Decline In Physical Capacity Research Articles

Cross-sectional interactive associations of physical activity and sedentary behaviour with physical capacity across adulthood.

The way physical activity (PA) and sedentary behaviour (SB) independently and interactively modify the age-related decline in physical capacity remains poorly understood. This cross-sectional study investigated the independent and interactive associations of PA and SB with physical function and performance throughout the adult life course. Data from 499 community-dwelling adults (63% female) aged 20-92years, involved in the INSPIRE Human Translational Cohort, were used in this cross-sectional study. Daily time spent on moderate-to-vigorous PA (MVPA, min/day) and SB (h/day) was measured with activPAL triaxial accelerometers. Physical function and performance were assessed through the measurement of the 4-m usual gait speed (m/s), handgrip strength (kg), lower-limb strength (isokinetic knee extension torque, N·m), estimated lower-limb power (five-time chair-rise test performance, s) and cardiorespiratory fitness (V̇O2max, mL/kg/min). Confounder-adjusted multiple linear and curvilinear regressions were performed to investigate how MVPA, SB and their interactions were associated with the physical outcomes (all square root-transformed except gait speed) throughout the adulthood spectrum. Interaction analyses revealed that the combination of higher levels of MVPA with lower levels of SB favourably reshaped the negative relationship between handgrip strength and age (age2×SB×MVPA: B=-7E-08, SE=3E-08, P<0.05). In addition, higher levels of MVPA were independently associated with an improved age-related profile in gait speed (age2×MVPA: B=3E-06, SE=1E-06, P<0.05), chair-rise performance (age×MVPA: B=-9E-05, SE=4E-05, P<0.05) and V̇O2max (MVPA at 21years: B=3E-02, SE=7E-03, P<0.05; age×MVPA: B=-5E-04, SE=2E-04, P<0.05). Conversely, the detrimental association of age with lower-limb muscle strength (age×SB: B=-1E-04, SE=6E-05, P<0.05) and chair-rise performance (age×SB: B=1E-05, SE=7E-06, P<0.05) was exacerbated with increasing duration of SB, independently of MVPA. Supplementary analyses further revealed that some of these associations were age and sex specific. This cross-sectional study demonstrated that reduced sedentary time and increased activity duration were independently and synergistically associated with an attenuated age-related loss in physical capacity. These findings need to be confirmed with longitudinal data but encourage both adopting an active lifestyle and reducing sedentary time as preventive measures against physical aging.

A Clustering-Based Approach to Functional and Biomechanical Parameters Recorded with a Pair of Smart Eyeglasses in Older Adults in Order to Determine Physical Performance Groups.

Falls and frailty status are often associated with a decline in physical capacity and multifactorial assessment is highly recommended. Based on the functional and biomechanical parameters measured during clinical tests with an accelerometer integrated into smart eyeglasses, the purpose was to characterize a population of older adults through an unsupervised analysis into different physical performance groups. A total of 84 participants (25 men and 59 women) over the age of sixty-five (age: 74.17 ± 5.80 years; height: 165.70 ± 8.22 cm; body mass: 68.93 ± 13.55 kg) performed a 30 s Sit-to-Stand test, a six-minute walking test (6MWT), and a 3 m Timed Up and Go (TUG) test. The acceleration data measured from the eyeglasses were processed to obtain six parameters: the number of Sit-to-Stands, the maximal vertical acceleration values during Sit-to-Stand movements, step duration and length, and the duration of the TUG test. The total walking distance covered during the 6MWT was also retained. After supervised analyses comparison (i.e., ANOVAs), only one of the parameters (i.e., step length) differed between faller groups and no parameters differed between frail and pre-frail participants. In contrast, unsupervised analysis (i.e., clustering algorithm based on K-means) categorized the population into three distinct physical performance groups (i.e., low, intermediate, and high). All the measured parameters discriminated the low- and high-performance groups. Four of the measured parameters differentiated the three groups. In addition, the low-performance group had a higher proportion of frail participants. These results are promising for monitoring activities in older adults to prevent the decline of physical capacities.

