Self-reported aging-related fatigue: a concept description and its relevance to physical therapist practice

The effectiveness of group music reminiscence therapy for people thriving with dementia: A systematic review of randomized controlled trials

Dementia is characterized by a progressive decline in cognition, behavioral and psychological symptoms (BPSD), and quality of life (QoL). The lack of curative therapies has led to a psychosocial discourse prioritizing QoL of people thriving with dementia (PTD). Group reminiscence therapy (RT) is a relatively inexpensive intervention, with music prompts being a preferred choice, owing to robust musical memory in the early disease stage. However, a synthesis of current evidence is needed to inform research and clinical use of group music RT in dementia care. Therefore, we conducted a systematic review on PubMed, Scopus, CINAHL, APA PsycInfo, and APA PsycArticles to critically appraise published randomized controlled trials examining group music RT to improve cognition, BPSD, and QoL in PTD. Of 14,725 articles, two RCTs involving 102 PTD were included. All studies used prerecorded music for group music RT. All studies were deemed of good quality, adhering to intention-to-treat analysis and assessor blinding. Based on the American Academy of Neurology guidelines, we assigned a Level C recommendation for group music RT for cognition and Level B recommendations for BPSD and QoL (ineffective). In conclusion, group music RT may be useful for symptomatic management in PTD. However, heterogeneous study designs, disease severity, dementia subtype, and outcome measures are likely barriers to meaningful clinical translation. Therefore, the rating of recommendations only serves as a point of reference. Future avenues include live performances as prompts for group music RT.

Effects of progressive body-weight versus barbell back squat training on strength, hypertrophy and body fat among sedentary young women

The objective of this study was to compare the effects of progressive bodyweight training and barbell back squat on muscle strength, muscluar hypertrophy, and body fat percentage in sedentary young women. Thirteen sedentary young women (aged 19.77 ± 0.83 years, height 164.91 ± 6.01) were randomly assigned to either the progressive bodyweight group (n = 6, consisting of 10 levels of movements progressing from bilateral to unilateral) or the barbell squat group (n = 7, 60-80% 1RM). Both groups underwent two training sessions per week for 6 weeks. Measurements of muscle strength (isokinetic knee extensor and flexor muscle peak torque of each leg), muscle thickness (gluteus maximus, rectus femoris, and gastrocnemius muscles), and body fat percentage were taken at baseline and post-testing. Both groups showed a significant increase in isometric peak torque of the knee extensor and flexor (p < 0.05), but there were no significant between-group differences in isometric peak torque of the knee extensor and flexor (p > 0.05) or in the mean concentric peak torque of the knee H/Q ratio (p > 0.05). Both groups also showed significant increases in muscle thickness (p < 0.05), with no significant differences in Gastrocnemius, Rectus femoris and Gluteus maximus (p > 0.05). The percentage of body fat significantly decreased in the barbell group (pre: 28.66 ± 4.58% vs post: 24.96 ± 5.91%, p = 0.044), but not in the bodyweight group (pre: 24.18 ± 4.63% vs post: 24.02 ± 4.48%, p = 0.679). Our findings indicate that while both training methods increased maximum strength and muscle mass, barbell back squat training may be more effective in reducing body fat percentage.

Evaluation of the Bidirectional Relations of Perceived Physical Fatigability and Physical Activity on Slower Gait Speed

BACKGROUND

Lower physical activity levels and greater fatigability contribute independently to slower gait speed in older adults. To fully understand the bidirectional relations between physical activity and fatigability, and to inform potential intervention strategies, we examined whether physical activity or fatigability explains more of the other factor's association on slower gait speed.

METHODS

Two generations (probands and offspring) of older adults (N = 2079, mean age 73.0 ± 10.0 years, 54.2% women, 99.7% White) enrolled in the Long Life Family Study were assessed at Visit 2 (2014-2017). Self-reported physical activity was measured with the Framingham Physical Activity Index and perceived physical fatigability using the Pittsburgh Fatigability Scale. Statistical mediation analyses were conducted separately by generation with linear mixed-effect models accounting for family relatedness and adjusted for demographics, health conditions, and field center.

RESULTS

Greater perceived physical fatigability explained the association of lower physical activity on slower gait speed via a 22.5% attenuation of the direct association (95% confidence interval [CI]: 15.0%-35.2%) for the probands and 39.5% (95% CI: 22.8%-62.6%) for the offspring. Whereas lower physical activity explained the association of greater perceived fatigability on slower gait speed via a 22.5% attenuation of the direct association (95% CI: 13.4%-32.8%) for the probands and 6.7% (95% CI: 3.8%-15.4%) for the offspring.

CONCLUSIONS

Our findings suggest that the impact of greater perceived physical fatigability on the association between lower physical activity and slower gait speed differs between younger-old and middle-to-oldest-old adults, indicating perceived physical fatigability as a potential mediator in the disablement pathway.

