Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability

Flywheel resistance training: Functionality and strength in older women - A randomized controlled trial

BACKGROUND

Resistance training enhances functionality and strength in older populations, but the comparative effectiveness of traditional versus inertial flywheel modalities is under-researched. This study evaluates the effect of these modalities on functionality and strength in older women.

METHODS

In a parallel two-group randomized controlled trial, 36 sedentary older women (≥60 years) without psychiatric disorders or uncontrolled chronic diseases were randomly assigned to either the inertial flywheel group (n = 18) using a multi-leg isoinertial device, or the traditional resistance training group (n = 18) using gym machines and free weights. Conducted from May to December 2023 at the Federal University of Viçosa, both groups performed six generic exercises over eight weeks (two sessions per week). Functionality and muscle strength were assessed using the Short Physical Performance Battery and Timed Up and Go tests. Blinding was maintained using opaque envelopes managed by an external researcher.

RESULTS

One participant from the traditional group withdrew, requiring data imputation. Both groups showed significant improvements in functionality (Short Physical Performance Battery scores, p = 0.008; Timed Up and Go times, p = 0.025) and strength (isometric, dynamic, and explosive). No significant differences between groups were observed (p > 0.05), with small to moderate effect sizes (ηp2 = 0.01 to 0.06) and low statistical power (1-β < 0.80). Adverse events were minor (grade 1).

CONCLUSIONS

Both traditional and inertial flywheel resistance training significantly improved functionality and strength in older women over 16 sessions. Either training approach can enhance physical performance in this population.

Is serum 25-hydroxyvitamin D deficiency a risk factor for the incidence of slow gait speed in older individuals? Evidence from the English longitudinal study of ageing

AIMS

Cross-sectional studies demonstrate an association between low serum levels of vitamin D and slower gait speed in older individuals. However, longitudinal studies remain inconclusive. This study investigates whether vitamin D deficiency and insufficiency are risk factors for the incidence of slowness.

MATERIALS AND METHODS

A total of 2815 participants from the English Longitudinal Study of Ageing (ELSA), aged ≥60 years and with a baseline gait speed >0.8 m/s, were followed for six years. Baseline serum levels of vitamin D [25(OH)D] were categorized as "sufficiency" (>50 nmol/L), "insufficiency" (>30 and ≤50 nmol/L) or "deficiency" (≤30 nmol/L). Gait speed was reassessed at four and six years of follow-up to identify incident cases of slowness (walking speed ≤0.8 m/s). A Poisson regression model, adjusted for sociodemographic, behavioural and clinical characteristics at baseline, was conducted to determine the association between serum 25(OH)D levels and the risk of slowness.

RESULTS

The incidence densities of slowness per 1000 person-years were 67.4 (95% CI: 60.93-74.64) for sufficiency, 76.7 (95% CI: 68.30-86.22) for insufficiency and 90.7 (95% CI: 78.46-104.92) for deficiency. Serum 25(OH)D deficiency was associated with a 22% increase in the risk of slowness (IRR: 1.22; 95% CI: 1.01-1.49) compared with serum 25(OH)D sufficiency. No significant association was observed for serum 25(OH)D insufficiency.

CONCLUSIONS

Serum 25(OH)D deficiency is a risk factor for the incidence of slowness in older individuals, suggesting that maintaining sufficient 25(OH)D levels could be a strategic approach to minimise long-term mobility impairment.

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.

Multivariate Profiling of Physical Resilience in Older Adults After Total Knee Replacement Surgery: Results From a Prospective Observational Study

BACKGROUND

As individuals age, their ability to cope with and recover from health challenges becomes vital for maintaining independence and quality of life. This study aims to develop a multivariate phenotype of physical resilience based on individual recovery dynamics before and after a physical stressor.

METHODS

This prospective observational study included 104 individuals aged ≥60 who underwent elective total knee replacement (TKR) for degenerative joint disease between December 2, 2019 and January 4, 2023. A multivariate resilience phenotype was derived from physical function assessments over 12 months after TKR using the Short Physical Performance Battery, the Pittsburgh Fatigability Scale Physical Subscale, the Knee Injury and Osteoarthritis Outcome Quality of Life Score, and the 36-Item Short Form Health Survey Physical Component Score. Validation was performed using markers (ie, frailty and self-reported health) and determinants (eg, the Charlson Comorbidity Index (CCI)) of recovery potential.

RESULTS

Distinct resilience profiles were identified across the 4 measures, showing varied baseline levels and/or change rates over 12 months. By combining and analyzing resilience profiles across measures, 2 distinct groups emerged: 33.7% were classified as nonresilient and 66.4% as resilient. The nonresilient group had a higher prevalence of frailty (37.1% vs 10.1%, p < .01), poor or fair self-reported health (48.6% vs 5.8%, p < .01), and moderate or severe comorbidity burden (CCI > 2; 28.6% vs 10.1%, p = .03).

CONCLUSIONS

Recovery trajectories after TKR revealed varying resilience levels that could not be fully explained by baseline health status. Understanding individual resilience can enhance patient care by promoting recovery and overall well-being.

Iron Metabolism and Muscle Aging: Where Ferritinophagy Meets Mitochondrial Quality Control

In older adults with reduced physical performance, an increase in the labile iron pool within skeletal muscle is observed. This accumulation is associated with an altered expression of mitochondrial quality control (MQC) markers and increased mitochondrial DNA damage, supporting the hypothesis that impaired MQC contributes to muscle dysfunction during aging. The autophagy-lysosome system plays a critical role in MQC by tagging and engulfing proteins and organelles for degradation in lysosomes. The endolysosomal system is also instrumental in transferrin recycling, which, in turn, regulates cellular iron uptake. In the neuromuscular system, the autophagy-lysosome system supports the structural integrity of neuromuscular junctions, and its dysfunction contributes to muscle atrophy. While MQC was thought to protect against iron-induced cell death, the discovery of ferroptosis, a form of iron-dependent cell death, has highlighted a complex interplay between MQC and iron-inflicted damage. Ferritinophagy, the autophagic degradation of ferritin, if overactivated, can induce ferroptosis. Alternatively, aging may impair ferritinophagy, leading to ferritin accumulation and the release of toxic labile iron under stress, exacerbating oxidative damage and cellular senescence. Physical activity supports muscle health also by preserving mitochondrial quantity and quality and enhancing bioenergetics. However, therapeutic strategies for preventing or reversing physical function decline in aging are still lacking due to the insufficient understanding of the underlying mechanisms. Unveiling how disruptions in iron homeostasis impact muscle quality in older adults may allow for the development of therapeutic strategies targeting iron handling to alleviate age-associated muscle decline.

Indicators of Functional Disability by Receipt of Disability Benefits Among Individuals With Systemic Lupus Erythematosus

OBJECTIVE

We estimated the prevalence of potential functional disability among those with systemic lupus erythematosus (SLE), by receipt of disability benefits.

METHODS

Participants (N = 443, mean age 46.2 years, 91.7% women, 82.6% Black) were recruited from a population-based SLE cohort. Indicators of potential disability included functioning impairments (Short Physical Performance Battery score ≤ 10; age-corrected National Institutes of Health Toolbox Cognition Battery composite score for fluid cognition < 77.5 [1.5 SD below the mean]); activity limitations (physical functioning T-scores < 35 [1.5 SD below the mean]); at least some difficulty performing ≥ 1 of the instrumental activities of daily living (IADLs) or basic activities of daily living (BADLs); and participation restrictions (any vs no reported effect of health on ability to work; restricted community mobility). We performed multivariable logistic regression models predicting potential disability indicators by self-reported receipt of disability benefits and then obtained adjusted prevalence estimates using postestimation margins.

RESULTS

Those who reported receiving disability benefits (45.6%) vs not (54.4%) were more likely to have impairments in functioning (physical performance [71.3% vs 50%, P < 0.001]; fluid cognition [35.4% vs 19.2%, P = 0.01]), limitations in activities (self-reported physical limitations [26.7% vs 7.5%, P < 0.001]; IADLs [73.1% vs 42.9%, P < 0.001]; BADLs [60.6% vs 30.8%, P < 0.001]), and restrictions in participation (work [77.8% vs 60.6%, P = 0.09]; community mobility [43.1% vs 22%, P < 0.001]). These associations were not changed with adjustment for personal and SLE factors.

CONCLUSION

Receipt of disability benefits may be an incomplete marker of functioning. A substantial proportion of those not receiving benefits have impairments, limitations, and restrictions that should be addressed.

Clinical Tools to Diagnose Frailty in Women With Geriatric Urinary Incontinence

IMPORTANCE

Establishing an efficient and accurate frailty measure in older women with bothersome urinary incontinence (UI) is necessary because frailty increases the risk of UI treatment failure and postoperative morbidity.

OBJECTIVE

This study aimed to primarily observe associations between the clinical frailty measure of gait speed and the electronic frailty index (eFI) to determine if the eFI may be a proxy in determining presence of frailty in older women with moderate-to-severe UI symptoms.

STUDY DESIGN

This was a secondary data analysis of a prospective cohort study of women, older than 70 years, seeking treatment for UI between 2016 and 2023. Participants underwent functional geriatric assessment to determine 4-m gait speed, chair stand pace, and UI symptom assessment. Participants with ≥2 UI episodes per day defined severe UI symptoms present with geriatric UI. Those with <2 UI episodes per day defined controls. Univariate analyses compared clinical and functional characteristics based on UI severity. Spearman rank correlated the association between the eFI, UI severity, and functional geriatric impairments. Logistic regression analyses determined the odds of having severe UI based on eFI frailty risk, adjusted for age and body mass index (BMI).

RESULTS

Eighty-one participants were included. The eFI was negatively correlated with gait speed ([r] = -0.29, P = 0.02) and did not correlate with chair stand pace. The eFI did not correlate with UI severity ([r] = 0.05, P = 0.74). The odds of having severe UI and at least mild frailty risk based on the eFI was OR of 1.15 (95% CI, 0.71-1.88]).

CONCLUSION

The eFI may have limited clinical utility in frailty risk assessment in women with geriatric UI.

