Timed Up And Go Time Research Articles

Balance and functional mobility predict low bone mineral density among postmenopausal women undergoing recent menopause with osteoporosis, osteopenia, and normal bone mineral density: A cross-sectional study

The purpose of this study was to determine whether balance and functional mobility independently predict bone mineral density (BMD) in postmenopausal women. BMD at the hip and spine was measured with dual-energy x-ray absorptiometry (DEXA). Participants were assigned into groups (i.e., osteoporosis: n=20; osteopenia: n=20; normal BMD: n=20) according to DEXA T-scores. Participants performed the single leg stance test (SLS), timed-up-and-go (TUG), and 6-meter walking test. An ordinal logistic regression was performed to determine whether the SLS, TUG, 6MWT independently predict BMD, while accounting for age, age at menopause, and body mass index. Three factors predicted low BMD: (1) less time to hold the SLS (odds ratio (OR): 0.50); (2) longer TUG time (OR: 2.85); and (3) older Age (OR: 1.31). Women with recent menopause diagnosed with osteoporosis are at a high-risk for fracture; incorporating the SLS and TUG into risk assessments may enable prompt and targeted intervention.

Association of anemia with mobility capacity in older adults: a Korean nationwide population-based cross-sectional study

BackgroundOver 10% of adults aged ≥65 years have anemia, as defined by the World Health Organization (WHO). As the timed up and go (TUG) test is one of the most widely used tests of mobility, this study investigated whether anemia was associated with mobility capacity assessed using the TUG test in older adults.MethodsSubjects belonging to the Korean National Health Insurance Service-National Health Screening Cohort of the National Health Information Database were reviewed. Subjects were included if they had completed the TUG test as part of the National Screening Program for Transitional Ages in Korea. An abnormal TUG test result was defined as a time of ≥10 s and anemia was defined according to the WHO criteria as a hemoglobin (Hb) concentration of < 13.0 g/dL in men and < 12.0 g/dL in women. The association between anemia and TUG test results was evaluated using four multiple logistic regression models with different levels of adjustment. Stratified analysis according to risk factors was performed.ResultsThe 81,473 subjects included 41,063 (50.4%) women and 40,410 (49.6%) men. Mean TUG time was 8.44 ± 3.08 s, and abnormal TUG test results were observed in 22,138 (27.2%) subjects. Mean Hb concentration was 13.72 ± 1.41 g/dL, and 10,237 (12.6%) subjects had anemia. U-shaped associations between Hb concentration and TUG test results were observed in both sexes. Subjects with anemia were 19% more likely to have abnormal TUG test results, according to the fully adjusted model (adjusted odds ratio: 1.192, 95% confidence interval: 1.137–1.247). Similar results were observed for both sexes. Stratified analysis showed that subjects with anemia were more likely to have abnormal TUG test results regardless of risk factors.ConclusionsIndividuals with anemia are more likely to have abnormal TUG test results, regardless of risk factors, than individuals without anemia. U-shaped relationships between Hb concentrations and TUG test results were observed in both sexes, although the optimal Hb concentration differed between men and women.

The timed up and go test predicts fracture risk in older women independently of clinical risk factors and bone mineral density

SummaryThe timed up and go (TUG) test measures physical performance and predicts falls in the elderly. In older women, TUG time predicts the risk of major osteoporotic fracture and hip fracture independently of clinical risk factors and bone mineral density, and has a substantial impact on fracture probabilities.IntroductionThe timed up and go (TUG) test measures physical performance and predicts falls in the elderly. A slow TUG has been associated with an increased fracture risk, but it is unclear whether the association is independent of clinical risk factors and bone mineral density (BMD). The aim of this study was to investigate if TUG time was associated with fracture risk independently of clinical risk factors and BMD and to determine its impact on fracture probabilities in older women.MethodsA standardized questionnaire was used to assess information regarding clinical risk factors in the large population-based SUPERB study of 3028 older women (75–80 years). At baseline, the TUG test was performed and BMD measured with DXA. The association between TUG time and the risk of hip fracture and major osteoporotic fracture (MOF) was examined using an extension of Poisson regression.ResultsFracture incidence increased steeply with increasing TUG time up to 12 s and subsequently started to level off. A slow TUG time was therefore defined as TUG > 12 s, a cutoff level then used in Cox models to study the association between slow TUG and fracture risk. A slow TUG time was associated with an increased risk of fracture (MOF 2.39 [1.80–3.18] and hip fracture 2.96 [1.62–5.40]). These associations were slightly attenuated but remained significant after adjustment for clinical risk factors and femoral neck BMD. Depending on BMD, the 4-year fracture probability of MOF increased by a factor of 1.5–1.9 in a 75-year-old woman with slow TUG (> 12 s).ConclusionThe TUG time predicts the risk of MOF and hip fracture independently of clinical risk factors and BMD and has a substantial impact on fracture probabilities, indicating that inclusion of the TUG test in patient evaluation should be considered in order to improve fracture prediction in older women.

