Sarcopenic obesity and associations with mortality in older women and men - a prospective observational study

Background

The combined effect of sarcopenia and obesity, i.e., sarcopenic obesity, has been associated with disability and worse outcomes in older adults, but results are conflicting. The objectives of this study were to describe the prevalence of sarcopenic obesity (SO) in older adults, and to examine how the risk of mortality is associated with SO and its various components.

Methods

Data were obtained from two Swedish population studies, the Gothenburg H70 Birth Cohort Studies of 521 women and men at the age of 75, and the Uppsala Longitudinal Study of Adult Men (ULSAM), which included 288 men aged 87 years. Sarcopenia was defined using the recently updated EWGSOP2 definition. Obesity was defined by any of three established definitions: body mass index ≥30 kg/m², fat mass > 30%/ > 42% or waist circumference ≥ 88 cm/≥102 cm for women and men, respectively. The Kaplan-Meier survival curve and the Cox proportional hazard model were used for 10-year and 4-year survival analyses in the H70 and ULSAM cohorts, respectively.

Results

SO was observed in 4% of the women and 11% of the men in the H70 cohort, and in 10% of the ULSAM male cohort. The 75-year-old women with SO had a higher risk (HR 3.25, 95% confidence interval (1.2–8.9)) of dying within 10 years compared to those with a “normal” phenotype. A potential similar association with mortality among the 75-year-old men was not statistically significant. In the older men aged 87 years, obesity was associated with increased survival.

Conclusions

SO was observed in 4–11% of community-dwelling older adults. In 75-year-old women SO appeared to associate with an increased risk of dying within 10 years. In 87-year-old men, the results indicated that obesity without sarcopenia was related to a survival benefit over a four-year period.

On the use of a six-level scale for physical activity

The 4-level questionnaire to assess leisure-time physical activity (PA) originally described by Saltin and Grimby has been extended to a 6 (or 7)-level questionnaire, especially for the elderly or other persons with a low level of PA, expanded to include household activities. There are currently two main versions, one used in Swedish, Danish, and Norwegian studies, and one with further modifications used in Finnish studies. In this review, predictive validity for mortality and different aspects of physical performance are demonstrated. In a study regarding concurrent validity in one of the Finnish versions, significant correlations with accelerometer-based PA variables are shown. The scale has been used in a number of studies concerning effects of different types of intervention, such as physical training and increased PA, or to describe the PA level in the studied cohort. In presenting and analyzing the data, different combinations of PA levels have been used. As there are major differences between the versions, validity studies cannot easily be transformed between them. Thus, it is suggested that a common consensus be reached with respect to details of the questionnaire.

Correlations between sensory-motor functions and motor performance measured by optoelectronic kinesiology in 75-year-olds

The motor performance in an everyday motor task, lifting an object from the floor and placing it on a shelf - the Posturo-Locomotor-Manual test (PLM test) - was recorded using optoelectronic kinesiology in 150 subjects within a broader study measuring functional capacity in 75-year-olds (the NORA 75 study). The results were correlated in all persons to tests for isometric muscle strength, visual acuity, postural balance, vibrotactile threshold, reaction time, pulmonary function and maximal walking speed. The PLM test performance correlated well with the isometric muscle strength measurements in men and strong individuals were consequently faster than weaker persons. A moderate correlation was found with pulmonary function in men. The association between the PLM test parameters and muscle strength was poor in women. Subjects with slower psychomotor and walking speed moved significantly slower in the PLM test in both sexes. No association was found with visual acuity, postural balance or vibrotactile threshold. The PLM test might be used to identify individuals at risk of disability caused by decline in muscle strength.

Muscle strength testing with one repetition maximum in the arm/shoulder for people aged 75 + - test-retest reliability

Objective: To investigate the reliability of a muscle strength test of the arm/shoulder in elderly people, aged 75 and older, and to compare subjects with and without previous muscle strength training experience.

Design: Reliability study - test-retest.

Setting: Research centre for the elderly.

Main measures: One repetition maximum (1 RM) was measured using an arm/shoulder strength-training device (Pull Down, Norway). Two measurements were conducted, approximately one week apart.

Results: Forty people were included in the study and 34 completed both sessions. Eleven participants had previous muscle strength training experience on the indicated device. There was a high correlation between the test sessions, r = 0.97 for both groups. The analysis of 95% limits of agreement for the mean difference was -4.3/+6.9 kg for the group without and -3.0/+6.4 kg for the group with previous experience, respectively.

Conclusion: One repetition maximum evaluated by the Pull Down device seems to be a reliable and safe method for dosing and evaluating a muscle strength training programme for elderly people. The observed variation of approximately -4/+7 kg cannot be interpreted as an effect of muscle training, but is more likely an effect of learning, fluctuations in daily condition and/or motivation.

Competitive physical activity early in life is associated with bone mineral density in elderly Swedish men

In this population-based study of 75-year-old men (n = 498), we investigated the association between physical activity (PA) early in life and present bone mineral density (BMD). We demonstrate that a high frequency of competitive sports early in life is associated with BMD at several bone sites, indicating that increases in BMD following PA are preserved longer than previously believed.

INTRODUCTION

Physical activity (PA) increases bone mineral density (BMD) during growth. It is unclear if the positive effects remain at old age. In this study, we aimed to determine if PA early in life was associated with BMD in elderly men.

METHODS

In this population-based study, 498 men, 75.2 +/- 3.3 (mean+/-SD) years old, were included. BMD was assessed using DXA. Data concerning lifetime PA, including both competitive (CS) and recreational sports (RS), and occupational physical load (OPL), were collected at interview.

