Physical Function In Older Adults Research Articles

Effects of Motor Learning Interventions on Walking Performance and Physical Function in Older Adults With Cognitive Impairment and Dementia: A Systematic Review and Meta-Analysis.

Older adults with cognitive impairment have deficits in executive systems that affect their gait automaticity. The aim of the meta-analysis and systematic review was to examine the effects of interventions focus on only motor learning principles on gait performance and physical functions (e.g.,dynamic balance). After inspections of 879 articles, 11 relevant studies were selected for systematic review and meta-analysis. The PEDro scale and Modified Downs and Black checklist were used to assess the quality of studies, and a random-effect model was used at a 95% confidence interval for calculating pooled effect sizes. The results of this systematic review and meta-analysis showed that motor learning interventions increased gait speed, cadence, stride length, and reduced gait cognitive cost but did not affect gait variability and physical function. In conclusion, practitioners should pay attention more to the potential benefits of motor learning interventions in rehabilitating older adults with cognitive impairment.

Effect of the GERAS DANcing for Cognition and Exercise Program on Physical Function in Older Adults.

GERAS DANcing for Cognition and Exercise is a therapeutic dance program for older adults with cognitive or mobility impairments. Using a pre-/posttest study design, we investigated the effect of 12weeks of dance on the short performance physical battery (SPPB). In 107 participants aged 61-93 (mean 76.1, SD = 7.0; 20% men), over 90% had multifrailty and/or cognitive impairment. The mean attendance rate was 18/24 classes (75%). A substantial minimal clinically important difference (>0.4) occurred for SPPB total (+0.53, SD = 2.04, p = .002) and chair stands (+0.45, SD = 0.92, p < .001). Individuals with baseline SPPB ≤8 points (n = 38)-indicative of sarcopenia and physical frailty-had the most marked improvement (SPPB total: +1.45, SD = 1.97, p < .001; balance: +0.65, SD = 1.27, p = .006; chair stands: +0.68, SD = 0.97, p < .001). GERAS DANcing for Cognition and Exercise may be a promising rehabilitation intervention to improve daily physical function.

Adaptation to repeated standing-slips in professional ballet dancers

Ballet training is being increasingly used to improve physical functions in older adults. Our previous work showed that ballet dancers react to a novel standing-slip more effectively than their non-dancer counterparts through better control of the recovery step and trunk movement. The purpose of this study was to test if and to what extent ballet dancers adapt differently to repeated standing-slips relative to non-dancers. Protected by a harness, twenty young adults (10 professional ballet dancers and 10 age/sex-matched non-dancers) experienced five repeated and standardized standing-slips on a treadmill. Changes from the first slip (S1) to the fifth slip (S5) in dynamic gait stability (primary outcome) and other variables, including the center of mass position and velocity, step latency, slip distance, ankle angle, and trunk angle (secondary outcomes) were compared between groups. Results revealed that both groups adopted similar proactive controls to improve dynamic gait stability by using the ankle and hip strategies. However, dancers showed a better reactive improvement in stability after the repeated slips than non-dancers. From S1 to S5, dancers reactively improved their dynamic gait stability more than non-dancers at the recovery step liftoff (p = 0.003). Dancers decreased their recovery step latency (p = 0.004) and shortened the slip distance (p = 0.004) significantly more than non-dancers from S1 to S5. These findings suggest that ballet dancers could facilitate the adaptation to repeated slips, which may be attributed to their ballet practice experience. This finding augments our understanding of the underlying mechanisms of ballet practice reducing falls.