Optimum Handle Location for the Hand-Assisted Sit-to-Stand Transition: A Tool

Background: The aging process contributes to the decline in physical capacity that leads to loss of independence in performing life activities. Immobility and instability are the most significant predictors and indicators of physical disability and dependence. As a result, a variety of assistive devices exist to address immobility and instability in older adults, including walkers, canes, crutches, wheelchairs and handrails. Sit-to-stand (STS) transitions are the most common transitions in daily mobility activities. The ability to perform STS transitions successfully is therefore one of the most important activities to focus attention on. As a result of physical deterioration, older adults will sooner or later be faced with their physical limitations, and in particular, will not be able to provide enough torque at critical body joints to make the STS transition. Aim: This paper suggests employing two-arm assistance using two handles located symmetrically in the body’s sagittal plane. During the aging process, people are faced with varying levels of muscle deterioration and body constraints and consequently require different levels of assistance to complete the transition successfully. This paper aims to develop a tool to find the optimum handle location for people based on their body constraints to reduce knee torque (identified as the critical joint in the STS transition). These findings are also used to measure the effects of assistive device handle position on the biomechanics of the two-arm assisted STS transition. Methods: For this purpose, a theoretical tool was developed by integrating human body kinetics with a multi-objective genetic algorithm to find the optimum hand force required at the seat-off point for a set of potential handle locations. The tool was set to achieve the minimum knee torque within the defined body constraints and assumptions. In line with the physics of the STS transition, the “seat-off point”, when subjects lose their seat support, was chosen as the most challenging point of the task. This was coupled with the “nose over toes” posture recommended to older adults by occupational therapists. Results and Discussion: The schematic of the developed tool shows that the best handle locations requiring the minimum torques at the body joints are positioned in handle zone 2, where the handles are placed vertically above the knee and below the hip joints and horizontally located ahead of the hip and behind the knee joints. Within this handle zone, both components of the hand forces (vertical downward and horizontal backward) provide assisting torque to all the body joints and consequently reduce the torques required at body joints.

The Co-Design/Co-Development and Evaluation of an Online Frailty Check Application for Older Adults: Participatory Action Research with Older Adults.

Frailty is an age-related condition characterized by a decline in physical capacity with an increased vulnerability to stressors. During the COVID-19 pandemic, there was considerable progression in frailty in older adults. Therefore, an online frailty check (FC) is required for continuous screening, especially acceptable to older adults. We aimed to co-design/co-develop an online FC application with FC supporters who were facilitators in a pre-existing onsite FC program in the community. It consisted of a self-assessment of sarcopenia and an 11-item questionnaire assessing dietary, physical, and social behaviors. Opinions obtained from FC supporters (median 74.0 years) were categorized and implemented. The usability was assessed using the system usability scale (SUS). For both FC supporters and participants (n = 43), the mean score was 70.2 ± 10.3 points, which implied a "marginally high" acceptability and a "good" adjective range. Multiple regression analysis showed that the SUS score was significantly correlated with onsite-online reliability, even after adjusting for age, sex, education level, and ICT proficiency (b = 0.400, 95% CI: 0.243-1.951, p = 0.013). We also validated the online FC score, which showed a significant association between onsite and online FC scores (R = 0.670, p = 0.001). In conclusion, the online FC application is an acceptable and reliable tool to check frailty for community-dwelling older adults.

PILATES METHOD IMPROVES PHYSICAL CAPACITY AND ANTI-OXIDATIVE SYSTEM IN ELDERLY WOMEN

Objective: The decline in physical capacity in humans occurs as a consequence of ageing. It is well established that oxidative mechanisms play a role in ageing process, leading to oxidative accumulation in tissue damage. Regular physical exercise can minimize the physiological changes that occur during aging and also contribute to improving the individual’s health and well-being. The aim of the present study is to verify the effects of resistance physical training on oxidative damage and physical capacity in elderly women who practice Pilates (P) or Strength Training (ST). Design and method: Elderly volunteer were evaluated and divided into P (68 ± 4 years age) or ST (66 ± 3 years age) groups (n = 20 per group), according to individual choice for the modality. The training protocol (moderate intensity) lasted 12 weeks, with 2 sessions of 60 minutes per week. All volunteers underwent dual-energy x-ray absorptiometry (DXA) and handgrip strength (HGS) for physical and functional assessment. Blood sample was collected for the analysis of oxidative stress markers (TBARS, Carbonilated proteins, NOX and SOD activities and Frap). Results: The results show that resistance exercises in P and ST modalities are effective in inducing changes in physical composition (body weight, fat percentage and bone density did not change). On the other hand, ST was effective in reducing fat mass in upper and lower limbs and increasing HGS (+40%), while P increased lean mass in limbs and trunk. Pilates method was more efficient in increasing muscle mass throughout the body, while strength training was more efficient in allowing fat loss. Finally, Pilates method was effective in increasing SOD activity (+20%), reducing protein oxidation (17%). On the other hand, strength training implemented an increase in the antioxidant system at the end of the ROS production cascade, which seems not to have been effective in reducing lipid oxidation (Frap increased 37%, while TBARS and NOX maintained 50% and 30% higher compared to Pilates, respectively). Conclusions: The results allow us to conclude that Pilates method, for a period of 12 weeks, is effective in bringing anti-oxidative capacity and in the quality of life of sedentary elderly women.

