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Winters-Stone KM, Stoyles SA, Dieckmann NF, Eckstrom E, Luoh SW, Horak FB, Roeland EJ, Li F. Can strength training or tai ji quan training reduce frailty in postmenopausal women treated with chemotherapy? A secondary data analysis of the GET FIT trial. J Cancer Surviv 2024; 18:1179-1189. [PMID: 38642204 DOI: 10.1007/s11764-024-01592-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/04/2024] [Indexed: 04/22/2024]
Abstract
PURPOSE To determine whether strength training or tai ji quan can reduce frailty in older, postmenopausal women treated with chemotherapy for cancer. METHODS We conducted a secondary data analysis from a 3-arm, single-blind, randomized controlled trial where older (50-75 years), postmenopausal women cancer survivors were randomized to supervised group exercise programs: tai ji quan, strength training, or stretching control for 6 months. We assessed frailty using a 4-criteria model consisting of weakness, fatigue, inactivity, and slowness. Using logistic regression, we determined whether the frailty phenotype (pre-frailty or frailty) decreased post-intervention, how many and which frailty criteria decreased, and what characteristics identified women most likely to reduce frailty. RESULTS Data from 386 women who completed baseline and 6-month testing were used (mean age of 62.0 ± 6.4 years). The odds of reducing overall frailty over 6 months were significantly higher in the strength training group compared to controls (OR [95%CI] 1.86 [1.09, 3.17]) but not for tai ji quan (1.44 [0.84, 2.50]). Both strength training (OR 1.99 [1.10, 3.65]) and tai ji quan (OR 2.10 [1.16, 3.84]) led to significantly higher odds of reducing ≥ 1 frailty criterion compared to controls. Strength training led to a three-fold reduction in inactivity (p < 0.01) and tai ji quan to a two-fold reduction in fatigue (p = 0.08) versus control. Higher baseline BMI, comorbidity score, and frailty status characterized women were more likely to reduce frailty than other women. CONCLUSIONS Strength training appears superior to tai ji quan and stretching with respect to reducing overall frailty phenotype among postmenopausal women treated with chemotherapy for cancer, but tai ji quan favorably reduced the number of frailty criteria. TRIAL REGISTRATION ClinicalTrials.gov identifier: GET FIT was registered as a clinical trial in clinicaltrials.gov: NCT01635413. IMPLICATIONS FOR CANCER SURVIVORS Supervised, group exercise training that emphasizes strength training and/or tai ji quan may help combat accelerated aging and reduce frailty after cancer treatment.
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Affiliation(s)
- Kerri M Winters-Stone
- Division of Oncological Sciences, Oregon Health & Science University, Portland, OR, 97239, USA.
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, 97239, USA.
| | - Sydnee A Stoyles
- School of Nursing, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Elizabeth Eckstrom
- Division of General Internal Medicine & Geriatrics, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Shiuh-Wen Luoh
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, 97239, USA
- Portland Veteran's Affairs Medical Center, Portland, OR, 97239, USA
| | - Fay B Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Eric J Roeland
- Knight Cancer Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Fuzhong Li
- Oregon Research Institute, Springfield, OR, 97477, USA
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Rose RA, Howlett SE. Preclinical Studies on the Effects of Frailty in the Aging Heart. Can J Cardiol 2024; 40:1379-1393. [PMID: 38460611 DOI: 10.1016/j.cjca.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/20/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024] Open
Abstract
Age is a major risk factor for the development of cardiovascular diseases in men and in women. However, not all people age at the same rate and those who are aging rapidly are considered frail, compared with their fit counterparts. Frailty is an important clinical challenge because those who are frail are more likely to develop and die from illnesses, including cardiovascular diseases, than fit people of the same age. This increase in susceptibility to cardiovascular diseases in older individuals might occur as the cellular and molecular mechanisms involved in the aging process facilitate structural and functional damage in the heart. Consistent with this, recent studies in murine frailty models have provided strong evidence that maladaptive cardiac remodelling in older mice is the most pronounced in mice with a high level of frailty. For example, there is evidence that ventricular hypertrophy and contractile dysfunction increase as frailty increases in aging mice. Additionally, fibrosis and slowing of conduction in the sinoatrial node and atria are proportional to the level of frailty. These modifications could predispose frail older adults to diseases like heart failure and atrial fibrillation. This preclinical work also raises the possibility that emerging interventions designed to "treat frailty" might also treat or prevent cardiovascular diseases. These findings might help to explain why frail older people are most likely to develop these disorders as they age.
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Affiliation(s)
- Robert A Rose
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Physiology and Pharmacology, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Susan E Howlett
- Department of Pharmacology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Medicine (Geriatric Medicine), Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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Winters K, Tibbitts D, Mancini M, Stoyles S, Dieckmann N, Graff J, El-Gohary M, Horak F. Daily life mobility detects frailty, falls, and functioning in ADT-treated prostate cancer survivors. RESEARCH SQUARE 2024:rs.3.rs-4402624. [PMID: 38854112 PMCID: PMC11160906 DOI: 10.21203/rs.3.rs-4402624/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background Androgen deprivation therapy (ADT) increases the risk of frailty, falls, and, poor physical functioning in prostate cancer survivors. Detection of frailty is limited to self-report instruments and performance measures, so unbiased tools are needed. We investigated relationships between an unbiased measure - daily life mobility - and ADT history, frailty, falls, and functioning in ADT-treated prostate cancer survivors. Methods ADT-treated prostate cancer survivors (N=99) were recruited from an exercise clinical trial, an academic medical center, and the community. Participants completed performance measures and surveys to assess frailty, fall history, and physical functioning, then wore instrumented socks to continuously monitor daily life mobility. We performed a principal component analysis on daily life mobility metrics and used regression analyses to investigate relationships between domains of daily life mobility and frailty, fall history, and physical functioning. Results Daily life mobility metrics clustered into four domains: Gait Pace, Rhythm, Activity, and Balance. Worse scores on Rhythm and Activity were associated with increased odds of frailty (OR 1.59, 95% CI: 1.04, 2.49 and OR 1.81, 95% CI: 1.19, 2.83, respectively). A worse score on Rhythm was associated with increased odds of ≥1 falls in the previous year (OR 1.60, 95% CI: 1.05, 2.47). Worse scores on Gait Pace, Rhythm, and Activity were associated with worse physical functioning. Mobility metrics were similar between current and past users of ADT. Conclusions Continuous passive monitoring of daily life mobility may identify prostate cancer survivors who have or are developing risk for frailty, falls, and declines in physical functioning.
