Research in Health and Medicine (ISSN: 3066-0777) is an open access, peer-reviewed journal. The journal encourages authors to submit research in the health sciences, epidemiology, physical activity, health disparities and other health-related lines of inquiry.
Copyright, 2026 by the authors. This work is licensed under the Creative Commons Attribution 4.0 International License.
Internal Hip Rotation and Swing Phase Knee Flexion in Adolescent Gait
Introduction: Stiff knee gait (SKG) is a common gait deviation in patients with cerebral palsy that can significantly impact walking function. SKG is often treated surgically with a distal rectus femoris transfer, however some researchers have documented mixed outcomes using existing patient selection criteria. It may be that other factors, such as hip internal rotation due to increased femoral anteversion, are playing a role in SKG, though this has not been explicitly studied. Methods: This descriptive case study involved a convenience sample of two 14-year-old adolescent girls, one with idiopathic increased internal hip rotation and one without. Lower body joint angles were calculated from motion capture data collected during normal overground walking. Two variables were extracted from each of 60 gait cycles (30 per side): peak knee flexion in swing, and average hip rotation in early swing. Two-way ANOVAS with participant and leg as factors, followed by Welch t-tests for significant interactions, were used to compare participants statistically. Given the non-independence of gait cycles within participants, a conservative threshold of p<0.001 was applied. Results: The participant who presented with idiopathic increased femoral anteversion walked with atypically high internal hip rotation in early swing compared to the participant without clinically increased femoral anteversion. In addition, the participant with higher internal hip rotation exhibited decreased peak knee flexion during swing. Statistical comparisons confirmed significant between-participants differences in both variables for each leg (p<0.001). Conclusions: Increased internal hip rotation in the early swing phase of gait may be a factor in the decreased swing phase peak knee flexion characteristic of SKG. Given the importance of patient selection for the treatment of SKG, further study in a larger sample with a wide range of severity of femoral anteversion may be warranted.
gait analysis, stiff knee gait, anteversion
Copyright (c) 2026 Krisanne Chapin, PhD https://creativecommons.org/licenses/by/4.0
Correlation of Coronary Angiographic Findings and Hemodynamic Risk During General Anesthesia: A Case Report
Introduction: The World Health Organization Safe Surgery Checklist requires confirmation that relevant imaging is available prior to surgery. In cardiac surgery, review of coronary angiography enhances clinicopathologic correlation and anticipatory management. This case study illustrates the importance of angiographic review to prevent refractory hypotension following anesthetic induction. Methods: A single-patient case study was conducted involving a 71-year-old male with severe multi-vessel coronary artery disease undergoing beating-heart, pump-assisted coronary artery bypass grafting. Clinical presentation, intraoperative hemodynamics, echocardiographic findings, and vasoactive management were analyzed in the context of preoperative angiographic data. Results: Following induction of anesthesia, the patient developed severe refractory hypotension (MAP 30 mmHg) and bradycardia (HR 48-55 BPM) despite phenylephrine administration. The diastolic blood pressure became inadequate to perfuse the left anterior descending (LAD) coronary artery, acutely compromising the myocardium. Escalation to epinephrine and norepinephrine provided transient stabilization. Transesophageal echocardiography revealed an acute reduction in left ventricular ejection fraction (LVEF) from 55-60% to 20%. Emergency sternotomy and initiation of cardiopulmonary bypass were required. Postoperative recovery was uneventful. Conclusions: In high-risk coronary lesions, hypotension may precipitate myocardial failure refractory to vasopressors. Early inotropic support may be preferable to reflexive vasopressor escalation. Lesions involving the LAD coronary artery increase the risk of intraoperative myocardial ischemia. Adequate preoperative coronary angiogram review may have predicted the ischemia-induced low cardiac output state observed in this case. With this knowledge, patient safety and clinical decision-making would likely have improved, and emergent initiation of cardiopulmonary bypass may have been avoided.
surgical safety checklist, induction of anesthesia, cardiac anesthesia
Anesthetic management for cardiac surgery
Copyright (c) 2026 Dr. Robert Poston, Tiffany Eye, Amy Cook, Evan Harris https://creativecommons.org/licenses/by/4.0
Patient Satisfaction Regarding Shared Decision-Making During the Menopausal Transition
Introduction: Shared decision-making (SDM) is central to patient-centered care but remains underexplored in menopause management. Many women report dissatisfaction with menopause care, including feeling dismissed, inadequately informed, or excluded from treatment decisions. This scoping review examined existing evidence on the relationship between SDM and patient satisfaction during the menopausal transition. Methods: Following PRISMA-ScR guidelines, literature searches were conducted in CINAHL, MEDLINE, and APA PsycINFO for peer-reviewed English-language studies published between 2002 and 2025. Studies examining SDM in menopause-related healthcare encounters with outcomes related to satisfaction, communication, or decision processes were included. Results: Eight studies met inclusion criteria, including randomized controlled trials, mixed-methods evaluations, quasi-experimental studies, and cross-sectional research. Interventions included decision aids, discussion guides, web-based tools, and pre-consultation preparation resources. Across studies, SDM interventions improved knowledge, reduced decisional conflict, and increased satisfaction with treatment decisions. Women reported higher satisfaction when clinical encounters included clear information, opportunities for participation, and relational elements such as empathy and validation. Conclusions: Patient satisfaction with menopause care appears influenced by both informational support and relational dynamics within SDM encounters. Integrating decision-support tools with communication strategies that emphasize validation and collaboration may improve engagement and satisfaction during the menopausal transition.
