BackgroundPhysical functioning (PF) tests are scalable screening tools for neurodegenerative risk that differ by race and ethnicity, reflecting upstream social inequities. Prior work shows that PF relates to Alzheimer's disease blood biomarkers differentially by race and ethnicity, yet it is unclear if similar associations exist with structural brain outcomes (hyperintensities and brain volumes).ObjectiveThis study evaluated associations between PF and white matter hyperintensity volume (WMH), total brain volume (TBV), and hippocampal volume (HV) and assessed heterogeneity by race and ethnicity.MethodsCognitively normal non-Hispanic Black (n = 420), non-Hispanic white (n = 917), and Hispanic (n = 828) older adults (mean [SD] age = 64.7 [8.4]) from the Healthy Aging Brain Study-Health Disparities cohort completed the Timed Up and Go (TUG) and Short Physical Performance Battery (SPPB). Brain imaging was collected via 3 T magnetic resonance imaging (MRI). Multivariable linear models related PF to brain imaging outcomes (normalized by intracranial volume) and assessed heterogeneity by race and ethnicity.ResultsBonferroni adjusted significant (p < 0.05) associations were observed between WMH and PF (TUG: β = 0.28, 95% CI = 0.17, 0.40; SPPB:β = -0.19, 95% CI = -0.32, -0.07), TBV and PF (TUG: β = -0.50, 95% CI = -0.61, -0.40; SPPB: β = 0.30, 95% CI = 0.18, 0.42), and HV and PF (TUG: β = -0.28, 95% CI = -0.38, -0.18). Associations were generally similar across race and ethnicity groups for TBV and HV.ConclusionsPoorer PF was associated with reduced TBV and HV and greater WMH. Results support PF tests as scalable, non-invasive indicators of brain health in community-based populations.

Parkinson's disease (PD) leads to motor and neuromuscular impairments, with the rigid-akinetic (RA) subtype progressing more rapidly and affecting daily activities and balance. Beyond medication, strength training can improve disease severity and muscle function. However, research on land-based and aquatic physiotherapy for the RA subtype is limited. The objective of the study was to describe and compare the effects of 12weeks of land-based physiotherapy (LP) and aquatic physiotherapy (AP) on the motor function of individuals with rigid-akinetic PD. Thirty individuals with rigid-akinetic PD were allocated to two groups (LP and AP) and participated in a 12-week intervention. Motor function was assessed using the Unified Parkinson's Disease Rating Scale-Part III (UPDRS III) (primary outcome). Secondary outcomes included trunk strength (explosive and maximal), functional capacity, mobility, flexibility, and balance, assessed through the rate of torque development (RTD) and peak torque (PT) using an isokinetic dynamometer, the Sit-to-Stand test (STS), Timed Up and Go (TUG), the Sit-and-Reach test (SR), and the Berg Balance Scale (BBS), respectively. Both LP and AP groups showed no significant changes in UPDRS III, RTD, PT, or TUG, while STS, SR, and BBS showed significant interactions over time (p<0.05). RTD intervals between 100 and 300ms, as well as STS and TUG, were significantly linearly associated with UPDRS scores (p<0.05). The results indicate that while motor function and explosive and maximal muscle strength were not significantly affected by the interventions, functional capacity and balance improved, highlighting the importance of continuing physical training as an integral component of rehabilitation. Clinical trial registration data are publicly accessible at ClinicalTrials.gov under the identifier NCT05866120.

Diabetic polyneuropathy (DPN) contributes to impaired postural control and increases the risk of falls due to sensory and motor deficits. The Feldenkrais Method (FM), a sensorimotor approach that enhances body awareness and coordination, may offer therapeutic benefits in addressing these challenges. To evaluate the effectiveness of the Feldenkrais Method in improving dynamic balance, postural control, fear of falling, and quality of life in adults with DPN. Twenty-six participants aged 45-60years with DPN were randomized into a study group receiving FM-based training or a control group receiving conventional balance training. Both interventions were administered twice weekly for 24weeks. Primary outcomes included Timed Up and Go (TUG), limits of stability (LoS), Falls Efficacy Scale (FES), and Diabetes-39 Questionnaire for quality of life (QoL). Data were analyzed using repeated-measures ANOVA and post hoc Bonferroni tests. Significant post-intervention improvements were observed in the FM group across all outcomes: TUG (p=0.0001), LoS (p=0.0001), FES (p=0.0001), and QoL (p=0.0001). Furthermore, the FM group demonstrated statistically significant superiority over the control group in all primary and secondary measures (p<0.05). The control group showed no statistically significant changes. The Feldenkrais Method appears effective in enhancing balance, postural control, and quality of life in individuals with DPN. These results support its integration into neurorehabilitation programs.

