Moving against frailty: does physical activity matter?

[Trends in leisure-time physical activity in Brazilian adults (2006-2016)]

This study aimed to analyze time trends in leisure-time physical activity in adults in Brazilian state capitals and the Federal District from 2006 to 2016. The study was based on data from the Risk and Protective Factors Surveillance System for Chronic Noncommunicable Diseases Through Telephone Interview (VIGITEL), collected by the Ministry of Health from 2006 to 2016 (n = 572,437). VIGITEL conducts interviews annually with more than 50,000 adults (≥ 18 years) living in households with hardline telephones. The main relevant VIGITEL questions for this study deal with leisure-time physical activity. We estimated the annual percentage of leisure-time physical activity in the three months prior to the interview, in addition to sufficient levels of such activit (≥ 150 minutes/week), available from 2009 to 2016 for the adult population as whole and according to sex, age, and schooling. There was an increase (p < 0.05) both in the percentage of leisure-time physical activity in the three months prior to the interview (from 44.0 to 53.6%, or 0.97 percentage points per year) and in the percentage of individuals that achieved recommended levels of physical activity, from 30.3 to 37.6% (1.20 percentage points per year) from 2009 to 2016. The increases were more frequent in women, younger adults, and those with more schooling. There was an increase in physical activity in the majority of the situations studied. Although this increase reduces the differences between men and women, the differences increased between young people and older individuals and between those at the extremes of educational levels.

The appeal of the Functional Fitness MOT to older adults and health professionals in an outpatient setting: a mixed-method feasibility study

Purpose

To understand the views and perceptions regarding the Functional Fitness MOT (FFMOT), a battery of functional tests followed by a brief motivational interview, of both the older people undergoing it and the health professionals delivering it.

Patients and methods

Physically inactive older adults (n=29) underwent the FFMOT and subsequently attended focus groups to share their perceptions of it and to discuss the barriers, motivators, health behavior change, and scope to improve physical activity (PA) levels. PA levels were recorded at baseline and again at 12 weeks together with a post-intervention questionnaire concerning behavior change. Participating physiotherapists and technical instructors were interviewed.

Results

Most participants felt they had learned about their abilities and comparisons with their peers, had a change in perception about the importance of good balance and strength, and felt the FFMOT helped raise their awareness of local and self-directed physical activity opportunities. Most felt their awareness of the need for PA had not changed, but 25% of participants started a new organized PA opportunity. The health professionals perceived the FFMOT as being easy to administer, educating, and motivating for participants to increase their PA. Space, time, finances, and insecurity about having the necessary skills to conduct the FFMOTs were seen as barriers in implementing the FFMOT in daily practice.

Conclusion

Over half of those offered the FFMOT accepted it, suggesting it is appealing. However, most participants felt they were already active enough and that their awareness of the need for PA had not changed. There were positive perceptions of the FFMOT from both professionals and older people, but both felt the FFMOT could be held in a community venue. The overall findings suggest that the FFMOT is feasible in the clinical setting, but its effectiveness has yet to be determined.

Feasibility of Virtual Tablet-Based Group Exercise Among Older Adults in Siberia: Findings From Two Pilot Trials

Background

Regular physical activity has a positive effect on physical health, well-being, and life satisfaction of older adults. However, engaging in regular physical activity can be challenging for the elderly population because of reduced mobility, low motivation, or lack of the proper infrastructures in their communities.

Objective

The objective of this paper was to study the feasibility of home-based online group training—under different group cohesion settings—and its effects on adherence and well-being among Russian older adults. We focused particularly on the technology usability and usage and on the adherence to the training (in light of premeasures of social support, enjoyment of physical activity, and leg muscle strength). As a secondary objective, we also explored the effects of the technology-supported intervention on subjective well-being and loneliness.

Methods

Two pilot trials were carried out exploring two different group cohesion settings (weak cohesion and strong cohesion) in the period from 2015 to 2016 in Tomsk, Russian Federation. A total of 44 older adults (59-83 years) participated in the two pilots and followed a strength and balance training program (Otago) for 8 weeks with the help of a tablet-based virtual gym app. Participants in each pilot were assigned to an interaction condition, representing the online group exercising, and an individual condition, representing a home-based individual training. Both conditions featured persuasion strategies but differed in the ability to socialize and train together.

Results

Both interaction and individual groups reported a high usability of the technology. Trainees showed a high level of technology acceptance and, particularly, a high score in intention to future use (4.2-5.0 on a 5-point Likert scale). Private texting (short service message [SMS]) was used more than public texting, and the strong cohesion condition resulted in more messages per user. Joint participations to training sessions (copresence) were higher for the social group with higher cohesion. The overall adherence to the training was 74% (SD 27%). Higher levels of social support at baseline were associated with higher adherence in the low cohesion condition (F1,18=5.23, P=.03), whereas in the high cohesion, such association was not found. Overall improvement in the satisfaction with life score was observed between pre and post measures (F1,31=5.85, P=.02), but no decrease in loneliness.

Conclusions

Online group exercising was proven feasible among healthy independently living older adults in Russia. The pilots suggest that a physical training performed in a virtual environment positively affect the life satisfaction of the trainees, but it does not provide support for a decrease in loneliness. High cohesion groups are preferable for group exercising, especially to mitigate effects of low social support on adherence. Further research in motivating group interactions in training settings is needed.

Feasibility and Impact of High-Intensity Walking Training in Frail Older Adults

To investigate the impact of high-intensity walking training (HIWT) on prefrail and frail older adults, five assisted living residents underwent a supervised 12-session intervention. The intervention consisted of 30 min of HIWT at 70–80% of heart rate reserve or ratings of 15 to 17 (hard to very hard) on the Borg Rating of Perceived Exertion scale. Training included walking at fast speeds, multi-directions, stairs, and outdoor surfaces with and without an assistive device. Training significantly reduced frailty using the SHARE-FI (p = .008), increased fast gait speed (p = .01), improved 6-min walk test distance (p = .03), and enhanced Berg Balance Scale scores (p = .03). There were no adverse events and all participants reached target training intensity in all 12 sessions. Participants viewed the walking intervention as highly satisfactory (9.6/10 on a Likert scale) and 100% recommended that the assisted living facility should offer HIWT as part of routine programming.

Immune biomarkers in older adults: Role of physical activity

Aging is associated with a decline in the normal functioning of the immune system. Several studies described the relationship between immunological alterations, including immunosenescence and inflammation, and aging or age-related outcomes, such as sarcopenia, depression, and neurodegenerative disorders. Physical activity is known to improve muscle function and to exert a number of benefits on older adult health, including reduced risk for heart and metabolic system chronic diseases. However, the positive influence of physical activity on the immune system has not been elucidated. In order to shed light on the role of physical activity in immune responses of older individuals, a number of immunological parameters comprising % lymphocyte subsets (CD3⁺, CD4⁺, CD8⁺, CD19⁺, and CD16⁺56⁺) and serum levels of neopterin and tryptophan metabolism products were evaluated in peripheral blood samples of older adults performing normal (N = 170) or reduced (N = 89) physical activity. In addition, the potential influence of other clinical and epidemiological factors was also considered. Results showed that subjects with reduced physical activity displayed significantly higher levels of CD4⁺/CD8⁺ ratio, kynurenine/tryptophan ratio, and serum neopterin, along with lower %CD19⁺ cells and tryptophan concentrations. Further, some immunological biomarkers were associated with cognitive impairment and functional status. These data contribute to reinforce the postulation that physical activity supports healthy aging, particularly by helping to protect the immunological system from aging-related changes.

