Background:Type 2 diabetes mellitus (T2DM) negatively impacts both the peripheral and central systems involved in postural control, leading to impairments, especially under dual-task conditions. This study investigated the effects of T2DM on postural sway using single- and multi-scale metrics during an attention-demanding dual-task standing protocol. Methods:Twenty-four relatively healthy older adults (76 ± 6 years) and 20 older adults with T2DM (76 ± 7 years) completed quiet standing (i.e., single-task, control) and dual-task (i.e., visual search) conditions. For the dual-task condition, participants counted the frequency of a designated letter in a block of text. Postural sway (i.e., elliptical area, jerk, path length, and range of acceleration) was assessed using a wearable motion sensor. Multi-scale entropy was used to quantify the complexity of postural sway in the medial-lateral (ML) and anterior-posterior (AP) directions. Postural adaptation was calculated as the percent change in sway metrics from control to visual search condition. Task performance was measured as percent accuracy in the visual search task. Results:Compared to the non-diabetic group, the T2DM group exhibited greater elliptical sway area (p = 0.007), jerk (p = 0.001), path length (p < 0.0001), and range of acceleration (p = 0.006), and lower ML sway complexity (p = 0.053), irrespective of task condition. There were no group differences in postural adaptation for any sway metric. Across participants, single-scale sway metrics were lower during the visual search compared to the control condition (p < 0.05). Within the non-diabetic group only, visual search performance was correlated with postural adaptation in elliptical sway area (r = -0.70, p < 0.0001) and range of acceleration (r = -0.66, p = 0.0009). Conclusion:The T2DM group exhibited altered single-scale sway measures and reduced ML sway complexity, highlighting the sensitivity of both single- and multi-scale postural sway metrics in detecting group differences in standing postural control. The link between postural adaptation and visual search performance, which was evident only in the non-diabetic group, may suggest a decoupling between perception and action in patients with T2DM.

Background: The rise in falls among middle-aged or older patients with type 2 diabetes mellitus (T2DM) has imposed a substantial social burden. However, there is currently a lack of research exploring a comprehensive evaluation method for assessing the risk of falls in older adults with T2DM.Research question: To investigate the correlation between fall risk (assessed by Timed Up and Go test (TUG), dual-task TUG (TUG-DT), and fall efficacy) and postural control ability, gait, cognition, sleep, depression, and T2DM characteristics in T2DM patients over the age of 50. Addtionaly, the study attempt to explore the potential utility of TUG-DT as a tool for assessing fall risk in T2DM.Method: This cross-sectional study involved 30 middle-aged or older T2DM patients and 30 healthy controls matched for age and gender. TUG, TUG-DT, fall efficacy, postural stability, gait, cognition, depression, sleep, and lifestyle factors were evaluated. The data were analyzed using chi-square test, non-parametric test, student t-test or Spearman correlation analysis.Result: The TUG, TUG-DT performance, Falls Efficacy Scale International (FES-I), Sensory Organization Test (SOT), Limits of Stability(LOS), and Center for Epidemiologic Studies Depression Scale (CES-D) were significantly higher in T2DM compared to healthy controls (all P < 0.05), and the difference between TUG and TUG-DT was significant in T2DM(P < 0.05). The SOT, LOS, Pittsburgh Sleep Quality Index(PSQI), CES-D, T2DM duration, insulin use, smoking, and exercise were significantly correlated with TUG, TUG-DT, or FES-I (all P < 0.05).Significance: T2DM patients exhibit a higher fall risk. Postural control deficits, poor sleep quality, depression, insulin use, smoking, exercise, and T2DM duration are associated with a higher risk. The TUG-DT test could potentially be used for evaluating fall risk in T2DM patients.

