Poor Physical Function Research Articles

Cut-off values for estimated cardiorespiratory fitness in terms of physical functioning among middle-aged to older adults.

Cardiorespiratory fitness is linked to various health outcomes. This study aimed to establish cut-off values for estimated cardiorespiratory fitness associated with poor physical functioning in middle-aged to older adults. A total of 2638 participants (1083 males), aged 40-69 years, performed a 6-min walking test (6MWT) to estimate cardiorespiratory fitness (VO<inf>2max)</inf> and completed a health-related questionnaire. Physical functioning was assessed using four outcomes: perceived health, perceived fitness, difficulties in 2-km walking, and difficulties in climbing several stairs. Receiver operator characteristics (ROC) curves were used to determine cut-off values for estimated VO<inf>2max</inf> and 6MWT distance linked to poor physical functioning based on the four outcomes. Analyses were done separately for males and females, and for 40- to 49-, 50- to 59-, and 60- to 69-year-old groups. Multinomial regression was used to analyze differences between fitness thirds in outcome variables. ROC analyses were significant for all outcomes (AUC 0.686-0.834, P<0.001). In the total group, cut-off values for estimated VO<inf>2max</inf> were 29.9-30.2 mL/kg/min, and for walking distance, 588.0-599.5 m. Cut-off values decreased with age, and mean differences between males and females were 3.3 mL/kg/min and 33 m. All cut-off values were within ±1.3 mL/kg/min of the lower fitness tertile. The odds ratios of having poor physical functioning in the middle and high fitness thirds were less than 0.50 compared to low fitness third. VO<inf>2max</inf> of 30 mL/kg/min and 600-m walking distance seemed reasonable cut-off values for poor physical functioning. Exceeding the currently proposed thresholds is a desirable goal to avoid consequences of insufficient fitness.

Bioelectrical impedance analysis (BIA) phase angle in stroke patients: A systematic review

Background and AimsPhase angle (PhA), a raw variable of bioelectrical impedance analysis (BIA), is an index of muscle structure and quality and might have a potential role in the evaluation of nutritional status.The aim of this systematic review was to evaluate in stroke patients: baseline PhA and its changes during hospital stay; the association of PhA with clinical features of patients, comorbidities, nutritional status or sarcopenia, and clinical outcomes. MethodsSystematic research on electronic databases (PubMed, Scopus, and Web of Science) up to June 14th, 2024 was performed according to PRISMA checklist.Using PECOS strategy, “P” (patients)=stroke patients, “E” (exposure)=lowest PhA values, “C” (comparison)=versus greatest PhA values, “O” (outcome)=nutritional and clinical outcomes, and “S” (study design)=all study types.Methodological quality was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies (NIH). ResultsEighteen papers met the inclusion criteria, with a low risk of bias. In stroke patients, evidence suggests that PhA was associated with malnutrition, sarcopenia and sarcopenic obesity, as well as with physical function. In addition, patients with low PhA had a longer hospital stay, higher inflammatory status and higher incidence of urinary tract infections and hospital-acquired pneumonia. ConclusionsSelected papers, although not conclusive, show that in acute and subacute stroke patients PhA was inversely associated with malnutrition and poor physical function. PhA could be a marker of health status and disease progression. PhA may be useful in a more comprehensive evaluation of nutritional status to be used for diagnosis and implementing therapy.

Body compositions phenotypes of older adults with COPD.

Changes in nutritional status are important extrapulmonary manifestations of the chronic obstructive pulmonary disease (COPD). The study aimed to assess the prevalence of different body composition phenotypes in older patients with COPD and to investigate the relationship between these phenotypes and the severity of the disease, as well as physical performance of the subjects. The study included 124 subjects aged ≥60 with COPD. In all of them body composition analysis and muscle strength measurement were performed. Additionally, data from patients' medical records were analyzed. Study sample was divided into four groups based on the phenotypic body composition: normal phenotype (N), sarcopenia, obesity and sarcopenic obesity (SO). Incidence of sarcopenia was significantly higher in patients with severe or very severe COPD based on GOLD in comparison with subjects with mild or moderate obstruction (p = 0.043). Participants with sarcopenia, obesity and SO had lower results of the 6-min walk test than subjects with N (225.77 m, 275.33 m, 350.67 m, 403.56 m, respectively). Moreover, sarcopenia and SO had lower results than obesity (p = 0.001, p = 0.041, respectively). Sarcopenia is common in patients with advanced COPD. Sarcopenia and SO are associated with poorer physical performance. All older people with COPD should routinely have their body composition assessed, instead of simply measuring of body weight or body mass index (BMI).

