Definition and Contextual Factors of Nursing Home Residents' Mobility in a Holistic View: A Delphi Study.

Background and Objectives: Current definitions of older adults' mobility do not cover the full range of influencing factors and do not consider nursing home residents. The present study reports expert ratings from a Delphi study regarding factors influencing the mobility of long-term nursing home residents. Research Design and Methods: We invited 129 professionals with expertise in a field relevant to research on mobility in older adults such as health care, medicine, or human movement science to participate in a Delphi study comprising 3 rounds of online questionnaires. Up to 40 experts participated in each round. In the first round, we used open-ended questions to solicit possible definitions, contextual factors, and assessment tools. In the second round, the participants used Likert scales (1-10) to rate their suitability. In the final round, we presented a definition based on consensus as well as the top-rated contextual factors and assessment tools from the first 2 rounds for a final rating of agreement. Results: The experts showed broad agreement on the final version of the mobility definition, with 8.9 ± 1.4 (mean ± standard deviation) out of 10 points. The experts also showed broad consensus on the selected contextual factors, with 8.4 ± 1.8 points to 8.9 ± 1.2 points (out of 10 points). This was also the case for the top 3 assessment tools selected from results of previous rounds, which showed an agreement of 7 or more points (out of 10 points) by 81.6% to 100% of all experts in the different categories. Discussion and Implications: Given that an interdisciplinary group of experts considered various hitherto neglected contextual factors as relevant, the Delphi survey and its results imply the need for an updated interdisciplinary and holistic understanding of mobility in nursing home residents and can provide a basis for putting it into practice.

Dual-Task Performance in Hearing-Impaired Older Adults-Study Protocol for a Cross-Sectional Mobile Brain/Body Imaging Study.

Background: Hearing impairments are associated with reduced walking performance under Dual-task (DT) conditions. Little is known about the neural representation of DT performance while walking in this target group compared to healthy controls or younger adults. Therefore, utilizing the Mobile Brain/Body Imaging approach (MoBI), we aim at gaining deeper insights into the brain dynamics underlying the interaction of cognitive and motor processes during different DT conditions (visual and auditory) controlling for age and the potential performance decrements of older adults with hearing impairments. Methods: The cross-sectional study integrates a multifactorial mixed-measure design. Between-subject factors grouping the sample will be age (younger vs. older adults) and hearing impairment (mild vs. not hearing impaired). The within-subject factors will be the task complexity (single- vs. DT) and cognitive task modality (visual vs. auditory). Stimuli of the cognitive task will vary according to the stimulus modality (visual vs. auditory), presentation side (left vs. right), and presentation-response compatibility (ipsilateral vs. contralateral). Analyses of DT costs and underlying neuronal correlates focus either on gait or cognitive performance. Based on an a priori sample size calculation 96 (48 healthy and 48 mildly hearing impaired) community-dwelling older adults (50-70 years) and 48 younger adults (20-30 years) will be recruited. Gait parameters of speed and rhythm will be captured. EEG activity will be recorded using 64 active electrodes. Discussion: The study evaluates cognitive-motor interference (CMI) in groups of young and older adults as well as older adults with hearing impairment. The underlying processes of the interaction between motor and cognitive tasks will be identified at a behavioral and neurophysiological level comparing an auditory or a visual secondary task. We assume that performance differences are linked to different cognitive-motor processes, i.e., stimulus input, resource allocation, and movement execution. Moreover, for the different DT conditions (auditory vs. visual) we assume performance decrements within the auditory condition, especially for older, hearing-impaired adults. Findings will provide evidence of general mechanisms of CMI (ST vs. DT walking) as well as task-specific effects in dual-task performance while over ground walking.

Multimodal Exercise Effects in Older Adults Depend on Sleep, Movement Biography, and Habitual Physical Activity: A Randomized Controlled Trial.

