ObjectiveTo assess whether vascular activity seen on 18F‐fluorodeoxyglucose–positron emission tom... more ObjectiveTo assess whether vascular activity seen on 18F‐fluorodeoxyglucose–positron emission tomography (FDG‐PET) scan is associated with angiographic change in large vessel vasculitis (LVV).MethodsPatients with LVV were recruited into a prospective cohort. All patients underwent magnetic resonance angiography or computed tomography angiography and FDG‐PET imaging. Follow‐up imaging using the same imaging modalities was obtained ≥6 months later per a standardized imaging protocol. Arterial damage, defined as stenosis, occlusion, or aneurysm, and corresponding FDG uptake were evaluated in 17 arterial territories. On follow‐up, development of new lesions was recorded, and existing lesions were characterized as improved, worsened, or unchanged.ResultsA total of 1,091 arterial territories from 70 patients with LVV (38 patients with Takayasu arteritis, 32 patients with giant cell arteritis) were evaluated. Over a median 1.6 years of follow‐up, new lesions developed only in 8 arterial territories in 5 patients with Takayasu arteritis. Arterial lesions improved in 16 territories and worsened in 6 territories. Most arterial territories that did not have vascular activity on FDG‐PET scan at baseline had no angiographic change over the follow‐up period (787 [99%] of 793). Few territories with baseline FDG‐PET activity had angiographic change over time (24 [8%] of 298), but of the territories that developed angiographic change, 80% had FDG‐PET activity at baseline. Within the same patient, an arterial territory with baseline FDG‐PET activity had significantly increased risk for angiographic change compared to a paired arterial territory without FDG‐PET activity (odds ratio 19.49 [95% confidence interval 2.44–156.02]; P < 0.01). Concomitant edema and wall thickening further increased risk for angiographic change.ConclusionDevelopment of angiographic change was infrequent in this cohort of patients with LVV. A lack of baseline FDG‐PET activity was strongly associated with stable angiographic disease. In cases of angiographic progression, change was preceded by the presence of FDG‐PET activity.
Background and Purpose: Few persons with Parkinson disease (PD) appear to engage in moderate-inte... more Background and Purpose: Few persons with Parkinson disease (PD) appear to engage in moderate-intensity walking associated with disease-modifying health benefits. How much time is spent walking at lower, yet still potentially beneficial, intensities is poorly understood. The purpose of this exploratory, observational study was to describe natural walking intensity in ambulatory persons with PD. Methods: Accelerometer-derived real-world walking data were collected for more than 7 days at baseline from 82 participants enrolled in a PD clinical trial. Walking intensity was defined according to the number of steps in each active minute (1-19, 20-39, 40-59, 60-79, 80-99, or ≥100 steps). Daily minutes of walking and duration of the longest sustained walking bout were calculated at each intensity. Number of sustained 10 to 19, 20 to 29, and 30-minute bouts and greater at any intensity also were calculated. Values were analyzed in the context of physical activity guidelines. Results: Most da...
Patients with systemic sclerosis complicated by both pulmonary hypertension (SSc‐PH) and intersti... more Patients with systemic sclerosis complicated by both pulmonary hypertension (SSc‐PH) and interstitial lung disease (SSc‐PH‐ILD) have poor prognosis compared to those with SSc‐PH or SSc‐ILD alone. Little is known of how ILD severity affects outcomes in those with SSc‐PH, or how PH severity affects outcomes in those with SSc‐ILD. Herein, we aimed to delineate clinical features of patients with SSc‐PH and SSc‐ILD and determine to what degree PH and ILD severity contribute to mortality in patients with SSc. We conducted parallel retrospective studies in cohorts of patients with SSc‐PH and SSc‐ILD. We categorized ILD severity by pulmonary function testing and PH severity by cardiopulmonary hemodynamics. Our primary outcome was all‐cause mortality from time of PH or ILD diagnosis for the SSc‐PH and SSc‐ILD cohorts, respectively. We calculated adjusted risks of time to all‐cause mortality using Cox proportional hazards models. In patients with SSc‐PH, severe ILD (HR: 3.54; 95% CI: 1.05, 11...
