Clinically Meaningful Change for Physical Performance: Perspectives of the ICFSR Task Force

Olfaction and Mobility in Older Adults

Importance

Decreased mobility is a hallmark of aging. Olfactory dysfunction is common in older adults and may be associated with declines in mobility.

Objective

To determine whether poor olfaction was associated with faster declines in mobility in older adults.

Design, Setting, and Participants

This cohort study included 2500 participants from the Health, Aging, and Body Composition Study. Participants completed the Brief Smell Identification Test during the year 3 clinical visit (1999-2000) and were followed for up to 7 years. A data analysis was conducted between January and July 2023.

Exposures

Olfaction was defined as good (test score, 11-12), moderate (9-10), hyposmia (7-8), or anosmia (0-6).

Main Outcomes and Measures

Mobility was measured using the 20-m usual and fast walking tests in clinical visit years 3 to 6, 8, and 10 and the 400-m fast walking test in years 4, 6, 8, and 10.

Results

The primary analyses included 2500 participants (1292 women [51.7%]; 1208 men [48.3%]; 960 Black [38.4%] and 1540 White [61.6%] individuals; mean [SD] age, 75.6 [2.8] years). Multivariate-adjusted analyses showed that poor olfaction was associated with slower walking speed at baseline and a faster decline over time. Taking the 20-m usual walking test as an example, compared with participants with good olfaction, the speed at baseline was 0.027 (95% CI, 0-0.053) m/s slower for those with hyposmia and 0.034 (95% CI, 0.005-0.062) m/s slower for those with anosmia. Longitudinally, the annual decline was 0.004 (95% CI, 0.002-0.007) m/s/year faster for those with hyposmia and 0.01 (95% CI, 0.007-0.013) m/s/year faster for those with anosmia. Similar results were obtained for the 20-m and 400-m fast walking tests. Further, compared with participants with good olfaction, the odds of being unable to do the 400-m test were 2.02 (95% CI, 1.17-3.48) times higher for those with anosmia at the year 8 visit and 2.73 (95% CI, 1.40-5.35) times higher at year 10. Multiple sensitivity and subgroup analyses supported the robustness and generalizability of the findings.

Conclusion and Relevance

The results of this cohort study suggest that poor olfaction is associated with a faster decline in mobility in older adults. Future studies should investigate underlying mechanisms and potential health implications.

Effects of Radio-Taiso on Health-Related Quality of Life in Older Adults with Frailty: A Randomized Controlled Trial

BACKGROUND

Radio-Taiso could be a sustainable public health strategy for maintaining quality of life (QoL) in older adults with frailty. This study aimed to investigate whether Radio-Taiso provided greater benefits for health-related quality of life (HR-QoL) and to identify the mechanisms underlying the effectiveness in this population.

METHODS

A 12-week randomized controlled trial enrolled 226 older Japanese adults with pre-frailty or frailty, assessed using the modified frailty phenotype. Participants were randomly allocated to the intervention (Radio-Taiso + nutrition program) or control (nutrition program) groups. The Radio-Taiso program comprised five 60-min group sessions and daily practice at the participants' homes. The primary outcome was the change in the mental domain of HR-QoL, assessed using the SF-36®. The secondary outcomes included six physical fitness items and exercise self-efficacy.

RESULTS

Overall, 104 and 105 participants in the intervention and control groups, respectively, were analyzed based on the intention-to-treat principle. The median (interquartile range) daily practice rate of Radio-Taiso was 94.1% (73.2-98.8%). Although general linear models adjusted for baseline values and allocation stratification factors showed that the intervention group obtained greater benefits (adjusted mean differences [95% confidence intervals]) in the up-and-go (0.3 [0.1, 0.6] s), 2-min step-in-place (-3.2 [-6.2, -0.2] steps) tests, and exercise self-efficacy scale (-1.4 [-2.6, -0.1] points) than the control group, there were no group differences in changes in the mental domain score of HR-QoL.

CONCLUSIONS

Radio-Taiso provided greater benefits for agility/dynamic balance, aerobic endurance, and exercise self-efficacy in older adults with frailty; however, these changes do not improve HR-QoL.

Construct validity of the electronic Veterans Affairs Frailty Index against clinician frailty assessment

BACKGROUND

Electronic frailty indices (eFIs) can expand measurement of frailty in research and practice and have demonstrated predictive validity in associations with clinical outcomes. However, their construct validity is less well studied. We aimed to assess the construct validity of the VA-FI, an eFI developed for use in the U.S. Veterans Affairs Healthcare System.

METHODS

Veterans who underwent comprehensive geriatric assessments between January 31, 2019 and June 6, 2022 at VA Boston and had sufficient data documented for a comprehensive geriatric assessment-frailty index (CGA-FI) were included. The VA-FI, based on diagnostic and procedural codes, and the CGA-FI, based on geriatrician-measured deficits, were calculated for each patient. Geriatricians also assessed the Clinical Frailty Scale (CFS), functional status (ADLs and IADLs), and 4-meter gait speed (4MGS).

RESULTS

A total of 132 veterans were included, with median age 81.4 years (IQR 75.8-88.7). Across increasing levels of VA-FI (<0.2; 0.2-0.4; >0.4), mean CGA-FI increased (0.24; 0.30; 0.40). The VA-FI was moderately correlated with the CGA-FI (r 0.45, p < 0.001). Every 0.1-unit increase in the VA-FI was associated with an increase in the CGA-FI (linear regression beta 0.05; 95% confidence interval [CI] 0.03-0.06), higher CFS category (ordinal regression OR 1.69; 95% CI 1.24-2.30), higher odds of ADL dependency (logistic regression OR 1.59; 95% CI 1.20-2.11), IADL dependency (logistic regression OR 1.68; 95% CI 1.23-2.30), and a decrease in 4MGS (linear regression beta -0.07, 95% CI -0.12 to -0.02). All models were adjusted for age and race, and associations held after further adjustment for the Charlson Comorbidity Index.

