Does a 6-Month Multicomponent Training Improve Functional Capacity of Individuals With a Neurocognitive Disorder?

Regular physical activity and exercise have been proposed as non-pharmacological therapeutic approaches to prevent and manage neurocognitive disorders (NCD). Multicomponent training (MT) combining aerobics, strength, postural and balance exercises seem to be effective at improving individuals with NCD in their ability to independently perform activities of daily living (ADL). This quasi-experimental controlled trial aims to analyze the effects of a 6-month MT intervention on functional capacity of individuals diagnosed with NCD. Forty-three subjects (N Major NCD: 36) participated in the Body&Brain Project and were subdivided in exercise group (EG; N: 23; 75.09 ± 5.65 years; age range: 61-83) or a control group (CG; N:20; 81.90 ± 5.95 years; age range: 70-89). The EG was submitted to bi-weekly exercise sessions, and the CG received monthly recreation sessions. At baseline and at post-intervention Timed-Up-and-Go (TUG), 6-meters Walk Speed and Handgrip tests were applied to evaluate lower body mobility, walking speed and handgrip strength, respectively. Results from linear mixed models revealed a statistically significant interaction between group (intervention vs. control) and time for TUG and walk speed test, but not for handgrip strength. The 6-month MT intervention improved lower body mobility and walking speed of older adults diagnosed with NCD, which might potentially impact ADL independence and quality of life. Trial registration: ClinicalTrials.gov - NCT04095962. Supported by FCT: “Body and Brain” (POCI-01-0145-FEDER-031808), CIAFEL (FCT/UIDB/00617/2020), and Ph.D. Grants (SFRH/BD/136635/2018) to FM and [2020.05911.BD] to DB.

The First Evaluation of a Geroscience Biomarker Index (TAME-BI) in a Trial of Caloric Restriction and Exercise

We leveraged the WF OAIC biorepository to measure a consensus-derived panel of blood-based biomarkers of aging and constructed a geroscience-guided biomarker index (TAME-BI), testing it for the first time in a clinical trial. We measured IL-6, TNF-α-receptor-I, growth differentiating factor-15, cystatin C, and N-terminal pro-B-type natriuretic peptide in a 20-week randomized trial of caloric restriction (CR), aerobic exercise (EX), CR+EX, or attention-control in 88 patients (67±5years) with heart failure with preserved ejection fraction (HFpEF). We calculated TAME-BI (analyte levels ranked, binned by quintile, and summed) and found a time×treatment interaction for improved TAME-BI with intervention (p≤0.05) and detected associations between change in TAME-BI and change in six-minute walk distance (r= -0.24), usual walk speed (r= -0.23), and left ventricular relative wall thickness (r= 0.31). In sum, CR+EX intervention improved TAME-BI and changes in TAME-BI were associated with changes in key functional measures in older HFpEF patients.

Self-administered acupressure and exercise for patients with osteoarthritis: A randomized controlled trial

Objective Knee osteoarthritis is a prevalent degenerative joint disease and seriously affects the athletic abilities of middle-aged and elderly patients. Acupressure is a traditional non-pharmacological intervention that promotes blood circulation and muscle activity. Self-administrated acupressure and exercise can be potential management for knee osteoarthritis. Design It is a randomized and controlled trial for knee osteoarthritis self-treatment. Settings Cangzhou Hospital. Interventions 221 patients with knee osteoarthritis were recruited and randomly divided into 4 groups: control group ( n = 55), exercise group ( n = 56), acupressure group ( n = 55) and exercise & acupressure group ( n = 55). In the first eight weeks, corresponding training courses were provided to different groups of patients. The patients were asked to carry out their own corresponding interventions for 16 weeks. The patient‘s condition was evaluated in the sixteenth week. Main measures The Western Ontario and McMaster Universities global scores of knee osteoarthritis patients were assessed at the 8th and 16th week of our trial. Results Self-administered acupressure and exercise significantly decreased visual analogue scale (3.75 ± 1.89 versus 2.93 ± 1.73, p < 0.05), pain (7.6 ± 2.8 versus 4.8 ± 2.7, p < 0.05), stiffness (3.75 ± 1.89 versus 2.93 ± 1.73, p < 0.05) at the 16th week ( p < 0.05) in patients with knee osteoarthritis compared to other intervention. The combination of acupressure and exercise also improved the range of motion (114.4 ± 11.5 versus 120.4 ± 11.9, p < 0.05) and walk speed (1.48 ± 0.48 versus 1.76 ± 0.50, p < 0.05) of osteoarthritis patients ( p < 0.05). Conclusion Self-administrated exercise and acupressure alleviate the arthritic symptoms (swelling, pain, joint dysfunction and joint deformities) and improve the joint functions, supporting its potential use in the clinical management for osteoarthritis.

