Impacts of Remote Physical Exercises on Functional Status and Mobility among Community-Dwelling Pre-Disabled Seniors during the Covid-19 Lockdown.

OBJECTIVES: To assess whether remote physical exercise interventions helped maintain function in daily life, level of physical activities, basic mobility and frailty status in pre-disabled seniors during the first Covid-19 lockdown. DESIGN: This is an interventional study conducted from May 2020 to May 2021. SETTING: Community-dwelling older adults in 2 Canadian cities. PARTICIPANTS: 84 pre-disabled seniors. INTERVENTION: 12-week physical exercise programs (1 hour/ 3 times/ week) in kinesiologist-guided groups using Zoom or phone-supervised individual booklet-based home-program (n=44) vs. Control (usual life habits; n=40). MEASUREMENTS: Functional status in daily activities (OARS scale); Daily level of aerobic (TAPA-1) and strengthening/flexibility (TAPA-2) physical activities; Basic mobility abilities (SPPB: balance, lower limbs strength, walking speed; Timed Up-and-Go) and Frailty (SOF index) were assessed at baseline and at 3, 6, 9 and 12-month follow-ups. RESULTS: The participants' mean age was 78.5 ± 7.2 and 76.5 % were women. There was a group * time effect for the OARS scale (p=0.02), the TAPA-1 (p=0.06) and the TAPA-2 (p=0.007) scores. For these outcomes, scores significantly improved during the first 3 months of follow-up and then stabilised in the intervention group whereas they remained constant in the control group over time. There was an overall time effect for the SPPB (p=0.004), the 4-m walking speed (p=0.02) and for the SOF index (p=0.004), with no between-group differences. Finally, no effect was observed for the TUG. CONCLUSION: Remote home-based physical exercise interventions and monitoring during the first Covid-19 lockdown seemed to have helped maintain seniors' level of physical activities without impacting on basic mobility abilities. Further studies are needed to identify parameters of remote exercise programs that can improve daily function and mobility in this population.

[Relation between grip strength of independent elders and functional decline following an emergency department visit : a pan-Canadian study]. / Capacité de prédiction de la force de préhension et de la peur de tomber des personnes âgées autonomes quant au déclin fonctionnel suite à une consultation aux urgences. Une étude pancanadienne.

OBJECTIVE: To determine whether grip strength and fear of falling are associated with functional decline at 3 or 6 months after a minor trauma assessed in the emergency department. METHOD: Prospective multicenter cohort study of patient's aged 65 years and older, independent for activities of daily living, consulting the emergency department for minor trauma. Functional status, fear of falling, and grip strength measurements were collected. Functional decline was measured at 3 and 6 months. STATISTICS: Two groups were compared : one with functional decline, the other without. A ROC curve explored the predictive power of grip strength and initial fear of falling on the occurrence of functional decline. RESULTS: Participants were 74.7 years old, 52 % men. Initial peak grip strengths were identical (p superior to 0.05). Grip strength and fear of falling were not predictive of functional decline (p = 0.55 and p = 0.53). However, fear of falling was associated with functional decline (OR: 1.141 95 % CI [1.032-1.261]; p = 0.009). CONCLUSION: In the autonomous elder with minor trauma in the emergency department, grip strength is not associated with subsequent functional decline. But fear of falling is associated with decline at 6 months.

Objectif : Déterminer si la force de préhension et la peur de tomber sont associées au déclin fonctionnel à 3 ou 6 mois d'un traumatisme mineur évalué aux urgences. Méthode : Étude prospective de cohorte multicentrique des patients de 65 ans et plus, autonomes pour les activités de la vie quotidienne, consultant aux urgences pour traumatismes mineurs. Le statut fonctionnel, la peur de tomber, et la mesure de la force de préhension ont été recueillis. Le déclin fonctionnel a été mesuré à 3 et 6 mois. Statistiques : Deux groupes sont comparés : un avec déclin fonctionnel, l'autre sans. Une courbe ROC a exploré la puissance prédictive de la force de préhension et de la peur de tomber initiale sur l'apparition du déclin fonctionnel. Résultats : Les participants avaient 74 ± 7 ans, 52 % d'hommes. Les forces de préhension maximales initiales étaient identiques (p sup�rieur a 0,05). La force de préhension et la peur de tomber ne sont pas prédictives du déclin fonctionnel (p = 0,55 et p = 0,53). Cependant, la peur de tomber est associée au déclin fonctionnel (OR: 1,141 IC95 % [1,032-1,261]; p = 0,009). Conclusion : Chez l'aîné autonome avec un traumatisme mineur aux urgences, la force de préhension n'est pas associée au déclin fonctionnel ultérieur. Mais la peur de tomber est associée à un déclin à 6 mois.

Feasibility and Acceptability of Remote Physical Exercise Programs to Prevent Mobility Loss in Pre-Disabled Older Adults during Isolation Periods Such as the COVID-19 Pandemic.

This study aimed to assess the feasibility and acceptability of remote physical exercise (PE) to prevent mobility loss among pre-disabled older adults during the COVID-19 lockdowns. Participants followed a 12-week PE remote program in Zoom© supervised groups (Web-Ex group, n=11) or phone-supervised individual booklet-based home-program (Booklet group, n=33). The total rate of adherence was 82.5% in the Web-Ex group and 85.8% in the Booklet group. The level of satisfaction was « a lot ¼ for 60% of the participants in the Web-ex group and for 37.9% of those included in the Booklet group. Respectively 10% and 31% of the participants rated the difficulty as « low ¼ in the web-ex and Booklet groups. Remote physical exercise using a web technology or booklets at home with regular and personalized follow-up during the lockdown was feasible and acceptable among pre-disabled seniors.

Cystosarcoma phylloides presenting as massive unilateral breast hypertrophy in an adolescent.

A 14-year-old girl presented with unilateral massive breast enlargement while the opposite breast had minimal development. A 565 gm tumor, benign cystosarcoma phylloides, was removed by wide local excision. The literature regarding the controversial tumor is reviewed. Methods of treatment for each category of cystosarcoma phylloides, based upon morphological criteria, are outlined and the prognosis discussed. The special problem of cystosarcoma phylloides in the adolescent is reviewed and treatment recommended.