We aimed to evaluate the effectiveness of combining low-frequency (1 Hz) rTMS (LF-rTMS) over the unaffected hemisphere or intermittent theta burst stimulation (iTBS) over the affected hemisphere with conventional rehabilitation (CR) on lower extremity motor function, balance, and gait. This single-center, randomized, sham-controlled study included patients with chronic stroke (>6mo) and unilateral hemiplegia (Brunnstrom stages 3 to 5), who were assigned to LF-rTMS+CR (n=21), iTBS+CR (n=21), or sham rTMS+CR (n=21) for 10 sessions using a figure-of-eight coil. All active participants completed treatment, and 18 sham participants were analyzed. The Fugl-Meyer Assessment, Berg Balance Scale (BBS), Timed-Up and Go (TUG) test, Functional Independence Measure, and 36-item Short-Form Health Survey (SF-36) were performed during pretreatment, post-treatment, and 6-week follow-up, alongside assessments of the Hmax/Mmax amplitude at baseline and 6-week follow-up. Both real rTMS groups showed greater improvements in balance and mobility (BBS and TUG) versus sham group. In addition, intragroup evaluation revealed that improvements in mental function and general health (SF-36) were more pronounced in the real rTMS groups. The combination of rTMS, including LF-rTMS or iTBS, with CR may serve as an effective neurorehabilitation strategy to improve balance and mobility in individuals with chronic stroke.

Preoperative rehabilitation is one of the strategies for enhanced recovery after surgery (ERAS) following total knee arthroplasty (TKA), but the optimal duration remains inconclusive. This study aims to evaluate the impact of a 4-week home-based prehabilitation program on accelerating postoperative recovery in patients undergoing TKA. In this retrospective cohort analysis, 176 patients undergoing primary unilateral TKA were categorized into two groups: those who completed a 4-week home-based prehabilitation program (training group, n = 72) and those who did not (control group, n = 104). Baseline demographics, perioperative data, pain scores, and functional outcomes were collected. Patients were followed for over 1year. The primary outcome was the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and secondary outcomes included visual analog scale (VAS), knee range of motion (ROM), Knee Society Score (KSS), timed up-and-go (TUG) test, and stair climbing test. Assessments were performed at baseline, before surgery, and multiple time points after TKA. Baseline characteristics were comparable between groups. The training group demonstrated significantly earlier first postoperative ambulation (median 9 versus 12h, P = 0.003) and shorter hospital stays (median 7 versus 10days, P = 0.002). Pain scores (VAS) were significantly lower in the training group at 1day and 1week postoperatively (P < 0.05). Functional outcomes including ROM, KSS, TUG, and stair test were superior in the training group at 1 and 3months (P < 0.05). WOMAC total scores and its subscales (pain, stiffness, function) also showed significant improvements in the Training group at 1 and 3months (P < 0.05). While advantages in ROM and TUG persisted up to 6months, no significant between-group differences were observed at 12months for any outcome measure. A 4-week home-based prehabilitation program significantly enhances early recovery after TKA, as evidenced by reduced hospital stay, lower early postoperative pain, and improved functional outcomes within the first 3months. Although benefits in certain functional measures persist up to 6months, outcomes converge by 12months. These findings support the integration of structured 4-week home-based prehabilitation program into ERAS pathways.

The effects of hybrid assistive limb (HAL) application on locomotor function and balance parameters in individuals with multiple sclerosis.

