The role of quadriceps muscle strength in the development of falls in the elderly people, a cross-sectional study

Exploring the associations between skeletal muscle echogenicity and physical function in aging adults: A systematic review with meta-analyses

BACKGROUND

Assessment and quantification of skeletal muscle within the aging population is vital for diagnosis, treatment, and injury/disease prevention. The clinical availability of assessing muscle quality through diagnostic ultrasound presents an opportunity to be utilized as a screening tool for function-limiting diseases. However, relationships between muscle echogenicity and clinical functional assessments require authoritative analysis. Thus, we aimed to (a) synthesize the literature to assess the relationships between skeletal muscle echogenicity and physical function in older adults (≥60 years), (b) perform pooled analyses of relationships between skeletal muscle echogenicity and physical function, and (c) perform sub-analyses to determine between-muscle relationships.

METHODS

CINAHL, Embase, MEDLINE, PubMed, and Web of Science databases were systematically searched to identify articles relating skeletal muscle echogenicity to physical function in older adults. Risk-of-bias assessments were conducted along with funnel plot examination. Meta-analyses with and without sub-analyses for individual muscles were performed utilizing Fisher's Z transformation for the most common measures of physical function. Fisher's Z was back-transformed to Pearson's r for interpretation.

RESULTS

Fifty-one articles (n = 5095, female = ∼2759, male = ∼2301, 72.5 ± 5.8 years, mean ± SD (1 study did not provide sex descriptors)) were extracted for review, with previously unpublished data obtained from the authors of 13 studies. The rectus femoris (n = 34) and isometric knee extension strength (n = 22) were the most accessed muscle and physical qualities, respectively. The relationship between quadriceps echogenicity and knee extensor strength was moderate (n = 2924, r = -0.36 (95% confidence interval: -0.38 to -0.32), p < 0.001), with all other meta-analyses (grip strength, walking speed, sit-to-stand, timed up-and-go) resulting in slightly weaker correlations (r:  -0.34 to -0.23, all p < 0.001). Sub-analyses determined minimal differences in predictive ability between muscle groups, although combining muscles (e.g., rectus femoris + vastus lateralis) often resulted in stronger correlations with maximal strength.

CONCLUSION

While correlations are modest, the affordable, portable, and noninvasive ultrasonic assessment of muscle quality is a consistent predictor of physical function in older adults. Minimal between-muscle differences suggest that echogenicity estimates of muscle quality are systemic. Therefore, practitioners may be able to scan a single muscle to estimate full-body skeletal muscle quality/composition, while researchers should consider combining multiple muscles to strengthen the model.

A Randomized Study of Myostaal® Liniment as an Add-On Therapy for Muscle Strengthening in Cases of Knee Osteoarthritis

INTRODUCTION

Knee osteoarthritis (OA) is a prevalent degenerative musculoskeletal condition, affecting approximately 277 million people worldwide, with significant impacts on mobility, especially in women and obese patients, and an increasing incidence among Indians aged 30 to 50 years. The primary objective was to evaluate the knee muscle-strengthening effect of Myostaal® liniment (Solumiks Herbaceuticals Limited, Mumbai, India) as an add-on to physiotherapy for 90 days compared to physiotherapy alone in participants with knee OA. Secondary objectives included assessing changes in the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, WOMAC Subscale scores, Six-Minute Walk Test (6MWT) distance, Single Leg Stance Test (SLST) duration, Visual Analogue Scale (VAS) score, and the number of adverse events from baseline to Day 90 between the two groups.

METHODS

Seventy participants were randomly allocated to Group A (Myostaal® liniment plus physiotherapy) or Group B (physiotherapy alone) for 90 days, with Myostaal® liniment applied twice daily in Group A. Data were recorded in Case Report Forms (CRFs) and analyzed using parametric tests for within-group comparisons (one-way ANOVA or Friedman test) and non-parametric tests (Mann-Whitney test) for between-group comparisons, with significance set at p<0.05.

RESULTS

The knee muscle strength (index knee) in Group A (test medication group) was significantly greater compared to Group B (standard treatment group) at Visit 3 (p<0.05; Day 60±3) and Visit 4 (p<0.001; Day 90±3). For the non-index (other) knee, a statistically significant increase in knee muscle strength was observed (p<0.001 at Day 90±3) solely in Group A. A notable reduction in total WOMAC score was seen in Group A from Visit 2 (p<0.01; Day 30±3) onward, compared to Visit 1 (Day 0). The scores at Visit 3 (p<0.001; Day 60±3) and Visit 4 (p<0.001; Day 90±3) were significantly lower than those at Visit 2 (Day 30±3).

CONCLUSION

The local application of Myostaal® liniment through massage as an adjunct to a physiotherapy regimen, improved knee muscle strength in participants with knee OA, leading to an enhancement in joint functionality. Additionally, Myostaal® liniment provided superior pain relief as an add-on therapy.

Investigating balance-related gait patterns and their relationship with maximum torques generated by the hamstrings and quadriceps in older adults - Results from the Baltimore longitudinal study of aging

BACKGROUND

Balance-related gait patterns in older adults can be objectively discerned through the examination of gait parameters, maximum leg torques, and their interconnections.

OBJECTIVE

To investigate the correlation between leg muscle strength and balance during gait concerning functional performance in healthy older adults.

METHODS

Participants included 117 adults aged 60-95 years were recruited from the Baltimore Longitudinal Study of Aging (BLSA). They underwent evaluations of gait, balance, and maximum isometric leg torque (for both hamstrings and quadriceps). Analyses examined the association between leg torque and functional performance among those with higher and lower balances.

RESULTS

Individuals with lower balance (n = 43) were older, more prone to experiencing a fear of falling, and exhibited lower functional performance (gait speeds and Generalized Gait Stability Scores (GGSS), ps < 0.001) compared to their counterparts with higher balance (n = 74). At a usual walking pace, the GGSS showed a positive association with concentric Quadriceps Maximum Torque (QMT) in participants with lower balance (p = 0.013). Conversely, it displayed a positive association with eccentric QMT in those with higher balance (p = 0.014). At a fast walking pace, only individuals with higher balance demonstrated a positive muscle torque association with both gait speed and GGSS, encompassing concentric and eccentric actions in both the quadriceps and hamstrings (ps < 0.050).

