Mobility of geriatric patients at admission to early post-acute rehabilitation facilities predicts change in living situation after discharge

Objectives: The identification of the problems and characteristics of geriatric patients at the beginning of post-acute rehabilitation therapy which predict the worsening of living situation after hospital discharge and which may be amenable to intensified rehabilitation interventions. Methods: In a cross-sectional survey a cohort of 128 elderly patients undergoing early post-acute rehabilitation was interviewed at the beginning of their rehabilitation therapy. To identify the patients’ problems the second level of the ICF (International Classification of Functioning, Disability and Health) was used. Predictors were analyzed by conducting a multiple logistic regression model with worsening of living conditions as the dependent variable and using age, gender and main diagnosis as forced-in variables. Results: The mean age of the population was 80.3 years (SD 7.2). Sixty-nine percent were female. The group of patients with a worse living situation after discharge from rehabilitation facility compared to the situation before the acute event which lead to hospital admission (52.3% of the sample) had more frequently trauma or joint replacement as main diagnosis and were in the mean one year older than the group of patients who did not worsen. The only “negative” predictor for worsening in living situation was the ICF category d465 “Moving around with equipment” (Odds ratio 2.92, 95% Confidence interval 1.24 – 6.83). This means that patients who were not able to move around with equipment at the beginning of rehabilitation therapy had a 2.9fold higher risk of being more dependent on assistance after their discharge. When using age, gender and main diagnosis as forced-in variables this result did not change. Conclusions: The use of the ICF to identify potential predictors for discharge destination provided the possibility of investigating a broad spectrum of patients’ functioning. The findings of the underlying study suggest that assistive technologies, especially those enhancing mobility, demand special attention in a geriatric inpatient rehabilitation setting. Use of assistive devices should have an early part in the planning of rehabilitation interventions

Transferring clinically established immune inflammation markers into exercise physiology

Over the last decades the cellular immune inflammation markers neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII = NLR × platelets) have emerged in clinical context as markers of disease-related inflammation and are now widely appreciated due to their integrative character. Transferring these clinically established inflammation markers into exercise physiology seems highly beneficial, especially due to the low temporal, financial and infrastructural resources needed for assessment and calculation. Therefore, the aim of this review is to summarize evidence on the value of the integrative inflammation markers NLR, PLR and SII for depiction of exercise-induced inflammation and highlight potential applications in exercise settings. Despite sparse evidence, multiple investigations revealed responsiveness of the markers to acute and chronic exercise, thereby opening promising avenues in the field of exercise physiology. In performance settings, they might help to infer information for exercise programming by reflecting exercise strain and recovery status or periods of overtraining and increased infection risk. In health settings, application involves the depiction of anti-inflammatory effects of chronic exercise in patients exhibiting chronic inflammation. Further research should, therefore, focus on establishing reference values for these integrative markers in athletes at rest, assess the kinetics and reliability in response to different exercise modalities and implement the markers into clinical exercise trials to depict anti-inflammatory effects of chronic exercise in different patient collectives

Erfahrungseffekte von Fußgänger:innen bei der Interaktion mit automatisierten Pkw : Ein Untersuchungskonzept

Dieser Beitrag für die DoktorandInnenwerkstatt zeigt ein Konzept zur Untersuchung des Verhaltens von Fußgänger:innen bei der Interaktion mit automatisierten Pkw und der Bildung von Verhaltensanpassungen mit steigender Interaktionserfahrung des Menschen auf

Untersuchungen zu Verhaltensanpassungen von zu Fuß Gehenden bei der Interaktion mit hochautomatisierten Pkw

