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Little information is available about the minimal clinically important differences (MCIDs) for objective physical measurements in people with lumbar spinal stenosis (LSS). To use disorder-specific anchor and, multiple anchor-, and distribution-based approaches to determine the MCIDs for walking capacity and physical activity in patients with LSS receiving nonsurgical treatment. Secondary analysis of a randomized controlled trial. Sixty-nine patients with neurogenic claudication caused by LSS receiving outpatient physical therapy. Zurich claudication questionnaire (ZCQ), self-paced walking test (SPWT), and number of daily steps measured by pedometry. All patients completed the ZCQ, SPWT, and pedometry at the baseline and after 6 weeks. For the anchor-based approach, ZCQ symptom severity, physical function, and satisfaction subscales were used as the external anchors. Using the receiver-operating characteristic (ROC) curve, the MCIDs were determined based on the optimal cutoff points for changes in the SPWT or daily steps. For the distribution-based approach, the MCIDs were estimated from the standard deviations (SDs) of the baseline scores of the SPWT and daily steps. In the anchor-based approach, only the ZCQ satisfaction subscale for the SPWT (0.73), and ZCQ symptom severity subscale for daily steps (0.71) exceeded the area under the ROC curve value of 0.7, which is considered acceptable. When using these subscales as anchors, the ROC curves and optimal cutoff points indicated MCIDs of 151 m for the SPWT and 1,149 steps for daily steps. The distribution-based approach estimated the MCIDs as 280 m for the SPWT and 1,274 steps for daily steps, and had a moderate effect size (0.5 SD). The anchor-based approach had limited external responsiveness when the ZCQ was used as the anchor. However, this information may be helpful for interpreting walking capacity and physical activity in patients with LSS receiving nonsurgical treatment and for estimating power and sample size when planning new trials. [ABSTRACT FROM AUTHOR]

Many older adults are discharged from skilled nursing facilities (SNFs) at functional levels below those needed for safe, independent home and community mobility. There is limited evidence explaining this insufficient recovery. The purpose of this secondary analysis was to determine predictors of physical function change following SNF rehabilitation. Secondary analysis of a prospective observational cohort study. Across 4 SNFs, data were collected from 698 adults admitted for physical rehabilitation following an acute hospitalization. Physical function recovery was evaluated as change from admission to discharge in Short Physical Performance Battery (SPPB) scores (N = 698) and gait speed (n = 444). Demographic and clinical characteristics collected at admission served as potential predictors of physical function change. Following imputation, a standardized model selection estimator was calculated for predictors per physical function outcome. Predictor estimates and 95% CIs were calculated for each outcome model. Higher cognitive scores [standardized β (β STD) = 0.11, 95% CI: 0.0004, 0.20] and higher activities of daily living (ADL) independence at admission (β STD = 0.22, 95% CI: 0.05, 0.34) predicted greater SPPB change; higher SPPB scores at admission (β STD = −0.26, 95% CI: −0.35, −0.14) predicted smaller SPPB change. Higher ADL independence at admission (β STD = 0.17, 95% CI: 0.01, 0.37) predicted greater gait speed change; faster gait speed at admission (β STD = −0.30, 95% CI: −0.44, −0.15) predicted smaller gait speed change. Admission cognition, ADL independence, and physical function predicted physical function change following post-hospitalization rehabilitation. Inverse findings for admission physical function and ADL independence predictors suggest independence with ADL is not necessarily aligned with mobility-related function. Findings highlight that functional recovery is multifactorial and requires comprehensive assessment throughout SNF rehabilitation. [ABSTRACT FROM AUTHOR]

Presently, child-specific tools and instruments related to active school travel (AST) are lacking. This methodological shortcoming often contributes to suboptimal AST behaviour evaluations and intervention programming. The aim of this paper was to develop and validate a theoretically informed child-specific scale regarding multiple perceived barriers and enablers known to impact children's participation in AST. Mixed methods. A mixed-methods and multistudy scale development approach featuring the application of social-ecological theory, a validation pilot study (n = 80), and test-retest study (n = 96) was conducted in collaboration with children in Ontario, Canada. In tandem with completing cognitive interviews and online surveys, multiple analyses, including a qualitative thematic analysis, along with weighted Cohen's kappa, Cronbach's alpha, and confirmatory factor analysis were undertaken. Qualitative analyses of the developed tool addressed face validity concerns related to the response options and definitions of terms used. Following the reliability analyses of 40 items, two confirmatory factor analyses were run to assess the construct validation of perceived AST barriers and enablers, and resulted in the development of the 24-item Perceived Active School Travel Enablers and Barriers – Child (PASTEB-C) questionnaire. The developed PASTEB-C questionnaire may be used to inform the programming and development of AST interventions, as well as conduct child-specific AST research. [ABSTRACT FROM AUTHOR]

Mental health and physical health are intrinsically linked, yet the mechanisms are not well understood. We investigated whether moderate-vigorous physical activity (MVPA) mediated the association between depression and physical function (PF) in midlife. Individuals from two UK birth cohorts born within one week in 1958 (n = 7278) and 1970 (n = 6097) with data on depression (ages 33/34; Malaise Inventory), MVPA (age 42; self-reported) and PF (ages 50/56; Short Form-36 subscale). Covariates included sex, childhood and adulthood social class, maternal mental health, childhood mood, alcohol consumption, smoking habits, sleep, marital status, BMI and long-standing illness/disability. Linear or multinomial logistic regression models examined associations between depression, MVPA and PF. We used a parametric g-computation mediation analysis approach to estimate percent differences in PF. Depression was associated with less frequent MVPA and poorer PF. Lower MVPA was associated with worse PF. The direct effect – randomised analogue not operating via MVPA – of depression on PF was −18.8 % (95%CI:--25.8,-11.8) and −15.8 % (20.6,-11.0) in the 1958 and 1970 cohorts, respectively. The indirect effect – operating via MVPA – was −0.5 % (−1.0,-0.03) and −0.2 % (−0.6, 0.3), resulting in a total proportion mediated of 3.1 % (0.1, 6.0) and 0.9 % (−1.6, 3.4). MVPA was self-reported. Intermediate confounders and mediators were measured at the same age, however associations did not change in sensitivity analysis considering age 46 MVPA (1958 cohort). Although higher MVPA was protective against poor PF, there was only minor evidence that it mediated the association between depression and PF. Further investigation into other potential mediators of pathways from mental to physical health is needed. • We studied MVPA as a mediator between depression and physical function. • Depression was associated with less frequent MVPA and worse physical function. • More frequent MVPA was associated with better physical function. • However, MVPA only mediated 0.9 to 3.1 % of the association. • Further inquiry of other mediators (e.g. sedentary behavior, sleep) is needed. [ABSTRACT FROM AUTHOR]

Food insecurity has been associated with mobility difficulty (MD) in old age. However, there is a scarcity of research on this topic from low- and middle-income countries, while the bio-psychological factors underlying this association are largely unknown. We investigated the food insecurity-MD link in Ghana and explored how sleep, anxiety, loneliness, and physical activity (PA) mediate the association. Community-based, representative cross-sectional data from the Aging, Health, Well-being, and Health-seeking Behavior Study were analyzed (N = 1201; M age = 66.5; women = 63%). MD was assessed with items from the SF-36 of the Medical Outcomes Study. We assessed food insecurity with items on hunger and breakfast-skipping frequency due to lack of food and resources. Adjusted OLS and mediation models via bootstrapping technique evaluated the associations. Results revealed the expected association between food insecurity and MD, such that greater food insecurity was significantly and positively associated with MD across paths (from β = 0.33 to β = 0.42, p <.001). Analyses of indirect effects showed that sleep problems (27.8%), anxiety (15.5%), loneliness (17.5%), and PA (18.0%) mediated the association between food insecurity and MD. Cross-level interactions revealed that food insecurity significantly modified the link between each mediator and MD. Our data provide novel evidence that bio-psychological mechanisms may underlie the food insecurity-MD link and should, therefore, be considered relevant targets for interventions to prevent/manage MD in later life. • Roles of biopsychosocial factors in food insecurity (FI)-mobility link is lacking. • FI increased mobility difficulty (MD) across all paths (β = 0.33 to β = 0.42, p <.001). • Sleep, anxiety, loneliness, and physical activity mediated the FI-MD association. • Significant cross-level interactions of FI and mediators on MD were observed. • Efforts to address FI-related MD should consider managing biopsychosocial factors. [ABSTRACT FROM AUTHOR]

