Age-stratified differences of physical capacity in rural community-dwelling Taiwanese older women: A cross-sectional study

ObjectivesPhysical capacity decline may precede physical disability. We explored age-related physical capacity decline among rural community-dwelling Taiwanese older women to provide reference values and to identify indicators of early-onset decline in physical capacity.MethodsOlder women aged 65–96 were recruited from rural community centers. Physical capacity was measured by handgrip strength (HS), gait speed (GS), five-times-sit-to-stand (5xSTS), timed up and go (TUG), and the Berg balance scale (BBS). Participants were stratified into four age groups: 65–69, 70–74, 75–79, and ≥80 years.ResultsOf 137 participants, 61 % exhibited poor 5xSTS, 34–49 % showed low HS, poor TUG and BBS, and 26 % had slow GS. The mean values in GS, HS, 5xSTS, TUG, and BBS were 1.02 m/s, 17.8 kg, 14.5 s, 12.6 s, and 50 points, respectively. Abnormal mean values were first noted at age 70–74 years for 5xSTS, age 75–79 years for HS, TUG, and BBS, and age ≥80 years for GS. Also, more than half the participants exhibited the first poor 5xSTS at age 70–74 years; the first poor HS and TUG at age 75–79 years; and lastly, the first poor BBS and GS at age ≥80 years. At age 65–69 years, 14–41 % of participants reported poor performance in all measures except for GS.ConclusionsLow HS and poor 5xSTS and TUG performance were more common and had earlier onset than slow GS. More attention should be directed toward the 5xSTS, TUG, and HS in rural community-dwelling Taiwanese older women.     

Can neuromuscular strength and function in people with dementia be rehabilitated using resistance-exercise training? Results from a preliminary intervention study

BACKGROUND: Neuromuscular weakness is a prominent symptom among people with central nervous system disorders, such as dementia, typically leading to disability in activities of daily life. We sought to evaluate the potential of resistance exercise to improve neuromuscular strength and function in the lower extremities among community-dwelling people with dementia. METHODS: Twenty-eight subjects, aged 70-88 years and with an average Mini-Mental State Examination score of 17.8 +/- 7.2, were recruited from a population of adult daycare facility users. Subjects underwent pre- and postintervention assessment of strength and physical function consisting of determination of bilateral maximum strength of the knee extensor, hip flexor, dorsiflexor muscles, and handgrip; and evaluation of lower-extremity function based on repeated chair stands and gait speed. The intervention consisted of moderate-intensity progressive resistance training of the hip extensors, abductors, knee extensors and flexors, and dorsiflexors using the Theraband resistance system for up to 3 days weekly over a 6-week period. RESULTS: Subjects completed an average of 11.4 +/- 2.5 exercise sessions. Among those who exercised at least twice per week (> or = 12), they improved an average of 15.6% in quadriceps strength, 10.1% in handgrip strength, 22.2% in sit-to-stand (STS) time, 9.9% in usual gait time, 5.4% in fast gait time (p =.03), and 14.0% in the timed-up-and-go (TUG) test. CONCLUSIONS: Subjects demonstrated improvements in some areas of muscular capacity (quadriceps and handgrip) and most tests of lower-extremity function (STS, gait, TUG), yet declines in other areas (dorsiflexion and iliopsoas strength). Although strength or functional deficits in all domains were not remediable, these results suggest the potential of a resistance-exercise intervention of longer duration and/or greater intensity to produce beneficial effects on the neuromuscular functioning of people with dementia.     

Independent and combined effect of home-based progressive resistance training and nutritional supplementation on muscle strength,muscle mass and physical function in dynapenic older adults with low protein intake: A randomized controlled trial

