Baseline Short Physical Performance Battery Research Articles

Association between fall history and performance-based physical function and postural sway in patients with rheumatoid arthritis

Objectives Patients with rheumatoid arthritis (RA) are at increased risk of falling; therefore, fall prevision and prevention are critical. The present study aimed to evaluate the ability of physical performance assessments to discriminate between RA patients with and without a history of falling. Methods Fifty patients with RA were divided into two groups according to the presence or absence of a history of falls within the previous 1 year. Physical performance was assessed using the short physical performance battery (SPPB), which consists of the timed standing balance, gait speed, and chair stand tests. Standing balance was also assessed as postural sway using a force platform in several positions including standing with both feet together, semitandem, and tandem. Backgrounds, SPPB, and postural sway were compared between the two groups. Results Fourteen patients (28%) reported one or more falls within the previous year. There were no significant intergroup differences in baseline characteristics or SPPB score. The group with a history of falls had significantly longer measured time for the 5-repetition chair stand test and significantly longer postural sway in the semitandem position. The discriminate analysis revealed that 5-repetition chair stand test or its combination with postural sway in the semitandem position significantly discriminated between fallers and non-fallers. Conclusion Numerical evaluation of the chair stand test and postural sway in the semitandem position seems more appropriate than SPPB for assessing the fall risk of patients with RA.

EFFECTS OF FUNCTIONAL BRAIN NETWORKS AND WHITE MATTER DISEASE ON MOBILITY OF OLDER ADULTS IN AN EXERCISE INTERVENTION

Declining mobility is associated with increased accumulation of white matter hyperintensities (WMH). However, a high WMH burden is not always accompanied by impaired mobility. Our previous work demonstrates that some variance in mobility may be explained by brain network connectivity. Here, we extended this work by measuring WMHs and brain networks in older adults participating in a lifestyle intervention. The Short Physical Performance Battery (SPPB) and resting state functional magnetic resonance imaging (fMRI) were collected before and after a 5-month caloric restriction plus aerobic exercise intervention in 57 obese, sedentary adults aged 65-78. Participants were categorized based on median splits of baseline SPPB scores and WMH burden: Expected Healthy (EH: low WMH, SPPB≥11, n=16), Expected Impaired (EI: high WMH, SPPB≤10, n=17), Unexpected Healthy (UH: high WMH, SPPB≥11, n=12), and Unexpected Impaired (UI: low WMH, SPPB≤10, n=12). Graph theory-based methods were used to characterize brain networks and compare the four groups. At baseline, the somatomotor cortex community structure (SMC-CS) was less consistent in EI (p=0.05) and UI (p=0.23) compared to EH. The EI (mean=1.25, p=0.003) and UI (mean=1.57, p=0.001) significantly improved their SPPB scores following the intervention. Although both groups had equivalent SPPB scores, SMC-CS was less consistent in the UH than EH (p=0.16). However, UH displayed a significant (p=0.004) increase in second-order connections to the precuneus compared to EH. These data suggest that studying brain networks could improve the understanding of the development of mobility disability and the CNS contributions to mobility independent of white matter disease.

CARDIOVASCULAR RISK MODERATES THE EFFECT OF RESISTANCE TRAINING ON PHYSICAL PERFORMANCE IN OLDER ADULT WOMEN

We aimed to examine whether the Framingham Cardiovascular Risk Profile Score (FCRP) moderates the effect of progressive resistance training (RT) on mobility in older adult women. This is an exploratory analysis of a single-blind, 12-month randomized controlled trial in 155 omen, aged 65 to 75 years old, who were randomized to: 1x/week progressive RT; or 2x/week progressive RT program; or 2x/week balance and tone (BAT). At baseline and trial completion, mobility was measured using the Short Physical Performance Battery (SPPB). The SPPB is a composite measure of usual gait speed, standing balance, and sit to stand performance; scores < 9/12 are indicative of functional decline. Baseline 10-year cardiovascular risk was calculated using the FCRP. Participants were classified as either low risk (<16.5% FCRP score; LCVR) or high risk ≥16.5% FCRP score; HCVR). A complete case analysis (n=126) was conducted using a two-way analysis of covariance (ANCOVA) to evaluate the interaction effect of group by FCRP risk on SPPB scores at trial completion; baseline SPPB scores and age in years were entered as covariates. There was a significant interaction effect (F(1,126)=3.74, p=0.027). At trial completion, both 1x/RT and 2x/RT participants with HCVR demonstrated greater SPPB scores than those with LCVR (11.59 vs. 11.38 for 1x/week; 11.86 vs 11.46 for 2x/week). In contrast, BAT participants with HCVR demonstrated worse SPPB scores than those with LCVR (11.18 vs 11.66). Our data suggest that RT may be more efficacious for improving mobility in older women with higher cardiovascular risk than women with lower risk.

