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Recent evidence suggests that regulated solute transport occurs across mammalian lower urinary tract epithelia (urothelia). To study the effects of dietary protein on net urothelial transport of urea, creatinine, and water, we used an in vivo rat bladder model designed to mimic physiological conditions. We placed groups of rats on 3-wk diets differing only by protein content (40, 18, 6, and 2%) and instilled 0.3 ml of collected urine in the isolated bladder of anesthetized rats. After 1 h dwell, retrieved urine volumes were unchanged, but mean urea nitrogen (UN) and creatinine concentrations fell 17 and 4%, respectively, indicating transurothelial urea and creatinine reabsorption. The fall in UN (but not creatinine) concentration was greatest in high protein (40%) rats, 584 mg/dl, and progressively less in rats receiving lower protein content: 18% diet, 224 mg/dl, 6% diet, 135 mg/dl, and 2% diet, 87 mg/dl. The quantity of urea reabsorbed was directly related to a urine factor, likely the concentration of urea in the instilled urine. In contrast, the percentage of instilled urea reabsorbed was greater in the two dietary groups receiving the lowest protein (26 and 23%) than in those receiving higher protein (11 and 9%), suggesting the possibility that a bladder/urothelial factor, also affected by dietary protein, may have altered bladder permeability. These findings demonstrate significant regulated urea transport across the urothelium, resulting in alteration of urine excreted by the kidneys, and add to the growing evidence that the lower urinary tract may play an unappreciated role in mammalian solute homeostasis. [ABSTRACT FROM AUTHOR]

Although mammalian urinary tract epithelium (urothelium) is generally considered impermeable to water and solutes, recent data suggest that urine constituents may be reabsorbed during urinary tract transit and storage. To study water and solute transport across the urothelium in an in vivo rat model, we instilled urine (obtained during various rat hydration conditions) into isolated in situ rat bladders and, after a 1-h dwell, retrieved the urine and measured the differences in urine volume and concentration and total quantity of urine urea nitrogen and creatinine between instilled and retrieved urine in rat groups differing by hydration status. Although urine volume did not change >1.9% in any group, concentration (and quantity) of urine urea nitrogen in retrieved urine fell significantly (indicating reabsorption of urea across bladder urothelia), by a mean of 18% (489 mg/dl, from an instilled 2,658 mg/dl) in rats receiving ad libitum water and by a mean of 39% (2,544 mg/dl, from an instilled 6,204 mg/dl) in water-deprived rats, but did not change (an increase of 15 mg/dl, P = not significant, from an instilled 300 mg/dl) in a water-loaded rat group. Two separate factors affected urea nitrogen reabsorption rates, a urinary factor related to hydration status, likely the concentration of urea nitrogen in the instilled urine, and a bladder factor(s), also dependent on the animal's state of hydration. Urine creatinine was also absorbed during the bladder dwell, and hydration group effects on the concentration and quantity of creatinine reabsorbed were qualitatively similar to the hydration group effect on urea transport. These findings support the notion(s) that urinary constituents may undergo transport across urinary tract epithelia, that such transport may be physiologically regulated, and that urine is modified during transit and storage through the urinary tract. [ABSTRACT FROM AUTHOR]

This cross-sectional study of adult (137 male, 128 female), urban, community dwelling users and nonusers of illicit drugs evaluated associations of demographic, medical, and drug factors with body composition. The population was 49% HIV-positive and 94% African-American. In multivariate analysis, there were no body composition differences among males based on drug use. Among females, the highest tertile of drug use had less fat (12.3 vs.19.9 kg, p = .01) and lower body mass index (21.9 vs. 25.1, p = .01) versus less frequent or nonusers. These data suggest a sex difference in body composition associated with drug use. [ABSTRACT FROM AUTHOR]

