Psychophysiological effects of walking in forests and urban built environments with disparate road traffic noise exposure: study protocol of a randomized controlled trial.

BACKGROUND: Stress is a widespread phenomenon and reality of everyday life, entailing negative consequences for physical and psychological wellbeing. Previous studies have indicated that exposure to greenspaces and nature-based interventions are promising approaches to reducing stress and promoting restoration. However, an increasing percentage of the population lives in urban regions with limited opportunities to spend time in greenspaces. In addition, urban settings typically feature increased levels of noise, which represents a major environmental stressor. Although various studies have compared the effects of exposure to greenspaces versus urban built environments, evidence of the effects of noise in this context is very limited. Psychophysiological benefits of exposure to greenspaces compared to urban built environments reported in earlier studies might be less (or at least not only) due to features of the greenspaces than to additional stressors, such as road traffic noise in the urban built environment. Hence, differences in the effects attributed to greenness in previous studies may also be due to potentially detrimental noise effects in comparison settings. This paper reports the study protocol for a randomized, controlled intervention study comparing the effects of walking in forest versus urban built environments, taking road traffic noise exposure during walks in the respective settings into account. METHODS: The protocol envisages a field study employing a pretest-posttest design to compare the effects of 30-min walks in urban built environments and forests with different road traffic noise levels. Assessments will consist of self-reported measures, physiological data (salivary cortisol and skin conductance), an attention test, and noise, as well as greenness measurements. The outcomes will be restoration, stress, positive and negative affect, attention, rumination, and nature connectedness. DISCUSSION: The results will inform about the restorative effect of walking in general, of exposure to different types of environments, and to different noise levels in these sites. The study will provide insights into the benefits of walking and nature-based interventions, taking into account the potential detrimental effects of noise exposure. It will thus facilitate a better understanding of low-threshold interventions to prevent stress and foster wellbeing. TRIAL REGISTRATION: ISRCTN48943261 ; Registered 23.11.2023.

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.

Investigating the dynamics of collective behavior among pedestrians crossing roads: A multi-user virtual reality approach.

The utility maximization theory, based on the rationality of human beings, has proven effective in modeling pedestrians' decision-making processes while crossing roads. However, there are still unexplained variations in crossing behavior, and deviations from the rational utility model frequently occur in real-life scenarios. This experimental study sheds new light on the presence of inter-individual interactions among pedestrians and the nature of collective behaviors during road crossings. The present study develops a multi-pedestrian virtual reality simulator specifically designed to investigate the impact of social interaction on pedestrians' eye-scanning patterns, perceived responses, crossing behaviors, and the associated crash risk. Our findings indicate that the collective behavior significantly influences pedestrians' behaviors by diverting their attention from essential eye-scanning patterns that reflect their cognitive processes. Pedestrians in pairs exhibit a higher tendency to fixate on each other, spend less time in the decision phase, walk at a slower pace during the crossing phase, and consequently face a higher degree of exposure to dangerous situations compared to when crossing alone. Encouraged by these findings on the effects of social interaction, we discuss preventive strategies to mitigate the negative impacts of collective behavior and foster pedestrians' safety awareness.

The impact of perceptual complexity on road crossing decisions in younger and older adults.

Cognitive abilities decline with healthy ageing which can have a critical impact on day-to-day activities. One example is road crossing where older adults (OAs) disproportionally fall victim to pedestrian accidents. The current research examined two virtual reality experiments that investigated how the complexity of the road crossing situation impacts OAs (N = 19, ages 65-85) and younger adults (YAs, N = 34, ages 18-24) with a range of executive functioning abilities (EFs). Overall, we found that OAs were able to make safe crossing decisions, and were more cautious than YAs. This continued to be the case in high cognitive load situations. In these situations, safe decisions were associated with an increase in head movements for participants with poorer attention switching than participants with better attention switching suggesting these groups developed compensation strategies to continue to make safe decisions. In situations where participants had less time to make a crossing decision all participants had difficulties making safe crossing decisions which was amplified for OAs and participants with poorer EFs. Our findings suggest more effort should be taken to ensure that road crossing points are clear of visual obstructions and more speed limits should be placed around retirement or care homes, neither of which are legislated for in the UK and Australia.

The impact of music making on neural efficiency & dual-task walking performance in healthy older adults.

