Can strength training or tai ji quan training reduce frailty in postmenopausal women treated with chemotherapy? A secondary data analysis of the GET FIT trial.

PURPOSE: To determine whether strength training or tai ji quan can reduce frailty in older, postmenopausal women treated with chemotherapy for cancer. METHODS: We conducted a secondary data analysis from a 3-arm, single-blind, randomized controlled trial where older (50-75 years), postmenopausal women cancer survivors were randomized to supervised group exercise programs: tai ji quan, strength training, or stretching control for 6 months. We assessed frailty using a 4-criteria model consisting of weakness, fatigue, inactivity, and slowness. Using logistic regression, we determined whether the frailty phenotype (pre-frailty or frailty) decreased post-intervention, how many and which frailty criteria decreased, and what characteristics identified women most likely to reduce frailty. RESULTS: Data from 386 women who completed baseline and 6-month testing were used (mean age of 62.0 ± 6.4 years). The odds of reducing overall frailty over 6 months were significantly higher in the strength training group compared to controls (OR [95%CI] 1.86 [1.09, 3.17]) but not for tai ji quan (1.44 [0.84, 2.50]). Both strength training (OR 1.99 [1.10, 3.65]) and tai ji quan (OR 2.10 [1.16, 3.84]) led to significantly higher odds of reducing ≥ 1 frailty criterion compared to controls. Strength training led to a three-fold reduction in inactivity (p < 0.01) and tai ji quan to a two-fold reduction in fatigue (p = 0.08) versus control. Higher baseline BMI, comorbidity score, and frailty status characterized women were more likely to reduce frailty than other women. CONCLUSIONS: Strength training appears superior to tai ji quan and stretching with respect to reducing overall frailty phenotype among postmenopausal women treated with chemotherapy for cancer, but tai ji quan favorably reduced the number of frailty criteria. TRIAL REGISTRATION: ClinicalTrials.gov identifier: GET FIT was registered as a clinical trial in clinicaltrials.gov: NCT01635413. IMPLICATIONS FOR CANCER SURVIVORS: Supervised, group exercise training that emphasizes strength training and/or tai ji quan may help combat accelerated aging and reduce frailty after cancer treatment.

The effect of Tai Chi lower extremity exercise on the balance control of older adults in assistant living communities.

BACKGROUND: Although Tai Chi (TC) is an evidence-based fall prevention training for older adults, its effective movements remain unclear, which may limit the practice of TC. The purpose of this study was to compare the effectiveness of TC lower extremity exercise (TC LEE), the 8-form Tai Chi (8-form TC), and a stretching control intervention for improving balance and functional mobility among older adults. METHODS: This was a randomized controlled trial. A total of 102 participants (79 ± 6 years old) were recruited from assisted living facilities. All participants were randomly assigned to the TC LEE (n = 40), 8-form TC (n = 31), and stretching (n = 31) groups in which they received the respective interventions for 16 weeks. The Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and center of pressure (COP) measurements during quiet stance were collected prior to and following the 16-week interventions. Comparisons on all measurements were conducted among all groups. RESULTS: Significant improvements were found in BBS (P = 0.002), TUG test (P = 0.001), root mean square amplitude of COP displacement in the anterior-posterior (P = 0.001) and medial-lateral (P = 0.001) directions, and average COP speed in the anterior-posterior (P = 0.001) and medial-lateral (P = 0.001) directions after training in the TC intervention groups compared with the stretching group. The upper limit of the 95% confidence interval (CI) of differences in change scores on the BBS (-0.8 - 1.3 points) between the TC LEE group and the 8-form TC group was within equivalence margins (1.8 points), while the upper limit of the 95% CI of differences in change scores on the TUG test (0.1 - 2.1 s) exceeded the equivalence margin (0.7 s) with the TC LEE group having the larger change scores. CONCLUSION: TC LEE can improve balance and functional mobility in older adults, and may have greater effect than the 8-form TC on improving functional mobility as measured by the TUG test. TRIAL REGISTRATION: ChiCTR2300070600 retrospectively registered.

LeGO-LOAM-FN: An Improved Simultaneous Localization and Mapping Method Fusing LeGO-LOAM, Faster_GICP and NDT in Complex Orchard Environments.

