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Kujawska A, Kujawski S, Dani M, Miglis MG, Hallman DM, Fudim M, Soysal P, Husejko J, Hajec W, Skierkowska-Kruszyńska N, Kwiatkowska M, Newton JL, Zalewski P, Kędziora-Kornatowska K. Prospective association of occupational and leisure-time physical activity with orthostatic blood pressure changes in older adults. Sci Rep 2023; 13:20704. [PMID: 38001151 PMCID: PMC10673924 DOI: 10.1038/s41598-023-46947-7] [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] [Received: 05/24/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Orthostatic hypotension (OH) is common in older people. We examined the influence of self-reported occupational-related physical activity (PA) and leisure-time physical exercise (PE) on orthostatic response in a sample of older people over a 2 year period. Supine and orthostatic systolic blood pressure (sBP), diastolic blood pressure (dBP), and mean blood pressure (mBP) were assessed in response to Active Stand (AS) test in 205 older subjects (> 60 years old) at baseline and 2-year follow-up. OH was found in 24 subjects (11.71%) at baseline and 20 subjects (9.76%) after 2 years, with a significant degree of variability in the occurrence of OH after 2 years. Twenty-two subjects who had OH at baseline were free of it after 2 years, two subjects had persistent OH at baseline and after 2 years. After 2 years, adults with occupational PA showed no significant decrease of blood pressure in response to AS test, while lack of undertaking an occupation-related PA was significantly related with a greater decrease in sBP and mBP in response to AS testing in the 1st min. Occupation-related PA and leisure-time-related PE were related to an increase in the response of BP on AS in change between baseline and after 2 years. High between-subjects variance in OH over 2 years was noted. Occupations that involved continuous physical activity and leisure-time physical exercise in middle age were both protective for BP decline on orthostatic stress test within 2 years.
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Affiliation(s)
- Agnieszka Kujawska
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Świętojańska 20, 85-077, Bydgoszcz, Kujawsko-Pomorskie, Poland
| | - Sławomir Kujawski
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Świętojańska 20, 85-077, Bydgoszcz, Kujawsko-Pomorskie, Poland.
| | - Melanie Dani
- Cutrale Peri-operative and Ageing Group, Imperial College London, London, W12 0BZ, UK
| | - Mitchell G Miglis
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - David M Hallman
- Department of Occupational Health Science and Psychology, University of Gävle, Gävle, Sweden
| | - Marat Fudim
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Jakub Husejko
- Department of Geriatrics, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094, Bydgoszcz, Poland
| | - Weronika Hajec
- Department of Basic Clinical Skills and Postgraduate Education of Nurses and Midwives, Faculty of Health Sciences, Collegium Medicum im. L. Rydygier in Bydgoszcz, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094, Bydgoszcz, Poland
- Department of Anesthesiology and Intensive Care, Professor Franciszek Łukaszczyk Oncology Center, 85-796, Bydgoszcz, Poland
| | - Natalia Skierkowska-Kruszyńska
- Department of Geriatrics, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094, Bydgoszcz, Poland
| | - Małgorzata Kwiatkowska
- Department of Geriatrics, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094, Bydgoszcz, Poland
| | - Julia L Newton
- Population Health Sciences Institute, The Medical School, Newcastle University, Newcastle-Upon-Tyne, NE2 4AX, UK
| | - Paweł Zalewski
- Department of Exercise Physiology and Functional Anatomy, Ludwik Rydygier Collegium Medicum in Bydgoszcz Nicolaus Copernicus University in Toruń, Świętojańska 20, 85-077, Bydgoszcz, Kujawsko-Pomorskie, Poland
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Warsaw Medical University, 1B Banacha Street, 02-097, Warsaw, Poland
| | - Kornelia Kędziora-Kornatowska
- Department of Geriatrics, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094, Bydgoszcz, Poland
