Effects of Vibration Training and Detraining on Balance and Muscle Strength in Older Adults

The purpose of this study was to analyze the effects of 2 days/week versus 4 days/week of Whole Body Vibration (WBV) during eight weeks of WBV training on health-related quality of life (SF-36), balance and lower body strength, as well as short-term detraining (3 weeks) on balance and lower body strength among older adults. Thirty-four older adults were randomly assigned to a control group (Control; n = 11) or to one of the vibration training groups: WBV 2 days/week (WBV_2d; n = 11) or WBV 4 days/week (WBV_4d; n = 12). The WBV groups exercised for 8 weeks, following 3 weeks of detraining. Lower body strength increased significantly (p < 0.05) for both groups, WBV_2d and WBV_4d, after 8-week training. A significant reduction in strength was observed following 3 weeks of detraining only in WBV_2d group (p < 0.05). All variables of the SF-36 and the balance test did not change after intervention in any group. 2 days/week and 4 days/week of WBV during 8 weeks showed the same improvements on muscle strength. 3 weeks of detraining did not reverse the gains in strength made during 32 sessions of WBV.

Key points

• 2 days and 4 days per week of WBV training during 8 weeks showed the same improvements on muscle strength.
• 3 weeks of detraining did not reverse the gains in strength made during 32 sessions of WBV exercise.
• 3 weeks of detraining did reverse the gains in strength made during 16 sessions of WBV exercise.

Key words: Whole-body vibrations, posturography, dose-response, equilibrium     

The Effect of Fall Biomechanics on Risk for Hip Fracture in Older Adults: A Cohort Study of Video-Captured Falls in Long-Term Care

Over 95% of hip fractures in older adults are caused by falls, yet only 1% to 2% of falls result in hip fracture. Our current understanding of the types of falls that lead to hip fracture is based on reports by the faller or witness. We analyzed videos of real-life falls in long-term care to provide objective evidence on the factors that separate falls that result in hip fracture from falls that do not. Between 2007 and 2018, we video-captured 2377 falls by 646 residents in two long-term care facilities. Hip fracture was documented in 30 falls. We analyzed each video with a structured questionnaire, and used generalized estimating equations (GEEs) to determine relative risk ratios (RRs) for hip fracture associated with various fall characteristics. All hip fractures involved falls from standing height, and pelvis impact with the ground. After excluding falls from lower than standing height, risk for hip fracture was higher for sideways landing configurations (RR = 5.50; 95% CI, 2.36–12.78) than forward or backward, and for falls causing hip impact (3.38; 95% CI, 1.49–7.67). However, hip fracture risk was just as high in falls initially directed sideways as forward (1.14; 95% CI, 0.49–2.67), due to the tendency for rotation during descent. Falling while using a mobility aid was associated with lower fracture risk (0.30; 95% CI, 0.09–1.00). Seventy percent of hip fractures involved impact to the posterolateral aspect of the pelvis. Hip protectors were worn in 73% of falls, and hip fracture risk was lower in falls where hip protectors were worn (0.45; 95% CI, 0.21–0.99). Age and sex were not associated with fracture risk. There was no evidence of spontaneous fractures. In this first study of video-captured falls causing hip fracture, we show that the biomechanics of falls involving hip fracture were different than nonfracture falls for fall height, fall direction, impact locations, and use of hip protectors. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.     

Balance,Falls Risk,and Related Disability in Untreated Vestibular Schwannoma Patients

Background Many vestibular schwannoma (VS) patients complain of balance dysfunction; however, validated standardized assessments are lacking. The relative contribution of imbalance and factors like anxiety to disability is unknown. Because imbalance significantly affects quality of life in this group and vestibular rehabilitation may improve outcomes, determining the severity of balance dysfunction is important to understand long-term rehabilitation needs.Aim To assess functional balance (Vertigo Symptom Scale-Vertigo [VSS-VER] and Functional Gait Assessment [FGA]) and the relative contribution of symptom severity (VSS-VER), ambulant posture (FGA), and anxiety symptoms (Vertigo Symptom Scale-Anxiety [VSS-SA]) to disability in untreated patients.Methods Patients not exposed to surgery completed the VSS, Vertigo Handicap Questionnaire (VHQ), and FGA. VSS scores were compared with migrainous vertigo (MV) patients, a mixed neuro-otological group, and healthy controls.Results A correlation was found between decreased FGA and increasing age (r = − 0.35; p < 0.01), female sex (r = 0.42; p = 0.001), increasing handicap (r = − 0.55; p < 0.001), and symptom severity (r = − 0.52; p < 0.001). In 12 of 21 patients (57%) > 60 years of age the FGA score was ≤ 22 suggesting increased falls risk.VSS-VER scores were higher than in healthy controls (p < 0.001) but lower than MV (p < 0.001) and mixed neuro-otology controls (p < 0.001).VSS-SA scores in VS patients with balance symptoms were higher than normal controls (p < 0.05) and correlated with handicap (r = 0.59; p < 0.001) and symptom severity (r = 0.74; p < 0.001).After controlling for age and sex, the VSS-VER, VSS-SA, and FGA explained 47% of the variation in VHQ scores.Conclusion Older VS patients are at significant risk of falls. Balance symptoms are more severe than in healthy controls but less than other neuro-otological patients. Balance symptom severity, anxiety symptoms, and ambulant posture were significant contributors to disability and should be the focus of vestibular rehabilitation strategies.     

