Reliability and Precision of the Nana Protocol to Assess Body Composition Using Dual Energy X-Ray Absorptiometry

Reliability of Multifrequency Bioelectrical Impedance Analysis to Quantify Body Composition in Patients After Musculoskeletal Trauma

BACKGROUND

Changes in body composition, especially loss of lean mass, commonly occur in the orthopedic trauma population due to physical inactivity and inadequate nutrition. The purpose of this study was to assess inter-rater and intra-rater reliability of a portable bioelectrical impedance analysis (BIA) device to measure body composition in an orthopedic trauma population after operative fracture fixation. BIA uses a weak electric current to measure impedance (resistance) in the body and uses this to calculate the components of body composition using extensively studied formulas.

METHODS

Twenty subjects were enrolled, up to 72 hours after operative fixation of musculoskeletal injuries and underwent body composition measurements by two independent raters. One measurement was obtained by each rater at the time of enrollment and again between 1-4 hours after the initial measurement. Reliability was assessed using intraclass correlation coefficients (ICC) and minimum detectable change (MDC) values were calculated from these results.

RESULTS

Inter-rater reliability was excellent with ICC values for body fat mass (BFM), lean body mass (LBM), skeletal muscle mass (SMM), dry lean mass (DLM), and percent body fat (PBF) of 0.993, 0.984, 0.984, 0.979, and 0.986 respectively. Intra-rater reliability was also high for BFM, LBM, SMM, DLM, and PBF, at 0.994, 0.989, 0.990, 0.983, 0.987 (rater 1) and 0.994, 0.988, 0.989, 0.985, 0.989 (rater 2). MDC values were calculated to be 4.05 kg for BFM, 4.10 kg for LBM, 2.45 kg for SMM, 1.21 kg for DLM, and 4.83% for PBF.

CONCLUSION

Portable BIA devices are a versatile and attractive option that can reliably be used to assess body composition and changes in lean body mass in the orthopedic trauma population for both research and clinical endeavors. Level of Evidence: III.

Effects of supervised high-intensity hardstyle kettlebell training on grip strength and health-related physical fitness in insufficiently active older adults: the BELL pragmatic controlled trial

The Ballistic Exercise of the Lower Limb (BELL) trial examined the efficacy and safety of a pragmatic hardstyle kettlebell training program in older adults. Insufficiently active men and women aged 59–79 years, were recruited to a 6-month repeated measures study, involving 3-months usual activity and 3-months progressive hardstyle kettlebell training. Health-related physical fitness outcomes included: grip strength [GS], 6-min walk distance [6MWD], resting heart rate [HR], stair-climb [SC], leg extensor strength [LES], hip extensor strength [HES], Sit-To-Stand [STS], vertical jump [CMVJ], five-times floor transfer [5xFT], 1RM deadlift, body composition (DXA), attendance, and adverse events. Sixteen males (68.8 ± 4.6 yrs, 176.2 ± 7.8 cm, 90.7 ± 11.0 kg, 29.2 ± 2.6 kg/m²) and sixteen females (68.6 ± 4.7 yrs, 163.9 ± 5.4 cm, 70.4 ± 12.7 kg, 26.3 ± 4.9 kg/m²) were recruited. Compliance with the supervised exercise program was very high (91.5%). Kettlebell training increased GS (R: MD = 7.1 kg 95% CI [4.9, 9.3], L: MD = 6.3 kg 95% CI [4.1, 8.4]), 6MWD (41.7 m, 95% CI [17.9, 65.5]), 1RM (16.2 kg, 95% CI [2.4, 30.0]), 30 s STS (3.3 reps, 95% CI [0.9, 5.7]), LES (R: MD = 61.6 N, 95% CI [4.4, 118.8]), HES (L: MD = 21.0 N,95% CI [4.2,37.8]), appendicular skeletal lean mass (MD = 0.65 kg, 95% CI [0.08, 1.22]), self-reported health change (17.1%, 95% CI [4.4, 29.8]) and decreased SC time (2.7 s, 95% CI [0.2, 5.2]), 5xFT time (6.0 s, 95% CI [2.2, 9.8]) and resting HR (7.4 bpm, 95% CI [0.7, 14.1]). There were four non-serious adverse events. Mean individual training load for group training sessions during the trial was 100,977 ± 9,050 kg. High-intensity hardstyle kettlebell training was well tolerated and improved grip strength and measures of health-related physical fitness in insufficiently active older adults.