CONCLUSION

Our results demonstrate the construct validity of the VA-FI through its associations with clinical measures of frailty, including summary frailty measures, functional status, and objective physical performance. Our findings complement others' in showing that eFIs can capture functional and mobility domains of frailty beyond just comorbidity and may be useful to measure frailty among populations and individuals.

The Effect of Family Wealth on Physical Function Among Older Adults in Mpumalanga, South Africa: A Causal Network Analysis

Objectives: The aging of the South African population could have profound implications for the independence and overall quality of life of older adults as life expectancy increases. While there is evidence that lifetime socio-economic status shapes risks for later function and disability, it is unclear whether, and how, the wealth of family members shapes these outcomes. We investigated the relationship between outcomes activities of daily living (ADL), grip strength, and gait speed, and the household wealth of non-coresident family members. Methods: Using data from Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) and the Agincourt Health and Demographic Surveillance System (AHDSS), we examined the relationship between physical function and household and family wealth in the 13 preceding years. HAALSI is a cohort of 5,059 adults who were 40 years or older at baseline in 2014. Using auto-g-computation-a recently proposed statistical approach to quantify causal effects in the context of a network of interconnected units-we estimated the effect of own and family wealth on the outcomes of interest. Results: We found no evidence of effects of family wealth on physical function and disability. Conclusion: Further research is needed to assess the effect of family wealth in early life on physical function and disability outcomes.

"We want more": perspectives of sarcopenic older women on the feasibility of high-intensity progressive resistance exercises and a whey-protein nutrition intervention

This qualitative study is nested within a 12-week pilot randomized-controlled, two-arm trial involving high-intensity progressive resistance training (PRT) or PRT with a multi-nutrient, whey-protein supplementation (PRT+WP) in sarcopenic older adults (trial registration no: TCTR20230703001). The aim was to investigate sarcopenic participants' perceptions and barriers to this multi-modal intervention strategy that may accelerate "real-world" implementation. Eighteen older adults (one man) with possible sarcopenia were invited to join the study, of whom 16 women were randomized to a thrice-weekly PRT (n = 8) program (80% of 1-repetitive maximum, six resistance band exercises) only or PRT plus daily weekday milk-based WP supplementation (PRT+WP, n = 8). Muscle strength (handgrip and 5-times sit-to-stand), mass (dual-energy X-ray absorptiometry), performance (Short Physical Performance Battery and stair ascent-descent), and nutrition status (Mini Nutritional Assessment) were assessed for changes. We randomly selected eight women for the semi-structured interview. Post-intervention, eight (50%) women were sarcopenia-free, six (38%) remained in possible sarcopenia, one (6%) improved to sarcopenia, and one (6%) deteriorated from possible to severe sarcopenia. There were no significant between-group differences, but significant within-group improvements (p < 0.05) were detected for handgrip strength (PRT+WP 5.0 kg, d = 0.93; PRT 6.1 kg, d = 0.55), 5-times sit-to-stand time (PRT 2.0 s, d = 1.04), nutrition score (PRT+WP 3.44, d = 0.52; PRT 1.80, d = 0.44), and stair ascent time (PRT+WP 0.97 s, d = 0.77; PRT 0.75 s, d = 0.97). Our thematic analyses identified four main themes, namely, (1) perceived benefits, (2) sustaining behavior changes, (3) challenges in participating, and (4) improved wellbeing. Participants expressed how they initially were skeptical and doubted that they could complete the exercises or tolerate the milk-based WP supplements. However, they reported positive experiences and benefits felt from strength gains, increased confidence, and better physical abilities. Participants were surprised by the zero adverse effects of WP supplements. The women wanted more nutritional information and structured, guided exercise programs and suggested a community-based implementation. In conclusion, our findings showed PRT was well received and may support reduced risks of sarcopenia. No added benefits were seen with the addition of WP supplementation, but a larger sample is required to address this question. Overall, older (previously sarcopenic) Malay women indicated that they want more multi-modal programs embedded in their community.

Study protocol of a cluster-randomised controlled trial assessing a multimodal machine-based exercise training programme in senior care facilities over 6 months - the bestform study (best function of range of motion)

BACKGROUND

Physical functioning is a crucial factor for independence and quality of life in old age. The aim of the "bestform-Best function of range of motion" trial is to investigate the effects of a 6 months multimodal machine-based strength, coordination and endurance training on physical function, risk of falls and health parameters in older adults.

METHODS

Bestform is a cluster-randomised trial including older adults  ≥ 65 years living in senior care facilities in Southern Germany. Senior care facilities are randomly allocated to the control group with usual care (n ≥ 10 care facilities) and to the intervention group (n ≥ 10 care facilities), overall including  ≥ 400 seniors. Residents belonging to the intervention group are offered a supervised machine-based exercise training programme twice weekly over 45-60 min over six months in small groups, while those in the usual care facilities will not receive active intervention. The primary outcome is the change in Short Physical Performance Battery over six months between groups. Secondary outcomes are change in risk of falling, fear of falling, number of falls and fall-related injuries, physical exercise capacity, handgrip strength, body composition, cardiac function, blood parameters, quality of life, risk of sarcopenia, activities of daily living, and cognition over three and six months.