Reliability and validity of a full-body function Get-Up test in older adults

Identifying deficiencies in physical function in older adults is critical to evaluate important health outcomes like sarcopenia, but current protocols are expensive and require complex equipment. This study evaluates the reliability and validity of an inexpensive, simple new Get-Up test in older adults. It involves participants moving quickly from standing upright, to lying flat, then rising to a standing position unassisted. A total of 293 relatively healthy older adults without severe health conditions (e.g., cardiovascular, psychological, degenerative, or physical impairments) completed the Get-Up test twice for familiarization and twice for timed trials on two separate days alongside numerous validated clinical tests commonly used to assess strength, function, and fitness in older adults. ANOVA with post-hoc analysis and intraclass correlation (0.928 (95% CI [0.914, 0.940])) indicated strong reliability, with the second timed trial comparable to trials on a separate day. The Get-Up test was significantly (p <.0001) negatively correlated with all referenced measures of strength (Biodex peak torque, r = -.41, 1-repetition maximum, r = -.26, handgrip, r = -.38) and function (Short Physical Performance Battery, r = -.49, gait speed, r = -.39) and significantly (p <.0001) positively correlated with fitness (400-m walk, r =.70), which strongly predicted Get-Up test performance, suggesting good validity. Poor performance was associated with baseline sarcopenia prevalence (bottom tertile vs. top tertile: odds ratio 3.99 (95% CI 1.64-9.67)) and sarcopenia incidence after 1-year follow-up (hazard ratio 3.47 (1.10, 10.98)), suggesting potential to evaluate sarcopenia. This simple and safe Get-Up test requires minimal equipment, personnel, and expertise, yet it has good reliability and validity as a potential novel tool for full-body physical function in older adults that is associated with sarcopenia prevalence and incidence.

Interprofessional homebased reablement intervention for older adults in Sweden: a randomized controlled trial

BACKGROUND

Reablement has a health promotive perspective. The goal is to enhance or maintain health and functional ability and, thereby, the ability of older adults to live in their own homes. The intervention described in this study was introduced so the older person would remain at home and be given the opportunity to regain or maintain functional ability physically, mentally, and socially to live independently and have optimal health and well-being. This paper aims to report the measured effects of reablement among the older adults in terms of bio-psycho-social health that emerged in the randomized controlled trial (RCT).

METHODS

A sample of older adults (65+) was studied, consisting of those who applied for homecare in the municipal home service (n = 237), those who received intensive home reablement (IHR) carried out by an interprofessional team, and a control group who received home-based care as usual. Data were collected at three different occasions with validated instruments: at inclusion, after completion of IHR, and 3 months after completed intervention.

RESULTS

Both groups improved significantly at the post-measurement, and this improvement was maintained at the 3-month follow-up regarding: global quality of life (HACT); general health (EQ-5D-5 L); the self-estimates for mobility, hygiene, daily activities, pain/discomfort, anxiety/depression (EQ-5D-5 L); subjective well-being (GP-CORE); self-assessed capacity to perform physical activities as well as satisfaction with performance (COPM); measures of physical activity capacity regarding lower extremities (SPPB); upper extremities (hand dynamometer test). No between group differences were statistically significant. At the 3-month follow-up, the average number of homecare hours was slightly lower in the group that underwent IHR than in the group receiving usual homecare and rehabilitation interventions, but the difference was not statistically certain.

CONCLUSIONS

In this RCT with a relatively short follow-up period, IHR was equivalent to traditional homecare regarding older people's self-reported health, physical activity ability and number of homecare hours.

TRIAL REGISTRATION

ClinicalTrials.gov (https://clinicaltrials.gov/study/NCT03565614?intr=Reablement&rank=4) Registration number: NCT03565614. Registered on 1 January 2016.

Restoring the complexity of walking in the elderly and its impact on clinical measures around the risk of falls

Introduction: The hypothesis of the loss of complexity with aging and disease has received strong attention. Especially, the decrease of complexity of stride interval series in older people, during walking, was shown to correlate with falling propensity. However, recent experiments showed that a restoration of walking complexity in older people could occur through the prolonged experience of synchronized walking with a younger companion. This result was interpreted as the consequence of a complexity matching effect. Experiment: The aim of the present study was to analyze the link between the restoration of walking complexity in older people and clinical measures usually used in the context of rehabilitation or follow-up of older people. Results: We evidenced a link between restoring complexity, improving overall health and reducing fear of falling. In addition, we showed that 3 weeks of complexity matching training can have a positive effect on complexity up to 2 months post-protocol. Finally, we showed that the restoration of walking complexity obtained in the previous works is not guide-dependent.

White matter integrity and motor function: a link between cerebral myelination and longitudinal changes in gait speed in aging

Gait speed is a robust health biomarker in older adults, correlating with the risk of physical and cognitive impairments, including dementia. Myelination plays a crucial role in neurotransmission and consequently affects various functions, yet the connection between myelination and motor functions such as gait speed is not well understood. Understanding this link could offer insights into diagnosing and treating neurodegenerative diseases that impair mobility. This study analyzed 437 longitudinal observations from 138 cognitively unimpaired adults, aged 22 to 94 years, to investigate the relationship between myelin content and changes in gait speed over an average of 6.42 years. Myelin content was quantified using a novel multicomponent magnetic resonance relaxometry method, and both usual and rapid gait speeds (UGS, RGS) were measured following standard protocols. Adjusting for covariates, we found a significant fixed effect of myelin content on UGS and RGS. Longitudinally, lower myelin content was linked to a greater decline in UGS, particularly in brain regions associated with motor planning. These results suggest that changes in UGS may serve as a reliable marker of neurodegeneration, particularly in cognitively unimpaired adults. Interestingly, the relationship between myelin content and changes in RGS was only observed in a limited number of brain regions, although the reason for such local susceptibility remains unknown. These findings enhance our understanding of the critical role of myelination in gait performance in unimpaired adults and provide evidence of the interconnection between myelin content and motor function impairment.

Physical activity complexity, cognition, and risk of cognitive impairment and dementia in the Baltimore Longitudinal Study of Aging

INTRODUCTION

Studies on physical activity (PA) and dementia mainly focus on activity quantity or intensity. Yet PA requires neuro-coordination of movement, and it is unclear whether complexity of daily activity varies by cognitive status. Thus, we examined the association between PA complexity, using multiscale entropy, and cognitive function, mild cognitive impairment (MCI), and dementia in older adults in the Baltimore Longitudinal Study of Aging (BLSA).

METHODS

A total of 637 older adults (age 73.9 ± 11.3 years) in the BLSA completed a 7-day wrist-worn accelerometer assessment and neuropsychological tests from 2015 to 2020. Using logistic regression and structural equation modeling, we examined cross-sectional associations of PA complexity with MCI/dementia and cognition. Cross-lagged panel models (CLPMs) were used to assess bidirectional associations at baseline and 2-year follow-up. Multivariable models were adjusted for age, sex, race, education years, body mass index, and comorbidities.

RESULTS

Participants in the lowest tertile of PA complexity had over double the odds of MCI/dementia (odds ratio = 2.63, 95% confidence interval [CI]: 1.02 to 6.79, p = 0.045) compared to those in the highest tertile in the fully adjusted model. Structural equation modeling showed that PA complexity was associated with global cognitive function (standardized B [SB] = 0.102, 95% CI: 0.033 to 0.171, p = 0.004), executive function (SB = 0.119, 95% CI: 0.049 to 0.189, p = 0.001), and visuospatial ability (SB = 0.096, 95% CI: 0.026 to 0.167, p = 0.008). CLPMs showed bidirectional associations between lower PA complexity and poorer executive function.

DISCUSSION

Lower complexity of accelerometry-detected movement is associated with poorer cognition and higher risk of MCI/dementia. Future studies should explore whether low PA complexity is an early indicator of dementia.

Highlights

Prior studies mainly focused on quantity or intensity of physical activity.Poorer cognitive function was associated with lower complexity of daily activity.Lower complexity of physical activity may be an early indicator of dementia.

Body Composition Assessment Provides Prognostic Information in Patients With Cancer Affected by Chronic Graft vs. Host Disease

BACKGROUND

Additional tools are needed to assess mortality risk among patients with cancer. Patients with chronic graft vs. host disease (cGVHD) after allogeneic haematopoietic cell transplantation (HCT) represent a high-risk cancer population with mortality risk explained by cGVHD severity, but also informed by baseline comorbidities, functional status before and after HCT, and cumulative toxicity from the procedure and its complications. Radiographic body composition metrics from CT scans have previously shown association with complications in other populations.

METHODS

We examined a single-centre consecutive series (2005-2016) of HCT recipients with cGVHD and CT-scans immediately proximal to cGVHD diagnosis to investigate association of radiographic body composition measures and mortality. Skeletal muscle index (SMI) and fat index (FI) were quantified on CT imaging at the 3rd lumbar (L3) and 4th thoracic (T4) vertebra. SM Hounsfield units (HU) were obtained to evaluate SM density. Cut points for SMI were from literature and cut points for FI were established by sex-specific optimal stratification.

RESULTS

A total of n = 113 patients met the inclusion criteria for this analysis, aged 51.2 ± 10.5(SD) years and predominantly male (n = 71, 63%) and diagnosed with NHL (n = 110, 97%). Onset cGVHD NIH overall severity was mild in N = 56 (49%), moderate in 44 (38%) and severe in 15 (13%), with median time to cGVHD onset after HCT of 173 days [IQR 122;295]. A CT scan at 77 days [IQR 33;202] post HCT was selected for analysis. In multivariate analysis, CT-defined body fat ≥ 35% was independently associated with increased mortality (HR 2.094 (95% CI 1.060, 4.136), p = 0.033) overall. Patients of male sex had higher FI than females and showed a more prominent association between high FI and mortality. SMI as well as other indices of adiposity were not associated with survival in multivariable analysis including BMI, sarcopenic obesity and low skeletal muscle radiodensity. In exploratory analyses, we demonstrated similar results per CT chest at T4, suggesting possible future application to a larger HCT population.

CONCLUSIONS

These data support that radiographic body composition measures provide prognostic information among patients with cancer affected by cGVHD post-HCT and suggest that high body fat % is a promising candidate for future study. These findings suggest that low skeletal muscle mass alone does not predict for poor outcomes in HCT patients with cGVHD as previously described in other cancers. Independent validation of this work is needed, including further studies based on CT chest to enhance application to a larger HCT population.

