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Background Slower gait speed may be driven by greater energy deficits and fatigability among older adults. We examined associations of walking energetics and perceived physical fatigability with gait speed among slower and faster walkers. Additionally, we used statistical mediation to examine the role of fatigability in the associations of walking energetics and gait speed using the Study of Muscle, Mobility and Aging (SOMMA). Methods Perceived physical fatigability was assessed using the Pittsburgh Fatigability Scale (PFS) Physical score (range 0–50, higher = greater). A 3-phase cardiopulmonary exercise treadmill test collected peak oxygen consumption (VO2peak, mL/kg/min), energetic cost of walking (ECW, mL/kg/m), and cost–capacity ratio (VO2/VO2peak*100, %). Slower (<1.01 m/s) versus faster (≥1.01 m/s) walkers were classified using median 4-m gait speed. Linear regressions and statistical mediation analyses were conducted. Results Slower walkers had lower VO2peak, higher ECW at preferred walking speed (PWS), and greater PFS Physical score compared to faster walkers (all p  < .05; N  = 849). One standard deviation (1- SD) higher VO2peak was associated with 0.1 m/s faster gait speed, while 1- SD higher ECW PWS, cost–capacity ratio at PWS and slow walking speed (SWS), and PFS Physical score were associated with 0.02–0.23 m/s slower gait speed. PFS Physical score was a significant statistical mediator in the associations between VO2peak (15.2%), SWS cost–capacity ratio (15.9%), and ECW PWS (10.7%) with gait speed and was stronger among slower walkers. Conclusions Slower walkers may be more influenced by perceptions of fatigue in addition to walking energetics. Our work highlights the importance of targeting both energetics and perceived fatigability to prevent mobility decline. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: As individuals age, the entorhinal cortex (ERC) and hippocampus--crucial structures for memory--tend to atrophy, with related cognitive decline. Simultaneously, lifestyle factors that can be modified, such as exercise and sleep, have been separately linked to slowing of brain atrophy and functional decline. However, the synergistic impact of fitness and sleep on susceptible brain structures in aging adults remains uncertain. Methods: We examined both independent and interactive associations of fitness and subjective sleep quality with regard to ERC thickness and hippocampal volume in 598middle-aged and older adults from the Human Connectome Lifespan Aging Project. Cardiorespiratory fitness was assessed using the 2-min walk test, whereas subjective sleep quality was measured with the continuous Pittsburgh Sleep Quality Index global score. High-resolution structural magnetic resonance imaging was used to examine mean ERC thickness and bilateral hippocampal volume. Through multiple linear regression analyses, we investigated the moderating effects of subjective sleep quality on the association between fitness and brain structure, accounting for age, sex, education, body mass index, gait speed, and subjective physical activity. Results: We found that greater cardiorespiratory fitness, but not subjective sleep quality, was positively associated with bilateral hippocampal volume and ERC thickness. Notably, significant interaction effects suggest that poor subjective sleep quality was associated with a weaker association between fitness and both hippocampal volume and ERC thickness. Conclusions: Findings suggest the potential importance of both cardiorespiratory fitness and subjective sleep quality in preserving critical, age-vulnerable brain structures. Interventions targeting brain health should consider potential combined effects of sleep and fitness on brain health. [ABSTRACT FROM AUTHOR]

Purpose: Cardiorespiratory fitness (CRF) measured by peak oxygen consumption (...) declines with aging and correlates with mortality and morbidity. Cardiopulmonary exercise testing (CPET) is the criterion method to assess CRF, but its feasibility, validity, and reliability in older adults are unclear. Our objective was to design and implement a dependable, safe, and reliable CPET protocol in older adults. Methods: ... was measured by CPET, performed using treadmill exercise in 875 adults ≥70 yr in the Study of Muscle, Mobility and Aging (SOMMA). The protocol included a symptom-limited peak (maximal) exercise and two submaximal walking speeds. An adjudication process was in place to review tests for validity if they met any prespecified criteria (... <12.0 mL⋅kg-1⋅min-1; maximum heart rate <100 bpm; respiratory exchange ratio <1.05 and a rating of perceived exertion <15). A subset (N = 30) performed a repeat test to assess reproducibility. Results: CPET was safe and well tolerated, with 95.8% of participants able to complete the // phase of the protocol. Only 56 (6.4%) participants had a risk alert and only two adverse events occurred: a fall and atrial fibrillation. Mean ± SD ... was 20.2 ± 4.8 mL⋅kg-1⋅min-1, peak heart rate 142 ± 18 bpm, and peak respiratory exchange ratio 1.14 ± 0.09. Adjudication was indicated in 47 tests; 20 were evaluated as valid and 27 as invalid (18 data collection errors, 9 did not reach ...). Reproducibility of ... was high (intraclass correlation coefficient = 0.97). Conclusions: CPET was feasible, effective, and safe for older adults, including many with multimorbidity or frailty. These data support a broader implementation of CPET to provide insight into the role of CRF and its underlying determinants of aging and age-related conditions. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine repetitive transcranial mag- netic stimulation, transcranial direct current stimulation, and cranial nerve noninvasive neuromodulation affect functional balance, gait speed, and walking cadence in stroke patients. Methods: We searched PubMed, Embase, Cochrane, and Scopus (June 22, 2022) for randomized controlled trials. Three reviewers independently performed data extraction and assessed the risk of bias. Network and pairwise meta-analyses were performed to assess indirect and direct comparisons. Results:We included 34 studies (N = 915 patients). Sixty percent had moderate-to-high methodological quality. The meta-analyses showed positive effects of repetitive transcranial magnetic stimulation combined with rehabilitation therapy compared with sham on gait speed, walking cadence, and balance function with weighted mean differences and 95% confidence interval of 0.08 (0.03 to 0.13), 7.16 (3.217 to 11.103), and 3.05 (0.52 to 5.57), respectively. Transcranial direct current stimulation showed improvement on the time up and go test (-0.88 [-1.68 to -0.08]). From the surface under the cumulative ranking analyses, repetitive transcranial magnetic stimulation is the best ranked treatment for gait speed and functional balance improvement compared with transcranial direct current stimulation and sham interventions. There were not enough studies to include cranial nerve noninvasive neuromodulation in the meta-analysis. Conclusions: Walking cadence and speed, functional balance significantly improved after repetitive transcranial magnetic stimulation with short-term effects, which were superior to that of transcranial direct current stimulation and sham treatments. Transcranial direct current stimulation showed short-term beneficial effects on the Time Up and Go test. [ABSTRACT FROM AUTHOR]

Understanding the natural biomechanics of walking at different speeds and activities is crucial to develop effective assistive devices for persons with lower-limb impairments. While continuous measures such as joint angle and moment are well-suited for biomimetic control of robotic systems, whole-stride summary metrics are useful for describing changes across behaviors and for designing and controlling passive and semi-active devices. Dynamic mean ankle moment arm (DMAMA) is a whole-stride measure representing the moment arm of the ground reaction impulse about the ankle joint—effectively, how “forefoot-dominated” or “hindfoot-dominated” a movement is. DMAMA was developed as a target and performance metric for semi-active devices that adjust once per stride. However, for implementation in this application, DMAMA must be characterized across various activities in unimpaired individuals. In our study, unimpaired participants walked at “slow,” “normal,” and “fast” self-selected speeds on level ground and at a normal self-selected speed while ascending and descending stairs and a 5-degree incline ramp. DMAMA measured from these activities displayed a borderline-significant negative sensitivity to walking speed, a significant positive sensitivity to ground incline, and a significant decrease when ascending stairs compared to descending. The data suggested a nonlinear relationship between DMAMA and walking speed; half of the participants had the highest average DMAMA at their “normal” speed. Our findings suggest that DMAMA varies substantially across activities, and thus, matching DMAMA could be a valuable metric to consider when designing biomimetic assistive lower-limb devices. [ABSTRACT FROM AUTHOR]