DISCUSSION

The bestform study investigates the change in physical function between seniors performing exercise intervention versus usual care over six months. The results of the study will contribute to the development of effective physical activity concepts in senior care facilities.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT04207307. Registered December 2019.

Feasibility of implementing a supervised telehealth exercise intervention in frail survivors of hematopoietic cell transplantation: a pilot randomized trial

BACKGROUND

Patients undergoing hematopoietic cell transplantation (HCT) are at high risk of chronic health complications, including frailty and physical dysfunction. Conventional exercise programs have been shown to improve frailty in other cancer populations, but these have largely been based out of rehabilitation facilities that may act as geographic and logistical barriers. There is a paucity of information on the feasibility of implementing telehealth exercise interventions in long-term HCT survivors.

METHODS

We conducted a pilot randomized trial to assess the feasibility of an 8-week telehealth exercise intervention in 20 pre-frail or frail HCT survivors. Participants were randomized to either a telehealth exercise (N = 10) or delayed control (N = 10). We administered a remote physical function assessment at baseline, followed by an 8-week telehealth exercise intervention (30-60 min/session, 3 sessions/week), and post-intervention. The primary endpoint was feasibility as determined by 1) > 70% of participants completing all remote physical functional assessments, and 2) > 70% of participants in the exercise group completing > 70% (17/24) of the prescribed exercise sessions. Exploratory outcomes included changes in gait speed, handgrip strength, and short physical performance battery.

RESULTS

The mean [standard deviation] age at study enrollment was 64.7 [9.1] years old. Twelve had undergone allogenic and 8 had undergone autologous HCT at an average of 17 years from study enrollment. Both feasibility criteria were achieved. Nineteen patients (95%) completed all remote study outcome assessments at baseline and post-intervention, and nine participants in the exercise group completed > 70% of prescribed exercise sessions. Overall, no significant group x time interaction was observed on handgrip strength, fatigue, body mass index, and short physical performance battery test (P < 0.05). However, there were significant within-group improvements in four-meter gait speed (+ 13.9%; P = 0.004) and 5-minute gait speed (+ 25.4%; P = 0.04) in the exercise group whereas non-significant changes in four-meter gait speed (-3.8%) and 5-minute gait speed (-5.8%) were observed after 8 weeks.

CONCLUSION

Implementing an 8-week telehealth exercise intervention for long-term HCT survivors was feasible. Our findings set the stage for innovative delivery of supervised exercise intervention that reduces the burden of frailty in HCT survivors as well as other at-risk cancer survivors.

TRIAL REGISTRATION

The protocol and informed consent were approved by the institutional IRB (IRB#20731) and registered (ClinicalTrials.gov NCT04968119; date of registration: 20/07/2021).

Elastography in the assessment of the Achilles tendon: a systematic review of measurement properties

BACKGROUND

Managing and rehabilitating Achilles tendinopathy can be difficult, and the results are often unsatisfactory. Currently, clinicians use ultrasonography to diagnose the condition and predict symptom development. However, relying on subjective qualitative findings using ultrasound images alone, which are heavily influenced by the operator, may make it difficult to identify changes within the tendon. New technologies, such as elastography, offer opportunities to quantitatively investigate the mechanical and material properties of the tendon. This review aims to evaluate and synthesise the current literature on the measurement properties of elastography, which can be used to assess tendon pathologies.

METHODS

A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, PubMed, Cochrane, Scopus, MEDLINE Complete, and Academic Search Ultimate were searched. Studies assessing the measurement properties concerning reliability, measurement error, validity, and responsiveness of the instruments identified in healthy and patients with Achilles tendinopathy were included. Two independent reviewers assessed the methodological quality using the Consensus-based Standards for the Selection of Health Measurement Instruments methodology.

RESULTS

Out of the 1644 articles identified, 21 were included for the qualitative analysis investigating four different modalities of elastography: axial strain elastography, shear wave elastography, continuous shear wave elastography, and 3D elastography. Axial strain elastography obtained a moderate level of evidence for both validity and reliability. Although shear wave velocity was graded as moderate to high for validity, reliability obtained a very low to moderate grading. Continuous shear wave elastography was graded as having a low level of evidence for reliability and very low for validity. Insufficient data is available to grade three-dimensional shear wave elastography. Evidence on measurement error was indeterminate so evidence could not be graded.

CONCLUSIONS

A limited number of studies explored quantitative elastography on Achilles tendinopathy as most evidence was conducted on a healthy population. Based on the identified evidence on the measurement properties of elastography, none of the different types showed superiority for its use in clinical practice. Further high-quality studies with longitudinal design are needed to investigate responsiveness.

The Clinical Effectiveness of Denosumab (Prolia®) for the Treatment of Osteoporosis in Postmenopausal Women, Compared to Bisphosphonates, Selective Estrogen Receptor Modulators (SERM), and Placebo: A Systematic Review and Network Meta-Analysis

