Examining the role of different weakness categories for mobility and future falls in older Americans.

BACKGROUND: Recently developed absolute and body size normalized handgrip strength (HGS) cut-points could be used individually and collectively to predict mobility problems and falls. AIMS: We examined the associations of (1) each absolute and normalized weakness cut-point, (2) collective weakness categories, and (3) changes in weakness status on future falls in older Americans. METHODS: The analytic sample included 11,675 participants from the 2006-2018 waves of the Health and Retirement Study. Falls were self-reported. Men were classified as weak if their HGS was < 35.5-kg (absolute), < 0.45 kg/kg (body mass normalized), or < 1.05 kg/kg/m2 (body mass index normalized). While, women were considered weak if their HGS was < 20.0-kg, < 0.337 kg/kg, or < 0.79 kg/kg/m2. Collective weakness categorized those below 1, 2, or all 3 cut-points. The collective weakness categories were also used to observe changes in weakness status over time. RESULTS: Older Americans below each absolute and normalized cut-point had greater odds for future falls: 1.23 (95% confidence interval (CI): 1.15-1.32) for absolute weakness, 1.20 (CI 1.11-1.29) for body mass index normalized weakness, and 1.26 (CI 1.17-1.34) for body mass normalized weakness. Persons below 1, 2, or all 3 weakness cut-points had 1.17 (CI 1.07-1.27), 1.29 (CI 1.18-1.40), and 1.36 (CI 1.24-1.48) greater odds for future falls, respectively. Those in some changing weakness categories had greater odds for future falls: 1.26 (CI 1.08-1.48) for persistent and 1.31 (CI 1.11-1.55) for progressive. DISCUSSION: Collectively using these weakness cut-points may improve their predictive value. CONCLUSION: We recommend HGS be evaluated in mobility and fall risk assessments.

The Effect of Direct and Remote Postexercise Ischemic Conditioning on Muscle Soreness and Strength 24 Hours After Eccentric Drop Jumps.

ABSTRACT: Lillquist, T, Mahoney, SJ, Kotarsky, C, McGrath, R, Jarajapu, Y, Scholten, SD, and Hackney, KJ. The effect of direct and remote postexercise ischemic conditioning on muscle soreness and strength 24 hours after eccentric drop jumps. J Strength Cond Res 37(9): 1870-1876, 2023-Strategic limb occlusion applied after exercise may facilitate recovery, not only in directly targeted tissue but also in remote areas of the body. The purpose of this study was to determine if postexercise ischemic conditioning (PEIC) applied directly to one leg facilitated recovery in the targeted leg and the contralateral leg that did not receive direct PEIC. Twenty active men participated in a single-blind, randomized, crossover design. Subjects completed 2 paired testing sessions (PEIC and control-SHAM) that included pre-assessments and 24-hour postassessments. Each paired testing session included an eccentric drop jump task, which has been shown to increase lower-body muscle soreness and decrease strength. After each drop jump task, occlusion cuffs were immediately applied. In the PEIC session, ∼198 mm Hg was applied directly to one leg (PEIC-Direct), whereas the contralateral leg received a nonphysiological stimuli of 20 mm Hg (PEIC-Remote). In the control-SHAM session, both legs directly and remotely received the 20 mm Hg pressure. Unilateral pre-assessments and 24-hour postassessments included muscle soreness using a visual analog scale and strength via peak torque assessment across the force-velocity spectrum (flexion/extension 60/60, 120/120, 180/180, 240/240, 300/300 °·s -1 ), and a maximal eccentric extension (30/30 °·s -1 ). Muscle soreness was significantly increased ( p < 0.05) at 24 hours compared with pretreatment except for PEIC-Direct (1.19 ± 0.78 vs. 2.32 ± 1.48, p = 0.096). Across the force-velocity spectrum, there were no significant differences observed between any associated pretest and posttest ( p > 0.05). PEIC applied directly to target leg after eccentric drop jumps attenuated perceived quadriceps muscle soreness 24 hours post; however, there was no effect on muscle strength.

Using Electronic Handgrip Dynamometry and Accelerometry to Examine Multiple Aspects of Handgrip Function in Master Endurance Athletes: A Pilot Study.

