Fat Oxidation during Exercise in People with Spinal Cord Injury, and Protocols Used: A Systematic Review

BACKGROUND

The aim of this study was to summarize evidence on energy metabolism through peak fat oxidation (PFO) and maximum fat oxidation (Fat_max), as well as to analyze the protocols used in people with spinal cord injury (SCI) and to examine the main factors related to fat oxidation ability (i.e., age, sex, level of physical activity, and level and degree of injury).

METHODS

Studies to determine PFO and Fat_max using indirect calorimetry with an arm exercise protocol for SCI patients were included after a systematic search. Other endpoints included study design, sample size, control group, demographic data, level of injury, physical condition, protocol, outcomes measured, and statistical findings.

RESULTS

Eight studies (n = 560) were included. The mean value of VO_2peak was 1.86 L∙min^-1 (range 0.75-2.60 L∙min^-1) (lowest value in the tetraplegic subjects). The PFO ranged between 0.06 and 0.30 g∙min^-1 (lowest rates: the non-trained subjects with cervical SCI; highest: the tetraplegic subjects). Two types of exercise protocol were found: arm cycle ergometer, and wheelchair propulsion with a computerized ergometer. Five studies used an incremental protocol (2-3 min/stage, different load increments); the rest performed tests of 20 min/stage at three intensities.

CONCLUSION

There are few existing studies measuring fat oxidation in SCI, many of which used small and heterogeneous samples. PFO was lower in SCI subjects when compared with non-injured people performing lower-limb exercise; however, comparing upper-limb exercise, people with SCI showed higher values.

Long-Term Exercise Intervention in Patients with McArdle Disease: Clinical and Aerobic Fitness Benefits

INTRODUCTION

The long-term effects of exercise in patients with McArdle disease-the paradigm of "exercise intolerance"-are unknown. This is an important question because the severity of the disease frequently increases with time.

PURPOSE

This study aimed to study the effects of a long-term exercise intervention on clinical and fitness-related outcomes in McArdle patients.

METHODS

Seventeen patients (exercise group: n = 10, 6 male, 38 ± 18 yr; control: n = 7, 4 male, 38 ± 18 yr) participated in a 2-yr unsupervised intervention including moderate-intensity aerobic (cycle-ergometer exercise for 1 h) and resistance (high load-low repetition circuit) training on 5 and 2-3 d·wk -1 , respectively. Patients were assessed at baseline and postintervention. Besides safety, outcomes included clinical severity (e.g., exercise intolerance features) on a 0-3 scale (primary outcome), and aerobic fitness, gross muscle efficiency, and body composition (total/regional fat, muscle, and bone mass; secondary outcomes).

RESULTS

The exercise program was safe and resulted in a reduction of 1 point (-1.0; 95% confidence interval, -1.6 to -0.5; P = 0.025) in clinical severity versus the control group, with 60% of participants in the exercise group becoming virtually asymptomatic and with no functional limitation in daily life activities. Compared with controls, the intervention induced significant and large benefits (all P < 0.05) in the workload eliciting the ventilatory threshold (both in absolute (watts, +37%) and relative units (watts per kilogram of total body mass or of lower-limb muscle mass, +44%)), peak oxygen uptake (in milliliters per kilogram per minute, +28%), and peak workload (in absolute (+27%) and relative units (+33%)). However, no significant changes were found for muscle efficiency or for any measure of body composition.

CONCLUSIONS

A 2-yr unsupervised intervention including aerobic and resistance exercise is safe and induces major benefits in the clinical course and aerobic fitness of patients with McArdle disease.

The medium-term consequences of COVID-19 lockdown on lifestyle among Spanish older people with hypertension, pulmonary, cardiovascular, and musculoskeletal-diseases, depression, and cancer

Objectives

To assess the influence of different chronic diseases on lifestyle and health behaviours changes after COVID-19 lockdown in Spanish older people compared to people without these diseases and compare the differences in these changes between both periods.

Methods

1092 participants (80.3±5.6y;66.5%women) from two Spanish cohorts were included. Telephone-based questionaries were used to evaluate health risk behaviours and lifestyle during lockdown and 7-months later. Self-reported physician-based diagnosis of chronic diseases was also reported. Cox-proportional models adjusted for main confounders were applied.

Results

Improvements concerning lifestyle were found in older people with chronic diseases, although they worsened the physical component (except cancer). When they were compared to those without these diseases, hypertension was associated with a lower frequency of increased alcohol consumption (Hazard ratio:0.73[95% confidence interval:0.55;0.99]). Pulmonary diseases were associated with a lower risk of both decreased sedentary time (0.58[0.39;0.86]) and worsening sleep quality (0.56[0.36;0.87]), while CVD was only associated with a lower frequency of decreased sedentary time (0.58[0.38;0.88]). Depression was linked to a higher risk of increasing diet quality (1.53[1.00;2.36]). Cancer was less likely to worsen sleep quality (0.44[0.22;0.89]), but more likely to worsen their social contact frequency (2.05[1.05;3.99]). No significant association related to musculoskeletal diseases.

