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Mou K, Chan SMH, Vlahos R. Musculoskeletal crosstalk in chronic obstructive pulmonary disease and comorbidities: Emerging roles and therapeutic potentials. Pharmacol Ther 2024; 257:108635. [PMID: 38508342 DOI: 10.1016/j.pharmthera.2024.108635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/13/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a multifaceted respiratory disorder characterized by progressive airflow limitation and systemic implications. It has become increasingly apparent that COPD exerts its influence far beyond the respiratory system, extending its impact to various organ systems. Among these, the musculoskeletal system emerges as a central player in both the pathogenesis and management of COPD and its associated comorbidities. Muscle dysfunction and osteoporosis are prevalent musculoskeletal disorders in COPD patients, leading to a substantial decline in exercise capacity and overall health. These manifestations are influenced by systemic inflammation, oxidative stress, and hormonal imbalances, all hallmarks of COPD. Recent research has uncovered an intricate interplay between COPD and musculoskeletal comorbidities, suggesting that muscle and bone tissues may cross-communicate through the release of signalling molecules, known as "myokines" and "osteokines". We explored this dynamic relationship, with a particular focus on the role of the immune system in mediating the cross-communication between muscle and bone in COPD. Moreover, we delved into existing and emerging therapeutic strategies for managing musculoskeletal disorders in COPD. It underscores the development of personalized treatment approaches that target both the respiratory and musculoskeletal aspects of COPD, offering the promise of improved well-being and quality of life for individuals grappling with this complex condition. This comprehensive review underscores the significance of recognizing the profound impact of COPD on the musculoskeletal system and its comorbidities. By unravelling the intricate connections between these systems and exploring innovative treatment avenues, we can aspire to enhance the overall care and outcomes for COPD patients, ultimately offering hope for improved health and well-being.
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Affiliation(s)
- Kevin Mou
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Stanley M H Chan
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - Ross Vlahos
- Centre for Respiratory Science and Health, School of Health & Biomedical Sciences, RMIT University, Melbourne, VIC, Australia.
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Yu CH, Yeh CC, Lu YF, Lu YL, Wang TM, Lin FYS, Lu TW. Recurrent Neural Network Methods for Extracting Dynamic Balance Variables during Gait from a Single Inertial Measurement Unit. SENSORS (BASEL, SWITZERLAND) 2023; 23:9040. [PMID: 38005428 PMCID: PMC10675772 DOI: 10.3390/s23229040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/23/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
Monitoring dynamic balance during gait is critical for fall prevention in the elderly. The current study aimed to develop recurrent neural network models for extracting balance variables from a single inertial measurement unit (IMU) placed on the sacrum during walking. Thirteen healthy young and thirteen healthy older adults wore the IMU during walking and the ground truth of the inclination angles (IA) of the center of pressure to the center of mass vector and their rates of changes (RCIA) were measured simultaneously. The IA, RCIA, and IMU data were used to train four models (uni-LSTM, bi-LSTM, uni-GRU, and bi-GRU), with 10% of the data reserved to evaluate the model errors in terms of the root-mean-squared errors (RMSEs) and percentage relative RMSEs (rRMSEs). Independent t-tests were used for between-group comparisons. The sensitivity, specificity, and Pearson's r for the effect sizes between the model-predicted data and experimental ground truth were also obtained. The bi-GRU with the weighted MSE model was found to have the highest prediction accuracy, computational efficiency, and the best ability in identifying statistical between-group differences when compared with the ground truth, which would be the best choice for the prolonged real-life monitoring of gait balance for fall risk management in the elderly.
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Affiliation(s)
- Cheng-Hao Yu
- Department of Biomedical Engineering, National Taiwan University, Taipei 10617, Taiwan; (C.-H.Y.); (C.-C.Y.); (Y.-L.L.)
| | - Chih-Ching Yeh
- Department of Biomedical Engineering, National Taiwan University, Taipei 10617, Taiwan; (C.-H.Y.); (C.-C.Y.); (Y.-L.L.)
| | - Yi-Fu Lu
- Department of Information Management, National Taiwan University, Taipei 10617, Taiwan; (Y.-F.L.); (F.Y.-S.L.)
| | - Yi-Ling Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei 10617, Taiwan; (C.-H.Y.); (C.-C.Y.); (Y.-L.L.)
- Department of Ophthalmology, Cheng Hsin General Hospital, Taipei 11220, Taiwan
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei 10051, Taiwan;
- Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei 10002, Taiwan
| | - Frank Yeong-Sung Lin
- Department of Information Management, National Taiwan University, Taipei 10617, Taiwan; (Y.-F.L.); (F.Y.-S.L.)
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taipei 10617, Taiwan; (C.-H.Y.); (C.-C.Y.); (Y.-L.L.)
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei 10051, Taiwan;
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Deane CS, Din USU, Sian TS, Smith K, Gates A, Lund JN, Williams JP, Rueda R, Pereira SL, Atherton PJ, Phillips BE. Curcumin Enhances Fed-State Muscle Microvascular Perfusion but Not Leg Glucose Uptake in Older Adults. Nutrients 2022; 14:nu14061313. [PMID: 35334969 PMCID: PMC8953570 DOI: 10.3390/nu14061313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/11/2022] [Accepted: 03/16/2022] [Indexed: 02/05/2023] Open
Abstract
Therapeutic interventions aimed at enhancing blood flow may combat the postprandial vascular and metabolic dysfunction that manifests with chronological ageing. We compared the effects of acute curcumin (1000 mg) coupled with an oral nutritional supplement (ONS, 7.5 g protein, 24 g carbohydrate and 6 g fat) versus a placebo and ONS (control) on cerebral and leg macrovascular blood flow, leg muscle microvascular blood flow, brachial artery endothelial function, and leg insulin and glucose responses in healthy older adults (n = 12, 50% male, 73 ± 1 year). Curcumin enhanced m. tibialis anterior microvascular blood volume (MBV) at 180 and 240 min following the ONS (baseline: 1.0 vs. 180 min: 1.08 ± 0.02, p = 0.01 vs. 240 min: 1.08 ± 0.03, p = 0.01), and MBV was significantly higher compared with the control at both time points (p < 0.05). MBV increased from baseline in the m. vastus lateralis at 240 min after the ONS in both groups (p < 0.05), and there were no significant differences between groups. Following the ONS, leg blood flow and leg vascular conductance increased, and leg vascular resistance decreased similarly in both conditions (p < 0.05). Brachial artery flow-mediated dilation and middle cerebral artery blood flow were unchanged in both conditions (p > 0.05). Similarly, the curcumin and control groups demonstrated comparable increases in glucose uptake and insulin in response to the ONS. Thus, acute curcumin supplementation enhanced ONS-induced increases in m. tibialis anterior MBV without potentiating m. vastus lateralis MBV, muscle glucose uptake, or systemic endothelial or macrovascular function in healthy older adults.
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Affiliation(s)
- Colleen S. Deane
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter EX1 2LU, UK;
- Living Systems Institute, University of Exeter, Stocker Road, Exeter EX4 4QD, UK
| | - Ushnah S. U. Din
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
| | - Tanvir S. Sian
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Ken Smith
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
| | - Amanda Gates
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
| | - Jonathan N. Lund
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - John P. Williams
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Ricardo Rueda
- Research and Development, Abbott Nutrition, 18004 Granada, Spain;
| | | | - Philip J. Atherton
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Correspondence: (P.J.A.); (B.E.P.)
| | - Bethan E. Phillips
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Correspondence: (P.J.A.); (B.E.P.)
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Din USU, Sian TS, Deane CS, Smith K, Gates A, Lund JN, Williams JP, Rueda R, Pereira SL, Atherton PJ, Phillips BE. Green Tea Extract Concurrent with an Oral Nutritional Supplement Acutely Enhances Muscle Microvascular Blood Flow without Altering Leg Glucose Uptake in Healthy Older Adults. Nutrients 2021; 13:nu13113895. [PMID: 34836149 PMCID: PMC8619110 DOI: 10.3390/nu13113895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 01/10/2023] Open
Abstract
Postprandial macro- and microvascular blood flow and metabolic dysfunction manifest with advancing age, so vascular transmuting interventions are desirable. In this randomised, single-blind, placebo-controlled, crossover trial, we investigated the impact of the acute administration of green tea extract (GTE; containing ~500 mg epigallocatechin-3-gallate) versus placebo (CON), alongside an oral nutritional supplement (ONS), on muscle macro- and microvascular, cerebral macrovascular (via ultrasound) and leg glucose/insulin metabolic responses (via arterialised/venous blood samples) in twelve healthy older adults (42% male, 74 ± 1 y). GTE increased m. vastus lateralis microvascular blood volume (MBV) at 180 and 240 min after ONS (baseline: 1.0 vs. 180 min: 1.11 ± 0.02 vs. 240 min: 1.08 ± 0.04, both p < 0.005), with MBV significantly higher than CON at 180 min (p < 0.05). Neither the ONS nor the GTE impacted m. tibialis anterior perfusion (p > 0.05). Leg blood flow and vascular conductance increased, and vascular resistance decreased similarly in both conditions (p < 0.05). Small non-significant increases in brachial artery flow-mediated dilation were observed in the GTE only and middle cerebral artery blood flow did not change in response to GTE or CON (p > 0.05). Glucose uptake increased with the GTE only (0 min: 0.03 ± 0.01 vs. 35 min: 0.11 ± 0.02 mmol/min/leg, p = 0.007); however, glucose area under the curve and insulin kinetics were similar between conditions (p > 0.05). Acute GTE supplementation enhances MBV beyond the effects of an oral mixed meal, but this improved perfusion does not translate to increased leg muscle glucose uptake in healthy older adults.
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Affiliation(s)
- Ushnah S. U. Din
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
| | - Tanvir S. Sian
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Colleen S. Deane
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter EX1 2LU, UK;
- Living Systems Institute, University of Exeter, Stocker Road, Exeter EX4 4QD, UK
| | - Ken Smith
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
| | - Amanda Gates
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
| | - Jonathan N. Lund
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - John P. Williams
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Ricardo Rueda
- Research and Development, Abbott Nutrition, 18004 Granada, Spain;
| | | | - Philip J. Atherton
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Correspondence: (P.J.A.); (B.E.P.)
| | - Bethan E. Phillips
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (U.S.U.D.); (T.S.S.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Correspondence: (P.J.A.); (B.E.P.)
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Koppelaar H, Kordestani-Moghadam P, Kouhkani S, Irandoust F, Segers G, de Haas L, Bantje T, van Warmerdam M. Proof of Concept of Novel Visuo-Spatial-Motor Fall Prevention Training for Old People. Geriatrics (Basel) 2021; 6:66. [PMID: 34210015 PMCID: PMC8293049 DOI: 10.3390/geriatrics6030066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/13/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022] Open
Abstract
Falls in the geriatric population are one of the most important causes of disabilities in this age group. Its consequences impose a great deal of economic burden on health and insurance systems. This study was conducted by a multidisciplinary team with the aim of evaluating the effect of visuo-spatial-motor training for the prevention of falls in older adults. The subjects consisted of 31 volunteers aged 60 to 92 years who were studied in three groups: (1) A group under standard physical training, (2) a group under visuo-spatial-motor interventions, and (3) a control group (without any intervention). The results of the study showed that visual-spatial motor exercises significantly reduced the risk of falls of the subjects.
