Search Results (30)

Context: Intermittent fasting (IF) and calorie restriction (CR) have gained interest as dietary strategies due to their potential for weight loss and multiple metabolic benefits. These strategies are often accompanied by exercise in an attempt to improve body composition and physical performance. However, further research is crucial to understanding whether or not physical performance is affected by the expected weight loss and related body composition changes in individuals on IF and CR, even when exercise is combined. Objective: We aimed to systematically evaluate the effects of IF and CR on exercise performance and body composition in adults aged 18 to 65 years. Data Source: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic review was conducted up to April 2024 by searching electronic databases, including PubMed, Web of Science, and Scopus. There was no limit on publication dates. Data Extraction: The search explored the impact of IF and CR combined with exercise vs. exercise alone (control) on exercise performance outcomes: VO_2max, handgrip strength, bench press strength, knee extensor strength, leg press strength, countermovement jump (CMJ), 400 m walk test, and gait speed; body weight, body mass index (BMI), and body composition: fat-free mass (FFM), fat mass (FM), and body fat percentage (BFP). Analyses included calculation of weighted mean difference (WMD), standardized mean difference (SMD), and 95% confidence intervals (CIs) to assess outcomes. Data Analysis: The meta-analysis included a total of 35 studies, ranging from 4 to 52 weeks and involving 1266 participants. The results showed that IF (hypocaloric or eucaloric diet) and CR combined with exercise increased handgrip strength [WMD = 1.707 kg, p = 0.01] compared to exercise alone. Moreover, IF and CR combined with exercise did not significantly affect VO_2max [SMD = 0.005, p = 0.94], bench press strength [WMD = 0.377 kg, p = 0.778], knee extensor strength [WMD = −4.729 kg, p = 0.12], leg press strength [WMD = −2.874 kg, p = 0.415], countermovement jump [WMD = −0.226 cm, p = 0.80], 400 m walk test performance [WMD = −8.794 s, p = 0.06], or gait speed [WMD = 0.005 m/s, p = 0.82] compared to exercise alone. Moreover, IF and CR combined with exercise decreased body weight [WMD = −4.375 kg, p = 0.001], BMI [WMD = −1.194 kg·m⁻², p = 0.001], FFM [WMD = −1.653 kg, p = 0.001], FM [WMD = −2.858 kg, p = 0.001], BFP [WMD = −0.826%, p = 0.001] compared to exercise alone. Conclusions: IF (hypocaloric or eucaloric) and CR can be effectively integrated into exercise training without negatively impacting most measures of physical performance, while significantly enhancing weight loss and adiposity-related outcomes. The findings from this meta-analysis involving both athletes and non-athletes suggest that weight loss induced by IF and CR combined with exercise does not necessarily result in reduced physical performance. In real-world scenarios, however, different outcomes are conceivable, as body composition, physical capacity, diet and exercise can vary considerably based on individual conditions. Full article

Cognitive–motor integration is the coordination of cognitive and motor processes; it is commonly impaired among people living with dementia (PWD) and may be improved through exercise. This pilot randomized controlled trial (1:1) aimed to determine the effect of 6 months of exercise on cognitive–motor integration compared to usual care in n = 42 PWD at two residential care facilities. Participants completed single- and dual-task standing (30 s of standing while counting backward by 1 s), walking (4 m walk while naming words), and timed-up-and-go (TUG) tests (TUG with a category task), measured using APDM inertial sensors at baseline and 6 months (age = 82 years, 35% female, Montreal Cognitive Assessment = 10.2 ± 5.9, NCT05488951). The adapted Otago Exercise Program involved 60 min of lower-body strength and balance exercises and walking 3x/week for 6 months. Usual care involved regular social activities and healthcare appointments. Exercise provoked increased single-task stride length and increased dual-task TUG turn velocity compared to usual care (p < 0.05). Usual care may reduce the ability to appropriately select cautious gait, as the usual care group exhibited faster dual-task gait speed at 6 months compared to the OEP plus usual care (p < 0.05), which was faster than their single-task gait speed. Our results support implementing the OEP to improve cognitive–motor integration in PWD. Full article

