Browsing by Subject "Motor Activity"
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Item Association of Fitness and Obesity with Right Ventricular Function(2018-03-23) Metzinger, Mark Philip; Berry, Jarett; Das, Sandeep; Rohatgi, AnandBACKGROUND: Low Cardiorespiratory Fitness (CRF) and obesity are well-established risk factors for heart failure (HF). However, the mechanisms through which CRF and BMI influence HF risk remain uncertain especially with regards to the right ventricle. OBJECTIVES: We hypothesized that lower levels of CRF and higher measures of obesity in young adulthood along with greater decline in CRF and greater increase in BMI from young adulthood to middle-age would be associated with greater abnormalities in RV function in middle-age. METHODS: The CARDIA study is a multi-center longitudinal cohort study of young adults. For the present study, 3,433 participants with baseline CRF test and BMI data and echocardiographic examination at year 25 were selected. 2,544 participants with repeat CRF test and BMI data at year 20 were included in secondary analyses. CRF was measured as the maximal treadmill test duration (in seconds) using a graded, symptom-limited maximal treadmill test using a modified Balke protocol. Study participants were stratified into fit/fat groups using median CRF and median BMI as cutoffs. TAPSE (Tricuspid Annular Plane Systolic Excursion) and RVS' (velocity of tricuspid annular systolic motion) were used as measures of RV systolic function with larger values representing better function. PASP (Pulmonary Artery Systolic Pressure) (N = 1,292 with adequate tricuspid regurgitation jet) was used as a measure of pulmonary artery filling pressures. Multivariable adjusted linear regression analyses were performed to evaluate the independent associations of baseline CRF, baseline BMI, % change in CRF ((CRF at year 20 - CRF at year 0)/CRF at year 0 *100), and % change in BMI ((BMI at year 20 - BMI at year 0)/BMI at year 0 *100) with each echocardiographic measure of RV function at year 25. RESULTS: In unadjusted analysis, both TAPSE and RVS' were highest in the high fitness/high BMI group; PASP was highest with higher BMI. In multivariable adjusted linear regression analyses we observed a significant, direct association between baseline BMI and PASP such that higher BMI in young adulthood was associated with higher PA pressures in middle-age (β 0.12, P-value .0002); this remained significant after adjusting for % change in CRF and % change in BMI. A similar result was seen with % change in BMI and PASP. On the other hand, baseline CRF levels were not significantly associated with PASP (β -.0004, P-value 0.99). While there was a significant negative association between % change in CRF and PASP (β -0.08, P-value 0.02), this association became nonsignificant after adjusting for % change in BMI (β -0.05, P-value 0.22). There was a significant, direct association observed between both baseline CRF levels and baseline BMI and measures of RV systolic function (TAPSE and RVS') such that both higher CRF and BMI at baseline were associated with better RV systolic function in middle-age. Similar results were seen in groups stratified by CRF and BMI where greater RVS' and TAPSE were seen in the high fitness/high BMI group while the lowest PASP was seen in the high fitness/low BMI group. CONCLUSIONS: Given that obesity rather than fitness was associated with higher PASP suggests that the risk of HF seen with obesity could move through the pathway of elevated PA filling pressures while the risk seen with decreased fitness moves through an independent pathway. Given that both fitness and BMI moved in the same direction with regards to TAPSE and RVS', measures of RV systolic dysfunction appear to be less helpful in assessing HF risk. This may have important implications in better understanding the contributions of weight loss towards prevention of diseases characterized by RV dysfunction and pulmonary hypertension.Item Family Studies of Sensorimotor Disturbances in Autism Spectrum Disorder(2016-07-26) Schmitt, Lauren Michelle; Mosconi, Matthew W.; Sweeney, John A.; White, Stormi P.; Bellone, Katherine; Tsai, PeterSensorimotor impairments are prevalent in individuals with autism spectrum disorder (ASD) and among the earliest emerging features, yet the pathophysiological mechanisms underlying these deficits remain poorly understood. Family studies are one approach to better understand these pathophysiological mechanisms by identifying sensorimotor impairments that are present in both individuals with ASD (probands) and their unaffected biological family members. Previous studies have identified reduced saccade accuracy and increased variability of saccade in probands as well as analogous deficits in unaffected relatives. We also have recently demonstrated reduced accuracy and increased variability of precision gripping in ASD. Accuracy of ocular and manual motor behaviors is controlled by feedforward motor control processes responsible for guiding initial motor output prior to available visual feedback as well as feedback processes that use visual feedback information to compensate for any systematic error. Thus, previous findings implicated disruptions of feedforward and feedback mechanisms in ASD. Here, we characterized saccade and precision gripping abnormalities in probands and their unaffected biological parents, and determined the extent to which these abnormalities are familial by studying family trios (proband, biological mother, biological father). Our results demonstrated that probands show reduced accuracy of rapid ocular and