Mindfulness, Education, and Exercise for age-related cognitive decline: Study protocol, pilot study results, and description of the baseline sample.

BACKGROUND/AIMS: Age-related cognitive decline is a pervasive problem in our aging population. To date, no pharmacological treatments to halt or reverse cognitive decline are available. Behavioral interventions, such as physical exercise and Mindfulness-Based Stress Reduction, may reduce or reverse cognitive decline, but rigorously designed randomized controlled trials are needed to test the efficacy of such interventions. METHODS: Here, we describe the design of the Mindfulness, Education, and Exercise study, an 18-month randomized controlled trial that will assess the effect of two interventions-mindfulness training plus moderate-to-vigorous intensity exercise or moderate-to-vigorous intensity exercise alone-compared with a health education control group on cognitive function in older adults. An extensive battery of biobehavioral assessments will be used to understand the mechanisms of cognitive remediation, by using structural and resting state functional magnetic resonance imaging, insulin sensitivity, inflammation, and metabolic and behavioral assessments. RESULTS: We provide the results from a preliminary study (n = 29) of non-randomized pilot participants who received both the exercise and Mindfulness-Based Stress Reduction interventions. We also provide details on the recruitment and baseline characteristics of the randomized controlled trial sample (n = 585). CONCLUSION: When complete, the Mindfulness, Education, and Exercise study will inform the research community on the efficacy of these widely available interventions improve cognitive functioning in older adults.

Sex differences in FITNESSGRAM® health risk based on aerobic capacity and body composition among urban public elementary school children.

Children residing in urban, low-resource neighborhoods may be at increased risk for poor aerobic fitness and obesity. The objective of this collaborative project with an urban public school district was to quantify the combination of poor aerobic capacity and high percent body fat using FITNESSGRAM® Healthy Fitness Zone (HFZ) standards among urban, predominantly Black, public elementary school boys and girls. Measurements of aerobic capacity with the 20-m Progressive Aerobic Cardiovascular Endurance Run (PACER) test and body composition by bioelectrical impedance analysis were completed on 1,775 fourth and fifth grade students in 45 public elementary schools in St. Louis, Missouri during three school years (2012-2015). Our findings reveal that a higher proportion of girls than boys failed to meet the HFZ for aerobic capacity (70.1% vs. 42.3%), percent body fat (53.0% vs. 29.9%), and the combination of aerobic capacity and percent body fat (44.4% vs. 21.8%, all P<0.001). These results highlight the importance of addressing modifiable, lifestyle-related health risks among urban minority children, particularly girls.

Influence of physical education on moderate-to-vigorous physical activity of urban public school children in St. Louis, Missouri, 2011-2014.

We quantified the moderate-to-vigorous physical activity (MVPA, heart rate ≥140 bpm) of urban public elementary school children on school days with and schooldays without physical education (PE) class by using continuous heart rate monitoring. The heart rate of 81 students (93.8% black) in grades 3 and 5 was recorded in 15-second intervals. On the basis of 575 school-day observations (mean 7.1 days/student), students accumulated 44.4 (standard deviation [SD], 34.4) minutes of MVPA on days with PE and 30.6 (SD, 29.9) MVPA minutes on days without PE (P < .001). School policies should promote daily PE to help children in under-resourced areas achieve the recommended 60 minutes per day of MVPA.

Comparison of Rectified and Unrectified Sockets for Transtibial Amputees.

The current method for fabricating prosthetic sockets is to modify a positive mold to account for the non-homogeneity of the residual limb to tolerate load (i.e., rectified socket). We tested unrectified sockets by retaining the shape of the residual limb, except for a distal end pad, using an alginate gel process instead of casting. This investigation compared rectified and unrectified sockets. Forty-three adults with unilateral transtibial amputations were tested after randomly wearing both rectified and unrectified sockets for at least 4 weeks. Testing included a gait analysis, energy expenditure and Prosthesis Evaluation Questionnaire (PEQ). Results indicated no differences between sockets for gait speed and timing, gait kinematics and kinetics, and gait energy expenditure. There were also no differences in the Prosthetic Evaluation Questionnaire and 16 subjects selected the rectified socket, 25 selected the unrectified socket, and 2 subjects selected to use both sockets as their exit socket. Results seemed to indicate that more than one paradigm exists for shaping prosthetic sockets, and this paradigm may be helpful in understanding the mechanisms of socket fit. The alginate gel fabrication method was simpler than the traditional method. The method could be helpful in other countries where prosthetic care is lacking, may be helpful with new amputees, and may be helpful in typical clinics to reduce costs and free the prosthetist to focus more time on patient needs.

Failure to meet aerobic fitness standards among urban elementary students.

