To evaluate interventions to promote physical activity, valid outcome measures are important. This study evaluated the validity and reliability of the ActivPAL3™ and the SENS motion® activity monitors with regard to the number of steps taken, walking, and sedentary behavior in hospitalized patients ( ) (older medical patients (+65 years) ( ), older patients (+65) with acute hip fracture ( ), and patients (+18) who underwent acute high-risk abdominal surgery ( )) . Both monitors showed good (≥60%) percentage agreement with direct observation for standing and no. of steps (all gait speeds) and high agreement (≥80%) for lying. For walking, ActivPAL3™ showed moderate percentage agreement, whereas SENS motion® reached high percentage agreement. The relative reliability was moderate for sedentary behavior for both monitors. The ActivPAL3™ showed poor (walking) to moderate (steps) reliability for walking and steps, whereas SENS motion® showed moderate reliability for both activities. For slow walkers, the relative reliability was moderate for SENS motion® and poor for ActivPAL3™. This trial is registered with the ClinicalTrials.gov identifier NCT04120740.

It is well-established that mobility is very limited among older hospitalized patients and associated with several negative outcomes. Therefore, this mixed-methods study aimed to quantify 24-hour mobility levels in acutely admitted older adults and simultaneously explore clinical practice with regards to mobilization and mobility through an ethnographic field study. Over a 6-week period, hospital mobility was assessed in 44 geriatric patients by SENS motion® activity sensors that the patients wore continuously for 24 h a day during their hospitalization. An ethnographic field study was conducted alongside the cohort study. It included participant observation on the ward and situated conversations with staff, patients, and relatives 2–3 times a week for 4–5 h at different times of the day. The observations were noted in field notes. Activity data were aggregated into a per day measure based on the mean of all available days for a given patient. Also, the per day measures were stratified by walking dependency (walking with or without a walking aid). The field notes were analyzed through a thematic analysis. During hospitalization, the patients spent most of their time (22.8 h/per day) in sedentary behavior and only 1.2 h/per day in uptime (walking and standing), including 43 min walking, and took less than 1200 steps daily. The field study revealed that most staff consider mobilization and mobility important tasks. However, mobilizing patients to a chair and performing functional level assessments are prioritized over patient mobility. Also, the patients’ perceived mobility opportunities are limited by the physical environment (e.g., congested hallways) and lack of purposeful activities to engage in. This study found low levels of mobility in geriatric inpatients during hospitalization. While mobility is considered important, mobilization to a chair and functional assessments are prioritized over patient mobility, which becomes dependent on the patient’s own initiative. Therefore, environmental adjustment, enhanced interprofessional collaboration, and targeted strategies for integrating mobility into daily care practices are warranted to enhance in-hospital mobility. ClincalTrials.Gov identifier NCT06421246.

Primary hypokalemic periodic paralysis (HypoPP) is a muscle channelopathy that can cause periodic paralysis and permanent weakness. Currently, little is known about how progressive this myopathy is. Natural history data for HypoPP can potentially answer the question of progressiveness and form the basis for outcome measures to be used in follow-up and emerging treatment trials. We aimed to describe the natural history of HypoPP and assess whether quantitative fat imaging is a valuable biomarker to monitor disease progression. In this prospective follow-up study, we examined disease progression using Dixon MRI to monitor changes in fat replacement of the muscle and stationary dynamometry to monitor changes in muscle strength. We included 37 persons (mean age 43 years, range 18–79 years) with HypoPP-causing variants in CACNA1S. Three participants were asymptomatic carriers, 22 had periodic paralysis, 3 had permanent weakness, and 9 had periodic paralysis in combination with permanent weakness. The median follow-up time was 20 months (range 12–25). We found that fat fraction increased in 10 of 21 examined muscles. An increase in the composite fat fraction of at least 1 muscle group was found in all symptomatic phenotypes. By contrast, we found no significant change in muscle strength. The results from this follow-up study support the use of quantitative muscle MRI to monitor subclinical disease progression in HypoPP in patients with and without attacks of paralysis.

Introduction: Polyneuropathy (PNP) is a chronic progressive disease that over time can lead to damage of sensory, motor and/or autonomic peripheral nerves. Symptoms vary from predominantly sensory to severe sensorimotor affection both proximally and distally. This can result in considerable functional impairments that affect activities of daily living. In other neurological patients, strength training has shown to improve strength and functional outcomes. Since medical treatment only exists for very few percentages of the underlying causes it is obvious to consider if strength training could be a potential treatment for functional impairments. To date little is known on the effect of strength training in patients with PNP.Aim: The aim of this scoping review was to summarize research on strength training and outcomes on physical function in patients with PNP.Methods: We systematically searched five data bases; Pubmed, Embase, Cinahl, Cochrane library and Web of science. Studies on strength training (load ≥70% of 1RM) in patients with PNP were included. The search was carried out in November 2022.Results: 362 articles were screened by title and abstract, 101 articles were full text screened. Eight studies were included. Patients with Charcot-Marie-Tooth (CMT), chronic inflammatory polyneuropathy (CIDP) and diabetic polyneuropathy (DPN) were represented in the studies (five RCTs, two case-series, and one cross-over trial). The methodological quality ranged from fair-poor in seven studies, one study reached good quality. Results from the studies indicated that strength training in CMT, CIDP and DPN may improve strength. However, various outcomes were used to evaluate strength training, so direct comparisons were difficult.Discussion: In this scoping review we summarized research on strength training and outcomes evaluated in interventions in patients with PNP. Eight studies were included, they indicated that strength training may be beneficial for patients with PNP. However, due to low methodological strength of most studies a recommendation for patients with PNP cannot be made. Thus, the low number of studies with relatively low quality, where various functional outcomes were used, underscores the importance of future studies to evaluate the effect of strength training on relevant functional outcomes and strength in patients with PNP.

This review provides an overview of the evidence regarding mtDNA and valid biomarkers for assessing mitochondrial adaptions. Mitochondria are small organelles that exist in almost all cells throughout the human body. As the only organelle, mitochondria contain their own DNA, mitochondrial DNA (mtDNA). mtDNA-encoded polypeptides are subunits of the enzyme complexes in the electron transport chain (ETC) that are responsible for production of ATP to the cells. mtDNA is frequently used as a biomarker for mitochondrial content, since changes in mitochondrial volume are thought to induce similar changes in mtDNA. However, some exercise studies have challenged this “gene-dosage theory”, and have indicated that changes in mitochondrial content can adapt without changes in mtDNA. Thus, the aim of this scoping review was to summarize the studies that used mtDNA as a biomarker for mitochondrial adaptions and address the question as to whether changes in mitochondrial content, induce changes in mtDNA in response to aerobic exercise in the healthy skeletal muscle. The literature was searched in PubMed and Embase. Eligibility criteria included: interventional study design, aerobic exercise, mtDNA measurements reported pre- and postintervention for the healthy skeletal muscle and English language. Overall, 1585 studies were identified. Nine studies were included for analysis. Eight out of the nine studies showed proof of increased oxidative capacity, six found improvements in mitochondrial volume, content and/or improved mitochondrial enzyme activity and seven studies did not find evidence of change in mtDNA copy number. In conclusion, the findings imply that mitochondrial adaptions, as a response to aerobic exercise, can occur without a change in mtDNA copy number.

[This corrects the article DOI: 10.1212/NXG.0000000000200211.].