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Background: Virtual reality (VR) technology constitutes a promising rehabilitation strategy, but its effect on frailty in older adults remains inconclusive. This study examined the effects of interactive VR training programs on lower-limb muscle strength, walking speed, balance, and fall risks in older adults with frailty., Methods: Various electronic databases comprising PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, Embase, the Chinese Electronic Periodical Service, the Chinese National Knowledge Infrastructure, and gray literature were searched from their inception through December 31, 2022 for relevant studies. Randomized controlled trials that examined the effects of interactive VR training programs on lower-limb muscle strength, balance, walking speed, and fall risks as measured by validated scales or methods. in older adults aged 65 years and older with frailty were included. A random-effects model was employed to examine the overall effect size, and the trim-and-fill method was adopted to examine publication bias., Results: For those studies that defined frailty using fall risks, substantial evidence demonstrated that interactive VR training interventions increased lower-limb muscle strength (Hedges' g = 0.35, p = 0.015), walking speed (Hedges' g = 0.29, p = 0.003), balance (Hedges' g = 0.62, p = 0.011), and fall risks (Hedges' g = -0.61, p < 0.001). Studies that defined frailty in accordance with the Fried frailty phenotype criteria indicated that interactive VR training interventions only increased walking speed (Hedges' g = 0.28, p = 0.023) and balance (Hedges' g = 0.27, p = 0.049)., Conclusions: Interactive VR training programs may benefit older adults with frailty with respect to walking speed and balance. More studies with good study quality are required to validate the effects of interactive VR exercise training on these frailty-related parameters in older adults., (© 2023 The American Geriatrics Society.)

Abstract Accurate prediction of walking travel rates is central to wide-ranging applications, including modeling historical travel networks, simulating evacuation from hazards, evaluating military ground troop movements, and assessing risk to wildland firefighters. Most of the existing functions for estimating travel rates have focused on slope as the sole landscape impediment, while some have gone a step further in applying a limited set of multiplicative factors to account for broadly defined surface types (e.g., “on-path” vs. “off-path”). In this study, we introduce the Simulating Travel Rates In Diverse Environments (STRIDE) model, which accurately predicts travel rates using a suite of airborne lidar-derived metrics (slope, vegetation density, and surface roughness) that encompass a continuous spectrum of landscape structure. STRIDE enables the accurate prediction of both on- and off-path travel rates using a single function that can be applied across wide-ranging environmental settings. The model explained more than 80% of the variance in the mean travel rates from three separate field experiments, with an average predictive error less than 16%. We demonstrate the use of STRIDE to map least-cost paths, highlighting its propensity for selecting logically consistent routes and producing more accurate yet considerably greater total travel time estimates than a slope-only model.

Background: Sarcopenia and frailty often worsen in older adults because of declines in activities of daily living and social connections that are associated with chronic diseases and traumatic injuries such as falls and fractures. Exercise intervention for sarcopenia can take >3 months to improve muscle mass, muscle strength, and walking speed. Thus, a specialized intervention system for shorter periods of time is needed. In this study, we aimed to evaluate the short-term efficacy of an exercise program using the wearable cyborg Hybrid Assistive Limb (HAL) lumbar type in physical function in mobility-limited older adults who do not require transition to long-term care. Methods: This randomized, single-blind, parallel-group study involved 79 community-dwelling older adults with physical frailty or locomotive syndrome assigned to an intervention group (n = 40) with the HAL lumbar type exercise program or a control group (n = 39) without the exercise program. The intervention group underwent trunk training (including trunk and hip flexion, standing and sitting from a single sitting position, and squats) and gait training (treadmill and parallel bars) twice a week for 5 weeks while wearing the HAL lumbar type. The 10-m usual and maximum walking speeds, Timed Up and Go test results, 5-times chair-standing test results, 5-question Geriatric Locomotive Function Scale (GLFS-5) scores, body-fat percentage, and muscle mass were measured before and after the intervention and analyzed using the intention-to-treat method. Results: The intervention (23 % male; mean age, 74.7 ± 4.7 years) and control (21 % male; mean age, 75.1 ± 4.1 years) groups did not differ significantly in baseline characteristics. Seventy-seven participants completed the program; two withdrew for personal reasons. The mean difference (standard error) between the groups for the primary outcome (usual walking speed) was 0.35 (0.04) m/s; the time-by-group interaction was significant (p

Background and objectives. MG is associated with muscle weakness which induces fatigue. This condition interferes with patients’ ability to pursue activities of daily living and could cause many complications such as decrement in walking and depression. Though rehabilitation has been proved to reduce symptoms, the optimal dosage of the rehabilitation program is still debatable due to lack of high-quality evidence. The aim of this study was to analyze the effect of aerobic cycle ergometer on maximal walking speed, cadence and fatigue of MG patients. Materials and methods. This randomized control group study was conducted to 20 Myasthenia Gravis patients with MGFA classification I until IIb. 10 meter walking test was used to assess maximal walking speed, 1 minute walking test was used to assess cadence, while Fatigue Severity Scale was used to measure fatigue. Measurement was done before and after 8 weeks of exercise. Paired t-test is used to analyze within group variables, and independent t test to evaluate between-group analysis. Results. There was improvement on maximal walking speed, cadence and fatigue at intervention group with large effect size (CI 95%, p = 0,05), even though the results didn’t differ statistically between groups. Conclusion. There is improvement of maximal walking speed, cadence and fatigue of Myasthenia Gravis patients after exercising using low intensity aerobic cycle ergometer.

