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Background: There is a scarcity of quality literature on the prevalence of frailty among community dwelling elderly in India. This study was originally planned to analyze the longitudinal trends in frailty status of community dwelling elderly in an Indian population as well to identify factors associated with frailty in the Indian context. However, the recruitment phase of this study coincided with one of the largest lockdowns in history, associated with the COVID-19 pandemic, and this gave us a unique opportunity to study the effects this pandemic enforced, as a result of the necessary restrictions, on the frailty status as well the factors affecting frailty in the elderly. Methods: A prospective observational study was designed and conducted amongst 19 community dwelling elderly of Dakshina Kannada District, in Karnataka India. Outcome variables of frailty (EFIP), physical activity (PASE), functional mobility (TUG), gait speed (10-meter walk test), nutritional status (MNA ®-SF) body composition (BIA), and strength (dynamometry), were measured at baseline and on follow-up after three months. The changes occurring in these variables over the three-month period were analyzed and the change in frailty was independently correlated with changes in each of the other outcomes. Results: We couldn't identify any statistically significant difference in frailty over a period of three months. However, there was a highly significant change in the physical activity status, lower extremity muscle strength, body composition, functional mobility, gait speed, and cognitive function in the same time period. Conclusions: Though individual determinants of frailty in community dwelling changed over a three-month period, these changes failed to produce any observable/measurable difference in frailty status.

Objective: Studies showed the benefits of virtual reality training (VRT) for functional mobility and balance in older adults. However, large variance in the study design and results is presented. We here thus completed a systematic review and meta-analysis to quantitatively examine the effects of VRT on functional mobility and balance in healthy older adults. METHODS: We systematically reviewed the publications in five databases. Studies examining the effects of VRT on the measures of functional mobility and balance in healthy older adults were screened and included if eligible. Subgroup analyses were completed to explore the effects of different metrics of the intervention design (e.g., session time) on those outcomes related to functional mobility and balance. Results: Fifteen studies of 704 participants were included. The quality of these studies was good. Compared to traditional physical therapy (TPT), VRT induced greater improvement in TUG (MD = -0.31s, 95%CI = -0.57 to -0.05, P = 0.02, I2 = 6.34%) and one-leg eyes-open stance (OLS-O) (MD =7.28s, 95%CI = 4.36 to 10.20, P = 0.00, I2 = 36.22%). Subgroup analyses revealed that immersive VRT with more than 800 minutes of total intervention time over eight weeks and at least 120 minutes per week, and/or designed by the two motor learning principles was optimal for functional mobility and balance. Conclusion: VRT can significantly improve functional mobility and balance in healthy older adults compared to TPT, and the findings provided critical knowledge of the optimized design of VRT that can inform future studies with more rigorous designs.

Bilateral and unilateral vestibulopathies mainly cause chronic imbalance/unsteadiness and oscillopsia, significantly impacting quality of life. Traditional clinical tests fail to assess functional impact on daily activities. This study aimed to characterize head movement patterns in bilateral vestibulopathy (BV) and unilateral vestibulopathy (UV) patients during functional mobility tasks in a semi-standardized environment. This study could provide useful information for rehabilitation and optimization of vestibular implant stimulation. Fifty-nine participants (19 BV, 20 UV, 20 healthy subjects) performed 10 functional mobility tasks, and a subtask extracted during analysis, while wearing inertial measurement units that recorded head angular velocities. Angular accelerations were derived from these. Vector norms and mode values of distribution histograms were calculated for both variables. Statistical analyses were performed using linear mixed-effects models to compare head movement parameters (angular velocity and angular acceleration) between groups (healthy subjects vs. patients) and tasks (walk vs. other tasks), including group × task interactions. Correlation analyses were also performed to compare the objective values with the patients' perception of task difficulty. Vestibulopathy patients demonstrated significantly reduced head movements compared to healthy subjects. BV patients showed the most restrictive patterns (angular velocities estimated between 8 and 12 deg/s; accelerations between 85 and 150 deg/s , with statistically significant main effects of group and task and specific significant group × task interactions). UV patients exhibited intermediate values with greater variability. Healthy subjects displayed task-specific adaptations and higher movement ranges (Q1-Q3 area: 5.97 vs. 3.58 vs. 2.69 deg /s (angular velocity x angular acceleration) for healthy, UV, and BV groups respectively). Vestibulopathy leads to compensatory head stiffening strategies specific to certain tasks, with BV patients exhibiting the most pronounced limitations. These findings may suggest that patients adopt cautious motor behaviors during their functional mobility activities. This ecological assessment provides essential parameters for optimizing vestibular rehabilitation protocols and defining realistic technical requirements for vestibular implants.

