Comparison of Effect of Two Exercise Programs on Activities of Daily Living in Individuals with Dementia: A 9-Week Randomized, Controlled Trial. Incidence of and predictors for chronic disability in activities of daily living among older people in Taiwan. Physiological Cost Index and Comfort Walking Speed in Two Level Lower Limb Amputees Having No Vascular Disease Energy expenditure and walking speed in lower limb amputees: a cross sectional study. Effects of Constraint-Induced Therapy Versus Bilateral Arm Training on Motor Performance, Daily Functions, and Quality of Life in Stroke Survivors A "client-centred activities of daily living" intervention for persons with stroke: One-year follow-up of a randomized controlled trial. Instrumental activities of daily living related to impairments and functional limitations in 70-year-olds and changes between 70 and 76 years of age. Physical activity is associated with incident disability in community-based older persons. Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Activities of daily living function and disability in older adults in a randomized trial of the health enhancement program. Improved functional ability and independence in activities of daily living for older adults at high risk of hospital readmission: a randomized controlled trial. Upper- versus lower-limb aerobic exercise training on health-related quality of life in patients with symptomatic peripheral arterial disease. Clinical outcome and its predictors in 1560 patients with critical leg ischaemia. Chronic Critical Leg Ischaemia Group. Embedding sustainable physical activities into the everyday lives of adults with intellectual disabilities: a randomised controlled trial Effect of fenofibrate on amputation events in people with type 2 diabetes mellitus (FIELD study): a prespecified analysis of a randomised controlled trial Objectively assessed physical activity and lower limb function and prospective associations with mortality and newly diagnosed disease in UK older adults: an OPAL four-year follow-up study Community Weight Loss to Combat Obesity and Disability in At-Risk Older Adults
OBJECTIVES To compare the effects of two exercise programs on proxy- and performance-based measures of activities of daily living ( ADLs ) and to explore potential motor and cognitive mediators underlying ADL improvements in individuals with dementia . DESIGN A parallel , three-group , single-blind , r and omized , controlled trial . SETTING Psychogeriatric wards . PARTICIPANTS Individuals with dementia ( mean age 85.6 ± 5.1 ) . INTERVENTIONS Each 9-week intervention consisted of thirty-six 30-minute sessions . A combined group ( n = 35 ) participated in two strength and two walking sessions , an aerobic group ( n = 35 ) participated in four walking sessions , and a social control group ( n = 35 ) participated in four nonexercise social visits per week . The social group was used as a reference for the mediation analysis , which was performed in the combined and aerobic groups . MEASUREMENTS ADLs were assessed using the Katz index ( proxy-reported ADL performance ) , Erlangen-ADL test ( E-ADL ) ( instrumental ADL performance ) , and 7-item Physical Performance Test ( PPT-7 ) ( physical ADL performance ) . RESULTS There was a group effect for Katz index ( P = .02 ) , E-ADL ( P < .001 ) , and PPT-7 ( P = .003 ) . Differences from baseline to after the intervention were similar in the combined and aerobic groups . Exercise-induced changes in global cognition mediated changes in Katz index ( 95 % confidence interval ( CI ) = 0.05 - 0.41 ) , leg muscle strength mediated changes in E-ADL ( 95 % CI = 0.03 - 0.43 ) , and leg muscle strength ( 95 % CI = 0.01 - 0.36 ) and walking endurance ( 95 % CI = 0.01 - 0.43 ) mediated changes in PPT-7 only in the combined group . CONCLUSION Physical exercise can improve ADL levels in individuals with dementia , but improvements are small and seem independent of exercise type . Additional analyses suggest that combined aerobic and strength exercise may be more effective than aerobic-only exercise to effectively target ADL dysfunction in individuals with dementia . Future research is warranted to justify these exercise-specific findings OBJECTIVES To estimate the incidence of chronic activities of daily living ( ADL ) disability and to analyze the sociodemographic , health status , adverse lifestyle , and leisure-time physical activity predictors for chronic ADL disability . DESIGN We recruited a cohort of community-dwelling older people in Taipei , Taiwan , who were not ADL disabled in August 1993 , and we followed them until August 1996 . SETTING S AND PARTICIPANTS The study subjects were 1321 community-dwelling people aged 65 years or older who were ADL