ObjectiveDiagnosis of pulmonary hypertension (PH) in systemic sclerosis (SSc) requires an invasiv... more ObjectiveDiagnosis of pulmonary hypertension (PH) in systemic sclerosis (SSc) requires an invasive right heart catheterization (RHC), often based on an elevated estimated pulmonary artery systolic pressure on screening echocardiography. However, because of the poor specificity of echocardiography, a greater number of patients undergo RHC than necessary, exposing patients to potentially avoidable complication risks. The development of improved prediction models for PH in SSc may inform decision‐making for RHC in these patients.MethodsWe conducted a retrospective study of 130 patients with SSc; 66 (50.8%) were diagnosed with PH by RHC. We used data from pulmonary function testing, electrocardiography, echocardiography, and computed tomography to identify and compare the performance characteristics of 3 models predicting the presence of PH: 1) random forest, 2) classification and regression tree, and 3) logistic regression. For each model, we generated receiver operating curves and cal...
Objective.To investigate whether walking speed at 1 timepoint, decline over the past 12 months, o... more Objective.To investigate whether walking speed at 1 timepoint, decline over the past 12 months, or both predict mortality risk over 11 years in adults with, or at risk of, knee osteoarthritis (OA).Methods.Using the data from the Osteoarthritis Initiative, we defined slow versus adequate walking speed as walking < 1.22 versus ≥ 1.22 m/s on a 20m walk test during the 12-month follow-up visit. We defined meaningful decline (yes/no) as slowing ≥ 0.08 m/s over the past year. At the 12-month visit, we classified adequate sustainers as those with adequate walking speed and no meaningful decline, slow sustainers as slow walking speed and no meaningful decline, adequate decliners as adequate walking speed and meaningful decline, and slow decliners as slow walking speed and meaningful decline. Mortality was recorded over 11 years. To examine the association of walking speed with mortality, HR and 95% CI were calculated using Cox regression, adjusted for potential confounders.Results.Of 422...
ObjectiveDespite increasing prevalence of end-stage renal disease (ESRD), little attention has be... more ObjectiveDespite increasing prevalence of end-stage renal disease (ESRD), little attention has been directed to how occupational exposures may contribute to risk. Our objective was to investigate the relationship between metalworking fluids (MWF) and ESRD in a cohort of 36 703 male autoworkers.MethodsWe accounted for competing risk of death, using the subdistribution hazard approach to estimate subhazard ratios (sHRs) and 95% CIs in models with cubic splines for cumulative exposure to MWF (straight, soluble or synthetic).ResultsBased on 501 ESRD cases and 13 434 deaths, we did not observe an association between MWF and ESRD overall. We observed modest associations between MWF and ESRD classification of glomerulonephritis and diabetic nephropathy. For glomerulonephritis, the 60th percentile of straight MWF was associated with an 18% increased subhazard (sHR=1.18, 95% CI: 0.99 to 1.41). For diabetic nephropathy, the subhazard increased 28% at the 60th percentile of soluble MWF (sHR=1....
Purpose: Current walking interventions for people with knee osteoarthritis (OA) focus on either r... more Purpose: Current walking interventions for people with knee osteoarthritis (OA) focus on either reducing knee joint loading or on increasing physical activity. There is a need for interventions that could address both quality and quantity of walking for people with knee OA. The goal of this randomized controlled trial (clinicaltrials.gov # NCT03064139) was to determine the feasibility of a mindful walking intervention to improve quality and quantity of walking in people with knee OA. Methods: Individuals with symptomatic knee OA were recruited from the community using advertisements. Study criteria are shown in Table 1. [Formula presented] During enrollment, the more symptomatic knee, or a knee selected at random in case of equal symptoms, was designated as the study knee. After the baseline visit, participants were randomized to either a mindful walking group (MWG) or an attention-matched self-management group (SMG). Participants in both groups received 11 intervention sessions delivered over a 6-month period (4 in 1 st month, 2 each in 2nd and 3rd months, 1 each in 4th, 5th, and 6th months). Interventions were delivered via in-person groups (4-10 in each group) and each session was 1.5-3 hours in duration. For MWG, a certified instructor provided training in mindful walking that includes whole-body movement retraining