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Background: The Exercise interveNtion outdoor proJect in the cOmmunitY (ENJOY) Seniors Exercise Park program uses specialized outdoor equipment and a physical activity program to engage older people in physical activity, with multiple health benefits. We determined the cost-effectiveness of the ENJOY program. Methods: The economic evaluation compared health care utilization costs 6 months prior to and 6 months post ENJOY program participation. Incremental cost-utility analysis for the primary aim (quality of life) and incremental cost-effectiveness analysis for the secondary aim (falls) were used. Analyses took a societal perspective inclusive of Australian government-funded health care and pharmaceuticals in addition to hospitalizations, community-based nursing and allied health, and community services. Productivity costs were also calculated. Results: Fifty participants (average age 72.8 y [SD 7.4] and 78.0% [n = 39/50] women) were included. Participation in the ENJOY program reduced health care costs in the 6 months following the program: preintervention, $9764.49 (SD $26,033.35); postintervention, $5179.30 (SD $3826.64); observed postintervention reduction −$4.585.20 (95% confidence interval, −$12,113.99 to $2943.59; P = .227) without compromising quality of life (mean difference [MD] 0.011; 95% confidence interval, −0.034 to 0.056; P = .631) or increasing the likelihood of a fall (−0.5; 95% confidence interval, 0.00 to −0.50; P = .160). The ENJOY intervention is likely cost-effective. Conclusions: Planning for shared community spaces should consider the benefits of a Seniors Exercise Park as part of the built environment.

Background The physical environment has been shown to have a positive effect on the promotion of physical activity of older people. Outdoor environments that incorporate specialised exercise equipment suitable for older people are uniquely placed to promote physical activity and social connectedness amongst older people. The ENJOY project included the installation of specialised outdoor exercise equipment (the Seniors Exercise Park) and the delivery of a physical and social activity program for older people as part of a prospective pre-post research design. The installation of the specialised equipment in public sites and an aged care facility was also aimed at increasing usage of the equipment by older people from the wider community and to increase physical and social activities. Method A conceptual framework for implementation and several engagement methods were utilised to guide the research and to support the participating partners throughout the project. This paper is a reflective narrative describing the collaborative process and approach utilised to engage local governments and community, and reports the challenges and the lessons learnt to inform future strategies for implementation. Results The conceptual framework for the implementation process that guided the conduct and delivery of the ENJOY project included the core elements of the Interactive Systems Framework and the ecologic framework. These models incorporate elements of research-to-practice and community-centred implementation to accommodate the unique perspectives of a range of stakeholders. Conclusion Partner characteristics such as local governments’ structure and policy as well as community factors can impact on implementation. Partnership with local governments with effective communication, strategic planning and community and seniors engagement approaches are recommended for successful implementation. The lessons learnt can further assist public health research design around changes to the built environment to positively impact on older people’s physical activity levels. Trial registration Trial registration number ACTRN12618001727235. Date of registration 19th October 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375979

The world population is aging. With increased life expectancy comes increased risk of major health problems that affect the health and well-being of older adults. Adequate levels of physical activity as specified by current global guidelines can reduce the risk of health problems in older adults. However, fewer than half of older adults are sufficiently active, and thus are unlikely to achieve these health benefits. Older adults living in residential aged care are even more sedentary, with multiple health issues and comorbidities. While meeting physical activity guidelines confers the greatest benefit for physical function, the practicality of adherence to these guidelines for older people who are not healthy and have complex medical issues is questionable. This special interest paper discusses research evidence on the topic of physical activity for older people across the health spectrum, with and without multiple comorbidities. This discussion is informed by professional experience, and suggests practical recommendations to positively impact physical activity engagement in the older adult population.

Objectives: Long-term engagement and participation in physical activity by older adults in the general population is poor. The Exercise interveNtion outdoor proJect in the cOmmunitY for older people (the ENJOY project) is a community-based research project utilizing an outdoor Seniors Exercise Park that demonstrated increased physical activity level as well as physical and mental health benefits. This study aims to explore participants’ perceptions about barriers and facilitators to ongoing participation as well as the usage pattern of the Seniors Exercise Park. Method: People aged ≥60 yr underwent a 12-wk structured supervised physical activity program using outdoor exercise park equipment followed by a 6-month maintenance phase. Participants completed two surveys: at the completion of the 12-wk structured supervised program and at the completion of the 6-month maintenance phase. Access to the Seniors Exercise Park was also electronically monitored during the maintenance phase. Results: The social aspect (60%), health benefits/improvement (41.5%), and supervision (36.9%) were the most cited factors in positively supporting participation, with 60.8% continued using the Exercise Park regularly during the maintenance phase. The main barriers to continued usage for both regular users and nonusers included other commitments (71.4%), the weather (60.7%), and medical/health problems (42.8%). Conclusions: The Seniors Exercise Park can be utilized to promote sustainable engagement in physical activity for older people. However, future implementation strategies should consider approaches to overcome barriers for participation.

Background Physical activity is important to maintain health in older age, with physical activity in the outdoors providing mental and physical health benefits for all age groups. One way by which older people can engage in physical activity in the outdoors is through using suitable age-friendly outdoor exercise equipment, the Seniors Exercise Park. The ENJOY MAP for HEALTH aims to evaluate the effect of the Seniors Exercise Park installation and associated capacity building activities on park visitation, park-based physical activity by older people and delivery of community physical activity programs. Method This study is a quasi-experimental (natural experiment) with pre and post study design evaluating the effect of age-friendly outdoor spaces with specialised outdoor exercise equipment on older people’s physical activity and wellbeing in six Victorian municipalities (local governments/councils). Each council will undergo four stages (site construction and development, promotion and marketing, capacity building and training, evaluation and sustainability). Several activities and methods will be employed from stage one through stage four to evaluate the potential impact of the age-friendly outdoor spaces on physical activity and wellbeing and will comprise the following elements: site observation and equipment utilisation, face to face intercept surveys, development of an online access monitor and community building activities. Discussion The project is expected to result in a significant change in the physical outdoor environment for the participating councils and communities whereby older people and other community members will be able to engage in safe physical and social activity programs, socialise more and hence improve the overall wellbeing of older people. Trial registration This trial is retrospectively registered with the Australian New Zealand Clinical Trials Registry. Trial registration number ACTRN12621000965808. Date registered 23/07/2021.

Outdoor exercise equipment has become popular as important environmental infrastructure to provide opportunities for physical activity and social connectedness in public settings. With higher sedentary behaviour and physical inactivity reported among older people, infrastructure changes and safe environments that promote older peoples’ health and mobility are required. Due to ageing‐related functional decline and health conditions associated with ageing, older adults may have special physical needs that require careful consideration when choosing outdoor equipment. However, limited information is available regarding the suitability of the types of exercise equipment for older people. This commentary provides further information on the type of equipment available, its functionality and suitability for older age populations and key considerations for the decision‐maker involved in selecting, installing and supporting community use of outdoor exercise equipment. Recommendations on what is required to maximise usability from a system or organisational‐based approach using research evidence is also discussed. Older people are more susceptible to the negative influences of their local environment and outdoor neighbourhood conditions. Consequently, the age‐friendliness and suitability of the outdoor exercise equipment characteristics, location and settings may facilitate older adults’ engagement in physical and social activities.

OBJECTIVE The present study was undertaken to assess the comparative responsiveness of outcome measures used for the assessment of pain and function in individuals with osteoarthritis (OA) of the first metatarsophalangeal (MTP) joint. METHODS Eighty-eight patients (mean ± SD age 57.2 ± 10.2 years) with OA of the first MTP joint who participated in a randomized trial completed the Foot Health Status Questionnaire (FHSQ), the Foot Function Index Revised Short Form (FFI-RS), and 100-mm visual analog scales (VAS) of pain and stiffness at baseline and 12 weeks. Responsiveness of the subscales for each outcome measure was determined using paired t-tests, Cohen's d coefficient, the standardized response mean (SRM), and the Guyatt index (GI). Sample size estimations were calculated based on minimal important differences (MIDs). RESULTS All outcome measures were sensitive to change and demonstrated at least medium effect sizes. Three outcome measures exhibited large or very large effect sizes for Cohen's d coefficient, the SRM, and the GI: the FHSQ pain subscale (d = 1.03; SRM 1.10, GI score 1.30), the FFI-RS pain subscale (d = 1.09; SRM 1.05, GI score 1.73), and the 100-mm VAS of pain severity while walking (d = 1.22; SRM 1.07, GI score 1.78). Sample size calculations indicated that between 20 and 33 participants per group would be required to detect MIDs using these measures. CONCLUSION The FHSQ pain subscale, FFI-RS pain subscale, and the 100-mm VAS of pain severity while walking are the most responsive outcome measures for the assessment of pain and function in individuals with OA of the first MTP joint. These findings provide useful information to guide researchers in selecting appropriate outcome measures for use in future clinical trials.