Background/Objectives: Functional electrical stimulation (FES) has been used to improve the quality of life of patients with stroke. Rehabilitation programs focus on standing and walking, which are vital to functional independence and keystone ingredients in functional competency. To examine the effects of simultaneous continuous ongoing FES of gluteus medius (GMed) and tibialis anterior (TA) muscles at isometric contraction during standing and walking in patients with stroke. Methods: Short- and long-term FES management programs of GMed and TA muscles during different conditions have been used in patients with stroke. FES was applied to hip abductors and dorsiflexor muscles of the affected limb during four different conditions: passive hip abduction and ankle dorsiflexion, respectively (condition 1), sit-to-stand (condition 2), 10 m walk test (condition 3), and walking on C-mill treadmill (condition 4). The Modified Ashworth Scale (MAS), Five Times sit-to-stand test (FTSST), 10-m walk test (10-MWT), and C-mill treadmill were used to assess spasticity in the hip adductor and calf muscles, sit-to-stand performance, and temporal–spatial characteristics, respectively. Results: Short- and long-term FES management programs significantly reduced spasticity in the hip adductor and calf muscles and improved sit-to-stand performance, gait speed, and gait temporal–spatial characteristics. Conclusions: Short- and long-term FES management programs of GMed and TA muscles can quickly and effectively improve the spasticity and ambulation of patients with stroke. Further research incorporating gait analysis with randomized controlled samples is needed. Full article

Background/Objectives: Advanced Glycation End Products (AGEs) are high-molecular-weight compounds formed through non-enzymatic reactions between sugars and proteins, lipids, or nucleic acids. This study aimed to comprehensively analyze the association between the accumulation of AGEs and lower-limb muscle strength, gait speed, and balance abilities related to mobility in elderly individuals. Methods: This cross-sectional correlational study included 552 community-dwelling older adults. AGE accumulation was assessed using skin autofluorescence (SAF) measured using an AGE reader. Mobility decline factors were evaluated using the sit-to-stand (STS), gait speed (4 m walk tests), single-leg stance (SLS), and Timed Up and Go (TUG) tests. Results: A comparison of the physical function across the quartile groups revealed that the group with the highest SAF values, Q4, exhibited a general decline in STS, gait speed, SLS, and TUG performance when compared with the other groups (p < 0.001). Spearman’s correlation analysis revealed that the SAF-AGEs demonstrated significant negative correlations with STS (r = −0.211, p < 0.001), gait speed (r = −0.243, p < 0.001) and SLS (r = −0.201, p < 0.001). Additionally, TUG showed a significant positive correlation (r = 0.239, p < 0.001). In the logistic regression analysis, compared with the Q1 group, the Q4 group had significantly higher odds of low STS performance (odds ratio (OR) = 2.43, p = 0.006), slow gait speed (OR = 2.28, p = 0.002), low SLS performance (OR = 2.52, p = 0.001), and slow TUG (OR = 2.00, p = 0.035). The optimal cutoff value of the SAF for mobility decline was 3.15 (area under the curve 0.694; 95% confidence interval: 0.618–0.771). Conclusions: This study has demonstrated that higher SAF values were associated with decreased lower-limb strength, gait speed, and balance, thereby suggesting that SAF may be a useful screening tool for predicting mobility decline in older adults. Full article