BackgroundWith the aging phenomenon, there is growing interest in developing effective strategies to counteract dynapenia, the age-related loss of muscle strength. The positive effect of progressive resistance training on muscle strength is well known, however, the effect of nutritional supplementation or its synergistic effect along with exercise on muscle strength is not a consensus in the literature, especially in populations with low protein intake.MethodsWe analyzed the muscle strength (handgrip strength and sit-to-stand test), muscle mass, body mass index, insulin resistance, and physical function (gait speed, timed up & go test, and single-leg-stance test) of 69 dynapenic older adults with low protein intake, before and after the intervention period of three months. The participants were randomly allocated into four groups: resistance training, supplementation, resistance training plus supplementation, and control.ResultsThere was a significant group x time interaction on the following outcome measures: handgrip strength (p < 0.001), gait speed (p = 0.023), and sit-to-stand test (p < 0.001). Considering the outcomes that showed a significant difference between and within groups, only the resistance training group and the resistance training plus supplementation group showed a large effect size in handgrip strength, gait speed, and sit-to-stand test, whereas the supplementation group showed a moderate effect size in gait speed. After the intervention period, there was no difference between the resistance training and the resistance training plus supplementation groups.ConclusionThis study reinforces the value of resistance training in improving muscle strength. The nutritional supplementation added no further benefits in this specific population.Registration number at the Brazilian registry of clinical trials: RBR-4HRQJF.     

Subgroup characteristics of the association between volunteering and the risk of functional disability among older Japanese people: The Tsurugaya project

Background and objectiveAlthough it has been well known that volunteering is associated with a significantly decreased risk of incident disability among older people, it remains unanswered which subgroups of older people the above association is most remarkable. We aimed to identify such subgroups by conducting subgroup analyses for age, sex, chronic medical condition, and socio-demographic factors.MethodsParticipants were 826 Japanese community-dwelling people aged ≥70 years who lived in Tsurugaya, Sendai. Volunteering status was assessed with a baseline survey conducted in 2003. Incident functional disability was defined as the first certification of Long-term Care Insurance until 2017. The Cox proportional hazard model was used to estimate the multivariate-adjusted hazard ratios (HR) with 95% confidence intervals (CI) for incident functional disability. Subgroup analyses were conducted according to sex, age, medical history, marital status, and educational level.ResultsThe association between current volunteering and the risk of incident functional disability was not significant (HR 0.77, 95% CI 0.56–1.06) compared to non-volunteers. In the subgroup analysis, the association between current volunteering and the risk of incident functional disability was significant among participants who were women (HR 0.52, 95% CI 0.30–0.91), those who were aged 75 years or over (HR 0.57, 95% CI 0.36–0.91), and those living without a spouse (HR 0.47, 95% CI 0.24–0.91).ConclusionThe association between volunteering and a decreased risk of incident functional disability was remarkable among vulnerable groups such as women, those aged 75 years or over, those living without a spouse.     

Association between the Trail Making Test and physical performance in elderly Japanese

Aim:   The Trail Making Test (TMT) is used in Western countries as an indicator of executive function, but there is little information regarding its use in Japan. Our previous initial study showed that the TMT was significantly associated with mobility-related functions among elderly Japanese living in the community and in this study, we increased the number of participants to clarify that result.
Methods:   The TMT, comprised of two parts (part A and part B), was administered to 493 subjects aged 65 years or older (164 men, 329 women). Our assessment used the time difference (ΔTMT) between parts B and A, and eight physical performance indicators: four of preventive care (usual walking speed, timed Up & Go [TUG], one-leg standing balance and handgrip strength) and four movement parameters (maximum walking speed, dual-task TUG, stair climbing and obstacle-negotiating gait).
Results:   The median ΔTMT score was 64.01 s for men and 65.56 s for women. The ΔTMT score increased with age, and there was no difference between sexes. Multinomial logistic regression analysis showed that a poor ΔTMT was related to low tertiles for all physical performances. It related to the intermediate tertile of TUG and maximum walking speed, dual-task TUG, stair climbing and obstacle-negotiating gait.
Conclusion:   The TMT reflects complex walking performance, so it can be a useful synthetic indicator for health programs promoting independence in elderly Japanese.     

Effects of whey protein nutritional supplement on muscle function among community-dwelling frail older people: A multicenter study in China