Use of time-to-boundary to assess postural instability and predict functional mobility in people with diabetes mellitus and peripheral neuropathy

BackgroundPeople with diabetes mellitus and peripheral neuropathy (DMPN) often have balance and mobility deficits. Time-to-boundary (TTB) is a parameter of postural control that combines position and velocity center of pressure data. While not previously investigated, assessment of TTB may provide new insight regarding postural control in people with DMPN. Research questionIs TTB reduced and related to a measure of mobility in people with DMPN? MethodsThirteen people with DMPN without fall history and 13 healthy matched controls participated in this case-control study. Participants stood in double-limb stance on a force plate. The anterior-posterior and medial-lateral center of pressure position and velocity relative to the boundaries of the base of support were used to calculate TTB (s). Lower values indicate less postural control. Time-to-failure during single-limb stance was a secondary measure of postural control. Time to complete the Timed Up and Go (TUG) was our measure of mobility. Longer TUG times correspond to decreased mobility, strength, and balance. Independent t-tests or Mann-Whitney U tests were conducted to assess group differences. Bivariate correlations between task outcomes were conducted. ResultsAnterior-posterior TTB and single-limb stance times were shorter in people with DMPN (p ≤ 0.04). TUG times were longer in the DMPN group (p = 0.04). In the DMPN group, inverse relationships were observed between TTB and TUG (anterior-posterior R2 = .34; medial-lateral R2 = .49; both p = 0.01), but not between single-limb stance times and TTB or TUG. SignificanceTTB was a sensitive measure of postural control in people with DMPN. The detected relationship between TTB and TUG newly establishes TTB as a clinically meaningful indicator of balance and function. Study findings may serve to further guide balance screening and rehabilitation efforts in people with DMPN.

Locomotor Function and Pain in Total Ankle Arthroplasty Patients at Six Months’ Follow-Up

Category:Ankle; Ankle ArthritisIntroduction/Purpose:Outcomes following total ankle arthroplasty (TAA) are largely positive, with high levels of patient satisfaction, but residual pain has been identified in up to 60% of cases. While associations between implant kinematics and pain following TAA have been found in a study of walking gait, there have been no studies to date of pain and function during more challenging locomotor tasks. The purposes of this study were (1) to examine pre- to post-operative (6 months) changes in function along with comparisons to healthy controls, and (2) to determine how functional changes are related to pain. We hypothesized that following TAA, function would improve but would not match that of healthy controls. We further hypothesized that improvements in function would be related to reductions in pain.Methods:Complete data sets were obtained for 11 TAA patients (age: 64.04 +- 9.26 y, height: 1.71 +- 0.07 m, body mass: 98.55+- 20.07 kg; 3 implant designs) and 15 age-matched control subjects (age: 63.14 +- 7.95 y, height: 1.68 +- 0.10 m, body mass: 75.57+- 13.66 kg). All procedures involving testing of human subjects were approved by the PSU HMC Institutional Review Board. Patients performed all tasks pre-operatively and six months post-operatively in a motion laboratory. Participants completed the RAND 36-Item Health Survey 1.0 (SF-36), whose global pain score was used in our analysis. Each patient and control participant performed three tasks to assess their locomotor function: Single-Leg Balance Test (SLBT); Timed Up-and-Go (TUG) Test, and Six- Minute Walk (6MW). Linear regression analysis incorporating covariates of change in pain (delta-pain) and BMI was performed to investigate how change in performance on these tests depended on these variables.Results:For 6MW velocity (r = 0.653, p = 0.030), normalized 6MW velocity (r = 0.624, p = 0.040), and SLBT (r = 0.695, p = 0.018) pre-operative scores were correlated with post-operative function. TUG performance had a very weak correlation (r = 0.226, p = 0.504) and pain levels had a moderate correlation (r = 0.646, p = 0.032). Linear regression did not predict change in function from delta-pain alone, but when BMI and the interaction of BMI with delta-pain were included, moderate to good fits for change in function were obtained (Table 1). Improvements in pain (when accounting for BMI) accounted for the majority of improvement in average walking velocity, and up to half of the variation in improvement in TUG.Conclusion:This is the first study relating changes in locomotor function to changes in pain following TAA. Our first hypothesis that performance on the three tests would be improved over pre-operative function, but without reaching that of healthy controls, was supported. Contrary to our second hypothesis, we found that pain improvement assessed using the pain score from the SF-36 did not explain variation in observed improvements in function. When we included the interaction between pain and BMI in our models, 80% of the changes in 6MW average velocity was explained, and approximately 50% of TUG time change was explained.