To assess the effectiveness and safety of denosumab (Prolia®) compared to bisphosphonates (alendronate, ibandronate, risedronate, zoledronate), selective estrogen receptor modulators (SERMs; bazedoxifene, raloxifene) or placebo, for the treatment of osteoporosis in postmenopausal women (PMW). Systematic searches were run in PubMed, Embase & Cochrane Library on 27-April-2022. Randomized controlled trials (RCTs) that included osteoporotic PMW allocated to denosumab, SERMs, bisphosphonates, or placebo were eligible for inclusion. RCTs were appraised using Cochrane Risk of Bias 2.0. Bayesian network and/or pairwise meta-analyses were conducted on predetermined outcomes (i.e. vertebral/nonvertebral fractures, bone mineral density [BMD], mortality, adverse events [AEs], serious AEs (SAEs), withdrawals due to AEs, AEs caused by denosumab discontinuation). A total of 12 RCTs (k = 22 publications; n = 25,879 participants) were included in the analyses. Denosumab, reported a statistically significant increase in lumbar spine (LS) and total hip (TH) BMD, compared to placebo. Similarly, denosumab also resulted in a statistically significant increase in TH BMD compared to the raloxifene and bazedoxifene. However, relative to denosumab, alendronate, ibandronate and risedronate resulted in significant improvements in both femoral neck (FN) and LS BMD. With regards to vertebral fractures and all safety outcomes, there were no statistically significant differences between denosumab and any of the comparator. Relative to placebo, denosumab was associated with significant benefits in both LS and TH BMD. Additionally, denosumab (compared to placebo) was not associated with reductions in vertebral and nonvertebral fractures. Finally, denosumab was not associated with improvement in safety outcomes, compared to placebo. These findings should be interpreted with caution as some analyses suffered from statistical imprecision.

Relationship between health literacy and physical function of patients participating in phase I cardiac rehabilitation: a multicenter clinical study

Health literacy (HL) is an important decision factor for health. Both low HL and low physical function cause adverse events in cardiovascular disease patients, but their relationship is not well documented. To clarify the relationship between HL and physical function of patients participating in cardiac rehabilitation and calculate the cutoff value of the 14-item HL scale (HLS) for low handgrip strength, this multicenter clinical study named the Kobe-Cardiac Rehabilitation project for people around the World (K-CREW) was conducted among four affiliated hospitals with patients who underwent cardiac rehabilitation. We used the 14-item HLS to assess HL, and the main outcomes were handgrip strength and Short Physical Performance Battery (SPPB) score. The study included 167 cardiac rehabilitation patients with a mean age of 70.5 ± 12.8 years, and the ratio of males was 74%. Among them, 90 patients (53.9%) had low HL and scored significantly lower in both handgrip strength and SPPB. Multiple linear regression analysis revealed that HL was a determinant factor (β = 0.118, p = 0.04) for handgrip strength. Receiver operating characteristic analysis revealed the cutoff value of the 14-item HLS for screening for low handgrip strength was 47.0 points, and the area under the curve was 0.73. This study showed that HL was significantly associated with handgrip strength and SPPB in cardiac rehabilitation patients and suggests the possibility of early screening for low HL to improve physical function in cardiac rehabilitation patients with low HL.

Pain, obesity, and physical function in Mexican American older adults during 20 years of follow-up

INTRODUCTION

Pain remains largely undertreated in older adults irrespective of health care setting. Mexican American adults in the United States have a high age-adjusted prevalence of obesity. However, the association of pain and obesity with physical function is understudied in this population.

OBJECTIVE

To examine the association of co-occurring pain and obesity with physical function over 20 years of follow-up in a cohort of older Mexican Americans who scored ≥7 (moderate to high) in the Short Physical Performance Battery (SPPB) test and were nondisabled at baseline.

DESIGN

Longitudinal population-based study.

SETTING

Community-dwelling older adults from Southwestern United States.

PARTICIPANTS

Mexican American adults age 65 years and older.

INTERVENTIONS

Not Applicable.

MAIN OUTCOME MEASURES

Physical function was assessed with the SPPB test (standing balance, timed 8-ft walk, and five repeated timed chair stands). Participants at baseline were divided into four groups: no pain-no obesity (n = 869), obesity only (n = 282), pain only (n = 216), and pain-obesity (n = 159). Generalized Estimating Equation models were used to estimate the odds ratio (OR) and 95% confidence interval (CI) of lower performance in physical function over 20 years as a function of pain-obesity grouping.

RESULTS

Participants with pain only (OR = 1.61, 95% CI = 1.34-1.95) and with co-occurring pain and obesity (OR = 2.32, 95% CI = 1.83-2.95) had significantly greater odds of physical function impairment over those with no pain-no obesity or obesity only, after controlling for all covariates.

CONCLUSION

Older Mexican American adults were at high risk for physical function impairment over time if they had pain or co-occurring pain and obesity. Early assessment and proper pain management as well as maintaining a healthy weight may reduce declines in physical function in older Mexican American adults.

Sensorimotor and Frontoparietal Network Connectivity Are Associated With Subsequent Maintenance of Gait Speed and Episodic Memory in Older Adults

BACKGROUND

Slow gait is predictive of functional impairments in older adults, while concomitant slow gait and cognitive complaints are associated with a greater risk for cognitive decline and dementia. However, functional neural correlates for gait speed maintenance are unclear. As the sensorimotor network (SMN) and frontoparietal network (FPN) are integral components of these functions, this study investigated differences in SMN and FPN in older adults with/without gait speed decline over 24 months; and whether these networks were associated with the maintenance of cognitive function.

METHODS

We included 42 community-dwelling older adults aged >70 years from the MOBILIZE Boston Study. Resting-state fMRI was performed at the study baseline. Participant characteristics, gait speed, Mini-Mental State Examination, and Hopkins Verbal Learning Test (HVLT) were assessed at baseline and at 24-month follow-up. Decliners were identified as individuals with >0.05 meters/second decline in gait speed from baseline to 24 months. Of the 26 decliners and 16 maintainers, decliners exhibited a significant decline in delayed-recall performance on the HVLT over 24 months.