BackgroundFrailty, featured by the presence of fatigue, weight loss, decrease in grip strength, decline gait speed and reduced activities substantially increase the risk of falls, disability, hospitalizations, and mortality of older people. Nutritional supplementation and resistance exercise may improve muscle function and reverse frailty status.ObjectiveTo evaluate whether whey protein supplements can improve muscle function of frail older people in addition to resistance exercise.Methods115 community-dwelling older adults who met the Fried's criteria for frailty from four hospitals’ out-patients clinic in Beijing, China completed the study. It's a case–control study which whey protein was used as daily supplementation for 12 weeks for active group and regular resistance exercise for active group and control group. Handgrip strength, gait speed, chair-stand test, balance score, and SPPB score were compared in both groups during the 12-week follow-up.ResultsOverall, 115 subjects were enrolled for study with 66 in active group and 49 in control group. Handgrip strength, gait speed, and chair-stand time were all significantly improved in both groups with significant between-group differences. The active group improved significantly in handgrip strength compared with the control group, which between-group effect (95% confidence interval) for female was 0.107 kg (0.066–0.149), p = 0.008 and for male was 0.89 kg (0.579–1.201), p = 0.007. For chair-stand time, between-group effect (95% confidence interval) was −2.875 s (−3.62 to −2.124), p = 0.004 and for gait speed, between-group effect (95% confidence interval) was 0.109 m/s (0.090 to 0.130), p = 0.003.ConclusionsThe 12-week intervention of whey protein oral nutritional supplement revealed significant improvements in muscle function among the frailty elderly besides aiding with resistance exercise. These results warrant further investigations into the role of a multi-modal supplementation approach which could prevent adverse outcomes among frailty elderly at risk for various disabilities.     

Efficacy of Multidomain Intervention Against Physio-cognitive Decline Syndrome: A Cluster-randomized Trial

BackgroundsTo investigate the efficacy of a community group-based intervention among community-dwelling older adults with physio-cognitive decline syndrome (PCDS).MethodsA prospective cluster randomized controlled trial included 733 community-dwelling older adults with adjusted Montreal Cognitive Assessment (MoCA adj) scores >18 from 40 community-based sites across Taiwan. PCDS was defined as the concomitant presence of physical declines, i.e., slowness and/or weakness plus dysfunction in any cognitive domain. The multidomain intervention integrated physical exercise, cognitive training, nutritional advices and health education lessons. Conventional health education in control group entailed periodic telephone calls to offer participants health education and advice. The primary outcome was the mean differences of MoCA adj total scores and all domains of MoCA adj between baseline and 6- and 12-month follow-up in each group of PCDS, cognitive dysfunction, mobility-type frailty and normal functioning, and the secondary outcomes included the changes of frailty score, handgrip strength, gait speed and physical activity. Intervention effects were analysed using a generalized linear mixed model.ResultsOverall, 18.9% of the study sample had PCDS. Multidomain intervention for 12 months significantly improved cognitive performance in people with PCDS, and those with cognitive dysfunction only. An early benefit on visuo-spatial executive function was seen in older adults with mobility-type frailty. Intervention also improved frailty scores among participants with mobility-type frailty, handgrip strength for participants with PCDS, and gait speed in the normal group.ConclusionsPCDS is a potentially reversible condition that may prevent subsequent disability and dementia, which deserves further investigation to confirm the long-term effects.     

Comparison of Fallers and Nonfallers on Four Physical Performance Tests: A Prospective Cohort Study of Community-Dwelling Older Indigenous Taiwanese Women

Background

In this study of older indigenous Taiwanese women, we sought to compare the scores of fallers and non-fallers on four tests of physical performance. Additionally, we aimed to establish cutoff scores that would be discriminate fallers from nonfallers.

The effectiveness of group Otago exercise program on physical function in nursing home residents older than 65 years: A randomized controlled trial

AimTo examine whether the 6-months group-based Otago exercise program is more effective than usual care on physical function and functional independence in nursing home residents older than 65 years.MethodsAn observer-blind randomized controlled study included 77 independently walking, cognitively unimpaired residents aged 78.4 ± 7.6 years, of which 66.2% were female. Physical function was assessed at baseline, after 3 and 6 months of the Otago exercise program by three performance tests: Berg Balance Scale (BBS), Timed Up and Go (TUG) and Chair Rising Test (CRT), and functional independence by the motor Functional Independence Measure (mFIM).ResultsSignificant within participant effects of time in EG for BBS, TUG and CRT (p < 0.001) and for mFIM (p = 0.010) were found. Between participant effects of groups on BBS, TUG, CRT and mFIM values were not significant. Changes in values of performed three tests regarding physical function were significantly different in EG and CG (p < 0.001), as well as for functional independence test (mFIM) (p = 0.019). In EG the values got better, while in CG values worsened. Effect sizes of change in the EG were higher for BBS, TUG and CRT compared to mFIM.ConclusionThe Otago exercise program was shown as effective in improving balance, functional mobility, lower limbs muscle strength and functional independence, indicating that it could help in slowing of disability progression.     

