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Background: Inhalation injuries can cause problems with diaphragmatic mobility and pulmonary function, which are accompanied by significant morbidity and mortality. No previous studies have determined the outcomes of acupoint transcutaneous electrical stimulation (Acu-TENS) in the treatment of inhalation burn injuries. The current study is therefore aimed at evaluating the influences of Acu-TENS on pulmonary functions and diaphragmatic mobility in adult-male patients experiencing after burn inhalation injury.Methods: This randomized controlled study was double blinded in an inpatient setting and was conducted between June 2018 and July 2019. Forty-male participants with inhalation-injury (20-40 yrs.) were randomly allocated into two study and control groups equal in numbers; the same pulmonary rehabilitation program plus early mobility exercise was conducted in both groups. The study group (group A) received additional Acu-TENS while shame Acu-TENS was carried out on the control group (group B). The intervention program continued for four weeks, three sessions a week for 45 min bilaterally on the bilateral Ding-Chuan points (Ex-B1). Spirometry was used to assess pulmonary functions, the 5-points-Likert scale was used to assess dyspnea, and ultrasonography was used to assess diaphragmatic mobility (DM), and evaluations were performed before and after interventions.Results: At baseline assessment, no significant differences were detected between the two study groups (p˃0.05). In the post-interventional program, a noteworthy difference was detected in all outcome measures in the two study groups (p˂0.05), supporting group A. After 4 weeks of intervention, the mean (SD) for FVC, FEV1, and DM was 83.7 ± 4.34, 86.75 ± 4.59, and 5.93 ± 1.13 in group A, 79.65 ± 5.14, 83.1 ± 4.44, and 5.08 ± 1.15, in-group B. The mean difference for FVC, FEV1, and DM was 4.05 (1: 7.09), 3.65 (0.75: 6.54), and 0.85 (0.11: 1.57) between groups after treatment, respectively.Conclusion: Depending on the study findings, Acu-TENS on bilateral Ding-Chuan points could be considered an effective approach for improving pulmonary functions and diaphragmatic mobility in patients with inhalation injuries after thermal burn. Future studies with a larger sample size and longer duration on different types of burn injuries are recommended. [ABSTRACT FROM AUTHOR]

During shading conditions, performance of physical relocation techniques for PV formations is more effective than total cross-tied (TCT) type of PV formation. The main purpose of physical relocation technique is to rearrange the physical position of PV modules in TCT formation without changing the electrical connections. Due to relocation of PV modules, the lengths of required wires are increased. So, the appropriate selection of PV formation is also important. In this paper, three different variants of physical relocation techniques are considered for 6×6 size TCT formation. These three variants are named as SuDoKu (SDK), ShapeDoKu (SPDK) and Futoshiki (FS). Moreover, these variants are analyzed on realistic assumptions of shading situations and these shading situations are categorized into eight different cases. Also, the comparative analysis of PV formations is reported in terms of P-V profiles, effects of shadings on individual rows and generation of energy and incomes. Further, from the obtained results of this paper, it is concluded that these variants of physical relocation techniques enhance the output power, energy and income generation in comparison of TCT type of PV formation. The SPDK variant of physical relocation technique is performing better than the other variants. [ABSTRACT FROM AUTHOR]

Purpose: Painful bone metastases hamper quality of life (QoL). The aim of this prespecified secondary analysis of the PRESENT trial was to compare change in global QoL, physical functioning, emotional functioning, functional interference, and psychosocial aspects after conventional radiation therapy (cRT) versus stereotactic body RT (SBRT).Methods and Materials: A total of 110 patients were enrolled in the phase 2 randomized controlled VERTICAL trial (NCT02364115) following the "trials within cohorts" design and randomized 1:1 to cRT or SBRT. Patient-reported global QoL, physical functioning, emotional functioning, functional interference, and psychosocial aspects were assessed by the European Organization for Research and Treatment of Cancer QoL Questionnaire (QLQ) Core 15 Palliative Care and QLQ Bone Metastases 22 modules. Changes in QoL domains over time were compared between patients treated with cRT and SBRT using intention-to-treat (ITT) and per-protocol (PP) linear mixed model analysis adjusting for baseline scores. Proportions of patients in the cRT versus SBRT arm reporting a clinically relevant change in QoL within 3 months were compared using a χ2 test.Results: QoL scores had improved over time and were comparable between groups for all domains in both the ITT and PP analyses, except for functional interference and psychological aspects in the ITT. Functional interference scores had improved more after 12 weeks in the cRT arm than in the SBRT arm (25.5 vs 14.1 points, respectively; effect size [ES] = 0.49, P = .04). Psychosocial aspects scores had improved more after 8 weeks in the cRT arm than in the SBRT arm (12.2 vs 7.3; ES = 0.56, P = .04). No clinically relevant differences between groups at 12 weeks in terms of global QoL, physical functioning, emotional functioning, functional interference, and psychosocial aspects were observed.Conclusions: Palliative RT improves QoL. Both SBRT and cRT have a comparable effect on patient-reported QoL outcomes in patients with painful bone metastases. Functional interference and psychological aspects scores improved more in patients treated with cRT versus patients offered SBRT. [ABSTRACT FROM AUTHOR]

