Physical Performance In Older Adults Research Articles

A 12-week multicomponent exercise program enhances frailty by increasing robustness, improves physical performance, and preserves muscle mass in older adults with HIV: MOVIhNG study.

Our aim was to analyze the effects of a multicomponent exercise program (MEP) on frailty and physical performance in older adults with HIV (OAWH) since exercise can reverse frailty in the older population overall, but there is no data for OAWH. A prospective longitudinal study with intervention and control group was designed. Sedentary adults 50 or over with and without HIV were included. The intervention was a 12-week home-based MEP. Dependent variables were frailty (frailty phenotype), physical performance (Senior Fitness Test), muscle mass (ASMI) by bioimpedance. Pre- and postintervention measurements were analyzed using McNemar's test for categorical variables and the Wilcoxon signed-rank test for quantitative variables. 40 OAWH and 20 OA without HIV. The median age was 56.5 years. 23.3% were women. The prevalence of frailty was 6.6% with no frail HIV-negative participants. Three of the four frail HIV-participants transitioned two (50%) from frail to prefrail and one (25%) to robust after the MEP. In participants with an adherence ≥50%, physical performance was significantly improved [basal vs. 12 week]: upper extremity strength [13 (13-15) vs. 16 (15-19), p = 0.0001], lower extremity strength [13 (11-16) vs. 15 (13-16), p = 0.004], aerobic endurance [62 (55-71) vs. 66 (58-80), p = 0.005]. Participants with low adherence experienced a significant worsening in ASMI [8.35 (7.44-9.26) vs. 7.09 (6.08-8.62), p = 0.03]. A 12-week MEP enhances frailty by increasing robustness in OAWH, and improves physical performance, and preserves muscle mass in older adults with good adherence to the MEP independently of HIV status.

Association of dietary protein intake, inflammation with muscle mass, physical performance and incident sarcopenia in Chinese community-dwelling older adults

ObjectivesInflammation and impaired muscle synthesis are important factors of sarcopenia. Plant protein may reduce inflammation but may not be as efficient as animal protein in providing essential amino acids. We therefore examined the associations between dietary protein intake and changes in muscle mass and physical performance, incident sarcopenia, and the interaction effect of inflammation. DesignProspective cohort study. SettingThe Mr. OS and Ms. OS (Hong Kong) cohort. ParticipantsA total of 2,811 sarcopenia-free participants and 569 sarcopenia participants aged ≥65 years were recruited from communities. MeasurementsDietary protein intake was assessed using a validated food frequency questionnaire. Serum high-sensitivity C-reactive protein (hs-CRP) was measured. Linear regression examined the associations between dietary protein intake and 4-year changes in muscle mass and physical performance. Cox regression examined the association between dietary protein intake and incident sarcopenia. ResultsHigher plant protein intake, but not total and animal protein, was associated with less decline in muscle mass and gait speed among sarcopenia-free participants. Conversely, higher ratio of animal-to-plant protein was associated with reduced muscle mass loss among participants with sarcopenia. The highest tertile of plant protein intake was associated with lower incident sarcopenia risk (HR: 0.75, 95% CI: 0.57−0.98; P-trend = 0.034) compared to the lowest tertile. Notably, this association was observed among participants with higher serum hs-CRP levels (HR: 0.57, 95% CI: 0.34−0.95), but not in those with lower hs-CRP levels. ConclusionDietary animal and plant protein intake have differential associations with muscle mass and physical performance in older adults with and without sarcopenia. The role of plant protein in preventing sarcopenia involves modulation of inflammation.

Associations Between Hypertension, Angiotensin-Converting Enzyme Inhibitors, and Physical Performance in Very Old Adults: Results from the ilSIRENTE Study