Body mass index and trajectories of muscle strength and physical function over time in Mexican American older adults: Sex differences

BACKGROUND AND AIMS

Worldwide, the prevalence of overweight and obesity has increased. We examined sex-specific patterns in the relationship of body mass index (BMI) with muscle strength and physical function among older Mexican Americans over time.

METHODS AND RESULTS

Participants (N = 1975) aged ≥65 years (mean = 72.4) were from a longitudinal study of Mexican American older adults (1993/94-2016). Measures collected at each interview included socio-demographics and health status; BMI (independent variable); short physical performance battery (SPPB) and handgrip strength (HGS) (outcomes). Participants were grouped into underweight (<18.5 kg/m2); normal weight (18.5-24.9 kg/m2); overweight (25-29.9 kg/m2); class I obesity (30-34.9 kg/m2); and class II/morbid obesity (≥35 kg/m2). Changes in SPPB and HGS by BMI and sex over time were estimated using general linear mixed models. Males deemed overweight (β = 0.46; Standard Error [SE] = 0.11; p-value = 0.0001), class I obesity (β = 0.43; SE = 0.15; p-value = 0.0037), and class II/morbid obesity (β = 0.66; SE = 0.29; p-value = 0.0246) scored higher in SPPB than those with normal weight. Females deemed overweight (β = 0.49; SE = 0.10; p-value = 0.0001) and class I obesity (β = 0.32; SE = 0.11; p-value = 0.0047) scored higher on the SPPB than those with normal weight. Males and females deemed overweight (β = 0.56; SE = 0.29; p-value = 0.0535 and β = 0.65; SE = 0.18; p-value = 0.0003, respectively) and class I obesity (β = 1.08; SE = 0.39; p-value = 0.0062 and β = 0.92; SE = 0.22; p-value = 0.0001, respectively) scored higher in HGS than those with normal weight.

CONCLUSION

We found no sex differences in the trajectories of decline for HGS and physical function. Females and males classed as overweight or class I obesity experienced slower decline in HGS and physical function.

Stress tests and biomarkers of resilience: Proceedings of the second state of resilience science conference

The "Stress Tests and Biomarkers of Resilience" conference, hosted by the American Geriatrics Society and the National Institute on Aging, marks the second in a series aimed at advancing the field of resilience science. Held on March 4-5, 2024, in Bethesda, Maryland, this conference built upon the foundational work from the first conference, which focused on defining resilience across various domains-physical, cognitive, and psychosocial. This year's gathering centered around three factors: the biology that underlies resilient outcomes; the social, environmental, genetic, and psychosocial factors that impact that resilience biology; and the biomarker testing and imaging that predicts resilient outcomes for older adults. The presentations and discussions around these topics were underscored by considerations around the many impacts of social determinants of health on resiliency interventions, and by advances in the modern training and research methodologies that influence data collection and experiment design.

Association of objective and subjective socioeconomic status with intrinsic capacity deficits among community-dwelling middle-aged and older adults in China: A cross-sectional study

BACKGROUND

Intrinsic capacity (IC), representing an individual's full range of physical and mental abilities, is influenced by objective socioeconomic status (SES); however, the impact of subjective SES remains unclear.

OBJECTIVES

This study aims to assess IC and investigate the relationship between SES and IC deficits, with a particular focus on the role of subjective SES.

DESIGN

Cross-sectional study SETTING: 45 communities in two provinces in China PARTICIPANTS: Community-dwelling middle-aged and older adults aged 50 and above MEASUREMENTS: IC was assessed following the Integrated Care for Older People guideline. SES was measured through objective SES (education and occupation) and subjective SES (measured by MacArthur Scale). Ordinal logistic regression models were performed to estimate the association between SES and IC.

RESULTS

Among 3,058 participants (61.3 ± 8.05 years, 54.8 % women), 2,333 (76.3 %) showed deficits in at least one IC subdomain, particularly sensory (63.5 %), vitality (25.8 %) and cognition (18.4 %). A dose-response association was observed between SES and IC deficits. Individuals with high subjective SES (OR: 0.72, 0.60-0.87), high education (OR: 0.54, 0.38-0.75), and high occupation (OR: 0.64 0.50-0.81) exhibited lower IC deficits risk compared with counterparts. Individuals with high education and middle subjective SES or high occupation and middle subjective SES had 67 % (OR: 0.33, 0.18-0.60) and 49 % (OR: 0.51, 0.35-0.74) lower risk than those with low SES.

CONCLUSIONS

These findings suggest that individuals with low SES may be more vulnerable to IC deficits. Addressing social inequalities in the early assessment of IC is crucial for reducing health disparities and promoting healthy ageing.

Cross-sectional assessment of the Tinetti performance-oriented mobility tool for screening physical frailty syndrome in older adults

BACKGROUND

Physical-functional fitness (PFF) assessments have become crucial tools for identifying physical frailty syndrome (PFS) in older adults, helping guide preventive and interventional strategies.

PURPOSE

This study aimed to evaluate the predictive value of performance-based PFF tests for detecting PFS among community-dwelling older adults in Tehran, Iran. Additionally, it sought to compare PFF variables between PFS groups to assess the applicability of these tests as practical screening tools in clinical and community settings.

METHODS

Data were collected from 161 participants (91 males, 56.5%; 70 females, 43.5%), including sociodemographic, anthropometric, medical history, PFF, and PFS assessments.

RESULTS

Frail participants exhibited significantly lower scores in various PFF tests, including the Tinetti balance, walking, and total score components, physical activity levels (PAL), mean hand grip strength (MGS), 30-s arm curl (30 s-AC), 30 s-chair stand (30 s-CS), Standing Stork Balance (SSB), and back stretch (BST) tests (p < 0.001). Frail individuals also had lower levels of education, shorter stature, and higher BMI compared to non-frail/pre-frail participants, highlighting broader vulnerabilities. Logistic regression analyses showed that all PFF tests, including Tinetti balance and walking components, MGS, 30 s-AC, 30 s-CS, were significant protective factors against FS. However, ROC curve analysis revealed optimal cutoff points for PFS identification, with PAL and MGS demonstrating the highest sensitivity and specificity for predicting PFS. The all components of Tinetti scale also proved to be strong predictors of FS.

CONCLUSION

Our findings demonstrate that, regardless of age, sex, education level, stature, and fall incidence, PFF assessments remain critical for identifying older adults at risk for PFS. The study highlights the predictive strength of key variables, such as PAL, MGS, and the Tinetti-POMA components, offering novel insights into the role of these tests in improving PFS screening accuracy. These results underscore the importance of integrating PFF assessments into routine clinical and community-based health evaluations, enabling early detection and timely interventions to promote healthier aging trajectories.

Low gait speed is better than frailty and sarcopenia at identifying the risk of disability in older adults

OBJECTIVE

To compare frailty, sarcopenia and their respective components to determine which is more effective in identifying the risk of disability in basic and instrumental activities of daily living (BADL and IADL, respectively).

METHODS

A longitudinal study involving 3,637 individuals without disabilities concerning BADL and 3,696 individuals without disabilities regarding IADL at baseline. Frailty was defined using the phenotype. Sarcopenia was determined according to the criteria proposed by the EWGSOP2: low strength (grip strength <27 kg for men and <16 kg for women), low skeletal muscle mass index (<9.36 kg/m2 for men and <6.73 kg/m2 for women) and low physical performance (gait speed ≤0.8 m/s). In addition to the complete constructs, each component was assessed. Poisson mixed models were utilised, with the outcome identified as incident cases of disability over 8 years, adjusted for covariates. Results: Pre-frailty was associated with a 17% and 18% annual increase in the risk of disability for BADL and IADL, respectively. These figures were 27% and 28% for individuals classified as frail. Sarcopenia was not associated with an increased risk of disability. Amongst the components of frailty and sarcopenia, low physical performance, assessed by gait speed ≤0.8 m/s, was the most effective for identifying the risk of disability (12% per year for BADL and 14% per year for IADL).

CONCLUSION

In clinical practice, low physical performance (gait speed ≤0.8 m/s) may be the preferred tool for screening the risk of functional decline in older adults.

Patient physical condition and functional sequelae following hospitalization with COVID-19: A cross-sectional observational study

After hospitalization caused by COVID-19, a high prevalence of physical deterioration has been observed, hence the importance of having tests to evaluate the functional status of patients and to be able to perform a partition and subsequent referral to the physiotherapy service. This cross-sectional observational study describes the physical status according to the short physical performance battery (SPPB) of patients admitted to the hospital setting for COVID-19 and to identify variables potentially related to this outcome. Thirty-six patients admitted to the hospital setting for COVID-19 in the first wave living in the community. Patients were evaluated with the SPPB, strength test, the International Physical Activity Questionnaire, the 1-minute sit-to stand, spirometry, the Barthel index, the Hospital Anxiety and Depression Scale, and other patient-related data were collected. We performed bivariate and regression analyses. A linear regression was fitted, having SPPB as a dependent variable to ascertain the impact of intensive care unit (ICU) admission on physical performance. Five variables were related to SPPB. There was a significant relationship between admission to the ICU and having a heart disease (P = .015), the level of physical activity (P = .049), number of years smoking (P = .029) and days of hospitalization (P = .005). A total of 22.22% of analyzed patients suffered frailty. SPPB is related to altered respiratory pattern, quadriceps strength, 1-minute sit-to-stand and FEV1, Barthel score, days of hospitalization and FEV/FVC ratio. Lack of association between ICU stay, age or sex with SPPB results differs from the results of other studies.