Among people living with HIV (PLWH), unhealthy drinking presents an increased risk for negative outcomes. Physical inactivity and sedentariness raise additional health risks. Despite evidence that physical activity (PA) is associated with improved physical and mental functioning and reduced alcohol cravings, there have been no PA studies conducted with PLWH engaged in unhealthy drinking. We describe a study protocol of a remote lifestyle physical activity (LPA) intervention to increase PA and reduce alcohol consumption among PLWH. Using online advertisements, 220 low-active PLWH engaged in unhealthy drinking will be recruited and randomized nationwide. After providing informed consent and completing a baseline interview, participants will receive a Fitbit. Participants will complete 15 days of ecologic momentary assessment through a phone application and up to 15 days of Fitbit wear time. Following this period, participants will be randomly assigned to a Fitbit-only control condition or a LPA and Fitbit intervention condition. Health counselors meet with control participants once (and have 6 subsequent brief check ins on Fibit use) and with intervention participants 7 times for PA counseling over a 12-week period. Follow-up assessments will be conducted at 3- and 6-months post-randomization. We hypothesize that individuals in the LPA and Fitbit condition will have lower rates of alcohol consumption and higher rates of PA at 6-month follow-up. The randomized controlled trial described in this paper investigates remote methods to influence multimorbidity among PLWH using a LPA approach for increasing PA and reducing alcohol consumption. • Unhealthy alcohol use and physical inactivity are common in people living with HIV (PLWH). • Lifestyle physical activity (LPA) offers unique advantageous over structured, gym-based programs. • A clinical trial protocol of an LPA intervention for PLWH engaged in unhealthy drinking is described. • A remotely delivered LPA may help to reduce drinking in PLWH. [ABSTRACT FROM AUTHOR]

Describe the rate of death over 4 consecutive quarters and determine optimal categorization of residents into risk-of-death categories, expanding the Changes in Health, Endstage Disease, Signs and Symptoms (CHESS) scale. Using secondary analysis design with Minimum Data Set (MDS) data, the CHESS scale provided the base upon which the DeathRisk-NH scale was developed. Baseline and 4 quarterly follow-up analyses of Canadian (n = 109,145) and US (n = 1,075,611) nursing home resident data were completed. Logistic regression analyses identified predictors of death, additive to CHESS, to form the DeathRisk-NH scale. The independent variable set used MDS items, focusing on clinical complexity indicators, diagnostic conditions, and measures of severe clinical distress. Country cohorts had similar percentages of residents with mean activities of daily living hierarchy scores, dependence in mobility, continence, memory, and overall CHESS scores. The percentage of individuals who died increased from 10.5% (3 months) to 30.7% (12 months). The average annual death rate for this cohort was 5.5 times higher than the national annual death rate of approximately 5.6%. The DeathRisk-NH is an effective prediction model to identify residents at risk of death within the first 12 months after admission to the nursing home. The tool may be helpful in patient care planning, resource allocation, and excess death monitoring. [ABSTRACT FROM AUTHOR]

The Six Minute Walk Test (6MWT) is a widely used measure of functional capacity in (p)rehabilitation of cancer patients, but it is time-consuming and requires specific space conditions. In this study we explore the association between the 6MWT with other measurements of physical functioning and their predictive value in classifying patients according to their estimated functional capacity. This prospective study included cancer patients referred to a prehabilitation programme prior to major surgery. For each patient, data on different measurements of physical functioning including the Duke Activity Status Index (DASI), the handgrip strength, the 30" Sit-to-Stand Test and self-reported physical activity levels were collected. Bivariate associations were performed to determine the association between the 6MWT and other variables. Multivariate analyses were performed to identify potential predictive factors of 6MWT in this population. A subsequent algorithm was developed to classify patients based on their functional capacity (good performance – 6MWT>400 m or poor performance 6MWT<400 m) Between mid-2018 to mid 2022, 692 patients were assessed of whom the 6MWT was performed in 524 (75.7 %) (mean age 72.5 ± 11.8 years; 57.1 % men). Moderate-to-strong correlations were found between 6MWT and 30" Sit-To-Stand Test (r = 0.54, p < 0.001), DASI (r = 0.68; p < 0.001) and handgrip strength (r = 0.5; p < 0.001). Multivariate analyses confirmed that a combination of six variables were able to classify 80 % of patients in good (>400 m) or poor (<400 m) performance in the 6MWT. The 6MWT was moderately associated with several variables of physical functioning, a combination of which can be used to predict performance in the 6MWT. [ABSTRACT FROM AUTHOR]

To develop a questionnaire-based Active Mobility Index (AMI) to assess going-out behavior with physical and social activity among older adults, and to assess the criterion-related and predictive validity of the AMI. Prospective cohort study. General community setting. Participants comprised 4432 older adults [mean age: 75.9 ± 4.3 (70-96) years; 2100 men (47.4%)]. AMI assessed life-space and activities in each life-space (distance from the respondent's home: <1 km, 1-10 km, or >10 km) according to physical or social activity during the past 1 month by noting frequency, purpose, type of transportation, interaction with others, and physical activity. Baseline characteristics and outcomes were compared by AMI score quartiles (highest: Q4). To examine the criterion-related validity of AMI, depressive symptoms, frailty, and cognitive function were assessed. During follow-up, incident disability was monitored by Long Term Care Insurance certification. Lower scores (Q1-Q3 groups) were associated with more depressive symptoms, frailty, and cognitive impairment compared with the Q4 group (all P <.001). Multiple logistic regression analyses revealed significantly higher odds ratios in the Q1 group in all health adverse outcomes compared with the Q4 group [depressive symptoms, odds ratio (OR) 3.94, 95% confidence interval (CI) 2.95-5.28; frailty, OR 3.20, 95% CI 2.31-4.44; cognitive impairment, OR 1.28, 95% CI 1.04-1.57]. Cox proportional hazards modeling indicated that the Q1 group had a higher risk of incident disability compared with the group (hazard ratio 1.53, 95% CI 1.24-1.88). AMI to assess life-space with physical and social activity among older people was associated with depressive symptoms, frailty, and cognitive impairment. Lower AMI scores were associated with higher incident disability risk. Further studies are needed to elucidate whether AMI is causally associated with incident adverse health outcomes. [ABSTRACT FROM AUTHOR]

Sarcopenia, with its high prevalence and its adverse health outcomes, amongst older adults is considered a major public health problem. Its primary, secondary and tertiary preventions are therefore very important. Our objective was to review the effects of lifestyle factors, including not only dietary habits and exercise but also social use of substances such as alcohol and tobacco, on the incidence of sarcopenia and on its health outcomes. We found that the effect of lifestyle on muscle parameters or physical function has been investigated in many trials of heterogeneous design and quality. However, based on data from interventional studies, we can be confident that loss of physical function and its consequences can be counteracted by physical activity. There are some interesting data, mainly evident from observational studies, suggesting that healthier dietary patterns may improve muscle health. The combination of exercise with dietary supplement has more conflicting results and the effect of other lifestyle changes, such as cessation of alcohol or tobacco use, is difficult to establish clearly. Further high-quality trials are needed to substantiate the mechanism of action of each intervention as well as to determine the optimal modalities of these in older adults. [ABSTRACT FROM AUTHOR]

