A machine learning approach to identify important variables for distinguishing between fallers and non-fallers in older women

Falls are a significant ongoing public health concern for older adults. At present, few studies have concurrently explored the influence of multiple measures when seeking to determine which variables are most predictive of fall risks. As such, this cross-sectional study aimed to identify those functional variables (i.e. balance, gait and clinical measures) and physical characteristics (i.e. strength and body composition) that could best distinguish between older female fallers and non-fallers, using a machine learning approach. Overall, 60 community-dwelling older women (≥65 years), retrospectively classified as fallers (n = 21) or non-fallers (n = 39), attended three data collection sessions. Data (281 variables) collected from tests in five separate domains (balance, gait, clinical measures, strength and body composition) were analysed using random forest (RF) and leave-one-variable-out partial least squares correlation analysis (LOVO PLSCA) to assess variable importance. The strongest discriminators from each domain were then aggregated into a multi-domain dataset, and RF, LOVO PLSCA, and logistic regression models were constructed to identify the important variables in distinguishing between fallers and non-fallers. These models were used to classify participants as either fallers or non-fallers, with their performance evaluated using receiver operating characteristic (ROC) analysis. The study found that it is possible to classify fallers and non-fallers with a high degree of accuracy (e.g. logistic regression: sensitivity = 90%; specificity = 87%; AUC = 0.92; leave-one-out cross-validation accuracy = 63%) using a combination of 18 variables from four domains, with the gait and strength domains being particularly informative for screening programmes aimed at assessing falls risk.

Isokinetic Dynamometer Leg Extensor Peak Torque Measurement: A Time-Delayed Reliability and Score Selection Analysis Study

The reliability of isokinetic peak torque (PT) has been reported mostly using a short-term (<~10 day) inter-trial testing time frame. However, many studies and programs utilize a long-term (several weeks to months) inter-trial testing period. Additionally, the methods by which the PT value is selected and reported from a multiple rep testing scheme have not been well investigated for both reliability and PT absolute performance comparisons. The purpose of this study was to investigate the long-term reliability of isokinetic and isometric PT of the leg extensors with an emphasis on the differences among several PT score selection methods. Thirteen men and women (age = 19.5 years) underwent two testing trials separated by 28.8 (±1.8) days. Testing included maximal voluntary contractions of three sets of three reps for two isokinetic contraction conditions of 60 (Isok60) and 240 (Isok240) deg/s velocities, and three sets of one rep of isometric contractions for the leg extensors. The PT score was derived from seven different methods (see text for descriptions). Reliability as assessed from intraclass correlation coefficients (ICCs) varied widely across contraction conditions and PT score selection parameters. The Isok60 velocity overall had lower reliability (ICCs = 0.48-0.81) than Isok240 (0.77-0.87) across the conditions whereas the isometric PT variables showed moderate reliability (0.71-0.73). Overall the set 1 PT score selection parameters were generally lower (p ≤ 0.05) than those that involved sets two and three. Systematic error (p ≤ 0.05) was shown for 6 out of the 17 PT selection variables. On a subjective interpretation basis, when taking everything into account the best overall combination of time/trial efficiency, reliability, best/highest PT score parameter, and reduced risk of systematic bias appears to be the PT variable that uses the average of the highest two reps of the first two sets of three reps-i.e., averaging the highest two values of the six total reps from the first two sets.

Cathepsin B and Muscular Strength are Independently Associated with Cognitive Control