7785 Muscle Strength and Physical Performance Are Closely Related to Muscle Quality Regardless of Muscle Mass or Diabetes Status

Abstract Disclosure: J. Seo: None. I. Jung: None. S. Park: None. D. Lee: None. J. Yu: None. H. Cho: None. K. Kim: None. E. Song: None. K. Kim: None. N. Kim: None. H. Yoo: None. S. Kim: None. K. Choi: None. N. Kim: None. C. Shin: None. Weakness or slowness is essential to define sarcopenia rather than less muscle mass. Myosteatosis is associated with low muscle strength and poor physical performance, and ectopic fat deposition is a characteristic of diabetes (DM). We investigated the association between muscle strength/physical performance and myosteatosis by considering DM status and muscle mass in community-dwelling older adults. A total of 982 subjects (447 men and 535 women) aged 54-83 years in 8th examination of the Korean Genome and Epidemiology Study Ansan cohort participated in this study. Handgrip strength (HSG), 4-m walking velocity (VEL) and 30-Seconds Sit-to-Stand Test (STST) were checked, appendicular skeletal muscle mass (ASM) and total muscle mass (TMM) by DXA were measured. In midthigh CT image, total muscle area (TMA) was measured and categorized into 3 components using Hounsfield Unit (HU): normal-attenuation muscle area (NAMA, 35-100HU), low-attenuation muscle area (LAMA, 0-34HU), and inter/intramuscular adipose tissue (IMAT) area. As muscle quality indices, the NAMA index, LAMA index, and IMAT index were defined by dividing each parameter by TMA. DM was diagnosed by fasting glucose ≥126 mg/dL, 2hr-OGTT glucose ≥200 mg/dL, HbA1c ≥6.5% or anti-diabetic medication. Subjects with DM (38% of total subjects) had higher age and body mass index (BMI) compared to non-DM subjects. Prevalence of low muscle mass (M:&amp;lt;7.0kg/m2, F:&amp;lt;5.4kg/m2 of ASM/height2) was not statistically different by the presence of DM (DM vs non-DM, 11.7% vs 9.7% in men, 3.6% vs 7.6% in women). However, prevalence of low HGS (M:&amp;lt;28kg, F:&amp;lt;18kg) and slow VEL (&amp;lt;1.0m/sec) was higher in DM subjects than non-DM subjects (DM vs non-DM, low HSG: 18.3% vs 5.6% in men, 28.0% vs 17.3% in women, slow VEL: 40.6% vs 30.7% in men, 61.7% vs 46.2% in women). After adjusting for age and BMI, men with DM had lower muscle mass (ASM, ASM/height2,), TMA and NAMA index but higher LAMA index and IMAT index compared to men without DM. Also, men with DM had lower HGS (p=0.001) and poor STST (p=0.008) than men without DM. In women, muscle mass and muscle quality indices were not significantly different with or without DM, but women with DM had worse STST than women without DM (p=0.013). Age and sex adjusted HSG, but not VEL and STST, was positively associated with muscle mass (ASM, ASM/height2, ASM/BMI, and TMM). Age and sex adjusted HSG, VEL, and STST were positively associated with NAMA index and negatively associated with LAMA index and IMAT index regardless of DM. Linear regression analysis revealed that both ASM and NAMA (or LAMA) indices were independent association factors for HGS. Subjects with DM showed a more pronounced decrease in physical performance and muscle strength than a decrease in muscle mass. In this population-based cohort, less myosteatosis was associated with greater muscle strength and better physical performance, regardless of muscle mass or DM status. Presentation: 6/2/2024

Ability of Heart Rate Recovery and Gait Kinetics in a Single Wearable to Predict Frailty: Quasiexperimental Pilot Study.