This trial evaluated a 6-month, church-based aerobic exercise intervention to increase physical activity among African American women relative to a health lecture and stretching condition. Participants were 196 women from 11 churches. Churches were randomized to an Aerobic Exercise Health N Stretch intervention. Results indicated that physical activity was not different in Aerobic Exercise and Stretch N Health, although attendance in both interventions was low. Both groups reduced physical inactivity prevalence from baseline (26% and 18% decline, respectively). Higher baseline social support predicted change in physical activity, regardless of treatment assignment. Researchers must continue to work to identify successful intervention strategies to increase physical activity in African American women who are at disproportionate risk of chronic diseases associated with physical inactivity. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess the prevalence and persistence of depression in patients with acute myocardial infarction (AMI) and the relationship between assessment modality and prevalence. DATA SOURCES: MEDLINE®, Cochrane, CINAHL®, PsycINFO®, and EMBASE®. REVIEW METHODS: A comprehensive search was conducted in March 2004 to identify original research studies published since 1980 that used a standardized interview or validated questionnaire to assess depression. The search was augmented by hand searching of selected Journals from October 2003 through April 2004 and references of identified articles and reviews. Studies were excluded ff only an abstract was provided, if not in English, or if depression was not measured by a validated method. RESULTS: Major depression was identified in 19.8% (95% confidence interval [CI] 19.1% to 20.8%) of patients using structured interviews (N=10,785, 8 studies). The prevalence of significant depressive symptoms based on a Beck Depression Inventory score ≥10 was 31.1% (CI 29.2% to 33.0%; N=2,273, 6 studies), using a Hospital Anxiety and Depression Scale (HADS) score ≥8%. 15.5% (CI 13.2% to 18.0%; N=863, 4 studies), and with a HADS score ≥11%, 7.3% (CI 5.5% to 9.3%: N=830, 4 studies). Although a significant proportion of patients continued to be depressed in the year after discharge, the limited number of studies and variable follow-up times precluded specification of prevalence rates at given time points. CONCLUSIONS: Depression is common and persistent in AMI survivors. Prevalence varies depending on assessment method, likely reflecting treatment of somatic symptoms. [ABSTRACT FROM AUTHOR]

Background: The mechanisms responsible for impaired cardiovascular hemodynamics during exercise among persons with milder forms of hypertension are not well documented. We examined the relationship of oxygen pulse during exercise, a correlate of stroke volume, with echocardiographic indices of resting left ventricular function to determine whether abnormal contractility and relaxation are related to abnormal cardiovascular dynamics during exercise among such persons. Methods: Subjects were 44 men and 55 women ages 55 to 75 years with mild hypertension but who were otherwise healthy. Resting left ventricular systolic and diastolic functions were assessed with 2-dimensional Doppler echocardiography and tissue Doppler imaging. Oxygen pulse (millimeters per beat) at rest and during multistage treadmill testing was derived from measurements of oxygen consumption and heart rate. The slope of oxygen pulse between successive exercise stages was calculated. Results: After a steep rise in oxygen pulse from rest to stage 1 of exercise, a markedly diminished oxygen pulse slope was seen between subsequent exercise stages. In stepwise regression analysis, the increase in the slope of oxygen pulse from rest to stage 1 was explained by a greater lean body mass (57%, P < .001) and a larger left atrial size (2%, P < .001). After exercise stage 1, the increase in the slope of oxygen pulse was explained by sex (24%, P < .001), higher mitral E/A ratio (6%, P < .001), and higher mitral annular systolic velocity (6%, P < .001). Conclusions: These results suggest that a blunted oxygen pulse response to exercise among older persons with milder forms of hypertension may reflect impaired left ventricular stroke volume changes during exercise secondary to subtle abnormalities in both systolic and diastolic left ventricular functions. [ABSTRACT FROM AUTHOR]

Background: Weight loss typically reduces bone mineral density (BMD). Exercise may preserve or increase BMD even while reducing fatness. We examined the relationships among exercise-induced changes in fitness and fatness with BMD. Design: Randomized controlled trial conducted between July 1999 and November 2003. Participants: Men and women (n =115) aged 55 to 75 years. Intervention: Six months of exercise training. Main Outcome Measures: Fitness measured as peak oxygen uptake and muscle strength, body composition by anthropometry, dual-energy x-ray absorptiometry, and magnetic resonance imaging. Results: A total of 51 men and 53 women completed the trial. Exercise increased aerobic and strength fitness and lean body mass, and reduced general and abdominal obesity. BMD did not change among men in either group. Among women exercisers, there were reductions in total skeleton BMD (p =0.02) and greater trochanter BMD (p =0.02). By bivariate correlation, among women, increased femoral neck BMD was associated with increased aerobic fitness (p =0.01) and with reduced body weight (p =0.02) and BMI (p =0.02). In the final regression model, 13% of the change in femoral neck BMD was explained by the change in aerobic fitness (p &#60;0.01). Among the men, increased total hip BMD and femoral shaft BMD were associated with increased lean mass and lower-body strength. In the final regression models, the change in lean mass explained 9% of the variance in total hip BMD (p =0.04). The change in lean mass explained 20% of the change in femoral shaft BMD (p &#60;0.01), and the change in lower-body strength explained an additional 6% (p &#60;0.04). Conclusions: When examined by group assignment, 6 months of exercise had no effect on BMD among men, and reduced BMD among women. When examined by change in fitness and fatness, women who had the greatest increases in aerobic capacity and men who had the greatest increases in strength and lean mass were more likely to increase their BMD. Exercise-induced reductions in fatness did not lead to bone loss. [Copyright &y& Elsevier]

