Article

Gait variability related to muscle quality and muscle power in frail nonagenarians in frail older adults

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Abstract

Background: Frailty has become the center of attention of basic, clinical and demographic research because of its incidence level and the gravity of adverse outcomes with age. Moreover, with advanced age, motor variability increases, particularly in gait. Muscle quality and muscle power seem to be closely associated with performance on functional tests in frail populations. Insight into the relationships among muscle power, muscle quality and functional capacity could improve the quality of life in this population. In this study, it was examined the relationship between the quality of the muscle mass and muscle strength with gait performance in a frail population. Methods: Twenty-two institutionalized frail elderly subjects (93.1 ± 3.6) participated in this study. Muscle quality was measured by segmenting areas of high- and low-density fibers as observed in computed tomography images. The assessed functional outcomes were leg strength and power, velocity of gait and kinematic gait parameters obtained from a tri-axial inertial sensor. Findings: Our results showed that a greater amount of high-density fibers, specifically those of the quadriceps femoris muscle, were associated with better gait performance in terms of step time variability, regularity and symmetry. Additionally, gait variability was associated with muscle power. In contrast, no significant relationship was observed between gait velocity and either muscle quality or muscle power. Interpretation: Gait pattern disorders could be explained by a deterioration of the lower limb muscles. It is known that an impaired gait is an important predictor of falls in older populations; thus, the loss of muscle quality and power could underlie the impairments in motor control and balance that lead to falls and adverse outcomes.

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... Frailty is characterized by a high vulnerability to adverse health outcomes such as disability, falls, hospitalization, institutionalization, and mortality [1]. Reduction or impairment of physical function is a prime indicator of frailty [2], and frailty is one of the major reasons for falls in old age [6][7][8][9][10][11][12]. Many definitions of frailty have been proposed: Fried et al. used five criteria (slowness, exhaustion, weakness, low-activity and weight-loss) to identify frailty [2]; Rockwood et al. developed a frailty index based on impairments in cognitive status, mood, motivation, communication, mobility, balance, bowel and bladder function, activities of daily living, nutrition, social resources and number of comorbidities [13]; Mitnitski et al. constructed a frailty index based on 20 deficits as observed in a structural clinical examination based on the comprehensive geriatric assessment (CGA) [14]; Jones et al. also based their frailty index based on CGA which included 10 standard domains to construct a three level frailty index permitting risk stratification of future adverse outcomes [15]; and Chin et al. compared three different working definitions of frailtyinactivity plus low energy intake, inactivity plus weight-loss and inactivity plus low body mass index [16]. ...
... In this study, we aimed to improve detection of frailtyrelated neuromuscular deficits based on gait performance parameters derived from unsupervised DPA. Previous studies have used trunk motion data from supervised inlab gait tests to characterize sensorimotor gait performance among frail elders including gait variability, asymmetry, initiation, and irregularity [11,12,[18][19][20][21][22]. We hypothesized that using more robust measures of unsupervised DPA gait performance such as gait variability, asymmetry and irregularity (instead of number of steps) it would be possible to distinguish between non-frail and pre-frail/frail older adults. ...
... Unbiased auto-correlation coefficients of gait signal, representing left-right step coordination [11,40] Gait Irregularity categories, univariate ANOVA models were used with each gait performance parameter as the dependent variable, and the Fried frailty categories (non-frail and prefrail/ frail) as the independent variable. Subsequently, gait performance parameters were used in a single multivariable nominal logistic model to assess the association between frailty categories and DPA gait performance parameters. ...
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Background: Frailty is a highly recognized geriatric syndrome resulting in decline in reserve across multiple physiological systems. Impaired physical function is one of the major indicators of frailty. The goal of this study was to evaluate an algorithm that discriminates between frailty groups (non-frail and pre-frail/frail) based on gait performance parameters derived from unsupervised daily physical activity (DPA). Methods: DPA was acquired for 48 h from older adults (≥65 years) using a tri-axial accelerometer motion-sensor. Continuous bouts of walking for 20s, 30s, 40s, 50s and 60s without pauses were identified from acceleration data. These were then used to extract qualitative measures (gait variability, gait asymmetry, and gait irregularity) and quantitative measures (total continuous walking duration and maximum number of continuous steps) to characterize gait performance. Association between frailty and gait performance parameters was assessed using multinomial logistic models with frailty as the dependent variable, and gait performance parameters along with demographic parameters as independent variables. Results: One hundred twenty-six older adults (44 non-frail, 60 pre-frail, and 22 frail, based on the Fried index) were recruited. Step- and stride-times, frequency domain gait variability, and continuous walking quantitative measures were significantly different between non-frail and pre-frail/frail groups (p < 0.05). Among the five different durations (20s, 30s, 40s, 50s and 60s), gait performance parameters extracted from 60s continuous walks provided the best frailty assessment results. Using the 60s gait performance parameters in the logistic model, pre-frail/frail group (vs. non-frail) was identified with 76.8% sensitivity and 80% specificity. Discussion: Everyday walking characteristics were found to be associated with frailty. Along with quantitative measures of physical activity, qualitative measures are critical elements representing the early stages of frailty. In-home gait assessment offers an opportunity to screen for and monitor frailty. Trial registration: The clinical trial was retrospectively registered on June 18th, 2013 with ClinicalTrials.gov, identifier NCT01880229.
... These groups of studies show a strong imbalance in favor of studies on activity patterns with the rest of the phenomena having a marginal presence. Even though studies on STS transitions and gait patterns are the most numerous, most of them do not monitor transparent activities: 14 out of 25 STS studies [57][58][59][60][61][62][63][64][65][66][67][68][69][70] and 17 out of 21 gait studies [57,58,63,64,70,72,73,[77][78][79][80][81][82][83][84][85][86] rely on non-transparent activities. ...
... The vast majority (all but one) of the studies relying on non-transparent activities involve an instrumented version of a standardized clinical test. The five repetitions chairstand test (STS5) [57,59,60,[62][63][64][65][66] and the 30-s CST [58,61,[67][68][69][70] in STS studies; the 3 m Walking Test (3-mWT), 4-mWT, 6-minWT, etc. in gait studies [57,58,63,64,70,72,73,[77][78][79][80][81][82][83][84][85][86]; the TUG test in up-and-go studies [59,62,64,[99][100][101][102][103]; the SPPB balance test [57,64], quiet standing test [63], one-foot eyes-closed [58,70] Romberg's test [104,105], or two-feet eyesclosed [86] in balance studies; a weight scale in weight studies [58,70,77]; the SF-36 and mini-GDS [70,77] in studies based on digitized questionnaires; the Jamar dynamometer in grip studies [77]; and the counter movement jump test in leg extension studies [64]. Only the study based on repetitive elbow flexion did not involve a standardized clinical test [112]. ...
... Finally, four studies have used a continuous scale of measurement [83,[88][89][90]. Slowness has been operationalized as speed of gait [51,52,63,73,74,76,83,85]. Different studies have operationalized weakness as the stopwatch measurement in an STS5 test [47,59,60,62], the number of SiSt transitions in a 30-s CST [51,58,61,67], lower limb muscle power [54,55,63,78], and grip strength [50,63,77]. The original Fried scale measured weakness of upper limbs, not lower limbs. ...
Article
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Ubiquity (devices becoming part of the context) and transparency (devices not interfering with daily activities) are very significant in healthcare monitoring applications for elders. The present study undertakes a scoping review to map the literature on sensor-based unobtrusive monitoring of older adults' frailty. We aim to determine what types of devices comply with unobtrusiveness requirements, which frailty markers have been unobtrusively assessed, which unsupervised devices have been tested, the relationships between sensor outcomes and frailty markers, and which devices can assess multiple markers. SCOPUS, PUBMED, and Web of Science were used to identify papers published 2010-2020. We selected 67 documents involving non-hospitalized older adults (65+ y.o.) and assessing frailty level or some specific frailty-marker with some sensor. Among the nine types of body worn sensors, only inertial measurement units (IMUs) on the waist and wrist-worn sensors comply with ubiquity. The former can transparently assess all variables but weight loss. Wrist-worn devices have not been tested in unsupervised conditions. Unsupervised presence detectors can predict frailty, slowness, performance, and physical activity. Waist IMUs and presence detectors are the most promising candidates for unobtrusive and unsupervised monitoring of frailty. Further research is necessary to give specific predictions of frailty level with unsupervised waist IMUs.
... For these reasons, there is a keen interest in determining factors that influence mobility to maximize it as people age (Fried et al., 2001). To this aim, kinematic measurements of mobility (i.e., balance, gait and sit-to-stand) assessed through the use of inertial units (IU) have been investigated and associated to muscle mass and muscle power in frail adults (Martinikorena et al., 2016). ...
... In the case of the 6-m GVT step regularity and predictability in both anterior-posterior and vertical directions were obtained (StepR AP , StepR VT , ApEntAP, ApEnt VT ). Moreover gait asymmetry has also been obtained as explained in (Martinikorena et al., 2016). Finally the range of motion during sit to stand (ROM SiSt ); maximum velocity for sit-to-stand (VelVT SiSt ), maximum power during stand-to-sit (MaxPW SiSt ) and duration of the impulse and sit-to-stand phases (T Imp , T SiSt ) of the 30-s CST were obtained as defined in (N. ...
... The absence of stronger correlations between muscle quality and gait kinematics can be explained because other factors than the muscle quality such as motor control impairments may contribute to the kinematic behaviour of the frail population. These results reinforce the idea that greater muscle mass makes the frail subject have a more predictable and less complex gait, with lower entropy values (De La Cruz Torres et al., 2013;Martinikorena et al., 2016) . In a previous study, the risk of falls in the elderly was evaluated by using the ApEnt parameter (Khandoker et al., 2008). ...
Article
Frailty is an important concept in clinical and demographic research in the elderly because of its incidence level and its relationship with adverse outcomes. Functional ability declines with advanced age, likely due to changes in muscle function. This study aimed to examine the relationship between muscle quality and muscle power with kinematics from functional tests in a population of 21 institutionalized frail nonagenarian (91.3 ± 3.1 years). Here, muscle quality was measured by segmenting areas of high- and low-density fibers with computerized tomography. In addition, muscle strength and muscle power were obtained through maximal strength and power tests using resistance exercises. Finally, functional capacity outcomes (i.e., gait velocity, sit-to-stand ability and balance), as well as kinematic parameters, were evaluated from a tri-axial sensor used during a battery of functional tests. Our results show that lower limb muscle quality, maximal strength and power output present statistically significant relationships with different kinematic parameters, especially during the sit-to-stand and gait tests (e.g. leg power and maximum power during sit-to-stand (r=0.80) as well as quadriceps muscle mass and step asymmetry (r=- 0,71). In particular, frail individuals with greater muscle quality needed less trunk range of motion to make the transition between sitting and standing, took less time to stand up, and exerted a major peak power of force. As a conclusion, a loss of muscle quality and power may lead to motor control impairments such as gait, sit-to-stand and balance that can be the cause of adverse events such as falls.
... It is well established that muscle quality and gait performance are linked (Martinikorena et al. 2016;Pandy and Andriacchi 2010;Scarborough et al. 1999). Several studies report muscular performance varies as a circadian rhythm, like that in core body temperature. ...
... In this study, we studied subjects who were either "moderately morning type" or "neither type" in order to homogenize our results. Jump height exhibited diurnal variation with an acrophase at 18:19 h, which approximates the results usually reported in other studies and confirms the diurnal changes of muscle power during the day that occurs in close synchrony with core body temperature Callard et al. 2000;Gauthier et al. 1996;Martinikorena et al. 2016;Sedliak et al. 2008a;Zbidi et al. 2016). ...
