Inflammatory markers and gait speed decline in older adults

Association between subjective walking speed and metabolic diseases in individuals with obesity: a cross-sectional analysis

The association between subjective walking speed and metabolic diseases has received limited attention, particularly in individuals with obesity. We aimed to clarify this association using comprehensive health checkup data of participants with obesity. In total, 8578 individuals with a body mass index ≥ 25.0 kg/m2, 9626 individuals with waist circumference ≥ 85 cm in men and ≥ 90 cm in women, and 6742 individuals who met both criteria of body mass index and waist circumference were included in this cross-sectional analysis. Subjective walking speed was investigated using the question "Is your walking speed faster than the speed of those of your age and sex?" in a health examination questionnaire. Metabolic diseases were defined according to the guidelines for each disease, and modified Poisson regression analyses were performed. In the model adjusted for age and sex, individuals with obesity based on body mass index and fast subjective walking speed showed significantly lower risk of diabetes mellitus (risk ratio [RR] 0.70; 95% CI 0.63-0.77) and dyslipidemia (RR 0.97; 95% CI 0.94-1.00). Similarly, among those with obesity based on waist circumference and both body mass index and waist circumference, fast subjective walking speed showed a significant negative association with hypertension (RR 0.94; 95% CI 0.90-0.97 and RR 0.95; 95% CI 0.92-0.99, respectively), diabetes mellitus (RR 0.70; 95% CI 0.64-0.77 and RR 0.70; 95% CI 0.63-0.77, respectively), and dyslipidemia (RR 0.96; 95% CI 0.94-0.99 and RR 0.96; 95% CI 0.94-0.99, respectively). Thus, among individuals with obesity, the odds of metabolic diseases were lower if their subjective walking speed was fast. This study contributes to earlier prevention of the cascade of diseases that begin with obesity.

Motoric cognitive risk syndrome as a predictive factor of cognitive impairment and dementia - A systematic review and meta-analysis

BACKGROUND

Motoric cognitive risk syndrome (MCR) is defined as the presence of slow gait-speed and subjective cognitive decline in older individuals without mobility disability or dementia. While some studies suggest that MCR is a pre-dementia syndrome and may help predict the risk of cognitive impairment and dementia, not all studies concur. The objective of this study is to comprehensively summarize and synthesize evidence to assess the association between MCR and cognitive impairment and dementia.

METHODS

Following a pre-specified protocol, two authors systematically searched PubMed, Embase, and The Cochrane Library from inception to 19 August 2024 for observational or randomized studies pertaining to the association between MCR and cognitive impairment and dementia. We favoured maximally adjusted hazards and odds ratios to determine the longitudinal and cross-sectional risk of cognitive impairment and dementia. We investigated for potential sources of heterogeneity and also conducted sensitivity and subgroup analyses by continent and the type of cognitive outcome. The quality of evidence was assessed using the Newcastle-Ottawa Scale (NOS) and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework.

RESULTS

We included 20 studies comprising a combined cohort of 1206,782 participants, of which 17 studies were included in the quantitative analysis. The pooled analysis outlined that individuals with MCR exhibited 2.20-fold higher risk of cognitive impairment and dementia, compared to controls (RR=2.20; 95 %CI=1.91-2.53). These findings remained robust across all subgroup analyses, sensitivity analyses and assessments of publication bias.

CONCLUSION

MCR may be considered a predictive factor for long-term cognitive impairment and dementia. This should be taken into consideration when clinically evaluating the risk of cognitive impairment and dementia but further research is required to lend greater clarity to this association.

Association between chronic disease status and transitions in depressive symptoms among middle-aged and older Chinese population: Insights from a Markov model-based cohort study

BACKGROUND

The relationship between chronic disease status (CDS) and transitions in depressive symptoms (DS) remains unclear. This study explores the association between CDS and DS transitions.

METHODS

This cohort study analyzed data from 8175 participants aged 45+, sourced from China Family Panel Studies (2016, 2018, 2020). DS were assessed using a brief version of Center for Epidemiologic Studies Depression Scale (CES-D). CDS was categorized into healthy, single disease, and multimorbidity. Markov models were used to estimate state transition intensities, mean sojourn times and hazard ratios (HRs).

RESULTS

DS transitions occurred between adjacent and non-adjacent states, but transition intensity between adjacent states was higher than among non-adjacent states. Self-transition intensities of severe-DS, mild-DS, and non-DS progressively increased, with average durations of 1.365, 1.482, and 7.854 years, respectively. Both single disease and multimorbidity were significantly associated with an increased risk of transitioning from non-DS to mild-DS, with multimorbidity showing a stronger association. In contrast, HRs for single diseases transitioning from mild-DS to severe-DS were significantly lower than 1. Furthermore, their HRs were almost <1 in recovery transitions but not statistically significant.

LIMITATIONS

Specific chronic diseases and their combinations were not analyzed.

CONCLUSIONS

The progression of DS exhibits various pathways. CDS is associated with DS transitions, but the roles of single disease and multimorbidity may differ across different DS progression stages. Both conditions were significantly linked to the risk of new-onset DS, with multimorbidity posing a greater association. However, this relationship is not observed in other progression stages. These findings could provide insights for early prevention and intervention for DS.

Association of dietary inflammatory index, composite dietary antioxidant index, and frailty in elderly adults with diabetes

BACKGROUND

We aimed to examine the relationship of 2 dietary scores [dietary inflammatory index (DII) and composite dietary antioxidant index (CDAI)] with frailty in elderly adults with diabetes.

METHODS

Data were gathered from the National Health and Nutrition Examination Survey (NHANES) between 2007 and 2018. The frailty index was calculated using 49 deficits across various systems to define frailty. To examine the relationship of 2 dietary scores (DII and CDAI) with frailty in elderly adults with diabetes, multiple logistic regression analyses were performed. In logistic regression model, DII and CDAI were calculated as both continuous and tertiles. Subgroup analyses were performed to demonstrate stability of results. Restricted cubic splines were utilized to examine the non-linear correlations.

RESULTS

A total of 2,795 elderly adults with diabetes were included in this study. In the multivariate logistic regression model, the odds ratio (OR) of DII for risk of frailty was 1.08 (95% CI 1.02-1.15) and the OR of CDAI for risk of frailty was 0.96 (95% CI 0.93-0.99). The ORs of DII for risk of frailty were 1.36 (95% CI 1.09-1.70) and 1.33 (95% CI 1.04-1.70) for tertiles 2 and 3, respectively (p for trend 0.027). The ORs of CDAI for risk of frailty were 0.94 (95% CI 0.75-1.17) and 0.75 (95% CI 0.58-0.98) for tertiles 2 and 3, respectively (p for trend 0.036). The subgroup analysis demonstrated reliable and enduring connections between 2 dietary scores and frailty (all p for interaction > 0.05). In the restricted cubic spline analyses, we discovered the non-linear relationship between DII and frailty (P for nonlinearity = 0.045) and linear relationship between CDAI and frailty (P for nonlinearity = 0.769).

CONCLUSION

The research showed connections between 2 dietary scores (DII and CDAI) and frailty as measured by frailty index in elderly adults with diabetes.

Simple Mobility Tests Predict Use of Assistive Devices in Older Adults

BACKGROUND

Assistive devices (ADs) for ambulation are commonly provided to improve safety and independence in older adults. Despite the common use of these devices, there are no standard prescribing guidelines, and non-health care providers, including caregivers and family members, often make decisions about the need for ADs. Identifying factors or a single screening test associated with AD use would benefit clinicians and non-health care caregivers in making decisions to adopt an AD for patients, clients, and family members.

PURPOSE/OBJECTIVES

The purpose of this cross-sectional study was to identify the test that best predicts ADs for ambulation and non-AD use among community-dwelling individuals.

METHODS

Eighty-five older adults (81.6 ± 8.2 years old) who underwent outpatient physical therapy participated in this study. They participated in a series of tests, including the Timed Up and Go, handgrip and quadriceps strength, the 30-second chair-rise test, the 5-m fast gait speed, the Functional Independence Measure, the locomotive syndrome tests (stand-up test, 2-step test [2ST], and the Locomo-5 Checklist), and numeric pain scales. Mann-Whitney U tests were used to identify differences between those who did and did not use an AD for ambulation. Logistic regression analyses were used to examine which test best predicted AD use.

RESULTS

80% of participants (n = 68) used an AD for ambulation. There were significant differences in all test variables between users and nonusers ( P = .033 to P < .001), except for quadriceps strength, age, and pain (all P > .05). Only the 2ST was a significant predictor of AD use, with a cutoff distance of the toe-to-toe stride shorter than 93% of body height (sensitivity: 72%, and specificity: 82%, P = .048).

DISCUSSION

Simple functional measures differed between those who did and did not use ADs for ambulation; however, only the 2ST predicted AD status. Individuals who cannot step 93% of their body height may be appropriate for an AD.

CONCLUSIONS

If comprehensive clinical evaluations are not available to make decisions about AD use, the 2ST can be used to make clinical recommendations for an AD for ambulation.