Objective: The purpose of this study was to determine the predictors of referral and enrollment, including racial differences, in phase 2 cardiac rehabilitation programs among African-American and white women who are eligible for such programs.Design: Prospective longitudinal design.Setting: One large academic medical center and two large community hospitals.Patients: A total of 253 women (108 African American, 145 white) were surveyed within the first month of discharge from the hospital for a percutaneous coronary intervention, coronary artery bypass surgery, or myocardial infarction without revascularization. A total of 234 (99 African American, 135 white) completed the 6-month follow-up.Main Results: The rate of referral to outpatient phase 2 cardiac rehabilitation was significantly lower for African-American women compared with white women, 12 (12%) versus 33 (24%) (P=.03). Only 35 (15%) of women in the study reported enrollment in phase 2 cardiac rehabilitation programs, with fewer African-American women reporting enrollment compared with white women, 9 (9%) versus 26 (19%) (P=.03). Controlling for age, education, angina class, and comorbidities, women with annual incomes <20,000 dollars were 66% less likely to be referred to cardiac rehabilitation (P=.01) and 60% less likely to enroll compared to women with incomes >20,000 dollars (P=.01). Although borderline significant, African-American women were 55% less likely to be referred (P=.059) and 58% less likely to enroll (P=.059) than white women.Conclusions: We found disparities in cardiac rehabilitation program participation, with women with lower incomes less likely to be referred and to have lower enrollment rates in cardiac rehabilitation and a strong trend for African-American women to be less likely to be referred and enroll. Because almost all patients who have had an acute coronary event, with or without revascularization procedures, will benefit from cardiac rehabilitation, automatic referral systems should be considered to increase utilization and reduce disparities. [ABSTRACT FROM AUTHOR]

Context: Hormone administration to elderly individuals can increase lean body mass (LBM) and decrease fat, but interactive effects of growth hormone (GH) and sex steroids and their influence on strength and endurance are unknown. Objective: To evaluate the effects of recombinant human GH and/or sex steroids on body composition, strength, endurance, and adverse outcomes in aged persons. Design, Setting, and Participants: A 26-week randomized, double-blind, placebo-controlled parallel-group trial in healthy, ambulatory, community-dwelling US women (n = 57) and men (n = 74) aged 65 to 88 years recruited between June 1992 and July 1998. Interventions: Participants were randomized to receive GH (starting dose, 30 µg/kg, reduced to 20 µg/kg, subcutaneously 3 times/wk) + sex steroids (women: transdermal estradiol, 100 µg/d, plus oral medroxyprogesterone acetate, 10 mg/d, during the last 10 days of each 28-day cycle [HRT]; men: testosterone enanthate, biweekly intramuscular injections of 100 mg) (n = 35); GH + placebo sex steroid (n = 30); sex steroid + placebo GH (n = 35); or placebo GH + placebo sex steroid (n = 31) in a 2 × 2 factorial design. Main Outcome Measures: Lean body mass, fat mass, muscle strength, maximum oxygen uptake (VO[sub 2]max) during treadmill test, and adverse effects. Results: In women, LBM increased by 0.4 kg with placebo, 1.2 kg with HRT (P = .09), 1.0 kg with GH (P = .001), and 2.1 kg with GH + HRT (P<.001). Fat mass decreased significantly in the GH and GH + HRT groups. In men, LBM increased by 0.1 kg with placebo, 1.4 kg with testosterone (P = .06), 3.1 kg with GH (P<.001), and 4.3 kg with GH + testosterone (P<.001). Fat mass decreased significantly with GH and GH + testosterone. Women's strength decreased in the placebo group and increased nonsignificantly with HRT (P = .09), GH (P = .29), and GH + HRT (P = .14). Men's strength also did not increase significantly except for a marginally significant increase of 13.5 kg... [ABSTRACT FROM AUTHOR]