Background: The promotion of healthy aging is one of the major challenges for healthcare systems in current times. The present study investigates the effects of a standardized physical activity intervention for older adults on cognitive capacity, self-reported health, fear of falls, balance, leg strength and gait under consideration of movement biography, sleep duration, and current activity behavior. Methods: This single-blinded, randomized controlled trial included 49 community-dwelling older adults (36 women; 82.9 ± 4.5 years of age (Mean [M] ± SD); intervention group = 25; control group = 24). Movement biography, sleep duration, cognitive capacity, self-reported health status, and fear of falls were assessed by means of questionnaires. Leg strength, gait, and current activity levels were captured using a pressure plate, accelerometers, and conducting the functional-reach and chair-rising-test. The multicomponent intervention took place twice a week for 45 min and lasted 16 weeks. Sub-cohorts of different sleep duration were formed to distinguish between intervention effects and benefits of healthy sleep durations. Change scores were evaluated in univariate analyses of covariances (ANCOVAs) between groups and sub-cohorts of different sleep duration in both groups. Changes in cognitive capacity, self-reported health, fear of falls, balance, leg strength, and gait were investigated using the respective baseline values, movement biography, and current activity levels as covariates. Analysis was by intention-to-treat (ITT). Results: We found sub-cohort differences in cognitive capacity change scores [F (3,48) = 5.498, p = 0.003, ηp 2 = 0.287]. Effects on fear of falls [F (1,48) = 12.961, p = 0.001, ηp 2 = 0.240] and balance change scores F (1,48) = 4.521, p = 0.040, ηp 2 = (0.099) were modified by the level of current activity. Effects on gait cadence were modified by the movement biography [F (1,48) = 4.545; p = 0.039, ηp 2 = 0.100]. Conclusions: Unlike for functional outcomes, our multicomponent intervention in combination with adequate sleep duration appears to provide combinable beneficial effects for cognitive capacity in older adults. Trainability of gait, fear of falls, and flexibility seems to be affected by movement biography and current physical activity levels. Trial registration: This study was registered at the DRKS (German Clinical Trials Register) on November 11, 2020 with the corresponding trial number: DRKS00020472.

The age-related decline in spatiotemporal gait characteristics is moderated by concerns of falling, history of falls & diseases, and sociodemographic-anthropometric characteristics in 60-94 years old adults.

BACKGROUND: Associations between age, concerns or history of falling, and various gait parameters are evident. Limited research, however, exists on how such variables moderate the age-related decline in gait characteristics. The purpose of the present study was to investigate the moderating effects of concerns of falling (formerly referred to as fear of falling), history of falls & diseases, and sociodemographic characteristics on changes in gait characteristics with increasing age in the elderly. METHODS: In this individual participant level data re-analysis, data from 198 participants (n = 125 females) from 60 to 94 years of age were analysed (mean 73.9, standard deviation 7.7 years). Dependent variables were major spatiotemporal gait characteristics, assessed using a capacitive force measurement platform (zebris FDM-T). Age (independent variable) and the moderating variables concerns of falling (FES-I), gender/sex, history of falls and fall-related medical records, number of drugs daily taken, and body mass index were used in the statistical analysis. Hierarchical linear mixed moderation models (multilevel analysis) with stepwise (forward) modelling were performed. RESULTS: Decreases of gait speed (estimate = -.03, equals a decrease of 0.03 m/s per year of ageing), absolute (- 1.4) and gait speed-normalized (-.52) stride length, step width (-.08), as well as increases in speed normalized cadence (.65) and gait speed variability (.15) are all age-related (each p < .05). Overall and specific situation-related concerns of falling (estimates: -.0012 to -.07) were significant moderators. History of potentially gait- and/or falls-affecting diseases accelerated the age-related decline in gait speed (-.002) and its variability (.03). History of falls was, although non-significant, a relevant moderator (in view of increasing the model fit) for cadence (.058) and gait speed (-.0027). Sociodemographics and anthropometrics showed further moderating effects (sex moderated the ageing effect on stride length, .08; height moderated the effect on the normalised stride length, .26; BMI moderated the effects on step width, .003). . CONCLUSION: Age-related decline in spatiotemporal gait characteristics is moderated by concerns of falling, (non-significantly) by history of falls, significantly by history of diseases, and sociodemographic characteristics in 60-94 years old adults. Knowing the interactive contributions to gait impairments could be helpful for tailoring interventions for the prevention of falls. TRIAL REGISTRATION: Re-analysis of [21-24].