Aims:This study examined the relationship between altered shoulder joint position sense (JPS) and trunk control, balance, and walking speed in patients with multiple sclerosis (MS).Methods:This case-control study included patients with MS and healthy controls. A digital inclinometer was used to determine shoulder JPS. Balance was measured using the Berg Balance Scale (BBS) and single-leg stance (SLS) test, trunk control using the Trunk Impairment Scale (TIS), and walking speed using the 10 meter walk test (10 mWT).Results:The study included 40 MS patients (mean age: 44.68±8.71 years, 75% were females) and 40 healthy control subjects (mean age: 43.56±9.91 years, 65% were females). The BBS and SLS scores were significantly lower and the 10 mWT time was longer in the patients compared with the controls (p

Background Considering concerns about conventional toe grip strength, we devised a method to measure toe pressure strength in the standing position, which is close to the actual motion. This study examined the association between toe pressure strength in the standing position and walking speed among older adults. Methods This cross-sectional study included 150 community-dwelling older adults (81±8 years, 73% female) who participated in the physical fitness test. We analyzed the correlation between the participants’ maximum walking speed and physical function. Furthermore, we performed regression analysis with the maximum walking speed as the dependent variable to examine the association with toe pressure strength in the standing position. We also examined the association between maximum walking speed and toe pressure strength in the standing position by introducing a covariate. Results Correlation analysis revealed a significant positive correlation between maximum walking speed and toe pressure strength in the standing position, with a moderate effect size (r=0.48, p

Recently, non-pharmacological treatments are gaining increasing importance for improving the quality of life in patients with chronic obstructive pulmonary disease (COPD). This pilot study aimed to evaluate the feasibility of conducting extensive research on Chuna manual therapy (CMT). This study investigated the effectiveness and safety of CMT adjuvant to Western medicine (WM) in patients with COPD. Forty patients with COPD were randomized into two groups in a 1:1 ratio: experimental (CMT plus WM) and control (WM only) groups. The CMT intervention was administered once a week for eight weeks. The primary outcome measured was the 6-min walk distance (6MWD). Secondary outcomes measured were: forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), assessments using the modified Medical Research Council (mMRC) scale and Visual Analog Scale (VAS) for dyspnea, the COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), and the EuroQoL five-dimensional questionnaire (EQ-5D). The mean differences in FEV1 (L) between Weeks 1 and 8 were statistically significant between the groups (p = 0.039). Additionally, the experimental group showed improved 6MWD, mMRC, VAS for dyspnea, CAT, SGRQ (total), and EQ-VAS scores than the control group. However, the differences between the two groups were not statistically significant. No adverse events were observed during this trial. CMT has the potential to alleviate symptoms, improve quality of life, and delay the decline in lung function in patients with COPD. The results of this pilot study could lead to large-scale clinical trials in the future. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To determine whether low muscle strength and low gait speed increase the risk of disability related to basic activities of daily living in community-dwelling older adults. Methods A longitudinal study (9 years of follow-up) was conducted with 390 older adults who were independent in basic activities of daily living at baseline and answered the Katz Index at follow-up. Associations were determined using Pearson’s χ2 test with a 5% significance level and logistic regression analysis. Results Increases in prevalence between baseline and follow-up were observed for low muscle strength (17.5%-38.2%), slow gait speed (26.0%-81.1%), and functional dependence (10.8%-26.6%). At follow-up, 11.7% of the participants had concomitant functional dependence, slow gait speed, and low muscle strength. Slow gait speed remained a predictor of dependence in basic activities of daily living (odds ratio=1.90; 95% confidence interval=1.06-3.41). Conclusion Slow gait speed is a predictor of functional dependence, constituting an important variable for screening functional decline.

Background Motoric cognitive risk syndrome (MCR) reduces the quality of life, independence, and social interaction in older adults. Social participation is a potentially modifiable factor that benefits cognitive and mental health. This study explored the mediating roles of social participation between MCR and depression and between MCR and loneliness. Methods We performed a secondary analysis of data from the 2015–2016 National Social Life, Health, and Aging Project. Slow gait speed and cognitive decline were used to assess MCR. Mediation analysis was applied to two models, both of which used MCR as an exposure and social participation as a mediator. The outcomes were depression and loneliness for each model, respectively. Results Among 1,697 older adults, 196 (11.6%) had MCR. The mediating role of social participation was statistically significant in both models. The indirect effect (β=0.267, p=0.001) of MCR on depression through social participation comprised 11.97% of the total effect (β=2.231, p

Background Focusing on the relationship between frail older people and gait speed is vital to minimize the need for long-term care or increased support. The relationship between gait speed, respiratory muscle strength, and dynamic balance, is not well understood in older people requiring long-term care or support. Therefore, this study aimed to provide new insights into the relationship between gait speed, respiratory muscle strength, and dynamic balance in community-dwelling older people who required long-term care or support and used a daycare center. Methods This was a cross-sectional study of 49 community-dwelling older people (21 men, 28 women) aged ≥65 years who were certified as requiring long-term care or support under the Japanese system. The participants’ maximal inspiratory pressure (PImax), maximal expiratory pressure (PEmax), walking speed (maximal and normal walking speed), and maximal double-step length test (MDST) results were recorded. The measurement data were evaluated using Pearson’s correlation coefficient and multiple regression analysis. Results Pearson’s correlation coefficient revealed correlations between PImax and the following: maximal walking speed (r = 0.606, p

Rehabilitation robots have shown promise in improving the gait of children with childhood-onset motor disabilities. This study aimed to investigate the long-term benefits of training using a wearable Hybrid Assistive Limb (HAL) in these patients. Training using a HAL was performed for 20 min a day, two to four times a week, over four weeks (12 sessions in total). The Gross Motor Function Measure (GMFM) was the primary outcome measure, and the secondary outcome measures were gait speed, step length, cadence, 6-min walking distance (6MD), Pediatric Evaluation of Disability Inventory, and Canadian Occupational Performance Measure (COPM). Patients underwent assessments before the intervention, immediately after the intervention, and at 1-, 2-, 3-month and 1-year follow-ups. Nine participants (five males, four females; mean age: 18.9 years) with cerebral palsy (n = 7), critical illness polyneuropathy (n = 1), and encephalitis (n = 1) were enrolled. After training using HAL, GMFM, gait speed, cadence, 6MD, and COPM significantly improved (all p < 0.05). Improvements in GMFM were maintained one year after the intervention (p < 0.001) and in self-selected gait speed and 6MD three months after the intervention (p < 0.05). Training using HAL may be safe and feasible for childhood-onset motor disabilities and may maintain long-term improvements in motor function and walking ability.

