The relationships between muscle strength, biomechanical functional moments and health-related quality of life in non-elite older adults

Effects of Postural Conditions During Magnetic Resonance Imaging on Thigh Muscle Size

Magnetic resonance imaging (MRI) is the gold standard for measuring muscle size. However, postural conditions for thigh musculature have not been standardized across studies, with some employing supine or prone positions and the thigh either placed on the examination table or suspended to avoid contact. In either case, the thigh is compressed or sagged by gravity, potentially affecting muscle size. This study aimed to examine the effects of postural conditions on thigh muscle size. Twenty Olympic-style weightlifters and 20 untrained controls (10 men and 10 women in each group) underwent 3-Tesla MRI in the supine and prone positions, with the thigh in compressed and suspended conditions to determine the maximal anatomical cross-sectional area (ACSAmax) and muscle volume of 15 thigh muscle groups/individual muscles. Postural conditions changed the ACSAmax of the quadriceps (range of postural-related changes: 1.0%-7.9%), hamstrings (0.8%-19.1%), and adductors (2.4%-19.2%). Regardless of measurement position, the total volume of thigh muscles decreased under compressed conditions (0.6%-3.8%). Quadriceps and adductors decreased in muscle volume under compressed conditions (0.9%-4.0% and 0.8%-6.6%), while hamstrings increased (1.4%-9.3%). Male weightlifters, who possessed the largest thigh muscle volume, showed greater postural-related changes in the muscle volume of quadriceps, hamstrings, and adductors than the other subgroups. Therefore, postural conditions during MRI substantially change thigh muscle size, and the magnitude of the change depends on muscle size. Our results provide in vivo evidence of the compressive behavior of thigh muscles and a new technical perspective for assessing thigh muscle size.

Instruments for measuring the neuromuscular function domain of vitality capacity in older persons: an umbrella review

PURPOSE

Recently, handgrip, knee extensor and respiratory muscle strength were proposed as candidate biomarkers to assess the neuromuscular function of vitality capacity in older persons. This umbrella review aims to provide an overview of the available instruments and their measurement properties to assess these biomarkers.

METHODS

The databases PubMed, Web of Science and Embase were systematically screened for systematic reviews and meta-analyses reporting on handgrip, knee extensor or respiratory muscle strength assessments, resulting in 7,555 articles. The COSMIN checklist was used to appraise psychometric properties and the AMSTAR for assessing methodological quality.

RESULTS

Twenty-seven systematic reviews were included in this study. Some of the identified reviews described the psychometric properties of the assessment tools. We found five assessment tools that can be used to measure neuromuscular function in the context of healthy ageing. Those are the handheld dynamometer for handgrip strength, the dynamometer for knee extensor strength and regarding respiratory muscle strength, the sniff nasal inspiratory pressure, maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP).

CONCLUSION

The handheld dynamometer for hand grip strength, the dynamometer for knee extensor strength, sniff nasal inspiratory pressure, MIP and MEP were identified. Therefore, these assessments could be used to identify community-dwelling older adults at risk for a declined neuromuscular function in the context of vitality capacity.

Factors associated with health-related quality of life among community-dwelling older adults: the APPCARE study

This study aimed to identify the factors associated with health-related quality of life (HRQOL) among community-dwelling older adults. Physical and mental HRQOL were measured by the 12-item Short Form Health Survey (SF-12) at baseline and follow-up. Linear regression models were used to evaluate associations between socio-demographic, health, and lifestyle factors and HRQOL. The sample included 661 participants (mean age = 77.4 years). Frailty was negatively associated with physical HRQOL (B = - 5.56; P < 0.001) and mental HRQOL (B = - 6.65; P < 0.001). Participants with a higher score on activities of daily living (ADL) limitations had lower physical HRQOL (B = - 0.63; P < 0.001) and mental HRQOL (B = - 0.18; P = 0.001). Female sex (B = - 2.38; P < 0.001), multi-morbidity (B = - 2.59; P = 0.001), and a high risk of medication-related problems (B = - 2.84; P < 0.001) were associated with lower physical HRQOL, and loneliness (B = - 3.64; P < 0.001) with lower mental HRQOL. In contrast, higher age (B = 2.07; P = 0.011) and living alone (B = 3.43; P < 0.001) were associated with better mental HRQOL in the multivariate models. Future interventions could be tailored to subpopulations with relatively poor self-reported HRQOL, such as frail or lonely older adults to improve their HRQOL.

Arsenic disrupts extracellular vesicle-mediated signaling in regenerating myofibers

Chronic exposure to environmental arsenic is a public health crisis affecting hundreds of millions of individuals worldwide. Though arsenic is known to contribute to many pathologies and diseases, including cancers, cardiovascular and pulmonary diseases, and neurological impairment, the mechanisms for arsenic-promoted disease remain unresolved. This is especially true for arsenic impacts on skeletal muscle function and metabolism, despite the crucial role that skeletal muscle health plays in maintaining cardiovascular health, systemic homeostasis, and cognition. A barrier to researching this area is the challenge of interrogating muscle cell-specific effects in biologically relevant models. Ex vivo studies investigating mechanisms for muscle-specific responses to arsenic or other environmental contaminants primarily utilize traditional 2-dimensional culture models that cannot elucidate effects on muscle physiology or function. Therefore, we developed a contractile 3-dimensional muscle construct model-composed of primary mouse muscle progenitor cells differentiated in a hydrogel matrix-to study arsenic exposure impacts on skeletal muscle regeneration. Muscle constructs exposed to low-dose (50 nM) arsenic exhibited reduced strength and myofiber diameter following recovery from muscle injury. These effects were attributable to dysfunctional paracrine signaling mediated by extracellular vesicles (EVs) released from muscle cells. Specifically, we found that EVs collected from arsenic-exposed muscle constructs recapitulated the inhibitory effects of direct arsenic exposure on myofiber regeneration. In addition, muscle constructs treated with EVs isolated from muscles of arsenic-exposed mice displayed significantly decreased strength. Our findings highlight a novel model for muscle toxicity research and uncover a mechanism of arsenic-induced muscle dysfunction by the disruption of EV-mediated intercellular communication.

Castillo M, Rodríguez-Blázquez C. Health state perception of people close to retirement age: Relationship with lifestyle habits and subjects' characteristics

Aim

Societal ageing increases the need for correct and healthy ageing to ensure the well-being of older adults. Practical strategies are needed to acquire healthy habits for the ageing process. This study aims to analyse the lifestyle habits of subjects who are retired or close to retirement and identify factors that could influence their perceived health and that could be related to these habits.

Methods

A Spanish observational, descriptive, cross-sectional study of subjects close to retirement-age. Socio-demographic, family, work, leisure, social, and clinical-psychological indicators were evaluated.

Results

1,700 participants (581 employed; 714 retirees; 405 other-status) were included, average age 63 years, 52% women. Most reported a satisfactory social life (90%), were in live-in relationships (74%), non-smoking (80%), followed a Mediterranean diet (73%), and took medicines daily (70%). Perceived health (EQ-VAS) was 75.9/100, with low disability (12-WHODAS) (7.4/100) and moderate/severe depression. Women reported higher disability (p < 0.001) and depression (p < 0.001), a better social life, and healthier lifestyle, but lower physical/work activity. Retirees reported less depression, better social life, healthier lifestyle, higher physical/work activity, and better sleeping habits. The multivariate model showed a significant association of health-status with disability level, number of chronic diseases, sleep habits, exercise, diet, and alcohol consumption. When depression level was introduced, age and being a woman were also related.

Conclusions

Retirement does not mean worse health but rather an opportunity to reinforce favourable health activities and improve lifestyle factors. Incorporating the differences related to gender and employment status in health-perception will facilitate the design of healthy ageing strategies.

The contribution of motor efficiency to drawing performance of older people with and without signs of cognitive decline

In clinical practice, different drawing tests are used for the assessment of cognitive efficiency in the geriatric population. However, so far, the contribution of motor skills to drawing performance has not been sufficiently examined in the late adult life span. This study was aimed at disentangling the role played by motor functioning in three well-known drawing tests that in the clinical field are commonly used to detect some signs of cognitive impairment of older individuals. One hundred and forty-nine community dwellers (M_age = 77.4 years, SD = 5.9 years) completed a battery of tests assessing global cognitive efficiency, drawing skills (i.e., Clock Drawing, Visuo-spatial Drawing ACE-R, Copy Figures Tests), handgrip muscular strength (HGS), and functional mobility (assessed through the Timed-Up-and-Go test). Significant relationships were found among those measures. Moreover, handgrip strength and functional mobility explained 12-19% of the variance in each drawing condition. Finally, participants exhibiting poorer HGS performed worse the drawing tasks and were successively recognized as cognitively deteriorated. In conclusion, these findings highlight that motor skills can significantly impact the assessment of cognitive efficiency in late adulthood. Therefore, in clinical practice, the concurrent assessment of basic motor functions (in terms of muscular strength and functional mobility) and cognitive efficiency of the geriatric population at risk for cognitive decline should be encouraged.

