Physical Function In Older Adults Research Articles

O.4.1-5 An online lifestyle intervention consisting of resistance exercise and advice on protein intake improves leg muscle strength and physical functioning in older adults

Abstract Purpose The lifestyle intervention ProMuscle, combining resistance exercise and an increased protein intake, was effective in improving muscle strength, muscle mass and physical functioning in older adults. However, the ageing population is increasing at a fast pace. This leads to growing numbers of older adults suffering from the negative consequences associated with ageing, such as a declined physical functioning. Due to insufficient healthcare professionals, the rapidly growing aging population cannot be personally guided in (preventive) care in the future. Innovative online lifestyle interventions provide opportunities to guide larger numbers of older adults, demanding lower deployment of healthcare professionals. The current study investigates the effects of the online version of ProMuscle on muscle strength and physical functioning in healthy older adults. Methods A single-arm longitudinal study was conducted in the Netherlands. In the 24-week intervention 19 healthy adults aged 55 and older were included. They conducted online resistance training twice a week during 24 weeks. In addition, older adults were advised on increasing protein intake via two online consultation by a dietitian in the first 12 weeks, and via a 12-week online learning platform in the second 12 weeks. The 1 repetition maximum (1RM) knee extension and repeated chair rise test were performed at baseline, in week 12 and 24. Linear mixed models were used to test differences over time. Adherence to the training sessions was measured as number of trainings watched, divided by number of trainings provided, times 100%. Results Mean age of participants at baseline was 69±6 years. The 1RM knee extension and repeated chair rise test improved significantly during the 24-week intervention (15.49 lbs, SE 1.92 and -1.16 seconds, SE 0.22 respectively). Adherence to training sessions was 72%. Conclusions The online lifestyle intervention ProMuscle, combining exercise and nutrition, can contribute to improved muscle strength and physical functioning in healthy older adults. Results from this one-armed trial should be interpreted with caution and larger trials are needed. Providing such lifestyle interventions online enables an increased number of older adults to follow the program, providing the opportunity to contribute to the health and independence of the rapidly growing ageing population.

S9-5 From a successful RCT to community implementation: lessons learnt from the REtirement in ACTion (REACT) group-based active ageing intervention targeting older adults with mobility limitations

Abstract Purpose Mobility limitation in older age reduces quality of life, generates substantial health and social care costs, and increases mortality. The REtirement in ACTion (REACT) trial established that a community-based, active ageing intervention can prevent decline in physical functioning in older adults already at increased risk of mobility limitations documenting significant savings in health and social care costs. Project description Recruitment: We recruited 777 older adults (mean age 77.6 yrs (SD 6.8 yrs); 66% female; with reduced lower limb physical functioning (Short Physical Performance Battery [SPPB] mean score 7.37, (SD 1.56) from three sites (Bristol/Bath; Birmingham; Exeter) in England. In terms of ethnicity (95.11% white) and deprivation, the sample was representative of the UK population of people 65+. Intervention Participants were randomly assigned to receive three healthy ageing sessions (n = 367) or a 12-month, group-based, multimodal programme including 64x1hr exercise, 43x20 min social and 21x45-min behavioural maintenance sessions (n = 410) delivered by qualified exercise specialists. Implementation The intervention was funded and delivered by community organisations including city councils, third sector organisations/charities, leisure industry providers. Currently REACT is implemented as a community programme in Bristol, UK while a strategy for rolling-out nationally is developed. Evaluation A multicentre, pragmatic, randomised controlled trial with process and health economic evaluations at baseline, six, 12 and 24 months. At the 24-month follow-up, the SPPB score was significantly greater in the intervention arm than in the control arm. Difference in lower limb function between intervention and control participants was clinically meaningful at both 12 and 24 months. Attrition rates were low (19%). Engagement with the REACT intervention was associated with positive changes in exercise competence, relatedness, enjoyment and perceived well-being benefits. The health economic analysis indicated substantial quality-of-life and health economic benefits within the 24-month trial window and across a lifetime horizon. Conclusions This study adds robust evidence that a relatively low-resource, 1-year multimodal exercise,social and behavioural maintenance intervention helps older adults to improve and retain physical functioning for at least 24 months. There are great opportunities and some challenges for a national and international roll-out of this evidence-based active ageing programme.