CONCLUSION

Evaluating muscle strength capacity in both concentric and eccentric phases during dynamic high-effort events, along with investigating their associations with gait performance, can be beneficial for identifying subtle gait deficits. This comprehensive approach may assist in the early detection of gait deterioration among healthy older adults, given the intricate muscle activations involved in lower body functional performance.

Relationship between quadriceps muscle architecture and lower limb strength and physical function in older adults community-dwelling individuals: a cross-sectional study

Background and objective

Factors related to muscle architecture may lead to functional limitations in activities of daily living in the older adults. This study aimed to investigate the relationship between quadriceps femoris (QF) architecture and physical function in older adults community-dwelling people.

Methods

The study included 25 community-dwelling older adults participants aged over 60 years (14 women and 11 men) who were not engaged in regular physical activity. The rectus femoris (RF) and vastus intermedius (VI) muscle thicknesses as well as the RF cross-sectional area (CSA) were assessed using 2D ultrasonography. The 30 Seconds Chair Stand test (30sCST) and Timed Up and Go Test (TUG) were used to assess lower body muscle power and functional mobility, respectively.

Results

The QF muscle architecture showed moderate and large correlations with the 30sCST (r range = 0.45-0.67, p < 0.05) and TUG (r range = 0.480-0.60, p < 0.05). RF thickness was a significant (p < 0.01) independent predictor of 30sCST (R 2 = 0.45) and TUG (R 2 = 0.36). VI thickness was a significant (p < 0.05) independent predictor of 30sCST (R 2 = 0.20) and TUG (R 2 = 0.231). RF CSA was a significant independent predictor of the 30sCST (R 2 = 0.250, p < 0.05) and TUG (R 2 = 0.27, p < 0.01). Multiple linear regression models explained 38% of the 30sCST variance and 30% of the TUG variance in the older adults group.

Conclusion

Quadriceps muscle group directly affects basic activities of daily living in the older adults. Ultrasound measurements, which are non-invasive tools, are extremely valuable for understanding the limitations of activities of daily living in the older adults.

Alterations in stride-to-stride fluctuations in patients with chronic obstructive pulmonary disease during a self-paced treadmill 6-minute walk test

Evaluating variability and stability using measures for nonlinear dynamics may provide additional insight into the structure of the locomotor system, reflecting the neuromuscular system's organization of gait. This is in particular of interest when this system is affected by a respiratory disease and it's extrapulmonary manifestations. This study assessed stride-to-stride fluctuations and gait stability in patients with chronic obstructive pulmonary disease (COPD) during a self-paced, treadmill 6-minute walk test (6MWT) and its association with clinical outcomes. In this cross-sectional study, eighty patients with COPD (age 62±7y; forced expiratory volume in first second 56±19%predicted) and 39 healthy older adults (62±7y) were analyzed. Gait parameters including stride-to-stride fluctuations (coefficient of variation (CoV), predictability (sample entropy) and stability (Local Divergence Exponent (LDE)) were calculated over spatiotemporal parameters and center of mass velocity. Independent t-test, Mann-Whitney U test and ANCOVA analyses were conducted. Correlations were calculated between gait parameters, functional mobility using Timed Up and Go Test, and quadriceps muscle strength using dynamometry. Patients walked slower than healthy older adults. After correction for Speed, patients demonstrated increased CoV in stride length (F(1,116) = 5.658, p = 0.019), and increased stride length predictability (F(1,116) = 3.959, p = 0.049). Moderate correlations were found between mediolateral center of mass velocity LDE and normalized maximum peak torque (ρ = -0.549). This study showed that patients with COPD demonstrate alterations in stride length fluctuations even when adjusted for walking speed, highlighting the potential of nonlinear measures to detect alterations in gait function in patients with COPD. Association with clinical outcomes were moderate to weak, indicating that these clinical test are less discriminative for gait alterations.

Assessment of lower limb muscle strength can predict fall risk in patients with chronic liver disease

Falls are caused by a combination of factors, including loss of lower limb muscle strength (LMS), and associated with declined performance status (PS). Age-related sarcopenia is generally associated with decreased muscle mass and strength of lower limb muscle but without a noticeable loss of those of upper limb or trunk muscle. However, no reports have focused on falls or LMS in chronic liver disease (CLD) patients. This study is the first to analyze the risk factors for falls in patients with CLD, focusing on LMS measurement using the Locomoscan. This study enrolled 315 CLD patients whose LMS was measured. The patients who experienced falls more than 1 year ago or during the observation period were classified as those who experienced falls. We found that risk factors for falls were PS1/2 and decreased LMS (< 0.32 N/kg). The group with sarcopenia had a higher frequency of decreased LMS (54 vs. 26%, p = 0.001) and falls (24 vs. 4.4%, p < 0.001) compared to the non-sarcopenia group. This study found that decreased LMS was an independent risk factor for falls. Assessment of LMS may be used as a better marker associated with the risk of falls in patients with CLD.

Relationship between Muscle Strength and Gait Parameters in Healthy Older Women and Men

Maintaining sufficient muscle strength is fundamental to prevent a decline in basic physical functions such as gait, and is therefore a prerequisite for a healthy independent life in older people. However, the relationship between gait parameters and the strength of single muscle groups is reported with inconclusive results. The objective of this study was to analyze the relationship of strength of nine single muscle groups of lower and upper leg muscles as well as handgrip strength for gait parameters in older adults. Sixty-nine independently living older adults participated in the study. Maximum ankle plantar- and dorsiflexion, knee flexion and extension, as well as hip abduction, adduction, flexion, and extension strength, were measured using an isokinetic dynamometer. Additionally, hand grip strength measured via a hand dynamometer was obtained. Walking gait parameters were recorded with a 3D motion capture system on an instrumented treadmill. The relationships between multiple strength and gait variables were analyzed by Pearson's correlation coefficient. Linear regression analyses were performed to identify the predictive ability of muscle strength (normalized to body weight) for gait speed, stride time, stance time, stride length and step width. Multiple significant weak to moderate positive ([r = 0.343, p = 0.047]-[r = 0.538, p = 0.002]) and negative ([r = -0.340, p = 0.046]-[r = 0.593, p = 0.001]) correlations that were unequally distributed between both sexes were detected. Significant regression models explained ([r² = 16.6%, p = 0.015]-[r² = 44.3 %, p = 0.003]) and ([r² = 21.8%, p = 0.022]-[r² = 36.1%, p = 0.044]) of the gait parameter variations for men and women, respectively. The results suggest a sex-specific relevance of single muscle groups for all gait parameters. This may be attributed to anatomical differences and it is important to prevent strength-related changes in gait parameters.