Associations of Handgrip Asymmetry With Impaired Health-Related Quality of Life Among Older Adults in South Korea: A Cross-Sectional Study Using National Survey Data

This study aimed to examine the associations of handgrip strength (HGS) and asymmetry with health-related quality of life among South Korean older adults. We enrolled 7395 older adults from the Korea National Health and Nutrition Examination Survey. Health-related quality of life was measured using the EuroQol-5 Dimension. Weakness was defined as a HGS of <26 kg for men and <18 kg for women. Handgrip strength symmetry was defined as an HGS ratio of 0.9:1.1, and HGS asymmetry was defined as a ratio outside that range. Data were analyzed using the Rao-Scott χ², F test, and multivariate logistic regression. Compared with those in the "symmetric HGS and not weak" group, those in the "asymmetric HGS and weak" group had impaired health-related quality of life for all variables among men (odds ratios [ORs] = 1.67-3.75, 95% confidence interval [CI] [1.14, 6.27]). A greater risk of impaired self-care (SC; odds ratio [OR] = 2.33, 95% CI [1.67, 3.25]) and anxiety/depression (AD; OR = 1.40, 95% CI [1.04, 1.88]) was observed among women in the "asymmetric HGS and weak" group. Handgrip weakness and asymmetry are associated with impaired health-related quality of life. Handgrip asymmetry can be a clinical marker of health-related quality of life in older adults and must be measured alongside HGS.

Association between Lower-Body Strength, Health-Related Quality of Life, Depression Status and BMI in the Elderly Women with Depression

INTRODUCTION

Depression is currently the most prevalent mental illness in the world. It is a very frequent geriatric syndrome that causes a high degree of disability and increases mortality in the elderly population. This mental disorder is a social and public health problem that alters the quality of life (Qol) of the patient. Physical strength work has been reported to improve the clinical picture of people with depression.

OBJECTIVE

To determine the relationship between lower body strength, health-related quality of life (HRQoL), depression status and body mass index (BMI) in older women with depression.

DESIGN

A cross-sectional descriptive study with 685 elder women with depression.

RESULTS

A mild direct correlation (Rho = -0.29; p ≤ 0.001) between stand-ip test and EQ-5D-3L test was shown. There is a mild inverse correlation between stand-up test and six of fifteen items of the Geriatric Depression Scale (GDS) (Rho item 1 = -0.24; p ≤ 0.001; item 4 = 0.11; p ≤ 0.001; item 5 = -0.20; p ≤ 0.001; item 7 = -0.15; p ≤ 0.001; item 11 = -0.19; p ≤ 0.001; item 13 = -0.21; p ≤ 0.001). Between Stand-Up test and BMI, the correlation is weak inverse (Rho = -0.20; p ≤ 0.001).

CONCLUSIONS

There is a significant association of lower body strength with HRQoL, and BMI, as well as some variables of depression status in elder women with depression. Better scores in the stand-up test lead to an improvement in HRQoL and BMI. Therefore, stand-up test could be a complementary tool in public health for improve HRQoL in the elderly women with depression.

Should knee extension strength testing be implemented as a screening test for identifying probable and confirmed sarcopenia in older T2DM patients?

Background

The accelerated loss of muscle strength and mass observed in older type 2 diabetes mellitus (T2DM) patients due to the combined effects of diabetes and obesity, greatly increases their risk for sarcopenia. Early detection and treatment of probable and confirmed sarcopenia is paramount to delay mobility disability. Using low handgrip strength cut-off points for the initial identification of sarcopenia according to the new European Working Group on Sarcopenia in Older People (EWGSOP2) guidelines may mask the presence of sarcopenia. Relative knee extension strength cut-off points using a simple hand-held dynamometer can assist clinicians in the diagnosis of probable and confirmed sarcopenia by possibly reducing false negative results.

Methods

A cohort of one hundred T2DM older patients (60% women) (mean age 74.5 years) mostly obese community dwelling older adults were evaluated for body composition by Bioelectrical impedance analysis (BIA), yielding appendicular skeletal mass index (ASMI) results. Patients underwent handgrip strength (HGS) and knee extension strength (KES) tests as well as functional ability tests. Prevalence of probable and confirmed sarcopenia using HGS and KES cut-off points were calculated. Pearson correlations were performed to evaluate the relationship between ASMI and limbs strength. A regression analysis was conducted to examine which variables best predict ASMI values. A multivariate analysis of covariance was performed to assess the effect of independent variables on KES and HGS.

Results

Using cutoff points for low KES identified 24 patients with probable sarcopenia and two with confirmed sarcopenia. Conversely, using the EWGSOP2 cut off points for low HGS, identified only one patient with probable sarcopenia and none of the patients with confirmed sarcopenia.

Conclusion

KES cut-off points using a simple hand-held dynamometer can assist in the identification of probable and confirmed sarcopenia using EWGSOP2 cut off points for low muscle mass in a population of older T2DM patients for further analysis and early treatment. This is notably true in patients possessing high body mass index (BMI) alongside normal ASMI and HGS, potentially reducing false positive sarcopenia screening results.

Trial registration

ClinicalTrials.gov PRS: NCT03560375. Last registration date (last update): 06/06/2018. The trial was a-priori registered before actual recruitment of subjects.

A portable isometric knee extensor strength testing device: test-retest reliability and minimal detectable change scores of the Q-Force ӀӀ in healthy adults

BACKGROUND

Although knee extensors are essential in daily activities (e.g. walking, climbing stairs), knee extensor strength is often not measured in clinical settings. Existing devices to test muscle strength are not always suitable to accurately measure the high forces of this muscle group. Therefore, a device to test muscle strength that is convenient, feasible, reliable, and valid in clinical settings is required. This study evaluated the reliability, responsiveness, and level of discomfort of the newly developed Q-Force ӀӀ (i.e. a portable device to measure isometric knee extensor strength) in healthy middle-aged and elderly adults.

METHODS

Participants (n = 22) conducted two standardized test sessions on the Q-Force ӀӀ (five to ten days apart). Each session consisted of one familiarisation trial followed by three trials of peak isometric knee extension per each leg. Per trial, peak and mean knee extension force (N) and torque (Nm) were measured at 90° flexion. The level of discomfort was determined using a visual analog scale (VAS: 0-100). Intra Class Correlation (ICC, model: two-way mixed with absolute agreement), Standard Error of Measurement (SEM), and minimal detectable change (MDC) were determined. A repeated measures ANOVA was used to determine between-test variation.

RESULTS

Excellent test-retest (ICC > 0.95) and inter-trial (ICC > 0.91) reliability for both legs were shown. No significant differences were found in peak and mean knee forces and torques between test and retest of both legs, indicating good test-retest reliability (P-value range: 0.360-0.538; F(1,21) range: 0.4-0.9). The SEM of the peak and mean forces and torques ranged from 28.0 to 30.4 N (6.0-6.8%) and from 9.2 to 10.4 Nm (6.4-7.7%), respectively. The MDC for these outcomes ranged respectively from 77.6 to 84.1 N (16.5-18.8%) and from 25.5 to 28.9 Nm (17.6-21.4%). The level of discomfort was low (median range: 7-10, IQR: 4-18).

CONCLUSION

The portable Q-Force ӀӀ is a comfortable, responsive, and relatively cheap device with excellent test-retest reliability. This device would be potentially suitable to measure isometric knee extensor strength in clinical settings.

Effectiveness of a community-delivered pneumatic machine resistance training programme (Gym Tonic) for older adults at neighbourhood senior centres - a randomized controlled trial

Background

Resistance training with pneumatic machines attenuates the age-associated loss in muscle strength and function in older adults. However, effectiveness of scaled-up pneumatic machine resistance training in the community is not known. We evaluated the effectiveness of a multi-site community-delivered 12-week pneumatic machine resistance programme (Gym Tonic (GT)) on muscle strength and physical function in older adults.

Methods

Three hundred eighteen community-dwelling older adults aged ≥65 years were randomized into 12-week (twice/week) coach-supervised-community-based-GT-programme(n = 168) and wait-list control groups(n = 150). After 12 weeks, the intervention group continued with GT-training and the control group received supervised-GT-programme for further 12 weeks (partial-crossover-design). Fried frailty score, lower-extremity muscle strength and physical function (i.e., fast and habitual gait-speed, balance, repeated-chair-sit-to-stand, short physical performance battery (SPPB)) were determined at baseline, 12 and 24 weeks. Analysis adopted a modified-intention-to-treat-approach.

Results

After 12 weeks, lower-extremity muscle strength improved by 11–26%(all p < 0.05) and fast gait-speed improved by 7%(p = 0.008) in GT-intervention group(n = 132) than controls(n = 118), regardless of frailty status. Other physical function performance did not differ between control and intervention groups after 12 weeks (all p > 0.05). Frailty score improved by 0.5 in the intervention but not control group(p = 0.004). Within the intervention group, lower-extremity muscle strength and physical function outcomes improved at 24 weeks compared with baseline (all p < 0.001). Within controls, lower-extremity muscle strength, SPPB, repeated-chair-sit-to-stand and fast gait-speed improved post-GT (24-week) compared to both pre-GT (12-week) and baseline. Programme adherence was high in intervention [0–12-weeks,90%(SD,13%); 12–24-weeks,89%(SD,17%)] and control [12–24-weeks,90%(SD,19%)] groups.

Conclusion

Community-delivered GT resistance training programme with pneumatic machines has high adherence, improves muscle strength and fast gait-speed, and can be effectively implemented at scale for older adults. Future studies could examine if including other multi-modal function-specific training to complement GT can achieve better physical/functional performance in power, balance and endurance tasks.