Background Self-efficacy for pain management is the key to successful pain management, yet little is known about the effect of cognitive performance on self-efficacy for pain management. This study aimed to examine to what extent cognitive performance is related to self-efficacy for pain management in older adults with chronic pain. Methods The analyses utilized data from the baseline assessment of the MOBILIZE Boston Study. Five neuropsychological tests—the Clock in the Box Test, Letter Fluency Test, Trail-making Test, Hopkins Verbal Learning Test, and WORLD Test—were performed to measure the cognitive performance domains of 458 participants, aged 70 years and reporting chronic pain and self-efficacy for pain management. We measured self-efficacy for pain management using the Chronic Pain Self-Efficacy Scale. Statistical analyses were done using multiple linear regression analysis. Results After adjusting for sociodemographic factors, general cognitive performance, executive function, as measured by the Clock in the Box Test, and attention, as measured by the Trail-Making Test Part A, were significantly associated with self-efficacy for pain management in older adults with chronic pain. However, after controlling for sociodemographic factors, chronic conditions, pain interference, and physical performance, the associations between cognitive performance measures and self-efficacy for pain management weakened. Conclusion Greater cognitive performance in attention and executive function might be associated with better self-efficacy for pain management. Future longitudinal research is required to investigate the long-term implications of cognitive performance changes on the progress of self-efficacy for pain management in community-dwelling older adults.

Previous studies have shown that Physical Activity (PA) has a positive association with emotional health and intelligence in adolescents but none have focused on the relationship of PA duration and intensity on Emotional Intelligence (EI). The purpose of this study was to cross-sectionally assess the association of PA measures on overall EI and its domains in a cohort of 2 029 adolescents aged 10-13 years of age in the National Longitudinal Survey for Children and Youth (NLSCY) from Canada. Multivariable linear regression analysis of EI was adjusted for age, sex, annual household income, and health status. One-way analysis of variance (ANOVA) was used to relate PA duration measured in minutes, frequency, and intensity categories with continuous GEI scores and also the corresponding scores for domains of GEI. The mean GEI scores were (28.3 +/- 6.6) for 0-30 minute (min) PA duration, (30.0 +/- 6.5) for 30 to < 60 min, (30.8 +/- 6.7) for 60-120 min, and (30.1 +/- 6.5) for >= 121 min. There was a statistically significant linear trend across PA duration categories, p = 0.000 4. Post-hoc pairwise comparison revealed that compared to the referent category (< 30 min PA category) was statistically significantly lower GEI than each of the other two PA categories (30-59 min; and 60-120 min), both p-values < 0.01. Meeting World Health Organization (WHO) guidelines for duration and vigorous intensity were positively associated with the higher overall EI and its domains except for Stress Management.

Chronic musculoskeletal pain is prevalent and undertreated in older adults. In particular, multisite pain is associated with serious functional consequences and falls and appears to be a novel geriatric syndrome. The causes of multisite pain are often multifactorial, and emerging evidence supports a complex pathway whereby multisite pain leads to cognitive problems, mobility decline, fear of falling, falls, and reduced participation in life roles. A few pharmacologic approaches are safe and effective for older adults with chronic multisite pain and evidence for effectiveness of non-pharmacologic treatments for this common condition is very limited. Compared to light physical exercise, mind-body exercise may prove to be more beneficial for older adults living with chronic pain. Tai Chi, as a movement-based mind-body exercise, can relieve pain symptoms, improve cognition and physical function, and lower risk for falls in older adults. However, little is known about the potential benefits of Tai Chi for older adults with multisite pain syndrome. Future large-scale randomized-controlled trials are needed to investigate the effectiveness of Tai Chi in alleviating pain and lowering fall risk in older adults with multisite pain, and the biological mechanisms that underlie its potential benefits to chronic pain, physical and cognitive functions, and falls in this at-risk population.

Background Understanding fall circumstances can help researchers better identify causes of falls and develop effective and tailored fall prevention programs. This study aims to describe fall circumstances among older adults from quantitative data using conventional statistical approaches and qualitative analyses using a machine learning approach. Methods The MOBILIZE Boston Study enrolled 765 community-dwelling adults aged 70 years and older in Boston, MA. Occurrence and circumstances of falls (ie, locations, activities, and self-reported causes of falls) were recorded using monthly fall calendar postcards and fall follow-up interviews with open- and close-ended questions during a 4-year period. Descriptive analyses were used to summarize circumstances of falls. Natural language processing was used to analyze narrative responses from open-ended questions. Results During the 4-year follow-up, 490 participants (64%) had at least 1 fall. Among 1 829 falls, 965 falls occurred indoors and 804 falls occurred outdoors. Commonly reported activities when the fall occurred were walking (915, 50.0%), standing (175, 9.6%), and going down stairs (125, 6.8%). The most commonly reported causes of falls were slip or trip (943, 51.6%) and inappropriate footwear (444, 24.3%). Using qualitative data, we extracted more detailed information on locations and activities, and additional information on obstacles related to falls and commonly reported scenarios such as "lost my balance and fell." Conclusions Self-reported fall circumstances provide important information on both intrinsic and extrinsic factors contributing to falls. Future studies are warranted to replicate our findings and optimize approaches to analyzing narrative data on fall circumstances in older adults.