Work-Related Differences in Postural Control and Habitual Physical Activity of Older Adults

Physical Activity (PA) is highly recommended to improve balance, prevent falls and maintain physical function in older adults. Unfortunately, for some people, engagement in PA tends to decline following retirement. The aim of this study was to investigate the differences in postural control and in the level of Habitual PA (HPA), between older workers and non-workers.

Comparison of strategies for assessment of rate of torque development in older and younger adults.

There is increasing appreciation of the role of rate of torque development (RTD) in physical function of older adults (OAs). This study compared various RTD strategies and electromyography (EMG) in the knee extensors and focused on discriminating groups with potential limitations in voluntary activation (VA) and associations of different RTD indices with functional tests that may be affected by VA in OAs. Neuromuscular function was assessed in 20 younger adults (YAs, 22.0 ± 1.7years) and 50 OAs (74.4 ± 7.0years). Isometric ballistic and peak torque during maximal voluntary contractions (pkTMVC), doublet stimulation and surface EMG were assessed and used to calculate VA during pkTMVC and RTD and rate of EMG rise during ballistic contractions. Select mobility tests (e.g., gait speed, 5× chair rise) were also assessed in the OAs. Voluntary RTDand RTD normalized to pkTMVC, doublet torque, and peak doublet RTD were compared. Rate of EMG rise and voluntary RTD normalized to pkTMVC did not differ between OAs and YAs, nor were they associated with functional test scores. Voluntary RTD indices normalized to stimulated torque parameters were significantly associated with VA (r = 0.319-0.459), and both indices were significantly lower in OAs vs YAs (all p < 0.020). These RTD indices showed significant association with the majority of mobility tests, but there was no clear advantage among them. Thus, voluntary RTD normalized to pkTMVC was ill-suited for use in OAs, while results suggests that voluntary RTD normalized to stimulated torque parameters may be useful for identifying central mechanisms of RTD impairment in OAs.Clinical trial registration number NCT02505529; date of registration 07/22/2015.

Segmental extracellular-to-intracellular water resistance ratio and physical function in older adults

ObjectivesThis study aimed to investigate the association between whole-body (WB), arm, and leg extracellular-to-intracellular water resistance (Recw/Ricw) ratios and various physical functions of each segment and muscle mass using segmental multifrequency bioelectrical impedance analysis. MethodsIn total, 988 community-dwelling older adults were included in the analysis. Physical function was assessed using hand grip, 5-repetition sit-to-stand, 5-m habitual walk, Timed Up and Go, and single-leg balance with eyes open tests. Each segmental Recw/Ricw ratio and muscle mass were assessed at 5 and 250 kHz resistances using a segmental multifrequency bioelectrical impedance analysis device. Pearson's correlation between the segmental Recw/Ricw ratio and muscle mass and physical function was calculated, and the difference in correlation coefficients was tested using Bonferroni correction. Multiple linear regression analysis was conducted using physical function as the dependent variable and the segmental Recw/Ricw ratio as the independent variable, adjusting for sex, age, body mass index, and segmental muscle mass. ResultsWB and leg Recw/Ricw ratios were significantly positively correlated with good hand grip performance, gait speed, mobility, balance, and standing power (p < 0.05), after adjusting for sex, age, body mass index, and muscle mass. Furthermore, the leg Recw/Ricw ratio was positively associated with lower extremity physical function compared with WB and arm Recw/Ricw ratios and muscle mass (p < 0.01). Conversely, WB muscle mass was more strongly related to grip strength than WB, arm, and leg Recw/Ricw ratios (p < 0.01). ConclusionsThe Recw/Ricw ratio is useful for identifying older adults with worse physical function. The Recw/Ricw ratio allows for easy and timely screening of older adults with worse physical function in clinical settings.