Diagnostic criteria for sarcopenia and physical performance

Relative and absolute muscle mass and muscle strength are used as diagnostic criteria for sarcopenia. We aimed to assess which diagnostic criteria are most associated with physical performance in 180 young (18–30 years) and 281 healthy old participants (69–81 years) of the European study MYOAGE. Diagnostic criteria included relative muscle mass (total or appendicular lean mass (ALM) as percentage of body mass), absolute muscle mass (ALM/height squared and total lean mass), knee extension torque, and handgrip strength. Physical performance comprised walking speed, Timed Up and Go test (TUG), and in a subgroup physical fitness. Diagnostic criteria for sarcopenia and physical performance were standardized, and the associations were analyzed using linear regression models stratified by age category, with adjustments for age, gender, and country. In old participants, relative muscle mass was associated with faster walking speed, faster TUG, and higher physical fitness (all p < 0.001). Absolute muscle mass was not associated with physical performance. Knee extension torque and handgrip strength were associated with faster walking speed (both p ≤ 0.003). Knee extension torque was associated with TUG (p = 0.001). Knee extension torque and handgrip strength were not associated with physical fitness. In young participants, there were no significant associations between diagnostic criteria for sarcopenia and physical performance, except for a positive association between relative muscle mass and physical fitness (p < 0.001). Relative muscle mass, defined as lean mass or ALM percentage, was most associated with physical performance. Absolute muscle mass including ALM/height squared was not associated with physical performance. This should be accounted for when defining sarcopenia.     

Perceived and objective entrance-related environmental barriers and daily out-of-home mobility in community-dwelling older people

PurposeWe studied whether entrance-related environmental barriers, perceived and objectively recorded, were associated with moving out-of-home daily in older people with and without limitations in lower extremity performance.MethodsCross-sectional analyses of the “Life-space mobility in old age” cohort including 848 community-dwelling 75–90-year-old of central Finland. Participants reported their frequency of moving out-of-home (daily vs. 0–6 times/week) and perceived entrance-related environmental barriers (yes/no). Lower extremity performance was assessed (Short Physical Performance Battery) and categorized as poorer (score 0–9) or good (score 10–12). Environmental barriers at entrances and in exterior surroundings were objectively registered (Housing Enabler screening tool) and divided into tertiles. Logistic regression analyses were adjusted for age, sex, number of chronic diseases, cognitive function, month of assessment, type of neighborhood, and years lived in the current home.ResultsAt home entrances a median of 6 and in the exterior surroundings 5 environmental barriers were objectively recorded, and 20% of the participants perceived entrance-related barriers. The odds for moving out-of-home less than daily increased when participants perceived entrance-related barrier(s) or when they lived in homes with higher numbers of objectively recorded environmental barriers at entrances. Participants with limitations in lower extremity performance were more susceptible to these environmental barriers. Objectively recorded environmental barriers in the exterior surroundings did not compromise out-of-home mobility.ConclusionEntrance-related environmental barriers may hinder community-dwelling older people to move out-of-home daily especially when their functional capacity is compromised. Potentially, reducing entrance-related barriers may help to prevent confinement to the home.     

Physical and functional factors in activities of daily living that predict falls in community‐dwelling older women

Aim: In order to propose rehabilitation strategies for the reduction of falls risk, thereby preventing falls in older women, the present study was designed to explore the physical and functional factors related to actual incidence of falls. Methods: Fifty‐eight female patients aged 65 years and older (mean age ± standard deviation, 80.5 ± 5.7), who were attending a geriatric outpatient clinic participated. All the participants were assessed with their activities of daily living, gait and balance using various scales. Their handgrip strength and muscle strength of lower extremities were also measured using dynamometers. Falls of the participants during the 6 months follow‐up period were recorded. Results: Correlation analysis investigating associations between the scores of assessment scales and actual measurement of muscle strength and balance showed that there were significant correlations between handgrip strength and Falls Efficacy Scale, Functional Reach test, Timed Up and Go test, Berg Balance Scale, Motor Fitness Scale, motor Functional Independence Measure in fallers and non‐fallers. A binary logistic stepwise regression analysis incorporating all the possible variables into the model revealed that only inability to “being able to go up and down the staircase” in the Motor Fitness Scale remained a significant variable to predict falls during the period of observation. Conclusion: The results confirmed that the sub‐item in the Motor Fitness Scale has a possibility of being a significant predictor of falls in older women, and therefore might prove useful in considering specific rehabilitation program on falls prevention as well as screening this population at risk of falls. Geriatr Gerontol Int 2011; 11: 348–357 .     

