A "test in-train out" program versus a "go home and walk" intervention for home-based exercise therapy in patients with peripheral artery disease: A randomized controlled trial.

OBJECTIVE: In this single-blinded randomized controlled trial, we compared the "Test in-Train Out" structured home-based exercise program (TiTo-SHB) with the traditional "go home and walk" exercise intervention in people with peripheral artery disease (PAD). METHODS: Peripheral artery disease patients at Leriche-Fontaine's stage II were randomized to receive TiTo-SHB or walking advice (C-WA). The TiTo-SHB group performed two daily 8-min sessions of pain-free interval walking at progressive low-to-moderate speed maintained with a metronome. The C-WA group was recommended to walk for 30 min at least three times per week and to endure claudication pain. Outcomes collected at baseline and at the end of the program (6 months) included: 6-min and pain-free walking distance (6MWD, PFWD), ankle-brachial index (ABI), 5-time sit-to-stand test (5STS), and health-related quality of life (HRQoL) by the VascuQoL-6 questionnaire. RESULTS: A total of 68 patients were randomized (males n = 50; aged 73 ± 9; TiTo-SHB n = 34). At the end of the program, patients in the TiTo-SHB group compared with the C-WA group had significantly improved 6MWD (Δ + 60 ± 32 m vs. Δ - 5 ± 37 m; p < 0.001) and PFWD (Δ + 140 ± 92 m vs. Δ - 7 ± 87 m; p < 0.001). A significant between-group difference in favor of the TiTo-SHB group was also recorded for all the secondary outcomes, including 5STS (Δ - 2.6 ± 1.8 s vs. Δ + 0.8 ± 2.6 s; p < 0.001), ABI of the more impaired limb (Δ + 0.10 ± 0.11 vs. Δ + 0.02 ± 0.08; p = 0.003), and VascuQoL-6 score (Δ +2 ± 2 vs. -1 ± 4; p < 0.001). CONCLUSION: In PAD patients with claudication, the pain-free in-home TiTo-SHB program was more effective in improving exercise capacity and HRQoL than the traditional walking advice recommendation.

Engaging underrepresented groups in community physical activity initiatives: a qualitative study of parkrun in the UK.

BACKGROUND: Underrepresented groups, including racial/ethnic minority groups and individuals with low socioeconomic status face complex barriers to engaging in community-based health initiatives. This research uses parkrun, an outdoor, mass-participation, weekly physical activity and volunteering initiative, to explore the engagement strategies ('outreach activities') that have been used to promote the inclusivity and diversity of parkrun events. METHODS: Ten adult parkrun Ambassadors who fulfilled volunteer roles that involved promoting parkrun to underrepresented groups in the UK were interviewed. Interviews took place via telephone or video call in April-July 2021. Interview transcripts were analysed thematically. RESULTS: Engagement strategies implemented by Ambassadors varied from opportunistic promotion within communities to strategic negotiations at higher decision-making levels. Approaches were characterised by a community-centred focus that ensured community networks and assets were utilised. Stories were considered valuable indicators of successful outreach. A common challenge to outreach for Ambassadors was limited personal and organisational capacity that impeded the widescale scope, reach and scalability of parkrun's engagement attempts. CONCLUSIONS: Parkrun Ambassadors have used a wide range of outreach activities at different levels of influence. A number of challenges to doing sustainable and effective outreach have been highlighted that need to be addressed. Working with and alongside communities where community-based health initiatives events take place to understand how to address inclusivity issues could contribute to greater participation by underrepresented groups.

Boosts for walking: how humorous messages increase brisk walking among cognitively fatigued individuals.

