Differences in handgrip strength protocols to identify sarcopenia and frailty - a systematic review

Postmenopausal women with higher TSH values within the normal range present improved handgrip strength: a pilot study

OBJECTIVE

To evaluate the possible association between thyroid function within the euthyroid range and musculoskeletal parameters as well as body composition in a sample of postmenopausal women.

METHODS

This cross-sectional study included 96 postmenopausal women with serum thyroid-stimulating hormone (TSH) within the normal laboratory reference range. Fasting venous blood samples were obtained for biochemical/hormonal assessment. Bone status and body composition were measured using Dual Energy X-ray absorptiometry (DXA). Physical activity was quantified using the International Physical Activity Questionnaire (IPAQ) index.

RESULTS

Serum TSH correlated with handgrip strength (HGS, r-coefficient = 0.233, p = .025), and total body bone mineral density (BMD) T-score values (r-coefficient = 0.321, p = .003). HGS measures were associated with BMD (r-coefficient = 0.415, p < .001), with bone mineral content (BMC, r-coefficient = 0.427, p < .001), and lean mass (r-coefficient = 0.326, p = .003). Women with low muscle strength, defined as HGS < 16 kg, had lower TSH levels than women with normal muscle strength (low vs. normal muscle strength, ANCOVA 1.13 ± 0.49 mU/L vs. 1.60 ± 0.83 mU/L, p = 0.024) independently of age, BMD, percentage of body fat or absolute lean mass. Multivariable linear regression analysis showed that HGS values were associated with TSH measurements (β-coefficient = 0.246, p = .014) and BMD T-score values (β-coefficient = 0.306, p = .002). All models were adjusted for age, body mass index (BMI), vitamin D, low-density lipoprotein cholesterol, current smoking, physical activity, and homeostasis model assessment of insulin resistance.

CONCLUSIONS

In this sample of postmenopausal women, lower serum TSH values, within normal range, were associated with lower muscle strength compared to higher normal TSH values. Further research is needed to elucidate the significance of our preliminary findings.

Adherence to the Mediterranean diet is associated with handgrip strength in postmenopausal women

OBJECTIVE

This study aimed to assess the possible association of adherence to the Mediterranean diet (MD) with muscle strength and body composition.

METHODS

The cross-sectional study evaluated 112 postmenopausal women (aged 41-71 years). Fasting blood samples were obtained for biochemical/hormonal assessment. The Mediterranean Dietary Score (MedDietScore) was calculated and used to stratify adherence by tertiles (low [T1], moderate [T2] or high [T3]). Handgrip strength (HGS) was measured by dynamometry and body composition with dual-X-ray absorptiometry.

RESULTS

Women with low-moderate MedDietScore (T1/T2) had lower HGS values than those with higher scores (19.5 ± 4.9 kg vs. 21.9 ± 3.9 kg, p = 0.023). A linear stepwise increase of HGS values per MedDietScore tertile was found (T1 vs. T2 vs. T3: 18.4 ± 4.4 kg vs. 20.6 ± 5.2 kg vs. 21.9 ± 3.9 kg, ANOVA p-value for linear trend = 0.009, ANCOVA p-value = 0.026). Multivariable models confirmed that HGS values were independently associated with the MedDietScore (β-coefficient = 0.266, p = 0.010). Lean mass values were associated with the MedDietScore (β-coefficient = 0.205, p = 0.040). All models were adjusted for age and cardiometabolic risk factors.

CONCLUSIONS

The data suggest that the higher the adherence to the MD, the better the muscle strength and lean mass in postmenopausal women. Prospective studies are required to evaluate the significance of these observations in cardiovascular prevention strategies at midlife.

Hand Grip Force-Time Curve Indicators Evaluated by Dynamometer: A Systematic Review

BACKGROUND

Handgrip strength (HGS) is an indicator of muscular strength, used in the diagnosis of sarcopenia, undernutrition, and physical frailty as well as recovery. Typically, the maximum HGS value is used; however, recent evidence suggests the exploration of new indicators provided based on the force-time curve to achieve a more comprehensive assessment of muscle function. Therefore, the objective was to identify indicators of the HGS profile beyond maximum HGS, based on force-time curves, and to systematize knowledge about their applications to various types of samples, health issues, and physical performance.

METHODS

A systematic review was performed including studies whose participants' HGS was assessed with a digital or adapted dynamometer. The outcome measures were HGS profile indicators calculated from the force-time curve.

RESULTS

a total of 15 studies were included, and the following indicators were identified: grip fatigue, fatigability index, fatigue rate, fatigue resistance, time to 80% maximal voluntary contraction, plateau coefficient of variability, time to maximum value, T-90%, release rate, power factor, grip work, average integrated area, endurance, cycle duration, time between cycles, maximum and minimum force-velocity, rate of grip force, final force, inflection point, integrated area, submaximal control, and response time.

CONCLUSIONS

Various indicators based on the force-time curve can be assessed through digital or adapted dynamometers. Future research should analyze these indicators to understand their implications for muscle function assessment, to standardize evaluation procedures, to identify clinically relevant measures, and to clarify their implications in clinical practice.

Sarcopenia in cirrhosis: Unraveling the prevalence and relationships with liver disease severity and complications

BACKGROUND AND OBJECTIVES

Sarcopenia in cirrhosis is associated with poor survival and adverse pre and post-transplant outcomes. The study aimed at determining the prevalence of sarcopenia and its association with the severity, complications and etiology of liver disease.

METHODS

As many as 416 cirrhotic patients who met the inclusion criteria underwent muscle strength testing using a dynamometer. As many as 109 probable sarcopenia patients underwent computed tomography (CT) scan to measure skeletal muscle index (SMI) at the L3 vertebral level and gait-speed testing. The gender-specific cut-offs used to define sarcopenia were an SMI of 36.54 cm2/m2 in males and 30.21 cm2/m2 in females. A gait speed ≤ 0.8 m/s was taken as a cut-off to define severe sarcopenia in both genders.

RESULTS

The mean age was 54.7 ± 9.51 years and male:female ratio was 2.2:1.The mean body mass index (BMI) was 24.2 ± 1.34 kg/m2. Alcohol and non-alcoholic steatohepatitis (NASH) were the two most common etiologies (45.9% and 31.2%). The proportion of patients belonging to Child-Pugh class A, B and C was 26.6%, 48.6% and 24.8%, respectively. Forty out of 109 (36.7%) patients had a model for end-stage liver disease (MELD) > 14. Ascites, upper gastrointestinal bleeding and hepatic encephalopathy (HE) were present in 59 (54.1%), 60 (55.0%) and 24 (22.0%) patients, respectively. The prevalence of probable sarcopenia, sarcopenia and severe sarcopenia was found to be 26.20%, 10.09% and 6.73%, respectively. Sarcopenia and severe sarcopenia were associated with Child-Pugh class (p < 0.001, p < 0.001), MELD (p = 0.007, 0.002), upper gastrointestinal bleed (p = 0.007, 0.004), ascites (p = 0.038, 0.025) and HE (0.001, < 0.001).

CONCLUSION

The prevalence of sarcopenia and severe sarcopenia was found to be 10.09% and 6.73%, respectively. Sarcopenia and severe sarcopenia had a significant association with the severity and complications of cirrhosis. However, no association was observed with etiology of liver disease.

Normative values of skeletal muscle mass, strength and performance in the Indian population

BACKGROUND AND OBJECTIVES

Skeletal muscle is characterized by its mass, strength and performance. These normative values are pivotal in defining sarcopenia. Sarcopenia is associated with poor outcome of numerous medical and surgical conditions. This study aimed to establish normative benchmarks for skeletal muscle mass, strength and performance within the context of the Asian (Indian) population.

METHODS

Our investigation utilized the computed tomography (CT) skeletal muscle index (SMI), handgrip strength (HGS), gait velocity and chair-stand test to construct reference values for muscle characteristics in the Indian population.

RESULTS

The SMI analysis incorporated 1485 cases of acute abdomen (54.7%) males). The calculated SMI (kg/m2) was 38.50 (35.05-42.30) in males and 36.30 (32.20-41.20) in females (p = 0.510). The study also involved 3083 healthy individuals (67.6% males) evaluated for muscle strength and performance between August 2017 and August 2018. Notably, HGS (kg force) was recorded at 34.95 (26.50-43.30) in males and 25.50 (18.60-31.20) in females (p < 0.001). Gait velocity (metres/second) exhibited values of 1.25 (1.04-1.56) in males and 1.24 (1.03-1.56) in females (p = 0.851). Additionally, chair-stand test (seconds) results were 10.00 (9.00-13.00) in males and 12.00 (10.00-14.00) in females (p < 0.001).

CONCLUSIONS

The investigation determined that males had greater muscle strength and performance than females. But gender wise, there was no significant difference in muscle mass. Interestingly, our population's muscle parameters were consistently lower compared to western literature benchmarks. These normative values will help to define sarcopenia parameters in our population, which have prognostic value in multiple ailments.

Are accelerometer-measured sitting and physical activity times associated with muscle mass and strength in healthy young adults in the UAE?

Background

A high prevalence of obesity, sedentary behavior, and physical inactivity could affect muscle mass and strength in young adults in the United Arab Emirates (UAE). Therefore, we investigated the association of sex, body mass index (BMI), and accelerometer-measured sitting and physical activity (PA) times with skeletal muscle mass index (SMI), hand grip, and thigh muscle strength in healthy young adults in the UAE.

Methods

In this cross-sectional study, 156 healthy young adults (age 21.68 ± 3.01 years, BMI 25.40 ± 4.79 kg/m2, 52.6 % women) were included. BMI and muscle mass were recorded using a bioelectrical impedance analyzer. Maximum hand grip strength and thigh muscle torque were assessed using the Jamar-smart hand-dynamometer and Biodex System-4-Pro, respectively. Participants wore a triaxial Fibion accelerometer on their anterior thigh for >10 h per day for 4-7 days to measure their sitting and PA times. Multiple linear regression analyses were used.