Article
Full-text available
Gait is one of the most basic movements, and walking activity accomplished in dual task conditions realistically represents daily life mobility. Much is known about diurnal variations of gait components such as muscle power, postural control, and attention. However, paradoxically only little is known about gait itself. The aim of this study was to analyze whether gait parameters show time-of-day fluctuation in simple and dual task conditions. Sixteen young subjects performed sessions at five specific hours (06:00, 10:00, 14:00, 18:00 and 22:00 h), performing a single (walking or counting) and a dual (walking and counting) task. When performing gait in dual task conditions, an additional cognitive task had to be carried out. More precisely, the participants had to count backwards from a two-digit random number by increments of three while walking. Spatio-temporal gait parameters and counting performance data were recorded for analysis. Walking speed significantly decreased, while stride length variability increased when the task condition switched from single to dual. In the single-task condition, diurnal variations were observed in both walking speed and counting speed. Walking speed was higher in the afternoon and in the evening (14:00 and 22:00 h) and lower in the morning (10:00 h). Counting speed was maximum at 10:00 and 14:00 h and minimum at 18:00 h. Nevertheless, no significant diurnal fluctuation was substanytiated in the dual task condition. These results confirm the existing literature about changes in gait between single and dual task conditions. A diurnal pattern of single-task gait could also be highlighted. Moreover, this study suggests that diurnal variations faded in complex dual task gait, when the cognitive load nearly reached its maximum. These findings might be used to reduce the risk for falls, especially of the elderly.
... Given the role that MQI plays in function and by measuring MQI from a practical standpoint, may be a fast and inexpensive metric to identify individuals at risk of functional decline (Fragala et al., 2015;Martinikorena et al., 2016;Studenski et al., 2014). Certainly, the strong correlation between field MQI and laboratory MQI measures demonstrated that our hypothesis to identify an index that would be both convenient and effective concurs with previous studies (Chiles Shaffer et al., 2017;Straight et al., 2013) The optimal method to quantify MQI is not clear, but MQI calculation varies in cost, complexity, and availability (Heymsfield et al., 2015). ...
... When considering previous studies, field-based estimates of muscle quality, such as handgrip normalized by BMI, should be considered a valid if not superior substitute for more costly burdensome measures of MQI (Chiles Shaffer et al., 2017;Straight et al., 2013;Studenski et al., 2014). Translational scientists may consider using MQI beyond a metric of muscle strength and may implement MQI as an indicator for physical performance in older adults (Brown et al., 2016;Martinikorena et al., 2016;Shin et al., 2012). ...
Article
Full-text available
Muscle quality (the ratio of strength to lean muscle mass) might be a better indicator of muscle function than strength alone. Differences in muscle quality index (MQI) between octogenarians and young older adults remain unclear. The aims of the present cross-sectional study were to compare (1) MQI between octogenarians and young older adults, (2) lab versus field-based MQI tools, and (3) determine possible confounding factors affecting MQI in older adults. Compiled data from two cross-sectional studies included 175 younger and older adults (31 men and 144 women) with a mean age of 75.93± 9.49 years. Participants with age ≥ 80 years old were defined as octogenarians (n= 79) and < 80 years was defined as young older adults (n= 96). Laboratory MQI was derived from the ratio of grip strength to arm muscle mass (in kg) measured by dual-energy x-ray absorptiometry. Field-based MQI was quantified from the ratio of grip strength to body mass index (BMI). Octoge-narians displayed lower field (P= 0.003) and laboratory MQI (P< 0.001) as compared with young older adults. There was a strong correlation effect between field MQI and laboratory MQI (P= 0.001, R= 0.85). BMI (P= 0.001), and diabetes mellitus (P= 0.001) negatively affected MQI. Women presented lower MQI (P= 0.001) values than men. In light of this information, rehabilitation specialists should consider the use of field-based MQI as a tool for evaluation and follow-up of older population.
... Given the role that MQI plays in function and by measuring MQI from a practical standpoint, may be a fast and inexpensive metric to identify individuals at risk of functional decline (Fragala et al., 2015;Martinikorena et al., 2016;Studenski et al., 2014). Certainly, the strong correlation between field MQI and laboratory MQI measures demonstrated that our hypothesis to identify an index that would be both convenient and effective concurs with previous studies (Chiles Shaffer et al., 2017;Straight et al., 2013) The optimal method to quantify MQI is not clear, but MQI calculation varies in cost, complexity, and availability (Heymsfield et al., 2015). ...
... When considering previous studies, field-based estimates of muscle quality, such as handgrip normalized by BMI, should be considered a valid if not superior substitute for more costly burdensome measures of MQI (Chiles Shaffer et al., 2017;Straight et al., 2013;Studenski et al., 2014). Translational scientists may consider using MQI beyond a metric of muscle strength and may implement MQI as an indicator for physical performance in older adults (Brown et al., 2016;Martinikorena et al., 2016;Shin et al., 2012). ...
Article
Muscle quality (the ratio of strength to lean muscle mass) might be a better indicator of muscle function than strength alone. Differences in muscle quality index (MQI) between octogenarians and young older adults remain unclear. The aims of the present cross-sectional study were to compare (1) MQI between octogenarians and young older adults, (2) lab versus field-based MQI tools, and (3) determine possible confounding factors affecting MQI in older adults. Compiled data from two cross-sectional studies included 175 younger and older adults (31 men and 144 women) with a mean age of 75.93± 9.49 years. Participants with age ≥ 80 years old were defined as octogenarians (n= 79) and < 80 years was defined as young older adults (n= 96). Laboratory MQI was derived from the ratio of grip strength to arm muscle mass (in kg) measured by dual-energy x-ray absorptiometry. Field-based MQI was quantified from the ratio of grip strength to body mass index (BMI). Octoge-narians displayed lower field (P= 0.003) and laboratory MQI (P< 0.001) as compared with young older adults. There was a strong correlation effect between field MQI and laboratory MQI (P= 0.001, R= 0.85). BMI (P= 0.001), and diabetes mellitus (P= 0.001) negatively affected MQI. Women presented lower MQI (P= 0.001) values than men. In light of this information, rehabilitation specialists should consider the use of field-based MQI as a tool for evaluation and follow-up of older population.
... Frailty is characterized by a high vulnerability to adverse health outcomes such as disability, falls, hospitalization, institutionalization, and mortality (1). Reduction or impairment of physical function is a prime indicator of frailty (2), and frailty is one of the major reasons for falls in old age (6)(7)(8)(9)(10)(11)(12). Many (15); and Chin et al compared three different working definitions of frailty -inactivity plus low energy intake, inactivity plus weight-loss and inactivity plus low body mass index (16). ...
... In this study, we aimed to improve detection of frailty-related neuromuscular deficits based on gait performance parameters derived from unsupervised DPA. Previous studies have used trunk motion data from supervised in-lab gait tests to characterize sensorimotor gait performance among frail elders including gait variability, asymmetry, initiation, and irregularity (11,12,(18)(19)(20)(21)(22). We hypothesized that using more robust measures of unsupervised DPA gait performance such as gait variability, asymmetry and irregularity (instead of number of steps) it would be possible to distinguish between non-frail and pre-frail/frail older adults. ...
Preprint
Full-text available
Background : Frailty is a highly recognized geriatric syndrome resulting in decline in reserve across multiple physiological systems. Impaired physical function is one of the major indicators of frailty. The goal of this study was to evaluate an algorithm that discriminates between frailty groups (non-frail and pre-frail/frail) based on gait performance parameters derived from unsupervised daily physical activity (DPA). Methods : DPA was acquired for 48 hours from older adults (≥65 years) using a tri-axial accelerometer motion-sensor. Continuous bouts of walking for 20s, 30s, 40s, 50s and 60s without pauses were identified from acceleration data. These were then used to extract qualitative measures (gait variability, gait asymmetry, and gait irregularity) and quantitative measures (total continuous walking duration and maximum number of continuous steps) to characterize gait performance. Association between frailty and gait performance parameters was assessed using multinomial logistic models with frailty as the dependent variable, and gait performance parameters along with demographic parameters as independent variables. Results : 126 older adults (44 non-frail, 60 pre-frail, and 22 frail, based on the Fried index) were recruited. Step- and stride-times, frequency domain gait variability, and continuous walking quantitative measures were significantly different between non-frail and pre-frail/frail groups ( p
... characterized by a high vulnerability to adverse health outcomes such as disability, falls, hospitalization, institutionalization, and mortality (1). Reduction or impairment of physical function is a prime indicator of frailty (2), and frailty is one of the major reasons for falls in old age (6)(7)(8)(9)(10)(11)(12) (15); and Chin et al compared three different working definitions of frailty -inactivity plus low energy intake, inactivity plus weight-loss and inactivity plus low body mass index (16). Although many definitions of frailty have been proposed, we use Fried's frailty criteria as the most commonly implemented frailty assessment tool in our study. ...
... In this study, we aimed to improve detection of frailty-related neuromuscular deficits based on gait performance parameters derived from unsupervised DPA. Previous studies have used trunk motion data from supervised in-lab gait tests to characterize sensorimotor gait performance among frail elders including gait variability, asymmetry, initiation, and irregularity (11,12,(18)(19)(20)(21)(22). We hypothesized that using more robust measures of unsupervised DPA gait performance such as gait variability, asymmetry and irregularity (instead of number of steps) it would be possible to distinguish between non-frail and pre-frail/frail older adults. ...
Preprint
Full-text available
Background: Frailty is a highly recognized geriatric syndrome resulting in decline in reserve across multiple physiological systems. Impaired physical function is one of the major indicators of frailty. Objective: The goal of this study was to evaluate an algorithm that discriminates between frailty groups (non-frail and pre-frail/frail) based on gait performance parameters derived from unsupervised daily physical activity (DPA). Methods: DPA was acquired for 48 hours from older adults (≥65 years) using a tri-axial accelerometer motion-sensor. Continuous bouts of walking for 20s, 30s, 40s, 50s and 60s without pauses were identified from acceleration data. These were then used to extract qualitative measures (gait variability, gait asymmetry, and gait irregularity) and quantitative measures (total continuous walking duration and maximum number of continuous steps) to characterize gait performance. Association between frailty and gait performance parameters was assessed using multinomial logistic models with frailty as the dependent variable, and gait performance parameters along with demographic parameters as independent variables. Results: 126 older adults (44 non-frail, 60 pre-frail, and 22 frail, based on the Fried index) were recruited. Step- and stride-times, frequency domain gait variability, and continuous walking quantitative measures were significantly different between non-frail and pre-frail/frail groups (p<0.05). Among the five different durations (20s, 30s, 40s, 50s and 60s), gait performance parameters extracted from 60s continuous walks provided the best frailty assessment results. Using the 60s gait performance parameters in the logistic model, pre-frail/frail group (vs. non-frail) was identified with 76.8% sensitivity and 80% specificity. Discussion: Everyday walking characteristics were found to be associated with frailty. Along with quantitative measures of physical activity, qualitative measures are critical elements representing the early stages of frailty. In-home gait assessment offers an opportunity to screen for and monitor frailty.
... Mobility limitations can be caused by an impairment in a body structure and/or function (WHO, 2013). Specifically, lower-limb skeletal muscle power has been demonstrated to be one of the strongest contributors to mobility limitations among older individuals (Bean et al., 2003;Foldvari et al., 2000;Martinikorena et al., 2016). A decrease of one standard deviation in maximal muscle power has been associated to a 27-42% increased likelihood of disability among older people (Kuo et al., 2006). ...
