Impact of telehealth on stroke survivor-caregiver dyad in at-home rehabilitation: A systematic review.

AIM: To examine studies involving the impact of telerehabilitation (TLR), tele-training and tele-support on the dyad stroke survivor and caregiver in relation to psychological, physical, social and health dimensions. DESIGN: A systematic review was conducted. DATA SOURCES: The following electronic databases were consulted until September 2023: PsycInfo, CINAHL, Eric, Ovid, PubMed, Scopus, Cochrane Central and Web of Science. REVIEW METHODS: It was conducted and reported following the checklists for Reviews of PRISMA 2020 Checklist. Critical evaluation of the quality of the studies included in the review was performed with the Joanna Briggs Institute Checklists. DATA SYNTHESIS: A total of 2290 records were identified after removing duplicates, 501 articles were selected by title and abstract and only 21 met the inclusion criteria. It included 4 quasi-experimental studies, 7 RCTs, 1 cohort study and 9 qualitative studies. The total number of participants between caregivers and stroke survivors was 1697, including 858 stroke survivors and 839 caregivers recruited from 2002 to 2022. For a total of 884 participants who carried out TLR activities in the experimental groups,11 impact domains were identified: cognitive/functional, psychological, caregiver burden, social, general health and self-efficacy, family function, quality of life, healthcare utilization, preparedness, quality of care and relationship with technology. CONCLUSIONS: The results support the application of telehealth in the discharge phase of hospitals and rehabilitation centres for stroke survivors and caregivers. TLR could be considered a substitute for traditional rehabilitation only if it is supported by a tele-learning programme for the caregiver and ongoing technical, computer and health support to satisfy the dyad's needs. IMPACT: Designing a comprehensive telemedicine programme upon the return home of the dyad involved in the stroke improves the quality of life, functional, psychological, social, family status, self-efficacy, use of health systems and the dyad's preparation for managing the stroke. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Classification and comparison of the physical characteristics and functions of various age groups of community-dwelling elderly individuals participating in the Kayoi-no-ba program.

[Purpose] To classify and compare the physical characteristics and functions of community-dwelling elderly individuals of various age groups participating in the Kayoi-no-ba program. [Participants and Methods] A total of 176 community-dwelling elderly individuals living in six cities and towns in the Niigata Prefecture who participated in the Kayoi-no-ba program between 2018 and 2020 were recruited in this study. Physical characteristics, such as strength, balance, and mobility, were assessed. [Results] Among elderly females and males who participated in the Kayoi-no-ba program, those >80 years of age showed shorter height, lighter weight, and lower body muscle mass than the other age groups. Strength, balance, and mobility functions, including grip strength, sit-to-stand test, single-leg-stand test, and timed up-and-go test, were significantly decreased, especially in patients aged >80 years. [Conclusion] Among community-dwelling elderly individuals participating in the Kayoi-no-ba program, physical characteristics and functions were affected by aging, with significant decline particularly in those aged >80 years old. These findings suggest that early intervention is necessary to maintain muscle mass, strength, balance, and mobility in the elderly.

Changes in physical function of frail elderly females in the one-year long-term care prevention program.

[Purpose] This study investigated changes in the physical function of frail elderly females who participated in a long-term care prevention project for ≥1 year. [Participants and Methods] There were 125 females included. Measurement items were body mass index, 5-m maximum gait time, 5-m normal gait time, standing on one leg with eyes open, timed up and go test, and grip strength and measured every six months. [Results] Grip strength decreased significantly after six months and one year compared to that of the start. The other measurements had no significant differences at start, after six months, and after one year. [Conclusion] This study investigated changes in physical functions in the frail community-dwelling elderly females one year after starting in a long-term prevention care program. Consequently, after one year in the program, no change was noted in measurements, such as gait speed, but only grip strength decreased. Likely, the exercise program mainly targeted the lower limb muscles. Therefore, although functions mainly use the lower limbs, such as walking, may be maintained, those using the upper limbs may be affected by aging.

A review on recent advances in the applications of composite Fe3O4 magnetic nanoparticles in the food industry.

