A randomised controlled trial to measure the effects of an augmented prescribed exercise programme (APEP) on length of stay, physical ability and quality of life in frail older medical patients in the acute setting

The aim of this thesis was to measure the effectiveness of additional exercises on length of stay, physical performance and quality of life for frail older medical inpatients. The thesis, in three phases (1) identified a suitable and accurate motion sensor to measure walking in hospital, (2) measured walking in hospital, and (3) measured the effectiveness of an augmented prescribed exercise programme (APEP) for frail older acute medical (RCT). Phase 1: A scholarly review identified two accelerometers and three pedometers showing potential, and a validation study (n=32), identified one of these as suitably accurate. Phase 2: The accelerometer was used to measure the association between walking (step-count) and (1) length of stay, (2) physical performance and (3) potential influencers of walking (n=154). More walking (50%) was associated with a 6% shorter hospital stay. Better physical performance on admission predicted 15% more walking, and assigned bed-rest and tethering treatments were associated with less walking (70% and 30% respectively). Phase 3: The effectiveness of the APEP was measured (n=190), using length of stay as the primary outcome measure. Twice-daily exercise sessions were delivered; strengthening/balance to the intervention group, stretching/relaxation to the control group. Many (35%) patients were transferred to sub-acute care. A 30% shorter length of stay (patients discharged directly home only), was detected, however, failed to reach significant significance (n=128), (HR 1.3 (CI 0.90-1.87) p=0.1). Improved physical performance at discharge (β 0.88 (CI 0.2-1.57) p=0.01), quality of life at follow-up (β 0.28 (CI 0.91-0.47) p=0.004) and less negative events (pooled falls, prolonged hospital stays, deaths and long-term care admissions) (OR 0.42 (0.2-0.92) p=0.03, post hoc analysis) were detected. The results indicate that older inpatients’ inactivity is associated with length of stay. Additional exercises improved physical performance and quality of life. Its effect on length of stay remains inconclusive

A review of the accuracy and utility of motion sensors to measure physical activity of frail older hospitalised patients.

The purpose of this review was to examine the utility and accuracy of commercially available motion sensors to measure step-count and time spent upright in frail older hospitalized patients. A database search (CINAHL and PubMed, 2004–2014) and a further hand search of papers’ references yielded 24 validation studies meeting the inclusion criteria. Fifteen motion sensors (eight pedometers, six accelerometers, and one sensor systems) have been tested in older adults. Only three have been tested in hospital patients, two of which detected postures and postural changes accurately, but none estimated step-count accurately. Only one motion sensor remained accurate at speeds typical of frail older hospitalized patients, but it has yet to be tested in this cohort. Time spent upright can be accurately measured in the hospital, but further validation studies are required to determine which, if any, motion sensor can accurately measure step-count

Step-count accuracy of three motion sensors for older and frail medical inpatients

Objectives: To measure the step-count accuracy of an ankle-worn accelerometer, a thigh-worn accelerometer and one pedometer in older and frail inpatients. Design: Cross-sectional design study. Setting: Research room within a hospital. Participants: Convenience sample of inpatients aged ≥65 years, able to walk 20 metres unassisted, with or without a walking-aid. Intervention: Patients completed a 40-minute programme of predetermined tasks while wearing the three motion sensors simultaneously. Video-recording of the procedure provided the criterion measurement of step-count. Main Outcome Measures: Mean percentage (%) errors were calculated for all tasks, slow versus fast walkers, independent versus walking-aid-users, and over shorter versus longer distances. The Intra-class Correlation was calculated and accuracy was visually displayed by Bland-Altman plots. Results: Thirty-two patients (78.1 ±7.8 years) completed the study. Fifteen were female and 17 used walking-aids. Their median speed was 0.46 m/sec (interquartile range, IQR 0.36-0.66). The ankle-worn accelerometer overestimated steps (median 1% error, IQR -3 to 13). The other motion sensors underestimated steps (40% error (IQR -51 to -35) and 38% (IQR -93 to -27), respectively). The ankle-worn accelerometer proved more accurate over longer distances (3% error, IQR 0 to 9), than shorter distances (10%, IQR -23 to 9). Conclusions: The ankle-worn accelerometer gave the most accurate step-count measurement and was most accurate over longer distances. Neither of the other motion sensors had acceptable margins of error

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

Ybiv from Escherichia coli K12 is a HAD phosphatase

The protein YbiV from Escherichia coli K12 MG1655 is a hypothetical protein with sequence homology to the haloacid dehalogenase (HAD) superfamily of proteins. Although numerous members of this family have been identified, the functions of few are known. Using the crystal structure, sequence analysis, and biochemical assays, we have characterized ybiV as a HAD phosphatase. The crystal structure of YbiV reveals a two domain protein, one with the characteristic HAD hydrolase fold, the other an inserted a/b fold. In an effort to understand the mechanism we also solved and report the structures of YbiV in complex with beryllofluoride (BeF3-) and aluminum trifluoride (AlF3) which have been shown to mimic the phosphorylated intermediate and transition state for hydrolysis, respectively, in analogy to other HAD phosphatases. Analysis of the structures reveals the substrate binding cavity, which is hydrophilic in nature. Both structure and sequence homology indicate ybiV may be a sugar phosphatase, which is supported by biochemical assays which measured the release of free phosphate on a number of sugar-like substrates. We also investigated available genomic and functional data in an effort to determine the physiological substrate

The effect of sport for LIFE: all island in children from low socio-economic status: a clustered randomized controlled trial

Abstract Background School-based interventions offer the opportunity to increase physical activity, health-related quality of life (HRQOL) and nutritional behaviours, yet methodological limitations hinder current research, particularly among under-represented children from low socio-economic status (SES). The aim was to determine the effect of a 12-week physical activity programme, Sport for LIFE: All Island (SFL:AI), on physical activity levels, HRQOL, and nutritional attitudes and behaviours in children of low SES across the island of Ireland. Methods A 2 (groups) × 4 (data collection points) clustered randomised controlled trial was conducted comprising an intervention group who received SFL:AI for 12 weeks, and a waiting-list control condition. In total 740 children (381 boys, 359 girls) aged 8–9 years (mean = 8.7; SD = .50) from 27 schools across four regions of Ireland (Ulster, Leinster, Connacht and Munster) took part. Physical activity was measured by accelerometers, and children completed a validated questionnaire at baseline, mid (i.e. 6-weeks), post-intervention (i.e. 12 weeks) and follow-up (i.e. 3 months post-intervention). Results No significant interaction effects for the intervention were found on any of the study outcomes. Main effects were reported for physical well-being, parental relations and autonomy and financial resources, as well as sweetened beverages, environment and intake, and attitude to vegetables. However, these changes were not statistically attributable to the intervention. Conclusions It remains unclear if school-based physical activity interventions can improve HRQOL through physical activity with children from low SES. Logistical and methodological considerations are outlined to explore the null effect of the programme, and to provide suggestions for future research and practice. Trial registration Trial registration number: ISRCTN76261698. Name of registry: ICRCTN. Date of registration: 23/08/2017. Date of enrolment: September 2014