Short Physical Performance Battery Score Research Articles

The effectiveness of video-based exercise training program for people with intellectual disability: a multicenter study

ObjectiveTo examine the effectiveness of a specially designed video-based exercise program in promoting physical and balance performance in people with intellectual disability.MethodsThis study was a multicenter controlled trial. Participants with intellectual disability were divided into exercise group and control group by cluster sampling. The participants in the exercise group received 1 h exercise training sessions twice a week for 8 weeks, and the controls continued their usual care without exercise training. The exercises were specially designed to match the physical ability level of the participants classified as high and low, and a third group called “special” was designed for those wheelchair-bound persons with limited mobility. Elements of light-tempo music and animation were introduced in the videos to motivate the participants. Recording the exercises in video format makes it easier for the class instructors and participants to perform the exercises together, and ensure consistency across different exercise groups conducted in different centers. Each participant underwent the pre- and post-intervention assessment including 30-s chair stand repetitions, five-time chair stand duration, 4-m comfortable walk time, standing static balance level, 6-min walk test, and short physical performance battery score. These variables were compared within each group at pre- and post-intervention stages, and they were also compared between the two groups.ResultsA total of 180 participants were enrolled in 16 subcenters, including 160 participants in the exercise group and 20 participants in the control group. After 8 weeks of exercise training, there were significant improvements in their physical performance including 30-s chair stand repetitions and five-time chair stand duration, 4-m comfortable walk time and also 6-min walk test, within the exercise group (all P < 0.05). Approximately 39% of the participants in the exercise group also showed significant improvement in standing static balance level. No significant differences were found when compared with the control group participants who did not have any regular exercise participation.ConclusionA specially designed video-based exercise program has demonstrated some positive effects on physical and balance performance after 8 weeks of training among adults with intellectual disability.

Collaborative Care for Injured Older Adults

Older adults with recent injuries can have impaired long-term biopsychosocial function and may benefit from interventions adapted to their needs. To determine if a collaborative care intervention, Trauma Medical Home (TMH), improved the biopsychosocial function of older patients in the year after injury. This was a single-blinded, randomized clinical trial conducted at 4 level I trauma centers in Indianapolis, Indiana, and Madison, Wisconsin. Between October 2017 and October 2021, patients aged 50 years and older with an Injury Severity Score (ISS) of 9 or greater and without traumatic brain or spinal cord injury were enrolled. Exclusions were significant brain injury or a spinal cord injury with a persistent neurologic deficit at the time of enrollment, extensive burns, pregnancy, incarceration, neurodegenerative disease, visual or auditory impairment that would preclude study participation, a life expectancy of less than 1 year, significant alcohol or drug use history, and acute stroke during admission. Of 10 276 patients screened, 430 were randomized and 299 completed 12-month follow-up. Data were analyzed from March to July 2023. Intervention patients received 6 months of TMH delivered by a nurse care coordinator guided by an interdisciplinary team (trauma surgeon, pulmonary critical care and geriatrician physicians, nurses, and psychologist) in partnership with primary care. The care coordinator used standard protocols to monitor and treat biopsychosocial symptoms. Primary outcomes were Medical Outcome Study Short Form-36 (SF-36) score and Short Physical Performance Battery (SPPB) score at 12 months. Secondary outcomes were Patient Health Questionnaire-9 (PHQ-9) score, the Generalized Anxiety Disorder scale-7 (GAD-7) score, and health care utilization. A total of 429 participants (228 [53.1%] female; mean [SD] age, 69.3 [10.8] years; mean [SD] ISS, 12.3 [4.6]) completed baseline assessments and were randomized. Follow-up was 76% (n = 324) at 6 months and 70% (n = 299) at 12 months. There were no differences between the TMH and usual care groups at 12 months in SF-36 Physical Component Summary score (mean [SD], 40.42 [12.82] vs 39.18 [12.43]), SF-36 Mental Component Summary score (mean [SD], 53.92 [10.02] vs 53.21 [10.82]), or SPPB score (mean [SD], 8.00 [3.60] vs 8.28 [3.88]). Secondary outcomes were also no different. Planned subgroup analysis revealed patients with baseline symptoms of anxiety or depression (high GAD-7 and PHQ-9 scores) experienced improvement in the Mental Component Summary score when randomized to the TMH intervention. The TMH intervention did not significantly influence quality of life, depressive and anxiety symptoms, or physical function of older adults with injury at 12 months. Subgroup analysis showed positive impact in patients with a high burden of anxiety and depression symptoms at enrollment. Collaborative care interventions may improve long-term outcomes of select patients, but further research is needed. ClinicalTrials.gov Identifier: NCT03108820.

