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This study was performed to determine whether prolonged endurance running results in acute endothelial dysfunction and wave‐reflection, as endothelial dysfunction and arterial stiffness are cardiovascular risk factors. Vascular function (conduit artery/macrovascular and resistance artery/microvascular) was assessed in 11 experienced runners (8 males, 3 females) before, during and after a 50 km ultramarathon. Blood pressure (BP), heart rate (HR), wave reflection, augmentation index (AIx) and AIx corrected for HR (AIx75) were taken at all time points—Baseline (BL), following 10, 20, 30 and 40 km, 1 h post‐completion (1HP) and 24 h post‐completion (24HP). Flow‐mediated dilatation (FMD) and inflammatory biomarkers were examined at BL, 1HP and 24HP. Reactive hyperaemia area under the curve (AUC) and shear rate AUC to peak dilatation were lower (∼75%) at 1HP compared with BL (P < 0.001 for both) and reactive hyperaemia was higher at 24HP (∼27%) compared with BL (P = 0.018). Compared to BL, both mean central systolic BP and mean central diastolic BP were 7% and 10% higher, respectively, following 10 km and 6% and 9% higher, respectively, following 20 km, and then decreased by 5% and 8%, respectively, at 24HP (P < 0.05 for all). AIx (%) decreased following 20 km and following 40 km compared with BL (P < 0.05 for both) but increased following 40 km when corrected for HR (AIx75) compared with BL (P = 0.02). Forward wave amplitude significantly increased at 10 km (15%) compared with BL (P = 0.049), whereas backward wave reflection and reflected magnitude were similar at all time points. FMD and baseline diameter remained similar. These data indicate preservation of macrovascular (endothelial) function, but not microvascular function resulting from the 50 km ultramarathon. What is the central question of this study?What are the acute effects of prolonged distance running (50 km race) on endothelial function, wave reflection and inflammation both during a distance race and within 24 h after completion of the race?What is the main finding and its importance?Even though macrovascular function remains unchanged after a 50 km ultramarathon, microvascular function is attenuated. However, the microvascular changes lasted less than 24 h post‐race suggesting the ultramarathon distance of 50 km has relatively short‐term effects in trained individuals. [ABSTRACT FROM AUTHOR]

Instrumenting the six-minute walk test (6MWT) adds information about gait quality and insight into fall risk. Being physically active and preserving multi-directional stepping abilities are also important for fall risk reduction. This analysis investigated the relationship of gait quality during the 6MWT with physical functioning and physical activity. Twenty-one veterans (62.2 ± 6.4 years) completed the four square step test (FSST) multi-directional stepping assessment, a gait speed assessment, health questionnaires, and the accelerometer-instrumented 6MWT. An activity monitor worn at home captured free-living physical activity. Gait measures were not significantly different between minutes of the 6MWT. However, participants with greater increases in stride time (ρ = −0.594, p < 0.01) and stance time (ρ = −0.679, p < 0.01) during the 6MWT reported lower physical functioning. Neither physical activity nor sedentary time were related to 6MWT gait quality. Participants exploring a larger range in stride time variability (ρ = 0.614, p < 0.01) and stance time variability (ρ = 0.498, p < 0.05) during the 6MWT required more time to complete the FSST. Participants needing at least 15 s to complete the FSST meaningfully differed from those completing the FSST more quickly on all gait measures studied. Instrumenting the 6MWT helps detect ranges of gait performance and provides insight into functional limitations missed with uninstrumented administration. Established FSST cut points identify aging adults with poorer gait quality. [ABSTRACT FROM AUTHOR]

Myosteatosis, or the infiltration of fatty deposits into skeletal muscle, occurs with advancing age and contributes to the health and functional decline of older adults. Myosteatosis and its inflammatory milieu play a larger role in adipose tissue dysfunction, muscle tissue dysfunction, and increased passive muscle stiffness. Combined with the age‐related decline of sex hormones and development of anabolic resistance, myosteatosis also contributes to insulin resistance, impaired muscle mechanics, loss of force production from the muscle, and increased risk of chronic disease. Due to its highly inflammatory secretome and the downstream negative effects on muscle metabolism and mechanics, myosteatosis has become an area of interest for aging researchers and clinicians. Thus far, myosteatosis treatments have had limited success, as many lack the potency to completely rescue the metabolic and physical consequences of myosteatosis. Future research is encouraged for the development of reliable assessment methods for myosteatosis, as well as the continued exploration of pharmacological, nutritional, and exercise‐related interventions that may lead to the success in attenuating myosteatosis and its clinical consequences within the aging population. [ABSTRACT FROM AUTHOR]

