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In people with Parkinson's disease, what is the effect of adding external cueing (ie, visual, auditory or somatosensorial cueing) to walking training compared with walking training alone in terms of walking, mobility, balance, fear of falling and freezing? Are any benefits carried over to participation or maintained beyond the intervention period? Systematic review of randomised trials with meta-analysis. Ambulatory adults with Parkinson's disease. Walking training with external cueing compared with walking training without external cueing. Walking (ie, speed, stride length and cadence), mobility, balance, fear of falling, freezing and participation. Ten trials involving a total of 309 participants were included. The mean PEDro score of the included trials was 5 (range 4 to 8). Walking training with auditory cueing improved walking speed by 0.09 m/s (95% CI 0.02 to 0.15) more than walking training alone. Although the best estimate was that auditory cueing may also improve stride length by 5 cm, this estimate was imprecise (95% CI –2 to 11). The addition of visual cueing to walking training did not improve walking speed or stride length. Results regarding cadence, mobility, balance, fear of falling, and freezing and maintenance of benefits beyond the intervention period remain uncertain. This systematic review provided low-quality evidence that walking training with auditory cueing is more effective than walking training alone for improving walking speed in Parkinson's disease. Cueing is an inexpensive and easy to implement intervention, so the mean estimate might be considered clinically worthwhile, although the confidence interval spans clinically trivial and worthwhile effects. PROSPERO CRD42021255065. [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]

This study aimed to investigate the association between combinations of sarcopenia criteria by the Asian Working Group of Sarcopenia (AWGS) 2019 guideline and incident adverse health outcomes. Longitudinal analyses of a cohort study. We conducted prospective 2-year follow-up analyses (N = 1959) among community-dwelling older adults enrolled in the nationwide Korean Frailty and Aging Cohort Study (KFACS). From the KFACS, 1959 older adults (52.8% women; mean age = 75.9 ± 3.9 years) who underwent assessments for appendicular skeletal mass using dual-energy X-ray absorptiometry, handgrip strength, usual gait speed, 5-times sit-to-stand test, and Short Physical Performance Battery (SPPB) at baseline were included. Participants with each adverse health outcome [mobility disability, falls, and instrumental activities of daily living (IADL) disabilities] at baseline were excluded for each corresponding analysis. Multivariable logistic regression was performed to examine whether sarcopenia defined by different diagnostic criteria was associated with incident adverse health outcomes after 2 years. A total of 444 participants (22.7%) were diagnosed with sarcopenia as defined by AWGS 2019. In the multivariable analysis, sarcopenia defined as both low muscle mass and low physical performance increased the risk of mobility disability (OR 2.14, 95% CI 1.35-3.38) and falls (1.74, 95% CI 1.21-2.49). Only the criterion defined as both low muscle mass and physical performance using the SPPB increased the risk of falls with fracture (2.53, 95% CI 1.01-6.35) and IADL disabilities (2.77, 95% CI 1.21-6.33). However, sarcopenia defined as both low muscle mass and low hand grip strength showed no associations with the incidence of any of the adverse health outcomes. Our study suggests that the predictive value of adverse health outcomes for community-dwelling older adults is better when diagnosed with sarcopenia based on low muscle mass and physical performance. Furthermore, using the SPPB as a diagnostic tool for low physical performance may improve the predictive validity for falls with fracture and IADL disability. Our findings may be helpful for the early detection of individuals with sarcopenia who have a higher risk of adverse health outcomes. [ABSTRACT FROM AUTHOR]

• The study examined the cross-sectional association between characteristics of reproductive history, use of exogenous hormones and fast walking speed among >30,000 French women aged 45 to 69 years. • Age at menarche, age at first birth and duration of breastfeeding were positively associated with fast walking speed. • There was a quadratic association of fast walking speed with parity among parous women. • Among menopausal women, age at menopause was positively associated with fast walking speed. • Fast walking speed increased with reproductive lifetime duration and decreased with time since onset of menopause. • There was no association of fast walking speed with oral contraception and postmenopausal hormone therapy. To investigate the cross-sectional associations of reproductive history and use of exogenous hormones with fast walking speed (WS) in women. Between 2012 and 2020, 33,892 French women aged 45 years or more, recruited at health centers, underwent physical function tests and self-reported information on reproductive history and use of exogenous hormones. Linear mixed models with the center as random intercept were used to estimate the association of exposures with WS. Fast WS. Mean WS was 172.2 cm/s. WS increased with age at menarche (β +1y = 0.23, 95 % confidence interval = 0.05 to 0.40), age at first birth (β +1y = 0.20, 95 % CI = 0.13 to 0.27) and duration of breastfeeding (β for ≥10 vs ≤5months = 1.38; 95 % CI = 0.39 to 2.36). In addition, parity was quadratically associated with WS, with women with 3 children having the highest WS (p for U-shaped relationship < 0.01). Menopausal status had no impact on WS but age at menopause was positively associated with WS (β +5y = 0.52, 95 % CI = 0.17 to 0.87) and partly explained the deleterious impact of artificial menopause on WS. WS increased with reproductive lifetime duration (β +5y = 0.49, 95 % CI = 0.16 to 0.83) and decreased with time since onset of menopause (β +5y = −0.65, 95 % CI = −0.99 to −0.31). By contrast, there was no association of WS with oral contraception and postmenopausal hormone therapy. Our findings suggest that reproductive life characteristics may be associated with WS and timing of exposure could play a role. [ABSTRACT FROM AUTHOR]

In people recovering from traumatic brain injury, is a 3-month ballistic resistance training program targeting three lower limb muscle groups more effective than non-ballistic exercise rehabilitation for improving mobility, strength and balance? Does improved mobility translate to better health-related quality of life? A prospective, multicentre, randomised trial with concealed allocation, intention-to-treat analysis and blinded measurement. A total of 144 people with a neurological movement disorder affecting mobility as a result of traumatic brain injury. For 3 months, the experimental group had three 60-minute sessions of non-ballistic exercise rehabilitation per week replaced by ballistic resistance training. The control group had non-ballistic exercise rehabilitation of equivalent time. The non-ballistic exercise rehabilitation consisted of balance exercises, lower limb stretching, conventional strengthening exercises, cardiovascular fitness training and gait training. The primary outcome was mobility measured using the High-Level Mobility Assessment Tool (HiMAT). Secondary outcomes were walking speed, strength, balance and quality of life. They were measured at baseline (0 months), after completion of the 3-month intervention (3 months) and 3 months after cessation of intervention (6 months). After 3 months of ballistic resistance training, the experimental group scored 3 points (95% CI 0 to 6) higher on the 54-point HiMAT than the control group and remained 3 points (95% CI –1 to 6) higher at 6 months. Although there was a transient decrement in balance at 3 months in the experimental group, the interventions had similar effects on all secondary outcomes by 6 months. Participants with a baseline HiMAT < 27 gained greater benefit from ballistic training: 6 points (1 to 10) on the HiMAT. This randomised trial shows that ballistic resistance training has a similar or better effect on mobility than non-ballistic training in people with traumatic brain injury. It may be better targeted towards those with more severe mobility limitations. ACTRN12611001098921. [ABSTRACT FROM AUTHOR]

