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Ordonez Diaz T, Fillingim RB, Cruz-Almeida Y, Nichols JA. A Secondary Analysis: Comparison of Experimental Pain and Psychological Impact in Individuals with Carpometacarpal and Knee Osteoarthritis. J Pain Res 2023; 16:4139-4149. [PMID: 38078018 PMCID: PMC10705720 DOI: 10.2147/jpr.s421689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/24/2023] [Indexed: 02/12/2024] Open
Abstract
Purpose Evaluate sensory and psychological differences in individuals with thumb carpometacarpal (CMC) and/or knee osteoarthritis (OA) pain. This secondary analysis focuses on comparing the effects of OA at large and small joints in community-dwelling adults. Patients and Methods A total of 434 individuals were recruited from communities in Gainesville, FL and Birmingham, AL. Each participant completed health and clinical history questionnaires, quantitative sensory testing, and physical functional tests. Participants were divided into four groups based on their pain ("CMC pain" (n = 33), "knee pain" (n = 71), "CMC + knee pain" (n = 81), and "pain-free" controls (n = 60)). ANCOVAs were performed to identify significant differences in experimental pain and psychological variables across groups. Results The "CMC + knee pain" group had lower pressure pain thresholds (lateral knee site, p < 0.01) and higher temporal summation of mechanical pain (knee, p < 0.01) when compared to "CMC pain" and "pain-free" groups. The "knee pain" group had lower heat pain tolerance at the forearm site (p = 0.02) and higher mechanical pain (p < 0.01) at both tested sites in comparison to the "CMC pain" group. Lastly, the "CMC + knee pain" group had the highest self-reported pain (p < 0.01) and disability (p < 0.01) compared to all other groups. Conclusion Results suggest knee OA compounded with CMC OA increases disease impact and decreases emotional health compared to OA at either the CMC or knee joint alone. Results also support a relationship between the number of painful joints and enhanced widespread pain sensitivity. Measuring pain at sites other than the primary OA location is important and could contribute to more holistic treatment and prevention of OA progression.
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Affiliation(s)
- Tamara Ordonez Diaz
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
| | - Jennifer A Nichols
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Orthopaedics & Sports Medicine, University of Florida, Gainesville, FL, USA
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Pua YH, Tay L, Terluin B, Clark RA, Thumboo J, Tay EL, Mah SM, Ng YS. Estimating cutpoints of gait speed and sit-to-stand test values for self-reported mobility limitations in a cohort of community-dwelling older adults from Singapore: comparing receiver operating characteristic (ROC) analysis with adjusted predictive modelling. Arch Gerontol Geriatr 2023; 112:105036. [PMID: 37075584 DOI: 10.1016/j.archger.2023.105036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023]
Abstract
OBJECTIVES Clinical interpretability of the gait speed and 5-times sit-to-stand (5-STS) tests is commonly established by comparing older adults with and without self-reported mobility limitations (SRML) on gait speed and 5-STS performance, and estimating clinical cutpoints for SRML using the receiver operating characteristics (ROC) method. Accumulating evidence, however, suggests that the adjusted predictive modeling (APM) method may be more appropriate to estimate these interpretational cutpoints. Thus, we aimed to compare, in community-dwelling older adults, gait speed and 5-STS cutpoints estimated using the ROC and APM methods. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS This study analyzed data from 955 community-dwelling independently walking older adults (73%women) aged ≥60 years (mean, 68; range, 60-88). METHODS Participants completed the 10-metre gait speed and 5-STS tests. Participants were classified as having SRML if they responded "Yes" to either of the 2 questions regarding walking and stair climbing difficulty. Cutpoints for SRML and its component questions were estimated using ROC analysis with Youden criterion and the APM method. RESULTS The proportions of participants with self-reported walking difficulty, self-reported stair climbing difficulty, and SRML were 10%, 19%, and 22%, respectively. Gait speed and 5-STS time were moderately correlated with each other (r=-0.56) and with the self-reported measures (absolute r-values, 0.39-0.44). ROC-based gait speed cutpoints were 0.14 to 0.16 m/s greater than APM-based cutpoints (P < 0.05) whilst ROC-based 5-STS time cutpoints were 0.8 to 3.3 s lower than APM-based cutpoints (P < 0.05 for walking difficulty). Compared with ROC-based cutpoints, APM-based cutptoints were more precise and they varied monotonically with self-reported walking difficulty, self-reported stair climbing difficulty, and SRML. CONCLUSIONS AND IMPLICATIONS In a sample of 955 older adults, our findings of precise and biologically plausible gait speed and 5-STS cutpoints for SRML estimated using the APM method indicate that this promising method could potentially complement or even replace traditional ROC methods.
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Affiliation(s)
- Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore; Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore.
| | - Laura Tay
- Department of General Medicine (Geriatric Medicine), Sengkang General Hospital, Singapore
| | - Berend Terluin
- Department of General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Ross Allan Clark
- School of Health and Behavioural Science, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Julian Thumboo
- Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital, Singapore; Health Services Research & Evaluation, SingHealth Office of Regional Health, Singapore
| | - Ee-Ling Tay
- Department of Physiotherapy, Sengkang General Hospital, Singapore
| | - Shi-Min Mah
- Department of Physiotherapy, Sengkang General Hospital, Singapore
| | - Yee-Sien Ng
- Geriatric Education and Research Institute, Singapore; Duke-NUS Medical School, Singapore; Department of Rehabilitation Medicine, Singapore General Hospital and Sengkang General Hospital, Singapore
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Harris R, Brach JS, Moye J, Ogawa E, Ward R, Halasz I, Bean J. The Live Long Walk Strong Rehabilitation Program Study: Design and Methods. Arch Rehabil Res Clin Transl 2022; 4:100205. [PMID: 36123980 PMCID: PMC9482036 DOI: 10.1016/j.arrct.2022.100205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To identify attributes targeted by rehabilitative treatment within which improvements lead to short- and long-term changes in mobility. Maintaining independence in mobility is important to many older adults and is associated with critical outcomes such as aging in place, morbidity, and mortality. Design The Live Long Walk Strong rehabilitation study is a phase 2 single-blind, randomized controlled trial. Setting Veterans Affairs Boston Healthcare System, outpatient physical therapy. Participants 198 community-dwelling middle- and older-aged veterans (aged 50 years and older) will be recruited from primary care practices (N=198). Interventions Comparing a moderate-vigorous intensity physical therapy program of 10 sessions with a waitlist control group. Main Outcome Measure The primary outcome measure is gait speed. Secondary outcomes include leg strength and power, trunk muscle endurance, gait smoothness, and exercise self-efficacy. Results Outcomes will be assessed within 2 weeks of intervention completion, at 8 weeks postintervention, and at 16 weeks postintervention. Two-sample t tests will compare mean change in gait speed and target attributes (leg power, trunk muscle endurance, gait smoothness, and exercise self-efficacy) between treatment and control groups. Paired t tests will examine within-person change at subsequent follow-up visits. Multivariable regression analyses will evaluate relationships between dependent and independent variables and potential mediation adjusting for relevant covariates. Conclusions Results of this study are expected to advance and refine the design of Live Long Walk Strong rehabilitative care and demonstrate its proof of concept and efficacy.