Aging is a risk factor for falls, frailty, and disability. The utility of wearables to screen for physical performance and frailty at the population level is an emerging research area. To date, there is a limited number of devices that can measure frailty and physical performance simultaneously. The aim of this study is to evaluate the accuracy and validity of a continuous digital monitoring wearable device incorporating gait mechanics and heart rate recovery measurements for detecting frailty, poor physical performance, and falls risk in older adults at risk of falls. This is a substudy of 156 community-dwelling older adults ≥60 years old with falls or near falls in the past 12 months who were recruited for a fall prevention intervention study. Of the original participants, 22 participants agreed to wear wearables on their ankles. An interview questionnaire involving demographics, cognition, frailty (FRAIL), and physical function questions as well as the Falls Risk for Older People in the Community (FROP-Com) was administered. Physical performance comprised gait speed, timed up and go (TUG), and the Short Physical Performance Battery (SPPB) test. A gait analyzer was used to measure gait mechanics and steps (FRAIL-functional: fatigue, resistance, and aerobic), and a heart rate analyzer was used to measure heart rate recovery (FRAIL-nonfunctional: weight loss and chronic illness). The participants' mean age was 74.6 years. Of the 22 participants, 9 (41%) were robust, 10 (46%) were prefrail, and 3 (14%) were frail. In addition, 8 of 22 (36%) had at least one fall in the past year. Participants had a mean gait speed of 0.8 m/s, a mean SPPB score of 8.9, and mean TUG time of 13.8 seconds. The sensitivity, specificity, and area under the curve (AUC) for the gait analyzer against the functional domains were 1.00, 0.84, and 0.92, respectively, for SPPB (balance and gait); 0.38, 0.89, and 0.64, respectively, for FRAIL-functional; 0.45, 0.91, and 0.68, respectively, for FROP-Com; 0.60, 1.00, and 0.80, respectively, for gait speed; and 1.00, 0.94, and 0.97, respectively, for TUG. The heart rate analyzer demonstrated superior validity for the nonfunctional components of frailty, with a sensitivity of 1.00, specificity of 0.73, and AUC of 0.83. Agreement between the gait and heart rate analyzers and the functional components of the FRAIL scale, gait speed, and FROP-Com was significant. In addition, there was significant agreement between the heart rate analyzer and the nonfunctional components of the FRAIL scale. The gait and heart rate analyzers could be used in a screening test for frailty and falls in community-dwelling older adults but require further improvement and validation at the population level.

The Association Between Patient-Level Factors and Physical Function in Lung Transplant Recipients

Purpose: Despite the dramatic improvement in pulmonary function after lung transplantation, lung transplant recipients often have reduced physical function. The purpose of this study was to investigate the associations between physical function and a wide range of patient-level factors among lung transplant recipients to allow researchers and health care providers to identify and better understand contributors to poor physical function. Methods: A cross-sectional study of lung transplant recipients enrolled in Lung Transplant Go, a randomized, controlled trial evaluating the efficacy of a telerehabilitation behavioral exercise intervention on physical function. Data were collected at the time of study enrollment for physical function using the 30-second sit-to-stand (STS-30) test, and patient-level factors included discharge destination, time since transplant, hospital length of stay, participation in exercise program outside the study, comorbidities, psychological distress, and symptoms. Regression analysis was performed to identify the association between physical function and patient-level factors. Results: A total of 72 lung transplant recipients with a mean age of 56 years (13), 58% male and 88% White, completed the STS-30 test. The bivariate analysis identified factors associated with STS-30 performance, which are age, marital status, time since transplant, Questionnaire for Lung Transplant Patients' activity intolerance subscale, and psychological distress. Factors that significantly predicted STS-30 performance using the regression analysis were age, time since transplant, and psychological distress (P &lt; .05). Conclusions: Age, time since lung transplantation, and psychological distress significantly predicted poor physical function. Interventions to prevent poor physical function after lung transplantation should consider these factors. Research is needed to better understand patient-level factors on other physical function measures.

Predictors Of Handgrip Strength And Its Relationship To Physical Performance In Older Irish Adults

Abstract Background Handgrip strength declines with age and predicts poor physical performance and increased risk of falls and mortality. However, the strength of the relationship between handgrip strength and other physical measures is less well studied. We aimed to explore the predictors of handgrip strength in older Irish adults and its relationship to the Timed and Up and Go (TUG). Methods Study participants were from a longitudinal cohort of Irish adults aged &amp;gt;60 years; Trinity Ulster University Department of Agriculture (TUDA) study. Participants on current or long-term steroids, a history of stroke and with MMSE &amp;lt;24 were excluded. Handgrip strength was assessed with a dynamometer and defined as &amp;lt;27 kg for males and &amp;lt;16 kg for females. Abnormal performance in the TUG was defined as &amp;gt;12 seconds. Predictors of impaired handgrip were explored in multivariate logistic regression. Results There were 748 participants (68.9% female, mean age 70.2 years), of whom 33.4% had abnormal handgrip strength, which was more common in female’s vs males (39.4 vs 20.2%, p&amp;lt;0.001). Both abnormal handgrip strength and TUG was present in 13.6%. Normal handgrip strength had a negative predictive value of 76.0% for ruling out poor TUG, while abnormal handgrip had a positive predictive value of 62% for poor TUG. Predictors of impaired handgrip strength were older age (P&amp;lt;0.0001), female sex (p&amp;lt;0.0001), lower protein intake (P=0.024) and higher waist hip ratio (p=0.014). Conclusion Handgrip strength had a modest correlation with TUG A significant proportion had abnormal TUG but normal handgrip. Changes in lower limb muscle strength (affecting TUG) precede muscle loss in the upper limb. Higher protein intake predicted greater grip strength and supports the recommendation to maintain adequate intakes to prevent sarcopenia. Greater waist hip ratio is associated with reduced lean muscle mass which may explain the negative relationship we identified with handgrip strength.

