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Tapanya W, Sangkarit N, Manoy P, Konsanit S. Modified Squat Test for Predicting Knee Muscle Strength in Older Adults. Ann Geriatr Med Res 2024; 28:209-218. [PMID: 38584428 PMCID: PMC11217660 DOI: 10.4235/agmr.24.0005] [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: 01/10/2024] [Revised: 03/18/2024] [Accepted: 03/30/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Methods for evaluating the strength of the knee extensor muscles play a vital role in determining the functionality of the lower limbs and monitoring any alterations that occur over time in older individuals. This study assessed the validity of the Modified Squat Test (MST) in predicting knee extensor muscle strength in older adults. METHODS This study included a total of 110 older adults. We collected demographic information such as sex, age, body weight, height, and thigh circumference. Muscle strength was assessed by measuring the maximum voluntary isometric contraction of the knee extensors, and by performing the MST (5 and 10 repetitions) and single-leg standing balance test. Stepwise multiple linear regression analysis was used to investigate multiple factors impacting the prediction of knee extensor strength. RESULTS Factors such as age, sex, thigh circumference, performance on the single-leg standing eye-open (SSEO) task, and the time required to complete the 10 MST repetitions together explained 77.8% of the variation in knee extensor muscle strength among older adults. We further developed a predictive equation to calculate strength as follows: strength = 36.78 - 0.24 (age) + 6.16 (sex) + 0.19 (thigh circumference) + 0.05 (SSEO) - 0.54 (time required to complete 10 MST repetitions) ± 5.51 kg. CONCLUSION The 10-repetition MST is an invaluable instrument for establishing an equation to accurately predict lower limb muscle strength.
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Affiliation(s)
- Weerasak Tapanya
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
| | - Noppharath Sangkarit
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
| | - Pacharee Manoy
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
| | - Saisunee Konsanit
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao, Thailand
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Katsushima U, Hase K, Fukushima T, Kubo T, Nakano J, Ogushi N, Okuno Y, Kamisako K, Nakanishi K, Okazaki Y, Ikoma T, Takeyasu Y, Yamanaka Y, Yoshioka H, Imai Y, Kurata T. Investigation of a practical assessment index to capture the clinical presentation of cachexia in patients with lung cancer. Jpn J Clin Oncol 2024; 54:305-311. [PMID: 38213068 DOI: 10.1093/jjco/hyad177] [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: 08/22/2023] [Accepted: 12/05/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVE Cancer cachexia constitutes a poor prognostic factor in patients with lung cancer. However, the factors associated with cancer cachexia remain unclear. This study aimed to identify factors that influence cancer cachexia in patients with lung cancer. METHODS In this retrospective observational study conducted at the Kansai Medical University, 76 patients with lung cancer were evaluated for physical function, nutritional status (Mini Nutritional Assessment-Short Form) and physical activity (International Physical Activity Questionnaire-Short Form) at the first visit to the rehabilitation outpatient clinic. The patients were divided into cachexia and noncachexia groups. The log-rank tests and Cox proportional hazards model were used to investigate the relationship between cachexia and prognosis. To examine the factors that influence cachexia, multivariate regression analysis with significant (P < 0.05) variables in the univariate logistic regression analysis was performed. Spearman's correlation analysis was performed to investigate the association between International Physical Activity Questionnaire-Short Form and performance status. RESULTS Overall, 42 patients (55.2%) had cachexia associated with survival time since their first visit to the outpatient rehabilitation clinic, even after confounders adjustment (hazard ratio: 3.24, 95% confidence interval: 1.12-9.45, P = 0.031). In the multivariate analysis, Mini Nutritional Assessment-Short Form (odds ratio: 20.34, 95% confidence interval: 4.18-99.02, P < 0.001) and International Physical Activity Questionnaire-Short Form (odds ratio: 4.63, 95% confidence interval: 1.20-17.89, P = 0.026) were identified as independent factors for cachexia. There was no correlation between International Physical Activity Questionnaire-Short Form and performance status (r = 0.155, P = 0.181). CONCLUSION Malnutrition and low physical activity were associated with cachexia in patients with lung cancer. The International Physical Activity Questionnaire-Short Form may be a useful indicator of physical activity in cachexia. Regularly assessing these factors and identifying suitable interventions for cachexia remain challenges to be addressed in the future.
