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Steinbrink GM, Martinez J, Swartz AM, Strath SJ. Sit-to-Stand Power Is a Stronger Predictor of Gait Speed than Knee Extension Strength. J Funct Morphol Kinesiol 2024; 9:103. [PMID: 38921639 DOI: 10.3390/jfmk9020103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/27/2024] Open
Abstract
With a growing aging population, the routine assessment of physical function may become a critical component of clinical practice. The purpose of this cross-sectional study is to compare two common assessments of muscular function: (1) isometric knee extension strength (KES) and (2) sit-to-stand (STS) muscle power tests, in predicting objective physical function (i.e., gait speed) in aging adults. 84 adults (56% female, mean (SD) age = 66.6 (9.4) years) had their relative KES, STS power, usual gait speed (UGS), and fast gait speed (FGS) assessed. Multiple linear regression examined the associations between KES, STS power, and gait outcomes. When entered in separate models, KES and STS power were both independently associated with UGS and FGS (Std. β = 0.35-0.44 and 0.42-0.55 for KES and STS power, respectively). When entered in the same model, STS power was associated with UGS and FGS (Std. β = 0.37 [95%CI: 0.15, 0.58] and 0.51 [95%CI: 0.31, 0.70], respectively), while KES was only associated with FGS (Std. β = 0.25 [95%CI: 0.02, 0.48]). STS power seems to be a valid indicator of function in aging adults. Its feasibility as a screening tool for "low" function in the primary care setting should be explored.
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Affiliation(s)
- Garrett M Steinbrink
- Zilber College of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Julian Martinez
- Zilber College of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Ann M Swartz
- Zilber College of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
| | - Scott J Strath
- Zilber College of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI 53211, USA
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Gaemelke T, Laustsen C, Feys P, Folkestad L, Andersen MS, Jørgensen NR, Jørgensen ML, Jespersen SN, Ringgaard S, Eskildsen SF, Dalgas U, Hvid LG. Effects of power training in older patients with multiple sclerosis on neurodegeneration, neuromuscular function, and physical function. A study protocol for the "power training in older multiple sclerosis patients (PoTOMS) randomized control trial. Contemp Clin Trials Commun 2024; 38:101279. [PMID: 38444875 PMCID: PMC10912361 DOI: 10.1016/j.conctc.2024.101279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/24/2024] [Accepted: 02/17/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Approximately one-third of all persons with multiple sclerosis (pwMS) are older, i.e., having an age ≥60 years. Whilst ageing and MS separately elicit deteriorating effects on brain morphology, neuromuscular function, and physical function, the combination of ageing and MS may pose a particular challenge. To counteract such detrimental changes, power training (i.e., a type of resistance exercise focusing on moderate-to-high loading at maximal intended movement velocity) presents itself as a viable and highly effective solution. Power training is known to positively impact physical function, neuromuscular function, as well as brain morphology. Existing evidence is promising but limited to young and middle-aged pwMS, with the effects of power training remaining to be elucidated in older pwMS. Methods The presented 'Power Training in Older MS patients (PoTOMS)' trial is a national, multi-center, parallel-group, randomized controlled trial. The trial compares 24 weeks of usual care(n = 30) to 24 weeks of usual care and power training (n = 30). The primary outcome is whole brain atrophy rate. The secondary outcomes include changes in brain micro and macro structures, neuromuscular function, physical function, cognitive function, bone health, and patient-reported outcomes. Ethics and dissemination The presented study is approved by The Regional Ethics Committee (reference number 1-10-72-222-20) and registered at the Danish Data Protection Agency (reference number 2016-051-000001). All study findings will be published in scientific peer-reviewed journals and presented at relevant scientific conferences independent of the results. The www.clinicaltrials.gov identifier is NCT04762342.