BackgroundResults regarding the associations between hypertension-related parameters and physical performance in older adults are conflicting. A possible explanation for these divergent results is that investigations may not have adjusted their analyses according to the use of angiotensin-converting enzyme inhibitors (ACEIs).ObjectivesTo examine the associations between hypertension-related parameters, ACEI use, and a set of physical performance tests in very old adults.DesignCross-sectional study from the ilSIRENTE database.SettingMountain community of the Sirente geographic area (L’Aquila, Abruzzo, Italy).ParticipantsAll persons born in the Sirente area (13 municipalities) before 1 January 1924 and living in that region at the time of study were identified and invited to participate. The final sample included 364 older adults (mean age: 85.8 ± standard deviation [SD] 4.8).MeasurementsPhysical performance was assessed using isometric handgrip strength (IHG), walking speed (WS) at normal and fast pace, 5-time sit-to-stand test (5STS), and muscle power measures. Blood pressure (BP) was measured after 20 to 40 min of rest, while participants sat in an upright position. Drugs were coded according to the Anatomical Therapeutic and Chemical codes. ACEIs were categorized in centrally (ACEI-c) and peripherally (ACEI-p) acting. Blood inflammatory markers, free insulin-like growth factor 1 (IGF-1), and IGF-binding protein 3 (IGFBP-3) were assayed.ResultsResults indicated that 5STS test was significantly and negatively associated with diastolic BP values. However, significance was lost when results were adjusted for ACEI use. Participants on ACEIs were more likely to have greater specific muscle power and higher blood levels of IGFBP-3 than non-ACEI users. When participants were categorized according to ACEI subtypes, those on ACEI-p had higher blood IGF-1 levels compared with ACEI-c users.ConclusionsThe main findings of the present study indicate that ACEI use might influence the association between hypertension-related parameters and neuromuscular parameters in very old adults. Such results may possibly be linked to the effects of ACEI-p on the IGF-1 pathway.

Effect of Exercise Programs on Physical Performance in Community-Dwelling Older Adults with and without Frailty: Systematic Review and Meta-Analysis.

The measurement of physical performance constitutes an indicator of the physical functional capacity of older adults with and without frailty. To present a synthesis of knowledge on the effect of exercise programs on physical performance in older adults with and without frailty in the community. A systematic review was carried out in accordance with the PRISMA-2020 criteria. The search for articles was made until 4 May 2023 in PubMed, Scopus, Web of Science, Cochrane Library, SciELO and LILACS. The outcome variable was physical performance, measured through the SPPB (Short Physical Performance Battery). The mean difference (MD) was estimated to evaluate the effect. We found 2483 studies, of which 12 met the eligibility criteria for the systematic review and 9 for the meta-analysis. The effect of exercise on SPPB scores was significantly higher in the exercise group compared to control in non-frail older adults with MD = 0.51 [95% CI, 0.05 to 0.96, p < 0.05]. Likewise, in older adults with frailty, the effect of exercise on the global SPPB score was significantly higher in the exercise group compared to the control with MD = 0.66 [95% CI, 0.09 to 1.24, p < 0.05]. Our findings suggest that exercise programs are effective in increasing and/or maintaining physical performance in older adults with and without frailty, whose effect is more evident in older adults with frailty, probably due to the greater margin of recovery of intrinsic capacity. This systematic review shows the differentiated effect of exercise training on physical performance in older adults with and without frailty. Scientific evidence reinforces the importance of implementing physical exercise programs in all older adults, including those who are frail. However, it is necessary to specify the types and doses (duration, frequency and intensity), for individualized groups, previously grouped according to the SPPB score.

Differences in cough strength, respiratory function, and physical performance in older adults with and without low swallowing function in the repetitive saliva swallowing test.

[Purpose] In older adults, the risk of aspiration pneumonia increases because of coexisting factors such as age-related decline in swallowing function, inefficient cough, reduced respiratory function, and poor physical performance. This study aimed to investigate the differences in cough strength, respiratory function, and physical performance in community-dwelling ambulatory older adults with and without low swallowing function. [Participants and Methods] In 225 community-dwelling ambulatory older adults, swallowing function (the repetitive saliva swallowing test, RSST), cough strength (peak cough flow), lung function (forced vital capacity, forced expiratory volume in 1 second/forced vital capacity), respiratory muscle strength (maximum inspiratory and expiratory pressures), and physical performance (30-second chair stand test and Timed Up and Go test) were evaluated. Participants with low swallowing function in RSST (low RSST group) were compared to age- and sex-matched participants without low swallowing function (control group). [Results] Peak cough flow and maximum inspiratory and expiratory pressures were significantly lower in the low RSST group (n=14) than the control group (n=14). [Conclusion] These preliminary results suggest that community-dwelling ambulatory older adults with low swallowing function in RSST might have lower cough and respiratory muscle strength, even if they have relatively preserved lung function and physical performance.