BACKGROUND: A well-studied internal barrier to regular physical activity, and more specifically brisk walking, is cognitive fatigue. However, thus far little research examined how cognitively fatigued individuals can be motivated to exercise, more specifically to engage in brisk walking. This study investigates whether humorous intervention messages might be an effective strategy to motivate cognitively fatigued individuals to brisk walk, and through which underlying processes. METHODS: An online experiment was performed in which variation in cognitive fatigue was induced through mental arithmetic questions. Afterwards, participants (n = 250) recruited through Prolific, randomly received either humorous or non-humorous intervention messages related to brisk walking. Potential mediators of the relations between physical activity, humour and cognitive fatigue were measured, were self-efficacy, self-control, and motivation. RESULTS: First, regression analyses confirmed that cognitive fatigue negatively influences brisk walking intentions and that the perceived humour of the intervention messages moderated this relationship. Second, results showed that self-control and self-efficacy are mediators explaining the relationship between cognitive fatigue and brisk walking intentions. Lastly, this study found that perceived humour of the intervention messages moderated the relationship between cognitive fatigue and self-control, indicating that perceptions of self-control were positively changed after receiving messages that were perceived as humorous compared to messages that were not perceived as humorous, subsequently increasing brisk walking intentions. CONCLUSIONS: This study is the first to unravel the underlying relationship between humorous intervention messages and brisk walking intentions through positive changes in perceptions of self-control within a cognitively fatigued sample. Results of this study suggest that existing smartphone applications monitoring and promoting brisk walking should integrate tailored message strategies within their cues to brisk walk by implementing humour as a strategy to motivate users when they are cognitively fatigued.

Participatory development of an mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED).

BACKGROUND: The escalating global prevalence of type 2 diabetes and prediabetes presents a major public health challenge. Physical activity plays a critical role in managing (pre)diabetes; however, adherence to physical activity recommendations remains low. The ENERGISED trial was designed to address these challenges by integrating mHealth tools into the routine practice of general practitioners, aiming for a significant, scalable impact in (pre)diabetes patient care through increased physical activity and reduced sedentary behaviour. METHODS: The mHealth intervention for the ENERGISED trial was developed according to the mHealth development and evaluation framework, which includes the active participation of (pre)diabetes patients. This iterative process encompasses four sequential phases: (a) conceptualisation to identify key aspects of the intervention; (b) formative research including two focus groups with (pre)diabetes patients (n = 14) to tailor the intervention to the needs and preferences of the target population; (c) pre-testing using think-aloud patient interviews (n = 7) to optimise the intervention components; and (d) piloting (n = 10) to refine the intervention to its final form. RESULTS: The final intervention comprises six types of text messages, each embodying different behaviour change techniques. Some of the messages, such as those providing interim reviews of the patients' weekly step goal or feedback on their weekly performance, are delivered at fixed times of the week. Others are triggered just in time by specific physical behaviour events as detected by the Fitbit activity tracker: for example, prompts to increase walking pace are triggered after 5 min of continuous walking; and prompts to interrupt sitting following 30 min of uninterrupted sitting. For patients without a smartphone or reliable internet connection, the intervention is adapted to ensure inclusivity. Patients receive on average three to six messages per week for 12 months. During the first six months, the text messaging is supplemented with monthly phone counselling to enable personalisation of the intervention, assistance with technical issues, and enhancement of adherence. CONCLUSIONS: The participatory development of the ENERGISED mHealth intervention, incorporating just-in-time prompts, has the potential to significantly enhance the capacity of general practitioners for personalised behavioural counselling on physical activity in (pre)diabetes patients, with implications for broader applications in primary care.

[Effects of non-face-to-face gait and muscle strength training for urinary incontinence in community-dwelling middle-aged and older women: A randomized controlled trial].