Although muscular strength has been linked to greater cognitive function across different cognitive domains, the mechanism(s) through which this occurs remain(s) poorly understood. Indeed, while an emerging body of literature suggests peripheral myokines released from muscular contractions may play a role in this relationship, additional research is needed to understand this link. Accordingly, this study sought to compare the influences of a particular myokine, Cathepsin B (CTSB), and muscular strength on hippocampal-dependent relational memory and cognitive control in 40 adults (age = 50.0±7.3 yrs). Overnight fasted venous blood draws were taken to assess plasma CTSB and muscular strength was assessed as maximal isokinetic strength testing using a Biodex dynamometer. Cognitive performance was assessed using a Spatial Reconstruction Task to assess relational memory and a modified Flanker task to assess cognitive control. Neuroelectric function for cognitive control was assessed using event-related potentials (ERPs) recorded during the Flanker task. Initial bivariate correlational analyses revealed that neither sex, age, lean body mass, or muscular strength was associated with CTSB. However, CTSB was inversely associated with reaction time and fractional peak latency of the P3 component of the Flanker task. Muscular strength was also inversely associated with reaction time and positively associated with relational memory performance. However, the influence of muscular strength on relational memory did not persist following adjustment for covariates. Greater circulating CTSB was selectively associated with greater cognitive control as well as faster information processing speed. These findings are the first to link circulating CTSB to both cognitive control and neuroelectric function. Future intervention studies are needed to examine the effects of changes in muscular strength, circulating myokines, and different domains of cognitive function.

A novel adaptable isometric strength analysis and exercise development system design

In this study, a low-cost and adaptable isometric strength measurement and exercise development system are described. The implemented system consists of mechanical structure, force measurement sensor, electronic circuit, and computer software. Isometric-isotonic (via spring resistance) strength analysis and various exercise programs can be applied with the system. The developed system has a lower cost compared to its counterparts in the literature and has a structure that can be adapted to different machines and measuring methods. The operability and reliability of the isometric strength measurement and exercise development system have been proven by calibration tests.

Higher protein intake during resistance training does not potentiate strength, but modulates gut microbiota, in middle-aged adults: a randomized control trial

Protein intake above the recommended dietary allowance (RDA) and resistance training are known anabolic stimuli to support healthy aging. Specifically, protein supplementation after resistance exercise and nightly are strategies to maximize utilization of protein intake above the RDA in healthy adults. As such, the primary objective was to examine the efficacy of protein supplementation and nutritional counseling resulting in either moderate (MOD: ∼1.0 g·kg^-1·day^-1) or higher (HIGH: ∼1.6 g·kg^-1·day^-1) protein intake during resistance training on strength (one-repetition maximum, 1-RM; isokinetic and isometric peak torque) in healthy middle-aged adults. Exploratory analyses include diet-exercise effects on lean body mass (LBM), clinical biomarkers, gut microbiota, and diet composition. In all, 50 middle-aged adults (age: 50 ± 8 yr, BMI: 27.2 ± 4.1 kg/m²) were randomized to either MOD or HIGH protein intake during a 10-wk resistance training program (3 × wk). Participants received dietary counseling and consumed either 15 g (MOD) or 30 g (HIGH) of protein from lean beef in the immediate postexercise period and each evening. Maximal strength (1-RM) for all upper and lower body exercises significantly increased with no effect of protein intake (P < 0.050). There was a main effect of time for LBM (P < 0.005). Cardiovascular, renal, or glycemic biomarkers were not affected by the intervention. Gut microbiota were associated with several health outcomes (P < 0.050). In conclusion, higher protein intake above moderate amounts does not potentiate resistance training adaptations in previously untrained middle-aged adults. This trial was registered at clinicaltrials.gov as NCT03029975.NEW & NOTEWORTHY Our research evaluates the efficacy of higher in comparison with moderate animal-based protein intake on resistance exercise training-induced muscle strength, clinical biomarkers, and gut microbiota in middle-aged adults through a dietary counseling-controlled intervention. Higher protein intake did not potentiate training adaptations, nor did the intervention effect disease biomarkers. Both diet and exercise modified gut microbiota composition. Collectively, moderate amounts of high-quality, animal-based protein is sufficient to promote resistance exercise adaptations at the onset of aging.

