Implementation of a Mindful Walking Intervention in Breast Cancer Patients After Their Primary Oncologic Treatment: Results of a Qualitative Study Within a Randomized Controlled Trial.

BACKGROUND: Breast cancer survivors often suffer from diagnosis- and therapy-related long-term side effects, such as cancer related fatigue, restricted stress resilience and quality of life. Walking as a physical activity and mindfulness practice have been shown to be helpful in studies. The aim of this study was to compare the individual experiences and subjectively perceived effects of walking in combination with mindfulness practice with moderate walking alone in breast cancer patients. This paper focuses on the qualitative results of a mixed-methods pilot study. METHODS: Breast cancer patients who had finished their primary oncologic treatment at least 6 months ago were randomized to an 8-week group intervention program of either mindful walking or moderate walking. Within the qualitative study part, semi-structured focus group interviews (2 interviews per study arm) were conducted and analyzed using a qualitative content analysis approach. Audio recorded interviews were transcribed verbatim and pseudonymized. The subsequent data analysis was performed by using MAXQDA®. RESULTS: A total of 51 women (mean age 55.8 [SD 10.9] years) were included in the RCT, among these 20 (mean age 56.7 [SD 12.0] years) participated in the focus group interviews (n = 11 patients of the mindful walking group; n = 9 patients of the walking group). Breast cancer patients in both groups described different effects in the complex areas of self-efficacy, coping, body awareness and self-reflection. While mindful walking primarily promoted body awareness and inner strength by mindfulness in breast cancer patients, moderate walking promoted self-efficacy by a confidence of their body and an easily integrated and accepted way of physical activity. CONCLUSIONS: Study interventions and the study setting triggered processes and reflections on one's own health and situation. However, mindful walking and moderate walking seem to address different resources. This important knowledge may help oncologists and other therapists to assess what type of interventions can best meet the needs and requirements of individual patients. TRIAL REGISTRATION: DKRS00011521; prospectively registered 21.12.2016; https://drks.de/search/de/trial/DRKS00011521.

The Effect of Walking Intervention on Cognitive Function Among Patients With Non-Central Nervous System Cancer: A Systematic Review.

BACKGROUND: Cognitive impairment is one of the most frequently reported symptoms in patients with non-central nervous system (non-CNS) cancer. Walking has positive effects on cognitive function. However, the effects of walking interventions on cognitive function outcomes in patients with non-CNS cancer are not well synthesized. OBJECTIVE: The aim of this study was to explore the characteristics of walking intervention and its effects on cognitive function in patients with non-CNS cancer. METHODS: Ten databases were searched to identify eligible randomized controlled trials from each database's inception to June 7, 2021. The Physiotherapy Evidence Database Scale was used to assess the quality of the included studies. RESULTS: Five randomized controlled trials involving 242 adults with non-CNS cancer were included. Two studies involving immediate treadmill walking interventions with moderate intensity at 40% to 60% maximal heart rate reported significantly improved objective cognitive domains of processing speed and spatial working memory with small to moderate effect sizes for cancer survivors. One study delivering home-based, moderate-intensity walking intervention had borderline significantly positive effects on perceived cognitive functioning for patients with non-CNS cancer during chemotherapy. CONCLUSION: Walking intervention with moderate intensity is a beneficial approach to improve objective cognitive domains of processing speed and spatial working memory and perceived cognitive function. IMPLICATIONS FOR PRACTICE: Nurses may provide moderate-intensity walking with 40% to 60% maximal heart rate monitoring to alleviate cognitive problems during the continuous process of cancer care. The modality and dosage of intervention should be adjusted depending on this population's tolerance to better maintain training.

Benefits of nature-based walking for breast cancer survivors.