Association between dynapenic obesity phenotypes and physical performance in middle-age and older women living in community.

Dynapenic obesity (DO) is the coexistence of excess adipose tissue/body weight and low muscle strength. This condition is associated with an increased risk of suffering from various chronic diseases and physical deterioration in older people. To analyze the association between DO phenotypes and physical performance in middle-aged women living in the community. This cross-sectional study was conducted on middle-aged and older women (≥50 years) residing in Guayaquil, Ecuador. Dynapenia was diagnosticated by a handgrip strength (HGS) < 16 kg; obesity was determined based on body mass index (BMI) ≥ 30 kg/m2. Participants were categorized into four groups based on their dynapenia and obesity status: non-dynapenic/non-obesity (ND/NO), obesity/non-dynapenic (O/ND), dynapenic/non-obesity (D/NO) and dynapenic/obesity (D/O). Physical performance was assessed by the Short Physical Performance Battery (SPPB). A total of 171 women were assessed. The median (IQR) age of the sample was 72.0 (17.0) years. Obesity and dynapenia were 35% (n = 60) and 57.8% (n = 99) of the participants, respectively. The prevalence of ND/NO was 25.1% (n = 43), O/ND 17% (n = 29), D/NO 39.8% (n = 68) and DO 18.1% (n = 31). The mean SPPB total score was 6.5 ± 3.2. Participants of D/NO and DO groups presented significantly lower mean SPPB scores (p < 0.001) compared to those of NO/ND and O/ND groups. Women with DO and D/NO exhibited significantly lower SPPB scores, indicating poorer physical performance. These findings emphasize the importance of incorporating a comprehensive assessment of muscle strength and obesity in middle-aged and older women.

Dietary protein intake and its association with physical fitness test among older adults with pre-sarcopenia and sarcopenia: A cross-sectional study.

Low protein intake and physical inactivity are factors that associated with muscle deterioration and poor physical performance among older adults. To assess the association between dietary protein intake and physical fitness tests among older adults with pre-sarcopenia and sarcopenia. A total of 110 older adults were recruited through a convenience sampling method. Data including sociodemography, anthropometry, body composition, medical history, and dietary protein intake were obtained through the interview-administered method. Most of the subjects have low household income (<RM 3030) (90%), Malay ethnicity (66.4%), and are married (64.5%). 74.55% of the subjects were pre-sarcopenic, whereas 25.45% were sarcopenic. Those with sarcopenia were mostly underweight (± 21.78 kg/m2), whereas those with pre-sarcopenia had a slightly higher Body Mass Index (BMI) (± 27.30 kg/m2). Both men and women did not meet the dietary protein requirement (± 43.86 g/ day) based on the Recommended Nutrient Intake (RNI) of 2017. Moreover, both pre-sarcopenic and sarcopenic subjects have reduced functional ability. Although no significant differences were found in the Short Physical Performance Battery (SPPB) score, those with sarcopenia had poorer physical performance than those with pre-sarcopenia (82.1% versus 69.5%). Apart from that, there was a significant association between the 2-min step test (2MST) and dietary protein intake among those with pre-sarcopenia (r-value = 0.252). In conclusion, lifestyle interventions among older adults are important, including ensuring adequate protein intake and encouraging appropriate physical activity to enhance muscle mass, strength, and performance to improve their daily life efficiency and quality of life.

Digital music and movement intervention to improve health and wellbeing in older adults in care homes: a pilot mixed methods study