Effects of Home-Based Exercise Programs on Mobility, Muscle Strength, Balance, and Gait in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis.

Individual unsupervised home-based exercise programs can enhance muscle strength, physical function, gait, and balance in older adults. However, the effectiveness of such programs may be limited by the lack of supervision. This study aims to verify the effectiveness of individual unsupervised home-based programs, compare the effects of individual unsupervised home-based to supervised programs, and verify the influence of supervision over individual unsupervised home-based programs on the physical function of older adults. A systematic literature search was performed in four electronic databases, and the trials involved randomized controlled comparing the home-based programs to supervised, control groups, or home-based + supervised evaluating the muscle strength, physical function, gait, and balance in older adults. Eleven studies met the inclusion criteria. The meta-analysis revealed no differences between home-based program versus supervised program in gait, mobility, and balance, revealing a trend of significance to supervised program on strength (standardized mean difference [SMD] = 0.27, p = .05). The analysis revealed effects in mobility (SMD = 0.40, p = .003), balance (SMD = 0.58, p = .0002), and muscle strength (SMD = 0.36, p = .02) favoring home-based program versus control group. Significant effects between home-based program versus home-based + supervised program were observed in balance (SMD = 0.74, p = .002) and muscle strength (SMD = 0.58, p = .01) in favor of home-based + supervised program. Home-based programs effectively improve older adults' physical function compared with control groups. However, supervised programs were more effective for muscle strength.

SMARTfit Dual-Task Exercise Improves Cognition and Physical Function in Older Adults With Mild Cognitive Impairment: Results of a Community-Based Pilot Study.

Mild cognitive impairment is an intermediate state between the cognitive decline often experienced in normal aging and dementia that affects 15% of Americans over 65years of age. Our communities have an opportunity to support the development and adoption of evidence-based programs to help older adults preserve cognition and physical function. In partnership with a local urban YMCA in an underserved, predominantly minority neighborhood, we tested the appeal and therapeutic benefits of SMARTfit training among older adults with mild cognitive impairment. The participants reported a positive training experience. After 12weeks of dual-task training, Trail-Making Test and Stroop Color-Word Interference Test scores improved, as did scores on the Short Physical Performance Battery. Results of our SMARTfit dual-task training intervention are encouraging. Larger randomized controlled trials must further investigate the development, implementation, and therapeutic impacts of SMARTfit dual-task training on cognitive and physical function in aging.

Physical function in older adults with and without a cancer history: Findings from the National Health and Aging Trends Study.

Previous studies identified physical function limitations in older cancer survivors, but few have included objective measures and most focused on breast and prostate cancer survivors. The current study compared patient-reported and objective physical function measures between older adults with and without a cancer history. Our cross-sectional study used a nationally representative sample of community-dwelling, Medicare beneficiaries from the 2015 National Health and Aging Trends Study (n = 7495). Data collected included patient-reported physical function, including a composite physical capacity score and limitations in strength, mobility, and balance, and objectively measured physical performance metrics, including gait speed, five time sit-to-stand, tandem stand, and grip strength. All analyses were weighted to account for the complex sampling design. Thirteen percent of participants (n = 829) reported a history of cancer, of which more than half (51%) reported a diagnosis other than breast or prostate cancer. In models adjusted for demographics and health history, older cancer survivors had lower Short Physical Performance Battery scores (unstandardized beta [B] = -0.36; 95% CI: -0.64, -0.08), slower gait speed (B = -0.03; 95% CI: -0.05, -0.01), reduced grip strength (B = -0.86; 95% CI: -1.44, -0.27), worse patient-reported composite physical capacity (B = -0.43; 95% CI: -0.67, -0.18) and patient-reported upper extremity strength (B = 1.27; 95% CI: 1.07, 1.50) compared to older adults without cancer. Additionally, the burden of physical function limitations was greater in women than in men, which may be explained by cancer type. Our results extend studies in breast and prostate cancer to show worse objective and patient-reported physical function outcomes in older adults with a range of cancer types compared to those without a cancer history. Moreover, these burdens seem to disproportionately affect older adult women, underscoring the need for interventions to address functional limitations and prevent further health consequences of cancer and its treatment.