Physical exercise for primary sarcopenia: an expert opinion

Sarcopenia is the age-related loss of skeletal muscle mass and function. Recently, research has focused on defining diagnostic criteria for this condition, now recognized as a muscle disease with a specific identifying code (ICD-10: M62.84). The diagnostic process for sarcopenia involves several stages, including the use of dedicated questionnaires and objective measurements of muscle strength and mass. According to international guidelines, therapeutic exercise is recommended to improve muscle mass, muscle strength, and physical performance. However, much of the supporting evidence comes from studies on non-sarcopenic elderly patients. Among types of therapeutic exercise, guidelines mainly emphasize muscle strengthening. The prescription of therapeutic exercise must consider the clinical and functional conditions of the patient (e.g., the presence of severe sarcopenia) and patient preferences. Muscle strengthening should target large muscle groups and include low-intensity resistance exercise for strength improvement, or high-intensity resistance exercise for additional benefits in muscle mass and function. Evidence suggests that an ideal therapeutic exercise program for sarcopenic patients should be multimodal, incorporating muscle strengthening, aerobic exercise, and balance control programs. This approach could enhance patient adherence by offering variety. Although multimodal therapeutic exercise improves muscle mass and function, these benefits can be lost during prolonged physical inactivity. Therefore, the exercise prescription must define intensity, volume (repetitions and sets), frequency, rest intervals, and duration, tailored to the type of exercise. Aerobic training programs improve endurance and optimize mitochondrial function. Balance training, important for reducing the risk of falls, should be done at least three times a week. Muscle strengthening should be done at least two days a week, starting at 50%-60% of 1 repetition maximum (RM) and progressing to 60%-80% of 1 RM, with approximately 10 exercises per session. Adopting comprehensive prescription protocols, such as those proposed in this paper, can significantly aid in the functional recovery and well-being of patients with sarcopenia.

Early Evaluation of the Short Physical Performance Battery in Hospitalized Patients with Chronic Kidney Disease Predicts Long-Term Hospitalization

BACKGROUND

The relationship between hospitalization duration and physical function in patients with chronic kidney disease (CKD) has not been thoroughly investigated. This study aimed to determine whether assessment of physical function one week after hospitalization can predict the length of stay in patients with CKD.

METHODS

A retrospective study was conducted on hospitalized patients with CKD who underwent rehabilitation between March 2019 and March 2020. Physical function was evaluated using the Short Physical Performance Battery (SPPB), grip strength, and Barthel Index and analyzed alongside clinical data.

RESULTS

The mean age of the participants was 73.4 ± 11.9 years, with 92% having stage G4 or G5 CKD. Multivariate analysis revealed that the SPPB (β = -0.33, p < 0.01) at one week after admission was significantly associated with the length of hospital stay (R2 = 0.11, p < 0.02). Notably, in the subgroup of patients who were transferred to other facilities, the SPPB alone showed a strong association with the length of stay (β = -0.66, p < 0.03, R2 = 0.23, p < 0.05).

CONCLUSIONS

The SPPB score in the early stages of hospitalization for patients with CKD was found to be a significant predictor of the length of stay, even after considering the eGFR and the Charlson Comorbidity Index. These findings may contribute to optimizing inpatient management and rehabilitation strategies for patients with CKD.

Effect of a Multicomponent Exercise Program with Virtual Reality (MEP-VR) versus standard approaches on functional and cognitive domains in hospitalised geriatric patients: Study protocol for a randomized controlled trial

BACKGROUND

Conventional care models for older adults often disregard negative effects of hospitalization and neglect potential benefits of technology. This trial aims to investigate effects of Multicomponent Exercise Program with Virtual Reality (MEP-VR) on functional and cognitive outcomes in hospitalized older adults, compared to MEP-only or usual care approaches.

METHODS

This three-arm, parallel-group, randomized controlled trial will include 255 participants aged 75 or older, with a Barthel Index score of at least 60, able to walk and cooperate, have an estimated hospital stay of at least four days, and provide informed consent. Patients with severe dementia, terminal illness, or clinical instability will be excluded. Participants will be randomly assigned to a control group or one of two intervention groups. The intervention groups will receive either MEP-VR or MEP-only program, consisting of supervised aerobic exercise, resistance training, and balance training, with or without a virtual reality component. The intervention will occur over four consecutive days, each session lasting 30-40min. The primary outcome measure will be functional changes at discharge. Cognition, mood, quality of life, and immersive virtual reality (IVR) usability will also be assessed.

DISCUSSION

Technological advances are rapidly increasing with population aging, creating potential benefits for integrating technology into older adult care. This study will evaluate the implementation of IVR combined with MEP. If our hypothesis proves accurate, it will pave the way for modifying the hospitalization system, helping to reduce the critical healthcare burden resulting from hospital-acquired disability in the older population.

TRIAL REGISTRATION

This study was approved by the Navarra Clinical Research Ethics Committee on June 14th, 2021 (PI_2021_90). The trial was retrospectively registered at ClinicalTrials.gov, registration number NCT06469554.

The Association of Physical Function and Physical Performance With DNA Methylation Clocks in Oldest-Old Living in Singapore-The SG90 Cohort

Deoxyribonucleic acid (DNA) methylation (DNAm) clocks estimate biological age according to DNA methylation. This study investigated the associations between measures of physical function and physical performance and 10 DNAm clocks in the oldest-old in Singapore. The SG90 cohort included a subset of community-dwelling oldest-old from the Singapore Chinese Health Study (SCHS) and Singapore Longitudinal Ageing Study (SLAS). Physical function and performance were assessed using Basic Activities of Daily Living (BADL), Instrumental Activities of Daily Living (IADL), World Health Organization Disability Assessment Schedule (WHODAS), Short Physical Performance Battery (SPPB), Timed Up and Go (TUG), handgrip strength, normal gait speed, SPPB fast gait speed (FGS), and. DNAm age from peripheral blood mononuclear cells (PBMC) was measured using 18 DNAm clocks, including first generation clocks (PCHorvath1, PCHorvath2, PCHannum, AltumAge, ENCen100+, ENCEN40+, IntrinClock, RetroAgev1 and RetroAgev2) second and third generation clocks (PCPhenoAge, PCGrimAge, GrimAge2, ZhangMRscore, DNAmFitAge and DunedinPACE) and causality-enriched clocks (YingCausAge, YingAdaptAge, YingDamAge). Linear regression was used to analyze associations. The 433 oldest-old individuals had a median age of 88.6 years [87.5; 90.4] and were predominantly Chinese (95.6%) and female (60.3%). Better performance in IADL, WHODAS, SPPB, SPPB FGS and balance were associated with lower GrimAge2 after adjustment for age, sex, and smoking status (pAdj < .05). GrimAge2 outperformed other DNAm clocks after adjustment for DNAm smoking-pack-years and DNAm-based cell compositions. Better physical function and physical performance were associated with lower DNAm age deviation and pace of aging. Longitudinal and intervention studies are needed to explore biological mechanisms underlying these observed associations.

Gait Speed Modifies Efficacy of Home-Based Exercise for Falls in Older Adults With a Previous Fall: Secondary Analysis of a Randomized Controlled Trial

OBJECTIVE

Exercise is an evidence-based strategy for preventing falls. However, its efficacy may vary based on individual characteristics, like gait speed. This study examined whether baseline gait speed modified the effects of home-based exercise on subsequent falls among older adults.

METHODS

This is a secondary analysis of a 12-month, randomized controlled trial in community-dwelling adults who were ≥70 years old and who had fallen within the previous 12 months. Participants were randomized to either 12 months of home-based exercise (n = 172) or standard of care (n = 172). This study examined intervention effects on fall rates at 6 and 12 months stratified by baseline gait speed (slow [<0.80 m/s] or normal [≥0.80 m/s]) using negative binomial regressions. Baseline gait speed was investigated as a potential modifier of the intervention effects on mobility and cognitive function using linear mixed modeling.

RESULTS

At baseline, 134 participants had slow (exercise = 70; standard of care = 64) and 210 had normal (exercise = 102; standard of care = 108) gait speeds. For participants with slow gait speed, exercise reduced fall rates by 44% at 6 months (incidence rate ratio = 0.56; 95% CI [confidence interval] = 0.33-0.95) but not at 12 months (incidence rate ratio = 0.63; 95% CI = 0.38-1.03) compared with standard of care; for participants with normal gait speed, there was no significant effect of exercise on fall rates at 6 or 12 months. Gait speed modified intervention effects; in the exercise group, participants with slow gait showed significant improvements in the Timed "Up & Go" Test at 6 months (estimated mean difference = -4.05; 95% CI = -6.82 to -1.27) and the Digit Symbol Substitution Test at 12 months (estimated mean difference = 2.51; 95% CI = 0.81-4.21).

CONCLUSION

Older adults with slow gait speed had a reduction in subsequent falls in response to exercise at 6 months. Gait speed modified the effects of exercise on mobility and cognition.

IMPACT

Older adults with slow gait speed may be a target population for exercise-based fall prevention.

Asymptomatic Carotid Stenosis is Associated With Mobility Dysfunction: Results From the InChianti Study

BACKGROUND

Older adults with mobility dysfunction are at risk for falls, hospitalization, and death. In an earlier pilot study, individuals with asymptomatic carotid artery stenosis (ACAS) demonstrated mobility dysfunction when compared to individuals without ACAS. We tested whether carotid stenosis affected mobility function in a larger community-dwelling cohort using the Invecchaire in Chianti (InCHIANTI) database.

METHODS

We analyzed data from participants in the InCHIANTI study who completed a medical history, carotid duplex testing, and mobility function testing (Short Physical Performance Battery- SPPB). Participants with a history of stroke, transient ischemic attack, or carotid endarterectomy were excluded. 709 participants met inclusion criteria (116 ACAS, 593 no ACAS). Our analytic approach sought to evaluate the impact of stenosis on mobility after accounting for age, sex and cardiovascular risk factors. Age was stratified into 2 age-groups (65-74 and 75-84 years). Two-way ANOVA was used to test the effect of stenosis-group, age-group, and their interactions on SPPB score with sex as a covariate.

RESULTS

Stenosis-group (P = 0.0002), age-group (P < 0.0001), and the interaction between stenosis-group and age-group (P = 0.0008) significantly affected SPPB. Post-hoc testing showed that participants with ACAS demonstrated worse performance on the SPPB (9.81 ± 0.37) compared to those with no ACAS (11.10 ± 0.11) in the 65-74 years age-group (P < 0.0001).

CONCLUSIONS

65-74-year-old adults with ACAS performed significantly worse on the SPPB than those without ACAS. These results lend further support that ACAS may be associated with mobility dysfunction in older adults.

