Physical fitness and 6.5-year mortality in an 85-year-old community-dwelling population

Functional Training in Portuguese Firefighters: Impact of Functional Training With or Without Personal Protective Equipment

OBJECTIVE

To investigate the influence of specific functional training (FT) with and without personal protective equipment (PPE) and self-contained breathing apparatus (SCBA), on firefighters (FFs) physical fitness condition.

METHODS

Sixty FFs run a 24 weeks intervention, divided into three groups (EG1 training with PPE+SCBA; EG2 training with regular equipment, and Control Group). FFs anthropometric and physical fitness (PF) were assessed pre- and post-intervention.

RESULTS

Significant differences were found between the training groups and control group. Both training groups interventions were effective in improving PF and lean mass. However, EG1 presented a higher percentage of improvement.

CONCLUSION

This 24-week FT intervention improved participants' muscle strength, endurance, and power, and it led to increases in lean body mass. Regularly FT with PPE+SCBA helps FFs maintain a healthy general physical condition and develop optimum fitness levels related to firefighting specific tasks, specially torso muscular endurance.

The effects of ageing on functional capacity and stretch-shortening cycle muscle power

[Purpose] To examine the effects of age and gender in an ageing population with respect to functional decline and the relationship between muscle power and functional capacity. [Participants and Methods] The cohort (N=154) was subdivided into youngest-old (65–70 years.; n=62), middle-old (71–75 years.; n=46), and oldest-old (76–81 years.; n=46). Measures of mechanical muscle function included countermovement jump height, muscle power, leg strength and grip strength. Functional performance-based measures included heel-rise, postural balance, Timed Up and Go, and gait speed. [Results] The oldest-old performed significantly worse than the middle-old, whereas the youngest-old did not outperform the middle-old to the same extent. Increased contribution of muscle power was observed with increasing age. Males had consistently higher scores in measures of mechanical muscle function, whereas no gender differences were observed for functional capacity. [Conclusion] The age-related decline in functional capacity appears to accelerate when approaching 80 years of age and lower limb muscle power seems to contribute to a greater extent to the preservation of functional balance and gait capacity at that stage. Males outperform females in measures of mechanical muscle function independent of age, while the findings give no support for the existence of gender differences in functional capacity.

Determinant factors of sarcopenia in individuals with Parkinson's disease

OBJECTIVE

Evaluate the occurrence of sarcopenia and determinant factors in individuals with Parkinson's disease (PD) in a city in northeastern Brazil.

METHODS

Case series with 77 men and women (adults and older adults) with PD. The risk of sarcopenia was determined using the SARC-F and SARC-CalF screening tools. The diagnosis of sarcopenia was based on the new consensus published by the European Working Group on Sarcopenia in Older People (EWGSOP2). Sarcopenic obesity was diagnosed based on the criteria proposed by Stenholm. Disease stage and severity were determined using the Hoehn and Yahr scale and the Unified Parkinson Disease Rating Scale, respectively.

RESULTS

The prevalence of sarcopenia was 19.5% and was associated with age, poor performance on activities of daily living and poor nutritional status. No significant association was found between the SARC-F score and the diagnosis of sarcopenia. The main factors that determined the variation in the parameters for the diagnosis of sarcopenia in the present sample were age, disease severity, body weight, and SARCF score.

CONCLUSION

Despite the low prevalence in the present study, sarcopenia progresses with the worsening of the nutritional status and functional capacity of individuals with PD. Further studies are needed on the factors involved in the genesis of sarcopenia. The SARC-F questionnaire is related to parameters for the diagnosis and severity of sarcopenia as well as the severity of PD.

Associations Between Handgrip Strength and Disease-Specific Mortality Including Cancer, Cardiovascular, and Respiratory Diseases in Older Adults: A Meta-Analysis

Several controversial studies linking handgrip strength and health have suggested that low handgrip strength in older adults may be related to health problems and have investigated whether there is a minimum handgrip strength level associated with reduced mortality. Thus, by meta-analysis, the authors identified an association between handgrip strength in older adults and disease-specific mortality and all-cause mortality. Thirty studies with a total of 194,767 older adult participants were included in this meta-analysis. Higher handgrip strength was associated with an 18% decrease in all-cause mortality. Lower handgrip strength was associated with increased all-cause mortality. The minimum handgrip strength in older women that did not increase all-cause mortality was 18.21 kg. Increased handgrip strength showed a decreased all-cause mortality, whereas decreased handgrip strength was associated with increased all-cause mortality. Strengthening the handgrip may help improve disease-specific mortality in older adults.

