Association of Nutritional Risk With Gait Function and Activities of Daily Living in Older Adult Patients With Hip Fractures.

OBJECTIVE: To investigate the association of nutritional risk with gait function and activities of daily living (ADLs) in older adult patients with hip fractures. METHODS: The retrospective data of older adult patients diagnosed with hip fractures who visited the recovery-phase rehabilitation ward between January 2019 and December 2022 were reviewed. Nutritional risk was evaluated using the Geriatric Nutritional Risk Index; gait function and ADLs were assessed using the modified Harris Hip Score subitem and Functional Independence Measure, respectively. Multivariate linear regression and path analysis with structural equation modeling were used to examine the factors associated with ADLs and the associations among the study variables. RESULTS: This study included 206 participants (172 females and 34 males; mean age, 85.0±7.3 years). In the multivariate analysis, gait function (ß=0.488, p<0.001), cognitive function (ß=0.430, p<0.001), and surgery (ß=-0.143, p<0.001) were identified as independent factors. Pathway analysis revealed that nutritional risk was not directly correlated with ADLs but was directly associated with gait and cognitive functions. Gait and cognitive functions, in turn, were directly related to ADLs. CONCLUSION: Nutritional risk was found to be associated with ADLs through an intermediary of gait and cognitive functions.

Gap between the prevalence of and consultation rate for lumbopelvic pain in postnatal Japanese women.

BACKGROUND: We aimed to assess the prevalence of lumbopelvic pain (LPP), including low back pain (LBP) and/or pelvic girdle pain (PGP), consultation rate, and desire for treatment of postnatal Japanese women. METHODS: We performed a cross-sectional study of 98 postnatal Japanese women within 1 year of childbirth. We retrospectively evaluated the prevalence of LBP before and during pregnancy and the prevalence of LPP after childbirth using a self-administered questionnaire. We used the distribution of pain to differentiate LBP and/or PGP after childbirth and its intensity was assessed using a visual analogue scale. The effects of LPP on daily life were assessed using the Oswestry disability index (ODI). In addition, we assessed the consultation rate for LPP and the desire to consult a healthcare professional, using self-administered questionnaires. RESULTS: The prevalence of LPP after childbirth was 66%. Women with a history of LBP before and during pregnancy were more likely to have LPP following childbirth (both P < 0.001). The consultation rate among the postnatal women with LPP was 9%, but 56% of the women wished to consult a healthcare professional. The ODI score was significantly higher in postnatal women who wanted to consult a healthcare professional than in those who did not (P < 0.01). CONCLUSIONS: Two thirds of the postnatal Japanese women who participated in this study had LPP, but the consultation rate was low. However, more than half of these women had the desire to consult a healthcare professional.

Protective effects of hachimijiogan (HJG), a Japanese Kampo medicine, on cancer cachectic muscle wasting in mice.

Myogenesis is required to generate skeletal muscle tissue and to maintain skeletal muscle mass. Decreased myogenesis under various pathogenic conditions results in muscular atrophy. Through a small screening of Japanese traditional (Kampo) medicines, hachimijiogan (HJG) was shown to promote the myogenic differentiation of C2C12 myoblasts through the upregulation of myogenin. In tumor-bearing cancer-cachectic mice, HJG was also found to have a protective effect against cancer-cachectic muscle wasting. This effect was significant when HJG was administered in combination with aerobic exercise by treadmill running. Moreover, HJG ameliorated the cellular atrophy of C2C12 myotubes induced by treatment with conditioned medium derived from a colon-26 cancer cell culture. In addition, HJG suppressed H2O2-dependent myotube atrophy, suggesting that HJG could reverse the atrophic phenotypes by eliminating reactive oxygen species.

Physical Frailty May Predict 2-Year Prognosis in Elderly Patients With Acute Myocardial Infarction　- A Report From the FLAGSHIP Study.