Trial registration: Prospectively registered: 20/08/2019, Australian New Zealand Clinical Trials Registry (ACTRN12619001177145).

Bone health of middle-aged and older surfers

Purpose

Given the lack of research investigating surfing and bone health, we aimed to assess the bone mineral density (BMD) of middle-aged and older surfers.

Patients and methods

In a cross-sectional observational design, we compared a group of middle-aged and older surfers to a group of non-surfers, age- and sex-matched controls. Participants were males, aged between 50 and 75 years. Volunteers were assessed for body mass index, bone-specific physical activity questionnaire (BPAQ) scores, daily calcium intake, and alcohol intake. Primary outcomes included BMD at the femur and lumbar spine (LS), and T-score, assessed via dual-energy X-ray absorptiometry. Bone biomarkers were also analyzed.

Results

A total of 104 participants (59 surfers and 45 controls) were assessed. Groups were similar with regards to all demographic characteristics except for percentage of lean mass (higher in surfers, mean difference [MD] +2.57%; 95% CI 0.05–5.09; p=0.046) and current BPAQ score (lower in surfers; MD −0.967; 95% CI −0.395 to −1.539; p=0.001). Surfers had a mean surfing experience of 41.2 (SD ±11.8) years and mean surfing exposure of 26.9 (SD ±15.0) hours/month. Controls were divided into two groups, according to their main physical activity: weight-bearing/high intensity (WBHI) and non-weight-bearing/low intensity (NWBLI). When compared to NWBLI controls, surfers had higher LS BMD (MD +0.064; 95% CI 0.002–0.126; p=0.041) and higher T-score (MD +0.40; 95% CI 0.01–0.80; p=0.042); however, surfers had a lower T-score than the WBHI group (MD −0.52; 95% CI −0.02 to −1.0; p=0.039). No other differences were found between groups.

Conclusion

The findings of this study support our hypothesis that regular surfing may be an effective physical activity for middle-aged and older men to decrease bone deterioration related to aging, as we identified positive results for surfers in relation to primary outcomes.

Whole-body dual-energy X-ray absorptiometry demonstrates better reliability than segmental body composition analysis in college-aged students

Dual-energy X-ray absorptiometry (DXA) is rapidly becoming more accessible and popular as a technique to monitor body composition. The reliability of DXA has been examined extensively using a number of different methodological approaches. This study sets up to investigate the accuracy of measuring the parameters of body composition (BC) by means of the whole-body and the segmental DXA method analysis with the typical error of measurement (TEM) that allows for expressing the error in the units of measure. The research was implemented in a group of 63 participants, all of whom were university students. Thirty-eight males (22.6±2.9 years, average body mass 77.5±8.4 kg) and 25 females (21.4±2.0 years, average body mass 58.6±7.2 kg) were recruited. The measured parameters included body mass (BM), fat-free mass (FFM), body fat (BF), bone mineral content (BMC), bone mineral density (BMD). For the whole-body analysis, the determined TEM was: BM at the level of 0.12 kg in females and 0.29 kg in males; BF 0.25kg and 0.44% females, 0.52 kg and 0.66% males; FFM 0.24 kg females and 0.42 kg males; BMC 0.02 kg females and males; BMD 0.01g/cm2 females and males. The TEM values in the segmental analysis were: BF within the range of 0.04-0.28 kg and 0.68-1.20% in females, 0.10-0.36 kg and 0.72-1.94% in males; FFM 0.08-0.41 kg females and 0.17-0.86 males, BMC 0.00-0.02 kg females and 0.01-0.02 kg males in relation to the body segment (upper limb, trunk, lower limb). The BMD value was at the level of 0.01-0.02g/cm2. The study results showed high reliability in measuring body composition parameters using the DXA method. The whole-body analysis showed a higher accuracy of measurement than the segmental. Only the changes that are greater than the TEM, or the upper bound (95%) of the confidence interval of the measurement can be considered demonstrable when interpreting repeated measurements.