Exercise to Prevent and Manage Frailty and Fragility Fractures

The effectiveness of virtual reality exercise games on balance functions and fear of falling in women with osteoporosis

To investigate and compare the effectiveness of Nintendo Wii games and home exercises on balance functions in patients with osteoporosis, an important disease adversely affecting balance functions. The patients included in the study were randomized into two groups the Wii exercise group (n = 30) and the home exercise group (n = 30). Wii exercise group performed balance exercises with a Nintendo Wii device and balance board three times a week for 12 weeks under the supervision of a physiotherapist in the hospital, and home exercise group was prescribed home exercises three days a week for 12 weeks. Balance functions were evaluated with the timed up-and-go-test and Berg Balance Scale, and the fall risk was evaluated with the Falls Efficacy Scale at the beginning and end of 12 weeks of treatment. Comparison of pre- and post-treatment timed up-and-go-test, Berg Balance Scale, and Falls Efficacy Scale results in both groups revealed statistically significant improvements (p = 0.001; p < 0.05). Furthermore, post-treatment test scores between the two groups demonstrated a significant enhancement in Wii exercise group regarding the Berg Balance Scale score (Mean ± SD 52.9 ± 3.63) (p = 0.001; p < 0.05). Within the osteoporotic population, balance functions serve as robust predictors of fall risk. Improvement in balance functions is crucial for the prevention of falls and subsequent osteoporotic fractures. In our study, we found that balance exercises performed with Wii games are effective in improving balance functions in patients with osteoporosis.

Factors Associated with Frailty in Older Adults in Community and Nursing Home Settings: A Systematic Review with a Meta-Analysis

Background: Frailty is a globally recognized issue. However, there is a lack of evidence exploring factors associated with frailty among older residents in community and nursing-home settings. Methods: To explore the prevalence and factors associated with frailty among older adults in community and nursing-home settings, we conducted a systematic search following the PRISMA guidelines across Web of Science, MEDLINE, EMBASE, PubMed, and Cochrane databases up until January 2024, selecting 38 studies which encompassed 150,642 participants. Results: Our findings showed higher frailty prevalence in nursing homes compared to communities. Frailty was significantly associated with sociodemographic (living alone, poor self-reported health), physiological (poor sleep, low activity of daily living), behavioral (physical inactivity) and disease (chronic conditions, depression) factors in both community and nursing-home settings. Conclusions: There are numerous factors associated with frailty in older adults in nursing-home and community settings. These factors underscore the significance of promptly identifying high-risk individuals and devising appropriate interventions to mitigate frailty among them.

Epidemiology and Sex-Specific Analysis of Basketball-Related Lower Extremity Fractures: A 10-Year Analysis of National Injury Data

BACKGROUND

Basketball-related fractures involving the lower extremities frequently present to emergency departments (ED) in the United States (US). This study aimed to identify the primary mechanisms, distribution, and trends of these injuries.

HYPOTHESIS

We hypothesize that (1) lower extremity fracture frequency will decrease from 2013 to 2022, (2) the ankle will be the most common fracture site, and (3) noncontact twisting will be the most common injury mechanism.

STUDY DESIGN

Descriptive epidemiological.

LEVEL OF EVIDENCE

Level 3.

METHODS

The National Electronic Injury Surveillance System (NEISS) was queried for lower extremity fractures from basketball presenting to US EDs from January 1, 2013 to December 31, 2022. Patient demographics, injury location, and disposition were recorded. The injury mechanism was characterized using the provided narrative. National estimates (NEs) were calculated using the NEISS statistical sample weight. Injury trends were evaluated by linear regression.

RESULTS

There were 6259 cases (NE: 185,836) of basketball-related lower extremity fractures. Linear regression analysis of annual trends demonstrated a significant decrease in lower extremity fractures over the study period (2013-2022: P = 0.01; R2 = 0.64). The most common injury mechanism was a noncontact twisting motion (NE: 49,897, 26.9%) followed by jumping (NE: 39,613, 21.3%). The ankle was the most common fracture site (NE: 69,936, 37.6%) followed by the foot (NE: 49,229, 26.49%). While ankle and foot fractures decreased significantly (P < 0.05), fractures of the lower leg, knee, toe, and upper leg showed no significant trends (P = 0.09, 0.75, 0.07, and 0.85, respectively).

CONCLUSION

Basketball-related lower extremity fractures decreased from 2013 to 2022, with the ankle being the most common fracture site and most fractures arising from a noncontact twist. Increasing utilization of outpatient clinics may have contributed to the decline, particularly for ankle and foot fractures. The prevalence of ankle fractures and twisting-related injuries reinforces the importance of protective footwear and targeted strengthening protocols.

The Association of nutritional status and physical activity on osteoporotic refractures among older adults

BACKGROUND

This paper focuses on revealing the relationship between the Geriatric Nutritional Risk Index (GNRI) and Activity of Daily Living (ADL) with osteoporotic refracture.

METHODS

Data from 1068 inpatients with osteoporotic fractures were analyzed. Binary logistic regression, Cox proportional hazard regression and Kaplan-Meier curves were performed for osteoporosis characteristics and its risk factors. Receiver operating characteristic (ROC) curve was developed to predict the cut-off value.

RESULTS

The study showed that older age, lower ADL and lower GNRI were independent risk factors for osteoporotic fracture with OR of 1.039, 0.946, 0.892 and HR of 1.033, 0.967, 0.947 respectively. According to the results of ROC, the predictive accuracy of GNRI was high with an area under ROC (AUC) of 0.715, sensitivity of 76.6%, specificity of 53.5% and a threshold value of 99.65.

CONCLUSION

Older age, lower ADL and lower GNRI were independent risk factors for osteoporotic refracture.