To solve the problem of cumulative errors when robots build maps in complex orchard environments due to their large scene size, similar features, and unstable motion, this study proposes a loopback registration algorithm based on the fusion of Faster Generalized Iterative Closest Point (Faster_GICP) and Normal Distributions Transform (NDT). First, the algorithm creates a K-Dimensional tree (KD-Tree) structure to eliminate the dynamic obstacle point clouds. Then, the method uses a two-step point filter to reduce the number of feature points of the current frame used for matching and the number of data used for optimization. It also calculates the matching degree of normal distribution probability by meshing the point cloud, and optimizes the precision registration using the Hessian matrix method. In the complex orchard environment with multiple loopback events, the root mean square error and standard deviation of the trajectory of the LeGO-LOAM-FN algorithm are 0.45 m and 0.26 m which are 67% and 73% higher than those of the loopback registration algorithm in the Lightweight and Ground-Optimized LiDAR Odometry and Mapping on Variable Terrain (LeGO-LOAM), respectively. The study proves that this method effectively reduces the influence of the cumulative error, and provides technical support for intelligent operation in the orchard environment.

Cattle Body Detection Based on YOLOv5-EMA for Precision Livestock Farming.

Accurate cattle body detection is crucial for precision livestock farming. However, traditional cattle body detection methods rely on manual observation, which is both time-consuming and labor-intensive. Moreover, computer-vision-based methods suffer prolonged training times and training difficulties. To address these issues, this paper proposes a novel YOLOv5-EMA model for accurate cattle body detection. By incorporating the Efficient Multi-Scale Attention (EMA) module into the backbone of YOLO series detection models, the performance of detecting smaller targets, such as heads and legs, has been significantly improved. The Efficient Multi-Scale Attention (EMA) module utilizes the large receptive fields of parallel sub-networks to gather multi-scale spatial information and establishes mutual dependencies between different spatial positions, enabling cross-spatial learning. This enhancement empowers the model to gather and integrate more comprehensive feature information, thereby improving the effectiveness of cattle body detection. The experimental results confirm the good performance of the YOLOv5-EMA model, showcasing promising results across all quantitative evaluation metrics, qualitative detection findings, and visualized Grad-CAM heatmaps. To be specific, the YOLOv5-EMA model achieves an average precision (mAP@0.5) of 95.1% in cattle body detection, 94.8% in individual cattle detection, 94.8% in leg detection, and 95.5% in head detection. Moreover, this model facilitates the efficient and precise detection of individual cattle and essential body parts in complex scenarios, especially when dealing with small targets and occlusions, significantly advancing the field of precision livestock farming.

YOLOv5-SA-FC: A Novel Pig Detection and Counting Method Based on Shuffle Attention and Focal Complete Intersection over Union.

The efficient detection and counting of pig populations is critical for the promotion of intelligent breeding. Traditional methods for pig detection and counting mainly rely on manual labor, which is either time-consuming and inefficient or lacks sufficient detection accuracy. To address these issues, a novel model for pig detection and counting based on YOLOv5 enhanced with shuffle attention (SA) and Focal-CIoU (FC) is proposed in this paper, which we call YOLOv5-SA-FC. The SA attention module in this model enables multi-channel information fusion with almost no additional parameters, enhancing the richness and robustness of feature extraction. Furthermore, the Focal-CIoU localization loss helps to reduce the impact of sample imbalance on the detection results, improving the overall performance of the model. From the experimental results, the proposed YOLOv5-SA-FC model achieved a mean average precision (mAP) and count accuracy of 93.8% and 95.6%, outperforming other methods in terms of pig detection and counting by 10.2% and 15.8%, respectively. These findings verify the effectiveness of the proposed YOLOv5-SA-FC model for pig population detection and counting in the context of intelligent pig breeding.

Clinical Effectiveness of Cognitively Enhanced Tai Ji Quan Training on Global Cognition and Dual-Task Performance During Walking in Older Adults With Mild Cognitive Impairment or Self-Reported Memory Concerns : A Randomized Controlled Trial.

