Agility performance in healthy older adults is associated with handgrip strength and force development: results from a 1-year randomized controlled trial

PURPOSE

Handgrip strength is considered as important indicator for general fitness in older adults. However, it does not notably reflect adaptations from whole-body training but may reflect adaptions of multicomponent exercise training. These approaches seem to be more functional and related to relevant daily tasks. Effects of multicomponent agility training on handgrip strength are analysed.

METHODS

Healthy older adults (N = 79, 69.3 ± 4.4 years, 64% female) were randomly assigned to an intervention (IG) or control group (CG). IG took part in a twice weekly 60 min multicomponent agility training for 12 months. Adherence rate of the participants was 75 ± 10 %.

RESULTS

Neither maximum handgrip strength (F_max) differed between groups (IG: 318 ± 97 N, CG: 302 ± 92 N) nor did it change after the intervention (IG: 315 ± 90 N, CG: 301 ± 97 N). Mixed ANOVA for F_max (F(1,49) = 0.018, p = 0.893) revealed no significant group × time interaction with an effect size of [Formula: see text]. Similar results were observed for rate of force development (RFD) (F(1,49) = 0.038, p = 0.847) with an effect size [Formula: see text] . RFD did not differ between groups in pre (IG: 876 ± 585 N/s, CG: 712 ± 303 N/s) and post (IG: 890 ± 424 N/s, CG: 702 ± 368 N/s) measurements. Correlation for ACE and F_max (r(64) = - 0.367, p = 0.005) and for RFD (r(64) = - 0.487, p < 0.001) was found to be negative.

CONCLUSION

A 1-year multicomponent agility training does not affect handgrip strength in healthy older adults. However, handgrip strength (F_max and RFD) is associated with agility, thus both handgrip strength indicators and agility might serve as local and functional vitality surrogates.

Factors associated with falls in older adults: A secondary analysis of a 12-month randomized controlled trial

PURPOSE

While identifying older adults at risk for falls is important, fall prediction models have had limited success, in part because of a poor understanding of which physical function measures to include. The purpose of this secondary analysis was to determine physical function measures that are associated with future falls in older adults.

METHODS

In a 12-month trial comparing Vitamin D3 supplementation versus placebo on neuromuscular function, 124 older adults completed physical function measures at baseline, including the Short Physical Performance Battery (SPPB), Timed Up and Go, tests of leg strength and power, standing balance on a force plate with firm and foam surfaces, and walking over an instrumented walkway. Falls were recorded with monthly diaries over 12 months and categorized as no falls vs. one or more falls. Univariate and multivariable logistic regression adjusting for demographics, treatment assignment, depression, and prescription medications were conducted to examine the association between each physical function measure and future falls. Models were additionally adjusted for fall history.

RESULTS

61 participants sustained one or more falls. In univariate analysis, white race, depression, fall history, SPPB, and postural stability on foam were significantly associated with future falls. In multivariable analysis, fall history (OR (95% CI): 3.20 (1.42-7.43)), SPPB (0.80 (0.62-1.01)), and postural stability on foam (3.01 (1.18, 8.45)) were each significantly associated with future falls. After adjusting for fall history, only postural stability on foam was significantly associated with falls.

CONCLUSIONS

When developing fall prediction models, fall history, the SPPB, and postural stability when standing on foam should be considered.

Quantification of sarcopenia in patients with rheumatoid arthritis by measuring the cross-sectional area of the thigh muscles with magnetic resonance imaging

PURPOSE

To determine the utility of cross-sectional area (CSA) measurements on magnetic resonance imaging (MRI), at the level of the thigh muscles, to estimate muscle mass in discriminating rheumatoid arthritis (RA) patients with sarcopenia from those without.

MATERIALS AND METHODS

Consecutive female RA patients were enrolled for this cross-sectional study. Patients were assessed for disease activity, radiological damage, handgrip strength, physical performance and for the presence of sarcopenia, identified in accordance with the EWGSOP2 criteria. A 1.5 T MRI machine was used to scan the thigh muscles. A dimensional region growth algorithm (Horos™) was used to segment the muscles CSAs (in cm²) on MR images located 25 cm above the knee joint (MRI-CSA-25). The MRI-CSA-25 was obtained by summing the CSAs of the individual muscles. MRI-CSA-25 was correlated (Pearson's r) with the other variables, and its optimal cut-off point (Youden index) for sarcopenia diagnosis was identified in relation to the EWGSOP2 criteria.

RESULTS

32 RA female patients were studied, 34.4% diagnosed as sarcopenic. The mean MRI-CSA-25 was 151.00 cm² for patient with sarcopenia, 275.57 cm² for patient without sarcopenia (p < 0.001). MRI-CSA-25 correlated significantly with measures of physical performance, and disease activity, but not with radiological damage or age. The MRI-CSA-25 optimal cut-off point in discriminating sarcopenic patients was identified at 182.00 cm² (AUC-ROC = 0.894).

CONCLUSION

MRI-CSA-25 can differentiate sarcopenic versus non-sarcopenic RA patients, representing an imaging biomarker of this condition.