Background: Few studies have examined the associations between changes in depressive symptoms and handgrip strength in older people. This study aimed to examine the magnitude of the association between depressive symptoms over 2 years and weak handgrip strength on the 4 years of follow-up.Methods: We conducted a longitudinal study using data from the English Longitudinal Study of Aging, a nationally representative panel survey of older adults in England. Data were derived from waves 4 (2008-2009), 5 (2010-2011), and 6 (2012-2013). A total of 5,080 participants were included in the analysis. Depressive symptoms were dichotomized using the eight-item Center for Epidemiological Studies Depression Scale in waves 4 and 5 and were regarded as the exposure. Handgrip strength measurements objectively measured in wave 6 were dichotomized according to the 25th percentile of the British norm and used as the outcome. The targeted maximum likelihood estimation model was utilized to assess time-variant depressive symptoms on handgrip strength, adjusted for time-variant and time-invariant covariates.Results: The maintenance of non-depressive symptoms (relative risk [RR], 0.72; 95% confidence interval [CI], 0.59-0.87) or improvement of depressive symptoms (RR, 0.71; 95% CI, 0.55-0.91) had a protective effect on weak handgrip strength compared with the persistence of depressive symptoms.Limitation: This study is not a randomized control trial but a longitudinal observational study, indicating that our study finding may still have been affected by unknown confounders.Conclusion: Our findings suggest the importance of managing depressive symptoms to prevent poor physical function. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine whether responses to Patient-Reported Outcomes Measurement Information System Short Form v2.0 - Physical Function 8c (PROMIS PF8c) items differed when the use of a 7-day recall period was compared with no specified recall period.Methods: Using a within-subject design, we surveyed 1810 individuals from the US general population, administering PROMIS PF8c at survey beginning and end. The order of measure presentation was randomly assigned. We calculated recall difference scores (RDSs) as no recall score minus 7-day recall score using both item response theory-based T scores and raw summed scores. We examined the distribution and created Bland-Altman plots for both RDSTscore and RDSRaw. We also calculated correlations between no recall versus 7-day recall T score and raw scores. Finally, we determined whether differences in no recall versus 7-day recall scores were associated with patient-reported PF.Results: RDSTscore and RDSRaw had means (root mean square differences) of 0.00 (5.43) and -0.04 (3.79), respectively. The vast majority (%) of RDSTscore and RDSRaw values fell between the Bland-Altman limits of agreement (-10.65 to 10.66 and -7.46 to 7.38, respectively). Pearson's correlations between no recall and 7-day recall for T scores and raw scores were 0.88 and 0.87, respectively. Effect sizes for mean RDSTscore and RDSRaw compared across level of Eastern Oncology Cooperative Group performance status, patient global impression of PF severity, and single PF items were near 0.Conclusions: We did not find any significant recall period effect on PF8c responses. Therefore, we recommend the use of the PROMIS physical function standard, with no specified recall time period. [ABSTRACT FROM AUTHOR]

Background: Adolescent depression can severely interfere with age-appropriate and lifetime development and functionality. Physical functioning in daily life (as a means of individual support) as well as social support from family and friends have been shown to enhance adolescent resilience against depression. By applying a multisystemic model of resilience, this study investigates how these resources reciprocally influence each other and how they interact with depression over time.Methods: Longitudinal data (three assessments over three years) from the Resilient Youth in Stressed Environments project was analyzed using panel network analysis to investigate short- and long-term uni- and bidirectional effects. The sample consisted of N = 500 adolescents from Canada (mean age = 18.49, SD = 3.01, 56.40% young women) at the first assessment.Results: Depression seemed to fluctuate, while the resources showed significant stability over the course of the study. Perceived family and friend support were not significantly influenced by depression while they had significantly negative temporal effects on depression. Only physical functioning showed a negative feedback loop, notably with somatic symptoms of depression. Family and friend support shared a reinforcing feedback loop, while physical functioning was not related to either type of support.Limitations: Future studies should address the low average of depressive symptomatology and subjective, global measures of social support.Conclusions: The resources show potential time-dependent effects: symptom-specific resources need to be applied in the short-term, while a pool of multisystemic resilience resources seems necessary over the long-term to increase the resilience to depression among adolescents. [ABSTRACT FROM AUTHOR]

To identify cognitive and health profiles of cognitively impaired older adults with the presence of prior mobility impairment, which may represent a specific pathway to the development of cognitive impairment or dementia. Retrospective longitudinal study. In adults aged ≥65 years who developed cognitive impairment or dementia, we compared cognitive and health profiles of those who did (n = 57) and did not (n = 86) experience slow gait up to 14 years before symptom onset. Measures of cognitive and biomarkers assessed longitudinally over an average of 7 years before symptom onset were compared between groups using linear mixed effects models, adjusted age, sex, race, and additionally adjusted for education for cognitive outcomes. Compared to those without prior slow gait, those with slow gait had lower Digit Symbol Substitution Test and Pegboard dominant and nondominant hand performance. The slow gait group also had greater body mass index (BMI), waist, systolic blood pressure, lower high-density lipoprotein and low-density lipoprotein, and lower lysophosphatidylcholine 18:2, a lipid associated with mitochondrial function, and showed greater increases in 2-hour glucose levels of an oral glucose tolerance test. The slow gait group was more likely to take medication for hypertension and hypercholesterolemia. During the presymptomatic stage, cognitively impaired older persons who experience prior slow gait are more likely to have deficits in psychomotor speed and manual dexterity, an unfavorable metabolic and vascular profile, and lower lipid levels related to mitochondrial function. Older persons who exhibit mobility impairment should be evaluated for metabolic and vascular dysfunction at an early stage, and successful treatment of these conditions may slow down the progression of cognitive impairment or dementia. [ABSTRACT FROM AUTHOR]

Context: The will to live (WTL) is an important indicator of subjective well-being. It may enable a deeper understanding of the well-being of nursing home residents.Objectives: To evaluate the intensity of WTL, its association with various factors, and its temporal evolution among residents ≥ 65 years old; we also aimed to compare it with proxy assessments of WTL.Methods: A cross-sectional study was conducted in five nursing homes in Switzerland. Participants with decisional capacity were asked to rate the intensity of their WTL on a single-item numerical rating scale ranging from 0-10. A short-term follow-up was conducted among a sub-sample of 17 participants after three and six weeks. Proxy assessment by residents' next of kin and professional caregivers was conducted, and inter-rater agreement was calculated.Results: Data from 103 participants (75.7% women, 87.3 ± 8.0 years) was analyzed. The median intensity of WTL was 8. Higher WTL was significantly associated with better physical mobility and shorter duration of daily care but not with age, gender, pre-admission care setting, or prognosis. Significant independent predictors of WTL were physical mobility and provenance from rehabilitative care. In the short-term follow-up assessment, WTL remained highly stable. Intraclass correlation coefficients were moderate for residents' next of kin and nurse assistants but poor for physicians and nurses; all proxy assessments underestimated the participants' WTL.Conclusion: Nursing home residents expressed a very strong WTL and proxy aents underestimated residents' WTL. It seems pivotal to proactively communicate with residents about their WTL. [ABSTRACT FROM AUTHOR]