Diurnal pattern of breaks in sedentary time and the physical function of older adults

BackgroundThe association of breaks in sedentary time with outcomes of physical function can vary according to the time of day. We examined the association of the diurnal pattern of breaks in sedentary time with physical function outcomes in older adults.MethodsA cross-sectional analysis was conducted among 115 older adults (≥60 years). The overall and time-specific breaks (morning: 06:00–12:00; afternoon: 12:00–18:00; evening: 18:00–24:00) in sedentary time were assessed using a triaxial accelerometer (Actigraph GT3X+). A break in sedentary time was defined as at least 1 min where the accelerometer registered ≥100 cpm following a sedentary period. Five physical function outcomes were assessed: handgrip strength (dynamometer), balance ability (single leg stance), gait speed (11-m walking), basic functional mobility (time up and go), and lower-limb strength (five times sit-to-stand). Generalized linear models were used to examine the associations of the overall and time-specific breaks in sedentary time with the physical function outcomes.ResultsParticipants showed an average of 69.4 breaks in sedentary time during the day. Less frequent breaks in the evening (19.3) were found than that in the morning (24.3) and the afternoon (25.3) (p < 0.05). Breaks in sedentary time during the day were associated with less time on gait speed in older adults (exp (β) = 0.92, 95% confidence interval [CI] 0.86–0.98; p < 0.01). Time-specific analysis showed that breaks in sedentary time were associated with less time on gait speed (exp (β) = 0.94, 95% CI 0.91–0.97; p < 0.01), basic functional mobility (exp (β) = 0.93, 95% CI 0.89–0.97; p < 0.01), and lower-limb strength (exp (β) = 0.92, 95% CI 0.87–0.97; p < 0.01) in the evening only.ConclusionA break in sedentary time, particularly during the evening, was associated with better lower extremity strength in older adults. Further strategies to interrupt sedentary time with frequent breaks, with an emphasis on evening hours, can be helpful to maintain and improve physical function in older adults.

Effects of dance video game training on cognitive functions of community-dwelling older adults with mild cognitive impairment

Some patients with minor cognitive impairment can revert to normal cognition if intervention is implemented early. Dance video games as multi-task training have shown beneficial effects on cognitive and physical functions in older adults. This study aimed to elucidate the effects of dance video game training on cognitive functions and prefrontal cortex activity in older adults with and without mild cognitive impairment. A single-arm trial was used for this study. The participants were divided based on the Japanese version of Montreal Cognitive Assessment scores into the mild cognitive impairment (n = 10) and normal cognitive function (n = 11) groups. Dance video game training was performed 60min/day, 1day/week, for a total of 12weeks. Neuropsychological assessments, prefrontal cortex activity using functional near-infrared spectroscopy, and step performance of dance video game were recorded at pre- and post-intervention. Dance video game training significantly improved the Japanese version of Montreal Cognitive Assessment score (p < 0.05), and tendency toward improvement was observed in the trail making test in the mild cognitive impairment group. The dorsolateral prefrontal cortex activity in the Stroop color word test was significantly increased in the mild cognitive impairment group (p < 0.05) after dance video game training. Dance video game training improved cognitive function and increased prefrontal cortex activity in the mild cognitive impairment group.

Memory performance mediates the relationship between depression and independence in instrumental activities of daily living among community-dwelling older adults: Evidence from the China Family Panel Study.

Our objective was to examine the link between depression and independence in the instrumental activities of daily living (IADLs) and to explore the mediating role of memory performance through a cross-sectional analysis of a nationally representative sample of community-dwelling older adults in China. In total, 3730 respondents age ≥ 60 (51.7% males) from the 2020 survey of the China Family Panel Study (CFPS) constituted the study sample. Their depressive symptoms, memory performance, and independence in the IADLs were measured. Based on the descriptive statistics, bivariate correlation analysis and bootstrapping mediation analysis were conducted. As hypothesized, independence in the IADLs was negatively related to depression, while it was positively associated with memory performance. Moreover, after controlling for demographic factors, memory performance was demonstrated to be a partial mediator between depression and independence in the IADLs. These findings support the development of clinical interventions which prevent disability or maintain the physical functioning of older adults through alleviating depression and enhancing memory performance.

Effects of Resistance Training on Pain Control and Physical Function in Older Adults With Low Back Pain: A Systematic Review With Meta-analysis.

