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Robotic hands perform several amazing functions similar to the human hands, thereby offering high flexibility in terms of the tasks performed. However, developing integrated hands without additional actuation parts while maintaining important functions such as human-level dexterity and grasping force is challenging. The actuation parts make it difficult to integrate these hands into existing robotic arms, thus limiting their applicability. Based on a linkage-driven mechanism, an integrated linkage-driven dexterous anthropomorphic robotic hand called ILDA hand, which integrates all the components required for actuation and sensing and possesses high dexterity, is developed. It has the following features: 15-degree-of-freedom (20 joints), a fingertip force of 34N, compact size (maximum length: 218 mm) without additional parts, low weight of 1.1 kg, and tactile sensing capabilities. Actual manipulation tasks involving tools used in everyday life are performed with the hand mounted on a commercial robot arm. Though robotic hands capable of adaptive grasping have been developed, realizing integrated hands with higher degree of freedom (DOF) movement and technology compatibility remains a challenge. Here, the authors report integrated linkage-driven robotic hand with improved design and performance.

TRACK-HD is a multinational prospective observational study of Huntington's disease (HD) that examines clinical and biological findings of disease progression in individuals with premanifest HD (preHD) and early-stage HD. We aimed to describe phenotypic changes in these participants over 36 months and identify baseline predictors of progression. Individuals without HD but carrying the mutant huntingtin gene (classed as preHD-A if ≥10·8 years and preHD-B if <10·8 years from predicted onset), participants with early HD (classed as HD1 if they had a total functional capacity score of 11–13 and HD2 if they had a score of 7–10), and healthy control individuals were assessed at four study sites in the Netherlands, the UK, France, and Canada. We measured 36-month change for 3T MRI, clinical, cognitive, quantitative motor, and neuropsychiatric assessments and examined their prognostic value. We also assessed the relation between disease progression and the combined effect of CAG repeat length and age. All participants were analysed according to their baseline subgroups. Longitudinal results were analysed using a combination of repeated-measure weighted least squares models and, when examining risk of new diagnosis, survival analysis. At baseline, 366 participants were enrolled between Jan 17, and Aug 26, 2008, and of these 298 completed 36-month follow-up: 97 controls, 58 participants with preHD-A, 46 with preHD-B, 66 with HD1, and 31 with HD2. In the preHD-B group, several quantitative motor and cognitive tasks showed significantly increased rates of decline at 36 months, compared with controls, whereas few had at 24 months. Of the cognitive measures, the symbol digit modality test was especially sensitive (adjusted mean loss 4·11 points [95% CI 1·49–6·73] greater than controls; p=0·003). Among psychiatric indicators, apathy ratings specifically showed significant increases (0·34 points [95% CI 0·02–0·66] greater than controls; p=0·038). There was little evidence of reliable change in non-imaging measures in the preHD-A group, with the exception of the speeded tapping inter-tap interval (0·01 s [95% CI 0·01–0·02] longer than controls; p=0·0001). Several baseline imaging, quantitative motor, and cognitive measures had prognostic value, independent of age and CAG repeat length, for predicting subsequent clinical diagnosis in preHD. Of these, grey-matter volume and inter-tap interval were particularly sensitive (p=0·013 and 0·002, respectively). Longitudinal change in these two measures was also greater in participants with preHD who received a diagnosis of HD during the study compared with those who did not, after controlling for CAG repeat length and age-related risk (p=0·006 and 0·0003, respectively). In early HD, imaging, quantitative motor, and cognitive measures were predictive of decline in total functional capacity and tracked longitudinal change; also, neuropsychiatric changes consistent with frontostriatal pathological abnormalities were associated with this loss of functional capacity (problem behaviours assessment composite behaviour score p<0·0001). Age and CAG repeat length explained variance in longitudinal change of multimodal measures, with the effect more prominent in preHD. We have shown changes in several outcome measures in individuals with preHD over 36 months. These findings further our understanding of HD progression and have implications for clinical trial design. CHDI Foundation.