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Affiliation(s)
- Henk Koppelaar
- Faculty of Electric and Electronic Engineering, Mathematics and Computer Science, Delft University of Technology, 2628 CD Delft, The Netherlands
| | | | - Sareh Kouhkani
- Department of Mathematics, Islamic University Shabestar Branch, Shabestar, Iran;
| | - Farnoosh Irandoust
- Department of Ophtalmology, Lorestan University of Medical Sciences, Korramabad, Iran;
| | - Gijs Segers
- Gymi Sports & Visual Performance, 4907 BC Oosterhout, The Netherlands;
| | - Lonneke de Haas
- Monné Physical Care and Exercise, 4815 HD Breda, The Netherlands; (L.d.H.); (T.B.)
| | - Thijmen Bantje
- Monné Physical Care and Exercise, 4815 HD Breda, The Netherlands; (L.d.H.); (T.B.)
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Kang T, Hong J, Radnaabaatar M, Park SY, Jung J. Effect of meteorological factors and air pollutants on fractures: a nationwide population-based ecological study. BMJ Open 2021; 11:e047000. [PMID: 34117046 PMCID: PMC8202114 DOI: 10.1136/bmjopen-2020-047000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To determine the association of meteorological factors and air pollutants (MFAPs) with fracture and to estimate the effect size/time lag. DESIGN This is a nationwide population-based ecological study from 2008 to 2017. SETTING Eight large metropolitan areas in Korea. PARTICIPANTS Of 8 093 820 patients with fractures reported in the Korea National Health Insurance database, 2 129 955 were analysed after the data set containing patient data (age, sex and site of fractures) were merged with MFAPs. Data on meteorological factors were obtained from the National Climate Data Center of the Korea Meteorological Administration. Additionally, data on air pollutants (atmospheric particulate matter ≤2.5 µm in diameter (PM2.5), PM10, ozone, nitrogen dioxide, sulfur dioxide and carbon monoxide) were obtained from the Air Korea database. PRIMARY AND SECONDARY OUTCOME MEASURES We hypothesised that there would be an association between MFAPs and the incidence of fracture. A generalised additive model was used while factoring in the non-linear relationship between MFAPs and fractures as well as a time lag ≤7 days. Multivariate analysis was performed. Backward elimination with an Akaike information criterion was used to fit the multivariate model. RESULTS Overall, in eight urban areas, 2 129 955 patients with fractures were finally analysed. These included 370 344, 187 370, 173 100, 140 358, 246 775, 6501, 228 346, 57 183 and 719 978 patients with hip, knee, shoulder, elbow, wrist, hand, ankle, foot and spine fractures, respectively. Various MFAPs (average temperature, daily rain, wind speed, daily snow and PM2.5) showed significant association with fractures, with positive correlations at time lags 7, 5-7, 5-7, 3-7 and 6-7 days, respectively. CONCLUSIONS Various MFAPs could affect the occurrence of fractures. The average temperature, daily rain, wind speed, daily snow and PM2.5 were most closely associated with fracture. Thus, improved public awareness on these MFAPs is required for clinical prevention and management of fractures.
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Affiliation(s)
- Taewook Kang
- Department of Orthopedics, Korea University College of Medicine and School of Medicine, Seoul, South Korea
| | - Jinwook Hong
- Artificial Intelligence and Big-Data Convergence Center, Gachon University Gil Medical Center, Incheon, South Korea
| | - Munkhzul Radnaabaatar
- Artificial Intelligence and Big-Data Convergence Center, Gachon University Gil Medical Center, Incheon, South Korea
| | - Si Young Park
- Department of Orthopedics, Korea University College of Medicine and School of Medicine, Seoul, South Korea
| | - Jaehun Jung
- Artificial Intelligence and Big-Data Convergence Center, Gachon University Gil Medical Center, Incheon, South Korea
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, South Korea
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Deane CS, Willis CRG, Phillips BE, Atherton PJ, Harries LW, Ames RM, Szewczyk NJ, Etheridge T. Transcriptomic meta-analysis of disuse muscle atrophy vs. resistance exercise-induced hypertrophy in young and older humans. J Cachexia Sarcopenia Muscle 2021; 12:629-645. [PMID: 33951310 PMCID: PMC8200445 DOI: 10.1002/jcsm.12706] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/26/2021] [Accepted: 03/29/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Skeletal muscle atrophy manifests across numerous diseases; however, the extent of similarities/differences in causal mechanisms between atrophying conditions in unclear. Ageing and disuse represent two of the most prevalent and costly atrophic conditions, with resistance exercise training (RET) being the most effective lifestyle countermeasure. We employed gene-level and network-level meta-analyses to contrast transcriptomic signatures of disuse and RET, plus young and older RET to establish a consensus on the molecular features of, and therapeutic targets against, muscle atrophy in conditions of high socio-economic relevance. METHODS Integrated gene-level and network-level meta-analysis was performed on publicly available microarray data sets generated from young (18-35 years) m. vastus lateralis muscle subjected to disuse (unilateral limb immobilization or bed rest) lasting ≥7 days or RET lasting ≥3 weeks, and resistance-trained older (≥60 years) muscle. RESULTS Disuse and RET displayed predominantly separate transcriptional responses, and transcripts altered across conditions were mostly unidirectional. However, disuse and RET induced directly inverted expression profiles for mitochondrial function and translation regulation genes, with COX4I1, ENDOG, GOT2, MRPL12, and NDUFV2, the central hub components of altered mitochondrial networks, and ZMYND11, a hub gene of altered translation regulation. A substantial number of genes (n = 140) up-regulated post-RET in younger muscle were not similarly up-regulated in older muscle, with young muscle displaying a more pronounced extracellular matrix (ECM) and immune/inflammatory gene expression response. Both young and older muscle exhibited similar RET-induced ubiquitination/RNA processing gene signatures with associated PWP1, PSMB1, and RAF1 hub genes. CONCLUSIONS Despite limited opposing gene profiles, transcriptional signatures of disuse are not simply the converse of RET. Thus, the mechanisms of unloading cannot be derived from studying muscle loading alone and provides a molecular basis for understanding why RET fails to target all transcriptional features of disuse. Loss of RET-induced ECM mechanotransduction and inflammatory profiles might also contribute to suboptimal ageing muscle adaptations to RET. Disuse and age-dependent molecular candidates further establish a framework for understanding and treating disuse/ageing atrophy.
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Affiliation(s)
- Colleen S Deane
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St. Luke's Campus, Exeter, UK.,Living Systems Institute, University of Exeter, Exeter, UK
| | - Craig R G Willis
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St. Luke's Campus, Exeter, UK
| | - Bethan E Phillips
- MRC-ARUK Centre for Musculoskeletal Ageing Research and National Institute of Health Research, Biomedical Research Centre, Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital Centre, School of Medicine, University of Nottingham, Derby, UK
| | - Philip J Atherton
- MRC-ARUK Centre for Musculoskeletal Ageing Research and National Institute of Health Research, Biomedical Research Centre, Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital Centre, School of Medicine, University of Nottingham, Derby, UK
| | - Lorna W Harries
- RNA-Mediated Mechanisms of Disease Group, Institute of Biomedical and Clinical Sciences, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ryan M Ames
- Living Systems Institute, University of Exeter, Exeter, UK
| | - Nathaniel J Szewczyk
- MRC-ARUK Centre for Musculoskeletal Ageing Research and National Institute of Health Research, Biomedical Research Centre, Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital Centre, School of Medicine, University of Nottingham, Derby, UK.,Ohio Musculoskeletal and Neurological Institute & Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | - Timothy Etheridge
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St. Luke's Campus, Exeter, UK
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Sian TS, Din USU, Deane CS, Smith K, Gates A, Lund JN, Williams JP, Rueda R, Pereira SL, Phillips BE, Atherton PJ. Cocoa Flavanols Adjuvant to an Oral Nutritional Supplement Acutely Enhances Nutritive Flow in Skeletal Muscle without Altering Leg Glucose Uptake Kinetics in Older Adults. Nutrients 2021; 13:nu13051646. [PMID: 34068170 PMCID: PMC8152976 DOI: 10.3390/nu13051646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022] Open
Abstract
Ageing is associated with postprandial muscle vascular and metabolic dysfunction, suggesting vascular modifying interventions may be of benefit. Reflecting this, we investigated the impact of acute cocoa flavanol (450-500 mg) intake (versus placebo control) on vascular (via ultrasound) and glucose/insulin metabolic responses (via arterialised/venous blood samples and ELISA) to an oral nutritional supplement (ONS) in twelve healthy older adults (50% male, 72 ± 4 years), in a crossover design study. The cocoa condition displayed significant increases in m. vastus lateralis microvascular blood volume (MBV) in response to feeding at 180 and 240-min after ONS consumption (baseline: 1.00 vs. 180 min: 1.09 ± 0.03, p = 0.05; 240 min: 1.13 ± 0.04, p = 0.002), with MBV at these timepoints significantly higher than in the control condition (p < 0.05). In addition, there was a trend (p = 0.058) for MBV in m. tibialis anterior to increase in response to ONS in the cocoa condition only. Leg blood flow and vascular conductance increased, and vascular resistance decreased in response to ONS (p < 0.05), but these responses were not different between conditions (p > 0.05). Similarly, glucose uptake and insulin increased in response to ONS (p < 0.05) comparably between conditions (p > 0.05). Thus, acute cocoa flavanol supplementation can potentiate oral feeding-induced increases in MBV in older adults, but this improvement does not relay to muscle glucose uptake.
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Affiliation(s)
- Tanvir S Sian
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (T.S.S.); (U.S.U.D.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Ushnah S. U. Din
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (T.S.S.); (U.S.U.D.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
| | - Colleen S. Deane
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter EX1 2LU, UK;
- Living Systems Institute, University of Exeter, Stocker Road, Exeter EX4 4QD, UK
| | - Ken Smith
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (T.S.S.); (U.S.U.D.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
| | - Amanda Gates
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (T.S.S.); (U.S.U.D.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
| | - Jonathan N. Lund
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (T.S.S.); (U.S.U.D.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - John P. Williams
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (T.S.S.); (U.S.U.D.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Department of Surgery and Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Ricardo Rueda
- Research and Development, Abbott Nutrition, 18004 Granada, Spain;
| | | | - Bethan E. Phillips
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (T.S.S.); (U.S.U.D.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Correspondence: (B.E.P.); (P.J.A.)
| | - Philip J. Atherton
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research and National Institute for Health Research Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby DE22 3DT, UK; (T.S.S.); (U.S.U.D.); (K.S.); (A.G.); (J.N.L.); (J.P.W.)
- Correspondence: (B.E.P.); (P.J.A.)
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9
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Jang EM, Park SH. Effects of Neuromuscular Electrical Stimulation Combined with Exercises versus an Exercise Program on the Physical Characteristics and Functions of the Elderly: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052463. [PMID: 33802260 PMCID: PMC7967594 DOI: 10.3390/ijerph18052463] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/16/2022]
Abstract
(1) Background-The application of neuromuscular electrical stimulation (NMES) combined with low-intensity exercise to the elderly can be more efficient than low-intensity exercise only in terms of delaying the loss of muscle mass. We aimed to assess the adjunct of NMES to low-intensity lower limb strengthening exercise to prevent falls in frail elderly for a relatively short period of 4 weeks. (2) Methods-Thirty elderly women aged 65 or above were randomly categorized into three groups: control group (CON, n = 8), exercise group (EX, n = 10), and NMES with exercise group (EX + NMES, n = 9). The exercise group took part in a lower limb strengthening exercise program for one hour three times a week for four weeks. Furthermore, the NMES with exercise group had added NMES stimulation when exercising. The limbs' muscle mass, body fat mass, calf circumference, grip force, five times sit-to-stand test, timed up-and-go test (TUG), one-leg stand test, and Y-balance test (YBT) were evaluated at baseline and 4 weeks after. (3) Results-Comparisons between the three groups showed that the TUG was significantly decreased and the YB was significantly increased in NMES with exercise group (p < 0.05). (4) Conclusions-These results suggested that a combination of NMES stimulation and exercises was more helpful in strengthening balance than exercises alone in the short term.