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Affiliation(s)
- Tobias Gaemelke
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Christoffer Laustsen
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Peter Feys
- REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Lars Folkestad
- Department of Endocrinology, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | | | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Sune Nørhøj Jespersen
- Department of Physics and Astronomy, Aarhus University, Aarhus, Denmark
- Center of Functionally Integrative Neuroscience and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Steffen Ringgaard
- The MR Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon F. Eskildsen
- Center of Functionally Integrative Neuroscience and MINDLab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulrik Dalgas
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lars G. Hvid
- Exercise Biology, Department of Public Health, Aarhus University, Aarhus, Denmark
- The Danish MS Hospitals, Ry and Haslev, Denmark
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Osawa Y, An Y, Nishita Y, Matsui Y, Takemura M, Simonsick EM, Shimokata H, Otsuka R, Arai H, Ferrucci L. Longitudinal association between muscle and bone loss: Results of US and Japanese cohort studies. J Cachexia Sarcopenia Muscle 2024; 15:746-755. [PMID: 38332659 PMCID: PMC10995282 DOI: 10.1002/jcsm.13438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/18/2023] [Accepted: 01/14/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Muscle and bone are physiologically interconnected, but joint changes of muscle and bone with aging, and whether the muscle-bone changes are different by sex and by country has been little studied. We examined longitudinal associations of bone mineral density (BMD) and muscle mass or muscle strength in community-dwelling 65 years or older in the United States and Japan. METHODS The present analytic sample included 1129 women and men from the Baltimore Longitudinal Study of Aging (BLSA) (mean age, 74.5 ± 7.5 years; women, 49.8%) and 1998 women and men from the National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) (mean age, 70.0 ± 4.5 years; women, 51.4%). Median follow-up was 4.6 (min-max, 0-15.4) years in the BLSA and 4.0 (min-max, 0-13.4) years in the NILS-LSA. We selected visits at which participants had BMD (whole body, pelvic, femoral neck, trochanter, and Ward's triangle BMDs) and muscle mass [appendicular lean mass, (ALM)] measured by DXA scan. In each bone site, we ran cohort-specific bivariate linear mixed-effects models adjusted for baseline age, sex, body height, body weight, fat mass, education year, and smoking status. Race was an additional adjustment in the BLSA. Additionally, we performed sex-specific analyses. RESULTS In the BLSA, the rate of change in ALM positively correlated with the rate of change in the whole body (rho = 0.30, P < 0.0001) and pelvic BMD (rho = 0.24, P < 0.0001), but not in trochanter, femoral neck, or Ward's triangle BMD (P > 0.05). In the NILS-LSA, ALM positively correlated with the rate of change in all bone sites (rho ranged from 0.20 to 0.71, P < 0.01). In women, ALM positively correlated with the rate of change in all bone sites in both cohorts (in the NILS-LSA, rho ranged from 0.35 to 0.91, P < 0.01; in the BLSA, rho ranged from 0.26 to 0.56, P < 0.05) except for femoral neck BMD in the BLSA. In men, ALM positively correlated with pelvic, trochanter, and Ward's triangle BMD in the NILS-LSA (rho ranged from 0.45 to 0.68, P < 0.0001), and whole body and trochanter BMD in the BLSA (both, rho = 0.20, P < 0.05). CONCLUSIONS Muscle loss co-occurred with bone loss in both cohorts, but the association in the NILS-LSA tended to be stronger than in the BLSA, and the association was higher in women than in men, implying that the association may differ by sex and country.
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Affiliation(s)
- Yusuke Osawa
- Graduate School of Health ManagementKeio UniversityKanagawaJapan
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on AgingNational Institutes of HealthBaltimoreMDUSA
- Sports Medicine Research CenterKeio UniversityKanagawaJapan
| | - Yang An
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on AgingNational Institutes of HealthBaltimoreMDUSA
| | - Yukiko Nishita
- Department of Epidemiology of AgingNational Center for Geriatrics and GerontologyAichiJapan
| | - Yasumoto Matsui
- Center for Frailty and Locomotive SyndromeNational Center for Geriatrics and GerontologyObuJapan
| | - Marie Takemura
- Center for Frailty and Locomotive SyndromeNational Center for Geriatrics and GerontologyObuJapan
| | - Eleanor M. Simonsick
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on AgingNational Institutes of HealthBaltimoreMDUSA
| | - Hiroshi Shimokata
- Section of NILS‐LSANational Center for Geriatrics and GerontologyObuJapan
- Graduate School of Nutritional SciencesNagoya University of Arts and SciencesNisshinJapan
| | - Rei Otsuka
- Department of Epidemiology of AgingNational Center for Geriatrics and GerontologyAichiJapan
| | - Hidenori Arai
- National Center for Geriatrics and GerontologyObuJapan
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on AgingNational Institutes of HealthBaltimoreMDUSA
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Hiramatsu R, Minata S, Imaoka S. Investigation of Factors Related to the Week 1 Cumulated Ambulation Score in Patients With Proximal Femoral Fractures Post-surgery Using Decision Tree Analysis. Cureus 2024; 16:e55407. [PMID: 38562354 PMCID: PMC10984705 DOI: 10.7759/cureus.55407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2024] [Indexed: 04/04/2024] Open
Abstract