Interrelation between functional decline and dementia: The potential role of balance assessment

OBJECTIVE

There has been growing interest in the past few years on the relationship between impairment of motor functions and cognitive decline, so that the first can be considered a marker of dementia. In MCI patients, the deficit in processing visual information interferes with postural control, causing oscillations and instability. Postural control is usually evaluated through the Short Physical Performance Battery (SPPB) test or Tinetti scale, but, to our knowledge, there are no many studies that considered the Biodex Balance System (BBS) in the evaluation of postural controls in MCI patients. The aim of this study was first to confirm the bi- directional relationship between cognitive and motor performance, and then to compare traditional evaluation scales (SPPB and Tinetti) with a biomechanical tool, the BBS.

MATERIALS AND METHODS

Observational retrospective study. In 45 elderly patients with cognitive impairment we evaluated cognition, assessed with the MMSE and MoCA, malnutrition with the MNA, and sarcopenia with DEXA (ASMMI). Motor performance was assessed with SPPB, Tinetti, and BBS.

RESULTS

MMSE correlated more with BBS than with the traditional scales, while MoCA was also correlated with SPPB and Tinetti scores.

CONCLUSIONS

BBS had a stronger correlation with cognitive performance compared with the traditional scales. The relationship between MoCA executive items and the BBS tests suggests the usefulness of targeted interventions involving cognitive stimulation to improve motor performance, and motor training to slow the progression of cognitive decline, particularly in MCI.

Towards a core-set of mobility measures in ageing research: The need to define mobility and its constructs

BACKGROUND

Mobility is a key determinant and outcome of healthy ageing but its definition, conceptual framework and underlying constructs within the physical domain may need clarification for data comparison and sharing in ageing research. This study aimed to (1) review definitions and conceptual frameworks of mobility, (2) explore agreement on the definition of mobility, conceptual frameworks, constructs and measures of mobility, and (3) define, classify and identify constructs.

METHODS

A three-step approach was adopted: a literature review and two rounds of expert questionnaires (n = 64, n = 31, respectively). Agreement on statements was assessed using a five-point Likert scale; the answer options 'strongly agree' or 'agree' were combined. The percentage of respondents was subsequently used to classify agreements for each statement as: strong (≥ 80%), moderate (≥ 70% and < 80%) and low (< 70%).

RESULTS

A variety of definitions of mobility, conceptual frameworks and constructs were found in the literature and among respondents. Strong agreement was found on defining mobility as the ability to move, including the use of assistive devices. Multiple constructs and measures were identified, but low agreements and variability were found on definitions, classifications and identification of constructs. Strong agreements were found on defining physical capacity (what a person is maximally capable of, 'can do') and performance (what a person actually does in their daily life, 'do') as key constructs of mobility.

CONCLUSION

Agreements on definitions of mobility, physical capacity and performance were found, but constructs of mobility need to be further identified, defined and classified appropriately. Clear terminology and definitions are essential to facilitate communication and interpretation in operationalising the physical domain of mobility as a prerequisite for standardisation of mobility measures.

Sarcopenia-defining parameters, but not sarcopenia, are associated with cognitive domains in middle-aged and older European men

BACKGROUND

Previous research suggests that sarcopenia is associated with lower cognitive functioning. Evidence on the longitudinal relationship between cognition and sarcopenia, according to the revised criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2), is scarce. This study aimed to investigate both cross-sectional and longitudinal associations between sarcopenia and its defining parameters (muscle strength, muscle mass and physical performance) and cognitive performance in middle-aged and older men.

METHODS

This was a secondary analysis of data from the European Male Ageing Study (EMAS), a multicentre cohort study of men aged 40-79 years, recruited from population registers in eight European centres. Cognitive functioning was assessed by using a battery of three neuropsychological tests, measuring fluid intelligence: Rey-Osterrieth Complex Figure (ROCF-Copy and ROCF-Recall), Camden Topographical Recognition Memory (CTRM) and Digit Symbol Substitution Test (DSST). Sarcopenia-defining parameters appendicular lean mass (aLM), gait speed (GS), chair stand test (CST) and handgrip strength (HGS) were measured. Sarcopenia was diagnosed according to the criteria of the EWGSOP2. All measurements were performed at baseline and after a follow-up of 4.3 years. Cross-sectional associations between cognition, sarcopenia-defining parameters and prevalent sarcopenia (EWGSOP2) were analysed. Longitudinally, the predictive value of baseline cognition on decline in sarcopenia-defining parameters, onset of new sarcopenia and vice versa was examined. Linear and logistic regression were used and adjusted for putative confounders.

RESULTS

In the whole cohort (n = 3233), ROCF-Copy (β = 0.016; P < 0.05), ROCF-Recall (β = 0.010; P < 0.05), CTRM (β = 0.015; P < 0.05), DSST score (β = 0.032; P < 0.05) and fluid cognition (β = 0.036; P < 0.05) were significantly and independently associated with GS at baseline. In the Leuven + Manchester subcohorts (n = 456), ROCF-Copy (β = 1.008; P < 0.05), ROCF-Recall (β = 0.908; P < 0.05) and fluid cognition (β = 1.482; P < 0.05) were associated with HGS. ROCF-Copy (β = 0.394; P < 0.05), ROCF-Recall (β = 0.316; P < 0.05), DSST (β = 0.393; P < 0.05) and fluid cognition (β = 0.765; P < 0.05) were associated with aLM. The prevalence of sarcopenia in this population was 17.8%. No associations were detected between cognition and prevalent or incident sarcopenia. Longitudinal analysis showed that low ROCF-Copy score at baseline was associated with an increase in CST in men ≥70 years (β = -0.599; P < 0.05). In addition, a decrease in ROCF-Recall was associated with a decrease in GS, and a decrease in DSST was associated with an increase in CST (β = 0.155; P < 0.0001, β = -0.595; P < 0.001, respectively) in persons with the highest change in both cognition and muscle function.