Clinical assessment of gait and functional mobility in Italian healthy and cognitively impaired older persons using wearable inertial sensors

AimThe main purpose of the present study was to verify the feasibility of wearable inertial sensors (IMUs) in a clinical setting to screen gait and functional mobility in Italian older persons. In particular, we intended to verify the capability of IMUs to discriminate individuals with and without cognitive impairments and assess the existence of significant correlations between mobility parameters extracted by processing trunk accelerations and cognitive status.MethodsThis is a cross-sectional study performed on 213 adults aged over 65 years (mean age 77.0 ± 5.4; 62% female) who underwent cognitive assessment (through Addenbrooke’s Cognitive Examination Revised, ACE-R) instrumental gait analysis and the Timed Up and Go (TUG) test carried out using a wearable IMU located in the lower back.ResultsIndividuals with cognitive impairments exhibit a peculiar gait pattern, characterized by significant reduction of speed (− 34% vs. healthy individuals), stride length (− 28%), cadence (− 9%), and increase in double support duration (+ 11%). Slight, but significant changes in stance and swing phase duration were also detected. Poorer performances in presence of cognitive impairment were observed in terms of functional mobility as overall and sub-phase TUG times resulted significantly higher with respect to healthy individuals (overall time, + 38%, sub-phases times ranging from + 22 to + 34%), although with some difference associated with age. The severity of mobility alterations was found moderately to strongly correlated with the ACE-R score (Spearman’s rho = 0.58 vs. gait speed, 0.54 vs. stride length, 0.66 vs. overall TUG time).ConclusionThe findings obtained in the present study suggest that wearable IMUs appear to be an effective solution for the clinical assessment of mobility parameters of older persons screened for cognitive impairments within a clinical setting. They may represent a useful tool for the clinician in verifying the effectiveness of interventions to alleviate the impact of mobility limitations on daily life in cognitively impaired individuals.

Association of Depression With Functional Mobility in Schizophrenia.

BackgroundFunctional immobility can cause functional disability in patients with schizophrenia and has been linked to prognosis and mortality. Although depression might be a barrier for physical activity engagement, scarce data are present on the relationship between depression and functional mobility (FM) in schizophrenia. Thus, we aimed to investigate the associations among FM, depression, and other clinical correlates in individuals with schizophrenia.MethodsFM was evaluated by the pedometer-assessed daily steps and Timed Up-and-Go (TUG) test in the daily-living and clinical settings, respectively. Psychiatric symptoms were assessed using the Beck Depression Inventory, Brief Psychiatric Rating Scale (BPRS), and State-Trait Anxiety Inventory. Cognitive function was evaluated using the Sternberg Working Memory (SWM) Task. Multiple regression analyses were performed to identify predictive factors associated with FM, with adjustment for relevant covariates.ResultsSixty patients were enrolled in this study. Depression was the most consistent explanatory variable for both pedometer (β = −0.34, p = 0.011) and TUG time (β = 0.32, p = 0.018). Additionally, SWM accuracy (β = −0.29, p = 0.018), BPRS-Withdrawal (β = 0.19, p = 0.139), and fasting blood sugar (β = 0.34, p = 0.008) were associated with TUG time. However, psychotic symptoms and anxiety were not associated with pedometer and TUG.ConclusionsWe identified an association between depression and FM after adjusting for other disorder-related correlates in schizophrenia. Since the intervention goal is functional recovery, improving FM by treating depression may have considerable therapeutic value.