The COVID-19 pandemic has taken a significant toll on people's health and wellbeing globally. In the pandemic, parks, gardens and other local green spaces have been recognised as vital to people's physical and mental health. Emerging global evidence shows increased access to local parks and recreational activities and a new appreciation of the natural surroundings. Various movements and organisations globally have called for actions to embrace recent trends and changes in relation to the planning of public spaces and urban built environments to enable better access to parks and nature. The crisis, however, has exposed the inequities around access to green space where vulnerable populations such as older people and those in low socioeconomic areas are particularly affected. The crisis presents an opportunity to positively impact on society, and an opportunity to consolidate new emerging trends to better integrate nature into the architecture, infrastructure, and public spaces of urban areas.

Background While the underlying neuropathology of dementia is not curable, interventions and treatment, such as physical activity, can offer physical and functional gains leading to better mobility, independence and quality of life. The Seniors Exercise Park program is an evidence-based physical and social activity program using an innovative design in outdoor exercise equipment specifically designed for older people. This unique program has never been tested with older people living with dementia. This study will evaluate the feasibility of delivering the Seniors Exercise Park program for people living with mild to moderate dementia in residential aged-care. This study will identify the optimal physical activity program, evaluate the safety of equipment usage and determine optimal supervision needs. The potential physical, social, quality of life and cognitive benefits of participation in the Seniors Exercise Park program will also be examined. Methods This is a feasibility pilot randomised controlled design with pre-post evaluation. Adults aged ≥ 60 years who have symptoms of dementia and/or who have been diagnosed with dementia will be recruited from an aged-care facility in Melbourne. Participants allocated to the intervention group will undergo a 12-week structured supervised physical activity program using the outdoor Seniors Exercise Park equipment followed by a 12-week maintenance phase (unstructured physical activity). Participants will be assessed at baseline, 3 and 6 months. Participants allocated to the control group will attend activities provided by the aged-care facility. A sample of 12 participants per group is the targeted sample size. Feasibility will be evaluated in terms of recruitment rate, retention, attendance, overall adherence, dropout rate, adverse events, modifications to the exercise program delivery and supervision needs. A comprehensive suite of cognitive and health-related questionnaires and physical function measures will also be collected. Discussion The ENJOY program for independence in dementia will determine the suitability of the Seniors Exercise Park program for people diagnosed with mild to moderate dementia. Outcomes could inform future design of dementia-friendly built environments to increase physical activity participation for residential aged-care facilities. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry—Registry Number ACTRN12620000733976. Registered on the 13th of July 2020.

OBJECTIVES Falls and fall-related injuries amongst older people continue to be a long-term public health issue. Access to specialist services that target fall prevention has been shown to improve outcomes. This project aimed to develop an online directory of public outpatient and ambulatory falls and balance clinics and programs in Victoria. METHOD Environmental scan of existing services and survey of service providers between January and August 2020. RESULTS Forty-seven community-based and 53 hospital-based falls and balance services across metropolitan (46%) and regional (54%) Victoria registered. The majority of services were programs (70%) targeting exercise and/or education, as opposed to clinics (30%), which focus on diagnosis and developing management plans. Survey responses were collated to develop an online service directory: https://www.nari.net.au/victorian-falls-directory CONCLUSION: The Victorian Falls and Balance Service Directory provides a centralised and accessible reference for clinicians and community members regarding available outpatient and ambulatory services that target fall prevention.

Background Creating inclusive and accessible outdoor environments that provide and encourage opportunities for older adults to engage in physical activity and social interaction is important for healthy ageing. The Senior Exercise Park is outdoor exercise equipment designed specifically for use by older people that provides physical and social benefits for older people in the community, and has the potential to be used widely as a sustainable mode of physical activity. The aim of this study is to implement and evaluate the effects of sustained engagement through the use of a community-based novel outdoor physical activity program (purpose-built exercise park) for older people on physical, mental and social health and physical activity outcomes (the ENJOY project). Methods This is a prospective pre-post design study with 12 months follow up. Adults aged ≥60 years will be recruited from the general community from the suburbs close to the Senior Exercise Parks locations in Melbourne. Participants will undergo a 12 week structured supervised physical activity program using the outdoor Senior Exercise Park equipment followed by 6 months unstructured physical activity program. Participants will be assessed at baseline, 3, 9, and 12 months. The following outcomes will be assessed: physical activity, physical function, psychosocial and mental health outcomes, falls risk and falls occurrence, participants’ feedback and satisfaction, and health care resource use. Discussion The ENJOY trial is designed to operate in a community setting with local government engagement to maximise the usage of the exercise park and provide an outdoor space for older people to be physically active. This project will evaluate the effectiveness and sustainability of the outdoor exercise park on a range of health outcomes and its long-term usability in the community. Trial registration This trial is prospectively registered with the Australian New Zealand Clinical Trials Registry. Trial registration number ACTRN12618001727235 registered 18th of October 2018. Electronic supplementary material The online version of this article (10.1186/s12889-019-7125-2) contains supplementary material, which is available to authorized users.

Since the beginning of time people explored and developed new technologies to make their activities of daily living less labour intense, more efficient and, consequently, more sedentary. In addition, technological advances in medicine throughout history have led to a substantial increase in life expectancy. However, the combination of increased sedentary behaviour and increased life-expectancy resulted in a sharp increase in overweight and obesity related chronic conditions and illness. Although people may live longer, they are doing so with poorer physical function and a reduced quality of life. In this review we explore how technological advances have influenced people's sedentary behaviour and, through the lens of the affective-reflective theory (ART), we propose a means by which technology could be repurposed to encourage greater engagement in physical activity.

Background\ud \ud The aim of this study was to compare centre of pressure (COP) characteristics between healthy adults with normal, planus or cavus feet who were allocated to groups based on reliable foot posture measurement techniques.\ud \ud Methods\ud \ud Ninety-two healthy adult participants (aged 18 to 45) were recruited and classified as either normal (n = 35), pes planus (n = 31) or pes cavus (n = 26) based on Foot Posture Index, Arch Index and normalised navicular height truncated measurements. Barefoot walking trials were conducted using an emed®-x 400 plantar pressure system (Novel GmbH, Munich, Germany). Average, maximum, minimum and range (difference between maximum and minimum) values were calculated for COP velocity and lateral-medial force index during loading response, midstance, terminal stance and pre-swing phases of stance. The COP excursion index was also calculated. One-way analyses of variance were used to compare the three foot posture groups.\ud \ud Results\ud \ud The cavus foot exhibited the slowest average and minimum COP velocity during terminal stance, but this pattern was reversed during pre-swing, when the cavus foot exhibited the fastest maximum COP velocity. The planus foot exhibited the smallest lateral medial force index range during terminal stance. There were no differences between the groups for COP excursion index.\ud \ud Conclusion\ud \ud These findings indicate that there are differences in COP characteristics between foot postures, which may represent different mechanisms for generating force to facilitate forward progression of the body during the propulsive phases of gait.

Background Many research studies evaluate physical activity interventions for older people in the community, however relatively few successfully promote maintenance of physical activity beyond the completion of the intervention. This study aimed to implement and evaluate the effects of sustained engagement in physical activity on mental, social and physical health outcomes through the use of the Seniors Exercise Park physical activity program for older people (the ENJOY project). Method People aged ≥60 years underwent a 12-week structured supervised physical activity program using outdoor exercise park equipment followed by 6 months unstructured independent use of the exercise park. Participants were assessed at baseline, 3 months and 9 months and completed a test battery evaluating physical activity, physical function and health related quality of life measures. Repeated measures ANOVA was used to compare differences between baseline, 3 and 9 months. Results Of the 95 participants, 80 (84.2%) completed the 3 months supervised program, and 58 (61%) completed the 9 month assessment (the latter impacted by COVID-19 restrictions). A significant increase in physical activity level was demonstrated following the 12 weeks intervention (p p p p p p p = 0.01) and loneliness (p = 0.03) at 3 months. At the 9 months follow up, significant improvements from baseline were demonstrated in the frequency, duration and total of physical activity level (p p p < 0.05). Conclusion The Seniors Exercise Park may be an effective modality for improving and sustaining older people’s physical function and wellbeing and can be an important public health infrastructure investment in promoting physical activity for older people. Future work should focus on wider implementation of the program and on scaling up this initiative to achieve public health benefit for the community. Trial registration Trial registration number ACTRN12618001727235, Date of registration 19th October 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375979

The objective of this systematic review was to examine the effectiveness of outdoor exercise park equipment on physical activity levels, physical function, psychosocial outcomes, and quality of life of older adults living in the community and to evaluate the evidence of older adults’ use of outdoor exercise park equipment. A search strategy was conducted from seven databases. Nine articles met the inclusion criteria. The study quality results were varied. Meta-analyses were undertaken for two physical performance tests: 30-s chair stand test and single-leg stance. The meta-analysis results were not statistically significant. It was not possible to conclude whether exercise parks were effective at improving levels of physical activity. The review shows that older adults value the benefits of health and social interaction from the use of exercise parks. Findings should be interpreted with caution due to the small sample sizes and the limited number of studies.