Conclusion

Beneficial changes in health risk behaviours and lifestyle after the COVID-19 lockdown in older people with chronic diseases were found. Particularly, older people with hypertension, pulmonary disease and cancer showed beneficial changes after lockdown compared to their counterparts without diseases. Those with CVD and depression showed lifestyles that could involve a health risk.

Osteoporosis and Its Association With Cardiovascular Disease, Respiratory Disease, and Cancer: Findings From the UK Biobank Prospective Cohort Study

OBJECTIVE

To investigate sex-specific associations of osteoporosis with incidence of and mortality from cardiovascular disease (CVD), respiratory disease, and cancer as well as with all-cause mortality.

METHODS

In total, 305,072 participants (53% [161,383] women) of UK Biobank were included in this study (2007-2010). Self-reported diagnosis of osteoporosis at baseline was the exposure of interest. The outcomes were CVD, respiratory disease, chronic obstructive pulmonary disease (COPD), all cancer, and prostate and breast cancer incidence and mortality and all-cause mortality. Associations between osteoporosis and outcomes were investigated using Cox proportional hazards models.

RESULTS

In men, osteoporosis was associated with a higher incident risk of all respiratory diseases (hazard ratio [HR], 1.26; 95% CI, 1.06 to 1.50) including COPD (HR, 1.82; 95% CI, 1.38 to 2.40). Men with osteoporosis also had a higher mortality risk from all causes (HR, 1.71; 95% CI, 1.38 to 2.11), CVD (HR, 1.68; 95% CI, 1.19 to 2.37), respiratory disease (HR, 2.35; 95% CI, 1.70 to 3.24), and COPD (HR, 3.64; 95% CI, 2.24 to 5.91). These associations persisted after adjustment for age, body mass index, and comorbidities. Women with osteoporosis had a higher risk of incident CVD (HR, 1.24; 95% CI, 1.97 to 1.44), respiratory disease (HR, 1.23; 95% CI, 1.13 to 1.33), and COPD (HR, 1.29; 95% CI, 1.10 to 1.52). Women with osteoporosis also had a higher mortality risk from respiratory disease (HR, 1.31; 95% CI, 1.00 to 1.72) and breast cancer (HR, 1.60; 95% CI, 1.14 to 2.26).

CONCLUSION

Compared with women, men with osteoporosis had a higher risk of all-cause mortality, mortality from respiratory diseases including COPD, and cancer incidence. Osteoporosis was strongly associated with respiratory disease and COPD in both sexes, even after full adjustment for covariates, although men with osteoporosis experienced a higher risk of adverse outcomes.

The Medium-Term Changes in Health-Related Behaviours among Spanish Older People Lifestyles during Covid-19 Lockdown

OBJECTIVES

The aim was to evaluate general changes and investigate the association between diet quality, physical activity (PA), and sedentary time (ST) during COVID-19 lockdown and the subsequent 7-month changes in health-related behaviours and lifestyles in older people.

PARTICIPANTS

1092 participants (67-97y) from two Spanish cohorts were included.

DESIGN

Telephone-based questionaries were used to evaluate health-related behaviours and lifestyle. Multinomial logistic regression analyses with diet quality, PA, and ST during lockdown as predictors for health-related behaviours changes post-lockdown were applied.

RESULTS

Diet quality, PA, and ST significantly improved post-lockdown, while physical component score of the SF-12 worsened. Participants with a low diet quality during lockdown had higher worsening of post-lockdown ST and anxiety; whereas those with high diet quality showed less likelihood of remaining abstainers, worsening weight, and improving PA. Lower ST was associated with a higher likelihood of remaining abstainers, and worsening weight and improving social contact; nevertheless, higher ST was linked to improvement in sleep quality. Lower PA was more likely to decrease alcohol consumption, while higher PA showed the opposite. However, PA was more likely to be associated to remain abstainers.

CONCLUSIONS

Despite improvements in lifestyle after lockdown, it had health consequences for older people. Particularly, lower ST during lockdown seemed to provide the most medium-term remarkable lifestyle improvements.

Cross-sectional and prospective associations of sleep, sedentary and active behaviors with mental health in older people: a compositional data analysis from the Seniors-ENRICA-2 study

BACKGROUND

Most studies on the effects of sleep, sedentary behavior (SB), and physical activity (PA) on mental health did not account for the intrinsically compositional nature of the time spent in several behaviors. Thus, we examined the cross-sectional and prospective associations of device-measured compositional time in sleep, SB, light PA (LPA) and moderate-to-vigorous PA (MVPA) with depression symptoms, loneliness, happiness, and global mental health in older people (≥ 65 years).

METHODS

Data were taken from the Seniors-ENRICA-2 study, with assessments in 2015-2017 (wave 0) and 2018-2019 (wave 1). Time spent in sleep, SB, LPA and MVPA was assessed by wrist-worn accelerometers. Depression symptoms, loneliness, happiness, and global mental health were self-reported using validated questionnaires. Analyses were performed using a compositional data analysis (CoDA) paradigm and adjusted for potential confounders.