INTRODUCTION: Physical activity (PA) promotes significant physical and psychosocial benefits for breast cancer survivors. While evidence exists regarding recommendations for the frequency, duration and intensity of exercise that optimise PA benefits for cancer survivors, the role of the environment in achieving optimal outcomes has yet to be determined. This paper presents a protocol for a clinical trial to evaluate the feasibility of a 3-month nature-based walking programme for breast cancer survivors. Secondary outcomes assessed include the impact of the intervention on fitness, quality of life outcomes, and biomarkers of ageing and inflammation. METHODS AND ANALYSIS: The trial is a 12-week single-arm pilot study. Twenty female breast cancer survivors will engage in a supervised moderate intensity walking intervention in small groups in a nature reserve for 50 minutes three times per week. Data will be collected at baseline and end of study, and include assessment of inflammatory cytokines and anti-inflammatory myokines (TNF-α, IL-1ß, IL-6, CRP, TGF-ß, IL-10, IL-13), as well as ageing (DNA methylation, ageing genes) biomarkers; surveys (Patient-Reported Outcomes Measurement Information System-29, Functional Assessment of Cancer Therapy-General, Post-Traumatic Growth Inventory); and fitness assessments (6 min Walk Test, Grip-Strength, One Repetition-Maximum Leg Press). Participants will also complete weekly surveys assessing social support and participate in an exit interview. This is an important first step for future research on the influence of exercise environment on cancer survivor PA outcomes. ETHICS AND DISSEMINATION: This study was approved by the Cedars Sinai Medical Center Institutional Review Board (IIT2020-20). Findings will be disseminated through academic manuscripts, conferences, and community presentations. TRIAL REGISTRATION NUMBER: NCT04896580.

Association of Bilateral Vestibulopathy With and Without Hearing Loss With Cognitive-Motor Interference.

Importance: The past years, evidence suggested that the primary symptoms traditionally associated with bilateral vestibulopathy (BV) do not represent the full picture of this patient population. Recent literature also demonstrated cognitive impairment. However, although multitasking and dual-tasking are widely present in everyday activities, most of these studies assessed cognitive function only in single-task conditions. Objective: To uncover the association of BV with and without hearing loss with cognitive and motor performance and cognitive-motor interference. Design, Setting, and Participants: This prospective case-control study assessed persons with an isolated BV and persons with BV and a concomitant hearing loss compared with a healthy control group. Data were analyzed in December 2022. The study was conducted at Ghent University (Ghent, Belgium). Data collection took place between March 26, 2021, and November 29, 2022. Main Outcomes and Measures: All participants completed the 2BALANCE dual-task protocol, comprising a static and a dynamic motor task that was combined with 5 visual cognitive tasks. These cognitive tasks assessed mental rotation, visuospatial memory, working memory, response inhibition (executive function), and processing speed. All cognitive tasks were performed in a single-task condition (while seated) and in a dual-task condition (combined with a static and a dynamic motor task). The static task comprised balancing on a force platform with foam pad, and the dynamic task comprised walking at a self-selected speed on the GAITRite Walkway. Both motor tasks were performed in the single-task and dual-task condition. Results: Nineteen persons with BV and hearing loss (mean [SD] age, 56.70 [10.12] years; 10 women [52.6%]), 22 persons with an isolated BV (mean [SD] age, 53.66 [13.35] years; 7 women [31.8%]), and 28 healthy control participants were included (mean [SD] age, 53.73 [12.77] years; 12 women [42.9%]). Both patient groups had mental rotation and working memory impairment in a single-task condition and slower processing speed when walking (ie, during the dynamic dual-task condition). Additionally, the patient group with hearing loss had impaired visuospatial memory and executive function deficits in single-task and dual-task conditions, while this could only be elicited when performing a motor task in persons with isolated BV (ie, when dual-tasking). Conclusion and Relevance: The findings of this case-control study suggest an association between vestibular function and cognitive and motor performance, even greater in persons with a concomitant hearing loss than in persons with an isolated BV.

Effectiveness and Ethics of Incentives for Research Participation: 2 Randomized Clinical Trials.