Novel Potential Targets for Function-Promoting Therapies: Orphan Nuclear Receptors, Anti-inflammatory Drugs, Troponin Activators, Mas Receptor Agonists, and Urolithin A.

In recent years, several new classes of therapies have been investigated with their potential for restoring or improving physical functioning in older adults. These have included Mas receptor agonists, regulators of mitophagy, skeletal muscle troponin activators, anti-inflammatory compounds, and targets of orphan nuclear receptors. The present article summarizes recent developments of the function-promoting effects of these exciting new compounds and shares relevant preclinical and clinical data related to their safety and efficacy. The development of novel compounds in this area is expanding and likely will need the advent of a new treatment paradigm for age-associated mobility loss and disability.

Adherence to the physical activity guideline beyond the recommended minimum weekly amount: impacts on indicators of physical function in older adults.

The extent to which additional health benefits of accumulating twice the minimum amount of time in moderate-to-vigorous physical activity (MVPA) affects indicators of physical function in older adults is unclear. Therefore, the aim of the present study was to assess indicators of physical function in older adults who accumulate at least 150 but less than 300 min/week of MVPA compared to those accumulating at least 300 min/week. Indicators of physical function, including handgrip strength, 5 times sit-to-stand test (5-STS), squat jump and 6-min walk test (6MWT) were assessed in a sample of 193 older men (n = 71, 67 ± 2 years), and women (n = 122, 67 ± 2 years), who all accumulated at least 150 weekly minutes of MVPA. Time in MVPA was assessed by accelerometry during 1 week and engagement in muscle strengthening activities (MSA) was assessed by self-report. Protein intake was assessed by a food-frequency-questionnaire. Participants were classified as physically active (≥150 but <300 min of MVPA per week) or as highly physically active (≥300 min of MVPA per week). Factorial analysis of variance revealed that older adults accumulating at least 300 min of MVPA per week had a significantly (p < 0.05) better 6MWT performance and overall physical function compared to the less active group. These findings remained significant after further adjustment for MSA, sex, waist circumference and protein intake. In contrast, no significant differences in indicators of muscle strength were observed between the two groups. Adherence to twice the recommended minimum amount of weekly MVPA time is related to a better physical function, evidenced by a better walking performance compared to adherence to the minimum weekly amount of MVPA. This finding emphasizes the benefits of accumulating daily MVPA beyond the minimum recommended amount to optimize the ability to perform activities of daily living, thus reducing the burden of physical disability and related health-care costs.

Effects of Tai Chi and Qigong on cognitive and physical functions in older adults: systematic review, meta-analysis, and meta-regression of randomized clinical trials