Effects of Aquatic Exercise on Physical Performance in Older Adults: A Systematic Review and Meta-Analysis.

This systematic review aimed to evaluate the effects of aquatic exercise on physical performance in older adults. Databases were searched up to July 2021. Randomized controlled trials were screened by two reviewers, who extracted data and assessed study quality. Ten randomized controlled trials (603 participants) were included. Compared with nonexercising controls, aquatic exercise probably improved lower limb muscle power (30-s Chair Stand Test; mean difference 4.75 repetitions; 95% confidence interval [0.07, 9.42]; I2 = 99%; 251 participants; very low-quality evidence). When comparing aquatic exercise with land exercise, there is probably no superiority in favor of either intervention on dynamic balance (Timed Up and Go Test; mean difference -0.12s; 95% confidence interval [-0.37, 0.12]; I2 = 3%; 244 participants; very low-quality evidence).

GEROSCIENCE BLOOD-BASED BIOMARKER INDICES AND PHYSICAL PERFORMANCE IN OLDER ADULTS

Abstract Dysregulation in cellular and molecular aging biomarkers are hypothesized to contribute to worse physical performance. We examined associations between blood-based geroscience biomarker indices and physical performance in 414 older adults (77.4±4.4 years; 69% female). Physical performance measures included the expanded SPPB, 4m and 400m walk, and grip strength. Serum IL-6, CRP, TNFr1, GDF15, and insulin were measured and three biomarker indices created: 1) a quintile index calculated by summing quintile scores for each of the biomarkers; 2) a composite z-score calculated using the standardized mean of individual biomarker z-scores; and 3) a principal component analysis (PCA) to identify biomarker factor(s). The quintile index and composite z-score were highly correlated (r=0.94, p&amp;lt; 0.0001). PCA identified two factors: TNFr1 and GDF-15 weighted heavily on Factor 1 and IL6 and CRP weighted heavily on Factor 2. The quintile index and composite z-score were correlated with PCA Factors 1 and 2 (r&amp;gt;0.61, p&amp;lt; 0.0001). Similar standardized beta coefficients were observed for the quintile index, composite z-score, and PCA Factor 1 with 4m and 400m gait speed (all p&amp;lt; 0.0001); every 1 SD higher biomarker index score was associated with ~0.25 SD slower gait speed. For expanded SPPB, higher standardized beta coefficients were observed for the quintile index and composite z-score (~-0.32) than PCA Factors 1 and 2 (~-0.24; all p&amp;lt; 0.0001). Weak associations between all indices and grip strength were observed (p≥0.05). Geroscience biomarker indices that capture inflammation and poor stress response appear to have similar associations with worse physical performance in older adults.

Power training in older adults: A pilot and feasibility study

Background: Previous research shows that power training can increase power output in older adults and may also improve physical performance, physical functioning, and independence. However, power training interventions have not been optimized for older adults. The aim of this study was to assess the feasibility and preliminary effectiveness of a power training program called Powerful Ageing in older adults. Methods: A total of 28 older adults participated in a 12-week power training intervention at an intensity of 20-30% 1RM. The primary outcome, feasibility, was assessed through intervention retention, adherence (attendance and compliance), and safety. Secondary outcomes were measured in health domains of the ICF. In the function domain, muscle power and anaerobic power were assessed using a weighted squat and Wingate test, respectively. In the activities domain, physical performance was measured using the 6-minute walk test, and in the participation domain, physical activity in daily life and health status were evaluated using an accelerometer and the SF-36 questionnaire, respectively. Results: With intervention retention and adherence at 100%, and 0% drop-out due to injuries, Powerful Ageing was considered feasible and safe for older adults. Power training significantly improved muscle power, anaerobic power, and physical performance in older adults, but did not have a significant effect on physical activity in daily life or health status. Conclusions: Preliminary results suggest that Powerful Ageing is a feasible and safe intervention that may improve muscle power, anaerobic power, and physical performance in older adults. Randomized clinical trials are necessary to fully assess the potential of power training as an exercise intervention for older adults.