Copyright (c) 2026 Heather Foulke https://creativecommons.org/licenses/by/4.0
Short-Term Effects of a Botanical Supplement on Anxiety, Mood, and Cognition: A Single-Arm Pilot Study
Introduction: Psychological stress and cognitive fatigue are increasingly prevalent in contemporary life, leading to greater interest in natural interventions that support mental well-being and cognitive performance. Botanicals such as Bacopa monnieri, Withania somnifera (ashwagandha), and Salvia officinalis (sage) have been traditionally used for their adaptogenic and nootropic effects 1,2. Methods: This pilot trial examined the short-term effects of a multi-ingredient botanical supplement containing Withania somnifera (ashwagandha), Bacopa monnieri, huperzine A, sage, and B vitamins on stress, anxiety, cognition, mood, and sleep over 14 days in healthy adults. Twenty-five participants (M = 30.0, SD = 12.9) consumed two caplets daily for 14 days. Primary outcomes were perceived stress and state anxiety. Secondary endpoints included cognitive performance, Profile of Mood States, Pittsburgh Sleep Quality Index, and salivary cortisol. Pre- and post-intervention data were analyzed using paired-samples t-tests. Results: Significant reductions were observed in perceived stress (12.3±7.1 to 9.7±6.1; p = 0.001) (p < .05) and state anxiety (31.8±9.6 to 28.9±6.7; p = 0.046). Mood profiles were enhanced, with lower Total Mood Disturbance (3.4±24.6 to -2.4±20.4; p = 0.192) and reduced tension (6.6±5.6 to 4.6±3.6; p = 0.091) and depression (2.9±4.1 to 1.9±4.3; p = 0.273). No significant changes were observed in sleep quality or cortisol levels. Conclusions: These findings suggest potential benefits of short-term botanical supplementation on mood and stress in healthy adults, warranting larger, controlled trials.
stress, anxiety, cognition, mood, botanicals, ashwagandha, Bacopa monnieri
Exercise Science, Sports Science, Nutrition
Copyright (c) 2026 Jason Curtis https://creativecommons.org/licenses/by/4.0
Unique and Overlapping Proteins of Subjective Feelings of Mental and Physical Energy and Fatigue: An Exploratory Study
Introduction: Recent evidence suggests that subjective feelings of mental energy (ME), mental fatigue (MF), physical energy (PE), and physical fatigue (PF) are unique and overlapping biological correlates. This exploratory study aimed to identify unique and overlapping proteomic markers and their associated pathways for ME, MF, PE, and PF. Methods: Participants (n=10) completed a 3-day protocol with saliva samples collected at multiple time points, including pre- and post-fatigue (Day 2). Trait and state levels of ME, MF, PE, and PF were assessed each day, and absolute and relative changes in mood and proteomic markers were calculated. Top 1% of proteomic markers were identified using a genetic algorithm with Random Forest Regressor, followed by Community Louvain network analysis and STRING-based protein–protein interaction analysis. Results: Our analysis identified unique and overlapping proteomic markers for each of the 4 moods. The PTP analysis revealed that energy was associated with ATP generation (p<0.001), activation (p=0.003) and regulation of adaptive immunity (p<0.001), and markers of cardiac myopathy (p=0.028) while fatigue was associated with catabolism (p=0.008), oxidative stress, innate immunity (p<0.001), and necroptosis. Conclusions: Consistent with prior research, the results highlight the distinct biological profiles of energy and fatigue, supporting their assessment as separate mental and physical state and trait moods.
Copyright (c) 2026 Ali Boolani, Bryndan Lindsey, Emanuel Petricoin, Weidong Zhou, Rayan Alhammad, Joshua Butcher, Joel Martin https://creativecommons.org/licenses/by/4.0
Enhancing Quality of Life for Hispanic Caregivers of Veterans Post-Stroke Through a Culturally Tailored Problem-Solving Intervention
Introduction: Caring for a stroke survivor is physically and emotionally demanding, often leading to reduced quality of life (QoL) for caregivers. Hispanic caregivers, particularly Spanish-speaking individuals, face additional challenges due to language barriers and cultural norms that shape help-seeking behaviors. Although problem-solving interventions can support the transition from hospital to home, few are tailored for this population. This paper reports findings on the impact of a problem-solving intervention on the quality of life of caregivers of Veterans post-stroke. Methods: A randomized clinical trial was conducted with 210 Hispanic Spanish-speaking stroke caregivers to evaluate the impact of a problem-solving intervention on caregivers’ outcomes. Physical and mental health were measured using the Veterans Rand 12 Item Health Survey (VR-12). A generalized least squares regression model for repeated measures compared groups on physical and mental QoL outcomes measured at baseline, 9-weeks, and 21-weeks. Results: The intervention group demonstrated significant improvement in mental health-related QoL, with scores increasing from 46.0±5.5 at baseline to 49.9±6.0 at 9-weeks and sustaining at 48.4±6.0 at 21-weeks, compared to the standard care group. Significant group-by-time effects were found at 9-weeks (p=.001) and 21-weeks (p=.044). The standard care group showed no change on mental QoL. Physical health–related QoL declined modestly in both groups, with no significant intervention effect. Conclusions: These findings underscore the value of culturally tailored support, as even brief interventions can lead to meaningful improvements in mental health among Hispanic caregivers. While the intervention improved mental health-related QoL, additional strategies may be needed to address physical health.
Copyright (c) 2026 Trucvy Nguyen, Janet Lopez, Nicole Haberland, Tatiana Orozco , Melanie Orejuela, Naiomi Rivera-Rivera, Nathaniel Eliazar-Macke, Magda Montague, I. Magaly Freytes https://creativecommons.org/licenses/by/4.0
Multiple Exposures to Blood Flow Restriction Walking Affects Ratings of Perceived Exertion but Not Pain
Introduction: Blood flow restriction (BFR) walking elicits improved fitness, but participants often report higher ratings of perceived exertion (RPE) and pain during BFR walking compared to non-BFR walking. The primary aim was to investigate how multiple BFR walking exposures might affect RPE and pain. Methods: 14 healthy, trained participants completed three BFR walking sessions on separate days. The treadmill speed that elicited 3/10 RPE while BFR was not applied was determined and that same speed was used during all BFR walking sessions. Participants walked for 15 minutes at the predetermined speed while 60% limb occlusion pressure was applied bilaterally to the thighs. RPE (0-10) and pain (0-10) were recorded during each minute of exercise. Two-way repeated measures analysis of variance determined if session (1-3) and/or time (1-15 minutes) affected RPE or pain. Statistical significance was established at p<0.05. Results: RPE was higher during session 1 compared to session 2 (minutes 8-15, 4.4±1.4 versus 3.6±0.8). RPE was higher during session 1 compared to session 3 (minutes 3-5, 3.5±0.7 versus 2.9±0.6; minutes 7-15, 4.3±1.3 versus 3.5±1.1). No significant differences were observed for pain. Conclusion: Participants might tolerate BFR walking better after completing two BFR walking sessions as lowered RPE responses were observed.
