Myths and methodologies: Assessing glycaemic control and associated regulatory mechanisms in human physiology research.

Accurate measurements of glycaemic control and the underpinning regulatory mechanisms are vital in human physiology research. Glycaemic control is the maintenance of blood glucose concentrations within optimal levels and is governed by physiological variables including insulin sensitivity, glucose tolerance and ß-cell function. These can be measured with a plethora of methods, all with their own benefits and limitations. Deciding on the best method to use is challenging and depends on the specific research question(s). This review therefore discusses the theory and procedure, validity and reliability and any special considerations of a range common methods used to measure glycaemic control, insulin sensitivity, glucose tolerance and ß-cell function. Methods reviewed include glycosylated haemoglobin, continuous glucose monitors, the oral glucose tolerance test, mixed meal tolerance test, hyperinsulinaemic euglycaemic clamp, hyperglycaemic clamp, intravenous glucose tolerance test and indices derived from both fasting concentrations and the oral glucose tolerance test. This review aims to help direct understanding, assessment and decisions regarding which method to use based on specific physiology-related research questions.

Acute Effects of Intracontrast Rest After Back Squats on Vertical Jump Performance During Complex Training.

ABSTRACT: Houlton, LJ, Moody, JA, Bampouras, TM, and Esformes, JI. Acute effects of intracomplex rest after back squats on vertical jump performance during complex training. J Strength Cond Res XX(X): 000-000, 2024-Postactivation performance enhancement and complex-contrast sets are prevalent in sports science research. Typical complex-contrast sets consist of heavy back squats, an intracontrast rest period (ICRP) and vertical jumps (countermovement jumps [CMJs], or squat jumps [SJs]). Propulsive impulse (Jprop) is considered the leading indicator of jump performance. However, studies evaluating jump performance during complex-contrast sets use jump height as the primary performance measure, limiting insight into ICRP's effect on jump performance. We assessed the effect of a 3 repetition maximum (3RM) back squat and 6 ICRPs on vertical jump Jprop and associated force-time components. Fourteen subjects completed 12 experimental conditions, assigned equally to 4 testing sessions. Independent variables, in a 6 × 2 randomized, counterbalanced design, were ICRP (0, 60, 120, 180, 240, 300 seconds; ICRP0, ICRP60, ICRP120, ICRP180, ICRP240, ICRP300, respectively) and vertical jump (CMJ and SJ). Conditions consisted of baseline vertical jumps, followed by 3 back squat repetitions at 100% 3RM, an ICRP and experimental jumps. Symmetrized percentage changes between experimental and baseline jumps were assessed using repeated measures analysis of variance (ANOVA) and pairwise effect sizes. Results showed significant effects (p ≤ 0.05) on CMJ average rate of force development (RFD) between ICRP0 and ICRP120 and ICRP0 and ICRP300. Pairwise comparisons showed medium and large effect sizes for and increases in CMJ RFD (g = 0.83-2.69) whereas SJ RFD decreased (g = 0.81-2.57). Small effect sizes were found for Jprop, peak force, and mean force. Results suggest limited change in Jprop (g = 0.01-0.58), but back squats may potentiate RFD via the stretch-shortening cycle.

Comparing proficiency of obstetrics and gynaecology trainees with general surgery trainees using simulated laparoscopic tasks in Health Education England, North-West: a prospective observational study.