Frailty and poor physical functioning as risk factors for driving cessation

IntroductionFrailty and low physical performance are modifiable factors and, therefore, targets for interventions aimed at delaying driving cessation (DC). The objective was to determine the impact of frailty and physical performance on DC.MethodsMultisite prospective cohort of older drivers. The key inclusion criteria are as follows: active driver age 65–79 years, possessing a valid driver’s license, without significant cognitive impairment, and driving a 1996 car or a newer model car. Of the 2,990 enrolled participants, 2,986 (99.9%) had at least one frailty or Short Physical Performance Battery (SPPB) measure and were included in this study. In total, 42% of participants were aged 65–69 years, 86% were non-Hispanic white, 53% were female, 63% were married, and 41% had a high degree of education. The Fried Frailty Phenotype and the Expanded Short Physical Performance Battery (SPPB) from the National Health and Aging Trends Study were utilized. At each annual visit, DC was assessed by the participant notifying the study team or self-reporting after no driving activity for at least 30 days, verified via GPS. Cox proportional hazard models, including time-varying covariates, were used to examine the impact of the SPPB and frailty scores on time to DC. This assessment included examining interactions by sex.ResultsSeventy-three participants (2.4%) stopped driving by the end of year 5. Among women with a fair SPPB score, the adjusted hazard ratio (HR) of DC was 0.26 (95% confidence interval (CI) 0.10–0.65) compared to those with a poor SPPB score. For those with a good SPPB score, the adjusted HR of DC had a p-value of <0.001. Among men with a fair SPPB score, the adjusted hazard ratio (HR) of DC was 0.45 (95% CI 0.25–0.81) compared to those with a poor SPPB score. For men with a good SPPB score, the adjusted HR of DC was 0.19 (95% CI 0.10–0.36). Sex was not an effect modifier between frailty and DC. For those who were categorized into pre-frail or frail, the adjusted ratio of HR to DC was 6.1 (95% CI 2.7–13.8) compared to those who were not frail.Conclusion and relevanceFrailty and poor physical functioning are major risk factors for driving cessation. Staying physically active may help older adults to extend their driving life expectancy and mobility.

Foot problems in older adults presenting to a Falls and Balance Clinic.

Foot problems, including musculoskeletal problems, peripheral neuropathy, peripheral arterial disease and dermatologic pathology are common in older adults and are associated with increased risk of falling. Multicomponent podiatry interventions have been shown to reduce the incidence of falls. This paper aims to identify older adults requiring podiatry input in a Falls and Balance clinic; to describe the model of foot health care they receive; to explore cross-sectional associations between foot problems and function and ultimately demonstrate the role of podiatry input in the multidisciplinary management of falls risk. Cohort study of patients attending a Falls and Balance Clinic for Comprehensive Geriatric Assessment. Demographic information was collected and functional independence, mobility, foot problems and footwear were assessed in clinic. One-hundred and two patients were included; median age 79.3 [73-84.3] years, 68.6% female, 93.1% residing independently, 62.7% used a gait aid. Podiatry referrals were made in 80.4% of cases, with muscle weakness being the most common problem identified (90.2%); 74.8% were found to be wearing inappropriate footwear. Most patients received footwear education and half were prescribed foot and ankle strengthening exercises. Hallux and lesser toe weakness were associated with lower Short Physical Performance Battery scores (p<0.001). The majority of older adults in the Falls and Balance Clinic required podiatry input, with foot weakness and inappropriate footwear being common reasons for referral. Those with weakness of the hallux and lesser toes had poorer balance and mobility, which is known to be associated with greater falls risk. This highlights the need for podiatry assessment and interventions as part of the multidisciplinary approach to the management of falls risk in older adults.