... The maintenance of functional ability during aging and the prevention of frailty is a public health priority (Cesari et al., 2016;WHO, 2015). Lower-limb muscle power represents a critical determinant of mobility limitations and disability in older people (Bean et al., 2003;Foldvari et al., 2000;Kuo et al., 2006;Martinikorena et al., 2016) and physical training to increase lower-limb muscle power has been demonstrated to be able to revert frailty status (Losa-Reyna et al., 2019). Consequently, the development of sensitive screening tools to detect the onset of muscle power decline or to identify critical periods in life in which muscle power is lost at an accelerated rate will allow to implement countermeasures that prevent the onset of frailty and disability, to ultimately improve individuals' quality of life (Katula et al., 2008) and reduce the economic costs associated with skeletal muscle dysfunction (Beaudart et al., 2014;Janssen et al., 2004). ...
Article
Background The 30-s sit-to-stand (STS) muscle power test is a valid test to assess muscle power in older people; however, whether it may be used to assess trajectories of lower-limb muscle power through the adult lifespan is not known. This study evaluated the pattern and time course of variations in relative, allometric and specific STS muscle power throughout the lifespan. Methods Subjects participating in the Copenhagen Sarcopenia Study (729 women and 576 men; aged 20 to 93 years) were included. Lower-limb muscle power was assessed with the 30-s version of the STS muscle power test. Allometric, relative and specific STS power were calculated as absolute STS power normalized to height squared, body mass and leg lean mass as assessed by DXA, respectively. Results Relative STS muscle power tended to increase in women (0.08 ± 0.05 W·kg⁻¹·yr⁻¹; p = 0.082) and increased in men (0.14 ± 0.07 W·kg⁻¹·yr⁻¹; p = 0.046) between 20 and 30 years, followed by a slow decline (−0.05 ± 0.05 W·kg⁻¹·yr⁻¹ and −0.06 ± 0.08 W·kg⁻¹·yr⁻¹, respectively; both p > 0.05) between 30 and 50 years. Then, relative STS power declined at an accelerated rate up to oldest age in men (−0.09 ± 0.02 W·kg⁻¹·yr⁻¹) and in women until the age of 75 (−0.09 ± 0.01 W·kg⁻¹·yr⁻¹) (both p < 0.001). A lower rate of decline was observed in women aged 75 and older (−0.04 ± 0.02 W·kg⁻¹·yr⁻¹; p = 0.039). Similar age-related patterns were noted for allometric and specific STS power. Conclusions The STS muscle power test appears to provide a feasible and inexpensive tool to monitor cross-sectional trajectories of muscle power throughout the lifespan.
... Previous epidemiological studies with older adults identified various associations between established PA parameters under habitual conditions, innovative gait parameters under laboratory conditions and clinically relevant constructs including motor performance (Callisaya et al., 2009;Chale-Rush et al., 2010;DePew, Karpman, Novotny, & Benzo, 2013;Hausdorff, Rios, & Edelberg, 2001;Martinikorena et al., 2016;Mudge & Stott, 2009;Osuka et al., 2015;Pettersson et al., 2017), life-space (Tsai et al., 2015), and psychosocial parameters (Brandler, 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 A c c e p t e d M a n u s c r i p t 7 Wang, Oh-Park, Holtzer, & Verghese, 2012;Kempen, van Haastregt, McKee, Delbaere, & Zijlstra, 2009;Salguero, Martinez-Garcia, Molinero, & Marquez, 2011). Surprisingly, these findings have hardly been used in studies evaluating construct validity of ambulatory PA sensor systems in older adults. ...
... Extreme short as well as long sleeping periods, and consequently both low and high durations of lying, were previously found to be associated with lower motor performance (Reyes, Algarin, Bunout, & Peirano, 2013;Stenholm et al., 2010) while sleep disorders are most prominent in persons with CI (Guarnieri & Sorbi, 2015), as in the present study. (Hausdorff et al., 2001;Martinikorena et al., 2016). ...
Article
Objective: The aim of the study was to investigate the psychometrical quality of a newly developed activity monitor (uSense) to document established physical activity parameters as well as innovative qualitative and quantitative gait characteristics in geriatric patients. Approach: Construct and concurrent validity, test-retest reliability, and feasibility of established as well as innovative characteristics for qualitative gait analysis, have been analyzed in multi-morbid, geriatric patients with cognitive impairment (n=110), recently discharged from geriatric rehabilitation. Main results: Spearman correlations of established and innovative uSense parameters reflecting active behavior with clinically relevant construct parameters were on average moderate to high for motor performance and life-space and low to moderate for other parameters, while correlations with uSense parameters reflecting inactive behavior were predominantly low. Concurrent validity of established physical activity parameters showed consistently high correlations between the uSense and an established comparator system (PAMSysTM) ,but the absolute agreement between both sensor systems was low. On average excellent test-retest reliability for all uSense parameters and good feasibility could be documented. Significance: The uSense monitor allows the assessment of established and -for the first time- a semi-qualitative gait assessment of habitual activity behavior in older persons most affected by motor and cognitive impairment and activity restrictions. On average moderate to good construct validity, high test-retest reliability, and good feasibility indicated a sound psychometrical quality of most measures, while the results of concurrent validity as measured by a comparable system indicated high correlation but low absolute agreement based on different algorithms used. Trial registration number: ISRCTN82378327.&#13.
... In fact, research in healthy older adults has shown strong associations between performance in tests of functional capacity and muscle power output (83)(84)(85). More recently, investigators have found that training for muscle power and explosiveness are also associated with improved functional capacity and a reduction in the incidence of falls in oldest-old populations such as those who are frail and/or institutionalised (84)(85)(86). Muscle power training should be prescribed where possible to both healthy and older individuals with sarcopenia, frailty and other co-morbidities. The combination of power training with slow concentric velocity resistance training optimises functional ability, reduces the incidence of falls, improves muscle strength and power output, and stimulates muscle hypertrophy (27). ...
... In addition, because of the strong associations between functional capacity test performance, muscle power output ,and rate of force development in the healthy older adult (83,86,208,234), explosive resistance training (power training) has emerged as an essential intervention to improve functional capacity in older adults, including those who are frail (25,27). Indeed, in a 12-week multicomponent exercise programme enrolling institutionalised frail nonagenarians and including a moderate-intensity power training (e.g., or at least the intention of moving fast) using a leg-press machine improved muscle cross-sectional area, muscle fat-infiltration, maximal strength and power, balance, gait, sit-to-stand ability, along with a reduction in the incidence of falls (44,69). ...
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The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent.
... In fact, research in healthy older adults has shown strong associations between performance in tests of functional capacity and muscle power output (83)(84)(85). More recently, investigators have found that training for muscle power and explosiveness are also associated with improved functional capacity and a reduction in the incidence of falls in oldest-old populations such as those who are frail and/or institutionalised (84)(85)(86). Muscle power training should be prescribed where possible to both healthy and older individuals with sarcopenia, frailty and other co-morbidities. The combination of power training with slow concentric velocity resistance training optimises functional ability, reduces the incidence of falls, improves muscle strength and power output, and stimulates muscle hypertrophy (27). ...
... In addition, because of the strong associations between functional capacity test performance, muscle power output ,and rate of force development in the healthy older adult (83,86,208,234), explosive resistance training (power training) has emerged as an essential intervention to improve functional capacity in older adults, including those who are frail (25,27). Indeed, in a 12-week multicomponent exercise programme enrolling institutionalised frail nonagenarians and including a moderate-intensity power training (e.g., or at least the intention of moving fast) using a leg-press machine improved muscle cross-sectional area, muscle fat-infiltration, maximal strength and power, balance, gait, sit-to-stand ability, along with a reduction in the incidence of falls (44,69). ...
Article
International Exercise Recommendations in Older Adults: Expert Concensus Guidelines
... With advanced age, there are increases in motor variability, especially in gait (Balasubramanian et al., 2015;Callisaya et al., 2010) and gait variability has been widely related to muscle system impairments (Cesari et al., 2014). Although increased gait variability is already recognized as a predictor of future falls and has been related with muscle power output in frail older adults (Montero-Odasso et al., 2011;Hausdorff, 2007;Martinikorena et al., 2016), the role of muscle power on gait performance has not been previously investigated in hospitalized older adults. Recent studies have examined the association between gait pattern and frailty syndrome (Callisaya et al., 2010;Purser et al., 2006), muscle mass quality , and cognitive impairment in the elderly population. ...
... The gait pattern parameters measured during the 4-m walking test, the GVT and the dual-task gait, which are related to gait disorders in frail older adults (Martinez-Ramirez et al., 2015;Martinikorena et al., 2016), were as follows: step and stride regularity, gait symmetry, gait variability, the signal root mean square (RMS) value, and approximate entropy (ApEn). All these measurements were obtained for three directions: anterior-posterior (AP), medio-lateral (ML), and vertical (V). ...
... The Yesavage GDS [44] and Trail Making part A [45] will be performed to assess depression and executive dysfunction. During functional tasks (such as balance, gait and rising from a chair) and cognitive evaluations (dual tasking), an inertial sensor unit (IU) will be attached over the lumbar spine (L3) to record the acceleration data in control and intervention participants [46,47]. Primary and secondary variables are presented in Table 1. ...
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Background: The benefit of physical exercise in ageing and particularly in frailty has been the aim of recent research. Moreover, physical activity in the elderly is associated with a decreased risk of mortality, of common chronic illnesses (i.e. cardiovascular disease or osteoarthritis) and of institutionalization as well as with a delay in functional decline. Additionally, very recent research has shown that despite its limitations, physical exercise is associated with a reduced risk of dementia, Alzheimer disease or mild cognitive decline. Nevertheless, the effect of a physical exercise as systematic, structured and repetitive type of physical activity, in the reduction of risk of cognitive decline in the elderly, is not very clear. The purpose of this study aims to examine whether an innovative multicomponent exercise programme called VIVIFRAIL has benefits for functional and cognitive status among prefrail/frail patients with mild cognitive impairment or dementia. Methods/Design: This study is a multicentre randomized clinical trial to be conducted in the outpatient geriatrics clinics of three tertiary hospitals in Spain. Altogether 240 patients aged 75 years or older being capable and willing to provide informed consent, with a Barthel Index ≥ 60 and mild cognitive impairment or mild dementia, pre-frail or frail and having someone to help too supervise them when conducting the exercises will be randomly assigned to the intervention or control group. Participants randomly assigned to the usual care group will receive normal outpatient care, including physical rehabilitation when needed. The VIVIFRAIL multicomponent exercise intervention programme consists of resistance training, gait retraining, and balance training which appear to be the best strategy for improving gait, balance and strength, as well as reducing the rate of falls in older individuals and consequently maintaining their functional capacity during ageing. The primary endpoint is change in functional capacity, assessed with the Barthel index of independence (5 points as clinically significant) and the Short Physical Performance Battery (SPPB; 1 point as clinically significant). Secondary endpoints are changes in cognitive and mood status, quality of life (EQ-5D), frailty according to Linda´s Fried criteria , 6-metre gait velocity and changes in gait parameters (i.e., gait velocity and gait variability) while performing a dual-task test (verbal and counting), handgrip, maximal strength and power of the lower limbs as well as Mini Nutritional Assessment (MNA) at baseline and at the one-month and three-month follow up. Discussion: Frailty and cognitive impairment are two very common geriatric syndromes in elderly patients and are frequently related and overlapped. Functional decline and disability are mayor adverse outcomes of these conditions. Exercise is a potential intervention for both syndromes. If our hypothesis is correct the relevance of this project is that the results can contribute to understand that individualized multicomponent exercise programme (VIVIFRAIL) for frail elderly patients with cognitive impairment is more effective in reducing functional and cognitive impairment than conventional care. Moreover, our study may be able to show that an innovative individualized multicomponent exercise prescription for these high-risk populations is plausible having at least with similar therapeutic effects than other pharmacological and medical prescriptions. Trial Registration: ClinicalTrials.gov ID: NCT03657940. https://clinicaltrials.gov/ct2/show/ NCT03657940) Date of registration: September 5, 2018
... Based on the evidence that multicomponent exercise interventions are more effective in improving most, if not all, of the frailty syndrome hallmarks (i.e., poor balance, reduced muscle strength, poor gait ability and increased incidence of falls), it is recommendable that this type of intervention, which includes resistance training, gait retraining and balance exercises, among others (e.g., occupational therapy) be prescribed to prevent frailty syndrome in the elderly, as well as in persons with prefrailty (Cadore et al., 2013;Izquierdo and Cadore, 2014;Lopez et al., 2018a;Lopez et al., 2018b;Arrieta et al., 2019). In addition, because of the strong associations between functional capacity test performance and muscle power output or rate of force development in the healthy elderly Reid and Fielding, 2012;Rech et al., 2014;Martinikorena et al., 2015;Lopez et al., 2017), explosive resistance training has emerged as a more appropriate intervention to improve functional capacity in older adults, including those who are frail . Indeed, in a 12-week multicomponent exercise program including explosive resistance training applied in institutionalized frail nonagenarians, improvements were observed in the muscle cross-sectional area, muscle fat-infiltration, maximal strength, muscle power output, balance, gait and sit-tostand ability, along with a reduction in the incidence of falls (Cadore et al., 2014a). ...