Introduction: We examined whether autonomic nervous system (ANS) and postural control regulation during orthostatic test reflect physical resilience by studying their associations with maximal walking speed and mortality. Methods: The participants were community-dwelling Finnish men (n = 303) and women (n = 386) aged 75, 80, and 85 years at baseline. Systolic and diastolic blood pressure (BP), heart rate, heart rate variability (HRV), respiratory rate, and postural sway were obtained using a digital sphygmomanometer, a single-channel ECG, and thigh- and chest-worn accelerometers. Linear and Cox regression models were used to estimate the associations of the physiological indices with maximal 10-m walking speed and 5-year mortality separately for sexes. Results: Better maintenance of BP under orthostatic stress was associated with faster walking speed in women and lower mortality hazard in men. Greater HRV in terms of low frequency power and lower respiration rate in supine position and smaller orthostatic changes in these were associated with faster walking speed especially in women. Less postural sway after standing up was associated with faster walking speed in women (−0.057, SE 0.022, p = 0.011) and more postural sway with increased mortality hazard in men (HR 1.71, 95 % CI 1.20–2.43) even after controlling for BP responses. Conclusions: In addition to ANS regulation at rest and under stress, adaptation of postural control system to orthostasis may be used in quantifying older adults' physical resilience. Wearable sensors capturing stimulus-response patterns and natural fluctuations of body functions may provide opportunities to monitor and incorporate different subsystems' resilience also in free-living conditions.

Abstract Objectives Gait parameters can measure risks of falling and mortality and identify early stages of frailty. The use of walking aid changes gait parameters. The aim of this study was to describe differences in gait parameters among healthy adults when walking on different surfaces and under different conditions, with and without a rollator. Results Ten healthy participants walked first without and then with a rollator upslope, downslope and on flat surface, on bitumen and gravel respectively. Step length, walking speed and sideway deviation was measured using an inertial measurement unit. Walking up a slope using a rollator generated the longest step length and walking down a slope using a rollator the shortest. Fastest walking speed was used when walking up a slope with rollator and slowest when walking down a slope with rollator. Sideway deviation was highest when walking down a slope and lowest when walking on gravel, both without rollator. Highest walk ratio was found when walk up a slope without rollator and lowest when walking down a slope with rollator. Data from this study provides valuable knowledge regarding gait parameters among healthy individuals, useful for future clinical research relevant for rehabilitation and public health.

The habit of using smartphones while walking has become widespread among modern individuals, particularly when pedestrians are in a hurry. However, there has been little exploration into the differences between standing and walking at various speeds in terms of smartphone use. In this study, we examined 60 young participants (30 men and 30 women) who engaged in smartphone tasks such as one-handed browsing or two-handed texting while standing, walking slowly, and walking normally. The measured variables included neck flexion (NF), head flexion (HF), gaze angle (GA), and viewing distance (VD). The study findings indicate that using smartphones while walking may cause a more pronounced kyphotic curve in the cervical spine compared to when standing, leading to increased strain in the neck region. The heightened neck load can be attributed to the concurrent dynamic nature of both walking and smartphone usage. Moreover, two-handed texting had a more detrimental impact on NF, HF, and GA when contrasted with one-handed browsing. The interplay among hand operation, posture, and maintaining arm position displayed an uncertain correlation with VD. While women typically exhibited smaller NF, HF, and GA than men, it is important to explore whether their shorter VD might contribute to increased eyestrain.

Background: A literature review reveals that studies on walking and fall occurrences in the context of cancer have predominantly centered on geriatric patients. Nonetheless, cancer patients of all ages are susceptible to such risks. Both cancer and its treatments contribute to significant risk factors for disturbances in walking and falls, encompassing muscle weakness, impaired balance, reduced proprioception, cognitive impairment, and functional limitations. Aim: to assess walking speed and the risk of falls among patients undergoing surgery for the most common malignancies: breast (BU), lung (P), colorectal (DS), and reproductive organs (G). Material and Methods: An observational study was conducted using a cohort design. A total of 176 individuals participated in the study, including 139 cancer patients, who were divided into four groups: BU (N = 30), P (N = 35), DS (N = 35), and G (N = 39), as well as 37 healthy volunteers in the control group (C, N = 37). All participants underwent an assessment of walking speed using BTS G-WALK® and an evaluation of the number of falls and the risk of falling using a Fall Control Card. Results: There was a significant decrease in walking speed after surgery compared to the time before surgery, from 2.7% in the BU group, through 9.3% in the P group, and 19.2% in the DS group, to 30.0% in the G group. At the same time, for groups G and DS, the average walking speed fell below 1.0 m/s, amounting to 0.84 m/s and 0.97 m/s, respectively, in the measurement after the surgery and 0.95 m/s and 1.0 m/s in the follow-up measurement. Falling occurred in all the groups except for the BU group. The created logistic regression model showed that increasing the walking speed measured after the procedure (study 2) by 1 m/s reduces the risk of falling by approximately 500 times (OR = 0.002). Limitations in daily activity were observed in the follow-up examination (study 3) in 75% of patients. Conclusions: Surgical intervention has an impact on walking speed, and being part of the study group influences the risk of falling. Further research is needed to determine the precise risk of falls in cancer patients.

Background and Objectives: An ankle sprain is one of the most common musculoskeletal injuries and has various complications. Various factors can predict post-injury complications, including ankle muscle strength, pain, and activity level. So far, no study has exclusively investigated the predictive role of these factors. Therefore, this study aims to investigate the role of these factors in ankle instability, functional mobility, and gait speed in individuals with ankle sprain. Methods: This study was conducted on 140 individuals with ankle sprains who were referred to medical centers in Shiraz City, Iran. The demographic information of the patients (including the time elapsed since the sprain, etc.) was recorded by a demographic questionnaire. Related tests were also used to evaluate ankle muscle strength, pain, activity level, ankle functional instability, functional mobility, and gait speed, respectively. Results: In the regression models, the predictive value for each outcome of ankle functional instability, functional mobility, and walking speed was 45.5%, 58.8%, and 65.3% of the variance, respectively. In all stepwise models, ankle muscle strength was the strongest predictor for the outcomes of functional ankle instability, functional mobility, and gait speed. Conclusion: Ankle muscle strength, level of education, history of sprain in the last year, and age were the vital predictors of ankle functional instability. Muscle strength, age, and sprain status were the critical predictors of functional mobility respectively. Muscle strength, pain, age, duration of sprain, and activity level were the crucial predictors of gait speed.

