Can 4-weeks of Backward Exercise Strategy Effect Mobility and Gait Outcomes in the Aging? - A Descriptive Case Series

Albeit limited, emerging evidence has supported the using of backwards walking. However, whether the intervention can be mimicked by recumbent exercise is less known. We aimed to describe longitudinal changes in mobility and gait outcomes using a seated NuStep cross trainer (NCT) and treadmill (TM) in aging participants. METHODS: Four older adults (2M/2F; 72 ± 3 yrs; 26.8 ± 2.3 kg/m2; Means ± SD) participated in a supervised 4-week (2x per week) exercise program utilizing a backward exercise strategy. Participants were randomized to either NCT or TM. Gait outcomes were obtained with the GAITRite system. Mobility was assessed with the 6 Minute Walk Test (6MWT) and Timed Up and Go (TUG). The initial exercise pace was guided by the participant’s rating of perceived exertion (RPE) and progressed 5-10% each week as tolerated. Targeted and externally focused verbal instructions were utilized to optimize the transfer to gait. RESULTS: All participants completed the 4-week intervention without complication. Regardless of modality, time (seconds) to complete TUG did not seem to change across all participants (∆M = 0.02 seconds, SD = 1.42 seconds). 6MWT distances improved in all participants (M = 57.74 m, SD = 55.16 m). NCT improved 6MWT (M = 67.55m, SD = 80.26). TM improved 6MWT (M = 47.93, SD = 47.98). FW gait velocity slightly increased in NCT participants (M = 6.73 cm/s, SD = 11.34 cm/s), but seemed unchanged in TM participants (M = -3.85 cm/s, SD = 12.45 cm/s). NCT saw changes in FW Swing% (Left: M = 0.50%, SD = 1.56%; Right: M = 1.23%, SD = 1.10%) and Stance% (Left: M = -0.55%, SD = 1.56%; Right: M = -1.20%, SD = 1.06%). TM saw minimal changes in FW Swing% (Left: M = -2.15%, SD = 0.42%; Right: M = -0.48%, Std = 0.74%) and Stance% (Left: M = 1.47%, SD = 0.43%; Right: M = 0.83%, SD = 1.03%). BW gait velocity increased in the NCT group (M = 13.25 cm/s, SD = 13.08 cm/s) but remained unchanged in TM participants (M = -1.10 cm/s, SD = 1.27 cm/s). NCT saw changes in BW Swing% (Left: M = 1.13%, SD = 0.11%; Right: M = -1.48%, SD = 0.25%) and Stance% (Left: M = -1.05%, SD = 0.07%; Right: M = -1.53%, SD = 1.45%). However, BW Swing% (Left: M = 0.02%, Std = 0.54%; Right: M = -1.48%, SD = 0.25%) and Stance% (Left: M = 0.53%, SD = 0.88%; Right: M = 0.83%, SD = 0.93%) remained unchanged in TM. CONCLUSION: These findings provide preliminary support for the longitudinal use of recumbent NCT exercise for gait retraining

Can Recumbent Exercise Improve Gait and Arterial Stiffness Outcomes? - a Longitudinal Case Study

Unilateral deficiencies in leg function may compromise the utility of upright and bipedal exercise, but recumbent exercise modes in such individuals provide a plausible alternative for fitness improvements. The purpose of this case study was to examine how longitudinal recumbent exercise may affect gait and arterial stiffness outcomes. METHODS: A 69-year-old female with history of left femur fracture participated in a supervised 6-week (2x per week) exercise program on the recumbent cross trainer (ReCT) at level 1 resistance. Gait outcomes were obtained prior to and one month into the intervention with the GAITRite system. Preceding each exercise bout, the participant completed (n = 3) sagittal plane dynamic mobility drills of the hip, knee and ankle. The initial exercise pace was guided by the participant’s rating of perceived exertion (RPE). Targeted and externally focused verbal instructions were utilized to optimize the transfer to gait. Resting blood pressure (brachial and aortic) and carotid-femoral pulse wave velocity (cf-PWV) was evaluated prior to and 6 weeks into the intervention using pulse wave analysis and pulse wave velocity. Time was progressed 5-10% each week as tolerated. Intra-intervention pain was monitored with the short-form McGill Pain Questionnaire 2 (sf-MPQ2). RESULTS: After 6 weeks, 20 minutes of continuous exercise at an RPE of 12-14 was well-tolerated. The intervention increased gait velocity (FW: +13.1 cm/sec; BW: +23.6 cm/sec), increased bilateral step length (FW: +5.27cm(L), +5.76cm (R); BW: +8.03cm (L), +17.55cm (R) while double support percentage was reduced (FW: -3.15%(L), -3.95% (R); BW: -6.5%). The stance % of each FW gait cycle was also reduced (L: Pre: 68.2% vs. Post: 67.5%; R: Pre: 68.95% vs. Post: 66.7%). Reductions in brachial and aortic systolic (-12mmHg) and diastolic (-11mmHg) pressures were similar, and cf-PWV was reduced from 9.3 m/s to 7.4 m/s. sf-MPQ-2 outlined subjective improvements in perceived exhaustion, superficial tenderness, and fear of falling. CONCLUSION: These findings provide preliminary support for the longitudinal use of recumbent NCT exercise for gait retraining. Furthermore, these findings support the pursuit of larger scaled investigations for attenuating arterial stiffness in the elderly with compromised postural control