Heart failure (HF) can cause metabolic imbalances, leading to anabolic resistance and increased energy expenditure, which often results in weight loss and cachexia. Comprehensive cardiac rehabilitation (CR), including exercise, nutritional support, and risk management, is crucial for enhancing the health and quality of life of patients with HF and is expected to play a central role in the prevention and treatment of HF-associated cachexia. However, the prevalence of cachexia in patients with HF undergoing comprehensive outpatient CR is currently unknown, and the detailed characteristics including of motor function of such patients remain undefined. Therefore, this cross-sectional study aimed to investigate the prevalence and characteristics of cachexia and the relationship between cachexia and lower limb motor function in patients with HF undergoing outpatient CR. This study included 115 consecutive patients with HF (43% male; mean age, 78 ± 8 years) who underwent comprehensive outpatient CR. The cachexia status was assessed according to the definition proposed by the Asian Working Group on Cachexia in 2023. The Short Physical Performance Battery (SPPB) and Mini Nutritional Assessment Short-Form (MNA-SF) were used to evaluate motor function of the lower limbs and nutritional status, respectively. Multivariate logistic regression analyses were used to examine the potential relationship between cachexia and low SPPB scores (≤ 9 points). The prevalence of cachexia was 30% in this study. Compared with those without cachexia, patients with cachexia were significantly older and showed notable reductions in body mass index, MNA-SF scores, handgrip strength, gait speed, and SPPB scores. A multivariate logistic regression analysis, adjusted for confounders, revealed that both age (odds ratio [OR], 1.129; 95% confidence interval [CI], 1.034–1.248; P = 0.016) and presence of cachexia (OR, 3.783; 95% CI, 1.213–11.796; P = 0.022) were independently associated with low SPPB scores. These findings highlight the importance of focusing on cachexia in patients with HF as part of a comprehensive outpatient CR and may be crucial in developing treatments to improve lower limb motor function in patients with HF who develops cachexia. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the differences in muscle activation and kinematic parameters between patients with unilateral knee osteoarthritis (OA) and healthy individuals. Additionally, the study aimed to determine the correlation between muscle activation and kinematic parameters with knee OA symptoms. Participants with unilateral knee OA (n = 32) and healthy individuals (n = 32) completed the gait test. Electromyography (EMG) and motion capture were employed to collect muscle activation data and kinematic parameters. Spearman's correlation coefficient was used to analysis the correlation between BMI, symptomatic side EMG parameters, kinematic parameters, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. Furthermore, a multiple linear regression analysis of WOMAC pain was also conducted. The peak root mean square, integrated electromyography, and co-activation index (CCI) were increased bilaterally in the unilateral knee OA group compared to the healthy group. Furthermore, these values were higher on the symptomatic side than on the asymptomatic side. Compared with the healthy group, the knee OA group had lower gait speed, decreased stride length and cadence on bilateral sides, longer total stance time and double-stance time, and shorter single stance time and swing time. The maximum knee flexion angle of the swing phase on the symptomatic side of the knee OA group was smaller than that on the asymptomatic side and healthy group. Changes in EMG and gait parameters on the symptomatic side correlated with WOMAC scores. The main factors influencing WOMAC pain were the CCI values of the lateral femoral and biceps femoris muscles and gait speed. Muscle activation and kinematic parameters in the lower limbs of patients with unilateral knee OA were altered bilaterally during walking. These alterations on the symptomatic side were associated with knee OA-related pain. ChiCTR2200064958. Date of registration: 2022–10-24. Key Points • Unilateral symptomatic knee OA leads to bilateral alterations in muscle activation and gait parameters. • Symptomatic muscle activation and gait parameter changes in knee OA patients are associated with knee OA symptoms. • Correcting abnormal muscle activation conditions and gait training may reduce knee OA-related pain. [ABSTRACT FROM AUTHOR]

Bolivia has an outstanding tetrapod ichnological record from the uppermost Cretaceous deposits plus a new Triassic locality recently reported. Here, we report a new ichnosite, the first for the Jurassic to earliest Cretaceous in the Castellón Formation (Tarija, Bolivia) bearing about 350 dinosaur tracks. With the exception of few tridactyl tracks, all exhibit sauropod characteristics. The exposed set consists of three mediumgauge, subparallel large quadrupedal trackways, with one trackway oriented in opposite direction to the other two. The best preserved trackway shows large pedes of about 95 cm and 75 cm in length and width, respectively. The trackmaker was about 3.80 m in height at the hip and walked at a speed under 5 km/h. Available evidence suggests that the producer of the more detailed trackway may be a member of non-Neosauropoda Eusauropoda, even if a titanosauriform producer cannot be discarded. Dozens of small-sized sauropod tracks, less than 15 cm in pes diameter, appear associated with two of the trackways. The distribution of these trackways provides elements to test gregariousness among trackmakers if a possible synchronism is accepted. Wanderings recognisable on the sediment surface suggest that they may collectively represent an ichnological example of herd behaviour. [ABSTRACT FROM AUTHOR]

There is a need to revisit movement dataset(s) currently used as egress determinants to assess whether they are truly representative of the current diverse occupant base. This is particularly important with our aging population as these sets contain very limited amounts of recent, age-specific data for older adults. This study provides data on walking speeds of older adults, obtained during standardized tests of walking, and compares those to default walking speeds used in current egress models. From experimental, short-distance walking trials (n = 451), it was seen that sex, increasing age, use of walking aids, those who have previously experienced a stroke (n = 116) and walking under cognitive load all resulted in decreases in walking speed. First iteration Pathfinder simulations showed that more realistic inputs for population walking speed resulted in simulated egress times that were on average 8 s slower compared to use of the current default range of walking speeds. Results suggest that the assumption of a uniform population in egress modelling, and consequently the standard practice of using a default walking speed for older adult occupants, should be reconsidered since, in reality the older adult population is extremely heterogeneous with regards to mobility, as reflected in the variability in walking speeds in this study. [ABSTRACT FROM AUTHOR]

Objectives: Plasma C-terminal agrin-fragment-22 (CAF22), a breakdown product of neuromuscular junction, is a potential biomarker of muscle loss. However, its levels from adolescence to octogenarians are unknown. Methods: We evaluated young (18–34 years, n = 203), middle-aged (35–59 years, n = 163), and old men (60–87 years, n = 143) for CAF22, handgrip strength (HGS), appendicular skeletal-mass index (ASMI), and gait speed. Results: We found an age-associated increase in CAF22 from young (100.9 ± 29 pmol) to middle-aged (128.3 ± 38.7 pmol) and older men (171.5 ± 35.5 pmol) (all p<0.05). This was accompanied by a gradual reduction in HGS (37.7 ± 6.1 kg, 30.2 ± 5.2 kg, and 26.6 ± 4.7 kg, for young, middle-aged, and old men, respectively), ASMI (8.02 ± 1.02 kg/m2, 7.65 ± 0.92 kg/m2, 6.87 ± 0.93 kg/m2, for young, middle-aged, and old men, respectively), and gait speed (1.29 ± 0.24 m/s, 1.05 ± 0.16 m/s, and 0.81 ± 0.13 m/s, for young, middle-aged, and old men, respectively). After adjustment for age, we found negative regressions of CAF22 with HGS (− 0.0574, p < 0.001) and gait speed (− 0.0162, p < 0.001) in the cumulative cohort. The receiver operating characteristics analysis revealed significant efficacy of plasma CAF22 in diagnosing muscle weakness (HGS < 27 kg) (middle-aged men; AUC = 0.731, 95% CI = 0.629–0.831, p < 0.001, Older men; AUC = 0.816, 95% CI = 0.761–0.833, p < 0.001), and low gait speed (0.8 m/s) (middle-aged men; AUC = 0.737, 95% CI = 0.602–0.871, p < 0.001, older men; AUC = 0.829, 95% CI = 0.772–0.886, p < 0.001), and a modest efficacy in diagnosing sarcopenia (middle-aged men; AUC = 0.701, 95% CI = 0.536–0.865, p = 0.032, older men; AUC = 0.822, 95% CI = 0.759–0.884, p < 0.001) in middle-aged and older men. Conclusion: Altogether, CAF22 increases with advancing age and may be a reliable marker of muscle weakness and low gait speed. [ABSTRACT FROM AUTHOR]

This scoping review aimed to explore and synthesize existing research on predictors of loneliness, and the impact of loneliness on physiological and psychological health outcomes and health behaviors in older adults with diabetes. Results from 12 studies showed that low education, being unmarried/divorced/separated, having diabetes-related complications, being physically inactive, having diabetes distress, being of a certain race/ethnicity, being female, having depressive symptoms, and being younger age were consistently identified as predictors of loneliness. In addition, loneliness was found to affect both psychological (depressive symptoms and negative perceptions of diabetes) and physiological health outcomes (increased postprandial blood glucose and A1C levels, decreased cortisol levels, increased MCP-1 levels, slower gait speed, and weaker hand grip) and health behaviors (decreased engagement in physical activity, increased disability in activities of daily living and instrumental activities of daily living, and increased likelihood of antidepressant use). The results of this scoping review suggest that loneliness is a complex issue for older adults with diabetes and its effects are far-reaching. Therefore, further research should be conducted to explore the potential causal relationships between loneliness and physiological and psychological health outcomes and to identify the best interventions to reduce loneliness in older adults with diabetes. For healthcare providers, it is important to recognize that loneliness is an appropriate risk factor for older adults with diabetes that may affect psychological and physiological health outcomes and health behaviors and to address it through interventions such as social support programs, group therapy, or psychosocial counseling. [ABSTRACT FROM AUTHOR]