Results

Participants spent most of their time sitting (11.37 ± 1.10 h), followed by standing (2.92 ± 0.86 h), walking (1.58 ± 0.55 h), and vigorous intensity PA (4.79 ± 5.85 min) per 16-h day. Sex (p < 0.001) and BMI (p < 0.001) were negatively associated with all muscle mass and strength variables. Men had more muscle mass and strength than women. As BMI increased, muscle mass and muscle strength decreased. Accelerometer-measured sitting and walking times were negatively associated with concentric hamstrings (p = 0.044) and quadriceps torques (p = 0.031), respectively.

Conclusion

Sex, BMI, and accelerometer-measured sitting and walking times were associated with muscle mass and/or muscle strength in healthy young adults. Women and those with a high BMI need interventions to improve their muscle mass and strength. The paradox regarding the association of PA with muscle mass and strength in younger adults may be due to possible influences from other factors (e.g., resistance training, dietary intakes, etc.) superseding that of accelerometer-measured PA.

Effects of Exercise on Frailty in Older People Based on ACSM Recommendations: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objectives: The objective of the study was to carry out an analysis of the methodological quality of clinical trials (effects of exercise on frailty in older people) based on ACSM recommendations. Methods: The search scope included PubMed, Embase, Web of Science, Cochrane, and literature that cannot be retrieved from the database. The topic was the impact of exercise on frailty in elderly people. Changes in five outcome measures (FP, BI, SPPB, GS, and BMI) were assessed using mean differences (MD) and 95% confidence intervals (95% CI). A random effects model (RE) was used to conduct a meta-analysis and compare the results between subgroups. Results: The intervention effects of exercise on the five outcome indicators of frailty in elderly people were all significant (p < 0.05). The effect of a high-consistency subgroup on outcome indicators FP and GS was more significant than that of the low- or uncertain-consistency subgroup (MD: -1.09 < -0.11, MD: 2.39 >1.1). There was no significant difference in the intervention effect as reflected in the outcome measures SPPB and BMI in the high-consistency subgroup (p = 0.07, p = 0.34). There was no significant difference in the impact of the intervention on the outcome measure BI between the two subgroups (p = 0.06, p = 0.14). Conclusions: Exercise prescriptions with high consistency with ACSM recommendations may be more effective in both FP and GS interventions than those with uncertain or low consistency. However, it is essential to note that the data derived from the meta-analysis is still subject to the small number of studies, the unknown degree of consistency of participants in individual studies, and the different mix of cases in the studies.

Health professional attitudes and perceptions of prehabilitation and nutrition before haematopoietic cell transplantation

BACKGROUND

Nutritional prehabilitation may improve haematopoietic cell transplantation (HCT) outcomes, although little evidence exists. The present study aimed to understand healthcare professional (HCP) perceptions of prehabilitation and nutritional care pre-HCT in UK centres.

METHODS

An anonymous online survey (developed and refined via content experts and piloting) was administered via email to multidisciplinary HCPs in 39 UK adult centres, between July 2021 and June 2022. Data are presented as proportions of responses. Routine provision denotes that care was provided >70% of time.

RESULTS

Seventy-seven percent (n = 66) of HCPs, representing 61.5% (n = 24) of UK adult HCT centres, responded. All HCPs supported prehabilitation, proposing feasible implementation between induction chemotherapy (60.4%; n = 40) and first HCT clinic (83.3%; n = 55). Only 12.5% (n = 3) of centres had a dedicated prehabilitation service. Nutrition (87.9%; n = 58), emotional wellbeing (92.4%; n = 61) and exercise (81.8%; n = 54) were considered very important constituents. HCPs within half of the HCT centres (n = 12 centres) reported routine use of nutrition screening pre-HCT with a validated tool; 66.7% of HCPs (n = 36) reported using the malnutrition universal screening tool (MUST). Sixty-two percent (n = 41) of HCPs reported those at risk, received nutritional assessments, predominantly by dietitians (91.6%; n = 22) using the dietetic care process (58.3%; n = 14). Body mass index (BMI) was the most frequently reported body composition measure used by HCPs (70.2%, n = 33). Of 59 respondents, non-dietitians most routinely provided dietary advice pre-HCT (82.4%; n = 28 vs. 68%; n = 17, p = 0.2); including high-energy/protein/fat and neutropenic diet advice. Prophylactic enteral feeding pre-HCT was rare, indicated by low BMI and significant unintentional weight loss. Just under half (n = 25 of 59, 42.4%) HCPs reported exercise advice was given routinely pre-HCT.

CONCLUSIONS

Nutrition and prehabilitation pre-HCT are considered important and deliverable by HCPs, but current provision in UK centres is limited and inconsistent.

Identifying characteristics and clinical conditions associated with hand grip strength in adults: the Project Baseline Health Study

Low hand grip strength (HGS) is associated with several conditions, but its value outside of the older adult population is unclear. We sought to identify the most salient factors associated with HGS from an extensive list of candidate variables while stratifying by age and sex. We used data from the initial visit from the Project Baseline Health Study (N = 2502) which captured detailed demographic, occupational, social, lifestyle, and clinical data. We applied MI-LASSO using group methods to determine variables most associated with HGS out of 175 candidate variables. We performed analyses separately for sex and age (< 65 vs. ≥ 65 years). Race was associated with HGS to varying degrees across groups. Osteoporosis and osteopenia were negatively associated with HGS in female study participants. Immune cell counts were negatively associated with HGS for male participants ≥ 65 (neutrophils) and female participants (≥ 65, monocytes; < 65, lymphocytes). Most findings were age and/or sex group-specific; few were common across all groups. Several of the variables associated with HGS in each group were novel, while others corroborate previous research. Our results support HGS as a useful indicator of a variety of clinical characteristics; however, its utility varies by age and sex.

Transcriptional Profiling of Muscle in Females With Distal Radius Fracture and Functional Sarcopenia

Skeletal muscle and bone interact with each other in mechanical and biochemical ways. This study aimed to investigate the molecular mechanisms of interaction between muscle and bone by analyzing the transcriptional profiles of total RNA from the muscle tissue of females with distal radius fractures. A total of 30 female participants (mean age 71.1 ± 8.9 years) with distal radius fractures were recruited. Participants were categorized into 2 groups: the NORM group consisted of participants with T score of the areal bone mineral density (aBMD) of the femoral neck higher than -1.0, handgrip strength greater than 18 kg, and gait speed faster than 1.0 m/s (n = 10). Otherwise, participants with T score of the aBMD of the femoral neck equal to or less than -1.0, handgrip strength lower than 18 kg, and gait speed slower than 1.0 m/s (n = 20) were categorized into EXP group. Pronator quadratus muscle samples were obtained from all participants. Total RNA was extracted from frozen muscle samples and sequenced. The gene ontology analysis demonstrated that the potential interactions between attached muscle function and the density of the associated bone would be linked with collagen biosynthetic activity and maintenance of extracellular matrix structures. The analysis of the pathway, network, and protein class exhibited that integrin signaling, inflammatory reactions, matrix metalloproteinase (MMP) activity, and extracellular matrix protein structure had possible associations with the molecular background of muscle-bone interaction. Through integrin signaling, MMP activity, inflammatory reactions, and collagen biosynthesis, muscle and bone may mutually interact with one another.

Metaheuristic-Based Feature Selection Methods for Diagnosing Sarcopenia with Machine Learning Algorithms

This study explores the efficacy of metaheuristic-based feature selection in improving machine learning performance for diagnosing sarcopenia. Extraction and utilization of features significantly impacting diagnosis efficacy emerge as a critical facet when applying machine learning for sarcopenia diagnosis. Using data from the 8th Korean Longitudinal Study on Aging (KLoSA), this study examines harmony search (HS) and the genetic algorithm (GA) for feature selection. Evaluation of the resulting feature set involves a decision tree, a random forest, a support vector machine, and naïve bayes algorithms. As a result, the HS-derived feature set trained with a support vector machine yielded an accuracy of 0.785 and a weighted F1 score of 0.782, which outperformed traditional methods. These findings underscore the competitive edge of metaheuristic-based selection, demonstrating its potential in advancing sarcopenia diagnosis. This study advocates for further exploration of metaheuristic-based feature selection's pivotal role in future sarcopenia research.

Sarcopenic patients "get even": The impact of COVID-19 vaccination on mortality

BACKGROUND

Coronavirus Disease-2019 (COVID-19), driven by the SARS-CoV-2 virus, has disproportionately affected the elderly, with comorbidities like sarcopenia worsening prognosis. Considering the significant impact of RNA vaccines on survival rates in this population, our objective is to investigate the impact of vaccination on the survival of hospitalized elderly patients with COVID-19, considering the presence or absence of sarcopenia.

METHODS

Prospective study conducted on 159 patients aged>65 years from September 2021 to March 2022. Data about clinical and body composition, and mortality at 12-months after discharge were recorded. Sarcopenia was diagnosed according to the 2019 European Consensus criteria.

RESULTS

At the twelfth month post-discharge, vaccinated sarcopenic individuals exhibited a mortality risk similar to vaccinated non-sarcopenic individuals, and lower than unvaccinated non-sarcopenic patients. Cox regression analysis, adjusted for age, gender, comorbidity, functional and vaccinal status, showed that the presence of sarcopenia did not significantly impact the risk of death within 12-months post-discharge.

DISCUSSION

Vaccination emerges as a protective measure for sarcopenic patients, countering the potential adverse effects of sarcopenia on COVID-19 outcomes, underscoring the importance of immunization in the frail elderly with a call for meticulous monitoring of its benefits.

CONCLUSIONS

Our study represents the first attempt to analyze the vaccine's effect on survival in sarcopenic hospitalized older adults with COVID-19. The administration of vaccination to sarcopenic patients proves pivotal, as its omission could lead to notably unfavorable outcomes within this specific population.

Comparison of three frailty measures for predicting hospitalization and mortality in the Canadian Longitudinal Study on Aging

BACKGROUND

Few studies have compared different measures of frailty for predicting adverse outcomes. It remains unknown which frailty measurement approach best predicts healthcare utilization such as hospitalization and mortality.