Fe3O4 magnetic nanoparticles (MNPs) have attracted tremendous attention due to their superparamagnetic properties, large specific surface area, high biocompatibility, non-toxicity, large-scale production, and recyclability. More importantly, numerous hydroxyl groups (-OH) on the surface of Fe3O4 MNPs can provide coupling sites for various modifiers, forming versatile nanocomposites for applications in the energy, biomedicine, and environmental fields. With the development of science and technology, the potential of nanotechnology in the food industry has also gradually become prominent. However, the application of composite Fe3O4 MNPs in the food industry has not been systematically summarized. Herein, this article reviews composite Fe3O4 MNPs, including their properties, modifications, and physical functions, as well as their applications in the entire food industry from production to processing, storage, and detection. This review lays a solid foundation for promoting food innovation and improving food quality and safety.

Feasibility and Effects of an Immersive Virtual Reality Exergame Program on Physical Functions in Institutionalized Older Adults: A Randomized Clinical Trial.

One of the pillars which underpins active aging is found in the performance of physical activity. While adherence to physical activity programs has traditionally been low in older people, immersive virtual reality (IVR) could provide an alternative and complementary training mode. A randomized clinical trial was conducted to explore the feasibility and effects of a 10-week IVR exergame program on physical functions of 24 institutionalized older adults who were allocated to an experimental group (EG n = 13; 85.08 ± 8.48 years) and control group (CG n = 11; 84.82 ± 8.10 years). The IVR intervention was feasible, with no adverse effects being reported (no Simulator Sickness Questionnaire symptoms; low negative experience scores on the Game Experience Questionnaire < 0.34/4), no dropouts, high adherence, and good post-gaming usability (System Usability Scale > 73.96%). The EG showed significant improvements: Tinetti scores for balance (1.84 ± 1.06; p < 0.001), gait (1.00 ± 1.08; p < 0.001), total score (2.84 ± 1.67; p < 0.001), and handgrip (4.96 ± 4.22; p < 0.001) (pre−post assessment). The CG showed significantly worsened compared to the EG: Five times sit-to-stand test, Tinetti scores for balance, gait, and total score, and the Timed Up and Go test total score (post-assessment). The findings show that the IVR intervention is a feasible method to approach a personalized exercise program and an effective way by which to improve physical function in the target population.

A systematic review of supervised comprehensive functional physiotherapy after radical prostatectomy.

INTRODUCTION: Radical prostatectomy (RP) can generate multidimensional physiological changes, like decrease in physical and emotional functioning, as well as Health Related Quality of Life (HRQoL). However, only pelvic floor muscle training (PFMT) is commonly recommended as conservative treatment after RP. More comprehensive interventions than only PFMT, such as physiotherapy promoting general coordination, flexibility, strength, endurance, fitness and functional capacity may seem more relevant and patient-centered. AIM OF THE REVIEW: Our aim was to evaluate whether a more Comprehensive Functional Physical Therapy (CFPT) than PFMT alone, focused on lower limb and lumbo-pelvic exercises, would improve physical capacities and functions (including urinary continence (UI)), emotional functions and HRQoL in patients after RP. EVIDENCE ACQUISITION: A systematic review was performed in accordance with the PRISMA reporting guidelines. A literature search was conducted in PubMed, PEDro, Web of Science and Cochrane Library databases from inception to January 2022. The PICO approach was used to determine the eligibility criteria. According to the quality of selected studies, levels of evidence were given. EVIDENCE SYNTHESIS: Eight clinical trials met the eligibility criteria. Regarding UI, all the studies reported positive outcomes for CFPT between pre- and post-physiotherapy (P<0.05). The selected studies reported positive outcomes for physical capacities as well as for physical and emotional functioning, and for HRQoL (P<0.05). CONCLUSION: Current literature indicates that CFPT was shown to be safe, non-invasive, and particularly effective in terms of UI recovery. CFPT could result in more positive outcomes, including physical capacities, physical and emotional functioning and HRQoL, than PFMT alone. Further standardized, physiotherapist-guided and well-designed clinical trials conducted by experienced multidisciplinary clinicians are still called for.