CONCLUSIONS

Sarcopenia was not associated with cognitive performance in this population, whereas several components of sarcopenia were associated with domain-specific cognitive performance. Longitudinally, baseline and change in subdomains of cognition predicted change in muscle function in specific subgroups.

Muscle strength and physical performance contribute to and improve fracture risk prediction in older people: A narrative review

Osteoporotic fractures present a major health problem with an increasing prevalence in older people. Fractures are associated with premature mortality, reduced quality of life, subsequent fracture, and increased costs. Hence, it is crucial to identify those at higher risk of fracture. Fracture risk assessment tools incorporated clinical risk factors to improve fracture predictive power over BMD alone. However, fracture risk prediction using these algorithms remains suboptimal, warranting further improvement. Muscle strength and physical performance measurements have been associated with fracture risk. In contrast, the contribution of sarcopenia, the composite condition of low muscle mass, muscle strength and/or physical performance, to fracture risk is unclear. It is uncertain whether this is due to the problematic definition of sarcopenia per se or limitations of the diagnostic tools and cut-off points of the muscle mass component. The recent position statement from the Sarcopenia Definition and Outcomes Consortium confirmed the inclusion of muscle strength and performance in the definition of sarcopenia but not DXA-assessed lean mass. Therefore, clinicians should focus on functional assessment (muscle strength and performance) rather than muscle mass, at least as assessed by DXA, as predictors of fractures. Muscle strength and performance are modifiable risk factors. Resistance exercise improves muscle parameters in the elderly, potentially leading to reduced risk of falls and fractures in the general population and in those who sustained a fracture. Therapists may consider exercise intervention to improve muscle parameters and potentially reduce the risk of fractures. The aim of this review was to explore 1) the contribution of muscle parameters (i.e., muscle mass, strength, and physical performance) to fracture risk in older adults, and 2) the added predictive accuracy of these parameters beyond the existing fracture assessment tools. These topics provide the rationale for investigating strength and physical performance interventions to reduce fracture risk. Most of the included publications showed that muscle mass is not a good predictor of fracture risk, while poor muscle strength and performance are associated with an increased risk of fracture, particularly in men, independent of age, BMD, and other risk factors for fractures. Muscle strength and performance can potentially improve the predictive accuracy in men beyond that obtained by the fracture risk assessment tools, Garvan FRC and FRAX.

Characteristics of reproductive history, use of exogenous hormones and walking speed among women: Data from the CONSTANCES French Cohort Study

OBJECTIVE

To investigate the cross-sectional associations of reproductive history and use of exogenous hormones with fast walking speed (WS) in women.

STUDY DESIGN

Between 2012 and 2020, 33,892 French women aged 45 years or more, recruited at health centers, underwent physical function tests and self-reported information on reproductive history and use of exogenous hormones. Linear mixed models with the center as random intercept were used to estimate the association of exposures with WS.

MAIN OUTCOME MEASURES

Fast WS.

RESULTS

Mean WS was 172.2 cm/s. WS increased with age at menarche (β_+1y = 0.23, 95 % confidence interval = 0.05 to 0.40), age at first birth (β_+1y = 0.20, 95 % CI = 0.13 to 0.27) and duration of breastfeeding (β_{for ≥10 vs ≤5months} = 1.38; 95 % CI = 0.39 to 2.36). In addition, parity was quadratically associated with WS, with women with 3 children having the highest WS (p for U-shaped relationship < 0.01). Menopausal status had no impact on WS but age at menopause was positively associated with WS (β_+5y = 0.52, 95 % CI = 0.17 to 0.87) and partly explained the deleterious impact of artificial menopause on WS. WS increased with reproductive lifetime duration (β_+5y = 0.49, 95 % CI = 0.16 to 0.83) and decreased with time since onset of menopause (β_+5y = -0.65, 95 % CI = -0.99 to -0.31). By contrast, there was no association of WS with oral contraception and postmenopausal hormone therapy.

CONCLUSION

Our findings suggest that reproductive life characteristics may be associated with WS and timing of exposure could play a role.

Weekly cumulative extracurricular core training time predicts cadet physical performance: A descriptive epidemiological study

Background

Core training can enhance athletic performance by enhancing core strength and stability. To achieve this outcome, however, a tailored training program is required; the normal military training curriculum is inadequate. The connection between cumulative weekly extracurricular training time, cumulative weekly extracurricular core training time and cadet performance is unknown.

Methods

The association between cumulative weekly extracurricular training time, cumulative weekly extracurricular core training time and performance has been discovered using a descriptive epidemiological study methodology. Questionnaires were used to collect information on personal characteristics and weekly cumulative extracurricular (core) training time, as well as the results of the Chinese Army Physical Fitness Test (C-APFT), which included 100-m dash, 5000-m run, 3000-m armed training run, 400-m steeplechase, 800 m breaststroke, horizontal bar pull-ups, 2-min sit-ups, 2-min push-ups, and hand grenade throwing. This study recruited two hundred and twenty male cadets (aged 18 to 23 years, 19.68 ± 0.91) from a military medical university.