Background: Multisite musculoskeletal pain is highly prevalent among older adults yet undertreated. Studies support the promise of Tai Chi for managing pain and lowering fall risk. Since the COVID-19 pandemic, effective alternatives to classroom-based exercise programming are warranted. Aims: To recruit 100 racially diverse older adults with multisite pain and increased fall risk, who are interested in participating in a future Tai Chi clinical trial, and to evaluate the feasibility and acceptability of a short-term, remotely delivered home-based Tai Chi program. Methods: A random sample of adults aged 65 years or older living in diverse Boston neighborhoods were sent mailed invitations to participate in a telephone screening survey. Eligible adults were invited to join a 4-week Tai Chi program offered online via Zoom. Primary outcomes were class attendance, experience, and program safety. Results: Among 334 survey respondents, 105 were eligible for the intervention. Average age of eligible partici-pants was 74 years, 75% were women, and 62% were Black. We assigned 32 participants to 4 Tai Chi or 2 light exercise groups conducted via Zoom; of these, 24 (75%) completed the program and 79% attended >= 6 of 8 classes. There were no adverse events reported. Two-thirds reported it was very easy to join the online classes and 88%, very easy to see the instructor. Conclusion: Mailed invitations were effective for recruiting a racially diverse sample. Remote exercise pro-gramming delivered online via live Zoom sessions is safe and feasible for diverse older adults who have multisite pain and risk of falls.

Objective: Dynamin-related protein 1 (Drp1) is the key regulator of mitochondrial fission. We and others have reported a strong correlation between enhanced Drp1 activity and impaired skeletal muscle insulin sensitivity. This study aimed to determine whether Drp1 directly regulates skeletal muscle insulin sensitivity and whole-body glucose homeostasis. Methods: We employed tamoxifen-inducible skeletal muscle-specific heterozygous Drp1 knockout mice (mDrp1(+/-)). Male mDrp1(+/- )and wildtype (WT) mice were fed with either a high-fat diet (HFD) or low-fat diet (LFD) for four weeks, followed by tamoxifen injections for five consecutive days, and remained on their respective diet for another four weeks. In addition, we used primary human skeletal muscle cells (HSkMC) from lean, insulin-sensitive, and severely obese, insulin-resistant humans and transfected the cells with either a Drp1 shRNA (shDrp1) or scramble shRNA construct. Skeletal muscle and whole-body insulin sensitivity, skeletal muscle insulin signaling, mitochondrial network morphology, respiration, and H2O2 production were measured.Results: Partial deletion of the Drp1 gene in skeletal muscle led to improved whole-body glucose tolerance and insulin sensitivity (P < 0.05) in diet-induced obese, insulin-resistant mice but not in lean mice. Analyses of mitochondrial structure and function revealed that the partial deletion of the Drp1 gene restored mitochondrial dynamics, improved mitochondrial morphology, and reduced mitochondrial Complex I-and II-derived H2O2 (P < 0.05) under the condition of diet-induced obesity. In addition, partial deletion of Drp1 in skeletal muscle resulted in elevated circulating FGF21 (P < 0.05) and in a trend towards increase of FGF21 expression in skeletal muscle tissue (P = 0.095). In primary myotubes derived from severely obese, insulin-resistant humans, ShRNA-induced-knockdown of Drp1 resulted in enhanced insulin signaling, insulin-stimulated glucose uptake and reduced cellular reactive oxygen species (ROS) content compared to the shScramble-treated myotubes from the same donors (P < 0.05).Conclusion: These data demonstrate that partial loss of skeletal muscle-specific Drp1 expression is sufficient to improve whole-body glucose homeostasis and insulin sensitivity under obese, insulin-resistant conditions, which may be, at least in part, due to reduced mitochondrial H2O2 production. In addition, our findings revealed divergent effects of Drp1 on whole-body metabolism under lean healthy or obese insulin-resistant conditions in mice.(c) 2023 The Author(s). Published by Elsevier GmbH. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Mitochondrial quality control processes are essential in governing mitochondrial integrity and function. The purpose of the study was to examine the effects of 10 weeks of high-intensity interval training (HIIT) on the regulatory protein machinery of skeletal muscle mitochondrial quality control and whole-body glucose homeostasis in diet-induced obese mice. Male C57BL/6 mice were assigned to low-fat diet (LFD) or high-fat diet (HFD) group. After 10 weeks, HFD-fed mice were divided into sedentary and HIIT (HFD + HIIT) groups for another 10 weeks (n = 9/group). Graded exercise test, glucose and insulin tolerance tests, mitochondrial respiration, and protein markers of mitochondrial quality control processes were determined. HFD-fed mice exhibited lower ADP-stimulated mitochondrial respiration (p < 0.05). However, 10 weeks of HIIT prevented this impairment (p < 0.05). Importantly, the ratio of Drp1(Ser(616)) over Drp1(Ser(637)) phosphorylation, an indicator of mitochondrial fission, was significantly higher in HFD-fed mice (p < 0.05), but such increase was attenuated in HFD-HIIT compared to HFD (-35.7%, p < 0.05). Regarding autophagy, skeletal muscle p62 content was lower in the HFD group than the LFD group (-35.1%, p < 0.05); however, such reduction was disappeared in the HFD + HIIT group. In addition, LC3B II/I ratio was higher in the HFD group than the LFD group (15.5%, p < 0.05) but was ameliorated in the HFD + HIIT group (-29.9%, p < 0.05). Overall, our study demonstrated that 10 weeks of HIIT was effective in improving skeletal muscle mitochondrial respiration and the regulatory protein machinery of mitochondrial quality control in diet-induced obese mice through the alterations of mitochondrial fission protein Drp1 phosphorylations and p62/LC3B-mediated regulatory machinery of autophagy.