Six-minute walk distance predicts hospitalization in elderly peritoneal dialysis patients: a single-center prospective cohort study

Background The risk of adverse events associated with peritoneal dialysis (PD) in elderly patients has not been thoroughly investigated. The purpose of this study was to assess the association between physical function and hospitalization in elderly PD patients. Methods This is a single-center prospective observational cohort study. Thirty-three aged patients (74.8 ± 5.9 years) participated in a 6-min walk distance, short physical performance battery (SPPB), lower extremity muscle strength, and 10-m walk speed. All subjects were followed until hospitalization to the end of the follow-up period. Results The 6-min walk distance was 332 ± 112.5 m; SPPB was 11 (8.3–12) points; the lower extremity muscle strength was 36.6 ± 9.6%; 10-m walk speed was 1.1± 0.2 m/s. During the follow-up, 19 patients (57.5%) were hospitalized. In the Kaplan-Meier survival analysis and log-rank test, a lower 6-min walk distance and PD vintage were significantly associated with hospitalization (p<0.05). After adjustment for PD vintage in Cox proportional analysis, the 6-min walk distance remained associated with hospitalization (95% confidence interval, 0.98–0.99). Conclusion Lower exercise tolerance assessed by the 6-min walk distance was significantly associated with hospitalization in elderly PD patients. Our findings indicate that measurement and intervention of exercise intolerance are essential to predict the clinical outcomes of elderly PD patients. Trial registration This study was prospectively registered at inception in the UMIN Clinical Trials Registry under identification number UMIN000038405.

Circulating Interleukin-6 (but Not Other Immune Mediators) Associates with Criteria for Fried’s Frailty among Very Old Adults

Background and Aim. Frailty is a geriatric condition resulting from physiological changes covering the musculoskeletal, immune, and neuroendocrine systems, leading to a greater inflammatory state. The present research aimed to investigate the association of components of Fried’s frailty (as well as of the phenotype as a whole) with total serum levels of a panel of inflammatory mediators. Methods. One hundred and sixty-one very old patients (aged ≥80 years) devoid of cognitive decline were eligible for analyses. Clinical and biochemical data along with physical and cognitive assessments encompassing dual-energy X-ray scans and hand dynamometry were adopted to investigate frailty criteria, while circulating immune mediators (IFNγ, IL-2, IL-4, IL-6, IL-10, and TNFα) were assessed using high-throughput flow cytometry. Results. Preliminarily, IL-6 correlated positively with waist-to-hip ratio and C-reactive protein and negatively with glycemia. In analyses controlled for these factors, serum levels of IL-6 were comparatively augmented among the very old participants with reduced grip strength (OR = 3.299; 95% CI 1.08–6.09; p = 0.032 ) and among those with slow walk speed (OR = 2.460; 95% CI 1.16–7.05; p = 0.022 ). Conclusions. Our study shows a strong negative correlation of IL-6 levels with Fried’s frailty components of grip strength and walk speed in very old adults, regardless of confounding factors.

Effects of the Immobilization of the Upper Extremities on Spatiotemporal Gait Parameters during Walking in Stroke Patients: A Preliminary Study

Background. The purpose of this study was to investigate the effects of upper extremity immobilization and consequent walking speed on spatiotemporal gait parameters in stroke patients with hemiparesis. Methods. The following variables were assessed or measured in 29 stroke patients: age, height, weight, disease duration, Korean version of the Mini-Mental State Examination (MMSE-K), Berg balance scale (BBS-K), functional gait assessment (FGA-K), cause of the disease (type of lesion), and hemiparetic side. The measurement of gait was performed using two pressure plates of 1.5 m to create a 3 m walking distance and leaving 1.5 m of extension at both start and end, to ultimately create a 6 m walking distance that the patient could walk through. The following gait patterns were randomly selected based on card draws: self-selected walk speed (SW), self-selected walk speed with immobilized upper extremities (SWI), fast walking (FW), and fast walking with immobilized upper extremities (FWI). Each patient was assessed for four different gait patterns, with three measurements per pattern (12 gait measurements in total). Results. While there were significant differences in the stride length, step width, velocity, and step length of the paretic side between self-selected walk speed (SW) and SWI, FWI did not show significant changes in any of the tested parameters. Conclusions. Immobilization of the upper extremities may affect walking at self-selected walk speeds. A comprehensive training program including upper extremity movement should be established for gait rehabilitation. Clinical Trial Registration. This trial is registered at http://cris.nih.go.kr/cris.