Impaired muscle strength, proprioceptive and vestibular deficits, and orthopedic dysfunction are common disorders associated with Down syndrome (DS). Hippotherapy uses the horses’ multidimensional movement to improve posture, balance, and overall function, both motor and sensory. Research evidence supports hippotherapy as an effective, medically recognized intervention for the rehabilitation of gross motor skills. The aim of this study was to determine the effect of hippotherapy on balance, functional mobility, and functional independence in children with DS. Thirty-four children with DS were randomly assigned to the experimental (hippotherapy) and control groups after the initial assessment. Both groups received physiotherapy including balance exercises, and the experimental group also received hippotherapy as an integrative therapy. Pediatric Balance Scale (PBS), Timed Up and Go Test (TUG), and Functional Independence Measure for Children (WeeFIM) were used before and after the intervention. Baseline outcome measures (PBS, TUG, WeeFIM) were statistically similar between groups ( p  > 0.05). After the intervention, PBS and TUG scores improved in both groups ( p  < 0.05). On the other hand, WeeFIM scores improved just in the hippotherapy group ( p  < 0.05).     Conclusion : Therefore, providing hippotherapy as an integrative therapy to physiotherapy will be more effective in improving the functional independence of children with DS.     Trial registration : NCT05297149 (March 2022, retrospectively registered). What is Known: • Hippotherapy has an improvement effect on balance and functional independence in different diseases and age groups, but the evidence is limited in DS. • There is limited evidence about the effect of hippotherapy on functional mobility in different diseases and age groups, but there is no evidence in DS. What is New: • Hippotherapy is a safe and effective approach to support improvement in functional independence in children with DS.

Background Mobility, cognitive processing, and balance confidence impairments can negatively affect functional mobility in people with Parkinson’s disease (PD). This study aimed to examine the effects of a cognitive dual-task on functional mobility during Timed Up and Go (TUG) sub-phases involving transitions and turns. A secondary aim was to explore whether balance confidence was associated with dual-task interference (DTI) on TUG total duration and sub-phases. Methods A cross-sectional design was employed. Participants completed TUG and TUG-COG (serial three subtractions) and inertial sensors recorded spatiotemporal data on transitions and turns. Paired samples t-tests and corresponding effect sizes (Cohen’s d) were used to compare TUG conditions. Multivariate linear regression assessed the association between balance confidence and DTI on total duration and sub-phases, controlling for gait speed and executive function. Results People with mild-to-moderate PD (N = 94, mean age: 68.7 years) completed TUG-COG 2.7 s slower than TUG (p < 0.001, d = 0.5, DTI = 22.9%). The cognitive task led to reduced performance across TUG sub-phases, with generally stronger effects observed in turning outcomes (d = 0.25–0.45) and comparatively smaller effects observed in postural transitions ( d = 0.02–0.38 ). Balance confidence explained variance in DTI for sit-to-stand duration (B = -−3.560, 95% CI [−5.499, −1.622], p < 0.001), whereas no effect was observed for other sub-phases. Conclusion Dual-tasking impaired nearly all components of the TUG, prolonging total duration and altering spatiotemporal characteristics of transitions and turns. Turning was more strongly impacted by dual-tasking than postural transitions, which has relevance for fall-prevention strategies. Together, the results of this study indicate that clinicians should prioritize turning during dual-task gait training and incorporate assessment of balance confidence to better capture functional capacity in transitional movements such as sit-to-stand.