Effects of Physical Activity in Nursing Home Residents with Dementia: A Randomized Controlled Trial.

BACKGROUND/AIMS: There is no consensus regarding the optimal nonpharmacological intervention to slow down dementia-related decline. We examined whether physical stimulation interventions were effective in reducing cognitive, physical, mood, and behavioral decline in nursing home residents with dementia. METHODS: Eighty-seven nursing home residents with dementia were randomly assigned to 3 physical activity interventions: activities of daily living (ADL) training, multicomponent exercise training, or combined multicomponent exercise and ADL training. Outcomes were measured at baseline, and after 3 and 6 months. RESULTS: A 6-month ADL training benefitted executive functions, physical endurance, and depression among men. Exercise training benefitted only grip strength of participants with mild-to-moderate cognitive impairment. A combined training benefitted functional mobility compared to ADL training, depressive symptoms and agitation compared to exercise training, and physical endurance compared to no physical stimulation. CONCLUSIONS: ADL training appears to be effective for nursing home residents with moderately severe dementia. It remains unclear whether exercise training is an effective type of stimulation.

The Association Between Self-Reported Adherence to Physical Activity Recommendations and Criteria for Maintaining Physical Independence of Older Adults.

While physical activity (PA) improves functions for activities of daily living, little is known of the association between meeting published PA Guidelines for Americans (PAGA) and meeting published physical function guidelines for maintaining independence. The purpose of this study was to examine the association between meeting the PAGA and meeting independence criteria on the Senior Fitness Tests (SFT). Older adults (N = 265) completed SFTs, assessing cardiorespiratory fitness, lower and upper body strength, mobility, and self-reported aerobic and resistance PA. Chi-square tests and logistic regressions examined associations between meeting PAGA and SFT independence criteria. A significant relationship was found between meeting aerobic PAGA and cardiorespiratory and upper body SFT criteria; a significant relationship was found between meeting resistance PAGA and upper body strength criteria. Although research suggests that PAGA are effective in maintaining fitness in older adults when PA is structured and monitored, mixed results were found for self-reported PA and SFT criteria.

Effects of increased physical activity on body composition, physical functions, vascular functions, HR-QOL, and self-efficacy in community-dwelling elderly people.

[Purpose] The objective of this study was to clarify the effects of increased number of steps on body composition, physical functions, vascular functions, health-related quality of life (HR-QOL) and self-efficacy in elderly people. [Subjects and Methods] The subjects were 47 elderly persons who resided in Port Island in the Chuo Ward of Kobe City in Hyogo Prefecture, Japan. After the calculation of the mean preintervention physical activity (PA), the subjects were instructed to increase their PA to a target baseline + 1,300 steps/day. Body composition, physical functions, vascular functions, HR-QOL, and self-efficacy were measured at baseline, after 3 and 6 months. These items were compared between a group that increased their PA and a group that did not. [Results] After 6 months, 26.1% of the subjects achieved the PA target. No significant improvements were observed in body composition, physical functions, vascular functions, or self-efficacy for either group after 3 and 6 months. However, the HR-QOL improved significantly after 6 months in the achievement group. [Conclusion] Although the intervention to increase PA did not produce significant improvements after 6 months in body composition, physical functions, vascular functions, or self-efficacy, the HR-QOL improved significantly during this relatively short period.

Association between occlusal force and physical functions in preschool children: a comparison of males and females.

[Purpose] To determine and compare changes over time in the physical strength of male and female children aged 4-5 years by measuring physical functions such as occlusal forces. [Subjects and Methods] The occlusal force, weight, height, grip strength, standing long jump, ball throwing, timed up and go (TUG), and the 25-m run time were measured of 331 children to determine their physical strength. All the children understood and were capable of completing all tests. [Results] Occlusal force among male infants significantly correlated with all items except ball throwing. Stepwise multiple regression analysis independently associated occlusal force with grip strength. In contrast, occlusal force of female infants significantly correlated with all the tested items. Stepwise multiple regression analysis also independently associated occlusal force with grip strength and TUG in females. [Conclusion] Grip strength indicating upper-limb muscle strength correlated with occlusal forces in both male and female children, whereas TUG, balance and walking ability indicating muscle strength of the lower limbs, correlated with items relevant to everyday functions in female infants. These findings show that different factors are involved in the occlusal forces of male and female children.