P0954EFFECTS OF INTRADIALYTIC EXERCISE FOR ADVANCED-AGED PATIENTS UNDERGOING HEMODIALYSIS: A RANDOMIZED CONTROLLED TRIAL

Background and Aims Exercise therapy, a treatment for poor physical function in patients undergoing dialysis, has shown some evidence of effectiveness. Some meta-analysis indicated the effectiveness of exercise interventions on exercise tolerance, muscle strength, and quality of life. However, most studies assessing the effects of exercise in patients undergoing hemodialysis have involved middle-aged patients; few data for advanced-age patients undergoing hemodialysis are available. The concept of exercise intervention for young to middle-aged patients undergoing hemodialysis is not entirely applicable to older patients, and whether exercise training improves physical function in older patients undergoing hemodialysis remains unclear. Therefore, the present randomized controlled trial (RCT) was performed to verify the effectiveness of exercise therapy in advanced-age patients undergoing hemodialysis. Method In this single-center, prospective, parallel RCT, all patients were randomly assigned to either the exercise or control group. The inclusion criteria were an age of ≥70 years and no acute or chronic medical conditions that would preclude assessment of the outcome measures or the performance of exercise. Ethical approval was provided by Seirei Christopher University. Patients randomized to the exercise group were offered 6 months of exercise training three times a week. The training program involved both resistance and aerobic training exercises. Four types of resistance exercises were performed using an elastic tube. The exercise intensity was adjusted by the tube stiffness to achieve a target a Borg score of 13 to 15 for fatigue. The aerobic exercise program consisted of ergometer cycling for 20 minutes. The exercise intensity was adjusted to a target Borg score of 13. The leg extremity muscle strength (LES), Short Physical Performance Battery (SPPB) score, and 10-m walk speed were evaluated before and after 6 months of training. The group effect was analyzed by analysis of covariance (ANCOVA) using the change in scores (Δ, post minus pre) as the dependent variable and baseline value of the dependent variable in the model as a covariate. Additional covariates for the ANCOVA models were identified by comparison of group means at baseline. The effect size (ES) was calculated as the change in the exercise group minus the change in the control group divided by the pooled standard deviation, corrected for sample size. Results Among the 101 randomly assigned patients, 17 (16.8%) were unavailable for follow-up testing. As a result, 84 patients (44 in the exercise group and 40 in the control group) were included in the analysis. The group comparison revealed no differences in any baseline characteristics between the two groups. Statistically significant increases in the ΔSPPB score were found in the exercise group (0.7 ± 2.1) as compared with the control group (−0.4 ± 2.0), with a moderate ES of 0.57. The ΔLES and Δ10-m walk speed were not significantly different between the groups, and the ES was 0.18 and 0.00, respectively. Conclusion The purpose of this RCT was to verify the effectiveness of exercise therapy in advanced-age patients undergoing hemodialysis. After 6 months of aerobic and resistance intradialytic training, we observed statistically significant increases in the ΔSPPB score in the exercise group as compared with the control group, with a moderate ES of 0.57. Exercise therapy improves physical function in older patients undergoing dialysis, and the effectiveness may differ from that in middle-aged patients; however, this change is clinically important in older patients.

Unreliability of Delay Caused by Bike Unavailability in Bike Share Systems

The recent proliferation of bike share operations has augmented established docked systems in major cities with several stationless operators. By relaxing control of where the bikes may be located, the stationless systems are more agile but less certain. We hypothesize that a stationless bike share system reduces access and egress distance while increasing unreliability, offering a trade-off from the customer’s perspective. This work presents a framework for quantifying the trade-off between expected trip time and variability in trip time for stationed and stationless bike share systems. The systems are modeled subject to shared assumptions where possible, and the trade-off is measured for about 1,000 simulated journeys corresponding to a 1 h simulation. Sensitivity to the shared assumptions is tested to support the generalizability of the results. The findings indicate that stationed systems have higher expected user costs and lower variance in user cost. As expected, the user cost distributions are asymmetrical. This analysis supports the context-specific adoption of stationed or stationless bike share operations based on user attributes (trip purpose, walk speed, destination choice, etc.) and operator attributes (budget for bicycles, support for public transport, value on reliability, etc.).

6-Minute Walk Test on the Treadmill in the Process of Effort Tolerance Assessment in Patients vith COPD

Treadmill test, cycloergometer test and walk tests are used to assess effort tolerance in patients with COPD. The 6-minute walk test (6MWT) is an easy and objective tool frequently used in clinical practice. The 6-minute walk test is used to assess effort tolerance in the process of qualification for an adequate model of pulmonological rehabilitation and as a way of assessing the effects of physiotherapy. The objective of this work was to verify the usefulness of the 6-minute walk test on the treadmill for effort tolerance assessment in patients with COPD. The research included 33 in-patients with COPD (18 males and 15 females) treated in MSWiA Hospital in Glucholazy. Before therapy, all patients were given a 6-minute walk test conducted in the hospital corridor and a 6-minute walk test on the treadmill. Distance, average walk speed and energy expenditure were recorded for each patient. Obtained data was subjected to statistical analysis with the use of the Wilcoxon Test with the level of statistical significance at p < 0.05 for all tests. The comparison of the results achieved by the patients in the 6-minute walk test carried out in the hospital corridor and the results of the 6-minute walk test conducted on the treadmill showed significant differences between these two test methods within the same group of patients. The differences in the values of parameters indicating both distance and MET in the two tests were of statistical significance (p < 0.05). Significantly higher parameter values indicating distance covered and MET were observed in the patients tested in the hospital corridor. The 6-minute walk test on the treadmill should not be used as an alternative to other tests for effort tolerance assessment for the same patients.Keywords: 6-min walk test, COPD, physiotherapy.