Resistance exercise effectively improves bone mineral density (BMD) and muscle quality (e.g., muscle mass and muscle strength). The present study aimed to examine the effect of a 24-week resistance exercise training (RT) program on body composition, BMD, functional fitness, and isokinetic muscle strength in obese older women. Forty obese older women were initially enrolled. Among them, 30 participants (age: 80.55 ± 4.94 years; body fat percentage: 36.25 ± 3.44%) completed the study. The participants were randomly assigned into two groups: the RT group (n = 15) and the control (CON) group (n = 15). The RT group participated in the exercise for 60 min per session and two sessions per week for 24 weeks. Pre-test and post-test body composition, BMD, functional fitness, and isokinetic muscle strength were evaluated. The RT group increased significantly in functional fitness (hand grip strength: 1.70 kg, p < 0.01, and lower body strength: 3.87 n, p < 0.001), and isokinetic muscle strength (non-dominant leg extensor peak torque %BW at 60°/s: 13.20%, p < 0.05, dominant leg (DL) flexor peak torque at 60°/s: 3.87 Nm, p < 0.05, and DL flexor peak torque %BW at 60°/s: 7.60%, p < 0.05). However, the CON group showed negative changes in body composition (fat mass: 1.15 kg, p < 0.001, body fat percentage: 1.59%, p < 0.001, and fat-free mass: −0.58 kg, p < 0.05), BMD (whole-body: −0.01 g/cm2, p < 0.001 and forearm: −0.01 g/cm2, p < 0.05), functional fitness (lower body flexibility: −3.23 cm, p < 0.01, upper body strength: −2.06 n, p < 0.01, and agility and dynamic balance: 0.54 s, p < 0.01), and isokinetic muscle strength at 60°/s and 180°/s (all peak torque % body weight variables: −7.31–−1.50, p < 0.05). Our findings show that the CON group negatively affects body composition, BMD, functional fitness, and isokinetic muscle strength in obese older women for 24 weeks.

Summary In this study, we compare the extent to which seven available definitions of sarcopenia and two related definitions predict the rate of falling. Our results suggest that the definitions of Baumgartner and Cruz-Jentoft best predict the rate of falls among sarcopenic versus non-sarcopenic community-dwelling seniors. Introduction The purpose of the study is to compare the extent to which seven available definitions of sarcopenia and two related definitions predict the prospective rate of falling. Methods We studied a cohort of 445 seniors (mean age 71 years, 45 % men) living in the community who were followed with a detailed fall assessment for 3 years. For comparing the rate of falls in sarcopenic versus non-sarcopenic individuals, we used multivariate Poisson regression analyses adjusting for gender and treatment (original intervention tested vitamin D plus calcium against placebo). Of the seven available definitions, three were based on low lean mass alone (Baumgartner, Delmonico 1 and 2) and four required both low muscle mass and decreased performance in a functional test (Fielding, Cruz-Jentoft, Morley, Muscaritoli). The two related definitions were based on low lean mass alone (Studenski 1) and low lean mass contributing to weakness (Studenski 2). Results Among 445 participants, 231 fell, sustaining 514 falls over the 3-year follow-up. The prospective rate of falls in sarcopenic versus non-sarcopenic individuals was best predicted by the Baumgartner definition based on low lean mass alone (RR = 1.54; 95 % CI 1.09–2.18) with 11 % prevalence of sarcopenia and the Cruz-Jentoft definition based on low lean mass plus decreased functional performance (RR = 1.82; 95 % CI 1.24–2.69) with 7.1 % prevalence of sarcopenia. Consistently, fall rate was non-significantly higher in sarcopenic versus non-sarcopenic individuals based on the definitions of Delmonico 1, Fielding, and Morley. Conclusion Among the definitions investigated, the Baumgartner definition and the Cruz-Jentoft definition had the highest validity for predicting the rate of falls.

Abstract Context We compared the efficacy, safety, and effect of 45-day isocaloric very-low-calorie ketogenic diets (VLCKDs) incorporating whey, vegetable, or animal protein on the microbiota in patients with obesity and insulin resistance to test the hypothesis that protein source may modulate the response to VLCKD interventions. Subjects and Methods Forty-eight patients with obesity (19 males and 29 females, homeostatic model assessment (HOMA) index ≥ 2.5, aged 56.2 ± 6.1 years, body mass index [BMI] 35.9 ± 4.1 kg/m2) were randomly assigned to three 45-day isocaloric VLCKD regimens (≤800 kcal/day) containing whey, plant, or animal protein. Anthropometric indexes; blood and urine chemistry, including parameters of kidney, liver, glucose, and lipid metabolism; body composition; muscle strength; and taxonomic composition of the gut microbiome were assessed. Adverse events were also recorded. Results Body weight, BMI, blood pressure, waist circumference, HOMA index, insulin, and total and low-density lipoprotein cholesterol decreased in all patients. Patients who consumed whey protein had a more pronounced improvement in muscle strength. The markers of renal function worsened slightly in the animal protein group. A decrease in the relative abundance of Firmicutes and an increase in Bacteroidetes were observed after the consumption of VLCKDs. This pattern was less pronounced in patients consuming animal protein. Conclusions VLCKDs led to significant weight loss and a striking improvement in metabolic parameters over a 45-day period. VLCKDs based on whey or vegetable protein have a safer profile and result in a healthier microbiota composition than those containing animal proteins. VLCKDs incorporating whey protein are more effective in maintaining muscle performance.