The aim of the present study was to develop a standardized contrast-enhanced duplex ultrasound (CE-DUS) protocol to assess lower-extremity muscle perfusion before and after exercise and determine relationships of perfusion with clinical and functional measures. CE-DUS (EPIQ 5G, Philips) was used before and immediately after a 10-minute, standardized bout of treadmill walking to compare microvascular perfusion of the gastrocnemius muscle in older (55-82 years) patients with peripheral arterial disease (PAD) (n = 15, mean ankle-brachial index, 0.78 ± 0.04) and controls (n = 13). Microvascular blood volume (MBV) and microvascular flow velocity (MFV) were measured at rest and immediately following treadmill exercise, and the Modified Physical Performance Test (MPPT) was used to assess mobility function. In the resting state (pre-exercise), MBV in patients with PAD was not significantly different than normal controls (5.17 ± 0.71 vs 6.20 ± 0.83 arbitrary units (AU) respectively; P =.36); however, after exercise, MBV was ∼40% lower in patients with PAD compared with normal controls (5.85 ± 1.13 vs 9.53 ± 1.31 AU, respectively; P =.04). Conversely, MFV was ∼60% higher in patients with PAD compared with normal controls after exercise (0.180 ± 0.016 vs 0.113 ± 0.018 AU, respectively; P =.01). There was a significant between-group difference in the exercise-induced changes in both MBV and MFV (P ≤.05). Both basal and exercise MBV directly correlated with MPPT score in the patients with PAD (r = 0.56-0.62; P <.05). This standardized protocol for exercise stress testing of the lower extremities quantifies calf muscle perfusion and elicits perfusion deficits in patients with PAD. This technique objectively quantifies microvascular perfusion deficits that are related to reduced mobility function and could be used to assess therapeutic efficacy in patients with PAD. [ABSTRACT FROM AUTHOR]

Background and Purpose: Sarcopenic obesity is associated with loss of independence among older adults, but the epidemiology of sarcopenic obesity and associated geriatric vulnerabilities are poorly understood. Thus, our objectives were to: (1) estimate the prevalence of older adults with sarcopenic obesity and (2) examine rates of geriatric vulnerabilities among obese older adults, with and without sarcopenia. Methods: A nationally representative sample of 1600 community-dwelling older adults 65 years and older with obesity and documented measures of muscle function from the National Health and Aging Trends Study (NHATS) was identified as sarcopenic using sex-adjusted grip strength and Short Physical Performance Battery scores. Differences in the prevalence of geriatric vulnerabilities (including pain, depression, disability, and social isolation) were compared between obese older adults with and without sarcopenia. Results and Discussion: Among obese older adults, 18% (n = 318/1600) were sarcopenic. After adjusting for age and sex, sarcopenic obese older adults had 3.7 times the odds of having 2 or more comorbid conditions (odds ratio [OR] = 3.7; 95% CI 2.2-5.0) and 6.4 times the odds of being frail (OR = 6.4; 95% CI 4.4-9.5) as compared with nonsarcopenic obese older adults. Sarcopenic obese older adults were also more likely to have 1 or more activities of daily living disabilities (OR = 3.7; 95% CI 2.5-5.4), be socially isolated (OR = 2.1; 95% CI 1.3-3.2), and report activity-limiting pain (OR = 2.0; 95% CI 1.5-2.7) as compared with nonsarcopenic obese older adults. These findings, in a nationally representative cohort, suggest obese older adults who are sarcopenic have higher rates of geriatric vulnerabilities that could impact delivery and outcomes of exercise and nutrition interventions. Conclusions: Concomitant obesity and sarcopenia are associated with higher rates of geriatric vulnerabilities among a nationally representative sample of older adults. More comprehensive interventions, beyond exercise and diet modifications, may be necessary to additionally address these newly identified social and physiological risks. [ABSTRACT FROM AUTHOR]

