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Item Leveraging Cardiac Magnetic Resonance Imaging to Assess Skeletal Muscle Progression in Duchenne Muscular Dystrophy(Elsevier, 2022) Kaslow, Jacob A.; Sokolow, Andrew G.; Donnelly, Thomas; Buchowski, Maciej S.; Damon, Bruce M.; Markham, Larry W.; Burnette, W. Bryan; Soslow, Jonathan H.; Pediatrics, School of MedicineDuchenne Muscular Dystrophy (DMD) is characterized by muscle deterioration and progressive weakness. As a result, patients with DMD have significant cardiopulmonary morbidity and mortality that worsens with age and loss of ambulation. Since most validated muscle assessments require ambulation, new functional measures of DMD progression are needed. Despite several evaluation methods available for monitoring disease progression, the relationship between these measures is unknown. We sought to assess the correlation between imaging metrics obtained from cardiac magnetic resonance imaging (CMR) and functional assessments including quantitative muscle testing (QMT), spirometry, and accelerometry. Forty-nine patients with DMD were enrolled and underwent CMR, accelerometry and QMT at baseline, 1-year and 2-year clinic visits with temporally associated pulmonary function testing obtained from the medical record. Imaging of the upper extremity musculature (triceps and biceps) demonstrated the most robust correlations with accelerometry (p<0.03), QMT (p<0.02) and spirometry (p<0.01). T1-mapping of serratus anterior muscle showed a similar, but slightly weaker relationship with accelerometry and QMT. T2-mapping of serratus anterior demonstrated weak indirect correlation with aspects of accelerometry. These images are either routinely obtained in standard CMR or can be added to a protocol and may allow for a more comprehensive assessment of a patient’s disease progression.Item A Personalized, Dynamic Physical Activity Intervention Is Feasible and Improves Energetic Capacity, Energy Expenditure, and Quality of Life in Breast Cancer Survivors(Frontiers Media, 2021-04-12) Ballinger, Tarah J.; Althouse, Sandra K.; Olsen, Timothy P.; Miller, Kathy D.; Sledge, Jeffrey S.; Medicine, School of MedicinePurpose: Despite survival and quality of life benefits associated with physical activity, many breast cancer survivors remain inactive. Effective, sustainable interventions must account for individual differences in capability, motivation, and environment. Here, we evaluate the feasibility, mechanics, and efficacy of delivering an individualized, dynamic intervention to increase energetic capacity and energy expenditure. Methods: Stage 0-III breast cancer patients who had completed primary treatment were enrolled. Prior to the intervention, detailed movement data was collected with a wearable GPS and accelerometer for 3 weeks to establish baseline activity. Movement data was collected continuously throughout the 12-week intervention, during which patients received electronically delivered, tailored, dynamic activity "prescriptions", adjusted based on demonstrated individual capability, daily movement in their environment, and progress. Results: Of 66 enrolled, 57 participants began and completed the intervention. The intervention resulted in significant improvements in average steps (+558 steps/day, p = 0.01), energetic capacity measured by power generation on a stationary bicycle (1.76 to 1.99 W/kg lean mass, p < 0.01), and quality of life (FACT-B TOI, 72.8 to 74.8, p = 0.02). The greatest improvement in functional energetic capacity was seen in the lowest performing tertile at baseline (0.76 to 1.12 W/kg, p < 0.01). Discussion: Wearable technology delivery of personalized activity prescriptions based on individual capability and movement behaviors demonstrates feasibility and early effectiveness. The high variability seen in baseline activity and function, as well as in response to the intervention, supports the need for future work in precision approaches to physical activity (NCT03158519).Item Physical Activity Correlates With Skeletal Muscle MRI Findings in Individuals With Duchenne Muscular Dystrophy(Wiley, 2025) Tamaroff, Jaclyn; Joy, Nicholas; Damon, Bruce; Markham, Larry W.; Donnelly, Thomas; Su, Karry; Buchowski, Maciej