Limb, joint and pelvic kinematic control in the quail coping with step perturbations

Small cursorial birds display remarkable walking skills and can negotiate complex and unstructured terrains with ease. The neuromechanical control strategies necessary to adapt to these challenging terrains are still not well understood. Here, we analyzed the 2D- and 3D pelvic and leg kinematic strategies employed by the common quail to negotiate visible step-up and step-down perturbations of 1 cm, 2.5 cm, and 5 cm. We used biplanar fluoroscopy to accurately describe joint positions in three dimensions and performed semi-automatic landmark localization using deep learning. Quails negotiated vertical perturbations without major problems and rapidly regained steady-state locomotion. When coping with step-up perturbations, the quail mostly adapted the trailing limb to permit the leading leg to step on the elevated substrate in a similar way as it did during level locomotion. When the quail negotiated step-down perturbations, both legs showed significant adaptations. For small and moderate perturbations (not inducing aerial running) the quail kept the function of the distal joints (i.e., their kinematic pattern) largely unchanged during uneven locomotion, and most changes occurred in proximal joints. The hip regulated leg length, while the distal joints maintained the spring-damped limb patterns. However, to negotiate the largest visible step perturbations, more dramatic kinematic alterations were observed. For these large perturbations, all joints contributed to leg lengthening/ shortening in the trailing leg and both the trailing and leading legs stepped more vertically and less abducted. This indicates a shift from a dynamic walking program to strategies that are focused on maximizing safety.

Is a Low Intensity Walking Intervention Successful in Reducing Depression Symptoms in Middle to Older Age Women?

Depression is a common syndrome that has a strong negative impact on people’s quality of life. Women, especially in middle age, are facing a greater risk for depressive disorders. Increasing one’s physical activity level has shown great effects on reducing depression symptoms. The study evaluated the effect of a 12-week goal-directed walking intervention on walking engagement and depression symptoms among middle-aged women. A total of 55 middle to older age female participants (age range: 50–74) were included in the analysis. The 12-week intervention instructed participants to increase 15% of baseline steps every other week. Depression levels were measured pre-and post-intervention by the Center for Epidemiologic Studies Depression Revised Scale (CESD-R). A baseline measure-time structure- was considered as a possible mediator of association between walking and depression. Although no intervention effects were found in steps promotion and depression reduction in this walking program, we found that more depressed or younger participants had lower walking consistency It suggested that people with higher depression level or younger age require more instruction over time when engaging in physical activity interventions. Additionally, adherence of participants showed a over-time decreasing trend in this self-paced walking program. This inspired us to give timelier adjusts goals and exercise performance feedback to bolster participants' adherence in the future.

Walking All over COVID-19: The Rapid Development of STRIDE in Your Room, an Innovative Approach to Enhance a Hospital-Based Walking Program during the Pandemic

Hospitalization is common among older adults. Prolonged time in bed during hospitalization can lead to deconditioning and functional impairments. Our team is currently working with Department of Veterans Affairs (VA) medical centers across the United States to implement STRIDE (assiSTed eaRly mobIlity for hospitalizeD older vEterans), a hospital-based walking program designed to mitigate the risks of immobility during hospitalization. However, the COVID-19 pandemic made in-person, or face-to-face, walking challenging due to social distancing recommendations and infection control concerns. In response, our team applied principles of implementation science, including stakeholder engagement, prototype development and refinement, and rapid dissemination and feedback, to create STRIDE in Your Room (SiYR). Consisting of self-guided exercises, light exercise equipment (e.g., TheraBands, stress ball, foam blocks, pedometer), the SiYR program provided safe alternative activities when face-to-face walking was not available during the pandemic. We describe the methods used in developing the SiYR program; present feedback from participating sites; and share initial implementation experiences, lessons learned, and future directions.

Barriers and Motivators to Physical Activity Prior to Starting a Community-Based Walking Program

Despite the clear benefits of an active lifestyle, most American adults fail to meet physical activity (PA) guidelines. Because of its safety and ease, walking is a promising population-level strategy to increase PA. There is a need to further understand why adults do and do not participate in walking. This study provides a broader understanding of barriers and motivators of walking prior to starting a walking program. Four years of baseline data from a community-based walking program were analyzed (n = 1491). Descriptive statistics summarized participant characteristics, barriers, reinforcements, and current PA. Chi-square tests were used to assess differences in the barrier and reinforcement responses between participant’s PA level and age categories. Open-ended responses were analyzed using thematic analysis. On average, participants were white (96%), middle-aged (52 ± 13 years old) females (92%). Poor weather and time were frequently reported barriers to walking. Open-ended responses (n = 141) identified additional barriers of lack of motivation (n = 37), joint issues (n = 29), fatigue (n = 24), safety or lack of environmental supports (n = 17), family or work demands (n = 15), and lacking a walking partner (n = 9). Good weather, health, and weight loss were frequently reported motivators. Additional motivators (n = 282) identified included stress relief and mental health (n = 82), social time (n = 70), dog care (n = 41), other health benefits (n = 38), connect with nature (n = 19), enjoyment (14), occupation (n = 11), and environmental and community supports (n = 6). Findings highlight the importance of understanding participant barriers and motivators for PA before starting a program. Future research should examine how reported barriers and motivators are related to program completion and adherence. Tailoring community-based programs to address specific barriers and motivators may enable more participants to effectively change and maintain PA.

