Effects of 12 weeks of neuromuscular electrical stimulation of the quadriceps muscles on the function and physio-biochemical traits in functionally fit female nursing-home residents aged 75 + years: a pilot study.

PURPOSE: Muscular changes induced by neuromuscular electrical stimulation (NMES) are well recognized, but knowledge of how NMES influences the physio-biochemical traits of the oldest old is still limited. This study investigated the effect of NMES applied for 12 weeks to the quadriceps muscles of female nursing-home residents aged 75 + on their functional capability and inflammatory, bone metabolism, and cardiovascular traits. METHODS: Nineteen women regularly taking part in two body conditioning sessions per week were randomized into an electrical stimulation group (ES; n = 10; 30 min sessions, 3 times per week) or a control group (CON; n = 9). At baseline and study week 12, all women performed the 30 s chair stand test (30sCST), the 6-minute walk test (6MWT), and the instrumented timed up and go test (iTUG). Resting heart rates, blood pressure, and the blood concentrations of inflammatory and bone metabolism markers were also measured twice. RESULTS: NMES increased the strength of participants' quadriceps muscles and their performance on the 30sCST and 6MWT while lowering resting arterial blood pressure and inflammatory marker levels; osteoclast activity showed a tendency to decrease. Changes in the iTUG results were not observed. A multiple regression analysis found that the results of functional tests in the ES group were best correlated with pulse pressure (the 30sCST and iTUG tests) and diastolic blood pressure (the 6MWT test). CONCLUSION: Twelve weeks of NMES treatment improved participants' functional capacity and inflammatory, bone metabolism, and cardiovascular traits. The ES group participants' performance on functional tests was best predicted by hemodynamic parameters.

Comparison of selected prooxidant-antioxidant balance and bone metabolism indicators and BDNF levels between older women with different levels of physical activity.

BACKGROUND: Given a lack of studies precisely indicating how many steps elderly people should take daily for their antioxidant defence, bone metabolism, and cognitive abilities to improve, our study set out to compare the selected antioxidant, prooxidant, bone turnover, and BDNF indicators between elderly women differing in physical activity (PA) measured by the daily number of steps. METHODS: The PA levels of 62 women aged 72.1 ± 5.4 years were assessed based on their daily number of steps and then were used to allocate the participants to three groups: group I (n = 18; <5,000 steps a day); group II (n = 22; from 5,000 to 9,999 steps a day); and group III (n = 22; ≥10,000 steps a day). Blood samples were collected from the participants in early morning hours and subjected to biochemical analysis for prooxidant-antioxidant balance indicators (SOD, CAT, GPx, GR, GSH, UA, MDA and TOS/TOC), bone metabolism indicators (Ca, 25-OH vitamin D, osteocalcin, CTX-I, and PTH), and BDNF levels. RESULTS: The groups were not statistically significantly different in the activity of SOD, CAT, GPx, and GR, but their concentrations of GSH (H = 22.10, p < 0.001) and UA (H = 12.20, p = 0.002) proved to be significantly associated with the groups' daily PA. The between-group differences in the concentrations of MDA and TOS/TOC were not significant, with both these indicators tending to take higher values in group I than in groups II and III. Significant differences between the groups were established for the concentrations of 25-OH vitamin D (H = 24.21, p < 0.001), osteocalcin (H = 7.88, p = 0.019), CTX-I (H = 12.91, p = 0.002), and BDNF (H = 14.47, p = 0.001), but not for Ca and PTH. CONCLUSIONS: Significantly higher concentrations of GSH, slightly lower oxidative stress indicators, significantly higher BDNF levels, and moderately better bone turnover indicators and resorption markers in the group taking more than 5,000 steps a day suggest that this level of PA can promote successful aging. More research is, however, needed to confirm this finding.

Electrical Stimulation in the Treatment of Pressure Injuries: A Systematic Review of Clinical Trials.

GENERAL PURPOSE: To provide information on evidence-based practice regarding the use of electrical stimulation for pressure injury management. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Apply clinical practice recommendations related to the use of electrical stimulation in the treatment of pressure injuries.2. Identify issues related to the use of electrical stimulation to treat pressure injuries.