Background Context: Physical inactivity has been described as both a cause and a consequence of low back pain (LBP) largely based on self-reported measures of daily activity. A better understanding of the connections between routine physical activity and LBP may improve LBP interventions.Purpose: In this study, we aim to objectively characterize the free-living physical activity of people with low back pain in comparison to healthy controls using accelerometers, and we aim to derive a set of LBP-specific physical activity minutes thresholds that may be used as targets for future physical activity interventions.Study Design: Cross-sectional.Patient Sample: A total of 22 low back pain patients and 155 controls.Outcome Measures: Accelerometry derived physical activity measures.Methods: Twenty-two people with LBP were compared to 155 age and gender-matched healthy controls. All subjects wore an ActiGraph accelerometer on the right hip for 7 consecutive days. Accelerometry-based physical activity features (count-per-minute CPM) were derived using Freedson's intervals and physical performance intervals. A random forest machine learning classifier was trained to classify LBP status using a leave-one-out cross-validation procedure. An interpretation algorithm, the SHapley Additive exPlanations (SHAP) algorithm was subsequently applied to assess the feature importance and to establish LBP-specific physical activity thresholds.Results: The LBP group reported mild to moderate disability (average ODI=18.5). The random forest classifier identified a set of 8 features (digital biomarkers) that achieved 88.1% accuracy for distinguishing LBP from controls. All of the top distinguishing features were related to differences in the sedentary and light activity ranges (<800 CPM), whereas moderate to vigorous physical activity was not discriminative. In addition, we identified and ranked physical activity thresholds that are associated with LBP prediction that can be used in future studies of physical activity interventions for LBP.Conclusions: We describe a set of physical activity features from accelerometry data associated with LBP. All of the discriminating features were derived from the sedentary and light activity range. We also identified specific activity intensity minutes thresholds that distinguished LBP subjects from healthy controls. Future examination on the digital markers and thresholds identified through this work can be used to improve physical activity interventions for LBP treatment and prevention by allowing the development of LBP-specific physical activity guidelines. [ABSTRACT FROM AUTHOR]

Ageing is associated with widespread physiological changes prominent within all tissues, including skeletal muscle and the brain, which lead to a decline in physical function. To tackle the growing health and economic burdens associated with an ageing population, the concept of healthy ageing has become a major research priority. Changes in skeletal muscle mitochondrial characteristics have been suggested to make an important contribution to the reductions in skeletal muscle function with age, and age-related changes in mitochondrial content, respiratory function, morphology, and mitochondrial DNA have previously been reported. However, not all studies report changes in mitochondrial characteristics with ageing, and there is increasing evidence to suggest that physical activity (or inactivity) throughout life is a confounding factor when interpreting age-associated changes. Given that physical activity is a potent stimulus for inducing beneficial adaptations to mitochondrial characteristics, delineating the influence of physical activity on the changes in skeletal muscle that occur with age is complicated. This review aims to summarise our current understanding and knowledge gaps regarding age-related changes to mitochondrial characteristics within skeletal muscle, as well as to provide some novel insights into brain mitochondria, and to propose avenues of future research and targeted interventions. Furthermore, where possible, we incorporate discussions of the modifying effects of physical activity, exercise, and training status, to purported age-related changes in mitochondrial characteristics. [ABSTRACT FROM AUTHOR]

• Menopause hormone therapy was associated with better performance on gait speed and timed 'up and go'. • No association was found for grip strength, balance, and chair rise. • Associations did not vary according to body mass index, physical activity, or duration of menopause hormone therapy. • The association found in this work may be restricted to women aged over 65 years. • Starting menopause hormone therapy less than 5 years after menopause was associated with better results. To examine the association between menopause hormone therapy (MHT) and physical performance among women from the Canadian Longitudinal Study on Aging. Cross-sectional study of 12,506 postmenopausal Canadian women. Grip strength (kg), gait speed (m/s), timed up and go (s), chair rise (s), and balance (s) were assessed following standard procedures. The association between MHT and physical performance was evaluated using linear regression models adjusted for age, education, study site, smoking, alcohol consumption, body mass index, diabetes, hypertension, and hysterectomy. Sensitivity analyses were conducted according to age at study visit (<65 vs. ≥65 years), body mass index (<25 kg/m2 vs. ≥25 kg/m2), physical activity level (less vs. more active), duration and type of MHT, and time of starting MHT after menopause. Compared with those who never used MHT, prior or current use was associated with better performance on the timed up and go test (β: −0.19; 95%CI: −0.28; −0.11) and faster gait speed (β = 0.01, 95%CI = 0.00; 0.02). No association was found for grip strength, balance, and chair rise. Results did not change by body mass index, physical activity, or duration of MHT use. When stratified by age at study visit, the effect remained significant only in among those aged 65 years or more. Starting MHT <5 years after menopause was associated with better physical performance. MHT was associated with better physical performance in gait speed and timed up and go tests. The cross-sectional design of the study limits causal interpretation. Prospective studies are needed to confirm our results. [ABSTRACT FROM AUTHOR]

• Distinct trajectories exist for physical activity and BMI from middle to older age. • Trajectories in physical activity included an emergent physical activity group. • Stable-high and emergent physical activity groups had better later-life function. • Benefits of physical activity on function existed across different BMI trajectories. We examined the effects of physical activity (PA) and body mass index (BMI) longitudinal patterns (trajectories) on subjective measures of mobility, function, and disability in adults and assessed whether effects of PA trajectories on function varied due to BMI. Group-based trajectory analyses were used to determine patterns of change in PA and BMI using data from the Health and Retirement Study 1931–1941 birth cohort (n = 10,507). Physical function was assessed by Mobility Limitations (0–5 scale) and Large Muscle Function (0–4 scale) Indexes, as well as with score for activities of daily living (ADLs) and instrumental activities of daily living (IADLs), with higher scores being worse. Our analyses estimated four distinct PA trajectories: decreasing, (2) fluctuating, (3) stable high, and (4) emergent (previously low/sedentary with increased PA over the study period). Worse mobility limitations, large muscle function, ADLs, and IADLs were associated with Decreasing and Fluctuating PA groups. Better outcomes were associated with Emergent and Stable High PA groups. The five BMI trajectories were stable normal/overweight, modest decreasing, fluctuating, steep decreasing, and increasing. No significant interaction existed between PA and BMI trajectories for Mobility Limitations (P = 0.577), Large Muscle Function (P = 0.511), ADLs (P = 0.600), and IADLs (P = 0.152). These findings may empower clinicians to promote messages to midlifers that meaningful changes in PA can improve function in older age. [ABSTRACT FROM AUTHOR]

Active mobility, encompassing walking and cycling for transportation, is a potential solution to health issues arising from inadequate physical activity in modern society. However, the extent of active mobility's impact on individual physical activity levels, and its association with health as mediated by physical activities, is not fully quantified. This study aims to clarify the direct relationship between active mobility usage and individual health, as well as the indirect relationship mediated by physical activity, with a focus on varying levels of physical activity intensity. Utilizing data from the 2017 U.S. National Household Travel Survey (NHTS), we employed Poisson regression to predict active mobility usage based on socio-demographic and household socio-economic characteristics. A Structural Equation Model (SEM) was then used to investigate the direct and indirect effects of active mobility on individual health, mediated by physical activity. We further segmented individuals according to their intensity of physical activity to examine how such effect differs between different levels of physical activity. The study demonstrates that active mobility usage positively correlates with both the amount and intensity of physical activity. The effect of active mobility on individual health includes a direct positive effect (29% for intensity, 67.7% for amount) and an indirect effect mediated by physical activity (71% for intensity, 32.3% for amount). Notably, the mediation effect of active mobility on health is more substantial in the context of vigorous physical activities compared to light or moderate activities. Our findings reveal a significant positive influence of active mobility on individual health, encompassing both direct and indirect effects mediated by physical activities. These results quantitatively underscore the health benefits of active mobility and suggest the importance of promoting active mobility as a strategy to improve public health. • We study the triadic relation between active mobility, physical activity, and health. • Active mobility increases both the amount and intensity of physical activity. • Active mobility has direct, positive effect on individual health. • Active mobility also has indirect effect on health mediated by physical activity. • Vigorous activities have greater mediation effect than light/moderate activities. [ABSTRACT FROM AUTHOR]

[Display omitted] • Isovolume maneuver (IVM) trial for regulating respiratory is effective in improving physical activity performance. • After IVM, the breathing rate, heart rate and the use of abdominal breathing during physical activity can be more stable. • The instantaneous phase difference of thoracoabdominal movement can identify breathing patterns during physical activity. (1) Objective: We performed a step test to investigate whether isovolume maneuver (IVM) trial is effective in improving cardiorespiratory fitness; (2) Methods: The experiment involved two consecutive step tests in which the IVM was employed between the two tests. The heart rate (HR), breathing rate (BR), instantaneous phase difference (IPD) of thoracoabdominal movement, and physical fitness index (PFI) of the participants were analyzed. We also obtained data on the ascending rate of HR (HR asc), the rate relative to the baseline HR during recovery, and the scores for a modified PFI (mPFI) based on the baseline PFI; (3) Results: We recruited 27 sedentary and healthy college students as participants. The results from the second step-test were compared with the first step-test. The participants' mean HR asc decreased by 30.66 % ± 32.52 %, their mean BR decreased by 13.08 % ± 31.90 %, their mean mPFI increased by 30.78 % ± 38.94 %, and their mean IPD increased by 15.31 % ± 28.44 %; (4) Conclusions: IVM reduced the participants' BR and HR asc and increased their mPFI and IPD. These findings verify that IVM can effectively improve physical activity performance. Furthermore, an IPD of 39° for implementation of abdominal breathing during exercise is a key threshold that warrants further research. [ABSTRACT FROM AUTHOR]

