Physical Function In Older Adults Research Articles

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

Protein intake and physical function in older adults: A systematic review and meta-analysis.

The present study explored cross-sectional and longitudinal associations between protein intake and physical function in older adults. We conducted a systematic review and meta-analysis of cross-sectional and longitudinal studies that investigated the association between protein intake and measures of physical function in older adults. Cross-sectional, case-control, and longitudinal cohort studies that investigated the association between protein intake and physical function as a primary or secondary outcome in people aged 60+years were included. Studies published in languages other than English, Italian, Portuguese, or Spanish were excluded. Studies were retrieved from MEDLINE, SCOPUS, EMBASE, CINAHL, AgeLine, and Food Science Source databases through January 31, 2022. A pooled effect size was calculated based on standard mean differences (SMD), MD, log odds ratio (OR) and Z-score.. Twenty-two cross-sectional studies examined a total of 11,332 community-dwellers, hospitalized older adults, and elite senior athletes with a mean age of approximately 75 years. The pooled analysis indicated that a protein intake higher than the recommended dietary allowance (RDA) was significantly associated with higher Short Physical Performance Battery (SPPB) scores (SMD: 0.63, 95% CI: 0.27, 0.99, P-value: 0.0006), faster walking speed, greater lower-limb (SMD: 0.22, 95% CI: 0.04, 0.40, P-value: 0.02) and isometric handgrip strength (Z-score: 0.087, 95% CI: 0.046-0.128, P-value: 0.0001), and better balance (SMD: 0.33, 95% CI: 0.05, 0.62, P-value: 0.02). Nine longitudinal studies investigated 12,424 community-dwelling and native older adults with a mean age of approximately 85 years. A protein intake higher than the current RDA was not associated with lower decline in either isometric handgrip strength (logOR: 0.99, 95% CI: 0.97-1.02, P-value= 0.67) or walking speed (logOR: 0.92, 95% CI: 0.77-1.10, P-value= 0.35). A protein intake higher than the RDA is cross-sectionally associated with better physical performance and greater muscle strength in older adults. However, a high consumption of proteins does not seem to prevent physical function decline over time.

Association between oral health markers and decline in muscle strength and physical performance in later life: longitudinal analyses of two prospective cohorts from the UK and the USA

Poor oral health could be associated with changes in musculoskeletal health over time. This aim of this study was to investigate the longitudinal relationship between oral health and decline in physical function in later life. We did a prospective analysis of two cohorts of older adults (aged 70 years or older) including men from the British Regional Heart Study (BRHS; n=612), and men and women from the Health, Aging and Body Composition (Health ABC) Study (n=1572), followed up for about 8 years. Data were available for clinical or self-reported oral health measures, muscle (grip) strength, and physical performance (chair stand and gait speed). ANCOVA models were used to assess the association between oral health and follow-up physical function scores. Multivariate logistic regression models were used to examine the associations between oral health and decline in physical function over the follow-up period. In the BRHS, changes in oral health and physical function were also assessed. All models were adjusted for relevant sociodemographic, behavioural, and health-related factors. In the BRHS, complete tooth loss and difficulty eating were associated with weaker grip strength at follow-up, and periodontal status was associated with decline in gait speed. In the Health ABC Study, complete tooth loss, poor self-rated oral health, and the presence of one oral health problem were associated with slower gait speed at follow-up. In both studies, dry mouth was associated with declines in physical function. In the BRHS, deterioration of dentition (tooth loss) over the follow-up period was associated with decline in chair stand speed (adjusted odds ratio 2·34 [95% CI 1·20-4·46]), as was deterioration in difficulty eating (2·41 [1·04-5·60]). Oral health problems are associated with poorer physical function and greater decline in physical function in older adults, and could be an indicator of individuals at risk of reduced physical capacity and subsequent frailty and disability in later life. The Dunhill Medical Trust and the US National Institutes of Health-National Institute of Dental and Craniofacial Research.

Interventions Including Smart Technology Compared With Face-to-face Physical Activity Interventions in Older Adults: Systematic Review and Meta-analysis.