IntroductionThe application of blood flow restriction (BFR) to low-intensity exercise may be able to increase strength not only in the trained limb but also in the homologous untrained limb. Whether this effect is repeatable and how that change compares to that observed with higher intensity exercise is unknown.PurposeExamine whether low-intensity training with BFR enhances the cross-education of strength compared to exercise without BFR and maximal efforts.MethodsA total of 179 participants completed the 6-week study, with 135 individuals performing isometric handgrip training over 18 sessions. Participants were randomly assigned to one of four groups: 1) low-intensity (4 × 2 min of 30% MVC; LI, n = 47), 2) low-intensity with blood flow restriction (LI + 50% arterial occlusion pressure; LI-BFR, n = 41), 3) maximal effort (4 × 5 s of 100% MVC; MAX, n = 47), and 4) non-exercise control (CON, n = 44).ResultsLI-BFR was the only group that observed a cross-education in strength (CON: 0.64 SD 2.9 kg, LI: 0.95 SD 3.6 kg, BFR-LI: 2.7 SD 3.3 kg, MAX: 0.80 SD 3.1 kg). In the trained hand, MAX observed the greatest change in strength (4.8 SD 3.3 kg) followed by LI-BFR (2.8 SD 4.0 kg). LI was not different from CON. Muscle thickness did not change in the untrained arm, but ulna muscle thickness was increased within the trained arm of the LI-BFR group (0.06 SD 0.11 cm).ConclusionIncorporating BFR into low-intensity isometric training led to a cross-education effect on strength that was greater than all other groups (including high-intensity training).

AbstractObjectiveTo assess the effect of electrically heated mittens on physical hand function in people with osteoarthritis of the hands compared with control mittens.DesignRandomised controlled trial.SettingOsteoarthritis outpatient clinic, Copenhagen, Denmark.Participants200 people with hand osteoarthritis aged 42-90 years. 100 participants were assigned to the intervention group and 100 to the control group.InterventionsElectrically heated mittens or control mittens (heating elements disconnected) worn for at least 15 minutes daily for six weeks.Main outcome measuresThe primary outcome was change in hand function measured on the function subscale of the Australian/Canadian hand osteoarthritis index (AUSCAN; score 0-100 points) at six weeks. Key secondary outcomes included changes in the AUSCAN hand pain subscale (score 0-100 points), global rating of hand osteoarthritis related problems (0-100 visual analogue scale), and grip strength (newtons) at six weeks. Analysis of secondary outcomes was performed using a hierarchical gatekeeping approach.Results91 participants in the intervention group and 95 in the control group completed the trial. The mean age of participants was 71 years, 87% (n=173) were women, and mean body mass index was 24.9 (SD 4.4). Median disease duration was 10 years (interquartile range 5-15 years). The between group difference for change in AUSCAN function at week 6 was 3.0 points (95% confidence interval (CI) −0.4 to 6.3; P=0.09) in favour of heated mittens. For the key secondary outcome, change in AUSCAN hand pain score from baseline, a group difference was observed of 5.9 points (95% CI 2.2 to 9.5) in favour of heated mittens. Changes in global rating of hand osteoarthritis related problems and grip strength did not differ between the groups with an observed difference between groups of 2.8 points (95% CI −3.7 to 9.2) and 2.3 newtons (95% CI −16.3 to 21.0) in favour of heated mittens, respectively.ConclusionUse of electrically heated mittens for six weeks was not related to a positive change in physical hand function compared with control mittens. Heated mittens provided no additional benefits on global rating of hand osteoarthritis related problems and grip strength. A small benefit was detected for hand pain, but this could have been overestimated.Trial registrationClinicalTrials.gov NCT04576403.

Sarcopenia a recognised geriatric syndrome. This study aims to evaluate the prevalence of possible sarcopenia, sarcopenia and severe sarcopenia among older Chinese adults and to identify any associated factors for possible sarcopenia according to the updated diagnostic criteria of the Asian Working Group for Sarcopenia 2019 (AWGS 2019). We used data from the China Health and Retirement Longitudinal Study (CHARLS). The main outcome of this study was possible sarcopenia. Handgrip strength was measured via a dynamometer. The muscle mass was estimated by anthropometric measures. Physical performance was measured by 5-time chair stand test and gait speed test. A multivariate logistic regression model with stepwise method was employed to identify factors associated with possible sarcopenia. A total of 6172 participants aged 60–94 years were included. The prevalence of possible sarcopenia, sarcopenia and severe sarcopenia was 38.5%, 18.6%, and 8.0%, respectively. Age, rural area, falls, higher C-reactive protein (CRP), and chronic diseases (including hypertension, chronic lung diseases, heart disease, psychiatric disease and arthritis) were associated with a higher risk of possible sarcopenia. Conversely, alcohol consumption, higher gait speed and high levels of hemoglobin were associated with decreased risk of possible sarcopenia. However, the associations between possible sarcopenia with alcohol consumption, heart disease, psychiatric disease and hemoglobin were not significant after Bonferroni correction. Our study reported a relatively high prevalence of sarcopenia among older Chinese population, and identified a range of factors associated with sarcopenia. We also found rural elders are more vulnerable to sarcopenia than urban elders. Additionally, we discovered systemic inflammation might be one of the contributing factors between sarcopenia and related comorbidities. We believe the findings of this study would help to identify individuals at high risk of sarcopenia early and therefore implement the prevention and treatment strategies to reduce the disease burden in China.

