Correlation of frailty assessment metrics in one-year follow-up of aged care residents: a sub-study of a randomised controlled trial

INTRODUCTION

Frailty is increasingly recognised as a dynamic syndrome, with multiple causes, dimensions and consequences. There is little understanding of how those frailty assessment metrics interact over time. The aim of this study was to describe the longitudinal correlation between five frailty metrics, namely multimorbidity, muscular strength, mood alterations, cognitive capacity, and functional capacity in a cohort study of aged care (nursing home) residents.

METHODS

248 aged care residents with Frailty Index at baseline of < 0.4 and no dementia were followed for 12 months. A multimorbidity score and an activity of daily living limitation score were created using individual items of the Frailty Index. Muscular strength was measured by grip strength. Cognitive capacity was measured using the Montreal Cognitive Assessment (MoCA) test. Mood alterations were measured using the anxiety/depression screening question from EQ-5D. We analysed the inter-individual correlation at baseline, association between baseline and future change, and within-individual correlation at baseline, 6 and 12 months.

RESULTS

Population analysis shows that metrics were not associated at baseline. All of the studied metrics at baseline were associated with change in 12 months, with the exception of anxiety/depression scores. Pairwise within-individual correlation was strong between MoCA and grip strength (0.13, p = 0.02) and activity of daily living (- 0.48, p < 0.001), and between activities of daily living and multimorbidity index (0.28, p < 0.001). No within-individual correlation was found between anxiety depression score and other metrics.

CONCLUSION

The results suggest an interdependence between comorbidities, physical capacity, cognition and activities of daily living in aged care residents. Comprehensive measurement of frailty-related metrics may provide improved understanding of frailty progression at later life stages.

The development and initial validation of the Exercise Causality Orientations Scale

Deci and Ryan's causality orientations theory suggests that there are individual differences in motivational orientation towards initiating and regulating behaviour. They described three causality orientations: autonomy, control and impersonal. The aim of this paper is to describe the development and concurrent validity of the Exercise Causality Orientations Scale (ECOS), which was designed to measure the strength of these three orientations within exercise. Altogether, 592 working adults aged 35.0 +/- 11.4 years (mean +/- s) completed the ECOS and measures of self-determination, self-consciousness and social desirability. The analysis was conducted in two parts. First, the data were subjected to confirmatory factor analysis using a multi-trait, multi-method framework. The original model resulted in a poor fit to the data. On the basis of its modification indices, three scenarios with ambiguous items were removed successively, resulting in a scale with good psychometric properties. Secondly, Pearson's correlations were conducted between the subscales of the ECOS and those of the questionnaires used for validation. Most of the results supported a priori hypotheses. In conclusion, our results show the ECOS to have good psychometric properties and they provide some support for its concurrent validity.

The effects of cognitive and somatic anxiety and self-confidence on components of performance during competition

This study considered the influence of competitive anxiety and self-confidence state responses upon components of performance. Basketball players (n = 12) were trained to self-report their cognitive anxiety, somatic anxiety and self-confidence as a single response on several occasions immediately before going on court to play. Performance was video-recorded and aspects of performance that could be characterized as requiring either largely anaerobic power (height jumped) or working memory (successful passes and assists) were measured. Intra-individual performance scores were computed from these measures and the data from seven matches were subjected to regression analyses and then hierarchical regression analyses. The results indicated that, as anticipated, somatic anxiety positively predicted performance that involved anaerobic demands. Self-confidence, and not cognitive anxiety, was the main predictor of performance scores with working memory demands. It would appear that different competitive state responses exert differential effects upon aspects of actual performance. Identifying these differences will be valuable in recommending intervention strategies designed to facilitate performance.

The effect of induced mood states on performance profile areas of perceived need

The performance profile technique is now widely used by a range of sports scientists, usually as the first step in implementing a training programme. The aim of this study was to examine the effect of altered mood states on areas of perceived need for an individual identified by the performance profile. Sixty-seven university sports science students (30 females, 37 males) participated in the study. They completed their performance profile and a shortened version of the Bi-polar Profile of Mood States before and after four separate mood manipulation treatments (happy, sad, neutral, control). The participants were allocated at random to one of four groups and completed the treatments in a counterbalanced order. Mood manipulation checks identified that both the happy and sad manipulations were successful. Profile areas of perceived need, identified through discrepancies in an individual's perceptions of ideal and current state, were not affected by the sad and neutral manipulations or by the control condition. However, areas of perceived need were significantly lower after the happy mood manipulation than before the treatment. Our results show that asking individuals to complete their profiles when in a happy mood state is likely to affect judgements and result in an underestimation of perceived need for improvement.

Physical self-perceptions, aerobic capacity and physical activity in male and female members of a corporate health and fitness club

As physical activity and fitness are believed to influence esteem and self-perceptions positively, the purpose of the study was to examine the relationships among participation in physical activity, aerobic capacity, and physical self-perceptions in 40 men and 33 women, members of a British corporate health and fitness club. Hierarchical multiple regression analyses indicated a significant linear relationship for men between scores on Physical Self-worth and composite scores on Participation in Physical Activity. Men's feelings regarding general physical self-worth may be an important determinant of their subsequent levels of physical exercise.