The effects of selected lifestyle components on the risk of developing dynapenia in women – a pilot study

Aging processes in a body inevitably lead to changes which may decrease the quality of life of the elderly. Dynapenia is a phenomenon which is still not well known and needs to be studied in the population. The aim of the research was to determine the effects of lifestyle on the risk of developing dynapenia in post-menopausal women. The study included 46 females aged 71.4 ±5.6 living in the town of Wysokie Mazowieckie. Basic body dimensions and body composition elements were assessed with the use of anthropometry and bioelectrical impedance analysis (BIA). A direct interview method with the use of the modified Sedentary Behavior Questionnaire (SBQ) was applied. In order to assess the prevalence of dynapenia, handgrip strength was measured with the use of hydraulic dynamometer. Physical activity was assessed with the use of a pedometer. The respondents’ nutrition was examined in an interview concerning their diet from the 24 hours preceding the examination according to the methodology of Food and Nutrition Institute (FNI). The intake of energy and nutritional elements in a diet was calculated with using DIETA 5.0 computer software. Dynapenia was diagnosed in 21.7% of the examined women. The women with dynapenia had significantly bigger waist and hip circumferences and higher BMI (p<0.05) as well as significantly weaker hand muscles than healthy women (p<0.001). Females with dynapenia spent significantly more time in a sedentary position, i.e. talking on the phone, participating in religious rituals or watching TV (p<0.05) compared to women without dynapenia. No significant differences concerning the diet of women with and without dynapenia were revealed. Physical activity may significantly decrease the risk of dynapenia among women over 60 years of age. Furher research is needed to assess the risk of dynapenia and methods of its prevention.

Daily step count and all-cause mortality in a sample of Japanese elderly people: a cohort study

Background

This study aimed to examine the relationship between pedometer-assessed daily step count and all-cause mortality in a sample of elderly Japanese people.

Methods

Participants included 419 (228 males and 191 females) physically independent, community-dwelling 71-year-old Japanese people. The number of steps per day was measured by a waist-mounted pedometer for seven consecutive days at baseline. Participants were divided into quartiles based on their average number of steps/day (first quartile, < 4503 steps/day; second quartile, 4503–6110 steps/day; third quartile, 6111–7971 steps/day; fourth quartile, > 7972 steps/day) and were followed up over a mean period of 9.8 years (1999–2010) for mortality.

Results

Seventy-six participants (18.1%) died during the follow-up period. The hazard ratios (adjusted for sex, body mass index, cigarette smoking, alcohol intake, and medication use) for mortality across the quartiles of daily step count (lowest to highest) were 1.00 (reference), 0.81 (95%CI, 0.43–1.54), 1.26 (95%CI, 0.70–2.26), and 0.46 (95%CI, 0.22–0.96) (P for trend = 0.149). Participants in the highest quartile had a significantly lower risk of death compared with participants in the lowest quartile.

Conclusion

This study suggested that a high daily step count is associated with a lower risk of all-cause mortality in physically independent Japanese elderly people.

Obesity, Physical Fitness and Inflammation in the Elderly

Among the elderly, obesity is paradoxically associated with a lower mortality risk. Thus, this study describes fitness levels by Body Mass Index (BMI) category and the associations of high-sensitivity C-reactive protein (hs-CRP) and Vitamin D levels with muscle strength, in community-dwelling older adults. A cross-sectional study, with 1338 subjects having mean age of 78.3 years, were assessed in anthropometrics, muscle strength, and cardiorespiratory fitness. In a sub-sample, blood samples were collected and objective markers of inflammation were provided: high-sensitivity C-reactive protein (hs-CRP) and Vitamin D (25(OH) D). Obese women (BMI ≥ 30.0 kg/m²) showed significantly better results for grip strength than normal weight group (BMI between 18.5–24.9 kg/m²): 22.3 (7.0) vs. 20.0 (6.8); p = 0.002. After adjustment, higher levels of hs-CRP were an independent predictor of lower levels of grip strength (β = −0.213, 95% CI: −0.424; −0.002) and Vitamin D levels were positively associated with higher levels of muscle strength (β = 0.098, 95% CI: 0.008–0.189). The multivariate analysis found a significant and positive association between 25(OH) D and grip strength: (β = 0.098, 95% CI: 0.008–0.189). A positive pattern of higher levels of absolute strength among obese older subjects could have an important impact on morbidity and mortality risk, through the inverse association with acute inflammation and an increase in Vitamin D profile.

