Resistance exercise training at different loads in frail and healthy older adults: A randomised feasibility trial

Behavioural and psychological factors associated with pre-frailty in community-dwelling adults aged 40 and over: a cross-sectional study

Frailty and pre-frailty are major public health concerns. While frailty is typically associated with older adults, evidence suggests that pre-frailty commonly starts in middle-age. This study examined associations between behavioural and psychological correlates of pre-frailty and frailty in adults from 40 years to help identify at-risk individuals and inform interventions. Participants (N = 321, mean age = 56 (10.55), 83% female) completed questionnaires on frailty status, physical activity, co-morbidities, quality of life, loneliness, social isolation, and attitudes towards ageing. Participants were classified as non-frail (35%), pre-frail (60%), or frail (5%). One-way ANCOVAs, controlling for age, BMI, and co-morbidities, found that pre-frail participants reported feeling older than their chronological age (F = 2.37, p < .014, η2 = .398); and pre-frail and frail participants reported greater loneliness (F = 6.31, p = .022, η2 = .073) and negative attitudes toward ageing (F = 2.41, p = .004, η2 = .210) compared to non-frail participants. These findings indicate the need for targeted holistic interventions in middle age to prevent or delay frailty.

Exploring the Validity of Measures of Health-Related Quality of Life in Older Adults at Increased Risk of Falls and/or Fractures in Exercise Clinical Trials

Exercise targeting physical function and body composition may mitigate falls and fracture risk among older adults. This study aimed to identify the most valid instrument(s) to assess quality of life (QoL) in this context by comparing the psychometric properties of the EQ-5D-3L, EQ-5D-5L, CDC Healthy Days measure, Modified Falls Efficacy Scale (MFES), and Work Productivity and Activity Impairment Questionnaire. Data from four exercise trials (n = 210, mean age 64.8 ± 7.4, 79.0% female) were analyzed. Construct validity and responsiveness were compared. There was moderate to strong convergence between the EQ-5D (-3L and -5L) and MFES, and EQ-5D-3L and CDC index (correlation: 0.45-0.61). Only the EQ-5D-3L demonstrated good known-group validity (effect size: 0.98-3.7). Responsiveness was low across all instruments (standardized response mean: -0.33-0.49). The instruments are valid for assessing QoL in older adults at risk of falls and/or fractures. However, variation in their psychometric properties should be considered when selecting instruments for exercise trials.

Effects of High-Intensity Functional Training (HIFT) on the Functional Capacity, Frailty, and Physical Condition of Older Adults with Mild Cognitive Impairment: A Blind Randomized Controlled Clinical Trial

Physical exercise has been established as an intervention in the integral approach for the physical, functional, and social health of older adults. The objective of this study was to determine the effects of a high-intensity functional training (HIFT) program on the physical condition and functional capacity of an elderly Colombian population with mild cognitive impairment. This research corresponds to a blind randomized controlled clinical trial. A total of 169 men and women aged over 65 years were evaluated and distributed in two groups: the experimental group that received a 12-week HIFT intervention (n = 82) and the control group (n = 87) that received general recommendations on the benefits of physical exercise. The outcome variables included physical condition, assessed using the Senior Fitness battery (SNB); Fried's frailty phenotype was applied, and gait and balance were assessed using the Tinetti scale. For the functional variables, activities of daily living, instrumental activities of daily living, and advanced activities of daily living were evaluated. All variables were measured pre- and post-intervention. Statistically significant improvements were observed in the IG for gait stability and balance (p < 0.001), as well as for independence in activities of daily living (p = 0.003), and instrumental and advanced activities (p < 0.001). Likewise, greater functionality was found when assessed with the SNB (p < 0.001), except for upper limb strength. The frailty classification did not show changes post-intervention (p = 0.170) nor in the group x time interaction. MANCOVA analysis showed that regardless of gender, health level, age, BMI, cognition, and health level, the HIFT intervention produced better results in functional capacity, balance, and gait (F = 0.173, p < 0.001, Wilks' λ = 88.231).

Resistance training of peripheral muscles benefits respiratory parameters in older women with sarcopenia: Randomized controlled trial

PURPOSE OF THE RESEARCH

Ageing entails a decrease in muscle mass and strength, known as sarcopenia, which also affects respiratory function. Physical exercise is an appropriate intervention to treat both conditions. This study aims to assess the efficacy of high-intensity resistance training (HIRT) on clinical parameters of respiratory function and health-related quality of life (QoL) in community-dwelling older women with sarcopenia.