BackgroundOlder adults experience age-related declines in physical and cognitive functions due to interactions between aging and chronic diseases. Tai Chi and Qigong (TCQ) might be beneficial in improving the physical function and delaying the cognitive decline of this population. The potential underlying mechanism was explored to determine the effects of TCQ on cognitive function via direct or indirect pathways.PurposeThe objective of this systematic review was to determine the effects of TCQ on cognitive and physical functions in older adults using meta-analysis, and to determine the impact of TCQ on cognitive function while controlling for physical function using a meta-regression approach.MethodsA systematic search of 13 electronic databases (in English, Korean, and Chinese languages) identified 10,292 potentially eligible studies published between inception and May 2022. The bias in individual studies was assessed using the Cochrane Risk of Bias (version 2.0) tool. The heterogeneity of the studies was evaluated using a 95% prediction interval, and the meta-analysis and meta-regression were implemented using the Comprehensive Meta-Analysis (version 3) software.ResultsOur search identified 17 randomized studies (n = 2,365, mean age = 70.3 years). The results of the meta-analysis that used a random-effects model indicated that TCQ had significant effects on both cognitive (Hedges' g = 0.29, 95% confidence interval [CI] = 0.17 to 0.42) and physical (Hedges' g = 0.32, 95% CI = 0.19 to 0.44) functions. We used meta-regression to explore the effect size of TCQ in association with physical function level. The regression model was significant (Q = 25.01, p = .070), and 55% of the heterogeneity was explained by physical function as a moderator variable. The effects of TCQ on cognitive function remained significant in this model when controlling for the effect of physical function (β = 0.46, p = .011).ConclusionThis meta-regression of 17 randomized studies strongly suggests that TCQ has beneficial effects on physical and cognitive functions in older adults. The effect of TCQ on cognitive function remained significant after taking into account the significant effects of physical function as a moderator. The findings imply the potential health benefits of TCQ by promoting cognitive function in older adults directly and indirectly through enhancing physical function.PROSPERO registration number*PROSPERO international prospective register of systematic reviews, registration ID CRD42023394358.

The effect of virtual reality and physical exercise training on cognitive function in older adults with mild cognitive impairment

AbstractBackgroundNumerous studies have shown that aerobic and resistance exercises, including leisure time physical activity help to reduce the risk of cognitive decline. Recently potential of cognitive training using immersive virtual reality (VR) has been growing in the non‐pharmacological interventions for mild cognitive impairment (MCI). However, there are not enough studies comparing the impact of two different interventional approaches on cognition and brain function especially on MCI patients. Therefore, we investigated the effectiveness of two non‐pharmacological intervention using VR and aerobic‐and resistance physical exercise (PE) on cognitive and brain function of older adults with MCI.MethodThis study included 99 participants (70.8 ± 5.4) with MCI randomly assigned to PE, VR, and control group. The PE training consisted of aerobic and resistance exercise performed for 50 mins 5 times/week for 12 weeks. The immersive VR‐based cognitive training consisted of series of cognitive games. 24 sessions of VR training (three days/week) were performed, and each session was 100 mins long. Global cognitive function was measured with Mini‐Mental State Examination (MMSE) test. Resting‐state electroencephalography (EEG) of neural oscillatory activity in different frequency bands was measured. Physical function was measured with hand grip strength (HGS), gait speed and timed up and go test.ResultAfter the intervention period, VR significantly enhanced global cognition (p&lt;0.045) and HGS (p&lt;0.001) whereas PE significantly improved HGS (p&lt;0.001) compared to baseline. One way Analysis of variance (ANOVA) of resting state EEG showed decreased theta/beta power ratio (TBR) (p&lt;0.018) in the central region of the brain in PE group compared to the control group. Although not significant, VR group also showed decreased TBR compared to control group.ConclusionOur study findings suggest that VR based cognitive training enhances both global cognition and physical function of older adults with MCI. The decrease in resting state TBR in PE and VR group also indicated improved attention. Further studies should peruse the effect of VR exergaming intervention, a combination of PE and cognitive games, to yield peak benefits on MCI patients.

Systemic Lupus, Metabolic Syndrome, Cardiac Disease, and Peripheral Artery Disease

Systemic Lupus, Metabolic Syndrome, Cardiac Disease, and Peripheral Artery Disease

Preliminary efficacy of a technology-based physical activity intervention for older Korean adults during the COVID-19 pandemic