• Baseline pulse pressure was associated with future handgrip strength, gait speed, and 6-min walking distance among older adults in this study. • Older adults with both high systolic blood pressure (≥140 mmHg) and high pulse pressure (≥60 mmHg) had a significantly increased risk of future weakness, slowness, and lower endurance. • Controlling pulse pressure could slow the age-related decline in physical function. This study examined the associations between pulse pressure, hypertension, and the decline in physical function in a prospective framework. The Healthy Aging Longitudinal Study tracked a group of Taiwanese adults aged 55 or more over an average of 6.19 years to assess pulse pressure and decline in physical function, including in handgrip strength, gait speed, and 6-min walking distance, at baseline (2009–2013) and in the second phase of assessments (2013−2020). Pulse pressure was calculated as the difference between systolic and diastolic blood pressure values. Weakness, slowness, and low endurance were defined as decreases of ≥0.23 m/s (one standard deviation) in gait speed, ≥5.08 kg in handgrip strength, and ≥ 57.73 m in a 6-min walk, as determined from baseline to the second phase of assessment. Linear and logistic regressions were employed to evaluate the associations between pulse pressure, hypertension, and decline in physical function. Baseline pulse pressure was associated with future handgrip strength (beta = −0.017, p = 0.0362), gait speed (beta = −0.001, p < 0.0001), and 6-min walking distance (beta = −0.470, p < 0001). In multivariable models, only handgrip strength (beta = −0.016, p = 0.0135) and walking speed (beta = −0.001, p = 0.0042) remained significantly associated with future pulse pressure. Older adults with high systolic blood pressure (≥140 mmHg) and elevated pulse pressure (≥60 mmHg) exhibited a significantly increased risk of weakness (odds ratio: 1.30, 95 % confidence interval: 1.08–1.58), slowness (1.29, 1.04–1.59), and diminished endurance (1.25, 1.04–1.50) compared with the reference group, who exhibited systolic blood pressure of <140 mmHg and pulse pressure of <60 mmHg. Among older adults, pulse pressure is associated with a decline in physical function, especially in terms of strength and locomotion. [ABSTRACT FROM AUTHOR]

• A fully automated system for gait analysis in the context of frailty. • Extraction of original features describing the older adults gait in regards to frailty status. • Assessment of frailty trajectory in elderly under unsupervised conditions during daily routine. • An added value in comparison with the standard frailty phenotype. Frailty in older individuals has been a hot research topic in the past two decades. This syndrome of physiological decline is characterized by damage to physical function. In the literature, walking speed and gait variability have been discussed and identified as major indicators of frailty. Short walking tests under supervised conditions are frequently considered when assessing the frailty status, where the subject is instructed to walk a certain distance, and the speed and temporospatial features are compared to thresholds. In this paper, we propose a more generalized and fully automated approach using wearable sensors, by suggesting a set of parameters extracted from acceleration signals. The interconnections between these variables, which are related to the gait quality and the frailty trajectory of the subject, are investigated. This study was done on older adults of diverse profiles, in free-living conditions during their daily routine, without any predefined protocol. [ABSTRACT FROM AUTHOR]

In recent years the focus of healthcare and nutritional science in older adults has shifted from mortality towards physical performance and quality of life. The aim of this review was to summarize observational studies on physical performance in malnourished (MN) or at risk of malnutrition (RMN) older adults compared with well-nourished (WN) older adults. Eligible studies had to report on nutritional status and objectively measured physical performance in older adults (≥60 y). MN or RMN groups had to be compared with a WN group, measured with a validated nutrition screener. Ovid Medline and Web of Science were searched until 13 November, 2020. Study quality was scored using a modified Newcastle–Ottawa Scale (NOS). Results were analyzed by meta-analysis when possible, or narratively reviewed otherwise. Forty-five studies (16,911 participants in total) were included from studies in outpatient clinics (n = 6), nursing homes (n = 3), community-dwelling older adults (n = 20), hospitalized patients (n = 15), or a combination (n = 1). Studies used 11 different screeners of malnutrition, and 8 types of physical performance measures. Meta-analysis showed that compared with MN, WN groups had better hand grip strength (mean difference [MD] = 4.92 kg; 95% CI: 3.43, 6.41; P < 0.001; n = 23), faster gait speed (MD = 0.16 m/s; 95% CI: 0.05, 0.27; P = 0.0033; n = 7), performed faster on timed-up-and-go (MD = –5.94 s; 95% CI: –8.98, –2.89; P < 0.001; n = 8), and scored 1.2 more short physical performance battery points (95% CI: 1.32, 2.73; P < 0.001; n = 6). Results were less pronounced when compared with RMN. Narratively, all studies showed an association for knee extension strength, 6-min walking test, and multicomponent tests, except for the chair stand test. Study limitations include no studies scoring "good" on NOS, lack of confounder adjustment, and high heterogeneity. Overall, evidence from cross-sectional studies indicate an association between malnutrition and worse physical performance in older adults. This study is registered in PROSPERO as CRD42020192893. [ABSTRACT FROM AUTHOR]

• Dynapenia: grip strength <17 and <20 kg identifies WS decline in women. • Probable sarcopenia: grip strength < 17 and < 20 kg identifies WS decline in women. • Low SMMI and sarcopenia in women didn't identify mobility decline risk. • Dynapenia, low SMMI, sarcopenia in men didn't identify mobility decline risk. To determine the best indicator of mobility decline between dynapenia, low skeletal muscle mass index (SMMI), and sarcopenia defined by the EWGSOP 2 using different cutoff points for grip strength. A longitudinal study was conducted with a follow-up of eight years, involving 2,680 individuals aged 60 and older who participated in the ELSA study with a walking speed greater than 0.8 m/s at baseline. Dynapenia was defined using different cutoff points for grip strength. SMMI was defined by the 20th percentile of the entire ELSA sample distribution and sarcopenia was defined based on the EWGSOP2 , using different cutoff points for grip strength. Mobility was analysed using the walking speed test. Over time, the greatest decline in walking speed occurred in dynapenic women with grip strength < 17 kg (-0.005 m/s per year; 95 % CI: -0.01 to -0.001) and < 20 kg (-0.007 m/s per year; 95 % CI: -0.01 to -0.001). With regards to sarcopenia, the greatest walking speed decline occurred in women with probable sarcopenia when defined by grip strength < 17 kg [(-0.006 m/s per year; 95 % CI: -0.01 to -0.001) or grip strength < 20 kg (-0.007 m/s per year; 95 % CI: -0.01 to -0.001)]. Dynapenia in men as well as low SMMI and sarcopenia in men and women did not enable identifying the risk of mobility decline. Dynapenia and probable sarcopenia defined by grip strength < 17 kg and < 20 kg enabled identifying walking speed decline over time only in women. [ABSTRACT FROM AUTHOR]