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Affiliation(s)
| | - So Hyun Park
- Correspondence: ; Tel.: +82-055-380-9465; Fax: +82-55-380-9305
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10
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Choi HG, Lee JK, Lee MJ, Park B, Sim S, Lee SM. Blindness increases the risk for hip fracture and vertebral fracture but not the risk for distal radius fracture: a longitudinal follow-up study using a national sample cohort. Osteoporos Int 2020; 31:2345-2354. [PMID: 32632509 DOI: 10.1007/s00198-020-05475-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/21/2020] [Indexed: 12/14/2022]
Abstract
UNLABELLED The risks for hip fracture and vertebral fracture, but not the risk for distal radius fracture, were significantly higher in the blindness group than in the control group with a maximum 12-year follow-up. PURPOSE To evaluate the influence of visual impairment on the risk for osteoporotic fractures at common sites: hip, thoracic/lumbar vertebra, and distal radius. METHODS This longitudinal follow-up study used a database of a national sample cohort from 2002 to 2013 provided by the Korean National Health Insurance Service. Of a total of 1,125,691 subjects, 3918 patients with visual impairment and age ≥ 50 years were enrolled in a 1:4 ratio; 15,672 control participants were matched for age, sex, income, and region of residence. Stratified Cox proportional-hazards models were used to evaluate the crude and adjusted (for steroid medication, rheumatoid arthritis, depression, osteoporosis, diabetes mellitus, and stroke history) hazard ratios (HRs) for each fracture site. Fracture diagnoses were based on the ICD-10 codes: hip fracture (S720, S721, S722), vertebral fracture (S220, S320), and distal radius fracture (S525). RESULTS The HRs for hip and vertebral fracture were significantly higher in the blindness group (adjusted HR = 2.46, p < 0.001 for hip fracture; adjusted HR = 1.42, p = 0.020 for thoracic/lumbar vertebral fracture) than in the matched control group. However, the HR for distal radius fracture was not higher in the blindness group. The HRs for all three fracture sites were not significantly higher in the non-blindness visual impairment group after adjustment. CONCLUSION The risks for hip fracture and vertebral fracture were significantly higher in the blindness group. However, the risk for distal radius fracture was not related to visual impairment including blindness.
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Affiliation(s)
- H G Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Republic of Korea
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Republic of Korea
| | - J K Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - M J Lee
- Department of Ophthalmology, Hallym University College of Medicine, Anyang, Republic of Korea
| | - B Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Republic of Korea
| | - S Sim
- Department of Statistics and Institute of Statistics, Hallym University, 1 Hallymdaehak-gil, Chuncheon-si, Gangwon-do, 24252, Republic of Korea.
| | - S-M Lee
- Department of Cornea, External Disease & Refractive Surgery, HanGil Eye Hospital, Catholic Kwandong University College of Medicine, 35 Bupyeong-daero, Bupyeong-gu, Incheon, 21388, Republic of Korea.
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11
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Dietary protein, exercise, ageing and physical inactivity: interactive influences on skeletal muscle proteostasis. Proc Nutr Soc 2020; 80:106-117. [PMID: 33023679 DOI: 10.1017/s0029665120007879] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Dietary protein is a pre-requisite for the maintenance of skeletal muscle mass; stimulating increases in muscle protein synthesis (MPS), via essential amino acids (EAA), and attenuating muscle protein breakdown, via insulin. Muscles are receptive to the anabolic effects of dietary protein, and in particular the EAA leucine, for only a short period (i.e. about 2-3 h) in the rested state. Thereafter, MPS exhibits tachyphylaxis despite continued EAA availability and sustained mechanistic target of rapamycin complex 1 signalling. Other notable characteristics of this 'muscle full' phenomenon include: (i) it cannot be overcome by proximal intake of additional nutrient signals/substrates regulating MPS; meaning a refractory period exists before a next stimulation is possible, (ii) it is refractory to pharmacological/nutraceutical enhancement of muscle blood flow and thus is not induced by muscle hypo-perfusion, (iii) it manifests independently of whether protein intake occurs in a bolus or intermittent feeding pattern, and (iv) it does not appear to be dependent on protein dose per se. Instead, the main factor associated with altering muscle full is physical activity. For instance, when coupled to protein intake, resistance exercise delays the muscle full set-point to permit additional use of available EAA for MPS to promote muscle remodelling/growth. In contrast, ageing is associated with blunted MPS responses to protein/exercise (anabolic resistance), while physical inactivity (e.g. immobilisation) induces a premature muscle full, promoting muscle atrophy. It is crucial that in catabolic scenarios, anabolic strategies are sought to mitigate muscle decline. This review highlights regulatory protein turnover interactions by dietary protein, exercise, ageing and physical inactivity.
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12
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Rohof B, Betsch M, Rath B, Tingart M, Quack V. The Nintendo ® Wii Fit Balance Board can be used as a portable and low-cost posturography system with good agreement compared to established systems. Eur J Med Res 2020; 25:44. [PMID: 32972447 PMCID: PMC7517684 DOI: 10.1186/s40001-020-00445-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background Almost all epidemiological studies over the past 40 years have determined that the incidence of fragility fractures is increasing. Therefore, the assessment of postural stability and monitoring any progress during balance training for geriatric patients to prevent falls are becoming more important. The Nintendo® Wii Fit Balance Board, with its integrated software and scoring system, might be a cheap and easily accessible tool for this purpose. Methods This prospective study analyzed the diagnostic value of the Wii Fit Balance Board in 41 healthy subjects using two measurements: the yoga task “tree,” which is performed in one-leg stance; and the balance game “table tilt.” Our investigation compared these tasks to two established, regularly used systems, the MFT-S3 Check and the Posturomed, by looking for correlation and agreement, using Bland–Altman plots, as well as for differences to demographic data. All measurement tools were also compared to the Sensory Organization Test—the gold standard for detecting impaired balance. Results We found a moderate correlation between the yoga exercise “tree” and the Sensory Organization Test (correlation coefficient r = 0.514, p = 0.001) as well as the MFT-S3 Check (r = 0.356–0.472, p = 0.002–0.022) and the Posturomed (r = 0.345, p = 0.027). However, results from the balance game “table tilt” did not show a significant correlation with those of the systems to which we compared it (p = 0.301–0.953). Conclusions According to the literature, the raw data from the Wii Fit Balance Board are comparable to that obtained by laboratory-grade force platforms. We have found, however, that the yoga pose “tree,” as integrated into the Nintendo® Wii Fit Balance Board with its own scoring system, also correlates with the gold-standard Sensory Organization Test. It also correlates with two frequently used diagnostic and therapeutic devices. We, therefore, conclude that the Wii Fit Balance Board is suitable for the evaluation of postural stability and may be useful in preventing falls among the geriatric population. Level of evidence 2b.
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Affiliation(s)
- Ben Rohof
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
| | - Marcel Betsch
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Björn Rath
- Department of Orthopaedic Surgery, Hospital Wels-Grieskirchen, Grieskirchner Str. 42, 4600, Wels, Austria
| | - Markus Tingart
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Valentin Quack
- Department of Orthopaedic Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany
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13
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Deane CS, Phillips BE, Smith K, Steele AM, Libretto T, Statton SA, Atherton PJ, Etheridge T. Challenges and practical recommendations for successfully recruiting inactive, statin-free older adults to clinical trials. BMC Res Notes 2020; 13:174. [PMID: 32209122 PMCID: PMC7092412 DOI: 10.1186/s13104-020-05017-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/13/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To outline the challenges and provide practical recommendations for recruiting inactive, statin-free older adults to facilitate feasible study designs. Data was obtained from a double-blind randomised-controlled clinical trial investigating the effects of acipimox versus placebo on muscle function and metabolism in older (65-75 years), inactive, statin-free males. The initial recruitment target was 20 volunteers within 12 months (November 2016-November 2017). RESULTS Recruitment occurred via the Exeter 10,000 database containing 236 'eligible' males, a Facebook campaign reaching > 8000 ≥ 65 years old males, 400 directly-addressed letters to ≥ 66 year old males, > 1500 flyers distributed within the community, > 40 emails to local community groups, 4 recruitment talks, 2 magazine adverts and 1 radio advert. Widespread recruitment efforts reaching > 120,000 people led to the recruitment of 20 volunteers (18 completed the clinical trial) within a 25-month timeframe, highlighting the challenge of the timely recruitment of inactive, statin-free older adults for clinical trials. We recommend recruitment for future clinical trials should take a multi-pronged approach from the outset, prioritising the use of volunteer databases, Facebook campaigns and delivering recruitment talks.
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Affiliation(s)
- Colleen S Deane
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St. Luke's Campus, Exeter, EX1 2LU, UK.
- Living Systems Institute, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK.
| | - Bethan E Phillips
- MRC-ARUK Centre for Musculoskeletal Ageing Research and National Institute of Health Research, Biomedical Research Centre, Division of Medicine and Graduate Entry Medicine, Royal Derby Hospital Centre, School of Medicine, University of Nottingham, Derby, DE22 3DT, UK
| | - Kenneth Smith
- MRC-ARUK Centre for Musculoskeletal Ageing Research and National Institute of Health Research, Biomedical Research Centre, Division of Medicine and Graduate Entry Medicine, Royal Derby Hospital Centre, School of Medicine, University of Nottingham, Derby, DE22 3DT, UK
| | - Anna M Steele
- National Institute for Health Research Exeter Clinical Research Facility, Research Innovation Learning and Development Building, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - Tina Libretto
- National Institute for Health Research Exeter Clinical Research Facility, Research Innovation Learning and Development Building, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - Sarah A Statton
- National Institute for Health Research Exeter Clinical Research Facility, Research Innovation Learning and Development Building, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK
| | - Philip J Atherton
- MRC-ARUK Centre for Musculoskeletal Ageing Research and National Institute of Health Research, Biomedical Research Centre, Division of Medicine and Graduate Entry Medicine, Royal Derby Hospital Centre, School of Medicine, University of Nottingham, Derby, DE22 3DT, UK
| | - Timothy Etheridge
- Department of Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, St. Luke's Campus, Exeter, EX1 2LU, UK
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14
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Bohannon RW. Grip Strength: An Indispensable Biomarker For Older Adults. Clin Interv Aging 2019; 14:1681-1691. [PMID: 31631989 PMCID: PMC6778477 DOI: 10.2147/cia.s194543] [Citation(s) in RCA: 356] [Impact Index Per Article: 71.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/13/2019] [Indexed: 12/20/2022] Open
Abstract
Grip strength has been proposed as a biomarker. Supporting this proposition, evidence is provided herein that shows grip strength is largely consistent as an explanator of concurrent overall strength, upper limb function, bone mineral density, fractures, falls, malnutrition, cognitive impairment, depression, sleep problems, diabetes, multimorbidity, and quality of life. Evidence is also provided for a predictive link between grip strength and all-cause and disease-specific mortality, future function, bone mineral density, fractures, cognition and depression, and problems associated with hospitalization. Consequently, the routine use of grip strength can be recommended as a stand-alone measurement or as a component of a small battery of measurements for identifying older adults at risk of poor health status.