ABSTRACT Physical activity (PA) interventions deployed using eHealth technologies have been shown to improve cardiovascular health (CVH) and physical function in older adults. This study tested the preliminary efficacy of a 12-week hybrid (web-based and center-based) PA intervention combining the use of a smartwatch and mobile application. Our intervention was concurrently implemented in-person at the local senior welfare center and at-home through a web-based modality. Participants (n = 120) had an average age of 72.7 year and were largely female (75%). Health status was categorized as low-risk (26.7%), middle-risk (43.3%), and high-risk (30%). Overall, increases were evident in diastolic blood pressure (t = −3.55, p < .01), and high-density-lipoprotein (t = −3.02, p < .01), with decreases seen for triglyceride levels (t = 2.42, p < .05) at posttest. Participants showed improvements in muscular function (t = −3.75, p < .001) and cardiopulmonary endurance (t = −2.34, p < .05). Moreover, while controlling for covariate, participants in the middle-risk health category showed lower diastolic blood pressure (b = −4.54, p < .05) and greater triglyceride levels (b = 37.74, p < .001) and cardiopulmonary endurance (b = 6.98, p < .05) than those within the low-risk health group. Participants with high-risk health showed greater triglyceride levels than those with low-risk group (b = 40.57, p < .001). Further studies should test a PA intervention using a randomized controlled trial design, with the expansion of the surveyed covariates and possible important mechanistic confounders.

Older adults with slow sit to stand times show reduced temporal precision of audio–visual integration

Sustained integration of sensory inputs over increased temporal delays is associated with reduced cognitive and physical functioning in older adults and adverse outcomes such as falls. Here, we explored the relationship between multisensory integration and a clinically relevant measure of balance/postural control; Sit-to-Stand Time, the efficiency with which an older adult can transition between a seated and a standing posture. We investigated whether temporal multisensory integration was associated with performance on the Five-Times Sit-to-Stand Test (FTSST) in a large sample of 2556 older adults (mean age = 63.62 years, SD = 7.50; 55% female) drawn from The Irish Longitudinal Study on Ageing (TILDA). K-means clustering was applied to FTSST data, yielding three clusters characterised by fast (mean = 10.88 s; n = 1122), medium (mean = 14.34 s; n = 1133) and slow (mean = 18.97 s; n = 301) sit-to-stand times. At wave 3 of TILDA, older adults participated in the Sound Induced Flash Illusion (SIFI), a measure of the precision of temporal audio–visual integration, which included three audio–visual stimulus onset asynchronies (SOAs): 70, 150 and 230 ms. Older adults with the slowest sit-to-stand times were more susceptible to the SIFI at the longest SOA (230 ms) compared to the shortest SOA (70 ms) relative to those with the fastest times (p = 0.02). Older adults who take longer to repeatedly transition from a seated to a standing posture exhibit an expanded temporal binding window for audio–visual events, supporting a link between multisensory perception and balance/postural control in ageing.

Effects of physical exercise on physical function in older adults in residential care: a systematic review and network meta-analysis of randomised controlled trials

Physical exercise is effective at attenuating ageing-related physical decline in general, but evidence of its benefits for older adults in residential care, who often have functional dependency, multimorbidity, and polypharmacy, is inconclusive. We aimed to establish the effects of exercise interventions on the physical function of this population. For this systematic review and network meta-analysis, we searched PubMed, Web of Science, Cochrane Library, Rehabilitation & Sports Medicine Source, and SPORTDiscus to identify randomised controlled trials assessing the effects of exercise interventions (vs usual care) on physical function (ie, functional independence, physical performance, and other related measures, such as muscle strength, balance, or flexibility) in adults aged 60 years or older living in residential care. Relevant studies published in English or Spanish up to Jan 12, 2023, were included in the systematic review. The quality of studies was assessed using the Tool for the Assessment of Study Quality and Reporting in Exercise (TESTEX) score. A network meta-analysis was performed for physical function-related outcomes reported in at least ten studies, with subanalyses for specific intervention (ie, exercise type, training volume, and study duration) and participant (eg, having cognitive impairment or dementia, pre-frail or frail status, and being functionally dependent) characteristics. The study protocol was registered on PROSPERO (CRD42021247809). 147 studies (11 609 participants, with mean ages ranging from 67 years [SD 9] to 92 years [2]) were included in the systematic review, and were rated as having overall good quality (median TESTEX score 9 [range 3-14]). In the meta-analysis (including 105 studies, n=7759 participants), exercise interventions were associated with significantly improved overall physical function, with a standardised mean difference [SMD] of 0·13 (95% credible interval [CrI] 0·04-0·21), which was confirmed in all analysed subpopulations. The strongest association was observed with 110-225 min per week of exercise, and the greatest improvements were observed with 170 min per week (SMD 0·36 [95% CrI 0·20-0·52]). No significant differences were found between exercise types. Subanalyses showed significant improvements for almost all analysed physical function-related outcomes (Barthel index, five-times sit-to-stand test, 30-s sit-to-stand test, knee extension, hand grip strength, bicep curl strength, Short Physical Performance Battery, 6-min walking test, walking speed, Berg balance scale, and sit-and-reach test). Large heterogeneity was found between and within studies in terms of population and intervention characteristics. Exercise interventions are associated with improved physical function in older adults in residential care, and should, therefore, be routinely promoted in long-term care facilities. None. For the Spanish translation of the abstract see Supplementary Materials section.