BACKGROUND: Elderly patients with acute myocardial infarction (AMI) are a high-risk population for heart failure (HF), but the association between physical frailty and worsening prognosis, including HF development, has not been documented extensively.Methods and Results: As part of the FLAGSHIP study, we enrolled 524 patients aged ≥70 years hospitalized for AMI and capable of walking at discharge. Physical frailty was assessed using the FLAGSHIP frailty score. The primary outcome was a composite outcome of all-cause death and HF rehospitalization within 2 years after discharge. The secondary outcome was all-cause death and HF rehospitalization. After adjusting for confounders, physical frailty showed a significant association with an increased risk of the composite outcome (hazard ratio [HR]=2.09, 95% confidence interval [CI]: 1.03-4.22, P=0.040). The risk of HF rehospitalization increased with physical frailty, but the association was not statistically significant (HR=2.14, 95% CI: 0.84-5.44, P=0.110). Physical frailty was not associated with an increased risk of all-cause death (HR=1.45, 95% CI: 0.49-4.26, P=0.501). CONCLUSIONS: The findings suggest that physical frailty assessment serves as a stratifying tool to identify high-risk populations for post-discharge clinical events among ambulant elderly patients with AMI.

Dyspnea and outcome expectations are associated with physical activity in persons with pneumoconiosis: a cross-sectional study.

BACKGROUND: There are various reports on factors associated with physical activity in patients with chronic respiratory diseases. However, there are no studies on the relationship between physical activity and psychological or environmental factors. In this study, we investigated the relationship between physical activity and psychological and environmental factors using questionnaires for patients with pneumoconiosis. METHODS: This cross-sectional study included patients with pneumoconiosis who underwent a pneumoconiosis health examination in 2019. A self-administered questionnaire was used to conduct the study. Physical activity was evaluated using the International Physical Activity Questionnaire, and subjective symptoms [dyspnea and quality of life (QOL)], environmental factors (environment around home and life space), psychological factors (depression, stage of change, self-efficacy, decisional balance, and outcome expectations), and others (e.g., experience with pulmonary rehabilitation) were investigated. RESULTS: The number of respondents in the study was 185 (men: 171, women: 14). Age, dyspnea, stage of change, self-efficacy, outcome expectations, QOL, depression, decisional balance, and life space were significantly correlated with physical activity. In the multivariate analysis, outcome expectations and dyspnea were extracted as independent factors. In the path analysis, outcome expectations and dyspnea had a direct influence on physical activity. Dyspnea directly impacted not only physical activity but also outcome expectations, stage of change, QOL, life space, and depression. CONCLUSIONS: Dyspnea and outcome expectations were associated with physical activity in patients with pneumoconiosis. To improve physical activity in pneumoconiosis patients, it was suggested that it may be necessary to improve dyspnea and promote an understanding of physical activity.

The effects of skin cold stimulation on quadriceps muscle activity during walking in older adults.

Purpose: Given that walking speed declines with ageing and decreasing walking speed restricts activities of daily living (ADL), it is important for the old to maintain walking speed in order to prevent affecting ADL. Although skin cold stimulation (SCS) facilitates instantaneous muscle activity, which occurs during walking, the effects of SCS on muscle activity during walking remain unclear. Thus, the present study aimed to investigate the effect of SCS during walking in older adults.Methods: Seventeen community-dwelling healthy older adults (73 ± 6 years old) participated in this study. Walking speed at a comfortable pace and the electromyographic (EMG) activity of the vastus lateralis (VL) and biceps femoris (BF) were measured. SCS, which maintains the skin temperature at 25 °C, was applied to the front of the thigh during the procedures. Walking speed, root mean square EMG (rmsEMG) and mean power frequency (MPF) were compared under SCS and control conditions.Results: SCS significantly increased the walking speed (p < 0.01) and the rmsEMG of the vastus lateralis (p = 0.032). No change in the rmsEMG of the BF was observed, and SCS had no effect on MPF of both the VL and BF. Furthermore, a significant relationship was observed between these changes (r = 0.619, p = 0.042).Conclusion: SCS increased the EMG activity of the VL while increasing walking speed. Our results suggest that SCS is an effective strategy that can be included in daily life in order to improve walking ability of older adults.

Identifying the Effects of Assistive and Resistive Guidance on the Gait of Elderly People Using a Smart Walker.