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Affiliation(s)
- Utae Katsushima
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Kimitaka Hase
- Department of Physical Medicine and Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Takuya Fukushima
- Department of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Takanari Kubo
- Department of Physical Medicine and Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Jiro Nakano
- Department of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Naoya Ogushi
- Department of Rehabilitation, Kansai Medical University, Osaka, Japan
| | - Yukiko Okuno
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Keisuke Kamisako
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Kentaro Nakanishi
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Yuta Okazaki
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Tatsuki Ikoma
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Yuki Takeyasu
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Yuta Yamanaka
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Hiroshige Yoshioka
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
| | - Yoshie Imai
- Department of Cancer Nursing, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takayasu Kurata
- Department of Thoracic Oncology, Kansai Medical University, Osaka, Japan
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Yeh PC, Syu DK, Ho CC, Lee TS. Associations of lower-limb muscle strength performance with static and dynamic balance control among older adults in Taiwan. Front Public Health 2024; 12:1226239. [PMID: 38414890 PMCID: PMC10896829 DOI: 10.3389/fpubh.2024.1226239] [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: 05/21/2023] [Accepted: 01/12/2024] [Indexed: 02/29/2024] Open
Abstract
Background Aging is an inevitable process of life development. These physical changes can cause a decline in the functional adaptability and health status of older adult individuals. Aims The purpose of this study was to investigate the association of lower-limb muscle strength performance with static and dynamic balance control among older adults in Taiwan. Methods We conducted a cross-sectional study and reviewed data derived from the National Physical Fitness Survey in Taiwan 2015-2016. A total of 20,846 Taiwanese older adult individuals aged 65 years old or older were recruited as study participants. Demographic characteristics, anthropometric assessments, lifestyle habits, and health-related physical fitness measurements from this dataset were analyzed using the chi-square test, one-way analysis of variance, and linear regression analysis. Lower-limb muscle strength performance was classified into 4 groups based on quartile (Quartile 1 [Q1], Quartile 2 [Q2], Quartile 3 [Q3], and Quartile 4 [Q4]) values. Results Increased lower-limb muscle strength levels were significantly associated with static balance in men (Q2: β = 2.539, p < 0.0001; Q3: β = 4.590, p < 0.0001; Q4: β = 7.700, p < 0.0001) and women (Q2: β = 2.022, p < 0.0001; Q3: β = 4.179, p < 0.0001; Q4: β = 6.920, p < 0.0001) after adjusting for potential confounders. In addition, we observed that increased lower-limb muscle strength levels were significantly associated with dynamic balance in men (Q2: β = -1.661, p < 0.0001; Q3: β = -2.434, p < 0.0001; Q4: β = -3.091, p < 0.0001) and women (Q2: β = -1.660, p < 0.0001; Q3: β = -2.548, p < 0.0001; Q4: β = -3.196, p < 0.0001) after adjusting for potential confounders. Conclusion Lower-limb muscle strength was the most important factor, as it was an improved method for static and dynamic balance control in both genders.
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Affiliation(s)
- Ping-Chun Yeh
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
- Sports Medicine Center, Fu Jen Catholic Hospital, New Taipei City, Taiwan
| | - De-Kai Syu
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
- Sports Medicine Center, Fu Jen Catholic Hospital, New Taipei City, Taiwan
| | - Chien-Chang Ho
- Sports Medicine Center, Fu Jen Catholic Hospital, New Taipei City, Taiwan
- Department of Physical Education, Fu Jen Catholic University, New Taipei City, Taiwan
- Research and Development Center for Physical Education, Health and Information Technology, College of Education, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Tian-Shyug Lee
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City, Taiwan
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Tabara Y, Okada Y, Ochi M, Ohyagi Y, Igase M. One-leg standing time is a simple measure for loss of skeletal muscle mass and fat deposition in muscle: the J-SHIPP study. Aging Clin Exp Res 2024; 36:7. [PMID: 38280978 PMCID: PMC10821963 DOI: 10.1007/s40520-023-02665-8] [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: 06/15/2023] [Accepted: 11/17/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUNDS One-leg standing time (OLST) has been frequently used physical performance measure; however, what muscular characteristics OLST represents remains uncertain. AIM This cross-sectional study aimed to investigate the association between OLST and muscle characteristics to clarify the possibility of using OLST as a physical performance measure. METHODS Study participants comprised 1144 older adults aged 65 years or older. Computed tomography images provided mid-thigh skeletal muscle cross-sectional area and mean attenuation value. OLST was measured for a maximum of 60 s. Static postural instability was assessed using a posturography. RESULTS A frequency of OLST < 20 s was increased by quartiles of muscle cross-sectional area (Q1: 33.6, Q2: 12.8, Q3: 13.6, Q4: 11.9%, P < 0.001) and mean attenuation value (Q1: 32.3, Q2: 21.7, Q3: 14.3, Q4: 7.7%, P < 0.001). Results of the multinomial regression analysis indicated that muscle cross-sectional area and mean attenuation value were independently associated with an OLST of less than 20 s. The crude odds ratio of OLST less than 20 s for the lowest quartiles of both cross-sectional area and mean attenuation value was 4.19 (95% CI: 3.01 - 5.84). The cross-sectional area of muscles with greater fat deposition was inversely associated with OLST, while that with smaller fat deposition showed a positive association with OLST, indicating why mean attenuation value and cross-sectional area were independently associated with OLST. No clear relationship was observed with static postural instability. CONCLUSION OLST was a simply measurable quantifiable physical measure representing the loss of muscle mass and quality in older adults.