Preservation of Temporal Organisation of Tennis Service Following Ageing in Recreational Players

Background: Ageing leads to functional changes in body systems. Purpose: This study sought to examine the age-based differences in temporal patterning, temporal variability and temporal regularity of tennis service in older adults. Research design: cross-sectional study. Study sample: Participants of this study were volunteers from young (n = 10) and older (n = 11) adults who were self-defined as non-competitive, participating in tennis at a recreational (sub-elite) level for 2-3 days per week regularly. Data collection: They were asked to perform 20 trials of the same serves (flat, slice or top-spin) on a regular size court. The timing (duration) of the serve action was recorded and analysed, using a high-speed digital camera. Participants performed the tennis serves during their routine training sessions on a tennis court. They undertook a structured general (10min) and a specific warm-up routine (10min) before performing services. There was a 30-second rest period between trials. Results: Findings showed that there were no statistically significant differences between the two groups in temporal patterning, whereas the younger group performed the serves with higher variability and regularity/consistency than the older adults in some phases of the action. Conclusion: Older adults who participate recreationally in sports are able to preserve some functional organisation of perceptual-motor capacities, such as timing, due to long-term practice effects. The findings illustrate how sport participation may help maintain functional movement organisation following ageing to mitigate age-related declines in perception and action in late adulthood.

Postoperative outcomes in patients operated for extra- and intracapsular hip fractures - a secondary analysis of two randomized controlled trials

BACKGROUND

Hip fractures are among the most common and serious injuries in older adults. There has been a perception that extracapsular hip fractures have worse outcome than intracapsular hip fractures. We aimed to examine postoperative outcomes in patients operated for extra- and intracapsular hip fractures.

METHODS

This is a secondary analysis of data from two randomized controlled trials evaluating the effect of orthogeriatric care. Bivariate analyses were conducted, comparing patients with extracapsular fracture to patients with intracapsular fracture. Mortality, length of hospital stay (LOS), new nursing home admissions, operative data and measures of functional and cognitive performance were assessed as endpoints.

RESULTS

The primary analysis included 711 patients; 283 patients had an extracapsular fracture and 428 an intracapsular fracture. At four months follow-up, the intracapsular fracture group had significantly better Short Physical Performance Battery (SPPB) (5.0 vs. 4.0, p = 0.007), personal Activities of Daily Living (p-ADL) (17.0 vs. 16.0, p = 0.007) and instrumental ADL (i-ADL) (32.5 vs. 28.0, p = 0.049). There were no statistically significant differences between the groups at 12 months.

CONCLUSIONS

Patients with an extracapsular fracture had worse mobility and ADL levels four months postoperatively, but there were no clinically relevant differences at 12 months postoperatively.

Validation of the revised multi-sensor-based electronic Short Physical Performance Battery (eSPPB) kiosk in community-dwelling older adults

PURPOSE

Recent studies highlight how technology can mitigate the reliance on trained staff for scalability of the Short Physical Performance Battery (SPPB). Although the original multi-sensor-based electronic SPPB (eSPPB) kiosk was previously validated in the outpatient setting, technical limitations and lack of user-friendliness impeded scalability to community settings where SPPB assessments are most often performed. We aim to evaluate the revised eSPPB kiosk in terms of construct validity, agreement, inter-rater, and test-retest reliability vis-à-vis manual SPPB (mSPPB) in community-dwelling older adults.

METHODS

Fifty-eight community-dwelling older adults (81% women, mean age = 75.0 ± 5.5, median FRAIL = 0 [range 0-2]) from active ageing centers performed the mSPPB and eSPPB concurrently. Twenty (34%) had a repeat assessment 2 weeks later for test-retest reliability. Convergent validity, discriminant ability, agreement, inter-rater, and test-retest reliability were evaluated using partial correlation adjusted for age and gender, independent sample t tests using SPPB cutoff ≤ 9, and cross-tabulation of mSPPB against eSPPB, Bland-Altman plots, and intra-class correlation coefficients (ICC), respectively.

RESULTS

eSPPB demonstrated excellent correlation with mSPPB (r = 0.922, p < 0.001); weak-moderate correlation with frailty and sarcopenia; and good discriminant ability for sarcopenia and frailty using SPPB cutoff ≤ 9. Bland-Altman plots showed good agreement between eSPPB and mSPPB (mean difference = 0.12, 95%CI - 1.10 to 1.34; r = -0.035, p = 0.505). Inter-rater reliability was excellent (ICC = 0.92, 95%CI 0.87-0.95), while test-retest reliability was comparable between mSPPB and eSPPB (ICC = 0.66, 95%CI 0.33-0.85 versus 0.61, 95%CI 0.25-0.82 respectively).

CONCLUSION

Our study corroborates the construct validity, agreement, inter-rater, and test-retest reliability between the eSPPB kiosk and mSPPB in healthy community-dwelling older adults. This paves the way for scalability studies examining real-world eSPPB screening of sarcopenia and frailty in the community setting.

Depression's double-edged impact on body mass index. A hidden catalyst for non-communicable diseases in South Africa's aging population in long-term care facilities

INTRODUCTION

The global population of older people, who have a high prevalence of non-communicable diseases, is on an upward trajectory, notably in South Africa. The expansion of this demographic will further strain an already overwhelmed healthcare system, primarily taxed by infectious diseases in younger populations. Physical activity has been shown to effectively reduce risk factors for non-communicable diseases in older people.

OBJECTIVE

To investigate the associations between depression, body mass index (BMI) and physical activity and its complex interplay on non-communicable diseases in older people residing in South African long-term care facilities.

METHOD

We conducted a cross-sectional study on 396 participants residing in South African rural and urban long-term care facilities to analyse BMI, waist-hip ratio, physical activity and depression levels. The Geriatric Depression Scale and the International Physical Activity Questionnaire was used to evaluate depression and physical activity respectively.

RESULTS

The sample had a mean BMI of 27.53 kg/m2 (95% CI [26.99, 28.07], SD = 5.49), with an obesity prevalence of 31.82%. Additionally, 35.10% of participants exhibited some degree of depressive symptoms. In an ordinal regression model BMI was a significant predictor (B = .10, p = .007) for increases in depression. Conversely in a linear regression model, depression (B = -2.01, p = .004) and physical activity (B = -.001, p = .008) were predictors for decreases in BMI.

CONCLUSION

The relationship between depression and BMI in older people is complex, with depression often leading to both weight loss and, conversely, increased BMI contributing to a higher risk of depression. Physical activity serves as a critical intervention, helping to reduce both BMI and depressive symptoms among older people residing in long-term care facilities. This underscores the importance of integrating PA programs into care strategies to improve overall health and well-being in this population.

The Mediating Role of Physical Function on the Self-Reported Pain and Cognitive Function Association

BACKGROUND/OBJECTIVES

Studies that have investigated the relationship between pain intensity and interference and cognitive function have failed to fully consider the role physical function may play in this relationship. Therefore, the purpose of this study was to examine the mediating role of physical function in the relationship between self-reported pain intensity and interference and cognitive function in middle-to-older aged adults with knee pain.

METHODS

Middle-to-older aged participants with knee pain (n = 202) completed the Graded Chronic Pain Scale to assess pain intensity and interference, the Short Performance Physical Battery to assess lower-extremity physical function, and the Montreal Cognitive Assessment to assess global cognitive function. Linear regression-based mediation analyses were used to assess associations between pain intensity and interference and cognitive function, with lower-extremity physical function as the mediator.

RESULTS

The direct relationship between pain intensity and cognitive function was significant (β = -0.269, p < .001) and remained significant when physical function was included as a mediator (c'=-0.0854, p = .003). The direct relationship between pain interference and cognitive function was also significant (β = -0.149, p = .023) but was attenuated when physical function was included as a mediator (c'=-0.0100, p = .09).

CONCLUSION

Physical function partially mediated the relationship between pain intensity and cognitive function and fully mediated the relationship between pain interference and cognitive function. Significance/Implications: Higher levels of pain intensity and interference may lead to worse cognitive function when physical function is also impaired. Improving physical function may improve cognitive function in those with pain.

South Korean study to prevent cognitive impairment and protect brain health through multidomain interventions via face-to-face and video communication platforms in mild cognitive impairment (SUPERBRAIN-MEET): A randomized controlled trial

INTRODUCTION

We investigated the efficacy of a multidomain intervention (MI) via face-to-face and video communication platforms using a tablet personal computer application in patients with mild cognitive impairment (MCI).

METHODS

Three hundred participants with MCI and ≥ 1 modifiable dementia risk factor, aged 60-85 years, were randomly assigned to either the MI group, who underwent a 24-week intervention, or the control group, who received usual care.

RESULTS

The overall adherence rate to MI was 84.7%. The adjusted mean change from baseline at 24 weeks in the total scale index score of the repeatable battery for the assessment of neuropsychological status was 8.43 in the MI group and 4.26 in the control group (difference, 4.17; 95% confidence interval, 1.92-6.43; p < 0.001). MI showed significant beneficial effects on cognition in both apolipoprotein E (APOE) ε4 carriers and noncarriers.

DISCUSSION

MI can exert beneficial effects on the cognition of patients with MCI.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT05023057 HIGHLIGHTS: Although the controls also demonstrated improved performance in cognition, multidomain interventions showed significantly greater benefits for cognition in MCI compared to the controls in a randomized controlled trial. Multidomain interventions improved depression and quality of life. Multidomain interventions significantly positively impacted cognition in both APOE ε4 carriers and noncarriers. Multidomain interventions may be more effective for amnestic than nonamnestic MCI.

Disturbed sleep after lung transplantation is associated with worse patient-reported outcomes and chronic lung allograft dysfunction

Background

Many lung transplant recipients fail to derive the expected improvements in health-related quality of life (HRQL) and survival. Sleep may represent an important, albeit rarely examined, factor associated with lung transplant outcomes.

Methods

Within a larger cohort study, 141 lung transplant recipients completed the Medical Outcomes Study Sleep Problems Index (SPI) Revised scale along with a broader survey of patient-reported outcome (PRO) measures and frailty assessment. From the SPI, we also derived an insomnia-specific subscale. Potential perioperative risk factors for disturbed sleep were derived from medical records. We investigated associations between perioperative predictors on SPI and insomnia and associations between SPI and insomnia on PROs and frailty by linear regressions, adjusting for age, sex, and lung function. We evaluated the associations between SPI and insomnia on time to chronic lung allograft dysfunction (CLAD) and death using Cox models, adjusting for age, sex, and transplant indication.