BACKGROUND: Training programmes for obstetrics and gynaecology (O&G) and general surgery (GS) vary significantly, but both require proficiency in laparoscopic skills. We sought to determine performance in each specialty. DESIGN: Prospective, observational study. SETTING: Health Education England North-West, UK. PARTICIPANTS: 47 surgical trainees (24 O&G and 23 GS) were subdivided into four groups: 11 junior O&G, 13 senior O&G, 11 junior GS and 12 senior GS trainees. OBJECTIVES: Trainees were tested on four simulated laparoscopic tasks: laparoscopic camera navigation (LCN), hand-eye coordination (HEC), bimanual coordination (BMC) and suturing with intracorporeal knot tying (suturing). RESULTS: O&G trainees completed LCN (p<0.001), HEC (p<0.001) and BMC (p<0.001) significantly slower than GS trainees. Furthermore, O&G found fewer number of targets in LCN (p=0.001) and dropped a greater number of pins than the GS trainees in BMC (p=0.04). In all three tasks, there were significant differences between O&G and GS trainees but no difference between the junior and senior groups within each specialty. Performance in suturing also varied by specialty; senior O&G trainees scored significantly lower than senior GS trainees (O&G 11.4±4.4 vs GS 16.8±2.1, p=0.03). Whilst suturing scores improved with seniority among O&G trainees, there was no difference between the junior and senior GS trainees (senior O&G 11.4±4.4 vs junior O&G 3.6±2.1, p=0.004). DISCUSSION: GS trainees performed better than O&G trainees in core laparoscopic skills, and the structure of O&G training may require modification. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT05116332).

Age-related changes to the attentional modulation of temporal binding.

During multisensory integration, the time range within which visual and auditory information can be perceived as synchronous and bound together is known as the temporal binding window (TBW). With increasing age, the TBW becomes wider, such that older adults erroneously, and often dangerously, integrate sensory inputs that are asynchronous. Recent research suggests that attentional cues can narrow the width of the TBW in younger adults, sharpening temporal perception and increasing the accuracy of integration. However, due to their age-related declines in attentional control, it is not yet known whether older adults can deploy attentional resources to narrow the TBW in the same way as younger adults. This study investigated the age-related changes to the attentional modulation of the TBW. Thirty younger and 30 older adults completed a cued-spatial-attention version of the stream-bounce illusion, assessing the extent to which the visual and auditory stimuli were integrated when presented at three different stimulus-onset asynchronies, and when attending to a validly cued or invalidly cued location. A 2 × 2 × 3 mixed ANOVA revealed that when participants attended to the validly cued location (i.e., when attention was present), susceptibility to the stream-bounce illusion decreased. However, crucially, this attentional manipulation significantly affected audiovisual integration in younger adults, but not in older adults. These findings suggest that older adults have multisensory integration-related attentional deficits. Directions for future research and practical applications surrounding treatments to improve the safety of older adults' perception and navigation through the environment are discussed.

Surgical stress: the muscle and cognitive demands of robotic and laparoscopic surgery.

Introduction: Surgeons are among the most at-risk professionals for work-related musculoskeletal decline and experience high mental demands. This study examined the electromyographic (EMG) and electroencephalographic (EEG) activities of surgeons during surgery. Methods: Surgeons who performed live laparoscopic (LS) and robotic (RS) surgeries underwent EMG and EEG measurements. Wireless EMG was used to measure muscle activation in four muscle groups bilaterally (biceps brachii, deltoid, upper trapezius, and latissimus dorsi), and an 8-channel wireless EEG device was used to measure cognitive demand. EMG and EEG recordings were completed simultaneously during (i) noncritical bowel dissection, (ii) critical vessel dissection, and (iii) dissection after vessel control. Robust ANOVA was used to compare the %MVCRMS and alpha power between LS and RS. Results: Thirteen male surgeons performed 26 laparoscopic surgeries (LS) and 28 robotic surgeries (RS). Muscle activation was significantly higher in the right deltoid (p = 0.006), upper trapezius (left, p = 0.041; right, p = 0.032), and latissimus dorsi (left, p = 0.003; right, p = 0.014) muscles in the LS group. There was greater muscle activation in the right biceps than in the left biceps in both surgical modalities (both p = 0.0001). There was a significant effect of the time of surgery on the EEG activity (p <0.0001). A significantly greater cognitive demand was observed in the RS than in the LS with alpha, beta, theta, delta, and gamma (p = 0.002 - p <0.0001). Conclusion: These data suggest greater muscle demands in laparoscopic surgery, but greater cognitive demands in robotic surgery.

What is the effect of ankle disk training and taping on proprioception deficit after lateral ankle sprains among active populations? - A systematic review.

