Body mass index and physical function in older women

Factors affecting pain and physical functions in patients with knee osteoarthritis: An observational study

Knee osteoarthritis (KOA) is more common as people age and have a higher body mass index (BMI). We must know the role of various factors in pain and physical functions in patients with KOA. Therefore, the present study sought to examine the factors associated with pain and physical functions in individuals with KOA. This cross-sectional observational study included patients with KOA (n = 125; 57 men, 68 women; mean age 52.9 years). Using the visual analogue scale and a reduced version of the Western Ontario McMaster Universities Osteoarthritis Index, pain severity and physical functions were assessed. Demographic factors such as age, BMI, sex, and Kellgren-Lawrence (K/L) radiographic grade of KOA were analyzed. Age (R = 0.263, P < .001), BMI (R = 0.379, P < .001), and K/L grade (R = 0.844, P < .001) were significantly associated with knee pain. Similarly, age (R = 0.310, P < .001), BMI (R = 0.374, P < .001), and K/L grade (R = 0.862, P < .001) were associated with physical functions. No significant association of sex with pain (R = 0.071, P = .440) and physical functions (R = 0.055, P = .545) was observed. Age, BMI, and K/L grade explained 71% and 74% of knee pain and physical functions, respectively. Age, BMI, and radiographic (K/L) grades were associated with pain and physical functions in patients with KOA. K/L grade was the most significant predictor of pain and physical functions in KOA.

Slower upper extremity function in older adults with hyperkyphosis negatively impacts the 6-min walk test

BACKGROUND

Approximately 30% to 40% of older adults have hyperkyphosis, defined as excessive curvature of the thoracic spine. Hyperkyphosis is associated with increased morbidity and mortality. This study aimed to determine whether hyperkyphosis (Cobb's angle) and upper extremity tasks were independently associated with the 6-min walk test (6MWT) in community-dwelling older adults with hyperkyphosis.

METHODS

In this cross-sectional study, we studied 71 women and 28 men aged 60-87 from the study of hyperkyphosis, exercise, and function trial (SHEAF) who had kyphosis, 3 timed upper extremity tasks and the 6MWT assessed at their baseline visit. We used standing lateral spine radiographs and a standardized protocol for thoracic kyphosis (T4-T12) to measure Cobb angle of kyphosis. In addition, 3 activity of daily living (ADL) extremity tests (putting on and removing a laboratory coat, picking up a penny from the floor, and lifting a 7-lb. book to a shelf) were used.

RESULTS

The mean ± SD age was 70.1 ± 6.1 years. The mean ± SD Cobb angle of kyphosis was 57.4 ± 12.5 degrees. On average ± SD, the participants walked 504.8 ± 84.2 m in 6 min and took 2.4 ± 2.2 prescription medications. The mean ± SD height was 164.7 ± 8.5 cm, weight was 68.7 ± 13.1 kg, and BMI was 25.2 ± 4.0 kg/m2. Multivariate regression revealed that age, height, upper extremity book lift task, and the number of prescribed medications were significant predictors of performance on the 6MWT (p < 0.05).

CONCLUSIONS

While kyphosis was not associated with the 6MWT, timed tests of upper extremity function indicated that upper body dynamics can affect walking performance. In addition, sociodemographic factors and the number of prescribed medications were significant contributing factors to the 6MWT in older adults with mild to moderate hyperkyphosis. These results illustrate multifactorial influences on physical performance and the need for an integrated and targeted approach in helping older hyperkyphotic adults maintain healthy physical functioning as they age.

Normative Static Grip Strength of Saudi Arabia's Population and Influences of Numerous Factors on Grip Strength

Most daily tasks require exerting static grip strength which can be challenging for the elderly as their strength diminishes with age. Moreover, normative static grip strength data are important in ergonomics and clinical settings. The goal of this study is to present the gender, age-specific, hand-specific, and body-mass-index-specific handgrip strength reference of Saudi males and females in order to describe the population's occupational demand and to compare them with the international standards. The secondary objective is to investigate the effects of gender, age group, hand area, and body mass index on the grip strength. A sample of 297 (146 male and 151 female) volunteers aged between 18 and 70 with different occupations participated in the study. Grip strength data were collected using a Jamar dynamometer with standard test position, protocol, and instructions. The mean maximum voluntary grip strength values for males were 38.71 kg and 22.01 kg, respectively. There was a curvilinear relationship of grip strength to age; significant differences between genders, hand area, and some age groups; and a correlation to hand dimensions depending on the gender.

Sit-to-Stand Power Across the Lifespan: A Cross-Sectional Analysis

Lower-body power measured by a linear position transducer during the sit-to-stand (STS) movement declines with age and may be a predictor of physical disability in older adults. The purpose of this study was to establish normative data for STS power across the lifespan and to determine if differences exist between age cohorts, sexes, and age cohort-sex subgroups. Adults (N = 557) aged 18-89 were divided into five age cohorts and performed the STS connected to a linear position transducer, which calculated power and velocity during the movement. Significantly lower (p < .01) velocity was observed in a younger age cohort in females than males, whereas males saw a significant average power decrement (p < .01) in a younger age cohort than females. STS power norms give clinicians a metric predicting physical disability and may be of particular interest to males as their power production begins to decline at an earlier age.

Colorectal cancer patients with malnutrition suffer poor physical and mental health before surgery

BACKGROUND

To determine whether there is an association between preoperative nutritional status and preoperative physical function, patient-reported quality of life, and body composition in colorectal cancer patients awaiting elective surgery.

METHODS

We conducted a pooled analysis of individual baseline patient data (n = 266) collected from 5 prehabilitation trials in colorectal cancer surgery. All data were collected approximately 4 weeks before surgery. Each patient's nutritional status was evaluated using the Patient-Generated Subjective Global Assessment: scores 4-8 indicated need for nutritional treatment, whereas ≥9 indicated critical need for a nutrition intervention. Physical function was measured with the 6-minute walk test; patient-reported quality of life was captured with the SF-36; body mass and composition were determined using multifrequency bioelectrical impedance.

RESULTS

Mean Patient-Generated Subjective Global Assessment score was 5.3 (standard deviation: 3.9). Approximately two-thirds of patients had a Patient-Generated Subjective Global Assessment of 4-8 or ≥9 (n = 162/266). The 6-minute walk test was progressively worse with higher Patient-Generated Subjective Global Assessment scores (PG-SGA <4: 471(119) m; PG-SGA 4-8: 417(125) m; PG-SGA ≥9: 311(125) m, P < .001). Every component of the SF-36 was lower in those with a Patient-Generated Subjective Global Assessment ≥9 compared to Patient-Generated Subjective Global Assessment <4, indicating that malnourished patients suffer worse quality of life. Interestingly, only the male patients with a Patient-Generated Subjective Global Assessment ≥9 presented with statistically significant lower body mass, reduced fat-free mass index, and a lower percent body fat relative to those with Patient-Generated Subjective Global Assessment <4, in part due to the higher variability among the females.