Results

Post-transplant hospital length of stay >30 days was associated with worse sleep by SPI and insomnia (SPI: p = 0.01; insomnia p = 0.02). Worse sleep by SPI and insomnia was associated with worse depression, cognitive function, HRQL, physical disability, health utilities, and Fried Frailty Phenotype frailty (all p < 0.01). Those in the worst quartile of SPI and insomnia exhibited an increased risk of CLAD (hazard ratio [HR] 2.18; 95% confidence interval [CI]: 1.22-3.89; p = 0.01 for SPI and HR 1.96; 95%CI 1.09-3.53; p = 0.03 for insomnia). Worsening in SPI but not insomnia was also associated with mortality (HR: 1.29; 95%CI: 1.05-1.58; p = 0.01).

Conclusions

Poor sleep after lung transplant appears associated with PROs, frailty, CLAD, and death. Clarifying the nature of this association may have important screening implications.

Different impact of chronic kidney disease in older patients with heart failure according to frailty

BACKGROUND

Chronic kidney disease (CKD) and frailty are often present in older patients with heart failure (HF). Our aim was to evaluate the association of CKD and frailty in one-year mortality in a cohort of older (≥75 years) outpatients with HF METHODS: Our data come from the FRAGIC study ("impacto de la FRAGilidad y otros síndromes Geriátricos en el manejo clínico y pronóstico del paciente anciano ambulatorio con Insuficiencia Cardíaca"), a multicenter prospective registry conducted in 16 cardiology services in Spain which included ≥75 years outpatients with HF. Renal function was assessed according to CKD-EPI formula. A comprehensive geriatric assessment was performed and frailty was identified according to visual mobility scale (frail if VMS≥2). Survival rates were analyzed by Cox regression model.

RESULTS

We included 499 patients, mean age 81.4 ± 4.3 years, 38 % women. Mean estimated glomerular filtration rate (eGFR) was 52.1 ± 17.5 ml/min/1.72 m2. Patients were classified in normal renal function (eGFR≥60 ml/min/1.72m2, 182 patients, 36 %), moderately impaired (eGFR 30-59 ml/min/1.72m2, 261 patients, 52.7 %) and severely impaired (eGFR<30 ml/min/1.72m2, 56 patients, 11.3 %). Patients with severe CKD were older, more often female, and presented a worse clinical profile, with higher comorbidity burden and frailty. After a median follow up of 371 days, 58 patients (11.6 %) died. Mortality was higher in patients with worse renal function (8.8 %, 11 % and 21 % according to renal function subgroups, respectively, p = 0.036) and frailty in the univariate analysis. However, only frailty, according to VMS, but not severe renal dysfunction, was independently associated with one year mortality.

CONCLUSIONS

Most HF patients≥75 years have renal dysfunction. CKD is a marker of worse prognosis in elderly patients with chronic HF, but it does not independently associate one-year mortality in the presence of frailty.

Wavelet-based time-frequency intermuscular beta-band coherence decreases with age but increases after mental fatigue in ankle muscles during gait independent of age

Mental fatigue can affect cognitive function and interfere with motor performance. We examined if mental fatigue affected gait through age-specific modulation of wavelet-based time-frequency intermuscular beta-band coherence in muscles while walking on a treadmill at 1.2 m·s-1. The Psychomotor Vigilance Task, and the AX-Continuous Performance and the Stroop tests were used to induce mental fatigue in groups of healthy young and older participants. Mental fatigue reduced stance time, stride length, and marginally step width and increased cadence, stride length and stance time variability. In older compared with young participants before the induction of mental fatigue, wavelet-based time-frequency intermuscular beta-band coherence measured during walking was lower in the tibialis-peroneus and tibialis-gastrocnemius muscle pairs in specific phases of the gait cycle. In both age groups, after induction of mental fatigue, selected clusters of wavelet-based time-frequency intermuscular beta-band coherence measured during walking increased in the biceps-semitendinosus, rectus-vastus, tibialis-peroneus, gastrocnemius-soleus, and tibialis-gastrocnemius muscle pairs. In conclusion, we observed that while old age might weaken oscillatory coupling between selected ankle muscle pairs during gait, reflecting a certain level of impairment in the descending drive to these muscles, wavelet-based time-frequency intermuscular beta-band coherence measured during gait after mental fatigue migth increase independent of age.

Lumbar Extensor Muscle Strength and Physical Performance in Community-Dwelling Older Adults: Findings From SarcoSpine Cohort

BACKGROUND

The lumbar extensor muscles (LEMs) play an important role in body posture and physical function in older adults. Because lumbar extensor strength decreases more rapidly than limb muscle strength with age, it should be evaluated to aid healthy aging. This study investigated the association between LEM strength and physical performance in community-dwelling older adults.

METHODS

This prospective observational cohort study of spinal sarcopenia (SarcoSpine) was conducted at a single center. One hundred and ten consecutive individuals who completed the baseline survey, including conventional sarcopenic indices, lumbar spine three-dimensional magnetic resonance imaging, isokinetic lumbar extensor strength, and physical performance tests (Short Physical Performance Battery, Berg Balance Scale, and Back Performance Scale [BPS]), were enrolled. A multivariate linear regression analysis was performed to determine the variables for evaluating their association with LEM strength.

RESULTS

Among the conventional sarcopenic indices, gait speed was significantly correlated with Short Physical Performance Battery results and Berg Balance Scale score in men and women. Handgrip strength was significantly correlated with the BPS score for both sexes. In the multivariable linear regression, age (β = -2.12, p < .01) and BPS score (β = -3.54, p = .01, R2 = .29) were independent indicators of LEM strength.

CONCLUSIONS

Our findings reveal the substantial association between LEM strength and BPS score in older women. The targeted intervention aimed at improving the LEMs strength would be needed to enhance physical performance in the aging population.

Adverse childhood experiences, sleep quality/duration and later-life lower extremity function among older adults in China: evidence from CHARLS

OBJECTIVE

This study aimed to explore the relationship between adverse childhood experiences (ACEs), sleep, and lower extremity function in older adults using a nationally representative cohort.

METHODS

This study included 4,439 participants aged 60 years or older (mean age: 67.2 ± 5.7 years) from the China Health and Retirement Longitudinal Study (CHARLS) 2015 national survey and the 2014 Life History Survey. ACEs, sleep duration, and sleep quality were assessed through self-report, and lower extremity function was measured using the Short physical performance battery (SPPB). The relationships between ACEs, sleep, and lower extremity function were analyzed using multivariate linear regression model and restricted cubic splines.

RESULTS

After adjusting for covariates, older adults with four or more ACEs exhibited worse lower extremity function compared to those with no ACEs (β: -0.175). 6-8 h of sleep was associated with improved lower extremity function (β: 0.119), while good sleep quality was also associated with higher lower extremity function scores (β: 0.177). Age-related differences revealed that the association between four or more ACEs and reduced lower extremity function (β: -0.431) was significant only in individuals aged 70 years and older. In the 60-69 years age group, the sleep duration of 6-8 h was significantly related to better lower extremity function (β: 0.150), however, in those aged 70 years and older, more than 8 h of sleep was associated with poorer function (β: -0.378). Furthermore, good sleep quality was associated with better lower extremity function in individuals aged 70 years and older (β: 0.246).

CONCLUSION

ACEs, particularly household mental illness and parental disability, are associated with poorer lower extremity function in older adults. Normal sleep duration and good sleep quality are linked to better lower extremity function and may mitigate the negative effects of ACEs. However, these associations vary by age.

Long-term burden of body mass index since childhood and impaired physical performance in midlife

BACKGROUND

The impact of long-term burden of body mass index (BMI) since childhood on physical performance in midlife remains unclear. We aimed to investigate the association between cumulative exposure to BMI since childhood and midlife physical performance by using data from the Bogalusa Heart Study (BHS).

METHODS

This longitudinal study consisted of 749 participants (aged 37.6 to 56.7 years at follow-up) who had been examined at least four times during childhood, with 39.3 years of follow-up.

RESULTS

BMI in childhood, adulthood, as a cumulative burden of BMI in childhood, or as a cumulative burden from childhood to adulthood were inversely associated with midlife Short Physical Performance Battery (SPPB) scores, 4-m gait speed, and 6-min walking distance. Individuals with higher BMI as adults but not as children did not have lower SPPB scores (OR,1.67; 95% CI, 0.85-3.27), while individuals with consistently high BMI from childhood to adulthood (2.13 1.18-3.82) and individuals with high childhood BMI (2.12 [1.10-4.10]) but low adult BMI had significantly increased risk compared with individuals with low child and low adult BMI.

CONCLUSION

Cumulative burden of BMI from childhood to midlife associated with worse midlife physical performance. Maintaining a healthy body weight throughout life may play a role in preventing or delaying the onset of functional decline.

IMPACT

We examined the impact of long-term burden of body mass index (BMI) since childhood on subsequent physical performance in midlife. We found that ①BMI in childhood and cumulative burden of BMI since childhood were associated with poor physical function in midlife; ② Individuals with high childhood BMI but low adult BMI have poor midlife physical performance; ③ Subjects with both high childhood and adulthood BMI have worse midlife physical performance. Our findings have important implications for active monitoring BMI from childhood and turning the focus of functional decline prevention to primary and primordial prevention.

Reproducibility and concordance of functional autonomy tests in older adult women: a comparative study of face-to-face and virtual assessments

Introduction

The literature does not explore functional assessments carried out remotely and in older women in virtual environments.

Objective

This study analyzed the reproducibility and agreement in applying functional autonomy tests face to face (FF) and virtually (V).

Methods

A single evaluator carried out two evaluations. The following tests were performed: walking 10 m, rising from the sitting position (RSP), rising from the ventral decubitus position (RVDP), and sitting and rising from a chair and walking around the house (SRCW).

Results

No significant changes were identified between V and FF (p > 0.05 for all). No significant changes were identified between tests considering FF and V conditions (p > 0.05 for all). The highest value for the intraclass correlation coefficient was <0.0001 for the SRCW (CL, r = 0.98 CI95%: 0.969-0.990 and ICC, r = 0.99 CI95%: 0.984-0.995), and the lowest was <0.0001 for the RSP (CL, r = 0.91 CI95%: 0.853-0.954 and ICC, r = 0.95 CI95%: 0.921-0.976). Regarding agreement between tests, a variation was found between the lowest value of 0.07 ± 0.74 BIAS for the RVDP and the highest value of 0.32 ± 1.89 BIAS for the SRCW.