Trial registration

ClinicalTrials.gov, NCT04661618, Registered 10 December 2020 - Retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s11556-021-00273-x.

ESTABLISHING THE NORMAL GAIT OF CHINESE YOUTH BASED ON THE PLANTAR PRESSURE TEST: AN EXPERIMENTAL STUDY

Objective: This study will measure the geometric and pressure centerlines of the foot’s plantar region in healthy Chinese youth to construct a gait norm. Methods: In the present experiment, 203 healthy college students and postgraduates (90 males and 113 females) were recruited as subjects. Their average age was [Formula: see text] years old, average height was [Formula: see text][Formula: see text]cm, and average weight was [Formula: see text][Formula: see text]kg. A double-blind method was used in this experiment. The plantar pressure and gait parameters of time and space among subjects were tested using a gait and balance function-training evaluation system. Data were collected using five pressure-sensor plates, based on the distribution in the geometric and pressure centers of the foot’s plantar area, according to the calculation formula of biomechanics. Results: From 20 selected subjects, the experiment gathered a total of 197 data points from the plantar pressure during walking. The results defined the foot’s centerline of maximum pressure while walking and showed that the pressure and geometric centerlines tended to converge and overlap in normal youth, irrespective of gender. In addition, differences were found between the foot’s centerline of pressure and the geometric and pressure centerlines of the plantar. Conclusion: This study showed that the plantar’s pressure and geometric centerlines can be used as a reference to assess normal gait in Chinese youth.

Relationship between Mobility-Related Activities of Daily Living and Health-Related Quality of Life among Healthy Older Adults: A Cross-Sectional Study Using Structural Equation Modeling

Objective: To develop a conceptual model that confirms whether mobility-related activities of daily living (ADLs) abilities are strongly associated with reduced health-related quality of life (HRQOL) in older adults. Methods: A total of 153 participants (63 men, 90 women) were analyzed. The mobility-related ADL survey from the Ministry of Education, Culture, Sports, Science, and Technology of Japan was used. The Japanese version (v1.2) of the Medical Outcomes Study 36-item Short-Form Health Survey was administered to evaluate HRQOL. Structural equation modeling was performed to test a hypothetical model: mobility-related ADL abilities would influence HRQOL. Results: The chi-square value was not significant (chi-square = 9.463, p = .305), and goodness-of-fit values were high, implying that the model was validated; goodness-of-fit index, 0.981; adjusted goodness-of-fit index, 0.949; comparative fit index, 0.996; and root mean square error of approximation, 0.035. Results showed that mobility-related ADL abilities influenced the physical health including physical function and general health in HRQOL. Conclusions: This study developed the conceptual model confirming the influence of mobility-related ADL abilities especially on physical health. Further intervention studies on instructions/training for physical activity of healthy older adults should assess this causal relationship.

The Human Muscle Size and Strength Relationship: Effects of Architecture, Muscle Force, and Measurement Location

PURPOSE

This study aimed to determine the best muscle size index of muscle strength by establishing if incorporating muscle architecture measurements improved the human muscle size-strength relationship. The influence of calculating muscle force, and the location of anatomical cross-sectional area (ACSA) measurements on this relationship were also examined.

METHODS

Fifty-two recreationally active males completed unilateral isometric knee extension strength assessments and MRI scans of the dominant thigh and knee to determine quadriceps femoris (QF) size variables (ACSA along the length of the femur, maximum ACSA [ACSAMAX] and volume [VOL]) and patellar tendon moment arm. Ultrasound images (2 sites per constituent muscle) were analyzed to quantify muscle architecture (fascicle length, pennation angle), and when combined with VOL (from MRI), facilitated calculation of QF effective PCSA (EFFPCSA) as potentially the best muscle size determinant of strength. Muscle force was calculated by dividing maximum voluntary torque (MVT) by the moment arm and addition of antagonist torque (derived from hamstring EMG).

RESULTS

The associations of EFFPCSA (r=0.685), ACSAMAX (r=0.697), or VOL (r=0.773) with strength did not differ, although qualitatively VOL explained 59.8% of the variance in strength, ~11-13% greater than EFFPCSA or ACSAMAX. All muscle size variables had weaker associations with muscle force than MVT. The association of strength-ACSA at 65% of femur length (r=0.719) was greater than for ACSA measured between 10-55% and 75-90% (r=-0.042-0.633) of femur length.

CONCLUSIONS

In conclusion, using contemporary methods to assess muscle architecture and calculate EFFPCSA did not enhance the muscle strength-size association. For understanding/monitoring muscle size, the major determinant of strength, these findings support the assessment of muscle volume, that is independent of architecture measurements, and was most highly correlated to strength.

Down stair walking: A simple method to increase muscle mass and performance in 65+ year healthy people

Exercise is important for prevention of sarcopenia in the elderly population. We tested two training modalities, ascending or descending stair walking, representing concentric (CON) and eccentric (ECC) exercise, respectively. We also tested the effects of additional weight during eccentric exercise (ECC+). Thirty-two healthy men and women (70 ± 3 [mean ± SE] yrs.) were randomly assigned to CON, ECC, or ECC+ (carrying +15% of body weight in a vest) in a 3 (n = 32) or 6 (n = 21) week intervention (3 sessions/week). Data was analysed by mixed models approach. Rate of perceived exertion (RPE; Borg scale 6-20; mean values from 3 and 6 weeks) during training did not differ between CON (12.3 ± 0.4), ECC (11.5 ± 0.3), and ECC+ (11.7 ± 0.4). After 6 weeks, leg muscle mass increased more in ECC+ (+0.29 ± 0.09 kg) vs CON (+0.08 ± 0.05 kg) (P<0.05) but not different from ECC (+0.16 ± 0.06 kg). 6-minute walk test (6MWT) increased after 6 weeks more (P<0.05) in ECC+ (+85 ± 23 m) compared with ECC (+37 ± 13 m) and CON (+27 ± 12 m). Intramyocellular glycogen content increased from 359 ± 19 nmol/mg d.w. in CON (to 511 ± 65 and 471 ± 44 after 3 and 6 wks, respectfully (P<0.05)), but not in ECC (to 344 ± 28 after 6 weeks) or in ECC+ (to 389 ± 20 after 6 weeks). Conclusion: carrying extra weight while descending stair walking do not increase RPE, but the ECC+ training resulted in greater muscle responses compared with CON, but glycogen synthesis was stimulated only in CON. Descending stairs is a simple model for prevention and treatment of sarcopenia and the stimulus is enhanced by carrying extra weights.

Association between 30-s Chair Stand-Up Test and Anthropometric Values, Vibration Perception Threshold, FHSQ, and 15-D in Patients with Type 2 Diabetes Mellitus

Simple Summary

Type 2 diabetes mellitus is a chronic global disease with a series of complications that lead to problems in the somatosensory system, the cardiovascular system, health-related quality of life, foot health, and even balance. These balance problems arise from deficits in lower limb strength, among other causes. The 30-s chair stand-up test is a test that evaluates leg strength and is an easy, quick, inexpensive, and predictive test of different parameters. How this test relates to health-related quality of life, vibration sensitivity threshold, and foot health has not been studied. This study tests the degree of the relationships of the 30-s chair stand-up test with the 15-dimensional (15-D) questionnaire, Foot Health Status Questionnaire (FHSQ), vibration sensitivity threshold, and body composition questionnaires.

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a chronic, worldwide disease affecting more than 400 million people. This pathology involves several associated problems, such as diabetic neuropathy complications, obesity, and foot problems, both in terms of health and sensitivity. Objective: The objective of this study was to explore the relationships of the 30-s chair stand-up test with the Foot Health Status Questionnaire (FHSQ), the vibration perception threshold (VPT), and the 15-dimensional (15-D) questionnaire in T2DM people. Methodology: Ninety participants with T2DM were assessed in terms of fat mass percentage, VPT, foot health, health-related quality of life (HRQoL), and the 30-s chair stand-up test. Results: The 30-s chair stand-up test was found to exhibit a moderate relationship with “physical activity” (rho = 0.441; p ≤ 0.001) and “vigor” (rho = 0.443; p ≤ 0.001) from FHSQ. The 30-s chair stand-up test was also found to be weakly associated with foot pain (rho = 0.358; p = 0.001), 15-D total score (rho = 0.376; p ≤ 0.001), “sleeping” (rho = 0.371; p < 0.001), and “depression” (rho = 0.352; p = 0.001). Conclusions: The 30-s chair stand-up test is associated with “physical activity”, “vigor”, and “foot pain” from the FHSQ and the 15-D questionnaire total score and its dimensions “sleeping” and “depression” in type 2 diabetes mellitus patients. Therefore, following the results obtained, qualified clinicians can use the 30-s chair stand-up test as a good tool for monitoring and managing type 2 diabetes.

