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Butcher L, Carnicero JA, Pérès K, Bandinelli S, García-García FJ, Rodriguez-Artalejo F, Rodriguez-Mañas L, Erusalimsky JD. Frailty Influences the Relationship between the Soluble Receptor for Advanced Glycation-End Products and Mortality in Older Adults with Diabetes Mellitus. Gerontology 2024:1-10. [PMID: 38593754 DOI: 10.1159/000538292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
INTRODUCTION Frailty is prevalent among older adults with diabetes mellitus. Elevated serum levels of the soluble receptor for advanced glycation-end products (sRAGE) predict mortality in frail older adults. The evidence that sRAGE is also related to higher mortality in older adults with diabetes mellitus is inconsistent. Therefore, this study explored if frailty status influences the relationship between sRAGE and mortality in older adults with this condition. METHODS We analysed data of 391 participants with diabetes mellitus (median age, 76 years) from four European cohorts enrolled in the FRAILOMIC project. Frailty was evaluated at baseline using Fried's criteria. Serum sRAGE was determined by ELISA. Participants were stratified by frailty status (n = 280 non-frail and 111 frail). Multivariate Cox proportional hazards regression and Kaplan-Meier survival analysis were used to assess the relationship between sRAGE and mortality. RESULTS During 6 years of follow-up, 98 participants died (46 non-frail and 52 frail). Non-survivors had significantly higher baseline levels of sRAGE than survivors (median [IQR]: 1,392 [962-2,043] pg/mL vs. 1,212 [963-1,514], p = 0.008). High serum sRAGE (>1,617 pg/mL) was associated with increased mortality in the whole diabetes sample after adjustment for relevant confounders (HR 2.06, 95% CI: 1.36-3.11, p < 0.001), and there was an interaction between sRAGE and frailty (p = 0.006). Accordingly, the association between sRAGE and mortality was stronger in the frail group compared to the non-frail group (HR 2.52, 95% CI: 1.30-4.90, p = 0.006 vs. HR 1.71, 95% CI: 0.91-3.23, p = 0.099, respectively). Likewise, Kaplan-Meier curves showed a significant difference in survival rates between frail participants with high sRAGE and those with low sRAGE (p = 0.001), whereas no survival difference was seen in the non-frail group (p = 0.09). CONCLUSIONS Frailty status influences the relationship between sRAGE and mortality in older adults with diabetes mellitus. Determination of sRAGE in this population could be a useful tool for risk stratification.
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Affiliation(s)
- Lee Butcher
- The Cellular Senescence and Pathophysiology Group, Cardiff Metropolitan University, Cardiff, UK
| | - Jose A Carnicero
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain
| | - Karine Pérès
- Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Inserm, Bordeaux, France
| | | | | | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, CIBERESP, and IMDEA-Food Institute (CEI UAM+CSIC), Madrid, Spain
| | - Leocadio Rodriguez-Mañas
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain
- Service of Geriatrics, Hospital Universitario de Getafe, Getafe, Spain
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Jorge D Erusalimsky
- The Cellular Senescence and Pathophysiology Group, Cardiff Metropolitan University, Cardiff, UK
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Álvarez-Bustos A, Laosa O, Marzetti E, Carnicero JA, Castro-Rodriguez M, Landi F, Sinclair AJ, Rodriguez-Mañas L. Response rates and associated factors after a multicomponent intervention in frail older adults with diabetes. Age Ageing 2024; 53:afad253. [PMID: 38251739 DOI: 10.1093/ageing/afad253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) and frailty are associated with functional decline in older population. OBJECTIVE To explore the individual response to a multimodal intervention on functional performance. DESIGN A cluster-randomised multicentre clinical trial. SETTING Outpatients in hospital or primary care. SUBJECTS 843 (77.83 years, 50.65% men) prefrail and frail individuals ≥70 years with T2DM. METHODS Participants were allocated to usual care group (UCG) or a multicomponent intervention group (IG): 16-week progressive resistance training, seven nutritional and diabetological educational sessions and achievement of glycated haemoglobin (7-8%) and blood pressure (<150 mmHg) targets. Functional performance was assessed with the Short Physical Performance Battery (SPPB) at 1 year. We used multivariate binomial and multinomial logistic regression models to explore the effect of the IG, and adherence on the outcomes studied, in several adjusted models. RESULTS 53.7% in the IG versus 38.0% in the UCG improved by at least 1 point in their SPPB score [OR (95% CI): 2.07 (1.43, 2.98), P value <0.001]. Age, SPPB score and number of frailty criteria met decreased the probability of improving the SPPB score. Factors associated with worsening were pertaining to IG (decreased), age, SPPB score and the number of frailty criteria (increased). An adherence ≥84% was needed to achieve benefits, reaching the peak in the probability of improving SPPB when this was ≥85% [OR(95%CI): 2.38 (1.29, 4.79), P value 0.014]. CONCLUSIONS Factors predicting the likelihood of improvement in a multimodal programme in pre-frail and frail older adults with diabetes are age, basal SPPB score, the number of frailty criteria and adherence.
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Affiliation(s)
- Alejandro Álvarez-Bustos
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Olga Laosa
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
- Fundación de Investigación Biomédica de Hospital Universitario de Getafe, Madrid, Spain
| | - Emanuele Marzetti
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Jose Antonio Carnicero
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
- Fundación de Investigación Biomédica de Hospital Universitario de Getafe, Madrid, Spain
| | | | - Francesco Landi
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Alan J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail, Medici Medical Practice, Luton LU1 3UA, UK; School of Life & Health Sciences, Aston University, Birmingham, UK
| | - Leocadio Rodriguez-Mañas
- Biomedical Research Center Network for Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain
- Department of Geriatrics, Hospital Universitario de Getafe, Madrid, Spain
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Calvani R, Picca A, Rodriguez-Mañas L, Tosato M, Coelho-Júnior HJ, Biancolillo A, Laosa O, Gervasoni J, Primiano A, Santucci L, Giampaoli O, Bourdel-Marchasson I, Regueme SC, Sinclair AJ, Urbani A, Landi F, Gambassi G, Marini F, Marzetti E. Amino Acid Profiles in Older Adults with Frailty: Secondary Analysis from MetaboFrail and BIOSPHERE Studies. Metabolites 2023; 13:metabo13040542. [PMID: 37110200 PMCID: PMC10147014 DOI: 10.3390/metabo13040542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
An altered amino acid metabolism has been described in frail older adults which may contribute to muscle loss and functional decline associated with frailty. In the present investigation, we compared circulating amino acid profiles of older adults with physical frailty and sarcopenia (PF&S, n = 94), frail/pre-frail older adults with type 2 diabetes mellitus (F-T2DM, n = 66), and robust non-diabetic controls (n = 40). Partial least squares discriminant analysis (PLS-DA) models were built to define the amino acid signatures associated with the different frailty phenotypes. PLS-DA allowed correct classification of participants with 78.2 ± 1.9% accuracy. Older adults with F-T2DM showed an amino acid profile characterized by higher levels of 3-methylhistidine, alanine, arginine, ethanolamine, and glutamic acid. PF&S and control participants were discriminated based on serum concentrations of aminoadipic acid, aspartate, citrulline, cystine, taurine, and tryptophan. These findings suggest that different types of frailty may be characterized by distinct metabolic perturbations. Amino acid profiling may therefore serve as a valuable tool for frailty biomarker discovery.
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Affiliation(s)
- Riccardo Calvani
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Anna Picca
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
- Department of Medicine and Surgery, LUM University, 70010 Casamassima, Italy
| | - Leocadio Rodriguez-Mañas
- Servicio de Geriatría, Hospital Universitario de Getafe, 28905 Getafe, Spain
- Centro de Investigación Biomédica en Red "Fragilidad y Envejecimiento Saludable" (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Matteo Tosato
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
| | - Hélio José Coelho-Júnior
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Alessandra Biancolillo
- Department of Physical and Chemical Sciences, Università degli Studi dell'Aquila, 67100 L'Aquila, Italy
| | - Olga Laosa
- Department of Medicine and Surgery, LUM University, 70010 Casamassima, Italy
- Geriatric Research Group, Biomedical Research Foundation at Getafe University Hospital, 28905 Getafe, Spain
| | - Jacopo Gervasoni
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
| | - Aniello Primiano
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
| | - Lavinia Santucci
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
| | - Ottavia Giampaoli
- Department of Chemistry, Sapienza Università di Roma, 00185 Rome, Italy
| | - Isabelle Bourdel-Marchasson
- Clinical Gerontology Department, Bordeaux University Hospital, 33000 Bordeaux, France
- CRMSB, CNRS UMR 5536, Université de Bordeaux, 33000 Bordeaux, France
| | - Sophie C Regueme
- CHU Bordeaux, Pole Gérontologie Clinique, 33000 Bordeaux, France
| | - Alan J Sinclair
- Foundation for Diabetes Research in Older People (fDROP), King's College, London WC2R 2LS, UK
| | - Andrea Urbani
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanni Gambassi
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Federico Marini
- Department of Chemistry, Sapienza Università di Roma, 00185 Rome, Italy
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, 00168 Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Henning T, Kochlik B, Ara I, González-Gross M, Fiorillo E, Marongiu M, Cucca F, Rodriguez-Artalejo F, Carnicero Carreño JA, Rodriguez-Mañas L, Grune T, Weber D. Patterns of Dietary Blood Markers Are Related to Frailty Status in the FRAILOMIC Validation Phase. Nutrients 2023; 15:nu15051142. [PMID: 36904142 PMCID: PMC10005398 DOI: 10.3390/nu15051142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 02/26/2023] Open
Abstract
The influence of nutritional factors on frailty syndrome is still poorly understood. Thus, we aimed to confirm cross-sectional associations of diet-related blood biomarker patterns with frailty and pre-frailty statuses in 1271 older adults from four European cohorts. Principal component analysis (PCA) was performed based on plasma levels of α-carotene, β-carotene, lycopene, lutein + zeaxanthin, β-cryptoxanthin, α-tocopherol, γ-tocopherol and retinol. Cross-sectional associations between biomarker patterns and frailty status, according to Fried's frailty criteria, were assessed by using general linear models and multinomial logistic regression models as appropriate with adjustments for the main potential confounders. Robust subjects had higher concentrations of total carotenoids, β-carotene and β-cryptoxanthin than frail and pre-frail subjects and had higher lutein + zeaxanthin concentrations than frail subjects. No associations between 25-Hydroxyvitamin D3 and frailty status were observed. Two distinct biomarker patterns were identified in the PCA results. The principal component 1 (PC1) pattern was characterized by overall higher plasma levels of carotenoids, tocopherols and retinol, and the PC2 pattern was characterized by higher loadings for tocopherols, retinol and lycopene together and lower loadings for other carotenoids. Analyses revealed inverse associations between PC1 and prevalent frailty. Compared to participants in the lowest quartile of PC1, those in the highest quartile were less likely to be frail (odds ratio: 0.45, 95% CI: 0.25-0.80, p = 0.006). In addition, those in the highest quartile of PC2 showed higher odds for prevalent frailty (2.48, 1.28-4.80, p = 0.007) than those in the lowest quartile. Our findings strengthen the results from the first phase of the FRAILOMIC project, indicating carotenoids are suitable components for future biomarker-based frailty indices.
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Affiliation(s)
- Thorsten Henning
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), 14558 Nuthetal, Germany
- Food4Future (F4F), c/o Leibniz Institute of Vegetable and Ornamental Crops (IGZ), Theodor-Echtermeyer-Weg 1, 14979 Grossbeeren, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, 14558 Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, 14469 Potsdam, Germany
| | - Bastian Kochlik
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), 14558 Nuthetal, Germany
- Food4Future (F4F), c/o Leibniz Institute of Vegetable and Ornamental Crops (IGZ), Theodor-Echtermeyer-Weg 1, 14979 Grossbeeren, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, 14558 Nuthetal, Germany
- Department of Nutrition and Gerontology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), 14558 Nuthetal, Germany
| | - Ignacio Ara
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45071 Toledo, Spain
- CIBER of Frailty and Healthy Aging, CIBERFES, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Marcela González-Gross
- ImFINE Research Group, Department of Health and Human Performance, Universidad Politécnica de Madrid, 28040 Madrid, Spain
- CIBER on Physiopathology of Obesity and Nutrition, CIBEROBN, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Edoardo Fiorillo
- Institute for Genetic and Biomedical Research, National Research Council (CNR), 09042 Monserrato, Italy
| | - Michele Marongiu
- Institute for Genetic and Biomedical Research, National Research Council (CNR), 09042 Monserrato, Italy
| | - Francesco Cucca
- Institute for Genetic and Biomedical Research, National Research Council (CNR), 09042 Monserrato, Italy
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, CIBERESP and IMDEA-Food Institute, Universidad Autonoma de Madrid, CEI UAM + CSIC, 28029 Madrid, Spain
| | - Jose Antonio Carnicero Carreño
- CIBER of Frailty and Healthy Aging, CIBERFES, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Biomedical Research Foundation, Getafe University Hospital, 28905 Getafe, Spain
| | - Leocadio Rodriguez-Mañas
- CIBER of Frailty and Healthy Aging, CIBERFES, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Division of Geriatrics, Hospital Universitario de Getafe, 28905 Getafe, Spain
| | - Tilman Grune
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), 14558 Nuthetal, Germany
- Food4Future (F4F), c/o Leibniz Institute of Vegetable and Ornamental Crops (IGZ), Theodor-Echtermeyer-Weg 1, 14979 Grossbeeren, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, 14558 Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, 14469 Potsdam, Germany
| | - Daniela Weber
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), 14558 Nuthetal, Germany
- Food4Future (F4F), c/o Leibniz Institute of Vegetable and Ornamental Crops (IGZ), Theodor-Echtermeyer-Weg 1, 14979 Grossbeeren, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, 14558 Nuthetal, Germany
- Correspondence:
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Sepúlveda-Loyola W, Carnicero JA, Álvarez-Bustos A, Probst VS, Garcia-Garcia FJ, Rodriguez-Mañas L. Pulmonary function is associated with frailty, hospitalization and mortality in older people: 5-year follow-up. Heart Lung 2023; 59:88-94. [PMID: 36796248 DOI: 10.1016/j.hrtlng.2023.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/18/2023] [Accepted: 01/31/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND The relationship between pulmonary impairment and frailty has rarely been studied in community-dwelling older adults. OBJECTIVE This study aimed to analyze the association between pulmonary function and frailty (prevalent and incident), identifying the best cut-off points to detect frailty and its association with hospitalization and mortality. METHODS A longitudinal observational cohort study with 1188 community-dwelling older adults was taken from the Toledo Study for Healthy Aging. The forced expiratory volume in the first second (FEV1) and the forced vital capacity (FVC) were measured with spirometry. Frailty was evaluated using the Frailty Phenotype and Frailty Trait Scale 5. Associations between pulmonary function and frailty, hospitalization and mortality in a 5-year follow-up and the best cut-off points for FEV1 and FVC were analyzed. RESULTS FEV1 and FVC were associated with frailty prevalence (OR from 0.25 to 0.60), incidence (OR from 0.26 to 0.53), and hospitalization and mortality (HR from 0.35 to 0.85). The cut-off points of pulmonary function identified in this study: FEV1 (≤1.805 L for male and ≤1.165 L for female) and FVC (≤2.385 L for male and ≤1.585 L for female) were associated with incident frailty (OR: 1.71-4.06), hospitalization (HR: 1.03-1.57) and mortality (HR: 2.64-5.17) in individuals with and without respiratory diseases (P < 0.05 for all). CONCLUSION Pulmonary function was inversely associated with the risk of frailty, hospitalization and mortality in community-dwelling older adults. The cut-off points for FEV1 and FVC to detect frailty were highly associated with hospitalization and mortality in the 5-year follow-up, regardless of the existence of pulmonary diseases.
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Affiliation(s)
- Walter Sepúlveda-Loyola
- Faculty of Health and Social Sciences, Universidad de Las Américas, Santiago, Chile; Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Masters and PhD Program in Rehabilitation Sciences, Londrina State University (UEL) and University North of Paraná (UNOPAR), Londrina, Brazil
| | - Jose A Carnicero
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain
| | - Alejandro Álvarez-Bustos
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Vanessa Suziane Probst
- Masters and PhD Program in Rehabilitation Sciences, Londrina State University (UEL) and University North of Paraná (UNOPAR), Londrina, Brazil
| | - Francisco J Garcia-Garcia
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Geriatría, Hospital Virgen del Valle, Toledo, Spain
| | - Leocadio Rodriguez-Mañas
- Centro de Investigación Biomédica en Red sobre Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Departamento de Geriatría, Hospital Universitario de Getafe, Carretera de Toledo, km 12,500, Getafe, Spain.
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Rodriguez-Mañas L, Castillo Gallego C. Talking to Experts: Frailty in Older Adults. J Nutr Health Aging 2023; 27:924-925. [PMID: 37960918 DOI: 10.1007/s12603-023-1989-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/15/2023] [Indexed: 11/15/2023]
Affiliation(s)
- L Rodriguez-Mañas
- Leocadio Rodriguez-Mañas, Department of Geriatrics at Hospital Universitario of Getafe Spain,
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Rico-Uribe LA, Morillo-Cuadrado D, Rodríguez-Laso Á, Vorstenbosch E, Weser AJ, Fincias L, Marcon Y, Rodriguez-Mañas L, Haro JM, Ayuso-Mateos JL. Worldwide mapping of initiatives that integrate population cohorts. Front Public Health 2022; 10:964086. [PMID: 36262229 PMCID: PMC9574101 DOI: 10.3389/fpubh.2022.964086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Laura Alejandra Rico-Uribe
- CIBERSAM (Network-Based Biomedical Research Consortium, Area of Mental Health), Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, Madrid, Spain
- School of Health Sciences, Universidad Internacional de La Rioja, Logroño, Spain
| | - Daniel Morillo-Cuadrado
- CIBERSAM (Network-Based Biomedical Research Consortium, Area of Mental Health), Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, Madrid, Spain
- Instituto de Investigación Sanitaria La Princesa (IIS-LP), Hospital Universitario de La Princesa, Madrid, Spain
- *Correspondence: Daniel Morillo-Cuadrado
| | - Ángel Rodríguez-Laso
- CIBERFES (Network-Based Biomedical Research Consortium, Area of Frailty and Healthy Ageing), Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, Madrid, Spain
| | - Ellen Vorstenbosch
- CIBERSAM (Network-Based Biomedical Research Consortium, Area of Mental Health), Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, Madrid, Spain
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Department of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Andreas J. Weser
- HUNT (The Trøndelag Health Study) Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Leocadio Rodriguez-Mañas
- CIBERFES (Network-Based Biomedical Research Consortium, Area of Frailty and Healthy Ageing), Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, Madrid, Spain
| | - Josep María Haro
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Department of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - José Luis Ayuso-Mateos
- CIBERSAM (Network-Based Biomedical Research Consortium, Area of Mental Health), Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, Madrid, Spain
- Instituto de Investigación Sanitaria La Princesa (IIS-LP), Hospital Universitario de La Princesa, Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
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Oviedo-Briones M, Rodríguez-Laso Á, Carnicero JA, Gryglewska B, Sinclair AJ, Landi F, Vellas B, Rodríguez Artalejo F, Checa-López M, Rodriguez-Mañas L. The ability of eight frailty instruments to identify adverse outcomes across different settings: the FRAILTOOLS project. J Cachexia Sarcopenia Muscle 2022; 13:1487-1501. [PMID: 35429109 PMCID: PMC9178160 DOI: 10.1002/jcsm.12990] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/04/2022] [Accepted: 03/07/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To compare the performance of eight frailty instruments to identify relevant adverse outcomes for older people across different settings over a 12 month follow-up. METHODS Observational longitudinal prospective study of people aged 75 + years enrolled in different settings (acute geriatric wards, geriatric clinic, primary care clinics, and nursing homes) across five European cities. Frailty was assessed using the following: Frailty Phenotype, SHARE-FI, 5-item Frailty Trait Scale (FTS-5), 3-item FTS (FTS-3), FRAIL scale, 35-item Frailty Index (FI-35), Gérontopôle Frailty Screening Tool, and Clinical Frailty Scale. Adverse outcomes ascertained at follow-up were as follows: falls, hospitalization, increase in limitation in basic (BADL) and instrumental activities of daily living (IADL), and mortality. Sensitivity, specificity, and capacity to predict adverse outcomes in logistic regressions by each instrument above age, gender, and multimorbidity were calculated. RESULTS A total of 996 individuals were followed (mean age 82.2 SD 5.5 years, 61.3% female). In geriatric wards, the FI-35 (69.1%) and the FTS-5 (67.9%) showed good sensitivity to predict death and good specificity to predict BADL worsening (70.3% and 69.8%, respectively). The FI-35 also showed good sensitivity to predict BADL worsening (74.6%). In nursing homes, the FI-35 and the FTSs predicted mortality and BADL worsening with a sensitivity > 73.9%. In geriatric clinic, the FI-35, the FTS-5, and the FRAIL scale obtained specificities > 85% to predict BADL worsening. No instrument achieved high enough sensitivity nor specificity in primary care. All the instruments predict the risk for all the outcomes in the whole sample after adjusting for age, gender, and multimorbidity. The associations of these instruments that remained significant by setting were for BADL worsening in geriatric wards [FI-35 OR = 5.94 (2.69-13.14), FTS-3 = 3.87 (1.76-8.48)], nursing homes [FI-35 = 4.88 (1.54-15.44), FTS-5 = 3.20 (1.61-6.38), FTS-3 = 2.31 (1.27-4.21), FRAIL scale = 1.91 (1.05-3.48)], and geriatric clinic [FRAIL scale = 4.48 (1.73-11.58), FI-35 = 3.30 (1.55-7.00)]; for IADL worsening in primary care [FTS-5 = 3.99 (1.14-13.89)] and geriatric clinic [FI-35 = 3.42 (1.56-7.49), FRAIL scale = 3.27 (1.21-8.86)]; for hospitalizations in primary care [FI-35 = 3.04 (1.25-7.39)]; and for falls in geriatric clinic [FI-35 = 2.21 (1.01-4.84)]. CONCLUSIONS No single assessment instrument performs the best for all settings and outcomes. While in inpatients several commonly used frailty instruments showed good sensitivities (mainly for mortality and BADL worsening) but usually poor specificities, the contrary happened in geriatric clinic. None of the instruments showed a good performance in primary care. The FI-35 and the FTS-5 showed the best profile among the instruments assessed.
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Affiliation(s)
- Myriam Oviedo-Briones
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Madrid, Spain.,Facultad de Medicina, Universidad de las Américas, Quito, Ecuador
| | - Ángel Rodríguez-Laso
- CIBERFES: CIBER (Centers of the Network of Biomedical Research) thematic area of Frailty and Healthy Ageing, Instituto de Salud Carlos III, Madrid, Spain
| | - José Antonio Carnicero
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Madrid, Spain
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical Collegium Medicum, Cracow, Poland
| | | | - Francesco Landi
- Hospital Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bruno Vellas
- Gerontopole, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Marta Checa-López
- Jefe de Servicio de Geriatría, Hospital Universitario de Getafe, Madrid, Spain
| | - Leocadio Rodriguez-Mañas
- CIBERFES: CIBER (Centers of the Network of Biomedical Research) thematic area of Frailty and Healthy Ageing, Instituto de Salud Carlos III, Madrid, Spain.,Jefe de Servicio de Geriatría, Hospital Universitario de Getafe, Madrid, Spain
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9
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Bernabei R, Landi F, Calvani R, Cesari M, Del Signore S, Anker SD, Bejuit R, Bordes P, Cherubini A, Cruz-Jentoft AJ, Di Bari M, Friede T, Gorostiaga Ayestarán C, Goyeau H, Jónsson PV, Kashiwa M, Lattanzio F, Maggio M, Mariotti L, Miller RR, Rodriguez-Mañas L, Roller-Wirnsberger R, Rýznarová I, Scholpp J, Schols AMWJ, Sieber CC, Sinclair AJ, Skalska A, Strandberg T, Tchalla A, Topinková E, Tosato M, Vellas B, von Haehling S, Pahor M, Roubenoff R, Marzetti E. Multicomponent intervention to prevent mobility disability in frail older adults: randomised controlled trial (SPRINTT project). BMJ 2022; 377:e068788. [PMID: 35545258 PMCID: PMC9092831 DOI: 10.1136/bmj-2021-068788] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether a multicomponent intervention based on physical activity with technological support and nutritional counselling prevents mobility disability in older adults with physical frailty and sarcopenia. DESIGN Evaluator blinded, randomised controlled trial. SETTING 16 clinical sites across 11 European countries, January 2016 to 31 October 2019. PARTICIPANTS 1519 community dwelling men and women aged 70 years or older with physical frailty and sarcopenia, operationalised as the co-occurrence of low functional status, defined as a short physical performance battery (SPPB) score of 3 to 9, low appendicular lean mass, and ability to independently walk 400 m. 760 participants were randomised to a multicomponent intervention and 759 received education on healthy ageing (controls). INTERVENTIONS The multicomponent intervention comprised moderate intensity physical activity twice weekly at a centre and up to four times weekly at home. Actimetry data were used to tailor the intervention. Participants also received personalised nutritional counselling. Control participants received education on healthy ageing once a month. Interventions and follow-up lasted for up to 36 months. MAIN OUTCOME MEASURES The primary outcome was mobility disability (inability to independently walk 400 m in <15 minutes). Persistent mobility disability (inability to walk 400 m on two consecutive occasions) and changes from baseline to 24 and 36 months in physical performance, muscle strength, and appendicular lean mass were analysed as pre-planned secondary outcomes. Primary comparisons were conducted in participants with baseline SPPB scores of 3-7 (n=1205). Those with SPPB scores of 8 or 9 (n=314) were analysed separately for exploratory purposes. RESULTS Mean age of the 1519 participants (1088 women) was 78.9 (standard deviation 5.8) years. The average follow-up was 26.4 (SD 9.5) months. Among participants with SPPB scores of 3-7, mobility disability occurred in 283/605 (46.8%) assigned to the multicomponent intervention and 316/600 (52.7%) controls (hazard ratio 0.78, 95% confidence interval 0.67 to 0.92; P=0.005). Persistent mobility disability occurred in 127/605 (21.0%) participants assigned to the multicomponent intervention and 150/600 (25.0%) controls (0.79, 0.62 to 1.01; P=0.06). The between group difference in SPPB score was 0.8 points (95% confidence interval 0.5 to 1.1 points; P<0.001) and 1.0 point (95% confidence interval 0.5 to 1.6 points; P<0.001) in favour of the multicomponent intervention at 24 and 36 months, respectively. The decline in handgrip strength at 24 months was smaller in women assigned to the multicomponent intervention than to control (0.9 kg, 95% confidence interval 0.1 to 1.6 kg; P=0.028). Women in the multicomponent intervention arm lost 0.24 kg and 0.49 kg less appendicular lean mass than controls at 24 months (95% confidence interval 0.10 to 0.39 kg; P<0.001) and 36 months (0.26 to 0.73 kg; P<0.001), respectively. Serious adverse events occurred in 237/605 (39.2%) participants assigned to the multicomponent intervention and 216/600 (36.0%) controls (risk ratio 1.09, 95% confidence interval 0.94 to 1.26). In participants with SPPB scores of 8 or 9, mobility disability occurred in 46/155 (29.7%) in the multicomponent intervention and 38/159 (23.9%) controls (hazard ratio 1.25, 95% confidence interval 0.79 to 1.95; P=0.34). CONCLUSIONS A multicomponent intervention was associated with a reduction in the incidence of mobility disability in older adults with physical frailty and sarcopenia and SPPB scores of 3-7. Physical frailty and sarcopenia may be targeted to preserve mobility in vulnerable older people. TRIAL REGISTRATION ClinicalTrials.gov NCT02582138.
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Affiliation(s)
- Roberto Bernabei
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, Università di Milano, Milan, Italy
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | | | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Centre for Regenerative Therapies, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | - Mauro Di Bari
- Geriatric Intensive Care Medicine, Università degli Studi di Firenze and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Tim Friede
- Department of Medical Statistics, University of Goettingen Medical Centre, Goettingen, Germany
- German Centre for Cardiovascular Research (DZHK) partner site Göttingen, Goettingen, Germany
| | | | | | - Pálmi V Jónsson
- Department of Geriatrics, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | | | - Marcello Maggio
- Department of Medicine and Surgery, Università degli Studi di Parma, Parma, Italy
- Cognitive and Motor Centre, Medicine and Geriatric Rehabilitation Department of Parma, University Hospital of Parma, Parma, Italy
| | - Luca Mariotti
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ram R Miller
- Translational Medicine, Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | | | | | | | - Joachim Scholpp
- Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma, Biberach an der Riss, Germany
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Universiteit Maastricht, Maastricht, Netherlands
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nurnberg, Germany
| | | | - Anna Skalska
- Department of Internal Medicine and Gerontology, Uniwersytet Jagiellonski Collegium Medicum, Faculty of Medicine, Krakow, Poland
| | - Timo Strandberg
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- University of Oulu, Centre for Life Course Health Research, Oulo, Finland
| | - Achille Tchalla
- Pôle Gérontologie Clinique, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Eva Topinková
- First Faculty of Medicine, Univerzita Karlova v Praze, Prague, Czech Republic
| | - Matteo Tosato
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Bruno Vellas
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Stephan von Haehling
- German Centre for Cardiovascular Research (DZHK) partner site Göttingen, Goettingen, Germany
- Department of Cardiology and Pneumology, University of Goettingen Medical Centre, Goettingen, Germany
| | - Marco Pahor
- Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Ronenn Roubenoff
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
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Bourdel-Marchasson I, Regueme SC, Kelson M, Poustis J, Barralon P, Laosa O, Rodriguez-Mañas L, Sinclair AJ. A Therapeutic Vibrating Insole Device for Postural Instability in Older People with Type 2 Diabetes: A Randomized Control Study. Diabetes Ther 2022; 13:995-1006. [PMID: 35322393 PMCID: PMC9076777 DOI: 10.1007/s13300-022-01246-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/02/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Frail older people with diabetes often present with or develop walking impairments, in part due to lower-limb sensory-motor neuropathy. Several studies suggest a possible improvement of balance control using somatosensory stimulation. We undertook a novel randomized control trial, the aim of which was to observe whether use of this device for 1 month improves walking speed as measured in the 10-m fast walking speed test standardized to body size at month 1 (M1) (FWS). Secondary outcomes were the differences between intervention (VS) and control (C) in the 10-m normal walking speed test, step length, short physical performance battery, timed up and go test, and posturographic measures. METHODS Subjects were aged ≥ 70 years and had had type 2 diabetes for at least 2 years. The intervention (VS) at home consisted of 22-min daily vibrating sequences with noise intensity set at 90% of the tactile threshold for each foot. The same device was used in group C but noise was set to 0. Compliance was retrieved from the device. RESULTS Among 56 subjects, 27 were in the VS group and 29 in the C group; 35 subjects were frail, 15 were prefrail ,and 6 were non-frail. Bilateral neuropathy was present in 17 subjects. More than half of sessions were done in 36 subjects with no discernible difference according to intervention. At M1 there were no discernible differences in FWS between the groups [VS: 0.96 (0.53) cm s-1 cm-1, C: 0.94 (0.47) cm s-1 cm-1]. There were also no discernible differences in other outcomes, irrespective of the presence of bilateral neuropathy. CONCLUSION In a cohort of frail, prefrail, or non-frail older subjects with diabetes, a 1-month intervention using a vibrating insole device did not alter measures of walking speed and related measures. Larger studies with longer term and different stimulation protocols are required to test this hypothesis more fully.
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Affiliation(s)
- Isabelle Bourdel-Marchasson
- CNRS/Université de Bordeaux, UMR 5536 Résonance Magnétique des systèmes Biologiques, 33000, Bordeaux, France.
- CHU Bordeaux, Pole gérontologie clinique, 33000, Bordeaux, France.
| | - Sophie C Regueme
- CHU Bordeaux, Pole gérontologie clinique, 33000, Bordeaux, France
| | - Mark Kelson
- Cardiff University School of Medicine, Cardiff, UK
- University of Exeter, Exeter, UK
| | - Joël Poustis
- Hexabio SARL, 286 av Pasteur, 33600, Pessac, France
| | - Pierre Barralon
- TECNALIA, Basque Research and Technology Alliance (BRTA), Mikeletegi Pasealekua 2, 20009, Donostia-San Sebastián, Spain
| | - Olga Laosa
- Department of Geriatrics, Hospital Universitario de Getafe, Madrid, Spain
| | | | - Alan J Sinclair
- Foundation for Diabetes Research in Older People at Diabetes Frail Ltd, Worcestershire, England, UK
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11
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Affiliation(s)
- Isabel Rodriguez-Sanchez
- Geriatrics Department, Hospital Clínico San Carlos, c/ Profesor Martín Lagos s/n, 28040-Madrid, Spain
| | - Leocadio Rodriguez-Mañas
- Servicio de Geriatría, Hospital Universitario de Getafe, Carretera de Toledo, Km 12.5, 28905-Getafe, Spain; Centro de Investigación Biomédica en Red "Fragilidad y Envejecimiento Saludable" (CIBERFES), Instituto de Salud Carlos III, c/ Sinesio Delgado, 10, 28029-Madrid, Spain.
| | - Olga Laosa
- Servicio de Geriatría, Hospital Universitario de Getafe, Carretera de Toledo, Km 12.5, 28905-Getafe, Spain; Geriatric Research Group, Biomedical Research Foundation at Hospital Universitario de Getafe, Carretera de Toledo, Km 12.5, 28905-Getafe, Spain
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12
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Quiñónez-Bareiro F, Carnicero JA, Alfaro-Acha A, Rosado-Artalejo C, Grau-Jimenez MC, Rodriguez-Mañas L, García-Garcia FJ. Risk of Frailty According to the Values of the Ankle-Brachial Index in the Toledo Study for Healthy Aging. J Frailty Aging 2022; 12:24-29. [PMID: 36629080 DOI: 10.14283/jfa.2022.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Vascular function (VF) is a general term used to describe the regulation of blood flow, arterial pressure, capillary recruitment, filtration and central venous pressure, it´s well known that age has direct effects on the VF, and this may affect the frailty status. OBJECTIVES To analyse the association between Frailty Trait Scale 5 (FTS 5) with VF and its changes at values below and above a nadir. DESIGN Prospective population-based cohort study. SETTING AND PARTICIPANTS Data from 1.230 patients were taken from the first wave (2006-2009) of the Toledo Study for Healthy Aging. MEASUREMENTS Frailty was evaluated using FTS 5, which evaluates 5 items: Body mass index, progressive Romberg, physical activity, usual gait speed and hand grip strength. VF was assessed using the ankle-brachial index (ABI) as an indirect measure of VF. Screening for cardiovascular and cerebrovascular disease was also performed by self-reporting and by searching medical records, and was used as exclusion criteria. RESULTS The optimal ABI cut-off point that maximized the adjusted R2 was 1.071. We observed a statistically significant association for FTS 5 score above and below the ABI cut-off points. For every tenth that the ABI decreased below the cut-off point the patient had an increase in the FTS 5 score of 0.47 points and in every tenth that increased above the cut-off point the increase in the FTS 5 score was 0.41 points. Of all FTS 5 items, the gait speed was the only item that showed a significant association with an ABI changes 0.28 and 0.21 points for every tenth below and above the cut-off point, respectively. CONCLUSIONS Frailty is highly associated with VF. In addition, FTS 5 and its gait speed criteria are useful to detect VF impairments, via changes in ABI.
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Affiliation(s)
- F Quiñónez-Bareiro
- Francisco Jose Garcia-Garcia, PhD, MD, Head of Geriatric Department, Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Crta de Cobisa s/n, 45071, Toledo, Spain,
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13
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Gonzalez-Bautista E, de Barreto PS, Salinas-Rodriguez A, Sourdet S, Rolland Y, Rodriguez-Mañas L, Andrieu S, Vellas B. Validation of the Integrated Care for Older People Screening Tool: Focus on the Chair Rise Test to Assess Locomotion. Innov Aging 2021. [PMCID: PMC8680757 DOI: 10.1093/geroni/igab046.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The Integrated Care for Older People (ICOPE) is a function- and person-centered healthcare pathway developed by the World Health Organization (WHO). ICOPE's first step (Step 1) consists of screening for impairments in the intrinsic capacity (IC) domains (namely sensorial, cognition, nutrition, psychological, and locomotion). For instance, the ICOPE Step1 tool suggests a cut-point of 14 seconds for five-repetition chair rise time as a marker of impaired locomotion. Given the lack of validation of this tool in the literature, we aimed to validate the ICOPE screening tool concerning incident health outcomes, focusing on the locomotion assessment. First, we analyzed the five-domain screening tool's ability to identify older adults (OA) at higher risk of incident outcomes (frailty, disability, dementia) using longitudinal data from the Multidomain Alzheimer Preventive Trial (MAPT). For the locomotion assessment (chair rise test), we derived and cross-validated age-specific cut points from two population-based cohorts using ROC (receiver operating characteristic) analysis. We further verified those cut points among OA real-life users of the health system and clinical trial participants. In conclusion, the ICOPE Step 1 screening tool was able to identify OA at higher risk of incident frailty, disability, and dementia. New chair-rise-time cut points for age groups 70-79 years old and 80 years and older were valid in populations from different settings. The ICOPE Step 1 tool provides a practical and integrative way of screening older adults for impairments in IC and detecting those at higher risk of functional decline.
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Affiliation(s)
| | - Philipe Souto de Barreto
- CHU Toulouse: Centre Hospitalier Universitaire de Toulouse, Gérontopôle de Toulouse, Institut du Vieillissement, Midi-Pyrenees, France
| | | | - Sandrine Sourdet
- Toulouse University Hospital (CHU Toulouse), Toulouse, Midi-Pyrenees, France
| | - Yves Rolland
- Toulouse University Hospital (CHU Toulouse), Toulouse, Midi-Pyrenees, France
| | | | - Sandrine Andrieu
- University of Toulouse III, INSERM, UPS, Toulouse, Midi-Pyrenees, France
| | - Bruno Vellas
- CHU Toulouse: Centre Hospitalier Universitaire de Toulouse, Gérontopôle de Toulouse, Institut du Vieillissement, Midi-Pyrenees, France
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Gomez-Cabrero D, Walter S, Abugessaisa I, Miñambres-Herraiz R, Palomares LB, Butcher L, Erusalimsky JD, Garcia-Garcia FJ, Carnicero J, Hardman TC, Mischak H, Zürbig P, Hackl M, Grillari J, Fiorillo E, Cucca F, Cesari M, Carrie I, Colpo M, Bandinelli S, Feart C, Peres K, Dartigues JF, Helmer C, Viña J, Olaso G, García-Palmero I, Martínez JG, Jansen-Dürr P, Grune T, Weber D, Lippi G, Bonaguri C, Sinclair AJ, Tegner J, Rodriguez-Mañas L. A robust machine learning framework to identify signatures for frailty: a nested case-control study in four aging European cohorts. GeroScience 2021; 43:1317-1329. [PMID: 33599920 PMCID: PMC8190217 DOI: 10.1007/s11357-021-00334-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 02/02/2021] [Indexed: 12/12/2022] Open
Abstract
Phenotype-specific omic expression patterns in people with frailty could provide invaluable insight into the underlying multi-systemic pathological processes and targets for intervention. Classical approaches to frailty have not considered the potential for different frailty phenotypes. We characterized associations between frailty (with/without disability) and sets of omic factors (genomic, proteomic, and metabolomic) plus markers measured in routine geriatric care. This study was a prevalent case control using stored biospecimens (urine, whole blood, cells, plasma, and serum) from 1522 individuals (identified as robust (R), pre-frail (P), or frail (F)] from the Toledo Study of Healthy Aging (R=178/P=184/F=109), 3 City Bordeaux (111/269/100), Aging Multidisciplinary Investigation (157/79/54) and InCHIANTI (106/98/77) cohorts. The analysis included over 35,000 omic and routine laboratory variables from robust and frail or pre-frail (with/without disability) individuals using a machine learning framework. We identified three protective biomarkers, vitamin D3 (OR: 0.81 [95% CI: 0.68-0.98]), lutein zeaxanthin (OR: 0.82 [95% CI: 0.70-0.97]), and miRNA125b-5p (OR: 0.73, [95% CI: 0.56-0.97]) and one risk biomarker, cardiac troponin T (OR: 1.25 [95% CI: 1.23-1.27]). Excluding individuals with a disability, one protective biomarker was identified, miR125b-5p (OR: 0.85, [95% CI: 0.81-0.88]). Three risks of frailty biomarkers were detected: pro-BNP (OR: 1.47 [95% CI: 1.27-1.7]), cardiac troponin T (OR: 1.29 [95% CI: 1.21-1.38]), and sRAGE (OR: 1.26 [95% CI: 1.01-1.57]). Three key frailty biomarkers demonstrated a statistical association with frailty (oxidative stress, vitamin D, and cardiovascular system) with relationship patterns differing depending on the presence or absence of a disability.
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Affiliation(s)
- David Gomez-Cabrero
- Translational Bioinformatics Unit, Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Stefan Walter
- Dept. of Medicine and Public Health, Rey Juan Carlos University, Alcorcon, Spain
| | | | | | | | - Lee Butcher
- Department of Biomedical Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Jorge D Erusalimsky
- Department of Biomedical Sciences, Cardiff Metropolitan University, Cardiff, UK
| | | | - José Carnicero
- Dept. of Geriatric Medicine, Complejo Hospitalario Universitario de Toledo (CHUT), Toledo, Spain
| | | | - Harald Mischak
- Mosaiques Diagnostics GmbH, Rotenburger Str. 20, 30659, Hannover, Germany
| | - Petra Zürbig
- Mosaiques Diagnostics GmbH, Rotenburger Str. 20, 30659, Hannover, Germany
| | - Matthias Hackl
- Evercyte GmbH; BOKU-University of Natural Resources and Life Sciences Vienna, Department of Biotechnology, Ludwig Boltzmann Institute of Experimental and Clinical Traumatology, Vienna, Austria
| | - Johannes Grillari
- Evercyte GmbH; BOKU-University of Natural Resources and Life Sciences Vienna, Department of Biotechnology, Ludwig Boltzmann Institute of Experimental and Clinical Traumatology, Vienna, Austria
| | - Edoardo Fiorillo
- Instituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Monserrato, Cagliari, Italy
| | - Francesco Cucca
- Instituto di Ricerca Genetica e Biomedica, Consiglio Nazionale delle Ricerche, Monserrato, Cagliari, Italy
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | | | | | - Catherine Feart
- Univ. Bordeaux, Bordeaux Population Health Research Center, UMR 1219, F-33000, Bordeaux, France
| | - Karine Peres
- Univ. Bordeaux, Bordeaux Population Health Research Center, UMR 1219, F-33000, Bordeaux, France
| | - Jean-François Dartigues
- Univ. Bordeaux, Bordeaux Population Health Research Center, UMR 1219, F-33000, Bordeaux, France
| | - Catherine Helmer
- Univ. Bordeaux, Bordeaux Population Health Research Center, UMR 1219, F-33000, Bordeaux, France
| | - José Viña
- Freshage, University of Valencia, Valencia, Spain
| | - Gloria Olaso
- Freshage, University of Valencia, Valencia, Spain
| | | | | | - Pidder Jansen-Dürr
- Research Institute for Biomedical Aging Research, University of Innsbruck, Innsbruck, Austria
| | - Tilman Grune
- German Institute for Human Nutrition, Potsdam, Germany
| | - Daniela Weber
- German Institute for Human Nutrition, Potsdam, Germany
| | - Giuseppe Lippi
- Clinical Biochemistry and Molecular Biology, Universita di Verona, Verona, Italy
| | - Chiara Bonaguri
- Laboratoy Medicine Technical Sciences, Parma University, Parma, Italy
| | | | - Jesper Tegner
- Dept. of Medicine, Karolinska Institute, Stockholm, Sweden
- Biological and Environmental Science and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Leocadio Rodriguez-Mañas
- CIBER of Frailty and Healthy Aging, Madrid, Spain.
- Dept. of Geriatric Medicine, Getafe University Hospital, Getafe, Spain.
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Ruiz JG, Dent E, Morley JE, Merchant RA, Beilby J, Beard J, Tripathy C, Sorin M, Andrieu S, Aprahamian I, Arai H, Aubertin-Leheudre M, Bauer JM, Cesari M, Chen LK, Cruz-Jentoft AJ, De Souto Barreto P, Dong B, Ferrucci L, Fielding R, Flicker L, Lundy J, Reginster JY, Rodriguez-Mañas L, Rolland Y, Sanford AM, Sinclair AJ, Viña J, Waters DL, Won Won C, Woo J, Vellas B. Screening for and Managing the Person with Frailty in Primary Care: ICFSR Consensus Guidelines. J Nutr Health Aging 2021; 24:920-927. [PMID: 33155616 PMCID: PMC7568453 DOI: 10.1007/s12603-020-1492-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J G Ruiz
- John E. Morley, MB, BCh, Division of Geriatric Medicine, Saint Louis University, SLUCare Academic Pavilion, Section 2500 1008 S. Spring Ave., 2nd Floor, St. Louis, MO 63110, USA, , Twitter: @drjohnmorley
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16
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Cesari M, Cherubini A, Guralnik JM, Beresniak A, Rodriguez-Mañas L, Inzitari M, Walston J. Early detection of accelerated aging and cellular decline (AACD): A consensus statement. Exp Gerontol 2021; 146:111242. [PMID: 33484892 DOI: 10.1016/j.exger.2021.111242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/20/2022]
Abstract
The cellular hallmarks of accelerated aging and their clinical expression may be grouped using the terms 'accelerated aging and cellular decline' (AACD) and/or 'age-associated cellular decline'. This construct is designed to capture the biological background predisposing the development of age-related conditions. By classifying risk factors, early indicators, and clinical differentiators of AACD through expert consensus, this study aimed to identify the signs, symptoms, and markers indicative of AACD. In doing so, this work paves the way for future implementation of the AACD concept in the clinical and research settings. An interdisciplinary panel of experts with clinical and research expertise was selected to participate in a virtual workshop to discuss AACD. A modified nominal group technique was used to establish consensus among the group. An extended group of international experts critically reviewed an early draft of the manuscript, and their feedback was then incorporated into the model. Experts identified 13 factors predisposing to or clinically manifesting AACD. Among these, chronic diseases, obesity, and unfavorable genetic background were considered as the most important. There was a consensus that a gradual and nonspecific development often characterizes AACD, making its clinical detection potentially challenging. In addition, signs and symptoms might have multifactorial causes and overlapping origins, such as genetic and epigenetic predispositions. As a result, an initial checklist was outlined, listing clinical factors of special relevance (e.g., fatigue, low quality of sleep, and low mood) to represent early manifestations of the organism's exhaustion, which are also frequently neglected in the clinical setting. Differentiating AACD from other conditions is essential. The use of a combination of biomarkers was proposed as a viable method in a two-step process of differentiation: 1) identification of early AACD clinical indicators, followed by 2) symptom and biomarker confirmation with a focus on system domains (to be potentially targeted by future specific interventions). Although the AACD construct is not yet ready for routine use in clinical practice, its operationalization may support the early identification of age-related conditions (when this might still be amenable to reversion) and also encourage preventative interventions. Further investigation is needed to establish specific biomarkers that confirm independent risk factors for AACD and provide a more definitive structure to the concept of AACD (and age-associated cellular decline).
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Affiliation(s)
- Matteo Cesari
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Via Camaldoli 64, 20100 Milano, Italy.
| | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di ricerca per l'invecchiamento, POR, Ancona, IRCCS INRCA, via della Montagnola 81, 60100, Ancona, Italy.
| | - Jack M Guralnik
- University of Maryland School of Medicine, Howard Hall, 660 W. Redwood Street, HH 132A, Baltimore, MD 21201, USA.
| | - Ariel Beresniak
- Data Mining International, International SA, World Trade Centre II CP856, 29 Route de Pre-Bois, CH-1215, Geneva 15, Switzerland.
| | - Leocadio Rodriguez-Mañas
- Geriatrics Department, Hospital Universitario de Getafe, Carr. Madrid-Toledo, Km 12,500, 28905, Getafe, Madrid, Spain.
| | - Marco Inzitari
- REFiT Bcn research group, Parc Sanitari Pere Virgili and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.
| | - Jeremy Walston
- Department of Medicine, Division of Geriatric Medicine and Gerontology, John Hopkins University, 5501 Hopkins Bayview Circle, Suite 1A, 62, Baltimore, MD, 21224, USA.
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Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, Aubertin-Leheudre M, Bernabei R, Cadore EL, Cesari M, Chen LK, de Souto Barreto P, Duque G, Ferrucci L, Fielding RA, García-Hermoso A, Gutiérrez-Robledo LM, Harridge SDR, Kirk B, Kritchevsky S, Landi F, Lazarus N, Martin FC, Marzetti E, Pahor M, Ramírez-Vélez R, Rodriguez-Mañas L, Rolland Y, Ruiz JG, Theou O, Villareal DT, Waters DL, Won Won C, Woo J, Vellas B, Fiatarone Singh M. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging 2021; 25:824-853. [PMID: 34409961 DOI: 10.1007/s12603-021-1665-8] [Citation(s) in RCA: 318] [Impact Index Per Article: 106.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.
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Affiliation(s)
- M Izquierdo
- Mikel Izquierdo, PhD, Department of Health Sciences, Public University of Navarra, Av. De Barañain s/n 31008 Pamplona (Navarra) Spain, Tel + 34 948 417876
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18
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Ruiz JG, Dent E, Morley JE, Merchant RA, Beilby J, Beard J, Tripathy C, Sorin M, Andrieu S, Aprahamian I, Arai H, Aubertin-Leheudre M, Bauer JM, Cesari M, Chen LK, Cruz-Jentoft AJ, Barreto PDS, Dong B, Ferrucci L, Fielding R, Flicker L, Lundy J, Reginster JY, Rodriguez-Mañas L, Rolland Y, Sanford AM, Sinclair AJ, Viña J, Waters DL, Won CW, Woo J, Vellas B. Erratum to: Screening for and Managing the Person with Frailty in Primary Care: ICFSR Consensus Guidelines. J Nutr Health Aging 2020. [PMCID: PMC7790018 DOI: 10.1007/s12603-020-1547-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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19
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Oviedo-Briones M, Laso ÁR, Carnicero JA, Cesari M, Grodzicki T, Gryglewska B, Sinclair A, Landi F, Vellas B, Checa-López M, Rodriguez-Mañas L. A Comparison of Frailty Assessment Instruments in Different Clinical and Social Care Settings: The Frailtools Project. J Am Med Dir Assoc 2020; 22:607.e7-607.e12. [PMID: 33162359 DOI: 10.1016/j.jamda.2020.09.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine which of 8 commonly employed frailty assessment tools demonstrate the most appropriate characteristics to be employed in different clinical and social settings. DESIGN Cross-sectional multicenter European-based study. SETTING AND PARTICIPANTS 1440 patients aged ≥75 years evaluated in geriatric inpatient wards, geriatric outpatient clinics, primary care clinics, and nursing homes. METHODS The frailty instruments used were Frailty Phenotype, SHARE-FI, 3-item Frailty Trait Scale (FTS-3), 5-item Frailty Trait Scale (FTS-5), FRAIL, 35-item Frailty Index (FI-35), Gérontopôle Frailty Screening Tool (GFST), and Clinical Frailty Scale (CFS). The settings were geriatrics wards, outpatient clinics, primary care, and nursing homes. Suitability was evaluated by considering the feasibility (patients with the test fully completed), administration time (time spent for administering the test), and interscale agreement (Cohen kappa index among instruments to detect frailty). RESULTS The prevalence of frailty varied across settings and adopted tests. The scales with the mean highest feasibility were the FRAIL scale (99.4%), SHARE-FI (98.3%), and GFST (95.0%). The mean shortest administration times were obtained with CFS (24 seconds), GFST (72 seconds), and FRAIL scale (90 seconds). The interscale agreement between most of the tests was fair. CFS followed by FTS-5 agreed at least moderately with a greater number of scales overall and in almost all settings. CONCLUSIONS AND IMPLICATIONS Based on feasibility, time to undertake the tool, and agreement with other scales, different scales would be recommended according to the setting considered. Our findings suggest that most of the tools evaluated are actually assessing different frailty constructs.
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Affiliation(s)
- Myriam Oviedo-Briones
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Madrid, Spain
| | - Ángel Rodríguez Laso
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Madrid, Spain
| | - José Antonio Carnicero
- Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Madrid, Spain
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Cracow, Poland
| | - Barbara Gryglewska
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Cracow, Poland
| | | | - Francesco Landi
- Hospital Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bruno Vellas
- Gerontopole, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INSERM-1027, Université de Toulouse III Paul Sabatier, Toulouse, France
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Laosa O, Pedraza L, Álvarez-Bustos A, Carnicero JA, Rodriguez-Artalejo F, Rodriguez-Mañas L. Rapid Assessment at Hospital Admission of Mortality Risk From COVID-19: The Role of Functional Status. J Am Med Dir Assoc 2020; 21:1798-1802.e2. [PMID: 33160872 PMCID: PMC7543696 DOI: 10.1016/j.jamda.2020.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 12/15/2022]
Abstract
Objective To evaluate the role of functional status along with other used clinical factors on the occurrence of death in patients hospitalized with COVID-19. Design Prospective cohort study. Setting Public university hospital (Madrid). Participants and Methods A total of 375 consecutive patients with COVID-19 infection, admitted to a Public University Hospital (Madrid) between March 1 and March 31, 2020, were included in the Prospective Cohort study. Death was the main outcome. The main variable was disability in activities of daily living (ADL) assessed with the Barthel Index. Covariates included sex, age, severity index (Quick Sequential Organ Failure Assessment, qSOFA), polypharmacy (≥5 drugs in the month before admission), and comorbidity (≥3 diseases). Multivariable logistic regression was used to identify risk factors for adverse outcomes. Estimated model coefficients served to calculate the expected probability of death for a selected combination of 5 variables: Barthel Index, sex, age, comorbidities, and severity index (qSOFA). Results Mean age was 66 years (standard deviation 15.33), and there were 207 (55%) men. Seventy-four patients died (19.8%). Mortality was associated with low Barthel Index (odds ratio per 5-point decrease 1.11, 95% confidence interval 1.03-1.20), male sex (0.23, 0.11-0.47), age (1.07, 1.03-1.10), and comorbidity (2.15, 1.08-4.30) but not with qSOFA (1.29, 0.87-1.93) or polypharmacy (1.54, 0.77-3.08). Calculated mortality risk ranged from 0 to 0.78. Conclusions and Implications Functional status predicts death in hospitalized patients with COVID-19. Combination of 5 variables allows to predict individual probability of death. These findings provide useful information for the decision-making process and management of patients.
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Affiliation(s)
- Olga Laosa
- Centre of Network Biomedical Research on Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain; Institute of Biomedical Research, University Hospital of Getafe, Getafe, Madrid, Spain
| | - Laura Pedraza
- Institute of Biomedical Research, University Hospital of Getafe, Getafe, Madrid, Spain
| | | | - Jose A Carnicero
- Centre of Network Biomedical Research on Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain; Institute of Biomedical Research, University Hospital of Getafe, Getafe, Madrid, Spain
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health. School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Leocadio Rodriguez-Mañas
- Centre of Network Biomedical Research on Frailty and Healthy Ageing (CIBERFES), Institute of Health Carlos III, Madrid, Spain; Geriatrics Department, University Hospital of Getafe, Getafe, Madrid, Spain.
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21
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García-García FJ, Carnicero JA, Losa-Reyna J, Alfaro-Acha A, Castillo-Gallego C, Rosado-Artalejo C, Gutiérrrez-Ávila G, Rodriguez-Mañas L. Frailty Trait Scale–Short Form: A Frailty Instrument for Clinical Practice. J Am Med Dir Assoc 2020; 21:1260-1266.e2. [DOI: 10.1016/j.jamda.2019.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 12/26/2022]
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Rodriguez-Mañas L. Urinary tract infections in the elderly: a review of disease characteristics and current treatment options. Drugs Context 2020; 9:dic-2020-4-13. [PMID: 32699546 PMCID: PMC7357682 DOI: 10.7573/dic.2020-4-13] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022] Open
Abstract
Urinary tract infections (UTIs) are common in the elderly, and cover a range of conditions from asymptomatic bacteriuria to urosepsis. Risk factors for developing symptomatic UTIs include immunosenescence, exposure to nosocomial pathogens, multiple comorbidities, and a history of UTIs. European guidelines on urological infections recommend antimicrobial treatment only for symptomatic UTIs. Non-antimicrobial options to treat and prevent UTIs include among others cranberry products, OM-89 Escherichia coli bacterial lysate vaccine, and estrogen therapy in postmenopausal women, although evidence for their efficacy is weak. Another non-antimicrobial option to control and prevent UTIs is a medical device (Utipro Plus®) containing xyloglucan, gelatin, propolis, and extracts of Hibiscus sabdariffa. The device acts in the intestine as a mechanical barrier to protect against invasion by uropathogenic E. coli strains. A randomized controlled trial of Utipro Plus® in patients with uncomplicated UTIs provided good-quality evidence of its efficacy compared with placebo. In an observational study of Utipro Plus® in patients with recurrent UTIs, more than 80% women reported a return to their pre-UTI clinical status and about 30% transitioned from symptomatic UTIs to asymptomatic bacteriuria. New treatment strategies that offer a safe and effective non-antimicrobial means of managing UTIs could have an important role in the elderly.
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Roller-Wirnsberger R, Lindner S, Liew A, O'Caoimh R, Koula ML, Moody D, Espinosa JM, van Durme T, Dimitrov P, Benjak T, Nicolaidou E, Hammar T, Vanhecke E, Junius-Walker U, Csizmadia P, Galluzzo L, Macijauskienė J, Salem M, Rietman L, Ranhoff AH, Targowski T, de Arriaga MT, Bozdog E, Gabrovec B, Hendry A, Martin FC, Rodriguez-Mañas L. European Collaborative and Interprofessional Capability Framework for Prevention and Management of Frailty-a consensus process supported by the Joint Action for Frailty Prevention (ADVANTAGE) and the European Geriatric Medicine Society (EuGMS). Aging Clin Exp Res 2020; 32:561-570. [PMID: 31970670 PMCID: PMC7170812 DOI: 10.1007/s40520-019-01455-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/16/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Interprofessional collaborative practice (ICP) is currently recommended for the delivery of high-quality integrated care for older people. Frailty prevention and management are key elements to be tackled on a multi-professional level. AIM This study aims to develop a consensus-based European multi-professional capability framework for frailty prevention and management. METHODS Using a modified Delphi technique, a consensus-based framework of knowledge, skills and attitudes for all professions involved in the care pathway of older people was developed within two consultation rounds. The template for the process was derived from competency frameworks collected in a comprehensive approach from EU-funded projects of the European Commission (EC) supported best practice models for health workforce development. RESULTS The agreed framework consists of 25 items structured in 4 domains of capabilities. Content covers the understanding about frailty, skills for screening and assessment as well as management procedures for every profession involved. The majority of items focused on interprofessional collaboration, communication and person-centred care planning. DISCUSSION This framework facilitates clarification of professionals' roles and standardizes procedures for cross-sectional care processes. Despite a lack of evidence for educational interventions, health workforce development remains an important aspect of quality assurance in health care systems. CONCLUSIONS The multi-professional capability framework for frailty prevention and management incorporated interprofessional collaborative practice, consistent with current recommendations by the World Health Organization, Science Advice for Policy by European Academies and the European Commission.
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Affiliation(s)
- Regina Roller-Wirnsberger
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
- European Geriatric Medicine Society (EuGMS), Genoa, Italy.
| | - Sonja Lindner
- Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Aaron Liew
- Health Service Executive of Ireland, Dublin, Ireland
- National University of Ireland, Galway, Ireland
| | - Ronan O'Caoimh
- Health Service Executive of Ireland, Dublin, Ireland
- National University of Ireland, Galway, Ireland
| | | | - Dawn Moody
- National Health Services Orkney, Orkney, Scotland
| | | | - Thérèse van Durme
- Catholic University of Louvain, Institute of Health and Society, Brussels, Belgium
| | - Plamen Dimitrov
- National Center of Public Health and Analyses, Sofia, Bulgaria
| | | | | | - Teija Hammar
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Eliane Vanhecke
- Ministry of Health and Social Solidarity, General Directorate for Health, Paris, France
| | | | | | | | | | - Mohamed Salem
- San Vincent De Paule Long Term Care Facility, Marsa, Malta
| | - Liset Rietman
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Tomasz Targowski
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | | | | | - Anne Hendry
- National Health Service Lanarkshire, Scotland, UK
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Rodriguez-Mañas L, Araujo de Carvalho I, Bhasin S, Bischoff-Ferrari HA, Cesari M, Evans W, Hare JM, Pahor M, Parini A, Rolland Y, Fielding RA, Walston J, Vellas B. ICFSR Task Force Perspective on Biomarkers for Sarcopenia and Frailty. J Frailty Aging 2020; 9:4-8. [PMID: 32150207 DOI: 10.14283/jfa.2019.32] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Biomarkers of frailty and sarcopenia are essential to advance the understanding of these conditions of aging and develop new diagnostic tools and effective treatments. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force - a group of academic and industry scientists from around the world -- met in February 2019 to discuss the current state of biomarker development for frailty and sarcopenia. The D3Cr dilution method, which assesses creatinine excretion as a biochemical measure of muscle mass, was suggested as a more accurate measure of functional muscle mass than assessment by dual energy x-ray absorptiometry (DXA). Proposed biomarkers of frailty include markers of inflammation, the hypothalamic-pituitary-adrenal (HPA) axis response to stress, altered glucose insulin dynamics, endocrine dysregulation, aging, and others, acknowledging the complex multisystem etiology that contributes to frailty. Lack of clarity regarding a regulatory pathway for biomarker development has hindered progress; however, there are currently several international efforts to develop such biomarkers as tools to improve the treatment of individuals presenting these conditions.
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25
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Calvani R, Rodriguez-Mañas L, Picca A, Marini F, Biancolillo A, Laosa O, Pedraza L, Gervasoni J, Primiano A, Conta G, Bourdel-Marchasson I, Regueme SC, Bernabei R, Marzetti E, Sinclair AJ, Gambassi G. Identification of a Circulating Amino Acid Signature in Frail Older Persons with Type 2 Diabetes Mellitus: Results from the Metabofrail Study. Nutrients 2020; 12:nu12010199. [PMID: 31940925 PMCID: PMC7019630 DOI: 10.3390/nu12010199] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 02/07/2023] Open
Abstract
Diabetes and frailty are highly prevalent conditions that impact the health status of older adults. Perturbations in protein/amino acid metabolism are associated with both functional impairment and type 2 diabetes mellitus (T2DM). In the present study, we compared the concentrations of a panel of circulating 37 amino acids and derivatives between frail/pre-frail older adults with T2DM and robust non-diabetic controls. Sixty-six functionally impaired older persons aged 70+ with T2DM and 30 age and sex-matched controls were included in the analysis. We applied a partial least squares-discriminant analysis (PLS-DA)-based analytical strategy to characterize the metabotype of study participants. The optimal complexity of the PLS-DA model was found to be two latent variables. The proportion of correct classification was 94.1 ± 1.9% for frail/pre-frail persons with T2DM and 100% for control participants. Functionally impaired older persons with T2DM showed higher levels of 3-methyl histidine, alanine, arginine, glutamic acid, ethanolamine sarcosine, and tryptophan. Control participants had higher levels of ornithine and taurine. These findings indicate that a specific profile of amino acids and derivatives characterizes pre-frail/frail older persons with T2DM. The dissection of these pathways may provide novel insights into the metabolic perturbations involved in the disabling cascade in older persons with T2DM.
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Affiliation(s)
- Riccardo Calvani
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.C.); (A.P.); (J.G.); (A.P.); (R.B.); (G.G.)
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | | | - Anna Picca
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.C.); (A.P.); (J.G.); (A.P.); (R.B.); (G.G.)
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Federico Marini
- Department of Chemistry, Sapienza Università di Roma, 00185 Rome, Italy; (F.M.); (G.C.)
| | - Alessandra Biancolillo
- Department of Physical and Chemical Sciences, Università degli Studi dell’Aquila, 67100 L’Aquila, Italy;
| | - Olga Laosa
- Foundation for Biomedical Research, Hospital Universitario de Getafe, 28905 Madrid, Spain; (O.L.); (L.P.)
| | - Laura Pedraza
- Foundation for Biomedical Research, Hospital Universitario de Getafe, 28905 Madrid, Spain; (O.L.); (L.P.)
| | - Jacopo Gervasoni
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.C.); (A.P.); (J.G.); (A.P.); (R.B.); (G.G.)
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Aniello Primiano
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.C.); (A.P.); (J.G.); (A.P.); (R.B.); (G.G.)
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Giorgia Conta
- Department of Chemistry, Sapienza Università di Roma, 00185 Rome, Italy; (F.M.); (G.C.)
| | | | - Sophie C. Regueme
- Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, France; (I.B.-M.); (S.C.R.)
| | - Roberto Bernabei
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.C.); (A.P.); (J.G.); (A.P.); (R.B.); (G.G.)
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Emanuele Marzetti
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.C.); (A.P.); (J.G.); (A.P.); (R.B.); (G.G.)
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-0630155559; Fax: +39-063051911
| | - Alan J. Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd., Luton LU1 3UA, UK;
| | - Giovanni Gambassi
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.C.); (A.P.); (J.G.); (A.P.); (R.B.); (G.G.)
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
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Butcher L, Carnicero JA, Gomez Cabrero D, Dartigues JF, Pérès K, Garcia-Garcia FJ, Rodriguez-Mañas L, Erusalimsky JD. Increased levels of soluble Receptor for Advanced Glycation End-products (RAGE) are associated with a higher risk of mortality in frail older adults. Age Ageing 2019; 48:696-702. [PMID: 31211360 DOI: 10.1093/ageing/afz073] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/05/2019] [Accepted: 05/24/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE to evaluate the relationship between serum levels of the soluble Receptor for Advanced Glycation End-products (sRAGE) and mortality in frail and non-frail older adults. METHODS we studied 691 subjects (141 frail and 550 non-frail) with a median age of 75 years from two population-based cohorts, the Toledo Study of Healthy Aging and the AMI study, who were enrolled to the FRAILOMIC initiative. Multivariate Cox proportional hazards regression and Kaplan-Meier survival analysis were used to assess the relationship between baseline sRAGE and mortality. RESULTS during 6 years of follow-up 101 participants died (50 frail and 51 non-frail). Frail individuals who died had significantly higher sRAGE levels than those who survived (median [IQR]: 1563 [1015-2248] vs 1184 [870-1657] pg/ml, P = 0.006), whilst no differences were observed in the non-frail group (1262 [1056-1554] vs 1186 [919-1551] pg/ml, P = 0.19). Among frail individuals higher sRAGE levels were associated with an increased risk of death after adjustment for relevant covariates (HR = 2.72 per unit increment in ln-sRAGE, 95%CI 1.48-4.99, P = 0.001). In contrast, in non-frail individuals sRAGE showed no association with mortality. Survival curves demonstrated that among frail individuals the incidence of death was significantly higher in the top sRAGE quartile compared to the three lower quartiles (P = 0.002). Area under the ROC curve analysis demonstrated that for frail individuals, inclusion of sRAGE in the hazard model increased its predictive accuracy by ~3%. CONCLUSIONS sRAGE is an independent predictor of mortality among frail individuals. Determination of sRAGE in frail subjects could be useful for prognostic assessment and treatment stratification.
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Affiliation(s)
- Lee Butcher
- Department of Biomedical Sciences, Cardiff Metropolitan University, Cardiff, UK
| | - Jose A Carnicero
- Fundacion para la investigación biomédica del Hospital Universitario de Getafe, Getafe, Spain
| | | | - Jean-François Dartigues
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | - Karine Pérès
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, Bordeaux, France
| | | | - Leocadio Rodriguez-Mañas
- Fundacion para la investigación biomédica del Hospital Universitario de Getafe, Getafe, Spain
- Hospital Universitario de Getafe, Getafe, Spain
| | - Jorge D Erusalimsky
- Department of Biomedical Sciences, Cardiff Metropolitan University, Cardiff, UK
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27
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Rodriguez-Mañas L, Laosa O, Vellas B, Paolisso G, Topinkova E, Oliva-Moreno J, Bourdel-Marchasson I, Izquierdo M, Hood K, Zeyfang A, Gambassi G, Petrovic M, Hardman TC, Kelson MJ, Bautmans I, Abellan G, Barbieri M, Peña-Longobardo LM, Regueme SC, Calvani R, De Buyser S, Sinclair AJ. Effectiveness of a multimodal intervention in functionally impaired older people with type 2 diabetes mellitus. J Cachexia Sarcopenia Muscle 2019; 10:721-733. [PMID: 31016897 PMCID: PMC6711410 DOI: 10.1002/jcsm.12432] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/21/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Type 2 diabetes, a highly prevalent chronic disease, is associated with increasing frailty and functional decline in older people. We aimed to evaluate the effectiveness of a multimodal intervention on functional performance in frail and pre-frail participants aged ≥70 years with type 2 diabetes mellitus. METHODS The MID-Frail study was a cluster-randomized multicenter clinical trial conducted in 74 trial sites across seven European countries. The trial recruited 964 participants who were aged >70 years [mean age in intervention group, 78.4 (SD 5.6) years, 49.2% male and 77.6 (SD 5.29) years, 52.4% male in usual care group], with type diabetes mellitus and determined to be frail or pre-frail using Fried's frailty phenotype. Participants were allocated by trial site to follow either usual care (UCG) or intervention procedures (IG). Intervention group participants received a multimodal intervention composed of (i) an individualized and progressive resistance exercise programme for 16 weeks; (ii) a structured diabetes and nutritional educational programme over seven sessions; and (iii) Investigator-linked training to ensure optimal diabetes care. Short Physical Performance Battery (SPPB) scores were used to assess change in functional performance at 12 months between the groups. An analysis of the cost-effectiveness of the intervention was undertaken using the incremental cost-effectiveness ratio (ICER). Secondary outcomes included mortality, hospitalization, institutionalization, quality of life, burden on caregivers, the frequency and severity of hypoglycaemia episodes, and the cost-effectiveness of the intervention. RESULTS After 12 months, IG participants had mean SPPB scores 0.85 points higher than those in the UCG (95% CI, 0.44 to 1.26, P < 0.0001). Dropouts were higher in frail participants and in the intervention group, but significant differences in SPPB between treatment groups remained consistent after sensitivity analysis. Estimates suggest a mean saving following intervention of 428.02 EUR (2016) per patient per year, with ICER analysis indicating a consistent benefit of the described health care intervention over usual care. No statistically significant differences between groups were detected in any of the other secondary outcomes. CONCLUSIONS We have demonstrated that a 12 month structured multimodal intervention programme across several clinical settings in different European countries leads to a clinically relevant and cost-effective improvement in the functional status of older frail and pre-frail participants with type 2 diabetes mellitus.
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Affiliation(s)
| | - Olga Laosa
- Foundation for Biomedical Research-Hospital Universitario de Getafe, Madrid, Spain
| | - Bruno Vellas
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | - Eva Topinkova
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | | | - Mikel Izquierdo
- IdiSNA, Navarra Institute for Health Research, Public University of Navarra, Pamplona, Spain
| | - Kerry Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | | | - Mirko Petrovic
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | | | - Mark J Kelson
- Department of Mathematics, University of Exeter, Exeter, UK
| | - Ivan Bautmans
- Gerontology Department, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gabor Abellan
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | | | | | | | | | - Alan J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Luton, UK
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Regueme SC, Cowtan C, Sedgelmaci MY, Kelson M, Poustis J, Rodriguez-Mañas L, Sinclair AJ, Dallaudière B, Bourdel-Marchasson I. A Therapeutic Insole Device for Postural Stability in Older People With Type 2 Diabetes. A Feasibility Study (SENSOLE Part I). Front Med (Lausanne) 2019; 6:127. [PMID: 31316984 PMCID: PMC6610457 DOI: 10.3389/fmed.2019.00127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/22/2019] [Indexed: 11/29/2022] Open
Abstract
The application of a stochastic mechanical noise has been shown to improve plantar touch sensitivity in patients with diabetic neuropathy and balance control. The present work aimed to test the feasibility of a specially designed vibrating device on gait and posture in older patients with type 2 diabetes with special interest on potential side effect (sensation of needles or tingling, dizziness or falls) before further investigations. For this, gait and balance tests were performed in 29 older out and in-patients (mean age 84 years, Barthel index ≥ 60/100) immediately before and after a 19 min plantar vibrating sequence, as well as 15 min after. These tests included posturographic measurements under eyes closed and static conditions and clinical gait tests (Short Physical Performance Battery and Timed-Up and Go tests). The results showed that no side effect was measured immediately, 15 min and up to 30 days after the vibration sequence. Besides, postural and clinical gait tests showed global positive effects at immediate and 15 min follow-up. Further investigation are now necessary to determine whether a daily stimulation sequence for a given time would lead to long-term positive effects on daily living (NCT01654341; https://clinicaltrials.gov/ct2/show/NCT01654341).
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Affiliation(s)
| | - Charles Cowtan
- South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | | | - Mark Kelson
- South East Wales Trials Unit, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | | | | | - Alan J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail, Luton, United Kingdom
| | - Benjamin Dallaudière
- Department of Radiology, CHU Bordeaux, Bordeaux, France.,University of Bordeaux, RMSB, UMR 5536, CNRS, Bordeaux, France.,CNRS, RMSB, UMR 5536, Bordeaux University, Bordeaux, France
| | - Isabelle Bourdel-Marchasson
- CHU Bordeaux, Pôle de Gérontologie, Bordeaux, France.,University of Bordeaux, RMSB, UMR 5536, CNRS, Bordeaux, France.,CNRS, RMSB, UMR 5536, Bordeaux University, Bordeaux, France
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Kochlik B, Stuetz W, Pérès K, Féart C, Tegner J, Rodriguez-Mañas L, Grune T, Weber D. Associations of Plasma 3-Methylhistidine with Frailty Status in French Cohorts of the FRAILOMIC Initiative. J Clin Med 2019; 8:E1010. [PMID: 31295923 PMCID: PMC6678434 DOI: 10.3390/jcm8071010] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/05/2019] [Accepted: 07/08/2019] [Indexed: 12/27/2022] Open
Abstract
Frailty and sarcopenia are characterized by a loss of muscle mass and functionality and are diagnosed mainly by functional tests and imaging parameters. However, more muscle specific biomarkers are needed to improve frailty diagnosis. Plasma 3-methylhistidine (3-MH), as well as the 3-MH-to-creatinine (3-MH/Crea) and 3-MH-to-estimated glomerular filtration rate (3-MH/eGFR) ratios might support the diagnosis of frailty. Therefore, we investigated the cross-sectional associations between plasma 3-MH, 3-MH/Crea and 3-MH/eGFR with the frailty status of community-dwelling individuals (>65 years). 360 participants from two French cohorts of the FRAILOMIC initiative were classified into robust, pre-frail and frail according to Fried's frailty criteria. General linear models as well as bivariate and multiple linear and logistic regression models, which were adjusted for several confounders, were applied to determine associations between biomarkers and frailty status. The present study consisted of 37.8% robust, 43.1% pre-frail and 19.2% frail participants. Frail participants had significantly higher plasma 3-MH, 3-MH/Crea and 3-MH/eGFR ratios than robust individuals, and these biomarkers were positively associated with frailty status. Additionally, the likelihood to be frail was significantly higher for every increase in 3-MH (1.31-fold) and 3-MH/GFR (1.35-fold) quintile after adjusting for confounders. We conclude that 3-MH, 3-MH/Crea and 3-MH/eGFR in plasma might be potential biomarkers to identify frail individuals or those at higher risk to be frail, and we assume that there might be biomarker thresholds to identify these individuals. However, further, especially longitudinal studies are needed.
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Affiliation(s)
- Bastian Kochlik
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), 14558 Nuthetal, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, 14558 Nuthetal, Germany
| | - Wolfgang Stuetz
- Institute of Nutritional Sciences, University of Hohenheim, 70599 Stuttgart, Germany
| | - Karine Pérès
- Inserm, Bordeaux Population Health Research Center, UMR 1219, University Bordeaux, 33000 Bordeaux, France
| | - Catherine Féart
- Inserm, Bordeaux Population Health Research Center, UMR 1219, University Bordeaux, 33000 Bordeaux, France
| | - Jesper Tegner
- Center for Molecular Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | | | - Tilman Grune
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), 14558 Nuthetal, Germany
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, 14558 Nuthetal, Germany
- German Center for Diabetes Research (DZD), 85764 Munich-Neuherberg, Germany
- German Center for Cardiovascular Research (DZHK), 13347 Berlin, Germany
| | - Daniela Weber
- Department of Molecular Toxicology, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), 14558 Nuthetal, Germany.
- NutriAct-Competence Cluster Nutrition Research Berlin-Potsdam, 14558 Nuthetal, Germany.
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Checa-López M, Oviedo-Briones M, Pardo-Gómez A, Gonzales-Turín J, Guevara-Guevara T, Carnicero JA, Alamo-Ascencio S, Landi F, Cesari M, Grodzicki T, Rodriguez-Mañas L. FRAILTOOLS study protocol: a comprehensive validation of frailty assessment tools to screen and diagnose frailty in different clinical and social settings and to provide instruments for integrated care in older adults. BMC Geriatr 2019; 19:86. [PMID: 30885132 PMCID: PMC6423863 DOI: 10.1186/s12877-019-1042-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/21/2019] [Indexed: 01/10/2023] Open
Abstract
Background Dozens of scales and questionnaires have been used in the detection of frailty; however, a generalized method for its screening and diagnosis is still lacking in clinical settings. FRAILTOOLS´ main objective is to evaluate the usefulness of frailty scales in the detection of frailty in different clinical and social settings, and its integration in management algorithms for the frail older patient. Methods FRAILTOOLS is an observational, longitudinal and prospective study with a follow-up of 6, 12 and 18 months. People older than 75 years old will be recruited from three separate clinical settings (acute geriatric wards, geriatric outpatient clinics and primary care) and one social setting (nursing homes). Exclusion criteria include Mini-mental State Examination < 20 points, and a Barthel index < 90 points, except in nursing home residents (< 40 points). The participants will be recruited in Spain, Italy, France, United Kingdom and Poland. The total sample size will be of 1.940 subjects, 97 subjects in each clinical setting by center. A personal interview with each participant will take place to register data on comorbidity (Charlson Index), functional (SPPB, Barthel and Lawton indexes), cognitive (MMSE) and frailty status (Fried Phenotype, Frailty Trait Scale – short version, SHARE-FI, 35-Items Rockwood Frailty Index, Clinical Frailty Scale, FRAIL scale and Gérontopôle Frailty Screening Tool) in the baseline visit, month 12 and month 18 visit of follow up. At 6 month a phone call will be made to assess whether there have been falls and to check the vital status. Discussion Currently, the usefulness of certain assessment tools in social and clinical settings have not been properly assessed, including their ability to predict the individual risk for different adverse outcomes, which is the main interest in daily practice. The FRAILTOOLS project concentrates on providing screening and diagnostic tools for frailty in those settings where its prevalence is the highest and where efforts in prevention could make a significant change in the trend towards disability. Trial registration Comprehensive validation of frailty assessment tools in older adults in different clinical and social settings (FRAILTOOLS), NCT02637518 (date of registration: 12/18/2015).
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Affiliation(s)
- Marta Checa-López
- Fundación de Investigación Biomédica Hospital Universitario de Getafe, Madrid, Spain.
| | - Myriam Oviedo-Briones
- Fundación de Investigación Biomédica Hospital Universitario de Getafe, Madrid, Spain
| | - Armando Pardo-Gómez
- Fundación de Investigación Biomédica Hospital Universitario de Getafe, Madrid, Spain
| | - Jimmy Gonzales-Turín
- Fundación de Investigación Biomédica Hospital Universitario de Getafe, Madrid, Spain
| | - Tania Guevara-Guevara
- Fundación de Investigación Biomédica Hospital Universitario de Getafe, Madrid, Spain
| | | | | | - Francesco Landi
- Hospital Centro Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore , Rome, Italy
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Rada P, Mosquera A, Muntané J, Ferrandiz F, Rodriguez-Mañas L, de Pablo F, González-Canudas J, Valverde ÁM. Differential effects of metformin glycinate and hydrochloride in glucose production, AMPK phosphorylation and insulin sensitivity in hepatocytes from non-diabetic and diabetic mice. Food Chem Toxicol 2018; 123:470-480. [PMID: 30414960 DOI: 10.1016/j.fct.2018.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/10/2018] [Accepted: 11/07/2018] [Indexed: 01/23/2023]
Abstract
The liver is a main target tissue of the biguanide metformin which activates AMP-activated protein kinase (AMPK). We previously reported that administration of metformin glycinate showed a greater decrease of glycated hemoglobin A1c than a placebo in patients with type 2 diabetes mellitus (T2DM). In this study, we compared the effects of metformin hydrochloride, the oral antidiabetic drug of first choice, with those of metformin glycinate in hepatocytes from non-diabetic and diabetic mice and humans. Both formulations were equally potent regard to the reduction of basal and glucagon-induced glucose production and mRNA levels of gluconeogenic enzymes (Pck1 and G6pc) in hepatocytes from C57/Bl6 mice and humans. On the contrary, phosphorylation of AMPK and its substrate acetyl CoA carboxylase (ACC) was faster in hepatocytes treated with metformin glycinate. Likewise, we found stronger reduction in hepatocytes from obese/diabetic db/db mice of glucagon-induced glucose output and more sustained AMPK phosphorylation after treatment with metformin glycinate. Importantly, insulin sensitization regarding phosphorylation of AKT (Ser473) was enhanced in hepatocytes from db/db mice or humans pretreated with metformin glycinate. In conclusion, our data indicate that metformin glycinate may be an alternative therapy against insulin resistance during obesity and/or T2DM.
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Affiliation(s)
- Patricia Rada
- Instituto de Investigaciones Biomédicas Alberto Sols (IIBm) (CSIC/UAM), C/ Arturo Duperier 4, 28029, Madrid, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERdem), ISCIII, 28029 Madrid, Spain
| | - Alejandra Mosquera
- Instituto de Investigaciones Biomédicas Alberto Sols (IIBm) (CSIC/UAM), C/ Arturo Duperier 4, 28029, Madrid, Spain
| | - Jordi Muntané
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, 28029 Madrid, Spain; Oncology Surgery, Cell Therapy and Transplant Organs, Institute of Biomedicine of Seville (IBiS)/University Hospital Virgen del Rocio/CSIC/University of Seville, Seville, Spain
| | | | - Leocadio Rodriguez-Mañas
- Department of Geriatrics, Hospital Universitario de Getafe and School of Health Sciences, Universidad Europea de Madrid, 28905 Getafe, Spain
| | - Flora de Pablo
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERdem), ISCIII, 28029 Madrid, Spain; Department of Molecular Biomedicine, Centro de Investigaciones Biológicas (CSIC), Madrid, Spain
| | | | - Ángela M Valverde
- Instituto de Investigaciones Biomédicas Alberto Sols (IIBm) (CSIC/UAM), C/ Arturo Duperier 4, 28029, Madrid, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERdem), ISCIII, 28029 Madrid, Spain.
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32
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Alcazar J, Losa-Reyna J, Rodriguez-Lopez C, Alfaro-Acha A, Rodriguez-Mañas L, Ara I, García-García FJ, Alegre LM. The sit-to-stand muscle power test: An easy, inexpensive and portable procedure to assess muscle power in older people. Exp Gerontol 2018; 112:38-43. [DOI: 10.1016/j.exger.2018.08.006] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/03/2018] [Accepted: 08/30/2018] [Indexed: 01/28/2023]
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Marzetti E, Cesari M, Calvani R, Msihid J, Tosato M, Rodriguez-Mañas L, Lattanzio F, Cherubini A, Bejuit R, Di Bari M, Maggio M, Vellas B, Dantoine T, Cruz-Jentoft AJ, Sieber CC, Freiberger E, Skalska A, Grodzicki T, Sinclair AJ, Topinkova E, Rýznarová I, Strandberg T, Schols AMWJ, Schols JMGA, Roller-Wirnsberger R, Jónsson PV, Ramel A, Del Signore S, Pahor M, Roubenoff R, Bernabei R, Landi F. The "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) randomized controlled trial: Case finding, screening and characteristics of eligible participants. Exp Gerontol 2018; 113:48-57. [PMID: 30261246 DOI: 10.1016/j.exger.2018.09.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/11/2018] [Accepted: 09/20/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The ongoing "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT)" randomized controlled trial (RCT) is testing the efficacy of a multicomponent intervention in the prevention of mobility disability in older adults with physical frailty & sarcopenia (PF&S). Here, we describe the procedures followed for PF&S case finding and screening of candidate participants for the SPRINTT RCT. We also illustrate the main demographic and clinical characteristics of eligible screenees. METHODS The identification of PF&S was based on the co-occurrence of three defining elements: (1) reduced physical performance (defined as a score on the Short Physical Performance Battery between 3 and 9); (2) low muscle mass according to the criteria released by the Foundation for the National Institutes of Health; and (3) absence of mobility disability (defined as ability to complete the 400-m walk test in 15 min). SPRINTT was advertised through a variety of means. Site-specific case finding strategies were developed to accommodate the variability across centers in catchment area characteristics and access to the target population. A quick "participant profiling" questionnaire was devised to facilitate PF&S case finding. RESULTS During approximately 22 months, 12,358 prescreening interviews were completed in 17 SPRINTT sites resulting in 6710 clinic screening visits. Eventually, 1566 candidates were found to be eligible for participating in the SPRINTT RCT. Eligible screenees showed substantial physical function impairment and comorbidity burden. In most centers, project advertisement through mass media was the most rewarding case finding strategy. CONCLUSION PF&S case finding in the community is a challenging, but feasible task. Although largely autonomous in daily life activities, older adults with PF&S suffer from significant functional impairment and comorbidity. This subset of the older population is therefore at high risk for disability and other negative health-related events. Key strategies to consider for successfully intercepting at-risk older adults should focus on mass communication methods.
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Affiliation(s)
- Emanuele Marzetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Italy; Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | - Matteo Tosato
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di Ricerca per l'Invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Mauro Di Bari
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Division of Geriatric Cardiology and Medicine, Department of Geriatrics and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marcello Maggio
- Department of Geriatric Rehabilitation, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Bruno Vellas
- Gérontopôle, University Hospital of Toulouse, Toulouse, France
| | | | | | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-University, Nuremberg, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-University, Nuremberg, Germany
| | - Anna Skalska
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Alan J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Limited, Worcestershire, UK
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Timo Strandberg
- University of Helsinki, Clinicum, Helsinki, Finland; Helsinki University Hospital, Medicine and Rehabilitation, Helsinki, Finland; University of Oulu, Center for Life Course Health Research, Oulu, Finland
| | - Annemie M W J Schols
- Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Pálmi V Jónsson
- Department of Geriatrics, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Alfons Ramel
- Department of Geriatrics, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | | | - Marco Pahor
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Ronenn Roubenoff
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Roberto Bernabei
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Álvarez C, Ramírez-Vélez R, Ramírez-Campillo R, Ito S, Celis-Morales C, García-Hermoso A, Rodriguez-Mañas L, Lucia A, Izquierdo M. Interindividual responses to different exercise stimuli among insulin-resistant women. Scand J Med Sci Sports 2018; 28:2052-2065. [DOI: 10.1111/sms.13213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2018] [Indexed: 01/08/2023]
Affiliation(s)
- C. Álvarez
- Department of Physical Activity Sciences; Universidad de Los Lagos; Osorno Chile
| | - R. Ramírez-Vélez
- School of Medicine and Health Sciences; Center for the Study of Physical Activity Measurement (CEMA); Universidad del Rosario; Bogotá Colombia
| | - R. Ramírez-Campillo
- Research Nucleus in Health; Physical Activity and Sports; Universidad de Los Lagos; Osorno Chile
| | - S. Ito
- Division of Cardiology; Sankuro Hospital; Toyota Japan
| | - C. Celis-Morales
- Centro de Investigación en Fisiología del Ejercicio (CIFE); Universidad Mayor; Santiago Chile
| | - A. García-Hermoso
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud; Facultad de Ciencias Médicas; Universidad de Santiago de Chile, USACH; Santiago Chile
| | - L. Rodriguez-Mañas
- Division of Geriatric Medicine; University Hospital of Getafe; Madrid Spain
| | - A. Lucia
- Faculty of Sports Sciences; Universidad Europea de Madrid; Madrid Spain
| | - M. Izquierdo
- Department of Health Sciences; Public University of Navarre; CIBERFES (CB16/10/00315); Navarre Spain
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Urrunaga-Pastor D, Moncada-Mapelli E, Runzer-Colmenares FM, Bailon-Valdez Z, Samper-Ternent R, Rodriguez-Mañas L, Parodi JF. Factors associated with poor balance ability in older adults of nine high-altitude communities. Arch Gerontol Geriatr 2018; 77:108-114. [PMID: 29738899 DOI: 10.1016/j.archger.2018.04.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/30/2018] [Accepted: 04/30/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Poor balance ability in older adults result in multiple complications. Poor balance ability has not been studied among older adults living at high altitudes. In this study, we analysed factors associated with poor balance ability by using the Functional Reach (FR) among older adults living in nine high-altitude communities. MATERIAL AND METHODS Analytical cross-sectional study, carried out in inhabitants aged 60 or over from nine high-altitude Andean communities of Peru during 2013-2016. FR was divided according to the cut-off point of 8 inches (20.32 cm) and two groups were generated: poor balance ability (FR less or equal than 20.32 cm) and good balance ability (greater than 20.32 cm). Additionally, we collected socio-demographic, medical, functional and cognitive assessment information. Poisson regression models were constructed to identify factors associated with poor balance ability. Prevalence ratio (PR) with 95% confidence intervals (95CI%) are presented. RESULTS A total of 365 older adults were studied. The average age was 73.0 ± 6.9 years (range: 60-91 years), and 180 (49.3%) participants had poor balance ability. In the adjusted Poisson regression analysis, the factors associated with poor balance ability were: alcohol consumption (PR = 1.35; 95%CI: 1.05-1.73), exhaustion (PR = 2.22; 95%CI: 1.49-3.31), gait speed (PR = 0.67; 95%CI: 0.50-0.90), having had at least one fall in the last year (PR = 2.03; 95%CI: 1.19-3.46), having at least one comorbidity (PR = 1.60; 95%CI: 1.10-2.35) and having two or more comorbidities (PR = 1.61; 95%CI: 1.07-2.42) compared to none. CONCLUSIONS Approximately a half of the older adults from these high-altitude communities had poor balance ability. Interventions need to be designed to target these balance issues and prevent adverse events from concurring to these individuals.
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Affiliation(s)
- Diego Urrunaga-Pastor
- Universidad de San Martín de Porres, Sociedad Científica de Estudiantes de Medicina, Lima, Peru.
| | - Enrique Moncada-Mapelli
- Universidad de San Martín de Porres, Sociedad Científica de Estudiantes de Medicina, Lima, Peru.
| | - Fernando M Runzer-Colmenares
- Universidad de San Martín de Porres, Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Lima, Peru; Bamboo Seniors Health Services, Lima, Peru; Universidad Cientifica del Sur, Facultad de Ciencias de la Salud, Lima, Peru.
| | - Zaira Bailon-Valdez
- Universidad de San Martín de Porres, Sociedad Científica de Estudiantes de Medicina, Lima, Peru.
| | - Rafael Samper-Ternent
- Internal Medicine/Geriatrics - Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA.
| | | | - Jose F Parodi
- Universidad de San Martín de Porres, Facultad de Medicina Humana, Centro de Investigación del Envejecimiento (CIEN), Lima, Peru; Bamboo Seniors Health Services, Lima, Peru.
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Dent E, Lien C, Lim WS, Wong WC, Wong CH, Ng TP, Woo J, Dong B, de la Vega S, Hua Poi PJ, Kamaruzzaman SBB, Won C, Chen LK, Rockwood K, Arai H, Rodriguez-Mañas L, Cao L, Cesari M, Chan P, Leung E, Landi F, Fried LP, Morley JE, Vellas B, Flicker L. The Asia-Pacific Clinical Practice Guidelines for the Management of Frailty. J Am Med Dir Assoc 2018. [PMID: 28648901 DOI: 10.1016/j.jamda.2017.04.018] [Citation(s) in RCA: 341] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To develop Clinical Practice Guidelines for the screening, assessment and management of the geriatric condition of frailty. METHODS An adapted Grading of Recommendations, Assessment, Development, and Evaluation approach was used to develop the guidelines. This process involved detailed evaluation of the current scientific evidence paired with expert panel interpretation. Three categories of Clinical Practice Guidelines recommendations were developed: strong, conditional, and no recommendation. RECOMMENDATIONS Strong recommendations were (1) use a validated measurement tool to identify frailty; (2) prescribe physical activity with a resistance training component; and (3) address polypharmacy by reducing or deprescribing any inappropriate/superfluous medications. Conditional recommendations were (1) screen for, and address modifiable causes of fatigue; (2) for persons exhibiting unintentional weight loss, screen for reversible causes and consider food fortification and protein/caloric supplementation; and (3) prescribe vitamin D for individuals deficient in vitamin D. No recommendation was given regarding the provision of a patient support and education plan. CONCLUSIONS The recommendations provided herein are intended for use by healthcare providers in their management of older adults with frailty in the Asia Pacific region. It is proposed that regional guideline support committees be formed to help provide regular updates to these evidence-based guidelines.
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Affiliation(s)
- Elsa Dent
- Center for Research in Geriatric Medicine, School of Medicine, The University of Queensland, Brisbane, Australia.
| | - Christopher Lien
- Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wei Chin Wong
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Chek Hooi Wong
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Tze Pin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jean Woo
- The S H Ho Center for Gerontology and Geriatrics, The Chinese University of Hong Kong, Hong Kong, China
| | - Birong Dong
- Geriatrics Center Huaxi Hospital, Sichuan University, Chengdu, China
| | - Shelley de la Vega
- University of the Philippines College of Medicine, Manila, Philippines; Institute on Aging, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Philip Jun Hua Poi
- Division of Geriatrics, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | | | - Chang Won
- Department of Family Medicine, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | | | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | | | - Li Cao
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | | | - Piu Chan
- Department of Geriatrics, Neurology, and Neurobiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Edward Leung
- Hong Kong Sanatorium and Hospital, Happy Valley, Hong Kong
| | | | - Linda P Fried
- Mailman School of Public Health, Columbia University Medical Center, New York, NY
| | - John E Morley
- Divisions of Geriatric Medicine and Endocrinology, Saint Louis University, St. Louis, MO
| | | | - Leon Flicker
- Western Australia Center for Health and Aging, University of Western Australia, Perth, Australia
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Borras C, Abdelaziz KM, Gambini J, Serna E, Inglés M, de la Fuente M, Garcia I, Matheu A, Sanchís P, Belenguer A, Errigo A, Avellana JA, Barettino A, Lloret-Fernández C, Flames N, Pes G, Rodriguez-Mañas L, Viña J. Human exceptional longevity: transcriptome from centenarians is distinct from septuagenarians and reveals a role of Bcl-xL in successful aging. Aging (Albany NY) 2017; 8:3185-3208. [PMID: 27794564 PMCID: PMC5270663 DOI: 10.18632/aging.101078] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 10/14/2016] [Indexed: 01/08/2023]
Abstract
Centenarians not only enjoy an extraordinary aging, but also show a compression of morbidity. Using functional transcriptomic analysis of peripheral blood mononuclear cells (PMBC) we identified 1721 mRNAs differentially expressed by centenarians when compared with septuagenarians and young people. Sub-network analysis led us to identify Bcl-xL as an important gene up-regulated in centenarians. It is involved in the control of apoptosis, cellular damage protection and also in modulation of immune response, all associated to healthy aging. Indeed, centenarians display lower plasma cytochrome C levels, higher mitochondrial membrane potential and also less cellular damage accumulation than septuagenarians. Leukocyte chemotaxis and NK cell activity are significantly impaired in septuagenarians compared with young people whereas centenarians maintain them. To further ascertain the functional role of Bcl-xL in cellular aging, we found that lymphocytes from septuagenarians transduced with Bcl-xL display a reduction in senescent-related markers. Finally, to demonstrate the role of Bcl-xL in longevity at the organism level, C. elegans bearing a gain of function mutation in the Bcl-xL ortholog ced-9, showed a significant increase in mean and maximal life span. These results show that mRNA expression in centenarians is unique and reveals that Bcl-xL plays an important role in exceptional aging.
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Affiliation(s)
- Consuelo Borras
- Facultad de Medicina, Universidad de Valencia, Valencia, Spain, INCLIVA and Spanish Centenarian Study Group; Facultad de Fisioterapia Universidad de Valencia, Valencia, Spain
| | - Kheira M Abdelaziz
- Facultad de Medicina, Universidad de Valencia, Valencia, Spain, INCLIVA and Spanish Centenarian Study Group; Facultad de Fisioterapia Universidad de Valencia, Valencia, Spain
| | - Juan Gambini
- Facultad de Medicina, Universidad de Valencia, Valencia, Spain, INCLIVA and Spanish Centenarian Study Group; Facultad de Fisioterapia Universidad de Valencia, Valencia, Spain
| | - Eva Serna
- Facultad de Medicina, Universidad de Valencia, Valencia, Spain, INCLIVA and Spanish Centenarian Study Group; Facultad de Fisioterapia Universidad de Valencia, Valencia, Spain
| | - Marta Inglés
- Facultad de Ciencias Biológicas, Universidad Complutense de Madrid, Madrid, España
| | | | - Idoia Garcia
- IIKERBASQUE, Basque Foundation for Science, Bilbao, Spain.,Servicio de Geriatría. Hospital de la Ribera. Alzira, Valencia, Spain
| | - Ander Matheu
- IIKERBASQUE, Basque Foundation for Science, Bilbao, Spain.,Servicio de Geriatría. Hospital de la Ribera. Alzira, Valencia, Spain
| | - Paula Sanchís
- Dipartimento di Medicina Clinica e Sperimentale, Viale San Pietro 8, I-07100 Sassari, Italy
| | - Angel Belenguer
- Dipartimento di Medicina Clinica e Sperimentale, Viale San Pietro 8, I-07100 Sassari, Italy
| | - Alessandra Errigo
- Instituto de Biomedicina de Valencia, IBV-CSIC, 46010 Valencia, Spain
| | - Juan-Antonio Avellana
- Dipartimento di Medicina Clinica e Sperimentale, Viale San Pietro 8, I-07100 Sassari, Italy
| | - Ana Barettino
- Departamento de Geriatría. Hospital Universitario de Getafe, Madrid, Spain
| | | | - Nuria Flames
- Departamento de Geriatría. Hospital Universitario de Getafe, Madrid, Spain
| | - Gianni Pes
- Instituto de Biomedicina de Valencia, IBV-CSIC, 46010 Valencia, Spain
| | | | - Jose Viña
- Facultad de Medicina, Universidad de Valencia, Valencia, Spain, INCLIVA and Spanish Centenarian Study Group; Facultad de Fisioterapia Universidad de Valencia, Valencia, Spain
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Davies B, García F, Ara I, Artalejo FR, Rodriguez-Mañas L, Walter S. Relationship Between Sarcopenia and Frailty in the Toledo Study of Healthy Aging: A Population Based Cross-Sectional Study. J Am Med Dir Assoc 2017; 19:282-286. [PMID: 29079029 DOI: 10.1016/j.jamda.2017.09.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Frailty and sarcopenia are correlates of musculoskeletal aging that represent a state of vulnerability increasing the risk of negative health outcomes. Standardized definitions are lacking for both, and sometimes both concepts are used interchangeably. However, no large study has assessed the coexistence of these 2 entities in a cohort of older community-dwelling people. METHODS Data were taken from the Toledo Study of Healthy Aging (TSHA), a study of community-dwelling elderly (≥65 years). The study population consists of 1611 participants with frailty and sarcopenia assessments. For sarcopenia, we used 3 criteria: European Working Group on Sarcopenia in Older People (EWGSOP), the Foundation for the National Institutes of Health (FNIH), and the FNIH fitted to the cut-off points of our population [standardized FNIH (sFNIH)]. Frailty was assessed according to the Fried criteria with cut-off points adjusted to our population. We used logistic regression to assess the relationship between sarcopenia and frailty and measures of diagnostic accuracy to evaluate the potential use of sarcopenia as a diagnostic marker for frailty. RESULTS The mean age of the population was 75.42 years (±5.86). Overall, 72 (4.5%) were frail. In addition, 352 (21.8%), 332 (20.6%), and 453 (28.1%) participants were considered sarcopenic according to the EWGSOP, FNIH, and sFNIH criteria, respectively. The prevalence of frailty among those with sarcopenia was 8.2% (29/352), 15.7% (52/332), and 10.4% (47/453). Moreover, among frail people, the prevalence of sarcopenia was 40.27%, 72.2%, and 65.3% according to the used criteria. Sarcopenia showed a low sensitivity (<10%) but high specificity (>97%) for the diagnosis of frailty, with a low intercorrelation (Cramer V = 0.16, 0.40, and 0.30) between the 3 criteria and frailty. Using multivariate logistic regression, frailty was associated with sarcopenia according to EWGSOP [odds ratio (OR) = 1.67, 95% confidence interval (CI) = 0.95, 2.96], FNIH (OR = 10.61, 95% CI = 5.8, 19.4), and sFNIH (OR = 6.63, 95% CI =3.5, 12.53). CONCLUSION Frailty and sarcopenia are distinct but related conditions. Sarcopenia is not a useful clinical biomarker of frailty, but its absence might be useful to exclude frailty.
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Affiliation(s)
- B Davies
- Fundación para la Investigación Biomédica Getafe University Hospital, Madrid, Spain
| | - F García
- Geriatrics Department, Virgen del Valle Hospital, Toledo, Spain; CIBER of Frailty and Healthy Aging-CIBERFES
| | - I Ara
- CIBER of Frailty and Healthy Aging-CIBERFES; Faculty of Sport Sciences, University of Castilla La Mancha, Spain
| | - F Rodríguez Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain; CIBER of Epidemiology and Public Health-CIBERESP
| | - L Rodriguez-Mañas
- Fundación para la Investigación Biomédica Getafe University Hospital, Madrid, Spain; CIBER of Frailty and Healthy Aging-CIBERFES; Geriatrics Department, Getafe University Hospital, Madrid, Spain.
| | - S Walter
- Fundación para la Investigación Biomédica Getafe University Hospital, Madrid, Spain; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
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del Pozo-Cruz B, Mañas A, Martín-García M, Marín-Puyalto J, García-García FJ, Rodriguez-Mañas L, Guadalupe-Grau A, Ara I. Frailty is associated with objectively assessed sedentary behaviour patterns in older adults: Evidence from the Toledo Study for Healthy Aging (TSHA). PLoS One 2017; 12:e0183911. [PMID: 28892505 PMCID: PMC5593182 DOI: 10.1371/journal.pone.0183911] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/14/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the association of sedentary behaviour patterns with frailty in older people. SETTING Clinical setting. DESIGN Cross-sectional, observational study. PARTICIPANTS AND MEASUREMENTS A triaxial accelerometer was used in a subsample from the Toledo Study for Healthy Aging (519 participants, 67-97 years) to assess several sedentary behaviour patterns including sedentary time per day, the number and duration (min) of breaks in sedentary time per day, and the proportion of the day spent in sedentary bouts of 10 minutes or more. Frailty was assessed using the Frailty Trait Scale (FTS). Regression analysis was used to ascertain the associations between sedentary behaviour patterns and frailty. RESULTS Sedentary time per day and the proportion of the day spent in sedentary bouts of 10 minutes or more, were positively associated with frailty in the study sample. Conversely, the time spent in breaks in sedentary time was negatively associated with frailty. CONCLUSION In summary, breaking up sedentary time and time spent in sedentary behaviour are associated with frailty in older people.
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Affiliation(s)
- Borja del Pozo-Cruz
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | - Asier Mañas
- GENUD Toledo Research Group, University of Castilla-La Mancha, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - María Martín-García
- GENUD Toledo Research Group, University of Castilla-La Mancha, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Jorge Marín-Puyalto
- GENUD Research Group, Faculty of Health and Sport Sciences, University of Zaragoza, Huesca, Spain
| | - Francisco J. García-García
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
- Geriatric Department, Hospital Virgen del Valle, Toledo, Spain
| | - Leocadio Rodriguez-Mañas
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
- Geriatric Department, Hospital Universitario de Getafe, Getafe, Spain
| | - Amelia Guadalupe-Grau
- Geriatric Department, Hospital Virgen del Valle, Toledo, Spain
- ImFINE Research Group, Department of Health and Human Performance, Technical University of Madrid, Madrid, Spain
| | - Ignacio Ara
- GENUD Toledo Research Group, University of Castilla-La Mancha, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
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Affiliation(s)
- M A Caballero-Mora
- Servicio de Geriatria, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - L Rodriguez-Mañas
- Servicio de Geriatria, Hospital Universitario de Getafe, Getafe, Madrid, Spain
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Gomez-Cabrera MC, Garcia-Valles R, Rodriguez-Mañas L, Garcia-Garcia FJ, Olaso-Gonzalez G, Salvador-Pascual A, Tarazona-Santabalbina FJ, Viña J. A New Frailty Score for Experimental Animals Based on the Clinical Phenotype: Inactivity as a Model of Frailty. J Gerontol A Biol Sci Med Sci 2017; 72:885-891. [PMID: 28329258 DOI: 10.1093/gerona/glw337] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 12/29/2016] [Indexed: 01/01/2023] Open
Abstract
The development of animal models to study human frailty is important to test interventions to be translated to the clinical practice. The aim of this work was to develop a score for frailty in experimental animals based in the human frailty phenotype. We also tested the effect of physical inactivity in the development of frailty as determined by our score. Male C57Bl/6J mice, individually caged, were randomly assigned to one of two groups: sedentary (inactive) or spontaneous wheel-runners. We compared the sedentary versus the active lifestyle in terms of frailty by evaluating the clinical criteria used in humans: unintentional weight loss; poor endurance (running time); slowness (running speed); weakness (grip strength), and low activity level (motor coordination) at five different ages: 17, 20, 23, 26 and 28 months of age. Each criterion had a designated cut-off point to identify the mice with the lowest performance. Lifelong spontaneous exercise significantly retards frailty. On the contrary sedentary animals become frail as they age. Thus, physical inactivity is a model of frailty in experimental animals. Our frailty score provides a tool to evaluate interventions in mice prior to translating them to clinical practice.
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Affiliation(s)
- Mari Carmen Gomez-Cabrera
- Department of Physiology, University of Valencia, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Spain
| | - Rebeca Garcia-Valles
- Department of Physiology, University of Valencia, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Spain
| | - Leocadio Rodriguez-Mañas
- Servicio de Geriatría, Hospital Universitario de Getafe, Ministerio de Sanidad y Consumo, Madrid, Spain. Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto de Salud Carlos III
| | | | - Gloria Olaso-Gonzalez
- Department of Physiology, University of Valencia, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Spain
| | - Andrea Salvador-Pascual
- Department of Physiology, University of Valencia, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Spain
| | - Francisco Jose Tarazona-Santabalbina
- Department of Geriatric Medicine, Hospital Universitario de la Ribera, Alzira, Spain.,Faculty of Nursing and Medicine, Catholic University of Valencia San Vicente Mártir, Spain
| | - Jose Viña
- Department of Physiology, University of Valencia, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Spain
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Angulo J, El Assar M, Martínez-Salamanca E, Fernández A, Sanchez-Ferrer A, Rodriguez-Mañas L. HP-01-003 Functional determinants of aging-related erectile dysfunction in rats. J Sex Med 2017. [DOI: 10.1016/j.jsxm.2017.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Idoate F, Cadore EL, Casas-Herrero A, Zambom-Ferraresi F, Martínez-Velilla N, Rodriguez-Mañas L, Azcárate PM, Bottaro M, Ramírez-Vélez R, Izquierdo M. Noncoronary Vascular Calcification, Bone Mineral Density, and Muscle Mass in Institutionalized Frail Nonagenarians. Rejuvenation Res 2017; 20:298-308. [PMID: 28193134 DOI: 10.1089/rej.2016.1868] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study was to compare the vascular calcification in thoracic aorta (TAC), abdominal aorta (AAC), iliac arteries (IAC), and femoral arteries (FAC) and bone mineral density (BMD) of the lumbar vertebrae between frail and robust nonagenarians, as well as to verify the associations between vascular calcification with BMD, muscle tissue quality, and quantity in both groups. Forty-two elderly subjects participated in this study: 29 institutionalized frail (92.0 ± 3.2 years) and 13 robust (89.0 ± 4.0 years) elderly participants. All patients underwent nonenhanced helical thoracic, abdominal, and thigh computed tomography. The frail group presented significantly greater FAC as well as less lumbar BMD than the robust group (p < 0.05). In the frail group, significant negative relationships were observed between the individual values of FAC with the individual values of BMD (r = -0.35 to -0.43, p < 0.05) and with the individual values of the quadriceps muscle quantity and quality (r = -0.52, p < 0.01), whereas no significant relationships were observed in the robust group. The robust group presented less vascular calcification and more BMD in the vertebral bodies than the frail group. In the frail group, femoral artery calcification was significantly negatively correlated with BMD, leg muscle quality, and muscle mass volume.
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Affiliation(s)
- Fernando Idoate
- 1 Department of Radiology, Clínica San Miguel , Pamplona, Spain
| | - Eduardo L Cadore
- 2 Exercise Research Laboratory, Federal University of Rio Grande do Sul , Porto Alegre, Brazil
| | - Alvaro Casas-Herrero
- 3 Division of Geriatric Medicine, Complejo Hospitalario de Navarra , CIBER de Fragilidad y Envejecimiento Saludable (CB16/10/00315) Pamplona, Navarra, Spain
| | - Fabricio Zambom-Ferraresi
- 4 Department of Health Sciences, Public University of Navarre , CIBER de Fragilidad y Envejecimiento Saludable (CB16/10/00315), Tudela, Navarre, Spain
| | - Nicolas Martínez-Velilla
- 3 Division of Geriatric Medicine, Complejo Hospitalario de Navarra , CIBER de Fragilidad y Envejecimiento Saludable (CB16/10/00315) Pamplona, Navarra, Spain
| | - Leocadio Rodriguez-Mañas
- 5 Division of Geriatric Medicine, University Hospital of Getafe , CIBER de Fragilidad y Envejecimiento Saludable (CB16/10/00464), Madrid, Spain
| | | | - Martim Bottaro
- 7 College of Physical Education, University of Brasília , Brasília, Brazil
| | - Robinson Ramírez-Vélez
- 8 Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario , Bogotá, Colombia
| | - Mikel Izquierdo
- 4 Department of Health Sciences, Public University of Navarre , CIBER de Fragilidad y Envejecimiento Saludable (CB16/10/00315), Tudela, Navarre, Spain
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Vallet-Regí M, Manzano M, Rodriguez-Mañas L, Checa López M, Aapro M, Balducci L. Management of Cancer in the Older Age Person: An Approach to Complex Medical Decisions. Oncologist 2017; 22:335-342. [PMID: 28220025 DOI: 10.1634/theoncologist.2016-0276] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/12/2016] [Indexed: 01/21/2023] Open
Abstract
The management of cancer in older aged people is becoming a common problem due to the aging of the population. There are many variables determining the complex situation that are interconnected. Some of them can be assessed, such as risk of mortality and risk of treatment complications, but many others are still unknown, such as the course of disease, the host-related factors that influence cancer aggressiveness, and the phenotype heralding risk of permanent treatment-related damage.This article presents a dynamic and personalized approach to older people with cancer based on our experience on aging, cancer, and their biological interactions. Also, novel treatments and management approaches to older individuals, based on their functional age and their social and emotional needs, are thoughtfully explored here. The Oncologist 2017;22:335-342 IMPLICATIONS FOR PRACTICE: The goal of this article is to suggest a practical approach to complexity, a clinical situation becoming increasingly common with the aging of the population. Beginning with the analysis of two clinical cases, the authors offer an algorithm for approaching cancer in the older person that involves the assessment of life expectancy without cancer, the risk that cancer might compromise a patient's survival, function, or quality of life, and the potential benefits and risks of the treatments based on a clinical evaluation. The authors then review possible laboratory assessment of functional age and the importance of rapid-learning databases in the study of cancer and age.
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Affiliation(s)
- María Vallet-Regí
- Departamento de Química Inorgánica y Bioinorgánica, Facultad de Farmacia, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital, 12 de Octubre i+12, Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Miguel Manzano
- Departamento de Química Inorgánica y Bioinorgánica, Facultad de Farmacia, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital, 12 de Octubre i+12, Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | | | - Marta Checa López
- Fundación para la Investigación Biomédica, Hospital Universitario de Getafe, Madrid, Spain
| | - Matti Aapro
- Breast Center, IMO Clinique de Genolier, Genolier, Switzerland
| | - Lodovico Balducci
- University of South Florida, College of Medicine, H. Lee Moffitt Cancer Center & Research Institute, Senior Adult Oncology Program, Tampa, Florida, USA
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Bousquet J, Bewick M, Cano A, Eklund P, Fico G, Goswami N, Guldemond NA, Henderson D, Hinkema MJ, Liotta G, Mair A, Molloy W, Monaco A, Monsonis-Paya I, Nizinska A, Papadopoulos H, Pavlickova A, Pecorelli S, Prados-Torres A, Roller-Wirnsberger RE, Somekh D, Vera-Muñoz C, Visser F, Farrell J, Malva J, Andersen Ranberg K, Camuzat T, Carriazo AM, Crooks G, Gutter Z, Iaccarino G, Manuel de Keenoy E, Moda G, Rodriguez-Mañas L, Vontetsianos T, Abreu C, Alonso J, Alonso-Bouzon C, Ankri J, Arredondo MT, Avolio F, Bedbrook A, Białoszewski AZ, Blain H, Bourret R, Cabrera-Umpierrez MF, Catala A, O'Caoimh R, Cesari M, Chavannes NH, Correia-da-Sousa J, Dedeu T, Ferrando M, Ferri M, Fokkens WJ, Garcia-Lizana F, Guérin O, Hellings PW, Haahtela T, Illario M, Inzerilli MC, Lodrup Carlsen KC, Kardas P, Keil T, Maggio M, Mendez-Zorrilla A, Menditto E, Mercier J, Michel JP, Murray R, Nogues M, O'Byrne-Maguire I, Pappa D, Parent AS, Pastorino M, Robalo-Cordeiro C, Samolinski B, Siciliano P, Teixeira AM, Tsartara SI, Valiulis A, Vandenplas O, Vasankari T, Vellas B, Vollenbroek-Hutten M, Wickman M, Yorgancioglu A, Zuberbier T, Barbagallo M, Canonica GW, Klimek L, Maggi S, Aberer W, Akdis C, Adcock IM, Agache I, Albera C, Alonso-Trujillo F, Angel Guarcia M, Annesi-Maesano I, Apostolo J, Arshad SH, Attalin V, Avignon A, Bachert C, Baroni I, Bel E, Benson M, Bescos C, Blasi F, Barbara C, Bergmann KC, Bernard PL, Bonini S, Bousquet PJ, Branchini B, Brightling CE, Bruguière V, Bunu C, Bush A, Caimmi DP, Calderon MA, Canovas G, Cardona V, Carlsen KH, Cesario A, Chkhartishvili E, Chiron R, Chivato T, Chung KF, d'Angelantonio M, De Carlo G, Cholley D, Chorin F, Combe B, Compas B, Costa DJ, Costa E, Coste O, Coupet AL, Crepaldi G, Custovic A, Dahl R, Dahlen SE, Demoly P, Devillier P, Didier A, Dinh-Xuan AT, Djukanovic R, Dokic D, Du Toit G, Dubakiene R, Dupeyron A, Emuzyte R, Fiocchi A, Wagner A, Fletcher M, Fonseca J, Fougère B, Gamkrelidze A, Garces G, Garcia-Aymeric J, Garcia-Zapirain B, Gemicioğlu B, Gouder C, Hellquist-Dahl B, Hermosilla-Gimeno I, Héve D, Holland C, Humbert M, Hyland M, Johnston SL, Just J, Jutel M, Kaidashev IP, Khaitov M, Kalayci O, Kalyoncu AF, Keijser W, Kerstjens H, Knezović J, Kowalski M, Koppelman GH, Kotska T, Kovac M, Kull I, Kuna P, Kvedariene V, Lepore V, MacNee W, Maggio M, Magnan A, Majer I, Manning P, Marcucci M, Marti T, Masoli M, Melen E, Miculinic N, Mihaltan F, Milenkovic B, Millot-Keurinck J, Mlinarić H, Momas I, Montefort S, Morais-Almeida M, Moreno-Casbas T, Mösges R, Mullol J, Nadif R, Nalin M, Navarro-Pardo E, Nekam K, Ninot G, Paccard D, Pais S, Palummeri E, Panzner P, Papadopoulos NK, Papanikolaou C, Passalacqua G, Pastor E, Perrot M, Plavec D, Popov TA, Postma DS, Price D, Raffort N, Reuzeau JC, Robine JM, Rodenas F, Robusto F, Roche N, Romano A, Romano V, Rosado-Pinto J, Roubille F, Ruiz F, Ryan D, Salcedo T, Schmid-Grendelmeier P, Schulz H, Schunemann HJ, Serrano E, Sheikh A, Shields M, Siafakas N, Scichilone N, Siciliano P, Skrindo I, Smit HA, Sourdet S, Sousa-Costa E, Spranger O, Sooronbaev T, Sruk V, Sterk PJ, Todo-Bom A, Touchon J, Tramontano D, Triggiani M, Tsartara SI, Valero AL, Valovirta E, van Ganse E, van Hage M, van den Berge M, Vandenplas O, Ventura MT, Vergara I, Vezzani G, Vidal D, Viegi G, Wagemann M, Whalley B, Wickman M, Wilson N, Yiallouros PK, Žagar M, Zaidi A, Zidarn M, Hoogerwerf EJ, Usero J, Zuffada R, Senn A, de Oliveira-Alves B. Building Bridges for Innovation in Ageing: Synergies between Action Groups of the EIP on AHA. J Nutr Health Aging 2017; 21:92-104. [PMID: 27999855 DOI: 10.1007/s12603-016-0803-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Accepted: 04/12/2016] [Indexed: 01/08/2023]
Abstract
The Strategic Implementation Plan of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) proposed six Action Groups. After almost three years of activity, many achievements have been obtained through commitments or collaborative work of the Action Groups. However, they have often worked in silos and, consequently, synergies between Action Groups have been proposed to strengthen the triple win of the EIP on AHA. The paper presents the methodology and current status of the Task Force on EIP on AHA synergies. Synergies are in line with the Action Groups' new Renovated Action Plan (2016-2018) to ensure that their future objectives are coherent and fully connected. The outcomes and impact of synergies are using the Monitoring and Assessment Framework for the EIP on AHA (MAFEIP). Eight proposals for synergies have been approved by the Task Force: Five cross-cutting synergies which can be used for all current and future synergies as they consider overarching domains (appropriate polypharmacy, citizen empowerment, teaching and coaching on AHA, deployment of synergies to EU regions, Responsible Research and Innovation), and three cross-cutting synergies focussing on current Action Group activities (falls, frailty, integrated care and chronic respiratory diseases).
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Affiliation(s)
- J Bousquet
- Professor Jean Bousquet, CHRU, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France, Tel +33 611 42 88 47,
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Bousquet J, Hellings PW, Agache I, Bedbrook A, Bachert C, Bergmann KC, Bewick M, Bindslev-Jensen C, Bosnic-Anticevitch S, Bucca C, Caimmi DP, Camargos PAM, Canonica GW, Casale T, Chavannes NH, Cruz AA, De Carlo G, Dahl R, Demoly P, Devillier P, Fonseca J, Fokkens WJ, Guldemond NA, Haahtela T, Illario M, Just J, Keil T, Klimek L, Kuna P, Larenas-Linnemann D, Morais-Almeida M, Mullol J, Murray R, Naclerio R, O'Hehir RE, Papadopoulos NG, Pawankar R, Potter P, Ryan D, Samolinski B, Schunemann HJ, Sheikh A, Simons FER, Stellato C, Todo-Bom A, Tomazic PV, Valiulis A, Valovirta E, Ventura MT, Wickman M, Young I, Yorgancioglu A, Zuberbier T, Aberer W, Akdis CA, Akdis M, Annesi-Maesano I, Ankri J, Ansotegui IJ, Anto JM, Arnavielhe S, Asarnoj A, Arshad H, Avolio F, Baiardini I, Barbara C, Barbagallo M, Bateman ED, Beghé B, Bel EH, Bennoor KS, Benson M, Białoszewski AZ, Bieber T, Bjermer L, Blain H, Blasi F, Boner AL, Bonini M, Bonini S, Bosse I, Bouchard J, Boulet LP, Bourret R, Bousquet PJ, Braido F, Briggs AH, Brightling CE, Brozek J, Buhl R, Bunu C, Burte E, Bush A, Caballero-Fonseca F, Calderon MA, Camuzat T, Cardona V, Carreiro-Martins P, Carriazo AM, Carlsen KH, Carr W, Cepeda Sarabia AM, Cesari M, Chatzi L, Chiron R, Chivato T, Chkhartishvili E, Chuchalin AG, Chung KF, Ciprandi G, de Sousa JC, Cox L, Crooks G, Custovic A, Dahlen SE, Darsow U, Dedeu T, Deleanu D, Denburg JA, De Vries G, Didier A, Dinh-Xuan AT, Dokic D, Douagui H, Dray G, Dubakiene R, Durham SR, Du Toit G, Dykewicz MS, Eklund P, El-Gamal Y, Ellers E, Emuzyte R, Farrell J, Fink Wagner A, Fiocchi A, Fletcher M, Forastiere F, Gaga M, Gamkrelidze A, Gemicioğlu B, Gereda JE, van Wick RG, González Diaz S, Grisle I, Grouse L, Gutter Z, Guzmán MA, Hellquist-Dahl B, Heinrich J, Horak F, Hourihane JOB, Humbert M, Hyland M, Iaccarino G, Jares EJ, Jeandel C, Johnston SL, Joos G, Jonquet O, Jung KS, Jutel M, Kaidashev I, Khaitov M, Kalayci O, Kalyoncu AF, Kardas P, Keith PK, Kerkhof M, Kerstjens HAM, Khaltaev N, Kogevinas M, Kolek V, Koppelman GH, Kowalski ML, Kuitunen M, Kull I, Kvedariene V, Lambrecht B, Lau S, Laune D, Le LTT, Lieberman P, Lipworth B, Li J, Lodrup Carlsen KC, Louis R, Lupinek C, MacNee W, Magar Y, Magnan A, Mahboub B, Maier D, Majer I, Malva J, Manning P, De Manuel Keenoy E, Marshall GD, Masjedi MR, Mathieu-Dupas E, Maurer M, Mavale-Manuel S, Melén E, Melo-Gomes E, Meltzer EO, Mercier J, Merk H, Miculinic N, Mihaltan F, Milenkovic B, Millot-Keurinck J, Mohammad Y, Momas I, Mösges R, Muraro A, Namazova-Baranova L, Nadif R, Neffen H, Nekam K, Nieto A, Niggemann B, Nogueira-Silva L, Nogues M, Nyembue TD, Ohta K, Okamoto Y, Okubo K, Olive-Elias M, Ouedraogo S, Paggiaro P, Pali-Schöll I, Palkonen S, Panzner P, Papi A, Park HS, Passalacqua G, Pedersen S, Pereira AM, Pfaar O, Picard R, Pigearias B, Pin I, Plavec D, Pohl W, Popov TA, Portejoie F, Postma D, Poulsen LK, Price D, Rabe KF, Raciborski F, Roberts G, Robalo-Cordeiro C, Rodenas F, Rodriguez-Mañas L, Rolland C, Roman Rodriguez M, Romano A, Rosado-Pinto J, Rosario N, Rottem M, Sanchez-Borges M, Sastre-Dominguez J, Scadding GK, Scichilone N, Schmid-Grendelmeier P, Serrano E, Shields M, Siroux V, Sisul JC, Skrindo I, Smit HA, Solé D, Sooronbaev T, Spranger O, Stelmach R, Sterk PJ, Strandberg T, Sunyer J, Thijs C, Triggiani M, Valenta R, Valero A, van Eerd M, van Ganse E, van Hague M, Vandenplas O, Varona LL, Vellas B, Vezzani G, Vazankari T, Viegi G, Vontetsianos T, Wagenmann M, Walker S, Wang DY, Wahn U, Werfel T, Whalley B, Williams DM, Williams S, Wilson N, Wright J, Yawn BP, Yiallouros PK, Yusuf OM, Zaidi A, Zar HJ, Zernotti ME, Zhang L, Zhong N, Zidarn M. ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle. Clin Transl Allergy 2016; 6:47. [PMID: 28050247 PMCID: PMC5203711 DOI: 10.1186/s13601-016-0137-4] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 12/05/2016] [Indexed: 12/13/2022] Open
Abstract
The Allergic Rhinitis and its Impact on Asthma (ARIA) initiative commenced during a World Health Organization workshop in 1999. The initial goals were (1) to propose a new allergic rhinitis classification, (2) to promote the concept of multi-morbidity in asthma and rhinitis and (3) to develop guidelines with all stakeholders that could be used globally for all countries and populations. ARIA—disseminated and implemented in over 70 countries globally—is now focusing on the implementation of emerging technologies for individualized and predictive medicine. MASK [MACVIA (Contre les Maladies Chroniques pour un Vieillissement Actif)-ARIA Sentinel NetworK] uses mobile technology to develop care pathways for the management of rhinitis and asthma by a multi-disciplinary group and by patients themselves. An app (Android and iOS) is available in 20 countries and 15 languages. It uses a visual analogue scale to assess symptom control and work productivity as well as a clinical decision support system. It is associated with an inter-operable tablet for physicians and other health care professionals. The scaling up strategy uses the recommendations of the European Innovation Partnership on Active and Healthy Ageing. The aim of the novel ARIA approach is to provide an active and healthy life to rhinitis sufferers, whatever their age, sex or socio-economic status, in order to reduce health and social inequalities incurred by the disease.
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Affiliation(s)
- J Bousquet
- Montpellier University Hospital, Montpellier, France ; MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France ; INSERM, U1168, Ageing and Chronic Diseases Epidemiological and Public Health Approaches, 94800 Villejuif, France ; CHRU Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France
| | - P W Hellings
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Louvain, Belgium
| | - I Agache
- Transylvania University Brasov, Brasov, Romania
| | - A Bedbrook
- MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - C Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
| | - K C Bergmann
- Allergy-Centre-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany ; Global Allergy and Asthma European Network (GA²LEN), Berlin, Germany
| | - M Bewick
- iQ4U Consultants Ltd, London, UK
| | - C Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - S Bosnic-Anticevitch
- Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Glebe, NSW Australia
| | - C Bucca
- University Pneumology Unit-AOU Molinette, Hospital City of Health and Science of Torino, Turin, Italy
| | - D P Caimmi
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - P A M Camargos
- Department of Pediatrics, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - G W Canonica
- Asthma and Allergy Clinic, Humanitas University, Rozzano, Milan, Italy
| | - T Casale
- Division of Allergy/Immunology, University of South Florida, Tampa, FL USA
| | - N H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - A A Cruz
- ProAR - Nucleo de Excelencia em Asma, Federal University of Bahia, Salvador, Brazil ; GARD Executive Committee, Salvador, Bahia Brazil
| | - G De Carlo
- EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - R Dahl
- ProAR - Nucleo de Excelencia em Asma, Federal University of Bahia, Salvador, Brazil
| | - P Demoly
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France ; EPAR U707 INSERM, Paris, France ; EPAR UMR-S UPMC, Paris VI, Paris, France
| | - P Devillier
- Laboratoire de Pharmacologie Respiratoire UPRES EA220, Hôpital Foch, Suresnes Université Versailles, Saint-Quentin, France
| | - J Fonseca
- Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal ; Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal ; Health Information and Decision Sciences Department - CIDES, Faculdade de Medicina, Universidade do Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
| | - W J Fokkens
- Department of Otorhinolaryngology, Academic Medical Centre, Amsterdam, The Netherlands
| | - N A Guldemond
- Institute of Health Policy and Management IBMG, Erasmus University, Rotterdam, The Netherlands
| | - T Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - M Illario
- Federico II University Hospital Naples (R&D and DISMET), Naples, Italy
| | - J Just
- Allergology Department, Centre de l'Asthme et des Allergies, Hôpital d'Enfants Armand-Trousseau (APHP), Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, 75013 Paris, France
| | - T Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany ; Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
| | - L Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - P Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - D Larenas-Linnemann
- Clínica de Alergia, Asma y Pediatría, Hospital Médica Sur, Mexico City, Mexico
| | - M Morais-Almeida
- Allergy and Clinical Immunology Department, Hospital CUF-Descobertas, Lisbon, Portugal
| | - J Mullol
- ENT Department, Hospital Clinic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, Universitat de Barcelona, Barcelona, Catalonia Spain
| | - R Murray
- MedScript Ltd, Dundalk, County Louth, Ireland
| | - R Naclerio
- Section of Otolaryngology-Head and Neck Surgery, The University of Chicago Medical Center and The Pritzker School of Medicine, The University of Chicago, Chicago, IL USA
| | - R E O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC Australia ; Department of Immunology, Monash University, Melbourne, VIC Australia
| | - N G Papadopoulos
- Center for Pediatrics and Child Health, Institute of Human Development, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK ; Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece
| | - R Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - P Potter
- Allergy Diagnostic and Clinical Research Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - D Ryan
- Woodbrook Medical Centre, Loughborough, UK ; Allergy and Respiratory Research Group, The University of Edinburgh, Edinburgh, UK
| | - B Samolinski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - H J Schunemann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - A Sheikh
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, UK
| | - F E R Simons
- Department of Pediatrics and Child Health, Department of Immunology, Faculty of Medicine, University of Manitoba, Winnipeg, MB Canada
| | - C Stellato
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - A Todo-Bom
- Centre of Pneumology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - P V Tomazic
- Department of ENT, Medical University of Graz, Graz, Austria
| | - A Valiulis
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania ; Public Health Institute, Vilnius University, Vilnius, Lithuania ; European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium
| | - E Valovirta
- Department of Lung Diseases and Clinical Allergology, University of Turku, Turku, Finland ; Allergy Clinic, Terveystalo, Turku, Finland
| | - M T Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | - M Wickman
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - I Young
- Queen's University, Belfast, Northern Ireland, UK
| | - A Yorgancioglu
- Department of Pulmonology, Celal Bayar University, Manisa, Turkey
| | - T Zuberbier
- Allergy-Centre-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany ; Global Allergy and Asthma European Network (GA²LEN), Berlin, Germany
| | - W Aberer
- Department of Dermatology, Medical University of Graz, Graz, Austria
| | - C A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - M Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - I Annesi-Maesano
- EPAR U707 INSERM, Paris, France ; EPAR UMR-S UPMC, Paris VI, Paris, France
| | - J Ankri
- INSERM, U1168, Ageing and Chronic Diseases Epidemiological and Public Health Approaches, 94800 Villejuif, France
| | - I J Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Erandio, Spain
| | - J M Anto
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain ; IMIM (Hospital del Mar Research Institute), Barcelona, Spain ; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain ; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - A Asarnoj
- Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden ; Department of Pediatric Pulmonology and Allergy, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - H Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, UK
| | | | - I Baiardini
- Asthma and Allergy Clinic, Humanitas University, Rozzano, Milan, Italy
| | - C Barbara
- Faculdade de Medicina de Lisboa, Portuguese National Programme for Respiratory Diseases (PNDR), Lisbon, Portugal
| | - M Barbagallo
- Geriatric Unit, Department of Internal Medicine (DIBIMIS), University of Palermo, Palermo, Italy
| | - E D Bateman
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - B Beghé
- Section of Respiratory Disease, Department of Oncology, Haematology and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy
| | - E H Bel
- Department of Respiratory Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - K S Bennoor
- Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
| | - M Benson
- Centre for Individualized Medicine, Department of Pediatrics, Faculty of Medicine, Linköping University, 58185 Linköping, Sweden
| | - A Z Białoszewski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - T Bieber
- Department of Dermatology and Allergy, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - L Bjermer
- Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden
| | - H Blain
- Department of Geriatrics, Montpellier University Hospital, Montpellier, France ; EA 2991, Euromov, University Montpellier, Montpellier, France
| | - F Blasi
- Department of Pathophysiology and Transplantation, IRCCS Fondazione Ca'Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - A L Boner
- Pediatric Department, University of Verona Hospital, Verona, Italy
| | - M Bonini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - S Bonini
- Second University of Naples and Institute of Translational Medicine, Italian National Research Council, Naples, Italy
| | | | | | - L P Boulet
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC Canada
| | - R Bourret
- Montpellier University Hospital, Montpellier, France
| | | | - F Braido
- Asthma and Allergy Clinic, Humanitas University, Rozzano, Milan, Italy
| | - A H Briggs
- Health Economics and Health Technology Assessment, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - C E Brightling
- Institute of Lung Health, Respiratory Biomedical Unit, University Hospitals of Leicester NHS Trust, Leicestershire, UK ; Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - J Brozek
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - R Buhl
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - C Bunu
- University of Medicine and Pharmacy Victor Babes, Timisoara, Romania
| | - E Burte
- INSERM, U1168, Ageing and Chronic Diseases Epidemiological and Public Health Approaches, 94800 Villejuif, France
| | - A Bush
- Royal Brompton Hospital NHS, Imperial College London, London, UK
| | | | - M A Calderon
- Royal Brompton Hospital NHS, Imperial College London, London, UK ; National Heart and Lung Institute, Imperial College London, London, UK
| | - T Camuzat
- Montpellier, Région Languedoc Roussillon France
| | - V Cardona
- S. Allergologia, S. Medicina Interna, Hospital Vall d'Hebron, Barcelona, Spain
| | - P Carreiro-Martins
- CEDOC, Respiratory Research Group, Nova Medical School, Campo dos Martires da Patria, Lisbon, Portugal ; Serviço de Imunoalergologia, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
| | - A M Carriazo
- Regional Ministry of Health of Andalusia, Seville, Spain
| | - K H Carlsen
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway ; University of Oslo, Oslo, Norway
| | - W Carr
- Allergy and Asthma Associates of Southern California, Mission Viejo, CA USA
| | - A M Cepeda Sarabia
- Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia ; SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Cartagena, Colombia
| | - M Cesari
- Gérontopôle de Toulouse, 31059 Toulouse, France
| | - L Chatzi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete Greece
| | - R Chiron
- Department of Respiratory Diseases, Montpellier University Hospital, Montpellier, France
| | - T Chivato
- School of Medicine, University CEU San Pablo, Madrid, Spain
| | - E Chkhartishvili
- Chachava Clinic, David Tvildiani Medical University-AIETI Medical School, Grigol Robakidze University, Tbilisi, Georgia
| | - A G Chuchalin
- Pulmonolory Research Institute FMBA, Moscow, Russia ; GARD Executive Committee, Moscow, Russia
| | - K F Chung
- National Heart and Lung Institute, Imperial College London, London, UK
| | - G Ciprandi
- Medicine Department, IRCCS-Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
| | - J Correia de Sousa
- ICVS/3B's-PT Government Associate Laboratory, Life and Health Sciences, Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
| | - L Cox
- Department of Medicine, Nova Southeastern University, Davie, FL USA
| | - G Crooks
- EIP on AHA, European Innovation Partnership on Active and Healthy Ageing, Reference Site, Scottish Centre for Telehealth and Telecare, NHS 24, Glasgow, UK
| | - A Custovic
- Department of Pediatric, Imperial College London, London, UK
| | - S E Dahlen
- The Centre for Allergy Research, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - U Darsow
- Department of Dermatology and Allergy, Technische Universität München, Munich, Germany ; ZAUM-Center for Allergy and Environment, Helmholtz Center Munich, Munich, Germany
| | - T Dedeu
- AQuAS, Barcelona, Spain ; EUREGHA, European Regional and Local Health Association, Brussels, Belgium
| | - D Deleanu
- Allergology and Immunology Discipline, "Luliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - J A Denburg
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON Canada
| | | | - A Didier
- Respiratory Diseases Department, Rangueil-Larrey Hospital, Toulouse, France
| | - A T Dinh-Xuan
- Service de Physiologie Respiratoire, Hôpital Cochin, Université Paris-Descartes, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - D Dokic
- University Clinic of Pulmology and Allergy, Medical Faculty, Ss Cyril and Methodius University, Skopje, Republic of Macedonia
| | - H Douagui
- Service de Pneumo-Allergologie, Centre Hospitalo-Universitaire de Béni-Messous, Algers, Algeria
| | - G Dray
- Ecole des Mines, Alès, France
| | - R Dubakiene
- Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - S R Durham
- Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - G Du Toit
- Guy's and St Thomas' NHS Trust, Kings College London, London, UK
| | - M S Dykewicz
- Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, MO USA
| | - P Eklund
- Computing Science Department, Umeå University, Umeå, Sweden ; Four Computing Oy, Halikko, Finland
| | - Y El-Gamal
- Pediatric Allergy and Immunology Unit, Ain Shams University, Cairo, Egypt
| | - E Ellers
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark
| | - R Emuzyte
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania ; Public Health Institute, Vilnius University, Vilnius, Lithuania ; European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium
| | - J Farrell
- Department of Health, Social Services and Public Safety, Belfast, Northern Ireland, UK
| | - A Fink Wagner
- Global Allergy and Asthma Platform GAAPP, Altgasse 8-10, 1130 Vienna, Austria
| | - A Fiocchi
- Division of Allergy, Department of Pediatric Medicine, The Bambino Gesù Children's Research Hospital Holy See, Rome, Italy
| | | | - F Forastiere
- Department of Epidemiology, Regional Health Service Lazio Region, Rome, Italy
| | - M Gaga
- Athens Chest Hospital, Athens, Greece
| | - A Gamkrelidze
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | - B Gemicioğlu
- Department of Pulmonary Diseases, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - J E Gereda
- Allergy and Immunology Division, Clinica Ricardo Palma, Lima, Peru
| | - R Gerth van Wick
- Section of Allergology, Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - S González Diaz
- Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Mexico
| | - I Grisle
- Center of Tuberculosis and Lung Diseases, Latvian Association of Allergists, Riga, Latvia
| | - L Grouse
- Faculty of the Department of Neurology, University of Washington School of Medicine, Seattle, WA USA
| | - Z Gutter
- National eHealth Centre, University Hospital Olomouc, Olomouc, Czech Republic
| | - M A Guzmán
- Immunology and Allergy Division Clinical Hospital, University of Chile, Santiago, Chile
| | - B Hellquist-Dahl
- Department of Respiratory Diseases, Odense University Hospital, Odense, Denmark
| | - J Heinrich
- Institute of Epidemiology I, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - F Horak
- Vienna Challenge Chamber, Vienna, Austria
| | - J O' B Hourihane
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - M Humbert
- Université Paris-Sud, Le Kremlin Bicêtre, France ; Service de Pneumologie, Hôpital Bicêtre, Le Kremlin Bicêtre, France ; Inserm UMR_S999, Le Kremlin Bicêtre, France
| | - M Hyland
- School of Psychology, Plymouth University, Plymouth, UK
| | - G Iaccarino
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - E J Jares
- Libra Foundation, Buenos Aires, Argentina
| | - C Jeandel
- MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France ; Department of Geriatrics, Montpellier University Hospital, Montpellier, France
| | - S L Johnston
- Airway Disease Infection Section, National Heart and Lung Institute, Imperial College London, London, UK ; MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, UK
| | - G Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - O Jonquet
- Medical Commission, Montpellier University Hospital, Montpellier, France
| | - K S Jung
- Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Gyeonggi-do South Korea
| | - M Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland
| | - I Kaidashev
- Ukrainian Medical Stomatological Academy, Poltava, Ukraine
| | - M Khaitov
- Laboratory of Molecular Immunology, National Research Center, Institute of Immunology, Federal Medicobiological Agency, Moscow, Russia
| | - O Kalayci
- Pediatric Allergy and Asthma Unit, School of Medicine, Hacettepe University, Ankara, Turkey
| | - A F Kalyoncu
- Immunology and Allergy Division, Department of Chest Diseases, School of Medicine, Hacettepe University, Ankara, Turkey
| | - P Kardas
- First Department of Family Medicine, Medical University of Lodz, Lodz, Poland
| | - P K Keith
- Department of Medicine, McMaster University, Health Sciences Centre 3V47, 1280 Main Street West, Hamilton, ON Canada
| | - M Kerkhof
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H A M Kerstjens
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - M Kogevinas
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain ; IMIM (Hospital del Mar Research Institute), Barcelona, Spain ; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain ; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - V Kolek
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, University Hospital Olomouc, Olomouc, Czech Republic
| | - G H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M L Kowalski
- Department of Immunology, Rheumatology and Allergy and HARC, Medical University of Lodz, Lodz, Poland
| | - M Kuitunen
- Children's Hospital, University of Helsinki, Helsinki, Finland
| | - I Kull
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - V Kvedariene
- Clinic of Infectious, Chest Diseases, Dermatology and Allergology, Vilnius University, Vilnius, Lithuania
| | - B Lambrecht
- VIB Inflammation Research Center, Ghent University, Ghent, Belgium
| | - S Lau
- Department for Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | | | - L T T Le
- University of Medicine and Pharmacy, Hochiminh City, Vietnam
| | - P Lieberman
- Divisions of Allergy and Immunology, Department of Internal Medicine and Pediatrics, University of Tennessee College of Medicine, Germantown, TN USA
| | - B Lipworth
- Scottish Centre for Respiratory Research, Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, UK
| | - J Li
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - K C Lodrup Carlsen
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - R Louis
- Department of Pulmonary Medicine, CHU Sart-Tilman, Liege, Belgium
| | - C Lupinek
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - W MacNee
- The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Y Magar
- Service de Pneumo-allergologie, Hôpital Saint-Joseph, Paris, France
| | - A Magnan
- Service de Pneumologie, UMR INSERM, UMR1087 and CNR 6291, l'institut du Thorax, University of Nantes, Nantes, France
| | - B Mahboub
- Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE
| | - D Maier
- Biomax Informatics AG, Munich, Germany
| | - I Majer
- Department of Respiratory Medicine, University of Bratislava, Bratislava, Slovakia
| | - J Malva
- Institute of Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra, Coimbra, Portugal ; Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | - P Manning
- Department of Medicine (RCSI), Bon Secours Hospital, Glasnevin, Dublin, Ireland
| | | | - G D Marshall
- Laboratory of Behavioral Immunology Research, Division of Clinical Immunology and Allergy, The University of Mississippi Medical Center, Jackson, MS USA
| | - M R Masjedi
- Tobacco Control Research Centre, Iranian Anti Tobacco Association, Tehran, Iran
| | | | - M Maurer
- Allergy-Centre-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Mavale-Manuel
- Department of Paediatrics, Maputo Central Hospital, Maputo, Mozambique
| | - E Melén
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - E Melo-Gomes
- Faculdade de Medicina de Lisboa, Portuguese National Programme for Respiratory Diseases (PNDR), Lisbon, Portugal
| | - E O Meltzer
- Allergy and Asthma Medical Group and Research Center, San Diego, CA USA
| | - J Mercier
- Department of Physiology, CHRU, PhyMedExp, INSERM U1046, CNRS UMR 9214, University Montpellier, Montpellier, France
| | - H Merk
- Hautklinik - Klinik für Dermatologie & Allergologie, Universitätsklinikum der RWTH Aachen, Aachen, Germany
| | | | - F Mihaltan
- National Institute of Pneumology M. Nasta, Bucharest, Romania
| | - B Milenkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia ; Serbian Association for Asthma and COPD, Belgrade, Serbia
| | - J Millot-Keurinck
- Caisse d'assurance retraite et de la santé au travail du Languedoc-Roussillon (CARSAT-LR), Montpellier, France
| | - Y Mohammad
- National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia, Syria
| | - I Momas
- Department of Public Health and Health Products, EA 4064, Paris Descartes University-Sorbonne Paris Cité, Paris, France ; Paris Municipal Department of Social Action, Childhood, and Health, Paris, France
| | - R Mösges
- Institute of Medical Statistics, Informatics and Epidemiology, Medical Faculty, University of Cologne, Cologne, Germany
| | - A Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
| | - L Namazova-Baranova
- Scientific Centre of Children's Health Under the Russian Academy of Medical Sciences, Moscow, Russia
| | - R Nadif
- INSERM, U1168, Ageing and Chronic Diseases Epidemiological and Public Health Approaches, 94800 Villejuif, France
| | - H Neffen