Cognitive Frailty: Mechanisms, Tools to Measure, Prevention and Controversy

Physical frailty is often associated with cognitive impairment, possibly because of common underlying pathophysiologic mechanisms. To stimulate research in this field, the concept cognitive frailty was proposed, emphasizing the important role of brain aging. Cognitive frailty was defined as the presence of cognitive deficits in physically frail older persons without dementia. This subtype of frailty is deemed important, as it may represent a prodromal phase for neurodegenerative diseases and is potentially a suitable target for early intervention. The aim of this report is to refine the framework for the definition and mechanisms of cognitive frailty and relevant screening tools.

Effects of online group exercises for older adults on physical, psychological and social wellbeing: a randomized pilot trial

BACKGROUND

Intervention programs to promote physical activity in older adults, either in group or home settings, have shown equivalent health outcomes but different results when considering adherence. Group-based interventions seem to achieve higher participation in the long-term. However, there are many factors that can make of group exercises a challenging setting for older adults. A major one, due to the heterogeneity of this particular population, is the difference in the level of skills. In this paper we report on the physical, psychological and social wellbeing outcomes of a technology-based intervention that enable online group exercises in older adults with different levels of skills.

METHODS

A total of 37 older adults between 65 and 87 years old followed a personalized exercise program based on the OTAGO program for fall prevention, for a period of eight weeks. Participants could join online group exercises using a tablet-based application. Participants were assigned either to the Control group, representing the traditional individual home-based training program, or the Social group, representing the online group exercising. Pre- and post- measurements were taken to analyze the physical, psychological and social wellbeing outcomes.

RESULTS

After the eight-weeks training program there were improvements in both the Social and Control groups in terms of physical outcomes, given the high level of adherence of both groups. Considering the baseline measures, however, the results suggest that while in the Control group fitter individuals tended to adhere more to the training, this was not the case for the Social group, where the initial level had no effect on adherence. For psychological outcomes there were improvements on both groups, regardless of the application used. There was no significant difference between groups in social wellbeing outcomes, both groups seeing a decrease in loneliness despite the presence of social features in the Social group. However, online social interactions have shown to be correlated to the decrease in loneliness in the Social group.

CONCLUSION

The results indicate that technology-supported online group-exercising which conceals individual differences in physical skills is effective in motivating and enabling individuals who are less fit to train as much as fitter individuals. This not only indicates the feasibility of training together despite differences in physical skills but also suggests that online exercise might reduce the effect of skills on adherence in a social context. However, results from this pilot are limited to a small sample size and therefore are not conclusive. Longer term interventions with more participants are instead recommended to assess impacts on wellbeing and behavior change.

Cognitive Decline, Body Mass Index, and Waist Circumference in Community-Dwelling Elderly Participants

OBJECTIVE

The aim of this study was to explore the association of body mass index (BMI), waist circumference (WC), and BMI and WC changes over time with cognitive decline in a nationally representative sample.

METHODS

A total of 5239 participants (≥65 years) were followed for 3 years as part of the National Health and Aging Trends Study. Cox proportional hazard regression was applied to model the risk of cognitive decline.

RESULTS

BMI, after adjusting for WC and main confounders, was associated with reduced risk of cognitive decline (hazard ratio [HR] 0.97 for each unit BMI increase, 0.95-0.99). After stratifying by gender and age, this effect remained significant among females and young elders ≤80 years. A BMI decrease and WC increase >10% over the study period were associated with increased risk of cognitive decline (HR 1.98, 1.16-3.38; HR 1.30, 1.04-1.62, respectively).

CONCLUSION

In the elderly individuals, lean mass, as measured by BMI adjusted for WC, was associated with reduced risk of cognitive decline. Loss of lean mass and gain of fat mass, as measured by WC adjusted for BMI, were associated with elevated risk of cognitive decline.

The prevalence and incidence of frailty in Pre-diabetic and diabetic community-dwelling older population: results from Beijing longitudinal study of aging II (BLSA-II)

BACKGROUND

Various factors including cardio-metabolic disorders are found to be correlated with frailty. With the increase in age, older adults are likely to have elevated blood glucose level. In this study we intend to investigate the prevalence and incidence of frailty in the pre-diabetic and diabetic community dwelling elderly population and the associated risk factors.

METHODS

At baseline total of 10,039 subjects with a mean age of 70.51 (±7.82) were included. A total of 6,293 older adults were followed up at 12 months. A Frailty index (FI) with 32 items was developed using Rockwood's cumulative deficits method. Frailty index ≥0.25 was used as cut-off criteria for the diagnosis of frailty. Diagnosis of pre-diabetes and diabetes was set according to the World Health Organization (WHO) criteria for fasting plasma glucose (FPG) level. Chi-square tests were performed to compare percentages by 3 major groups (non-diabetes, pre-diabetes, diabetes), ANOVA and student's t-tests was used to compare means of group for continuous variables. Multiple logistic regression models were performed to estimate the risk factors for frailty in non-diabetic, pre-diabetic and diabetic elderly populations using baseline and longitudinal data.

RESULTS

Diabetic population had a much higher prevalence (19.32%) and incidence (12.32%) of frailty, compared to that of non-diabetic older adults (prevalence of 11.92% and incidence of 7.04%). And pre-diabetics had somewhat similar prevalence of 11.43% and slightly higher incidence of 8.73% for frailty than non-diabetic older adults. Diabetics were at 1.36 (95% CI = 1.18,1.56) and 1.56 (95%CI = 1.32,1.85) fold increase in risk of frailty compared to non-diabetic population for prevalence and incidence, respectively. Being female, urban living, high waist circumference, less house work and need regular anti-diabetic medications were independent risk factors only in pre-diabetic and diabetic older adults.

CONCLUSION

This study confirms that diabetes is an independent serious chronic condition to increase the risk of frailty in community dwelling older adults in northern China. To effectively delay or avoid frailty, older adults should be advised for taking proper control of blood glucose level and avoiding the associated risk factors and implementing the protective factors in primary-care setting.

The prevalence and incidence of frailty in Pre-diabetic and diabetic community-dwelling older population: results from Beijing longitudinal study of aging II (BLSA-II)

BACKGROUND

Various factors including cardio-metabolic disorders are found to be correlated with frailty. With the increase in age, older adults are likely to have elevated blood glucose level. In this study we intend to investigate the prevalence and incidence of frailty in the pre-diabetic and diabetic community dwelling elderly population and the associated risk factors.

METHODS

At baseline total of 10,039 subjects with a mean age of 70.51 (±7.82) were included. A total of 6,293 older adults were followed up at 12 months. A Frailty index (FI) with 32 items was developed using Rockwood's cumulative deficits method. Frailty index ≥0.25 was used as cut-off criteria for the diagnosis of frailty. Diagnosis of pre-diabetes and diabetes was set according to the World Health Organization (WHO) criteria for fasting plasma glucose (FPG) level. Chi-square tests were performed to compare percentages by 3 major groups (non-diabetes, pre-diabetes, diabetes), ANOVA and student's t-tests was used to compare means of group for continuous variables. Multiple logistic regression models were performed to estimate the risk factors for frailty in non-diabetic, pre-diabetic and diabetic elderly populations using baseline and longitudinal data.

RESULTS

Diabetic population had a much higher prevalence (19.32%) and incidence (12.32%) of frailty, compared to that of non-diabetic older adults (prevalence of 11.92% and incidence of 7.04%). And pre-diabetics had somewhat similar prevalence of 11.43% and slightly higher incidence of 8.73% for frailty than non-diabetic older adults. Diabetics were at 1.36 (95% CI = 1.18,1.56) and 1.56 (95%CI = 1.32,1.85) fold increase in risk of frailty compared to non-diabetic population for prevalence and incidence, respectively. Being female, urban living, high waist circumference, less house work and need regular anti-diabetic medications were independent risk factors only in pre-diabetic and diabetic older adults.