ObjectivesThis study aims to determine domains of pain interference in daily routines assessed using the Brief Pain Inventory, in relation to multisite musculoskeletal pain among older adults living in the community.DesignThe MOBILIZE Boston Study is a population-based study of 749 adults aged 70 and older.MeasurementsChronic musculoskeletal pain was assessed using a joint pain questionnaire and grouped as: no pain, single-site and multisite pain. The Brief Pain Inventory pain interference (PI) sub-scale assessed level of pain interference (0–10 rating) in 7 domains including general activity, mood, walking, work, relationships with people, sleep, and enjoyment of life. Interference ratings were grouped as: none (0), mild (>0 and ≤ 2), and moderate to severe (>2) PI.ResultsPI was more common among women and those with less education compared to others. Older adults with chronic conditions such as osteoarthritis, depression, spinal stenosis, peripheral artery disease, and asthma/lung disease were more likely than their peers to report PI (p < 0.05). Multisite musculoskeletal pain was strongly associated with pain interference in all domains (p < 0.05). More than half of older adults with multisite musculoskeletal pain reported moderate to severe PI with general activity and walking. The highest prevalence of moderate to severe PI (score >2) in general activity was seen in participants with depression (62%), knee and hand osteoarthritis (71%) and peripheral artery disease (65%).ConclusionGreater attention to PI and PI domains such as general activity and walking, could aid in efforts to reduce the overall impact of multisite musculoskeletal pain among older adults.

Abstract Type II diabetes mellitus (T2DM) is associated with a reduction in sensory integration capacity that often results in cognition and postural control deficits. The effects of T2DM on the ability to adapt one’s postural sway while standing and performing a visual search task (VST) are unknown. Twenty-three healthy older adults (HOA) (70–90 years) and 20 older adults with T2DM (67–93 years) performed multiple trials of quiet standing with and without a VST (i.e., counting 1 target letter in a grid of random letters). Postural sway acceleration measures were jerk, velocity, range, and pathlength in the anterior-posterior (AP) and medial-lateral (ML) direction, as well as elliptical area. Postural adaptation to the VST was defined as the absolute change between conditions. VST accuracy (%) was defined as the percentage of participant-reported target letters compared to total target letters. In general, for both groups, performing the VST resulted in an average reduction in sway jerk, velocity, pathlength, and range when performing the VST, compared to control (T2DM & HOA, p < 0.04). VST accuracy and the magnitude of postural adaptation to the VST were similar between groups (p>0.15). Within the T2DM group, those who performed worse on the VST exhibited less adaptation (i.e., smaller decrease) in ML velocity (r=0.47, p=0.04). No other differences or associations were observed. Compared to healthy older adults, those with T2DM demonstrated a similar capacity to adapt their postural control in response to a VST. However, this group exhibited different characteristic changes in sway which were linked to task performance.