The association of allopurinol with persistent physical disability and frailty in a large community based older cohort.

The protective effects of allopurinol on physical function in older adults are not well understood, despite its potential to improve functional gains and reduce sarcopenia. This study aims to determine the association between allopurinol, persistent physical disability, and frailty in older gout patients. This analysis used data from a randomized trial in an older cohort, ASPirin in Reducing Events in the Elderly (ASPREE). ASPREE recruited 19,114 participants aged ≥65 years without prior cardiovascular events, dementia, or independence-limiting physical disability at trial enrolment. This analysis examined the association of baseline and time-varying allopurinol use with persistent physical disability and new-onset frailty in participants with gout at baseline (self-report or use of any anti-gout medications). Frailty was measured using the Fried frailty phenotype (score ≥3/5) and a deficit accumulation frailty index (FI) (score >0.21/1.0). Multivariable Cox proportional-hazards models were used for main analyses. This analysis included 1155 gout participants, with 630 taking allopurinol at baseline and 525 not. During a median follow-up of 5.7 years, 113 new allopurinol users were identified. Compared with nonusers, baseline allopurinol use was associated with a significant risk reduction of persistent physical disability (Adjusted HR 0.46, 95% CI 0.23-0.92, p = 0.03). The strength of the association was modestly attenuated in the time-varying analysis (Adjusted HR 0.56, 0.29-1.08, p = 0.08). No significant associations with frailty measures were observed for either baseline allopurinol use (Fried frailty: Adjusted HR 0.83, 0.62-1.12; FI: Adjusted HR 0.96, 0.74-1.24) or time-varying allopurinol use (Fried frailty: Adjusted HR 0.92, 0.69-1.24; FI: Adjusted HR 1.02, 0.78-1.33). Allopurinol use in older adults with gout is associated with a reduced risk of persistent physical disability but not associated with risk of frailty.

Terminal Decline in Physical Function in Older Adults.

It is currently unclear whether (and when) physical function exhibits a terminal decline phase, that is, a substantial acceleration of decline in the very last years before death. 702 deceased adults aged 70 years and older from the Yale PEP Study provided 4 133 measurements of physical function (Short Physical Performance Battery, SPPB) up to 20 years before death. In addition, continuous gait and chair rise subtest scores (in seconds) were assessed. Generalized mixed regression models with random change points were used to estimate the onset and the steepness of terminal decline in physical function. Decline accelerated in the last years of life in all 3 measures of physical function. The onset of terminal decline occurred 1 year before death for the SPPB, and at 2.5 and 2.6 years before death for chair rise and gait speed test scores, respectively. Terminal declines in physical function were 6-8 times steeper than pre-terminal declines. Relative to those whose condition leading to death was frailty, participants who died from dementia and cancer had an up to 6 months earlier and 3 months later onset of terminal decline in SPPB, respectively. Terminal decline in physical function among older adults is comparable to the more established terminal decline phenomenon in cognition. Our results provide additional evidence of late-life rapid decline in physical function due to impending death.