ABSTRACT: Klawitter, LA, Hackney, KJ, Christensen, BK, Hamm, JM, Hanson, M, and McGrath, R. Using electronic handgrip dynamometry and accelerometry to examine multiple aspects of handgrip function in master endurance athletes: A Pilot Study. J Strength Cond Res 37(9): 1777-1782, 2023-Electronic handgrip dynamometry and accelerometry may provide novel opportunities to comprehensively measure muscle function for human performance, especially for master athletes. This investigation sought to determine the multivariate relationships between maximal strength, asymmetry, rate of force development, fatigability, submaximal force control, bimanual coordination, and neuromuscular steadiness to derive one or more handgrip principal components in master-aged endurance athletes. We included n = 31 cyclists and triathletes aged 35-70 years. Maximal strength, asymmetry, rate of force development, fatigability, submaximal force control, bimanual coordination, and neuromuscular steadiness were measured twice on each hand using electronic handgrip dynamometry and accelerometry. The highest performing measures were included in the analyses. A principal component analysis was conducted to derive a new collection of uncorrelated variables from the collected handgrip measurements. Principal components with eigenvalues >1.0 were kept, and individual measures with a factor loading of |>0.40| were retained in each principal component. There were 3 principal components retained with eigenvalues of 2.46, 1.31, and 1.17. The first principal component, "robust strength," contained maximal strength, rate of force development, submaximal force control, and neuromuscular steadiness. The second principal component, "bilateral synergy," contained asymmetry and bimanual coordination, whereas the third principal component, "muscle conditioning," contained fatigability. Principal components 1, 2, and 3 explained 44.0, 31.6, and 24.4% of the variance, respectively. Different dimensions of muscle function emerged from our findings, suggesting the potential of a muscle function battery. Further research examining how these measures are associated with appropriate human performance metrics and lower extremity correlates is warranted.

Prevalence and Trends of Weakness Among Middle-Aged and Older Adults in the United States.

ABSTRACT: McGrath, R, FitzSimmons, S, Andrew, S, Black, K, Bradley, A, Christensen, BK, Collins, K, Klawitter, L, Kieser, J, Langford, M, Orr, M, and Hackney, KJ. Prevalence and trends of weakness among middle-aged and older adults in the United States. J Strength Cond Res 37(12): 2484-2490, 2023-Muscle weakness, which is often determined with low handgrip strength (HGS), is associated with several adverse health conditions; however, the prevalence and trends of weakness in the United States is not well-understood. We sought to estimate the prevalence and trends of weakness in Americans aged at least 50 years. The total unweighted analytic sample included 22,895 Americans from the 2006-2016 waves of the Health and Retirement Study. Handgrip strength was measured with a handgrip dynamometer. Men with weakness were below at least one of the absolute or normalized (body mass, body mass index) cut points: <35.5 kg, <0.45 kg/kg, <1.05 kg/kg/m 2 . The presence of any weakness in women was also identified as being below one of the absolute or normalized HGS cut points: <20.0 kg, <0.34 kg/kg, or <0.79 kg/kg/m 2 . There was an increasing trend in the prevalence of any weakness over time ( p < 0.001). The prevalence of weakness was 45.1% (95% confidence interval [CI]: 44.0-46.0) in the 2006-2008 waves and 52.6% (CI: 51.5-53.7) in the 2014-2016 waves. Weakness prevalence was higher for older (≥65 years) Americans (64.2%; CI: 62.8-65.5) compared with middle-aged (50-64 years) Americans (42.2%; CI: 40.6-43.8) in the 2014-2016 waves. Moreover, the prevalence of weakness in the 2014-2016 waves was generally higher in women (54.5%; CI: 53.1-55.9) than in men (50.4%; CI: 48.7-52.0). Differences existed in weakness prevalence across races and ethnicities. The findings from our investigation suggest that the prevalence of weakness is overall pronounced and increasing in Americans. Efforts for mitigating and better operationalizing weakness will elevate in importance as our older American population grows.

A Miniaturized MicroRNA Sensor Identifies Targets Associated with Weight Loss in a Diet and Exercise Intervention among Healthy Overweight Individuals.