CONCLUSION

The consequences of malnutrition are far-reaching and are strongly associated with the physical and mental health of colorectal cancer patients awaiting elective resection.

Effect of lorcaserin in different age groups: a post hoc analysis of patients from the BLOOM, BLOSSOM and BLOOM-DM studies

INTRODUCTION

The elderly population is projected to be the fastest growing group of individuals with obesity group in the United States. As such, there is merit in examining factors that contribute to healthy aging and weight management. The effects of newer weight loss medications approved after 2013 have been studied but are not often assessed specifically in older persons.

METHODS

This post hoc analysis evaluated the magnitude of weight loss in adults across age quartiles with lorcaserin, a serotonin (5-HT) 2C receptor agonist indicated as an adjunct to a reduced-caloric diet and increased physical activity for chronic weight management. Data from three lorcaserin pivotal phase 3 studies were used in this analysis. Data for patients with overweight/obesity without type 2 diabetes (T2D; BLOOM/BLOSSOM; body mass index [BMI] 27.0-29.9 kg/m2 and ≥1 comorbidity or BMI 30.0-45.0 kg/m2) and patients with overweight/obesity with T2D (BLOOM-DM; BMI 27.0-45.0 kg/m2) were used. Patients were randomized to receive lorcaserin 10 mg twice daily or placebo in addition to diet and exercise for 52 weeks. Age quartiles between the studies differed as the T2D population was on average, 9 years older.

RESULTS

This analysis shows that lorcaserin was associated with improved weight loss relative to placebo regardless of age. Importantly, these results were consistent for patients with and without T2D. Interestingly, the magnitude of weight loss for lorcaserin appeared to increase with increasing age. In patients without T2D, odds of achieving ≥5% and ≥10% reduction in body weight at 52 weeks were significantly higher for patients >36 years. Lorcaserin was well tolerated in all patients across all quartiles including the oldest quartile.

CONCLUSIONS

In summary, this post hoc analysis demonstrates that lorcaserin treatment in patients with and without T2D was safe and effective at reducing weight across all age groups analysed. Weight loss appeared to be greater for older patients; additional analyses are warranted to confirm these findings and to better understand the factors for improved weight loss.

Do self-efficacy, body mass index, duration of onset and pain intensity determine performance on selected physical tasks in individuals with unilateral knee osteoarthritis?

PURPOSE

To investigate the contributions of Pain Self-Efficacy (PSE), Function Self-Efficacy (FSE), Body Mass Index (BMI), duration of onset of Knee OsteoArthritis (KOA) and Present Pain Intensity (PPI) to performance on Stair Task Test (STT), Timed Up-and-Go (TUG) and 20-Meter Walk Test (20-MWT) and explore correlations among the variables in individuals with unilateral KOA.

METHODS

Participants were 51 (22 male, 29 female) consecutively-selected patients with unilateral KOA. Participants' self-efficacy (PSE, FSE), and PPI were assessed using Arthritis Self-Efficacy Scale and Box Numerical pain scale respectively. Participants' performance on STT, TUG and 20-MWT was also assessed. Data were analyzed with Pearson product moment correlation and Stepwise linear regression at alpha level of 0.05.

RESULTS

Participants' mean age, duration of KOA onset and BMI were 52.18 ± 10.69 years, 30.29 ± 29.03months and 26.06 ± 3.86 kg/m² respectively. Participants' scores on 20MWT, TUG and STT had significant direct correlations with each other and with PPI while PPI had significant indirect correlations with PSE (r = -0.59) and FSE (r = -0.56). PSE had significant direct correlation (r = 0.65) with FSE. Both PSE and FSE had significant but low inverse correlations with scores on the performance tests. PPI explained about 43% or more of the variance in 20-MWT, TUG and STT. PPI and onset of KOA explained 62% of variance in 20-MWT while PPI and BMI jointly explained 60% of variance in TUG.

CONCLUSION

Though PSE and FSE significantly correlated with scores on the performance tests, PPI, duration of OA and BMI were the significant determinants of performance.

The Effect of Medical Marijuana Laws on Body Weight

This study is the first to examine the effects of medical marijuana laws (MMLs) on body weight, physical wellness, and exercise. Using data from the 1990 to 2012 Behavioral Risk Factor Surveillance System and a difference-in-difference approach, we find that the enforcement of MMLs is associated with a 2% to 6% decline in the probability of obesity. We find some evidence of age-specific heterogeneity in mechanisms. For older individuals, MML-induced increases in physical mobility may be a relatively important channel, while for younger individuals, a reduction in consumption of alcohol, a substitute for marijuana, appears more important. These findings are consistent with the hypothesis that MMLs may be more likely to induce marijuana use for health-related reasons among older individuals, and cause substitution toward lower-calorie recreational 'highs' among younger individuals. Our estimates suggest that MMLs induce a $58 to $115 per-person annual reduction in obesity-related medical costs. Copyright © 2015 John Wiley & Sons, Ltd.

Changes in Obesity Prevalence Among Women Aged 50 Years and Older

Obesity is an important public health issue facing Americans of all ages. Behavioral Risk Factor Surveillance System data are used to illustrate the change in body mass index distribution in just one decade (1990-2000) in women aged = 50. The sample size ranged from 18,474women = 50 in 1990 to 45,820 in 2000. Forwomen aged = 50, there is a slight decline in the prevalence of underweight (from 3.1% in 1990 to 2.4% in 2000) and a significant increase in obesity (from 14.4% to 21.7%). Not smoking, having less education, being in poor health, having diabetes, and not exercising are all associated with increased odds of being obese. Although factors significantly related to obesity in older women are consistent with those previously identified in younger women, the weight group distributions in olderwomen differ. The physical and social influences of age and gender need to be incorporated into health promotion programs.

The multidomain mobility lab in older persons: from bench to bedside. The assessment of body composition in older persons at risk of mobility limitations

With body composition it is possible to divide human body in compartments on the basis of different physical properties. The two level body composition model subdividing the whole body in fat mass and fat free mass is the most used in epidemiological and clinical studies in the elderly. Body composition techniques may be used to study ageing process. Changes in body composition occur as part of the normal ageing process and are associated with important effects on health and function. It has been shown that body composition changes with aging, with an increase in fat mass and a decrease in muscle mass, have important consequences on health and physical disability. Moreover body fat distribution changes with adverse metabolic profiles and increased cardiovascular risk. The purpose of this review is to describe the basic principles and techniques for fat free mass and fat mass evaluation, highlighting the advantages and limitations of different available body composition methods.

Effect of body mass index on hemiparetic gait

OBJECTIVE

To evaluate the relationship between body mass index (BMI) and spatiotemporal, kinematic, and kinetic gait parameters in chronic hemiparetic stroke survivors.

DESIGN

Secondary analysis of data collected in a randomized controlled trial comparing two 12-week ambulation training treatments.

SETTING

Academic medical center.

PARTICIPANTS

Chronic hemiparetic stroke survivors (N = 108, >3 months poststroke)

METHODS

Linear regression analyses were performed of BMI, and selected pretreatment gait parameters were recorded using quantitative gait analysis.

