Walking in hospital is associated with a shorter length of stay in older medical inpatients

Evidence suggests that inactivity during a hospital stay is associated with poor health outcomes in older medical inpatients. We aimed to estimate the associations of average daily step-count (walking) in hospital with physical performance and length of stay in this population. Medical in-patients aged ⩾65 years, premorbidly mobile, with an anticipated length of stay ⩾3 d, were recruited. Measurements included average daily step-count, continuously recorded until discharge, or for a maximum of 7 d (Stepwatch Activity Monitor); co-morbidity (CIRS-G); frailty (SHARE F-I); and baseline and end-of-study physical performance (short physical performance battery). Linear regression models were used to estimate associations between step-count and end-of-study physical performance or length of stay. Length of stay was log transformed in the first model, and step-count was log transformed in both models. Similar models were used to adjust for potential confounders. Data from 154 patients (mean 77 years, SD 7.4) were analysed. The unadjusted models estimated for each unit increase in the natural log of stepcount, the natural log of length of stay decreased by 0.18 (95% CI −0.27 to −0.09). After adjustment of potential confounders, while the strength of the inverse association was attenuated, it remained significant (βlog(steps) = −0.15, 95%CI −0.26 to −0.03). The back-transformed result suggested that a 50% increase in step-count was associated with a 6% shorter length of stay. There was no apparent association between step-count and end-of-study physical performance once baseline physical performance was adjusted for. The results indicate that step-count is independently associated with hospital length of stay, and merits further investigation.

A study protocol of a randomised controlled trial to measure the effects of an augmented prescribed exercise programme (APEP) for frail older medical patients in the acute setting

Background: Older adults experience functional decline in hospital leading to increased healthcare burden and morbidity. The benefits of augmented exercise in hospital remain uncertain. The aim of this trial is to measure the short and longer-term effects of augmented exercise for older medical in-patients on their physical performance, quality of life and health care utilisation. Design and Methods: Two hundred and twenty older medical patients will be blindly randomly allocated to the intervention or sham groups. Both groups will receive usual care (including routine physiotherapy care) augmented by two daily exercise sessions. The sham group will receive stretching and relaxation exercises while the intervention group will receive tailored strengthening and balance exercises. Differences between groups will be measured at baseline, discharge, and three months. The primary outcome measure will be length of stay. The secondary outcome measures will be healthcare utilisation, activity (accelerometry), physical performance (Short Physical Performance Battery), falls history in hospital and quality of life (EQ-5D-5 L). Discussion: This simple intervention has the potential to transform the outcomes of the older patient in the acute setting.

Le rôle des réponses cardiovasculaires et respiratoires sur la cognition chez les jeunes et les ainés sains

En plus de contribuer à améliorer la santé de façon générale, l’activité physique chronique pourrait modérer le déclin cognitif associé au vieillissement normal et pathologique (Colcombe et Kramer, 2003; Heyn et al., 2004). Plus précisément, la pratique à long terme d’activités cardiovasculaires aurait des effets positifs sur la cognition des ainés et plus particulièrement sur le contrôle attentionnel, un aspect précocement touché au cours du vieillissement (Raz, 2000; Bherer et al., 2008). Toutefois, les mécanismes par lesquels l’exercice physique aigu améliore la cognition demeurent limités. Malgré ses nombreuses implications théoriques et pratiques, la réponse aiguë de l’oxygénation cérébrale à l’exercice physique et sa relation avec la cognition sont trop peu étudiées. Cette thèse se consacre à cette question. Des études récentes en neuro-imagerie chez les jeunes adultes démontrent que la relation entre l’oxygénation cérébrale et l’intensité de l’exercice suit la forme d’un U inversé. Il existe un seuil au-delà duquel l’oxygénation cérébrale diminue avec l’augmentation de l’intensité de l’exercice. Supposant que les performances cognitives dépendent de la disponibilité de l’oxygène cérébral, cette relation en U inversé devrait affecter les performances cognitives. Avant de préciser le rôle exact de l’oxygénation cérébrale sur les fonctions cognitives, nous avons d’abord examiné le temps nécessaire pour que l’oxygénation cérébrale atteigne un état stable et la durée pendant laquelle cette période stable peut être maintenue lors de paliers de sept minutes à une puissance sous-maximale (40%, 60% et 85% de la puissance aérobie maximale). Nos résultats soulignent l’existence d’une relation inverse entre la durée de l’état stable et l’intensité de l’exercice. Suite à cette vérification méthodologique, la prochaine étape a été de tester la possible relation entre l’oxygénation cérébrale, l’intensité de l’exercice et les performances cognitives, au cours du processus de vieillissement. Les résultats de ces études démontrent que la chute de l’oxygénation cérébrale observée lors des exercices de haute intensité est associée avec une diminution des performances cognitives. Les résultats de cette thèse corrigent l’écart existant dans la documentation entre l’exercice, les fonctions cognitives et les mécanismes neurophysiologiques.

