Association between education and walking speed: counterfactual mediation analysis in favor of a motor reserve hypothesis

We quantified the extent to which the association between education and fast walking speed (FWS) is explained by 17 mediators (cardiovascular risk factors/diseases, comorbidities, health behaviors, socioprofessional characteristics, cognition), and examined whether mediators interact with education, in favor of a reserve hypothesis. Cross-sectional analyses are based on Constances (a population-based study of French adults 45-69 years). Three-meter FWS was measured using photoelectric cells. Education was categorized as lower vs higher. After multiple imputation of missing values, we used counterfactual mediation models for multiple mediators allowing for education × mediator interactions, to estimate the total effect (TE), total indirect effect (TIE), and mediated interaction (IMD) of lower education on FWS. Analyses are based on 71 222 participants (52.6% women; mean age = 57.2 years; 27.2% higher education; mean FWS = 180.2 cm/s). In joint mediation analyses, the TE of lower education was -8.19 cm/s (95% CI, -8.87 to -7.51), with a TIE of -5.76 cm/s (95% CI, -6.10 to -5.41; proportion mediated = 70.3%; 95% CI, 65.6-75.0). The IMD was negative (-2.52; 95% CI, -3.31 to -1.72); 30.8% of the TE and 43.8% of the TIE were attributable to the IMD. Several mediators explain a large part of the association between lower education and slower FWS. The detrimental effect of mediators was more pronounced in participants with lower than in those with higher education, in agreement with a reserve hypothesis.

Neuroimaging Correlates of 3 Distinct Physical-Cognitive Phenotypes in Cognitively Normal Older Adults: The Gothenburg H70 Cohort Study

BACKGROUND AND OBJECTIVES

Individuals aged 70 and older frequently experience an increased risk of deficits in both physical and cognitive functions. However, the natural progression and interrelationship of these deficits, as well as their neurologic correlates, remain unclear. We aimed to classify the data-driven physical-cognitive phenotypes and then investigate their associations with neuroimaging markers.

METHODS

This cross-sectional study included 70-year-old participants from the Gothenburg H70 Birth Cohort (2014-2016). Based on physical performance (grip strength, balance, walking speed, and chair stand) and cognitive measures (episodic memory, perceptual speed, executive function, verbal fluency, and visuospatial abilities), we applied latent class analysis to identify physical-cognitive phenotypes. Based on the brain MRI measurements, 3 groups of neuroimaging markers were involved-neurodegeneration, cerebral small vessel disease (cSVD), and microstructural white matter (WM) integrity. We performed multinomial logistic regressions to examine the differences between the physical-cognitive phenotypes.

RESULTS

In total, 1,140 participants (female: 53.3%) without dementia and disability were included in the study, with 721 (female: 52.2%) undergoing MRI scans. Three physical-cognitive phenotypes were identified: an "optimal" group characterized by high performance in both physical and cognitive functions, an "intermediate" group showing a slight reduction in both domains, and a "physical deficit" group marked by a significant reduction in physical performance. Compared with the optimal group, the other 2 groups were more likely to present with vascular risk factors. The physical deficit group had higher odds of experiencing depression compared with the intermediate group (adjusted odds ratio [aOR] 2.9, 95% CI 1.4-5.9). Compared with the optimal group, the odds of presenting all 3 severe neuroimaging markers were higher in both the intermediate (aOR 3.4, 95% CI 1.5-7.9) and physical deficit (aOR 10.3, 95% CI 2.4-45.0) groups.

DISCUSSION

This study highlights the variability in physical and cognitive performance among older adults and suggests that neuroimaging markers of neurodegeneration, cSVD, and microstructural WM integrity may account for these variations. Our findings indicate the potential for developing group-based strategies to prevent and manage age-related functional decline. Further research with larger sample sizes is needed to deepen our understanding of physical-cognitive decline patterns.

Improving the neuromuscular fitness of patients with type 2 diabetes by aquatic exercise training - The Diabetes and Aquatic Training Study (DATS 3): a randomized controlled trial

BACKGROUND

To compare the effects of aquatic aerobic and combined training on neuromuscular outcomes in patients with type 2 diabetes.

METHODS

Patients with type 2 diabetes were randomized to an aerobic aquatic training (AERO), a combined aquatic training (COMBI) or a procedure control (CON) three weekly for 15 weeks. The sessions were 50 minutes long. Maximal strength and muscle endurance were assessed by the 1RM and maximum repetitions at 60% 1RM tests, respectively, in knee extension and elbow flexion exercises. Timed up and go test, testosterone, cortisol and testosterone:cortisol ratio also were evaluated.

RESULTS

Participants had 59.0±8.2 years, 51% women. All groups increased (P<0.001) the maximal knee extension strength (Mean Difference: AERO: 21.1 kg; COMBI: 14.6 kg; CON: 4.4 kg), while only COMBI group increased (P<0.001) the maximal elbow flexion strength (Mean Difference: 2.6 kg). Muscle endurance in both exercises were increased in all groups. The Timed Up and Go test at the usual and maximal speed decreased in all groups. Testosterone were not modified in present study, while cortisol and testosterone:cortisol were improved in COMBI group.

CONCLUSIONS

Aquatic training, especially combined aquatic training, improve the neuromuscular fitness of patients with type 2 diabetes.