NUTRITIONAL INTAKE AND STATUS AND PHYSICAL FUNCTION OF OLDER ETHNIC MINORITIES: A LONGITUDINAL STUDY

There are limited longitudinal data regarding nutritional intake and status, and physical function in community-dwelling ethnically diverse older adults. This study explored these variables and their relationship at baseline (n=100) and after 8-months (n=81) among community-dwelling ethnically diverse older adults (≥60 years) in Birmingham, United Kingdom. Multiple pass 24-hour dietary recalls and the Mini Nutritional Assessment-Short Form assessed nutritional intake and status, respectively. The Short Physical Performance Battery(SPPB) and handgrip strength measured physical function. Linear and multinomial regression analyses were used to predict the relationship between nutritional intake, status and physical function. Mean(SD) age was 70(8.1) years (60% male), with 62% of the sample being obese. Significant decreases in intakes of vitamin B6(0.88-0.77mg/day, p=0.014); vitamin B1(0.73-0.63mg/day, p=0.029); iron(6.16-5.85mg/d, p=0.045); folate(113.23-106.66µg/d, p=0.043); and magnesium(154.54-144.59mg/d, p=0.031) occurred over time. At both timepoints, across sexes, daily intakes of all micronutrients except vitamin B12, phosphorus and manganese were below the Recommended Nutrient Intakes. There were significant declines in SPPB scores(Z=-4.01, p<0.001) and nutritional status(Z=-2.37,p=0.018) over time. At baseline, younger age, better nutritional status, and higher vitamin D and fibre intakes were associated with higher SPPB scores. At follow-up, higher baseline SPPB scores (OR=0.54 95% CI:0.35, 0.81) were associated with reduced decline in nutritional status. The observed declines in nutritional status and physical function, and the inadequate nutrient intakes in the absence of weight loss within eight months pose serious challenges to healthy ageing. There is an urgent need to re-evaluate and tailor appropriate dietary advice for this population to support them to age healthily.

A pilot study on Short Physical Performance Battery in Geriatric Heart Failure: Prediction of adverse events at six months?

Aims: To evaluate the outcomes of heart failure in the elderly (60 years or older) by Short Physical Performance Battery scores at six months of discharge. Methods: One hundred elderly patients with heart failure were evaluated at discharge, at 3 and 6 months after discharge by Short Physical Performance Battery. Results: Of the 100 patients discharged from hospital, mean age was 65.13 ± 6.3 years, 65 percent were males, Heart failure with reduced ejection fraction was present in 77%, and 26 (26%) had died by six months. Readmissions were mainly due to acute decompensated heart failure or Chronic Obstructive Pulmonary Disease exacerbations. There was a good correlation between Short Physical Performance Battery and Ejection fraction. The Short Physical Performance Battery scores were low at discharge but improved over six months in those who were alive. All those who died at six months had a baseline Short Physical Performance Battery score of 6 or less. Conclusion: The Short Physical Performance Battery can identify heart failure patients at discharge who have a high risk of short term mortality. A multi-disciplinary intervention may be useful in improving outcomes.

Effect of an exercise rehabilitation program on physical function over 1 year in chronic kidney disease: an observational study.