Background: About 50% of Americans and 70% of US military service members use dietary supplements (DSs).Objectives: This cross-sectional survey examined current prevalence of and factors associated with DS use in service members.Methods: A stratified random sample of 200,000 service members from the Air Force, Army, Marine Corps, and Navy was obtained from military manpower records, and these service members were asked to complete a questionnaire on their DS use and personal characteristics. Chi-square statistics and multivariable logistic regression examined differences across various strata of demographic, lifestyle, and military characteristics.Results: About 18% of successfully contacted service members (n = 26,681) completed the questionnaire between December 2018 and August 2019 (mean ± SD age: 33 ± 8 y, 86% male). Overall, 74% reported using ≥1 DS/wk. Multivitamins/multiminerals were the most commonly used DSs (45%), followed by combination products (44%), proteins/amino acids (42%), individual vitamins/minerals (31%), herbals (20%), joint health products (9%), and purported prohormones (5%). In multivariable analysis, factors independently associated with DS use included female gender [OR (female/male): 1.91; 95% CI: 1.73, 2.11], older age [OR (≥40/18-24 y): 1.25; 95% CI: 1.08, 1.44], higher education level [OR (college degree/high school or less): 1.35; 95% CI: 1.19, 1.53], higher BMI [OR (≥30/<25 kg/m2): 1.37; 95% CI: 1.25, 1.52], more weekly resistance training [OR (>300/≤45 min/wk): 5.05; 95% CI: 4.55, 5.61], smokeless tobacco use [OR (user/nonuser): 1.30; 95% CI: 1.17, 1.44], higher alcohol intake [OR (≥72/0 mL/wk): 1.41; 95% CI: 1.29, 1.54], and higher military rank [OR (senior officer/junior enlisted): 1.26; 95% CI: 1.06, 1.51].Conclusions: Compared with civilian data from the NHANES, service members were much more likely to use DSs and used different types of DSs, especially combination products and proteins/amino acids often used to purportedly enhance physical performance. Comparisons with previous military data suggest DS use has increased over time. [ABSTRACT FROM AUTHOR]

Modern, reliable, and valid outcome measures are essential to understanding the health needs of young children with burn injuries. Burn-specific and age-appropriate legacy assessment tools exist for this population but are hindered by the limitations of existing paper-based instruments. The purpose of this study was to develop item pools comprised of questions appropriate for children aged 1-5 with burn injuries. Item development was based on a framework provided by previous work to develop the Preschool Life Impact Burn Recovery Evaluation (LIBRE) Conceptual Model. The Preschool LIBRE Conceptual Model work established four sub-domains of functioning for children with burns aged 1-5. Item development involved a systematic literature review, a qualitative item review process with clinical experts, and parent cognitive interviews. Four item pools were established: (1) communication and language development; (2) physical functioning; (3) psychological functioning and (4) social functioning for preschool-aged children with burn injuries. We selected and refined candidate items, recall periods, survey instructions, and response option choices through clinical and parental feedback during the qualitative review and cognitive interview processes. Item pools are currently being field-tested as part of the process to calibrate and validate the Preschool1-5 LIBRE Computer Adaptive Test (CAT) Profile. [ABSTRACT FROM AUTHOR]

Introduction: Limitations in physical function are predictive of adverse health outcomes, and screening has been recommended in clinical settings for older adults. Rarely assessed in community-based settings, physical function could provide insight for tailoring health-related community-based programs and raise awareness about this important aspect of health. This cross-sectional study seeks to demonstrate the feasibility of integrating physical function assessments into health screenings in African American churches in Chicago, Illinois, through a large health partnership and to determine the prevalence and correlates of physical function limitations among midlife (aged 40-59 years) and late-life (aged ≥60 years) participants.Methods: Screenings were held in 7 churches in Spring 2018. Physical function was assessed using the Short Physical Performance Battery. Demographics, medical history, health status, and health behaviors were assessed. Age-stratified logistic regression identified independent associations with physical function limitations (Score ≤9) among midlife and late-life participants (data were analyzed in 2018-2019).Results: Among 731 participants (median age=57 [IQR=51-65] years, 58% women, 97% African American), 25% of midlife and 56% of late-life participants had physical function limitations. For midlife participants, fair/poor health (OR=1.83, 95% CI=1.10, 3.05), stroke/neurologic conditions (OR=2.42, 95% CI=1.07, 5.46), and arthritis (OR=2.25, 95% CI=1.32, 3.81) were associated with higher odds of limitations. Fair/poor health (OR=1.97, 95% CI=1.11, 3.50) and stroke/neurologic conditions (OR=7.85, 95% CI=2.22, 27.74) were related to limitations among late-life participants.Conclusions: Physical function screening was successfully implemented into this large-scale church-based health screening program. Physical function limitations were prevalent, particularly at midlife; this information will be used to guide future programs. [ABSTRACT FROM AUTHOR]

Purpose: The effects of thoracic radiation therapy (RT) on physical functioning and quality of life (QoL) are incompletely defined. We determined the associations between thoracic RT dose volume metrics, physical activity, and QoL in patients with cancer.Methods and Materials: Participants with breast cancer, lung cancer, or mediastinal lymphoma treated with radiation with or without chemotherapy were enrolled in a prospective, longitudinal cohort study. Data were collected pre-RT, immediately post-RT, and 5 to 9 months post-RT. At each timepoint, self-reported physical activity was assessed via the Godin-Shephard Leisure-Time Physical Activity Questionnaire, and QoL metrics were assessed via Functional Assessment of Chronic Illness Therapy Fatigue and Dyspnea Scales. Multivariable adjusted linear regression models were stratified by breast cancer alone and lung cancer and lymphoma combined.Results: One hundred thirty participants were included in the study. In breast cancer (n = 80), each 1-Gy increase in mean heart dose was associated with worse Functional Assessment of Chronic Illness Therapy Fatigue scores (-1.0; 95% confidence interval [CI], -1.9 to -0.2; P = .021); similar associations were observed between V5 and fatigue (-2.5; 95% CI, -4.4 to -0.6; P = .010 for each 10% increase in V5). In lung cancer and lymphoma (n = 50), each 10% increase in V5 was associated with decreased physical activity (Godin-Shephard Leisure-Time Physical Activity Questionnaire score -2.3; 95% CI, -4.3 to -0.4; P = .017). Although the associations between baseline levels of physical activity and fatigue and dyspnea were of borderline significance in breast cancer alone (P < .10), increased physical activity over time was associated with improvements in fatigue and dyspnea across all cancer types (P < .05 for all).Conclusions: Higher cardiac RT dose was associated with worse fatigue and physical activity across breast cancer, lung cancer, and mediastinal lymphoma. Longitudinal increases in physical activity were associated with concurrent improvements in QoL measures. Strategies to increase physical activity and decrease cardiac RT dose may improve physical functioning and QoL for patients with cancer. [ABSTRACT FROM AUTHOR]

Introduction: Emerging technologies show promise for enhanced characterization of Parkinson's Disease (PD) motor manifestations. We evaluated quantitative mobility measures from a wearable device compared to the conventional motor assessment, the Movement Disorders Society-Unified PD Rating Scale part III (motor MDS-UPDRS).Methods: We evaluated 176 PD subjects (mean age 65, 65% male, 66% H&Y stage 2) during routine clinic visits using the motor MDS-UPDRS and a 10-min motor protocol with a body-fixed sensor (DynaPort MT, McRoberts BV), including the 32-ft walk, Timed Up and Go (TUG), and standing posture with eyes closed. Regression models examined 12 quantitative mobility measures for associations with (i) motor MDS-UPDRS, (ii) motor subtype (tremor dominant vs. postural instability/gait difficulty), (iii) Montreal Cognitive Assessment (MoCA), and (iv) physical functioning disability (PROMIS-29). All analyses included age, gender, and disease duration as covariates. Models iii-iv were secondarily adjusted for motor MDS-UPDRS.Results: Quantitative mobility measures from gait, TUG transitions, turning, and posture were significantly associated with motor MDS-UPDRS (7 of 12 measures, p < 0.05) and motor subtype (6 of 12 measures, p < 0.05). Compared with motor MDS-UPDRS, several quantitative mobility measures accounted for a 1.5- or 1.9-fold increased variance in either cognition or physical functioning disability, respectively. Among minimally-impaired subjects in the bottom quartile of motor MDS-UPDRS, including subjects with normal gait exam, the measures captured substantial residual motor heterogeneity.Conclusion: Clinic-based quantitative mobility assessments using a wearable sensor captured features of motor performance beyond those obtained with the motor MDS-UPDRS and may offer enhanced characterization of disease heterogeneity. [ABSTRACT FROM AUTHOR]

Context: Sickle cell disease (SCD) is associated with recurrent pain that could lead to abnormal sensory patterns (ASPs).Objectives: The purpose of this study is to compare children with SCD who had normal sensory patterns (NSPs) and ASPs in pain experience, physical function, pain coping, and pain catastrophizing.Methods: Children with quantitative sensory testing data were selected from a larger study that examined pain and symptoms in children with SCD. Comparisons were made between children with NSP (n = 35; 13.9 ± 1.9 years) and ASP (n = 13; 12.8 ± 1.9 years). Children completed the Adolescent Pediatric Pain Tool, Functional Disability Inventory, Pain Coping Questionnaire, and Pain Catastrophizing Scale.Results: No significant differences were found in pain intensity (2.9 ± 3.0 vs. 2.6 ± 2.8 on 0-10 Visual Analogue Scale) between the NSP and ASP, respectively. The most common marked pain sites for both groups were lower extremities (22.9%), head and neck (20.8%), and upper extremities (20.8%). Functional Disability Inventory scores were significantly worse in ASP (38.5%) compared with NSP (11.4%). The ASP group had significantly worse scores in emotion-focused pain coping subscales.Conclusion: Children with SCD with ASP had worse functional disability, were expressing more affective pain quality, and had emotion-focused pain coping compared with NSP. Future studies are needed to examine the effectiveness of physical activities on the physical function as well as psychosocial interventions such as peer support and creative arts expression to minimize development of ASP in children with SCD. [ABSTRACT FROM AUTHOR]

• The effects of hypertension on physical function should be considered. • Compared to normotensives hypertensives had slower processing speed. • Balance and mobility was decreased more in hypertensives than normotensives. • The fear of falling was higher in the hypertensives compared to normotensives. • Clinicians should include preventive and rehabilitative strategies in hypertensives. Hypertension (HT) contributes substantially to poor physical function, cognitive dysfunction, cardiovascular problems and to all-cause mortality. Performance in activities requiring attention, speed and coordination might also be affected in individuals with HT. This study compared the processing speed, static and dynamic balance, functional mobility and fear of falling between individuals with hypertension (HT group) and normotensive individuals (NT group). One-hundred and twenty-eight individuals were included: NT group (n = 64) and HT group (n = 64). The Choice Stepping Reaction Time Test was used for the evaluation of processing speed, Single Leg Stance test for static balance evaluation, "Y" Balance Test for dynamic balance evaluation, Timed Up and Go test with single and dual tasking for the evaluation of functional mobility and Falls Efficacy Scale for assessing fear of falling. The processing speed of the HT group was slower than that of the NT group; the total response time (RsT) in Stepping Reaction Test (SRT) (mean difference [MD] = −0.2, 95% CI = −0.3, 0), and Stroop Test (ST) [ST-A (MD = −0.4, 95% CI = −0.5, −0.2), ST-B (MD = −0.5, 95% CI = −0.7, −0.2) and ST-C (MD = −0.6, 95% CI = −0.8, −0.3). Additionally, the static [single leg stance, eyes open, right side (MD = 12.7, 95% CI = 6.3, 19.0) and left side (MD = 13.6, 95% CI = 7.2, 19.9)] and dynamic balance [Y balance test, composite score, right lower extremity (MD = 8.5, 95% CI = 4.4, 12.5) and left lower extremity (MD = 5.2, 95% CI = 1.5, 8.8) scores of the HT group were lower than those of the NT group. The HT group required a longer time to complete the functional mobility test measured with Timed Up And Go Test during both single task (MD = −0.8, 95% CI = −1.1, −0.4), cognitive dual task (MD = −1.5, 95% CI = −2.4, −0.5) and manual dual task (MD = −0.9, 95% CI = −1.3, −0.4) in comparison to the NT group. Also, the HT group had higher levels of fear of falling (MD = −7.6, 95% CI = −10.9, −4.2). Hypertensive individuals present slower processing speed, reduced static and dynamic balance, decreased functional mobility and higher fear of falling in comparison to normotensive individuals. [ABSTRACT FROM AUTHOR]

