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There are limited reports of community-based nutrition education with culinary instruction that measure biomarkers, particularly in low-income and underrepresented minority populations. Teaching kitchens have been proposed as a strategy to address social determinants of health, combining nutrition education, culinary demonstration, and skill building. The purpose of this paper is to report on the development, implementation, and evaluation of Journey to Health, a program designed for community implementation using the RE-AIM planning and evaluation framework. Reach and effectiveness were the primary outcomes. Regarding reach, 507 individuals registered for the program, 310 participants attended at least one nutrition class, 110 participants completed at least two biometric screens, and 96 participants attended at least two health coaching appointments. Participants who engaged in Journey to Health realized significant improvements in body mass index, blood pressure, and triglycerides. For higher risk participants, we additionally saw significant improvements in total and LDL cholesterol. Regarding dietary intake, we observed a significant increase in cups of fruit and a decrease in sugar sweetened beverages consumed per day. Our findings suggest that Journey to Health may improve selected biometrics and health behaviors in low-income and underrepresented minority participants. [ABSTRACT FROM AUTHOR]

Muscle inflammation and fibrosis underlie disuse‐related complications and may contribute to impaired muscle recovery in aging. Cellular senescence is an emerging link between inflammation, extracellular matrix (ECM) remodeling and poor muscle recovery after disuse. In rodents, metformin has been shown to prevent cellular senescence/senescent associated secretory phenotype (SASP), inflammation, and fibrosis making it a potentially practical therapeutic solution. Thus, the purpose of this study was to determine in older adults if metformin monotherapy during bed rest could reduce muscle fibrosis and cellular senescence/SASP during the re‐ambulation period. A two‐arm controlled trial was utilized in healthy male and female older adults (n = 20; BMI: <30, age: 60 years+) randomized into either placebo or metformin treatment during a two‐week run‐in and 5 days of bedrest followed by metformin withdrawal during 7 days of recovery. We found that metformin‐treated individuals had less type‐I myofiber atrophy during disuse, reduced pro‐inflammatory transcriptional profiles, and lower muscle collagen deposition during recovery. Collagen content and myofiber size corresponded to reduced whole muscle cellular senescence and SASP markers. Moreover, metformin treatment reduced primary muscle resident fibro‐adipogenic progenitors (FAPs) senescent markers and promoted a shift in fibroblast fate to be less myofibroblast‐like. Together, these results suggest that metformin pre‐treatment improved ECM remodeling after disuse in older adults by possibly altering cellular senescence and SASP in skeletal muscle and in FAPs. [ABSTRACT FROM AUTHOR]

Objective. Physical function is associated with important outcomes, yet there is often a lack of continuity in routine assessment. The purpose of this study was to determine data elements and instruments for longitudinal measurement of physical function in routine care among patients transitioning from acute care hospital setting to home with home health care. Methods. A 4-round modified Delphi process was conducted with 13 participants with expertise in physical therapy, health care administration, health services research, physiatry/medicine, and health informatics. Three anonymous rounds identified important and feasible data elements. A fourth in-person round finalized the recommended list of individual data elements. Next, 2 focus groups independently provided additional perspectives from other stakeholders. Results. Response rates were 100% for online rounds 1, 3, and 4 and 92% for round 2. In round 1, 9 domains were identified: physical function, participation, adverse events, behavioral/emotional health, social support, cognition, complexity of illness/disease burden, health care utilization, and demographics. Following the fourth round, 27 individual data elements were recommended. Of these, 20 (74%) are "administrative" and available from most hospital electronic medical records. Additional focus groups confirmed these selections and provided input on standardizing collection methods. A website has been developed to share these results and invite other health care systems to participate in future data sharing of these identified data elements. Conclusion. A modified Delphi consensus process was used to identify critical data elements to track changes in patient physical function in routine care as they transition from acute hospital to home with home health. Impact. Expert consensus on comprehensive and feasible measurement of physical function in routine care provides health care professionals and institutions with guidance in establishing discrete medical records data that can improve patient care, discharge decisions, and future research. [ABSTRACT FROM AUTHOR]

Objective Poor knowledge of the relationships between physical function (PF) in the hospital and patient outcomes in an inpatient rehabilitation facility (IRF) limits the identification of patients most appropriate for discharge to an IRF. This study aimed to test for independent associations between PF measured via the AM-PAC "6-clicks" basic mobility short form in the hospital and outcomes in an IRF. Methods This was a retrospective cohort study. Primary data were collected from an acute hospital and IRF at 1 academic medical center. Associations were tested between PF at hospital admission or discharge and PF improvement in the IRF, discharge from the IRF to the community, and 30-day hospital events by estimating adjusted relative risk (aRR) using modified Poisson regression and the relative difference in IRF length of stay (LOS) using Gamma regression. Results A total of 1323 patients were included. Patients with moderately low, (aRR = 1.50; 95% CI = 1.15–1.93), moderately high (aRR = 1.52; 95% CI = 1.16–2.01), or high (aRR = 1.37; 95% CI = 1.02–1.85) PF at hospital discharge were more likely than those with very low PF to improve their PF while in the IRF. These same patients were more likely to discharge from IRF to the community and had significantly shorter IRF LOS. Hospital-measured PF did not differentiate risk for 30-day hospital events. Conclusion Patients with moderate—but not very low or very high—PF measured near the time of acute hospital discharge were likely to achieve meaningful PF improvement in an IRF. They also had a shorter IRF LOS so may be ideal candidates for discharge to IRF. Prospective studies with larger samples are necessary to test this assertion. Impact Providers in the hospital should identify patients with moderate PF near the time of hospital discharge as those who may benefit most from post-acute rehabilitation in an IRF. [ABSTRACT FROM AUTHOR]

Purpose: Investigate the construct validity of prognostic factors purported to predict clinical success with stabilization exercise for low back pain by exploring their associations with lumbar multifidus composition. Methods: Patients with low back pain were recruited from a hospital imaging department. The presence of fivepredictors (age <40 years, positive prone instability test, aberrant trunk flexion movements, straight leg raise range of motion >91°, spinal hypermobility) were identified by standardized physical examination. Predictors were grouped by total positive findings and status on a clinical prediction rule. The proportion of lower lumbar multifidus intramuscular adipose tissue was measured with 3.0 T magnetic resonance imaging. Univariate and multivariate associations were examined with linear regression and reported with standardized beta coefficients (β) and 95% confidence intervals. Results: Data from 62 patients (11 female) with mean (SD) age of 45.2 (11.8) years were included. Total number of predictors (β[95% CI] = −0.37[−0.61,−0.12]; R2 = 0.12), positive prediction rule status (β[95% CI] = −0.57[−0.79,−0.35]; R2 = 0.30), and age <40 years were associated with lower intramuscular adipose tissue (β[95% CI] = −0.55[−0.77,−0.33]; R2 = 0.27). No other individual factors were associated with lumbar multifidus intramuscular adipose tissue. Conclusions: These findings support the construct validity of the grouped prognostic criteria. Future research should examine the clinical utility of these criteria. Low back pain is the single largest cause of disability worldwide and exercise therapy is recommended by international low back pain treatment guidelines. Lower levels of lumbar multifidus intramuscular adipose tissue were associated with predictors of clinical success with stabilization exercise. Higher proportions of lumbar multifidus intramuscular adipose tissue may help identify patients who require longer duration exercise training, or those who are unlikely to respond to stabilization exercise. [ABSTRACT FROM AUTHOR]

In the article, the authors discuss the possible barriers in integrating learning health system (LHS) researchers into health systems, the innovative models used to overcome said barriers, and the characteristics of the embedded research models. Topics include the goal of LSH to enhance health through cycles of discovery and implementation and the four models of rehabilitation researchers within health systems like the mentored research trainees and local research scientists.