Acidification of intracellular pH in MM tumor cells overcomes resistance to hypoxia-mediated apoptosis in vitro and in vivo

IntroductionMultiple myeloma (MM) is an incurable cancer of malignant plasma cells that engraft in the bone marrow (BM). It is more than likely that the poorly investigated physical parameters of hypoxia and pH in the tumor microenvironment (TME) is critical for MM survival. Here, we explore the effects of a hypoxic environment on pH regulation and its role in MM survival.MethodsWe used in vitro models of MM, in which the culturing medium was modified to specific pH and pO2 levels and then measured the effects on cell survival that was correlated with changes in intracellular (pHi) and extracellular pH (pHe). In a MM xenograft model, we used PET/CT to study hypoxia-mediated effects on tumor growth. ResultsHypoxia-mediated apoptosis of MM cells is correlated with acidic intracellular pHi (less than < 6.6) that is dependent on HIF activity. Using a polyamide HIF responsive element binding compound, a carbonic anhydrase inhibitor (acetazolamide), and an NHE-1 inhibitor (amiloride) acidified the pHi and lead to cell death. In contrast, treatment of cells with an alkalization agent, Na-lactate, rescued these cells by increasing the pHi (pH > 6.6). Finally, treatment of mice with acetazolamide decreased cell growth in the tumor nodules. DiscussionTargeting hypoxia and HIF have been proposed as an anti-tumor therapy but the clinical efficacy of such strategies are modest. We propose that targeting the pHi may be more effective at treating cancers within a hypoxic TME

What works for whom with telemental health: A rapid realist review

BACKGROUND: Telemental health (delivering mental health care via video calls, telephone calls or text messages) is increasingly widespread. Telemental health appears to be useful and effective in providing care to some service users in some settings, especially during an emergency restricting face-to-face contact such as the COVID-19 pandemic. However, important limitations have been reported, and telemental health implementation risks reinforcing pre-existing inequalities in service provision. If it is to be widely incorporated in routine care, a clear understanding is needed of when and for whom it is an acceptable and effective approach, and when face-to-face care is needed. OBJECTIVE: The aim of this rapid realist review was to develop theory about which telemental health approaches work, or do not work, for whom, in which contexts and through what mechanisms. METHODS: Rapid realist reviewing involves synthesising relevant evidence and stakeholder expertise to allow timely development of context-mechanism-outcome (CMO) configurations in areas where evidence is urgently needed to inform policy and practice. The CMOs encapsulate theories about what works for whom, and by what mechanisms. Sources included eligible papers from (a) two previous systematic reviews conducted by our team on telemental health, (b) an updated search using the strategy from these reviews, (c) a call for relevant evidence, including "grey literature", to the public and key experts, and (d) website searches of relevant voluntary and statutory organisations. CMOs formulated from these sources were iteratively refined, including through (a) discussion with an expert reference group including researchers with relevant lived experience and front-line clinicians and (b) consultation with experts focused on three priority groups: 1) children and young people, 2) users of inpatient and crisis care services, and 3) digitally excluded groups. RESULTS: A total of 108 scientific and grey literature sources were included. From our initial CMOs, we derived 30 overarching CMOs within four domains: 1) connecting effectively; 2) flexibility and personalisation; 3) safety, privacy, and confidentiality; and 4) therapeutic quality and relationship. Reports and stakeholder input emphasised the importance of personal choice, privacy and safety, and therapeutic relationships in telemental health care. The review also identified particular service users likely to be disadvantaged by telemental health implementation, and a need to ensure that face-to-face care of equivalent timeliness remains available. Mechanisms underlying successful and unsuccessful application of telemental health are discussed. CONCLUSIONS: Service user choice, privacy and safety, the ability to connect effectively and fostering strong therapeutic relationships, need to be prioritised in delivering telemental health care. Guidelines and strategies co-produced with service users and frontline staff are needed to optimise telemental health implementation in real-world settings. CLINICALTRIAL