Investigation of Physical Activity Levels and Associated Factors of Greek Older Adults During COVID-19 Pandemic: A Community-Based Cross-Sectional Study.

The purpose of this cross-sectional study was to investigate the self-reported impact of the COVID-19 pandemic on physical activity (PA), anxiety, and depression amongst Greek older adults. Participants were older adults (>60 years) recruited from community centers of Achaia (Open Care Centers for Older Adults), in Western Greek mainland during the period of December 2020-March 2021. The information was gathered through telephone interviews. Questions on social demographics, health history, diagnosis, quarantine, and hospitalization were asked, as well as impact of the pandemic health status and physical activity behavior. The level of PA was assessed via the International Physical Activity Questionnaire (IPAQ) questionnaire, while anxiety and depression via the Hospital and Anxiety and Depression Scale (HADS). The study protocol was approved by the Ethical Committee of the University of Patras. Four-hundred eleven (411) older adults (306 women, 105 men; mean age of 72.47 ± 6.89 years years) completed the survey. About half of the sample (n = 179; 43.5%) reported a decrease in physical activity due to the pandemic and social isolation restrictions. From the total sample, 211 older adults (51.3%) recorded fear of COVID-19 infection and 9 participants (2.1%) reported to have been diagnosed with the COVID-19 infection. The findings of this study demonstrated that PA was associated with place of living (r = 0.55; p ≤ 0.001), incidence of falls (r = 0.45; p ≤ 0.001), COVID-19 infection (r = 0.6; p ≤ 0.001), fear of COVID-19 infection (r = 0.45; p ≤ 0.05), and anxiety (r = 0.5; p ≤ 0.001). In summary, a decline in PA due to COVID-19 pandemic was reported by the majority of Greek older adults. Results of the present study show that the COVID-19 pandemic may have induced PA behavior changes in many older adults, which may accelerate their risk of developing frailty, sarcopenia, and disability. Interventions to improve PA in older adults should take into account social and community factors and should be key components of current and future pandemic plans, particularly for vulnerable groups.

Relationship of Ηand Grip Strength, Physical Activity, and Anthropometric Characteristics in a Sample of Male and Female Physiotherapy Students.

The present study aimed to determine gender differences in the hand grip strength (HGS) and to examine the relations between HGS, anthropometric characteristics, and physical activity (PA) in Greek young adults. A cross-sectional observational study of 276 students (21.5 ± 4.1 years, 122 men, 154 women) was conducted at the University of Patras, Greece. HGS was assessed via a hand-held grip strength dynamometer; body composition was determined by bioelectrical impedance analysis; and calf, mid-arm, and waist circumferences with inelastic tape. PA was assessed with the modified Baecke Questionnaire for Habitual Physical Activity (mBQHPA). The mean of HGS was 37.15 ± 11.2 kg. Men had significantly (p < 0.001) greater HGS than women. Statistically large correlation was detected between HGS and muscle mass (r = 0.73; p ≤ 0.001), gender (r = 0.6; p ≤ 0.001), mid-arm (r = 0.74; p ≤ 0.001), and calf circumference (r = 0.69; p ≤ 0.001). Results show that fat mass was a risk factor associated with HGS, found using regression analyses in both genders. However, PA was a significant associated factor only for women participants (ΟR = 0.77; 95% confidence interval [CI]: 0.17-1.38; p ≤ 0.05). In summary, the HGS of Greek physiotherapy students was associated with muscle mass, gender, mid-arm, and calf circumference.

The Effects of Exercise in Older Adults with Hyperkyphotic Posture.

The objective of this review was to investigate the effects of exercise in older adults with hyperkyphosis. Medline and Google Scholar databases were searched from June to August 2022 for studies related to exercise interventions in older adults above 60 years of age. All types of exercise interventions (such as strengthening, stretching, Yoga, and/or any other exercise with a focus on treatment or prevention of postural malalignment) were included. The keywords used were "hyperkyphosis," "exercise," and "older adults." Ten studies were included involving 625 older adults with hyperkyphotic posture. The exercise interventions included spine strengthening (strengthening of back and abdominal muscles), poses of Yoga and postural alignment, and flexibility and respiratory muscle exercises. Duration of exercise programs varied from 6 weeks (1 study) to 8 weeks (3 studies), 12 weeks (4 studies), and 6 months (3 studies). Exercise adherence was generally good in studies. In summary, low to moderate evidence suggest that exercises in age-related hyperkyphosis have a role in the management of this group of patients. It can be beneficial in order to improve postural control, spinal stability, and kyphosis outcomes. The adherence reported across studies suggests that exercise is an acceptable treatment option for people with age-related hyperkyphosis. Types of exercise and dose-response parameters of exercise eliciting improvement warrant further investigation. Due to heterogeneity in clinical trials, future research is needed with the goal of improving the health of our growing geriatric population.