* BACKGROUND: Individuals with total knee arthroplasty (TKA) display interlimb knee extensor moment (KEM) asymmetry during level walking that is exacerbated as task demands are increased. Studies using biofeedback to correct interlimb KEM asymmetry following TKA have reported mixed results. * OBJECTIVE: To compare the immediate effect of 2 forms of real-time kinetic biofeedback-vertical ground reaction force (vGRF) or KEM-on improving interlimb peak KEM symmetry during the weight-acceptance phase of decline walking in persons who have undergone TKA. * METHODS: In this cross-sectional, controlled laboratory study, 30 participants (17 men; mean ± SD age, 61.9 ± 8.5 years; body mass index, 28.4 ± 3.7 kg/m²) were allocated to either a vGRF or KEM real-time biofeedback group. Peak KEM interlimb asymmetry was obtained during both nonbiofeedback and biofeedback decline walking trials 3 months following TKA. * RESULTS: Significant interlimb asymmetry in peak KEM was observed in both groups during the nonbiofeedback condition (KEM, P = .02; vGRF, P<.01). The KEM biofeedback group demonstrated an immediate improvement in peak KEM asymmetry (P = .42). No change in peak KEM asymmetry was observed in the vGRF biofeedback group (P = .01). * CONCLUSION: Knee extensor moment biofeedback has an immediate effect on improving peak KEM asymmetry 3 months post TKA. [ABSTRACT FROM AUTHOR]

Key points: Insulin sensitivity (as determined by a hyperinsulinaemic‐euglyceamic clamp) decreased 15% after reduced activity. Despite not fully returning to baseline physical activity levels, insulin sensitivity unexpectedly, rebounded above that recorded before 2 weeks of reduced physical activity by 14% after the recovery period.Changes in insulin sensitivity in response to reduced activity were primarily driven by men but, not women.There were modest changes in ceramides (nuclear/myofibrillar fraction and serum) following reduced activity and recovery but, in the absence of major changes to body composition (i.e. fat mass), ceramides were not related to changes in inactivity‐induced insulin sensitivity in healthy older adults. Older adults are at risk of physical inactivity as they encounter debilitating life events. It is not known how insulin sensitivity is affected by modest short‐term physical inactivity and recovery in healthy older adults, nor how insulin sensitivity is related to changes in serum and muscle ceramide content. Healthy older adults (aged 64–82 years, five females, seven males) were assessed before (PRE), after 2 weeks of reduced physical activity (RA) and following 2 weeks of recovery (REC). Insulin sensitivity (hyperinsulinaemic‐euglyceamic clamp), lean mass, muscle function, skeletal muscle subfraction, fibre‐specific, and serum ceramide content and indices of skeletal muscle inflammation were assessed. Insulin sensitivity decreased by 15 ± 6% at RA (driven by men) but rebounded above PRE by 14 ± 5% at REC. Mid‐plantar flexor muscle area and leg strength decreased with RA, although only muscle size returned to baseline levels following REC. Body fat did not change and only minimal changes in muscle inflammation were noted across the intervention. Serum and intramuscular ceramides (nuclear/myofibrillar fraction) were modestly increased at RA and REC. However, ceramides were not related to changes in inactivity‐induced insulin sensitivity in healthy older adults. Short‐term inactivity induced insulin resistance in older adults in the absence of significant changes in body composition (i.e. fat mass) are not related to changes in ceramides. Key points: Insulin sensitivity (as determined by a hyperinsulinaemic‐euglyceamic clamp) decreased 15% after reduced activity. Despite not fully returning to baseline physical activity levels, insulin sensitivity unexpectedly, rebounded above that recorded before 2 weeks of reduced physical activity by 14% after the recovery period.Changes in insulin sensitivity in response to reduced activity were primarily driven by men but, not women.There were modest changes in ceramides (nuclear/myofibrillar fraction and serum) following reduced activity and recovery but, in the absence of major changes to body composition (i.e. fat mass), ceramides were not related to changes in inactivity‐induced insulin sensitivity in healthy older adults. [ABSTRACT FROM AUTHOR]

ABSTRACT: Patients with total knee arthroplasty (TKA) have large deficits in physical performance in comparison to their healthy age‐matched peers. Limb asymmetry stemming from less relative load borne by the surgical limb during daily mobility is associated with diminished performance and worsens with greater mobility demands. How common targets of postoperative care, such as muscle weakness, lower limb extension power, residual knee pain, and poor balance confidence can influence asymmetrical limb loading remains unclear. Forty‐six patients with unilateral TKA underwent testing of impairments and motion analysis during 10° decline walking at 3 and 6 months postoperatively. At 3 months, only quadriceps femoris strength asymmetry was found to be significantly related to both total support moment (MT) (β = 0.431; p < 0.001) and knee extensor moment (MK) (β = 0.493; p < 0.001) asymmetry. Again at 6 months, only quadriceps strength asymmetry was related to MT (β = 0.432; p < 0.001) and MK (β = 0.534; p < 0.001) asymmetry. Quadriceps strength significantly improved over time in both limbs, however, deficits between limbs remained. Persistent quadriceps weakness is a key factor associated with walking compensation patterns that are limiting the capacity for greater physical performance of patients with TKA. The pronounced asymmetry in limb and knee loading at 3 months remains unchanged until at least 6 months after surgery, and its association with quadriceps strength asymmetry does not substantially change over time. While other factors may also prompt gait compensations, emphasis on improved quadriceps strength should be a focus of efforts to resolve gait compensations and enhance physical performance outcomes. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2355–2363, 2018. [ABSTRACT FROM AUTHOR]

Background. The impact of physical therapy on the outcomes of patients with acute low back pain (LBP) stratified by the STart Back Screening Tool (SBST) is unclear. Objective. The purpose of this study was to compare the outcomes of patients with acute LBP who were stratified as medium or high risk. Design. This was a secondary analysis of a randomized trial. Setting. Patients were recruited between March 2011 and November 2013 from primary care clinics in Salt Lake City, Utah. Participants. One hundred eighty-one participants with acute LBP who were strati- fied as medium risk (n = 120) or high risk (n = 61) by the SBST were included. They were aged 18 through 60 years, with duration of symptoms less than 16 days, no symptoms below the knee, no treatment for LBP in the past 6 months, and an Oswestry Disability Index (ODI) score of 20% or greater. Intervention. After participants received education on how to manage their LBP, they were randomized to receive usual care (n = 97) by their primary care provider or early intervention (n = 84) by a physical therapist. Measurements. The primary (3-month ODI score) outcome measure was obtained at baseline and at 4 weeks, 3 months, and 1 year. Results. No differences were detected in the effect of intervention between participants stratified as medium or high risk. For the high-risk subgroup, there was a significant difference between the early intervention and usual care groups for the 3-month ODI (mean difference = -5.87 [95% CI = -11.24, -0.50]) favoring early intervention. Limitations. The primary study was not designed to examine the SBST. Conclusions. Patients with acute LBP stratified as high risk seem likely to respond well to one session of education. They may experience additional benefit by 3 months from evidence-based physical therapy treatments. These effects disappear at 1 year. [ABSTRACT FROM AUTHOR]