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Affiliation(s)
- Richard W Bohannon
- Department of Physical Therapy, Campbell University, Lillington, NC, USA
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15
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Quach LT, Ward RE, Pedersen MM, Leveille SG, Grande L, Gagnon DR, Bean JF. The Association Between Social Engagement, Mild Cognitive Impairment, and Falls Among Older Primary Care Patients. Arch Phys Med Rehabil 2019; 100:1499-1505. [PMID: 30825422 DOI: 10.1016/j.apmr.2019.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/10/2019] [Accepted: 01/23/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To examine associations between mild cognitive impairment (MCI) and falls among primary care patients, and to investigate whether social engagement (SE) modifies these associations. DESIGN Cross sectional analysis using baseline data from an observational cohort study. SETTING Primary care. PARTICIPANTS Community-dwelling older adults (N=430) at risk of mobility decline with a mean age of 76.6 years (range 65-96y). MAIN OUTCOME MEASURES The number of falls in the past year was reported at the baseline interview. MCI was identified using a cutoff of 1.5 SD below the age-adjusted mean on at least 2 of the standardized cognitive performance tests. SE (eg, keeping in touch with friends and family, volunteering, participating social activities…) was assessed with the Late Life Function and Disability Instrument, and required a score above the median value 49.5 out of 100. RESULTS MCI was present among 42% of participants and 42% reported at least 1 fall in the preceding year. Using generalized estimating equations, MCI was associated with a 77% greater rate of falls (P<.05). There was a statistically significant interaction between SE and MCI on the rate of falls (P<.01), such that at a high level of SE, MCI was not statistically associated with falls (P=.83). In participants with lower levels of SE, MCI is associated with 1.3 times greater rate of falls (P<.01). CONCLUSIONS While MCI is associated with a greater risk for falls, higher levels of SE may play a protective role.
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Affiliation(s)
- Lien T Quach
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA; Massachusetts Veterans Epidemiology and Research Information Center, VA Boston Healthcare System, Boston, MA; Department of Gerontology, University of Massachusetts Boston, Boston, MA.
| | - Rachel E Ward
- Massachusetts Veterans Epidemiology and Research Information Center, VA Boston Healthcare System, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA; Harvard Medical School, Cambridge, MA
| | - Mette M Pedersen
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Denmark
| | - Suzanne G Leveille
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA; Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Cambridge, MA
| | - Laura Grande
- Beth Israel Deaconess Medical Center, Boston, MA; VA Boston Healthcare System, Boston, MA
| | - David R Gagnon
- Massachusetts Veterans Epidemiology and Research Information Center, VA Boston Healthcare System, Boston, MA; Department of Biostatistics, Boston University, Boston, MA
| | - Jonathan F Bean
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA; Spaulding Rehabilitation Hospital, Boston, MA; Harvard Medical School, Cambridge, MA
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16
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Hogea B, Bardan R, Sandesc M, Patrascu Jr JM, Cumpanas A, Andor B. Are night-time voiding and lower urinary tract symptoms significant risk factors for hip fractures caused by falling during the night in male subjects? Patient Prefer Adherence 2019; 13:1191-1197. [PMID: 31413547 PMCID: PMC6659779 DOI: 10.2147/ppa.s205229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 06/14/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The aim of our study was to assess the incidence of night-time voiding in a population of male patients with hip fracture, and to analyze the correlations between the severity of the lower urinary symptoms and the other most significant comorbidities of the patients. PATIENTS AND METHODS We have initially selected a group of patients containing all males admitted into a Department of Orthopedic Surgery with the diagnosis of hip fracture, with indication for replacement surgery, over a four-year period. Applying well-defined inclusion and exclusion criteria, we have selected all the patients who have reported that falling during the night, on the way to the toilet (for micturition), was the event leading to the hip fracture. A comprehensive medical history and the International Prostate Symptom Score (IPSS) Questionnaire were gathered from all the patients and the obtained data were analyzed. RESULTS From a total of 363 patients with hip fractures, 68 cases were attributable to night-time voiding. The detailed analysis of the 68 patients has shown that all of them had significant nocturia (2.72 episodes of voiding per night, in average), but only 11 of them were already diagnosed with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). Moreover, only four of the eleven patients diagnosed with BPH were taking specific therapy at the moment of their falling leading to hip fracture. Subsequent analysis has shown that a group of 45 patients with no previously known co-morbidities, had similar IPSS score results with the total group of 68 patients. CONCLUSIONS Night-time voiding and LUTS are underdiagnosed in the general male population, as they represent significant risk factors for hip fractures due to falling during the night. The low level of BPH/LUTS therapy adherence adds a supplementary risk for falling during the night.
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Affiliation(s)
- Bogdan Hogea
- Department of Anatomy, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Razvan Bardan
- Department of Urology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
- Correspondence: Razvan BardanDepartment of Urology, Victor Babes University of Medicine and Pharmacy, 156 Liviu Rebreanu Blvd., 300736Timisoara, RomaniaTel +40 72 330 7888Email
| | - Mihai Sandesc
- Second Department of Orthopedics, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Jenel Marian Patrascu Jr
- Second Department of Orthopedics, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Alin Cumpanas
- Department of Urology, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Bogdan Andor
- Second Department of Orthopedics, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
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17
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The Association Between Overactive Bladder and Falls and Fractures: A Systematic Review. Adv Ther 2018; 35:1831-1841. [PMID: 30255417 PMCID: PMC6223978 DOI: 10.1007/s12325-018-0796-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Indexed: 11/18/2022]
Abstract
Introduction Urinary symptoms are associated with an increased risk of falls, but few studies have focused on patients with overactive bladder (OAB). This study aimed to synthesize estimates of the risk of falls and fractures in patients with OAB. Methods Medline, EMBASE, the Cumulative Index to Nursing and Allied Health Literature, and Scopus were systematically searched for observational studies that focused on patients with OAB. When available, data from a non-OAB comparison sample were included. Double independent review and data extraction were performed. Falls and fractures data were summarized by unadjusted and adjusted risks, and percent attributable risk (PAR) of falls and fractures associated with OAB. Results Fifteen studies were included in the analyses. The proportion of patients with OAB experiencing at least one fall over a year ranged from 18.9% to 50.0%, and the proportion of patients with OAB experiencing recurrent or serious falls ranged from 10.2% to 56.0%. In studies that included a non-OAB comparison sample, a higher risk of falls was observed in patients with OAB compared to those without. A significantly increased (1.3- to 2.3-fold) adjusted OAB-associated risk of falls was reported, while unadjusted PARs for OAB associated falls ranged from 3.7% to 15.5%. Risk was higher among women and those 65 years of age or older. While analysis of fractures showed elevated point estimates, most studies were underpowered to detect a statistically significant difference between groups. Conclusions Evidence from the published literature clearly demonstrates the importance of OAB and its symptoms as risk factors for falls and fractures. Funding Astellas. Electronic supplementary material The online version of this article (10.1007/s12325-018-0796-8) contains supplementary material, which is available to authorized users.
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18
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Brook MS, Wilkinson DJ, Mitchell WK, Lund JN, Phillips BE, Szewczyk NJ, Greenhaff PL, Smith K, Atherton PJ. Synchronous deficits in cumulative muscle protein synthesis and ribosomal biogenesis underlie age-related anabolic resistance to exercise in humans. J Physiol 2016; 594:7399-7417. [PMID: 27654940 PMCID: PMC5157077 DOI: 10.1113/jp272857] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/19/2016] [Indexed: 12/25/2022] Open
Abstract
KEY POINTS Resistance exercise training (RET) is one of the most effective strategies for preventing declines in skeletal muscle mass and strength with age. Hypertrophic responses to RET with age are diminished compared to younger individuals. In response to 6 weeks RET, we found blunted hypertrophic responses with age are underpinned by chronic deficits in long-term muscle protein synthesis. We show this is likely to be the result of multifactorial deficits in anabolic hormones and blunted translational efficiency and capacity. These results provide great insight into age-related exercise adaptations and provide a platform on which to devise appropriate nutritional and exercise interventions on a longer term basis. ABSTRACT Ageing is associated with impaired hypertrophic responses to resistance exercise training (RET). Here we investigated the aetiology of 'anabolic resistance' in older humans. Twenty healthy male individuals, 10 younger (Y; 23 ± 1 years) and 10 older (O; 69 ± 3 years), performed 6 weeks unilateral RET (6 × 8 repetitions, 75% of one repetition maximum (1-RM), 3 times per week). After baseline bilateral vastus lateralis (VL) muscle biopsies, subjects consumed 150 ml D2 O (70 atom%; thereafter 50 ml week-1 ), further bilateral VL muscle biopsies were taken at 3 and 6 weeks to quantify muscle protein synthesis (MPS) via gas chromatography-pyrolysis-isotope ratio mass spectrometry. After RET, 1-RM increased in Y (+35 ± 4%) and O (+25 ± 3%; P < 0.01), while MVC increased in Y (+21 ± 5%; P < 0.01) but not O (+6 ± 3%; not significant (NS)). In comparison to Y, O displayed blunted RET-induced increases in muscle thickness (at 3 and 6 weeks, respectively, Y: +8 ± 1% and +11 ± 2%, P < 0.01; O: +2.6 ± 1% and +3.5 ± 2%, NS). While 'basal' longer term MPS was identical between Y and O (∼1.35 ± 0.1% day-1 ), MPS increased in response to RET only in Y (3 weeks, Y: 1.61 ± 0.1% day-1 ; O: 1.49 ± 0.1% day-1 ). Consistent with this, O exhibited inferior ribosomal biogenesis (RNA:DNA ratio and c-MYC induction: Y: +4 ± 2 fold change; O: +1.9 ± 1 fold change), translational efficiency (S6K1 phosphorylation, Y: +10 ± 4 fold change; O: +4 ± 2 fold change) and anabolic hormone milieu (testosterone, Y: 367 ± 19; O: 274 ± 19 ng dl-1 (all P < 0.05). Anabolic resistance is thus multifactorial.
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Affiliation(s)
- Matthew S. Brook
- MRC‐ARUK Centre of Excellence for Musculoskeletal Ageing ResearchClinical, Metabolic and Molecular PhysiologyUniversity of NottinghamDerbyUK
| | - Daniel J. Wilkinson
- MRC‐ARUK Centre of Excellence for Musculoskeletal Ageing ResearchClinical, Metabolic and Molecular PhysiologyUniversity of NottinghamDerbyUK
| | - William K. Mitchell
- MRC‐ARUK Centre of Excellence for Musculoskeletal Ageing ResearchClinical, Metabolic and Molecular PhysiologyUniversity of NottinghamDerbyUK
- Departments of SurgeryRoyal Derby HospitalDerbyUK
| | - Jonathan N. Lund
- MRC‐ARUK Centre of Excellence for Musculoskeletal Ageing ResearchClinical, Metabolic and Molecular PhysiologyUniversity of NottinghamDerbyUK
- Departments of SurgeryRoyal Derby HospitalDerbyUK
| | - Bethan E. Phillips
- MRC‐ARUK Centre of Excellence for Musculoskeletal Ageing ResearchClinical, Metabolic and Molecular PhysiologyUniversity of NottinghamDerbyUK
| | - Nathaniel J. Szewczyk
- MRC‐ARUK Centre of Excellence for Musculoskeletal Ageing ResearchClinical, Metabolic and Molecular PhysiologyUniversity of NottinghamDerbyUK
| | - Paul L. Greenhaff
- MRC‐ARUK Centre of Excellence for Musculoskeletal Ageing ResearchClinical, Metabolic and Molecular PhysiologyUniversity of NottinghamDerbyUK
| | - Kenneth Smith
- MRC‐ARUK Centre of Excellence for Musculoskeletal Ageing ResearchClinical, Metabolic and Molecular PhysiologyUniversity of NottinghamDerbyUK
| | - Philip J. Atherton
- MRC‐ARUK Centre of Excellence for Musculoskeletal Ageing ResearchClinical, Metabolic and Molecular PhysiologyUniversity of NottinghamDerbyUK
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Benichou O, Lord SR. Rationale for Strengthening Muscle to Prevent Falls and Fractures: A Review of the Evidence. Calcif Tissue Int 2016; 98:531-45. [PMID: 26847435 DOI: 10.1007/s00223-016-0107-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/04/2016] [Indexed: 12/11/2022]
Abstract
Falls represent a major public health problem in older people, predominantly due to the resulting injuries which lead to progressive disability, immobilization and resulting comorbidities, dependency, institutionalization, and death. Reduced muscle strength and power have been consistently identified as risk factors for falls and related injuries, and it is likely these associations result from the central role played by reduced muscle strength and power in poor balance recovery. In addition, muscle strength and power are involved with protective responses that reduce the risk of an injury if a fall occurs. Progressive resistance training (PRT) is the standard way to increase muscle strength and power, and this training forms one of the main components of fall prevention exercise interventions. However, PRT has rarely been implemented in routine practice due to multiple challenges inherent to frail older people. The ongoing development of drugs expected to increase muscle power offers a new opportunity to reduce the risk of falls and fall-related injuries. The intent here is not to replace exercise training with drugs but rather to offer a pharmacologic alternative when exercise is not possible or contraindicated. The target population would be those most likely to benefit from this mechanism of action, i.e., weak older people without major causes for falls independent of muscle weakness. Provided such a tailored strategy was followed, a muscle anabolic may address this major unmet need.