Ankle plantar flexor spasticity is a common post-stroke impairment that may influence functional performance and responsiveness. However, descriptive responsiveness patterns across spasticity severity levels remain insufficiently explored. This study aimed to descriptively examine functional changes and responsiveness across ankle plantar flexor spasticity severity categories in individuals with subacute stroke. In this prospective observational cohort study with a 4-week follow-up, 58 participants were categorized based on ankle plantar flexor spasticity severity using Modified Ashworth Scale (MAS) scores (MAS=0, MAS=1-1+, and MAS≥2). Functional performance was assessed using the 10-M Walk Test (10mWT), 6-Minute Walk Test (6MWT), Timed Up and Go (TUG), 5-Times Sit-to-Stand Test (5-Times STS), Figure-of-8 Walk Test (F8WT), and Four Square Step Test (FSST) at baseline and after 4weeks. Responsiveness was quantified using effect size (ES) and standardized response mean (SRM), and subgroup findings were descriptively examined across MAS categories. All outcome measures showed changes over 4weeks, with moderate-to-large responsiveness observed across tests. Responsiveness estimates appeared numerically greater in the MAS=0 subgroup, whereas more variable estimates were observed in participants with spasticity (MAS≥1). Similar patterns were observed across gait-related and functional mobility measures. Responsiveness estimates varied across spasticity levels, suggesting that responsiveness, as a measurement property, may differ according to impairment severity. These findings provide preliminary descriptive information regarding responsiveness across spasticity severity categories. Given the exploratory design and descriptive subgroup analyses, the findings should be interpreted cautiously.

Mobility deficits are the most common form of disability in the United States and can significantly impair function and activities of daily living. Assistive devices have the potential to reduce physical limitations and support functional independence. This pilot study evaluated the Gigstride wearable device for its effects on pain reduction and gait-related outcomes. This prospective, single-arm feasibility study was conducted at a tertiary academic center and included adults ≥18 years with lower extremity deficits. The primary outcome was pain, measured by the Numeric Rating Scale (NRS) during level ambulation and stair climbing. Secondary outcomes included performance on the modified 10-meter walk test with return and the Timed Up and Go (TUG) test. Patient-reported experience and the practicality of implementing the device in a larger-scale study were also assessed. A total of forty-four patients were enrolled (mean age 66 years; 57% female). Gigstride use significantly reduced pain during level ambulation and stair climbing, with no significant changes in secondary outcomes. Median walking pain decreased by 1 NRS point (p = 0.00032), and stair-related pain decreased by 0.5 NRS points (p = 0.00025). Gigstride wearable device use appears feasible and may provide modest reductions in mobility-related pain. However, the limited magnitude of pain reduction and absence of functional improvement in this study highlights the need for larger, controlled studies. The www.ClinicalTrials.gov identifier is NCT06548087.

To evaluate the effects of adding repetitive transcranial magnetic stimulation (rTMS) to dorsolateral prefrontal cortex(DLPFC) with dual-task (DT) exercise on DT mobility, balance and cognitive performance in individuals with sub-acute stroke. Thirty sub-acute stroke patients [age, mean (SD)=59.2 (7.9) years] were randomly assigned to the experimental group (N=15), or the sham stimulation group (N=15). 5Hz rTMS (90% resting motor threshold, 1200 pulses/session) or sham stimulation was applied to the ipsilesional DLPFC, 1 session/day, 5days/week for 2weeks, followed by dual-task training. Two mobility tests [10m walking and timed-up-and-go (TUG) test] and two cognitive tasks (serial 3 subtractions and verbal fluency) were assessed separately [that is, single-task (ST) condition] and concurrently (i.e., DT condition) before and after the intervention. The experimental group had greater improvement in TUG time under both ST and DT conditions (p<0.05), while the step length of the paretic leg during the 10m walking test of the experimental group only showed better improvement under ST condition and in DT condition when performed with serial 3 subtractions task. Cadence changes did not reach significance in any DT condition. Greater increment in the DT cognitive performance was observed only when verbal fluency task performed with 10m walking test in the experimental group. The experimental group had better gain in Montreal cognitive assessment, Mini balance evaluation systems test, and Activities-specific balance confidence scores than controls. The 2-week rTMS to DLPFC combined with DT training augments DT walking performance, and improves balance and cognitive function in mild to moderate motor and cognitive impairment individuals with sub-acute stroke. This combined intervention is a feasible, effective strategy to improve real-world mobility in sub-acute stroke rehabilitation. Chinese Clinical Trial Registry platform (www.chictr.org.cn), with the registration number ChiCTR2200066237.