MAIN OUTCOME MEASURES

Spatiotemporal, kinematic, and kinetic gait parameters.

RESULTS

A series of linear regression models that controlled for age, gender, stroke type (ischemic versus hemorrhagic), interval poststroke, level of motor impairment (Fugl-Meyer score), and walking speed found BMI to be positively associated with step width (m) (β = 0.364, P < .001), positively associated with peak hip abduction angle of the nonparetic limb during stance (deg) (β = 0.177, P = .040), negatively associated with ankle dorsiflexion angle at initial contact of the paretic limb (deg) (β = -0.222, P = .023), and negatively associated with peak ankle power at push-off (W/kg) of the paretic limb (W/kg)(β = -0.142, P = .026).

CONCLUSIONS

When walking at a similar speed, chronic hemiparetic stroke subjects with a higher BMI demonstrated greater step width, greater hip hiking of the paretic lower limb, less paretic limb dorsiflexion at initial contact, and less paretic ankle power at push-off as compared to stroke subjects with a lower BMI and similar level of motor impairment. Further studies are necessary to determine the clinical relevance of these findings with respect to rehabilitation strategies for gait dysfunction in hemiparetic patients with higher BMIs.

Functional impairment in obesity: a focus on knee and back pain

SUMMARY Cross-sectional and longitudinal evidence strongly indicate that obesity is related to physical impairment and joint pain, particularly in the lumbar spine, sacroiliac and knee joints. What is most disturbing is that obese children under 15 years are now reporting joint pain and cannot perform functional tasks as well as their nonobese counterparts. As the prevalence of obesity rises, so do the rates of musculoskeletal disease and physical dysfunction. Functional tasks that involve supporting or transferring body weight are typically painful and difficult to perform. Of most concern is that some of these tasks are simply impossible depending on the severity of obesity. As a consequence, the individual's quality of life suffers. A BMI of 35 kg/m(2) is emerging as the threshold at which functional impairment rates rise dramatically. To restore functional independence and optimize functional gains over the long term, a combination of treatments for the obese patient with joint pain may be effective. The initial use of physical therapy, pain medications or joint viscosupplementation, coupled with diet, exercise, or bariatric surgery are options for weight loss and reduction of pain symptoms. Irrespective of age, weight loss can reduce or eliminate joint pain. As body weight is reduced, so should the reliance on medication with a concomitant improvement in functional mobility.

Low weight and overweightness in older adults: risk and clinical management

The prevalence of individuals who are overweight or obese is growing exponentially in the United States and worldwide. This growth is concerning, as both overweightness and obesity lead to impaired physical function, decreased quality of life, and increased risk of chronic diseases. Additionally, overweightness and obesity are related to increased mortality among young and middle-aged adults. This weight-related risk of mortality is more ambiguous among older adults. In fact, obesity may be protective in this population, a relationship described as the "obesity paradox". In this review we discuss the effects of overweightness and obesity among the elderly on cardiovascular disease and all-cause mortality, along with the risks of low weight. We conclude by discussing the goal of weight management among older adults, focusing particularly on benefits of preserving lean body mass and muscular strength while stabilizing body fat. Ideally, overweight or mildly obese elderly individuals should devise a plan with their physicians to maintain their weight, while increasing lean body mass through a plan of healthy diet, behavioral therapy, and physical activity.

Does change in the neighborhood environment prevent obesity in older women?

Neighborhood environment is consistently associated with obesity; changes to modifiable aspects of the neighborhood environment may curb the growth of obesity in the US and other developed nations. However, currently the majority of studies are cross-sectional and thus not appropriate for evaluating causality. The goal of this study was to evaluate the effect of a neighborhood-changing intervention on changes in obesity among older women. Over the past 30 years the Portland, Oregon metropolitan region has made significant investments in plans, regulatory structures, and public facilities to reduce sprawl and increase compact growth centers, transit-oriented development approaches, and green space. We used geocoded residential addresses to link data on land-use mix, public transit access, street connectivity, and access to green space from four time points between 1986 and 2004, with longitudinal data on body mass index (BMI) from a cohort of 2003 community-dwelling women aged 66 years and older. Height and weight were measured at clinic visits. Women self-reported demographics, health habits, and chronic conditions, and self-rated their health. Neighborhood socioeconomic status was assessed from census data. Neighborhood walkability and access to green space improved over the 18-year study period. On average there was a non-significant mean weight loss in the cohort between baseline (mean age 72.6 years) and the study's end (mean age 85.0 years). We observed no association between neighborhood built environment or change in built environment and BMI. Greater neighborhood socioeconomic status at baseline was independently associated with a healthier BMI at baseline, and protected against an age-related decline in BMI over time. BMI decreases with age reflect increased frailty, especially among older adults with complex morbidities. Future research should consider the influence of the neighborhood environment on additional relevant health outcomes and should include measures of the social environment in conjunction with built environment measures.

Relationship between body mass index and rehabilitation outcomes in chronic stroke

OBJECTIVE

The aim of this study was to evaluate the relationship between body mass index (BMI) and change in motor impairment and functional mobility after a gait rehabilitation intervention in chronic stroke subjects.

DESIGN

Correlation and linear regression analyses of pretreatment and end-of-treatment Fugl-Meyer scores and modified Emory Functional Ambulation Profile scores from hemiparetic subjects (n = 108, >3 mos post stroke) who participated in a randomized controlled trial comparing two 12-wk ambulation training treatments were generated.

RESULTS

A series of linear regression models that controlled for age, sex, stroke type, interval post-stroke, and training device found the change in the Fugl-Meyer score to be significantly negatively associated with pretreatment BMI (β = -0.207, P = 0.036) and the change in the "up and go" modified Emory Functional Ambulation Profile score to be significantly positively associated with BMI (β = 0.216, P = 0.03). Changes in modified Emory Functional Ambulation Profile scores in floor, carpet, obstacles, or stair climbing were not significantly associated with BMI.

CONCLUSIONS

Chronic stroke subjects with a higher BMI were less likely to demonstrate improvement in motor impairment and up and go functional mobility performance in response to ambulation training, irrespective of treatment intervention. Stroke rehabilitation clinicians should consider BMI when formulating rehabilitation goals. Further studies are necessary to determine whether obesity is a predictor of longer-term post-stroke motor and functional recovery.

Excess weight and physical health-related quality of life in postmenopausal women of diverse racial/ethnic backgrounds

BACKGROUND

Studies of weight and health-related quality of life (HRQOL) generally focus on white populations. This analysis examines the association between clinical weight categories and physical HRQOL in five racial/ethnic groups of older women and determines the extent to which emotional/psychological (social support, caregiver burden) and physical health (diabetes, osteoarthritis) factors modify this relationship.

METHODS

The cross-sectional analysis, completed in 2007, used baseline data from postmenopausal women enrolled in the Women's Health Initiative (WHI) during the 5-year recruitment period (1993-1998).