Results

(a) The correlation between cumulative weekly extracurricular training time and C-APFT score is significant. The 100-m dash, 5000-m run, 3000-m armed training run, 400-m steeplechase, and 2-min push-ups performed the best when participants exercised for 5 to 10 h per week. (b) The number of cadets scoring good or excellent on the C-APFT improves with cumulative weekly extracurricular core training time. The recommended amount of core training for cadets per week is 120 min. (c) The average cumulative weekly extracurricular core training time was a effective predictor of performance on the 400-m steeplechase (R2 = 0.470, F = 10.641, P＜0.01), horizontal bar pull-ups (R2 = 0.238, F = 68.191, P＜0.01), 2-min sit-ups (R2 = 0.280, F = 84.710, P＜0.01), 100-m run (R2 = 0.031, F = 6.920, P＜0.01), 3000-m armed training run (R2 = 0.025, F = 5.603, P＜0.05), 2-min push-ups (R2 = 0.019, F = 4.295, P＜0.05), and hand grenade tossing (R2 = 0.025, F = 5.603, P＜0.05).

Conclusions

Active participation in extracurricular core training can improve cadets' C-APFT scores. An average cumulative weekly extracurricular training duration of 5-10 h showed the most progress, and more than 120 min per week was ideal for extracurricular core training. The amount of extracurricular time spent on core training exercises each week can be used as a predictor of the C-APFT.

Physical activity levels in cognitively normal and cognitively impaired oldest-old and the association with dementia risk factors: a pilot study

BACKGROUND

Research assessing the relationship of physical activity and dementia is usually based on studies with individuals younger than 90 years of age. The primary aim of this study was to determine physical activity levels of cognitively normal and cognitively impaired adults older than 90 years of age (oldest-old). Our secondary aim was to assess if physical activity is associated with risk factors for dementia and brain pathology biomarkers.

METHODS

Physical activity was assessed in cognitively normal (N = 49) and cognitively impaired (N = 12) oldest-old by trunk accelerometry for a 7-day period. We tested physical performance parameters and nutritional status as dementia risk factors, and brain pathology biomarkers. Linear regression models were used to examine the associations, correcting for age, sex and years of education.

RESULTS

Cognitively normal oldest-old were on average active for a total duration of 45 (SD 27) minutes per day, while cognitively impaired oldest-old seemed less physically active with 33 (SD 21) minutes per day with a lower movement intensity. Higher active duration and lower sedentary duration were related to better nutritional status and better physical performance. Higher movement intensities were related to better nutritional status, better physical performance and less white matter hyperintensities. Longer maximum walking bout duration associated with more amyloid binding.

CONCLUSION

We found that cognitively impaired oldest-old are active at a lower movement intensity than cognitively normal oldest-old individuals. In the oldest-old, physical activity is related to physical parameters, nutritional status, and moderately to brain pathology biomarkers.

Do clinicians address impairments in muscle strength and physical performance for older adults with cancer?

INTRODUCTION

Low physical function is associated with adverse outcomes in older adults with cancer, but evidence on real-world, clinical management of low physical function in oncology is lacking. We explored whether impairments in muscle strength and/or physical performance triggered downstream management by clinicians, the types of recommended strategies, and the reasons for not providing a referral/strategy for addressing such impairments in older cancer survivors prior to treatment.

MATERIALS AND METHODS

We conducted a retrospective, cross-sectional study of older adults who completed a comprehensive geriatric assessment (CGA) prior to cancer treatment in a tertiary cancer centre. Muscle strength and physical performance were assessed through grip strength and the Short Physical Performance Battery (SPPB), respectively. Patients who exhibited an impairment in grip strength and/or SPPB were classified as having abnormal objective physical function. Downstream management strategies and clinicians' reasons for not providing referrals were retrieved from clinical notes and an institutional database.

RESULTS

In total, 515 older adults (mean age: 80.7 years) were included. Low grip strength and/or SPPB combined was observed in 66.4% (n = 342) of participants, of whom 54.1% (n = 185) received an acceptable intervention. However, 41.2% (n = 141) were not provided with a referral/strategy by clinicians to address such impairments following CGA. No reasons were provided in clinical notes for not addressing impairments in physical function for 100 participants (70.9%).

DISCUSSION

Many older adults with cancer have impaired physical function prior to treatment. However, we found that such impairments are not systematically addressed by clinicians, and documentation was often suboptimal, identifying gaps in patient care that need to be addressed.

Brain predicted age difference mediates pain impact on physical performance in community dwelling middle to older aged adults

The purpose of the study was to examine associations between physical performance and brain aging in individuals with knee pain and whether the association between pain and physical performance is mediated by brain aging. Participants (n=202) with low impact knee pain (n=111), high impact knee pain (n=60) and pain-free controls (n=31) completed self-reported pain, magnetic resonance imaging (MRI), and a Short Physical Performance Battery (SPPB) that included balance, walking, and sit to stand tasks. Brain predicted age difference, calculated using machine learning from MRI images, significantly mediated the relationships between walking and knee pain impact (CI: -0.124; -0.013), walking and pain-severity (CI: -0.008; -0.001), total SPPB score and knee pain impact (CI: -0.232; -0.025), and total SPPB scores and pain-severity (CI: -0.019; -0.001). Brain-aging begins to explain the association between pain and physical performance, especially walking. This study supports the idea that a brain aging prediction can be calculated from shorter duration MRI sequences and possibly implemented in a clinical setting to be used to identify individuals with pain who are at risk for accelerated brain atrophy and increased likelihood of disability.