Weight loss through dietary and exercise intervention is commonly prescribed but is not effective for all individuals. Recent studies have demonstrated that circulating microRNA (miR) biomarkers could potentially be used to identify individuals who will likely lose weight through diet and exercise and attain a healthy body weight. However, accurate detection of miRs in clinical samples is difficult, error-prone, and expensive. To address this issue, we recently developed iLluminate-a low-cost and highly sensitive miR sensor suitable for point-of-care testing. To investigate if miR testing and iLluminate can be used in real-world obesity applications, we developed a pilot diet and exercise intervention and utilized iLluminate to evaluate miR biomarkers. We evaluated the expression of miRs-140, -935, -let-7b, and -99a, which are biomarkers for fat loss, energy metabolism, and adipogenic differentiation. Responders lost more total mass, tissue mass, and fat mass than non-responders. miRs-140, -935, -let-7b, and -99a, collectively accounted for 6.9% and 8.8% of the explained variability in fat and lean mass, respectively. At the level of the individual coefficients, miRs-140 and -935 were significantly associated with fat loss. Collectively, miRs-140 and -935 provide an additional degree of predictive capability in body mass and fat mass alternations.

Increased velocity at VO2max and load carriage performance in army ROTC cadets: prescription using the critical velocity concept.

The purpose of this study was to evaluate the effects of using the critical velocity (CV) concept to prescribe two separate high-intensity interval training (HIT) exercise programs aimed at enhancing CV and load carriage performance. 20 young adult participants (male = 15, female = 5) underwent a 4-week training period where they exercised 2 d wk-1. Participants were randomly assigned into two groups: (1) HIT or (2) Load Carriage-HIT (LCHIT). Pre- and post-training assessments included running 3-minute All-Out Test (3MT) to determine critical velocity (CV) and distance prime (D') and two load carriage tasks (400 and 3200 m). There were significant increases in CV (p = 0.005) and velocity at V˙ O2max (vV˙ O2max) (p = 0.037) among the sample but not between training groups. Improvements were observed in 3200 m load carriage performance time (p < 0.001) with a 9.8 and 5.4% decrease in the LCHIT and HIT groups, respectively. Practitioner summary: Critical velocity has shown efficacy as a marker for performance in tactical populations. With the addition of load carriage, there is a reduction in the individual's CV. The CV-concept-prescribed exercises (HIT and LCHIT) 2 days per week for 4 weeks showed improvements in CV, vV˙ O2max and load carriage performance. The use of the CV concept provides a method to prescribe HIT to increase running and load carriage performances in tactical populations.

Weakness and cognitive impairment are independently and jointly associated with functional decline in aging Americans.

BACKGROUND: Discovering how certain health factors contribute to functional declines may help to promote successful aging. AIMS: To determine the independent and joint associations of handgrip strength (HGS) and cognitive function with instrumental activities of daily living (IADL) and activities of daily living (ADL) disability decline in aging Americans. METHODS: Data from 18,391 adults aged 50 years and over who participated in at least one wave of the 2006-2014 waves of the Health and Retirement Study were analyzed. A hand-held dynamometer assessed HGS and cognitive functioning was examined with a modified version of the Telephone Interview of Cognitive Status. IADL and ADL abilities were self-reported. Participants were stratified into four distinct groups based on their HGS and cognitive function status. Separate covariate-adjusted multilevel models were conducted for the analyses. RESULTS: Participants who were weak, had a cognitive impairment, and had both weakness and a cognitive impairment had 1.70 (95% confidence interval (CI) 1.57-1.84), 1.97 (CI 1.74-2.23), and 3.13 (CI 2.73-3.59) greater odds for IADL disability decline, respectively, and 2.26 (CI 2.03-2.51), 1.26 (CI 1.05-1.51), and 4.48 (CI 3.72-5.39) greater odds for ADL disability decline, respectively. DISCUSSION: HGS and cognitive functioning were independently and jointly associated with IADL and ADL disability declines. Individuals with both weakness and cognitive impairment demonstrated substantially higher odds for functional decline than those with either risk factor alone. CONCLUSIONS: Including measures of both HGS and cognitive functioning in routine geriatric assessments may help to identify those at greatest risk for declining functional capacity.