Pain symptoms and physical performance in older adults: cross-sectional findings from the International Mobility in Aging Study (IMIAS).

To analyze the associations between pain and physical performance in different aging contexts. Data from 1725 older adults from Canada, Brazil, Colombia, and Albania from the 2014 wave of the IMIAS were used to assess the associations between Back Pain (BP) or Lower Limb Pain (LLP) and physical performance by the Short Physical Performance Battery (SPPB). Three binary logistic regression models adjusted for sex, age, study site, education, income sufficiency, BMI, depressive symptoms, and chronic conditions were used to estimate the associations between LLP or BP and SPPB. The SPPB was classified into good performance (8 points or more) and poor physical performance (< 8 points). The mean age of the older men was 71.2 (± 3.0) and the mean age of the women was 71.2 (± 2.8) years. Older men (72.8%, p < 0.05) and women (86.1%, p-value < 0.05) from Albania had the highest frequencies of self-reported general pain. Older women in Colombia had the highest frequencies of LLP or BP (33.5%, p-value < 0.05). In the fully adjusted logistic regression model, LLP or BP was significantly associated with poor SPPB (OR = 0.48, 0.35 to 0.66 95% CI, p < 0.01). Pain symptoms are associated with reduced physical performance in older people, even when adjusted for other clinical and sociodemographic factors. Protocols for aiming to increase the level of physical activity to manage pain should be incorporated into health care strategies.

Comparing remote and face-to-face assessments of physical performance in older adults: A reliability study

IntroductionOlder people often experience a decline in their physical performance. Tests have been approved to evaluate this performance in person. Yet, the constraints associated with in-person assessments (e.g. lack of medical facilities, pandemic lockdown, and contagion risk) are making us contemplate setting up assessments remotely. ObjectivesTo determine whether remote physical performance measurements of older adults are reliable and valid compared to face-to-face measurements. MethodsForty-five subjects aged 65 and over completed the normal/fast speed test (NWT/FWT), the unipodal balance test (UBT), the normal/fast timed up and go test (NTUG/FTUG), the 5 and 10 rep sit to stand test (5STS and 10STS), the 30 sec chair stand (30CS), the 2 minute step test (2MST) and the flexibility before standing (SAD) once face-to-face and twice remotely, by two different observers. The intraclass correlation coefficients (ICC), the standard errors of measurement (SEM%) and minimum detectable changes (MDC%) were calculated for both intra- and inter-observer conditions, to assess the relative and the absolute reliability. An ICC value exceeding 0.90 indicates a very high reliability, while an ICC between 0.70 and 0.89 signifies a high reliability. In clinical practice, a SEM % of less than 10% is considered acceptable. A smaller MDC % indicates a measurement that is more sensitive to detecting changes. ResultsIntra-observer relative reliability was very high (ICC>0.9) for the UBT, NWT, NTUG, FTUG, 5STS, 10STS, 30CS and the SAD; and high (ICC>0.7) for the 2MST and FWS. SEM% values ranged from 0% to 24.03% and MDC from 0% to 9.93%. Inter-observer relative reliability was considered very high (ICC>0.9) for all tests. SEM% values ranged from 0% to 17.68% and MDC from 0% to 7.32%. ConclusionOur findings demonstrate that remote assessments exhibited consistently high to very high levels of intra- and inter-observer relative reliability when compared to face-to-face assessments. Additionally, certain remote evaluations showed acceptable absolute reliability, making them viable alternatives for healthcare professionals when in-person assessments are not feasible in clinical practice.

The Effects of Different Exercise Training Types on Body Composition and Physical Performance in Older Adults with Sarcopenic Obesity: A Systematic Review and Meta-Analysis.