Importance: Incentivizing research participation is controversial and variably regulated because of uncertainty regarding whether financial incentives serve as undue inducements by diminishing peoples' sensitivity to research risks or unjust inducements by preferentially increasing enrollment among underserved individuals. Objective: To determine whether incentives improve enrollment in real randomized clinical trials (RCTs) or serve as undue or unjust inducements. Design, Setting, and Participants: Two RCTs of incentives that were embedded in 2 parent RCTs, 1 comparing smoking cessation interventions (conducted at smoking cessation clinics in 2 health systems) and 1 evaluating an ambulation intervention (conducted across wards of the Hospital of the University of Pennsylvania) included all persons eligible for the parent trials who did not have prior knowledge of the incentives trials. Recruitment occurred from September 2017 to August 2019 for the smoking trial and January 2018 through May 2019 for the ambulation trial; data were analyzed from January 2020 to July 2020. Interventions: Patients were randomly assigned to incentives of $0, $200, or $500 for participating in the smoking cessation trial and $0, $100, or $300 for the ambulation trial. Main Outcomes and Measures: The primary outcome of each incentive trial was the proportion of people assigned to each recruitment strategy that consented to participate. Each trial was powered to test the hypotheses that incentives served neither as undue inducements (based on the interaction between incentive size and perceived research risk, as measured using a 10-point scale, on the primary outcome), nor unjust inducements (based on the interaction between incentive size and participants' self-reported income). Noninferiority methods were used to test whether the data were compatible with these 2 effects of incentives and superiority methods to compare the primary and other secondary outcomes. Results: There were a total of 654 participants (327 women [50.0%]; mean [SD] age, 50.6 [12.1] years; 394 Black/African American [60.2%], 214 White [32.7%], and 24 multiracial individuals [3.7%]) in the smoking trial, and 642 participants (364 women [56.7%]; mean [SD] age, 46.7 [15.6] years; 224 Black/African American [34.9%], 335 White [52.2%], and 5 multiracial individuals [0.8%]) in the ambulation trial. Incentives significantly increased consent rates among those in the smoking trial in 47 of 216 (21.8%), 78 of 217 (35.9%), and 104 of 221 (47.1%) in the $0, $200, and $500 groups, respectively (adjusted odds ratio [aOR] for each increase in incentive, 1.70; 95% CI, 1.34-2.17; P < .001). Incentives did not increase consent among those in the ambulation trial: 98 of 216 (45.4%), 102 of 212 (48.1%), and 92 of 214 (43.0%) in the $0, $100, and $300 groups, respectively (aOR, 0.88; 95% CI, 0.64-1.22; P = .45). In neither trial was there evidence of undue or unjust inducement (upper confidence limits of ORs for undue inducement, 1.15 and 0.99; P < .001 showing noninferiority; upper confidence limits of ORs for unjust inducement, 1.21 and 1.26; P = .01 and P < .001, respectively). There were no significant effects of incentive size on the secondary outcomes in either trial, including time spent reviewing the risk sections of consent forms, perceived research risks, trial understanding, perceived coercion, or therapeutic misconceptions. Conclusions and Relevance: In these 2 randomized clinical trials, financial incentives increased trial enrollment in 1 of 2 trials and did not produce undue or unjust inducement or other unintended consequences in either trial. Trial Registration: ClinicalTrials.gov Identifier: NCT02697799.

Early Pain Catastrophizing Exacerbates Impaired Limb Loading and 6-Minute Walk Test Distance 12 Months After Lower Extremity Fracture.

OBJECTIVE: Disability is common after lower extremity fracture (LEF). Although psychosocial factors have been associated with patient-reported outcomes after LEF, they have not been associated with objective measures of function. Aberrant gait patterns are important markers of function, but are poorly defined after LEF. The primary purpose of this study was to explore whether pain catastrophizing and fear of movement 6 weeks after surgery were associated with injured limb loading outcomes and 6-minute walk test (6MWT) distance 12 months after femur or tibia fracture. The secondary purpose was to determine if limb loading characteristics differed between injured and uninjured limbs. METHODS: At 6 weeks after LEF, patients completed validated measures of pain catastrophizing, fear of movement, and depression. At 12 months, patients completed a 6MWT while wearing instrumented insoles that recorded the limb loading outcomes of stance time, impulse, and loading rate. Bivariate correlations assessed how patient and psychosocial characteristics at 6 weeks were associated with injured limb loading outcomes and 6MWT distance. Multivariable regression analyses were performed to determine if psychosocial variables were associated with each outcome after controlling for depression and patient demographic and clinical characteristics. Finally, paired t tests compared limb loading outcomes between limbs. RESULTS: Forty-seven participants completed the 6MWT at 12 months (65%), and 38 completed the 6MWT with the instrumented insoles. Fear of movement carried a poor relationship (r = 0.11-0.32) and pain catastrophizing a moderate relationship (r = 0.46-0.54) with 12-month outcomes. The regression results indicated that pain catastrophizing continued to be associated with all outcomes. Finally, the injured limb had significantly lower limb loading outcomes than the uninjured limb at 12 months (Cohen d = 0.54-0.69). CONCLUSION: Pain catastrophizing early after LEF was associated with impaired limb loading and 6MWT distance at 12 months. IMPACT: Impaired limb loading persists 12 months after LEF. Further research is needed to determine whether rehabilitative efforts focused on pain catastrophizing can restore limb loading after LEF.

Functional Ability Classification Based on Moderate and Severe Kinesophobia and Demoralization Scores in Degenerative Spine Patients.