The role of geriatric assessment tests and anthropometric measurements in identifying the risk of falls in elderly nursing home residents

Objectives:

To determine the relation among the risk of falls, geriatric assessment, and anthropometric measurements, including the mini mental state examination, geriatric depression scale, handgrip test, and key pinch test.

Methods:

This prospective study included 89 residents hospitalized between May 2014 and September 2015 in the geriatric care unit of the Istanbul Balikli Rum Hospital, Istanbul, Turkey. Patients were followed-up for one year, and their falls were recorded. Medical records of the included patients were retrieved and analyzed.

Results:

A total of 89 patients, comprising 37 men and 52 women with an average age of 75.8 ± 8.2 years were included in the study. The residents’ annual falling averages were 1.0 ± 1.5. The most significant factors were identified to be predicted muscle mass, skeletal muscle index, whole body bioimpedance, dominant arm muscle strength, dominant arm bioimpedance, and free fat mass.

Conclusions:

The mini mental test, geriatric depression scale and lawton-brody scale combined with the handgrip, 6-meters walking, and bioimpedance tests are favorable for detecting the risk of falls and recurrent falls in vulnerable elderly nursing home residents.

Evaluation of hip abductor and adductor strength in the elderly: a reliability study

BACKGROUND

In elderly individuals an increased muscle strength contributes to the diminution of the falls risk and associated adverse events. An increasing interest in lateral control exists due to the fatal consequences of postero-lateral falls. Therefore a proper assessment of frontal plane hip muscle strength in elderly is important but remains challenging. Therefore we aimed to investigate the feasibility and repeatability of a hip abductor and adductor maximum voluntary isometric strength (MVIS) and rate of force generation (RFG) test in elderly. This represents an initial step in the development process of a new and clinically relevant test that could lead to more specific treatment protocols for this population.

METHODS

In this measurement focused study hip abduction (ABD) and adduction (ADD) MVIS and RFG were tested twice within one to three hours with a dynamometer fixed to a custom made frame in a geriatric population including fallers and non-fallers. Intraclass correlation coefficient (ICCagreement), standard error of measurement (SEM), and smallest detectable difference (SDD) were determined.

RESULTS

All recruited persons (N = 76; mean age (SD) 80.46 (7.05) years old) completed the tests. The average time needed to complete the strength tests was 10.58 min. (1.56) per muscle group. The reliability of the hip ABD and ADD was high with ICC'sagreement ranging from 0.83 to 0.97. The SDD varied between 18.1 and 81.8% depending on the muscle group and type of strength that was evaluated.

CONCLUSION

Hip abductor and adductor strength measures in older person are feasible and reliable. However, the significance of moderate changes in these measurements may be limited by the large SDD and SEM. Therefore, physical therapist should be careful when using this measure for assessing the progress of an individual person in a daily clinical use.

Effects of a Community-Based Multimodal Exercise Program on Health-Related Physical Fitness and Physical Function in Breast Cancer Survivors: A Pilot Study

PURPOSE

Breast cancer and oncological treatment can result in significant acute and late localized and systemic negative effects on health-related physical fitness and physical function. The aim of this single-arm study was to examine the effects of a 12-week community-based multimodal exercise program on health-related physical fitness and physical function in breast cancer survivors.

METHODS

A total of 52 female breast cancer survivors (mean age = 59.7 ± 10.4 years) completed supervised exercise training consisting of (1) aerobic conditioning, (2) resistance training, and (3) balance and flexibility training, for 30 minutes each, totaling 90 minutes twice weekly for 12 weeks. Pretreatment and posttreatment outcome measures-mobility: (1) Timed Up and Go (TUG) and (2) 6-minute walk test (6MWT); muscular strength: (3) leg press strength and (4) chest press strength; upper-extremity flexibility: (5) back scratch test; and balance: (6) functional reach (FR) and (7) single-leg stance time-were assessed and compared.