BackgroundExercise rehabilitation may help maintain physical function in chronic kidney disease (CKD), but long-term clinical effectiveness is unknown. We evaluated the effect of an exercise rehabilitation program on physical function over 1 year in individuals with CKD.MethodsThis clinical program evaluation included adults with CKD (any stage) registered in a provincial renal program from 1 January 2011 to 31 March 2016. Attenders were referred to and attended a 10-week exercise rehabilitation program (n = 117). Nonattenders were referred, but did not attend the program (n = 133). Individuals enrolled in a longitudinal frailty study (n = 318) composed a second control group. Primary outcome: Change in physical function [short physical performance battery (SPPB) score]. Secondary outcomes included change in health-related quality of life, physical activity, exercise behaviour, hospitalization over 1 year. Predictors of improved SPPB were assessed using logistic regression.ResultsIn sum, 53, 40 and 207 participants completed 1-year follow-up in attender, nonattender and second control groups, respectively. Baseline median SPPB [interquartile range (IQR)] scores were 10.5 (9–12), 10 (8–12) and 9 (7–11) in attender, nonattender and second control groups, respectively (P = 0.02). Mean change in SPPB score over 1 year was not significantly different between groups (P = 0.7). Attenders with baseline SPPB score <12, trended toward increased likelihood of improved SPPB score at 1 year [odds ratio (OR) 2.18; 95% confidence interval (CI) 0.95–5.02; P = 0.07]. More attenders (60%) exercised regularly at 1 year than nonattenders (35%) (P = 0.03).ConclusionsThe impact of clinical exercise rehabilitation programs on physical function at 1 year needs further delineation. However, our observation of improved exercise behaviour at 1 year suggests sustained benefits with such programs in CKD.

The baseline speed of 10-m gait predicts ambulatory discharge for hospitalized frail elderly after DOPPO rehabilitation.

The discharge of elderly patients from hospital on the basis of their independent gait program (DOPPO) is a new rehabilitation strategy for physically frail hospitalized elderly that aims to recover independent gait and to achieve ambulatory discharge. We retrospectively investigated baseline determinants of physical measures associated closely with the 6-min walking distance (6MWD) after DOPPO. Participants were 137 consecutive elderly inpatients, irrespective of the causative disease (mean age: 82±7 years; 76 women), who had a Short Physical Performance Battery (SPPB) score of less than 12 and low independent walking capacity. The rehabilitation comprised muscle stretching, muscle strengthening, balance training, and endurance exercise, including walking. The exercises were gradually increased until the goal of ambulatory discharge was attained. The SPPB, isometric knee-extension muscle strength (IKEMS), functional reach test (FRT), one-leg stance time (OLST), and the 10-m gait speed (TMGS) were measured, before and after the DOPPO intervention, and their association with the 6MWD was evaluated. All participants achieved ambulatory discharge, requiring on average 35±19 hospital days and 32±18 h of rehabilitation. The SPPB, IKEMS, FRT, OLST, and TMGS improved. The SPPB scores increased from 7.1 at baseline to 9.2 at discharge. Eighty-eight patients completed the 6MWD. The SPPB, IKEMS, FRT, OLST, and TMGS were strongly associated with the 6MWD. Only the baseline TMGS and SPPB predicted the 6MWD, with a cut-off TMGS value of 0.84 m/s providing the best prediction of achieving a distance of more than 300 m on the 6MWD. Thus, the baseline TMGS is the best prediction of the ambulatory outcome after the present DOPPO rehabilitation.

DISSIMILARITIES IN TRAJECTORIES OF PHYSICAL FUNCTION DECLINE IN OLDER ADULTS BY SEX

Purpose: Aging is associated with decline of physical function with heterogeneous rates of decline across individuals. We aimed at identifying risk factors for accelerated decline of lower extremity performance over 9-year follow up in participants of the InCHIANTI study aged 65–75 years, with a Short Physical Performance Battery (SPPB) score >9 and non-disabled at baseline evaluation. Methods: Time trajectories of SPPB were characterized by Latent Class Growth Curve, separately in men and women and categorized as fast and slow linear decline. Predictors of SPPB decline were identified by logistic regression among demographic, physiological and biomarker variables. Fit of the model prediction was explored by ROC curve. Results: 507 participants (246M, 261F both 70 ± 3.0ys of age) were included. Average baseline SPPB was 11.7 ± 0.6 for men and 11.2 ± 1.0 for women. Significant predictors of SPPB decline for males were none and low physical activity (OR=9.4 and OR=4.1), number of diseases (OR=1.4), hip flexion strength (OR=0.9) and total cholesterol (OR=0.98). Main predictors for women were different and included: age (OR=1.5), vitamin D <60nmol/L (OR=3.0), C-reactive protein >5µg/mL (OR=2.9) and hip flexion strength (OR=0.8). AUC values derived from ROC analyses were 81.9% for males and 85.6% for females. Conclusion: Risk factors for differential rates of decline of physical function with age include both functional variables and blood biomarkers but are different between men and women. Of particular interest, C-reactive protein is a risk factor only in women confirming previous reports.