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Duggan E, Murphy CH, Knight SP, Davis JRC, O'Halloran AM, Kenny RA, Romero-Ortuno R. Differential Associations Between Two Markers of Probable Sarcopenia and Continuous Orthostatic Hemodynamics in The Irish Longitudinal Study on Ageing. J Gerontol A Biol Sci Med Sci 2023; 78:1376-1382. [PMID: 36480700 PMCID: PMC10395558 DOI: 10.1093/gerona/glac243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Sarcopenia and orthostatic hypotension are growing age-related health burdens associated with adverse outcomes, including falls. Despite a possible pathophysiological link, the association between the 2 disorders is not well elucidated. We sought to investigate this relationship in The Irish Longitudinal Study on Ageing (TILDA). METHODS Data from 2 858 participants at wave 3 of TILDA were analyzed. Probable sarcopenia was defined as per the European Working Group on Sarcopenia in Older People revised definition cutoffs (hand grip strength [HGS] <27 kg in men, <16 kg in women, and/or 5-chair stand test [5CST] time >15 seconds). Participants underwent an active stand orthostatic test with continuous blood pressure (BP) monitoring. Multilevel mixed-effects models, controlling for possible confounders, were used to assess the effect of probable sarcopenia by HGS and 5CST criteria on the change in BP after standing. RESULTS HGS- and 5CST-defined probable sarcopenia were independently associated with an attenuated BP recovery at 10-20 seconds poststand (systolic BP: β -0.54, p < .001; β -0.25, p < .001). On average, those meeting HGS probable sarcopenia criteria had a significantly lower BP at 20, 30, and 40 seconds (differences in systolic BP: -5.01 mmHg, -3.68 mmHg, -2.32 mmHg, p < .05 for all). Those meeting 5CST probable sarcopenia criteria had a significant difference in systolic BP at 20 seconds (-1.94 mmHg, p = .002) but not at 30 or 40 seconds. CONCLUSION Probable sarcopenia had a significant association with delayed orthostatic BP recovery, with HGS-defined probable sarcopenia having a stronger association than 5CST-defined probable sarcopenia. Results support a modest but significant pathophysiological link between probable sarcopenia and orthostatic hypotension.
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Affiliation(s)
- Eoin Duggan
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Caoileann H Murphy
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, Dublin, Ireland
- Teagasc, Food Research Centre, Ashtown, Dublin, Ireland
| | - Silvin P Knight
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - James R C Davis
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Aisling M O'Halloran
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Roman Romero-Ortuno
- The Irish Longitudinal Study on Ageing (TILDA), School of Medicine, Trinity College Dublin, Dublin, Ireland
- Discipline of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Looze CD, Scarlett S, Newman L, Kenny RA. Sleep duration and disturbance are associated with orthostatic heart rate recovery: Findings from the Irish Longitudinal Study on Ageing. Sleep Health 2022; 8:654-662. [PMID: 36216751 DOI: 10.1016/j.sleh.2022.08.002] [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: 01/14/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine a novel measurement of autonomic innervation, the early heart rate response to orthostasis, in relation to sleep duration and disturbance (actigraphy-based and self-reported) in healthy older adults. DESIGN Cross-sectional analyses of a nationally representative prospective cohort study, the Irish Longitudinal Study on Ageing (TILDA). PARTICIPANTS Nine hundred sixty community-dwelling adults aged 50 and over (mean age 65.6 ± 8.1; 53% women). MEASUREMENT Orthostatic heart rate response was measured during an active stand test. Beat-to-beat heart rate was monitored over 3 minutes using noninvasive digital photoplethysmography. Mean values at each 10-second time point after standing were generated and differences from baseline at each time point were used for analysis. Actigraphy-based sleep measures were extracted from wrist-worn GENEactiv devices; self-reported sleep measures using interview questions. RESULTS Linear mixed-effects regression analyses, with inclusion of a large number of confounders, show that self-reported sleep duration and actigraphy-based sleep duration and disturbance were associated with altered orthostatic heart rate response, particularly within the first 20 seconds poststanding. Self-reported short sleep (β = -0.06; 95% confidence interval [CI]: -0.11, -0.01) and long sleep (β = -0.15; 95% CI: -0.24, -0.05) and actigraphy-based short sleep (β = -0.08; 95% CI: -0.14, -0.01) were characterized by a smaller increase at 10 seconds (p < .01). Actigraphy-based short sleep (β = 0.15; 95% CI: 0.08, 0.22) and sleep disturbance (β = 0.04; 95% CI: 0.02, 0.06) were associated with a slower return toward baseline at 20 seconds (p < .001). CONCLUSIONS Our findings suggest sympathetic dysregulation, impaired vagal reactivation, and/or decreased baroreceptor sensitivity in the presence of shortened or disturbed sleep.