Effect of Progressive Calisthenic Push-up Training on Muscle Strength and Thickness.

Kotarsky, CJ, Christensen, BK, Miller, JS, and Hackney, KJ. Effect of progressive calisthenic push-up training on muscle strength and thickness. J Strength Cond Res 32(3): 651-659, 2018-Calisthenics, a form of resistance training, continue to increase in popularity; however, few studies have examined their effectiveness for muscle strength improvement. The purpose of this study was to determine whether progressive calisthenic push-up training (PUSH) is comparable with traditional bench press training (BENCH) as a technique for increasing muscle strength and thickness. Twenty-three healthy, moderately trained men (mean ± SD: age 23 ± 6.8 years) completed the study. Subjects were randomly assigned to PUSH (n = 14) and BENCH (n = 9) groups and were trained 3 days per week for 4 weeks. Muscle thickness (MT), seated medicine ball put (MBP), 1 repetition maximum (1RM) bench press, and push-up progression (PUP) were measured before and after training. Results revealed significant increases in 1RM (p < 0.001) and PUP (p < 0.001) for both groups after training. The increase in PUP was significantly greater for PUSH (p < 0.001). No significant differences were found within groups for MT and MBP (p > 0.05). This study is the first to demonstrate that calisthenics, using different progressive variations to maintain strength training programming variables, can improve upper-body muscle strength.

The Astronaut-Athlete: Optimizing Human Performance in Space.

It is well known that long-duration spaceflight results in deconditioning of neuromuscular and cardiovascular systems, leading to a decline in physical fitness. On reloading in gravitational environments, reduced fitness (e.g., aerobic capacity, muscular strength, and endurance) could impair human performance, mission success, and crew safety. The level of fitness necessary for the performance of routine and off-nominal terrestrial mission tasks remains an unanswered and pressing question for scientists and flight physicians. To mitigate fitness loss during spaceflight, resistance and aerobic exercise are the most effective countermeasure available to astronauts. Currently, 2.5 h·d, 6-7 d·wk is allotted in crew schedules for exercise to be performed on highly specialized hardware on the International Space Station (ISS). Exercise hardware provides up to 273 kg of loading capability for resistance exercise, treadmill speeds between 0.44 and 5.5 m·s, and cycle workloads from 0 and 350 W. Compared to ISS missions, future missions beyond low earth orbit will likely be accomplished with less vehicle volume and power allocated for exercise hardware. Concomitant factors, such as diet and age, will also affect the physiologic responses to exercise training (e.g., anabolic resistance) in the space environment. Research into the potential optimization of exercise countermeasures through use of dietary supplementation, and pharmaceuticals may assist in reducing physiological deconditioning during long-duration spaceflight and have the potential to enhance performance of occupationally related astronaut tasks (e.g., extravehicular activity, habitat construction, equipment repairs, planetary exploration, and emergency response).

Influence of muscle strength to weight ratio on functional task performance.

Existing models of muscle deconditioning such as bed rest are expensive and time-consuming. We propose a new model utilizing a weighted suit to manipulate muscle strength, power, or endurance relative to body weight. The aims of the study were to determine as to which muscle measures best predict functional task performance and to determine muscle performance thresholds below which task performance is impaired. Twenty subjects performed seven occupational astronaut tasks (supine and upright seat egress and walk, rise from fall, hatch opening, ladder climb, object carry, and construction board activity), while wearing a suit weighted with 0-120 % of body weight. Models of the relationship between muscle function/body weight and task completion time were developed using fractional polynomial regression and verified with pre- and post-flight astronaut performance data. Spline regression was used to identify muscle function thresholds for each task. Upright seat egress and walk was the most difficult task according to the spline regression analysis thresholds. Thresholds normalized to body weight were 17.8 N/kg for leg press isometric force, 17.6 W/kg for leg press power, 78.8 J/kg for leg press work, 5.9 N/kg isometric knee extension and 1.9 Nm/kg isokinetic knee extension torque. Leg press maximal isometric force/body weight was the most reliable measure for modeling performance of ambulatory tasks. Laboratory-based manipulation of relative strength has promise as an analog for spaceflight-induced loss of muscle function. Muscle performance values normalized to body weight can be used to predict occupational task performance and to establish relevant strength thresholds.