Abstract PO1-12-11: How do chemotherapy and age affect physical performance in breast cancer patients over 12 months of treatment? Results from the UPBEAT Study (UPBEAT WF-97415)

Abstract Introduction: Chemotherapy-associated functional decline is a concern for women with breast cancer. Objective: To assess effects of chemotherapy and age on objectively measured physical performance among women with breast cancer over time. Methods: Analyses utilized the multicenter, longitudinal Understanding and Predicting fatigue, cardiovascular decline, and events after BrEast cAncer sTudy (UPBEAT), a study conducted through the Wake Forest NCORP Research Base (5UG1CA189824). We examined physical performance at baseline and at 3 and 12 months and compared means across time by age group (< 65 years v. 65+ years at baseline) and by cancer/control group. For the latter variable, we had 3 groups of participants: 1) newly diagnosed breast cancer patients with Stage 1-3 breast cancer who received chemotherapy (CC; n= 201); 2) newly diagnosed breast cancer patients receiving no chemotherapy (CNC; n=57); and age-matched healthy controls (HC; n=145). The primary outcome was the Short Physical Performance Battery (SPPB) score (range 0-12, worst to best performance, including chair stands, gait speed, and balance testing). Effects of cancer/control group, age group, and time (treated categorically rather than ordinally) were estimated in a mixed model with a random subject effect and fixed effects of time (baseline, 3 month, 12 month) and cancer/control group. In the model we included all first-order interactions as well as the one second-order interaction between all three predictors. We also used linear contrasts to compare estimated means within groups. Analyses were conducted in SAS 9.4. A two-tailed alpha of 0.05 was used throughout to denote statistical significance. Results: Among 403 patients accrued through the Wake Forest Research Base of NCORP, 201 were in the CC group, and 18.9% of these were aged 65 and older; 57 were in the CNC group, and 33.3% were older; and 145 were in the HC group, and 15.9% were 65 or older. We observed a significant (p< 0.0001) main effect of older age group in our model: across all 3 groups, and all 3 time points, those who were 65 years of age or older had worse SPPB scores than those who were younger. Healthy controls tended to have better mean scores than the other 2 cancer/control groups, though the main effect of group did not achieve statistical significance (p=0.06). We observed no significant interaction terms; in other words, the effect of being older (in terms of association with worse SPPB scores) did not vary by time or group. Within the CC group, both the older and the younger groups declined significantly (p=0.04) in mean SPPB at 3 months compared to baseline, but by 12 months, the means had returned to their starting points. No other groups showed significant changes over time. Conclusions: Chemotherapy was associated with decline in SPPB score over the 12-month time period regardless of age. Older adults, regardless of chemotherapy status and time point, had lower SPPB scores. Citation Format: Shirley Bluethmann, Beverly Levine, Brianna Leitzelar, Katherine Ansley, Alexandra Thomas, Nancy Avis, Gregory Hundley, Heidi Klepin, Kathryn Weaver, Glenn Lesser. How do chemotherapy and age affect physical performance in breast cancer patients over 12 months of treatment? Results from the UPBEAT Study (UPBEAT WF-97415) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-12-11.

Physical performance strongly predicts all-cause mortality risk in a real-world population of older diabetic patients: machine learning approach for mortality risk stratification

BackgroundPrognostic risk stratification in older adults with type 2 diabetes (T2D) is important for guiding decisions concerning advance care planning.Materials and methodsA retrospective longitudinal study was conducted in a real-world sample of older diabetic patients afferent to the outpatient facilities of the Diabetology Unit of the IRCCS INRCA Hospital of Ancona (Italy). A total of 1,001 T2D patients aged more than 70 years were consecutively evaluated by a multidimensional geriatric assessment, including physical performance evaluated using the Short Physical Performance Battery (SPPB). The mortality was assessed during a 5-year follow-up. We used the automatic machine-learning (AutoML) JADBio platform to identify parsimonious mathematical models for risk stratification.ResultsOf 977 subjects included in the T2D cohort, the mean age was 76.5 (SD: 4.5) years and 454 (46.5%) were men. The mean follow-up time was 53.3 (SD:15.8) months, and 209 (21.4%) patients died by the end of the follow-up. The JADBio AutoML final model included age, sex, SPPB, chronic kidney disease, myocardial ischemia, peripheral artery disease, neuropathy, and myocardial infarction. The bootstrap-corrected concordance index (c-index) for the final model was 0.726 (95% CI: 0.687–0.763) with SPPB ranked as the most important predictor. Based on the penalized Cox regression model, the risk of death per unit of time for a subject with an SPPB score lower than five points was 3.35 times that for a subject with a score higher than eight points (P-value <0.001).ConclusionAssessment of physical performance needs to be implemented in clinical practice for risk stratification of T2D older patients.

Exploring previously used thresholds for computed tomography-defined low skeletal muscle mass in predicting functional limitations among lung cancer patients.