Bereits heute wird die Interaktion zwischen hochautomatisierten Pkw und zu Fuß Gehenden erforscht, um zukünftig einen sicheren und effizienten Straßenverkehrsfluss zu gewährleisten. Die hohe Automatisierung der dynamischen Fahrzeugführungsaufgabe bedingt nicht nur die Ergänzung, sondern den zeitweisen vollständigen Ersatz des Menschen als fahrende Person, weshalb die Mensch-Maschine-Schnittstelle (MMS) für die Interaktion zwischen hochautomatisierten Pkw und zu Fuß gehenden Personen an Bedeutung gewinnt. Diese technologisch induzierte Veränderung kann die Ursache für Verhaltensanpassungen von zu Fuß Gehenden im Straßenverkehr sein. Eine Forschungslücke besteht darin, die Verhaltensanpassungen von zu Fuß Gehenden zu untersuchen. Dementsprechend ist das Ziel dieser Arbeit, Verhaltensanpassungen zu Fuß Gehender bei der Interaktion mit hochautomatisierten Pkw unter dem Aspekt steigender Erfahrung des Menschen bei der Interaktion sowie der Automationstransparenz, als Variable der Gestaltung der MMS von hochautomatisierten Pkw, zu untersuchen. Zur Erfüllung dieser Zielstellung wurden zwei empirische Untersuchungen als explorative Interviewstudie mit 36 Teilnehmenden und als quasi-experimentelle Studie mit Messwiederholungen durchgeführt. Auf einem abgesperrten Testgelände interagierten 37 Versuchspersonen an drei aufeinanderfolgenden Versuchstagen mit einem hochautomatisierten Pkw als Realfahrzeug mit Wizard-of-Oz Konzept. Neben der interaktionsbezogenen Variablen der Bereitschaft zur Querung wurden das Vertrauen in und das mentale Modell bezüglich hochautomatisierter Pkw erhoben. Die Ergebnisse der Interviewstudie zeigen, dass Erfahrung eine zentrale Einflussgröße einer Verhaltensanpassung von zu Fuß Gehenden bei der Interaktion mit hochautomatisierten Pkw ist. Außerdem deckt sich das mentale Modell der interviewten Personen nicht mit dem konzeptuellen Modell eines hochautomatisierten Pkw. Aus den explorativen Erkenntnissen der Interviewstudie wurden Hypothesen abgeleitet, die in dem kontrollierten Feldtest geprüft wurden. Die Ergebnisse dieser zweiten empirischen Untersuchung zeigen, dass in Abhängigkeit der Fahrstrategie des Pkw und der Automationstransparenz die Bereitschaft zur Querung von zu Fuß Gehenden mit zunehmender Erfahrung bei der Interaktion mit hochautomatisierten Pkw zunimmt. Des Weiteren nimmt das Vertrauen von zu Fuß Gehenden in hochautomatisierte Pkw mit zunehmender Interaktionserfahrung zu. Demgegenüber entwickelt sich das mentale Modell der Versuchspersonen von einem hochautomatisierten Pkw nicht innerhalb der drei Versuchstage. Die Ausprägung des mentalen Modells bezüglich hochautomatisierter Pkw ist jedoch von der erlebten Automationstransparenz abhängig. Für die Erforschung der Interaktion zwischen zu Fuß Gehenden und hochautomatisierten Pkw bietet diese Arbeit einen Mehrwert, weil bislang experimentelle Untersuchungen zu Verhaltensanpassungen von zu Fuß Gehenden in realitätsnahen Untersuchungsumgebungen fehlen. Aus der Arbeit leitet sich die praktische Implikation ab, dass hochautomatisierte Pkw mit einer hohen Automationstransparenz gestaltet werden sollten, wenn sie mit zu Fuß Gehenden im Straßenverkehr interagieren

Secular trends in motor performance of children and adolescents between 2010 and 2020