Habitual Physical Activity and Sleep Duration in Institutionalized Older Adults.

Background: Physical activity and sleep quality are both major factors for improving one's health. Knowledge on the interactions of sleep quality and the amount of physical activity may be helpful for implementing multimodal health interventions in older adults. Methods: This preliminary cross-sectional study is based on 64 participants [82.1 ± 6.4 years (MD ± SD); 22 male: 42 female]. The amount of physical activity was assessed by means of an accelerometer (MyWellness Key). Self-reported sleep parameters were obtained using the Pittsburgh Sleep Quality Index. The Barthel Index was used for physical disability rating. Bivariate correlations (Spearman's Rho) were used to explore relationships between the amount of physical activity and sleep quality. To analyse differences between categorial subgroups univariate ANOVAs were applied; in cases of significance, these were followed by Tukey-HSD post-hoc analyses. Results: No linear association between physical activity and sleep quality was found (r = 0.119; p > 0.05). In subgroup analyses (n = 41, Barthel Index ≥90 pts, free of pre-existing conditions), physical activity levels differed significantly between groups of different sleep duration (≥7 h; ≥6 to <7 h; ≥5 to <6 h; <5h; p = 0.037). Conclusion: There is no general association between higher activity levels and better sleep quality in the investigated cohort. However, a sleep duration of ≥5 to <6 h, corresponding to 7.6 h bed rest time, was associated with a higher level of physical activity.

An interrater reliability study of gait analysis systems with the dual task paradigm in healthy young and older adults.

BACKGROUND AND AIMS: One reason for the controversial discussion of whether the dual task (DT) walking paradigm has an added value for diagnosis in clinical conditions might be the use of different gait measurement systems. Therefore, the purpose was 1) to detect DT effects of central gait parameters obtained from five different gait analysis devices in young and old adults, 2) to assess the consistency of the measurement systems, and 3) to determine if the absolut and proportional DT costs (DTC) are greater than the system-measurement error under ST. METHODS: Twelve old (72.2 ± 7.9y) and 14 young adults (28.3 ± 6.2y) walked a 14.7-m distance under ST and DT at a self-selected gait velocity. Interrater reliability, precision of the measurement and sensitivity to change were calculated under ST and DT. RESULTS: An age effect was observed in almost all gait parameters for the ST condition. For DT only differences for stride length (p < .029, ɳ2p = .239) as well as single and double limb support (p = .036, ɳ2p = .227; p = .034, ɳ2p = .218) remained. The measurement systems showed a lower absolute agreement compared to consistency across all systems. CONCLUSIONS: When reporting DT effects, the real changes in performance and random measurement errors should always be accounted for. These findings have strong implications for interpreting DT effects.

Relating Lifetime Activity Behavior to the Current Level of Physical Activity of Older Adults.

This study investigates methods of data gathering and management, along with the relationship of lifespan and older adults' activity. Community-dwelling older adults (n = 47, 81.7 ± 3.6 years) completed the Lifetime Leisure Physical Activity Questionnaire. Current activity was assessed by use of accelerometers. The data were converted to the metabolic equivalent of task hours. Correlations between the main outcomes (metabolic equivalent of task/hour, Lifetime Leisure Physical Activity Questionnaire), as well as individual estimation errors for data adjustments, were computed. The accelerometer and Lifetime Leisure Physical Activity Questionnaire data for the last 12 months' activity were associated (r = .31, p = .033). The average overestimation in the self-reported data was 176%. The adapted data on lifetime physical activity reveals correlations between older adults' activity and the activity levels of three 15-year episodes (r = .354; r = .336; r = .323; each p < .05), as well as compliance with guidelines throughout life (Hotelling's T2 = 45-164; p ≤ .002). Our findings indicate a relationship between lifetime and older adults' activity and provide further support for lifelong engagement in physical activity.