Older adults after hip fracture surgery experience progressive muscle atrophy and weakness, limiting full recovery. Further understanding of the molecular mechanisms in muscle with adaptation to exercise training in this vulnerable population is necessary. Therefore, we conducted a pilot study to investigate the skeletal muscle inflammatory and ceramide biosynthesis gene expression levels associated with the toll-like receptor (TLR) pathway before (Pre) and following a 3-mo multicomponent exercise training program in older adults (3M, 4F; 78.4 ± 13.3 yr; 25.5 ± 2.3 kg/m2) ~4 mo after repair from hip fracture (HipFx). Vastus lateralis biopsies from the surgical limb were obtained before (Pre) and after training. Molecular end points and muscle function data were also compared with matched nonexercise healthy controls (CON). As a follow-up analysis, we evaluated specific sphingolipid pools in HipFx and CON muscle. Following training, quadriceps cross-sectional area, strength, and 6-min walk (6MW) increased in the surgical limb (P < 0.05). Additionally, MYD88, TAK1, NFKB1, IL6, SPT2, and CERS1 gene expression decreased after training (P ≤ 0.05), but some remained elevated above CON levels. Interestingly, MYD88 mRNA was inversely correlated to quadriceps CSA, strength, and 6MW. Finally, muscle dihydroceramides and phosphoceramides in HipFx were lower than CON at Pre (P ≤ 0.05), but after training differences from CON were removed. Together, our pilot data support that exercise training alters skeletal muscle inflammation and ceramide metabolism associated with TLR signaling in older adults recovering from hip fracture surgery and may be related to improvements in muscle function recovery. [ABSTRACT FROM AUTHOR]

Diabetic peripheral neuropathy (DPN) occurs in more than 50% of people with diabetes and is an important risk factor for skin breakdown, amputation, and reduced physical mobility (ie, walking and stair climbing). Although many beneficial effects of exercise for people with diabetes have been well established, few studies have examined whether exercise provides comparable benefits to people with DPN. Until recently, DPN was considered to be a contraindication for walking or any weight-bearing exercise because of concerns about injuring a person's insensitive feet. These guidelines were recently adjusted, however, after research demonstrated that weight-bearing activities do not increase the risk of foot ulcers in people who have DPN but do not have severe foot deformity. Emerging research has revealed positive adaptations in response to overload stress in these people, including evidence for peripheral neuroplasticity in animal models and early clinical trials. This perspective article reviews the evidence for peripheral neuroplasticity in animal models and early clinical trials, as well as adaptations of the integumentary system and the musculoskeletal system in response to overload stress. These positive adaptations are proposed to promote improved function in people with DPN and to foster the paradigm shift to including weight-bearing exercise for people with DPN. This perspective article also provides specific assessment and treatment recommendations for this important, high-risk group. [ABSTRACT FROM AUTHOR]

The article discusses research which investigated the impact of an intense lifestyle intervention on neuropathy progression and quality of life in individuals with diabetic peripheral neuropathy (DPN). Topics discussed include the administration of 18 months of supervised exercise training, actigraphy-based counseling and individualize dietary counseling to the intervention group, neuropathy progression as measured by intraepidermal nerve fiber density and limitations of the study.

Introduction: Preliminary evidence in adults with spinal muscular atrophy (SMA) and in SMA animal models suggests exercise has potential benefits in improving or stabilizing muscle strength and motor function.Methods: We evaluated feasibility, safety, and effects on strength and motor function of a home-based, supervised progressive resistance strength training exercise program in children with SMA types II and III. Up to 14 bilateral proximal muscles were exercised 3 times weekly for 12 weeks.Results: Nine children with SMA, aged 10.4 ± 3.8 years, completed the resistance training exercise program. Ninety percent of visits occurred per protocol. Training sessions were pain-free (99.8%), and no study-related adverse events occurred. Trends in improved strength and motor function were observed.Conclusions: A 12-week supervised, home-based, 3-day/week progressive resistance training exercise program is feasible, safe, and well tolerated in children with SMA. These findings can inform future studies of exercise in SMA. [ABSTRACT FROM AUTHOR]

Key points Five days of bed rest resulted in a reduction in leg lean mass and strength in older adults., After bed rest, older (but not younger) adults had reduced amino acid-induced anabolic sensitivity (blunted muscle protein synthesis; MPS) and enhanced markers associated with the ubiquitin proteasome and autophagy-lysosomal systems (increase in molecular markers related to muscle proteolysis)., Younger adults did not lose leg lean mass (via DXA) after 5 days of bed rest despite blunted amino acid-induced mTORC1 signalling and increased skeletal muscle REDD1, REDD2 and MURF1 mRNA expression., Exercise rehabilitation restored bed rest-induced deficits in lean mass, strength, nutrient-induced protein anabolism (protein synthesis and mTORC1 signalling) and select muscle proteolytic markers in older adults., Abstract Bed rest-induced muscle loss and impaired muscle recovery may contribute to age-related sarcopenia. It is unknown if there are age-related differences in muscle mass and muscle anabolic and catabolic responses to bed rest. A secondary objective was to determine if rehabilitation could reverse bed rest responses. Nine older and fourteen young adults participated in a 5-day bed rest challenge (BED REST). This was followed by 8 weeks of high intensity resistance exercise (REHAB). Leg lean mass (via dual-energy X-ray absorptiometry; DXA) and strength were determined. Muscle biopsies were collected during a constant stable isotope infusion in the postabsorptive state and after essential amino acid (EAA) ingestion on three occasions: before (PRE), after bed rest and after rehabilitation. Samples were assessed for protein synthesis, mTORC1 signalling, REDD1/2 expression and molecular markers related to muscle proteolysis (MURF1, MAFBX, AMPKα, LC3II/I, Beclin1). We found that leg lean mass and strength decreased in older but not younger adults after bedrest ( P < 0.05) and was restored after rehabilitation. EAA-induced mTORC1 signalling and protein synthesis increased before bed rest in both age groups ( P < 0.05). Although both groups had blunted mTORC1 signalling, increased REDD2 and MURF1 mRNA after bedrest, only older adults had reduced EAA-induced protein synthesis rates and increased MAFBX mRNA, p-AMPKα and the LC3II/I ratio ( P < 0.05). We conclude that older adults are more susceptible than young persons to muscle loss after short-term bed rest. This may be partially explained by a combined suppression of protein synthesis and a marginal increase in proteolytic markers. Finally, rehabilitation restored bed rest-induced deficits in lean mass and strength in older adults. [ABSTRACT FROM AUTHOR]