Fear of Falling and Balance Confidence in Older Adults with Diabetes Mellitus

Several determinants of fear of falling (FoF) and low balance confidence overlap with the consequences/complications of diabetes mellitus (DM). FoF is strongly associated with low balance confidence, and balance confidence mediates the relationship between FoF and balance and physical function. The purpose of this thesis was two-fold: (1) to examine the prevalence, severity and determinants of FoF in older adults (aged≥65) with DM, and (2) to evaluate the validity of the short version of the Activities-specific Balance Confidence scale (ABC-6) and its association with balance and postural control in older adults with DM. Three separate studies were conducted of older adults with DM (DM-group) and without DM (noDM-group). Study I revealed that although FoF prevalence adjusted for age and sex was not different between-groups, the DM-group had 8.8% fewer participants in the low and 8.4% more in the high Falls-Efficacy Scale International categories when compared to the noDM-group. Higher FoF severity in the DM-group was associated with poor physical performance, being female, fall history and clinical depressive symptoms. Study II provided evidence of convergent, discriminant and concurrent validity of the ABC-6 for use in older adults with DM with and without diabetic peripheral neuropathy (DPN). Notably, the ABC-6 was more sensitive in detecting subtle differences in balance confidence between the DM-group and noDM-group when compared to the original ABC scale (ABC-16), and can be administered in less time. Study III explored balance confidence (ABC-6) and its association with balance and postural control in older adults with DM. Subtle differences in axial segmental control (i.e., lower trunk roll velocity and higher head-trunk correlations) while walking and lower balance confidence were apparent in the DM-group, even in the absence of DPN, when compared to the noDM-group. Balance confidence partially explained the variance in head-trunk stiffening between-groups, and consequently low balance confidence in older adults with DM may contribute to the dependence on postural control strategies that are normally only utilized in high-risk situations. Findings from this thesis will help to guide the development of protocols for screening and intervention recommendations of patient education and targeted rehabilitation programs for older adults with DM.

“My people seem to be falling to bits”: impotence, memory, and the co-possibility of body and mind in Samuel Beckett’s works

The present thesis examines the representation of the impotent body and mind in a selection of Samuel Beckett’s dramatic and prose works. Aiming to show that the body-mind relation is represented as one of co-implication and co-constitution, this thesis also takes the representation of memory in Beckett’s work as a key site for examining this relation. The thesis seeks to address the centrality of the body and embodied subjectivity in the experience of memory and indeed in signification and experience more generally. In these terms, Chapter 1 analyzes the representation of the figure of the couple in Beckett’s drama of the 1950s – as a metaphor of the body-mind relation – and, in light of Jacques Derrida’s theory of the supplement and Bernard Stiegler’s theory of technics, it discusses how the relationship between physical body and mind is defined by an essential supplementarity that is revealed even (or especially) in their apparent separation. Furthermore, the impotence that marks both elements in Beckett’s writings, when it is seen to lay bare this intrication, can be viewed, in important respects, as enabling rather than merely privative. Chapter 2 discusses the somatic structure of memory as represented in four of Beckett’s later dramatic works composed in the 1970s and 1980s. Similarly to Chapter 1, the second chapter focuses on the more “extreme” representation of bodily impotence in Beckett and demonstrates that rather than a merely “mental” recollection, memory in the work of Beckett is presented as necessarily experienced through, and shaped by, the body itself. In this light, then, it is shown that despite the impotence that marks the body in Beckett’s work of the 1970s and 1980s, the body is a necessary site of memory and retains or discovers a kind of activity in this impotence. Finally, Chapter 3 shifts its attention to Beckett’s prose works in order to explore how such works, reliant on language rather than the physical performance of actors onstage, sustain questions of embodied subjectivity at their heart. Specifically, the chapter argues that, on closer inspection, Beckett’s “literature of the unword” is not an abstention from meaning and its materialization, but one that paradoxically foregrounds that “something” which remains an essential part of it, that is, an embodied subjectivity.