This is a systematic review of randomized controlled trials and a meta-analysis comparing smart technology with face-to-face physical activity (PA) interventions in community-dwelling older adults (mean age 60 years). This study aims to determine the effect of interventions including smart technology components compared with face-to-face PA interventions on PA and physical function in older adults. The secondary outcomes are depression, anxiety, and health-related quality of life. We searched MEDLINE, Embase, CINAHL, and AMED electronic databases from inception to February 2021. Two independent reviewers screened titles, abstracts, and full texts and performed data extraction and risk of bias assessments using the Cochrane risk of bias tool. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the quality of the evidence. We provided a narrative synthesis on all included studies and, where possible, performed meta-analyses for similar outcomes. This review included 19 studies with a total of 3455 participants. Random effects meta-analyses showed that interventions with smart technology components resulted in improved step count (mean difference 1440 steps, 95% CI 500-2390) and total PA (standardized mean difference 0.17, 95% CI 0.02-0.32) compared with face-to-face alone. There was no difference between groups in terms of the measures of physical function. Smart technology alone did not show significant differences between groups in any outcome. The quality of the evidence was very low based on the Grading of Recommendations Assessment, Development and Evaluation criteria. Interventions that include smart technology may improve daily step counts by an average of 1440 steps in community-dwelling older adults; however, the quality of the evidence was very low. Future studies are needed to improve the certainty of these results. PROSPERO CRD42020135232; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=135232.

Exploring the association between handgrip, lower limb muscle strength, and physical function in older adults: A narrative review.

Widely used in daily practice, handgrip strength (HGS) is a low cost, easy-to-use, and portable test to assess overall muscle and physical function. It can be used as a stand-alone or a first-line tool for evaluating muscle weakness, though controversy surrounds its use for assessing global or lower limb muscle function. Lower limb mobility and physical activity are reduced with advancing age. This decline is difficult to quantify with isokinetic or isometric devices in routine settings (hospital and nursing home). For this narrative review we explored and summarized the findings of studies that investigated the association between HGS, lower limb muscle strength, and physical performance in older adults. The review also provides directions for future research. We noted contrasting findings for an association between HGS, lower limb strength, and physical performance. We found insufficient evidence for endorsing the handgrip dynamometer as a definitive tool for measuring overall muscle strength and physical function. More evidence is needed from comparable studies involving larger samples of men and women and investigating other areas such as lifestyle, daily physical activity levels, and health-related disorders.

Effects of combined hip exercise and passive stretching on muscle stiffness, pain perception and painrelated disability, and physical function in older adults with low back pain.

This study aimed to examine the effects of combined hip exercise and passive stretching as a novel treatment method for low back pain (LBP) in older adults. Altogether, 20 Koreans with LBP aged 60-79 years (67.3 ± 5.92 years) were randomly assigned to undertake combined exercise (CE; n = 10) or lumbar stabilization exercise (LSE; n = 10). All participants performed their respective exercise program for 25-30 min with an OMNI scale of 6-8 for 8 weeks, three times a week. Body composition, muscle stiffness, pain-visual analog scale (P-VAS), Oswestry disability index, and physical function were evaluated before and after the exercise intervention. The CE group demonstrated greater improvements in lean body mass (η2 = 0.402, p = 0.003) and percent body fat (η2 = 0.222, p = 0.036) than the LSE group. Both groups demonstrated significant improvements in muscle stiffness, P-VAS scores, and Oswestry disability index scores, although no significant differences were observed between the interventions. All physical function parameters demonstrated a significant improvement in both groups, and the CE group demonstrated greater improvement in the YMCA sit-and-reach (η2 = 0.338, p = 0.007) and straight leg raise tests (η2 = 0.283, p = 0.016) than the LSE group. CE is comparable to LSE as an effective and successful exercise intervention that reduces muscle stiffness and P-VAS scores. Moreover, CE is more effective than LSE in enhancing the physical function of older adults with LBP.

Effects of a 24-Week Exercise Program on Functional Fitness, Oxidative Stress, and Salivary Cortisol Levels in Elderly Subjects.