BackgroundLow physical activity among older adults is related to adverse health outcomes such as depression and loneliness, poor physical function and increased risk of falls. This study was designed to increase physical activity through a digital, group-based, physical activity and music intervention and to examine its effectiveness on social, mental and physical health outcomes.MethodsParticipants were 34 older adults (65 years +) recruited across four care homes in Scotland to a pilot study. Surveys were administered at baseline and post-intervention, comprising measures of fear of falling, depression and anxiety, loneliness, sleep satisfaction and quality of life. A battery of physical function tests and saliva sampling for cortisol and dehydroepiandrosterone hormone analysis were also conducted at each time point. Additionally, process evaluation measures (recruitment, intervention fidelity, attendance, retention rates and safety) were monitored. The intervention comprised 12 weeks of three prescribed digital sessions per week: movement and music (n = 2) and music-only (n = 1), delivered by an activity coordinator in the care home. Post-intervention interviews with staff and participants were conducted to gain qualitative data on the acceptability of the intervention.ResultsAn average of 88% of prescribed sessions were delivered. Pre- to post-intervention intention-to-treat analysis across all participants revealed significant improvements in anxiety, salivary DHEA, fear of falling and loneliness. There were no significant improvements in health-related quality of life, perceived stress, sleep satisfaction or physical function tests, including handgrip strength. Qualitative analysis highlighted benefits of and barriers to the programme.ConclusionsThe digital movement and music intervention was deemed acceptable and delivered with moderate fidelity, justifying progression to a full-scale trial. Although a proper control group would have yielded more confident causal relationships, preliminary psychosocial and biological effects were evident from this trial. To show significant improvements in physical function, it is likely that a bigger sample size providing sufficient power to detect significant changes, greater adherence, longer intervention and/or higher exercise volume may be necessary.Trial registrationThe trial is registered at ClinicalTrials.gov, number NCT05601102 on 01/11/2022.

Association of Hormonal Exposures With Grip Strength in Women >45 Years: Data From the CONSTANCES Cohort Study.

Although biological findings show that estrogens are beneficial for muscular mass maintenance and bone resorption inhibition, the association of hormonal exposure with physical performance are controversial. We investigated the association of reproductive history and exogenous hormone use with hand-grip strength (GS) in women. Using the data from the CONSTANCES French prospective population-based cohort study, we ran linear mixed models to investigate the association of reproductive history and exogenous hormones use with maximal GS in 37 976 women aged 45 to 69 years recruited between 2012 and 2020. We used multiple imputation by chained equations to control missing values and corrections for multiple testing. The mean age of women was 57.2 years. Mean GS was 26.6 kg. After adjustment for age and confounders, GS increased with age at menarche (β+1 year = 0.14; 95% CI, 0.10-0.17) and duration of breastfeeding (β for ≥10 months vs <5 months = 0.39; 95% CI, 0.20-0.59; P for linear trend <.01). Compared to nonmenopausal women, postmenopausal women had significantly lower GS (β = -0.78; 95% CI, -0.98 to -0.58). GS was negatively associated with hormone therapy (HT) past use (β = -0.25; 95% CI, -0.42 to -0.07). Our results suggested that menopausal transition was strongly associated with lower GS. However, despite our hypothesis, increased age at menarche and duration of breastfeeding were associated with higher GS and HT past users presented lower GS than HT never users. These findings could help identify women at high risk of poor physical performance.

Prevalence and incidence of pelvic organ prolapse, bowel and urinary dysfunction in the Integrated Woman's Health Program

ObjectiveDespite its high prevalence, little information is available on the natural history of pelvic floor dysfunction. We aimed to determine the prevalence, incidence and persistence of pelvic organ prolapse (POP), bowel and urinary symptoms over 6–7 years and its associated factors. Study designWomen from a midlife cohort in Asia completed baseline and 6–7-year follow-up assessments. Sociodemographic characteristics and health conditions were obtained at baseline using validated questionnaires. Body mass index (BMI) and physical performance were objectively measured. Main outcome measuresPOP, bowel, and urinary dysfunction were measured using the Pelvic Floor Distress Inventory Short Form 20 at both timepoints. Binary logistic regression was used to analyze independent associations between baseline risk factors and prevalent, new, and persistent symptoms. ResultsOf the 1201 women enrolled at baseline, 62.3 % had symptoms in at least one domain of pelvic floor dysfunction. Poor sleep, poorer perceived health, and disability were associated with prevalent pelvic floor symptoms, while poor sleep doubled the adjusted risk of incident POP (adjusted odds ratio, aOR: 2.3, 95 % Confidence Interval: 1.4–3.9), bowel (aOR: 2.3, 1.4–3.7) and urinary (aOR: 1.7, 1.1–2.9) symptoms at the 6.6-year follow-up visit. Postmenopausal women had reduced risks of prevalent POP (aOR: 0.5, 0.3–0.7) and urinary symptoms (aOR: 0.4, 0.3–0.6), as well as a reduced risk of developing incident urinary symptoms (aOR: 0.4, 0.2–0.8). Good physical performance scores at baseline reduced the risk of incident bowel symptoms (aOR: 0.5, 0.2–0.9), whereas obesity increased the risks of persistent symptoms. ConclusionPoor sleep quality independently predicted incident pelvic floor dysfunction, while poor physical performance was associated with incident bowel symptoms.

Descriptive Study on the Relationship between Dyspnea, Physical Performance, and Functionality in Oncology Patients.