Directly Measured Physical Function in Cardiac Rehabilitation.

The Short Physical Performance Battery (SPPB) is a strong predictor for risk of physical disability in older adults. Roughly half of individuals participating in phase II cardiac rehabilitation (CR) are 65 years or older, many presenting with low aerobic capacities and may be at increased risk for physical disability. The cohort consisted of 196 consecutive patients (136 men), aged 65 years or older, entering CR who were prospectively evaluated by the SPPB. Data were also obtained for age, self-reported physical function (Medical Outcomes Study Short Form-36 questionnaire), and peak aerobic capacity. Measures were repeated upon completion of CR for those individuals who completed the program. The average age of patients was 74 ± 0.5 years. At baseline, total SPPB score was 9.7 ± 0.2 (out of 12). Followup data were obtained on 133 (68%) patients, with a mean improvement of 0.8 ± 0.1 (P < .0001), which was not clinically significant (≥1 point). Focusing on patients with a low baseline SPPB score, 72 subjects scored ≤9 (7.1 ± 0.2), with 45 completing exit measures. Improvements were found in gait speed (0.5 ± 0.1, P < .0001), chair-stand (1.0 ± 0.1, P < .0001), and total SPPB (1.6 ± 0.3, P < .0001) in this more disabled group. Measures of (Equation is included in full-text article.)O2peak were significantly reduced in the low SPPB group (13.5 ± 0.4 vs 17.5 ± 0.4 mL/kg/min, P < .0001). Measured (Equation is included in full-text article.)O2peak (R = 26%, P < .0001) and self-reported physical function score (R = 5%, P = .02) were the only multivariate predictors of baseline SPPB. For patients who enter CR with low SPPB scores (37%), significant improvements in physical function were noted, largely explained by improved walking speed and leg strength (chair-stand).

Physical Activity After a Hip Fracture: Effect of a Multicomponent Home-Based Rehabilitation Program—A Secondary Analysis of a Randomized Controlled Trial

ObjectivesTo investigate the effect of a yearlong multicomponent rehabilitation program on the level of physical activity (PA) and the maintenance of the level of PA over 1-year follow-up among older people recovering from a recent hip fracture. DesignSecondary analysis of a randomized, controlled, parallel-group trial. SettingHome-based rehabilitation; measurements in university laboratory. ParticipantsCommunity-dwelling people (N=81) aged ≥60 years recovering from a hip fracture. Participants were randomly assigned to an intervention (n=40) or a control (n=41) group, on average, 42±23 days after discharge from the hospital. InterventionA yearlong intervention included evaluation and modification of environmental hazards, guidance for safe walking, nonpharmacologic pain management, a progressive home exercise program, PA counseling, and standard care. Main Outcome MeasuresThe outcome was the level of PA, which was assessed with the questionnaire (a modified Grimby scale) at baseline, and 3, 6, 12, and 24 months after baseline. Three PA categories were defined: inactivity, light PA, and moderate to heavy PA. Physical function was assessed using the Short Physical Performance Battery (SPPB) at baseline. The effects of the intervention were analyzed with generalized estimating equations. ResultsIn the intervention group, a significant increase was observed in the level of PA after the intervention (interaction P=.005) and after 1-year follow-up (P=.021) compared with the standard care only. The benefit was particularly evident among the participants with a baseline SPPB score of ≥7 (interaction P<.001). ConclusionsThe 12-month individualized multicomponent rehabilitation program increased PA among older patients with hip fracture. The increase was found to be maintained at the 1-year follow-up.

The Effect of Chronic Kidney Disease on a Physical Activity Intervention: Impact on Physical Function, Adherence, and Safety.

