The “Walking Estimated Limitation Stated by History” (WELSH) visual tool is applicable and accurate to determine walking capacity, even in people with low literacy level

Determination of the self-reported walking capacity by interview or standardized questionnaire is important. However, the existing questionnaires require the patient to be able to read and write in a specific language. We recently proposed the WELSH (Walking Estimated Limitation Stated by History) tool to be administrable to illiterate people. The main objective was to assess the applicability of WELSH tool in the community and in a large group. We performed a prospective study in the city of Bobo-Dioulasso in Burkina Faso during June 2020. We recruited 630 interviewers among medical students. They were trained to administer the WELSH, and to conduct a 6-minute walk test. We performed a Pearson’s “r” correlation between the WELSH and maximal walking distance (MWD). Of the 1723 participants available for the analysis, 757 (43.9%: 41.6–46.3) never went to school or attended only elementary school. The percentage of questionnaires with participant filling-in errors corrected by the investigator decreased with the decrease in educational level (p<0.001). The average WELSH score was 53 ± 22 and the average MWD was 383 ±142 meters. The Spearman correlation coefficient between the WELSH score and the MWD was r = 0.567 (p<0.001). Correlations ranged from 0.291 to 0.576 in males and females, (all p values < 0.05) and in different levels of education, with the highest coefficients found in illiterate people. The WELSH is feasible on the community by a wide variety of interviewers. It correlates with the MWD estimated by the 6-minutes’ walk test even for people with little or no schooling.

Sarcopenia: Technological Advances in Measurement and Rehabilitation

Sarcopenia is an important recently defined disease affecting people aged ≥65 years all over the world. Improving the assessment of loss of muscle mass is becoming mandatory. In this regard, various new technologies have been advanced. Although the gold standard is represented by magnetic resonance imaging (MRI) or magnetic resonance spectroscopy (MRS), computed tomography (CT) or dual-energy X-ray absorptiometry (DXA), followed by biological impedance analysis (BIA) compared with DXA, there are numerous correlations between sarcopenia and health domain of everyday life that must be investigated and addressed, trying to obtain the best possible outcome in the older population. In this review, we focused on all types of new technologies assessing loss of muscle mass, frailty, independence, walking, capacity to get dressed, and loss of balance or sleepiness in older people and that could improve the diagnosis of sarcopenia or the rehabilitation of sarcopenic patients to prevent possible accidents. Different technologies have been proposed to investigate the factors promoting the loss of muscle mass and weakness. Despite the standard EWGSOP 2019 guidelines defining a specific methodology for the diagnosis of sarcopenia, not all domains and devices were included, and new frontiers of prevention have been explored.

Correlates of Objectively Measured Physical Activity Among People With Multiple Sclerosis: A Cross-Sectional Study

Background: Identifying correlates of physical activity (PA) for people with multiple sclerosis (MS) is essential to design effective PA interventions.Methods: Participants completed a battery of questionnaires and wore an ActiGraph accelerometer. Light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA) (min/day) were calculated. Associations were examined using multiple linear regression adjusted for demographic and clinical confounders.Results: Fifty-eight adults with MS participated (mean ± SD age: 56.8 ± 9.2 yr; 67% women). MS type was associated with time in LPA. Participants with secondary progressive MS (B = −54.0, 95% CI −84.7 to −23.3) and primary progressive MS (B = −42.9, 95% CI −77.5 to −8.3) spent less time in LPA than those with relapsing remitting MS. Walking capacity, assessed using the 12-item MS walking scale (MSWS-12), was associated with time in MVPA (B = −0.36, 95% CI −0.72 to −0.01).Conclusion: This work identifies walking capacity and type of MS as correlates of PA, which may indicate development of interventions to promote PA.