Risk Factors for Fractures and Falls in Older Women with Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (DM) is associated with an increased risk of hip fractures despite patients with this condition having normal to high bone mineral density (BMD). Therefore, nonskeletal risk factors may be important in the etiology of fractures in these patients. The aim of this cross-sectional retrospective study was to determine risk factors for falling and fracture in older women with type 2 DM. We randomly recruited 150 women from a community-based diabetes register. They underwent detailed clinical assessment, and BMD was measured by dual-energy X-ray absorptiometry (DXA) and heel quantitative ultrasound (QUS). Mean age was 74 years, mean duration of DM 11 years, mean body mass index 30 kg/m², and mean HbA_1c 7.6%. Mean BMD Z scores were significantly higher than the manufacturer’s reference range for all skeletal sites. Previously, 53/150 (35%) of the women had reported a low trauma fracture. The fracture group did not differ significantly from the nonfracture group by age, diabetes-related risk factors or DXA BMD Z scores. However, QUS variables were lower in the fracture group (P = 0.04). A history of one or more falls in the previous 12 months was reported by 61/89 (41%) women. Fallers had a higher vibration perception threshold vs. nonfallers (mean 21.1 vs. 17.6 volts, respectively; P = 0.05). There were no other differences in diabetes or fall-related risk factors. These data suggest that reduced vibration perception (a measure of peripheral neuropathy) is an important risk factor for falling and that QUS, as opposed to DXA, may be a more useful method for fracture risk prediction in older women with type 2 DM. These findings need to be confirmed prospectively.     

The Association Between Physical Activity and Sex-Specific Oxidative Stress in Older Adults

Oxidative stress increases with advancing age and is a mediator of several diseases including cancer, cardiovascular disease, and diabetes. Moreover, postmenopausal women have a lower estrogen concentration, which is associated with elevated oxidative stress. However, there is no definitive evidence regarding the relationship between daily physical activity and oxidative stress status in older adults, including postmenopausal women. Twenty-nine adults (age, 70.1 ± 1.0 years, mean ± SE; 12 women and 17 men) were examined in this cross-sectional study. Prior to blood collection, the participants were asked to wear a uniaxial accelerometer for 4 consecutive weeks to determine their level of physical activity. After a 48-h period of physical activity avoidance and a 10-h overnight fast, venous blood samples were obtained from each participant. Fasting plasma derivatives of reactive oxygen metabolites (d-ROMs) and malondialdehyde (MDA) concentrations of oxidative stress markers were negatively correlated with the amount of physical activity in women (d-ROMs; r = -0.708, p = 0.002) (MDA; r = -0.549, p = 0. 028), but not in men. Fasting plasma biological antioxidant potential of antioxidant capacity marker was positively correlated with the amount of physical activity in women (BAP; r = 0.657, p = 0.006) (GSH; r = 0.549, p = 0.028), but not in men. Moreover, superoxide dismutase activity of antioxidant capacity marker was positively correlated with the amount of physical activity in men (r = 0.627, p = 0.039), but not in women. There were no associations between physical activity and other oxidative stress markers (reduced and oxidized glutathione, glutathione peroxidise, thioredoxin). These findings suggest that regular physical activity may have a protective effect against oxidative stress by increasing total antioxidant capacity, especially in postmenopausal women.

Key Points

• It is important to consider daily physical activity status when evaluating antioxidant capacity.
• Sex differences affect the alteration of oxidative stress markers induced by daily physical activity.
• Regular physical activity may have a protective effect against oxidative stress by increasing total antioxidant capacity, especially in postmenopausal women.

