Upper and lower limb muscle power relationships in mobility-limited older adults

Association between Hospital-acquired Disability and Clinical Outcomes in Older Patients Who Underwent Cardiac Surgical

OBJECTIVE

This study aimed to clarify the association between hospital-acquired disability (HAD) and prognosis in older patients who underwent cardiac surgery.

METHODS

This single-center, retrospective, observational study included 141 patients aged ≥65 years who underwent cardiac surgery at our hospital from November 2016 to August 2021. The primary endpoint of this study was the occurrence of major adverse cardiac and cerebrovascular events (MACCEs) within 2 years of hospital discharge. HAD was defined as a score of ≤5 on any one of the functional independence measure (FIM) subitems at discharge compared to preoperatively.

RESULTS

MACCE was observed in 16.3%, and the incidence of MACCE was significantly higher in the HAD group than that in the non-HAD group (12.1 vs. 34.5%, log-rank, p = 0.003). HAD was also significantly associated with the MACCE (hazard ratio [HD]: 2.575, 95% confidence interval [CI]: 1.001-9.655, p = 0.046). The incidence rate of HAD was 20.6%, with age (odds ratio [OR]: 1.260, 95% CI: 1.080-1.470, p = 0.004), preoperative short physical performance battery (SPPB) score (OR: 0.462, 95% CI: 0.301-0.708, p <0.001), and postoperative delirium (OR: 6.660, 95% CI: 1.480-30.000, p = 0.014) identified as significant factors.

CONCLUSION

HAD is an independent predictor of MACCE in older patients who underwent cardiac surgery.

The quality of life in Alzheimer's disease is not associated with handgrip strength but with activities of daily living-a composite study from 28 European countries

OBJECTIVES

The relationship between handgrip strength (HGS) and quality of life is inconsistent. The purpose of this study was to investigate the potential association between HGS and quality of life in the settings of ageing and Alzheimer's disease (AD).

METHODS

We investigated the HGS, CASP-12 (control, autonomy, self-realization, and pleasure) measure of quality of life, and physical capacity in European adults above 50, including controls (n = 38,628) and AD subjects (n = 460) using the survey of health, ageing, and retirement in Europe (SHARE; 2022).

RESULTS

AD subjects exhibited lower HGS and CASP-12 scores than controls (both p < 0.05). Participants with higher CASP-12 quartiles had higher HGS in controls but not in AD subjects. A linear positive relation was found between HGS and CASP-12 in controls (0.0842, p < 0.05) but not in AD subjects (0.0636, p = 0.091). There was no effect of gender on this finding. Lastly, we found significant negative associations of difficulties walking, rising from chair, climbing stairs, and fatigue with CASP-12 scores in controls and AD subjects (all p < 0.05).

CONCLUSIONS

Altogether, HGS was not associated with quality of life in individuals with AD. Conversely, difficulties in activities of daily living seem to be negatively associated with quality of life; thus, strategies are recommended to improve physical capacity.

Correlation between Power Elbow Flexion and Physical Performance Test: A Potential Predictor for Assessing Physical Performance in Older Adults

BACKGROUND

With the increasing number of older adults and their declining motor and cognitive function, it is crucial to find alternative methods for assessing physical functionality. The Short Physical Performance Battery (SPPB), the Time Up and Go (TUG) test, the 4 Meter Walk Test and the Barthel Index (BI) have been used to evaluate mobility and fragility and predict falls. But some of these functional test tasks could be difficult to perform for frail older adults or bedridden patients that cannot ambulate. This study aimed to evaluate the relationship between these functional tests and the power elbow flexion (PEF test).

MATERIAL AND METHODS

A correlation study was designed with 41 older adults over 65 years of age. The upper limb muscle power was measured using a linear encoder (VITRUBE VBT) with the flexion of the elbow.

RESULTS

Strong correlations were found between the PEF test and the 4mWT (rho = 0.715, p = 0.001) and TUG (rho= -0.768, p = 0.001), indicating that the greater the upper limb muscle power is, the greater physical performance will be. Moderate correlations were also found between the PEF and Barthel Index (rho = 0.495, p = 0.001) and SPPB (rho = 0.650, p < 0.001).

CONCLUSIONS

There is a strong correlation between PEF and the functional tests, proving that older adults that have greater upper limb muscle power have better physical performance. Upper limb muscle power and PEF could be an interesting tool for the assessment of physical performance in bedridden older adults.

Muscle distribution in relation to all-cause and cause-specific mortality in young and middle-aged adults

BACKGROUND

The relationship between muscle and prognosis, especially that between muscle distribution across different body parts, and the related prognosis is not well established.

OBJECTIVE

To investigate the relationship between muscle distribution and all-cause and cause-specific mortality and their potential modifiers.

DESIGN

Longitudinal cohort study. C-index, IDI, and NRI were used to determine the best indicator of prognosis. COX regression analysis was performed to explore the relationship between variables and outcomes. Interaction and subgroup analyses were applied to identify the potential modifiers.

PARTICIPANTS

A total of 5052 participants (weighted: 124,841,420) extracted from the NHANES 2003-2006 of median age 45 years and constituting 50.3% men were assessed. For validation, we included 3040 patients from the INSCOC cohort in China.

MAIN MEASURES

Muscle mass and distribution. KEY RESULTS: COX regression analysis revealed that upper limbs (HR = 0.41, 95% CI 0.33-0.51), lower limbs (HR = 0.54, 95% CI 0.47-0.64), trunk (HR = 0.71, 95% CI, 0.59-0.85), gynoid (HR = 0.47, 95% CI 0.38-0.58), and total lean mass (HR = 0.55, 95% CI 0.45-0.66) were all associated with the better survival of participants (P trend < 0.001). The changes in the lean mass ratio of the upper and lower limbs and the lean mass ratio of the android and gynoid attenuated the protective effect of lean mass. Age and sex acted as potential modifiers, and the relationship between lean mass and the prognosis was more significant in men and middle-aged participants when compared to that in other age groups. Sensitive analyses depicted that despite lean mass having a long-term impact on prognosis (15 years), it has a more substantial effect on near-term survival (5 years).