Relationship Of Health-related Quality Of Life To Functional Fitness In Rural Cancer Survivors

Health-related quality of life (HRQoL) is of high interest in exercise oncology due to decreases in HRQoL during and following cancer treatments. Functional fitness assessments (FFA) are also commonly assessed in this population due to the treatment-related side effects that may impact the patient's ability to perform activities of daily living (ADLs). However, the relationship between these variables has not been previously explored. PURPOSE: To examine the relationship between HRQoL and FFA in a group of rural cancer survivors. METHODS: Fifteen (Females, n=8; Males, n=7) subjects with a previous diagnosis of cancer aged 62.0 ± 8.5 years and BMI of 21.8 ± 7.9 kg/m2 were assessed in several areas of FFA including waist circumference, body fat percentage, fat free mass (FFM), timed up and go (TUG), and 30 second chair stand (30CS). They were also given the Functional Assessment of Chronic Illness-Fatigue (FACIT-F) with subscales in physical well-being (PWB), social/family well-being (SWB), emotional well-being (EWB), functional well-being (FWB), and fatigue. The types of cancer and staging were diverse. Treatment types included chemotherapy, radiation, and surgery. FFA were completed and the FACIT-F completed at home and returned at the following session. RESULTS: Pearson Correlations were significant between SWB and TUG (r = -0.844, p = 0.000), SWB and 30CS (r = 0.715, p = 0.003), and between fatigue and FFM (r = 0.668, p = 0.006). A correlation trending toward significance was seen between FWB and TUG (r = -0.504, p = 0.055). No other significant correlations were found. CONCLUSION: Moderate-to-strong relationships were observed between SWB, TUG time, and 30CS. This shows cancer survivors who are more mobile may have a greater ability to engage in social tasks and ADLs. In addition, higher amounts of FFM were moderately correlated with having less fatigue meaning cancer survivors with more FFM may have less fatigue.

Is The Physical Activity Vital Sign Associated With Fall Risk In Older Adults?

PURPOSE: ACSM Exercise Is Medicine (EIM) initiative recommends the use of Physical Activity Vital Signs (PAVS) as an objective measure to assess compliance with the Physical Activity Guidelines for Americans. While physical activity is important for overall health, it may not necessarily improve balance and reduce risk of falls. The purpose of this study is to determine the associations between PAVS and measures of fall risk. METHODS: 65 seniors (age=81.2+8.0) participated. The PAVS was calculated in accordance with ACSM Exercise is Medicine. Fall risk was assessed using the Activities-Specific Balance Confidence Scale (ABC), Timed-Up-and-Go (TUG), and BTrackS™ Balance Plate. A less than 68-point ABC score suggested less balance confidence and a fall risk. A greater than 12-second TUG time and greater postural sway on the balance plate (based on BTrackS normative data) suggested a fall risk. Dependent measures were dichotomized as fall risk or no fall risk. Separate point biserial correlations were conducted to determine associations between the PAVS and fall risk category for the ABC, TUG, and postural sway. RESULTS: No signficant associations existed between PAVS and ABC (r = .23; p = .06), TUG (r = .20; p = .12), or postural sway (r = -.01; p = .94). CONCLUSIONS: Increasing physical activity levels based on the PAVS was not strongly associated with scores from commonly used fall risk assessments. This finding suggests that meeting physical activity guidelines alone may not be sufficient to reduce fall risk. While the PAVS can provide benefical information regarding other health factors, clinicians should utilize established balance screening tools and incorporate balance exercises into physical activity prescription to reduce fall risk in older adults.

Gait and Functional Mobility in Multiple Sclerosis: Immediate Effects of Transcranial Direct Current Stimulation (tDCS) Paired With Aerobic Exercise.