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Grants
- Grant-in-Aid for Scientific Research (20390185 Ministry of Education, Culture, Sports, Science and Technology of Japan
- 23659382 Ministry of Education, Culture, Sports, Science and Technology of Japan
- 24390084 Ministry of Education, Culture, Sports, Science and Technology of Japan
- 23659352 Ministry of Education, Culture, Sports, Science and Technology of Japan
- 25293141 Ministry of Education, Culture, Sports, Science and Technology of Japan
- 26670313 Ministry of Education, Culture, Sports, Science and Technology of Japan
- 17H04123 Ministry of Education, Culture, Sports, Science and Technology of Japan
- 21H04850) Ministry of Education, Culture, Sports, Science and Technology of Japan
- Research Japan Agency for Medical Research and Development
- Development Grants for Longevity Science (dk0110040) Japan Agency for Medical Research and Development
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Affiliation(s)
- Yasuharu Tabara
- Graduate School of Public Health, Shizuoka Graduate University of Public Health, Kita-Ando 4-27-2, Aoi-Ku, Shizuoka, 420-0881, Japan.
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Yoko Okada
- Department of Geriatric Medicine and Neurology, Ehime University Graduate School of Medicine, Toon City, 791-0295, Japan
| | - Masayuki Ochi
- Department of Geriatric Medicine and Neurology, Ehime University Graduate School of Medicine, Toon City, 791-0295, Japan
| | - Yasumasa Ohyagi
- Department of Geriatric Medicine and Neurology, Ehime University Graduate School of Medicine, Toon City, 791-0295, Japan
| | - Michiya Igase
- Department of Anti-Aging Medicine, Ehime University Graduate School of Medicine, Toon City, 791-0295, Japan
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Yamamoto A, Fujita K, Yamada E, Ibara T, Nihey F, Inai T, Tsukamoto K, Kobayashi Y, Nakahara K, Okawa A. Gait characteristics in patients with distal radius fracture using an in-shoe inertial measurement system at various gait speeds. Gait Posture 2024; 107:317-323. [PMID: 37914562 DOI: 10.1016/j.gaitpost.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 09/07/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Distal radius fractures (DRF) commonly occur in early postmenopausal females as the first fragility fracture. Although the incidence of DRF in this set of patients may be related to a lower ability to control their balance and gait, the detailed gait characteristics of DRF patients have not been examined. RESEARCH QUESTION Is it possible to identify the physical and gait features of DRF patients using in-shoe inertial measurement unit (IMU) sensors at various gait speeds and to develop a machine learning (ML) algorithm to estimate patients with DRF using gait? METHODS In this cross-sectional case control study, we recruited 28 postmenopausal females with DRF as their first fragility fracture and 32 age-matched females without a history of fragility fractures. The participants underwent several physical and gait tests. In the gait performance test, the participants walked 16 m with the in-shoe IMU sensor at slower, preferred, and faster speeds. The gait parameters were calculated by the IMU, and we applied the ML technique using the extreme gradient boosting (XGBoost) algorithm to predict the presence of DRF. RESULTS The fracture group showed lower hand grip strength and lower ability to change gait speed. The difference in gait parameters was mainly observed at faster speeds. The amplitude of the change in the parameters was small in the fracture group. The XGBoost model demonstrated reasonable accuracy in predicting DRFs (area under the curve: 0.740), and the most relevant variable was the stance time at a faster speed. SIGNIFICANCE Gait analysis using in-shoe IMU sensors at different speeds is useful for evaluating the characteristics of DRFs. The obtained gait parameters allow the prediction of fractures using the XGBoost algorithm.
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Affiliation(s)
- Akiko Yamamoto
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Koji Fujita
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
| | - Eriku Yamada
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Takuya Ibara
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Fumiyuki Nihey
- Environmental and Material Research Laboratories, NEC Corporation 1131, Hinode, Abiko-city, Chiba 270-1198, Japan
| | - Takuma Inai
- QOL and Materials Research Group, Health and Medical Research Institute, Department of Life Science and Technology, National Institute of Advanced Industrial Science and Technology, 2217-14 Hayashi-cho, Takamatsu-city, Kagawa 761-0301, Japan
| | - Kazuya Tsukamoto
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
| | - Yoshiyuki Kobayashi
- Human Augmentation Research Center, National Institute of Advanced Industrial Science and Technology, 2-8-5 Aomi, Koto-ku, Tokyo 135-0064, Japan
| | - Kentaro Nakahara
- Environmental and Material Research Laboratories, NEC Corporation 1131, Hinode, Abiko-city, Chiba 270-1198, Japan
| | - Atsushi Okawa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan
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Tapanya W, Maharan S, Sangkarit N, Poncumhak P, Konsanit S. Using a Standing Heel-Rise Test as a Predictor of Ankle Muscle Strength in the Elderly. Sports (Basel) 2023; 11:146. [PMID: 37624126 PMCID: PMC10459321 DOI: 10.3390/sports11080146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 08/26/2023] Open
Abstract
The senior population is at increased risk of falling due to a reduction in ankle muscle strength. Evaluating the strength of the ankle muscles in older adults is of paramount importance. The purpose of this study was to formulate an equation to estimate ankle muscle strength by utilizing the basic physical characteristics of the subject and the variables related to their ability to perform the standing heel-rise test (SHRT). One hundred and thirty-two healthy elderly participants (mean age 67.30 ± 7.60) completed the SHRT and provided demographic information. Ankle plantar flexor (PF) muscle strength was evaluated using a push-pull dynamometer. Multiple regression analysis was utilized to develop a prediction equation for ankle PF muscle strength. The study revealed that the ankle PF strength equation was derived from variables including the power index of the SHRT, gender, age, calf circumference, and single-leg standing balance test. The equation exhibited a strong correlation (r = 0.816) and had a predictive power of 65.3%. The equation is represented as follows: ankle PF strength = 24.31 - 0.20(A) + 8.14(G) + 0.49(CC) + 0.07(SSEO) + 0.20(BW/t-SHRT). The equation had an estimation error of 5.51 kg. The strength of ankle PFs in elderly individuals can be estimated by considering demographic variables, including gender, age, calf circumference, single-leg standing balance test, and the power index of the SHRT. These factors were identified as significant determinants of ankle PF strength in this population.