• We review Medical Microwave Radiometry (MWR) usage for brain internal temperature measurements and diagnostics. Brain temperature (BT) is a crucial physiological parameter used to monitor cerebral status. Physical activities and traumatic brain injuries (TBI) can affect BT; therefore, non-invasive BT monitoring is an important way to gain insight into TBI, stroke, and wellbeing. The effects of BT on physical performance have been studied at length. When humans are under extreme conditions, most of the energy consumed is used to maintain the BT. In addition, measuring the BT is useful for early brain diagnostics. Passive microwave radiometry (MWR) measures the intrinsic radiation of tissues in the 1–4 GHz range. It was shown that non-invasive passive MWR technology can successfully measure BT and identify even small TBIs. Here, we review the potential applications of MWR for assessing BT. [ABSTRACT FROM AUTHOR]

• Mental fatigue induced by cognitively demanding activity alters motor control. • The negative effects of mental fatigue persist after 20 min of passive recovery. • Listening to music or moderate physical activity counteract mental fatigue effects. • Non-bioactive strategies could be used to reduce the effects of mental fatigue. Mental fatigue impairs both cognitive and physical performance. Bioactive substances (e.g., caffeine) have been used to counteract mental fatigue but could have side effects. The present study aimed to test two non-bioactive strategies to counteract mental fatigue: physical activity and listening to music. The participants first performed an arm-pointing task, then carried out a 32-min cognitively demanding task to induce mental fatigue (TLDB task), followed by another arm-pointing task at the end of the experiment. Between the end of the cognitively demanding task and the last arm-pointing task, 20 min went during which participants performed either 15 min of physical activity, of listening to music or of discussion (control). The subjective feeling of mental fatigue was assessed before each arm-pointing task and after the cognitively demanding task. For "physical activity" and "listening to music" groups, EEG was recorded at rest after each evaluation of subjective feeling of mental fatigue and during the cognitively demanding task. An increase in alpha power during the cognitively demanding task evidenced the presence of mental fatigue, without recovery during the following 20-min period. In the control condition, the arm-pointing task performance was deteriorated 20-min after the cognitively demanding task, while it remained stable after both physical activity and listening to music. Furthermore, recovery on the subjective feeling of mental fatigue was similar for both groups. The present results suggested that practicing physical activity and listening to music could be efficient strategies to counteract the negative effects of mental fatigue on motor performances. [ABSTRACT FROM AUTHOR]

We examined relationships between combinations of protective factors (healthy weight, never smoking, and at least moderate levels of physical activity) and moderate or substantial limitations of physical function (PF) versus minimal PF limitations in women who had had a hysterectomy only (n = 1771) or a hysterectomy and bilateral oophorectomy (BO) (n = 738) participating in the Australian Longitudinal Study on Women's Health. We found a dose-response effect that was strongest for substantial PF limitations; for each additional healthy behaviour, for women who had undergone hysterectomy only the relative risk (RR) was 0.62 (95% confidence interval (CI) 0.56-0.69) and for women who had undergone hysterectomy-BO the RR was 0.70 (95% CI 0.60-0.82). Support to adopt these modifiable factors may improve physical function in women who have had a hysterectomy. [ABSTRACT FROM AUTHOR]

• Non-pharmacological interventions improve many outcomes in non-affective psychosis. • Effect is observed on cognitive, clinical and functional and life-quality outcomes. • Benefit is larger in exercise interventions, especially moderate aerobic exercise. • Effect lasts after follow-up on anthropometric outcomes especially in psychotherapy. • Benefit is observed also specifically in chronic stages of non-affective psychosis. Patients with non-affective psychosis often lead unhealthy lifestyles. We performed a systematic review and meta-analysis on non-pharmacological RCTs for improvement of diet and physical activity in non-affective psychosis patients, including first-episode psychosis. A variety of outcomes was analysed, including metabolic, psychopathology, cognitive, functional and quality of life outcomes. Fifty-nine studies were included. An improvement in anthropometric measurements (BMI, weight, waist circumference) was observed post-intervention, persisting after follow-up. Post-intervention benefit was found also for psychotic symptoms severity (also persisting after follow-up), many cognitive domains and physical and global functioning and quality of life. Conversely, no effect was observed in relation to most blood metabolites, blood pressure and non-psychotic psychopathology and spontaneous physical activity. Improvement was generally larger for interventions including exercise, especially moderate/vigorous aerobic exercise, but follow-up maintenance was greater for psychotherapy interventions. Sensitivity analyses limited to chronic stages of psychosis and low risk of bias studies produced comparable results. Further studies are needed to design optimized interventions in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Nitrate supplements can improve vascular and muscle function. Whether higher habitual dietary nitrate is associated with better muscle function remains underexplored.Objective: The aim was to examine whether habitual dietary nitrate intake is associated with better muscle function in a prospective cohort of men and women, and whether the relation was dependent on levels of physical activity.Methods: The sample (n = 3759) was drawn from the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab) (56% female; mean ± SD baseline age: 48.6 ± 11.1 y). Habitual dietary intake was assessed over 12 y by obtaining an average [of at least 2 time points, e.g., baseline (2000/2001) and 2004/2005 and/or 2011/2012] from a food-frequency questionnaire. Nitrate intake was calculated from a validated nitrate database and other published literature. Muscle function was quantified by knee extension strength (KES) and the 8-ft-timed-up-and-go (8ft-TUG) test performed in 2011/2012. Physical activity was assessed by questionnaire. Generalized linear models and logistic regression were used to analyze the data.Results: Median (IQR) total nitrate intake was 65 (52-83) mg/d, with ∼81% derived from vegetables. Individuals in the highest tertile of nitrate intake (median intake: 91 mg/d) had 2.6 kg stronger KES (11%) and 0.24 s faster 8ft-TUG (4%) compared with individuals in the lowest tertile of nitrate intake (median intake: 47 mg/d; both P < 0.05). Similarly, individuals in the highest tertile of nitrate intake had lower odds for weak KES (adjusted OR: 0.69; 95% CI: 0.47, 0.73) and slow 8ft-TUG (adjusted OR: 0.63; 95% CI: 0.50, 0.78) compared with those in the lowest tertile. Physical activity did not influence the relationship between nitrate intake and muscle function (KES; P-interaction = 0.86; 8ft-TUG; P-interaction = 0.99).Conclusions: Higher habitual dietary nitrate intake, predominantly from vegetables, could be an effective way to promote lower-limb muscle strength and physical function in men and women. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess diaphragm thickness (DT) and mobility (DM) and to investigate their relationship to clinical parameters in patients with non-cystic fibrosis (non-CF) bronchiectasis. Thirty-eight patients with non-CF bronchiectasis were enrolled in this cross-sectional study. DT was measured using ultrasound at different lung volumes (at residual volume [DTRV], functional residual capacity [DTFRC] and total lung capacity [DTTLC]). DM was measured using ultrasound during quiet breathing (DMQB) and deep breathing (DMDB). Disease severity, pulmonary function, respiratory muscle strength, exercise capacity and physical activity were assessed. DTRV correlated with disease severity (ρ = 0.332, p = 0.042), FEV1% (r = 0.387, p = 0.016) and FVC% (r = 0.405, p = 0.012). DTFRC correlated with FVC% (r = 0.331, p = 0.042). DTTLC correlated with disease severity (r = 0.430, p = 0.007) and total physical activity time (r = 0.379, p = 0.019). DMDB correlated with disease severity (ρ = -0.380, p = 0.019), FEV1% (r = 0.369, p = 0.023) and FVC% (r = 0.405, p = 0.012). DT is related to disease severity, pulmonary function and physical activity, while DM is related to disease severity and pulmonary function in patients with non-CF bronchiectasis. [ABSTRACT FROM AUTHOR]