Low back pain (LBP) has a high prevalence in older adults and is associated with elevated health care costs. This systematic review and meta-analysis examines the effects of progressive resistance training (PRT) interventions on physical function (PF) and pain control in community-dwelling older adults with chronic LBP. A meta-analysis applying the quality effect method was performed by calculating the effect sizes (ESs) using the Cohen d with a 95% CI. A subgroup analysis was performed according to the participant and intervention characteristics. The statistical significance of differences between subgroups was calculated using a Z -test. Study bias was estimated using the version 2 of the Cochrane risk of bias tool for randomized trials (RoB 2.0) and quality of evidence (Qi) index. Small study effect/publication bias was estimated using the Doi plot and Luis Furuya-Kanamori (LFK) index. The systematic search was conducted in major databases for clinical trials published between January 1, 1990, and January 9, 2021. The inclusion criteria were articles that (1) were peer-reviewed; (2) had participants' mean age of more than 60 years; (3) studied PRT interventions; (4) had participants with LBP; (5) measured LBP or PF outcomes; (6) measured PF in terms of functionality; (7) were randomized controlled trials; (8) and non-randomized controlled trials. The exclusion criteria were (1) articles not written in English, (2) nonexperimental studies, and (3) repeated publications. Twenty-one studies were included (n = 1661). Clear improvements were found in PF (ES = 0.32 [95% CI, 0.05-0.58]; I2 = 75.1%; P < .001), but results on LBP decrease were inconclusive (ES = 0.24 [95% CI, -0.05 to 1.10]; I2 = 75.7%; P < .001). The overall evidence of this aggregated data meta-analysis of clinical trials is level C+. Main limitations are the use of aggregated data and the large heterogeneity between studies. The Qi of this meta-analysis is level I (C+). We concluded that PRT interventions are useful for PF improvement in older adults with generalized LBP, LBP not arising from lumbar spinal stenosis, and having body mass index less than 27. In older adults with LBP not arising from lumbar spine stenosis, PRT interventions also decrease LBP. Interventions should have a frequency of at least 3 sessions per week. In addition, at a lower level of evidence IV (C+), we recommend that interventions with a duration of more than 12 weeks should be considered, whenever possible.

Association of Dual Sensory Impairment with Declining Physical Function in Community-Dwelling Older Adults.

Few studies have investigated whether dual sensory impairment (DSI) adversely affects the deterioration of physical function in older adults compared to single sensory impairment (SSI, visual or auditory). We studied the association between DSI and declining physical function by analyzing the data of 2780 Korean community-dwelling adults aged 70-84 years. Sensory impairment was assessed through pure tone audiometry and visual acuity testing. Muscle strength (handgrip strength) and physical performance (timed up and go test and short physical performance battery (SPPB)) were evaluated. In the cross-sectional analysis, DSI was associated with higher odds of having low muscle strength (odds ratio (OR), 1.78; 95% confidence interval (CI), 1.27-2.48) and poor physical performance (SPPB: OR, 2.04; 95% CI, 1.38-3.00) than SSI. Among all sensory impairment groups in the longitudinal analysis, DSI at baseline increased the risk of deteriorating physical performance during the follow-up period (OR, 1.94; 95% CI, 1.31-2.88; p < 0.01) the most. DSI showed a more severe adverse effect on the decline in physical function among community-dwelling older adults than SSI. More comprehensive care is needed to prevent the deterioration of physical function in older adults due to DSI.

Cardiovascular health profiles, systemic inflammation, and physical function in older adults: A population-based study

We examined the association of modifiable cardiovascular health (CVH) metrics with physical function among rural older adults in China and the potential role of inflammatory mechanisms in the association. This study included 3733 stroke- and dementia-free participants (age ≥65 years; 56.9% women) in the baseline survey of a multimodal intervention study in rural China. From March-September 2018, data were collected via face-to-face interviews, clinical assessments, and laboratory tests. The Short Performance Physical Battery (SPPB) test was performed to assess physical function. We defined six modifiable CVH metrics according to the modified American Heart Association's recommendations. Serum interleukin (IL)-6 was measured in a subsample (n = 1156). Data were analyzed with multiple general linear and logistic regression models and structural equation modeling. Poor physical function (SPPB score ≤9) was defined in 1443 participants. Ideal CVH (vs. poor CVH) was associated with multivariable-adjusted odds ratio of 0.60 (95%CI 0.48–0.75) for poor physical function. Ideal CVH was significantly associated with higher scores on balance, chair stand, and walking speed tests (all p < 0.05). Moreover, ideal CVH profile was associated with lower serum IL-6 (multivariable-adjusted β=-0.04; 95% CI -0.06, -0.01). Mediation analysis revealed that serum IL-6 accounted for 14% of the association of CVH with total SPPB score and 10% of the association with walking speed score (p < 0.05). This study suggests that an ideal CVH profile is associated with better physical function among stroke- and dementia-free older adults, partly via inflammatory mechanisms. The preventive implications of these findings warrant further investigation in cohort studies.