Various cutoffs have been used to diagnose computed tomography (CT)-defined low skeletal muscle mass; however, the impact of this variability on predicting physical functional limitations (PFL) remains unclear. In the present study we aimed to evaluate the diagnostic test metrics for predicting PFLs using a fixed cutoff value from previous reports and sought to create a prediction score that incorporated the skeletal muscle index (SMI) and other clinical factors. In this cross-sectional study including 237 patients with lung cancer, the SMI was assessed using CT-determined skeletal muscle area at the third lumbar vertebra. Physical function was assessed using the short physical performance battery (SPPB) test, with PFL defined as an SPPB score ≤9. We analyzed the diagnostic metrics of the five previous cutoffs for CT-defined low skeletal muscle mass in predicting PFL. The mean age of participants was 66.0 ± 10.4 years. Out of 237 patients, 158 (66.7%) had PFLs. A significant difference was observed in SMI between individuals with and without PFLs (35.7 cm2/m2 ± 7.8 vs. 39.5 cm2/m2 ± 8.4, p < 0.001). Diagnostic metrics of previous cutoffs in predicting PFL showed suboptimal sensitivity (63.29%-91.77%), specificity (11.39%-50.63%), and area under the receiver operating characteristic curve (AUC) values (0.516-0.592). Age and the SMI were significant predictors of PFL; therefore, a score for predicting PFL (age - SMI + 21) was constructed, which achieved an AUC value of 0.748. Fixed cutoffs for CT-defined low skeletal muscle mass may inadequately predict PFLs, potentially overlooking declining physical functions in patients with lung cancer.

Relationship between cachexia and short physical performance battery scores in patients with heart failure attending comprehensive outpatient cardiac rehabilitation.

Heart failure (HF) can cause metabolic imbalances, leading to anabolic resistance and increased energy expenditure, which often results in weight loss and cachexia. Comprehensive cardiac rehabilitation (CR), including exercise, nutritional support, and risk management, is crucial for enhancing the health and quality of life of patients with HF and is expected to play a central role in the prevention and treatment of HF-associated cachexia. However, the prevalence of cachexia in patients with HF undergoing comprehensive outpatient CR is currently unknown, and the detailed characteristics including of motor function of such patients remain undefined. Therefore, this cross-sectional study aimed to investigate the prevalence and characteristics of cachexia and the relationship between cachexia and lower limb motor function in patients with HF undergoing outpatient CR. This study included 115 consecutive patients with HF (43% male; mean age, 78 ± 8years) who underwent comprehensive outpatient CR. The cachexia status was assessed according to the definition proposed by the Asian Working Group on Cachexia in 2023. The Short Physical Performance Battery (SPPB) and Mini Nutritional Assessment Short-Form (MNA-SF) were used to evaluate motor function of the lower limbs and nutritional status, respectively. Multivariate logistic regression analyses were used to examine the potential relationship between cachexia and low SPPB scores (≤ 9 points). The prevalence of cachexia was 30% in this study. Compared with those without cachexia, patients with cachexia were significantly older and showed notable reductions in body mass index, MNA-SF scores, handgrip strength, gait speed, and SPPB scores. A multivariate logistic regression analysis, adjusted for confounders, revealed that both age (odds ratio [OR], 1.129; 95% confidence interval [CI], 1.034-1.248; P = 0.016) and presence of cachexia (OR, 3.783; 95% CI, 1.213-11.796; P = 0.022) were independently associated with low SPPB scores. These findings highlight the importance of focusing on cachexia in patients with HF as part of a comprehensive outpatient CR and may be crucial in developing treatments to improve lower limb motor function in patients with HF who develops cachexia.

Usefulness of the serum creatinine/cystatin C ratio as a blood biomarker for sarcopenia components among age groups in community-dwelling older people: The SONIC study.