The onset of sarcopenia is intimately linked with aging, posing significant implications not only for individual patient quality of life but also for the broader societal healthcare framework. Early and accurate identification of sarcopenia and a comprehensive understanding of its mechanistic underpinnings and therapeutic targets paramount to addressing this condition effectively. This review endeavors to present a cohesive overview of recent advancements in sarcopenia research and diagnosis. We initially delve into the contemporary diagnostic criteria, specifically referencing the European Working Group on Sarcopenia in Older People (EWGSOP) 2 and Asian Working Group on Sarcopenia (AWGS) 2019 benchmarks. Additionally, we elucidate comprehensive assessment techniques for muscle strength, quantity, and physical performance, highlighting tools such as grip strength, chair stand test, dual-energy X-ray Absorptiometry (DEXA), bioelectrical impedance analysis (BIA), gait speed, and short physical performance battery (SPPB), while also discussing their inherent advantages and limitations. Such diagnostic advancements pave the way for early identification and unequivocal diagnosis of sarcopenia. Proceeding further, we provide a deep-dive into sarcopenia's pathogenesis, offering a thorough examination of associated signaling pathways like the Myostatin, AMP-activated protein kinase (AMPK), insulin/IGF-1 Signaling (IIS), and the nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathways. Each pathway's role in sarcopenia mediation is detailed, underscoring potential therapeutic target avenues. From a mechanistic perspective, the review also underscores the pivotal role of mitochondrial dysfunction in sarcopenia, emphasizing elements such as mitochondrial oxidative overload, mitochondrial biogenesis, and mitophagy, and highlighting their therapeutic significance. At last, we capture recent strides made in sarcopenia treatment, ranging from nutritional and exercise interventions to potential pharmacological and supplementation strategies. In sum, this review meticulously synthesizes the latest scientific developments in sarcopenia, aiming to enhance diagnostic precision in clinical practice and provide comprehensive insights into refined mechanistic targets and innovative therapeutic interventions, ultimately contributing to optimized patient care and advancements in the field. [Display omitted] [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]

Gait is one of the best measures of physical function in older adults. The study examined the association between spatiotemporal gait variables and mortality among older adults. The participants were 4,298 older adults in the National Center for Geriatrics and Gerontology - Study of Geriatric Syndromes. At baseline we measured the following spatiotemporal gait variables: gait speed, stride length, cadence, and stride length variability. Demographic variables, medical conditions, cognitive function, and physical inactivity were also assessed at baseline. We obtained gait measurements over five trials using an electronic gait-measuring device mounted at the middle 2.4 m section of a 6.4 m straight and flat pathway, with 2 m allowed for acceleration and deceleration. Participants' usual gait speed was measured. Subsequent incident death was confirmed using administrative data. During follow-up (mean duration: 1,571 days), there were 185 incident deaths among participants. Low function on all gait variables increased risk of mortality (adjusted hazard ratio [95% confidence interval], gait speed: 1.83 [1.31-2.56], stride length: 1.85 [1.31-2.62], cadence: 1.60 [1.17-2.18], stride length variability: 1.50 [1.09-2.06]). In addition, mortality risk increased with the number of variables showing low gait function compared with normal gait function (p < .05). Slower gait speed, shorter stride length, lower cadence, and higher stride length variability were associated with increased mortality. Multifaceted gait analysis could be useful for evaluating mortality risk. [ABSTRACT FROM AUTHOR]

Although oxygen uptake (VO 2) during exercise stress is a surrogate marker for prognosis in patients with cardiovascular disease (CVD), the stress test is sometimes difficult to perform owing to patient conditions, such as ageing or comorbidities. We investigated the relationships between VO 2 during usual gait with physical function and prognosis in patients with CVD. This single-centre observational study enrolled consecutive patients who were hospitalized for CVD treatment. Isometric quadriceps strength (QS) and 6-min walk distance (6MWD) as physical functions, and VO 2 during usual gait speed were measured at hospital discharge. We assessed the changes in VO 2 per body weight between at rest and during gait divided by gait speed (VO 2 /kg/gait) and analysed the relationships of VO 2 /kg/gait with physical functions and composite incidences of all-cause death or unplanned readmission after discharge. In 367 patients (age, 65 ± 13 years; females, 34%), 112 clinical events occurred. VO 2 /kg/gait showed significant negative correlations to QS (β = −0.114, p = 0.024) and 6MWD (β = −0.163, p < 0.001) after adjusting for confounding factors. High VO 2 /kg/gait was significantly associated with a high rate of clinical events (hazard ratio for 1 standard deviation of VO 2 /kg/gait, 1.36; 95% confidence interval, 1.11–1.66). This association was also observed in subgroups of older age and frailty. High VO 2 during usual gait was a relevant factor for low physical function and poor prognosis in patients with CVD and even in older age and frailty, meaning that VO 2 during usual gait might be a novel and useful marker in clinical practice. [Display omitted] • VO 2 during usual gait is an indicator of movement efficiency. • We examined the clinical usefulness of VO 2 during usual gait in patients with CVD. • A high VO 2 during gait correlated with low physical function and high incident rate. • High gait VO 2 correlated with a poor prognosis in subgroups of older age and frailty. • VO 2 during gait is a useful marker that is relevant to physical function and prognoses in CVD. [ABSTRACT FROM AUTHOR]

Background: Locomotive syndrome (LS) was proposed by the Japanese Orthopedic Association and refers to a scenario in which imminent future nursing care services will be required by elderly adults to manage the functional deterioration of their locomotive organs. It is a social imperative to clarify the risk factors and treatment strategy for LS. However, the relationship between LS and adult spinal deformity (ASD) in those who are treated with spinal corrective surgery remains largely unknown.Methods: Forty consecutive patients who had ASD and underwent spinal surgery for their disorder were included in this study. Locomotive dysfunction was evaluated using the 25-item Geriatric Locomotive Function Scale-25 (GLFS-25) questionnaire and physical performance tests including the one-legged standing test, the two-step test, the stand-up test, the handgrip strength, and gait speed test which were measured preoperatively, 6 months after surgery, and 1 year after surgery.Results: Of the patients with ASD treated surgically, 95% of them had LS preoperatively and LS prevalence decreased significantly 1 year after surgery by 67.5% compared with the preoperative rate. Among physical performance tests, the walking stride and one-legged standing test improved significantly after spinal corrective surgery. The GLFS-25 items for the domains of pain, mobility, and domestic life improved overall postoperatively, whereas items in the self-care domain did not and the item for difficulty in putting on and taking off trousers and pants worsened.Conclusions: Spinal corrective surgery significantly improved physical performance tests as well as the frequency and severity of LS in patients with ASD. However, some GLFS-25 items can worsen after surgery and require attention. [ABSTRACT FROM AUTHOR]