Association of adipose tissue inflammation and physical fitness in older adults

An active lifestyle is of key importance for reduction of obesity and inflammation, as well as circulating levels of adipokines. Therefore, the aim of our study was to assess the relationship of physical fitness with chronic inflammatory status, and to evaluate biomarkers useful in the analysis of adipose tissue dysfunction. Sixty-three older adults (69.6 ± 5.1 years) were allocated to a high n = 31 (women n = 23 and men n = 8 male) or low physical fitness n = 32 (women n = 29 and men n = 3) group based on gait speed values (1.4-1.8 m/s or ≤ 1.3 m/s). The gait speed correlated with hand grip strength (rs = 0.493, p = 0.0001) and with leptin level (R = -0.372, p = 0.003), which shows the benefits of physical activity on muscle strength and circulating adipokines. In low physical fitness group, 58.1% individuals had adiponectin to leptin ratio (Adpn/Lep) < 0.5 revealing dysfunction of adipose tissue and high cardiometabolic risk; 20% of the group were obese with BMI ≥ 30 kg/m2. In high physical fitness group, 25.8% of individuals had Adpn/Lep ≥ 1.0 i.e., within the reference range. Markers of systemic inflammation were significantly related to physical fitness: CRP/gait speed (rs = -0.377) and HMGB-1/gait speed (rs = -0.264). The results of the ROC analysis for Adpn (AUC = 0.526), Lep (AUC = 0.745) and HMGB-1 (AUC = 0.689) indicated their diagnostic potential for clinical prognosis in older patients. The optimal threshold values corresponded to 1.2 μg/mL for Adpn (sensitivity 74.2%, specificity 41.9%, OR = 1.4, 95%Cl 0.488-3.902), 6.7 ng/mL for Lep (sensitivity 56.2%, specificity 93.5%, OR = 14.8, 95%Cl 3.574-112.229), 2.63 mg/L for CRP (sensitivity 51.6%, specificity 84.3%, OR = 4.4, 95% Cl 1.401- 16.063) and 34.2 ng/mL for HMGB-1 (sensitivity 62.0%, specificity 86.6%, OR = 12.0, 95%Cl 3.254-61.614). The highest sensitivity and specificity were observed for Leptin and HMGB-1. The study revealed changes in inflammatory status in older adults at various levels of physical fitness and demonstrated diagnostic usefulness of adipokines in the assessment of adipose tissue inflammation.

Associations of mid-to-late-life inflammation with late-life mobility and the influences of chronic comorbidities, race, and social determinants of health: The Atherosclerosis Risk in Communities Study

BACKGROUND

Relationships of midlife inflammation with late-life mobility and influences of chronic health conditions, race, and social determinants of health (SDoH) on these relationships are poorly understood.

METHODS

Among 4758 community-dwelling participants (41% men, 20% Black), high-sensitivity C-reactive protein (hsCRP) was measured over 20+ years: in midlife at study visit 2 (V2: 1990-1992, 47-68 years); at V4 (1996-1998, 53-74 years); and with concurrent late-life 4-m gait speed at V5 (2011-2013, 67-88 years, mean 75 years). SDoH measures included race, the national-rank area deprivation index, education, and income. We examined associations of late-life gait speed with midlife hsCRP (V2 continuous and clinically high ≥3 mg/L), with 20-year hsCRP history from midlife (V2-V5 average continuous hsCRP and clinically high ≥3 mg/L) and with inflammation accumulation (visits and years with high hsCRP). Regression models adjusted for demographic, cardiovascular, and SDoH measures; effect modification by the presence of other common chronic conditions (obesity, diabetes, hypertension) and race were examined, with and without accounting for SDoH.

RESULTS

High midlife hsCRP was associated with slower late-life gait speed, even among those without chronic conditions in midlife: -4.6 cm/s (95% CI: -6.4, -2.8). Importantly, sustained high hsCRP was associated with a 20-year slowing of -10.0 cm/s (-14.9, -5.1) among those who never experienced obesity, diabetes, or hypertension over the 20-year period. Associations were similar between Black participants, -3.8 cm/s (-6.9, -0.7) and White participants -3.3 (-4.5, -2.2) per interquartile range of midlife hsCRP; effect modifications by chronic conditions and race were unsupported throughout. Results were robust to accounting for SDoH or otherwise; however, worse SDoH was associated with higher inflammation and slower gait speed in both Black and White participants.

CONCLUSIONS

Inflammation in midlife may contribute to clinically meaningful late-life slowing of gait speed, even among otherwise healthy-appearing adults and regardless of race and socioeconomic disadvantage. Regular monitoring and interventions for inflammation may be warranted from midlife.

Effects of ankle-foot orthoses on gait parameters in post-stroke patients with different Brunnstrom stages of the lower limb: a single-center crossover trial

BACKGROUND

Ankle-foot orthoses (AFO) can improve gait posture and walking ability in post-stroke patients. However, the effect of AFO on gait parameters in post-stroke patients according to the Brunnstrom stage of stroke recovery of the lower limbs remains unclear. The study aimed to investigate whether stroke patients with different Brunnstrom stages benefit from wearing AFO.

METHODS

Twenty-five post-stroke participants included 18 men (50 ± 13 years) and 7 women (60 ± 15 years). The patients were divided based on Brunnstrom stage III or IV of the lower limbs. All patients underwent the gait and timed up and go (TUG) test using a gait analysis system while walking barefoot or with an AFO. The spatiotemporal and asymmetric parameters were analyzed.

RESULTS

All 25 patients completed the study. Significant differences were observed between barefoot and AFO use in TUG time (P < 0.001) but not walking velocity (P > 0.05). The main effect of the swing time ratio was significant in both groups (P < 0.05); however, the main effects of stride length, stance time, and gait asymmetry ratio were nonsignificant (P > 0.05). For barefoot versus AFO, the main effects of stride length (P < 0.05) and swing time (P < 0.01) ratios were significant, whereas those of stance time and gait asymmetry ratio were nonsignificant (P > 0.05).

CONCLUSIONS

Post-stroke patients with lower Brunnstrom stages benefitted more from AFO, particularly in gait asymmetry.

Biomarkers of Cellular Senescence Predict the Onset of Mobility Disability and Are Reduced by Physical Activity in Older Adults

Studies in mice and cross-sectional studies in humans support the premise that cellular senescence is a contributing mechanism to age-associated deficits in physical function. We tested the hypotheses that circulating proteins secreted by senescent cells are (i) associated with the incidence of major mobility disability (MMD), the development of persistent mobility disability (PMMD), and decrements in physical functioning in older adults, and (ii) influenced by physical activity (PA). Using samples and data obtained longitudinally from the Lifestyle Interventions in Elders Study clinical trial, we measured a panel of 27 proteins secreted by senescent cells. Among 1 377 women and men randomized to either a structured PA intervention or a healthy aging (HA) intervention, we observed significant associations between several senescence biomarkers, most distinctly vascular endothelial growth factor A (VEGFA), tumor necrosis factor receptor 1 (TNFR1), and matrix metallopeptidase 7 (MMP7), and the onset of both MMD and PMMD. Moreover, VEGFA, GDF15, osteopontin, and other senescence biomarkers were associated with reductions in short physical performance battery scores. The change in senescence biomarkers did not differ between PA and HA participants. In the whole cohort, higher levels of PA were associated with significantly greater reductions in 10 senescence-related proteins at 12 and/or 24 months. These data reinforce cellular senescence as a contributing mechanism of age-associated functional decline and the potential for PA to attenuate this hallmark of aging. Clinical Trials Registration Number: NCT01072500.

Role of Cognitive Frailty in Older Adults With Cardiovascular Disease

As the older adult population expands, an increasing number of patients affected by geriatric syndromes are seen by cardiovascular clinicians. One such syndrome that has been associated with poor outcomes is cognitive frailty: the simultaneous presence of cognitive impairment, without evidence of dementia, and physical frailty, which results in decreased cognitive reserve. Driven by common pathophysiologic underpinnings (eg, inflammation and neurohormonal dysregulation), cardiovascular disease, cognitive impairment, and frailty also share the following risk factors: hypertension, diabetes, obesity, sedentary behavior, and tobacco use. Cardiovascular disease has been associated with the onset and progression of cognitive frailty, which may be reversible in early stages, making it essential for clinicians to diagnose the condition in a timely manner and prescribe appropriate interventions. Additional research is required to elucidate the mechanisms underlying the development of cognitive frailty, establish preventive and therapeutic strategies to address the needs of older patients with cardiovascular disease at risk for cognitive frailty, and ultimately facilitate targeted intervention studies.

Relationship between neck vessel abnormalities and sarcopenia: results of a study examining trends in health and aging in western China

OBJECTIVE

To elucidate the association between cervical vascular abnormalities (high Crouse score, high carotid intima-media thickness [CIMT], high plaque score [PS]) and sarcopenia and its diagnostic elements.

STUDY DESIGN

This cross-sectional investigation selected patients from the Western China Health and Aging Trends Study (WCHAT) aged 60 years and older. High CIMT and high Crouse score was defined as values ≥ upper quartile cutoff. Moreover, PS ≥ 3 was set as an high PS. Sarcopenia diagnosis and the definition of sarcopenia diagnostic elements were based on the Asian Working Group on Sarcopenia (AWGS) 2019 consensus. Lastly, associations between high Crouse score, high PS, high CIMT, and sarcopenia and its diagnostic elements were assessed using logistic regression.