CONCLUSION

This study confirms that diabetes is an independent serious chronic condition to increase the risk of frailty in community dwelling older adults in northern China. To effectively delay or avoid frailty, older adults should be advised for taking proper control of blood glucose level and avoiding the associated risk factors and implementing the protective factors in primary-care setting.

Physical activity and exercise as countermeasures to physical frailty and sarcopenia

The identification of cost-effective interventions that improve the health status and prevent disability in old age is one of the most important public health challenges. Regular physical activity is the only intervention that has consistently been shown to improve functional health and energy balance and to reduce the risk of cardiovascular disease, stroke, diabetes, several cancers, depression and falls. In advanced age, physical activity is also effective at mitigating sarcopenia, restoring robustness, and preventing/delaying the development of disability. On the other hand, physical inactivity is recognized as one of the leading causes of several chronic degenerative diseases and is also a major contributing factor to sarcopenia and functional disability. This compelling evidence has prompted the World Health Organization to recommend engaging in regular physical activity throughout one's life course. The present review summarizes the available evidence in support of physical activity as a remedy against physical frailty and sarcopenia. The relevant pathways through which the benefits of physical activity are conveyed are also discussed.

Changes in Physical Activity and Function with Transition to Retirement Living: A Pilot Study

This pilot study examined changes in physical activity and function among older adults moving from community dwellings to retirement living. Twelve community-dwelling older adults, recruited from the wait-lists of two retirement living facilities, were assessed prior to and following the transition to retirement living. Physical activity was assessed using an Actigraph (GT3X+) activity monitor; physical activity by type was reported with the CHAMPS activity questionnaire. Physical function was assessed using the Senior Fitness Test. Objectively monitored total physical activity decreased after the transition to retirement living (p = 0.02). Reports of physical activity by type indicated that only activities of daily living decreased (p < 0.01) although intentional exercise increased (p < 0.03) with the transition. Endurance and strength also improved (p < 0.05 and p < 0.04). Pilot results indicate that possible physical benefits accrue from retirement living, although efforts to reduce sedentary time are needed.

Longitudinal changes in physical activity and sedentary time in adults around retirement age: what is the moderating role of retirement status, gender and educational level?

Background

The start of retirement is an important stage in an (older) adult’s life and can affect physical activity (PA) and/or sedentary behaviors, making it an ideal period to implement health interventions. To identify the most optimal timing of such interventions it is important to determine how PA and sedentary behaviors change not only when making the transition to retirement, but also during the first years of retirement. The main study aim was to examine whether PA and sedentary behaviors change differently in retiring adults compared with recently retired adults. A second aim was to examine potential moderating effects of gender and educational level.

Methods

A longitudinal study was conducted in Ghent, Belgium. Baseline measurements took place in 2012–2013 and follow-up data were collected 2 years later. In total, 446 adults provided complete data at both time points. Of the participants 105 adults were not retired at baseline but retired between baseline and follow-up (i.e. retiring) and 341 were already retired at baseline (i.e. recently retired). All participants completed a questionnaire on PA, sedentary behaviors, socio-demographic factors and physical functioning. Repeated measures MANOVAs were conducted in SPSS 22.0. to analyze the data.

Results

Leisure-time cycling increased over time in retiring adults, but decreased in recently retired adults (p < 0.01). (Voluntary) work-related walking and moderate-to-vigorous PA decreased strongly in retiring adults, while slight increases were found in recently retired adults (p < 0.001 and p < 0.01). Passive transport decreased more strongly in recently retired than in retiring adults (p < 0.05), and computer use increased more in retiring adults than in the recently retired group (p < 0.001). Low-educated recently retired adults had the strongest decrease in walking for transport (p < 0.05) and strongest increase in TV viewing time (p < 0.01) and computer use (p < 0.10). For gender, almost no moderating effects were found.

Conclusions

Future interventions should focus on PA and/or specific sedentary behaviors in retiring adults, but should definitely include long-term follow-up, as recently retired adults seem to be prone to lapse into an unhealthy lifestyle. Specific attention should be paid to low-educated adults as they are particularly susceptible to a decrease in PA and increased TV viewing time and computer use.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3792-4) contains supplementary material, which is available to authorized users.

Effectiveness of the self-regulation eHealth intervention 'MyPlan1.0.' on physical activity levels of recently retired Belgian adults: a randomized controlled trial

The study purpose was to test the effectiveness of the self-regulation eHealth intervention 'MyPlan1.0.' to increase physical activity (PA) in recently retired Belgian adults. This study was a randomized controlled trial with three points of follow-up/modules (baseline to 1-week to 1-month follow-up). In total, 240 recently retired adults (intervention group [IG]: n = 89; control group [CG]: n = 151) completed all three modules. The IG filled in evaluation questionnaires and received 'MyPlan1.0.', an intervention focusing on both pre- and post-intentional processes for behavioural change. The CG only filled in evaluation questionnaires. Self-reported PA was assessed using the long International Physical Activity Questionnaire, usual week version. Repeated-measures multivariate analysis of variances were conducted in SPSS 22.0. On the short-term (baseline to 1 week), the intervention significantly increased walking for transport (IG: +11 min/week, CG: -6 min/week; P < 0.01). On the intermediate-term (baseline to 1 month), the intervention increased transport-related walking (IG: +14 min/week, CG: +6 min/week; P < 0.01), leisure-time walking (IG: +26 min/week, CG: -14 min/week; P < 0.10), leisure-time vigorous PA (IG: +16 min/week, CG: -4 min/week; P < 0.01), moderate-intensity gardening (IG: +4 min/week, CG: -34 min/week; P < 0.10) and voluntary work-related vigorous PA (IG: +28 min/week, CG: +13 min/week; P < 0.10). Results show that our eHealth intervention is effective in recently retired adults. Future studies should include long-term follow-up to examine whether the effects persist over a longer period.

Patient-centred physical therapy is (cost-) effective in increasing physical activity and reducing frailty in older adults with mobility problems: a randomized controlled trial with 6 months follow-up

BACKGROUND

Despite the well-known health benefits of physical activity, it is a great challenge to stay physically active for frail-older adults with mobility limitations. The aim of this study was to test the (cost-) effectiveness of a patient-centred physical therapy strategy (Coach2Move) in which individualized treatment (motivational interviewing, physical examination, individualized goal setting, coaching and advice on self management, and physical training) is combined to increase physical activity level and physical fitness and, thereby, to decrease the level of frailty.

METHODS

A randomized controlled trial was performed in 13 physical therapy practices with measurements at 3 and 6 months. Eligible patients were aged 70 years or over and had mobility problems (i.e. difficulties with walking, moving, getting up and changing position from bed or chair to standing, or stair climbing). The primary outcome was physical activity (total and moderate intensity) in minutes per day. Secondary outcomes were as follows: frailty, walking speed and distance, mobility, and quality of life. Data were analysed using linear mixed models for repeated measurements. Healthcare costs and quality-adjusted life years (QALYs) were computed and combined using net monetary benefit (NMB) for different willingness to pay thresholds. Data on costs, QALYs, and NMBs were analysed using linear mixed models.

RESULTS

One hundred and thirty patients participated in this study. At 6 months, the between-group difference was significant for moderate-intensity physical activity in favour of the Coach2Move group [mean difference: 17.9 min per day; 95% confidence interval (CI) 4.0 to 34.9; P = 0.012]. The between-group difference for total physical activity was 14.1 min per day (95% CI -6.6 to 34.9; P = 0.182). Frailty decreased more in the Coach2Move group compared with usual care [mean difference: -0.03 (95% CI: -0.06 to -0.00; P = 0.027)]. Compared with usual treatment, the Coach2Move strategy resulted in cost savings (€849.8; 95% CI: 1607 to 90; P = 0.028), an improvement in QALYs, (0.02; 95% CI: 0.00 to 0.03; P = 0.03), and a higher NMB at every willingness to pay threshold.