Background: This study aims to evaluate the association between the risk of hip fracture and score on the Short Physical Performance Battery (SPPB) and handgrip strength in community-dwelling elderly people in China.Methods: A total of 5,958 community-dwelling Chinese people aged 60 years or more from the China Health and Retirement Longitudinal Study (CHARLS) were surveyed in 2011 (baseline) and followed through to 2016. Score on the SPPB (which comprises tests of balance, walking speed, and repeated chair stands) and handgrip strength were determined at baseline. Binary logistic regression models were used to estimate the risk ratio (RR) and 95 % CI.Result: During an average of approximately 4 years of follow-up, 180 (3.0 %) participants experienced incident hip fracture. After multivariate adjustment, the overall SPPB score and repeated chair stands alone distinguished a gradient of hip fracture risks. The risk of hip fracture was 1.65-fold higher in poor SPPB performers (score 0-6) than in good SPPB performers (score 10-12). Participants unable to complete repeated chair stands, and those who took ≥16.7 s or 13.7-16.6 s to complete them, had a higher risk than those who took ≤ 11.1 s to complete them, with RRs of 2.45, 2.12, and 1.93, respectively. Participants unable to complete the balance tests had a higher hip fracture risk than those with scores of 4, with an RR of 2.16. Walking speed and handgrip strength were not associated with increased hip fracture risk.Conclusion: Among community-dwelling elderly Chinese people, overall SPPB score, as well as performance on repeated chair stands and balance tests within the SPPB, were significantly and independently associated with increased hip fracture risk. These indicators could be used to predict hip fracture in clinical settings. [ABSTRACT FROM AUTHOR]

Challenging children with Down syndrome to walk fast and with external ankle load has demonstrated acute adjustments, such as increased step length and decreased step width, and improved joint stability. However, it is unknown to what extent these task constraints affect gait stability. Assessing dynamic gait stability through margin-of-stability not only quantifies adjustments related to balance control, but also informs safety considerations. Twenty-four children with and without Down syndrome participated in this study. Subjects walked overground at two speed conditions: self-selected (normal) and as fast as possible (fast); and two ankle load conditions: no load and ankle load of 2% body mass. We assessed margin-of-stability in the anteroposterior and mediolateral directions, separately, at three gait events of toe-off, mid-swing, and heel strike. Children with Down syndrome walked with greater mediolateral margin-of-stability than typically developing children. Children with Down syndrome demonstrated less anteroposterior margin-of-stability than typically developing children only before heel-strike at normal speed but increased anteroposterior margin-of-stability at fast speed. The ankle load increased the mediolateral margin-of-stability in both groups but did not impact the anteroposterior margin-of-stability. In addition, children with Down syndrome took shorter and wider steps for more lateral placement of mediolateral margin-of-stability. Children with Down syndrome were capable of adjusting their margin-of-stability for fast walking and ankle-load conditions. However, children with Down syndrome walked with less mediolateral stability and anteroposterior mobility than typically developing children. Children with Down syndrome overcompensate the mediolateral foot placement to recapture their margin-of-stability and maintain gait stability. • Children with Down syndrome walked with a distinct joint pattern compared to peers. • Increased walking speed improved ankle kinematics, but challenged knee kinematics. • Ankle load improved hip and knee kinematics, but challenged ankle plantarflexion. • Intervention design can consider the manipulation of walking speed and ankle load. [ABSTRACT FROM AUTHOR]

The primary objective of this study was to determine whether pretransplant physical function is correlated with posttransplantation outcomes. We performed a retrospective study of patients that participated in pretransplantation screening and subsequently underwent lung transplantation. Pretransplant variables of interest included demographics, muscle mass, body composition, physical function, and physical frailty. Correlation tests were performed to assess relationships with significance set at 0.05. Twenty-five patients with a mean age of 57 ± 13 years (68% male) with pretransplant lung allocation score of 45 ± 14 were included. This cohort had a 3-year mortality rate of 32% (n = 8). Pretransplant 4-m gait speed was significantly related to performance on the Short Physical Performance Battery (r = 0.74, P =.02) and distance ambulated on the 6-minute walk test (r = 0.62, P =.07) at hospital discharge. Older age was associated with slower gait speed and worse performance on sit-to-stand testing at hospital discharge (r = −0.76, P =.01 and r = −0.75, P =.01, respectively). Statistically, only diagnosis of cystic fibrosis was associated with 3-year mortality. Our study demonstrates that demographic, clinical, and physical function assessed prior to lung transplantation may be indicators of functional recovery. [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]

Hypophosphatasia (HPP) is a rare, heritable metabolic disorder caused by deficient activity of tissue-nonspecific alkaline phosphatase (TNSALP). Asfotase alfa (AA) is a human recombinant TNSALP that promotes bone mineralization and is approved to treat eligible patients with HPP. This prospective single-center observational study evaluated AA in adults with pediatric-onset HPP over 2 years of treatment (ClinicalTrials.gov NCT03418389). Primary outcomes evaluated physical function; secondary outcomes assessed quality of life (QoL) and pain. The study included 17 females and 5 males (mean age: 48.7 years). Median distance walked in the 6-Minute Walk Test increased significantly from baseline to 12 months (P = 0.034) and results were sustained. Median Timed Up and Go test time significantly decreased from baseline at 12 (P = 0.003) and 24 months (P = 0.005), as did the median chair rise time test at 12 (P = 0.003) and 24 months (P < 0.002). The change from baseline in usual gait speed was significant at 12 (P = 0.003) and 24 months (P = 0.015). Mean dominant and nondominant hand grip strength improved at 24 months (P = 0.029 and P = 0.019, respectively). Median Short Form 36 Physical Component Summary scores significantly improved from baseline at 12 (P = 0.012) and 24 (P = 0.005) months, and median Lower Extremity Functional Scale scores improved from baseline at 12 (P = 0.001) and 24 (P = 0.002) months. No significant change was noted in pain level at these timepoints. While injection site reactions occurred in 86.4 % of the participants, there were no severe side effects or safety findings. Adults with pediatric-onset HPP treated with AA experienced marked improvement in functional and QoL outcomes that were observed as early as within 3 months of initial treatment and were sustained over 24 months. • Asfotase alfa in adults with hypophosphatasia was evaluated over 24 months. • Patients had marked improvement in functional and quality of life outcomes. • Response of bone turnover markers suggests onset of bone tissue remodeling. [ABSTRACT FROM AUTHOR]

• The adjusted predictive modeling (APM) method estimates interpretational thresholds. • The APM method generates biologically plausible cutpoints for mobility difficulty. • The APM-based cutpoints are more precise than ROC-based cutpoints. • The APM method uses common regression methods and can be easily applied. Clinical interpretability of the gait speed and 5-times sit-to-stand (5-STS) tests is commonly established by comparing older adults with and without self-reported mobility limitations (SRML) on gait speed and 5-STS performance, and estimating clinical cutpoints for SRML using the receiver operating characteristics (ROC) method. Accumulating evidence, however, suggests that the adjusted predictive modeling (APM) method may be more appropriate to estimate these interpretational cutpoints. Thus, we aimed to compare, in community-dwelling older adults, gait speed and 5-STS cutpoints estimated using the ROC and APM methods. Cross-sectional study. This study analyzed data from 955 community-dwelling independently walking older adults (73%women) aged ≥60 years (mean, 68; range, 60–88). Participants completed the 10-metre gait speed and 5-STS tests. Participants were classified as having SRML if they responded "Yes" to either of the 2 questions regarding walking and stair climbing difficulty. Cutpoints for SRML and its component questions were estimated using ROC analysis with Youden criterion and the APM method. The proportions of participants with self-reported walking difficulty, self-reported stair climbing difficulty, and SRML were 10%, 19%, and 22%, respectively. Gait speed and 5-STS time were moderately correlated with each other (r =-0.56) and with the self-reported measures (absolute r- values, 0.39–0.44). ROC-based gait speed cutpoints were 0.14 to 0.16 m/s greater than APM-based cutpoints (P < 0.05) whilst ROC-based 5-STS time cutpoints were 0.8 to 3.3 s lower than APM-based cutpoints (P < 0.05 for walking difficulty). Compared with ROC-based cutpoints, APM-based cutptoints were more precise and they varied monotonically with self-reported walking difficulty, self-reported stair climbing difficulty, and SRML. In a sample of 955 older adults, our findings of precise and biologically plausible gait speed and 5-STS cutpoints for SRML estimated using the APM method indicate that this promising method could potentially complement or even replace traditional ROC methods. [ABSTRACT FROM AUTHOR]