Evaluation of Associations of Growth Differentiation Factor-11, Growth Differentiation Factor-8 and their Binding Proteins Follistatin and Follistatin-like protein-3 with Measures of Skeletal Muscle Mass, Muscle Strength and Physical Function in Older Adults.

Based on studies from animal models, growth differentiation factor-11 (GDF-11) may have rejuvenating effects in humans. GDF-11 has high sequence homology with GDF-8 (also known as myostatin); follistatin, and follistatin like 3 protein (FSTL3) are inhibitory proteins of both GDF-8 and GDF-11. Using highly specific LC-MS/MS assays for GDF-11 and GDF-8 and immunoassays for follistatin and FSTL3, we quantified the association of these factors with muscle size, strength and physical performance in two prospective cohort studies of community-dwelling older adults (Health ABC and CHS). GDF-8 levels were positively associated with thigh muscle cross sectional area and density in Health ABC (data not available in CHS). GDF-8 levels were positively associated with lean mass (a surrogate of muscle mass) in Health ABC but not CHS, and grip strength in CHS but not Health ABC. FSTL3 (and perhaps follistatin) were negatively associated with lean mass and had variable associations with other variables. In contrast, GDF-11 was not significantly associated with strength or performance. GDF-8 and its binding proteins, follistatin and FSTL3, may constitute a counter-regulatory system (chalones) to restrain age-related loss of muscle mass and strength.

Differential plasma protein expression after ingestion of essential amino acid-based dietary supplement verses whey protein in low physical functioning older adults

In a recent randomized, double-blind, placebo-controlled trial, we were able to demonstrate the superiority of a dietary supplement composed of essential amino acids (EAAs) over whey protein, in older adults with low physical function. In this paper, we describe the comparative plasma protein expression in the same subject groups of EAAs vs whey. The plasma proteomics data was generated using SOMA scan assay. A total of twenty proteins were found to be differentially expressed in both groups with a 1.5-fold change. Notably, five proteins showed a significantly higher fold change expression in the EAA group which included adenylate kinase isoenzyme 1, casein kinase II 2-alpha, Nascent polypeptide-associated complex subunit alpha, peroxiredoxin-1, and peroxiredoxin-6. These five proteins might have played a significant role in providing energy for the improved cardiac and muscle strength of older adults with LPF. On the other hand, fifteen proteins showed slightly lower fold change expression in the EAA group. Some of these 15 proteins regulate metabolism and were found to be associated with inflammation or other comorbidities. Gene Ontology (GO) enrichment analysis showed the association of these proteins with several biological processes. Furthermore, protein–protein interaction network analysis also showed distinct networks between upregulated and downregulated proteins. In conclusion, the important biological roles of the upregulated proteins plus better physical function of participants in the EAAs vs whey group demonstrated that EAAs have the potential to improve muscle strength and physical function in older adults. This study was registered with ClinicalTrials.gov: NCT03424265 “Nutritional interventions in heart failure.”

Cross‐sectional and longitudinal study of the relationship between phase angle and physical function in older adults