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is an adverse effect of frequently used chemotherapy agents in cancer treatment. It is a painful and dose-limiting condition of the peripheral nerves. Exercise is known to limit the progression of CIPN and reduce sensory and motor symptoms. CIPN can be disabling as it leads to loss of balance control, gait disturbances and frequent falls. The study aims to review the effectiveness of different exercise interventions in improving gait speed and postural control in individuals who underwent chemotherapy. Method: Randomized controlled trials assessing the effect of exercise on postural control and gait are selected. A search strategy was performed in PubMed, PEDro, Scopus, and Web of Science databases. Data were extracted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Result: A total of 1450 search results were found, and 4 studies were selected. Exercises like endurance training, balance exercises and sensorimotor training are beneficial in CIPN for reducing postural sway and increasing gait speed. Twice weekly sessions for 30 min each for 4–18 weeks are common exercise regime given to the participants. A combination of more than one type of exercise was shown to be effective in reducing CIPN symptoms. Conclusion: Exercise is beneficial in improving the postural control and gait parameters in individuals with CIPN. Further studies are required to analyze the potential effect of different exercises to improve gait and balance. [ABSTRACT FROM AUTHOR]

Purpose: The Functional Ambulation Categories (FAC) is a measurement tool used to classify walking ability according to the amount of physical support required. In this study, the FAC is translated into Danish and the reliability and validity of the FAC are established in a population of patients with acquired brain injury (ABI). Methods: The study took place in a neuro-rehabilitation setting. The translation process followed an accepted forward–backward translation method in six steps. For the assessment of clinometric properties a cross-sectional study design was applied. Interrater reliability was assessed with weighted Cohen's kappa. Construct validity of the FAC was assessed with Spearman's rho by correlating the FAC to walking velocity assessed with the 10-meter walk test and to the number of daily steps assessed with accelerometers. Results: The FAC was successfully translated into Danish. For the assessment of clinometric properties, 53 patients were included. Almost perfect interrater reliability was found (κ = 0.92, p < 0.0001). Construct validity was high between FAC and walking velocity (r2 = 0.87, p < 0.0001) and moderate between FAC and the number of daily steps (r2 = 0.62, p < 0.0001). Conclusion: The Danish version of the FAC was found reliable and valid for use in-patients with ABI. IMPLICATIONS FOR REHABILITATION: The Functional Ambulation Categories (FAC) has been translated into Danish and is available for use by researchers and clinicians in Denmark. Steps to ensure high reliability are described and can be replicated in other settings and these steps include developing a practice scoring sheet with a patient case for each FAC score. The reliability and validity of the FAC have been established, and the results are generalizable to similar populations of patients with acquired brain injury. [ABSTRACT FROM AUTHOR]

Cognition and gait share brain substrates in aging and dementia. Cognitive reserve (CR) allows individuals to cope with brain pathology and delay cognitive impairment and dementia. Yet, evidence for that CR is associated with age-related cognitive decline is mixed, and evidence for that CR is associated with age-related gait decline is limited. In 1,079 older (M Age = 75.4 years; 56.0% women) LonGenity study participants without dementia at baseline and up to 12 years of annual follow-up (M follow-up = 3.9 years, SD = 2.5 years), high CR inferred from cognitive (education years), physical (number of blocks walked per day; weekly physical activity days), and social (volunteering/working; living with someone) proxies were associated with slower rates of age-related decline in global cognition – not gait speed decline. Thus, cognitive, physical, and social CR proxies are associated with cognitive decline in older adults without dementia. The multifactorial etiology and earlier decline in gait than cognition may render it less modifiable by CR proxies later in life. • Cognitive reserve permits people to cope with brain pathology and delay dementia. • Cognitive reserve can be accrued from cognitive, physical, and social activities. • Cognitive reserve slowed age-related cognitive decline – not gait speed decline. • Results were consistent across cognitive, physical, and social reserve proxies. [ABSTRACT FROM AUTHOR]

We determined beta-band intermuscular (IMC) and corticomuscular coherence (CMC) as a function of age and walking balance difficulty. Younger (n=14, 23y) and older individuals (n=19, 71y) walked 13 m overground, on a 6-cm-wide ribbon overground, and on a 6-cm-wide (5-cm-high) beam. Walking distance as a proxy for walking balance and speed were computed. CMC was estimated between electroencephalographic signal at Cz electrode and surface electromyographic signals of seven leg muscles, while IMC was calculated in four pairs of leg muscles, during stance and swing gait phases. With increasing difficulty, walking balance decreased in old individuals and speed decreased gradually independent of age. Beam walking increased IMC, while age increased IMC in proximal muscle pairs, and decreased IMC in distal muscle pairs. Age and difficulty increased CMC independent of gait phases. Concluding, CMC and IMC increased with walking balance difficulty and age, except for distal muscle pairs, which had lower IMC with age. These findings suggest an age-related increase in corticospinal involvement in the neural control of walking balance. The datasets used in this study are available from the corresponding author upon reasonable request. • Walking balance decreased strongly in older individuals. • Walking speed decreased gradually with balance difficulty independent of age. • Cortico- and intermuscular coherence increased with walking balance difficulty. • Cortico- and intermuscular coherence increased with age. • Intermuscular coherence of distal muscle pairs reduced with age. [ABSTRACT FROM AUTHOR]

The article offers a comprehensive update on recent advancements in diabetes research and treatments. Topics discussed include the influence of walking speed on the risk of developing type 2 diabetes, emerging evidence linking type 2 diabetes to Alzheimer's disease, and the innovative use of xenotransplantation involving pig organs to address the shortage of human kidneys for transplantation.

This article is a book review of "Optimizing Project Work Management, and Delivery" by Gary L. Richardson and Brad M. Jackson. The book aims to provide an integrated decision architecture for project management that can be applied to all project types. It discusses various delivery methods, project profiles, project success drivers, and project externals. The book also explores different delivery strategies, such as the classic predictive model, the iterative development model, and the critical chain model. It concludes with a series of success recipes for project managers to follow. The reviewer recommends this book to project managers and program managers in various industries. [Extracted from the article]

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Traditional measurements of gait are typically performed in clinical or laboratory settings where functional assessments are used to collect episodic data, which may not reflect naturalistic gait and activity patterns. The emergence of digital health technologies has enabled reliable and continuous representation of gait and activity in free-living environments. To provide further evidence for naturalistic gait characterization, we designed a master protocol to validate and evaluate the performance of a method for measuring gait derived from a single lumbar-worn accelerometer with respect to reference methods. This evaluation included distinguishing between participants' self-perceived different gait speed levels, and effects of different floor surfaces such as carpet and tile on walking performance, and performance under different bouts, speed, and duration of walking during a wide range of simulated daily activities. Using data from 20 healthy adult participants, we found different self-paced walking speeds and floor surface effects can be accurately characterized. Furthermore, we showed accurate representation of gait and activity during simulated daily living activities and longer bouts of outside walking. Participants in general found that the devices were comfortable. These results extend our previous validation of the method to more naturalistic setting and increases confidence of implementation at-home. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Gait performance can provide valuable insights into cognitive functioning in older adult and may be used to screen for cognitive impairment. However, the optimal test condition and spatiotemporal parameter for accuracy have not yet been determined. This study aims to determine the gait measure with the highest accuracy identifying cognitive decline.A total of 711 participants were recruited, including 332 cognitively healthy individuals, 264 with mild cognitive impairment (MCI), and 115 with dementia, with a mean age of 72 years (interquartile range 69–76), and 43% (n = 307) of women. The participants underwent gait assessment in three different conditions, including a single task and dual tasks of counting backward by ones and naming animals.Gait performance was deteriorated as cognitive impairment progressed. The gait test performed during naming animals condition was the most accurate in differentiating between cognitive groups. Specifically, the naming animals gait speed was more accurate in discriminating control participants from those with cognitive impairment (area under the curve [AUC] = 76.9% for MCI and 99.7% for people with dementia with control group as reference). The coefficient of stride length variability while naming animals was the most effective parameter in discriminating between MCI and dementia groups (AUC = 96.7%).The naming animals dual‐task gait test can be a valuable assessment for screening cognitive impairment in older adults, regardless of their cognitive abilities. The test is useful in clinical settings for subjects with a range of cognitive profiles. [ABSTRACT FROM AUTHOR]