Falls and decreased physical function increase markedly with age and result in injury, hospitalization, and premature death. Emerging studies show potential benefits of supplemental cocoa extract on physical performance, including grip strength and walking speed in older adults. However, there are no large, long-term randomized controlled trials of effects of supplemental cocoa extract on falls, muscle performance, and/or fall-related injuries. The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is a double-blind, placebo-controlled, 2 × 2 factorial trial investigating effects of supplementation with cocoa extract (500 mg/d, including 80 mg (−)-epicatechin) and/or a multivitamin on prevention of cardiovascular disease and cancer in 21,442 women (≥65 years) and men (≥60 years). COSMOS: Effects on Falls and Physical Performance is an ancillary study to COSMOS that will clarify effects of cocoa extract and/or multivitamin supplementation on falls, physical performance, and incident fracture outcomes in older adults. Injurious fall(s) resulting in healthcare utilization and recurrent falls were regularly assessed by follow-up questionnaires in the overall cohort. Incident fractures were also assessed by annual questionnaires. Circumstances surrounding falls and any fall-related injuries will be confirmed by medical record review. Effects of the interventions on 2-year changes in physical performance measures (grip strength, walking speed, and the Short Physical Performance Battery) will be tested in a clinic sub-cohort (n = 603). Results from this ancillary study will determine whether supplemental cocoa extract slows age-related declines in physical performance and decrease injurious and recurrent falls and fall-related injuries and fractures that are major public health problems in older adults. [ABSTRACT FROM AUTHOR]

• Intensive exercise in the early postoperative rehabilitation after hip fracture (up to 3 months postoperatively) is beneficial to the recovery of physical function in older adults. • Intensive exercise with more load lead to greater improvements in muscle strength, balance, and functional ability. • Older adults with cognitive impairment were not included in the studies selected for this review, conclusions about the training results may not be extended to this population. Individuals commonly experience age-related systemic decreases in skeletal muscle strength, physical function, and mobility, leading to falls and potential associated hip fractures. To evaluate whether intensive exercise can improve physical function, mobility, and independence in activities of daily living (ADL) and shorten the length of hospital stay in older adults after hip fracture surgery. This systematic review was conducted under the PRISMA guidelines. Searches were performed on January 5, 2022 in eight databases. Randomized controlled trials (RCTs) were included. The participants included older adults with hip fracture, and the intervention studied was intensive exercise. The outcomes were physical function, mobility, ADLs, and the length of hospital stay. Meta-analyses were conducted using RevMan 5.3. Fifteen studies were included in this review. After hip fracture surgery, intensive exercise improved participants' physical function to a greater extent than regular or no exercise (standardized mean difference [SMD] = 0.74; 95% CI: 0.25, 1.23). Intensive exercise was particularly more effective for gait speed (SMD = 0.15, 95% CI: 0.01, 0.30), the timed up-and-go test results (mean difference [MD] = -4.34, 95%CI: -6.74, -1.94), balance (SMD =0.42, 95% CI: 0.38, 0.89), and ADLs (SMD = 0.55, 95% CI: 0.24, 0.87). The quality of the evidence was low due to risk of bias, inconsistency, and imprecision. Intensive exercise early post-operation provides potential additional benefits compared to no or regular exercises on older adults after hip fracture surgery. [ABSTRACT FROM AUTHOR]

An aberrant intestinal permeability is often associated with systemic inflammation and cardiovascular diseases accompanied by compromised physical performance. However, the link between these complications is poorly defined. Here we investigated the potential association of zonulin, a regulator of intestinal permeability, with ischemic and non-ischemic heart failure (HF) and, associated physical disability. The investigation including echocardiography, short physical performance battery (SPPB) and measurement of plasma zonulin and c-reactive protein (CRP), was performed in 59 HF patients and an equal number of healthy controls. As expected, the left ventricular end-systolic dimension (LVESD) was significantly higher, which was accompanied by a significantly lower LV ejection fraction (EF) in the HF patients compared to controls. The levels of plasma zonulin and CRP was profoundly elevated in both ischemic (P < 0.0001) and non-ischemic (P < 0.01) HF patients. Interestingly, LVESD positively (r2 = 0.156, P = 0.001) and LVEF negatively (r2 = 0.186, P = 0.0006) correlated with the level of zonulin in HF patients. The SPPB scores for balance, chair sit-to-stand (STS), gait speed (GS), and hand grip strength (HGS) were consistently compromised in HF patients. Moreover, LVESD was negatively (r2 = 0.118, P = 0.007), and there was trend of positive correlation of LVEF (r2 = 0.05, P = 0.08) with the SPPB scores for balance. Consistently, zonulin levels was negatively correlated with SPPB scores for balance (r2 = 0.176, P = 0.0009), STS (r2 = 0.120, P = 0.001) and HGS (r2 = 0.085, P = 0.02). Chronic cardiac complications induce the level of plasma zonulin, which predicts the cardiac remodeling and dysfunction and physical performance in patients with chronic HF. [ABSTRACT FROM AUTHOR]

The present study explored cross-sectional and longitudinal associations between protein intake and physical function in older adults. We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated the association between protein intake and measures of physical function in older adults. Cross-sectional, case-control, and longitudinal cohort studies that investigated the association between protein intake and physical function as a primary or secondary outcome in people aged 60 + years were included. Studies published in languages other than English, Italian, Portuguese, or Spanish were excluded. Studies were retrieved from MEDLINE, SCOPUS, EMBASE, CINAHL, AgeLine, and Food Science Source databases through January 31, 2022. A pooled effect size was calculated based on standard mean differences (SMD), MD, log odds ratio (OR) and Z-score.. Twenty-two cross-sectional studies examined a total of 11,332 community-dwellers, hospitalized older adults, and elite senior athletes with a mean age of approximately 75 years. The pooled analysis indicated that a protein intake higher than the recommended dietary allowance (RDA) was significantly associated with higher Short Physical Performance Battery (SPPB) scores (SMD: 0.63, 95% CI: 0.27, 0.99, P-value: 0.0006), faster walking speed, greater lower-limb (SMD: 0.22, 95% CI: 0.04, 0.40, P-value: 0.02) and isometric handgrip strength (Z-score: 0.087, 95% CI: 0.046–0.128, P-value: 0.0001), and better balance (SMD: 0.33, 95% CI: 0.05, 0.62, P-value: 0.02). Nine longitudinal studies investigated 12,424 community-dwelling and native older adults with a mean age of approximately 85 years. A protein intake higher than the current RDA was not associated with lower decline in either isometric handgrip strength (logOR: 0.99, 95% CI: 0.97–1.02, P-value= 0.67) or walking speed (logOR: 0.92, 95% CI: 0.77–1.10, P-value= 0.35). A protein intake higher than the RDA is cross-sectionally associated with better physical performance and greater muscle strength in older adults. However, a high consumption of proteins does not seem to prevent physical function decline over time. • A protein intake higher than the current RDA is significantly associated with numerous several physical performance tests. • A protein intake higher than the current RDA is not longitudinally associated with upper-limb muscle strength and mobility. • No clear associations were found between protein distribution or sources and physical function. [ABSTRACT FROM AUTHOR]