RESULTS

Of 161,393 women, 83% were non-Hispanic white, 9% were African American, 4% were Hispanic/Latina, 3% were Asian/Pacific Islander, and <1% were American Indian/Alaska Native. Obesity (body mass index [BMI] > or =30 kg/m(2)) was most common in non-Asian minority groups. Regression modeling showed higher odds of poor physical HRQOL with increasing weight category in all groups. In the total sample, these odds were at least 6 times as high in women with class 3 obesity as in women of normal weight and were only mildly attenuated after the analysis adjusted for emotional/psychological factors. Further adjustment for physical health factors made odds ratio (OR) estimates drop from 2.36 to 1.59 for class 1 obesity and from 6.96 to 3.71 for class 3 obesity. This pattern generally persisted within each racial/ethnic group.

CONCLUSIONS

Heavier weight negatively affects physical HRQOL in postmenopausal women across diverse racial/ethnic backgrounds. Weight-relevant physical health factors have a greater impact on this weight-HRQOL association than do emotional/psychological factors.

Obesity in Older Adults: Technical Review and Position Statement of the American Society for Nutrition and NAASO, The Obesity Society

Obesity causes serious medical complications and impairs quality of life. Moreover, in older persons, obesity can exacerbate the age-related decline in physical function and lead to frailty. However, appropriate treatment for obesity in older persons is controversial because of the reduction in relative health risks associated with increasing body mass index and the concern that weight loss could have potential harmful effects in the older population. This joint position statement from the American Society for Nutrition and NAASO, The Obesity Society reviews the clinical issues related to obesity in older persons and provides health professionals with appropriate weight-management guidelines for obese older patients. The current data show that weight-loss therapy improves physical function, quality of life, and the medical complications associated with obesity in older persons. Therefore, weight-loss therapy that minimizes muscle and bone losses is recommended for older persons who are obese and who have functional impairments or medical complications that can benefit from weight loss.

[Social determinants of health in the elderly]

Health is affected throughout the course of life by characteristics of social context, which produce inequalities in terms of exposure and vulnerability. These social determinants interfere with the well-being, functional independence and quality of life of the elderly, but are generally overlooked in interventions and policies. Therefore, the aim of this study was to systematize the knowledge of the social determinants of health in the elderly, using the Dahlgren and Whitehead model as a conceptual guide. The effects of demographic changes in the aging process and morbidity profile were approached at the structural level. The conditions of life and work with impact on current and future health and the role of social cohesion were studied at the intermediate level. Lastly, the behavior and lifestyles of major risk were examined at close quarters. It was detected that equity in health requires attention to social determinants during the course of life in order to minimize chronic diseases and deficiencies of the elderly, which reflect their social positions in early life.

Obesity and weight loss in the treatment and prevention of osteoarthritis

Obesity is associated with an increasing prevalence of musculoskeletal complaints and pain. Obesity is a major risk factor for osteoarthritis (OA), and pain can manifest in load-bearing and nonload-bearing joints. The lumbar spine and the knee are 2 primary sites for pain onset in the obese patient. Irrespective of the weight loss method, reduction of body fat can lower the mechanical and inflammatory stressors that contribute to OA. Single or combined methods of weight loss including exercise, dietary modification, medications, and bariatric surgery are associated with lower joint pain and increased physical function. Methods of weight loss or maintenance in early years may reduce the life exposure of joints to the obesity induced stressors on load bearing joints.

Análise do desempenho motor associado ao estado nutricional de idosos cadastrados no Programa Saúde da Família, no município de Vitória de Santo Antão-PE

Investigar a associação entre o estado nutricional, e o desempenho das habilidades motoras, de idosos, cadastrados no Programa Saúde da Família, zona urbana, do município de Vitória de Santo Antão (PE). Estudo epidemiológico, transversal de campo do tipo descritivo-analítico. Participaram desta pesquisa 235 idosos com idade superior ou igual a 60 anos, do gênero masculino e feminino, residentes em Vitória (PE) e cadastrados nas unidades de saúde da família da zona urbana da cidade. O estado nutricional foi avaliado segundo o Índice de Massa Corporal e a Circunferência de Panturrilha. Para análise do desempenho motor foram utilizados quatro testes motores: Time Up&Go, Índice de Tinetti, Alcance Funcional e Apoio Unipodal. As associações foram verificadas segundo a correlação de Spearman. A associação do estado nutricional com os testes motores foi estatisticamente significativa entre os gêneros masculino* e feminino** (time up&go rho = 0,290*, 350**, alcance funcional rho = 0,232*, 352**, índice de Tinetti rho = 243*, 363** e apoio unipodal rho = 221*, 475**) não apresentando distinção entre sexo. A avaliação dos resultados mostrou associação entre o estado nutricional e a capacidade funcional entre os idosos independente do sexo; tendo sido a obesidade apontada como a condição nutricional limitante ao desempenho adequado nos testes.

The frailty syndrome: a comprehensive review

The frailty syndrome is defined as unintentional weight and muscle loss, exhaustion, and declines in grip strength, gait speed, and activity. Evidence with respect to the clinical definition, epidemiology, mechanisms, interactions, assessment, prevention, and treatment of frailty in the older adult is reviewed.

Coordenação global, equilíbrio, índice de massa corporal e nível de atividade física: um estudo correlacional em idosos de Ivoti, RS, Brasil

OBJETIVO: Buscou-se verificar se existe correlação entre o índice de massa corporal, nível de atividade física em METs, coordenação global e equilíbrio estático de idosos da cidade de Ivoti, RS. MATERIAIS E MÉTODOS: estudo descritivo de corte transversal que avaliou 202 idosos, de ambos os gêneros, residentes em Ivoti-RS e selecionados por conveniência. Para as avaliações foram utilizados testes de coordenação global e de equilíbrio, o Questionário Internacional de Atividade Física (IPAQ) formato curto, e calculado o Índice de Massa Corporal segundo os pontos de corte propostos: desnutrição: <22,0 kg/m², eutrofia: de 22,0 a 27,0 kg/m² e obesidade: >27,0 kg/m². O nível de atividade foi classificado em Mets-min/semana como: muito ativo de 1500 a 3000 Mets-min./semana; suficientemente ativo, entre 1499 e 600 Mets-min./semana e insuficientemente ativo, menos de 600 Mets-min./semana. Os dados foram submetidos à estatística descritiva e correlação de Spearman (α = 0,05), através do programa SPSS, versão 16.0. O estudo foi aprovado pelo CEP da Universidade Feevale, Novo Hamburgo, RS. RESULTADOS: A amostra foi composta por 62 (30,7%) homens e 140 (69,3%) mulheres, idade média masculina de 69,53 ± 6,23 e feminina de 67,52 ± 5,69 anos. A idade média geral da amostra foi de 68,14 ± 5,92 anos. Foram verificadas associações negativas entre as variáveis IMC e coordenação global e IMC e equilíbrio, r= -0,423 (p<0,01) e r= -0,3060 (p<0,01) respectivamente. Porém, quando estratificadas por gênero, essas associações não foram significativas nos homens. O nível de atividade física demonstrou correlação negativa com a variável IMC (r= -0,219) e com a idade (r= -0,241); da mesma forma, apresentou correlação positiva com a coordenação motora (r= 0,274) e o equilíbrio (r=0,191). Mas o IMC e o equilíbrio, assim como a idade e o equilíbrio, não apresentaram correlação nas pessoas idosas suficientemente ativas. A coordenação global e o equilíbrio estão relacionados positivamente ao nível de atividade física apenas nas mulheres. Entretanto, o IMC está relacionado negativamente ao nível de atividade física em ambos os sexos. CONCLUSÃO: Para as mulheres da amostra, o alto valor do IMC gerou possivelmente resultados inferiores no desempenho dos testes de coordenação global e equilíbrio. Tal fato não pôde ser observado entre os homens, mas constatou-se correlação positiva entre o nível de atividade física em METs totais, coordenação global e equilíbrio na amostra total do estudo.