AIMS

This study aims to compare three approaches to measuring frailty-grip strength, frailty phenotype, and frailty index-in predicting hospitalization and mortality among middle-aged and older Canadians.

METHODS

We analyzed baseline and the first 3-year follow-up data for 30,097 participants aged 45 to 85 years from the comprehensive cohort of the Canadian Longitudinal Study on Aging (CLSA). Using separate logistic regression models adjusted for multimorbidity, age and biological sex, we predicted participants' risks for overnight hospitalization in the past 12 months and mortality, at the first 3-year follow-up, using each of the three frailty measurements at baseline. Model discrimination was assessed using Harrell's c-statistic and calibration assessed using calibration plots.

RESULTS

The predictive performance of all three measures of frailty were roughly similar when predicting overnight hospitalization and mortality risk among CLSA participants. Model discrimination measured using c-statistics ranged from 0.67 to 0.69 for hospitalization and 0.79 to 0.80 for mortality. All measures of frailty yielded strong model calibration.

DISCUSSION AND CONCLUSION

All three measures of frailty had similar predictive performance. Discrimination was modest for predicting hospitalization and superior in predicting mortality. This likely reflects the objective nature of mortality as an outcome and the challenges in reducing the complex concept of healthcare utilization to a single variable such as any overnight hospitalization.

Dynapenia and sarcopenia: association with the diagnosis, duration and complication of type 2 diabetes mellitus in ELSA-Brasil

Sarcopenia (the loss of muscle mass, strength and skeletal muscle function) increases mortality and the risk of hospitalization in the older population. Although it is known that older adults with type 2 diabetes mellitus (T2DM) have a higher risk of dynapenia and sarcopenia, few studies have investigated these conditions in middle-aged populations. The objective of this study was to investigate whether T2DM, its duration, the presence of albuminuria, and glycemic control are associated with sarcopenia and its components in adults. The cross-sectional analysis was based on data from visit 2 of the Brazilian Longitudinal Study of Adult Health (2012-2014). The 2018 European Working Group on Sarcopenia in Older People criteria were used to define dynapenia, low appendicular muscle mass (LAMM), and sarcopenia (absent/probable/confirmed). The explanatory variables were: T2DM; duration of T2DM; T2DM according to the presence of albuminuria; and glycemic control (HbA1C < 7%) among people with T2DM. A total of 12,132 participants (mean age = 55.5, SD: 8.9 years) were included. The odds ratio for LAMM was greater among those with T2DM, T2DM duration from 5 to 10 years, and T2DM without albuminuria. Chances of dynapenia were higher among those with T2DM, T2DM duration > 10 years, and T2DM with and without albuminuria. The variables T2DM, T2DM ≥ 10 years, and T2DM with albuminuria increased the odds of probable sarcopenia, and T2DM duration from 5 to 10 years increased the odds of confirmed sarcopenia. The results support the importance of frequently monitoring the musculoskeletal mass and strength of individuals with T2DM to prevent sarcopenia and related outcomes.

Effects of measurement protocols and repetitions on handgrip strength weakness and asymmetry in patients with cancer

BACKGROUND

The use of handgrip strength (HGS) in clinical cancer research is surging. The association between HGS and outcomes in patients with cancer varied across studies, which might be due to the different measurement protocols for HGS. We aimed to answer three questions: (1) Did the use of various protocols for HGS, along with different numbers of repetitions, lead to significant differences in maximum HGS values? (2) If yes, were these differences clinically significant? (3) Did the differences in HGS protocols and repetitions affect the identification of HGS weakness or HGS asymmetry?

METHODS

We continuously recruited adult patients with solid tumours. Two protocols were used to measure HGS: Method A, following the American Society of Hand Therapists guidelines, and Method B, following the National Health and Nutrition Examination Survey guidelines. To analyse HGS, we used the maximal value obtained from either two or three repetitions of the dominant hand or four or six repetitions of both hands.

RESULTS

We included 497 patients (326 men and 171 women, median age: 58 years). The maximal HGS values, measured with Method B, were significantly higher than those measured by Method A in both men and women, despite repetitions (all P < 0.05). The maximum HGS values were significantly different across the repetition groups, regardless of measurement protocols and sex (all P < 0.01). The protocol-induced differences in maximal HGS values might be clinically meaningful in over 60% of men and 40% of women despite repetitions. The repetition-induced difference was only clinically significant in 4.3-17.8% of men and 4.1-14.6% of women. To identify HGS weakness, using Method A (six repetitions) as the 'gold' standard, the other protocols demonstrated an overall accuracy of 0.923-0.997 in men and 0.965-1 in women. To identify HGS asymmetry, using Method A (six repetitions) as the 'gold' standard, Method B (six repetitions) demonstrated a diagnostic accuracy of 0.972 in men and 0.971 in women. Method A (four repetitions) showed a diagnostic accuracy of 0.837 in men and 0.825 in women, while Method B (four repetitions) showed a diagnostic accuracy of 0.825 in men and 0.807 in women.

CONCLUSIONS

Both measurement protocols and repetitions significantly affect the maximal HGS values. The identification of HGS weakness is not significantly affected by either protocols or repetitions, while the identification of HGS asymmetry may be affected by different repetitions but not protocols.

The comparison of functional status and health-related parameters in ovarian cancer survivors with healthy controls

PURPOSE

The primary purpose of this study was to evaluate functional status and health-related parameters in ovarian cancer (OC) survivors and to compare these parameters with healthy controls. The secondary purpose of this study was to compare these parameters in early and advanced OC survivors.

METHODS

Thirty-two OC survivors (n = 15 early stage; n = 17 advanced stage) with no evidence/suspicion of cancer recurrence after completing adjuvant local and systemic treatments for at least 12 months and 32 healthy controls were recruited for functional- and health-related assessments. Participants were assessed using the following methods of measuring the following: 6-min walk test (6MWT) for functional exercise capacity, 30-s chair stand test (30 s-CST) for functional fitness and muscle endurance, a handheld dynamometer for peripheral muscle strength, and a handheld dynamometer for lower extremity strength, Medical Micro RPM for respiratory muscle strength, International Physical Activity Questionnaire-Short Form (IPAQ-SF) for physical activity level, and Eastern Cooperative Oncology Group Performance Scale (ECOG-PS) for performance status, Checklist Individual Strength (CIS) for fatigue, Treatment/Gynecological Oncology-Neurotoxicity (FACT/GOG-NTX) for neuropathy, the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression level, and the World Health Organization-Five Well-Being Index (WHO-5) for generic quality of life.

RESULTS

All OC survivors underwent surgery and chemotherapy, and only 9.4% received radiotherapy in addition to chemotherapy. The median recurrence-free period post-completion of adjuvant treatments was 24.00 (12.00-75.00) months. OC survivors had lower 6MWT (m) (p < 0.001, r = 1.50), peripheral muscle strength (p = 0.005, r = 0.72), knee extension (p < 0.001, r = 1.54), and respiratory muscle strength (maximal inspiratory pressure) (p < 0.001, r = 1.90) (maximal expiratory pressure) (p < 0.001, r = 1.68) compared to healthy controls. HADS-A (p = 0.005, r = 0.75) and CIS scores (p = 0.025, r = 0.59) were also higher in the OC survivors. Early-stage OC survivors had better 6MWT (m) than advanced-stage OC survivors (p = 0.005, r = 1.83). Peripheral muscle strength was lower in advanced-stage OC survivors (p = 0.013, r = 0.92). FACT/GOG-NTX scores were higher in early-stage OC survivors (p < 0.001, r = 1.42). No significant differences were observed between early- and advanced-stage OC survivors in other measures (p < 0.05).

CONCLUSION

The findings suggest functional status, and health-related parameters are negatively affected in OC survivors. Additionally, higher levels of fatigue, neuropathy anxiety, and depression were reported in advanced OC survivors.

Hand grip strength as a proposed new vital sign of health: a narrative review of evidences

Hand grip strength (HGS) serves as a fundamental metric in assessing muscle function and overall physical capability and is particularly relevant to the ageing population. HGS holds an important connection to the concept of sarcopenia, which encompasses the age-related decline in muscle mass, strength, and function. It has also been reported to indicate the health of an individual. We reviewed the interplay between HGS and various health parameters, including morbidity and mortality, by carrying out a literature search on PubMed, Scopus and Google Scholar between 10 and 30 August 2023, to identify the relevant papers on the relationship between health and HGS. We used several keywords like 'hand grip strength', 'muscle strength, 'sarcopenia', 'osteosarcopenia', 'health biomarker', 'osteoporosis', and 'frailty', to derive the appropriate literature for this review. This review has shown that the HGS can be measured reliably with a hand-held dynamometer. The cut-off values are different in various populations. It is lower in Asians, women, less educated and privileged, and those involved in sedentary work. Several diseases have shown a correlation with low HGS, e.g., Type 2 diabetes, cardiovascular disease, stroke, chronic kidney and liver disease, some cancers, sarcopenia and fragility fractures. The low HSG is also associated with increased hospitalization, nutritional status, overall mortality and quality of life. We believe that there is adequate evidence to show that HGS stands as an important biomarker of health. Its utility extends to the identification of diverse health issues and its potential as a new vital sign throughout the lifespan.

Neuropsychiatric Symptoms are Related to Blood-biomarkers in Major Neurocognitive Disorders

BACKGROUND

Neuropsychiatric symptoms (NPS) are highly prevalent among individuals with major neurocognitive disorders (MNCD).

OBJECTIVE

Here, we characterized blood biomarkers (metabolic, inflammatory, neurotrophic profiles and total antioxidant), body composition, physical fitness and quality of life (QoL) in individuals with MNCD according to NPS.

METHODS

The sample comprised 34 older adults (71.4% women; 74.06±6.03 yrs, with MNCD diagnosis) categorized according to 50th percentile [Low (≤12) or High (≥13)] for NPS (Neuropsychiatric Inventory Questionnaire). Sociodemographic, clinical data, body composition, anthropometric, cognitive assessment (ADAS-Cog), physical fitness (Senior Fitness Test), QoL (QoL-Alzheimer's Disease scale) were evaluated, and blood samples were collected for biochemical analysis.