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Affiliation(s)
- Olivier Benichou
- Eli Lilly and Company, 24, Boulevard Vital-Bouhot, 92200, Neuilly, France.
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de Abreu EL, de Oliveira MHA. Evaluation of the quality of life of patients undergoing hemiarthroplasty of the hip. Rev Bras Ortop 2015; 50:530-6. [PMID: 26535198 PMCID: PMC4610992 DOI: 10.1016/j.rboe.2015.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 09/11/2014] [Indexed: 11/14/2022] Open
Abstract
Objective This was a comparative analysis on the quality of life of patients who underwent hemiarthroplasty of the hip, assessed before the operation and 3 and 6 months after the operation, by means of the SF-36 questionnaire (Medical Outcomes Study 36-Item Short Form health survey). Methods A prospective study was conducted on 12 patients with femoral neck fractures who underwent partial hip arthroplasty between June 2013 and July 2014. Female patients predominated (58.3%). The mean age was 83 years and, in 91.7%, the fracture was due to falling from a standing position. The SF-36 questionnaire was applied before the operation and 3 and 6 months after the operation. Results With regard to physical health, the patients presented low scores for functional capacity and physical aspects. They had good scores for the subitem of general state and high scores regarding pain. Vitality, social aspect and mental health had moderate scores and emotional aspects had a low score. Conclusion With the sample analyzed here, we can say that the hip hemiarthroplasty procedure for cases of unstable femoral neck fractures, in patients with low functional demands analyzed over a postoperative period of 6 months, does indeed allow quality of life to be maintained.
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Hikichi H, Kondo N, Kondo K, Aida J, Takeda T, Kawachi I. Effect of a community intervention programme promoting social interactions on functional disability prevention for older adults: propensity score matching and instrumental variable analyses, JAGES Taketoyo study. J Epidemiol Community Health 2015; 69:905-10. [PMID: 25888596 PMCID: PMC4552922 DOI: 10.1136/jech-2014-205345] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 03/05/2015] [Accepted: 03/26/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND The efficacy of promoting social interactions to improve the health of older adults is not fully established due to residual confounding and selection bias. METHODS The government of Taketoyo town, Aichi Prefecture, Japan, developed a resident-centred community intervention programme called 'community salons', providing opportunities for social interactions among local older residents. To evaluate the impact of the programme, we conducted questionnaire surveys for all older residents of Taketoyo. We carried out a baseline survey in July 2006 (prior to the introduction of the programme) and assessed the onset of functional disability during March 2012. We analysed the data of 2421 older people. In addition to the standard Cox proportional hazard regression, we conducted Cox regression with propensity score matching (PSM) and an instrumental variable (IV) analysis, using the number of community salons within a radius of 350 m from the participant's home as an instrument. RESULTS In the 5 years after the first salon was launched, the salon participants showed a 6.3% lower incidence of functional disability compared with non-participants. Even adjusting for sex, age, equivalent income, educational attainment, higher level activities of daily living and depression, the Cox adjusted HR for becoming disabled was 0.49 (95% CI 0.33 to 0.72). Similar results were observed using PSM (HR 0.52, 95% CI 0.33 to 0.83) and IV-Cox analysis (HR 0.50, 95% CI 0.34 to 0.74). CONCLUSIONS A community health promotion programme focused on increasing social interactions among older adults may be effective in preventing the onset of disability.
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Affiliation(s)
- Hiroyuki Hikichi
- Center for Preventive Medical Science, Chiba University, Chiba, Japan
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Naoki Kondo
- School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Science, Chiba University, Chiba, Japan
- Centor for Well-being and Society, Nihon Fukushi University, Nagoya, Japan
| | - Jun Aida
- Department of International and Community Oral Health, Tohoku University Graduate School of Density, Sendai, Japan
| | - Tokunori Takeda
- Faculty of Rehabilitation and Care, Seijoh University, Tokai, Japan
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
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Avaliação da qualidade de vida dos pacientes submetidos à hemiartroplastia do quadril. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2014.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Effect of Agility Training Under Single-Task Condition Versus Training Under Dual-Task Condition With Different Task Priorities to Improve Balance in the Elderly. TOPICS IN GERIATRIC REHABILITATION 2015. [DOI: 10.1097/tgr.0000000000000054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dotta TDAG, Bonadio MB, Furlaneto ME, Silva JDS, Leme LEG. Prevalence of acute diseases in the elderly assisted in emergency department of orthopedics. ACTA ORTOPEDICA BRASILEIRA 2014; 22:99-101. [PMID: 24868189 PMCID: PMC4031255 DOI: 10.1590/1413-78522014220200854] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 11/19/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To make an analysis of the care of elderly in an Emergency Department of Orthopedics with the primary objective to know the percentage of elderly treated, their conditions of origin and level of accidental conditions, and examine possible comorbidities, evolution and mortality rate. METHODS Retrospective observational epidemiological study based on survey records of a tertiary hospital during one year (January to December 2006). RESULTS In the year 2006 (January to December) 12,916 calls to patients older than 60 were performed. CONCLUSION Massive attendance of the elderly population was observed, however, the vast majority related to chronic problems that do not require urgent attention. Patients requiring urgent attention suffer from trauma related to falls and are between the seventh and ninth decades of life, mostly female and requiring hospitalization for longer periods. Level of Evidence VI, Cases Series.
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Affiliation(s)
- Thiago de Angelis Guerra Dotta
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil, Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcelo Batista Bonadio
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil, Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Maria Elisabet Furlaneto
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil, Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Jorge Dos Santos Silva
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil, Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Luiz Eugênio Garcez Leme
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil, Institute of Orthopedics and Traumatology, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Letts L, Moreland J, Richardson J, Coman L, Edwards M, Ginis KM, Wilkins S, Wishart L. The physical environment as a fall risk factor in older adults: Systematic review and meta-analysis of cross-sectional and cohort studies. Aust Occup Ther J 2010; 57:51-64. [DOI: 10.1111/j.1440-1630.2009.00787.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Peeters G, van Schoor NM, Lips P. Fall risk: the clinical relevance of falls and how to integrate fall risk with fracture risk. Best Pract Res Clin Rheumatol 2009; 23:797-804. [DOI: 10.1016/j.berh.2009.09.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kikuchi R, Kozaki K, Iwata A, Hasegawa H, Toba K. Evaluation of risk of falls in patients at a memory impairment outpatient clinic. Geriatr Gerontol Int 2009; 9:298-303. [DOI: 10.1111/j.1447-0594.2009.00539.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Delbaere K, Crombez G, Van Den Noortgate N, Willems T, Cambier D. The risk of being fearful or fearless of falls in older people: An empirical validation. Disabil Rehabil 2009; 28:751-6. [PMID: 16754572 DOI: 10.1080/09638280500304794] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the risk of being fearful or fearless of falls in older people. METHODS Using a force plate, postural control in different sensory and rhythmic conditions was measured in 263 community-dwelling older people. Other assessments included fear of falling, and handgrip strength. Fall incidence was assessed at baseline and during a one-year follow-up period. RESULTS Logistic regression analysis revealed that increased lateral sway in near-tandem stance with eyes open (OR = 5.33; p < 0.01) and a worse performance on anteroposterior rhythmic weight shifts (OR = 0.65; p < 0.05) were related to falls. Univariate analyses revealed that older people with inappropriate high fear of falling according to their fall incidence had worse balance capacities on the rhythmic weight shifts (p < 0.05) but had similar static balance and physical capacities. Older people with inappropriate low fear of falling had a better hand grip (p < 0.05) but equally worse balance capacities than the comparison group. CONCLUSIONS The results indicate the importance of lateral stability in relation to falls. They also suggest a substantial impact of inappropriate fear of falling on physical performance. Inappropriate high fear of falling may result in worse performance during dynamic balance tests, whereas older people with inappropriate low fear seem to overrate their capacities because of higher strength.
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Affiliation(s)
- Kim Delbaere
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Belgium.
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Roig M, Eng JJ, Road JD, Reid WD. Falls in patients with chronic obstructive pulmonary disease: a call for further research. Respir Med 2009; 103:1257-69. [PMID: 19419852 DOI: 10.1016/j.rmed.2009.03.022] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Accepted: 03/31/2009] [Indexed: 12/25/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a respiratory disease that results in airflow limitation and respiratory distress. The effects of COPD, however, are not exclusively limited to respiratory function and people with COPD face many non-respiratory manifestations that affect both function and mobility. Deficits in function and mobility have been associated with an increased risk for falling in older adults. The purpose of this study was to provide a theoretical framework to identify risks factors for falls in people with COPD. We have analyzed the literature to identify possible relationships between pathophysiological changes observed in COPD and common risk factors for falls. Well-established fall risk factors in people with COPD include lower limb muscle weakness and impaired activities of daily living. Other intrinsic risk factors such as gait and balance deficits, nutritional depletion, malnutrition, depression, cognitive impairments and medications are possible risk factors that need to be confirmed with more studies. There is no evidence that visual deficits are common in COPD. The role that precipitating factors such as syncope and postural hypotension may have on fall risk is unclear. Exacerbations and dyspnea do not have a precipitating effect on fall risk but they contribute to the progressive physical deterioration that may theoretically increase the risk for falls. While these results suggest that people with COPD might have an increased susceptibility to fall compared to their healthy peers, further research is needed to determine the prevalence of falls and specific risk factors for falls in people living with COPD.
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Affiliation(s)
- Marc Roig
- Department of Physical Therapy, University of British Columbia, 828 West 10th Avenue, Vancouver, Canada.
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Ulusoy H, Bilgici A, Kuru O, Sarica N, Arslan S, Erkorkmaz U. A new value of proximal femur geometry to evaluate hip fracture risk: true moment arm. Hip Int 2009; 18:101-7. [PMID: 18645983 DOI: 10.1177/112070000801800206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study was undertaken to determine the influence of proximal femur geometry on hip fracture risk independent of bone mineral density. We examined 34 hip fracture subjects (17 men, 17 women) and 36 control subjects (18 men, 18 women). The control subjects were matched with the hip fracture patients by femoral neck bone mineral density (+ or - 0.100 g/cm(2)). Hip axis length (HAL), femoral axis length (FAL), femoral neck-shaft angle (Theta angle), lateral and medial femoral cortical thickness were measured on standart pelvic radiographs. In the literature, there are conflicting views of the relationship between femur geometry and hip fracture risk which may be explained by different definitions of some parameters. We investigated the effect of a new parameter called true moment arm (TMA) on hip fracture risk. Longer TMA may be correlated to higher transmission of impact energy to the femoral neck. Thus it may be useful to define fracture prone individuals. The results of this study showed that HAL, FAL and TMA were significantly longer in the hip fracture subjects compared to the control group (p<0.001). Hip fracture patients had thinner lateral and medial femoral cortical thickness (p<0.001). Theta angle was wider in the hip fracture group than in the control group (p<0.001). In conclusion, our study showed that evaluation of TMA in addition to HAL, FAL, Theta angle, MCT and LCT can be used to determine of the fracture risk independently of BMD.