Resistance training improves mobility disability in community-dwelling older adults: a meta-analysis

Mobility disability is the impairment in function that affects the performance of daily tasks due to declines in physical function. Exercise interventions, particular resistance training, may have a positive impact on mobility disability, but the evidence for the effects of resistance training in older adults with mobility disability has not been previously systematically reviewed. This study was a systematic review of evidence related to resistance training on physical function for adults over 65 years of age with mobility disability. Four databases (PEDro, MedLine, Ovid, Web of Science) were searched from inception to February 2, 2021 for randomized controlled trials. Twenty-four articles from 22 studies (3,656 participants) were included in the review. Mean participant age ranged from 63-87 years and exercise interventions ranged from 10 weeks to 12 months in duration. Greater changes in 6-minute Walk Test (6MWT) distance (n=638, p&lt;0.0001; mean difference (MD) 16.1 metres; 95%CI 12.3-19.9), lower extremity strength (n=785, p&lt;0.0001; standard MD 2.01; 95%CI 1.27-2.75) and usual gait speed (n=2,106, p&lt;0.001; MD 0.05 metres/second, 95%CI 0.03-0.07) were seen with resistance training as compared to control. These results were maintained if resistance training was a sole intervention or a component of a multi-component program. Sensitivity analysis based on risk of bias concerns did not change results. This review demonstrates that resistance training improves walking capacity, strength and walking speed in community-dwelling older adults and may facilitate aging in place. Since improvements in strength and gait speed contribute to independence, our results indicate highly beneficial outcomes for older persons.

The Effects of Over-Ground Robot-Assisted Gait Training for Children with Ataxic Cerebral Palsy: A Case Report

Poor balance and ataxic gait are major impediments to independent living in ataxic cerebral palsy (CP). Robot assisted-gait training (RAGT) has been shown to improve the postural balance and gait function in children with CP. However, there is no report on the application of RAGT for children with ataxic CP. Here, we report two cases of children with ataxic CP who underwent over-ground RAGT along with conventional therapy for 4 weeks. Outcome measures including the gross motor function measure (GMFM), pediatric balance scale, pediatric reach scale, one-minute walk test, and Timed Up and Go test were assessed before and after the 4-week intervention. Both cases were well adapted to the RAGT system without any significant adverse event. Improvements in the GMFM after RAGT, compared with that in the GMFM, after intensive conventional therapy have been reported previously. It is noteworthy that over-ground RAGT improved areas of the GMFM that did not improve with conventional therapy. In addition, over-ground RAGT with conventional therapy led to improvements in functional balance and walking capacity. These findings suggest that over-ground RAGT is feasible and may be a potential option for enhancing balance and functional walking capacity in children with ataxic CP.

Robotic walking for recovery of functional capacity in individuals with incomplete spinal cord injury: A randomized pilot trial

Objective: Activity-based Training (ABT) represents the current standard of neurological rehabilitation. Robotic Locomotor Training (RLT) is an innovative technique that aims to enhance rehabilitation outcomes, however, its efficacy in SCI rehabilitation, particularly within a low-middle income setting, is currently unclear. The primary aim of this study was to determine the feasibility of a locomotor training program within XX, in terms of recruitment, attendance, drop-out rates and safety. Secondary aims were to determine the effects of RLT compared to ABT on functional capacity in people with chronic SCI. Design: Participants with chronic traumatic motor incomplete tetraplegia (n = 16) were recruited. Each intervention involved 60-minute sessions, 3x per week, over 24-weeks. RLT involved walking in the Ekso GTTM suit. ABT involved a combination of resistance, cardiovascular and weight-bearing exercise. Primary feasibility outcomes included recruitment rate, adherence rate, and adverse events. Validated tests were performed at baseline, 6, 12 and 24-weeks to assess the secondary outcomes of functional capacity. Results: Out of 110 individuals who expressed interest in participating in the study, 17 initiated the program (recruitment rate = 15.4 %). Of these, 16 individuals completed the program (drop-out rate = 5.8 %) and attended sessions (attendance rate = 93.9%). There were no significant differences between the intervention groups for lower or upper extremity motor scores (UEMS effect size (ES) = 0.09; LEMS ES = 0.05), back strength (ES = 0.14) and abdominal strength (ES = 0.13) after training. However, both groups showed a significant increase of 2.00 points in UEMS and a significant increase in abdominal strength from pre- to post intervention. Only the RLT group showed a significant change in LEMS, with a mean increase of 3.00 [0.00; 16.5] points over time. Distance walked in the Functional Ambulatory Inventory (SCI-FAI) increased significantly (p = 0.02) over time only for the RLT group. Conclusions: Recruitment, attrition and adherence rates of the intervention and outcomes justify a subsequent powered RCT comparing RLT to ABT as an effective rehabilitation tool for potentially improving functional strength and walking capacity in people with incomplete SCI.