Walking impairments are a debilitating feature of multiple sclerosis (MS) because of the direct interference with daily activity. The management of motor symptoms in those with MS remains a therapeutic challenge. Transcranial direct current stimulation (tDCS) is a type of non-invasive brain stimulation that is emerging as a promising rehabilitative tool but requires further characterization to determine its optimal therapeutic use. In this randomized, sham-controlled proof-of-concept study, we tested the immediate effects of a single tDCS session on walking and functional mobility in those with MS. Seventeen participants with MS completed one 20-min session of aerobic exercise, randomly assigned to be paired with either active (2.5 mA, n = 9) or sham (n = 8) tDCS over the primary motor cortex (M1). The groups (active vs. sham) were matched according to gender (50% vs. 60% F), age (52.1 ± 12.85 vs. 54.2 ± 8.5 years), and level of neurological disability (median Expanded Disability Status Scale score 5.5 vs. 5). Gait speed on the 10-m walk test and the Timed Up and Go (TUG) time were measured by a wearable inertial sensor immediately before and following the 20-min session, with changes compared between conditions and time. There were no significant differences in gait speed or TUG time changes following the session in the full sample or between the active vs. sham groups. These findings suggest that a single session of anodal tDCS over M1 is not sufficient to affect walking and functional mobility in those with MS. Instead, behavioral motor response of tDCS is likely to be cumulative, and the effects of multiple tDCS sessions require further study.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03658668.

Diagnostic ability of the Timed Up & Go test for balance impairment prediction in chronic obstructive pulmonary disease.

BackgroundBalance assessment is now recommended by clinical practice guidelines, specific tests have yet to be suggested. The Timed Up and Go (TUG) test is a simple measure of balance status and functional mobility. Nowadays, we need more data of an optimum cut off point of TUG time for detecting balance impairment in patients with chronic obstructive pulmonary disease (COPD). Thus the aim of this study was to evaluate the diagnostic ability relative to balance impairment of the TUG in subjects with COPD.MethodsThe cross-sectional study was conducted in stable COPD patient at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand from November 2015 to October 2017. Balance impairment test was measured using the Berg Balance Scale (BBS), a score of ≤45 indicates balance impairment. The TUG was evaluated using sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR−), Youden’s index, and the area under receiver operating characteristic curve (AUROC) from various points of TUG to identify the optimum cut-off point for detecting balance impairment. Multivariable logistic regressions were performed to identify the optimum cut off point of TUG test time for prediction of balance impairment in COPD.ResultsOne hundred and eighteen smoking related COPD subjects 86 (72.9% male) with a mean age of 73.5±8.1 years were included in this study. Univariable analysis showed that the AUROC of TUG test to indicate those who had impaired balance was 0.93 [95% confidence interval (CI): 0.88, 0.98]. A cut off point of TUG test time ≥12 seconds had sensitivity, specificity, LR+, LR−, Youden’s index, and AUROC of 95.8%, 90.4%, 10.01, 0.05, 86.2, and 0.93 for detecting balance impairment, respectively. Multivariable analysis identified the TUG test time ≥12 seconds was the best predictor of balance impairment in COPD patients with adjusted risk ratio (RR) of 25.2 (95% CI: 1.6, 312.0, P=0.021) and, the AUROC was 0.98 (95% CI; 0.96, 1.00).ConclusionsOur study indicates the TUG test time ≥12 seconds has a high diagnostic ability for balance impairment prediction in COPD. The result supports a potential role for this simple test to be incorporated into routine COPD assessment to stratify patients’ balance.

The Effects of Dog Walking on Gait and Mobility in People with Parkinson Disease: A Pilot Study.

The objective of this study was to assess the effects of dog walking on gait and mobility in people with Parkinson disease (PD). This single-group, single-session, observational pilot study included nineteen participants with PD in Hoehn and Yahr stages II (n = 9) and III (n = 10). Primary measures were a gait analysis and the Timed Up and Go (TUG). Three trials of two conditions (walking with and without a dog) were completed. Walking with a dog resulted in slower gait velocity (mean difference = 0.11 m/s, p = 0.003, d = 0.77), shorter step length (left: mean difference = 7.11 cm, p = 0.000; right: mean difference = 3.05, p = 0.01), and stride length (left: mean difference = 7.52, p = 0.003; right: mean difference = 8.74, p = 0.001). The base of support was more narrowed (Z = −2.13, p = 0.03), with increased double limb stance time (left: Z = −2.89, p = 0.004; right: Z = −2.59, p = 0.01). Walking with a dog caused slower TUG times (mean difference = −1.67, p = 0.000) and increased number of steps (Z = −3.73, p = 0.000). No significant change shown in step time (left: mean difference = −0.001, p = 0.81; right: mean difference = 0.002, p = 0.77) or cadence (Z = −1.67, p = 0.10). In conclusion, there was an overall decline of gait parameters in people with PD when walking with a dog.

Handgrip Strength and Timed Up-and-Go (TUG) Test are Predictors of Short-Term Mortality among Elderly in a Population-Based Cohort in Singapore.