Mobilise-D insights to estimate real-world walking speed in multiple conditions with a wearable device

This study aimed to validate a wearable device's walking speed estimation pipeline, considering complexity, speed, and walking bout duration. The goal was to provide recommendations on the use of wearable devices for real-world mobility analysis. Participants with Parkinson's Disease, Multiple Sclerosis, Proximal Femoral Fracture, Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, and healthy older adults (n = 97) were monitored in the laboratory and the real-world (2.5 h), using a lower back wearable device. Two walking speed estimation pipelines were validated across 4408/1298 (2.5 h/laboratory) detected walking bouts, compared to 4620/1365 bouts detected by a multi-sensor reference system. In the laboratory, the mean absolute error (MAE) and mean relative error (MRE) for walking speed estimation ranged from 0.06 to 0.12 m/s and - 2.1 to 14.4%, with ICCs (Intraclass correlation coefficients) between good (0.79) and excellent (0.91). Real-world MAE ranged from 0.09 to 0.13, MARE from 1.3 to 22.7%, with ICCs indicating moderate (0.57) to good (0.88) agreement. Lower errors were observed for cohorts without major gait impairments, less complex tasks, and longer walking bouts. The analytical pipelines demonstrated moderate to good accuracy in estimating walking speed. Accuracy depended on confounding factors, emphasizing the need for robust technical validation before clinical application.Trial registration: ISRCTN - 12246987.

Association of Motor Function With Cognitive Trajectories and Structural Brain Differences: A Community-Based Cohort Study

BACKGROUND AND OBJECTIVES

The association of motor function with cognitive health remains controversial, and the mechanisms underlying this relationship are unclear. We aimed to examine the association between motor function and long-term cognitive trajectories and further explore the underlying mechanisms using brain MRI.

METHODS

In the Rush Memory and Aging Project, a prospective cohort study, a total of 2,192 volunteers were recruited from the communities in northeastern Illinois and followed up for up to 22 years (from 1997 to 2020). Individuals with dementia, disability, missing data on motor function at baseline, and missing follow-up data on cognitive function were excluded. At baseline, global motor function was evaluated using the averaged z scores of 10 motor tests covering dexterity, gait, and hand strength; the composite score was tertiled as low, moderate, or high. Global and domain-specific cognitive functions-including episodic memory, semantic memory, working memory, visuospatial ability, and perceptual speed-were measured annually through 19 cognitive tests. A subsample (n = 401) underwent brain MRI scans and regional brain volumes were measured. Data were analyzed using linear mixed-effects models and linear regression.

RESULTS

Among the 1,618 participants (mean age 79.45 ± 7.32 years) included in this study, baseline global motor function score ranged from 0.36 to 1.82 (mean 1.03 ± 0.22). Over the follow-up (median 6.03 years, interquartile range 3.00-10.01 years), low global motor function and its subcomponents were related to significantly faster declines in global cognitive function (β = -0.005, 95% CI -0.006 to -0.005) and each of the 5 cognitive domains. Of the 344 participants with available MRI data, low motor function was also associated with smaller total brain (β = -25.848, 95% CI -44.902 to -6.795), total white matter (β = -18.252, 95% CI -33.277 to -3.226), and cortical white matter (β = -17.503, 95% CI -32.215 to -2.792) volumes, but a larger volume of white matter hyperintensities (β = 0.257, 95% CI 0.118-0.397).

DISCUSSION

Low motor function is associated with an accelerated decline in global and domain-specific cognitive functions. Both neurodegenerative and cerebrovascular pathologies might contribute to this association.

Causal effects of walking pace on osteoarthritis: a two-sample mendelian randomization study

Background: Osteoarthritis (OA) is one of the most common joint diseases worldwide, imposing a substantial burden on individuals and society. Numerous pieces of evidence suggest that walking pace (WP) can serve as a predictive indicator for the risk of various diseases, and observational studies have also found a potential link between WP and the risk of OA. However, the causal relationship between WP and the risk of OA remains unclear. Methods: We conducted a mendelian randomization (MR) study using data from the European Genome-wide Association Study, which included WP (including 459,915 participants), OA (including 10,083 cases and 40,425 controls), knee OA (including 24,955 cases and 378,169 controls), and hip OA (including 15,704 cases and 378,169 controls). Single nucleotide polymorphisms (SNPs) associated with WP were utilized to infer causal associations with OA and its subtypes. The Inverse Variance Weighted (IVW) technique served as the primary causal analysis method. Three auxiliary MR methods - MR-Egger, weighted median, and maximum likelihood - were used to substantiate the IVW results. Sensitivity analyses were performed to examine heterogeneity and pleiotropy. In addition, multivariate MR (MVMR) analysis was used to assess causality after adjustment for three potential confounders. Results: According to the results of the IVW method, every 1 standard deviation increased in genetic WP corresponds to an 89% reduction in the risk of OA (odds ratio (OR) = 0.11; 95% confidence interval (CI), 0. 06-0.19; p = 1.57 × 10-13), an 83% reduction in the risk of knee OA (OR = 0.17; 95% CI, 0.11-0.28; p = 2.78 × 10-13), and a 76% reduction in the risk of hip OA (OR = 0.24; 95% CI, 0.14-0.43; p = 1.51 × 10-6). These results were confirmed by the three additional MR methods and validated by the sensitivity analysis. Ultimately, the MVMR analysis confirmed that the role of WP in reducing the risk of OA and its subtypes remains consistent regardless of potential confounders. Conclusion: The results of our MR study highlight a significant causal association between WP and the susceptibility to OA, including its knee and hip subtypes. These findings propose that WP could be utilized as a potential prognostic factor for OA risk.