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Debain A, Loosveldt FA, Knoop V, Costenoble A, Lieten S, Petrovic M, Bautmans I. Frail OLDER ADULTS are more likely TO have autonomic dysfunction: A systematic review and META-ANALYSIs. Ageing Res Rev 2023; 87:101925. [PMID: 37028604 DOI: 10.1016/j.arr.2023.101925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/26/2023] [Accepted: 04/01/2023] [Indexed: 04/09/2023]
Abstract
Autonomic dysfunction and frailty are two common and complex geriatric syndromes. Their prevalence increases with age and they have similar negative health outcomes. In PubMed and Web of Science we screened studies identifying a relationship between autonomic function (AF) and frailty in adults aged ≥65 years. Twenty-two studies of which two prospective and 20 cross-sectional were included (n=8375). We performed a meta-analysis for the articles addressing orthostatic hypotension (OH). Frailty was associated with 1.6 higher odds of suffering from consensus OH (COH) {OR=1.607 95%CI [1.15-2.24]; 7 studies; n=3488}. When measured for each type of OH the largest trend was seen between initial OH (IOH) and frailty {OR=3.08; 95%CI [1.50-6.36]; 2 studies; n=497}. Fourteen studies reported other autonomic function alterations in frail older adults with 4-22% reduction in orthostatic heart rate increase, 6% reduction in systolic blood pressure recovery, 9-75% reduction in most common used heart rate variability (HRV) parameters. Frail older adults were more likely to have impaired AF. Diagnosis of frailty should promptly lead to orthostatic testing as OH implicates specific treatment modalities, which differ from frailty management. As IOH is most strongly correlated with frailty, continuous beat to beat blood pressure measurements should be performed when present at least until cut-off values for heart rate variability testing are defined.
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Affiliation(s)
- Aziz Debain
- Gerontology department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium; Frailty in Ageing (FRIA) Research department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium
| | - Fien Ann Loosveldt
- Gerontology department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium; Frailty in Ageing (FRIA) Research department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium
| | - Veerle Knoop
- Gerontology department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium; Frailty in Ageing (FRIA) Research department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium
| | - Axelle Costenoble
- Gerontology department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium; Frailty in Ageing (FRIA) Research department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium
| | - Siddhartha Lieten
- Frailty in Ageing (FRIA) Research department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium; Department of Geriatrics, Universitair Ziekenhuis Gent (UZGent), Corneel Heymanslaan 10, 9000 Gent
| | - Mirko Petrovic
- Frailty in Ageing (FRIA) Research department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium; Department of Geriatrics, Universitair Ziekenhuis Gent (UZGent), Corneel Heymanslaan 10, 9000 Gent
| | - Ivan Bautmans
- Gerontology department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium; Frailty in Ageing (FRIA) Research department, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, B-1090 Brussels, Belgium.
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Álvarez-Millán L, Lerma C, Castillo-Castillo D, Quispe-Siccha RM, Pérez-Pacheco A, Rivera-Sánchez J, Fossion R. Chronotropic Response and Heart Rate Variability before and after a 160 m Walking Test in Young, Middle-Aged, Frail, and Non-Frail Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148413. [PMID: 35886265 PMCID: PMC9320251 DOI: 10.3390/ijerph19148413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023]
Abstract
The frailty syndrome is characterized by a decreased capacity to adequately respond to stressors. One of the most impaired physiological systems is the autonomous nervous system, which can be assessed through heart rate (HR) variability (HRV) analysis. In this article, we studied the chronotropic response (HR and HRV) to a walking test. We also analyzed HRV indices in rest as potential biomarkers of frailty. For this, a 160 m-walking test and two standing rest tests (before and after the walking) were performed by young (19−29 years old, n = 21, 57% women), middle-aged (30−59 years old, n = 16, 62% women), and frail older adults (>60 years old, n = 28, 40% women) and non-frail older adults (>60 years old, n = 15, 71% women), classified with the FRAIL scale and the Clinical Frailty Scale (CFS). Frequency domain parameters better allowed to distinguish between frail and non-frail older adults (low-frequency power LF, high-frequency power HF (nu), LF/HF ratio, and ECG-derived respiration rate EDR). Frail older adults showed an increased HF (nu) and EDR and a reduced LF (nu) and LF/HF compared to non-frail older adults. The increase in HF (nu) could be due to a higher breathing effort. Our results showed that a walk of 160 m is a sufficient cardiovascular stressor to exhibit an attenuated autonomic response in frail older adults. Several HRV indices showed to be potential biomarkers of frailty, being LF (nu) and the time required to reach the maximum HR the best candidates.
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Affiliation(s)
- Lesli Álvarez-Millán
- Programa de Doctorado en Ciencias Biomédicas, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico;
- Centro de Ciencias de la Complejidad (C3), Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico
| | - Claudia Lerma
- Departamento de Instrumentación Electromecánica, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
| | - Daniel Castillo-Castillo
- Servicio de Geriatría, Hospital General de México Dr. Eduardo Liceaga, Mexico City 06720, Mexico;
| | - Rosa M. Quispe-Siccha
- Unidad de Investigación y Desarrollo Tecnológico, Hospital General de México Dr. Eduardo Liceaga, Mexico City 06720, Mexico; (R.M.Q.-S.); (A.P.-P.); (J.R.-S.)
| | - Argelia Pérez-Pacheco
- Unidad de Investigación y Desarrollo Tecnológico, Hospital General de México Dr. Eduardo Liceaga, Mexico City 06720, Mexico; (R.M.Q.-S.); (A.P.-P.); (J.R.-S.)
| | - Jesús Rivera-Sánchez
- Unidad de Investigación y Desarrollo Tecnológico, Hospital General de México Dr. Eduardo Liceaga, Mexico City 06720, Mexico; (R.M.Q.-S.); (A.P.-P.); (J.R.-S.)
| | - Ruben Fossion
- Centro de Ciencias de la Complejidad (C3), Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico
- Instituto de Ciencias Nucleares, Universidad Nacional Autónoma de México (UNAM), Mexico City 04510, Mexico
- Correspondence: ; Tel.: +52-55-5622-4672 (ext. 5104)
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Yeh SL, Li SH, Jingling L, Goh JOS, Chao YP, Tsai AC. Age-Related Differences in the Neural Processing of Idioms: A Positive Perspective. Front Aging Neurosci 2022; 14:865417. [PMID: 35693339 PMCID: PMC9177212 DOI: 10.3389/fnagi.2022.865417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022] Open
Abstract
We examined whether older adults benefit from a larger mental-lexicon size and world knowledge to process idioms, one of few abilities that do not stop developing until later adulthood. Participants viewed four-character sequences presented one at a time that combined to form (1) frequent idioms, (2) infrequent idioms, (3) random sequences, or (4) perceptual controls, and judged whether the four-character sequence was an idiom. Compared to their younger counterparts, older adults had higher accuracy for frequent idioms and equivalent accuracy for infrequent idioms. Compared to random sequences, when processing frequent and infrequent idioms, older adults showed higher activations in brain regions related to sematic representation than younger adults, suggesting that older adults devoted more cognitive resources to processing idioms. Also, higher activations in the articulation-related brain regions indicate that older adults adopted the thinking-aloud strategy in the idiom judgment task. These results suggest re-organized neural computational involvement in older adults' language representations due to life-long experiences. The current study provides evidence for the alternative view that aging may not necessarily be solely accompanied by decline.