Background Combined creatine monohydrate (CRE) and β-hydroxy-β-methylbutyrate (HMB) supplementation may counteract age-related declines in functional capacity, yet evidence in physically active older adults is scarce. Objective To investigate the effects of six weeks of CRE + HMB supplementation integrated with a supervised multicomponent exercise program on functional performance, metabolic efficiency, and physiological health in older adults. Methods Thirty physically active adults aged ≥ 60 years (20 men, 10 women) completed a randomized, double-blind, placebo-controlled crossover trial involving two 6-week intervention phases (CRE + HMB or placebo), separated by a 3-week washout. The exercise program (4 sessions/week) combined strength, endurance, and coordination training. Functional tests (4-m gait speed, 5-repetition sit-to-stand, Timed Up and Go, 400-m walk), metabolic indices, and cardiopulmonary and inflammatory markers were assessed pre- and post-intervention. Results CRE + HMB significantly improved gait speed, sit-to-stand, TUG, and 400-m walk ( p  < 0.05), with large effect sizes (η² p  = 0.15–0.29). Basal metabolic rate and metabolic rate index increased, while visceral adiposity showed favorable trends. Women exhibited reductions in diastolic blood pressure and higher expiratory strength; men showed a transient rise in endothelial protein C receptor (EPCR). No period, sequence, or carryover effects were detected. Conclusions Six weeks of CRE + HMB supplementation integrated with supervised multicomponent training enhanced mobility, metabolic efficiency, and selected physiological outcomes in physically active older adults. This strategy represents a safe, feasible, and practical approach to sustain functional independence and metabolic health with aging.

Existing clinical assessments of Parkinson’s disease (PD) primarily focus on stratifying symptom severity or progression rate, which limits their ability to capture changes in functional mobility—an important factor in evaluating rehabilitation outcomes. To address this gap, we developed a novel methodology, the Functional Mobility Assessment for Parkinson’s (FMA-P), which integrates motion capture and pressure-sensitive gait analysis to explore key aspects of functional mobility. Study 1. To develop the FMA-P, we conducted a pilot study involving 12 individuals with PD and 12 age-matched healthy controls, who each completed the FMA-P sequence three times. The sequence included the following tasks: rising from a chair, walking through a doorway, turning, bending to pick up and place an object, and returning to a seated position. Results from Study 1 demonstrated that the FMA-P is a sensitive tool for identifying functional impairments in PD. In particular, significant differences between people with Parkinson’s (PwP) and controls were observed during chair rise (higher peak trunk inclination, p = 0.006; lower mean trunk jerk, p = 0.003) and turning task (longer task duration, p = 0.026 and lower mean heel strike angle, p = 0.007), providing critical insights into postural stability. Study 2. To assess changes in functional mobility over time, we conducted a 12-week repeated-measures intervention study with 12 participants with PD. Results from Study 2 indicated notable improvements in turning stability and balance. Participants demonstrated reduced turning time (p = 0.006) and increased yaw rotation in the head (p = 0.001), trunk (p = 0.002), and pelvis (p = 0.012). In contrast, no significant changes were observed in standard clinical measures (i.e., Timed Up and Go and task duration). The FMA-P offers fine-grained insights into movement quality, making it a valuable tool for early diagnosis, monitoring intervention efficacy, and guiding rehabilitation strategies in individuals with PD.

Acute lymphoblastic leukaemia/lymphoma (ALL/LBL) and its treatment interfere with normal physical functioning. However, it remains unclear how physical fitness (PF) is affected throughout treatment for ALL/LBL. Sixty-two patients (2.1 to 18.3 years) treated for ALL/LBL underwent four physical tests at nine timepoints from baseline up to 6 months post-treatment. We assessed muscle strength of the quadriceps and tibialis anterior, standing broad jump test (SBJ) for functional mobility and six-minute walk test (6MWT) for endurance. One-sample t -tests were used to compare our results to the norm at each timepoint. Norm-referenced Z -scores were predicted based on time, risk group and age at diagnosis, using linear mixed models. Quadriceps strength, SBJ and 6MWT scores were significantly lower than norm values at all timepoints from diagnosis up to 6 months after maintenance therapy. Significant decreases over time were encountered for quadriceps strength and SBJ, mainly occurring after induction therapy ( F  = 3.568, p  < 0.001 and F  = 2.699, p  = 0.008, respectively). Age at diagnosis was a significant predictor for tibialis anterior strength ( F  = 5.266, p  = 0.025), SBJ ( F  = 70.422, p  < 0.001) and 6MWT ( F  = 15.890, p  < 0.001) performances, with lower results in adolescents at all timepoints. Six months after treatment, quadriceps strength, 6MWT and SBJ scores remained below expected levels. Conclusion : The decreased quadriceps strength, functional mobility and endurance at all timepoints, with a large deterioration following induction therapy, suggest the need for early interventions, specifically in the adolescent population. The continued low results 6 months after therapy emphasise the importance of long-term rehabilitation. What is Known: •Acute lymphoblastic leukaemia is the most common type of cancer among children, with increasing survival rates due to therapeutic improvements. •Acute lymphoblastic leukaemia/lymphoma and its treatment can cause muscle weakness, neuromuscular toxicity and a decreased cardiopulmonary fitness. Together with physical inactivity, this can result in a decreased physical fitness. What is New: •Quadriceps strength, functional mobility and endurance are decreased during treatment for acute lymphoblastic leukaemia/lymphoma. The lowest measurements are observed after induction therapy, suggesting the need for early interventions. •We observed continued lower results for quadriceps strength, functional mobility and endurance at the end of treatment, up to 6 months after therapy, supporting the need for long-term rehabilitation.