Progression of technology has expanded applications of smart walkers in clinical fields. However, it is essential to investigate the effects of different types of gait guidance in order to introduce smart walkers more widely throughout these fields. The purpose of this study was to identify the effects of assistive and resistive guidance on the gait of elderly people using a smart walker. Gait parameters, surface electromyography of lower limb muscles, and trunk acceleration were measured. The assistive guidance force significantly increased gait speed, step length, and cadence while increasing trunk acceleration variability. The same amount of resistive guidance force did not change gait parameters; instead, however, it restrained the speed-dependent increase of trunk acceleration variability in the mediolateral direction. An analysis of muscle activity suggested that the lower limb muscle activity could be increased by varying gait parameters including speed, step length, and cadence.

Gait-phase-dependent control using a smart walker for physical training.

Falling has become a key factor that affects the quality of life of the elderly. Currently, the use of a few rehabilitation robots can contribute to the restoration of balance. In this paper, a walker-based rehabilitation robot with a gait-phasedependent control algorithm is proposed to promote dynamic balance in the elderly. It has unique characteristics in that the level of the walker to resist the propulsion force exerted by a user can vary depending on the gait-phase that is estimated using the interaction force between the robot and the user. The robot efficiently improves the muscle power of various muscle groups of the user. Experiments with three young subjects were conducted to validate the effectiveness of the walker with the gait-phase-dependent control algorithm.

Role of the BDNF-TrkB pathway in KCC2 regulation and rehabilitation following neuronal injury: A mini review.

In most mature neurons, low levels of intracellular Cl- concentrations ([Cl-]i) are maintained by channels and transporters, particularly the K+-Cl- cotransporter 2 (KCC2), which is the only Cl- extruder in most neurons. Recent studies have implicated KCC2 expression in the molecular mechanisms underlying neuronal disorders, such as spasticity, epilepsy and neuropathic pain. Alterations in KCC2 expression have been associated with brain-derived neurotrophic factor (BDNF) and its receptor tropomyosin-related kinase B (TrkB). The present review summarizes recent progress regarding the roles of Cl- regulators in immature and mature neurons. Moreover, we focus on the role of KCC2 regulation via the BDNF-TrkB pathway in spinal cord injury and rehabilitation, as prior studies have shown that the BDNF-TrkB pathway can affect both the pathological development and functional amelioration of spinal cord injuries. Evidence suggests that rehabilitation using active exercise and mechanical stimulation can attenuate spasticity and neuropathic pain in animal models, likely due to the upregulation of KCC2 expression via the BDNF-TrkB pathway. Moreover, research suggests that such rehabilitation efforts may recover KCC2 expression without the use of exogenous BDNF.

Translational movement within the glenohumeral joint at different rotation velocities as seen by cine MRI.

BACKGROUND: The glenohumeral joint is subjected to opposing forces when the direction of shoulder motion is changed, accelerating and decelerating to make the movements. The influence of motion velocity or acceleration on translation of the humeral head has not been evaluated although direction and distance of humeral head translation has been analyzed in real time in normal shoulders. We hypothesized that, in a normal shoulder, the humeral head does not deviate significantly or suddenly during active shoulder rotation regardless of motion velocity. The purpose of this study was to clarify normal intraarticular kinematics of humeral head position and translation during axial shoulder rotation with the arm by the side of the body at different rotational velocities using cine magnetic resonance imaging (MRI). METHODS: Both shoulders of ten healthy adults (mean age group between 27.80 ± 6.05 years) were used in this study. Prior to MRI scan, dynamic glenohumeral stability was confirmed by physical examination. The glenohumeral joint was scanned during active shoulder rotation at three angular velocities (low, medium and high velocities), with the arm by the side of the body by real-time cine MRI while recording with the help of a video camera. Translation of the humeral head and rotation angles on MR imaging and video camera were measured to match shoulder rotational positions. RESULTS: There were no statistical differences of the humeral head position and translation among three rotation velocities (p > 0.05). Translation of the humeral head was distributed from 1.44 ± 2.45 mm anteriorly to 0.65 ± 1.84 mm posteriorly at low velocity, from 0.74 ± 1.92 mm anteriorly to 0.75 ± 2.17 mm posteriorly at medium velocity, and from 2.62 ± 2.19 anteriorly to 1.17 ± 1.44 mm posteriorly at high velocity. CONCLUSIONS: Translation of the humeral head was shown to undergo no significant change throughout the ranges of internal and external rotation, or among different rotational velocities in dynamic stability of the glenohumeral joint.