OBJECTIVE: To investigate the effect of disk training and tape application on diminished proprioception after Lateral Ankle Sprain (LAS) in active populations. ELIGIBILITY CRITERIA: Only clinical trials investigating the effectiveness of disk training and ankle tape on proprioception deficits following LAS by assessing JPS or kinaesthesia were included. INFORMATION SOURCES: Electronic databases of PubMed, MEDLINE, SPORTDiscus, CINAHL, Web of Science, Cochrane and PEDro were searched. The main search was conducted in February 2022. RISK OF BIAS: The physiotherapy Evidence Database (PEDro) scale was utilised to assess the methodological quality of each article. RESULT: The search yielded six studies investigating the effects of disk training and four studies investigating the effects of inelastic tape. Five articles showed a significant improvement on JPS after disk training. However, no difference across different intervention groups was observed in one study. Only one trial presented an immediate significant improvement when taped, while another study showed that external ankle supports significantly improved JPS after 2 weeks and after 2 months. Three of four studies found no immediate improvement on proprioceptive deficits by the use of tape. CONCLUSIONS: This review found that disk training may improve impaired proprioception after LAS, whilst the efficacy of inelastic tape was not evident due to methodological quality of the few available studies. Further studies are needed to establish whether these interventions can be used clinically with sufficient evidence.

Should All Minimal Access Surgery Be Robot-Assisted? A Systematic Review into the Musculoskeletal and Cognitive Demands of Laparoscopic and Robot-Assisted Laparoscopic Surgery.

BACKGROUND: Surgeons are among the most at risk of work-related musculoskeletal health decline because of the physical demands of surgery, which is also associated with cognitive fatigue. Minimally invasive surgery offers excellent benefits to patients but the impact of robotic or laparoscopic surgery on surgeon well-being is less well understood. This work examined the musculoskeletal and cognitive demands of robot-assisted versus standard laparoscopic surgery. METHODS: Medline, Embase and Cochrane databases were systematically searched for 'Muscle strain' AND 'musculoskeletal fatigue' AND 'occupational diseases' OR 'cognitive fatigue' AND 'mental fatigue' OR 'standard laparoscopic surgery' AND 'robot-assisted laparoscopic surgery'. Primary outcomes measured were electromyographic (EMG) activity for musculoskeletal fatigue and questionnaires (NASA-TLX, SMEQ, or Borg CR-10) for cognitive fatigue. A systematic review was conducted in accordance with the Synthesis Without Meta-analysis (SWiM) Guidelines. The study was preregistered on Prospero ID: CRD42020184881. RESULTS: Two hundred and ninety-eight original titles were identified. Ten studies that were all observational studies were included in the systematic review. EMG activity was consistently lower in robotic than in laparoscopic surgery in the erector spinae and flexor digitorum muscles but higher in the trapezius muscle. This was associated with significantly lower cognitive load in robotic than laparoscopic surgery in 7 of 10 studies. CONCLUSIONS: Evidence suggests a reduction in musculoskeletal demands during robotic surgery in muscles excluding the trapezius, and this is associated with most studies reporting a reduced cognitive load. Robotic surgery appears to have less negative cognitive and musculoskeletal impact on surgeons compared to laparoscopic surgery.

Improved Ankle Mobility After a 4-Week Training Program Affects Landing Mechanics: A Randomized Controlled Trial.