Wearables-based walking program in addition to usual physiotherapy care for the management of patients with low back pain at medium or high risk of chronicity: A pilot randomized controlled trial

Background Although chronic low back pain (LBP) is a leading cause of disability and accounts for large costs, none of the available conventional treatments are clearly more favourable in treating people at increased risk of chronicity. Objectives To examine the feasibility and initial efficacy of a wearables-based walking intervention in addition to usual physiotherapy care in people with LBP at risk of chronicity. Methods Twenty-six adult participants, diagnosed with non-specific LBP with medium or high risk of chronicity, were recruited from physiotherapy private practices. Participants were randomized into usual physiotherapy care (control, n = 14) and usual physiotherapy care plus a wearables-based walking intervention (experimental, n = 12). The intervention duration was 8 weeks. Feasibility outcomes included recruitment rate, adherence to the intervention, dropout rate, and serious adverse events reporting rate. Other outcomes included disability and pain (primary); and physical activity level, daily walking steps, depression, pain catastrophizing and fear of movement (secondary). The outcomes were assessed at baseline, post-intervention and 26 weeks post-randomization follow-up. Results Adherence of experimental participants with the prescribed walking program was moderate. Four participants dropped out during the intervention, and no serious adverse events were reported. Participants in the experimental group showed significant improvement in pain at 26 weeks (β = -0.38; 95% confidence interval (CI) -0.66, -0.10; P = .013), compared with the control group. No between-group differences were found for disability at any time point and pain immediately post-intervention. Experimental participants demonstrated post-intervention improvement in light-intensity (β = 156.71; 95% CI 86.79, 226.64; P < .001), moderate-intensity physical activity (β = 0.46; 95% CI 0.12, 0.80; P = .012), and daily walking steps (β = 7099.13; 95% CI 4522.93, 9675.32; P < .001). Experimental participants demonstrated post-intervention increase in pain catastrophizing (β = 0.52, 95% CI 0.18, 0.86; P = .006). No between-group differences were found for pain catastrophizing at 26 weeks and other secondary outcomes. Conclusion Usual physiotherapy care plus a wearables-based walking intervention program was safe and moderately feasible, and provided significant reduction in pain at 26 weeks as well as increasing the total volume of light- and moderate-intensity physical activity, and daily walking steps immediately post-intervention.

Remote Health Coaching Text-based Walking Program in Ethnic Minority Primary Care Patients who are Overweight and Obese: A Feasibility and Acceptability Pilot (Preprint)

BACKGROUND Over half of adults in the United States have at least one chronic disease including obesity. Although physical activity is an important component of chronic disease self-management, few reach the recommended goals for physical activity. Individuals who identify as racial and ethnic minorities are disproportionally impacted by chronic diseases and physical inactivity. Interventions utilizing consumer-based wearable devices have shown promise for increasing physical activity among patients with chronic diseases; however, populations with the most to gain such as minorities, have been poorly represented to date. OBJECTIVE To assess the feasibility, acceptability, and preliminary outcomes of an 8-week text-based coaching and Fitbit program aimed to increase steps among a predominantly ethnic minority population with overweight and obesity. METHODS Overweight (body mass index [BMI] >25 kg/m2) patients were recruited from an internal medicine clinic located within an inner-city academic medical center to participate. Fitbit devices were provided. Using 2-way text messaging, HCs guided patients to establish weekly step goals that were Specific, Measurable, Attainable, Realistic, and Time-bound (SMART). Texting and Fitbit activities were managed with a custom designed application. Program feasibility was assessed via the recruitment rate, retention rate (defined as the proportion of eligible participants completing the 8-week program) and patient engagement (based on number of weekly text message goals set with the HC across the 8-week period). Acceptability was assessed through a qualitative summative evaluation. Exploratory statistical analysis included evaluating the average weekly steps in week 1 compared to week 8 using a paired t-test and modeling daily steps over time using a linear mixed model. RESULTS Thirty (91%) of the thirty-three patients initially screened were enrolled. At baseline, the average BMI was 39.3 kg/m2 (SD = 9.3 kg/m2), with 23 (73%) of the participants presenting as obese. Nine (30%) self-rated their health as either "fair" or "poor.” Twenty-two patients (87%) set up ≥6 weekly goals across the 8-week program. Twenty-eight (93%) participants completed the qualitative summative evaluation. Ten themes emerged from the evaluation: (1) patient motivation, (2) convenient texting experience, (3) social support, (4) supportive accountability, (5) technology support, (6) self-determined goals, (7) achievable goals, (8) feedback from Fitbit, and (9) challenges, and (10) habit formation. There was no significant group change in the average weekly steps for week 1 compared to week 8 (mean difference: 7.26, p=0.99). However, five participants (17.9%) had a significant increase in their daily steps. CONCLUSIONS Overall, the results demonstrate the feasibility and acceptability for a remotely delivered walking study which included a HC, text messaging, wearable device (Fitbit), and SMART goals within a ethnic minority group of patients. These preliminary results of a walking program recruiting from primary care support further development and testing in larger samples to explore the efficacy. CLINICALTRIAL n/a