Age differences in reactive strategies and execution time during choice stepping with visual interference.

PURPOSE: We aimed to explore the effects of visual interference from a flanker task on a reactive strategy and execution speed of choice stepping among young and older adults. METHODS: Twenty-two healthy young (21.9 ± 1.4 years) and 21 older participants (72.6 ± 4.9 years) were instructed to execute forward stepping as quickly and accurately as possible on the side indicated by a central arrow (←left vs. right→) of a visual cue during a neutral condition. During a flanker condition, participants were additionally required to ignore flanker arrows on each side of the central arrow (→→→→→ congruent or incongruent →→←→→). Errors in the direction of the initial weight transfer [anticipatory postural adjustment (APA) errors], step execution time, and divided phases (reaction, APA, and swing phases) were measured from the data of vertical force. RESULTS: Incongruence had larger effects on step execution times and APA phase in older adults than in young adults, while incongruence had smaller effects on reaction phase in older adults than in young adults. Step execution times were prolonged for trials with APA errors relative to trials without those in both groups. Only older adults showed that step execution times during trials with APA errors increased prominently in the incongruent condition as compared to the other conditions. CONCLUSION: Older adults might have a tendency to make hastier judgments, and might be vulnerable to potential motor program errors caused by an interference effect. Composite measurement of inhibition and stepping in a functional context may increase discriminative ability for age-related deficits in postural control.

Analysis of Choice Stepping with Visual Interference Can Detect Prolonged Postural Preparation in Older Adults with Mild Cognitive Impairment at High Risk of Falling.

BACKGROUND/AIMS: We aimed to clarify postural control deficits in older adults with mild cognitive impairment (MCI) at high risk of falling by addressing the inhibitory process. METHODS: This study involved 376 community-dwelling older adults with MCI. Participants were instructed to execute forward stepping on the side indicated by the central arrow while ignoring the 2 flanking arrows on each side (→→→→→, congruent, or →→←→→, incongruent). Initial weight transfer direction errors [anticipatory postural adjustment (APA) errors], step execution times, and divided phases (reaction, APA, and swing phases) were measured from vertical force data. Participants were categorized as fallers (n = 37) and non-fallers (n = 339) based on fall experiences in the last 12 months. RESULTS: There were no differences in the step execution times, swing phases, step error rates, and APA error rates between groups, but fallers had a significantly longer APA phase relative to non-fallers in trials of the incongruent condition with APA errors (p = 0.005). Fallers also had a longer reaction phase in trials with the correct APA, regardless of the condition (p = 0.01). CONCLUSION: Analyses of choice stepping with visual interference can detect prolonged postural preparation as a specific falling-associated deficit in older adults with MCI.

Effects of speed and accuracy strategy on choice step execution in response to the flanker interference task.

The purpose of this study is to examine the effects of a speed or accuracy strategy on response interference control during choice step execution. Eighteen healthy young participants were instructed to execute forward stepping on the side indicated by a central arrow (←, left vs. →, right) under task instructions that either emphasized speed or accuracy of response in the neutral condition. In the flanker condition, they were additionally required to ignore the 2 flanking arrows on each side (→→→→→, congruent or →→←→→, incongruent). Errors in the direction of the initial weight transfer (APA errors) and the step execution times were measured from the vertical force data. APA error was increased in response to the flanker task and step execution time was shortened with a speed strategy compared to an accuracy strategy. Furthermore, in response to the visual interference of the flanker task, speed instructions in particular increased APA errors more than other instructions. It may be important to manipulate the level of the speed-accuracy trade-off to improve efficiency and safety. Further research is needed to explore the effects of advancing age and disability on choice step reaction in a speed or accuracy strategy.

Effects of visual interference on initial motor program errors and execution times in the choice step reaction.