The coexistence of type 2 diabetes and hypertension is especially damaging to cardiovascular health. Most trials of exercise training for these conditions have focused on glycemic control and blood pressure reduction. Less is known about the effects of exercise on the cardiovascular consequences of diabetes and hypertension. This article reviews the available evidence and plausible mechanisms by which exercise training may improve the cardiovascular health of persons with type 2 diabetes and hypertension and provides practical guidelines for exercise prescription. A MEDLINE search was performed for January 1985 to June 2002. Bibliographies from relevant articles, professional society clinical practice guidelines, and books were also reviewed. Because few large, randomized trials exist on these topics, meta-analyses, smaller trials, nonrandomized trials, and animal studies were also considered. Data quality was determined by publication in peer-reviewed journals or professional society literature. Type 2 diabetes and hypertension result in abnormalities in central and peripheral parameters of cardiovascular structure and function. Evidence for an exercise training benefit is strongest for improvements in endothelial vasodilator function and left ventricular diastolic function. The data for exercise training's improvement of arterial stiffness and system inflammation and reduction of left ventricular mass are less robust. However, this assertion is based more on a lack of randomized controlled trials rather than data to the contrary. Exercise training also reduces total and abdominal fat. These changes in body composition mediate improvements in insulin sensitivity and blood pressure and may improve endothelial vasodilator function. The current evidence, albeit not fully confirmed in randomized trials, suggests that the benefits of exercise training go beyond the recognized benefits of glycemic control and blood pressure reduction. [ABSTRACT FROM AUTHOR]

Wearable sweat sensors have enabled real-time monitoring of sweat profiles (sweat concentration versus time) and could enable monitoring of electrolyte loss during exercise or for individuals working in extreme environments. To assess the feasibility of using a wearable sweat chloride sensor for real-time monitoring of individuals during exercise, we recorded and analyzed the sweat profiles of 50 healthy subjects while spinning at 75 Watts for 1 hour. The measured sweat chloride concentrations were in the range from 2.9–34 mM. The sweat profiles showed two distinct sweat responses: Type 1 (single plateau) and Type 2 (multiple plateaus). Subjects with Type 2 profiles had higher sweat chloride concentration and weight loss, higher maximum heart rate, and larger changes in heart rate and rating of perceived exertion during the trial compared to subjects with Type 1 profiles. To assess the influence of level of effort, we recorded sweat profiles for five subjects at 75 W, 100 W, and 125 W. While all five subjects showed Type 1 sweat profiles at 75 W, four of the subjects had Type 2 profiles at 125 W, showing an increase in sweat chloride with exercise intensity. Finally, we show that sweat profiles along with other physiological parameters can be used to predict fluid loss. [ABSTRACT FROM AUTHOR]

Wearable sensors enable the monitoring of an individual's sweat composition in real time. In this work, we recorded real-time sweat chloride concentration for 12 healthy subjects in three different protocols involving step changes in exercise load and compared the results to laboratory-based analysis. The sensor results reflected the changes in exercise load in real time. On increasing the exercise load from 100 W to 200 W the sweat chloride concentration increased from 12.0 ± 5.9 to 31.4 ± 16 mM (mean ± SD). On decreasing the load from 200 W to 100 W, the sweat chloride concentration decreased from 27.7 ± 10.5 to 14.8 ± 8.1 mM. The half-time associated with the change in sweat chloride, defined as the time at which the concentration reached half of the overall change, was about 6 minutes. While the changes in sweat chloride were statistically significant, there was no correlation with changes in sweat rate or other physiological parameters, which we attribute to intra-individual variation (SD = 1.6–8.1 mM). The response to exercise-induced sweating was significantly different to chemically-induced sweating where the sweat chloride concentration was almost independent of sweat rate. We speculate that this difference is related to changes in the open probability of the CFTR channel during exercise, resulting in a decrease in reabsorption efficiency at higher sweat rates. [ABSTRACT FROM AUTHOR]

Presents a discussion about exercise training for claudication, the primary symptom of peripheral arterial disease. Description of claudication defined as walking-induced pain in one or both legs; Discussion about the functional benefits of exercise training; Outline of a prescription for exercise; Discussion about combining exercise with other treatments; Conclusions that exercise training appears to be an effective treatment for claudication.