To summarize evidence regarding the use of electrical stimulation for pressure injury (PI) management with a systematic review of randomized clinical trials. The authors searched scientific databases (PubMed, EBSCO, Medline, and Elsevier) and the online resources of gray publications for studies published between January 1, 1980, and June 20, 2021, using the keywords "electrostimulation," "electrical stimulation," "pressure ulcer," "pressure injury," "bedsore," and "decubitus ulcer." The search procedure generated 342 articles. Of these, 241 were disqualified after title screening, 52 after abstract screening, and 33 after full-text review; 16 articles were included in the review. Included articles were full-text reports of randomized clinical trials involving patients with PIs that had at least two patient groups, detailed how wounds healed, and were written in English. The authors extracted information about the purpose and design of each trial, patient inclusion and exclusion criteria, research methods, statistical analysis, findings, and conclusions. Researchers applied high-voltage monophasic pulsed current (HVMPC) in 10 trials, two trials used low-voltage monophasic pulsed current, three trials tested a low-voltage biphasic pulsed current, and one trial used low-intensity direct current. The effect of HVMPC in the treatment of PIs has been most thoroughly investigated in clinical trials. The results are consistent and indicate that HVMPC (twin-peak impulse, 50­154 µs, 100 pps, 45­60 min/d) is effective in PI treatment.

Does physical activity lower the risk for metabolic syndrome: a longitudinal study of physically active older women.

BACKGROUND: The associations between physical activity and metabolic syndrome (MetS) have been mainly found in cross-sectional studies. The aim of this longitudinal study was to examine the relationship between meeting step-based guidelines and changes in the risk of metabolic syndrome. METHODS: This study included data from older women (baseline age 62.9 ± 4.3 years) from a 7-year longitudinal study in Central Europe. At baseline and follow-up, physical activity was measured by an accelerometer, and the risk for MetS was assessed according to the NCEP-ATP III criteria. In 59 women, multivariate repeated measures ANOVA was used to compare differences in changes in the risk of MetS in groups based on meeting step-based guidelines (10,000 steps/day and 9000 steps/day for women aged <65 and ≥ 65 years, respectively). RESULTS: Over 7 years, steps/day increased from 10,944 ± 3560 to 11,652 ± 4865, and the risk of MetS decreased from 41 to 12% in our sample. Women who longitudinally met step-based guidelines had a significantly higher mean concentration of high-density cholesterol (HDL-C) (64.5 and 80.3 mg/dL at baseline and follow-up, respectively) and a lower concentration of triglycerides (TGs) (158.3 and 123.8 mg/dL at baseline and follow-up, respectively) at follow-up compared to baseline. Moreover, women who increased their daily steps over 7 years to the recommended steps/day value significantly decreased the concentration of TGs (158.3 mg/dL and 123.8 mg/dL at baseline and follow-up, respectively). CONCLUSIONS: Our study might suggest that the long-term meeting of step-based guidelines or an increase in daily steps/day to achieve the recommended value could be related to a lower risk of MetS, specifically in concentrations of HDL-C and TG. These findings may help in designing interventions aiming to decrease the risk of MetS in older women.

Aging effect on the instrumented Timed-Up-and-Go test variables in nursing home women aged 80-93 years.

Although the total "Timed-Up-and Go" test (TUG) performance time can characterize an age-related decline of general mobility, this result alone doesn't give any detailed information about the test subtasks. The primary objective of the study was to identify in nursing home women a variable extracted from instrumented TUG (iTUG) that is the best predictor of age. The secondary objective was to assess whether this variable is associated with the results of the isometric knee extension peak torque (IKEPT); lower limb strength measured by the 30-s chair stand test (30sCST), and walking capacity measured by the 6-min walk test (6MWT). Twenty-six women (mean ± SD: age-85.8 ± 3.6 years; body weight-59.4 ± 12.3 kg; body height-151.0 ± 7.3 cm; BMI-26.0 ± 4.9 kg/m2) performed iTUG (while wearing a body-fixed inertial sensor) and functional tests. Total iTUG performance time significantly correlated with age (r = 0.484; p < 0.05), 30sCST (r = -0.593; p < 0.01), and 6MWT (r = -0.747; p < 0.001) but not with absolute nor relative IKEPT (p > 0.05). Additionally, the subjects' age correlated with 30sCST (r = -0.422; p < 0.05), 6MWT (r = -0.482; p < 0.05), IKEPT (r = -0.392; p < 0.05) and IKEPT/FFM (r = -0.407; p < 0.05). Five out of 16 analyzed iTUG variables were significantly related to age, and multiple regression analysis showed the best correlation with the sit-to-stand vertical acceleration range (STSVAR) (r2 = 0.430; SEE = 3.041; ß = -0.544 ± 0.245; B = -1.204 ± 0.543; p < 0.05). Moreover, STSVAR was significantly associated with %Fat (r = 0.415; p < 0.05), 30sCST (r = 0.519; p < 0.01), 6MWT (r = 0.585; p < 0.01) but not with absolute nor relative IKEPT (p > 0.05). The obtained results suggest that in the oldest old group of nursing home women an age-related decline in TUG performance is mainly associated with a reduction of "explosive" strength of lower limb muscles.