Summary Muscle density is a risk factor for fractures in older adults; however, its association with falls is not well described. After adjusting for biologically relevant confounding factors, a unit decrease in muscle density was associated with a 17 % increase in odds of reporting a fall, independent of functional mobility. Introduction Falls are the leading cause of injury, disability, and fractures in older adults. Low muscle density (i.e., caused by muscle adiposity) and functional mobility have been identified as risk factors for incident disability and fractures in older adults; however, it is not known if these are also independently associated with falls. The purpose of this study was to explore the associations of muscle density and functional mobility with fall status. Methods Cross-sectional observational study of 183 men and women aged 60–98 years. Descriptive data, including a 12-month fall recall, Timed Up and Go (TUG) test performance, lower leg muscle area, and density. Odds ratio (OR) of being a faller were calculated, adjusted for age, sex, body mass index, general health status, diabetes, and comorbidities. Results Every mg/cm 3 increase in muscle density (mean 70.2, SD 2.6 mg/cm 3 ) independently reduced the odds of being a faller by 19 % (OR 0.81 [95 % CI 0.67 to 0.97]), and every 1 s longer TUG test time (mean 9.8, SD 2.6 s) independently increased the odds by 17 % (OR 1.17 [95 % CI 1.01 to 1.37]). When both muscle density and TUG test time were included in the same model, only age (OR 0.93 [95 % CI 0.87 to 0.99]) and muscle density (OR 0.83 [95 % CI 0.69 to 0.99]) were independently associated with fall status. Conclusions Muscle density was associated with fall status, independent of functional mobility. Muscle density may compliment functional mobility tests as a biometric outcome for assessing fall risk in well-functioning older adults.

Background Falls have a major impact on individual patients, their relatives, the healthcare system and related costs. Physical exercise programmes that include multiple categories of exercise effectively reduce the rate of falls and risk of falling among older adults. Methods This 12-month, assessor-blinded, three-armed multicentre randomised clinical trial was conducted in adults aged ≥ 65 years identified as at risk of falling. Four hundred and five participants were randomly allocated into 3 groups: experimental group ( n  = 166) with the Test&Exercise partially supervised programme based on empowerment delivered with a tablet, illustrated manual and cards, reference group ( n  = 158) with the Otago partially supervised programme prescribed by a physiotherapist delivered with an illustrated manual and control group ( n  = 81) with the Helsana self-administrated programme delivered with cards. Experimental and reference groups received partially supervised programmes with 8 home sessions over 6 months. Control group received a self-administered program with a unique home session. The 3 groups were requested to train independently 3 times a week for 12 months. Primary outcome was the incidence rate ratio of self-reported falls over 12 months. Secondary outcomes were fear of falling, basic functional mobility and balance, quality of life, and exercise adherence. Results A total of 141 falls occurred in the experimental group, 199 in the reference group, and 42 in the control group. Incidence rate ratios were 0.74 (95% CI 0.49 to 1.12) for the experimental group and 0.43 (95% CI 0.25 to 0.75) for the control group compared with the reference group. The Short Physical Performance Battery scores improved significantly in the experimental group (95% CI 0.05 to 0.86; P  = 0.027) and in the reference group (95% CI 0.06 to 0.86; P  = 0.024) compared with the control group. Conclusion The self-administered home-based exercise programme showed the lowest fall incidence rate, but also the highest dropout rate of participants at high risk of falling. Both partially supervised programmes resulted in statistically significant improvements in physical performance compared with the self-administered programme. Trial registration NCT02926105. ClinicalTrials.gov. Date of registration: 06/10/2016.