The purpose of this study was to examine whether visual interference has any effect on error in the initial direction of anticipatory postural adjustment (APA) prior to a step (indicating a motor program error) and response time during the choice step execution. Twenty healthy young participants were instructed to execute forward stepping as quickly and accurately as possible on the side indicated by a central arrow (←, left vs. →, right) of a visual cue in the neutral condition. In the flanker condition, they were additionally required to ignore the 2 flanking arrows on each side (→→→→→, congruent or →→←→→, incongruent). Errors in the direction of the initial weight transfer (APA errors) and the step execution times were measured from the vertical force data. In the incongruent condition, the percentage of APA errors and the step execution times were significantly greater than those in the neutral and congruent conditions. A linear mixed model revealed that the step execution time in trials with APA errors was longer than those in trials without APA errors. The visual interference effect of a flanker task may load selective attention and judgment processing during movement initiation, leading to increased initial motor program errors and prolonged step execution times even in healthy young adults.

[Factors associated with fear of falling among community-dwelling elderly adults without reduced performance in instrumental activities of daily living].

AIM: The purpose of this study was to examine factors related to fear of falling (FOF) in elderly adults who showed no reduced performance regarding independent instrumental activities of daily living (IADL). METHODS: A total of 119 elderly adults participated in the study (mean age, 75.7±7.2 years, women, n=60). We investigated the prevalence of FOF, anamnesis, medications, body pain, and history of falls, the Geriatric Depression Scale, International Physical Activity Questionnaire, Life-Space Assessment (LSA). The Timed Up and Go test (TUG) and one-legged standing time were measured to evaluate physical performance. Participants were divided into elderly adults with FOF (FOF group) and those without FOF (non-FOF group). The unpaired t-test or chi-square test was used for group comparisons. Multiple logistic regression analysis was then performed to examine the factors associated with FOF. RESULTS: The prevalence of FOF was 51.3% overall. The FOF group had a higher prevalence of anamnesis, body pain, and history of falls than the non-FOF group. The FOF group had lower LSA scores, longer durations on the TUG, and shorter durations on the one-legged standing test than the non-FOF group. On multiple logistic regression analysis, LSA (total score, 120 points) was significantly associated with FOF (odds ratio: 0.96, 95% confidence interval=0.93-0.99). CONCLUSION: Fear of falling was significantly associated with life space in community-dwelling elderly adults who showed no reduced performance regarding IADL. In future, it will be necessary to clarify any possible causal relationship by longitudinal investigations.

Anti-IL-6 receptor antibody causes less promotion of tuberculosis infection than anti-TNF-α antibody in mice.

Objective. Our aim was to investigate the effects of IL-6 blockade on the progression of Mycobacterium tuberculosis (TB) and compare them with those of TNF-α blockade in mice. Methods. Mice were intravenously infected with TB and injected with antibodies. Survival was monitored and histological and immunological studies were carried out. Results. All anti-IL-6R Ab-treated mice and 8 of 10 control mice survived until sacrificed 224 days after TB challenge, whereas anti-TNF-α Ab-treated mice all died between 120 and 181 days. Anti-IL-6R Ab-treated mice exhibited no significant differences in TB CFU in organs, including the lungs, and no deterioration in histopathology compared to control mice at 4 weeks. In contrast, anti-TNF-α Ab-treated mice exhibited increased TB CFU and greater progression of histopathological findings in organs than control mice. Spleen cells from anti-TNF-α Ab-treated mice had decreased antigen-specific response in IFN-γ release and proliferation assays. The results in anti-IL-6R Ab-treated mice suggest that spleen cell responses were decreased to a lesser degree. Similar results were obtained in IL-6 knockout (KO) mice, compared with TNF receptor 1 (TNFR1) KO and TNFR1/IL-6 double KO (DKO) mice. Conclusion. IL-6R blockade promotes the progression of TB infection in mice far less than TNF-α blockade.

IL-6 plays an essential role in neutrophilia under inflammation.