Background: Gait ability can be objectively assessed using gait analysis. Three-dimensional gait analysis, the most commonly used analytical method, has limitations, such as a prolonged examination, high system costs, and inconsistently reported gait symmetry in patients with knee osteoarthritis (OA). Therefore, we aimed to evaluate the gait symmetry and changes before and after unilateral total knee arthroplasty (TKA) using the Walkway analyzer, a sheet-type gait analyzer. Methods: The healthy group included 38 participants from the Locomotor Frailty and Sarcopenia Registry study with lower limb pain or Kellgren–Lawrence classification grade 3 or 4 OA. The OA group included 34 participants from the registry study who underwent unilateral TKA. The walking speed, step length, step width, cadence, stride time, stance time, swing phase time, double-limb support phase time, stride, step length, and step width were analyzed per side using the Walkway gait analyzer. Results: No significant differences between the right and left sides were observed in the healthy group. In the OA group, the time indices and stance phase (p = 0.011) and the double-limb support phase time (p = 0.039) were longer on the contralateral side and the swing phase was longer on the affected side (p = 0.004) pre-operatively. However, these differences disappeared post-operatively. There were no significant differences in the spatial indices. Thus, this study revealed that patients undergoing unilateral TKA had an asymmetric gait pre-operatively, with a time index compensating for the painful side, and an improved symmetric gait post-operatively. Conclusions: The Walkway analyzer employs a simple test that requires only walking; hence, it is expected to be used for objective evaluation in actual clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: When walking and stepping over an obstacle of a certain height, tripping occurs more frequently with the trailing limb than the leading limb. The present study was designed to address whether collisions involving the trailing limb can be improved with experimental manipulation of the placement of the leading limb after stepping over an obstacle. We used an immersive, virtual obstacle-crossing task to ensure that the collision was not improved simply due to the experience of physical collision with an obstacle. Methods: Fourteen young participants (12 males and 2 females, 28.7 ± 3.5 years) were required to walk and step over a virtual horizontal pole under one of four conditions. In three conditions, participants were required to place their leading foot on a square target located along their walking path after crossing the obstacle. The target was positioned so that it was relatively close to the obstacle (10 cm from the obstacle, referred to hereafter as the closer condition), at a position that would naturally be stepped on in successful trials without a collision (20 cm from the obstacle, the middle condition), or relatively far from the obstacle (40 cm from the obstacle, the farther condition). For the fourth condition, participants were free to select where they would step after stepping over the obstacle (the control condition). Results and discussion: The results showed that the collision rate of the trailing limb was significantly lower under the closer condition than under the other three conditions. Compared to the control condition, under the closer condition the movement of the trailing limb was modified so that obstacle crossing was performed at approximately the moment when the height of the toe of the trailing limb was higher, and the walking speed was slower. These findings suggest that placing the foot of the leading limb closer to the obstacle after crossing the obstacle may ensure safe obstacle avoidance by the trailing limb. [ABSTRACT FROM AUTHOR]

Understanding individuals' distinct movement patterns is crucial for health, rehabilitation, and sports. Recently, we developed a machine learning-based framework to show that "gait signatures" describing the neuromechanical dynamics governing able-bodied and post-stroke gait kinematics remain individual-specific across speeds. However, we only evaluated gait signatures within a limited speed range and number of participants, using only sagittal plane (i.e., 2D) joint angles. Here we characterized changes in gait signatures across a wide range of speeds, from very slow (0.3 m/s) to exceptionally fast (above the walk-to-run transition speed) in 17 able-bodied young adults. We further assessed whether 3D kinematic and/or kinetic (ground reaction forces, joint moments, and powers) data would improve the discrimination of gait signatures. Our study showed that gait signatures remained individual-specific across walking speeds: Notably, 3D kinematic signatures achieved exceptional accuracy (99.8%, confidence interval (CI) 99.1–100%) in classifying individuals, surpassing both 2D kinematics and 3D kinetics. Moreover, participants exhibited consistent, predictable linear changes in their gait signatures across the entire speed range. These changes were associated with participants' preferred walking speeds, balance ability, cadence, and step length. These findings support gait signatures as a tool to characterize individual differences in gait and predict speed-induced changes in gait dynamics. [ABSTRACT FROM AUTHOR]

Dysmobility Syndrome (DMS), is a combination, that is analogous to the approach taken with metabolic syndrome, The diagnosis of DMS is complex. So this study aimed to explore the relationship between 25-(OH) Vit D with Dysmobility Syndrome (DMS)in type 2 diabetes mellitus(T2DM) patients. This is a cross-sectional study, including 330 patients (67.0 ± 8.8 years old) with T2DM who were admitted to the Qinhuangdao First Hospital from October 2020 to February 2022. Selected independent variables include grip strength, six-meter gait speed, level of 25-(OH) vitamin D, and bone mineral density (BMD) measured by Dual-energy X-ray (DXA). DMS includes six conditions: osteoporosis, low muscle mass, low muscle strength, slow gait speed, occurrences of falls in the past year ≥ 1, and obesity, having three or more of these conditions were diagnosed with DMS. Patients were classified based on DMS. The detection rate of DMS in patients with T2DM was 25.5%. The proportion of vitamin deficiency is 67.9% in patients with T2DM. The 25-(OH) Vit D deficiency was defined based on the 25th percentile into two groups; < 36.2 nmol/L. The vitamin D levels in Group DMS were significantly lower than that in Group Non-DMS (41.74 ± 14.60 vs. 47.19 ± 13.01, P < 0.05). After adjusting confounder factors including sex, age, vitamin D levels, HbA1c, ALB, HDLC, eGFR, diabetes microvascular complications and macrovascular, there was an independent association between risk of DMS and age (OR value = 1.160, 95% CI 1.091–1.234, P = 0.000), HbA1c(OR value = 1.262, 95% CI 1.046–1.532, P = 0.015), and vitamin D deficiency (< 36.2 nmol/L) (OR value = 2.990, 95% CI 1.284–6.964, P = 0.011). Our findings suggest that low levels of vitamin D are a predictor of DMS in middle-aged and elderly patients with poor control of type 2 diabetes. [ABSTRACT FROM AUTHOR]

Our study, conducted between April 2022 and January 2024, was aimed at clarifying components of the rest-activity rhythm (RAR) involved in improvement of social frailty state before or after a 3-month multi-component exercise intervention in the elderly. Participants were recruited from the general population in Akita prefecture, Japan. We administered a four-item social frailty screening questionnaire to classify the severity of social frailty in each participant before and after the 3-month intervention. The RAR parameters were measured on an Actiwatch Spectrum Plus device worn by the subjects for 7 continuous days. As the final sample, 65 participants classified into the improved/maintained group (n = 36) or the deteriorated group (n = 29) according to the change in the social frailty classification after the intervention were included in the analysis. The results of a binomial logistic regression analysis showed significantly higher values of interdaily stability (IS) and usual walking speed at the post-test after the intervention. Based on our findings, we propose that stability of the rest-activity rhythm related to synchronization with external stimuli (such as social effect and physical activity) might have clinical impact on improvement of social frailty state in elderly community-dwellers. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Respiratory sarcopenia (RS) has been newly defined in a position paper by four professional organizations in Japan, and it is necessary to examine its incidence and influencing factors using this new definition. So far, little work has been undertaken; we therefore conducted a longitudinal study to fill this gap.Our data were extracted from the China Health and Retirement Longitudinal Study. A total of 4301 older adults with complete data and without RS were chosen in 2011, of whom 3065 were followed up until 2015. The presence of low respiratory muscle strength plus low appendicular skeletal muscles mass was defined as RS based on t. A logistic regression model was used to identify the influencing factors for incident RS.After an average of 4 years of follow‐up, the cumulative incidence of RS was 5.2%, and it was particularly high in participants aged >80 (20.9%). Logistic regression analysis showed that being unmarried/divorced/widowed (odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.28–2.66, P = 0.001), not having dyslipidemia (OR = 0.35, 95% CI = 0.19–0.65, P = 0.001), having digestive disease (OR = 1.56, 95% CI = 1.11–2.19, P = 0.010), asthma (OR = 2.77, 95% CI = 1.55–4.94, P = 0.001), edentulism (OR = 1.73, 95% CI = 1.24–2.42, P = 0.001), low handgrip strength (OR = 2.82, 95% CI = 1.99–3.99, P < 0.001), or low 5‐m gait speed (OR = 1.92, 95% CI = 1.23–3.01, P = 0.004) were associated with a greater likelihood of developing RS. After further adjustment for age and body mass index, asthma, edentulism, and low handgrip strength remained significant.The identification and management of older adults with the influencing factors described above could be important in preventing RS. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsDiscussion and conclusions\nIMPLICATIONS FOR REHABILITATIONParticipating in physical activity may benefit health-related outcomes for adults with cerebral palsy (CP). The aim of this review is to provide a synthesis of the evidence from both qualitative and quantitative studies on the impact of physical activity and exercise interventions in adults with CP.Literature searches were conducted from inception to November 2023 in nine electronic databases. A meta-analysis was carried out to evaluate the efficacy of the interventions on walking speed related outcomes and muscle strength.Twenty-two studies met the inclusion criteria. The interventions of the nine studies included in the meta-analysis did not improve walking speed over a distance of 10 m (SMD = −0.03, 95% CI: −0.34–0.40, p = 0.88, I2 = 0%) or endurance (distance covered in 2 or 6 min) (SMD = 0.25, 95% CI: −0.10–0.59, p = 0.16, I2 = 0%), but there was an improvement in lower limb muscle strength in favour of the experimental groups (SMD = 0.59, 95% CI: 0.19–0.99, p = 0.004, I2 = 20%). Only a few studies reported on psychosocial outcomes, quality of life, or intervention sustainability.Further research is needed to explore the impact on psychosocial outcomes and quality of life in adults with CP and the sustainability of physical activity participation.Meta-analyses identified improvement in lower limb muscle strength, but not in walking related outcomes in adults with cerebral palsy.Practitioners should be aware that enjoyment and confidence are key themes associated with a positive experience of physical activity participation.Rehabilitation should include psychosocial and participation outcomes as these are of critical importance for long-term participation.Practitioners should refer their clients to physical activity and exercise opportunities that are accessible and sustainable long-term.Meta-analyses identified improvement in lower limb muscle strength, but not in walking related outcomes in adults with cerebral palsy.Practitioners should be aware that enjoyment and confidence are key themes associated with a positive experience of physical activity participation.Rehabilitation should include psychosocial and participation outcomes as these are of critical importance for long-term participation.Practitioners should refer their clients to physical activity and exercise opportunities that are accessible and sustainable long-term. [ABSTRACT FROM AUTHOR]