Following instructions from working memory: Why does action at encoding and recall help?

Two experiments investigated the consequences of action at encoding and recall on the ability to follow sequences of instructions. Children aged 7–9 years recalled sequences of spoken action commands under presentation and recall conditions that either did or did not involve their physical performance. In both experiments, recall was enhanced by carrying out the instructions as they were being initially presented and also by performing them at recall. In contrast, the accuracy of instruction-following did not improve above spoken presentation alone, either when the instructions were silently read or heard by the child (Experiment 1), or when the child repeated the spoken instructions as they were presented (Experiment 2). These findings suggest that the enactment advantage at presentation does not simply reflect a general benefit of a dual exposure to instructions, and that it is not a result of their self-production at presentation. The benefits of action-based recall were reduced following enactment during presentation, suggesting that the positive effects of action at encoding and recall may have a common origin. It is proposed that the benefits of physical movement arise from the existence of a short-term motor store that maintains the temporal, spatial, and motoric features of either planned or already executed actions.

There is something about Mary… and Ted! : Training in mixed-sex groups makes you work harder. A study about the effort when training with the opposite sex.

In many sport associations, regardless of level, women and men rarely practice together. Previous studies indicate that work groups are generally more efficient when there is an even distribution between the sexes. Could that also be the case in sports? This study aims to investigate whether the sex composition of a training group affects the effort and performance of the participants. Eleven volunteers participated in the crossover study consisting of three different 150-meter sprint conditions; individually, single-sex group and mixed-sex group. Sprint times, heart rate and RPE were recorded during all three trials. The result of this study suggests that there might be practical benefits in regards to physical performance and effort to exercise in a training group consisting of both sexes instead of training only with the same-sex or individually. The understanding could be useful in areas such as; training optimisation for both athletes and in patient- and rehabilitation groups, increasing efficiency in work environments, in schools and sports clubs striving for both athletic success and gender equality.

Oförändrad prestation, men varierande motivation under menstruationscykeln : Ett examensarbete som undersöker om maximalstyrka och explosivitet förändras under menstruationscykeln samt om motivationen korrelerar med prestationen

Syfte - Studien avser att undersöka om prestation gällande maximalstyrka och explosivitet varierar under menstruationscykeln. Dessutom undersöks om den psykologiska motivationen eller känslan korrelerar med prestationen. Studiens syfte är att skapa en utgångspunkt för att se om periodisering av styrketräning i relation till menstruationscykeln faser är aktuell för kvinnor inom prestationsidrotter. Metod - Testerna genomfördes under en menstruationscykel, fyra veckor. Ett test genomfördes varje vecka för att täcka in fyra faser under menstruationscykeln och för att erhålla ett konsekvent veckomönster. Menstruationscykelns faser räknades ut i efterhand för att inte i förhand påverka testdeltagarnas motivation och prestation i förhållande till menstruationscykeln. Fas 1 menstruationsfas, fas 2 intermenstruation, fas 3 intermenstruation/ägglossning och fas 4 premenstruation. I testgruppen ingick fyra kvinnor, 32 år (± 10), längd 162,8 cm (± 7,32), vikt 57,4 kg (± 5,79). I kontrollgruppen ingick en man och två kvinnor utan menstruation, 26,67 år (± 9,02), längd 168,3 cm (± 8,96), vikt 71,7 kg (± 11,02). Fysiska tester, längdhopp och knäböj. En standardiserad uppvärmning genomfördes inför varje test, följdes av tre stycken jämfota längdhopp utan ansats med två minuter vila mellan hoppen. Bästa hoppet av tre dokumenterades. Längdhopp (CV 1,8 %) (Hopkins, Schabort & Hawley, 2001), knäböj, en repetition max [1RM] (CV 1,57 %) (Urquhart, Moir, Graham & Connaboy, 2015). En specifik uppvärmning genomfördes även inför 1RM knäböj därefter försök på en repetition på 1RM. Frågeformulär gällande hälsotillstånd och motivation “Snabbkollen” (Cross & Lyle, 1999) besvarades inför varje testtillfälle. Vid sista testtillfället fick alla testdeltagare fylla i ett frågeformulär om upplevda symptom och tillstånd under den gångna menstruationscykeln. Resultat och slutsats - Det är ur denna studie svårt att tyda om menstruationscykelns olika faser skulle ha någon relevant effekt värd att ta hänsyn till när det gäller prestationen hos idrottande kvinnor. Dock visar resultaten att menstruationscykeln påverkar motivationen.  