To carry out a systematic review and meta-analysis to verify the effects of different exercise training types on body composition and physical performance in older adults with sarcopenic obesity (SO). Systematic review and meta-analysis. Older adults (≥60 years). Database searches were performed in MEDLINE (via PubMed), EMBASE, Cochrane Library, Web of Science, SCOPUS, and LILACS on January 10th, 2023. We included: randomized and/or controlled clinical trials; physical exercise as an intervention; analysis of body composition and/or muscle function; and sarcopenic obesity diagnosis. We used the Risk of Bias 2 tool and PEDro scale. The GRADE certainty of evidence was also performed. Fourteen studies were included in the systematic review and nine studies in the meta-analysis. A decrease in body fat (%) favoring the exercise group was identified (SMD: -0.34 [95% CI: -0.53 to -0.16]; p=0.0003) (GRADE: ⊕⊕⊕◯ Moderate). Only resistance training showed fat reduction (SMD: -0.27 [95% CI: -0.48 to -0.06]; p=0.01). Increases in upper (SMD: 0.41 [95% CI: 0.04 to 0.78]; p=0.03) (GRADE: ⊕⊕◯◯ Low) and lower (SMD: 0.80 [95% CI: 0.22 to 1.39]; p=0.007) (GRADE: ⊕⊕⊕⊕ High) limb strength was identified with exercise. Chair stand test showed increases with exercise (SMD: 0.73 [95% CI: 0.40 to 1.07]; p<0.0001) (GRADE: ⊕⊕⊕⊕ High), especially for resistance training (SMD: 0.62 [95% CI: 0.21 to 1.02]; p=0.003) and combined training (SMD: 0.99 [95% CI: 0.40 to 1.57]; p=0.0005). The PEDro scale for the studies in our review ranged from 3 to 8 (mean = 5.8 (1.6)), meaning fair methodological quality, and most studies were overall judged with at least low/some concerns in terms of risk of bias. Overall, moderate to high certainty of evidence was found for body fat, lower limb strength, and chair stand test. On the other hand, low certainty of evidence was found for upper limb strength. Resistance, combined, and aerobic training evoked divergent results between the variables analyzed. Although promising, our results should be considered sparingly, but may guide additional exercise recommendations to improve specific health parameters in older adults with SO.

Defining Clinically Meaningful Cut Points for Leg Power Impairment Using Physical Performance in Older Adults: A Secondary Analysis From Boston RISE

ObjectiveTo identify clinically meaningful thresholds of leg power impairment identified by the stair climb power test (SCPT). DesignCross-sectional analysis using the baseline data from an observational cohort study. SettingThe Boston Rehabilitative Impairment Study of the Elderly. ParticipantsCommunity-dwelling older adults (N=413). Main Outcome MeasuresSCPT and the Short Physical Performance Battery (SPPB). ResultsUsing the receiver operating characteristic curves and Youden's J statistics, the optimal threshold for the SCPT associated with mobility limitation as defined by an SPPB score ≤9 was 3.07 Watts/kg for men with a sensitivity of 74%, a specificity of 73% and, an area under the curve (AUC) value of 0.78. For women, the optimal threshold was 2.59 Watts/kg with a sensitivity of 83%, a specificity of 69%, and an AUC value of 0.81. The classification and regression tree sensitivity analysis demonstrated similar thresholds, 2.88 Watts/kg and 2.53 Watts/kg for men and women, respectively. ConclusionsThe study identified clinically meaningful thresholds of impairment for the SCPT for mobility limited older primary care patients. These thresholds may be used to inform rehabilitation care to improve functional mobility of older adults and should be validated in larger more representative clinical trials.

203 Secondary hyperparathyroidism is associated with poor physical performance in older adults: results from the TUDA study

Abstract Background Vitamin D deficiency frequently leads to secondary hyperparathyroidism and is associated with frailty and sarcopenia. However, the role of hyperparathyroidism in the pathophysiology of frailty and impaired physical function is unclear. In this study, we evaluated the relationship between secondary hyperparathyroidism and poor physical performance as assessed by the Timed-Up-and-Go (TUG) test. Methods Participants were from a cross-sectional study of Irish adults aged &amp;gt;60 years. Those with eGFR &amp;lt;30 mL/min and serum calcium ≥2.5 mmol/L were excluded to avoid hyperparathyroidism due to renal impairment and primary hyperparathyroidism. We also excluded participants on drugs that may affect parathyroid hormone (PTH): (teriparatide, denosumab, activated forms of vitamin D), factors affecting physical function (glucocorticoid use: current or past &amp;gt;3 months and history of stroke) and those with an MMSE &amp;lt;24. Hyperparathyroidism was defined as a PTH ≥65 nmol/L and abnormal physical performance by TUG ≥12 seconds. The relationship between hyperparathyroidism and abnormal TUG was explored in logistic regression. Results There were 3,405 participants. 72.4% were female and mean age was 77.5 +/−7.6 years, with 36.7% having a TUG ≥12 seconds. Secondary hyperparathyroidism was significantly associated with TUG ≥12 (OR: 1.34; CI: 1.04–1.74, p = 0.026) after adjustment for age, sex, body mass index, serum 25-hydroxyvitamin D, eGFR, dairy intake, alcohol use, smoking, diabetes mellitus, cardiovascular disease (ischaemic heart disease, heart failure) and peripheral artery disease. Conclusion Secondary hyperparathyroidism was associated with a 34% increased risk of poor physical performance. Other research has demonstrated an association between elevated PTH and sarcopenia supporting a role for its direct effect on muscle function. This study highlights the importance of ensuring both adequate vitamin D status and calcium intake in older adults to reduce the risk of secondary hyperparathyroidism and its potential negative impact on the musculoskeletal system.