Copyright (c) 2026 Trent Cayot, Stefanie Markwardt, Kimberly Bowers, Noah Cantu, Hadley Fisher, Tom Saint-Juvin, Nathanial Eckert https://creativecommons.org/licenses/by/4.0
The Impact of Familiarization on Pressure and Heat Pain Scores
Introduction: Quantitative sensory testing (QST) provides an effective means to better understand the pain process; however, inherent variability exists depending on how QST methods are implemented. The current study sought to investigate the impact of pain testing familiarization on pain pressure testing (PPT) and heat pain testing during QST in young, healthy participants. Methods: 25 participants (13(m)/12(f); 22.5 ± 2.5 yrs) underwent 4 separate testing sessions of pressure pain threshold (PPT) and pressure pain supra-threshold (PPTs) and heat pain threshold (HT) and 50/100 Visual Analogue Scale (H50), which included pain familiarization. Results: No significant effects were seen across session for PPT (F(3,184) = 1.205, p = 0.309) or PPTs (F(3,184) = 0.227, p = 0.8774) and trial type for PPT (F(1,184) = 0.12, p = 0.722) or PPTs (F(1,184) = 0.743, p = 0.390). A significant main effect for the independent variable of trial was found for the dependent variable of H50 (F(1,184) = 109.42, p = < 0.000) with the experimental trial values lower than familiarization values. This was not seen within the HT (F(1,184) = 3.374, p = 0.068) values. Conclusions: When testing for moderate levels of heat pain, familiarization should be considered. Additional research is still needed to support or deny the need for familiarization to be included in pain testing research to increase the accuracy of future research studies.
Copyright (c) 2026 Nathanial Eckert, Alyssa M. Valadez, Leah Richardson, Jhovana Brena, Gabriel Brual, Nicholas Foy, Kelly M. Naugle, Trent E. Cayot https://creativecommons.org/licenses/by/4.0
A Single Bout of Continuous Blood Flow Restriction Walking Does Not Negatively Affect Lower Limb Microvascular Function
Introduction: Diminished macrovascular vasodilatory function has been reported following one blood flow restriction (BFR) walking bout. The primary aim was to investigate the potential effect that walking exercise (control, BFR) and cool-down (supine, rolling massage [RM], walk) had on microvascular function. Methods: Fourteen participants walked for 15 minutes at a 3/10 rating of perceived exertion without (Session 1) and with (Sessions 2-4) BFR (60% limb occlusion pressure, LOP). Participants either rested supine, had RM performed on the thigh, or actively walked for the first two minutes of the cool-down. Microvascular functions of the quadriceps and calf muscles of a randomized leg were measured before and 20 minutes after each walking bout using the vascular occlusion test (VOT) via near-infrared spectroscopy. Between session intraclass correlations (ICC) and minimal detectable change (MDC) were calculated for microvascular function of each muscle. Two-way repeated measures analysis of variance was performed to assess if condition (CON+Supine, BFR+Supine, BFR+RM, BFR+Walk) and/or time (pre-exercise, post-exercise) affected microvascular function. Statistical significance was set at p<0.05. Results: Quadriceps (ICC=0.891, MDC=0.60 %/s) and calf (ICC=0.839, MDC=0.63 %/s) microvascular function demonstrated good between session reliability. Microvascular function statistically increased in the quadriceps (0.88±0.74 %/s vs 1.07±0.70 %/s) and calf (0.56±0.57 %/s vs 0.75±0.70 %/s) muscles after exercise; however, the changes (quadriceps=0.13 %/s, calf=0.19 %/s) did not exceed the MDC. No significant differences in microvascular function were observed between conditions. Conclusions: Microvascular function was maintained following fifteen minutes of continuous BFR walking with 60% LOP, regardless of the cool-down procedure.
Copyright (c) 2026 Trent Cayot, Stefanie Markwardt, Hadley Fisher, Kimberly Bowers, Tom Saint-Juvin, Noah Cantu, Nathanial Eckert https://creativecommons.org/licenses/by/4.0
Associations Between Fall Risk and Lower Limb Joint Range of Motion During Sit-to-Stand Among Community-Dwelling Older Adults
Introduction: Despite the sit-to-stand transition being an acute period of increased fall risk among older adults, it is currently unclear how lower-limb joint range-of-motion (ROM) during this task relates to fall risk. Methods: We examined 45 community-dwelling older adults (female = 32 (71.1%), age = 76.5±6.1years, BMI = 26.4±4.0kg/m2) within this cross-sectional study, assessing lower-limb mobility during 10 seconds of sit-to-stand repetitions using a single camera marker-less system. Hip and knee flexion, hip adduction, and ankle dorsiflexion were assessed for the right and left limbs, as well as asymmetry indices between sides. Fall risk was assessed using the STEADI checklist, Short Physical Performance Battery (SPPB), lower-body muscular power, postural sway, the Short Fall Efficacy Scale-International (FES-I), and 4-meter walking gait speed. Spearman’s rho (ρ) and Kruskal Wallis H-test were used due to nonnormal data distributions. Results: High fall risk participants had significantly lower muscular power (2.8±0.6W/kg, p = 0.004, ε2 = 0.187) and higher knee flexion asymmetry (4.5±2.5°; p = 0.021, ε2 = 0.121) than low fall risk participants (3.6±1.0W/kg; 2.9±2.4°). All correlations between joint movements and fall risk assessments were relatively small/weak (ρ ≤ |0.38|). Hip flexion asymmetries were significantly correlated with SPPB performance (ρ = -0.33, p = 0.03) and Short FES-I scores (i.e., fear of falling; ρ = 0.35, p = 0.02). Conclusions: Lower-limb ROM during the sit-to-stand transition may not be a strong indicator of fall risk on its own but may provide clinically relevant insight when paired with a validated fall risk assessment.