Evaluation of the Healing Progress of Pressure Ulcers Treated with Cathodal High-Voltage Monophasic Pulsed Current: Results of a Prospective, Double-blind, Randomized Clinical Trial.

OBJECTIVE: To investigate the effectiveness of high-voltage monophasic pulsed current (HVMPC) as an adjunct to a standard wound care for the treatment of Stage II and III pressure ulcers (PrUs). DESIGN: Prospective, randomized, double-blind, controlled clinical study. SETTING: Two nursing and care centers. PATIENTS: Patients with PrUs that did not respond to previous treatment for at least 4 weeks were randomly assigned to the electrical stimulation (ES) group (25 patients; mean age of 79.92 ± 8.50 years; mean wound surface area [WSA] of 10.58 ± 10.57 cm) or to the control group (24 patients; mean age of 76.33 ± 12.74 years; mean WSA of 9.71 ± 6.70 cm). INTERVENTIONS: Both the ES and control groups received standard wound care and respectively, cathodal HVMPC (154 microseconds; 100 pulses per second; 0.24 A; 250 µ/s) applied continuously for 50 minutes once a day, 5 times a week, or sham HVMPC. MAIN OUTCOME: Percentage area reduction over 6 weeks of intervention. MAIN RESULTS: In the ES group, there was a statistically significant decrease in WSA after 1 week of treatment (35% ± 30.5%) compared with 17.07% ± 34.13% in the control group (P = .032). After treatment, at week 6, percentage area reduction in the ES group was 80.31% ± 29.02% versus 54.65% ± 42.65% in the control group (P = .046). CONCLUSIONS: Cathodal HVMPC reduces the WSA of Stage II and III PrUs. The results are consistent with the results of other researchers who used HVMPC to treat PrUs.

Effect of Physical Activity on Static and Dynamic Postural Balance in Women Treated for Breast Cancer: A Systematic Review.

BACKGROUND: Therapies against breast cancer (BC) frequently involve complications that impair patients' daily function and quality of life, the most common of which are motor coordination and balance disorders, increasing the risk of falls and injuries. In such cases, physical activity is recommended. Designed following the PRISMA guidelines, this study presents a systematic review of randomised and pilot clinical trials investigating the effect of physical exercises on postural balance in women treated for BC. METHODS: Scientific databases (PubMed, EBSCO) and the online resources of grey publications were searched for trial reports published between January 2002 and February 2022. The inclusion criteria necessitated full-text, English-language reports from randomised clinical trials (RCTs) or pilot clinical trials (pilot CTs), whose authors used physical exercises to treat women with BC and the experimental and control groups consisted of at least 10 women. The methodological quality of the RCTs and pilot CTs were measured using the Physiotherapy Evidence Database (PEDro) scale and the Methodological Index for Non-Randomized Studies (MINORS), respectively. Data were extracted on the effect of exercise on the women's static and dynamic balance. RESULTS: Seven reports, five RCTs and two pilot CTs involving a total of 575 women (aged 18-83 years) were included in the systematic review. Their training protocols utilised a variety of aerobic, strength, endurance, sensorimotor, Pilates exercises, and fitness exercises with elements of soccer. The experimental groups usually worked out in fitness or rehabilitation centres under the supervision of physiotherapists or trainers. Training sessions of 30-150 min were held 2 or 3 times a week for 1.5-24 months. Most trials reported that static and dynamic balance in the experimental groups improved significantly more compared with the control groups. CONCLUSIONS: Physical exercises are able to improve static and dynamic postural balance in women treated for BC. However, as all evidence in support of this conclusion comes from only two pilot CT and five RCTs whose methodologies varied widely, more high quality research is needed to validate their findings and determine which exercise protocols are the most effective in improving postural control in women with BC.

Sensitivity and Specificity of Anthropometric Indices in Identifying Obesity in Women over 40 Years of Age and Their Variability in Subsequent Decades of Life.