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Affiliation(s)
- Weerasak Tapanya
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand; (S.M.); (N.S.); (P.P.); (S.K.)
| | - Sinthuporn Maharan
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand; (S.M.); (N.S.); (P.P.); (S.K.)
- Unit of Excellence of Human Potential Development and Herbs, University of Phayao, Phayao 56000, Thailand
| | - Noppharath Sangkarit
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand; (S.M.); (N.S.); (P.P.); (S.K.)
| | - Puttipong Poncumhak
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand; (S.M.); (N.S.); (P.P.); (S.K.)
| | - Saisunee Konsanit
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand; (S.M.); (N.S.); (P.P.); (S.K.)
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Kobayashi T, Morimoto T, Shimanoe C, Ono R, Otani K, Mawatari M. A Simplified Screening Tool for the One-Leg Standing Test to Determine the Severity of Locomotive Syndrome. Life (Basel) 2023; 13:life13051190. [PMID: 37240835 DOI: 10.3390/life13051190] [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: 03/18/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
This study determined the cut-off time for the one-leg standing test (OLST) to simply screen the severity of locomotive syndrome (LS). We conducted this cross-sectional study on 1860 community-dwelling residents (age, 70.5 ± 9.5 years old; males, n = 826; females, n = 1034) who underwent the OLST and completed the 25-question geriatric locomotive function scale (GLFS-25). Multivariate linear regression and multivariate logistic regression analyses were conducted to assess the relationship between the OLST and the GLFS-25 score and LS after adjusting for age, sex, and body mass index. A receiver operating characteristic (ROC) curve analysis was performed to calculate the optimal cut-off time of the OLST for determining LS severity. The multivariate linear regression and multivariate logistic regression analyses showed that the OLST was significantly associated with the GLFS-25 score and a diagnosis of LS. The optimal cut-off times of the OLST to screen LS-1, LS-2, and LS-3 were 42 s (sensitivity 65.8%, specificity 65.3%), 27 s (sensitivity 72.7%, specificity 72.5%), and 19 s (sensitivity 77.4%, specificity 76.8%), respectively. We developed a simplified screening tool for the OLST to determine LS severity.
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Affiliation(s)
- Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - Chisato Shimanoe
- Department of Pharmacy, Saga University Hospital, Saga 849-0937, Japan
| | - Rei Ono
- Department of Physical Activity Research, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1, Toyama, Shinjuku-ku, Tokyo 162-8636, Japan
| | - Koji Otani
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
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Lee K. Home-Based Exergame Program to Improve Physical Function, Fall Efficacy, Depression and Quality of Life in Community-Dwelling Older Adults: A Randomized Controlled Trial. Healthcare (Basel) 2023; 11:healthcare11081109. [PMID: 37107943 PMCID: PMC10137686 DOI: 10.3390/healthcare11081109] [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: 01/23/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 04/29/2023] Open
Abstract
This study aimed to investigate the effects of home-based exergame programs on physical function, fall efficacy, depression, and health-related quality of life in community-dwelling older adults. Fifty-seven participants aged 75 years or older were divided into control and experimental groups. The experimental group received a home-based exergame program that included balance and lower-extremity muscle strength for 8 weeks. The participants exercised at home for 50 min three times a week and were monitored through a video-conference application. Both groups received online education on musculoskeletal health once a week, whereas the control group did not exercise. Physical function was assessed using the one-leg standing test (OLST), Berg balance scale (BBS), functional reaching test (FRT), timed up-and-go test (TUGT), and five-times sit-to-stand (FTSTS). Fall efficacy was assessed using the modified falls efficacy scale (MFES). Depression was assessed using the geriatric depression scale (GDS). Health-related quality of life was assessed using a 36-item short-form health survey (SF-36). The experimental group showed an overall improvement in OLST, BBS, FRT, TUGT, and FTSTS (p < 0.05). MFES was significantly increased in the experimental group after the intervention (p < 0.05). The GDS significantly decreased in the experimental group after the intervention (p < 0.05). In SF-36, role limitations due to physical health, general health, and fatigue (energy and fatigue) items improved in the experimental group after intervention (p < 0.05). An 8-week home-based exergame program improved physical function, fall efficacy, depression, and health-related quality of life in older adults. The study was registered on ClinicalTrials.gov (NCT05802537).