Associations between physical fitness and cardiovascular disease in older adults with intellectual disabilities: Results of the Healthy Ageing and Intellectual Disability study

BACKGROUND

Reduced physical fitness is a cardiovascular disease (CVD) risk factor in the general population. However, generalising these results to older adults with intellectual disabilities (ID) may be inappropriate given their pre-existing low physical fitness levels and high prevalence of co-morbidities. Therefore, the aim of this study is to investigate the difference in physical fitness between older adults with ID with and without CVD.

METHOD

Baseline data of a cohort of older adults with borderline to profound ID (HA-ID study) were used (n = 684; 61.6 ± 8.2 years; 51.3% male). CVD status (coronary artery disease, heart failure, stroke) was obtained from medical files. Cardiorespiratory fitness (10-m incremental shuttle walking test), comfortable and fast gait speed (over 5 m distance) and grip strength (hand dynamometer) were measured. Multivariable linear regression models were used to investigate the association between these physical fitness components and the presence of CVD, adjusted for participant characteristics.

RESULTS

Of the 684 participants 78 (11.4%) had CVD. Participants with CVD scored lower on cardiorespiratory fitness (-81.4 m, P = 0.002), comfortable gait speed (-0.3 km/h, P = 0.04) and fast gait speed (-1.1 km/h, P = 0.04). No significant differences were found for grip strength (-0.2 kg, P = 0.89).

CONCLUSIONS

Older adults with CVD had significantly lower physical fitness levels than those without CVD, except for grip strength. Longitudinal research is needed to investigate causality.

Brisk Walking Pace Is Associated with Better Cardiometabolic Health in Adults: Findings from the Chilean National Health Survey 2016-2017

BACKGROUND

Although the importance of walking for promoting a better cardiometabolic health is widely known (this includes both cardiovascular and metabolic/endocrine systems), there is little knowledge regarding its appropriate pace to provide adults with more cardiometabolic benefits.

AIM

To analyze the associations between different walking pace categories and cardiometabolic health markers in the adult Chilean population.

METHODS

Cross-sectional study. A total of 5520 participants aged 15 to 90 years old from the Chilean National Health Survey (CNHS) 2016-2017 were included. Walking pace categories (slow, average, and brisk) were collected through self-reported methods. Glycaemia, glycosylated hemoglobin (HbA1c), gamma glutamyl transferase (GGT), vitamin D2, vitamin D3, systolic and diastolic blood pressure, and lipid profile (Total, HDL, LDL, VLDL, No HDL cholesterol and triglycerides) were determined using blood sample tests and measured with the standardized methods described in the CNHS 2016-2017.

RESULTS

People who had a brisk walking pace were associated with lower levels of glycaemia, HbA1c, GGT, systolic and diastolic blood pressure, and higher vitamin D3 levels compared with those with a slow walking pace. Moreover, people with a brisk walking pace had lower levels of VLDL cholesterol compared with those with a slow walking pace. However, after adjusting the model to include sociodemographic background, nutritional status, and lifestyle variables, the differences remained only for glycaemia, HbA1c and systolic blood pressure levels.

CONCLUSIONS

A brisk walking pace was associated with better cardiometabolic health markers and lipid profile compared with a slow walking pace.

SARcopenia Assessment in Hypertension: The SARAH Study

OBJECTIVES

The aims of the study were to investigate the relationship between sarcopenia and renin-angiotensin system-related disorders and to explore the effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on muscle mass/function and physical performance.

DESIGN

This multicenter, cross-sectional study was performed using ISarcoPRM algorithm for the diagnosis of sarcopenia.

RESULTS

Of the 2613 participants (mean age = 61.0 ± 9.5 yrs), 1775 (67.9%) were hypertensive. All sarcopenia-related parameters (except chair stand test in males) were worse in hypertensive group than in normotensive group (all P < 0.05). When clinical/potential confounders were adjusted, hypertension was found to be an independent predictor of sarcopenia in males (odds ratio = 2.403 [95% confidence interval = 1.514-3.813]) and females (odds ratio = 1.906 [95% confidence interval = 1.328-2.734], both P < 0.001). After adjusting for confounding factors, we found that all sarcopenia-related parameters (except grip strength and chair stand test in males) were independently/negatively related to hypertension (all P < 0.05). In females, angiotensin-converting enzyme inhibitors users had higher grip strength and chair stand test performance values but had lower anterior thigh muscle thickness and gait speed values, as compared with those using angiotensin II receptor blockers (all P < 0.05).

CONCLUSIONS

Hypertension was associated with increased risk of sarcopenia at least 2 times. Among antihypertensives, while angiotensin-converting enzyme inhibitors had higher muscle function values, angiotensin II receptor blockers had higher muscle mass and physical performance values only in females.