Objectives　Although the effectiveness of status-to-interview-guided exercise therapy to improve urinary incontinence has been reported, reports on non-face-to-face guided exercise therapy are lacking. This study aimed to analyze the effect of using non-face-to-face training guidance for walking and strength training on the frequency and degree of urinary incontinence and improvement in the urinary incontinence-induced decline in the quality of life (QoL) of community-dwelling middle-aged and older women.Methods　This study included 68 women, aged 46-64 years, having self-evaluated stress urinary incontinence. The participants in the intervention group watched a video that guided them on how to walk effectively and gradually increase their number of steps. Additionally, a non-face-to-face lecture was conducted on the comprehensive training content, including muscle strengthening exercises necessary for walking at home, as muscle weakness is one of the causes of urinary incontinence. The control group was instructed to continue living as usual without any interventions. The intervention period was 12 weeks. The primary endpoints included the urinary leakage frequency score, urinary leakage volume score, and degree of decline in the QoL, and these were compared before and after the intervention using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). To elucidate the effect of the increase in the step count on the primary outcome, we calculated the rate of increase in the step count before and after the intervention in the intervention group. Moreover, a sub-analysis was performed for the high-step count (n=16) and low step-count (n=16) groups before and after the intervention.Results　Significant differences were observed in the urinary leakage frequency, urinary leakage volume, and ICIQ-SF scores at 12 weeks post-intervention between the groups (P<0.05). In the high-step count group, both the urinary leakage frequency and ICIQ-SF scores showed a significant tendency to improve from 8 weeks compared to the pre-intervention scores.Conclusion　Since this study was conducted as an open-label trial, the possibility of an inherent bias in subjective outcome assessment should be considered during interpretation of the results. Our findings indicate that walking and muscle strength training, even with non-face-to-face guidance, for middle-aged and older community-dwelling women with urinary incontinence can effectively improve the urinary leakage symptoms and degree of decline in the QoL. Furthermore, greater effects could be expected by encouraging an increase in the number of daily steps with the intervention.

Predictors of intentions of adults over 35 years to participate in walking sport programs: A social-ecological mixed-methods approach.

There is a growing need to identify acceptable and feasible opportunities to engage adults over 35 years in physical activity. Walking sports may be a potential means to engage adults in sport; however, there is limited evidence regarding appeal and feasibility to support its implementation and delivery. Using a two-step mixed-methods approach, we aimed (1) to quantitively identify significant predictors of intentions of adults over 35 years to participate in walking sports and (2) to understand why and how these identified predictors may be contextually relevant to the target group. In phase one, 282 adults over 35 years (Mage = 46.08, SD = 9.75) without prior experience of walking sports completed an online questionnaire assessing personal, psychosocial, program-related, and environmental predictors, and intentions to participate in walking sports. Hierarchical multiple linear regressions showed that perceived health status, attitudes, subjective norms, and distance of venue were significant predictors of intentions. In phase two, interviews with a subset of 17 participants indicated that, when implementing walking sport programs, program labeling, fear of the unknown, and individual differences in the appeal of walking sport warrant consideration. Together, these findings offer insight into the complex interplay of personal, psychosocial, program-related, and environmental predictors of adults' intentions to participate in walking sports. Addressing these elements of a walking sport program would make such programs more appealing to potential participants, and ultimately, more feasible and sustainable to conduct in the long run.

A park-based group mobility program for older adults with difficulty walking outdoors: a quantitative process evaluation of the Getting Older Adults Outdoors (GO-OUT) randomized controlled trial.

BACKGROUND: Process evaluations of randomized controlled trials (RCTs) of community exercise programs are important to help explain the results of a trial and provide evidence of the feasibility for community implementation. The objectives of this process evaluation for a multi-centre RCT of outdoor walking interventions for older adults with difficulty walking outdoors, were to determine: 1) implementation fidelity (the extent to which elements of the intervention were delivered as specified in the original protocol) and 2) participant engagement (the receipt of intervention components by the participants) in the Getting Older Adults Outdoors (GO-OUT) trial. METHODS: GO-OUT participants attended an active 1-day workshop designed to foster safe, outdoor walking skills. After the workshop, 190 people at 4 sites were randomized to an outdoor walk group (OWG) (n = 98) which met 2x/week for 10 weeks, or the weekly reminders (WR) group (n = 92) which received a phone reminder 1x/week for 10 weeks. The OWG had 5 components - warm-up, continuous distance walk, task-oriented walking activities, 2nd continuous distance walk, and cool-down. Data on implementation fidelity and participant engagement were gathered during the study through site communications, use of standardized forms, reflective notes of the OWG leaders, and accelerometry and GPS assessment of participants during 2 weeks of the OWG. RESULTS: All sites implemented the workshop according to the protocol. Participants were engaged in all 8 activity stations of the workshop. WR were provided to 96% of the participants in the WR intervention group. The 5 components of the OWG sessions were implemented in over 95% of the sessions, as outlined in the protocol. Average attendance in the OWG was not high - 15% of participants did not attend any sessions and 64% of participants in the OWG attended > 50% of the sessions. Evaluations with accelerometry and GPS during week 3 and 9 OWG sessions suggest that participants who attended were engaged and active during the OWG. CONCLUSIONS: This process evaluation helps explain the main study findings and demonstrates the flexibility required in the protocol for safe and feasible community implementation. Future research could explore the use of additional behaviour change strategies to optimize attendance for community implementation. TRIAL REGISTRATION: ClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.