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Affiliation(s)
- H Ulusoy
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey.
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Abstract
Falls are common in the elderly, and frequently result in injury and disability. Most falls result from an interaction between individual characteristics that increase an individual's propensity to fall and acute mediating risk factors that provide the opportunity to fall. Predisposing risk factors include age-associated changes in strength and balance, comorbidities such as osteoarthritis, visual impairment and dementia, psychotropic medications, and certain types of footwear. Fewer studies have focused on acute precipitating factors, but environmental and situational factors are clearly important to fall risk. Approximately 30% of falls result in an injury that requires medical attention, with fractures occurring in approximately 10%. In addition to the risk factors for falls, the fall descent, fall impact, and bone strength are all important determinants of whether a fall will result in a fracture. In recent years, numerous studies have been directed toward the development of effective fall and fall-related fracture prevention interventions.
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Affiliation(s)
- Sarah D. Berry
- Hebrew SeniorLife, Institute for Aging Research, 1200 Centre Street, Boston, MA 02131, 617-363-8237,
| | - Ram Miller
- Division of Gerontology, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, 410-706-2406,
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van Londen GJ, Levy ME, Perera S, Nelson JB, Greenspan SL. Body composition changes during androgen deprivation therapy for prostate cancer: a 2-year prospective study. Crit Rev Oncol Hematol 2008; 68:172-7. [PMID: 18706829 DOI: 10.1016/j.critrevonc.2008.06.006] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Revised: 05/30/2008] [Accepted: 06/17/2008] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Little is known about the long-term impact of androgen deprivation therapy (ADT) on body composition in men with prostate cancer. We compared body composition parameters in men with non-metastatic prostate cancer on or not on therapy with healthy, age-matched controls at baseline and monitored changes over a 2-year period. METHODS We measured body fat mass and lean body mass in 81 men with prostate cancer on no ADT, 43 men on acute ADT (less than 6 months), 67 men on chronic ADT (more than 6 months) and 53 age-matched healthy controls. Measurements were performed every 6 months for 2 years. RESULTS Men with prostate cancer on acute ADT (mean 3 months) had significant gains in body fat mass [1499.56+/-322.28g (mean+/-S.E.) after 12 months, 2167.15+/-676.45g after 24 months, p<0.01 for both] and losses in lean body mass (929.74+/-296.36g after 12 months, 1785.81+/-501.31g after 24 months, p<0.01 for both) over 2 years. Men on chronic ADT (mean 31 months) had smaller but still significant body composition changes over 24 months. Changes in body composition in men on no ADT were small and healthy controls had no significant changes. CONCLUSIONS Men with prostate cancer on ADT have significant gains in body fat mass and losses lean body mass over 2 years. These changes are most pronounced with initiation of ADT.
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Repressive coping in geriatric patients’ reports – Impact on fear of falling. Z Gerontol Geriatr 2008; 42:137-44. [DOI: 10.1007/s00391-008-0552-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Accepted: 05/06/2008] [Indexed: 10/21/2022]
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Tarnopolsky M, Zimmer A, Paikin J, Safdar A, Aboud A, Pearce E, Roy B, Doherty T. Creatine monohydrate and conjugated linoleic acid improve strength and body composition following resistance exercise in older adults. PLoS One 2007; 2:e991. [PMID: 17912368 PMCID: PMC1994592 DOI: 10.1371/journal.pone.0000991] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2007] [Accepted: 09/05/2007] [Indexed: 12/22/2022] Open
Abstract
Aging is associated with lower muscle mass and an increase in body fat. We examined whether creatine monohydrate (CrM) and conjugated linoleic acid (CLA) could enhance strength gains and improve body composition (i.e., increase fat-free mass (FFM); decrease body fat) following resistance exercise training in older adults (>65 y). Men (N = 19) and women (N = 20) completed six months of resistance exercise training with CrM (5g/d)+CLA (6g/d) or placebo with randomized, double blind, allocation. Outcomes included: strength and muscular endurance, functional tasks, body composition (DEXA scan), blood tests (lipids, liver function, CK, glucose, systemic inflammation markers (IL-6, C-reactive protein)), urinary markers of compliance (creatine/creatinine), oxidative stress (8-OH-2dG, 8-isoP) and bone resorption (Ν-telopeptides). Exercise training improved all measurements of functional capacity (P<0.05) and strength (P<0.001), with greater improvement for the CrM+CLA group in most measurements of muscular endurance, isokinetic knee extension strength, FFM, and lower fat mass (P<0.05). Plasma creatinine (P<0.05), but not creatinine clearance, increased for CrM+CLA, with no changes in serum CK activity or liver function tests. Together, this data confirms that supervised resistance exercise training is safe and effective for increasing strength in older adults and that a combination of CrM and CLA can enhance some of the beneficial effects of training over a six-month period. Trial Registration. ClinicalTrials.gov NCT00473902
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Affiliation(s)
- Mark Tarnopolsky
- Department of Pediatrics and Medicine, McMaster University, Hamilton, Ontario, Canada.
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Windelinckx A, De Mars G, Beunen G, Aerssens J, Delecluse C, Lefevre J, Thomis MAI. Polymorphisms in the vitamin D receptor gene are associated with muscle strength in men and women. Osteoporos Int 2007; 18:1235-42. [PMID: 17406766 DOI: 10.1007/s00198-007-0374-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2006] [Accepted: 03/16/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Vitamin D receptor (VDR) polymorphisms have been associated with fracture risk and muscle strength, although evidence for the latter is limited and conflicting. METHODS BsmI, TaqI and FokI VDR polymorphisms were genotyped in 253 men (54.9 +/- 10.2 yr) and 240 women (41.5 +/- 13.2 yr). Haplotypes were constructed for BsmI and TaqI. Handgrip, isometric (at 60 degrees , 120 degrees and 180 degrees joint angle) and eccentric torques (60 degrees /s) of knee extension and flexion were analysed using AN(C)OVA. Torque-velocity curves were constructed for concentric torques at 60 degrees /s, 180 degrees /s and 240 degrees /s and analysed using multivariate AN(C)OVA. Age, height and fat-free mass were included as covariates. RESULTS Quadriceps isometric and concentric strength were higher in female f/f homozygotes compared to F allele carriers. Adjustment for confounding factors rendered results for quadriceps isometric strength at 120 degrees non-significant. No significant association was found with BsmI-TaqI haplotype in women. In contrast, male Bt/Bt homozygotes had higher isometric quadriceps strength at 150 degrees and higher concentric quadriceps strength than bT allele carriers without and with adjustment for confounding factors. No association was observed with FokI in men. In both genders, no interaction effect was present between BsmI-TaqI haplotype and FokI. CONCLUSIONS Different VDR gene polymorphisms are associated with quadriceps strength in men and women.
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Affiliation(s)
- A Windelinckx
- Research Center for Exercise and Health, Department of Biomedical Kinesiology, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, B-3001, Leuven, Belgium.
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Melov S, Tarnopolsky MA, Beckman K, Felkey K, Hubbard A. Resistance exercise reverses aging in human skeletal muscle. PLoS One 2007; 2:e465. [PMID: 17520024 PMCID: PMC1866181 DOI: 10.1371/journal.pone.0000465] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 04/25/2007] [Indexed: 01/07/2023] Open
Abstract
Human aging is associated with skeletal muscle atrophy and functional impairment (sarcopenia). Multiple lines of evidence suggest that mitochondrial dysfunction is a major contributor to sarcopenia. We evaluated whether healthy aging was associated with a transcriptional profile reflecting mitochondrial impairment and whether resistance exercise could reverse this signature to that approximating a younger physiological age. Skeletal muscle biopsies from healthy older (N = 25) and younger (N = 26) adult men and women were compared using gene expression profiling, and a subset of these were related to measurements of muscle strength. 14 of the older adults had muscle samples taken before and after a six-month resistance exercise-training program. Before exercise training, older adults were 59% weaker than younger, but after six months of training in older adults, strength improved significantly (P<0.001) such that they were only 38% lower than young adults. As a consequence of age, we found 596 genes differentially expressed using a false discovery rate cut-off of 5%. Prior to the exercise training, the transcriptome profile showed a dramatic enrichment of genes associated with mitochondrial function with age. However, following exercise training the transcriptional signature of aging was markedly reversed back to that of younger levels for most genes that were affected by both age and exercise. We conclude that healthy older adults show evidence of mitochondrial impairment and muscle weakness, but that this can be partially reversed at the phenotypic level, and substantially reversed at the transcriptome level, following six months of resistance exercise training.
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Affiliation(s)
- Simon Melov
- Buck Institute for Age Research, Novato, California, United States of America
- * To whom correspondence should be addressed. E-mail: (SM); (MT)
| | - Mark A. Tarnopolsky
- McMaster University, Department of Pediatrics and Medicine, Hamilton, Canada
- * To whom correspondence should be addressed. E-mail: (SM); (MT)
| | - Kenneth Beckman
- Center for Genetics, Children's Hospital Oakland Research Institute, Oakland, California, United States of America
| | - Krysta Felkey
- Buck Institute for Age Research, Novato, California, United States of America
| | - Alan Hubbard
- Buck Institute for Age Research, Novato, California, United States of America
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Garcia R, Leme MD, Garcez-Leme LE. Evolution of Brazilian elderly with hip fracture secondary to a fall. Clinics (Sao Paulo) 2006; 61:539-44. [PMID: 17187090 DOI: 10.1590/s1807-59322006000600009] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Accepted: 08/29/2006] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To contribute to fall prevention by studying the epidemiological profile, mortality, and functional evolution of elderly persons with hip fracture, in Brazil, in the year following a fracture. METHOD Fifty-six elderly patients aged 60 years and over with hip fracture secondary to a fall and admitted in 2000 were included. In addition to the medical record data, patients or their guardians filled a form providing information regarding personal data, history of fall and fracture, physical evaluation, and ability to perform basic and instrumental activities of daily living prior to and 1 year after their fracture, using Katz's Index and Lawton's Index, respectively. RESULTS Fractures were more common among Caucasian widowed women, and most falls occurred at home. General mortality within 1 year after the occurrence of fracture was 30.35% and was associated with sex and age. There was an increase in the inability to walk and in the use of a supporting device. A significant reduction in the functional ability to perform basic and instrumental activities of daily living was found. CONCLUSION The evolution of hip fracture in the year following it is related to high mortality and to a decrease in functional ability, with age and male sex being the factors associated with a worse prognosis, emphasizing the need for special follow-up care of these groups during the immediate and late postoperative periods.
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Affiliation(s)
- Rosamaria Garcia
- Department of Orthopedics and Traumatology, Orthogeriatric Group, São Paulo University Medical School, São Paulo, SP, Brazil
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Shigematsu R, Rantanen T, Saari P, Sakari-Rantala R, Kauppinen M, Sipilä S, Heikkinen E. Motor speed and lower extremity strength as predictors of fall-related bone fractures in elderly individuals. Aging Clin Exp Res 2006; 18:320-4. [PMID: 17063067 DOI: 10.1007/bf03324666] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS The purpose of this prospective population-based study was to examine the combined effects of motor speed and knee extension strength on risk of fall-related bone fractures in elderly individuals over a 10-year period. METHODS Participants were 307 men and women aged 75 or 80 years at baseline, who visited the research laboratory at the University of Jyväskylä, Finland. Multi-choice motor speed tests and maximal isometric knee extension strength tests were carried out at baseline. Information on fractures was collected from hospital and health center records. The presence of impairment was defined as a score in the lowest tertile of sex- and age-stratified distribution of results in each test. RESULTS During the 10-year period, 93 participants had at least one fracture. In Cox proportional hazards models for motor speed and knee extension strength, the risk of fracture was almost double in the lowest vs the highest tertile of each test score. For those in the poorest speed and strength tertiles compared with the best speed and strength tertiles, the relative risk of fracture adjusted for age, sex and bone mineral density was 4.69 (95% confidence interval 1.72-12.81). CONCLUSIONS Increased risk of fracture was observed for those with either slow motor speed or poor lower extremity strength; however, a combination of these impairments increased the fracture risk significantly when compared with those with no impairments. A co-impairment approach may prove useful in gaining better understanding of the risk of fall-related bone fractures and the development of effective interventions.