RESULTS

Low compared to high NPS group showed higher levels of IL-6, IGF-1and neurotrophic zscore (composite of IGF-1, VEGF-1, BDNF). Additionally, low compared to high NPS group have higher QoL, aerobic fitness and upper body and lower body strength.

CONCLUSION

The severity of NPS seems to be related to modified neurotrophic and inflammatory outcomes, lower physical fitness, and poor QoL. Strategies to counteract NPS development may preserve the physical and mental health of individuals with MNCD.

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Comparison of devices used to measure blood pressure, grip strength and lung function: A randomised cross-over study

BACKGROUND

Blood pressure, grip strength and lung function are frequently assessed in longitudinal population studies, but the measurement devices used differ between studies and within studies over time. We aimed to compare measurements ascertained from different commonly used devices.

METHODS

We used a randomised cross-over study. Participants were 118 men and women aged 45-74 years whose blood pressure, grip strength and lung function were assessed using two sphygmomanometers (Omron 705-CP and Omron HEM-907), four handheld dynamometers (Jamar Hydraulic, Jamar Plus+ Digital, Nottingham Electronic and Smedley) and two spirometers (Micro Medical Plus turbine and ndd Easy on-PC ultrasonic flow-sensor) with multiple measurements taken on each device. Mean differences between pairs of devices were estimated along with limits of agreement from Bland-Altman plots. Sensitivity analyses were carried out using alternative exclusion criteria and summary measures, and using multilevel models to estimate mean differences.

RESULTS

The mean difference between sphygmomanometers was 3.9mmHg for systolic blood pressure (95% Confidence Interval (CI):2.5,5.2) and 1.4mmHg for diastolic blood pressure (95% CI:0.3,2.4), with the Omron HEM-907 measuring higher. For maximum grip strength, the mean difference when either one of the electronic dynamometers was compared with either the hydraulic or spring-gauge device was 4-5kg, with the electronic devices measuring higher. The differences were small when comparing the two electronic devices (difference = 0.3kg, 95% CI:-0.9,1.4), and when comparing the hydraulic and spring-gauge devices (difference = 0.2kg, 95% CI:-0.8,1.3). In all cases limits of agreement were wide. The mean difference in FEV1 between spirometers was close to zero (95% CI:-0.03,0.03), limits of agreement were reasonably narrow, but a difference of 0.47l was observed for FVC (95% CI:0.53,0.42), with the ndd Easy on-PC measuring higher.

CONCLUSION

Our study highlights potentially important differences in measurement of key functions when different devices are used. These differences need to be considered when interpreting results from modelling intra-individual changes in function and when carrying out cross-study comparisons, and sensitivity analyses using correction factors may be helpful.

Nutritional Status and Risk of Sarcopenia among Hospitalized Older Adults Residing in a Rural Region in Turkey

BACKGROUND

This study aimed to determine the prevalence of sarcopenia and its associated factors in community-dwelling older adults at risk of malnutrition based on the Mini Nutritional Assessment (MNA), Prognostic Nutritional Index (PNI), and Geriatric Nutritional Risk Index (GNRI).

METHODS

The study participants were 345 adults aged >65 years who visited Geriatric Internal Medicine outpatient clinics. The study included people without acute illness for whom the risk of malnutrition could be assessed and appropriate measurements taken. At the baseline visit, participants' data and measurements were gathered. The primary data included sociodemographic details, anthropometric measurements, malnutrition screening tests, and functional assessments.

RESULTS

The participants' mean age was 76.21±5.59 years, and 57.1% were men (n=97). The prevalence rate of sarcopenia was 45.5%. Compared to individuals without sarcopenia, those with it were older; had lower MNA, PNI, and GNRI scores; and had lower muscle mass, muscle strength, and lower leg circumferences (p<0.001). After adjusting for potential confounding factors, we found that sarcopenia, advanced age, male sex, high risk of malnutrition, calf circumference, and a low PNI score were all significantly associated with a low GNRI score (p<0.001).

CONCLUSION

Sarcopenia was significantly associated with advanced age, male sex, and high risk of malnutrition. Patients' nutritional and functional status should always be assessed for therapeutic interventions and lifestyle changes.

Handgrip strength asymmetry as a new biomarker for sarcopenia and individual sarcopenia signatures

BACKGROUND

Although handgrip strength (HGS) asymmetry has clinical screening utility, its relevance to sarcopenia is unknown. This study examined the relationship between HGS asymmetry and sarcopenia signatures, and explored the relevance of circulating neural/neuromuscular markers.

METHODS

9403 individuals aged 18-92 years participated in this study. Maximal HGS and skeletal muscle index (SMI) were determined using hand dynamometry and DXA. Sarcopenia was diagnosed upon the presence of low HGS and low SMI, according to cohort-specific thresholds. Plasma biomarkers were measured by ELISA in a sub-group of 269 participants aged 50-83 years. Asymmetry was determined as the highest recorded HGS divided by the highest recorded HGS of the opposite hand. Individuals with a ratio > 1.10 were classified as having asymmetrical HGS.

RESULTS

Subjects with asymmetrical HGS had significantly lower SMI (7.67 kg/m2 vs 7.71 kg/m2, p = 0.004) and lower HGS (37.82 kg vs 38.91 kg, p < 0.001) than those with symmetrical HGS. In those aged ≥ 50 years asymmetrical HGS was associated with 2.67 higher odds for sarcopenia [95% confidence interval: (CI) = 1.557-4.561, p < 0.001], 1.83 higher odds for low HGS only (CI 1.427-2.342, p < 0.001), and 1.79 higher odds for low SMI only (CI 1.257-2.554, p = 0.001). HGS asymmetry demonstrated acceptable diagnostic accuracy for sarcopenia (AUC = 0.727, CI 0.658-0.796, p < 0.001). Plasma neural cell adhesion molecule concentrations were 19.6% higher in individuals with asymmetrical HGS (185.40 ng/mL vs 155.00 ng/mL, p < 0.001) than those with symmetrical HGS.

DISCUSSION

Our findings demonstrate the utility of HGS asymmetry as a screening tool that may complement existing strategies seeking to combat sarcopenia. Biomarker analyses suggest that heightened denervation may be an important aetiological factor underpinning HGS asymmetry.

Physical Fitness Variables, General Health, Dementia and Quality of Life in Individuals with Intellectual and Developmental Disabilities: A Cross-Sectional Study

The average life expectancy of individuals with intellectual and developmental disabilities (IDDs) is increasing. However, living more years does not mean living better, leading to the need for research on comorbidities associated with the aging process. Associated with this process are the physical characteristics most prevalent in an individual with IDD: low levels of all physical capacities, the accumulation of central fat, hyperglycemia, dyslipidemia, and hypertension, variables considered to be some of the main risk factors of the onset of metabolic and cardiovascular diseases, and variables that can negatively impact quality of life (QoL). Therefore, the aim of this study is to evaluate a sample of 21 institutionalized adults with IDD (42.81 ± 10.99 years old) in terms of their anthropometric characteristics, body composition, general health status, functional capacity, neuromuscular capacity, and dementia/cognitive function, and the possible associations with QoL. All assessments were performed in the laboratory of the Faculty of Sport Sciences and Physical Education-University of Coimbra. Participants, in the present study, have low levels of physical fitness and high metabolic and cardiovascular markets, which need to be improved. On the other hand, functional and neuromuscular ability seems to be associated with QoL (p ≤ 0.05). This study highlights the role of primary and secondary care providers in diagnosis, prevention, and supporting individuals with IDDs to promote QoL.

Determining a Cutoff Value for Hand Grip Strength to Predict Favorable Outcomes of Adult Spinal Deformity Surgery

STUDY DESIGN

Retrospective review.

OBJECTIVES

To establish a cutoff value for hand grip strength and predict the favorable outcomes of adult spinal deformity surgery.

SUMMARY OF BACKGROUND DATA

Hand grip strength (HGS) has been suggested to predict surgical outcomes in various fields, including adult spinal deformity (ASD). However, to the best of our knowledge, no study has established a cutoff value for HGS in patients with ASD.

METHODS

This study included 115 female patients who underwent reconstructive spinal surgery for ASD between September 2016 and September 2020. HGS was measured preoperatively. The Oswestry Disability Index (ODI), EuroQOL-5-dimension (EQ-5D), and visual analog scale (VAS) scores for back pain were all recorded both before and after surgery. Patients were dichotomized either into favorable or unfavorable outcome groups using an ODI cutoff score of 22 at 1 year after surgery. Multivariate logistic regression analysis was done to identify significant factors leading to favorable outcomes. A receiver operating characteristic (ROC) curve was drawn to define the cutoff value of HGS for favorable outcomes.

RESULTS

Multivariate logistic regression analysis showed that HGS is significantly associated with favorable surgical outcomes in ASD (P = .031). The ROC curve suggested a cutoff value of 14.20 kg for HGS (area under the curve (AUC) = .678, P = .013) to predict favorable surgical outcomes in ASD. The surgical complications were not significantly affected by HGS.

CONCLUSION

The HGS of patients with ASD can be interpreted with a cutoff value of 14.20 kg. Patients with HGS above this cutoff value showed superior surgical outcomes at 1 year after surgery compared to those below this cutoff value.

Discordance in Frailty Measures in Old Community Dwelling People with Multimorbidity - A Cross-Sectional Study

Purpose

Assessment of frailty is a key method to identify older people in need of holistic care. However, agreement between different frailty instrument varies. Thus, groups classified as frail by different instruments are not completely overlapping. This study evaluated differences in sociodemographic factors, cognition, functional status, and quality of life between older persons with multimorbidity who were discordantly classified by five different frailty instruments, with focus on the Clinical Frailty Scale (CFS) and Fried's Frailty Phenotype (FP).

Participants and Methods

This was a cross-sectional study in a community-dwelling setting. Inclusion criteria were as follows: ≥75 years old, ≥3 visits to the emergency department the past 18 months, and ≥3 diagnoses according to ICD-10. 450 participants were included. Frailty was assessed by CFS, FP, Short Physical Performance Battery (SPPB), Grip Strength and Walking Speed.