CONCLUSION

Muscle mass and its distribution affect the prognosis with a more significant impact on the near-term than that on the long-term prognosis. Age and sex acted as vital modifiers.

Muscle Power in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis

This study aimed to review the impact of training on muscle power in patients with chronic obstructive pulmonary disease (COPD). Randomized controlled trials evaluating the effects of exercise-based interventions on limbs muscle power and rate of force development in COPD patients were investigated. Five international databases were searched until October 2022. Meta-analyses were performed calculating the mean difference or standardized mean difference. Risk of bias in studies was assessed using Cochrane Risk of Bias tool 2.0. A total of nine studies were included in the analysis. There were concerns about risk of bias in seven out of nine studies. Comparison of exercising and non-exercising groups showed a significant effect of exercise in improving muscle power (P=0.0004) and rate of force development (P<0.001), in five and three trials, respectively. Four studies comparing different trainings showed no significant results on muscle power (P=0.45). Eight to 16 weeks of exercise-based intervention versus no intervention might be beneficial to enhance upper and lower limbs muscle power and rate of force development in people with COPD. In contrast, muscle power did not improve when different training modalities were compared. Future studies performing power training in COPD patients are encouraged.

Validity and feasibility of using a seated push-up test among community-dwelling older adults

BACKGROUND

Older individuals face a high risk of mobility and body composition decline, which can affect their independence. In light of a current uncertain healthcare situation created by the coronavirus (COVID-19) pandemic, healthcare paradigm has been shifted with increased demand for a practical measure to promote standard home healthcare services for all individuals, including older adults.

OBJECTIVE

This study explored the feasibility and validity of seated push-up tests (SPUTs) as clinical measures to reflect the body composition, muscle strength, and mobility among community-dwelling older individuals, aged ≥ 65 years (n = 82 ).

METHODS

Participants were cross-sectionally assessed using SPUTs with various demanding forms, including the 1-time SPUT (1SPUT) along with its upper limb loading SPUT (ULL-SPUT), 5-time SPUT (5SPUT), 10-time SPUT (10SPUT), and 1-min SPUT (1minSPUT) and standard measures.

RESULTS

Participants who passed and failed a 1SPUT showed significant differences in the outcomes of all standard measures (p < 0 . 05 ). The ULL-SPUT significantly correlated to all body composition, muscle strength, and mobility (r = 0 . 247 -0.785; p < 0 . 05 ). Outcomes of 1minSPUT significantly correlated with muscle strength and mobility outcomes (r = 0 . 306 -0.526; p < 0 . 05 ). Participants reported no adverse effects following the SPUTs.

CONCLUSION

The findings suggest the use of the 1SPUT, ULL-SPUT, and 1minSPUT as practical measures to reflect the body composition, muscle strength, and mobility of older individuals, according to their functional levels. The tests may especially clinically benefit those with lower limb limitations and those in settings with limited space and equipment.

Exercise as Medicine for Older Women

Exercise is associated with protective effects, yet most adult women in this country do not meet the physical activity recommendations set forth in the Physical Activity Guidelines for Americans. This article discusses how exercise affects disease and prevents functional decline. It also clarifies why exercise is not a generic cure-all but is instead a tool physicians can use with precision to affect a myriad of health issues. Specifics will be provided regarding physical fitness assessments and comprehensive treatments and how physicians can be more involved in using physical fitness to keep their older female patients healthy.

Moderate-to-vigorous physical activity duration is more important than timing for physical function in older adults

The positive association between the total duration of physical activity and performances of physical function may vary at different times of the day as circadian rhythm regulates individuals in response to external stimulations. We aimed to examine the association of timing-specific and overall moderate-to-vigorous physical activity (MVPA) with performances of physical function in older adults. A cross-sectional analysis was conducted among 118 older adults (mean age = 70.0 ± 5.0 years). We assessed and identified timing-specific (morning: 06:01–12:00; afternoon: 12:01–18:00; evening: 18:01–24:00) and overall MVPA using a triaxial accelerometer. Different measures of physical function were evaluated including handgrip strength (by grip dynamometer), gait speed (5-m walk test), basic functional mobility (timed up and go test), and lower limb strength (five times sit-to-stand test). Multivariate linear regression models adjusting for covariates were used to investigate the associations. Participants spent 25.0 (± 26.2) minutes in MVPA per day on average, half the time spent during the morning (47.7%), followed by during the afternoon (29.9%) and evening (21.6%). The time spent on overall MVPA was generally associated with better physical function performances. There was statistical evidence for the percentages of MVPA engagement during the morning [B = 0.214, 95% confidence interval (CI) 0.001 to 0.428] and afternoon (B = − 0.273, 95% CI − 0.518 to − 0.027) associated with basic functional mobility but with contrary directions; the percentage of MVPA engagement during the evening was associated with less time spent in gait speed performance (B = − 0.237, 95% CI − 0.468 to − 0.006). Our findings inform implications that the overall MVPA engagement was more important than timing-specific MVPA to older adults’ physical function performances. Strategies for accumulating time of MVPA is more practical and effective than encouraging to engage MVPA in specific timing for the enhancement of functional ability and therefore prevent disability among older adults.

Physical fitness in older adults: Is there a relationship with the modified Functional Movement Screen™?

INTRODUCTION

The modified Functional Movement Screen™ (mFMS) has been used to screen for mobility, stability, motor control, and balance in older adults, yet, its relationship to measures of physical fitness is not fully understood. The purpose of this study was to determine the association between mFMS scores and measures of physical fitness in older adults. A secondary aim was to determine physical fitness differences depending on mFMS Lower Body Motor Control Screen scores.

METHODS

One hundred and eight older adults completed this cross-sectional study. Measurements of physical fitness included: Handgrip Strength (HG), Back-Leg Strength Dynamometer (BLS), 8 foot Up and Go (8UG), Vertical Jump (VJ), Medicine Ball Throw (MBT), Chair Stand (CST), Arm Curl (AC), and 6-Minute Walk test (6 MW). The mFMS consisted of four screens: Shoulder Mobility Screen (SMS), Deep Squat (DS), Active Straight Leg Raise (ASLR), and a Lower Body Motor Control Screen (LB-MCS). Spearman's R correlations determined associations between physical fitness tests and mFMS scores (DS, SMS, ASLR). Independent t-tests or Mann Whitney U tests determined whether individuals who passed the LB-MCS displayed higher physical fitness scores.