Age and Gender Differences in Fall-Related Factors Affecting Community-Dwelling Older Adults

BACKGROUND

Falls are one of the major adverse events affecting older adults that can result in serious injuries. Hospitalizations and deaths because of fall-related injuries have been increasing. Nevertheless, there is a dearth of studies examining the physical condition and current exercise habits of older adults. Moreover, studies analyzing the role of factors related to fall risk by age and gender in large populations are also scarce.

PURPOSE

This study was designed to investigate the prevalence of falls among community-dwelling older adults and elucidate the effects of age and gender on the related factors using a biopsychosocial model.

METHODS

This cross-sectional study utilized data from the 2017 National Survey of Older Koreans. On the basis of the biopsychosocial model, the biological factors related to falls included chronic diseases, number of medications, visual difficulties, activity of daily living (ADL) dependence, lower-limb muscle strength, and physical performance; psychological factors included depression, cognitive ability, regular smoking, alcohol consumption, nutritional status, and exercise; and the social factors included educational level, annual income, living conditions, and instrumental ADL dependence.

RESULTS

Of the 10,073 older adults surveyed, 57.5% were women and approximately 15.7% had experienced falls. The results of the logistic regression showed that, in men, falls were significantly associated with taking more medications and being able to climb 10 stair steps; in women, falls were significantly associated with poor nutritional status and instrumental ADL dependence; and in both genders, falls were significantly associated with greater depression, ADL dependence, and the presence of more chronic diseases and negatively associated with physical performance.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The results suggest that practicing kneeling and squatting is the most effective strategy for reducing fall risk in older adult men and that improving nutritional status and strengthening physical ability is the most effective strategy for reducing fall risk in older adult women.

Musculoskeletal health state and physical function of intensive care unit survivors: protocol for a UK multicentre prospective cohort study (the MSK-ICU study)

INTRODUCTION

Survivors of critical illness frequently experience long-term physical impairment, decreased health-related quality of life and low rates of return to employment. There has been limited investigation of the underlying problems affecting physical function post-intensive care unit (ICU) admission. Musculoskeletal (MSK) conditions may be complex in presentation, with ICU survivors potentially at greater risk of their development due to the rapid muscle mass loss seen in ICU. The MSK health state of ICU survivors and its impact on physical function remain largely unknown. The aim of the MSK-ICU study is to determine and characterise the MSK health state of ICU survivors 6 months following admission to ICU, in order to inform development of targeted rehabilitation interventions.

METHODS AND ANALYSIS

The MSK-ICU study is a multicentre prospective longitudinal cohort study, evaluating the MSK health state of ICU survivors 6 months after admission to ICU. The study consists of a primary study and two substudies. The primary study will be a telephone follow-up of adults admitted to ICU for more than 48 hours, collecting data on MSK health state, quality of life, employment, anxiety and depression and symptoms of post-traumatic stress disorder. The planned sample size is 334 participants. Multivariable regression will be used to identify prognostic factors for a worse MSK health state, as measured by the MSK-Health Questionnaire. In substudy 1, participants who self-report any MSK problem will undergo a detailed, in-person MSK physical assessment of pain, peripheral joint range of movement and strength. In substudy 2, participants reporting a severe MSK problem will undergo a detailed physical assessment of mobility, function and muscle architecture.

ETHICS AND DISSEMINATION

Ethical approval has been obtained through the North of Scotland Research Ethics Committee 2 (21/NS/0143). We aim to disseminate the findings through international conferences, international peer-reviewed journals and social media.

TRIAL REGISTRATION NUMBER

ISRCTN24998809.

Relationship between fall history and toe grip strength in older adults with knee osteoarthritis in Japan: A cross-sectional study

BACKGROUND

Knee osteoarthritis (KOA), one of the most common musculoskeletal diseases in older adults, is associated with a high incidence of falls. Similarly, toe grip strength (TGS) is associated with a history of falls in older adults; however, the relationship between TGS and falls in older adults with KOA who are at risk of falling is not known. Therefore, this study aimed to determine if TGS is associated with a history of falls in older adults with KOA.

METHODS

The study participants, older adults with KOA scheduled to undergo unilateral total knee arthroplasty (TKA), were divided into two groups: non-fall (n = 256) and fall groups (n = 74). Descriptive data, fall-related assessments, modified Fall Efficacy Scale (mFES), radiographic data, pain, and physical function including TGS were evaluated. The assessment was conducted on the day before performing TKA. Mann-Whitney and chi-squared tests were performed to compare the two groups. Multiple logistic regression analysis was performed to determine the association of each outcome with the presence or absence of falls.

RESULTS

Mann-Whitney U test revealed that the fall group had statistically significantly lower height, TGS on the affected and unaffected sides, and mFES. Multiple logistic regression analysis revealed that the incidence of fall history is associated with TGS on the affected side; the weaker the affected TGS of the KOA, the more likely the individual is to fall.

CONCLUSIONS

Our results indicate that TGS on the affected side is related to a history of falls in older adults with KOA. The significance of evaluating TGS among patients with KOA in routine clinical practice was demonstrated.

Development of reference charts for monitoring quadriceps strength with handheld dynamometry after total knee arthroplasty

Purpose: To develop reference charts that describe normative quadriceps strength recovery after total knee arthroplasty (TKA) as measured by handheld dynamometry (HHD).Materials and Methods: We conducted a retrospective analysis of post-TKA quadriceps strength recovery in a longitudinal dataset consisting of both clinical and research HHD data. We created sex-specific models for recovery using Generalized Additive Models for Location, Scale, and Shape. We created reference charts from the models to display the recovery of population centiles over the first six postoperative months.Results: A total of 588 patient records with 1176 observations were analyzed. Reference charts for both sexes demonstrated a rapid increase in quadriceps strength over the first 60 postoperative days followed by a more gradual increase over the next 120 days. Males appeared to demonstrate faster recovery and greater strength on average compared to females. The quadriceps strength recovery of three female patient records was plotted on the reference chart to illustrate the charts' potential clinical utility.Conclusions: These reference charts provide normative data for quadriceps strength recovery after TKA as assessed by HHD. The reference charts may augment clinicians' ability to monitor and intervene upon quadriceps weakness-a pronounced and debilitating post-TKA impairment-throughout rehabilitation.Implications for RehabilitationHandheld dynamometry (HHD) is an objective and clinically feasible method for assessing muscle strength, but normative HHD values are lacking for quadriceps strength recovery after total knee arthroplasty (TKA).We created sex-specific reference charts which provide normative quadriceps strength HHD values for the first 180 days after TKA.These reference charts may improve clinicians' ability to monitor and intervene upon post-TKA quadriceps strength deficits.