Agreement and consistency of five different clinical gait analysis systems in the assessment of spatiotemporal gait parameters.

BACKGROUND: Measuring gait function has become an essential tool in the assessment of mobility in aging populations for both, clinicians and researchers. A variety of systems exist that assess gait parameters such as gait cycle time, gait speed or duration of relative gait phases. Due to different measurement principles such as inertial or pressure sensors, accurate detection of spatiotemporal events may vary between systems. RESEARCH QUESTION: To compare the absolute agreement and consistency in spatiotemporal gait parameters among five different clinical gait analysis systems using different sensor technologies. METHODS: We compared two devices using inertial sensors (GaitUp & Mobility Lab), two devices using pressure sensor systems (GAITRite & Zebris) as well as one optical system (OptoGait). Twelve older adults walked at self-selected speed through a walkway integrating all of the above systems. Basic spatiotemporal parameters (gait cycle time, cadence, gait speed and stride length) as well as measures of relative phase (stance phase, swing phase, double stance phase, single limb support) were extracted from all systems. We used Intraclass Correlation Coefficients as measures of agreement and consistency. RESULTS: High agreement and consistency between all systems was found for basic spatiotemporal parameters, whereas parameters of relative phase showed poorer agreement and consistency. Overground measurement (GAITRite & OptoGait) showed generally higher agreement with each other as compared to inertial sensor-based systems. SIGNIFICANCE: Our results indicate that accurate detection of both, the heel-strike and toe-off event are crucial for reliable results. Systematic errors in the detection of one or both events may only have a small impact on basic spatiotemporal outcomes as errors remain consistent from step to step. Relative phase parameters on the other hand may be affected to a much larger extent as these differences lead to a systematic increase or reduction of relative phase durations.

Physical activity and health promotion for nursing staff in elderly care: a study protocol for a randomised controlled trial.

INTRODUCTION: Nursing staff is burdened by high workload and stress. Furthermore, heavy lifting, as well as transferring nursing home residents, cause lumbar tissue damage and back pain. Exercise intervention studies to reduce work-related problems are rare and the evidence for efficacy of studies among nurses is limited. Studies including targeted analysis of requirements are necessary to generate effective recommendations and tailored interventions for health promotion programmes. The purpose of this multicentred intervention study is to identify work-related problems, to implement health promotion programmes and to evaluate their effectiveness. METHODS AND ANALYSIS: A randomised controlled trial will be conducted, including a total of 48 nursing home facilities in eight regions of Germany with an estimated sample size of 700 nurses. Standardised ergonomics and posture training (10 weeks, once a week for 20-30 min) and subsequently, back-fitness training (12 weeks, once a week for 45-60 min) will be administered. Following the implementation of standardised health promotion programmes, further demand-oriented interventions can be implemented. The perceived exposure to work-related demands, work-related pain in different parts of the body, health-related quality of life, perceived stress, work-related patterns of behaviour and experience, presentism behaviour, work environment as well as general needs and barriers to health promotion, will be assessed at baseline (pre-test), at 10 weeks (post-test, after ergonomics training), at 22 weeks (post-test, after back-fitness training) and at 34 weeks of the programme (follow-up). ETHICS AND DISSEMINATION: The study was reviewed and approved by the local ethics committee of the University of Hamburg (AZ: 2018_168). The results of the study will be published in open-access and international journals. Furthermore, the results will be presented in the participating nursing homes and at national and international conferences. TRIAL REGISTRATION NUMBER: DRKS.de (DRKS00015241).

Traditional Neuropsychological Testing Does Not Predict Motor-Cognitive Test Performance.