BACKGROUND: Mild cognitive impairment (MCI) negatively impacts cognition and dual-task abilities. A physical-cognitive integrated treatment approach could mitigate this risk for dementia. OBJECTIVE: To compare the effectiveness of cognitively enhanced tai ji quan versus standard tai ji quan or stretching exercise in improving global cognition and reducing dual-task walking costs in older adults with MCI or self-reported memory concerns. DESIGN: 3-group, randomized (1:1:1), superiority trial. (ClinicalTrials.gov: NCT04070703). SETTING: Community residential homes. PARTICIPANTS: 318 older adults with self-reported memory decline or concern and a Clinical Dementia Rating (CDR) global score of 0.5 or lower at baseline. INTERVENTION: Cognitively enhanced tai ji quan (n = 105), standard tai ji quan (n = 107), or stretching (n = 106). All groups exercised at home via real-time videoconferencing, 1 hour semiweekly for 24 weeks. MEASUREMENTS: The co-primary endpoints were change in Montreal Cognitive Assessment (MoCA; range, 0 to 30) and dual-task walking costs (difference between single- and dual-task gait speed, expressed in percentage) from baseline to 24 weeks. Secondary outcomes included CDR-Sum of Boxes (CDR-SB), Trail Making Test B, Digit Span Backward (DSB), and physical performance tests. Outcomes were assessed at 16, 24 (primary endpoint), and 48 weeks (6 months after intervention). RESULTS: A total of 304 participants (96%) completed the 24-week assessment. Cognitively enhanced tai ji quan outperformed standard tai ji quan and stretching with a greater improvement in MoCA score (mean difference, 1.5 points [98.75% CI, 0.7 to 2.2 points] and 2.8 points [CI, 2.1 to 3.6 points], respectively) and in dual-task walking (mean difference, 9.9% [CI, 2.8% to 16.6%] and 22% [CI, 13% to 31%], respectively). The intervention effects persisted at 48-week follow-up. LIMITATION: There was no nonexercise control group; participants had subjective or mild cognitive impairment. CONCLUSION: Among community-dwelling older adults with MCI, cognitively enriched tai ji quan therapy was superior to standard tai ji quan and stretching exercise in improving global cognition and reducing dual-task gait interference, with outcomes sustained at 48 weeks. PRIMARY FUNDING SOURCE: National Institute on Aging.

Can strength training or tai ji quan training reduce frailty in postmenopausal women treated with chemotherapy? A secondary data analysis of the GET FIT trial.

Purpose: To determine whether strength training or tai ji quan can reduce frailty in older, postmenopausal women treated with chemotherapy for cancer. Methods: We conducted a secondary data analysis from a 3-arm, single-blind, randomized controlled trial where older (50+ years), postmenopausal women cancer survivors were randomized to supervised group exercise programs: tai ji quan, strength training, or stretching control for 6 months. We assessed frailty using a 4-criteria model consisting of weakness, fatigue, inactivity, and slowness. Using logistic regression, we determined whether the frailty phenotype (pre-frailty or frailty) decreased post-intervention, how many and which frailty criteria decreased, and what characteristics identified women most likely to reduce frailty. Results: Data from 386 women who completed baseline and 6-month testing were used (mean age of 62.0 ± 6.4 years). The odds of improving overall frailty phenotype over 6 months was significantly higher in the strength training group compared to controls (OR [95%CI]: 1.86 [1.09, 3.17]), but not for for tai ji quan (1.44 [0.84, 2.50]). Both strength training (OR 1.99 [1.10, 3.65]) and tai ji quan (OR 2.10 [1.16, 3.84]) led to significantly higher odds of reducing ≥1 frailty criterion compared to controls. Strength training led to a three-fold reduction in inactivity (p <0.01), and tai ji quan to a two-fold reduction in fatigue (p=0.08) versus control. Higher baseline BMI, comorbidity score, and frailty status characterized women more likely to reduce frailty than other women. Conclusions: Strength training appears superior to tai ji quan and stretching with respect to reducing overall frailty phenotype among postmenopausal women treated with chemotherapy for cancer, but tai ji quan favorably impacted the number of frailty criteria. Implications for Cancer Survivors: Supervised, group exercise training that emphasizes strength training and/or tai ji quan may help combat accelerated aging and reduce frailty after cancer treatment.

Superelastic Cobalt Silicate@Resorcinol Formaldehyde Resin Core-Shell Nanobelt Aerogel Monoliths with Outstanding Fire Retardant and Thermal Insulating Capability.