intact at the initial interview in August 1993 . The study sample was a subset of a probability sample ( n = 1583 ) r and omly selected from household registration s in the four districts of the Taipei metropolitan area . MEASUREMENTS Baseline information regarding various factors potentially associated with the development of chronic ADL disability was assessed and collected at the beginning of the study . Study participants were assessed annually for ADL function by a structured home interview using a six-item scale . Participants who were unable to perform independently at least one of the six items -- eating , bathing , dressing , toileting ,  transfers , and walking inside the house -- for more than 3 months were considered chronically ADL disabled . Cox proportional hazard regression models were utilized to examine the independent effect of the potential predictors on risk of chronic ADL disability . RESULTS During the 3-year study period , 145 ( 11.0 % ) participants developed chronic ADL disability , 58 ( 4.4 % ) participants were lost to follow-up , and 83 ( 6.3 % ) participants died . Multiple hazard regression analysis showed that individuals aged 70 to 79 years or older than age 80 had increased risk of ADL disability ( relative risk : 2.05 ( 95 % confidence interval ( CI ) , 1.35 - 3.11 ) and 3.89 ( 95%CI , 2.33 - 6.50 ) , respectively ) compared with those participants younger than age 70 . Risk of chronic ADL disability was inversely associated with routine exercise ( RR = 0.52 ; 95 % CI , 0.39 - 0.68 ) . CONCLUSIONS Age is the most significant predictor of chronic ADL disability . Lack of routine exercise is also a significant predictor of ADL disability in older adults Background : The Physiological Cost Index  ( PCI ) was introduced by MacGregor to estimate the energy cost in walking of healthy people , also it has been reported for persons with lower limb amputation , walking with prosthesis . Objective : To assess energy cost and walking speed in two level lower limb amputation : transfemoral and transtibial amputation  and to determine if the age and prosthetic walking supported with walking aids have impact on energy cost and walking speed . Methods : A prospect i ve cross sectional study was performed in two level lower limb amputees with no vascular disease who were rehabilitated at the Department of Prosthetics and Orthotics at the University Clinical Center of Kosovo . The  Physiological Cost Index ( PCI )  was assessed by five minutes of continuous indoor walking at Comfort Walking Speed ( CWS ) . Results : Eighty three lower limb amputees were recruited . It is shown relevant impact of level of amputation in PCI ( t=6.8 , p<0.001 ) and CWS ( T=487 , p<0.001 ) . The great influence of using crutches during prosthetic walking in  PCI  ( ANOVA F= 39.5 P < 0.001 ) and CWS ( ANOVA F=32.01 , P < 0.001 ) has been shown by One Way ANOVA test . The correlation coefficient ( R ) showed a significant correlation of age with PCI and CWS in both groups of amputation . Conclusions : Walking with transfemoral prosthesis or using walking aids during prosthetic ambulation is matched with higher cost of energy and slower walking speed . Advanced age was shown with high impact on PCI and CWS in both groups of amputees BACKGROUND Energy expenditure and walking speed are generally recommended for use as measures of status and outcome for walking . The objective of this study was to measure the  physiological cost index ( PCI ) and  comfort walking speed ( CWS )  at three levels of lower limb amputation : transfemoral , transtibial and Syme level , and the relationship of these physiological variables to prosthetic ambulation supported with walking aids and stump length . MATERIAL AND METHODS This study was a prospect i ve cross-sectional study .Eighty-nine individuals with lower limb amputation for reasons other than peripheral vascular disease ( PVD ) were recruited among patients at the Department of Prosthetics and Orthotics in University Clinical Center of Kosovo .  PCI  was assessed by five minutes of continuous indoor walking at CWS . RESULTS Significant differences were found in PCI ( F=29.87 , P < 0.001 ) and CWS ( F=19.33 , P < 0.001 ) among the three amputation groups . Prosthetic ambulation supported with crutches showed an important impact on PCI ( F=35.1 , P < 0.001 ) and CWS ( F=28.42 , P < 0.001 ) . Stump length was associated with significantly increased PCI ( r=0.53 , P = 0.02 ) and reduced CWS ( r=0.58 , P = 0.004 ) in transfemoral amputees . CONCLUSIONS 1 . A higher level of amputation is associated with less energy-efficient walking and with lower walking speed . 2 . Prosthetic ambulation supported with crutches has significant impact on increasing of energy expenditure and decreasing walking speed . 