Cancer is a leading cause of morbidity and mortality globally. Dyspnea, affecting up to 60% of cancer patients, exacerbates physical and psychological distress, reducing quality of life. This study aims to explore the relationship between dyspnea and factors such as age, sex, clinical diagnosis, and treatment lines in cancer patients, with the goal of improving understanding and management of this debilitating symptom to enhance patient care and quality of life. This study employed an observational, cross-sectional, and descriptive approach to investigate patients with oncological disease at the University Hospital of Salamanca between March 2021 and April 2024. A convenience sample was selected, including patients over 18 years old with a pathological diagnosis of cancer, experiencing any degree of dyspnea, and who consented to participate by signing the informed consent. Exclusion criteria included lack of consent and clinical conditions that prevented an interview. The studied variables encompass sociodemographic (age, gender, diagnosis, tumor stage, number of treatment lines) and clinical aspects (daily activities, degree of dyspnea, functional capacity, physical performance), evaluated using the Barthel Index, the mMRC Dyspnea Scale, the ECOG Scale, and the Short Physical Performance Battery (SPPB). Data were collected through semistructured interviews and medical records, and analyzed using specialized software. This research has ethical approval CEiM Code 2023 12 1472, Reference 2024/01. The mean age was 66.82 years. Lung cancer was predominant (60.2%), with most patients in stage 3 (65.7%) and receiving three treatment lines (68.7%). Higher age, advanced disease stage, and more treatment lines correlated with lower Barthel and SPPB scores, and higher ECOG and mMRC scores, indicating worse functionality, physical performance, and greater dyspnea. No significant correlations were found between gender or pathological diagnosis and the studied variables. Advanced age, higher disease stage, and more treatment lines are associated with decreased functionality, poorer physical performance, and increased dyspnea in cancer patients. Gender and specific cancer diagnosis do not significantly affect these relationships. Addressing dyspnea is crucial to improving the quality of life and physical performance in this population. Future studies should explore additional factors like treatment types and nutritional status.

Type 2 Diabetes and Fracture Risk in Older Women

The reasons for the increased fracture risk in type 2 diabetes (T2D) are not fully understood. To determine if poorer skeletal characteristics or worse physical function explain the increased fracture risk in T2D. This prospective observational study is based on the population-based Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone Fractures study cohort of older women, performed in the Gothenburg area between March 2013 and May 2016. Follow-up of incident fracture data was completed in March 2023. Data analysis was performed between June and December 2023. Data were collected from questionnaires and through examination of anthropometrics, physical function, and bone measurements using bone densitometry (dual-energy x-ray absorptiometry), and high-resolution peripheral computed tomography. A subsample underwent bone microindentation to assess bone material strength index (BMSi). Baseline assessment of bone characteristics and physical function and radiograph verified incident fractures. Of 3008 women aged 75 to 80 years, 294 women with T2D (mean [SD] age, 77.8 [1.7] years) were compared with 2714 women without diabetes (mean [SD] age, 77.8 [1.6] years). Women with T2D had higher bone mineral density (BMD) at all sites (total hip, 4.4% higher; femoral neck (FN), 4.9% higher; and lumbar spine, 5.2% higher) than women without. At the tibia, women with T2D had 7.4% greater cortical area and 1.3% greater density, as well as 8.7% higher trabecular bone volume fraction. There was no difference in BMSi (T2D mean [SD], 78.0 [8.3] vs controls, 78.1 [7.3]). Women with T2D had lower performance on all physical function tests. The study found 9.7% lower grip strength, 9.9% slower gait speed, and 13.9% slower timed up-and-go time than women without diabetes. During a median (IQR) follow-up of 7.3 (4.4-8.4) years, 1071 incident fractures, 853 major osteoporotic fractures (MOF), and 232 hip fractures occurred. In adjusted (for age, body mass index, clinical risk factors, and FN BMD) Cox regression models, T2D was associated with an increased risk of any fracture (HR, 1.26; 95% CI, 1.04-1.54) and MOF (HR, 1.25; 95% CI, 1.00-1.56). In this cohort study of older women, T2D was associated with higher BMD, better bone microarchitecture, and no different BMSi but poorer physical function, suggesting that poor physical function is the main reason for the increased fracture risk in T2D women.

Psychosocial and emotional well-being of Syrian refugee children and adolescents in Jordan: In-camp versus out-of-camp comparative analysis.