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Affiliation(s)
- Ryosuke Shigematsu
- Faculty of Education, Mie University, Kurima-machiya 1577, Tsu, Mie 514-8507, Japan.
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Shigematsu R, Okura T. A novel exercise for improving lower-extremity functional fitness in the elderly. Aging Clin Exp Res 2006; 18:242-8. [PMID: 16804371 DOI: 10.1007/bf03324655] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Many falls in the elderly are caused by tripping. After tripping, a certain level of lower-extremity functional fitness is necessary, in order to make protective responses and to avoid falling. The purpose of this study was to test whether our new exercise program (a square-stepping exercise: SSE) would improve lower-extremity functional fitness in the elderly. METHODS Fifty-two individuals aged 60-80 years were divided into two groups (non-randomized control design); SSE (n=26) and controls (n=26). Lower-extremity functional fitness was defined as standing up from a lying position (agility), chair-stand in ten seconds (leg power), walking round two cones (locomotion speed), sit-and-reach (flexibility) and single-leg balance with eyes closed (balance). The SSE group participated in a six-month regimen of SSE once a week. SSE was performed on a thin mat of 250 cm by 100 cm, partitioned into 40 small squares (25 cm each side). SSE included not only forward steps but also backward, lateral and oblique steps, and step patterns were progressively made more complicated. Controls maintained their usual lifestyles. RESULTS In the SSE group, significant improvements were observed in agility, leg power, locomotion speed, flexibility and balance. No significant changes were detected in any tests in the control group. CONCLUSIONS The SSE program improved lower-extremity functional fitness, lack of which constitutes a risk factor for falls in the elderly. This program should be tested further to determine if it can effectively reduce the incidence of falls in the elderly.
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Affiliation(s)
- Ryosuke Shigematsu
- Faculty of Education, Mie University, Tsu-city, Mie Prefecture, Japan 514-8507.
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Lehtola S, Koistinen P, Luukinen H. Falls and injurious falls late in home-dwelling life. Arch Gerontol Geriatr 2006; 42:217-24. [PMID: 16125808 DOI: 10.1016/j.archger.2005.07.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Revised: 07/04/2005] [Accepted: 07/07/2005] [Indexed: 10/25/2022]
Abstract
Of the Finnish persons aged 85 years or older, living at home, 555 (67% of this age class) were monitored for two years to describe the circumstances and the frequency of falls and injury-causing falls. The incidence rates of falls, major soft tissue injuries and fractures were 1039 (95% confidence interval = CI: 974-1093), 74 (58-92) and 89 (72-108), respectively. The incidence of falls was higher among women 1127 (1055-1199) than among men 755 (651-870), but only among those younger than 90 years. The probability of getting injured in a fall was higher in the morning (p = 0.010) and in the evening (p = 0.007) as compared to the daytime. More injury-causing falls than other falls were non-defined as regards ongoing activity at the time of fall (p < 0.001) and type of falling (p < 0.001). Ongoing activity and type of falling did not discriminate injury-causing falls from other falls after exclusion of the non-defined falls. We conclude that incidence of falls among the home-dwelling elderly increases up to the oldest ages, especially among the men. Time of day affects the occurrence of injuries in falls. Ongoing activity and type of falling play a minor role in falls causing injuries among the most elderly.
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Affiliation(s)
- Sari Lehtola
- Department of Public Health Science and General Practice, University of Oulu, PB 5000, FIN-90014 Oulu, Finland
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Sipilä S, Heikkinen E, Cheng S, Suominen H, Saari P, Kovanen V, Alén M, Rantanen T. Endogenous Hormones, Muscle Strength, and Risk of Fall-Related Fractures in Older Women. J Gerontol A Biol Sci Med Sci 2006; 61:92-6. [PMID: 16456199 DOI: 10.1093/gerona/61.1.92] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Among older people, fracture-causing fall often leads to health deterioration. The role of endogenous hormone status and muscle strength on fall-related fracture risk is unclear. This study investigates if, after adjustment for bone density, endogenous hormones and muscle strength would predict fall-related limb fracture incidence in older community-dwelling women followed-up over 10 years. METHODS As a part of a prospective population-based study, 187 75-year-old women were investigated. Serum estradiol, testosterone, sex hormone binding globulin, and dehydroepiandrosterone sulfate concentrations were analyzed, and isometric muscle strength and bone mineral density were assessed. Fall-related limb fractures were gathered from patient records. RESULTS Serum estradiol concentration was a significant predictor of fall-related limb fractures. Women with serum estradiol concentrations less than 0.022 nmol/L had a 3-fold risk (relative risk 3.05; 95% confidence interval, 1.26-7.36), and women with estradiol concentrations between 0.022 and 0.066 nmol/L doubled the risk (relative risk 2.24; 95% confidence interval, 0.97-5.19) of fall-related limb fracture compared to the women with estradiol concentrations ()above 0.066 nmol/L. Adjustment for muscle strength and bone mineral density did not materially change the risk estimates. High muscle strength was associated with a low incidence of fall-related limb fractures. CONCLUSIONS This study showed that in 75-year-old women higher serum estradiol concentration and greater muscle strength were independently associated with a low incidence of fall-related limb fractures even after adjustment for bone density. Our results suggest that hormonal status and muscle strength have their own separate mechanisms protecting from fall-related fractures. This finding is of importance in developing preventive strategies, but calls for further study.
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Affiliation(s)
- Sarianna Sipilä
- Department of Health Sciences, University of Jyväskylä, P.O. Box 35 (Viv), FIN-40014 Jyväskylä, Finland.
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Greenspan SL, Coates P, Sereika SM, Nelson JB, Trump DL, Resnick NM. Bone loss after initiation of androgen deprivation therapy in patients with prostate cancer. J Clin Endocrinol Metab 2005; 90:6410-7. [PMID: 16189261 DOI: 10.1210/jc.2005-0183] [Citation(s) in RCA: 295] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Although androgen deprivation therapy (ADT) for prostate cancer is associated with bone loss, little is known about when this bone loss occurs. OBJECTIVE We postulated that men on ADT would experience the greatest bone loss acutely after initiation of ADT. DESIGN AND SETTING We conducted a 12-month prospective study at an academic medical center. PATIENTS OR OTHER PARTICIPANTS We studied 152 men with prostate cancer (30 with acute ADT, < 6 months; 50 with chronic ADT, > or = 6 months; and 72 with no ADT) and 43 healthy age-matched controls. MAIN OUTCOME MEASURES We assessed bone mineral density (BMD) of the hip, wrist, total body, and spine; body composition; and markers of bone turnover. RESULTS After 12 months, men receiving acute ADT had a significant reduction in BMD of 2.5 +/- 0.6% at the total hip, 2.4 +/- 1.0% at the trochanter, 2.6 +/- 0.5% at the total radius, 3.3 +/- 0.5% at the total body, and 4.0 +/- 1.5% at the posteroanterior spine (all P < 0.05). Men with chronic ADT had a 2.0 +/- 0.6% reduction in BMD at the total radius (P < 0.05). Healthy controls and men with prostate cancer not receiving ADT had no significant reduction in BMD. Both use and duration of ADT were associated with change in bone mass at the hip (P < 0.05). Men receiving acute ADT had a 10.4 +/- 1.7% increase in total body fat and a 3.5 +/- 0.5% reduction in total body lean mass at 12 months, whereas body composition did not change in men with prostate cancer on chronic ADT or in healthy controls (P < 0.05). Markers of bone formation and resorption were elevated in men receiving acute ADT after 6 and 12 months compared with the other men with prostate cancer and controls (P < 0.05). Men in the highest tertile of bone turnover markers at 6 months had the greatest loss of bone density at 12 months. CONCLUSIONS Men with prostate cancer who are initiating ADT have a 5- to 10-fold increased loss of bone density at multiple skeletal sites compared with either healthy controls or men with prostate cancer who are not on ADT, placing them at increased risk of fracture. Bone loss is maximal in the first year after initiation of ADT, suggesting initiation of early preventive therapy.
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Affiliation(s)
- Susan L Greenspan
- Osteoporosis Prevention and Treatment Center, University of Pittsburgh, Kaufmann Medical Building, Suite 1110, 3471 Fifth Avenue, Pittsburgh, Pennsylvania 15213-3221, USA.
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Takazawa K, Arisawa K. Relationship between the type of urinary incontinence and falls among frail elderly women in Japan. THE JOURNAL OF MEDICAL INVESTIGATION 2005; 52:165-71. [PMID: 16167534 DOI: 10.2152/jmi.52.165] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Urinary incontinence and falls are serious problem among elderly people, because of restriction of the Activities of Daily Living (ADL) and Quality of Life. Previous studies have examined the association between urinary incontinence and falls. However, results have been inconsistent. In Japan, with the rapid aging of the society, the number of elderly women who have urinary incontinence and are at risk of falling is increasing. We investigated the relationship between type of urinary incontinence and risk of falls among elderly users of day-care services in a long-term care system. Our study population comprised 118 ambulatory women. At baseline, we evaluated incontinent status, lower extremity muscle strength, balance ability, ADL, and Instrumental ADL. We asked subjects about number of falls every 4 months during a year. In univariate analysis, lower extremity muscle strength (p = 0.001) and mixed incontinence (p = 0.050) differed significantly according to the fall status. Stress and urge incontinence were not significantly associated with falls. In logistic regression analysis, subjects who had mixed incontinence were 3.05 (95% confidence interval 1.01-10.2) times more likely to fall than those without. These results suggest that mixed incontinence have independent associations with falls. Incontinent status should be considered to prevent falls among elderly persons who are partially dependent and need support.
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Affiliation(s)
- Kotaro Takazawa
- Department of Rehabilitation, Shinjuen Hospital, 3453-1, Yagihara, Seihi, Saikai, Nagasaki 851-3423, Japan
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Bergland A, Laake K. Concurrent and predictive validity of "getting up from lying on the floor". Aging Clin Exp Res 2005; 17:181-5. [PMID: 16110729 DOI: 10.1007/bf03324594] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Older age, higher morbidity and lower functional capacity are associated with fall injuries. Inability to get up from the floor is associated with older age, higher morbidity and lower functional capacity. The purpose of this study was to assess the concurrent and predictive validity of the ability of elderly women to get up from lying on the floor. METHODS In a random sample of 307 women aged 75 years and over (mean 80.8 years, response rate 74.5%) living in the community, baseline registrations of ability to get up from lying on the floor, health and function were recorded. Serious fall injuries during the subsequent year served as the outcome. RESULTS 240 (78.2%) managed to get up independently. The highest independent association was with items primarily related to mobility, e.g., ability to climb steps and performance on the Timed Up & Go test (TUG). However, arthrosis of the hip and difficulty with walking indoors were among the variables independently associated with the ability to get up from lying on the floor. During the follow-up year, 50.5% experienced falls, of which one in four resulted in serious injury and one in eight in a fracture. The ability to get up from lying on the floor was a significant predictor of serious fall-related injury (OR 2.1). Among those who experienced a fall, the risk of injury was markedly higher for those unable to rise (OR 3.7). The positive predictive value of being unable to rise for serious injury was 0.30, indicating that nearly one out of three of the elderly women with such problems are predicted to experience a serious fall-related injury during the following 12 months. CONCLUSIONS The test "get up from lying on the floor" is a marker of failing health and function in the elderly and a significant predictor of serious fall injuries.