RESULTS

In cross-sectional analyses at wave 0 (n = 2489), time-use composition as a whole was associated with depression and happiness (all p < 0.01). The time spent in MVPA relative to other behaviors was beneficially associated with depression (γ = -0.397, p < 0.001), loneliness (γ = -0.124, p = 0.017) and happiness (γ = 0.243, p < 0.001). Hypothetically, replacing 30-min of Sleep, SB or LPA with MVPA was beneficially cross-sectionally related with depression (effect size [ES] ranged -0.326 to -0.246), loneliness (ES ranged -0.118 to -0.073), and happiness (ES ranged 0.152 to 0.172). In prospective analyses (n = 1679), MVPA relative to other behaviors at baseline, was associated with favorable changes in global mental health (γ = 0.892, p = 0.049). We observed a beneficial prospective effect on global mental health when 30-min of sleep (ES = 0.521), SB (ES = 0.479) or LPA (ES = 0.755) were theoretically replaced for MVPA.

CONCLUSIONS

MVPA was cross-sectionally related with reduced depression symptoms and loneliness and elevated level of happiness, and prospectively related with enhanced global mental health. Compositional isotemporal analyses showed that hypothetically replacing sleep, SB or LPA with MVPA could result in modest but significantly improvements on mental health indicators. Our findings add evidence to the emerging body of research on 24-h time-use and health using CoDA and suggest an integrated role of daily behaviors on mental health in older people.

Breaking Sedentary Time Predicts Future Frailty in Inactive Older Adults: A Cross-Lagged Panel Model

BACKGROUND

Cross-sectional evidence exists on the beneficial effects of breaks in sedentary time (BST) on frailty in older adults. Nonetheless, the longitudinal nature of these associations is unknown. This study aimed to investigate the direction and temporal order of the association between accelerometer-derived BST and frailty over time in older adults.

METHODS

This longitudinal study analyzed a total of 186 older adults aged 67-90 (76.7 ± 3.9 years; 52.7% females) from the Toledo Study for Healthy Aging over a 4-year period. Number of daily BST was measured by accelerometry. Frailty was assessed with the Frailty Trait Scale. Multiple cross-lagged panel models were used to test the temporal and reciprocal relationship between BST and frailty.

RESULTS

For those physically inactive (n = 126), our analyses revealed a reciprocal inverse relationship between BST and frailty, such as higher initial BST predicted lower levels of later frailty (standardized regression coefficient [β] = -0.150, 95% confidence interval [CI] = -0.281, -0.018; p < .05); as well as initial lower frailty levels predicted higher future BST (β = -0.161, 95% CI = -0.310, -0.011; p < .05). Conversely, no significant pathway was found in the active participants (n = 60).

CONCLUSIONS

In physically inactive older adults, the relationship between BST and frailty is bidirectional, while in active individuals no associations were found. This investigation provides preliminary longitudinal evidence that breaking-up sedentary time more often reduces frailty in those older adults who do not meet physical activity recommendations. Targeting frequent BST may bring a feasible approach to decrease the burden of frailty among more at-risk inactive older adults.

Changes in Health Behaviors, Mental and Physical Health among Older Adults under Severe Lockdown Restrictions during the COVID-19 Pandemic in Spain

We used data from 3041 participants in four cohorts of community-dwelling individuals aged ≥65 years in Spain collected through a pre-pandemic face-to-face interview and a telephone interview conducted between weeks 7 to 15 after the beginning of the COVID-19 lockdown. On average, the confinement was not associated with a deterioration in lifestyle risk factors (smoking, alcohol intake, diet, or weight), except for a decreased physical activity and increased sedentary time, which reversed with the end of confinement. However, chronic pain worsened, and moderate declines in mental health, that did not seem to reverse after restrictions were lifted, were observed. Males, older adults with greater social isolation or greater feelings of loneliness, those with poorer housing conditions, as well as those with a higher prevalence of chronic morbidities were at increased risk of developing unhealthier lifestyles or mental health declines with confinement. On the other hand, previously having a greater adherence to the Mediterranean diet and doing more physical activity protected older adults from developing unhealthier lifestyles with confinement. If another lockdown were imposed during this or future pandemics, public health programs should specially address the needs of older individuals with male sex, greater social isolation, sub-optimal housing conditions, and chronic morbidities because of their greater vulnerability to the enacted movement restrictions.

Fitness vs. fatness as determinants of survival in non-institutionalized older adults: The EXERNET multi-center study

BACKGROUND

Physical fitness and body composition are important health indicators, nevertheless their combined pattern inter-relationships and their association with mortality are poorly investigated.

METHODS

This longitudinal study is part of the Spanish EXERNET-Elder project. Person-months follow-up were calculated from the interview date, performed between June 2008 and November 2009, until date of death or censoring on March 2018 (whichever came first). In order to be included, participants had to fulfill the following criteria: 1) be over 65 years old, 2) live independently at home, 3) not suffer dementia and/or cancer and 4) have a BMI above 18.5. Body fat and weight were assessed by a bioelectrical impedance analyzer. Fitness was measured with the Senior Fitness and the one leg static balance tests. The Spanish Death Index was consulted for the death's identification. Cluster analysis was performed to identify Fat-Fit patterns and traditional cut points and percentiles to create the Fat-Fit groups. Cox proportional hazards regression models were used to calculate the hazard ratios of death in clustered Fat-Fit patterns and in traditional Fat-Fit groups.

