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To describe lumbar spine (LS) trabecular bone score (TBS) values after SCI, and to explore the differences in fractures risk assessment between FRAX® and TBS-adjusted FRAX® in individuals living with chronic SCI. Baseline dual-energy x-ray absorptiometry (DXA) scans from an established cohort were acquired using a Hologic Discovery QDR 4500. TBS measurements were performed using the TBS iNsightTM software version 2.1.2.0. A Welch's t-test was performed to explore differences in TBS, FRAX®, and TBS-adjusted FRAX® between men and women, between participants ≤49 years and ≥50 years, and between subgroups with and without history of fracture and with complete and incomplete injury. We analyzed 37 scans; the mean TBS was 1.336 ± 0.107. The mean 10-year fracture risk was 8.8% ± 11.4% for major osteoporotic fracture and 4.0% ± 10.8% for hip fracture according to FRAX®, and 6.6% ± 2.8% for major osteoporotic fracture and 2.8% ± 6.7% for hip fractures according to TBS-adjusted FRAX®. The 10-year fracture risk for major osteoporotic fractures was higher in individuals with a prior fragility fracture compared to those without, according to FRAX® (p =.033) and TBS-adjusted FRAX® (p =.001). Over a half of our sample presented a partially degraded bone microarchitecture based on TBS. TBS was not different between people with motor complete and motor incomplete injury or with and without prior fragility fracture. Future studies are needed to define the clinical relevance of TBS and TBS-adjusted FRAX® in people with chronic SCI. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate previous research to determine if exercise can improve preexisting hyperkyphosis by decreasing the angle of thoracic kyphosis in adults aged ≥45 years.Data sourcesPubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature databases were searched for studies related to posture, exercise, and age ≥45 years. Online conference proceedings of the American Society for Bone and Mineral Research, American Physical Therapy Association, and Gerontological Society of America were also searched.Study selectionTwo independent reviewers screened the titles and abstracts and selected studies that tested the effect of exercise on measures of kyphosis, or forward head posture, in individuals with hyperkyphosis at baseline (defined as angle of kyphosis ≥40°). Reviews, letters, notes, and non-English language studies were excluded.Data extractionA pilot-tested abstraction form was used by each reviewer to extract data from each study regarding details of exercise intervention, participant characteristics, safety, adherence, and results. The Cochrane Collaboration's tool for assessing risk of bias was used to assess methodologic quality. Discrepancies on the abstraction forms between the 2 reviewers were resolved by a third reviewer. A formal meta-analysis was not performed.Data synthesisThirteen studies were abstracted and included in the review; of these, 8 studies saw improvements in ≥1 measure of posture. The main sources of bias were related to blinding participants and incomplete outcome data. The adherence reported across studies suggests that exercise is an acceptable intervention for individuals with age-related hyperkyphosis.ConclusionsThe scarcity and quality of available data did not permit a pooled estimate of the effect of exercise on hyperkyphotic posture; however, the positive effects observed in high-quality studies suggest some benefit and support the need for an adequately designed randomized controlled trial examining the effect of exercise on hyperkyphosis.

Walking is a common activity among older adults. However, the effects of walking on health-related outcomes in people with low bone mineral density (BMD) are unknown. The authors included randomized controlled trials comparing walking to control in individuals aged ≥50 years with low BMD and at risk of fractures. The authors identified 13 randomized controlled trials: nine multicomponent interventions including walking, one that was walking only, and three Nordic walking trials. Most studies had a high risk of bias. Nordic walking may improve the Timed Up-and-Go values (1.39 s, 95% CI [1.00, 1.78], very low certainty). Multicomponent interventions including walking improved the 6-min walk test (39.37 m, 95% CI [21.83, 56.91], very low certainty) and lumbar spine BMD (0.01 g/cm2, 95% CI [0.00, 0.03], low certainty evidence). The effects on quality of life or femoral neck BMD were not significant. There were insufficient data on fractures, falls, or mortality. Nordic walking may improve physical functioning. The effects on other outcomes are less certain; one may need to combine walking with other exercises to be of benefit. [ABSTRACT FROM AUTHOR]

Persons with dementia have the right to equal inclusion in rehabilitation, including physical activity. However, the perspectives of persons with dementia are rarely integrated into decision-making related to physical activity programming, services, and supports. Here, we describe the participatory action research (PAR) approach used to develop the Dementia-Inclusive Choices for Exercise (DICE) toolkit, which aims to increase the quality and number of physical activity opportunities available to persons with dementia. The DICE Research Team included persons with dementia, a family care partner, exercise professionals, community and dementia service providers, health care professionals, and researchers who worked to: 1) Engage/maintain the Research Team; 2) Set/navigate ways of engagement; 3) Understand barriers to physical activity; 4) Prioritize the audience and actions; 5) Develop the toolkit; 6) Conduct usability testing; and 7) Implement and evaluate. Guided by the Behaviour Change Wheel, and informed by interviews, focus groups, and existing research, our PAR Team chose to prioritize training exercise providers; exercise providers can enable exercise for persons with dementia if they understand common changes with dementia and how to support persons with dementia in exercise. The content and format of the toolkit was co-developed: drafted by our Research Team, adapted through a stakeholder workshop, and refined through iterative development and usability testing. The product of our PAR process, the DICE toolkit, includes videos meant to destigmatize dementia, training modules and a training manual for exercise providers, a physical activity handout for persons with dementia, and wallet cards to help persons with dementia communicate their abilities, needs, and preferences. Our usability study indicated that the toolkit could be used by exercise providers and may improve attitudes about dementia. Our vision is that our co-developed DICE toolkit will empower exercise providers to improve physical activity opportunities and support for persons with dementia. [ABSTRACT FROM AUTHOR]