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Affiliation(s)
- Céline De Looze
- The Irish Longitudinal Study of Ageing (TILDA), School of Medicine, Trinity College Dublin, Dublin, Ireland.
| | - Siobhan Scarlett
- The Irish Longitudinal Study of Ageing (TILDA), School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Louise Newman
- The Irish Longitudinal Study of Ageing (TILDA), School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study of Ageing (TILDA), School of Medicine, Trinity College Dublin, Dublin, Ireland; Mercer's Institute for Successful Ageing (MISA), St James's Hospital, Dublin, Ireland
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Personalised physiological medicine: Orthostatic hypotension. Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Tran J, Mol A, Iseli RK, Lim WK, Meskers CGM, Maier AB. Feasibility of Diagnosing Initial Orthostatic Hypotension Using a Continuous Blood Pressure Device in Geriatric Rehabilitation Inpatients: RESORT. Gerontology 2022; 68:951-960. [PMID: 35038699 PMCID: PMC9501774 DOI: 10.1159/000521411] [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: 04/25/2021] [Accepted: 12/01/2021] [Indexed: 11/19/2022] Open
Abstract
Background Initial orthostatic hypotension (IOH) is highly prevalent in older adults and may interfere with the ability to regain function after acute hospitalization. IOH assessment requires a non-invasive, beat-to-beat continuous blood pressure device, which is not widely used in geriatric rehabilitation. Our aim was to test the feasibility of diagnosing IOH using a continuous blood pressure device in geriatric rehabilitation inpatients. Methods Geriatric rehabilitation inpatients of the REStORing Health of Acutely Unwell AdulTs (RESORT) cohort admitted to a tertiary hospital were randomly selected to undergo continuous blood pressure monitoring (Finapres) for 5 min in the supine position and 3 min of standing or sitting when unable to stand. Interventions to warm hands and adjusting the cuff pressure sizes were attempted if no signal was obtained or an error message occurred. Results Of 37 randomly selected inpatients, 29 {55.2% female; mean age 82.8 (standard deviation [SD]) 6.6 years} agreed to the continuous blood pressure measurement. Successful measurements were achieved in 20 out of 29 inpatients, two after hand warming. Patients with unsuccessful measurements were likely to be older (mean age 87.2 [SD] 4.4 years, p = 0.03), have cerebrovascular disease (p = 0.006), lower body mass index (p = 0.012), and a lower short physical performance battery score (p = 0.039). Eight out of 20 patients had IOH. Conclusion The number of unsuccessful continuous blood pressure measurements was high in a population with high IOH prevalence despite multiple interventions to establish a signal. Future research should focus on improving the efficiency of continuous blood pressure devices in hospitalized patients with unsuccessful signals.
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Affiliation(s)
- Jennifer Tran
- Department of Medicine and Aged Care, the Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Arjen Mol
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rebecca K Iseli
- Department of Medicine and Aged Care, the Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Wen Kwang Lim
- Department of Medicine and Aged Care, the Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Carel G M Meskers
- Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, the Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.,Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Centre for Healthy Longevity, National University Health System, Singapore, Singapore
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Diagnostic criteria for initial orthostatic hypotension: a narrative review. Clin Auton Res 2021; 31:685-698. [PMID: 34677720 DOI: 10.1007/s10286-021-00833-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/13/2021] [Indexed: 12/20/2022]
Abstract
Abnormalities in orthostatic blood pressure changes upon active standing are associated with morbidity, mortality, and reduced quality of life. However, over the last decade, several population-based cohort studies have reported a remarkably high prevalence (between 25 and 70%) of initial orthostatic hypotension (IOH) among elderly individuals. This has raised the question as to whether the orthostatic blood pressure patterns in these community-dwelling elderly should truly be considered as pathological. If not, redefining of the systolic cutoff values for IOH (i.e., a value ≥ 40 mmHg in systolic blood pressure in the first 15 s after standing up) might be necessary to differ between normal aging and true pathology. Therefore, in this narrative review, we provide a critical analysis of the current reference values for the changes in systolic BP in the first 60 s after standing up and discuss how these values should be applied to large population studies. We will address factors that influence the magnitude of the systolic blood pressure changes following active standing and the importance of standardization of the stand-up test, which is a prerequisite for quantitative, between-subject comparisons of the postural hemodynamic response.