and mindful body-awareness skill building. Biomechanical elements include: shorter stride length, higher cadence, greater toe-in, and more aligned posture. Participants were coached to progressively increase their mindful walking activity each week. Mindfulness elements include mindful body-awareness skills to increase sensitivity and awareness of deviations from the taught techniques. The approach is based on “ChiWalking®” so called because the movement approaches are drawn in part from T’ai Chi. For SMG, a researcher delivered a curriculum consisting of education and self-management techniques (e.g., importance of physical activity and exercise, nutrition, weight-management, etc.). This information was also provided to MWG in a condensed form. Gait analyses and physical performance tests were completed at baseline and 6-months. Physical activity was assessed using a commercial wrist-worn activity monitor (Charge 3, Fitbit Inc, San Francisco, CA). Participant-reported outcomes (PROs) were completed at baseline and every 3-months. Participants were remotely followed for an additional 6-months after the end of the intervention. Given the feasibility nature of the study, primary outcomes included recruitment, adherence, retention and number of adverse events. Secondary outcomes included peak external knee adduction moment [KAM], daily step count, Knee injury and osteoarthritis outcome score (KOOS) Pain, Five Facet Mindfulness Questionnaire (FFMQ), Arthritis Self-Efficacy Scale (ASES), 30-second chair stand test (30STS), 40-meter fast paced walk test (40FPW), and Stair Climbing Test (SCT). Analyses were conducted on intention-to-treat basis with all randomized participants included and missing values were not imputed. Results: Participants were recruited between March 2019 and January 2020. During this period, ∼450 individuals completed pre-screening questionnaires (∼41 per month), 66 completed in-person screening visits, 47 were enrolled, and 44 were randomized (Table 2). Interventions for 19 participants were interrupted, delayed for 3-months, and then transitioned to virtual format due to the COVID-19 pandemic. While the original recruitment goal was 62, the trial was halted earlier due to COVID-19. [Formula presented] Attendance is shown in Table 3. On average, MWG group attended 63% of the sessions vs. 70% in the SMG group. Among those who attended at least 1 session, MWG group attended 69% vs. 77% for SMG. Among those who attended at least 3 sessions, MWG group attended 75% vs. 84% for SMG. Post-intervention, 65% (n=15) and 87% (n=20) of MWG completed the in-person visits and PROs, respectively. In SMG, 81% (n=17) completed in-person visits and PROs. At 12-months, 91% (n=21) and 71% (n 15) completed the PROs for MWG and SMG, respectively. [Formula presented] Participant feedback at 6- and 12-months showed that the intervention was acceptable (Table 4). There were no serious adverse events related to the intervention in either group. Within group and between group differences for secondary outcomes are shown in Table 5. [Formula presented] [Formula presented] Conclusions: Our benchmarks were recruitment over 1.5 years, attendance of 75% in MWG group, and retention of 80% of participants at 6-months. While all of these benchmarks were negatively impacted by COVID-19, the recruitment rates over the period studied, adherence in those who attended at least 3 sessions, and retention for some secondary outcomes were acceptable. Participants in both groups found the interventions helpful, enjoyable, and rated it highly. At 12-month follow-up, MWG participants continued to practice mindful…
Endogenous and exogenous ligands of microbial origin stimulate inflammation associated with ather... more Endogenous and exogenous ligands of microbial origin stimulate inflammation associated with atherosclerosis progression via the innate immune Toll like receptors (TLRs). The oral pathogen Porphyromonas gingivalis induces inflammatory oral bone destruction manifested as periodontal disease, a common chronic disease. P. gingivalis-mediated periodontal disease is now recognized as a risk factor for systemic inflammatory diseases including, diabetes, stroke, and atherosclerotic and cardiovascular diseases. We have previously demonstrated that TLR2 deficiency diminished P. gingivalis-mediated atherosclerosis in an ApoE-/-mouse model. In the current study we demonstrate that TLR4 plays a protective role in P. gingivalis induced atherosclerosis. ApoE-/- and Apoe-/-TLR4-/- mice on normal chow diet were orally challenged with P. gingivalis or saline 5 times / week for 3 weeks. Thirteen weeks after the last challenge, plaque and inflammatory cell accumulation was analyzed in aortic tissue. Pl...