Cross cultural adaptation, reliability and validity of the Greek version of Identification of Functional Ankle Instability (IdFAI) questionnaire.

BACKGROUND: The objectives of our study were to develop the Greek version of the Identification of Functional Ankle Instability (IdFAI) questionnaire and to evaluate its psychometric properties. METHODS: The IdFAI was translated and adapted into Greek according to the guidelines for cross-cultural adaptation of self report measures. It was tested for test-retest reliability, validity, internal consistency and floor-ceiling effects in 141 participants (54 males, 87 females; 23.5 ± 7.2 years). All participants were asked to fill the Greek IdFAI (IdFAI-GR), the Cumberland Ankle Instability Tool (CAIT), and the Lower Extremity Functional Scale (LEFS), in order to determine construct validity. To determine the test-retest reliability, fifty randomly selected individuals re-filled IdFAI seven days after the first session. RESULTS: The IdFAI-GR had high internal consistency (Cronbach alpha = 0.94) and excellent test-retest reliability (ICC2,1 = 0.97; SEM = 0.7). The IdFAI-GR had strong correlation with the CAIT (r = 0.7; p < 0.001) and moderate correlation with the LEFS (r = 0.5; p < 0.001). No ceiling or floor effects were observed. CONCLUSION: The Greek IdFAI questionnaire has proven to be a valid and reliable instrument to identify functional ankle instability. It can therefore, be used for both clinical and research purposes in Greek-speaking individuals.

Hand Grip Strength in Patients on Hemodialysis: An Observational Study.

The objective of this study is to evaluate hand grip strength (HGS) in patients on hemodialysis and to investigate associated factors (anthropometric characteristics, body composition, and quality of life). An observational study of 60 patients in one hemodialysis center (Filoxenia Dialysis center, Aigio, Greece) was conducted. Measures of HGS were performed with a hydraulic dynamometer (Saehan Corporation, South Korea) on the non-fistula hand before the hemodialysis session. Demographic and clinical data (dialysis start date, comorbidities, and etiology of chronic kidney disease) were collected from the patients' medical charts. Body composition was determined by bioelectrical impedance analysis and calf circumference with inelastic tape. Quality of life was assessed via EuroQol (EQ-5D) questionnaire. Descriptive statistics were used for data analyses. The association between variables was calculated using Pearson's r correlation coefficients. The experimental design of this study was approved by the Ethics Committee of the Technological Educational Institute of Western Greece. A total of 54 patients (71.2 ± 10.9 years old, 24% diabetic, BMI of 26.34 ± 5.2) participated in this study (response rate 90%). The average duration of hemodialysis was 4.29 ± 6.36 years. The maximum HGS in the dominant was 19.19 ± 12.1 kg (female 12.04 ± 7.26 kg, male 21.82 ± 12.52 kg, p < 0.001). HGS was significantly correlated with age (r = 0.5; p < 0.001) and moderately correlated with gender (r = 0.36; p = 0.008), BMI (r = 0.3; p = 0.03), calf circumference (r = 0.4; p = 0.03), and quality of life (r = 0.37; p = 0.006). The use of hand-held dynamometry could be a fundamental element of the physical examination of patients receiving hemodialysis, particularly if they are older adults.

The Effects of Exercise in Patients with Sarcopenia.

The aim of this study was to assess the effects of different types of exercise interventions for treating sarcopenia compared to no specific treatment, a minimal intervention (e.g., education), or another active treatment (nutritional supplements). A review was conducted of the recent English literature searching PubMed and ScienceDirect databases. Ten randomized controlled trials (RCTs) were included in this review, presenting the results of 671 sarcopenic patients. The exercise interventions were resistance training (four studies), a multimodal program (five studies, encompassing resistance training and additional exercises such as aerobic exercises, flexibility, balance and strength training), and a whole body vibration program (one study). Results show that exercise interventions could have beneficial effects in improving muscle mass, muscle strength, and physical performance in 3 months of intervention. Resistance training, added to an adequate nutrition and aerobic exercise, appeared to deliver the most positive outcome after 3 months of intervention. Types of exercise and dose-response parameters of exercise eliciting improvement warrant further investigation. Due to the significant heterogeneity in clinical trials, the current evidence provides limited guidance. Well-designed studies evaluating exercise interventions are needed before treatment guidelines can be developed.

Association of low back pain on physical, sociodemographic and lifestyle factors across a general population sample within Greece.