RESULTS

A total of 2299 older adults (76.8% of women) were included with a baseline mean age of 71.9 ± 5.2 years. A total of 196 deaths (8.7% of the sample) were identified during the 8 years of follow up. Four clustered Fat-Fit patterns (Low fat-Fit, Medium fat-Fit, High fat-Unfit and Low fat-Unfit) and nine traditional Fat-Fit groups emerged. Using the Low fat-Fit pattern as the reference, significantly increased mortality was noted in High fat-Unfit (HR: 1.68, CI: 1.06 - 2.66) and Low fat-Unfit (HR: 2.01, CI: 1.28 - 3.16) groups. All the traditional Fit groups showed lower mortality risk when compared to the reference group (obese-unfit group).

CONCLUSIONS

Physical fitness is a determinant factor in terms of survival in community-dwelling older adults, independently of adiposity levels.

Functional Frailty, Dietary Intake, and Risk of Malnutrition. Are Nutrients Involved in Muscle Synthesis the Key for Frailty Prevention?

Frailty is a reversible condition, which is strongly related to physical function and nutritional status. Different scales are used to screened older adults and their risk of being frail, however, Short Physical Performance Battery (SPPB) may be more adequate than others to measure physical function in exercise interventions and has been less studied. Thus, the main aims of our study were: (1) to describe differences in nutritional intakes by SPPB groups (robust, pre-frail and frail); (2) to study the relationship between being at risk of malnourishment and frailty; and (3) to describe differences in nutrient intake between those at risk of malnourishment and those without risk in the no-frail individuals. One hundred one participants (80.4 ± 6.0 year old) were included in this cross-sectional study. A validated semi-quantitative food frequency questionnaire was used to determine food intake and Mini Nutritional Assessment to determine malnutrition. Results revealed differences for the intake of carbohydrates, n-3 fatty acids (n3), and saturated fatty acids for frail, pre-frail, and robust individuals and differences in vitamin D intake between frail and robust (all p < 0.05). Those at risk of malnutrition were approximately 8 times more likely to be frail than those with no risk. Significant differences in nutrient intake were found between those at risk of malnourishment and those without risk, specifically in: protein, PUFA n-3, retinol, ascorbic acid, niacin equivalents, folic acid, magnesium, and potassium, respectively. Moreover, differences in alcohol were also observed showing higher intake for those at risk of malnourishment (all p < 0.05). In conclusion, nutrients related to muscle metabolism showed to have different intakes across SPPB physical function groups. The intake of these specific nutrients related with risk of malnourishment need to be promoted in order to prevent frailty.

Associations between Daily Movement Distribution, Bone Structure, Falls, and Fractures in Older Adults: A Compositional Data Analysis Study

With aging, bone density is reduced, increasing the risk of suffering osteoporosis and fractures. Increasing physical activity (PA) may have preventive effects. However, until now, no studies have considered movement behaviors with compositional data or its association to bone mass and structure measured by peripheral computed tomography (pQCT). Thus, the aim of our study was to investigate these associations and to describe movement behavior distribution in older adults with previous falls and fractures and other related risk parameters, taking into account many nutritional and metabolic confounders. In the current study, 70 participants above 65 years old (51 females) from the city of Zaragoza were evaluated for the EXERNET-Elder 3.0 project. Bone mass and structure were assessed with pQCT, and PA patterns were objectively measured by accelerometry. Prevalence of fear of falling, risk of falling, and history of falls and fractures were asked through the questionnaire. Analyses were performed using a compositional data approach. Whole-movement distribution patterns were associated with cortical thickness. In regard to other movement behaviors, moderate-to-vigorous PA (MVPA) showed positive association with cortical thickness and total true bone mineral density (BMD) at 38% (all p < 0.05). In addition, less light PA (LPA) and MVPA were observed in those participants with previous fractures and fear of falling, whereas those at risk of falling and those with previous falls showed higher levels of PA. Our results showed positive associations between higher levels of MVPA and volumetric bone. The different movement patterns observed in the groups with a history of having suffered falls or fractures and other risk outcomes suggest that different exercise interventions should be designed in these populations in order to improve bone and prevent the risk of osteoporosis and subsequent fractures.