Article
Frailty syndrome encompasses several physical hallmarks such as loss of muscle strength, power output and mass, which leads to poor gait ability, fatigue, falls and overall difficulty to perform activities of daily living. On the other hand, physical exercise interventions induce marked improvements in frailty physical hallmarks (e.g., gait ability, muscle strength, balance and falls). In addition, because cognitive impairment is closely related to frailty syndrome, exercise is an effective intervention to counteract the physical consequences of mild cognitive impairment and dementia. Moreover, exercise and early rehabilitation programs are among the interventions through which functional decline is prevented in older patients during acute hospitalization. This narrative review provides a summary of the effectiveness of different exercise interventions in the hallmarks of frailty. Furthermore, this review addresses special considerations on exercise in frail older with cognitive impairment. Also, we review the role of exercise interventions in acute hospitalized older patients. There is strong evidence that exercise training is an effective intervention for improving muscle strength, muscle mass, incidence of falls, and gait ability in frail older adults. In addition, it seems that multicomponent exercise intervention programs including resistance, gait and balance training is the best strategy for improving the frailty hallmarks, as well as for reducing the rate of falls in frail individuals, and so maintaining their functional capacity during aging. This training modality also proved to be safe and effective to revert the functional decline and cognitive impairment in acutely hospitalized older adults of advanced age. Based on the association between muscle power output and physical function, explosive resistance training should be included in the exercise intervention in order to optimize the functional outcomes in frail older adults.
... Moving the COP beyond the limits of foot support causes loss of balance, which is interfaced with the motor response [47]. A decrease in muscle strength, delay in muscle activation, and slower reaction time affect greater balance disorders [48]. Body balance is considered to be a crucial element of many everyday activities, starting from maintaining a calm position to more complex activities, such as walking during a conversation or a change of the walking direction [49]. ...
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Introduction: Low muscle strength is common and important in geriatric syndromes including frailty and sarcopenia. The epidemiology of grip strength of older people under long-term care facilities has been little explored. Purpose: The aim of this study was to assess handgrip strength of older women and men covered by institutional care and to analyse the associations between HGS and mobility, leg strength, flexibility, and postural balance. Materials and methods: This is a cross-sectional study carried out at care homes in southeastern Poland. After considering the inclusion criteria, 209 older people aged 65 to 85 were included in the study. Sociodemographic data were collected, and tests of muscular strength, mobility, flexibility, and postural balance were carried out by the use of the stabilometric platform CQ Stab 2P. Results: The average handgrip strength in the study group amounted to 19.8 kg, including 14.8 kg in women and 25.9 kg in men. Low grip strength was found in 67.83% women and 52.13% men in institutional care. A negative correlation between handgrip strength (HGS) and the Timed Up and Go (TUG) test was demonstrated, both with and without cognitive task and strength of lower limbs. Gait speed and dynamic balance were positively correlated with HGS. A negative correlation was found between the total length of the centre of pressure (COP) path, the length of the COP path in the lateral-medial direction, and the sway area delimited by the COP and HGS for the dominant hand. Speaking of women, gait speed was most strongly associated with HGS, while among men, it was upper limb flexibility. Conclusion: Regardless of gender, HGS is associated with mobility, strength of the lower limbs, and dynamic balance. By means of simple tools, early diagnosis will facilitate the planning of appropriate interventions in order to prevent disability and mortality in long-term care facilities.
... The measured gait parameters, which have been related to gait disorders 22e24 in frail older adults, 25,26 were as follows: stride regularity, gait symmetry, and gait variability. The measurements were obtained for 3 directions: anterior-posterior, medio-lateral, and vertical. ...
Article
Objectives: To evaluate the effects of an exercise intervention on physical function, maximal muscle strength and muscle power in very old hospitalized patients. Design: In a randomized controlled trial, 130 hospitalized patients were allocated to an exercise intervention (n=65) or a control group (n=65). The intervention consisted of a multicomponent exercise training program performed during 5-7 consecutive days (2 sessions/day). The usual care group received habitual hospital care, which included physical rehabilitation when needed. Setting and participants: Acute Care for Elderly (ACE) unit. Older adults aged>75 years. Measures: Physical function, assessed with the Short Physical Performance Battery (SPPB) test and the Gait Velocity Test (GVT), were the primary endpoints. The GVT was also administered under dual-task conditions (i.e., verbal and arithmetic GVT). The functional tasks were recorded using an inertial sensor unit to determine the movement pattern. The secondary endpoints were maximal muscle strength and muscle power output. Results: The exercise intervention program provided significant benefits over usual care. At discharge (primary time point), the exercise group showed a mean increase of 1.7 points in the SPPB scale (95%CI, 0.98, 2.42) and 0.14 m·s-1 in the GVT (95%CI, 0.086, 0.194) over the usual care group. The intervention also improved the verbal (0.151; 95%CI 0.119, 0.184 vs. -0.001; 95%CI -0.025, 0.033 in the control group) and arithmetic GVT (0.115; 95%CI 0.077, 0.153 vs. -0.004; 95%CI -0.044, 0.035). Significant benefits were also observed in the intervention group in movement pattern, as well as in muscle strength and muscle power. Conclusions and implications: An individualized multicomponent exercise training program improves physical function, maximal muscle strength, and muscle power in acutely hospitalized old patients. These findings support the importance of physical exercise for avoiding the loss of physical functional capacity that frequently occurs during hospitalization in older adults.
... 3 Gait variability is related to multisystem functions such as peripheral and central neural system function, activity of autonomic system especially with cardiac adaptation mechanisms, musculoskeletal system, and psychiatric disorders. 4,5 Previous studies have measured the gait characteristics of individuals with amputations to differentiate the population based on fall history or reason for amputation. 6,7 Vanicek et al. 6 implied that there were differences between the "fallen" and the "not-fallen" individuals with limb loss in relation to swing time duration of the intact limb along with kinematic and kinetic measures, while there were no other differences in spatiotemporal or variability measures of gait. ...
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Purpose:: Gait variability is a determinant of qualified locomotion and is useful for monitoring the effects of therapeutic interventions. The aim of this study was to compare gait variability and symmetry in trained individuals with transtibial (TT) amputation and transfemoral (TF) amputation. Methods:: The design of this study was planned as observational. Eleven individuals with TF amputation, 14 individuals with TT amputation, and 14 healthy individuals (HI) were evaluated with a motorized treadmill. The mean step length, the step length variability, an ambulation index, and the time on each foot (stance phase symmetry) of participants were recorded. Results:: There were differences between the three groups in the residual/non-preferred limb (RNp) step length ( p = 0.031), the intact/preferred (IP) limb step length variability ( p = 0.001), the RNp step length variability ( p < 0.001), the time on each foot ( p < 0.001), and the ambulation index score ( p < 0.001). There was a similarity between the groups (TF, TT, HI) in IP limb step lengths ( p = 0.127) and duration of prosthesis usage since amputation in individuals with lower limb loss ( p = 0.224). Conclusions:: This study provided basic data about gait variability and symmetry in individuals with traumatic lower limb loss. The results of the study showed that the variability of gait increased with the level of loss, and individuals with TT amputation showed partially equivalent performance with the healthy group. Similarities in gait characteristics may have resulted from effective prosthetic usage or effective gait rehabilitation.
... The ability to exert high force at higher velocities show a pronounced and particularly sharp decline with age, with an even more pronounced decline than that in muscle mass and strength (Edwen et al., 2014). This loss of muscle power has been associated with an increased risk of falling and with impairments in quality of life, cognitive function and functional performance (Alcazar et al., 2018;Bean et al., 2002;Martinikorena et al., 2016). Therefore, adopting strategies that aim to preserve or increase muscle power might be of great importance to older people. ...
... One of the main evidence-based strategies to counteract the deleterious effect of aging on functional ability is exercise Tak et al., 2013). Specifically, muscle power capacity has been demonstrated to be a stronger predictor of functional limitations than any other physical capability, such as muscle strength or maximal aerobic capacity (Foldvari et al., 2000;Martinikorena et al., 2016). This makes muscle power evaluation a critical tool for the management of functional trajectories in older people. ...
Article
Introduction: Skeletal muscle power has been demonstrated to be a stronger predictor of functional limitations than any other physical capability. However, no validated alternatives exist to the usually expensive instruments and/or time-consuming methods to evaluate muscle power in older populations. Our aim was to validate an easily applicable procedure to assess muscle power in large cohort studies and the clinical setting and to assess its association with other age-related outcomes. Methods: Forty community dwelling older adults (70-87 years) and 1804 older subjects (67-101 years) participating in the Toledo Study for Healthy Aging were included in this investigation. Sit-to-stand (STS) velocity and muscle power were calculated using the subject's body mass and height, chair height and the time needed to complete five STS repetitions, and compared with those obtained in the leg press exercise using a linear position transducer. In addition, STS performance, physical (gait speed) and cognitive function, sarcopenia (skeletal muscle index (SMI)) and health-related quality of life (HRQoL) were recorded to assess the association with the STS muscle power values. Results: No significant differences were found between STS velocity and power values and those obtained from the leg press force-velocity measurements (mean difference ± 95% CI = 0.02 ± 0.05 m·s-1 and 6.9 ± 29.8 W, respectively) (both p > 0.05). STS muscle power was strongly associated with maximal muscle power registered in the leg press exercise (r = 0.72; p < 0.001). In addition, cognitive function and SMI, and physical function, were better associated with absolute and relative STS muscle power, respectively, than STS time values after adjusting by different covariates. In contrast, STS time was slightly more associated with HRQoL than STS muscle power measures. Conclusion: The STS muscle power test proved to be a valid, and in general, a more clinically relevant tool to assess functional trajectory in older people compared to traditional STS time values. The low time, space and material requirements of the STS muscle power test, make this test an excellent choice for its application in large cohort studies and the clinical setting.
... The ability to exert high force at higher velocities show a pronounced and particularly sharp decline with age, with an even more pronounced decline than that in muscle mass and strength (Edwen et al., 2014). This loss of muscle power has been associated with an increased risk of falling and with impairments in quality of life, cognitive function and functional performance (Alcazar et al., 2018;Bean et al., 2002;Martinikorena et al., 2016). Therefore, adopting strategies that aim to preserve or increase muscle power might be of great importance to older people. ...