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Affiliation(s)
- Su-Ling Yeh
- Department of Psychology, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Brain and Mind Sciences, National Taiwan University, Taipei, Taiwan
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
- Center for Artificial Intelligence and Advanced Robotics, National Taiwan University, Taipei, Taiwan
| | - Shuo-Heng Li
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Li Jingling
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Joshua O. S. Goh
- Department of Psychology, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Brain and Mind Sciences, National Taiwan University, Taipei, Taiwan
- Neurobiology and Cognitive Science Center, National Taiwan University, Taipei, Taiwan
- Center for Artificial Intelligence and Advanced Robotics, National Taiwan University, Taipei, Taiwan
- Taiwan International Graduate Program, Interdisciplinary Neuroscience, Academia Sinica, Taipei, Taiwan
| | - Yi-Ping Chao
- Department of Computer Science and Information Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Arthur C. Tsai
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
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Toosizadeh N, Eskandari M, Ehsani H, Parvaneh S, Asghari M, Sweitzer N. Frailty assessment using a novel approach based on combined motor and cardiac functions: a pilot study. BMC Geriatr 2022; 22:199. [PMID: 35287574 PMCID: PMC8919591 DOI: 10.1186/s12877-022-02849-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 02/14/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Previous research showed association between frailty and an impaired autonomic nervous system; however, the direct effect of frailty on heart rate (HR) behavior during physical activity is unclear. The purpose of the current study was to determine the association between HR increase and decrease with frailty during a localized upper-extremity function (UEF) task to establish a multimodal frailty test. METHODS Older adults aged 65 or older were recruited and performed the UEF task of rapid elbow flexion for 20 s with the right arm. Wearable gyroscopes were used to measure forearm and upper-arm motion, and electrocardiography were recorded using leads on the left chest. Using this setup, HR dynamics were measured, including time to peak HR, recovery time, percentage increase in HR during UEF, and percentage decrease in HR during recovery after UEF. RESULTS Fifty-six eligible participants were recruited, including 12 non-frail (age = 76.92 ± 7.32 years), and 40 pre-frail (age = 80.53 ± 8.12 years), and four frail individuals (age = 88.25 ± 4.43 years). Analysis of variance models showed that the percentage increase in HR during UEF and percentage decrease in HR during recovery were both 47% smaller in pre-frail/frail older adults compared to non-frails (p < 0.01, effect size = 0.70 and 0.62 for increase and decrease percentages). Using logistic models with both UEF kinematics and HR parameters as independent variables, frailty was predicted with a sensitivity of 0.82 and specificity of 0.83. CONCLUSION Current findings showed evidence of strong association between HR dynamics and frailty. It is suggested that combining kinematics and HR data in a multimodal model may provide a promising objective tool for frailty assessment.
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Affiliation(s)
- Nima Toosizadeh
- Department of Biomedical Engineering, University of Arizona, 1230 N Cherry Avenue, Tucson, AZ, 85719, USA.
- Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, USA.
- Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, USA.
| | - Maryam Eskandari
- Department of Computer Sciences, University of Arizona, Tucson, AZ, USA
| | - Hossein Ehsani
- Kinesiology Department, University of Maryland, College Park, MD, USA
| | | | - Mehran Asghari
- Department of Biomedical Engineering, University of Arizona, 1230 N Cherry Avenue, Tucson, AZ, 85719, USA
| | - Nancy Sweitzer
- Arizona Sarver Heart Center, Department of Medicine, University of Arizona, Tucson, USA
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Ruberto K, Ehsani H, Parvaneh S, Mohler J, Fain M, Sweitzer NK, Toosizadeh N. The association between heart rate behavior and gait performance: The moderating effect of frailty. PLoS One 2022; 17:e0264013. [PMID: 35171947 PMCID: PMC8849485 DOI: 10.1371/journal.pone.0264013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 02/01/2022] [Indexed: 12/17/2022] Open
Abstract
Introduction Research suggests that frailty not only influence individual systems, but also it affects the interconnection between them. However, no study exists to show how the interplay between cardiovascular and motor performance is compromised with frailty. Aim To investigate the effect of frailty on the association between heart rate (HR) dynamics and gait performance. Methods Eighty-five older adults (≥65 years and able to walk 9.14 meters) were recruited (October 2016—March 2018) and categorized into 26 non-frail (age = 78.65±7.46 years) and 59 pre-frail/frail individuals (age = 81.01±8.17) based on the Fried frailty phenotype. Participants performed gait tasks while equipped with a wearable electrocardiogram (ECG) sensor attached to the chest, as well as wearable gyroscopes for gait assessment. HR dynamic parameters were extracted, including time to peak HR and percentage increase in HR in response to walking. Using the gyroscope sensors gait parameters were recorded including stride length, stride velocity, mean swing velocity, and double support. Results Among the pre-frail/frail group, time to peak HR was significantly correlated with all gait parameters (p<0.0001, r = 0.51–0.59); however, for the non-frail group, none of the correlations between HR dynamics and gait performance parameters were significant (p>0.45, r = 0.03–0.15). The moderation analysis of time to peak HR, demonstrated a significant interaction effect of HR dynamics and frailty status on walking velocity (p<0.01), and the interaction effect was marginally non-significant for other gait parameters (p>0.10). Conclusions Current findings, for the first time, suggest that a compromised motor and cardiac autonomic interaction exist among pre-frail/frail older adults; an impaired HR performance (i.e., slower increase of HR in response to stressors) may lead to a slower walking performance. Assessing physical performance and its corresponding HR behavior should be studied as a tool for frailty screening and providing insights about the underlying cardiovascular-related mechanism leading to physical frailty.
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Affiliation(s)
- Kayleigh Ruberto
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, United States of America
| | - Hossein Ehsani
- Kinesiology Department, University of Maryland, College Park, MD, United States of America
| | - Saman Parvaneh
- Edwards Life Sciences, Irvine, CA, United States of America
| | - Jane Mohler
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, United States of America
| | - Mindy Fain
- Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, Arizona, United States of America
- Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Nancy K. Sweitzer
- Arizona Sarver Heart Center, Department of Medicine, University of Arizona, Tucson, Arizona, United States of America
| | - Nima Toosizadeh
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, United States of America
- Division of Geriatrics, General Internal Medicine and Palliative Medicine, Department of Medicine, University of Arizona, Tucson, Arizona, United States of America
- Arizona Center on Aging, Department of Medicine, University of Arizona, Tucson, Arizona, United States of America
- * E-mail:
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Eskandari M, Parvaneh S, Ehsani H, Fain M, Toosizadeh N. Frailty Identification using Heart Rate Dynamics: A Deep Learning Approach. IEEE J Biomed Health Inform 2022; 26:3409-3417. [PMID: 35196247 DOI: 10.1109/jbhi.2022.3152538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Previous research showed that frailty can influence autonomic nervous system and consequently heart rate response to physical activities, which can ultimately influence the homeostatic state among older adults. While most studies have focused on resting state heart rate characteristics or heart rate monitoring without controlling for physical activities, the objective of the current study was to classify pre-frail/frail vs non-frail older adults using heart rate response to physical activity (heart rate dynamics). Eighty-eight older adults (65 years) were recruited and stratified into frailty groups based on the five-component Fried frailty phenotype. Groups consisted of 27 non-frail (age=78.807.23) and 61 pre-frail/frail (age=80.638.07) individuals. Participants performed a normal speed walking as the physical task, while heart rate was measured using a wearable electrocardiogram recorder. After creating heart rate time series, a long-short term memory model was used to classify participants into frailty groups. In 5-fold cross validation evaluation, the long-short term memory model could classify the two above-mentioned frailty classes with a sensitivity, specificity, F1-score, and accuracy of 83.0%, 80.0%, 87.0%, and 82.0%, respectively. These findings showed that heart rate dynamics classification using long-short term memory without any feature engineering may provide an accurate and objective marker for frailty screening.