Age-friendly cities are crucial to achieve the WHO goal of healthy aging. Such cities promote opportunities for health, participation, and security, thus enhancing quality of life as people age. Older people commonly experience psychosocial challenges such as anxiety, depression, substance abuse, loss of autonomy, grief, fear, and loneliness. Australian and Canadian cities continue to seek innovation to improve healthy urban aging and create more age-friendly environments for older adults. There is increasing evidence on the effectiveness and feasibility of mobile technology in health promotion and closing psychological treatment gaps. Older adults have been demonstrated to engage frequently with mobile devices, particularly text messaging. In this article, we conceptualize the Text4HealthyAging, an evidence-based text messaging innovation to support healthy urban aging in Canadian and Australian cities.

Patients undergoing total knee arthroplasty often have unfulfilled expectations from the surgery that can lead to dissatisfaction. This study aimed to examine the discrepancy between patients’ expectations and actual functional abilities prior to undergoing knee replacement surgery, and at 6 and 12 months following the surgery. A survey was undertaken of patients before, and 6 and 12 months post-surgery. The survey included the Knee Surgery Perception Questionnaire (KSPQ) to assess patients’ current perception of their level of function and pain, their desired outcomes, and the discrepancy between the two. Pain, function and quality of life were also assessed. Repeated measure ANOVAs were used to assess differences between pre- and post-surgery. A total of 176 patients were surveyed. Significant differences in the KSPQ discrepancy scores (subscale and total scores) were demonstrated between the three assessment point times (p

Issue addressed: Exercising outdoors provide beneficial effect on mental and physical health for all ages. However, few older people exercise outdoors other than walking. While outdoor gyms have become increasingly common in Australia, limited outdoor exercise equipment specifically designed for older people is available in public spaces. We have set up and evaluated a unique purpose-built outdoor exercise park for older people in the community setting and demonstrated positive physical and wellbeing outcomes associated with the provision of this unique exercise mode and social program. Methods: This study is a reflective narrative describing this innovative exercise approach and reports challenges associated with establishment of the exercise park, conducting the randomised trial, strategies adopted to address these challenges and recommendations for future implementation of this approach in the community. Results: Many challenges were encountered, including securing appropriate land to locate the exercise park, control of environmental factors for safety (non-slippery ground and equipment) as well as logistics in running the exercise program itself. Several adjustments in the equipment were also required to ensure safe use by older people. Conclusion: The inclusion of outdoor equipment for older people in public spaces or urban parks is important and careful consideration needs to be taken by local/public authorities to provide access, amenities and safety for all as well as activities to suit all ages. So what?: Seniors’ exercise parks can be installed in public places and may provide an enjoyable and effective approach to engage older individuals in a more active and healthier lifestyle.

This study aimed to investigate the acceptability, barriers, enablers, perceived benefits, and outcomes in undertaking an exercise intervention using a novel outdoor exercise park designed for senior citizens. This study was a parallel randomised controlled trial with pre- and post-intervention design (outcome assessments at baseline and at eighteen weeks after participation commencement). Twenty-seven independent community-dwelling adults (75.1 ± 7.9 years; seventeen females; ten males) underwent an interview after completing the eighteen-week exercise intervention. A thematic analysis approach was used to evaluate the content of the interviews. Participants reported that the exercise intervention proposed was very enjoyable and had varied perceived benefits. The exercise intervention has been positively rated by the participants. The main outcomes perceived from their participation were physical (e.g., improvements in muscle strength, balance, flexibility, and gait), psychological (e.g., improved confidence and well-being and reduced depression symptoms) and psychosocial (e.g., improved social interaction). Participants also perceived an improvement on their ability to perform activities of daily living (e.g. climbing stairs, tying shoelaces, and catching public transport). The exercise-park program has been shown to be a well-accepted, novel option for older adults to exercise outdoors and therefore might enhance exercise uptake and attendance and sustain participation in exercise programs for older adults in the community.

Muscle function is often impaired in patients with knee osteoarthritis (OA), with reduced strength and increased pain. The role of vitamin D and the vitamin D-endocrine pathway in muscle health has recently been placed in the spotlight, with various groups reporting positive effects on muscle development, function and health. Recently, it has been shown that uptake into muscle of the specialized vitamin D binding protein (DBP) is dependent on the endocytic receptor, megalin. Here we analyse circulating vitamin D, and muscle DBP, megalin and the cognate vitamin D receptor (VDR) in patients with knee OA and compare them to asymptomatic controls. Muscle and blood samples were collected from 19 patients with end-stage OA of the knee and 10 age-matched controls. Muscle biopsies from the OA group were performed during knee replacement surgery and a needle biopsy was used on control volunteers. Immunoblots performed with specific antibodies were used to detect the presence of DBP, megalin, VDR (using the specific D-6 antibody) and albumin in the muscle biopsies. Results were correlated with FoxO1, a key regulator of the ubiquitin-proteasome degradation pathway in muscle. There were no differences in circulating levels of 25 (OH) vitamin D3 between the groups, and no subjects were vitamin D deficient. We found increased VDR, DBP and albumin protein in the muscle from patients with OA compared to controls, with no change in muscle megalin expression. Furthermore, DBP levels in the muscle correlated with FoxO1, suggesting an association between muscle protein breakdown and the activation of the vitamin D-endocrine pathway in muscle surrounding an OA affected joint. We show, for the first time, that the factors involved in the vitamin D-endocrine-pathway are present at higher levels in muscles from OA patients compared to asymptomatic controls. This is despite no differences in circulating 25 (OH) vitamin D levels between the groups. These findings indicate the activation of vitamin D pathway in these muscles that may provide a beneficial compensatory stimulation of the repair process in muscles that are subject to inflammatory and proteolytic processes.

Self-efficacy is positively associated with adherence behaviours and rehabilitation outcomes following Anterior Cruciate Ligament (ACL) reconstruction. An internet resource can be an effective way to provide information, goal setting, patient monitoring and hence support overall self-management.This study examined the feasibility of a three month 'internet-based intervention' (mobile-oriented site) to enhance recovery for patients following ACL reconstruction. The potential effect of the internet-based intervention on knee pain, function, self-efficacy and fear of pain were also assessed.This was a pilot randomised controlled trial (RCT) with pre and post intervention design (assessments at one week and three months following ACL reconstruction) comparing: (1) a control group and (2) an intervention group (internet-based intervention). A set of qualitative and quantitative assessments were included to evaluate potential improvements in self-efficacy, pain and function and perception of the internet intervention.Seventeen participants were available for analysis (n = 10 intervention and n = 7 control group). Participants reported the internet-based intervention to be a useful tool for information, reminder and reinforcement for performing their exercise rehabilitation with 30.3% (±35.3%) adherence to the internet-based intervention. No differences were observed between the groups over time on the outcome questionnaires (p 0.05). Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616001379404.

Background Total hip/total knee replacement (THR/TKR) surgery is becoming an increasingly common approach for the management of primarily lower limb osteoarthritis. A number of factors such as reducing mobility, structural joint changes, and pain may predispose those awaiting hip and knee surgery to falls, which may impact on pre- and postsurgery functions. The aim of this study was to identify the prevalence of falls in the year preceding THR/TKR surgery, and factors associated with falls. Methods Cross-sectional survey of patients scheduled for THR/TKR, including measures of joint disease severity, falls, falls efficacy, quality of life, pain, and depression. Comparisons across falls status (nonfaller, single faller, or multiple faller) and high/low disease severity for both THR and TKR groups were undertaken. Results A total of 282 people (mean age 67.3 years) completed surveys before the surgery (197 TKR). As much as 41% reported one or more falls in the preceding year, and participants reported that the affected joint contributed to the fall in 35% of the cases. TKR multiple fallers (≥ 2 falls) had significantly lower falls efficacy, worse function, greater pain catastrophizing and depression, and poorer 36-Item Short Form Survey Mental Component Scores than nonmultiple fallers. For both THR and TKR groups, several measures were significantly worse for those with greater disease severity, including falls efficacy, depression, pain catastrophizing, self-rated health, and physical activity. Conclusion Falls are common in the 12 months preceding total hip or knee surgery. A number of factors are associated with risk of multiple falls and with joint disease severity. Strategies to reduce falls risk should be a priority in the year preceding lower limb joint surgery to optimize presurgery and postsurgery outcomes.