Objective Unmyelinated cutaneous axons are vulnerable to physical and metabolic injury, but also capable of rapid regeneration. This balance may help determine risk for peripheral neuropathy associated with diabetes or metabolic syndrome. Capsaicin application for 48 hours induces cutaneous fibers to die back into the dermis. Regrowth can be monitored by serial skin biopsies to determine intraepidermal nerve fiber density (IENFD). We used this capsaicin axotomy technique to examine the effects of exercise on cutaneous regenerative capacity in the setting of metabolic syndrome. Methods Baseline ankle IENFD and 30-day cutaneous regeneration after thigh capsaicin axotomy were compared for participants with type 2 diabetes (n = 35) or metabolic syndrome (n = 32) without symptoms or examination evidence of neuropathy. Thirty-six participants (17 with metabolic syndrome) then joined twice weekly observed exercise and lifestyle counseling. Axotomy regeneration was repeated in month 4 during this intervention. Results Baseline distal leg IENFD was significantly reduced for both metabolic syndrome and diabetic groups. With exercise, participants significantly improved exercise capacity and lower extremity power. Following exercise, 30-day reinnervation rate improved (0.051 ± 0.027 fibers/mm/day before vs 0.072 ± 0.030 after exercise, p = 0.002). Those who achieved improvement in more metabolic syndrome features experienced a greater degree of 30-day reinnervation ( p < 0.012). Interpretation Metabolic syndrome was associated with reduced baseline IENFD and cutaneous regeneration capacity comparable to that seen in diabetes. Exercise-induced improvement in metabolic syndrome features increased cutaneous regenerative capacity. The results underscore the potential benefit to peripheral nerve function of a behavioral modification approach to metabolic improvement. ANN NEUROL 2015;77:146-153 [ABSTRACT FROM AUTHOR]

Early diabetic neuropathy is characterized by loss of unmyelinated axons, resulting in pain, numbness, and progressive decline in intraepidermal nerve fiber density. Patients with type 2 diabetes, without neuropathy, were assigned to quarterly lifestyle counseling ( N = 40) or structured, supervised weekly exercise ( N = 60) for 1 year. Distal leg IENFD significantly increased in the exercise cohort and remained unchanged in the counseling cohort (1.5 ± 3.6 vs. −0.1 ± 3.2 fibers/mm, P = 0.03). These results suggest preclinical injury to unmyelinated axons is potentially reversible, and that IENFD may be a responsive biomarker useful in future neuropathy prevention clinical trials. [ABSTRACT FROM AUTHOR]

Background and Objectives. Reduced lean mass and physical function is a characteristic of frailty. However, it is currently unknown if proteolysis through the E3 ubiquitin ligases and the autophagic lysosomal pathway is dysregulated in inactive frail older women. The purpose of this study was to determine the expression of key markers of ubiquitin-mediated and autophagic lysosomal proteolysis in inactive (N = 7) compared with active (N = 7) older women. Methods. Strength, mobility, leg lean mass, and physical activity assessment were used to characterize activity levels and frailty in older women. Vastus lateralis biopsies were collected after an overnight fast and were assessed for gene and protein targets related to E3 ubiquitin ligases and the autophagic lysosomal system. Results. We found that AMP-activated protein kinase alpha (Thr172) was increased (p = .045), and forkhead box O3A (FOXO3A) gene expression (p = .047) was lower in inactive frail older women. Foxo3a (Ser253), Beclin1 (Ser93/96), and class III phosphatidylinositol-3-kinase (VPS34) protein expression were not different between the groups (p > .05). Neural precursor cell-expressed developmentally downregulated protein 4, muscle ring finger 1, muscle atrophy F-box, and the autophagy/mitophagy gene expression markers, Beclin1, autophagy-related-7, BCL2/adenovirus E1B 19kDa interacting protein 3 (BNIP3), dynamin-related protein 1, and Parkinson protein 2 (PARKIN) were lower in inactive frail older women (p < .05). Autophagy/mitophagy markers were positively correlated with the 6-minute walk and leg lean mass (p < .05). Conclusions. We conclude that physical inactivity in frail older women is associated with a downregulation of ubiquitin-mediated and autophagic lysosomal skeletal muscle gene expression, perhaps related to low muscle mass and poor physical function. [ABSTRACT FROM PUBLISHER]

Objective. Greater skeletal muscle fat infiltration occurs with age and contributes to numerous negative health outcomes. The primary purpose was to determine whether intermuscular adipose tissue (IMAT) can be influenced by an exercise intervention and if a greater reduction in IMAT occurs with eccentric versus traditional resistance training. Methods. Seventy-seven older adults (age 75.5 ± 6.8) withmultiple comorbidities and a history of falling completed a three-month exercise intervention pairedwith either eccentric or traditional resistance training. MRI of the mid-thigh was examined at three time points to determine changes inmuscle composition after intervention. Results. No differences in IMAT were observed over time, and there were no differences in IMAT response between intervention groups. Participants in the traditional group lost a significant amount of lean tissue (P = 0.007) in the ninemonths after intervention,while participants in the eccentric group did not (P = 0.32).When IMAT levelswere partitioned into high and low IMAT groups, there were differential IMAT responses to intervention with the high group lowering thigh IMAT. Conclusions. There is no decrease in thigh IMAT after a three-month exercise intervention in older adults at risk for falling and no benefit to eccentric training over traditional resistance training for reducing IMAT in these individuals. [ABSTRACT FROM AUTHOR]

Muscle's structural composition is an important factor underlying muscle strength and physical function in older adults. There is an increasing amount of research to support the clear disassociation between the loss of muscle lean tissue mass and strength with aging. This disassociation implies that factors in addition to lean muscle mass are responsible for the decreases in strength and function seen with aging. Intermuscular adipose tissue (IMAT) is a significant predictor of both muscle function and mobility function in older adults and across a wide variety of comorbid conditions such as stroke, spinal cord injury, diabetes, and COPD. IMAT is also implicated in metabolic dysfunction such as insulin resistance. The purpose of this narrative review is to provide a review of the implications of increased IMAT levels in metabolic, muscle, and mobility function. Potential treatment options to mitigate increasing levels of IMAT will also be discussed. [ABSTRACT FROM AUTHOR]

Objective. Intramuscular adipose tissue (IMAT) and sarcopenia may adversely impact mobility function and physical activity. This study determined the association of locomotor muscle structure and function with mobility function in older adults. Method. 109 older adults with a variety of comorbid disease conditions were examined for thigh muscle composition via MRI, knee extensor strength via isometric dynamometry, and mobility function. The contribution of strength, quadriceps lean tissue, and IMAT to explaining the variability in mobility function was examined using multivariate linear regression models. Results. The predictors as a group contributed 27-45% of the variance in all outcome measures; however, IMAT contributed between 8-15% of the variance in all four mobility variables, while lean explained only 5% variance in only one mobility measure. Conclusions. Thigh IMAT, a newly identified muscle impairment appears to be a potent muscle variable related to the ability of older adults to move about in their community. [ABSTRACT FROM AUTHOR]