Background Maintaining both walking speed and cognitive function is essential for active, healthy aging. This study investigated age-related differences in walking speed and global cognitive function with aging and the association between them among older adults residing in the developing country of China. Methods This cross-sectional study measured usual (UWS) and maximal walking speed (MWS) of participants for six meters. The Chinese version of the Montreal Cognitive Assessment was used to evaluate global cognition through in-person interviews. Analyses of variance were used to compare the differences in UWS, MWS, and global cognition between genders and age groups. Multiple linear regression models were used to determine the association between walking speed and global cognitive function. Results In total, 791 Chinese adults (252 men and 539 women) aged 60–89 years were included in this study. Markedly slowed UWS and worse global cognitive function scores were observed for both genders among adults ≥80 years of age. MWS slowed considerably in men ≥85 years of age and in women ≥80 years of age. There was a significant gender difference in MWS—with men walking faster than women—but not in UWS. Linear regression analysis adjusted for the confounding factors of gender, height, weight, years of education, and chronic disease indicated that MWS, but not UWS, was significantly associated with global cognitive function (β = 0.086, [0.177, 1.657], P = 0.015) such that slower maximal walking speed was associated with poorer cognitive performance. This association was statistically significant only for adults aged 75-79 years (β = 0.261 [0.647, 4.592], P = 0.010). Conclusion Walking speed was slower in the older age groups. Global cognitive function deteriorated markedly after 80 years of age. After controlling for confounding variables, slower MWS, but not UWS, was associated with poorer global cognitive function. MWS may serve as a potential indicator for earlier identification of poor cognition and motoric cognitive risk syndrome in an older Chinese population.

Introduction Walking speed is related to functionality in daily activities. Preventive Medicine Examination of the Chilean older adults is a vital prevention program for Chilean community- dwelling older adults. However, this evaluation does not include speed in its battery of tests. Objective To evaluate the functional classification spaces for threshold, reference, and categorization val-ues of self- selected and maximum walking speed applied to self- sufficient older adults. Methods Seventy- two self- sufficient older adults participated in this observational, exploratory, and cross- sectional study. Each participant was asked to walk naturally and then at full speed for three minutes. Through a dispersion graph between self- selected walking speed (axis "x") and maximum walking speed (axis "y"), functional classification spaces were constructed according to documented values for i) thresholds of basic functionality, ii) referential for the instrumental spectrum and iii) functional categorization for "household walker" (< 0.4 meters per second, m/s), "limited community ambulator" (0.40 to 0.80 m/s), "community ambulator" (0.81 to 1.3 m/s), and "cross street safely" (> 1.3 m/s). The relative frequency (%) of older adults who meet each established quadrant was determined. Results The threshold was reached by 100% of the participants (basic daily activities). About 80% of the older adults have a functional classification space below the reference limit (instrumental and advanced daily activities). It was also found that 81% of women and 69% of men are "efficient in the community", and 31% of men and 14% of women reach the minimum value for "effec-tive street crossing" (advanced daily activities). Conclusions The exploration of functional classification spaces according to self- selected walking speed and maximum walking speed applied to a group of self- sufficient older adults reveals that this pop-ulation is at risk of deteriorating instrumental and advanced activities of daily living.

Objective To examine the association between observer-assessed functional status and perceived recovery in the late phase after stroke. The study also aimed to determine whether observer-assessed functional improvements as a result of horse-riding therapy (H-RT) are related to enhanced perception of stroke recovery. Methods This is a descriptive correlational study using data derived from a three-armed randomized controlled trial in which 123 individuals were enrolled, among whom 43 received H-RT for 12 weeks. The measures included the Modified Motor Assessment Scale, Berg Balance Scale, Timed Up and Go, timed 10-m walk, and perceived recovery from stroke indicated by item #9 in the Stroke Impact Scale (version 2.0). Spearman rank order correlation (rs) was used in the analyses. Results There were moderate to strong positive or negative correlations between all four observer-assessed motor variables and participants’ ratings of perceived late-phase stroke recovery at trial entrance, ranging from rs=-0.49 to rs=0.54 (p

Chronic obstructive pulmonary disease (COPD) is a group of diseases with high levels of comorbidity. Pathological changes of peripheral skeletal and respiratory muscles in COPD patients, which are often underestimated, occupy a special place. Aim. To study the relationship between functional and quantitative parameters of the peripheral (limb muscle) and respiratory muscles in COPD patients. Materials and methods. 127 patients (98 men/29 women, mean age 67.68.2 years) were under observation without acute COPD. All COPD patients were classified according to GOLD (2019) into groups A, B, C, D. The algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP2) was used to diagnose sarcopenia. The muscle mass was measured using dual energy X-ray absorptiometry (DXA) and the appendicular lean mass index (ASM) was estimated. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured by body plethysmograph MasterScreen Body. Quantitative assessment of thoracic muscle cross-sectional areas were performed using the CT scan using Vidar Dicom Viewer software. Results. Sarcopenia was diagnosed in 43.3% of COPD patients. Respiratory muscle dysfunction was determined in 66.1% of patients with COPD, its probability increased in groups C and D in comparison with groups A and B [chance ratio 6.6 (95% confidence interval 2.915.0); p0.0001]. Correlations between the functional parameters of sarcopenia and respiratory muscle strength as well as between the mass of peripheral skeletal muscles and respiratory muscle area have been established according to the data of computerized tomography (р0.01). Sarcopenia as well as respiratory muscle dysfunction was observed more frequently in persons with severe and extremely severe airway obstruction and in patients with predominantly emphysematic COPD phenotype (p0.01). Conclusion. Sarcopenia is a frequent comorbidity in COPD and its development is connected with the severity of the course of the main disease. Correlation between parameters of peripheral (limb muscle) and respiratory muscles in patients with COPD has been determined.