The practical applications of resorcinol formaldehyde resin (RFR) aerogels are prevented by their poor mechanical properties. Herein, a facile template-directed method is reported to produce macroscopic free-standing cobalt silicate (CS)@RFR core-shell nanobelt aerogels that display superelastic behavior and outstanding thermal insulating and fire-resistant capability. The synthesis relies on the polymerization of RFR on pre-formed CS nanobelts which leads to in situ formation of hydrogel monoliths that can be transformed to corresponding aerogels by a freeze-drying method. The composite nanobelt aerogel can withstand a compressive load of more than 4000 times of its own weight and fully recover after the removal of the weight. It can also sustain 1000 compressive cycles with 6.9% plastic deformation and 91.8% of the maximum stress remaining, with a constant energy loss coefficient as low as 0.16, at the set strain of 30%. The extraordinary mechanical properties are believed to be associated with the structural flexibility of the nanobelts and the RFR-reinforced joints between the crosslinked nanobelts. These inorganic-organic composite aerogels also show good thermal insulation and excellent fire-proof capability. This work provides an effective strategy for fabricating superelastic RFR-based aerogels which show promising applications in fields such as thermal insulation, energy storage, and catalyst support.

TSML: A New Pig Behavior Recognition Method Based on Two-Stream Mutual Learning Network.

Changes in pig behavior are crucial information in the livestock breeding process, and automatic pig behavior recognition is a vital method for improving pig welfare. However, most methods for pig behavior recognition rely on human observation and deep learning. Human observation is often time-consuming and labor-intensive, while deep learning models with a large number of parameters can result in slow training times and low efficiency. To address these issues, this paper proposes a novel deep mutual learning enhanced two-stream pig behavior recognition approach. The proposed model consists of two mutual learning networks, which include the red-green-blue color model (RGB) and flow streams. Additionally, each branch contains two student networks that learn collaboratively to effectively achieve robust and rich appearance or motion features, ultimately leading to improved recognition performance of pig behaviors. Finally, the results of RGB and flow branches are weighted and fused to further improve the performance of pig behavior recognition. Experimental results demonstrate the effectiveness of the proposed model, which achieves state-of-the-art recognition performance with an accuracy of 96.52%, surpassing other models by 2.71%.

GET FIT: A Randomized Clinical Trial of Tai Ji Quan Versus Strength Training for Fall Prevention After Chemotherapy in Older, Postmenopausal Women Cancer Survivors.

PURPOSE: To compare the efficacy of tai ji quan versus strength training to prevent falls after chemotherapy in older, postmenopaual women. METHODS: We conducted a three-arm, single-blind, randomized controlled trial where older (50+ years), postmenopausal women cancer survivors participated in one of three supervised group exercise programs (tai ji quan, strength training, or stretching control) twice weekly for 6 months and were followed up 6 months after training stopped. The primary outcome was the incidence of falls. Secondary outcomes included fall-related injuries, leg strength (1 repetition maximum; kg), and balance (sensory organization [equilibrium score] and limits of stability [LOS; %] tests). RESULTS: Four hundred sixty-two women were enrolled (mean age, 62 ± 6.3 years). Retention was 93%, and adherence averaged 72.9%. In primary analysis, there was no difference in the incidence of falls between groups after 6 months of training, nor during 6-month follow-up. A post hoc analysis detected a significantly reduced incidence of fall-related injuries within the tai ji quan group over the first 6 months, dropping from 4.3 falls per 100 person-months (95% CI, 2.9 to 5.6) at baseline to 2.4 falls per person-months (95% CI, 1.2 to 3.5). No significant changes occurred during 6-month follow-up. Over the intervention period, leg strength significantly improved in the strength group and balance (LOS) improved in the tai ji quan group, compared with controls (P < .05). CONCLUSION: We found no significant reduction in falls for tai ji quan or strength training relative to stretching control in postmenopausal women treated with chemotherapy.

A Novel Improved YOLOv3-SC Model for Individual Pig Detection.

Pork is the most widely consumed meat product in the world, and achieving accurate detection of individual pigs is of great significance for intelligent pig breeding and health monitoring. Improved pig detection has important implications for improving pork production and quality, as well as economics. However, most of the current approaches are based on manual labor, resulting in unfeasible performance. In order to improve the efficiency and effectiveness of individual pig detection, this paper describes the development of an attention module enhanced YOLOv3-SC model (YOLOv3-SPP-CBAM. SPP denotes the Spatial Pyramid Pooling module and CBAM indicates the Convolutional Block Attention Module). Specifically, leveraging the attention module, the network will extract much richer feature information, leading the improved performance. Furthermore, by integrating the SPP structured network, multi-scale feature fusion can be achieved, which makes the network more robust. On the constructed dataset of 4019 samples, the experimental results showed that the YOLOv3-SC network achieved 99.24% mAP in identifying individual pigs with a detection time of 16 ms. Compared with the other popular four models, including YOLOv1, YOLOv2, Faster-RCNN, and YOLOv3, the mAP of pig identification was improved by 2.31%, 1.44%, 1.28%, and 0.61%, respectively. The YOLOv3-SC proposed in this paper can achieve accurate individual detection of pigs. Consequently, this novel proposed model can be employed for the rapid detection of individual pigs on farms, and provides new ideas for individual pig detection.