Walking against traffic and pedestrian injuries in the United Kingdom: new insights.

BACKGROUND: Studies from Finland and Taiwan have shown that walking against traffic was beneficial for reducing pedestrian crashes and fatalities. This study examined whether such beneficial effects are consistent across various circumstances. METHODS: This study aimed to investigate pedestrian fatalities in walking-against or with-traffic crashes by analysing the UK STATS19 crash data for the period between 1991 and 2020. We firstly employed Chi-square tests to examine risk factors for pedestrian injury severity. These variables were then incorporated into stepwise logistic regression models with multiple variables. We subsequently conducted joint effect analysis to investigate whether the beneficial effects of walking against traffic on injury severity vary across different situations. RESULTS: Our data contained 44,488 pedestrian crashes, of which 16,889 and 27,599 involved pedestrians walking against and with traffic, respectively. Pedestrians involved in with-traffic crashes were more likely to sustain fatalities (adjusted odds ratio [AOR] = 1.542; confidence interval [CI] = 1.139-1.927) compared with those in walking against-traffic crashes. The detrimental effect of walking with traffic on fatalities appeared to be more pronounced in darkness-unlit conditions (AOR = 1.48; CI = 1.29-1.70), during midnight hours (00:00-06:59 am) (AOR = 1.60; CI = 1.37-1.87), in rural areas (AOR = 2.20; CI = 1.92-2.51), when pedestrians were elderly (≥ 65 years old) (AOR = 2.65, CI = 2.16-3.26), and when heavy goods vehicles were crash partners (AOR = 1.51, CI = 1.28-1.78). CONCLUSIONS: Walking against traffic was beneficial in reducing pedestrian fatalities compared with walking with traffic. Furthermore, such a beneficial effect was more pronounced in darkness-unlit conditions, at midnights (00:00-06:59 am), in rural areas, when pedestrians were elderly, and when heavy goods vehicles struck pedestrians.

Mapping and analysis of laws influencing built environments for walking and cycling in Australia.

BACKGROUND: Physical inactivity is a significant public health concern, with limited signs of improvement despite a global commitment to achieving the World Health Organization's target of 15% reduction by 2030. A systems approach is required to tackle this issue, involving the creation of environments that are conducive to physical activity. Laws represent an important tool for regulating the built environment for physical activity, are a mechanism for systems change, and have the capacity to reorient the goals and rules of a system. However, they are understudied and potentially underutilised for physical activity. Scientific legal mapping is a first step towards understanding how laws could impact the built environment to facilitate greater population physical activity. METHOD: We conducted a legal assessment of state and territory laws in Australia, to systematically characterise how they address built environment considerations with specific relevance to walking and cycling. An interdisciplinary team of researchers with public health, law and urban planning expertise was formed to complete the multistage process. Key steps included a systematic search of laws using a combination of original legal research, consultation of secondary sources, and review and verification by an urban planning expert; development of a coding scheme; and completion of coding and quality control procedures. RESULTS: Most jurisdictions in Australia do not currently embed objectives in primary legislation that would promote physical activity and support an integrated approach to land use and transport planning that encourages active and sustainable lifestyles. Only two jurisdictions addressed the large majority of evidence-based standards that promote active living. Of the standards addressed in law, few fully met evidence-based recommendations. While most jurisdictions legislated responsibility for enforcement of planning law, few legislated obligations for monitoring implementation. CONCLUSION: Increasing physical activity is a systems issue, requiring actions across multiple sectors. An in-depth examination of the legal environment is an important step towards understanding and influencing the existing physical activity system, why it may not be generating desired outcomes, and potential opportunities for improvement. Our findings reveal opportunities where laws could be strengthened to promote more active environments. Updating this dataset periodically will generate longitudinal data that could be used to evaluate the impact of these laws on the built environment and physical activity behaviours.

