Background/purpose: For prevention of sarcopenia and functionaldecline in community-dwelling older adults, a higher daily proteinintake is needed. A new e-health strategy for dietary counselling wasused with the aim to increase total daily protein intake to optimallevels (minimal 1.2 g/kg/day, optimal 1.5 g/kg/day) through use ofregular food products.Methods: The VITAMIN (VITal Amsterdam older adults IN the city)RCT included 245 community-dwelling older adults (age ≥ 55y):control, exercise, and exercise plus dietary counselling (protein)group. The dietary counselling intervention was based on behaviourchange and personalization. Dietary intake was measured by a 3ddietary record at baseline, after 6-month intervention and 12-monthfollow-up. The primary outcome was average daily protein intake(g/kg/day). Sub-group analysis and secondary outcomes includeddaily protein distribution, sources, product groups. A Linear MixedModels (LMM) of repeated measures was performed with STATAv13.Results: Mean age of the 224 subjects was 72.0(6.5) years, a BMI of26.0(4.2). The LMM showed a significant effect of time and time*group(p<0.001). The dietary counselling group showed higher protein intakethan either control (1.41 vs 1.13 g/kg/day; β +0.32; p<0.001) or exercisegroup (1.41 vs 1.11 g/kg/day; β +0.33; p<0.001) after 6-month interventionand 12-month follow-up.Conclusions and implications: This study shows digitally supporteddietary counselling improves protein intake sufficiently in communitydwellingolder adults with use of regular food products. Protein intakeincrease by personalised counselling with e-health is a promising strategyfor dieticians.
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Stimulating physical activity behaviour in persons with a physical disability is important, especially after discharge from rehabilitation. A tailored counselling programme covering both the period of the rehabilitation treatment and the first months at home seems on the average effective. However, a considerable variation in response is observed in the sense that some patients show a relevant beneficial response while others show no or only a small response on physical activity behaviour. The Rehabilitation, Sports and Active lifestyle (ReSpAct) study aims to estimate the associations of patient and programme characteristics with patients' physical activity behaviour after their participation in a tailored counselling programme. METHODS AND ANALYSIS: A questionnaire-based nationwide longitudinal prospective cohort study is conducted. Participants are recruited from 18 rehabilitation centres and hospitals in The Netherlands. 2000 participants with a physical disability or chronic disease will be followed during and after their participation in a tailored counselling programme. Programme outcomes on physical activity behaviour and patient as well as programme characteristics that may be associated with differences in physical activity behaviour after programme completion are being assessed. Data collection takes place at baseline and 14, 33 and 52 weeks after discharge from rehabilitation. ETHICS AND DISSEMINATION: The study protocol has been approved by the Medical Ethics Committee of the University Medical Centre Groningen and at individual participating institutions. All participants give written informed consent. The study results will provide new insights into factors that may help explain the differences in physical activity behaviour of patients with a physical disability after they have participated in the same physical activity and sports stimulation programme. Thereby, it will support healthcare professionals to tailor their guidance and care to individual patients in order to stimulate physical activity after discharge in a more efficient and effective way.
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Purpose: With the ageing population, there is an increasing demand for strategies to optimise muscle mass, strength and physical performance in community dwelling older adults. We designed a new innovative e-health intervention "VITAMIN" to improve physical performance in older adults. The blended home-based exercise intervention contains digital support to improve personalised coaching as well as dietary protein counselling. This study evaluates the 6 months effectiveness of the intervention. Methods: The cluster RCT included 245 community dwelling older adults (age = 55y) randomised to control, exercise, and exercise+dietary protein counselling group. Data was collected at baseline and after 6 months of intervention. The primary outcome was the modified Physical Performance test (mPPT) with an emphasis on daily functioning. Secondary measures were gait speed (GS; m/s), physical activity level (PAL), protein intake (g/kg/d), appendicular skeletal muscle mass by DXA (ASMM; kg), hand grip strength (HGS; kg). For statistical analysis SPSSv24.0 was used. A mixed models analysis was performed, with group, time and group*time interaction as fixed factors, subject and cluster as random factors, and additional posthoc Bonferroni test. Results: Mean age of the 224 evaluated participants was 72.0±smn;6.5y, 71% were females and 44% low educated. No significant intervention effect was found for mPPT (p=.889). Secondary outcomes showed a significant intervention effect: GS (p=.002), PAL (p=.014), protein intake (p<.001), ASSM (p=.029),HGS (p<.001). Posthoc Bonferroni showed that exercise+protein group had statistical improved outcome compared to control for these secondary outcomes (p<.001; p=.003; p<.001; p=.009; p<.001). Control group showed declined values at 6 months compared to baseline for GS (D-.23 m/s), PAL (D -.03), ASSM (D -.32 kg) and HGS (D -.96 kg).Conclusions: Older adults had already very high scores for physical performance (mPPT), however the blended home-based exercise intervention with protein counselling was still effective for gait speed, physical activity level, dietary protein intake, muscle mass and strength. This personalised innovative e-health intervention showed to be a promising strategy for community dwelling older adults for maintenance instead of declining physical function.