BODY: Purpose Hypothesis: Declines in the amount and intensity of natural walking behavior in peo... more BODY: Purpose Hypothesis: Declines in the amount and intensity of natural walking behavior in people with Parkinson disease (PD) may precede declines in motor behavior, gait, and balance.[1,2] Physical interventions targeting walking behavior in PD may have the greatest impact on slowing the progression of disability.[3-5] Despite a lack of supporting evidence, however, clinicians may be more likely to rely on quick performance measures of walking speed, capacity, and balance to make inferences about a patient’s walking health, rather than direct measures of natural walking behavior. Our primary purpose, therefore, was to examine the extent to which clinical walking measures might predict natural walking behavior in early to mid-stage PD. Secondarily we sought to explore differences in the predictive capability of clinical measures between relatively less active and more active participants. Number of Subjects: 58 Materials/Methods: Data were collected from 34 males and 24 females (...
cautious when using clinical measures to make inferences about Natural Walking Behavior in people... more cautious when using clinical measures to make inferences about Natural Walking Behavior in people with Parkinson disease. Non-Cognitive Predictors of Student Success: A Predictive Validity Comparison Between Domestic and International Students Non-Cognitive Predictors of Student Success: A Predictive Validity Comparison Between Domestic and International Students INTRODUCTION • Declines in the amount and intensity of natural walking behavior in people with PD may precede declines in motor behavior, gait and balance. • Yet clinicians may be more likely to rely on quick performance measures of walking speed, capacity, and balance to make inferences about walking health, rather than employ direct measures of natural walking behavior. METHODS • Baseline assessment for prospective clinical trial. • 58 participants with PD: 34 Male / 24 Female 67.7 ± 8.0 years H&Y 2.0-3.0 • Clinical Measures: Walking speed (10MWT, 10m Walk Test, m/s) Walking distance (6MWT, 6 Minute Walk Test, m) Dynamic ...
Archives of Physical Medicine and Rehabilitation, 2021
OBJECTIVE To examine the association of the volume and intensity of daily walking at baseline wit... more OBJECTIVE To examine the association of the volume and intensity of daily walking at baseline with the risk of knee replacement (KR) over five years in adults with advanced structural knee osteoarthritis. DESIGN Prospective, longitudinal, and multi-center observational study. SETTING Osteoarthritis Initiative study with follow-up from 2008 to 2015. PARTICIPANTS Community-dwelling adults with or at risk of knee OA were recruited from four sites in the United States. We included participants with advanced structural disease, without KR and had valid daily walking data (quantified using Actigraph GT1M), at baseline. INTERVENTION Not applicable. MAIN OUTCOMES KR. Walking volume was measured as steps/day and intensity as minutes/day spent not walking (0 steps/min), and walking at very-light (1-49 steps/min), light (50-100 steps/min), or moderate (>100 steps/min) intensities. To examine the relationship of walking volume and intensity with the risk of KR, we calculated hazard ratios (aHR) and 95% confidence intervals (CI) adjusting for covariates. RESULTS Of 516 adults with advanced structural disease ([mean±sd] age: 67.7±8.6 years, BMI: 29.3±4.7 kg/m2, 52% female), 88 (17%) received a KR over five years. Walking an additional 1,000 steps/day was not associated with the risk of KR (adjusted HR 0.95, 95% CI [0.84, 1.04]). Statistically replacing 10 minutes/day of very-light and light walking with 10 minutes/day of moderate walking reduced the risk of KR incidence by 35% and 37%, respectively (adjusted HR 0.65, 95% CI [0.45 to 0.94] for very light, and adjusted HR 0.63, 95%CI [0.40 to 1.00] for light). CONCLUSION Daily walking volume and intensity did not increase KR risk over five years, and may be protective in some cases in adults with advanced structural knee OA.
Background and Purpose: Walking activity in persons with Parkinson disease (PD) is important for ... more Background and Purpose: Walking activity in persons with Parkinson disease (PD) is important for preventing functional decline. The contribution of walking activity to home and community mobility in PD is poorly understood. Methods: Cross-sectional baseline data (N = 69) were analyzed from a randomized controlled PD trial. The Life-Space Assessment (LSA) quantified the extent, frequency, and independence across 5 expanding levels of home and community mobility, producing individual subscores and a total score. Two additional summed scores were used to represent mobility within (Levels 1-3) and beyond (Levels 4-5) neighborhood limits. An accelerometer measured walking activity for 7 days. Regression and correlation analyses evaluated relationships between daily steps and mobility scores. Mann-Whitney U tests secondarily compared differences in mobility scores between the active and sedentary groups. Results: Walking activity contributed significantly to the summed Level 1-3 score (β ...