Genicular nerve radiofrequency ablation (RFA) efficacy for knee osteoarthritis (OA) remains debated. This prospective pilot study evaluated the feasibility and outcomes of a novel 5-nerve ultrasound-guided protocol targeting: Superior-Medial (SMGN), Superior-Lateral (SLGN), Inferior-Medial (IMGN), Inferior-Lateral (ILGN) Genicular Nerves and Recurrent Fibular Nerve (RFN). Nineteen patients were enrolled. Feasibility was assessed through protocol adherence and safety (adverse events rate). Primary outcomes were pain (Numerical Rating Scale - NRS) and function (Western Ontario and McMaster Universities Osteoarthritis Index - WOMAC) defining responders as ≥50% improvement. Secondary assessments included Environmental Quality of Life Scale (EQoL-5), 6-Minute Walk Test (6MWT), Timed-Up-and-Go (TUG), and Medical Research Council (MRC) scale at 1 and 3 months. Significant improvements occurred in NRS (p < 0.001), WOMAC (p < 0.001), and EQoL-Index (p = 0.003); responder rate was 63.2% (n = 12/19). One patient withdrew after T1 due to dissatisfaction; no study attrition or adverse events (notably motor deficits) occurred. Baseline 6MWT >200 m associated with treatment response (p = 0.048), though small sample size limits generalizability. This 5-nerve protocol demonstrated clinical plausibility and safety. Lack of a control group precludes definitive attribution of improvements to RFA over placebo. Robust RCTs comparing 3-nerve vs. 5-nerve protocols are mandatory before clinical implementation.

Levodopa-induced dyskinesia (LID) is a major source of disability in advanced Parkinson's disease (PD), whose impact on gait and balance across medication states still remains unclear. We aimed to compare gait and balance performance between comparable dyskinetic (Dysk-matched) and non-dyskinetic (No-Dysk) PD patients in OFF and ON state, and to explore neural correlates using structural and resting-state functional MRI (rs-fMRI). PD patients were consecutively enrolled among candidates for device-aided therapies. Gait and balance were assessed using validated wearable inertial sensors during a 2-minute walk test, a 3-meters Timed-Up-and-Go (TUG), and a sway test, providing spatiotemporal gait parameters, variability, asymmetry, and postural sway metrics. Groups were compared using propensity score matching (PSM) for age, sex, disease duration, motor severity and axial disability. A subgroup underwent exploratory investigation with structural and rs-fMRI collected in ON state. After PSM (22 pairs), Dysk-matched group showed slower gait speed (p = 0.007), shorter stride length (p = 0.006), longer double support (p = 0.047), and prolonged TUG (p = 0.049) in the OFF state. Dysk-matched patients showed increased sway from OFF to ON (p = 0.030). Neuroimaging (10 Dysk-matched, 9 No-Dysk) revealed increased functional connectivity in sensorimotor regions and reduced SMA connectivity within a cerebellar network in Dysk-matched patients, without structural difference. Overall, the association of LID with impaired gait and postural control even in the OFF state is consistent with the hypothesis of broader motor network dysfunction beyond overt involuntary movements.