Muscle atrophy is associated with healthy aging (i.e., sarcopenia) and may be compounded by comorbidities, injury, surgery, illness, and physical inactivity. While a bout of resistance exercise increases protein synthesis rates in healthy young skeletal muscle, the effectiveness of resistance exercise to mount a protein synthetic response is less pronounced in older adults. Improving anabolic sensitivity to resistance exercise, thereby enhancing physical function, is most critical in needy older adults with clinical conditions that render them "low responders". In this paper, we discuss potential mechanisms contributing to anabolic impairment to resistance exercise and highlight the need to improve anabolic responsiveness in low responders. This is followed with evidence suggesting that the recovery period of resistance exercise provides an opportunity to amplify the exercise-induced anabolic response using protein/essential amino acid ingestion. This anabolic strategy, if repeated chronically, may improve lean muscle gains, decrease time to recovery of function during periods of rehabilitation, and overall,maintain/improve physical independence and reduce mortality rates in older adults. [ABSTRACT FROM AUTHOR]

It is intuitive to think that sarcopenia should be associated with declines in physical function though recent evidence questions this assertion. This study investigated the relationship between absolute and relative sarcopenia, with physical performance in 202 nonobese (mean BMI = 26.6 kg/ht2) community-dwelling older (mean age = 73.8 ± 5.9 years) adults. While absolute sarcopenia (appendicular skeletal mass (ASM)/ht2) was either not associated, or weakly associated with physical performance, relative sarcopenia (ASM/kg) demonstrated moderate (r = 0.31 to r = 0.51, P < 0.01) relationships with performance outcomes in both males and females. Knee extension strength (r = 0.27) and leg extension power (r = 0.41) were both related to absolute sarcopenia (P < 0.001) in females and not in males. Strength and power were associated with relative sarcopenia in both sexes (from r = 0.47 to r = 0.67, P < 0.001). The ratio of lean mass to total body mass, that is, relative sarcopenia, is an important consideration relative to physical function in older adults even in the absence of obesity. Stratifying these individuals into equal tertiles of total body fat revealed a trend of diminished regression coefficients across each incrementally higher fat grouping for performance measures, providing further evidence that total body fat modulates the relationship between sarcopenia and physical function. [ABSTRACT FROM AUTHOR]

Rehabilitation services are less-studied aspects of the management following total knee arthroplasty (TKA) despite long-term suboptimal physical functioning and chronic deficits in muscle function. This paper describes the preliminary findings of a sixweek (12 session) eccentrically-biased rehabilitation program targeted at deficits in physical function and muscle function, initiated one month following surgery. A quasiexperimental, one group, pretest-posttest study with thirteen individuals (6 female, 7 male; mean age 57 ± 7 years) examined the effectiveness of an eccentrically-biased rehabilitation program. The program resulted in improvements in the primary physical function endpoints (SF-36 physical component summary and the six-minute walk test) with increases of 59% and 47%, respectively. Muscle function endpoints (knee extension strength and power) also increased 107% and 93%, respectively. Eccentrically-biased exercise used as an addition to rehabilitation may help amplify and accelerate physical function following TKA surgery. [ABSTRACT FROM AUTHOR]

Background: Resistance exercise programs with high compliance are needed to counter impaired muscle and mobility in older cancer survivors. To date outcomes have focused on older prostate cancer survivors, though more heterogeneous groups of older survivors are in-need. The purpose of this exploratory pilot study is to examine whether resistance exercise via negative eccentrically-induced work (RENEW) improves muscle and mobility in a diverse sample of older cancer survivors. Methods: A total of 40 individuals (25 female, 15 male) with a mean age of 74 (± 6) years who have survived (8.4 ± 8 years) since their cancer diagnosis (breast, prostate, colorectal and lymphoma) were assigned to a RENEW group or a non-exercise Usual-care group. RENEW was performed for 12 weeks and measures of muscle size, strength, power and mobility were made pre and post training. Results: RENEW induced increases in quadriceps lean tissue average cross sectional area (Pre: 43.2 ± 10.8 cm²; Post: 44.9 ± 10.9 cm²), knee extension peak strength (Pre: 248.3 ± 10.8 N; Post: 275.4 ± 10.9 N), leg extension muscle power (Pre: 198.2 ± 74.7 W; Post 255.5 ± 87.3 W), six minute walk distance (Pre: 417.2 ± 127.1 m; Post 466.9 ± 125.1 m) and a decrease on the time to safely descend stairs (Pre: 6.8 ± 4.5 s; Post 5.4 ± 2.5 s). A significant (P < 0.05) group x time interaction was noted for the muscle size and mobility improvements. Conclusions: This exploration of RENEW in a heterogeneous cohort of older cancer survivors demonstrates increases in muscle size, strength and power along with improved mobility. The efficacy of a high-force, low perceived exertion exercise suggests RENEW may be suited to older individuals who are survivors of cancer. Trial Registration: ClinicalTrials.gov Identifier: NCT00335491 [ABSTRACT FROM AUTHOR]

Unlabelled: Muscle and mobility deficits can persist for years after a total knee arthroplasty (TKA). The purposes of this study were (1) to determine if 12 weeks of rehabilitation with resistance exercise induces increases in muscle size, strength, and mobility in individuals 1 to 4 years after a TKA; and (2) to compare the muscle and mobility outcomes of a traditional resistance exercise rehabilitation program with a rehabilitation program focused on eccentric resistance exercise. Seventeen individuals (13 women, four men; mean age, 68 years; age range, 55-80 years) with either a unilateral or bilateral TKA (total of 24 knees) were included in this matched and randomized repeated-measures rehabilitation pilot trial. Increases in quadriceps muscle volume and knee extension strength followed 12 weeks of eccentric exercise. Improvements were also noted in four mobility tests. Similar improvements were noted in the traditional group in two mobility tests. An increase in muscle size and strength and an improvement in levels of mobility can occur after 12 weeks of resistance exercise in older individuals 1 to 4 years after TKA. When the exercise mode focuses on eccentric resistance, the muscle growth response is greater as is the improvement in important mobility tasks.Level Of Evidence: Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Background: Menopause is associated with both a loss of muscle mass and a worsening of insulin sensitivity (IS). Although eccentric resistance exercise (ECC) can effectively improve muscle mass over time, a single bout of ECC can worsen IS. This study assessed the effect of repeated ECC on IS, muscle mass, and function in postmenopausal women with impaired glucose tolerance (IGT). Methods: Sixteen PM women (aged 56 years ± 6.4) with IGT were randomly assigned to a 12-week, knee extensor ECC program ( n = 10) or a nonexercise control group (CON) ( n = 6). Participants underwent hyperinsulinemic-euglycemic clamps, dual-energy x-ray (DEXA) absorptiometry, quadriceps strength assessment, 6-minute walk (6MW) tests, and an assessment of steps taken per day before and after training. Results: ECC participants experienced greater increases in leg lean soft tissue mass (ECC, 0.41 kg; CON, −0.53 kg; p = 0.03), quadriceps strength (ECC, 9.3 kg force; CON, −2.9 kg force; p = 0.02), and 6MW distance (ECC, 56.4 meters; CON, 3.3 meters; p = 0.03) than CON participants and demonstrated a trend toward more steps taken per day posttraining (ECC, +1747 steps; CON, +339 steps; p = 0.10). IS was unchanged. Conclusions: This novel exercise improves muscle mass and function without worsening IS in postmenopausal women with IGT. Because it can be performed at low levels of exertion and improves muscle mass and function without impairing IS, ECC should be used to ameliorate muscle loss in physically inactive postmenopausal women. The impact of longer-term ECC on IS should be investigated. Demonstrating that ECC does not worsen IS in this population is significant because it has promise to combat the muscle-mediated impairments common in aging women. [ABSTRACT FROM AUTHOR]