A qualitative longitudinal study of motivation in the REtirement in ACTion (REACT) physical activity intervention for older adults with mobility limitations

BackgroundPhysical activity (PA) is beneficial for older adults’ health, however they remain the least active age group in the UK. This qualitative longitudinal study aims to understand motivations in older adults receiving the REACT physical activity intervention, through the lens of self-determination theory.MethodsParticipants were older adults randomised to the intervention arm of the Retirement in ACTion (REACT) Study, a group-based physical activity and behaviour maintenance intervention to prevent decline of physical functioning in older adults (≥ 65 years). Stratified purposive sampling by physical functioning (Short Physical Performance Battery scores) and 3-month attendance was employed. Fifty-one semi-structured interviews were conducted at 6, 12 and 24-months with twenty-nine older adults (Mean age (baseline) = 77.9 years, SD 6.86, 69% female) and at 24-months with twelve session leaders and two service managers. Interviews were audio recorded, transcribed verbatim and analysed using Framework Analysis.ResultsPerceptions of autonomy, competence and relatedness were associated with adherence to the REACT programme and maintenance of an active lifestyle. Motivational processes and participants’ support needs, changed during the 12-month REACT intervention and across the 12-months post-intervention. Group interactions were an important source of motivation during the first six months but increased competence and mobility drove motivation at the later stages (12 months) and post-intervention (24 months).ConclusionsMotivational support needs vary in different stages of a 12-month group-based programme (adoption and adherence) and post-intervention (long-term maintenance). Strategies to accommodate those needs include, (a) making exercise social and enjoyable, (b) understanding participants’ capabilities and tailoring the programme accordingly, (c) capitalising on group support to motivate participants to try other activities and prepare sustainable active living plans.Trial registrationThe REACT study was a pragmatic multi-centre, two-arm, single-blind, parallel-group, RCT (ISRCTN registration number 45627165).

Potential nutritional strategies to prevent and reverse sarcopenia in aging process: Role of fish oil-derived ω-3 polyunsaturated fatty acids, wheat oligopeptide and their combined intervention

IntroductionNutritional support is potentially considered an essential step to prevent muscle loss and enhance physical function in older adults. ObjectivesThis study aimed to assess the role of potential nutritional strategies, i.e., fish oil-derived ω-3 polyunsaturated fatty acids (PUFAs), wheat oligopeptide and their combined intervention, in preventing and reversing sarcopenia in aging process. MethodsOne hundred 25-month-old Sprague-Dawley rats were randomly divided into 10 groups, and 10 newly purchased 6-month-old rats were included in young control group (n = 10). Fish oil (200, 400 or 800 mg/kg body weight), wheat oligopeptide (100, 200 or 400 mg/kg body weight), fish oil + wheat oligopeptide (800 + 100, 400 + 200 or 200 + 400 mg/kg body weight) or the equal volume of solvent were administered daily by gavage for 10 weeks. The effects of these interventions on natural aging rats were evaluated. ResultsAll intervention groups had a significant increase in muscle mass and grip strength and reduction in perirenal fat weight when compared to the aged control group (P < 0.05). The results of biochemical parameters, magnetic resonance imaging, proteomics and western blot suggested that the combination of wheat oligopeptide and fish oil-derived ω-3 PUFA, especially group WFM 2 (400 + 200 mg/kg body weight fish oil + wheat oligopeptide), was found to be more effective against aging-associated muscle loss than single intervention. Additionally, the interventions ameliorated fatty infiltration, muscle atrophy, and congestion in the intercellular matrix, and inflammatory cell infiltration in muscle tissue. The interventions also improved oxidative stress, anabolism, hormone levels, and inflammatory levels of skeletal muscle. ConclusionsThe combination of fish oil-derived ω-3 PUFA and wheat oligopeptide was found to be a promising nutritional support to prevent and reverse sarcopenia. The potential mechanism involved the promotion of protein synthesis and muscle regeneration, as well as the enhancement of muscle strength.