Aim:Frailty has become an important health issue in recent years. The aim of this study was to investigate the relationship between frailty and medicine use and polypharmacy in people over 65 years of age.Methods:Patients aged 65 years and over, who were admitted to family medicine outpatient clinics, were included in the study. The Tilburg frailty indicator, timed up and go test and gait speed test were used. Multivariate linear and logistic regression model were conducted.Results:Individuals, who used five or more medicines (polypharmacy) daily, constituted 49.1% of all participants. 55.6% of patients on polypharmacy were frail. Gender (β=-0.560, 95% Cl=-0.943-0.177) and the number of chronic diseases (β=1.496, 95% Cl=1.376-1.616) were found to have an effect on the total number of medicines. According to the results of logistic regression analysis on polypharmacy; female gender (aOR=3.4, 95% Cl=1.412-8.639), living alone (single/divorced/widowed) (aOR=2.8, 95% Cl=1.133-7.201) and number of chronic diseases (aOR=6.8, 95% Cl=4.218-11.075) were significantly associated with increased risk of polypharmacy.Conclusion:A significant increase in frailty score and reduction in walking speeds were detected in patients aged 65 years and over on polypharmacy. It should be kept in mind that polypharmacy is significantly related with frailty in elderly patients.

Amaç: Yaşlılarda kronik hastalıkların ve semptomların çokluğu nedeniyle polifarmasi yaygındır. 5 veya daha fazla ilaç kullanımı polifarmasi olarak tanımlanmıştır. Bununla birlikte hastanede yatan yaşlıların çoğunda 5 veya fazla ilaç kullanımı vardır, bu yüzden hastanede yatan yaşlılarda polifarmasinin yeniden tanımlanması gerekebilir. Bir çalışmada hastanede tüm yatış boyunca 10 ve daha fazla ilaç kullanımı polifarmasi olarak tanımlanmış ve polifarmasi yürüme hızı ve el sıkma gücü ile negatif ilişkili saptanmış. Bu çalışmada ise hastanede yatan yaşlılarda ölçüm günü el sıkma gücü ve yürüme hızı ile ilaç sayısı arasındaki ilişkiyi araştırmayı amaçladık. Materyal ve Metot: Çalışma yatan hastalarda kesitsel olarak planlandı. Hastaların yaş, cinsiyet, hastalık, ilaç, hastanede kalış süresi bilgileri, mini nutrisyonel değerlendirme testi (MNDT), mini mental durum testi (MMDT), 4 metre yürüme hızı ve el sıkma gücü skorları not edildi. Ölçümlerin yapıldığı gün 10 ve fazla ilaç kullananlar polifarmasi grubuna dâhil edildi. Polifarmasisi olanlar ve olmayanlar yürüme hızı ve el sıkma gücü açısından karşılaştırıldı. İlaç sayısı ile yürüme hızı ve el sıkma gücü arasındaki ilişkiyi araştırmak için korelasyon analizi uygulandı. Bulgular: Çalışmaya 54 erkek 58 kadın olmak üzere 112 hasta dâhil edildi. Hastaların ortanca yaşı 79.00 (63.00 – 99.00) yıl idi. Gönüllülerin ortanca ilaç sayısı 8,00 (1,00 – 16,00) olarak saptandı. Hastanede yatan yaşlılarda polifarmasi sıklığı %31,3 olarak bulundu. Polifarmasisi olanlarda olmayanlara göre yürüme hızı anlamlı olarak düşükken (p =,006), el sıkma gücü açısından iki grup arasında anlamlı fark yoktu (p>,05). Ek olarak, ilaç sayısı ile yürüme hızı arasında negatif korelasyon saptandı (rs=-,220, p=,020). Sonuç: Polifarmasinin ilaç-ilaç etkileşimi, ilaç yan etkisi ve düşme gibi yaşlılarda çok sayıda olumsuz sonuçları mevcuttur. Çalışmamızda polifarmasi yürüme hızı ile negatif ilişkili bulunmuşken el sıkma gücü ile ilişkili bulunmadı. Bu durum muhtemelen baş dönmesi, düşme riski gibi ilaç yan etkileri nedeniyle hareket yeteneğinin etkilenmesinden kaynaklanmış olabilir. Bu bulgulara, dayanarak yatan hastalarda fiziksel performansın daha iyi sağlanması ve immobilizasyondan kaçınmak için polifarmasiden kaçınılmasını öneriyoruz

Background : We aimed to compare 4 automatic devices with a conventional stopwatch for measuring gait speed.Methods : We used 4 experimental devices to automatically measure gait speed: 1) Gaitspeedometer (GSM) 1, with laser sensors; 2) GSM2, with ultrasound sensors; 3) GSM3, with infrared sensors; and 4) GSM4, with a light detection and ranging sensor. To assess compatibility between different versions of GSMs, we collected 426 data points from 4 young engineers walking at random speeds and with varying postures. We used these data to convert gait speed measured by GSM1 and 2 for compatibility with GSM3 in the Korean Frailty and Aging Cohort Study (KFACS) dataset.Results : Mean gait speeds measured with GSMs 1–4 were 1.7% slower (R2=0.997), 12.2% faster (R2=0.993), 1.3% slower (R2=0.999), and 4.3% slower (R2=0.996), respectively, than the gait speed measured with a stopwatch. The concordance correlation coefficient between each GSM and the stopwatch was higher than 0.9. Using linear regression analysis with no constant term, conversion formulas for GSMs were established for the KFACS dataset using GSM1 and GSM2.Conclusion : The 4 methods of automatic gait speed measurement and the manually measured gait speed correlated well with each other, and we hope these new technologies reduce barriers to measuring older people’s gait speed in busy clinical settings.

Introduction: Many people with multiple sclerosis (MS) experience difficulty with balance and walking, which can make daily activities difficult. Recent studies in rehabilitation procedures emphasize on functional suspension training using body weight resistance against gravity by unstable tools and equipment that are similar to daily activities. Therefore, the purpose of this study was to determine the effect of total body resistance exercise (TRX) suspension training on functional balance in patients with MS. Materials & Methods: This study included 34 females with MS and expanded disability status scale of 1-4 as well as the age range of 20-50 years who referred to Isfahan MS Society. The participants were intentionally selected and assigned nonrandomly into two groups of control (n=15) and experimental (n=19). The training protocol included 8 TRX movements with four difficulty levels from simple to difficult for 8 weeks, 3 sessions per week, and each session lasting 45 minutes. The functional balance was measured through using Timed Up and Go (TUG), 10-Metre Walk Test (10MWT), and forward and lateral functional reach tests. Data were analyzed using ANCOVA. P-value less than 0.05 were considered statistically significant. Ethics code: IR.UI.REC.1396.014, Clinical trial: IRCT20180521039762N1 Findings: The results obtained from the posttest showed a significant improvement in functional balance of the experimental group, compared to the control group in terms of the TUG test (P=0.001), 10MWT (P=0.001), and lateral functional reach tests to the left and right (P=0.013). However, there was no significant difference between the two groups regarding forward functional reach test (P=0.053). Discussion & Conclusions: According to the results, it can be concluded that TRX suspension training improves functional balance, walking speed, and balance during walking in patients with MS. Therefore, it is recommended to perform TRX training as a functional training intervention to improve functional balance and walking in MS patients.