RESULTS

The DS was significantly correlated with all fitness measures (p < 0.05). Higher DS scores were associated with better HG (r = 0.31), BLS (r = 0.49), VJ height (r = 0.54), MBT (r = 0.41), CST (r = 0.57), AC (r = 0.30), 6 MW (r = 0.50), and 8UG (r = -0.61) performance. Individuals who passed the LB-MCS displayed superior BLS, 8UG test, and 6 MW test performance (p < 0.05).

DISCUSSION & CONCLUSION

Higher DS scores are associated with higher physical fitness scores. Individuals who passed the LB-MCS displayed better physical fitness scores. Practitioners may desire to use the mFMS to measure physical fitness in older adults.

Effect of High-velocity Resistance Exercise on 24-h Blood Pressure in Hypertensive Older Women

This study investigated the acute post-exercise effect of high-velocity resistance exercise on ambulatory blood pressure in hypertensive older women. Fourteen volunteers (67.9±5.1 years) performed a high-velocity resistance exercise session (8 exercises using Thera-Band, 3 sets of 6 repetitions as fast as possible in the concentric phase with moderate intensity) and a control session, separated by a 7-10-day period. Ambulatory blood pressure was monitored following 12-h post-sessions and compared between conditions at 1 to 4-h, 5 to 8-h, and 9 to 12-h. Average 24-h ambulatory blood pressure, awake, asleep periods, and blood pressure load were also analyzed. There was a condition by time interaction for systolic ambulatory blood pressure over 12-h post-sessions (P=0.043). It was observed a lower systolic ambulatory blood pressure in the first 4-h period following the high-velocity resistance exercise session compared to the control session (-6.7 mmHg, 95% CI  - 11.6 to -1.8 mmHg; P=0.011). No changes were observed for diastolic ambulatory blood pressure over 12-h post-sessions as well as for the other variables analyzed (P>0.05). In summary, a single high-velocity resistance exercise session elicits a post-exercise antihypertensive effect and may be considered as a strategy to acutely improve blood pressure control in hypertensive older women.

Reliability and Validity of the Sit-to-Stand as a Muscular Power Measure in Older Adults

The study aims were to analyze the reliability and validity of the GymAware™ linear position transducer's velocity and power measures during the sit-to-stand, compared with the Dartfish 2D videography analysis, and to assess the relationship of age and handgrip strength with velocity and power in 48 older men and women (77.6 ± 11.1 years). The results showed excellent agreement between GymAware- and Dartfish-derived sit-to-stand velocity (intraclass correlation coefficient2-1 = .94 and power intraclass correlation coefficient2-1 = .98) measures. A moderate and negative relationship was found between age and velocity (r = -.62; p < .001) and age and power (r = -.63; p < .001). A moderate and positive relationship was found between handgrip strength and velocity (r = .43; p = .002) and handgrip strength and power (r = .54; p < .001). The results show the GymAware velocity and power measures during the sit-to-stand in older adults to be reliable and valid.

The Effects of High- Versus Low-Intensity Power Training on Muscle Power Outcomes in Healthy, Older Adults: A Systematic Review

Power training (PT) improves muscle power in older adults; however, intensity recommendations are less clear. A narrative approach was used to compare high- versus low-intensity PT on muscle power (and function) in healthy, older adults. Searches were performed using Medline, Embase, CINAHL, SPORTDiscus, AgeLine, and Scopus. Interventions in which older subjects (60+ years) were instructed to perform the concentric phase "as fast as possible" were included. After searches were performed, a third category of PT (moderate intensity) was included. Evidence from 27 studies (32 PT groups) showed changes in muscle power that averaged 26.8%, 33.4%, and 21.5% for high-, moderate-, and low-intensity PT, respectively, with greater changes with longer training duration and in mildly mobility-limited older adults. Function improved similarly across categories. In conclusion, both low- and high-intensity PT led to clinically significant changes in power and are viable options for improving power and function in older adults.

Relationship of muscle function to circulating myostatin, follistatin and GDF11 in older women and men

Background

Myostatin, its inhibitor follistatin, and growth/differentiation factor 11 (GDF11) have been proposed as factors that could potentially modify biological aging. The study aimed to test whether there is a relationship between these plasma circulating proteins and muscle strength, power and optimal shortening velocity (υ_opt) of older adults.

Methods

The cross-sectional study included 56 women and 45 men aged 60 years and older. Every participant underwent examination which included anthropometric and bioimpedance analysis measurements, functional and cognitive performance tests, muscle strength of upper and lower extremities, muscle power testing with two different methods and blood analyses.

Results

Women had higher plasma levels of myostatin and GDF11 than men. Men had higher plasma level of follistatin than women. In women, plasma level of myostatin was negatively correlated with left handgrip strength and υ_opt. Follistatin was negatively correlated with maximum power output (P_max), power relative to kg of body mass (P_max∙kg^− 1) (friction-loaded cycle ergometer) and power at 70% of the 1-repetition maximum (1RM) strength value (P70%) of leg press (Keiser pneumatic resistance training equipment), and positively correlated with the Timed Up & Go (TUG) test. GDF11 was negatively correlated with body mass, body mass index, waist circumference, fat mass and the percentage of body fat. In men, there were no significant correlations observed between circulating plasma proteins and muscle function measures.

Conclusions

The circulating plasma myostatin and follistatin are negatively associated with muscle function in older women. There is stronger relationship between these proteins and muscle power than muscle strength. GDF11 has a higher association with the body mass and composition than muscle function in older women.

Efficacy of rhythmic exercise and walking exercise in older adults' exercise participation rates and physical function outcomes

AIM

The purpose of the present study was to evaluate the efficacy of two different exercise types, rhythmic exercise designed from local music and dance (RE) and walking exercise (WE), in terms of exercise participation and physical function changes in older adults over a period of 12 weeks.