The Effect of Group Training or Spinal Orthosis on Quality of Life and Potential Plasma Markers of Pain in Older Women With Osteoporosis. A Randomized Controlled Trial

Objective

Primary purpose was to examine the effects of exercise and use of a spinal orthosis on quality of life (QoL). Secondary, to explore the effects of above-mentioned interventions on plasma levels of potential markers of pain: substance P (SP), calcitonin gene-related peptide (CGRP), and interleukin-6 (IL-6).

Design

Randomized controlled trial.

Setting

Community-dwelling women in Stockholm.

Participants

A total of 113 women aged 60-93 years suffering from back pain and self-reported osteoporosis (n=113).

Interventions

The randomized controlled trial was 3-armed: participation in an equipment exercise group, treatment with an activating spinal orthosis or controls. The intervention time was 6 months.

Main Outcome Measures

QoL (QUALEFFO-41 and SF-36), plasma levels of SP, CGRP, and IL-6 measured at baseline and after 6 months in all 3 arms.

Results

No improvement of QoL was found. Comparing change in mobility (QUALEFFO-41), the effect in least squares means was lower in the spinal orthosis group compared with controls. In the exercise group, the role emotional score (SF-36) deteriorated during the intervention. Effect size varied between 0.02 and 0.6. There was no change in the levels of CGRP or SP, while IL-6 levels were lower at 6 months in the spinal orthosis group compared with the other groups. At least 1 previous vertebral fracture was verified by X-ray in 46 women.

Conclusion

The interventions showed none or negative effect on QoL, which was unexpected. The modest effect size may prompt a cautious interpretation. We found a lowering of IL-6 levels in the spinal orthosis group, but more studies are needed.

Rehabilitation Prognostic Factors following Hip Fractures Associated with Patient's Pre-Fracture Mobility and Functional Ability: A Prospective Observation Study

Low physical function is associated with poor outcomes in the elderly population suffering from hip fractures. The present study aims to evaluate the prognostic tools for predicting patient recovery after hip fractures and investigate the correlation between the pre-fracture motor and functional statuses. A prospective study was performed, including 80 patients suffering from hip fractures. Patient history, previous falls, the type of fracture and overall survival were evaluated. Patient-reported outcome measures (SF-36, EQ-5D/VAS, Charlson Comorbidity Index (CCI), Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) and Harris Hip Score (HHS)) were monitored before hospital discharge at 6 weeks, and 3, 6 and 12 months postoperatively. Overall, 55% of patients experienced at least one fall, and 46% of them used crutches before the fracture. The average CCI score was 6.9. The SPPB score improved from 1.4 ± 1.3 (1 week) to 4.4 ± 2.1 (48 weeks). A one-year age increase, female sex, and prior history of falls lead to 0.1-, 0.92-, 0.56-fold lower SPPB scores, respectively, at 12 months. The HHS recorded the greatest improvement between 6 and 12 weeks (52.1 ± 14.6), whereas the TUG score continued to improve significantly from 139.1 ± 52.6 s (6 weeks) to 66.4 ± 54 s (48 weeks). The SPPB and performance test can be routinely used as a prognostic tool.

Stepping On Fall Prevention Program Reduces Falls in Older Adults: An Observational Prospective Study

The purpose of the current study was to assess the impact of the Stepping On fall prevention program on the incidence of falls and frailty measures in older adults. Participants completed pre- and post-fall prevention program questionnaires and the Frail Scale Assessment at baseline and post-program. They also completed a follow-up questionnaire and Frail Scale Assessment at 6- and 12-month intervals post-program. Univariate analysis was performed comparing robust (n = 11), pre-frail (n = 29), and frail (n = 7) participants. Frail participants were significantly older (mean age = 77.7 years [SD = 4.9 years] vs. 74 years [SD = 5.9 years] vs. 70.4 [SD = 3.9], respectively; p = 0.026) and more likely to live alone (71.4% vs. 65.5% vs. 18.2%, respectively; p = 0.017) compared to pre-frail and robust participants. At 12-month post-program, reported falls and frailty scores decreased compared to baseline (12.8% vs. 29.8%, p = 0.044 and 0.91 [SD = 1.1] vs. 1.3 [SD = 1.082], respectively; p = 0.009). Data show that 41.4% of pre-frail participants at baseline improved to robust. Participation in Stepping On led to a decrease in reported falls and frailty scores 12 months post-program, suggesting that participation in the program may help delay frailty progression. [Journal of Gerontological Nursing, 49(8), 43-50.].

A Brief Narrative Review of the Underlying Mechanisms Whereby Omega-3 Fatty Acids May Influence Skeletal Muscle: From Cell Culture to Human Interventions

Skeletal muscle is essential for human locomotion as well as maintaining metabolic homeostasis. Age-related reduction in skeletal muscle mass, strength, and function (i.e., sarcopenia) is a result of pathophysiological processes that include inflammation, alteration of molecular signaling for muscle protein synthesis and degradation, changes in insulin sensitivity, as well as altered skeletal muscle satellite cell activity. Finding strategies to mitigate skeletal muscle loss with age is deemed paramount as the percentage of the population continues to shift towards having more older adults with sarcopenia. Recent research indicates omega-3 fatty acid supplementation can influence anabolic or catabolic pathways in skeletal muscle. Our brief review will provide a synopsis of some underlying mechanisms that may be attributed to omega-3 fatty acid supplementation's effects on skeletal muscle. We will approach this review by focusing on cell culture, animal (pre-clinical models), and human studies evaluating omega-3 fatty acid supplementation, with suggestions for future research. In older adults, omega-3 fatty acids may possess some potential to modify pathophysiological pathways associated with sarcopenia; however, it is highly likely that omega-3 fatty acids need to be combined with other anabolic interventions to effectively ameliorate sarcopenia.