Combined Effect of Dynapenia and Abdominal Obesity on the Prevalence of Peripheral Artery Disease in Older Adults Over 75 Years Old in China

The objective is to examine the separate and joint effects of dynapenia and abdominal obesity on the prevalence of peripheral artery disease (PAD) in older adults of different ages (60-74 and over 75 years old). This study comprised 1293 community-dwelling Chinese participants recruited from Shanghai, China, who were aged at least 60 years (753 women; mean age: 72.0 ± 5.9 years). Dynapenia was defined as low-grip strength (<28.0 kg for males and <18.0 kg for females) but normal skeletal muscle index (≥7.0 kg/m² for males and ≥5.7 kg/m² for females). Abdominal obesity was determined according to waist circumference (≥90 cm for males and ≥85 cm for females), and PAD was diagnosed by an ankle-brachial index  ≤ 0.9. Binary logistic regression models were performed to determine associations between dynapenia, abdominal obesity, and the combination of dynapenia and abdominal obesity and PAD. According to dynapenia and abdominal obesity status stratified by age (60-74 or over 75), the patients were divided into 4 groups: normal, dynapenia alone, abdominal obesity alone, and co-occurring groups. A logistic regression showed that the co-occurring groups (odds ratio = 4.63, 95% confidence interval = 1.41-15.21) had a higher prevalence of PAD than the normal group after adjusting for the covariates in older adults over 75 years of age. The combination of dynapenia and abdominal obesity increase the prevalence of PAD in older adults over 75 years. The present findings have important implications for the early identification of older adults with PAD and appropriate interventions should be implemented.

Effectiveness of Adapted Taekwondo, Multi-Component Training and Walking Exercise on Health Status in Independent Older Women: Study Protocol for a Randomized Controlled Trial (TKD & Aging Project)

This study protocol aims to analyze and compare the effects of an adapted taekwondo program with respect to multi-component training and walking exercise on health status in independent older women. Secondarily, we analyze the variability of the inter-individual response and compare it according to the designated training system. The sample will consist of 64 women between 60 and 65 years, randomly assigned to experimental group 1 (n = 16; adapted taekwondo), experimental group 2 (n = 16; multi-component training), experimental group 3 (n = 16, walking exercise) or control group (n = 16; no intervention). The experimental groups will perform the designated training for three sessions (60 min per session) per week over 16-weeks, while the control group will not receive any treatment. The main outcome will provide information about (i) blood pressure, (ii) lipid profile, (iii) frequency of food consumption, (iv) body composition, (v) cognitive status, (vi) brain activity, (vii) health-related quality of life (HRQoL) and (viii) physical-functional fitness. Our hypothesis indicates that adapted taekwondo produces more significant effects and greater inter-individual responses in cognitive status, brain activity, HRQoL, and postural balance than the others training methods. If this intervention proves effective, it could be an alternative for older women.

Heart-Focused Anxiety Affects Behavioral Cardiac Risk Factors and Quality of Life: A Follow-Up Study Using a Psycho-Cardiological Rehabilitation Concept

Background

Heart-focused anxiety (HFA) raises the risk for adverse outcomes in patients with heart disease. Despite this great importance, it is rarely assessed in clinical practice. Three dimensions are commonly defined in the context of HFA: heart-related fear, avoidance, and attention. The impact of these aspects on cardiac risk factors is essentially unclear. In this study, we investigated the relationship between HFA and behavioral cardiac risk factors as well as health-related quality of life (HRQoL), which represent important treatment outcomes of inpatient psycho-cardiological rehabilitation.

Methods

A prospective observational design was used to examine 238 rehabilitation inpatients with comorbidity of cardiac disease and psychiatric disorder. We assessed HFA using the Cardiac Anxiety Questionnaire (CAQ), HRQoL using the SF-12 Health Survey, exercise capacity using the 6-minute walk test, and smoking behavior, respectively at admission (t0) and discharge (t1). Physical activity was assessed at t0 and in a follow-up survey 6 months after discharge (t2) using the International Physical Activity Questionnaire (IPAQ). Multiple regression models were used to analyze the predictive value of HFA for the outcome variables at t0, t1, and t2, adjusted for socio-demographic factors and depression. Predictive values for changes over time were evaluated by the regressor variable approach.

Results

Exercise capacity and physical activity were negatively predicted by baseline heart-related avoidance, both cross-sectionally and prospectively. Avoidance at t1 also negatively predicted long-term changes over time in physical activity at t2. Total HFA and the subcomponent avoidance negatively predicted physical HRQoL both cross-sectionally and prospectively. Mental HRQoL was cross-sectionally predicted by heart-focused attention at t0, and prospectively predicted by total HFA and by avoidance. Regarding changes in the course of rehabilitation, baseline avoidance negatively predicted improvement in physical HRQoL during rehabilitation. Concerning smoking behavior, no associations with HFA were found.

Conclusions

HFA is a relevant inhibiting factor for the achievement of therapy goals in psycho-cardiological rehabilitation such as health behavior and HRQoL. Heart-related avoidance in particular, has a negative impact on exercise capacity, physical activity, and self-reported physical health. Its prospective negative predictive value for physical activity and physical health underlines the relevance of HFA for psycho-cardiological interventions.

Pattern Changes in the Heart Rate Variability of Patients Undergoing Coronary Artery Bypass Grafting Surgery

Introduction

Coronary artery bypass grafting (CABG) with extracorporeal circulation is a key therapy for coronary artery disease (CAD). However, cardiovascular events and cardiac arrhythmias may still occur in these patients following surgery. Many studies have demonstrated a correlation between cardiac arrhythmias and heart rate variability (HRV). This study aimed to establish the temporal change pattern of HRV observed following CABG.