ABSTRACT: Howe, LP, Bampouras, TM, North, JS, and Waldron, M. Improved ankle mobility after a 4-week training program affects landing mechanics: a randomized controlled trial. J Strength Cond Res 36(7): 1875-1883, 2022-This study examined the effects of a 4-week ankle mobility intervention on landing mechanics. Twenty subjects with restricted ankle dorsiflexion range of motion (DF ROM) were allocated to either a strength training only (n = 9) or a strength training and ankle mobility program (n = 11). Subjects performed a weight-bearing lunge test and bilateral drop-landings before and after the intervention. Normalized peak vertical ground reaction force (vGRF), time to peak vGRF, and loading rate were calculated, alongside sagittal-plane initial contact angles, peak angles, and sagittal-plane joint displacement for the ankle, knee, and hip. Frontal-plane projection angles were also calculated. After the intervention, only the strength and mobility group improved ankle DF ROM (mean difference = 4.1°, effect size [ES] = 1.00, p = 0.002). A one-way analysis of covariance found group effects for ankle joint angle at initial contact (p = 0.045), ankle (p < 0.001) and hip joint angle at peak flexion (p = 0.041), and sagittal-plane ankle (p < 0.001) and hip joint displacement (p = 0.024) during bilateral drop-landings. Post hoc analysis revealed that the strength and mobility group landed with greater ankle plantarflexion at initial contact (mean difference = 1.4 ± 2.0°, ES = 0.46) and ankle dorsiflexion at peak flexion (mean difference = 6.3 ± 2.9°, ES = 0.74) after the intervention, resulting in a greater ankle joint displacement (mean difference = 7.7 ± 4.0°, ES = 1.00). However, the strength training only group landed with increased peak hip flexion (mean difference = 14.4 ± 11.0°, ES = 0.70) and hip joint displacement (mean difference = 8.0 ± 6.6°, ES = 0.44) during post-testing. The findings suggest that changes in landing strategies following the performance of a strength training program are specific to whether restrictions in ankle mobility are considered as part of the intervention.

Weighted vests in CrossFit increase physiological stress during walking and running without changes in spatiotemporal gait parameters.

This study quantified the physiological and biomechanical effects of the 20 lb (9.07 kg, males) and 14 lb (6.35 kg, females) weighted vest used in CrossFit, and whether they were predisposed to injury. Twenty subjects (10 males, 10 females) undertook walking (0%, 5% and 10% gradient) and running trials in two randomised study visits (weighted vest/no weighted vest). Physiological demand during walking was increased with the vest at 10% but not 5% or 0% with no change in gait variables. In the running trial, the weighted vest increased oxygen uptake (males; females) (+0.22L/min, p < 0.01; +0.07 L/min, p < 0.05), heart rate (+11bpm, p < 0.01; +11bpm, p < 0.05), carbohydrate oxidation (+0.6 g/min, p < 0.001; +0.2 g/min, p < 0.01), and energy expenditure (+3.8 kJ/min, p < 0.001; +1.5 kJ/min, p < 0.05) whilst blood lactate was increased only in males (+0.6 mmol/L, p < 0.05). There was no change in stride length or frequency. Weighted vest training increases physiological stress and carbohydrate oxidation without affecting measured gait parameters. Practitioner summary: We examined the effect of weighted vest training prescribed in CrossFit (20 lb/9.07 kg, males and 14 lb/6.35 kg, females) in a randomised controlled trial. We found that physiological stress is increased in both sexes, although three-fold greater in males, but with no change in biomechanical gait that predisposes to lower-limb injury.

High Intensity Interval Training (HIIT) as a Potential Countermeasure for Phenotypic Characteristics of Sarcopenia: A Scoping Review.