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Affiliation(s)
- Rebekah Harris
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA
| | - Jennifer S. Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Jennifer Moye
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, VA Boston Healthcare System, Boston, MA
- Department of Psychiatry, Harvard Medical School, Cambridge, MA
| | - Elisa Ogawa
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA
| | - Rachel Ward
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA
- Massachusetts Veterans Epidemiology and Research Information Center, VA Boston Healthcare System, Boston, MA
| | - Ildiko Halasz
- Department of Medicine, VA Boston Healthcare System, Boston, MA
| | - Jonathan Bean
- New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, MA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA
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Nascimento CFD, Roman Lay AA, Duarte YAO, Chiavegatto Filho ADP. Functional mobility and 10-year all-cause and cause-specific mortality in older people from São Paulo, Brazil. Braz J Phys Ther 2022; 26:100431. [PMID: 35944315 PMCID: PMC9379516 DOI: 10.1016/j.bjpt.2022.100431] [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: 12/02/2021] [Revised: 06/24/2022] [Accepted: 07/13/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A better understanding of performance in functional mobility tasks related to the mortality patterns for the different causes of death for the Brazilian older population is still a challenge. OBJECTIVE To analyze if gait speed and chair stand test performance are associated with mortality in older adults, and if the overall mobility status changes the effect of other mortality risk factors. METHODS The data were from SABE (Health, Well-being and Aging Study), a multiple-cohort study conducted in São Paulo, Brazil, with a representative sample of people aged 60 and more. Cox regression models were used to analyze 10-year all-cause and cause-specific mortality with consideration for gait speed and the chair stand test. RESULTS Of the 1411 participants, 26% died during the follow-up. The performance in the chair stand test had a more consistent association with mortality (hazard ratio (HR)=1.03, 95%CI: 1.00, 1.05) than gait speed. Being unable to perform the test also increased the risk to die by all-cause (HR=1.71, 95%CI: 1.21, 2.42) and by diseases of the circulatory system (HR=2.14, 95%CI: 1.25, 3.65). The stratified analysis of mobility performance changed the effects of some of the mortality risk factors, such as cognitive impairment and multimorbidity. CONCLUSIONS The chair stand test could be a better choice than 3-meters walking test as a mortality predictor. In addition, the impact of cognitive decline and multimorbidity were greater among those with reduced mobility, supporting the development of preventive interventions and public policies targeted at more vulnerable groups of older adults.
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Rezola-Pardo C, Irazusta J, Mugica-Errazquin I, Gamio I, Sarquis-Adamson Y, Gil SM, Ugartemendia M, Montero-Odasso M, Rodriguez-Larrad A. Effects of multicomponent and dual-task exercise on falls in nursing homes: The AgeingOn Dual-Task study. Maturitas 2022; 164:15-22. [PMID: 35763894 DOI: 10.1016/j.maturitas.2022.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/28/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the effects of a multicomponent exercise program and a dual-task exercise program on the number of falls (fall rate) and number of fallers (fall incidence) and on parameters associated with fall risk in older adults living in long-term nursing homes (LTNH). STUDY DESIGN This is a secondary analysis of a single-blind randomized controlled trial involving 85 older adults in nine LTNHs (Gipuzkoa, Spain). Participants allocated to the multicomponent group underwent a twice-a-week 3-month individualized and progressive resistance and balance program. The dual-task group performed simultaneous cognitive training with the same multicomponent exercises. MAIN OUTCOMES Fall rate and incidence were analyzed using Poisson regression (adjusting for cognitive function and previous fall rate) and Kaplan-Meier analysis, respectively. Handgrip asymmetry, single- and dual-task TUG velocity and cost were assessed using two-way ANOVA for repeated measures and paired Student's t-tests. RESULTS The dual-task group showed a 3.8 times greater risk of falling than the multicomponent group during the intervention, and a 2.59 times greater risk during the 12-month follow-up. There were no between-group differences in fall incidence. There were between-group differences in handgrip strength asymmetry in favor of the multicomponent group. While only the multicomponent group improved on the TUG test, the dual-task group improved on dual-task cost. CONCLUSIONS Compared with the dual-task program, the multicomponent exercise program showed more benefits in reducing falls and in parameters associated with fall risk in LTNH residents. Future studies are warranted to confirm our results and continue to explore physical and cognitive interventions to prevent falls in LTNHs. Australian New Zealand Clinical Trials Registry ACTRN12618000536268.
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Affiliation(s)
- Chloe Rezola-Pardo
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain.
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain; BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Itxaso Mugica-Errazquin
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Donostia, Gipuzkoa, Spain
| | - Ines Gamio
- Matia Bermingham, Matia Fundazioa, Donostia, Gipuzkoa, Spain
| | - Yanina Sarquis-Adamson
- Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Susana María Gil
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
| | - Maider Ugartemendia
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Donostia, Gipuzkoa, Spain
| | - Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute and Lawson Health Research Institute, University of Western Ontario, London, Ontario, Canada; Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Ana Rodriguez-Larrad
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain; BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
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do Nascimento CF, Batista AFDM, Duarte YAO, Chiavegatto Filho ADP. Early identification of older individuals at risk of mobility decline with machine learning. Arch Gerontol Geriatr 2022; 100:104625. [DOI: 10.1016/j.archger.2022.104625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/09/2022] [Accepted: 01/19/2022] [Indexed: 12/20/2022]
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Prevett C, Moncion K, Phillips S, Richardson J, Tang A. The role of resistance training in mitigating risk for mobility disability in community-dwelling older adults: a systematic review and meta-analysis. Arch Phys Med Rehabil 2022; 103:2023-2035. [PMID: 35504310 DOI: 10.1016/j.apmr.2022.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/15/2022] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the effects of community-based resistance training (RT) on physical function for older adults with mobility disability. DATA SOURCES Four databases (PEDro, MedLine, Ovid, CINAHL and Web of Science) were searched from inception to February 2, 2021. STUDY SELECTION Randomized controlled trials that examined community-based RT for improving physical function in community-dwelling older adults were included. DATA EXTRACTION Two reviewers independently conducted title and abstract screening, full-text evaluation, data extraction, and risk of bias quality assessment. DATA SYNTHESIS Twenty-four studies (3,656 participants, age range 63-83 years) were included. RT programs ranged from 10 weeks to 18 months in duration. RT was more effective than control in improving 6MWT distance (n=638; mean difference (MD) 16.1 meters; 95% CI 12.27-19.94, p<0.0001), lower extremity strength (n=785; standard MD 2.01; 95% CI 1.27-2.75, p<0.0001) and usual gait speed (n= 2,106; MD 0.05 meters/second, 95% CI 0.03-0.07, p<0.001). In sensitivity analyses, benefits were maintained when studies with a high risk of bias were excluded. There was no effect of RT on fast gait speed or Short Physical Performance Battery score compared to control. CONCLUSIONS RT improves walking distance, lower extremity strength, and usual gait speed in older adults with mobility disability. Improvements in physical function could increase independence in activities of daily living for this at-risk population.