Use It or Lose It? A Meta-Analysis on the Effects of Resistance Training Cessation (Detraining) on Muscle Size in Older Adults

This review aimed to explore the effect of resistance training cessation (detraining) on muscle size in older adults. Five databases were searched to find eligible studies. Their methodological quality was assessed using the PEDro checklist. The data were pooled in a random-effects meta-analysis. Six studies, with eight groups, were included in the review. Resistance training interventions lasted from 9 to 24 weeks. The detraining duration was from 12 to 52 weeks. Studies were classified as being of fair or good methodological quality. Compared to the baseline data, muscle size significantly increased following the resistance training intervention (Cohen's d: 0.99; 95% confidence interval: 0.63, 1.36). Compared to the post-resistance training data, there was a significant decrease in muscle size following training cessation (Cohen's d: -0.83; 95% confidence interval: -1.30, -0.36). In subgroup analyses, there was no significant decrease in muscle size following 12-24 weeks of training cessation (Cohen's d: -0.60; 95% confidence interval: -1.21, 0.01). There was a significant decrease in muscle size following 31-52 weeks of training cessation (Cohen's d: -1.11; 95% confidence interval: -1.75, -0.47). In summary, resistance training increases muscle size in older adults. In contrast, training cessation is associated with a decrease in muscle size. However, the loss of muscle size might be related to detraining duration, with greater muscle loss occurring during longer duration detraining periods. Future studies are required to establish the time course of muscle size changes during detraining in older adults.

Can an Eight-Session Multicomponent Physical Exercise Program Reduce Fall Risk and Fear of Falling among the Elderly?

In older populations, falls are responsible for decrease autonomy and increased pain and injuries. With aging, fall risk is multifactorial and associated with sarcopenia, impaired balance, falls themselves and psychological factors such as fear of falling. The objectives of the present study were: (a) to test the effects of a short multicomponent physical exercise program on fall risk and fear of falling; and (b) to analyze the relationship between fall risk and fear of falling. The participants were thirty-five older persons who were engaged in an eight-session physical exercise program. Balance (i.e., One-leg Balance Test, and Functional Reach Test), lower-limb endurance (i.e., Wall-sit Test) and fear of falling were measured before and after the multicomponent physical exercise program. Results indicated an increase in balance and a diminution of fear of falling after the end of the physical exercise program (p < 0.05). The program has an effect on lower limb endurance (p > 0.05). Gains in balance were correlated to the diminution of fear of falling (p < 0.05). An 8-week multicomponent physical exercise program based on balance is efficient to reduce fall risk and fear of falling among the elderly.

Knee extensor force production and discomfort during neuromuscular electrical stimulation of quadriceps with and without gluteal muscle co-stimulation

Purpose

To investigate whether Neuromuscular Electrical Stimulation (NMES) simultaneously applied on the quadriceps (Q) and gluteal (G) muscles, as compared to single Q-stimulation alters the knee extensor force production and discomfort.

Methods

A total of 11 healthy participants (6 females), with normal weight and age between 19 and 54 years were included. The unilateral, isometric maximal voluntary contraction (MVC) was assessed for each participant in an isokinetic dynamometer (Biodex, system 3). NMES was, in a randomized order, applied only on the Q-muscle and on the Q- and G-muscles (QG) simultaneously. NMES-intensity was increased stepwise until the maximal tolerable level was reached regarding discomfort, graded according to the visual analogue scale (VAS). VAS and the % of MVC produced by NMES, were registered for each level, expressed as median (inter-quartile range).

Results

The maximum tolerated NMES-intensity applied on Q compared to QG resulted in equally high discomfort, 8.0 (6.0–9.0) vs 8.0 (6.3–9.0), and in equivalent knee extensor force production, 36.7 (29.9–47.5) and 36.2 (28.9–49.3), respectively, in % of MVC. At 20% of MVC, NMES applied on Q compared to QG resulted in equal acceptable discomfort, 3.0 (2.0–4.5) vs 3.0 (3–5.5), and comparable intensity levels, 41.5 (38.0–45.8) vs 43.5 (37.0–48.8), respectively.

Conclusions

Simultaneous QG-NMES, as compared to single Q-NMES, does not seem to affect the knee extensor force production or discomfort. Q-NMES, without voluntary muscle contraction, can with an acceptable level of discomfort result in at least 20% of MVC.

Nurses’ perceptions of fall risk factors and fall prevention strategies in acute care settings in Saudi Arabia

Aim

This study aimed to explore nurses’ perceptions of the factors associated with falls and of fall prevention strategies in acute care settings in Saudi Arabia.

Design

This is a cross‐sectional, correlational, descriptive study.

Methods

Data were collected from 102 nurses using a survey on the risk factors and prevention strategies of injurious falls.

Results

We found that impaired balance and muscle strength, limited mobility, and an inability to follow safety instructions were reported as the top factors in falls. Multidisciplinary fall prevention strategies are effective in reducing the prevalence of falls. Nurses with higher levels of education had higher perceptions towards the risk factors of falls. Formal patient safety training, including fall prevention education programmes, were shown to reduce falls by making nurses more aware of fall risk factors and prevention strategies. The findings of this study can be used to inform managers about factors that may contribute to falls in acute care settings.