S.; Crum, Kimberly; Slaughter, James C.; Xu, Meng; Burnette, W. Bryan; Soslow, Jonathan; Pediatrics, School of MedicineIntroduction/aims: Skeletal muscle magnetic resonance imaging (MRI) is a validated noninvasive tool to assess Duchenne muscular dystrophy (DMD) progression. There is interest in finding DMD biomarkers that decrease the burden of clinical trial participation, such as wearable devices. Our aim was to evaluate the relationship between activity, via accelerometry, and skeletal muscle MRI, particularly T2 mapping. Methods: DMD children and young adults completed skeletal muscle MRI and were asked to wear an accelerometer on the dominant wrist for 7 days. MRI data included fat-suppressed transverse relaxation time (T2) mapping of the calves and longitudinal relaxation time (T1) mapping. Activity was assessed as vector magnitudes (VMs) and fraction of time (FOT) in activity groups (sedentary 1 or 2, low 1 or 2, moderate-to-vigorous physical activity (MVPA)). Results: Participants (n = 22; median age 11.4 years, 41% ambulatory) wore the accelerometer for a median of 7 days. Longer T2 in multiple lower extremity muscles was negatively correlated with VMs per minute (tibialis posterior Spearman's rho = -0.68, p < 0.001), even when accounting for age, ambulatory status, or glucocorticoid use. Longer T2 of the tibialis posterior was positively correlated with FOT in sedentary 1 (rho = 0.49, p = 0.02) and negatively correlated with FOT in higher activity levels (low 1 (rho = -0.58, p = 0.004), low 2 (rho = -0.67, p = 0.002), MVPA (rho = -0.7, p < 0.001)). Discussion: In individuals with DMD, longer T2 on skeletal muscle MRI of the calves moderately correlated with lower activity levels indicating the potential use of home accelerometry as a future clinical trial biomarker of skeletal muscle health and progression in DMD.Item Prediction of sustained harmonic walking in the free-living environment using raw accelerometry data(IOP Publishing, 2018-02-28) Urbanek, Jacek K.; Zipunnikov, Vadim; Harris, Tamara; Fadel, William; Glynn, Nancy; Koster, Annemarie; Caserotti, Paolo; Crainiceanu, Ciprian; Harezlak, Jaroslaw; Biostatistics, School of Public HealthOBJECTIVE: Using raw, sub-second-level accelerometry data, we propose and validate a method for identifying and characterizing walking in the free-living environment. We focus on sustained harmonic walking (SHW), which we define as walking for at least 10 s with low variability of step frequency. APPROACH: We utilize the harmonic nature of SHW and quantify the local periodicity of the tri-axial raw accelerometry data. We also estimate the fundamental frequency of the observed signals and link it to the instantaneous walking (step-to-step) frequency (IWF). Next, we report the total time spent in SHW, number and durations of SHW bouts, time of the day when SHW occurred, and IWF for 49 healthy, elderly individuals. MAIN RESULTS: The sensitivity of the proposed classification method was found to be 97%, while specificity ranged between 87% and 97% and the prediction accuracy ranged between 94% and 97%. We report the total time in SHW between 140 and 10 min d-1 distributed between 340 and 50 bouts. We estimate the average IWF to be 1.7 steps-per-second. SIGNIFICANCE: We propose a simple approach for the detection of SHW and estimation of IWF, based on Fourier decomposition.Item Spirometry Correlates with Physical Activity in Patients with Duchenne Muscular Dystrophy(Wiley, 2023) Kaslow, Jacob A.; Sokolow, Andrew G.; Donnelly, Thomas; Buchowski, Maciej S.; Markham, Larry W.; Burnette, W. Bryan; Soslow, Jonathan. H.; Pediatrics, School of MedicineBackground: Duchenne muscular dystrophy (DMD) is associated with progressive muscle weakness and respiratory decline. To date, studies have focused on respiratory decline and loss of ambulation as a metric of loss of skeletal muscle strength. However, new functional measures can assess skeletal muscle disease regardless of ambulatory status. The relationship between these tests and concurrent lung function is currently unexplored. Objective: To assess the correlation between spirometry measurements and functional muscle assessments such as accelerometry and quantitative muscle testing (QMT). Methods: Enrolled patients with DMD underwent accelerometry and QMT at study clinic visits. Any pulmonary function testing within 6 months of visit was obtained from the electronic medical record. The Spearman correlation coefficient was used to assess the relationship between spirometry and functional muscle testing. Results: Forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1 ) demonstrated the strongest correlation with accelerometry. Both FVC and FEV1 showed a similar relationship to accelerometry when activity was divided into intensity categories, with low intensity and moderate-to-vigorous activity categories showing the strongest correlation. Maximal expiratory pressure (MEP) and FVC showed the most robust correlations with total QMT (p < 0.001 and p < 0.01, respectively). Conclusion: Lung function, specifically FVC percent predicted and FEV1 %p, shows a good correlation with upper and lower extremity skeletal muscle functional testing such as accelerometry and QMT.Item Stride variability measures derived from wrist- and hip-worn accelerometers(Elsevier, 2017-02) Urbanek, Jacek K.; Harezlak, Jaroslaw; Glynn, Nancy W.; Harris, Tamara; Crainiceanu, Ciprian; Zipunnikov, Vadim; Biostatistics, School of Public HealthMany epidemiological and clinical studies use accelerometry to objectively measure physical activity using the activity counts, vector magnitude, or number of steps. These measures use just a fraction of the information in the raw accelerometry data as they are typically summarized at the minute level. To address this problem, we define and estimate two measures of temporal stride-to-stride gait variability based on raw accelerometry data: Amplitude Deviation (AD) and Phase Deviation (PD). We explore the sensitivity of our approach to on-body placement of the accelerometer by comparing hip, left and right wrist placements. We illustrate the approach by estimating AD and PD in 46 elderly participants in the Developmental Epidemiologic Cohort Study (DECOS) who worn accelerometers during a 400m walk test. We also show that AD and PD have a statistically significant association with the gait speed and sit-to-stand test performance.Item The Validity and Reliability of the PAVS and IPAQ-SF as Physical Activity Assessment Tools in Patients with Obstructive Sleep Apnea(2020-01) Adolphs, Max W.; Kaleth, Anthony; Keith, NiCole; Riley, Zachary; Warden, StuartEfforts to encourage the medical community to prescribe exercise for disease prevention and management have increased significantly in recent years. In patients with obstructive sleep apnea (OSA), it is encouraging that exercise has been shown to improve sleep efficiency, daytime sleepiness, and disease severity. However, in order to better understand the dose-response relationship between exercise and OSA-related outcomes, accurate and reliable methods for assessing physical activity habits are needed. Purpose: To determine the test-retest reliability and validity of two self-report physical activity questionnaires [Physical Activity Vital Sign (PAVS); International Physical Activity Questionnaire-Short Form (IPAQ-SF)] in an OSA population. Methods: 39 adults with moderate-to-severe OSA wore an accelerometer for seven consecutive days and completed the PAVS and IPAQ-SF (twice within 10 d), along with questionnaires on quality of life, sleepiness, and treatment adherence. Test-retest reliability was determined using intraclass correlation coefficients (ICC). Criterion and construct validity were determined using Pearson (r) and Spearman correlation coefficients (ρ), respectively. Results: PAVS and IPAQ-SF scores were reported as total min/wk of moderate-vigorous physical activity (MVPA). Test-retest reliability for MVPA was excellent for PAVS (ICC = 0.982) and good for IPAQ-SF (ICC = 0.766). MVPA assessed via accelerometry was strongly correlated with PAVS (r = 0.802) and moderately with IPAQ-SF (r = 0.569). Both PAVS and IPAQ-SF were significantly correlated with body mass index (BMI) (ρ = -0.273 and -0.268, respectively), but no other variables. Conclusions: The PAVS and IPAQ-SF are reliable and valid PA questionnaires and may be utilized as a tool for accurately assessing physical activity levels in OSA patients.