Objectives: Systemic sclerosis (SSc) patients exhibit a heightened vulnerability to sarcopenia, a condition characterized by the loss of muscle mass and strength. This study aims to determine the prevalence of sarcopenia in patients with SSc and to investigate the associated factors contributing to this condition. Methods: Eighty patients with SSc were included in the study, and their demographic and clinical characteristics, body composition by bioelectrical impedance analysis, SARC-F score, chair-stand test performance, and 4 m walking speed were recorded. Results: Among the 80 participants, 91.3% were female, with a median age of 56.5 years (range 45–65). The majority (70%) had limited SSc, and 71.3% reported at least one comorbidity. According to the International Physical Activity Questionnaire, only 12.5% of participants met the criteria for an active lifestyle. The SARC-F questionnaire indicated that 20% of patients were at risk for sarcopenia. The prevalence of sarcopenia among patients showed considerable variability: 5% (95% CI 0.1–9) were identified through the appendicular skeletal muscle index (ASMI), 8.8% (95% CI 2.4–15) via the fat-free mass index (FFMI), and a concerning 20% (95% CI 11–29) according to the skeletal muscle mass index (SSMI). A multivariate logistic regression analysis identified age as the only factor significantly influencing the SARC-F score, with an odds ratio of 1.081 (95% CI 1.012–1.154, p = 0.020). Additionally, the older age group demonstrated a lower level of physical activity, poorer chair-stand test outcome, and slower 4 m gait speeds (p = 0.013, p = 0.008, p = 0.001, respectively), as well as a higher reported frequency of falls (p = 0.039). Conclusions: Sarcopenia is a prevalent issue among individuals with SSc, particularly in the older population. This study did not identify a direct correlation between sarcopenia and SSc subtype, disease activity, or other clinical parameters. However, the need for an improved cut-off value for diagnosing sarcopenia in this specific cohort is evident. Full article

The attractor complexity index (ACI) is a recently developed gait analysis tool based on nonlinear dynamics. This study assesses ACI’s sensitivity to attentional demands in gait control and its potential for characterizing age-related changes in gait patterns. Furthermore, we compare ACI with classical gait metrics to determine its efficacy relative to established methods. A 4 × 200 m indoor walking test with a triaxial accelerometer attached to the lower back was used to compare gait patterns of younger (N = 42) and older adults (N = 60) during normal and metronome walking. The other linear and non-linear gait metrics were movement intensity, gait regularity, local dynamic stability (maximal Lyapunov exponents), and scaling exponent (detrended fluctuation analysis). In contrast to other gait metrics, ACI demonstrated a specific sensitivity to metronome walking, with both young and old participants exhibiting altered stride interval correlations. Furthermore, there was a significant difference between the young and old groups (standardized effect size: −0.77). Additionally, older participants exhibited slower walking speeds, a reduced movement intensity, and a lower gait regularity. The ACI is likely a sensitive marker for attentional load and can effectively discriminate age-related changes in gait patterns. Its ease of measurement makes it a promising tool for gait analysis in unsupervised (free-living) conditions. Full article

Background: Gait disturbances in children with cerebral palsy can increase the hindrance caused by loss of independence and social engagement. The Lokomat, developed by Hocoma, shows promise as a supplementary tool for gait rehabilitation. This study investigates the impact of Lokomat training on gait parameters and trends observed during training. Methods: A total of 26 children (13 male individuals) with a diagnosis of cerebral palsy (CP), aged 4 to 23 years, were enrolled in the study. Patients participated in a standard comprehensive rehabilitation program with additional Lokomat training sessions. Gait function was assessed using the Timed Up and Go Test (TUG) and the 10 m walking test (10mWT) at the beginning and end of the rehabilitation period. Changes in Lokomat parameters (step number, session duration, speed, body weight support, and guidance force) were also analysed. Results: The median duration of the 10mWT and TUG significantly decreased across the groups after the treatment program. The highest increases were observed for the number of steps taken. Across the entire cohort, the linear trend curves for distance and number of steps exhibited near-perpendicular alignment with the horizontal axis, suggesting significant improvement in these parameters. A consistent trend was noted for speed, with the trend line aligned parallel with the horizontal axis. Decreasing trends were observed for body weight support and guidance force. Conclusions: Therapy with the Lokomat functioning as the active gait orthosis can be used as a form of support to the standard rehabilitation protocol for patients with CP. Full article