Sarcopenia, Obesity, and Sarcopenic Obesity: Relationship with Skeletal Muscle Phenotypes and Single Nucleotide Polymorphisms

Obesity may aggravate the effects of sarcopenia on skeletal muscle structure and function in the elderly, but no study has attempted to identify the gene variants associated with sarcopenia in obese women. Therefore, the aims of the present study were to: (1) describe neuromuscular function in sarcopenic and non-sarcopenic women with or without obesity; (2) identify gene variants associated with sarcopenia in older obese women. In 307 Caucasian women (71 ± 6 years, 66.3 ± 11.3 kg), skeletal muscle mass was estimated using bioelectric impedance, and function was tested with a 30 s one-leg standing-balance test. Biceps brachii thickness and vastus lateralis cross-sectional area (VL_ACSA) were measured with B-mode ultrasonography. Handgrip strength, maximum voluntary contraction elbow flexion (MVC_EF), and knee extension torque (MVC_KE) were measured by dynamometry, and MVC_KE/VL_ACSA was calculated. Genotyping was performed for 24 single-nucleotide polymorphisms (SNPs), selected based on their previous associations with muscle-related phenotypes. Based on sarcopenia and obesity thresholds, groups were classified as sarcopenic obese, non-sarcopenic obese, sarcopenic non-obese, or non-sarcopenic non-obese. A two-way analysis of covariance was used to assess the main effects of sarcopenia and obesity on muscle-related phenotypes and binary logistic regression was performed for each SNP to investigate associations with sarcopenia in obesity. There were no significant obesity * sarcopenic status interactions for any of the investigated muscle-related phenotypic parameters. Neither sarcopenia nor obesity had a significant effect on biceps brachii thickness, but sarcopenia was associated with lower VL_ACSA (p = 0.003). Obesity was associated with lower MVC_EF (p = 0.032), MVC_KE (p = 0.047), and MVC_KE/VL_ACSA (p = 0.012) with no significant effect of sarcopenia. Adjusted for age and height, three SNPs (ACTN3 rs1815739, MTHFR rs1801131, and MTHFR rs1537516) were associated with sarcopenia in obese participants. Sarcopenia was associated with a smaller muscle size, while obesity resulted in a lower muscle quality irrespective of sarcopenia. Three gene variants (ACTN3 rs1815739, MTHFR rs1801131, and MTHFR rs1537516) suspected to affect muscle function, homocysteine metabolism, or DNA methylation, respectively, were associated with sarcopenia in obese elderly women. Understanding the skeletal muscle features affected by sarcopenia and obesity, and identification of genes related to sarcopenia in obese women, may facilitate early detection of individuals at particular risk of sarcopenic obesity.

Chronic Quadriceps Tendon Rupture Reconstruction with Sartorius Muscle Transfer: A Report of Five Cases

Disruption of the knee extensor mechanism is an unfavorable situation because efficient mobilization requires a functioning knee extensor apparatus. The purpose of this retrospective study was to report our technique of sartorius muscle transfer for restoration of extension mechanism function and the outcomes of five patients. Patients with ruptured knee extensor mechanism secondary to trauma or knee arthroplasty-related issues were studied retrospectively. In all patients, sartorius muscle was transferred to restore the quadriceps tension deficit. Increase in the knee active range of motion, increase in the extensor mechanism power by one grade on Medical Research Council scale, and improvement in the extension lag were observed in all patients. The sartorius muscle transfer can be a reliable option to restore the knee extensor mechanism in chronic quadriceps tendon injuries. Our initial results are promising and showed improvement of the extensor mechanism muscle power, increased knee active range of motion, and decreased knee extension lag. The complications we observed did not impair the successful outcome of the sartorius transfer and were anticipated given the complexity of the studied cases. We encourage additional studies of sartorius muscle transfer to treat chronic quadriceps tendon injuries.

Evaluation of short-term multi-component exercise programming on major variables that directly influence fall risk in older women: a pilot study

Falls are linked to gait and balance inconsistencies influenced by a combination of variables including muscle strength and power. Multicomponent athlete training models that incorporate high-intensity challenging activities have been shown to significantly improve strength, power, and balance. This study evaluated the efficacy of a short-term multi-component dynamic training program on strength, power, and balance in older women. Seventeen women participated in 8-weeks of specialized exercise training. Significant changes were observed in all performance variables from baseline. Results suggest short-term, high intensity multi-component programming can be used safely and effectively to improve major variables that influence falls in older women.

Effects of Photobiomodulation/Laser Therapy Combined With Resistance Training on Quadriceps Hypertrophy and Strength, and Postural Balance in Older Women: A Randomized, Triple-Blinded, Placebo-Controlled Study

BACKGROUND AND PURPOSE

Physical and therapeutic strategies to maintain and rehabilitate skeletal muscle mass, strength, and postural balance are clinically relevant to improve the health, well-being, and quality of life of older adults. The purpose of this study was to investigate the effects of photobiomodulation (PBM)/laser therapy combined with a resistance training (RT) program on quadriceps hypertrophy and strength, and postural balance in older women.

METHODS

In a randomized, triple-blinded, placebo-controlled design, twenty-two older women (age 66.6 ± 5.2 years) were engaged in a supervised 10-wk RT program (2 times per week) involving unilateral leg extension exercise, in which each leg of the same participant was randomly assigned to receive active (λ = 808 nm, optical output = 100 mW, total energy = 42 J) or placebo laser PBM immediately before the RT sessions. Maximal dynamic strength by unilateral knee extension 1-repetition maximum (1RM), muscle hypertrophy by vastus lateralis muscle thickness, and postural balance by one-legged stance test on a force platform were assessed before and after the training program.

RESULTS

Significance statistical analysis revealed a similar improvement (time P = .003) from pre- to posttraining for muscle hypertrophy and strength, and postural balance between active and placebo laser conditions. However, clinical interpretation for muscle hypertrophy showed a moderate effect (effect size [ES] = 0.58) for the active laser and a small effect (ES = 0.38) for the placebo laser. Clinical difference was not noticed between conditions for other analyzed variables.

CONCLUSIONS

These findings indicate that RT alone can be clinically important for counteracting the deleterious effects of aging on muscle size, strength, and balance, and that applying laser PBM therapy before the RT sessions may further improve gains in muscle hypertrophy.

Associations Between Obesity With Low Muscle Mass and Physical Function in Patients With End-Stage Knee Osteoarthritis

Objective

To investigate the prevalence of obesity with low muscle mass and its impact on physical function, quality of life (QOL) and pain in patients with end-stage knee osteoarthritis over 65 years old.

Methods

In this cross-sectional study, we assessed a total of 562 patients. After separating the group into males and females, we divided patients into 4 further groups: normal BMI with normal muscle mass, obesity with normal muscle mass, normal BMI with low muscle mass and obesity with low muscle mass. All patients completed stair climbing test (SCT), 6-minute walk test, timed up and go test (TUG), instrumental gait analysis, Western Ontario McMaster Universities Osteoarthritis Index, VAS, and EuroQOL 5 dimensions questionnaire.