Background: Sarcopenia is defined as a progressive and generalized loss of skeletal muscle quantity and function associated predominantly with aging. Physical activity appears the most promising intervention to attenuate sarcopenia, yet physical activity guidelines are rarely met. In recent years high intensity interval training (HIIT) has garnered interested in athletic populations, clinical populations, and general population alike. There is emerging evidence of the efficacy of HIIT in the young old (i.e. seventh decade of life), yet data concerning the oldest old (i.e., ninth decade of life onwards), and those diagnosed with sarcopenic are sparse. Objectives: In this scoping review of the literature, we aggregated information regarding HIIT as a potential intervention to attenuate phenotypic characteristics of sarcopenia. Eligibility Criteria: Original investigations concerning the impact of HIIT on muscle function, muscle quantity or quality, and physical performance in older individuals (mean age ≥60 years of age) were considered. Sources of Evidence: Five electronic databases (Medline, EMBASE, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials [CENTRAL]) were searched. Methods: A scoping review was conducted using the Arksey and O'Malley methodological framework (2005). Review selection and characterization were performed by two independent reviewers using pretested forms. Results: Authors reviewed 1,063 titles and abstracts for inclusion with 74 selected for full text review. Thirty-two studies were analyzed. Twenty-seven studies had a mean participant age in the 60s, two in the 70s, and three in the 80s. There were 20 studies which examined the effect of HIIT on muscle function, 22 which examined muscle quantity, and 12 which examined physical performance. HIIT was generally effective in Improving muscle function and physical performance compared to non-exercised controls, moderate intensity continuous training, or pre-HIIT (study design-dependent), with more ambiguity concerning muscle quantity. Conclusions: Most studies presented herein utilized outcome measures defined by the European Working Group on Sarcopenia in Older People (EWGSOP). However, there are too few studies investigating any form of HIIT in the oldest old (i.e., ≥80 years of age), or those already sarcopenic. Therefore, more intervention studies are needed in this population.

Upper limb muscle strength and knee frontal plane projection angle asymmetries in female water-polo players.

Water-polo players frequently perform overhead throws that could result in shoulder imbalances. For overhead throws, execution of the 'eggbeater kick' (cyclical movement of the legs) is required to lift the body out of the water. Although a symmetrical action, inter-limb differences in task execution could lead to knee frontal plane projection (FPPA) differences. The present study examined imbalances shoulder and knee FPPA in female players. Eighteen competitive female field players (24.1 ± 5.5 years, 1.68 ± 0.06 m, 72.9 ± 13.3 kg) had their shoulder strength assessed in a shot-mimicking position with a portable dynamometer, standing and seated (isolating the shoulder contribution). Anterior: posterior and shooting: non-shooting shoulder comparison were made. Additionally, players performed a drop jump. Knee FPPA was recorded from digitising and comparing the frames just before landing and at stance phase. During standing, players exhibited higher shooting: non-shooting asymmetry (p = 0.032) in the anterior contraction direction, while during seated the shooting shoulder anterior: posterior asymmetry was higher (p = 0.032). Interlimb knee FPPA asymmetry was higher in the stance phase (p = 0.02). Despite the overhead throwing and egg-beater demands impacting differently on each limb, considerable asymmetries do not develop, suggesting the overall training requirements (e.g. swimming, resistance training) were sufficient to maintain the asymmetry within desirable limits.

Home-based exercise for people living with frailty and chronic kidney disease: A mixed-methods pilot randomised controlled trial.

BACKGROUND: Frailty is associated with adverse health outcomes in people with chronic kidney disease (CKD). Evidence supporting targeted interventions is needed. This pilot randomised controlled trial (RCT) aimed to inform the design of a definitive RCT evaluating the effectiveness of a home-based exercise intervention for pre-frail and frail older adults with CKD. METHODS: Participants were recruited from nephrology outpatient clinics to this two-arm parallel group mixed-methods pilot RCT. Inclusion criteria were: ≥65 years old; CKD G3b-5; and Clinical Frailty Scale score ≥4. Participants categorised as pre-frail or frail using the Frailty Phenotype were randomised to a 12-week progressive multi-component home-based exercise programme or usual care. Primary outcome measures included eligibility, recruitment, adherence, outcome measure completion and participant attrition rate. Semi-structured interviews were conducted with participants to explore trial and intervention acceptability. RESULTS: Six hundred and sixty-five patients had an eligibility assessment with 217 (33%; 95% CI 29, 36) eligible. Thirty-five (16%; 95% CI 12, 22) participants were recruited. Six were categorised as robust and withdrawn prior to randomisation. Fifteen participants were randomised to exercise and 14 to usual care. Eleven (73%; 95% CI 45, 91) participants completed ≥2 exercise sessions/week. Retained participants completed all outcome measures (n = 21; 100%; 95% CI 81, 100). Eight (28%; 95% CI 13, 47) participants were withdrawn. Fifteen participated in interviews. Decision to participate/withdraw was influenced by perceived risk of exercise worsening symptoms. Participant perceived benefits included improved fitness, balance, strength, well-being, energy levels and confidence. CONCLUSIONS: This pilot RCT demonstrates that progression to definitive RCT is possible provided recruitment and retention challenges are addressed. It has also provided preliminary evidence that home-based exercise may be beneficial for people living with frailty and CKD. TRIAL REGISTRATION: ISRCTN87708989; https://clinicaltrials.gov/.