A multifactorial interdisciplinary intervention to prevent functional and mobility decline for more participation in (pre-)frail community-dwelling older adults (PromeTheus): study protocol for a multicenter randomized controlled trial

BackgroundAge-related decline in physical capacity can lead to frailty, associated with an increased vulnerability to adverse health outcomes and greater healthcare utilization. In an aging population, effective strategies to prevent physical decline and frailty, and preserve independence are needed. Prevention programs for vulnerable community-dwelling older adults are, however, often not yet established and implemented in routine practice. Research on the feasibility, implementation, and (cost-)effectiveness of multifactorial, interdisciplinary intervention programs that take advantage of available services of healthcare providers is also limited. The main aim of this study is to evaluate the effectiveness of such an intervention program (PromeTheus) to prevent functional and mobility decline for more participation in community-dwelling (pre-)frail older adults.MethodsThe study is designed as a three-center, randomized controlled trial with a 12-month intervention period. Four hundred community-dwelling (pre-)frail (Clinical Frailty Scale score 4–6) older adults (≥70 years) will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will receive the PromeTheus program consisting of obligatory home-based physical exercises (Weight-bearing Exercise for Better Balance) accompanied by physiotherapists and facultative counseling services (person-environment-fit, coping with everyday life, nutrition, group-based activities) delivered via existing healthcare structures (e.g., social workers, nutritionists). The CG will receive usual care and a one-time counseling session on recommendations for physical activity and nutrition. Primary outcomes assessed at months 6 and 12 are the function component of the Late-Life Function and Disability Instrument and the University of Alabama at Birmingham Life-Space Assessment. Secondary outcomes are disability, physical capacity and activity, frailty, nutritional status, falls, fear of falling, health status, and psychosocial components. Process and economic evaluations are also conducted. Primary statistical analyses will be based on the intention-to-treat principle.DiscussionCompared to usual care, the PromeTheus program is expected to result in higher function and mobility, greater independence and lower need for care, and more participation. As the PromeTheus program draws on existing German healthcare structures, its large-scale translation and delivery will be feasible, if evidence of (cost-)effectiveness and successful implementation can be demonstrated.Trial registrationGerman Clinical Trials Register, . Registered on March 11, 2021.

Longitudinal changes in daily patterns of objectively measured physical activity after falls in older adults with varying degrees of glaucoma.

BackgroundVisually impaired older adults have a greater risk of falling, making them particularly susceptible to fall-related health consequences and restricted physical activity. Unclear however, is the relationship between having falls and longitudinal changes in daily patterns of objectively measured physical activity in older adults with visual impairments.MethodsWe created a three-year prospective cohort study (Falls in Glaucoma Study) of older adults with primary or suspected glaucoma at the Johns Hopkins Wilmer Eye Institute from 2013 to 2015. Cumulative incidence of falls was determined through self-reported fall calendars over 12 months. Participants were then classified into one of three groups: multiple fallers (≥2 falls), single fallers (1 fall), and non-fallers (0). Daily physical activity was measured over 1 week using a waist-bound accelerometer during baseline and three-year follow-ups. Activity fragmentation was defined as the reciprocal of the mean activity bout length, with higher fragmentation reflecting shorter, more fractured bouts of continuous activity. Multivariate linear mixed-effects models were used to assess three-year longitudinal changes in: 1) activity fragmentation, and 2) accumulation of activity across six three-hour intervals from 5 AM to 11 PM.FindingsIn adjusted models accounting for visual field damage and other factors, multiple fallers demonstrated greater annual declines (per year) in daily active bouts (-1.79 bouts/day, 95% confidence interval [CI]: -3.35, -0.22), daily active minutes (-17.15 min/day, 95% CI: -26.35, -7.94), and increased fragmentation (1%, 95% CI: 0, 2%) over the three-year follow-up period as compared to non-fallers; no such changes were seen when comparing single fallers and non-fallers. In time-of-day analyses, multiple fallers experienced greater annual declines in average hourly steps over all periods of the day, though the rate of decline was only significant between 5 PM and 8 PM (-27.07 steps/hour, 95% CI: -51.15, -2.99) compared to non-fallers.InterpretationIn an older population with visual impairment, multiple falls over 12 months were associated with more transient and fragmented activity over a subsequent three-year period, and activity declines during evening hours, compared to non-fallers. These findings suggest that multiple fallers with visual impairment may be at high risk for a decline in physical capacity and endurance, warranting clinical interventions.FundingThe research was supported in part by National Institutes of Health Grant EY022976.