CONCLUSIONS

Older adults with mobility problems are able to safely increase physical activity in their own environment and reduce frailty. This study emphasizes both the potential cost-effectiveness of a patient-centred approach in the frail elderly and the importance of physical activity promotion in older adults with mobility limitations.

Comparing AquaStretch with supervised land based stretching for Chronic Lower Back Pain

OBJECTIVE

Chronic Lower Back Pain (CLBP) is a major health problem affecting 70-85% of the population in the UK. AquaStretch, a new form of assisted stretching in water, is compared with supervised land based stretching (LBS) for subjects with CLBP looking at pain reduction, kinesiophobia and disability.

METHOD

29 subjects were randomly allocated into three groups, LBS (N = 10), AquaStretch (N = 10) and Control (N = 9). Modified Oswestry Low Back Pain Questionnaire (MOLBPQ) and Tampa Scale of Kinesiophobia (TSK) questionnaires were completed in weeks 1, 6, and 12. Visual Analogue Scale (VAS) pain scores were collected weekly till week 12. Treatment groups received two 30 min sessions per week for 12 weeks, control group continued their normal physical activity.

RESULTS & CONCLUSION

Statistical significance (p < 0.05) was observed in the AquaStretch group for pain reduction (P = 0.006), kinesiophobia (P = 0.029), and perceived disability (P = 0.001). Both techniques are suggested to be beneficial for CLBP patients however AquaStretch has key additional benefits including time efficiency, cost effectiveness and the ability to be performed by qualified individuals other than physiotherapists. A reduction in pain post eight weeks of treatment using AquaStretch versus twelve weeks of land based stretching could result in potentially less treatment time needed and a possibility of less medication. Future research is recommended to determine the duration of AquaStretch benefits, and to compare AquaStretch with land based physical therapy programmes for CLBP and to research the potential reduction of Medication required for chronic pain conditions for both its relative clinical effectiveness together with potential health cost savings.

Physical activity in older adults in a combined functional circuit and walking program

Our study examined the impact of a 16-week functional circuit/walking program on physical activity (PA) in older adults in independent-living facilities. Exploratory goals included examination of associations among self-efficacy, neighborhood and mobility. Participants (N = 13) were female (M = 77.8, SD = 7.44, range = 65-85 years). One third were African-American; the remainder Caucasian; 1/3 used assistive devices. PA increased from 70 min/week (SD = 35.51) at baseline to 81.31 min/week (SD = 34.21) at 16 weeks. PA was associated with self-efficacy for overcoming neighborhood and facility barriers to walking at all measurement points (baseline r = .73, p < .05 and r = .68, p < .05, respectively). At eight weeks, PA was associated with self-efficacy for walking duration (r = .58, p < .05), self-efficacy for individual (r = .66, p < .05), facility (r = .58, p < .05) and neighborhood (r = .70, p < .05) barriers. At sixteen weeks, physical activity was associated with balance confidence (r = .72, p < .05), and self-efficacy for individual (r = .76, p < .05), facility (r = .71, p < .05), and neighborhood (r = .80, p < .01) barriers. Functional circuit/walking interventions can increase PA in older adults. Further examination of self-efficacy, mobility, neighborhoods and PA is needed.

Exercise prescription for the older population: The interactions between physical activity, sedentary time, and adequate nutrition in maintaining musculoskeletal health

Regular physical activity (PA) promotes musculoskeletal health in older adults. However, the majority of older individuals do not meet current PA guidelines and are also highly sedentary. Emerging evidence indicates that large amounts of sedentary time accelerate the loss of skeletal muscle mass (i.e., sarcopenia) and physical function with advancing age. However, current PA recommendations for sedentary time are non-specific (i.e., keep sedentary time to a minimum). Research indicates that physical inactivity and large amounts of sedentary time accelerate sarcopenic muscle loss by inducing skeletal muscle 'anabolic resistance'. These findings suggest a critical interaction between engaging in 'sufficient' levels of PA, minimising sedentary time, and consuming 'adequate' nutrition to promote optimal musculoskeletal health in older adults. However, current PA recommendations do not take into account the important role that nutrition plays in ensuring older adults can maximise the benefits from the PA in which they engage. The aim of this narrative review is: (1) to briefly summarise the evidence used to inform current public health recommendations for PA and sedentary time in older adults; and (2) to discuss the presence of 'anabolic resistance' in older adults, highlighting the importance of regular PA and minimising sedentary behaviour. It is imperative that the synergy between PA, minimising sedentary behaviour and adequate nutrition is integrated into future PA guidelines to promote optimal musculoskeletal health and metabolic responses in the growing ageing population.

Handgrip strength and physical activity in frail elderly

Abstract OBJECTIVE To investigate the association between handgrip strength (HS) and physical activity in physical frailty elderly. METHOD Cross-sectional quantitative study with a sample of 203 elderly calculated based on the population estimated proportion. Tests were applied to detect cognitive impairment and assessment of physical frailty. Descriptive statistics and multivariate analysis by binary logistic regression were used, and also Student's t-test and Fisher's exact test. RESULTS A total of 99 (64.3%) elderly showed decreased handgrip strength and 90 (58.4%) elderly presented decrease in physical activity levels. There was a statistically significant difference between these two components (p=0.019), in which elderly who have decreased HS have lower levels of physical activity. For low levels of physical activity and decreased HS, there was no evidence of significant difference in the probability of the classification as frail elderly (p<0.001). CONCLUSION The components handgrip strength and physical activity are associated with the frail elderly. The joint presence of low levels of physical activity and decreased handgrip strength leads to a significantly higher probability of the elderly to be categorized as frailty.

Associations of frailty and psychosocial factors with autonomy in daily activities: a cross-sectional study in Italian community-dwelling older adults

Frailty has been recognized as a risk factor for geriatric adverse events. Little is known of the role of psychosocial factors associated with frailty in explaining negative outcomes of aging. This study was aimed at 1) evaluating the differences in psychosocial factors among robust, prefrail, and frail individuals and 2) investigating whether there was any interaction effect of frailty status with empirically identified clusters of psychosocial factors on autonomy in the activities of daily living (ADLs). Two-hundred and ten older adults (age 73±6 years, 66% women) were involved in this study. Frailty was assessed using an adapted version of the frailty phenotype. The psychosocial factors investigated were depressive symptoms using the 20-item Center for Epidemiologic Studies Depression Scale, social isolation using the Friendship Scale, and loneliness feeling using the eight-item UCLA Loneliness Scale. The autonomy in ADLs was measured with the Groningen Activity Restriction Scale. Thirty-one percent of participants were robust, 55% prefrail, and 14% frail. We performed an analysis of covariance which showed differences between robust, prefrail, and frail individuals for all the psychosocial variables: Center for Epidemiologic Studies Depression Scale, F(2, 205)=18.48, P<0.001; Friendship Scale, F(2, 205)=4.59, P=0.011; UCLA Loneliness Scale, F(2, 205)=5.87, P=0.003, controlling for age and sex. Using the same covariates, the two-way analysis of covariance indicated an interaction effect of frailty with psychosocial factors in determining ADLs, F(4, 199)=3.53, P=0.008. This study demonstrates the close relationship between frailty and psychosocial factors, suggesting the need to take into account simultaneously physical and psychosocial components of human functioning.

Application and Revision of Montreal Cognitive Assessment in China's Military Retirees with Mild Cognitive Impairment

Objective

In an effort to accommodate MOCA to better fit for the Chinese context, this study was designed to employ the MOCA criteria to screen mild cognitive impairment (MCI) and analyze associated risk factors in military retirees.