Article
Objective: to compare the effects of 12 weeks of high-speed resistance training on functional performance and quality of life in elderly women when using either a traditional-set (TS) or a cluster-set (CS) configuration for inter-set rest. Methods: Three groups of subjects were formed by block-design randomization as follows: (i) control group (CG, n=17; age, 66.5±5.4 years); (ii) 12-week high-speed resistance training group under a CS configuration (CSG, n=15; age, 67.6±5.4 years); and (iii) 12-week high-speed resistance training group under a TS configuration (TSG, n=20; age, 68.0±5.3 years). Training was undertaken three times per week, including high-speed resistance training exercises. The main difference between the training groups was the recovery set structure. In the TSG, women rested for 150 s after each set of eight repetitions, whereas the CSG used an interest rest redistribution, such that after two consecutive repetitions, a 30-s rest was allowed. Results: Group×test interactions were observed for a 10-m walking speed test, an 8-foot up-and-go test, a sit-to-stand test, and physical quality of life (p<0.05; d=0.12-0.81). The main results suggest that both training methods improve functional performance and quality of life, however, the CS configuration induced significantly greater improvements in functional performance and quality of life than the TS configuration. Conclusion: these results should be considered when designing appropriate and better resistance training programs for older adults.
... 5 Similar results were noted in a study performed on nonagenarian adults that identified muscle power output as a factor in gait variability. 6 Investigators in a 2002 study noted that women with a history of falls were 24% less powerful than their peers who had not sustained falls. 7 Initial studies focusing on generational differences among men revealed an 8.3% decrease in maximal anaerobic power per decade. ...
Article
Context: Falls are the second-leading cause of unintentional injury and death worldwide. Objective: To determine if a relationship exists between lower body power scores and center of pressure (CoP) and limits of stability (LoS) scores. Methods: A one-shot case study design (n = 13) was selected for the investigation. All participants were assessed stability scores via computerized posturography to determine CoP and LoS balance scores. Participants stood on a perturbed surface with their eyes open and closed. An experimental stair ramp with a switch mat timing device was used to determine lower body power scores in watts. Results: There was a strong correlation (r = 0.725, p = 0.005) between the posterior (LoS) plane and relative peak power. An intraclass R revealed a strong correlation among the three trials (R = 0.831) performed on the stair ramp. Conclusion: Muscle power output and LoS scores have moderate to strong correlations with balance scores in older adults.
... In this study, we aimed to improve detection of frailty-related neuromuscular deficits based on gait performance parameters derived from unsupervised DPA. Previous studies have used trunk motion data from supervised inlab gait tests to characterize sensorimotor gait performance among frail elders including gait variability, asymmetry, initiation, and irregularity (11,12,(18)(19)(20)(21)(22). We hypothesized that using more robust measures of unsupervised DPA gait performance such as gait variability, asymmetry and irregularity (instead of number of steps) it would be possible to distinguish between non-frail and pre-frail/frail older adults. ...
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Background: Frailty is a highly recognized geriatric syndrome resulting in decline in reserve across multiple physiological systems. Impaired physical function is one of the major indicators of frailty. The goal of this study was to evaluate an algorithm that discriminates between frailty groups (non-frail and pre-frail/frail) based on gait performance parameters derived from unsupervised daily physical activity (DPA). Methods: DPA was acquired for 48 hours from older adults (≥65 years) using a tri-axial accelerometer motion-sensor. Continuous bouts of walking for 20s, 30s, 40s, 50s and 60s without pauses were identified from acceleration data. These were then used to extract qualitative measures (gait variability, gait asymmetry, and gait irregularity) and quantitative measures (total continuous walking duration and maximum number of continuous steps) to characterize gait performance. Association between frailty and gait performance parameters was assessed using multinomial logistic models with frailty as the dependent variable, and gait performance parameters along with demographic parameters as independent variables. Results: 126 older adults (44 non-frail, 60 pre-frail, and 22 frail, based on the Fried index) were recruited. Step- and stride-times, frequency domain gait variability, and continuous walking quantitative measures were significantly different between non-frail and pre-frail/frail groups (p<0.05). Among the five different durations (20s, 30s, 40s, 50s and 60s), gait performance parameters extracted from 60s continuous walks provided the best frailty assessment results. Using the 60s gait performance parameters in the logistic model, pre-frail/frail group (vs. non-frail) was identified with 76.8% sensitivity and 80% specificity. Discussion: Everyday walking characteristics were found to be associated with frailty. Along with quantitative measures of physical activity, qualitative measures are critical elements representing the early stages of frailty. In-home gait assessment offers an opportunity to screen for and monitor frailty. Trial registration: The clinical trial was retrospectively registered on June 18th, 2013 with ClinicalTrials.gov, identifier NCT01880229.
... 4,16,17 More recently, it was found that muscle power and explosiveness are also associated with functional capacity and incidence of falls in the oldest old populations, including the frail institutionalized oldest old. 5,18 Some studies and meta-analysis have shown that RT aimed to improve muscle power output (ie, explosive RT) is more effective to improve functional abilities (ie, sit-to-stand, walking ability, stairs climbing) than traditional RT (ie, slow controlled velocity of concentric actions). 19e24 In a meta-analysis by Steib et al, 24 explosive RT was significantly more effective than traditional RT in improving sit-to-stand ability, and approached significance for stair climbing performance. ...
Article
Functional ability, retaining autonomy and independence as people age is the cornerstone of healthy aging, a term established by World Health Organization in its first world report on aging and health. Physical function parameters, therefore, are currently being proposed as biomarkers of aging in humans, are predictive of adverse health events, disability, and mortality, and are commonly used as functional outcomes for clinical trials. Among the main physical function outcomes, muscle power output preservation will be in the palestra for counteraction the age-related decline of functional capacity.
... ApEn is used to estimate the regularity of acceleration signals collected from the IMU during gait. 23 ApEn is one of the entropies that measure the complexity of time series data. The more regular the gait is, the smaller the calculated ApEn becomes. ...
Article
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Purpose: Sarcopenia is a symptom in which muscle mass decreases due to decreasing in the number of muscle fibers and muscle cross-sectional area as aging. This study aimed to develop a machine learning classification model for predicting sarcopenia through a inertial measurement unit (IMU)-based physical performance measurement data of female elderly. Patients and methods: Seventy-eight female subjects from an elderly population (aged: 78.8±5.7 years) volunteered to participate in this study. To evaluate the physical performance of the elderly, the experiment conducted timed-up-and-go test (TUG) and 6-minute walk test (6mWT) with worn a single IMU. Based on literature review, 132 features were extracted from collected data. Feature selection was performed through the Kruskal-Wallis test, and features datasets were constructed according to feature selection. Three major machine learning-based classification algorithms classified the sarcopenia group in each dataset, and the performance of classification models was compared. Results: As a result of comparing the classification model performance for sarcopenia prediction, the k-nearest neighborhood algorithm (kNN) classification model using 40 major features of TUG and 6mWT showed the best performance at 88%. Conclusion: This study can be used as a basic research for the development of self-monitoring technology for sarcopenia.
... Although they did not examine frail older people specifically, previous studies have reported that aging is associated with decreased muscle activity during walking and decreased proprioception in distal areas compared with that in proximal areas 43,44 . One previous study of frail older adults reported that gait variability of frail older adults was associated with quadriceps quality 45 . Therefore, we speculate that these aging and frailty-related phenomena may affect the knee and ankle joints, possibly increasing the variability of joint angle in frail participants. ...
Article
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Frailty is associated with gait variability in several quantitative parameters, including high stride time variability. However, the associations between joint kinematics during walking and increased gait variability with frailty remain unclear. In the current study, principal component analysis was used to identify the key joint kinematics characteristics of gait related to frailty. We analyzed whole kinematic waveforms during the entire gait cycle obtained from the pelvis and lower limb joint angle in 30 older women (frail/prefrail: 15 participants; non-frail: 15 participants). Principal component analysis was conducted using a 60 × 1224 input matrix constructed from participants’ time-normalized pelvic and lower-limb-joint angles along three axes (each leg of 30 participants, 51 time points, four angles, three axes, and two variables). Statistical analyses revealed that only principal component vectors 6 and 9 were related to frailty. Recombining the joint kinematics corresponding to these principal component vectors revealed that frail older women tended to exhibit greater variability of knee- and ankle-joint angles in the sagittal plane while walking compared with non-frail older women. We concluded that greater variability of knee- and ankle-joint angles in the sagittal plane are joint kinematic characteristics of gait related to frailty.
... During functional tasks (such as balance, gait and rising from a chair) and dual task walk, an inertial sensor unit (XSENS, Xsens Technologies B.V. Enschede, Netherlands) will be attached over the lumbarspine (L3) to record raw acceleration data. Afterwards, the raw signal we be processed to compute kinematic parameters related to physical frailty [98][99][100] by using the software designed by Movalys (Movalsys SL, Pamplona, Spain). ...
Article
Full-text available
Background Falls represent important drivers of intrinsic capacity losses, functional limitations and reduced quality of life in the growing older adult’s population, especially among those presenting with frailty. Despite exercise- and cognitive training-based interventions have shown effectiveness for reducing fall rates, evidence around their putative cumulative effects on falls and fall-related complications (such as fractures, reduced quality of life and functional limitations) in frail individuals remains scarce. The main aim of this study is to explore the effectiveness program combining an individualized exercise program and an executive function-based cognitive training (VIVIFRAIL-COGN) compared to usual care in the prevention of falls and fall-related outcomes over a 1-year follow-up. Methods This study is designed as a four-center randomized clinical trial with a 12-week intervention period and an additional 1-year follow-up. Three hundred twenty frail or pre-frail (≥ 1 criteria of the Frailty Phenotype) older adults (≥ 75 years) with high risk of falling (defined by fall history and gait performance) will be recruited in the Falls Units of the participating centers. They will be randomized in a 1:1 ratio to the intervention group (IG) or the control group (CG). The IG will participate in a home-based intervention combining the individualized Vivifrail multicomponent (aerobic, resistance, gait and balance and flexibility) exercise program and a personalized executive function-based cognitive training (VIVIFRAIL-COGN). The CG group will receive usual care delivered in the Falls Units, including the Otago Exercise Program. Primary outcome will be the incidence of falls (event rate/year) and will be ascertained by self-report during three visits (at baseline, and 6 and 12 weeks) and telephone-based contacts at 6, 9 and 12 months after randomization. Secondarily, effects on measures of physical and cognitive function, quality of life, nutritional, muscle quality and psychological status will be evaluated. Discussion This trial will provide new evidence about the effectiveness of an individualized multidomain intervention by studying the effect of additive effects of cognitive training and physical exercise to prevent falls in older frail persons with high risk of falling. Compared to usual care, the combined intervention is expected to show additive effects in the reduction of the incidence of falls and associated adverse outcomes. Trial registration NCT04911179 02/06/2021.
... Measuring muscle power requires complex and sometimes expensive machines, necessitates training for both clinicians and subjects; it is timeconsuming with no available standardized protocols with a lack of standardized cut-off points to define a low muscle power, hence, assessments can hardly be considered useful in daily practice (18). Hence, while it has been documented that muscle power was more related to the functional measures than the muscle strength (30)(31)(32), its harder assessment caused lower attention in both research and clinical setting (33). Alcazar et al. very recently overcame the assessment problem of muscle power by developing a simple calculation to estimate muscle power derived from 5 repeats CSST (33). ...