The Association Between Time in Range %, and Physical &amp; Functional Indices Amongst Older People With Type 2 Diabetes: A Cross Sectional Study

Abstract Diabetes is a major public health burden associated with high mortality, morbidity, hospitalization and health care services utilization rates. People with diabetes have an increased risk for mobility disability compared to those without diabetes, after controlling for age. People with diabetes also have a higher risk for falls and fractures. Data from the last several years suggests that this increased risk is not only due to diabetes co-morbidities but also due to an accelerated decline in physical capacity due to lower muscle quality and a more rapid decline in muscle mass (sarcopenia) and lower extremity strength over time. HBA1C is a measure of average glucose levels; however, it does not provide information about glycemic variability, or daily patterns of glycemia. In the last several years, several organizations have published consensus statements on the role of continuous glucose monitoring (CGM) in glucose control. The use of CGM has brought about the development of many glucose indices, amongst them is: Time In Range% (TIR) of 70–180 mg/dL (3.9–10 mmol/L). Less is known regarding the association between TIR and sarcopenia, muscle mass loss that leads to deterioration in mobility, disabilities and decline in physical indices in older people with diabetes. Aims: To assess among older people with diabetes type 2, the cross sectional association between: TIR and aerobic capacity, gait speed, strength, balance and frailty indices. Methods: A cross sectional study, conducted amongst people with diabetes over the age of 60. Participants were provided with a blinded CGM system- (I Pro2 carelink, Medtronic) for 1 week and underwent elaborate physical-functional assessment in the beginning and at the end of that week. The association between the % of time in range (Time in Range-TIR) and several physical indices was determined using linear regression. Results: This analysis pertains to 55 men and women who completed the evaluation. After adjustment for age and gender, we found that 1% increase in TIR was associated with a 0.341 higher score on the 30 second Sit to Stand score (a measure of lower extremity strength) (P-value=0.02), a 0.351 higher score on the BERG scale (a measure of balance) (P-value=0.01), a 0.271 lower score on the timed up and go score (a measure of fall risk and balance) (P-value=0.008), a 0.289 higher score on the 6-minute walk score (a measure of aerobic capacity and endurance) (P-value=0.02) and a 0.261 lower score on the 360 turn test (a measure of dynamic balance) (P-value=0.0004). The same was not observed for the relationship between HGA1C &amp; physical indices.

Age-stratified differences of physical capacity in rural community-dwelling Taiwanese older women: A cross-sectional study

ObjectivesPhysical capacity decline may precede physical disability. We explored age-related physical capacity decline among rural community-dwelling Taiwanese older women to provide reference values and to identify indicators of early-onset decline in physical capacity. MethodsOlder women aged 65–96 were recruited from rural community centers. Physical capacity was measured by handgrip strength (HS), gait speed (GS), five-times-sit-to-stand (5xSTS), timed up and go (TUG), and the Berg balance scale (BBS). Participants were stratified into four age groups: 65–69, 70–74, 75–79, and ≥80 years. ResultsOf 137 participants, 61 % exhibited poor 5xSTS, 34–49 % showed low HS, poor TUG and BBS, and 26 % had slow GS. The mean values in GS, HS, 5xSTS, TUG, and BBS were 1.02 m/s, 17.8 kg, 14.5 s, 12.6 s, and 50 points, respectively. Abnormal mean values were first noted at age 70–74 years for 5xSTS, age 75–79 years for HS, TUG, and BBS, and age ≥80 years for GS. Also, more than half the participants exhibited the first poor 5xSTS at age 70–74 years; the first poor HS and TUG at age 75–79 years; and lastly, the first poor BBS and GS at age ≥80 years. At age 65–69 years, 14–41 % of participants reported poor performance in all measures except for GS. ConclusionsLow HS and poor 5xSTS and TUG performance were more common and had earlier onset than slow GS. More attention should be directed toward the 5xSTS, TUG, and HS in rural community-dwelling Taiwanese older women.