Methods

A prospective method was used to study 119 consecutive patients with stable CAD who were assessed using 24-hour Holter recordings 2 days before CABG and 1 week, 3 months, and 6 months after the surgery at Hanoi Heart Hospital from June 2016 to August 2018. Main results: All the time-domain and frequency-domain parameters of HRV decreased precipitately after CABG and were mostly recovered 3 months postoperatively. The percentage of decreased HRV before surgery was 28.6% and 51.8% after 7 days, 19.6% after 3 months, and 12.7% after 6 months. ASDNN and SDNN before and after surgery had the highest rates of change.

Conclusion

The early decrease in HRV observed 7 days after CABG may be related to the acute effects of the surgery. The recovery of HRV at 3 months after surgery, regardless of the preoperative state of the patients, implies that the autonomic nervous system (ANS) disorder may be improved at this time. At 6 months after surgery, the autonomic nervous injury was recovered in combination with improvement of reperfusion, resulting in improvement in almost all HRV indices compared with those indices preoperatively.

Timed up and go test predicts mortality in older adults in Peru: a population-based cohort study

Background

While there is evidence about stablished risk factors (e.g., raised blood pressure) and higher mortality risk in older population, less has been explored about other functional parameters like the Timed Up and Go test and the Gait Speed in older people at low- and middle-income countries. We aimed to study these mobility tests as predictors of mortality in a population of older people in Peru.

Methods

Population-based prospective cohort study (2013–2020). Random sampling of people aged 60+ years in a community of Lima, Peru. Geriatricians conducted all clinical evaluations and laboratory tests were conducted in the local hospital. Participants were sought in the national vital registration system, and we collated cause (ICD-10) and date of death. We conducted a nested forward multivariate Cox proportional hazard model to identify all potential predictors of all-cause, communicable and non-communicable diseases mortality.

Results

At baseline, there were 501 older people (mean age 70.6 and 62.8% were women), complete follow-up information was available from 427 people. Mean follow-up time was 46.5 months (SD = 25.3). In multivariate models, the Timed Up and Go test was associated with higher risk of all-cause mortality (HR = 1.05; 95% CI: 1.02–1.09). For cause-specific mortality, history of heart disease (HR = 2.25; 95% CI: 1.07–4.76) and age in years (HR = 1.05; 95% CI: 1.01–1.09) were predictors of non-communicable diseases mortality.

Conclusions

In addition to established risk factors for mortality in older population, the Timed Up and Go test, a functional parameter, raised as a relevant predictor of all-cause mortality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02749-6.

Association of Combined Slow Gait and Low Activity Fragmentation With Later Onset of Cognitive Impairment

IMPORTANCE

Among older people, slow walking is an early indicator of risk for Alzheimer disease (AD). However, studies that have assessed this association have not considered that slow walking may have different causes, some of which are not necessarily associated with higher AD risk.

OBJECTIVE

To evaluate whether low activity fragmentation among older adults with slow gait speed indicates neurological causes of slow walking that put these individuals at higher risk of AD.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study performed survival analyses using data from the Baltimore Longitudinal Study of Aging. Participants included 520 initially cognitively normal persons aged 60 years or older. New diagnoses of mild cognitive impairment (MCI) or AD were adjudicated during a mean (SD) follow-up of 7.3 (2.7) years. Initial assessment of gait speed and activity fragmentation occurred from January 3, 2007, to May 11, 2015, with follow-up completed on December 31, 2020. Data were analyzed from February 1 to May 15, 2021.

EXPOSURES

Gait speed for 6 m and activity fragmentation assessed by accelerometry.

MAIN OUTCOMES AND MEASURES

Associations of gait speed, activity fragmentation, and their interaction with incident MCI/AD were evaluated using Cox proportional hazards models, adjusted for covariates.

RESULTS

Among the 520 participants (265 women [51.0%]; 125 Black participants [24.0%]; 367 White participants [70.6%]; mean [SD] age, 73 [8] years), MCI/AD developed in 64 participants. Each 0.05-m/s slower gait was associated with a 7% increase in risk of developing MCI/AD (hazard ratio [HR], 1.07 [95% CI, 1.00-1.15]; P = .04). Activity fragmentation alone was not associated with MCI/AD risk (HR, 0.83 [95% CI, 0.56-1.23]; P = .35), but there was a significant interaction between gait speed and activity fragmentation (HR, 0.92 [95% CI, 0.87-0.98]; P = .01). At low activity fragmentation (-1 SD), each 0.05-m/s slower gait speed was associated with a 19% increase in hazard of developing MCI/AD (HR, 1.19 [95% CI, 1.07-1.32]), whereas at higher activity fragmentation (+1 SD), gait speed was not associated with MCI/AD (HR, 1.01 [95% CI, 0.93-1.10]). Among participants with slow gait, higher activity fragmentation was associated with higher odds of having lower extremity osteoarthritis (odds ratio, 1.31 [95% CI, 1.01-1.69]) and less decline in pegboard dominant hand performance (β = 0.026 [SE, 0.009]; P > .05).

CONCLUSIONS AND RELEVANCE

These findings suggest that frequent rests among older adults with slow gait speed are associated with lower risk of future MCI/AD and that this behavioral strategy is associated with a lower likelihood of subclinical neurological impairment.