Macroporous Vanadium Oxide Ion Storage Films Enable Fast Switching Speed and High Cycling Stability of Electrochromic Devices.

Compared to the significant effort dedicated toward developing efficient electrochromic materials for the working electrodes of electrochromic (EC) devices, the attention paid to developing ion storage counter electrode materials for EC devices has been trivial. Herein, we report that a macroporous crystalline V2O5 film as an ion storage layer paired with a WO3 working electrode results in an EC device with high performance. The macroporous vanadium oxide films are prepared by a simple template-free photodeposition method that allows us to tune the thickness and crystallinity of the film, thus giving access to a full EC device with optimal EC performance: short response time of about 2 s, high electrochromic cycling stability up to 10,000 times, long memory effect over 24 h, and an exceedingly high coloration efficiency of 189 cm2/C that are superior to the state-of-the-art performance of solution-processed vanadium oxide based EC devices. The extraordinary EC performance can be attributed to the macroporous structure, high crystallinity, and optimized thickness of the vanadium oxide films that boost the charge-balancing capability of the films. The easy and controllable preparation and the efficient charge-balancing capability of the macroporous vanadium oxide film make it a promising ion storage material for developing high-performance EC devices.

Modelling of a seasonally perturbed competitive three species impulsive system.

The population of biological species in the ecosystem is known sensitive to the periodic fluctuations of seasonal change, food resources and climatic conditions. Research in the ecological management discipline conventionally models the behavior of such dynamic systems through specific impulsive response functions, but the results of such research are applicable only when the environments conform exactly to the conditions as defined by the specific response functions that have been implemented for specific scenarios. This means that the application of previous work may be somewhat limited. Moreover, the intra and inter competitions among species have been seldom studied for modelling the prey-predator ecosystem. To fill in the gaps this paper models the delicate balance of two-prey and one-predator system by addressing three main areas of: ⅰ) instead of using the specific impulse response this work models the ecosystem through a more general response function; ⅱ) to include the effects due to the competition between species and ⅲ) the system is subjected to the influences of seasonal factors. The seasonal factor has been implemented here in terms of periodic functions to represent the growth rates of predators. The sufficient condition for the local and global asymptotic stability of the prey-free periodic solution and the permanence of the system have been subsequently obtained by using the Comparison techniques and the Floquet theorems. Finally, the correctness of developed theories is verified by numerical simulation, and the corresponding biological explanation is given.

Combining convolutional sparse coding with total variation for sparse-view CT reconstruction.

Conventional dictionary-learning-based computed tomography (CT) reconstruction methods extract patches from an original image to train, ignoring the consistency of pixels in overlapping patches. To address the problem, this paper proposes a method combining convolutional sparse coding (CSC) with total variation (TV) for sparse-view CT reconstruction. The proposed method inherits the advantages of CSC by directly processing the whole image without dividing it into overlapping patches, which preserves more details and reduces artifacts caused by patch aggregation. By introducing a TV regularization term to enhance the constraint of the image domain, the noise can be effectively further suppressed. The alternating direction method of multipliers algorithm is employed to solve the objective function. Numerous experiments are conducted to validate the performance of the proposed method in different views. Qualitative and quantitative results show the superiority of the proposed method in terms of noise suppression, artifact reduction, and image details recovery.

A cognitively enhanced online Tai Ji Quan training intervention for community-dwelling older adults with mild cognitive impairment: A feasibility trial.