Falls are a major public health concern among older adults and contribute substantially to disability, reduced quality of life, and increased healthcare burden. Fall prevention-related health literacy practices, reflecting the application of health literacy skills in daily life, may influence an individual's ability to recognize risk factors and adopt appropriate preventive behaviors. This study aimed to examine factors associated with fall prevention-related health literacy practices among community-dwelling older adults in Northern Thailand. A community-based cross-sectional study was conducted among 415 older adults residing in Chiang Rai Province, Thailand, between February to May 2025. Participants were selected using a multi-stage stratified sampling approach. Data were collected through structured questionnaires assessing sociodemographic characteristics, fear of falling, and fall prevention-related health literacy. Functional mobility was evaluated using the Timed Up and Go (TUG) test. Data were analyzed using IBM SPSS Statistics for Windows, Version 29.0 (IBM Corp., Armonk, NY, USA). Multivariable logistic regression analyses were performed to identify factors independently associated with adequate fall prevention-related health literacy and its subdomains. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Most participants were female (58.3%), and 61.9% were aged 60-69 years. Overall, 88.70% demonstrated inadequate fall prevention-related health literacy. Housing characteristics (AOR = 3.166, 95% CI: 1.505-6.660) and TUG performance (AOR = 0.352, 95% CI: 0.163-0.761) were significantly associated with adequate fall prevention-related health literacy. Housing characteristics were consistently associated with access (AOR = 1.959, 95% CI: 1.168-3.284), cognitive (AOR = 2.055, 95% CI: 1.203-3.511), communication (AOR = 2.125, 95% CI: 1.233-3.665), and self-management skills (AOR = 1.830, 95% CI: 1.095-3.059). TUG performance was significantly associated with access and cognitive literacy. Additionally, cognitive literacy was significantly associated with marital status and fear of falling, while education level was significantly associated with self-management (AOR = 0.504, 95% CI: 0.296-0.861) and media literacy (AOR = 0.342, 95% CI: 0.211-0.556). A substantial proportion of community-dwelling older adults had inadequate fall prevention-related health literacy. Environmental and functional factors were consistently associated with health literacy across multiple domains, with additional associations for marital status, educational attainment, and fear of falling. These findings highlight the need for community-based fall prevention strategies incorporating adapted health communication, environmental modification, mobility assessment, and targeted interventions to strengthen preventive capacity among older adults. Not applicable.

Patients with Parkinson disease (PD) along with subjective cognitive decline (PD-SCD) are considered an intermediate status between those with normal cognition (PD-NC) and those with mild cognitive impairment (PD-MCI). Wearable digital monitoring technologies and machine learning models offer significant potential for assessing cognitive impairment in patients with PD. We aimed to evaluate the utility of wearable technology and machine learning for identifying ordinal cognitive stages (OCS) in PD based on timed up and go (TUG) tests (including single-task TUG [TUGst] and dual-task TUG [TUGdt]). Patients with PD along with SCD, MCI, and NC were recruited in a movement disorder clinic. Patients performed TUGst and TUGdt gait trials wearingamotorfunctionandmotorsymptomquantitativeassessmentsystem. In total, 209 kinematic parameters were synthesized for individual TUG to illustrate patients' motion profiles. We constructed dual-task cost parameters (DTC), describing the magnitude of the effect of the cognitive challenge on motion performance. Covariate-adjusted ordered logistic regression was used to compare parameter differences among 3 groups. Multiple machine learning models were used to classify the participants into 3 cognitive impairment levels, with features being selected based on P values from intergroup statistical tests. The total population was randomly divided into a training set and an independent validation set in a 7:3 ratio, and 10-fold cross-validation was used in the training set. Furthermore, this study used permutation importance and Shapley Additive Explanations (SHAP) analysis (including summary plots, bar plots, and waterfall plots) to explain the feature importance of the final model. The study included 65 age-matched patients (PD-NC: PD-SCD: PD-MCI= 14:21:30). Forty-five kinematic parameters were significantly different (P<.05) among the 3 groups, distributed across TUGst (n=25), TUGdt (n=12), and DTC (n=8) paradigms. Gait phase analysis revealed 35 parameters from walking phases, 9 from stand-to-sit transitions, and 1 from sit-to-stand transitions. Feature type distribution demonstrated predominance of variability features (n=20), followed by pace (n=12) and axial (n=8) characteristics. TUGdt paradigm analysis revealed pronounced movement differences between PD-MCI and both PD-NC and PD-SCD groups, particularly in variability, amplitude, pace, and axial domains. Cross-paradigm analysis identified consistent significant differences in specific features. These findings provide objective kinematic biomarkers for early cognitive state identification in Parkinson disease, with TUGdt parameters demonstrating superior discriminative capacity. This suggests patients with PD-SCD could have early kinetic signs of cognitive impairment, positioning them between PD-NC and PD-MCI, and our multiclass support vector machineclassification model with kinematic parameters achieved a recall rate above 0.70 in both training and validation datasets. The feature importance analysis revealed that DTC_Trunk-Right Rotation Max, DTC_Trunk-Max Transverse Angular Velocity, and dTUG_Lumbar-Right Sway Max Std were the most critical features for distinguishing cognitive states, providing scientific evidence for cognitive function screening based on kinematic parameters.

Trajectories of physical function during a 12-week resident-led health promotion program (HATSURATSU) among community-dwelling older adults in Japan.