Although the validity of the assessment in older adults has been supported by several studies, cross-sectional and longitudinal relationships between phase angle (PhA) and physical function by sex have not been clarified. This study aimed to examine (i) cross-sectional relationships and (ii) longitudinal relationships between PhA and physical function in older adults. A total of 816 and 445 community-dwelling older adults were included in cross-sectional and longitudinal analyses, respectively. We evaluated their physical function using grip strength, 5-repetition sit-to-stand test (5-STS), 5-meter habitual walk, Timed Up and Go test (TUG), single-leg balance with eyes open, and sit-and-reach test. A multifrequency bioelectrical impedance analyzer was used to determine the PhA at 50 kHz as well as the participants' body composition. In the cross-sectional analysis, a higher PhA was significantly associated with higher grip strength, sit-and-reach, single-leg balance with eyes open, 5-STS and lower TUG in women, as well as higher grip strength, single-leg balance with eyes open, lower 5-STS and TUG in men, adjusting for age, body mass index and muscle mass. In the longitudinal analysis, there was a significant interaction between PhA and year in the TUG test (B=-0.08; 95% CI, -0.136 to -0.025; P=0.005) in men. There was no significant interaction between the PhA value and year for the other physical functions. The PhA is a useful indicator for assessing physical function in both older men and women. Furthermore, the PhA may be able to predict mobility limitation in older men. Geriatr Gerontol Int 2023; 23: 141-147.

Muscle fiber type grouping does not change in response to prolonged resistance exercise training in healthy older men

BackgroundAgeing of skeletal muscle is characterized in some by muscle fiber type grouping due to denervation-reinnervation cycles, but the severity of fiber type grouping varies widely across individuals of the same chronological age. It remains unknown whether fiber type grouping is associated with lower muscle mass and/or reduced physical function in elderly. Therefore, we assessed the relationship between fiber type grouping and indices of muscle mass and physical function in older adults. In addition, we assessed whether fiber type grouping is affected by prolonged resistance training in older adults. MethodsTwenty young (21 ± 2 y) and twenty older (70 ± 4 y) healthy men participated in the present study. Body composition (DXA-scan), quadriceps cross-sectional area (CT-scan) and muscle strength (1RM) were assessed at baseline (young and old) and following 12 weeks of resistance training (old only). Percutaneous skeletal muscle biopsies from the vastus lateralis were collected at baseline (young and old) and following exercise training (old only). Immunohistochemical analyses were performed to evaluate type I and type II muscle fiber distribution, size, myonuclear content and grouping. ResultsAt baseline, type II fibers were significantly (P < 0.05) smaller in older compared with young adults (5366 ± 1288 vs 6705 ± 1168 μm2). Whereas no differences were observed in type I, type II fiber grouping was significantly (P < 0.05) lower in older (18 ± 18 %) compared with young (32 ± 25 %) men. No significant correlations were observed between fiber type grouping and muscle mass or physical function. Prolonged resistance training in old men resulted in a significant increase (P < 0.05) in type II fiber size (from 5366 ± 1288 to 6165 ± 1484 μm2) with no significant changes in the proportion of type I muscle fibers found grouped. ConclusionMuscle fiber type grouping is not associated with lower body strength or muscle mass in healthy, older men. In addition, twelve weeks of resistance exercise training results in type II muscle fiber specific hypertrophy but does not affect fiber type grouping.

Combined Exercise and Education Program: Effect of Smaller Group Size and Longer Duration on Physical Function and Social Engagement among Community-Dwelling Older Adults.

Exercise, education, and social engagement are critical interventions for older adults for a healthy life expectancy and to improve their physical function. To conduct a combined exercise and education (CEE) program for improved social engagement and physical function of older adults. Based on a short-term program we conducted in our previous study, in this study, the program was conducted for half the number of participants of the earlier study but for a longer duration. A community of older adults in Ami, Japan, was the setting of the study. 23 healthy older adults >65 years living in the community were the participants in the study. Five 80-minute sessions conducted once in two weeks comprised 60-min exercise instruction and 20-min educational lectures per session on health. We examined the improvement in physical and social engagement before and after participation. Physical function and health-related questionnaire data were collected before and after the program. Data analysis from 15 participants showed improved physical performance but no effect on social engagement. A higher program frequency, rather than program duration, may be vital to improving exercise performance and social engagement and maximizing the effects of high group cohesion in small groups. Further studies are needed to develop more effective interventions to extend healthy life expectancy.

Pet Ownership and Maintenance of Physical Function in Older Adults-Evidence From the Baltimore Longitudinal Study of Aging (BLSA).