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Eight Orthostatic Haemodynamic Patterns in The Irish Longitudinal Study on Ageing (TILDA): Stability and Clinical Associations after 4 Years. Geriatrics (Basel) 2021; 6:geriatrics6020050. [PMID: 34064800 PMCID: PMC8162355 DOI: 10.3390/geriatrics6020050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 01/27/2023] Open
Abstract
Previous research cross-sectionally characterised eight morphological systolic blood pressure (SBP) active stand (AS) patterns using a clinical clustering approach at Wave 1 (W1) of the Irish Longitudinal Study on Ageing. We explored the longitudinal stability and clinical associations of these groupings at Wave 3 (W3), four years later. Eight AS groups had their clinical characteristics and AS patterns at W3 compared to W1. We explored longitudinal associations (new cognitive decline, falls, syncope, disability, and mortality) using multivariate logistic regression models. In total, 2938 participants (60% of Wave 1 sample) had adequate AS data from both W1 and 3 for analysis. We found no longitudinal stability of the eight AS groups or their morphological patterns between the waves. A pattern of impaired stabilisation and late deficit seemed more preserved and was seen in association with new cognitive decline (OR 1.63, 95% CI: 1.12–2.36, p = 0.011). An increase in antihypertensive usage seemed associated with reduced immediate SBP drops, improved AS patterns, and reduced orthostatic intolerance (OI). In pure longitudinal groups, AS patterns were not preserved after 4 years. AS patterns are longitudinally dynamic, and improvements after 4 years are possible even in the presence of higher antihypertensive burden.
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Lee HJ, Lee KH, Moon JY, Kim YC. Prevalence of autonomic nervous system dysfunction in complex regional pain syndrome. Reg Anesth Pain Med 2021; 46:196-202. [PMID: 33419877 DOI: 10.1136/rapm-2020-101644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND We aimed to investigate the prevalence of dysautonomia in complex regional pain syndrome (CRPS) via the combined autonomic nervous system (ANS) function tests, including the deep breathing test (DBT), orthostatic test (OST) and sympathetic skin response (SSR). METHOD We retrospectively examined 263 patients who underwent the combined ANS tests to evaluate CRPS between August 2013 and December 2016. Based on the Budapest clinical criteria, patients were stratified into confirmed-CRPS or suspected-CRPS groups. We performed binary logistic regression analysis using the inverse probability of treatment weighting to investigate the association between the tests and CRPS. Sensitivity and specificity were calculated to assess the diagnostic performance of the ANS tests for CRPS. We compared the results of these tests between the outcomes of sympathetic nerve blocks (SNBs). RESULTS Among 247 patients, finally included in this study, 199 patients (80.6%) were diagnosed with CRPS. Abnormal results of overall or each ANS function test showed significant associations with CRPS, excluding OST (overall abnormality: OR 2.44, 95% CI 1.51 to 3.95; p<0.001; DBT: OR 2.57, 95% CI 1.23 to 5.38, p=0.013; OST: OR 1.88, 95% CI 0.92 to 3.84, p=0.085; SSR: OR 2.71, 95% CI 1.38 to 5.32, p=0.004). However, their prevalence in CRPS and their sensitivities for CRPS were low (overall abnormality: 26.1%; each test: <15%). No significant association existed between dysautonomia and SNB outcomes. CONCLUSION Dysautonomia, as evaluated using the combined ANS tests, were observed in a small portion of patients with CRPS. The diagnostic performances of these tests for CRPS were inadequate for clinical purposes.