Relationships between the Occlusal Force and Physical/Cognitive Functions of Elderly Females Living in the Community.

[Purpose] The present study, was conducted to examine the occlusal force and physical, cognitive, and attentional functions of elderly females living in the community to evaluate the significance of measuring the occlusal force. [Subjects and Methods] The number of subjects was 104. The Occlusal Force Meter GM10 was used to measure their occlusal force. Their physical functions were assessed using eight examinations, including the 30-second Chair Stand Test, and the cognitive functions of the Mini-Mental State Examination and attention functions of the Trail Making Test. [Results] Significant correlations were noted between the occlusal force and all measurements, except for the results of forward bending in a sitting position. Multiple regression analysis was conducted with the occlusal force as an objective variable, and significant partial correlations were noted with the 30-second Chair Stand Test. [Conclusion] These results suggest that it is necessary to provide the elderly with comprehensive support focusing on maintaining their occlusal force, as a nursing care-prevention measure, to help them continue to live a healthy, independent life.

Exploring previously used thresholds for computed tomography-defined low skeletal muscle mass in predicting functional limitations among lung cancer patients.

BACKGROUND: Various cutoffs have been used to diagnose computed tomography (CT)-defined low skeletal muscle mass; however, the impact of this variability on predicting physical functional limitations (PFL) remains unclear. In the present study we aimed to evaluate the diagnostic test metrics for predicting PFLs using a fixed cutoff value from previous reports and sought to create a prediction score that incorporated the skeletal muscle index (SMI) and other clinical factors. METHODS: In this cross-sectional study including 237 patients with lung cancer, the SMI was assessed using CT-determined skeletal muscle area at the third lumbar vertebra. Physical function was assessed using the short physical performance battery (SPPB) test, with PFL defined as an SPPB score ≤9. We analyzed the diagnostic metrics of the five previous cutoffs for CT-defined low skeletal muscle mass in predicting PFL. RESULTS: The mean age of participants was 66.0 ± 10.4 years. Out of 237 patients, 158 (66.7%) had PFLs. A significant difference was observed in SMI between individuals with and without PFLs (35.7 cm2/m2 ± 7.8 vs. 39.5 cm2/m2 ± 8.4, p < 0.001). Diagnostic metrics of previous cutoffs in predicting PFL showed suboptimal sensitivity (63.29%-91.77%), specificity (11.39%-50.63%), and area under the receiver operating characteristic curve (AUC) values (0.516-0.592). Age and the SMI were significant predictors of PFL; therefore, a score for predicting PFL (age - SMI + 21) was constructed, which achieved an AUC value of 0.748. CONCLUSION: Fixed cutoffs for CT-defined low skeletal muscle mass may inadequately predict PFLs, potentially overlooking declining physical functions in patients with lung cancer.

Dance Exergames for Older Adults: A Systematic Review and Meta-Analysis With Narrative Synthesis.