Comparable Acute Metabolic Responses when Walking with Blood Flow Restriction and Walking with Load Carriage: Implication for Tactical Professionals.

The current study aimed to investigate exercise with blood flow restriction (BFR) as a low-intensity conditioning strategy in tactical professionals with load carriage. During the low-intensity exercise, researchers examined the acute metabolic responses from low-intensity BFR walking, walking with load carriage, and walking with BFR and load carriage. Twelve healthy adult males (age = 21.8 ± 1.5 yrs, height = 181.3 ± 7.2 cm, body mass = 84.4 ± 11.1 kg and BMI = 25.6 ± 2.6 kg·m2) completed five bouts of 3-min treadmill walking at 4.8 km·h-1 with 1-min rest interval under three different conditions: 1) blood flow restriction (BFR), 2) loaded with 15% of body mass (LOAD) and 3) loaded with 15% of body mass with blood flow restriction (BFR-LOAD). Oxygen consumption (V̇O2), heart rate, and local muscle oxygen saturation was measured during the exercise bouts. V̇O2 increased by 7% during the BFR- LOAD (p = 0.001) compared with BFR or LOAD alone. There were no differences in V̇O2 between BFR and LOAD (p = 0.202). BFR-LOAD showed significantly lower (-9%) muscle oxygen saturation (p = 0.044) and deoxygenated hemoglobin (p = 0.047) compared to LOAD. Low-intensity walking with the addition of BFR shares acute metabolic characteristics similar to walking with a load. These characteristics suggest there is potential for the use of BFR to increase exercise intensity for individuals training with load carriage.

Muscle specific declines in oxygen saturation during acute ambulation with hands-free and conventional mobility devices.

Disuse is associated with reduced muscle oxygen saturation (SmO2). Improving oxygen delivery to tissues is important for healing, preventing muscle atrophy, and reducing the risk of deep vein thrombosis. Mobility devices are used during disuse periods to ambulate and protect the injured limb. This study examined SmO2 in walking and ambulation with various mobility devices. Thirty-eight participants randomly completed four, ten-minute trials which included: (1) walking, (2) medical kneeling scooter (MKS), (3) hands-free crutch (HFC), and (4) axillary crutch (AC). During each trial, near infrared spectroscopy sensors were placed on the vastus lateralis (VL), biceps femoris (BF), and lateral gastrocnemius (LG) of the right limb. Compared to walking, all mobility devices showed a decline in SmO2 in the VL of ∼10% (mean ± SD; 75% ± 12%-65% ± 17%, P < 0.05). In the BF, SmO2 declined ∼9% in AC compared to walking (76% ± 12%-67% ± 17%, P = 0.025). In the LG, SmO2 declined in AC (64% ± 16%) compared to MKS (70% ± 15%, P = 0.005). There were no differences in LG SmO2 compared to walking (69% ± 13%) in MKS (P > 0.05) or HFC (65% ± 15%, P > 0.05). In young, healthy volunteers, the use of mobility devices altered muscle oxygenation in several muscles. AC reduced muscle oxygenation in the VL, BF, and LG; while MKS and HFC maintained BF and LG muscle oxygenation at a level consistent with ambulatory walking.

Contributions from incumbent police officer's physical activity and body composition to occupational assessment performance.