STUDY DESIGN: A prospective cohort study. OBJECTIVE: To assess the relationship of fear avoidance and demoralization on gait and balance and determine a threshold score for the Tampa Scale for Kinesophobia (TSK) and the Demoralization Scale (DS) that identifies spine patients with gait and balance dysfunction amplified by underlying psychological factors. SUMMARY OF BACKGROUND DATA: Fear avoidance and demoralization are crucial components of mental health that impact the outcomes in spine surgery. However, interpreting their effect on patient function remains challenging. Further establishing this correlation and identifying a threshold of severity can aid in identifying patients in whom a portion of their altered gait and balance may be amplified by underlying psychologic distress. METHODS: Four hundred five symptomatic spine patients were given the TSK and DS questionnaires. Patient's gait and balance were tested with a human motion capture system. A TSK score of 41 and a DS score of 30 were chosen as thresholds to classify moderate versus severe dysfunction based on literature and statistical analysis. RESULTS: Higher TSK and DS scores were correlated with worse walking speed (P < 0.001), longer stride time (P = 0.001), decreased stride length (P < 0.048), and wider step width (<0.001) during gait as well as increased sway across planes (P = 0.001) during standing balance. When classified by TSK scores >41, patients with more severe fear avoidance had slower walking speed (P < 0.001), longer stride time (P = 0.001), shorter stride length (P = 0.004), increased step width (P < 0.001), and increased sway (P = 0.001) compared with their lower scoring counterparts. Similarly, patients with DS > 30 had slower walking speed (P = 0.012), longer stride time (P = 0.022), and increased sway (P = 0.003) compared with their lower scoring counterparts. CONCLUSION: This study demonstrates that fear avoidance and demoralization directly correlate with worsening gait and balance. Furthermore, patients with TSK > 41 and DS > 30 have more underlying psychological factors that contribute to significantly worse function compared with lower scoring peers. Understanding this relationship and using these guidelines can help identify and treat patients whose gait dysfunction may be amplified by psychologic distress.Level of Evidence: 3.

Associations of park access, park use and physical activity in parks with wellbeing in an Asian urban environment: a cross-sectional study.

BACKGROUND: Relationships between park access, park use, and wellbeing remain poorly understood. The objectives of this study were to investigate: (1) perceived and objective park access in relation to park use and physical activity in parks; and; (2) perceived and objective park access, park use and physical activity in parks and their associations with wellbeing. METHODS: An interviewer-assisted survey collected data on perceived time to walk to parks, park use time, park physical activity time and wellbeing (using a scale containing nine domains) amongst adult participants of the Singapore Multi-Ethnic Cohort. Geospatial maps of parks and the "walkable" street networks were created for the city-state of Singapore to objectively determine distances to accessible points on park boundaries. Multiple linear regression models estimated the importance of park access to park use and associations of park access and park use with wellbeing, adjusting for potential confounders. RESULTS: Participants' (n = 3435) average age was 48.8 years (SD, 12.8), 44.8% were male and 72.6% were of Chinese ethnicity. Better perceived but not true park access was significantly associated with greater park use. Park access (perceived or true) was not associated with physical activity time in parks. Greater participant park time and physical activity time in parks were associated with higher wellbeing scores (p < 0.001). The differences in wellbeing scores between the reference groups, who spent negligible time in parks, and the highest quartiles of time in parks (10.8 h/month) and physical activity in parks (8.3 h/month) were 3.2 (95% CI 2.1-4.4) and 4.2 (95% CI 4.1-6.3) points out of 100 respectively. These associations were similar for most domains of wellbeing, with clear dose-response relationships. CONCLUSIONS: While perceived park access was strongly associated with park use and well-being, true park access was not, and neither park access measure was associated with park physical activity. Future studies could investigate the influence of park attributes on park use, physical activity in parks and wellbeing. The consistent associations of park use and particularly physical activity in parks with wellbeing suggest that promoting park use, and especially physical activity in parks, is a promising strategy for improving wellbeing in urban settings.

A influência da prática de atividade física no estado de humor de mulheres adultas / The influence of physical activity on the mood of adult women

O objetivo do presente estudo foi comparar os níveis de estado de humor de mulheres adultas praticantes de atividade física regular com os de mulheres adultas sedentárias. Participaram do estudo 57 mulheres (53,36 ± 10,68 anos de idade), divididas em dois grupos: ativas e sedentárias. Utilizou-se um questionário para caracterização da amostra e a Escala de Humor de Brunel (BRUMS). Os resultados do presente estudo demonstraram que as mulheres ativas apresentaram estado de humor positivo, além de apresentaram baixos escores para o estado de humor negativo, quando comparadas aos escores das mulheres sedentárias. Pode-se concluir que a atividade física pode influenciar positivamente o estado de humor.