BACKGROUND: A systematic review and meta-analysis with narrative synthesis was conducted to evaluate the impact of dance exergaming on older adults' health-related outcomes and its feasibility, usability, and safety. METHODS: PubMed, Scopus, CINAHL, Web of Science, The Cochrane Library, ProQuest Dissertations and Theses Global, and Google Scholar were searched from inception to December 7, 2023. Interventional studies using immersive or nonimmersive virtual reality platforms conducted on older adults ≥60 years old were eligible. Meta-analysis was conducted using the random effects model by pooling mean differences (MD) or standardized mean differences. Outcomes were narratively synthesized when meta-analysis was not possible. RESULTS: Forty-three articles from 37 studies were included (n = 1 139 participants at baseline). Postintervention, dynamic balance measured using Berg Balance Scale (pooled MD = 2.65, 95% CI: 1.73-3.57, p < .0001), Timed-Up-and-Go times (pooled MD = -1.04, 95% CI: -2.06 to -0.03, p = .04), choice stepping reaction time (pooled MD = -92.48, 95% CI: -167.30 to -17.67, p = .02), and movement time (pooled MD = -50.33, 95% CI: -83.34 to -17.33, p = .003) were significantly better in the experimental group compared to the control group. Adherence ranged from 76.5% to 100%, whereas attrition ranged from 9.1% to 31.9%. Most participants completed the intervention with no or minimal adverse effects. CONCLUSIONS: Dance exergames are effective, feasible, usable, and safe for older adults. Further research is needed as the findings were limited by small sample sizes. Many studies could not be included in the meta-analysis as outcomes were too varied.

Walking and physical performance in black and white adults with multiple sclerosis controlling for social determinants of health.

BACKGROUND: There is evidence for reduced walking and physical performance in persons with multiple sclerosis (MS) compared with healthy controls (HCs). There is further evidence suggesting increased overall mobility disability in Black persons with MS compared with White counterparts, yet little is known about the interplay of social determinants of health (SDOH) when considering differences in walking and physical performance. PURPOSE: This cross-sectional, comparative study examined differences in walking and physical performance in Black and White persons with MS and HCs (MS Status), statistically controlling for SDOH. METHODS: The study sample consisted of 208 persons with MS (141 White participants and 67 Black participants) and 95 HCs (59 White participants and 36 Black participants). Walking and physical function were measured using timed 25-foot walk (T25FW), six-minute walk (6MW), timed-up-and-go (TUG), and short physical performance battery (SPPB). We examined the differences in the walking and physical functions as a function of MS Status (MS vs. HCs) and Race (Black vs. White) using Multivariate Analysis of Covariance, controlling for age, sex, marital status and SDOH (i.e., education, employment, income). RESULTS: There were no significant interactions between MS Status and Race on the outcomes, and the main effects of MS Status and Race remained statistically significant, controlling for SDOH and covariates. The main effects indicated significant lower T25FW (F = 34.6, p < .001, È p2 = 0.11), 6MW (F = 58.5, p < .001, È p2 = 0.18), TUG (F = 22.1, p < .001, È p2 = 0.08), and SPPB (F = 25.2, p < .001, È p2 = 0.09) performance for MS than HCs, and lower T25FW (F = 15.5, p < .001, È p2 = 0.05), 6MW (F = 11.6, p < .001, È p2 = 0.04), and TUG (F = 4.1, p < .05, È p2 = 0.02) performance in Black than White samples. CONCLUSIONS: We conclude that MS Status and Race independently influence walking and physical performance even after accounting for SDOH, and Black persons with MS have compromised walking and physical performance, perhaps necessitating focal rehabilitation.

Association Between Internet Use, Sleep, Cognition and Physical Activity Levels During COVID-19 Lockdown.

Purpose: The purpose of this study was to compare internet usage, sleep, cognition and physical activity in college professors and collegiate students during COVID-19 lockdown and to study the association of internet overuse with sleep quality, cognition and physical activity during the COVID-19 lockdown. Methods: A sample of 125 participants {professors (n = 52) and collegiate students (n = 73)} was recruited from Jamia Hamdard, New Delhi, India. Criteria for inclusion were college professors and collegiate students who uses internet. Both the groups were assessed for internet usage (Internet Addiction Test), sleep quality (Pittsburgh Sleep Quality Index), cognition (Cognitive Failure Questionnaire) and physical activity (Global Physical Activity Questionnaire) via google forms. Results: There was a significant difference for internet usage (p < 0.05), sleep quality (p = 0.032), cognition (distractibility, p = 0.019) and physical activity in college professors and collegiate students. It has been also reported that there was a significant association of internet usage with sleep quality and cognition and sleep quality with cognition. Conclusion: Students have more problematic internet usage, bad sleep quality, more cognitive failures and less physical activity than college professors during pandemic lockdown. It has been also observed that problematic internet usage has correlation with sleep quality, cognition and physical activity.