Over the last few years, numerous studies have proclaimed a negative trend in the motor performance of children and adolescents. Drawing from the online Fitness Olympiad database, the data of 8239 children and adolescents from Germany were analyzed by age, sex, and motor performance measured using the Dordel–Koch–test (DKT). Results were compared from the 2010-2012 and 2018-2020 cohorts. The results of the 2010-2012 and 2018-2020 cohorts were then compared regarding the general and sex-specific changes in the development of motor performance. A negative trend was shown for three of five motor performance test items, with decreases of 0.9%-4.8% in abdominal and leg strength and coordination under time pressure, respectively, being found. In contrast, endurance improved by 0.4% and arm and trunk muscle strength by 3.1%. The negative development can be seen as a correlate of exercise deficit disorder (EDD) due to increasing sedentarism. Therefore, the correlation between motor performance and health indicates a clear motivation to appropriately promote the main forms of motor activity

Steckbrief Hortisol (Gartenboden)

Der Steckbrief informiert über den ˈHortisolˈ (Gartenboden). Der ˈHortisolˈ zählt zur Bodenklasse der `Terrestrischen anthropogenen Böden` und ist in Sachsen überregional vertreten. Er ist ein seit Jahrhunderten intensiv genutzter Boden, der sich durch die Gartenbewirtschaftung aus einem früheren, nicht mehr erkennbaren Boden entwickelt hat. Die Steckbrief ˈHortisolˈ richtet sich an alle Interessierte, die sich über die Entstehung Verbreitung und das Erscheinungsbild typischer, repräsentativer Böden Sachsens informieren möchten

Cycling in primary progressive multiple sclerosis (CYPRO): study protocol for a randomized controlled superiority trial evaluating the effects of high-intensity interval training in persons with primary progressive multiple sclerosis

Background: Primary progressive multiple sclerosis (PPMS) is the least prevalent multiple sclerosis (MS) phenotype. For persons with PPMS (pwPPMS), pharmacological treatment options are limited. As a complementary non-pharmacological treatment, endurance training improves the health-related quality of life (HRQoL), numerous MS symptoms, and MS-related performance impediments. High-intensity interval training (HIIT) has been shown to induce superior effects compared to moderate-intensity continuous training (MCT). As current evidence is based on MS samples with mixed phenotypes, generalizability to pwPPMS remains unclear. Methods: CYPRO is a parallel-group, single-center, and single-blind randomized controlled superiority trial evaluating the effects of HIIT compared to MCT in pwPPMS. Sixty-one pwPPMS are randomized (1:1) to perform volume-matched HIIT or MCT sessions on bicycle ergometers two to three times per week in addition to standard rehabilitative care during their three-week inpatient stay at Valens rehabilitation clinic, Switzerland. Standard rehabilitative care comprises endurance and strength training, physiotherapy, and occupational therapy. HIIT sessions include six 90-second intervals at 95% peak heart rate (HRpeak), interspersed by 90-second active breaks with unloaded pedaling, aimed to reach 60%HRpeak. MCT represents the standard treatment at Valens rehabilitation clinic and is performed as continuous cycling at 60%HRpeak for the duration of 26 minutes. The primary outcome is cardiorespiratory fitness, assessed as peak oxygen consumption (V̇O2peak) during cardiopulmonary exercise testing (CPET). Secondary outcomes include peak power output during CPET, walking capacity, cognitive performance, HRQoL, fatigue, anxiety and depressive symptoms, and blood-derived biomarkers (e.g., serum neurofilament light chain, glial fibrillary acidic protein, kynurenine pathway metabolites) related to MS pathophysiology. All outcomes are assessed at baseline and discharge after three weeks. Venous blood sampling is additionally performed immediately and two hours after the first HIIT or MCT session. Discussion: CYPRO will expand current knowledge on symptom management and rehabilitation in MS to the subpopulation of pwPPMS, and will contribute to the exploration of potential disease-modifying effects of endurance training in MS. The superiority design of CYPRO will allow deriving explicit recommendations on endurance training design in pwPPMS that can be readily translated into clinical practice. Trial registration: CYPRO has been prospectively registered at ClinicalTrials.gov on 8 February 2022 (NCT05229861)

Effects and Moderators of Acute Aerobic Exercise on Subsequent Interference Control: A Systematic Review and Meta-Analysis