Music making is linked to improved cognition and related neuroanatomical changes in children and adults; however, this has been relatively under-studied in aging. The purpose of this study was to assess neural, cognitive, and physical correlates of music making in aging using a dual-task walking (DTW) paradigm. Study participants (N = 415) were healthy adults aged 65 years or older, including musicians (n = 70) who were identified by current weekly engagement in musical activity. A DTW paradigm consisting of single- and dual-task conditions, as well as portable neuroimaging (functional near-infrared spectroscopy), was administered. Outcome measures included neural activation in the prefrontal cortex assessed across task conditions by recording changes in oxygenated hemoglobin, cognitive performance, and gait velocity. Linear mixed effects models examined the impact of music making on outcome measures in addition to moderating their change between task conditions. Across participants (53.3% women; 76 ± 6.55 years), neural activation increased from single- to dual-task conditions (p < 0.001); however, musicians demonstrated attenuated activation between a single cognitive interference task and dual-task walking (p = 0.014). Musicians also displayed significantly smaller decline in behavioral performance (p < 0.001) from single- to dual-task conditions and faster gait overall (p = 0.014). Given evidence of lower prefrontal cortex activation in the context of similar or improved behavioral performance, results indicate the presence of enhanced neural efficiency in older adult musicians. Furthermore, improved dual-task performance in older adult musicians was observed. Results have important clinical implications for healthy aging, as executive functioning plays an essential role in maintaining functional ability in older adulthood.

The role of positive psychological wellbeing in walking speed differences among married and unmarried English older adults.

Objectives: Walking speed has been identified as an important indicator of functional independence and survival among older adults, with marital status being related to walking speed differences. We explored explanatory factors, with a focus on positive psychological wellbeing, in walking speed differences between married and non-married individuals in later life. Methods: We used wave 8 (2016/17) cross-sectional data from adults aged 60-79 years who participated in the English Longitudinal Study of Ageing (n = 3,743). An Oaxaca-Blinder decomposition was used to compute walking speed differences between married and unmarried individuals, and the portion of those differences that could be explained by characteristic differences in those groups, particularly wellbeing. Results: Overall, married individuals had walking speeds that were 0.073 m/s (95% confidence interval: 0.055-0.092 m/s) faster than their unmarried counterparts. This was primarily driven by differences between the married and separated/divorced group, and the widowed group. Included covariates explained roughly 89% of the overall walking speed difference. Positive psychological wellbeing consistently explained a significant portion of walking speed differences, ranging between 7% to 18% across comparisons. Conclusion: Although wealth has been previously found to partially explain walking speed differences by marital status, we found that positive psychological wellbeing also demonstrated pertinence to these differences.

Stand up to better pay attention, sit down to better subtract: a new perspective on the advantage of cognitive-motor interactions.

The Stroop task and subtraction rely on the different cognitive processes and cerebral regions, but both these cognitive functions interact with posture. The study of cognitive-motor interactions falls under the concept of sharing resources, implying that resources for processing are limited. Researchers try to understand this interaction by constructing dual task (DT) paradigms. None have investigated the Stroop and subtraction tasks in three inherently simple postures in two groups of young adults. This study aimed to test whether a given posture benefits a given cognitive function when cognitive and postural tasks are not overly demanding and are underpinned by common cerebral structures. This study presents the results of 60 healthy young adults performing a subtraction task in three postures (sitting, standing, and walking) and 57 healthy young adults performing the Stroop task in the same three postures. Our results showed that performance at the Stroop task, in terms of number of correct answers and interference, are better while standing or even walking compared to sitting while subtraction is better sitting compared to standing and walking. Moreover, static postural parameters did not vary when in DT compared to single task. This means that there was no additional cost on posture when achieving the cognitive activity simultaneously. The absence of impact of the DT on postural parameters in static postures and the changes in the gait pace when walking suggest that cognitive tasks can be achieved in various postures, without being too costly on posture.

Relationship between Walking and Driving, and Cognitive Functioning Common to Both Modes of Mobility, in Healthy Older Adults.

