Assessing the Clinical Effectiveness of an Exergame-Based Exercise Training Program Using Ring Fit Adventure to Prevent and Postpone Frailty and Sarcopenia Among Older Adults in Rural Long-Term Care Facilities: Randomized Controlled Trial.

BACKGROUND: Frailty and sarcopenia are geriatric syndromes of increasing concern and are associated with adverse health outcomes. They are more prevalent among long-term care facility (LTCF) users than among community dwellers. Exercise, especially multicomponent and progressive resistance training, is essential for managing these conditions. However, LTCFs, particularly in rural areas, face challenges in implementing structured exercise programs due to health care professional shortages. Moreover, older adults often become bored with repetitive exercise training and may lose interest over time. The Nintendo Switch Ring Fit Adventure (RFA) exergame is a novel exergame that combines resistance, aerobic, and balance exercises and offers a potential solution by boosting motivation in an immersive manner and reducing staff intervention needs. OBJECTIVE: We aimed to evaluate the clinical effectiveness of an exergame-based exercise training program delivered via RFA (exergame-RFA) in improving muscle mass and functional performance among older adult LTCF users. METHODS: This was a randomized controlled trial conducted from August 2022 to September 2023 and involved older adult LTCF users (aged ≥60 y) in rural southern Taiwan. Participants were randomized into an intervention group (exergame-RFA plus standard care) or a control group (standard care alone). The intervention, conducted seated with arm fit skills and trunk control exercises using the RFA, lasted 30 minutes twice weekly over 12 weeks. The primary outcomes measured were the Study of Osteoporotic Fractures index (serving as an indicator of frailty status) and the diagnostic criteria for sarcopenia (appendicular skeletal muscle mass index, handgrip strength, and gait speed). The secondary outcomes included functional performance (box and block test as well as maximum voluntary isometric contraction of the dominant upper extremity), muscle condition (muscle thickness measured using ultrasonography), activities of daily living (Kihon checklist), health-related quality of life (Short Form Health Survey-36), and cognitive function (brain health test). We used an intention-to-treat analysis, incorporating a simple imputation technique in statistical analysis. A mixed ANOVA, with time as a within-participant factor and intervention as a between-participant factor, was used to compare the training effects on outcomes. RESULTS: We recruited 96 individuals, of whom 60 (62%) underwent randomization. Of these 60 participants, 55 (92%) completed the study. Significant group×time interactions were observed in the intervention group in all primary outcomes (all P<.001, except P=.01 for handgrip strength) and most secondary outcomes, including maximum voluntary isometric contraction of the biceps (P=.004) and triceps brachii (P<.001) muscles, biceps muscle thickness measured using ultrasonography (P<.001), box and block test (P<.001), Kihon checklist (physical function: P=.01, mood status: P=.003, and total: P=.003), and brain health test (P<.001). CONCLUSIONS: The exergame-RFA intervention significantly improved muscle mass, strength, and functional performance among older adult users of rural LTCFs, offering a novel approach to addressing frailty and sarcopenia. TRIAL REGISTRATION: ClinicalTrials.gov NCT05360667; https://clinicaltrials.gov/study/NCT05360667. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.3389/fmed.2022.1071409.

Tailoring Oxygen-Depleted and Unitary Ti3C2Tx Surface Terminals by Molten Salt Electrochemical Etching Enables Dendrite-Free Stable Zn Metal Anode.

Two-dimensional Ti3C2Tx MXene materials, with metal-like conductivities and versatile terminals, have been considered to be promising surface modification materials for Zn-metal-based aqueous batteries (ZABs). However, the oxygen-rich and hybridized terminations caused by conventional methods limit their advantages in inhibiting zinc dendrite growth and reducing corrosion-related side reactions. Herein, -O-depleted, -Cl-terminated Ti3C2Tx was precisely fabricated by the molten salt electrochemical etching of Ti3AlC2, and controlled in situ terminal replacement from -Cl to unitary -S or -Se was achieved. The as-prepared -O-depleted and unitary-terminal Ti3C2Tx as Zn anode coatings provided excellent hydrophobicity and enriched zinc-ionophilic sites, facilitating Zn2+ horizontal transport for homogeneous deposition and effectively suppressing water-induced side reactions. The as-assembled Ti3C2Sx@Zn symmetric cell achieved a cycle life of up to 4200 h at a current density and areal capacity of 2 mA cm-2 and 1 mAh cm-2, respectively, with an impressive cumulative capacity of up to 7.25 Ah cm-2 at 5 mA cm-2//2 mAh cm-2. These findings provide an effective electrochemical strategy for tailoring -O-depleted and unitary Ti3C2Tx surface terminals and advancing the understanding of the role of specific Ti3C2Tx surface chemistry in regulating the plating/stripping behaviors of metal ions.

Manipulating Zn Metal Texture with Guided Zincophilic Sites via Electrochemical Stripping for Dendrite-Free Zn Anodes.

Constructing a three-dimensional (3D) structure along with Zn (002) texture selective exposure is a promising strategy to tackle the issues faced by Zn metal anodes. Herein, for the first time, we proposed an electrochemical stripping strategy to achieve controlled modification of the texture and microstructure of zinc foils in one step, building a hierarchical structure with (002) texture preferred exposed Zn (SZ). The SZ with favorable zincophilic properties not only can reduce the concentration polarization at the interface but also allow Zn to grow horizontally on the edge of the (002) texture by guiding the adsorption sites for Zn2+. Moreover, the honeycomb-like structure is beneficial to rearrange the distribution of the Zn2+ flux as well as alleviating stress changes during cycling. Thus, the SZ||Cu cell exhibits excellent stability with a Coulombic efficiency of 99.76% over 1800 cycles. The SZ||NaV3O8·xH2O cell with inconspicuous self-discharge effect maintains a high areal capacity of 3.67 mA h cm-2 even after 700 cycles with a low N/P ratio of 3.6. This work achieves texture architecture and structure designing on Zn foils simultaneously by metallurgical electrochemical methods and opens up a potential strategy to implement the practicality of zinc metal anodes.

Engineering a Ni-Al Brucite-Based Interface Layer with Regulated Zn2+ Flux for Highly Reversible Zn Metal Anodes.

Practical aqueous Zn-ion batteries are appealing for grid-scale energy storage with intrinsic safety and cost-effectiveness, yet their cycling stability and reversibility are limited by unwanted dendrite growth and water-induced erosions on Zn. Herein, a hydrophilic and Zn2+-conductive Ni-Al layered double hydroxide (NiAl-LDH) interphase layer is constructed on the surface of Zn, in which NiAl-LDH enables a more uniformly distributed Zn2+ concentration and interfacial electric field owing to its large internal Zn2+ channels and favorable charge redistribution effect. Consequently, the NiAl-LDH-integrated Zn anode achieves low voltage hysteresis and high reversibility of Zn plating/stripping with uniform underneath deposition behaviors. Remarkably, the resultant NiAl-2 LDH@Zn delivers superior cycling durability over 2800 h (∼4 months, 0.5 mA cm-2), realizes high reversibility with 99.4% average Coulombic efficiency over 1400 cycles, and confers stable operation of full Zn cells with high V2O5 mass loadings. This work offers a facile and instructive interface design approach for achieving highly stable Zn metal anodes.