RESULT

In all, we recruited 932 subjects in this study, among which, 138 people (14.81%) were diagnosed with sarcopenia. The rates of high Crouse score (sarcopenia vs. non-sarcopenia: 37.68% vs. 23.30%, P < 0.001) and high PS (sarcopenia vs. non-sarcopenia: 34.78% vs. 18.39%, P < 0.001) in subjects with sarcopenia were higher than those in subjects without sarcopenia. Logistic regression analysis and the correction of possible confounding factors showed that high Crouse score and high PS were related to sarcopenia (high Crouse score: OR = 1.573; 95%CI: 1.032-2.4; high PS: OR = 1.845; 95%CI: 1.195-2.851). Further analysis indicated that high Crouse score were associated with low muscle mass (OR = 1.403; 95%CI: 1.002-1.966) and low physical function (OR = 1.93; 95%CI: 1.3-2.866). High PS was found to be related to low physical function (OR = 1.83; 95%CI: 1.209-2.771).

CONCLUSION

While both high Crouse score and high PS are related to sarcopenia, further analysis showed that high Crouse score were mainly associated with low muscle mass and low physical function while high PS was associated with low physical function.

How Loneliness Gets Under the Skin: Inflammation Mediates the Relationship Between Loneliness and Gait Speed

OBJECTIVE

Loneliness is linked to interleukin 6 (IL-6), a marker of systemic inflammation, which chronically has deleterious effects on physical and mental health across the adult life span. This study investigated cross-sectional relationships among loneliness, IL-6, demographics, multimorbidity, depression, obesity, friendship quantity, and slowed gait.

METHODS

Data from the Midlife Development in the United States Biomarker Project, a national adult sample ( N = 822; age range, 26-78 years) was used for this study. The PROCESS macro tested the hypothesis that IL-6 would mediate the relationship between loneliness and gait, after adjusting for demographic and health risk factors.

RESULTS

Age ( β = 0.292, p < .001), sex ( β = 0.197, p < .001), body mass index (BMI, β = 0.374, p < .001), waist-hip ratio ( β = 0.242, p < .001), and loneliness ( β = 0.089, p = .025) but not multimorbidity ( β = 0.043, p = .20), depression history ( β = 0.022, p = .47), depression symptoms ( β = 0.036, p = .28), and number of friends ( β = 0.022, p = .46) contributed to the variance in IL-6. Serial mediation analyses supported the chained effect of loneliness on walking time through BMI and IL-6. Results also showed specific indirect effects of BMI and IL-6 on walking time, suggesting more than one pathway by which loneliness influences health.

CONCLUSIONS

These results suggest that loneliness may increase the risk of systemic inflammation, leading to slowed gait and adverse health outcomes. Psychosocial interventions that address loneliness may provide an optimal treatment target for reducing inflammation and preventing declines in health.

Physio-cognitive decline syndrome among middle-aged diabetes patients: Handgrip strength significantly correlates with glycaemic control and cognitive score

Aims

To investigate the correlation between glycaemic control with component of Physio-Cognitive Decline Syndrome (PCDS) and among each component of PCDS itself.

Methods

A cross sectional study was conducted (January 2021-November 2022) at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia on consecutively recruited T2DM outpatients aged 40-59 years old. Data on the latest three months HbA1c, hand grip strength (HGS), usual gait speed (GS), and Indonesian Montreal Cognitive Assessment (MoCA-Ina) were evaluated. Pearson or Spearman's test was used to analyse the correlations.

Results

There were 133 subjects with median age 53 (40-59) years. The PCDS was found in 48.1 % subjects, of which 64.1 % with uncontrolled glycaemia. Significant correlations were found between HGS and HbA1c (r = -0.24, R2 = 0.06, p < 0.01) and MoCA-Ina score (r = 0.21, R2 = 0.04, p < 0.05).

Conclusion

The higher HbA1c and the lower MoCA-Ina score, the weaker handgrip strength was.

Inflammatory Biomarkers and Gait Impairment in Older Adults: A Systematic Review

Peripheral inflammation and gait speed alterations are common in several neurological disorders and in the aging process, but the association between the two is not well established. The aim of this systematic literary review is to determine whether proinflammatory markers are a positive predictor for gait impairments and their complications, such as falls in older adults, and may represent a risk factor for slow gait speed and its complications. The systematic review was performed in line with the Preferred Report Items for Systematic Review and Meta-Analyses (PRISMA). A protocol for literature searches was structured a priori and designed according to the International Perspective Register of Systemic Review (PROSPERO: CRD42023451108). Peer-reviewed original articles were identified by searching seven electronic databases: Excerpta Medica Database (EMBASE), SciVerse (ScienceDirect), Scopus, PubMed, Medline, Web of Science, and the Cochrane Library. The search strategy was formulated based on a combination of controlled descriptors and/or keywords related to the topic and a manual search was conducted of the reference lists from the initially selected studies to identify other eligible studies. The studies were thoroughly screened using the following inclusion criteria: older adults, spatiotemporal gait characteristics, and proinflammatory markers. A meta-analysis was not performed due to the heterogeneity of the studies, and the results were narratively synthesized. Due to the clinical and methodological heterogeneity, the studies were combined in a narrative synthesis, grouped by the type of biomarkers evaluated. A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, spatiotemporal gait parameters such as gait velocity, and proinflammatory markers such as TNF-α, high sensitivity C-reactive (CRP) proteins, and IL-6. We included 21 out of 51 studies in our review, which examined the association between inflammatory biomarkers and gait impairment. This review highlights the role of TNF-α, CRP, and IL-6 in gait impairment. Biomarkers play an important role in the decision-making process, and IL-6 can be an effective biomarker in establishing the diagnosis of slow gait speed. Further longitudinal research is needed to establish the use of molecular biomarkers in monitoring gait impairment.

Correlates of Gait Speed Among Older Adults From 6 Countries: Findings From the COSMIC Collaboration

BACKGROUND

Few studies have compared gait speed and its correlates among different ethnogeographic regions. The goals of this study were to describe usual and rapid gait speed, and identify their correlates across Australian, Asian, and African countries.

METHODS

We used data from 6 population-based cohorts of adults aged 65+ from 6 countries and 3 continents (N = 6 472), with samples ranging from 231 to 1 913. All cohorts are members of the Cohort Studies of Memory in an International Consortium collaboration. We investigated whether clinical (body mass index [BMI], hypertension, stroke, apolipoprotein status), psychological (cognition, mood, general health), and behavioral factors (smoking, drinking, physical activity) correlated with usual (N = 4 cohorts) and rapid gait speed (N = 3 cohorts) similarly across cohorts. Regression models were controlled for age, sex, and education, and were sex-stratified.

RESULTS

Age- and sex-standardized usual gait speed means ranged from 0.61 to 1.06 m/s and rapid gait speed means ranged from 1.16 to 1.64 m/s. Lower BMI and better cognitive function consistently correlated with faster gait speed in all cohorts. Less consistently, not having hypertension and greater physical activity engagement were associated with faster gait speed. Associations with mood, smoking, and drinking were largely nonsignificant. These patterns were not attenuated by demographics. There was limited evidence that the associations differed by sex, except physical activity, where the greater intensity was associated with usual gait among men but not women.

CONCLUSIONS

This study is among the first to describe the usual and rapid gait speeds across older adults in Africa, Asia, and Australia.

CRP, but not fibrinogen, is associated with gait speed as early as middle age, in females but not males

Low grade systemic inflammation and age-related gait speed decline are known to be related in older adults, but their relations in the early stages of the aging process are yet to be fully described. The aim of this study was to examine the relationship between gait speed and two inflammation markers-c-reactive protein (CRP) and fibrinogen-in a cohort of middle-aged adults in Israel. 326 healthy, middle-aged, Muslim-Arabs from three villages in northern Israel participated in this cross-sectional study. Serum CRP and fibrinogen were measured via blood tests, and gait speed was assessed with the 6-min walk test (6MWT). After adjusting for sex, age, height, BMI, systolic blood pressure, fasting blood glucose and triglycerides, executive function, smoking status and aerobic physical activity, gait speed was negatively and significantly associated with CRP (b = - 0.01, p = 0.029). When stratifying by gender, this link remained significant only among females (b = - 0.012, p = 0.041), such as that an increase of one SD unit of CRP was associated with a 0.047 m/s decrease in gait speed. No significant link was found between fibrinogen levels and gait speed. Blood CRP levels are associated with a slower walking speed already in middle age, independent of age, executive function and cardio-metabolic factors, among female Arab-Muslims in Israel. Future studies should examine this relationship longitudinally and investigate a broader array of inflammation markers. Systemic inflammation may serve as an early marker for people at risk of decreased walking or accelerated aging; Early identification and intervention among at-risk individuals may help prevent or slow gait speed decline, and promote healthier aging.

Association of handgrip strength with new-onset CKD in Korean adults according to gender

Introduction

Handgrip strength (HGS) is an indicator of many diseases such as pneumonia, cardiovascular disease and cancer. HGS can also predict renal function in chronic kidney disease (CKD) patients, but the value of HGS as a predictor of new-onset CKD is unknown.

Methods

173,195 subjects were recruited from a nationwide cohort and were followed for 4.1  years. After exclusions, 35,757 participants remained in the final study, and CKD developed in 1063 individuals during the follow-up period. Lifestyle, anthropometric and laboratory data were evaluated in relation to the risk of CKD.

Results

The participants were subdivided into quartiles according to relative handgrip strength (RGS). Multivariate Cox regression demonstrated that RGS was inversely associated with incident CKD. Compared with the lowest quartile, the hazard ratios (HRs) [95% confidence intervals (CIs)] for incident CKD for the highest quartile (Q4) was 0.55 (0.34-0.88) after adjusting for covariates in men and 0.51 (0.31-0.85) in women. The incidence of CKD decreased as RGS increased. These negative associations were more significant in men than in women. The receiver operating characteristic (ROC) curve showed that baseline RGS had predictive power for new-onset CKD. Area under the curve (AUC) (95% CIs) was 0.739 (0.707-0.770) in men and 0.765 (0.729-0.801) in women.