METHODS

Exercise participation was assessed through the attendance rate and retention rate, and physical function was evaluated through the Short Physical Performance Battery, static balance test and gait test.

RESULTS

The RE group showed significantly higher attendance and retention rates; greater improvement in Short Physical Performance Battery scores; and greater improvement in static balance, as compared with the WE. No differences were found between the RE and WE groups in gait parameters.

CONCLUSIONS

The results suggest that RE was more effective than WE in retaining exercise participation and improving physical function in older adults. Geriatr Gerontol Int 2017; 17: 2311-2318.

A cross-sectional study of the association between dynapenia and higher-level functional capacity in daily living in community-dwelling older adults in Japan

Background

There are many reports that dynapenia, sarcopenia and frailty each have associations with bodily function or with Instrumental Activities of Daily Living (IADL). However, studies that compare all three conditions and their effects on IADL are lacking. The purpose of this study is to examine associations of sarcopenia, frailty, and dynapenia with IADL.

Methods

Participants included 123 community-dwelling older adults (31 men, 92 women,) aged 65 years or older (75.0 ± 5.3 years) who were independent in IADL. In terms of physical function, measurements were performed for muscle mass, grip strength, walking speed, isometric knee extension strength, and unipedal standing. A questionnaire survey was carried out, the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was administered, and participants were asked about sense of fatigue and amount of activity.

Results

Dynapenia was associated with classifications of both frailty and sarcopenia. In addition, sarcopenia had a sensitivity and specificity for dynapenia of 33 and 89%, respectively. Frailty had a sensitivity and specificity for dynapenia of 17 and 98%, respectively. Dynapenia was a significant independent related factor for the TMIG-IC (β = −0.21, P < 0.05).

Conclusions

Dynapenia, more than sarcopenia or frailty, was related to difficulties with IADL; therefore, assessment of dynapenia should be given greater emphasis in evaluating the physical functioning of older adults.

The reliability and validity of gait speed with different walking pace and distances against general health, physical function, and chronic disease in aged adults

[Purpose]

Gait speed is an important objective values associated with several health-related outcomes including functional mobility in aging people. However, walking test methodologies and descriptions are not standardized considering specific aims of research. This study examine the reliability and validity of gait speed measured at various distances and paces in elderly Koreans.

[Methods]

Fifty-four female participants ≥70 years of age were recruited from a local retirement community. Gait speed was assessed at 4, 6 and 10 meters, and at usual- and fast-pace walking mode. The short physical performance battery (SPPB) that estimates senior fitness includes three tests of lower-body function. Data concerning for the chronic conditions and self-perceived health of the participants was collected using questionnaires. Concurrent validity of gait speed using the aforementioned test protocols was determined by calculating the Pearson correlation coefficients.

[Results]

Significant positive correlations were evident between skeletal muscle mass and maximal pace walking regardless of distance (r=.301~.308; p<.05), but not with body fat. All gait tests significantly positively correlated with self-rated health (normal pace r=.328~.346, p<.05; maximal pace r=.427~.472, p<.001) and depression (normal pace r=.279~.430, p<.05; maximal pace r=.413~.456, p<.001).

[Conclusion]

Walking test at the normal pace appears suitable for estimating physical function and deterioration due to chronic disease. Walking test at a maximum pace might be useful for estimating subjective general health and skeletal muscle mass.

Physical activity and sarcopenic obesity: definition, assessment, prevalence and mechanism

Sarcopenic obesity is the coexistance of sarcopenia and obesity. Modern sarcopenia definition includes low muscle mass, weak muscle strength (handgrip strength) and poor physical function (slow walking), although the clinical definition of each varies worldwide. The cut-points for low muscle mass for men and women using appendicular lean mass divided by height (kg/m2) are ≤7.0 and ≤5.4 in Asians, and ≤7.23 and ≤5.67 in Caucasians, respectively. The cut-points for weak handgrip strength (kg) for men and women are <26 and <18 in Asians, and <30 and <20 in Caucasians, respectively. The cut-point for slow walking is ≤0.8 m/s in men and women. Current data suggest the potential benefits of physical activity and fitness on sarcopenic obesity in older adults.

Causality Analysis of Inertial Body Sensors for Multiple Sclerosis Diagnostic Enhancement

Inertial body sensors have emerged in recent years as an effective tool for evaluating mobility impairment resulting from various diseases, disorders, and injuries. For example, body sensors have been used in 6-min walk (6 MW) tests for multiple sclerosis (MS) patients to identify gait features useful in the study, diagnosis, and tracking of the disease. However, most studies to date have focused on features localized to the lower or upper extremities and do not provide a holistic assessment of mobility. This paper presents a causality analysis method focused on the coordination between extremities to identify subtle whole-body mobility impairment that may aid disease diagnosis. This method was developed for and utilized in an MS pilot study with 41 subjects (28 persons with MS (PwMS) and 13 healthy controls) performing 6 MW tests. Compared with existing methods, the causality analysis provided better discrimination between healthy controls and PwMS and a deeper understanding of MS disease impact on mobility.

['Autonometer'. Proposal of a scale to assess independence in the elderly]

INTRODUCTION

The demographic forecast predicts an aging population in all developed countries, and this will lead to an increase of frailty in the elderly. Gerontology professionals need tools to detect frailty in advance. A test is presented for assessing multidimensional independence, consisting of a questionnaire and a test.

MATERIAL AND METHOD

A test of cognitive functional assessment was designed for the elderly, consisting of a questionnaire of 40 questions (Autonometro-Q) and a test of 26 tasks (Autonometro-T) that can be used together or independently.

RESULTS

Autonometro-T test obtained a Cronbach α of 0.85 with four dimensions, and a Kappa coefficient of 0.40. Autonometro-Q is a five-dimensional short questionnaire with a Cronbach α of 0.94, a Kappa coefficient of 0.63 and has a sensitivity of 85% and a specificity of 87%, with positive and negative predictive values of 73% and 94%, respectively, using Autonometro-T as the reference standard.

CONCLUSIONS

Autonometro is a useful tool for frailty screening in the elderly, which examines the physical markers related to daily living activities, using an objective test.