Type 2 diabetes patients often present diabetic peripheral neuropathy (DPN), and have an increased risk of falling. However, high fall incidence is also found in diabetic people without DPN. PURPOSE: To explore the association between postural control deficits and type2 diabetes beyond DPN. METHODS: We searched Pubmed, Embase, Medline, Web of Science, and Cochrane Library entries up to November 2021, using keywords including “diabetes” and “postural control” and their synonym. Cohort studies, case-control studies, and cross-sectional studies assessing the postural control of type 2 diabetes patients without DPN, and compared to non-diabetic controls were included. Center of pressure (COP)-based measures of postural sway were the primary outcome. Data were extracted by 2 independent reviewers and analyzed using STATA version 14.0. Random-effect models were applied to estimate the effect size with 95% confidence intervals (CIs), and I2 was used to evaluate the heterogeneity. RESULTS:Thirteen studies met the inclusion criteria, and 602 people (299 type 2diabetes patients and 303 healthy individuals) were included. Type 2 diabetes led to standing postural deficits on the floor with visual support (SMD = 1.25, 95% CI 0.70-1.1.79, P = 0.000, I2 = 88.4%), standing on floor without visual support (SMD = 1.18, 95%CI 0.63-1.84, P = 0.000, I2 = 89.7%), standing on foam with visual support (SMD = 1.03, 95%CI 0.21-1.84,P = 0.014, I2 = 87.0%), and standing on foam without visual support (SMD = 1.30, 95%CI 0.43-2.18,P = 0.004, I2 = 90.0%). Subgroup analysis demonstrated that postural sway increased significantly in patients with a diabetes duration of ≥5 years (SMD = 0.88, 95%CI 0.38-1.38, P = 0.001), BMI < 24.9 kg/m2 (SMD = 1.38, 95%CI 0.15-2.6, P = 0.028), and age < 50 years (SMD = 2.33, 95%CI 1.04-3.62, P = 0.000). CONCLUSIONS: Current literature indicates that postural control deficits are significantly associated with type 2 diabetes beyond DPN. Interestingly, this association is more evident in patients with a younger age or a normal BMI.

Background: Chronic pain is a risk factor contributing to mobility impairment and falls in older adults. Little is known about the patterns of circumstances of falls among older adults with chronicpain. Objective: To examine the relationship between chronic pain and circumstances of falls including location, activities at the time of falls and self-reported causes of falls in older adults. Design: Prospective cohort study. Setting: Communities in/around Boston, Massachusetts. Subjects: The MOBILIZE Boston Study enrolled 765 adults aged >= 70 years. Methods: Pain severity, fall occurrence and fall circumstances were recorded using monthly calendar postcards and fall follow-up interviews during a 4-year follow-up period. Generalised estimating equation models were performed to examine the relation between monthly pain ratings and circumstances of the first fall in the subsequent month. Results: Compared to fallers without chronic pain, fallers with moderate-to-severe pain had around twice the likelihood of reporting indoor falls (aOR = 1.93, 95%CI: 1.32-2.83), falls in living or dining rooms (aOR = 2.06, 95%CI: 1.27-3.36), and falls due to health problems (aOR = 2.08, 95%CI: 1.16-3.74) or feeling dizzy or faint (aOR = 2.10, 95%CI: 1.08-4.11), but they were less likely to report falls while going down stairs (aOR = 0.48, 95%CI: 0.27-0.87) or falls due to a slip or trip (aOR = 0.67, 95%CI: 0.47-0.95) in the subsequent month. Conclusions: Given the exploratory nature of the study, these findings should be interpreted with caution. Future studies may investigate whether better pain management and tailored fall prevention in older people with chronic pain could lead to fewer falls.