Compromised abduction ability after reverse shoulder arthroplasty is primarily linked to limited glenohumeral range of motion while scapulothoracic mobility can typically be maintained. Glenohumeral joint forces strongly depend on the resulting scapulohumeral rhythm, however, an association between the acting muscle and joint forces and the subject-specific scapulohumeral rhythm after reverse shoulder arthroplasty has not been established. Eleven reverse shoulder arthroplasty patients were divided into groups of poor and excellent abduction ability. Subject-specific models were developed and scaled for each patient using existing motion capture data in AnyBody™. Shoulder muscle and joint forces were obtained using inverse dynamics calculations during shoulder abduction to 100° in the scapula plane. The scapulohumeral rhythm, the resting abduction angle and internal body forces between the outcome groups were compared using a Mann Whitney U test. The mean glenohumeral and scapulothoracic contribution to overall shoulder abduction for the excellent group was on average 9.7% higher and 21.4% lower, respectively, compared to the mean of the poor group. For shoulder abduction angles between 30° and 60°, the excellent group demonstrated on average 25% higher muscle forces in the anterior deltoid which was significantly higher compared to the poor outcome patients. Scapulothoracic muscle activity did not differ significantly between the two functional groups. Accordingly, rehabilitation strategies focusing on strengthening the anterior part of the deltoid in particular may improve clinical outcomes. • Forces modelled for reverse arthroplasty patients with distinct shoulder rhythm. • Good mobility of reverse shoulder arthroplasty with higher anterior deltoid forces. • Poor outcome patients compensate lost mobility with scapulothoracic rotation. [ABSTRACT FROM AUTHOR]

• Assessing life-space in older adults with AD is important and should be used in clinical practice. • Older adults with AD have lower life-space mobility and require assistance to achieve higher levels of mobility. • Encouraging and enabling assistance is fundamental to a greater life-space for older adults with dementia. Mobility is an important component of functioning. Motor and cognitive impairment in older people with Alzheimer's disease can exert a negative impact on life-space mobility. To compare life-space mobility in older adults with mild and moderate Alzheimer-type dementia and those without dementia and determine associations with health factors. Life-space mobility was assessed using the Life Space Assessment (LSA) in 33 older adults with Alzheimer-type dementia (AD group) and 24 older adults without dementia (WD group). The World Health Organization Disability Assessment Schedule (WHODAS 2.0), Addenbrooke's Cognitive Examination (ACE-R), Geriatric Depression Scale (GDS), Modified Baecke Questionnaire for Older Adults (MBQOA), and Short Physical Performance Battery (SPPB) were completed. Statistical analysis was performed with unpaired t -test or Mann-Whitney tests for comparisons between groups and Spearman's correlation test. The AD group had a lower total LSA score compared to the WD group (44 vs 65, mean difference = −20.7 [95% CI: −28.6, −12.9]), 21% of the AD group were restricted to their homes when no assistance was available. In both groups, moderate correlations were found between LSA and both functioning and physical activity level. Symptoms of depression presented moderate correlation only in the WD group. Older adults with AD have lower life-space mobility and require assistance to achieve higher levels of mobility. Clinical implications: LSA can help assess life-space mobility. Encouraging and enabling assistance is fundamental to a greater life-space for older adults with dementia [ABSTRACT FROM AUTHOR]

• Cognitive health is essential for the healthy life of older people. • We compared the venue and home-visit surveys in a sample of urban older people. • Rate of cognitive decline measured by the MMSE was higher in the home-visit survey. • Participants in the home visit-survey could be more difficult in their daily lives. • Home-visit surveys can help increase the representativeness of older people. We conducted surveys in older people at a venue and in home-visits, and compared cognitive and health status between the two groups to assess their cognitive and everyday functioning. Among 7,614 persons aged 70 years and older living in an urban area, 5,430 responded to a mail survey for sociodemographic characteristics and self-rated questionnaires including the Geriatric Depression Scale-short form (GDS-15). Of these, 1,360 agreed to attend a venue survey, and 693 agreed to take a home-visit survey. Trained nurses examined participants' blood pressure, medical history, and daily functions using the dementia assessment sheet for community-based integrated care system (DASC-21), and tested their cognitive function using the Mini-Mental State Examination (MMSE). Of 2,053 participants, 2,020 (venue: 1,352; home-visit: 668) completed the MMSE. Median MMSE scores for the venue and home-visit groups were 28 and 26 points, respectively, with 130/1,352 (9.6%) and 205/668 (30.7%) participants below the traditional 23/24 cutoff score. The home-visit group had lower mobility, lower frequency of going out, poorer mental health, and lower independence in instrumental daily activities. Notably, 39.9% and 43.7% of the venue and home-visit groups lived alone, respectively. In this sample of urban older people, the rate of cognitive decline detected using the MMSE was three times higher in the home-visit group than in the venue group. Home-visit participants were more likely to have difficulty in physical, cognitive, and everyday functioning, suggesting they have a greater need for daily living support to continue living in the community. [ABSTRACT FROM AUTHOR]

We examined whether the comorbidity burden of patients with hip fracture was associated with quality of in-hospital care reflected by fulfillment of process performance measures. Population-based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry (DMHFR). Patients aged 65 years or older with an incident hip fracture from 2014 to 2018 registered in the DMHFR (n = 31,443). Comorbidity was measured using the Charlson Comorbidity Index based on hospital diagnoses. Quality of in-hospital care was defined as fulfillment of eligible process performance measures, including preoperative optimization, early surgery, early mobilization, pain assessment, basic mobility, nutritional risk, need for anti-osteoporotic medication, fall prevention, and a post-discharge rehabilitation program, reflecting guideline-recommended in-hospital care. The outcomes were (1) an all-or-none composite measure defined as fulfillment of all relevant process performance measures, and (2) fulfillment of the individual process performance measures. Using binary regression, we calculated relative risk (RR) for the association between comorbidity level and outcomes. The overall proportion of patients with hip fracture who fulfilled the all-or-none measure was 31%. Among patients with no comorbidity, 34% fulfilled the all-or-none measure versus 29% among patients with high comorbidity (Charlson ≥ 3). This corresponds to a 15% lower chance (RR = 0.85, 95% confidence interval 0.81–0.89). Increasing comorbidity was also associated with lower fulfillment of the individual process performance measures. The largest difference was seen for preoperative optimization, early surgery, and early mobilization, where patients with high comorbidity had 6% to 11% lower chance of fulfillment of these process performance measures compared with patients without comorbidity. Increasing level of comorbidity was associated with lower quality of in-hospital care among patients with hip fracture. Our results highlight the need for tailored clinical initiatives to ensure that comorbid patients also benefit from the positive progress in hip fracture care in recent years. [ABSTRACT FROM AUTHOR]

