Summer Cook Associate Professor of Kinesiology (COLA) travels to Australia

I was partially supported by a CIE International development grant to travel to Perth, Australia for one month in 2016. Dr. Timothy Fairchild, a colleague and friend, invited me to visit the Department of Psychology and Exercise Science at Murdoch University in the hopes of establishing a research relationship with the University of New Hampshire Department of Kinesiology. Over the last several years, I have had students earn Summer Undergraduate Research Fellowships (SURF) from the Hamel Center and have always wanted to give students an opportunity to apply for SURF abroad grants or to study abroad while conducting research within our field. The idea of international collaboration and the opportunity to leave the New England winter to work on the coast of Western Australia made the decision to travel very simple

Strength asymmetry increases gait asymmetry and variability in older women.

Purpose—The aim of the research was to determine how knee extensor strength asymmetry influences gait asymmetry and variability since these gait parameters have been related to mobility and falls in older adults. Methods—Strength of the knee extensors was measured in 24 older women (65 – 80 yr). Subjects were separated into symmetrical strength (SS, n = 13) and asymmetrical strength (SA, n = 11) groups using an asymmetry cutoff of 20%. Subjects walked at a standard speed of 0.8 m s−1 and at maximal speed on an instrumented treadmill while kinetic and spatiotemporal gait variables were measured. Gait and strength asymmetry were calculated as the percent difference between legs and gait variability as the coefficient of variation over twenty sequential steps. Results—SA had greater strength asymmetry (27.4 ± 5.5%) than SS (11.7 ± 5.4%, P \u3c 0.001). Averaged across speeds, SA had greater single (7.1% vs. 2.5%) and double-limb support time asymmetry (7.0 vs. 4.3%) than SS and greater single-limb support time variability (9.7% vs. 6.6%, all P \u3c 0.05). Group × speed interactions occurred for weight acceptance force variability (P = 0.02) and weight acceptance force asymmetry (P = 0.017) with greater variability at the maximal speed in SA (5.0 ± 2.4% vs. 3.7 ± 1.2%) and greater asymmetry at the maximal speed in SA (6.4 ± 5.3% vs. 2.5 ± 2.3%). Conclusion—Gait variability and asymmetry are greater in older women with strength asymmetry and increase when they walk near their maximal capacities. The maintenance of strength symmetry, or development of symmetry through unilateral exercise, may be beneficial in reducing gait asymmetry, gait variability, and fall risk in older adults

Cardiorespiratory and Metabolic Responses to Low-Intensity Blood-Flow Restricted Running

Low-intensity (LI) aerobic exercise with blood-flow restriction (BFR) increases heart rate (HR), oxygen consumption (VO2), and ratings of perceived exertion (RPE), sometimes to similar levels as high-intensity (HI) exercise. Distance runners may benefit from LI-BFR running in periods of reduced volume or intensity, possibly due to injury. PURPOSE: To compare HR, VO2, blood lactate (BLa), and RPE during LI-BFR running and HI running without BFR. METHODS: Fifteen female distance runners (age 23+4yrs, height 1.67+0.50m, body mass 57.6+5.7kg, VO2max 51.0+4.5mL•kg-1•min-1) completed three randomized 12-minute running conditions: LI control (40% VO2max), HI (80% VO2max), and LI-BFR (40% VO2max). VO2, HR, and RPE were measured at rest, and every 3-minutes. BLa was measured at rest, immediately-post (ImmPost), and 3-minutes post-exercise (3minPost). RESULTS: VO2 remained steady among each condition (p=0.075,ηp2=0.155). The average VO2 differed between the conditions (p\u3c0.001), as HI (39.4+3.9mL•kg-1•min-1) \u3e LI-BFR (25.3+2.6mL•kg-1•min-1) \u3e LI (22.5+3.1mL•kg-1•min-1). HR increased at the onset of exercise and differed between the conditions (p\u3c0.001,ηp2=0.745). The average HR for HI, LI-BFR, and LI were 166+8bpm, 142+13bpm, and 124+11bpm, respectively. BLa was similar in HI and LI-BFR ImmPost and 3minPost (p\u3e0.05), and both were higher than LI (p\u3c0.017). Average RPE in the HI and LI-BFR conditions were similar (p=0.236). CONCLUSION: HI elicits greater VO2 and HR responses than LI-BFR running, suggesting that HI would result in more robust long-term training responses. However, if one cannot engage in HI running because of injury and rehabilitation, LI-BFR running could be a feasible temporary alternative