Slowness, generally assessed by walking speed (WS), is an estimator of frailty and its outcomes. Because of potential difficulties in assessing WS, the Moberg picking-up test (MPUT) might be an alternative. This study investigated the capacity of slowness measurements (WS and MPUT) to predict nonfatal adverse consequences of frailty: primarily, decline in basic activities of daily living (BADL); and secondarily, decline in instrumental activities of daily living (IADL), fall, hospitalization, and incident disease. Observational (prospective longitudinal study). This study used data from the population-based Lausanne cohort 65+. At baseline, 1887 individuals (aged 72-77 years) completed both WS (time to walk 20 m at usual pace) and MPUT (time to pick up 12 objects) assessments. All outcomes, assessed at 1- and 4-year follow-ups, were entered in separate logistic regression models with adjustment for age, sex, and respective values at baseline. The prediction of all outcomes by either WS or MPUT was assessed using area under the receiver operating characteristic curve and compared by χ2 tests. There were positive associations between slowness either assessed by WS [relative risk (RR) = 2.48; P <.001] or MPUT (RR = 1.91; P <.001) and decline in BADL at 1-year follow-up. These associations remained significant at 4-year follow-up for both WS (RR = 2.28; P <.001) and MPUT (RR = 1.95; P <.001). There was no significant difference between predictive values of slow WS and MPUT for decline in BADL at 1-year (P =.328) and 4-year follow-ups (P =.413). The prediction was not significantly different for secondary outcomes, except for decline in IADL for which the prediction was slightly better for WS. MPUT may be an alternative measurement of slowness with predictive value of functional decline. No significant difference in predictive capabilities of MPUT and WS for specific adverse consequences of frailty is promising in favor of using MPUT for measuring slowness. [ABSTRACT FROM AUTHOR]

Slow gait speed and sit-to-stand performance are associated with adverse clinical outcomes in older adults. Identifying older adults with functional performance "below norms" is the first step toward prevention. We aimed to (1) examine the associations of age, body height, and gender with gait speed and sit-to-stand performance and (2) develop subgroup-specific reference ranges in older adults with no self-reported mobility limitations. Cross-sectional study. This study analyzed data from 775 community-dwelling older adults who reported no difficulty walking 100 m, climbing stairs, and rising from the chair. Gait speed and sit-to-stand performance were measured by the 10-m gait speed test and 5-times sit-to-stand test, respectively. Bayesian linear regression was used to derive 95% reference ranges for gait speed and sit-to-stand performance, defined by different levels of age, body height, and gender. Overall, 95% reference range was 0.89-1.79 m/s for habitual gait speed and 7.4-27.9 stands/30 s for sit-to-stand pace. Age had the highest posterior probability (>99%) of a meaningful association with both functional outcomes. Additionally, height was strongly associated with gait speed: a 10-cm increase in height was associated with 0.07 m/s (95% credible interval, 0.05-0.10) faster gait speed. For sit-to-stand test, the lower 95% reference range limits tended to be similar across gender and gender-specific height subgroups, owing to the associations of faster sit-to-stand pace with shorter height and male gender. Because extensive tables of reference ranges are impractical, a web-based application (https://sghpt.shinyapps.io/ippts/) is created to provide subgroup-specific reference ranges. In a large sample of mobile-intact older adults, reference ranges for gait speed and sit-to-stand performance differed meaningfully by age. Furthermore, gait speed was stature dependent. Although requiring validation, our findings may be used to define subgroup-specific "below-range" values and to complement existing universal clinical cut points for gait speed and sit-to-stand performance. [ABSTRACT FROM AUTHOR]

• The chair stand test was a better predictor of mortality than gait speed. • Those with poorer mobility are at increased risk of dying from cardiovascular causes. • Cognitive impairment increased the risk of dying among those with worse mobility. • Multimorbidity also increased the risk of dying among those with worse mobility. • Worst performance in the tests was marginally associated with mortality by neoplasms. A better understanding of performance in functional mobility tasks related to the mortality patterns for the different causes of death for the Brazilian older population is still a challenge. To analyze if gait speed and chair stand test performance are associated with mortality in older adults, and if the overall mobility status changes the effect of other mortality risk factors. The data were from SABE (Health, Well-being and Aging Study), a multiple-cohort study conducted in São Paulo, Brazil, with a representative sample of people aged 60 and more. Cox regression models were used to analyze 10-year all-cause and cause-specific mortality with consideration for gait speed and the chair stand test. Of the 1411 participants, 26% died during the follow-up. The performance in the chair stand test had a more consistent association with mortality (hazard ratio (HR)=1.03, 95%CI: 1.00, 1.05) than gait speed. Being unable to perform the test also increased the risk to die by all-cause (HR=1.71, 95%CI: 1.21, 2.42) and by diseases of the circulatory system (HR=2.14, 95%CI: 1.25, 3.65). The stratified analysis of mobility performance changed the effects of some of the mortality risk factors, such as cognitive impairment and multimorbidity. The chair stand test could be a better choice than 3-meters walking test as a mortality predictor. In addition, the impact of cognitive decline and multimorbidity were greater among those with reduced mobility, supporting the development of preventive interventions and public policies targeted at more vulnerable groups of older adults. [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]

Retraining stepping reactions in people post-stroke is vital. However, the relationship between the stimulus and resulting stepping performance in people post-stroke is unknown. We explored relationships between stepping stimulus and stepping reactions initiated by either paretic or non-paretic legs of people post-stroke and controls. Relationships were examined in the context of clinical measures of balance. Centre of mass dynamics were measured during self-initiated destabilizing leaning stimuli that required stepping reactions by paretic and non-paretic legs of people post-stroke (n = 10) and controls (n = 10) to recover balance. Step characteristics of the first two steps of stepping reactions were measured. Correlations were calculated between clinical measures of balance and mobility and the centre of mass and step characteristics. Steps were shorter and slower with decreased centre of mass fore-aft and downward displacement and velocity when initiated by paretic and non-paretic legs compared with controls. However, increase in centre of mass displacement and velocity in the fore-aft and downward direction tended to be associated with a greater increase in step length and speed when stepping reactions were initiated by the paretic and non-paretic legs compared with controls. Time to step initiation in response to onset of falling stimulus did not differ between groups. Strong positive correlations were found between clinical balance and mobility scores and centre of mass and step dynamics in fore-aft and vertical directions. These results support objective measurement of centre of mass to quantify the stimulus influencing step dynamics and stepping performance during retraining interventions following stroke. • Centre of mass and step characteristics are associated in step reactions. • Centre of mass/step characteristics are associated with balance post-stroke. • Centre of mass dynamics may inform retraining stepping reactions post-stroke. [ABSTRACT FROM AUTHOR]