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Affiliation(s)
- Ho-Jin Lee
- Anesthesiology and Pain Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
| | - Kang Hee Lee
- Anesthesiology and Pain Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
| | - Jee Youn Moon
- Anesthesiology and Pain Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of) .,Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Yong-Chul Kim
- Anesthesiology and Pain Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of).,Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
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O'Connor JD, O'Connell MDL, Romero-Ortuno R, Hernández B, Newman L, Reilly RB, Kenny RA, Knight SP. Functional Analysis of Continuous, High-Resolution Measures in Aging Research: A Demonstration Using Cerebral Oxygenation Data From the Irish Longitudinal Study on Aging. Front Hum Neurosci 2020; 14:261. [PMID: 32765238 PMCID: PMC7379867 DOI: 10.3389/fnhum.2020.00261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/12/2020] [Indexed: 12/16/2022] Open
Abstract
Background: A shift towards the dynamic measurement of physiologic resilience and improved technology incorporated into experimental paradigms in aging research is producing high-resolution data. Identifying the most appropriate analysis method for this type of data is a challenge. In this work, the functional principal component analysis (fPCA) was employed to demonstrate a data-driven approach to the analysis of high-resolution data in aging research. Methods: Cerebral oxygenation during standing was measured in a large cohort [The Irish Longitudinal Study on Aging (TILDA)]. FPCA was performed on tissue saturation index (TSI) data. A regression analysis was then conducted with the functional principal component (fPC) scores as the explanatory variables and transition time as the response. Results: The mean ± SD age of the analysis sample was 64 ± 8 years. Females made up 54% of the sample and overall, 43% had tertiary education. The first PC explained 96% of the variance in cerebral oxygenation upon standing and was related to a baseline shift. Subsequent components described the recovery to before-stand levels (fPC2), drop magnitude and initial recovery (fPC3 and fPC4) as well as a temporal shift in the location of the minimum TSI value (fPC5). Transition time was associated with components describing the magnitude and timing of the nadir. Conclusions: Application of fPCA showed utility in reducing a large amount of data to a small number of parameters which summarize the inter-participant variation in TSI upon standing. A demonstration of principal component regression was provided to allow for continued use and development of data-driven approaches to high-resolution data analysis in aging research.
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Affiliation(s)
- John D O'Connor
- The Irish Longitudinal Study on Aging, Trinity College, The University of Dublin, Dublin, Ireland
| | - Matthew D L O'Connell
- The Irish Longitudinal Study on Aging, Trinity College, The University of Dublin, Dublin, Ireland.,Department of Population Health Sciences, King's College London, London, United Kingdom
| | - Roman Romero-Ortuno
- The Irish Longitudinal Study on Aging, Trinity College, The University of Dublin, Dublin, Ireland.,The Global Brain Health Institute, Trinity College, The University of Dublin, Dublin, Ireland
| | - Belinda Hernández
- The Irish Longitudinal Study on Aging, Trinity College, The University of Dublin, Dublin, Ireland
| | - Louise Newman
- The Irish Longitudinal Study on Aging, Trinity College, The University of Dublin, Dublin, Ireland
| | - Richard B Reilly
- Trinity Centre for Biomedical Engineering, Trinity College, The University of Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Aging, Trinity College, The University of Dublin, Dublin, Ireland
| | - Silvin P Knight
- The Irish Longitudinal Study on Aging, Trinity College, The University of Dublin, Dublin, Ireland
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Nolan H, O'Connor JD, Donoghue OA, Savva GM, O'Leary N, Kenny RA. Factors Affecting Reliability of Grip Strength Measurements in Middle Aged and Older Adults. HRB Open Res 2020. [DOI: 10.12688/hrbopenres.13064.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Grip strength is a well-established marker of frailty and a good predictor of mortality that has been measured in a diverse range of samples including many population studies. The reliability of grip strength measurement in longitudinal studies is not well understood. Methods: Participants (n=130) completed a baseline and repeat health assessment in the Irish Longitudinal Study on Ageing. Grip strength was assessed using dominant and non-dominant hands (two trials on each). Repeat assessments were conducted 1-4 months later and participants were randomised into groups so that 50% changed time (morning or afternoon assessment) and 50% changed assessor between assessments. Intra-class correlation (ICC) and minimum detectable change (MDC95) were calculated and the effects of repeat assessment, time of day and assessor were determined. Results: Aggregated measures had little variation by repeat assessment or time of day; however, there was a significant effect of assessor (up to 2 kg depending on the measure used). Reliability between assessments was good (ICC>0.9) while MDC95 ranged from 5.59–7.96 kg. Non-aggregated measures alone, taken on the non-dominant hand were susceptible to repeat assessment, time of day, assessor and repeated measures within-assessment effects whereas the dominant hand was only affected by assessor. Conclusions: Mean and maximum grip strength had a higher ICC and lower MDC95 than measures on the dominant or non-dominant hands alone. The MDC95 is less than 8 kg regardless of the specific measure reported. However, changing assessor further increases variability, highlighting the need for comprehensive assessor training and avoiding changes within studies where possible.