The Role of Gait Speed in Dementia: A Secondary Analysis from the SABE Colombia Study

INTRODUCTION

Gait speed (GS) is a predictor of negative outcomes in older adults and in those in risk to develop cognitive impairment; as such, it has been associated with dementia. Studies in Latin-American older adults showing this association are scarce. This study aimed to evaluate the relationship between GS and dementia in a representative sample of Colombian older adults.

METHODS

This study is a secondary analysis from the Survey on Health, Well-Being, and Aging, SABE (from initials in Spanish: Salud, Bienestar &amp; Envejecimiento) Colombia's survey conducted in 2015 with a sample of 23,694 elderly adults aged 60 years or older.

RESULTS

A total of 19,470 participants from the SABE Colombia survey were available for analysis. The multivariate analysis shows that dementia was associated with slow GS (PR 2.39; CI 1.91-3.01) independently to the other variables (p < 0.001). Similarly, GS as a continuous variable shows a statistically significant association with dementia in the adjusted analysis (OR 0.06; CI 0.04-0.09; p < 0.001).

CONCLUSION

Dementia was associated with slow GS. This finding provides evidence to include GS as a complementary parameter in the assessment of Colombian elderly adults.

Reassessing Sarcopenia in Hypertension: STAR and ACE Inhibitors Excel

BACKGROUND

Hypertension and sarcopenia are commonly seen in older adults. The renin-angiotensin system and the therapeutic use of angiotensin-converting enzyme (ACE) inhibitors have been on the agenda of sarcopenia in different perspectives. Our aim was to explore the frequency of sarcopenia in patients with hypertension and to investigate the association between the use of ACE inhibitors and sarcopenia.

METHODS

A total of 272 community-dwelling adults were recruited. Anterior thigh muscle thickness was measured by ultrasound. Handgrip strength, gait speed, and chair stand test were evaluated. Low muscle mass was diagnosed in the presence of low sonographic thigh adjustment ratio (STAR) values and sarcopenia was diagnosed if low STAR values were coupled with low functional tests.

RESULTS

136 subjects (50.0%) had no comorbid disease; 102 (37.5%) had one, 21 (7.7%) had two, nine (3.3%) had three and four (1.5%) had four comorbid diseases. Both low muscle mass (41.9% vs 13.2%) and sarcopenia (32.2% vs 7.8%) were more commonly seen in hypertensive when compared with normotensive older adults. Subgroup analysis of older adults with hypertension revealed that sarcopenia was less prevalent (P = .003) in patients using ACE inhibitors (8.7%) than those using angiotensin II receptor blockers (48.7%) and other antihypertensive drugs (46.4%). After binary logistic regression analyses; only the presence of hypertension seemed to independently predict the development of sarcopenia in older adults [OR = 6.5 (95% CI: 2.4-17.8, P < .001)].

CONCLUSIONS

Sarcopenia is highly prevalent in hypertensive older adults. Amongst many antihypertensive medications, ACE inhibitors seem to have favourable effects on both disorders.

Walking pace and the risk of stroke: A meta-analysis of prospective cohort studies

PURPOSE

The extent to which walking pace is associated with a reduced risk for stroke remains unclear. This study examined the association between walking pace and stroke risk based on prospective cohort studies.

METHODS

Databases of PubMed, EMBASE, Web of Science, Scopus, and China National Knowledge Internet were searched from the inception dates to January 31, 2019, for prospective cohort studies focusing on walking pace and risk of stroke in adults. Two reviewers independently extracted data and assessed the quality of the studies. The dependent measure was stroke incidence. Using random-effects models, a meta-analysis was performed to estimate the overall relative risks (RR) of stroke incidence and 95% confidence intervals (CIs) for the individuals with the fastest walking paces vs. individuals with the slowest walking paces. A dose-response relationship was also examined.

RESULTS

After screening 1294 titles/abstracts and 14 full-text studies identified in the search, 7 studies (from 8 cohorts) were included in the meta-analysis. The 7 studies included a total of 135,645 participants (95.2% women; mean age 63.6 years) and 2229 stroke events (median follow-up time = 8.0 years). Compared to individuals in the slowest walking-pace category (median = 1.6 km/h), individuals in the fastest walking-pace category (median = 5.6 km/h) had a 44% lower risk of stroke (pooled RR = 0.56, 95%CI: 0.48-0.65). There was also a linear dose-response relationship (RR = 0.87; 95%CI: 0.83-0.91), with the risk of stroke decreased by 13% for every 1 km/h increment in baseline walking pace. We observed similar results across walking-pace assessment, type of stroke ascertainment, stroke subtypes, sex, sample size, and duration of follow-up.

CONCLUSION

Findings from this meta-analysis indicate that walking pace is inversely associated with the risk of stroke.

Small Steps in Fitness, Major Leaps in Health for Adults With Intellectual Disabilities

Physical fitness is positively related to health outcomes like morbidity and all-cause mortality, with minimally required cutoff values to generate those health benefits. Individuals with intellectual disability (ID) exhibit very low fitness levels well below those cutoff values. Our novel hypothesis is that even among very unfit, older adults with ID, small changes in fitness translate to major changes in health.