Lower Leg Power and Grip Strength Are Associated With Increased Fall Injury Risk in Older Men: The Osteoporotic Fractures in Men Study

BACKGROUND

Past research has not investigated both lower-extremity power and upper-extremity strength in the same fall injury study, particularly nonfracture fall injuries.

METHODS

In the Osteoporotic Fractures in Men Study (baseline: N = 5 994; age 73.7 ± 5.9 years; 10.2% non-White), fall injuries (yes/no) were assessed prospectively with questionnaires approximately every 3 years over 9 years. Maximum leg power (Watts) from Nottingham single leg press and maximum grip strength (kg) from handheld dynamometry were assessed at baseline and standardized to kg body weight. Physical performance included gait speed (6-m usual; narrow walk) and chair stands speed.

RESULTS

Of men with ≥1/4 follow-ups (N = 5 178; age 73.4 ± 5.7 years), 40.4% (N = 2 090) had ≥1 fall injury. In fully adjusted repeated-measures logistic regressions, lower power/kg and grip strength/kg had higher fall injury risk (trend across quartiles: both p < .0001), with lower quartiles at significantly increased risk versus highest Q4 except for grip strength Q3 versus Q4. Fall injury risk was 19% higher per 1 standard deviation (SD) lower power/kg (95% confidence interval [CI]: 1.12-1.26) and 16% higher per SD lower grip strength/kg (95% CI: 1.10-1.23). In models including both leg power/kg and grip strength/kg, odds ratios (ORs) were similar and independent of each other and physical performance (leg power/kg OR per SD = 1.13, 95% CI: 1.06-1.20; grip strength/kg OR per SD = 1.11, 95% CI: 1.05-1.17).

CONCLUSIONS

Lower leg power/kg and grip strength/kg predicted future fall injury risk in older men independent of physical performance. Leg power potentially identifies fall injury risk better than grip strength at higher muscle function, though grip strength may be more suitable in clinical/practice settings.

Relationships of Cerebral Perfusion With Gait Speed Across Systolic Blood Pressure Levels and Age: A Cohort Study

BACKGROUND

This study aimed to examine if the association of cerebral perfusion with gait speed differs across systolic blood pressure (SBP) and age.

METHODS

Cerebral perfusion was measured via arterial spin labeled (ASL)-MRI among community-dwelling adults aged 31-94 years in the population-based Mayo Clinic Study of Aging. Usual gait speed was assessed over 5.6 meters on an electronic mat. Sex- and body mass index (BMI)-adjusted linear regression models estimated cross-sectional gait speed associations with ASL and modifying effects of age and SBP using 3-way and 2-way interaction terms between continuous age, SBP, and ASL. Results report estimated differences in gait speed per standard deviation (SD) lower ASL for exemplar SBPs and ages.

RESULTS

Among 479 participants (mean age 67.6 years; 44% women; mean gait speed 1.17 m/s), ASL relations to gait speed varied by age (ASL-x-age interaction: p = .001) and SBP (ASL-x-SBP interaction: p = .009). At an SBP of 120 mmHg, each SD lower ASL was associated with a 0.04 m/s (95% confidence interval [CI]: 0.01, 0.07) slower gait speed at 65 years, 0.07 m/s (0.04, 0.10) at 75 years, and 0.09 m/s (0.05, 0.13) at 85 years. At an SBP of 140 mmHg, ASL associations with gait speed were attenuated to 0.01 (-0.01, 0.04), 0.04 (0.02, 0.06), and 0.06 (0.04, 0.09) m/s slower gait speed at ages 65, 75, and 85, respectively.

CONCLUSION

Poorer cerebral perfusion is associated with clinically meaningful slower gait speeds, particularly with older age, while higher perfusion markedly attenuates age differences in gait speed.

Interindividual Variability in Mental Fatigue-Related Impairments in Endurance Performance: A Systematic Review and Multiple Meta-regression

BACKGROUND

The negative effect of mental fatigue (MF) on physical performance has recently been questioned. One reason behind this could lie in the interindividual differences in MF-susceptibility and the individual features influencing them. However, the range of individual differences in mental fatigue-susceptibility is not known, and there is no clear consensus on which individual features could be responsible for these differences.

OBJECTIVE

To give an overview of interindividual differences in the effects of MF on whole-body endurance performance, and individual features influencing this effect.

METHODS

The review was registered on the PROSPERO database (CRD42022293242). PubMed, Web of Science, SPORTDiscus and PsycINFO were searched until the 16th of June 2022 for studies detailing the effect of MF on dynamic maximal whole-body endurance performance. Studies needed to include healthy participants, describe at least one individual feature in participant characteristics, and apply at least one manipulation check. The Cochrane crossover risk of bias tool was used to assess risk of bias. The meta-analysis and regression were conducted in R.