Pet ownership or human-animal interaction has been associated with better health outcomes in individuals with disease or disability. We hypothesized that pet ownership, as well as dog ownership and cat ownership separately, are associated with maintaining physical function, and leisure time physical activity and that among dog owners, dog walking is associated with maintaining these outcomes for generally healthy community-dwelling older adults participating in the Baltimore Longitudinal Study of Aging. A total of 637 men (44.1%) and women aged 50-100 years (M = 68.3, standard deviation [SD] = 9.6) completed a comprehensive pet ownership questionnaire that ascertained pet ownership history 10-13 years and had serial assessments of physical function every 1-4 years prior. Linear or generalized linear mixed models with time varying pet ownership were used to examine change in physical function over a mean of 7.5 years (range 1-13, SD = 3.6) according to pet ownership. Pet owners (n = 185) were significantly younger (p < .001) and had fewer comorbidities (p = .03) than nonowners; thus, age and comorbidities were included as covariates in the longitudinal analyses. Physical function and leisure time physical activity declined with aging across all outcomes (p < .001); the decline was slower among pet owners in overall physical performance (p < .001), rapid gait speed (p = .03), usual gait speed (p = .032), cardiorespiratory fitness (p < .001), and physical well-being (p = .002) controlling for age and comorbidities. Changes in leisure time physical activities with aging did not differ between pet owners and nonowners. Dog walking was not independently related to the maintenance of physical function or leisure time physical activity with aging. This study provides the first longitudinal evidence that pet ownership is associated with maintained physical function among community-dwelling generally healthy older adults.

DOES TAI CHI PROMOTE COGNITIVE FUNCTION WITHOUT THE EFFECTS OF PHYSICAL FUNCTION?: META-REGRESSION APPROACH

Abstract This systematic review aimed to examine the effects of TCQ on cognitive and physical functions in older adults using a meta-regression approach. The systematic search in 13 electronic databases identified 19 randomized studies (n=2365, mean age=70.3 years) published in English (k=17), Korean (k=1) and Chinese (k=1). A review of bias was assessed by two raters according to Cochrane RoB 2.0, resulting in low risk (k=6), some concern (k=12), and one high-risk study. Tai Chi (k=16) and Qigong (k=3) were applied for an average duration of 20.2 weeks. The control groups received either alternative exercise (k=14) or no treatment (k=5). The results of the meta-analysis on 19 RCTs using a random-effects model showed the significant effect of TCQ on cognitive function (Hedges’s g =0.32, 95% CI= 0.18, 0.46) and physical function (Hedges’s g= 0.35, 95% CI= 0.21, 0.49). In addition, meta-regression was used to explore the effect size of TCQ in association with the level of physical function. The effects of TCQ on cognitive function remained significant (Q=38.86, p=.003) when controlling for the effect of physical function in this model (unexplained variance = 0.0199). The coefficient of the physical function was significant (b=0.47, p=.008), showing that 58% of heterogeneity was explained by physical function as a moderator variable. It confirmed that changes in physical function were associated with changes in cognitive function. The findings imply the potential health benefits of TCQ in promoting cognitive function among older adults directly and indirectly through improving physical function.

FRIENDSHIP IS IN THE DETAILS: CO-CONSTRUCTION OF RELATIONSHIPS AMONG PERSONS WITH DEMENTIA IN LONG-TERM CARE

Abstract Friendships have been linked to psychological and emotional wellbeing and better physical functioning in older adults. Conversely, negative consequences (e.g., depression) are associated with losing friendships and shrinking social networks. While cognitive decline might be a limiting factor for persons with dementia (PWD) to establish friendships, this has not been proven in the literature. This paper reports on 20 interactions between PWD collected during the Friendship Study (de Medeiros et al. 2011), an ethnographic study of friendship in long-term care (LTC). Participants are male and female residents in an LTC community. Diagnoses range from mild to severe Alzheimer’s disease. Conversational interactions were transcribed and coded for linguistic and discursive devices signaling friendly interactions. Findings reveal that friendships are co-constructed by PWD using 4 primary linguistic discursive devices, including topic (meals, religion, medication, furniture, directions, baking), co-constructed narrative, repetition, and alignment. Implications for future research on friendship among PWD are discussed.