In a two-arm pilot trial, we examined the feasibility, acceptability, and preliminary efficacy of a 12-week, adaptive text message intervention (TMI) to promote health behaviors and psychological well-being in 60 individuals with multiple cardiac risk conditions (i.e., hypertension, hyperlipidemia, and/or type 2 diabetes) and suboptimal adherence to exercise or dietary guidance. Participants were allocated to receive the TMI or enhanced usual care (eUC). The TMI included daily adaptive text messages promoting health behaviors, twice-weekly messages to set goals and monitor progress, and monthly phone check-ins. Feasibility (primary outcome) and acceptability were measured by rates of successful text message delivery and daily participant ratings of message utility (0–10 Likert scale). We also assessed impact on health behavior adherence, psychological health, and functional outcomes. The TMI was feasible (99.3% of messages successfully sent) and well-accepted (mean utility = 7.4/10 [SD 2.6]). At 12 weeks, the TMI led to small-sized greater improvements in moderate to vigorous physical activity (d = 0.37), overall physical activity (d = 0.23), optimism (d = 0.20), anxiety (d = −0.36), self-efficacy (d = 0.22), and physical function (d = 0.20), compared to eUC. It did not impact other outcomes substantially at this time point. This 12-week, adaptive TMI was feasible, well-accepted, and associated with small-sized greater improvements in health behavior and psychological outcomes. Though larger studies are needed, it has the potential to be a scalable, low-intensity program that could be used in clinical practice. ClinicalTrials.gov registration: NCT04382521 • We conducted a trial of a text message intervention to promote health behaviors. • The intervention was feasible and well-accepted by participants. • The intervention led to small increases in health behaviors, compared to usual care. [ABSTRACT FROM AUTHOR]

• Seven latent statuses of physical function were identified. • Physical function decline progress in some typical stages. • Indicative limitation and transition trend are useful for developing preventive intervention and tailored care for physically limited elderly. Multiple limitations often co-occur and accumulate, leading to subsequent function decline. However, there is a scarcity of longitudinal studies examining the progression of physical function among the general population of older adults in China. This study aimed to define typical physical function status and its change, which were characterized by the coexistence and accumulation of diverse limitations targeting a Chinese sample of older adults. This study used the three recent public data waves of the Chinese Longitudinal Healthy Longevity Survey during a 6-year follow-up period. 9765 individuals who were over 65 and participated in the 2011 survey were included. Latent transition analysis was used to identify the latent physical function status and explore the transition of older adults among different latent statuses. Seven latent statuses of physical function were identified, with visual impairment and related limitations being particularly prevalent among older adults. Upper limb mobility appeared to be a differentiated indicator of physical functional status. Physical function decline mainly started with the limitations in squatting, carrying weights and walking, then to the status with intact upper limb mobility and hearing function only, or converted directly into the latter, then to complete dysfunction. Our findings suggest some indicative limitations and critical steps in the process of functional decline among older adults. These results may provide insight for researchers and policymakers to develop tailored preventive and rehabilitation care and provide support for physically limited elderly according to their latent status and course of functional decline. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is a very disabling disease. Pathologically, it is characterized by the presence of amyloid plaques and neurofibrillary tangles in the brain that results in neurodegeneration. Its clinical manifestations include progressive memory impairment, language decline and difficulty in carrying out activities of daily living (ADL). The disease is managed using interventions such as pharmacological interventions and aerobic exercise. Use of aerobic exercise has shown some promises in reducing the risk of developing AD, and improving cognitive function and the ability to carry out both basic and instrumental ADL. Although, the mechanisms through which aerobic exercise improves AD are poorly understood, improvement in vascular function, brain glucose metabolism and cardiorespiratory fitness, increase in antioxidant capacity and haemoglobin level, amelioration of immune-related and inflammatory responses, modulation of concentration of circulating Neurotrophins and peptides and decrease in concentration of tau protein and cortisol level among others seem to be the possible mechanisms. Therefore, understanding these mechanisms is important to help characterize the dose and the nature of the aerobic exercise to be given. In addition, they may also help in finding ways to optimize other interventions such as the pharmacological interventions. However, more quality studies are needed to verify the mechanisms. • Alzheimer's disease (AD) seriously affects cognitive and physical function. • A promising intervention in patients with AD is aerobic exercise. • The exercise modulates disease biomarkers, and improves brain glucose metabolism and vascular function. • It also increases antioxidant capacity and levels of brain-derived neurotrophic factor. • Modulation of those biomarkers helps to slow down progression of the disease. [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]

Background: Cognitive impairment has been reported in patients with Major Depressive Disorder (MDD). This study aims to explore the association between lifestyle habits and health-related factors and the presence of cognitive symptoms in MDD patients.Methods: Demographic, clinical, health-related variables and cognitive scores measured with the Cambridge Neuropsychological Test Automated Battery (CANTAB) were compared between 74 patients with current MDD and 68 healthy controls (HC). To test the hypothesis of associated factors to cognitive symptoms, multivariate backward stepwise linear regression models were run.Results: Significant neuropsychological deficits were evident in MDD compared with HC in the global cognitive index (F=8.29; df=1, 140; p=0.005). In the regression analysis performed on MDD and HC, years of schooling (β=-0.11; p=<0.001), job status (β=-0.50; p=0.016), physical activity (β=-0.25; p=0.04) and age at illness onset (β=0.17; p=0.017) were statistically significant factors associated to cognitive impairment. The regression model ran in HC showed that only years of schooling were significant (β=-0.07; p=<0.001) in this group.Limitations: Sample size was relatively small. Everyday cognitive skills were not evaluated.Conclusions: MDD patients have cognitive deficits. These deficits are linked with the years of education, job status, age of onset of the disease and the performance of physical activity. These results support the importance of the implementation of interventions targeting the cognitive reserve and lifestyle habits of MDD patients, in addition to the conventional therapeutic approach focused on symptoms control. [ABSTRACT FROM AUTHOR]

Type 2 diabetes and obesity characterized by hallmarks of insulin resistance along with an imbalance in brain oxidative metabolism would impair intrinsic capacities (ICs), a new concept for assessing mental and physical functioning. Here, we explored the impact of physical activity on antioxidant responses and oxidative metabolism in discrete brain areas of HFD or standard diet (STD) fed mice but also its consequences on specific domains of ICs. 6-week-old Swiss male mice were exposed to a STD or a HFD for 16 weeks and half of the mice in each group had access to an activity wheel and the other half did not. As expected HFD mice displayed peripheral insulin resistance but also a persistent inhibition of aconitase activity in cortices revealing an increase in mitochondrial reactive oxygen species (ROS) production. Animals with access to the running wheel displayed an improvement of insulin sensitivity regardless of the diet factor whereas ROS production remained impaired. Moreover, although the access of the running wheel did not influence mitochondrial biomass, in the oxidative metabolism area, it produced a slight decrease in brain SOD1 and catalase expression notably in HFD fed mice. At the behavioural level, physical exercise produced anxiolytic/antidepressant-like responses and improved motor coordination in both STD and HFD fed mice. However, this non-pharmacological intervention failed to enhance cognitive performance. These findings paint a contrasting landscape about physical exercise as a non-pharmacological intervention for positively orienting the aging trajectory. • HFD induced peripheral insulin resistance in 6-month old male swiss mice and signs of an increase in cortical ROS production. • Despite impairments in glucose homeostasis and brain oxidative metabolism, HFD did not induce behavioral deficits. • Although exercise did not improve brain oxidative metabolism, it improved behavioral parameters in both STD and HFD fed mice. • Non-pharmacological intervention would be effective for slowing down some aspects of aging. [ABSTRACT FROM AUTHOR]

Changes in gene expression are involved in many brain functions. Epigenetic processes modulate gene expression by histone modification and DNA methylation or RNA-mediated processes, which is important for brain function. Consequently, epigenetic changes are also a part of brain diseases such as mental illness and addiction. Understanding the role of different factors on the brain epigenome may help us understand the function of the brain. This review discussed the effects of caffeine, lipids, addictive substances, physical activity, and pollutants on the epigenetic changes in the brain and their modulatory effects on brain function. • A complex interplay between epigenetic modifications and their substantial impact on brain functions. • Micronutrients, caffeine, toxins, and harmful substances affect the brain's epigenetic landscape. • The links between epigenetic changes and behavioral outcomes emphasize the targeted therapies in brain disorders. [ABSTRACT FROM AUTHOR]