RESULTS

Controlling for baseline age and multiple comparisons, contrary to initial hypothesis, maintainers exhibited lower baseline primary motor and premotor connectivity (p = .01) within the SMN, and greater baseline ventral visual-supramarginal gyrus connectivity within the FPN (p = .02) compared to decliners. Lower primary motor-premotor connectivity was correlated with maintenance of delayed-recall performance on the HVLT (p = .04).

CONCLUSION

These findings demonstrated a potential compensatory mechanism involved in the link between the decline in gait speed and episodic memory, whereby baseline connectivity of the SMN and FPN may underlie subsequent maintenance of gait speed and cognitive function in old age.

Impact of Exercise and Cognitive Stimulation Therapy on Physical Function, Cognition and Muscle Mass in Pre-Frail Older Adults in the Primary Care Setting: A Cluster Randomized Controlled Trial

OBJECTIVES

Multicomponent exercise program have shown to improve function and cognition in older adults but studies on pre-frail older adults in the primary care setting are limited. This study aimed i) to evaluate impact of 6 months exercise (Ex) versus complementary effect of 3 months of cognitive stimulation therapy (CST) to 6 months of Ex (Ex+CST) on physical function, muscle mass and cognition versus control group at 3, 6 and 12 months ii) inflammatory biomarkers such as Interleukin-6 (IL-6) and Tumor Necrosis Factor Alpha (TNF-α).

DESIGN

Cluster randomised control trial.

SETTING AND INTERVENTION

Pre-frail older adults ≥ 65 years attending primary care clinic. Two intervention groups i) Ex 6 months ii) CST 3 months with Ex 6 months.

MEASUREMENTS

At 0, 3, 6 and 12 months, questionnaires (on demographics, physical function, cognition, and depression) were administered and physical function assessment (gait speed, short physical performance battery (SPPB) test, handgrip strength, five times sit-to-stand (5x-STS)) was conducted. Muscle mass and its surrogates such as phase angle and body cell mass were measured using bioelectrical impedance analysis machine. Inflammatory biomarkers were measured at 0 and 3 months.

RESULTS

Data from 190 participants was analysed at 3 months (111 control, 37 Ex and 41 Ex+CST). At 3 months, significant improvement in cognition was seen only in the Ex+CST group whereas improvements in depression, gait speed, SPPB and 5x-STS were seen in both the Ex and Ex+CST groups. At 6 months, the Ex+CST group improved in cognition and depression whereas improvement in frailty and muscle mass indices were seen in both the interventions groups. At 12 months, both the interventions groups had better perceived health, gait speed and less decline in muscle mass compared with control groups. Both the Ex and Ex+CST had significant association with TNF-α at 3 months (β -2.71 (95% CI -4.80 - -0.62); p = 0.012 and β -1.74 (95% CI -3.43 - -0.06); p = 0.043 respectively).

CONCLUSION

Combined Ex+CST had significant improvement in cognition whereas the intervention groups improved in depression, physical function, muscle mass, frailty, perceived health and TNF-α levels. With growing evidence of the benefits of multicomponent interventions at primary care level, incorporating it into mainstream care with action plans on long-term sustainability and scalability should be a priority for every country.

Physical performance in older age by sex and educational level: the HUNT Study

BACKGROUND

Population-based studies on physical performance provide important information on older people's health but rarely include the oldest and least-healthy segment of the population. The aim of this study was to provide representative estimates of physical performance by age, sex, and educational level based on recent data from a population-based health study in Norway that includes older people with a wide range in age and function.

METHODS

In the fourth wave of the Trøndelag Health Study (2017-2019), all participants aged 70 + were invited to an additional examination of physical performance assessed by the Short Physical Performance Battery (SPPB), either by attending a testing station or by visits from ambulatory teams. The distribution and variation in SPPB total and subscores, as well as gait speed, are presented by sex, age, and educational level.

RESULTS

The SPPB was registered in 11,394 individuals; 54.8% were women; the age range was 70-105.4 years, with 1,891 persons aged 85 + . SPPB scores decreased by 0.27 points (men) and 0.33 points (women) for each year of age, and gait speed by 0.02 m/sec (men) and 0.03 m/sec (women). Using a frailty cut-off for gait speed at < 0.8 m/sec, the proportion of participants categorized as frail increased from 13.9% in the 70-74 years cohort to 73.9% in participants aged 85 + . Level of education [Formula: see text] 10 years corresponded to 6 years (men) and 4 years (women) earlier onset of frailty (SPPB [Formula: see text] 9) compared to education [Formula: see text] 14 years.

CONCLUSION

We found that the SPPB captured a gradual decline and wide distribution in physical performance in old age. The results provide information about physical performance, health status, and risk profiles at a population level and can serve as reference data for clinicians, researchers, and healthcare planners.

A community-based single fall prevention exercise intervention for older adults (STEADY FEET): Study protocol for a randomised controlled trial

BACKGROUND

Falls and fall-related injuries in older adults are a leading cause of disability and death. Evidence has shown the benefits of exercises in improving functional outcomes and reducing fall rates among community-dwelling older adults. However, there is lack of effective community-based single exercise intervention for a broad population of older adults who are at high risk for falls. We aim to evaluate the effectiveness of Steady Feet (SF), a 6-month tailored community fall prevention exercise programme for improving functional outcomes. SF classes are facilitated by community fitness instructors and an exercise video. The main outcome is between-group changes in short physical performance battery (SPPB) scores. Secondary outcomes include balance confidence, fear of falling, quality of life, fall rates, and cost effectiveness.