Anthropometric measurements and indices are a simple and inexpensive method to assess normal physical development and quickly identify the risk of diseases. The aim of the study was to verify the sensitivity (Se) and specificity (Sp) of selected anthropometric indices in a group of women over 40 years. The study included 87 women (group I-40 to 49 years, group II-50 to 59 years, group III-60 to 69 years, and group IV-70 to 79 years). Anthropometric characteristics were measured: body mass (BM), body height (BH), waist circumference (WC), and hip circumference (HC). Body mass index (BMI), body adiposity index (BAI), waist-hip ratio (WHR), and waist-to-height ratio (WHTR) were calculated. The percentage of fat tissue (FT) and visceral fat volume (FV) were evaluated using DEXA. A decrease in mean BH with an increase in the mean WC, WHR, and WHTR in subsequent decades. There were strong statistically significant correlations between FT and most indicators (except for WHR). FV was correlated at a strong or moderate level with most parameters. In the group of women aged 40 to 80 years, the most favorable AUC was obtained for WC, followed by BMI. BAI can be recommended as a complementary indicator to BMI.

Effect of Whole-Body Vibration Training on Selected Intrinsic Risk Factors in Women Aged 60+ at Fall Risk: A Randomized Controlled Trial.

The aim of the study was to determine whether Whole Body Vibration Training (WBVT) affects intrinsic risk factors for falls in women aged 60+ at fall risk. DESIGN: Randomized controlled clinical trial. Blinding was applied to the persons in charge of evaluating the intervention's clinical results and statistical analysis. METHODS: Forty-two women over 60 years old were randomly assigned to an experimental group (EG-12-week WBVT; n = 22) and a control group (CG-no additional physical activities; n = 20). Fear of falling was measured by the FES-I questionnaire, gait and dynamic balance using the Time-Up and Go test (TUG), aerobic endurance with the 6-Minute Walk Test (6MWT), and the functional strength of the lower body muscles with the 30-s Chair Stand Test (30SCST) at baseline and post-intervention. Additionally assayed were participants' blood concentrations of interleukin-6 (IL-6). RESULTS: The 12-week WBVT improves gait and balance (TUG, p = 0.009), exercise tolerance (6MWT, p = 0.001), and functional strength (30SCST; p = 0.027) but does not reduce the intensity of fear of falling (FES-I, p = 0.655) and the IL-6 serum concentration (p = 0.377). CONCLUSIONS: WBVT affects selected fall risk factors in women aged 60+ at fall risk.

Home-Based Exercise to Improve Motor Functions, Cognitive Functions, and Quality of Life in People with Huntington's Disease: A Systematic Review and Meta-Analysis.

Exercise in different settings has become a fundamental part of Huntington's disease (HD) management. The aim of this systematic review and meta-analysis was to investigate the effectiveness of home-based exercises (HBE) in HD. Randomized controlled trials (RCTs) investigating the effect of HBE on motor, cognitive, or health-related quality of life (QoL) outcomes in HD were included. Standardized mean difference (SMD), the 95% confidence interval, and p-values were calculated by comparing the outcomes change between HBE and control groups. Seven RCTs met the inclusion criteria. The included RCTs prescribed different types of HBEs, i.e., aerobic strengthening, walking, balance, and fine motor exercises. The HBE protocol length was between 6 and 36 weeks. The meta-analyses showed a significant effect of HBE intervention on motor function measure by Unified Huntington Disease Rating and overall QoL measure by Short Form-36 post-treatment respectively, [SMD = 0.481, p = 0.048], [SMD = 0.378, p = 0.003]. The pooled analysis did not detect significant changes in cognition, gait characteristics, or functional balance scales. The current study shows the positive effect of HBE in HD, especially on motor function and QoL. No significant adverse events were reported. The current results support the clinical effect of HBE intervention on motor function and QoL in HD patients. However, these results should be taken with caution due to the limited available evidence. Well-designed clinical studies that consider the disease severity and stages are required in the future.

Assessment of Quality of Life and Pain Severity in Older Men with Osteoporosis: Cross-Sectional Study.

BACKGROUND: The quality of life in osteoporosis is studied for men rather than for women. Aim of the study was to determine how bone mass density (BMD) relates to life quality components and the severity of pain felt by men affected by osteoporosis. METHODS: Presented research is a cross-sectional study. The cohort of 62 men aged 65 to 85 years was divided into a group with osteoporosis (N = 27) and a group without osteoporosis (N = 35). The participants' quality of life was measured with the Qualeffo41 Questionnaire, BMD was quantified by densitometry, and pain intensity was assessed on the Visual Analogue Scale. RESULTS: We found that lower BMD was strongly correlated to participants' quality of life (r = -0.72), especially the quality of leisure and social activities (r = -0.66), general health perception (r = -0.59), and mobility (r = -0.57). Pain significantly affected general health perception in older men with osteoporosis. General health assessment and pain were highly correlated with each other (r = 0.888). CONCLUSION: BMD and the overall quality of life of the study participants were related to each other. The strongest relationship occurred between reduced BMD and leisure and social activities component. The pain significantly affected participants' general health perception. The results may be employed to create new prophylactic strategies to improve life quality in men with osteoporosis.