Erratum: Frailty is independently associated with worse health-related quality of life in chronic kidney disease: a secondary analysis of the Frailty Assessment in Chronic Kidney Disease study.

[This corrects the article DOI: 10.1093/ckj/sfz038.].

Restrictions in Ankle Dorsiflexion Range of Motion Alter Landing Kinematics But Not Movement Strategy When Fatigued.

CONTEXT: Ankle dorsiflexion range of motion (DF ROM) has been associated with a number of kinematic and kinetic variables associated with landing performance that increase injury risk. However, whether exercise-induced fatigue exacerbates compensatory strategies has not yet been established. OBJECTIVES: (1) Explore differences in landing performance between individuals with restricted and normal ankle DF ROM and (2) identify the effect of fatigue on compensations in landing strategies for individuals with restricted and normal ankle DF ROM. DESIGN: Cross-sectional. SETTING: University research laboratory. PATIENTS OR OTHER PARTICIPANTS: Twelve recreational athletes with restricted ankle DF ROM (restricted group) and 12 recreational athletes with normal ankle DF ROM (normal group). MAIN OUTCOME MEASURE(S): The participants performed 5 bilateral drop-landings, before and following a fatiguing protocol. Normalized peak vertical ground reaction force, time to peak vertical ground reaction force, and loading rate were calculated, alongside sagittal plane initial contact angles, peak angles, and joint displacement for the ankle, knee, and hip. Frontal plane projection angles were also calculated. RESULTS: At the baseline, the restricted group landed with significantly less knee flexion (P = .005, effect size [ES] = 1.27) at initial contact and reduced peak ankle dorsiflexion (P < .001, ES = 1.67), knee flexion (P < .001, ES = 2.18), and hip-flexion (P = .033, ES = 0.93) angles. Sagittal plane joint displacement was also significantly less for the restricted group for the ankle (P < .001, ES = 1.78), knee (P < .001, ES = 1.78), and hip (P = .028, ES = 0.96) joints. CONCLUSIONS: These findings suggest that individuals with restricted ankle DF ROM should adopt different landing strategies than those with normal ankle DF ROM. This is exacerbated when fatigued, although the functional consequences of fatigue on landing mechanics in individuals with ankle DF ROM restriction are unclear.

Effect of environmental temperature change on the neuromechanical function of the quadriceps muscle.

AbstractThis study compared neuromechanical characteristics of voluntary (maximum voluntary contraction (MVC) peak torque, rate of torque development (RTD), voluntary activation (VA)) and electrically stimulated contractions (peak torque, RTD) when performed under the same temperature conditions. Twelve physically active males performed two isometric MVCs of the quadriceps muscle group in an isokinetic dynamometer. The MVCs were performed after lower limb submersion for 20 min in hot (40°C) or cold (10°C) water. A control MVC was performed in ambient room temperature (17 ± 0.7°C). Electrical twitches were delivered at rest pre-MVC (Unpotentiated), during the plateau phase of the MVC (Superimposed) and post-MVC (Potentiated). Peak torque for MVC, Unpotentiated and Potentiated was recorded. RTD was calculated for the MVC (at 50, 100, 150, 200 ms and peak torque time points), Unpotentiated and Potentiated twitches, while VA (using the central activation ratio method) was calculated. There was no significant change between conditions in MVC peak torque, MVC RTD, VA and (averaged) twitch peak torque (p > 0.05). Twitch RTD for the hot condition (1025.0 ± 163.0 N·m·s-1) was significantly higher (p = 0.003) than control (872.3 ± 142.9 N·m·s-1). In conclusion, environmental temperature changes, in the range examined, do not affect the ability to generate maximum torque or any of the RTD parameters in maximum voluntary isometric contractions. In contrast, increased heat results in higher RTD in electrically stimulated contractions, most likely induced by reduced contraction time. This has practical implications for the use of electromyostimulation for injury prevention.