Global aging is a vital issue of public health from the medical, social and economic points of view. Together with the aging of the population, there is also a higher risk of low mineral density (BMD) especially among people over the age of sixty which indirectly leads to significantly more fractures. The aim of the study is to evaluate the connection between selected factors connected to health, and predict the risk of fractures, obtained by means of an FRAX calculator. The study was conducted on a group of 540 people aged between 60 - 74 (early old age), 75 - 89, and 75 - 89 (late old age) living at home. The Timed Up and Go (TUG) test was used to evaluate functional fitness and the risk of falls. A scale of complex everyday activities as per Lawton (IADL). Moreover, to assess the risk of fracture, a Fracture Risk Assessment Tool (FRAX) was used. Ten-year-long absolute risk of fractures as per the FRAX calculator was: on a low level - 41.85%, medium level - 36.11% and on a high level - 22.04% of the study participants. A correlation was observed between the FRAX and the number of medications taken only once (p=0.000), fear of falling (p<0.001), body mass indicator (BMI) (p<0.001), ability to perform complex everyday activities (p<0.001), falling (p<0.001) and hospitalization during the last 12 months, 6 medicines taken together, fear of falling, experienced in the last year.

Early identification of discharge destination is an important aspect of hospital care for frail older adults. This retrospective cohort study examined whether physical, cognitive and social functioning assessments at admission are associated with discharge destination. Data from 114 community-dwelling patients aged ≥65 years, acutely admitted to a geriatric ward, were analyzed. Frailty was defined at admission by impaired Katz-Activities of Daily Living (ADL) or increased fall risk. Initial screening included Katz-ADL, fall risk and the Malnutrition Universal Screening Tool (MUST). Additional assessments comprised handgrip strength, Timed-Up-and-Go (TUG), Six-item Cognitive Impairment Test (6-CIT) and living situation. Multivariable logistic regression, adjusted for age and sex, showed that worse Katz-ADL scores (OR 1.45, 95% CI 1.18-1.78), lower handgrip strength (OR 2.28, 95% CI 1.02-5.10) and slower TUG performance (OR 11.19, 95% CI 3.40-36.89) were significantly associated with non-home discharge. Cognitive status and living situation were not. These findings indicate that these functional assessments are associated with discharge destination in frail older adults.

Regional barriers and innovative solutions in the medical rehabilitation of children with cochlear implants in Uzbekistan: A telemonitored home-based versus center-based comparative study.

Repetitive transcranial magnetic stimulation (rTMS) is increasingly used as a neuromodulatory intervention to facilitate motor recovery after stroke. However, the frequency-specific effects of rTMS on lower-limb motor control and their neurophysiological correlates remain insufficiently clarified. To compare the effects of low-frequency (1 Hz) rTMS applied over the contralesional (unaffected) lower-limb motor area of the primary motor cortex and high-frequency (10 Hz) rTMS applied over the ipsilesional (affected) lower-limb motor area on electroencephalographic (EEG) activity, affected-side lower-limb muscle activation, balance, and gait in individuals with chronic stroke. Thirty-nine participants with chronic stroke were randomly assigned to a low-frequency rTMS group (n = 13), a high-frequency rTMS group (n = 13), or a sham group (n = 13). rTMS was delivered for 10 sessions over 2 weeks. Resting-state EEG (relative beta-band power at Cz), surface EMG of the affected-side rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius during sit-to-stand, Timed Up and Go (TUG), 10-meter walk test (10MWT), and limits of stability (LOS) were assessed before and after the intervention. A 3 × 2 mixed-design analysis of variance (ANOVA) (group × time) was conducted. Significant group × time interactions were observed for rectus femoris activation (p < 0.001) and TUG performance (p = 0.037). Post hoc pairwise comparisons confirmed significantly greater improvements in TUG performance and rectus femoris activation in the low-frequency rTMS group than in the high-frequency and sham groups. Relative beta-band activity at Cz demonstrated a significant main effect of time (p < 0.001) without a significant interaction effect. Similarly, 10MWT and LOS showed significant time effects (p < 0.05) but no significant group × time interactions. No significant main effects of group were identified across outcomes. Short-term rTMS was associated with improvements in selected neuromuscular outcomes, while changes in resting cortical activity, gait speed, and postural stability appeared to reflect general time-related effects. Low-frequency rTMS demonstrated greater improvements in rectus femoris activation and TUG performance compared with high-frequency and sham stimulation. These findings suggest that frequency-specific rTMS may preferentially influence neuromuscular strategies underlying dynamic mobility rather than steady-state gait performance.