Evaluation of Fatigue among Older Population in Jordan

Objective: Fatigue among older adults has not received empirical attention in the Arabic region. Thus, this study aimed to assess the levels of fatigue and its related psychosocial factors and examine the predictors of fatigue in older Jordanians aged 60 years and more.Methods: This study used a cross-sectional design and our sample was 250 older adults receiving health services at comprehensive healthcare centers in Amman Governorate, the capital of Jordan. The study used the following scales: Fatigue scale, Rosenberg Self-Esteem Scale, Perceived Stress Scale, Multidimensional Social Support Scale, and sociodemographic and lifestyle behaviors datasheet.Results: The results showed that approximately 57% of the participants experienced severe fatigue. Nearly 90% of the older adults reported having moderate to high levels of stress, around 97% experienced moderate and high levels of social support, and almost 68% had normal self-esteem. The significant predictors of the total fatigue scores were, consuming soft drinks, practicing exercise, perceived levels of stress, and social support levels.Conclusions: Awareness of the magnitude and the factors predicting fatigue among elderlies in Jordan should inform the practice and encourage clinicians to implement individualized care plans that include fatigue reduction strategies, to elderlies visiting healthcare centers.

Carbon Dioxide Expiration and Performance Fatigability Following Aerobic Exercise Training: A Longitudinal, Observational, Pilot Study

Purpose

This study examined the influence of aerobic exercise training (AET) on components of carbon dioxide expiration (VCO2), cardiorespiratory function, and fatigability.

Methods

Twenty healthy adults completed peak cardiopulmonary exercise (CPX) and submaximal tests before and after a vigorous, 4-week AET regimen. Each test was followed by a 10-min recovery and endurance test at 70% of peak wattage attained during CPX. Fatigability was assessed using testing durations and power output. Respiratory buffering (excess VCO2) and non-buffering (metabolic VCO2) were calculated. Data were analyzed for significance (p<0.05) using regressions and paired t-tests.

Results

Significant improvements in all measures of fatigability were observed after AET. A significant increase in excess VCO2 was observed, though not in metabolic VCO2. Excess VCO2 was strongly predictive of fatigability measures.

Conclusion

Significant decreases in fatigability are often observed in clinical populations such as obstructive or restrictive lung disease or pulmonary hypertension following AET, even when peak cardiorespiratory function does not appear to adapt. Decreases in fatigability appear to predict longevity with no yet identified mechanism. These results suggest that respiratory buffering and metabolic components of VCO2 may adapt independently to AET, introducing foundational plausibility for an influence of respiratory buffering adaptation to AET on fatigability status.

Role of Respiratory Buffering in the Relationship Between Recovery and Performance Fatigability Following Aerobic Exercise Training: A Longitudinal, Observational, Pilot Study

Purpose:

This study characterized the influence of excess expired carbon dioxide (excess V̇co 2) in the relationship between recovery and fatigability.

Methods:

Twenty healthy adults completed peak cardiopulmonary exercise tests (CPXs) and constant work rate tests before and after a vigorous, 4-week aerobic exercise training (AET) regimen. Each test was followed by 10 minutes of recovery and an endurance test at 70% of peak watts attained during CPX. Fatigability was assessed by measures of time to exhaustion and power output. Metabolic and recovery capacity indices were obtained. Data were analyzed using correlations and regressions and compared pre/post AET using paired t tests.

Results:

Significant improvements in recovery and fatigability were observed after AET, along with significant increases in total and excess V̇co 2. Relationships between measures of recovery and fatigability were observed, although strengths of the relationships were diminished after controlling analyses for the effect of excess V̇co 2.

Conclusions:

This study suggests that the ionic buffering capacity may moderate the relationship between recovery and fatigability. These results could have implications regarding AET-induced buffering dynamics, and its role in fatigue resistance when performing activities above moderate intensities. This may be of particular importance in patients with cardiopulmonary complications, unable to improve peak aerobic capacity.

Effects of an Individualized Exercise Program Plus Behavioral Change Enhancement Strategies for Managing Fatigue in Older People Who Are Frail: Protocol for a Cluster Randomized Controlled Trial

BACKGROUND

Although the evidence suggests that general fatigue is a strong indicator of rapid aging, frailty, and disability, general fatigue is undertreated in gerontological care.

OBJECTIVE

The aim of this study is to investigate whether an individualized exercise program with and without behavioral change enhancement (BCE) strategies for older people who are frail and have general fatigue will reduce their fatigue and symptoms of frailty.

DESIGN

A 3-arm, single-blind, cluster randomized controlled trial registered with ClinicalTrials.gov (NCT03394495) will be conducted.

SETTING

The study will be conducted in a community setting.

PARTICIPANTS

Two hundred eighty-five community-dwelling older people with general fatigue will be recruited from 12 district community health centers.

INTERVENTION

People from each center will be randomized to one of three groups. The combined group will receive a 16-week combined intervention consisting of individualized exercise training and the BCE program, plus two booster sessions at 2 and 6 months after the program. The exercise group will receive exercise training and health talks only. The control group will receive health talks only.