Objective: To determine predictors of the association between being a Veteran and adult food security, as well as to examine the relation of potential covariates to this relationship. Design: Data collected during 2011–2012, 2013–2014 and 2015–2016 National Health and Nutrition Examination Survey (NHANES) were pooled for analyses. Veterans (self-reported) were matched to non-Veterans on age, race/ethnicity, sex and education. Adjusted logistic regression was used to determine the odds of Veterans having high food security v. the combination of marginal, low and very low food security compared with non-Veterans. Setting: 2011–2012, 2013–2014 and 2015–2016 NHANES. Participants: 1227 Veterans; 2432 non-Veterans. Results: Veteran status had no effect on the proportion of food insecurities between Veterans and non-Veterans reporting high (Veterans v. non-Veteran: 79 % v. 80 %), marginal (9 % v. 8 %), low (5 % v. 6 %) and very low (8 % v. 6 %) food security (P = 0·11). However, after controlling for covariates, Veterans tended to be less likely to have high food security (OR: 0·82 (95 % CI 0·66, 1·02), P = 0·07). Further, non-Hispanic White Veterans (OR: 0·72 (95 % CI 0·55, 0·95), P = 0·02) and Veterans completing some college (OR: 0·71 (95 % CI 0·50, 0·99), P < 0·05) were significantly less likely to experience high food security compared with non-Veterans. Conclusion: This study supports previous research findings that after controlling for covariates, Veterans tend to be less likely to have high food security. It also highlights ethnicity and level of education as important socio-economic determinates of food security status in Veterans. [ABSTRACT FROM AUTHOR]

Veterans represent a unique population of older adults, as they are more likely to self-report a disability and be overweight or obese compared with the general population. We sought to compare changes in mobility function across the obesity spectrum in older veterans participating in 6 months of Gerofit, a clinical exercise program. A total of 270 veterans (mean age: 74 years) completed baseline, 3-, and 6-month mobility assessments and were divided post hoc into groups: normal weight, overweight, and obese. The mobility assessments included 10-m walk time, 6-min walk distance, 30-s chair stands, and 8-foot up-and-go time. No significant weight x time interactions were found for any measure. However, clinically significant improvements of 7-20% were found for all mobility measures from baseline to 3 months and maintained at 6 months (all ps < .05). Six months of participation in Gerofit, if enacted nationwide, appears to be one way to improve mobility in older veterans at high risk for disability, regardless of weight status. [ABSTRACT FROM AUTHOR]

Children with hematologic and oncologic health conditions are at risk of impaired skeletal muscle strength, size, and neuromuscular activation that may limit gross motor performance. A comprehensive assessment of neuromuscular function of these children is essential to identify the trajectory of changes in skeletal muscle and to prescribe therapeutic exercise and monitor its impact. Therefore, this review aims to (a) define fundamental properties of skeletal muscle; (b) highlight methods to quantify muscle strength, size, and neuromuscular activation; (c) describe mechanisms that contribute to muscle strength and gross motor performance in children; (d) recommend clinical assessment measures; and (e) illustrate comprehensive muscle assessment in children using examples of sickle cell disease and musculoskeletal sarcoma. [ABSTRACT FROM AUTHOR]

Purpose: This study examined changes in circulating levels of inflammatory cytokines [IL-6, sIL-6R, TNF-α, and calprotectin], skeletal muscle morphology, and muscle strength following a 50km race in non-elite athletes. Methods: Eleven individuals (8 men; 3 women) underwent pre-race assessments of rectus femoris muscle thickness (resting and contracted) using ultrasound, isometric knee extensor torque, and plasma cytokines. Measures were repeated after 10km of running, the 50km finish (post-race), and again 24-hrs post-race. Results: Compared with baseline values, Δ muscle thickness (resting to contracted) increased significantly 24 hrs post-race (11 ± 11% vs. 22 ± 8%; P = 0.01). Knee extensor torque was significantly reduced immediately post-race (151 ± 46 vs. 134 ± 43 Nm; P = 0.047) but remained similar to post-race values at 24 hrs post-race (P = 0.613). Compared with pre-race levels, IL-6 and calprotectin concentrations increased 302% and 50% after 10km, respectively (P<0.017 for both), peaked post-race (2598% vs. pre-race for IL-6 and 68% vs. pre-race for calprotectin; P = 0.018 for both), and returned to pre-race levels at 24-hrs post-race (P>0.05 for both). Creatine kinase levels rose steadily during and after the race, peaking 24-hrs post-race (184 ± 113 U/L pre-race vs. 1508 ± 1815 U/L 24-hrs post-race; P = 0.005). Conclusion: This is the first report of delayed increases in Δ muscle thickness at 24 hrs post-50km, which are preceded by reductions in knee extensor torque and elevations in plasma IL-6, and calprotectin. Recreational athletes should consider the acute muscle inflammatory response when determining training and recovery strategies for 50km participation. [ABSTRACT FROM AUTHOR]