Key words: Aging, physical activity, oxidative stress, antioxidant capacity, sex     

Association of CKD and Cancer Risk in Older People

People with ESRD are at increased risk for cancer, but it is uncertain when this increased risk begins in the spectrum of chronic kidney disease (CKD). The aim of our study was to determine whether moderate CKD increases the risk for cancer among older people. We linked the Blue Mountains Eye Study, a prospective population-based cohort study of 3654 residents aged 49 to 97 yr, and the New South Wales Cancer Registry. During a mean follow-up of 10.1 yr, 711 (19.5%) cancers occurred in 3654 participants. Men but not women with at least stage 3 CKD had a significantly increased risk for cancer (test of interaction for gender P = 0.004). For men, the excess risk began at an estimated GFR (eGFR) of 55 ml/min per 1.73 m² (adjusted hazard ratio [HR] 1.39; 95% confidence interval [CI] 1.00 to 1.92) and increased linearly as GFR declined. For every 10-ml/min decrement in eGFR, the risk for cancer increased by 29% (adjusted HR 1.29; 95% CI 1.10 to 1.53), with the greatest risk at an eGFR <40 ml/min per 1.73 m² (adjusted HR 3.01; 95% CI 1.72 to 5.27). The risk for lung and urinary tract cancers but not prostate was higher among men with CKD. In conclusion, moderate CKD (stage 3) may be an independent risk factor for the development of cancer among older men but not women, and the effect of CKD on risk may vary for different types of cancer.Chronic kidney disease (CKD) is common in older people. Among those aged ≥50 yr, the prevalence of moderate (stage 3) CKD or worse, defined as estimated GFR (eGFR) <60 ml/min per 1.73 m², is >20% in the United States and Australia.^1,2 CKD is associated with significant morbidity and premature death. Cardiovascular complications and deaths are increased in the CKD population independent of traditional risk factors such as diabetes, hypertension, and dyslipidemia.^3–5 Increased cancer risk is also well defined in the end-stage kidney disease (ESKD) and kidney transplant populations.^6–8 The overall cancer incidence after transplantation is approximately three-fold greater than in the general population.Observational studies have suggested an increased cancer risk in people with early-stage CKD, before requiring dialysis or transplantation.^9,10 An excess risk of 1.2 times for all cancers was reported during the 5 yr before renal replacement therapy in a population-based cohort study of dialysis and transplant patients, but inclusion was limited to those who progressed to ESKD, and comorbidity data were limited.⁶ Recently, an association between elevated albumin-to-creatinine ratio and cancer incidence was reported in a longitudinal population-based study of older individuals.¹¹ Previous studies have not evaluated the threshold of CKD that is associated with an increased risk for cancer, adjusted for measurement error in estimating the severity of CKD, or determined the independent effect of CKD after accounting for known risk factors for cancer. The aim of our study was to estimate the independent effect of mild to moderately reduced kidney function on the risk for incident cancers among older people and to identify the threshold at which any excess risk begins.     

修订版社区老年人跌倒危险评估工具的预测准确性评价

目的评价修订版社区老年人跌倒危险评估工具(MFROP-Com)预测跌倒的准确性,确定评估高危跌倒的最佳临界值。方法使用MFROP-Com对211名社区老年人进行跌倒危险评估,根据评估结果绘制受试者操作特征(ROC)曲线,评价其预测准确性。结果 MFROP-Com的ROC曲线下面积为0.862,当选取临界值为11.50时,工具预测效度的综合评价指标Youden指数最高为0.592,此时灵敏度为0.800,特异度为0.792,阳性预测值为80.7%,阴性预测值为78.4%。此评估工具评估老人跌倒与否与实际跌倒发生的一致性检验Kappa值为0.592。结论 MFROP-Com在社区老年人跌倒危险的筛查中具有合适的临界值、较高的预测准确性,是筛选高危跌倒人群的简便而可靠的评估工具。     

Vitamin D Receptor Polymorphisms and Falls Among Older Adults Living in the Community: Results From the ilSIRENTE Study

Vitamin D receptor (VDR) genotypes were associated with cognitive status, depressive symptoms, strength, and sarcopenia, but, thus far, no study has assessed their relationship with falls. The objective of this study is to evaluate whether, in a population of older adults living in the community, VDR FokI and BsmI genotypes are associated with falls. To this aim, we used data from the baseline evaluation of the ilSIRENTE study, which enrolled older adults ≥80 yr of age living in the community in Italy. Falls occurring within 90 days of assessment were assessed by study personnel. The mean age of 259 study participants was 85.0 ± 4.5 (SD) yr; 172 (66.4%) were women. Overall, 33 (12.7%) participants reported one or more falls. The rate of falls was 19.5% in participants with the BB genotype, 11.1% in those with Bb genotype, and 5.9% in those with bb genotype (p for linear trend = 0.02). After adjusting for potential confounders, compared with participants with the BB genotype, those with the bb genotype had a significantly lower OR for falls 0.14 (95% CI, 0.03–0.66). Rate of falls did not differ significantly across FokI genotypes (FF: 14.4%, Ff: 11.9%, ff: 9.1%; p = 0.43). In conclusion, the VDR bb genotype of the BsmI gene is associated with a reduced rate of falls compared with the BB genotype, whereas no effect on falls was shown for FokI polymorphism. Further studies conducted in larger population are needed to confirm the association of BsmI genotype and falls and to understand reasons for these findings.     