Results

385 participants had data on all frailty instruments. Prevalence of frailty ranged from 34% (CFS) to 75% (SPPB). Nine percent of participants were non-frail by all instruments, 20% were frail by all instruments and 71% had discordant frailty classifications. Those who were frail according to CFS but not by the other instruments had lower cognition and functional status. Those who were frail according to FP but not CFS were, to a larger extent, women, lived alone, had higher cognitive ability and functional status.

Conclusion

The CFS might not identify physically frail women in older community-dwelling people with multimorbidity. They could thus be at risk of not be given the attention their frail condition need.

Trial in Elderly with Musculoskeletal Problems due to Underlying Sarcopenia-Faeces to Unravel the Gut and Inflammation Translationally (TEMPUS-FUGIT): protocol of a cross-sequential study to explore the gut-muscle axis in the development and treatment of sarcopenia in community-dwelling older adults

BACKGROUND

Gut microbiota (GM) might play a role in muscle metabolism and physiological processes through a hypothesized gut-muscle axis, influencing muscle mass and function and thus, sarcopenia. The Trial in Elderly with Musculoskeletal Problems due to Underlying Sarcopenia-Faeces to Unravel the Gut and Inflammation Translationally (TEMPUS-FUGIT) aims to explore the gut-muscle axis in sarcopenia.

METHODS

First, in a cross-sectional case-control phase, 100 community-dwelling adults without sarcopenia will be compared to 100 community-dwelling adults (≥ 65 years) with sarcopenia of similar age-, gender and BMI-ratio, participating in the ongoing 'Exercise and Nutrition for Healthy AgeiNg' (ENHANce; NCT03649698) study. Sarcopenia is diagnosed according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. GM composition and intestinal inflammatory markers (fecal calprotectin, lactoferrin and S100A12) will be determined in fecal samples. Systemic inflammatory markers (hs-CRP, IL-4, IL-6, TNF-α, IL-13, IL-1β and creatine kinase) will be determined in fasted blood samples. Both groups will be compared using appropriate statistical testing, whereas linear regression will be used for cross-sectional associations between gut, inflammatory and sarcopenia parameters. Second, in the longitudinal phase, sarcopenic older adults will be requested to deliver five fecal samples during the 12-week intervention to assess the effects of protein, omega-3 and a physical exercise program on the GM.

DISCUSSION

TEMPUS-FUGIT aims to explore the gut-muscle axis by comparing GM composition between sarcopenic and non-sarcopenic older adults and to determine the association of GM with intestinal and systemic inflammatory markers and sarcopenia-defining parameters (muscle mass, muscle strength and physical performance). Furthermore, effects of single or combined, optimized and individualized anabolic interventions (exercise, protein and omega-3 supplementation), on GM will be explored in persons with sarcopenia. TEMPUS-FUGIT aims to impact clinical practice by clarifying the relationship between the gut-muscle axis and sarcopenia. TEMPUS-FUGIT is expected to contribute to the discovery of clinical and microbial biomarkers for sarcopenia and insights in its pathophysiology, opening possible future perspectives for novel sarcopenia treatment strategies targeting GM.

TRIAL REGISTRATION

ClinicalTrails.gov NCT05008770, registered on August 17, 2021; first participant enrolled on September 21 2021.

Implementation and Core Components of a Multimodal Program including Exercise and Nutrition in Prevention and Treatment of Frailty in Community-Dwelling Older Adults: A Narrative Review

Increasing disability-free life expectancy is a crucial issue to optimize active ageing and to reduce the burden of evitable medical costs. One of the main challenges is to develop pragmatic and personalized prevention strategies in order to prevent frailty, counteract adverse outcomes such as falls and mobility disability, and to improve quality of life. Strong evidence reports the effectiveness of exercise interventions to improve various physical parameters and muscle function that are cornerstones of frailty. Other findings also suggest that the interactions between nutrition and physical exercise with or without health behavior promotion prevent the development of frailty. Multimodal programs, including structured exercise, adequate dietary intervention and health behavior promotion, appear increasingly consensual. However, in order for implementation in real-life settings, some pitfalls need to be addressed. In this perspective, structuring and tailoring feasible, acceptable and sustainable interventions to optimize exercise training responses are essential conditions to warrant short, medium and long-term individual benefits. The different components of exercise programs appear to be fairly consensual and effective. However, specific composition of the programs proposed (frequency, intensity, type, time, volume and progressiveness) have to be tailored to individual characteristics and objectives in order to improve exercise responses. The intervention approaches, behavioral strategies and indications for these programs also need to be refined and framed. The main objective of this work is to guide the actions of healthcare professionals and enable them to widely and effectively implement multimodal programs including exercise, nutrition and behavioral strategies in real-life settings.

Comparison of two handgrip dynamometers in older adults before elective surgery

BACKGROUND

Handgrip strength is a useful measurement of muscle strength and has been proposed as a single predictor of postoperative outcomes in older adults. The aim of this study was to assess the correlation and concordance of Camry digital hand grip dynamometer (EH101) with gold standard Jamar® hydraulic handgrip dynamometer in older adults previous to elective surgery.

METHODS

A cross-sectional study was conducted on patients ≥ 65 years old admitted to a Chilean private hospital for elective surgery between March 2018 and February 2019. Handgrip strength was assessed 2 times with each hand prior to surgery, using both the Jamar® dynamometer and the Camry digital dynamometer. The highest value of each dynamometer was used for analysis.

RESULTS

We included a total of 220 patients (mean age 73.1 years old ± 6.3). Maximal handgrip strength averaged 26.9 kg ± 9.6 with the Camry dynamometer and 26.9 kg ± 9.7 with the Jamar® dynamometer in the right hand and 25.5 kg ± 9.5 with the Camry dynamometer and 25.7 kg ± 9.2 with the Jamar® dynamometer with the left hand. The difference between both measures did not differ significantly from 0, with Pearson correlation index of 0.95 and Lin's concordance index of 0.95 (p < 0001). The Bland-Altman graphics show that 90% of the measures were inside the confidence limits, without systematic bias.

CONCLUSION

Camry digital dynamometer is an inexpensive and valid device to measure handgrip strength in older adults previous to elective surgery, compared to the gold standard Jamar® hydraulic handgrip dynamometer.

A combination of metformin and galantamine exhibits synergistic benefits in the treatment of sarcopenia

Age-associated sarcopenia, characterized by a progressive loss in muscle mass and strength, is the largest cause of frailty and disability in the elderly worldwide. Current treatments involve nonpharmacological guidelines that few subjects can abide by, highlighting the need for effective drugs. Preclinical models were employed to test the benefits of RJx-01, a combination drug composed of metformin and galantamine, on sarcopenia. In worms, RJx-01 treatment improved lifespan, locomotion, pharyngeal pumping, and muscle fiber organization. The synergistic effects of RJx-01 were recapitulated in a transgenic mouse model that displays an exacerbated aging phenotype (Opa1-/-). In these mice, RJx-01 ameliorated physical performance, muscle mass and force, neuromuscular junction stability, and systemic inflammation. RJx-01 also improved physical performance and muscle strength in 22-month-old WT mice and also improved skeletal muscle ultrastructure, mitochondrial morphology, autophagy, lysosomal function, and satellite cell content. Denervation and myofiber damage were decreased in RJx-01-treated animals compared with controls. RJx-01 improved muscle quality rather than quantity, indicating that the improvement in quality underlies the beneficial effects of the combination drug. The studies herein indicate synergistic beneficial effects of RJx-01 in the treatment of sarcopenia and support the pursuit of RJx-01 in a human clinical trial as a therapeutic intervention for sarcopenia.

Grip strength cut-points from the Swiss DO-HEALTH population

BACKGROUND

While grip strength (GS) is commonly assessed using a Dynamometer, the Martin Vigorimeter was proposed as an alternative method especially in older adults. However, its reference values for Swiss older adults are missing. We therefore aimed to derive sex- and age-specific GS cut-points for the dominant and non-dominant hand (DH; NDH) using the Martin Vigorimeter. Additionally, we aimed to identify clinically relevant weakness and assess convergent validity with key markers of physical function and sarcopenia in generally healthy Swiss older adults.

METHODS

This cross-sectional analysis includes baseline data from Swiss participants enrolled in DO-HEALTH, a 3-year randomized controlled trial in community-dwelling adults age 70 + . For both DH and NDH, 4 different definitions of weakness to derive GS cut-points by sex and age category (≤ 75 vs. > 75 years) were used: i) GS below the median of the 1st quintile, ii) GS below the upper limit of the 1st quintile, iii) GS below 2-standard deviation (SD) of the sex- and age-specific mean in DO-HEALTH Swiss healthy agers (i.e. individuals without major chronic diseases, disabilities, cognitive impairment or mental health issues) and iv) GS below 2.5-SD of the sex- and age-specific mean in DO-HEALTH Swiss healthy agers. To assess the proposed cut-points' convergent validity, we assessed their association with gait speed, time to complete the 5 Times Sit-To-Stand (5TSTS) test, and present sarcopenia.

RESULTS

In total, 976 participants had available GS at the DH (mean age 75.2, 62% women). According to the 4 weakness definitions, GS cut-points at the DH ranged from 29-42 and 25-39 kPa in younger and older women respectively, and from 51-69 and 31-50 kPa in younger and older men respectively. Overall, weakness prevalence ranged from 2.0% to 19.3%. Definitions of weakness using the median and the upper limit of the 1st GS quintile were most consistently associated with markers of physical performance. Weak participants were more likely to have lower gait speed, longer time to complete the 5TSTS, and sarcopenia, compared to participants without weakness.

CONCLUSIONS

In generally healthy Swiss older adults, weakness defined by the median or the upper limit of the 1st GS quintile may serve as reference to identify clinically relevant weakness. Additional research is needed in less healthy populations in order to derive representative population-based cut-points.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01745263.

Handgrip strength as a diagnostic tool for frailty risk in elderly patients with moderate to severe asthma

OBJECTIVE

To evaluate handgrip strength (HGS) as a diagnostic tool for frailty risk in elderly patients with asthma, as well as to investigate the prevalence of frailty in this population.