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Briggs LG, Reitblat C, Bain PA, Parke S, Lam NY, Wright J, Catto JWF, Copeland RJ, Psutka SP. Prehabilitation Exercise Before Urologic Cancer Surgery: A Systematic and Interdisciplinary Review. Eur Urol 2021; 81:157-167. [PMID: 34074558 DOI: 10.1016/j.eururo.2021.05.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/12/2021] [Indexed: 01/01/2023]
Abstract
CONTEXT The Consensus on Therapeutic Exercise Training (CONTENT) scale assesses the therapeutic validity of exercise programs. To date, prehabilitation exercise programs for heath optimization before urologic cancer surgeries have not been assessed for therapeutic validity or efficacy. OBJECTIVE To systematically assess prehabilitation exercise programs before urologic cancer surgery for therapeutic validity and efficacy, informing discussion of best practices for future intervention. EVIDENCE ACQUISITION A systematic review was performed using Ovid, Embase, Web of Science, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases through June 2020. The review included prospective (randomized controlled and uncontrolled) trials where patients were enrolled in prehabilitation exercise programs before urologic cancer surgery. The primary outcomes of interest included therapeutic validity and efficacy (measures of cardiorespiratory fitness and postsurgical outcomes). Studies were evaluated for the risk of bias. A narrative synthesis was carried out given heterogeneity in populations, interventions, and outcomes across studies. EVIDENCE SYNTHESIS Ten unique studies and two associated post hoc analyses met the inclusion criteria. Seven studies demonstrated therapeutic validity. Eight demonstrated a high risk of bias. All demonstrated significant improvement in cardiorespiratory fitness. Four of five studies evaluating quality of life observed significant improvements. To date, zero trials have demonstrated reduction in postsurgical complications, mortality, length of stay, or readmission rates following prehabilitation exercise interventions. CONCLUSIONS While prehabilitation exercise may result in improved cardiorespiratory fitness and quality of life, current studies have yet to demonstrate impact on surgical outcomes. When designing prehabilitation exercise programs for use before urologic cancer surgery, the therapeutic validity of the intervention should be considered. Future prehabilitation studies should employ standardized content rubrics to ensure therapeutic validity. Consensus is needed regarding the appropriate outcomes to adjudicate prehabilitation efficacy. PATIENT SUMMARY In this report, we looked at the effectiveness and quality of prehabilitation exercise programs before urologic cancer surgery. We found that these programs effectively improve presurgical fitness, but may benefit from the use of structured methodology and outcome assessment to understand their potential to improve surgical outcomes.
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Affiliation(s)
| | | | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Sara Parke
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Phoenix, AZ, USA
| | - Ny-Ying Lam
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, WA, USA
| | - Jonathan Wright
- Department of Urology, University of Washington, Seattle, WA, USA
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Robert J Copeland
- Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA, USA.
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11
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Frailty and heart response to physical activity. Arch Gerontol Geriatr 2020; 93:104323. [PMID: 33340830 DOI: 10.1016/j.archger.2020.104323] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/18/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although previous studies showed that frail older adults are more susceptible to develop cardiovascular diseases, the underlying effect of frailty on heart rate dynamics is still unclear. The goal of the current study was to measure heart rate changes due to normal speed and rapid walking among non-frail and pre-frail/frail older adults, and to implement heart rate dynamic measures to identify frailty status. METHODS Eighty-eight older adults (≥65 years) were recruited and stratified into frailty groups based on the five-component Fried frailty phenotype. While performing gait tests, heart rate was recorded using a wearable ECG and accelerometer sensors. Groups consisted of 27 non-frail (age = 78.70 ± 7.32) and 61 pre-frail/frail individuals (age = 81.00 ± 8.14). The parameters of interest included baseline heart rate measures (mean heart rate and heart rate variability), and heart rate dynamics due to walking (percentage change in heart rate and required time to reach the maximum heart rate). RESULTS Respectively for normal and rapid walking conditions, pre-frail/frail participants had 46% and 44% less increase in heart rate, and 49% and 27% slower occurrence of heart rate peak, when compared to non-frail older adults (p < 0.04, effect size = 0.71 ± 0.12). Measures of heart rate dynamics showed stronger associations with frailty status compared to baseline resting-state measures (sensitivity = 0.75 and specificity = 0.65 using heart rate dynamics measures, compared to sensitivity = 0.64 and specificity = 0.62 using baseline parameters). CONCLUSIONS These findings suggest that measures of heart rate dynamics in response to daily activities may provide meaningful markers for frailty screening.
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12
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Angulo J, El Assar M, Álvarez-Bustos A, Rodríguez-Mañas L. Physical activity and exercise: Strategies to manage frailty. Redox Biol 2020; 35:101513. [PMID: 32234291 PMCID: PMC7284931 DOI: 10.1016/j.redox.2020.101513] [Citation(s) in RCA: 236] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 12/25/2022] Open
Abstract
Frailty, a consequence of the interaction of the aging process and certain chronic diseases, compromises functional outcomes in the elderly and substantially increases their risk for developing disabilities and other adverse outcomes. Frailty follows from the combination of several impaired physiological mechanisms affecting multiple organs and systems. And, though frailty and sarcopenia are related, they are two different conditions. Thus, strategies to preserve or improve functional status should consider systemic function in addition to muscle conditioning. Physical activity/exercise is considered one of the main strategies to counteract frailty-related physical impairment in the elderly. Exercise reduces age-related oxidative damage and chronic inflammation, increases autophagy, and improves mitochondrial function, myokine profile, insulin-like growth factor-1 (IGF-1) signaling pathway, and insulin sensitivity. Exercise interventions target resistance (strength and power), aerobic, balance, and flexibility work. Each type improves different aspects of physical functioning, though they could be combined according to need and prescribed as a multicomponent intervention. Therefore, exercise intervention programs should be prescribed based on an individual's physical functioning and adapted to the ensuing response.
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Affiliation(s)
- Javier Angulo
- Servicio de Histología-Investigación, Unidad de Investigación Traslacional en Cardiología (IRYCIS-UFV), Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mariam El Assar
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain
| | | | - Leocadio Rodríguez-Mañas
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Geriatría, Hospital Universitario de Getafe, Getafe, Spain.