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Affiliation(s)
- Kyeongjin Lee
- Department of Physical Therapy, College of Health Science, Kyungdong University, Wonju 24764, Republic of Korea
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Lai TF, Liao Y, Lin CY, Hsueh MC, Koohsari MJ, Shibata A, Oka K, Chan DC. Diurnal pattern of breaks in sedentary time and the physical function of older adults. Arch Public Health 2023; 81:35. [PMID: 36879250 PMCID: PMC9990209 DOI: 10.1186/s13690-023-01050-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The association of breaks in sedentary time with outcomes of physical function can vary according to the time of day. We examined the association of the diurnal pattern of breaks in sedentary time with physical function outcomes in older adults. METHODS A cross-sectional analysis was conducted among 115 older adults (≥60 years). The overall and time-specific breaks (morning: 06:00-12:00; afternoon: 12:00-18:00; evening: 18:00-24:00) in sedentary time were assessed using a triaxial accelerometer (Actigraph GT3X+). A break in sedentary time was defined as at least 1 min where the accelerometer registered ≥100 cpm following a sedentary period. Five physical function outcomes were assessed: handgrip strength (dynamometer), balance ability (single leg stance), gait speed (11-m walking), basic functional mobility (time up and go), and lower-limb strength (five times sit-to-stand). Generalized linear models were used to examine the associations of the overall and time-specific breaks in sedentary time with the physical function outcomes. RESULTS Participants showed an average of 69.4 breaks in sedentary time during the day. Less frequent breaks in the evening (19.3) were found than that in the morning (24.3) and the afternoon (25.3) (p < 0.05). Breaks in sedentary time during the day were associated with less time on gait speed in older adults (exp (β) = 0.92, 95% confidence interval [CI] 0.86-0.98; p < 0.01). Time-specific analysis showed that breaks in sedentary time were associated with less time on gait speed (exp (β) = 0.94, 95% CI 0.91-0.97; p < 0.01), basic functional mobility (exp (β) = 0.93, 95% CI 0.89-0.97; p < 0.01), and lower-limb strength (exp (β) = 0.92, 95% CI 0.87-0.97; p < 0.01) in the evening only. CONCLUSION A break in sedentary time, particularly during the evening, was associated with better lower extremity strength in older adults. Further strategies to interrupt sedentary time with frequent breaks, with an emphasis on evening hours, can be helpful to maintain and improve physical function in older adults.
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Affiliation(s)
- Ting-Fu Lai
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei City, Taiwan
| | - Yung Liao
- Graduate Institute of Sport, Leisure and Hospitality Management, National Taiwan Normal University, Taipei City, Taiwan.,Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Chien-Yu Lin
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Ming-Chun Hsueh
- Graduate Institute of Sport Pedagogy, University of Taipei, Taipei City, Taiwan.,Master's Program of Transition and Leisure Education for Individuals with Disabilities, University of Taipei, Taipei, Taiwan
| | - Mohammad Javad Koohsari
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan.,School of Knowledge Science, Japan Advanced Institute of Science and Technology, Ishikawa, Japan
| | - Ai Shibata
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Japan
| | - Koichiro Oka
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei City, 100, Taiwan. .,Department of Internal Medicine, National Taiwan University Hospital, Taipei City, Taiwan.