Core Stability and Athletic Performance in Male and Female Lacrosse Players

International Journal of Exercise Science 12(4): 1138-1148, 2019. This study determined the relationship of core stability with power production, agility, and dynamic stability of collegiate lacrosse players and whether core stability is more evident in these performance variables in either males or females. Twenty male and female collegiate lacrosse players (20.3 ± 1.0 years, 173.2 ± 11.8 cm, 72.6 ± 13.0 kg) performed the pro-agility shuttle, the countermovement jump (CMJ), the Star Excursion Balance Test (SEBT), and prone, right lateral, and left lateral planks on two sessions- familiarization and testing. Independent T-tests were used to compare sexes. SPSS 24.0 was used; significance was accepted at p\u3c 0.05. Pearson correlations were used to compare the relationship of core stability to the performance variables in participants. There was a significant relationship found between the prone plank and pro-agility shuttle in all participants (r = -0.50). No significant relationships were found between core stability and performance variables. A significant difference was found in the pro-agility shuttle (p= 0.001) and the CMJ (p= 0.001) but not in core stability or dynamic stability. Agility, power production, and dynamic stability were not related to core stability in neither male or female lacrosse players. There were no significant differences in core stability and dynamic stability between males and females. A significant difference was found in dynamic stability in the SEBT right leg and left leg composite scores between sexes. From these results, it is suggested that core stability may not directly influence the performance variables in collegiate male and female lacrosse players

Using Natural Language Processing and Sentiment Analysis to Augment Traditional User-Centered Design: Development and Usability Study

Background: Sarcopenia, defined as the age-associated loss of muscle mass and strength, can be effectively mitigated through resistance-based physical activity. With compliance at approximately 40% for home-based exercise prescriptions, implementing a remote sensing system would help patients and clinicians to better understand treatment progress and increase compliance. The inclusion of end users in the development of mobile apps for remote-sensing systems can ensure that they are both user friendly and facilitate compliance. With advancements in natural language processing (NLP), there is potential for these methods to be used with data collected through the user-centered design process. Objective: This study aims to develop a mobile app for a novel device through a user-centered design process with both older adults and clinicians while exploring whether data collected through this process can be used in NLP and sentiment analysis. Methods: Through a user-centered design process, we conducted semistructured interviews during the development of a geriatric-friendly Bluetooth-connected resistance exercise band app. We interviewed patients and clinicians at weeks 0, 5, and 10 of the app development. Each semistructured interview consisted of heuristic evaluations, cognitive walkthroughs, and observations. We used the Bing sentiment library for a sentiment analysis of interview transcripts and then applied NLP-based latent Dirichlet allocation (LDA) topic modeling to identify differences and similarities in patient and clinician participant interviews. Sentiment was defined as the sum of positive and negative words (each word with a +1 or −1 value). To assess utility, we used quantitative assessment questionnaires—System Usability Scale (SUS) and Usefulness, Satisfaction, and Ease of use (USE). Finally, we used multivariate linear models—adjusting for age, sex, subject group (clinician vs patient), and development—to explore the association between sentiment analysis and SUS and USE outcomes. Results: The mean age of the 22 participants was 68 (SD 14) years, and 17 (77%) were female. The overall mean SUS and USE scores were 66.4 (SD 13.6) and 41.3 (SD 15.2), respectively. Both patients and clinicians provided valuable insights into the needs of older adults when designing and building an app. The mean positive-negative sentiment per sentence was 0.19 (SD 0.21) and 0.47 (SD 0.21) for patient and clinician interviews, respectively. We found a positive association with positive sentiment in an interview and SUS score (ß=1.38; 95% CI 0.37 to 2.39; P=.01). There was no significant association between sentiment and the USE score. The LDA analysis found no overlap between patients and clinicians in the 8 identified topics. Conclusions: Involving patients and clinicians allowed us to design and build an app that is user friendly for older adults while supporting compliance. This is the first analysis using NLP and usability questionnaires in the quantification of user-centered design of technology for older adults

Simple guide to starting a research group

Conducting cutting-edge research and scholarship becomes more complicated with each passing year; forming a collaborative research group offers a way to navigate this increasing complexity. Yet many individuals whose work might benefit from the formation of a collaborative team may feel overwhelmed by the prospect of attempting to build and maintain a research group. We propose this simple guide for starting and maintaining such an enterprise