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13
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Kim S, Jung HW, Won CW. What are the illnesses associated with frailty in community-dwelling older adults: the Korean Frailty and Aging Cohort Study. Korean J Intern Med 2020; 35:1004-1013. [PMID: 32264654 PMCID: PMC7373975 DOI: 10.3904/kjim.2019.097] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/12/2019] [Accepted: 04/29/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND/AIMS Frailty is mainly due to an age-related decrease in the physiological reserves needed to maintain biological homeostasis, but it can also occur as a result of chronic diseases. The purpose of this study was to identify illnesses associated with frailty in Korean community-dwelling older adults. METHODS This was a cross-sectional study that included 2,936 older adults aged between 70 and 84 years who had completed both interviews and physical function assessments for the Korean Frailty and Aging Cohort Study. Current illnesses diagnosed by physicians were included in the analysis. The definition of frailty was derived from the Fried frailty phenotype. RESULTS The prevalence of hypertension, diabetes mellitus (DM), arthritis, osteoporosis, urinary incontinence, and lung disease (including asthma, chronic obstructive pulmonary disease, and chronic bronchitis) was higher in the frail group (p < 0.05). After adjusting for age, sex, physical activity, alcohol, smoking, education, and presence of a spouse, the odds ratios for DM and urinary incontinence in frailty were 1.51 (95% confidence interval [CI], 1.10 to 2.01; p = 0.01) and 1.88 (95% CI, 1.11 to 3.18; p = 0.02). CONCLUSION In Korean community-dwelling older adults, DM and urinary incontinence were associated with frailty after adjusting for various factors. In the future, the list of comorbid diseases that are appropriate for Korean population-specific frailty assessment should be inventoried.
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Affiliation(s)
- Sunyoung Kim
- Department of Family Medicine, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hee-Won Jung
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chang Won Won
- Elderly Frailty Research Center, Department of Family Medicine, Kyung Hee University College of Medicine, Seoul, Korea
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14
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Aida K, Kamiya K, Hamazaki N, Matsuzawa R, Nozaki K, Ichikawa T, Nakamura T, Yamashita M, Maekawa E, Yamaoka-Tojo M, Matsunaga A, Ako J. Usefulness of the Simplified Frailty Scale in Predicting Risk of Readmission or Mortality in Elderly Patients Hospitalized with Cardiovascular Disease. Int Heart J 2020; 61:571-578. [PMID: 32418965 DOI: 10.1536/ihj.19-557] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The simplified frailty scale is a simple frailty assessment tool modified from Fried's phenotypic frailty criteria, which is easy to administer in hospitalized patients. The applicability of the simplified frailty scale to indicate prognosis in elderly hospitalized patients with cardiovascular disease (CVD) was examined.This cohort study was performed in 895 admitted patients ≥ 65 years (interquartile range, 71.0-81.0, 541 men) with CVD. Patients were classified as robust, prefrail, or frail based on the five components of the simplified frailty scale: weakness, slowness, exhaustion, low activity, and weight loss. The primary endpoint was the composite outcome of all-cause mortality and unplanned readmission for CVD.Patients positive for greater numbers of frailty components showed higher risk of all-cause mortality or unplanned CVD-related readmission (P for trend < 0.001). Classification as both frail (adjusted HR: 3.27, 95% confidence interval [CI]: 1.49-7.21, P = 0.003) and prefrail (adjusted HR: 2.19, 95% CI: 1.00-4.79, P = 0.049) independently predicted the composite endpoint compared with robust after adjusting for potential confounding factors. The inclusion of prefrail, frail, and number of components of frailty increased both continuous net reclassification improvement (0.113, P = 0.049; 0.426, P < 0.001; and 0.321, P < 0.001) and integrated discrimination improvement (0.007, P = 0.037; 0.009, P = 0.038; and 0.018, P = 0.002) for the composite endpoint.Higher scores on the simplified frailty scale were associated with increased risk of mortality or readmission in elderly patients hospitalized for CVD.
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Affiliation(s)
- Keita Aida
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences
| | - Kentaro Kamiya
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences
| | | | - Ryota Matsuzawa
- Department of Physical Therapy, School of Rehabilitation, Hyogo University of Health Sciences
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital
| | | | - Takeshi Nakamura
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences
| | - Masashi Yamashita
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences.,Department of Rehabilitation, Kitasato University School of Allied Health Sciences
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
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15
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Charles A, Buckinx F, Cataldo D, Rygaert X, Gruslin B, Reginster JY, Bruyère O. Relationship between peak expiratory flow and incidence of frailty, deaths and falls among nursing home residents: Results of the SENIOR cohort. Arch Gerontol Geriatr 2019; 85:103913. [PMID: 31357107 DOI: 10.1016/j.archger.2019.103913] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To correlate peak expiratory flow (PEF) with the incidence of frailty, deaths and falls among nursing home residents. METHODS This is a 1-year longitudinal analysis performed on the clinical data of the SENIOR cohort. PEF, measured by peak flow meter, was considered as "low" when the observed value was ≤80% of the theoretical value. Physical capacity was evaluated using Short Physical Performance Battery, balance and gait using Tinetti test and muscle strength using a dynamometer. The incidence of frailty was defined as the transition from a "robust" or "prefrail" status to a "frail" status following Fried's criteria. Deaths and falls were also collected. RESULTS Among 646 subjects included at baseline (83.2 ± 9 years and 72.1% women), 297 (45.7%) displayed a low PEF. In this subgroup, physical capacity (p-values from 0.01 to <0.001), muscle strength (p < 0.001), balance and gait score (p < 0.001) were significantly lower compared to subjects displaying normal PEF. Subjects who became frail after one year displayed a lower % of the theoretical PEF value compared to those that did not (88.52 ± 45.06 vs 102.78 ± 50.29, respectively, p = 0.03). After adjustment for potential confounding variables (calf circumference, Tinetti test, SPPB test and handgrip strength), PEF was no longer associated with the occurrence of frailty. There was no association between PEF and mortality and falls. CONCLUSION In a nursing home setting, PEF is not an independent factor associated with the incidence of frailty, deaths and falls.
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Affiliation(s)
- Alexia Charles
- Department of Public Health, Epidemiology and Health Economics, University of Liège, WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Avenue Hippocrate 13, Liège, Belgium.
| | - Fanny Buckinx
- Department of Public Health, Epidemiology and Health Economics, University of Liège, WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Avenue Hippocrate 13, Liège, Belgium.
| | - Didier Cataldo
- Department of Respiratory Diseases and Laboratory of Tumor Biology and Development, University of Liège and CHU Liege, Avenue de l'Hôpital 11, Liège, Belgium.
| | - Xavier Rygaert
- Department of Public Health, Epidemiology and Health Economics, University of Liège, WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Avenue Hippocrate 13, Liège, Belgium.
| | - Bastien Gruslin
- Department of Public Health, Epidemiology and Health Economics, University of Liège, WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Avenue Hippocrate 13, Liège, Belgium.
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Avenue Hippocrate 13, Liège, Belgium; Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia.
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Avenue Hippocrate 13, Liège, Belgium; Department of Rehabilitation and Sport Sciences, University of Liège, Allée des Sports 4, Liège, Belgium.
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16
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Bertolotti M, Lancellotti G, Mussi C. Management of high cholesterol levels in older people. Geriatr Gerontol Int 2019; 19:375-383. [PMID: 30900369 DOI: 10.1111/ggi.13647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/23/2019] [Accepted: 01/31/2019] [Indexed: 12/22/2022]
Abstract
The management of hypercholesterolemia in older adults still represents a challenge in clinical medicine. The pathophysiological alterations of cholesterol metabolism associated with aging are still incompletely understood, even if epidemiological evidence suggests that serum cholesterol levels increase with ongoing age, possibly with a plateau after the age of 80 years. Age is also one of the main determinants of cardiovascular disease, according to all cardiovascular risk estimate tools. Cholesterol-lowering treatment, therefore, would be expected to bring significant protection, even in these patients. Unfortunately, direct experimental evidence is extremely limited, particularly in the very old age strata of the population; a clinical benefit still seems to be present, but the risk for drug-related adverse events is clearly higher. At any rate, at the present time, definite guidelines for the correct management of hypercholesterolemia in older patients are not available. Therefore, the decision whether or not a pharmacological treatment should be set up, and the choice of the drug, need to be tailored to the individual patient, and requires accurate clinical judgment. The specific aspects of frailty and disability, along with the actual age of the patients, have to be considered together, with a comprehensive assessment approach. The present review summarizes the evidence regarding the modifications of cholesterol metabolism in older patients, the impact of lipid-lowering drugs on cardiovascular outcomes and focuses on the considerations that can help to define the most appropriate treatment strategy, in view of the individual functional profile. Geriatr Gerontol Int 2019; 19: 375-383.
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Affiliation(s)
- Marco Bertolotti
- Department of Biomedical, Metabolic and Neural Sciences, Center for Gerontological Evaluation and Research, University of Modena and Reggio Emilia, Modena, Italy.,Division of Geriatric Medicine, City Hospital Sant'Agostino-Estense of Modena, Modena, Italy
| | - Giulia Lancellotti
- Department of Biomedical, Metabolic and Neural Sciences, Center for Gerontological Evaluation and Research, University of Modena and Reggio Emilia, Modena, Italy.,Division of Geriatric Medicine, City Hospital Sant'Agostino-Estense of Modena, Modena, Italy
| | - Chiara Mussi
- Department of Biomedical, Metabolic and Neural Sciences, Center for Gerontological Evaluation and Research, University of Modena and Reggio Emilia, Modena, Italy.,Division of Geriatric Medicine, City Hospital Sant'Agostino-Estense of Modena, Modena, Italy
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17
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Farkhooy A, Bodegård J, Erikssen JE, Janson C, Hedenström H, Stavem K, Malinovschi A. Cross-sectional and longitudinal analyses of the association between lung function and exercise capacity in healthy Norwegian men. BMC Pulm Med 2018; 18:118. [PMID: 30021542 PMCID: PMC6052523 DOI: 10.1186/s12890-018-0655-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is widely accepted that exercise capacity in healthy individuals is limited by the cardiac function, while the respiratory system is considered oversized. Although there is physiological, age-related decline in both lung function and physical capacity, the association between decline in lung function and decline in exercise capacity is little studied. Therefore, we examined the longitudinal association between lung function indices and exercise capacity, assessed by the total amount of work performed on a standardized incremental test, in a cohort of middle-aged men. METHODS A total of 745 men between 40 and 59 years were examined using spirometry and standardized bicycle exercise ECG test within "The Oslo Ischemia Study," at two time points: once during 1972-1975, and again, approximately 16 years later, during 1989-1990. The subjects exercise capacity was assessed as physical fitness i.e. the total bicycle work (in Joules) at all workloads divided by bodyweight (in kg). RESULTS Higher FEV1, FVC and PEF values related to higher physical fitness at both baseline and follow-up (all p values < 0.05). Higher explanatory values were found at follow-up than baseline for FEV1 (r2 = 0.16 vs. r2 = 0.03), FVC (r2 = 0.14 vs. r2 = 0.03) and PEF (r2 = 0.13 vs. r2 = 0.02). No significant correlations were found between decline in physical fitness and declines in FEV1, FVC or PEF. CONCLUSIONS A weak association between lung function indices and exercise capacity, assessed through physical fitness, was found in middle-aged, healthy men. This association was strengthened with increasing age, suggesting a larger role for lung function in limiting exercise capacity among elderly subjects. However, decline in physical fitness over time was not related to decline in lung function.
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Affiliation(s)
- Amir Farkhooy
- Department of Medical Sciences, Clinical Physiology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden. .,Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
| | - Johan Bodegård
- Department of Cardiology, Oslo University Hospital, Ullevaal, Norway
| | | | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Hans Hedenström
- Department of Medical Sciences, Clinical Physiology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Knut Stavem
- Institute of Clinical Medicine, University of Oslo, Lørenskog, Norway.,Department of Pulmonary Medicine, Medical Division, Akershus University Hospital, Lørenskog, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Andrei Malinovschi
- Department of Medical Sciences, Clinical Physiology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
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18
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Higuchi R, Takayama M, Hagiya K, Saji M, Mahara K, Takamisawa I, Shimizu J, Tobaru T, Iguchi N, Takanashi S. Prolonged Intensive Care Unit Stay Following Transcatheter Aortic Valve Replacement. J Intensive Care Med 2017; 35:154-160. [PMID: 28931366 DOI: 10.1177/0885066617732290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Postoperative intensive care unit (ICU) stay after cardiac surgeries has been extensively studied, but little attention has been given to ICU stay following transcatheter aortic valve replacement (TAVR). This study examined ICU stay after TAVR. METHODS Two hundred and forty-five patients who underwent TAVR between April 2010 and October 2016 were studied retrospectively. We investigated the status of ICU stay, the predictors of prolonged ICU stay (PICUS), and its impact on short- and long-term outcomes. Prolonged ICU stay was defined as post-TAVR ICU stay longer than 2 days (day of TAVR + 1 day). RESULTS Length of ICU stay was 2.6 ± 4.9 days, and PICUS was identified in 14.7% of the patients. The predominant reason for PICUS was congestive heart failure or circulatory failure (41.7%). Pulmonary dysfunction and nontransfemoral approach were independent predictors of PICUS (pulmonary dysfunction: odds ratio = 2.64, 95% confidence interval [CI]: 1.05-7.35; nontransfemoral approach: odds ratio = 2.81, 95% CI: 1.15-6.89). Prolonged ICU stay was associated with higher rate of 30-day combined end point (PICUS vs non-PICUS: 44.4% vs 3.3%, P < .0001), longer postoperative hospital stay (49.9 ± 141.9 days vs 12.0 ± 6.0 days, P < .0001), and lower rate of discharge home (77.8% vs 95.2%, P = .0002). Patients with PICUS had worse long-term survival (P < .0001), and PICUS was a predictor of mortality (hazard ratio: 4.21, 95% CI: 2.09-8.22). CONCLUSION Prolonged ICU stay following TAVR was found in 14.7%, and pulmonary dysfunction and nontransfemoral approach were associated with PICUS. Short- and long-term prognoses were worse in patients with PICUS than those without.