Mitochondrial DNA copy number (mtDNA-CN) measured in blood has been associated with many aging-related diseases, with higher mtDNA-CN typically associated with lower disease risk. Exercise training is an excellent preventative tool against aging-related disorders and has been shown to increase mitochondrial function in muscle. Using the Sugar, Hypertension, and Physical Exercise cohorts (N = 105), we evaluated the effect of 6-months of exercise intervention on mtDNA-CN measured in blood. Although there was no significant relationship between exercise intervention and mtDNA-CN change (P = 0.29), there was a nominally significant association between mtDNA-CN and metabolic syndrome (P = 0.04), which has been seen in previous literature. We also identified a nominally significant association between higher mtDNA-CN and higher insulin sensitivity (P = 0.02). [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To describe the body composition and fat distribution of childhood bone marrow transplantation (BMT) survivors at least one year post-transplantation and examine the ability of the Centers for Disease Control and Prevention criteria to identify survivors with elevated body fat percentage.Design: Cross-sectional, descriptive.Setting: Pediatric oncology program at a National Cancer Institute-designated comprehensive cancer center.Sample: 48 childhood BMT survivors (27 males and 21 females).Methods: Measurements included dual-energy x-ray absorptiometry scan, height, weight, and physical activity. Descriptive statistics were reported and mixed-model linear regression models were used to describe findings and associations.Main Research Variables: Total body fat percentage and central obesity (defined as a ratio of central to peripheral fat of 1 or greater).Findings: Fifty-four percent of survivors had body fat percentages that exceeded recommendations for healthy body composition and 31% qualified as having central obesity. Previous treatment with total body irradiation was associated with higher body fat percentage and central obesity, and graft-versus-host disease was associated with lower body fat percentage. The body mass index (BMI) criteria did not correctly identify the BMT survivors who had elevated body fat percentage.Conclusions: Survivors of childhood BMT are at risk for obesity and central obesity that is not readily identified with standard BMI criteria.Implications for Nursing: Nurses caring for BMT survivors should include evaluation of general and central obesity in their assessments. Patient education materials and resources for healthy weight and muscle building should be made available to survivors. Research is needed to develop appropriate interventions. [ABSTRACT FROM AUTHOR]

Despite high bone mineral density (BMD), persons with type 2 diabetes are at greater risk of fracture. The relationship between body composition and BMD in noninsulin-requiring diabetes is unclear. The aim was to examine how fat and lean mass independently affect the skeleton in this population. Subjects for this cross-sectional analysis were men ( n = 78) and women ( n = 56) aged 40-65 years (56 ± 6 years) with uncomplicated, noninsulin-requiring type 2 diabetes. Total body fat and lean mass, total body, hip and lumbar spine BMD were measured with dual energy X-ray absorptiometry. Magnetic resonance imaging measured total abdominal, visceral and subcutaneous (SQ) fat. Subjects had normal all-site BMD and were obese to overweight (body mass index 29-41 kg/m) with controlled diabetes (HbA1c women 6·6 ± 1·2%, men 6·7 ± 1·6%). Lean mass was positively associated with total body, hip, femoral neck and hip BMD in both sexes. Fat mass, abdominal total and SQ fat were associated with total body and hip BMD in women. In multivariate analyses adjusted for sex, lean mass significantly predicted total, hip and femoral neck BMD in men and women. In unadjusted models, lean mass continued to predict BMD at these sites in men; fat mass also predicted total body, femoral and hip BMD in women. In men and women with uncomplicated, noninsulin-requiring diabetes, lean mass significantly predicted BMD at the total body, hip and femoral neck. Further research is needed to determine whether acquisition or maintenance of lean mass in T2DM can prevent hip fracture in this at-risk population. [ABSTRACT FROM AUTHOR]

This study examined the bone mineral density (BMD) of 46 (median age 16.3, 8-29) survivors of autologous and allogeneic bone marrow transplantation (BMT). Areal (g/m2) BMD was acquired with dual energy x-ray absorptiometry and volumetric (g/cm3) BMD values were calculated. Abnormal BMD was identified in 24% (11/46) of survivors with areal measures and 22% (10/46) with volumetric measures. Comparison of areal and volumetric BMD revealed the measures were highly correlated (r = 0.73, p<0.001) but clinical diagnosis of osteopenia/osteoporosis were not consistent. Volumetric z-scores were higher for 7/8 of the survivors who were < 3rd percentile for height. Associations of BMD and body composition and disease and treatment factors were assessed with multiple linear regression. When controlling for other significant associations and cumulative steroid dose, the body composition measure of fat mass index (FMI) was associated with higher volumetric BMD z-scores (CI: 0.006, 0.193; p = 0.037). CNS irradiation (CI: -1.710,-0.200; p = 0.015), age at time of testing (CI: -0.116, -0.024; p = 0.004) and female sex (CI: -1.375, -0.155; p = 0.015) were associated with lower volumetric BMD z-scores. Conclusions: Childhood BMT survivors are at risk for diminished BMD. Areal and volumetric DEXA derived measures of BMD are highly correlated and volumetric measures may correct for underestimation of BMD in BMT survivors who are small for age. Survivors who received CNS irradiation, are older and female may be at greater risk for diminished BMD while fat mass is associated with higher BMD in childhood BMT survivors. [Copyright &y& Elsevier]