3 . Stump length is shown to have a major impact on PCI and CWS in transfemoral amputees Background and Objective . This study investigated the relative effects of distributed constraint-induced therapy ( CIT ) and bilateral arm training ( BAT ) on motor performance , daily function , functional use of the affected arm , and quality of life in patients with hemiparetic stroke . Methods . A total of 60 patients were r and omized to  distributed CIT , BAT , or a control intervention of less specific but active therapy . Each group received intensive training for 2 hours/day , 5 days/week , for 3 weeks . Pretreatment and posttreatment measures included the Fugl — Meyer Assessment ( FMA ) , Functional Independence Measure ( FIM ) , Motor Activity Log ( MAL ) , and Stroke Impact Scale ( SIS ) . The proximal and distal scores of FMA were used to examine separate upper limb ( UL ) elements of movement . Results . The distributed CIT and BAT groups showed better performance in the overall and the distal part score of the FMA than the control group . The BAT group exhibited greater gains in the proximal part score of the FMA than the distributed CIT and control groups . Enhanced performance was found for the distributed CIT group in the MAL , the subtest of locomotion in the FIM , and certain domains of the SIS ( eg , ADL/IADL ) . Conclusion . BAT may uniquely improve proximal UL motor impairment . In contrast , distributed CIT may produce greater functional gains for the affected UL in subjects with mild to moderate chronic hemiparesis OBJECTIVE To compare changes regarding perceived participation , independence in activities of daily living ( ADL ) and life satisfaction between 3 , 6 and 12 months after inclusion in a study of a client-centred ADL intervention and usual ADL intervention after stroke . DESIGN A multicentre r and omized controlled trial . METHODS Sixteen rehabilitation units were r and omly assigned to provide client-centred ADL intervention or usual ADL intervention .  Eligible participants were persons ≤ 3 months after stroke who had been treated in a stroke unit , were dependent in two ADL domains , had not been diagnosed with dementia , and were able to underst and instructions . Data collection was performed by blinded assessors . The primary outcome , perceived participation , was assessed with the Stroke Impact Scale 3.0 , domain 8 . The secondary outcomes , participation , independence in ADL , and life satisfaction , were assessed with vali date d instruments . For statistical power , 280 participants were required . Statistical analyses were performed on an intention-to-treat basis . RESULTS There were no differences between the groups regarding changes in perceived participation , independence in ADL , or life satisfaction during the first 12 months . There was a trend towards a clinical ly meaningful positive change in perceived participation that favoured client-centred ADL intervention . CONCLUSION Further research is required to underst and the benefits of client-centred interventions The aim of this study was to analyse in particular dependence in instrumental daily life activities ( I-ADLs ) and its association with physical impairments and functional limitations in the elderly . The study was based on cross-sectional data on 70-year-olds ( n = 602 ) and longitudinal data on subjects followed up to the age of 76 ( n = 371 ) . Persons dependent in ADL  had lower values in maximum walking speed , grip strength , knee extensor strength , stair climbing capacity and in forward reach , compared with those who were independent in ADL .  Walking speed in both women and men and sight impairment in men had the greatest influence on dependence in ADL . Possible critical levels for disability in ADL are discussed , as persons who developed dependence between 70 and 76 already had a lower capacity in walking speed and knee extensor strength at age 70 than persons who retained their independence in ADL OBJECTIVES To examine the association between physical activity and the risk of incident disability , including impairment in activities of daily living ( ADLs ) and instrumental activities of daily living ( IADLs ) , in community-based older persons free of dementia . DESIGN Prospect i ve , observational cohort study . SETTING Approximately 40 retirement communities across the Chicago metropolitan area . PARTICIPANTS More than 1,000 older persons from the Rush Memory and Aging Project , an ongoing longitudinal clinical -pathological study of common chronic conditions of old age . MEASUREMENTS All participants underwent detailed annual clinical evaluations that included assessment s of  physical activity , ADLs , IADLs , and