Erratum: Frailty is independently associated with worse health-related quality of life in chronic kidney disease: a secondary analysis of the Frailty Assessment in Chronic Kidney Disease study.

[This corrects the article DOI: 10.1093/ckj/sfz038.].

The EX-FRAIL CKD trial: a study protocol for a pilot randomised controlled trial of a home-based EXercise programme for pre-frail and FRAIL, older adults with Chronic Kidney Disease.

INTRODUCTION: Frailty is highly prevalent in adults with chronic kidney disease (CKD) and is associated with adverse health outcomes including falls, poorer health-related quality of life (HRQOL), hospitalisation and mortality. Low physical activity and muscle wasting are important contributors to physical frailty in adults with CKD. Exercise training may improve physical function and frailty status leading to associated improvements in health outcomes, including HRQOL. The EX-FRAIL CKD trial aims to inform the design of a definitive randomised controlled trial (RCT) that investigates the effectiveness of a progressive, multicomponent home-based exercise programme in prefrail and frail older adults with CKD. METHODS AND ANALYSIS: The EX-FRAIL CKD trial is a two-arm parallel group pilot RCT. Participants categorised as prefrail or frail, following Frailty Phenotype (FP) assessment, will be randomised to receive exercise or usual care. Participants randomised to the intervention arm will receive a tailored 12-week exercise programme, which includes weekly telephone calls to advise on exercise progression. Primary feasibility outcome measures include rate of recruitment, intervention adherence, outcome measure completion and participant attrition. Semistructured interviews with a purposively selected group of participants will inform the feasibility of the randomisation procedures, outcome measures and intervention. Secondary outcome measures include physical function (walking speed and Short Physical Performance Battery), frailty status (FP), fall concern (Falls Efficacy Scale-International tool), activities of daily living (Barthel Index), symptom burden (Palliative care Outcome Scale-Symptoms RENAL) and HRQOL (Short Form-12v2). ETHICS AND DISSEMINATION: Ethical approval was granted by a National Health Service (NHS) Regional Ethics Committee and the NHS Health Research Authority. The study team aims to publish findings in a peer-reviewed journal and presents the results at relevant national and international conferences. A summary of findings will be provided to participants, a local kidney patient charity and the funding body. TRIAL REGISTRATION NUMBER: ISRCTN87708989.

WITHIN-SESSION RELIABILITY FOR INTER-LIMB ASYMMETRIES IN ANKLE DORSIFLEXION RANGE OF MOTION MEASURED DURING THE WEIGHT-BEARING LUNGE TEST.

BACKGROUND: The identification of asymmetrical inter-limb ankle dorsiflexion range of motion (DF ROM) has the potential to influence the course of treatment during the rehabilitation process, with limitations in ankle DF ROM potentially increasing injury risk. However, reliability for methods to identify ankle DF ROM asymmetries remain under described in the literature. PURPOSE: To determine the reliability of the trigonometric calculation method for measuring ankle DF ROM during the weight-bearing lunge test (WBLT) for both a single limb and the symmetry values. The secondary purpose was to establish values of ankle DF ROM asymmetry and identify the influence of leg dominance on ankle DF ROM. STUDY DESIGN: Cross-sectional study. METHODS: Ankle DF ROM was measured bilaterally in 50 healthy and recreationally active participants (28 men, 22 women, age = 22 ± 4 years, height = 172.8 ± 10.8 cm, body mass 71.5 ± 15.1 kg), using the trigonometric measurement method during the WBLT. Each ankle was measured twice in a single testing session to establish within-session reliability. RESULTS: Values are presented for asymmetries in DF ROM. No differences were identified between the dominant and non-dominant limb (p = 0.862). Within-session reliability for measuring a single limb was classified as 'good' (ICC = 0.98) with a minimal detectable change value of 1.7 °. For measuring ankle DF ROM asymmetry, reliability was established as 'good' (ICC = 0.85) and a minimal detectable change value of 2.1 ° was determined. CONCLUSIONS: Although symmetry in ankle DF ROM may not be assumed, the magnitude of asymmetry may be less than previously reported in a population of recreationally active individuals. Discrepancies between previous research and the findings of the present study may have been impacted by differences in measurement methods. Furthermore, clinicians should be aware that the error associated with measures of asymmetry for ankle DF ROM during the WBLT is greater than that of a single limb. LEVEL OF EVIDENCE: 2b.