BackgroundBecause chronic kidney disease (CKD) is associated with muscle wasting, older adults with CKD are likely to have physical function deficits. Physical activity can improve these deficits, but whether CKD attenuates the benefits is unknown. Our objective was to determine if CKD modified the effect of a physical activity intervention in older adults.MethodsThis is an exploratory analysis of the LIFE-P study, which compared a 12-month physical activity program (PA) to a successful aging education program (SA) in older adults. CKD was defined as a baseline eGFR < 60 mL/min/1.73 m2. We examined the Short Physical Performance Battery (SPPB) at baseline, 6 and 12 months. Secondary outcomes included serious adverse events (SAE) and adherence to intervention frequency. Linear mixed models were adjusted for age, sex, diabetes, hypertension, CKD, intervention, site, visit, baseline SPPB, and interactions of intervention and visit and of intervention, visit, and baseline CKD.ResultsThe sample included 368 participants. CKD was present in 105 (28.5%) participants with a mean eGFR of 49.2 ± 8.1 mL/min/1.73 m2. Mean SPPB was 7.38 ± 1.41 in CKD participants; 7.59 ± 1.44 in those without CKD (p = 0.20). For CKD participants in PA, 12-month SPPBs increased to 8.90 (95% CI 8.32, 9.47), while PA participants without CKD increased to 8.40 (95% CI 8.01, 8.79, p = 0.43). For CKD participants in SA, 12-month SPPBs increased to 7.67 (95% CI 7.07, 8.27), while participants without CKD increased to 8.12 (95% CI 7.72, 8.52, p = 0.86). Interaction between CKD and intervention was non-significant (p = 0.88). Number and type of SAEs were not different between CKD and non-CKD participants (all p > 0.05). In PA, adherence for CKD participants was 65.5 ± 25.4%, while for those without CKD was 74.0 ± 22.2% (p = 0.12).ConclusionDespite lower adherence, older adults with CKD likely derive clinically meaningful benefits from physical activity with no apparent impact on safety, compared to those without CKD.

Rhythmic Interlimb Coordination Impairments and the Risk for Developing Mobility Limitations.

The identification of novel rehabilitative impairments that are risk factors for mobility limitations may improve their prevention and treatment among older adults. We tested the hypothesis that impaired rhythmic interlimb ankle and shoulder coordination are risk factors for subsequent mobility limitations among older adults. We conducted a 1-year prospective cohort study of community-dwelling older adults (N = 99) aged 67 years and older who did not have mobility limitations (Short Physical Performance Battery score > 9) at baseline. Participants performed antiphase coordination of the right and left ankles or shoulders while paced by an auditory metronome. Using multivariable logistic regression, we determined odds ratios (ORs) for mobility limitations at 1-year follow-up as a function of coordination variability and asymmetry. After adjusting for age, sex, body mass index, Mini-Mental State Examination score, number of chronic conditions, and baseline Short Physical Performance Battery score, ORs were significant for developing mobility limitations based on a 1 SD difference in the variability of ankle (OR = 1.88; 95% confidence interval [CI]: 1.16-3.05) and shoulder (OR = 1.96; 95% CI: 1.17-3.29) coordination. ORs were significant for asymmetry of shoulder (OR = 2.11; 95% CI: 1.25-3.57), but not ankle (OR = 0.95; 95% CI: 0.59-1.55) coordination. Similar results were found in unadjusted analyses. The results support our hypothesis that impaired interlimb ankle and shoulder coordination are risk factors for the development of mobility limitations. Future work is needed to further examine the peripheral and central mechanisms underlying this relationship and to test whether enhancing coordination alters mobility limitations.

Muscle Strength and Changes in Physical Function in Women With Systemic Lupus Erythematosus.

Cross-sectional studies have observed that muscle weakness is associated with worse physical function among women with systemic lupus erythematosus (SLE). The present study examines whether reduced upper and lower extremity muscle strength predict declines in function over time among adult women with SLE. One hundred forty-six women from a longitudinal SLE cohort participated in the study. All measures were collected during in-person research visits approximately 2 years apart. Upper extremity muscle strength was assessed by grip strength. Lower extremity muscle strength was assessed by peak knee torque of extension and flexion. Physical function was assessed using the Short Physical Performance Battery (SPPB). Regression analyses modeled associations of baseline upper and lower extremity muscle strength with followup SPPB scores controlling for baseline SPPB, age, SLE duration, SLE disease activity (Systemic Lupus Activity Questionnaire), physical activity level, prednisone use, body composition, and depression. Secondary analyses tested whether associations of baseline muscle strength with followup in SPPB scores differed between intervals of varying baseline muscle strength. Lower extremity muscle strength strongly predicted changes over 2 years in physical function even when controlling for covariates. The association of reduced lower extremity muscle strength with reduced physical function in the future was greatest among the weakest women. Reduced lower extremity muscle strength predicted clinically significant declines in physical function, especially among the weakest women. Future studies should test whether therapies that promote preservation of lower extremity muscle strength may prevent declines in function among women with SLE.