The efficacy of resistance training in addition to usual care for adults with acute burn injury: A randomised controlled trial

Resistance training immediately after a burn injury has not been investigated previously. This randomised, controlled trial assessed the impact of resistance training on quality of life plus a number of physical, functional and safety outcomes in adults with a burn injury. Patients were randomly assigned to receive, in addition to standard physiotherapy, four weeks of high intensity resistance training (RTG) or sham resistance training (CG) three days per week, commenced within 72h of the burn injury. Outcome data was collected at six weeks, three and six months after burn injury. Quality of life at 6 months was the primary endpoint. Data analysis was an available cases analysis with no data imputed. Regression analyses were used for all longitudinal outcome data and between-group comparisons were used for descriptive analyses. Forty-eight patients were randomised resistance training (RTG) (n=23) or control group (CG) (n=25). The RTG demonstrated improved outcomes for the functional domain of the Burn Specific Health Scale-Brief (p=0.017) and the Quick Disability of Arm Shoulder and Hand (p<0.001). Between group differences were seen for C-reactive protein and retinol binding protein (p=0.001). Total quality of life scores, lower limb disability, muscle strength and volume were not seen to be different between groups (p>0.05). Resistance training in addition to usual rehabilitation therapy showed evidence of improving functional outcomes, particularly in upper limb burn injuries. Additionally, resistance training commenced acutely after a burn injury was not seen to be harmful to patients.

Physical and Psychological Factors Associated with Poor Self-Reported Health Status in Older Adults with Falls

Background: Previous studies have proposed various physical tests for screening fall risk in older adults. However, older adults may have physical or cognitive impairments that make testing difficult. This study describes the differences in individual, physical, and psychological factors between adults in good and poor self-rated health statuses. Further, we identified the physical or psychological factors associated with self-rated health by controlling for individual variables. Methods: Data from a total of 1577 adults aged 65 years or over with a history of falls were analyzed, using the 2017 National Survey of Older Persons in South Korea. Self-reported health status was dichotomized as good versus poor using the 5-point Likert question: “poor” (very poor and poor) and “good” (fair, good, and very good). Results: Visual/hearing impairments, ADL/IADL restriction, poor nutrition, and depression were more frequently observed in the group with poor self-rated health. Multivariable logistic regression revealed that poor self-reported health was significantly associated with hearing impairments (OR: 1.51, 95% CI 1.12–2.03), ADL limitation (OR: 1.77, 95% CI 1.11–2.81), IADL limitation (OR: 2.27, 95% CI 1.68–3.06), poor nutrition (OR: 1.36, 95% CI 1.05–1.77), and depression (OR 3.77, 95% CI 2.81–5.06). Conclusions: Auditory impairment, ADL/IADL limitations, poor nutrition, and depression were significantly associated with poor self-reported health. A self-rated health assessment could be an alternative tool for older adults who are not able to perform physical tests.

Correlation between Health-Related Quality of Life and Hand Grip Strength among Older Adults

Background: With advanced age, the progressive loss of muscle strength estimated by the handgrip strength (HGS) may result in a poorer health-related quality of life (HRQoL). Studying this association becomes a vital area of research for promoting aging-well. The aim of this study was to examine the correlation between HRQoL and HGS among community-dwelling older adults above 60 years old.Methods: Participants comprised of 176 older adults (mean age: 68.15 ± 6.74). The HGS was tested with Jamar® Dynamometer, and the EuroQuol-5 Dimensions 5Levels (EQ-5D-5L) questionnaire was used to assess HRQoL.Results: Both HGS and HRQoL were negatively correlated with age (p < .001). Lower values of HGS and HRQoL were recorded among older adults who had diagnosed with one or more chronic diseases (p < .001). Significant correlations were recorded between HGS and functioning, and subjective well-being domains of EQ-5D-5L. A relatively higher association was recorded between the functioning variables of EQ-5D-5L and HGS compared to subjective well- being variables.Conclusion: Handgrip strength is a simple and practical measure in identifying older adults at risk of physical decline. Maintaining handgrip strength may contribute to improving HRQoL, and can add an imperative dimension to promote aging-well in older adults ≥60 years old.

Defining Vitality Using Physical and Mental Well-Being Measures in Nursing Homes: A Prospective Study

OBJECTIVES

To propose an objective definition of vitality and to evaluate its predictive value regarding the evolution of functional ability, as well as the risk of hospitalization and mortality in very old NH residents.

DESIGN

Observational study.

SETTINGS

Nursing homes.

PARTICIPANTS

541 participants.

MEASUREMENTS

We operationalized tree definitions of vitality (binary variables discriminating vital from non-vital individuals): Mental vitality, assessed using three items of the geriatric depression scale; Physical vitality measured through hand grip strength test; and combined vitality, which combined mental and physical vitality definitions. Outcome measures were the 1-year evolution of functional ability as measured by a scale of activities of daily living (ADL) (score from 0 to 6) and the incidence of hospitalizations and mortality (time-to-event).

RESULTS

First, 204 (37.7%) residents were defined as mentally vital. Second, 139 (27.5%) residents were defined as physically vital. And 52 (9.6%) were defined as vital when combining physical and. Combined vitality was associated with a reduced risk of hospitalization compared to combined non-vitality. Physically vital residents were associated with a reduced risk of mortality. No prospective associations were found between vital and non-vital individuals on the evolution of ADL scores across the three vitality definitions. But mentally vital individuals were associated with a worsening of ADL score.

CONCLUSIONS

Better combined vitality seems to be associated with a reduced risk for hospitalizations, but more studies are needed to confirm a valid measurement of vitality in people living in NH in regards to ADL and mortality.

Effects of resistance training on self-reported disability in older adults with functional limitations or disability - a systematic review and meta-analysis

BACKGROUND

Self-reported disability has a strong negative impact on older people's quality of life and is often associated with the need for assistance and health care services. Resistance training (RT) has been repeatedly shown to improve muscle function (e.g. strength) and functional capacity (e.g. gait speed, chair-rise) in older adults with functional limitations. Nevertheless, it is unclear whether such objectively assessed improvements translate into a reduction in self-reported disability.

OBJECTIVES

To assess: i) whether and to what extent RT interventions have an effect on self-reported disability in older adults (≥65 years) with functional limitations or disability; and ii) whether the effects on self-reported disability are associated with changes in objective measures of muscle strength and functional capacity across studies.

METHODS

PubMed, Embase, Web of Science, CINAHL and SPORTDiscus electronic databases were searched in June 2018. Randomized controlled trials reporting effects of RT on self-reported disability/function in ≥65 year-old adults with defined, functional limitations or self-reported disability were eligible. Data on self-reported disability/function were pooled by calculating adjusted standardized mean differences (SMD) using Hedges'g. Likewise, effect sizes for three secondary outcomes: knee extensor muscle strength; gait capacity; and lower body functional capacity were calculated and fit as covariates in separate meta-regressions with self-reported disability as the dependent factor.

RESULTS

Fourteen RCTs were eligible for the primary meta-analysis on self-reported disability. The total number of participants was 651 (intervention n = 354; control n = 297). A significant moderate positive effect of RT was found (SMD: 0.59, 95% CI: 0.253 to 0.925, p = 0.001). Between-study heterogeneity was present (I2 statistic = 75,1%, p <  0.001). RT effects on objective measures of lower body functional capacity were significantly associated with effects on self-reported disability (Adj. R2 = 99%, p = 0.002, n = 12 studies), whereas no significant associations with gait capacity or knee extensor strength were found.

CONCLUSIONS

This review provides evidence that RT has a moderate positive effect on self-reported disability/function in old people with or at risk for disability. The effects are strongly associated with effects on objective measures of lower body functional capacity.

Comparison between grip strength and grip strength divided by body weight in their relationship with metabolic syndrome and quality of life in the elderly

Strength measures should be normalized by body mass; however, the definition of sarcopenia includes only simple grip strength. Thus, we compared the relationship of grip strength and grip strength divided by body weight or body mass index to two major consequences of sarcopenia, namely metabolic syndrome and poor quality of life. Data from the participants (aged 60 years or older) of the Sixth Korea National Health and Nutrition Examination were analyzed. Metabolic syndrome was defined according to the Adult Treatment Panel III guidelines with some modifications appropriate for Koreans. Quality of life was assessed using the EuroQoL Five-dimension questionnaire. Multiple logistic regression models were used to evaluate the association of grip strength and grip strength divided by body weight with metabolic syndrome and quality of life. A total of 1273 men and 1436 women were included in the analyses. Grip strength was not related to metabolic syndrome, whereas grip strength divided by body weight and grip strength normalized by body mass index revealed a dense dose-response relationship. All measures showed a similar correlation with quality of life. Grip strength divided by body weight can be superior to simple grip strength and grip strength normalized by body mass index in representing the metabolic aspects of sarcopenia.

Correlation between lower limb isometric strength and muscle structure with normal and challenged gait performance in older adults

BACKGROUND

Muscular parameters have been considered to influence gait of older adults, but it is still unclear which specific lower limb muscular parameters correlate with kinematics of overground and obstacle crossing in older adults.

RESEARCH QUESTION

What lower limb muscular parameters correlate and explain kinematics of overground walking and obstacle crossing ability in the elderly?

METHODS

Muscle structure was evaluated in 15 older individuals (75.4 ± 5 years) through measures of architecture (muscle thickness, fascicle length, and pennation angle) and muscle quality (echo intensity) from lower limb muscles (vastus lateralis, biceps femoris, rectus femoris, tibialis anterior, and gastrocnemius medialis). Muscle function was assessed through isometric strength of hip, knee and ankle joint muscles. Gait kinematics (toe and heel clearances, step length and gait speed) was evaluated during walking with and without obstacle crossing at preferred and maximal gait speeds. Correlation and regression analyses were performed considering a significance level of 0.05.

RESULTS

Isometric strength did not correlate with gait kinematics and gait speed. Tibialis anterior thickness correlated with lead limb toe clearance, and vastus lateralis thickness with gait speed and step length. Vastus lateralis echo intensity correlated with step length and gait speed.