gait performance . The associations between  physical activity , mortality , and incident disability were examined using a series of Cox proportional hazards models controlled for age , sex , education , and baseline gait . RESULTS At baseline , participants spent a mean+/-st and ard deviation of 3.0+/-3.5 hours per week engaging in physical activity ( range 0 - 35 ) . In a proportional hazards model , the risk of death decreased 11 % ( hazard ratio (HR)=0.89 , 95 % confidence interval (CI)=0.83 - 0.95 ) for each additional hour of physical activity per week . For those who were not disabled at baseline , the risk of developing disability in ADLs decreased 7 % ( HR=0.93 , 95 % CI=0.88 - 0.98 ) for each additional hour of physical activity per week . Similarly , the risk of disability in IADLs decreased 7 % ( HR=0.93 , 95 % CI=0.89 - 0.99 ) for each additional hour of physical activity . CONCLUSION For community-based older persons without dementia , physical activity is associated with maintenance of functional status , including a reduced risk of developing impairment in ADLs and IADLs BACKGROUND The prevention of disability in activities of daily living ( ADL ) may prolong older persons ' autonomy ( older persons are defined in this study as those aged > or = 60 years ) . However , proved preventive strategies for ADL disability are lacking . A sedentary lifestyle is an important cause of disability . This study examines whether an exercise program can prevent ADL disability . METHODS A 2-center , r and omized , single-blind , controlled trial was conducted in which participants were assigned to an aerobic exercise program , a resistance exercise program , or an attention control group .  Of the 439 community-dwelling persons aged 60 years or older with knee osteoarthritis originally recruited , the 250 participants initially free of ADL disability were used for this study .  Incident ADL disability , defined as developing difficulty in transferring from a bed to a chair , eating , dressing , using the toilet , or bathing , was assessed quarterly during 18 months of follow-up . RESULTS The cumulative incidence of ADL disability was lower in the exercise groups ( 37.1 % ) than in the attention control group ( 52.5 % ) ( P = .02 ) . After adjustment for demographics and baseline physical function , the relative risk of incident ADL disability for assignment to exercise was 0.57 ( 95 % confidence interval , 0.38 - 0.85 ; P = .006 ) . Both exercise programs prevented ADL disability ; the relative risks were 0.60 ( 95 % confidence interval , 0.38 - 0.97 ; P = .04 ) for resistance exercise and 0.53 ( 95 % confidence interval , 0.33 - 0.85 ; P = .009 ) for aerobic exercise . The lowest ADL disability risks were found for participants with the highest compliance to exercise . CONCLUSIONS Aerobic and resistance exercise may reduce the incidence of ADL disability in older persons with knee osteoarthritis .  Exercise may be an effective strategy for preventing ADL disability and , consequently , may prolong older persons ' autonomy BACKGROUND Disability in basic activities of daily living ( ADLs ) implies a loss of independence and increases the risk for hospitalization , nursing home admission , and death . Little is known about ways by which ADL disability can be prevented or reversed . The authors evaluated the efficacy of the Health Enhancement Program in preventing and reducing ADL disability in community-dwelling older adults . METHODS The authors analyzed data from a 12-month , r and omized , single-blinded , controlled trial of a  disability prevention , chronic disease self-management program involving 201 adults aged 70 years and older that was conducted from February 1995 to June 1996 at a senior center in western Washington state .  Activities of daily living disability incidence , improvement , and worsening were assessed using intention-to-treat methods . RESULTS The cumulative incidence of ADL disability among those who were not ADL disabled at baseline ( n = 56 in the intervention group , n = 57 in the control group ) was modestly lower in the intervention group than in the control group at 12 months ( 14.3 % vs 21.3 % , p = .466 ) . Cumulative improvement in ADL function among those who reported any ADL disability at baseline ( n = 41 in the intervention group , n = 43 in the control group ) was greater in the intervention group at 12 months ( 80.5 % vs 46.5 % , p = .026 ) . The likelihood for ADL improvement was greater in the intervention group compared with controls at 12 months ( adjusted hazard ratio , 1.84 ; 95 % confidence interval , 1.05 to 3.22 ; p = .020 ) . Cumulative worsening of ADL function was slightly lower in the intervention group at 12 months ( 18.6 % vs 