Article
Background/Objective While assessment of sarcopenia has drawn much attention, assessment of low muscle power has not been studied widely. This is, to a large extend, due to a more difficult assessment of power in practice. We aimed to compare the associations of low power and sarcopenia with functional and performance measures.Material and Methods We designed a retrospective and cross-sectional study. Community-dwelling outpatient older adults applied to a university hospital between 2012 and 2020 composed the population. We estimated body composition by bioimpedance analysis. Other measures were handgrip strength, timed-up-and-go-test (TUG), usual gait speed (UGS), activities of daily living (ADL) and instrumental activities of daily living (IADL) tests. We assessed muscle power by a practical equation using a 5-repetition sit-to-stand power test. We adjusted the power by body weight and defined low muscle power threshold as the lowest sex-specific tertile. We noted demographic characteristics, number of medications, and diseases. We defined sarcopenia by EWGSOP2 definition.ResultsCut points for low relative muscle power were <2.684 and <1.962 W/kg in males and females, respectively. Low muscle power was related with both measures of disability (impaired ADL and IADL) (OR=2.4, 95% CI= 1.4–4.0, p=0.001; OR=2.4, 95% CI= 1.4–4.1, p=0.001; respectively). Low muscle strength (i.e. probable sarcopenia) was only related with disability in IADL (OR=3.6, 95% CI= 1.6–8.; p=0.002); confirmed sarcopenia was related with neither measures. Low muscle power was not related with impaired TUG (p=1) but with impaired UGS (OR=6.6, 95% CI= 3.6–11.0; p<0.001). Probable sarcopenia was not related with impaired TUG (p=0.08) but with impaired UGS (OR=2.4, 95% CI= 1.1–5.3; p=0.03) and confirmed sarcopenia was related with neither measures (p=1, p=0.3; respectively).Conclusion Low muscle power detected by simple and practically applicable CSST (Chair Sit To-Stand Test) power test was a convenient measure associated with functional and performance measures. It was related to functionality and performance measures more than sarcopenia. Future longitudinal studies are needed to examine whether it predicts future impairment in ADL, IADL, and performance measures.
... The pathological changes of motor nerves are aggravated with neuropathy's progress, which is manifested by decreased muscle activity and delayed peak value. 2 Muscle strength decline is a potential factor for falls, and walking speed can be used as an indicator of muscle strength decline. 27 It has been reported that the walking speed of diabetic neuropathy patients decreased significantly. 28 This paper showed that the walking speed with peripheral neuropathy is significantly less than those of the control group. ...
Article
Background: Previous studies have shown that the gait of patients with type-2 diabetes mellitus is abnormal compared with the healthy group. Currently, a three-dimensional motion analyzer system is commonly used for gait analysis. However, it is challenging to collect data and use in clinical study due to extensive experimental conditions and high price. In this study, we used a wearable gait analysis system (Gaitboter) to investigate the spatial and temporal parameters, and kinematic data of gait in diabetic patients, especially those with peripheral neuropathy. The aim of the study is to evaluate the wearable gait analysis system in diabetic study. Materials and methods: We conducted a case-control study to analyze the gait of type 2 diabetes mellitus. Gaitboter was used to detect and collect gait data in the ward of Beijing Chao-yang Hospital, Capital Medical University from June 2018 to October 2018. We collected the gait data of participants (N= 146; 73 patients with type 2 diabetes, 16 with peripheral neuropathy and 57 without peripheral neuropathy, and 73 matched controls). The gait data (stance phase, swing phase, double-foot stance phase, single-foot stance phase, walking cadence, stride length, walking speed, off-ground angle, landing angle, maximum swing angle, minimum swing angle, and foot progression angle) in diabetic patients were recorded and compared with controls. SPSS 22.0 statistical software was used to analyzed the gait parameter data. Results: We found that the landing angle and the maximum swing angle of diabetes patients with or without peripheral neuropathy were significantly less than those of the control group (P < 0.05). The walking speed of diabetes patients with peripheral neuropathy is significantly less than those of the control group (P < 0.05). Conclusion: This study confirms that the wearable gait analysis system (Gaitboter) is an ideal system to identify abnormal gait in patients with type 2 diabetes and provides a new device and method for diabetes-related gait research.
... If there are additional higher-density muscle fibers in the quadriceps, the elderly person performed significantly better in step time variability, gait performance, and velocity. 14 Modifying exercise programs to address improving lower body strength and power would vastly improve stability and functional movement. e study by Shim et al 7 demonstrated a strong correlation between posterior limit of stability plane among 13 seniors over the age of 65 and relative peak power by using a 15-foot ramp to measure power output in seniors (n = 17) and observing that lower body power output does have a relationship with balance scores. ...
Article
Backgroud: Past literature has shown that balance and strength are important in preventing falls, but few studies have focused on developing strength and power in a lateral plane. The purpose of this study was to determine if a lateral pedal recumbent training device can improve balance scores among older adults in 4 weeks. Methods: A 2-group experimental-control multivariate design (43 women, 13 men; age, 77.4 ± 3 years; weight, 78.91 ± 0.2 kg; height, 167.13 ± 0.8 cm; body mass index, 28.7 ± 0.5 kg/m) was selected for the study. Participants (n = 56) were divided into 2 groups and were pretested and posttested on a computerized posturography plate to determine center of pressure scores with eyes opened with stable surface (EOSS), with eyes closed with stable surface (ECSS), with eyes open with perturbed surface (EOPS), and with eyes closed with perturbed surface (ECPS). The experimental group used the lateral trainer for 15 minutes, 3 times per week, for 4 consecutive weeks; the control group maintained a sedentary lifestyle. A mixed-effects repeated measures multiple analysis of variance was used to determine significance. Results: There were statistically significant differences over time for EOPS (p = 0.047) and ECPS (p = 0.047). Likewise, there were statistically significant differences for each univariate outcome with EOSS (p = 0.045), ECSS (p = 0.033), EOPS (p = 0.010), and ECPS (p = 0.026). Conclusion: A recumbent lateral stability device can improve balance scores among older adults within 4 weeks of training.
... It is noteworthy that the muscle action at maximalintended velocity against a force, such as resistance training (RT), might increase upperand lower-limbs muscle power better than traditional RT [12]. On the other hand, the loss of muscle power is associated with an increased risk of falls and a decrease in functional capacity, interfering negatively with quality of life [13,14]. ...
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Introduction: Undulating training has been investigated in sedentary and trained adults, but less is known about the influence of undulating training in older adults. Purpose: This study aimed to evaluate body composition, strength levels, and physical fitness in response to traditional or undulating training in older adults. Methods: A controlled, double-arm trial was conducted in eighteen older adults (10 males, 8 females; 64 ± 2.1 years; 165.12 ± 7.5 cm; 72.5 ± 11.4 kg; 26.5 ± 3.2 k·gm-2) who were randomly assigned to traditional (n = 9, TT) or undulating training (n = 9, UT) for eight weeks. Dual X-ray absorptiometry was used to measure fat-free mass (FFM), fat mass (FM), and bone mineral density (BMD). Strength levels were evaluated by the handgrip strength and the one-repetition maximum in vertical chest press, rowing machine, squat, monopodal horizontal leg press, and leg extension. In addition, functional capacity was assessed using the Senior Fitness Test (SFT). Statistical analysis included mean/median comparisons to establish the difference after the intervention (paired Student's t-test or Wilcoxon test), and effect size calculations based on estimates. Results: After correction for fat-free adipose tissue, a significant increase in FFM was observed in both groups, while no significant changes were found in FM and BMD. Upper- and lower-limbs strength showed significant increases in both groups, although clinical significance varied among exercises. Favorable results were seen on the cardiorespiratory fitness and strength components of the SFT in both groups. Conclusions: The 8-week UT and TT protocols are valid options for improving FFM and increasing strength and functional capacity in women and men over 60 years of age.
... Although the relevance of the assessment of sarcopenia in the management of functional trajectories with aging must be acknowledged (Cruz-Jentoft and Sayer, 2019), muscle power has been reported to be of higher relevance for older people's functional ability (Foldvari et al., 2000;Martinikorena et al., 2016;Metter et al., 2004). The superiority of low relative muscle power over sarcopenia in terms of being associated with physical performance, frailty, disability and poor quality of life among older men and women may be due to the fact that muscle power reflects the ability of the motor system to perform mechanical work per unit of time, while other factors such as muscle mass or strength are partial contributors to this ability. ...
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Introduction The assessment and treatment of low relative muscle power in older people has received little attention in the clinical setting when compared to sarcopenia. Our main goal was to assess the associations of low relative power and sarcopenia with other negative outcomes in older people. Methods The participants were 1189 subjects (54% women; 65–101 years old) from the Toledo Study for Healthy Aging. Probable sarcopenia was defined as having low handgrip strength, while confirmed sarcopenia also included low appendicular skeletal muscle index (assessed by dual energy X-ray absorptiometry) (EWGSOP2's definition). Low relative (i.e. normalized to body mass) muscle power was assessed with the 5-repetition sit-to-stand power test (which uses an equation that converts sit-to-stand performance into mechanical power) and diagnosed in those subjects in the lowest sex-specific tertile. Low usual gait speed (UGS), frailty (according to Fried's criteria and the Frailty Trait Scale), limitations in basic (BADL) and instrumental activities of daily living (IADL) and poor quality of life were also recorded. Results Age-adjusted logistic regression analyses demonstrated that low relative muscle power was associated with low UGS (odds ratio (OR) = 1.9 and 2.5), frailty (OR = 3.9 and 4.7) and poor quality of life (OR = 1.8 and 1.9) in older men and women, respectively, and with limitations in BADL (OR = 1.6) and IADL (OR = 3.8) in older women (all p < 0.05). Confirmed sarcopenia was only associated with low UGS (OR = 2.5) and frailty (OR = 5.0) in older men, and with limitations in IADL in older women (OR = 4.3) (all p < 0.05). Conclusions Low relative muscle power had a greater clinical relevance than low handgrip strength and confirmed sarcopenia among older people. An operational definition and algorithm for low relative muscle power case finding in daily clinical practice was presented.
... Further studies on this issue are, therefore, needed. In line with this and compared with the other parameters of physical performance, muscle power may be the capacity that is most related to functional limitations in older adults [60,61] including LTNH residents [62]. Given that few studies have related muscle power to nutrition [22,63], our results provide valuable evidence of this relationship and may inform new lines of research in which the variable of muscle power could be analyzed in order to ascertain the role that muscle power might play in the nutritional status of institutionalized older individuals. ...
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Among older adults living in long-term nursing homes (LTNHs), maintaining an adequate functional status and independence is a challenge. Whilst a poor nutritional status is a potential risk factor for a decreased function in this population, its role is not fully understood. Here, using a transversal multicenter study of 105 older adults living in 13 LTNHs, we analyzed the associations between nutritional status, as measured by the Mini Nutritional Assessment (MNA), and the parameters of functional status, physical performance, physical activity, and frailty as well as comorbidity and body composition. The MNA scores were positively correlated with the Barthel Index, handgrip strength, Short Physical Performance Battery (SPPB) scores, absolute muscle power, and Assessment of Physical Activity in Frail Older People (APAFOP) scores and were negatively correlated with dynamic balance and frailty. In a multiple linear regression model controlling for gender and age, the APAFOP score (β = 0.386), BMI (β = 0.301), and Barthel Index (β = 0.220) explained 31% of the variance in the MNA score. Given the observed close relationship between the MNA score and functional status, physical performance and activity, and frailty, interventions should jointly target improvements in both the nutritional status and functional status of LTNH residents. Strategies designed and implemented by interdisciplinary professional teams may be the most successful in improving these parameters to lead to better health and quality of life.
... Other studies, such as the present one, pointed out the adoption of adaptive patterns and the asymmetry between limbs, persisting during gait, also when sitting, getting up, and climbing stairs and ramps [22][23][24] . Although the origin of gait variability in individuals with amputation is not well defined, studies showed that it is related to multisystemic issues such as neuromotor control dysfunction, peripheral and central nervous system function, autonomic nervous system, and cardiac, musculoskeletal and psychological adaptation [25][26][27] . ...