Tai chi is known to improve balance and reduce falls in older adults. Yet, little is known about the impact of group tai chi on perceived social support and its relationship with participant self-efficacy and adherence. The current systematic review, guided by Social Cognitive Theory and Successful Aging, includes an overview of tai chi interventions with and without enhancements (e.g., music, mentorship, group practice) that evaluated social support among their outcomes (N = 10). PubMed, CINAHL, and PsycINFO databases were searched for studies eligible under the inclusion criteria: sample population aged >= 60 years and published between 1999 and 2019. Four articles reported on tai chi interventions with specific enhancements to promote social interaction and reported increased perceived social support (p < 0.05). Six studies evaluated social support outcomes of tai chi programs without specific modifications to promote social engagement. Four of the six traditional tai chi intervention studies reported improved social support (p < 0.05). Group tai chi interventions for older adults may increase social support and therefore further increase health benefits of tai chi exercise among this population.

High intensity interval training (HIIT) is a time-efficient training strategy that improves cardiometabolic health. Mitochondrial quality control (i.e., mitochondrial biogenesis, fission, fusion and mitophagy) plays a critical role in regulating skeletal muscle and whole-body metabolic health. However, a complete profile of regulatory proteins of mitochondrial quality control in response to HIIT and their association with HIIT-induced metabolic benefits have not be fully evaluated in the setting of obesity. PURPOSE: To examine the effects of 10-week HIIT intervention on the regulatory machinery of skeletal muscle mitochondrial quality control in diet-induced obese mice. METHODS: Male C57BL/6 mice were randomly assigned to a low-fat diet (LFD) and high-fat diet (HFD). After 10 weeks, mice fed with HFD were further divided to sedentary and HIIT groups (3-minute treadmill running at 90% maximal speed followed by a 2-minute recovery at 50% maximal speed, 30 minutes) while remaining on HFD for another 10 weeks (n = 10/group). Glucose tolerance test (GTT) and insulin tolerance test (ITT) were administered to evaluate whole-body metabolic health. Expression of mitochondrial quality control proteins were determined by immunoblots. One-way ANOVA was used to assess between group differences. RESULTS:Drp1(ser637) phosphorylation, a marker of mitochondrial fusion, and p62 protein expression, a marker of autophagy were significantly increased in HFD-fed mice following HIIT when compared to their sedentary counterparts (0.015 ± 0.002 vs. 0.011 ± 0.003 and 0.67 ± 0.11 vs. 0.51 ± 0.10, respectively, P < 0.05), and no differences when compared to LFD group. Lastly, Drp1(ser637) phosphorylation was negatively correlated with the Area Under the Curve of ITT test (r = -0.56, P < 0.05). Despite these positive alterations in skeletal muscle mitochondrial quality control machinery, GTT and ITT responses were not improved in HFD-fed mice following HIIT when compared to the sedentary counterparts. CONCLUSION: Our study demonstrated that 10 weeks of HIIT is effective in improving skeletal muscle mitochondrial quality control machinery, but not sufficient to ameliorate impaired whole-body glucose homeostasis in diet-induced obese mice. Supported By: UMass Boston Joseph P. Healey Research Grant

The goal of this study was to evaluate feasibility and acceptability of a remote Tai Chi program in diverse older adults with multisite pain and risk for falls during the COVID-19 pandemic. Adults aged ≥65y living in diverse Boston neighborhoods were invited through mailed letters to participate in a recruitment and screening survey. Eligible adults were re-contacted to join a 4-week Tai Chi or light exercise program offered online twice weekly. We conducted pre- and post-interviews to assess pain characteristics, fall risk, computer use, and satisfaction with the program. Primary outcomes were class attendance, experience, and program safety. Among 335 survey respondents, 105 (31%) were eligible based on multisite pain and fall history or cane/walker use. Of the eligible respondents, average age was 74y, 75% were women, 62% were Black, and 31% had high school education or less. We assigned 32 participants to 4 Tai Chi (Yang-style Tai Chi tailored to older adults with pain) or 2 light exercise (stretching and strength exercise) groups conducted via zoom; of these, 24 (75%) completed the program. Overall, 79% attended ≥6 of 8 classes. There were no adverse events reported. Regarding experiences with remote exercise, 67% reported it was very easy to join, 88%, very easy to see the instructor and 83%, very easy to participate. For future planning, 29% prefer remote classes, 33% prefer in-person classes, and 38% could do either. In conclusion, remote exercise programming is safe and feasible for diverse older adults who have multisite pain and risk of falls.