Background: The aim of this paper is to describe the utility of various recruitment modalities utilized in the Working to Increase Stability through Exercise (WISE) study. WISE is a pragmatic randomized trial that is testing the impact of a 3-year, multicomponent (strength, balance, aerobic) physical activity program led by trained volunteers or delivered via DVD on the rate of serious fall-related injuries among adults 65 and older with a past history of fragility fractures (e.g., vertebral, fall-related). The modified goal was to recruit 1130 participants over 2 years in three regions of Pennsylvania.Methods: The at-risk population was identified primarily using letters mailed to patients of three health systems and those over 65 in each region, as well as using provider alerts in the health record, proactive recruitment phone calls, radio advertisements, and presentations at community meetings.Results: Over 24 months of recruitment, 209,301 recruitment letters were mailed, resulting in 6818 telephone interviews. The two most productive recruitment methods were letters (72% of randomized participants) and the research registries at the University of Pittsburgh (11%). An average of 211 letters were required to be mailed for each participant enrolled. Of those interviewed, 2854 were ineligible, 2,825 declined to enroll and 1139 were enrolled and randomized. Most participants were female (84.4%), under age 75 (64.2%), and 50% took an osteoporosis medication. Not having a prior fragility fracture was the most common reason for not being eligible (87.5%). The most common reason provided for declining enrollment was not feeling healthy enough to participate (12.6%).Conclusions: The WISE study achieved its overall recruitment goal. Bulk mailing was the most productive method for recruiting community-dwelling older adults at risk of serious fall-related injury into this long-term physical activity intervention trial, and electronic registries are important sources and should be considered. [ABSTRACT FROM AUTHOR]

Background: The Strategy to Reduce the Incidence of Postoperative Delirium in the Elderly trial tested the hypothesis that limiting sedation during spinal anaesthesia decreases in-hospital postoperative delirium after hip fracture repair. This manuscript reports the secondary outcomes of this trial, including mortality and function.Methods: Two hundred patients (≥65 yr) undergoing hip fracture repair with spinal anaesthesia were randomised to heavier [modified Observer's Assessment of Alertness/Sedation score (OAA/S) 0-2] or lighter (OAA/S 3-5) sedation, and were assessed for postoperative delirium. Secondary outcomes included mortality and return to pre-fracture ambulation level at 1 yr. Kaplan-Meier analysis, multivariable Cox proportional hazard model, and logistic regression were used to evaluate intervention effects on mortality and odds of ambulation return.Results: One-year mortality was 14% in both groups (log rank P=0.96). Independent risk factors for 1-yr mortality included: Charlson comorbidity index [hazard ratio (HR)=1.23, 95% confidence interval (CI), 1.02-1.49; P=0.03], instrumental activities of daily living [HR=0.74, 95% CI, 0.60-0.91; P=0.005], BMI [HR=0.91, 95% CI 0.84-0.998; P=0.04], and delirium severity [HR=1.20, 95% CI, 1.03-1.41; P=0.02]. Ambulation returned to pre-fracture levels, worsened, or was not obtained in 64%, 30%, and 6% of 1 yr survivors, respectively. Lighter sedation did not improve odds of ambulation return at 1 yr [odds ratio (OR)=0.76, 95% CI, 0.24-2.4; P=0.63]. Independent risk factors for ambulation return included Charlson comorbidity index [OR=0.71, 95% CI, 0.53-0.97; P=0.03] and delirium [OR=0.32, 95% CI, 0.10-0.97; P=0.04].Conclusions: This study found that in elderly patients having hip fracture surgery with spinal anaesthesia supplemented with propofol sedation, heavier intraoperative sedation was not associated with significant differences in mortality or return to pre-fracture ambulation up to 1 yr after surgery.Clinical Trial Registration: ClinicalTrials.gov NCT00590707. [ABSTRACT FROM AUTHOR]