Results

Obesity with low muscle mass was diagnosed in 6 males subjects (7.8%) and 9 female subjects (1.9%). Patients with obesity and low muscle mass performed the SCT-ascent and descent significantly slower than other body composition groups in both males and females. TUG in males and gait speed in females were also significantly slower in the obesity with low muscle mass group. Stepwise multiple linear regression analysis revealed that in males, obesity with low muscle mass was significantly predictive of SCT ascent (β = 0.409, p < 0.001), SCT-descent (β = 0.405, p < 0.001), and TUG (β = 0.283, p = 0.009), and in females, obesity with low muscle mass was significantly predictive of SCT-ascent (β = 0.231, p < 0.001), SCT-descent (β = 0.183, p < 0.001), and gait speed (β=-0.129, p = 0.004).

Conclusions

This study confirms that the combination of obesity and low muscle mass is associated with impaired physical function in patients with end-stage knee osteoarthritis.

Early Maximal Strength Training Improves Leg Strength and Postural Stability in Elderly Following Hip Fracture Surgery

Introduction:

Hip fractures predominantly occur in the geriatric population and results in increased physical inactivity and reduced independency, largely influenced by a downward spiral of ambulatory capacity, related to loss of skeletal muscle strength and postural stability. Thus, effective postoperative treatment, targeting improvements in muscle strength, is sought after.

Materials & Methods:

Twenty-one hip fracture patients (>65 yr) were randomized to 8 weeks of either conventional physiotherapy control group (CG), or leg press and hip abduction maximal strength training (MST) 3 times per week. MST was performed applying heavy loads (85-90% of 1 repetition maximum; 1RM) and 4-5 repetitions in 4 sets. Maximal strength (bi- and unilateral 1RM), postural stability (unipedal stance test; UPS), and DEXA-scan bone mineral content/ density (BMC/BMD) were measured before and after the 8-week rehabilitation.

Results:

Both MST and conventional physiotherapy improved bilateral leg press 1RM by 41 ± 27 kg and 29 ± 17 kg, respectively (both p < 0.01), while unilateral leg press 1RM only increased after MST (within group and between groups difference: both p < 0.05). MST also resulted in an increase in abduction 1RM in both the fractured (5 kg, 95%CI: 2-7; p < 0.01) and healthy limb (6 kg, 95%CI: 3-9; p < 0.01), while no such improvement was apparent in the CG (between groups difference: p < 0.01). Finally, MST improved UPS of the fractured limb (p < 0.05). No differences were observed in BMC or BMD following the 8 weeks.

Discussion:

Early postoperative MST improved lower extremities maximal muscle strength more than conventional physiotherapy and was accompanied by improvements in postural stability.

Conclusion:

Implementing MST in early rehabilitation after hip fracture surgery should be considered as a relevant treatment to curtail the downward spiral of reduced ambulatory capacity typical for this patient group, possibly reducing the risk of recuring falls and excess mortality.

Trial Registration:

https://clinicaltrials.gov/ct2/show/NCT03030092

The results of patellar stainless steel wire extensor mechanism reconstruction in proximal tibial tumour excision mega-prosthesis surgeries for proximal tibial sarcomas

BACKGROUND

Extensor mechanism function after a proximal tibial tumour excision is the major determining factor for the limb function. However, problems of extensor lag, delayed healing and poor functional outcomes exist with the previous methods of its reconstruction. We describe a novel technique of using a patellar stainless steel (SS) wire to reconstruct the extensor apparatus of the knee in non-porous coated implants and examine the functional outcome and associated complications.

METHODS

This was a retrospective analytical interventional study. Twenty-six patients operated between 2011 and 2019 were included. Extensor lag measured at 6 months and 12 months postoperative, total range of motion at 12 months and Musculoskeletal Tumor Society (MSTS) score at the final visit were retrieved. Complications that occurred during the follow up period were noted. Patellar position was measured using comparative patellar-position-ratio.

RESULTS

Mean extensor lag at 6 months was 18.5° which improved to 8.7° at 12 months. Patellar malposition and deep infection were found to be the causes of poor functional outcome. A patellar-position-ratio between 0.9 and 1.1 led to a well-functioning extensor apparatus. Four patients underwent above-knee amputations. Deep infection and amputations reduced the MSTS score. An SS wire give way after 6 months did not affect the extensor power. A medial gastrocnemius flap reduced the infection rates.

CONCLUSION

Patellar SS wiring is an effective technique for reconstructing the knee extensor apparatus following a proximal tibial tumour excision mega-prosthesis. Proper position of the SS wire prevents wire-related complications. For a well-functioning extensor apparatus, use of a gastrocnemius flap cover intra-operatively is pertinent along with lack of infection for a pain-free, stable and mobile limb.

Risk factors associated with history of falls in adults with intellectual disability

BACKGROUND

Adults with intellectual disability (ID) have a higher risk for falls than the general population.

AIM

The purpose of this study was to identify risk factors for falls in adults with ID using objective measurements.

METHODS

Eighty adults with ID (men 36 women 44 age 43 ± 13 years) provided data on falls history, health problems or limitations in daily life, physical activity (PA), and physical performance. We conducted independent-samples t-tests, and Chi-square (χ²) tests to examine the difference between fallers and non-fallers. Multivariate logistic regressions were performed to identify the independent effects of risk factors for falls in adults with ID.

RESULTS

Fallers had significantly lower SPPB, mobility, and moderate PA than non-fallers (p <  .05). Fallers were more likely to be older, need support with activities of daily living (ADLs), and have arthritis or rheumatism, walking problem, and limitations to participating in PA than non-fallers (p <  .05). Among these variables, only needing support with ADLs remained a significant independent predictor of falls in a multivariate model.

CONCLUSION

Support need for ADLs can predict falls in individuals with ID. Caregivers may need to closely monitor adults with ID who need support for ADLs.

Patients performing lower limb exercises in an orthopedic ward: a best practice implementation project

AIMS

The evidence-based project sought to educate patients on doing lower limb exercises within 24 h of their admissions to the ward. Patients spend most of their time in bed during their hospital stays, which imposes negative outcomes due to inactivity, such as risks of reduced muscle mass and deconditioning, which may further implicate patients' conditions.

METHODS

The project occurred in three phases over a period of 18 months. The project was undertaken in an orthopedic ward of an acute tertiary hospital. A preimplementation and postimplementation audit strategy using the Joanna Briggs Institute's Practical Application of Clinical Evidence System was conducted on a sample of 20 adult patients. The Getting Research into Practice framework was utilized to analyze the barriers and gaps encountered in the clinical ground.