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Donoghue OA, Savva GM, Börsch-Supan A, Kenny RA. Reliability, measurement error and minimum detectable change in mobility measures: a cohort study of community-dwelling adults aged 50 years and over in Ireland. BMJ Open 2019; 9:e030475. [PMID: 31719075 PMCID: PMC6858113 DOI: 10.1136/bmjopen-2019-030475] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To estimate the effects of repeat assessments, rater and time of day on mobility measures and to estimate their variation between and within participants in a population-based sample of Irish adults aged ≥50 years. DESIGN Test-retest study in a population representative sample. SETTING Academic health assessment centre of The Irish Longitudinal Study on Ageing (TILDA). PARTICIPANTS 128 community-dwelling adults from the Survey for Health, Ageing and Retirement in Europe (SHARE) Ireland study who agreed to take part in the SHARE-Ireland/TILDA collaboration. INTERVENTIONS Not applicable. OUTCOME MEASURES Participants performed timed up-and-go (TUG), repeated chair stands (RCS) and walking speed tests administered by one of two raters. Repeat assessments were conducted 1-4 months later. Participants were randomised with respect to a change in time (morning, afternoon) and whether the rater was changed between assessments. Within and between-participant variance for each measure was estimated using mixed-effects models. Intraclass correlation (ICC), SE of measurement and minimum detectable change (MDC) were reported. RESULTS Average performance did not vary between baseline and repeat assessments in any test, except RCS. The rater significantly affected performance on all tests except one, but time of day did not. Reliability varied from ICC=0.66 (RCS) to ICC=0.88 (usual gait speed). MDC was 2.08 s for TUG, 4.52 s for RCS and ranged from 19.49 to 34.73 cm/s for walking speed tests. There was no evidence for lower reliability of gait parameters with increasing time between assessments. CONCLUSIONS Reliability varied for each test when measurements are obtained over 1-4 months with most variation due to rater effects. Usual and motor dual task gait speed demonstrated highest reliability.
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Affiliation(s)
- Orna A Donoghue
- The Irish Longitudinal Study on Ageing (TILDA), University of Dublin Trinity College, Dublin, Ireland
| | | | - Axel Börsch-Supan
- Munich Center for the Economics of Aging, Max Planck Institute for Social Law and Social Policy, Munchen, Germany
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), University of Dublin Trinity College, Dublin, Ireland
- Mercer's Institute for Successful Ageing, St. James' Hospital, Dublin, Ireland
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Finucane C, van Wijnen VK, Fan CW, Soraghan C, Byrne L, Westerhof BE, Freeman R, Fedorowski A, Harms MPM, Wieling W, Kenny R. A practical guide to active stand testing and analysis using continuous beat-to-beat non-invasive blood pressure monitoring. Clin Auton Res 2019; 29:427-441. [PMID: 31076939 DOI: 10.1007/s10286-019-00606-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 04/02/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE The average adult stands approximately 50-60 times per day. Cardiovascular responses evoked during the first 3 min of active standing provide a simple means to clinically assess short-term neural and cardiovascular function across the lifespan. Clinically, this response is used to identify the haemodynamic correlates of patient symptoms and attributable causes of (pre-)syncope, and to detect autonomic dysfunction, variants of orthostatic hypotension, postural orthostatic tachycardia syndrome and orthostatic hypertension. METHODS This paper provides a set of experience/expertise-based recommendations detailing current state-of-the-art measurement and analysis approaches for the active stand test, focusing on beat-to-beat BP technologies. This information is targeted at those interested in performing and interpreting the active stand test to current international standards. RESULTS This paper presents a practical step-by-step guide on (1) how to perform active stand measurements using beat-to-beat continuous blood pressure measurement technologies, (2) how to conduct an analysis of the active stand response and (3) how to identify the spectrum of abnormal blood pressure and heart rate responses which are of clinical interest. CONCLUSION Impairments in neurocardiovascular control are an attributable cause of falls and syncope across the lifespan. The simple active stand test provides the clinician with a powerful tool for assessing individuals at risk of such common disorders. However, its simplicity belies the complexity of its interpretation. Care must therefore be taken in administering and interpreting the test in order to maximise its clinical benefit and minimise its misinterpretation.
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Affiliation(s)
- Ciarán Finucane
- Department of Medical Physics and Bioengineering, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland.