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Affiliation(s)
- Christina Prevett
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada, L8S 1C7
| | - Kevin Moncion
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada, L8S 1C7
| | - Stuart Phillips
- Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada, L8S 1C7
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada, L8S 1C7
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada, L8S 1C7.
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Wagner PP, Foesser D, Chapurlat R, Szulc P. Risk Factors for the Incident Decline of Physical Performance in Older Men: The Prospective Strambo Study. Calcif Tissue Int 2022; 110:428-440. [PMID: 34718830 DOI: 10.1007/s00223-021-00926-0] [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: 06/17/2021] [Accepted: 10/17/2021] [Indexed: 11/25/2022]
Abstract
Risk factors of physical performance decline in older men remain uncertain. We assessed risk factors of incident physical performance deterioration in older men followed up prospectively. In a cohort of 821 men aged 60-87, physical performance was assessed by four tests (five chair stands, standing with closed eyes, forward and backward tandem walk) at baseline, 4 and 8 years. Various predictive biological measurements were performed at baseline. Serum creatinine/ cystatin C (Cr/CysC) ratio was used as an index of muscle mass. In multivariate models, higher age, higher fat mass index (FMI = fat mass/height2), low physical activity, prior stroke and fracture were associated with poor physical performance at baseline. Higher age, low physical activity, low calcium intake, prior non-vertebral fractures, low apparent free testosterone concentration and poor health status were associated with higher risk of loss to follow-up. Low grip strength, Parkinson's disease and stroke were associated with higher risk of incident inability to do five chair stands. Low Cr/CysC ratio and high FMI were associated with high risk of incident inability to perform forward and backward tandem walk. Sarcopenic obesity (co-occurrence of lower tertile of Cr/CysC and upper tertile of FMI) was associated with higher risk of incident inability to perform forward (OR = 3.31, 95% CI 1.88-5.84, p < 0.001) and backward tandem walk and of incident inability to perform more than one test (OR = 5.82, 95% CI 1.29-26.27, p < 0.001). In conclusion, sarcopenic obesity and poor health are associated with higher risk of incident severe decline of physical performance.
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Affiliation(s)
- Philippe Paul Wagner
- INSERM UMR1033, University of Lyon, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France
| | - Dominique Foesser
- INSERM UMR1033, University of Lyon, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France
| | - Roland Chapurlat
- INSERM UMR1033, University of Lyon, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France
- Department of Rheumatology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France
| | - Pawel Szulc
- INSERM UMR1033, University of Lyon, Hôpital Edouard Herriot, Pavillon F, Place d'Arsonval, 69437, Lyon, France.
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Implication of Exercise for Healthy Longevity in Older People. TOPICS IN GERIATRIC REHABILITATION 2022. [DOI: 10.1097/tgr.0000000000000350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Marín-Jiménez N, Cruz-León C, Perez-Bey A, Conde-Caveda J, Grao-Cruces A, Aparicio VA, Castro-Piñero J, Cuenca-García M. Predictive Validity of Motor Fitness and Flexibility Tests in Adults and Older Adults: A Systematic Review. J Clin Med 2022; 11:jcm11020328. [PMID: 35054020 PMCID: PMC8779466 DOI: 10.3390/jcm11020328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
Motor fitness and flexibility have been linked to several health issues. We aimed to investigate the predictive validity of motor fitness and flexibility tests in relation to health outcomes in adults and older adults. Web of Science and PubMed databases were screened for studies published from inception to November 2020. Two authors systematically searched, evaluated, and extracted data from identified original studies and systematic reviews/meta-analysis. Three levels of evidence were constructed: strong, moderate, and limited/inconclusive evidence. In total, 1182 studies were identified, and 70 studies and 6 systematic reviews/meta-analysis were summarized. Strong evidence indicated that (i) slower gait speed predicts falls and institutionalization/hospitalization in adults over 60 years old, cognitive decline/impairment over 55 years old, mobility disability over 50 years old, disability in instrumental activities of daily living (IADL) over 54 years old, cardiovascular disease risk over 45 years old, and all-cause mortality over 35 years old; (ii) impaired balance predicts falls and disability in IADL/mobility disability in adults over 40 years old and all-cause mortality over 53 years old; (iii) worse timed up&go test (TUG) predicts falls and fear of falling over 40 years old. Evidence supports that slower gait speed, impaired balance, and worse TUG performance are significantly associated with an increased risk of adverse health outcomes in adults.
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Affiliation(s)
- Nuria Marín-Jiménez
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, 11519 Cádiz, Spain; (N.M.-J.); (C.C.-L.); (J.C.-C.); (A.G.-C.); (J.C.-P.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), University of Cádiz, 11009 Cádiz, Spain
| | - Carolina Cruz-León
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, 11519 Cádiz, Spain; (N.M.-J.); (C.C.-L.); (J.C.-C.); (A.G.-C.); (J.C.-P.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), University of Cádiz, 11009 Cádiz, Spain
| | - Alejandro Perez-Bey
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, 11519 Cádiz, Spain; (N.M.-J.); (C.C.-L.); (J.C.-C.); (A.G.-C.); (J.C.-P.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), University of Cádiz, 11009 Cádiz, Spain
- Correspondence: ; Tel.: +34-65-7588624
| | - Julio Conde-Caveda
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, 11519 Cádiz, Spain; (N.M.-J.); (C.C.-L.); (J.C.-C.); (A.G.-C.); (J.C.-P.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), University of Cádiz, 11009 Cádiz, Spain
| | - Alberto Grao-Cruces
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, 11519 Cádiz, Spain; (N.M.-J.); (C.C.-L.); (J.C.-C.); (A.G.-C.); (J.C.-P.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), University of Cádiz, 11009 Cádiz, Spain
| | - Virginia A. Aparicio
- Department of Physiology, Institute of Nutrition and Food Technology “José Mataix Verdú”, University of Granada, 18071 Granada, Spain;
- Sport and Health University Research Centre, University of Granada, 18007 Granada, Spain
| | - José Castro-Piñero
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, 11519 Cádiz, Spain; (N.M.-J.); (C.C.-L.); (J.C.-C.); (A.G.-C.); (J.C.-P.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), University of Cádiz, 11009 Cádiz, Spain
| | - Magdalena Cuenca-García
- GALENO Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Puerto Real, 11519 Cádiz, Spain; (N.M.-J.); (C.C.-L.); (J.C.-C.); (A.G.-C.); (J.C.-P.); (M.C.-G.)
- Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), University of Cádiz, 11009 Cádiz, Spain
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Pain relief for osteoarthritis through combined treatment (PROACT): Protocol for a randomized controlled trial of mindfulness meditation combined with transcranial direct current stimulation in non-Hispanic black and white adults with knee osteoarthritis. Contemp Clin Trials 2020; 98:106159. [PMID: 32992020 DOI: 10.1016/j.cct.2020.106159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 12/17/2022]
Abstract
Knee osteoarthritis (OA) is a leading cause of late life pain and disability, and non-Hispanic black (NHB) adults experience greater OA-related pain and disability than non-Hispanic whites (NHWs). Recent evidence implicates psychosocial stress, cognitive-attentional processes, and altered central pain processing as contributors to greater OA-related pain and disability among NHBs. To address these ethnic/race disparities, this clinical trial will test whether a mindfulness intervention (Breathing and Attention Training, BAT) combined with transcranial direct current stimulation (tDCS) will enhance pain modulatory balance and pain-related brain function, reduce clinical pain, and attenuate ethnic differences therein, among NHBs and NHWs with knee OA. Participants will complete assessments of clinical pain, function, psychosocial measures, and quantitative sensory testing (QST), including mechanical temporal summation and conditioned pain modulation. Neuroimaging will be performed to examine pain-related brain structure and function. Then, participants will be randomized to one of four groups created by crossing two BAT conditions (Real vs. Sham) with two tDCS conditions (Real vs. Sham). Participants will then undergo five treatment sessions during which the assigned BAT and tDCS interventions will be delivered concurrently for 20 min over one week. After the fifth intervention session, participants will undergo assessments of clinical pain and function, QST and neuroimaging identical to the pretreatment measures, and monthly follow-up assessments of pain will be conducted for three months. This will be the first study to determine whether mindfulness and tDCS treatments will show additive or synergistic effects when combined, and whether treatment effects differ across ethnic/race groups.
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Meier NF, Lee DC. Physical activity and sarcopenia in older adults. Aging Clin Exp Res 2020; 32:1675-1687. [PMID: 31625078 DOI: 10.1007/s40520-019-01371-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/01/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sarcopenia is prevalent in ever growing older adult populations. AIM The aim of this study was to quantify the association between physical activity (PA), sedentary time (SED), cardiorespiratory fitness (CRF), and strength (STR) with sarcopenia in community-dwelling older adults using a standard definition of sarcopenia. METHOD This cross-sectional study examined a large group of older adults (n = 304) who provided a broad range of health, lifestyle, and socioeconomic variables. PA was assessed using a pedometer worn for 7 days. SED was assessed by survey. CRF was assessed by 400-m walk test performance. Strength (STR) was assessed by one-repetition maximum chest and leg press. The European Working Group on Sarcopenia in Older People (EWGSOP) definition defined 10.9% (n = 33) as sarcopenic. RESULTS PA, CRF, and STR were significantly associated with sarcopenia components (muscle mass, muscle strength, and muscle function). The upper two-thirds of CRF had significantly lower odds of having sarcopenia, whereas the strongest third of STR was associated with lower odds of sarcopenia. All exposure variables had significant odds ratios associated with at least one component of sarcopenia. Joint analyses indicated additional benefit may be gained from being both active (≥ 5000 daily steps) and fit (top two-thirds), active and strong (top two-thirds), and fit and strong. DISCUSSION Overall, objectively measured PA, CRF, and STR, and self-reported SED, are associated with sarcopenia and its components. CONCLUSION Therefore, older adults who are physically active, maintain higher levels of cardiorespiratory fitness, upper and lower body strength, and avoid sedentary time may have significantly lower odds of sarcopenia.
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Affiliation(s)
- Nathan F Meier
- Department of Kinesiology, College of Arts and Sciences, Concordia University Irvine, 1530 Concordia West, Irvine, CA, 92612, USA.
- Department of Kinesiology, College of Human Sciences, Iowa State University, 103H Forker, 534 Wallace Dr., Ames, IA, 50011, USA.
| | - Duck-Chul Lee
- Department of Kinesiology, College of Human Sciences, Iowa State University, 103H Forker, 534 Wallace Dr., Ames, IA, 50011, USA
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Brown RT, Covinsky KE. Moving prevention of functional impairment upstream: is middle age an ideal time for intervention? Womens Midlife Health 2020; 6:4. [PMID: 32695430 PMCID: PMC7366897 DOI: 10.1186/s40695-020-00054-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 07/13/2020] [Indexed: 12/20/2022] Open
Abstract
To live independently, individuals must be able to perform basic activities of daily living (ADLs), including bathing, dressing, and transferring out of a bed or chair. When older adults develop difficulty or the need for help performing ADLs, they experience decreased quality of life and an increased risk of acute care utilization, nursing home admission, and death. For these reasons, slowing or preventing the progression to functional problems is a key focus of the care of older adults. While preventive efforts currently focus mainly on older people, difficulty performing basic ADLs (“functional impairment”) affects nearly 15% of middle-aged adults, and this prevalence is increasing. People who develop functional impairment in middle age are at increased risk for adverse outcomes similar to those experienced by older adults. Developing ADL impairment in middle age also impacts work force participation and health expenditures, not just in middle age but also older age. Middle-aged adults have a high capacity for recovery from functional impairment, and many risk factors for developing functional impairment in middle and older age have their roots in mid-life. Taken together, these findings suggest that middle age may be an ideal period to intervene to prevent or delay functional impairment. To address the rising prevalence of functional impairment in middle age, we will need to work on several fronts. These include developing improved prognostic tools to identify middle-aged people at highest risk for functional impairment and developing interventions to prevent or delay impairment among middle-aged people. More broadly, we need to recognize functional impairment in middle age as a problem that is as prevalent and central to health outcomes as many chronic medical conditions.