SIGNIFICANCE

Tibialis anterior and vastus lateralis muscles deserve attention in physical training to improve gait of older adults. Specifically, tibialis anterior should receive more attention on exercise programs aiming at improvement of obstacle crossing, and knee extensors when aiming at improving gait speed and step length.

Muscular strength and function after total hip arthroplasty performed with three different surgical approaches: one-year follow-up study

BACKGROUND

Surgical approach influences short-term muscular strength, and leg-strength asymmetry has been demonstrated after total hip arthroplasty (THA). We evaluated muscular strength, physical function and patient-reported outcome measures (PROMs) up to 12 months postoperatively, in patients operated on using 3 different surgical approaches.

METHODS

60 patients scheduled for primary THA were allocated to the direct lateral (DLA), posterior (PA) or anterior (AA) approach. The following parameters were evaluated: leg press and abduction strength, pain, 6-minute walking test, Harris Hip Score and Hip disability and Osteoarthritis Outcome Score - Physical Function Shortform (HOOS-PS).

RESULTS

Abduction strength in the DLA group was significantly more reduced than the PA and AA groups 12 months postoperatively (p < 0.001). A significant interleg difference in abduction (p < 0.01) and leg press (p < 0.03) persisted in all groups up to 6 months, and up to 12 months in the DLA (p < 0.05). In the AA group, interleg difference in leg press was present up to 12 months (p = 0.01). Pain scores were higher in the DLA than the AA group at 6 months (p = 0.01). Patients in the PA group had better HOOS-PS score than those in the DLA group 3 months postoperatively (p = 0.02). No intergroup differences in pain or PROMs were found 12 months postoperatively.

CONCLUSION

Patients operated via the DLA had reduced muscular strength, HOOS-PS scores and higher pain scores than those who underwent PA and AA type surgery. The non-operated leg was significantly stronger than the operated leg in all groups 6 months postoperatively and this persisted up to 12 months postoperatively for the DLA and AA groups. Clinical Trial Protocol number: ClinicalTrials.gov (NCT01506024).

Strength Abilities in Men 50+ as an Effect of Long-Distance Run Training

The aim of this study was to evaluate the effect of long-term running training on muscle strength of men aged 50 and above. The study involved two groups of men aged 50 and above: physically active (E, n = 34) and inactive (NE, n = 20). Body composition was assessed with the electrical bioimpedance method. The isometric maximum voluntary contraction (MVC) was the main measurement. The value of muscle torque achieved by a group of synergists (operating in the given joint) during a short isometric contraction was evaluated. Ten groups of flexor and extensor muscles of the elbow, shoulder, hip, knee, and torso joints were measured. In addition, a 3 s measurement of grip strength of the right (F_r) and left (F_l) hand was taken using a hand dynamometer. The obtained values enabled to calculate the symmetry index (SI).

Men who had been running regularly were characterized by a significantly lower strength level (p < .05). Results in the NE group were determined to a great extent by significantly different body weights (p < .001) and a significantly higher body fat mass (FAT) content (p < .001). SI was statistically higher in the reference group (p < .05).

Long-distance run training reduces FAT while maintaining a high level of muscle strength. These studies indirectly confirm the effect of strengthening slow-twitch motor units in men aged 50 (Doherty & Brown 1993; Kanda & Hashizume 1989). In addition, stimulating the body through physical effort helps it also to maintain a high level of strength symmetry, which is a preventive factor in reducing the number of injuries.

The relationship between physical fitness and health self-assessment in elderly

BACKGROUND

The process of population aging inclines to seek determinants of the quality of life in the older people. Health self-assessment is the one of the main elements of the quality of life. In the older people it is associated with functional efficiency. The aim of the study was to determine correlations of physical fitness and health self-assessment.

METHODS

The study group included 123 people aged 60 to 86 years. Physical fitness was evaluated using the Senior Fitness Test (SFT). Self-esteem of health was assessed by the SF-36 questionnaire.

RESULTS

The analysis included sex factor and the occurrence of chronic diseases. When comparing with healthy participants, people suffering from chronic diseases revealed a lower level of physical fitness (P < .05) and health self-assessment (P < .05). The results of a significant percentage of study participants were worse than norms proposed as standards. The percentage of people below norms varied depending on sex, age, and SFT assessment and ranged from 0 to 89.5%.

CONCLUSION

Physical fitness and health self-assessment among elderly may be strongly determined by cultural conditions, for example, habits, lifestyle in various regions. The application of conclusions suggests that the key element of rehabilitation programs among elderly should be focused on improving coordination and locomotor capabilities. Assessment of the elderly is more clearly associated with physical fitness in women than in men and also more in patients chronically ill than in healthy person. Comprehensive assessment of physical fitness according to standardized values does not indicate the diversity by sex.

A Scoping Review of Epidemiological, Ergonomic, and Longitudinal Cohort Studies Examining the Links between Stair and Bathroom Falls and the Built Environment

Stair and bathroom falls contribute to injuries among older adults. This review examined which features of stairs and bathrooms have been assessed in epidemiological, ergonomic, and national aging studies on falls or their risk factors. Epidemiological and ergonomic studies were eligible if published from 2006-2017, written in English, included older persons, and reported built environment measures. The data extracted included the following: study population and design, outcome measures, and stair and bathroom features. National aging studies were eligible if English questionnaires were available, and if data were collected within the last 10 years. Sample characteristics; data collection methods; and data about falls, the environment, and assistive device use were extracted. There were 114 eligible articles assessed-38 epidemiologic and 76 ergonomic. Among epidemiological studies, 2 assessed stair falls only, 4 assessed bathroom falls only, and 32 assessed falls in both locations. Among ergonomic studies, 67 simulated stairs and 9 simulated bathrooms. Specific environmental features were described in 14 (36.8%) epidemiological studies and 73 (96%) ergonomic studies. Thirteen national aging studies were identified-four had stair data and six had bathroom data. Most epidemiologic and national aging studies did not include specific measures of stairs or bathrooms; the built environment descriptions in ergonomic studies were more detailed. More consistent and detailed environmental measures in epidemiologic and national aging studies would better inform fall prevention approaches targeting the built environment.

Physical fitness of women over 50 years of age and self-esteem quality of life and health

Study aim: The aim of this study was to examine whether in women over 50 years of age the rate of decline in physical fitness with age affects the self-assessment of health and quality of life.

Material and methods: The survey was conducted among 113 women, aged 50–70. The women were divided into two groups: of low and high assessment of their own health and quality of life (WHOQOL-bref). The strength of the dominant hand muscles was tested and the Senior Functional Fitness Test was performed [21]. Linear regression analysis was used in the studies.

Results: Women satisfied with their health and quality of life were characterized by alower rate of decline in physical fitness after the age of 50, in particular the strength of the dominant hand muscles, aerobic capacity, upper body flexibility, and speed and coordination, than the dissatisfied or undecided women.

Conclusions: Physical fitness of women is important in assessing one’s own health and quality of life.

Prospective associations of low muscle mass and strength with health-related quality of life over 10-year in community-dwelling older adults

AIMS

This study aims to describe the associations of low muscle mass, handgrip (HGS) and lower-limb muscle strength (LMS) with health-related quality of life (HRQoL) over 10 years in community-dwelling older adults.

METHODS

Participants (N = 1002; 51% women; mean age 63 ± 7.4 years) were prospectively followed for 10 years. HRQoL was measured using the validated assessment of quality of life (AQoL) instrument. Appendicular lean mass (ALM) was assessed using dual energy X-ray absorptiometry and normalized to body mass index (BMI). HGS and LMS were assessed using dynamometers. Low ALM/BMI (ALM/BMI_LOW), LMS (LMS_LOW) and HGS (HGS_LOW) at baseline were defined as the lowest 20% of the sex-specific distribution for each measure. Linear mixed effect regression models, adjusting for confounders, were used to estimate the association between ALM/BMI_LOW, LMS_LOW, and HGS_LOW at baseline and HRQoL over 10 years.

RESULTS

Participants with LMS_LOW (β = -0.061, 95% CI: -0.089, -0.033) and women (β = -0.089, 95% CI: -0.129, -0.049) but not men (β = -0.023, 95% CI: -0.064, 0.019) with HGS_LOW had clinically meaningful reductions in HRQoL over 10 years compared to those with normal strength. There was a weaker but statistically significant association between ALM/BMI_LOW and 10-year HRQoL (β = -0.038, 95% CI: -0.068, -0.008).

CONCLUSIONS

Lower-limb muscle strength and handgrip strength (in women only), which can be easily measured in clinical practice, appear more important than muscle mass for HRQoL.