Frailty is independently associated with worse health-related quality of life in chronic kidney disease: a secondary analysis of the Frailty Assessment in Chronic Kidney Disease study.

Background: Understanding how frailty affects health-related quality of life (HRQOL) in those with chronic kidney disease (CKD) could assist in the development of management strategies to improve outcomes for this vulnerable patient group. This study aimed to evaluate the relationship between frailty and HRQOL in patients with CKD Stages 4 and 5 (G4­5) and those established on haemodialysis (G5D). Methods: Ninety participants with chronic kidney disease (CKD G4­5D) were recruited between December 2016 and December 2017. Frailty was assessed using the Frailty Phenotype, which included assessments of unintentional weight loss, weakness (handgrip strength), slowness (walking speed), physical activity and self-perceived exhaustion. HRQOL was assessed using the RAND 36-Item Health Survey Version 1.0 (SF-36). Results: Nineteen (21%) patients were categorized as frail. Frailty, when adjusted for age, gender, dialysis dependence and comorbidity, had a significant effect on five of the eight SF-36 domains: physical functioning, role limitations due to emotional problems, energy/fatigue, social functioning and pain. Regression modelling best explained the variation in the physical functioning domain (adj. R2 = 0.27, P < 0.001), with frailty leading to a 26-point lower score. Exhaustion was the only Frailty Phenotype component that had a significant effect on scores across all SF-36 domains. Conclusions: Frailty is independently associated with worse HRQOL in patients with CKD G4­5D, with self-perceived exhaustion being the most significant Frailty Phenotype component contributing to HRQOL. Efforts should be made to identify frail patients with CKD so that management strategies can be offered that aim to improve morbidity, mortality and patient-reported outcomes, including HRQOL and fatigue.

Restricted Unilateral Ankle Dorsiflexion Movement Increases Interlimb Vertical Force Asymmetries in Bilateral Bodyweight Squatting.

Crowe, MA, Bampouras, TM, Small, K, and Howe, LP. Restricted unilateral ankle dorsiflexion movement increases interlimb vertical force asymmetries in bilateral bodyweight squatting. J Strength Cond Res 34(2): 332-336, 2020-The purpose of this study was to investigate the effect of unilateral restrictions in ankle-dorsiflexion range of motion (DF-ROM) on interlimb vertical ground reaction force (vGRF) asymmetries. Twenty healthy and physically active volunteers (age 23 ± 3 years; height 1.72 ± 0.1 m; mass 74.9 ± 20.3 kg) performed 3 barefoot bodyweight squats (control condition) and with a 10° custom-built forefoot wedge under the right foot to artificially imitate ankle DF-ROM restriction (wedge condition). Force data were used to calculate the mean asymmetry index score for the upper descent phase, lower descent phase, lower ascent phase, and upper ascent phase during the bilateral squat. Significant differences were found for comparisons for each phase between conditions, with effect sizes ranging between 0.7 and 1.1. Asymmetry index scores indicated that for all phases, the unrestricted limb in the wedge condition produced greater vGRF. Therefore, interlimb differences in ankle DF-ROM can cause interlimb asymmetries in vGRF during bilateral squatting. As such, athletes with asymmetrical squat mechanics should be screened for interlimb differences in ankle DF-ROM to ascertain whether it is a contributing factor.