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Affiliation(s)
- Rebecca T Brown
- Division of Geriatric Medicine, Perelman School of Medicine at the University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104 USA.,Geriatrics and Extended Care, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA.,Center for Health Equity and Research Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA USA
| | - Kenneth E Covinsky
- Division of Geriatrics, University of California, San Francisco, CA USA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA USA
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Berglind D, Yacaman-Mendez D, Lavebratt C, Forsell Y. The Effect of Smartphone Apps Versus Supervised Exercise on Physical Activity, Cardiorespiratory Fitness, and Body Composition Among Individuals With Mild-to-Moderate Mobility Disability: Randomized Controlled Trial. JMIR Mhealth Uhealth 2020; 8:e14615. [PMID: 32014846 PMCID: PMC7055745 DOI: 10.2196/14615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 10/14/2019] [Accepted: 10/22/2019] [Indexed: 01/19/2023] Open
Abstract
Background Adequate levels of physical activity (PA) and good cardiorespiratory fitness (CRF) are associated with profound health benefits for individuals with mobility disability (MD). Despite the vast amount of research published in the field of PA interventions, little attention has been given to individuals with MD. Objective The aim of this study was to examine the efficacy of an app-based versus a supervised exercise and health coaching program to support adults with MD to increase levels of PA, CRF, and improve body composition. Methods Participants with self-perceived MD, aged 18 to 45 years, were included in this 12-week parallel-group randomized controlled trial and allocated at random to an app-based intervention, using commercially available apps—the Swedish Military training app (FMTK), the Acupedo walking app, and the LogMyFood food photography app—or a supervised exercise and health coaching intervention, including 1 weekly supervised exercise session and healthy lifestyle coaching. The primary outcome was the level of moderate-to-vigorous PA (MVPA) measured with accelerometers. Secondary outcomes included CRF measured by a submaximal test performed on a stationary bicycle and body composition measured by bioelectrical impedance. All outcomes were measured at baseline, 6 weeks, and 12 weeks. Linear mixed-effect models were used to assess the between-group differences, as well as the within-group changes through time, in each intervention group. Results A total of 110 participants with MD were randomized to an app-based intervention (n=55) or a supervised exercise and health intervention (n=55). The mean age of participants was 34.9 years (SD 6.1), and 81.8% (90/110) of the participants were women. CRF showed a moderate increase in both groups after 12 weeks—1.07 (95% CI –0.14 to 2.27) mL/kg/min increase in the app-based group and 1.76 (95% CI 0.70 to 2.83) mLkg/min increase in the supervised exercise group. However, the intention-to-treat analysis showed no significant differences between the groups in MVPA or CRF after 12 weeks. Waist circumference was significantly lower in the app-based intervention group. Conclusions Commercially available apps increased levels of CRF and improved body composition over 12 weeks to the same extent as supervised exercise sessions, showing that both are equally effective. However, neither the app-based intervention nor the supervised exercise intervention increased MVPA. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 22387524; http://isrctn.com/ISRCTN22387524.
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Affiliation(s)
- Daniel Berglind
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Catharina Lavebratt
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Forsell
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Booker S, Cardoso J, Cruz-Almeida Y, Sibille KT, Terry EL, Powell-Roach KL, Riley JL, Goodin BR, Bartley EJ, Addison AS, Staud R, Redden D, Bradley L, Fillingim RB. Movement-evoked pain, physical function, and perceived stress: An observational study of ethnic/racial differences in aging non-Hispanic Blacks and non-Hispanic Whites with knee osteoarthritis. Exp Gerontol 2019; 124:110622. [PMID: 31154005 PMCID: PMC6660381 DOI: 10.1016/j.exger.2019.05.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) is a pervasive musculoskeletal condition, often exacerbated by movement-evoked pain (MEP). Despite established research demonstrating significant racial differences in OA pain, few studies have investigated ethnic/racial group differences in MEP and lower extremity function and their association with psychosocial factors, such as perceived stress. Therefore, the primary aims were: (1) to identify ethnic/racial group differences in persons with or at risk for knee OA pain based on MEP, physical performance, and perceived stress measures, and (2) to determine if perceived stress explains the relationship between MEP and function in non-Hispanic Blacks (NHBs) and non-Hispanic Whites (NHWs). METHODS A total of 162 NHB and NHW community-dwelling older adults (50-78 years of age) were included in this analysis from the Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD) cross-sectional cohort study. Demographic, anthropometric, pain and functional parameters were assessed using a battery of validated instruments. Descriptive statistics, parametric, and multivariate analyses were conducted to determine ethnic/racial differences in perceived stress, MEP, and function. RESULTS Our results support the hypothesis that among persons with knee OA pain, NHBs have significantly greater MEP and lower functional level, despite similar levels of perceived stress. However, perceived stress was more strongly related to MEP in NHB compared to NHWs. Differences in function were limited to walking speed, where NHWs demonstrated faster gait speed. CONCLUSIONS Our cross-sectional study demonstrated important ethnic/racial differences in MEP and function. Also, perceived stress had a stronger effect on MEP in NHBs, suggesting that perceived stress may more strongly influence pain with physical movement among NHB adults. MEP may be a clinically important pain outcome to measure in persons with OA, and these data warrant future research on the impact of stress on pain and functional outcomes in older adults, particularly in NHBs.
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Affiliation(s)
- Staja Booker
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA.