This study aimed to identify factors associated with the Cumulated Ambulation Score (CAS) in the first week post-surgery (Week 1 CAS) in patients with proximal femoral fractures. Proximal femoral fractures are prevalent in the elderly, with rising incidence rates and significant social and functional implications. The ability to walk postoperatively is a critical determinant of patient prognosis. The study included 53 patients out of 79 who underwent surgery for proximal femoral fractures at the orthopedics department of Oita Oka Hospital from January 2021 to December 2021. Exclusion criteria were pre-existing walking difficulties, inability to be evaluated in the first postoperative week, non-weight bearing post-surgery, and complications during hospitalization. The physical therapy program followed Oita Oka Hospital's clinical path, starting ambulation with a walker within the first week post-surgery. Data collected included patient background, surgical techniques, pre-injury ambulatory status, and pre-admission residential environment. Physical function assessments one week postoperatively included range of motion (ROM), manual muscle testing (MMT), pain evaluation (NRS), and CAS. Statistical analyses involved the Shapiro-Wilk test, independent t-test, Mann-Whitney U test, chi-square test, and decision tree analysis using classification and regression trees (CART). Patients were categorized into 'favorable' and 'poor' groups based on Week 1 CAS. Significant differences in dementia presence and pre-admission living environment were noted between groups. Knee extension MMT at Week 1 postoperatively showed a significant difference. The decision tree analysis identified knee extension MMT as the primary variable, with a threshold of 3.5. In patients with MMT below 3.5, dementia presence was a secondary factor, with 81% in the poor CAS group. In patients with MMT above 3.5, knee extension strength continued to be significant. The model's accuracy was 64%, with precision at 71%, recall at 63%, and an F1-score of 0.67. The study highlights knee extension MMT and dementia presence as significant factors influencing Week 1 CAS in patients with proximal femoral fractures. The poor CAS group had a higher proportion of dementia and weaker knee extension MMT. Dementia hinders rehabilitation effectiveness, impacting recovery in knee extension strength and CAS. The decision tree analysis provided an intuitive understanding of variable interrelationships, emphasizing knee extension strength as the primary factor, followed by dementia in cases with lower MMT scores. This study elucidated factors related to Week 1 CAS in postoperative patients with proximal femoral fractures. Knee extension MMT emerged as the initial factor, followed by the presence of dementia, influencing Week 1 CAS. These findings are crucial for rehabilitation planning and long-term prognostic predictions in this patient population. However, the study's limitations include potential selection bias and a small sample size, necessitating further research for enhanced predictive accuracy.
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Seko T, Akasaka H, Koyama M, Himuro N, Saitoh S, Ogawa S, Miura S, Mori M, Ohnishi H. The Contributions of Knee Extension Strength and Hand Grip Strength to Factors Relevant to Physical Frailty: The Tanno-Sobetsu Study. Geriatrics (Basel) 2024; 9:9. [PMID: 38247984 PMCID: PMC10801561 DOI: 10.3390/geriatrics9010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Sarcopenia is the core factor of frailty. This study specifically focused on lower limb muscle strength and examined muscle indices that indicate the risk of frailty or pre-frailty in older adults. The study included 327 community-dwelling individuals aged ≥65 years (43.7% male) who participated in the cohort. Frailty was defined based on five symptoms: weight loss, low activity level, exhaustion, weakness and slowness. Participants were classified into frail (three or more applicable), pre-frail (one to two applicable) and non-frail groups. Muscle strength (knee extension strength, toe grip strength and hand grip strength) were assessed, and appendicular muscle mass was assessed via a bioelectrical impedance analysis. The adjusted odds ratio (OR) of muscle indices for with frailty (frail group vs. pre-frail group) or pre-frailty (pre-frail group vs. non-frail group) were calculated. The prevalence of frail and pre-frail was 7% and 40%, respectively. Adjusted for age, sex, albumin and medical history, knee extension strength was significantly associated with frailty (odds ratio 0.95, 95% CI 0.92-0.98), while hand grip strength was associated with pre-frailty (odds ratio 0.92, 95% CI 0.88-0.97) but not with other muscle indices. This study is significant for identifying knee extension strength as a factor relevant to frailty in older adults considered pre-frailty, emphasizing the importance of this specific muscle measure in predicting and managing frailty.
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Affiliation(s)
- Toshiaki Seko
- Department of Rehabilitation, Hokkaido Chitose College of Rehabilitation, Chitose 066-0055, Japan; (S.O.); (M.M.)
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; (M.K.); (N.H.); (H.O.)
| | - Hiroshi Akasaka
- Department of Geriatric and General Medicine, Osaka University Graduate School of Medicine, Suita 565-0871, Japan;
| | - Masayuki Koyama
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; (M.K.); (N.H.); (H.O.)
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
| | - Nobuaki Himuro
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; (M.K.); (N.H.); (H.O.)
| | - Shigeyuki Saitoh
- Division of Medical and Behavioral Subjects, Sapporo Medical University School of Health Science, Sapporo 060-8556, Japan;
| | - Shunichi Ogawa
- Department of Rehabilitation, Hokkaido Chitose College of Rehabilitation, Chitose 066-0055, Japan; (S.O.); (M.M.)
| | - Sayo Miura
- Department of Rehabilitation, Japan Health Care College, Sapporo 062-0053, Japan;
| | - Mitsuru Mori
- Department of Rehabilitation, Hokkaido Chitose College of Rehabilitation, Chitose 066-0055, Japan; (S.O.); (M.M.)
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan; (M.K.); (N.H.); (H.O.)