Fear of falling is a common issue among older adults, which decreases quality of life and leads to an avoidance of activities they are still able to do. The goal of this secondary data analysis was to explore the relationship between fear of falling and exercise self-efficacy in 141 women with at least one nontraumatic Genant Grade 2 vertebral fracture. Fear of falling, exercise self-efficacy, history of falling, the number of falls, the use of assisting devices, and pain at rest or during movement were obtained using medical history and health status questionnaires. There was a negative association between fear of falling and exercise self-efficacy (pseudo R2 =.253; p =.004), which persisted when the analysis was adjusted for history and number of falls, use of assistive devices, and pain at rest (pseudo R2 =.329; p <.0001) or during movement (pseudo R2 =.321; p <.0001). Fear of falling may be negatively associated with exercise self-efficacy in older women with vertebral fracture. [ABSTRACT FROM AUTHOR]

Persons with mild cognitive impairment (MCI) and early dementia are often physically inactive, despite associated benefits. This study explored the barriers, facilitators, and preferences for exercise among persons living with MCI/early dementia. The authors conducted 2 focus groups among persons living with MCI/early dementia (n = 4, 6 participants) and 2 focus groups among care partners (n = 3, 4 participants). The transcripts were analyzed using thematic analysis, guided by the social-ecological model. Three themes emerged, reinforcing motivation to exercise, managing changes to cognitive and physical health, and variable perceptions of dementia, each with influences from individual, care partner, and community levels. Low intrinsic motivation, poor physical/cognitive health, and stigma restricted the exercise among persons living with MCI/early dementia. The care partners motivated their partners and provided company and transportation to exercise. People with MCI/early dementia also indicated poor access to exercise providers and exercise opportunities that met their needs and preferences was a barrier to exercise participation. Knowledge translation research should develop exercise interventions at the individual, social, and community levels. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore the experiences and perspectives of individuals with chronic health conditions who had an adverse event (AE) as a result of resistance training (RT). We conducted web conference or telephone-based one-on-one semi-structured interviews with 12 participants with chronic health conditions who had an AE as a result of RT. Interview data were analyzed using the thematic framework method. Six themes were identified: (1) personal experiences with aging influence perceptions of RT; (2) physical and emotional consequences of AEs limit activities and define future RT participation; (3) injury recovery defines the severity of AE; (4) health conditions influence the perceived risks and benefits of participating in RT; (5) RT setting and trained supervision influence exercise behaviors and risk perceptions; and (6) experiencing a previous AE influences future exercise behavior. Despite participant awareness of the value and benefits of RT in both the context of aging and chronic health conditions, there is concern about experiencing exercise-related AEs. The perceived risks of RT influenced the participants' decision to engage or return to RT. Consequently, to promote RT participation, the risks, not just the benefits, should be properly reported in future studies, translated, and disseminated to the public. Novelty: –To increase the quality of published research with respect to AE reporting in RT studies. –Health care providers and people with common health conditions will be able to make evidence-based decisions as to whether the benefits of RT truly outweigh the risks. [ABSTRACT FROM AUTHOR]

Introduction: Muscle-strengthening and balance activities are associated with the prevention of illness and injury. Age-specific Canadian 24-Hour Movement Guidelines include recommendations for muscle/bone-strengthening and balance activities. From 2000-2014, the Canadian Community Health Survey (CCHS) included a module that assessed frequency in 22 physical activities. In 2020, a healthy living rapid response module (HLV-RR) on the CCHS asked new questions on the frequency of muscle/bonestrengthening and balance activities. The objectives of the study were to (1) estimate and characterize adherence to meeting the muscle/bone-strengthening and balance recommendations; (2) examine associations between muscle/bone-strengthening and balance activities with physical and mental health; and (3) examine trends (2000-2014) in adherence to recommendations. Methods: Using data from the 2020 CCHS HLV-RR, we estimated age-specific prevalence of meeting recommendations. Multivariate logistic regressions examined associations with physical and mental health. Using data from the 2000-2014 CCHS, sex-specific temporal trends in recommendation adherence were explored using logistic regression. Results: Youth aged 12 to 17 years (56.6%, 95% CI: 52.4-60.8) and adults aged 18 to 64 years (54.9%, 95% CI: 53.1-56.8) had significantly greater adherence to the muscle/bone-strengthening recommendation than adults aged 65 years and older (41.7%, 95% CI: 38.9-44.5). Only 16% of older adults met the balance recommendation. Meeting the recommendations was associated with better physical and mental health. The proportion of Canadians who met the recommendations increased between 2000 and 2014. Conclusion: Approximately half of Canadians met their age-specific muscle/bonestrengthening recommendations. Reporting on the muscle/bone-strengthening and balance recommendations elevates their importance alongside the already recognized aerobic recommendation. [ABSTRACT FROM AUTHOR]