RESULTS

Twenty-eight studies were included, with 23 added to the meta-analysis. Overall risk of bias of the included studies was high, with only three presenting an unclear or low rating. The meta-analysis shows the effect of MF on endurance performance was on average slightly negative (g = - 0.32, [95% CI - 0.46; - 0.18], p < 0.001). The multiple meta-regression showed no significant influences of the included features (i.e. age, sex, body mass index and physical fitness level) on MF-susceptibility.

CONCLUSIONS

The present review confirmed the negative impact of MF on endurance performance. However, no individual features influencing MF-susceptibility were identified. This can partially be explained by the multiple methodological limitations such as underreporting of participant characteristics, lack of standardization across studies, and the restricted inclusion of potentially relevant variables. Future research should include a rigorous description of multiple different individual features (e.g., performance level, diet, etc.) to further elucidate MF mechanisms.

Protocol for a randomised, placebo-controlled, double-blinded clinical trial on the effect of oestrogen replacement on physical performance to muscle resistance exercise for older women with osteoarthritis of knee joint: the EPOK trial

BACKGROUND

Knee osteoarthritis (KOA) is highly prevalent in older women, and previous studies suggest the involvement of hormonal factors play a role in the pathogenesis of osteoarthritis. KOA causes musculoskeletal impairment, resulting in decreased physical activity, muscle mass, and strength, which leads to sarcopenia and further increases the burden on healthcare systems. Oestrogen replacement therapy (ERT) improves joint pain and muscle performance in early menopausal women. Muscle resistance exercise (MRE) is a non-pharmacological method that preserves the physical functions of patients with KOA. However, data on short-term oestrogen administration combined with MRE in postmenopausal women, especially in those aged > 65 years, are limited. Therefore, this study presents a protocol of a trial aimed to examine the synergistic effect of ERT and MRE on lower-limb physical performance in older women with KOA.

METHODS

We will conduct a double-blinded, randomised placebo-controlled trial in 80 Japanese women aged > 65 years living independently with knee pain. The participants will be randomly categorised into two groups: (1) 12-week MRE programme with transdermal oestrogen gel containing 0.54 mg oestradiol per push and (2) 12-week MRE programme with placebo gel. The primary outcome measured using the 30-s chair stand test, and secondary outcomes (body composition, lower-limb muscle strength, physical performance, self-reported measure of knee pain, and quality of life) will be measured at baseline, 3 months, and 12 months, and these outcomes will be analysed based on the intention-to-treat.

DISCUSSION

The EPOK trial is the first study to focus on the efficacy of ERT on MRE among women aged > 65 years with KOA. This trial will provide an effective MRE to prevent KOA-induced lower-limb muscle weakness, confirming the benefit of short-term oestrogen administration.

TRIAL REGISTRATION

Japan Registry of Clinical Trials: jRCTs061210062. Registered 17th December 2021, https://jrct.niph.go.jp/en-latest-detail/jRCTs061210062 .

Allostatic load and physical performance in older adults: Findings from the International Mobility in Aging Study (IMIAS)

OBJECTIVE

This study aimed to evaluate the association between Allostatic Load (AL) and physical performance scores in older adults from four cities in North and South America.

METHODS

In this cross-sectional study, data from 1101 volunteers from three countries (Canada, Brazil, and Colombia) from the International Mobility in Aging Study (IMIAS) were used to evaluate the association between AL index and Short Physical Performance Battery (SPPB) scores. Three multiple linear regression models adjusted by age, Socioeconomic Status (SES), chronic conditions, depression symptoms, and Leganés Cognitive Test (LCT) were developed to estimate the independent association between SPPB and AL. Mediation analysis with 2012 LA data and covariates was performed to access the total, direct, and indirect effects of mediation on SPPB scores from 2016.

RESULTS

AL and SPPB were inversely associated, with older adults with high allostatic load scoring lower on SPPB (β: -0.234, Std: 0.033, p-value: <0.001).  Indirect effects were evidenced between age, SES and chronic conditions with AL and SPPB scores. Chronic conditions also had a total effect on SPPB scores and were also mediated by AL. However, indirect effects of depressive symptoms and LCT on SPPB scores mediated by AL were not observed.

CONCLUSIONS

Findings from this study support that increased AL index determines worse physical performance states after full adjustments. AL has a mediator role between the number of chronic diseases, depressive symptoms, cognitive status and physical performance. Socioeconomic status also influenced physical scores mediated by the AL index.

Association of physical function and body composition with falls in pre-frail older adults with poor physical performance: A cross-sectional study

BACKGROUND

Falls in pre-frail older adults is often attributed to poor physical performance, lower muscle quality and quantity. The aims of our study were to determine (i) demographics, physical function, and body composition in pre-frail older adults with poor physical performance (ii) characteristics of fallers amongst those with poor physical performance and (iii) association of physical function and body composition measures with falls in pre-frail older adults with poor physical performance.

METHODS

Cross-sectional study of 328 pre-frail community-dwelling older adults ≥ 60 years. Data was collected on demographics, cognition, short physical performance battery (SPPB) and gait speed. Poor physical performance was defined by SPPB ≤ 9, 5x chair-stand time ≥12 s or gait speed <1 m/s. InBody S10 used to measure body composition.