Maximum movement velocity of the upper limbs reflects maximum gait speed in community-dwelling adults aged older than 60 years

AIM

A number of studies have shown that the maximum movement velocity of the lower limbs is a critical determinant of gait speed in elderly adults. However, it is still unclear whether gait speed is associated with the movement velocity of the lower limbs or the movement velocity itself. Therefore, we measured the movement velocity of upper limbs that would not have a direct effect on gait, and examined the relationship between the movement velocity and gait speed.

METHODS

A total of 76 community-dwelling adults aged older than 60 years (mean age 73.3 years) participated in the study. We measured the movement velocity of the upper limbs, maximum gait speed, quadriceps strength, trunk muscle endurance and skeletal muscle mass index.

RESULTS

A significant correlation was found between the movement velocity of the upper limbs and maximum gait speed (r=0.47; P<0.01). In a stepwise multiple regression analysis using maximum gait speed as a dependent variable, age, movement velocity of the upper limbs, body mass index and quadriceps strength were selected as independent variables (R(2)=0.55, P<0.001).

CONCLUSIONS

The movement velocity of the upper limbs is a significant determinant of maximum gait speed, suggesting that the ability to move any region rapidly might be a critical factor in maximum gait speed.

Power training in patients with knee osteoarthritis: a pilot study on feasibility and efficacy

PURPOSE

To explore the feasibility and efficacy of using a power training exercise programme for the quadriceps femoris (QF) in elderly women with knee osteoarthritis (OA).

METHOD

A one-group quasi-experimental design with pre- and post-intervention measurements was conducted on 17 older adult women with knee OA pain. A bilateral QF exercise programme (24 sessions over 8 weeks) consisting of 3 series of 10 repetitions of flexion-extension as fast as possible at 40% of their one-repetition maximum (1RM) was performed in an outpatient physiotherapy clinic. The primary outcome measures were the knee function and associated problems using the Knee injury Osteoarthritis Outcome Score (KOOS) questionnaire and the weekly mean pain score from pain diaries using a visual analogue scale (VAS). QF strength (QFS), power (QFP) and work (QFW) were measured with an isokinetic dynamometer as secondary outcomes.

RESULTS

Significant improvements (p<0.05) were noted on the five categories of the KOOS. Significant decrease (p<0.01) was noted in pain intensity on VAS. QFP and QFW increased significantly on both sides (p<0.05). Exercise compliance was 99.5% for 16 participants.

CONCLUSIONS

A short power-training exercise programme is a feasible training modality for patients with knee OA, and significant functional improvements can be achieved. Further studies must be conducted to better understand the effects of the programme parameters and the generalizability of the findings.

Validation of the COURAGE Built Environment Self-Reported Questionnaire

The built environment (BE) impacts on people's disability and health, in terms of overweight, depression, alcohol abuse, poor self-rated health and presence of psychological symptoms; it is reasonable to assume that BE also impacts on participation levels. This paper presents the validation of the COURAGE Built Environment Self-Reported Questionnaire (CBE-SR), an instrument designed to evaluate BE in the context of health and disability. Subjects participating to COURAGE, a cross-sectional study conducted on 10,800 citizens of Poland, Finland and Spain, completed a protocol inclusive of the CBE-SR. Psychometric properties and factor structure were analysed, and factor scores created. Gender differences, differences between persons from different age groups and persons reporting the environment as facilitating, hindering or neutral were calculated. Eight items were deleted so that the final version of CBE-SR comprises 19 items. Cronbach's alpha ranged from 0.743 to 0.906, and test-retest stability was demonstrated for the majority of items. Four subscales were identified: Usability of the neighbourhood environment; Hindrance of walkable environment; Easiness of use of public buildings, places and facilities; and Risk of accidents and usability of the living place. Younger respondents reported their neighbourhood as more usable but perceived walkways as more hindering and public buildings as less easy to use; gender differences were almost inexistent. The CBE-SR is a four-scale instrument with good psychometric properties that measures the person-environment interaction. It is sensitive across age groups and is consistent with the subject's overall judgement of the degree to which the environment is facilitating or hindering.

KEY PRACTITIONER MESSAGE

Poor built environments have a negative impact on the level of a person's participation. However, instruments measuring the person-environment interaction are lacking. The CBE-SR is a valid and reliable instrument that researchers can use to assess the relationships between the intrinsic health state and the objective features of the environment. Understanding this relationship would provide further insight into the need of addressing the individual's functioning either by means of interventions directed to the individual or by making changes to the individual's environment.

Strength Training in the Elderly People

Proces starzenia się człowieka charakteryzuje się licznymi zmianami, które dotyczą struktur na poziomie molekularnym, komórkowym, narządowym oraz całego organizmu. Jednym ze skutków zmniejszającej się aktywności fizycznej oraz postępujących procesów starzenia się organizmu człowieka jest systematyczne obniżanie się siły mięśniowej, któremu towarzyszy pogorszenie sprawności w podstawowych czynnościach codziennych. Ćwiczenia fizyczne, w tym ćwiczenia ukierunkowane na zwiększenie siły mięśniowej, wykonywane przez osoby starsze spowalniają proces starzenia się i zapobiegają występowaniu wielu chorób. Jakkolwiek nawet stała i regularna aktywność fizyczna nie może zapobiec spadkowi siły wraz z wiekiem, to zmiany adaptacyjne w centralnym układzie nerwowym i mięśniowym wywołane stosowaniem ćwiczeń siłowych w dużym stopniu mogą rekompensować ten proces.

Ćwiczenia ukierunkowane na zwiększenie siły i masy mięśniowej, nazywane ćwiczeniami siłowymi, są na świecie powszechnie znane i stosowane przez ludzi w podeszłym wieku. W Polsce model usprawniania fizycznego osób starszych bazuje prawie wyłącznie na ćwiczeniach wytrzymałościowych i rozciągających, a stosowanie klasycznych ćwiczeń siłowych często wywołuje obawy.

Celem pracy jest uzasadnienie potrzeby stosowania ćwiczeń ukierunkowanych na zwiększenie siły mięśniowej w usprawnianiu osób starszych i przedstawienie efektów ich zastosowania.

