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Mobility disability is associated with functional decline in older adults. Resistance training (RT) improves mobility disability, but adherence to national RT guidelines is poor. We evaluated the effects of a 12-week brief, home-based functional RT program, FAST (Functional Activity Strength Training)-2, on adherence and functional impairment in older, inactive adults ≥ 65 years of age, with pre-existing walking difficulty. Eligible older adults were randomized using stratified assignment based on biological sex and age (65-72 and 73+) to either the FAST-2 intervention involving a 4-minute daily workout of four exercises lasting 30 seconds each or the delayed treatment control condition. Video coaching at baseline and at weeks 2, 4 and 8, provided feedback on exercise form, modifications and progression. Daily email reminders were sent for workout completion, and to report exercise performance and rate perceived exertion. Performance and adherence feedback were emailed biweekly. Functional performance was measured by video using the Five-Times Sit-to-Stand (FTSTS) test, One-Legged Stance Test (OLST) and the 30-second chair stand test at baseline and at weeks 6 and 12. Ninety-seven participants were randomized to either the FAST-2 treatment intervention (n = 44) or the delayed treatment control condition (n = 53). The linear mixed-effect model showed the intervention group decreased the FTSTS by 2.3 seconds (95% CI: 0.5-4.1, p = 0.01), increased OLST by 3.6 seconds (95% CI: 0.6-6.5, p = 0.02) and increased the number of chair stands by 4.2 repetitions (95% CI: 2.8-5.7, p < 0.001) more than the control group over 12 weeks. Intervention participants completed the workout 81% of the days. No significant adverse events were reported. The 12-week FAST-2 intervention, including only 60-seconds of lower extremity exercises in older individuals with pre-existing walking difficulty, yielded improvement in functional performance. ClinicalTrials.gov: ID NCT05697497 Study Details | NCT05697497 | Functional Activity Strength Training | ClinicalTrials.gov.

Resistance training (RT) improves strength and physical function; however, only 35% of older adults meet national guidelines for muscle strengthening activities. Though time is often noted as a barrier to physical activity participation, little is known about the interest of older adults in brief RT programs. This study compared preferences for brief, more frequent vs longer, less frequent RT programs. A nationwide survey was conducted among 611 US adults aged 65 and over. Preference for either (1) a traditional (45 minutes per session, three days per week) RT program or (2) a short (5 minutes per session, daily) RT program was compared. Overall, 2.2 times as many older adults preferred the daily 5-minute RT program versus the traditional RT program (68.4% v. 31.6%). Preference for the brief, daily RT program was 5.3 times higher among adults with difficulty walking (84.2% v. 15.8%) than for the traditional RT program. Preference for a daily 5-minute RT program is significantly higher than for traditional 45-minute, three times weekly programs. This difference is larger in older adults who have serious difficulty walking or climbing stairs. Brief daily RT options may help engage older adults in RT at a population level, particularly those with poorer health and mobility disability. Future investigations should evaluate differences in uptake, adherence, and outcomes from two RT programs of varying durations and frequencies.

Rural primary care providers report increasing rates of professional burnout, which can further exacerbate rural provider shortages and health disparities. From 2023 to 2025, the Project ECHO team at Penn State University developed and delivered an educational rural health telementoring program, collaboratively with stakeholders, to disseminate guideline-concordant care to rural primary care clinicians. The program focused on key rural topics and created a professional learning community aimed at decreasing participant burnout. Self-reported results of the pilot program's participants ( = 106) demonstrate increased knowledge ( < .001) and reduced professional isolation. Future programing will expand data collection to explore longer-term impact.

Background Little is known about the musculoskeletal (MSK) exam providers use during the Preparticipation Physical Examination (PPE). The primary aims of this study were to determine current practice with regards to the MSK screening exam, if goals are being met, and if there may be opportunities for improvement. Methods This cross-sectional survey-based study utilized a REDCap instrument that was distributed to members of the American Academy of Family Physicians (AAFP) and the American Medical Society for Sports Medicine (AMSSM). Questions focused on participant demographics and MSK exam practices for the PPE. Descriptive statistics were used. Results The study had a total of 616 participants with a response rate of 9 %. The majority of respondents (82 %) were familiar with the 4th Edition PPE Monograph and 80 % either moderately or strongly agreed that they use this as a guideline for their MSK screening exam. The 90 s MSK screening test was implemented by 52 % of the participants. The majority of participants use an orthopedic exam as part of their PPE (82 %). Ninety-two percent of participants felt satisfied that their MSK exam would screen for current injury, while only 42 % were satisfied that it effectively screened for future injury. 86 % of participants agree that the MSK exam should be performed, while 26 % said that they don’t perform a physical exam at all. Discussion There is a lack of understanding of the PPE Monograph as there is wide variability in MSK screening techniques providers use despite the majority of participants being familiar with the guidelines described in the monograph. Additionally, providers don’t believe that the MSK exam screens for future injury. Conclusions The goals of the MSK portion of the 4th Edition PPE monograph are not adequately being met and there is a need for further research to validate screening exams for the prevention of MSK injury.