METHODS

This was a cross-sectional study including 96 patients ≥ 60 years of age diagnosed with moderate to severe asthma and treated at a tertiary referral center in Brazil. We measured HGS using a calibrated hydraulic hand dynamometer. We used a frailty scale and the AUC to assess the diagnostic accuracy of the HGS test.

RESULTS

The median age of participants was 67 years. Most (78%) were women and non-White (91%) of low socioeconomic status. HGS identified those at risk for frailty, with an AUC of 71.6% (61.5-80.4%; p < 0.002), as well as a sensitivity of 73.58% and a specificity of 67.53%, on the basis of a cutoff of ≤ 19 kgf.

CONCLUSIONS

HGS appears to be a simple, reliable tool for clinicians to determine frailty risk in older asthma patients in a point-of-care setting.

Physical Functional Ability and Quantitative Assessment of the Multifidus Muscle of the Lumbar Spine in the Elderly

Aging is associated with muscle atrophy and fatty infiltration of skeletal muscle. The multifidus muscle stabilizes the lumbar spine and undergoes adipose accumulation with age, leading to functional decline in the elderly. Therefore, quantitative assessment of the multifidus muscle can be beneficial for the elderly when formulating treatment strategies and reducing future complications. Fifty-seven patients (mean age, 73.89 ± 6.09; 23 male patients) who underwent lumbar Magnetic resonance imaging (MRI) were prospectively recruited. The cross-sectional area (CSA) of the multifidus from the L2-S1 level and the CSA of the L4-5 level psoas muscle were measured. The functional CSA (fCSA) of the multifidus muscle was measured by excluding the fat infiltration area from the multifidus CSA. The CSA to fCSA ratio was obtained by multiplying 100 by the value obtained by dividing CSA by the fCSA. Pfrrmann classification was used to evaluate the degree of disc degeneration. The functional disability measurements were the Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), grip strength, and functional reach test (FRT). Pearson's correlation analysis was used to examine the relationship between the functional disability measurements and the multifidus muscle. The CSA to fCSA ratio value was relatively constant at each spine level and showed a significant correlation with the SPPB, grip strength, FRT, and psoas index (p < 0.05). However, degree of disc and multifidus muscle degeneration was not statistically significant. So, age-related changes play a significant role in developing back muscle fatty infiltration than disc degeneration. Moreover, Grip strength showed a stronger relationship with the quality of the multifidus muscle than other functional disability measurements.

Comparison of Grip Strength Measurements by Widely Used Three Dynamometers in Outpatients Aged 60 Years and Over

Grip strength (GS) is widely used in various fields such as sports, rehabilitation, and geriatrics to assess muscle strength, and to diagnose sarcopenia and frailty in older adults. There is a potential for measurement differences among different dynamometers available, and studies comparing GS measurements by variable tools have conflicting results. The two most frequently used dynamometers are the Jamar hydraulic (Jamar) and spring-type hand grip dynamometers, and Jamar has not been compared to Jamar PLUS+ Digital (Jamar+) dynamometer in older adults. So, we aimed to assess GS measurements with the Jamar as the reference standard against Jamar+, and spring-type Takei T.KK. 5401 (Takei) digital dynamometers. One hundred and ten outpatients aged >60 years were included. Inter-instrumental reliability was determined. The differences between dynamometers were evaluated by Bland-Altman plots and measurement error. The measurements with Jamar+, and Takei dynamometers were reliable and valid regarding the Jamar dynamometer. Takei and Jamar+ dynamometers overestimated GS over the Jamar dynamometer. Though the differences in the measured values might be disregarded in clinical practice, individuals defined to have low GS varied by the use of different dynamometers. Grip strength better be measured by the same dynamometer in serial measurements of older individuals.

The influence of vitamin D on handgrip strength in elderly trauma patients

BACKGROUND AND OBJECTIVES

The treatment of elderly patients is an increasing challenge and the long-term sequelae often affect activities of daily living and quality of life in those patients. Handgrip strength (HGS) appears as a promising value to predict the outcome after trauma in elderly patients and to assess the overall muscle strength. Besides the possible role of psychological and hormonal factors, vitamin D may have a positive influence. Furthermore, some data suggest that Vitamin D is beneficial regarding muscle strength and possibly prevents further falls and injuries in orthogeriatric patients. The purpose of this study was to identify if Vitamin D is an influencing factor for HGSin elderly trauma patients.

MATERIALS AND METHODS

94 elderly patients in a Level I Trauma Center aged 60 years or older were prospectively enrolled and HGS as well as serum 25-OH Vitamin D concentration (VDC) were measured. In addition, the standardized questionnaires Barthel Index (BI), Parker Mobility Score (PMS), Short Physical Performance Battery (SPPB), Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls (SARC-F) and European Quality of Life 5 Dimensions 5 Levels Questionnaire (EQ-5D-5L), were used to record mental health status and demographic data.

RESULTS

HGS is mainly related to age and sex in elderly trauma patients. HGS was higher in men (mean_male = 27.31 kg (± 8.11), mean_female = 15.62 kg (± 5.63), p < 0.001 and decreased with age (β_age = - 0.58, p < 0.001). A significant negative correlation between HGS and VDC exists in the overall sample (β_VDC = - 0.27, p_VDC < 0.008), which still remains after adjusting for age (p_VDC < 0.004), but is not significant after adjustment for both main confounders, age and sex (p_VDC < 0.08). Furthermore, the HGS was lower in pateints who reported frequent falls, stumbling, dizziness or a late onset of menopause, and decreased if patients felt anxious or depressed during measurements (β_{anxiety+depression} = - 0.26, p_{anxiety+depression} < 0.01).

CONCLUSIONS

These results do not support the hypothesis that Vitamin D has a positive influence on muscle strength measured by HGS. Nevertheless, this study could confirm the usefulness of HGS as a tool to detect the risk for frequent falls or stumbling. Furthermore, HGS seems to be associated with dizziness and age at onset of menopause. A significant decrease of HGS could also be shown in patients with anxiety and depression. This underlines the importance of interdisciplinary treatment of elderly trauma patients and needs to be taken into account for further studies, as especially the psychological motivation seems to have a significant influence and is sometimes not considered enough in elderly musculo-skeletal patients.

Study protocol for a pilot randomised controlled trial evaluating the feasibility and effectiveness of non-pharmacological interventions to recover functionality after a transient ischaemic attack or a minor stroke: the 'Back to Normal' trial

INTRODUCTION

Transient ischaemic attack (TIA) and minor stroke are frequently assumed as temporary or non-disabling events. However, evidence suggests that these patients can experience relevant impairment and functional disability. Therefore, the present study aims to evaluate the feasibility and effectiveness of a 3-month multidomain intervention programme, composed of five non-pharmacological strategies, aimed at accelerating return to pre-event level of functionality in patients with TIA or minor stroke.

METHODS AND ANALYSIS

Patients diagnosed with a TIA or a minor stroke are being recruited at the emergency or neurology departments of the Hospital Pedro Hispano, located in Matosinhos, Portugal (n=70). Those who accept to participate will be randomly allocated to two groups (1:1): (a) Intervention-receives a 3 months combined approach, initiating early post-event, composed of cognitive training, physical exercise, nutrition, psychoeducation and assessment/correction of hearing loss; (b) Control-participants will not be subject to any intervention. Both groups will receive the usual standard of care provided to these diseases. Recruitment began in May 2022 and is expected to continue until March 2023. Socio-demographic characteristics, lifestyles, health status, cognitive function, symptoms of anxiety and depression and quality of life will be assessed; as well as anthropometry, blood pressure and physical condition. Time to complete or partial recovery of instrumental activities of daily living will be assessed using an adapted version of the Frenchay Activities Index. All participants will be evaluated before the intervention and after 3 months.

ETHICS AND DISSEMINATION

This study was approved by the Ethics Committee of the Local Health Unit of Matosinhos (Ref. 75/CES/JAS). Written informed consent will be required from all the participants; data protection and confidentiality will be also ensured. The findings of this project are expected to be submitted for publication in scientific articles, and the main results will be presented at relevant scientific meetings.

TRIAL REGISTRATION NUMBER

NCT05369637.

Association between masseter muscle volume, nutritional status, and cognitive status in older people

OBJECTIVES

Clinical evidence has suggested that oral function is associated with cognitive, physical, and nutritional status of older people. A smaller volume of masseter, a crucial muscle for mastication, was associated with frailty. It has remained unknown if smaller masseter is associated with cognitive impairment. The current study investigated the association between masseter muscle volume, nutritional status, and cognitive status in older people.

MATERIALS AND METHODS

We recruited 19 patients with mild cognitive impairment (MCI), 15 patients with Alzheimer's disease (AD), and 28 sex and age-matched non-cognitive impairment (non-CI) older subjects. The number of missing teeth (NMT), masticatory performance (MP), maximal hand-grip force (MGF), and calf circumference (CC) were assessed. The masseter volume index (MVI) was calculated based on the masseter volume measured using magnetic resonance imaging.

RESULTS

The MVI was significantly lower in the AD group, compared to the MCI as well as the non-CI group. Multiple regression analyses revealed that the MVI was significantly associated with nutritional status (as indexed by CC) in the analysis of combination of NMT, MP, and the MVI. Moreover, the MVI was a significant predictor of CC only in patients with cognitive impairment (i.e., MCI+AD) but not in the non-CI group.

CONCLUSIONS

Our findings suggested that in addition to the NMT and MP, masseter volume is a critical oral factor associated with cognitive impairment.

CLINICAL RELEVANCE

Reduction of MVI should be carefully monitored for patients with dementia and frailty, to whom a lower MVI may indicate worse nutrient intake.