Introduction: Police officers must perform various tasks in unpredictable work environments and potentially volatile situations. This study aimed to determine if cardiovascular fitness, body composition, and physical activity levels could predict performance in a Midwest Police Department's Physical Readiness Assessment (PRA). Methods: Researchers collected data from thirty incumbent police officers (33.9 ± 8.3 years, female = 5). Anthropometric data included height, body mass, body fat percentage (BF%), fat-free mass (FFM), and maximal hand grip strength. The police officers also completed a physical activity rating (PA-R) scale to estimate maximal oxygen consumption (V˙O2max) and the International Physical Activity Questionnaire (IPAQ). Police officers then conducted their department's PRA. Stepwise linear regression analyses were used to determine the relationship between predictor variables and PRA performance. Pearson's product-moment correlations investigated relationships between anthropometric, physical fitness, and physical activity variables and PRA performance using SPSS (v.28). The significance level was set at p < 0.05. Results: Descriptive data for the sample includes BF%: 27.85 ± 7.57%, FFM: 65.73 ± 10.72 kg, hand grip strength: 55.51 ± 11.07 kg, weekday sedentary time (WST): 328 ± 28.26 min, weekend day sedentary time (WDST): 310 ± 28.92 min, daily moderate-to-vigorous physical activity (MVPA): 29.02 ± 39.41 min, PRA: 273.6 ± 51.4 s and estimated V˙O2max: 43.26 ± 6.35 mL kg-1 min-1. The stepwise regression analyses indicated that BF% was predictive of PRA time (R2 = 0.32, p < 0.01); estimated V˙O2max predictive of PRA time (R2 = 0.45, p < 0.001). There were significant correlations between BF % and PRA time (r = 0.57, p < 0.001), PA-R and MVPA (r = 0.71, p < 0.001), %BF % and WDST (r = -0.606, p < 0.001), hand grip and FFM (r = 0.602, p < 0.001) and PA-R and PRA time (r = -0.36, p < 0.05). Discussion: The results of this exploratory study highlight that higher estimated V˙O2max and lower BF% were the best predictors for faster PRA completion times, accounting for 45% and 32% of the variance, respectively. The findings of this study support the need for wellness and fitness initiatives in law enforcement agencies focused on increasing cardiovascular fitness and physical activity while decreasing BF% to ensure optimal performance in policing and overall health.

Reliability of a Novel Automated Ultrasound Technology for Body Composition Assessment and Comparisons with Dual Energy X-Ray Absorptiometry.

Body composition tools vary in reliability, portability, and accessibility. The purpose of this study was to evaluate test-retest reliability of MuscleSound® (MS) and dual-energy x-ray absorptiometry (DXA) for both two compartment (region) and three compartment (tissue) models. A secondary aim was to compare body composition values produced by both devices. Fifty participants (n = 25 male, n = 25 female) aged 18-39 years completed two body composition assessments, twice in a single session. Participants arrived at the lab after a 12-hour fast. DXA required participants to lay supine for 10-15 minutes during the scanning process. Thereafter, MS was utilized to measure subcutaneous adipose tissue thickness at seven sites: chest, subscapula, triceps, axilla, suprailium, abdomen, and mid-thigh. MS automatically estimated body composition utilizing a modified Jackson-Pollock equation and the Siri equation within the software. The sequence of assessments was then repeated. Statistical analysis included paired T-tests with Pearson correlations, intraclass correlation coefficients (ICC), and least significant change (LSC). Both methods were strongly reliable (ICCMS = .997, ICCDXA-region = .999, ICCDXA-tissue = .999). MS and DXA-region body fat percentages were significantly different (mean difference (%): 2.60 ± 1.32, p < .001) but highly correlated (r = .928, p < .001). Notably, the mean difference was within DXA-region's calculated least significant change of 3.24%. MS is reliable for assessing body fat percentage in young and middle-aged adults and operators can utilize MS to collect body composition data in the field.

Optimization of Exercise Countermeasures to Spaceflight Using Blood Flow Restriction.

INTRODUCTION: During spaceflight missions, astronauts work in an extreme environment with several hazards to physical health and performance. Exposure to microgravity results in remarkable deconditioning of several physiological systems, leading to impaired physical condition and human performance, posing a major risk to overall mission success and crew safety. Physical exercise is the cornerstone of strategies to mitigate physical deconditioning during spaceflight. Decades of research have enabled development of more optimal exercise strategies and equipment onboard the International Space Station. However, the effects of microgravity cannot be completely ameliorated with current exercise countermeasures. Moreover, future spaceflight missions deeper into space require a new generation of spacecraft, which will place yet more constraints on the use of exercise by limiting the amount, size, and weight of exercise equipment and the time available for exercise. Space agencies are exploring ways to optimize exercise countermeasures for spaceflight, specifically exercise strategies that are more efficient, require less equipment, and are less time-consuming. Blood flow restriction exercise is a low intensity exercise strategy that requires minimal equipment and can elicit positive training benefits across multiple physiological systems. This method of exercise training has potential as a strategy to optimize exercise countermeasures during spaceflight and reconditioning in terrestrial and partial gravity environments. The possible applications of blood flow restriction exercise during spaceflight are discussed herein.Hughes L, Hackney KJ, Patterson SD. Optimization of exercise countermeasures to spaceflight using blood flow restriction. Aerosp Med Hum Perform. 2021; 93(1):32-45.