Medial bicompartmental arthroplasty patients display more normal gait and improved satisfaction, compared to matched total knee arthroplasty patients.

PURPOSE: Medial bicompartmental arthroplasty, the combination of ipsilateral medial unicompartmental and patellofemoral arthroplasty, is an alternative to total knee arthroplasty for patients with medial tibiofemoral and severe patellofemoral arthritis, when the lateral tibiofemoral compartment and anterior cruciate ligament are intact. This study reports the gait and subjective outcomes following medial bicompartmental arthroplasty. METHODS: Fifty-five subjects were measured on the instrumented treadmill at top walking speeds, using standard metrics of gait. Modular, single-stage, medial bicompartmental arthroplasty subjects (n = 16) were compared to age, body mass index, height- and sex-matched healthy (n = 19) and total knee arthroplasty (n = 20) subjects. Total knee arthroplasty subjects with pre-operative evidence of tricompartmental osteoarthritis or anterior cruciate ligament dysfunction were excluded. The vertical component of ground reaction force and temporospatial measurements were compared using Kruskal-Wallis, then Mann-Whitney test with Bonferroni correction (α = 0.05). Oxford Knee and EuroQoL EQ-5D scores were compared. RESULTS: Objectively, the medial bicompartmental arthroplasty top walking speed of 6.7 ± 0.8 km/h was 0.5 km/h (7%) slower than that of healthy controls (p = 0.2), but 1.3 km/h (24%) faster than that of total knee arthroplasty subjects (5.4 ± 0.6 km/h, p < 0.001). Medial bicompartmental arthroplasty recorded more normal maximum weight acceptance (p < 0.001) and mid-stance forces (p = 0.03) than total knee arthroplasty subjects, with 11 cm (15%) longer steps (p < 0.001) and 21 cm (14%) longer strides (p = 0.006). Subjectively, medial bicompartmental arthroplasty subjects reported Oxford Knee Scores of median 41 (interquartile range 38.8-45.5) compared to total knee arthroplasty Oxford Knee Scores of 38 (interquartile range 30.5-41, p < 0.02). Medial bicompartmental arthroplasty subjects reported EQ-5D median 0.88 (interquartile range 0.84-0.94) compared to total knee arthroplasty median 0.81 (interquartile range 0.73-0.89, p < 0.02.) CONCLUSION: This study finds that, in the treatment of medial tibiofemoral osteoarthritis with severe patellofemoral arthritis, medial bicompartmental arthroplasty results in nearer-normal gait and improved patient-reported outcomes compared to total knee arthroplasty. LEVEL OF EVIDENCE: III.

mCrutch: A Novel m-Health Approach Supporting Continuity of Care.

This paper reports the architecture of a low-cost smart crutches system for mobile health applications. The prototype is based on a set of sensorized crutches connected to a custom Android application. Crutches were instrumented with a 6-axis inertial measurement unit, a uniaxial load cell, WiFi connectivity, and a microcontroller for data collection and processing. Crutch orientation and applied force were calibrated with a motion capture system and a force platform. Data are processed and visualized in real-time on the Android smartphone and are stored on the local memory for further offline analysis. The prototype's architecture is reported along with the post-calibration accuracy for estimating crutch orientation (5° RMSE in dynamic conditions) and applied force (10 N RMSE). The system is a mobile-health platform enabling the design and development of real-time biofeedback applications and continuity of care scenarios, such as telemonitoring and telerehabilitation.

No Placebo Effect beyond Regression to the Mean on the Six Minute Walk Test in Pulmonary Arterial Hypertension Trials.