Background. The role of C‐reactive protein (CRP), an inflammatory marker, in the development of sarcopenia remains uncertain. Methods. This cross‐sectional research involved the enrollment of 207 patients, classified into two groups: 74 patients with sarcopenia and 133 patients without sarcopenia. Clinical data of the participants, including hand grip strength, walking speed, appendicular lean mass (ALM), and calf circumference, were collected and recorded. We evaluated the extent to which CRP levels are associated with the risk of sarcopenia using both univariate and multivariate logistic regression models. Besides, the correlation between CRP levels, hand grip strength, ALM, and walking speed was examined using the Spearman rank correlation test. Moreover, we have employed the Mendelian randomization (MR) analysis technique to explore the causal relationship between CRP levels and the occurrence of sarcopenia. Results. The sarcopenia group showed a higher proportion of older women, with significant differences in anemia prevalence, calf circumference, gait speed, ALM, hand grip strength, and elevated CRP levels compared to the control group. Logistic regression analyses identified CRP as an independent risk factor for sarcopenia (OR: 1.151, 95% CI:1.070−1.238, and P < 0.001). Correlation analysis results revealed a noteworthy inverse association with hand grip strength (R = −0.454 and P < 0.001), ALM (R = −0.426 and P < 0.001), and walking speed (R = −0.431 and P < 0.001). MR analysis provided further evidence of a significant detrimental link between genetically predicted CRP levels and essential sarcopenia characteristics, with consistent results across various statistical models. Conclusions. Our study uncovered strong evidence supporting a noteworthy inverse association and causality between CRP concentrations and sarcopenia, indicating that CRP has the potential to serve as a biomarker for sarcopenia. [ABSTRACT FROM AUTHOR]

The effect of gait feedback training for older people remains unclear, and such training methods have not been adapted in clinical settings. This study aimed to examine whether inertial measurement unit (IMU)-based real-time feedback gait for older inpatients immediately changes gait parameters. Seven older inpatients (mean age: 76.0 years) performed three types of 60-s gait trials with real-time feedback in each of the following categories: walking spontaneously (no feedback trial); focused on increasing the ankle plantarflexion angle during late stance (ankle trial); and focused on increasing the leg extension angle, which is defined by the location of the ankle joint relative to the hip joint in the sagittal plane, during late stance (leg trial). Tilt angles and accelerations of the pelvis and lower limb segments were measured using seven IMUs in pre- and post-feedback trials. To examine the immediate effects of IMU-based real-time feedback gait, multiple comparisons of the change in gait parameters were conducted. Real-time feedback increased gait speed, but it did not significantly differ in the control (p = 0.176), ankle (p = 0.237), and leg trials (p = 0.398). Step length was significantly increased after the ankle trial (p = 0.043, r = 0.77: large effect size). Regarding changes in gait kinematics, the leg trial increased leg extension angle compared to the no feedback trial (p = 0.048, r = 0.77: large effect size). IMU-based real-time feedback gait changed gait kinematics immediately, and this suggests the feasibility of a clinical application for overground gait training in older people. [ABSTRACT FROM AUTHOR]

Background: The association between lung function and motoric cognitive risk syndrome (MCR) is unclear. We aimed to explore the association of peak expiratory flow (PEF) with MCR using cross-sectional and longitudinal analyses. Methods: Within the CHARLS, 5095 participants were included in the cross-sectional analysis, and 4340 MCR-free participants were included in the longitudinal analysis. The PEF was assessed with a lung peak flow meter. MCR was characterized by cognitive complaints and a slow walking speed with normal mobility and without dementia. Logistic regression, Cox regression, and Laplace regression models were employed for data analysis. Results: In this cross-sectional study, logistic regression analyses revealed that continuous PEF was associated with MCR (odds ratio [OR], 0.998; 95% confidence interval [CI], 0.998, 0.999), and the ORs (95% CIs) of MCR prevalence were 0.857 (0.693, 1.061) for the middle tertile and 0.665 (0.524, 0.845) for the highest tertile compared to the lowest tertile. In a longitudinal cohort study, continuous PEF was dose-dependently associated with the risk of MCR. Compared with those in the lowest tertile of PEF, the hazard ratios (95% CIs) of incident MCR were 0.827 (0.661, 1,036) for the middle tertile and 0.576 (0.432, 0.767) for the highest tertile. Furthermore, compared with the lowest tertile, the highest tertile was associated with a delayed onset time of MCR of 0.484 (95% CI: 0.151, 0.817) years. Conclusion: A higher PEF was related to a lower prevalence of MCR and a lower risk for MCR, and a higher PEF also prolonged the onset time of MCR. [ABSTRACT FROM AUTHOR]

Introduction: Stereotype threat can lead older adults to perceive their experiences in a biased manner, giving rise to interfering thoughts and negative emotions that generate stress and anxiety. Negative beliefs about aging may serve as an additional factor that increases the need for attentional demand, potentially resulting in a performance level below their actual capabilities. In the present study, we asked whether negative aging stereotypes influence a dynamic balance task and explored the means to counteract them in healthy elderly participants. Methods: The performance of balance was compared in two groups of participants aged 65 to 75 years (n = 22) under stereotype threat or reducedthreat situation. Balance abilities were tested under dynamic conditions, requiring participants to maintain balance on a moving platform and using a gradient of difficulty (with eyes open or closed, without or with foam). Postural performance was evaluated by means of posturographic evaluation of the center of pressure displacement and motion analysis. Additionally, we investigated the effects of stereotype threat on a preferred walking speed task and on the Timed Up and Go (TUG) test. Results: Participants under stereotype threat showed poorer balance, particularly in challenging conditions (eyes closed, on foam), with less effective body segments stabilization. Their postural stabilization on foam was worse compared to a solid surface. Conversely, those in the reduced threat condition maintained better body segment stabilization across all conditions, indicating consistent postural control regardless of the presence of foam. Stereotype threat did not affect preferred walking speed or the time to complete the "Time Up and Go" test. Discussion-conclusion: This study provides the first description of age-based stereotype threat effects on a dynamic balance task and how to counteract them in healthy older adults. We suggest that the decrease in postural performance observed in participants exposed to stereotype threat can be attributed to a split in attentional focus between negative intrusive thoughts and the attention needed for maintaining balance. These findings open new perspectives on how to overcome negative expectations when evaluating and training physical abilities, thereby contributing to fall prevention among older adults. [ABSTRACT FROM AUTHOR]