INTRODUCTION: Driving and walking, the two main modes of mobility, require numerous common skills in the motor, sensory, and cognitive domains that deteriorate with age. The objective of this study was to investigate the relationship between walking and driving in healthy older drivers and to determine whether certain cognitive processes are involved in both modes of mobility. METHOD: Seventy-six older drivers from the Safe Move cohort were assessed in the following three domains: (1) cognition, using parts A and B of the Trail Making Test (TMT), the digit symbol substitution test (DSST), the Stroop test, and the Digit span; (2) gait, using a dual-task (DT) paradigm with a counting task; and (3) driving, assessed via a 40-50 min on-road test. Analyses were also performed on 2 subgroups: young-old (70-74 years old; n = 43) and old-old (≥75 years; n = 33). RESULTS: Four significant correlations were found across the whole sample between gait performance under DT conditions and driving scores. One correlation was also found in old-old adults. None were found in young-old adults. Furthermore, several cognitive measures were significantly correlated to both modes of mobility: TMT-A and B completion time in the whole sample, and DSST performance in the whole sample and old-old adults. DISCUSSION/CONCLUSION: Walking in complex conditions and on-road driving performance are closely related in healthy older drivers. Visuospatial attention, processing speed, and executive function are crucial and common cognitive processes to both modes of mobility in this population. Impairment in these cognitive functions should thus alert health professionals as it can quickly lead to mobility disorders, loss of autonomy and social isolation. Developing specific preventive programs and mobility support systems for healthy older adults is also crucial.

Road crossing behavior and preferences among pedestrians: From the lens of the theory of interpersonal behavior.

OBJECTIVE: As a major safety intervention, infrastructural facilities such as footbridges, underpasses or signals are provided for pedestrians to remove their direct interactions with vehicles and consequently ensure safe crossing as they attempt to cross roadways. Interestingly, it is evident that even within the proximity of footbridges or underpasses, some individuals are more willing to take the risk of crossing at-grade even where there are no signals or crosswalk markings to separate their movement from vehicles. These crossing alternatives may have different utilization depending on location and road user types. Therefore, sustainable crossing facilities are needed to meet pedestrian needs. This study attempts to investigate the factors that influence pedestrians to avoid provided footbridges and engage in at-grade crossing behaviors. METHODS: The crossing point preference is an interpersonal behavior which is a multifaceted and complex phenomenon involving conscious (intentions) and subconscious (habits) factors. This study employs Triandis' Theory of Interpersonal Behavior (TIB) as a theoretical framework and structural equation modeling to achieve study objectives. Pedestrians were intercepted randomly and socio-demographics, trip characteristics and perceptions data collected through a stated preference survey. RESULTS: Perceived consequence, affect, and social factors were found as significant antecedents of at-grade crossing intentions. Habits and facilitating conditions significantly moderate the impact of crossing intentions on actual at-grading crossing behavior. Pedestrians' perceived consequence was found to significantly mediate the impact of social factors and affective factors on intention to cross at-grade. Apart from gender, age, satisfaction with footbridge features, work trips, and crossing frequency were all significant determinants of actual crossing at-grade behavior. CONCLUSIONS: The study findings can help road safety agencies provide acceptable sustainable facilities that will be used by pedestrians to ensure that the purpose of investments toward pedestrian crossing safety is achieved. Effective road safety education and awareness campaigns on negative consequences of crossing at-grade, while highlighting the benefits of using provided footbridges are suggested to be undertaken by government agencies.

Effects of greenery at different heights in neighbourhood streetscapes on leisure walking: a cross-sectional study using machine learning of streetscape images in Sendai City, Japan.

BACKGROUND: It has been pointed out that eye-level greenery streetscape promotes leisure walking which is known to be a health -positive physical activity. Most previous studies have focused on the total amount of greenery in the eye-level streetscape to investigate its association with walking behaviour. While it is acknowledged that taller trees contribute to greener environments, providing enhanced physical and psychological comfort compared to lawns and shrubs, the examination of streetscape metrics specifically focused on greenery height remains largely unexplored. Therefore, this study examined the relationship between objective indicators of street greenery categorized by height from a pedestrian viewpoint and leisure walking time. METHODS: We created streetscape indices of street greenery using Google Street View Images at 50-m intervals in an urban area in Sendai City, Japan. The indices were classified into four ranges according to the latitude of the virtual hemisphere centred on the viewer. We then investigated their relationship to self-reported leisure walking. RESULTS: Positive associations were identified between the street greenery in higher positions and leisure walking time, while there was no significant association between the greenery in lower positions. CONCLUSION: The findings indicated that streets with rich greenery in high positions may promote residents' leisure walking, indicating that greenery in higher positions contributes to thermally comfortable and aesthetic streetscapes, thus promoting leisure walking. Increasing the amount of greenery in higher positions may encourage residents to increase the time spent leisure walking.

Daily walking kinematic characteristics of the elderly in different residential settings: experimental study on Chinese community-living elderly and long-term nursing home residents.