Measures of Maximal Tactile Pressures during a Sustained Grasp Task Using a TactArray Device Have Satisfactory Reliability and Concurrent Validity in People with Stroke

Sensor-based devices can record pressure or force over time during grasping and therefore offer a more comprehensive approach to quantifying grip strength during sustained contractions. The objectives of this study were to investigate the reliability and concurrent validity of measures of maximal tactile pressures and forces during a sustained grasp task using a TactArray device in people with stroke. Participants with stroke (n = 11) performed three trials of sustained maximal grasp over 8 s. Both hands were tested in within- and between-day sessions, with and without vision. Measures of maximal tactile pressures and forces were measured for the complete (8 s) grasp duration and plateau phase (5 s). Tactile measures are reported using the highest value among three trials, the mean of two trials, and the mean of three trials. Reliability was determined using changes in mean, coefficients of variation, and intraclass correlation coefficients (ICCs). Pearson correlation coefficients were used to evaluate concurrent validity. This study found that measures of reliability assessed by changes in means were good, coefficients of variation were good to acceptable, and ICCs were very good for maximal tactile pressures using the average pressure of the mean of three trials over 8 s in the affected hand with and without vision for within-day sessions and without vision for between-day sessions. In the less affected hand, changes in mean were very good, coefficients of variations were acceptable, and ICCs were good to very good for maximal tactile pressures using the average pressure of the mean of three trials over 8 s and 5 s, respectively, in between-day sessions with and without vision. Maximal tactile pressures had moderate correlations with grip strength. The TactArray device demonstrates satisfactory reliability and concurrent validity for measures of maximal tactile pressures in people with stroke.

Gamified Physical Rehabilitation for Older Adults With Musculoskeletal Issues: Pilot Noninferiority Randomized Clinical Trial

BACKGROUND

Resource-rich countries are facing the challenge of aging societies, a high risk of dependence, and a high cost of care. Researchers attempted to address these issues by using cost-efficient, innovative technology to promote healthy aging and regain functionality. After an injury, efficient rehabilitation is crucial to promote returning home and prevent institutionalization. However, there is often a lack of motivation to carry out physical therapies. Consequently, there is a growing interest in testing new approaches like gamified physical rehabilitation to achieve functional targets and prevent rehospitalization.

OBJECTIVE

The purpose of this study is to assess the effectiveness of a personal mobility device compared with standard care in the rehabilitation treatment of patients with musculoskeletal issues.

METHODS

A total of 57 patients aged 67-95 years were randomly assigned to the intervention group (n=35) using the gamified rehabilitation equipment 3 times a week or to the control group (n=22) receiving usual standard care. Due to dropout, only 41 patients were included in the postintervention analysis. Outcome measures included the short physical performance battery (SPPB), isometric hand grip strength (IHGS), functional independence measure (FIM), and the number of steps.

RESULTS

A noninferiority related to the primary outcome (SPPB) was identified during the hospital stay, and no significant differences were found between the control and intervention groups for any of the secondary outcomes (IHGS, FIM, or steps), which demonstrates the potential of the serious game-based intervention to be as effective as the standard physical rehabilitation at the hospital. The analysis by mixed-effects regression on SPPB showed a group×time interaction (SPPB_I_t1=-0.77, 95% CI -2.03 to 0.50, P=.23; SPPB_I_t2=0.21, 95% CI -1.07 to 0.48, P=.75). Although not significant, a positive IHGS improvement of more than 2 kg (Right: 2.52 kg, 95% CI -0.72 to 5.37, P=.13; Left: 2.43 kg, 95% CI -0.18 to 4.23, P=.07) for the patient from the intervention group was observed.

CONCLUSIONS

Serious game-based rehabilitation could potentially be an effective alternative for older patients to regain their functional capacities.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03847454; https://clinicaltrials.gov/ct2/show/NCT03847454.

Reliability and validity of the K-force grip dynamometer in healthy subjects: do we need to assess it three times?

Introduction

Digital dynamometers to assess grip strength are becoming more common in research and clinical settings. The aim of the study was to assess validity and reliability of the K-force dynamometer compared to the Jamar dynamometer. We also aimed to assess differences over the course of three measurements.

Methods

Twenty-seven healthy participants were included. Three trials with the K-force and Jamar dynamometers were completed. Testing order was randomised. Intraclass correlation coefficients (ICCs) with absolute agreement assessed reliability and validity. Standard error of the measurement (SEM) and minimal detectable change (MDC95) were calculated. Concurrent validity was assessed using Pearson's correlations and ICCs. Differences between the three repetitions were assessed using one-way repeated measures ANOVAs.

Results

Both the K-force and the Jamar presented excellent intra-rater reliability with ICCs ranging from 0.96 to 0.97. The SEM ranged from 1.7 to 2 kg and the MDC from 4.7 to 5.7 kg for both dynamometers. The concurrent validity of the K-force was high (r ≥ 0.89). However, the K-force underestimated the grip strength by 4.5-8.5 kg. There was no change in grip strength with either dynamometer over the course of three trials.

Conclusions

The K-force is reliable, but it underestimates grip strength by 4.5-8.5 kg compared to the Jamar dynamometer. K-force can be used to monitor progress over time but cannot be used to compare results against normative data. The use of a single measurement when assessing grip strength is sufficient when assessing healthy subjects.

Handgrip Measurement Method Affects Asymmetry but Not Weakness Identification in Community-Dwelling Older Adults

OBJECTIVES

The Asian Working Group for Sarcopenia (AWGS) 2019 recommends different measurement protocols for handgrip strength (HGS). We aimed to explore (1) whether these protocols induce a significant difference in HGS; (2) whether these differences be clinically meaningful; and (3) whether these protocols affect the identification of HGS weakness or asymmetry.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

A total of 356 community-dwelling older adults (mean age 67.9 years; 146 women).

METHODS

Maximal HGS was measured according to protocols from the National Health and Nutrition Examination Survey (Method A, standing with full elbow extended) and the American Society of Hand Therapists (Method B, sitting with elbow flexed at 90°). HGS was analyzed using the maximal value of 2 or 3 repetitions of the dominant hand or 4 or 6 repetitions of both hands.

RESULTS

The difference in maximal HGS between Method A and Method B might have clinical meaning in approximately half of the participants. When measured using Method A, respective proportions of individuals with differences in HGS between the 6 repetitions group and the other repetition groups beyond the noninferiority threshold were 42%, 20%, and 25% in men and 39%, 21%, and 17% in women. Using Method B, the corresponding percentages were 25%, 18%, and 6% in men, and 27%, 20%, and 5% in women, respectively. Different protocols did not significantly affect the identification of HGS weakness, as different protocols reached diagnostic accuracies of 0.910 to 0.967 in men and 0.911 to 0.986 in women when using Method A (6 repetitions) as the reference standard. However, different protocols significantly affected the identification of HGS asymmetry, as different protocols had diagnostic accuracies of 0.667 to 0.886 in men and 0.658 to 0.863 in women.

CONCLUSIONS AND IMPLICATIONS

The different protocols recommended by the AWGS 2019 update significantly affect maximal HGS values and the identification of HGS asymmetry but not HGS weakness.

COVID-19 in Older Patients: Assessment of Post-COVID-19 Sarcopenia

(1) Background: Acute COVID-19 infections produce alterations in the skeletal muscle, leading to acute sarcopenia, but the medium- and long-term consequences are still unknown. The aim of this study was to evaluate: (1) body composition; (2) muscle strength and the prevalence of sarcopenia; and (3) the relationship between muscle strength with symptomatic and functional evolution in older patients affected by/recovered from COVID-19; (2) Methods: A prospective, longitudinal study of patients aged ≥65 years who had suffered from COVID-19 infection between 1 March and 31 May 2020, as confirmed by PCR or subsequent seroconversion. Persistent symptoms, as well as anthropometric, clinical, and analytical characteristics, were analyzed at 3 and 12 months after infection. The degree of sarcopenia was determined by dynamometry and with SARC-F; (3) Results: 106 participants, aged 76.8 ± 7 years, were included. At 3 months postinfection, a high percentage of sarcopenic patients was found, especially among women and in those with hospitalization. At 12 months postinfection, this percentage had decreased, coinciding with a functional and symptomatic recovery, and the normalization of inflammatory parameters, especially interleukin-6 (4.7 ± 11.6 pg/mL vs. 1.5 ± 2.4 pg/mL, p < 0.05). The improvement in muscle strength was accompanied by significant weight gain (71.9 ± 12.1 kg vs. 74.7 ± 12.7 kg, p < 0.001), but not by an increase in lean mass (49.6 ± 10 vs. 49.9 ± 10, p 0.29); (4) Conclusions: Older COVID-19 survivors presented a functional, clinical, and muscular recovery 12 months postinfection. Even so, it is necessary to carry out comprehensive follow-ups and assessments that include aspects of nutrition and physical activity.

Are physical performance and frailty assessments useful in targeting and improving access to adjuvant therapy in patients undergoing resection for pancreatic cancer?

BACKGROUND

Many patients fail to receive adjuvant chemotherapy following pancreatic cancer surgery. This study implemented a multimodal, multidisciplinary approach to improving recovery after pancreatoduodenectomy (the 'Fast Recovery' programme) and measured its impact on adjuvant chemotherapy uptake and nutritional decline. The predictive accuracies of a bundle of frailty and physical performance assessments, with respect to the recipient of adjuvant chemotherapy, were also evaluated.

RESULTS

The N = 44 patients treated after the introduction of the 'Fast Recovery' programme were not found to have a significantly higher adjuvant chemotherapy uptake than the N = 409 treated before the pathway change (80.5 vs. 74.3%, p = 0.452), but did have a significantly lower average weight loss at six weeks post-operatively (mean: 4.3 vs. 6.9 kg, p = 0.013). Of the pre-operative frailty and physical performance assessments tested, the 6-min walk test was found to be the strongest predictor of the receipt of adjuvant chemotherapy (area under the ROC curve: 0.91, p = 0.001); all patients achieving distances ≥ 360 m went on to receive adjuvant chemotherapy, compared to 33% of those walking < 360 m.

CONCLUSIONS

The multimodal 'Fast Recovery' programme was not found to significantly improve access to adjuvant chemotherapy, but did appear to have benefits in reducing nutritional decline. Pre-operative assessments were found to be useful in identifying patients at risk of non-receipt of adjuvant therapies, with markers of physical performance appearing to be the best predictors. As such, these markers could be useful in targeting pre- and post-habilitation measures, such as physiotherapy and improved dietetic support.