Aims To assess the knowledge of certified athletic trainers (ATs) on the presenting signs and symptoms of type 1 diabetes (T1D). Methods We conducted a 31‐question survey of secondary school ATs recruited from the National Athletic Training Association that established demographic information, knowledge of presenting signs and symptoms of T1D, and previous personal or professional exposure to individuals with T1D. We report descriptive statistics and univariate analyses evaluating the characteristics associated with T1D knowledge. We then report a multivariable model incorporating age, gender, years of experience and education level with T1D knowledge as the dependent variable. Results 128 participants (92f:34m) met inclusion criteria and were included in this study. The majority of participants correctly identified frequent thirst (96.1%, n = 123) and frequent urination (85.9%, n = 110) as common presenting signs and symptoms of T1D, while fewer participants identified weight gain (58.6%, n = 75) or joint pain (39.1%, n = 50) as incorrect presenting signs and symptoms of T1D. Participants with over ten years of experience or previous exposure to individuals with T1D had increased T1D knowledge. Participants with advanced education (Master's degree or Doctorate) had no statistically significant difference in T1D knowledge compared to those with a Bachelor's degree. The only factor that demonstrated a significant association with T1D knowledge on multivariable analysis was the female gender. Conclusions Educational awareness campaigns of T1D symptoms to reduce the rate of DKA at diagnosis of T1D have never included ATs. This study illustrates the importance of targeting future educational interventions on newly trained ATs. Educational interventions on presenting symptoms of type 1 diabetes (T1D) to childhood contacts have successfully reduced the rate of diabetic ketoacidosis at diagnosis of T1D. No previous educational interventions have included athletic trainers (ATs) and no literature reported ATs knowledge of the presenting symptoms of T1D and characteristics associated with increased knowledge. We report experienced ATs (>10 years) or previous exposure to an individual with T1D was positively associated with T1D knowledge in univariate analysis, while the only factor that demonstrated an association in multivariable analysis was the female gender.

Introduction/Objectives: One in four older adults in the United States (US) reports being socially isolated or lonely, leading to increases in the odds of having heart disease, a stroke, and dementia. Physical activity (PA) has many benefits in this population, both physical and psychological. One such type of PA growing in popularity is pickleball. Our objective was to understand the relationship of pickleball participation with perceived loneliness and social isolation among older adults in the US. Methods: We conducted a national cross-sectional survey of 825 US adults over age 50 years. We compared the effect of 3 levels of pickleball play history (never played (NP); played previously, not currently (PP); and currently play (CP)) on loneliness and social isolation. Results: Most participants (65%) who had ever played pickleball were still currently playing. Over half of the sample (57%) reported being lonely. The adjusted odds of being lonely were greater for NP (adjusted odds ratio 95% CI = 1.53, 1.04-2.23), and PP (1.95, 1.24-3.05) groups. Compared to NP, PP, and CP groups were found to be associated with having made more social connections and reporting a greater number of social engagements, thus appearing to experience less social isolation. Conclusion: Older adults who participate in pickleball had an associated decreased perceived loneliness and reduced risk of social isolation. Further research is needed to determine if recommendations for those able to physically participate in pickleball might result in similar changes to loneliness and social isolation.

Telemedicine has a very important role in today's healthcare system, which has been accentuated during the SARS-CoV-2 pandemic. Virtual medical evaluations offer a myriad of benefits for both patients and providers. Evaluations of the musculoskeletal system, however, present unique challenges because diagnosis significantly relies on a physical examination, something not easily accomplished by virtual means. The shoulder, a complex region with four separate articulations, is no exception. Nevertheless, a properly planned and executed telemedicine visit may yield successful results even with challenging shoulder pathologies. This narrative review aims to offer clinicians who are novices in the practice of telemedicine a basic framework with instructions, questions, and some examples of interpretation of patient answers to guide them through encounters for the evaluation of shoulder complaints via telephone and video consultation.