The ecological validity of neuropsychological testing (NT) has been questioned in the sports environment. A frequent criticism is that NT, mostly consisting of pen and paper or digital assessments, lacks relevant bodily movement. This study aimed to identify the determinants of a newly developed testing battery integrating both cognitive and motor demands. Twenty active individuals (25 ± 3 years, 11 males) completed the new motor-cognitive testing battery (MC), traditional NT (Stroop test, Trail Making test, Digit Span test) and isolated assessments of motor function (MF; Y-balance test, 20m-sprint, counter-movement jump). Kendal's tau and partial Spearman correlations were used to detect associations between MC and NT/MF. Except for two items (Reactive Agility A and counter-movement jump; Run-Decide and sprint time; r = 0.37, p < 0.05), MC was not related to MF. Similarly, MC and NT were mostly unrelated, even when controlling for the two significant motor covariates (p > 0.05). The only MC item with (weak to moderate) associations to NT was the Memory Span test (Digit Span backwards and composite; r = 0.43-0.54, p < 0.05). In sum, motor-cognitive function appears to be largely independent from its two assumed components NT and MF and may represent a new parameter in performance diagnostics.

Computerized Cognitive Training with Minimal Motor Component Improves Lower Limb Choice-Reaction Time.

The role of cognitive training in sports has experienced a recent surge in popularity. However, there is a paucity of longitudinal trials examining the effectiveness of related methods. This study aimed to investigate the impact of a cognitive training with minimal motor components on lower limb choice-reaction performance. A total of 44 healthy individuals (26.4 ± 3.7 years, 27 males) were randomly allocated to a cognitive training (CT) or an inactive control group (CON). The CT group participants, three times per week, engaged in a computerized exercise program targeting skills such as attention, reaction time, processing speed or inhibition control. Before and after the 6-week intervention period, lower limb choice-reaction time was assessed using the Quick Feet Board device. An ANCOVA of the post-intervention values, controlling for baseline data, demonstrated superior unilateral choice-reaction performance (stance on dominant leg) in the CT group (p = 0.04, r = 0.31). Conversely, no difference was found for the bilateral component of the test (p > .05). Off-court cognitive training may represent a suitable method to enhance reactive motor skills in athletes.

Activity and Health During the SARS-CoV2 Pandemic (ASAP): Study Protocol for a Multi-National Network Trial.

Introduction: The worldwide spread of the novel coronavirus (SARS-CoV2) has prompted numerous countries to restrict public life. Related measures, such as limits on social gatherings, business closures, or lockdowns, are expected to considerably reduce the individual opportunities to move outside the home. As physical activity (PA) and sport participation significantly contribute to health, this study has two objectives. The objectives of this study are to assess changes in PA and well-being since the coronavirus outbreak in affected countries. Additionally, we will evaluate the impact of digital home-based exercise programs on PA as well as physical and mental health outcomes. Method: A multinational network trial will be conducted with three planned phases (A, B, and C). Part A consists of administering a structured survey. It investigates changes in PA levels and health during the coronavirus outbreak and measures the preferences of the participants regarding online training programs. Part B is a two-armed randomized-controlled trial. Participants assigned to the intervention group (IG) will complete a digital 4-week home exercise training (live streaming via internet) guided by the survey results on content and time of program. The control group (CG) will not receive the program. Part C is 4-week access of both CG and IG to a digital archive of pre-recorded workouts from Part B. Similar to Part A, questionnaires will be used in both Part B and C to estimate the effects of exercise on measures of mental and physical health. Results and Discussion: The ASAP project will provide valuable insights into the importance of PA during a global pandemic. Our initial survey is the first to determine how governmental confinement measures impact bodily and mental well-being. Based on the results, the intervention studies will be unique to address health problems potentially arising from losses in PA. If proven effective, the newly developed telehealth programs could become a significant and easy-to-distribute factor in combating PA decreases. Results of the study may hence guide policy makers on methods to maintain PA and health when being forced to restrict public life. Study Register: DRKS00021273.

Can we measure perceptual-cognitive function during athletic movement? A framework for and reliability of a sports-related testing battery.