In the present study, we explored the involvement of interleukin-6 (IL-6) in neutrophilia under inflammatory conditions. The neutrophil count in the peripheral blood was high in arthritic monkeys, and anti-IL-6 receptor antibody reduced neutrophil counts to normal levels. IL-6 injection into normal monkeys significantly increased neutrophil counts in the blood 3h after injection. The expression of cluster of differentiation (CD) 162 on circulating neutrophils was reduced by IL-6 injection. IL-6 treatment in vitro did not affect CD162 expression on neutrophils from human blood. In IL-6-treated monkeys, IL-8 and granulocyte-macrophage colony-stimulating factor (GM-CSF) levels in plasma were clearly elevated. IL-8 and GM-CSF treatment in vitro reduced cell-surface CD162 expression on human neutrophils, and moreover, increased soluble CD162 expression in the cell supernatant. The addition of IL-6 into human whole peripheral blood induced IL-8 production and reduced CD162 expression on neutrophils. Furthermore, IL-8 and GM-CSF augmented mRNA expression of a disintegrin and metalloprotease like domain 10 (ADAM10) in neutrophils. Knock-down of ADAM10 by siRNA in neutrophil-like HL-60 cells partially reversed the expression of CD162 reduced by GM-CSF and IL-8 on HL-60 cells. In conclusion, IL-6 induced neutrophilia and reduced CD162 expression on neutrophils in inflammation.

Tocilizumab, a humanized anti-interleukin-6 receptor antibody, improved anemia in monkey arthritis by suppressing IL-6-induced hepcidin production.

We have reported that serum IL-6 level was related with the degree of anemia in monkey collagen-induced arthritis (CIA). In this study, we examined whether IL-6 blockade ameliorated an anemia in monkey CIA. CIA was induced by twice immunization of bovine type II collagen with adjuvant. When anemia became evident, anti-IL-6 receptor antibody, tocilizumab was intravenously injected once a week for 4 weeks. Controls received PBS in a same manner. Hematological and biochemical parameters were measured regularly and serum hepcidin-25 levels were measured by SELDI-TOF mass spectrometry. Moreover, hepcidin mRNA induction in Hep3B cells by serum from arthritic monkeys was examined by real-time PCR. Administration of tocilizumab rapidly decreased CRP levels and improved iron-deficient anemia within 1 week. Tocilizumab induced rapid but transient reduction in serum hepcidin-25. Hepcidin mRNA expression was more potently induced by serum from arthritic monkey and this was inhibited by the addition of tocilizumab. Blockade of IL-6 signaling rapidly improved anemia in monkey arthritis via the inhibition of IL-6-induced hepcidin production.

How often and how far do frail elderly people need to go outdoors to maintain functional capacity?

The purpose of this study was to investigate the relationship between the frequency of going outdoors into the life-space and functional impairment in community-living frail elderly people. Participants were 1872 community-dwelling elderly people (65-100 years). The participants were asked activities of daily living (ADL) status and how far they traveled and how often they traveled to that area in the 4 weeks before the assessment. We selected two demographic variables, five physiological variables, 11 primary diseases or geriatric syndromes, and four psychosocial variables as possible confounding factors of ADL limitations and correlates of going outdoors. After adjusting for the confounders, multiple logistic regression showed that limitations in basic ADL and instrumental ADL were most strongly associated with going outside the home less than once a week and with going into the neighborhood less than once a week, respectively. Low self-efficacy for going outdoors related most strongly to restrictions in these outdoor activities. These results suggest that going outdoors into the neighborhood at least once a week is beneficial for maintaining physical function in frail elderly people.

[Relationship between exercise capacity and physical fitness in elderly people with chronic heart failure and chronic respiratory failure].

AIM: The purpose of this study was to examine the relationship between exercise capacity and physical fitness in healthy elderly people and elderly subject with chronic respiratory failure and chronic heart failure, and whether that relationship differs depending on level of exercise capacity. METHODS: Measurements were made in 15 healthy elderly people, 17 people with chronic respiratory failure, and 15 people with chronic heart failure in the incremental shuttle walking test, timed up and go test, functional reach test, one leg balance test, grip force, knee extension force, half-squat test, step test, and sitting trunk flexion. The correlation between incremental shuttle walking test distance and other variables was compared between the disease groups, and between groups with incremental shuttle walking test distance under and over 450 m, which was the index of physical capacity for heart transplant. RESULTS: In the disease groups, more physical fitness variables correlated with exercise capacity than in the healthy elderly group. The under-450 m group had poorer balance, muscular endurance, and agility than the over-450 m group. In the under-450 m group, exercise capacity was correlated with balance, muscle power, and agility. CONCLUSIONS: In elderly people with chronic respiratory failure and chronic heart failure, exercise capacity is influenced by various factors of physical performance. Training to improve physical fitness may be necessary for elderly people with incremental shuttle walking test distance of below 450 m.