Conclusion

This is the novel study demonstrating that RGS is associated with incident CKD in both men and women. The relationship between RGS and incident CKD is more significant in women than in men. RGS can be used in clinical practice to evaluate renal prognosis. Regular measurement of handgrip strength is essential to CKD detection.

The association of dietary inflammatory potential with sarcopenia in Chinese community-dwelling older adults

BACKGROUND

Dietary-induced inflammation is potentially associated with sarcopenia. Nevertheless, few studies have investigated the structure of the inflammatory diet and its correlation with muscle function and performance in both the upper and lower limbs. This study was performed to explore the association of the dietary inflammatory index (DII) with sarcopenia and its diagnostic parameters.

METHODS

We conducted a cross-sectional survey on a sample of 515 Chinese community-dwelling older adults selected through multistage cluster sampling from three districts in Shanghai. DII scores were calculated using a validated food frequency questionnaire. Sarcopenia and its diagnostic parameters were determined based on the definition set by the Asian Working Group on Sarcopenia (AWGS).

RESULTS

The mean age of study participants was 71.31 ± 4.71 years. The prevalence of sarcopenia in the cohort was 12.4%. Older adults in the highest DII quartile had a 3.339 times increased risk of sarcopenia compared to those in the lowest quartile (OR _Quartile4vs1:3.339, 95%CI: 1.232, 9.052, p-trend: 0.004) after adjusting for confounding factors. Additionally, a more pro-inflammatory diet was associated with lower appendicular skeletal muscle index (ASMI) (OR _Quartile4vs1: 3.005, 95%CI: 1.275, 7.318, p-trend: 0.005), a higher 5-times sit-stand test time score (OR _Quartile4vs1: 4.942, 95%CI: 1.745, 13.993, p-trend: 0.005), and lower gait speed (OR _Quartile4vs1: 2.392, 95%CI: 1.104, 5.185, p-trend: 0.041) after adjusting for confounding factors. However, there was no significant association between DII, handgrip strength, and Short Physical Performance Battery (SPPB) score in either the unadjusted or adjusted model.

CONCLUSION

This study found that the association between consuming a more pro-inflammatory diet and sarcopenia in Chinese community-dwelling older adults was mainly due to underlying low intakes of dietary energy, protein, and anti-inflammatory foods, and not due to the high intake of pro-inflammatory foods. Meanwhile, DII was more highly correlated with lower limb muscle strength and performance compared to upper limb muscle strength.

Biomarkers of cellular senescence in idiopathic pulmonary fibrosis

BACKGROUND

Cellular senescence is a cell fate in response to diverse forms of age-related damage and stress that has been implicated in the pathogenesis of idiopathic pulmonary fibrosis (IPF). The associations between circulating levels of candidate senescence biomarkers and disease outcomes have not been specifically studied in IPF. In this study we assessed the circulating levels of candidate senescence biomarkers in individuals affected by IPF and controls and evaluated their ability to predict disease outcomes.

METHODS

We measured the plasma concentrations of 32 proteins associated with senescence in Lung Tissue Research Consortium participants and studied their relationship with the diagnosis of IPF, parameters of pulmonary and physical function, health-related quality of life, mortality, and lung tissue expression of P16, a prototypical marker of cellular senescence. A machine learning approach was used to evaluate the ability of combinatorial biomarker signatures to predict disease outcomes.

RESULTS

The circulating levels of several senescence biomarkers were significantly elevated in persons affected by IPF compared to controls. A subset of biomarkers accurately classified participants as having or not having the disease and was significantly correlated with measures of pulmonary function, health-related quality of life and, to an extent, physical function. An exploratory analysis revealed senescence biomarkers were also associated with mortality in IPF participants. Finally, the plasma concentrations of several biomarkers were associated with their expression levels in lung tissue as well as the expression of P16.

CONCLUSIONS

Our results suggest that circulating levels of candidate senescence biomarkers are informative of disease status, pulmonary and physical function, and health-related quality of life. Additional studies are needed to validate the combinatorial biomarkers signatures that emerged using a machine learning approach.

Urinary Phthalate Metabolites and Slow Walking Speed in the Korean Elderly Environmental Panel II Study

BACKGROUND

Previous epidemiological studies have suggested that phthalate exposure may contribute to neurocognitive and neurobehavioral disorders and decreased muscle strength and bone mass, all of which may be associated with reduced physical performance. Walking speed is a reliable assessment tool for measuring physical performance in adults age 60 y and older.

OBJECTIVE

We investigated associations between urinary phthalate metabolites and slowness of walking speed in community-dwelling adults ages 60-98 y.

METHODS

We analyzed 1,190 older adults [range, 60-98 y of age; mean±standard deviation (SD) , 74.81±5.99] from the Korean Elderly Environmental Panel II study and measured repeatedly up to three times between 2012 and 2014. Phthalate exposure was estimated using the following phthalate metabolites in urine samples: mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP), mono-n-butyl phthalate (MnBP), mono-(2-ethyl-5-carboxypentyl) phthalate (MECPP), and mono-benzyl phthalate (MBzP). Slowness was defined as a walking speed of <1.0meter/second. We used logistic and linear regression models to evaluate the association between each urinary phthalate metabolite and slowness or walking-speed change. We also used Bayesian kernel machine regression (BKMR) to examine overall mixture effects on walking speed.

RESULTS

At enrollment, MBzP levels were associated with an increased odds of slowness [odds ratio (OR) per doubling increase: 1.15, 95% confidence interval (CI): 1.02, 1.30; OR for the highest vs. lowest quartile: 2.20 (95% CI: 1.12, 4.35) with p-trend across quartiles=0.031]. In longitudinal analyses, MEHHP levels showed an increased risk of slowness [OR per doubling increase: 1.15 (95% CI: 1.02, 1.29), OR for the highest vs. lowest quartile: 1.47 (95% CI: 1.04, 2.06), p- trend=0.035]; whereas those with higher MnBP showed a reduced risk of slowness [OR per doubling increase: 0.84 (95% CI: 0.74, 0.96), OR in the highest (vs. lowest) quartile: 0.64 (95% CI: 0.47, 0.87), p-trend=0.006]. For linear regression models, MBzP quartiles were associated with slower walking speed (p-trend=0.048) at enrollment, whereas MEHHP quartiles were associated with slower walking speed, and MnBP quartiles were associated with faster walking speed in longitudinal analysis (p-trend=0.026 and <0.001, respectively). Further, the BKMR analysis revealed negative overall trends between the phthalate metabolite mixtures and walking speed and DEHP group (MEHHP, MEOHP, and MECPP) had the main effect of the overall mixture.

DISCUSSION

Urinary concentrations of prevalent phthalates exhibited significant associations with slow walking speed in adults ages 60-98 y. https://doi.org/10.1289/EHP10549.

Effect of change of interleukin-6 over time on gait speed response: Results from the lifestyle interventions and independence for elders study

Interleukin (IL)-6 is a well-accepted biomarker of chronic low-grade inflammation possibly conditioning the effect of physical activity (PA) intervention on physical performance in mobility-limited older adults. We evaluated PA intervention effects on 400 m gait speed by yearly change of IL-6 levels in a post-hoc analysis from Lifestyle Interventions and Independence for Elders (LIFE) Study, a multicenter single-blind randomized clinical trial on 1300 sedentary older adults (mean age:78.85 ± 5.23,65.85 % women) at risk for mobility disability. We compared the intervention effects on 400 m gait speed at 12 months follow-up, according to yearly IL-6 change categorized for 1 pg/ml increase or decrease, and subsequently for larger range of yearly variation. Among subjects with yearly IL-6 change between -1 and + 2 pg/ml, we observed a significant difference of gait speed in PA intervention group compared to healthy educational intervention group [0.041 m/s,95 % confidence interval (CI):0.008-0.074,p = 0.006;Cohen's d:0.26, 95 % CI:0.12-0.41). No effects were observed on 400 m gait speed for wider range of variation of plasma IL-6 levels. Limiting change of IL-6 levels under this specific hormetic window could be an important goal to achieve better benefit from PA intervention in terms of gait speed change and prevention of mobility disability.

Longitudinal Associations Between Falls and Risk of Gait Decline: Results From the Central Control of Mobility and Aging Study

OBJECTIVE

To examine whether falls are associated with longitudinal changes in different gait domains and onset of clinical gait abnormalities.

DESIGN

Longitudinal study.

SETTING

General community.

PARTICIPANTS

Ambulatory older adults free of dementia (N=428; mean age, 77.8±6.4 years).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Gait was assessed with a computerized walkway. Pace, rhythm, and variability (outcome measures) were derived from individual gait measures, using principal component analysis. Clinical gait abnormalities (neurologic, nonneurologic, mixed) were visually assessed by clinicians. Linear mixed-effects models were used to examine the associations between falls (the exposure variable coded as none, single, and multiple) and changes in gait domains. Multinomial logistic regression was used to examine associations between falls and the onset of clinical gait abnormalities. Models were adjusted for sex, education, age, body mass index, number of comorbidities, gait speed at the first follow-up, and time between the last fall and the first follow-up gait assessment.