Background The risk of falling is significantly higher in people with chronic stroke and it is, therefore, important to design interventions to improve mobility and decrease falls risk. Minimum Toe Clearance (MTC) is the key gait cycle event for predicting tripping-falls because it occurs mid-swing during the walking cycle where forward velocity of the foot is maximum. High forward velocity coupled with low MTC increases the probability of unanticipated foot-ground contacts. Training procedures to increase toe-ground clearance (MTC) have potential, therefore, as a falls prevention intervention. The aim of this project is to determine whether augmented sensory information via real-time visual biofeedback during gait training can increase MTC. Methods Participants will be over 18 years, have sustained a single stroke (ischaemic or hemorrhagic) at least 6 months previously, able to walk 50 metres independently and capable of informed consent. Using a secure web-based application (REDCap) 150 participants will be randomly assigned to either no-feedback (Control) or feedback (Experimental) groups, all will receive 10 sessions of treadmill training for up to 10 minutes at a self-selected speed over five to six weeks. The intervention group will receive real-time, visual biofeedback of MTC during training and will be asked to modify their gait pattern to match a required “target” criterion. Biofeedback is continuous for the first six sessions then progressively reduced (faded) across the remaining four sessions. Control participants will walk on the treadmill without biofeedback. Gait assessments are conducted at baseline, immediately following the final training session and then during follow-up, at 1, 3 and 6 months. The primary outcome measure is MTC. Monthly falls calendars will also be collected for 12 months from enrolment. Discussion The project will contribute to understanding how stroke-related changes to sensory and motor processes influence gait biomechanics and associated tripping risk. The research findings will guide our work in gait rehabilitation following stroke and may reduce falls rates. Treadmill training procedures incorporating continuous real-time feedback may need to be modified to accommodate stroke patients who have greater difficulties with treadmill walking.

The risk of falling is significantly higher in people with chronic stroke and it is, therefore, important to design interventions to improve mobility and decrease falls risk. Minimum toe clearance (MTC) is the key gait cycle event for predicting tripping-falls because it occurs mid-swing during the walking cycle where forward velocity of the foot is maximum. High forward velocity coupled with low MTC increases the probability of unanticipated foot-ground contacts. Training procedures to increase toe-ground clearance (MTC) have potential, therefore, as a falls-prevention intervention. The aim of this project is to determine whether augmented sensory information via real-time visual biofeedback during gait training can increase MTC. Participants will be aged > 18 years, have sustained a single stroke (ischemic or hemorrhagic) at least six months previously, able to walk 50 m independently, and capable of informed consent. Using a secure web-based application (REDCap), 150 participants will be randomly assigned to either no-feedback (Control) or feedback (Experimental) groups; all will receive 10 sessions of treadmill training for up to 10 min at a self-selected speed over 5–6 weeks. The intervention group will receive real-time, visual biofeedback of MTC during training and will be asked to modify their gait pattern to match a required “target” criterion. Biofeedback is continuous for the first six sessions then progressively reduced (faded) across the remaining four sessions. Control participants will walk on the treadmill without biofeedback. Gait assessments are conducted at baseline, immediately following the final training session and then during follow-up, at one, three, and six months. The primary outcome measure is MTC. Monthly falls calendars will also be collected for 12 months from enrolment. The project will contribute to understanding how stroke-related changes to sensory and motor processes influence gait biomechanics and associated tripping risk. The research findings will guide our work in gait rehabilitation following stroke and may reduce falls rates. Treadmill training procedures incorporating continuous real-time feedback may need to be modified to accommodate stroke patients who have greater difficulties with treadmill walking. Australia New Zealand Clinical Trials Registry, ACTRN12617000250336 . Registered on 17 February 2017.

Objective: To investigate the feasibility, effectiveness, and short-term effects of an exercise intervention using a novel exercise park in improving seniors’ balance, physical function, and quality of life. Method: Randomized controlled trial with pre- and post-intervention design (baseline and 18-week intervention) was used. Outcome measures included measures of balance, strength, and function, as well as quality of life and fear of falling. MANCOVA was used to assess differences between groups (control and exercise intervention) over time. Results: Intervention group showed significant improvement on single leg stance ( p = .02, 95% confidence interval [CI] = [−8.35, −0.549]), knee strength ( p < .01, 95% CI = [−29.14, −5.86]), 2-min walk ( p = 0.02, 95% CI = [−19.13, −0.859]), and timed sit to stand ( p = .03, 95% CI = [−2.26, −0.143]) tests. Discussion: The exercise park program improved physical function and had high adherence and participation rate. Such intervention has been shown to be safe and therefore might enhance participation in exercise programs for older adults.

Context:The forward-step-down (FSD) test may be used to identify underlying pathologies related to lower-extremity injuries. However, research on its interrater reliability is limited.Objective:To assess the interrater reliability of the FSD test with a broad cohort of clinicians and to compare the level of agreement with an expert panel.Design:Single-measure, interrater reliability.Setting:Annual conference of the Israeli Physical Therapy Society.Participants:15 healthy subjects who performed the FSD test and 142 physical therapists (PTs) who evaluated performance.Methods:Each subject performed the FSD while being videoed. Six videos were selected by an expert panel for analysis. After viewing the videos, FSD performance was rated by 142 PTs, as well as by the expert panel, using a 3-level scale.Main Outcome Measures:Interrater reliability determined by intraclass correlation coefficient (ICC) and percentage of agreement with the expert panel.Results:Fair to good reliability and acceptable agreement were found for the entire sample of raters (ICC –.61, agreement 74%). The percentage of agreement was greater in the subgroup of raters who were familiar with the FSD than in those who were not (78.08% vs 69.32%, respectively, P = .004). Years of work experience did not affect the percentage of agreement (P = .141).Conclusions:Fair to good interrater reliably of the FSD test was demonstrated by a broad cohort of PTs. The findings support the clinical utility of the FSD test as an assessment tool for quality of movement.

Summary Objectives Using a mouse surgical model of post-traumatic osteoarthritis (OA), we sought to determine if muscle function is altered following acute joint injury and whether this relates to OA progression. Design Male C57BL/6 mice underwent surgical transection of the medio-meniscal tibial ligament destabilisation of the medial meniscus (DMM) or sham surgery on one knee. Tibialis anterior (TA) muscle function was assessed in situ at 1, 4 and 8 weeks post-surgery. Cartilage damage and joint inflammation were assessed by histologic scoring. Muscle mRNA expression was quantified by qRT-PCR. Results Tetanic and twitch force production between DMM and sham muscle did not differ at 1 week post-surgery. Muscle function improved in both groups with time, but specific force production in DMM muscles was 18% and 22% lower than sham muscles at 4 and 8 weeks post-surgery respectively. At 8 weeks post-surgery, DMM muscles had a 40% slower relaxation rate and reduced expression of sarcoplasmic/endoplasmic reticulum Ca 2+ ATPase (Serca) pump mRNA compared to sham muscles; both observations indicate likely alterations in muscle Ca 2+ handling. There were no histologic signs of muscle atrophy or inflammation in DMM TA muscles. Specific force production in both sham and DMM mice showed a negative correlation with the severity of joint inflammation. Conclusions Acute knee injury in the DMM model of post-traumatic OA leads to a persistent deficit in TA muscle function that occurs in the absence of muscle atrophy. This study highlights that the impact of acute knee injury is unlikely to be limited to the muscles controlling knee movement.

Objective To evaluate the effects of prefabricated foot orthoses and rocker-sole footwear on spatiotemporal parameters, hip and knee kinematics, and plantar pressures in people with first metatarsophalangeal (MTP) joint osteoarthritis (OA). Methods. A total of 102 people with first MTP joint OA were randomly allocated to receive prefabricated foot orthoses or rocker-sole footwear. The immediate biomechanical effects of the interventions (compared to usual footwear) were examined using a wearable sensor motion analysis system and an in-shoe plantar pressure measurement system. Results Spatiotemporal/kinematic and plantar pressure data were available from 88 and 87 participants, respectively. The orthoses had minimal effect on spatiotemporal or kinematic parameters, while the rocker-sole footwear resulted in reduced cadence, percentage of the gait cycle spent in stance phase, and sagittal plane hip range of motion. The orthoses increased peak pressure under the midfoot and lesser toes. Both interventions significantly reduced peak pressure under the first MTP joint, and the rocker-sole shoes also reduced peak pressure under the second through fifth MTP joints and heel. When the effects of the orthoses and rocker-sole shoes were directly compared, there was no difference in peak pressure under the hallux, first MTP joint, or heel; however, the rocker-sole shoes exhibited lower peak pressure under the lesser toes, second through fifth MTP joints, and midfoot. Conclusion Prefabricated foot orthoses and rocker-sole footwear are effective at reducing peak pressure under the first MTP joint in people with first MTP joint OA, but achieve this through different mechanisms. Further research is required to determine whether these biomechanical changes result in improvements in symptoms.