The serum creatinine/cystatin C ratio (CCR) or sarcopenia index is considered a useful marker of muscle mass. However, its usefulness in late-stage older adults remains unclear. We aimed to determine the usefulness of CCR as an indicator of sarcopenia in community-dwelling Japanese adults aged >75 years. Our study recruited participants aged 70, 80, and 90 ± 1 years during the baseline years, and included a 3-year follow-up in the Septuagenarians, Octogenarians, Nonagenarians, Investigation with Centenarians study. From 2015 to 2018, 955 participants were eligible: 367 in their 70s, 304 in their 80s, and 284 in their 90s. The diagnostic components of sarcopenia, including "low muscle mass, plus low muscle strength, and/or low physical performance," were evaluated using the bioelectrical impedance analysis-measured skeletal muscle mass index (SMI), handgrip strength, and short physical performance battery (SPPB) score, respectively, in accordance with the Asia Working Group for Sarcopenia 2019 criteria. Separate analyses were performed between each component and CCR, adjusting for sex, body mass index, and other blood biomarkers in each group. The relationship between CCR and sarcopenia components was significant for handgrip strength (β = 0.21, 0.13, 0.19, and P < 0.0001, =0.0088, <0.0001, for the 70s, 80s, and 90s age groups, respectively); however, it was limited for SMI (β = 0.14; P = 0.0022, only for the 90s) and not significant for the SPPB score. CCR is a limited indicator of sarcopenia in late-stage older adults. Although its association with muscle strength was significant, its relationship with muscle mass and physical performance was less pronounced. Geriatr Gerontol Int 2024; ••: ••-••.

Effect of a 12-week nutritional intervention in the food intake of patients on the waiting list for liver transplantation: A secondary analysis of a randomized controlled trial

BackgroundInadequate food intake contributes to malnutrition in patients with cirrhosis on the waiting list for liver transplantation (LTx). ObjectiveTo evaluate food intake during 12 weeks of nutritional follow-up and assess factors independently associated with the difference between caloric and protein intake in LTx patients. MethodsA secondary analysis of data from a randomized controlled trial that evaluated the effects of HMB supplementation in patients on a liver transplant waiting list. Dietary guidelines for patients with cirrhosis were used to prescribe the nutritional plan (35kcal/kg; 1.5g/kg dry weight for protein) and to evaluate the nutritional goals (30kcal/kg; 1.2g/kg dry weight for protein). Food intake was assessed in six moments: Baseline, week 0(W0), week 2(W2), week 4(W4), week 8(W8), and week 12(W12). ResultsForty-seven patients (55.0±10.6y;72.3% male) were evaluated. Only 25.5% (n=12) of patients achieve nutritional goals at the end of the study. The mean energy intake in baseline was 1782±784kcal (27.6±13.2kcal/kg) without difference between times. The protein intake increased between week W0 [63.4±29.8g; 0.8(0.2-2.2g/kg)] and W8 [72.0±28.0g; 1.0(0.4–2.6g/kg); p=0.03; p=0.03, respectively]. The consumption of cholesterol, calcium, phosphorus, magnesium, iron, and niacin increased (p<0.05), as well as the consumption of the leguminous; roots and tubers; dairy; and meat, poultry, and fish groups through the time (p<0.05). The presence of ascites, patients nourished, frailty index classification, short physical performance battery score, systemic symptoms, and emotional function were independently associated with the caloric intake difference W12-Baseline (p<0.05). Diabetes mellitus, patients with moderately malnourishment, poor performance, fatigue, systemic symptoms, and emotional function were independently associated with the difference in protein intake between W12-Baseline (p<0.05). ConclusionPatients on the liver transplant waiting list showed slight food intake improvement during the follow-up, but few met nutritional guidelines. Various clinical and nutritional factors independently affected energy and protein intake from W12 to baseline.

Partially supervised exercise programmes for fall prevention improve physical performance of older people at risk of falling: a three-armed multi-centre randomised controlled trial

BackgroundFalls have a major impact on individual patients, their relatives, the healthcare system and related costs. Physical exercise programmes that include multiple categories of exercise effectively reduce the rate of falls and risk of falling among older adults.MethodsThis 12-month, assessor-blinded, three-armed multicentre randomised clinical trial was conducted in adults aged ≥ 65 years identified as at risk of falling. Four hundred and five participants were randomly allocated into 3 groups: experimental group (n = 166) with the Test&Exercise partially supervised programme based on empowerment delivered with a tablet, illustrated manual and cards, reference group (n = 158) with the Otago partially supervised programme prescribed by a physiotherapist delivered with an illustrated manual and control group (n = 81) with the Helsana self-administrated programme delivered with cards. Experimental and reference groups received partially supervised programmes with 8 home sessions over 6 months. Control group received a self-administered program with a unique home session. The 3 groups were requested to train independently 3 times a week for 12 months. Primary outcome was the incidence rate ratio of self-reported falls over 12 months. Secondary outcomes were fear of falling, basic functional mobility and balance, quality of life, and exercise adherence.ResultsA total of 141 falls occurred in the experimental group, 199 in the reference group, and 42 in the control group. Incidence rate ratios were 0.74 (95% CI 0.49 to 1.12) for the experimental group and 0.43 (95% CI 0.25 to 0.75) for the control group compared with the reference group. The Short Physical Performance Battery scores improved significantly in the experimental group (95% CI 0.05 to 0.86; P = 0.027) and in the reference group (95% CI 0.06 to 0.86; P = 0.024) compared with the control group.ConclusionThe self-administered home-based exercise programme showed the lowest fall incidence rate, but also the highest dropout rate of participants at high risk of falling. Both partially supervised programmes resulted in statistically significant improvements in physical performance compared with the self-administered programme.Trial registrationNCT02926105. ClinicalTrials.gov. Date of registration: 06/10/2016.