Comparing the torque- and power-velocity relationships between children and adolescents during isokinetic leg extension muscle actions

The purpose of this study was to use polynomial regression analyses to examine the torque- and power-velocity relationships and calculate and compare the vertices of these nonlinear models, and how they relate to measurements of muscle size and maximal strength, between male and female children and adolescents during maximal isokinetic leg extension muscle actions. Sixteen children (n = 8 males, n = 8 females) and 22 adolescents (n = 11 males, n = 11 females) participated in this study. Measurements of growth included age, maturity offset, height, body mass, fat-free mass, and quadriceps femoris muscle cross-sectional area (CSA). Participants completed maximal voluntary isometric contractions (MVICs) of the leg extensors and maximal voluntary isokinetic leg extensions at 60, 120, 180, 240, and 300°·s^-1. Variables calculated during all leg extension muscle actions included peak torque (PT, Nm) and mean power (MP, W). Polynomial regression analyses determined the model of best fit for the PT- and MP-velocity relationships. For each participant, the vertex from the PT- and MP-velocity quadratic models were quantified as the predicted maximum velocity of last measurable torque (V_PT) and the predicted velocity of maximum mean power (V_MP), respectively. Measurements of growth, PT and MP at all velocities, V_PT, and V_MP were greater in the adolescents than children. When normalized to CSA, V_PT and V_MP remained greater for adolescents than children, and exhibited low to very high relationships with measurements of growth. When normalized to MVIC strength, V_PT and V_MP were no longer different between children and adolescents and exhibited negligible to low relationships with measurements of growth. The results of the present study suggest that the ability to produce torque and power at high velocities may be more dependent on muscle strength than muscle size, which suggests that mechanisms other than muscular hypertrophy affect torque and power production at high velocities in young males and females.

Electromyographic amplitude versus torque relationships are different in young versus postmenopausal females and are related to muscle mass after controlling for bodyweight

PURPOSE

To examine differences in the electromyographic vs torque (EMG-T) relationship, as well as muscle strength and indicators of muscle mass and quality between young versus postmenopausal females, and explore whether the potential differences in the EMG-T relationships could be explained by differences in muscle mass.

METHODS

Thirty young (age = 20.7 ± 2.8 y) and 30 postmenopausal (age = 56.3 ± 4.7 y) females completed maximal isometric strength testing (MVIT) and isometric ramp contractions at 40% and 70% MVIT, during which electromyographic signals were collected to quantify the slopes (Slope₄₀; Slope₇₀) and intercepts (Intercept₄₀; Intercept₇₀) of the EMG-T relationships. Muscle mass and quality measurements were also completed.

RESULTS

Postmenopausal females exhibited lower skeletal muscle mass (- 2.3 ± 1.5 kg), fat-free mass index (- 1.1 ± 0.7 kg·m^-2), MVIT (- 17.1 ± 16.3 Nm), phase angle (- 0.5 ± 0.0°), muscle cross-sectional area (- 5.5 ± 1.1 cm²), muscle quality (- 0.1 ± 0.0 a.u), Slope₄₀ (- 0.0003 ± 0.0002 mV·%MVIT^-1), Slope₇₀ (- 0.0003 ± 0.0002 mV·%MVIT^-1), and had a higher echo intensity (+ 9.8 ± 2.8 a.u), Intercept₄₀ (+ 0.001 ± 0.001 mV), and Intercept₇₀ (+ 0.004 ± 0.003 mV) (p ≤ 0.001-0.04) than the young females. The EMG-T relationship variables were correlated with both muscle mass and quality after controlling for bodyweight. When controlling for muscle mass and bodyweight, group differences in the slopes of the EMG-T relationship and muscle strength were eliminated.

CONCLUSION

Muscle mass and quality are primary contributors to the decrements in neuromuscular function observed in postmenopausal versus young females, and the preservation of muscle mass should be prioritized in the years leading up to, during, and immediately after menopause.

Response to fatigue observed through magnetic resonance imaging on the quadriceps muscle in postmenopausal women

OBJECTIVES

Menopause marks the end of women's reproductive period and can lead to sarcopenia and osteoporosis (OP), increasing the risk of falls and fractures. The aim of this study is to evaluate the influence of normal and low bone mineral density (BMD) on muscular activity, observed through inflammatory edema when mapping using magnetic resonance imaging (MRI) on the quadriceps muscle of postmenopausal women.

METHODS

This was a cross-sectional study involving 16 older women, who were divided into two groups: osteoporosis group (OG), older women with OP, and control group (CG), older women without OP. The groups were evaluated in terms of nuclear MRI exam before and after carrying out fatigue protocol exercises using an isokinetic dynamometer and squatting exercises.