METHODS

We present the design of a 6-month randomised controlled trial of 260 older adults (≥ 60 years old). Individuals will be randomised in a 1:1 allocation ratio to the SF group or usual care group. Participants will be assessed at baseline, 3-month, and 6-month. Data on socio-demographics, co-morbidities, balance confidence, fear of falling, quality of life, physical activity level, rate of perceived exertion, fall(s) history, healthcare utilisation and cost, and satisfaction levels will be collected. Participants will also undergo functional assessments such as SPPB. Moreover, providers' satisfaction and feedback will be obtained at 3-month.

DISCUSSION

An effective community fall prevention programme may lead to improved functional outcomes and reduced fall rates. Findings will also help inform the implementation and scaling of SF nation-wide.

TRIAL REGISTRATION

Clinicaltrials.gov registration: NCT04801316. Registered on 15th March 2021.

Clinical and Biological Adaptations in Obese Older Adults Following 12-Weeks of High-Intensity Interval Training or Moderate-Intensity Continuous Training

Sarcopenia and obesity are considered a double health burden. Therefore, the implementation of effective strategies is needed to improve the quality of life of older obese individuals. The aim of this study was to compare the impact of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on functional capacities, muscle function, body composition and blood biomarkers in obese older adults. Adipose tissue gene expression and markers of muscle mitochondrial content and quality control involved in exercise adaptations were also investigated. Sixty-eight participants performed either HIIT (n = 34) on an elliptical trainer or MICT (n = 34) on a treadmill, three times per week for 12 weeks. HIIT produced significantly higher benefits on some physical parameters (six-minute walking test (HIIT: +12.4% vs. MICT: +5.2%); step test (HIIT: +17.02% vs. MICT: +5.9%); ten-repetition chair test (HIIT: −17.04% vs. MICT: −4.7%)). Although both HIIT and MICT led to an improvement in lower limb power (HIIT: +25.2% vs. MICT: +20.4%), only MICT led to higher improvement in lower limb muscle strength (HIIT: +4.3% vs. MICT: +23.2%). HIIT was more beneficial for increasing total lean body mass (HIIT: +1.58% vs. MICT: −0.81%), while MICT was more effective for decreasing relative gynoid fat mass (HIIT: −1.09% vs. MICT: −4.20%). Regarding adipose tissue gene expression, a significant change was observed for cell death-inducing DFFA (DNA fragmentation factor-alpha)-like effector A (CIDEA) in the HIIT group (A.U; HIIT at T0: 32.10 ± 39.37 vs. HIIT at T12: 48.2 ± 59.2). Mitochondrial transcription factor A (TFAM) content, a marker of mitochondrial biogenesis, increased significantly following HIIT (+36.2%) and MICT (+57.2%). A significant increase was observed in the HIIT group for Translocase of Outer Membrane 20 (TOM20; +54.1%; marker of mitochondrial content), Mitofusin-2 (MFN2; +71.6%; marker of mitochondrial fusion) and Parkin RBR E3 Ubiquitin Protein Ligase (PARKIN; +42.3%; marker of mitophagy). Overall, our results indicate that even though MICT (walking on treadmill) and HIIT (on an elliptical) are effective intervention strategies in obese older adults, HIIT appears to have slightly more beneficial effects. More specifically, HIIT led to higher improvements than MICT on functional capacities, lean mass and skeletal muscle markers of mitochondrial content, fusion, and mitophagy. Thus, MICT but also HIIT (time-efficient training) could be recommended as exercise modalities for obese older adults to maintain or improve mobility, health and quality of life.

Are vertical jumps able to predict 24-month follow-up functional geriatric assessment in a healthy community-dwelling older cohort?

BACKGROUND

When older adults fall below the thresholds of functional geriatric assessment (FGA), they may already be at risk of mobility impairment. A reduction in (jumping) power could be an indication of functional decline, one of the main risk factors for falls.

OBJECTIVE

This paper explores whether six-month delta (∆) values of muscle power can predict 24-month follow-up FGA in older adults.

METHODS

This observational study of independent, healthy, high-performing community-dwelling adults aged 70 + years involved FGA (mobility, balance, and endurance tests) at baseline (t₀), after 6 months (t₁), and after 24 months (t₂); maximum jumping power (max JP) was determined at t₀ and t₁. A predictive linear model was developed in which the percentage change of Δmax JP_0,1 was transferred to all FGA (t₀) values. The results were compared with measured FGA values at t₂ via sensitivity and specificity in terms of the clinically meaningful change (CMC) or the minimal detectable change (MDC).

RESULTS

In 176 individuals (60% female, mean age 75.3 years) the mean percentage (SD) between predicted and measured FGA ranged between 0.4 (51.3) and 18.11 (51.9). Sensitivity to identify the CMC or MDC of predicted FGA tests at t₂ ranged between 17.6% (Timed up and go) and 75.0% (5-times-chair-rise) in a test-to-test comparison and increased to 97.6% considering clinically conspicuousness on global FGA.

CONCLUSION

The potential of jumping power to predict single tests of FGA was low regarding sensitivity and specificity of CMC (or MDC). 6 months Δmax JP seem to be suitable for predicting physical function, if the measured and predicted tests were not compared at the test level, but globally, in the target group in the long term.

Contribution of a multicomponent intervention on functional capacity and independence on activities of daily living in individuals with neurocognitive disorder

BACKGROUND

To examine the effects of a 6-month multicomponent (MT) exercise intervention in the functional capacity and ability to independently perform activities of daily living (ADL) of individuals diagnosed with neurocognitive disorder (NCD).