The aim of this study was to compare mood levels of adult women engaged in regular physical activity with those of sedentary adult women. Fifty-seven women participated in the study (53.36 ± 10.68 years' old), divided into two groups: active and sedentary. A questionnaire was used to characterize the sample, and the Brunel Mood Scale (BRUMS) was also applied. The results demonstrated that active women had a positive mood state in addition to having low scores for negative mood state when compared to the scores of sedentary women. It can be concluded that physical activity can have a positive influence on mood state.

Church Attendance and Mobility Limitation Among Black and White Men With Prostate Cancer.

Prostate cancer is a significant impediment that can reduce physical functional status. Mobility is fundamental for quality of life and church attendance to be associated with improved physical functioning. Few studies have examined how religious participation have implications for mobility limitation among men in general and among prostate cancer survivors in particular. The purpose of this study was to assess the association between church attendance and mobility limitation among Black and White prostate cancer patients and survivors. Data for this investigation were drawn from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes Study that consisted of 804 Black and White men with complete information on the primary outcome and predictor variables. Mobility limitation was the primary outcome variable, and church attendance was the main independent variable. The analytic sample was almost equally divided between Black (N = 382) and White men (N = 422). The proportion of Black men reporting mobility limitation (30.09%) more than doubled the corresponding percentage for White men (14.7%). Black men had a higher proportion of individuals who reported weekly church attendance (49.2% vs. 45.0%). Fully adjusted modified Poisson regression models produced results indicating that respondents attending church weekly had a lower mobility limitation prevalence (PR = 0.56, 95% CI [0.39, 0.81]) than those never attending church. Results from this study contribute to the body of evidence asserting the health benefits of church attendance. These findings suggest that health providers should consider how religion and spirituality can present opportunities for improved outcomes in prostate cancer patients and survivors.

Associations between smoking and walking, fatigue, depression, and health-related quality of life in persons with multiple sclerosis.

Smoking is associated with increased multiple sclerosis (MS) risk. In addition, some studies have reported that smoking is associated with anxiety and depression. However, the associations between smoking, walking, and fatigue are needed to be investigated. The objective was to investigate the associations between cigarette smoking and walking, fatigue, depression symptom severity, and health-related quality of life in persons with MS. Two hundred seventy-nine persons with MS were evaluated in this cross-sectional study. Study outcomes were neurological disability level, walking speed, walking endurance, perceived walking impact of MS, fatigue, depression symptom severity, and health-related quality of life. There were 95 (34.1%) current smokers who had significantly higher fatigue (p = 0.003, pη2 = 0.031) and depression (p = 0.044, pη2 = 0.015), and lower health-related quality of life (p = 0.003, pη2 = 0.031) after adjusting for age, gender, neurological disability level, and disease duration compared to non-smokers (n = 184). There was no significant difference between smokers and non-smokers in walking measures (p > 0.05). Smoking intensity was significantly correlated with age (r = 0.487), neurological disability level (r = 0.227), disease duration (r = 0.30), walking speed (r = 0.574), walking endurance (r = - 0.461), perceived walking impact of MS (r = 0.684), fatigue (r = 0.370), health-related quality of life (r = - 0.259), and depression (r = 0.269) in current smokers. Cigarette smokers with MS had significantly more fatigue and depression symptom severity and less health-related quality of life compared to non-smokers. Increased pack-years of cigarette smoking was associated with worse walking ability and health-related quality of life, and greater depression symptom severity and fatigue.

Continuous walking and time- and intensity-matched interval walking: Cardiometabolic demand and post-exercise enjoyment in insufficiently active, healthy adults.

We compared cardiometabolic demand and post-exercise enjoyment between continuous walking (CW) and time- and intensity-matched interval walking (IW) in insufficiently active adults. Sixteen individuals (13 females and three males, age 25.3 ± 11.1 years) completed one CW and one IW session lasting 30 min in a randomised-counterbalanced design. For CW, participants walked at a mean intensity of 65-70% predicted maximum heart rate (HRmax). For IW, participants alternated between 3 min at 80% HRmax and 2 min at 50% HRmax. Expired gas was measured throughout each protocol. Participants rated post-exercise enjoyment following each protocol. Mean HR and V˙O2 showed small positive differences in IW vs. CW (2, 95%CL 0, 4 beat.min-1; d = 0.23, 95%CL 0.06, 0.41 and 1.4, 95%CL 1.2 ml.kg-1.min-1, d = 0.36, 95%CL 0.05, 0.65, respectively). There was a medium positive difference in overall kcal expenditure in IW vs. CW (25, 95%CL 7 kcal, d = 0.58, 95%CL 0.33, 0.82). Post-exercise enjoyment was moderately greater following IW vs. CW (9.1, 95%CL 1.4, 16.8 AU, d = 0.62, 95%CL 0.06, 0.90), with 75% of participants reporting IW as more enjoyable. Interval walking elicits meaningfully greater energy expenditure and is more enjoyable than CW in insufficiently active, healthy adults.