Obesity and fracture in men and women: an epidemiologic perspective

In Western societies, mean body weight has increased dramatically in older people, and a similar trend exists in Asia. Yet insufficient attention has been directed to the problem of osteoporotic fractures in the overweight and obese. Many, if not most, osteoporotic fractures occur in overweight or obese people, and obese men may be particularly susceptible. We discuss the potential implications of these findings, including the challenge of identifying individuals at highest risk, screening and treatment strategies, and future research directions.

Obese elderly women exhibit low postural stability: a novel three-dimensional evaluation system

OBJECTIVE

The aim of this study was to evaluate the multisegmental static postural balance of active eutrophic and obese elderly women using a three-dimensional system under different sensory conditions.

METHODS

A cross-sectional study was conducted on 31 elderly women (16 eutrophic and 15 obese) aged 65 to 75 years. The following anthropometric measurements were obtained: weight, height, waist and hip circumference, and handgrip strength. The physical activity level was evaluated using the International Physical Activity Questionnaire. Body composition was measured using the deuterium oxide dilution technique. The Polhemus(®) Patriot (three-dimensional) equipment was used to measure the parameters of postural balance along the anteroposterior and laterolateral axes. The data acquisition involved one trial of 60 s to test the limit of stability and four trials of 90 s each under the following conditions: (1) eyes open, stable surface; (2) eyes closed, stable surface; (3) eyes open, unstable surface; and (4) eyes closed, unstable surface.

RESULTS

For the limit of stability, significant differences were observed in the maximum anteroposterior and laterolateral displacement (p<0.01) and in the parameter maximum anteroposterior displacement in the eyes closed stable surface condition (p<0.01) and maximum anteroposterior and laterolateral displacement in the eyes open unstable surface (p<0.01 and p = 0.03) and eyes closed unstable surface (p<0.01 and p<0.01) conditions.

CONCLUSIONS

Obese elderly women exhibited a lower stability limit (lower sway area) compared with eutrophic women, leaving them more vulnerable to falls.

Obesity and use of compensatory strategies to perform common daily activities in pre-clinically disabled older adults

OBJECTIVES

To examine the association between the use of compensatory strategies to successfully complete common daily activities-an indicator of pre-clinical disability-and body mass in pre-clinically disabled older adults.

DESIGN

Cross-sectional observational study.

PARTICIPANTS

Two hundred and fifty-nine pre-clinically disabled older adults defined as having changed the frequency or manner of performing daily tasks without reporting any difficulty.

MEASUREMENTS

The use of compensatory strategies were objectively evaluated using the Modification (MOD) scale-a reliable and valid scale for assessing the manner in which common daily activities were completed. Height and weight were measured to classify participants into the following body mass index (BMI) categories: (1) normal: 18.5-24.9 kg/m(2), (2) overweight: 25.0-29.9 kg/m(2), (3) obese class I: 30.0-34.9 kg/m(2), and (4) obese class II: 35.0-39.9 kg/m(2).

RESULTS

Compared to other BMI categories, individuals with class II obesity demonstrated a significantly higher probability of using ≥1 compensatory strategies when rising from a chair (30 cm height), kneel to stand, stair ascent, stair descent, and supine to stand tasks. When summarized over all tasks, individuals with class II obesity were 18 times more likely to use extensive compensatory strategies (≥6 on MOD scale) compared to normal weight older adults. Similar trends at a lesser magnitude were found in obese and overweight compared to normal weight older adults.

CONCLUSION

Obesity is associated with extensive use of compensatory strategies when performing common daily tasks prior to the onset of perceived difficulty, thus placing them at higher risk of disability compared to their peers with lower body mass.

Obesity and knee osteoarthritis are not associated with impaired quadriceps specific strength in adults

OBJECTIVE

To assess whether adults, aged 50-59 years, who are obese or moderately to severely obese have impaired quadriceps strength and muscle quality in comparison with adults who are not obese, both groups with and without knee osteoarthritis (OA).

DESIGN

Cross-sectional observational study.

SETTING

Rural community acquired sample.

SUBJECTS

Seventy-seven men and 84 women, aged 50-59 years.

METHODS

Comparisons by using mixed models for clustered data (2 lower limbs per participant) between groups defined by body mass index (BMI) (<30 kg/m(2), 30-35 kg/m(2), and ≥35 kg/m(2)), with and without knee OA MAIN OUTCOME MEASUREMENT: The slope of the relationship between quadriceps muscle cross-sectional area (CSA) and isokinetic knee extensor strength (dynamometer) in each BMI and OA group.

RESULTS

There were 113 limbs (48.7% women), 101 limbs (38.6% women), and 89 limbs (73.0% women) in the <30 kg/m(2), 30-35 kg/m(2), and ≥35 kg/m(2) BMI groups, respectively; knee OA was present in 10.6%, 28.7%, and 58.4% of the limbs in each of these respective groups. Quadriceps CSA did not significantly differ among BMI groups in either gender or between subjects with and without knee OA. Peak quadriceps strength also did not significantly differ by BMI group or by the presence of knee OA. Multivariable analyses also demonstrated that peak quadriceps strength did not differ by BMI group, even after adjusting for (a) gender, (b) OA status, (c) intramuscular fat, or (d) quadriceps attenuation. The slopes for the relationships between quadriceps strength and CSA did not differ by BMI group, OA status, or their interaction.

CONCLUSIONS

Individuals who were obese and at risk for knee OA did not appear to have altered muscle strength or muscle quality compared with adults who were not obese and were aged 50-59 years. The absence of a difference in the relationship between peak quadriceps strength and CSA provided further evidence that there was not an impairment in quadriceps muscle quality in this cohort, which suggests that factors other than strength might mediate the association between obesity and knee OA.

The impact of weight and fat mass loss and increased physical activity on physical function in overweight, postmenopausal women: results from the Women on the Move Through Activity and Nutrition study

OBJECTIVE

The aim of this study was to determine whether changes in leisure time physical activity (LTPA) and body composition reflect concomitant changes in 400-meter walk time.