RESULTS

Postintervention assessment measures given as percentage improvement and effect size (ES) for mobility, TUG (18%, 0.59), and 6MWT (14%, 0.74) were significantly (P < .001) improved. Outcome measures of muscular strength, leg press strength (32%, 0.58) and chest press strength (40%, 0.61), both significantly (P < .001) improved. Postintervention assessment measure of upper-extremity flexibility (42%, 0.41) showed significant (P < .001) improvements. Outcome measures for balance, FR (18%, 0.75) and single leg stance time (24%, 0.30), showed significant (P < .001) improvements.

CONCLUSIONS

Outcome measures showed moderate to large ES improvements after participants completed the 12-week multimodal exercise program for breast cancer survivors.

Live strong and prosper: the importance of skeletal muscle strength for healthy ageing

Due to improved health care, diet and infrastructure in developed countries, since 1840 life expectancy has increased by approximately 2 years per decade. Accordingly, by 2050, a quarter of Europe’s population will be over 65 years, representing a 10 % rise in half a century. With this rapid rise comes an increased prevalence of diseases of ageing and associated healthcare expenditure. To address the health consequences of global ageing, research in model systems (worms, flies and mice) has indicated that reducing the rate of organ growth, via reductions in protein synthetic rates, has multi-organ health benefits that collectively lead to improvements in lifespan. In contrast, human pre-clinical, clinical and large cohort prospective studies demonstrate that ageing leads to anabolic (i.e. growth) impairments in skeletal muscle, which in turn leads to reductions in muscle mass and strength, factors directly associated with mortality rates in the elderly. As such, increasing muscle protein synthesis via exercise or protein-based nutrition maintains a strong, healthy muscle mass, which in turn leads to improved health, independence and functionality. The aim of this review is to critique current literature relating to the maintenance of muscle mass across lifespan and discuss whether maintaining or reducing protein synthesis is the most logical approach to support musculoskeletal function and by extension healthy human ageing.

Association of regional muscle strength with mortality and hospitalisation in older people

BACKGROUND

the association between muscular strength, mortality and hospitalisation with ageing can change depending on sex and the body region analysed (e.g. upper and lower limb muscles).

OBJECTIVE

to determine the effect of measuring lower and upper extremities muscular strength on the relationship between strength, mortality and hospitalisation risk in elder men and women.

DESIGN

a population-based cohort study using data from the Toledo Study for Healthy Aging (TSHA).

METHODS

a Spanish population sample of 1,755 elders aged ≥65 years participated in this study. Upper (handgrip and shoulder) and lower limbs (knee and hip) maximal voluntary isometric strength was obtained using standardised techniques and equipment. Cox proportional hazards model was used to examine mortality and hospitalisation over 5.5 and 3 years of follow-up, respectively.

RESULTS

after adjustment for potential confounding factors, including co-morbidities and BMI, hazard ratio of death and hospitalisation was significantly lower in the stronger women and men, but showing regional- and sex-specific differences. That is shoulder, knee and hip muscle regions in women and handgrip and shoulder in men (all P < 0.05). There was a cumulative effect of measuring several muscle strengths over the risk of health events (P < 0.05), so that mortality hazard ratio increased by 45% in women and 25% in men per muscular strength (shoulder, grip, knee and hip) in the weaker strength quartile increase (P < 0.01).

CONCLUSIONS

regional muscle strength is a predictor of medium-term mortality and hospitalisation in elder men and women. Multiple strength measures including lower and upper body limb muscles are better predictors than a single strength measurement.

The relationship between health-related fitness and quality of life in postmenopausal women from Southern Taiwan

Background

Health-related fitness has been reported to be associated with improved quality of life (QoL) in the elderly. Health-related fitness is comprised of several dimensions that could be enhanced by specific training regimens. It has remained unclear how various dimensions of health-related fitness interact with QoL in postmenopausal women.

Objective

The purpose of the current study was to investigate the relationship between the dimensions of health-related fitness and QoL in elderly women.