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Background: The majority of older veterans do not meet the minimum healthy diet or physical activity recommendations despite known benefits. Identifying ways to increase adherence to programs that improve dietary quality and physical activity may reduce the risk of disability in older veterans. Peer-based interventions may be one method for facilitating lasting behavior change because peers often share a common culture and knowledge regarding problems their community experiences. Objective: This study aims to develop, pilot, and evaluate a theory-driven, 12-week, peer-led nutrition and exercise intervention that targets older veterans with dysmobility and assess its feasibility in 2 diverse urban areas with underrepresented populations. Methods: Community-dwelling veterans aged >65 years with self-reported dysmobility (defined as difficulty in at least 1 of the following: walking quickly across a street, walking a mile, ascending a flight of stairs, rising from a chair without the use of arms, or a fear of falling) from 2 Department of Veterans Affairs Geriatric Research, Education, and Clinic Centers (Baltimore, Maryland, and San Antonio, Texas) will be eligible to participate. First, this study will use validated mixed methods via web-based surveys (n=50 per site) to assess potential physical, social or environmental, and behavioral or lifestyle barriers that affect physical activity and dietary quality (phase 1). Next, we will use knowledge gained from these assessments and feedback from a focus group (n=10 per site) to adapt established Department of Veterans Affairs diet and exercise program materials to develop peer-led intervention materials and train peer leaders (n=3 per site). Finally, we will determine the feasibility and acceptability of the intervention to assess reach (recruitment and retention), adoption (satisfaction, perceived utility, attendance, and engagement), and implementation (fidelity of intervention), as well as the estimated magnitude and potential impact on selected outcomes (ie, diet quality and mobility) in 20 older veterans with dysmobility (n=10 per site). Results: The study was funded on January 1, 2022, with a projected data collection period of June 1, 2022, to December 31, 2023. Conclusions: This study offers an innovative approach to identifying strategies that increase long-term adherence to lifestyle modification programs that improve dietary quality and physical activity in older veterans with dysmobility. [ABSTRACT FROM AUTHOR]

Understanding the physiological variables that contribute to a functional task provides important information for trainers and clinicians to improve functional performance. The hip abductors and adductors muscles appear to be important in determining the performance of some functional tasks; however, little is known about the relationship of the hip abductor/adductors muscle strength, activation, and size with functional performance. This study aimed to investigate the relationship of maximum torque, rate of torque development (RTD), rate of activation (RoA), and muscle thickness of the hip abductors [tensor fascia latae (TFL) and gluteus medius (GM)] and adductor magnus muscle with the Four Square Step Test (FSST) and the two-leg hop test in healthy young adults. Twenty participants (five males) attended one testing session that involved ultrasound image acquisition, maximal isometric voluntary contractions (hip abduction and hip adduction) while surface electromyography (EMG) was recorded, and two functional tests (FSST and two-leg side hop test). Bivariate correlations were performed between maximum voluntary torque (MVT), RTD at 50, 100, 200, and 300ms, RoA at 0–50, 0–100, 0–200, and 0–300, and muscle thickness with the dynamic stability tests. For the hip abduction, MVT (r =−0.455, p =0.044) and RTD300 (r =−0.494, p =0.027) was correlated with the FSST. GM RoA50 (r =−0.481, p =0.032) and RoA100 (r =−0.459, p =0.042) were significantly correlated with the two-leg side hop test. For the hip adduction, there was a significant correlation between the FSST and RTD300 (r =−0.500, p =0.025), while the two-leg side hop test was correlated with RTD200 (r =0.446, p =0.049) and RTD300 (r =0.594, p =0.006). Overall, the ability of the hip abductor and adductor muscles to produce torque quickly, GM rapid activation, and hip abductor MVT is important for better performance on the FSST and two-leg hop tests. However, muscle size appears not to influence the same tests. [ABSTRACT FROM AUTHOR]