Abstract Background Understanding the effects of gait speed on biomechanical variables is fundamental for a proper evaluation of alterations in gait, since pathological individuals tend to walk slower than healthy controls. Therefore, the aim of the study was to perform a systematic review of the effects of gait speed on spatiotemporal parameters, joint kinematics, joint kinetics, and ground reaction forces in healthy children, young adults, and older adults. Methods A systematic electronic search was performed on PubMed, Embase, and Web of Science databases to identify studies published between 1980 and 2019. A modified Quality Index was applied to assess methodological quality, and effect sizes with 95% confidence intervals were calculated as the standardized mean differences. For the meta-analyses, a fixed or random effect model and the statistical heterogeneity were calculated using the I 2 index. Results Twenty original full-length studies were included in the final analyses with a total of 587 healthy individuals evaluated, of which four studies analyzed the gait pattern of 227 children, 16 studies of 310 young adults, and three studies of 59 older adults. In general, gait speed affected the amplitude of spatiotemporal gait parameters, joint kinematics, joint kinetics, and ground reaction forces with a decrease at slow speeds and increase at fast speeds in relation to the comfortable speed. Specifically, moderate-to-large effect sizes were found for each age group and speed: children (slow, − 3.61 to 0.59; fast, − 1.05 to 2.97), young adults (slow, − 3.56 to 4.06; fast, − 4.28 to 4.38), and older adults (slow, − 1.76 to 0.52; fast, − 0.29 to 1.43). Conclusions This review identified that speed affected the gait patterns of different populations with respect to the amplitude of spatiotemporal parameters, joint kinematics, joint kinetics, and ground reaction forces. Specifically, most of the values analyzed decreased at slower speeds and increased at faster speeds. Therefore, the effects of speed on gait patterns should also be considered when comparing the gait analysis of pathological individuals with normal or control ones.

Background Decreased walking speed has been revealed to be related to many negative events. Several researchers support the importance of triceps surae function as a cause of decreased walking speed. The purpose of this study was to investigate the relationship between walking speed and plantar flexor power during the terminal stance of gait in community-dwelling middle-aged and elderly women using an inertial sensor. Methods One hundred thirty-six healthy female middle-aged to elderly community-dwelling women were included in this study. We measured two-step score, grip strength, walking speed and accelerometer data from which we estimated ankle power (estimated ankle power) during walking using an inertial sensor. All participants were classified into the four different age strata, fifties (50–59), sixties (60–69), seventies (70–79) and eighties (80–89). The differences in each parameter between the four age groups were compared using repeated analysis of variance and post-hoc Bonferroni corrections for multiple comparisons to establish significance. Multiple regression analysis was carried out using a stepwise method to determine the correlations with comfortable walking speed. Comfortable walking speed was considered a dependent variable. Results The normalized estimated ankle power of the eighties group was significantly decreased in comparison with seventies age groups and fifties age groups (P < 0.05), but there were no significant differences in normalized estimated ankle power between the sixties and eighties age-groups. The results of stepwise multiple regression analysis revealed that the normalized estimated ankle power, two-step value and body weight were highly-significant partial regression coefficients (adjusted R2 = 0.57).

Background The functional movement screen (FMS)TM is a screening tool used to evaluate fundamental motor function. A score of 14 for the composite total FMS score (TFMS) is generally used as the cut-off point (≤14/21). In addition, gait analysis is used to evaluate fundamental motor function in humans. Thus, evaluating the fundamental motor function using the FMSTM test and gait analysis at various speeds can provide further understanding of any decline in gait stability. In this study, we aimed to investigate the association between gait ability and fundamental movement patterns in young adults according to the cut-off point. Methods A total of 439 participants (male: 203, female: 236) successfully completed the FMS test and a 1 min treadmill test; the participants were classified into two groups: low TFMS (≤14) and high TFMS (>14). Results The low TFMS group exhibited slower and shortened walking patterns and worsen gait variability than the high TFMS group. The coefficient of variance (CV) for the double support phase at a faster speed (male) and the stride length at a slower speed (female) were classifiers between the two groups. In addition, the low TFMS group demonstrated insufficient gait adaptation at the preferred and faster speeds based on the CV of the double support phase and gait asymmetry. Lower TFMS is associated with a decline in gait ability. Therefore, participants with a lower TFMS and poor gait ability may require intervention programs to prevent risk of future injury and to enhance motor function.

Introduction: Stroke is one of the leading cause of long term disabilities. The most commonly affected activity is walking. Though conventional therapy is producing beneficial effects in the gait of stroke patients, Backward walking is proposed to be effective in improving the gait of stroke patients. Aim: To examine the effectiveness of backward walking training on gait performance of stroke patients. Materials and Methods: The study design was an experimental study. Thirty hemiplegic patients were selected by convenient sampling technique and divided into two groups. Subjects in both groups received 40 minutes of conventional training one session per day for two weeks. Subjects in the experimental group received additional backward training for 30 minutes. Gait performance was measured using Wisconsin gait scale. Gait parameters, cadence and walking speed were also measured before and after treatment. Statistical analysis was done using independent ‘t’ test and paired ‘t’ test for between the groups and within the groups respectively. Results: After four weeks of training period, subjects in the experimental group showed much improvement than those in control group for gait performance (score: 17.42±1.53 versus 22.47±1.52) (p

Background: Gait speed is an informative marker of individual’s functional capacity and health status. Neck pain is suggested to be associated with impaired gait speed. However, there is limited evidence for a clinical assessment of gait speed in patients with neck pain. Objectives: To investigate maximum gait speed using the timed 10 meter walk test in individuals with and without neck pain. Relationships between gait speed and characteristics of neck pain were also determined. Materials and methods: Twenty six men and women aged between 18 and 59 years with chronic neck pain and 26 healthy controls of similar age and gender were recruited into the study. Participants were instructed to walk barefoot at their maximum speed along a 10 meter walk way. Time was recorded for the intermediate 6 meters. Test was performed twice and mean maximum gait speed was calculated for analysis. Results: Participants with neck pain demonstrated a slower gait speed during walking at maximum speed compared to the control group (p