Effects of Physical Activity on Physical Fitness and Functional Ability in Older Adults.

A cross-sectional survey was done to investigate the pathways the physical activity acts in improving physical fitness and functional outcomes of older adults (60 years and above) using 880 community-dwelling older adults in Sri Lanka. Structural Equation Modeling (SEM) was used. The final SEM model included five latent factors and 14 co-variances. Goodness of Fit Index (GFI), Comparative fit index (CFI) and Root Mean Square Error of Approximation (RMSEA) values of the model were 0.95, 0.93, 0.91, and 0.05 respectively, indicating a good model fit. Strength enhances balance (ß = .52, p < .01) and reduces the time required to complete physical functions (ß = -.65, p < .01). Since strength declines with advancing age, muscle-strengthening activity programs should be promoted to enhance balance and functional performances in older adults in advanced ages. Strength test (hand grip and leg strength) can be used as a screening test to predict potential risk of falls and functional disabilities in older adults.

Functional outcomes of patients in ICU using the Chelsea Critical Care Physical Assessment tool: An integrative review.

Background: Outcome measures can assess the change in the health status of a patient in an intensive care unit (ICU). The Chelsea Critical Care Physical Assessment (CPAx) tool is used to assess the functional outcomes to monitor patient progression or regression in an ICU. Objectives: Our study aimed to identify studies that assess the functional outcomes of patients nursed in ICUs that use the CPAx tool. Method: An integrative review framework was used. Data were analysed in five steps to formulate a conclusion that aligned with the objective of our study. Data were extracted from peer-reviewed articles published online between 2013 and 2022. Databases that were used include Google Scholar, Directory of Open Access Journals (DOAJ) and PubMed for reviewed articles. Keywords were used in the search strategy, and screening of abstracts was done to extract studies that met the inclusion criteria. Results: We retrieved 41 studies, of which 11 matched the inclusion criteria. Data were thematically arranged into studies measuring the validity and reliability of the CPAx tool, using the CPAx tool to measure outcomes in the ICU, the tool used at ICU and hospital discharge. Conclusion: The use of the CPAx tool has no impact on measuring the hospital length of stay or quality of life. Clinical implications: The tool is comprehensive and enhances the accuracy of patient assessment.

Feasibility of a Health Coach Intervention to Reduce Sitting Time and Improve Physical Functioning Among Breast Cancer Survivors: Pilot Intervention Study.

BACKGROUND: Sedentary behavior among breast cancer survivors is associated with increased risk of poor physical function and worse quality of life. While moderate to vigorous physical activity can improve outcomes for cancer survivors, many are unable to engage in that intensity of physical activity. Decreasing sitting time may be a more feasible behavioral target to potentially mitigate the impact of cancer and its treatments. OBJECTIVE: The purpose of this study was to investigate the feasibility and preliminary impact of an intervention to reduce sitting time on changes to physical function and quality of life in breast cancer survivors, from baseline to a 3-month follow-up. METHODS: Female breast cancer survivors with self-reported difficulties with physical function received one-on-one, in-person personalized health coaching sessions aimed at reducing sitting time. At baseline and follow-up, participants wore the activPAL (thigh-worn accelerometer; PAL Technologies) for 3 months and completed physical function tests (4-Meter Walk Test, Timed Up and Go, and 30-Second Chair Stand) and Patient-Reported Outcomes Measurement Information System (PROMIS) self-reported outcomes. Changes in physical function and sedentary behavior outcomes were assessed by linear mixed models. RESULTS: On average, participants (n=20) were aged 64.5 (SD 9.4) years; had a BMI of 30.4 (SD 4.5) kg/m2; and identified as Black or African American (n=3, 15%), Hispanic or Latina (n=4, 20%), and non-Hispanic White (n=14, 55%). Average time since diagnosis was 5.8 (SD 2.2) years with participants receiving chemotherapy (n=8, 40%), radiotherapy (n=18, 90%), or endocrine therapy (n=17, 85%). The intervention led to significant reductions in sitting time: activPAL average daily sitting time decreased from 645.7 (SD 72.4) to 532.7 (SD 142.1; ß=-112.9; P=.001) minutes and average daily long sitting bouts (bout length ≥20 min) decreased from 468.3 (SD 94.9) to 366.9 (SD 150.4; ß=-101.4; P=.002) minutes. All physical function tests had significant improvements: on average, 4-Meter Walk Test performance decreased from 4.23 (SD 0.95) to 3.61 (SD 2.53; ß=-.63; P=.002) seconds, Timed Up and Go performance decreased from 10.30 (SD 3.32) to 8.84 (SD 1.58; ß=-1.46; P=.003) seconds, and 30-Second Chair Stand performance increased from 9.75 (SD 2.81) to 13.20 completions (SD 2.53; ß=3.45; P<.001). PROMIS self-reported physical function score improved from 44.59 (SD 4.40) to 47.12 (SD 5.68; ß=2.53; P=.05) and average fatigue decreased from 52.51 (SD 10.38) to 47.73 (SD 8.43; ß=-4.78; P=.02). CONCLUSIONS: This 3-month pilot study suggests that decreasing time spent sitting may be helpful for breast cancer survivors experiencing difficulties with physical function and fatigue. Reducing sitting time is a novel and potentially more feasible approach to improving health and quality of life in cancer survivors.