Aims: Muscle strength testing is a core aspect in the pediatric physical and occupational therapy clinical examination and evaluation, and quadriceps muscle strength is associated with the ability to perform gross motor skills. The aim of this study was to assess the reliability of handheld dyamometry (HHD) and ultrasonography to measure quadriceps muscle strength and thickness in children, adolescents, and young adults. Methods: In 30 participants (6–26 years), without motor impairment, quadriceps strength was measured with HHD in seated and supine with the knee flexed to 90° and 35°. Rectus femoris (RF) and vastus lateralis (VL) muscle thickness was measured using ultrasonography. Typical error of measurement (TEM), coefficient of variation (CV%), and intra-class correlation coefficient (ICC) were used to assess the error and reliability of measures. Results: The average CV% among three trials of strength testing was 7.07%–9.94% and improved when using the top two trials (4.49%–5.61%). The average TEM was 2.21 Nm for strength and 0.03 cm for muscle thickness. Intra-rater and inter-rater reliability of muscle thickness was good to excellent (0.91–1.00). Conclusions: The results of this study suggest quadriceps muscle strength and thickness measurements using HHD and ultrasonography are reliable in children, adolescents, and young adults. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine the association between light-intensity physical activity and the incidence of all-cause and cardiovascular mortality in patients with peripheral artery disease (PAD) limited by claudication followed for up to 18.7 yr. Methods: A total of 528 patients with PAD and claudication were screened in Baltimore between 1994 and 2002, and 386 were deemed eligible for the study. At baseline, patients were classified into three physical activity groups: 1) physically sedentary, 2) light intensity, and 3) moderate to vigorous intensity based on a questionnaire. All-cause and cardiovascular mortality of patients through December 2014 was determined using the National Death Index and the U.S. Department of Veterans Affairs and the U.S. Department of Defense Suicide Data Repository. Results: Median survival time was 9.9 yr (interquartile range, 4.9–15.7 yr; range, 0.38–18.7 yr). During follow-up, 257 patients (66.6%) died, consisting of 40/48 (83.3%) from the sedentary group, 135/210 (64.3%) from the light-intensity group, and 82/128 (64.0%) from the moderate- to vigorous-intensity group. For all-cause mortality, light-intensity activity status (hazard ratio [HR] = 0.523, P = 0.0007) and moderate- to vigorous-intensity status (HR = 0.425, P < 0.0001) were significant predictors. During follow-up, 125 patients died because of cardiovascular causes (32.4%), in which light-intensity activity status (HR = 0.511, P = 0.0113) and moderate- to vigorous-intensity activity status (HR = 0.341, P = 0.0003) were significant predictors. Conclusions: Light-intensity physical activity is associated with nearly 50% lower risk of all-cause and cardiovascular mortality in high-risk patients with PAD and claudication. Furthermore, moderate- to vigorous-intensity physical activity performed regularly is associated with 58% and 66% lower risk of all-cause and cardiovascular mortality, respectively. The survival benefits associated with light-intensity physical activity make it a compelling behavioral intervention that extends beyond improving ambulation. [ABSTRACT FROM AUTHOR]

The amount of tissue between the muscle and surface electromyography (sEMG) electrode influences the sEMG signals. Increased intramuscular adipose tissue (IMAT) of the hip abductor muscles negatively impacts balance in older individuals, but it is unknown if this is related to the ability to activate the muscles. The aim of this preliminary study was to investigate the influence of gluteus medius (GM) IMAT on sEMG amplitude during maximal voluntary isometric contractions (MVIC) of the hip abductors in older adults. We recruited 12 healthy community-dwelling older adults that underwent a spiral computerized tomography scan. High density lean (HDL), IMAT, and subcutaneous adipose tissue (SUBFAT) cross-sectional area of the GM were assessed. sEMG signal from the GM was recorded while participants performed an MVIC of the hip abductors. There was a negative correlation between GM activation and IMAT (r = −0.58, P = 0.046), and also SUBFAT (r = −0.78, P = 0.002) and a positive correlation with HDL (r = 0.73, P = 0.006). When controlling for SUBFAT, the partial correlations demonstrated a consistent negative correlation between GM activation and IMAT (r = −0.60, P = 0.050) but no relationship with HDL. The current results are important for helping to interpret the results from sEMG by accounting for IMAT. In conclusion, the neuromuscular activation of the GM may be reduced by the quantity of IMAT. [ABSTRACT FROM AUTHOR]