Relationship between Physical Performance and Frailty Syndrome in Older Adults: The Mediating Role of Physical Activity, Sedentary Time and Body Composition

The objectives were to clarify whether the relationship between physical performance and frailty was independently and jointly mediated by movement behaviors and body composition. We analyzed 871 older adults (476 women) from The Toledo Study for Healthy Aging. Skeletal muscle index (SMI) and fat index (FI) were determined using bone densitometry. Sedentary time (ST) and moderate-to-vigorous physical activity (MVPA) were assessed using accelerometry. The Frailty Trait Scale and The Short Physical Performance Battery (SPPB) were used to evaluate frailty and physical performance, respectively. Simple and multiple mediation analyses were carried out to determine the role of movement behaviors and body composition, adjusted for potential confounders. ST and MVPA acted independently as mediators in the relationship between SPPB and frailty (0.06% for ST and 16.89% for MVPA). FI also acted as an independent mediator in the same relationship (36.47%), while the mediation role of SMI was not significant. MVPA and FI both acted jointly as mediators in this previous relationship explaining 58.15% of the model. Our data support the fact that interventions should simultaneously encourage the promotion of MVPA and strategies to decrease the FI in order to prevent or treat frailty through physical performance improvement.

Long-Term Benefits of Tailored Exercise in Severe Sarcoidosis: A Case Report

BACKGROUND

We studied the effects of a supervised, structured exercise program in a severe sarcoidosis patient.

METHODS

After being clinically stable for two years, a 52-year-old woman (stage IV, American Thoracic Society) who originally had irreversible lung fibrosis, pulmonary arterial hypertension (PAH), mild mitral insufficiency, and atrial dilatation, and was candidate for lung transplant, performed a combined high-intensity interval, high load resistance, and inspiratory muscle training for 4.5 years, and was tested (cardiopulmonary exercise testing and dual X-ray absorptiometry) every six months.

RESULTS

Cardiorespiratory fitness (CRF) and maximal pulmonary ventilation increased by 44% and 60%, respectively. Ventilatory efficiency also improved (decrease in the ventilatory equivalent for oxygen by 32% and 14% at the ventilatory threshold and respiratory compensation point, respectively). She improved New York Heart Association (NYHA) class (from III to II), and cardiac alterations as well as PAH reversed so that she was not in need of lung transplantation anymore. Likewise, she suffered no more episodes of hemoptysis. Bone health was overall maintained despite the post-menopausal status and the corticoid treatment.

CONCLUSIONS

A long-term combined exercise intervention safely contributed-at least partly-to improve CRF and NYHA class in a patient with severe sarcoidosis, suggesting a potential coadjuvant effect to attenuate clinical manifestations.

Prospective Changes in the Distribution of Movement Behaviors Are Associated With Bone Health in the Elderly According to Variations in their Frailty Levels

Frailty is associated with poor bone health and osteoporosis, and physical activity (PA) is one of the best treatments for both pathologies in older adults. Nonetheless, because daily time is limited, how the time is distributed during the waking hours is critical. The waking hours are spent according to different movement behaviors: sedentary behaviors (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). The aim of this study was to use compositional data analyses to examine the effects of the change in movement behaviors on bone health during aging in older people, related to the changes in their frailty levels. We analyzed 227 older people aged 65 to 94 (125 women and 102 men) over a 4-year period. Movement behaviors were assessed using accelerometry. Both bone mineral density (BMD) and bone mineral content (BMC) were determined using bone densitometry. The Frailty Trait Scale was used to divide the sample by frailty level evolution during aging. The R statistical system was used for the compositional data analysis and, in addition, all models were adjusted for several covariates. The changes in the distribution of all movement behaviors within a waking hour period were significantly associated with spine and femoral neck BMD changes in the subgroup with a positive change in frailty level and spine BMC in the subgroup with no change in frailty level (p ≤ .05). Likewise, MVPA relative to the change in other movement behaviors was also associated in both subgroups with higher BMD and BMC, respectively, in the same body areas (p ≤ .05). No significant associations were found in the negative change in frailty level subgroup. Older people who achieved a positive change in frailty level during a 4-year period showed higher BMD changes compared to those with no changes or increases in their frailty level. Therefore, increasing MVPA relative to the change in the other movement behaviors during a 4-year period could perhaps produce bone health improvements in the elderly that do not worsen their frailty level. © 2020 American Society for Bone and Mineral Research.

Sex Differences and the Influence of an Active Lifestyle on Adiposity in Patients with McArdle Disease

McArdle disease (glycogenosis-V) is associated with exercise intolerance, however, how it affects an important marker of cardiometabolic health as it is adiposity remains unknown. We evaluated the association between physical activity (PA) and adiposity in patients with McArdle disease. We assessed 199 adults of both sexes (51 McArdle patients (36 ± 11 years) and 148 healthy controls (35 ± 10 years)). Body fat (BF) was determined using dual-energy X-ray absorptiometry (DXA) method and each patient’s PA was assessed with the International PA Questionnaire (IPAQ). Although body mass index values did not differ between patients and controls, McArdle patients had significantly higher values of BF in all body regions (p < 0.05) and higher risk of suffering obesity (odds ratio (OR): 2.54, 95% confidence interval (95% CI): 1.32–4.88). Male patients had higher BF and obesity risk (OR: 3.69, 95% CI: 1.46−9.34) than their sex-matched controls, but no differences were found within the female sex (p < 0.05). In turn, active female patients had lower trunk BF than their inactive peers (p < 0.05). Males with McArdle seem to have adiposity problems and a higher risk of developing obesity than people without the condition, while female patients show similar or even better levels in the trunk region with an active lifestyle. Therefore, special attention should be given to decrease adiposity and reduce obesity risk in males with McArdle disease.