Background and Objectives: Aging is a biological and irreversible process characterized by physiological alterations resulting in a progressive decline in biological functions, decreased resistance or adaptability to stress, and increased disease susceptibility. A decline in functional fitness, imbalance between pro- and antioxidant capacity, and/or hormonal dysregulation adversely impact physical capacity, emotional status, and overall quality of life, especially within the elderly population. On the other hand, regular physical activity is considered an effective strategy to prevent and reduce those changes associated with primary aging and concurrent chronic disease, while slowing age-related physical degeneration. However, there is still limited evidence-based information regarding both the intensity and interval of effective interventions on physical functioning in older adults. Thus, the aim of the study was to assess the effects of a 24-week regular multimodal exercise program on functional fitness, oxidative stress, salivary cortisol level, and self-perceived quality of life in a group of eighteen physically active elderly subjects (mean age 72.8 ± 7.5 years). Materials and Methods: A set of anthropometric and physical measurements (grip strength, chair sit to stand, sit and reach and back scratch) assessing the functional fitness performance were evaluated. Moreover, biochemical markers (derived-reactive oxygen metabolites (d-ROMs) and the biological antioxidant potential (BAP) tests, and salivary cortisol levels) and the EuroQoL 5-Dimension 3-Level (EuroQoL 5-D 3-L) self-perceived questionnaire of quality of life were measured before and after the intervention program. All measurements were normally distributed as assessed by D’Agostino and Pearson’s omnibus normality test. Student’s t-tests were used to evaluate the differences in all the parameters measured at baseline (T0) and after the 24-week physical program (T1). Results: The results showed that an age-tailored structured intervention exercise program (1 h per session, twice per week, for 24 weeks) was effective in improving flexibility and other biomechanical parameters, such as muscle strength and the dynamic balance fitness component, which are key to performing daily tasks independently. Moreover, biochemical analyses demonstrate that the proposed intervention program has beneficial effects on the balance between plasma ROS production and their neutralization. Conclusions: The results confirm the benefits of regular physical activity in older adults resulting in improved physical strength and flexibility in the functional fitness parameters, and in regulating anti- and pro-oxidant activity and cortisol (stress hormone) levels.

Associations between long-term air pollution exposure and physical function in older adults

Associations between long-term air pollution exposure and physical function in older adults

Undiagnosed Dementia Is Associated with Poor Physical Function in Older Adults.

Older adults with a cognitive impairment, including those not yet diagnosed, may have deficits in their physical function. We sought to determine the associations of cognitive impairment consistent with dementia (CICD) diagnosis status on handgrip strength, gait speed, and functional disability in older adults. The analytical sample included 8,383 adults aged ≥65-years without history of stroke, cancers, neurological conditions, or brain damage who participated in at least one-wave of the 2010-2016 waves of the Health and Retirement Study. A handgrip dynamometer measured handgrip strength. Men with handgrip strength <26 kg and women <16 kg were weak. Gait speed was timed across a 2.5-m course and those with slowness had gait speed <0.8 m/s. Participants with difficulty or an inability in completing any basic activities of daily living had a functional disability. The adapted Telephone Interview of Cognitive Status evaluated cognitive function. Persons with scores <7 had a CICD. Healthcare provider dementia-related diagnosis was self-reported. Undiagnosed CICD was defined as no reported dementia-related diagnosis but had CICD, while diagnosed CICD was classified as reporting a dementia-related diagnosis. Covariate-adjusted logistic models were used for the analyses. Persons with undiagnosed CICD had 1.37 (95% confidence interval (CI): 1.04-1.80) greater odds for weakness and 2.02 (CI: 1.39-2.94) greater odds for slow gait speed. Older adults with diagnosed CICD had 2.29 (CI: 1.32-3.97) greater odds for slowness and 1.85 (CI: 1.19-2.90) greater odds for functional disability. Screening for CICD could be recommended when defects in physical function are observed in older adults.

The association between global cognitive function and walking capacity in individuals with broad ranges of cognitive and physical function: Are there sex differences?

IntroductionCognitive function is known to be associated with physical function, where greater walking capacity has been shown to have moderate to strong correlations with global cognitive function and other various domains of cognition in older adults with and without chronic conditions. Biological sex may moderate the relationship between cognitive and physical function, but whether sex differences exist in this association has not been examined in an aging population. The purpose of this study was to examine the associations between global cognitive function (Montreal Cognitive Assessment; MoCA), walking capacity (6-Minute Walk Test distance; 6 MWT) and sex in an aging population with broad ranges of cognitive and physical function.MethodsParticipants were assessed for global cognitive function (MoCA) and walking capacity (6 MWT). Multivariable regression analyses were performed to examine the interaction of sex in the association between MoCA and 6 MWT. First, we presented the unadjusted model (Model 1), then the model adjusted for age, history of stroke, and height (Model 2). To determine if there were sex-based differences in the association between global cognitive function and walking capacity, we included sex and an interaction term between sex*6 MWT distance in Models 3 and 4.ResultsTwenty-three females and 36 males were included in the multivariable regression analyses, respectively. Our sample represented broad ranges of cognitive and physical function levels, where MoCA scores ranged from 13 to 30, and 6 MWT distances from 203 to 750 m. 6 MWT distance was associated with MoCA in models unadjusted (R2 = 0.17; F(1,56) = 11.4; p < 0.01) and adjusted for age, stroke history, and height (R2 = 0.20; F(4,53) = 3.2; p = 0.02). No interaction with sex was found, but a main effect of sex was observed (R2 = 0.26; F(5,21) = 3.72; p = 0.03). When adjusting for age, height and history of stroke, males MoCA scores were 2.9 ± 1.3 less than the mean MoCA scores for females.DiscussionOur findings confirm the positive relationship between cognitive and physical function in older adults. Notably, we also observed superior performance in global cognition among females that was consistent across a broad spectrum of walking capacity.