26.5 % , p = .237 ) . Intervention participants tended to be at lower risk for ADL worsening ( adjusted hazard ratio , 0.71 ; 95 % confidence interval , 0.38 to 1.30 ; p = .266 ) compared with control participants . CONCLUSION The Health Enhancement Program intervention led to improved ADL functioning  in those who were disabled initially and thereby offers a promising strategy for limiting or reversing functional decline in disabled elderly persons OBJECTIVE During hospitalization older people often experience functional decline which impacts on their future independence . The objective of this study was to evaluate a multifaceted transitional care intervention including home-based exercise strategies for at-risk older people on functional status , independence in activities of daily living ( ADLs ) and walking ability . METHODS A r and omized controlled trial was undertaken in a metropolitan hospital in Australia with 128 patients ( 64 intervention , 64 control ) aged over 65 years with an acute medical admission and at least one risk factor for hospital readmission . The intervention group received an individually tailored programme for exercise and follow-up care which was commenced in hospital and included regular visits in hospital by a physiotherapist and a registered nurse , a home visit following discharge and regular telephone follow-up for 24 weeks following discharge . The programme was design ed to improve health-promoting behaviours , strength , stability , endurance and mobility . Data were collected at baseline , then 4 , 12 and 24 weeks following discharge using the Index of ADL , Instrumental Activities of Daily Living ( IADL ) and the Walking Impairment Question naire ( WIQ ; modified ) . RESULTS Significant improvements were found in the intervention group in IADL scores ( P < 0.001 ) , ADL scores ( P < 0.001 ) and WIQ scale scores ( P < 0.001 ) in comparison to the control group . The greatest improvements were found in the first 4 weeks following discharge . CONCLUSIONS Early introduction of a transitional model of care incorporating a tailored exercise programme and regular telephone follow-up for hospitalized at-risk older adults can improve independence and functional ability OBJECTIVE This r and omized controlled trial investigated the effects of upper- and lower-limb aerobic exercise training on disease-specific functional status and generic health-related quality of life ( QOL ) in patients with intermittent claudication . METHODS The study recruited 104 patients ( mean age , 68 years ; range , 50 - 85 ) from the Sheffield Vascular Institute . Patients were r and omly allocated to groups that received upper-limb ( ULG ) or lower-limb ( LLG ) aerobic exercise training , or to a nonexercise control group . Exercise was performed twice weekly for 24 weeks at equivalent limb-specific relative exercise intensities . Main outcome measures were scores on the Walking Impairment Question naire ( WIQ ) for disease-specific functional status , the Medical Outcomes Study Short Form version 2 ( SF-36v2 ) , and European Quality of Life Visual Analog Scale ( EQ-VAS ) for health-related QOL . Outcomes were assessed at baseline , and at 6 , 24 , 48 , and 72 weeks . RESULTS After 6 weeks , improvements in the perceived severity of claudication ( P = .023 ) and stair climbing ability ( P = .011 ) vs controls were observed in the ULG , and an improvement in the general health domain of the SF-36v2 vs controls was observed in the LLG ( P = .010 ) . After 24 weeks , all four WIQ domains were improved in the ULG vs controls ( P ≤ .05 ) , and three of the four WIQ domains were improved in the LLG ( P < .05 ) . After 24 to 72 weeks of follow-up , more consistent changes in generic health-related QOL domains were apparent in the ULG . CONCLUSIONS These findings support the use of alternative , relatively pain-free forms of exercise in the clinical management of patients with intermittent claudication OBJECTIVE to assess the predictivity of clinical variables in patients with chronic critical leg ischaemia ( CLI ) . Design observational prospect i ve cohort study . METHODS the i.c.a.i . ( ischemia critica degli arti inferiori ) trial data base was used to assess the impact of patients ' history , cardiovascular risk , manifestations of the disease and specific invasive and pharmacological interventions on mortality , amputation rate and persistence of CLI . RESULTS of 1560 patients , 298 died within one year ; at six months 187 were amputees and 746 still suffered from CLI . Prior major vascular events doubled the risk of dying within one year . Previous revascularisation was associated with a lower mortality , but also with a higher probability of amputation . Among cardiovascular risk factors , only diabetes affected prognosis , in terms of increased mortality and lower probability of recovery from CLI .  