Feasibility of Post‐Hospitalization Interventions to Improve Physical Function in Older Adults

Acute hospitalization can have catastrophic consequences for physical function and independence in older adults. The inability to regain function following a hospital stay is a strong predictor of re‐hospitalization and mortality. We have shown that nutritional interventions, exercise, and anabolic steroids independently increase muscle size and function, thus representing promising therapeutic strategies.The goal of this pilot study was to test the feasibility of interventions (placebo supplement (P), nutrition supplement (N, whey protein), progressive in‐home exercise + placebo (E+P), exercise + nutrition (E+N), or single testosterone injection (T)) to improve physical function in older adults following acute hospitalization.Subjects (&gt;65 years) were recruited during hospitalization at UTMB Acute Care for Elders unit. Demographics and short physical performance battery (SPPB) were collected at hospital discharge and 1‐month post discharge.Mean baseline SPPB score was 6.6. At 1‐mo testing, interventions tended to enhance improvement in raw SPPB score (P: 1.3, N: 3.3, E+P: 2.2, E+N: 3.2, T: 2.3) and percent of subjects with a clinically meaningful improvement (蠅1 point) (P: 50%, N: 100%, E+P: 80%, E+N: 80%, T: 88%). Gait speed was low in all groups at baseline (0.60‐ 0.71 m/s). Interventions tended to augment gait speed at 1‐mo (P: 25%, N: 50%, E+P: 45%, E+N: 44%, T: 21%).These preliminary data (n=4‐8), from an ongoing clinical trial, indicate that interventions after acute hospitalization are feasible and can improve physical function in older adults.Dairy Research Institute (1229) and UTMB Claude D. Pepper OAIC (5P30‐ AG024832).

Efecto de un programa de ejercicios fisioterapéuticos sobre el desempeño físico en adultos mayores institucionalizados

ObjectiveTo evaluate changes in physical performance in institutionalized older adults through a program of physiotherapy exercises. Materials and methodsA quasi-experimental study was conducted on adults over 60 years-old, institutionalized in Lima, Peru. The exercise program was implemented in 45minutes sessions included warming-up, muscle strengthening exercises, balance, gait training and cooling phase, three times a week for 12 weeks. Physical performance was measured with the Short Physical Performance Battery (SPPB) one week before and after the intervention. It included 45 participants, of whom 16 did not attend any of the sessions and was used as a control group. ResultsThe mean age was 77.6±7.1 years, and 62.2% were women. The mean baseline SPPB was 7.0±1.6 in the intervention group, and 6.9±1.9 in the control group (P=.90). A change of 2.6±1.8 was observed in the SPPB of the intervention group versus -1.4±2.0 in the control group (P<.001). ConclusionsThe development of a physiotherapy exercise program for institutionalized elderly increases physical performance, which could be implemented in care centers for elderly.