- Hospital de Niños Orlando Alassia, Santa Fe, Argentina
| | - K Nekam
- Hospital of the Hospitaller Brothers in Buda, Budapest, Hungary
| | - A Nieto
- Neumología y Alergología Infantil, Hospital La Fe, Valencia, Spain
| | - B Niggemann
- Department for Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | - L Nogueira-Silva
- Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal ; Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal ; Health Information and Decision Sciences Department - CIDES, Faculdade de Medicina, Universidade do Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal ; Department of Internal Medicine, Centro Hospitalar Sao Joao, Porto, Portugal
| | - M Nogues
- MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France ; Caisse d'assurance retraite et de la santé au travail du Languedoc-Roussillon (CARSAT-LR), Montpellier, France
| | - T D Nyembue
- ENT Department, University Hospital of Kinshasa, Kinshasa, Congo
| | - K Ohta
- National Hospital Organization, Tokyo National Hospital, Tokyo, Japan
| | - Y Okamoto
- Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
| | - K Okubo
- Department of Otolaryngology, Nippon Medical School, Tokyo, Japan
| | - M Olive-Elias
- Montpellier University Hospital, Montpellier, France ; Institute of Health Policy and Management IBMG, Erasmus University, Rotterdam, The Netherlands ; Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - S Ouedraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - P Paggiaro
- Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy
| | - I Pali-Schöll
- Department of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine, Medical University, Vienna, Austria
| | - S Palkonen
- EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - P Panzner
- Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - A Papi
- Respiratory Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - H S Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - G Passalacqua
- Asthma and Allergy Clinic, Humanitas University, Rozzano, Milan, Italy
| | - S Pedersen
- University of Southern Denmark, Kolding, Denmark
| | - A M Pereira
- Center for Research in Health Technologies and Information Systems - CINTESIS, Universidade do Porto, Porto, Portugal ; Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal ; Health Information and Decision Sciences Department - CIDES, Faculdade de Medicina, Universidade do Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal ; Allergy Unit, CUF-Porto Hospital and Institute, Porto, Portugal
| | - O Pfaar
- Center for Rhinology and Allergology, Wiesbaden, Germany ; Department of Otorhinolaryngology, Head and Neck Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - R Picard
- Conseil Général de l'Economie, Ministère de l'Economie, de l'Industrie et du Numérique, Paris, France
| | - B Pigearias
- Société de Pneumologie de Langue Française, Espace francophone de Pneumologie, Paris, France
| | - I Pin
- Département de pédiatrie, CHU de Grenoble, Grenoble, France
| | - D Plavec
- Children's Hospital Srebrnjak, Zagreb, Croatia ; School of Medicine, University J.J. Strossmayer, Osijek, Croatia
| | - W Pohl
- Karl Landsteiner Institute for Clinical and Experimental Pneumology, Hietzing Hospital, Vienna, Austria
| | - T A Popov
- Clinic of Allergy and Asthma, Medical University Sofia, Sofia, Bulgaria
| | - F Portejoie
- MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France, European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
| | - D Postma
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - L K Poulsen
- Laboratory of Medical Allergology, Allergy Clinic, Copenhagen University Hospital at Gentofte, Copenhagen, Denmark
| | - D Price
- Academic Centre of Primary Care, University of Aberdeen, Aberdeen, Scotland, UK ; Research in Real-Life, Cambridge, UK
| | - K F Rabe
- LungenClinic Grosshansdorf, Airway Research Center North, German Center for Lung Research (DZL), Grosshansdorf, Germany ; Department of Medicine, Christian Albrechts University, Airway Research Center North, German Center for Lung Research (DZL), Kiel, Germany
| | - F Raciborski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - G Roberts
- NHS Foundation Trust, University Hospitals of Southampton, Southampton, UK
| | - C Robalo-Cordeiro
- Centre of Pneumology, Coimbra University Hospital, Coimbra, Portugal
| | - F Rodenas
- Polibienestar Research Institute, University of Valencia, Valencia, Spain
| | | | - C Rolland
- Association Asthme et Allergie, Paris, France
| | - M Roman Rodriguez
- Primary Care Respiratory Research Unit, Institutode Investigación Sanitaria de Palma IdisPa, Palma de Mallorca, Spain
| | - A Romano
- Allergy Unit, Complesso Integrato Columbus, Rome, Italy
| | - J Rosado-Pinto
- Serviço de Imunoalergologia, Hospital da Luz, Lisbon, Portugal
| | - N Rosario
- Hospital de Clinicas, University of Parana, Curitiba, Brazil
| | - M Rottem
- Division of Allergy Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel
| | - M Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico-Docente La Trinidad and Clínica El Avila, Caracas, Venezuela
| | | | - G K Scadding
- The Royal National TNE Hospital, University College London, London, UK
| | | | - P Schmid-Grendelmeier
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - E Serrano
- Otolaryngology and Head and Neck Surgery, CHU Rangueil-Larrey, Toulouse, France
| | - M Shields
- Child Health, Queen's University, Belfast, Northern Ireland, UK ; Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland, UK
| | - V Siroux
- INSERM, Université Grenoble Alpes, IAB, U 1209, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Université Joseph Fourier, Grenoble, France
| | - J C Sisul
- Sociedad Paraguaya de Alergia Asma e Inmunologıa, Asunción, Paraguay
| | - I Skrindo
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway ; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - H A Smit
- Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - D Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - T Sooronbaev
- Kyrgyzstan National Centre of Cardiology and Internal Medicine, Euro-Asian Respiratory Society, Bishkek, Kyrgyzstan
| | - O Spranger
- Global Allergy and Asthma Platform GAAPP, Altgasse 8-10, 1130 Vienna, Austria
| | - R Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - P J Sterk
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - T Strandberg
- European Union Geriatric Medicine Society (EUGMS), Helsinki, Finland
| | - J Sunyer
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain ; IMIM (Hospital del Mar Research Institute), Barcelona, Spain ; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain ; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - C Thijs
- Department of Epidemiology, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - M Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - R Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - A Valero
- Pneumology and Allergy Department, Hospital Clínic, Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain
| | | | - E van Ganse
- PELyon, Lyon, France ; HESPER 7425, Health Services and Performance Resarch, Université Claude Bernard Lyon, Villeurbanne, France
| | - M van Hague
- Clinical Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden ; Department of Pediatric Pulmonology and Allergy, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden ; University Hospital, Stockholm, Sweden
| | - O Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - L L Varona
- Philippines Society of Allergy, Asthma and Immunology, Manila, Philippines
| | - B Vellas
- Gérontopôle de Toulouse, 31059 Toulouse, France
| | - G Vezzani
- Pulmonary Unit, Department of Cardiology, Thoracic and Vascular Medicine, Arcispedale S. Maria Nuova/IRCCS, Research Hospital, Reggio Emilia, Italy ; Regional Agency for Health and Social Care, Reggio Emilia, Italy
| | - T Vazankari
- Finnish Lung Association (FILHA), Helsinki, Finland
| | - G Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy ; CNR Institute of Biomedicine and Molecular Immunology "A. Monroy", Palermo, Italy
| | | | - M Wagenmann
- Department of Otorhinolaryngology, HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - S Walker
- Asthma UK, Mansell Street, London, UK
| | - D Y Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - U Wahn
- Department for Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | - T Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - B Whalley
- School of Psychology, Plymouth University, Plymouth, UK
| | - D M Williams
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC USA
| | | | - N Wilson
- Northern Health Alliance, Newcastle, UK
| | - J Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - B P Yawn
- Department of Research, Olmsted Medical Center, Rochester, MN USA
| | | | - O M Yusuf
- The Allergy and Asthma Institute, Lahore, Pakistan
| | - A Zaidi
- Social Sciences, University of Southampton, Southampton, UK
| | - H J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa ; MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - M E Zernotti
- Universidad Católica de Córdoba, Córdoba, Argentina
| | - L Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Beijing, China ; Beijing Institute of Otolaryngology, Beijing, China
| | - N Zhong
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - M Zidarn
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
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Viña J, Rodriguez-Mañas L, Salvador-Pascual A, Tarazona-Santabalbina FJ, Gomez-Cabrera MC. Exercise: the lifelong supplement for healthy ageing and slowing down the onset of frailty. J Physiol 2016; 594:1989-99. [PMID: 26872560 DOI: 10.1113/jp270536] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 12/14/2015] [Indexed: 12/30/2022] Open
Abstract
The beneficial effects of exercise have been well recognized for over half a century. Dr Jeremy Morris's pioneering studies in the fifties showed a striking difference in cardiovascular disease between the drivers and conductors on the double-decker buses in London. These studies sparked off a vast amount of research on the effects of exercise in health, and the general consensus is that exercise contributes to improved outcomes and treatment for several diseases including osteoporosis, diabetes, depression and atherosclerosis. Evidence of the beneficial effects of exercise is reviewed here. One way of highlighting the impact of exercise on disease is to consider it from the perspective of good practice. However, the intensity, duration, frequency (dosage) and counter indications of the exercise should be taken into consideration to individually tailor the exercise programme. An important case of the beneficial effect of exercise is that of ageing. Ageing is characterized by a loss of homeostatic mechanisms, on many occasions leading to the development of frailty, and hence frailty is one of the major geriatric syndromes and exercise is very useful to mitigate, or at least delay, it. Since exercise is so effective in reducing frailty, we would like to propose that exercise be considered as a supplement to other treatments. People all over the world have been taking nutritional supplements in the hopes of improving their health. We would like to think of exercise as a physiological supplement not only for treating diseases, but also for improving healthy ageing.
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Affiliation(s)
- Jose Viña
- Department of Physiology, University of Valencia, Fundacion Investigacion Hospital Clinico Universitario/INCLIVA, Spain
| | - Leocadio Rodriguez-Mañas
- Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto de Salud Carlos III, Servicio de Geriatría, Hospital Universitario de Getafe, Ministerio de Sanidad y Consumo, Madrid, España
| | - Andrea Salvador-Pascual
- Department of Physiology, University of Valencia, Fundacion Investigacion Hospital Clinico Universitario/INCLIVA, Spain
| | | | - Mari Carmen Gomez-Cabrera
- Department of Physiology, University of Valencia, Fundacion Investigacion Hospital Clinico Universitario/INCLIVA, Spain
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Ramirez-Campillo R, Diaz D, Martinez-Salazar C, Valdés-Badilla P, Delgado-Floody P, Méndez-Rebolledo G, Cañas-Jamet R, Cristi-Montero C, García-Hermoso A, Celis-Morales C, Moran J, Buford TW, Rodriguez-Mañas L, Alonso-Martinez AM, Izquierdo M. Effects of different doses of high-speed resistance training on physical performance and quality of life in older women: a randomized controlled trial. Clin Interv Aging 2016; 11:1797-1804. [PMID: 28008239 PMCID: PMC5167493 DOI: 10.2147/cia.s121313] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE This study aimed to compare the effects of two frequencies of high-speed resistance training (HSRT) on physical performance and quality of life of older women. METHODS A total of 24 older women participated in a 12-week HSRT program composed of either two or three sessions/week (equated for volume and intensity). Women were randomized into three arms: a control group (CG, n=8), a resistance training group performing two sessions/week (RT2, n=8), and a resistance training group performing three sessions/week (RT3, n=8). The training program for both experimental groups included exercises that required high-speed concentric muscle actions. RESULTS No baseline differences were observed among groups. Compared with the CG, both training groups showed similar small to moderate improvements (P<0.05) in muscle strength, power, functional performance, balance, and quality of life. CONCLUSION These results suggest that equated for volume and intensity, two and three training sessions/week of HSRT are equally effective for improving physical performance and quality of life of older women.
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Affiliation(s)
- Rodrigo Ramirez-Campillo
- Department of Physical Activity Sciences
- Laboratory of Measurement and Assessment in Sports, Research Nucleus in Health, Physical Activity and Sports, Universidad de Los Lagos, Osorno
- Unit of Integrative Physiology, Laboratory of Exercise Sciences, MEDS Clinic, Santiago, Chile
| | - Daniela Diaz
- School of Occupational Therapy, Faculty of Health, Universidad Santo Tomás, Osorno
| | | | - Pablo Valdés-Badilla
- Institute of Physical Activity and Health, Universidad Autónoma de Chile, Temuco
| | - Pedro Delgado-Floody
- Department of Physical Education, Sport and Recreation, Universidad de La Frontera
| | | | - Rodrigo Cañas-Jamet
- Laboratory of Physiology, Department of Biological Sciences, Faculty of Biological Sciences, Universidad Andres Bello, Viña del Mar
- School of Kinesiology, Faculty of Medicine, Universidad Diego Portales, Santiago
| | - Carlos Cristi-Montero
- IRyS Group, Physical Education School, Pontificia Universidad Católica de Valparaíso, Valparaíso
| | - Antonio García-Hermoso
- Laboratory of Physical Activity Sciences, Sport and Health, Faculty of Medical Sciences, Universidad de Santiago de Chile, USACH, Santiago, Chile
| | - Carlos Celis-Morales
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow
| | - Jason Moran
- Centre for Sports and Exercise Science, School of Biological Sciences, University of Essex, Colchester, UK
| | - Thomas W Buford
- Department of Aging and Geriatric Research, Institute of Aging, University of Florida, College of Medicine, Gainesville, Florida, USA
| | | | | | - Mikel Izquierdo
- Department of Health Sciences, Public University of Navarre, Navarre, Spain
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49
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Bousquet J, Bewick M, Cano A, Eklund P, Fico G, Goswami N, Guldemond NA, Henderson D, Hinkema MJ, Liotta G, Mair A, Molloy W, Monaco A, Monsonis-Paya I, Nizinska A, Papadopoulos H, Pavlickova A, Pecorelli S, Prados-Torres A, Roller-Wirnsberger RE, Somekh D, Vera-Muñoz C, Visser F, Farrell J, Malva J, Andersen Ranberg K, Camuzat T, Carriazo AM, Crooks G, Gutter Z, Iaccarino G, de Keenoy EM, Moda G, Rodriguez-Mañas L, Vontetsianos T, Abreu C, Alonso J, Alonso-Bouzon C, Ankri J, Arredondo MT, Avolio F, Bedbrook A, Białoszewski AZ, Blain H, Bourret R, Cabrera-Umpierrez MF, Catala A, O’Caoimh R, Cesari M, Chavannes NH, Correia-Da-Sousa J, Dedeu T, Ferrando M, Ferri M, Fokkens WJ, Garcia-Lizana F, Guérin O, Hellings PW, Haahtela T, Illario M, Inzerilli MC, Lodrup Carlsen KC, Kardas P, Keil T, Maggio M, Mendez-Zorrilla A, Menditto E, Mercier J, Michel JP, Murray R, Nogues M, O’Byrne-Maguire I, Pappa D, Parent AS, Pastorino M, Robalo-Cordeiro C, Samolinski B, Siciliano P, Teixeira AM, Tsartara SI, Valiulis A, Vandenplas O, Vasankari T, Vellas B, Vollenbroek-Hutten M, Wickman M, Yorgancioglu A, Zuberbier T, Barbagallo M, Canonica GW, Klimek L, Maggi S, Aberer W, Akdis C, Adcock IM, Agache I, Albera C, Alonso-Trujillo F, Angel Guarcia M, Annesi-Maesano I, Apostolo J, Arshad SH, Attalin V, Avignon A, Bachert C, Baroni I, Bel E, Benson M, Bescos C, Blasi F, Barbara C, Bergmann KC, Bernard PL, Bonini S, Bousquet PJ, Branchini B, Brightling CE, Bruguière V, Bunu C, Bush A, Caimmi DP, Calderon MA, Canovas G, Cardona V, Carlsen KH, Cesario A, Chkhartishvili E, Chiron R, Chivato T, Chung KF, D’Angelantonio M, de Carlo G, Cholley D, Chorin F, Combe B, Compas B, Costa DJ, Costa E, Coste O, Coupet AL, Crepaldi G, Custovic A, Dahl R, Dahlen SE, Demoly P, Devillier P, Didier A, Dinh-Xuan AT, Djukanovic R, Dokic D, du Toit G, Dubakiene R, Dupeyron A, Emuzyte R, Fiocchi A, Wagner A, Fletcher M, Fonseca J, Fougère B, Gamkrelidze A, Garces G, Garcia-Aymeric J, Garcia-Zapirain B, Gemicioğlu B, Gouder C, Hellquist-Dahl B, Hermosilla-Gimeno I, Héve D, Holland C, Humbert M, Hyland M, Johnston SL, Just J, Jutel M, Kaidashev IP, Khaitov M, Kalayci O, Kalyoncu AF, Keijser W, Kerstjens H, Knezović J, Kowalski M, Koppelman GH, Kotska T, Kovac M, Kull I, Kuna P, Kvedariene V, Lepore V, Macnee W, Maggio M, Magnan A, Majer I, Manning P, Marcucci M, Marti T, Masoli M, Melen E, Miculinic N, Mihaltan F, Milenkovic B, Millot-Keurinck J, Mlinarić H, Momas I, Montefort S, Morais-Almeida M, Moreno-Casbas T, Mösges R, Mullol J, Nadif R, Nalin M, Navarro-Pardo E, Nekam K, Ninot G, Paccard D, Pais S, Palummeri E, Panzner P, Papadopoulos NK, Papanikolaou C, Passalacqua G, Pastor E, Perrot M, Plavec D, Popov TA, Postma DS, Price D, Raffort N, Reuzeau JC, Robine JM, Rodenas F, Robusto F, Roche N, Romano A, Romano V, Rosado-Pinto J, Roubille F, Ruiz F, Ryan D, Salcedo T, Schmid-Grendelmeier P, Schulz H, Schunemann HJ, Serrano E, Sheikh A, Shields M, Siafakas N, Scichilone N, Siciliano P, Skrindo I, Smit HA, Sourdet S, Sousa-Costa E, Spranger O, Sooronbaev T, Sruk V, Sterk PJ, Todo-Bom A, Touchon J, Tramontano D, Triggiani M, Tsartara SI, Valero AL, Valovirta E, van Ganse E, van Hage M, van den Berge M, Vandenplas O, Ventura MT, Vergara I, Vezzani G, Vidal D, Viegi G, Wagemann M, Whalley B, Wickman M, Wilson N, Yiallouros PK, Žagar M, Zaidi A, Zidarn M, Hoogerwerf EJ, Usero J, Zuffada R, Senn A, de Oliveira-Alves B. Erratum to: Building bridges for innovation in ageing: Synergies between action groups of the EIP on AHA. J Nutr Health Aging 2016. [DOI: 10.1007/s12603-016-0850-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Viña J, Salvador-Pascual A, Tarazona-Santabalbina FJ, Rodriguez-Mañas L, Gomez-Cabrera MC. Exercise training as a drug to treat age associated frailty. Free Radic Biol Med 2016; 98:159-164. [PMID: 27021963 DOI: 10.1016/j.freeradbiomed.2016.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/16/2016] [Accepted: 03/24/2016] [Indexed: 12/31/2022]
Abstract
Exercise causes an increase in the production of free radicals [1]. As a result of a hormetic mechanism antioxidant enzymes are synthesised and the cells are protected against further oxidative stress. Thus, exercise can be considered as an antioxidant [2]. Age-associated frailty is a major medical and social concern as it can easily lead to dependency. In this review we describe that oxidative stress is associated with frailty and the mechanism by which exercise prevents age-associated frailty. We propose that individually tailored multicomponent exercise programmes are one of the best ways to prevent and to treat age-associated frailty.
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Affiliation(s)
- Jose Viña
- Department of Physiology, University of Valencia, Investigación Hospital Clínico Universitario/INCLIVA, Spain; Hospital Universitario de la Ribera, Alzira, Valencia, Spain; School of Nursing, Catholic University of Valencia San Vicente Mártir, Spain; Servicio de Geriatría, Hospital Universitario de Getafe, Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto de Salud Carlos III, Spain
| | - Andrea Salvador-Pascual
- Department of Physiology, University of Valencia, Investigación Hospital Clínico Universitario/INCLIVA, Spain; Hospital Universitario de la Ribera, Alzira, Valencia, Spain; School of Nursing, Catholic University of Valencia San Vicente Mártir, Spain; Servicio de Geriatría, Hospital Universitario de Getafe, Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto de Salud Carlos III, Spain
| | | | - Leocadio Rodriguez-Mañas
- Servicio de Geriatría, Hospital Universitario de Getafe, Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto de Salud Carlos III, Spain
| | - Mari Carmen Gomez-Cabrera
- Department of Physiology, University of Valencia, Investigación Hospital Clínico Universitario/INCLIVA, Spain; Hospital Universitario de la Ribera, Alzira, Valencia, Spain; School of Nursing, Catholic University of Valencia San Vicente Mártir, Spain; Servicio de Geriatría, Hospital Universitario de Getafe, Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad (RETICEF), Instituto de Salud Carlos III, Spain.
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