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Myong Y, Park S, Cho M, Cho SY, Lee WH, Oh BM, Kim S. Development and validation of a portable articulated dynamometry system to assess knee extensor muscle strength. Sci Rep 2023; 13:11887. [PMID: 37482569 PMCID: PMC10363537 DOI: 10.1038/s41598-023-39062-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 07/19/2023] [Indexed: 07/25/2023] Open
Abstract
Muscle strength assessment is important in predicting clinical and functional outcomes in many disorders. Manual muscle testing, although commonly used, offers suboptimal accuracy and reliability. Isokinetic dynamometers (IKDs) have excellent accuracy and reliability; but are bulky and expensive, offering limited accessibility. This study aimed to design a portable dynamometer that is accessible, accurate and reliable, and to validate the device in a general population. The portable articulated dynamometry system (PADS) is a portable device with an embedded high-precision load cell, designed to measure muscle strength with optimal accuracy. Seventy-two participants underwent maximal isometric and isokinetic knee extensor torque measurement with the PADS and IKD, respectively. The PADS results were cross-validated against IKD results using change in mean (CIM). Interrater and intra-rater reliabilities were assessed using intraclass correlation coefficients, standard error of measurement, and minimal detectable change. The PADS maximal knee extensor strength results were not significantly different from those by IKD (CIM: - 2.13 Nm; 95% CI - 4.74, 0.49 Nm). The PADS showed interrater reliability (Pearson's r: 0.958; ICC: 0.979; SEM: 5.51%) and excellent intra-rater reliability (Pearson's r: 0.912; ICC: 0.954; SEM: 8.38%). The proposed PADS may be an effective alternative to IKD, offering good accuracy, reliability, and potentially better accessibility.
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Affiliation(s)
- Youho Myong
- Department of Biomedical Engineering, Seoul National University College of Medicine, 101 Daehak-ro, Jongno gu, Seoul, 03080, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno gu, Seoul, 03080, Republic of Korea
| | - Sungwoo Park
- Graduate School, Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, 08826, Republic of Korea
- Institute of Innovative Medical Technology, Seoul National University Hospital Biomedical Research Institute, Jongno gu, Seoul, 03122, Republic of Korea
| | - Minwoo Cho
- Department of Transdisciplinary Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno gu, Seoul, 03080, Republic of Korea
- Department of Medicine, College of Medicine, Seoul National University, Seoul, 03080, Republic of Korea
| | - Seung Yeon Cho
- Graduate School, Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, 08826, Republic of Korea
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno gu, Seoul, 03080, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno gu, Seoul, 03080, Republic of Korea.
- Department of Rehabilitation Medicine, National Traffic Injury Rehabilitation Hospital, Yangpyeong, Gyeonggi, 12564, Republic of Korea.
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, 101 Daehak-ro, Jongno gu, Seoul, 03080, Republic of Korea.
- Graduate School, Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, 08826, Republic of Korea.
- Institute of Bioengineering, Seoul National University, 101 Daehak-ro, Jongno gu, Seoul, 03080, Republic of Korea.
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Osawa Y, Candia J, Abe Y, Tajima T, Oguma Y, Arai Y. Plasma amino acid signature for sarcopenic phenotypes in community-dwelling octogenarians: Results from the Kawasaki Aging Wellbeing Project. Exp Gerontol 2023; 178:112230. [PMID: 37286061 DOI: 10.1016/j.exger.2023.112230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/29/2023] [Accepted: 06/01/2023] [Indexed: 06/09/2023]
Abstract
Sarcopenia is one of the primary risk factors for various adverse health events in later life. However, its pathophysiology in the very old population remains unclear. Hence, this study aimed to examine whether plasma free amino acids (PFAAs) correlate with major sarcopenic phenotypes (i.e., muscle mass, muscle strength, and physical performance) in community-dwelling adults aged 85-89 years living in Japan. Cross-sectional data from the Kawasaki Aging Well-being Project were used. We included 133 adults aged 85-89 years. In this study, fasting blood was collected to measure 20 plasma PFAAs. Measures for the three major sarcopenic phenotypes included appendicular lean mass assessed by multifrequency bioimpedance, isometric handgrip strength, and gait speed from a 5 m walk at a usual pace. Furthermore, we used phenotype-specific elastic net regression models adjusted for age centered at 85 years, sex, body mass index, education level, smoking status, and drinking habit to identify significant PFAAs for each sarcopenic phenotype. Higher histidine and lower alanine levels were associated with poor gait speed, but no PFAAs correlated with muscle strength or mass. In conclusion, PFAAs such as plasma histidine and alanine are novel blood biomarkers associated with physical performance in community-dwelling adults aged 85 years or older.