Barriers and Strategies for Type 1 Diabetes Management Among Emerging Adults: A Qualitative Study.

Purpose: Individuals in the emerging adult age group (18-30 years) with type 1 diabetes (T1DM) have unique medical and social needs. The purpose of this study was to observe barriers and strategies for diabetes management among emerging adults with T1DM. Methods: A qualitative grounded theory model was utilized. An open-ended approach with a telephone interview was designed to allow a deeper understanding of the T1DM experience. The participants were from a larger survey-volunteer participant group and were asked to complete 1 interview in spring 2020 (n = 21, diagnosed age: mean 15.00 ± 8.00, females, n = 19). The data were analyzed for cohesive themes using grounded theory. Results: Participants indicated three main barrier themes (physiology, environment, and insurance) and 3 barrier subthemes (mental health, lack of social support, and weather). Three main strategy themes to diabetes management were recognized (medical technology, access to social support, and physical activity). There were 2 strategy subthemes (social media and social accountability). Conclusions: Regular use of social media can be a key tool for social accountability while lack of social support and physiological shifts can be barriers to management of T1DM. Physical activity should be considered as part of an individualized plan for management of diabetes.

Popliteal Blood Flow With Lower-Extremity Injury Mobility Devices.

Background: Ambulation devices may differ in their utility, muscle activation patterns, and how they affect regional blood flow. This study aimed to evaluate popliteal blood flow and vessel dimensions in response to ambulation with a hands-free crutch (HFC), axillary crutches (AC), a medical kneeling scooter (MKS), and regular walking in healthy adults. Methods: HFC, AC, MKS, and regular walking were completed in a random order by 40 adults aged 18-45 years. Participants ambulated at a comfortable pace for 10 minutes with each device. At baseline and immediately following each trial, a trained operator used diagnostic ultrasonography to capture popliteal vein and artery dimensional and flow characteristics. Results: Significant increases were observed from baseline (0.65 ± 0.23 cm) in venous diameter following walking (0.71 ± 0.21 cm, P = .012) and MKS (0.73 ± 0.21 cm, P = .003). Venous blood flow was also significantly different between conditions (P = .009) but was only greater following walking (124 ± 79 mL/min) compared to MKS (90 ± 64 mL/min, P = .021). No differences were observed in arterial dimensions between ambulation conditions. Significant increases were found in arterial blood flow from baseline (107 ± 69 mL/min) following walking (184 ± 97 mL/min, P < .001) and HFC (163 ± 86 mL/min, P < .001). Arterial blood flow following walking was greater than AC (132 ± 72 mL/min, P = .016) and MKS (128 ± 74 mL/min, P = .003). Conclusion: We found an average decrease in venous time-averaged mean velocity between walking and use of the MKS, but no such decrease with either HFCs or use of ACs in this healthy experimental cohort. Level of Evidence: Level III, diagnostic comparative study.

Energy Expenditure and Substrate Utilization with Hands-Free Crutches Compared to Conventional Lower-Extremity Injury Mobility Devices.