BACKGROUND: Although low back pain (LBP) is a debilitating problem internationally, there is not a lot of research on its impact on physical, psychosocial and lifestyle factors. Especially in mediterranean countries, such as Greece, it is not sufficiently explored whether physical (pain location, activity limitation etc.), sociodemographic (education, smoking etc.) or lifestyle factors (i.e. quality of life or anxiety) are influenced by LBP. OBJECTIVE: To estimate LBP prevalence in the Greek general population and explore its association with particular sociodemographic, physical and lifestyle factors. METHOD: A sample of 3125 people of the Greek adult population was randomly selected by stratified sampling encompassing rural and urban representation within the Greek mainland. An extended survey form was developed entailing three sections; personal (sociodemographic) information, questions on symptomatology and physical factors (i.e. pain characteristics, recurrence, physical disability etc.) and 3 self-administered questionnaires (including mostly lifestyle factors); Hospital Anxiety and Depression (HAD) scale for anxiety and depression, SF-12 for quality of life (QoL) and Roland-Morris for disability. RESULTS: A total of 471 (15%) people reported LBP (210 males, mean age: 47.04 ± 15.03). Amongst them 60% reported sciatica, 76% suffered recurrent LBP and 70% received specialist care. Low disability levels, moderate to high pain intensity, gender differences and good self-reported QoL and psychosocial status were reported. Sociodemographic characteristics (income, smoking, marital status etc.) were not associated with LBP physical factors, apart from age which correlated with physical disability and wellness (r being 0.446 and 0.405, respectively, p< 0.001). Physical factors (particularly pain intensity and location) correlated with lifestyle factors (QoL) and disability (r ranging between 0.396 and 0.543, p< 0.001). Mental wellness, anxiety and depression (as lifestyle factors) were not associated with sociodemographic or physical factors. CONCLUSIONS: Physical parameters were amongst the most prevalent characteristics of the Greek sample, thus offering a direction towards a more targeted treatment and rehabilitation planning. Unlike previous literature, most sociodemographic characteristics were not correlated with any LBP physical or lifestyle factors, thus possibly indicating a different socioeconomic background and aetiology domain to that of the usual non-specific LBP spectrum.

The effect of total knee arthroplasty on patients' balance and incidence of falls: a systematic review.

PURPOSE: Despite the high incidence of falls in patients with OA, few studies have explored whether falls risk is affected after patients undergo total knee arthroplasty (TKA). Therefore, the aim of this systematic review was to identify the extent of the effects of TKA on balance and incidence of falls by critically reviewing the available literature. METHODS: A systematic review of published literature sources was conducted up to March 2014. All studies assessing balance and incidence of falls after TKA (without physiotherapeutic intervention) were included. The methodological quality of each study was reviewed using the Critical Appraisal Skill Programme tool. RESULTS: Thirteen studies were included, comprising of ten cohort studies (Level II) and three studies with Level of evidence III. CONCLUSIONS: Findings provide evidence that TKA improves significantly single-limb standing balance (~60%) and dynamic balance up to 1-year following surgery (Level of evidence II). Moreover, TKA influences positively fear of falling and incidence of falls by switching 54.2 % of pre-operative fallers to post-operative non-fallers (Level of evidence II-III). It is highlighted that knee extension strength, proprioception and symmetrization of postural strategies have not fully recovered post-TKA and influence balance performance. Clinically, these persistent deficits need to be mitigated by physiotherapy even before TKA takes place.

Endurance markers are related with local neuromuscular response for the intact but not for the ACL reconstructed leg during high intensity running.

AIM: It has been demonstrated that the local neuromuscular response during high intensity exercise has a strong relationship with endurance markers. However, a diminished neuromuscular response has been reported for the operated leg in athletes having undergone anterior cruciate ligament reconstruction (ACLR). The purpose of the present study was to examine the relationships between endurance markers and the EMG response during high intensity running in ACLR athletes. METHODS: Fourteen ACLR soccer players underwent a GXT test to volitional exhaustion and a 10-min bout of high intensity running. During the 10-min bout, EMG data were recorded at the 3rd and 10th minute from the vastus lateralis bilaterally using a telemetric system. The final EMG levels were expressed as a percentage of the initial values. Pearson moment product correlations were used to assess the relationship between the endurance markers of VO2max, velocity at lactate threshold (vLT), velocity at 4mM (V4) and the final EMG levels. RESULTS: Final EMG levels for the intact leg had a very strong relationship with vLT (r=0.77, P=0.001) and a strong relationship with V4 (r=0.68, P=0.008). Final EMG levels for the reconstructed leg had moderate relationship with vLT (r=0.47, P=0.09) and V4 (r=0.52, P=0.06). CONCLUSION: The neuromuscular response of the intact leg during high intensity running shows strong to very strong relationships with endurance markers. Failure of the ACLR leg to present relationships of similar strength may indicate that chronic perturbations modify the ability of the local muscular environment to tolerate sustained high intensity efforts.