Objective To compare the effectiveness of prefabricated foot orthoses to rocker-sole footwear in reducing foot pain in people with first metatarsophalangeal (MTP) joint osteoarthritis (OA). Methods Participants (n = 102) with first MTP joint OA were randomly allocated to receive individualized, prefabricated foot orthoses or rocker-sole footwear. The primary outcome measure was the pain subscale on the Foot Health Status Questionnaire (FHSQ) at 12 weeks. Secondary outcome measures included the function, footwear, and general foot health subscales of the FHSQ; the Foot Function Index; severity of pain and stiffness at the first MTP joint; perception of global improvement; general health status; use of rescue medication and co-interventions to relieve pain; physical activity; and the frequency of self-reported adverse events. Results The FHSQ pain subscale scores improved in both groups, but no statistically significant difference between the groups was observed (adjusted mean difference 2.05 points, 95% confidence interval [95% CI] −3.61, 7.71; P = 0.477). However, the footwear group exhibited lower adherence (mean ± SD total hours worn 287 ± 193 versus 448 ± 234; P < 0.001), were less likely to report global improvement in symptoms (39% versus 62%; relative risk [RR] 0.63, 95% CI 0.41, 0.99; P = 0.043), and were more likely to experience adverse events (39% versus 16%; RR 2.47, 95% CI 1.12, 5.44; P = 0.024) compared to the orthoses group. Conclusion Prefabricated foot orthoses and rocker-sole footwear are similarly effective at reducing foot pain in people with first MTP joint OA. However, prefabricated foot orthoses may be the intervention of choice due to greater adherence and fewer associated adverse events.

This systematic review evaluated the available evidence for the effects of Masai Barefoot Technology (MBT) footwear on lower limb biomechanics during gait. Electronic databases (MEDLINE, EMBASE, CINAHL, SPORTDiscus, and PubMed) were searched in January 2015. Methodological quality of included studies was evaluated using the Quality Index. Standardised mean differences and 95% confidence intervals were calculated, and meta-analysis was conducted where possible. 17 studies satisfied the inclusion criteria; 16 cross-sectional studies and one randomised control trial (RCT). Quality Index scores ranged from 7 to 12 (out of 15). All 17 studies investigated walking gait only. Evidence showed that MBT footwear caused asymptomatic individuals to walk with a shorter stride length, reduced peak hip flexion, increased peak knee extension, and reduced hip and knee range of motion throughout gait. All kinematic effects occurred in the sagittal plane. There was a trend towards a decrease in internal and external joint moments and power, except for the foot, where increases in force were observed. There were only a small number of changes to lower limb muscle amplitude and timing. No statistically significant effects were observed in symptomatic individuals with knee osteoarthritis or following total knee replacement, but there was an increase in cadence and a decrease in step length in individuals following tibiotalar arthrodesis. These findings suggest that MBT footwear does change lower limb biomechanics in both asymptomatic and symptomatic individuals during gait. However, further clinical trials need to be undertaken to determine whether these changes are therapeutically beneficial.

To explore the perceptions of people with severe knee osteoarthritis and increased cardiovascular risk about participating in a walking program.Qualitative study using semistructured interviews for people with severe knee osteoarthritis and increased cardiovascular risk who participated in a 12-week walking program. Interviews were audiotaped, transcribed verbatim, member-checked, coded and themes developed using thematic analysis. Findings were triangulated with quantitative data including pain, function and cardiovascular risk factors from previously reported data.Twenty-one participants were interviewed after the completion of the walking program. The main theme identified was the preoccupation with the knee including pain, damage and the view that surgery was required. Three subthemes to emerge were (i) the perception of functional, cardiovascular and psychosocial benefits with the walking program; (ii) that supervision, monitoring and commitment were important enablers; and (iii) external factors such as ill-health, weather and the environment were key barriers. The perceived functional and cardiovascular benefits converged with results from quantitative data.Even when patients with severe osteoarthritis of the knee report other benefits from participating in a walking program, the core theme to emerge was their preoccupation with knee pain, knee damage and the view that they needed a knee replacement. Implications for Rehabilitation Patients with severe osteoarthritis of the knee and moderate cardiovascular risk reported functional, cardiovascular and psychosocial benefits from participating in a walking program. Despite patients reporting functional, cardiovascular and psychosocial benefits, the core theme to emerge was their preoccupation with knee pain, knee damage and the view that they needed a knee replacement. The core theme highlights the challenges in promoting physical activity for patients with severe knee osteoarthritis.

This study aimed to develop a low-cost real-time biofeedback system to assist with rehabilitation for patients following total knee replacement (TKR) and to assess its feasibility of use in a post-TKR patient case study design with a comparison group.The biofeedback system consisted of Microsoft Kinect(TM) and Nintendo Wii balance board with a dedicated software. A six-week inpatient rehabilitation program was augmented by biofeedback and tested in a single patient following TKR. Three patients underwent a six weeks standard rehabilitation with no biofeedback and served as a control group. Gait, function and pain were assessed and compared before and after the rehabilitation.The biofeedback software incorporated real time visual feedback to correct limb alignment, movement pattern and weight distribution. Improvements in pain, function and quality of life were observed in both groups. The strong improvement in the knee moment pattern demonstrated in the case study indicates feasibility of the biofeedback-augmented intervention.This novel biofeedback software has used simple commercially accessible equipment that can be feasibly incorporated to augment a post-TKR rehabilitation program. Our preliminary results indicate the potential of this biofeedback-assisted rehabilitation to improve knee function during gait. Research is required to test this hypothesis. Implications for Rehabilitation The real-time biofeedback system developed integrated custom-made software and simple low-cost commercially accessible equipment such as Kinect and Wii board to provide augmented information during rehabilitation following TKR. The software incorporated key rehabilitation principles and visual feedback to correct alignment of the lower legs, pelvic and trunk as well as providing feedback on limbs weight distribution. The case study patient demonstrated greater improvement in their knee function where a more normal biphasic knee moment was achieved following the six-week biofeedback intervention.

Summary Objective To determine how much physical activity, in the form of walking, can be safely and feasibly tolerated for people with severe knee osteoarthritis (OA). Design Phase I dose response trial with escalating walking doses of 10, 20, 35, 50, 70, and 95 min over 1 week, were prescribed non-randomly to people with severe knee OA. The primary stopping rule was a substantial increase in knee pain. The primary outcomes were an estimation of the maximum tolerated dose of walking; and the proportion of people who did not complete the dose for feasibility reasons. The secondary outcomes were pain, stiffness and activity limitation Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results Twenty-four participants (13 women) aged 53–83 years, and average body mass index (BMI) of 34 kg/m 2 (SD 9) were recruited. Three participants were assigned to each dose between 10 and 70 min, and nine participants assigned to the 95-min dose. The trial was stopped at 95 min due to the maximum number of adverse events occurring at this dose. Therefore, the maximum tolerated dose was 70 min. No participant stopped due to reasons related to feasibility. There was a moderate association between dose and increased activity (linear R 2 = 0.31, cubic R 2 = 0.69) and reduced stiffness (linear R 2 = 0.20, cubic R 2 = 0.52), with increased benefits at moderate to higher doses. Conclusions There is preliminary evidence that 70 min per week of moderate intensity supervised walking was safe and feasible for people with severe OA of the knee; for higher doses there was a risk of exacerbating knee pain levels.

Background Variations in foot posture, such as pes planus (low medial longitudinal arch) or pes cavus (high medial longitudinal arch) are associated with some lower limb injuries. However, the mechanism that links foot posture to injury is not clear. Research question: The aim of this study was to compare plantar pressure between healthy individuals with normal, planus or cavus feet. Methods Ninety-two healthy volunteers (aged 18 to 45) were classified as either normal (n = 35), pes planus (n = 31) or pes cavus (n = 26) based on the Foot Posture Index, Arch Index and normalised navicular height truncated. Barefoot walking trials were conducted using an emed® -x400 plantar pressure system (Novel GmbH, Munich, Germany). An 11 region mask was used that included the medial heel, lateral heel, midfoot, 1st, 2nd, 3rd, 4th and 5th metatarsophalangeal joints, hallux, 2nd toe, and the 3rd, 4th and 5th toes. Peak pressure, pressure-time integral, maximum force, force-time integral and contact area were calculated for each region. One way analyses of variance and effect sizes were used to compare the three foot posture groups. Results Overall, the largest differences were between the planus and cavus foot groups in forefoot pressure and force. In particular, peak pressures at the 4th and 5th MTPJs in the planus foot group were lower compared to the normal and cavus foot groups, and displayed the largest effect sizes. Significance This study confirms that foot posture does influence plantar pressures, and that each foot posture classification displays unique plantar pressure characteristics.