Background: Novel interventions that can safely and effectively overload muscle early following anterior cruciate ligament reconstruction are needed to minimize atrophy and weakness that often becomes longstanding.Evidence Acquisition: Eccentrically induced forces can be safely applied during the early stages of rehabilitation following surgery and serve as a potent stimulus for increasing muscle size and strength.Results: Compared to a standard rehabilitation program, adding an early 12-week eccentric resistance-training program 3 weeks after anterior cruciate ligament reconstruction induces improvement in quadriceps and gluteus maximus volume at 15 weeks and at 1 year after surgery. Likewise, those who performed an eccentrically biased rehabilitation program also achieved greater improvements in quadriceps strength and hopping ability measured at 15 weeks and at 1 year after surgery.Clinical Relevance: There is potential to safely and feasibly perform eccentric contractions as part of a formal rehabilitation program following anterior cruciate ligament reconstruction. [ABSTRACT FROM AUTHOR]

The article reports on early progressive eccentric exercise and the effects on muscle size and function following anterior cruciate ligament reconstruction (ACL-R). A randomized clinical trial involving 40 ACL-R patients was conducted comparing the rehabilitation results of early progressive eccentric exercise and standard rehabilitation programs. Patients underwent a follow-up after one year of rehabilitation where magnetic resonance images of their thighs were taken as well as knee examinations and other functional testing. It was found that eccentric exercise contributed to greater muscle volume increases in the quadriceps femoris and the gluteus maximus.

Objective: The prevalence of diabetes (type 2) in the general population has increased dramatically over the last decade, yet patients with diabetes are rarely referred for physical therapy management of their condition. The majority of patients referred for outpatient physical therapy have musculoskeletal-related conditions. Secondary conditions, such as diabetes, may be prevalent in this population, and physical therapists need to be aware of this to adjust interventions and treatment. The purpose of this article is to describe the prevalence of diabetes and the associated risk factors in adults referred for physical therapy in a primary care outpatient setting. Subjects and Methods: Patients aged 18 years or older referred for physical therapy were identified from the Centricity Electronic Medical Records database during the period of December 13, 1995, to June 30, 2007. Patients were evaluated on the basis of clinical (height, weight, blood pressure, laboratory values), treatment (prescriptions), and diagnostic (ICD-9 codes) criteria to identify the presence of diabetes or associated risk factors (eg, hypertension, elevated triglerides, low high- density lipoprotein, body mass index, and prediabetes). Results: There were 52,667 patients referred for physical therapy, the majority of whom were referred for a musculoskeletal-related condition. Approximately 80% of the total study population had diabetes, prediabetes, or risk factors associated with diabetes. The prevalence of diabetes in the study population was 13.2%. Of the diabetes-associated risk factors evaluated, hypertension was the most prevalent (70.4%), and less than half (39.1%) of the study population had an elevated body mass index. Only 20% of the study population had values within normal limits for all clinical, treatment, and diagnostic criteria. Clinical and treatment measurements available to physical therapists identified the majority of associated risk factors. Conclusions: Although not the primary indications for referral, diabetes and associated risk factors were identified in a high proportion of the study population. The evaluation of associated conditions in the outpatient orthopedic setting needs to be considered for treatment planning adjustments and to optimize care. [ABSTRACT FROM AUTHOR]

Background and Purpose: The purpose of this study was to compare the outcomes between a diabetes exercise training program using combined aerobic and high-force eccentric resistance exercise and a program of aerobic exercise only. Subjects and Methods: Fifteen participants with type 2 diabetes mellitus (T2DM) participated in a 16-week supervised exercise training program: 7 (mean age = 50.7 years, SD=6.9) in a combined aerobic and eccentric resistance exercise program (AE/RE group) and 8 (mean age=58.5 years, SD=6.2) in a program of aerobic exercise only (AE group). Outcome measures included thigh lean tissue and intramuscular fat (IMF), glycosylated hemoglobin, body mass index (BMI), and 6-minute walk distance. Results: Both groups experienced decreases in mean glycosylated hemoglobin after training (AE/RE group: -0.59% [95% confidence interval (CI)= -1.5 to 0.28] ; AE group: -0.31% [95% CI=-0.60 to -0.03]), with no significant between-group differences. There was an interaction between group and time with respect to change in thigh lean tissue cross-sectional area, with the AE/RE group gaining more lean tissue (AE/RE group: 15.1 cm2 [95% CI=7.6 to 22.5]; AE group: -5.6 cm2 [95% CI=-10.4 to 0.76]). Both groups experienced decreases in mean thigh IMF crosssectional area (AE/RE group: -1.2 cm2 [95% CI=-2.6 to 0.26]; AE group: -2.2 cm2 [95% CI=-3.5 to -0.84]) and increases in 6-minute walk distance (AE/RE group: 45.5 m [95% CI=7.5 to 83-6]; AE group: 29.9 m [95% CI=-7.7 to 67.5]) after training, with no between-group differences. There was an interaction between group and time with respect to change in BMI, with the AE/RE group experiencing a greater decrease in BMI. Discussion and Conclusion: Significant improvements in long-term glycemic control, thigh composition, and physical performance were demonstrated in both groups after participating in a 16-week exercise program. Subjects in the AE/RE group demonstrated additional improvements in thigh lean tissue and BMI. Improvements in thigh lean tissue may be important in this population as a means to increase resting metabolic rate, protein reserve, exercise tolerance, and functional mobility. [ABSTRACT FROM AUTHOR]

Background: Thigh muscle atrophy is a major impairment that occurs early after reconstruction of the anterior cruciate ligament and persists for several years. Eccentric resistance training has the potential to induce considerable gains in muscle size and strength that could prove beneficial during postoperative rehabilitation. The purpose of this study was to evaluate the effects of progressive eccentric exercise on thigh muscle structure following reconstruction of the anterior cruciate ligament.Methods: Beginning three weeks after reconstruction of the anterior cruciate ligament, forty patients were randomly assigned to a program involving either twelve weeks of eccentric exercises or a standard rehabilitation protocol. Patients were matched by surgical procedure, sex, and age. The final series consisted of two cohorts of twenty patients each who had been treated with one of two types of graft (semitendinosus-gracilis or bone-patellar tendon-bone), with ten patients treated with each of the two rehabilitation protocols in each graft cohort. To evaluate changes in muscle structure, magnetic resonance images of the involved and uninvolved thighs were acquired before and after training. The volume and peak cross-sectional area of the quadriceps, hamstrings, and gracilis and the distal portion of the gluteus maximus were calculated from these images.Results: The volume and peak cross-sectional area of the quadriceps and gluteus maximus, in both the involved and the uninvolved thighs and in the patients treated with each type of graft, improved significantly more in the eccentric-exercise group (p < 0.001). The magnitude of the volume change was more than twofold greater in that group. No significant differences in any hamstring or gracilis structural measurements were observed between the rehabilitation groups. However, the volume and peak cross-sectional area of the gracilis were markedly reduced, compared with the pretraining values, in the patients who had undergone reconstruction with the semitendinosus-gracilis graft.Conclusions: Eccentric resistance training implemented three weeks after reconstruction of the anterior cruciate ligament can induce structural changes in the quadriceps and gluteus maximus that greatly exceed those achieved with a standard rehabilitation protocol. The success of this intervention can be attributed to the gradual and progressive exposure to negative work through eccentric exercise, ultimately leading to production of high muscle force. [ABSTRACT FROM AUTHOR]

Background: Thigh muscle atrophy is a major impairment that occurs early after reconstruction of the anterior cruciate ligament and persists for several years. Eccentric resistance training has the potential to induce considerable gains in muscle size and strength that could prove beneficial during postoperative rehabilitation. The purpose of this study was to evaluate the effects of progressive eccentric exercise on thigh muscle structure following reconstruction of the anterior cruciate ligament. Methods: Beginning three weeks after reconstruction of the anterior cruciate ligament, forty patients were randomly assigned to a program involving either twelve weeks of eccentric exercises or a standard rehabilitation protocol. Patients were matched by surgical procedure, sex, and age. The final series consisted of two cohorts of twenty patients each who had been treated with one of two types of graft (semitendinosus-gracilis or bone-patellar tendon-bone), with ten patients treated with each of the two rehabilitation protocols in each graft cohort. To evaluate changes in muscle structure, magnetic resonance images of the involved and uninvolved thighs were acquired before and after training. The volume and peak cross-sectional area of the quadriceps, hamstrings, and gracilis and the distal portion of the gluteus maximus were calculated from these images. Results: The volume and peak cross-sectional area of the quadriceps and gluteus maximus, in both the involved and the uninvolved thighs and in the patients treated with each type of graft, improved significantly more in the eccentric- exercise group (p < 0.001). The magnitude of the volume change was more than twofold greater in that group. No significant differences in any hamstring or gracilis structural measurements were observed between the rehabilitation groups. However, the volume and peak cross-sectional area of the gracilis were markedly reduced, compared with the pretraining values, in the patients who had undergone reconstruction with the semitendinosus-gracilis graft. Conclusions: Eccentric resistance training implemented three weeks after reconstruction of the anterior cruciate ligament can induce structural changes in the quadriceps and gluteus maximus that greatly exceed those achieved with a standard rehabilitation protocol. The success of this intervention can be attributed to the gradual and progressive exposure to negative work through eccentric exercise, ultimately leading to production of high muscle force. [ABSTRACT FROM AUTHOR]

Strength deficits in persons with Parkinson's disease (PD) have been identified as a contributor to bradykinesia. However, there is little research that examines the effect of resistance training on muscle size, muscle force production, and mobility in persons with PD. The purpose of this exploratory study was to examine, in persons with PD, the changes in quadriceps muscle volume, muscle force production, and mobility as a result of a 12-week high-force eccentric resistance training program and to compare the effects to a standard-care control. Nineteen individuals with idiopathic PD were recruited and consented to participate. Matched assignment for age and disease severity resulted in 10 participants in the eccentric group and 9 participants in the control group. All participants were tested prior to and following a 12-week intervention period with testing and training conducted at standardized times in their medication cycle. The eccentric group performed high-force quadriceps contractions on an eccentric ergometer 3 days a week for 12 weeks. The standard-care group exercise program encompassed standard exercise management of PD. The outcome variables were quadriceps muscle volume, muscle force, and mobility measures (6-minute walk, stair ascent/descent time). Each outcome variable was tested using separate one-way analyses of covariance on the difference scores. Muscle volume, muscle force, and functional status improvements occurred in persons with PD as a result of high-force eccentric resistance training. The eccentric group demonstrated significantly greater difference scores for muscle structure, stair descent, and 6-minute walk ( P < 0.05). Magnitude of effect size estimators for the eccentric group consistently exceeded those in the standard-care group for all variables. To our knowledge, this is the first clinical trial to investigate and demonstrate the effects of eccentric resistance training on muscle hypertrophy, strength, and mobility in persons with PD. Additional research is needed to determine the anatomical and neurological mechanisms of the observed strength gains and mobility improvements. © 2006 Movement Disorder Society [ABSTRACT FROM AUTHOR]

Evaluates the outcome of patients who received no surgery or formal rehabilitation program for an acute grade III acromioclavicular separation, a type of shoulder injury. Tests conducted on the patients; History of the patients; Results of visual analog scale of several patients.

Introduction: Intramuscular adipose tissue (IMAT) is a potential contributor to declining force production and may be related to impaired central activation; therefore, the purpose of this report is to describe IMAT composition and its association with central activation in older adults. The central activation ratio (CAR) of the knee extensors was assessed using a superimposition technique in 15 older adults (29 legs) along with the cross-sectional area of IMAT and lean tissue. Results: IMAT and CAR are inversely related in older adults ( r = −0.51, P = 0.005), and many subjects with high IMAT have deficits in central activation, whereas those with low IMAT have normal central activation. Conclusions: These novel findings may assist in unraveling why muscle force production and lean tissue cross-sectional area are not strongly linked, as the ability to centrally activate muscle appears to be unrelated to lean muscle area and may be dependent in part on IMAT levels. Muscle Nerve 46:813-816, 2012 [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome polyneuropathy (MSP), sensory peripheral neuropathy associated with diabetes or prediabetic metabolic syndrome affects more than 10% of Americans over 40 years old. Screening exam measures commonly used in primary care (PC), such as 10 gram monofilament testing measure loss of protective sensation and predict development of foot ulcers and infection, but are not sensitive enough to detect early sensory loss. The Utah Early Neuropathy Scale (UENS) is a 2-minute exam scale focused on sensory loss to pin sensation in the foot that has been validated for early neuropathy screening. Objectives: To examine reliability of the UENS when performed by medical assistants in a PC setting. Methods: PC medical assistants were trained to perform the UENS, then screened consenting primary care patients selected by best practice alert (BPA) for age >40 and BMI > 30 with 3 neuropathy-focused questions and the UENS. A blinded neurologist (JRS), performed UENS and a brief exam at the same visit to examine reliability. Results: 135 patients meeting BPA criteria were screened with UENS. Of these, 18% had a UENS score >4, suggesting neuropathy. Intraclass correlation coefficient for 20 comparison UENS exams was 86%. Sub-scores for pin sensation, strength and joint position sense were highly coherent, while vibration sense proved less reliable. Pin (37.9%), vibration (34.8%) and deep tendon reflex (23.4%) sub scores contributed the most to total UENS score overall, with pin sub score most likely to contribute to UENS scores 4-8 (44%). Discussion: UENS can be performed reliably by medical assistants in a primary care setting, and is a sensitive screening modality for MSP. Pin and vibration contribute the bulk of UENS score points in patients with mild neuropathy, suggesting that a simplified UENS could be used in PC screening. Disclosure: S.C. Foster-Palmer: None. J. Singleton: None. C. Revere: None. R.L. Marcus: None. M. Shakeri: None. A. Castillo: None. S. Shafi: None. Funding: University of Utah Health [ABSTRACT FROM AUTHOR]