Multivariate isokinetic strength asymmetries of the knee and ankle in professional soccer players.

AIM: Soccer players possess various degrees of functional footedness. Their lower limbs are subjected to consistent asymmetrical workloads and neuromuscular adaptations, and as a result develop asymmetrical patterns of musculoskeletal function. This study focused on the myodynamic profile of the knee and ankle joint in professional soccer players. Special emphasis was put on the multivariate quantification of three types of asymmetry: directional (left vs. right), fluctuating (dominant vs. non dominant) and absolute (left vs. right). METHODS: One-hundred professional soccer players (mean age 23.4 years, weight 73.3, height 177.6) were tested isokinetically for concentric and eccentric isokinetic muscle strength (1) of the knee flexors and extensors, and (2) of the ankle dorsal and plantar flexors. Knee flexion-extension was tested at 60o, 180o and 300o/s for the concentric mode of contraction and at 60o and 180o/s for the eccentric. The ankle joint was tested only at 60o/s for both the concentric and eccentric action. RESULTS: MANOVA showed significances for all three types of strength asymmetry (joint and action combined): directional (Wilks' Λ=0.66, F=2.957, P=0.001), fluctuating (Wilks' Λ=0.61, F=2.957, P=0.007), and absolute asymmetry (Wilks' Λ=0.47, F=116.26, P=0.000). Several significant asymmetries were also revealed at the univariate level of analysis (P<0.05). CONCLUSION: It seems that the lower limbs of professional soccer players are characterized by significant compound muscle strength asymmetries. These findings substantiate the idea of asymmetry in the myodynamic adaptations that take place at the knee and ankle joint of soccer players during the game. Individual modification of the training load, targeting in strength asymmetry correction, should be taken into consideration for injury prevention.

Electromechanical delay of the knee extensor muscles is not altered after harvesting the patellar tendon as a graft for ACL reconstruction: implications for sports performance.

Although the scar tissue, which heals the donor site defect, has different elasticity from the neighbouring patellar tissue, it remains unclear if this scar tissue can lead to the changes of the electromechanical delay (EMD) of the knee extensor muscles. If such changes do exist, they can possibly affect both the utilization of the stored energy in the series elastic component, as well as the optimal performance of the knee joint movement. The purpose of this study was to investigate the influence of harvesting the patellar tendon during anterior cruciate ligament (ACL) reconstruction and the associated patellar tendon scar tissue development on the EMD of the rectus femoris (RF) and vastus medialis (VM) muscles. Seventeen patients who underwent an ACL reconstruction using the medial third of the patellar tendon were divided in two groups based upon their post-operative time interval. Maximal voluntary contraction from the knee extensors, surface EMG activity, and ultrasonographic measurements of the patellar tendon cross-section area were obtained from both knees. Our results revealed that no significant changes for the maximal voluntary contraction of the knee extensors and for the EMD of the RF and the VM muscles due to patellar scar tissue development after harvesting the tendon for ACL reconstruction. The EMD, as a component of the stretch reflex, is important for the utilization of the stored energy in the series elastic component and thus, optimal sports performance. However, from our results, it can be implied that the ACL reconstruction using a patellar tendon graft would not impair sports performance as far as EMD is concerned.

Hamstring weakness as an indicator of poor knee function in ACL-deficient patients.

Anterior cruciate ligament (ACL) rupture causes instability to the knee joint which leads each patient to a different degree of disability. The purpose of this study was to examine the strength of the quadriceps and the hamstrings in ACL-deficient amateur soccer players at different levels of functional status. Thirty male amateur soccer players were separated into three groups according to their Lysholm score; the high-L1 (Lysholm > or =84), the intermediate-L2 (84> Lysholm > or =72) and the low-L3 (Lysholm <72) knee function groups. The control group consisted of 12 amateur soccer players. The strength of the quadriceps and hamstrings was assessed isokinetically at 60 degrees/s. The quadriceps demonstrated significant deficits of the injured knee compared to the intact knee in all groups, whilst the hamstrings showed significant weakness only in the low function group. Respective percentage deficits in groups L1, L2 and L3 were 13.7%, 16.0% and 18.6% for the quadriceps and 2.4%, 5.6% and 19.2% for the hamstrings. All groups had significant quadriceps weakness which did not differ between the groups. In contrast, the strength deficit of the hamstrings was an indicator of poor knee function, since they were significantly weak only in group L3, which represented patients who clearly failed to compensate for instability symptoms. In groups L1 and L2 the side-to-side differences were within the area of asymmetry measured in the control group. Clinical importance of the results is discussed.