Objectives: Gait speed indicates the individual’s functional status and predicts overall health. This study aims to determine (1) the intra- and inter-rater and test–retest reliability of the dynamic 4 m gait speed test protocol; (2) establish the normative reference values of habitual and fast gait speeds in community-dwelling healthy Singaporean adults aged 21 to 80; and (3) explore the association of age, gender, height, weight, and body mass index (BMI) on gait speed. Methods: This prospective cross-sectional study recruited healthy ambulatory community-dwelling Singaporeans aged 21 to 80 who could ambulate independently without aid. Participants were excluded if they required walking aids; were pregnant; or had physical, medical, or cognitive conditions that may affect gait. Each participant completed at least two habitual and fast gait speed test trials via a 4 m walkway with a dynamic start. The data were analysed by descriptive statistics, the Mann–Whitney test, the Spearman coefficient, and the interclass correlation coefficient (ICC). Results: In total, 178 males and 201 females were included in the data analysis. The median age was 45.0 years [interquartile range (IQR) 26.2–59.0], and the median height was 1.64 metres (m) (IQR 1.58–1.70). The median habitual gait speed was 1.08 metre/second (m/s) (IQR 0.97–1.22), and the fast gait speed was 1.55 m/s (IQR 1.40–1.70). The ICC for reliability ranged from 0.84 to 0.99, indicating that the 4 m gait speed test had good-to-excellent reliability. Conclusions: Gait speeds were not influenced by gender but declined with age advancement. Age and height and age and BMI were weakly correlated to habitual and fast gait speed, respectively. We established the norm values for the 4 m gait speeds in Singapore and proved it to be a reliable gait speed assessment ready for immediate community applications. Full article

This study investigates the effects of a self-administered eye exercise (SEE) program on the balance and gait ability of chronic stroke patients hospitalized due to hemiplegia. This study includes 42 patients diagnosed with stroke-related hemiplegia and hospitalized at D Rehabilitation Hospital. The researcher randomly allocated 42 patients into two groups: the experimental group (EG, n = 21, mean age = 58.14 ± 7.69 years, mean BMI = 22.83 ± 2.19 kg/m²) and the control group (CG, n = 21, mean age = 58.57 ± 6.53 years, mean BMI = 22.81 ± 2.36 kg/m²). The SEE program was applied to the EG and the general self-administered exercise (SE) program was applied to the CG. After 4 weeks of intervention, weight distribution of the affected side, the Timed Up and Go test (TUG), step length of the affected side, step length of the unaffected side, gait speed, and cadence were analyzed and compared. In the within-group comparison, both groups showed significant differences in weight distribution (p < 0.05), TUG (p < 0.05), step length of the affected side (p < 0.05), step length of the unaffected side (p < 0.05), gait speed (p < 0.05), and cadence (p < 0.05). In the between-group comparison, a significant difference in the TUG (p < 0.05) was observed. The SEE program had an overall similar effect to the SE program in improving the balance and gait ability of chronic stroke patients, and had a greater effect on dynamic balance ability. Therefore, the SEE program can be proposed as a self-administered exercise program to improve balance and gait ability in stroke patients who are too weak to perform the SE program in a clinical environment or have a high risk of falling. Full article

Background: People with Parkinson’s disease (pwPD) present alterations of spatiotemporal gait parameters that impact walking ability. While preliminary studies suggested that dual-task gait training improves spatiotemporal gait parameters, it remains unclear whether dual-task gait training specifically improves dual-task gait performance compared to single-task gait training. The aim of this review is to assess the effect of dual-task training relative to single-task gait training on specific gait parameters during dual-task tests in pwPD. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), searching three electronic databases. Two reviewers independently selected RCTs, extracted data, and applied the Cochrane risk-of-bias tool for randomized trials (Version 2) and the GRADE framework for assessing the certainty of evidence. The primary outcomes were dual-task gait speed, stride length, and cadence. Secondary outcomes included dual-task costs on gait speed, balance confidence, and quality of life. Results: We included 14 RCTs (548 patients). Meta-analyses showed effects favoring dual-task training over single-task training in improving dual-task gait speed (standardized mean difference [SMD] = 0.48, 95% confidence interval [CI] = 0.20–0.77; 11 studies; low certainty evidence), stride length (mean difference [MD] = 0.09 m, 95% CI = 0.04–0.14; 4 studies; very low certainty evidence), and cadence (MD = 5.45 steps/min, 95% CI = 3.59–7.31; 5 studies; very low certainty evidence). We also found a significant effect of dual-task training over single-task training on dual-task cost and quality of life, but not on balance confidence. Conclusions: Our findings support the use of dual-task training relative to single-task training to improve dual-task spatiotemporal gait parameters in pwPD. Further studies are encouraged to better define the features of dual-task training and the clinical characteristics of pwPD to identify better responders. Full article