Copyright (c) 2026 Kworweinski Lafontant, Carla Stokes Leinbach, Nicolle Armas, Patria Marcano Maldonado, Jethro Raphael M. Suarez, Chitra Banarjee, Janet Lopez, Jeffrey R. Stout, David H. Fukuda, Ladda Thiamwong https://creativecommons.org/licenses/by/4.0
Cognitive Impairment and Depressive Symptoms Among Low-Income Hispanic and Non-Hispanic White Older Adults: A Cross-Sectional Analysis
Introduction: Hispanic older adults represent a rapidly growing demographic in the United States and may be disproportionately affected by cognitive impairment and depression. This study aimed to examine ethnic differences in the prevalence of cognitive impairment and depression among low-income Hispanic and non-Hispanic White older adults, and to explore the relationship between cognitive impairment and depressive symptoms within these groups. Methods: This cross-sectional study included 157 older adults (age = 76.3 ± 6.7 years, female = 133), recruited from independent living facilities and low-income community centers in Central Florida. The sample consisted of Hispanic (n = 91) and non-Hispanic White (n = 66) older adults. Cognitive impairment was assessed using the Memory Impairment Screen, and depression was measured using the Patient Health Questionnaire-9 (PHQ-9). Chi-square tests and Mann-Whitney U tests were used to analyze group differences. Results: A significant difference in cognitive impairment prevalence was found between ethnic groups (χ² = 7.528, p = .006), with Hispanic participants showing higher rates. However, depression scores did not significantly differ between Hispanic and non-Hispanic White participants (U = 2930.50, p = .79), nor between those with and without cognitive impairment within each ethnic group (Hispanic: U = 839.00, p = .71; non-Hispanic White: U = 227.50, p = .93). Conclusions: Cognitive impairment is more prevalent among low-income Hispanic older adults compared to their non-Hispanic White counterparts. These findings emphasize the need for culturally tailored interventions to improve cognitive health care access for older adults.
Copyright (c) 2026 Cecil Latta, Janet Lopez, Dahee Kim, Kworweinski Lafontant, Nicole Haberland, Trucvy Nguyen, Ayse Malatyali, Ladda Thiamwong https://creativecommons.org/licenses/by/4.0
Artificial Intelligence in Long-Term Care: Benefits and Concerns
In recent days, artificial intelligence (AI) has emerged as a valuable tool to reshape the long-term care industry. Integrating AI into long-term care facilities is a revolutionary achievement in supporting the growing aging population.
AI-powered technologies, health outcomes, quality of life.
Copyright (c) 2026 Kallol Kumar Bhattacharyya https://creativecommons.org/licenses/by/4.0
Mindfulness, Depression, and Fall Risk in Low-Income Older Adults
Introduction: Mindfulness, through mind-body practices, promotes awareness and presence. Its practice, along with reduced depression, may improve balance and lower fall risk in older adults. This study examined the association between mindfulness, depression, and fall risk among low-income, community-dwelling older adults. Methods: A descriptive cross-sectional study was conducted with 103 community-dwelling, low-income older adults, including 16 males and 87 females, with a mean age = 75.70 years (95% CI ± 7.19). Mindfulness was assessed with the Mindful Attention Awareness Scale (MAAS), depression using the Patient Health Questionnaire (PHQ-9) and fall risk with the CDC’s checklist for elderly accidents and injuries. Multiple regression analysis was conducted. Results: Mindfulness was negatively correlated with fall risk (r=-.437, p<.001), while depression was positively correlated with fall risk (r=.486, p<.001). These variables explained 31.1% of the variance in fall risk (R² = .311, p < .001). Mindfulness (β = -.262, p =.006) and depression (β = .306, p =.001), respectively, were significantly associated with fall risk. Conclusions: This study demonstrates that mindfulness and depression are predictors of fall risk. Community-dwelling low-income older adults may benefit from mind-body exercises. These exercises can help them become more aware and enhance their mental health, which may lower their risk of falling.
Community-dwelling low-income older adults
Copyright (c) 2025 Aleeyah Uddeen, Janet Lopez, Renata Komalasari, Manika Petcharat, Veronica Decker , Tatiana Orozco , Ladda Thiamwong https://creativecommons.org/licenses/by/4.0
Using Ecological Momentary Assessment to Examine Predictors of Motivation for Physical Activity in Older Adults
Introduction: Ecological Momentary Assessment (EMA) involves repeated assessments of patients’ real-time experiences. Smartphone delivery of EMA can monitor healthy behaviors, including physical activity (PA). PA is critical for maintaining mobility and independence in older adults. We aimed to utilize EMA for monitoring motivation for PA, while assessing PA and physical function (PF) as predictors. Methods: We collected 179 EMA responses from 28 community-dwelling older adults (Mage = 72.67±6.55 years, 82.1% female) over one week. Motivation for PA was determined using a single question delivered by a smartphone, PA was monitored using accelerometers, and PF was assessed using dynamic balance (Timed-Up-and-Go) and lower limb power (Sit-to-Stand). Results: Motivation for PA showed weak correlations with PA (ρ=0.187), dynamic balance (ρ=-0.157) and lower limb power (ρ=0.200). However, mixed effects models revealed that only better dynamic balance (p=0.001) predicted increased motivation. Conclusions: This study revealed the feasibility of monitoring motivation through mobile delivery of EMA, validating the method for future interventions. Evaluation of motivation can assess older adults’ subjective attitudes towards interventions. Additionally, these findings have implications for intervention designs that aim to increase engagement in PA; exercises or methods designed to improve dynamic balance may provide more lasting improvements than focusing on increasing PA alone.
Copyright (c) 2025 Chitra Banarjee, Rui Xie, Chen Chen, Janet Lopez, Ladda Thiamwong https://creativecommons.org/licenses/by/4.0
Accuracy of Physical Function-based Fall Risk Assessments Among Community-Dwelling Older Adults: An ROC Analysis
Introduction: Physical function assessments, such as the Timed-Up-and-Go (TUG) and Short Physical Performance Battery (SPPB), are commonly used to evaluate fall risk among older adults, yet they may misclassify individuals. Center-of-pressure postural sway path length (PS) is a criterion for assessing fall risk, but it is unclear how TUG and SPPB compare. This study examined the sensitivity, specificity, and accuracy of these three assessments in classifying older adults as high or low fall risk. Methods: We conducted a cross-sectional study of 234 community-dwelling older adults (women=203, age=75.0±7.0 years, height=159±7.9cm, Body Mass Index=30.0±6.3kg/m²). Cut off values for SPPB (<7 out of 12), TUG (≥20 seconds), and PS (>30 cm) were used to categorize participants as high or low fall risk. McNemar tests were used to compare fall risk assessment between assessments. Results: Participants had a mean TUG time of 10.2±6.3 seconds, SPPB score of 8.7±2.3, and PS of 34.7±21.3cm. Both TUG (high risk=10, low risk=224; X²=95.9, p<0.001) and SPPB (high risk=40, low risk=194; X²=55.7, p<0.001) significantly differed in fall risk assessment compared to PS (high risk=115, low risk=119). Compared to postural sway, TUG had a sensitivity of 4.3%, specificity of 95.8%, and accuracy of 50.9%. Similarly, SPPB had a sensitivity of 23.5%, specificity of 89.1%, and accuracy of 56.8%. Conclusions: TUG and SPPB both demonstrated low sensitivity and accuracy, suggesting that they may be better as measures of physical function rather than fall risk. Clinicians may benefit from using PS or other criterion measures to screen for fall risk.