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Lower limb amputation highly impacts the lives of individuals. The inability to walk due to difficulties in adapting to wearing prosthesis can potentially result in physical degeneration and comorbidity in this population. In this randomized clinical trial study, we investigated if a low-cost and easily implementable physiotherapy intervention was effective in improving gait performance and adaptation to lower limb prosthesis in individuals with an amputation. A total of 26 individuals participated in the study, 16 with lower limb amputation and 10 without amputation. Participants with amputation were further divided in intervention and control groups. The intervention group underwent a rehabilitation protocol aimed at strengthening muscles and improving prosthesis adaptation. Muscle strengthening targeted the hip segment, prioritizing the abdominal muscles, hip flexors, extensors, adductors and abductors, followed by cicatricial mobilization and weight-bearing on the stump for desensitization. Assessment and measures were performed across the kinetic and kinematic parameters of gait. In the comparison between pre-and post-intervention, a significant increase in gait speed (0.68—2.98, 95% CI, 1.83, effect size ES) and cadence (0.56—2.69, 95% CI, 1.63, ES) was found between groups and time points. Step (0.73—3.11, 95% CI, 1.92, ES) and stride length (0.62—2.84, 95% CI, 1.73) increased between pre- and post-intervention, while in the control group both variables remained smaller. The intervention group decreased stance phase as a percentage of gait cycle between pre- and post-intervention (− 1.33—0.62, 95% CI, − 36, ES), while it increased in the control group. Improvement in a combination of important gait parameters indicates that the intervention protocol promoted the adaptation to prosthesis and the functional independence of individuals with lower limb amputation. It is recommended that the participants continue receiving follow-up assessments and rehabilitation interventions.
... Muscular strength and power are factors that enable motor and postural control. Decreasing these functions can lead to increased fall risk [55]. Falls are one of the main causes of morbidity and mortality in the adult population [6]. ...
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Background: Ageing in women is associated with chronic degenerative pain leading to a functional decrease and therefore increase fall risk. It is therefore essential to detect early functional decreases in the presence of pain related to osteoarthritis. Objective: This cross-sectional study aimed to assess the impact of pain on functionality, postural control and fall risk in women aged between 45 to 64 years old. Methods: Twenty-one (21) women aged 45 to 64 were evaluated by clinical and functional measures such as a pain questionnaire (Lequesne Index), functional tests (Stair Step Test, 5 times sit-to-stand, 6MWD, Timed-up and Go) and postural performance (under force platform). Women were classified into 2 groups from the Lequesne Pain Index (PI): low pain (score ≤ 9) and strong pain (score ≥ 10) for subsequent comparisons on functionality (physical and postural control performance). Results: A significant impact was observed between the pain index (strong PI) and 3 of the 4 functional tests carried out including Stair Step Test (p = 0.001; g = 1.44), walking distance (p = 0.003; g = 1.31) and Timed-up and Go (p = 0.04; g = -0.93). The group with a strong PI score reported further poor postural control under force platform compared to the weak pain group. Conclusion: Pain and severity based on the PI index negatively modulate physical and postural control performance in women aged 45 to 64 years old.
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Purpose: The aim of this study was to establish an association between grip strength and gait variability in the elderly. Methods: The participants in this experiment (n = 20) were aged 65 or older. Power grip and lateral pinch forces were obtained in grip strength tests, and spatiotemporal gait parameters were collected from IMU sensors during 6 min actual walking to test the gait of participants. The collected gait parameters were converted to coefficient of variation (CV) values. To confirm the association between grip strength and gait variability, a partial correlation analysis was conducted in which height, weight, and gait speed were input as controlling variables. Results: Grip power showed a significant negative correlation with the stride length CV (r = -0.52), and the lateral pinch force showed a significant negative correlation with the stance CV (r = -0.65) and swing CV (r = -0.63). Conclusion: This study reveals that gait variability decreases as grip strength increases, although height, weight, and gait speed were controlled. Thus, grip strength testing, a simple aging evaluation method, can help identify unstable gait in older adults at risk of falling, and grip strength can be utilized as a non-invasive measurement method for frailty management and prevention.
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This systematic review aimed to identify the physical/motor fitness tests for nursing home residents and to examine their psychometric properties. Electronic databases were searched for articles published between January 2005 and October 2021 using MeSh terms and relevant keywords. Of the total of 4196 studies identified, 3914 were excluded based on title, abstracts, or because they were duplicates. The remaining 282 studies were full-text analyzed, and 41 were excluded, resulting in 241 studies included in the review. The most common physical component assessed was muscle strength; 174 (72.2%) studies assessed this component. Balance (138 studies, 57.3%) and agility (102 studies, 42.3%) were the second and third components, respectively, most widely assessed. In this review, we also describe the most used assessment tests for each physical/motor component. Some potentially relevant components such as manual dexterity and proprioception have been little considered. There are few studies assessing the psychometric properties of the tests for nursing home residents, although the data show that, in general, they are reliable. This review provides valuable information to researchers and health-care professionals regarding the physical/motor tests used in nursing home residences, helping them select the screening tools that could most closely fit their study objectives.
Article
Purpose of review: Disability and its preceding condition, frailty, are outstanding issues for achieving healthy aging. Diabetes is a very prevalent chronic disease among older patients that favours frailty status. This review will analyse the relationship between diabetes and frailty in the elderly and summarize the current strategies to improve physical function in diabetic older patients. Recent findings: We have analyzed the current knowledge providing insight on the relationship between frailty and diabetes in older people. Epidemiological evidences and potential mechanisms connecting diabetes with frailty in the aging process have been examined. Finally, the strategies to reduce frailty in aged population with diabetes were discussed. Summary: Current evidence reveals the high prevalence of diabetes in frail older patients, producing an additional impairment of physical performance in this population. Insulin resistance seems to contribute to this clinical manifestation which is related to the impact of diabetes on skeletal muscle function, on vascular function, and on the hormonal milieu. Exercise, nutritional and educational interventions, and less strict glycaemic control appear as the most effective strategies to reduce frailty in diabetic older people.
Chapter
This chapter provides a rationale for using exercise and physical activity for health promotion and disease prevention and treatment in older adults. Physical inactivity is a key factor contributing to the onset of muscle mass and function decline, which in turn appears to be a vital contributant to frailty. The chapter discusses the exercise in terms of the specific modalities and doses that have been studied in randomised controlled trials for their role in the physiological changes of ageing, disease prevention, and treatment of older people with chronic disease and disability. It focuses on changes in functional capacity, physical fitness and body composition, quality of life, and disease burden, rather than on changes in longevity itself. There is a growing body of observational data and experimental evidence that physical activity can significantly influence a wide range of cognitive functions. The chapter offers recommendations to address gaps in knowledge and clinical implementation needs in this field.
Article
A decrease in dynamic balance ability (DBA) in the elderly is closely associated with aging. Various studies have investigated different methods to quantify the DBA in the elderly through DBA evaluation methods such as the timed up and go test (TUG) and the six-minute walk test (6MWT), applying the G-Walk wearable system. However, these methods have generally been difficult for the elderly to intuitively understand. The goal of this study was thus to generate a regression model based on machine learning (ML) to predict the age of the elderly as a familiar indicator. The model was based on inertial measurement unit (IMU) data as part of the DBA evaluation, and the performance of the model was comparatively analyzed with respect to age prediction based on the IMU data of the TUG test and the 6MWT. The DBA evaluation used the TUG test and the 6MWT performed by 136 elderly participants. When performing the TUG test and the 6MWT, a single IMU was attached to the second lumbar spine of the participant, and the three-dimensional linear acceleration and gyroscope data were collected. The features used in the ML-based regression model included the gait symmetry parameters and the harmonic ratio applied in quantifying the DBA, in addition to the features of description statistics for IMU signals. The feature set was differentiated between the TUG test and the 6MWT, and the performance of the regression model was comparatively analyzed based on the feature sets. The XGBoost algorithm was used to train the regression model. Comparison of the regression model performance according to the TUG test and 6MWT feature sets showed that the performance was best for the model using all features of the TUG test and the 6MWT. This indicated that the evaluation of DBA in the elderly should apply the TUG test and the 6MWT concomitantly for more accurate predictions. The findings in this study provide basic data for the development of a DBA monitoring system for the elderly.
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Background Older adults with hip osteoarthritis (OA) suffer a progressive loss of muscle quality and strength, affecting their daily activities and quality of life. The purpose of this study is to compare the levels of isometric strength among older adults with and without hip OA and healthy young adults, and to determine the relationship between muscle quality index (MQI) and isometric strength. Methods Fourteen subjects with hip OA (65.6 ± 3.0 years), 18 healthy older adults (66.6 ± 6.5 years) and 32 young adults (20.7 ± 2.0 years) participated in the study. MQI, isometric muscle strength of the hip, ten time sit-to-stand tests, and body composition were measured. Results The MQI was lower in subjects with hip OA, with no significant differences between groups ( p > 0.054). Subjects with OA produced significantly less isometric strength in hip extension ( p < 0.001), flexion ( p < 0.001), abduction ( p < 0.05), adduction ( p < 0.001), external ( p < 0.05) and internal rotation ( p < 0.05). Subjects with OA demonstrated longer time in the execution of the sit-to-stand test ( p < 0.001) in comparison with healthy older and young adults. High correlations between MQI, sit-to-stand ( r = − 0.76, p < 0.01) and peak force during hip abduction ( r = 0.78, p < 0.01) where found in subjects with OA. Moderate correlation between MQI and peak force during hip flexion ( r = 0.55, p < 0.05) and external rotation ( r = 0.61, p < 0.05) were found in the OA group. Conclusions Subjects with OA have lower MQI than old and young healthy controls. In subjects with OA, there was a significant relationship between isometric strength of hip muscles and performance on the sit-to-stand test and the MQI.
Article
Background: Decreased muscular strength and poorer postural stability impact the physical function of breast cancer survivors (BCS) and increases their risk of falls. Gait assessment, particularly in the backward direction, is often used as an indicator of fall risk in several populations. However this information is unknown in BCS. Research question: What are the differences in forward, backward, and accelerated forward walking in BCS in comparison to individuals without a prior cancer diagnosis? Methods: 17 postmenopausal BCS (mean age: 58.5 (8.5) years) and 17 age-matched women without a prior cancer diagnosis (mean age: 59.11 (5.55) years) completed 5 trials each of forward, backward, and fast forward walking conditions. Absolute (Means) and variability (Coefficient of variation) estimates were obtained for spatio-temporal gait parameters. Lower body, upper body and handgrip strengths were measured. Results: For absolute estimates of gait, significant group main effects indicated that BCS had 7% shorter step length (P = 0.019) and 8% slower gait speed (P = 0.048). For variability estimates of gait, there was a significant interaction for stance time (P = 0.035). BCS had greater stance time variability during forward and fast forward conditions, but lesser variability during backward condition. Averaged across all the conditions, BCS had 38% greater step length variability (P = 0.043), 50% greater gait speed variability (P = 0.028), and 28.5% greater single support time variability (P = 0.004). Averaged across both the groups, all the variables except for swing time variability were significantly different among the conditions (all P< = 0.013). BCS also had significantly reduced upper body strength (P = 0.036). Significance: Slower and shorter steps while walking both forwards and backwards could be indicative of a more cautious gait strategy by BCS. Also, BCS possibly focused on controlling spatial parameters during forward walking but temporal parameters while backward walking. Whether these alterations are related to an increased fall risk within BCS needs to be determined.