RESULTS

Mean age 72.51 years, 185(56.4%) females, 276(84.1%) of Chinese ethnicity and 257 (78.4%) had poor physical performance. Within the poor performers, SPPB balance (OR 0.50; 95% CI 0.27-0.92; p = 0.025) and 5x-chair-stand (OR 1.09; 95% CI 1.01-1.18; p = 0.038) in addition to higher body fat percentage, fat mass index, fat mass to fat free mass ratio, all segmental lean masses except for left leg and body cell mass were significantly associated with falls.

CONCLUSIONS

Longer chair-stand time, lower balance, low muscle and high fat mass are associated with falls in poor performers and could serve as screening tools for those at increased risk of falls. The findings from our study need to be validated prospectively in a larger population study.

Rationale and design of an ancillary study evaluating the effects of the cocoa flavanol and/or multivitamin interventions on falls and physical performance outcomes in the COcoa Supplement and Multivitamin Outcomes Study (COSMOS)

BACKGROUND

Falls and decreased physical function increase markedly with age and result in injury, hospitalization, and premature death. Emerging studies show potential benefits of supplemental cocoa extract on physical performance, including grip strength and walking speed in older adults. However, there are no large, long-term randomized controlled trials of effects of supplemental cocoa extract on falls, muscle performance, and/or fall-related injuries.

METHODS

The COcoa Supplement and Multivitamin Outcomes Study (COSMOS) is a double-blind, placebo-controlled, 2 × 2 factorial trial investigating effects of supplementation with cocoa extract (500 mg/d, including 80 mg (-)-epicatechin) and/or a multivitamin on prevention of cardiovascular disease and cancer in 21,442 women (≥65 years) and men (≥60 years).

COSMOS

Effects on Falls and Physical Performance is an ancillary study to COSMOS that will clarify effects of cocoa extract and/or multivitamin supplementation on falls, physical performance, and incident fracture outcomes in older adults. Injurious fall(s) resulting in healthcare utilization and recurrent falls were regularly assessed by follow-up questionnaires in the overall cohort. Incident fractures were also assessed by annual questionnaires. Circumstances surrounding falls and any fall-related injuries will be confirmed by medical record review. Effects of the interventions on 2-year changes in physical performance measures (grip strength, walking speed, and the Short Physical Performance Battery) will be tested in a clinic sub-cohort (n = 603).

CONCLUSION

Results from this ancillary study will determine whether supplemental cocoa extract slows age-related declines in physical performance and decrease injurious and recurrent falls and fall-related injuries and fractures that are major public health problems in older adults.

Military field training exercise with prolonged physical activity and sleep restriction causes hormonal imbalance in firefighter cadets

PURPOSE

To evaluate the impact of the "Search and rescue" field military training exercise (SR_FTX) on hormonal modulation and identify their possible correlation with physical and cognitive performance.

METHODS

An observational (before and after) study was carried out, with male firefighters cadets (n = 42; age = 23[22;27] years) undergoing a nine-day military exercise (SR_FTX). The Countermovement jump (physical performance), the Stroop test (cognitive alertness), and blood tests for testosterone, cortisol, GH, and IGF-1 were applied. Wilcoxon for paired samples and Spearman's correlation tests were used.

RESULTS

Testosterone (751.10 [559.10;882.8] vs. 108.40 [80.12;156.40] ng/dL) and IGF-1 (217.5 [180;239.30] vs. 105 [93;129] ng/mL) significantly decreased while GH (0.10 [0.06;0.18] vs. 1.10 [0.58;2.28] ng/mL) and cortisol (9.60 [8.20;11.55] vs. 15.55 [12.28;18.98] ug/dL) significantly increased. Physical performance (31.2 [30.04;35.4] vs. 21.49 [19,02;23,59] cm) and cognitive alertness were significantly worse after SR_FTX (Congruent task: 1,78 (0183) vs. 1,56 (0185) response/s and incongruous task: 1,23 (0191) vs. 1,02 (0207) response/s). The physical performance showed a strong correlation with testosterone (rho = 0.694) and regular correlations with both IGF-1 (rho = 0.598) and cortisol (rho = - 0.580). The Stroop test presented weak correlations with GH (rho = - 0.350) and cortisol (rho = - 0.361).

CONCLUSION

SR_FTX negatively impacted hormonal modulation, physical and cognitive performance. These findings could help commanders decide to replace the employed firefighters in a real mission more frequently. Also, if the real scenario allows, they could think about providing better work conditions, such as improving caloric intake and rest periods, to preserve the military performance and health.

Hearing threshold and physical performance in older people: a cross-sectional study from the HUNT4 cohort

PURPOSE

To evaluate the association between increased hearing loss and reduced physical performance in older people.

METHODS

Cross-sectional population-based study using data from the fourth wave of the Trøndelag Health Survey (HUNT4) in Norway. Data were obtained from the subproject HUNT4 Hearing which collected audiometric data of people > 70 years (N = 13,197). Analyses were performed on all participants who had completed audiometry and measured balance using the Short Physical Performance Battery (SPPB), which was scored from 0 (worst score) to 12. The hearing threshold was expressed as a pure tone average (PTA). Associations between the hearing threshold for the best and worst ear and physical performance were analyzed by linear regression models adjusted for age, sex, education, diabetes, and cardiovascular disease. Hearing threshold was indicated with steps of 10 dB.