Is the perceived neighborhood built environment associated with domain-specific physical activity in Latin American adults? An eight-country observational study.

BACKGROUND: Characteristics of the neighborhood built environment are associated with physical activity (PA). However, few studies with representative samples have examined environmental correlates of domain-specific PA in Latin America. We examined the associations of the perceived neighborhood built environment with domain-specific PA in a large sample of adults from eight Latin American countries. METHODS: This study examined data from 8185 adults (aged 18-65 years) from eight Latin American countries. The Neighbourhood Environment Walkability Survey - Abbreviated (NEWS-A) scale was used to assess perceptions of land use mix-diversity, land use mix-access, street connectivity, walking/cycling facilities, aesthetics, safety from traffic, and safety from crime. Perceived proximity from home to public open spaces (metropolitan parks, playgrounds, public squares) and to shopping centers was also measured. Transport-related and leisure-time PA were assessed using the long form of the International Physical Activity Questionnaire. Both logistic and linear regression models were estimated on pooled data. RESULTS: Perceptions of higher land use mix-access (OR: 1.40; 95% CI: 1.22,1.61), the existence of many alternative routes in the neighbourhood (1.12; 1.04,1.20), slow speed of traffic (1.19; 1.03,1.35) and few drivers exceeding the speed limits (1.09; 1.03,1.15) were associated with greater odds of reporting at least 10 min/week of transport-related PA. Perceptions of higher levels of land use mix-diversity, better aesthetics and greater safety from crime, the presence of crosswalks and pedestrian signals, and greater proximity of shopping centers were associated with more min/week of transport-related PA. Perceptions of higher land use mix-diversity (1.12; 1.05,1.20), higher land use mix-access (1.27; 1.13,1.43), more walking/cycling facilities (1.18; 1.09,1.28), and better aesthetics (1.10; 1.02,1.18) were associated with greater odds of engaging in at least 10 min/week of leisure-time PA versus none. Perceptions of higher land use mix-diversity were associated with more min/week of leisure PA. CONCLUSIONS: Different perceived neighborhood built environment characteristics were associated with domain-specific PA among adults from Latin America countries. Interventions designed to modify perceptions of the neighbourhood built environment might influence initiation or maintenance of domain-specific PA. TRIAL REGISTRATION: ClinicalTrials. Gov NCT02226627 . Retrospectively registered on August 27, 2014.

Exercise Types and the Risk of Developing Cognitive Decline in Older Women: A Prospective Study.

BACKGROUND: Participation in exercise may be useful for dementia prevention; however, the specific exercise types which may best to reduce the risk of developing cognitive decline have remained unidentified in the literature. OBJECTIVE: To examine the relationships of specific exercise types with the risk of developing cognitive decline in older women. METHODS: This 1- to 2-year population-based cohort study included 687 community-dwelling older Japanese women without disability, neurological disease, dementia, or cognitive impairment assessed as <24 points on the Mini-Mental State Examination (MMSE) at the baseline survey. Developing cognitive decline was defined as a decrease of ≥3 points in the participant's MMSE score during the follow-up. We classified individuals into participation (≥3 months) and non-participation (<3 months) groups for 17 different exercise types. Log-binominal regression analyses were applied to compare risk ratios and confidence intervals of developing cognitive decline between the two groups. RESULTS: Thirty-nine participants (5.7%) developed cognitive decline during the follow-up period. After adjusting for confounders (age, MMSE score, depressive symptoms, body mass index, heart disease, hypertension, diabetes, smoking, low educational level, and the follow-up period in the baseline survey), those who participated in calisthenics demonstrated a significantly lower risk of developing cognitive decline than those who did not participate in calisthenics. No significant relationships between other exercise types and the risk of developing cognitive decline were found. CONCLUSION: Participation in calisthenics significantly reduced the risk of cognitive decline in community-dwelling older Japanese women, indicating that calisthenics may be a useful type of exercise for promoting dementia prevention.

Factors associated with mobility apprehension in persons with lower limb amputation.