OBJECTIVES: Perceptual-cognitive function (PCF) has been linked to performance and injury risk. However, to date, research used digitalized or pen-and-paper-based PCF tests without major motor components. This study provides a rationale and a testing battery for the measurement of PCF during sports-related movement. DESIGN: Test-Retest. SETTING: University. PARTICIPANTS: Thirteen healthy, active individuals (8 females, 27 ± 4 years). MAIN OUTCOME MEASURES: Participants twice (5-min interval) completed six motor-cognitive tasks using a sensor-based system with LED lights. Four tests focussed on simple movements and relatively isolated PCF (reaction, choice-reaction, memory span, stop-signal), two represented more multifaceted and complex tasks (reactive agility, run-decide). Test-retest reliability was determined with the intraclass correlation coefficient (ICC). RESULTS: All tests, except for one sub-dimension of the stop-signal test (upper limb, error count), displayed at least sufficient or higher reproducibility (ICC>.5, p < .05): Test-retest reliability was moderate for one (stop-signal), moderate to high for three (reaction, choice-reaction, run-decide, memory span) and excellent for one (reactive agility) of the tasks. CONCLUSIONS: The presented tests display moderate-to-high reliability and can be used in clinical and scientific settings. Future research should elucidate its predictive value regarding performance and injury as well as its association with the results of conventional PCF tests not incorporating movement.

[Psychometric properties of the questionnaire data on individual history of activity : Validity and reliability of the lifetime leisure physical activity questionnaire in community-dwelling older adults]. / Gütekriterien der Fragebogenerfassung individueller Bewegungshistorien : Validität und Reliabilität des Lifetime Leisure Physical Activity Questionnaire bei Senioren in betreuten Wohnanlagen.

BACKGROUND: The lifetime leisure physical activity questionnaire (LLPAQ) is a derivative of the historical leisure activity questionnaire (HLAQ) of Kriska et al. (1988) for capture of the complete activity biography. The present study investigated the reliability and the validity of the LLPAQ of Engeroff and Vogt (2018). METHODS: A total of 47 seniors (75-90 years old) participated in an objective measurement of activity and completed the LLPAQ. For validation of the questionnaire accelerometer-based data were compared with the subjective report in the LLPAQ on physical activity from the last year of life using a correlation analysis. Data from a second LLPAQ filled out by 14 participants (after 6 weeks) were used for reliability analysis (difference and correlation). RESULTS: Subjectively captured data on the physical activity of the last year correlated with the objectively measured activity data (r = 0.311, p = 0.033). Although self-reporting overestimated the amount by almost 176%, test-retest data on MET-hours per episode showed a correlation (r = 0.824; p < 0.001). Check for internal consistency of individual episodes across the lifespan yielded a Cronbach's alpha of 0.8 (p < 0.001). DISCUSSION: The LLPAQ showed good reliability values in the retest at 6 weeks, particularly considering the problem of manifold errors of subjective activity measurement in participants at old age. Regarding the discrepancy between the time periods of objective (1 week) and subjective (1 year) surveys, the proven medium effect strength indicates the high validity of the questionnaire.

Why Are You Running and Does It Hurt? Pain, Motivations and Beliefs about Injury Prevention among Participants of a Large-Scale Public Running Event.

Organized running events have gained substantial popularity. This study aimed to elucidate the prevalence of musculoskeletal pain, knowledge about injury prevention as well as the attitudes and motivations of individuals participating in the JP Morgan Corporate Challenge in Frankfurt (Germany). A total of 720 recreational runners completed a digital questionnaire immediately prior to the start. The majority of them displayed low to moderate physical activity levels and were rather unambitious regarding targeted finishing time. One quarter (25.3%) participated for the first time in an organized race. The most stated reasons to register were team building (76.4%) and experiencing the run's atmosphere (50.6%). In contrast, improving health played a minor role (19.4%). More than one in five individuals (n = 159 runners) reported pain, with the most common locations being the knee and lower back. Both at rest (3.2/10 on a numerical rating scale) and during activity (4.7/10), average pain intensity was clinically relevant. Almost three thirds of the participants believed that stretching and wearing appropriate shoes would be effective for injury prevention while other methods such as resistance training, balance exercise or wearing of orthoses were rarely named. Musculoskeletal pain is a significant burden in runners participating in an urban mass event. In view of the poor knowledge about injury prevention, organizers and coaches may consider offering structured preparation programs as well as tailored running-related health education.