Patients with tissue loss had a higher amputation rate and less probability of recovery . Ankle pressure was predictive of mortality and amputation only when unmeasurable . Patients requiring revascularisation had better chances of recovering from CLI , but not of longer-term survival or limb salvage compared to those in whom surgery was deemed unnecessary . Antiplatelet drugs caused resolution of CLI and decreased the amputation rate by about 1/3 , while the advantage of the test treatment ( alprostadil-alpha-cyclodextrine ) was confined to CLI resolution only . CONCLUSIONS this study documents the high mortality and heterogeneity of patients with CLI . It provides stratification criteria for reliably estimating the achievable benefit in routine practice and for clinical trials Background Adults with intellectual disability ( ID ) are physically very inactive . This study will compare two approaches to increasing physical activity in adults with ID : a lifestyle physical activity ( light-moderate intensity ) approach and a structured exercise ( moderate-vigorous intensity ) approach . The trial will compare the short-term ( 3-month ) and long-term ( 9-month ) outcomes and sustainability of each approach with a usual-care control group . Methods / Design A three-arm r and omised controlled trial ( RCT ) will be conducted . Ninety adults with ID aged 18 - 55 will be r and omly assigned to one of three groups : 1 ) a lifestyle physical activity group ( n = 30 ) , 2 ) a structured exercise group ( n = 30 ) , or 3 ) a usual care control group ( n = 30 ) . Participants in both groups will receive a 12-week intervention delivered by exercise specialists in the community with disability service staff , after which intervention will continue for 6 months , delivered by disability service staff only . Primary outcomes are aerobic fitness , 12-hour energy expenditure , and proxy-reported everyday physical activity . Secondary outcomes include objective ly assessed physical activity and sedentary behaviour , intervention compliance , functional walking capacity , participation in domestic activities , muscle strength , body composition , psychosocial outcomes , quality of life and health care costs . Discussion The trial results will determine the effectiveness and sustainability of two approaches to increasing physical activity and exercise among adults with ID.Trial registration IS RCT N77889248 ( 18 April 2012 ) Summary Background Amputations in people with type 2 diabetes mellitus substantially impair their quality of life and impose high costs on health-care systems . Our aim was to assess the effect of fenofibrate on amputation events in a large cohort of patients with type 2 diabetes . Methods In the Fenofibrate Intervention and Event Lowering in Diabetes ( FIELD ) study , 9795 patients aged 50–75 years with type 2 diabetes were r and omly assigned by computer-generated r and omisation sequence to receive fenofibrate 200 mg per day ( n=4895 ) or matching placebo ( n=4900 ) for 5 years ' duration . Information about non-traumatic amputation — a prespecified tertiary endpoint of the study —was routinely gathered . Clinicians who were masked to treatment allocation adjudicated amputations as minor or major ( below or above the ankle , respectively ) . Amputations were also classified on the basis of whether or not large-vessel disease was present in the limb , to distinguish those related to large-artery atherosclerosis from those predominantly related to microvascular disease . Analysis was by intention to treat ( ITT ) . The FIELD study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N64783481 . Findings All 9795 patients were included in the ITT population . 115 patients had one or more non-traumatic lower-limb amputations due to diabetes .  Previous cardiovascular disease , microvascular disease , previous non-traumatic amputation or skin ulcer , smoking , and longer duration of diabetes were more frequent in patients who had amputations during the trial than in those who had other cardiovascular events or in those who had neither event ( all p<0·001 for three-way comparison ) . Mean lipid concentrations differed between patients who had on- study amputations and those who had other cardiovascular events or neither event , but by no more than 0·2 mmol/L. The risks of first amputation ( 45 vs 70 events ; hazard ratio [ HR ] 0·64 , 95 % CI 0·44–0·94 ; p=0·02 ) and minor amputation events without known large-vessel disease ( 18 vs 34 events ; 0·53 , 0·30–0·94 ; p=0·027 ) were lower for patients assigned to fenofibrate than for patients assigned to placebo , with no difference between groups in risk of major amputations ( 24 vs 26 events ; 0·93 , 0·53–1·62 ; p=0·79 ) . Interpretation Classic markers of macrovascular and microvascular risk were associated with lower extremity amputations in patients with type 2 diabetes . Treatment with fenofibrate was associated with a lower risk of amputations , particularly minor amputations without known large-vessel disease , probably through non-lipid mechanisms . These findings could lead to a change in st and ard treatment for the prevention of diabetes-related lower-limb amputations . Funding Laboratoires Fournier SA ( now part of Solvay Pharmaceuticals ) and National Health and Medical Research Council of Australia Background : objective measures of physical activity and function with a diverse cohort of UK adults in their 70s and 80s were used to investigate relative risk of all-cause mortality and diagnoses of new diseases over a 4-year period . Participants : two hundred and forty older adults were r and omly recruited from 12 general practice s in urban and suburban areas of a city in the United Kingdom . Follow-up included 213 of the baseline sample . Methods : socio-demographic variables , height and weight , and self-reported diagnosed diseases were recorded at baseline . Seven-day accelerometry was used to assess total physical activity , moderate-to-vigorous activity and sedentary time . A log recorded trips from home .  Lower limb function was assessed using the Short Physical Performance Battery . Medical records were accessed on average 50 months post baseline , when new diseases and deaths were recorded . Analyses : ANOVAs were used to assess socio-demographic , physical activity and lower limb function group differences in diseases at baseline and new diseases during follow-up . Regression models were constructed to assess the prospect i ve associations between physical activity and function with mortality and new disease . Results : for every 1,000 steps walked per day , the risk of mortality was 36 % lower ( hazard ratios 0.64 , 95 % confidence interval ( CI ) 0.44–0.91 , P = 0.013 ) . Low levels of moderate-to-vigorous physical activity ( incident rate ratio ( IRR ) 1.67 , 95 % CI 1.04–2.68 , P = 0.030 ) and low frequency of trips from home ( IRR 1.41 , 95 % CI 0.98–2.05 , P = 0.045 ) were associated with diagnoses of more new diseases . Conclusion : physical activity should be supported for adults in their 70s and 80s , as it is associated with reduced risk of mortality and new disease development Background Among older , overweight , and obese adults with either cardiovascular disease or the metabolic syndrome , reduced mobility and loss of leg strength are important risk factors for morbidity , disability , and mortality . It is unclear whether community-based approaches to weight loss may be an effective solution to this public health challenge . Methods An 18-month three-site , r and omized controlled trial conducted by YMCA staff , with blinded assessors , enrolled 249 older , overweight , and obese adults with either cardiovascular disease or metabolic syndrome with r and omization to three interventions : weight loss alone ( WL ) , weight loss + aerobic training ( WL + AT ) , and weight loss + resistance training ( WT + RT ) . The dual primary outcomes were 400-m walk time in seconds and knee extensor strength in Newton meters . Results All groups lost weight from baseline : average baseline adjusted change of -6.1 % ( 95 % confidence interval [ CI ] : -7.5 to -4.7 ) for WL only , -8.6 % ( 95 % CI : -10.0 to -7.2 ) for WL + AT , and -9.7 % ( 95 % CI : -11.1 to -8.4 ) for WL + RT . Combined , the two physical activity + WL training groups had greater improvement in walk time than WL alone ( mean difference 16.9 seconds [ 95 % CI : 9.7 to 24.0 ] , p < .0001 ) . Baseline adjusted change in knee extensor strength was no greater with WL + RT than WL + AT ( mean difference -3.6 Nm [ 95 % CI : -7.5 to 0.3 ] , p = .07 ) . Conclusions At risk , older , overweight and obese adults can achieve clinical ly significant reductions in body weight with community-based weight loss programs . The change in percent weight loss and improvements in mobility are significantly enhanced when either RT or AT is combined with dietary WL
During walking , oxygen consumption ( ml O2/kg/min ) and heart rate ( beats/min ) increased with a higher walking speed and a more proximal amputation .
During walking , oxygen consumption ( ml O2/kg/min ) and heart rate ( beats/min ) increased with a higher walking speed and a more proximal amputation .
OBJECTIVE To systematic ally review the literature on the metabolic costs of activities of daily living ( ADL ) in persons with a lower limb amputation ( LLA ) .