Background: A Hands-Free crutch (HFC) is a relatively new device that can be used during the nonweightbearing period to increase mobility. The primary aim of this investigation was to examine aerobic oxygen consumption (V.o2) and substrate utilization with HFC compared to conventional ambulation devices as well as normal ambulation. A secondary purpose was to quantify perceived exertion, pain, and performance during each ambulation condition. Methods: Forty participants completed 4 separate 10-minute ambulation conditions around a rectangular course. The order of the ambulation conditions was randomized and consisted of (1) walking, (2) medical knee scooter (MKS), (3) HFC, and (4) axillary crutch (AC). Indirect calorimetry was used to determine V.o2 and the respiratory exchange ratio (RER), an indicator of substrate utilization. Perceived exertion and pain were also assessed using questionnaires. Results: All mobility devices significantly elevated V.o2 (+35%) compared to walking (13.14 ± 1.70 mL/kg/min; P < .001). AC had significantly greater V.o2 requirements (20.26 ± 2.62 mL/kg/min) compared to both the MKS (15.28 ± 2.29 mL/kg/min; P < .001) and HFC (15.88 ± 2.03 mL/kg/min; P < .001). There was no difference in average V.o2 between MKS and HFC (P = .368). Compared to walking (0.78 ± 0.43), RER was significantly elevated in MKS (0.81 ± 0.05, P < .001) and AC (0.84 ± 0.06, P < .001), but not in HFC (0.79 ± 0.04, P = .350). RPE and pain were elevated in all ambulatory conditions (all P values <.001). Pain was significantly greater in AC compared with MKS (P < .001) and HFC (P < .001). Conclusion: HFC and MKS share similar V.o2 requirements over a 10-minute ambulation interval and are below those needed in AC. Substrate utilization in HFC was similar to regular walking with a greater reliance on lipid utilization for energy as evidenced by a lower RER. Exertion and pain scores were the most tolerable in HFC and MKS. Level of Evidence: Level II, prospective comparative study.

Handgrip Strength Asymmetry Is Associated With Limitations in Individual Basic Self-Care Tasks.

This investigation sought to determine the associations between handgrip strength (HGS) asymmetries and limitations in individual activities of daily living (ADL). The analytic sample included 18,468 participants from the 2006 to 2016 waves of the Health and Retirement Study. Those with HGS >10% stronger on either hand had any HGS asymmetry. Individuals with HGS >10% stronger on their dominant or non-dominant hand had dominant or non-dominant HGS asymmetry, respectively. ADL abilities were self-reported. Those with any HGS asymmetry had 1.21 (95% confidence interval [CI] = [1.01-1.46]) greater odds for a toileting limitation and 1.25 (CI = [1.03-1.52]) greater odds for a transferring limitation. Individuals with dominant HGS asymmetry had 1.24 (CI = [1.01-1.53]) greater odds for a transferring limitation. Those with non-dominant HGS asymmetry had 1.39 (CI = [1.01-1.93]) and 1.44 (CI = [1.05-1.96]) greater odds for a bathing and toileting limitation, respectively. HGS asymmetries could help to identify future limitations in specific ADLs.

Undiagnosed Dementia Is Associated with Poor Physical Function in Older Adults.

BACKGROUND: Older adults with a cognitive impairment, including those not yet diagnosed, may have deficits in their physical function. OBJECTIVE: We sought to determine the associations of cognitive impairment consistent with dementia (CICD) diagnosis status on handgrip strength, gait speed, and functional disability in older adults. METHODS: The analytical sample included 8,383 adults aged ≥65-years without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010-2016 waves of the Health and Retirement Study. A handgrip dynamometer measured handgrip strength. Men with handgrip strength <26 kg and women <16 kg were weak. Gait speed was timed across a 2.5-m course and those with slowness had gait speed <0.8 m/s. Participants with difficulty or an inability in completing any basic activities of daily living had a functional disability. The adapted Telephone Interview of Cognitive Status evaluated cognitive function. Persons with scores <7 had a CICD. Healthcare provider dementia-related diagnosis was self-reported. Undiagnosed CICD was defined as no reported dementia-related diagnosis but had CICD, while diagnosed CICD was classified as reporting a dementia-related diagnosis. Covariate-adjusted logistic models were used for the analyses. RESULTS: Persons with undiagnosed CICD had 1.37 (95% confidence interval (CI): 1.04-1.80) greater odds for weakness and 2.02 (CI: 1.39-2.94) greater odds for slow gait speed. Older adults with diagnosed CICD had 2.29 (CI: 1.32-3.97) greater odds for slowness and 1.85 (CI: 1.19-2.90) greater odds for functional disability. CONCLUSION: Screening for CICD could be recommended when defects in physical function are observed in older adults.