BACKGROUND: Long-term nursing home (NH) care helps NH residents with their daily activities and improves their quality of life, but negatively affects their independent physical activities and increases the risk of dangerous events. Dangerous events in the elderly usually occur in the conversion of walking periods when forward striding has already happened, but the body has not yet entered a completely steady walking. OBJECTIVES: Compare the gait characteristics in Chinese long-term NH residents and community-living elderly during the walking Transitional Period (TP) and Stabilization Period (SP). METHODS: 32 long-term NH residents and 33 age- and sex-matched community-living elderly were recruited. The 30-Second Chair Stand Test (30-s CST), Timed Up and Go Test (TUGT), and Modified Falls Efficacy Scale (MFES) were used to assess their body function. The Xsens MVN BIOMECH system was used to collect and analyze the gait parameters of participants. RESULTS: Compared to community-living elderly, NH residents had fewer numbers of 30-s CST, took more time to complete TUGT, and lower MEFS scores. NH residents showed slower gait speed (P < 0.001), less peak hip flexion (P = 0.022) and extension (P = 0.003), knee internal rotation (P = 0.023), and ankle plantarflexion (P = 0.001) and internal rotation (P = 0.007) angles during walking. When walking progressed from TP to SP, NH residents showed increased ankle dorsiflexion (P < 0.001), decreased hip internal rotation (P < 0.001), and community-living elderly had increased hip extension (P = 0.005) angles. CONCLUSIONS: Chinese long-term NH residents had reduced lower extremities strength and postural balance, and higher fear of falling compared to community-living elderly. Their walking performance also showed high fall risk. Besides, long-term NH residents adopted a distal strategy to propel the body forward, which may be a compensatory measure to compensate for inadequate proximal joint control from forward walking to stable walking, and long-term NH residents have reduced postural stability during this process.

Untangling the confounded relationship between perceiver sex and walker sex on the bistable perception of emotion displaying point-light walkers.

Point-light displays of walking gait carries an assortment of information about the individual and this information is often perceivable to others. Some of these bits of information are entangled, with some facilitating and others inhibiting each other. We sought to untangle the perception of basic threat emotions from sex of the walker and the perceiver, as expressed through the bistable perception of anticipated approaching or withdrawing point-light walkers. Stationary point-light walkers displaying anger or fear were shown to 164 psychology student perceivers, who were told that the walkers would be either walking towards them or walking away from them. Perceivers were asked to identify the displayed emotion for each walker stimulus. Expected walker direction showed no influence on the perception of either emotion, across either sex of the perceivers or walkers. Anger was identified better on male walkers and fear was identified better on female walkers. Female perceivers were able to identify both emotions better than male perceivers, but only when displayed by female walkers. The sex of both the perceiver and the walker interact to influence the perception of basic threat emotions displayed through point-light walking gait, with implications for the development of inter-sexual and intra-sexual group cohesion programs.

Uneven surface and cognitive dual-task independently affect gait quality in older adults.

BACKGROUND: Real-world mobility involves walking in challenging conditions. Assessing gait during simultaneous physical and cognitive challenges provides insights on cognitive health. RESEARCH QUESTION: How does uneven surface, cognitive task, and their combination affect gait quality and does this gait performance relate to cognitive functioning? METHODS: Community-dwelling older adults (N = 104, age=75 ± 6 years, 60 % females) performed dual-task walking paradigms (even and uneven surface; with and without alphabeting cognitive task (ABC)) to mimic real-world demands. Gait quality measures [speed(m/s), rhythmicity(steps/minute), stride time variability (%), adaptability (m/s2), similarity, smoothness, power (Hz) and regularity] were calculated from an accelerometer worn on the lower back. Linear-mixed modelling and Tukey analysis were used to analyze independent effects of surface and cognitive task and their interaction on gait quality. Partial Spearman correlations compared gait quality with global cognition and executive function. RESULTS: No interaction effects between surface and cognitive task were found. Uneven surface reduced gait speed(m/s) (ß = -0.07). Adjusted for speed, uneven surface reduced gait smoothness (ß = -0.27) and increased regularity (ß = 0.09), Tukey p < .05, for even vs uneven and even-ABC vs uneven-ABC. Cognitive task reduced gait speed(m/s) (ß = -0.12). Adjusted for speed, cognitive task increased variability (ß = 7.60), reduced rhythmicity (ß = -6.68) and increased regularity (ß = 0.05), Tukey p < .05, for even vs even-ABC and uneven vs uneven-ABC. With demographics as covariates, gait speed was not associated with cognition. Gait quality [lower variability during even-ABC (ρp =-.31) and uneven-ABC (ρp =-.28); greater rhythmicity (ρp between.22 and.29) and greater signal-adaptability AP (ρp between.22 and.26) during all walking tasks] was associated with better global cognition. Gait adaptability during even (ρp =-0.21, p = 0.03) and uneven(ρp =-0.19, p = 0.04) walking was associated with executive function. SIGNIFICANCE: Surface and cognitive walking tasks independently affected gait quality. Our study with high-functioning older adults suggests that task-related changes in gait quality are related to subtle changes in cognitive functioning.