Combinations of gait speed testing protocols (automatic vs manual timer,dynamic vs static start) can significantly influence the prevalence of slowness: Results from the Korean Frailty and Aging Cohort Study

AimThis study aimed to compare 4-m usual gait speed obtained with different protocols and to determine the prevalence of slowness using different diagnostic criteria in a large cohort of community-dwelling older adults.MethodsA total of 1177 non-disabled community-dwelling older adults aged 70–84 years were assessed for 4-m usual gait speed using four different testing protocols: (1) automatic timer (ultrasonic sensor), dynamic start; (2) manual timer (stopwatch), dynamic start; (3) automatic timer, static start; and (4) manual timer, static start. To assess agreement between usual gait speed and the testing protocols, linear regression and Bland-Altman analyses were performed.ResultsThere was systematic bias (i.e., difference between automatic timer and manual timer methods), with underestimation of usual gait speed (bias 0.0695 m/s for dynamic start; bias 0.0702 m/s for static start) by the manual timer. There was systematic bias in start conditions, with underestimation of usual gait speed with a static start using both timer methods, compared with that in dynamic start assessment (P < 0.001). The prevalence of slowness ranged from 2.3 to 4.7% in men and 5.9–11.1% in women for <0.80 m/s, and from 17.1 to 30.5% in men and 26.3–45.9% in women for <1.00 m/s.ConclusionsThe findings of this study indicated that 4-m usual gait speed measured under different testing protocols was able to determine different prevalence rates of slowness among non-disabled community-dwelling older adults. An automatic timer may be useful for measuring gait speed changes in individuals likely to have faster gait speed in community-based research settings.     

Sarcopenia,but not sarcopenic obesity,predicts mortality for older old men: A 3-year prospective cohort study

BackgroundThe prognostic significance of sarcopenia and sarcopenic obesity (SO) among older people remains controversial. The main aim of this study was to evaluate the mortality risk of sarcopenia and SO among men aged 75 years and older in Taiwan.MethodsThis prospective cohort study recruited all residents of the Banciao Veterans Home, a veterans retirement community in Taipei City in northern Taiwan. For all study participants, the demographic profile, comorbid medical conditions, biochemical markers, handgrip strength and gait speed, sarcopenia, SO, and all-cause mortality were collected during a 3-year follow-up period.ResultsIn the study, 680 residents participated. The prevalence of sarcopenia and SO was 60.3% and 19.7%, respectively. During the study period, 140 (20.6%) deaths were identified. The diseased individuals were older, more prone to having diabetes mellitus and sarcopenia, had lower serum levels of total cholesterol and triglycerides, but had no difference in SO. Comparisons between different statuses of SO showed that age; diabetes mellitus; metabolic syndrome; body mass index; waist circumference; handgrip strength; gait speed; systolic blood pressure; fasting plasma glucose; serum levels of total cholesterol, triglyceride, high-density lipoprotein; and mortality were all significantly different between the groups. Sarcopenia [odds ratio (OR), 2.64; 95% confidence interval (C.I.), 1.687–4.135; p < 0.001], diabetes mellitus (OR, 1.70; 95% CI, 1.083–2.267; p = 0.021) were independent risk factors for mortality; whereas the serum level of triglyceride was protective (OR, 0.99; 95% CI, 0.989–0.997; p = 0.001). The Cox proportional hazard model confirmed that sarcopenia was significantly associated with mortality with or without obesity.ConclusionThe mortality risk of sarcopenia significantly outweighed the survival benefits of obesity in old age. The unfavorable impact of SO may eventually result from sarcopenia, but not obesity.     