Power Training Vs. Traditional Strength Training On Physical Function In Older Adults: A Systematic Review And Meta-analysis

Power Training Vs. Traditional Strength Training On Physical Function In Older Adults: A Systematic Review And Meta-analysis

Comparing Online And In-person Delivery Of An Exercise Program For Older Adults

BACKGROUND: The COVID-19 pandemic has forced many exercise programs to provide participants with online delivery. Online delivery increases accessibility, but their ability to improve perceived and mental health, and functional outcomes in older adults is unknown. Therefore, there is a need to test the efficacy of online delivery compared with in person delivery in older adults. PURPOSE: To compare perceived mental health, and functional outcomes following an online exercise program offered to older adults and compare the benefits with in-person delivery. METHODS: The Zoomers on the Go program is a peer-led exercise program of 12 weeks. The program offers resistance exercise, aerobic activities, balance, and flexibility two times per week to adults aged 50 and above. The main outcome was power as measured by the 30-second chair stand test. Secondary outcomes included dropout, attendance, balance (one leg stance), cardiorespiratory fitness (2-minute step test or 6-minute walk test), perceived health (SF-36), and mental health (Depression, Anxiety and Stress Scale - 21 Items). RESULTS: The proportion of dropout was 28.1% and 11.5% in the online and the in-person group respectively (p < 0.001). A total of 74 participants (66.3 ± 7.1 years old) in the online group and 84 participants in the in-person group (67.3 ± 7.2 years old) completed the program. The attendance was 19.6 ± 4.8 sessions for the online group and 16.7 ± 2.9 sessions for the in-person group (p < 0.001) out of 24. Participants in both groups improved significantly their 30 seconds chair stand (online: 14.4 ± 2.7 to 17.0 ± 4.2 vs. in person: 14.1 ± 4.2 to 17.5 ± 5.1; all p < 0.001), cardiorespiratory fitness, and balance without any difference between groups. However, only the in-person group improved general perceived health measured by SF-36 questionnaire. Similarly, only the in-person group significantly reduced the level of stress and depression following the program (p < 0.05). CONCLUSIONS: Exercise program delivered online leads to greater attendance and similar improvement in physical function in older adults compared to in person delivery. However, in-person delivery might be needed to improve stress, depression symptoms, and perceived general health in older adults. Funding: Healthy Seniors Pilot Project- Public Health Agency of Canada

Effects of a 6-Month Multifaceted Diet and Exercise Intervention on Cognition in Older Adults at Risk of Cognitive Decline: The PONDER Double-Blind, Placebo-Controlled Randomized Trial.

Multidomain interventions which incorporate exercise and dietary supplementation to target both cognitive and physical health domains may be an important approach to delay cognitive decline. The Protein Omega-3 aNd vitamin D Exercise Research (PONDER) study investigated the effects of a 6-month multifaceted intervention in community-dwelling older adults with subjective memory impairment on cognition (primary outcome), physical function, and body composition with a further 6-month follow up for cognition (secondary outcomes). Single-center, community-based, parallel-group, randomized, double-blind placebo-controlled trial involving a 6-month multifaceted intervention with a further follow-up at 12 months. A total of 147 participants [mean age 70.2 years (SD 6.1), 70% female] were randomized to a multimodal exercise program consisting of twice-weekly supervised resistance and aerobic training, combined with a daily omega-3 (900 mg EPA, 600 mg DHA), vitamin D (1000 IU) and protein (20 g) supplement (n = 73), or a control condition (n = 74) comprising stretching/flexibility sessions combined with a placebo. The primary outcome was a composite CogState measure and Trail-Making Test B-A. There were no significant between-group differences in the change of cognition at 6 or 12 months or physical function outcomes at 6 months, but the intervention significantly improved total lean mass compared to controls [0.72 kg (95% CI 0.26-1.19), p = 0.001]. A multi-faceted intervention including an omega-3, vitamin D and protein-enriched supplement with twice-weekly exercise training did not provide any benefits to cognitive or physical function in older adults with subjective memory impairment, despite improvements in lean mass.