Trail Making Test Predicts Physical Impairment and Mortality in Older Persons

To examine whether performance in the Trail Making Test (TMT) predicts mobility impairment and mortality in older persons. Prospective cohort study. Community-dwelling older persons enrolled in the Invecchiare in Chianti (InCHIANTI) Study. Five hundred eighty-three participants aged 65 and older and free of major cognitive impairment (Mini-Mental State Examination score >21) with baseline data on TMT performance. Of these, 427 performed the Short Physical Performance Battery (SPPB) for the assessment of lower extremity function at baseline and after 6 years. Of the initial 583 participants, 106 died during a 9-year follow-up. The TMT Parts A and B (TMT-A and TMT-B) and SPPB were administered at baseline and 6-year follow-up. Impaired mobility was defined as an SPPB score less than 10. Vital status was ascertained over a 9-year follow-up. InCHIANTI participants in the fourth quartile of the time to complete TMT-B minus time to complete TMT-A (TMT (B-A)) were significantly more likely to develop an SPPB score less than 10 during the 6-year follow-up than those in the first quartile (relative risk (RR)=2.4, 95% confidence interval (CI)=1.4-3.9, P=.001). After adjusting for potential confounders, these findings were substantially unchanged (RR=2.2, 95% CI=1.4-3.6, P=.001). Worse performance on the TMT was associated with significantly greater decline in SPPB score over the 6-year follow-up, after adjusting for age, sex, and baseline SPPB scores (beta=-0.01, standard error=0.003, P=.004). During the 9-year follow-up, 18.2% of the participants died. After adjustment for age and sex, the proportion of participants who died was higher in participants in the worst than the best performance quartile of TMT (B-A) scores (hazard ratio (HR)=1.7, 95% CI=1.0-2.9, P=.048). Results were similar in a parsimonious adjusted model (HR=1.8, 95% CI=1.0-3.2, P=.04). Performance on the TMT is a strong, independent predictor of mobility impairment, accelerated decline in lower extremity function, and death in older adults living in the community. The TMT could be a useful addition to geriatric assessment.

Abstract 5790: High Levels of Homocysteine and D-dimer Are Associated With Faster Functional Decline Among Men and Women With Lower Extremity Peripheral Arterial Disease

BACKGROUND. We assessed associations of baseline biomarker levels with functional decline among participants with lower extremity peripheral arterial disease (PAD). METHODS. Participants were 352 men and women with an ankle brachial index (ABI) &lt; 0.90 who attended a baseline and up to three annual follow-up visits. Baseline levels of homocysteine, C-reactive protein (CRP), interleukin-6 (IL-6), and D-dimer were obtained. Participants performed a six-minute walk test and the short physical performance battery (SPPB) at baseline and annually. The SPPB is a composite measure of lower extremity functioning scored on a 0 –12 scale (12= best). Outcomes were average annual decline in six-minute walk distance, average annual decline in the SPPB, and mobility loss. Mobility loss was defined as becoming unable to walk 1/4 mile or walk up and down one flight of stairs without assistance, among those without baseline mobility limitations. Results adjust for age, sex, race, body mass index, ABI, smoking, comorbidities, and other potential confounders. RESULTS . The 352 participants were average age 75±8 and 47% were women. The average ABI was 0.63 ± 0.16 and 33% had diabetes mellitus. Average baseline six-minute walk distance and SPPB scores were 1,101 feet ± 432 and 9 ± 3, respectively. Adjusting for confounders, higher CRP levels were associated with more rapid decline in six-minute walk performance (1 st (lowest) Tertile -50 feet/year; 2 nd Tertile -44 feet/year; 3 rd (highest) Tertile -65 feet/year, p trend value = 0.04). Higher CRP levels were also associated with more rapid decline in the SPPB (1 st (lowest) Tertile 0.3/year; 2 nd Tertile -0.3/year; 3 rd (highest) Tertile -0.5/year, p trend = 0.02). Similarly, higher levels of homocysteine were associated with more rapid decline in the SPPB (1 st Tertile 0.3/year; 2 nd Tertile -0.4/year; 3 rd Tertile -0.5/year, p trend = 0.03). Higher levels of homocysteine were also associated with higher rates of mobility loss, p trend = 0.04). IL-6 and D-dimer were not significantly associated with declining functional performance. CONCLUSIONS . This study demonstrates, for the first time, that higher baseline levels of CRP and homocysteine are associated with faster rates of decline in functional performance among men and women with PAD.