ObjectiveTo assess whether vascular activity seen on 18F‐fluorodeoxyglucose–positron emission tom... more ObjectiveTo assess whether vascular activity seen on 18F‐fluorodeoxyglucose–positron emission tomography (FDG‐PET) scan is associated with angiographic change in large vessel vasculitis (LVV).MethodsPatients with LVV were recruited into a prospective cohort. All patients underwent magnetic resonance angiography or computed tomography angiography and FDG‐PET imaging. Follow‐up imaging using the same imaging modalities was obtained ≥6 months later per a standardized imaging protocol. Arterial damage, defined as stenosis, occlusion, or aneurysm, and corresponding FDG uptake were evaluated in 17 arterial territories. On follow‐up, development of new lesions was recorded, and existing lesions were characterized as improved, worsened, or unchanged.ResultsA total of 1,091 arterial territories from 70 patients with LVV (38 patients with Takayasu arteritis, 32 patients with giant cell arteritis) were evaluated. Over a median 1.6 years of follow‐up, new lesions developed only in 8 arterial territories in 5 patients with Takayasu arteritis. Arterial lesions improved in 16 territories and worsened in 6 territories. Most arterial territories that did not have vascular activity on FDG‐PET scan at baseline had no angiographic change over the follow‐up period (787 [99%] of 793). Few territories with baseline FDG‐PET activity had angiographic change over time (24 [8%] of 298), but of the territories that developed angiographic change, 80% had FDG‐PET activity at baseline. Within the same patient, an arterial territory with baseline FDG‐PET activity had significantly increased risk for angiographic change compared to a paired arterial territory without FDG‐PET activity (odds ratio 19.49 [95% confidence interval 2.44–156.02]; P &lt; 0.01). Concomitant edema and wall thickening further increased risk for angiographic change.ConclusionDevelopment of angiographic change was infrequent in this cohort of patients with LVV. A lack of baseline FDG‐PET activity was strongly associated with stable angiographic disease. In cases of angiographic progression, change was preceded by the presence of FDG‐PET activity.
Background and Purpose: Few persons with Parkinson disease (PD) appear to engage in moderate-inte... more Background and Purpose: Few persons with Parkinson disease (PD) appear to engage in moderate-intensity walking associated with disease-modifying health benefits. How much time is spent walking at lower, yet still potentially beneficial, intensities is poorly understood. The purpose of this exploratory, observational study was to describe natural walking intensity in ambulatory persons with PD. Methods: Accelerometer-derived real-world walking data were collected for more than 7 days at baseline from 82 participants enrolled in a PD clinical trial. Walking intensity was defined according to the number of steps in each active minute (1-19, 20-39, 40-59, 60-79, 80-99, or ≥100 steps). Daily minutes of walking and duration of the longest sustained walking bout were calculated at each intensity. Number of sustained 10 to 19, 20 to 29, and 30-minute bouts and greater at any intensity also were calculated. Values were analyzed in the context of physical activity guidelines. Results: Most da...
Patients with systemic sclerosis complicated by both pulmonary hypertension (SSc‐PH) and intersti... more Patients with systemic sclerosis complicated by both pulmonary hypertension (SSc‐PH) and interstitial lung disease (SSc‐PH‐ILD) have poor prognosis compared to those with SSc‐PH or SSc‐ILD alone. Little is known of how ILD severity affects outcomes in those with SSc‐PH, or how PH severity affects outcomes in those with SSc‐ILD. Herein, we aimed to delineate clinical features of patients with SSc‐PH and SSc‐ILD and determine to what degree PH and ILD severity contribute to mortality in patients with SSc. We conducted parallel retrospective studies in cohorts of patients with SSc‐PH and SSc‐ILD. We categorized ILD severity by pulmonary function testing and PH severity by cardiopulmonary hemodynamics. Our primary outcome was all‐cause mortality from time of PH or ILD diagnosis for the SSc‐PH and SSc‐ILD cohorts, respectively. We calculated adjusted risks of time to all‐cause mortality using Cox proportional hazards models. In patients with SSc‐PH, severe ILD (HR: 3.54; 95% CI: 1.05, 11...