METHODS

A quasi-experimental controlled trial with a parallel design study was conducted in multicentered community-based settings. Forty-three individuals (N Female: 30) were allocated to an exercise group (EG; N: 23; mean 75.09, SD = 5.54 years) or a control group (CG; N:20; mean 81.90, SD = 1.33 years). The EG engaged in a 6-month MT program (60-min sessions, twice a week). Exercise sessions were divided into a warm-up, specific training (e.g., coordination and balance, lower and upper body strength, and aerobics), and cool down. Lower body function, mobility, and gait speed were evaluated through Short Physical Performance Battery (SPPB), Timed-Up and Go test (TUG) and 6-Meter Walk test, respectively. The Barthel Index (BI) was administered to assess individuals' ADL independence. Evaluations were performed before and after the 6-month intervention.

RESULTS

Linear Mixed Models revealed a statistically significant interaction (time X group) effect factor on SPPB (B = 2.33, 95% CI: 1.39-3.28, p < 0.001), TUG (B = - 11.15, 95% CI: - 17.23 - - 5.06, p = 0.001), and 6-Meter Walk test (B = 0.17, 95% CI: 0.08-0.25, p < 0.001). No differences between groups or assessment moments were found in the ability of individuals to independently perform ADL.

CONCLUSIONS

The 6-month MT exercise intervention improves the functional capacity of older adults living with NCD.

TRIAL REGISTRATION

ClinicalTrials.gov - identifier number NCT04095962 ; retrospectively registered on 19 September 2019.

The degree of frailty as a translational measure of health in aging

Frailty is a multiply determined, age-related state of increased risk for adverse health outcomes. We review how the degree of frailty conditions the development of late-life diseases and modifies their expression. The risks for frailty range from subcellular damage to social determinants. These risks are often synergistic-circumstances that favor damage also make repair less likely. We explore how age-related damage and decline in repair result in cellular and molecular deficits that scale up to tissue, organ and system levels, where they are jointly expressed as frailty. The degree of frailty can help to explain the distinction between carrying damage and expressing its usual clinical manifestations. Studying people-and animals-who live with frailty, including them in clinical trials and measuring the impact of the degree of frailty are ways to better understand the diseases of old age and to establish best practices for the care of older adults.

Comparison of Human Interpretation and a Rule-Based Algorithm for Instrumented Sit-to-Stand Test

BACKGROUND

The five times sit-to-stand test (5STS) is one of the most commonly used tests to assess the physical performance of lower extremities. This study assessed the correlation between human interpretation (5STShuman) and a rule-based algorithm (5STSrule) using instrumented 5STS with two sensors.

METHODS

We analyzed clinical records of 148 patients who visited the geriatric outpatient clinic of Asan Medical Center between December 2020 and March 2021 and underwent physical performance assessment using the electronic Short Physical Performance Battery (eSPPB) protocol. For STS, time-weight and time-distance curves were constructed using a loadcell and light detection and ranging (LiDAR). We manually assessed the grids of these curves to calculate 5STShuman, while 5STSrule used an empirical rule-based algorithm.

RESULTS

In the study population, the mean 5STShuman and 5STSrule times, i.e., 12.2±0.4 and 11.4±0.4 seconds, respectively, did not differ significantly (p=0.232). Linear regression analysis showed that 5STShuman and 5STSrule were positively correlated (β=0.99, R2=0.99). The measures also did not differ (p=0.381) in classifying sarcopenia according to the Asian Working Group Society criteria, with C-indices of 0.826 for 5STShuman and 0.820 for 5STSrule.

CONCLUSION

An empirical rule-based algorithm correlated with human-interpreted 5STS and had comparable classification ability for sarcopenia.

Validation of perceived physical fatigability using the simplified-Chinese version of the Pittsburgh Fatigability Scale

BACKGROUND

The Pittsburgh Fatigability Scale (PFS) was developed to capture fatigue and demand in a single tool, filling a gap that no validated questionnaire existed to measure perceived fatigability. Since fatigability is a more sensitive measure of a person's susceptibility to fatigue, we validated the simplified-Chinese version of the PFS among Chinese community-dwelling older adults.

METHODS

This cross-sectional study was conducted in an urban community in Beijing between November 2018 and July 2019. The PFS was translated into simplified-Chinese by the translation, retro-translation method. Internal consistency of the Physical subscale of the PFS was evaluated by Cronbach's alpha. Convergent validity and discriminant validity were evaluated against physical performance measures (i.e., Short Physical Performance Battery & Timed Up and Go Test) and daily living performance (i.e., Barthel Index & Instrumental activity of daily living).

RESULTS

Our study included 457 participants, including 182 men (39.8%) and 275 women (60.2%). The age range of the included participants was 61-96 years (mean = 84.8 years, SD = 5.8 years). The simplified-Chinese version of PFS Physical scores showed strong internal consistency (Cronbach's alpha = 0.81). Higher PFS Physical scores were associated with worse physical performance, and daily living performance (|correlation coefficient| range: 0.36-0.56, p < .001). Age- and sex-adjusted PFS Physical scores had moderate to good overall discrimination for correctly classifying people by their physical performance and daily living performance (AUCs range 0.70-0.87, p < .001).

CONCLUSIONS

The PFS simplified-Chinese version is a valid instrument to assess perceived physical fatigability in Chinese-speaking older adults with good convergent validity. Thus, the PFS, with low cost and greater feasibility, is a desired tool to measure fatigability in large population studies.