Performance-Based Functional Assessment in Older Hospitalized Patients: Feasibility and Clinical Correlates

Functional evaluation is a cornerstone of multidimensional geriatric assessment; however, little is known of the clinical value of standardized performance-based assessment in the acute care setting. The aim of this study was to evaluate the clinical correlates and short-term predictive value of the Short Physical Performance Battery (SPPB) in older patients admitted to the hospital for an acute medical event. We enrolled 92 women and men 65 years old or older who were able to walk, who had a Mini-Mental State Examination (MMSE) score > or =18, and who were admitted to the hospital with a clinical diagnosis of congestive heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), or minor stroke. The SPPB was assessed at hospital admission and discharge. Self-report functional assessment included basic activities of daily living (ADL) and instrumental activities of daily living (IADL). Spearman's rank correlation coefficients and multivariable linear regression analyses were used to study the association of SPPB score and functional and clinical characteristics, including length of hospital stay. The mean age was 77.7 years (range 65-94 years), 49% were female, 64.1% had congestive heart failure, 16% COPD, 13.1% pneumonia, and 6.5% minor stroke. At hospital admission the mean SPPB score was 6.0 +/- 2.7. SPPB scores were inversely correlated with age, the severity of the index disease, and IADL and ADL difficulty 2 weeks before hospital admission (p <.01), and were directly correlated with MMSE score (p =.002). On average, SPPB score increased 1 point (+0.97, standard error of the mean = 0.2; p for paired t test <.001) from baseline to hospital discharge assessment. After adjustment for potential confounders, baseline SPPB score was significantly associated with the length of hospital stay (p <.007). In older acute care inpatients, SPPB is a valid indicator of functional and clinical status. SPPB score at hospital admission is an independent predictor of the length of hospital stay.

Adverse Outcomes and Correlates of Change in the Short Physical Performance Battery Over 36 Months in the African American Health Project

The Short Physical Performance Battery (SPPB) is a well-established measure of lower body physical functioning in older persons but has not been adequately examined in African Americans or younger persons. Moreover, factors associated with changes in SPPB over time have not been reported. A representative sample of 998 African Americans (49-65 years old at baseline) living in St. Louis, Missouri were followed for 36 months to examine the predictive validity of SPPB in this population and identify factors associated with changes in SPPB. SPPB was calibrated to this population, ranged from 0 (worst) to 12 (best), and required imputation for about 50% of scores. Adverse outcomes of baseline SPPB included death, nursing home placement, hospitalization, physician visits, incident basic and instrumental activity of daily living disabilities, and functional limitations. Changes in SPPB over 36 months were modeled. Adjusted for appropriate covariates, weighted appropriately, and using propensity scores to address potential selection bias, baseline SPPB scores were associated with all adverse outcomes except physician visits, and were marginally associated with hospitalization. Declines in SPPB scores were associated with low falls efficacy (b = -1.311), perceived income adequacy (-0.121), older age (-0.073 per year), poor vision (-0.754), diabetes mellitus (-0.565), refusal to report household income (1.48), ever had Medicaid insurance (-0.610), obesity (-0.437), hospitalization in the prior year (-0.521), and kidney disease (-.956). The effect of baseline SPPB on adverse outcomes in this late middle-age African American population confirms reports involving older, primarily white participants. Alleviating deterioration in lower body physical functioning guided by the associated covariates may avoid or delay multiple age-associated adverse outcomes.

Effects of a Physical Activity Intervention on Measures of Physical Performance: Results of the Lifestyle Interventions and Independence for Elders Pilot (LIFE-P) Study

The Short Physical Performance Battery (SPPB), which includes walking, balance, and chair stands tests, independently predicts mobility disability and activities of daily living disability. To date, however, there is no definitive evidence from randomized controlled trials that SPPB scores can be improved. Our objective was to assess the effect of a comprehensive physical activity (PA) intervention on the SPPB and other physical performance measures. A total of 424 sedentary persons at risk for disability (ages 70-89 years) were randomized to a moderate-intensity PA intervention or a successful aging (SA) health education intervention and were followed for an average of 1.2 years. The mean baseline SPPB score on a scale of 0-12, with 12 corresponding to highest performance, was 7.5. At 6 and 12 months, the PA versus SA group adjusted SPPB (+/- standard error) scores were 8.7 +/- 0.1 versus 8.0 +/- 0.1, and 8.5 +/- 0.1 versus 7.9 +/- 0.2, respectively (p < .001). The 400-meter walking speed was also significantly improved in the PA group. The PA group had a lower incidence of major mobility disability defined as incapacity to complete a 400-meter walk (hazard ratio = 0.71, 95% confidence interval = 0.44-1.20). A structured PA intervention improved the SPPB score and other measures of physical performance. An intervention that improves the SPPB performance may also offer benefit on more distal health outcomes, such as mobility disability.