Which one came first: movement behavior or frailty? A cross-lagged panel model in the Toledo Study for Healthy Aging

BACKGROUND

There has been limited longitudinal assessment of the relationship between moderate-to-vigorous physical activity (MVPA) and sedentary behaviour (SB) with frailty, and no studies have explored the possibility of reverse causality. This study aimed to determine the potential bidirectionality of the relationship between accelerometer-assessed MVPA, SB, and frailty over time in older adults.

METHODS

Participants were from the Toledo Study for Healthy Aging. We analysed 186 older people aged 67 to 90 (76.7 ± 3.9; 52.7% female participants) over a 4-year period. Time spent in SB and MVPA was assessed by accelerometry. Frailty Trait Scale was used to determine frailty levels. A cross-lagged panel model design was used to test the reciprocal relationships between MVPA/SB and frailty.

RESULTS

Frailty Trait Scale score changed from 35.4 to 43.8 points between the two times (P < 0.05). We also found a reduction of 7 min/day in the time spent on MVPA (P < 0.05), and participants tended to spend more time on SB (P = 0.076). Our analyses revealed that lower levels of initial MVPA predicted higher levels of later frailty [std. β = -0.126; confidence interval (CI) = -0.231, -0.021; P < 0.05], whereas initial spent time on SB did not predict later frailty (std. β = -0.049; CI = -0.185, 0.087; P = 0.48). Conversely, an initial increased frailty status predicted higher levels of later SB (std. β = 0.167; CI = 0.026, 0.307; P < 0.05) but not those of MVPA (std. β = 0.071; CI = -0.033, 0.175; P = 0.18).

CONCLUSIONS

Our observations suggest that the relationship between MVPA/SB and frailty is unidirectional: individuals who spent less time on MVPA at baseline are more likely to increase their frailty score, and individuals who are more frail are more likely to spent more time on SB at follow-up. Interventions and policies should aim to increase MVPA levels from earlier stages to promote successful aging.

Body Composition as a Mediator between Cardiorespiratory Fitness and Bone Mass during Growth

INTRODUCTION AND PURPOSE

To examine the effect of cardiorespiratory fitness (CRF) and muscle power output (MPO) on bone mass of prepubertal and pubertal children using lean mass (LM) and percentage of fat mass (%FM) as mediator variables. The hypothesis was that both LM and %FM would be independent mediators of the relationships during the sexual maturation period.

METHODS

We analyzed 200 children (88 boys and 112 girls [11.5 ± 2.0 yr]). Body composition was analyzed by bone densitometry, and indirect calorimetry and cycle ergometer were used to calculate V˙O2peak (mL·kg·min) and MPO (W) during an incremental exercise test. Sample was divided by pubertal status.

RESULTS

In the prepubertal group, LM and %FM acted independently as mediators in the relationship between bone mass and CRF or MPO (22%-25% for LM and 37%-50% for %FM, respectively). In pubertal children, LM acted as mediator at 37%.

CONCLUSIONS

Although the independent mediator role of LM and %FM in the associations between CRF or MPO and bone mass was present during the prepubertal stage, only LM remain its mediator role in these associations during the postpubertal period. Therefore, with growth and sexual maturation, the full effect of LM seems to increase, whereas the influence of %FM seems to disappear.

Compositional Influence of Movement Behaviors on Bone Health during Aging

INTRODUCTION AND PURPOSE

Physical activity (PA) is considered the best nonpharmacological treatment for the decrease in bone mass (BM) produced during aging. Therefore, it is essential to assess how the time spent in PA is distributed to control further changes. This work examines the relationship between movement behaviors and BM during aging, using compositional data analysis.

METHODS

We studied 227 older people 65 to 94 yr old (102 men and 125 women), divided by sex and bone status, over a period of 4 yr. Time spent in sedentary behavior (SB), light PA (LPA), and moderate to vigorous PA (MVPA), was assessed using accelerometry. BM was determined by dual-energy x-ray absorptiometry.

RESULTS

The changes in MVPA were positively associated with the rate of BM decay at spine and leg in the whole sample and men's subgroup (P ≤ 0.05). In women, the rate of BM decay at spine and Ward's triangle were negatively associated with SB changes, and BM decay at femoral neck and Ward's triangle were positively associated with LPA (P ≤ 0.05).

CONCLUSION

Increasing MVPA related to other movement behaviors produces improvements in the rate of bone change in older men, whereas to increase LPA and maintain MVPA would be the best approach to enhance BM in older women.

Dose-response association between physical activity and sedentary time categories on ageing biomarkers

Background

Physical activity and sedentary behaviour have been suggested to independently affect a number of health outcomes. To what extent different combinations of physical activity and sedentary behaviour may influence physical function and frailty outcomes in older adults is unknown. The aim of this study was to examine the combination of mutually exclusive categories of accelerometer-measured physical activity and sedentary time on physical function and frailty in older adults.