Background: The literature demonstrates a high prevalence of asymptomatic knee and hip findings on magnetic resonance imaging (MRI) in athletes. Baseball pitchers are shown to have a high prevalence of asymptomatic shoulder MRI findings, but the incidence of asymptomatic shoulder MRI findings has not been systematically evaluated in nonthrowing contact athletes. Purpose/Hypothesis: The purpose of this study was to determine the prevalence of shoulder abnormalities in asymptomatic professional and collegiate hockey players. We hypothesized that, similar to overhead throwing athletes, ice hockey players will have a high prevalence of asymptomatic MRI findings, including labral, acromioclavicular (AC), and rotator cuff pathology on MRI. Study Design: Cross-sectional study; Level of evidence, 4. Methods: A total of 25 asymptomatic collegiate and professional hockey players (50 shoulders) with no history of missed games or practice because of shoulder injury, pain, or dysfunction underwent bilateral shoulder noncontrast 3.0-T MRI. MRIs were read blinded by 2 board-certified radiologists at 2 separate time points, 3 months apart, to determine the prevalence of abnormalities of the joint fluid, bone marrow, rotator cuff tendon, biceps tendon, labrum, AC joint, and glenohumeral joint. Interrater and intrareader reliability was determined, and regression analysis was performed to identify the prevalence and relationship to stick-hand dominance. Results: Labral abnormalities were seen in 25% of the shoulders. AC joint abnormalities and rotator cuff findings were noted in 8% and 6% of shoulders, respectively. One shoulder was noted to have a biceps tendon abnormality, and 1 shoulder demonstrated glenohumeral joint chondral findings. Interrater reliability coefficients were 0.619 for labral abnormalities. Intrareader reliability kappa coefficients were 0.493 and 0.718 for both readers, respectively, for labral abnormalities. Regression analysis was performed and revealed that the overall shoulder pathology was more common in the nondominant stick hand (top stick hand) (coefficient –0.731; P = .021). Conclusion: Professional and collegiate ice hockey players had an overall prevalence of labral abnormalities in 25% of their shoulders, with findings more often found in the nondominant stick hand. Rotator cuff abnormalities were uncommon in ice hockey players. These findings differ significantly from published reports examining professional baseball players and other overhead sports athletes.

Background: Screening for poor physical performance has the potential to identify older adults at risk for loss of future independence, yet clinically feasible measures have yet to be identified. Methods: Using data from the National Health and Aging Trends Study, we evaluated the diagnostic utility of self-reported physical capacities of older adults (walking three blocks or six blocks, climbing 10 stairs or 20 stairs) compared to the objectively measured Short Physical Performance Battery (SPPB). Sensitivity, specificity, and likelihood ratio (LR) were calculated across three SPPB cut-points (≤8, ≤9, ≤10). Results: Sensitivity of single item-measures for detecting a low SBBP averaged 0.39 (range: 0.26–0.52), specific averaged 0.97 (range: 0.94–0.99) and likelihood ratio averaged 20.0 (range: 9.0–35.5). Among age and gender subgroups, all measures maintained clinically applicable LRs (minimum = 4.59). Conclusion: Single-item self-reported physical capacities are accurate for screening older adults with physical limitations, making them potentially useful in healthcare settings.

We present the case of a 28-year-old man with a growing mass in his right popliteal fossa causing pain on exertion. The differential diagnosis included Baker's cyst, entrapment syndrome of the popliteal artery, as well as a benign or malignant neoplasm. An ultrasound was non-specific. Follow-up MRI of the knee demonstrated cystic adventitial disease (CAD). With only about 500 cases reported in the literature since its discovery in 1947, CAD is a rare entity. The disease is characterised by mucinous or gelatinous cysts in the arterial or venous adventitia. The disease is predominantly seen in the popliteal artery and typically affects otherwise healthy males in the fourth to fifth decade of life. It presents clinically as intermittent exertional claudication. Examination of our case and a review of the literature will highlight the importance of considering CAD in patients who report of a popliteal mass and intermittent claudication.