Falls and the Social Isolation of Older Adults in the National Health and Aging Trends Study

Thesis (Ph.D.)--University of Washington, 2016-08

A qualidade de vida dos idosos com coxartrose

Um dos fenómenos marcantes desde os meados do século XX até aos dias de hoje é o processo de envelhecimento das sociedades a nível mundial (Moura, 2006). Envelhecer de forma saudável e com boa qualidade de vida é algo que todas a pessoas desejam, mas muitas vezes o envelhecimento é acompanhado por diferentes tipos de alterações que poderão provocar alterações da qualidade de vida do idoso. A investigação científica acerca da relação entre a qualidade de vida do idoso com coxartrose e o impacto da artroplastia total da anca é ainda um tema recente. Assim esta investigação tem como objetivo avaliar a perceção da qualidade de vida dos idosos com coxartrose, antes da cirurgia da artroplastia total da anca, e avaliar a perceção da qualidade de vida dos idosos após o sexto mês da artroplastia total da anca. Procedeu-se assim a um estudo de natureza descritivo, longitudinal e de abordagem quantitativa, com 35 utentes idosos que foram submetidos a artroplastia total da anca por patologia de coxartrose. Foi utilizado como instrumento de recolha de dados o questionário genérico de qualidade de saúde SF-36 no dia antes da cirurgia e após 6 meses da artroplastia total da anca e um questionário de forma a fazer uma caracterização sócio - demográfica da amostra. Verifica-se que a perceção da qualidade de vida dos idosos com coxartrose, antes da cirurgia da artroplastia total da anca é limitada em várias dimensões como função física desempenho físico, dor corporal, perceção geral de saúde, vitalidade, função social, desempenho emocional, saúde mental e transição de saúde. Após o sexto mês da artroplastia total da anca, a perceção da qualidade de vida dos idosos apresenta-se na maioria dos sujeitos melhorada.

Comparación de un programa de ejercicio intradiálisis frente a ejercicio domiciliario sobre capacidad física funcional y nivel de actividad física

Introducción: El ejercicio durante la hemodiálisis es beneficioso, aunque son pocas las unidades de hemodiálisis que ofrecen un programa de ejercicio adaptado a estos pacientes. Por ello es necesario encontrar alternativas más económicas para realizar ejercicio. El objetivo es comparar los efectos de un programa de ejercicio intradiálisis frente a ejercicio domiciliario, sobre la adherencia al programa, la capacidad física funcional y el nivel de actividad física. Métodos: 17 pacientes en hemodiálisis de un centro de Valencia fueron aleatorizados dividiéndoles en un grupo de ejercicio intradiálisis (n=9) y un grupo domiciliario (n=8). Ambos programas incluían ejercicio aeróbico y de fuerza durante 4 meses. Se valoró una amplia batería de pruebas funcionales (Short Physical Performance Battery, equilibrio monopodal, Timed Up and Go, Sit To Stand to sit test 10 y 60, dinamometría de mano, fuerza de tríceps, 6 minutos marcha) y dos cuestionarios de nivel de actividad física (Human Activity Profile y Physical Activity Scale for Elderly). Resultados: 2 pacientes del grupo intradiálisis y 5 pacientes de ejercicio domiciliario finalizaron el programa y fueron analizados. Se observó un efecto significativo del factor tiempo en el caso del Human Activity Profile (P<.017). En las pruebas funcionales no se encontró ninguna diferencia significativa. En cuanto a la adherencia al ejercicio los pacientes del grupo intradiálisis cumplieron el 92.7% y el grupo domiciliario el 68.7% del total de las sesiones. Conclusiones: En ambos grupos se observa un aumento del nivel de actividad física. Sin embargo, es necesario modificar factores, tanto en el personal sanitario como en los propios pacientes, para conseguir mayor adherencia a los programas de ejercicio.