Methods

771 older adults (54% women; 76.8 ± 4.9 years) from the Toledo Study for Healthy Aging participated in this cross-sectional study. Physical activity and sedentary time were measured by accelerometry. Physically active was defined as meeting current aerobic guidelines for older adults proposed by the World Health Organization. Low sedentary was defined as residing in the lowest quartile of the light physical activity-to-sedentary time ratio. Participants were then classified into one of four mutually exclusive movement patterns: (1) ‘physically active & low sedentary’, (2) ‘physically active & high sedentary’, (3) ‘physically inactive & low sedentary’, and (4) ‘physically inactive & high sedentary’. The Short Physical Performance Battery was used to measure physical function and frailty was assessed using the Frailty Trait Scale.

Results

‘Physically active & low sedentary’ and ‘physically active & high sedentary’ individuals had significantly higher levels of physical function (β = 1.73 and β = 1.30 respectively; all p < 0.001) and lower frailty (β = − 13.96 and β = − 8.71 respectively; all p < 0.001) compared to ‘physically inactive & high sedentary’ participants. Likewise, ‘physically inactive & low sedentary’ group had significantly lower frailty (β = − 2.50; p = 0.05), but significance was not reached for physical function.

Conclusions

We found a dose-response association of the different movement patterns analysed in this study with physical function and frailty. Meeting the physical activity guidelines was associated with the most beneficial physical function and frailty profiles in our sample. Among inactive people, more light intensity relative to sedentary time was associated with better frailty status. These results point out to the possibility of stepwise interventions (i.e. targeting less strenuous activities) to promote successful aging, particularly in inactive older adults.

The Impact of Movement Behaviors on Bone Health in Elderly with Adequate Nutritional Status: Compositional Data Analysis Depending on the Frailty Status

The aim of this study was to determine the relationship between bone mass (BM) and physical activity (PA) and sedentary behavior (SB) according to frailty status and sex using compositional data analysis. We analyzed 871 older people with an adequate nutritional status. Fried criteria were used to classify by frailty status. Time spent in SB, light intensity PA (LPA) and moderate-to-vigorous intensity PA (MVPA) was assessed from accelerometry for 7 days. BM was determined by dual-energy X-ray absorptiometry (DXA). The combined effect of PA and SB was significantly associated with BM in robust men and women (p ≤ 0.05). In relation to the other behaviors, SB was negatively associated with BM in robust men while BM was positively associated with SB and negatively with LPA and MVPA in robust women. Moreover, LPA also was positively associated with arm BM (p ≤ 0.01). Finally, in pre-frail women, BM was positively associated with MVPA. In our sample, to decrease SB could be a good strategy to improve BM in robust men. In contrast, in pre-frail women, MVPA may be an important factor to consider regarding bone health.

Can Physical Activity Offset the Detrimental Consequences of Sedentary Time on Frailty? A Moderation Analysis in 749 Older Adults Measured With Accelerometers

OBJECTIVES

To determine whether or not and to what extent the association between sedentary time and frailty was moderated by moderate-to-vigorous physical activity in older adults.

DESIGN

Cross-sectional.

SETTING

Community-dwelling individuals.

PARTICIPANTS

749 (403 females and 346 males) white older adults.

MEASUREMENTS

Sedentary time and moderate-to-vigorous physical activity were measured with accelerometers. Frailty was objectively measured using the Frailty Trait Scale. All models were adjusted for age, sex, education, income, marital status, body mass index, moderate-to-vigorous physical activity, and accelerometer wear time.

RESULTS

The regression model reported a significant effect of sedentary time on frailty (P < .05). Nevertheless, the results indicated that moderate-to-vigorous physical activity moderates the relationship between frailty status and sedentary time. The Johnson-Neyman technique determined that the estimated moderate-to-vigorous physical activity point was 27.25 minutes/d, from which sedentary time has no significant effect on frailty.

CONCLUSIONS

Moderate-to-vigorous physical activity is a moderator in the relationship between sedentary time and frailty in older adults, offsetting the harmful effects of sedentary behavior with 27 minutes/d of moderate-to-vigorous activity. Engaging in moderate-to-vigorous physical activities should be encouraged. Reducing sedentary behavior may also be beneficial, particularly among inactive older adults.

Non-osteogenic muscle hypertrophy in children with McArdle disease

INTRODUCTION

McArdle disease is an inborn disorder of muscle glycogen metabolism that produces exercise intolerance, and has been recently associated with low values ​​of lean mass (LM) and bone mineral content (BMC) and density (BMD) in affected adults. Here we aimed to study whether this bone health problem begins in childhood.

METHODS

Forty children and adolescents were evaluated: 10 McArdle disease and 30 control children (mean age of both groups, 13 ± 2y). Body composition was evaluated by dual-energy X-ray absorptiometry and creatine kinase (CK) levels were determined in the patients as an estimate of muscle damage.

RESULTS

Legs bone mass was significantly lower in patients than in controls (-36% for BMC and -22% for BMD). Moreover, patients had significantly higher LM values in the legs than controls, whereas no difference was found for fat mass. CK levels were positively associated with LM in McArdle patients. A correlation was found between LM and BMD variables in the control group but not in McArdle patients.