Copyright (c) 2025 Estefania Zamarripa, Kworweinski Lafontant, David H. Fukuda, Jeffrey R. Stout, Ladda Thiamwong https://creativecommons.org/licenses/by/4.0
Firefighter Years: Mediating Effects of Years of Service on Physical Fitness
Introduction: Firefighters' biological age and years of service (YOS) often vary significantly, as individuals may enter the profession at any age. YOS introduces cumulative occupational stressors that may mediate age-related declines in physical fitness. While age-related reductions in physical fitness are well-documented, the mediating effect of YOS on firefighters' fitness remains unclear. Thus, the purpose of this study was to investigate the mediating role of YOS in the relationship between age and physical fitness outcomes and assess whether sex moderates the effects of YOS on these outcomes. Methods: A retrospective analysis of physical fitness testing data from 2019 to 2021 of 1,281 firefighters (1,136 males, 145 females; Age: 39.2 ± 9.3 years; YOS: 11.0 ± 7.3 years) was conducted. Fitness tests included maximum pull-ups (PL), push-ups within 60 seconds (PU), sit-ups within 60 seconds (SU), and a 3-minute step test to estimate VO2max. Pearson’s correlation tested the relationship between age and YOS, while path analysis evaluated YOS as a mediator between age and fitness outcomes. A moderation analysis examined the influence of sex on these relationships. Results: Age and YOS were moderately correlated (r = 0.66). YOS fully mediated the relationship between age and SU (p < 0.001) and partially mediated the effects of age on PL (p < 0.001) and PU (p < 0.001). No mediation effect of YOS was observed for VO2max (p > 0.05). Sex significantly moderated the relationship between age, YOS, and several physical fitness outcomes. Specifically, the relationship between age and pull-up performance was stronger for males (b = -0.152, p < 0.001) than females (b = -0.065, p < 0.05), while YOS was significantly related to pull-up performance in males (b = -0.123, p < 0.001) but not in females (b = -0.071, p > 0.05). Conclusions: YOS exacerbates declines in musculoskeletal strength and endurance, independent of age, particularly in male firefighters. Fire departments should consider YOS and sex, alongside age, when designing fitness assessments and training programs to optimize performance and safety.
Copyright (c) 2025 Joel Martin , Mike Toczko, Angela Miller, Shane Caswell https://creativecommons.org/licenses/by/4.0
Geographic Disparities in Vaccine Clinical Trial Access in the Mid-West: Impact of COVID-Era Clinical Trial Reform
Introduction: The COVID-19 pandemic prompted numerous vaccine studies. The Food and Drug Administration (FDA) also modified research regulatory guidelines, such as allowing virtual visits, in March 2020 that could make clinical research in rural areas more feasible. This study evaluates the effect of 2020 clinical trial reform on vaccine trial access in rural/underserved regions of the mid-West. Methods: Clinicaltrials.gov data was accessed from 1/1/2018-9/30/2022 for vaccination studies conducted in Kentucky, Tennessee, Illinois, Indiana, and Ohio. Trial locations were categorized by Rural-Urban Commuting Area codes (urban, suburban, small town and isolated rural) and identified as pre- vs. post-pandemic regulations. Trial locations from pre- and post-pandemic regulation dates were analyzed by paired t-test. Comparison of trial location category by state was analyzed by one-way ANOVA with pairwise multiple comparisons. Results: Pandemic-era deregulation had no impact on vaccine trial geographic availability (p=0.8637). Overall, 95% of study locations were in urban/metropolitan areas, 4% in suburban/micropolitan areas, 0.5% in small town/rural areas, and 0.1% in isolated rural areas. Results varied by state (p<0.0001) with Kentucky offering the most suburban and rural trial availability (31%). Conclusions: While modifications in the FDA’s regulatory guidelines may have increased flexibility for patients, these changes did not improve access to vaccine clinical trials at community sites in suburban, small town, and rural areas as measured by RUCA code. Increasing geographic diversity in vaccine clinical trials is critical for the development of more effective and equitable vaccines, as well as enhancing public trust in vaccination programs.
Underserved, COVID-19 pandemic, Telemedicine.
COVID-19, Underserved, Rural Health Disparity, Vaccination
Copyright (c) 2025 Dr. Elizabeth A. Gordon https://creativecommons.org/licenses/by/4.0
Fluctuations in Physical Activity over the Course of the COVID-19 Pandemic
Introduction: Several studies have indicated that physical activity (PA) declined during the restrictions associated with the onset of the COVID-19 pandemic. However, research comparing PA before the pandemic and during the pandemic-related restrictions to a more recent period when pandemic-related restrictions ended is limited. The purpose of this study was to compare PA across three timepoints: prior to the start of the pandemic (T1), the initial six-months of the pandemic (T2), and 18 – 24 months after the onset of the pandemic (T3). Methods: University students (N = 149, n = 80 female) who owned an Apple iPhone reported PA (average steps/day) using the Health app at three timepoints: T1 (9/2019-3/2020), T2 (3/2020-8/2020), and T3 (9/2021-3/2022). Results: A one-way repeated measures ANOVA demonstrated a significant main effect (F = 11.4, p < 0.001) for changes in average daily steps across timepoints. Steps were significantly lower (p £ 0.004) during T2 (5045 ± 2423 steps/day) when compared to T1 (5674 ± 2856 steps/day) and T3 (6010 ± 2616 steps/day). No significant differences (p = 0.11) were found between T1 and T3. Conclusions: During the initial six months of the pandemic participants reduced steps by 11%, which supports previous research. Subsequently, current evidence supports a novel recovery in steps in the six months prior to data collection as PA returned to baseline values. Future research is warranted to determine if other negative behaviors that may have been adopted during the pandemic have since abated.