RESULTS

Pace declined while rhythm and variability increased at a faster rate (P<.05) among 32 participants with multiple falls in the first year of follow-up compared with 299 participants with no falls. Risk for clinical gait abnormalities between those with no falls, a single fall, or multiple falls was not different.

CONCLUSIONS

Multiple falls predict future gait decline in multiple domains in aging. Interventions to prevent gait decline after multiple falls should be investigated.

Association between handgrip strength and metabolic syndrome: A meta-analysis and systematic review

BACKGROUND

Although muscle strength has been reported to be associated with metabolic syndrome (MetS), the association is still controversial. Therefore, the purpose of this meta-analysis was to identify the association between handgrip strength (HGS) and MetS.

METHODS

Original research studies involving HGS and MetS from database inception to 20 May 2022 were selected from PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang databases, and Chinese Biomedical Document Service System. The odds ratios (ORs) with 95% confidence intervals (CIs) of MetS for HGS were calculated using a random-effects model. A dose-response analysis was performed. Subgroup analysis and meta-regression were also conducted.

RESULTS

Thirty effect sizes (reported in 19 articles) with a total of 43,396 participants were included in this meta-analysis. All studies were considered to be of moderate-to-good quality. An inverse association between HGS (low vs. high) with MetS was shown (OR: 2.59, 95% CI: 2.06-3.25). Subgroup analyses demonstrated the pooled ORs of relative HGS (HGS/weight), relative HGS (HGS/BMI), and absolute HGS were 2.97 (95% CI: 2.37-3.71), 2.47 (95% CI: 1.08-5.63), and 1.34 (95% CI: 1.06-1.68), respectively. Dose-response analysis revealed a significant linear dose-response relationship between relative HGS (HGS/weight) and MetS in observational studies (0.1 HGS/weight: OR, 0.68; 95% CI: 0.62-0.75). Univariate meta-regression analysis indicated that country status, measuring tools of HGS, components of MetS, and diagnosed criteria of MetS explained 16.7%, 26.2%, 30.1%, and 42.3% of the tau-squared in the meta-regression, respectively.

CONCLUSION

The results of the current meta-analysis indicated that lower HGS is associated with a higher risk of MetS. A linear dose-response association between lower relative HGS (HGS/weight) and increased prevalence of MetS was found. Accordingly, a lower HGS is a significant predictor of MetS.

SYSTEMATIC REVIEW REGISTRATION

[https://www.crd.york.ac.uk/PROSPERO/], identifier [CRD42021276730].

Association of walking speed with cognitive function in Chinese older adults: A nationally representative cohort study

BACKGROUND

Slow walking speed has been shown to predict cognitive decline in older individuals, but studies conducted among Chinese older adults are scarce. We examined the association of walking speed with cognitive function and the trajectory of cognitive decline among Chinese adults aged 60 years and older.

METHODS

Data was from the China Health and Retirement Longitudinal Study (CHARLS), an ongoing nationally representative prospective cohort study. Walking speed was evaluated over a straight 2.5-meter flat course at baseline and categorized into tertiles (the lowest, middle, and highest). Cognitive function was assessed at each wave in three domains: episodic memory, mental status, and global cognition. Data were analyzed using linear mixed-effects models.

RESULTS

A total of 3,954 older adults (48.6% female; mean age: 67.6 ± 5.55 years) were followed for up to 7 years. Participants with lowest walking speed have poorer episodic memory (β = -0.37; 95% CI: -0.46, -0.28), mental status (β = -0.45; 95% CI: -0.60, -0.29), and global cognition (β = -0.81; 95% CI: -1.03, -0.60) over the follow-up. Compared with the highest tertile of walking speed, the lowest walking speed was associated with a faster decline in episodic memory (β = -0.04; 95% CI: -0.07, -0.02), mental status (β = -0.04; 95% CI: -0.07, -0.01), and global cognition (β = -0.06; 95% CI: -0.11, -0.01).

CONCLUSION

Slower walking speed is associated with subsequent risk of poorer cognitive function and faster cognitive decline in older Chinese adults.

Indoor Mobility, Frailty, and Disability in Community-Dwelling Older Adults: A Mediation Model

The general population, but especially older adults, were forced or encouraged to stay home during the recent COVID-19 pandemic. In this context, indoor mobility (IM, the number of steps performed daily at home) may be informative about the general health status of older adults. The present study aimed at evaluating the relationship between IM, frailty (loss of functional reserve including both physical and psychosocial domains), and disability (loss of autonomy measured as activities of daily life, ADLs) in a sample of community-dwelling Italian older adults. Specifically, the primary objective was to investigate IM and disability differences between robust and frail older adults. The secondary objective was to test if frailty is in the causal sequence between IM and disability, i.e., as a mediator in their relationship. Thirty-two participants (mean age = 70 ± 6 years; 56.2% women) were recruited. Frailty and disability were evaluated using the Tilburg Frailty Indicator and the Groningen Activity Restriction Scale, respectively. IM at home was measured via an Adamo wristwatch (a connected accelerometer). One-way analyses of covariance, controlling for age and gender, showed that robust participants, classified according to a score higher than five points in the Tilburg Frailty Indicator, performed significantly more IM (F_1,28 = 4.639; p = 0.04) and presented lower disability grade than frail ones (F_1,28 = 4.342; p =0.046). Only physical frailty was a mediator in the relationship between IM and disability (F_2,29 = 8.538, p < 0.001), with a fully mediated model (z = -2.073, p < 0.04). Conversely, the total frailty score was not a mediator in the same relationship, but with IM accounted for the variance in disability (F_2,29 = 8.538, p < 0.001; R² = 33.7%). Our results suggested that frail older adults restricted their IM more and presented a higher level of disability compared to robust older adults. Moreover, data suggest that IM reduction may have a negative impact on physical frailty and indirectly increase disability.

Mindfulness stress-buffering model of health: implications for successful aging

OBJECTIVES

Age-related variations in emotional, physical, and cognitive health are poorly understood. This multimethod study extends previous work by investigating mechanistic models by which trait mindfulness, perceived stress, and negative affect (NA) influence health outcomes in adults aged 57-87 years old.

METHOD

In this cross-sectional study, 119 adults completed clinical interviews, cognitive and gait assessments, the Mindful Attention and Awareness Scale, Positive and Negative Affect Schedule, and Perceived Stress Scale. Gait velocity and executive function (Flanker test of inhibitory control), which are important predictors of global health and functioning in older adults, served as objective health outcome measures.

RESULTS

Correlational analyses found that trait mindfulness is positively associated with age, gait velocity, and inhibitory control and negatively associated with NA and perceived stress. NA but not perceived stress was associated with slower gait velocity. PROCESS mediation analyses suggested that those higher in trait mindfulness showed lower NA as a result of less perceived stress, while moderation analyses indicated the relationship between gait velocity and age varied by levels of trait mindfulness.

CONCLUSION

Our findings are consistent with a mindfulness stress-buffering model of health. It is plausible that trait mindfulness, which has both mediating and moderating effects on health, might help to promote more successful aging and provide resilience to age-related declines in physical health.

Higher anticholinergic burden from medications is associated with significant increase in markers of inflammation in the EPIC-Norfolk prospective population-based cohort study

BACKGROUND

Higher medication anticholinergic burden is associated with increased risk of cardiovascular disease and cognitive decline. A mechanistic pathway has not been established. We aimed to determine whether inflammation may mediate these associations.

METHODS

Participants were drawn from the European Prospective Investigation into Cancer, Norfolk cohort (40-79 years at baseline). Anticholinergic burden score (ACB) was calculated at first (1HC) (1993/97) and second (2HC) (1998/2000) health checks. Fibrinogen and C-reactive protein (CRP) were measured during 1HC and tumour necrosis factor alpha (TNF-α) and interleukin 6 (IL-6) during 2HC. Cross-sectional associations between ACB and inflammatory markers were examined for both health checks. Prospective associations were also examined between 1HC ACB and 2HC inflammatory markers. Models were adjusted for age, sex, lifestyle factors, comorbidities and medications.

RESULTS

In total, 17 678 and 22 051 participants were included in cross-sectional analyses for CRP, and fibrinogen, respectively. Furthermore, 5101 participants with data on TNF-α and IL-6 were included in the prospective analyses. Cross-sectionally, compared to ACB = 0, ACB ≥ 4 was associated with higher fibrinogen, beta (95% confidence interval) = 0.134 g/L (0.070, 0.199), CRP 1.175 mg/L (0.715, 1.634), IL-6 0.593 pg/mL (0.254, 0.932) and TNF-α 0.137 pg/mL (0.033, 0.241). In addition, a point increase in ACB was associated with higher levels of all markers. Prospectively, compared to ACB = 0, ACB ≥ 4 was associated with higher IL-6(pg/mL) of 0.019 (-0.323, 0.361) and TNF-α (pg/mL) of 0.202% (0.81, 0.323). A unit increase in ACB was associated with a significantly higher TNF-α and IL-6.

CONCLUSION

Higher ACB was associated with higher inflammatory markers. Inflammation may mediate the relationship between anticholinergic medications and adverse outcomes.

Prevalence and Correlates of Motoric Cognitive Risk Syndrome in Chinese Community-Dwelling Older Adults

Background: Motoric cognitive risk (MCR) syndrome is considered to be a pre-dementia syndrome. Although an increasing number of studies have begun to focus on this syndrome, few investigations have been launched in China. This study was performed to examine the prevalence and correlates of MCR in China.