• Physical activity (PA) is beneficial for patients with axial spondyloarthritis (axSpA) and its management. However, patients with axSpA are generally less active than healthy controls. • This study reveals a discrepancy between knowledge and agreement on the one hand and implementation of PA in the daily life of patients with axSpA on the other hand. • Health care providers should be motivated to inform and encourage patients to integrate regular PA in their daily life with special emphasis on those patients who are not active and do not know about the benefits of PA. The course of axial spondyloarthritis (axSpA) is often characterized by impairments in physical function and mobility. Regular physical activity (PA) is a cornerstone of axSpA management. Recent European League Against Rheumatism (EULAR) recommendations for PA have stressed the importance of their implementation. Cohort study to investigate the awareness on and individual implementation of axSpA patients towards PA. Patients with axSpA and impaired physical function (Bath AS Functional Index [BASFI] score ≥ 2.0) were recruited consecutively. All patients underwent a clinical examination including assessments of disease activity, physical function, mobility and global functioning. Patients also had to fill out structured questionnaires on knowledge, awareness and individual attitudes to PA. Out of a total of 100 patients enrolled, 96 were included. Most respondents (n = 82, 85.4%) were aware that PA has significant health benefits for patients with axSpA. Even though less than half of the patients (n = 44, 42.7%) were aware that actual EULAR recommendations do exist, 45 patients (46.9%) did already fulfill these in terms of frequency/week. The majority of patients (n = 61, 67.7%) had been informed about the benefits of PA by their physician, and physiotherapy had often been prescribed (n = 61, 63.3%). Many patients (n = 51, 53.1%) reported to perform individual exercise programs, and some (n = 22, 22.9) supervised PA. Even though the majority of axSpA patients are not aware of the recent EULAR recommendations for PA, many understand and agree that PA is beneficial for their health status. Health care providers should concentrate on the patients who are not active and do not know about the benefits of PA. [ABSTRACT FROM AUTHOR]

As the global population ages, the prevalence of cognitive decline and dementia is expected to rise, creating a significant health and economic burden. The purpose of this trial is to rigorously test, for the first time, the efficacy of yoga training as a physical activity intervention to mitigate age-related cognitive decline and impairment. We are conducting a 6-month randomized controlled trial (RCT) of exercise among 168 middle aged and older adults to compare the efficacy of yoga vs. aerobic exercise on cognitive function, brain structure and function, cardiorespiratory fitness, and circulating inflammatory and molecular markers. Using a single-blind, three arm RCT, 168 older adults ages 55-79 will be assigned to either: a Hatha yoga group, an aerobic exercise group or a stretching-toning active control group. Participants will engage in hour long group exercise 3x/week for 6-months. A comprehensive neurocognitive test battery, brain imaging, cardiovascular fitness test, and a blood draw will take place at baseline; end of the 6-month intervention, and at 12-month follow-up. Our primary outcomes of interest are brain regions, such as hippocampal volume and prefrontal cortex, and cognitive functions, such as episodic memory, working memory and executive functions, that are typically affected by aging and Alzheimer's disease. Not only will this RCT test whether yoga is a means to mitigate age-related cognitive decline, but it may also offer an alternative to aerobic exercise, which could be particularly appealing to older adults with compromised physical functioning. ClinicalTrials.gov Identifier: NCT04323163 [ABSTRACT FROM AUTHOR]

• People with mental disorders who are more physically active are also more likely to have better global functioning. • The association between physical activity and global functioning may be bidirectional, but the design of the included studies prevents us from drawing firm conclusions about the direction of the findings. • High-quality prospective studies are needed to explore the moderators of the association between global functioning and physical activity in this population. Physical activity is associated with better global functioning in the general population and in people with physical conditions. However, there is no meta-analytic evidence on the associations between daily physical activity levels and global functioning in people with mental disorders. The objective of the present meta-analysis therefore was to evaluate the associations between daily physical activity levels and global functioning in individuals with mental disorders. Pubmed, Embase, PsycINFO and SPORTdiscus were searched from inception to August 1st, 2022. Risk of bias was assessed using the National Institutes of Health Study Quality Assessment Tools. A random-effects meta-analysis was performed. Ten studies were identified and six were meta-analyzed including 251 adults (39.2 ± 11.9 years, 33.6% of women). The pooled results from six studies found a moderate positive correlation (r = 0.39, 95% CI 0.242 to 0.528, p <0.001, I²=49.3%) between daily physical activity and global functioning. Three out of four studies not included in the meta-analysis also found significant associations between physical activity and global functioning. The current meta-analysis demonstrated a moderate association between daily physical activity and global functioning in individuals with mental disorders. However, the evidence is based on cross-sectional studies and a causal relationship cannot be established. High-quality longitudinal studies aiming to address this relationship should be conducted. [ABSTRACT FROM AUTHOR]

This cross-sectional study aimed to compare physical activity levels, plantar sensation, and fear of falling between individuals with diabetes undergoing hemodialysis, with or without walking aids. Sixty-four participants were recruited, with 37 not using walking aids (age = 65.8 ± 0.7 years, 46% female) and 27 using walking aids (age = 69.2 ± 1.2 years, 63% female). Physical activity was measured using validated pendant sensors over two consecutive days. Concern for falling and plantar numbness were assessed using the Falls Efficacy Scale-International and vibration perception threshold test, respectively. Participants using walking aids exhibited a greater fear of falling (84% vs. 38%, p < 0.01) and fewer walking bouts (p < 0.01, d = 0.67) and stand-to-walk transitions (p < 0.01, d = 0.72) compared to those not using walking aids. The number of walking bouts was negatively correlated with concern for falling scores (ρ = −0.35, p = 0.034) and vibration perception threshold (R = −0.411, p = 0.012) among individuals not using walking aids. However, these correlations were not significant among those using the walking aid. There was no significant group difference in active behavior (walking + standing %) and sedentary behavior (sitting + lying %). Those undergoing hemodialysis often lead sedentary lives, with mobility affected by fear of falling and plantar numbness. Using walking aids can help, but it doesn't guarantee more walking. A combined psychosocial and physical therapy approach is key for managing fall concerns and improving mobility. • Individuals receiving hemodialysis (HD) treatment are prone to a sedentary lifestyle. • Mobility among HD patients influenced by fear of falling and plantar sensation • Walking aid use might be able to compensate for the fear of falling and loss of plantar sensation. • Walking aids usage doesn't ensure higher mobility [ABSTRACT FROM AUTHOR]

Objective: To examine how physical activity and physical mobility are related to obesity in the elderly. Study design: A cross-sectional study of 2558 men and women aged 65 years and older who participated in a population survey in 2012 was conducted in mid-Sweden with an overall response rate of 67%. Methods: Obesity (body mass index ≥30 kg/m²) was based on self-reported weight and height, and physical activity and physical mobility on questionnaire data. Chi-squared test and multiple logistic regressions were used as statistical analyses. Results: The overall prevalence of obesity was 19% in women and 15% in men and decreased after the age of 75 years. A strong association between both physical activity and obesity, and physical mobility and obesity was found. The odds for obesity were higher for impaired physical mobility (odds ratio [OR] 2.83, 95% confidence interval [CI] 2.14-3.75) than for physical inactivity (OR 1.63, 95% CI 1.28-2.08) when adjusted for gender, age, socio-economic status and fruit and vegetable intake. However, physical activity was associated with obesity only among elderly with physical mobility but not among those with impaired physical mobility. Conclusion: It is important to focus on making it easier for elderly with physical mobility to become or stay physically active, whereas elderly with impaired physical mobility have a higher prevalence of obesity irrespective of physical activity. [ABSTRACT FROM AUTHOR]