\u201cCan do, don\u2019t do\u201d are not the lazy ones: a longitudinal study on physical functioning in patients with COPD

Background and objectiveReduced physical capacity (PC) and physical activity (PA) are common in COPD patients and associated with poor outcome. However, they represent different aspects of physical functioning and interventions do not affect them in the same manner. To address this, a new PC-PA quadrant concept was recently generated to identify clinical characteristics of sub-groups of physical functioning. The objective of this study was to I) proof the new concept and to verify their differentiating clinical characteristics, II) evaluate the consistency of the concept over time, III) assess whether patients changed their quadrant affiliation over time, IV) and to test if changes in quadrant affiliations are associated with changes in clinical characteristics.MethodsIn a longitudinal, prospective, non-interventional cohort with mild to very severe COPD patients, PC and PA as well as respiratory variables, COPD-specific health status, comorbidities, survival, and exacerbations were yearly assessed.ResultsData from 283 patients were analysed at baseline. Mean (min/max) follow-up time was 2.4 (0.5/6.8) years. The PC-PA quadrants could be characterized as follows: I) “can’t do, don’t do”: most severe and symptomatic, several comorbidities II) “can do, don’t do”: severe but less symptomatic, several comorbidities III) “can’t do, do do”: few patients, severe and symptomatic, less comorbidities IV) “can do, do do”: mildest and less symptomatic, less comorbidities, lowest exacerbation frequency. Of the 172 patients with at least one follow-up, 58% patients never changed their quadrant affiliation, while 17% declined either PC, PA or both, 11% improved their PC, PA or both, and 14% showed improvement and decline in PC, PA or both during study period. None of the clinical characteristics or their annual changes showed consistent significant and relevant differences between all individual sub-groups.ConclusionOur findings suggest that there are no clinical characteristics allowing to distinguish between the PC-PA quadrants and the concept seems not able to illustrate disease process. However, the already low PA but preserved PC in the “can do, don’t do” quadrant raises the question if regularly assessment of PA in clinical practice would be more sensitive to detect progressive deterioration of COPD compared to the commonly used PC.Clinical trial registrationwww.ClinicalTrials.gov, NCT01527773.

The Association between Glucose Control and Functional Indices in Older People with Diabetes.

Diabetes may be viewed as a disease of accelerated aging as it is a risk factor for physical disability and impairment in simple and complex activities, and is a higher risk for falls and fractures. Data from the last several years suggests that this increased risk is due not only to recognized diabetes complications but also to an accelerated decline in physical capacity due to lower muscle quality and a more rapid decline in muscle mass and lower extremity strength over time. Aim. To find the association between glucose control and functional indices. Methods. A cross-sectional study conducted at the Center for Successful Aging with Diabetes at the Sheba Medical Center. Individuals with a diagnosis of type 2 diabetes over the age of 60 were included. Functional status was assessed using tools that assess aerobic, strength, and balance capacities. Medical assessment was conducted through interview, physical examination, and collection of information from medical records. The association between functional indices and A1C was assessed using linear regression. Results. 153 consecutive individuals were evaluated. There was an inverse association between A1C and score achieved on the 6-minute walk; with increasing meters walked on the 6-minute walk test, there was a reduction in A1C (p = 0.003). There was also an inverse association with the 10-meter walk (p = 0.007), BERG balance test (p = 0.0006), and timed up and go (p = 0.01). Conclusion. In this cohort of older people with diabetes, there was an association between A1C and measures of functional indices. Future studies of glucose-lowering medication should include physical and functional assessment.