In drug studies, patients are often included when the disease activity is high. This will make any treatment appear to lessen disease activity, although the improvement is biased by selection. This effect is known as regression towards the mean (RTM). We aimed at investigating drug trials in Pulmonary Arterial Hypertension (PAH) using the 6-minute walking distance test (6MWD) as a primary outcome for the phenomenon of RTM. An existing registry of 43 open label studies and 23 randomized controlled trials conducted between 1990 and 2009 was used as the data source. Data analysis was carried out for 18 randomized controlled trials (RCTs) and 24 open label studies out of this registry. Data were analyzed for verum and placebo arms of the RCTs separately, as well as for the open label arms. In the verum arms, the overall effect given as 33.2 m (95% CI: 25.7; 40.6]); 6MWD was slightly lower than the effect in the observational studies, with 44.6 m (95% CI: [25.4; 63.8]). After studying and interpreting the data, we found that regression towards the mean plays only a minor role in PAH studies. In particular, placebo effects in the RCTs were negligibly small, with a mean 6MWD of -2.5 m (95% CI: [-9.8; 4.7]) in the placebo arm. Therefore, our analysis indicates that results of non-randomized observational studies can be regarded as valid tools for gaining valid clinical effects in patients with PAH.

Effect of a pulmonary rehabilitation program combined with cognitive training on exercise tolerance and cognitive functions among Tunisian male patients with chronic obstructive pulmonary disease: A randomized controlled trial.

BACKGROUND: Cognitive impairment has been well described in patients with Chronic Obstructive Pulmonary Disease (COPD) in addition to cardiorespiratory disability. To reduce this impairment, researchers have recommended the use of single or combined exercise training. However, the combined effect of cognitive training (CT) and pulmonary rehabilitation (PR) program on selective cognitive abilities in patients with COPD has not been fully evaluated. Therefore, we aimed to assess the impact of PR combined with CT on 6 minutes walking test (6MWT) and cognitive parameters in Tunisian males' patients with COPD. METHODS: Thirty-nine patients with COPD were randomly assigned to an intervention group (n = 21, age = 65.3 ± 2.79) and a control group (n = 18, age = 65.3 ± 3.2). The intervention group underwent PR combined with CT, and the control group underwent only PR, three times per week for 3 months. The primary outcomes were 6MWT (6 minutes walking test -6MWT-parameters) and cognitive performance, as evaluated by Montreal cognitive assessments (MOCA) and P300 test. Secondary outcomes were patient's characteristics and spirometric data. These tests were measured at baseline and after 3 months of training programs. RESULTS: Results showed a significant improvement of the 6MWT distance after the rehabilitation period in both groups (p < .001). Moreover, both groups showed significant improvement (p < .001) in cognitive performance including MOCA score and P300 test latency in three midline electrodes. However, the improvement in cognitive performance was significantly greater in the PR+CT group than the PR group. CONCLUSION: In conclusion, although PR alone improves 6MWT parameters and cognitive function, the addition of CT to PR is more effective in improving cognitive abilities in patients with COPD. This combined approach may provide clinicians with a complementary therapeutic option for improving cognitive abilities in patients with COPD.

Randomized Controlled Trial Comparing Early Mobilization vs Six Weeks of Immobilization in a Walking Cast Following Total Ankle Replacement.

Rehabilitation for patients after total ankle replacement traditionally involves weeks of immobilization in a plaster cast followed by progressive mobilization. In a small randomized trial, we compared teh outcomes of patients who received a 3-component cementless, unconstrained, mobile-bearing prosthesis and were initially immobilised in a plaster cast for 6 weeks to thoese who received the same prosthesis but were allowed to mobilise early. Gait, clinical, patient-reported, and radiologic outcomes were measured. The study included 20 patients, 10 in the plaster cast group and 10 in the early mobilization group, and the demographics of the groups did not differ significantly. All patients were followed-up for 24 months. There were no significant differences between the 2 groups 2 years after surgery in ankle dorsiflexion, spatiotemporal gait characteristics, American Orthopaedic Foot and Ankle Society ankle-hindfoot scores, Timed Up and Go Test times, WOMAC (pain, stiffness, function) scores, SF-36 (quality-of-life) scores, or patient satisfaction (pain relief, daily-living, recreational activities, and overall) (all p > .05). Bone mineral density decrease of the medial malleolus and increase at middle tibia, calculated with DEXA scans, was significantly better in early mobilization than plaster cast group at one and 2 years postoperatively, but this was also the case preoperatively. The lack of differences in outcomes suggests that early ankle mobilization may be a safe and reliable method to enhance recovery following ankle arthroplasty with a 3-component cementless, unconstrained, mobile-bearing prosthesis. Compared to traditional plaster casting, patients who are engaged in early mobilization after arthroplasty may enjoy similar functional, mobility, quality-of-life, pain relief, activity level, and satisfaction outcomes.