IMPROVE-BMT: A Pilot Randomized Controlled Trial of Prehabilitation Exercise for Adult Hematopoietic Stem Cell Transplant Recipients.

Background: There is limited evidence on the effects of aerobic and resistance training exercise interventions to improve physical function and patient-reported outcomes prior to autologous and allogeneic hematopoietic stem cell transplant (HSCT). IMPROVE-BMT was a single-site, pilot randomized controlled trial investigating the feasibility, acceptability, and safety of a pragmatic resistance training exercise program prior to HSCT compared to usual HSCT care. Secondary aims included differences in physical function between the exercise group (EX) and usual care control group (UC). Methods: Outcome measurements were assessed: prior to HSCT, on/around day of HSCT admission, +30 days post-HSCT, and +100 days post-HSCT. The exercise intervention was a home-based exercise program that incorporated resistance-band and bodyweight exercises. Results: Acceptability among participants was 83%; exercise adherence averaged at 92%; and there were zero exercise-related adverse or serious adverse events. The average pre-transplant exercise phase was 6.28 weeks (2.71-18.29 weeks). EX (n = 36) demonstrated larger increases in the six-minute walk test distance, short physical performance battery scores, and 30-s chair stands compared to UC (n = 38) and demonstrated significant within-group improvements for the six-minute walk test, the short physical performance battery, the 30-s chair stands, and the timed up-and-go test. Conclusions: IMPROVE-BMT demonstrates that pragmatic exercise is highly feasible for HSCT recipients and can potentially lead to enhanced recovery that may not be achievable in non-exercisers.

Effectiveness of physical therapy on physical activity and employment status in kidney transplant recipients in their sixties: a case report with literature review

BackgroundFew reports have been published on preoperative and long-term postoperative rehabilitation after kidney transplantation. Poor physical function after kidney transplantation is associated with adverse events; hence, physical function should be improved postoperatively. We report a case in which physical therapy was provided just before the operation and 12 months postoperatively to improve physical performance.Case presentationA 64-year-old man, working as a janitor and maintenance worker at a driving school, received a living-donor kidney transplant from his wife. The just before the operation assessment revealed a decline in his physical function, indicating he had become frail. Accordingly, physical therapy was initiated prior to kidney transplantation. Subsequently, his Short Physical Performance Battery score improved from 10 to 12, and his knee extension muscle strength improved from 0.38 to 0.43 kgf/kg, enabling him to resume work. The work functioning impairment scale improved from 13 to 7.ConclusionsThis case reveals that just before the operation and long-term rehabilitation is crucial in enhancing physical activity in kidney transplantation patients. Although this focused rehabilitation approach holds promise, evaluating its efficacy requires the examination of a larger cohort of cases.

Prevalence of Sarcopenia in Chronic Heart Failure and Modulating Role of Chronic Kidney Disease