Correlation between Power Elbow Flexion and Physical Performance Test: A Potential Predictor for Assessing Physical Performance in Older Adults.

With the increasing number of older adults and their declining motor and cognitive function, it is crucial to find alternative methods for assessing physical functionality. The Short Physical Performance Battery (SPPB), the Time Up and Go (TUG) test, the 4 Meter Walk Test and the Barthel Index (BI) have been used to evaluate mobility and fragility and predict falls. But some of these functional test tasks could be difficult to perform for frail older adults or bedridden patients that cannot ambulate. This study aimed to evaluate the relationship between these functional tests and the power elbow flexion (PEF test). A correlation study was designed with 41 older adults over 65 years of age. The upper limb muscle power was measured using a linear encoder (VITRUBE VBT) with the flexion of the elbow. Strong correlations were found between the PEF test and the 4mWT (rho = 0.715, p = 0.001) and TUG (rho= -0.768, p = 0.001), indicating that the greater the upper limb muscle power is, the greater physical performance will be. Moderate correlations were also found between the PEF and Barthel Index (rho = 0.495, p = 0.001) and SPPB (rho = 0.650, p < 0.001). There is a strong correlation between PEF and the functional tests, proving that older adults that have greater upper limb muscle power have better physical performance. Upper limb muscle power and PEF could be an interesting tool for the assessment of physical performance in bedridden older adults.

Review articles (Meta-Analyses) effects of walking on cognitive function in individuals with mild cognitive impairment: a systematic review and meta-analysis

BackgroundMild cognitive impairment (MCI) is the stage between the expected cognitive decline of normal aging and the more serious decline of dementia. Previous studies have shown that regular exercise can improve cognition and physical performance in older adults. Walking is a low-technology and low-cost exercise that has been proven to improve cognition and mobility in healthy elderly individuals. However, no systematic review or meta-analysis has explored whether walking can improve cognitive function in older adults with MCI. This study aimed to explore the effects of walking interventions on cognitive functions in individuals with MCI.MethodsIn accordance with the PRISMA guidelines, MEDLINE, PubMed, SPORTDiscus, Cochrane Central Register of Controlled Trials, CINAHL, Web of Science, Airiti Library, and the National Digital Library of Theses and Dissertations in Taiwan were searched from inception to July 2023. Independent reviewers selected randomized clinical trials (RCT) that compared the effects of walking with no intervention or other exercises in individuals with MCI. The primary outcomes were cognitive functions, and the secondary outcome was walking endurance. Three reviewers independently conducted data extraction. The risk of bias was assessed using the Revised Cochrane Risk of Bias assessment tool.ResultsFourteen RCTs were included in this review. The quality of evidence in these studies was rated as good to excellent. The results of the meta-analysis showed that the individuals with MCI had no significant improvement in cognitive function but had significant improvement in the 6-min walk test (Mean Difference=23.70, p=0.008) after walking interventions compared to no intervention or other exercises.ConclusionWalking intervention has no significant improvement on cognitive functions in older adults with MCI. However, walking induces beneficial effects on aerobic capacity.Trial registrationThis systematic review has the registration number CRD42021283753 on PROSPERO.

Effects of Exergames and Conventional Physical Therapy on Functional Physical Performance in Older Adults: A Randomized Controlled Trial.