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Affiliation(s)
- Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Morimasa Takayama
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Kenichi Hagiya
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Keitaro Mahara
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Jun Shimizu
- Department of Anesthesiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Nobuo Iguchi
- Department of Cardiology, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Asahi-cho, Fuchu, Tokyo, Japan
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19
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Angulo J, El Assar M, Rodríguez-Mañas L. Frailty and sarcopenia as the basis for the phenotypic manifestation of chronic diseases in older adults. Mol Aspects Med 2016; 50:1-32. [PMID: 27370407 DOI: 10.1016/j.mam.2016.06.001] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/18/2016] [Indexed: 12/13/2022]
Abstract
Frailty is a functional status that precedes disability and is characterized by decreased functional reserve and increased vulnerability. In addition to disability, the frailty phenotype predicts falls, institutionalization, hospitalization and mortality. Frailty is the consequence of the interaction between the aging process and some chronic diseases and conditions that compromise functional systems and finally produce sarcopenia. Many of the clinical manifestations of frailty are explained by sarcopenia which is closely related to poor physical performance. Reduced regenerative capacity, malperfusion, oxidative stress, mitochondrial dysfunction and inflammation compose the sarcopenic skeletal muscle alterations associated to the frailty phenotype. Inflammation appears as a common determinant for chronic diseases, sarcopenia and frailty. The strategies to prevent the frailty phenotype include an adequate amount of physical activity and exercise as well as pharmacological interventions such as myostatin inhibitors and specific androgen receptor modulators. Cell response to stress pathways such as Nrf2, sirtuins and klotho could be considered as future therapeutic interventions for the management of frailty phenotype and aging-related chronic diseases.
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Affiliation(s)
- Javier Angulo
- Unidad de Investigación Cardiovascular (IRYCIS/UFV), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mariam El Assar
- Instituto de Investigación Sanitaria de Getafe, Getafe, Madrid, Spain
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20
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Abstract
Cardiovascular disease (CVD) is a common problem in the elderly. In particular, the morbidity and mortality of patients with heart failure (HF) increase with age. The poor outcomes of elderly patients with HF can be explained partly by cardiac aging at the cellular and organ levels. Moreover, recent evidence has demonstrated that functional evaluation, which may reflect the status of individual aging, predicts mortality in patients with HF. Age-related changes occur throughout the body and in virtually all organ systems. Thus, we should pay more attention to geriatric conditions when treating patients with HF. Frailty represents a complex clinical syndrome that results from multiple impairments across different organs and is characterized by decreased physiological reserves and increased vulnerability to stressors. Frail patients with CVD have a worse prognosis than non-frail patients. Evidence demonstrates that frailty is an independent risk factor for incident HF among older people. The ways in which cellular senescence promotes age-related CVD and frailty remain an important issue in the biology of aging and clinical geriatrics. Senescent cells that have acquired a senescence-associated secretory phenotype (SASP) can cause local and potentially systemic inflammation. SASP might be a key phenomenon in the association between cellular senescence and the development of age-related CVD and frailty. Frailty is a dynamic and potentially reversible state; therefore, translational research efforts are focused on obtaining mechanistic insights into the pathobiology of frailty, the development of novel therapeutics, and the identification of biomarkers for frailty. This is particularly important in developed countries that are confronted with an aging society.
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21
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Parvaneh S, Howe CL, Toosizadeh N, Honarvar B, Slepian MJ, Fain M, Mohler J, Najafi B. Regulation of Cardiac Autonomic Nervous System Control across Frailty Statuses: A Systematic Review. Gerontology 2015; 62:3-15. [PMID: 26159462 PMCID: PMC4930075 DOI: 10.1159/000431285] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 05/11/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Frailty is a geriatric syndrome that leads to impairment in interrelated physiological systems and progressive homeostatic dysregulation in physiological systems. OBJECTIVE The focus of the present systematic review was to study the association between the activity of the cardiac autonomic nervous system (ANS) and frailty. METHODS A systematic literature search was conducted in multiple databases: PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, CINAHL, and ClinicalTrials.gov; the last search was performed in March 2015. Inclusion criteria were: (1) that the studied population was classified for frailty according to a standard definition, such as Fried's criteria; (2) that the study had a nonfrail control group, and (3) that heart rate (HR) and/or heart rate variability (HRV) were parameters of interest in the study. RESULTS Of the 1,544 articles screened, 54 were selected for full-text review and 6 studies met the inclusion criteria. Assessment of HRV using different standard time domain, frequency domain, and nonlinear domain approaches confirmed the presence of an impaired cardiac ANS function in frail compared to nonfrail participants. Furthermore, HR changes while performing a clinical test (e.g., the seated step test or the lying-to-standing orthostatic test) were decreased in the frail group compared to the nonfrail group. CONCLUSIONS The current systematic review provides evidence that the cardiac ANS is impaired in frail compared to nonfrail older adults, as indicated by a reduction in the complexity of HR dynamics, reduced HRV, and reduced HR changes in response to daily activities. Four out of 6 included articles recruited only female participants, and in the other 2 articles the effect of gender on impairment of cardiac ANS was insufficiently investigated. Therefore, further studies are required to study the association between cardiac ANS impairments and frailty in males. Furthermore, HRV was studied only during static postures such as sitting, or without considering the level of activity as a potential confounder. Accordingly, simultaneous measurement of both physiological (i.e., HRV) and kinematic (e.g., using wearable sensor technology) information may provide a better understanding of cardiac ANS impairments with frailty while controlling for activity.
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Affiliation(s)
- Saman Parvaneh
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
- Arizona Center on Aging, University of Arizona, Tucson, USA
| | - Carol L. Howe
- Arizona Center on Aging, University of Arizona, Tucson, USA
- Arizona Health Sciences Library, University of Arizona, Tucson, USA
| | - Nima Toosizadeh
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Bahareh Honarvar
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
| | - Marvin J. Slepian
- Department of Medicine and Biomedical Engineering, University of Arizona, Tucson, USA
- Sarver Heart Center, University of Arizona, Tucson Arizona, USA
| | - Mindy Fain
- Arizona Center on Aging, University of Arizona, Tucson, USA
| | - Jane Mohler
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
- Arizona Center on Aging, University of Arizona, Tucson, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, College of Medicine, University of Arizona, Tucson, USA
- Arizona Center on Aging, University of Arizona, Tucson, USA
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Morrissey MB, Viola D, Shi Q. Relationship between pain and chronic illness among seriously ill older adults: expanding role for palliative social work. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2014; 10:8-33. [PMID: 24628140 DOI: 10.1080/15524256.2013.877861] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Confronting the issue of pain among chronically ill older adults merits serious attention in light of mounting evidence that pain in this population is often undertreated or not treated at all (Institute of Medicine, 2011 ). The relationship between pain and chronic illness among adults age 50 and over was examined in this study through the use of longitudinal data from the University of Michigan Health and Retirement Study, sponsored by the National Institute on Aging and the Social Security Administration. Findings suggested positive associations between pain and chronic disease, pain and multimorbidity, as well as an inverse association between pain and education. Policy implications for workforce development and public health are many, and amplification of palliative social work roles to relieve pain and suffering among seriously ill older adults at all stages of the chronic illness trajectory is needed.