There is a notable gap in understanding how different living arrangements influence the psychosocial and emotional well-being of Syrian refugee children and adolescents. Moreover, limited literature exists on the comparison between in-camp and out-of-camp living situations. The aim of this study was to compare the psychosocial and emotional status between camp and non-camp Syrian refugee children and adolescents living in Jordan. A nationwide school survey was conducted in Jordan from December 2022 to April 2023 and targeted children (8-11 years) and adolescents (12-18 years), encompassing Jordanians, Syrians, and Palestinians, both in camps (camp refugees) and urban areas (urban refugees). In this paper, the analysis was limited to Syrian refugees. A total of 1,420 children and 1,249 adolescents were included. Children in camps had higher rates of hyperactivity (12.7% vs 8.3%) and total difficulties (19.3% vs 13.9%) compared to urban dwellers. However, they had lower rates of bedtime problems (12.8% vs 17.0%) and problematic internet use (19.9% vs 34.8%). Camp adolescents had higher rates of separation anxiety disorder (44.0% vs 37.8%) and conduct problems (22.2% vs 15.0%), but lower rates of poor physical functioning (43.3% vs 52.3%) compared to urban adolescents. Adjusted analysis showed lower odds of generalized anxiety disorder (OR=0.59), problematic internet use (OR=0.39), and bedtime problems (OR=0.67) for camp children. However, they had higher odds of emotional symptoms (OR=1.47), hyperactivity (OR=2.08), and overall difficulties (OR=1.50). Camp adolescents had higher odds of overall difficulties (OR=1.49) but lower odds of poor physical functioning (OR=0.67) compared to urban adolescents. In conclusion, children in refugee camps had lower rates of problematic internet use and bedtime issues but higher rates of hyperactivity and overall difficulties than urban children. Similarly, camp adolescents faced more total difficulties but reported better physical functioning than their urban peers. The complex interplay between living conditions and well-being underscores the need for tailored mental health interventions for displaced populations.

Sleep Composition of Patients With Colorectal Cancer and Their Sleep-Partner Caregivers: Physical Health Correlates of Sleep Diary and Actigraphy Measurements.

Disturbed sleep is frequently identified in adult patients with cancer and their caregivers, with detrimental impact on physical health. Less known is the extent to which self-reported and actigraph-measured sleep patterns are similar between patients and their sleep-partner caregivers, and how these different modes of sleep measurements are related to physical health. Patients diagnosed with colorectal cancer and their sleep-partner caregivers (81 dyads) completed a questionnaire for physical functioning and collected saliva samples for seven consecutive days, from which cortisol slope was quantified. Additionally, participants completed a daily sleep diary and wore actigraph for 14 consecutive days, from which sleep duration, sleep onset latency (SOL), and duration of wake after sleep onset (WASO) were calculated. Participants reported sleep patterns that fell within or close to the optimal range, which were similar between patients and their caregivers. Self-reported and actigraph-measured sleep duration had moderate levels of agreement (ICC=0.604), whereas SOL and WASO had poor agreement (ICC=0.269). Among patients, longer self-reported WASO was associated with poorer physical health and flatter cortisol slope (p≤0.013). Among caregivers, longer self-reported SOL was associated with poorer physical functioning, actigraph-measured WASO was associated with steeper cortisol slope, and longer self-reported sleep markers studied than actigraph-measured were associated with poorer physical functioning (p≤0.042). Findings suggest that employing multiple assessment modes for sleep and physical health is vital for comprehensive understanding of sleep health. Furthermore, when addressing patients' sleep health, it may be beneficial to include their sleep-partner caregivers who may experience similar disturbed sleep.

Objective and self-reported assessment of sleep quality during each trimester of pregnancy: A prospective observational study

ObjectivesStudies on actual circumstances of sleep in pregnant women are limited to surveys of self-reported symptoms, and objective assessments are missing. Sleep disturbances due to hormonal imbalances are common during pregnancy. This study aimed to assess sleep quality by objective assessment using an actigraph and by self-reported assessment using a questionnaire for sleep during each trimester of pregnancy and to elucidate how sleep quality changed from the first to the third trimester of pregnancy. Study designA longitudinal questionnaire survey was administered and sleep measurements using an actigraph were recorded at three time points during the first, second, and third trimesters in primiparous women who had conceived naturally. ResultsDuring the first trimester, “feeling of being refreshed when waking up in the morning” was not noted, and a decline was observed in mental function. During the second trimester, a positive correlation was observed between morning sickness and sleep quality. ConclusionsSleep quality was the worst during the third trimester, with the shortest total sleep time and poor sleep efficiency, along with poor physical function scores. Back pain and leg cramps significantly correlated with sleep efficiency in the third trimester. Poor sleep during pregnancy begins in the first trimester. If minor problems, such as morning sickness, continue in the second trimester, sleep quality is greatly affected. Furthermore, during the third trimester of pregnancy, low back pain and leg cramps are more likely to occur due to an increase in the abdominal area and may interfere with sleep.