This research examined the association between the risk of falls and cognitive function in older individuals at risk of mild cognitive impairment. One hundred seventy-five older adults were included in 2021. Balance confidence was scored using the Activities-Specific Balance Confidence Scale (ABC), gait speed was assessed by the 4 m test, handgrip strength by a digital dynamometer, and balance by the Timed Up-and-Go Test (TUG). The Mini-Mental State Examination (MMSE), The Controlled Oral Word Association Test, and The Boston Naming Test short-version questionnaires assessed global cognitive function, verbal fluency, and language, respectively. A bivariate correlation analysis and multivariate linear regressions were applied, adjusting for confounders (BMI, sex, age, and educational level). Shorter time in the TUG and greater educational status were independently associated with improved scores on the MMSE. Lower age and greater educational status were independently associated with increased phonological fluency. Better ABC and performance on the TUG and higher educational attainment were independently associated with enhanced semantic fluency. Higher education level and gait speed were independently associated with increased language (all p < 0.05). Improved physical factors, such as gait speed, grip strength, balance, and balance confidence enhanced cognitive function, particularly global cognitive function, verbal fluency, and language, in individuals over 60, with education as a potential confounder. Full article

End-of-life care (EOLC) is palliative support provided in the last 6 months to 1 year of a patient’s life. Although there are established criteria for its indication, few studies describe the clinical and functional characteristics of individuals with interstitial lung diseases (ILD) in EOLC. ILD individuals underwent various assessments, including lung function, exercise capacity (6 min walk test), physical activity in daily life (PADL), peripheral muscle strength, maximal respiratory pressures, body composition, quality of life (SGRQ-I), symptoms of anxiety and depression, dyspnea (MRC scale), and sleep quality. Fifty-eight individuals were included and divided into two groups according to the indication for commencing EOLC (ILD with an indication of EOLC (ILD-EOLC) or ILD without an indication of EOLC (ILD-nEOLC). There were differences between the groups, respectively, for steps/day (2328 [1134–3130] vs. 5188 [3863–6514] n/day, p = 0.001), time spent/day carrying out moderate-to-vigorous physical activities (1 [0.4–1] vs. 10 [3–19] min/day, p = 0.0003), time spent/day in standing (3.8 [3.2–4.5] vs. 4.8 [4.1–6.7] h/day, p = 0.005), and lying positions (5.7 [5.3–6.9] vs. 4.2 [3.6–5.1] h/day, p = 0.0004), the sit-to-stand test (20 ± 4 vs. 26 ± 7 reps, p = 0.01), 4 m gait speed (0.92 ± 0.21 vs. 1.05 ± 0.15 m/s, p = 0.02), quadriceps muscle strength (237 [211–303] vs. 319 [261–446] N, p = 0.005), SGRQ-I (71 ± 15 vs. 50 ± 20 pts, p = 0.0009), and MRC (4 [3–5] vs. 2 [2–3] pts, p = 0.001). ILD individuals with criteria for commencing EOLC exhibit reduced PADL, functional performance, peripheral muscle strength, quality of life, and increased dyspnea. Full article

It is a challenge to manage and assess heart failure with preserved left ventricular ejection fraction (HFpEF) patients. Six-Minute Walk Test (6MWT) is used in this clinical population as a functional test. The objective of the study was to assess gait and kinematic parameters in HFpEF patients during the 6MWT with an inertial sensor and to discriminate patients according to their performance in the 6MWT: (1) walk more or less than 300 m, (2) finish or stop the test, (3) women or men and (4) fallen or did not fall in the last year. A cross-sectional study was performed in patients with HFpEF older than 70 years. 6MWT was carried out in a closed corridor larger than 30 m. Two Shimmer3 inertial sensors were used in the chest and lumbar region. Pure kinematic parameters analysed were angular velocity and linear acceleration in the three axes. Using these data, an algorithm calculated gait kinematic parameters: total distance, lap time, gait speed and step and stride variables. Two analyses were done according to the performance. Student’s t-test measured differences between groups and receiver operating characteristic assessed discriminant ability. Seventy patients performed the 6MWT. Step time, step symmetry, stride time and stride symmetry in both analyses showed high AUC values (>0.75). More significant differences in velocity and acceleration in the maximum Y axis or vertical movements. Three pure kinematic parameters obtained good discriminant capacity (AUC > 0.75). The new methodology proved differences in gait and pure kinematic parameters that can distinguish two groups according to the performance in the 6MWT and they had discriminant capacity. Full article