Gait speed is a simple, inexpensive and clinically useful marker of physical function in older adults. We aimed to establish gait speed reference values for community-dwelling older adults. To this end, we further explored the association of age, sex and height with gait speed. This study included community-dwelling participants aged 50 years and over enrolled in the Rotterdam Study. Participants completed the gait protocol between 2009 and 2016. The mean gait speed was calculated for age and height groups, stratified by sex. Reference values for gait speed were calculated using a quantile regression model adjusted for sex, the non-linear effects of age and height, as well as the interaction between age and sex plus the interaction between age and height. The study population included 4656 Dutch participants with a mean (standard deviation) age of 67.7 (9.5) years, comprising 2569 (55.2%) women. The mean height of the participants was 1.69 (0.10) meters and the mean gait speed was 1.20 (0.20) m/s. Gait speed was lower with older age and greater with taller stature, but the effect of height disappeared above the age of 80 years. Sex did not affect gait speed after accounting for age and height. Age-, sex-, and height-specific reference values for gait speed are available for use at https://emcbiostatistics.shinyapps.io/GaitSpeedReferenceValues/. We found that height explains the commonly noted difference in usual gait speed between sexes and that neither height nor sex impacts gait speed in the very oldest adults. We developed reference values for usual gait speed in Western European community-dwelling older adults. • Height explains commonly noted sex differences in usual gait speed. • Neither height nor sex impacts gait speed in the very oldest adults. • We established gait speed reference values for a community based Dutch population. • We created a web application to allow interpretation of gait speed reference values. [ABSTRACT FROM AUTHOR]

• Significant improvement in fatigue, shortness of breath and a sense of unwellness occurs within 2 weeks of starting ibrutinib in CLL patients. • Ibrutinib rapidly improves physical activities, such as sit-to-stand and 4 m walking speeds, in CLL patients. • Ibrutinib suppresses the inflammatory cytokine and signaling molecules, TNF-α/-β, CCL3, CCL4, CCL17, and IL-16 levels, in CLL patients. A prospective pilot study was carried out on 34 CLL patients treated with ibrutinib, evaluating the effects on symptoms and physical function with changes in plasma exosomes (EXs), β2-microglobulin (β2M) and 26 plasma cytokines. The revised Edmonton Symptom Assessment Scale (ESAS-R) demonstrated moderate fatigue, shortness of breath and a sense of unwellness before treatment, which significantly improved within 2 weeks of starting ibrutinib. These changes were associated with a rapid improvement in sit-to-stand and 4 m walking speeds. The plasma levels of CCL11, IL-7, -8 and -10 dropped initially while the levels of TNF-α/-β, CCL3, CCL4, CCL17, and IL-16 continued to decline for 12 months. Despite the initial lymphocytosis, plasma β2M levels fell but no consistent change in plasma EXs occurred. Thus, ibrutinib can produce a rapid and sustained improvement in symptoms and physical function in CLL, associated with a decline in multiple plasma cytokines. [ABSTRACT FROM AUTHOR]

• PCDS features the mutual declines of physical and cognitive function of older people. • 18.9% of the community-dwelling older persons had PCDS. • Multidomain intervention improved cognitive performance of PCDS, as well as some subdomains of physical function • PCDS is a potentially reversible condition that may prevent disability & dementia. To investigate the efficacy of a community group-based intervention among community-dwelling older adults with physio-cognitive decline syndrome (PCDS). A prospective cluster randomized controlled trial included 733 community-dwelling older adults with adjusted Montreal Cognitive Assessment (MoCA adj) scores >18 from 40 community-based sites across Taiwan. PCDS was defined as the concomitant presence of physical declines, i.e., slowness and/or weakness plus dysfunction in any cognitive domain. The multidomain intervention integrated physical exercise, cognitive training, nutritional advices and health education lessons. Conventional health education in control group entailed periodic telephone calls to offer participants health education and advice. The primary outcome was the mean differences of MoCA adj total scores and all domains of MoCA adj between baseline and 6- and 12-month follow-up in each group of PCDS, cognitive dysfunction, mobility-type frailty and normal functioning, and the secondary outcomes included the changes of frailty score, handgrip strength, gait speed and physical activity. Intervention effects were analysed using a generalized linear mixed model. Overall, 18.9% of the study sample had PCDS. Multidomain intervention for 12 months significantly improved cognitive performance in people with PCDS, and those with cognitive dysfunction only. An early benefit on visuo-spatial executive function was seen in older adults with mobility-type frailty. Intervention also improved frailty scores among participants with mobility-type frailty, handgrip strength for participants with PCDS, and gait speed in the normal group. PCDS is a potentially reversible condition that may prevent subsequent disability and dementia, which deserves further investigation to confirm the long-term effects. [ABSTRACT FROM AUTHOR]

• Handgrip < 32 kg was the best cutoff point to identify mobility limitation in men. • Handgrip < 21 kg was the best cutoff point to identify mobility limitation in women. • Handgrip < 32 kg for men has 49.1% sensitivity, 79.8% specificity and AUC of 0.82. • Handgrip < 21 kg for women has 58.6% sensitivity, 72.9% specificity and AUC of 0.83. Mobility limitation is commonly the first sign of impaired physical function and predisposes older adults to disability. Moreover, recent epidemiological studies have classified neuromuscular strength as the best explanator of mobility limitation. However, existing cutoffs have not been adequately analyzed regarding accuracy. Therefore, our aims were to define and compare the accuracy of different cutoff points of handgrip strength for the identification of mobility limitation. Cross-sectional study with 5783 participants from the SABE (Saúde, Bem-Estar e Envelhecimento [Health, Wellbeing and Aging]) and ELSA (English Longitudinal Study of Ageing) cohorts aged 60 years or older. Handgrip strength was measured using a dynamometer. Walking speed <0.8 m/s was considered mobility limitation. Receiver operating characteristic curves and probabilities of presenting mobility limitation were calculated. Handgrip strength <32 kg for men and <21 kg for women demonstrated good diagnostic accuracy for mobility limitation, with 49.1% sensitivity and 79.8% specificity for men and 58.6% sensitivity and 72.9% specificity for women. The fully adjusted models had an area under the curve of 0.82 for men and 0.83 for women, with odds of presenting mobility limitation of 1.88 [95% CI: 1.50 – 2.37] for men and 1.89 [95% CI: 1.57 - 2.27] for women. The results of this study support the accuracy of handgrip strength as a clinical marker of mobility limitation. Furthermore, manual dynamometry is easily incorporated into clinical practice, has a good cost-benefit, besides being a simple, valid, reliable and effective method for use in both the scientific community and outpatient practice. [ABSTRACT FROM AUTHOR]

Given the small but growing body of literature related to physical functioning and the scarce data related to fine motor and cognitive functioning in adults with hypophosphatasia (HPP), our objective was to characterize physical, functional, and cognitive performance in adults with HPP. A future objective is to utilize this characterization to develop guidelines for evaluation by physical therapists (PT), occupational therapists (OT), and speech-language pathologists (SLP). We evaluated physical, functional, and cognitive performance in 15 adults with HPP through standardized assessments of mobility, balance, fine motor control, activities of daily living, cognition, and self-reported measures of health-related quality of life, fatigue, depression, and anxiety. The median age at enrollment was 44 years (range 26–79 years). Among the participants, 11 (73%) were women. Five participants (33%) were on enzyme replacement therapy. Compared with the general population, HPP participants traveled shorter distances on the Six-Minute Walk Test (420 m (m) [SD: 132] vs 620 m [SD: 49], p < 0.00005), had slower gait on the 10-Meter Walk Test [HPP men (3.71 ft/s (f/s) [SD: 0.77] vs 4.70 f/s [SD: 0.14], p < 0.00005) and HPP women (3.39 f/s [SD: 0.67] vs 4.56 f/s [SD: 0.09], p < 0.00005)]. HPP participants had decreased upper extremity (UE) dexterity by Nine Hole Peg Test [right UE in HPP men (22.7 s (s) [SD: 2.3] vs 19.0 s [SD: 3.9], p = 0.03), left UE in HPP men (23.3 s [SD: 0.7] vs 19.8 s [SD: 3.7], p = 0.03), right UE in HPP women (19.8 s [SD: 2.0] vs 17.7 s [SD: 3.2], p = 0.01), and left UE in HPP women (21.1 s [SD: 2.5] vs 18.9 s[SD: 3.4], p = 0.02)], and some had abnormally slow bilateral UE reaction times via Dynavision (0.9 s [0.85,0.96], functional speed <1.15 s). On the Short Form-36 (SF36), HPP patients reported worse energy/fatigue (30.4 [SD 22.7] vs 52.2 [SD: 22.4], p = 0.0001), social functioning (54.5 [SD: 34.2] vs 78.8 [SD: 25.5], p = 0.0002), pain (46.1 [SD: 27.3] vs 70.8 [SD: 25.5], p = 0.0001), general health (36.8 [SD: 24.0] vs 57.0 [SD: 21.1], p = 0.0002), and health change i.e. perception of health improvement (32.1 [SD: 15.3] vs 59.1 [SD: 23.1], p < 0.00005) than the general population. Fatigue Severity Scale scores were well above the median for a healthy population (5.21 [SD: 1.8] vs 2.3 [SD: 1.21], p < 0.00005), indicating significant fatigue. HPP participants had significantly higher DASS scores for depression (8.5 [SD: 6.5] vs 5.0 [SD: 7.5], p = 0.02), anxiety (7.9 [SD: 6.7] vs 3.4 [SD: 5.1], p = 0.00009), and stress (14.7 [SD: 12.4] vs 8.1 [SD: 8.4], p = 0.0003) compared to the general population. Objective functional assessments demonstrated defects in physical functioning, including decreased ability to walk distances, slow gait speed, and diminished ability to repeatedly rise from a sitting position. In addition, participants self-reported significant limitations due to physical dysfunction. Decreased upper extremity dexterity may indicate problems with activities of daily living and delayed reaction times can have safety implications. Some patients with HPP have increased difficulties with depression, anxiety, and stress. PT, OT, and SLP specialists can aid in establishing baseline assessment of impairment and objective metrics for assessing efficacy of treatment. • Patients with HPP have impaired impaired upper extremity dexterity and fine motor skills. • Compared to the general population, patients with HPP demonstrated higher measures of depression, anxiety, and stress. • Cognitive deficits were not found to be consistently present in patients with HPP. [ABSTRACT FROM AUTHOR]

Severe primary hyperparathyroidism may be associated with muscle weakness and fatigue, but little is known about this effect in milder forms of the disease. This study aimed to evaluate physical function and quality of life in patients with normocalcemic (NPHPT) and hypercalcemic (HPHPT) primary hyperparathyroidism. This was a case-control study on 40 postmenopausal women. Thirteen patients with NPHPT, 7 patients with HPHPT, and their controls were studied. Mean serum PTH in the control group was 49.10 ± 12.38 pg/mL. All of the participants answered the Medical Outcomes Short-Form Health Survey (SF36) and were submitted to 2 strength tests (Hand Grip strength and Chair stand test) and 2 performance tests for physical function (Short physical performance battery and Gait speed). Body composition analysis was performed by dual-energy X-ray absorptiometry (DXA) and multifrequency bioimpedance (BIA). Patients with NPHPT had lower grip strength (p = 0.005), a higher mean time of the chair stand test (p = 0.012), a lower mean gait speed (p < 0.001) and a lower score for the Short Physical Performance Battery (SPPB) (p = 0.010) than the control group. Patients with HPHPT had lower handgrip strength (p = 0.027), a higher mean time of the chair stand test (p = 0.017), and a lower score for the SPPB (p = 0.049) than the control group. Patients with NPHPT showed a higher gait speed when compared to HPHPT (p = 0.048). There was no difference between BIA and DXA body composition indices between the PHPT groups and their controls. The evaluation of the SF-36 showed significantly less quality of life in the general health domain among the NPHPT group and in the mental health domain among the HPHPT than in the controls. Patients with NPHPT and HPHPT have decreased physical performance and strength. • Normocalcemic Primary hyperparathyroidism (NPHPT) is associated with muscle weakness. • Hypercalcemic Primary hyperparathyroidism (HPHPT) is associated with muscle weakness. • NPHPT and HPHPT patients have decreased physical performance compared to controls. • There were no differences comparing the muscle composition between controls and PHPT patients. [ABSTRACT FROM AUTHOR]

Gait and cognitive impairments are common in individuals with Multiple Sclerosis (MS) and can interfere with everyday function. Those with MS have difficulties executing cognitive tasks and walking simultaneously, a reflection of dual-task interference. Therefore, dual-task training may improve functional ambulation. Additionally, using technology such as virtual reality can provide personalized rehabilitation while mimicking real-world environments. The purpose of this randomized controlled trial is to establish the benefits of a combined cognitive-motor virtual reality training on MS symptoms compared to conventional treadmill training. This study will be a single-blinded, two arm RCT with a six-week intervention period. 144 people with MS will be randomized into a treadmill training alone group or treadmill training with virtual reality group. Both groups will receive 18 sessions of training while walking on a treadmill, with the virtual reality group receiving feedback from the virtual system. Primary outcome measures include dual-task gait speed and information processing speed, which will be measured prior to training, one-week post-training, and three months following training. This study will provide insight into the ability of a multi-modal cognitive-motor intervention to reduce dual-task cost and to enhance information processing speed in those with MS. This is one of the first studies that is powered to understand whether targeted dual-task training can improve MS symptoms and increase functional ambulation. We anticipate that those in the virtual reality group will have a significantly greater increase in dual-task gait speed and information processing speed than those achieved via treadmill training alone. [ABSTRACT FROM AUTHOR]