ObjectiveDiagnosis of pulmonary hypertension (PH) in systemic sclerosis (SSc) requires an invasiv... more ObjectiveDiagnosis of pulmonary hypertension (PH) in systemic sclerosis (SSc) requires an invasive right heart catheterization (RHC), often based on an elevated estimated pulmonary artery systolic pressure on screening echocardiography. However, because of the poor specificity of echocardiography, a greater number of patients undergo RHC than necessary, exposing patients to potentially avoidable complication risks. The development of improved prediction models for PH in SSc may inform decision‐making for RHC in these patients.MethodsWe conducted a retrospective study of 130 patients with SSc; 66 (50.8%) were diagnosed with PH by RHC. We used data from pulmonary function testing, electrocardiography, echocardiography, and computed tomography to identify and compare the performance characteristics of 3 models predicting the presence of PH: 1) random forest, 2) classification and regression tree, and 3) logistic regression. For each model, we generated receiver operating curves and cal...
Objective.To investigate whether walking speed at 1 timepoint, decline over the past 12 months, o... more Objective.To investigate whether walking speed at 1 timepoint, decline over the past 12 months, or both predict mortality risk over 11 years in adults with, or at risk of, knee osteoarthritis (OA).Methods.Using the data from the Osteoarthritis Initiative, we defined slow versus adequate walking speed as walking < 1.22 versus ≥ 1.22 m/s on a 20m walk test during the 12-month follow-up visit. We defined meaningful decline (yes/no) as slowing ≥ 0.08 m/s over the past year. At the 12-month visit, we classified adequate sustainers as those with adequate walking speed and no meaningful decline, slow sustainers as slow walking speed and no meaningful decline, adequate decliners as adequate walking speed and meaningful decline, and slow decliners as slow walking speed and meaningful decline. Mortality was recorded over 11 years. To examine the association of walking speed with mortality, HR and 95% CI were calculated using Cox regression, adjusted for potential confounders.Results.Of 422...
ObjectiveDespite increasing prevalence of end-stage renal disease (ESRD), little attention has be... more ObjectiveDespite increasing prevalence of end-stage renal disease (ESRD), little attention has been directed to how occupational exposures may contribute to risk. Our objective was to investigate the relationship between metalworking fluids (MWF) and ESRD in a cohort of 36 703 male autoworkers.MethodsWe accounted for competing risk of death, using the subdistribution hazard approach to estimate subhazard ratios (sHRs) and 95% CIs in models with cubic splines for cumulative exposure to MWF (straight, soluble or synthetic).ResultsBased on 501 ESRD cases and 13 434 deaths, we did not observe an association between MWF and ESRD overall. We observed modest associations between MWF and ESRD classification of glomerulonephritis and diabetic nephropathy. For glomerulonephritis, the 60th percentile of straight MWF was associated with an 18% increased subhazard (sHR=1.18, 95% CI: 0.99 to 1.41). For diabetic nephropathy, the subhazard increased 28% at the 60th percentile of soluble MWF (sHR=1....
Purpose: Current walking interventions for people with knee osteoarthritis (OA) focus on either r... more Purpose: Current walking interventions for people with knee osteoarthritis (OA) focus on either reducing knee joint loading or on increasing physical activity. There is a need for interventions that could address both quality and quantity of walking for people with knee OA. The goal of this randomized controlled trial (clinicaltrials.gov # NCT03064139) was to determine the feasibility of a mindful walking intervention to improve quality and quantity of walking in people with knee OA. Methods: Individuals with symptomatic knee OA were recruited from the community using advertisements. Study criteria are shown in Table 1. [Formula presented] During enrollment, the more symptomatic knee, or a knee selected at random in case of equal symptoms, was designated as the study knee. After the baseline visit, participants were randomized to either a mindful walking group (MWG) or an attention-matched self-management group (SMG). Participants in both groups received 11 intervention sessions delivered over a 6-month period (4 in 1 st month, 2 each in 2nd and 3rd months, 1 each in 4th, 5th, and 6th months). Interventions were delivered via in-person groups (4-10 in each group) and each session was 1.5-3 hours in duration. For MWG, a certified instructor provided training in mindful walking that includes whole-body movement retraining