RESULTS

Subjects in the highest frequency group of CS in the early period (10-35 years), had higher BMD at the total body (4.2%, p < 0.01), total hip (7.0%, p < 0.01), trochanter (8.7%, p < 0.01), and lumbar spine (7.9%, p < 0.01), than subjects not involved in CS. A stepwise linear regression model showed that frequency of CS in the early period independently positively predicted present BMD at the total body (beta = 0.12, p < 0.01), total hip (beta = 0.11, p < 0.01), trochanter (beta = 0.12, p < 0.01), and lumbar spine (beta = 0.11, p = 0.01).

CONCLUSIONS

We demonstrate that PA in CS early in life is associated with BMD in 75-year-old Swedish men, indicating that increases in BMD following PA are preserved longer than previously believed.

Balance function and fall-related efficacy in patients with newly operated hip fracture

OBJECTIVE

To investigate the relation between fall-related efficacy in daily-life activities and functional as well as instrumental tests of balance in patients with hip fracture.

DESIGN

Analysis of different aspects of balance using the Falls Efficacy Scale, Swedish version FES(S), questions on fear of falling, Functional Reach (FR) and tests on a balance platform (Chattanooga).

SUBJECTS

Fifty-five elderly inpatients (mean age 82.3) with newly operated hip fracture who were assessed during the last week in hospital before discharge.

RESULTS

The results showed a significant relationship between the subjective ability measured with the FES(S) and the objectively measured balance in the Functional Reach test and also between fall-related efficacy measured with FES(S) and fear of falling. Very few significant correlations were found between the results from balance tests on the force platform and those obtained with FES(S) and FR.

CONCLUSIONS

Both the Falls Efficacy Scale, Swedish version, and the Functional Reach have been shown to be useful in analysing balance function in elderly patients newly operated on for hip fracture. The Falls Efficacy Scale also indicates which of the daily activities the patient perceives as troublesome and thus require further training.

Functional balance tests in 76-year-olds in relation to performance, activities of daily living and platform tests

Functional balance was studied in a sample of 98 women and 75 men from a population study. Tests used were one-legged stance and walking in a figure of eight. The results revealed that both static and dynamic functional balance were significantly correlated to isometric knee extensor strength, walking speed and stair-climbing capacity, while the association with activities of daily living (ADL) was modest in this sample of relatively healthy elderly persons. A sub-sample of 17 women and 10 men also performed balance tests on a force plate. Velocity of the sway path with both open and closed eyes was significantly correlated to the functional balance tests. Mean sway in the anterior-posterior direction and area tested with closed eyes were significantly correlated to the functional static balance test. There were no significant associations between the platform variables and the results in the performance tests. This study demonstrated differences between the sexes in that males were able to stand for a longer time on one leg, while they swayed more than females on the platform.

Instrumental activities of daily living related to impairments and functional limitations in 70-year-olds and changes between 70 and 76 years of age

The aim of this study was to analyse in particular dependence in instrumental daily life activities (I-ADLs) and its association with physical impairments and functional limitations in the elderly. The study was based on cross-sectional data on 70-year-olds (n = 602) and longitudinal data on subjects followed up to the age of 76 (n = 371). Persons dependent in ADL had lower values in maximum walking speed, grip strength, knee extensor strength, stair climbing capacity and in forward reach, compared with those who were independent in ADL. Walking speed in both women and men and sight impairment in men had the greatest influence on dependence in ADL. Possible critical levels for disability in ADL are discussed, as persons who developed dependence between 70 and 76 already had a lower capacity in walking speed and knee extensor strength at age 70 than persons who retained their independence in ADL.

A life span perspective on patterns of physical activity and functional performance at the age of 76

In a population study, involving 293 women and 233 men, the relation between level of physical activity in earlier life and both physical activity and performance at age 76 has been analysed. The life span was divided into five age periods from the age of 10 and described as competition sport, recreational sport, occupational physical load, household work and means of transportation. The results revealed that when all fields of activity were combined into a total measure of physical activity, created through weighting, the earliest periods alone could not explain activity patterns or performance late in life. After the age of 35 years in men and 50 years in women, however, the associations grew stronger and the activity level of the last life period (66-76) was strongly correlated to all variables incorporated in the study. When, on the other hand, each field of activity was treated alone, above all recreational sport turned out to be positively related to walking speed and physical activity at age 76 in both women and men for most life periods.

On the use of the WHO handicap classification in a population study of 73- and 76-year-old men and women

The WHO ICIDH classification of handicap was used in a population sample studied at 73 (n = 504) and 76 (n = 649) years of age. In the sample, there was either no handicap at all or the degree of handicap was generally low. In most handicap categories, however, the grades increased from 73 to 76 years. The self-rated activity level and the handicap category Occupation showed only low correlation. Good agreement was found between the handicap category Physical independence and assessments of Personal and Instrumental ADL and there was also a correlation between Mobility and maximal walking speed. Correlations were found between the handicap categories and the dimensions in the Nottingham Health Profile (NHP), but r-values were generally rather low. The highest correlation was that with the dimension of Physical mobility. The difference between self-assessed health aspects of quality of life and observer ratings using given norms is stressed.

Walking habits and health-related factors in a 70-year-old population

Walking and other physical activities were studied in a representative population sample of 619 70-year-old people in the city of Gothenburg, Sweden. Walking was the most common physical activity declared, and two thirds of those without an obvious disability walked 30 min or more every day. Subjects who took a daily walk of at least 30 min had a significantly better climbing capacity, higher bone mineral content and lower concentration of blood triglycerides than subjects who walked less. Male 'walkers' had a significantly larger lung volume than 'non-walkers'. Walkers had a more positive attitude towards physical activity as well as a higher estimation of their own physical fitness than non-walkers.