Methods

Three hundred and four retired military cadres were recruited using a random cluster sampling technique with information collected including personal, prevalence, MOCA scale, and related neuropsychiatry scale. Thirty retirees were randomly chosen to be further analyzed one month later using the revised MOCA scale.

Results

①Our data indicated an incidence rate of 64.8% for mild cognitive impairment in retired military cadres. The incidence rate for MCI was significantly higher in those aged 80 or above compared with those 80 years of age or younger (P<0.05). The incidence rate of MCI was significantly higher in those with fewer than 6 years of education compared with those with over 7 years of education (P<0.05). The MCI incidence was higher for those with little exercise than those taking regular exercise (P<0.01). Moreover, the MCI incidence was higher in stroke patients than those who never had a stroke episode (P<0.05). ②There was a significant correlation between MOCA and MMSE scale scores (r = 0.81). MOCA scale scores were negatively correlated with ADL and CES-D scores (although not PSQI scores). ③ MOCA recension Cronbach’s alpha value was 0.862. The related coefficient of MOCA and MOCA recension was 0.878(P<0.01). When the Score of cut-off -point of the MOCA recension was 28, the area in ROC curve analyses was 0.859, as well as the largest area.

Conclusion

Retired cadres exhibited a greater incidence of MCI (than general population), which was closely associated with age, level of education and physical exercise and cerebral apoplexy. Revised MOCA scale displays a better validity and reaction degree of reliability and is more suitable for screening and diagnosis of MCI in the elderly in China.

Depression and frailty in later life: a systematic review

Frailty and depression are important issues affecting older adults. Depressive syndrome may be difficult to clinically disambiguate from frailty in advanced old age. Current reviews on the topic include studies with wide methodological variation. This review examined the published literature on cross-sectional and longitudinal associations between frailty and depressive symptomatology with either syndrome as the outcome, moderators of this relationship, construct overlap, and related medical and behavioral interventions. Prevalence of both was reported. A systematic review of studies published from 2000 to 2015 was conducted in PubMed, the Cochrane Database of Systematic Reviews, and PsychInfo. Key search terms were "frailty", "frail", "frail elderly", "depressive", "depressive disorder", and "depression". Participants of included studies were ≥ 55 years old and community dwelling. Included studies used an explicit biological definition of frailty based on Fried et al's criteria and a screening measure to identify depressive symptomatology. Fourteen studies met the inclusion/exclusion criteria. The prevalence of depressive symptomatology, frailty, or their co-occurrence was greater than 10% in older adults ≥ 55 years old, and these rates varied widely, but less in large epidemiological studies of incident frailty. The prospective relationship between depressive symptomatology and increased risk of incident frailty was robust, while the opposite relationship was less conclusive. The presence of comorbidities that interact with depressive symptomatology increased incident frailty risk. Measurement variability of depressive symptomatology and inclusion of older adults who are severely depressed, have cognitive impairment or dementia, or stroke may confound the frailty syndrome with single disease outcomes, accounting for a substantial proportion of shared variance in the syndromes. Further study is needed to identify medical and behavioral interventions for frailty and depressive symptomatology that prevent adverse sequelae such as falls, disability, and premature mortality.

Effects of physical exercise interventions in frail older adults: a systematic review of randomized controlled trials

BACKGROUND

Low physical activity has been shown to be one of the most common components of frailty, and interventions have been considered to prevent or reverse this syndrome. The purpose of this systematic review of randomized, controlled trials is to examine the exercise interventions to manage frailty in older people.

METHODS

The PubMed, Web of Science, and Cochrane Central Register of Controlled Trials databases were searched using specific keywords and Medical Subject Headings for randomized, controlled trials published during the period of 2003-2015, which enrolled frail older adults in an exercise intervention program. Studies where frailty had been defined were included in the review. A narrative synthesis approach was performed to examine the results. The Physiotherapy Evidence Database (PEDro scale) was used to assess the methodological quality of the selected studies.

RESULTS

Of 507 articles, nine papers met the inclusion criteria. Of these, six included multi-component exercise interventions (aerobic and resistance training not coexisting in the intervention), one included physical comprehensive training, and two included exercises based on strength training. All nine of these trials included a control group receiving no treatment, maintaining their habitual lifestyle or using a home-based low level exercise program. Five investigated the effects of exercise on falls, and among them, three found a positive impact of exercise interventions on this parameter. Six trials reported the effects of exercise training on several aspects of mobility, and among them, four showed enhancements in several measurements of this outcome. Three trials focused on the effects of exercise intervention on balance performance, and one demonstrated enhanced balance. Four trials investigated functional ability, and two showed positive results after the intervention. Seven trials investigated the effects of exercise intervention on muscle strength, and five of them reported increases; three trials investigated the effects of exercise training on body composition, finding improvements in this parameter in two of them; finally, one trial investigated the effects of exercise on frailty using Fried's criteria and found an improvement in this measurement. Exercise interventions have demonstrated improvement in different outcome measurements in frail older adults, however, there were large differences between studies with regard to effect sizes.

CONCLUSIONS

This systematic review suggested that frail older adults seemed to benefit from exercise interventions, although the optimal program remains unclear. More studies of this topic and with frail populations are needed to select the most favorable exercise program.

The Report-AGE project: a permanent epidemiological observatory to identify clinical and biological markers of health outcomes in elderly hospitalized patients in Italy

BACKGROUND

Italy is expected to experience the largest growth in persons ≥65 years (>20% by 2020). This demographic shift allows for geriatric research on predictive clinical and biological markers of outcomes related to frailty, re-hospitalization and mortality.

AIMS

To describe rationale and methods of the Report-AGE study project of acute care patients in Italian National Research Center on Aging (INRCA) research hospitals.

METHODS

Report-AGE study is a large observational study on health conditions and outcomes of hospitalized elderly patients (≥65 years). The primary objective of the study is to create a high-level data resource of demographics, comprehensive geriatric assessments, clinical and diagnostic information, as well as biological and molecular markers in all older patients admitted to INRCA Hospitals. Assessments in physical and nutritional parameters, co-morbid health conditions, and associations with frailty parameters are ongoing in older hospitalized adults following an acute event. Study collection began in September 2011.

RESULTS

Up to date, there are 3479 patients ≥65 years (mean age: 85 ± 7years) with 1543 men and 1936 women enrolled. Data have been recorded regarding functional and clinical parameters before, during hospital admission and at discharge. Data collection for primary outcome analyses related to re-hospitalization and mortality is estimated for September 2016.

DISCUSSION

This study aims at collecting precise clinical data, comprehensive geriatric assessment, risk factors, and biological data from acute care patients. Data will also be used to identify mechanisms underlying frailty in this specific population.

CONCLUSION

This study provides a descriptive epidemiological collection of the health conditions of older in-patients.

An Administrator's Perspective on the Organization of Physical Activity for Older Adults in Long-Term Care Facilities

BACKGROUND

The positive influence of physical activity (PA) on health is well documented. Even at old age, PA remains useful but participation in PA decreases with age. In long-term care facilities (LTCFs), PA appears to be reduced to a bare minimum. Because administrators have a key role in developing the care policy of LTCFs, it is important that they support the organization of PA in LTCFs.

OBJECTIVE

The main objective of this mixed-method study was to identify motivators and barriers for organizing PA in LTCFs according to administrators. A secondary goal was to examine the knowledge of the World Health Organization (WHO) guidelines regarding PA and to reveal potential motivators and barriers for the implementation of the guidelines.