Dynamics of Variation in Physical Capacity of Elderly People

Research background and hypothesis. Increase in physical capacity and ftness can lead to additional improvements in health status, which is so important for healthy aging. Most scientists emphasize the physical activity decline in people of all ages. Therefore, it is important to assess health-related physical capacity and encourage people of various ages to improve their health, physical ftness and the quality of their life. Hypothesis – a signifcant decline in physical capacity of the elderly will be identifed during the research period. Research aim – to identify the variation dynamics of physical capacity indices of elderly people. Research methods. 60–69-year-old males and females were selected for the data analysis (n = 244). The anthropometric data and the physical capacity test results of trunk flexion, sit ups, balance and 1000 meter run were analysed. Physical capacity tests were carried out on the basis of the ‘Euroft’ test methodology. The methods of descriptive statistics were used for the data analysis. Research results. Body balance (43.8%) and aerobic capacity (20.8%) of the elderly males signifcantly declined (p &lt; 0.05) during the experimental period. However, improvement in the flexibility of males 16.5% (p &lt; 0.05) was identifed. The capacity of trunk flexor muscles of elderly females improved signifcantly by 39.3%, while the balance – by 18.1% (p &lt; 0.05). Analysis of the results in reference to gender showed that the balance, the capacity of trunk flexor muscles and aerobic capacity of elderly females increased signifcantly in comparison with males (p &lt; 0.05). Nevertheless, the flexibility variation of males was higher than the one of females (p &lt; 0.05) at the end of the research period. Discussion and conclusions. The balance and aerobic capacity of elderly males signifcantly decreased, whereas the flexibility improved. The capacity of trunk flexor muscles and balance of elderly females resulted in a statistically signifcant increase. In reference to the gender aspect it was determined that the majority of physical capacity results of elderly females statistically signifcantly developed more than the physical capacity results of males. Keywords: physical capacity, elderly people, ‘Euroft’.

Inspiratory muscle training improves physical performance and cardiac autonomic modulation in older women.

Aging impairs the autonomic balance reducing the vagal and increasing the sympathetic components of heart rate variability (HRV) and this could be associated with a decline in physical capacity. Inspiratory muscle training (IMT) is a possible tool to attenuate this physical capacity decline in older women. The aim of this study was to investigate the influence of IMT in the older women on physical capacity and autonomic cardiac modulation at rest and post exercise. 20 female participants 60-72years old were randomly allocated in two groups. One group underwent IMT set at 50% of maximum inspiratory pressure (MIP), every day for 4weeks (IMT-group). The placebo group performed the same training procedure but with a minimal resistance (5% MIP; PLA-group). Every week, the IMT load was readjusted and the HRV evaluated at rest. The six-minute walk test (6MWT) was performed once pre and post IMT-intervention. The IMT-group and PLA-group performed the same test and intervention procedures. After a 5 weeks intervention, the MIP had significantly improved in the IMT-group but not in the PLA-group (p < 0.01; es = 1.17). The high frequency power of the HRV spectrum had already improved by the second week (p < 0.01; es = 1.13) and remained elevated until the last week of intervention (p < 0.01; es = 1.43). The same positive results were described in 6MWT distance (p = 0.04; es = 0.39) and the change (∆) of heart rate recovery (HRR) from 1min (p = 0.02; es = 0.68). IMT increases HRV, improves 6MWT distance and HRR.

Elderly patients with multiple myeloma: towards a frailty approach?

To describe how to better identify frail multiple myeloma patients and to treat them appropriately. Proteasome inhibitors, such as bortezomib, carfilzomib, and ixazomib, and immunomodulatory agents (IMiDs), such as thalidomide, lenalidomide, and pomalidomide, have significantly improved the outcome of multiple myeloma patients in the last decade. However, both in clinical trials and in daily clinical practice, elderly multiple myeloma patients have shown lesser benefit. This is mainly due to less stringent use of proteasome inhibitors and IMiDs, increased toxicity, and subsequent early discontinuation of therapy in elderly. Multiple myeloma typically affects elderly patients. Approximately one-third of patients are older than 75 years at diagnosis. Moreover, at least 30% are frail, both due to disease-related symptoms and (age-related) decline in physical capacity, presence of comorbidities, frailty, polypharmacy, nutritional status, and cognitive impairment. Treatment regimens that are investigated in clinical trials for transplant-ineligible patients have largely been investigated in fit, rather than frail patients, the latter being typically excluded or highly underrepresented therein. Data on the feasibility and efficacy of current standards of care are therefore lacking in frail patients. Preliminary data suggest a higher toxicity and discontinuation rate, loss of efficacy, and impaired quality of life in frail patients. Geriatric assessment helps to identify frail patients according to their functional and cognitive status. Both the International Myeloma Working Group (IMWG)-frailty index and Revised Myeloma Comorbidity Index constitute recently proposed algorithms that easily identify intermediate-fit and frail patients. Ongoing and future clinical trials, specifically designed for frail patients, will hopefully define frailty-directed treatment selection.