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Affiliation(s)
- Yusuke Osawa
- Graduate School of Health Management, Keio University, Kanagawa, Japan; Sports Medicine Research Center, Keio University, Kanagawa, Japan; Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, United States.
| | - Julián Candia
- Translational Gerontology Branch, National Institute on Aging, Baltimore, MD, United States
| | - Yukiko Abe
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Takayuki Tajima
- Sports Medicine Research Center, Keio University, Kanagawa, Japan; Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuko Oguma
- Graduate School of Health Management, Keio University, Kanagawa, Japan; Sports Medicine Research Center, Keio University, Kanagawa, Japan
| | - Yasumichi Arai
- Center for Supercentenarian Medical Research, Keio University School of Medicine, Tokyo, Japan; Faculty of Nursing and Medical Care, Keio University School of Medicine, Kanagawa, Japan.
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Muscle strength performed better than muscle mass in identifying cognitive impairment risk in maintenance hemodialysis patients. Eat Weight Disord 2022; 27:2533-2540. [PMID: 35389149 DOI: 10.1007/s40519-022-01375-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/29/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES The association between muscle mass and cognitive impairment (CI) is conflicting. We aimed to evaluate and compare the associations of muscle strength, muscle mass and CI risk in maintenance hemodialysis (MHD) patients. METHODS We conducted a multicenter, cross-sectional study. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) score. Muscle strength was assessed by hand grip strength (HGS), muscle mass was assessed by lean tissue mass (LTM). Education status was divided into two groups: lower education status (senior middle school and below) and higher education status (high school and above). Multivariable logistic regression models and subgroup analyses were performed. Receiver-operating characteristic (ROC) analyses were conducted to compare their predictive power in discriminating CI. RESULTS 2827 adult MHD patients were included in our final analysis. Patients in the lowest quartile of HGS was 2.82-fold as likely to have CI as compared to those in the highest quartile, while participants in the lowest quartile of LTM group were 1.52-fold as likely to have CI, when compared with the highest quartile group of LTM after adjusting for age, gender and education level. The association persisted in all subgroups except for women and well-educated participants. There was a significant interaction between HGS and education status on CI and age played an interactive role in the association between LTM and incident CI (P for interaction < 0.05). The AUC value of the HGS was significantly higher than that of LTM (0.69 VS 0.63, P < 0.001). CONCLUSIONS Muscle strength performed better than muscle mass in identifying individuals at high risk of CI, particularly in male and less educated Chinese MHD patients. LEVEL OF EVIDENCE Level V, cross-sectional study.
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Jurado-Castro JM, Muñoz-López M, Ledesma AST, Ranchal-Sanchez A. Effectiveness of Exercise in Patients with Overweight or Obesity Suffering from Knee Osteoarthritis: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10510. [PMID: 36078226 PMCID: PMC9518463 DOI: 10.3390/ijerph191710510] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The main purpose of this study was to review the evidence about the effectiveness of exercise in patients with overweight or obesity suffering from knee osteoarthritis. METHODS Randomized clinical trials (RCTs) published between January 2002 and May 2022 were included. RESULTS A total of 64 articles were identified, of which six met the criteria for meta-analysis. The pain scale score was higher in the control group (mean difference 0.95; confidence interval 0.42-1.47; p < 0.001; I2 = 44%). The physical function scale (lower scores indicate lower levels of symptoms or physical disability) presented a higher score in the control group (mean difference 3.74; confidence interval 0.85-6.53; p < 0.05; I2 = 56%). Moreover, the intervention group achieved a greater distance (meters) walking in a 6 min interval (mean difference 38.18; confidence interval 20.01-56.35; p < 0.001; I2 = 0%). CONCLUSIONS Exercise interventions seem effective in improving quality of life in people with overweight or obesity suffering from knee osteoarthritis, reducing pain and improving physical function.