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10
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Effects of 12-week Tai Chi program on physical function, depression, and quality of life among cognitively impaired older adults: a feasibility study. BMC Geriatr 2023; 23:118. [PMID: 36869290 PMCID: PMC9983256 DOI: 10.1186/s12877-023-03840-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Older adults with cognitive decline need physical activity for maintaining brain health and mitigating cognitive decline. Tai Chi is a safe and gentle aerobic exercise and has been recommended for people with various health conditions to improve their physical functioning, well-being, and quality of life (QoL). This study aimed to determine the feasibility of a 12-week program of Tai Chi for memory (TCM) among older adults with mild cognitive impairment (MCI) or dementia; and to determine the pilot effects of TCM on physical functioning, depression, and health-related QoL. METHODS A quasi-experimental design was used with two groups: MCI and dementia. The feasibility of the 12-week TCM program was assessed after it finished in terms of its acceptability, demand, implementation, practicality, adaptation, integration, expansion, and limited-efficacy testing. Other health-related outcomes, physical functioning, depression, and health-related QoL were measured before and after the TCM program. Outcome measures consist of a digital hand dynamometer for grip strength, the standard sit-and-reach test, the one-leg-standing balance test, timed up and go (TUG) test, the Korean version of the Geriatric Depression Scale, and the 12-item Short Form survey (SF-12). Paired and independent t-tests were used to compare the effects of TCM within and between groups. RESULTS The TCM program was completed by 41 participants with MCI (n = 21) or dementia (n = 20), and its accepted feasibility was assessed. After TCM, the MCI group exhibited significant enhancements in right-hand grip strength (t = - 2.13, p = .04) and physical-health-related QoL (t = - 2.27, p = .03). TUG scores improved in both groups (MCI, t = 3.96 p = .001; dementia, t = 2.54 p = .02). The adopted form of the TCM program was effectively and safely applied to those with various levels of cognitive impairment. The program was well accepted by the participants with a mean attendance rate of 87%. No adverse events were reported during the program. CONCLUSION TCM has the potential to improve physical functioning and QoL. Since there was no comparison group to control for confounding factors and low statistical power in the present study, further studies are warranted with a stronger design that includes longer follow-up periods. This protocol was retrospectively registered on Dec 1, 2022 (NCT05629650) at ClinicalTrials.gov.
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11
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Gupta P, Kumar S. Sarcopenia and Endocrine Ageing: Are They Related? Cureus 2022; 14:e28787. [PMID: 36225400 PMCID: PMC9533189 DOI: 10.7759/cureus.28787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/04/2022] [Indexed: 11/05/2022] Open
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12
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Liang T, Hong L, Xiao J, Wei L, Liu X, Wang H, Dong B, Liu X. Directed network analysis reveals changes in cortical and muscular connectivity caused by different standing balance tasks. J Neural Eng 2022; 19. [PMID: 35767971 DOI: 10.1088/1741-2552/ac7d0c] [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: 02/24/2022] [Accepted: 06/29/2022] [Indexed: 11/12/2022]
Abstract
Objective.Standing balance forms the basis of daily activities that require the integration of multi-sensory information and coordination of multi-muscle activation. Previous studies have confirmed that the cortex is directly involved in balance control, but little is known about the neural mechanisms of cortical integration and muscle coordination in maintaining standing balance.Approach.We used a direct directed transfer function (dDTF) to analyze the changes in the cortex and muscle connections of healthy subjects (15 subjects: 13 male and 2 female) corresponding to different standing balance tasks.Main results.The results show that the topology of the EEG brain network and muscle network changes significantly as the difficulty of the balancing tasks increases. For muscle networks, the connection analysis shows that the connection of antagonistic muscle pairs plays a major role in the task. For EEG brain networks, graph theory-based analysis shows that the clustering coefficient increases significantly, and the characteristic path length decreases significantly with increasing task difficulty. We also found that cortex-to-muscle connections increased with the difficulty of the task and were significantly stronger than the muscle-to-cortex connections.Significance.These results show that changes in the difficulty of balancing tasks alter EEG brain networks and muscle networks, and an analysis based on the directed network can provide rich information for exploring the neural mechanisms of balance control.
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Affiliation(s)
- Tie Liang
- Key Laboratory of Digital Medical Engineering of Hebei Province, Hebei University, Baoding 071002, People's Republic of China.,Institute of Electric Engineering, Yanshan University, Qinhuangdao, Hebei 066004, People's Republic of China
| | - Lei Hong
- Key Laboratory of Digital Medical Engineering of Hebei Province, Hebei University, Baoding 071002, People's Republic of China
| | - Jinzhuang Xiao
- Key Laboratory of Digital Medical Engineering of Hebei Province, Hebei University, Baoding 071002, People's Republic of China
| | - Lixin Wei
- Institute of Electric Engineering, Yanshan University, Qinhuangdao, Hebei 066004, People's Republic of China
| | - Xiaoguang Liu
- Key Laboratory of Digital Medical Engineering of Hebei Province, Hebei University, Baoding 071002, People's Republic of China
| | - Hongrui Wang
- Key Laboratory of Digital Medical Engineering of Hebei Province, Hebei University, Baoding 071002, People's Republic of China.,Institute of Electric Engineering, Yanshan University, Qinhuangdao, Hebei 066004, People's Republic of China
| | - Bin Dong