and mindful body-awareness skill building. Biomechanical elements include: shorter stride length, higher cadence, greater toe-in, and more aligned posture. Participants were coached to progressively increase their mindful walking activity each week. Mindfulness elements include mindful body-awareness skills to increase sensitivity and awareness of deviations from the taught techniques. The approach is based on “ChiWalking®” so called because the movement approaches are drawn in part from T’ai Chi. For SMG, a researcher delivered a curriculum consisting of education and self-management techniques (e.g., importance of physical activity and exercise, nutrition, weight-management, etc.). This information was also provided to MWG in a condensed form. Gait analyses and physical performance tests were completed at baseline and 6-months. Physical activity was assessed using a commercial wrist-worn activity monitor (Charge 3, Fitbit Inc, San Francisco, CA). Participant-reported outcomes (PROs) were completed at baseline and every 3-months. Participants were remotely followed for an additional 6-months after the end of the intervention. Given the feasibility nature of the study, primary outcomes included recruitment, adherence, retention and number of adverse events. Secondary outcomes included peak external knee adduction moment [KAM], daily step count, Knee injury and osteoarthritis outcome score (KOOS) Pain, Five Facet Mindfulness Questionnaire (FFMQ), Arthritis Self-Efficacy Scale (ASES), 30-second chair stand test (30STS), 40-meter fast paced walk test (40FPW), and Stair Climbing Test (SCT). Analyses were conducted on intention-to-treat basis with all randomized participants included and missing values were not imputed. Results: Participants were recruited between March 2019 and January 2020. During this period, ∼450 individuals completed pre-screening questionnaires (∼41 per month), 66 completed in-person screening visits, 47 were enrolled, and 44 were randomized (Table 2). Interventions for 19 participants were interrupted, delayed for 3-months, and then transitioned to virtual format due to the COVID-19 pandemic. While the original recruitment goal was 62, the trial was halted earlier due to COVID-19. [Formula presented] Attendance is shown in Table 3. On average, MWG group attended 63% of the sessions vs. 70% in the SMG group. Among those who attended at least 1 session, MWG group attended 69% vs. 77% for SMG. Among those who attended at least 3 sessions, MWG group attended 75% vs. 84% for SMG. Post-intervention, 65% (n=15) and 87% (n=20) of MWG completed the in-person visits and PROs, respectively. In SMG, 81% (n=17) completed in-person visits and PROs. At 12-months, 91% (n=21) and 71% (n 15) completed the PROs for MWG and SMG, respectively. [Formula presented] Participant feedback at 6- and 12-months showed that the intervention was acceptable (Table 4). There were no serious adverse events related to the intervention in either group. Within group and between group differences for secondary outcomes are shown in Table 5. [Formula presented] [Formula presented] Conclusions: Our benchmarks were recruitment over 1.5 years, attendance of 75% in MWG group, and retention of 80% of participants at 6-months. While all of these benchmarks were negatively impacted by COVID-19, the recruitment rates over the period studied, adherence in those who attended at least 3 sessions, and retention for some secondary outcomes were acceptable. Participants in both groups found the interventions helpful, enjoyable, and rated it highly. At 12-month follow-up, MWG participants continued to practice mindful…
Endogenous and exogenous ligands of microbial origin stimulate inflammation associated with ather... more Endogenous and exogenous ligands of microbial origin stimulate inflammation associated with atherosclerosis progression via the innate immune Toll like receptors (TLRs). The oral pathogen Porphyromonas gingivalis induces inflammatory oral bone destruction manifested as periodontal disease, a common chronic disease. P. gingivalis-mediated periodontal disease is now recognized as a risk factor for systemic inflammatory diseases including, diabetes, stroke, and atherosclerotic and cardiovascular diseases. We have previously demonstrated that TLR2 deficiency diminished P. gingivalis-mediated atherosclerosis in an ApoE-/-mouse model. In the current study we demonstrate that TLR4 plays a protective role in P. gingivalis induced atherosclerosis. ApoE-/- and Apoe-/-TLR4-/- mice on normal chow diet were orally challenged with P. gingivalis or saline 5 times / week for 3 weeks. Thirteen weeks after the last challenge, plaque and inflammatory cell accumulation was analyzed in aortic tissue. Pl...