The aim of this study was to explore the relationship of aerobic fitness with the elementary school environment and student characteristics among 4th and 5th grade children attending urban public schools in St. Louis, MO, USA. This cross-sectional study was conducted during 2012-2015 and included 2381 children (mean age 10.5 y) who completed the FITNESSGRAM® 20-m Progressive Aerobic Cardiovascular Endurance Run. Healthy Fitness Zone (HFZ) was defined according to FITNESSGRAM® aerobic capacity criteria. Other student-level variables included age, race, National School Lunch Program eligibility, BMI z-score, weight status, and daily pedometer steps. School environment variables included playground features and playground safety, physical education and recess practices, and school census tract data on vacant houses and median household income. Bivariate analyses with sex stratification were used to identify student-level and school-level predictors of failure to achieve the aerobic HFZ; predictors were then included in a multivariable logistic regression model. Failure to meet the aerobic HFZ was observed among 33% of boys and 57% of girls. School environment was not predictive, but higher age and fewer daily steps were: each additional year of age was associated with 41% higher odds of failing to meet the aerobic HFZ among boys and 100% higher odds among girls. Conversely, each additional 1000 daily steps was associated with 15% (boys) and 13% (girls) lower odds of failure. Obesity posed a 60% higher risk of failure to meet HFZ among girls. These results highlight the importance of childhood physical activity opportunities, especially for girls residing in low-resource areas.

Effects of Two Years of Calorie Restriction on Aerobic Capacity and Muscle Strength.

PURPOSE: Calorie restriction (CR) improves health span and delays age-related diseases in many species. The multicenter Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) study was the first randomized controlled trial of CR in nonobese humans. The aim of this investigation was to determine the effects of CR on V˙O2max and muscle strength in the CALERIE trial. METHODS: Healthy, normal-weight, and mildly overweight women and men (n = 218, mean ± SE age = 37.9 ± 0.5 yr) were randomized to 25% CR or an ad libitum (AL) control condition in a 2:1 allocation (143 CR, 75 AL). V˙O2max was determined with an incremental treadmill test; the strength of the knee flexors and extensors was assessed by dynamometry at baseline, 1 yr, and 2 yr. RESULTS: The CR group achieved an average 11.9% ± 0.7% CR during the 2-yr intervention. Body weight decreased in CR (-7.7 ± 0.4 kg), but not AL (+0.2 ± 0.5 kg). Absolute V˙O2max (L·min) decreased at 1 and 2 yr with CR, whereas V˙O2max expressed relative to body mass increased at both time points (1 yr: +2.2 ± 0.4; 2 yr: +1.9 ± 0.5 mL·kg·min) and relative to AL. The CR group increased their treadmill test time and workload at 1 and 2 yr. Strength results in CR were similar, with decreases in absolute flexor and extensor strength, but increases when expressed relative to body mass. No changes were observed for V˙O2max expressed relative to lean body mass or leg lean mass. CONCLUSIONS: Two years of modest CR without a structured exercise component did not appear to compromise aerobic capacity in healthy nonobese adults. The clinical implications of the observed changes in V˙O2max and muscle strength will be important to explore in future studies.

Relationships between spinal landmarks and skin surface markers.

This investigation determined relationships between coronal vertical alignment (CVA) and sagittal vertical alignment (SVA) variables calculated from radiographs and surface markers representing bony landmarks. Biplanar radiographs were taken on 28 subjects (standing) after 2 metallic surface markers were placed on the skin superficial to C7 and S2. The CVA-R and SVA-R were measured on the radiographs. Similar variables were calculated from the surface markers (CVA-P-R, SVA-P-R). Correlation between CVA-R and CVA-P-R was 0.894 (p<0.000), and between SVA-R and SVA-P-R was 0.946 (p<0.000). Results lead to three recommendations: (1) obtain surface marker data when radiographs are taken to establish relationships between the two sets of data, (2) take care in providing instructions to the subjects if measures are to be taken at different times, and (3) observe caution in interpreting results when simultaneous x-ray and surface marker data were not recorded.

Prospective comparison of gait and trunk range of motion in adolescents with idiopathic thoracic scoliosis undergoing anterior or posterior spinal fusion.