Copyright (c) 2024 Jessica Smith-Ricketts, Gretchen E. Elsey, David Kohan, Andrew Lepp, Jacob E. Barkley https://creativecommons.org/licenses/by/4.0
Effect of Properly Describing the Borg Rating of Perceived Exertion (RPE) Scale on Heart Rate Response
Introduction: The Rating of Perceived Exertion (RPE) scale is often used to guide intensity during exercise. The purpose of this study was to determine if a thorough explanation of the scale is necessary to achieve optimal heart rate during indoor group cycling. Methods: The study consisted of a familiarization visit and two 60-minute instructor-led group cycling classes. The cycling sessions were identical in procedure; the only difference was that during one session, there was no explanation of the RPE scale (RPE-NE), and in the other, it was fully described in detail (RPE-E). Heart rate (HR) was continuously monitored. Maximal and average HR were calculated for each stage of the class. Repeated measures ANOVAs (condition x stage) were used to compare the mean HR, HRmax and %HRmax between conditions. Paired-samples t-tests were used to compare session RPE between conditions. Results: There were no differences between conditions for average HR (p=.436), HRmax (p=.086), or %HRmax (p=.084). There was also no difference between conditions in session RPE (RPE-NE: 15.7±1.4; RPE-E: 16.0±1.3; p=.432) Conclusions: A detailed explanation of the RPE scale before a group cycling class elicits a HR response similar to simply having a poster of the RPE scale posted and referenced.
Copyright (c) 2024 Khari Dickey, Nicholas Hanson, Rachel Maceri https://creativecommons.org/licenses/by/4.0
The Association of Hip Strength and Range of Motion with Hip and Groin Pain in Collegiate Ice Hockey Players
Introduction: Hip and groin pain is common in male ice hockey players. The relationship between physical examination findings and hip and groin pain in collegiate male hockey players is not well established. The purpose of this study was to explore associations between hip strength and hip range of motion (ROM) and hip and groin pain in male collegiate ice hockey players. Methods: This was a cross-sectional study of 59 male ice hockey players. The Sport subscale of the Copenhagen Hip and Groin Outcome Score (HAGOS) were collected to identify those with hip and groin pain. Measurements of hip ROM and strength were obtained at the beginning of the season. Between group comparisons were made and logistic regression was used to determine the strength of the association. Results: Compared to those without, male ice hockey players with hip and groin pain (n=17) had a lower amount of hip internal rotation ROM (-6.21; 95% CI 2.29, 10.14; p<0.01) and a lower ratio of hip adductor to abductor strength (-0.16; 95% CI -0.27, -0.05; p<0.01). These two variables explained 37% of the difference between groups (R2=0.37; p<0.01). There was no significant difference in hip external rotation ROM between groups. Conclusions: Hip internal rotation ROM and the ratio of hip adductor to abductor strength were lower in male collegiate ice hockey players with hip and groin pain compared to those without. These findings may help inform secondary prevention and rehabilitation strategies in this population.
Copyright (c) 2024 William Suits, Stacie Fruth, Paul Whitehead, Kieran Fogarty https://creativecommons.org/licenses/by/4.0
A Preliminary Investigation of Turkesterone: It’s Not Deca
Introduction: It has been suggested that supplementation with turkesterone, a type of ecdysteroid, may have anabolic properties that promote improvements in body composition. Thus, the purpose of this investigation was to determine if four weeks of Turkesterone (500 mg daily dose) supplementation affected body composition in healthy males and females. Methods: Thirty-one active males (n=14) and females (n=17) volunteered for this investigation. Research participants were assessed pre and four weeks post for body composition (i.e., dual-energy X-ray absorptiometry). After pre-testing, they were randomized into a placebo (rice flour) or treatment group (i.e., 500 mg per day of turkesterone [Ajuga Extract]). Subjects were instructed to maintain the same diet and exercise habits during the study. Results: The delta scores of the treatment and placebo groups were compared using an independent samples t-test. There were no between-group differences (p>0.05) at baseline for age, height, or body mass. There were no between-group differences in the delta score between the turkesterone and placebo groups in body mass (p=0.38), lean body mass (p=0.68), fat mass (p=0.06), or percent body fat (p=0.14); (Delta score, mean±SD: body mass kg – treatment -0.4±1.8, placebo 0.1±1.8; lean body mass kg - treatment -0.6±1.4, placebo -0.3±1.7; fat mass kg - treatment 0.1±0.6, placebo 0.5±0.6, % fat treatment 0.3±0.6, placebo 0.7±0.9). Conclusions: Four weeks of supplementation with 500 mg of turkesterone did not affect body composition in active, healthy males and females
Copyright (c) 2024 Jose Antonio, Tobin Silver, Ava Lukowiak , Lia Jiannine https://creativecommons.org/licenses/by/4.0
Training, Nutrition, and Sports Supplement Strategies of an Elite Female Masters Cyclist: A Case Study
Background: The purpose of this case report was to compare the training, diet, and supplement strategies of a 54-year-old female national-class cyclist to what is typically recommended in the literature. Methods: This case study examined the training, nutrition, and supplement strategies of a 54-year-old Masters female cyclist who won the 2023 USA Cycling Time Trials. Data was acquired via a smartwatch that the athlete wore in all of her training sessions over 29 weeks, outlining the volume of training as well as macronutrient and supplement consumption. Results: Her average weekly training volume was 167.0±61.4 miles (268.8±98.8 km; mean ± standard deviation [SD]). The number of training sessions per week was 8.4±2.1. In addition, the percentage of the weekly training sessions that consisted of high-intensity interval training was 55.3±20.1 %. Her mean energy intake was 2444±101 kcal or 36.6 kcal/kg. Her macronutrient intake was 228±33 grams (g) of carbohydrate, 95±34 g of fat, and 196±25 g of protein. Expressed per unit body weight daily (kilograms or kg), her macronutrient intake was 3.3 g/kg carbohydrate, 1.4 g/kg fat, and 2.9 g/kg protein. After 29 weeks of training, the athlete won first place in the 30k USA Cycling Time Trial (Masters) with an average speed of 23.35 miles per hour (37.6 km/hr.). Conclusions: The results highlight that for this particular female athlete, consuming a high-protein diet coupled with a moderate intake of carbohydrates is a viable strategy for endurance events (e.g., cycling time trials). It should also be noted that the majority of her training sessions consisted of interval training.