Skeletal muscle fat infiltration (known as myosteatosis) is an ectopic fat depot that increases with aging and is recognized to negatively correlate with muscle mass, strength, and mobility and disrupt metabolism (insulin resistance, diabetes). An interdisciplinary workshop convened by the National Institute on Aging Division of Geriatrics and Clinical Gerontology on September 2018, discussed myosteatosis in the context of skeletal muscle function deficit (SMFD). Its purpose was to gain a better understanding of the roles of myosteatosis in aging muscles and metabolic disease, particularly its potential determinants and clinical consequences, and ways of properly assessing it. Special attention was given to functional status and standardization of measures of body composition (including the value of D3-creatine dilution method) and imaging approaches [including ways to better use dual-energy X-ray absorptiometry (DXA) through the shape and appearance modeling] to assess lean mass, sarcopenia, and myosteatosis. The workshop convened innovative new areas of scientific relevance to light such as the effect of circadian rhythms and clock disruption in skeletal muscle structure, function, metabolism, and potential contribution to increased myosteatosis. A muscle-bone interaction perspective compared mechanisms associated with myosteatosis and bone marrow adiposity. Potential preventive and therapeutic approaches highlighted ongoing work on physical activity, myostatin treatment, and calorie restriction. Myosteatosis' impact on cancer survivors raised new possibilities to identify its role and to engage in cross-disciplinary collaboration. A wide range of research opportunities and challenges in planning for the most appropriate study design, interpretation, and translation of findings into clinical practice were discussed and are presented here. [ABSTRACT FROM AUTHOR]

Concentrations of different circulating microparticles (MPs) may have clinical and physiological relevance to cardiovascular disease pathologies. Purpose: To quantify plasma concentrations of CD31+/CD42b−, CD62E+, and CD34+ MPs across healthy individuals and those with coronary artery disease (CAD) or acute cardiovascular events (non‐ST elevation myocardial infarction (NSTEMI)). Fasted blood was obtained from CAD patients (n = 10), NSTEMI patients (n = 13), and healthy older men (n = 15) 60–75 years old. Methods: CD31+/CD42b−, CD62E+, and CD34+ MPs were isolated from plasma and quantified using flow cytometry. Relationships between MP subtypes, fasting blood lipids, blood glucose, blood pressure, body mass index, and total number of medications were assessed. Results: Concentrations of CD31+/CD42b− MPs were significantly lower in CAD and NSTEMI subjects compared with healthy individuals (p =.02 and.003, respectively). No differences between groups were found for CD62E+ or CD34+ MPs (p >.05 for both). Surprisingly, among all variables assessed, only CD62E+ MP concentrations were positively correlated with triglyceride levels (p =.012) and inversely correlated with SBP (p =.03). Conclusions: Our findings provide support for the use of different MP subtypes, specifically CD31+/CD42b− MPs, as a potential biomarker of cardiovascular disease. Importantly, results from this study should be looked at in adjunct to previous MP work in CVD conditions as a way of highlighting the complex interactions of variables such as comorbid conditions and medications on MP concentrations. [ABSTRACT FROM AUTHOR]

Abstract Persons with Parkinson's disease (PD) have significant impairments in functional mobility, including the ability to initiate gait. Three-dimensional analysis of kinetic and kinematic outcomes has become one of the most powerful tools in evaluating abnormalities in gait initiation for persons with PD. Surprisingly however, the psychometric properties of spatial and temporal measures of gait initiation for persons with PD have not been established using force-platforms. The purposes of this study were to determine the reliability of kinetic and kinematic measures of gait initiation and to identify the minimal detectable change of these measures in persons with PD during On and Off medication conditions. Sixteen participants with idiopathic PD performed a series of 3 repeated trials of gait initiation by starting from a quiet stance position on 2 AMTI OR-6 force platforms, and walking forward across the floor following a signal from the investigators. Testing was performed first in the Off medication condition, after which participants took their medication and waited 60 min before repeating the gait initiation assessments. Relative test-retest reliability was good-to-excellent for most outcome measures (range 0.417–0.960). Bland-Altman analysis revealed no systematic variance in the majority of outcome measures when tested in distinct medication conditions (On vs. Off medication). Most outcome measures required low-to-moderate amounts of change (<50%) to indicate true change in individual participants. These results suggest that spatial and temporal measures of gait initiation using force-platforms are highly reliable and responsive to changes in performance for persons with PD, regardless of whether individuals are optimally medicated. [ABSTRACT FROM AUTHOR]