| | - Josue Cardoso
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | - Yenisel Cruz-Almeida
- The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA; The University of Florida, Department of Aging & Geriatric Research, College of Medicine, Gainesville, FL 32611, USA
| | - Kimberly T Sibille
- The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA; The University of Florida, Department of Aging & Geriatric Research, College of Medicine, Gainesville, FL 32611, USA
| | - Ellen L Terry
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | - Keesha L Powell-Roach
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | - Joseph L Riley
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | - Burel R Goodin
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL 35294, USA
| | - Emily J Bartley
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | | | - Roland Staud
- The University of Florida, Department of Medicine, Gainesville, FL 32608, USA
| | - David Redden
- University of Alabama at Birmingham, Department of Biostatistics, Birmingham, AL 35294, USA; University of Alabama at Birmingham, Department Medicine and Rheumatology, Birmingham, AL 35294, USA
| | - Laurence Bradley
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL 35294, USA
| | - Roger B Fillingim
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
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Tsuji T, Rantakokko M, Portegijs E, Viljanen A, Rantanen T. The effect of body mass index, lower extremity performance, and use of a private car on incident life-space restriction: a two-year follow-up study. BMC Geriatr 2018; 18:271. [PMID: 30409120 PMCID: PMC6225643 DOI: 10.1186/s12877-018-0956-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 10/18/2018] [Indexed: 12/05/2022] Open
Abstract
Background The purpose of the study was to explore the single and combined contributions of body mass index (BMI) and lower extremity performance as modifiable physical factors, and the influence of use of a private car as an environmental factor on prevalent and incident life-space restriction in community-dwelling older people. Methods Community-dwelling people aged 75–90 years (n = 823) participated in the Life-Space Mobility in Old Age (LISPE) two-year follow-up study. Participants who reported that the largest life-space area they had attained, without aid from any device or another person, was the neighborhood or less were considered to have life-space restriction. Incident life-space restriction was the endpoint of Cox’s proportional hazard model. BMI, lower extremity performance (Short Physical Performance Battery, SPPB), and use of a private car were predictors. Results At baseline, people who had both obesity (BMI ≥30.0) and impaired lower extremity performance (SPPB 0–9) had a higher prevalence of life-space restriction (prevalence ratio 3.6, 95% confidence interval, CI, 2.0–6.3) compared to those with normal weight (BMI 23.0–24.9) and intact physical performance (SPPB 10–12). The 581 people without life-space restriction at the baseline contributed 1033 person-years during the two-year follow-up. Incident life-space restrictions were reported by 28.3% participants. A higher hazard ratio (HR) for incident life-space restriction was observed in subjects having both obesity and impaired lower extremity performance (HR 3.6, 95% CI, 1.7–7.4), impaired lower extremity performance only (HR 1.9, 95% CI 0.9–4.1), and obesity only (HR 1.8, 95% CI, 0.9–3.5) compared to those with normal weight and intact performance. Private car passengers (HR 2.0, 95% CI, 1.3–3.0) compared to car drivers had a higher risk of life-space restriction. All models were adjusted for age, sex, chronic diseases, and education. Conclusions Older people with impaired lower extremity performance have an increased risk of incident life-space restriction especially if combined with obesity. Also, not driving a car renders older people vulnerable to life-space restriction.
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Affiliation(s)
- Taishi Tsuji
- Center for Preventive Medical Sciences, Chiba University, 1-8-1 Inohana, Chuo Ward, Chiba City, Chiba, 260-8670, Japan.
| | - Merja Rantakokko
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyvaskyla, PO Box 35, FI-40014, Jyväskylä, Finland
| | - Erja Portegijs
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyvaskyla, PO Box 35, FI-40014, Jyväskylä, Finland
| | - Anne Viljanen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyvaskyla, PO Box 35, FI-40014, Jyväskylä, Finland
| | - Taina Rantanen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyvaskyla, PO Box 35, FI-40014, Jyväskylä, Finland
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Marzetti E, Cesari M, Calvani R, Msihid J, Tosato M, Rodriguez-Mañas L, Lattanzio F, Cherubini A, Bejuit R, Di Bari M, Maggio M, Vellas B, Dantoine T, Cruz-Jentoft AJ, Sieber CC, Freiberger E, Skalska A, Grodzicki T, Sinclair AJ, Topinkova E, Rýznarová I, Strandberg T, Schols AMWJ, Schols JMGA, Roller-Wirnsberger R, Jónsson PV, Ramel A, Del Signore S, Pahor M, Roubenoff R, Bernabei R, Landi F. The "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) randomized controlled trial: Case finding, screening and characteristics of eligible participants. Exp Gerontol 2018; 113:48-57. [PMID: 30261246 DOI: 10.1016/j.exger.2018.09.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/11/2018] [Accepted: 09/20/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The ongoing "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT)" randomized controlled trial (RCT) is testing the efficacy of a multicomponent intervention in the prevention of mobility disability in older adults with physical frailty & sarcopenia (PF&S). Here, we describe the procedures followed for PF&S case finding and screening of candidate participants for the SPRINTT RCT. We also illustrate the main demographic and clinical characteristics of eligible screenees. METHODS The identification of PF&S was based on the co-occurrence of three defining elements: (1) reduced physical performance (defined as a score on the Short Physical Performance Battery between 3 and 9); (2) low muscle mass according to the criteria released by the Foundation for the National Institutes of Health; and (3) absence of mobility disability (defined as ability to complete the 400-m walk test in 15 min). SPRINTT was advertised through a variety of means. Site-specific case finding strategies were developed to accommodate the variability across centers in catchment area characteristics and access to the target population. A quick "participant profiling" questionnaire was devised to facilitate PF&S case finding. RESULTS During approximately 22 months, 12,358 prescreening interviews were completed in 17 SPRINTT sites resulting in 6710 clinic screening visits. Eventually, 1566 candidates were found to be eligible for participating in the SPRINTT RCT. Eligible screenees showed substantial physical function impairment and comorbidity burden. In most centers, project advertisement through mass media was the most rewarding case finding strategy. CONCLUSION PF&S case finding in the community is a challenging, but feasible task. Although largely autonomous in daily life activities, older adults with PF&S suffer from significant functional impairment and comorbidity. This subset of the older population is therefore at high risk for disability and other negative health-related events. Key strategies to consider for successfully intercepting at-risk older adults should focus on mass communication methods.