BACKGROUND: Factors that are related to mobility apprehension were measured in a sample of persons with lower-limb amputation. OBJECTIVES: The purpose was to determine whether intensity, interference, or catastrophizing are associated with mobility apprehension. STUDY DESIGN: Cross-sectional study. METHODS: Persons with amputation of a lower limb who were attending a national limb loss conference were recruited to complete a survey. Subjects were administered the Tampa Scale for Kinesiophobia to measure mobility apprehension. The Brief Pain Inventory was administered to quantify the affect of pain on general activity, walking ability, and enjoyment of life. The Pain Catastrophizing Scale was administered to assess the tendency to ruminate and magnify pain sensations. A multivariable linear regression was performed to determine factors associated with mobility apprehension. RESULTS: Fifty-three people with lower-limb amputation participated in the study. The mean (standard deviation) score for mobility apprehension was 34.2 (6.0). Mean (standard deviation) pain intensity and interference scores were 1.6 (1.7) and 2.5 (2.6), respectively. The mean (standard deviation) pain catastrophizing score was 9.1 (10). Pain catastrophizing was the only variable associated with higher mobility apprehension (ß = 0.31, p < 0.001, R2 = 0.32). Results suggest that for every one-point increase in the pain catastrophizing score, mobility apprehension will increase by 0.3 of a point. CONCLUSION: These preliminary results suggest that pain catastrophizing was related to mobility apprehension in this cohort of persons with lower-limb amputation. This relationship indicates that the exploration of avoidance behaviors, such as pain catastrophizing, may be useful when developing a program for physical rehabilitation. CLINICAL RELEVANCE: Pain catastrophizing, an avoidance behavior, may be associated with higher levels of mobility apprehension in persons with major lower-limb amputation. Understanding the impact of fear-avoidance behavior will allow clinicians to identify individuals at risk for poor outcomes following amputation surgery and to develop psychological strategies to complement treatment.

Race differences in mobility status among prostate cancer survivors: The role of socioeconomic status.

The objective of this paper was to determine whether there were any race differences in mobility limitation among PCa survivors, and understand the impact of socioeconomic status (SES) on this relationship. Data consisted of 661 PCa survivors (296 Black and 365 White) from the Diagnosis and Decisions in Prostate Cancer Treatment Outcomes (DAD) Study. Mobility limitation was defined as PCa survivors who reported difficulty walking a quarter mile or up 1 flight of stairs. Race was based on the PCa survivors self-identification of either White or Black. SES consisted of education level (i.e., less than high school, high school/GED, some college/associate, bachelors, masters/PhD) and annual household income (i.e., less than $50,000; $50,000-$100,000; greater than $100,000). Adjusting for age, marital status, health insurance, Gleason Score, treatment received, and time to treatment, Black PCa survivors had a higher prevalence of mobility limitation (PR=1.58, 95% CI: 1.17-2.15) relative to White PCa survivors. When adding education and income to the adjusted model, Black PCa survivors had a similar prevalence of mobility limitation (PR=1.12, 95% CI: 0.80-1.56) as White PCa survivors. The unequal distribution of SES resources between Black and White PCa survivors accounted for the observed race differences in mobility limitation. This work emphasizes the importance of SES in understanding race differences in mobility among PCa survivors.

Exercise experiences in patients with metastatic lung cancer: A qualitative approach.

BACKGROUND: Patients with metastatic lung cancer can have severe cancer-related symptoms and treatment-induced side effects. Exercise is beneficial for patients with metastatic lung cancer; however, little information is available on guiding patients how to perform exercise during hospitalization. The purpose of this qualitative study was to understand exercise experiences in patients with metastatic lung cancer. METHODS: Patients with metastatic lung cancer (n = 24) participated in face-to-face in-depth interviews at an inpatient ward of a medical center in central Taiwan. Interview transcripts were evaluated using narrative analysis to extract and validate themes. RESULTS: Three primary themes were identified: (1) modifying exercise to maximize physical functions; (2) living with symptoms and frustration, but still exercising; and (3) doing exercise to sustain hopes, inner power, and life. Secondary findings included: (1) adopting walking as their main form of exercise because of its convenience; and (2) among patients with severe symptoms, adjusting exercise towards shorter time durations and shorter distances, slower speeds, and higher frequencies. CONCLUSIONS: The study found physically active lung cancer patients, although with metastatic condition, adjusted their exercise activities to balance disease and treatment-induced deteriorations and boost themselves to feel hope and fight for cancer. However, the results may not be applicable to physically inactive patients. Future research to explore experiences from those with even worse physical conditions and further helping them to take some mild exercise to enhance the positive side of cancer experiences are suggested.