Asian studies on how physical tests predict short-term mortality in elderly are scarce. We assessed handgrip strength and timed-up-and-go (TUG) as such predictors among elderly Chinese in Singapore. Prospective cohort study. Community-dwelling Chinese elderly in Singapore. We used data from 13,789 subjects in the prospective, population-based Singapore Chinese Health Study, who had a mean age of 74 (range 63 to 97) years at time of measurements. Subjects underwent assessment for handgrip strength and TUG. They were followed for mortality via linkage with nationwide death registry through 2018. In multivariable analyses, handgrip strength was inversely associated with risk of mortality in a dose-dependent manner: the hazard ratio (HR) [95% confidence interval (CI)] comparing extreme quartiles was 2.05 (1.44-2.90) (Ptrend<0.001). TUG was positively associated with mortality in a stepwise manner: the HR (95% CI) comparing extreme quartiles was 3.08 (2.17-4.38) (Ptrend<0.001). Compared to those with stronger handgrip and faster TUG, participants who either had weaker handgrip or slower TUG had a significant 1.59 to 2.11 fold increase in risk of mortality; while the HR (95% CI) for those who had both weaker handgrip and slower TUG was 3.93 (3.06-5.05). In time-dependent receiver operating characteristic curves, adding handgrip strength and TUG time to a Cox model containing sociodemographic and lifestyle factors, comorbidities, and body measurements significantly improved the area under the curve for the prediction of mortality from 0.5 to 2 years (P≤0.001). Among elderly in a Chinese population, handgrip strength and TUG test were strong and independent predictors of short-term mortality.

Automated Stage Discrimination of Parkinson’s Disease

Abstract Background: Treatment plans for Parkinson’s disease (PD) are based on a disease stage scale, which is generally determined using a manual, observational procedure. Automated, sensor-based discrimination saves labor and costs in clinical settings and may offer augmented stage determination accuracy. Previous automated devices were either cumbersome or costly and were not suitable for individuals who cannot walk without support. Methods: Since 2017, a device has been available that successfully detects PD and operates for people who cannot walk without support. In the present study, the suitability of this device for automated discrimination of PD stages was tested. The device consists of a walking frame fitted with sensors to simultaneously support walking and monitor patient gait. Sixty-five PD patients in Hoehn and Yahr (HY) stages 1 to 4 and 24 healthy controls were subjected to supported Timed Up and Go (TUG) tests, while using the walking frame. The walking trajectory, velocity, acceleration and force were recorded by the device throughout the tests. These physical parameters were converted into symptomatic spatiotemporal quantities that are conventionally used in PD gait assessment. Results: An analysis of variance (ANOVA) test extended by a confidence interval (CI) analysis indicated statistically significant separability between HY stages for the following spatiotemporal quantities: TUG time (p &lt; 0.001), straight line walking time (p &lt; 0.001), turning time (p &lt; 0.001), and step count (p &lt; 0.001). A negative correlation was obtained for mean step velocity (p &lt; 0.001) and mean step length (p &lt; 0.001). Moreover, correlations were established between these, as well as additional spatiotemporal quantities, and disease duration, L-dihydroxyphenylalanine-(L-DOPA) dose, motor fluctuation, dyskinesia and the mobile part of the Unified Parkinson Disease Rating Scale (UPDRS). Conclusions: We have proven that stage discrimination of PD can be automated, even to patients who cannot support themselves. A similar method might be successfully applied to other gait disorders.

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

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

Mobility performance among healthy older adults eligible for long-term care in Japan: a prospective observational study.

Disability is an important health problem among older individuals, prompting the need for long-term care. Age-related disability is usually associated with mobility; however, little is known about the association between mobility and long-term care. Therefore, this study aimed to clarify the association between the timed up and go (TUG) test measuring mobility and long-term care eligibility. We analyzed follow-up data of 489 community-dwelling healthy older adults (≥ 65years) who participated in a prospective observational study. They were divided into certified (59 participants) and uncertified (430 participants) groups based on long-term care eligibility. Anthropometric and physical functioning measures included the TUG test and hand grip strength (HGS), among others. These measures were compared between groups and a multivariate logistic regression analysis evaluated the association between the TUG test times and long-term care eligibility. Participants' minimum follow-up period was 4years. TUG times were significantly slower (median time: 7.4 vs. 8.3s, p < 0.001) and HGS and knee-extension strength significantly lower in the certified group than in the uncertified group. The logistic regression analysis showed that TUG times were significantly associated with long-term care eligibility after adjusting for potential covariates. In addition, mediation analysis showed that 53.1% of the association between HGS and long-term care eligibility was mediated through TUG times. The TUG test was associated with long-term care eligibility among healthy older adults, implying that the test may be helpful as a predictor for the early determination of dependence in old age.