Gait biomechanics after combined HTO-ACL reconstruction versus HTO alone: A matched cohort study

The purpose of the present study was to compare bilateral external knee moments during gait in patients with concomitant medial compartment knee OA, varus alignment and chronic anterior cruciate ligament (ACL) deficiency who underwent either medial opening-wedge high tibial osteotomy alone (HTO) or simultaneous HTO and ACL reconstruction (HTO-ACLR). Fifty-two patients (26 matched pairs) completed 3D gait analysis preoperatively and at a minimum 5 years postoperatively. Patients were matched for preoperative age, sex, body mass index and magnitude of correction. Primary outcomes selected a priori were the peak knee adduction moment (KAM) and knee flexion (KFM) moment during stance. Moments were compared using mixed model repeated measures analysis of variance (ANOVA). For the peak KAM, there was a significant time by limb interaction. For both groups, there were similar reductions in the peak KAM 5 years postoperatively in the surgical limb only [-1.34 %BW × Ht (-1.71, -0.96) and -1.72 %BW × Ht (-1.99, -1.44) for HTO and HTO-ACLR, respectively]. For the peak KFM, there was a significant time by group by limb interaction. There was a decrease in the peak KFM 5 years postoperatively in the HTO group [-0.88 %BW × Ht (-1.45, -0.31)] but not in the HTO-ACLR group [0.03 %BW × Ht (-0.43, 0.48)]. These results suggest that individuals with medial knee OA, varus alignment and chronic ACL deficiency who undergo simultaneous medial opening-wedge HTO and ACL reconstruction may not experience the same long-term (5 year) changes in sagittal plane knee biomechanics observed in patients undergoing HTO alone. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Grip strength and quality of life in the second half of life: hope as a moderator

OBJECTIVES

The purpose of the current study was to investigate grip strength, hope, and their interaction as predictors of quality of life four years later in a nationally representative sample of older adults.

METHOD

Data were derived from the first (2005-2006) and second wave (2009) of the Israeli component of the Survey of Health Ageing and Retirement in Europe (SHARE; N = 344). Hope was measured by three items from the Hope   Scale, and quality of life was measured by the CASP-12 (Control, Autonomy, Self-Realization, and Pleasure). Multiple regression analyses were conducted.

RESULTS

Grip strength at T1 predicted QoL in T2, but hope was not a significant predictor. Furthermore, hope moderated the effect of handgrip on QoL, such that the effect was weaker for higher levels of hope.

CONCLUSION

As hypothesized, hope acted as a moderator, such that poor grip strength was associated with worse QoL for less hopeful older adults, but grip strength was not associated with QoL for more hopeful older adults. Findings are consistent with a theoretical conceptualization of hope as a buffer between physical challenges and negative outcomes like QoL. Encouraging a hopeful perspective could enhance QoL for older adults with decreased muscle strength.

Clustering of Self-Organizing Maps as a means to support gait kinematics analysis and symmetry evaluation

Gait analysis is relevant for the functional diagnostic of several musculoskeletal disorders. Walking patterns can be analyzed using techniques such as video processing and inertial measurement units (IMU). In this work, a Self-Organizing Maps (SOM) algorithm is applied to reduce the complexity of kinematic features obtained by IMU sensors of a sample of 40 individuals. Our system provides a simpler data representation (2-D graphic) than conventional methods, which often applies statistical analysis. We have tested the proposed method to analyze typical and simulated limping gait pattern under well-controlled conditions. Based on kinematic parameters and symmetry-related features, SOM algorithm was able to organize the sample in groups of subjects with three different gait patterns, normal and limping with each lower limb. Moreover, our system may be used to evaluate the recovery of a patient, offering intuitive information of his walking pattern in an assessment report. However, further research with atypical-gait subjects is necessary before applying such method as a clinical tool.

Muscle strength, functional endurance, and health-related quality of life in active older female golfers

Background

Grip strength is a reliable predictor of whole body strength in older adults, but muscle characteristics of people with different activity levels have not been studied previously. The present study examined the relationship between grip strength (GS), quadriceps peak torque (QPT), functional endurance, and health-related quality of life (HRQoL) in older female golfers.

Methods

Twenty-nine healthy female golfers (mean age 69.1 years, SD 3.4) participated. The ISOCOM and JAMAR dynamometers were used to assess QPT and GS, respectively. Functional endurance tests included 1-min sit-to-stand test (1MSTS), 30-s wall press (30SWP), and 2-min stair climb (2MSC). HRQol was assessed using the SF-36 questionnaire.

Results

Mean GS and QPT were 27.5 ± 4 kg/f and 103.7 ± 25.1 N m, respectively. Mean scores for the 1MSTS, 30SWP, and 2MSC were 31 ± 7.7, 17.4 ± 3.5, and 237.5 ± 48.6 repetitions, respectively. GS was moderately correlated with QPT (r = 0.44), 1MSTS (r = 0.36), and 2MSC (r = 0.36), but had weak correlation with 30SWP (r = 0.003). Moderate correlation was observed between quadriceps peak torque and the 1MSTS (r = 0.50; p = 0.01), 2MSC (r = 0.44; p = 0.02) and 30SWP (r = 0.33). 30SWP and 2MSC had moderate correlations with PF r = 0.41 (p = 0.03) and r = 0.61 (p < 0.0005) and general physical well-being r = 0.47 (p = 0.01) and r = 0.39 (p = 0.04), respectively.

Conclusion

Quadriceps strength was more closely associated with functional endurance than grip strength. A single strength measure may not reflect overall muscle characteristics in active older females, and hence, assessment of both upper and lower limb strengths may be appropriate.

A randomized controlled trial on maximal strength training in 60 patients undergoing total hip arthroplasty

Background and purpose - Total hip arthroplasty (THA) patients have reduced muscle strength after rehabilitation. In a previous efficacy trial, 4 weeks' early supervised maximal strength training (MST) increased muscle strength in unilateral THA patients <65 years. We have now evaluated muscle strength in an MST and in a conventional physiotherapy (CP) group after rehabilitation in regular clinical practice. Patients and methods - 60 primary THA patients were randomized to MST or CP between August 2015 and February 2016. The MST group trained at 85-90% of their maximal capacity in leg press and abduction of the operated leg (4 × 5 repetitions), 3 times a week at a municipal physiotherapy institute up to 3 months postoperatively. The CP group followed a training program designed by their respective physiotherapist, mainly exercises performed with low or no external loads. Patients were tested pre- 3, 6, and 12 months postoperatively. Primary outcomes were abduction and leg press strength at 3 months. Other parameters evaluated were pain, 6-min walk test, Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Score (HOOS) Physical Function Short-form score. Results - 27 patients in each group completed the intervention. MST patients were substantially stronger in leg press and abduction than CP patients 3 (43 kg and 3 kg respectively) and 6 months (30 kg and 3 kg respectively) postoperatively (p ≤ 0.002). 1 year postoperatively, no intergroup differences were found. No other statistically significant intergroup differences were found. Interpretation - MST increases muscle strength more than CP in THA patients up to 6 months postoperatively, after 3 months' rehabilitation in clinical practice. It was well tolerated by the THA patients and seems feasible to conduct within regular clinical practice.

A comparison of gait one year post operation in an RCT of robotic UKA versus traditional Oxford UKA

Robot-assisted unicompartmental knee surgery has been shown to improve the accuracy of implant alignment. However, little research has been conducted to ascertain if this results in a measureable improvement in knee function post operatively and a more normal gait. The kinematics of 70 OA knees were assessed using motion analysis in an RCT (31 receiving robotic-assisted surgery, and 39 receiving traditional manual surgery) and compared to healthy knees. Statistically significant kinematic differences were seen between the two surgical groups from foot-strike to mid-stance. The robotic-assisted group achieved a higher knee excursion (18.0°, SD 4.9°) compared to the manual group (15.7°, SD 4.1°). There were no significant difference between the healthy group and the robotic assisted group, however there was a significant difference between the healthy group and the manual group (p < 0.001). Hence robotically-assisted knee replacement with Mako Restoris Implants appears to lead not only to better implant alignment but also some kinematic benefits to the user during gait.

Validity of maximal isometric knee extension strength measurements obtained via belt-stabilized hand-held dynamometry in healthy adults

[Purpose] To determine the validity of knee extension muscle strength measurements using belt-stabilized hand-held dynamometry with and without body stabilization compared with the gold standard isokinetic dynamometry in healthy adults. [Subjects and Methods] Twenty-nine healthy adults (mean age, 21.3 years) were included. Study parameters involved right side measurements of maximal isometric knee extension strength obtained using belt-stabilized hand-held dynamometry with and without body stabilization and the gold standard. Measurements were performed in all subjects. [Results] A moderate correlation and fixed bias were found between measurements obtained using belt-stabilized hand-held dynamometry with body stabilization and the gold standard. No significant correlation and proportional bias were found between measurements obtained using belt-stabilized hand-held dynamometry without body stabilization and the gold standard. The strength identified using belt-stabilized hand-held dynamometry with body stabilization may not be commensurate with the maximum strength individuals can generate; however, it reflects such strength. In contrast, the strength identified using belt-stabilized hand-held dynamometry without body stabilization does not reflect the maximum strength. Therefore, a chair should be used to stabilize the body when performing measurements of maximal isometric knee extension strength using belt-stabilized hand-held dynamometry in healthy adults. [Conclusion] Belt-stabilized hand-held dynamometry with body stabilization is more convenient than the gold standard in clinical settings.