Conclusion

The tests used in the present study showed good reproducibility and agreement in older people when carried out face to face and virtually.

Effects of a Physical Activity Intervention on Perceived Stress, Fatigue, and Depressive Symptoms in Older Adults: A Secondary Analysis of the LIFE Study

BACKGROUND

Engaging in physical activity is critical for maintaining well-being in older adults, particularly those at heightened risk for mobility disability. We assessed the effects of a physical activity (PA) intervention on perceived stress, fatigue, and depressive symptoms compared to a health education (HE) program in older adults with mobility challenges and evaluated differential effects of the interventions among those with the poorest self-rated mental health at baseline.

METHODS

Secondary data analysis of the Lifestyle Interventions and Independence for Elders (LIFE) Study, a single-blinded, parallel randomized controlled trial conducted between February 2010 and December 2013. The PA intervention included walking, strength exercises, balance training, and flexibility activities. The HE intervention consisted of workshops on health topics for older adults. The main outcomes for our analysis included standardized scales with participants self-reporting their stress, fatigue, and depressive symptoms at baseline, 12 months, and 24 months postrandomization.

RESULTS

Results from the 1 495 participants (Mage = 78 years; 66% female in both groups) showed no significant between-group differences in perceived stress, fatigue, or depressive symptom scores over time. However, in both intervention groups, participants with worse baseline scores showed a steady improvement in symptom scores over time compared to the remaining participants, who showed some decline (p value for interaction < .05).

CONCLUSIONS

Among mobility-impaired individuals, a long-duration, group-based PA intervention had no more impact on stress, fatigue, or depressive symptoms compared to a group-based HE intervention. However, participants with higher symptoms at baseline showed improvement over time in both intervention groups.

Frailty or sarcopenia: which is a better indicator of mortality risk in older adults?

BACKGROUND

Despite the different conditions, frailty and sarcopenia overlap regarding their common link: the assessment of walking speed and muscle strength. This study aimed to compare the frailty phenotype to the sarcopenia using different cut-off points for low grip strength to determine which better identifies mortality risk over a 14-year follow-up period.

METHODS

4597 participants in the English Longitudinal Study of Ageing. Frailty was measured using the Fried phenotype. Sarcopenia (European Working Group on Sarcopenia in Older People 2) was defined using different cut-off points for low grip strength (<36, <32, <30, <27 and <26 kg for men and <23, <21, <20 and <16 kg for women), low skeletal muscle mass index (<9.36 kg/m² for men and<6.73 kg/m² for women) and slowness (gait speed: ≤0.8 m/s). Cox models were run and adjusted for sociodemographic, behavioural and clinical factors.

RESULTS

When the coexistence of frailty and sarcopenia is considered, only the cut-off points <36 kg for men and <23 kg for women to define low grip strength identified the risk of mortality among individuals classified as having probable sarcopenia (HR=1.17, 95% CI 1.02 to 1.34), sarcopenia (HR=1.31, 95% CI 1.07 to 1.60) and severe sarcopenia (HR=1.62, 95% CI 1.33 to 1.96). In this situation, frailty identified the mortality risk (HR=1.49, 95% CI 1.22 to 1.81), whereas pre-frailty did not. Sarcopenia using other cut-off points for defining low grip strength did not identify mortality risk.

CONCLUSION

Sarcopenia using <36 kg for men and <23 kg for women as cut-off points seems to be better than the frailty phenotype for identifying the risk of mortality in older adults.

Frailty index, frailty phenotype and 6-year mortality trends in the FRASNET cohort

Background

Frailty, a geriatric syndrome associated with adverse outcomes, lacks a universal definition. No consensus exists on the most effective frailty scale for predicting mortality.

Methods

This prospective observational study followed community-dwelling volunteers for 6 years. Frailty was measured with the Frailty Index (FI) and the Frailty Phenotype (FP). Concordance was assessed using Cohen's Kappa coefficients. Age-and sex-adjusted Cox regression analyses were conducted to evaluate the association with mortality.

Results

Out of 1,114 participants (median age 72 years, IQR 69-77), 186 were classified as frail by the FI, 13 by the FP and 48 by both definitions. The concordance between the two measures was fair (κ = 0.26). Thirty-nine individuals died during the follow-up period. The FI showed a stronger association with mortality (HR 75.29, 95% CI 8.12-697.68, p < 0.001) compared to the FP (HR 3.3, 95% CI 1.45-7.51, p = 0.004). Individuals classified as frail by both definitions had the highest mortality risk and the highest FI scores (median 0.36).

Conclusion

Definitions of frailty identify different individuals as frail. The FI was more closely related to mortality than the FP. Individuals classified as frail according to both definitions displayed the highest complexity (corresponding also ho higher FI scores) and the greatest mortality. The FI demonstrated a more accurate ability to predict mortality due to its comprehensive nature.

Ageing, clinical complexity, and exercise therapy: a multidimensional approach

Ageing is a multidimensional concept related to the progressive decline in physiological functions. The decrease of physical autonomy due to the ageing process leads to frailty, which in turn is associated with disability and comorbidity. Ageing represents the primary risk factor for chronic degenerative diseases, especially involving cardiovascular, metabolic, respiratory, and osteoarticular systems, determining the decrease in activities and quality of daily life. Regular physical activity can significantly reduce the risk of chronic degenerative diseases, moderate or severe functional limitations, and premature death in older adults. In light of the relationship between ageing, sedentary lifestyle, disability, comorbidity, and physical activity, a clear need emerges within the health system. Better control on the territory of pathologies related to ageing with the management of clinical and care complexity, multidimensional and multi-professional evaluation of the elderly complex and fragile patient, also through the definition of specific outpatient packages for pathology that allow the simplification of the evaluation process. There is a need for integration between local services, hospitals, and social assistance services. Aim of this review is to highlight the importance of the multidimensional approach is essential to be able to classify the complex elderly patient according to a multi-professional vision aimed at evaluating comorbidities and frailties, including sarcopenia, nutritional deficits, functional capacity, and planning a personalized and monitored motor training program, to improve motor, metabolic, cardiovascular and respiratory functions. In addition, developing an integrated hospital-community-care services management program to follow up with patients post-care is crucial.

Prognostic Value of Sarcopenia Definitions and Outcomes Consortium Criteria in Older Patients with Heart Failure

OBJECTIVES

The Asian Working Group for Sarcopenia in 2019 (AWGS 2019) emphasized muscle mass measurements. In contrast, the Sarcopenia Definitions and Outcomes Consortium (SDOC) prioritizes functional strength and mobility. Therefore, this study aimed to compare the prognostic utility of the SDOC and AWGS 2019 criteria for all-cause mortality in older patients with heart failure.

DESIGN

A post hoc analysis of the Prevalence and Prognostic Value of Physical and Social Frailty in Geriatric Patients Hospitalized for Heart Failure (FRAGILE-HF) study, a prospective, multicenter, observational study.

SETTING AND PARTICIPANTS

Patients aged ≥65 years hospitalized for heart failure across 15 hospitals in Japan.

METHODS

Sarcopenia was diagnosed according to the AWGS 2019 and SDOC definitions. According to the SDOC criteria and by integrating insights from previous research, patients were categorized into nonsarcopenia, possible sarcopenia, and sarcopenia groups. The primary outcome was 2-year mortality.

RESULTS

Of the 1282 study patients, possible sarcopenia and sarcopenia were diagnosed in 357 and 786 individuals, respectively. Kaplan-Meier analysis revealed a significant difference between the groups. Adjusted Cox proportional hazards analysis indicated a significant stepwise association between sarcopenic status and mortality risk (possible sarcopenia: hazard ratio, 1.22; 95% CI, 0.66-2.28; P = .525; sarcopenia: hazard ratio, 1.89; 95% CI, 1.08-3.34; P = .027). When sarcopenia defined by the SDOC and AWGS 2019 criteria was added to the model incorporating conventional risk factors, no significant difference was observed in the prognostic capabilities between the 2 models (net reclassification improvement, -0.009; 95% CI, -0.193 to 0.174; P = .920, with areas under the receiver operating characteristic curve of 0.697 for SDOC and 0.703 for AWGS 2019; P = .675).

CONCLUSIONS AND IMPLICATIONS

Among older patients with heart failure, the SDOC criteria for sarcopenia diagnosis are useful for risk stratification and provide prognostic capabilities equivalent to those of the AWGS 2019 criteria.

Exploring geriatric assessment-driven rehabilitation referral patterns and its influence on functional outcomes and survival in older adults with advanced cancer

BACKGROUND

Older adults with advanced cancer experience functional disability that warrants rehabilitation services; however, evidence indicates inconsistencies in referral. The purpose was to (1) identify predictors of geriatric assessment (GA)-driven referrals to rehabilitation services and (2) explore associations between referral and change in function, health-related quality of life (HRQoL), and overall survival among older adults with advanced cancer.

METHODS

This was a secondary analysis (NCT020107443, UG1CA189961) of a nationwide GA clinical trial. Patients were older adults with advanced cancer who had at least one GA-defined physical performance or functional status impairment. Primary outcomes were oncologist-initiated discussion about or referral to rehabilitation services after the GA (Aim 1) and decline in activities of daily living (ADL), Instrumental ADL (IADL), and HRQoL within 3 months, and overall survival at 1 year (Exploratory Aims). Analyses included multivariable logistic regression and Cox proportional hazards models. Demographic and clinical factors were controlled for by using 1:1 propensity score matching.

RESULTS

In total 265 patients were analyzed. After adjustment, impaired cognition (odds ratio [OR] = 2.25, p = 0.01), Karnofsky score indicating disability (OR = 2.86, p < 0.01), and receipt of monoclonal antibodies (OR = 1.95, p = 0.04) were associated with higher odds of referral. In contrast, polypharmacy was associated with lower odds of referral (OR = 0.31, p < 0.01). Referred patients were less likely to decline in ADL (OR 0.30, p = 0.07) and IADL (OR 0.64, p = 0.35), but more likely to decline in HRQoL (OR 1.20, p = 0.67) and have worse survival (HR 1.18, p = 0.62).

CONCLUSIONS

Cancer treatment, polypharmacy, cognition, and disability status likely influence oncologists' decision to refer for rehabilitation. Referral was not independently associated with change in functional disability, HRQoL, or survival. Future studies should evaluate patients' utilization of rehabilitation services post-referral and determine whether dose/timing of rehabilitation services influence clinical outcomes.