Objective: To evaluate the effects of exergames added to a conventional physical therapy (CPT) program on functional fitness and dynamometric muscle performance for the sit-to-stand (STS) maneuver in older adults and to compare their results concerning a CPT-only intervention. Materials and Methods: Fifty independent older adults were randomly assigned to CPT and exergames (CPT+ExG group; n = 25; age = 71.8 ± 6.8 years) or CPT alone (CPT group; n = 25; age = 71.3 ± 7.4 years). CPT was performed twice a week (60 min/session) for 8 weeks. The CPT+ExG group added exergames for 30 minutes in each session. The Senior Fitness Test was applied, considering the 30-second chair stand test as the primary outcome. Additionally, dynamometric muscle performance during the STS maneuver was assessed. Results: The CPT+ExG group improved the 30-second chair stand (lower body strength), back scratch (upper body flexibility), and 8-foot up-and-go (agility/dynamic balance) tests (all P < 0.05). Both groups improved the kinetic dynamometric variables peak force, peak power, and total work (all P < 0.05). Also, both groups improved the 30-second arm curl test (upper body strength) (P < 0.05), although the increase was higher in the CPT+ExG group compared with the CPT group (time × group; P < 0.05). Conclusion: Adding exergames to a CPT program only significantly increases upper limb strength compared with CPT alone. The findings of this study have implications for the design of future exergame interventions focused on improving STS maneuver performance in older adults.

The Impact of Self-acupressure on the Pain, Joint Stiffness, and Physical Functioning of Patients With Knee Osteoarthritis

Background: People with knee osteoarthritis have a low quality of life due to joint pain and stiffness, severely limiting their daily activities. This study aims to investigate the impact of self-acupressure on the pain, joint stiffness, and physical functioning of patients with knee osteoarthritis. Methods: This randomized clinical trial was conducted on 78 patients aged 50 to 70 with knee osteoarthritis, referred to Imam Khomeini Hospital and private orthopedic clinics in Ahvaz City, Iran, in 2018. The patients were recruited based on the inclusion criteria and then randomly assigned to three groups: self-acupressure (n=26), sham (n=26), and control (n=26). Patients in the intervention group applied daily self-acupressure to 5 specific points around their knees for 8 consecutive weeks. The sham group applied pressure on the points different from those used by the intervention group. The control group received no intervention. The study data were collected using the Western Ontario and McMaster osteoarthritis index (WOMAC), visual analog scale (VAS), and a checklist for daily recordings of pain medication. The obtained data were analyzed using the chi-square test and analysis of variance in SPSS software, version 20. The significance level was set at P&lt;0.05. Results: The comparison of changes within the group showed that the intensity of pain in the intervention group decreased over time (P&lt;0.0001). Also, the joint stiffness, physical functioning, and total WOMAC score significantly decreased in the intervention group (P&lt;0.0001). The frequency of analgesic use was also reduced in the intervention group over time (P=0.026). Conclusion: According to the results, self-acupressure effectively reduces the intensity of pain and joint stiffness and improves the physical performance of older adults with knee osteoarthritis. Overall, this easy and affordable intervention is recommended for this group.

Movement, non-movement behaviors and physical performance in older adults: An isotemporal substitution approach

IntroductionThe time dedicated to movement (e.g., physical activity) and non-movement behaviours (e.g., sitting) has important implications in terms of maintaining physical performance (PP), while it has also been independently associated with better or poorer PP. Physical performance in older adults may be significantly improved by changing daily movement and non-movement behaviours. Therefore, the aims of this study were: (i) to analyse the associations of the time dedicated to movement and non-movement behaviours (i.e., lying down, sitting, standing, and locomotion) with PP (Time up and Go test and the Short Physical Performance Battery); and (ii) to examine how theoretically reallocating time between these behaviours is associated with this outcome. MethodsForty-nine older adults (mean age: 82.9 ± 6.9 yrs) wore an activity monitor to measure periods of lying down, sitting, standing and locomotion. PP measures included the Time up and Go test (TUG) and the Short Physical Performance Battery (SPPB). ResultsReplacing 60 min∙d-1 of lying down time with standing resulted in a significant improvement in TUG (β = −4.99, 95% CI = −8.81, −1.17), and SPPB (β = −0.93, 95% CI = 0.04, 1.82). Likewise, replacing 60 min∙d-1 of sitting time with standing also resulted in a significant improvement in TUG (β = −4.51, 95% CI = −8.67, −0.37). Meanwhile, replacing 60 min∙d-1 of lying down or sitting time with locomotion resulted in a significant improvement in the Sit to Stand test of the SPPB (β = 0.82, 95% CI = 0.14, 1.49, and β = 0.90, 95% CI = 0.23, 1.56, respectively). Discussion and conclusionIsotemporal substitution modelling suggests that replacing 60 min∙d-1 of non-movement or stationary behaviours, such as standing, with an equivalent locomotion time may contribute to improved PP in older adults.