Summary The association between vitamin D and muscle function associated with balance recovery and falls in people with knee osteoarthritis is unclear. Those with vitamin D insufficiency demonstrated poorer knee function during balance recovery, greater pain and locomotor dysfunction. Vitamin D insufficiency may have an adverse effect on muscle power function. Purpose Low vitamin D status in people with knee osteoarthritis (OA) is often reported to be associated with increased pain and locomotor dysfunction. However, despite the growing evidence of the effect of vitamin D on the pathogenesis of knee OA, its role remains conflicting. Importantly, muscle function is important for knee joint health; however, the association between vitamin D levels and muscle function associated with balance recovery and falls is unclear. This study investigated the effect of circulating 25-hydroxyvitamin D (25 (OH) D) on pain, quadriceps strength, lower limb muscle mass and knee power function during balance recovery in people with knee OA. Methods Twenty-four participants with clinical symptoms of knee OA (68.6 ± 6.2 years) participated in the study. Serum levels of 25 (OH) D were assessed and participants were classified as follows: vitamin D insufficiency ≤ 50 nmol/L and vitamin D sufficiency > 50 nmol/L. The groups were compared on knee function during balance recovery tasks, lower limb strength and muscle mass as well as perceived pain and function. Results Seven patients (29.1%) were classified as vitamin D-insufficient. Vitamin D insufficiency was associated with reduced knee muscle function during the balance recovery task, increased pain (Western Ontario and McMasters University Osteoarthritis Index (WOMAC) subscore), dysfunction (WOMAC subscore) and total WOMAC score (p < 0.05). Conclusion People with knee OA with vitamin D insufficiency demonstrated poorer knee function during balance recovery, greater pain and locomotor dysfunction. Vitamin D insufficiency may have an adverse effect on muscle power function.

Background There has been a lack of research examining the relationship among self-perceptions, behaviour, cognitions and functioning in older adults. This study, therefore, examined the relationship between global and physical self-perceptions, physical activity behaviour, and fear of falling taking into considerations objective measures of physical functioning in community dwelling older adults. Methods/design Sixty-six participants between 60 and 90 years old (71.9 ± 6.6 years; 47 females; 19 males) completed questionnaires assessing physical and global self-description (PSDQ), planned and incidental physical activity behaviour (IPEQ), and falls efficacy (Short FES-I) as well as tests measuring physical functioning. Backwards multiple linear regression modelling was used to assess possible relationships among variables. Results Findings showed that physical self-perceptions (activity, coordination, endurance, flexibility) were associated with self-reported planned and incidental PA whereas sit-to-stand was the only objectively measured physical functioning variable associated with planned PA. Similarly, more falls, global self-esteem, general physical and domain specific physical self-perceptions (flexibility and strength) as well as knee strength were associated with fear of falling. There were also associations between some of the objectively measured physical functioning variables and self-perceptions of the physical self, providing some predictive validity for the PDSQ. Conclusions The findings of this study come to corroborate that the belief system of older adults ideally need to be taken into consideration when designing interventions that aim to enhance PA behaviour or reduce fear of falling. Coupling that with goal-setting, life coaching and behaviour change strategies would also be beneficial to address engagement and adherence to such interventions. Trial registration This trial was retrospectively registered with the Australian New Zealand Clinical Trials Registry - Registry No. ACTRN12614000700639 on the Jul 03rd 2014.

Background The number of falls experienced by people with knee osteoarthritis (OA) is almost double the number experienced by people with no OA. The neuromuscular elements required to arrest a fall are more impaired in people with knee OA compared to their asymptomatic counterparts. Therefore, these elements may need to be incorporated into an exercise intervention to reduce the risk of falling. The aim of this study will be to examine the feasibility, safety and patient satisfaction of a high-speed resistance-training program, with and without balance exercises, in people with knee OA compared to a control group. The effect of these exercise programs on lower-limb muscle strength and physiological and functional risk factors for falls will also be examined. Methods This study will be a pilot randomized controlled trial with a pre- and post-intervention design (outcome assessments at baseline and 8 weeks after participation commencement) comparing three groups: a control group (no intervention), a high-speed resistance-training group and a high-speed resistance-training plus balance exercises group. Thirty people with knee osteoarthritis aged 60–90 years will be recruited and randomized to one of the three groups. Feasibility and safety will be assessed by examining adherence to the exercise program, dropout rate, pain level during and following exercise, number of exercises stopped due to pain, and any adverse event or any incident that prevents the participant from completing the prescribed exercise. Secondary measures of lower-limb strength, physical function, self-reported pain and function, fear of falls, and executive function and quality of life will also be assessed. To determine statistical trends of effectiveness and hence to inform sample size for a fully powered study, analyses of the secondary outcomes will be performed to assess the changes within and between groups over time (pre-post) using repeated measure ANOVA. Discussion The results of this study will improve understanding of what type of exercise is safe and beneficial for people with knee OA to reduce their risk of falling, and hence will inform the development of a future large research trial. Trial registration Australian New Zealand Clinical Trials Registry, ID: ACTRN12616001382460. Registered on 6 October 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2129-7) contains supplementary material, which is available to authorized users.

Background Osteoarthritis of the first metatarsophalangeal joint (1st MTPJ OA) is a common and disabling condition commonly managed with footwear and orthotic interventions. The objective of this study was to identify factors associated with a successful treatment response in people with 1st MTPJ OA provided with prefabricated orthoses or rocker-sole footwear as part of a randomised clinical trial. Methods People with 1st MTPJ OA (n = 88) who participated in a randomised trial were allocated to receive prefabricated foot orthoses (n = 47) or rocker-sole footwear (n = 41) and completed a baseline questionnaire including information on demographics, anthropometrics, general health, pain characteristics (including the Foot Health Status Questionnaire [FHSQ] and Foot Function Index [FFI]) and perceptions of the interventions, and a clinical assessment of foot posture, range of motion, radiographic severity and in-shoe plantar pressures. Adherence was documented using diaries. At 12 weeks, participants documented their perception of improvement on a 15-point scale. Those reporting at least moderate improvement on this scale were classified as ‘responders’. Results There were 29 responders (62%) in the orthoses group and 16 responders (39%) in the rocker-sole group. In the orthoses group, responders had greater baseline pain severity while walking, a higher FFI difficulty score, and wore their orthoses more frequently. In the rocker-sole group, responders had a higher FFI stiffness score and greater radiographic severity. However, the accuracy of these variables in identifying responders in each group was modest (62 and 53%, respectively). Conclusion The response to prefabricated orthoses or rocker-sole footwear in people with 1st MTPJ OA is related to measures of increased pain and disease severity. However, the overall classification accuracy associated with these factors is not sufficient for identifying individuals who are most likely to benefit from these interventions. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12613001245785

Purpose The aim of the study was to determine whether higher fibrosis markers in skeletal muscle of older adults are accompanied by increased expression of components of the canonical TGF-β signal transduction pathway. Methods Fourteen healthy young (21–35 years; 9 males and 5 females) and seventeen older (55–75 years; 9 males and 8 females) participants underwent vastus lateralis biopsies to determine intramuscular mRNA and protein expression of fibrogenic markers and TGF-β signaling molecules related to TGF-β1 and myostatin. Results Expression of mRNA encoding the pro-fibrotic factors; axin 2, collagen III, β-catenin and fibronectin, were all significantly higher (all p < 0.05) in the older participants (350, 170, 298, and 641%, respectively). Furthermore, axin 2 and β-catenin mRNA were significantly higher in older females than older males (p < 0.05). Gene expression of ActRIIB, myostatin, and TGF-β1 were higher in older adults compared to younger adults (all p < 0.05). There was, however, no difference in the total protein content of myostatin, myoD or myogenin (all p > 0.05), whereas Smad3 protein phosphorylation was 48% lower (p < 0.05) in muscle from older adults. Conclusions Increased abundance of mRNA of fibrotic markers was observed in muscle from older adults and was partly accompanied by altered abundance of pro-fibrotic ligands in a sex specific manner.