Sarcopenia is recognized as a major public health concern because of its association with several adverse health events. Beta-hydroxy-beta-methylbutyrate (HMB) supplementation reportedly delays the loss of muscle mass and function; however, the effect of HMB on sarcopenia remains inconclusive. We aimed to evaluate the impact of HMB intervention on muscle strength, physical performance, body compositions, and inflammatory factors in older adults with sarcopenia. Randomized, double-blind, placebo-controlled trial. This study included subjects aged ≥60 years with sarcopenia which were assigned to the HMB group (HMBG, n=18) and the placebo group (PG, n=16). The HMBG and PG were supplied with HMB and placebo products twice daily for 12 weeks, and both received resistance exercise training twice a week in 12 weeks. Hand grip strength was selected as the primary outcome; gait speed, five-time chair stand test, body composition and inflammatory indicators were selected as the secondary outcomes. The differences in changes from baseline between the two groups were analyzed using the analysis of covariance(ANCOVA). After the 12-week intervention, the HMBG demonstrated significantly greater improvements in handgrip strength (4.61(95%CI:2.93,6.28) kg, P<0.001), gait speed (0.11(95%CI:0.02,0.20)m/s, P=0.014), five-time chair stand test (−3.65 (95%CI:−5.72, −1.58)s, P=0.001), muscle quality (2.47(95%CI:1.15,3.80),kg·kg−1 P=0.001) and tumor necrosis factorlike weak inducer of apoptosis (−15.23(95%CI:−29.80,−0.66)pmol/mL, P=0.041) compared with the PG; no significant differences in skeletal muscle mass, skeletal muscle index, and other body composition parameters were found between the two groups. In older adults with sarcopenia, HMB significantly enhance the effect of resistance exercise training on muscle strength, physical performance, muscle quality, and reduced inflammatory factors. Therefore, HMB supplementation could be an effective treatment for sarcorpenia. The trial protocol was registered at http://www.chictr.org.cn/showproj.aspx?proj=47571 as ChiCTR2000028778.

Strength training is a form of healthy ageing in older women. Although recommendations currently exist, some are very broad or fail to cover the needs of aging. Therefore, the purpose of this study was to analyze the effects of blocks strength training based on age-related functional consequences on functional performance in older adult women. 82 community-dwelling older women (70.17 ± 6.04 y) were randomly assigned to either experimental (n = 40) or control (n = 42) group. Experimental group performed a Block Strength Training (BST) program based on strength, power, and muscular endurance, and different level of effort for 9 weeks, and control maintained daily routine with physical activity recommendations. Functional performance was assessed using absolute handgrip strength [AHS], timed up and go [TUG], two-minutes step test [2MST], five times stand-to-sit test [5-SST], 6-m walking speed test [6-WS] pre-post intervention. Statistical analyses were performed using two-way ANOVA (Time*Group) and effect size (partial eta-squared, ŋ P2 ) with a significance level of p  < 0.05. BST improved functional performance in the protocols of AHS (21.51 vs. 23.07-kg; + 7%), TUG (8.22 vs. 7.29-sec; + 11%), 2MST (78.76 vs. 97.18-steps; + 23%), 5-SST (12.68 vs. 9.43-sec; + 26%), and 6-WS (1.16 vs. 1.36- m·s -1 ; + 17%) compared to control (19.31 vs. 19.66-kg; 8.94 vs. 9.26-sec; 62.68 vs. 63.73-steps; 13.99 vs. 14.25-sec; 1.06 vs. 1.06-m·s -1 , respectively) in a Time*Group interaction effect ( p  < 0.01; ŋ P2   > 0.11). This BST is effective in improving overall functional performance and thus reducing the risk of physical frailty in community-dwelling older women. These findings strengthen the approach to exercise programming over recommendations, moving toward effective precision dosing for older adults.