Le rôle des réponses cardiovasculaires et respiratoires sur la cognition chez les jeunes et les ainés sains

En plus de contribuer à améliorer la santé de façon générale, l’activité physique chronique pourrait modérer le déclin cognitif associé au vieillissement normal et pathologique (Colcombe et Kramer, 2003; Heyn et al., 2004). Plus précisément, la pratique à long terme d’activités cardiovasculaires aurait des effets positifs sur la cognition des ainés et plus particulièrement sur le contrôle attentionnel, un aspect précocement touché au cours du vieillissement (Raz, 2000; Bherer et al., 2008). Toutefois, les mécanismes par lesquels l’exercice physique aigu améliore la cognition demeurent limités. Malgré ses nombreuses implications théoriques et pratiques, la réponse aiguë de l’oxygénation cérébrale à l’exercice physique et sa relation avec la cognition sont trop peu étudiées. Cette thèse se consacre à cette question. Des études récentes en neuro-imagerie chez les jeunes adultes démontrent que la relation entre l’oxygénation cérébrale et l’intensité de l’exercice suit la forme d’un U inversé. Il existe un seuil au-delà duquel l’oxygénation cérébrale diminue avec l’augmentation de l’intensité de l’exercice. Supposant que les performances cognitives dépendent de la disponibilité de l’oxygène cérébral, cette relation en U inversé devrait affecter les performances cognitives. Avant de préciser le rôle exact de l’oxygénation cérébrale sur les fonctions cognitives, nous avons d’abord examiné le temps nécessaire pour que l’oxygénation cérébrale atteigne un état stable et la durée pendant laquelle cette période stable peut être maintenue lors de paliers de sept minutes à une puissance sous-maximale (40%, 60% et 85% de la puissance aérobie maximale). Nos résultats soulignent l’existence d’une relation inverse entre la durée de l’état stable et l’intensité de l’exercice. Suite à cette vérification méthodologique, la prochaine étape a été de tester la possible relation entre l’oxygénation cérébrale, l’intensité de l’exercice et les performances cognitives, au cours du processus de vieillissement. Les résultats de ces études démontrent que la chute de l’oxygénation cérébrale observée lors des exercices de haute intensité est associée avec une diminution des performances cognitives. Les résultats de cette thèse corrigent l’écart existant dans la documentation entre l’exercice, les fonctions cognitives et les mécanismes neurophysiologiques.

O efeito das substituições no comportamento tático e no rendimento físico dos jogadores profissionais de futebol de alto rendimento

O objetivo deste estudo foi analisar o impacto das substituições no comportamento tático e no rendimento físico de jogadores profissionais de futebol da primeira liga inglesa. Foram analisadas 40 substituições diretas de jogadores das posições de médios centro, extremos e avançados, ocorridas durante a segunda parte dos jogos. Para captar o comportamento tático individual dos jogadores foram utilizadas duas variáveis compostas: a variação da distância de cada jogador ao seu locus de referência espacial e a distribuição espacial dos deslocamentos de cada jogador (heat map). A partir destas variáveis foram calculadas a média, desvio padrão e coeficiente de variação, assim como duas medidas de entropia - que permitem mensurar a regularidade e a variabilidade/imprevisibilidade do comportamento tático individual de cada jogador. Para captar o rendimento físico dos jogadores foi utilizada a distância total percorrida e a distância percorrida em cinco categorias de intensidade. Os médios centro e os avançados substituídos apresentaram uma diminuição da imprevisibilidade no período inicial do jogo comparativamente com o período anterior à substituição. Foi também evidente a tendência para ocorrer uma diminuição do rendimento físico nos jogadores substituídos entre o período inicial de jogo e o período imediatamente anterior à substituição. Da mesma forma, para os médios e os extremos, os jogadores quando entraram na qualidade de substitutos apresentam também um maior rendimento físico que os jogadores substituídos. O jogador da posição do substituto/substituído, que permaneceu em campo apresentou também menor rendimento físico que os substitutos. Estes resultados sugerem que as motivações táticas justificam as substituições de médios centro e avançados e as motivações físicas justificam as substituições de médios centro e extremos.