The worldwide pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has impacted all healthcare systems. One potential sequela experienced by hospitalized coronavirus disease 2019 (COVID-19) survivors includes muscle weakness with a reduction in strength and, consequently, a possible increase in frailty. The aim of this clinical trial was to evaluate the efficacy of adding an online therapeutic exercise program for 8 weeks to the medical prescriptions on functional variables in patients hospitalized due to COVID-19. A randomized controlled trial including 70 previously hospitalized COVID-19 survivors was conducted. Patients were randomly allocated to an experimental (n = 35) or control (n = 35) group. Both groups received regular prescriptions provided by their medical doctors. The experimental group also received a live online therapeutic exercise program for 8 weeks (3 sessions/week). Handgrip strength, gait speed, lower-extremity strength, balance, and frailty were assessed at baseline, at the end of the program, and one month after the end of the intervention. The repeated measures analysis of variance revealed significant Group*Time interactions for all the outcomes: (handgrip dominant: F = 17.395, p < 0.001, η² = 0.24; handgrip non-dominant: F = 33.197, p < 0.001, η² = 0.33; 4 m walk test (4WT): F = 13.039, p = 0.001, η² = 0.16; short physical performance battery (SPPB): F = 26.421, p < 0.001, η² = 0.28; the five chair-raise test (5CRT): F = 5.628, p = 0.004, η² = 0.08; FRAIL scale: F = 11.249, p = 0.001, η² = 0.14): patients in the experimental group experienced greater improvements in all outcomes than those assigned to the control group. This study revealed that the addition of an online exercise program for 8 weeks obtained greater improvements in handgrip strength, gait speed, lower-extremity strength, balance, and frailty in a sample of previously hospitalized COVID-19 survivors than application of just usual medical prescription. Full article

Background: This study aimed to analyze the applicability of sit-to-stand (STS) muscle power tests for evaluating functional reserve in patients with hospital-associated deconditioning (HAD). Methods: This study is a single group preliminary observational study. STS tests were performed in the early stages of comprehensive rehabilitation treatment, and the interval changes in the clinical indicators were assessed after four weeks of clinical observation. A STS capacity ratio was estimated by the time duration of five STS repetitions (5r-STS) and the maximum number of STS repetitions over 30 s (30s-STS); the activities were measured using a three-dimension motion capture system and force plate. Results: After 4 weeks of comprehensive rehabilitation, the 10 m gait speed (p = 0.004), hand grip power (p = 0.022), hip extensor power (p = 0.002), Berg balance scale (p < 0.001), and modified Barthel index (MBI) (p = 0.001), respectively, were significantly improved. The force plate-derived (FPD) 30s-STS power and the number of repeats in the FPD 30s-STS showed a positive correlation with improvements in the hand grip power (Spearman’s Rho = 0.477, p = 0.045), hip extensor power (Spearman’s Rho = 0.482, p = 0.043), and MAI (Spearman’s Rho = 0.481, p = 0.043), respectively. The STS capacity ratio was correlated with higher improvements in the 10 m gait speed (Spearman’s Rho = 0.503, p = 0.034), hip extensor power (Spearman’s Rho = 0.494, p = 0.037), and MBI (Spearman’s Rho = 0.595, p = 0.009). Despite individual variability in the differences between the FPD and estimated STS power, the results for the correlation between the STS capacity ratio and clinical outcomes were consistent. Conclusions: The STS capacity ratio showed a positive correlation with the clinical outcomes, including gait speed, and may reflect a part of the functional reserve excluding the individual variability of performance. Full article