Methods: We included 5,725 adults aged over 60 years from China Health and Retirement Longitudinal Study (CHARLS). MCR was defined as the presence of subjective cognitive complaints and a gait speed ≤20th percentile of the weighted population distribution adjusted for sex and height. The associations among selected modifiable associated factors and clinical measures with MCR were examined using multivariate logistic regression analysis.

Results: Of the participants, 414 met the criteria for MCR with an overall prevalence 7.29% (95% CI: 6.62–7.96%). MCR was found to be more prevalent among women than men (9.73 vs 4.85%), and more prevalent among participants ≥75 years than those &lt;75 years (7.85 vs 5.23%). After multivariable adjustment, lower or upper extremity functional limitations, activities of daily living (ADL) disabilities, weak grip strength, exhaustion, and history of hypertension were found to be significantly associated with MCR. The multivariate analysis also showed higher levels of cystatin C and C-reactive protein were associated with increased odds for MCR.

Conclusions: The present study showed that MCR syndrome is highly prevalent among Chinese community-dwelling older adults, and revealed several factors that were correlated with MCR. Longitudinal studies are warranted to further explore the modifiable risk factors of MCR.

Gait Speed and Sleep Duration Is Associated with Increased Risk of MCI in Older Community-Dwelling Adults

This study aimed to examine the linear and nonlinear associations between sleep duration and gait speed and the risk of developing mild cognitive impairment (MCI) in community-dwelling older adults. Participants were 233 older adults who met the study inclusion criteria. The MCI diagnosis was based on medical evaluations through a clinical interview conducted by a dementia specialist. Self-reported sleep duration was evaluated using the Pittsburgh Sleep Quality Index. The usual gait speed was calculated from the time taken to walk along a 4 m walkway. Multivariate logistic regression analysis was used to calculate the odds ratio (OR) and the 95% confidence interval (95% CI) of developing MCI in relation to sleep duration and gait speed. Generalized additive models were used to examine the dose−response relationships between sleep duration, gait speed, and the risk of developing MCI. Slower gait speed (OR: 1.84, 95%; CI: 1.00−3.13) and poor sleep duration (OR: 1.76, 95%; CI: 1.00−3.35) were associated with the risk of developing MCI, compared with their optimal status. In addition, the combination of poor sleep and slower gait was associated with a higher risk of developing MCI than optimal sleep duration and gait speed (OR: 3.13, 95%; CI: 1.93−5.14). Furthermore, gait speed and sleep duration were non-linearly associated with the risk of developing MCI. These results highlight the complex interplay and synergism between sleep duration and gait abilities on the risk of developing MCI in older adults. In addition, our results suggest that slower gait speed (<1.0 m/s) and short (<330 min) and long (>480 min) sleep duration may be linked to MCI risks through underlying pathways.

Physical decline and cognitive impairment in frail hypertensive elders during COVID-19

BACKGROUND

Hypertension is common in older adults and its incidence increases with age. We investigated the correlation between physical and cognitive impairment in older adults with frailty and hypertension.

METHODS

We recruited frail hypertensive older adults during the COVID-19 pandemic, between March 2021 and December 2021. Global cognitive function was assessed through the Montreal Cognitive Assessment (MoCA), physical frailty assessment was performed following the Fried criteria, and all patients underwent physical evaluation through 5-meter gait speed test.

RESULTS

We enrolled 203 frail hypertensive older adults and we found a significant correlation between MoCA score and gait speed test (r: 0.495; p<0.001) in our population. To evaluate the impact of comorbidities and other factors on our results, we applied a linear regression analysis with MoCA score as a dependent variable, observing a significant association with age, diabetes, chronic obstructive pulmonary disease (COPD), and gait speed test.

CONCLUSIONS

Our study revealed for the first time a significant correlation between physical and cognitive impairment in frail hypertensive elderly subjects.

The Relationships of Fibrinogen and C-Reactive Protein With Gait Performance: A 20-Year Longitudinal Study

Background

Gait speed, a central marker of aging, has been linked to various health outcomes, such as cognitive and physical functions in middle-aged adults. Although long-term systemic low-grade inflammation is considered a mechanism underlying a variety of aging-related risk factors, the longitudinal associations between inflammation markers and gait speed are yet to be fully investigated.

Objective

To explore the associations of CRP and fibrinogen levels, measured two decades ago, with gait speed among community dwelling adults, considering the contribution of cardio-metabolic factors and cognition.

Methods

Study participants took part in two phases of the of the “Kibbutzim Family Study” (i.e., Phase II, 1999–2000 and Phase III, 2017–2019). Blood samples collected in Phase II (baseline) were used to determine level of inflammatory markers. Gait speed was assessed under single-task (ST) and dual-task (DT) conditions in Phase III. Demographic, anthropometric and clinical data were collected in both phases. Linear regression models were used to assess the adjusted associations of inflammation and gait speed.

Results

A total of 373 individuals aged 34–99 (mean 64 ± 13 years) in Phase III were included in the study. Gait speed under ST was negatively associated with baseline levels of fibrinogen (b per standard deviation (SD) = −0.053, p = 0.0007) and CRP (b per SD = −0.043, p = 0.010), after adjusting for baseline and concurrent cardiometabolic risk factors. Accounting for executive functions, associations of fibrinogen with gait under ST were somewhat attenuated, yet associations remained statistically significant (p < 0.05). Associations with CRP were attenuated to the null. In contrast, there were no associations between inflammation markers and gait under DT.

Conclusion

Our findings demonstrate that in a sample including younger to older adults, higher systemic inflammatory activity was linked with gait 20 years later, beyond age and cardiometabolic health, and to a certain extent, beyond executive functions. Thus, systemic inflammation may serve as an early marker to identify individuals at risk for gait decline.

Inflammatory cytokines and sarcopenia in Iranian adults-results from SARIR study

Some studies suggested the effects of inflammatory cytokines in reducing muscle mass and muscle strength and, performance. This study aimed to compare pro-inflammatory cytokines in sarcopenic and non-sarcopenic subjects. 120 men and women were selected out from the cross-sectional study ‘sarcopenia and its determinants among Iranian elders’ (SARIR). Sarcopenia was defined based on the first ‘European Working Group on sarcopenia in older people’ (EWGSOP₁) guidelines. A fasting blood sample was taken from each participant to measure serum high-sensitivity C-reactive protein (hs-CRP), Interleukin 6 (IL-6), and tumor necrosis factor α (TNFα). A total of 120 participants were included in this study. Mean age was 66.7 ± 7.7 years and mean body mass index (BMI) was 27.3 ± 4.2 kg/m². Forty participants had the criteria of EWGSOP₁ sarcopenia. A statistically significant difference was seen between normal and abnormal groups of muscle strength in hs-CRP (P-value = 0.04). Furthermore, we did not observe any remarkable association between inflammatory biomarkers including IL-6 (OR 1.15; 95% CI 0.31–4.28), TNF-α (OR 0.68; 95% CI 0.17–2.77), and hs-CRP (OR 2.39; 95% CI 0.87–6.55) and the presence of sarcopenia even after controlling for plausible confounders. We found that inflammatory biomarkers level was not associated with odds of sarcopenia. The lack of correlation between inflammatory cytokines and sarcopenia could be due to the participants’ age and genetics. Future studies are required to confirm these findings.

Influences of dopaminergic system dysfunction on late-life depression

Deficits in cognition, reward processing, and motor function are clinical features relevant to both aging and depression. Individuals with late-life depression often show impairment across these domains, all of which are moderated by the functioning of dopaminergic circuits. As dopaminergic function declines with normal aging and increased inflammatory burden, the role of dopamine may be particularly salient for late-life depression. We review the literature examining the role of dopamine in the pathogenesis of depression, as well as how dopamine function changes with aging and is influenced by inflammation. Applying a Research Domain Criteria (RDoC) Initiative perspective, we then review work examining how dopaminergic signaling affects these domains, specifically focusing on Cognitive, Positive Valence, and Sensorimotor Systems. We propose a unified model incorporating the effects of aging and low-grade inflammation on dopaminergic functioning, with a resulting negative effect on cognition, reward processing, and motor function. Interplay between these systems may influence development of a depressive phenotype, with an initial deficit in one domain reinforcing decline in others. This model extends RDoC concepts into late-life depression while also providing opportunities for novel and personalized interventions.

Inflammatory biomarkers and motoric cognitive risk syndrome: Multicohort survey

•

Raised IL-6 and CRP levels are associated with increased odds of MCR.

•

IL-6 and CRP are involved in overlapping inflammatory, vascular, and neurological pathology.

•

Establishing these pathways can guide interventions to prevent progression of MCR to dementia.

Background

Inflammation may play a role in Motoric Cognitive Risk (MCR) syndrome, a pre-dementia syndrome comprised of slow gait and cognitive complaints. Our objective was to examine associations of inflammatory biomarkers with MCR.

Methods

We examined association of interleukin-6 (IL-6) and C-reactive protein (CRP) with prevalent MCR using logistic regression in 3,101 older adults (52% female) from five cohorts (National Center for Geriatrics & Gerontology Study of Geriatric Syndromes [NCGG-SGS], Central Control of Mobility in Aging [CCMA], Tasmanian Study of Cognition and Gait [TASCOG], LonGenity, and Einstein Aging Study [EAS]). Associations were reported as odds ratios adjusted for sex, age, education, depressive symptoms, body mass index, and vascular diseases (aOR) with 95% confidence intervals (CI). Meta-analysis and analyses stratified by vascular disease were also done.