BACKGROUND: This study examines the feasibility, acceptability, and safety of a newly developed cognitive-enhancing Tai Ji Quan training intervention, delivered via remote videoconferencing, for older adults with mild cognitive impairment (MCI). METHODS: In a three-arm feasibility trial, community-dwelling older adults with MCI (N = 69; mean age = 74.6 years, 57% women) were randomized to a cognitively enhanced Tai Ji Quan (n = 23), standard Tai Ji Quan (n = 22), or stretching group (n = 24) and participated in a 60-minute online exercise session via Zoom, twice weekly for 16 weeks. Participants were recruited primarily in the state of Oregon through mass mailing and word of mouth. The primary outcomes were intervention feasibility (with respect to recruitment, online intervention delivery, fidelity and compliance, and attrition and retention rates), acceptability, and safety. We also assessed feasibility of online data collection and test-retest reliability and explored preliminary trends on secondary outcomes that included global cognitive function, dual-task cost, and domain-specific cognition function. RESULTS: The study had an average recruitment rate of 55%. Feasibility was demonstrated by the overall successful online program implementation, with good fidelity, acceptable compliance (76%), and excellent retention (94%). The cognitively enhanced Tai Ji Quan intervention was shown to be acceptable to participants as well as safe, with no major intervention-related moderate/severe events. At week 16, the group receiving cognitively enhanced Tai Ji Quan training showed a positive trend in the cognitive function and dual-task outcome measures whereas the group receiving standard Tai Ji Quan training exhibited positive trends on global and domain-specific cognitive measures. CONCLUSIONS: Preliminary findings of this pilot study indicate the feasibility, acceptability, and safety of a tailored, cognitively enhanced Tai Ji Quan training intervention delivered remotely to home settings via videoconferencing for community-dwelling older adults with MCI. TRIAL REGISTRATION: Clinicaltrials.gov identifier NCT04070703.

Delivering exercise medicine to cancer survivors: has COVID-19 shifted the landscape for how and who can be reached with supervised group exercise?

PURPOSE: Due to stay-at-home orders during COVID-19, we transitioned supervised, group, in-person resistance training interventions in two clinical trials in cancer survivors to live, online delivery using video-conferencing technology. We describe the feasibility, preliminary efficacy, and safety of live online group training and compare to in-person training. METHODS: Adherence (% sessions attended), retention (% participants completing intervention), and safety (# adverse events) data of resistance training groups from two randomized controlled trials in cancer survivors that participated before or during the COVID-19 pandemic were collated. Participants were post-treatment breast cancer survivors and their spouses (n = 62) and prostate cancer survivors (n = 32) (age range: 38-82 years). During COVID-19, delivery of supervised, group resistance exercise sessions was delivered live online via video-conference. Preliminary evidence for training efficacy was assessed by chair stand performance over the 6-month intervention. RESULTS: Feasibility of online resistance training was better than in-person for both studies (adherence: 86% vs 82% and 91% vs. 81% and retention 95% vs. 80% and 92% vs. 84% for online and in-person classes). Improvements in chair stand time were similar in prostate cancer and spouse groups that trained online vs. in-person, except for breast cancer survivors who improved more with in-person training (7% vs. 14% for online vs. in-person). Safety was similar between formats (12 vs. 11 adverse events for online vs. in-person). CONCLUSION: Supervised, in-person group resistance training can be feasibly adapted for live, online delivery and could help broaden approaches to exercise delivery in cancer survivors, including older adults. TRIAL REGISTRATION: The studies described in this commentary were registered on ClinicalTrials.gov on August 3, 2018 (NCT03630354) and on October 30, 2018 (NCT03741335).

Protocol for GET FIT Prostate: a randomized, controlled trial of group exercise training for fall prevention and functional improvements during and after treatment for prostate cancer.

BACKGROUND: Many prostate cancer survivors are treated with androgen deprivation therapy (ADT), but these therapies may increase frailty, worsen physical functioning, and increase fall risk. While exercise may counter functional declines associated with ADT, no studies have tested whether and which type of exercise may reduce falls and frailty. The purpose of this trial is to compare the relative efficacy of strength training versus tai ji quan training against each other and to a stretching control group on falls, frailty, and physical functioning in men expose to ADT for prostate cancer. METHODS: Prostate cancer survivors treated with ADT (N = 360) who have fallen in the past year or are at risk of a fall based on validated risk factors will be recruited to participate in this single-blind, parallel group, randomized trial. Participants will be randomized to one of three supervised, group training programs: (i) strength training, (ii) tai ji quan training, or (iii) stretching (control), that train 3×/week for 6 months. Outcomes are assessed at baseline, 3 (mid-intervention), 6 (immediately post-intervention), and 12 (follow-up) months. The primary outcome is falls assessed by monthly self-report. Secondary outcomes include the following: frailty (low lean body mass (by bioelectrical impedance analysis), exhaustion (by SF-36 vitality scale), low activity (by CHAMPS physical activity survey), slowness (by 4 m usual walk speed), and weakness (by chair stand time)); objective and subjective measures of physical function will also be collected. Negative binomial regression models will be used to assess differences in falls between groups, while mixed effects modeling will be used to compare the relative efficacy of training group on secondary outcomes. DISCUSSION: Exercise represents a non-pharmacologic approach to mitigate the problem of falls experienced among men treated with ADT. By engaging in appropriate exercise, men may be able to avoid or delay falls, frailty, and disability associated with their cancer treatment. Findings of the trial are expected to inform clinical practice about how exercise could be prescribed as part of cancer care for prostate cancer survivors prescribed ADT. TRIAL REGISTRATION: ClinicalTrials.gov NCT03741335 . Registered on November 18, 2018.