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Background: A validated, standardized, and feasible test to assess muscle power in older adults has recently been reported: the sit-to-stand (STS) muscle power test. This investigation aimed to assess the relationship between relative STS power and age and to provide normative data, cut-off points, and minimal clinically important differences (MCID) for STS power measures in older women and men. Methods: A total of 9320 older adults (6161 women and 3159 men) aged 60-103 years and 586 young and middle-aged adults (318 women and 268 men) aged 20-60 years were included in this cross-sectional study. Relative (normalized to body mass), allometric (normalized to height squared), and specific (normalized to legs muscle mass) muscle power values were assessed by the 30 s STS power test. Body composition was evaluated by dual energy X-ray absorptiometry and bioelectrical impedance analysis, and legs skeletal muscle index (SMI; normalized to height squared) was calculated. Habitual and maximal gait speed, timed up-and-go test, and 6 min walking distance were collected as physical performance measures, and participants were classified into two groups: well-functioning and mobility-limited older adults. Results: Relative STS power was found to decrease between 30-50 years (-0.05 W·kg-1 ·year-1 ; P > 0.05), 50-80 years (-0.10 to -0.13 W·kg-1 ·year-1 ; P < 0.001), and above 80 years (-0.07 to -0.08 W·kg-1 ·year-1 ; P < 0.001). A total of 1129 older women (18%) and 510 older men (16%) presented mobility limitations. Mobility-limited older adults were older and exhibited lower relative, allometric, and specific power; higher body mass index (BMI) and legs SMI (both only in women); and lower legs SMI (only in men) than their well-functioning counterparts (all P < 0.05). Normative data and cut-off points for relative, allometric, and specific STS power and for BMI and legs SMI were reported. Low relative STS power occurred below 2.1 W·kg-1 in women (area under the curve, AUC, [95% confidence interval, CI] = 0.85 [0.84-0.87]) and below 2.6 W·kg-1 in men (AUC [95% CI] = 0.89 [0.87-0.91]). The age-adjusted odds ratios [95% CI] for mobility limitations in older women and men with low relative STS power were 10.6 [9.0-12.6] and 14.1 [10.9-18.2], respectively. MCID values for relative STS power were 0.33 W·kg-1 in women and 0.42 W·kg-1 in men. Conclusions: Relative STS power decreased significantly after the age of 50 years and was negatively and strongly associated with mobility limitations. Our study provides normative data, functionally relevant cut-off points, and MCID values for STS power for their use in daily clinical practice.
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Objectives Digital health interventions (DHIs) are interesting resources to improve various health conditions. However, their use in the older and frail population is still sparse. We aimed to give an overview of DHI used in the frail older population. Design Scoping review with PRISMA guidelines based on Population, Concept, and Context. Setting and participants We included original studies in English with DHI (concept) on people described as frail (population) in the clinical or community setting (context) and no limitation on date of publication. We searched 3 online databases (PubMed, Scopus, and Web of Science). Measures We described DHI in terms of purpose, delivering, content and assessment. We also described frailty assessment and study design. Results We included 105 studies that fulfilled our eligibility criteria. The most frequently reported DHIs were with the purpose of monitoring (45; 43%), with a delivery method of sensor-based technologies (59; 56%), with a content of feedback to users (34; 32%), and for assessment of feasibility (57; 54%). Efficacy was reported in 31 (30%) studies and usability/feasibility in 57 (55%) studies. The most common study design was descriptive exploratory for new methodology or technology (24; 23%). There were 14 (13%) randomized controlled trials, with only 4 of 14 studies (29%) showing a low or moderate risk of bias. Frailty assessment using validated scales was reported in only 47 (45%) studies. Conclusions and Implications There was much heterogeneity among frailty assessments, study designs, and evaluations of DHIs. There is now a strong need for more standardized approaches to assess frailty, well-structured randomized controlled trials, and proper evaluation and report. This work will contribute to the development of better DHIs in this vulnerable population.
Article
Objective: To investigate the effects of exercise and milk fat globule membrane (MFGM) supplementation on walking ability and walking parameters in community-dwelling elderly Japanese women with declined walking ability. Methods: A randomized placebo controlled trial was performed on 126 elderly community-dwelling women over 79 years old. Participants were randomly assigned to one of four three-month interventions: exercise and MFGM (Ex + MFGM), exercise and placebo (Ex + P), MFGM, and placebo interventions. The exercise intervention group performed one-hour progressive exercise classes twice a week. The MFGM supplementation included ingesting 1 g of MFGM per day. Medical history, physical function measurements included grip strength, knee extension strength, walking speed, as well as walking parameters, and blood components were analyzed. Results: Significant group × time interactions were observed in usual walking speed, stride, and foot progression angle between the groups. Walking speed improved in both exercise groups (P < 0.001). Similarly, stride significantly increased in the exercise groups compared to the MFGM and placebo groups (P < 0.001). Foot progression angle decreased in the exercise groups (P = 0.023) but not in MFGM or placebo groups. Participants with decreased or unchanged walking speed had significantly lower knee extension strength at baseline (P = 0.016), and a higher prevalence of knee OA (P = 0.033, P = 0.010, respectively). Conclusion: The exercise interventions alone or combined with nutrition were effective in improving walking speed as well as other walking parameters. Improvement in stride and foot progression angle may have contributed to the increase in walking speed. However, augmented effects of MFGM with exercise could not be confirmed.
Article
Background Our main goal was to evaluate the pattern and time course of changes in relative muscle power and its constituting components throughout the lifespan. Methods A total of 1305 subjects (729 women and 576 men; aged 20-93 years) participating in the Copenhagen Sarcopenia Study took part. Body mass index (BMI), leg lean mass assessed by DXA, and leg extension muscle power (LEP) assessed by the Nottingham power rig were recorded. Relative muscle power (normalized to body mass) and specific muscle power (normalized to leg lean mass) were calculated. Segmented regression analyses were used to identify the onset and pattern of age-related changes in the recorded variables. Results Relative muscle power began to decline above the age of 40 in both women and men, with women showing an attenuation of the decline above 75 years. Relative muscle power decreased with age due to i) the loss of absolute LEP after the fourth decade of life and ii) the increase in BMI up to the age of 75 years in women and 65 years in men. The decline in absolute LEP was caused by a decline in specific LEP up to the age of 75 in women and 65 in men, above which the loss in relative leg lean mass also contributed. Conclusions Relative power decreased i) above 40 years by the loss in absolute power (specific power only) and the increase in body mass, and ii) above ̴ 70 years by the loss in absolute power (both specific power and leg lean mass).
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it is not clear if gait variability is linked to muscle strength or muscle quality (MQ). This study examined the relation between leg strength and lower extremity MQ and gait variability in healthy ambulatory older adults. seventy-two older adults (43 females and 29 males; age: 69.5 ± 6.1 years) underwent assessments of gait, leg strength and body composition. Leg strength was assessed with an isokinetic dynamometer and body composition by dual-energy X-ray absorptiometry (DXA). MQ was calculated from the information muscle strength and body composition. Gait was assessed by having the subjects walk down a pressure sensitive walkway at self-selected normal speed. Variability of spatial and temporal parameters of gait was calculated. there were minimal correlations between muscle strength and spatial parameters. However, both lower leg and upper leg MQ were negatively associated with spatial (r's = -0.24 to -0.49, P < 0.05) and temporal gait variability (r's = -0.27 to -0.35, P < 0.05). Also, lower leg MQ was found to be a better predictor of gait variability than upper leg MQ. the results highlight that MQ may be an important determinant of gait function, even in healthy older adults.
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a large proportion of falls in older people occur when walking; however the mechanisms underlying impaired balance during gait are poorly understood. to evaluate acceleration patterns at the head and pelvis in young and older subjects when walking on a level and an irregular walking surface, in order to develop an understanding of how ageing affects postural responses to challenging walking conditions. temporo-spatial gait parameters and variables derived from acceleration signals were recorded in 30 young people aged 22-39 years (mean 29.0, SD 4.3), and 30 older people with a low risk of falling aged 75-85 years (mean 79.0, SD 3.0) while walking on a level and an irregular walking surface. Subjects also underwent tests of vision, sensation, strength, reaction time and balance. older subjects exhibited a more conservative gait pattern, characterised by reduced velocity, shorter step length and increased step timing variability. These differences were particularly pronounced when walking on the irregular surface. The magnitude of accelerations at the head and pelvis were generally smaller in older subjects; however the smoothness of the acceleration signals did not differ between the two groups. Older subjects performed worse on tests of vision, peripheral sensation, strength, reaction time and balance. the adoption of a more conservative basic gait pattern by older people with a low risk of falling reduces the magnitude of accelerations experienced by the head and pelvis when walking, which is likely to be a compensatory strategy to maintain balance in the presence of age-related deficits in physiological function, particularly reduced lower limb strength.
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This chapter examines the current state of research on frailty. A number of competing and complementary models for its development are described, followed by a working definition of frailty. Criteria for the identification of frailty in older individuals are discussed, and consideration is given to emotional, social, and psychological criteria, in addition to physical criteria of frailty. Promising future directions for research are noted throughout the chapter. The aim is to provide useful background information about frailty for researchers interested in the field. Frailty is an area of inquiry still early in its evolution.
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To evaluate the prevalence of frailty and interrelationships among body composition, physical function, and quality of life in community-dwelling obese elderly (OE) persons. Fifty-two OE, 52 nonobese frail, and 52 nonobese nonfrail subjects, matched for age and sex, were studied. Subjective and objective measures of functional status were evaluated by using the physical performance test, exercise stress test, lower extremity (LE) strength, gait speed, static and dynamic balance, functional status questionnaires, and health-related quality-of-life questionnaire (Medical Outcomes Short Form). Body composition was evaluated by using DXA, and muscle quality was evaluated by determining the ratio of LE strength to LE lean mass. Among OE subjects, 96% met our standard criteria for mild to moderate frailty. Compared with the nonobese nonfrail group, the OE and nonobese frail groups had lower and similar scores in physical performance test, peak aerobic power, and functional status questionnaire, and exhibited similar impairments in strength, walking speed, balance, and health-related quality of life. Although absolute fat-free mass (FFM) was greater, the percentage body weight as FFM and muscle quality was lower in the OE group than in the other two groups. Physical frailty, which predisposes to loss of independence, is common in community-living OE men and women. Physical frailty in OE subjects was associated with low percentage FFM, poor muscle quality, and decreased quality of life. These findings suggest that weight loss therapy may be particularly important in OE persons to improve physical function, in addition to improving the medical complications associated with obesity.
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Lower muscle mass has been correlated with poor physical function; however, no studies have examined this relationship prospectively. This study aims to investigate whether low muscle mass, low muscle strength, and greater fat infiltration into the muscle predict incident mobility limitation. Our study cohort included 3075 well-functioning black and white men and women aged 70-79 years participating in the Health, Aging, and Body Composition study. Participants were followed for 2.5 years. Muscle cross-sectional area and muscle tissue attenuation (a measure of fat infiltration) were measured by computed tomography at the mid-thigh, and knee extensor strength by using a KinCom dynamometer. Incident mobility limitation was defined as two consecutive self-reports of any difficulty walking one-quarter mile or climbing 10 steps. Mobility limitations were developed by 22.3% of the men and by 31.8% of the women. Cox's proportional hazards models, adjusting for demographic, lifestyle, and health factors, showed a hazard ratio of 1.90 [95% confidence interval (CI), 1.27-2.84] in men and 1.68 (95% CI, 1.23-2.31) in women for the lowest compared to the highest quartile of muscle area (p <.01 for trend). Results for muscle strength were 2.02 (95% CI, 1.39-2.94) and 1.91 (95% CI, 1.41-2.58), p <.001 trend, and for muscle attenuation were 1.91 (95% CI, 1.31-2.83) and 1.68 (95% CI, 1.20-2.35), p <.01 for trend. When included in one model, only muscle attenuation and muscle strength independently predicted mobility limitation (p < .05). Among men and women, associations were similar for blacks and whites. Lower muscle mass (smaller cross-sectional thigh muscle area), greater fat infiltration into the muscle, and lower knee extensor muscle strength are associated with increased risk of mobility loss in older men and women. The association between low muscle mass and functional decline seems to be a function of underlying muscle strength.