CONCLUSION

We have identified a 'non-osteogenic muscle hypertrophy' in children with McArdle disease. This phenomenon warrants special attention since low osteogenesis at an early age predicts a high risk for osteoporosis later in life.

Associations between sedentary time, physical activity and bone health among older people using compositional data analysis

INTRODUCTION

Aging is associated with a progressive decrease in bone mass (BM), and being physical active is one of the main strategies to combat this continuous loss. Nonetheless, because daily time is limited, time spent on each movement behavior is co-dependent. The aim of this study was to determine the relationship between BM and movement behaviors in elderly people using compositional data analysis.

METHODS

We analyzed 871 older people [395 men (76.9±5.3y) and 476 women (76.7±4.7y)]. Time spent in sedentary behavior (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA), was assessed using accelerometry. BM was determined by bone densitometry (DXA). The sample was divided according to sex and bone health indicators.

RESULTS

The combined effect of all movement behaviors (PA and SB) was significantly associated with whole body, leg and femoral region BM in the whole sample (p≤0.05), with leg and pelvic BM (p<0.05) in men and, with whole body, arm and leg BM (p<0.05) in women. In men, arm and pelvic BM were negatively associated with SB and whole body, pelvic and leg BM were positively associated with MVPA (p≤0.05). In women, whole body and leg BM were positively associated with SB. Arm and whole body BM were positively associated and leg BM was negatively associated with LPA and arm BM was negatively associated with MVPA (p≤0.05). Women without bone fractures spent less time in SB and more in LPA and MVPA than the subgroup with bone fractures.

CONCLUSION

We identified that the positive effect of MVPA relative to the other behaviors on bone mass is the strongest overall effect in men. Furthermore, women might decrease bone fracture risk through PA increase and SB reduction, despite the fact that no clear benefits of PA for bone mass were found.

A New Condition in McArdle Disease: Poor Bone Health-Benefits of an Active Lifestyle

INTRODUCTION-PURPOSE

McArdle disease (muscle glycogen phosphorylase deficiency) is a genetic condition associated with exercise intolerance, but how it affects lean mass (LM) and bone mineral content (BMC) and density (BMD) in patients is unknown. We compared these variables between McArdle patients and age-/sex-matched healthy controls and assessed their potential association with physical activity levels in patients.

METHODS

A case-control, cross-sectional design was used to examine LM, BMC, and BMD by using dual-energy x-ray absorptiometry in 136 young adults of both sexes (36 McArdle patients (33 ± 15 yr) and 103 controls (34 ± 11 yr)). Physical activity was assessed using the International Physical Activity Questionnaire.

RESULTS

McArdle patients had significantly lower LM values in whole-body and regional sites compared with their corresponding controls, whereas no differences were found (except for the trunk) when physically active patients (n = 23) were compared with controls. All bone-related variables were significantly lower in patients than in controls (average difference of 13% for BMC and 7.6% for BMD). By contrast, no significant differences at the lumbar spine, pelvis, and femur sites were found between physically active patients and controls.

CONCLUSIONS

We report on a previously undescribed condition in McArdle patients, poor bone health, which warrants further attention because it can occur in relatively young adults. An active lifestyle can at least partly alleviate this disorder presumably because of its beneficial effect on LM.

Force-velocity profiling in older adults: An adequate tool for the management of functional trajectories with aging

INTRODUCTION

The actual mechanisms leading to a reduced muscle power and functional ability in older adults are poorly understood. We investigated the association between different force-velocity (F-V) profiles and impaired muscle power, physical and cognitive function, frailty, and health-related quality of life (HRQoL) in older people.

METHODS

Physical function (habitual gait speed, timed up-and-go test, sit-to-stand and stair-climbing ability), cognitive function, HRQoL and frailty were evaluated in 31 older subjects (70-85 years). The F-V relationship and maximal muscle power (P_max) were assessed in the leg press exercise. The skeletal muscle index (SMI) and fat index, moderate-to-vigorous physical activity (MVPA) and sedentary time were obtained from DXA scans and accelerometry, respectively.

RESULTS

While some subjects showed a force deficit (F_DEF), others presented a velocity deficit (V_DEF), both leading to an impaired muscle power [Effect size (ES) = 1.30-1.44], and to a likely-very likely moderate harmful effect in their physical and cognitive function, HRQoL and frailty levels (except the V_DEF group for cognitive function) [ES = 0.76-1.05]. Leg muscle mass and specific force were similarly associated with force at P_max, while MVPA but not sedentary time was related to fat index, force at P_max, and power values (all p < 0.05). A trend was found for the negative association between fat index and relative P_max (p = 0.075).

CONCLUSION

Older subjects exhibited different mechanisms (force vs. velocity deficits) leading to impaired muscle power. Both deficits were associated with a lower physical function and quality of life, and a higher frailty, whereas only a force deficit was associated with a lower cognitive function. Interventions aimed at reversing age- and/or disuse-related impairments of muscle power might evaluate the specific responsible mechanism and act accordingly.