Aerobic versus resistance training effects on health-related quality of life, body composition, and function of older adults

This study aimed to investigate the effects of training on health-related quality of life (HRQoL), body composition, and function in older adults. Fifty participants were randomized into aerobic training (AT--70%-80% HR reserve), resistance training (RT--80% 1RM), or controls. They had HRQoL, body composition, and function assessed before and after 8 months. Training groups reduced body fat, increased performance in the stair ascent, 8-ft up-and-go and sit-to-stand five-times tests, and improved their physical component score (PCS; p ≤ .03). AT increased performance in the 6MWT test, and improved general and mental health (MH) domains when compared to controls (p < .01). Finally, changes in stair ascent were associated with changes in bodily pain, MH, and mental component score (p ≤ .04), while changes in handgrip strength were associated with changes in physical role and MH (p = .03). AT and RT were effective interventions for decreasing body fat and improving functionality and the PCS in older adults.

Strength training as a countermeasure to aging muscle and chronic disease

Strength training (ST) has long been considered a promising intervention for reversing the loss of muscle function and the deterioration of muscle structure associated with advanced age but, until recently, the evidence was insufficient to support its role in the prevention or treatment of disease. In recent decades, there has been a long list of quality reviews examining the effects of ST on functional abilities and a few on risk factors for specific diseases, but none have provided a comprehensive assessment of ST as an intervention for a broad range of diseases. This review provides an overview of research addressing the effectiveness of ST as an intervention for the prevention or treatment of the adverse consequences of (i) aging muscle; (ii) the metabolic syndrome (MetS) and its components, i.e. insulin resistance, abdominal obesity, hyperlipidaemia and hypertension; (iii) fibromyalgia; (iv) rheumatoid arthritis; and (v) Alzheimer's disease. Collectively, these studies indicate that ST may serve as an effective countermeasure to some of the adverse consequences of the MetS, fibromyalgia and rheumatoid arthritis. Evidence in support of the hypothesis that ST reduces insulin resistance or improves insulin action comes both from indirect biomarkers, such as glycosylated haemoglobin (HbA(1c)), and insulin responses to oral glucose tolerance tests, as well as from more direct procedures such as hyperglycaemic and hyperinsulinaemic-euglycaemic clamp techniques. The evidence for the use of ST as a countermeasure of abdominal obesity is less convincing. Although some reports show statistically significant reductions in visceral fat, it is unclear if the magnitude of these changes are physiologically meaningful and if they are independent of dietary influences. The efficacy of ST as an intervention for reducing dyslipidaemia is at best inconsistent, particularly when compared with other pharmacological and non-pharmacological interventions, such as aerobic exercise training. However, there is more consistent evidence for the effectiveness of ST in reducing triglyceride levels. This finding could have clinical significance, given that elevated triglyceride is one of the five criterion measures for the diagnosis of the MetS. Small to moderate reductions in resting and exercise blood pressure have been reported with some indication that this effect may be genotype dependent. ST improves or reverses some of the adverse effects of fibromyalgia and rheumatoid arthritis, particularly pain, inflammation, muscle weakness and fatigue. Investigations are needed to determine how these effects compare with those elicited from aerobic exercise training and/or standard treatments. There is no evidence that ST can reverse any of the major biological or behavioural outcomes of Alzheimer's disease, but there is evidence that the prevalence of this disease is inversely associated with muscle mass and strength. Some indicators of cognitive function may also improve with ST. Thus, ST is an effective countermeasure for some of the adverse effects experienced by patients of many chronic diseases, as discussed in this review.

Prediction of ambulation ability following total hip arthroplasty

BACKGROUND

In early postoperative rehabilitation after THA, it is essential to clarify some factors related to future ambulation ability. The aim of this study was to examine whether it is possible to predict ambulation ability for patients with THA at 6 months postoperatively.

METHODS

The subjects of this study were 123 patients who had undergone unilateral THA. The hip abductor and knee extensor strength was assessed, and a timed up and go (TUG) test was performed at 4 weeks after the operation. Then, the patients were divided into two groups according to their ability to walk and to go up and down stairs at 6 months postoperatively: the good ambulatory group (n = 64) and the non-good ambulatory group (n = 59).

RESULTS

The discriminating criteria between the two groups were 0.47 (Nm/kg) for hip abductor strength, 1.07 (Nm/kg) for knee extensor strength, and 10 s for TUG test. By multiple logistic regression, knee extensor strength and TUG test at 4 weeks were significantly associated with the categorization at 6 months.

CONCLUSIONS

The results of this study suggest that the TUG test and knee extensor strength at an early stage after THA were useful indicators for predicting patients' ambulation ability at 6 months postoperatively.

Dynapenia and aging: an update

In 2008, we published an article arguing that the age-related loss of muscle strength is only partially explained by the reduction in muscle mass and that other physiologic factors explain muscle weakness in older adults (Clark BC, Manini TM. Sarcopenia =/= dynapenia. J Gerontol A Biol Sci Med Sci. 2008;63:829-834). Accordingly, we proposed that these events (strength and mass loss) be defined independently, leaving the term "sarcopenia" to be used in its original context to describe the age-related loss of muscle mass. We subsequently coined the term "dynapenia" to describe the age-related loss of muscle strength and power. This article will give an update on both the biological and clinical literature on dynapenia-serving to best synthesize this translational topic. Additionally, we propose a working decision algorithm for defining dynapenia. This algorithm is specific to screening for and defining dynapenia using age, presence or absence of risk factors, a grip strength screening, and if warranted a test for knee extension strength. A definition for a single risk factor such as dynapenia will provide information in building a risk profile for the complex etiology of physical disability. As such, this approach mimics the development of risk profiles for cardiovascular disease that include such factors as hypercholesterolemia, hypertension, hyperglycemia, etc. Because of a lack of data, the working decision algorithm remains to be fully developed and evaluated. However, these efforts are expected to provide a specific understanding of the role that dynapenia plays in the loss of physical function and increased risk for disability among older adults.