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Huntington’s disease (HD) and various spinocerebellar ataxias (SCA) are autosomal dominantly inherited neurodegenerative disorders caused by a CAG repeat expansion in the disease-related gene1. The impact of HD and SCA on families and individuals is enormous and far reaching, as patients typically display first symptoms during midlife. HD is characterized by unwanted choreatic movements, behavioral and psychiatric disturbances and dementia. SCAs are mainly characterized by ataxia but also other symptoms including cognitive deficits, similarly affecting quality of life and leading to disability. These problems worsen as the disease progresses and affected individuals are no longer able to work, drive, or care for themselves. It places an enormous burden on their family and caregivers, and patients will require intensive nursing home care when disease progresses, and lifespan is reduced. Although the clinical and pathological phenotypes are distinct for each CAG repeat expansion disorder, it is thought that similar molecular mechanisms underlie the effect of expanded CAG repeats in different genes. The predicted Age of Onset (AO) for both HD, SCA1 and SCA3 (and 5 other CAG-repeat diseases) is based on the polyQ expansion, but the CAG/polyQ determines the AO only for 50% (see figure below). A large variety on AO is observed, especially for the most common range between 40 and 50 repeats11,12. Large differences in onset, especially in the range 40-50 CAGs not only imply that current individual predictions for AO are imprecise (affecting important life decisions that patients need to make and also hampering assessment of potential onset-delaying intervention) but also do offer optimism that (patient-related) factors exist that can delay the onset of disease.To address both items, we need to generate a better model, based on patient-derived cells that generates parameters that not only mirror the CAG-repeat length dependency of these diseases, but that also better predicts inter-patient variations in disease susceptibility and effectiveness of interventions. Hereto, we will use a staggered project design as explained in 5.1, in which we first will determine which cellular and molecular determinants (referred to as landscapes) in isogenic iPSC models are associated with increased CAG repeat lengths using deep-learning algorithms (DLA) (WP1). Hereto, we will use a well characterized control cell line in which we modify the CAG repeat length in the endogenous ataxin-1, Ataxin-3 and Huntingtin gene from wildtype Q repeats to intermediate to adult onset and juvenile polyQ repeats. We will next expand the model with cells from the 3 (SCA1, SCA3, and HD) existing and new cohorts of early-onset, adult-onset and late-onset/intermediate repeat patients for which, besides accurate AO information, also clinical parameters (MRI scans, liquor markers etc) will be (made) available. This will be used for validation and to fine-tune the molecular landscapes (again using DLA) towards the best prediction of individual patient related clinical markers and AO (WP3). The same models and (most relevant) landscapes will also be used for evaluations of novel mutant protein lowering strategies as will emerge from WP4.This overall development process of landscape prediction is an iterative process that involves (a) data processing (WP5) (b) unsupervised data exploration and dimensionality reduction to find patterns in data and create “labels” for similarity and (c) development of data supervised Deep Learning (DL) models for landscape prediction based on the labels from previous step. Each iteration starts with data that is generated and deployed according to FAIR principles, and the developed deep learning system will be instrumental to connect these WPs. Insights in algorithm sensitivity from the predictive models will form the basis for discussion with field experts on the distinction and phenotypic consequences. While full development of accurate diagnostics might go beyond the timespan of the 5 year project, ideally our final landscapes can be used for new genetic counselling: when somebody is positive for the gene, can we use his/her cells, feed it into the generated cell-based model and better predict the AO and severity? While this will answer questions from clinicians and patient communities, it will also generate new ones, which is why we will study the ethical implications of such improved diagnostics in advance (WP6).