Wearable technology is experiencing remarkable progress, prompting the need for sustainable power sources like triboelectric nanogenerators (TENGs). However, integrating TENGs into fabrics and insufficient power outputs that allows for comfortable wear without obstructing user's movements presents a significant challenge. In this study, a novel kind of diamond‐structured fabric‐based triboelectric nanogenerators (DSF‐TENGs) is introduced utilizing an easy, economical, and scalable weaving method without any chemical modification. Owing to its 3D diamond pattern, surface interactions are enhanced for greater charge generation together with strengthened mechanical engagement for more effective charge transfer. The DSF‐TENG, with its unique self‐resilient structure, achieves impressive electric performance, including output voltage of ≈763 V, short‐circuit current of ≈20.4 µA, and power density of 2862.78 mW m−2, which is multiple times higher than most existing fabric‐based TENGs. It also offers excellent air permeability of 560 mm s−1, consistent electricity generation and sensing even after ten washing cycles, and incredible durability, withstanding over 30 000 cycles. Furthermore, DSF‐TENG is included in an insole that is capable of sensing gait patterns, walking speed, and fall detections of patients with Parkinson's disease. The remarkable power generation capabilities of DSF‐TENG indicate a strong potential for future developments in wearable electronics and healthcare applications. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to: 1) Explore the mobility experiences of seniors with slow walking speeds (SSWS) in urban neighborhoods; and 2) Investigate their environmental barriers and supports. Methods: Go-along interviews were conducted with 36 SSWS residing in urban neighborhoods of Chongqing City, China. The mobility patterns and built environment factors influencing their mobility were revealed through cartographic analysis and thematic analysis. Results: SSWS primarily focused their activities within a 400-meter radius of their homes. Built environment themes included topography, neighborhood services, sidewalks, seating, traffic safety, weather, greenery, and lighting. Significant mobility barriers included long stairs, steep slopes, fast-moving objects on sidewalks, road crossings, and fast traffic. Available handrails, nearby food-service places, ample seating, and greenery were identified as supportive factors for their mobility. Conclusion: This study stands out as the first to specifically examine the mobility of SSWS within the built environment. We suggest that SSWS should be taken into account when establishing a benchmark for general design frameworks. These improvements not only contribute to the mobility of slow walkers but also have positive impacts on the broader population. [ABSTRACT FROM AUTHOR]

Background: Seniors wearing a passive hip exoskeleton (Exo) show increased walking speed and step length but reduced cadence. We assessed the test–retest reliability of seniors' gait characteristics with Exo. Methods: Twenty seniors walked with and without Exo (noExo) on a 10 m indoor track over two sessions separated by one week. Speed, step length, cadence and step time variability were extracted from one inertial measurement unit (IMU) placed over the L5 vertebra. Relative and absolute reliability were assessed using the intraclass correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable change (MDC). Results: The relative reliability of speed, step length, cadence and step time variability ranged from "almost perfect to substantial" for Exo and noExo with ICC values between 0.75 and 0.87 and 0.60 and 0.92, respectively. The SEM and MDC values for speed, step length cadence and step time variability during Exo and noExo were <0.002 and <0.006 m/s, <0.002 and <0.005 m, <0.30 and <0.83 steps/min and <0.38 s and <1.06 s, respectively. Conclusions: The high test–retest reliability of speed, step length and cadence estimated from IMU suggest a robust extraction of spatiotemporal gait characteristics during exoskeleton use. These findings indicate that IMUs can be used to assess the effects of wearing an exoskeleton on seniors, thus offering the possibility of conducting longitudinal studies. [ABSTRACT FROM AUTHOR]

Walking is crucial for independence and quality of life. This study leverages wrist-worn sensor data from UK Biobank participants to establish normative daily-life walking data, stratified by age and sex, to provide benchmarks for research and clinical practice. The Watch Walk digital biomarkers were developed, validated, and applied to 92,022 participants aged 45–79 who wore a wrist sensor for at least three days. Normative data were collected for daily-life walking speed, step-time variability, step count, and 17 other gait and sleep biomarkers. Test–retest reliability was calculated, and associations with sex, age, self-reported walking pace, and mobility problems were examined. Population mean maximal and usual walking speeds were 1.49 and 1.15 m/s, respectively. The daily step count was 7749 steps, and step regularity was 65%. Women walked more regularly but slower than men. Walking speed, step count, longest walk duration, and step regularity decreased with age. Walking speed is associated with sex, age, self-reported pace, and mobility problems. Test–retest reliability was good to excellent (ICC ≥ 0.80). This study provides large-scale normative data and benchmarks for wrist-sensor-derived digital gait and sleep biomarkers from real-world data for future research and clinical applications. [ABSTRACT FROM AUTHOR]

The accurate estimation of lower-limb joint angles and moments is crucial for assessing the progression of orthopedic diseases, with continuous monitoring during daily walking being essential. An inertial measurement unit (IMU) attached to the lower back has been used for this purpose, but the effect of IMU misalignment in the frontal plane on estimation accuracy remains unclear. This study investigated the impact of virtual IMU misalignment in the frontal plane on estimation errors of lower-limb joint angles and moments during walking. Motion capture data were recorded from 278 healthy adults walking at a comfortable speed. An estimation model was developed using principal component analysis and linear regression, with pelvic accelerations as independent variables and lower-limb joint angles and moments as dependent variables. Virtual IMU misalignments of −20°, −10°, 0°, 10°, and 20° in the frontal plane (five conditions) were simulated. The joint angles and moments were estimated and compared across these conditions. The results indicated that increasing virtual IMU misalignment in the frontal plane led to greater errors in the estimation of pelvis and hip angles, particularly in the frontal plane. For misalignments of ±20°, the errors in pelvis and hip angles were significantly amplified compared to well-aligned conditions. These findings underscore the importance of accounting for IMU misalignment when estimating these variables. [ABSTRACT FROM AUTHOR]

Background: Patients with lower extremity burn injuries have decreased gait function. Gait dysfunctions are compensated by activation of executive areas such as the prefrontal cortex (PFC). Although robot-assisted gait training (RAGT) can improve gait function, the training mechanisms of RAGT are unknown. We aimed to determine the clinical effects of RAGT in patients with burns and investigate their underlying mechanisms. Methods: This single-blind, randomized controlled trial involved 54 patients with lower extremity burns. The RAGT group underwent RAGT using SUBAR® and conventional training. The control (CON) group underwent only conventional training. The primary outcome was cortical activity measured using a functional near-infrared spectroscopy device before and after 8 weeks of training to confirm the compensatory effect of gait dysfunction. The secondary outcomes were the functional ambulation category (FAC) to evaluate gait performance, 6-min walking test (6 MWT) distance to measure gait speed, isometric force and range of motion (ROM) of lower extremities to evaluate physical function, and the visual analog scale (VAS) score to evaluate subjective pain during gait. Results: PFC activation during the gait phase in the RAGT group decreased significantly compared with that of the CON. The VAS score decreased and FAC score improved after 8 weeks of training in both groups. The 6 MWT scores, isometric strengths (the left knee flexor and bilateral ankle plantar flexors), and the ROMs (the extensions of bilateral hip and bilateral knee) of the RAGT group were significantly improved compared with those of the CON. RAGT improved gait speed, lower extremity ROMs, and lower extremity muscles strengths in patients with burns. Conclusions: The improvement in gait speed and cerebral blood flow evaluation results suggests that the automatization of gait is related to the treatment mechanism during RAGT. [ABSTRACT FROM AUTHOR]

Gait dysfunction (GD) is a common impairment of Parkinson's disease (PD), which negatively impacts patients' quality of life. Among the most recent rehabilitation technologies, a lower-limb powered exoskeleton (LLEXO) arises as a useful instrument for gait training in several neurological conditions, including PD. However, some questions relating to methods of use, achievable results, and usefulness compared to traditional rehabilitation methodologies still require clear answers. Therefore, in this review, we aim to summarise and analyse all the studies that have applied an LLEXO to train gait in PD patients. Literature research on PubMed and Scopus retrieved five articles, comprising 46 PD participants stable on medications (age: 71.7 ± 3.7 years, 24 males, Hoehn and Yahr: 2.1 ± 0.6). Compared to traditional rehabilitation, low-profile lower-limb exoskeleton (lp-LLEXO) training brought major improvements towards walking capacity and gait speed, while there are no clear major benefits regarding the dual-task gait cost index and freezing of gait symptoms. Importantly, the results suggest that lp-LLEXO training is more beneficial for patients with an intermediate-to-severe level of disease severity (Hoehn and Yahr > 2.5). This review could provide a novel framework for implementing LLEXO in clinical practise, highlighting its benefits and limitations towards gait training. [ABSTRACT FROM AUTHOR]