Default mode network and the timed up and go in MCI: A structural covariance analysis.

The timed up and go (TUG) is a test used to assess mobility in older adults and patients with neurological conditions. This study aims to compare brain gray matter (GM) correlates and structural covariance networks associated with the TUG time in cognitively healthy individuals (CHI) and in patients with mild cognitive impairment (MCI). The TUG time was measured in 326 non-demented older community-dwellers (age 71.3 ± 4.5; 42% female) - 156 CHI and 170 MCI. GM covariance networks were computed using voxel-based morphometry with the main neural correlates of TUG for each group as seed regions. Increased TUG time (i.e., poor performance) was associated with distinct brain volume reductions between CHI and MCI. The covariance analysis showed cortical regions involving the default mode network in CHI and bilateral cerebellar regions in MCI. GM networks associated with the TUG vary between CHI and MCI, suggesting distinct brain control for locomotion between CHI and MCI patients.

The effect of mobilization with movement on pain and function in patients with knee osteoarthritis: a randomized double-blind controlled trial

BackgroundFew studies have investigated the effects of mobilization with movement (MWM) in patients with knee osteoarthritis (OA) compared to other procedures. Sham procedures are generally more appropriate control than using no or usual treatments. Moreover, studies investigating the widespread hypoalgesic effects of MWM in patients with knee OA are lacking. The aim was to investigate the effect of MWM on function and pain in patients with knee OA compared to sham MWM.MethodsThis is a randomized double-blind (patients and assessor) controlled trial. Forty adult patients with knee OA of grade II and above were recruited to receive either MWM treatment or sham MWM for the knee. The outcome measures included the following: a visual analogue scale (VAS) for pain, the pressure pain threshold (PPT) test, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index, the timed up and go (TUG) test, knee strength and knee range of motion (ROM). The measurements were taken at baseline, immediately after intervention and 2 days later.ResultsCompared with sham MWM, MWM resulted in greater immediate improvement in pain [mean difference (95% CI): − 2.2 (− 2.8, − 1.6)], PPT at both the knee [176 (97, 254)] and shoulder [212 (136, 288)], TUG time [− 1.6 (− 2.1, − 1.1)], knee flexor strength [2.0 (1.3, 2.7)] and extensor strength [5.7 (4.1, 7.2)] and knee flexion ROM [12.8 (9.6, 15.9)] (all, p < 0.001) but not knee extension ROM [− 0.8 (− 1.6, 0.1)] (p = 0.067). After 2 days of intervention, patients who received MWM also demonstrated a greater improvement in pain [− 1.0 (− 1.8, − 0.1)], PPT at the shoulder [107 (40, 175)], TUG time [− 0.9 (− 1.4, − 0.4)], knee flexor strength [0.9 (0.2, 1.7)] and extensor strength [2.9 (2.1, 3.9)] and knee flexion ROM [8.3 (4.7, 11.9)] (all, p ≤ 0.026). However, WOMAC scores and knee extension ROM showed no evidence of change at any stage after intervention (p ≥ 0.067).ConclusionsMWM provided superior benefits over sham MWM in terms of local and widespread pain, physical function (walking), knee flexion and extension muscle strength and knee flexion ROM for at least 2 days in patients with knee OA.Trial registrationClinicalTrials.gov (NCT02865252), registered on August 12, 2016.

Use of home neuromuscular electrical stimulation in the first 6 weeks improves function and reduces pain after primary total knee arthroplasty: a matched comparison.