Detection and Monitoring of Repetitions Using an mHealth-Enabled Resistance Band

Sarcopenia is defined as an age-related loss of muscle mass and strength which impairs physical function leading to disability and frailty. Resistance exercises are effective treatments for sarcopenia and are critical in mitigating weight-loss induced sarcopenia in older adults attempting to lose weight. Yet, adherence to home-based regimens, which is a cornerstone to lifestyle therapies, is poor and cannot be ascertained by clinicians as no objective methods exist to determine patient compliance outside of a supervised setting. Our group developed a Bluetooth connected resistance band that tests the ability to detect exercise repetitions. We recruited 6 patients aged 65 years and older and recorded 4 specific, physical therapist-led exercises. Three blinded reviewers examined the findings and we also applied a peak finding algorithm to the data. There were 16.6 repetitions per exercise across reviewers, with an intraclass correlation of 0.912 (95%CI: $0.853-0.953$, $p\u3c0.001$) between reviewers and the algorithm. Using this novel resistance band, we feasibly detected repetition of exercises in older adults. Sarcopenia is defined as an age-related loss of muscle mass and strength which impairs physical function leading to disability and frailty. Resistance exercises are effective treatments for sarcopenia and are critical in mitigating weight-loss induced sarcopenia in older adults attempting to lose weight. Yet, adherence to home-based regimens, which is a cornerstone to lifestyle therapies, is poor and cannot be ascertained by clinicians as no objective methods exist to determine patient compliance outside of a supervised setting. Our group developed a Bluetooth connected resistance band that tests the ability to detect exercise repetitions. We recruited 6 patients aged 65 years and older and recorded 4 specific, physical therapist-led exercises. Three blinded reviewers examined the findings and we also applied a peak finding algorithm to the data. There were 16.6 repetitions per exercise across reviewers, with an intraclass correlation of 0.912 (95%CI: $0.853-0.953$, $p\u3c0.001$) between reviewers and the algorithm. Using this novel resistance band, we feasibly detected repetition of exercises in older adults

Barriers and facilitators in implementing a pilot, pragmatic, telemedicine-delivered healthy lifestyle program for obesity management in a rural, academic obesity clinic

Few evidence-based strategies are specifically tailored for disparity populations such as rural adults. Two-way video-conferencing using telemedicine can potentially surmount geographic barriers that impede participation in high-intensity treatment programs offering frequent visits to clinic facilities. We aimed to understand barriers and facilitators of implementing a telemedicine-delivered tertiary-care, rural academic weight-loss program for the management of obesity

Feasibility and acceptability of a rural, pragmatic, telemedicine‐ delivered healthy lifestyle programme

Background: The public health crisis of obesity leads to increasing morbidity that are even more profound in certain populations such as rural adults. Live, two‐way video‐conferencing is a modality that can potentially surmount geographic barriers and staffing shortages. Methods: Patients from the Dartmouth‐Hitchcock Weight and Wellness Center were recruited into a pragmatic, single‐arm, nonrandomized study of a remotely delivered 16‐week evidence‐based healthy lifestyle programme. Patients were provided hardware and appropriate software allowing for remote participation in all sessions, outside of the clinic setting. Our primary outcomes were feasibility and acceptability of the telemedicine intervention, as well as potential effectiveness on anthropometric and functional measures. Results: Of 62 participants approached, we enrolled 37, of which 27 completed at least 75% of the 16‐week programme sessions (27% attrition). Mean age was 46.9 ± 11.6 years (88.9% female), with a mean body mass index of 41.3 ± 7.1 kg/m2 and mean waist circumference of 120.7 ± 16.8 cm. Mean patient participant satisfaction regarding the telemedicine approach was favourable (4.48 ± 0.58 on 1‐5 Likert scale—low to high) and 67.6/75 on standardized questionnaire. Mean weight loss at 16 weeks was 2.22 ± 3.18 kg representing a 2.1% change (P \u3c .001), with a loss in waist circumference of 3.4% (P = .001). Fat mass and visceral fat were significantly lower at 16 weeks (2.9% and 12.5%; both P \u3c .05), with marginal improvement in appendicular skeletal muscle mass (1.7%). In the 30‐second sit‐to‐stand test, a mean improvement of 2.46 stands (P = .005) was observed. Conclusion: A telemedicine‐delivered, intensive weight loss intervention is feasible, acceptable, and potentially effective in rural adults seeking weight loss