[Lifestyle-integrated functional exercise for fall prevention : How and why do walking characteristics change?] / Lebensstilintegriertes funktionelles Training zur Sturzprävention : Wie und warum verändert sich das Gehverhalten?

BACKGROUND: The lifestyle-integrated functional exercise (LiFE) program has been shown to increase physical activity. It remains unclear, however, how these changes translate into long vs. short walking episodes. OBJECTIVE: The aim of this work was to investigate changes in short vs. long walking episodes between baseline and 6­month follow-up and to determine which factors are associated with these changes. MATERIAL AND METHODS: This was a two-arm randomized noninferiority study with 309 older adults (mean age 78.7 ± 0.3 years; 73.5% female) at risk of falling who exercised either in a group (gLiFE; n = 153) or individually (LiFE; n = 156). Walking episodes were measured using activPAL 4micro sensors: a distinction was made between walking episodes < 10s, < 20s, and > 60 s. Changes in walking episodes between baseline and 6­month follow-up were analyzed, including calculation of effect sizes (Cohen's d). Determinants of changes in the walking episodes were analyzed using multiple regression. RESULTS: The walking episodes < 10s and < 20 s showed a significant increase in both intervention groups but not for > 60 s. The overall daily walking duration and average steps per day had an influence on changes in the walking episodes between baseline and 6 months. Parameters of objective and subjective function explained a very small but significant amount of the variance. CONCLUSION: The LiFE program seems to work on a behavioral rather than on a functional level. By accumulating short walking episodes, large gains in physical activity can potentially be achieved. This can be of health-promoting benefit especially for persons living in institutional settings or for those who are cautious or even anxious to undertake longer walking episodes (e.g., outdoors).

Depression as a major component of a gait disorder-Successful multimodal treatment including electroconvulsive therapy : A case report.

This case report describes an 82-year-old patient who was treated in a gerontological psychiatric ward due to a multifactorial gait disorder with falls. The main component of the gait disorder was depression, which was accompanied by a pronounced fear of falling. Other factors were polyneuropathy, gonarthrosis and an exercise deficit after previous inactivity. An important part of the multimodal treatment was electroconvulsive therapy (ECT). A total of nine sessions of ECT in right unilateral stimulation were conducted. The treatment resulted in a significant improvement of the depression and the gait disorder, which was impressively reflected in the geriatric assessment. The presented case shows that depression and fear of falling should not be underestimated as (main) components of a gait disorder. Here, a multimodal treatment including treatment of the depression by ECT was successful.

Making Chile More Pedestrian-Friendly for Older Persons: Expert Perspectives.

Walking provides numerous benefits to older persons, but its practice is hindered by social factors and the built environment. This article aims to understand the factors that encourage or discourage older people's walking behaviors, as well as the policies influencing those factors in Chile. It does so by reporting the analysis of twenty-five semi-structured interviews with Chilean policymakers and local leaders. The experts consistently represented walking as a beneficial activity for older persons that, nonetheless, occurs in adverse built environments. They asserted that the absence of older people in the public discussion and a top-down policy-making structure hamper its promotion.

Walking as a cultural act and a profit for the landscape. A case study in the Iberian Peninsula.