METHODS

Data were collected at the baseline and 48-month visits in the Women on the Move Through Activity and Nutrition study. At baseline, participants (n = 508) were randomized to the lifestyle intervention or health education group. The lifestyle intervention focused on weight (7%-10%) and waist circumference reduction through healthy lifestyle behavior change. Change in walk time over 48 months was the primary outcome. Secondary measures included change in LTPA and body composition measures including, body weight, body mass index, waist circumference, and dual-energy x-ray absorptiometry--derived fat and lean mass.

RESULTS

Increased LTPA and reductions in body weight, body mass index, waist circumference, and fat mass were associated with decreased walk time from baseline to 48 months (P < 0.01). After stratification by group, LTPA was no longer significantly related to walk time in the health education group.

CONCLUSIONS

Increased LTPA and weight loss resulted in improved physical function, as measured by the 400-meter walk, in a group of overweight, postmenopausal women. These findings support the use of the 400-meter walk to evaluate progress in physical activity or weight loss programs.

Association of body mass index with self-report and performance-based measures of balance and mobility

BACKGROUND

The incidence of obesity is increasing in older adults, with associated worsening in the burden of disability. Little is known about the impact of body mass index (BMI) on self-report and performance-based balance and mobility measures in older adults.

OBJECTIVE

The purposes of this study were (1) to examine the association of BMI with measures of balance and mobility and (2) to explore potential explanatory factors.

DESIGN

This was a cross-sectional, observational study.

METHODS

Older adults (mean age=77.6 years) who participated in an ongoing observational study (N=120) were classified as normal weight (BMI=18.5-24.9 kg/m(2)), overweight (BMI=25.0-29.9 kg/m(2)), moderately obese (BMI=30.0-34.9 kg/m(2)), or severely obese (BMI ≥ 35 kg/m(2)). Body mass index data were missing for one individual; thus, data for 119 participants were included in the analysis. Mobility and balance were assessed using self-report and performance-based measures and were compared among weight groups using analysis of variance and chi-square analysis for categorical data. Multiple linear regression analysis was used to examine the association among BMI, mobility, and balance after controlling for potential confounding variables.

RESULTS

Compared with participants who were of normal weight or overweight, those with moderate or severe obesity were less likely to report their mobility as very good or excellent (52%, 55%, 39%, and 6%, respectively); however, there was no difference in self-report of balance among weight groups. Participants with severe obesity (n=17) had the lowest levels of mobility on the performance-based measures, followed by those who were moderately obese (n=31), overweight (n=42), and of normal weight (n=29). There were no differences on performance-based balance measures among weight groups. After controlling for age, sex, minority status, physical activity level, education level, and comorbid conditions, BMI still significantly contributed to mobility (β=-.02, adjusted R(2)=.41).

CONCLUSIONS

Although older adults with severe obesity were most impaired, those with less severe obesity also demonstrated significant decrements in mobility.

Hand Grip Strength: age and gender stratified normative data in a population-based study

BACKGROUND

The North West Adelaide Health Study is a representative longitudinal cohort study of people originally aged 18 years and over. The aim of this study was to describe normative data for hand grip strength in a community-based Australian population. Secondary aims were to investigate the relationship between body mass index (BMI) and hand grip strength, and to compare Australian data with international hand grip strength norms.

METHODS

The sample was randomly selected and recruited by telephone interview. Overall, 3 206 (81% of those recruited) participants returned to the clinic during the second stage (2004-2006) which specifically focused on the collection of information relating to musculoskeletal conditions.

RESULTS

Following the exclusion of 435 participants who had hand pain and/or arthritis, 1366 men and 1312 women participants provided hand grip strength measurement. The study population was relatively young, with 41.5% under 40 years; and their mean BMI was 28.1 kg/m2 (SD 5.5). Higher hand grip strength was weakly related to higher BMI in adults under the age of 30 and over the age of 70, but inversely related to higher BMI between these ages. Australian norms from this sample had amongst the lowest of the hand grip strength of the internationally published norms, except those from underweight populations.

CONCLUSIONS

This population demonstrated higher BMI and lower grip strength in younger participants than much of the international published, population data. A complete exploration of the relationship between BMI and hand grip strength was not fully explored as there were very few participants with BMI in the underweight range. The age and gender grip strength values are lower in younger adults than those reported in international literature.

Race/Ethnicity differences in the relationship between obesity and gait speed among older Americans

Projections indicate that the older American population will become more racially diverse in the future. Therefore, eliminating health disparities among older adults should be a public health priority. Using data from the 1999-2002 National Health and Nutrition Examination Survey, we examined the relationship between obesity, measured by BMI and waist circumference, and gait speed, a performance-based measure of physical function, in 2,285 older adults (≥60 y) in order to determine whether this relationship varies by race/ethnicity. Overweight and obesity, indicated by a BMI ≥ 25 kg/m(2) and a waist circumference in quartiles 3 (male: 102.4-109.9 cm; female: 97.3-106.3 cm) and 4 (male: 110.2-156.6 cm; female: 106.4-147.5 cm), were associated with slower gait speed in non-Hispanic Whites. Among non-Hispanic Blacks, only extreme obesity, indicated by a BMI ≥ 35 kg/m(2) and a waist circumference in quartile 4 (male: 110.2-149.6 cm; female: 106.4-137.7 cm), was associated with a slower gait speed. Among Mexican Americans, only extreme obesity, indicated by a BMI ≥ 35 kg/m(2), was associated with a slower gait speed. Thus we found the relationship between obesity and gait speed differed by race/ethnicity. The goal of eliminating health disparities in access to and quality of health care is only possible when differences in the associations between possible risk factors and physical function are identified.

Physical performance is associated with executive functioning in older african american women

An older adult's ability to perform physical tasks is predictive of disability onset and is associated with declines in cognition. Risk factors for physical performance declines among African Americans, a group with the highest rates of disability, remain understudied. This study sought to identify demographic, health, and cognitive factors associated with lower-extremity physical performance in a sample of 106 African American women ages 56 to 91. After controlling for global cognitive functioning (Mini Mental State Exam), physical performance was associated with executive functioning (Stroop Color/Word), but not visuospatial construction (WASI Block Design) or processing speed (Trail Making Test, Part A). Executive functioning remained associated with physical performance after entry of demographic variables, exercise, depression, disease burden, and body mass index (BMI). Age, and BMI were also significant in this model. Executive functioning, age and BMI are associated with lower-extremity physical performance among older African American women.

Obesity and mobility disability in the older adult

Mobility disability is becoming prevalent in the obese older population (> or = 60 years of age). We included a total of 13 cross-sectional and 15 longitudinal studies based on actual physical assessments of mobility in the obese older population in this review. We systematically examined existing evidence of which adiposity estimate best predicted mobility disability. Cross-sectional studies (82-4000 participants) showed poorer lower extremity mobility with increasing obesity severity in both men and women. All longitudinal studies (1-22 years) except for one, reported relationships between adiposity and declining mobility. While different physical tests made interpretation challenging, a consistent finding was that walking, stair climbing and chair rise ability were compromised with obesity, especially if the body mass index (BMI) exceeded 35 kg m(-2). More studies found that obese women were at an increased risk for mobility impairment than men. Existing evidence suggests that BMI and waist circumference are emerging as the more consistent predictors of the onset or worsening of mobility disability. Limited interventional evidence shows that weight loss is related with increased mobility and lower extremity function. Additional longitudinal studies are warranted that address overall body composition fat and muscle mass or change on future disability.