Walking performance is associated with coronary artery calcification in very old adults

BACKGROUND

Coronary artery calcification (CAC) scores have good predictive value for atherosclerosis-related outcomes in the geriatric population. The low availability of cardiac computed tomography is an obstacle to assess CAC in clinical practice. Thus, clinical signs with a good degree of association with CAC can help to estimate cardiovascular risk, particularly in low-income populations.

OBJECTIVES

To assess whether clinical, biochemical and functional measures explain the CAC scores in older individuals.

METHODS

We characterized 89 non-institutionalized older volunteers (≥ 80 years old) by means of a comprehensive biochemical and anthropometric evaluation along with assessments of CAC scores determined by computerized tomography, and tested their association with walking speed test (WS) and handgrip strength (HS) performance.

RESULTS

Analyses of variance showed that body mass index (BMI) and waist circumference (WC) differed significantly (p ≤ 0.01 and p ≤ 0.03; respectively) across quartiles, so that subsequent tests were adjusted for anthropometry. ANCOVA revealed that the two lower quartiles of CAC had better performance in WS compared to the third and fourth quartiles (p ≤ 0.04). Multinomial logistic regression analysis showed that WS scores exhibit enough power (R² = 0.379, p = 0.05) to explain CAC scores. There were no significant differences for HS between quartiles (p = 0.87).

CONCLUSION

WS is associated and explain CAC scores, and may be useful to stratify atherosclerotic burden in apparently healthy very old individuals regardless of body composition.

Does the association between physical capability and mortality differ by deprivation? Findings from the UK Biobank population-based cohort study

BACKGROUND

To investigate whether the excess risk of adverse health outcomes associated with a lower physical capability in adulthood differs by deprivation levels.

METHODS

279,030 participants from the UK Biobank were included. Handgrip strength and walking pace were the exposures. All-cause mortality, CVD mortality and incidence were the outcomes. Townsend deprivation index was treated as a potential effect modifier. The associations were investigated using Cox-regression models with years of follow-up as the time-varying covariate.

RESULTS

A significant interaction between deprivation and handgrip strength was found for all-cause mortality (p = 0.024), CVD mortality (p = 0.006) and CVD incidence (p = 0.001). The hazard ratio for all-cause mortality was 1.18 [1.09; 1.29] per 1-tertile higher level of grip strength in the least deprived group, whereas it was 1.30 [1.18; 1.43] in the most deprived individuals. Similar results were found for CVD mortality and incidence per tertile increment in handgrip strength in the least and most deprived quintiles, respectively. No significant interactions between deprivation and walking pace were found for any of the outcomes.

CONCLUSION

Low handgrip strength is a stronger predictor of morbidity and mortality in individuals living in more deprived areas.

Association between Walking Pace and Diabetes: Findings from the Chilean National Health Survey 2016-2017

BACKGROUND

Walking pace is a well-known indicator of physical capability, but it is also a strong predictor of type 2 diabetes (T2D). However, there is a lack of evidence on the association between walking pace and T2D, specifically, within developing countries such as Chile.

AIM

To investigate the association between self-reported walking pace and T2D in the Chilean adult population.

METHODS

5520 Chilean participants (aged 15 to 90 years, 52.1% women) from the Chilean National Health Survey 2016-2017 were included in this cross-sectional study. Both walking pace (slow, average, and brisk) and diabetes data were collected through self-reported methods. Fasting blood glucose (reported in mg/dl) and glycosylated haemoglobin A (HbA1c) scores were determined via blood exams.

RESULTS

In the unadjusted model, and compared to people who reported a slow walking pace, those with average and brisk walking pace had lower blood glucose levels (β = -7.74 mg/dL (95% CI: -11.08 to -4.40) and β = -11.05 mg/dL (95% CI: -14.36 to -7.75), respectively) and lower HbA1c (β = -0.34% (95% CI: -0.57 to -0.11) and β= -0.72% (95% CI: -0.94 to -0.49)), respectively. After adjusting for sociodemographic, Body Mass Index and lifestyle factors, the association between glycaemia and HbA1c remained only for brisk walkers. Both the average and brisk walker categories had lower odds of T2D (OR: 0.59 (95% CI: 0.41 to 0.84) and (OR 0.48 (95% CI: 0.30 to 0.79), respectively).

CONCLUSION

Brisk walkers were associated with lower blood glucose and HbA1c levels. Moreover, average to brisk walking pace also showed a lower risk for T2D.

Reference value on daily living walking parameters among Japanese adults

Aim

Walking speed is closely related to numerous health outcomes. It has typically been measured in laboratory settings, where individuals can intentionally change their walking speed. It can be accurately measured in daily life using a smartphone global positioning system. We aimed to present a reference value on walking speed in daily life by sex and age.

Methods

The data were obtained using a walking monitoring service involving global positioning system technology. A secondary data analysis was carried out. Four daily living walking parameters – daily living walking speed, daily living walking cycle, daily living step length and daily living cadence – of 8429 Japanese persons were measured in their daily life using a smartphone application.

Results

The means (standard deviations) of daily living walking speed, daily living walking cycle, daily living step length and daily living cadence were 1.30 m/s (0.10 m/s), 1.02 s (0.06 s), 65.55 cm (5.38 cm) and 118.86 steps/min (6.76 steps/min), respectively. Notably, daily living walking speed in those aged >65 years was significantly slower than in those aged <65 years.

