Short physical performance battery as a predictor of mortality in community-dwelling older adults: a longitudinal study in the Brazilian Amazon region

Performance in a Balance Test and Prediction of All-Cause Mortality in Community-Dwelling Elderly Ambulatory Individuals: A Systematic Review and Meta-analysis

Objective: This systematic review and meta-analysis was performed to evaluate the association between an inability to perform a static balance test and mortality in community-dwelling older ambulatory individuals. Methods: PubMed, Embase, and Scopus were searched for relevant cohort studies. Hazard ratios (HR) were pooled (random-effect model). Meta-regression was performed with independent demographic variables (PROSPERO ID: CRD42022381137). Results: A total of 11,713 articles were screened and 15 were included. An inability to perform a static balance test was significantly associated with a higher risk of mortality irrespective of whether confounding variables were considered [HR, 1.14 (95% CI: 1.07-1.21); p < .001; i2, 87.96% (p < .01)] or not [HR, 1.11 (95% CI: 1.03-1.20); p = .01; i2, 95.28% (p < .01)] (both moderate GRADE evidence). Also, this association was correlated with progressive age. Conclusion: An inability to successfully complete a static balance test was significantly associated with a higher risk of mortality among community-dwelling older ambulatory individuals.

Metformin improves skeletal muscle and physical capacity by stabilizing neuromuscular junction in older adults

OBJECTIVES

Metformin is an anti-diabetic drug with protective effects on skeletal muscle and physical capacity. However, the relevant mechanisms of action on skeletal muscle remain poorly understood. We investigated the potential contribution of neuromuscular junction (NMJ) degradation to skeletal muscle and physical capacity in geriatric men taking metformin.

METHOD

We recruited geriatric men for placebo (Age=73.1 ± 4.2 years, n = 70) and metformin (Age=70.1 ± 4.5 years, n = 62) groups. The patients in the metformin group received 1700 mg of metformin twice a day for 16 weeks. We measured plasma c-terminal agrin-fragment-22 (CAF22) and neurofilament light chain (NfL) as markers of neuromuscular junction (NMJ) degradation and neurodegeneration, respectively, with relevance to handgrip strength (HGS) and short physical performance battery (SPPB; a marker of physical capacity) in older adults taking metformin. These findings were associated with reduced oxidative stress in the metformin group.

RESULTS

At baseline, both groups had similar HGS, gait speed, SPPB scores, and plasma biochemistry. Metformin improved HGS, gait speed, and cumulative SPPB scores in geriatric men (all p < 0.05). Metformin also reduced plasma CAF22 and NfL levels when compared to baseline. Similar observations were not found in the placebo group. Correlation analysis revealed significant correlations of plasma CAF22 with HGS, gait speed, and cumulative SPPB scores in the metformin group. These observations were associated with reduced oxidative stress in the metformin group.

CONCLUSION

Altogether, the restorative effects of metformin on skeletal muscle and physical capacity involve NMJ stabilization. Our data is clinically relevant for geriatric men with functional disabilities.

Implementing regular physical activity for older individuals in the family strategy program using the RE-AIM framework to ensure feasibility and sustainability: EISI study protocol

The EISI study protocol aims to address the low participation rate in physical exercise programs among older individuals, emphasizing its significance as a non-pharmacological therapeutic approach for overall health and increased physical activity. The objectives include implementing physical activity (PA) and educational health programs in Jequié, Bahia, Brazil, targeting the Family Health Strategy population to enhance local physical activity levels among older individuals. The study also seeks to evaluate the program's feasibility, safety, and sustainability for large-scale implementation, along with assessing its impact on immune and inflammatory response biomarkers to the SARS-CoV virus, as well as physical-functional and brain health. Participants, aged 60 or above, will be divided into two groups: multicomponent exercise (MCE) and behavioral change interventions (BCI). The study employs a mixed-method approach, utilizing a non-randomized controlled short-term pathway model for a 4-8 weeks of pilot study and 16-week intervention impact assessment. Data collection encompasses various aspects such as sociodemographic information, mental health, physical fitness, fall risk, functional capacity, anthropometric measurements, hemodynamic assessment, habitual physical activity, and health-related quality of life. Blood and saliva samples are collected for cytokine and antibody biomarker analysis related to SARS-CoV immunity. Pre- and post-intervention evaluations for both groups will be conducted, with the hypothesis that MCE will yield more favorable responses compared to BCI. The study's holistic approach, including the assessment of feasibility, safety, and sustainability, aims to contribute to achieving Sustainable Development Goals (SDG) 3 and SDG 9 b y promoting accessible and sustainable healthcare initiatives for older individuals. This research aligns with global efforts to enhance health and well-being, emphasizing the importance of regular exercise in the aging population.

Physical performance and muscle strength rather than muscle mass are predictor of all-cause mortality in hemodialysis patients

Objectives

Patients undergoing maintenance hemodialysis usually suffer a high burden of poor functional status. The aim of this study was to investigate the association between muscle mass, muscle strength as well as physical performance with all-cause mortality in hemodialysis patients.

Methods

923 hemodialysis patients (565 men, mean aged 61.3 ± 12.7 years) were included from eight facilities in Tianjin and Shanghai of China from 2019 to 2021. Muscle mass was evaluated by skeletal muscle index (SMI) and muscle strength was assessed by handgrip strength. Different measures of physical performance were measured via gait speed, Timed Up and Go Test (TUGT) and short physical performance battery (SPPB). Cox proportional hazards regression models were used to determine the adjusted hazard ratios (HRs) of mortality with 95% confidence intervals (95% CIs) for baseline muscle mass, muscle strength and different measures of physical performance. Additionally, the area under the Receiver Operating Characteristic (ROC) curves were constructed to determine which index is a better predictor of mortality.

Results

During a median follow-up of 14 (12-17 months), 79 (8.6%) patients died. Using the Cox regression analysis, we founded that muscle strength and physical performance rather than muscle mass were significantly negatively associated with mortality. The C-index for different measures of physical performance in predicting mortality were 0.709 for SPPB, 0.7 for TUGT and 0.678 for gait speed, respectively. The C-index for muscle strength was 0.635, and the ability of prediction was significantly lower than the physical performance.

Conclusions

Physical performance seems to a better indicator of mortality than muscle mass and strength in hemodialysis patients. Simple measures of physical performance may be appropriately used as a screening tool targeting high-risk hemodialysis patients for the prevention of mortality.

Friendly Residential Environments That Generate Autonomy in Older Persons

OBJECTIVE

This study aimed to explore the housing and residential environment conditions associated with functional autonomy in older persons.

METHODS

A quantitative cross-sectional study was conducted, including 175 individuals over the age of 60. Participants were non-institutionalized urban residents of Medellín, Colombia, selected by random two-stage sampling (neighborhoods and blocks). Analysis was done according to functional autonomy of action (dependent variable); and demographic conditions, housing, and the physical and social environment suggested by the World Health Organization (WHO) in the strategy of age-friendly cities (independent variables). Univariate, bivariate, and multivariate analyses were performed with these variables, where the odds ratio (OR), association hypothesis test, and confidence intervals were estimated, using logistic regression models.

RESULTS

89.7% of older persons had moderate physical performance. The performance of intergenerational activities (OR = 5.28) and community actions (OR = 11.28) were part of social environments. The adaptations in public transport (OR = 90.33), sanitary services (OR = 4.1), and lighting in parks (OR = 19.9) of the physical environment were the associations found with functional autonomy.

CONCLUSIONS

Exploring how the physical and social environments surrounding housing are associated with the functional performance of older persons can generate useful information to support public health and city infrastructure strategies that improve their physical performance and maintain autonomy.