endurance, periodization, high protein, macronutrient, polarized training
Copyright (c) 2024 Jose Antonio, Jose Rojas, Jason Curtis, Cassandra Evans, Flavia Pereira https://creativecommons.org/licenses/by/4.0
Risk of Disordered Eating, Exercise Dependence, Body Dissatisfaction, and Fueling Habits in Masters Trail Runners
Introduction: Masters-level trail runners comprise a large percentage of trail and ultramarathon racers. Endurance training may increase the risk of developing disordered eating (DE) patterns and exercise dependence (EXD). This study investigated the risk of DE and EXD in masters-level runners, and compared the risk of EXD, body dissatisfaction, injuries, and fueling habits in runners at risk vs. not at risk for DE. Methods: In this cross-sectional study design, male (n = 457) and female (n = 564) masters trail runners (41-65 years of age) completed a Qualtrics survey comprising the Disordered Eating Screen for Athletes (DESA-6), Exercise Dependence Scale (EDS-21), and questions pertaining to fueling strategies, dietary preferences, and body image satisfaction. Results: 46% of females and 32% of males were at risk for DE based on the DESA-6. 80% of female and 79% of male runners were classified as symptomatic for EXD. For the entire population, there was a significant association between DE risk (88.2%) and symptomatic EXD (χ21 = 32.5, p < 0.001). The majority of participants (71.4%) reported being dissatisfied with their weight. Conclusion: This study demonstrated a high prevalence of DE, EXD, and body dissatisfaction in masters trail runners.
Copyright (c) 2024 Alyssum M. Reno-Smith, Dr. Kelly L. Pritchett, Keely A. Henninger https://creativecommons.org/licenses/by/4.0
Applicability of Ratings of Perceived Exertion as a Measure of Subjective Fatigue in First Responders: An Exploratory Study
Introduction: Many researchers use Ratings of Perceived Exertion (RPE) as an indicator of subjective fatigue. Recent findings suggest that energy and fatigue are two distinct unipolar moods. Methods: Eleven first responders (FR) participated in a 90-minute strenuous exercise battery where they ended the protocol by completing a graded VO2max test where they were asked to perform until volitional fatigue, measured through RPE. Subjective feelings of mental energy (ME) and fatigue (MF) and physical energy (PE) and fatigue (PF) were measured before the beginning of the protocol and right after. Data was not normally distributed and presented in median and interquartile ranges. Spearman correlation coefficients were calculated for RPE, post mood state, and changes in mood states. Results: Participants’ self-reported RPE at the conclusion of the VO2max test was 18.27 [18.00,19.00]. Post PE (r=-0.012, p=0.97), PF (r=-0.036, p=0.92), ME (r=-0.13, p=0.69), and MF (r=0.43, p=0.19) displayed insignificant correlations with RPE. Similarly, insignificant correlations were observed between changes in PE (r=0.26, p=0.44), PF (r=0.46, p=0.15), ME (r=0.35, p=0.30), MF (r=-0.43, p=0.19), and RPE. Five participants reported an increase in feelings of PE (15.00 [13.00,19.00]) and seven participants reported lower feelings of PF (-12.00 [-19.50,-8.00]) post assessment. Seven participants reported improvements in ME (22.00 [8.00,68.00]) and three reported a reduction in MF (-13.00 [-27.00, -7.00]). Conclusions: Our findings suggests that self-reported RPE may not be a reliable measure of subjective fatigue in FR populations during acute strenuous exercise. Further our findings support previous work that ME, MF, PE, and PF are four distinct unipolar moods, and researchers seeking to assess fatigue in FR should use RPE with caution as it seems to be a measure of subjective perception of exercise intensity instead of a true measure of subjective fatigue.
physical energy, mental energy, mood states
Copyright (c) 2024 Michael Toczko, Dr. Ali Boolani, Dr. Joel Martin https://creativecommons.org/licenses/by/4.0
Qualitative Description of the Exertional Symptoms of Participants with Persistent Symptoms of Lyme Disease during a Low Intensity Resistance Training Intervention
Introduction: Greater emphasis needs to be placed on approaches to improve the health-related quality of life of patients with persistent symptoms of Lyme disease (PSLD), but little information exists to inform an exercise professional’s expectations of their supervision of resistance training (RT) programs with PSLD patients. In order to build this knowledge base, a secondary qualitative analysis was performed to explore the RT exertional symptoms of PSLD patients that participated in a 4-week study investigating the feasibility of an RT intervention. Methods: Comments regarding exertional symptoms that were recorded in a daily exercise log were the main source of data for this secondary analysis. A manifest content analysis was performed in order to identify recurrent themes of exertional symptoms experienced by this sample of PSLD patients during RT. Results: The reported findings revealed that strain, discomfort, crepitus, tightness, shaking, and control loss were the major themes of exertional symptoms recorded during the RT intervention. Conclusions: These results provide insights intended to inform the expectations of supervisors of exercise (personal trainers, physical therapists, exercise researchers, etc.) when directing RT programming with patients with PSLD.
Resistance training intervention for persistent symptoms of Lyme disease, exertional symptom management during resistance training
Copyright (c) 2024 Charlie McMillin, PhD, Dr. Bridget Melton, CSCS*D, TSAC-F*D, EP-C, Nicholas Murray, PhD, Chris D'Adamo, PhD https://creativecommons.org/licenses/by/4.0
Impact of Firefighting Equipment on Aerobic Performance in the Forestry Step Test in New Firefighter Cadets: A Pilot Study
Introduction: Firefighting is a physically demanding occupation, which involves tasks such as rescuing victims, pulling a hose, and carrying a ladder. Thus, firefighters must have excellent cardiovascular fitness (CF). However, the cumbersome movement and added mass of firefighting personal protective equipment (PPE) can place additional stress on the cardiovascular system, not accounted for through traditional CF testing. Purpose: Determine the effect of wearing PPE on predicted CF compared to athletic attire (AT) in firefighter (FF) cadets completing the Forestry Step Test (FST). Methods: Male and female (N = 17) FFs performed two trials of the FST, one trial completed in PPE and one in AT. Recovery heart rate was measured at the end of each trial and predicted VO2max was calculated. Paired samples t-tests compared heart rate and predicted VO2max values between the PPE and AT conditions. Results: Predicted VO2max (p < 0.001) was lower in the PPE (37.53 + 3.20 ml.kg.min-1) compared to the AT condition (46.35 + 7.63 ml.kg.min-1). Conclusion: Predicted aerobic capacity is lower when wearing PPE compared to AT using the FST as the aerobic capacity assessment method. The effect of PPE on CF effort of firefighting should be considered when developing assessments.