Methods

A cohort of 408 postmenopausal women in a rural area of Taiwan was prospectively collected. Dimensions of health-related fitness, consisting of muscular strength, balance, cardiorespiratory endurance, flexibility, muscle endurance, and agility, were assessed. QoL was determined using the Short Form Health Survey (SF-36). Differences between age groups (stratified by decades) were calculated using a one-way analysis of variance (ANOVA) and multiple comparisons using a Scheffé test. A Spearman’s correlation analysis was performed to examine differences between QoL and each dimension of fitness. Multiple linear regression with forced-entry procedure was performed to evaluate the effects of health-related fitness. A P-value of <0.05 was considered statistically significant.

Results

Age-related decreases in health-related fitness were shown for sit-ups, back strength, grip strength, side steps, trunk extension, and agility (P<0.05). An age-related decrease in QoL, specifically in physical functioning, role limitation due to physical problems, and physical component score, was also demonstrated (P<0.05). Multiple linear regression analyses demonstrated that back strength significantly contributed to the physical component of QoL (adjusted beta of 0.268 [P<0.05]).

Conclusion

Back strength was positively correlated with the physical component of QoL among the examined dimensions of health-related fitness. Health-related fitness, as well as the physical component of QoL, declined with increasing age.

[Physical activity diminishes aging-related decline of physical and cognitive performance]

Aging-related decline of muscle force, walking speed, locomotor coordination, aerobic capacity and endurance exert prognostic impact on life expectancy. Proper use of training may diminish the aging process and it may improve the quality of life of elderly persons. This paper provides a brief summary on the impact of training on aging-related decline of physical and cognitive functions.

Biomarkers of healthy ageing: expectations and validation

The challenge of devising a set of biomarkers capable of measuring the ageing rate in human subjects was articulated long ago. In recent years, progress in the basic biology of ageing suggests the realistic possibility of preventive or restaurative interventions that may extend healthy lifespan in mammals including human subjects. Specifically, frailty is being increasingly recognised as a clinically relevant syndrome that may be therapeutically addressed. This greatly enhances the need for sensitive and specific biomarkers of healthy ageing that are validated in both experimental animals and, importantly, in human subjects over the whole age range. Here, we will discuss the present challenges and requirements for biomarker validation in human subjects. We propose the central requirements for a validated biomarker of healthy ageing as: (i) better predictive power than chronological age for multiple dimensions of ageing; (ii) identification of the age range in which the marker is informative; (iii) establishment of sensitivity/specificity as indicators of its predictive power at the level of the individual; (iv) minimisation of methodological variation between laboratories.

New normative values for handgrip strength: results from the UK Biobank

OBJECTIVES

To develop normative values for right and left handgrip strength after stratification for confounders like gender, age, and height.

DESIGN

Cross-sectional, descriptive.

SETTING

General population.

PARTICIPANTS

A total of 502,713 people living in the United Kingdom.

INTERVENTION

None.

MEASUREMENTS

Handgrip strength was measured using a Jamar hydraulic hand dynamometer, which is considered to be an accurate instrument to measure handgrip strength. In addition, self-reported chronic conditions and ethnic background were registered, and lung function was assessed using spirometry.

RESULTS

After exclusion of all individuals with missing data, a nonwhite ethnic background, the presence of 1 or more self-reported conditions, and/or an obstructive lung function (defined as FEV1/FVC <0.7), new normative values for right and left handgrip strength were derived from 224,830 and 224,852 individuals (54.2% women; age: 55.0 [8.0] years; height: 169.0 [9.2] cm; body mass index: 26.9 [4.4] kg/m(2)) with a nonobstructed spirometry (FEV1: 3.0 [0.8] L). Men were stronger than women. Moreover, significant associations were found between handgrip strength and height, and between handgrip strength and age. Finally, percentiles 5, 10, 25, 50, 75, 90, and 95 were calculated for right and left handgrip strength, after stratification for gender, age, and height.

CONCLUSION

The UK Biobank dataset provided the opportunity to determine new normative values for handgrip strength in men and women aged 39 to 73 years. These normative values take into consideration age, height, and measurement side. Therefore, these new normative handgrip strength values are of broad clinical interest.

Physical function measurements predict mortality in ambulatory older men

BACKGROUND

To assess and compare the predictive value of physical function measurements (PFMs) for all-cause mortality in older men and to evaluate the Timed Up and Go test (TUG) as a predictor in subjects with underlying comorbidity.