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland.
- Department of Medical Gerontology, Trinity College Dublin, The Irish Longitudinal Study on Ageing (TILDA), Dublin, Ireland.
| | - V K van Wijnen
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C W Fan
- Department of Gerontology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - C Soraghan
- Department of Medical Physics and Bioengineering, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland
| | - L Byrne
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland
| | - B E Westerhof
- Amsterdam UMC, Vrije Universiteit Amsterdam, Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Amsterdam UMC, University of Amsterdam, Medical Biology, Section of Systems Physiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - R Freeman
- Neurology Department, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, USA
| | - A Fedorowski
- Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - M P M Harms
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Wieling
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - R Kenny
- Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland
- Department of Medical Gerontology, Trinity College Dublin, The Irish Longitudinal Study on Ageing (TILDA), Dublin, Ireland
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Tzur I, Izhakian S, Gorelik O. Orthostatic hypotension: definition, classification and evaluation. Blood Press 2019; 28:146-156. [DOI: 10.1080/08037051.2019.1604067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Irma Tzur
- Department of Internal Medicine "F", Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Shimon Izhakian
- Department of Internal Medicine "F", Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Oleg Gorelik
- Department of Internal Medicine "F", Assaf Harofeh Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
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Bai R. Initial orthostatic hypotension: A common cause of syncope but uncommonly overlooked. Int J Cardiol 2018; 271:293-294. [PMID: 30049490 DOI: 10.1016/j.ijcard.2018.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Rong Bai
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA.
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15
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Initial orthostatic hypotension among patients with unexplained syncope: An overlooked diagnosis? Int J Cardiol 2018; 271:269-273. [DOI: 10.1016/j.ijcard.2018.05.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/03/2018] [Accepted: 05/14/2018] [Indexed: 12/31/2022]
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Briggs R, Carey D, Kennelly SP, Kenny RA. Longitudinal Association Between Orthostatic Hypotension at 30 Seconds Post-Standing and Late-Life Depression. Hypertension 2018; 71:946-954. [DOI: 10.1161/hypertensionaha.117.10542] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/09/2017] [Accepted: 01/18/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Robert Briggs
- From the Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland (R.B., D.C., R.A.K.); Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland (R.B., R.A.K.); and Age-Related Health Care, Tallaght Hospital, Dublin, Ireland (R.B., S.P.K.)
| | - Daniel Carey
- From the Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland (R.B., D.C., R.A.K.); Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland (R.B., R.A.K.); and Age-Related Health Care, Tallaght Hospital, Dublin, Ireland (R.B., S.P.K.)
| | - Sean P. Kennelly
- From the Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland (R.B., D.C., R.A.K.); Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland (R.B., R.A.K.); and Age-Related Health Care, Tallaght Hospital, Dublin, Ireland (R.B., S.P.K.)
| | - Rose Anne Kenny
- From the Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland (R.B., D.C., R.A.K.); Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland (R.B., R.A.K.); and Age-Related Health Care, Tallaght Hospital, Dublin, Ireland (R.B., S.P.K.)
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17
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Freud T, Punchik B, Kagan E, Barzak A, Press Y. Orthostatic hypotension and overall mortality in 1050 older patients of the outpatient comprehensive geriatric assessment unit. Geriatr Gerontol Int 2018; 18:1009-1017. [DOI: 10.1111/ggi.13291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/17/2017] [Accepted: 01/24/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Tamar Freud
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Boris Punchik
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva Israel
- Comprehensive Geriatric Assessment Unit; Clalit Health Services; Beer-Sheva Israel
- Unit for Community Geriatrics, Division of Health in the Community; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Ella Kagan
- Comprehensive Geriatric Assessment Unit; Clalit Health Services; Beer-Sheva Israel
- Unit for Community Geriatrics, Division of Health in the Community; Ben-Gurion University of the Negev; Beer-Sheva Israel
| | - Alex Barzak
- Comprehensive Geriatric Assessment Unit; Clalit Health Services; Beer-Sheva Israel
| | - Yan Press
- Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences; Ben-Gurion University of the Negev; Beer-Sheva Israel
- Comprehensive Geriatric Assessment Unit; Clalit Health Services; Beer-Sheva Israel
- Unit for Community Geriatrics, Division of Health in the Community; Ben-Gurion University of the Negev; Beer-Sheva Israel
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