Background: Combining machine learning (ML) with gait analysis is widely applicable for diagnosing abnormal gait patterns. Objective: To analyze gait adaptability characteristics in stroke patients, develop ML models to identify individuals with GAD, and select optimal diagnostic models and key classification features. Methods: This study was investigated with 30 stroke patients (mean age 42.69years, 60% male) and 50 healthy adults (mean age 41.34years, 58% male). Gait adaptability was assessed using a CMill treadmill on gait adaptation tasks: target stepping, slalom walking, obstacle avoidance, and speed adaptation. The preliminary analysis of variables in both groups was conducted using t-tests and Pearson correlation. Features were extracted from demographics, gait kinematics, and gait adaptability datasets. ML models based on Support Vector Machine, Decision Tree, Multi-layer Perceptron, K-Nearest Neighbors, and AdaCost algorithm were trained to classify individuals with and without GAD. Model performance was evaluated using accuracy (ACC), sensitivity (SEN), F1-score and the area under the receiver operating characteristic (ROC) curve (AUC). Results: The stroke group showed a significantly decreased gait speed (p = 0.000) and step length (SL) (p = 0.000), while the asymmetry of SL (p = 0.000) and ST (p = 0.000) was higher compared to the healthy group. The gait adaptation tasks significantly decreased in slalom walking (p = 0.000), obstacle avoidance (p = 0.000), and speed adaptation (p = 0.000). Gait speed (p = 0.000) and obstacle avoidance (p = 0.000) were significantly correlated with global F-A score in stroke patients. The AdaCost demonstrated better classification performance with an ACC of 0.85, SEN of 0.80, F1-score of 0.77, and ROC-AUC of 0.75. Obstacle avoidance and gait speed were identified as critical features in this model. Conclusion: Stroke patients walk slower with shorter SL and more asymmetry of SL and ST. Their gait adaptability was decreased, particularly in obstacle avoidance and speed adaptation. The faster gait speed and better obstacle avoidance were correlated with better functional mobility. The AdaCost identifies individuals with GAD and facilitates clinical decision-making. This advances the future development of user-friendly interfaces and computer-aided diagnosis systems. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is characterized by important extrapulmonary alterations that could affect the performance in dual task (DT) (motor and cognitive tasks executed simultaneously), which is defined as DT interference (DTI). Objective: To compare the performance of DT between individuals with COPD and healthy control subjects (HCSs). Methods: The literature search was conducted in seven databases (Medline, Scopus, Web of Science, PEDro, SciELO, LILACS, and Google Scholar) up to December 2023, including studies published in English, Spanish, or Portuguese. Studies with individuals diagnosed with COPD older than 60 years, who were evaluated with any DT assessment, and compared with HCS were included. The quality of the studies was evaluated using the risk of bias in nonrandomized studies of interventions (ROBINS‐I). The meta‐analysis was performed with JAMOVI software 5.4. The study protocol was registered on PROSPERO (CRD42023435212). Results: From a total of 128 articles, 5 observational studies were selected in this review, involving 252 individuals aged between 60 and 80 years, from France, Italy, Canada, Turkey, and Belgium. Notable DTI was observed in individuals with COPD compared to HCS (standard mean difference [SMD] = 0.91; 95% confidence interval (CI) 0.06–1.75, p = 0.04). Individuals with COPD had impaired gait speed, balance control, muscle strength, and cognitive interference during DT compared to HCS. DT assessment protocols included different combination of motor and cognitive tasks, using functional test, gait analysis, and muscle strength paired with countdown and verbal fluency tasks. Studies presented low (n = 2), moderate (n = 1), and serious (n = 2) overall risk of bias. Conclusion: Older adults diagnosed with COPD exhibited a significant DTI compared to HCSs, which is characterized by poorer physical and cognitive performance during DT execution. These findings highlight the importance of incorporating DT assessments into clinical practice for individuals with COPD. [ABSTRACT FROM AUTHOR]

In this paper, we explore the use of opinion dynamics models to examine changes in opinions of lifelong learning, and to identify groups of people for targeted intervention to improve their reception to lifelong learning. This method has a multitude of potential applications related to clustering and segmentation. Singapore's initiative for lifelong learning, SkillsFuture, serves as a case study for the application of the technique. We first found a positive correlation between how motivated people are to learn and a negative correlation between how much people know about SkillsFuture opportunities, with respect to their reception to SkillsFuture courses. Then, we used an opinion dynamics model to model the evolution of opinions to produce clusters of people whose opinions will converge. The clusters were then grouped into three groups: those with the largest increase, largest decrease and a middle group. Further examining the covariates of the people in each cluster (e.g., age, last drawn salary, etc.), we propose organizing sharing sessions for the group with the largest increase, intervention for the group with the largest decrease, and gathering more information about the motivations of the middle group. [ABSTRACT FROM AUTHOR]

Background: Repetitive transcranial magnetic stimulation (rTMS), as an emerging non-invasive neuromodulation technique, is now widely employed in rehabilitation therapy. The purpose of this paper is to comprehensively summarize existing evidence regarding rTMS intervention for lower limb motor function in patients at different stages of stroke. Methods: A systematic search was conducted to identify randomized controlled trials (RCTs) assessing the efficacy of rTMS for treating lower limb motor dysfunction after stroke. Multiple databases, including China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, VIP Database, PubMed, Embase, Web of Science, and Cochrane Library, were searched. The search period extended from the inception of the libraries to June 2024. Literature information was extracted, and methodological quality was evaluated using the risk of bias assessment tool in the Cochrane Handbook. Meta-analysis was performed using Stata 17.0 software. Results: Overall, 49 appropriate studies (including 3,558 stroke subjects) were found. Meta-analysis results demonstrated that rTMS effectively improved lower limb motor function across all stages of stroke. The intervention was particularly more effective in patients in the subacute stage than in the acute or chronic stages. Subgroup analysis revealed that, for acute-stage patients, low-frequency stimulation targeting the M1 or DLPFC brain regions on the unaffected side with 20-40 sessions significantly improved FMA-LE scores. In subacute-phase patients, low-frequency stimulation targeting the M1 brain regions on the unaffected side with 18 sessions significantly improved FMALE scores. The results demonstrated that HF-rTMS was more effective than LF-rTMS in improving walking speed, with the greatest efficacy observed at 20 sessions. While for enhancing gait balance in stroke patients, LF-rTMS with the best therapeutic effect was observed at a frequency of 20-40 treatments. Conclusion: This study demonstrates the efficacy of rTMS in improving lower limb motor function, balance, and walking speed in stroke patients at various stages. The findings provide a valuable reference for the development of optimized rTMS treatment plans in clinical practice. [ABSTRACT FROM AUTHOR]

Travel times between different locations form the basis for most contemporary measures of spatial accessibility. Travel times allow to estimate the potential for interaction between people and places, and is therefore a vital measure for understanding the functioning, sustainability, and equity of cities. Here, we provide an open travel time matrix dataset that describes travel times between the centroids of all cells in a grid (N = 13,132) covering the metropolitan area of Helsinki, Finland. The travel times recorded in the dataset follow a door-to-door approach that provides comparable travel times for walking, cycling, public transport and car journeys, including all legs of each trip by each mode, such as the walk to a bus stop, or the search for a parking spot. We used the r5py Python package, that we developed specifically for this computation. The data are sensitive to diurnal variations and to variations between people (e.g. slow and fast walking speed). We validated the data against the Google Directions API and present use cases from a planning practice. The five key principles that guided the data set design and production – comparability, simplicity, reproducibility, transferability, and sensitivity to temporal and interpersonal variations – ensure that urban and transport planners, business and researchers alike can use the data in a wide range of applications. [ABSTRACT FROM AUTHOR]

Lesser peak vertical ground reaction force (vGRF) has been widely reported among individuals with anterior cruciate ligament reconstruction (ACLR). Peak vGRF remains less than uninjured controls and relatively stable during the first year following ACLR. However, it is unknown whether there are subgroups of individuals exhibiting consistently greater peak vGRF in the first 6‐months following ACLR and if individuals with consistently greater peak vGRF exhibit kinematic and kinetic gait differences compared to individuals with low vGRF. The purpose of this study was to determine if distinct clusters exist based upon magnitude of peak vGRF 2‐ and 6‐months post‐ACLR. Subsequently, we explored between cluster differences in vGRF, knee flexion angle, and sagittal and frontal plane knee kinetics throughout stance between clusters. Forty‐three individuals (58.1%female, 21.4 ± 4.4 years‐old, 95.3% patellar‐tendon autograft) completed five gait trials at their habitual walking speed 2‐ and 6‐months post‐ACLR. A single K‐means cluster analysis was used to identify clusters of individuals based on peak vGRF at 2‐ and 6‐months post‐ACLR. Functional waveform analyses were used to compare gait outcomes between clusters with and without controlling for gait speed and age. We identified two clusters that included a subgroup with high vGRF (n = 16) and low vGRF (n = 27). The cluster with high vGRF demonstrated greater vGRFs, knee flexion angles, and knee extension moments during early stance as compared to the low vGRF cluster 2‐ and 6‐months post‐ACLR. Individuals with peak vGRF ≥1.02 times body‐weight 2‐months post‐ACLR had 35.4 times greater odds of being assigned to the high vGRF cluster. [ABSTRACT FROM AUTHOR]