The Role of Cognitive Performance and Physical Functions in the Association between Age and Gait Speed: A Mediation Study.

INTRODUCTION: With vulnerable aging, gait speed (GS) undergoes progressive changes, becoming slower. In this process, cognitive performance (CP) and physical function (PF) both play an important role. This study aims (1) to investigate the association between CP and PF with GS and (2) to examine whether CP and PF mediate the association between age and GS in a large sample of Brazilian older adults. METHODS: A cross-sectional study analyzed 697 individuals (mean age 70.35 ± 6.86 years) from the state of Amazonas. The CP was evaluated by the COGTEL test battery, PF by the Senior Fitness Test battery, and GS with the 50-foot Walk Test. RESULTS: Older adults with a lower CP and PF had a 70% and 86% chance of slow GS, respectively. When CP and PF were placed simultaneously as mediators, the direct effect estimated by the model revealed a non-significant relationship between age and GS. Specifically, CP and PF mediated the association between age and GS, at approximately 12% and 98%, respectively. CONCLUSIONS: CP and PF show the potential to estimate GS performance among older adults. Moreover, CP and PF indicated a negative and direct association between age and slow GS, especially PF.

Associations between physical function, falls, and the fear of falling among older adults participating in a community-based physical exercise program: A longitudinal multilevel modeling study.

OBJECTIVES: Exercises that target muscle strength, balance, and gait prevent falls in older people. Moreover, exercise may reduce fear of falling by improving physical function. Many studies have examined the risk factors for falls and fear of falling separately. However, few studies have examined the associations between physical function, falls, and fear of falling simultaneously. This study aimed to identify the key physical functions influencing falls and fear of falling. DESIGN: Longitudinal observational study SETTING AND PARTICIPANTS: This study included 2,397 older adults (women: 82.8%, mean age: 74.3 ± 8.0 years) who participated in community-based physical exercise. METHODS: Physical functions such as muscle strength, balance, gait speed, and flexibility were measured regularly during the program. A questionnaire regarding falls and fear of falling was also administered simultaneously. Multilevel modeling was used to investigate the association between physical function and falls and fear of falling. RESULTS: The prevalence of falls and fear of falling at enrolment were 27.1% and 49.8%, respectively. Statistical analyses revealed that (1) falls were significantly associated with balance, age, fall history, fear of falling, and duration of participation; (2) fear of falling was significantly associated with muscle strength, balance, gait speed, age, and fall history. Long-term participation was significantly associated with an improvement in balance. CONCLUSIONS AND IMPLICATIONS: The risk factors for falls and fear of falling were different. Our research showed the importance of including balance training in all prevention programs.