Obesity in older adults: relationship to functional limitation

PURPOSE OF REVIEW

The present review is intended to provide a critical overview of recent investigations of obesity among older persons with emphasis upon associated functional limitations, potential for intervention, and a future research agenda.

RECENT FINDINGS

Obesity is growing in prevalence among older persons. The association between obesity and functional decline is well documented. Recent findings suggest possible contributions of obesity-associated inflammatory milieu, sarcopenia, and impairment of muscle function/strength to adverse functional outcomes. A growing body of literature supports consideration of moderate weight reduction to secure improved metabolic and functional parameters for obese older persons.

SUMMARY

Obesity is associated with an unfortunate burden of chronic disease, functional limitation, and poor life quality. In view of the growing numbers of afflicted older individuals, there must be research priority to discern how obesity impacts function so that appropriate prevention and treatment strategies may be adopted.

High BMI and waist circumference are associated with a high prevalence of comorbidities in older Americans Act programs in Georgia senior centers

OBJECTIVE

This study characterized the relationship of body mass index (BMI) and high waist circumference (WC) with the prevalence of selected comorbidities among older adults receiving nutrition and wellness services from Georgia's Older Americans Act programs at senior centers.

METHODS

Participants were a convenience sample (N = 759, mean age = 75 years, 81% female, 63% white, 36% black). Correction factors were applied to measured WC and to measured and self-reported height and weight.

RESULTS

The prevalence of several comorbidities showed striking relationships with WC and BMI, independent of age, gender, and race.

CONCLUSION

The health burden of overweight/obesity is very high in these older adults creating an urgent need for evidence-based nutrition, physical activity programs, and therapeutic lifestyle counseling to prevent and manage weight-related comorbidities.

A influência do exercício físico no perfil lipídico e na aptidão física em mulheres idosas

Resumo Objetivo: Avaliar a influência do nível de atividade física no perfil lipídico, na glicose sanguínea, na composição corporal, na aptidão cardiovascular (VO2max), na aptidão muscular e na agilidade/equilíbrio em mulheres idosas. Métodos: Para verificar interferência do nível de atividade física nos níveis lipídicos, glicêmicos, de composição corporal e de aptidão física, foi utilizado o teste t de Student independente, precedido do teste de normalidade de Shapiro-Wilks. Foram avaliadas 23 mulheres com mais de 60 anos, divididas em um grupo ativo (GA) e grupo inativo (GI) segundo classificação do IPAQ. Resultados: Mulheres idosas do grupo ativo apresentaram valores significativamente superiores no teste de agilidade/equilíbrio e idade média superior ao do grupo inativo. Além disso, o grupo ativo apresentou valores superiores na massa de gordura, massa corporal magra e força de membros inferiores, mas não estatisticamente significativos. De forma inversa, o colesterol total, triglicérides e a glicose sanguínea mostraram-se inferiores no grupo ativo, mas também não estatisticamente significativos. As demais variáveis antropométricas, perfil qualitativo alimentar, e demais testes de aptidão física não mostraram diferenças entre os grupos. Conclusão: Conclui-se que a adoção e manutenção de um estilo de vida ativo, mesmo em idades avançadas, por meio da atividade física, têm efeitos benéficos na manutenção da independência de pessoas idosas.

Obesity paradox in the elderly: is fatter really fitter?

Obesity is a highly prevalent metabolic disorder affecting most of the world and all sections of society, from young children to the elderly. Obesity is a common problem in the elderly, and is associated with increased all-cause and cardiovascular morbidity and mortality. Impaired physical function and decreased quality of life accompany development of the complications associated with obesity, such as diabetes and vascular disorders. Despite these adverse associations, numerous studies indicate an ‘obesity paradox’, in that overweight and obese patients with cardiovascular diseases including heart failure, hypertension and coronary heart disease have a favorable prognosis. Here, we summarize the supporting evidence for the obesity paradox in elderly adults with these cardiovascular conditions, discuss the pros and cons of being obese and conclude with a statement on the optimal weight for a healthy living.

Relationship of a lifelong physical workload with physical function and low back pain in retired women

BACKGROUND AND AIMS

The effect of heavy work-related physical loads (WRPL) on low back pain (LBP) and impaired physical function has been studied extensively in active workers but not in pensioners.

METHODS

We compared LBP and physical function in post-menopausal pensioners, divided according to their life-long WRPL into 114 heavy physical workers (HPW), and 391 light physical workers (LPW). LBP and physical function (domains of mobility, home routines) were scored by a questionnaire. Data on age, age at menopause, number of years in retirement, age at menarche, number of pregnancies, body mass index (BMI), femoral neck bone density, WRPL, years spent at work, and smoking were also collected.

RESULTS

HPW were older (p=0.004), had worked fewer years (p=0.001), had reduced mobility (p=0.001), worse LBP (p=0.001) and performed home routine activities worse (p=0.001) than LPW. Logistic regression adjusted for confounders (LBP, home routines and mobility dichotomised at the median) showed that heavy WRPL, aging and high BMI were LBP risk factors, whereas heavy WRPL, high BMI and early menopause were mobility risk factors. The area under receiver-operating characteristic curves showed that predicted probabilities, derived from logistic models, predicted mobility (area 0.816, SE 0.020) better than pain (area 0.643, SE 0.024) (Hanley McNeil test p<0.001).

CONCLUSIONS

Lifelong heavy WRPL and high BMI seem to be risk factors for worse LBP and mobility in retired women. Mobility seems to be especially affected by these risk factors, and should be further investigated for prevention purposes.

The impact of obesity and arthritis on active life expectancy in older Americans

This article examines the relationship of obesity and arthritis to length of life and length of disabled life in older American men and women. Secondary data analysis is conducted on three waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey (n = 7,381). Using integrated Markov chains, total, active, and disabled life expectancy in Americans aged > or =70 is estimated, with and without obesity and arthritis. Results indicate that neither obesity nor arthritis is related to the length of life for older men and women, alone or in combination. However, both conditions are significantly individually associated with increased length of disabled life in older men (1.4 years attributable to obesity; 1.2 years to arthritis at age 70; P < 0.05) and women (1.7 years attributable to obesity; 2.1 years to arthritis at age 70; P < 0.05). In addition, the combination of the two is significantly related to decreased active life, with nearly 50 and 60% of remaining life for 70-year-old men and women lived with disability, respectively (P < 0.05). Coupled with the fact that both obesity and arthritis are growing in prevalence, these findings represent one of the few clearly negative health trends in older adults today. These results should provide incentives for health-care professionals to make concerted efforts to address both conditions in clinical settings.