Intervening on the side effects of hormone-dependent cancer treatment: the role of strength training

While prostate and breast cancers are both highly prevalent and treatable using hormone suppression therapy, a constellation of side effects ensue, which mimic typical aging effects but at an accelerated pace. Because strength training is considered to be an intervention of choice for addressing the musculoskeletal and metabolic consequences of normal aging in older adults, it may be an effective intervention to attenuate or reverse the side effects of hormone-dependent cancer treatment. This paper provides an overview of the independent effects of strength training on common musculoskeletal and metabolic side effects of hormone-dependent therapy used for prostate and breast cancers. Strength training appears to be an effective complementary therapy for some of the adverse effects of prostate and breast treatment. Future research needs to address potential mechanisms to explain recent findings and to explore the role of strength training in addressing specific risk factors resulting from cancer treatment.

Resistência aeróbia e força de membros inferiores de idosos praticantes e não-praticantes de ginástica recreativa em um centro de convivência

OBJETIVO: Analisar a resistência aeróbia e força de membros inferiores de idosos praticantes e não-praticantes de um programa de ginástica recreativa em um centro de convivência. MÉTODOS: Fizeram parte do estudo 54 voluntários - 26 não-praticantes (71,2 ± 6 anos e 26 ± 4,7 kg/m²) e 28 praticantes de ginástica recreativa (68,6 ± 7,7 anos e 27,5 ± 4,5 kg/m²). Todos foram submetidos ao teste de sentar-levantar da cadeira em 30 segundos (avaliação da força de membros inferiores) e teste de caminhada de seis minutos (avaliação da resistência aeróbia). RESULTADOS: O grupo participante do programa de ginástica obteve melhor média tanto no teste de sentar-levantar da cadeira em 30 segundos (16,1 ± 2,8 vs. 12,1 ± 2,7 execuções - p < 0,001), quanto no teste de caminhada de seis minutos (439,2 ± 46,1 vs. 373,1 ± 58,5 metros - p < 0,001). CONCLUSÃO: De acordo com os resultados obtidos, é possível concluir que os idosos participantes do programa de ginástica recreativa do centro de convivência analisado apresentaram melhores indicadores de resistência aeróbia e força de membros inferiores, sugerindo melhor nível de capacidade funcional em relação aos não-participantes.

Equilíbrio estático, força do quadríceps e torque dos dorsiflexores do tornozelo em mulheres férteis e na pós-menopausa

INTRODUÇÃO: A menopausa é um período em que a mulher apresenta progressivas alterações em seu organismo. A perda de força muscular e do equilíbrio corporal são importantes exemplos dessas alterações. OBJETIVO: Avaliar e correlacionar o equilíbrio estático, a força de quadríceps e o torque dos dorsiflexores de tornozelo de mulheres no período fértil (n=20) e de mulheres na pós-menopausa (n = 45). MÉTODOS: Foram registrados o torque dos dorsiflexores de tornozelo e a força do quadríceps. O equilíbrio estático foi avaliado utilizando-se o sistema Polhemus. RESULTADOS: O grupo controle apresentou maior torque dos dorsiflexores de tornozelo e maior força de quadríceps comparado ao grupo pós-menopausa, porém o equilíbrio estático não apresentou diferença entre os grupos. No grupo controle, foi observada correlação somente entre a força de quadríceps com a condição plataforma fixa olhos fechados. No grupo de mulheres na pós-menopausa houve correlação entre torque dos dorsiflexores de tornozelo e equilíbrio estático nas condições plataforma fixa olhos abertos (r = 0,386; p = 0,008), plataforma fixa olhos fechados (r = 0,373; p = 0,01) e plataforma instável olhos abertos (r = 0,343; p = 0,02). Neste mesmo grupo também houve correlação entre força de quadríceps e equilíbrio estático na condição plataforma fixa olhos fechados (r = 0,315; p = 0,03). CONCLUSÕES: Os resultados sugerem que a diminuição da força muscular após a menopausa parece estar relacionada ao hipoestrogenismo e que o torque dos dorsiflexores de tornozelo é um fator importante para a manutenção do equilíbrio estático nos primeiros anos da menopausa.

A biomechanical evaluation of resistance: fundamental concepts for training and sports performance

Newton's second law of motion describes the acceleration of an object as being directly proportional to the magnitude of the net force, in the same direction as the net force and inversely proportional to its mass (a = F/m). With respect to linear motion, mass is also a numerical representation of an object's inertia, or its resistance to change in its state of motion and directly proportional to the magnitude of an object's momentum at any given velocity. To change an object's momentum, thereby increasing or decreasing its velocity, a proportional impulse must be generated. All motion is governed by these relationships, independent of the exercise being performed or the movement type being used; however, the degree to which this governance affects the associated kinematics, kinetics and muscle activity is dependent on the resistance type. Researchers have suggested that to facilitate the greatest improvements to athletic performance, the resistance-training programme employed by an athlete must be adapted to meet the specific demands of their sport. Therefore, it is conceivable that one mechanical stimulus, or resistance type, may not be appropriate for all applications. Although an excellent means of increasing maximal strength and the rate of force development, free-weight or mass-based training may not be the most conducive means to elicit velocity-specific adaptations. Attempts have been made to combat the inherent flaws of free weights, via accommodating and variable resistance-training devices; however, such approaches are not without problems that are specific to their mechanics. More recently, pneumatic-resistance devices (variable) have been introduced as a mechanical stimulus whereby the body mass of the athlete represents the only inertia that must be overcome to initiate movement, thus potentially affording the opportunity to develop velocity-specific power. However, there is no empirical evidence to support such a contention. Future research should place further emphasis on understanding the mechanical advantages/disadvantages inherent to the resistance types being used during training, so as to elicit the greatest improvements in athletic performance.

Regional muscle and whole-body composition factors related to mobility in older individuals: a review

PURPOSE

To describe previously reported locomotor muscle and whole-body composition factors related to mobility in older individuals.

METHODS

A narrative review of the literature, including a combination of search terms related to muscle and whole-body composition factors and to mobility in older individuals, was carried out. Statistical measures of association and risk were consolidated to summarize the common effects between studies.