METHODS

First, 24 administrators completed semistructured interviews. Data were analyzed using the deductive approach of qualitative content analysis. The obtained motivators and barriers were categorized on 3 different levels (intrapersonal, interpersonal, and community) according to the socioecological model by 2 independent reviewers; conflicts were resolved with a third researcher. Next, 127 administrators of Flemish (Belgium) LTCFs completed an online questionnaire survey containing open-ended, unique, and multiple choice questions regarding the LTCFs, PA, and the WHO guidelines, as well as statements (scored on a 5-point Likert scale) regarding perceived motivators and barriers for organizing PA sessions in the LTCF.

RESULTS

In the qualitative component, the administrators reported 31 motivators and 24 barriers for organizing PA in the LTCF. In the survey, maintaining or enhancing general health of the residents (98%) and improving the psychological well-being of the residents were marked as key motivators at the intrapersonal level. The administrators (97%) were convinced that PA is a useful way to spend time for LTCF residents. Encouraging social contact (94%) and countering loneliness (86%) are the motivators cited at the interpersonal level. At the community level, the infrastructure of the facility (91%) and adequate and sufficient material (88%) are the main motivators. The barriers that were presented to the participants were scored as less important. The majority of the administrators (83%) are not familiar with the WHO guidelines for PA; 70% of the participants believe that the guidelines are useful, but only 40% is convinced that it is realistic to implement the guidelines in an LTCF.

CONCLUSIONS

This study described different motivators and barriers for administrators to organize PA in LTCFs. Contrary to other studies, lack of staff, lack of adequate equipment, and lack of financial resources were rejected as potential barriers for organizing PA. Despite the fact that administrators were not familiar with the WHO guidelines for PA, they believed that the guidelines are useful. The participants reported several barriers for implementation of the guidelines. Administrators of LTCFs are motivated to implement the guidelines if PA can be integrated in daily activities and education of LTCF staff regarding PA is provided.

Rethinking Hospital-Associated Deconditioning: Proposed Paradigm Shift

Physical therapists often treat older adults with marked deficits in physical function secondary to an acute hospitalization. These deficits are often collectively defined as hospital-associated deconditioning (HAD). However, there is a paucity of evidence that objectively demonstrates the efficacy of physical therapy for older adults with HAD. Older adults with HAD represent a highly variable and complex population and thus may be difficult to study and develop effective interventions for using our current rehabilitation strategies. This perspective article outlines an innovative framework to operationalize and treat older adults with HAD. This framework may help therapists apply emerging exercise strategies to this population and facilitate additional research to support the total value of physical therapy for older adults in postacute care settings-with value measured not only by improvements in physical performance but perhaps also by reduced rates of disability development, rehospitalization, and institutionalization.

Dementia, walking outdoors and getting lost: incidence, risk factors and consequences from dementia-related police missing-person reports

OBJECTIVES

To estimate incidence, identify consequences and potential risk factors for harm in people with dementia who got lost in one UK policing region.

METHODS

In a retrospective observational study, data were extracted from missing-person records over a four-year period in one UK policing region (population of 2.1 million).

RESULTS

Two hundred and eighty-one incidents of getting lost were identified. Incidence of getting lost was estimated at 0.5% of the regional dementia population. Fifty-nine percent of reports came from domestic settings, 29% from care homes/hospitals, and 12% on excursions from home. Five percent (n = 15) sustained significant harm, including two deaths. Average age was 78 years (SD 8.3). Harm was associated with older age (mean difference 6.16 years, CI 1.86 to 10.46, p = 0.005, t = 2.82), length of time missing (Mdn time 2.48 hours; IQR 0.97 to 9.45, p = 0.02), and season (9% winter, 2% summer, p = 0.006). The length of time missing increased with delays in reporting to police (r = 0.15, p = 0.018), getting lost at night (Mdn time 1.70 hours, IQR 0.52-3.32, p = 0.028), driving themselves (Mdn time 2.45 hours, IQR 0.42-2.00, p = 0.001), and using public transport (Mdn 1.78 hours, IQR 1.07-3.92, p = 0.001).

CONCLUSION

Incidence in this study suggests getting lost is a low-frequency event for people with dementia but for a small minority, the risks are considerable. Exploratory analyses suggest individual and environmental factors increase the risk of harm. Suitable methods need to be developed to replicate these findings in larger prospective samples. A focus on the predictors of harm may aid development of assessment protocols to ensure intervention is proportionate.

Exercise Capacity and Aging

A growing body of literature suggests that regular exercise among older individuals regardless of the degree of frailty, with or without underlying chronic disease, may attenuate the consequences of age-related changes on exercise capacity. The purpose of this article is to review the effects of age-related changes on exercise capacity and the benefits of prescribing exercise to older persons.

Translation of fit & strong! For middle-aged and older adults: examining implementation and effectiveness of a lay-led model in central Texas

The Fit & Strong! program is an evidence-based, multi-component program promoting physical activity among older adults, particularly those suffering from lower-extremity osteoarthritis. The primary purpose of the study is to examine if the Fit & Strong! program translated into a lay-leader model can produce comparable outcomes to the original program taught by physical therapists and/or certified exercise instructors. A single-group, pre–post study design was employed, and data were collected at the baseline (n = 136 participants) and the intervention conclusion (n = 71) with both baseline and post-intervention data. The measurements included socio-demographic information, health- and behavior-related information, and health-related quality of life. Various statistical tests were used for the program impact analysis and examination of the association between participant characteristics and program completion. As in the original study, there were statistically significant (p < 0.05) improvements in self-efficacy for exercise, aerobic capacity, joint stiffness, level of energy, and amount and intensity of physical activities. The odds of completing the program were significantly lower for the participants from rural areas and those having multiple chronic conditions. Successful adaptation of the Fit & Strong! program to a lay-leader model can increase the likelihood of program dissemination by broadening the selection pool of instructors and, hence, reducing the potential issue of resource limitation. However, high program attrition rates (54.1%) emphasize the importance of adopting evidence-based strategies for improving the retention of the participants from rural areas and those with multiple chronic conditions.

Cardiovascular disease and osteoarthritis: common pathways and patient outcomes

BACKGROUND

Osteoarthritis (OA) and cardiovascular disease (CVD) are the two most prevalent conditions in the population aged over 70 in developed countries. Both conditions share common risk factors, in particular age and body mass index. However, the very high level of co-occurrence of both diseases cannot be accounted by common risk factors alone.

MATERIALS AND METHODS

We reviewed the recent literature published in English in PubMed for articles relating to osteoarthritis and cardiovascular disease.

RESULTS

On the one hand, the disability caused by OA increases the risk of CVD and in particular of ischemic events and mortality beyond what can be explained by known common risk factors, such as ageing and obesity. Moreover, the presence of OA has a synergistic effect on CVD symptoms considerably worsening them. On the other hand, at least in women, there appears to be a common pathogenic mechanism underlying atherosclerosis (but not hypertension) and actual joint damage.

CONCLUSION

There are some possible molecular mechanisms underlying both diseases, in particular relating to low grade inflammation and female hormones. However, the data available to date also indicate that OA may be considered as an indirect cause of CVD by increasing walking disability and the use of analgesic medication such as NSAIDs. We discuss future directions that need to be taken to address these highly prevalent, costly and disabling morbidities.

The contribution of former work-related activity levels to predict physical activity and sedentary time during early retirement: moderating role of educational level and physical functioning

Background

The transition to retirement introduces a decline in total physical activity and an increase in TV viewing time. Nonetheless, as more time becomes available, early retirement is an ideal stage to implement health interventions. Therefore, knowledge on specific determinants of physical activity and sedentary time is needed. Former work-related physical activity has been proposed as a potential determinant, but concrete evidence is lacking. The aim of this study was to examine if former work-related sitting, standing, walking or vigorous activities predict physical activity and sedentary time during early retirement. Additionally, moderating effects of educational level and physical functioning were examined.