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Affiliation(s)
- Jose Manuel Jurado-Castro
- Metabolism and Investigation Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Cordoba, Spain
- Ciencias De La Actividad Física y El Deporte, Escuela Universitaria de Osuna (Centro Adscrito a la Universidad de Sevilla), 41640 Osuna, Spain
| | - Mariano Muñoz-López
- Ciencias De La Actividad Física y El Deporte, Escuela Universitaria de Osuna (Centro Adscrito a la Universidad de Sevilla), 41640 Osuna, Spain
| | - Agustín Sánchez-Toledo Ledesma
- Instituto de Seguridad y Bienestar Laboral, 14001 Cordoba, Spain
- Higher School of Engineering and Technology, International University of La Rioja (UNIR), 26004 Logroño, Spain
| | - Antonio Ranchal-Sanchez
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Cordoba, 14071 Cordoba, Spain
- Grupo De Investigación Clínico Epidemiológica De Atención Primaria, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, 14004 Cordoba, Spain
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Osawa Y, Tian Q, An Y, Studenski SA, Resnick SM, Ferrucci L. Longitudinal Associations Between Brain Volume and Knee Extension Peak Torque. J Gerontol A Biol Sci Med Sci 2021; 76:286-290. [PMID: 32333769 DOI: 10.1093/gerona/glaa095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Muscle strength and brain volume decline with aging; changes in the brain manifested as change in volume may play a role in age-related strength loss, but this hypothesis has never been tested longitudinally. We examined longitudinal associations between brain volume changes and knee extension peak torque change in participants of the Baltimore Longitudinal Study of Aging. METHODS Brain volumes and isokinetic concentric knee extension peak torque at 30 deg/s were measured in 678 participants (55.2% women; baseline age, 50.1-97.2 years; median follow-up time in those who visited two or more times (n = 375, 4.0 [interquartile range {IQR}, 2.3-5.0] years). Correlations between longitudinal changes in brain volumes and knee extension peak torque were examined using bivariate linear mixed-effects models, adjusted for baseline age, sex, race, education, and intracranial volume. RESULTS Greater decline in muscle strength was associated with greater atrophies in global gray matter, temporal lobe, frontal gray matter, temporal gray matter, superior frontal gyrus, inferior frontal gyrus, supramarginal gyrus, middle temporal gyrus, inferior temporal gyrus, and occipital pole (r ranging from .30 to .77, p < .05). After multiple comparison adjustment, only larger decrease in middle temporal gyrus remained significantly related to larger decrease in muscle strength (q = 0.045). CONCLUSIONS In older adults, declines in knee extension muscle strength co-occurred with atrophies in frontal, temporal, and occipital gray matter. These findings support the idea that age-related knee extension muscle strength is linked with atrophy in some specific brain regions related to motor control.
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Affiliation(s)
- Yusuke Osawa
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Qu Tian
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Yang An
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Stephanie A Studenski
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
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11
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Chu SF, Liou TH, Chen HC, Huang SW, Liao CD. Relative Efficacy of Weight Management, Exercise, and Combined Treatment for Muscle Mass and Physical Sarcopenia Indices in Adults with Overweight or Obesity and Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials. Nutrients 2021; 13:1992. [PMID: 34200533 PMCID: PMC8230320 DOI: 10.3390/nu13061992] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/31/2022] Open
Abstract
Aging and osteoarthritis are associated with high risk of muscle mass loss, which leads to physical disability; this loss can be effectively alleviated by diet (DI) and exercise (ET) interventions. This study investigated the relative effects of different types of diet, exercise, and combined treatment (DI+ET) on muscle mass and functional outcomes in individuals with obesity and lower-limb osteoarthritis. A comprehensive search of online databases was performed to identify randomized controlled trials (RCTs) examining the efficacy of DI, ET, and DI+ET in patients with obesity and lower-extremity osteoarthritis. The included RCTs were analyzed through network meta-analysis and risk-of-bias assessment. We finally included 34 RCTs with a median (range/total) Physiotherapy Evidence Database score of 6.5 (4-8/10). DI plus resistance ET, resistance ET alone, and aerobic ET alone were ranked as the most effective treatments for increasing muscle mass (standard mean difference (SMD) = 1.40), muscle strength (SMD = 1.93), and walking speed (SMD = 0.46). Our findings suggest that DI+ET is beneficial overall for muscle mass in overweight or obese adults with lower-limb osteoarthritis, especially those who are undergoing weight management.
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Affiliation(s)
- Shu-Fen Chu
- College of Nursing and Health Management, Shanghai University of Medicine and Health Sciences, Shanghai 201318, China;
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (T.-H.L.); (H.-C.C.); (S.-W.H.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Hung-Chou Chen
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (T.-H.L.); (H.-C.C.); (S.-W.H.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (T.-H.L.); (H.-C.C.); (S.-W.H.)
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Chun-De Liao
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (T.-H.L.); (H.-C.C.); (S.-W.H.)
- Master Program in Long-Term Care, Taipei Medical University, College of Nursing, Taipei 110301, Taiwan
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12
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Schroeder A, Wang N, Felson DT, Lewis CE, Nevitt MC, Segal NA. Knee Extensor and Flexor Torque Variability During Maximal Strength Testing and Change in Knee Pain and Physical Function at 60-Mo Follow-Up: The Multicenter Osteoarthritis Study (MOST). Am J Phys Med Rehabil 2021; 100:196-201. [PMID: 32932359 PMCID: PMC8024112 DOI: 10.1097/phm.0000000000001587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT As the population ages, there is a growing burden owing to musculoskeletal diseases, such as knee osteoarthritis, and subsequent functional decline. In the absence of a cure, there is a need to identify factors amenable to intervention to prevent or slow this process. The Multicenter Osteoarthritis Study cohort was developed for this purpose. In this study, associations between variability in peak knee flexor and extensor torque at baseline and worsening of pain and physical function over the subsequent 60 mos were assessed in a cohort of 2680 participants. The highest quartile of baseline knee flexor torque variability was found to be associated longitudinally with worsening pain (fourth quartile ß estimate, mean ± SE, 0.49 ± 0.19; P = 0.0115; with R2 = 0.28 and P for trend across quartiles = 0.0370) and physical function scores (fourth quartile ß estimate, mean ± SE, 1.39 ± 0.64; P = 0.0296; with R2 = 0.25 and P for trend across quartiles = 0.0371), after adjusting for baseline knee osteoarthritis and maximum knee flexor torque. There were no associations between baseline knee extensor torque and worsening pain or physical function by 60 mos. The presence of greater variability in maximum knee flexor strength may identify patients who may benefit from therapies aimed at preventing worsening knee pain and physical function.