Results

Although associations between higher (worse) CRP and IL-6 tertiles and MCR were only seen in three out of the five cohorts (EAS, TASCOG, and LonGenity), when a pooled meta-analysis was performed, a robust association was demonstrated. In meta-analysis, highest tertiles of IL-6 (aOR 1.57, 95%CI 1.01- 2.44) and CRP (aOR 1.65, 95%CI 1.09–2.48) was associated with MCR versus lowest tertiles in the pooled sample. Higher CRP was associated with MCR among those with vascular disease in TASCOG and LonGenity cohorts, and among those without vascular disease in EAS.

Conclusions

IL-6 and CRP levels are associated with MCR in older adults, and this association varies by presence of vascular disease.

Gait changes over time in hospitalized older adults with advanced dementia: Predictors of mobility change

People with dementia are at risk of mobility decline. In this study, we measured changes in quantitative gait measures over a maximum 10-week period during the course of a psychogeriatric admission in older adults with dementia, with the aims to describe mobility changes over the duration of the admission, and to determine which factors were associated with this change. Fifty-four individuals admitted to a specialized dementia inpatient unit participated in this study. A vision-based markerless motion capture system was used to record participants' natural gait. Mixed effect models were developed with gait measures as the dependent variables and clinical and demographic variables as predictors. We found that gait stability, step time, and step length decreased, and step time variability and step length variability increased over 10 weeks. Gait stability of men decreased more than that of women, associated with an increased sacrum mediolateral range of motion over time. In addition, the sacrum mediolateral range of motion decreased in those with mild neuropsychiatric symptoms over 10 weeks, but increased in those with more severe neuropsychiatric symptoms. Our study provides evidence of worsening of gait mechanics and control over the course of a hospitalization in older adults with dementia. Quantitative gait monitoring in hospital environments may provide opportunities to intervene to prevent adverse events, decelerate mobility decline, and monitor rehabilitation outcomes.

High Sensory Responsiveness in Older Adults is Associated with Walking Outside but Not Inside: Proof of Concept Study

Background and Purpose

Reduced mobility and a higher risk of falls among older adults are related to aging-associated sensory alteration. Sensory responsiveness (SR) has been found to be strongly correlated with postural control in studies on young adults in stimulating environments; however, SR has not been studied in the context of mobility among older adults, despite its potential to enhance fall risks. The aim of the current study is to characterize the associations between SR and gait under single and dual-task (ST, DT) conditions inside and outside the laboratory.

Methods

Twenty-six community-dwelling older adults (age 70.3 ± 4.6 years, 65.4% women) participated in this cross-sectional study. Gait variables were measured using the APDM system under single and dual task conditions, in a quiet corridor inside and in an ecological (outside) environment. SR was evaluated using the SR questionnaire and cognition was assessed with the Trail-Making Test and the Montreal Cognitive Assessment.

Results

SR was negatively associated with gait speed during ST (r_s = −0.491, p < 0.05) and DT (r_s = −0.528, p < 0.01) outside and with ST gait speed inside (r_s = −0.528, p < 0.01). SR was positively associated with gait variability under DT (r_s = 0.41, p < 0.05) and with DT cost (r_s = 0.44, p < 0.05) only outside.

Conclusion

SR may play an important role in understanding mobility deterioration throughout the aging process, especially outside, illuminating the importance of SR evaluation among older adults during mobility assessment. Therefore, accounting for SR in gait research may contribute to a better understanding of mobility decline throughout the aging process.

Associations Between Neurochemistry and Gait Performance Following Concussion in Collegiate Athletes

OBJECTIVE

To evaluate the strength of associations between single-task and dual-task gait measures and posterior cingulate gyrus (PCG) neurochemicals in acutely concussed collegiate athletes.

SETTING

Participants were recruited from an NCAA Division 1 University.

PARTICIPANTS

Nineteen collegiate athletes acutely (<4 days) following sports-related concussion.

DESIGN

We acquired magnetic resonance spectroscopy (MRS) in the PCG and gait performance measurements in the participants, acutely following concussion. Linear mixed-effects models were constructed to measure the effect of gait performance, in the single- and dual-task settings, and sex on the 6 neurochemicals quantified with MRS in mmol. Correlation coefficients were also calculated to determine the direction and strength of the relationship between MRS neurochemicals and gait performance, postconcussion symptom score, and number of previous concussions.

MAIN MEASURES

Average gait speed, average cadence, N-acetyl aspartate, choline, myo-inositol, glutathione, glutamate plus glutamine, and creatine.

RESULTS

Single-task gait speed (P = .0056) and cadence (P = .0065) had significant effects on myo-inositol concentrations in the PCG, independent of sex, in concussed collegiate athletes. Single-task cadence (P = .047) also had a significant effect on glutathione in the PCG. No significant effects were observed between dual-task gait performance and PCG neurochemistry.

CONCLUSIONS

These findings indicate that increased concentrations of neuroinflammatory markers in the PCG are associated with slower single-task gait performance within 4 days of sports-related concussion.

Elevated IL-6 and CRP levels are associated with incident self-reported major mobility disability: A pooled analysis of older adults with slow gait speed

BACKGROUND

Elevated Interleukine-6 (IL-6) and C-reactive protein (CRP) are associated with aging-related reductions in physical function, but little is known about their independent and combined relationships with major mobility disability (MMD), defined as the self-reported inability to walk a quarter-mile.

METHODS

We estimated the absolute and relative effect of elevated baseline IL-6, CRP, and their combination on self-reported MMD risk among older adults (≥68 years; 59% female) with slow gait speed (<1.0m/s). Participants were MMD-free at baseline. IL-6 and CRP were assessed using a central laboratory. The study combined a cohort of community dwelling high-functioning older adults (Health ABC) with two trials of low-functioning adults at risk of MMD (LIFE-P, LIFE). Analyses utilized Poisson regression for absolute MMD incidence and proportional hazards models for relative risk.

RESULTS

We found higher MMD risk per unit increase in log IL-6 [HR=1.26 (95% CI 1.13 to 1.41)]. IL-6 meeting pre-determined threshold considered to be high (>2.5 pg/mL) was similarly associated with higher risk of MMD [HR=1.31 (95% CI: 1.12 to 1.54)]. Elevated CRP (CRP >3.0 mg/L) was also associated with increased MMD risk [HR=1.38 (95% CI: 1.10 to 1.74)]. The CRP effect was more pronounced among participants with elevated IL-6 [HR=1.62 (95% CI: 1.12 to 2.33)] compared to lower IL-6 levels [HR=1.19 (95% CI: 0.85 to 1.66)].

CONCLUSIONS

High baseline IL-6 and CRP were associated with increased risk of MMD among older adults with slow gait speed. A combined biomarker model suggests CRP was associated with MMD when IL-6 was elevated.

Gait strategy and body composition in patients with Prader-Willi syndrome

PURPOSE

Individuals with Prader-Willi syndrome (PWS) exhibit reduced lean body mass and increased fat-lean mass ratio when compared with individuals of normal weight and obese ones. Thus, research on the association of functional limitations during gait and body composition may be of great importance from a rehabilitative viewpoint. In particular, the aim of this study was to compare the gait profile of persons with PWS to that of unaffected individuals and to see if a relationship exists between gait profile and body composition in individuals with PWS.

METHODS

Eighteen individuals with PWS and 20 unaffected individuals (Healthy Group: HG) were assessed. Their gait pattern was quantified with 3D-Gait Analysis (3D-GA). Overall body weight, lean and fat masses were measured by dual-energy X-ray absorptiometry.

RESULTS

Individuals with PWS were found to be characterized by a significantly different (p < 0.05) gait pattern with respect to healthy controls in terms of both kinematic and kinetic parameters. No correlations were found between kinematic parameters and overall mass and lean/fat mass, while some parameters associated with ground reaction force were found to be significantly correlated with overall mass, lean mass and fat mass. Significant regression models were obtained, including impact and propulsive force and loading rate.

CONCLUSION

Our data suggest that in individuals with PWS, gait is influenced by the overall and lean body mass. Thus, therapeutic strategies should target both weight reduction and lean mass increase to optimize gait, minimize articular stress, and reduce the risk of repetitive strain on the lower limbs.

LEVEL OF EVIDENCE

Level III: Case-control analytic study.

Why Do They Fall? The Impact of Insomnia on Gait of Older Adults: A Case-Control Study

STUDY OBJECTIVES

To compare gait and cognitive performance conducted separately as a single- (ST) and simultaneously as a dual-task (DT), ie, when a cognitive task was added, among community-dwelling older adults with and without insomnia.

METHODS

Participants included: 39 (28 females) community-dwelling older adults with insomnia, 34 (21 females) controls without insomnia. Subject groups were matched for age, gender, and education. Sleep quality was evaluated based on two-week actigraphy. Gait speed and cognition were assessed as ST and DT performance. DT costs (DTCs) were calculated for both tasks. Outcomes were compared via independent samples t-tests or Mann-Whitney U-tests.