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.

Association of Perceived Neighborhood Environments With Cognitive Function in Older Adults.

The current study examined the associations between perceptions of the social and physical neighborhood environments and cognitive function in older adults. This cross-sectional study analyzed 821 adults aged ≥65 years from the Adult Changes in Thought study. Perceived neighborhood attributes were measured by the Physical Activity Neighborhood Environment Scale. Cognitive function was assessed using the Cognitive Ability Screening Instrument. The associations were tested using multivariate linear regression. One point greater perceived access to public transit was associated with 0.56 points greater cognitive function score (95% confidence interval [CI] [0.25, 0.88]), and an additional one point of perceived sidewalk coverage was related to 0.22 points higher cognitive function score (95% CI [0.00, 0.45]) after controlling for sociodemographic factors. The perception of neighborhood attributes alongside physical infrastructure may play an important role in supporting older adults' cognitive function. [Journal of Gerontological Nursing, 49(8), 35-41.].

Dual Task Performance in Adolescents With Idiopathic Scoliosis.

Daily life activities commonly include many combinations of dual tasks. Although dual task ability has been studied in healthy young adults, dual task performance in adolescents with idiopathic scoliosis (IS) has not been explored. Our objective in this study was to investigate dual task performance in adolescents with IS. We paired 33 adolescents diagnosed with IS and 33 healthy control participants (age range: 11-17 years) and administered to both groups the Stroop Color and Word test as a measure of cognitive ability, and both the Expanded Timed Up and Go (ETUG) test and the Tandem Gait test as measures of motor tasks. During the motor tasks, we had participants spell five-letter words in reverse and count down by seven from a randomly presented number between 50 and 100 to assess their dual task (cognitive-motor) performance. All cognitive, motor, and dual cognitive-motor test scores differed significantly between the IS and healthy control groups. The time taken to complete all these tasks was longer for participants with IS compared with controls (p < .05). These results revealed diminished performances on dual cognitive-motor tasks among adolescents with IS when compared to peers without IS. Dual task performance is a new research paradigm in the scoliosis rehabilitation field, and it should be further investigated in future studies.

Differences in Habitual and Maximal Gait Velocity Across Age Groups: A Cross-Sectional Examination.

Prior work, primarily focusing on habitual gait velocity, has demonstrated a cost while walking when coupled with a cognitive task. The cost of dual-task walking is exacerbated with age and complexity of the cognitive or motor task. However, few studies have examined the dual-task cost associated with maximal gait velocity. Thus, this cross-sectional study examined age-related changes in dual-task (serial subtraction) walking at two velocities. Participants were classified by age: young-old (45-64 years), middle-old (65-79 years), and oldest-old (≥80 years). They completed single- and dual-task walking trials for each velocity: habitual (N = 217) and maximal (N = 194). While no significant Group × Condition interactions existed for habitual or maximal gait velocities, the main effects for both condition and age groups were significant (p < .01). Maximal dual-task cost (p = .01) was significantly greater in the oldest-old group. With age, both dual-task velocities decreased. Maximal dual-task cost was greatest for the oldest-old group.

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.

Cognitive and visual task effects on gaze behaviour and gait of younger and older adults.

Cognitive dual tasks alter gait of younger and older adults and recent research has demonstrated that they also influence gaze behaviour and standing postural control. These findings suggest that age-related changes in cognitive and gaze function might increase fall risk in older adults. The purpose of this study was to determine the effect cognitive and visual dual tasks on the gait and gaze behaviour of younger and older adults. Ten older and ten younger adults walked for 3 min on a treadmill at preferred walking speed under three conditions, single task, cognitive and visual dual task conditions. Gait dynamics were measured using accelerometry and gaze behaviour was measured using wearable eye-trackers. Stride time variability and centre of mass (COM) motion complexity increased in dual-task conditions in older adults but had no difference for younger adults. Dual tasks had limited effect on gaze behaviour; however, visual input duration was greater, and visual input frequency and saccade frequency were lower in older than younger adults. The gaze adaptations in older adults may be the result of slower visual processing or represent a compensatory strategy to suppress postural movement. The increase in gait COM motion complexity in older adults suggests the dual tasks led to more automatic gait control resulting from both cognitive and visual tasks.