Association between trail use and self-rated wellness and health.

BACKGROUND: Incorporating trail use into daily activity routines could be an important venue to increase a population's physical activity. This study presents important health impacts of trail use. METHODS: A cross-sectional study was conducted on 8 trails throughout the State of Indiana. A mix of urban, suburban, and rural trails were selected. Recruitment sessions were completed during four 1-week periods throughout the study in various locations and at various times of day on each trail between April and October 2017. Data were collected through online and paper surveys. For each type of physical activity, a generalized additive model for self-rated wellness and health was built adjusting for demographics, socioeconomic status, amounts of physical activity on trails, mood status, sleep pattern, diet and smoking habit. The plots of estimated smoothing spline function with 95% confidence band were pictured. All statistical analyses were conducted using R. RESULTS: The final sample size included 1299 trail users; 92% were White, 79% aged 18-65 years, 71% were married and 56% were male. Biking, walking and running were the main activities with 52, 29 and 19%, respectively. Female to male ratio was 3:2 in walkers vs. 2:3 in runners and bikers. Runners were significantly younger than the other two groups. Runners also had the highest percentage of college graduates and above, the highest rate of employment, the highest income, and the lowest percentage of being retired among the three groups. They more commonly used the trails alone than the walkers and bikers. Bikers had the highest rate of job satisfaction. They also showed a better mean score of mood than that the walkers and runners. There was a linear association between walking and self-rated wellness and health, and a curved association between running/biking and self-rated wellness and health. Running < 6.5 miles/week and biking > 14 miles/week were associated with steeper rise in self-rated wellness and health. CONCLUSIONS: Employed educated married middle-aged people had the highest prevalence of walking, running or biking. The higher the walking, the higher self-rated wellness and health. A similar association was observed for running up to 6.5 miles/week or biking > 14 miles/week.

Impact of slope on dynamics of running and climbing.

By combining biological studies and modeling work, the dynamics of running on horizontal terrain and climbing pure vertical surfaces have been distilled down to simple reduced order models. These models have inspired distinct control and design considerations for robots operating in each terrain. However, while the extremes are understood, the intermediate regions of moderate slopes have yet to be fully explored. In this paper, we examine how cockroaches vary their behavior as slope is changed from horizontal to vertical, with special care to examine individual leg forces when possible. The results are then compared with a lateral leg spring based (LLS, horizontal running) and Full-Goldman based (FG, vertical running) models. Overall, from the experimental data, there appears to be a continuous shift in the dynamics as slope varies, which is confirmed by similar behaviors exhibited by the LLS and FG models. Finally, by examining the stability and efficiency of the models, it is shown that there are stability limits related to the amount of energy added by the front versus rear legs. This corresponds to the shift in leg usage demonstrated by the biological experiments and may have significant implications for the design and control of multi-modal robotic systems.

Predicting Engagement With Online Walking Promotion Among Metropolitan and Rural Cancer Survivors.

BACKGROUND: Physical activity has numerous associated benefits for cancer survivors. Compared with their urban counterparts, rural Australians experience a health disadvantage, including poorer survival rate after diagnosis of cancer. OBJECTIVE: The aims of this study were to test the effectiveness of an online 12-week walking intervention designed for cancer survivors and explore region-specific psychological predictors of behavior change. METHODS: This was a quasi-randomized controlled trial of an online resource designed according to Social Cognitive Theory and Self-determination Theory, based on individualized goal setting. Measures of habitual walking, motivation, and self-efficacy were taken at baseline, postintervention, and 3-month follow-up in an intervention group (n = 46) and active control group (n = 45). The control group was provided a pedometer but did not have access to the online program. RESULTS: An increase in steps/day at 12 weeks was observed in both groups, with a larger increase in the intervention group; these increases were not sustained at the 3-month follow-up. Psychological predictors of maintained change in steps per day (motivation, barrier self-efficacy, and relapse self-efficacy) did not differ between metropolitan and rural participants. Changes in steps per day among intervention participants were predicted by changes in relapse self-efficacy and barrier self-efficacy. CONCLUSIONS: The intervention was successful in increasing physical activity postintervention; however, changes were not maintained at follow-up. There were no region-specific predictors of engagement in the intervention. IMPLICATIONS FOR PRACTICE: Nurses are seamlessly positioned to promote health interventions like walking. Nurses should reframe physical activity with patients so that relapse is seen as common and possibly inevitable when adopting a regular physical activity habit.