BODY: Purpose Hypothesis: Declines in the amount and intensity of natural walking behavior in peo... more BODY: Purpose Hypothesis: Declines in the amount and intensity of natural walking behavior in people with Parkinson disease (PD) may precede declines in motor behavior, gait, and balance.[1,2] Physical interventions targeting walking behavior in PD may have the greatest impact on slowing the progression of disability.[3-5] Despite a lack of supporting evidence, however, clinicians may be more likely to rely on quick performance measures of walking speed, capacity, and balance to make inferences about a patient’s walking health, rather than direct measures of natural walking behavior. Our primary purpose, therefore, was to examine the extent to which clinical walking measures might predict natural walking behavior in early to mid-stage PD. Secondarily we sought to explore differences in the predictive capability of clinical measures between relatively less active and more active participants. Number of Subjects: 58 Materials/Methods: Data were collected from 34 males and 24 females (...
cautious when using clinical measures to make inferences about Natural Walking Behavior in people... more cautious when using clinical measures to make inferences about Natural Walking Behavior in people with Parkinson disease. Non-Cognitive Predictors of Student Success: A Predictive Validity Comparison Between Domestic and International Students Non-Cognitive Predictors of Student Success: A Predictive Validity Comparison Between Domestic and International Students INTRODUCTION • Declines in the amount and intensity of natural walking behavior in people with PD may precede declines in motor behavior, gait and balance. • Yet clinicians may be more likely to rely on quick performance measures of walking speed, capacity, and balance to make inferences about walking health, rather than employ direct measures of natural walking behavior. METHODS • Baseline assessment for prospective clinical trial. • 58 participants with PD: 34 Male / 24 Female 67.7 ± 8.0 years H&Y 2.0-3.0 • Clinical Measures: Walking speed (10MWT, 10m Walk Test, m/s) Walking distance (6MWT, 6 Minute Walk Test, m) Dynamic ...
Archives of Physical Medicine and Rehabilitation, 2021
OBJECTIVE To examine the association of the volume and intensity of daily walking at baseline wit... more OBJECTIVE To examine the association of the volume and intensity of daily walking at baseline with the risk of knee replacement (KR) over five years in adults with advanced structural knee osteoarthritis. DESIGN Prospective, longitudinal, and multi-center observational study. SETTING Osteoarthritis Initiative study with follow-up from 2008 to 2015. PARTICIPANTS Community-dwelling adults with or at risk of knee OA were recruited from four sites in the United States. We included participants with advanced structural disease, without KR and had valid daily walking data (quantified using Actigraph GT1M), at baseline. INTERVENTION Not applicable. MAIN OUTCOMES KR. Walking volume was measured as steps/day and intensity as minutes/day spent not walking (0 steps/min), and walking at very-light (1-49 steps/min), light (50-100 steps/min), or moderate (>100 steps/min) intensities. To examine the relationship of walking volume and intensity with the risk of KR, we calculated hazard ratios (aHR) and 95% confidence intervals (CI) adjusting for covariates. RESULTS Of 516 adults with advanced structural disease ([mean±sd] age: 67.7±8.6 years, BMI: 29.3±4.7 kg/m2, 52% female), 88 (17%) received a KR over five years. Walking an additional 1,000 steps/day was not associated with the risk of KR (adjusted HR 0.95, 95% CI [0.84, 1.04]). Statistically replacing 10 minutes/day of very-light and light walking with 10 minutes/day of moderate walking reduced the risk of KR incidence by 35% and 37%, respectively (adjusted HR 0.65, 95% CI [0.45 to 0.94] for very light, and adjusted HR 0.63, 95%CI [0.40 to 1.00] for light). CONCLUSION Daily walking volume and intensity did not increase KR risk over five years, and may be protective in some cases in adults with advanced structural knee OA.
Background and Purpose: Walking activity in persons with Parkinson disease (PD) is important for ... more Background and Purpose: Walking activity in persons with Parkinson disease (PD) is important for preventing functional decline. The contribution of walking activity to home and community mobility in PD is poorly understood. Methods: Cross-sectional baseline data (N = 69) were analyzed from a randomized controlled PD trial. The Life-Space Assessment (LSA) quantified the extent, frequency, and independence across 5 expanding levels of home and community mobility, producing individual subscores and a total score. Two additional summed scores were used to represent mobility within (Levels 1-3) and beyond (Levels 4-5) neighborhood limits. An accelerometer measured walking activity for 7 days. Regression and correlation analyses evaluated relationships between daily steps and mobility scores. Mann-Whitney U tests secondarily compared differences in mobility scores between the active and sedentary groups. Results: Walking activity contributed significantly to the summed Level 1-3 score (β ...
Uploads
Papers by Michael Lavalley