Protein intake is not associated with functional biomarkers of physical frailty: A cross-sectional analysis of community-dwelling older adults with type 2 diabetes mellitus

Background and aimFrailty has emerged as a third category of complication in patients with type 2 diabetes mellitus (T2DM). It has been suggested that adequate protein intake is an important dietary strategy for counteracting frailty. Therefore, we explored the association between protein intake and functional biomarkers of frailty in older adults with T2DM.Methods and resultsFrailty was operationalized as the presence of three of the following: exhaustion, low muscle strength, low physical activity, slow gait speed, and weight loss. Functional biomarkers included handgrip strength (HGS), chair stands, the short physical performance battery and gait speed. Eighty-seven older adults (71.2 ± 8.2 years; 66.7% males) were included. A total of n = 6 (~7%) and n = 32 (~37%) participants were identified as frail and pre-frail respectively. No significant difference was observed for protein intake across staging of frailty (pre-frail/frail: 1.3 ± 0.4 g/kg BW; non-frail: 1.4 ± 0.4 g/kg BW; P = 0.320). A significant association was observed for total protein intake and HGS (β = 0.44; 95% CI: 0.23–1.8; P = 0.01). However, this was no longer significant after adjusting for age, gender, physical activity, energy intake and total appendicular lean muscle (β = 0.03; 95% CI: ?0.45–0.60; P = 0.78). Nil other associations were observed between total protein intake and functional biomarkers of frailty.ConclusionAdequate protein intake was not associated with functional biomarkers in older adults with T2DM. Future research should focus on the efficacy of protein on attenuating functional decline in vulnerable older adults with low protein intake.     

Os benefícios da reabilitação cardíaca na doença coronária: uma questão de género?

Introduction and ObjectivesCoronary heart disease is the leading cause of death in women worldwide and several studies have shown that they are under‐represented in cardiac rehabilitation therapy. The objectives of this study were to assess the prevalence of women in a cardiac rehabilitation program and to assess their response to this intervention.MethodsThis is a retrospective study of 858 patients who attended an exercise‐based cardiac rehabilitation program after an acute coronary syndrome or elective percutaneous coronary intervention, between January 2008 and December 2012. The patients were analyzed by gender, and the impact of the intervention on cardiovascular risk factors and NT‐proBNP was studied. In a subgroup of 386 patients the impact on functional capacity, resting heart rate, chronotropic index and heart rate recovery was also analyzed.ResultsOnly 24% of the 858 patients who attended the program were women. Women showed statistically significant improvements in all cardiovascular risk factors, NT‐proBNP, functional capacity and heart rate recovery (p<0.05) after the program. There were also improvements in resting heart rate and chronotropic index, but these were not statistically significant (p=0.08 and p=0.40, respectively) and when the improvements in these two parameters were compared between genders, there was no statistically significant difference (p=0.33 and p=0.17, respectively).ConclusionsOnly 24% of the patients attending the program were women. We found that they benefited from cardiac rehabilitation therapy, with significant improvements in cardiovascular risk factors and in most of the prognostic markers studied.     

The handgrip strength threshold of 16 kg discriminates successful rehabilitation: A prospective short-term study of 258 women with hip fracture

AimIn 2019 the European Working Group on Sarcopenia in Older People (EWGSOP) indicated weakness as the key characteristic of sarcopenia and released the threshold of 16 kg for handgrip strength to define weakness in women. We aimed to externally validate the 16 kg cut-off point for predicting functional recovery in 258 women with subacute hip fracture admitted to our rehabilitation ward.MethodsWe assessed handgrip strength by a hand-grip Jamar dynamometer at admission to inpatient rehabilitation and functional ability in activities of daily living by the Barthel index at the end of the rehabilitation course. Successful rehabilitation was defined with a Barthel index score ≥85 and highest possible recovery with a Barthel index effectiveness = 100 %.ResultsA handgrip strength ≥16 kg significantly predicted both successful rehabilitation (χ² = 23.5, P < 0.001) and highest possible recovery (χ² = 31.05, P < 0.001). For the women with a handgrip strength ≥16 kg, the odds ratios to gain successful rehabilitation and highest possible recovery were 2.68 (95 % CI from 1.19 to 6.04; P = 0.018) and 2.81 (95 % CI from 1.47 to 5.37; P = 0.002), after adjustment for Barthel index scores before rehabilitation, age, hip-fracture type (either medial or lateral), cognitive impairment and 25-hydroxyvitamin D levels.ConclusionOur results provide an external validation of the 16 kg handgrip strength threshold recently released to discriminate functional outcomes: it significantly predicted the short-term ability to perform activities of daily living after hip fracture in women.     