RESULTS

The results of the present study showed that in intragroup comparisons, for both groups, there was a significant increase (p<0.05) in the T2 signal of the nuclear MRI in the quadriceps muscle after carrying out exercises using both thighs. In the intergroup comparison, no statistically significant difference was observed between the OG and CG, pre- (p=0.343) and postexercise (p=0.874).

CONCLUSION

The acute muscular activation of the quadriceps evaluated by T2 mapping on nuclear MRI equipment is equal in women with and without OP in the postmenopausal phase. BMD did not interfere with muscle response to exercise when muscle fatigue was reached.

Variations in Verbal Encouragement Modify Isokinetic Performance

Rendos, NK, Harriell, K, Qazi, S, Regis, RC, Alipio, TC, and Signorile, JF. Variations in verbal encouragement modify isokinetic performance. J Strength Cond Res 33(3): 708-716, 2019-Verbal instruction and encouragement are common in exercise testing; however, the verbiage used during exercise testing is rarely controlled despite the likelihood it may affect the participant's performance. Although variations in verbal cuing based on rate and intensity have been examined during isometric contractions, they have not been examined during isokinetic testing, which is a standardized assessment of muscle performance in athletic, rehabilitation, and research settings. This study examined the effects of 4 variations in verbal encouragement during isokinetic knee flexion and extension exercises. Twenty-three healthy participants (aged 19-34 years) completed 4 isokinetic testing sessions on a Biodex isokinetic dynamometer. Each session consisted of 5, 10, and 15 repetitions at 1.05 rad·s (60°·s), 3.14 rad·s (180°·s), and 5.24 rad·s (300°·s), respectively, separated by 5-minute passive recoveries. The variations in verbal encouragement randomized during each testing session used the following statements: (a) "as fast as you can" (FAST); (b) "as hard as you can" (HARD); (c) "as hard and as fast as you can" (BOTH); and (d) no verbal encouragement (NO CUE). Repeated-measures analyses of variance with a Bonferroni post hoc analysis revealed that the FAST and BOTH verbal cues produced greater work, peak torque, and power at all 3 speeds of isokinetic testing. These findings indicate the verbal cues "as fast as you can" and "as hard and as fast as you can" should be used to maximize performance during isokinetic testing.

Reliability and Minimum Detectable Change for Common Clinical Physical Function Tests in Sarcopenic Men and Women

OBJECTIVES

To determine the test-retest reliability and minimum detectable change scores for seven common clinical measurements of muscle strength and physical function in a multiethnic sample of sarcopenic, malnourished men and women.

DESIGN

Each participant visited the laboratory seven times over 25 to 26 weeks. Reliability was assessed for each measurement from Familiarization 1 to Familiarization 2 (R1), Familiarization 2 to baseline testing (R2), Familiarization 3 to 12-week testing (R3), and Familiarization 4 to 24-week testing (R4).

SETTING

Data were collected during a clinical trial at 23 sites in the United States, Belgium, Italy, Mexico, Poland, Spain, Switzerland, and the United Kingdom.

PARTICIPANTS

Sarcopenic, malnourished, older adults (N = 257; n = 98 men aged 76.8 ± 6.3, n = 159 women aged 75.9 ± 6.6).

MEASUREMENTS

During each visit, participants completed the Short Physical Performance Battery (SPBB) and isometric handgrip and isokinetic leg extensor and flexor strength testing at a slow (1.05 rad/s) and fast (3.15 rad/s) velocity.

RESULTS

Handgrip strength, gait speed, SPPB score, and isokinetic leg extension and flexion peak torque (PT) had intraclass correlation coefficients (ICCs) that were significantly greater than 0 (all ≥0.59) at R1, R2, R3, and R4, although most of these variables demonstrated systematic increases at R1, and several exhibited systematic variability beyond the baseline testing session.

CONCLUSION

The ICCs and standard errors of the measurement (SEMs) generally improved with familiarization, which emphasizes the need for at least one familiarization trial for these measurements in sarcopenic, malnourished older adults. A three tier-approach to interpreting the clinical importance of statistically significant results that includes null hypothesis testing, examination and interpretation of the effect magnitude, and comparison of individual changes with the SEM and minimum detectable change of the measurements used is recommended.