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Affiliation(s)
- Mary Beth Morrissey
- a Global Healthcare Innovation Management Center , Fordham University Graduate School of Business Administration , West Harrison , New York , USA
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Parentoni AN, Lustosa LP, Santos KDD, Sá LF, Ferreira FO, Mendonça VA. Comparação da força muscular respiratória entre os subgrupos de fragilidade em idosas da comunidade. FISIOTERAPIA E PESQUISA 2013. [DOI: 10.1590/s1809-29502013000400010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A fragilidade é composta por um tripé constituído por: sarcopenia, disfunção imunológica e desregulação neuroendócrina. A sarcopenia é definida como uma diminuição na força e na potência muscular, sendo que os músculos respiratórios também são afetados. O objetivo foi comparar a força muscular respiratória (FMR) em idosas residentes na comunidade, classificadas como não frágeis (NF), pré-frágeis (PF) e frágeis (F) e correlacionar a FMR com a força de preensão manual (FPM). O estudo foi do tipo transversal, com uma amostra de conveniência composta por 106 idosas. As participantes foram classificadas quanto ao fenótipo de fragilidade. A FMR foi avaliada por meio da pressão inspiratória máxima (PImáx) e da pressão expiratória máxima (PEmáx). Foram encontradas diferenças significativas da FMR entre os grupos NF e F (PImáx: p=0,001 e PEmáx: p<0,001) e entre os grupos PF e F (PImáx: p<0,001 e PEmáx: p<0,001). Em relação à FPM, foram observadas diferenças significativas entre todos os grupos (p<0,001). Houve correlação entre FMR e FPM apenas no grupo frágil. Desta forma, a FPM pode ser importante na prática clínica para diferenciar os subgrupos de fragilidade e identificar a perda de força muscular, incluindo a perda da FMR.
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Afilalo J, Alexander KP, Mack MJ, Maurer MS, Green P, Allen LA, Popma JJ, Ferrucci L, Forman DE. Frailty assessment in the cardiovascular care of older adults. J Am Coll Cardiol 2013; 63:747-62. [PMID: 24291279 DOI: 10.1016/j.jacc.2013.09.070] [Citation(s) in RCA: 758] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 09/25/2013] [Accepted: 09/30/2013] [Indexed: 12/16/2022]
Abstract
Due to the aging and increasingly complex nature of our patients, frailty has become a high-priority theme in cardiovascular medicine. Despite the recognition of frailty as a pivotal element in the evaluation of older adults with cardiovascular disease (CVD), there has yet to be a road map to facilitate its adoption in routine clinical practice. Thus, we sought to synthesize the existing body of evidence and offer a perspective on how to integrate frailty into clinical practice. Frailty is a biological syndrome that reflects a state of decreased physiological reserve and vulnerability to stressors. Upward of 20 frailty assessment tools have been developed, with most tools revolving around the core phenotypic domains of frailty-slow walking speed, weakness, inactivity, exhaustion, and shrinking-as measured by physical performance tests and questionnaires. The prevalence of frailty ranges from 10% to 60%, depending on the CVD burden, as well as the tool and cutoff chosen to define frailty. Epidemiological studies have consistently demonstrated that frailty carries a relative risk of >2 for mortality and morbidity across a spectrum of stable CVD, acute coronary syndromes, heart failure, and surgical and transcatheter interventions. Frailty contributes valuable prognostic insights incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients. Interventions designed to improve outcomes in frail elders with CVD such as multidisciplinary cardiac rehabilitation are being actively tested. Ultimately, frailty should not be viewed as a reason to withhold care but rather as a means of delivering it in a more patient-centered fashion.
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Affiliation(s)
- Jonathan Afilalo
- Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
| | - Karen P Alexander
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Michael J Mack
- Division of Cardiothoracic Surgery, Baylor Health Care System, The Heart Hospital Baylor Plano, Plano, Texas
| | - Mathew S Maurer
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Philip Green
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Larry A Allen
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeffrey J Popma
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Daniel E Forman
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, VA Boston Healthcare Center, Boston, Massachusetts
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25
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Bennett JA, Winters-Stone KM, Dobek J, Nail LM. Frailty in older breast cancer survivors: age, prevalence, and associated factors. Oncol Nurs Forum 2013; 40:E126-34. [PMID: 23615146 PMCID: PMC3988495 DOI: 10.1188/13.onf.e126-e134] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe frailty and associated factors in breast cancer survivors (BCSs) and evaluate whether BCSs are frail at an earlier age than female participants from in two large epidemiological studies. DESIGN Descriptive, cross-sectional. SETTING School of Nursing at Oregon Health and Science University. SAMPLE 216 BCSs aged 53-87 years who were a mean 5-7 years post-treatment and not currently participating in exercise. METHODS Performance tests, clinical measures, and self-reported questionnaires provided baseline data on five criteria for frailty. MAIN RESEARCH VARIABLES Frailty was defined as meeting three of the five criteria of the frailty phenotype: shrinking, exhaustion, low activity, slowness, and weakness. Data were compared to published data from women in the Cardiovascular Health Study (CHS) and Women's Health and Aging Study (WHAS). FINDINGS Eighteen percent of BCSs aged 70-79 years were frail compared to 11% of women of the same age in the CHS and WHAS. Frailty was more common at a younger age in BCSs, and more BCSs were frail in all age groups compared to women in the CHS study until about age 80 years, when prevalence of frailty was similar in the two groups. Fifty percent of BCSs were classified as prefrail because they met one or two of the five frailty criteria. Higher body mass index increased the odds of frailty, and higher physical activity decreased the odds of frailty (odds ratio [OR] = 1.12, p = 0.003, and OR = 0.99, p = 0.000, respectively). CONCLUSIONS Frailty and prefrailty may be common in BCSs and may occur at an earlier age than in adults without a history of breast cancer. IMPLICATIONS FOR NURSING Nurses should be alert to prefrailty or frailty at a younger age in BCSs. Awareness and early intervention may delay or prevent frailty. KNOWLEDGE TRANSLATION BCSs may be frail even when they are not yet considered older adults. Prefrailty in BCSs is important to recognize because it suggests impending frailty that could lead to reduced physical functioning or poor health. Prefrailty and frailty could be assessed in BCSs aged 50 years and older in a clinical setting using a few questions about weight, fatigue, and activity levels, in addition to simple tests of walking speed and grip strength, if warranted.
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Affiliation(s)
- Jill A Bennett
- School of Nursing, Oregon Health and Science University, Portland, USA.
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Kaminsky LA, Arena R, Beckie TM, Brubaker PH, Church TS, Forman DE, Franklin BA, Gulati M, Lavie CJ, Myers J, Patel MJ, Piña IL, Weintraub WS, Williams MA. The Importance of Cardiorespiratory Fitness in the United States: The Need for a National Registry. Circulation 2013; 127:652-62. [DOI: 10.1161/cir.0b013e31827ee100] [Citation(s) in RCA: 265] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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