Implementing an Online Virtual Falls Prevention Intervention During a Public Health Pandemic for Older Adults with Mild Cognitive Impairment: A Feasibility Trial.

PURPOSE: This study evaluates the feasibility of delivering a virtual (online) falls prevention intervention for older adults with mild cognitive impairment (MCI). METHODS: Community-dwelling older adults with MCI (mean age = 76.2 years, 72% women) were randomized to either a Tai Ji Quan (n = 15) or stretching group (n = 15) and participated in 60-minute virtual exercise sessions, via Zoom, twice weekly for 24 weeks. The primary outcome was the incidence of falls. Secondary outcomes were the number of fallers and changes from baseline in the 4-Stage Balance Test, 30-second chair stands, and Timed Up and Go Test under both single- and dual-task conditions. RESULTS: The intervention was implemented with good fidelity, an overall attendance rate of 79%, and 13% attrition. Compared with stretching, Tai Ji Quan did not reduce falls (incidence rate ratio = 0.58; 95% confidence interval [CI], 0.32 to 1.03) or the number of fallers (relative risk ratio = 0.75; 95% CI, 0.46 to 1.22) at week 24. The Tai Ji Quan group, however, performed consistently better than the stretching group in balance (between-group difference in change from baseline, 0.68 points; 95% CI, 0.12 to 1.24), 30-second chair stands (1.87 stands; 95% CI, 1.15 to 2.58), and Timed Up and Go under single-task (-1.15 seconds; 95% CI, -1.85 to -0.44) and dual-task (-2.35; 95% CI, -3.06 to -1.64) conditions. No serious intervention-related adverse events were observed. CONCLUSION: Findings from this study suggest the feasibility, with respect to intervention fidelity, compliance, and potential efficacy, of implementing an at-home, virtual, interactive Tai Ji Quan program, delivered in real-time, as a potential balance training and falls prevention intervention for older adults with MCI. The study provides preliminary data to inform future trials.

Efficacy of exercise-based interventions in preventing falls among community-dwelling older persons with cognitive impairment: is there enough evidence? An updated systematic review and meta-analysis.

OBJECTIVE: Exercise prevents falls in the general older population, but evidence is inconclusive for older adults living with cognitive impairment. We performed an updated systematic review and meta-analysis to assess the potential effectiveness of interventions for reducing falls in older persons with cognitive impairment. METHODS: PubMed, EMBASE, CINAHL, Scopus, CENTRAL and PEDro were searched from inception to 10 November 2020. We included randomised controlled trials (RCTs) that evaluated the effects of physical training compared to a control condition (usual care, waitlist, education, placebo control) on reducing falls among community-dwelling older adults with cognitive impairment (i.e. any stage of Alzheimer's disease and related dementias, mild cognitive impairment). RESULTS: We identified and meta-analysed nine studies, published between 2013 and 2020, that included 12 comparisons (N = 1,411; mean age = 78 years; 56% women). Overall, in comparison to control, interventions produced a statistically significant reduction of approximately 30% in the rate of falls (incidence rate ratio = 0.70; 95% CI, 0.52-0.95). There was significant between-trial heterogeneity (I2 = 74%), with most trials (n = 6 studies [eight comparisons]) showing no reductions on fall rates. Subgroup analyses showed no differences in the fall rates by trial-level characteristics. Exercise-based interventions had no impact on reducing the number of fallers (relative risk = 1.01; 95% CI, 0.90-1.14). Concerns about risk of bias in these RCTs were noted, and the quality of evidence was rated as low. CONCLUSIONS: The positive statistical findings on reducing fall rate in this meta-analysis were driven by a few studies. Therefore, current evidence is insufficient to inform evidence-based recommendations or treatment decisions for clinical practice.PROSPERO Registration number: CRD42020202094.