Possible Sarcopenia and Impact of Dual-Task Exercise on Gait Speed, Handgrip Strength, Falls, and Perceived Health

Background: Sarcopenia is defined as a progressive age-related loss in muscle mass and strength affecting physical performance. It is associated with many negative outcomes including falls, disability, cognitive decline, and mortality. Protein enriched diet and resistance training have shown to improve muscle strength and function but there is limited evidence on impact of dual-task exercise in possible sarcopenia.

Objective: To evaluate impact of community-based dual-task exercise on muscle strength and physical function in possible sarcopenia defined by either slow gait (SG) or poor handgrip strength (HGS). The secondary aims include effect on cognition, frailty, falls, social isolation, and perceived health.

Methods: Community-dwelling older adults ≥60 years old were recruited from screening program intended to identify seniors at risk, and invited to participate in dual-task exercise program called HAPPY (Healthy Aging Promotion Program for You). One hundred and eleven participants with possible sarcopenia completed 3 months follow-up. Questionnaire was administered on demographics, frailty, sarcopenia, falls, perceived health, social network, functional, and cognitive status. Physical performance included assessment of HGS, gait speed, and Short Physical Performance Battery test (SPPB).

Results: The mean age of the Exercise group was 75.9 years old and 73.0% were women. The Exercise group had more female (73.0 vs. 47.5%), were older (75.9 vs. 72.5 years old), had higher prevalence of falls (32.4 vs. 15.0%), lower BMI (23.7 vs. 25.8), and education (4.0 vs. 7.2 years). The gait speed of the Exercise group increased significantly with significant reduction in the prevalence of SG and poor HGS. All components of SPPB as well as the total score increased significantly while the prevalence of pre-frailty and falls dropped by half. The risk of social isolation reduced by 25% with significant improvement in perceived health and cognition in the Exercise group. Significant impact on improvement gait speed and SPPB persisted after adjustment for baseline factors.

Conclusion: Dual-task exercise program is effective in improving gait speed, SPPB score, and reducing the prevalence of poor HGS with significant improvement in perceived health, cognition, and reduction in falls and frailty. Future prospective randomized control trials are needed to evaluate the effectiveness of dual-task interventions in reversing sarcopenia.

Exploring Clinically Meaningful Changes for the Frailty Index in a Longitudinal Cohort of Hospitalized Older Patients

BACKGROUND

Clinically meaningful change (CMC) for frailty index (FI) scores is little studied. We estimated the CMC by associating changes in FI scores with changes in the Clinical Frailty Scale (CFS) in hospitalized patients.

METHODS

The Serious Outcomes Surveillance Network of the Canadian Immunization Research Network enrolled older adults (65+ years) admitted to hospital with acute respiratory illness (mean age = 79.6 ± 8.4 years; 52.7% female). Patients were assigned CFS and 39-item FI scores in-person at admission and via telephone at 1-month postdischarge. Baseline frailty state was assessed at admission using health status 2 weeks before admission. We classified those whose CFS scores remained unchanged (n = 1,534) or increased (n = 4,390) from baseline to hospital admission, and whose CFS scores remained unchanged (n = 1,565) or decreased (n = 2,546) from admission to postdischarge. For each group, the CMC was represented as the FI score change value that best predicted one level CFS change, having the largest Youden J value in comparison to no change.

RESULTS

From baseline to admission, 74.1% increased CFS by ≥1 level. From admission to postdischarge, 61.9% decreased CFS by ≥1 levels. A change in FI score of 0.03 best predicted both one-level CFS increase (sensitivity = 70%; specificity = 69%) and decrease (sensitivity = 66%; specificity = 61%) in comparison to no change. Of those who changed CFS by ≥1 levels, 70.9% (baseline to admission) and 72.4% (admission to postdischarge) changed their FI score by at least 0.03.

CONCLUSIONS

A clinically meaningful change of 0.03 in the frailty index score holds promise as a benchmark for assessing the meaningfulness of frailty interventions.

Effectiveness of a Short-Term Mixed Exercise Program for Treating Sarcopenia in Hospitalized Patients Aged 80 Years and Older: A Prospective Clinical Trial

OBJECTIVES

To assess the effectiveness of short-term exercise for treating sarcopenia in hospitalized older patients aged 80 years and over.

DESIGN

Prospective clinical trial.

SETTING

A post-acute care unit.

PARTICIPANTS

Sarcopenic patients aged 80 years or over.

INTERVENTIONS

The participants were allocated to the intervention group (to receive a mixed exercise program with 10 sessions over two weeks) or the control group (usual care) based on the sequence of admission.

OUTCOMES

The primary outcome was the improvement in activities of daily living (ADL) estimated by the change in Barthel Index (BI) score from the baseline to the end of the 2-week intervention. The secondary outcomes were the changes in gait speed, handgrip strength, the time "UP and GO" test (TUG) score, and the Short Physical Performance Battery (SPPB) score.

RESULTS

We included 121 participants (intervention group: n = 62; control group: n = 59). All participants in the intervention group finished all 10 exercise sessions. After the 2-week intervention, patients in the mixed exercise group achieved a significant improvement in ADL compared with their counterparts in the control group (the adjusted mean difference of the change in BI score was 7.8 points, 95% confidence interval (CI) 4.0 to 11.8 points). The mixed exercise program significantly but slightly improved gait speed (adjusted group difference in mean change: 0.06 m/s, 95% CI 0.02 to 0.11 m/s). However, the mixed exercise program did not significantly improve the handgrip strength, SPPB score, or TUG score compared with usual care.

CONCLUSION

Very old inpatients with sarcopenia can benefit from a mixed exercise program (even as short as two weeks) by improving their ADL and gait speed. However, the long-term effects of exercise on important clinical outcomes need to be further evaluated.