Associations between the serum levels of selected bone turnover markers and biological traits in nursing home women aged 80+ without inflammation. A pilot study.

BACKGROUND: Bone turnover markers (BTM) reflect the status of bone remodeling processes responsible for bone mineral density. The existing body of evidence that osseous tissue can interact with many other body tissues and organs suggests that the cross-talks can lead to different relationships. The biological traits associated with BTMs have not been thoroughly studied in the elderly despite bone turnover being known to increase with age. OBJECTIVE: To determine whether the C-terminal crosslinking telopeptides of type I collagen (CTXI) and the serum levels of total (TAP) and bone-specific (BAP) alkaline phosphatase are associated with the biological traits in nursing home women aged 80-92 years without inflammation and, if so, to indicate the best predictors of these BTM's blood concentrations. METHODS: A group of 64 female volunteers aged 80 years and older, the residents of nursing homes, were screened for the study. Fifty two women were ineligible as they met the exclusion criteria. As a result, the study group consisted of 12 participants (85.1 ± 3.9 years; 58.1 ± 8.7 kg; 1.52 ± 0.06 m), all having blood C-reactive protein (CRP) levels below 3 mg/l. Also assessed were the participants' morphology, glucose and insulin levels, lipid profiles, CTXI, TAP, and BAP. Other measured parameters included body composition, resting heart rate and arterial blood pressure, isometric knee extension peak torque (IKEPT), and walking capacity (6-min walk test). The statistical analysis was performed using Pearson's correlation coefficients, the Benjamini-Hochberg procedure, and a stepwise multiple regression analysis with backward elimination. RESULTS: Inverse correlations were found between CTX-I and hemoglobin concentration (HGB) (r = -0.680; p = .015), red blood cells count (RBC) (r = -0.664; p = .019), fat-free mass (r = -0.633; p = .027), body weight (r = -0.589; p = .044), and total cholesterol (r = -0.581; p = .048). The multiple regression analysis of CTX-I showed that body weight was the only independent variable that was statistically significant (r2 = 0.346; p < .05; SEE = 0.347 ng/ml). BAP was positively correlated with double product (DP) (r = 0.742; p = .006), RBC (r = 0.650; p = .022), HGB (r = 0.637; p = .026), mean arterial pressure (MAP) (r = 0.622; p = .031), diastolic blood pressure (DBP) (r = 0.612; p = .034), body height (r = 0.603; p = .038), IKEPT (r = 0.565; p = .056), and systolic blood pressure (SBP) (r = 0.538; p = .071). BAP, a dependent variable, was the most closely correlated with DP (r2 = 0.550; p < .01; SEE = 9.161 U/l). TAP was also significantly associated with DP (r = 0.775; p = .003), with the association being stronger than between BAP and DP (r2 = 0.600; p < .01; SEE = 1000.5 beats/min*mm Hg). CONCLUSIONS: In relatively healthy the oldest-old nursing home women without inflammation, total body weight was the best predictor of bone resorption shown by the CTX-I concentration, whereas the rate pressure product (DP) turned out to best predict osteoblastic activity determinable from serum alkaline phosphatase activity. The results of the study suggest that the activity of serum TAP and BAP can be enhanced by different mechanisms.

Video-based time assessment in 360 degrees turn Berg balance test.

The Great Geriatric Problems include dementia syndromes, locomotion disorders, and falls. In geriatrics, one of the most commonly used methods for assessing the balance of seniors is the Berg Balance Scale (BBS). It is a set of 14 exercises that reflect daily activates. In this paper focused on the 11th Berg Balance Test, a novel method is introduced, based on the time of rotation calculated using the CamShift algorithm. The method is tested on 57 recordings of seniors. The average relative error of presented method is 4.74%, which refers to the average absolute error at the level of 0.83 s.

Osteoporosis in Polish Older Women: Risk Factors and Osteoporotic Fractures: A Cross-Sectional Study.