Mobility is a cornerstone of healthy ageing typically assessed using self-report and performance-based measures. Recent research suggests these measures are poor proxies for real-world mobility. Device-derived measures of real-world mobility reflect the relative proportions of time a person allocates to sedentary behaviour (SB), light-intensity physical activity (LIPA), and moderate-to-vigorous physical activity (MVPA) that together form the waking-day movement behaviour composition. The aim of this study was to examine the associations between commonly used mobility measures and the waking-day movement behaviour composition in older adults. A cross-sectional analysis of data from over 1200 older adults ≥ 65 years of age from the baseline cohort (2022-2024) of the McMaster Monitoring My Mobility (MacM3) study was conducted. Compositional data analysis was used to examine the associations between 6 self-report and 10 performance-based measures of mobility and multiple components of the waking-day movement behaviour composition and establish differences in movement behaviours according to different levels of mobility. Examples of included measures are the Physical Activity Scale for the Elderly (PASE) and Timed Up and Go (TUG). Data from 1227 older adults (73.6 ± 5.3 years) were analysed. Significant differences in waking-day movement behaviour composition were found across the self-report and performance-based mobility measures. Older adults with lower mobility accumulated more SB and less MVPA throughout the day. For example, those with poorer TUG performance accumulated 34 more minutes/day of SB, and 22min/day less of MVPA compared to those with better performance. The PASE, 400-meter walk, and fast gait speed tests were the strongest indicators of real-world mobility; however, the effect sizes were small. No measure showed a significant association with LIPA. Traditional self-report and performance-based measures of mobility are associated with the waking-day movement behaviour composition in older adults; however, their ability to explain real-world mobility is limited and varies across measures. The lack of association between any of the measures and LIPA is surprising, given that older adults spend most of their time in this activity intensity. These findings challenge the widespread use of traditional mobility measures to make inferences about real-world mobility.

Physical functioning (PF) is critical to quality of life and longevity among older adults and is related to biomarkers of Alzheimer's disease, cardiovascular and respiratory disease, and functional health. Physical functioning varies by age, sex, and race and ethnicity, yet its distribution across these groups is not well characterized. This study aimed to (1) characterize age-PF patterns by sex and race and ethnicity and (2) generate sex-, race and ethnicity-, and age-specific percentile distributions for PF. Cross-sectional data from the Health & Aging Brain Study-Health Disparities (HABS-HD; n = 6712; ages 50-92 years) were analyzed. Physical functioning was assessed using Timed Up and Go (TUG) time (seconds) and Short Physical Performance Battery (SPPB) total time (seconds) among participants able to complete the tests. Adjusted regression models assessed associations between age and PF. Unadjusted percentiles (5th-95th) within sex × race and ethnicity (non-Hispanic White [NHW], non-Hispanic Black [NHB], and Hispanic) × age categories (50-64, 65-69, and ≥70 years) were reported among the full sample, low-comorbidity participants (no cognitive impairment, diabetes, or assistive device use), and comorbidity-free participants (additionally free of hypertension and dyslipidemia). Among participants (62.6% female; mean age 66.5 ± 8.7 years), physical function declined with age, with longer TUG and SPPB times across all groups. Among all participants, the mean (SD) time (seconds) for TUG and SPPB were 10.0 (2.9) and 10.6 (2.2), respectively. Among low-comorbidity participants, TUG 95th percentiles (seconds) ranged from 10.93 (NHW females, 50-64 years) to 17.12 (NHB females, ≥70 years). The SPPB 95th percentiles (seconds) ranged from 17.90 (NHW males, 50-64 years) to 34.64 (Hispanic males, ≥70 years). Sensitivity analyses indicated that comorbidities explained a substantial proportion, but not all, of the observed age, sex, and race and ethnicity disparities in PF. These values provide a descriptive framework for clinicians and researchers to contextualize PF and monitor change over time. Future studies should aim to establish valid percentile prognostic cut-points for various health outcomes.