More than 150,000 Utahns have diabetes, costing the state over one billion dollars each year. The risk for developing type 2 diabetes is significantly higher among members of minority racial or ethnic groups. The Wellness Bus is a mobile health unit that aims to reduce the burden of type 2 diabetes in Utah's underserved communities. The program represents a unique partnership between researchers, community health workers, student volunteers, and community health partners. Objective: To describe the characteristics and needs—both medical and social—of community members being served by the Wellness Bus in its first 6 months of implementation, and to discuss how the mobile health unit and its partners are addressing these critical gaps in access to care. Methods: Participants included 501 individuals who visited the Wellness Bus's weekly neighborhood sites between June and December of 2018. Participants were ages 18 to 88 years (Mean age = 46.8), 50% Female; 28% white; and 67% Hispanic/Latino. Descriptive data from routinely-collected assessments during Wellness Bus visits at the weekly sites including participant self-report surveys, biometric screenings, and social service referrals were analyzed with R statistical software. Results: Of all individuals, 57% reported Spanish as their primary language, 67% were uninsured, and 61% did not have a primary care provider; 23% had been previously diagnosed with diabetes or prediabetes. More than half of high-risk individuals had HbA1c levels > 5.7. Mean BMI = 29.8, with 82% overweight or obese; more than half screened with elevated blood pressure. Service referrals were made for 160 individuals, most to community medical/dental services. In regard to the social risk assessment, 35% reported experiencing food insecurity. Through the first 6 months of the Wellness Bus program, we have gained an understanding of our communities' needs and are addressing these gaps. We are developing strategies to increase the number of follow-up visits. Disclosure: R.L. Marcus: None. B.L. Bannon: None. R.K. Delaney: None. A. Fagerlin: None. [ABSTRACT FROM AUTHOR]

Assigned exercise and other lifestyle modification can alter the natural history of diabetic neuropathy, but adherence to lifestyle change protocols poses a challenge in a clinical trial setting. In particular, the commitment for participants to begin engagement with the assigned intervention is a critical juncture. The Activity for DiAbetic neuroPaThy (ADAPT) trial is an NIDDK sponsored two-center single blinded protocol that randomizes type 2 diabetic neuropathy patients for 18 months to either brief lifestyle counseling or a combination of monitored exercise, diet counseling and actigraphy driven anti-sedentary behavioral modification. 103 participants have consented, screened, and been found eligible for ADAPT. Of these, 20 dropped from the trial during baseline evaluation (n=3), randomization (n=1), or before the first intervention visit or 3-month follow-up (n=16). Of the 83 who have reached 3-month follow-up, only 7 participants have dropped from the study. The pattern of early attrition has differed at the two sites. At one site, early attrition was essentially equal between assigned groups. The second site 9 of those randomized to intervention and one assigned to control dropped before 3 months. At the second site, protocol changes to improve "hand-off" from the assessment to intervention coordinators, and marked reduction in time from randomization to first intervention visit has improved retention. Structured counseling to set expectations, reduce performance anxiety, and address disappointment with assignment to the less intensive arm has improved initial retention at both sites. Once familiar with the intervention process, most participants will continue with behavioral modification. Clinical trials utilizing patient-motivated lifestyle modification protocols should seek to minimize physical barriers to initial engagement, and focus counseling and motivational effort on the critical early trial period during which participants commit internally to the intervention process. Disclosure: C. Revere: None. A. Smith: Consultant; Self; Alexion Pharmaceuticals, Inc., Disarm, Regenesis. P. Kluding: None. R.L. Marcus: None. M. Dimachkie: Research Support; Self; Viromed. F. Vivanco: None. S.C. Foster-Palmer: None. P.E. Hauer: None. A.B. Aperghis: None. M. Pasnoor: Advisory Panel; Self; Alexion Pharmaceuticals, Inc., Terumo BCT. Consultant; Self; Momenta Pharmaceuticals. A. Stonebraker: None. A.N. Hawks: None. L. Herbelin: None. J. Singleton: None. Funding: National Institute of Diabetes and Digestive and Kidney Diseases; National Center for Advancing Translational Sciences [ABSTRACT FROM AUTHOR]

Length-dependent neuropathy is the most common and costly complication of diabetes and frequently causes injury primarily to small-diameter cutaneous nociceptive fibers. Not only persistent hyperglycemia but also metabolic, endocrine, and inflammatory effects of obesity and dyslipidemia appear to play an important role in the development of diabetic neuropathy. Rational therapies aimed at direct control of glucose or its increased entry into the polyol pathway, oxidative or nitrosative stress, advanced glycation end product formation or signaling, microvascular ischemia, or adipocyte-derived toxicity have each failed in human trials of diabetic neuropathy. Aerobic exercise produces salutary effects in many of these pathogenic pathways simultaneously and, in both animal models and human trials, has been shown to improve symptoms of neuropathy and promote re-growth of cutaneous small-diameter fibers. Behavioral reduction in periods of seated, awake inactivity produces multimodal metabolic benefits similar to exercise, and the two strategies when combined may offer sustained benefit to peripheral nerve function. [ABSTRACT FROM AUTHOR]

Background: Resistance exercise programs with high compliance are needed to counter impaired muscle and mobility in older cancer survivors. To date outcomes have focused on older prostate cancer survivors, though more heterogeneous groups of older survivors are in-need. The purpose of this exploratory pilot study is to examine whether resistance exercise via negative eccentrically-induced work (RENEW) improves muscle and mobility in a diverse sample of older cancer survivors.Methods: A total of 40 individuals (25 female, 15 male) with a mean age of 74 (± 6) years who have survived (8.4 ± 8 years) since their cancer diagnosis (breast, prostate, colorectal and lymphoma) were assigned to a RENEW group or a non-exercise Usual-care group. RENEW was performed for 12 weeks and measures of muscle size, strength, power and mobility were made pre and post training.Results: RENEW induced increases in quadriceps lean tissue average cross sectional area (Pre: 43.2 ± 10.8 cm2; Post: 44.9 ± 10.9 cm2), knee extension peak strength (Pre: 248.3 ± 10.8 N; Post: 275.4 ± 10.9 N), leg extension muscle power (Pre: 198.2 ± 74.7 W; Post 255.5 ± 87.3 W), six minute walk distance (Pre: 417.2 ± 127.1 m; Post 466.9 ± 125.1 m) and a decrease on the time to safely descend stairs (Pre: 6.8 ± 4.5 s; Post 5.4 ± 2.5 s). A significant (P < 0.05) group x time interaction was noted for the muscle size and mobility improvements.Conclusions: This exploration of RENEW in a heterogeneous cohort of older cancer survivors demonstrates increases in muscle size, strength and power along with improved mobility. The efficacy of a high-force, low perceived exertion exercise suggests RENEW may be suited to older individuals who are survivors of cancer. [ABSTRACT FROM AUTHOR]