RESULTS

Fifty-three studies were reviewed. Muscle and whole-body factors accounted for a substantial amount of the variability in walking speed, with coefficients of determination ranging from 0.30 to 0.47. Muscle power consistently accounted for a greater percentage of the variance in mobility than did strength. Risks associated with high fat mass presented a minimum odds ratio (OR) of 0.70 and a maximum OR of 4.07, while the minimum and maximum ORs associated with low lean mass were 0.87 and 2.30 respectively. Whole-body and regional fat deposits accounted for significant amounts of the variance in mobility.

CONCLUSION

Muscle power accounts for a greater amount of the variance in the level of mobility in older individuals than does muscle strength. Whole-body fat accounts for a greater amount of the variance in level of mobility than does whole-body lean tissue. Fat stored within muscle also appears to increase the risk of a mobility limitation in older individuals.

Aging and the force-velocity relationship of muscles

Aging in humans is associated with a loss in neuromuscular function and performance. This is related, in part, to the reduction in muscular strength and power caused by a loss of skeletal muscle mass (sarcopenia) and changes in muscle architecture. Due to these changes, the force-velocity (f-v) relationship of human muscles alters with age. This change has functional implications such as slower walking speeds. Different methods to reverse these changes have been investigated, including traditional resistance training, power training and eccentric (or eccentrically-biased) resistance training. This review will summarise the changes of the f-v relationship with age, the functional implications of these changes and the various methods to reverse or at least partly ameliorate these changes.

Muscle deficits persist after unilateral knee replacement and have implications for rehabilitation

BACKGROUND

Knee joint arthritis causes pain, decreased range of motion, and mobility limitation. Knee replacement reduces pain effectively. However, people with knee replacement have decreases in muscle strength ("force-generating capacity") of the involved leg and difficulties with walking and other physical activities.

OBJECTIVE AND DESIGN

The aim of this cross-sectional study was to determine the extent of deficits in knee extensor and flexor muscle torque and power (ability to perform work over time) and in the extensor muscle cross-sectional area (CSA) after knee joint replacement. In addition, the association of lower-leg muscle deficits with mobility limitations was investigated.

METHODS

Participants were 29 women and 19 men who were 55 to 75 years old and had undergone unilateral knee replacement surgery an average of 10 months earlier. The maximal torque and power of the knee extensor and flexor muscles were measured with an isokinetic dynamometer. The knee extensor muscle CSA was measured with computed tomography. The symmetry deficit between the knee that underwent replacement surgery ("operated knee") and the knee that did not undergo replacement surgery ("nonoperated knee") was calculated. Maximal walking speed and stair-ascending and stair-descending times were assessed.

RESULTS

The mean deficits in knee extensor and flexor muscle torque and power were between 13% and 27%, and the mean deficit in the extensor muscle CSA was 14%. A larger deficit in knee extension power predicted slower stair-ascending and stair-descending times. This relationship remained unchanged when the power of the nonoperated side and the potential confounding factors were taken into account.

LIMITATIONS

The study sample consisted of people who were relatively healthy and mobile. Some participants had osteoarthritis in the nonoperated knee.

CONCLUSIONS

Deficits in muscle torque and power and in the extensor muscle CSA were present 10 months after knee replacement, potentially causing limitations in negotiating stairs. To prevent mobility limitations and disability, deficits in lower-limb power should be considered during rehabilitation after knee replacement.

Relationship between performance-based and laboratory tests for lower-limb muscle strength and power assessment in healthy older women

The aim of the study was to assess the relationship between performance-based and laboratory tests for muscular strength and power assessment in older women. Thirty-two women aged 68.8 +/- 2.8 years were recruited. All participants were asessed for: (a) two performance-based tests--the box-stepping test (mean 296 +/- 51 J) and two-revolution maximum test (mean 7.1 +/- 2 kg) performed while pedalling on a cycle ergometer; and (b) muscular function tests--maximal instantaneous peak power jumping on a force platform (mean 1528 +/- 279 W); maximal voluntary contraction (MVC) during knee extension (mean 601 +/- 571 N) and leg press (mean 626 +/- 126 N), and leg press power (mean 483 +/- 98 W) on a dynamometer. Using univariate analysis, performance-based tests were compared with laboratory muscle strength and power measurements. Muscle power correlated most strongly with the performance-based tests for both jumping and leg press power (r-values between 0.67 and 0.75; P < 0.01). The correlation with muscle strength measures ranged between 0.48 and 0.61 (P < 0.01). The proposed tests may have particular relevance in geriatric and rehabilitation environments as they represent an easy, practical, and inexpensive alternative for the assessment of muscular strength and power.

Ten years of growth hormone (GH) replacement normalizes muscle strength in GH-deficient adults

CONTEXT

GH replacement for 1-5 yr improves, but does not fully normalize, muscle strength. OBJECTIVE, DESIGN, AND PATIENTS: In this single-center, open-labeled, prospective study, the effects of 10 yr of GH replacement on muscle strength and neuromuscular function were followed in 109 consecutive adults (61 men; mean age 50.0 yr; range 22-74 yr) with adult-onset GH deficiency.

RESULTS

The mean initial GH dose of 0.88 mg/d was gradually lowered to 0.47 mg/d. The mean IGF-I sd score increased from -1.54 at baseline to 1.12 at study end. GH replacement induced a sustained increase in lean mass and isometric knee flexor strength (60 degrees). In most other measures of upper leg and handgrip strength, there were transient increases during the first half of the study (0-5 yr), whereas during the second half (5-10 yr), the absolute values of muscle strength decreased and returned to or even below the baseline values. However, after correction for age and gender using observed/predicted value ratios, there were sustained and, until 7 yr, even progressive increases in the measures of muscle strength. At study end, knee flexor strength had increased to 104-110% of predicted, knee extensor strength to 93-108%, and handgrip strength to 88-93%. Measurements of neuromuscular function showed reduced voluntary motor unit activation after 10 yr.

CONCLUSIONS

Ten years of GH replacement therapy increased muscle strength during the first half of the study and thereafter partly protected against the normal age-related decline in muscle strength and neuromuscular function, resulting in approximately normalized muscle strength after 10 yr.