To determine if a pre-operative group rehabilitation programme can improve arthritis self-efficacy for people with severe hip and knee osteoarthritis.Single group, repeated measures design: 4-week baseline phase followed by a 6-week intervention phase of water exercise, and education with self-management strategies. The primary outcome was arthritis self-efficacy. The secondary outcomes were measures of pain (WOMAC), activity limitation (WOMAC), activity performance (30 s chair stand test, 10 m walk test) and health-related quality of life (EuroQol).Twenty participants (10 knee osteoarthritis and 10 hip osteoarthritis) with a mean age of 71 years (SD 7) attended 92% (SD 10%) of the scheduled sessions. All measures demonstrated baseline stability between two time points for measurements at week 1 and measurements at week 4. After the 6-week intervention programme there were no significant improvements for arthritis self-efficacy. There was a 12% increase for fast walking speed (mean increase of 0.14 m/s, 95% CI 0.07, 0.22). There were no significant improvements for other secondary outcomes.A pre-operative water-based exercise and educational programme did not improve arthritis self-efficacy, self-reported pain and activity limitation, and health-related quality of life for people with hip and knee osteoarthritis who were candidates for joint replacement. While there was a significant increase in one measure of activity performance (walking speed), these findings suggest the current programme may be of little value. Implications for Rehabilitation This pre-operative group rehabilitation programme for people with severe hip and knee osteoarthritis did not change arthritis self-efficacy, pain, activity limitation and health-related quality of life. This programme may have little value in preparing people for joint replacement surgery. The optimal pre-operative programme requires further design and investigation.

Pain and disability often persist following hip (THR) and knee replacement (TKR) surgery predisposing patients to increased risk of falling. This study identified pre-operative predictors for post-operative falls in TKR and THR patients, and the incidence and circumstances of falls in the 12 months post-surgery. A survey was undertaken of patients before THR and TKR, and was repeated 12 months post-operation. The survey included (1) medical history and medications usage, (2) pain and function, (3) health-related and physical activity and (4) fear of falls and history of falls questionnaires. Patients were classified as ‘fallers’ (≥1 fall) or ‘non-fallers’ based on prospectively documented falls in the 12 months post-surgery. Binary logistic regression was conducted to identify independent pre-operative predictors of incident falls status. Eighty-two of the 243 participants (33.7%) reported ≥1 fall in the 12 months post-operatively [60 (34.1%) patients following TKR and 22 (32.8%) following THR]. The logistic regression model was statistically significant, χ 2 = 24.731, p

Summary Objective The primary aim was to evaluate the effect of a dosed walking program on knee pain for patients with severe knee osteoarthritis (OA). Secondary aims evaluated the effects on cardiovascular health, function and quality of life. Design Participants with severe knee OA and increased cardiovascular risk were randomly assigned to a 12-week walking program of 70 min/week of at least moderate intensity, or to usual care. The primary outcome was knee pain (0–10). Secondary outcomes were of cardiovascular risk including physical activity, blood pressure, blood lipid and glucose levels, body mass index and waist circumference; WOMAC Index scores; physical function; and quality of life. Results Forty-six participants (23 each group) were recruited. Sixteen participants (70%) adhered to the walking program. Intention to treat analysis showed no between-group difference in knee pain. The walking group had increased odds of achieving a healthy systolic blood pressure (OR = 5.7, 95% CI 1.2–26.9), and a faster walking speed (Mean Difference (MD) = 0.12 m/s, 95% CI 0.02–0.23). Per protocol analysis based on participant adherence showed the walking group had more daily steps (MD = 1345 steps, 95% CI 365–2325); more time walking (MD = 18 min/day, 95% CI 5–31); reduced waist circumference (MD = −5.3 cm, 95% CI −10.5 to −0.03); and increased knee stiffness (MD = 0.9 units, 95% CI 0.07–1.8). Conclusions Patients with severe knee OA prescribed a 12-week walking program of 70 min/week may have had cardiovascular benefits without decreasing knee pain. Australian New Zealand Clinical Trials Registry ACTRN12615000015549.

AIM: We investigated differences in function, strength and pain in those with knee osteoarthritis (OA) who responded with a single step compared to multiple steps during balance recovery during an induced forward fall. METHOD: The stepping response of 24 participants with knee OA (50% female, age 68.6 ± 6.2 years) as they recovered balance from an induced forward fall was recorded. Participants were grouped based on their stepping response as single-stepper and multi-stepper. Comparison was made between the groups for functional and strength tests and self-reported pain, function, quality of life, fear of falls and physical activity. RESULTS: Fourteen of the participants (58%) responded with a multiple step response. Multiple steppers demonstrated greater time for the up and go (P = 0.01), the stair climb tests (P = 0.05), as well as reduced distance during the 2 min walk test (P = 0.001) and reduced isokinetic knee extension strength (P = 0.02). CONCLUSION: Those who demonstrated multiple step response had impaired function, reduced strength and were less physically active. Given the high prevalence of falls in people with knee OA, further studies are required to better understand the ability of people with knee OA to respond and avoid falls.© 2016 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd. Language: en

s / Osteoarthritis and Cartilage 24 (2016) S63eS534 S92 143 BALANCE RECOVERY DURING INDUCED FALLS IS IMPAIRED IN PEOPLE WITH KNEE OSTEOARTHRITIS: IMPLICATIONS FOR FALLS PREVENTION P. Levinger y, H. Nagano y, C. Downie y, A. Hayes y, K. Sanders z, F. Cicuttini x, R. Begg y. yVictoria Univ., Melbourne, Australia; zAustralian Catholic Univ., Melbourne, Australia; xMonash Univ., Melbourne, Australia Purpose: Knee osteoarthritis (OA) is a major risk factor for falls with high falls rates reported; 50% in people with knee OA who are over the age of 60. Increased neuromuscular deficits are common in people with knee OAwhichmay further impact on postural control mechanisms and the ability to defend against a fall. Despite the high prevalence of falls in people with knee OA, the mechanism of falling in this group is unclear. This study investigated the biomechanical response of the lower limb joints during a forward induced fall under different task conditions in people with knee OA. Moreover, the balance recovery step responses (single vs multi steps) were also investigated to determine how dynamic postural control would be affected due to the presence of knee OA while undertaking the three task conditions. Methods: Twenty four participants with knee OA (68.6± 6.2 years) and fifteen asymptomatic healthy controls (72.4± 4.8 years) participated in the study. Forward fallwas induced by releasing participants froma static forward leaning position. Participants were required to recover balance during three conditions: normal, physical dual task (obstacle clearance) and cognitive dual task (counting backwards). Spatiotemporal parameters, lower limb joint kinematics and kinetics of the recovery limb were compared between the two groups and across the three task conditions using two way full factorial Multiple Analyses of Covariate (MANCOVA) with Bonferroni-adjusted post-hoc tests with age as a covariate. Results: TheOAgroupdemonstrated significantly slower spatio-temporal characteristics and reduced hip and knee flexion angles, joint moments/ powers and lower knee and ankle negative works. Cognitive dual task resulted in reduced centre of mass velocity and step length (p1⁄4 0.03) compared to the physical dual task condition. Reduced knee (p1⁄4 0.02) and hip powers (p1⁄4 0.03) were demonstrated in the OA group during the dual task conditions especially obstacle clearance where additional cognitive demand was required. The number of participants who responded with multi steps was similar for both groups during normal balance recovery task (60%; p>0.05). Although not significant, with increased task complexity the number of multi-step responders increased in the OA group compared to the control (75% for OA vs 60% for control during the obstacle task and 83% for OA vs 60% for control during the cognitive task). Conclusions: When simulating a forward fall, participants with knee OA demonstrated difficulty in absorbing the impact and slowing down the forward momentum of the body during a recovery step. Differences in biomechanical response of the hip and knee were identified which could provide useful and important information regarding the strategies used by people with knee OA to recover balance and avoid a potential fall. Poor dynamic postural control was also demonstrated when required to simultaneously recover balance and attend to a secondary task such as obstacle clearance and cognitive task. As task complexity increased (i.e. use of physical/cognitive dual task), poor recovery strategies (multiple steps) were used more often in the knee OA group. Hence, balance impairment may be further exacerbated by impaired attention dynamics in people with knee OA. 144 TIBIOFEMORAL CONTACT FORCES 2e3 YEARS FOLLOWING ANTERIOR CRUCUATE LIGAMENT RECONSTRUCTION: A COMPARISON WITH HEALTHY INDIVIDUALS D.J. Saxby y, A.L. Bryant z, L. Modenese y, P. Gerus x, B. Killen y, J. Konrath y, K. Fortin z, T.V. Wrigley z, K.L. Bennell z, F.M. Cicuttini k, C. Vertullo y, J.A. Feller ¶, T. Whitehead#, P. Gallie yy, D.G. Lloyd y. yCtr. for Musculoskeletal Res., Menzies Hlth.Inst. Queensland, Griffith Univ., Gold Coast, Australia; zCtr. for Hlth., Exercise and Sports Med., Univ. of Melbourne, Melbourne, Australia; x Lab. of Human Motion, Ed. and Hlth., Univ. of Nice Sophia-Antipolis, Nice, France; kDept. of Epidemiology and Preventive Med., Monash Univ., Melbourne, Australia; Coll. of Sci., Hlth.and Engineering, La Trobe Univ., Melbourne, Australia; OrthoSport Victoria, Melbourne, Australia; yy Pacific Private Clinic, Gold Coast, Australia Purpose: Due to the risk of osteoarthritis development in those with anterior cruciate ligament (ACL) rupture and reconstruction (ACLR), we need to better understand in vivo articular contact loading in ACLR knees. To date, few studies have explored in vivo tibiofemoral contact forces in ACLR knees, and of those studies the examination has focused on affected and unaffected limbs, considered only females and/or been confined to small sample sizes. As a result, it remains unclear whether the ACLR tibiofemoral contact forces are comparable with healthy individuals, or whether they are peculiar in some way. The purpose of this study was to compare in vivo tibiofemoral contact forces in a large sample of ACLR individuals and healthy controls during normal walking and sporting gait tasks. Methods: This cross-sectional study was conducted at Griffith University’s Centre for Musculoskeletal Research (CMR) and University of Melbourne’s Centre for Health, Exercise and Sports Medicine (CHESM) (ethics approvals CMR: PES/36/10/HREC, CHESM: 0932864.3). Both ACLRs (68% male, n1⁄4 107, 29.7 ± 6.5 years, 78.1± 14.4 kg) and healthy controls (58% male, 27.5 ± 5.4 years, 67.8± 14.0 kg) participated. ACLRs were tested 2e3 years after a single combined hamstrings autograft reconstruction (2.51± 0.44 years). All participants underwent comprehensive 3-dimensional gait analysis wherein they walked (1.42 ± 0.20 m.s-1), ran (4.46± 0.46 m.s-1) and ran with a 45 diagonal sidestep (3.66± 0.60 m.s-1). Gait tasks were performed shod (Dunlop Volleys), and surface electromyography (EMG) was performed on the eight major muscles (rectus femoris, vastii, gastrocnemii, hamstrings, tensor fasciae latae) on the reconstructed (ACLRs) or randomized (controls) knee. From the gait analysis data, joint kinematics and kinetics were determined using OpenSim, and an EMG-driven neuromusculoskeletal model was then developed for each subject to determine their in vivo tibiofemoral contact forces during the different gait tasks. Analyses of variance were performed to determine if main and interaction effects existed for group (ACLR and controls) and gait task (walk, run, sidestep). If significant effects were found, ttests with Bonferroni corrections were applied to assess specific differences. Results: ACLRs and controls were of similar age, sex, tested limb-side and height, and had similar spatiotemporal parameters (i.e. velocity, cadence, etc...) during the different gait tasks. Compared to controls, ACLRs had a significantly smaller peak flexion angle, excursion and moment during running (angle: 41.4 ± 6 vs 44± 5.9 , excursion: 32.4 ± 5.4 vs 34.4 ± 4.6 , and moment: 0.25± 0.08 Nm.kg-1 vs 0.29 ± 0.06 Nm.kg-1) and sidestepping (angle: 50.6± 6.9 vs 53.4 ± 7.3 , excursion: 39.9 ± 6.7 vs 42.5 ± 7.1 , and moment: 0.29 ± 0.1 Nm.kg-1 vs 0.33 ± 0.1 Nm.kg-1) (all p