Multicomponent Training Program with Weight-Bearing Exercises Elicits Favorable Bone Density,Muscle Strength,and Balance Adaptations in Older Women

Physical exercise is advised as a preventive and therapeutic strategy against aging-induced bone weakness. In this study we examined the effects of 8-month multicomponent training with weight-bearing exercises on different risk factors of falling, including muscle strength, balance, agility, and bone mineral density (BMD) in older women. Participants were randomly assigned to either an exercise-training group (ET, n = 30) or a control group (CON, n = 30). Twenty-seven subjects in the ET group and 22 in the CON group completed the study. Training was performed twice a week and was designed to load bones with intermittent and multidirectional compressive forces and to improve physical function. Outcome measures included lumbar spine and proximal femoral BMD (by dual X-ray absorptiometry), muscle strength, balance, handgrip strength, walking performance, fat mass, and anthropometric data. Potential confounding variables included dietary intake, accelerometer-based physical activity, and molecularly defined lactase nonpersistence. After 8 months, the ET group decreased percent fat mass and improved handgrip strength, postural sway, strength on knee flexion at 180°/s, and BMD at the femoral neck (+2.8%). Both groups decreased waist circumference and improved dynamic balance, chair stand performance, strength on knee extension for the right leg at 180°/s, and knee flexion for both legs at 60°/s. No associations were found between lactase nonpersistence and BMD changes. Data suggest that 8 months of moderate-impact weight-bearing and multicomponent exercises reduces the potential risk factors for falls and related fractures in older women.     

Acid-Suppressive Medications and Risk of Bone Loss and Fracture in Older Adults

Recent studies have suggested an increased fracture risk with acid-suppressive medication use. We studied two cohorts of men and women over age 65 who were enrolled in the Osteoporotic Fractures in Men Study (MrOS) and the Study of Osteoporotic Fractures (SOF), respectively. We used dual-energy X-ray absorptiometry and assessed baseline use of proton pump inhibitors (PPIs) and/or H2 receptor antagonists (H2RAs) in 5,755 men and 5,339 women. Medication use and bone mineral density (BMD) were assessed, and hip and other nonspine fractures were documented. On multivariate analysis, men using either PPIs or H2RAs had lower cross-sectional bone mass. No significant BMD differences were observed among women. However, there was an increased risk of nonspine fracture among women using PPIs (relative hazard [RH] = 1.34, 95% confidence interval [CI] 1.10–1.64). PPI use was also associated with an increased risk of nonspine fracture in men but only among those who were not taking calcium supplements (RH = 1.49, 95% CI 1.04–2.14). H2RA use was not associated with nonspine fractures, and neither H2RA use nor PPI use was associated with incident hip fractures in men or women. The use of PPIs in older women, and perhaps older men with low calcium intake, may be associated with a modestly increased risk of nonspine fracture. On behalf of the SOF and MrOS Research Groups.     

Effects of Hallux Valgus Surgery on Balance and Gait in Middle Aged and Older Adults

Hallux valgus is associated with balance deficits, and has been implicated as an independent risk factor for falls in older adults. However, it is unknown what effect hallux valgus surgery has on static and dynamic (i.e., while walking) balance in older adults. We enrolled 13 middle-aged and older aged adults (mean age 54.3 ± 12.7 years, range 47 to 70) who underwent isolated hallux valgus surgery and followed them for 12 months. Preoperative and postoperative gait and balance performance was assessed using non-invasive body worn sensors with standardized and validated testing protocols. Visual analog scale (VAS) for pain and radiographic angles were also assessed. All subjects reported improvements in pain (VAS mean change -38.3 ± 10.3 mm), and all subjects demonstrated improvements in their hallux valgus angles and first/second intermetatarsal angles (mean change 16.3 ± 8.8°, and 5.5 ± 3.0°, respectively). While standing in full tandem, center of mass (COM) sway was improved upon by 59% at 1 year postoperative (p < .05, paired t-test). While most gait parameters demonstrated little change postoperatively, patients tended to spend less time in double support (p = .08, paired t-test), while gait variability increased by 55% (p = .03, paired t-test) and medial-lateral sway while walking increased by 43% (p = .08, paired t-test) 12 months postoperatively. Balance improved after hallux valgus surgery in our population, particularly when subjects were forced to rely on their operative foot for support (e.g., full tandem). Patients also seemed to walk with greater variability in stride velocity and with greater medial-lateral sway postoperatively, suggesting perhaps increased ambulatory confidence after successful hallux valgus surgery.