- Key Laboratory of Digital Medical Engineering of Hebei Province, Hebei University, Baoding 071002, People's Republic of China.,Development Planning Office, Affiliated Hospital of Hebei University, Baoding 071002, People's Republic of China
| | - Xiuling Liu
- Key Laboratory of Digital Medical Engineering of Hebei Province, Hebei University, Baoding 071002, People's Republic of China
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Impact of grip strength and gait speed on exercise tolerance in patients with pulmonary hypertension without left heart disease. Heart Vessels 2022; 37:1928-1936. [PMID: 35593926 DOI: 10.1007/s00380-022-02091-2] [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: 11/10/2021] [Accepted: 04/27/2022] [Indexed: 11/04/2022]
Abstract
Patients with pulmonary hypertension (PH) suffer from poor exercise tolerance due to impaired oxygenation and/or reduced cardiac output. However, the relationship between exercise tolerance and physical function remains unclear. The purpose of this study was to investigate the relationship between exercise tolerance and physical function in patients with PH. A total of 94 patients without left heart disease (61.3 ± 14.7 years old, 69.1% females, 22/8/60/4 patients with Group 1/3/4/5 PH) were retrospectively analysed. Physical function was measured using muscle strength (grip strength, knee extension muscle strength), balance function (one-leg standing time), and gait speed within 7 days of cardiac catheterization. Exercise tolerance was measured using the 6-min walking distance (6-MWD). A total of 194 6-MWD measurements and the corresponding physical function were evaluated in 94 patients. Multivariable linear regression analysis using adaptive-LASSO methods indicated that the World Health Organization functional classification, pulmonary vascular resistance, mixed venous oxygen saturation, grip strength, and gait speed were independently associated with the 6-MWD. Low grip strength (< 28 kg for males and < 18 kg for females; adjusted odds ratio and 95% confidence interval: 2.06 [1.30-3.26], p = 0.002), and slow gait speed (< 1.0 m/s for both sexes; 13.33 [3.61-49.19], p < 0.001) were independent predictors of poor exercise tolerance (6-MWD < 440 m) in a logistic regression analysis. Grip strength and gait speed as measures of physical function, pulmonary vascular resistance, and mixed venous oxygen saturation were associated with exercise tolerance in patients with PH without left heart disease.
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14
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Bednarczuk G, Rutkowska I. Factors of balance determining the risk of falls in physically active women aged over 50 years. PeerJ 2022; 10:e12952. [PMID: 35186507 PMCID: PMC8855720 DOI: 10.7717/peerj.12952] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/26/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Balance disorders are believed to be one of the main reasons for falls in older adults. They are related to natural processes of ageing, resulting in deterioration of information integration and processing from the vestibular, somatosensory and visual systems. The consequence is an increased number of postural sways, which are some of balance factors. Balance control in static and dynamic activities is an essential element of daily functioning of older citizens. It seems that balance assessment is essential to determine the risk of falls, as well as to determine which factors of balance have greatest impact on the risk of falls. METHODS The study involved physically active female students (n = 36, mean age 67,11 ± 5,35) of a University of the Third Age. We used the Balance System SD platform to assess their balance in four tests with eyes open and with eyes closed and to determine the risk of falls. We assessed the relationships between individual balance indices (overall stability index, anterior/posterior stability index, medial/lateral stability index) and the falls risk index. We also determined those factors which predicted the risk of falls the most. RESULTS The studied subjects had low risk of falls for their age category. In most measurements there were relationships between the risk of falls and the size of sways in the coronal plane and the overall stability index. We also found that the overall stability index calculated in measurements with eyes closed predicted the risk of falls of the studied physically active females most accurately (R2 0.391 F(1.34)=23.475; <0.000). The subjects were physically active and their falls risk index was low - this allowed us to presume that there was a relationship between these two factors. Preventive programmes should include exercise performed with eyes closed, and tests conducted with eyes closed seem to be most sensitive in determining balance disorders in physically active women.
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Affiliation(s)
- Grzegorz Bednarczuk
- Department of Movement Teaching, Faculty of Rehabilitation, Józef Piłsudski University of Physical Education, Warsaw, Poland
| | - Izabela Rutkowska
- Department of Movement Teaching, Faculty of Rehabilitation, Józef Piłsudski University of Physical Education, Warsaw, Poland
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15
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Walsh GS, Low DC, Arkesteijn M. The Relationship between Postural Control and Muscle Quality in Older Adults. J Mot Behav 2021; 54:363-371. [PMID: 34558383 DOI: 10.1080/00222895.2021.1977602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study aimed to determine relationships between muscle quality, the ratio of muscle strength to muscle mass, and postural control and compare postural control of older adults with higher and lower muscle quality. Twenty-five older adults had leg muscle quality and postural control with eyes open and closed measured. Linear and non-linear postural control variables were calculated from center of pressure movements. There was a significant canonical correlation between muscle quality and sway complexity, but no relationship between muscle quality and sway magnitude. Higher muscle quality older adults had greater medio-lateral sway complexity than lower muscle quality older adults. These findings suggest that higher muscle quality relates to greater sway complexity in older adults, suggesting maintenance of muscle quality should be considered important to attenuate postural control declines.