Aging is associated with reduced muscle mass, weakness, and increased fatigability. In skeletal muscle, the Na+-K+ pump (NKA) is important in regulating Na+-K+ gradients, membrane excitability, and thus contractility, but the effects of aging on muscle NKA are unclear. We investigated whether aging is linked with reduced muscle NKA by contrasting muscle NKA isoform gene expression and protein abundance, and NKA total content in 17 Elderly (66.8 ± 6.4 yr, mean ± SD) and 16 Young adults (23.9 ± 2.2 yr). Participants underwent peak oxygen consumption assessment and a vastus lateralis muscle biopsy, which was analyzed for NKA α1-, α2-, α3-, β1-, β2-, and β3-isoform gene expression (real-time RT-PCR), protein abundance (immunoblotting), and NKA total content ([3H]ouabain binding sites). The Elderly had lower peak oxygen consumption (−36.7%, P = 0.000), strength (−36.3%, P = 0.001), NKA α2- (−24.4%, 11.9 ± 4.4 vs. 9.0 ± 2.7 arbitrary units, P = 0.049), and NKA β3-protein abundance (−23.0%, P = 0.041) than Young. The β3-mRNA was higher in Elderly compared with Young ( P = 0.011). No differences were observed between groups for other NKA isoform mRNA or protein abundance, or for [3H]ouabain binding site content. Thus skeletal muscle in elderly individuals was characterized by decreased NKA α2- and β3-protein abundance, but unchanged α1 abundance and [3H]ouabain binding. The latter was likely caused by reduced α2 abundance with aging, preventing an otherwise higher [3H]ouabain binding that might occur with a greater membrane density in smaller muscle fibers. Further study is required to verify reduced muscle NKA α2 with aging and possible contributions to impaired exercise capability and daily living activities.

Objectives. Foot orthoses are commonly used in the management of knee OA, although the relationship between foot function and knee OA is still unclear. The purpose of the study was to examine foot function during walking in people with and without medial compartment knee OA. Methods. Motion of the tibia, rearfoot and forefoot in 32 patients with medial compartment knee OA and 28 age-matched control subjects was investigated. Multivariate analysis was used to compare the groups. Results. The knee OA group contacted the ground with a more everted rearfoot, demonstrated greater peak rearfoot eversion and exhibited reduced rearfoot frontal plane range of motion and reduced rearfoot peak inversion. The tibia was more internally rotated and laterally tilted throughout the gait cycle, with reduced peak external rotation. Conclusion. People with medial compartment knee OA exhibit altered foot kinematics during gait that are indicative of a less mobile, more everted foot type. The presence and degree of tibial malalignment and the available rearfoot range of motion during walking may affect individual responses to load-altering interventions, such as foot orthoses and footwear modifications. Trial registration: Australian New Zealand Clinical Trials Registry, www.anzctr.org.au/, ACTRN

Background Excessive rearfoot eversion is thought to be a risk factor for patellofemoral pain syndrome development, based on theoretical rationale linking it to greater tibial internal rotation and hip adduction. This study aimed to establish the relationship of rearfoot eversion with tibial internal rotation and hip adduction during walking in individuals with and without patellofemoral pain syndrome. Methods Twenty-six individuals with patellofemoral pain syndrome and 20 controls (18–35 years) participated. Each underwent instrumented three-dimensional motion analysis during over-ground walking. Pearson's correlation coefficients (r) were calculated to establish the relationship of rearfoot eversion with tibial internal rotation and hip adduction (peak and range of motion). Findings Greater peak rearfoot eversion was associated with greater peak tibial internal rotation in the patellofemoral pain syndrome group (r = 0.394, P = 0.046). Greater rearfoot eversion range of motion was associated with greater hip adduction range of motion in the patellofemoral pain syndrome (r = 0.573, P = 0.002) and control (r = 0.460, P = 0.041) groups; and greater peak hip adduction in the control group (r = 0.477, P = 0.033). Interpretation Associations between greater rearfoot eversion and greater hip adduction indicate that interventions targeted at the foot or hip in individuals with patellofemoral pain syndrome may have similar overall effects on lower limb motion and clinical outcomes. The relationship between rearfoot eversion and tibial internal rotation identified in the patellofemoral pain syndrome group may be related to aetiology. However, additional prospective research is needed to confirm this.

Older adults have an increase in circulating markers of inflammation. The current study examined whether there is an increase in the expression of inflammatory markers within the vastus lateralis, a major locomotive muscle, of older adults, and if so, whether the reduction in muscle strength and aerobic capacity in older adults is related to increased muscle inflammation. Skeletal muscle biopsies were taken from older adults (n = 17, 67 ± 1.6 years) and young individuals (n = 16, 24 ± 0.6 years) under resting and fasting conditions. Muscle was analyzed for mRNA levels of intracellular inflammatory molecules (MCP1, TNFα and IL-1β) and total cellular protein abundance of cytokines, chemokines and kinases (IL-6, IL-8, MCP1, TNFα, p65 (NF-κB), JNK1/2 and STAT3). MCP1 expression was significantly higher (p 0.05; 50 %, mRNA and 40 %, protein) in elderly than younger participants, as was IL-8 (4 %). No detectable difference in kinase protein expression was observed for STAT3, JNK or p65 (NF-κB), TNFα or IL-6. Muscle strength was lower in the elderly compared to the young group (1.55 ± 0.17 vs. 2.56 ± 0.13 Nm/kg, p 0.001). The elderly group also had a significantly lower VO(2peak) compared to the young group (24.9 ± 1.9 vs. 39.3 ± 1.9, p 0.001), but muscle strength and VO(2peak) were not correlated with the examined inflammatory markers. Older adults have increased MCP1 (mRNA and protein abundance) and IL-8 (protein abundance) and also reduced muscle strength and VO(2peak). However, the reduction in muscle strength and VO(2peak) was not related to the increase in muscle inflammatory markers in this cohort.