The use of neuromuscular electrical stimulation (NMES) after total knee arthroplasty (TKA) has been demonstrated to facilitate quadriceps muscle recovery and to reduce pain. However, to our knowledge, this therapeutic modality has not been directly tested in patients who receive muscle stimulators for home use immediately after surgery. Therefore, the purpose of this study was to assess the effect of NMES use at home in addition to standard therapy program in patients after primary TKA surgery, and to compare the early functional results to a matching group of post TKA patients who did not receive home NMES units. A total of 41 patients scheduled for a primary TKA during April 1st, 2017 to January 31st, 2018 were identified as being eligible for the study. There were 15 patients deemed ineligible to be part of the study, resulting in 26 patients who were fitted either 1 week before or within 1 week of surgery a home NMES device. The device was controlled by a smart phone. Patients were asked to use the NMES device daily for 20 minutes, 3 times a day, for 6 weeks after surgery. As their ability to activate their quadriceps muscle improved, patients were encouraged to increase their exercise regimens. The NMES patients were compared to a matched cohort of 26 patients who had a TKA performed between June 1st, 2015 and July 31st, 2016, but did not receive home an NMES device. Comparative outcomes included: timed up and go (TUG) test, single limb stance (SLS) time, time to ascend and descend one flight of stairs, quadriceps lag, active and passive range of motion (ROM), 2-minute walking distance, and pain rating on a visual analog scale (VAS). A P value of 0.05 was set as the threshold for statistical significance for the matched comparison. Patients in the home NMES had significantly better scores for quadriceps lag (P<0.001), TUG (P<0.001), time to ascend and descend one flight of stairs (P=0.001), SLS time (P<0.001). They also experienced significantly lower resting pain (P<0.001) and lower worst reported pain scores (P<0.001) compared to the control cohort. Additionally, there were a higher percentage of patients in the control cohort that could not use stairs reciprocally compared to the home NMES group (53.85% vs. 23.08%). Furthermore, passive range of motion for flexion was statistically better in the home NMES group (P=0.037). This matched comparison of primary TKA patients demonstrated significant pain reductions both at rest and lower worst reported pain scores and improved function with use of the home-based NMES units for the sub-acute phase of recovery. Patients walked longer distances safely as shown by improvements in TUG, quadriceps lag, and single limb support time. Larger proportions of patients in home NMES group were able to negotiate stairs reciprocally and faster than the matched control group. These findings may have important economic and functional implications for the post-operative care of TKA patient.

Neuromuscular adaptations and sensorimotor integration following a unilateral transfemoral amputation

BackgroundFollowing an amputation, the human postural control system develops neuromuscular adaptations to regain an effective postural control. We investigated the compensatory mechanisms behind these adaptations and how sensorimotor integration is affected after a lower-limb transfemoral amputation.MethodsCenter of pressure (CoP) data of 12 unilateral transfemoral amputees and 12 age-matched able-bodied subjects were recorded during quiet standing with eyes open (EO) and closed (EC). CoP adjustments under each leg were recorded to study their contribution to posture control. The spatial structure of the CoP displacements was characterized by measuring the mean distance, the mean velocity of the CoP adjustments, and the sway area. The Entropic Half-Life (EnHL) quantifies the temporal structure of the CoP adjustments and was used to infer disrupted sensory feedback loops in amputees. We expanded the analysis with measures of weight-bearing imbalance and asymmetry, and with two standardized balance assessments, the Berg Balance Scale (BBS) and Timed Up-and-Go (TUG).ResultsThere was no difference in the EnHL values of amputees and controls when combining the contributions of both limbs (p = 0.754). However, amputees presented significant differences between the EnHL values of the intact and prosthetic limb (p < 0.001). Suppressing vision reduced the EnHL values of the intact (p = 0.001) and both legs (p = 0.028), but not in controls. Vision feedback in amputees also had a significant effect (increase) on the mean CoP distance (p < 0.001), CoP velocity (p < 0.001) and sway area (p = 0.007). Amputees presented an asymmetrical stance. The EnHL values of the intact limb in amputees were positively correlated to the BBS scores (EO: ρ = 0.43, EC: ρ = 0.44) and negatively correlated to the TUG times (EO: ρ = − 0.59, EC: ρ = − 0.69).ConclusionThese results suggest that besides the asymmetry in load distribution, there exist neuromuscular adaptations after an amputation, possibly related to the loss of sensory feedback and an altered sensorimotor integration. The EnHL values suggest that the somatosensory system predominates in the control of the intact leg. Further, suppressing the visual system caused instability in amputees, but had a minimal impact on the CoP dynamics of controls. These findings points toward the importance of providing somatosensory feedback in lower-limb prosthesis to reestablish a normal postural control.Trial registrationDRKS00015254, registered on September 20th, 2018.