Combined resistance and endurance training at a moderate-to-high intensity improves physical condition and quality of life in liver transplant patients

Although currently moderate and high intensity concurrent physical exercise is prescribed in populations with special needs due to its greater effect on physical condition and health-related quality of life (HRQOL), there are no data in the liver transplantation (LT) setting. The aim of this study is to evaluate changes in maximal strength, aerobic capacity, body composition, liver function, and HRQOL in LT patients after a moderate-to-high intensity combined resistance-endurance training. Six months after LT, 54 patients were randomized into 2 groups: intervention group (IG) and control group (CG). A total of 50 patients completed the study with repeat testing at 6 and 12 months after LT. The IG completed a 6-month exercise training program, consisting of exercising 2 days for 24 weeks in the hospital facilities, whereas the CG followed usual care recommendations. Patients completed a 5-multijoint exercise circuit with elastic bands involving the major muscle groups. The effects of the concurrent training program on maximal oxygen consumption, overall and regional maximal strength, body composition, liver function, and HRQOL were analyzed. The IG showed a significant improvement (P < 0.05) in outcome measurements compared with the CG in aerobic capacity, hip extension, elbow flexion, overall maximal strength, physical functioning, and vitality of HRQOL, whereas no changes were observed in body composition and liver function tests. In conclusion, this is the first study that combines supervised resistance and aerobic training performed at moderate-to-high intensity in LT recipients. It results in significant improvements in aerobic capacity, maximal strength, and HRQOL. Liver Transplantation 23 1273-1281 2017 AASLD.

What Are the Preoperative Outcome Measures That Predispose to Periprosthetic Fractures After Primary Total Knee Arthroplasty?

BACKGROUND

There is little known in the literature about whether preoperative patient-reported outcome measures (PROMs) would affect the risk of periprosthetic fractures (PPFs) after primary total knee arthroplasty (TKA). Our study aims to evaluate the predictive values of PROMs on PPF after primary TKA. We hypothesize that poorer PROMs are associated with a higher risk of PPF after primary TKA.

METHODS

We reviewed prospectively collected data in our hospital arthroplasty registry. Patients who sustained PPF after primary TKA between 2000 and 2015 were identified. Forty-two patients were identified and matched for gender, age, and body mass index to a control group of 84 patients who had primary TKA without PPF in a 2:1 ratio. Preoperative demographics, Short Form-36 (SF-36) scores, Oxford Knee score and Knee Society Score were evaluated. Variables of PROMs were entered into a multivariate logistic regression model. A variable was considered to be a significant predictor if its odds ratio was significant at P < .05.

RESULTS

After multivariate regression analysis, SF-36 subdomains of physical functioning (PF) and vitality (VT) were identified as significant predictors for PPFs after primary TKA. A lower SF-36 PF and VT scores were associated with higher risks of sustaining a PPF after primary TKA.

CONCLUSION

From our study, low preoperative SF-36 PF and VT scores are associated with a higher risk of PPFs after primary TKA. These results can allow the preoperative identification of patients at higher risk of PPF, and appropriate preoperative counseling, optimization, and close follow-up can be instituted for this at-risk group.

Effects of progressive resistance training combined with a protein-enriched lean red meat diet on health-related quality of life in elderly women: secondary analysis of a 4-month cluster randomised controlled trial

Resistance training (RT) and increased dietary protein are recommended to attenuate age-related muscle loss in the elderly. This study examined the effect of a lean red meat protein-enriched diet combined with progressive resistance training (RT+Meat) on health-related quality of life (HR-QoL) in elderly women. In this 4-month cluster randomised controlled trial, 100 women aged 60-90 years (mean 73 years) from self-care retirement villages participated in RT twice a week and were allocated either 160 g/d (cooked) lean red meat consumed across 2 meals/d, 6 d/week or ≥1 serving/d (25-30 g) carbohydrates (control group, CRT). HR-QoL (SF-36 Health Survey questionnaire), lower limb maximum muscle strength and lean tissue mass (LTM) (dual-energy X-ray absorptiometry) were assessed at baseline and 4 months. In all, ninety-one women (91 %) completed the study (RT+Meat (n 48); CRT (n 43)). Mean protein intake was greater in RT+Meat than CRT throughout the study (1·3 (sd 0·3) v. 1·1 (sd 0·3) g/kg per d, P<0·05). Exercise compliance (74 %) was not different between groups. After 4 months there was a significant net benefit in the RT+Meat compared with CRT group for overall HR-QoL and the physical component summary (PCS) score (P<0·01), but there were no changes in either group in the mental component summary (MCS) score. Changes in lower limb muscle strength, but not LTM, were positively associated with changes in overall HR-QoL (muscle strength, β: 2·2 (95 % CI 0·1, 4·3), P<0·05). In conclusion, a combination of RT and increased dietary protein led to greater net benefits in overall HR-QoL in elderly women compared with RT alone, which was because of greater improvements in PCS rather than MCS.

Changes in agonist neural drive, hypertrophy and pre-training strength all contribute to the individual strength gains after resistance training

PURPOSE

Whilst neural and morphological adaptations following resistance training (RT) have been investigated extensively at a group level, relatively little is known about the contribution of specific physiological mechanisms, or pre-training strength, to the individual changes in strength following training. This study investigated the contribution of multiple underpinning neural [agonist EMG (QEMG_MVT), antagonist EMG (HEMG_ANTAG)] and morphological variables [total quadriceps volume (QUADS_VOL), and muscle fascicle pennation angle (QUADSθ _p)], as well as pre-training strength, to the individual changes in strength after 12 weeks of knee extensor RT.

METHODS

Twenty-eight healthy young men completed 12 weeks of isometric knee extensor RT (3/week). Isometric maximum voluntary torque (MVT) was assessed pre- and post-RT, as were simultaneous neural drive to the agonist (QEMG_MVT) and antagonist (HEMG_ANTAG). In addition QUADS_VOL was determined with MRI and QUADSθ _p with B-mode ultrasound.

RESULTS

Percentage changes (∆) in MVT were correlated to ∆QEMG_MVT (r = 0.576, P = 0.001), ∆QUADS_VOL (r = 0.461, P = 0.014), and pre-training MVT (r = -0.429, P = 0.023), but not ∆HEMG_ANTAG (r = 0.298, P = 0.123) or ∆QUADSθ _p (r = -0.207, P = 0.291). Multiple regression analysis revealed 59.9% of the total variance in ∆MVT after RT to be explained by ∆QEMG_MVT (30.6%), ∆QUADS_VOL (18.7%), and pre-training MVT (10.6%).

CONCLUSIONS

Changes in agonist neural drive, quadriceps muscle volume and pre-training strength combined to explain the majority of the variance in strength changes after knee extensor RT (~60%) and adaptations in agonist neural drive were the most important single predictor during this short-term intervention.

A canonical correlation analysis on the relationship between functional fitness and health-related quality of life in older adults

OBJECTIVE

This study aimed to explore the relationship between the functional fitness (FF) and health-related quality of life (HRQoL) in older adults, and to identify the key subdimensions of FF and HRQoL influencing their overall relationship.

METHODS

This cross-sectional study was performed among 851 independent community members (65-84 years; men=402). The Senior Fitness Test and the Short Form 36 Health Survey were used to measure FF and HRQoL, respectively. A canonical correlation analysis was conducted using seven fitness variables as predictors of eight HRQoL variables to examine the relationship between FF and HRQoL.

RESULTS

The overall FF was positively correlated with the overall HRQoL in both men (canonical correlation=0.350) and women (canonical correlation=0.456). The up-and-go and 2-min step contributed the most to FF, and physical functioning contributed the most to HRQOL among men. Conversely, the up-and-go and 30-s chair stand contributed the most to FF, and physical functioning contributed the most to HRQoL in women.

CONCLUSIONS

There were positive and moderate relationships between overall FF and overall HRQOL in older adults. The FF has a significant influence on HRQoL, particularly physical functioning. The main FF components influencing the relationship between FF and HRQoL in men are balance and agility and aerobic endurance, whereas in women they are balance and agility and lower extremity muscle strength. Results from this study facilitate comprehensively understanding the relationship between FF and HRQoL, and generating critical insight into HRQoL improvement from the perspective of FF enhancement.

The association between social participation and lower extremity muscle strength, balance, and gait speed in US adults

Social participation is associated with healthy aging, and although associations have been reported between social participation and demographics, no published studies have examined a relationship between social participation and measures amenable to intervention. The purpose was to explore the association between self-reported social participation and lower extremity strength, balance, and gait speed. A cross-sectional analysis of US adults (n = 2291; n = 1,031 males; mean ± standard deviation age 63.5 ± 0.3 years) from the 2001–2 National Health and Nutrition Examination Survey was conducted. Two questions about self-reported difficulty with social participation were categorized into limited (yes/no). The independent variables included knee extension strength (n = 1537; classified as tertiles of weak, normal, and strong), balance (n = 1813; 3 tests scored as pass/fail), and gait speed (n = 2025; dichotomized as slow [less than 1.0 m/s] and fast [greater than or equal to 1.0 m/s]). Logistic regression, accounting for the complex survey design and adjusting for age, sex, physical activity, and medical conditions, was used to estimate the odds of limitation in social participation with each independent variable. Alpha was decreased to 0.01 due to multiple tests. Slower gait speed was significantly associated with social participation limitation (odds ratio = 3.1; 99% confidence interval: 1.5–6.2). No significant association was found with social participation and lower extremity strength or balance. The odds of having limitation in social participation were 3 times greater in those with slow gait speed. Prospective studies should examine the effect of improved gait speed on levels of social participation.

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Social participation is a component of healthy aging.

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Population-based studies can explore associations amenable to intervention.

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Walking speed and social participation were significantly associated.

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Strength and balance were not associated with social participation.

Clinical assessment tools identify functional deficits in fragility fracture patients

Purpose

To identify inexpensive, noninvasive, portable, clinical assessment tools that can be used to assess functional performance measures that may put older patients at risk for falls such as balance, handgrip strength, and lumbopelvic control.