• The physical treatment of low back pain includes a wide range of non-specific and specific physical activity. • The value of physical activity in acute or subacute low back pain has not been demonstrated. • General exercise, more specific interventions and multidisciplinary functional restoration programs reduce pain and improve physical function in patients with chronic low back pain. • The optimal delivery of physical activity in terms of modalities, quantity and intensity of the intervention, supervision, and setting is not well defined. Non-specific low back pain (LBP) is the leading cause of years lived with disability worldwide. Physical activity is an integral part of LBP treatment. To critically review available evidence regarding the efficacy of physical activity for people with LBP. Up to date critical narrative review of the efficacy of physical activity for the managment LBP. The process of article selection was unsystematic; articles were selected based on authors' expertise, self-knowledge and reflective practice. Therapeutic physical activity for LBP includes a wide range of non-specific and specific activities. The efficacy of physical activity on pain and activity limitations has been widely assessed. In acute and subacute LBP, exercise did not reduce pain compared to no exercise. In chronic low back pain (CLBP), exercise reduced pain at the earliest follow-up compared with no exercise. In a recent systematic review, exercise improved function both at the end of treatment and in the long-term compared with usual care. Exercice also reduced work disability in the long-term. We were unable to establish a clear hierarchy between different exercise modalities. Multidisciplinary functional programs consistently improved pain and function in the short- and long-term compared with usual care and physiotherapy and improved the long-term likelihood of returning to work compared to non-multidisciplinary programs. Physical activity of all types is an effective treatment for CLBP. [ABSTRACT FROM AUTHOR]

• Higher serum DHEA-S levels were associated with lower risk of frailty. • This was especially true for mobility-subtype frailty. • Low serum DHEA-S also showed a trend towards an association with weight loss. Previous studies suggest that lower serum levels of dehydroepiandrosterone sulfate (DHEA-S) are associated with physical frailty. Associations with subtypes of physical frailty have not been studied. This study aimed to investigate associations between serum DHEA-S levels and physical frailty and its subtypes in older Japanese community-dwellers using panel data. This study was conducted within the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA). Repeated measurement data were collected from 1,886 older community-dwellers (60–91 years). Frailty was identified according to modified Cardiovascular Health Study criteria (weight loss, weakness, slowness, exhaustion, low physical activity) and was classified into following subtypes: mobility (weakness/slowness), non-mobility (weight loss/exhaustion), and low physical activity. Associations with serum DHEA-S (sex-specific tertiles [T1−T3]) were estimated by random-effects logistic regression models adjusting for age, sex, education, disease history (stroke, hypertension, heart disease, diabetes), smoking status, depressive symptoms, and survey wave. We found an average prevalence of 6.0% for frailty (mobility subtype, 7.0%; non-mobility subtype, 34.8%; low physical activity subtype, 9.4%) across survey waves. Mean (SD) sex-specific DHEA-S levels (μg/dL) at T1, T2, and T3 were 46.8 (20.8), 88.7 (28.4), and 158.0 (58.9), respectively. Compared with T1, the adjusted ORs (95% CIs) for frailty were 0.69 (0.44, 1.08) for T2 and 0.50 (0.30, 0.83) for T3 (P trend = 0.007). The corresponding values for mobility subtype were 0.80 (0.51, 1.24) for T2 and 0.55 (0.33, 0.90) for T3. Higher serum DHEA-S levels were associated with lower risk of frailty, especially mobility-subtype frailty, in older community-dwellers. [ABSTRACT FROM AUTHOR]

It is well documented that regular physical activity (PA) participation improves physical functions of children with a developmental disability (DD). Researchers have begun to pay attention to virtual reality (VR) based PA programs, but there is a lack of research evidence. We aimed to examine the effect of a VR-based PA program on motor skills and PA levels in children with DD. Twenty-three children with DD were randomly assigned to an experimental and a control group. The intervention was conducted for 24 sessions, 40 min each, and twice a week. Each participant rode a stationary bike with a cadence sensor wearing a VR headset. TGMD–3 and a GENEActiv accelerometer were used to measure motor skills and PA levels one week before and after the intervention. Children in the experimental group showed a significant increase in locomotor skills. Ball skills also increased but did not have significant differences. For PA levels, both groups did not have significant increase after the intervention. A VR-based PA program was effective in improving locomotor skills among children with DD. To significantly change ball skills and PA levels of children with DD, VR-based PA program mixed with reality-based PA program is probably necessary. • Stationary bicycle-based VR exergaming has a positive effect on motor skills, especially in locomotor skills, in children with a developmental disability. • Ball skills in children with a developmental disability also increased but did not have significant difference meaning that steering the body for redirection or using a controller is not enough to improve the skills of controlling an object. • VR-based physical activity does not increase the physical activity levels of children with a developmental disability, and thus additional or modified interventions are necessary. [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]

• Exercise improves metabolic profile in a juvenile model of diet-induced cognitive impairment. • Exercise rescues spatial memory impairments induced by chronic high-fat diet. • Exercise rescues recognition memory impairments induced by chronic high-fat diet. • Exercise restored central and peripheric function even without HFD interruption. Childhood and adolescent exposure to obesogenic environments has contributed to the development of several health disorders, including neurocognitive impairment. Adolescence is a critical neurodevelopmental window highly influenced by environmental factors that affect brain function until adulthood. Post-weaning chronic exposure to a high-fat diet (HFD) adversely affects memory performance; physical activity is one approach to coping with these dysfunctions. Previous studies indicate that voluntary exercise prevents HFD's detrimental effects on memory; however, it remains to evaluate whether it has a remedial/therapeutical effect when introduced after a long-term HFD exposure. This study was conducted on a diet-induced obesity mice model over six months. After three months of HFD exposure (without interrupting the diet) access to voluntary physical activity was provided. HFD produced weight gain, increased adiposity, and impaired glucose tolerance. Voluntary physical exercise ameliorated glucose tolerance and halted weight gain and fat accumulation. Additionally, physical activity mitigated HFD-induced spatial and recognition memory impairments. Our data indicate that voluntary physical exercise starting after several months of periadolescent HFD exposure reverses metabolic and cognitive alterations demonstrating that voluntary exercise, in addition to its known preventive effect, also has a restorative impact on metabolism and cognition dysfunctions associated with obesity. [ABSTRACT FROM AUTHOR]

National guidelines promote physical activity to reduce cardiovascular disease (CVD); yet, no RCT has tested the effectiveness of physical activity as the sole intervention for primary CVD prevention in older adults. The Women's Health Initiative (WHI) Strong and Healthy (WHISH) trial, a pragmatic trial embedded in the WHI-Extension Study (ES), is testing whether increasing physical activity and decreasing sedentary behavior will reduce major CV events in older women. The randomized consent design was used to assign 49,331 women (aged 68–99 years in 2015) who had consented to ongoing WHI-ES follow-up and for whom CV outcomes were available through WHI-ES procedures (N = 18,985) and/or linkage to the Centers for Medicare and Medicaid Services (N = 30,346) to a physical activity (PA) intervention designed to promote national recommendations (N = 24,657) or "usual activity" comparison (N = 24,674). Women assigned to the intervention provided passive consent to receive the intervention and provide data. A multi-component PA intervention is delivered by seasonal (quarterly) newsletters with targeted inserts (lower, middle, higher) based on self-reported levels of physical functioning (PF) and physical activity; monthly motivational telephone messages; monthly emails; a website; and contact with staff, as requested. Major CV events, myocardial infarction (MI), stroke, or CVD death, collected annually through WHI-ES, comprise the primary outcome. Hip fracture and non-CVD death are primary safety outcomes. Intention-to-treat analyses in all randomized participants will include 8 years of follow-up. Determining whether increased physical activity and decreased sedentary behavior reduce major CV events in older women is of major public health significance. Clinical trials registration: ClinicalTrials.gov identifier: NCT02425345 [ABSTRACT FROM AUTHOR]