athletic attire, predicted VO2max, recovery heart rate
Copyright (c) 2024 Ryan Conners, Robert Cochrum, Cristina Northcutt, Haley Radden, Dakota Powell, MaryAnn Wiethop https://creativecommons.org/licenses/by/4.0
Health Science Approaches for Fall and Injury Prevention
According to the National Electronic Injury Surveillance System (NEISS) Injury Program operated by the Consumer Product Safety Commission, falls represent the number one cause of nonfatal injuries, increasing overtime from 2017-2021 (31.89%)1. Indeed, falls and fall-related injuries appear to be a growing concern, especially for an aging population and those with disabilities (e.g., mobility deficits, visual impairments). One challenge is that falls are multi-faceted, with the likelihood of a fall depending on various factors (e.g., visual, hearing, and muscular strength deficits) that affect balance and increase in prevalence with age. The projected number of individuals aged 40 and above with blindness or low vision will double between 2015 and 2050. Additionally, approximately 27.8% of adults 71 years and older have vision impairment, with 10% having contrast sensitivity impairment2. For those 85 years and older, contrast sensitivity worsens to 22.6%, which affects one’s ability to perceive sharp and clear outcomes of objects. Indeed, low vision negatively impacts one’s ability to do everyday activities, and challenges in identifying key objects compound the risk of falls3-5. Unfortunately, fall risk for individuals with visual impairment is as much as two to three times more than those without visual impairment6, with falls resulting in injury, decreased mobility, and loss of independence7. Given the preventative lenses of the health science field, future research should leverage preventative approaches to reduce fall risks and related injuries.
Copyright (c) 2024 Sara Harper https://creativecommons.org/licenses/by/4.0
Exploring the Use of Mindfulness-Based Meditation and Physical Activity to Reduce Stress in College Students
Introduction: With the prevalence of stress increasing among college students, stress reduction interventions are essential. This study explored the use of brief mindfulness meditation (BMM) and current physical activity on college students’ perceived stress. Methods: A single-cohort pre-test/posttest design was used to evaluate the effects of an 8-week classroom-based BMM. Current exercise levels and perceived stress, using the Perceived Stress Scale-10 (PSS-10), were measured in a convenience sample of college students (N = 42). Results: Brief mindfulness meditations were more effective in reducing stress for those who self-identified as “less than moderate” exercisers, SMD = 3.33 (t = 2.801, p = .023) than “moderate,” SMD = -.24 (t = -.162, p = .873) or “vigorous” exercisers, SMD = 2.56 (t = 1.577, p = .136). Discussion: The intervention was more beneficial for those who did not participate in regular physical activity. Thus, BMM sessions held during class served as a helpful means of stress reduction for these students.
Copyright (c) 2023 Phrosini Samis-Smith Samis-Smith, Nola Schmidt https://creativecommons.org/licenses/by/4.0
Implementation of a Triathlon Program for Primary School Students as part of Health and Physical Education
Introduction: The significance of triathlon is reflected in the teaching and development of motor, social and emotional skills. Because triathlon has great educational potential, this case study sought to explore whether a modified Physical Activity Enjoyment Scale (PACES) survey can be used as a suitable measure of enjoyment of physical activity in elementary school children when applied to a sports-specific task such as triathlon. Methods: The sample consisted of 12 female elementary school students (10.3 ± 1.3 years) from an inner-city high school. A modified triathlon program was delivered for one hour per week over a four-week duration with a modified PACES survey distributed each week. Survey responses were coded and then averaged over the four-week duration with the children’s responses subsequently analyzed using a Wilcoxon Signed Ranks Test to examine differences in the coded characteristic response scores of the survey. Further comparisons were made using a Student’s t-test and a coefficient of variation (CV). Results: A greater sense of pleasure and fun was reported by the participants at the conclusion of the four-week triathlon program while there was no change in the children’s sense of excitement (p < 0.5). Characteristic responses to ‘neutral’ decreased with a simultaneous increase in the ‘slightly enjoyed’ response when viewed over the four-week duration of the program (p <0.001) Conclusions: This PACES case study was designed as a feasible, simple, and innovative approach to monitor enjoyment levels in elementary school children who participated in a triathlon program. Overall, the positive enjoyment reported from this simple, low-cost intervention could be used to inform the development of future sport-specific elementary school programs.
Education. Health Education. Health and Physical Edcucation
Copyright (c) 2023 Stuart Evans https://creativecommons.org/licenses/by/4.0
The Effect of Acute Aerobic Exercise on Measures of Stress and Inflammation in Healthy Young Adults
Introduction: While the effects of long-term measures of inflammation and stress are well studied, less is known about the effects of an acute exercise challenge on exercise in young healthy individuals. Methods: This was a randomized crossover design (mean age = 19.25, SD = 1.45) that measured biomarkers of stress (cortisol and salivary alpha amylase, sAA) and inflammation (IL-1β, CRP) in an exercise and control condition. In the exercise condition, participants walked or ran on a treadmill at 75-85% of their maximum heart rate for 40 minutes. Under the control condition, participants stood for 40 minutes to control for orthostatic effects. Biomarkers were quantified from saliva collected before, 1 minute after, and 45 minutes after the exercise and control condition. Results: The change in biomarkers from baseline values (+1 min and + 45 min) between exercise and control conditions showed that compared to the control condition, the acute exercise bout significantly increased sAA CRP at +1min at +45 min and in IL-1β +45 min. Cortisol levels significantly decreased at both time points in the control condition Conclusions: Ultimately, the results of this study show how small and realistically achievable amounts of exercise can acutely strengthen the body’s physiological responses to immune challenges.
Copyright (c) 2023 Julien Tartar , Anthony Ricci, Jonathan Banks , Hannah Murphy, Cassandra Evans , Jose Antonio, Jaime Tartar https://creativecommons.org/licenses/by/4.0