Medical history of the city of Rijeka is a rich treasure trove of events, celebrities and valuable innovations in the field of healthcare. The historical development of Rijeka was largely determined by her geopolitical position as a border town with a multicultural population, marked by strong conflicts of interest and numerous identity turmoil. The great exodus of the domicile population of Italian nationality after World War II has significantly changed the social picture of the city. Among many of such esuli (immigrants) were brothers Giovanni (b. 1932) and Abdon (b. 1933) Pamich, whose lives are reminiscent of the fate of many displaced people from Rijeka who were forced to live in exile after the war. After leaving their hometown during the formative years of their childhood, they had successful careers in Italy in the fields of medicine and healthcare. The older brother Giovanni became a successful surgeon and the younger Abdon a psychologist. Along with his positions as the head of general surgery at the Monfalcone and Gorizia Hospitals, Giovanni Pamich was teaching at the University of Trieste. Abdon Pamich collaborated with the best Italian tennis players in the field of sports psychology, and was a psychologist for the Italian handball team. They both practiced athletics, and Abdon Pamich won the silver medal in speed walking at the 1958 European Championships in Sweden and the gold medal at the 1964 Tokyo Olympics. In addition to emphasizing the achievements of the two brothers in the field of medicine, this paper also addresses the position of the migrant, which is highlighted in Robert Covaz’s book “Abdon Pamich, memorie di un marciatore (Rome, 2016), an exciting biography of an emigrant from Rijeka. The paper also explores the concept of thematizing the limits of differences and experiences of migration of Rijeka residents facing the existential issues. [ABSTRACT FROM AUTHOR]

Aim: Frailty has become an important health issue in recent years. The aim of this study was to investigate the relationship between frailty and medicine use and polypharmacy in people over 65 years of age. Methods: Patients aged 65 years and over, who were admitted to family medicine outpatient clinics, were included in the study. The Tilburg frailty indicator, timed up and go test and gait speed test were used. Multivariate linear and logistic regression model were conducted. Results: Individuals, who used five or more medicines (polypharmacy) daily, constituted 49.1% of all participants. 55.6% of patients on polypharmacy were frail. Gender (β=-0.560, 95% CK0.943-0.177) and the number of chronic diseases (β=1.496, 95% Cl=1.376-1.616) were found to have an effect on the total number of medicines. According to the results of logistic regression analysis on polypharmacy; female gender (aOR=3.4, 95% Cl=1.412-8.639), living alone (single/divorced/widowed) (aOR=2.8, 95% Cl=1.133-7.201) and number of chronic diseases (aOR=6.8, 95% Cl=4.218-11.075) were significantly associated with increased risk of polypharmacy. Conclusion: A significant increase in frailty score and reduction in walking speeds were detected in patients aged 65 years and over on polypharmacy. It should be kept in mind that polypharmacy is significantly related with frailty in elderly patients. [ABSTRACT FROM AUTHOR]

This study evaluated the Timed Up & Go test (TUG) among healthy Japanese individuals without walking problems to clarify the relationship of TUG performance with physical characteristics and physical activity according to sex and age groups. In total, 797 men and women (30–84 years old) in Toon City, Ehime Prefecture, were assessed from 2016 to 2017. The survey data for physical characteristics, TUG performance, and physical activity measures were used. After adjusting for age according to TUG time and categorization into sex and age groups (30–64 and 65–84 years), the relationship of TUG performance with physical characteristics and physical activities was confirmed using multiple regression analysis. In men, TUG performance was associated with work and household chores in the 30–64-year age group, whereas it was only associated with skeletal muscle mass among those older than 65 years. In women, TUG performance was associated with height and amount of exercise, regardless of age. In conclusion, TUG performance may be maintained by increasing the amount of physical activity for men through work and housework, and increasing the amount of exercise for women, which may prevent the need for long-term care in the future.

ABSTRACT CONTEXT AND OBJECTIVE: Sarcopenia is an emerging public health issue in Brazil. Because of its high prevalence and the lack of national data, the objective here was to identify cutoff points for appendicular skeletal muscle (ASM) and handgrip strength in relation to fear of falling among Brazilian older adults. DESIGN AND SETTING: Cross-sectional study; in the community. METHODS: Participants underwent morphological and functional evaluations; and were asked about previous falls and fear of falling. Different adjustments to ASM and handgrip strength were used. Slow walking speed was defined as < 0.8 m/s or 1.0 m/s. Gender and age groups were compared using t tests, analysis of variance (ANOVA), chi-square test or Fisher’s exact test. Receiver operating characteristic curves were used to identify cutoffs for ASM and handgrip strength in relation to fear of falling. RESULTS: 578 older adults participated in this study. Function levels decreased with increasing age, and body composition differed between the sexes. In relation to fear of falling, the cutoffs for ASM adjusted for body mass index (BMI) were < 0.85 for men and < 0.53 for women; the cutoffs for absolute handgrip strength and relative handgrip strength (adjusted for BMI) were 30.0 kgf and 21.7 kgf, and 1.07 and 0.66, for men and women, respectively. CONCLUSION: The values presented can be used as references in clinical practice and research. We recommend use of ASM adjusted for BMI and choosing between absolute and relative handgrip strength for men and women, according to study needs.

Purpose: Because walking is the main activity of humans for movement, many research studies have been conducted to understand its details. One of the main issues in this regard is gait symmetry and the effect of various factors on it. Accordingly, the present study aimed to review the selected factors affecting gait symmetry. Methods: A literature review was performed on articles published from 2000 to 2016 using Science Direct, Google scholar, PubMed, Ovid Medline, Scopus and Medline databases. The search keywords were “gait asymmetry”, “bilateral coordination”, “bilateral asymmetry”, “limb dominance”, “laterality”, “limb preference” and “performance asymmetry.” Results: A total of 60 scientific articles were selected according to the research criteria by searching the relevant articles published from 2000 to 2016 in reliable scientific databases. Conclusion: A review of the previous studies shows that walking in normal people is asymmetric in terms of the lower limb function. Also, limb disorder due to the illness and or disorder creates gait asymmetry. Therefore, regaining perfect symmetry or decreasing gait asymmetry by exercise and intervention in such individuals is considered a method to examine the success of rehabilitation process. However, as factors like movement speed and age can affect gait asymmetry, they should be controlled during the examination of gait asymmetry. Moreover, this information could be useful for gait assessment, clinical prescriptions for patients with abnormalities, designing orthosis and prosthesis, as well as improving the performance of athletes.