Methods

In total, 392 recently retired Belgian adults (>6 months, <5 years) completed the International Physical Activity Questionnaire, the SF-36 Health Survey and a questionnaire on sociodemographics and former work-related activities. Generalized linear regression analyses were conducted in R. Moderating effects were examined by adding cross-products to the models.

Results

More former work-related sitting was predictive of more screen time during retirement. Lower levels of former work-related vigorous activities and higher levels of former work-related walking were associated with respectively more cycling for transport and more walking for transport during retirement. None of the predictors significantly explained passive transportation, cycling and walking for recreation, and leisure-time moderate-to-vigorous physical activity during retirement. Several moderating effects were found, but the direction of the interactions was not univocal.

Conclusions

Former-work related behaviors are of limited importance to explain physical activity during early retirement, so future studies should focus on other individual, social and environmental determinants. Nonetheless, adults who previously had a sedentary job had higher levels of screen time during retirement, so this is an important subgroup to focus on during interventions. Because of the inconsistent moderating effects of educational level and physical functioning, no clear recommendations can be formulated.

Feasibility and effects of applying stochastic resonance whole-body vibration on untrained elderly: a randomized crossover pilot study

Background

Aging is associated with loss of balance and activity in daily life. It impacts postural control and increases the risk of falls. The current study was conducted to determine the feasibility and long-term impact of stochastic resonance whole-body vibration (SR-WBV) on static and dynamic balance and reaction time among elderly individuals.

Methods

A randomized crossover pilot study with blinding of the participants. Twenty elderly were divided into group A (SR-WBV 5 Hz, Noise 4/SR-WBV 1 Hz, Noise 1) or group B (SR-WBV 1 Hz, Noise 1/SR-WBV 5 Hz, Noise 1). Feasibility outcomes included recruitment, compliance and safety. Secondary outcomes were Semi-Tandem Stand (STS), Functional Reach Test (FRT), Expanded Timed Get Up-and-Go (ETGUG), walking under single (ST) & dual task (DT) conditions, hand and foot reaction time (RTH/RTF). Puri and Sen Rank-Order L Statistics were used to analyse carry-over effects. To analyse SR-WBV effects Wilcoxon signed-ranked tests were used.

Results

With good recruitment rate (55%) and compliance (attrition 15%; adherence 85%) rates the intervention was deemed feasible. Three participants dropped out, two due to knee pain and one for personal reasons. ETGUG 0 to 2 m (p = 0.143; ES: 0.36) and ETGUG total time (p = 0.097; ES: 0.40) showed medium effect sizes.

Conclusions

Stochastic resonance training is feasible in untrained elderly resulting in good recruitment and compliance. Low volume SR-WBV exercises over 12 training sessions with 5 Hz, Noise 4 seems a sufficient stimulus to improve ETGUG total time. The stimulation did not elicit changes in other outcomes.

Trial registration

This trial has been registered at the U.S. National Institutes of Health under ClinicalTrials.gov: NCT01045746.

Impact of tai-chi on falls among preclinically disabled older people. A randomized controlled trial

OBJECTIVE

To investigate the effectiveness of tai-chi in preventing falls among community-dwelling older people.

DESIGN

Multisite parallel group individually randomized controlled trial.

SETTING

Melbourne, Australia.

PARTICIPANTS

Preclinically disabled community-dwelling people 70 + years (n = 503), without major medical conditions or moderate to severe cognitive impairment.

INTERVENTION

Sixty-minute modified Sun style tai-chi group-based exercise program twice weekly for 48 weeks; control intervention was a seated group-based flexibility exercise program of the same dose.

MEASUREMENTS

All falls, self-reported using a monthly calendar, analyzed at 24 weeks and 48 weeks. Injurious falls reported in follow-up telephone interviews for each reported fall.

RESULTS

The adjusted fall incidence rate ratios at 24 and 48 weeks were 1.08 [(95% confidence interval (CI) 0.64-1.81)], and 1.12 (95% CI 0.75-1.67), respectively. A higher proportion of intervention participants ceased attendance in the first 24 weeks (difference 17.9%, 95% CI 9.6-25.8), and the second 24 weeks (2.7%, 95% CI -5.0 to 10.4). Intervention participants who ceased attendance had lower left quadriceps strength (difference 3.3 kg 95% CI 0.15-6.36) and required longer to complete the timed up and go test (difference 1.7 seconds 95% CI 0.22-3.17) at baseline.

CONCLUSIONS

This study does not support modified Sun style tai-chi as a falls prevention measure among relatively well community-dwelling older people with modified mobility and at increased risk of disability. Insufficient intervention intensity, or low exercise class attendance may have contributed to the lack of effect, as may have attrition bias among the intervention group.

Cognitive frailty, a novel target for the prevention of elderly dependency

Frailty is a complex and heterogeneous clinical syndrome. Cognitive frailty has been considered as a subtype of frailty. In this study, we refine the definition of cognitive frailty based on existing reports about frailty and the latest progress in cognition research. We obtain evidence from the literature regarding the role of pre-physical frailty in pathological aging. We propose that cognitive impairment of cognitive frailty results from physical or pre-physical frailty and comprises two subtypes: the reversible and the potentially reversible. Reversible cognitive impairment is indicated by subjective cognitive decline (SCD) and/or positive fluid and imaging biomarkers of amyloid-β accumulation and neurodegeneration. Potentially reversible cognitive impairment is MCI (CDR=0.5). Based on the severity of cognitive impairment, it is possible to determine the primary and secondary preventative measures for cognitive frailty. We further determine whether SCD is a component of pre-clinical AD or the early stage of other neurodegenerative diseases, which is required for guiding personal clinical intervention.

Correlation between Frailty and Cognitive Function in Non-Demented Community Dwelling Older Koreans

Background

Frailty and cognitive impairment are considered the most common and yet least understood conditions in older adults. This study was conducted to investigate the correlation between frailty and cognitive function in non-demented older Koreans.

Methods

Korean Mini-Mental Status Examination (K-MMSE) scores and Cardiovascular Health Study Frailty Indices were obtained for 486 older adults aged 65 and over who registered at six senior welfare centers in Seoul and Gyeonggi province. Multiple linear regression was performed to identify the association between frailty and K-MMSE scores.

Results

Of the 486 older adults, 206 (42.4%) were robust, 244 (50.2%) were prefrail, and 36 (7.4%) were frail. Prevalence of cognitive impairment (K-MMSE ≤ 23) was 6.3% in the robust group, 16.8% in the prefrail group, and 30.6% in the frail group (P < 0.001), and mean K-MMSE score was 27.5 ± 2.2, 26.5 ± 3.1, and 23.7 ± 5.3, respectively (P < 0.001). Frailty tended to be associated with lower MMSE scores (B = -1.92, standard error, 0.52; P < 0.001).

Conclusion

Frailty was found to be correlated with cognitive impairment in non-demented older Koreans. However, further cohort studies are required to determine the association between frailty and cognitive function.

Immediate effects after stochastic resonance whole-body vibration on physical performance on frail elderly for skilling-up training: a blind cross-over randomised pilot study

OBJECTIVE

This pilot study examined the feasibility outcome recruitment, safety and compliance of the investigation for stochastic resonance whole-body vibration (SR-WBV) training. Another aim was to evaluate the effect size of one SR-WBV intervention session on Short Physical Performance Battery (SPPB), Expanded Timed Get Up-and-Go (ETGUG), isometric maximal voluntary contraction (IMVC) and rate of force development (IRFD) and chair rising (CR).

DESIGN

Randomised double-blinded controlled cross-over pilot study.