Relationship between quadriceps femoris muscle architecture and muscle strength and physical function in older adults with heart failure with preserved ejection fraction

Heart failure (HF)-related factors potentially lead to sarcopenia. Ultrasound (US) assessment has all the advantages of being used in clinical practice to assess muscle architecture. This study aimed to assess the relationship between the quadriceps femoris (QF) muscle architecture with the gender, age, body mass index (BMI), muscle strength and physical function in older adults with HF with preserved ejection fraction (HFpEF) as well as to assess the difference in these relationships between the two genders. Patients 70 years and older with HFpEF were included. The gender, age and BMI were collected. The QF muscle thickness, the QF muscle echo-intensity, the subcutaneous fat tissue thickness (FT) and the subcutaneous fat tissue echo-intensity were assessed by the US. The six-minute walk test, the short physical performance battery (SPPB), the timed up and go test (TUG), and the gait speed test (UGS) were used to assess physical function. The five-repetitions sit-to-stand test (5-STS) was performed to assess muscle strength. Bivariant Pearson correlations and subsequent multivariate linear regression analysis were conducted. Seventy older adults with HFpEF [81.00 (5.97) years] were recruited. The FT showed a correlation between poor and moderate muscle strength and physical function in women with HFpEF. The FT explained 24.5% of the 5-STS variance, 32.4% of the SPPB variance, 31.5% of the TUG variance, 28.6% of the UGS variance, and 21.4% of the FGS variance in women. The US assessment could allow clinicians to assess muscle architecture biomarkers related to muscle strength and physical function in older adults with HFpEF.Trial registration NCT03909919. April 10, 2019. Retrospectively registered.

A group-based exercise and behavioural maintenance intervention for adults over 65 years with mobility limitations: the REACT RCT

Background Mobility limitation in older age reduces quality of life, generates substantial health- and social-care costs, and increases mortality. Objective The REtirement in ACTion (REACT) trial aimed to establish whether or not a community-based active ageing intervention could prevent decline in physical functioning in older adults already at increased risk of mobility limitation. Design A multicentre, pragmatic, two-arm, parallel-group randomised controlled trial with parallel process and health economic evaluations. Setting Urban and semi-rural locations across three sites in England. Participants Physically frail or pre-frail older adults (aged ≥ 65 years; Short Physical Performance Battery score of 4–9). Recruitment was primarily via 35 primary care practices. Interventions Participants were randomly assigned to receive brief advice (three healthy ageing education sessions) or a 12-month, group-based, multimodal exercise and behavioural maintenance programme delivered in fitness and community centres. Randomisation was stratified by site and used a minimisation algorithm to balance age, sex and Short Physical Performance Battery score. Data collection and analyses were blinded. Main outcome measures The primary outcome was change in lower limb physical function (Short Physical Performance Battery score) at 24 months, analysed using an intention-to-treat analysis. The economic evaluation adopted the NHS and Personal Social Services perspective. Results Between June 2016 and October 2017, 777 participants (mean age 77.6 years, standard deviation 6.8 years; 66% female; mean Short Physical Performance Battery score 7.37, standard deviation 1.56) were randomised to the intervention arm (n = 410) or the control arm (n = 367). Data collection was completed in October 2019. Primary outcome data at 24 months were provided by 628 (80.8%) participants. At the 24-month follow-up, the Short Physical Performance Battery score was significantly greater in the intervention arm (mean 8.08, standard deviation 2.87) than in the control arm (mean 7.59, standard deviation 2.61), with an adjusted mean difference of 0.49 (95% confidence interval 0.06 to 0.92). The difference in lower limb function between intervention and control participants was clinically meaningful at both 12 and 24 months. Self-reported physical activity significantly increased in the intervention arm compared with the control arm, but this change was not observed in device-based physical activity data collected during the trial. One adverse event was related to the intervention. Attrition rates were low (19% at 24 months) and adherence was high. Engagement with the REACT intervention was associated with positive changes in exercise competence, relatedness and enjoyment and perceived physical, social and mental well-being benefits. The intervention plus usual care was cost-effective compared with care alone over the 2 years of REACT; the price year was 2019. In the base-case scenario, the intervention saved £103 per participant, with a quality-adjusted life-year gain of 0.04 (95% confidence interval 0.006 to 0.074) within the 2-year trial window. Lifetime horizon modelling estimated that further cost savings and quality-adjusted life-year gains were accrued up to 15 years post randomisation. Conclusion A relatively low-resource, 1-year multimodal exercise and behavioural maintenance intervention can help older adults to retain physical functioning over a 24-month period. The results indicate that the well-established trajectory of declining physical functioning in older age is modifiable. Limitations Participants were not blinded to study arm allocation. However, the primary outcome was independently assessed by blinded data collectors. The secondary outcome analyses were exploratory, with no adjustment for multiple testing, and should be interpreted accordingly. Future work Following refinements guided by the process evaluation findings, the REACT intervention is suitable for large-scale implementation. Further research will optimise implementation of REACT at scale. Trial registration This trial is registered as ISRCTN45627165. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 14. See the NIHR Journals Library website for further project information.