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Affiliation(s)
- Astrid Bergland
- Faculty of Health Sciences, Oslo University College, Oslo, Norway.
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Gerdhem P, Ringsberg KAM, Akesson K, Obrant KJ. Clinical history and biologic age predicted falls better than objective functional tests. J Clin Epidemiol 2005; 58:226-32. [PMID: 15718110 DOI: 10.1016/j.jclinepi.2004.06.013] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2004] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Fall risk assessment is important because the consequences, such as a fracture, may be devastating. The objective of this study was to find the test or tests that best predicted falls in a population-based sample of elderly women. STUDY DESIGN AND SETTING The fall-predictive ability of a questionnaire, a subjective estimate of biologic age and objective functional tests (gait, balance [Romberg and sway test], thigh muscle strength, and visual acuity) were compared in 984 randomly selected women, all 75 years of age. RESULTS A recalled fall was the most important predictor for future falls. Only recalled falls and intake of psycho-active drugs independently predicted future falls. Women with at least five of the most important fall predictors (previous falls, conditions affecting the balance, tendency to fall, intake of psychoactive medication, inability to stand on one leg, high biologic age) had an odds ratio of 11.27 (95% confidence interval 4.61-27.60) for a fall (sensitivity 70%, specificity 79%). CONCLUSION The more time-consuming objective functional tests were of limited importance for fall prediction. A simple clinical history, the inability to stand on one leg, and a subjective estimate of biologic age were more important as part of the fall risk assessment.
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Affiliation(s)
- Paul Gerdhem
- Department of Orthopaedics, Malmö University Hospital, SE-205 02 Malmö, Sweden.
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Gnudi S, Malavolta N, Testi D, Viceconti M. Differences in proximal femur geometry distinguish vertebral from femoral neck fractures in osteoporotic women. Br J Radiol 2004; 77:219-23. [PMID: 15020363 DOI: 10.1259/bjr/79551075] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bone mineral density (BMD) is generally used to predict the risk of fracture in osteoporotic subjects. However, femoral neck BMD and spine BMD have been reported not to be significantly different among patients with hip or vertebral fractures, suggesting that other risk factors are needed to determine the different fracture types. Proximal femur geometry (PFG) parameters, such as hip axis length (HAL), femoral neck-shaft angle (NSA) and femoral neck diameter (FND) have also been shown to predict the risk of hip fracture. These parameters are statistically different in spine fractures compared with both types of hip fractures (trochanteric and femoral neck) when considered together. We wanted to assess the difference in these parameters by comparing spine fractures with a homogeneous group of hip fractures, i.e. femoral neck fractures. 807 post-menopausal women were divided into three groups; those with vertebral fractures (182), those with femoral neck fractures (134) and a control group without fractures (491). Dual X-ray absorptiometry (DXA) scans of the spine and hip were carried out to measure BMD and define the PFG parameters of the hip. Data were statistically analysed. In agreement with other authors, we found that women with femoral neck fractures had longer HAL, wider FND and larger NSA than controls, whereas there were no statistically significant differences in PFG between women with spine fractures and controls. Logistic regression showed HAL and NSA could predict the risk of femoral neck but not vertebral fracture. These data indicate specificity of some PFG parameters for hip fracture risk.
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Affiliation(s)
- S Gnudi
- Modulo Dipartimentale di Medicina Generale, Istituto Ortopedico Rizzoli, Via Pupilli, 1, 40100 Bologna, Italy
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Murphy SL, Dubin JA, Gill TM. The development of fear of falling among community-living older women: predisposing factors and subsequent fall events. J Gerontol A Biol Sci Med Sci 2003; 58:M943-7. [PMID: 14570863 PMCID: PMC3050034 DOI: 10.1093/gerona/58.10.m943] [Citation(s) in RCA: 143] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fear of falling is a common and potentially modifiable health problem among older persons. However, relatively little is known about who develops fear of falling or why. METHODS From a representative cohort of community-living persons aged 72 years or older, we evaluated 313 women who had no fear of falling. These participants underwent a comprehensive in-home assessment and were reassessed for fear of falling 1 year later. Fall events were ascertained monthly using a validated fall calendar. RESULTS 84 (27%) participants developed fear of falling at 1 year and 77 (25%) participants experienced at least one fall event. The predisposing factors for developing fear of falling included age 80 years or older (adjusted relative risk 1.48; 95% confidence intervals 1.04-2.12), visual impairment (1.42; 1.01-2.00), a sedentary lifestyle (1.96; 1.35-2.84), and no available emotional support (2.64; 1.57-4.41). The occurrence of a subsequent fall event was also significantly associated with developing fear of falling (unadjusted relative risk 1.70; 1.18-2.45), although this effect was observed only among participants who had at least one predisposing factor. CONCLUSIONS Among community-living older women, fear of falling develops due to a combination of predisposing factors and subsequent fall events. Since many of the predisposing factors are related to fall risk, preventive efforts to reduce fear of falling may also decrease the likelihood of falling.
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Affiliation(s)
- Susan L Murphy
- Institute of Gerontology, University of Michigan, Institute of Gerontology, Ann Arbor, MI 48109-2007, USA.
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DeGoede KM, Ashton-Miller JA, Schultz AB. Fall-related upper body injuries in the older adult: a review of the biomechanical issues. J Biomech 2003; 36:1043-53. [PMID: 12757814 DOI: 10.1016/s0021-9290(03)00034-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although the epidemiology of fall-related injuries is well established for the elderly population over 65 years of age, the biomechanics of how, when and why injuries do and do not occur when arresting a fall have received relatively little attention. This paper reviews the epidemiological literature in the MEDLINE data base pertinent to the biomechanics of fall-related injuries, including data on fall rates, fall-related injury rates, fall directions and types of injuries available. It also covers primary sources not listed on MEDLINE, along with the pertinent biomechanics literature. Many falls in older adults are in a forward direction, and as a result the upper extremities are one of the most commonly injured structures, presumably in protecting the head and torso. In this review emphasis is placed on what is, and what is not, known of the biomechanical factors that determine the impact forces and injury risk associated with upper extremity injuries in forward falls. While decreased bone mineral density may be contributory, it is not a reliable predictor of fracture risk. Evidence is presented that fall-related impact forces can be reduced by appropriate volitional arrest strategies. Further theoretical and experimental research is needed to identify appropriate fall-arrest strategies for the elderly, as well as the physical capacities and skills required to do so. Inexpensive interventions might then be developed to teach safe fall-arrest techniques to older individuals.
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Affiliation(s)
- K M DeGoede
- Department of Mechanical Engineering, University of Michigan, G.G. Brown 3208, Ann Arbor, MI 48109-2125, USA
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Klein BEK, Moss SE, Klein R, Lee KE, Cruickshanks KJ. Associations of visual function with physical outcomes and limitations 5 years later in an older population: the Beaver Dam eye study. Ophthalmology 2003; 110:644-50. [PMID: 12689880 DOI: 10.1016/s0161-6420(02)01935-8] [Citation(s) in RCA: 161] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE To examine the association of performance-based measures of visual functioning with the occurrence of falls, fractures, physical outcomes, and limitations in an older population. DESIGN A population-based study of Beaver Dam, Wisconsin, of persons who were 43 to 86 years of age was performed from 1988 through 1990 (n = 4926), 1993 through 1995 (n = 3722), and 1998 through 2000 (n = 2962). PARTICIPANTS Participants in the Beaver Dam Eye Study at the 1993 through 1995 examination. METHODS Historical information was obtained by interview at each examination. Current binocular visual acuity, best-corrected visual acuity, near acuity, log contrast sensitivity, and visual sensitivity (threshold) were measured by standard protocols at the 5-year follow-up (1993-1995) of the cohort. Outcomes were ascertained at the 10-year follow-up examination (1998-2000). MAIN OUTCOME MEASURES History of physical limitations, falls, fractures, and change in time to walk a measured course. RESULTS The incidence of outcomes was as follows: nursing home residence, 4.6%; not driving at night, 9.7%; any fracture, 11.0%; two or more falls, 7.5%; fear of falling, 11.9%; and use of walking aids, 3.6%. The increase in time to walk a 10-foot course was 0.14 seconds. Age was associated with higher incidence of virtually every outcome and with time to walk a measured course. Incidence of not driving at night, any fracture, and fear of falling were more common in women after adjusting for age. We evaluated the relationship of outcomes to current binocular vision, best-corrected vision, near vision, contrast sensitivity, and visual sensitivity (threshold), as measured by perimetry (the latter four for the better eye). When controlling for confounders in multivariable models, the odds ratios of nursing home placement for the poorest categories of function were 3.20 (95% confidence interval [CI], 1.85, 5.56) for current binocular vision, 4.23 (95% CI, 2.34, 7.64) for best-corrected visual acuity in the better eye, 5.00 (95% CI, 2.28, 10.94) for near vision, and 2.40 (95% CI, 1.46, 3.92) for contrast sensitivity. The odds ratio for not driving at night for the poorest category of visual sensitivity was 2.22 (95% CI, 1.31, 3.75). The odds ratios for any fractures for the categories of poorest function were 1.75 (95% CI, 1.02, 2.99) for current binocular acuity, 2.00 (95% CI, 1.10, 3.62) for best-corrected vision in the better eye, 3.04 (95% CI, 1.34, 6.86) for near vision, and 1.64 (95% CI, 1.05, 2.56) for visual sensitivity. The odds ratios for 2 or more falls in the past year for the poorest categories of visual function were 2.02 (95% CI, 1.13, 3.63) for current binocular acuity and 1.85 (95% CI, 1.10, 3.12) for visual sensitivity. The incidence of fear of falling was associated with the poorest category of best-corrected acuity (odds ratio, 2.95; 95% CI, 1.52, 5.70), and use of walking aids was associated with visual sensitivity (odds ratio, 3.51; 95% CI, 1.72, 7.18). Change in time to walk the measured course was not significantly associated with any of the visual functions. CONCLUSIONS Visual function is associated with some physical outcomes and limitations 5 years later in middle- to older-aged adults. These associations are likely to be related, in part, to the presence of other medical conditions.
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Affiliation(s)
- Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin Medical School, Madison, Wisconsin 53705-2397, USA
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Balance Self-Efficacy Predicts Risk Factors for Side Falls and Frequent Falls in Community-Dwelling Elderly. J Aging Phys Act 2003. [DOI: 10.1123/japa.11.1.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study assessed changes in balance self-efficacy (BSE) over 1 year in community-dwelling elderly, compared changes in BSE between fallers and nonfallers, and assessed the relationship between specific balance and mobility risk factors for side falls and BSE scores. Elderly fallers (n = 67; 80.2 ± 5.9 years) and nonfallers (n = 75; 79.4 ± 4.9), categorized based on self-reported falls over 1 year, were tested at baseline on postural sway, hip-abduction strength, lateral-stepping velocity, tandem walk, and get-up-and-go and given a BSE questionnaire. Fallers had lower BSE scores than nonfallers did (141.6 ± 33.5 and 154.9 ± 25.4; p = .008). BSE did not change over 1 year. In stepwise regression, BSE scores were predictive of time on the get-up-and-go, mediolateral sway, and tandem walk independent of age, height, and strength (p < .001). The BSE scale might be useful for screening individuals at risk for injurious falls because it is inexpensive and noninvasive.
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