Background: Osteoporosis is a skeletal disease. It is still not known which of the risk factors have the greatest impact on osteoporosis development. The study aimed to determine how the selected osteoporosis risk factors contribute to the development of the disease and to assess the risk of osteoporotic fractures in older women. Methods: A cohort of 99 older females was divided into two groups (with and without osteoporosis). The risk of osteoporosis was determined using assessment forms and bone densitometry data subjected to logistic regression. The risk of osteoporotic fractures was assessed by the FRAX tool (FRAX, Center for Metabolic Bone Diseases, University of Sheffield, UK). Results: The logistic regression analysis showed that the highest risk of developing osteoporosis associated with lifestyle, mainly cigarette smoking (odds ratio: OR = 2.12), past gynecological operations (OR = 1.46), corticosteroid therapies (OR = 1.38). More than half of participants were at a medium risk of femoral neck fractures (over 90% in the osteoporotic group). Conclusion: Most of the Polish women living in care facilities are at medium risk of low-energy fractures. Smoking appeared to have the strongest effect on osteoporosis among analyzed risk factors. The results may contribute to the creation of more appropriate prevention strategies.

Effect of Physical Activity on the Quality of Life in Osteoporotic Females Living in Residential Facilities: A Randomized Controlled Trial.

BACKGROUND AND PURPOSE: The study aimed to assess the effect of a program of modified Sinaki exercises and Nordic Walking on the life quality in osteoporotic and osteopenic females living in residential care facilities, taking into account their baseline level of activity and risk of falling. The study was designed as a randomized controlled trial. METHODS: A sample of 91 females 65 to 98 years of age, the residents of Upper Silesian residential care facilities, was randomized into 4 groups. All groups received the same pharmacological treatment. In group 1 (control group), drugs were the only therapy; in group 2, the therapy was enhanced by program of modified Sinaki exercises; group 3 participated in Nordic Walking workout; and group 4 did both Sinaki exercises and Nordic Walking. Locomotor activity of the participants was estimated from pedometer readings. The risk of falling was assessed with the "Timed Up and Go" Test and the Functional Reach Test. With the QUALEFFO-41 questionnaire, the life quality of the participants was evaluated at baseline and after 12 months of intervention. RESULTS AND DISCUSSION: The study revealed that the studied women were at high risk of falling and that their physical activity was relatively low, likewise the quality of their lives. Their satisfaction with life was reduced by poor health, limited mobility, and the lack of social activities. Life quality improved in all 3 intervention groups, but in the control group, it decreased. The results of Bonferroni's post hoc test pointed to statistically significantly better quality of life in groups 2 (P = .01) and 4 (P < .01). CONCLUSION: Both modified Sinaki exercises and Nordic Walking significantly improved the participants' quality of life, but the most effective therapeutically was the combination of both these forms of physical activity.

Pressure Injuries Treated With Anodal and Cathodal High-voltage Electrical Stimulation: the Effect on Blood Serum Concentration of Cytokines and Growth Factors in Patients With Neurological Injuries. A Randomized Clinical Study.