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Affiliation(s)
- Allison Schroeder
- From the Department of PM&R, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (AS); Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, Massachusetts (NW); Boston University, Boston, Massachusetts (DTF); University of Alabama at Birmingham, Birmingham, Alabama (CEL); University of California, San Francisco, San Francisco, California (MCN); University of Kansas Medical Center, Kansas City, Kansas (NAS); and The University of Iowa, Iowa City, Iowa (NAS)
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13
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Ozaki H, Sawada S, Osawa T, Natsume T, Yoshihara T, Deng P, Machida S, Naito H. Muscle Size and Strength of the Lower Body in Supervised and in Combined Supervised and Unsupervised Low-Load Resistance Training. J Sports Sci Med 2020; 19:721-726. [PMID: 33239946 PMCID: PMC7675625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/27/2020] [Indexed: 06/11/2023]
Abstract
This study aimed to clarify whether low-load resistance training at a low frequency (twice a week) using body weight and elastic band improves muscle size, muscle strength, and physical functions and to compare the training effects between supervised training and a combination of supervised and unsupervised training in untrained older adults. Fifty-one older adults (ages: 57-75 years) selected to either a supervised (S) training group (n = 34) or a combined supervised and unsupervised (SU) group (n = 17). Both groups performed low-load resistance training composed of nine exercises for 12 weeks. The S group participated in supervised exercise sessions twice a week, and the SU group performed a supervised exercise session once a week and an unsupervised exercise session at home also once a week. For muscle thicknesses in the anterior aspects of the forearm, upper arm, and thigh and the posterior aspect of the thigh, group × time interactions were observed (p < 0.05). The hypertrophic effects were higher in the S group. Isometric knee extension strength and physical functions increased similarly in both groups. Low-load resistance training using body weight and elastic band twice a week for 12 weeks induces muscle hypertrophy and increases muscle strength and physical functions in older adults. Although the muscle hypertrophic effects are greater in the S group than in the SU group, the other effects were similar between the groups.
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Affiliation(s)
- Hayao Ozaki
- School of Sport and Health Science, Tokai Gakuen University, Miyoshi, Aichi, Japan
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
| | - Shuji Sawada
- COI Project Center, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Takuya Osawa
- Faculty of Sports and Health Sciences, Japan Women's College of Physical Education, Setagaya-ku, Tokyo, Japan
| | | | - Toshinori Yoshihara
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
| | - Pengyu Deng
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
| | - Shuichi Machida
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
- COI Project Center, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Hisashi Naito
- Graduate School of Health and Sports Science, Juntendo University, Inzai, Chiba, Japan
- COI Project Center, Juntendo University, Bunkyo-ku, Tokyo, Japan
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14
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Sieljacks PS, Søberg CA, Michelsen AS, Dalgas U, Hvid LG. Lower extremity muscle strength across the adult lifespan in multiple sclerosis: Implications for walking and stair climbing capacity. Exp Gerontol 2020; 139:111025. [DOI: 10.1016/j.exger.2020.111025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/03/2020] [Accepted: 07/16/2020] [Indexed: 01/22/2023]
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15
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Meaningful measures in cancer cachexia: implications for practice and research. Curr Opin Support Palliat Care 2020; 13:323-327. [PMID: 31599817 DOI: 10.1097/spc.0000000000000472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Cancer cachexia is a complex inflammatory syndrome, which presents with a variety of discrete symptoms and signs. This creates a challenge for both clinicians and researchers in recognizing and assessing the syndrome. This review explores the evidence for various measures used in the assessment of cachexia. RECENT FINDINGS Objectively, cachexia may be assessed using CT-derived measures of skeletal muscle [skeletal muscle index (SMI) and skeletal muscle density (SMD)]. Evidence suggests that SMD may be of equal or greater value than SMI in assessing cachexia. Inflammatory markers are also used, and include interleukin(IL)-1α; IL-1β; IL-6 and Interferon Gamma (IFNγ). Other robust measures include performance status and the modified Glasgow prognostic score (mGPS). These measures, however, are more commonly used in academia. By comparison, clinical assessment is limited to individual measures of patient function, such as hand grip strength (HGS), calf circumference, gait speed, and the 'timed up and go test' (TUG). These have each been linked with components of cachexia but are less well evidenced. Evidence also exists for patient-reported quality-of-life measures, based upon the EORTC- QLQ-C30 questionnaire, in assessing cachexia. SUMMARY Further assessment is required to compare clinical measures of cachexia and determine their utility.