Inflammation and Fat Mass as Determinants of Changes in Physical Capacity and Mobility in Older Adults Displaying A Large Variability in Body Composition: The NuAge Study

Background/Study context: Determining whether C-reactive protein (CRP), blood lipids, total and trunk fat mass (FM), and waist circumference (WC) are associated with changes in physical capacity over 3 years (Δ) in elderly.Methods: One hundred twenty-two men and women 68–83 years of age participated in a 3-year follow-up study. Physical capacity was measured using five objective tests: (1) Timed Up and Go (TUG), (2) chair stand (CS), (3) normal walking speed (NWS), (4) fast walking speed (FWS), and (5) one-leg stand (LS), along with physical performance score (PPS) at baseline (T1) and 3 years later (T4). Total and trunk FM, WC, blood lipids, and CRP measured at baseline, were considered as potential predictors.Results: At baseline, CRP and total FM were significantly correlated with all physical capacity tests, whereas trunk FM was correlated with CS and LS, and blood lipids only with FSW. No significant correlation was observed for WC. Total and trunk FM measured at baseline were correlated with ΔTUG and ΔPPS, whereas trunk FM and WC measured at baseline were correlated with ΔNWS. CRP and blood lipids, measured at baseline, were not associated with any changes over 3 years. At the end, WC measured at baseline was the strongest independent predictor for all physical capacity measures at baseline (T1), and ΔPPS measured over 3 years could be predicted by baseline WC.Conclusion: FM distribution seems more useful to determine physical capacity than inflammation. Interestingly, over a short follow-up of 3 years, WC significantly predicted changes in a composite score of physical activity. More studies are needed to elucidate factors that may influence physical capacity decline over time.

Positive effects of 1-year football and strength training on mechanical muscle function and functional capacity in elderly men.

A decline in physical capacity takes place with increasing age that negatively affects overall physical function including work ability and the ability to perform typical activities of daily living (ADL). The overall aim of the present study was to determine the neuromuscular adaptations to long-term (1year) football and strength training in older untrained adults, and to assess the concurrent effect on functional ADL capacity. Twenty-seven healthy elderly males (68.2±3.2years) were randomly assigned to 12months of either recreational football training (FT: n=10), strength training (ST: n=9) or served as inactive controls (CON: n=8). Recreational football training consisted of small-sided training sessions whereas strength training consisted of high intensity exercises targeting the lower extremity and upper body. Maximal thigh muscle strength and rate of force development (RFD) were assessed with isokinetic dynamometry, while postural balance and vertical jumping performance were evaluated using force plate analysis. Furthermore, functional ability was evaluated by stair-ascent and chair-rising testing. A total of nine, nine and seven participants from FT, ST and CON, respectively, were included in the analysis. Both exercise regimens led to substantial gains in functional ability, evidenced by 24 and 18% reduced stair-ascent time, and 32 and 21% increased chair-rising performance in FT and ST, respectively (all P < 0.05). Long-term strength training led to increased concentric (14%; P<0.01) and isometric (23%; P<0.001) quadriceps and isometric hamstring strength (44%; P<0.0001), whereas football training mainly resulted in enhanced hamstring strength (18%, P<0.05) and RFD (89%, P<0.0001). Long-term (1year) strength training led to increased quadriceps and hamstring strength, whereas the adaptations to football training mainly included enhanced strength and rapid force capacity of the hamstring muscles. Gains in functional ability were observed in response to both training regimens, evidenced by reduced stair-ascent time and increased chair-rising performance. Long-term football exercise and strength training both appear to be effective interventional strategies to improve factors of importance for ADL by counteracting the age-related decline in lower limb strength and functional capacity among old male adults. This could potentially be a way to improve work ability of senior workers.