RESULTS

The baseline audit result revealed that only 35% of the patients received education on the exercise program and that there was poor compliance on nursing documentation of the intervention in daily note-free texts. Following the implementation, there was an improvement in nurses' documentation compliance. In follow-up audits one and two, the nurses achieved compliance rates of 60 and 90% in nursing documentation, respectively.

CONCLUSION

Overall, there were improvements in provision of lower limb exercise education to patients. This project has demonstrated that patients were willing to exercise during hospitalization. Nurses play a significant role in providing early education to patients to do simple exercises. The implementation of the evidence-based project may increase the awareness of the importance of exercises to minimize hospital-acquired deconditioning and functional declines among ward nurses and patients.

Skeletal Muscle Mitochondrial Dysfunction Is Present in Patients with CKD before Initiation of Maintenance Hemodialysis

BACKGROUND AND OBJECTIVES

Patients with CKD suffer from frailty and sarcopenia, which is associated with higher morbidity and mortality. Skeletal muscle mitochondria are important for physical function and could be a target to prevent frailty and sarcopenia. In this study, we tested the hypothesis that mitochondrial dysfunction is associated with the severity of CKD. We also evaluated the interaction between mitochondrial function and coexisting comorbidities, such as impaired physical performance, intermuscular adipose tissue infiltration, inflammation, and oxidative stress.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Sixty-three participants were studied, including controls (n=21), patients with CKD not on maintenance hemodialysis (CKD 3-5; n=20), and patients on maintenance hemodialysis (n=22). We evaluated in vivo knee extensors mitochondrial function using ³¹P magnetic resonance spectroscopy to obtain the phosphocreatine recovery time constant, a measure of mitochondrial function. We measured physical performance using the 6-minute walk test, intermuscular adipose tissue infiltration with magnetic resonance imaging, and markers of inflammation and oxidative stress in plasma. In skeletal muscle biopsies from a select number of patients on maintenance hemodialysis, we also measured markers of mitochondrial dynamics (fusion and fission).

RESULTS

We found a prolonged phosphocreatine recovery constant in patients on maintenance hemodialysis (53.3 [43.4-70.1] seconds, median [interquartile range]) and patients with CKD not on maintenance hemodialysis (41.5 [35.4-49.1] seconds) compared with controls (38.9 [32.5-46.0] seconds; P=0.001 among groups). Mitochondrial dysfunction was associated with poor physical performance (r=0.62; P=0.001), greater intermuscular adipose tissue (r=0.44; P=0.001), and increased markers of inflammation and oxidative stress (r=0.60; P=0.001). We found mitochondrial fragmentation and increased content of dynamin-related protein 1, a marker of mitochondrial fission, in skeletal muscles from patients on maintenance hemodialysis (0.86 [0.48-1.35] arbitrary units (A.U.), median [interquartile range]) compared with controls (0.60 [0.24-0.75] A.U.).

CONCLUSIONS

Mitochondrial dysfunction is due to multifactorial etiologies and presents prior to the initiation of maintenance hemodialysis, including in patients with CKD stages 3-5.

Falling risk in patients with end-stage knee osteoarthritis

Although 25% of patients with end-stage knee osteoarthritis (OA) have reported a fall, there is limited information about risk factors for falling in patients awaiting total knee arthroplasty (TKA). The purpose of this study was to identify clinical and functional measures related to fall risk. A total of 259 participants awaiting TKA for OA participated in this secondary cross-sectional study. Participants were divided into fallers and non-fallers based on falling history in the prior 6 months. Clinical measures (hip and knee pain, neck and low back pain (LBP), knee range of motion, and quadriceps strength) and functional measures (six-minute walk test (6MWT), timed up and go test, and Knee Injury and Osteoarthritis Outcome Score (KOOS)) were assessed in patients 2-4 weeks prior to TKA. Independent t tests were used to examine differences between groups. Odds ratio was calculated to identify clinical risk factors for falling. Of all participants, 47 (18%) reported a fall in the previous 6 months. Fallers had 30% greater LBP (3.0 ± 2.5 vs. 2.1 ± 2.6; p = 0.025). Fallers walked 12% shorter distance in the 6MWT than non-fallers (378 ± 100 vs. 422 ± 105 m; p = 0.010). For every 1-point increase in LBP on a 0-10 scale, there was a 14% greater risk of falling (p = 0.028). For every 10-m increase in 6MWT, there was a 3.8% reduction in fall risk (p = 0.011). Greater LBP and worse walking endurance are associated with falls in individuals with end-stage OA. Future studies should determine if interventions that reduce LBP and improve walking performance also reduce the chance of falling.

Effects of A "Modified" Otago Exercise Program on the Functional Abilities and Social Participation of Older Adults Living in the Community-The AGA@4life Model

Strength and balance exercises form part of multifactorial programs to reduce the risk of falling and promote active ageing. The aim of this study was to evaluate the effect of a strength and balance exercise program, adapted from the traditional Otago Exercise Program (OTAGO) into a technological system. A non-randomized experimental study enrolled 34 participants (83.24 ± 6.89 years) from a daycare center in Portugal, who were distributed into an intervention group (IG; 18 participants) and a control group (CG; 16 participants). The IG underwent a "modified" OTAGO incorporated in a technological system using pressure and inertial sensors, feedback, and Exergames for 8 weeks, 3 times a week. The CG continued their regular activities. Outcome measures were evaluated at baseline and after 8 weeks of intervention. After the program, differences were observed between the groups in handgrip strength (p = 0.03), step test (p = 0.03), 4stage balance test "modified" (p < 0.001) and activities and participation profile related to mobility (PAPM) (p < 0.001). The IG showed positive results in the self-efficacy for exercise (p = 0.03), PAPM (p = 0.00) and all functional tests, except for timed up and go (p = 0.35). No significant changes were observed in the CG. The results support this intervention program as a good exercise solution to improve functional abilities, social participation, and self-efficacy, reducing the risk of falling.

Postural balance, muscle strength, and history of falls in end-stage renal disease patients living with a kidney transplant: A cross-sectional study

BACKGROUND

End-stage renal disease patients living with a kidney transplant (KT) often present with frailty, functional disability, and mobility impairments that may result in a high risk of falls. Postural balance and muscle strength are implicated in the etiology of falls in the geriatric population, and both may be impaired in KT patients.