Automatic oxygen titration versus constant oxygen flow rates during walking in COPD: a randomised controlled, double-blind, crossover trial

RationaleIn patients with COPD, oxygen (O2)-supplementation via a constant flow oxygen system (CFOS) can result in insufficient oxygen saturation (SpO2 <90%) during exercise. An automatically titrating O2-system (ATOS) has been shown to be beneficial compared with an untitrated CFOS, however, it is unknown if ATOS is superior to CFOS, titrated during exercise as stipulated by guidelines. The aim was to investigate the effects of ATOS compared with titrated CFOS on walking capacity in people with hypoxaemic COPD.MethodsFifty participants completed this prospective randomised controlled, double-blind, crossover trial. Participants performed two endurance shuttle walk tests (ESWTs) with: (1) exercise titrated CFOS (ESWTCFOS) and (2) ATOS targeting an SpO2 of 92% (ESWTATOS). Primary outcome measure was walking time. Secondary measures were SpO2, transcutaneous-PCO2 (TcPCO2), respiratory rate (RR), heart rate (HR) at isotime (end of shortest ESWT) with blood gases and dyspnoea at rest and end exercise.ResultsParticipants (median (IQR): age 66 (59, 70) years, FEV1 28.8 (24.8, 35.1) % predicted, PO2 54.7 (51.0, 57.7) mm Hg, PCO2 44.2 (38.2, 47.8) mm Hg) walked significantly longer with ESWTATOS in comparison to ESWTCFOS (median effect (95% CI) +144.5 (54 to 241.5) s, p<0.001). At isotime, SpO2 was significantly higher (+3 (95% CI 1 to 4) %, p<0.001) with ATOS while TcPCO2, RR and HR were comparable. End exercise, PO2 (+8.85 (95% CI 6.35 to 11.9) mm Hg) and dyspnoea (−0.5 (95% CI −1.0 to −0.5) points) differed significantly in favour of ATOS (each p<0.001) while PCO2 was comparable.ConclusionIn patients with hypoxaemia with severe COPD the use of ATOS leads to significant, clinically relevant improvements in walking endurance time, SpO2, PO2 and dyspnoea with no impact on PCO2.Trial registration numberNCT03803384.

The type and dosage of exercise therapy to facilitate the recovery from stroke for balance, walking and quality of life: a systematic review and meta-analysis of randomized controlled trials

Background Exercise therapy (aerobic or resistance therapy) could have a beneficial effect on balance, walking and quality of life (QoL). Objective This systematic review and meta-analysis aimed to quantify the effects of different modes, dosages and setting of exercise therapy on balance, walking capacity and QoL in stroke survivors. Methods We searched PubMed, CINHAL and Hinari to identify randomized controlled trials (RCT) that investigated the effects of aerobic (AT) and/or resistance therapy (RT) on balance, walking and QoL in stroke survivors. The treatment effect was computed by the standard mean differences (SMDs). Results We included 27 RCT comprising 1,549 chronic stroke survivors. Any modality was effective to improve balance. There was high-level evidence that AT interventions were most effective in improving walking capacity (SMD=0.36 [0.06, 0.66], p=0.02). Both AT, and AT combined with RT were effective to improve QoL (SMD=0.39 [0.09, 0.69], p=0.01). RT programs were not effective to improve walking and QoL. For walking capacity, a lower volume weekly (&lt;60 minutes/session or &lt;3 session/week) and higher intensity (&gt;60% heart rate reserve; rate of perceived exertion (6–20) &gt;14) of AT and RT exercises demonstrated significant higher effect. Hospital located rehabilitation settings trended to improve walking (SMD=0.23 [0.00, 0.45], p=0.05), when compared to home/community and laboratory settings. Conclusions In chronic stroke, in particular AT executed in hospital located settings, with a lower volume and high intensity seems more effective strategy to facilitate walking capacity and improve QoL and should thus be incorporated into rehabilitation programs for stroke. FUNDunding Acknowledgement Type of funding sources: None.