Effect of tele-rehabilitation on glucose control,exercise capacity,physical fitness,muscle strength and psychosocial status in patients with type 2 diabetes: A double blind randomized controlled trial

AimTo determine the effect of a tele-rehabilitation (TR) program on glucose control, exercise capacity, physical fitness, muscle strength and psychosocial status in patients with type 2 diabetes mellitus (DM).MethodFifty type 2 DM participants were enrolled in the study and divided randomly into two groups; TR (n = 25, mean age: 52.82 ± 11.86) or control (n = 25, mean age: 53.04 ± 10.45) group. Participants in the TR group performed breathing and callisthenic exercises, three times a week, for 6 weeks, at home by internet based video conferences. Outcome measures including, HbA1c level, 6 min walk testing, physical fitness and muscle strength dynamometer measurement, Beck Depression Inventory were performed before and after the 6 weeks.ResultsHbA1c (p = 0.00), 6 min walking distance (p = 0.00), physical fitness subparameters; sit-up (p = 0.00), sit-and-reach (p = 0.04), back scratch (p = 0.00), lateral flexion right (p = 0.04), left (p = 0.00) and time up go tests (p = 0.00), muscles strength (p = 0.00); deltoideus-anterior, middle, quadriceps femoris and gluteus maximus, and depression levels (p = 0.00) changed significantly (p = 0.00) in TR groups. There were no significant improvements in control group (p > 0.05).ConclusionOur findings suggest that TR interventions found to be safe and effective, and may be an alternative treatment model for type 2 DM management. In addition to these health benefits, patients and rehabilitation team may save time, labor and treatment costs by using TR.     

Mobility performance tests for discriminating high risk of frailty in community-dwelling older women

We aimed to compare and identify high and low risk of frailty in community-dwelling older women by using five mobility performance tests. The participants were 166 older women at high risk and 171 age-matched controls at low risk of frailty according to the long-term care insurance (LTCI) system (age: 65-90 years). The mobility performance tests included 5-chair sit-to-stand (STS), alternate step, timed up-and-go (TUG), timed rapid gait (TRG), and usual gait speed (UGS). Data analysis showed that high-risk individuals (81.9%) were more likely to be pre-frail than low-risk individuals (55.0%) by Fried's frailty phenotype. The four mobility performance tests, except the 5-chair STS, had the largest areas under the curve (AUC) for discriminating older women at high and low risk (AUC > 0.80, p < 0.001). The optimal cutpoint (6 s) for the TRG test had the highest sensitivity (78%) and specificity (83%) in identifying high risk of frailty. Our results suggest that walking ability tests are clinically useful in screening older individuals at high risk of frailty. In particular, the TRG test is more likely than other tests to discriminate older women at high risk of frailty based on the LTCI system.     

Frailty,physical function and affective status in elderly patients on hemodialysis

ObjetivesTo analyze depression, cognition, and physical function change in older adults on hemodialysis at 12-month follow-up, depending on frailty status.DesignOngoing cohort study.Participants117 patients older than 69 years on hemodialysis; 75 men.MeasurementsFrailty was measured with the frailty phenotype, disability in basic and instrumental activities of daily living with the Barthel and Lawton index respectively, physical function with the Short Physical Performance Battery (SPPB), cognitive status with the Mini Cognitive Examination, and depression with the Yesavage´s Geriatric Depression Scale (GDS), at hemodialysis initiation and after 12-month follow-up. Inflammatory and nutrition profile was determined with C-reactive protein (CRP), albumin, and haemoglobin levels.ResultsThe mean age of the participants was 78.1 years; 63 (53.8 %) were frail. Frail participants had a higher 12-month mortality risk compared to the non frail ones, hazard ratio 2.6 (95 % CI 0.9–7.9). Frail 12-month survivors presented an improvement in median GDS scores (10 to 9; p = .009). There was no change in frail survivors from SPPB ≤ 6 to SPPB > 6 and a shift in 29.3 % of non-frail survivors from SPPB > 6 to SPPB ≤ 6 (p = .007) after 12-month follow-up. Median CRP and haemoglobin levels improved in frail 12-month survivors from 13.9 to 8.3 mg/dL (p = .019) and 9.9–11.1 g/dL (p < .001) respectively.ConclusionsFrail older adults that initiate hemodialysis present higher mortality than the non-frail ones at 12-month follow-up. Frail patients that survive improve physical function, depression and inflammatory profile compared to the non frail ones.