MEASUREMENTS

Outcome measures will be collected at baseline, at the midpoint (week 8) of the program, and then at 1 week, 6 months, and 12 months after the end of the program. The primary outcome---level of fatigue---will be measured using the Multidimensional Fatigue Inventory. Secondary outcomes will include the participants' frailty status, strength, mobility, exercise self-efficacy, and habitual physical activity.

LIMITATIONS

A self-reported level of fatigue will be used.

CONCLUSIONS

The effect of exercise and BCE strategies on general fatigue among older people who are frail is not known. This study will be a pioneering interventional study on how general fatigue among older people who are frail can be managed and how fatigue-related frailty can be prevented or minimized.

Effects of Fatigue on Balance in Individuals With Parkinson Disease: Influence of Medication and Brain-Derived Neurotrophic Factor Genotype

BACKGROUND AND PURPOSE

Because falls can have deleterious consequences, it is important to understand the influence of fatigue and medications on balance in persons with Parkinson disease (PD). Thus, the purpose of this study was to investigate the effects of fatigue on balance in individuals with PD. Because brain-derived neurotrophic factor (BDNF) has been shown to be related to motor performance, we also explored its role.

METHODS

A total of 27 individuals (age = 65.4 ± 8.1 years; males = 14, females = 13) with neurologist-diagnosed PD with 13 genotyped for BDNF as Val66Val, 11 as Val66Met, 2 as Met66Met (1 refused). Participants were tested both on and off medication, 1 week apart. On both days, they completed a pre- and posttest separated by a fatiguing condition. Factorial analyses of variance were performed for the following balance domains: (1) anticipatory postural responses; (2) adaptive postural responses; (3) dynamic balance; (4) sensory orientation; and (5) gait kinematics. For BDNF, t-tests were conducted comparing genotype for the pre-post difference scores in both the on and off medication states.

RESULTS

There were no interactions between time (pre- and postintervention) and medication for any of the domains (Ps ≥ 0.187). Participants with BDNF Met alleles were not significantly different from Val66Val participants in balance (Ps ≥ 0.111) and response to a fatiguing condition (Ps ≥ 0.070).

DISCUSSION AND CONCLUSIONS

Fatigue does not appear to have a detrimental effect on balance, and there was not a differential effect of medication in individuals with PD. These results also indicate that participants with a BDNF Met allele did not have a greater decay in function after a fatiguing condition.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A196).

Systematic content evaluation and review of measurement properties of questionnaires for measuring self-reported fatigue among older people

PURPOSE

The assessment of fatigue in older people requires simple and user-friendly questionnaires that capture the phenomenon, yet are free from items indistinguishable from other disorders and experiences. This study aimed to evaluate the content, and systematically review and rate the measurement properties of self-report questionnaires for measuring fatigue, in order to identify the most suitable questionnaires for older people.

METHODS

This study firstly involved identification of questionnaires that purport to measure self-reported fatigue, and evaluation of the content using a rating scale developed for the purpose from contemporary understanding of the construct. Secondly, for the questionnaires that had acceptable content, we identified studies reporting measurement properties and rated the methodological quality of those studies according to the COSMIN system. Finally, we extracted and synthesised the results of the studies to give an overall rating for each questionnaire for each measurement property. The protocol was registered with PROSPERO (CRD42013005589).

RESULTS

Of the 77 identified questionnaires, twelve were selected for review after content evaluation. Methodological quality varied, and there was a lack of information on measurement error and responsiveness.

CONCLUSIONS

The PROMIS-Fatigue item bank and short forms perform the best. The FACIT-Fatigue scale, Parkinsons Fatigue Scale, Perform Questionnaire, and Uni-dimensional Fatigue Impact Scale also perform well and can be recommended. Minor modifications to improve performance are suggested. Further evaluation of unresolved measurement properties, particularly with samples including older people, is needed for all the recommended questionnaires.

More years, less yawns: fresh evidence on tiredness by age and other factors

OBJECTIVES

It is commonplace for people to complain about being tired. There have been actually few studies of tiredness in large general population samples, and where studies do exist, the measures often rely on external assessments. We use a diary-based method to overcome these limitations in a representative sample of U.S. residents.

METHODS

Data come from the 2010 American Time Use Survey. Around 13,000 respondents provided a diary about the prior day and rated how tired they felt during selected activities. Regression analysis is used to explain variance in tiredness by age.

RESULTS

Regression analysis reveals that tiredness decreases with age. This relationship exists when we control for hours of sleep, gender, self-rated health, ethnic group, number of children, marital status, employment status, level of education, and the amount of time participants spent doing tiring activities.

DISCUSSION

Contrary to much previous research, tiredness decreases with age. People who are more than 65 years of age are almost one point on a 0-6 scale less tired than people aged between 15 and 24. Clinical implications and methodological limitations are discussed.