Psychological affect at different ratings of perceived exertion in high- and low-active women: a study using a production protocol

The purpose of this study was to examine psychological affect at different ratings of perceived exertion (RPE) in 15 high- and 15 low-active women. Both groups performed three steady-state exercise bouts on a cycle ergometer at RPEs 9, 13, and 17 and reported their affect in the last 20 sec. of and 5 min. after each work rate. There were no differences between groups in percentage of maximal oxygen uptake (% VO2max) at each RPE. Low-active women reported feeling significantly more negative at RPE 17 than RPE 9 and less positive than the high-active women at RPEs 9, 13, and 17. In addition, all subjects reported more positive feelings 5 min. postexercise than in the last 20 sec. of exercising, especially at RPE 17. These results have implications for exercise prescription in groups differing in habitual activity levels.

Changes in ratings of perceived exertion and psychological affect in the early stages of exercise

The purpose of this study was to examine differences in the rating of perceived exertion (RPE) and affect, as assessed by a bipolar feeling scale (FS) during cycle ergometry in a steady-state and a nonsteady-state condition in active and inactive individuals. 71 subjects completed a self-report questionnaire on physical activity and were assigned to two groups, a low-active group of 16 men and 18 women and a high-active group of 18 men and 19 women. On Day 1 all subjects completed a sub-maximal exercise test to predict maximum oxygen uptake (VO2max) from which work rates corresponding to 60% and 90% VO2max were calculated. On Day 2 half of the subjects completed a work rate equivalent to 60% VO2max whilst the other half completed a 90% VO2max work rate. On Day 3 alternative work rates were completed. RPE and FS were recorded after 2 and 4 min, at each work rate on both days. Mixed-model, 4-factor (gender x group x work rate x time) analyses of variance with repeated measures on work rate and time were conducted on the FS and RPE data. RPE was higher after 4 min, at both intensities, and there was a greater increase in RPE between 2 and 4 min, at the 90% than the 60% work rate. Rated feeling was more positive at the 60% work rate, high-active subjects were more positive than low-active subjects and rated feeling was lower in Minute 4 for both groups. The following interactions were observed: rated feeling was more negative after 4 min. for the low-active group compared to the high-active group at 2 and 4 min. and the low-active group reported more negative feeling at the 90% work rate compared to the 60% work rate while the high-active group did not change significantly. Timing of the RPE is important if used to prescribe exercise intensity. Further, low-active subjects should be encouraged to exercise at moderate intensities and discouraged from focusing on how they feel immediately before they finish a session.

Performance catastrophes in sport: a test of the hysteresis hypothesis

An experiment is reported which tests Fazey and Hardy's (1988) catastrophe model of anxiety and performance. Eight experienced crown green bowlers performed a bowling task under conditions of high and low cognitive anxiety. On each of these occasions, physiological arousal (measured by heart rate) was manipulated by means of physical work in such a way that the subjects were tested with physiological arousal increasing and decreasing. A repeated-measures three-factor ANOVA was used to test the hysteresis hypothesis that the performance x heart rate graph would follow a different path for heart rate increasing compared with heart rate decreasing in the high cognitive anxiety condition, but not in the low cognitive anxiety condition. The ANOVA revealed the predicted three-way interaction of cognitive anxiety, heart rate, and the direction of change in heart rate upon performance, with follow-up tests indicating that the interaction was due to hysteresis occurring in the high cognitive anxiety condition but not in the low cognitive anxiety condition. Other statistical procedures showed that, in the high cognitive anxiety condition, subjects' best performances were significantly better, and their worst performances significantly worse, than in the low cognitive anxiety condition. However, the results did not provide unequivocal support for the catastrophe model of anxiety and performance.

The effects of competitive anxiety on memory span and rebound shooting tasks in basketball players

Two theoretical models were used to investigate aspects of basketball performance: Eysenck's (1979, 1984) compensatory arousal model and Humphreys and Revelle's (1984) twin resources model. Cognitive and somatic anxiety were manipulated using a 'time to event' paradigm. The aspects of performance were a short-term memory task (letter span) and a low memory demand, motoric-sustained information transfer task (rebound shooting). Hypotheses based on the different models were formulated and subsequently tested using analysis of variance and polynomial regression analysis. The results indicated significant (P < 0.01) linear relationships with negative slopes between cognitive anxiety and letter span, and between somatic anxiety and letter span; while significant (P < 0.01) linear relationships with positive slopes were recorded between cognitive anxiety and rebound shooting, and between somatic anxiety and rebound shooting. The analysis of variance results were in agreement with a positive effect (P < 0.05) for cognitive anxiety upon rebound shooting, and a negative effect which approached significance (P < 0.07) for somatic anxiety upon letter span. The results were interpreted as offering partial support for Eysenck's (1979) theoretical model, although further examination of multidimensional anxiety effects via the two models is warranted.

A catastrophe model of anxiety and performance

An experiment is reported which tests Fazey & Hardy's (1988) catastrophe model of anxiety and performance. Eight experienced basketball players were required to perform a set shooting task, under conditions of high and low cognitive anxiety. On each of these occasions, physiological arousal was manipulated by means of physical work in such a way that subjects were tested with physiological arousal increasing and decreasing. Curve-fitting procedures followed by non-parametric tests of significance confirmed (p less than .002) Fazey & Hardy's hysteresis hypothesis: namely, that the polynomial curves for the increasing vs. decreasing arousal conditions would be horizontally displaced relative to each other in the high cognitive anxiety condition, but superimposed on top of one another in the low cognitive anxiety condition. Other non-parametric procedures showed that subjects' maximum performances were higher, their minimum performances lower, and their critical decrements in performance greater in the high cognitive anxiety condition than in the low cognitive anxiety condition. These results were taken as strong support for Fazey & Hardy's catastrophe model of anxiety and performance. The implications of the model for current theorizing on the anxiety-performance relationship are also discussed.