Introduction: Sarcopenia, heart failure (HF), and chronic kidney disease (CKD) are common among the older people. Our objective was to evaluate the frequency of sarcopenia, among community-dwelling older adults with HF, possible causative factors, and the additive factor of CKD. Methods: A cross-sectional analysis of 1,420 older people living in the community was carried out. Participants (aged 75 years and more) came from a European multicenter prospective cohort (SCOPE study). Global geriatric assessment including short physical performance battery, handgrip strength test, and bioelectrical impedance analysis was performed. Previous known HF was defined as physician-diagnosed HF registered in the patient’s medical record or the use of HF-related medications, regardless of left ventricular ejection fraction (LVEF). Sarcopenia was defined by the updated criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). Estimated glomerular filtration rate was calculated using Berlin Initiative Study (BIS) to define the stages of CKD. Two-year mortality was also collected. Results: A total of 226 (15.9%) participants had a prior chronic HF diagnosis, with a median age of 80.0 (5.0), and 123 (54.4%) were women. Using EWGSOP2 definition, 11.5% HF and 10.7% in non-HF participants met diagnostic criteria for sarcopenia. In multivariate analyses, only a lower body mass index (BMI) (odds ratios [OR], 0.82; 95% confidence interval [CI], 0.73–0.93) and lower short physical performance battery score (OR, 0.81; 95% CI, 0.69–0.96) were associated with sarcopenia. Patients with HF and sarcopenia have a similar all-cause mortality risk but higher 2-year cardiovascular mortality risk (p = 0.047). Discussion/Conclusion: One out of ten community-dwelling older adults with concurrent clinical stable chronic HF, without considering LVEF, have sarcopenia. Lower BMI and poor physical performance are associated with sarcopenia in this population, but not CKD.

Home-based mobile-guided exercise-based cardiac rehabilitation among patients undergoing transcatheter aortic valve replacement (REHAB-TAVR): protocol for a randomised clinical trial

IntroductionTranscatheter aortic valve replacement (TAVR) is a standard treatment for aortic stenosis, particularly in older adults. Reduced exercise capacity and frailty significantly impact outcomes in TAVR patients, yet current management...

Bone involvement in the early stages of Parkinson's disease: a case-control study.

To evaluate the qualitative and quantitative alterations of bone tissue in patients with early-stage Parkinson's disease (PD) and to measure the associations between bone mineral density (BMD), trabecular bone score (TBS) and physical performance. This case-control study enrolled patients with early-stage PD and age-matched controls. BMDs for the left femoral neck (L-FN) and lumbar spine (LS) were measured. Bone microarchitecture for the LS was determined using TBS. Muscle performance was assessed using the short physical performance battery (SPPB). Patients and controls were stratified in two groups based on the SPPB score: a poor performance group (SPPB score ≤8) and high performance group (SPPB > 8). This study included 26 patients: 13 in the PD group and 13 age-matched controls. The mean ± SD BMD results in the PD group were: L1-L4 BMD = 0.935 ± 0.183 g/cm2; L-FN BMD = 0.825 ± 0.037 g/cm2; with bone microarchitecture degraded in four patients and partially degraded in three patients. TBS was significantly different in the patients with PD stratified according to SPPB. Among the controls, there was a significant difference in body mass index between the two SPPB groups. TBS might identify bone involvement earlier than BMD in the initial stages of PD.

Short physical performance battery is not associated with falls and injurious falls in older persons: longitudinal data of the SCOPE project.

Falls and fall-related injuries in older persons are a major public health problem. Our objective was to study the predictive value of the Short Physical Performance Battery (SPPB) in the cohort of the SCOPE project on falls, injurious falls, and possible difference of prediction between indoors and outdoors falls. For this sub-study of the SCOPE project participants reporting no falls at baseline, and survey data on falls at the 12-month and 24-month follow-up were included. Participant´s characteristics were assessed during the baseline interview and medical examinations. Falls as well as injurious falls and fall circumstances were obtained self-reported. SPPB and its association with fallers vs. no fallers at 12 and at 24months were studied with logistic regression models. The 1198 participants had a median age of 79years (77-82), and a median SPPB of 10 (8-11), with a 52.5% of female. A total of 227 and 277 falls (12- and 24- month visits, respectively) were reported. In the crude model, the SPPB sum scores (p < 0.001) as well as most single item scores were significant different between fallers and non-fallers over time. However, the association was attenuated in models adjusted for age, sex, marital status, number of medications, quality of life, handgrip strength, and muscle mass [e.g., 12months; OR 0.94 (0.87-1.02)]. While SPPB fails to differentiate between injurious and non-injurious falls (p = 0.48), a lower SPPB score was associated with falls at home (p < 0.01) after 24months. SBPP was not able to significantly predict the risk of falling as well as experiencing an injurious fall. This study was registered prospectively on 25th February 2016 at clinicaltrials.gov (NCT02691546).

Association Between the Length of Leukocyte Telomeres and Functional Performance of Older Adults: Observational Study.