METHOD

Feasibility outcomes included recruitment, safety and compliance. For secondary outcomes, SPPB, ETGUG, IMVC, IRFD and CR were measured before and 2-min after intervention. Nonparametric Rank-Order Tests of Puri and Sen L Statistics to Ranked Data were proposed. Wilcoxon signed-ranked tests were used to analyse the differences after SR-WBV intervention and sham intervention. Treatment effects between the interventions were compared by a Mann-Whitney U test.

RESULTS

Among 24 eligible frail elderly, 12 agreed to participate and 3 drop out. The adherence was 15 of 24 intervention sessions. For secondary outcome, effect sizes (ES) for SR-WBV intervention on SPPB, ETGUG and CR were determined.

CONCLUSION

This pilot study indicate that the training protocol used in this form for frail elderly individuals is feasible but with modification due to the fact that not all defined feasibility outcomes target was met. SR-WBV with 6 Hz, noise level 4 shows benefit improvements on SPPB (ES 0.52), ETGUG (part sit-to-stand movement: ES 0.81; total time: ES 0.85) and CR (ES 0.66). Further research is desired to determine whether a new adapted training protocol is necessary for SR-WBV in the "skilling up" phase in frail elderly individuals.

The prediction of disability by self-reported physical frailty components of the Tilburg Frailty Indicator (TFI)

Disability is an important health outcome for older persons; it is associated with impaired quality of life, future hospitalization, and mortality. Disability also places a high burden on health care professionals and health care systems. Disability is regarded as an adverse outcome of physical frailty. The main objective of this study was to assess the predictive validity of the eight individual self-reported components of the physical frailty subscale of the TFI for activities of daily living (ADL) and instrumental activities of daily living (IADL) disability. This longitudinal study was carried out with a sample of Dutch citizens. At baseline the sample consisted at 429 people aged 65 years and older and a subset of all respondents participated again two and a half years later (N=355, 83% response rate). The respondents completed a web-based questionnaire comprising the TFI and the Groningen Activity Restriction Scale (GARS) for measuring disability. Five components together (unintentional weakness, weakness, poor endurance, slowness, low physical activity), referring to the phenotype of Fried et al., predicted disability, even after controlling for previous disability and other background characteristics. The other three components of the physical frailty subscale of the TFI (poor balance, poor hearing, poor vision) together did not predict disability. Low physical activity predicted both total and ADL disability, and slowness both total and IADL disability. In conclusion, self-report assessment using the physical subscale of the TFI aids the prediction of future ADL and IADL disability in older persons two and a half years later.

Tablet-based strength-balance training to motivate and improve adherence to exercise in independently living older people: part 2 of a phase II preclinical exploratory trial

BACKGROUND

Home-based exercise programs can improve physical functioning and health status of elderly people. Successful implementation of exercise interventions for older people presents major challenges and supporting elderly people properly while doing their home-based exercises is essential for training success. We developed a tablet-based system-ActiveLifestyle-that offers older adults a home-based strength-balance training program with incorporated motivation strategies and support features.

OBJECTIVE

The goal was to compare 3 different home-based training programs with respect to their effect on measures of gait quality and physical performance through planned comparisons between (1) tablet-based and brochure-based interventions, (2) individual and social motivation strategies, and (3) active and inactive participants.

METHODS

A total of 44 autonomous-living elderly people (mean 75, SD 6 years) were assigned to 3 training groups: social (tablet guided, n=14), individual (tablet guided, n=13), and brochure (brochure guided, n=17). All groups joined a 12-week progressive home-based strength-balance training program. Outcome measures were gait performance under single and dual task conditions, dual task costs of walking, falls efficacy, and physical performance as measured by the Short Physical Performance Battery (SPPB). Furthermore, active (≥75% program compliance) and inactive (<75% program compliance) individuals were compared based on their characteristics and outcome measures.

RESULTS

The tablet groups showed significant improvements in single and dual task walking, whereas there were no significant changes observable in the brochure group. Between-groups comparisons revealed significant differences for gait velocity (U=138.5; P=.03, r=.33) and cadence (U=138.5, P=.03 r=.34) during dual task walking at preferred speed in favor of the tablet groups. The brochure group had more inactive participants, but this did not reach statistical significance (U=167, P=.06, r=.29). The active participants outperformed the inactive participants in single and dual task walking, dual task costs of walking, and SPPB scores. Significant between-groups differences were seen between the tablet groups and the brochure group, in favor of the tablet groups.

CONCLUSIONS

A tablet-based strength-balance training program that allows monitoring and assisting autonomous-living older adults while training at home was more effective in improving gait and physical performance when compared to a brochure-based program. Social or individual motivation strategies were equally effective. The most prominent differences were observed between active and inactive participants. These findings suggest that in older adults a tablet-based intervention enhances training compliance; hence, it is an effective way to improve gait.

Rehabilitation and supportive therapy in elderly patients with Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) very often coexists with cardiovascular, musculoskeletal and metabolic comorbidities. This condition significantly impact on the general health, function, frailty and disability of such patients, and consequently on their prognosis. Indeed, complex and recurrent symptoms of general dysfunction are commonly present and burden on the health status. Symptomatic COPD patients, even with chronic and complex comorbidities or with different degree of severity, may benefit from rehabilitation including exercise and maintenance of physical activity, in order to reducing symptoms and restoring the highest possible level of independent function. This review will focus on the associated and relevant clinical problems of these patients at the onset of disability, methods of assessment and useful non-pharmacological treatments for caring and supporting them.

Age and gender, two key factors in the associations between physical activity and strength during the ageing process

OBJECTIVES

The aims of this study were to identify if the associations of physical activity (PA) and muscle strength may vary throughout the ageing process; to study the differences among genders in the relationships between PA and strength in elderly people and to test whether these differences are explained by the hormonal, nutritional and inflammatory status.

STUDY DESIGN

A total of 1741 people ≥65 years of age participated in this cross-sectional study.

MAIN OUTCOME MEASURES

Upper- and lower-limbs maximal voluntary isometric strength was obtained using standardized techniques and equipment. PA was recorded by a validated questionnaire. The associations of PA with strength were assessed using generalized linear regression models with a Gamma-distributed dependent variable.

RESULTS

A significant gender by PA interaction was found for all strength-related variables (all P<0.01). Moreover, when sexual hormones, albumin or C-Reactive protein were taken into account in the model, the results did not significantly change. In women, PA was positively associated with upper and lower-body strength; however in men, PA was only associated with grip and knee strength (both P<0.01). Higher strength values were associated with higher levels of PA, especially in women. However, this tendency had a different pattern across the age range, showing a stronger association in the 'young' elderly compared with the 'old' elderly.

CONCLUSION

Higher levels of PA are related to greater muscle strength, especially in women and those who were younger.

Physical performance is associated with working memory in older people with mild to severe cognitive impairment

BACKGROUND

Physical performances and cognition are positively related in cognitively healthy people. The aim of this study was to examine whether physical performances are related to specific cognitive functioning in older people with mild to severe cognitive impairment.

METHODS

This cross-sectional study included 134 people with a mild to severe cognitive impairment (mean age 82 years). Multiple linear regression was performed, after controlling for covariates and the level of global cognition, with the performances on mobility, strength, aerobic fitness, and balance as predictors and working memory and episodic memory as dependent variables.

RESULTS

The full models explain 49-57% of the variance in working memory and 40-43% of episodic memory. Strength, aerobic fitness, and balance are significantly associated with working memory, explaining 3-7% of its variance, irrespective of the severity of the cognitive impairment. Physical performance is not related to episodic memory in older people with mild to severe cognitive impairment.

CONCLUSIONS

Physical performance is associated with working memory in older people with cognitive impairment. Future studies should investigate whether physical exercise for increased physical performance can improve cognitive functioning. This trial is registered with ClinicalTrials.gov NTR1482.