Association between functional aspects and health-related quality of life in patients with colorectal cancer: can handgrip strength be the measure of choice in clinical practice?

PURPOSE

We aimed to investigate the association between handgrip strength (HGS) and health-related quality of life (HRQoL) in patients with colorectal cancer (CRC). A cross-sectional study was conducted including CRC patients.

METHODS

We performed an assessment of aspects of functional health using the criteria of frailty phenotype (defined by Fried et al., 2001), sarcopenia (defined by the European Working Group on Sarcopenia in Older People 2, 2018) and by HGS, which measures muscle strength using a manual dynamometer. HRQoL was assessed using the EORTC questionnaire QLQ-C30. Analyses of variance and multivariate linear regression were used to compare frailty, sarcopenia, and HGS with HRQoL.

RESULTS

A total of 142 patients were included (age 62.7 ± 11.4 years; 56.3% women; 18.3% of patients with frailty; 9.9% with sarcopenia, and 15.5% had low HGS). After adjusting for sociodemographic, clinical, and nutritional variables, the regression analysis showed that frailty and sarcopenia were associated with worse HRQoL. Low HGS was associated with worse HRQoL in patients with CRC regardless of both frailty components (global health status: B =  - 13.4, p = 0.004; physical function: B =  - 10.4, p = 0.006; emotional function: B =  - 18.1, p = 0.041; fatigue: B = 9.1, p = 0.027; dyspnea: B = 10.7, p = p = 0.024; appetite loss: B = 12.4, p = 0.041) and sarcopenia components (global health status: B =  - 13.2, p = 0.004; physical function: B =  - 15.0, p = 0.001; emotional function: B =  - 25.1, p = 0.006; fatigue: B = 15.2, p = 0.007; pain: B = 18.7, p = 0.024, dyspnea: B = 11.4, p = 0.017).

CONCLUSION

We concluded that HGS was positively associated with HRQoL in patients with CRC and may initially be the variable of choice in clinical practice, which is associated with HRQoL.

A systematic review and meta-analysis of the association between sarcopenia and myocardial infarction

BACKGROUND

Systematic review and meta-analysis of the association between sarcopenia and the development of myocardial infarction.

METHODS

PubMed, Cochrane Library, and Embase were searched for studies on the association between sarcopenia and myocardial infarction from their inception until November 26, 2022. The fixed-effects model was used to calculate the combined risk ratio (RR) of sarcopenia in patients with myocardial infarction. Sensitivity analysis was used to test the robust of the combined result, and funnel plot were used to test publication bias.

RESULTS

Five studies were included finally. There was no significant association between sarcopenia and risk of developing myocardial infarction [RR = 1.01; 95% CI = 0.94, 1.08; P = 0.317]. The sensitivity analysis showed robust of the combined result. The funnel plot showed no significant publication bias.

CONCLUSION

Limited evidence suggests no definitive association between sarcopenia and risk of myocardial infarction.

The Assessment of Ankle Range-of-Motion and Its Relationship with Overall Muscle Strength in a Cross-Section of Soccer Players

Soccer (football) practice can induce a limitation of ankle range of motion (ROM) that is a possible risk factor for injury and other negative consequences over time. The main objective of this research was to investigate the effects of soccer practice on ankle ROM throughout the entire period of a sports career of soccer players (SP). Furthermore, the relationship between ankle ROM and muscle strength in SP of different ages was studied. A total of 204 SP (range 6.7−45.1 years) and 87 controls (range: 7.5−45.2 years) matched for age, body mass index (BMI), and gender, were assessed. Ankle ROM in both plantar flexion (APF) and dorsiflexion (ADF) in addition to handgrip strength (HGS) were evaluated using an inclinometer and the Jamar hydraulic hand dynamometer, respectively. The comparison between SP and control groups showed a significant reduction in ankle ROM of both APF (26.3 ± 7.2° vs. 32.6 ± 7.4°; d = −0.90; p < 0.001) and ADF (95.5 ± 15.6° vs. 105.5 ± 15.8°; d = −0.66; p < 0.001). In SP, the results of the ANOVAs test indicate that age had a significant effect on ADF (F = 4.352, p = 0.038, partial eta-squared (ηp2) = 0.015) but not on APF (F = 0.430, p = 0.746, ηp2 = 0.001). Moreover, considering only the SP, a weak inverse correlation between ADF and HGS group ADF was found (rs = −0.27; p < 0.001). Factors such as the non-linear trend of growth in young SP could hinder the definition of the relationship between ankle ROM, age, and muscle strength. However, the appropriate consideration of age and muscle strength could facilitate the management of ankle ROM in PF of different ages.

Fitness and frailty in myeloma

As the aging population grows, so too does the number of well-tolerated antimyeloma therapies. Physicians will see an increasing volume of patients for subsequent lines of therapy, which could now extend this relationship for over a decade. For younger patients, treatment choices are infrequently impacted by concerns of fitness, but instead about effecting the deepest, most durable response. Older adults, in contrast, are more likely to experience under- than overtreatment, and therefore more objective (and ideally straightforward) ways to evaluate their fitness and ability to tolerate therapy will increasingly assist in decision-making. Post hoc analyses categorizing the fitness of trial patients in the modern treatment era globally demonstrate that even in highly selected populations, those that are recategorized as less fit or frail are consistently at higher risk of inferior outcomes and increased toxicities. Real-world data are comparatively lacking but do demonstrate that most patients with myeloma are not representative of those enrolled on clinical trials, generally more heavily burdened by comorbidities and more likely to be categorized as "less than fit." Simultaneously, the number of therapeutic options open to patients in the relapsed setting continues to grow, now including T-cell engagers and cellular therapies, with their unique toxicity profiles. The aim of this review is to summarize the available data, highlight some of the approaches possible to easily assess fitness and how results might inform treatment selection, and illustrate ways that patients' condition can be optimized rather than lead to exclusion from the more complex therapies newly available.

Handgrip strength as an indicator for death events in China: A longitudinal cohort study

Studies have shown the indicative role of handgrip strength in health. However, there is limited evidence revealing its potential effect on death events among middle-aged and older adults in China. We aimed to prospectively evaluate if lower handgrip strength is associated with the event of death. Among 17,167 middle-aged and older adults between age 45 to 96, handgrip strength was collected by a handheld dynamometer in a Chinese longitudinal study of aging trend (CHARLS) 2011-2018. Using Cox proportional hazard models with exposures, we assessed the association between handgrip strength and death events. Elevated handgrip strength values were independently associated with the decreased death risk. These results illustrate that lower handgrip strength is an independent indicator of death risks among middle-aged and older Chinese, which highlights the significance of related intercessions. The median values of five levels of handgrip strength in the entire cohort were 16.5,23,28,33,42kg at baseline. A linear association existed between the handgrip strength values and the risk of all-cause death within 34.2kg. Handgrip strength can serve as an independent indicator for death risks.

Sex differences in frailty of geriatric outpatients with type 2 diabetes mellitus: a multicentre cross-sectional study

Frailty and type 2 diabetes mellitus (T2DM) can occur concurrently and are increasingly prevalent in older populations. There is a marked variability in frailty progression between men and women. This study aimed to investigate sex differences in the prevalence and factors associated with frailty in older outpatients with T2DM. This multicentre cross-sectional study included 638 outpatients (aged ≥ 60 years; median age 71 years [interquartile range, 66-77]; male, 55.5%) and was conducted from January 2019 to July 2020. Frailty was assessed using the Fried frailty phenotype. Factors associated with frailty were assessed using a logistic regression analysis. The overall frailty prevalence was 28.2% (men, 26.8%; women, 29.9%; P = 0.388). In the adjusted model, the factors associated with greater odds of being frail were older age (odds ratio [OR], 1.08; 95% confidence interval [CI], 1.05-1.11; P < 0.001) and body mass index (BMI) less than 20 kg/m² (OR, 1.96; 95% CI, 1.16-3.32; P = 0.012). Higher education (OR, 0.64; 95% CI, 0.42-0.98; P = 0.041) and productive work (OR, 0.11; 95% CI, 0.03-0.36; P < 0.001) were protective factors against frailty. Frailty was associated with all four factors in women, but only with older age and productive work in men. Our study found that the prevalence of frailty in older outpatients with T2DM was 28.2%, though not significantly different between men and women. While older age and BMI less than 20 kg/m² can increase the odds of frailty, and higher education and productive work can decrease the odds of frailty in women, only age and productive work were associated with frailty in men with T2DM.

Impact of preoperative sarcopenia on postoperative complications and survival outcomes of patients with esophageal cancer: a meta-analysis of cohort studies

The effects of preoperative sarcopenia on postoperative complications and survival outcomes of patients undergoing esophageal cancer resection are controversial. From database establishment to 16 May 2021, we systematically searched PubMed, Embase, the Cochrane Library, Web of Science, and Chinese Biomedical Literature Database to collect relevant studies investigating the effects of preoperative sarcopenia on postoperative complications, survival outcomes, and the risk of a poor prognosis of patients undergoing esophagectomy. The Newcastle-Ottawa scale was used to evaluate the quality of the included literature, and RevMan 5.3 software was used for the meta-analysis. A total of 26 studies (3 prospective cohort studies and 23 retrospective cohort studies), involving 4,515 patients, were included. The meta-analysis showed that preoperative sarcopenia significantly increased the risk of overall complications (risk ratio [RR]: 1.15; 95% confidence interval [CI]: 1.08-1.22), pulmonary complications (RR: 1.78; 95% CI: 1.48-2.14), and anastomotic leakage (RR: 1.29; 95% CI: 1.04-1.59) and reduced the overall survival rate (hazard ratio: 1.12; 95% CI: 1.04-1.20) following esophageal cancer resection. Preoperative sarcopenia increased the risks of overall postoperative and pulmonary complications in patients undergoing esophageal cancer resection. For patients with esophageal cancer, assessing the preoperative risk of preoperative sarcopenia is necessary.