Aim Method Results Interpretation To systematically review the evidence for intensive mobility training in cerebral palsy (CP) and to determine the minimum effective dose to improve mobility.Randomized controlled trials (RCTs) or quasi‐RCTs that included participants with CP, and which used intensive task‐oriented training (TOT) mobility interventions and reported mobility outcomes, were included. Five databases were searched; two independent reviewers selected studies and extracted data. The Grading of Recommendations Assessment, Development, and Evaluation system and the Cochrane Risk of Bias 2 tool were used to rate the certainty of evidence at the outcomes level and to determine the risk of bias respectively. Meta‐analyses were conducted with clinically homogeneous studies. Threshold dose was analysed through meta‐regression.Forty‐six RCTs with 1449 participants (mean age range 1 year 2 months to 16 years 4 months) were included. TOT had statistically and clinically significant effects on walking speed (p = 0.001), cadence (p = 0.02), gross motor function (p = 0.03), and functional mobility (p = 0.009) compared with control interventions. The threshold dose was undeterminable owing to the high heterogeneity of studies.TOT may improve walking speed, walking endurance, and balance. Studies with homogeneous samples and outcomes are needed to support clinical recommendations for intensive mobility interventions. [ABSTRACT FROM AUTHOR]

Patient-reported outcomes (PROs) are essential for understanding the effects of MS and its treatments on patients’ lives; they play an important role in multiple sclerosis (MS) research and practice. We present the protocol for an observational study to prospectively assess the effect of cladribine tablets on PROs and their correlation to disability and physical activity in adults with highly active relapsing MS switching from a first disease modifying drug (DMD) to cladribine tablets in routine clinical practice at study sites in Italy. The primary objective will be to evaluate changes from baseline in the impact of highly active MS on self-assessed physical functioning 52  weeks after the switch to cladribine tablets using the Multiple Sclerosis Impact Scale-29 (MSIS-29). Secondary objectives will include self-assessed psychological impact of highly active MS in daily life and general health after the switch to cladribine tablets as well as changes in cognitive function, anxiety, and depression symptoms. Additional PRO measures will include the Hospital Anxiety and Depression Scale (HADS), the EuroQoL 5-Dimension 5-Level (EQ-5D-5L), the Work Productivity and Activity Impairment Questionnaire: Multiple Sclerosis (WPAI:MS), and the Patient-Reported Outcomes Measurement Information System (PROMIS). Wearable devices will acquire activity data (step counts, walking speed, time asleep, and energy expenditure). Additional clinical, radiological, and laboratory data will be collected when available during routine management. The findings will complement data from controlled trials by providing insight from daily clinical practice into the effect of cladribine tablets on the patient’s experience and self-assessed impact of treatment on daily life. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to investigate the effects of cavaletti pole height on temporospatial (TPS) and ground reaction force (GRF) variables as compared to a walking gait in healthy dogs. Animals: A total of 25 client-owned dogs were included in this study. Procedures: This study used client-owned dogs to explore the effects of cavaletti pole height on TPS and GRF variables. Dogs were first walked over a validated pressure-sensitive walkway (PSW) and then walked over the PSW over which six cavaletti poles were set. Cavaletti pole height was initially set at 2 inches and then increased incrementally to 4 inches, 6 inches, and 8 inches. TPS and GRF variables were obtained for all dogs walking across a PSW without cavaletti poles and at each cavaletti height. TPS variables were then compared to those obtained at a normal walking gait. Results: Increasing cavaletti height resulted in significant decreases in walking gait velocity and the number of gait cycles per minute. Conversely, significant increases in gait cycle duration (duration of one complete cycle of gait, which includes the time from the initial contact of one paw to the subsequent contact of the same paw) and gait time (duration to walk the total distance on the PSW) were noted. Increases in stance time, normalized maximum force, and normalized vertical impulse were observed. Conclusion and clinical relevance: Cavaletti height does influence TPS variables in healthy dogs at a walking gait. The effects were most notable with regard to velocity. Due to the lack of consistent velocity for all cavaletti heights, no conclusions can be drawn regarding the effect of cavaletti height on ground reaction forces. Further investigation is needed to elucidate whether it is the velocity, cavaletti height, or combination of both that impacts ground reaction force variables. When selecting cavaletti pole heights for a therapeutic exercise program, an increase in cavaletti height results in a slower walking gait. [ABSTRACT FROM AUTHOR]

Aims SARC-F ≥ 4 points are used for detecting sarcopenia; however, finding a lower SARC-F cut-off value may lead to early detection of sarcopenia. We investigated the SARC-F score with the highest sensitivity and specificity values to identify sarcopenia in older patients with cardiovascular disease (CVD). Motor performances were also examined for each SARC-F score. Methods and results This retrospective cross-sectional study examined the sensitivity and specificity of every 1-point increase in the SARC-F score to predict sarcopenia. Eligible participants included patients with CVD (≥65 years old) who were admitted for acute CVD treatment and participated in cardiac rehabilitation. Patients completed the SARC-F questionnaire and the sarcopenia assessment. Area under the curves (AUCs) were investigated for the ability to predict sarcopenia. Multivariable linear regression was used to compare the mean value of physical functions (e.g. walking speed, leg strength, and 6 min walking distance) of each SARC-F score. A total of 1066 participants (63.8% male; median age: 76 years) were included. Sarcopenia was present in 401 patients. A SARC-F cut-off ≥2 presented the optimal balance between sensitivity (68.3%) and specificity (55.6%) to detect sarcopenia (AUCs = 0.658; 95% confidence interval: 0.625–0.691). When the patients had low scores (1–3), every 1 point increase in the SARC-F score was associated with lower physical functions such as lower muscle strength and shorter walking distance (all P < 0.001). Conclusion A SARC-F cut-off ≥2 was optimal for screening sarcopenia, and even a low SARC-F score is useful in detecting sarcopenia and low physical function at an early stage in patients with CVD. [ABSTRACT FROM AUTHOR]

Objective Total knee replacement (TKR) is a common solution for patients with advanced knee osteoarthritis (OA). Still, fall rates remain relatively high after surgery. TKR may alter pain and knee function, balance control, and proprioception. However, given the role of complex (dual-task) walking in fall prediction for older adults, it is unknown how TKR alters the attentional demand of walking in older adults. The goal of this study was to examine the effect of TKR on dual-task walking among older adults. Methods Participants were evaluated 1 month before surgery and 4.5 months after surgery. Participants walked along an instrumented 7-meter path for 1 minute with and without a cognitive task (serial-3 subtraction). Pain and knee function, knee proprioception, dynamic balance, and balance confidence, as well as dual-task costs (DTC) were compared before and after the surgery and factors associated with change in gait DTCs were assessed. Results Thirty-eight participants completed the study (age 72.6 years, SD = 4.9; 11 men). A significant decrease in pain was found following TKR, with no change in balance, balance confidence, or proprioception. There were no differences in gait DTCs before and after the surgery. However, change in dynamic balance, specifically reactive postural control and dynamic gait, predicted changes in gait speed and stride time DTCs. Conclusion The absence of an effect of TKR on gait DTCs can potentially underlie increased fall risk after TKR. Results from this study emphasize the significance of balance as a measure and focal point for rehabilitation after TKR. Impact This study contributes to our understanding of the attentional cost of walking in people before and after TKR, as well as to factors associated with it. Results from this work can assist formulation of rehabilitation programs for people with knee OA. [ABSTRACT FROM AUTHOR]

Lady beetles (Coleoptera: Coccinellidae) are important biocontrol agents that are considered generalist predators, although some tribes, such as Scymnini, are specialized in predation of sucking pests, such as mealybugs, aphids, and whiteflies. However, prey preference or pre‐imaginal conditioning may occur as coccinellids are subjected to large‐scale rearing. Thus, predator–prey interaction may be an outcome of conditioning to prey stimuli. To evaluate possible pre‐imaginal conditioning, population lines were created for the lady beetles Cryptolaemus montrouzieri Mulsant and Tenuisvalvae notata (Mulsant), each fed for at least eight generations the mealybugs Ferrisia dasylirii (Cockrell) or Planococcus citri Risso (Hemiptera: Pseudococcidae). Next, the behavioral response of these coccinellids was measured in arenas treated with prey volatiles or footprints, regarding walking time, walking speed, walking distance, and residence time. Finally, food preference between prey species was measured in laboratory and semi‐field conditions on infested cotton plants. Conditioned coccinellids responded similarly to volatiles released by either prey species offered. Furthermore, there were no changes in predator behavior towards footprints of either prey species. Both predator species consumed more P. citri in all tests, regardless of rearing prey indicating no pre‐imaginal conditioning. These results suggest that rearing prey may not affect the predator behavior, and both coccinellid species are effective in the biological control of mealybugs. [ABSTRACT FROM AUTHOR]