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16
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Nakamura T, Kamiya K, Hamazaki N, Matsuzawa R, Nozaki K, Ichikawa T, Yamashita M, Maekawa E, Reed JL, Noda C, Meguro K, Yamaoka-Tojo M, Matsunaga A, Ako J. Quadriceps Strength and Mortality in Older Patients With Heart Failure. Can J Cardiol 2020; 37:476-483. [PMID: 32622879 DOI: 10.1016/j.cjca.2020.06.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/21/2020] [Accepted: 06/28/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This study was performed to test the hypothesis that low quadriceps isometric strength (QIS) is associated with greater risk of mortality and has the additive prognostic significance to the severity of heart failure (HF) and gait speed in older patients with HF. METHODS A retrospective cohort study was performed in 1273 patients ≥ 60 years of age with HF (mean age 75 ± 8 years, 59.1% men); all of whom were evaluated during hospitalization for usual gait speed and maximal QIS. The QIS was expressed relative to body mass (% BM). The endpoint was all-cause mortality. RESULTS Over a median follow-up period of 1.59 years (interquartile range, 0.58 to 3.42 years), 224 patients died. The cutoff value based on the Youden index for the QIS discriminating those at high risk of mortality was 36.2% BM for overall, and we defined less than this cutoff point of QIS as low QIS. After adjustment for the HF risk score, the hazard ratio in low QIS was 1.55 for overall (95% confidence interval [CI], 1.17-2.06). The addition of low QIS to the HF risk score and gait speed was associated with significant increases in both net reclassification improvement (NRI, 0.239 for overall; 95% CI, 0.096-0.381) and integrated discrimination improvement (IDI, 0.004 for overall; 95% CI, 0.001-0.009) for all-cause mortality. CONCLUSION Low QIS was strongly associated with poor prognosis and showed complementary prognostic predictive capability to the HF risk score and gait speed in older patients with HF.
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Affiliation(s)
- Takeshi Nakamura
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, Juntendo University Hospital, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan.
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences, Kobe, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Takafumi Ichikawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Jennifer L Reed
- Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Chiharu Noda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kentaro Meguro
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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17
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Osawa Y, Chiles Shaffer N, Shardell MD, Studenski SA, Ferrucci L. Changes in knee extension peak torque and body composition and their relationship with change in gait speed. J Cachexia Sarcopenia Muscle 2019; 10:1000-1008. [PMID: 31273957 PMCID: PMC6818676 DOI: 10.1002/jcsm.12458] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 05/08/2019] [Accepted: 05/14/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Slow gait speed is a powerful predictor of disability in activities of daily living and mortality. Muscle strength and body composition change over time, but their changes differ by sex. How these parameters jointly affect gait speed decline is unknown. Understanding this association could help develop and evaluate the sex-specific effects of lifestyle interventions to delay gait speed decline in older adults. We assessed whether changes in strength (Δstrength), appendicular lean mass (ΔALM), and fat mass (Δfat) jointly relate to change in gait speed and whether the association differs by sex. METHODS The analytic sample comprised 575 women and 539 men aged 22-95 years enrolled in the Baltimore Longitudinal Study of Aging. Mean follow-up was 4.0 years. Measures included isometric knee extension strength, dual-energy X-ray absorptiometry-assessed ALM and fat mass, and gait speed from the 400 m fast pace walk. Sex-specific linear mixed models were adjusted for follow-up time and baseline age, race, height, ALM, fat mass, peak torque, and gait speed. We also included second-order interaction terms of the key predictive variables (e.g. Δstrength × ΔALM). To interpret the interactions, we estimated average gait declines using the 25th or 75th percentile of the two significant predictive variables and then assessed which condition relates to larger decline in gait speed. RESULTS In both sexes, independent of ΔALM and Δfat, larger decline in strength significantly related to larger decline in gait speed (P = 0.01 for both sexes). In men, interactions between Δstrength × ΔALM and Δfat by ΔALM were associated with change in gait speed; men with greater declines in both muscle strength and ALM or greater declines in both ALM and fat have steeper gait speed decline. In contrast, in women, the interaction between Δfat and ΔALM was associated with change in gait speed; women with an increase in fat mass combined with less decline in ALM have steeper gait speed decline. CONCLUSIONS While change in strength affects change in gait speed in both sexes, the effects of body composition change differ by sex. Dual-energy X-ray absorptiometry-based estimates of lean mass may be confounded by intramuscular fat. Future studies should examine sex-specific combined effects of change in strength and body composition on mobility using multiple techniques to measure body composition. Intervention studies should consider testing sex-specific interventions on body composition.
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Affiliation(s)
- Yusuke Osawa
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, USA
| | - Nancy Chiles Shaffer
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, USA
| | - Michelle D Shardell
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, USA
| | - Stephanie A Studenski
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, USA
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, USA
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