manual motor responses as well as increased variability of sustained manual motor behaviors, suggesting that cerebellar-mediated feedforward and feedback motor control processes are disrupted in ASD. Biological parents demonstrated a similar pattern of sensorimotor abnormalities to individuals with ASD. Further, impaired saccade dynamics and variability of sustained gripping inter-correlated among probands and their parents indicating that these deficits may be familial. Oculomotor and manual motor abilities were relatively independent in controls, whereas these abilities were correlated in both probands and parents suggesting reduced differentiation of these motor control systems in ASD. Sensorimotor deficits also were related to core diagnostic features in probands as well as to sub-clinical phenotypic features in parents, suggesting that deficits in sensorimotor behaviors may share pathogenic mechanisms with core symptoms. Overall, our findings provide support that sensorimotor impairments are highly prevalent in ASD, and that they may be familial, suggesting their use as intermediate phenotypes and potential biological markers of risk in ASD.Item Reduced Physical Activity Levels in Children after Acute Venous Thromboembolism(2018-01-23) Yang, Zhuo; Malone, Kendra; Zia, AyeshaINTRODUCTION: Venous thromboembolism (VTE), accompanied by its chronic sequelae such as post-thrombotic syndrome, has reached epidemic proportions. Early identification may offer an opportunity for effective intervention and reduction of long-term morbidity. Currently, no data is available regarding physical activity post-VTE in children and its relation to adverse post-VTE sequelae over time. Therefore, we sought to: (1) assess self-reported physical activity levels in children 6 months post-VTE and change over time from acute diagnosis, (2) compare activity levels of patients with and without adverse post-VTE sequelae, and (3) determine predictors of activity limitations after VTE and assess its association with health related quality of life (HRQoL). METHODS: Data on 50 children ages 2-21 years were extracted from our ongoing TOP study, with 36 diagnosed with lower extremity DVT and PE. We assessed pre-, 3, and 6 months post-VTE physical activity, using the Godin activity questionnaire. Age, race, ethnicity, gender, BMI, site of VTE, clot burden at diagnosis and follow-up, coagulation activation, dyspnea score, 6-minute walk distance (6MWD), and HRQoL were measured during follow-up. RESULTS: Out of 36 subjects, 20 had DVT, 16 had PE, and 3 had both DVT and PE. Of those followed for 12 months, 65% were active at 6 months post-diagnosis compared to 80% before. 36% of subjects had evidence of post-thrombotic sequelae ヨ a composite of post-thrombotic syndrome per the Manco-Johnson Instrument and post-PE impairment at 12 months post-diagnosis. In multivariate analysis, age, race, ethnicity, gender, BMI, site of VTE, baseline or residual clot burden, and type of anticoagulant were not predictive of activity limitations at 6 months post-VTE. Decreased activity level at 6 months was not associated with a decreased HRQoL at this time. Insufficient activity compared with high activity, reduced 6MWD at 6 months, and coagulation activation (defined by D-dimer > 500 ng/mL at 3 months post-diagnosis) were predictive of increased short-term risk for post-thrombotic sequelae when assessed at 12 months post-diagnosis (OR 1.55, p <0.001; OR 2.7, p=0.02; OR 4.2, p=0.02 respectively). CONCLUSION: 35% of children with DVT and PE had activity limitations post-VTE that adversely influenced short-term post-VTE sequelae. Only 65% of children had resumed their usual activity within 6 months after VTE, highlighting this as a critical time period for interventions aimed at preventing post-VTE disease. Continual data accrual from our ongoing, prospective study may offer further insight to predict risk factors for decreased activity levels and walking distance in children after VTE.Item [UT News](1985-12-01) Lyon, PamelaItem Voluntary Exercise Alters Adaptive Immunity Prior to Injury(2013-01-22) McPartlin, Angelica; Stowe, Anne M.; Poinsatte, Katherine; Mouti, Mariam; Ireland, Sarah J.; Li, MinOBJECTIVE: Exercise provides a neuroprotective role in the setting of cerebral infarct. However, the exact mechanism for this protection is unclear. This study established an exercise preconditioning protocol to test the hypothesis that exercise mediates protection from stroke by altering the immune profile prior to injury to reduce inflammation post-infarct. MATERIALS/METHODS: In our first trial, a three week exercise preconditioning protocol was established using nine C57 mice that endogenously expressed green fluorescent protein (GFP) under the PLP promoter. This biomarker was used to identify oligodendrocyte precursor cells (OPC) to qualify their relationship with voluntary exercise. Exercise activity was recorded and tissues were collected for histological and serological analysis. Analysis of histological sections acquired through Nanozoomer imaging was performed using an unbiased quantification (Stereo Investigator). Ten Swiss Webster (SW) mice with no endogenous fluorescence were used in the subsequent trial. Following sacrifice of the SW mice, samples of the spleen and peripheral blood were collected and analyzed by flow cytometry and microarray was used to analyze resident B cell expression (IPA software). Standard ELISA analysis of peripheral blood was also used for all trials. Significance was determined using t-test or ANOVA. RESULTS: Voluntary exercise in PLP-EGFP mice correlated with a trend increase