It remains unclear whether electrical currents can affect biological factors that determine chronic wound healing in humans. PURPOSE: The aim of this study was to determine whether anodal and cathodal high-voltage monophasic pulsed currents (HVMPC) provided to the area of a pressure injury (PI) change the blood level of cytokines (interleukin [IL]-1ß, IL-10, and tumor necrosis factor [TNF]-α) and growth factors (insulin-like growth factor [IGF]-1 and transforming growth factor [TGF]-ß1) in patients with neurological injuries and whether the level of circulatory cytokines and growth factors correlates with PI healing progression. METHODS: This study was part of a randomized clinical trial on the effects of HVMPC on PI healing. All patients with neurological injuries (spinal cord injury, ischemic stroke, and blunt trauma to the head) and a stage 2, stage 3, or stage 4 PI of at least 4 weeks' duration hospitalized in one rehabilitation center were eligible to participate if older than 18 years of age and willing to consent to donating blood samples. Exclusion criteria included local contraindications to electrical stimulation (cancer, electronic implants, osteomyelitis, tunneling, necrotic wounds), PIs requiring surgical intervention, patients with poorly controlled diabetes mellitus (HbA1C > 7%), critical wound infection, and/or allergies to standard wound treatment. Participants were randomly assigned to 1 of 3 groups: anodal (AG) or cathodal (CG) HVMPC treatment (154 µs; 100 Hz; 360 µC/sec; 1.08 C/day) or a placebo (PG, sham) applied for 50 minutes a day, 5 days per week, for 8 weeks. TNF-α, IL-1ß, IL-10, TGF-ß1, and IGF-1 levels in blood serum were assessed using the immunoenzyme method (ELISA) and by chemiluminescence, respectively, at baseline and week 4. Wound surface area measurements were obtained at baseline and week 4 and analyzed using a digitizer connected to a personal computer. Statistical analyses were performed using the maximum-likelihood chi-squared test, the analysis of variance Kruskal-Wallis test, the Kruskal-Wallis post-hoc test, and Spearman's rank order correlation; the level of significance was set at P ≤.05. RESULTS: Among the 43 participants, 15 were randomized to AG (mean age 53.87 ± 13.30 years), 13 to CG (mean age 51.08 ± 20.43 years), and 15 to PG treatment (mean age 51.20 ± 14.47 years). Most PIs were located in the sacral region (12, 74.42%) and were stage 3 (11, 67.44%). Wound surface area baseline size ranged from 1.00 cm2 to 58.04 cm2. At baseline, none of the variables were significantly different. After 4 weeks, the concentration of IL-10 decreased in all groups (AG: 9.8%, CG: 38.54%, PG: 27.42%), but the decrease was smaller in the AG than CG group (P = .0046). The ratio of pro-inflammatory IL-10 to anti-inflammatory TNF-α increased 27.29% in the AG and decreased 26.79% in the CG and 18.56% in the PG groups. Differences between AG and CG and AG and PG were significant (AG compared to CG, P = .0009; AG compared to PG, P = .0054). Other percentage changes in cytokine and growth factor concentration were not statistically significant between groups. In the AG, the decrease of TNF-α and IL-1ß concentrations correlated positively with the decrease of PI size (P <.05). CONCLUSION: Anodal HVMPC elevates IL-10/TNF-α in blood serum. The decrease of TNF-α and IL-1ß concentrations in blood serum correlates with a decrease of PI wound area. More research is needed to determine whether the changes induced by anodal HVMPC improve PI healing and to determine whether and how different electrical currents affect the activity of biological agents responsible for specific wound healing phases, both within wounds and in patients' blood. In clinical practice, anodal HVMPC should be used to increase the ratio of anti-inflammatory IL-10 to pro-inflammatory TNF-α , which may promote healing.

Blood pressure response to isometric handgrip testing and aerobic capacity and associations with sprint performance in middle-aged men following high-intensity interval training.

BACKGROUND: The aim of this study was to determine if a 6-week high-intensity interval training (HIIT) protocol with increasing exercise volume affects aerobic capacity and arterial blood pressure (BP) measured during a fatiguing isometric handgrip test (IHT) in middle-aged, normotensive men and to assess whether sprint performance is associated with training-induced changes in BP. METHODS: Fourteen recreationally active men (age 43.0±0.9 years, body mass 74.4±2.1 kg, body height 1.74±0.02 m, BMI 24.7±0.5 kg/m2 [mean±SE]) participated in 12 HIIT sessions at an intensity of 85% of heart rate reserve. Sprinting ability was estimated at baseline using the 50-yard dash test (50YDT). Pre- and post-HIIT aerobic capacity and pressor response was assessed by the 12-min Cooper run test (12CT) and the IHT at 30% of maximal voluntary contraction, respectively. RESULTS: Following the intervention, the distance covered in the 12CT and handgrip time to fatigue (HTF) significantly increased (P<0.05) but only diastolic BP significantly decreased (P<0.05) compared with pre-HIIT values. Changes (Δ - post- vs. pre-HIIT values) in HTF correlated positively with 50YDT performance (P<0.05). However, significant negative relationships were found between 50YDT and Δ in systolic, diastolic, and mean BP during the IHT except for resting values. CONCLUSIONS: The findings suggest that a HIIT intervention in middle-aged, normotensive men enhances aerobic capacity with a concomitant decrease in DBP and that training-induced ΔBP during IHT are dependent on sprinting ability.

Effect of physical activity on the sequelae of osteoporosis in female residents of residential care facilities.