Caracterização de casos de lesão medular e a sua relação com a independência funcional e qualidade de vida

Introdução: As lesões medulares acarretam consigo a problemática da deficiência, as suas respectivas sequelas interferem na qualidade de vida bem como na independência funcional destas pessoas, sendo habitual a existência de limitações que se prolongam ao longo a vida. O presente estudo visa a caracterização de sujeitos com lesão medular há mais de um ano, no que diz respeito à sua qualidade de vida e independência funcional, assim como, a relação entre as variáveis sóciodemográficas (género, idade, estado civil, escolaridade e profissão) e clínicas em estudo (nível, tipo, etiologia e data da lesão). Materiais e Métodos: O presente trabalho apresenta-se como um estudo observacional exploratório descritivo com abordagem quantitativa. A amostra foi formada por indivíduos adultos com lesão medular recrutados através da Associação Salvador e Associação Vida Independente. As medidas instrumentais utilizadas pelo estudo são o questionário sóciodemográfico e clínico, bem com a escala MIF (Granger, Hamilton, Keith, Zielezny, & Sherwins, 1986) e a escala SF-36 (Ware % Sherbourne, 1992). Resultados e Discussão: As análises demonstraram valores satisfatórios. A independência funcional e sua respectiva dimensão física e sóciocognitiva revelam resultados estatisticamente significativos com a variável nível neurológico. No que diz respeito à qualidade de vida esta demonstrou resultados estatisticamente significativos entre a dimensão desempenho emocional e a escolaridade entre o desempenho físico e a profissão e vitalidade e idade. Revelou igualmente valores satisfatórios entre todas as dimensões e o nível neurológico, entre a função social e data da lesão e por último entre a etiologia e função social, vitalidade, dor, saúde geral e mental. Conclusão: Os resultados obtidos com este estudo vêm reforçar a visão de que apesar dos indivíduos experienciarem um evento traumático e aspetos negativos após a lesão medular, há diferentes níveis de percepção de QoL e IF e que estas variam em função de algumas variáveis sóciodemográficas e clínicas. Neste ponto são ainda apresentadas as limitações do estudo e discutidas propostas de trabalhos futuros.

Impact d’une supplémentation protéino-énergétique sur les performances physiques en réadaptation chez la personne âgée traumatisée crânienne : un projet pilote.

L’exacerbation de la perte d’autonomie des personnes âgées hospitalisées est fréquente. Le traumatisme craniocérébral (TCC) est une condition médicale associée à un état de stress et d’hypercatabolisme particulièrement élevé (Cook, 2008) qui rend la personne âgée encore plus vulnérable. De plus, les recommandations en vigueur pour l’apport protéique (0,8 g/kg) semblent insuffisantes pour freiner la perte de masse musculaire qui conduit à la sarcopénie. L’objectif de cette étude était de déterminer l’impact d’un supplément protéino-énergétique sur les performances physiques de la personne âgée traumatisée crânienne en réadaptation, plus spécifiquement sur la distance de marche, la force de préhension, ainsi que le test du « Time up and go » (TUG). Vingtquatre sujets, âgés de 65 à 94 ans (14 hommes) ont consenti à participer à cette étude randomisée contrôlée à double-aveugle dans un centre de réadaptation fonctionnelle intensive à Montréal. L’intervention consistait à ingérer un supplément nutritionnel (230 kcal, 15 g protéines, 25 g glucides) ou un placebo immédiatement après le traitement régulier de physiothérapie (45 à 60 minutes, 4 à 5 fois par semaine). Aucune différence significative n’a été trouvée dans les caractéristiques de base des 2 groupes. Une amélioration significative a été trouvée dans le groupe supplément pour le test du TUG. Notre étude d’intervention est la première en nutrition en sol québécois dans les Centres de réadaptation. La consommation d’un supplément chez la personne âgée durant le traitement de physiothérapie est une mesure simple et facile à introduire dans un contexte clinique. Même en l’absence de gains significatifs sur l’ensemble des mesures physiques, le supplément nutritionnel permet d’augmenter les apports caloriques et protéiques, ce qui peut contribuer à optimiser l’état nutritionnel. La littérature documente largement les impacts négatifs de la malnutrition et toute mesure pouvant contribuer à diminuer la prévalence de cette dernière ne peut donc qu’être positive.