Excessive adipose tissue infiltration in skeletal muscle in individuals with obesity, diabetes mellitus, and peripheral neuropathy: association with performance and function

BACKGROUND AND PURPOSE

The primary purpose of this study was to report differences in calf intermuscular adipose tissue (IMAT), muscle strength (peak torque), power, and physical function in individuals with obesity, diabetes mellitus (DM), and peripheral neuropathy (PN) compared with those without these impairments. A secondary purpose was to assess the relationship between IMAT and muscle strength, power, and physical function.

SUBJECTS AND METHODS

Six participants with obesity, DM, and PN (2 women, 4 men; mean age=58 years, SD=10; mean body mass index=36.3, SD=5; mean modified Physical Performance Test [PPT] score=22, SD=3) and 6 age- and sex-matched control subjects without these impairments were assessed and compared in muscle strength, muscle power, physical functioning, and muscle and fat volume, including IMAT in the calf muscles. Muscle, adipose tissue, and IMAT volumes of each calf were quantified by noninvasive magnetic resonance imaging. Muscle strength and power of the plantar-flexor and dorsiflexor muscles were quantified using isokinetic dynamometry. The modified PPT was used to assess physical function.

RESULTS

Leg muscle and fat volumes were similar between groups, although IMAT volumes were 2.2-fold higher in the subjects with obesity, DM, and PN (X=120 cm(3), SD=47) than in the control subjects (X=54 cm(3), SD=41). Muscle strength, muscle power, ratio of leg muscle power to leg muscle volume, and modified PPT scores were lower in subjects with obesity, DM, and PN compared with the control subjects.

DISCUSSION AND CONCLUSION

The data indicate that excess fat infiltration in leg skeletal muscles is associated with low calf muscle strength, low calf muscle power, and impaired physical function in individuals who are obese with DM and PN.

Regular vigorous physical activity and disability development in healthy overweight and normal-weight seniors: a 13-year study

OBJECTIVES

We examined the relationship of regular exercise and body weight to disability among healthy seniors.

METHODS

We assessed body mass index (BMI) and vigorous exercise yearly (1989-2002) in 805 participants aged 50 to 72 years at enrollment. We studied 4 groups: normal-weight active (BMI< 25 kg/m(2); exercise> 60 min/wk); normal-weight inactive (exercise<or= 60 min/wk); overweight active (BMI>or= 25 kg/m(2)); and overweight inactive. Disability was measured with the Health Assessment Questionnaire (0-3; 0= no difficulty, 3= unable to do). We used multivariable analysis of covariance to determine group differences in disability scores after adjustment for determinants of disability.

RESULTS

The cohort was 72% men and 96% White, with a mean age of 65.2 years. After 13 years, overweight active participants had significantly less disability than did overweight inactive (0.14 vs 0.19; P= .001) and normal-weight inactive (0.22; P= .03) participants. Similar differences were found between normal-weight active (0.11) and normal-weight inactive participants (P< .001).

CONCLUSIONS

Being physically active mitigated development of disability in these seniors, largely independent of BMI. Public health efforts that promote physically active lifestyles among seniors may be more successful than those that emphasize body weight in the prevention of functional decline.

Relative contributions of adiposity and muscularity to physical function in community-dwelling older adults

OBJECTIVE

To determine the relative contributions of adiposity and muscularity to multi-dimensional performance-based and perceived physical function in older adults living independently.

METHODS AND PROCEDURES

Data from 109 women and men, aged 60 or older, with low serum dehydroepiandrosterone (DHEA) sulfate levels were included in this cross-sectional analysis of baseline measures from a single-site, randomized, controlled trial of DHEA replacement therapy. Physical function was determined by means of performance on the 100-point Continuous Scale-Physical Functional Performance (CS-PFP) test and by self-reporting using the physical function subscale of the Medical Outcomes Short Form-36 (SF36PF). Body composition was measured by dual-energy X-ray absorptiometry (DXA). Linear regression analyses were used to determine the contributions of body mass index (BMI; kg body mass/m2), fat index (FI; kg fat/m2), and appendicular skeletal muscle index (ASMI; kg muscle/m2) to the CS-PFP and SF36PF scores, adjusted for age and sex.

RESULTS

Age-adjusted regression analyses indicated that FI, but not ASMI, was a significant (P<0.001) determinant of CS-PFP (R2=0.54) and SF36PF (R2=0.37). When adjusted for age and sex, BMI was nearly as good a predictor of CS-PFP (R2=0.50) and SF36PF (R2=0.34) as FI.

DISCUSSION

Adiposity was a stronger predictor of measured and self-reported physical function than was muscularity in older adults living independently. BMI, adjusted for sex, is a reasonable substitute for adiposity in the prediction of physical function.

Quality of life in obese postmenopausal women

The aim of this review was to identify the ways in which obesity affects the health-related quality of life (HRQoL) of postmenopausal women. This was considered important because a growing body of literature has identified obesity as a significant predictor for a poor psychological wellbeing and negative HRQoL, particularly in women, and because during the transition through the menopause women tend to accumulate more body weight. After searching eight electronic databases, only nine papers appeared meaningful. Although a meta-analysis was not possible, we found that a body mass index (BMI) >30 kg/m2 was associated with a poor HRQoL in postmenopausal women; particularly in the areas associated with physical functioning, energy and vitality, and health perceptions. Thus, clinical management of obese postmenopausal women should focus on weight reduction and exercise in an attempt to improve wellbeing in these areas. However, the paucity of research, the different instruments chosen to measure HRQoL and the methodological limitations of the studies identified, prevented firm conclusions being made about whether the relationship between BMI and HRQoL is linear in postmenopausal women. Further research is needed to explore this relationship; particularly in comparison with underweight postmenopausal women and obese premenopausal women, where a few papers have identified these women as having a worse HRQoL than their obese postmenopausal counterparts. Other measures of central adiposity, including waist circumference and waist-hip ratio are recommended as useful supplemental measures to BMI in future studies.

Individualizing recommendations for weight management in the elderly

PURPOSE OF REVIEW

This review provides current strategies for weight management in the elderly population as it can be different from young adults due to multiple factors: co-morbidities, polypharmacy, limitation of functional activities, social issues.

RECENT FINDINGS

The recommendations for weight management for all age groups include exercise, diet, pharmacotherapy and surgery. In the elderly population, because of changes in age-related body composition, reduced energy requirement and expenditure, the standard young adult recommendations cannot be applied directly. The goal of weight management in the elderly differs from the young adult. The preferred method is maintenance of weight rather than aggressive weight loss with achieving a healthy, functional, and good quality of life.

SUMMARY

The growing prevalence of obesity in the elderly population is becoming a major health problem and can affect functional status, can contribute to frailty and decline in activity, as well as worsening co-morbid medical problems. Practical recommendations for weight management in the elderly are challenging because of the obesity paradox in the elderly, and the lack of substantial research in this population. Individualized recommendations should be considered for elderly patients with a focus on the underlying medical problems, functional status and living environments.