Vitamin D Supplementation and Muscle Power, Strength and Physical Performance in Older Adults: A Randomized Controlled Trial

BackgroundLow 25-hydroxyvitamin D (25[OH]D) concentrations (<30 ng/mL [<50 nmol/L]) have been associated with muscle weakness and impaired physical performance in observational studies. However, the effect of vitamin D supplementation on changes in muscle strength and physical performance in randomized controlled trials has been mixed. ObjectivesTo determine the effect of daily vitamin D supplementation on leg power, strength, and physical performance in low-functioning older adults with 25(OH)D concentrations of 18 to <30 ng/mL. MethodsIn this double-blind, randomized controlled trial, 136 low-functioning [Short Physical Performance Battery (SPPB) scores ≤10] adults aged 65–89 y with 25(OH)D concentrations of 18 to <30 ng/mL were randomly assigned to 2000 IU/d vitamin D3 or placebo for 12 mo. Lower-extremity leg power (primary outcome), leg and grip strength, SPPB, timed up and go (TUG), postural sway, and gait velocity and spatiotemporal parameters (secondary outcomes) were assessed at baseline, 4 and 12 mo. A subset (n = 37) also underwent a muscle biopsy at baseline and 4 mo and muscle fiber composition and contractile properties were assessed. ResultsParticipants’ mean ± SD age and SPPB scores at baseline were 73.4 ± 6.3 y and 7.8 ± 1.8, respectively. Mean ± SD 25(OH)D concentrations at baseline and 12 mo were 19.4 ± 4.2 ng/mL and 28.6 ± 6.7 ng/mL in the vitamin D group and 19.9 ± 4.9 ng/mL and 20.2 ± 5.0 ng/mL in the placebo group for a mean ± SE difference of 9.1 ± 1.1 ng/mL (P < 0.0001). However, there were no differences in change in leg power, leg or grip strength, SPPB score, TUG, postural sway, or gait velocity and spatiotemporal parameters by intervention group over 12 mo or muscle fiber composition and contractile properties over 4 mo. ConclusionsIn low-functioning older adults with 25(OH)D concentrations of 18 to <30 ng/mL, randomization to 2000 IU/d vitamin D3 did not result in improvements in leg power, strength, or physical performance or muscle fiber composition and contractile properties.This trial was registered at clinicaltrials.gov as NCT02015611.

Effects of Neuromuscular Training on Physical Performance in Older People: A Systematic Review.

This systematic review aimed to assess the available evidence on the effects of neuromuscular training on physical performance in older adults. A literature search was conducted across four databases (Psychology and Behavioral (EBSCO), Scopus, Web of Science and PubMed). The PRISMA guidelines were followed. The PEDro scale and Cochrane risk of bias tool were used to assess the quality of and risk of bias in the studies, respectively. The protocol was registered in PROSPERO (code: CRD42022319239). The outcomes were muscle strength, cardiorespiratory fitness, postural balance and gait speed. From 610 records initially found, 10 were finally included in the systematic review, involving 354 older people with a mean age of 67.3 years. Nine of them reported significant changes in at least one variable related to physical performance in the intervention compared to the control groups. The neuromuscular training caused significant improvements in postural balance, flexibility, cardiorespiratory fitness, strength power of the upper and lower limbs and autonomy. The available evidence indicates that neuromuscular training has a positive effect on some variables of physical performance, especially in postural balance; however, the methodological quality and certainty of the evidence in the available literature are limited. Therefore, a greater number of high-quality studies are required to draw definitive conclusions.