Engaging in physical activity early after lumbar spine surgery has promising effects on long-term postoperative recovery, including improved physical function. However, whether this effect is mediated through improvement in psychosocial factors is yet to be established. The purpose of this study was to investigate the longitudinal postoperative relationship between physical activity, psychosocial factors, and physical function in patients undergoing lumbar spine surgery. Secondary analysis from randomized controlled trial. This study included 248 participants (mean ± SD; age=62.2±11.9 years; BMI=32.4±6.6 kg/m2 and 51% females) who underwent surgery for a degenerative lumbar spine condition. Physical activity, defined as steps per day, was measured using a triaxial accelerometer (Actigraph GT3X) worn for >10 hours for >1 day(s) at 6 weeks (6wk), 6 months (6M), 12 months (12M) and 24 months (24M) following spine surgery. Physical function, measured with Patient-Reported Outcomes Measurement Information System, and psychosocial factors pain self-efficacy [Pain Self-Efficacy Questionnare], depression [Patient Health Questionnaire-9] and fear of movement [Tampa Scale for Kinesiophobia]) were assessed at preoperative visit and 6wk, 6M, 12M and 24M after surgery. Structural equation modeling (SEM) was used to analyze data and compute standardized coefficients to determine the effects of physical activity, function and psychosocial factors. Multiple imputation accounted for missing data and pooled coefficients and p-values were calculated using Rubin's approach. The mediation effect of each psychosocial factor on the effect of physical activity on physical function were computed by dividing the direct effects with the indirect effects. All SEM models controlled for age, employment, comorbidities, prior spine surgery, and preoperative pain self-efficacy, depression, fear of movement, physical function, and back and leg pain. Each SEM models was tested for model fit by assessing the established fit indexes. The overall standardized direct effect of physical activity (ie, steps per day) on physical function ranged from 0.08 to 0.19 (p<0.05), while the overall effect of physical function on physical activity ranged from non-existent to 0.14 (p<0.01 to 0.3). The effect of physical activity on physical function remained consistent after accounting for psychosocial factors in each of the mediation models. Pain self-efficacy did not mediate but depression and fear of movement at 6M mediated 3.4% and 5.4% of the effect of physical actvity at 6Wk on physical function at 12M, respectively. The findings of this study support the use of early postoperative strategies to address physical activity in order to improve long-term physical function. Pain self-efficacy did not have a mediating effect while depression and fear of movement had a very small mediating effect; therefore, additional work is needed to investigate other potential mediating factors such as pain catastrophizing, resilience and exercise self-efficacy. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Limitations in physical function are common in Multiple Sclerosis (MS), yet it is neither clear how muscle power implicates physical function and walking-fatigability. This pilot-study aims to investigate (1) deficits in muscle power/force alongside walking in persons with MS; (2) associations between muscle power/force and physical functions and (3) the impact of prolonged walking in muscle power/force. 30 relapse-remitting persons with MS and 28 healthy controls performed chair rise and plantar flexion on a force platform before and after 12-minutes of intermittent walking to measure lower extremity muscle power/force. GaitRite measured walking speed. The percentage change in distance walked was also calculated. Persons with MS were classified into subgroups according to walking-fatigability and mobility disability status (Patient Determined Disease Steps). Higher deficits in muscle power compared to force were observed in persons with MS vs. healthy controls particularly in persons with MS having higher disability. Muscle power and force were associated with walking capacity, mobility disability and subjective fatigue, but not with percentage change in distance walked. Persons with MS slowed down over the course of the 12-min intermittent walking, whereas decrements in walking speed and muscle power/force (derived from chair rise) were observed in persons with MS presenting walking-fatigability only. Muscle power and force are impaired in persons with MS and appear to be critical for physical function in MS. This exploratory pilot study further suggests that muscle power/force from chair rise could contributes to walking-fatigability which therefore offer future treatment targets. • More pronounced deficit in muscle power vs. muscle force in persons with MS. • Muscle power/force were associated with walking capacity and mobility disability. • Muscle functions were associated with subjective fatigue but not with fatigability. • Persons with MS slowed down during 12-min of intermittent walking. [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]

Smartphones have become central to our daily lives and are often present in the same contexts as their users. Researchers take advantage of this phenomenon by using data from smartphone sensors to infer everyday activities, such as mobility, physical activity, and sleep. For example, that a person is sleeping might be inferred from the fact that their phone is idle and that there is no sound and light around the phone. The success of inference from raw smartphone sensor data to activity outcomes depends, among other factors, on how smartphone owners use their device. Not having the smartphone in close proximity throughout the day, turning the device off, or sharing the device with others can constitute barriers that interfere with accurately measuring everyday activity with data from the phone's native sensors. Against this background, we surveyed two independent, large-scale samples of German smartphone owners (n 1 = 3956; n 2 = 2525) on how they use their smartphones, with a focus on three everyday activities: mobility, physical activity, and sleep. We find that both sociodemographic as well as smartphone-related characteristics are associated with how people use their smartphones, and that this affects the suitability of smartphone data for measuring everyday activities. • Turning smartphone off, leaving it at home, and not carrying it close to body are common behaviors among users. • Smartphone usage behavior differs by sociodemographic and smartphone-related user characteristics. • Bias in measures of everyday activities from smartphone sensors can be attributed to how people use their devices. [ABSTRACT FROM AUTHOR]

International treatment recommendations for fibromyalgia (FM) highlight the importance of adapted physical activity (APA) combined with patient education. Cognitive and behavioral therapies as well as an interdisciplinary approach can be proposed for more complex or severe clinical situations, with a biopsychosocial vision of rehabilitation. To personalize the rehabilitation's therapeutic approach, a clinician can use simple and validated instruments for measuring physical performance that will highlight levels of physical conditioning, which range from low to very low in FM patients. Several systematic reviews and meta-analyses have found strong evidence that supervised aerobic and resistance-training programs reduce the pain intensity and significantly improve the quality of life and the physical and psychological functioning of female FM subjects. These therapeutic approaches appear safe and promising in terms of cost-effectiveness and should be the subject of more randomized controlled trials among male FM subjects and adolescents. [ABSTRACT FROM AUTHOR]

Mobility interventions have been shown to mitigate functional decline in various clinical populations; however, the effects of mobility programs in older hospitalized patients are unclear. The objective of this study was to determine the effects of unstructured mobility programs on physical activity, physical function, length of stay (LOS), and quality of life (QOL) in older (≥60 years) general medicine inpatients. In this systematic review and meta-analysis, we systematically searched MEDLINE, Embase, CINAHL, and AMED databases from inception to March 2020, plus hand screening references of relevant studies. We included randomized controlled trials (RCTs) and quasi-experimental studies assessing the effects of mobility programs compared to usual care in older adults admitted to general medicine units. Teams of 2 reviewers independently extracted data, assessed risk of bias, and evaluated quality of evidence. Where study population, intervention, and outcomes were similar, results from RCTs were combined by meta-analysis. Three RCTs and 10 quasi-experimental studies met eligibility criteria. Interventions mainly included ambulation and staff, patient, or caregiver education. Meta-analyses showed that mobility interventions had a moderate effect on physical activity [step count standardized mean difference 0.60, 95% confidence interval (CI) 0.23-0.97] and a nonsignificant effect on LOS (mean difference –0.36, 95% CI –1.92 to 1.21), both favoring mobility. Narrative synthesis showed consistent evidence for improvement in physical function, potential decrease in LOS, and no increase in adverse events with mobility interventions. Unstructured mobility interventions in general medicine units may improve older hospitalized patients' physical activity and physical function; however, the quality of evidence was low. More RCTs are needed to evaluate the effectiveness of mobility interventions, particularly on LOS and QOL. [ABSTRACT FROM AUTHOR]

While low-income midlife and older adults are disproportionately affected by non-communicable diseases that can be alleviated by regular physical activity, few physical activity programs have been developed specifically with their needs in mind. Those programs that are available typically do not address the recognized local environmental factors that can impact physical activity. The specific aim of the Steps for Change cluster-randomized controlled trial is to compare systematically the initial (one-year) and sustained (two-year) multi-level impacts of an evidence-based person-level physical activity intervention (Active Living Every Day [ALED] and age-relevant health education information), versus the ALED program in combination with a novel neighborhood-level citizen science intervention called Our Voice. The study sample (N = 300) consists of insufficiently active adults ages 40 years and over living in or around affordable senior public housing settings. Major study assessments occur at baseline, 12, and 24 months. The primary outcome is 12-month change in walking, and secondary outcomes include other forms of physical activity, assessed via validated self-report measures supported by accelerometry, and physical function and well-being variables. Additional intervention impacts are assessed at 24 months. Potential mediators and moderators of intervention success will be explored to better determine which subgroups do best with which type of intervention. Here we present the study design and methods, including recruitment strategies and yields. clinicaltrial.gov Identifier = NCT03041415 [ABSTRACT FROM AUTHOR]