HOMEFOOD randomized trial—beneficial effects of 6-month nutrition therapy on body weight and physical function in older adults at risk for malnutrition after hospital discharge

Background/objectivesMalnutrition is common among older adults. Dietary intervention studies in older adults aiming to improve anthropometrics measures and physical function have been inconsistent. We aimed to investigate the effects of nutrition therapy in combination with home delivered meals and oral nutritional supplements (ONS) in community-dwelling older adults discharged from hospital.MethodsA total of 106 participants (>65 years) were randomized into the intervention group (n = 53) and into the control group (n = 53). The intervention group received individual nutrition therapy (five in person visits and three phone calls) and freely delivered energy- and protein- rich foods, while the control group received standard care. Dietary intake, anthropometrics, and short physical performance battery (SPPB) were assessed at baseline and at endpoint.ResultsEnergy intake at baseline was similar in both groups (~1500 kcal at the hospital) but there was a significant increase in energy intake and body weight in the intervention group (+919 kcal/day and 1.7 kg, P < 0.001 in both cases) during the study period, compared to a significant decrease in both measures among controls (−815 kcal/day and −3.5 kg, P < 0.001 in both cases). SPPB score increased significantly in the intervention group while no changes were observed among controls.ConclusionsMost Icelandic older adults experience substantial weight loss after hospital discharge when receiving current standard care. However, a 6-month multi-component nutrition therapy, provided by a clinical nutritionist in combination with freely delivered supplemental energy- and protein-dense foods has beneficial effects on body weight, physical function, and nutritional status.Study registrationThis study was registered at ClinicalTrials.gov (NCT03995303).

Trajectories of physical functioning and its predictors in older adults: A 12-year longitudinal study in China.

ObjectiveMaintaining and delaying a decline in physical function in older adults is critical for healthy aging. This study aimed to explore trajectories, critical points of the trajectory changes, and predictors among older people in the Chinese community.DesignThis study was one with a longitudinal design performed in China.Setting and participantsThe target population was community-dwelling older adults aged over 65 years. A total of 2,503 older adults from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included in this study.MethodsPhysical functioning was measured by instrumental activities of daily living (IADL). Population-based trajectory models were used to identify potential heterogeneity in longitudinal changes over 12 years and to investigate associations between baseline predictors and different trajectories for different cohort members using LASSO regression and logistic regression.ResultsFour trajectories of physical function were identified: slow decline (33.0%), poor function and moderate decline (8.1%), rapid decline (23.5%), and stable function (35.4%). Older age, male sex, worse self-reported health status, worse vision status, more chronic diseases, worse cognitive function, and a decreased frequency of leisure activity influenced changes in the trajectory of physical function. Having fewer teeth, stronger depressive symptoms, a lack of exercise, and reduced hearing may increase the rate of decline.Conclusion and implicationsFour trajectories of physical function were identified in the Chinese elderly population. Early prevention or intervention of the determinants of these trajectories can maintain or delay the rate of decline in physical function and improve healthy aging.

The effectiveness of the Healthworks Staying Steady community-based falls prevention exercise programme to improve physical function in older adults: a 6-year service evaluation