PURPOSE:To investigate the effects of different exercise components on physical function and mobility in adults after hip fracture. METHODS:Pubmed, Embase, Cochrane Library, Web of Science, CINAHL, and PsycINFO were searched up to March 2021. Randomized controlled trials investigating the effects of exercise interventions on physical function and mobility in adults after hip fracture were included. RESULTS:Fifteen studies (12 trials) were included (n = 1198, age = 80 ± 8 years). Exercise interventions had a moderate effect on overall physical function after hip fracture compared to non-exercise (SMD = 0.46, 95% CI = 0.27-0.65). Among different exercise components, progressive resistance exercise showed the largest effect (SMD = 0.48, 95% CI = 0.27-0.69), while aerobic exercise alone had no effect (SMD 0.41, 95% -0.44 to1.26) on physical function. Exercise had a small effect on mobility (SMD = 0.28, 95% CI = 0.12-0.43). Specifically, functional exercise showed a moderate effect (SMD = 0.41, 95% CI = 0.16-0.65) on mobility. CONCLUSIONS:Available evidence supports that exercise interventions improve physical function and mobility in older adults after hip fracture; specifically, resistance exercise with progressive load of 60-80% 1RM, and functional exercise may be critical intervention components respectively. Future high-quality research is needed to establish best practices. IMPLICATIONS FOR REHABILITATIONProgressive resistance exercise with 60-80% 1RM resulted in the largest improvement in physical function after hip fracture.Functional exercise appears to be a critical component for improving mobility after hip fracture. Functional exercise plus resistance and balance exercises was the most effective intervention for enhancing mobility.Exercise should be supervised by a trainer or a physiotherapist, and self-reported exercise may not result in the same benefits.

BACKGROUND:Pain catastrophizing has been associated with pain intensity and mobility limitations in adults, and may be associated with mobility problems among older adults with chronic pain. This study examined the associations between pain catastrophizing and pain characteristics, and physical performance in older people. METHODS:The MOBILIZE Boston Study II (MBS) included 354 adults aged ≥70 years, living in the Boston area, originally enrolled in the MBS I from 2005-2008. Pain catastrophizing was measured using the 13-item Pain Catastrophizing Scale (PCS), with scores ranging from 13-65. Pain severity and pain interference were assessed by subscales of the Brief Pain Inventory. Pain distribution was classified as none, single site, and multisite. Mobility performance was assessed using the Short Physical Performance Battery (SPPB). Falls were assessed prospectively using monthly fall calendar postcards. RESULTS:One-fourth of all participants (24 %) had high scores on the PCS (score>30). PCS was inversely associated with age and was greater among those with osteoarthritis, depression, or anxiety (p-value<0.05). PCS score was associated with global measures of pain including pain severity (p-value = 0.01), pain interference (p-value = 0.004) and multisite pain compared to no pain (p-value = 0.006). After adjusting for confounders, PCS was not associated with mobility and fall in this older population. CONCLUSION:Although pain catastrophizing is prevalent in older adults with chronic pain, it was not associated with mobility or falls in older people. Further research is needed to determine possible long-term effects of pain catastrophizing on chronic pain and functioning in older adults.

This cross-sectional study examines the association between chronic musculoskeletal pain and foot reaction time (RT) among older community-living adults. Participants were 307 adults aged 71 years and older in the MOBILIZE Boston Study II. Pain severity, interference, and location were measured by the Brief Pain Inventory and a joint pain questionnaire. With participants seated, simple foot reaction time was measured as self-selected foot response time to an intermittent light, and choice foot reaction time was measured as response time to the light on the corresponding side of the sensored gait mat. We performed multivariable linear regression to determine associations of pain and foot RT, adjusted for sociodemographic and health characteristics, and serially adjusted for cognitive function (MMSE or Trail Making A). Pain severity and interference were associated with slower simple foot reaction time (P < .05). Pain severity and knee pain were associated with slower choice foot reaction time (P < .05). Adjustment for cognitive measures had little impact on the pain-RT relationship. This significant relationship was only observed among participants with less education. These results support the idea that chronic pain may lead to slower foot RT, thus could represent a fall hazard in older adults. Neuromotor mechanisms underlying the pain-fall relationship warrant further investigation. PERSPECTIVE: This study provides insights on the mechanisms underlying the pain-fall relationship. Chronic pain may contribute to slower foot RT thus increase fall risk in older adults. This may help inform interventions such as stepping training to reduce fall risk in older adults living with chronic pain.