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Affiliation(s)
- Emanuele Marzetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Italy; Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | - Matteo Tosato
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di Ricerca per l'Invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Mauro Di Bari
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Division of Geriatric Cardiology and Medicine, Department of Geriatrics and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marcello Maggio
- Department of Geriatric Rehabilitation, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Bruno Vellas
- Gérontopôle, University Hospital of Toulouse, Toulouse, France
| | | | | | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-University, Nuremberg, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-University, Nuremberg, Germany
| | - Anna Skalska
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Alan J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Limited, Worcestershire, UK
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Timo Strandberg
- University of Helsinki, Clinicum, Helsinki, Finland; Helsinki University Hospital, Medicine and Rehabilitation, Helsinki, Finland; University of Oulu, Center for Life Course Health Research, Oulu, Finland
| | - Annemie M W J Schols
- Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Pálmi V Jónsson
- Department of Geriatrics, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Alfons Ramel
- Department of Geriatrics, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | | | - Marco Pahor
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Ronenn Roubenoff
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Roberto Bernabei
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Lee MC, Hsu CC, Tsai YF, Chen CY, Lin CC, Wang CY. Criterion-Referenced Values of Grip Strength and Usual Gait Speed Using Instrumental Activities of Daily Living Disability as the Criterion. J Geriatr Phys Ther 2018; 41:14-19. [PMID: 28079633 DOI: 10.1519/jpt.0000000000000106] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE Current evidence suggests that grip strength and usual gait speed (UGS) are important predictors of instrumental activities of daily living (IADL) disability. Knowing the optimum cut points of these tests for discriminating people with and without IADL disability could help clinicians or researchers to better interpret the test results and make medical decisions. The purpose of this study was to determine the cutoff values of grip strength and UGS for best discriminating community-dwelling older adults with and without IADL disability, separately for men and women, and to investigate their association with IADL disability. METHODS We conducted secondary data analysis on a national dataset collected in the Sarcopenia and Translational Aging Research in Taiwan (START). The data used in this study consisted of health data of 2420 community-dwelling older adults 65 years and older with no history of stroke and with complete data. IADL disability was defined as at least 1 IADL item scored as "need help" or "unable to perform." Receiver operating characteristics analysis was used to estimate the optimum grip strength and UGS cut points for best discriminating older adults with/without IADL disability. The association between each physical performance (grip strength and UGS) and IADL disability was assessed with odds ratios (ORs). RESULTS AND DISCUSSION With IADL disability as the criterion, the optimal cutoff values of grip strength were 28.7 kg for men and 16.0 kg for women, and those for UGS were 0.76 m/s for men and 0.66 m/s for women. The grip strength test showed satisfactory discriminant validity (area under the curve > 0.7) in men and a strong association with IADL disability (OR > 4). Our cut points using IADL disability as the criterion were close to those indicating frailty or sarcopenia. CONCLUSIONS Our reported cutoffs can serve as criterion-referenced values, along with those previously determined using different indicators, and provide important landmarks on the performance continua of older adults' grip strength and UGS. These landmarks could be useful in interpreting test results, monitoring changes in performance, and identifying individuals requiring timely intervention. For identifying older adults at risk of IADL disability, grip strength is superior to UGS.
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Affiliation(s)
- Meng-Chih Lee
- Taichung Hospital, Ministry of Health and Welfare, and Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Yi-Fen Tsai
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Ching-Yu Chen
- Department of Family Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Chieh Lin
- Department of Family Medicine, China Medical University & Hospital, Taichung, Taiwan
| | - Ching-Yi Wang
- School of Physical Therapy & Center for Education and Research on Geriatrics and Gerontology, Chung Shan Medical University, and Physical Therapy Room, Chung Shan Medical University Hospital, Taichung Taiwan
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Heiland EG, Qiu C, Wang R, Santoni G, Liang Y, Fratiglioni L, Welmer AK. Cardiovascular Risk Burden and Future Risk of Walking Speed Limitation in Older Adults. J Am Geriatr Soc 2017; 65:2418-2424. [PMID: 29124731 DOI: 10.1111/jgs.15158] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore the association between cardiovascular risk factor (CRF) burden and limitation in walking speed, balance, and chair stand and to verify whether these associations vary according to age and cognitive status. DESIGN Longitudinal population-based study. SETTING Urban area of Stockholm, Sweden. PARTICIPANTS Individuals aged 60 and older who participated in the Swedish National Study on Aging and Care in Kungsholmen and were free of limitations in walking speed (n = 1,441), balance (n = 1,154), or chair stands (n = 1,496) at baseline (2001-04). MEASUREMENTS At baseline, data on demographic characteristics, CRFs, other lifestyle factors, C-reactive protein, and cognitive function were collected. CRF burden was measured using the Framingham general cardiovascular risk score (FRS). Limitations in walking speed (<0.8 m/s), balance (<5 seconds), and chair stand (inability to rise 5 times) were determined at 3-, 6-, and 9-year follow-up. Data were analyzed using Cox proportional hazards models stratified according to age (<78, ≥78). RESULTS During follow-up, 326 persons developed limitations in walking speed, 303 in balance, and 374 in chair stands. An association between the FRS and walking speed limitation was evident only in adults younger than 78 (for each 1-point increase in FRS: hazard ratio (HR) = 1.09, 95% confidence interval (CI) = 1.02-1.17) after controlling for potential confounders including cognitive function (correspondingly, in adults aged ≥78: HR = 0.98, 95% CI = 0.92-1.03). Also, higher FRS was significantly associated with faster decline in walking speed (P < .001). CONCLUSION A higher FRS is associated with greater risk of subsequent development of walking speed limitation in adults younger than 78, independent of cognitive function. Interventions targeting multiple CRFs in younger-old people may help in maintaining mobility function.
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Affiliation(s)
- Emerald G Heiland
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - Rui Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - Giola Santoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
| | - Yajun Liang
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Anna-Karin Welmer
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Could Activity Modifications Indicate Physical Decline Among Adults With Symptomatic Knee Osteoarthritis? Am J Phys Med Rehabil 2017; 97:96-103. [PMID: 28763325 DOI: 10.1097/phm.0000000000000802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Mobility activity modifications indicate early functional losses that act as precursors to future declines among community-dwelling older adults. However, there is scarce evidence on whether activity modifications indicate poorer physical health among adults with symptomatic osteoarthritis, a major cause of disability. Our purpose was to investigate whether patient-reported mobility activity modifications indicated poorer physical health among adults with symptomatic knee osteoarthritis. DESIGN Secondary cross-sectional analysis of randomized trial data was performed. Preclinical Disability Questionnaire was used to group participants into the following three categories: difficulty, modified, and no difficulty walking/stair climbing. Kruskal Wallis and χ tests were used to compare clinical factors across groups. RESULTS Among 121 participants (median age = 60 yrs; 73% female; 60% white), less than 10% had modified walking/stair climbing. Compared with those with no walking difficulty, participants with modified walking had significantly less balance (P = 0.01) and global health (P = 0.01) as well as greater knee pain (P = 0.05) and physical disability (P = 0.04). Those with modified stair climbing had significantly smaller walking distances (P = 0.03) compared with those with no difficulty stair climbing. CONCLUSIONS Activity modifications may signal early impairments in physical health among people with symptomatic knee osteoarthritis. If confirmed, patient-reported activity modifications may enhance symptom evaluation in osteoarthritis and enable a better understanding of the disablement process.