BACKGROUND: Osteoporosis is one of the most common diseases that develop with age and cause high morbidity and mortality among elderly people. OBJECTIVES: This study was set out to evaluate the influence of a program of modified Sinaki exercises, Nordic walking (NW) and a combination of these physical activities on people with osteoporosis. MATERIAL AND METHODS: A sample consisting of 91 women aged 65-98 years living in residential care facilities was randomized into 4 groups. The control group (group 1) received only pharmacological treatment. In the other 3 groups, the same drug therapy was enhanced by a program of modified Sinaki exercises (group 2), Nordic walking (group 3), and Sinaki exercises and Nordic walking applied together (group 4). At baseline and after 12 months of intervention, the participants were assessed for bone density, rib cage mobility, motor abilities, risk of falling (Timed Up and Go Test - TUG, Functional Reach Test - FRT), and locomotor activity (based on pedometer readings). The intervention was completed by 83 participants. RESULTS: Bone density (T-score) was higher in all intervention groups and in the control group (p < 0.003). The improvement in rib cage mobility was statistically significant in groups 2 (p < 0.001) and 4 (p < 0.002). Locomotor activity significantly improved in groups 3 (p < 0.000) and 4 (p < 0.000). The post-intervention results of the TUG and FRT tests showed a significantly lower risk of falling in group 4. In groups 1 and 2, the risk was higher, but not statistically significantly, and in group 3, it did not change. CONCLUSIONS: Modified Sinaki exercises and Nordic walking significantly improved the mobility of the rib cage, locomotor activity and motor abilities in the women comprising groups 2 and 3, but the best results of the intervention were noted in the group treated with both forms of physical activity.

The relationship between selected body fatness indices and the level of blood interleukin-6 in female nursing home residents aged 80+ years without inflammation: A pilot study.

BACKGROUND: Interleukin-6 (IL-6) production facilitates a shift from acute to chronic inflammation that may induce the development of some diseases and aging. Several studies have suggested that adiposity is closely related to serum IL-6 level, but their authors examined relatively young older adults (aged 60-80 years), so it is not clear whether this association would also occur in people at a more advanced age. OBJECTIVE: to assess whether in elderly women without inflammation the widely used anthropometric obesity indices are associated with serum IL-6 level and, if so, to determine the best anthropometric predictor of this inflammatory biomarker. METHODS: The sample consisted of 12 women (85.1 ±â€¯3.9 years; 58.1 ±â€¯8.7 kg; 151.9 ±â€¯6.3 cm), the residents of nursing homes, who did not use anti-inflammatory drugs, statins or diuretics and whose blood C-reactive protein (CRP) concentration was lower than 3 mg/l. To determine CRP and IL-6 concentrations, venous blood samples were collected in the morning in a fasted state. The following anthropometric measurements were made in all participants: body weight, body height, the circumferences of waist, hip and neck. Body fat percentage and visceral fat rating (VFR) were determined by bioelectrical impedance analysis. The measurements were then used to calculate body mass index (BMI), body fat mass index (BFMI), body adiposity index (BAI), the waist-hip ratio (WHR) and the waist-height ratio (WHtR). In the statistical analysis, Pearson's correlation coefficients and stepwise multiple regression analysis with backward elimination were used. RESULTS: A direct relationship was established between IL-6 and CRP levels (r = 0.639; p < 0.05). Moreover, IL-6 significantly and positively correlated with hip and neck circumferences, BMI, BFMI, and BAI, as well as with VFR (r range 0.597-0.704; p < 0.05). The multiple regression analysis for IL-6 showed that the neck circumference was the only statistically significant independent variable (r2 = 0.496; p < 0.05; SEE = 0.554 pg/ml). CONCLUSIONS: The results suggest that of all popular indices of adiposity neck circumference is the best predictor of serum IL-6 concentration in the oldest old women without inflammation.

Effectiveness of Mirror Therapy for Subacute Stroke in Relation to Chosen Factors.

PURPOSE: The aim of this study was to determine the effectiveness of mirror therapy (MT) combined with comprehensive treatment and to investigate the possible relationships of functional state. DESIGN: Prospective, controlled trial of 60 stroke inpatients. METHODS: The Functional Index "Repty" (FIR) was an outcome measure to assess changes of independence in daily activities. The Frenchay Arm Test (FAT) and Motor Status Score were outcome measures to assess changes in hand function. FINDINGS: The analysis of pre- and posttest data indicated a significant improvement in hand function ([INCREMENT]FAT in the Mirror group p = .035, N = 30). Age factor indicated a significant change in relation to FIR outcome ([INCREMENT]FIR in the Mirror group p = .005, N = 30 and [INCREMENT]FIR in the Mirror group [left hand paresis] p = .037, N = 15). CONCLUSIONS: Additional MT influenced improvement in hand function. The age is significant in terms of functional state. The older adults are likely to benefit from MT. CLINICAL RELEVANCE: A positive impact of combining MT with other treatment was indicated.