Relationship of total sagittal spinal alignment index of thoracic kyphosis and lumbar lordosis with physical function in community-dwelling older adults

ABSTRACT Background Overall spinal curvature is evaluated by calculating the difference between the angles of lumbar lordosis (LL) and thoracic kyphosis (TK) and is expressed as LL minus TK (LL-TK). It is unclear whether LL-TK is associated with physical function in community-dwelling older adults and whether it is more relevant than TK or LL alone. Objective This study aimed to identify whether LL-TK is associated with physical function in community-dwelling older adults, and whether it is strongly associated than TK or LL alone. Methods The participants comprised 1,674 community-dwelling older adults who underwent physical assessments (women, n = 1,099; mean age, 67.4 ± 5.3 years). As spinal alignment indices, TK and LL were measured using skin surface methods, and LL-TK was calculated as the difference between them. Decreased LL-TK indicated increased overall spinal curvature. Physical function was determined by measuring single-leg standing, five-times chair-stand, and usual gait speed. Stepwise multiple regression analyses were performed with each physical function as the dependent variable and spinal alignment indices as the independent variables, with adjustments. Results Multiple regression analyses showed that single-leg standing (β = 0.092, 95% confidence interval [CI] = 0.071 to 0.214, p < .001) and five-times chair-stand (β=-0.142, 95% CI = −0.037 to −0.019, p < .001) were significantly associated with LL-TK, but not LL. Both LL-TK (β = 0.121, 95% CI = 0.001 to 0.004, p < .001) and LL (β = 0.087, 95% CI = 0.001 to 0.003, p = .003) were significant determinants of usual gait speed. Conclusions This study showed that decreased LL-TK may be associated with poor physical function. This association may be stronger than that observed for TK or LL alone.

Coronary artery disease management in older adults: revascularization and exercise training.

The mean age of patients with coronary artery disease (CAD) is steadily increasing. In older patients, there is a tendency to underutilize invasive approach, coronary revascularization, up-to-date pharmacological therapies, and secondary prevention strategies, including cardiac rehabilitation. Older adults with CAD commonly exhibit atypical symptoms, multi-vessel disease involvement, complex coronary anatomy, and a higher presence of risk factors and comorbidities. Although both invasive procedures and medical treatments are characterized by a higher risk of complications, avoidance may result in a suboptimal outcome. Often, overlooked factors, such as coronary microvascular disease, malnutrition, and poor physical performance, play a key role in determining prognosis, yet they are not routinely assessed or addressed in older patients. Historically, clinicians have relied on sub-analyses or observational findings to make clinical decisions, as older adults were frequently excluded or under-represented in clinical studies. Recently, dedicated evidence through randomized clinical trials has become available for older CAD patients. Nevertheless, the management of older CAD patients still raises several important questions. This review aims to comprehensively summarize and critically evaluate this emerging evidence, focusing on invasive management and coronary revascularization. Furthermore, it seeks to contextualize these interventions within the framework of improved risk stratification tools for older CAD patients, through user-friendly scales along with emphasizing the importance of promoting physical activity and exercise training to enhance the outcomes of invasive and medical treatments. This comprehensive approach may represent the key to improving prognosis in the complex and growing patient population of older CAD patients.

The association between neighborhood disadvantage and patient-reported outcomes in burn survivors

BackgroundBurns can cause long-term complications including pain and poor physical function. While neighborhood disadvantage is associated with burn severity, its effect on long-term complications has not been investigated. We hypothesized that patients from areas of higher area of deprivation index (ADI) will report poorer long-term outcomes. MethodsWe linked patient data from the Burn Model System with ADI state decile (1 = least, 10 = most disadvantaged) using year and residence at time of injury. We performed bivariate analyses to identify associations between ADI and patient and burn characteristics and multivariate regressions to determine whether ADI was associated with PROMIS-29 pain and physical function 6- and 24-months post-burn. ResultsWe included 780 patients; 69 % male, median age = 46 years, median ADI = 6, and median TBSA = 8 %. Multivariate regressions adjusting for TBSA, race, age, sex, anxiety, depression, and pain interference demonstrated that higher ADI was a significant predictor of higher pain intensity 6- (p = 0.001) and 24-months (p = 0.037) post-burn but not worse physical function 24-months post-burn (p = 0.089). ConclusionsHigher neighborhood disadvantage was associated with higher long-term pain intensity post-burn. This study highlights the importance of socioeconomic factors that may impact long-term outcomes and the use of aggregate markers to identify patients at risk for worse outcomes.