Objective: Falls are major problems for people with Parkinson’s disease. This study aimed to determine fall frequency, and the relation of socio-demographic and clinical factors in idiopathic Parkinson’s disease (IPH). Materials and Methods: Eighty-seven patients with IPH who were under follow-up in Erciyes University Faculty of Medicine, Neurology Department [37 females (42.5%), and 50 males (57.5%)] were included in the study. The participants were evaluated with neurologic examination, mini-mental state examination, the Unified Parkinson’s Disease Rating Scale (UPDRS), 6-meter walking test, turning time, freezing phenomenon, Hoehn and Yahr (H&Y) Scale, and ranking of fear of falls. Fall was recorded as history of fall in the 6 months before testing. Results: A total of 22 (25.3%) patients reported a fall in the 6-month period before testing. Twenty-five patients (28.7%) were stage 1.5, and 22 (25.3%) were stage 2 according to the H&Y Scale. Freezing phenomenon was observed in 34 39.1%) patients. There was no significant difference between patients with and without a history of falls according to age, sex, education, occupation, and marital status (p>0.05). According to disease period, H&Y Scale and the UPDRS, motor, turning time 360 degrees from right, turning time 360 degrees from left, balance defect at 360 degrees right turning, balance defect at 360 degrees left turning, and freezing phenomenon there were no significant difference between those with and without a history of fall (p>0.05). There was a significant difference between those who had fallen and had not fallen according to UPDRS-mental, UPDRS-ADL, degree of fear of falling, 6-m walking time, 6-m walking test, and number of steps (p

Many studies have explored the effects of auditory and visual stimuli on the perception of an environment. However, there is a lack of investigations examining direct behavioral responses to noise in specific environments. In this study, a behavioral variable, walking speed, was analyzed, as a response to the sounds and visual features of a specific environment. The study examined the effects of birdsongs compared to traffic noise on walking speed in a real outdoor urban environment. It was supposed that the interaction of audition and vision in the perception of an environment may also be shaped by the perceived congruence of the visual and auditory features of the environment. The participants (N = 87 and N = 65), young university students, walked along a 1.8-km urban route. They listened to a soundtrack of crowded city noise or birdsongs, or they walked in the real outdoor environment without listening to any acoustic stimuli. To investigate the effect of the congruence between acoustic and visual stimuli, the experiment was conducted in two different seasons (fall and spring). The results did not show significant differences between the crowded city noise condition and the real outdoor condition. Listening to the soundtrack with birdsongs decreased walking speed, but this effect was significant only in the experiment conducted in spring. These findings can be explained in terms of the congruence between the sounds and the visual environment. The findings raise questions regarding the restorative function of urban greenery during different seasons.

Background and Objectives: Analysis of gait parameters and energy expenditure in different walking speeds in trans-tibial amputees has been less investigated. This may provide an insight into how they respond to it. The main aim of this study was to investigate the effect of walking speed changes on gait parameters and metabolic energy consumption in unilateral trans-tibial amputees using the prosthesis. Methods: Thirty trans-tibial amputees fulfilling inclusion criteria were investigated for gait parameters using a ten-meter walk test while these subjects walked with three different walking speeds (comfortable, fast, and slow). Temporal-spatial gait parameters, such as step length, stride length, velocity and cadence, and Physiological Cost Index (PCI) for metabolic energy consumption were analyzed by repeated-measures ANOVA. Results: Step length of a prosthetic side in the fast walking speed (0.67±0.10 m) was higher than the normal comfortable speed (0.56±0.13 m) and least in slow walking (0.42±0.06 m). A similar trend was observed for all gait parameters. PCI (beats/m) was least in normal comfortable speed (0.08±0.09), followed by fast walking speed (0.11±0.08). It was highest when patients walked at a slow speed (0.18±0.12). There was a significant difference in all temporal-spatial gait parameters and PCI in three walking speed conditions (p

Young people are also at risk of developing locomotive syndrome for unclear reasons. Therefore, we sought to evaluate the locomotive syndrome risk in young Japanese women and the relationship between standing posture and gait patterns. We used survey materials for physical measurements, locomotive syndrome risk tests, normal and maximum walking test, a standing posture test, and physical activity measures. A questionnaire-based cross-sectional survey was conducted with 100 Japanese female university students. The participants were divided into two groups (high-risk and low-risk groups) based on locomotive syndrome risk tests. The high-risk group accounted for 65.0% of the total participants. The high-risk group had a significantly slower walking speed and lower walking stride length than the low-risk group during maximum walking. Additionally, this high-risk group had a more prone posture than the low-risk group. Furthermore, the low-risk group included more individuals who belonged to middle and high school athletic clubs than the high-risk group. The locomotive syndrome risk was related to the walking pattern, standing posture, and past exercise habits. Therefore, long stride length, correct standing posture, and exercise habits acquired from a young age are important measures for preventing locomotive syndrome in young adults.

Objectives: This paper describes further improvement and preliminarily evaluation of a novel viscoelastic ankle-foot prosthesis prototype. The objective was to control the ankle hysteresis at slow and normal walking speeds. Methods: Inspired by the ankle biomechanics, in which the hysteresis differs based on the gait speeds, a manually damping control mechanism imbedded in the prosthesis for adjusting the ankle damping at slow and normal walking speeds. The prototype was then preliminarily tested on an able-bodied subject wearing an adaptor which simulates the amputee walking. The ankle joint kinetics and kinematics were measured in a gait analysis lab at different walking speeds. Results: The results suggest that the viscoelastic ankle foot prosthesis prototype could provide a smooth normal-like walking for most of the measured gait characteristics in slow and normal speeds. Discussion: Therefore, it is suggested to apply a controllable damping mechanism based on the gait speeds in the design of new prosthetic feet.