Malnutrition modifies the response to multimodal prehabilitation: A pooled analysis of prehabilitation trials

Introduction: Patients with colorectal cancer are at risk of malnutrition before surgery. Multimodal prehabilitation (nutrition, exercise, stress reduction) readies patients physically and mentally for their operation. However, it is unclear whether extent of malnutrition influences prehabilitation outcomes. Methods: We conducted a pooled analysis from five 4-week multimodal prehabilitation trials in colorectal cancer surgery (prehabilitation: n=195; control: n=71). Each patient’s nutritional status was evaluated at baseline using the Patient-Generated Subjective Global Assessment (PG-SGA; higher score, greater need for treatment of malnutrition). Functional walking capacity was measured with the six-minute walk test (6MWD) at baseline and before surgery. A multivariable mixed effects logistic regression model evaluated the potential modifying effect of PG-SGA on a clinically meaningful change of >=19m in 6MWD before surgery. Results: Multimodal prehabilitation increased the odds by 3.4 times that colorectal cancer patients improved their 6MWD before surgery as compared to control (95%CI:1.6 to 7.3; P=0.001, n=220). Nutritional status significantly modified this outcome (P=0.007): Neither those patients with PG-SGA>=9 (adjusted odds ratio:1.3; 95% CI: 0.23 to 7.2, P=0.771, n=39) nor PG-SGA <4 (adjusted odds ratio:1.3; 95% CI: 0.5 to 3.8, P=0.574, n=87) improved in 6MWD with prehabilitation. Conclusion: Baseline nutritional status modifies prehabilitation effectiveness before colorectal cancer surgery. Patients with a PG-SGA score 4-8 appear to benefit most (physically) from 4 weeks of multimodal prehabilitation. Novelty bullets: 1) Nutritional status is an effect modifier of prehabilitation physical function outcomes; 2) Patients with a PG-SGA score 4-8 benefited physically from 4 weeks of multimodal prehabilitation.

Walking Impairment Questionnaire and Walking Tests are Reliable Indicators of Success of Treatment of Peripheral Artery Disease

The functional capacity of patients with peripheral arterial disease (PAD) represents an important indicator of patient health and quality of life. The aim of this prospective study was to investigate the validity of a walking impairment questionnaire (WIQ) compared with walking tests for the estimation of the therapeutic effect of lower limb revascularization. The study included 36 patients with PAD in whom successful percutaneous revascularization of a lower limb was performed due to disabling intermittent claudication. Before the revascularization procedure and 4–6 weeks after successful revascularization, clinical examination, ankle brachial index (ABI) measurement, 6-min walk test, treadmill test, and WIQ were performed. After revascularization, significant improvement in walking capacity was shown by both 6-min walk test and treadmill exercise test as well as with WIQ. However, the increase in ABI was borderline. Significant correlations between improvement of 6-min walk test and treadmill exercise test results and the sum of WIQ points were found. The ABI was significantly correlated with treadmill maximal walking distance only. According to our results, the WIQ correlates well with walking tests and is a reliable indicator of effective revascularization of lower limb arterial occlusions, even in patients with a nonsignificant improvement of the ABI.