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21
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Karvonen-Gutierrez CA. The importance of disability as a health issue for mid-life women. Womens Midlife Health 2015; 1:10. [PMID: 30766697 PMCID: PMC6297968 DOI: 10.1186/s40695-015-0011-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 09/25/2015] [Indexed: 12/17/2022] Open
Abstract
Data suggest that disability prevalence among mid-aged populations is increasing in recent years; current prevalence estimates for mid-aged adults range from 20 to 40 %. The World Health Organization’s International Classification of Functioning (ICF) has provided a multi-dimensional biopsychosocial model to understand disability that is highly relevant to mid-aged populations. Under the ICF framework, mid-aged women experience high levels of work, non-work, and mobility-associated disability but very little difficulty with self care. Despite the high prevalence, evidence suggests that there is a large proportion of non-chronic disability and that mid-aged women can both worsen and improve their functioning. Thus, the mid-life period may represent a critical window during which interventions to improve disability may be most efficacious for the improvement of current and future functioning. Interventions that are initiated during the mid-life are highly relevant as a strategy to reduce disability during this life stage and prevent or forestall the onset of late life disability. Targets for intervention include improvement of depressive symptoms and increasing physical activity levels, both of which have shown to be efficacious in older populations and are correlates of mid-life functioning and disability.
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Affiliation(s)
- Carrie A Karvonen-Gutierrez
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Room 6618, Ann Arbor, MI 48109 USA
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22
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Measurement of gait speed in older adults to identify complications associated with frailty: A systematic review. J Geriatr Oncol 2015; 6:484-96. [PMID: 26362356 DOI: 10.1016/j.jgo.2015.08.006] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/24/2015] [Accepted: 08/17/2015] [Indexed: 11/22/2022]
Abstract
Several frailty screening tests in older cancer patients were developed but their statistical performance is low. We aimed to assess whether measurement of usual gait speed (GS) alone could be used as a frailty screening test in older cancer patients. This systematic review was conducted on "pub med" between 1984 and 2014 and included reviews and original studies. Eligibility criteria were: GS over a short distance, alone or included in composite walking tests (Timed Get Up and Go test: TGUG, Short Physical Performance Battery: SPPB) in older people (aged 65 and over) living in a community setting and predictive value of GS on medical complications associated with frailty. 46 articles were finally selected. GS alone is consensual and recommended for screening sarcopenia in elderly. A slow GS is predictive of early death, disability, falls and hospitalization/institutionalization in older people living in a community setting. GS alone is comparable to composite walking tests that do not provide additional information on the medical complications associated with frailty. Despite few studies in geriatric oncology, GS seems to predict overall survival and disability. We suggest GS over 4m (at a threshold of 1m/s) as a new frailty screening test in older cancer patients (65 and over) to guide the implementation of a comprehensive geriatric assessment during the initial management phase or during follow-up. Prospective cohort studies are needed to validate this algorithm and compare it with other screening tool.
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Bartali B, Curto T, Maserejian NN, Araujo AB. Intake of antioxidants and subsequent decline in physical function in a racially/ethnically diverse population. J Nutr Health Aging 2015; 19:542-7. [PMID: 25923484 DOI: 10.1007/s12603-015-0449-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Oxidative stress is considered a risk factor for physical function (PF) decline with aging. The objective of this study was to examine the relationship between antioxidant intake and change in PF over a 5-year period. DESIGN, SETTING, PARTICIPANTS The Boston Area Community Health (BACH) Survey is a population-based longitudinal study including 5,502 racially/ethnically diverse and randomly selected participants aged 30-79 years. MEASUREMENTS In total, 2828 persons aged 30-79 years completed the validated Block Food Frequency Questionnaire (FFQ) and participated in the follow-up study. Change in PF from baseline (2002-2005) to follow-up (2006-2010) was assessed using the validated SF-12 questionnaire. Linear models were used to examine the association between energy-adjusted quartiles of vitamins C, E and carotenoids and change in PF. RESULTS A low intake (first quartile) of vitamin E was associated with a greater decline in PF compared with the highest quartile, with a mean difference in change in PF of -1.73 (95%CI:-3.31,-0.15). Notably, this mean difference was clinically meaningful as it was equivalent to the effect estimate we found for participants who were approximately 15 years apart in age in our cohort, as 1 year increase in age was associated with a mean difference in change in PF of -0.11 (95%CI:-0.16,-0.06). PF decline was not significantly different in the lowest compared with the highest quartile of vitamin C (mean difference=-1.29, 95%CI:-2.61, 0.03) or carotenoids (mean difference=-0.62, 95%CI:-2.22,0.99). CONCLUSIONS Low intake of vitamin E was significantly associated with decline in PF with aging. These results are clinically meaningful, extend previous findings that oxidative stress contributes to PF decline, and may inform the development of future prevention strategies aimed at reducing this clinical and public health problem.
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Affiliation(s)
- B Bartali
- B. Bartali, Senior Research Scientist, ; Office Tel: +1 617972 3350
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Lusa AL, Amigues I, Kramer HR, Dam TT, Giles JT. Indicators of walking speed in rheumatoid arthritis: relative influence of articular, psychosocial, and body composition characteristics. Arthritis Care Res (Hoboken) 2015; 67:21-31. [PMID: 25155859 DOI: 10.1002/acr.22433] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 08/05/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To explore the contributions from and interactions between articular swelling and damage, psychosocial factors, and body composition characteristics on walking speed in rheumatoid arthritis (RA). METHODS RA patients underwent the timed 400-meter long-corridor walk. Demographics, self-reported levels of depressive symptoms and fatigue, RA characteristics, and body composition (using whole-body dual X-ray absorptiometry, and abdominal and thigh computed tomography) were assessed and their associations with walking speed explored. RESULTS A total of 132 RA patients had data for the 400-meter walk, among whom 107 (81%) completed the full 400 meters. Significant multivariable indicators of slower walking speed were older age, higher depression scores, higher reported pain and fatigue, higher swollen and replaced joint counts, higher cumulative prednisone exposure, nontreatment with disease-modifying antirheumatic drugs, and worse body composition. These features accounted for 60% of the modeled variability in walking speed. Among specific articular features, slower walking speed was primarily correlated with large/medium lower-extremity joint involvement. However, these articular features accounted for only 21% of the explainable variability in walking speed. Having any relevant articular characteristic was associated with a 20% lower walking speed among those with worse body composition (P < 0.001), compared with only a 6% lower speed among those with better body composition (P = 0.010 for interaction). CONCLUSION Psychosocial factors and body composition are potentially reversible contributors to walking speed in RA. Relative to articular disease activity and damage, nonarticular indicators were collectively more potent indicators of an individual's mobility limitations.
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Affiliation(s)
- Amanda L Lusa
- Columbia University, College of Physicians and Surgeons, New York, New York
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Middleton A, Fritz SL. Assessment of Gait, Balance, and Mobility in Older Adults: Considerations for Clinicians. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s13670-013-0057-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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