METHODS

Fifty-one sarcopenic community-dwelling women aged 70 years and older were randomized to either six months of HIRT (n = 24) or control (n = 27). At baseline and post-intervention, participants were assessed for skeletal-muscle sarcopenia; respiratory sarcopenia status; respiratory function: spirometry (FEV₁, FVC, FEV₁/FVC, and FEF_25-75) and expiratory (MEP) and inspiratory (MIP) respiratory muscle strength parameters; and health-related QoL (EURO-QOL 5D-3 L).

RESULTS

A group-by-time interaction effect for MEP (p = 0.044, Ƞ²=0.108) was observed. CG showed a significant decrease in FEV₁ (mean difference [MD] -0.12 L; 95% confidence interval [CI] -0.20, -0.05; p = 0.002); and FVC (MD -0.18 L; 95% CI -0.33, -0.03; p = 0.024) after six months, whereas the HIRT maintained respiratory function without change. Post-intervention, mean EQ-VAS increased in the HIRT and decreased in CG, resulting in a significant between-group difference (mean 73.0 standard deviation [SD] 16.99 vs 61.1 SD 18.2 points, respectively; p = 0.044). Respiratory sarcopenia status was reverted in the HIRT.

CONCLUSIONS

HIRT increased muscle strength and halted age-related respiratory function decline in sarcopenic old women. A strength intervention could benefit health-related QoL and physical well-being. REGISTERED IN CLINICALTRIALS.GOV: NCT03834558.

Improving muscle strength and physical function in older people living with sarcopenia and physical frailty: Not all exercise is created equal

Exercise is an increasingly widely used treatment for older people across a range of clinical conditions including sarcopenia and physical frailty. Whilst exercise can have many benefits for older people, adaptations to exercise are specific to the exercise mode that is performed and not all exercise is created equal. The correct type of exercise, at the correct dose, needs to be prescribed to maximise effectiveness in treating sarcopenia and physical frailty where maintaining or improving muscle strength and physical function represent key aims. Resistance exercise (RE) is the most potent approach to improving muscle strength and physical function and should be prioritised within exercise programmes delivered to this group. Resistance exercise programme design should be underpinned by the fundamental principles of exercise prescription in order to deliver an appropriate and individualised exercise dose to maximise the potential of RE as a treatment for older people living with sarcopenia and physical frailty.

Are there functional biomechanical differences in robotic arm-assisted bi-unicompartmental knee arthroplasty compared with conventional total knee arthroplasty? A prospective, randomized controlled trial

AIMS

The aim of this study was to compare any differences in the primary outcome (biphasic flexion knee moment during gait) of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) at one year post-surgery.

METHODS

A total of 76 patients (34 bi-UKA and 42 TKA patients) were analyzed in a prospective, single-centre, randomized controlled trial. Flat ground shod gait analysis was performed preoperatively and one year postoperatively. Knee flexion moment was calculated from motion capture markers and force plates. The same setup determined proprioception outcomes during a joint position sense test and one-leg standing. Surgery allocation, surgeon, and secondary outcomes were analyzed for prediction of the primary outcome from a binary regression model.

RESULTS

Both interventions were shown to be effective treatment options, with no significant differences shown between interventions for the primary outcome of this study (18/35 (51.4%) biphasic TKA patients vs 20/31 (64.5%) biphasic bi-UKA patients; p = 0.558). All outcomes were compared to an age-matched, healthy cohort that outperformed both groups, indicating residual deficits exists following surgery. Logistic regression analysis of primary outcome with secondary outcomes indicated that the most significant predictor of postoperative biphasic knee moments was preoperative knee moment profile and trochlear degradation (Outerbridge) (R² = 0.381; p = 0.002, p = 0.046). A separate regression of alignment against primary outcome indicated significant bi-UKA femoral and tibial axial alignment (R² = 0.352; p = 0.029), and TKA femoral sagittal alignment (R² = 0.252; p = 0.016). The bi-UKA group showed a significant increased ability in the proprioceptive joint position test, but no difference was found in more dynamic testing of proprioception.

CONCLUSION

Robotic arm-assisted bi-UKA demonstrated equivalence to TKA in achieving a biphasic gait pattern after surgery for osteoarthritis of the knee. Both treatments are successful at improving gait, but both leave the patients with a functional limitation that is not present in healthy age-matched controls. Cite this article: Bone Joint J 2022;103-B(4):433-443.