The Importance of Exercise for Chronic Kidney Disease Patients

Due to fatigue and muscle weakness, patients with chronic kidney disease (CKD) have low levels of physical activity1. The decline in physical capacity in this patient cohort is noteworthy as it is associated with deconditioning and muscle wasting, declining kidney function and an increased risk of comorbidities such as cardiovascular disease 2. Thus a downward spiral between disease, disuse and deconditioning exists leading to a reduced quality of life, increased hospitalization rates and mortality.

The functional demand (FD) placed on the knee and hip of older adults during everyday activities

Age-related decline in physical capacity and diminishing physiological reserves may increase the demand placed on lower extremity joints during everyday activities. This study aimed to characterize the FD at the knee and hip joints of older adults during various mobility activities. Eighty-four healthy participants (60–88 years) performed strength tests using a custom-built dynamometer. Biomechanical assessment of gait, chair rise (CR) and sit-down (CSt), stair ascent (SA) and descent (SD) was performed using an 8-camera VICON system (120Hz) and Kistler force plates. Comparisons between groups (60s, 70s and 80s) were made using ANOVA. The FD was defined as the muscle moment generated during a task, divided by the maximum isometric strength (expressed as a percentage). FD was higher in the 80s age group compared to those in the 60s. The demand on hip and knee extensors was normally higher than those of flexors across all the activities. The knee extensor demand during gait (101%), SA (103%) and SD (120%), and hip extensor demand during gait (127%) were high requiring moments in excess of the maximum isometric muscle strength available at these joints. FD during CR and CSt was comparatively lower with knee extensor demands of 73% and 69% and hip extensor demands of 88% and 51%, respectively. Gait, SA and SD placed high demands on the knee extensors while hip extensor demand was high for gait, CR, CSt and SA. The levels of demand leave little reserve capacity for the older adult to draw on in unexpected circumstances.

Socio-economic position and its relationship to physical capacity among elderly people living in Jyväskylä, Finland: five- and ten-year follow-up studies

Socio-economic differences in self-reported disability are well described but much less is known about their associations with more objective measures of physical capacity. The aim was to study socio-economic differences in performance-based physical capacity in 75-year-old persons, examining changes in performance at five- and ten-year follow-up intervals. At the baseline 350 residents of the city of Jyväskylä, Finland, aged 75 were interviewed and 295 of them took part in clinical examinations. The corresponding figures at the five-year follow-up were 234 and 191 and at the ten-year follow-up 139 and 103. The statistical significance of differences in physical capacity between the socio-economic groups and genders were tested using ANOVA in univariate and repeated measures models and ANCOVA, with confounders added to the models. Generally, higher education and income were separately related to better maximal walking speed and vital capacity at every measurement point. In addition, higher income was related to better maximal isometric hand grip strength at both follow-ups. When education and income were in the same model, only income was related to physical capacity, almost without exception. Similarly, in the five- and ten-year follow-up periods, both education and income groups showed a parallel decline in physical capacity. The association between income and physical capacity remained even after adjusting for smoking, physical activity and number of chronic diseases. The results indicate that elderly people in disadvantaged socio-economic groups show lower levels of performance in almost all domains of physical capacity, but change in capacity over time does not differ significantly between either markers of socio-economic position.

A 16-year follow-up study of physical capacity in relation to perceived workload among ageing employees

The main purpose of this study was to ascertain musculoskeletal and cardiovascular capacity among ageing employees in relation to workload over a period of 16 years. The data were obtained by physical capacity tests and ratings of perceived exertion (RPE) during working day. The study group consisted of 89 subjects, who were all employed in the municipal branch and were on average 51.9 years old at the beginning of the follow-up period in 1981 and 67.3 years in 1997, when the most of the subjects had retired (with only two subjects still working). During the 16-year follow-up period, age-related decline in physical capacity was observed. Nevertheless the improvement in flexibility of spine and in isometric trunk muscle strength compared with the same age subjects was more common among the subjects with high workload than among the subjects with low workload. However, among the subjects with high workload, physical capacity was poorer than among the subjects with low workload, especially among the women. The results suggest the conclusion that there are differences in workers' physical capacity in relation to their perceived workload during working life. These differences remained when the subjects had retired. Interestingly, those who had high workload had lower muscle strength than those who had low workload. This may indicate that high physical workload does not have any training effect on the muscle strength of ageing workers.