RESULTS

Older adults with insomnia demonstrated significantly slower gait speed during ST (1 ± 0.29 vs 1.27 ± 0.17 m/s, p<0.001) and DT (0.77 ± 0.26 vs 1.14 ± 0.20 m/s, p<0.001) and fewer correct responses in the cognitive task during ST (21 ± 7 vs 27 ± 11, p=0.009) and DT (19 ± 7 vs 23 ± 9, p=0.015) compared to control group. DTC for the gait task was higher among older adults with insomnia (18.32%, IQR: 9.48-30.93 vs 7.81% IQR: 4.43-14.82, p<0.001). However, no significant difference was observed in DTC for the cognitive task (14.71%, IQR: -0.89-38.84 vs 15%, IQR: -0.89-38.84%, p=0.599).

CONCLUSION

Older adults with insomnia have lower gait speed and poorer cognitive performance during ST and DT and an inefficient pattern of task prioritization during walking, compared to counterparts without insomnia. These findings may explain the higher risk of falls among older adults with insomnia. Geriatric professionals should be aware of potential interrelationships between sleep and gait.

Changes in Physical Functioning as Short-Term Predictors of Mortality

OBJECTIVES

Both performance-based and self-reported measures of physical functioning are predictors of mortality. There has been relatively little research examining whether their changes predict mortality. This study examines whether 5-year changes in performance-based and self-reported measures of functioning predict subsequent mortality.

METHOD

Data are from the 2006 wave of the Social Environment and Biomarkers of Aging Study, 2011 wave of the Taiwan Longitudinal Study of Aging, and mortality follow-up through 2015. Gompertz proportional hazard models predict mortality from changes in ability to complete performance-based tests and changes in performance-based and self-reported functioning.

RESULTS

Incident inability to complete at least one performance-based test of functioning is associated with twice the risk of subsequent 4-year mortality. Conditional on the baseline measurement, a one standard deviation (SD) decline in grip strength is associated with a 61% increased risk of 4-year mortality; a one-SD decline in walking speed and a one-SD increase in self-reported limitations are both associated with around a 40% increased risk of 4-year mortality. Conditional on the most recent measurement of functioning, prior change is not significantly associated with subsequent mortality.

DISCUSSION

Repeated measures of performance-based and self-reported functioning are valuable in that they provide an updated measurement of functioning.

Frailty and Risk of Incident Motoric Cognitive Risk Syndrome

BACKGROUND

Frailty is highly prevalent among older adults, and associated with cognitive decline. Relationship between frailty and motoric cognitive risk syndrome (MCR), a pre-dementia syndrome characterized by the presence of subjective cognitive complaints and slow gait, is yet to be elucidated.

OBJECTIVE

To examine whether frailty increases the risk of developing incident MCR.

METHODS

We analyzed 641 adults, aged 65 and above, participating in the LonGenity study. Frailty was defined using a 41-point cumulative deficit frailty index (FI). MCR was diagnosed at baseline and annual follow-up visits using established criteria. Cox proportional hazard models were used to study the association of baseline frailty with incident MCR, and reported as hazard ratio (HR) with 95% confidence intervals (CI) adjusted for age, sex, and education.

RESULTS

At baseline, 70 participants (10·9%) had prevalent MCR. Of the remaining 571 non-MCR participants (mean age 75.0, 57.3% women), 70 developed incident MCR (median follow-up 2.6 years). Higher frailty scores at baseline were associated with an increased risk of incident MCR (HR for each 0.01 increase in the FI: 1.07; 95% CI 1.03-1.11; p = 0.0002). The result was unchanged even after excluding mobility related or chronic illnesses items from the FI as well as accounting for reverse causation, competing risk of death, baseline cognitive status, social vulnerability, and excluding participants with mild cognitive impairment syndrome.

CONCLUSIONS

Higher levels of frailty increase risk for developing MCR and suggest shared mechanisms. This association merits further study to identify strategies to prevent cognitive decline.

Association between handgrip strength and the risk of new-onset metabolic syndrome: a population-based cohort study

OBJECTIVES

A lower relative handgrip strength (HGS) may disrupt metabolic homeostasis and then lead to metabolic syndrome (MetS). There is a paucity of longitudinal studies to examine whether relative HGS at baseline is linked to incident MetS. Thus, the purpose of the present study was to explore the association between relative HGS and new-onset MetS.

DESIGN

This is an observational and longitudinal research.A nationally representative sample of population in China.

PARTICIPANTS

A total of 3350 subjects without MetS were selected for analysis in the present study. Data are from the China Health and Retirement Longitudinal Study (2011-2015).

OUTCOME MEASURES

We calculated the relative HGS by dividing the HGS by body weight. Participants were divided into gender-specific quartiles. We estimated HRs for MetS and its components using Cox proportional hazard models according to the relative HGS categories.

RESULTS

After multiple adjustment, the risk of MetS increased with the lower quartile of relative HGS in both sexes. Using the highest quartile (Q4) as a reference, the HR for quartile Q3-1 was 1.49 (0.95, 2.34), 1.67 (1.08, 2.59) and 1.76 (1.12, 2.78), respectively, in men, and 1.14 (0.82, 1.58), 1.30 (1.02, 1.57) and 1.28 (1.03, 1.55), respectively, in women. Additionally, we observed that relative HGS was negatively or inversely associated with the risk of abdominal obesity in both sexes.

CONCLUSIONS

The current study demonstrated that relative HGS was inversely and independently associated with an increased risk of MetS and abdominal obesity, suggesting a possible role of relative HGS as a useful and simple index for muscle strength in the prediction of occurrence of MetS.

Are body fat and inflammatory markers independently associated with age-related muscle changes?

BACKGROUND & AIMS

A growing number of studies have shown that body fat and inflammation are associated with age-related changes in body muscle composition. However, most of these studies did not control for potential confounders. The aim was to determine whether there is an association between body fat and inflammatory cytokines with muscle mass/strength decline in community-dwelling older adults.

METHODS

Anthropometric, physical and functionality variables were collected. Nutritional status was assessed by the MNA form. Dynapenia was assessed with handgrip strength on the dominant hand using a dynamometer. Sarcopenia was determined using adapted criteria from the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Inflammatory cytokines were evaluated in plasma using a multiplex assay. Associations to muscle mass/strength decline were analyzed using a multinominal logistic regression, adjusted for potential confounders.

RESULTS

We recruited a convenience sample of 311 adults aged 60 years or older. Most of subjects were sufficiently active females with a median age of 68 years (interquartile range [IQR], 64-74 years), whereas about a half (46.3%) were at risk of malnutrition. The prevalence of dynapenia was 38.3%, whereas sarcopenia was 13.2%. After controlling for potential confounders, we found that relative fat mass index is independently associated with sarcopenia. Loss of strength was independently associated only with female sex, lower physical activity, worse nutrition and IL-10/TNF-α ratio, whereas female sex, an insufficiently active lifestyle and relative fat mass index were the key determinants of sarcopenia.

CONCLUSIONS

These findings highlight the importance of physical activity and healthy diet as effective interventions to prevent muscle mass/strength decline, and points to IL-10/TNF-α ratio and body fat as independently associated factors for dynapenia and sarcopenia, respectively.

Mortality Risk Among Older People Who Did Versus Did Not Sustain a Fracture: Baseline Prefracture Strength and Gait Speed as Predictors in a 15-Year Follow-Up

BACKGROUND

Physiological reserve, as indicated by muscle strength and gait speed, may be especially determinant of survival in people who are exposed to a health stressor. We studied whether the association between strength/speed and mortality risk would be stronger in the time period after a fracture compared to other time periods.

METHODS

Participants were population-based sample of 157 men and 325 women aged 75 and 80 years at baseline. Maximal 10-m gait speed and maximal isometric grip and knee extension strength were tested at the baseline before the fracture. Subsequent fracture incidence and mortality were followed up for 15 years. Cox regression analysis was used to estimate fracture time-stratified effects of gait speed and muscle strength on mortality risk in three states: (i) nonfracture state, (ii) the first postfracture year, and (iii) after the first postfracture year until death/end of follow-up.

RESULTS

During the follow-up, 20% of the men and 44% of the women sustained a fracture. In both sexes, lower gait speed and in women lower knee extension strength was associated with increased mortality risk in the nonfracture state. During the first postfracture year, the mortality risk associated with slower gait and lower strength was increased and higher than in the nonfracture state. After the first postfracture year, mortality risk associated with lower gait speed and muscle strength attenuated.

CONCLUSIONS

Lower gait speed and muscle strength were more strongly associated with mortality risk after fracture than during nonfracture time, which may indicate decreased likelihood of recovery.

Dietary Inflammatory Index and the Risk of Frailty Among Older Adults: A Systematic Review and Meta-Analysis

A systematic review and meta-analysis was conducted to comprehensively examine the association between Dietary Inflammatory Index (DII®) score and risk of frailty. Frailty risk were available from five studies comprising 13,908 older adults. Furthermore, frailty related parameters were extacted from two studies with 7,539 individuals. A pooled adjusted odds ratio analysis indicated that there was an association between DII® score and frailty risk (OR = 1.24, 95%CI: 1.6-1.33, P < 0.001, I² = 0.0%). The results of frailty related parameters demonstrated that DII® score was associated with weakness risk (OR = 1.12, 95%CI: 1.05-1.19, P = 0.014, I² = 0.0%), but not other frailty-related parameters including exhaustion, low BMI or low physical activity. The results of this meta-analysis suggest that older adults who exhibit higher DII® scores have an increased frailty risk. Further prospective cohort studies with longer follow-up periods, are needed to support this possible association between DII® score and frailty risk.

Physical activity and exercise: Strategies to manage frailty

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.