BackgroundFalls prevention exercise programmes are evidence-based and recommended for improving physical function in older adults. However, few service evaluations exist to assess the effectiveness of community-delivered interventions in practice.MethodsWe conducted a six-year, retrospective evaluation of the community-delivered Staying Steady programme (Healthworks, United Kingdom). Staying Steady is a 27-week, tailored strength and balance programme delivered in a group setting (1-h, once/week) and at home (30–40 min, 2–3 times/week). Participants were referred by healthcare professionals, or self-referred, due to a history or risk of falling. Routinely collected outcome measures (30-s chair stand, Timed Up and Go, four-stage balance test, and patient reported outcomes; including ‘fear of falling’ and ‘ability to manage health’) were analysed. Factors associated with programme completion were reported. The intervention effect on physical function was analysed in subgroups: participants used arms to chair-stand or a walking-aid at both (‘aided’), neither (‘unaided’), or one assessment timepoint (‘aided at baseline only’ or ‘aided at follow-up only’).ResultsThere were 1,426 referrals; 835 (67.3%) participants enrolled on to the Staying Steady programme, 406 (32.7%) declined, 185 (13.0%) were inappropriately referred and excluded from analysis. After enrolling, 451 (54.0%) participants completed, and 384 (46.0%) dropped out. Chair stand performance improved in participants who were unaided (n = 264; median 2.0 [1.0, 4.0] repetitions; P < 0.001), or aided at baseline, follow-up or both (n = 170, P < 0.05). Timed Up and Go performance improved in the unaided (n = 387; median ˗3.1 [˗5.4, ˗1.4] s, P < 0.001), and aided at baseline only (n = 32; median ˗4.9 [˗10.8, ˗3.4] s, P < 0.001) groups. Four-stage balance performance improved (n = 295; median 1.0 [0.0, 1.0] points, P < 0.001). After programme completion, participants self-reported an improved ability to manage their health and daily activities, improved confidence, and a reduced fear of falling. Presence of chronic obstructive pulmonary disease, fear of falling, prescribed nutritional support, disability and social deprivation influenced non-completion of Staying Steady.ConclusionsCompleting Staying Steady improved physical function in older adults. Methods to encourage retention of participants from groups associated with low uptake and adherence should be investigated.

Pain Is Associated With Depressive Symptoms, Inflammation, and Poorer Physical Function in Older Adults With HIV.

ABSTRACTObjectivePeople living with HIV (PLWH) frequently experience pain, which often co-occurs with psychological symptoms and may impact functional outcomes. We investigated cross-sectional associations between pain, depressive symptoms, and inflammation, and then explored whether pain was related to poorer physical function among older PLWH.MethodsWe examined data from PLWH aged 54 to 78 years (n = 162) recruited from a single outpatient program for a larger study on HIV and aging. Participants reported depressive symptoms (10-item Center for Epidemiological Studies Depression Scale) and then attended a biomedical visit in which they reported past-month pain (Medical Outcomes Study-HIV pain subscale), completed physical function assessments, and provided blood samples (assayed for interleukin 6, interferon-γ, tumor necrosis factor α, and C-reactive protein). Links between pain, depressive symptoms, inflammation, and physical function were tested using linear regression models.ResultsPLWH with greater depressive symptoms experienced more pain than did those with fewer depressive symptoms (B = 1.31, SE = 0.28, p < .001), adjusting for age, sex, race, body mass index, smoking, disease burden, time since HIV diagnosis, and medication use. Higher composite cytokine levels were associated with worse pain (B = 5.70, SE = 2.54, p = .027 in adjusted model). Poorer physical function indicators, including slower gait speed, weaker grip strength, recent falls, and prefrail or frail status, were observed among those with worse pain. Exploratory mediation analyses suggested that pain may partially explain links between depressive symptoms and several physical function outcomes.ConclusionsPain is a potential pathway linking depressive symptoms and inflammation to age-related health vulnerabilities among older PLWH; longitudinal investigation of this pattern is warranted. PLWH presenting with pain may benefit from multidisciplinary resources, including behavioral health and geriatric medicine approaches.

Association between Neutrophil-to-Lymphocyte Ratio and Physical Function in Older Adults: A Community-Based Cross-Sectional Study in Japan.

Inflammatory responses contribute to physical decline in older adults. Clinical studies have shown that the neutrophil-to-lymphocyte ratio (NLR), a marker of inflammation, is associated with physical decline. However, its association with physical function in community-dwelling older people is still unclear. Hence, we used cross-sectional data to investigate the relationship between NLR and physical function in community-dwelling older adults. Specifically, we analyzed data corresponding to 818 individuals (336 men and 482 women) aged ≥ 75 years, all of whom participated in comprehensive health examinations, including face-to-face interviews, biochemical analyses, and physical function tests. Using these data, we performed multivariable logistic regression analysis to assess the relationship between NLR and physical function, adjusting for sex, age, education, alcohol consumption, smoking, instrumental activity of daily living, body mass index, chronic disease, physical activity, serum albumin level, and depressive mood. The results showed that a higher NLR was associated with a lower grip strength, lower knee extension strength, and slower walking speed. Importantly, the relationship between NLR and physical function was maintained after adjusting for the confounding factors. Thus, we showed a significant association between NLR and physical function, supporting the use of NLR as a marker of physical function in community-dwelling older adults.