Slow Walking Research Articles

Design, Analysis, and Development of Low-Cost State-of-the-Art Magnetorheological-Based Microprocessor Prosthetic Knee.

For amputees, amputation is a devastating experience. Transfemoral amputees require an artificial lower limb prosthesis as a replacement for regaining their gait functions after amputation. Microprocessor-based transfemoral prosthesis has gained significant importance in the last two decades for the rehabilitation of lower limb amputees by assisting them in performing activities of daily living. Commercially available microprocessor-based knee joints have the needed features but are costly, making them beyond the reach of most amputees. The excessive cost of these devices can be attributed to custom sensing and actuating mechanisms, which require significant development cost, making them beyond the reach of most amputees. This research contributes to developing a cost-effective microprocessor-based transfemoral prosthesis by integrating off-the-shelf sensing and actuating mechanisms. Accordingly, a three-level control architecture consisting of top, middle, and low-level controllers was developed for the proposed prosthesis. The top-level controller is responsible for identifying the amputee intent and mode of activity. The mid-level controller determines distinct phases in the activity mode, and the low-level controller was designed to modulate the damping across distinct phases. The developed prosthesis was evaluated on unilateral transfemoral amputees. Since off-the-shelf sensors and actuators are used in i-Inspire, various trials were conducted to evaluate the repeatability of the sensory data. Accordingly, the mean coefficients of correlation for knee angle, force, and inclination were computed at slow and medium walking speeds. The obtained values were, respectively, 0.982 and 0.946 for knee angle, 0.942 and 0.928 for knee force, and 0.825 and 0.758 for knee inclination. These results confirmed that the data are highly correlated with minimum covariance. Accordingly, the sensors provide reliable and repeatable data to the controller for mode detection and intent recognition. Furthermore, the knee angles at self-selected walking speeds were recorded, and it was observed that the i-Inspire Knee maintains a maximum flexion angle between 50° and 60°, which is in accordance with state-of-the-art microprocessor-based transfemoral prosthesis.

Frailty and risk of microvascular disease in adults with prediabetes

Background and aimsTo assess the relationship between frailty phenotypes and the risk of MVD among prediabetics in two prospective cohorts. MethodsThe study included 66,068 and 226 participants with prediabetes from the UK Biobank (UKB) and Chinese Ocular Imaging Project (COIP) in Guangzhou, China, respectively. Frailty was evaluated using the Fried phenotype, which includes weight loss, fatigue, low grip strength, low physical activity, and slow walking pace. The outcome was incident microvascular diseases, including diabetic retinopathy, nephropathy, and neuropathy in UKB, and decline rate of retinal capillary density in COIP. Cox models were used to calculate hazard ratios (HRs) and 95 % confidential intervals (CIs), and mixed linear model was used to determine the β and 95 % CIs. ResultsAt baseline, 27,491 (41.6 %) and 3332 (5.0 %) prediabetics were classified as pre-frail and frail, respectively in UKB. During a median follow-up of 8.9 years, 3784 cases of incident microvascular diseases were identified. Pre-frailty and frailty were significantly associated with a higher risk of microvascular diseases (HR 1.21 [1.12, 1.30] for pre-frailty; HR 1.60 [1.42, 1.81] for frailty). Compared to no frailty, the adjusted HRs for frailty were 1.42 (0.73, 2.76) for retinopathy, 1.49 (1.31, 1.70) for nephropathy, and 2.37 (1.69, 3.33) for neuropathy. Fatigue and walking pace were the strongest mediators of frailty and microvascular diseases. In the COIP, the lowest handgrip strength group exhibited 62%–63 % faster annually decline in retinal capillary density compared with the highest group (all P<0.05). ConclusionsEach frailty point is important for prediabetics because both pre-frailty and frailty phenotypes are strongly associated with an increased risk of microvascular diseases and its subtypes. Lower handgrip strength presents with faster decline in retinal capillary density.

A feasibility randomized controlled trial of a community-level physical activity strategy for older adults with motoric cognitive risk syndrome.

The motoric cognitive risk syndrome (MCR) is a syndrome characterized by subjective memory complaints and slow walking speeds that can identify older adults at increased risk for developing Alzheimer's disease or a related dementia (ADRD). To date, the feasibility of community-based physical activity (PA) programs for improving outcomes in MCR have yet to be examined. To address this knowledge gap, we conducted a translational randomized controlled trial (RCT) comparing 24-weeks of PA to a healthy aging education (HE) control intervention delivered within the infrastructure of an urban senior center in Greater Boston (clincaltrials.gov identifier: NCT03750682). An existing senior center employee was trained to administer the multimodal group-based PA program that included moderate-intensity aerobic walking, strength, flexibility and balance training. A total of 79 older adults attended the senior center for a screening visit, of whom 29 met the MCR criteria and 25 were randomized to PA or HE (mean age: 74.4 ± 7years; BMI: 32.4 ± 7kg/m2; 85% female; 3MSE score: 92.4 ± 7; gait speed: 0.52 ± 0.1m/s; SPPB score 4.8 ± 1.9). Due to the Covid-19 pandemic the study was stopped prematurely. Participants could successfully adhere to the study interventions (overall attendance rate: PA: 69% vs. HE:70% at study termination). Participants also successfully completed baseline and follow-up study assessments that included a computerized cognitive testing battery and objective tests of physical performance and functional exercise capacity. No study-related adverse events occurred. Notable trends for improved cognitive performance, gait speed and 6-min walk distance were exhibited in PA compared to HE. Our study provides important preliminary information to aid the design of larger-scale RCTs of PA that may help to preserve the independence of vulnerable older adults at high risk for ADRD in community-based settings.

Design and simulation of scaffolds with lattice microstructures for bioprinting bone tissue.

Tissue engineering seeks to improve, maintain, or replace the biological functions of damaged organs or tissues with biological substitutes such as the development of scaffolds. In the case of bone tissue, they must have excellent mechanical properties like native bone. In this work, three geometric models were designed for scaffolds with different structure lattices and porosity that could be biomechanically suitable and support cell growth for trabecular bone replacement applications in tissue engineering and regenerative medicine to the proximal femur area. Geometries were designed using computer-aided design (CAD) software and evaluated using finite element analysis in compression tests. Three loads were considered according to the daily activity: 1177 N for slow walking, 2060N for fast walking, and 245.25 N for a person in a bipedal position. All these loads for an adult weight of 75 kg. For each of them, three biomaterials were assigned: two polymers (poly-glycolic acid (PGA) and poly-lactic acid (PLA)) and one mineral (hydroxyapatite (HA)). 54 tests were performed: 27 for each of the tests. The results showed Young's modulus (E) between 1 and 4 GPa. If the resultant E is in the range of 0.1 to 5 GPa, the biomaterial is considered an appropriate alternative for the trabecular bone which is the main component of the proximal bone. However, for the models applied in this study, the best option is the poly-lactic acid which will allow absorbing the acting loads.

Study on the relationship between the construction of community slow walking system and residents' activity range

Study on the relationship between the construction of community slow walking system and residents' activity range

The Effectiveness of Various Physical Activities on Glycemic Control in Individuals with Prediabetes Mellitus in Semarang Municipality

Currently, diabetes mellitus is a prevalence in Indonesia, with a rate of 2.1% based on relevant diagnoses or symptoms. It is estimated that by 2030, the number of individuals suffering form diabetes mellitus will reach 21.3 million. Conversely, the proportion of individuals with prediabetes is 2-4 times higher than those with diabetes. Physical activity has been identified as a preventive measure for prediabetes. Several studies have demonstrated the significant impact of physical activity on glycemic control. This study aimed to determine the effectiveness of different physical activities on glycemic control in prediabetic clients residing in Semarang municipality. A randomized control trials with a pretest-posttest design was conducted on 60 prediabetic clients using different treatments, including healthy/slow walking, brisk walking, and a combination of both slow and brisk walking. The data of the study were analyzed using univariate, and bivariate analysis using repeated ANOVA. All statistical analyses were carried out using SPSS version 22. The average level of glycemic control before intervention in the healthy walking group was 5.57%, which decreased to 5.46% after intervention. The combination group decreased from 5.93% to 5.78%, and the slowly walking group decreased from 5.74% to 5.71%. However, there was no significant effect of slowly walking on glycemic control (HbA1c levels). In contrast, brisk walking and the combination of slow walking and brisk walking had a significant effect on glycemic control (p&lt;0.05). The combination of the physical activity group demonstrated the greatest impact on glycemic control (p&lt;0.05).

Research on the Design and Gait Planning of a Hexapod Robot Based on Improved Triangular Gait for Lunar Exploration

To address the challenges posed by the loose lunar surface structure, including the adhesive nature of lunar soil, strong corrosiveness and the slow walking speed of robots using traditional tripod gaits, this paper proposes the design of a small lunar exploration hexapod robot with hollow legs, employing anti-corrosive aerospace materials throughout. Additionally, an inverted gait motion mode is introduced. Simulation analysis is conducted on the displacement, angular velocity, angular acceleration and joint torque of the robot’s body under both traditional tripod gaits and the “inverted gait” motion mode. A physical prototype of the robot is developed to validate the rationality of its structure. Our research results indicate that the designed lunar exploration hexapod robot’s body structure is reasonable, enabling it to stand and walk normally on the unstructured lunar terrain. The hollow design reduces the adhesion of lunar soil. The inverted gait motion mode expands the effective swinging range of the robot’s legs and increases the effective step length during leg swing. Additionally, it improves the robot’s movement speed, eliminates vibrations at the joints during motion and improves the robot’s stability during the support phase.

THE ASSOCIATION OF HEARING LOSS AND FRAILTY AMONG OLDER ADULTS IN THE US

Abstract Frailty is common in older adults and increases the risk of functional limitations and death. Hearing loss affects ~2/3 of older adults in the U.S. and is associated with poorer physical and cognitive function and social isolation, which may increase the risk for frailty. We aimed to determine if hearing loss is associated with higher odds of being frail or pre-frail versus robust and if hearing aid use is protective. We analyzed data from 2,361 participants from the National Health and Aging Trends Study (NHTAS), a U.S. nationally representative sample of older adults, collected in 2021. Hearing was assessed by pure-tone audiometric testing, and we used a speech-frequency (0.5-4 kHz) better hearing ear’s pure-tone average (BPTA) to categorize participants into no hearing loss (BPTA≤25 dB HL), mild (26-40), and moderate or greater (&amp;gt;40) hearing loss. Physical frailty was categorized according to the presence of the frailty phenotype components (unintentional weight loss, exhaustion, low physical activity, weakness, slow walking speed) into robust (0), pre-frail (1-2), and frail (≥3). In our study population (mean age=81, 56% female, 19% Black), there were 1,724 (73%) participants with hearing loss. Using multinomial logistic regression, we found that participants with moderate or greater hearing loss (vs. those without) had higher odds of being frail versus robust (OR=1.82, 95% CI 1.11, 2.99, p-trend=0.016). Hearing loss may be a risk factor for frailty. Future studies on the impact of hearing interventions in preventing and managing frailty will have significant public health and clinical importance.

FEASIBILITY OF A COMMUNITY-LEVEL PHYSICAL ACTIVITY STRATEGY FOR OLDER ADULTS WITH MOTORIC COGNITIVE RISK SYNDROME

Abstract The motoric cognitive risk syndrome (MCR) is a pre-dementia syndrome characterized by slow walking speeds and subjective memory complaints. To date, the feasibility of a community-based physical activity (PA) program for improving outcomes in MCR has not been examined. To address this knowledge gap, we conducted a translational randomized controlled trial (RCT) of 24-weeks of PA or a healthy aging education (HE) control intervention delivered within the existing infrastructure of an urban senior center in Greater Boston. A senior center employee was trained to administer the multimodal group-based PA program that included moderate-intensity aerobic walking, strength, flexibility and balance training. A total of 79 older adults attended the senior center for a screening visit of whom 25 met the MCR criteria and were randomized to PA or HE (mean age: 74.4 ± 7 yrs; BMI: 32.4 ± 7 kg/m2; 85% female; 3MSE score: 92.4 ± 7; gait speed: 0.52 ± 0.1 m/sec; SPPB score 4.8 ± 1.9). Due to COVID-19 the study was terminated early, however participants successfully completed baseline and follow-up study assessments that included objective tests of physical function and an iPad-based cognitive testing battery. Participants could appropriately adhere to the study interventions (overall attendance rate: PA: 69.3% vs. HE:70.1% at study termination). No study-related adverse events occurred. Trends for improved executive cognitive performance were exhibited in PA compared to HE. Our study provides important preliminary information to aid the design of larger-scale RCTs to preserve the independence of vulnerable older adults with MCR in community-based settings.

A MEDITERRANEAN LIFESTYLE AND FRAILTY INCIDENCE IN OLDER ADULTS: THE SENIORS-ENRICA-1 COHORT

Abstract Background Frailty is a geriatric syndrome that entails high risk of hospitalization, disability, and death. While adherence to Mediterranean diet has been associated with lower risk of frailty, the joint effect of diet and lifestyle is uncertain. This study examined the association between a Mediterranean lifestyle (diet, customs, and traditions) and frailty incidence in older adults. Methods We analyzed data from 1 880 individuals aged ≥ 60 from the prospective Seniors-ENRICA-1 cohort. Adherence to the Mediterranean lifestyle was assessed at baseline with the 27-item MEDLIFE index (higher scores representing better adherence), divided into 3 blocks: (1) “Mediterranean food consumption,” (2) “Mediterranean dietary habits” (practices around meals),” and (3) “Physical activity, rest, social habits and conviviality.” Frailty was ascertained as the presence of ≥ 3 of the 5 Fried criteria: (a) Exhaustion; (b) Muscle weakness; (c) Low physical activity; (d) Slow walking speed; and (e) Unintentional weight loss. Main statistical analyses were performed using logistic regression models, adjusting for the main confounders. Results After a 3.3-year follow-up, 136 incident frailty cases were ascertained. Compared with participants in the lowest tertile of the MEDLIFE score, the OR (95% CI) for frailty was 0.88 (0.58-1.34) for the second tertile, and 0.38 (0.21-0.69) for the third tertile (p-trend = .003). Blocks 1 and 3 of the MEDLIFE score were independently associated with lower frailty risk. Most items within these blocks showed a tendency to reduced frailty. Conclusions Higher adherence to a Mediterranean lifestyle was associated with lower risk of frailty.

HOW DOES EXECUTIVE FUNCTION IMPACT ADHERENCE AND COMPLIANCE TO NOVEL PHYSICAL THERAPY INTERVENTION AMONG VETERANS?

Abstract Executive function problems may make it difficult for a person to adhere to and comply with Physical Therapy (PT) treatment. This study examined adherence and compliance to a novel PT intervention among Veterans with and without executive function deficits (EFD+/EFD-). This study was a preplanned secondary analysis of an ongoing Randomized Controlled Trial among middle to older Veterans (≥50yrs) with slow walking speed. Participants’ adherence (dropouts) and compliance (attendance, post-treatment exercise) to 8-week PT treatment were evaluated based on their baseline EFD status. Seventy-two participants were included in this study (mean age 72) and 22% (n=16) were EFD+. Veterans with EFD+ at baseline had worse mobility both objectively (Short Physical Performance Battery, 7.7 ± 1.9 vs. 9.5 ± 2.2, p&amp;lt; 0.01) and subjectively (Activity Measure for Post-Acute Care (AM-PAC), 57.6 ± 4.7 vs. 62.2 ± 5.7, p&amp;lt; 0.01). Dropout rates for EFD+ and EFD- were 44% and 25%, respectively. In the multivariable logistic regression, dropouts were associated with pain interference, depressive symptoms, mobility, and living alone. There were no differences in treatment attendance or post-treatment exercise compliance based on EFD status measured by number of attended sessions or number of post-treatment exercise days. In conclusion, EFD+ was associated with poor mobility and higher rates of dropping out. Screening for EFD is critical and may assist in predicting individuals who will need more support to enhance mobility.

PLASMA NEUROFILAMENT LIGHT CHAIN IS ASSOCIATED WITH PHYSICAL FRAILTY IN OLDER ADULTS WITHOUT DEMENTIA

Abstract Evidence suggests a link between brain biomarkers of neurodegeneration and physical function and frailty. However, the association of neurodegenerative biomarkers in the plasma with physical frailty in older adults remains unelucidated, as current evidence is limited and inconsistent. We tested the association between plasma neurofilament light chain (NFL), a plasma neurodegeneration biomarker, and physical frailty in a sample of community-dwelling older adults. We used baseline demographics, frailty, and plasma NFL data collected from 97 participants in a randomized controlled trial in community-dwelling, sedentary older adults without dementia [Montreal Cognitive Assessment (MoCA)&amp;gt;17]. Physical frailty was assessed using a composite measure of weakness, slow walking speed, unintentional weight loss, exhaustion, and low physical activity. Participants’ frailty levels were categorized into robustness, pre-intermediate frailty, and frailty. Multiple linear regression and ordinal logistic regression models adjusting for age, sex, race, education, and comorbidities were conducted to test the associations of NFL with frailty and levels of frailty. The sample was 70.0 ± 6.0 years old, with 80% being females, 72% having intact cognition, and 28% having mild cognitive impairment (MCI). In the adjusted models, higher plasma NFL was associated with higher frailty scores (β=0.16, 95%CI [Confidence Interval] = [0.06,0.26]) and a higher likelihood of being in a higher level of frailty group (odds ratio=1.28, 95% CI =1.02, 1.61). In summary, plasma NFL was associated with greater frailty in our sample of non-demented older adults. Plasma NFL may be a sensitive and promising neurodegenerative biomarker for physical frailty in older adults without dementia.

MITOCHONDRIAL DNA COPY NUMBER IS ASSOCIATED WITH PHYSICAL FUNCTION

Abstract Mitochondria generate the energy required by cells to maintain functionality and muscle health. They may play a key role in age-related physical function decline. Skeletal muscle mitochondrial function is associated with gait speed and muscle strength. Blood-derived mitochondrial DNA copy number (mtDNAcn) is a biomarker of mitochondrial health, but its association with physical function is unclear. We examined cross-sectional associations of mtDNAcn estimated by whole genome sequencing with gait speed and grip strength in participants aged 50+ from two population-based studies: Baltimore Longitudinal Study of Aging(BLSA,n=688) and UK Biobank(n=150,448). Gait speed was measured using 6-meter walk in BLSA and self-reported walking pace in UK Biobank. Handgrip strength was measured using a hand dynamometer. We additionally tested sex differences because of known sex differences in gait speed and grip strength. We found that higher mtDNAcn was associated with faster gait speed and greater grip strength, after adjustment for age,sex,race,and autosomal coverage. Specifically, each standard deviation increase in mtDNAcn was associated with a 0.05 m/sec faster in gait speed and a 19% lower odds of reporting slow walking pace(both p&amp;lt; 0.0001). There was no significant sex-by-mtDNAcn interaction for gait (both p&amp;gt;0.05). There was a significant sex-by-mtDNAcn interaction for grip strength. In sex-stratified analysis, the association with grip strength was stronger in men (β=0.129,p=0.002;β=0.032,p&amp;lt; 2e-16,respectively) than in women (β=0.007,p=0.784;β=0.015,p&amp;lt; 2e-16,respectively). These findings suggest that blood-based estimate of mitochondrial function is related to physical function in community-dwelling middle-aged and older adults. Further research is needed to understand its relationship with physical function decline and underlying mechanisms.

MITOCHONDRIAL ENERGETICS AND PERCEIVED PHYSICAL FATIGABILITY SEVERITY IN OLDER ADULTS

Abstract It has been hypothesized that lower skeletal muscle energetics may contribute to onset of age-related perceived fatigability. Consistent with this idea, previous research found that maximal ATP production (ATPmax) was associated with higher perceived exertion (i.e., fatigability) measured in older adults with the Borg Scale at the end of a slow walking task. We extend this work to SOMMA examining skeletal muscle energetics (ATPmax and maximal complex I&amp;II supported oxidative phosphorylation [maxOXPHOS]) with perceived physical fatigability using the Pittsburgh Fatigability Scale (PFS, range 0-50, higher=greater). PFS captures fatigue perception anchored to activities of varying intensity and duration. We assessed ATPmax in vivo by 31P magnetic resonance spectroscopy following an acute knee extensor exercise bout. maxOXPHOS was quantified ex vivo in permeabilized fiber bundles by high-resolution spectroscopy. Participants (N=721 with PFS and ≥1 energetics measure) were aged 76.4±5.0 years, 56.7% women, 86.7% White. Lower ATPmax (r=-0.21) and maxOXPHOS (r=-0.29) correlated with higher PFS scores (both p&amp;lt;0.001). Linear regressions adjusted for age, sex, technician, and total daily accelerometry-derived physical activity revealed that each one SD lower ATPmax (0.15 mM/sec) was associated with 1.15 (95% CI: 0.50, 1.79) higher PFS scores; each one SD lower maxOXPHOS (18.5 pmol/(sec*mg)) was associated with 1.79 (95% CI: 1.14, 2.45) higher PFS scores. Impaired skeletal muscle energetics may be implicated in the etiologic pathway of age-related fatigability. Next steps will examine the longitudinal association between changes in skeletal muscle energetics and age-related fatigability.

SENSORIMOTOR IMPAIRMENTS AND DEMENTIA: A CROSS-SECTIONAL ANALYSIS OF NATIONAL HEALTH AND AGING TRENDS STUDY

Abstract Sensory impairments in vision and hearing are linked to dementia in older adults. However, this association has not been investigated in conjunction with motor function performance. We examined cross-sectional sensory and motor function and dementia status data from 1,765 participants in the National Health and Aging Trends Study (NHATS R11, 2021) (32.7% aged ≥80 years; 55% women) who completed objective physical function and sensory testing. Motor function was defined using grip strength (kg), gait speed (m/s), standing balance, and chair stand speed (stands/sec). Sensory function was defined using hearing (pure tone average for better ear (BPTA) (dB)) and vision (contrast sensitivity (logCS)). Dementia was categorized as possible or probable using NHATS dementia classification. Survey-weighted logistic regression models estimated the likelihood of dementia by impairment in sensory and motor function, adjusted for demographic and medical conditions. 185 (10.5%) participants had possible or probable dementia. In models incorporating both motor and sensory impairments, impaired standing balance (&amp;lt;3 standing balance score in SPPB) and slow walking speed (&amp;lt;0.8m/s) were associated with higher odds of dementia (OR=1.75; 95%CI 1.10-2.79; and 2.39 95%CI 1.37-4.15, respectively), while hearing impairment (BPTA&amp;gt;25dB) and contrast sensitivity (&amp;lt;1.55logCS) were not associated with higher prevalence of dementia. In this nationally representative sample of older US adults, results suggest motor function is more strongly associated with dementia relative to sensory function among participants able to complete physical function testing. Future research is needed to understand how the associations of sensory and motor function with dementia change from mid-to-late life.

Structural equation modeling of negative emotion and walking behavior by smoke-filled model-scale tunnel experiments

This study investigated the relationship between emotion and evacuation behavior in smoke for future modeling of irrational behavior by conducting experiments using a model-scale smoke-filled tunnel. Furthermore, the causal relationship between emotions and walking behavior was investigated through structural equation modeling. The results show that emotions influence slow walking behavior. The increase in heart rate due to the walking exercise was smaller than that caused by emotions. Moreover, the heart rate change degree with emotion corresponded to Proulx’s proposal order, from low-stress to anxiety.

CAGSI: A Classification Approach towards Gait Speed Identification

The last few decades have witnessed a remarkable amount of research addressing numerous challenges in the domain of human activity recognition. One popular problem in this domain has been that of gait analysis. A subproblem in this domain is to identify the speed of a mobile object through gait analysis. Apart from clinical diagnostic applications, the detection of the speed of a person is also important in remote health monitoring, tracking of the mentally incompetent, and determining proper ambulatory assistive devices for the orthopaedically impaired. Gait analysis-related problems commonly deal with large volumes of interrelated data for which machine-learning techniques have been proven effective. However, the size of the feature set used in such problems is a crucial factor. The choice of a large feature set may complicate the approach for long-term analysis. The present work addresses the problem of human walking speed classification through the machine learning approach. Data was experimentally collected with the mobile phone sensors carried by volunteers of different physiques. Only the acceleration readings along the three axes of the accelerometer are considered for further experimentation. Although walking speed is a personal trait, four classes of data have been curated, namely, slow walking, moderate walking, fast walking, and sitting. The speeds of the walks were not pre-defined so the volunteers performed the walks as per their own comfort, which enhances the challenge of distinguishing between sensor signals of varying speed. Experiments have been performed using different supervised learning algorithms with only acceleration data. The performance of the learning models has been analyzed with the help of accuracy, precision, recall, f1-score, and the ROC curve in a One-vs-Rest approach. The results demonstrate that the performance of this system for walking speed identification is comparable to state-of-the-art works. Our work has a unique perspective as it uses a primary dataset comprising only three features.

NAFLD Associates with Sarcopenia Defined by Muscle Mass and Slow Walking Speed: A Cross-Sectional Analysis from the Framingham Heart Study.

Sarcopenia is associated with NAFLD. It is unknown if the association is explained by shared risk factors. Our study sought to investigate the association between liver fat and sarcopenia in our cohort. Liver fat was measured on CT between 2008 and 2011. We excluded heavy alcohol use and missing covariates. Muscle mass in a subset (n = 485) was measured by 24 h urinary creatinine. Physical function was defined by h strength and walking speed. Sarcopenia was defined as low muscle mass and/or low physical function. We created multivariable-adjusted regression models to evaluate cross-sectional associations between liver fat and low muscle mass, grip strength, and walking speed. The prevalence of hepatic steatosis was 30% (n = 1073; 58.1% women; mean age 65.8 ± 8.6 years). There was a significant positive association between liver fat and muscle mass in linear regression models. The association was not significant after adjusting for BMI. The odds of sarcopenia increased by 28% for each SD in liver fat (OR 1.28; 95% CI 1.02, 1.60) and persisted after accounting for confounders in multivariable-adjusted models (OR 1.30, 95% CI 1.02, 1.67). Further studies are needed to determine if there is a causal relationship between liver fat and sarcopenia and whether treatment of sarcopenia improves liver fat.

Current status of exercise and its impact on quality of life in patients undergoing peritoneal dialysis in the post-COVID-19 period.

The aims of this study were to investigate the current status and the influence factors of exercise, and to explore the impact of exercise on the quality of life (QoL) in peritoneal dialysis (PD) patients in the post-COVID-19 period. Those PD patients who were followed up between September 2020 and August 2021 were enrolled. The collected data included demographic information, clinical data, exercise data, and QoL. In total, 339 PD patients were included in this cross-sectional study. The mean age was 44.0 ± 13.0 years, with a median PD duration of 6.7 (1.7 - 41.9) months. The primary renal disease was glomerulonephritis (68.4%). 277 (81.7%) PD patients performed exercise, with median exercise time 5.0 (3.5 - 7.8) hours per week. The main type of exercise was slow walking. Pain (odds ratio (OR) = 0.311, p = 0.002) and lower hemoglobin level (OR = 1.016, p = 0.033) were independent risk factors for exercise. Moreover, male sex (B = 2.803, p < 0.001) was an independent protective factor, while advanced age (B = -0.097, p < 0.001), higher body mass index (B = -0.154, p < 0.001), and pain (B = -0.643, p = 0.023) were independent risk factors for exercise intensity. After adjustment for other confounders, exercise (B = 5.787, p = 0.037) was an independent protective factor for total score of QoL in PD patients. In the current study, 81.7% of PD patients performed exercise in the post-COVID-19 period. Pain and anemia were independent risk factors for exercise in PD patients. Advanced age, female sex, higher body mass index, and pain were independently associated with lower exercise capacity in PD patients. PD patients undergoing exercise had better QoL.

Physical frailty deteriorates after a 5-day dexamethasone course in children with acute lymphoblastic leukemia, results of a national prospective study.

Dexamethasone is important in the treatment for pediatric acute lymphoblastic leukemia (ALL) but induces muscle atrophy with negative consequences for muscle mass, muscle strength, and functional abilities. The aim of this study was to establish the effect of a dexamethasone course on sarcopenia and physical frailty in children with ALL, and to explore prognostic factors. Patients with ALL aged 3-18 years were included during maintenance therapy. Patients had a sarcopenia/frailty assessment on the first day of (T1) and on the day after (T2) a 5-day dexamethasone course. Sarcopenia was defined as low muscle strength in combination with low muscle mass. Prefrailty and frailty were defined as having two or ≥three of the following components, respectively: low muscle mass, low muscle strength, fatigue, slow walking speed, and low physical activity. Chi-squared and paired t-tests were used to assess differences between T1 and T2. Logistic regression models were estimated to explore patient- and therapy-related prognostic factors for frailty on T2. We included 105 patients, 61% were boys. Median age was 5.3 years (range: 3-18.8). At T1, sarcopenia, prefrailty, and frailty were observed in respectively 2.8%, 23.5%, and 4.2% of patients. At T2, the amount of patients with frailty had increased to 17.7% (p = 0.002), whereas the number of patients with sarcopenia and prefrailty remained similar. Higher ASMM (odds ratio [OR]: 0.49, 95% CI: 0.28-0.83), stronger handgrip strength (OR: 0.41, 95% CI: 0.22-0.77) and more physical activity minutes per day (OR: 0.98, 95% CI: 0.96-0.99) decreased the risk of frailty at T2. Slower walking performance (OR: 2, 95% CI: 1.2-3.39) increased the risk. Fatigue levels at T1 were not associated with frailty at T2. Physical frailty increased strikingly after a 5-days dexamethasone course in children with ALL. Children with poor physical state at start of the dexamethasone course were more likely to be frail after the course.