Walking as a means of travel, when done voluntarily, becomes a cultural act that can have a beneficial effect both for the people who carry out the routes and for the space itself that is walked on. The fact of moving at a slow speed allow us to recover a more appropriate pace to enjoy the landscape, to reconnect with nature and with the position of human in the world, while improving our health. In contemporary society, some cultural tourist routes have become successful destinations, with the continuous arrival of thousands of visitors throughout the year. Thus, the historical cultural route Way of St. James has become a globally successful cultural tourism product. Close to this destination, the Ribeira Sacra, that has been recently designated by the regional government as a Cultural Landscape, with the intention of preserving its historical legacy, may be in the future a privileged destination in Galicia for walking. The research carried out allows us to ensure that this fact, taking long walks following routes with a rich cultural content, has a positive impact on the space from two different processes that are reinforced as the routes become more popular. First, from the recovery and promotion of an alternative communication network between different places. And second, through a series of laws and regulations that protect historic trails and adjacent landscapes.

Effects of Yi Jin Jing on juvenile cervical spondylopathy in China: A parallel, randomized, assessor-blinded clinical trial.

Background: Cervical spondylopathy is a common musculo-articular disorder, multiple exercises are recommended. Chinese fitness exercises are prevalent and used to treat various diseases. Aim: To explore the efficacy of Chinese fitness exercise Yi Jin Jing exercise in intervening the cervical spondylopathy in adolescents. Patients and Methods: The study was conducted in 60 adolescent patients with cervical spondylopathy, with 30 patients in each group. Methods: The study was conducted in 60 adolescent patients with cervical spondylopathy, with 30 patients in each group. The observation group was required to take Yi Jin Jing exercise, and the control group took the brisk walking exercise. The first week was the preparatory period for the patients, and then the participants were required to do exercises three times a week for at least 30 minutes in the later 3 weeks. Before and after treatment, Neck Disability Index (NDI) scores, pain visual analog scale (VAS) scores, and cervical curvature in both groups were observed, and the incidence of adverse events in both groups was recorded during the trial. Results: The NDI and VAS scores in both groups statistically decreased after intervention and mildly increased at follow-up, while the reduction in scores of the Yi Jin Jing group was more significant. Cervical curvature in both groups improved on day 28 compared to day 0. There were no adverse reactions during the evaluation period. Conclusion: The Chinese health-care qigong Yi Jin Jing exercise is more effective than brisk walking in improving the cervical range of motion and relieving pain in adolescents with cervical spondylopathy. Trial registration/Protocol registration: Clinical Trial Registry (ChiCTR2000030723).

Mobility in Older Adults Receiving Maintenance Hemodialysis: A Qualitative Study.

RATIONALE & OBJECTIVE: For older adults, maintaining mobility is a major priority, especially for those with advanced chronic diseases like kidney failure. However, our understanding of the factors affecting mobility in older adults receiving maintenance hemodialysis is limited. STUDY DESIGN: Descriptive qualitative study. SETTING & PARTICIPANTS: Using purposive sampling, we recruited (1) persons aged≥60 years receiving maintenance hemodialysis; and (2) care partners (≥18 years) providing regular support to an older adult receiving hemodialysis. During a single in-person home visit, we assessed mobility using the Short Physical Performance Battery (SPPB) and conducted individual one-on-one interviews regarding important personal factors related to mobility. ANALYTICAL APPROACH: Descriptive statistics were used for demographic and SPPB data. Transcripts underwent thematic coding, informed by the International Classification of Function framework of mobility. We used conceptual content analysis to inductively extract themes and subthemes. RESULTS: We enrolled 31 older adults receiving hemodialysis (42% female, 68% Black) with a mean age of 73±8 years and mean dialysis vintage of 4.6±3.5 years; their mean SPPB score was 3.6±2.8 points. Among 12 care partners (75% female, 33% Black), the mean age was 54±16 years and mean SPPB score was 10.1±2.4 points. Major themes extracted were (1) mobility represents independence; (2) mobility is precarious; (3) limitations in mobility cause distress; (4) sources of encouragement and motivation are critical; and (5) adaptability is key. LIMITATIONS: Modest sample from single geographic area. CONCLUSIONS: For older adults receiving hemodialysis, mobility is severely limited and is often precarious in nature, causing distress. Older adults receiving hemodialysis and their care partners have identified sources of encouragement and motivation for mobility, and cite an adaptable mindset as important. Future studies should conceptualize mobility as a variable condition and build on this outlook of adaptability in the development of interventions.