The present study examined the effect of the isocaloric low-carbohydrate ketogenic diet (LCKD) with or without exercise training for 6 weeks on postpartum weight retention (PPWR), body composition, metabolic profile and physical activity performance in postpartum mice. Postpartum mice were assigned to four groups (n=8/group) as follows: (1) those on a control diet without aerobic exercise (CN); (2) those on a control diet with aerobic exercise (CN+EX), (3); those on a LCKD without aerobic exercise (LCKD); (4) those on a LCKD with aerobic exercise (LCKD+EX). CN+EX and LCKD+EX mice performed 6 weeks of exercise training on a treadmill. After the 6-week intervention, physical activity performance was determined. Postpartum mice in all groups experienced progressive reductions in body weight over the study period. The LCKD group had the smallest reduction in PPWR (P<.05). The LCKD group had significantly higher total cholesterol, low-density lipoprotein cholesterol and lactate dehydrogenase levels, and liver lipid concentrations with a worsened glucose tolerance, compared to the CN group (P<.05). The LCKD group showed significant reductions in physical activity performance, whilst the LCKD+EX group showed significant improvement in endurance performance, and paralleled the concomitant elevation in blood ketone levels. Six-week LCKD feeding on its own was less effective for reducing PPWR, and more detrimental to the postpartum metabolic outcomes and physical activity performance of the postpartum mice. The feasibility of a LCKD with or without exercise during the postpartum period as a strategy for managing PPWR and improving postpartum metabolic profiles should be carefully considered. [ABSTRACT FROM AUTHOR]

In the literature, it is thought that spine or pelvic malalignment and changes in the abdominal muscle structure may affect the uterine position and cause menstrual pain. However, the overall lumbopelvic structure related to lumbopelvic muscle endurance, thickness, alignment, and mobility in women with primary dysmenorrhea has not been well investigated. This study aimed to compare women with primary dysmenorrhea and asymptomatic controls in terms of lumbopelvic structure. Women with primary dysmenorrhea (primary dysmenorrhea group, n: 38, age: 21 years (18–28), body mass index (BMI): 20.70 (17.31–28.73) kg/m2) and without primary dysmenorrhea (asymptomatic group, n: 39, age: 20 years (19–23), BMI: 20.83 (17.31–27.10) kg/m2) were included. The severity of menstrual pain, lumbopelvic muscle endurance, morphology, alignment, and mobility were assessed with the Visual Analogue Scale, McGill trunk muscle endurance tests, ultrasonographic imaging, and a Valedo® Shape device, respectively. The median value of the menstrual pain in the primary dysmenorrhea group was 6.5 cm (min-max: 4.0–10.0). Lumbopelvic muscle endurance (p < 0.001), muscle thickness (p < 0.001), frontal lumbar angle (p: 0.05), sagittal pelvic mobility (p < 0.001), and frontal lumbar mobility (p: 0.002) were lower in the primary dysmenorrhea group compared to the asymptomatic group. Muscle endurance, thickness, alignment, and mobility of the lumbopelvic structure in women with primary dysmenorrhea compared to asymptomatic women have been affected negatively. These findings should be considered in management of primary dysmenorrhea. • Lumbopelvic muscle endurance and thickness have reduced in primary dysmenorrhea. • Biomechanical changes in the spine may be important in primary dysmenorrhea. • Decrease in lumbopelvic mobility may be seen in women with primary dysmenorrhea. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, some countries introduced early evening curfews. Several studies try to measure the effectiveness of such measures across different countries, but disentangling competing effects can be elusive. We examined the impact of an early evening curfew on mobility by studying a shift in curfews from 9pm to 6pm in Greece using Google mobility data. We followed a difference-in-differences (DiD) econometric approach, where we compared trends in mobility in residential spaces as well as groceries and pharmacies, before and after the introduction of the 6pm curfew in Attica with trends in three other comparable Regions. We found little or no evidence of an effect of the early curfew on daily mobility relating to groceries and pharmacies, and that an 18.75% reduction in hours where people were allowed to leave home led to a relatively small increase in time spent in residential spaces. This less-than-proportionate reduction in mobility outside the household suggests a possibility that the curfew led to more people coinciding in indoor public spaces, such as grocery shops – which constitutes a contagion risk factor. Results should be treated with caution, especially with regards to the magnitude of any effect, as Google mobility data do not report the time of the day, so the time density of activities cannot be estimated. Lockdowns and other measures are necessary to tackle Covid-19, but it is important to avoid substitution by activities that contribute further to spreading the virus. Interventions should therefore be based on a thorough analysis of human behaviour. • A shift from 9pm to 6pm curfews were introduced in Attica, Greece, to fight COVID-19. • We used a difference-in-differences approach using other regions as control groups. • There was a small relative increase in time spent in residential spaces. • The early curfew had little or no effect on daily grocery and pharmacy mobility. • This might have led to more people coinciding in indoor spaces, such as supermarkets. [ABSTRACT FROM AUTHOR]

To examine the association between cocalibrated functional scores across post-acute care settings and the subsequent risk of hospital readmission. Retrospective cohort study. We analyzed 781,021 fee-for-service Medicare beneficiaries discharged to either inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), or home health agencies (HHA) after an acute hospital stay for stroke (N = 143,277), lower extremity joint replacements (512,577), and hip/femur fracture (125,167) between January 1, 2013, and August 31, 2014. Functional items from IRF-PAI, MDS, and OASIS were categorized into self-care and mobility domains. We cocalibrated admission functional scores across post-acute settings and divided scores into 4 functional levels using quartiles (Q1-Q4, with Q4 representing the most independent function). The primary outcomes were 30-day and 90-day hospital readmissions (yes/no) after an initial post-acute stay. Patients who were more dependent in self-care and mobility at the initial post-acute setting were significantly more likely to experience hospital readmission [eg, hazard ratios of 30-day readmission in stroke: 1.54 (95% confidence interval [CI] 1.47-1.61), 1.18 (95% CI 1.14-1.23), and 1.12 (95% CI 1.08-1.16) for Q1, Q2 and Q3, compared to Q4]. We found similar results for risk of 90-day hospital readmission across impairment conditions. Patients who were more functionally dependent at the initial post-acute setting had a higher risk to readmit to the hospitals after discharging from the post-acute setting for 30 and 90 days, compared with patients who were more functionally independent. This finding is consistent across impairment conditions and post-acute settings. Future research should determine effective strategies of maintaining and facilitating functional performance across post-acute settings to optimize long-term patient outcomes. [ABSTRACT FROM AUTHOR]

Ankle mobility is known to be of uttermost importance to generate propulsive forces and control balance during gait initiation. Impaired mobility of the postural chain occurs with normal ageing and is exacerbated in patients with Parkinson's disease. This study questions whether short-term stretching session applied to the triceps surae improves ankle mobility and, consequently, dynamical postural control in patients with Parkinson's disease performing gait initiation. Nineteen patients with Parkinson's disease participated in this study and were randomly assigned to an "intervention group" or a "sham group". In the intervention group, patients were exposed to a 4 × 60 seconds triceps surae stretching. In the sham group, they were exposed to forearm stretching. Additionally, ten age-matched healthy elderly, who were not exposed to any stretching-treatment, were assigned to a "control group". Participants performed series of gait initiation on a force-plate before and after their treatment. Ankle mobility was improved in the intervention group after triceps surae stretching. The forward velocity of the center-of-mass at heel-off and motor performance related-parameters (progression velocity, center-of-mass velocity at foot-contact and swing phase duration) were also improved in the intervention group, with large effect sizes (d ≥ 0.8). None of the stability parameters were modified by the treatments. Short-term triceps surae stretching is an efficient method to increase ankle mobility and improve the capacity to generate forward propulsive forces in patients with Parkinson's disease. These findings are congruent with the "posturo-kinetics capacity" theory according to which dynamical postural control depends on postural chain mobility. • Ankle mobility and gait initiation are impaired in patients with Parkinson's disease • These motor functions are both improved by short-term triceps surae stretching • Facilitation of gait initiation may be related to increased ankle mobility • These findings globally support the "Posturo-Kinetics Capacity" theory [ABSTRACT FROM AUTHOR]

There is a dearth of studies examining associations between active school travel and children's health-related quality of life. Additionally, studies have not examined how perceived neighbourhood characteristics may moderate these associations. This study aims to examine the relationship between regular active school travel, children's physical and psychosocial health-related quality of life, and the potential moderating effects of their perceived neighbourhood safety (interpersonal and traffic). This cross-sectional study used data from Ontario schoolchildren (aged 8-14) as part of the Spatial Temporal Environment and Activity Monitoring (STEAM) Project. Results showed no significant direct relationship between regular active school travel and children's physical or psychosocial functioning; but the relationships were moderated by perceived neighbourhood safety. Regular active school travelers with high levels of perceived neighbourhood interpersonal safety, had higher physical and psychosocial functioning than regular active school travelers with low levels of perceived neighbourhood interpersonal safety. Additionally, at higher levels of perceived neighbourhood traffic safety, regular active school travelers had higher psychosocial functioning than regular active school travelers with lower perceived neighbourhood traffic safety. Interventions promoting active school travel should consider the environments through which children will be traveling. [ABSTRACT FROM AUTHOR]

Linking geospatial neighbourhood design characteristics to health and behavioural data from population-representative cohorts is limited by data availability and difficulty collecting information on environmental characteristics (e.g. greenery, building setbacks, dwelling structure). As an alternative, this study examined the feasibility of Generative Adversarial Networks (GANs) - machine learning - to measure neighbourhood design using 'street view' and aerial imagery to explore the relationship between the built environment and physical function. This study included 3102 adults aged 45 years and older clustered in 200 neighbourhoods in 2016 from the How Areas in Brisbane Influence Health and Activity (HABITAT) project in Brisbane, Australia. Exposure data were Google Street View and Google Maps images from within the 200 neighbourhoods, and outcome data were self-reported physical function using the PF-10 (a subset of the SF-36). Physical function scores were aggregated to the neighbourhood level, and the highest and lowest 20 neighbourhoods respectively were used in analysis. We found that the aerial imagery retrieved was unable to be used to adequately train the model, meaning that aerial imagery failed to produce meaningful results. Of the street view images, n = 56,330 images were downloaded and used to train the GAN model. Model outputs included augmented street view images between neighbourhoods classed as having high function and low function residents. The GAN model detected differences in neighbourhood design characteristics between neighbourhoods classed as high and low physical function at the aggregate level. Specifically, differences were identified in urban greenery (including tree heights) and dwelling structure (e.g. building height). This study provides important lessons for future work in this field, especially related to the uniqueness, diversity and amount of imagery required for successful applications of deep learning methods. [ABSTRACT FROM AUTHOR]

Objective: The GETSET trial found that guided graded exercise self-help (GES) improved fatigue and physical functioning more than specialist medical care (SMC) alone in adults with chronic fatigue syndrome (CFS) 12 weeks after randomisation. In this paper, we assess the longer-term clinical and health economic outcomes.Methods: GETSET was a randomised controlled trial of 211 UK secondary care patients with CFS. Primary outcomes were the Chalder fatigue questionnaire and the physical functioning subscale of the short-form-36 survey. Postal questionnaires assessed the primary outcomes and cost-effectiveness of the intervention 12 months after randomisation. Service costs and quality-adjusted life years (QALYs) were combined in a cost-effectiveness analysis.Results: Between January 2014 and March 2016, 164 (78%) participants returned questionnaires 15 months after randomisation. Results showed no main effect of intervention arm on fatigue (chi2(1) = 4.8, p = 0.03) or physical functioning (chi2(1) = 1.3, p = 0.25), adjusting for multiplicity. No other intervention arm or time*arm effect was significant. The short-term fatigue reduction was maintained at long-term follow-up for participants assigned to GES, with improved fatigue from short- to long-term follow up after SMC, such that the groups no longer differed. Healthcare costs were £85 higher for GES and produced more QALYs. The incremental cost-effectiveness ratio was £4802 per QALY.Conclusions: The short-term improvements after GES were maintained at long-term follow-up, with further improvement in the SMC group such that the groups no longer differed at long-term follow-up. The cost per QALY for GES compared to SMC alone was below the usual threshold indicating cost-effectiveness, but with uncertainty around the result. [ABSTRACT FROM AUTHOR]

Abstract: The theory of allostatic load [McEwen, B.S., Stellar, E., 1993. Stress and the individual: mechanisms leading to disease. Arch. Intern. Med. 153, 2093–2101] describes how the cumulative experience of emotional challenges and stressful events over the life course may take a significant physiological toll on multiple interrelated systems of the body. Various summary measures of these effects have been proposed in the literature, but few studies focus on systematically evaluating them. We use data from a population-based sample of older Taiwanese to compare the explanatory power and cross-sectional predictive performance of several measures of allostatic load for diverse health outcomes. We find that choices regarding which biomarkers to include in a summary measure and how the measure is formed have modest effects across the basic prediction models we evaluate. Our findings suggest that count-based summary measures incorporating risk at both high and low tails and measures that preserve the continuous properties of the biological variables are strategies that may yield stronger predictions of a wider array of health outcomes than other measures. These fundamental insights are useful for researchers in search of empirical formulations of allostatic load and for those who are focused on the development of improved measurement strategies. [Copyright &y& Elsevier]

This study employed novel GPS methods to assess the effect of a multilevel physical activity (PA) intervention on device-measured walking locations in 305 community dwelling older adults, ages 65+ (mean age = 83, 73% women). Retirement communities were randomized to a 1-year PA intervention that encouraged neighborhood walking, or to a healthy aging control condition. Total time and time spent walking in four life-space domains were assessed using GPS and accelerometer devices. The intervention increased the time spent walking as a proportion of total time spent in the Campus, Neighborhood and Beyond Neighborhood domains. Intervention effects on walking location were observed in both genders and across physical and cognitive functioning groups. Results demonstrate that an intervention providing individual, social and environmental support for walking can increase PA in larger life-space domains for a broad spectrum of older adults. [ABSTRACT FROM AUTHOR]

Mobilisation alarms are a falls prevention strategy used in hospitals to alert staff when an at risk patient is attempting to mobilise. Mobilisation alarms have an estimated annual cost of $AUD58MIL in Australia. There is growing evidence from randomised controlled trials indicating mobilisation alarms are unlikely to prevent falls. The primary aim of this study was to describe the rate of mobilisation alarm false triggers and staff response time across different health services. The secondary aim was to compare pre to post mobilisation alarm utilisation following the introduction of policy to reduce or eliminate mobilisation alarms. This descriptive and comparative study was conducted through Monash Partners Falls Alliance across six health services in Melbourne, Australia. This study described true and false alarm triggers and trigger response times across three health services and usual care mobilisation alarm utilisation across six health services; and then compared alarm utilisation across two health services following the introduction of policy to reduce (<2.5%) or eliminate (0.0%) mobilisation alarms in the acute and rehabilitation settings. The most frequent observation was a false alarm (n = 74, 52%), followed by a true alarm (n = 67, 47%) and no alarm (n = 3, 2%). Time to respond to the true and false alarms was an average of 37 seconds (SD 92) and this included 61 occasions of 0 seconds as a member of staff was present when the alarm triggered. If the 61 occasions of staff being present when the alarm triggered were removed, the average time to respond was 65 seconds (SD114). Usual care mobilisation alarm utilisation in acute was 7% (n = 171/2,338) and in rehabilitation was 11% (n = 286/2,623). Introducing policy for reduced and eliminated mobilisation alarm conditions was successful with a reduced utilisation rate of 1.8% (n = 11/609) and an eliminated utilisation rate of 0.0% (n = 0/521). Half of mobilisation alarm triggers are false and when alarms trigger without staff present, staff take about a minute to respond. While usual care has one in fourteen patients in acute and one in nine patients in rehabilitation using a mobilisation alarm, it is possible to introduce policy which will change practice to reduce or eliminate the use of mobilisation alarms, providing evidence of feasibility for future disinvestment effectiveness studies that it is feasible to disinvest in the alarms. [ABSTRACT FROM AUTHOR]

• MgO boards displayed comparable physical characteristics as traditional board types. • Gypsum/wood boards were more vulnerable to soak-dry and freeze-thaw than MgO boards. • MgO boards had similar resistance to soak-dry and freeze-thaw as fibre cement boards. • Mg oxysulphate boards were more sensitive to high humidity than Mg oxychloride boards. The use of sheeting materials within the construction industry is becoming increasingly common as building materials and the way they are used evolves. Recently, magnesium-based construction boards have received more attention as alternatives for traditional sheeting materials. This is due to some of their enhanced properties, particularly fire resistance and lower embodied carbon. However, the lack of standardised documentation has caused concern regarding their composition, performance and long-term behaviour. This paper evaluates some of the test methods commonly used when assessing the performance of construction boards. A comparison between relatively novel magnesium-based boards and traditional boards is also conducted. Physical, mechanical and durability properties are investigated. Magnesium-based boards can provide relatively good bending strength values and water absorption behaviour which is comparable with other board types. Findings also demonstrate good performance for magnesium-based boards when exposed to soak-dry and freeze-thaw cycles. They suffered relatively small changes in bending strength, similar to that of fibre cement boards and superior to that of gypsum plasterboards and wood-based boards. [ABSTRACT FROM AUTHOR]

Physical activity in people with dementia (PwD) may enhance physical and mental functioning. Exergaming, which combines physical exercise with cognitive stimulation in a gaming environment, was developed to overcome barriers in performing physical activities. We evaluated the effects of exergaming in day care centers (DCCs) for PwD and informal caregivers (ICs). A randomized controlled trial among 23 DCCs across the Netherlands randomized to exergaming (interactive cycling during 6 months) or a care-as-usual control group. A total of 112 (73 exergaming, 39 control) community-dwelling dyads (PwD, IC), with the PwD visiting a DCC at least twice per week. All outcomes were assessed using structured questionnaires during interviews with PwD and ICs at baseline (T0), 3 months (T1), and 6 months (T2). Primary outcomes: physical activity and mobility of the PwD. Secondary outcomes: physical, cognitive, emotional and social functioning, and quality of life for PwD. For ICs: experienced burden, quality of life, and positive care experiences. Mixed-model analyses showed no statistically significant effects on primary outcomes. There were statistically significant positive effects on PwD's secondary outcomes at T2 on cognition [Mini-Mental State Examination (MMSE): r = 2.30, 95% confidence interval (CI): 0.65, 3.96, P =.007; and Trail Making Test part A (TMT-A): r = −28.98, 95% CI: −54.89, −3.08, P =.029], social functioning (Behavior Observation Scale for Intramural Psychogeriatrics subscale 1 (GIP): r = −1.86, 95% CI: −3.56, −0.17, P =.031), and positive post-test effects in ICs on distress caused by the PwD's neuropsychiatric symptoms (NPI-Q total distress: r = −3.30, 95% CI: −6.57, −0.03, P =.048) and on sense of competence (SSCQ: r = 2.78, 95% CI: 0.85, 4.71, P =.005). Exergaming appeared not effective on the primary outcomes. Despite the study being underpowered, we found positive effects on secondary outcomes for PwD and ICs, and no negative effects. We therefore recommend further study, dissemination, and implementation. [ABSTRACT FROM AUTHOR]