in OPCs as well as a trend increase in cortical angiogenesis (p=0.06). However, voluntary exercise did not increase hippocampal neuron counts. Voluntary exercise in SW mice showed decreases in percent and raw number of splenic neutrophils and CD8+ T cells (both p<0.01), with a concomitant increase in B cell representation (p<0.05). Peripheral blood samples demonstrated a decrease in percent CD4+ T cells (p<0.01) and decrease in CCL2 (p<0.05) and VEGF (p<0.01) protein. Microarray showed a significant upregulation of 1844 genes and significant downregulation of 1333 genes in the resident splenic B cells of SW exercise mice over the sedentary controls. CONCLUSION: Three weeks of voluntary exercise in mice results in a change in the immune profile prior to an injury occurring. Downregulation of neutrophils, cytotoxic T cells, and CCL2 suggest that this alteration in immunity is anti-inflammatory. Microarray analysis of isolated B cells showed an upregulation of genes associated with lymphocyte maturation and differentiation, with simultaneous downregulation of genes responsible for apoptosis and B cell death. Further studies will determine the significance of these immune adaptations and their mechanistic role in decreased deficits following neurovascular injury.Item Weightbearing and Activity Restriction Treatments and Quality of Life in Patients with Perthes Disease(2021-05-01T05:00:00.000Z) Do, Dang-Huy; Kim, Harry K. W.; Huo, Michael; Wells, JoelBACKGROUND: Weightbearing and activity restrictions are commonly prescribed during the active stages of Perthes disease. These restrictions, ranging from cast or brace treatment with nonweightbearing to full weightbearing with activity restrictions, may have a substantial influence on the physical, mental, and social health of a child. However, their impact on the patient's quality of life is not well-described. OBJECTIVES: After controlling for confounding variables, are restrictions on weightbearing and activity associated with physical health measures (as expressed by the Patient-Reported Outcome Measurement Information System [PROMIS] mobility, PROMIS pain interference, and PROMIS fatigue), mental health measures (PROMIS depressive symptoms and PROMIS anxiety), and social health measures (PROMIS peer relationships)? METHODS: Between 2013 and 2020, 211 patients with Perthes disease at a single institution were assigned six PROMIS measures to assess physical, mental, and social health. Patients who met the following eligibility criteria were analyzed: age 8 to 14 years old, completion of six PROMIS measures, English-speaking, and active stage of Perthes disease (Waldenstrom Stage I, II, or III). Weightbearing and activity restrictions were clinically recommended to patients in the initial through early reossification stages of Perthes disease when patients had increasing pain, loss of hip motion, loss of hip containment, progression of femoral head deformity, increased hip synovitis, and femoral head involvement on magnetic resonance imaging (MRI), or as a postoperative regimen. Patients were categorized into four intervention groups based on weightbearing and activity regimen. We excluded 111 patients who did not meet the inclusion criteria. The following six pediatric self-report PROMIS measures were assessed: mobility, pain interference, fatigue, depressive symptoms, anxiety, and peer relationships. Analysis of variance (ANOVA) was used to compare differences between the mean PROMIS T-scores of these weightbearing/activity regimens. Results were assessed with a significance of p < 0.05 and adjusted for Waldenstrom stage, gender, age of diagnosis, and history of major surgery using multivariate regression analysis. RESULTS: After controlling for confounding variables, the mild- (β regression coefficient -15 [95% CI -19 to -10]; p < 0.001), moderate- (β -19 [95% CI -24 to -14]; p < 0.001), and severe- (β -25 [95% CI -30 to -19]; p < 0.001) restriction groups were associated with worse mobility T-scores compared with the no-restriction group, but no association was detected for the pain interference or fatigue measures. Weightbearing and activity restrictions were not associated with mental health measures (depressive symptoms and anxiety). Weightbearing and activity restrictions were not associated with social health measures (peer relationships). Earlier Waldenstrom stage was associated with worse pain interference (β 10 [95% CI 2 to 17]; p = 0.01) and peer relationships scores (β -8 [95% CI -15 to -1]; p = 0.03); female gender was linked with worse depressive symptoms (β 7 [95% CI 2 to 12]; p = 0.005) and peer relationships scores (β -6 [95% CI -12 to 0]; p = 0.04); and earlier age at diagnosis was associated with worse peer relationships scores (β 1 [95% CI 0 to 2]; p = 0.03). History of major surgery had no connection to any of the six PROMIS measures. CONCLUSION: We found that weightbearing and activity restriction treatments are associated with poorer patient-reported mobility in the active stages of Perthes disease after controlling for confounding variables, but not pain interference, fatigue, depressive symptoms, anxiety, or peer relationships. Understanding how these treatments are associated with Perthes disease patients' quality of life can aid in decision-making for providers, help set expectations for patients and their parents, and provide opportunities for better education and preparation. Because of the chronic nature of Perthes disease, future studies may focus on longitudinal trends in patient-reported outcomes to better understand the overall impact of this disease and its treatment.