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Affiliation(s)
- Gregory S Walsh
- Department of Sport, Health Sciences and Social Work, Oxford Brookes University, Oxford, UK
| | - Daniel C Low
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, UK.,Centre for Human Performance, Exercise and Rehabilitation, Brunel University London, London, UK
| | - Marco Arkesteijn
- Institute of Biological, Environmental and Rural Sciences, Aberystwyth University, Aberystwyth, UK
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Khanal P, He L, Degens H, Stebbings GK, Onambele-Pearson GL, Williams AG, Thomis M, Morse CI. Dietary Protein Requirement Threshold and Micronutrients Profile in Healthy Older Women Based on Relative Skeletal Muscle Mass. Nutrients 2021; 13:nu13093076. [PMID: 34578954 PMCID: PMC8471109 DOI: 10.3390/nu13093076] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 08/28/2021] [Accepted: 08/29/2021] [Indexed: 11/16/2022] Open
Abstract
Although multiple nutrients have shown protective effects with regard to preserving muscle function, the recommended amount of dietary protein and other nutrients profile on older adults for maintenance of high muscle mass is still debatable. The aims of this paper were to: (1) identify dietary differences between older women with low and high relative skeletal muscle mass, and (2) identify the minimal dietary protein intake associated with high relative skeletal muscle mass and test the threshold ability to determine an association with skeletal muscle phenotypes. Older women (n = 281; 70 ± 7 years, 65 ± 14 kg), with both low and high relative skeletal muscle mass groups, completed a food questionnaire. Skeletal muscle mass, fat-free mass (FFM), biceps brachii thickness, vastus lateralis anatomical cross-sectional area (VLACSA), handgrip strength (HGS), maximum elbow flexion torque (MVCEF), maximum knee extension torque (MVCKE), muscle quality (HGS/Body mass), and fat mass were measured. Older women with low relative skeletal muscle mass had a lower daily intake of protein, iodine, polyunsaturated fatty acid (PUFA), Vit E, manganese, milk, fish, nuts and seeds (p < 0.05) compared to women with high relative skeletal muscle mass. The minimum required dietary protein intake for high relative skeletal muscle mass was 1.17 g/kg body mass/day (g/kg/d) (sensitivity: 0.68; specificity: 0.62). Women consuming ≥1.17 g/kg/d had a lower BMI (B = -3.9, p < 0.001) and fat mass (B = -7.8, p < 0.001), and a higher muscle quality (B = 0.06, p < 0.001). The data indicate that to maintain muscle mass and function, older women should consume ≥1.17 g/kg/d dietary protein, through a varied diet including milk, fish and nuts that also contain polyunsaturated fatty acid (PUFA) and micronutrients such as iodine, Vit E and manganese.
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Affiliation(s)
- Praval Khanal
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester M15 6BH, UK; (L.H.); (G.K.S.); (G.L.O.-P.); (A.G.W.); (C.I.M.)
- Department of Movement Sciences, Physical Activity, Sports & Health Research Group, KU Leuven, 3001 Leuven, Belgium;
- Correspondence:
| | - Lingxiao He
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester M15 6BH, UK; (L.H.); (G.K.S.); (G.L.O.-P.); (A.G.W.); (C.I.M.)
- Department of Movement Sciences, Physical Activity, Sports & Health Research Group, KU Leuven, 3001 Leuven, Belgium;
| | - Hans Degens
- Department of Life Sciences, Manchester Metropolitan University, Manchester M15 6BH, UK;
- Institute of Sport Science and Innovations, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
- Pharmacy of Targu Mures, University of Medicine, 540142 Targu Mures, Romania
| | - Georgina K. Stebbings
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester M15 6BH, UK; (L.H.); (G.K.S.); (G.L.O.-P.); (A.G.W.); (C.I.M.)
| | - Gladys L. Onambele-Pearson
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester M15 6BH, UK; (L.H.); (G.K.S.); (G.L.O.-P.); (A.G.W.); (C.I.M.)
| | - Alun G. Williams
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester M15 6BH, UK; (L.H.); (G.K.S.); (G.L.O.-P.); (A.G.W.); (C.I.M.)
- Institute of Sport, Exercise and Health, University College London, London W1T 7HA, UK
- Applied Sports Science Technology and Medicine Research Centre, Faculty of Science and Engineering, Swansea University, Swansea SA1 8EN, UK
| | - Martine Thomis
- Department of Movement Sciences, Physical Activity, Sports & Health Research Group, KU Leuven, 3001 Leuven, Belgium;
| | - Christopher I. Morse
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester M15 6BH, UK; (L.H.); (G.K.S.); (G.L.O.-P.); (A.G.W.); (C.I.M.)
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Khanal P, Morse CI. Reply to the Letter "Disputing the use of static one-leg standing balance test for screening low muscle mass". Aging Clin Exp Res 2021; 33:2311-2312. [PMID: 34100242 DOI: 10.1007/s40520-021-01904-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Praval Khanal
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, M15 6BH, UK.
- Department of Movement Sciences, Physical Activity, Sports and Health Research Group, KU Leuven, Leuven, Belgium.
| | - Christopher I Morse
- Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, M15 6BH, UK
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Disputing the use of static one-leg standing balance test for screening low muscle mass. Aging Clin Exp Res 2021; 33:2309-2310. [PMID: 33999377 DOI: 10.1007/s40520-021-01872-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
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