Background: Acute aerobic exercise leads to positive physiological adaptations within the central nervous system. These findings inspired research on potential cognitive benefits following acute aerobic exercise. The effects of acute aerobic exercise on subsequent cognitive performance, by far, have been the most researched for interference control, a subcomponent of executive function. The results of primary studies on the effects of acute aerobic exercise on subsequent interference control performance are inconsistent. Therefore, we used meta-analytic methods to pool available effect sizes, and to identify covariates that determine the magnitude of exercise-induced interference control benefits. Methods: Medline, PsycINFO, and SPORTDiscus were searched for eligible records. Hedges' g corrected standardized mean difference values (SMDs) were used for analyses. Random-effects weights were used to pool effect sizes. Moderator analyses were conducted using meta-regressions and subgroups analyses. Covariates that were here tested for moderation included parameters of the applied exercise regimen (exercise intensity and exercise duration), characteristics of examined participants (age and fitness), and methodological features of existing research (type of control group, familiarization with test procedure, type of test variable, delay between exercise cessation, and testing). Results: Fifty studies, with data from 2,366 participants, were included in qualitative and quantitative synthesis. A small, significant beneficial effect of acute aerobic exercise on time-dependent measures of interference control was revealed (k = 49, Hedges' g = −0.26, 95%CI: −34 to −0.18). Effect sizes from time-dependent measures of interference control varied widely and heterogeneity reached statistical significance (T2 = 0.0557, I2 = 28.8%). Moderator analyses revealed that higher exercise intensities (vigorous intensity and high-intensity interval training), also participants at younger or older age, and participants who are familiar with the testing procedure prior to the experiment, benefitted most from acute aerobic exercise. However, noticeable heterogeneity remained unexplained within specific subgroups (high-intensity interval training, preadolescent children, and active and supervised control group). Conclusion: Acute aerobic exercise improves subsequent interference control performance. However, the covariates exercise intensity, participants' age, and familiarization with testing procedure determine the magnitude of that effect. Methodological features were not found to influence the magnitude of effects. This dismisses some doubts that exercise induced benefits for interference control performance are scientific artifacts. The fact that large heterogeneity remained unexplained in some subgroups indicates the need for further research on covariates within these subgroups. It should be noted that effect sizes for all analyses were small. © Copyright © 2019 Oberste, Javelle, Sharma, Joisten, Walzik, Bloch and Zimmer

Fitness, physical activity, and exercise in multiple sclerosis

Background A moderate to high level of physical activity, including regular exercise, represents an established behavioral and rehabilitative approach for persons with multiple sclerosis (pwMS). Although being increasingly proposed to limit disease activity and progression, high-quality evidence is lacking. Objective The objective of the study is to provide valuable information for MS clinicians and researchers by systematically evaluating the current state of evidence (i) whether exercise interventions affect established clinical measures of disease activity and progression in pwMS (i.e., EDSS, relapse rate, lesion load, brain volume, MSFC) and (ii) how the physical activity and fitness level interact with these measures. Methods Literature search was conducted in MEDLINE, EMBASE, CINAHL, and SPORTDiscus. Evaluation of evidence quality was done based on standards published by The American Academy of Neurology. Results It is likely that exercise improves the MSFC score, whereas the EDSS score, lesion load, and brain volume are likely to remain unchanged over the intervention period. It is possible that exercise decreases the relapse rate. Results from cross-sectional studies indicate beneficial effects of a high physical activity or fitness level on clinical measures which, however, is not corroborated by high evidence quality. Conclusions A (supportive) disease-modifying effect of exercise in pwMS cannot be concluded. The rather low evidence quality of existing RCTs underlines the need to conduct more well-designed studies assessing different measures of disease activity or progression as primary end points. A major limitation is the short intervention duration of existing studies which limits meaningful exercise-induced effects on most disability measures. Findings from cross-sectional studies are difficult to contextualize regarding clinical importance due to their solely associative character and low evidence quality