Conclusions

The present reference values and age differences of daily living walking parameters can be used to compare daily living walking speed data measured by other devices, such as accelerometers. This could allow for a consensus on the definition of daily walking speed that can be utilized for assessing health outcomes among older individuals. Geriatr Gerontol Int 2020; 20: 664–669.

Gait Speed at Discharge and Risk for Readmission or Death: A Prospective Study of an Emergency Ward Population

Background

There has been a growing interest in measuring gait speed for assessing long-term mortality and risk for hospital readmission in different populations.

Objective

We studied the association between a 10-meter gait speed test at hospital discharge and the risk for 30- and 90-day hospital readmission or death in a mixed population of patients hospitalized for emergency care.

Patients and Methods

Patients were prospectively included from 5 wards at the Karolinska University Hospital. The 10-meter gait speed test was measured on the day of discharge. Statistical analysis was performed using logistic regression.

Results

A total of 344 patients were included. Forty-one patients (n=41) were readmitted to hospital or died within 30 days, and 81 were readmitted or died within 90 days after discharge. Readmitted patients were older and had more comorbidities. A 0.1 m/s reduction in gait speed was associated with a 13% greater odds of readmission or death within 30 days (OR 1.13 [95% CI 1.00–1.26]). The area under the receiver operating characteristic curve (AUC) was 0.59 (95% CI 0.51–0.68). The results were similar for 90-day readmission or death where a 0.1 m/s decrement in gait speed was associated with an OR of 1.13 (95% CI 1.04–1.24). When age, eGFR, hemoglobin concentration, and active cancer, which all were univariate predictors of 30-day readmissions, were added to the model it yielded an AUC of 0.68 (95% CI 0.60 to 0.77).

Conclusion

In a mixed population of patients hospitalized for emergency care, low gait speed at discharge was associated with an increased risk of 30- and 90-day readmission or death. However, the test did not discriminate well between those who were readmitted or died and those who did not; therefore we do not recommend its use as a stand-alone test in this population.

Association of gait speed and grip strength with risk of cardiovascular events in patients on haemodialysis: a prospective study

Background

Gait speed (GS) and handgrip strength (HGS), both factors associated with frailty and sarcopenia, are reportedly associated with CV events in the general population. However, little is known about the impact of these factors on the outcome of patients on dialysis. This study aimed to evaluate whether evaluation of GS and HGS could be associated the onset of fatal/non-fatal cardiovascular (CV) events in patients on haemodialysis (HD).

Methods

One-hundred-eighty-two patients with end-stage renal disease (ESRD) undergoing HD at four dialysis clinics in April 2015 provided written informed consent to participate in the study. We excluded patients who had physical disability, were unable to walk without help, or had recently experienced CV events. Usual GS over a 4-m walk and HGS were measured at baseline, and 173 patients (men, 124; women, 49) were divided into sex-specific quartiles according to GS and HGS and were followed-up for fatal/non-fatal CV events for a median of 2 years. We examined the association of GS and HGS with CV events and determined cut-off values using Cox regression analysis adjusted for age, sex, HD duration, history of CVD, and diabetes.

Results

During the follow-up period, 46 CV events occurred. Both physical performance factors were significantly associated with CV events. Low GS (< 0.82 m/s for men and 0.81 m/s for women) and weak HGS (< 29.0 kg for men and 19.7 kg for women) were associated with CV events. For low vs. high GS, the hazard ratio (HR) for CV events was 2.29 [95% confidence interval (CI): 1.20–4.33; P = 0.01], and for low vs. high HGS, the HR was 2.15 [95% CI: 1.00–5.04; P < 0.05]. These HRs remained significant after adjusting for confounding factors, such as sex, age, dialysis vintage, history of CV disease, and diabetes.

Conclusions

Slow GS and weak HGS in patients on HD were suggested to be independent predictors of fatal/non-fatal CV events.

Electronic supplementary material

The online version of this article (10.1186/s12882-019-1370-6) contains supplementary material, which is available to authorized users.

6th vital sign app: Testing validity and reliability for measuring gait speed

BACKGROUND

Gait speed tests are useful predictors of different health outcomes in people. These tests can be administered by the convenience of one's smartphone.

RESEARCH QUESTION

Is the 6th Vital Sign app valid and reliable for measuring gait speed?

METHODS

The study used a prospective test-retest design. Fifteen college subjects were asked to walk at their normal pace for 2 min. Each subject performed two trials. Speed was recorded by the 6th Vital Sign app, Brower timing gates, and by hand-measurement of distance walked divided by the 2 min. Criterion validity was assessed by paired t-tests, Cohen's D effect sizes, and Pearson correlation tests. Inter-trial reliability within each device was assessed with Pearson correlation tests.

RESULTS

Speed measured by the app was significantly lower than speed measured by gates (p = 0.004) and by hand-measurement (p = 0.009). The difference between gates and hand-measurement was not significant (p = 0.684). The speed measured by gates and hand-measurement were very highly correlated (r = 0.974), but speed measured by app was only moderately correlated with gates (r = 0.370) and hand-measurement (r = 0.365). The inter-trial reliability was fairly high with correlations r = 0.916, 0.944, and 0.941 when speed was measured by the app, gates, and hand-measurement, respectively.

SIGNIFICANCE

The app tended to underestimate speed when compared to gate and hand-measurements. Therefore, we conclude that the 6^th Vital Sign app is not valid for use for clinical diagnosis or prognosis.