field and has a significant rate of morbidity and mortality. In the intermediate stages, exercise therapy is recommended by the guidelines, although supervised programs are scarcely available. This single-center observational study aimed to evaluate the long-term outcomes of patients with PAD and claudication receiving optimal medical care and follow-up or revascularization procedures or structured home-based exercise. The records of 1590 PAD patients with claudication were assessed at the Vascular Surgery Unit between 2008 and 2017. Based on the findings of the recruitment visit, patients were assigned to one of the three following groups according to the available guidelines: Revascularization (Rev), structured exercise therapy (Ex), or control (Co). The exercise program was prescribed at the hospital and executed at home with two daily 10-minute interval walking sessions at a pain-free speed. The number and date of deaths, all-cause hospitalizations, and peripheral revascularizations for 5 years were collected from the Emilia-Romagna regional database. At entry, 137 patients underwent revascularization; 1087 patients were included in the Ex group, and 366 were included in the Co group. At baseline, patients in the Rev group were significantly younger and had fewer comorbidities (p 0.001). A propensity score matching analysis was performed, and three balanced subgroups of 119 patients were each created. The mortality rate was significantly (p 0.001) greater in the Co (45%) group than in the Rev (11%) and Ex (11%) groups, as was the incidence of all-cause hospitalizations (Co: 95%; Rev 56%; Ex 60%; p 0.001). There were no differences in peripheral revascularizations (Co: 19%; Rev: 17%; Ex 11%). In PAD patients with claudication, both revascularization procedures and structured home-based exercise sessions are associated with better long-term clinical outcomes than walking advice and follow-up only.

The PAD-adapted 30-20-10 during Nordic walking: A new exercise training session in patients with symptomatic peripheral artery disease.

This study aimed to investigate the feasibility of a peripheral artery disease (PAD)-adapted 30-20-10 Nordic walking session in patients with symptomatic PAD and to compare the cardiovascular response of this new training session to a traditional walking (TW) and 4 × 4 minutes Nordic walking session. This is a prospective observational study. Patients with Fontaine stage II PAD were included. Patients participated in Nordic walking sessions, which were randomly assigned as TW, 4 × 4 minute intervals, and peripheral artery disease adapted 30-20-10 exercise session (PAD-adapted 30-20-10 sessions). PAD-adapted 30-20-10 and 4 × 4 minutes sessions consisted of 4 repetitions of 4 minutes of effort followed by 3 minutes of passive recovery. PAD-adapted 30-20-10 session was characterized by 4 continuous 1-min repetitions at 3 different walking speeds [high (30 seconds), moderate (20 seconds) and low (10 seconds)]. During the 4 × 4 minutes session, patients were asked to cover the maximal distance at a constant speed. During TW session, patients were asked to walk at a speed inducing moderate-to-severe claudication pain. Heart rate, rating of perceived exertion (RPE) and claudication pain intensity using a visual analog scale were assessed. The perceived enjoyment of each session was assessed using a visual analog scale ranging from 0 (not enjoyable) to 10 (very enjoyable). Eleven patients with chronic symptomatic PAD were included (62 ± 13 years; 54% women). The mean heart rate during the time of effort was significantly higher in PAD-adapted 30-20-10 group than in 4 × 4 minutes and TW groups (127 ± 12, 122 ± 12, 114 ± 11 bpm, respectively; P ≤ .001). The mean rating of perceived exertion (16 ± 1, 15 ± 1, 13 ± 1; P ≤ .001) and claudication pain intensity (8 ± 1, 7 ± 1; 7 ± 1 mm; P ≤ .019) were significantly higher during PAD-adapted 30-20-10 sessions than during 4 × 4 minutes and TW sessions. The perceived enjoyment was similar among sessions (8.7 ± 1.6 for TW, 8.6 ± 1.7 for 4 × 4 minutes, and 8.8 ± 1.8 mm for PAD-adapted 30-20-10 sessions; P = .935). The PAD-adapted 30-20-10 session is feasible and induces higher cardiovascular stimulation and claudication pain than 4 × 4 minutes and TW procedures in patients with symptomatic PAD. Despite these different responses, a similar perceived enjoyment among the sessions has been shown. Future investigations are needed to examine the effects of this new training session in these patients.