The Prognostic Value of Physical Function in Older Adults with Acute Myeloid Leukemia Treated with Low Intensity Treatment

Several prognostic models have been developed to identify patients at high risk of death, treatment resistance, or poor survival after conventional intensive chemotherapy in older adults with acute myeloid leukemia (AML). There are growing evidence that geriatric assessment can detect unrecognized vulnerabilities in patients with hematological malignancies to help predict treatment tolerance and survival. We prospectively demonstrated the prognostic value of physical function for survival outcomes in intensively treated older adults with AML (Min et al. Blood 2022). However, there are limited evidence for prognostic value of physical function in older adults with AML who were treated with low-intensity therapy, such as hypomethylating agents (HMA) with or without venetoclax (VEN). Thus, we evaluated the prognostic role of physical function scores in older adults with AML treated with low-intensity treatment in a prospective observation cohort (CRIS number; KCT0002261). We have measured physical function by the Short Physical Performance Battery (SPPB) since 2018 in older adults with AML treated with low-intensity treatment. Between 2018 Jan and 2022 May, 71 newly diagnosed AML patients who were aged ≥ 65 years and received low-intensity treatment were examined with SPPB at a median of 3 days prior to the initiation of treatment. The prognostic role of SPPB score on overall survival (OS) was analyzed by the Kaplan-Meier estimates and the log-rank test, and a multivariable Cox hazard model. The median age of 71 patients was 75 years (interquartile range: 70-78). Males were 59.2%, and patients with an Eastern Cooperative Oncology Group (ECOG) score of 2 or higher was 19.7%. Secondary AML patients were 12.7%. Genetic risk stratification by European Leukemia Net (ELN) 2017 classified 23.9%, 36.6%, and 39.4% as favorable, intermediate, and adverse risk, respectively. Patients were treated with HMA alone (azacitidine or decitabine; 59.2%) or HMA and VEN combination (40.8%). Seventy percent of patients were classified as unfavorable group by Wheatley index, which is a validated prognostic model for low-intensity treatment. There were no differences between HMA alone and HMA and VEN combination in terms of Wheatley index. The median SPPB score of patients was 8 (range, 6-11). The SPPB score had a significant association with OS. In univariable analysis, the hazard ratio (HR) for a 3-point decrease in SPPB was 1.11 (95% confidence interval [CI], 1.02-1.20]. The cut-off of SPPB at which the difference in OS was most pronounced was 8. Patients with an SPPB score of 8 or higher had a median OS of 20.2 months (95% CI: 11.3-Not achieved), whereas that of patients with an SPPB less than 8 was 6.9 months (95% CI: 3.3-16.9, p=0.04, Figure A). In a multivariable Cox model of SPPB with other genetic, etiologic variables, the impact of SPPB on OS was still significant (HR for 3-point decrease in SPPB: 1.35 [95% CI: 1.03-1.78], Figure B). Our data show that physical function measured by SPPB is a significant prognostic factor for survival in older adults with AML treated with low-intensity treatment, contrasting limited value of 2017 ELN. This suggests that specified prognostic models including diverse geriatric assessment domains should be studied in these elderly population treated with low-intensity treatment. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal