Muscle mass, strength, and physical performance predicting activities of daily living: a meta-analysis

A therapeutic assessment of tranexamic acid on functional recovery after rotator cuff repair surgery: A study of early and mid-term follow-up

Purpose

To perform therapeutic assessment of tranexamic acid on functional recovery after rotator cuff repair surgery in terms of early and mid-term follow up.

Methods

From December 2021 to April 2023, a total of 40 patients with rotator cuff injury were enrolled and randomly assigned to two groups with equal number of patients, and all patients received shoulder arthroscopic surgery before receiving either tranexamic acid or normal saline managements. Patients in the experimental group, group A, treated with 2g tranexamic acid (diluted with normal saline to 20ml) via intra-articular injection, while patients in the control group (group B) received 20ml normal saline management. The whole process was conducted in accordance with randomized double-blind controlled trials. Clinical outcomes were assessed preoperatively and postoperatively via American Shoulder and Elbow Surgeons (ASES) score, a UCLA shoulder rating, a CONSTANT score, and visual analog scale (VAS). Early and mid-term follow-up were performed at 1 week, 1 month, 3 months, and 6 months after surgery.

Results

The ASES score and CONSTANT score at 1 month, 3 months and 6 months after operation in the tranexamic acid group were higher than those in the normal saline group (p < 0.05). Meanwhile, the UCLA score at 3 months and 6 months after operation in the tranexamic acid group was higher than that in the normal saline group (p < 0.05). In addition, the muscle strength score and external rotation value at 6 months after operation in the tranexamic acid group and normal saline group were higher than those in the normal saline group (p < 0.05). There was no significant difference in the VAS score between the two groups at each observation cut-off point (p > 0.05).

Conclusions

Injection of tranexamic acid after rotator cuff repair surgery plays an positive role on the recovery of patients muscle strength and tone as well as shoulder flexibility. Therapeutic assessment demonstrates the favorable clinic efficacy either early or mid-term follow-up.

Cumulative blood pressure burden and the risk of functional dependence in elderly cohorts: An exploration of the influencing factors

BACKGROUND

To investigate the correlation between cumulative blood pressure levels and functional dependence in individuals aged 60 and older.

METHODS

Data were sourced from two distinct elderly databases: CHARLS and ELSA. Various statistical techniques, including logistic regression analysis, restricted cubic spline analysis, forest plot visualization, and interaction analyses, were employed to delve into the associations between cumulative blood pressure and difficulties in performing activities of daily living.

RESULTS

Across both cohorts, there was a discernible trend towards an increased risk of ADL difficulties with escalating cumulative blood pressure levels. Logistic regression analysis confirmed a statistically significant relationship between cumulative blood pressure and ADL difficulties (P < 0.001). The results derived from restricted cubic spline plots further underscored this relationship, demonstrating that, after adjusting for a multitude of confounding factors, the risk of ADL difficulties augmented with rising cumulative blood pressure. Additionally, the forest plot and interaction plot findings revealed that the association between heightened cumulative blood pressure and the risk of ADL difficulties was contingent upon factors such as body mass index, gender, and memory-related disorders.

CONCLUSIONS

Our findings indicate a positive correlation between cumulative blood pressure and the risk of experiencing difficulties with ADLs. Furthermore, this association appears to be modulated by BMI, gender, and the presence of memory-related diseases.

Biomarkers of aging: from molecules and surrogates to physiology and function

Many countries face an unprecedented challenge in aging demographics. This has led to an exponential growth in research on aging, which, coupled to a massive financial influx of funding in the private and public sectors, has resulted in seminal insights into the underpinnings of this biological process. However, critical validation in humans has been hampered by the limited translatability of results obtained in model organisms, additionally confined by the need for extremely time-consuming clinical studies in the ostensible absence of robust biomarkers that would allow monitoring in shorter time frames. In the future, molecular parameters might hold great promise in this regard. In contrast, biomarkers centered on function, resilience, and frailty are available at the present time, with proven predictive value for morbidity and mortality. In this review, the current knowledge of molecular and physiological aspects of human aging, potential antiaging strategies, and the basis, evidence, and potential application of physiological biomarkers in human aging are discussed.

Effects of Paralyzed, Nonparalyzed, and Whole-Body Phase Angle on Physical Performance in Older Patients with Stroke

OBJECTIVES

This study investigated the association between phase angle (PhA) and physical performance in older patients with stroke, focusing on lower-limb PhA and predicting rehabilitation outcomes.

DESIGN

A retrospective cohort study.

SETTING AND PARTICIPANTS

Seventy-one patients with stroke aged ≥65 years at a Japanese rehabilitation hospital.

METHODS

Bioelectrical impedance analysis was used to measure whole-body PhA, paralyzed side lower-limb PhA, and nonparalyzed side lower-limb PhA. Physical performance was assessed using the Short Physical Performance Battery (SPPB) test at admission and discharge, with subdomains including balance, gait speed, and chair-rise performance. Multiple regression analysis was performed to determine whether different PhAs affected SPPB scores at discharge after adjusting for various potential confounders.

RESULTS

Higher nonparalyzed side lower-limb PhA were significantly associated with better SPPB scores at discharge (β = 0.313, P = .004), and improved balance (β = 0.281, P = .016) and chair-rise performance (β = 0.388, P = .004). Paralyzed side lower-limb PhA was a predictor of total SPPB (β = 0.290, P = .020), but nonparalyzed side lower-limb PhA was more associated with total SPPB. Whole-body PhA was not associated with either total SPPB or any of the SPPB subitems.

CONCLUSIONS AND IMPLICATIONS

Lower-limb PhA, particularly on the nonparalyzed side, is a significant predictor of physical performance in older patients with stroke. Paralyzed side lower-limb PhA plays a role, particularly in predicting walking ability. These findings suggest that site-specific PhA may represent valuable biomarkers for rehabilitation planning and prognostic assessment in patients recovering from subacute stroke events.

Development of an Annual Mobility Screen for Preclinical Mobility Limitation: Test Selection and Interpretation Guidelines

BACKGROUND

Preclinical mobility limitation (PCML) is an emerging public health issue in the United States. A standardized assessment to identify those with PCML has not been established. A Task Force of the American Physical Therapy Association's Academy of Geriatric Physical Therapy (APTA Geriatrics) developed an evidence-based protocol for an Annual Mobility Screen (AMS) with the potential to meet this gap in practice. Early identification of PCML increases the potential for remediation, improved function, and a slower rate of decline. Because mobility is key for independence and quality of life, aging adults would value access to mobility screening. Physical therapists, experts in movement, are uniquely qualified to provide this service.

METHODS

This report reviews decision-making for the selection of test/measures and the development of an interpretation rationale for an AMS. Test selection criteria included ratio level measures (time, distance, repetition), time or equipment requirements, ability to predict adverse health events, and availability of reference values.

RESULTS

Four performance-based measures met inclusion criteria: self-selected and fast walking speed (overall mobility and functional reserve), 30 s Chair Stand (lower extremity muscle performance), Four Square Step test (dynamic balance stepping over low obstacles and changing direction), and Timed Up Go cognitive (ability to dual task while moving). Classification of mobility was based on normal distribution of performance across the population of aging adults as follows: PCML unlikely (at or above-0.5 SD or more from mean for age/gender), PCML likely (between -0.5 SD and - 1.0 SD from mean), and impending mobility limitation (-1 SD below the mean).

CONCLUSION

The AMS was developed to identify older adults with PCML. The reliability and validity of the AMS and its interpretation strategies will be evaluated as the screening protocol is piloted.

High-Intensity Functional Exercises Associated or Not With Cognitive Stimulation Improves Cognition and Physical Performance in Older Adults: A Double-Blind Randomized Controlled Trial

BACKGROUND/OBJECTIVES

Studies suggest that physical exercise improves physical and cognitive function in older adults, though the benefits of dual-task interventions remain controversial. This study aimed to assess whether adding cognitive training in a dual-task fashion to a high-intensity functional exercise program enhances gait speed, lower-extremity strength, dynamic balance, balance confidence, and cognitive function in older adults after 16 weeks.

METHODS

This double-blind randomized controlled trial included 96 community-dwelling older adults, randomly assigned to either a high-intensity functional exercise program, with 50% of physical exercises incorporating a cognitive task, or the same program without the cognitive task. Both groups performed two sessions per week of group training, including progressive strength and balance exercises, over 16 weeks. Physical and cognitive performances were assessed at baseline and after 16 weeks.

RESULTS

Mixed repeated-measure analysis of variance only demonstrated a significant effect of time on most assessed outcomes (p < .05), indicating that, independent of the group, the experimental intervention had positive effects on gait speed, functional lower extremity strength, balance confidence, and cognitive function.

CONCLUSIONS

Both interventions improved cognition and physical performance. Simultaneous cognitive dual-task training does not appear to offer greater benefits compared with a high-intensity functional exercise program in community-dwelling older adults. Significance/Implications: Regardless of the simultaneous stimulation with cognitive tasks, our results add further evidence about the beneficial role of physical exercise in maintaining and/or improving health outcomes in community-dwelling older adults.

Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight

AIMS

We assessed changes in body composition following tirzepatide treatment in a substudy of participants with obesity or overweight from the SURMOUNT-1 trial, overall and post hoc in clinically relevant subgroups.

MATERIALS AND METHODS

Substudy participants (n = 160 of the 2539 in SURMOUNT-1) underwent dual-energy X-ray absorptiometry (DXA) at baseline and Week 72. Body composition parameters were evaluated by analysis of covariance, logistic regression or Fisher's exact test. Post hoc subgroup analyses were conducted by sex (female or male), age (<50, 50 to <65, or ≥65 years) and total body weight reduction tertiles (≤15.3 kg, >15.3 to ≤25.9 kg, or >25.9 kg).

RESULTS

The 160 participants (pooled tirzepatide doses n = 124, placebo n = 36) with baseline and end of study DXA data were 73% female and had a mean weight of 102.5 kg and body mass index of 38.0 kg/m2. The change in body weight, fat mass and lean mass from baseline to Week 72 was -21.3%, -33.9% and -10.9% with tirzepatide and -5.3%, -8.2% and -2.6% with placebo, respectively (p < 0.001 for all comparisons). Of the body weight lost, approximately 75% was fat mass and 25% was lean mass for both tirzepatide and placebo. These proportions remained consistent across most subgroup analyses.

CONCLUSIONS

In participants with obesity or overweight from the SURMOUNT-1 trial, tirzepatide treatment significantly reduced body weight, fat mass and lean mass compared with placebo, while in post hoc analyses, the proportion of body weight lost as fat or lean mass was relatively consistent including in clinically relevant subgroups.

Longitudinal trajectories of disability index and associated factors in Chinese older adults

BACKGROUND

As the global population ages, understanding the trajectories of disability in older adults is crucial for improving health outcomes and quality of life. This study aimed to identify patterns of disability index trajectories and associated factors influencing these trajectories in older adults.

METHODS

A total of 3,227 older adults aged 60 years and older were recruited from four waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018). We used group-based trajectory model to jointly estimate trajectories of disability index and attrition probability, while assessing baseline factors associated with the trajectory membership.

RESULTS

Our findings revealed four distinct trajectories of disability index: slightly limited-gradual deterioration (n = 1661, 51.5%), fluctuating change (n = 588, 18.2%), slightly limited-substantial deterioration (n = 397, 12.3%), and stable severely limited (n = 581, 18.0%). Women, unmarried, lower educational level, living in rural areas, no pension, comorbidity, poor self-rated health, a history of falls, short sleep duration, inadequate social activity, weakness, slowness, and poor chair standing were significantly associated with a higher probability of being in poorer disability index trajectories.

CONCLUSIONS

This study highlights the heterogeneity of disability index trajectories in older adults and the multifaceted factors that influence them. Our findings underscore the importance of targeting early prevention or intervention based on the determinants of these trajectories to individual needs to maintain or delay the rate of deterioration of disability in older adults.

Sarcopenia is associated with lower quality of life scores among community-dwelling older Filipinos: Findings from a cross-sectional study

BACKGROUND AND OBJECTIVES

Sarcopenia, characterized by a progressive decline in muscle mass and strength, is a significant concern among older individuals, impacting their functionality and overall quality of life (QOL). The relationship between sarcopenia and QOL among Filipino older adults remains underexplored. Thus, the study aims to determine the prevalence of sarcopenia and its association with the QOL of community-dwelling older adults in selected Philippine cities.

DESIGN

This cross-sectional study used convenience sampling in the selection of the cities. Participants were randomly selected from the list provided by each local city government.

SETTING AND PARTICIPANTS

536 apparently healthy community-dwelling Filipino older adults from three major islands in the Philippines.

METHODS

Sarcopenia was determined using the 2019 Asian Working Group for Sarcopenia criteria which is the presence of low muscle mass, plus low muscle strength, and/or low physical performance. Quality of life was assessed using the culturally-validated WHO-QOL short form questionnaire. Mixed Model logistic regression adjusted for covariates was performed to study the association of sarcopenia indicators to quality of life.

RESULTS

24.3 % of older Filipinos were found to have sarcopenia. Sarcopenic community-dwelling older adults had significantly decreased odds of attaining higher score in the physical domain (OR 0.63; 0.40-0.98), psychological domain (OR 0.55; CI 0.35-0.84), and overall quality of life (OR 0.57; CI 0.37-0.89) than the non-sarcopenic group.

CONCLUSION

One in four community-dwelling Filipino older adults met the sarcopenia criteria. Sarcopenia is associated with decreased QOL scores, particularly in the physical health and psychological health domains. Sarcopenia needs to be considered in the context of public health to come up with targeted nutrition and health interventions for improved QOL.

The impact of hip fracture on resilience in health-related quality of life: a cohort study

PURPOSE

Hip fractures significantly impact health-related quality of life (HRQoL) in older adults. This study aimed to investigate and quantify changes in different domains of HRQoL following a hip fracture and to identify factors associated with maintaining HRQoL (resilience).

METHODS

The study included a cohort of 2,529 individuals aged 65 + who experienced their first hip fracture between 2016 and 2020. HRQoL was assessed using the EQ5D-5L tool both prior to and 4 months after the fracture. Resilience was defined as maintaining or improving pre-fracture EQ5D levels at follow-up. Associations between sociodemographic characteristics, acute conditions, medical factors, and resilience in specific EQ5D domains-Mobility, Usual Activities, Self-Care, Pain/Discomfort, and Anxiety/Depression-were analyzed using regression models.

RESULTS

Sixty-nine percent were women and the mean age was 82.6 years. A decline was observed across all EQ5D domains and in the global EQ5D index following a hip fracture. The proportion of patients exhibiting resilience varied by domain, ranging from 36 to 77%, with Mobility being the most adversely affected and Anxiety/Depression the least affected. Factors associated with resilience differed by domain. Mobility, Usual Activities, and Self-Care followed a similar pattern, while Pain/Discomfort and Anxiety/Depression showed distinct patterns. Notably, the absence of fall-risk-increasing medications was the only factor consistently associated with resilience across all domains.

CONCLUSIONS

While hip fractures generally lead to declines in HRQoL, a significant proportion of patients demonstrate resilience within 4 months post-fracture. Patterns of resilience vary across EQ5D domains, with physical functions being most impacted and mental health the least.

Cardiorespiratory fitness in stroke patients with different activities of daily living levels: a cross-sectional study

Understanding the relationship between cardiorespiratory function (CRF) and activities of daily living (ADL) in stroke patients is essential for improving rehabilitation outcomes. A total of 153 participants were enrolled in this study. Cardiopulmonary exercise was tested at admission. A multivariable linear regression was performed to identify variables associated with peak oxygen uptake (VO2peak). Participants with low ADL exhibited poorer responses to exercise than those with high ADL levels. After adjusting for confounders, the multiple linear regression analysis showed that albumin-to-globulin ratio (AGR) and left ventricular posterior wall thickness (LVPW) were significantly associated with VO2peak in all patients. In the low ADL subgroup, the positive association between AGR and VO2peak was consistent. Conversely, the negative association between LVPW and VO2peak was uncertain. Otherwise, no significant association were found between AGR, LVPW, and VO2peak in the high ADL subgroup. This study provides new insights into the relationship between CRF and ADL in stroke patients, with a focus on ARG and LVPW. Future studies with larger sample sizes are needed to further explore the role of AGR and LVPW in improving the CRF in stroke patients.

Associated factors of sarcopenia among urban community-dwelling older adults in West Jakarta: A cross-sectional study

Introduction

Sarcopenia has many risk factors and an increased likelihood of adverse effects. However, the exact mechanism of how these risk factors cause sarcopenia remains to be elucidated. This study aimed to evaluate the association between physical components, olfactory function impairment and sarcopenia in urban communities.

Methods

This cross-sectional study involved 334 participants aged 60 years and above residing in urban villages in West Jakarta. The medical history, physical ability, cognitive function and olfactory function of participants were examined. Physical ability was assessed based on activities of daily living and instrumental activities of daily living (IADLs). Regarding olfactory function, six scratch test-type odours common in Indonesia were used. Sarcopenia was measured based on muscle mass, muscle strength and physical performance. Binary logistic analysis and backward logistic regression analysis were utilised to explore the association of sarcopenia with the other variables.

Results

Sarcopenia was significantly associated with older age (adjusted odds ratio [AOR]=2.613, 95% confidence interval [CI] = 1.471-4.640), obesity (AOR=0.190 (0.110-0.329), impaired olfactory function (AOR=1.822, 95% CI=1.086-3.056) and frailty (AOR=3.117, 95% CI=1.375-7.064).

Conclusion

The associated factors of sarcopenia include olfactory function, older age, unemployment, impaired IADLs, obesity and frailty.

Probable and confirmed sarcopenia are still better predictors of disability than sarcopenic obesity following ESPEN/EASO consensus steps

BACKGROUND

Studies comparing different operational definitions of sarcopenia (S) and sarcopenic obesity (SO) defined according to the ''European Society for Clinical Nutrition and Metabolism and the European Association for the Study of Obesity'' (ESPEN/EASO) criteria with functionality are scarce. Our aim is to investigate whether SO or S with different skeletal muscle mass (SMM) adjustments is better associated with functional disability.

METHODS

This retrospective study was carried out in older individuals ≥ 65 years of age in a geriatric outpatient clinic. Probable and confirmed sarcopenia were evaluated with the revised European Working Group on Sarcopenia in Older People (EWGSOP2) criteria, and SO with ESPEN/EASO consensus steps. For SMM component for both S and SO, different adjustments (weight, body mass index, and height square (W, BMI, H2 respectively)) were used. Functional disability was examined with activities of daily living (ADL), and instrumental ADL (IADL). Receiver operating characteristic (ROC) curves were drawn and area under ROC curve (AUC) were calculated to find which operational definition best predicts disability.

RESULTS

Data from 1477 older adults were screened. 408 participants (median age; 73 (65-101), 65% female) were included. Prevelance of SO was 6.9%. Probable sarcopenia, confirmed sarcopenia BMI-adjusted and confirmed sarcopenia W-adjusted were significantly associated with impaired IADL (p < 0.001), and showed fair accuracy for predicting IADL disability. Sarcopenic obesity did not show significant associations with ADL and IADL disability and didn't predict ADL and IADL disability. Only confirmed sarcopenia by BMI predicted ADL disability with poor accuracy. Among operational definitions of sarcopenia, probable sarcopenia had the highest sensitivity (83.6%) and negative predictive value (NPV) (94.2%) for predicting IADL disability.

CONCLUSION

We found that probable sarcopenia (with the highest sensitivity and NPV) and confirmed sarcopenia (BMI-adjusted with higher sensitivity and NPV than W-adjusted) were the most relevant for predicting IADL disability, but their diagnostic accuracy was limited. Confirmed sarcopenia by BMI predicted ADL disability with poor accuracy. Other operational definitions, including SO did not predict functional disability in our study. Future studies need to refine the definitions of SO and investigate its distinct impact on functional impairment compared to sarcopenia alone.

Assessment of Gait Parameters Using Wearable Sensors and Their Association With Muscle Mass, Strength, and Physical Performance in Korean Older Adults: Cross-Sectional Study

Background

Gait speed indicates the onset or decline of physical performance in sarcopenia. However, real-time measurements of other gait parameters, such as step length, stride length, step width, and support time, are limited. The advent of wearable technology has facilitated the measurement of these parameters, necessitating further investigation into their potential applications.

Objective

This study aimed to investigate the relationship between gait parameters measured using wearable sensors and muscle mass, strength, and physical performance in community-dwelling older adults.

Methods

In a cross-sectional study of 91 participants aged ≥65 years, gait parameters, such as step count, step length, cadence, single and double support times, vertical oscillation, and instantaneous vertical loading rate (IVLR), measured using a wireless earbud device, were analyzed on the basis of the appendicular skeletal muscle mass index (SMI), calf circumference, handgrip strength, 5-time chair stand test, short physical performance battery (SPPB), and the SARC-F (strength, assistance with walking, rise from a chair, climb stairs and fall frequency) questionnaire. This study was conducted from July 10 to November 1, 2023, at an outpatient clinic of a university hospital in Seoul, Korea. Multiple regression analysis was performed to investigate independent associations after adjusting for age, sex, BMI, and comorbidities.

Results

Among 91 participants (45 men and 46 women; mean age 74.1 years for men and 73.6 years for women), gait speed and vertical oscillation showed negative associations with their performance in the 5-time chair stand test (P<.001) and SARC-F and positive associations with their performance in the SPPB (P<.001). Vertical oscillations were also associated with grip strength (P=.003). Single and double support times were associated with performance in the 5-time chair stand test and SPPB (P<.001). In addition, double support time was associated with SARC-F scores (P<.001). Gait speed, support time, vertical oscillation, and IVLR showed independent associations with performance in the 5-time chair stand test and SPPB (P<.001), both related to muscle strength or physical performance. Gait speed, double support time, and vertical oscillation all had significant associations with SARC-F scores.

Conclusions

This study demonstrated a significant association between gait monitoring using wearable sensors and quantitative assessments of muscle strength and physical performance in older people. Furthermore, this study substantiated the extensive applicability of diverse gait parameters in predicting sarcopenia.

Rate of force development in ankle extensors correlates with performance on functional tests that demand speed and power in older women

PURPOSE

Despite the background of decreased ankle extensor muscle strength with aging, there is still debate regarding whether the rate of force development has any relationship with musculoskeletal and functional characteristics. Therefore, we investigated the correlation between the rate of force development (RFD) in ankle extensors during heel rise (HR) and musculoskeletal characteristics and performance in functional tests in community-dwelling older women. Additionally, determine the correlation by decades of age (60-90 years).

METHODS

Correlational cross-sectional design analyzed 61 older women (72.8 ± 6.9 years, 29.4 ± 4.9 kg/m2). HR was evaluated on a force platform. In addition, anthropometric, musculoskeletal characteristics, and functional tests were measured. RFD was defined in three-time intervals (0-50 ms, 0-100 ms, and 0-peak). Peak force (Fpeak) and time to peak were also determined. Relative power-STS (STS-power), calf circumference, and skeletal muscle mass were considered musculoskeletal characteristics. Functional tests were timed up-and-go (TUG), walk speed (WS), grip strength, five sit-and-stand (5-STS), sit-and-reach, and single-leg stance.

RESULTS

The RFD and the STS-power were correlated, and the Fpeak with the musculoskeletal characteristics except with the skeletal muscle mass. RFD was correlated with the TUG, WS, and 5-STS, particularly with early RFD (0-50 ms). Oldest old women (80-90 years) only showed correlations between early RFD and the two walk-related tests (TUG and WS), compared to younger old women.

CONCLUSION

RFD during HR correlates with functional tasks involving ankle extensor's speed and power demands. Impaired RFD of ankle extensors would expose older women to more significant risks of functional loss, especially at older ages.

Effects of Taekwondo training on thigh muscle cross-sectional area, health-related physical fitness, HbA1c, and GLP-1 in sedentary older women

Background

Sedentary lifestyles in older individuals are associated with reduced physical function and an increased risk of metabolic diseases such as type 2 diabetes. Physical exercise can enhance muscle mass, insulin sensitivity, and metabolic health. Taekwondo, a martial art that integrates both aerobic and resistance components, may improve strength, balance, and metabolic health in older individuals. This study investigated the effect of long-term Taekwondo training on thigh muscle cross-sectional area, health related physical fitness, and metabolic indicators in sedentary older women.

Methods

Seventeen participants (aged 65 years and older, sedentary time 8 h and more per day) were randomly assigned to a Taekwondo group (n = 9) and a control group (n = 8). Outcomes, including thigh muscle cross-sectional area, health-related physical fitness, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), and Glucagon-like peptide-1 (GLP-1) were measured before and after the Taekwondo program. The Taekwondo group underwent 60 min of training, three times per week for 12 weeks. Variable changes over time and between groups were analyzed using two-way repeated measures ANOVA performed for significant interactions.

Results

The Taekwondo group exhibited a significant reduction in body weight, body mass index, body fat, and mean arterial blood pressure (p < 0.05), as well as increased thigh muscle cross-sectional area, lean body mass and lower limb muscle mass (p < 0.05). Improvements in balance and gait speed, stride were observed (p < 0.05), indicating reduced fall risk and enhanced mobility. Laboratory analyses revealed reduced triglyceride and free fatty acids and elevated HDL-cholesterol and GLP-1 levels (p < 0.05). Increased thigh muscle cross-sectional area was inversely correlated with fasting glucose, insulin, and HOMA-IR, suggesting improved insulin sensitivity and glucose regulation.

Conclusion

Long-term Taekwondo training improved thigh muscle cross-sectional area, health-related physical fitness and insulin resistance markers in sedentary older women, providing evidence for its use as an effective intervention to promote metabolic health in this population.

Associations of sarcopenia status and its components with the risk of developing functional disability in older Chinese adults: evidence from the China health and retirement longitudinal study

OBJECTIVES

In the aging population, sarcopenia has become a major concern due to its association with increased risks of disability, including impairments in both activities of daily living (ADL) and instrumental activities of daily living (IADL). This relationship, however, has been rarely studied within the Chinese population. This study was conducted to assess the relationships of sarcopenia status and its components with the risk of developing ADL/IADL disability among Chinese community-dwelling elderly people.

METHODS

In this study, we used data from the China Health and Retirement Longitudinal Study. The ADL and IADL scales were used to assess an individual's functional disability. Logistic regression models were used to assess the association between sarcopenia status and its components and the risk of developing ADL/IADL disability in the overall population. Sex-specific receiver operating characteristic (ROC) curves was used to evaluate the value of sarcopenia component indicators for predicting ADL/IADL disability.

RESULTS

A total of 4,893 participants were included in the study, comprising 2,220 males and 2,673 females, with ages ranging from 60 to 102 years. There were greater IADL disability risks in the possible sarcopenia group (OR = 1.87, 95% CI: 1.48-2.37), sarcopenia group (OR = 1.85, 95% CI: 1.24-2.76) and severe sarcopenia group (OR = 2.54, 95% CI: 1.63-3.94). The results were similar (possible sarcopenia: OR = 2.16, 95% CI: 1.44-3.22; severe sarcopenia: OR = 4.99, 95% CI: 2.52-9.87)) for ADL disability, except for the sarcopenia group (OR = 2.00, 95% CI: 0.97-4.12). We found that handgrip strength (HS) (OR = 0.95, 95% CI: 0.92-0.97) and gait speed (GS) (OR = 0.33, 95% CI: 0.12-0.86) were negatively associated with the risk of developing ADL disability and that the repeated chair stand (RCS) test results (OR = 1.09, 95% CI: 1.05-1.12) were positively associated with the risk of developing ADL disability. Similar results were found for the associations between several sarcopenia component indicators and the risk of developing IADL disability. The area under the curve (AUC) of HS was 0.702, which could better recognize ADL disability and showed good discriminant validity in males.

CONCLUSION

The prevalence of sarcopenia is high among the elderly Chinese population. Additionally, HS showed good discriminant validity for discriminating ADL disability in males. Further prospective studies are needed to clarify the relationship between sarcopenia status and the risk of developing functional disability and to determine whether indicators of the separate sarcopenia components can be used for early warning, screening and identifying functional disability.

Knee strength balance ratios are not affected by aging among male runners

Objectives

This study aimed to assess thigh muscular strength, conventional and functional strength balance ratios, and muscle quality in well-trained male runners aged 20-70 yr.

Methods

Eighty-nine male runners were divided into five age categories: 20-29, 30-39, 40-49, 50-59, and 60-70 yr. Participants underwent an isokinetic strength test for knee flexor and extensor muscles and a body composition analysis via dual-energy X-ray absorptiometry.

Results

No significant difference was observed in concentric peak torque of the knee extensor muscles between the 20-29 and 40-49 age groups. However, the 50-59 age group showed significantly lower strength than the 20-29 age group (p = 0.049), and the 60-70 age group demonstrated significantly lower strength than the 40-49 group (p < 0.001). The conventional and functional balance ratios remain stable across all age groups.

Conclusion

Knee flexor and extensor strength in male runners decreases significantly after the age of 50, while conventional and functional strength balance ratios remain stable.

Health disparities between native and foreign-born older population in India: Does migration status matter in later life?

BACKGROUND

Ageing and migration are both contemporary phenomena and challenging for modern society in the 21st century. Persons ageing with migration status might have a double risk of vulnerability to poor health outcomes. This study examines the health disparities between foreign-born and native populations in India.

METHODS

The data drawn for the study from the Longitudinal Ageing Study in India (LASI) Wave-I (2017-18). The study used univariate and bivariate analysis to examine health disparities between native and foreign-born groups, and logistic regression analysis was used to examine the association between migration status and health outcomes of older persons.

RESULTS

Over fifty percent (56.5%) of the older persons (age 60+ years) were migrants; of these migrants of older persons, 55% were internally migrated, and 1.5% were foreign-born migrants in India. The foreign-born migrants persons showed a higher prevalence of poor SRH, chronic conditions, depression symptoms, and physical limitations than internal migrants and non-migrant groups. Further, the logistic regression result shows that foreign-born migrants were more likely to have poor SRH [AOR:1.72; CI: 1.45-2.04], chronic conditions [AOR=1.56; CI: 1.26-1.81], depression symptoms [AOR 1.14; CI: 1.07-1.21], and physical limitations [AOR 1.29; CI: 1.21-1.38], than non-migrants. Moreover, the study shows that the migrants' health disparities also vary with their length of stay and country of origin.

CONCLUSIONS

This cross-sectional study suggests that persons with internal and foreign-born migrant status were more vulnerable to poor health outcomes than non-migrants in their later life. This study predicts that migrants need separate health policies as they are in poorer health conditions than non-migrants. Policymakers should initiate equal access to healthcare services for older internal and foreign-born migrants in India.

Health outcomes of sarcopenia: a consensus report by the outcome working group of the Global Leadership Initiative in Sarcopenia (GLIS)

The Global Leadership Initiative in Sarcopenia (GLIS) aims to standardize the definition and diagnostic criteria for sarcopenia into one unifying, common classification. Among other actions to achieve this objective, the GLIS has organized three different working groups (WGs), with the WG on outcomes of sarcopenia focusing on reporting its health outcomes to be measured in clinical practice once a diagnosis has been established. This includes sarcopenia definitions that better predict health outcomes, the preferred tools for measuring these outcomes, and the cutoffs defining normal and abnormal values. The present article synthesizes discussions and conclusions from this WG, composed of 13 key opinion leaders from different continents worldwide. Results rely on systematic reviews, meta-analyses, and relevant cohort studies in the field. With a high level of evidence, sarcopenia is significantly associated with a reduced quality of life, a higher risk of falls and fractures and a higher risk of mortality. Sarcopenia has been moderately associated with a higher risk of reduced instrumental activities of daily living (IADL). However, the GLIS WG found only inconclusive level of evidence to support associations between sarcopenia and higher risks of hospitalization, nursing home admission, mobility impairments, and reduced basic activities of daily living (ADL). This limitation underscores the scarcity of longitudinal studies, highlighting a barrier to understanding its progression and implications over time.

Association of handgrip strength weakness and asymmetry with cognitive impairment and depressive symptoms in older Chinese adults

This study investigated the association between handgrip strength (HGS) asymmetry and weakness with cognitive function and depressive symptoms among 920 community-dwelling adults aged above 60 years in suburban Shanghai. Participants were selected using a multistage cluster-stratified sampling approach. Assessments included HGS measured with a dynamometer, the Montreal Cognitive Assessment (MoCA) for cognition, and the Geriatric Depression Scale (GDS) for depressive symptoms. Restricted cubic splines revealed a positive association between dominant HGS and MoCA scores, indicating better cognitive performance, and a negative association with GDS scores, suggesting fewer depressive symptoms. The association between the HGS ratio and MoCA scores and the HGS ratio and GDS scores varied by sex. Women with HGS weakness alone (odds ratio (OR) = 2.00, 95% confidence interval (CI) = 1.17-3.37), asymmetry alone (OR = 1.93, 95% CI = 1.14-3.29), or weakness and asymmetry together (OR = 2.57, 95% CI = 1.48-4.46) had a significantly increased risk of cognitive impairment. However, no such associations observed in men. These findings suggest that HGS weakness and asymmetrical HGS may be associated with a higher risk of cognitive decline and depressive symptoms, particularly in women. This study emphasizes the need for sex-specific assessments and prevention strategies to address cognitive and mental health issues among older adults.

Personality and Markers of Lower Extremity Function: Findings From Six Samples

ObjectivesThis study investigated the associations between Five-Factor Model personality traits and balance impairment and lower limb strength.MethodsMiddle-aged and older adults (Age range: 34-104 years; N >27,000) from six large samples from the US and England were assessed for standing balance, lower limb strength, personality traits, sociodemographic, and health-related variables.ResultsHigher extraversion, openness, agreeableness, and conscientiousness were related to lower balance impairment risk and better lower limb strength. Higher neuroticism was associated with higher risk of balance impairment and with weaker lower limb strength. Biological, clinical, behavioral, and psychological factors partially accounted for these associations between personality and risk of balance impairment. Depressive symptoms and physical activity partially mediated the associations between personality traits and limb strength.DiscussionPersonality traits have replicable associations with lower extremity functions. The study identifies potential moderators and mediators of these associations.

Understanding the Needs and Wishes of Older Adults in Interprofessional Treatment for Malnutrition and Sarcopenia: A Grounded Theory Study

Background

Malnutrition and sarcopenia impact the physical health and quality of life of community-dwelling older adults. Managing these conditions requires integrating nutritional and exercise interventions delivered by professionals from diverse backgrounds. Interprofessional collaboration holds promise for providing integrated, person-centered care to older adults. However, to tailor such care, it is essential to understand the needs and wishes of older adults, which remain underexplored. This study aimed to understand the needs and wishes of community-dwelling older adults regarding interprofessional treatment for (risk of) malnutrition and sarcopenia.

Methods

We conducted a grounded theory study. Data collection involved semi-structured interviews and focus groups with community-dwelling older adults who are undergoing treatment or have been treated for (risk of) malnutrition and/or sarcopenia. We systematically analyzed the data using open, axial, and selective coding and developed a conceptual model.

Results

Interviews and focus groups were conducted with 18 older adults. Three selective codes were identified: 1) older adults need to be involved in their interprofessional treatment, 2) older adults need healthcare professionals to be well-informed about their interprofessional treatment, and 3) older adults need collaboration amongst involved healthcare professionals in interprofessional treatment. Our conceptual model addresses the needs and wishes of older adults in relation to interprofessional collaboration. Older adults' needs highlight what is missing, while their wishes offer ways to fulfill these needs.

Conclusion

Older adults' need for involvement in interprofessional treatment can be met by engaging them actively in healthcare decisions and as partners to healthcare professionals. The need for well-informed healthcare professionals can be fulfilled by ensuring accessible healthcare information, the prevention of conflicting advice, and the prevention of repeating medical history. Finally, the need for collaboration among healthcare professionals can be fulfilled by healthcare professionals communicating openly and directly and working closely together.

Does the Combination of Metabolic Syndrome and Low Fat-Free Mass Shorten an Individual's Disability-Free Life? A 12-Year Prospective Cohort Study of the Korean Genome and Epidemiology Study (KoGES)

OBJECTIVE

This study aims to explore the combined risk of metabolic syndrome (MetS) and low fat-free mass (FFM) on an individual's disability-free survival (DFS). Disability is defined as a composite of dementia, physical disability, and mortality.

METHODS

Using data from the Korean Genome and Epidemiology Study, we divided 3721 participants aged 40-69 years based on their MetS status and FFM index (FFMI) score. Kaplan-Meier survival analysis and Cox regression were used to analyze differences in DFS between the four groups.

RESULTS

From 108 events, MetS group had significantly shorter DFS than the non-MetS group regardless of FFMI (p < 0.0001). After adjusting other potential confounding variables, the MetS group had a higher risk of shortened DFS regardless of FFMI, and the MetS group with low FFMI had a 2.06-fold increased risk compared to the non-MetS group with high FFMI (p < 0.001). Older age and lower income were also associated with higher risk of shorter DFS (p < 0.001).

CONCLUSIONS

The combination of MetS and low FFMI contribute to a cumulative risk of shortened DFS. Community nurses can perform MetS screening and body composition assessment to predict and control the risk of developing disability over time.

A Situation-Specific Theory on the Use of Immersive Virtual Reality in Rehabilitation for Patients With Disabilities

A primary challenge impeding optimal health outcomes in patients with disabilities is the lack of rehabilitation adherence. Immersive virtual reality emerges as a promising intervention with the potential to significantly enhance this key health outcome. This paper presents a situation-specific theory that outlines the mechanisms through which immersive virtual reality can promote rehabilitation adherence. Outcomes of immersive virtual reality encompass psychological (ie, motivation, self-efficacy, mood state) as well as physical responses (ie, pain management, muscle strength). Mechanisms by which immersive virtual reality influences outcomes are explained by proximal and distal mediators (attention, sense of presence, enjoyment). Possible moderators of these mechanisms (ie, age, gender, social support, trust in technology, cognitive status) are also described.

Association of sarcopenia with basic activities of daily living and dyspnea-related limitations in patients with interstitial lung disease

Background

Sarcopenia is characterized by loss of muscle mass and function and is known to impair activities of daily living (ADL) in community-dwelling elderly people. However, the impact of sarcopenia on ADL in patients with interstitial lung disease (ILD) remains unclear. This study aimed to determine the relationship between sarcopenia and ADL in ILD patients and to identify sarcopenia components that contribute to these impairments.

Methods

This cross-sectional study included 50 patients (median age 76 years) with stable ILD who were hospitalized at Hyogo Medical University Hospital between June 2022 and February 2024. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia 2019 criteria. Basic ADL were evaluated using the Barthel Index (BI), and the impact of dyspnea on ADL was assessed using the Barthel Index-dyspnea (BI-d). Clinical assessments included the 6-min walk test, the Hospital Anxiety and Depression Scale score, and the EuroQol-5 Dimensions-5 Levels tool. Statistical analyses were performed to compare outcomes between patients with and without sarcopenia and to identify factors affecting BI and BI-d scores.

Results

Sarcopenia was diagnosed in 21 patients (42%). The BI score was significantly lower (85 vs. 90, P<0.01) and the BI-d score was significantly higher (45 vs. 10, P<0.01) in the sarcopenia group. The sarcopenia group also had a shorter 6-min walk distance (245.0 vs. 318.5 m, P=0.03), a higher score for the depression component of the Hospital Anxiety and Depression Scale (6.0 vs. 5.0, P=0.02), and a lower EuroQol-5 Dimensions-5 Levels score (0.58 vs. 0.84, P<0.01). Multiple linear regression analyses showed a significant association of sarcopenia with a lower BI score (β=-0.30, P=0.03) and a higher BI-d score (β=0.45, P<0.01). The skeletal muscle mass index (SMI) was the only component of sarcopenia that had a significant association with the BI score, and gait speed was associated with the BI-d score in both men and women.

Conclusions

Sarcopenia was significantly associated with greater impairment of basic ADL and limitation of ADL by dyspnea in patients with ILD. SMI and gait speed are components of sarcopenia that affect these outcomes. Targeted interventions are needed to improve ADL and quality of life in these patients.

Effect of depression combined with cognitive impairment on dependency risk in rural older adults: analysis of data from the China health and retirement longitudinal study (CHARLS 2020)

BACKGROUND

This study aims to investigate the relationship between cognitive impairment, depressive symptoms, and Activities of Daily Living (ADL)/ Instrumental Activities of Daily Living (IADL) dependency among older people living in rural areas.

METHODS

We analyzed data from the China Health and Aging Longitudinal Study 2020, focusing on the rural older adults over 60. We identified four groups and constructed three regression models (models 1-3) to investigate the relationship between cognitive impairment or depression and dependency.

RESULTS

Based on a logistic regression model, older adults living in rural areas face a sequentially increased risk of dependence on ADL if they in group 2 (OR = 1.33, 95% CI = 1.09-1.63), group 3 (OR = 1.76, 95% CI = 1.43-2.17), or group 4 (OR = 2.38, 95% CI = 1.95-2.91), when compared to a reference group 1. Group 2 (OR = 2.44, 95% CI = 2.03 to 2.93) was more likely to be at risk of IADL dependence than Group 3 (OR = 1.99, 95% CI = 1.64 to 2.43).

CONCLUSIONS

This study highlights the substantial impact of depression and cognitive impairment on ADL/IADL dependence among rural older adults, with an especially heightened risk when both disorders are present simultaneously. Moreover, factors such as gender, age, inpatient services, outpatient services, and self-rated health are strongly associated with functional dependence in this population.

Are strategies to increase muscle mass and strength as effective in people with type 2 diabetes?

People with type 2 diabetes (T2D) have a 2-3-time higher risk of developing sarcopenia, a musculoskeletal disease marked by a progressive loss of skeletal muscle mass and strength, compared to people without T2D. This narrative review examines the effectiveness of lifestyle interventions in enhancing muscle mass and strength in people with T2D, emphasizing their growing importance with advancements in obesity treatments. PubMed and Google Scholar were utilized to identify the most relevant published studies based on the authors' knowledge. The maintenance of skeletal muscle strength and mass in people with T2D is becoming more prominent due to the advent of weight loss therapies such as low-energy diets, bariatric surgery and pharmacotherapies. Although the weight loss is to be commended, a large proportion (20-50%) of the weight loss comes from lean mass, indicative of a loss in muscle mass. There are currently no pharmacotherapies to increase, or mitigate the loss of, lean mass, with lifestyle strategies prominent in this arena. Resistance exercise is the most effective method to increase muscle mass and strength in people with T2D, but there is some evidence of an anabolic resistance. Aerobic exercise and increased dietary protein intake may result in small increases in muscle mass and strength, with no evidence of an anabolic resistance to these stimuli. Exercise and protein supplementation can increase, or aid in the retention of, muscle strength and mass in individuals with T2D, but further research is needed to explore their benefits in patients undergoing concomitant pharmaceutical and surgical treatments.

Sarcopenia, Depressive Symptoms, and Fall Risk: Insights from a National Cohort Study in the Chinese Population

Background

Previous investigations have indicated that both sarcopenia and depressive symptoms are linked to a heightened risk of falls. However, the potential synergistic effect of these conditions on fall risk remains unclear. This study aims to assess the combined influence of sarcopenia and depressive symptoms on the occurrence of falls in the Chinese population.

Methods

The analysis included 8,405 participants from the China Health and Retirement Longitudinal Study (CHARLS), conducted from 2011 to 2015. Sarcopenia was confirmed using the 2019 Asian Working Group for Sarcopenia (AWGS) algorithm consisting of muscle strength, appendicular skeletal muscle mass (ASM), and physical performance. ASM was calculated using the formula: 0.193 × weight (kg) + 0.107 × height (cm) - 4.157 × sex - 0.037 × age (years) - 2.631. The Center for Epidemiological Research Depression Scale was utilized to assess depressive symptoms, with a cut-off score of 12 points. Depressive sarcopenia is defined as the coexistence of sarcopenia and depression. Multiple logistic regression analyses were conducted to explore the associations among sarcopenia, depressive symptoms, and fall occurrences.

Results

During the four-year follow-up, 1,275 participants reported experiencing falls. A significant synergistic effect was identified between sarcopenia and depressive symptoms regarding fall risk. Compare to robust individuals, those with sarcopenia alone or depression alone had increased falls risks, but those with both conditions exhibited the highest fall risk, with adjusted odds ratios (OR) of 1.21 (95% CI 1.03, 1.42; P = 0.0174), 1.53 (95% CI 1.24, 1.88; P < 0.001), and 1.78 (95% CI 1.48, 2.15; P < 0.001), respectively.

Conclusion

The findings highlight a synergistic effect between sarcopenia and depressive symptoms on fall risk. This study highlights the importance of early detection and intervention for both conditions, especially in older and middle-aged individuals, to mitigate fall risk.

Assessment of muscle fatigability using isometric repetitive handgrip strength in frail older adults. A cross-sectional study

BACKGROUND

Fatigue has a significant impact on physical performance and quality of life in older adults, but is subjectively assessed in the Fried phenotype, so early deterioration may be overlooked. This study explores whether repetitive handgrip strength (HGS) provides an objective method of differentiating levels of frailty by comparing fatigue and recovery ratios with subjective measures and their correlations with frailty indicators.

METHODS

Participants (n = 217) were included based on mobility and cognitive function (MMSE > 17), with exclusions for neuromuscular disease or hand injury. The protocol consisted of two 10-maximal grip assessments one hour apart, calculating fatigue ratios 1 and 2 (maximum/mean force) at each session and recovery ratios between sessions. Logistic regression analysed associations between Fried's criteria components (Unintentional Weight Loss, Exhaustion Single Question, Multidimensional Fatigue Inventory (MFI), Short Physical Performance Battery (SPPB), Physical Activity Scale for the Elderly (PASE), standard Maximum HGS, Fatigue Ratio, and Recovery Ratio).

RESULTS

Among the participants (58 non-frail, 68 pre-frail, 91 frail; ages 74.7, 79.4, 83.8 years), significant differences were found for Fatigue Ratio 1 of 1.12 (non-frail), 1.23 (pre-frail), 1.40 (frail), Fatigue Ratio 2 of 1.12, 1.21, 1.45, and Recovery Ratio of 1.03, 1.01, 0.90, respectively. Fatigue Ratios 1, 2 and Recovery correlated more strongly with frailty status (r = 0.67, 0.69, -0.68) than MFI (r = 0.50), standard maximum HGS (r = -0.51) or a single fatigue question (r = 0.21). In logistic regression for predicting fatigue (MFI), Fatigue Ratio (OR = 1.51, p < 0.001) and Recovery Ratio (OR = 0.83, p = 0.022) were stronger predictors than single-question fatigue (OR = 1.15, p = 0.047) and maximum HGS. For predicting frailty, physical performance (SPPB) was the strongest predictor (OR = 0.72, p < 0.001), followed by Fatigue Ratio 1 (OR = 1.28, p < 0.001), with a higher Recovery Ratio reducing frailty risk (OR = 0.86, p = 0.050).

CONCLUSION

The repetitive HGS protocol is equivalent to the SPPB in assessing frailty and outperforms standard HGS and subjective fatigue measures. This objective method supports the identification of frailty by measuring strength, fatigue resistance and recovery capacity.

Enhanced Functionality Using a Powered Upper Extremity Exoskeleton in Patients With Brachial Plexus Injuries

Traumatic brachial plexus injury (BPI) results in significant disability, often hindering functionality in the patient's daily life. Post- surgery, muscle strength recovery can take up to two years, with 40% of patients requiring even longer. A powered elbow orthosis can enhance functionality during activities of daily living (ADLs). This study tested a novel powered myoelectric elbow orthosis (PMEO) during ADLs. Subjects with BPI were fitted with the PMEO and divided into two groups: more impaired (Manual Muscle Test (MMT) < 3, N = 5) and less impaired (MMT≤ 3, N = 4). They performed four ADLs involving full elbow motion, including an activity requiring the subjects to lift a basket with weights. Upper extremity kinematics, electromyographic activity, weight lifted, and subject feedback on the device's form and fit were collected and analyzed. Results showed that the PMEO significantly improved elbow range of motion in the more impaired group (14 ± 23 degrees, p = 0.019) without any additional compensatory motions in the shoulder or trunk. More impaired subjects lifted an average of 1.1 ± 0.6 kg with the PMEO, whereas they could not do so without it (p = 0.011). Subjects appreciated the PMEO's weight, fit, and form. All could don and doff the device with minimal assistance. These findings demonstrate that the PMEO is a viable option to enhance ADL function for patients with BPI.

Longitudinal association between handgrip strength and depressive symptoms in middle-aged and older Chinese adults: mediating role of functional limitation

Background

The relationship between handgrip strength (HGS) at baseline and subsequent depressive symptoms among middle-aged and older Chinese adults remains highly uncertain. This research endeavored to investigate the effect of functional limitation on the association between these two variables.

Methods

A total of 5,684 participants aged ≥45 years from the China Longitudinal Study of Health and Retirement (CHARLS) were enrolled, using data from the 2015 and 2018 waves. Functional limitation was evaluated based on participants' self-reported basic activities of daily living (BADL) and instrumental activities of daily living (IADL). Logistic regression models were utilized to analyze the relationship between HGS and subsequent depressive symptoms, and bootstrap analysis was performed to explore the potential mediating role of functional limitation.

Results

After adjusting for confounders, an inverse correlation was detected between HGS and functional limitation (B = -0.885, p < 0.001), a positive correlation was found between functional limitation and subsequent depressive symptoms (B = 1.054, p < 0.001). The mediated effect size of HGS on depressive symptoms through functional limitation was a*b = -0.933 (BCa 95% CI: -1.224, -0.642). Functional limitation had a significant impact on 18.9% of the overall association.

Conclusion

Among the Chinese middle-aged and senior population, functional limitation accounted for 18.9% of the connection between HGS and depressive symptoms. Interventions targeting the enhancement of muscle strength should be regarded as crucial elements for maintaining physical function and preventing depressive symptoms.

Insulin Sensitivity and Muscle Loss in the Absence of Diabetes Mellitus: Findings from a Longitudinal Community-Based Cohort Study

Background/Objectives: Muscle loss is a serious complication in chronic disease patients, yet studies on long-term changes in muscle mass based on insulin sensitivity in the absence of diabetes mellitus are scarce. This community-based cohort study analyzed the longitudinal association between insulin sensitivity and muscle loss in middle-aged South Korean adults. Methods: This study included 6016 subjects (aged 40-65 years) from the Korean Genome and Epidemiology Study, conducted between 2001 and 2016. Fat-free mass, fat mass, body weight, and kidney function were assessed biennially. Subjects were categorized into four groups based on the composite (Matsuda) insulin sensitivity index (ISI) quartiles. The primary outcome was muscle loss, defined as a decline in fat-free mass of 10% or more from baseline. The secondary outcome was the occurrence of all-cause mortality. Results: During 69,480 person-years of follow-up, muscle loss occurred in 311 (5.2%) subjects. Multivariable Cox regression revealed a reverse-graded association between insulin sensitivity and muscle loss risk. Hazard ratios (95% confidence intervals) for the second, third, and highest ISI quartiles were 0.70 (0.51-0.94), 0.69 (0.50-0.95), and 0.65 (0.46-0.92), respectively, compared with the lowest quartile. Insulin sensitivity, however, was not significantly associated with all-cause mortality, though the mortality risk was higher in individuals with muscle loss. Conclusions: A reverse-graded relationship between insulin sensitivity and muscle loss risk was identified in middle-aged South Korean adults, with the lowest risk in the highest ISI quartile. These findings suggest that higher insulin sensitivity may reduce the risk of muscle loss.

Has Muscle Power Better Discriminative Capacity Compared to Muscle Strength in Predicting Worsening Disability in Older Adults?

BACKGROUND

Poor muscle strength is a risk factor for disability; nonetheless, its discriminative capacity in identifying people who will become disabled is poor. We evaluated whether muscle power, which also is a risk factor for disability, has better discriminative capacity compared to muscle strength.

METHODS

We used data from the population-based InCHIANTI study. Our outcome measure was the loss of at least 1 basic or instrumental activity of daily living between baseline and 3-year follow-up visit. Body weight standardized knee isometric strength and leg power (power rig) were used as exposure variables. Discriminative capacity was estimated using the area under the receiver-operating curves. Both strength and power were dichotomized as below versus equal of above sex-specific first quartile. Sensitivity, specificity, and positive/negative predictive values (PPV, NPV) were calculated.

RESULTS

We included 763 participants (415 women), with a mean age of 73.5 years (standard deviation: 6.4). In men, using muscle strength we obtained an area under the curve (AUC) of 0.70, with sensitivity = 0.45, specificity = 0.80, PPV = 0.27, and NPV = 0.90; using muscle power we obtained an AUC of 0.82, sensitivity = 0.73, specificity = 0.86, PPV = 0.46, and NPV = 0.95. In women, using muscle strength we obtained an AUC of 0.62, with sensitivity = 0.39, specificity = 0.81, PPV = 0.39, and NPV = 0.81; using muscle power we obtained an AUC = 0.69, sensitivity = 0.40, specificity = 0.83, PPV = 0.42, and NPV = 0.82.

CONCLUSIONS

We found that in men muscle power had better discriminative capacity, especially higher sensitivity, compared to muscle strength for prediction of worsening disability. No meaningful difference in overall discriminative capacity was found in women.

Changes in nutritional status and effectiveness of the dietary intervention of multimodal prehabilitation for patients with colorectal cancer: A secondary analysis of the PREHAB randomized clinical trial

BACKGROUND & AIMS

Prehabilitation is a preoperative multimodal program including exercise, nutritional, and psychological support. Little is known about changes in nutritional status during prehabilitation.

METHODS

This secondary analysis of the PREHAB trial aims to assess changes in nutritional status and explore the effectiveness of a four-week nutritional intervention. Data were collected at baseline and preoperatively (end of the program), including body composition with bioelectrical impedance analysis (single frequency, 50 kHz), muscle strength (indirect 1RM leg press), three-day food diaries and the scored PG-SGA. Protein requirements were set at 1.5 g/kg body weight.

RESULTS

Sixty-seven participants were enrolled, 34 to standard care and 33 to four-week prehabilitation. Nutritional status improved in both groups: -1 point change in the standard care group (p = , 0.027), and -1.5 point in the prehabilitation group (p = 0.015). Those who received prehabilitation statistically increased fat free mass (0.9 kg, p = 0.017) and appendicular skeletal muscle mass (0.5 kg, p = 0.007. In contrast, an increase in fat mass (0.6 kg, p = 0.016) was observed within the standard care group only. Participants in the prehabilitation group had a substantial increase of 27 % muscle strength (p = <0.001). Optimal protein intake was more often achieved within the prehabilitation group (47 %, p = <0.001).

CONCLUSION

Our study provides evidence for the positive impact of multimodal prehabilitation on preoperative nutritional status in adult patients with CRC, especially in body composition and muscle strength. Achieving optimal protein intake was challenging, both dietary counseling and supplements are recommended to improve intake.

TRIAL REGISTER

PREHAB RCT: NTR5947.

Development and Validation of a Nutritional Frailty Phenotype for Older Adults Based on Risk Prediction Model: Results from a Population-Based Prospective Cohort Study

OBJECTIVES

Malnutrition is generally studied to be involved in outlining hazard frailty trajectories, resulting in adverse outcomes. In view of frailty's multidimensional nature, we aimed to assess the contribution of nutritional items in existing frailty tools to adverse outcomes, and develop and validate a nutritional frailty phenotype based on machine learning.

DESIGN

A population-based prospective cohort study.

SETTING AND PARTICIPANTS

A total of 7641 older adults from the China Health and Retirement Longitudinal Study (CHARLS) were included as the training set to develop the nutritional frailty phenotype between 2011 at baseline and 2013 at follow-up, and 8656 older adults between 2013 at baseline and 2015 at follow-up were included for temporally external validation.

METHODS

The important predictors for 2-year incident adverse outcomes including all-cause mortality, disability, and combined outcomes were selected based on the least absolute shrinkage and selection operator. The nutritional frailty phenotype was developed using 2 machine learning models (random forest and eXtreme Gradient Boosting), and modified Poisson regression with the robust (sandwich) estimation of variance.

RESULTS

Slowness (walking speed), lower extremity function (chair-stand test), and upper limb function (grip strength) were selected as important predictors for each outcome using least absolute shrinkage and selection operator. For the training set, the models for predicting all-cause mortality [area under the receiver operating characteristics curves (AUCs), 0.746-0.752; mean AUCs of the 5-fold cross validation: 0.746-0.752] and combined outcome (AUCs, 0.706-0.708; mean AUCs of the 5-fold cross validation, 0.706) showed acceptable discrimination, whereas the models for predicting incident disability had approximately acceptable discrimination (AUCs, 0.681-0.683; mean AUCs of the 5-fold cross validation, 0.681-0.684). For external validation, all models had acceptable discrimination, overall prediction performance, and clinical usefulness, but only the modified Poisson regression model for predicting incident disability had acceptable calibration.

CONCLUSIONS AND IMPLICATIONS

A novel nutritional frailty phenotype may have direct implications for decreasing risk of adverse outcomes in older adults. Weakness and slowness play a major role in the progression of nutritional frailty, emphasizing that nutritional supplementation combined with exercise may be one of the feasible pathways to prevent or delay adverse outcomes.

Why are we not exploring the potential of lower limb muscle power to identify people with sarcopenia?

Sarcopenia refers to a neuromuscular disease characterized by age-related declines in muscle mass and function. Since Professor Rosenberg first introduced the concept of sarcopenia in 1989, numerous operational paradigms have been proposed, tested, and validated against negative outcomes. The most recent recommendations advocate that dynapenia, or reduced of muscle strength, should be used alongside low muscle mass for the identification of sarcopenia. This approach is based on the understanding that impairments in muscle strength are a major consequence of muscle failure. However, empirical evidence has yielded conflicting results regarding the ability of current sarcopenia definitions to identify individuals at higher risk of adverse health-related events. Muscle power - the capacity to generate strength rapidly - has emerged as a critical domain of physical performance in old age. Not only does it decline earlier and more drastically than other measures (e.g., muscle strength), but it is also more strongly associated with adverse outcomes. In this view point, we provide an appraisal of muscle power as a more reliable indicator of muscle failure, compared with other measures (e.g., strength), for identifying individuals with sarcopenia in both geriatric and non-geriatric settings. We also discuss major challenges hindering the conduct of meaningful investigations on this subject.

Is a higher body mass index associated with longer duration of survival with disability in frail than in non-frail older adults?

BACKGROUND/OBJECTIVES

This study investigated the hitherto unclear association of body mass index (BMI) with age at overall, disability, and disability-free survival in older adults with and without frailty.

METHODS

This prospective cohort study enroled 10232 Japanese adults aged ≥65 years, who underwent follow-up for adverse events, from the Kyoto-Kameoka Study conducted from 2011-2016. BMI, calculated based on self-reported height and body weight, was classified into five categories: <18.5, 18.5-21.4, 21.5-24.9, 25.0-27.4, and ≥27.5 kg/m2. Frailty was assessed using the validated Kihon Checklist. The relationships between BMI and disability and mortality were analysed using multivariate Cox proportional hazards models and Laplace regression.

RESULTS

During the 5.3-year median follow-up period (45472 person-years), 2348 (22.9%) incidences of disabilities occurred. After adjusting for confounders, including medical history and lifestyle, individuals in the lowest and highest BMI categories had a higher hazard ratio (HR) of disability [<18.5 kg/m2: HR: 1.31, confidence interval (CI): 1.16-1.49; ≥27.5 kg/m2: HR: 1.27, 95% CI: 1.08-1.49, p for non-linearity <0.001] compared with that of those with BMI = 21.5-24.9 kg/m2. In the 50th percentile differences in age at overall and disability-free survival, participants with BMI < 18.5 kg/m2 were more likely to die before disability incidence [survival with disability (overall survival - disability-free survival): -10.2 months]; those with BMI ≥ 27.5 kg/m2 had longer survival with disability (12.5 months). These relationships were more marked in the frailty-stratified model, where in the BMI ≥ 27.5 kg/m2 group, individuals with frailty survived longer with disability (27.2 months) than did individuals without frailty (6.2 months).

CONCLUSION

Higher BMI is associated with a longer duration of survival with disability among older adults, especially in those with frailty. Therefore, reversing frailty should be prioritised because individuals with frailty have a shorter probability of disability-free survival than do individuals without frailty, regardless of BMI.

Pre-stroke patient characteristics that influence skeletal muscle quality: A cross-sectional study

AIM

One of the parameters that is measurable using bioelectrical impedance is the phase angle (PhA), which is an indicator of skeletal muscle quality. The PhA reflects cellular health and nutritional status and is an important parameter for monitoring recovery after stroke. However, the factors affecting skeletal muscle quality remain unclear. Therefore, this study aimed to identify the factors associated with skeletal muscle quality in patients with acute stroke.

METHODS

A total of 505 consecutively hospitalized patients with acute stroke were included in this study. The primary outcome was the PhA measured by bioelectrical impedance analysis, which evaluates muscle quality. Multiple regression analysis was performed to identify the factors affecting PhA.

RESULTS

The mean age of the participants was 75.1 years, and 44% were female. The median National Institutes of Health Stroke Scale (NIHSS) score upon admission was 4, and the mean length of stay was 18 days. The mean PhA for skeletal muscle quality was 4.9° in males and 3.9° in females. Multiple regression analysis showed that age, sex, pre-stroke modified Rankin Scale (pre-mRS), Geriatric Nutritional Risk Index, type 2 diabetes mellitus, atrial fibrillation, and chronic kidney disease had independent effects on PhA (R2 = 0.575; P = 0.001). Age, pre-mRS, NIHSS, dementia, and PhA independently associated with functional independence measure at discharge (R2 = 0.657; P = 0.001).

CONCLUSIONS

This study identified determinants contributing to the deterioration of muscle quality upon admission in acute stroke patients. Further investigation is needed to ascertain whether modulation of these factors improves muscle quality. Geriatr Gerontol Int 2025; 25: 213-219.

Iron Chelation Prevents Age-Related Skeletal Muscle Sarcopenia in Klotho Gene Mutant Mice, a Genetic Model of Aging

BACKGROUND

A decline in skeletal muscle mass and function known as skeletal muscle sarcopenia is an inevitable consequence of aging. Sarcopenia is a major cause of decreased muscle strength, physical frailty and increased muscle fatigability, contributing significantly to an increased risk of physical disability and functional dependence among the elderly. There remains a significant need for a novel therapy that can improve sarcopenia and related problems in aging. Iron accumulation, especially catalytic iron (labile iron) through increased oxidative stress, could be one of the contributing factors to sarcopenia. Our study aimed to examine the effect of an iron chelator on age-related sarcopenia in mice.

METHODS

We investigated the effect of iron chelation (deferiprone, DFP) in sarcopenia, using mice with klotho deficiency (kl/kl), an established mouse model for aging. Four weeks old Klotho -/- male mice were treated with 25 mg/kg body weight of iron chelator deferiprone in drinking water for 8-14 weeks (n = 12/group, treated and untreated). At the end of the study, gastrocnemius, quadriceps and bicep muscles were dissected and used for western blot and immunohistochemistry analysis, histopathology and iron staining. Serum total iron, catalytic iron and cytokine ELISAs were performed with established methods.

RESULTS

Treatment with DFP significantly reduced loss of muscle mass in gastrocnemius and quadriceps muscles (p < 0.0001). Total and catalytic iron content of serum and iron in muscles were significantly (both p < 0.0001) lower in the treated animals. The inhibitory factor of myogenesis, the myostatin protein in gastrocnemius muscles (p = 0.019) and serum (p = 0.003) were downregulated after 8 weeks of therapy accompanied by an increased in muscle contractile protein myosin heavy chain (~2.9 folds, p = 0.0004). Treatment decreased inflammation (serum IL6 and TNFα) (p < 0.0001, p = 0.005), respectively, and elevated insulin-like growth factor levels (p = 0.472). This was associated with reduced DNA damage and reduced 8-hydroxy 2 deoxyguanosine in muscle and HO-1 protein (p < 0.001, p = 079), respectively. Significant weight loss (p < 0.001) and decreased water intake (p = 0.012) were observed in untreated mice compared to treatment group. Kaplan-Meier survival curves show the median life span of treated mice was 108 days as compared to 63 days for untreated mice (p = 0.0002).

CONCLUSIONS

In summary, our research findings indicate that deferiprone reduced age-related sarcopenia in the muscles of Klotho-/- mice. Our finding suggests chelation of excess iron could be an effective therapy to counter sarcopenia. However, additional studies are needed to evaluate and determine the efficacy in humans.

The association of muscle weakness with functional disability in older patients with Diabetes mellitus: Measured by three different grip strength thresholds

The association of muscle weakness with poor outcomes is well defined in general older population, but there is insufficient data on the association of muscle weakness with functionality in older patients with diabetes mellitus (DM). We aimed to investigate the predictivity of muscle weakness defined as low grip strength thresholds determined by EWGSOP2, and two regional thresholds in older patients with DM for functional disability. Activities of Daily Living (ADL), Instrumental ADL (IADL), grip strength, comorbidities, anthropometric and biochemical data from outpatient clinic medical records were screened retrospectively. Low grip strength was determined by EWGSOP2, and two regional thresholds. Receiver operating characteristic (ROC) analysis, sensitivity and negative predictive values were conducted to identify the discrimination power of three different grip strength thresholds for functional disability in patients with DM. A total of 197 patients with DM and 215 controls were included. In ROC analyses, regional thresholds were with higher sensitivity and negative predictive values for functional disability in both groups. For patients with DM, regional normative thresholds predicted functional disability both for ADLs and IADLs whereas for patients without DM normative thresholds predicted ADL, and calculated thresholds predicted IADL disability. Regional normative thresholds predicted both ADL and IADL functional disability in older patients with DM.

A 4-Week Mobile App-Based Telerehabilitation Program vs Conventional In-Person Rehabilitation in Older Adults With Sarcopenia: Randomized Controlled Trial

BACKGROUND

Sarcopenia is closely associated with a poor quality of life and mortality, and its prevention and treatment represent a critical area of research. Resistance training is an effective treatment for older adults with sarcopenia. However, they often face challenges when receiving traditional rehabilitation treatments at hospitals.

OBJECTIVE

We aimed to compare the effects of a digital rehabilitation program with those of traditional therapist-supervised rehabilitation training on older adults with sarcopenia.

METHODS

In total, 58 older adults with sarcopenia were recruited offline and randomized (1:1) into 2 groups: the telerehabilitation group (TRG, n=29, 50%) and the in-person rehabilitation group (IRG, n=29, 50%). Both groups underwent 4-week resistance training targeting 6 major muscle groups. The TRG received exercise guidance via a mobile app, while the IRG received in-person training from a therapist. Offline assessments of body composition, grip strength, and balance using the 30-Second Arm Curl Test (30SACT), 30-Second Sitting-to-Rising Test (30SSRT), quadriceps femoris extension peak torque (EPT) and extension total power (ETP), Berg Balance Scale (BBS), Timed Up-and-Go Test (TUGT), 6-Minute Walk Test (6MWT), and Instrumental Activities of Daily Living (IADL) scale, were conducted before and after the intervention.

RESULTS

Of the 58 patients, 51 (88%; TRG: n=24, 47%; IRG: n=27, 53%) completed the trial. After 4 weeks of intervention, the mean grip strength increased from 18.10 (SD 5.56) to 19.92 (SD 5.90) kg in the TRG (P=.02) and from 18.59 (SD 5.95) to 19.59 (SD 6.11) kg in the IRG (P=.01). The 30SACT and 30SSRT scores increased from 12.48 (SD 2.68) to 14.94 (SD 3.68) times (P=.01) and from 15.16 (SD 7.23) to 16.58 (SD 8.42) times (P=.045), respectively, in the TRG and from 12.25 (SD 4.19) to 14.68 (SD 4.36) times (P=.003) and from 14.31 (SD 4.04) to 16.25 (SD 4.91) times (P=.01), respectively, in the IRG. The quadriceps femoris EPT increased from 26.19 (SD 10.26) to 35.00 (SD 13.74) Nm (P=.004) in the TRG and from 26.95 (SD 11.81) to 32.74 (SD 12.33) Nm (P=.003) in the IRG. The BBS scores significantly improved in both groups (P<.001), with the mean TRG score increasing by 3.19 (SD 2.86) points and the mean IRG score by 3.06 (SD 2.44) points. Neither group exhibited significant within-group changes on the TUGT or the 6MWT. Both groups reported significant improvements in the IADL (TRG: P=.04; IRG: P=.02). Between-group comparisons revealed no significant differences in changes in all indicators.

CONCLUSIONS

A 4-week remote resistance training program is effective in improving strength, balance, and the IADL in older adults with sarcopenia, with effects comparable to rehabilitation supervised by a physical therapist. Telerehabilitation may be a convenient and effective alternative for older adults with sarcopenia who have limited access to rehabilitation resources.

TRIAL REGISTRATION

ChiCTR 2300071648; https://www.chictr.org.cn/showprojEN.html?proj=196313.

Dietary inflammatory index and disability among older adults in Guangzhou: a cross-sectional analysis

Objective

This study aims to evaluate factors linked to the degree of disability among older adults and explore the relationship between the dietary inflammatory index (DII) and the degree of disability among older adults in southern China.

Methods

Conducted in two districts of Guangzhou, China, this cross-sectional study included 262 older adults with mild-to-severe disabilities. Disability levels were assessed using the "Assessment Standard for Long-term Care Disability" from the Medical Insurance Bureau, including Activities of Daily Living (ADL), Cognitive Ability, and Sensory Perception and Communication Skills (SPCS). Dietary data were collected via Food Frequency Questionnaire (FFQ) and used to calculate the DII and intake of nutrients (e.g., Protein, Carbohydrate and Fat). A multivariable ordinal logistic regression model was employed to analyze the influence of various factors and the DII on the degree of disability among older adults. Restricted cubic spline and sensitivity analyses were used to assess the association between DII and the degree of disability of the older adult population.

Results

Inactivity (never exercising, OR = 8.48, 95% CI = 2.30-31.31) and reduced activity (formerly exercising, OR = 4.85, 95% CI = 1.39-16.96), stroke (OR = 2.78, 95% CI = 1.61-4.80), and dementia (OR = 2.69, 95% CI = 1.26-5.78) were significantly associated with increased disability. After adjusting for confounding factors, a higher DII was linked to a greater degree of disability, with the highest DII quartile showing a notably higher risk (OR = 2.61, 95% CI = 1.21-5.61) compared to the lowest quartile.

Conclusion

Lack of exercise, previous exercise, stroke, and dementia are correlated with increased disability among older adults. Additionally, a higher DII is associated with a more severe degree of disability.

A cross-sectional network analysis of successful aging in a resilience-based framework

Aging inevitably gives rise to many challenges and transitions that can greatly impact our (mental) well-being and quality of life if these are not controlled adequately. Hence, the key to successful aging may not be the absence of these stressors, but the ability to demonstrate resilience against them. The current study set out to explore how resilience and successful aging may intersect by investigating how various resilience capacity-promoting (protective) and resilience capacity-reducing (risk) factors relate to mental well-being and quality of life. Through a large-scale (N = 2000, age 55+, 30 factors) network analysis, we established the interplay between risk/protective factors from various domains, including demographics, (mental) health, (environmental) stress, lifestyle, coping/personality, and ageism. We revealed some unique pathways through which each of these factors contribute to individuals' mental well-being and/or quality of life, and interpreted these findings in terms of a resilience-based framework of successful aging. Our findings emphasize the complexity of factors that can impact quality of life and mental well-being in later life and can steer researchers and practitioners in devising efficacious, multi-pronged interventions that target risk and protective factors simultaneously, thereby maximizing their potential in boosting beneficial outcomes among older individuals.

Physical function and perceived pain following inpatient intensive interdisciplinary pain treatment for children and adolescents

BACKGROUND

Chronic pain among children and adolescents negatively impacts overall functioning and quality of life. Although Intensive Interdisciplinary Pain Treatment (IIPT) programs aim to reduce functional impairment and perceived pain, overall evidence is limited and restricted by small sample sizes and limited diversity in pain diagnoses.

OBJECTIVE

To determine whether children and adolescents with chronic pain participating in an inpatient IIPT program experience improvements in their physical function and perceived pain.

DESIGN

Cross-sectional, secondary analysis.

SETTING

Inpatient acute rehabilitation.

PARTICIPANTS

Children and adolescents with chronic pain (n = 258; females/males = 204/54; age = 16.5 ± 2.6) admitted to a 4-week inpatient IIPT program from November 2011 to January 2023.

INTERVENTION

Participants attended individual and group sessions involving physical therapy, occupational therapy, aquatic therapy, cognitive behavioral therapy, school-related tasks, and meditation. The sessions focused on improving strength, endurance, and function, while helping participants modify physical sensations, catastrophic thinking, and maladaptive behaviors.

MAIN OUTCOME MEASURES

Collected at admission and discharge: pain intensity (Numerical Pain Rating Scale; scale: 0-10), lower extremity function (Lower Extremity Functional Scale [LEFS]; scale: 0-80), upper extremity function (Upper Extremity Functional Index [UEFI]; scale: 0-80), motor proficiency (Bruininks-Oseretsky Test of Motor Proficiency, Second Edition short form [BOT-2 SF]; scale: 0-70), and occupational performance and satisfaction (Canadian Occupational Performance Measure [COPM]; scale: 0-10 for both).

RESULTS

Overall, participants reported significant improvements (p < .05) in median LEFS (median change [MC] = +30.5; 25th, 75th percentile range [PR] = 19, 42), UEFI (MC = +21; PR = 12.8, 31), BOT-2 SF (MC = +9; PR = 5, 15), COPM performance (MC = +4; PR = 2.8, 5.4), and COPM satisfaction (MC = +5.6; PR = 3.8, 7.2). Moreover, participants reported significant reduction (p < .05) in median pain intensity (MC = -3; PR = 1, 5). For a majority of participants, MC surpassed previously reported minimally clinical important difference thresholds.

CONCLUSIONS

Findings highlight the relevance of inpatient IIPT programs in enhancing physical function and reducing perceived pain in children and adolescents with chronic pain.

Inflammation mediates the association between muscle mass and accelerated phenotypic aging: results from the NHANES 2011-2018

Background

Muscle mass plays a pivotal role in health maintenance, yet its connection to biological aging remains underexplored. This study investigates the association between appendicular skeletal muscle mass index (ASMI) and phenotypic age(PhenoAge), while examining the mediating role of systemic inflammation.

Methods

The analysis included 7,440 participants from the NHANES 2011-2018. Phenotypic Age Acceleration (PhenoAgeAccel) was calculated as the residuals from regressing PhenoAge on chronological age. Multivariable linear regression analyses were performed to assess the association between ASMI and PhenoAgeAccel. Mediation analysis was conducted to quantify the extent to which systemic inflammation contributes to this association.

Results

Our analysis revealed that higher ASMI is linked to slower biological aging, as evidenced by lower PhenoAgeAccel (β = -0.48, 95% CI: -0.66 to -0.29, p = 0.0001). Systemic inflammation partially mediated this effect, with a mediation proportion of 35.1%. The association varied notably across demographic and health-related subgroups, being particularly significant in females, individuals with obesity, and those with lower physical activity.

Conclusion

These findings highlight the critical importance of muscle mass in slowing biological aging, with systemic inflammation emerging as a key biological mediator. The public health implications are substantial, suggesting that targeted interventions-such as resistance training, anti-inflammatory diets, and personalized medical approaches-could play a pivotal role in decelerating biological aging and improving long-term health outcomes.

Effect of Multimorbidity on Old-Age Disability Among Adults Over 50 Years Old: Evidence From a Meta-Analysis

This is a meta-analysis study to assess the relationship between multimorbidity and disability among older adults over 50 years old. Population-based studies, aged ≥ 50 years, assessing associations between multimorbidity (numbers and patterns) and disability in older adults, and reporting risk estimation with odds ratios (OR), were included. Homogeneity (I2), risk of bias, and publication bias were assessed. PROSPERO registration: 411007, and this meta-analysis was reported in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) recommendations. Twelve studies were included. For the older adults with 2 chronic conditions and ≥ 3 chronic conditions, the ORs of disability are 2.52 (95% CI 2.30-2.76) and 3.38 (95% CI 3.05-3.75), respectively. Among three multimorbidity patterns, the combination of cardiovascular and metabolic diseases pattern (OR 8.01, 95% CI 7.60-8.44) had the highest disability incidence rate. Chronic conditions in the multimorbidity patterns of combination of cardiovascular and metabolic diseases and mental health problems have an enhancement effect (1 + 1 > 2) on old-age disability impairment, whereas those in the multimorbidity pattern of musculoskeletal disorders have a dampening effect (1 + 1 < 2). The differentiated and specific early interventions should be developed based on the different multimorbidity patterns to prevent the old-age functional decline and disability in older adults.

The concurrent validity of a portable ultrasound probe for muscle thickness measurements

Ultrasound imaging is extensively used by both practitioners and researchers in assessing muscle thickness (MT); however, its use in the field is constrained by the transportability of stationary devices. New portable ultrasound probes pose as a cost-effective and transportable alternative for field-based assessments. This study evaluated the concurrent validity of a portable probe (Lumify) against a laboratory-based device (Vivid S5) in measuring MT. Eighteen participants (nine males and nine females) visited the laboratory and their MT measurements were collected using each device at five different sites (anterior and posterior arm, anterior and posterior thigh, and posterior lower leg). Bland-Altman plots (systematic and proportional bias, random error, and 95% limits of agreement), Pearson's product-moment correlation coefficient (r), and paired samples t-tests with Cohen's d effect sizes (ES) were used to assess the concurrent validity of the Lumify device. Systematic bias was low at all sites ( ≤ 0.11 cm) while proportional bias was detected only at the posterior lower leg (r2 = 0.217 [r = 0.466]). The difference in MT between devices was significant only at the anterior thigh (p < 0.05); however, ES for all sites were considered trivial (ES ≤ 0.131). Linear associations were found between the devices at each site of measurement (r ≥ 0.95). These results highlight that the Lumify probe can be used interchangeably with the Vivid S5 for MT measurements, providing practitioners and researchers with a more cost-effective and portable alternative for field-based assessments.

Impacts of osteosarcopenia on musculoskeletal health, risks of falls and fractures, and activities of daily living among population aged 50 and above: an age- and sex-matched cross-sectional analysis

AIMS

We conducted this study to investigate the impact of muscle loss on musculoskeletal health, fall and fracture risks, and activities of daily living (ADL) in elderly patients with osteoporosis.

MATERIALS AND METHODS

This age- and sex-matched cross-sectional study analyzed data from a medical center involving patients aged ≥ 50 from 2020 to 2022. The included participants were formed into three groups: 100 with osteoporosis only, 100 with osteosarcopenia, and 50 control individuals without osteoporosis and sarcopenia. We compared groups based on their baseline characteristics, bone and muscle health measurements, and the risks of falls and fractures using the STRATIFY scale and FRAX, respectively. Additionally, ADL was assessed using the Barthel Index. A multivariate analysis was performed to identify factors associated with declined ADL in osteosarcopenic patients.

RESULTS

The mean age was 76.17 years, and 82% were female. The osteosarcopenic group demonstrated poorer bone and muscle quality and quantity, with greater risks of major osteoporotic-related fractures, hip fractures, and falls, as well as significantly decreased ADL than other groups. When comparing sexes, females exhibited worse performance than males across groups. Slow gait speed and high STRATIFY score are independent predictors of declined ADL in osteosarcopenic patients.

CONCLUSION

Sarcopenia exacerbates osteoporotic patients, particularly women, worsening bone deterioration, increasing fall and fracture risks, and significantly impairing daily activities. Enhancing walking speed and reducing fall risk can boost independence in individuals with osteosarcopenia. Early detection, proper management, and preventive measures are essential for mitigating these adverse outcomes in high-risk individuals.