Objective: The Veterans Health Administration's Care Assessment Need (CAN) score is a statistical model, aimed to predict high-risk patients. We were interested in determining if a relationship existed between physical function and CAN scores. Method: Seventy-four older (71 ± 1 years) male Veterans underwent assessment of CAN score and subjective (Short Form–36 [SF-36]) and objective (self-selected walking speed, four square step test, short physical performance battery) assessment of physical function. Results: Approximately 25% of participants self-reported limitations performing lower intensity activities, while 70% to 90% reported limitations with more strenuous activities. When compared with cut points indicative of functional limitations, 35% to 65% of participants had limitations for each of the objective measures. Any measure of subjective or objective physical function did not predict CAN score. Conclusion: These data indicate that the addition of a physical function assessment may complement the CAN score in the identification of high-risk patients. [ABSTRACT FROM AUTHOR]

Purpose: The study is to compare the Modified Physical Performance Test (MPPT) and Short Physical Performance Battery (SPPB) as metrics of mobility and function in older men with peripheral arterial disease (PAD). Materials and methods: A total of 51 men (55-87 years) with PAD underwent functional testing including the SPPB, MPPT, Walking Impairment Questionnaire (WIQ), stair ascent, and 6-min walk distance. Individuals were grouped according to SPPB and MPPT scores as not limited on either, limited only on the MPPT, or limited on both. Results: The MPPT identified a higher proportion of patients as being functionally limited than the SPPB (p < 0.001). Men identified as limited only by the MPPT, and not the SPPB, were subsequently confirmed to have lower function on all measures compared to those not identified as limited by either the SPPB or the MPPT (p < 0.02). Conclusions: These findings suggest the MPPT is an appropriate measure to identify early declines in men with PAD and may identify global disability better than SPPB. Implications for rehabilitation: Individuals with peripheral arterial disease have low activity levels and are at risk for a loss of independence and global disability. Early detection of decline in mobility and global function would allow for interventions before large changes in ambulatory ability or a loss of functional independence occur. This study shows the Modified Physical Performance Test may be an appropriate test to identify early decline in function in men with peripheral arterial disease. [ABSTRACT FROM AUTHOR]

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

Background and Purpose: Parkinson's disease is a progressive neurodegenerative disorder that affects neurophysiologic function, movement abilities, and quality of life (QOL). Research examining the effects of exercise has suggested benefits related to a variety of outcomes; however, no reviews have synthesized research findings across the spectrum of disability. This project sought to systematically review studies that examined the impact of exercise interventions on balance outcomes for people with Parkinson's disease, within the categories defined by the World Health Organization in the International Classification of Functioning, Disability, and Health (ICF) model. Methods: A systematic review of medical literature databases was performed using keywords Parkinson's disease and exercise. Studies were eligible if the intervention included exercise and examined variables within one of the three ICF categories. Following the ICF model, outcomes regarding Body Structure and Function, Activity, and Participation were measured, respectively, in terms of postural instability, balance task performance, and QOL and fall events. Results: Within the Body Structure and Function category, there was moderate evidence that exercise resulted in improvements in postural instability. Within the Activity category, there was moderate evidence that exercise was effective for improving balance task performance. In contrast, within the Participation category, there was limited evidence that exercise resulted in improvements in QOL measures or fall events. Discussion and Conclusions: Regardless of the strength of the evidence, the studies reviewed all report that exercise resulted in improvements in postural stability and balance task performance. Despite these improvements, the number and quality of the studies and the outcomes used were limited. There is a need for longer term follow-up to establish trajectory of change and to determine if any gains are retained long term. The optimal delivery and content of exercise interventions (dosing, component exercises) at different stages of the disease are not clear. [ABSTRACT FROM AUTHOR]

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