Patients and methods

Twenty fragility fracture patients and 21 healthy control subjects were evaluated using clinical assessment tools (Nintendo Wii Balance Board [WBB], a handheld dynamometer, and an application for the Apple iPod Touch, the Level Belt) that measure functional performance during activity of daily living tasks. The main outcome measurements were balance (WBB), handgrip strength (handheld dynamometer), and lumbopelvic control (iPod Touch Level Belt), which were compared between fragility fracture patients and healthy controls.

Results

Fragility fracture patients had lower scores on the vertical component of the WBB Torso Twist task (P=0.042) and greater medial–lateral lumbopelvic sway during a 40 m walk (P=0.026) when compared to healthy controls. Unexpectedly, the fracture patients had significantly higher scores on the left leg (P=0.020) and total components (P=0.010) of the WBB Single Leg Stand task as well as less faults during the left Single Leg Stand task (P=0.003).

Conclusion

The clinical assessment tools utilized in this study are relatively inexpensive and portable tools of performance measures capable of detecting differences in postural sway between fragility fracture patients and controls.

Association of frail index and quality of life among community-dwelling older adults

AIMS AND OBJECTIVES

To examine the independent effect of frailty on quality of life.

BACKGROUND

The World Health Organisation has proposed that frailty be used to indicate a lack of successful ageing. However, studies investigating the relationship between frail phenotypes and quality of life are lacking.

DESIGN

This research employed a cross-sectional design.

METHODS

The Study of Osteoporotic Fractures index was used based on the following three criteria: unexpected weight loss, inability to rise from a chair without using the armrests five times, and feeling a lack of energy. Participants who fulfilled more than two, one or zero criteria were considered as frail, prefrail or robust respectively. Moreover, this study used the Taiwanese version of the World Health Organisation Quality of Life-BREF to assess the quality of life of older people. A multiple linear regression was performed to investigate the independent effect of frail status on each quality of life subscale.

RESULTS

A total of 239 older people [average age = 74·77 years; standard deviation = 7·02 years; 104 males (43·5%) and 135 females (56·5%)] participated in this study. The multiple linear regression analysis showed that the older people who were more advanced in age and had been diagnosed with a greater number of chronic diseases had a lower comprehensive quality of life. The Study of Osteoporotic Fractures index was associated only with the environmental domain of the World Health Organisation Quality of Life-BREF.

CONCLUSIONS

Compared with robust and prefrail older people, frail older people have worse biomarkers, health statuses, and quality of life. The Study of Osteoporotic Fractures index was correlated only with the quality of life environmental domain.

RELEVANCE TO CLINICAL PRACTICE

Professional nurses must understand the differences among frail, prefrail and robust older people with regard to their biomarkers, health status, and quality of life. In addition, a comprehensive nursing intervention programme must be developed to improve the quality of life of older people.

The Gait Deviation Index Is Associated with Hip Muscle Strength and Patient-Reported Outcome in Patients with Severe Hip Osteoarthritis-A Cross-Sectional Study

Background

The Gait Deviation Index summarizes overall gait ‘quality’, based on kinematic data from a 3-dimensional gait analysis. However, it is unknown which clinical outcomes may affect the Gait Deviation Index in patients with primary hip osteoarthritis. The aim of this study was to investigate associations between Gait Deviation Index as a measure of gait ‘quality’ and hip muscle strength and between Gait Deviation Index and patient-reported outcomes in patients with primary hip osteoarthritis.

Method

Forty-seven patients (34 males), aged 61.1 ± 6.7 years, with BMI 27.3 ± 3.4 (kg/m²) and with severe primary hip osteoarthritis underwent 3-dimensional gait analysis. Mean Gait Deviation Index, pain after walking and maximal isometric hip muscle strength (flexor, extensor, and abductor) were recorded. All patients completed the ‘Physical Function Short-form of the Hip disability and Osteoarthritis Outcome Score (HOOS-Physical Function) and the Hip disability and Osteoarthritis Outcome Score subscales for pain (HOOS-Pain) and quality-of-life (HOOS-QOL).

Results

Mean Gait Deviation Index was positively associated with hip abduction strength (p<0.01, r = 0.40), hip flexion strength (p = 0.01, r = 0.37), HOOS-Physical Function (p<0.01, r = 0.41) HOOS-QOL (p<0.01, r = 0.41), and negatively associated with HOOS-Pain after walking (p<0.01, r = -0.45). Adjusting the analysis for walking speed did not affect the association.

Conclusion

Patients with the strongest hip abductor and hip flexor muscles had the best gait ‘quality’. Furthermore, patients with higher physical function, quality of life scores and lower pain levels demonstrated better gait ‘quality’. These findings indicate that interventions aimed at improving hip muscle strength and pain management may to a moderate degree improve the overall gait ‘quality’ in patients with primary hip OA.

Age-associated declines in muscle mass, strength, power, and physical performance: impact on fear of falling and quality of life

This 3-year longitudinal study among older adults showed that declining muscle mass, strength, power, and physical performance are independent contributing factors to increased fear of falling, while declines of muscle mass and physical performance contribute to deterioration of quality of life. Our findings reinforce the importance of preserving muscle health with advancing age.

INTRODUCTION

The age-associated loss of skeletal muscle quantity and function are critical determinants of independent physical functioning in later life. Longitudinal studies investigating how decrements in muscle components of sarcopenia impact fear of falling (FoF) and quality of life (QoL) in older adults are lacking.

METHODS

Twenty-six healthy older subjects (age, 74.1 ± 3.7; Short Physical Performance Battery (SPPB) score ≥10) and 22 mobility-limited older subjects (age, 77.2 ± 4.4; SPPB score ≤9) underwent evaluations of lower extremity muscle size and composition by computed tomography, strength and power, and physical performance at baseline and after 3-year follow-up. The Falls Efficacy Scale (FES) and Short Form-36 questionnaire (SF-36) were also administered at both timepoints to assess FoF and QoL, respectively.

RESULTS

At 3-year follow-up, muscle cross-sectional area (CSA) (p < 0.013) and power decreased (p < 0.001), while intermuscular fat infiltration increased (p < 0.001). These decrements were accompanied with a longer time to complete 400 m by 22 ± 46 s (p < 0.002). Using linear mixed-effects regression models, declines of muscle CSA, strength and power, and SPPB score were associated with increased FES score (p < 0.05 for each model). Reduced physical component summary score of SF-36 over follow-up was independently associated with decreased SPPB score (p < 0.020), muscle CSA (p < 0.046), and increased 400 m walk time (p < 0.003).

CONCLUSIONS

In older adults with and without mobility limitations, declining muscle mass, strength, power, and physical performance contribute independently to increase FoF, while declines of muscle mass and physical performance contribute to deterioration of QoL. These findings provide further rationale for developing interventions to improve aging muscle health.

The associations between quadriceps muscle strength, power, and knee joint mechanics in knee osteoarthritis: A cross-sectional study

BACKGROUND

Abnormal knee joint mechanics have been implicated in the pathogenesis and progression of knee osteoarthritis. Deficits in muscle function (i.e., strength and power) may contribute to abnormal knee joint loading. The associations between quadriceps strength, power and knee joint mechanics remain unclear in knee osteoarthritis.

METHODS

Three-dimensional motion analysis was used to collect peak knee joint angles and moments during the first 50% of stance phase of gait in 33 participants with knee osteoarthritis. Quadriceps strength and power were assessed using a knee extension machine. Strength was quantified as the one repetition maximum. Power was quantified as the peak power produced at 40-90% of the one repetition maximum.

FINDINGS

Quadriceps strength accounted for 15% of the variance in peak knee flexion angle (P=0.016). Quadriceps power accounted for 20-29% of the variance in peak knee flexion angle (P<0.05). Quadriceps power at 90% of one repetition maximum accounted for 9% of the variance in peak knee adduction moment (P=0.05).

INTERPRETATION

These data suggest that quadriceps power explains more variance in knee flexion angle and knee adduction moment during gait in knee osteoarthritis than quadriceps strength. Additionally, quadriceps power at multiple loads is associated with knee joint mechanics and therefore should be assessed at a variety of loads. Taken together, these results indicate that quadriceps power may be a potential target for interventions aimed at changing knee joint mechanics in knee osteoarthritis.

Association Between Lower Extremity Performance and Health-Related Quality of Life in Elderly Mexican Americans

OBJECTIVE

To examine the longitudinal association between levels of lower extremity performance (LEP) and health-related quality of life (HRQoL) in older Mexican Americans aged 72 years or older participating in the Hispanic Established Population for the Epidemiological Study of the Elderly (2000-2006).

METHOD

LEP was measured in 621 non-institutionalized participants with the Short Physical Performance Battery (SPPB). Participants were divided into high (SPPB score 10-12), intermediate (SPPB score 7-9), and low (SPPB score 0-6) groups based on LEP. HRQoL was assessed using the Medical Outcomes Study Short Form (SF-36), which includes a Physical Composite Scale (PCS) and a Mental Composite Scale (MCS).

RESULTS

Participants in the high LEP group had slower rates of decline in the PCS, and those in the intermediate LEP group had slower rates of decline in the MCS score over time.

DISCUSSION

Increased LEP was associated with slower rates of decline in physical and mental HRQoL in older Mexican Americans.