RESEARCH QUESTION

We conducted a cross-sectional investigation to estimate the prevalence of falls, as well as to explore the association between postural balance, muscle strength and history of falls in end-stage renal disease patients living with a KT.

METHODS

Fifty-nine prevalent KT patients (age = 53.2 ± 11 years) were enrolled in this cross-sectional study. Participants were classified as fallers/non-fallers and underwent an objectively-measured assessment of postural balance on a stabilometric platform in eyes open (EO), eyes closed (EC), and dual-task (DT) conditions. Center of pressure (CoP) variables were taken for the analysis. In addition, participants underwent isometric (IM) and isokinetic (IK) assessments of lower limb muscle strength on a multi-joint evaluation system.

RESULTS

Thirty-four percent of the study participants reported at least one fall in the previous 12 months. In logistic regression analysis, CoP velocity in EO (OR: 1.23, 95 % CI: 1.06-1.43, p = .007), and IK ankle dorsiflexion strength (OR: 0.87, 95 % CI: 0.77-0.99, p = .034) were independently associated with increased odds of falling.

SIGNIFICANCE

This cross-sectional study indicates that patients living with a KT presented with a prevalence of falls indicative of a high risk of falling. Postural balance and muscle strength are exercise-modifiable factors and further research is warranted to establish to what extent these measures may be implicated in the etiology of falling in this patient group.

Does Patellar Tendon Repair With Gastrocnemius Flap Augmentation Effectively Restore Active Extension After Proximal Tibial Sarcoma Resection?

BACKGROUND

A rotational gastrocnemius flap is often used for soft tissue reconstruction after proximal tibia sarcoma resection. However, little is known about the frequency and severity of complications and the recovery of extensor function after this procedure.

QUESTIONS/PURPOSES

After gastrocnemius flap reconstruction with split-thickness skin grafting (STSG) to augment the extensor mechanism repair after proximal tibial resection for sarcoma, we asked: (1) What ROM was achieved (including extensor lag and active flexion)? (2) How often did complications and reoperations occur and what caused them?

METHODS

Between 1991 and 2014, one surgeon treated 26 patients with proximal tibial resections for primary bone sarcoma. Of these, 18 were reconstructed with the preferred approach: resecting the proximal tibia leaving the patellar tendon in continuity with the tibialis anterior fascia whenever possible (10), cementing a stemmed proximal tibial endoprosthesis, suturing the patellar tendon to the implant, rotating a medial (16) or lateral (two) gastrocnemius flap over the tendon and prosthesis to augment the repair, and covering the flap with STSG. Alternative methods were used when this was technically impossible (one patient), when there was no advantage to secondary soft tissue coverage (two patients), or when the limb could not be salvaged (five patients). Of the 18 treated with gastrocnemius flaps, two were lost to followup or died of disease before the 24-month minimum and excluded; the median followup of the remaining 16 was 6 years (mean, 9.9 years; range, 2.3-21.7 years); three patients died of disease, and four have not been seen within the last 5 years. We reviewed medical records for passive and active extension, maximum flexion achieved, and complications requiring reoperation. ROM in patients with successful limb salvage was graded as excellent (flexion ≥ 110° and no lag), good (flexion 90°-110° and lag ≤ 10°), fair (one function limited: either flexion < 90° or lag > 10°), or poor (both functions limited: flexion < 90° and lag > 10°).

RESULTS

At latest followup, three patients had undergone amputation for deep infection. Of those remaining, median active flexion was 110° (mean, 104°; range, 60°-120°) and extensor lag was 0° (mean, 4°; range, 0°-10°). ROM was excellent in nine patients, good in three, fair in one, and poor in none. We observed 18 complications requiring reoperation in 12 patients, including deep infection (four), patellar tendon avulsion/attenuation (three), and flap necrosis (one). Survivorship free from revision or loss of the gastrocnemius flap was 74% (95% confidence interval [CI], 5.6-95.8) at 2, 5, and 10 years. Survivorship free from reoperation for any cause was 74% (95% CI, 52.0-96.0) at 2 years, 52% (95% CI, 25.8-77.8) at 5 years, and 35% (95% CI, 0-61.5) at 10 years using Kaplan-Meier analysis.

CONCLUSIONS

Although most patients regained functional ROM including active extension, 12 required reoperation for complications including infection and early extensor mechanism failures. Despite the observed risks, we believe the gastrocnemius flap with STSG should be considered a suitable approach to provide active extension and soft tissue coverage given the paucity of good surgical options for extensor mechanism reconstruction in this challenging clinical setting.

LEVEL OF EVIDENCE

Level IV, therapeutic study.

The effect of resistance training on health-related quality of life in older adults: Systematic review and meta-analysis

Background: Resistance training (RT) is recommended as part of our national physical activity guidelines which includes working all major muscle groups on two or more days a week.Older adults can gain many health benefits from RT, such as increased muscle strength,increased muscle mass, and maintenance of bone density. Additionally, certain dimensions of health-related quality of life (HRQOL) have been shown to improve in older adults due to RT intervention. The purpose of this study was to use systematic review and meta-analytic techniques to examine the effect of RT on HRQOL in older adults.

Methods: A systematic review of current studies (2008 thru 2017) was conducted using PubMed. Studies were included if they used a randomized controlled design, had RT as an intervention, measured HRQOL using the SF-36/12 assessment, and included adults 50+ years of age. Eight dimension scores (physical functioning, bodily pain, physical role function, general health, mental health, emotional role function, social function, and vitality) and two summary scores (physical component and mental component) were extracted. Ten meta-analyses were performed using standardized mean effect sizes and random effects models. Study quality,moderator and sensitivity analyses were conducted.

Results: A total of 16 studies were included in the analyses with a mean Physiotherapy Evidence Database (PEDro) score of 4.9 (SD=1.0). Among the mental health measures, RT had the greatest effect on mental health (Effect size [ES]=0.64, 95% CI: 0.30-0.99, I²=79.7). Among the physical health measures, RT had the largest effect on body pain (ES=0.81, 95% CI: 0.26-1.35, I²=85.9).Initially, RT did not significantly affect measures of emotional role function, social function or physical role function. However, after removing a single study, RT significantly increased all HRQOL measures.

Conclusion: The meta-analytic evidence presented in this research clearly supports the promotion of RT in improving HRQOL in older adults.