Moderate and Vigorous Physical Activity Intensity Cut-Points for Hip-, Wrist-, Thigh-, and Lower Back Worn Accelerometer in Very Old Adults

Physical activity (PA) reduces the risk of negative mental and physical health outcomes in older adults. Traditionally, PA intensity is classified using METs, with 1 MET equal to 3.5 mL O2·min-1·kg-1. However, this may underestimate moderate and vigorous intensity due to age-related changes in resting metabolic rate (RMR) and VO2max. VO2reserve accounts for these changes. While receiver operating characteristics (ROC) analysis is commonly used to develop PA, intensity cut-points, machine learning (ML) offers a potential alternative. This study aimed to develop ROC cut-points and ML models to classify PA intensity in older adults. Sixty-seven older adults performed activities of daily living (ADL) and two six-minute walking tests (6-MWT) while wearing six accelerometers on their hips, wrists, thigh, and lower back. Oxygen uptake was measured. ROC and ML models were developed for ENMO and Actigraph counts (AGVMC) using VO2reserve as the criterion in two-third of the sample and validated in the remaining third. ROC-developed cut-points showed good-excellent AUC (0.84-0.93) for the hips, lower back, and thigh, but wrist cut-points failed to distinguish between moderate and vigorous intensity. The accuracy of ML models was high and consistent across all six anatomical sites (0.83-0.89). Validation of the ML models showed better results compared to ROC cut-points, with the thigh showing the highest accuracy. This study provides ML models that optimize the classification of PA intensity in very old adults for six anatomical placements hips (left/right), wrist (dominant/non-dominant), thigh and lower back increasing comparability between studies using different wear-position. Clinical Trial Registration: clinicaltrials.gov identifier: NCT04821713.

The challenge of applying the F-A-C-S pathway from EWGSOP2 for sarcopenia diagnosis in patients with chronic obstructive pulmonary disease: A diagnostic accuracy study

OBJECTIVE

The main objective was to evaluate the performance of the SARC-F questionnaire and muscle function tests used in pulmonary rehabilitation settings following the F-A-C-S (Find cases-Assess-Confirm-Severity) algorithm of the European Working Group on Sarcopenia in Older People (EWGSOP2).

METHODS

Diagnostic accuracy study in consecutive patients with chronic obstructive pulmonary disease (COPD) referred to pulmonary rehabilitation.

RESULTS

Of 205 patients (66.8 years; 74.1% men), 29 (14.1%) met the diagnostic criteria for sarcopenia according to EWGSOP2. The sensitivity and specificity of SARC-F were 13% and 92.8%, respectively. Cutoff points with the highest diagnostic accuracy were calculated, with handgrip at 30.3kg in men and quadriceps maximal voluntary isometric contraction (Q-MVIC) at 17.3kg in women.

CONCLUSIONS

The diagnostic accuracy of the SARC-F questionnaire as a screening tool is low and it did not identify sarcopenia in rehabilitation patients with COPD, suggesting that this population could benefit from a direct approach (A-C-S). Handgrip strength determination provided the best diagnostic accuracy in men, with a cutoff point of 30.3kg, and in women, Q-MVIC determination showed better performance for sarcopenia diagnosis, with a cutoff point of 17.3kg.

Long-term impact of Diabetes Prevention Program interventions on walking endurance

Objectives

Type 2 diabetes (T2D) and prediabetes are associated with poor walking endurance, a marker of physical function. We aimed to examine the long-term effects of metformin or intensive lifestyle intervention in adults at high risk of T2D on their 6-min walk test (6MWT) performance.

Methods

Participants were randomized in the 3-year Diabetes Prevention Program (DPP) to one of the three groups: lifestyle intervention, metformin, or placebo, and were subsequently followed in the DPP Outcomes Study. A 6MWT was conducted 20 years after randomization. Associations between DPP interventions and 6MWT completion (achieving a distance ≥200 m) were assessed using logistic regression. Among the test completers, differences in distance walked (6MWD) were evaluated using multivariable linear regression. Additional variables of interest included concomitant measures of body mass index (BMI) and grip strength along with mean measures of HbA1c and self-reported physical activity (PA).

Results

Data on 1830 participants were analyzed. The interventions were not associated with test completion or the 6MWD among test completers (362, 364, and 360 m in the lifestyle, metformin, and placebo groups, respectively, p = 0.8). Age, education, grip strength, and PA were each significantly associated with the 6MWT completion and the 6MWD after adjustment. Grip strength, PA, and education were positively associated with the 6MWD, while age, BMI, and HbA1c were negatively associated with the 6MWD.

Conclusion

We confirmed that the 6MWT is related to other measures of physical ability such as PA and grip strength in persons at risk for and with T2D, suggesting potential long-term benefits of maintaining a healthy lifestyle. However, we did not observe a sustained effect of the original randomized interventions.

Clinical trial registration

http://www.clinicaltrials.gov/ct/show/NCT00004992, identifier DPP NCT00004992; http://www.clinicaltrials.gov/ct/show/NCT00038727, identifier DPPOS NCT00038727.

A Remotely Delivered Light-Intensity Physical Activity Intervention for Older Cancer Survivors: Protocol for a Feasibility Randomized Controlled Trial

BACKGROUND

Older cancer survivors face age- and treatment-related comorbidities, including physical functional impairment, which are exacerbated by physical inactivity and sedentary behavior. Regular physical activity can reduce this risk, yet less than 30% of older cancer survivors meet the recommended guidelines for physical activity.

OBJECTIVE

This study aims to describe the design, methods, and rationale for a remotely delivered intervention that uses a whole-of-day approach to physical activity in older cancer survivors. This approach focuses on the accumulation of intermittent bouts of light-intensity activity throughout the entire day by disrupting and reducing sedentary activity. The intervention was guided by social cognitive and self-determination theories and incorporated motivational interviewing.

METHODS

The 12-week Move for Your Health trial randomly assigned 64 older cancer survivors to a theory-based physical activity intervention or a waitlist control. A Fitbit (Google) activity tracker and smartphone app were used to promote awareness of activity levels and enable self-monitoring of both activity and inactivity in tandem with health coaching phone calls. Motivational interviewing was used to engage participants and tailor strategies to achieve goals during the 12-week intervention. Data were collected at baseline, immediately after the intervention, and at longer-term follow-up (3 months thereafter). Feasibility outcomes included recruitment, retention, adherence, adverse events, and acceptability. Other outcomes included obtaining the parameter estimates for changes in physical function, physical performance, physical activity, sedentary behavior, and quality of life.

RESULTS

Recruitment for the Move for Your Health randomized controlled trial was completed in June 2023. Data collection was completed in March 2024. Data analyses are ongoing.

CONCLUSIONS

The results of this trial will provide information on the feasibility of implementing this intervention in the target patient population, as well as data that will provide information about the potential impact of the intervention on the outcomes. Both of these outcomes will inform the design of a larger randomized controlled trial to more fully test a physical activity intervention in an older cancer survivor population.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05582889; https://clinicaltrials.gov/study/NCT05582889.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/59504.

Plant-Based Diets and Their Associations with Physical Performance in the Baltimore Longitudinal Study of Aging

BACKGROUND

Plant-based diets are associated with various health benefits; however, their impact on physical performance in aging populations remains unclear.

OBJECTIVES

To investigate the associations between adherence to plant-based diets and physical performance, focusing on their potential protective effects against age-related declines in function.

METHODS

Data were obtained from men and women aged 40 years or older in the Baltimore Longitudinal Study of Aging (BLSA) (mean ± SD age: 68 ± 13 years at the first dietary visit; n = 1389). Dietary intake was assessed using a food frequency questionnaire (FFQ). Plant-based diets, calculated from 18 food groups, were categorized as overall (PDI), healthful (hPDI), or unhealthful (uPDI), and their tertiles across visits were analyzed. Multivariable linear mixed-effects models were used to examine the association between repeated measurements of three physical performance outcomes-Short Physical Performance Battery (SPPB), grip strength (kg), and gait speed (m/s)-and adherence to each plant-based diet.

RESULTS

In fully adjusted models, SPPB and grip strength were significantly associated with both hPDI and uPDI, but not with PDI. For hPDI, the intermediate tertile showed the greatest benefit, with SPPB scores 0.5 points higher (βT2vs.T1 = 0.50, 95% CI: 0.30-0.70, p < 0.001) over the follow-up period. In contrast, for uPDI, a 0.27-point lower SPPB score was seen (βT3vs.T1 = -0.27, 95% CI: -0.48 to -0.07, p = 0.009). Longitudinally, grip strength was positively associated with hPDI (βT3vs.T1 = 1.14, 95% CI: 0.24-2.05, p = 0.0013). Similar results were observed in older adults aged ≥65 years.

CONCLUSIONS

Adherence to hPDI may benefit lower body function and muscle strength, while uPDI appears to have adverse effects. This suggests that the quality of plant-based foods is essential for maintaining functional well-being in older adults. Further research is needed to confirm these findings, explore underlying mechanisms, and identify strategies to optimize plant-based dietary patterns for aging populations.

Analysis of Inertial Measurement Unit Data for an AI-Based Physical Function Assessment System Using In-Clinic-like Movements

Assessing objective physical function in patients with cancer is crucial for evaluating their ability to tolerate invasive treatments. Current assessment methods, such as the timed up and go (TUG) test and the short physical performance battery, tend to require additional resources and time, limiting their practicality in routine clinical practice. To address these challenges, we developed a system to assess physical function based on movements observed during clinical consultations and aimed to explore relevant features from inertial measurement unit data collected during those movements. As for the flow of the research, we first collected inertial measurement unit data from 61 patients with cancer while they replicated a series of movements in a consultation room. We then conducted correlation analyses to identify keypoints of focus and developed machine learning models to predict the TUG test outcomes using the extracted features. Regarding results, pelvic velocity variability (PVV) was identified using Lasso regression. A linear regression model using PVV as the input variable achieved a mean absolute error of 1.322 s and a correlation of 0.713 with the measured TUG results during five-fold cross-validation. Higher PVV correlated with shorter TUG test results. These findings provide a foundation for the development of an artificial intelligence-based physical function assessment system that operates without the need for additional resources.