RESULTS

Of 13,197 eligible participants, 4101 who completed audiometry and SPPB (52.3% women. mean age 76.3 years) were included. The analyses revealed an association between reduced SPPB and increased hearing threshold in the best ear (b = - 0.296; 95% CI - 0.343 to - 0. 249; P < 0.001) and the worst ear (b = - 0.229; 95% CI - 0.270 to - 0.189; P < 0.001).

CONCLUSIONS

In this population study, we found that the increased hearing threshold was associated to reduced physical performance as measured by SPPB. The association seemed to be strongest for the best ear. The association between hearing threshold and physical performance illustrates the importance of assessing physical performance in people with hearing loss to prevent the risk of falls and disability. The underlying causes of the associations between hearing loss and poorer physical performance are not fully understood and should be further investigated.

LEVEL OF EVIDENCE

Level 3.

Development and Validation of the Disability Index Among Older Adults

BACKGROUND

With the rapid population aging, the challenge to provide care for disabled older adults is becoming bigger. This study aims to develop the Disability Index (DI) to assess disability to indicate care needs, and we evaluated the reliability and validity of the DI among older adults aged 65-105.

METHODS

A total of 12 559 older adults (54.0% women; mean age = 84.3; SD = 11.2) from 22 provinces in China were investigated in 2017-2018. We developed the 21-item DI covering 4 subdomains, including Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), physical performance, and cognitive function. Cronbach's alpha was used to determine internal consistency. The convergent and divergent validity were assessed by Spearman rank order correlation coefficients and Pearson correlation coefficients. The known-group validity was assessed by Mann-Whitney U tests. The concurrent validity was assessed by the area under the receiver operating characteristic curve (AUC).

RESULTS

In the total sample, the internal consistency of the full DI and its subdomains were satisfactory with Cronbach's alpha ≥0.70; the convergent and divergent validity of the 4 subdomains were supported by all the alternative measures; the known-group validity of the full DI and its subdomains were supported by clear discriminative ability; and the concurrent validity of the full DI was supported with all the AUCs ≥0.70. The reliability and validity of the full DI and its subdomains were additionally supported by age subgroups and sex subgroups.

CONCLUSIONS

The DI is a reliable and valid instrument to assess disability status among older adults.

The effect of tDCS on improving physical performance and attenuating effort perception during maximal dynamic exercise in non-athletes

OBJECTIVES

This study aimed to test the effects of transcranial direct current stimulation (tDCS), using different electrode positioning and montages, on physical performance in maximum incremental tests of healthy non-athlete subjects.

DESIGN

A double-blinded, crossover, sham-controlled study.

METHOD

Fifteen subjects (aged 25.8 ± 5 years, nine women) received one of five different tDCS protocols: (i) anodal tDCS on the primary motor cortex (M1) (a-tDCS/M1), (ii) anodal tDCS on the left temporal cortex (T3) (a-tDCS/T3), (iii) cathodal tDCS on M1 (c-tDCS/M1), (iv) cathodal on T3 (c-tDCS/T3), or (v) sham tDCS. The protocols were assigned in a random order in separate sessions. After tDCS, the volunteers performed the maximal incremental exercise test (MIT) on a cycle ergometer in each session. The following measures were used to evaluate physical performance (primary outcome) during MIT: time to exhaustion (TE), maximum power (MAX-P), and Borg Rating of Perceived Exertion (RPE) scale. In addition, as a secondary outcome measure, we assessed the lower-limb corticospinal excitability and electrical muscular activity.

RESULTS

tDCS applied over T3 or M1 did not influence electrical muscular activity or increase physical performance during MIT in healthy non-athlete subjects. However, our data confirmed that a-tDCS on the M1 increases lower-limb cortical excitability.

CONCLUSIONS

Our results suggest that tDCS is not effective in improving performance during maximal dynamic exercise in non-athletes. However, we confirmed that the a-tDCS M1 protocol used in this study might increase cortical excitability in the lower limb motor cortex.

Differential association of total and regional muscle mass and quality with physical performance in community-dwelling older adults

PURPOSE

In this study, we examined the association among total muscle mass, regional muscle mass, muscle quality, and various types of physical performance in community-dwelling older adults.

METHODS

This study included 195 community-dwelling older adults (61 males and 134 females). The muscle thickness and echo intensity of the quadriceps femoris and triceps surae were measured using ultrasound, and the skeletal muscle mass index was evaluated using bioelectrical impedance analysis. Physical performance was measured using the 30-s standing test (CS30), Timed up-and-go test (TUG), 10-m maximum walking speed (10MWT), vertical jump test (VJT), and grip strength.

RESULTS

Partial correlation analysis after controlling for age, sex, and body mass index showed that CS30 was significantly correlated with muscle thickness and echo intensity of the quadriceps femoris. The TUG and VJT were significantly correlated with muscle thickness of the triceps surae, and grip strength was significantly correlated with muscle thickness of the triceps surae and skeletal muscle mass index. Stepwise multiple regression analyses indicated that the echo intensity of the quadriceps femoris was a significant predictor of CS30, and the muscle thickness of the triceps surae was a significant predictor of TUG, VJT, and grip strength, whereas the skeletal muscle mass index was not a significant predictor of any physical performance test.

CONCLUSION

Our results suggest that regional muscle mass and quality are more important than skeletal muscle mass index for predicting physical performance.