DESIGN

Observational study of a population-based sample of 352 ambulatory older men aged 71-86 at study baseline. The Rapid disability rating scale-2, 36-Item short form health survey, Grip strength, Five times sit-to-stand test, Standing balance, and TUG were determined at baseline. Associations with all-cause mortality were assessed using Cox proportional hazard analyses. Age, Body mass index (BMI), smoking status, education, physical activity and cognitive status were included as confounders. Follow-up exceeded 15 years. Comorbidity status was categorized into cardiovascular disease, chronic obstructive pulmonary disease (COPD) and diabetes mellitus.

RESULTS

All examined PFMs were associated with all-cause mortality. TUG was the best predictor (adjusted HR per SD increase = 1·58, 95% CI = 1·40-1·79, P < 0·001) for global mortality and continued to be predictive in subjects with cardiovascular disease (adjusted HR per SD increase = 1·80, 95% CI = 1·40-2·33, P < 0·001).

CONCLUSIONS

The assessment of physical functioning is important in the evaluation of older persons. We encourage the use of the TUG as a reliable, quick and feasible screening tool in clinical settings.

Physical performance as long-term predictor of onset of activities of daily living (ADL) disability: a 9-year longitudinal study among community-dwelling older women

Disability in ADL of aging women is an important public health concern. It is thus of interest to identify modifiable factors underlying onset of ADL disability. We assessed whether three physical performance-based measurements could predict ADL disability 9 years later. The participants were 113 non-disabled community-dwelling women with a mean age of 79.5 years at baseline. The baseline examinations of physical performance were: functional reach, climbing steps and comfortable walking speed. ADL disability was defined as need of personal assistance in at least one of five basic ADL items. The participants were followed for 9 years. Logistic regression models were fitted for each of the physical performance measurements together with the covariates in relation to ADL disability. At follow-up 25.7% were disabled in ADL. All three performance measurements were significantly associated with the onset of ADL disability at 9 years of follow-up, however, only walking speed remained significantly related to onset of ADL disability, when all three performance measurements were included in the same model. In conclusion all the three performance measurements were related to onset of ADL disability, with walking speed having the strongest predictive value. Systematic screening based on walking speed measurements of non-disabled older women might help health professionals to identify those at risk of ADL disability and introduce preventive measures in time.

Physical performance and 13.5-year mortality in elderly women

AIMS

To examine whether four modifiable physical performance-based measurements predicted 13.5-year mortality in 300 elderly women.

METHODS

This prospective observational cohort study followed 300 randomly-selected community-dwelling women, with a mean age of 80.9 years at baseline, for 13.5 years. Baseline physical performance measurements were: comfortable walking speed, Timed Up and Go (TUG), functional reach, and one-leg stance. Demographic and health measurements were recorded. Date of death was recorded from the national population registry. Cox proportional hazard models were fitted, with time from baseline assessment to death or censored date as the dependent variable.

RESULTS

At follow-up, 71% of the participants had died. All performance-based measurements except one-leg stance were significantly associated with 13.5-year mortality. Only walking speed remained significantly independently associated with mortality when the three significant performance measurements were included in the same multiple proportional hazard Cox model.

CONCLUSIONS

Comfortable walking speed, TUG and functional reach predicted 13.5-year mortality, and walking speed was the strongest predictor of mortality. Screening elderly women with performance measurements may aid in identifying those at risk and thus targeted interventions may be applied.

What is dynapenia?

Dynapenia (pronounced dahy-nuh-pē-nē-a, Greek translation for poverty of strength, power, or force) is the age-associated loss of muscle strength that is not caused by neurologic or muscular diseases. Dynapenia predisposes older adults to an increased risk for functional limitations and mortality. For the past several decades, the literature has largely focused on muscle size as the primary cause of dynapenia; however, recent findings have clearly demonstrated that muscle size plays a relatively minor role. Conversely, subclinical deficits in the structure and function of the nervous system and/or impairments in the intrinsic force-generating properties of skeletal muscle are potential antecedents to dynapenia. This review highlights in the contributors to dynapenia and the etiology and risk factors that predispose individuals to dynapenia. In addition, we address the role of nutrition in the muscular and neurologic systems for the preservation of muscle strength throughout the life span.