Despite current literature pointing to a link between shortened telomeres and aging, chronic diseases, and geriatric syndromes, the precise implications of this connection remain unclear. The aim of this exploratory, cross-sectional, observational study was to investigate the association between the relative telomere length (RTL) of peripheral blood leukocyte subtypes (mononuclear cells and granulocytes) and physical performance using the Short Physical Performance Battery (SPPB) in older adults. A cohort of 95 participants was recruited, which included men and women aged over 60 years (70.48 ± 5.5 years). It was found that mononuclear cell RTL was significantly lower than that of granulocytes (p < 0.0001). Moreover, individuals with good SPPB performance exhibited lower mononuclear cell RTL compared with those with moderate or poor performance. However, no significant differences were observed in granulocyte RTL between different SPPB performance groups. The global SPPB score showed an inverse correlation with mononuclear cell RTL, but this correlation was not present with granulocyte RTL. Similarly, the SPPB sit-to-stand domain correlated with mononuclear cell RTL, but no such correlation was found with granulocyte RTL. Our findings challenge conventional expectations, suggesting that shorter mononuclear cell RTL may be associated with favorable functional capacity. The variations in RTL between mononuclear cells and granulocytes highlight their distinct biological roles and turnover rates. A history of immune responses may influence mononuclear cell RTL dynamics, while telomerase activity may protect granulocyte RTL from significant shortening. The unexpected associations observed in mononuclear cell RTL emphasize the complex interplay between immune responses, cellular aging, and functional capacity in older adults.

Virtual Physical Prehabilitation in Lung Transplant Candidates: A Proof-of-Concept Study.

This study aimed to preliminary test the effectiveness of 12-week virtual physical prehabilitation program followed by a maintenance phase. The main objective was to estimate the extent to which it affects exercise capacity, frailty, lower limb strength and health-related quality of life (HRQOL) in lung transplant candidates. The program offered supervised strengthening exercises, independent aerobic exercises and weekly phone calls (maintenance phase). Primary outcome was the six-minute walk distance (6MWD). Secondary outcomes: the Short Physical Performance Battery (SPPB), five-times sit-to-stand test (5STS), the St George's Respiratory Questionnaire (SGRQ) for HRQOL. Twenty patients were included (mean age 57.9; 6 women/14 men); fourteen completed the prehabilitation program and 5 completed the maintenance phase. There was no statistically significant improvement in 6MWD, SPPB or SGRQ after the 12-week program. Most patients either maintained or improved the 6MWT and SPPB scores. There was a significant improvement in the 5STS. After the maintenance phase, most patients either improved or maintained their scores in all outcomes except for the sub-score of symptoms in the SGRQ. A 12-week virtual physical prehabilitation program with a 12-week maintenance phase can help lung transplant candidates improve or maintain their physical function while waiting for transplantation.

Prevalence of iron deficiency in patients admitted to a geriatric unit: a multicenter cross-sectional study

BackgroundIron deficiency (ID) is often associated with other comorbidities in older patients and is a factor of morbimortality. However, the prevalence of ID remains poorly documented in this population.MethodsThe CARENFER PA study was a French multicenter cross-sectional study whose objective was to evaluate ID in patients (> 75 years) admitted to a geriatric unit. The primary endpoint was the ID prevalence defined as: serum ferritin < 100 µg/L and/or transferrin saturation coefficient (TSAT) < 20%. The Short Physical Performance Battery (SPPB) test was used to identify older patients at high risk of adverse events (e.g., disability, falls, hospitalization, death).ResultsA total of 888 patients (mean age, 85.2 years; women, 63.5%) from 16 French centers were included from October 2022 to December 2022. The prevalence of ID was 57.6% (95% CI, 54.3–60.9) in the cohort of older patients (62.6% in anemic and 53.3% in non-anemic patients; p = 0.0062). ID prevalence increased significantly with the presence of more than three comorbidities (65.6% vs. 55.9%; p = 0.0274), CRP ≥ 12 mg/L (73.0% vs. 49.3%; p < 0.001) and treatment that may influence ID/anemia (60.5% vs. 49.6%; p = 0.0042). In multivariate analysis, only CRP ≥ 12 mg/L was an independent predictive factor of ID (odds ratio, 2.78; 95% CI, 1.92–4.08; p < 0.001). SPPB scores were low (0–6) in 60.5% of patients with ID versus 48.6% of patients without ID (p = 0.0076).ConclusionMore than half of older patients had ID, including non-anemic patients. ID was associated with the presence of inflammation and a low SPPB score.Trial registrationNCT05514951.