STUDY DESIGN: Prospective evaluation of gait and spinal range of motion (ROM) in adolescent idiopathic scoliosis (AIS) patients undergoing either an anterior or a posterior spinal fusion. OBJECTIVE: Compare changes in gait and spine ROM between AIS patients undergoing either an anterior or posterior spinal fusion. SUMMARY AND BACKGROUND DATA: Problems with AIS posterior spinal fusion and attempts to minimize the number of spinal segments fused have led to the promotion of anterior spinal fusion. Comparison of functional outcomes of the two surgeries has not been reported. MATERIALS AND METHODS: Thirty-one patients with single or double thoracic AIS undergoing an anterior (n = 16) or posterior (n = 15) instrumented spinal fusion underwent gait and triplanar ROM tests before surgery and 24 months postoperative. Videography with reflective surface markers on the scapula, spine, and pelvis were used to quantify changes in gait and trunk ROM. RESULTS: Surgical results indicated that an average of four fewer levels was fused and the lowest instrumented vertebrae were one level higher in the spine for the anterior group compared to the posterior group. Gait results showed no change in gait speed and no change in coronal and sagittal plane kinematics, regardless of group. Transverse plane motion during gait was reduced in both groups. Spinal ROM results indicated motion loss in all three planes, regardless of group, with the posterior group having less postoperative ROM than the anterior group. Unlinking surgical approach from number of fused levels and lowest instrumented vertebrae with a subset of subjects also indicated less postoperative ROM for the posterior group. CONCLUSIONS: The surgical and ROM results seem to favor the anterior approach over the posterior approach for the classification of patients in this investigation. However, it should be noted that both groups had decreased postoperative ROM.

Gait changes as the result of deformity reconstruction surgery in a group of adults with lumbar scoliosis.

STUDY DESIGN: This was a prospective analysis of adult spinal deformity patients having fusions from the thoracic spine down to L5 or the sacrum. Gait analysis was performed before surgery and 1 and 2 years postoperatively, as was questionnaire analysis. OBJECTIVES: To compare the preoperative and postoperative gait of revision and primary patients having long fusions to the distal lumbar spine or sacrum with that of a group of able-bodied adults. The experimental hypothesis was that both patient groups would have significantly compromised preoperative gait and gait endurance compared to the able-bodied group and that significant changes would be noted in both groups at 1 and 2 years postoperation. SUMMARY OF BACKGROUND DATA: Spinal reconstructive surgery is often performed on adults with progressive lumbar spinal deformities. These patients can be divided into two major groups. The first are those patients who have degenerative changes superimposed on idiopathic scoliosis (primary patients) without previous operative treatment; the second are those patients who have already had a long fusion to L4, L5, or the sacrum (revision patients). METHODS: Twenty-nine women participated in the investigation (8 primary, 12 revision, 9 able-bodied controls). A gait analysis was performed before surgery and 1 and 2 years postoperation. Walking endurance (time) was estimated from a submaximal graded treadmill exercise test. Motion variables describing the gait of the subjects, as well as gait speed, were determined. The SRS, Oswestry questionnaires, and an analog pain scale were also administered. RESULTS: The primary group showed no adverse changes in lower extremity kinematics after surgery, and their gait speed improved such that it was not significantly different from the able-bodied group at 2 years postoperation. The revision group displayed lower extremity gait kinematics that were significantly different from the able-bodied group before surgery, but were no longer different from the able-bodied 2 years after surgery. They also had a significant increase in gait endurance. Questionnaire data indicated significant improvements for both groups after surgery. CONCLUSIONS: Objective gait data quantifying the efficacy of reconstructive spinal surgery in both primary and revision patients indicated improved gait. Gait endurance was improved in the revision group, and gait speed for the primary was not significantly different from able-bodied at 2 years postoperation. Clinically, it would appear that rehabilitation strategies to improve gait endurance and gait speed could be implemented to further improve the gait of these patients.

Methods to locate center of gravity in scoliosis.

STUDY DESIGN: Prospective evaluation of the location of the center of gravity during supine, standing, and gait. OBJECTIVE: Develop methods to quantify center of gravity locations in patients with scoliosis and controls and to evaluate the merit of the quantitative assumptions relative to spinal fusion surgery. SUMMARY AND BACKGROUND DATA: The center of gravity, or balance point of the body, is generally considered to be the single best estimate of the body's location. To date, investigators have not examined the body's center of gravity location to assist surgical planning to maintain and/or restore coronal and sagittal plane balance, nor have they used center of gravity location to help assess surgical outcomes. MATERIALS AND METHODS: The whole-body center of gravity (MR-COG) was determined for three subjects from magnetic resonance imaging data obtained supine. The whole-body center of gravity was also determined using subject specific (SS-COG) and literature-based (STD-COG) segment center of gravity locations in conjunction with a video motion capture system obtained supine, standing and during gait. RESULTS: Differences existed among the three methods of determining COG locations in supine, with the SS-COG and MR-COG being most closely aligned. Results from gait data indicated typical anterior/superior and right/left COG shifts during the gait cycle. The SS-COG method consistently determined a COG location inferior to the STD-COG method; however, variation within the gait cycle was similar. Shifts in COG locations relative to a coordinate system fixed in the pelvis were more than 5 cm in the superior/inferior direction, approximately 4 cm in the anterior/posterior direction, and minimal in the left/right direction. CONCLUSIONS: Methods have been developed to determine locations of the whole body COG in both preoperative and postoperative subjects undergoing spinal fusion surgery and controls. The methods are robust to include men and women, subjects with and without instrumentation, and subjects in various positions including gait.