The interrelationship between physical exercise, muscle strength and body adiposity in a healthy elderly population

Nasogastric Tube Feeding in Older Patients: A Review of Current Practice and Challenges Faced

Nasogastric tube feeding is an essential way of delivering enteral nutrition when the oral route is insufficient or unsafe. Malnutrition is recognised as a reversible factor for sarcopenia and frailty. It is therefore crucial that malnutrition is treated in older inpatients who have dysphagia and require enteral nutrition. Despite five National Patient Safety Alerts since 2005, “Never Events” related to nasogastric feeding persist. In addition to placement errors, current practice often leads to delays in feeding, which subsequently result in worse patient outcomes. It is crucial that tube placement is confirmed accurately and in a timely way. Medical advancements in this area have been slow to find a solution which meets this need. In this paper, we provide an updated review on the current use of feeding nasogastric tubes in the older population, the issues associated with confirming correct placement, and innovative solutions for improving safety and outcomes in older patients.

Effects of physical activity on strength and skeletal muscle fat infiltration in older adults: a randomized controlled trial

Considerable evidence suggests that the loss of strength and muscle mass appear to be inevitable consequences of aging. Moreover, aging is associated with an increase in body fat. This study examined whether increased physical activity could prevent or reverse the losses of strength and skeletal muscle mass as well as the gain in fat in older adults. Eleven men and 31 women completed a randomized trial consisting of either a physical activity (PA; n = 22) or successful aging health educational control (SA; n = 20) group. Isokinetic knee extensor strength and computed tomography-derived midthigh skeletal muscle and adipose tissue cross-sectional areas (CSA) were assessed at baseline and at 12 mo following randomization. Total body weight and muscle CSA decreased in both groups, but these losses were not different between groups. Strength adjusted for muscle mass decreased (-20.1 +/- 9.3%, P < 0.05) in SA. The loss of strength was completely prevented in PA (+2.5 +/- 8.3%). In addition, there was a significant increase (18.4 +/- 6.0%) in muscle fat infiltration in SA, but this gain was nearly completely prevented in PA (2.3 +/- 5.7%). In conclusion, regular physical activity prevents both the age-associated loss of muscle strength and increase in muscle fat infiltration in older adults with moderate functional limitations.

Management of Obesity in the Elderly

Over the last few decades, there has been an unprecedented increase in the prevalence of obesity, especially in economically developed countries. Furthermore, it is becoming an increasingly recognized health problem in the elderly. The precise mechanisms underlying increased adiposity in the elderly are not known. Aging is associated with a host of biologic changes that limit the ability of the individual to regulate energy homeostasis. Thus, it is likely that older individuals may be more likely to develop the two extremes of the spectrum of nutritional abnormalities, namely malnutrition and increased adiposity. These nutritional abnormalities are associated with significant morbidity and mortality. Current guidelines define overweight as a body mass index (BMI) of 25-29.9 kg/m2 and obesity as a BMI of 30 kg/m2 or more. However, the optimal BMI may be different in older individuals. Management strategies should attempt to optimize the nutritional status of older individuals. Age per se cannot be used as a justification for denying medical management of obesity to elderly individuals. Individualized programs with the goal of achieving modest weight reduction in obese patients are likely to result in immediate (e.g. alleviation of arthritic pains and reduction of glucose intolerance) and possibly long-term (e.g. reduction in cardiovascular risk) healthcare benefits. Management should emphasize lifestyle modifications, while the use of pharmacologic agents such as sibutramine and orlistat should be reserved for select groups of patients who do not respond to lifestyle modification.

Facilitators and barriers to elders' practice of t'ai chi. A mind-body, low-intensity exercise

Research has documented the positive effects that t'ai chi has on the well-being of elders. However, the reasons that elders practice t'ai chi have not been explored. The purpose of this study was to describe the facilitators and barriers to t'ai chi practice in elderly populations. Taiwanese community-dwelling elders (40 of whom practiced t'ai chi and 40 who did not) aged 65 and older, matched on age and gender, were interviewed. Results showed that encouragement from others was the most important factor for elders to practice t'ai chi, whereas positive health outcomes were the reason they continued to practice it. Most of the non-t'ai chi group participants had never thought about practicing t'ai chi because they felt they were too weak to practice. Because t'ai chi can be helpful in promoting the well-being of elders, it is essential for health care professionals to overcome the barriers to its uses in elderly populations.

Effects of strength training on cardiovascular responses during a submaximal walk and a weight-loaded walking test in older females

PURPOSE

The purpose of this study was to examine the effects of a total body strength training program on oxygen uptake (VO2), heart rate (HR), systolic blood pressure (SBP), and rate pressure product (RPP) during a submaximal walk and a weight-loaded walking test in healthy women 60-77 years old.

METHODS

The submaximal walk (2 mph and 3.5% grade) took place during stage 3 of a graded exercise test. The weight-loaded walking task consisted of treadmill walking at 2 mph while carrying a box weighing 40% of maximum isometric elbow flexion strength. The women strength trained three times per week for approximately 1 hour per session for 16 weeks.

RESULTS

Paired t tests determined that strength increased by 57% on six isotonic strength tests (one repetition maximum) and by 29% on two isometric strength tests. A repeated measures analysis of variance (ANOVA) was used to determine the pre- to post-differences between and within the two tests (alpha = 0.05). There was no change in VO2 but HR, SBP, and RPP decreased significantly during the submaximal walk and the weight-loaded walking test. However, average HR (135 to 120 bpm) and RPP (23.3 x 10(3) to 19.3 x 10(3)) decreased more during the weight-loaded walking test than during the submaximal walk (HR: 108 to 104 bpm; RPP 18.3 x 10(3) to 17.0 x 10(3)).

CONCLUSIONS

In conclusion, the reduced HR, SBP, and RPP indicates that strength training may reduce cardiovascular stress during daily tasks in healthy older women.