基于低强度有氧训练对高龄老年人步行速度的影响研究

目的研究低强度有氧训练对高龄老年人步行速度的影响。方法选取2016年1月-2019年1月在复旦大学附属华东医院住院老年患者30例,按照随机数字表法分为观察组和对照组,每组15例。观察组采用低强度有氧训练,对照组采用康复宣教的常规步行训练,持续干预3个月。用起立行走试验(TUG)和10 m步行测试(10MWT),对2组干预前后步行能力进行评估。结果干预前,2组的TUG和10 MWT结果比较差异无统计学意义(P>0.05);干预后,观察组TUG和10MWT小于干预前(P<0.001),也均小于对照组干预后(P<0.05);而对照组干预前后TUG和10 MWT差异无统计学意义(P>0.05)。两组干预前后血压、心率未见明显变化。结论低强度有氧训练可有效地提高高龄老年人的步行速度,并且安全、可靠。     

步行能走出很多好处

美国最新研究发现,经常步行能改善糖尿病和外周动脉疾病（PAD）患者的步行速度与生活质量．不过对步行距离的提高未见明显作用。     

老年人糖化血红蛋白与脉搏波传导速度的相关性

糖化血红蛋白(HbA1c)是血红蛋白与血糖结合的产物,其发生过程是不可逆过程,并且与血糖浓度呈正比,因此其可作为临床上预测高血糖的重要指标〔1〕。脉搏波传导速度(PWV)是用于反映动脉扩张及弹性的非侵入性指标〔2〕。高血压、糖尿病等慢性病老年患者其动脉硬化程度较正常人群高〔3〕。本文旨在探讨健康体检老年人糖化血糖蛋白与脉搏波传导速度的相关性。     

明星“糖友”的步行经验

别以为走路和健身无关,其实当你闲庭漫步时,体内的脂肪也在活动,与其他运动相比,走路更舒适、安全,达到一定运动量还有助于控制血糖。运动量取决于步行速度和步行时间,人们为了方便,一般会佩戴计步器,以每天走多少步来衡量运动量。     

双重任务起立步行测试评估脑卒中患者肢体功能的相关性分析

目的探讨脑卒中患者双重任务下的起立步行(time up and go,TUG)测试与运动功能、平衡功能及日常生活能力的相关性。方法选取在瑞安市红十字医院就诊的80例符合入选标准的脑卒中患者,分别进行单一任务的TUG(TUG-single)测试、运动双重任务的TUG(TUG-motor)测试、认知双重任务的TUG(TUG-cognitive)测试、Berg平衡评估(Berg balance scale,BBS)、Fugl-meyer运动功能评估(Fugl-Meyer assessment,FMA)、Barthel指数量表(Barthel index,BI)检查。采用单因素方差分析TUG-single、TUG-motor、TUG-cognitive的差异。采用Pearson相关分析TUG-single、TUG-cognitive、TUG-motor与BBS、FMA、BI的相关性。结果TUG-single与BBS、BI、FMA上肢得分、FMA下肢得分、FMA总分呈显著负相关(r=-0.657,P=0.00;r=-0.687,P=0.00;r=-0.616,P=0.00;r=-0.543,P=0.00;r=-0.653,P=0.00);TUG-motor与BBS、BI、FMA上肢得分、FMA下肢得分以及FMA总分呈显著负相关(r=-0.621,P=0.00;r=-0.737,P=0.02;r=-0.760,P=0.00;r=-0.578,P=0.01;r=-0.669,P=0.00);TUG-cognitive与BBS、FMA上肢得分、FMA下肢得分以及FMA总分呈显著负相关(r=-0.574,P=0.03;r=-0.358,P=0.02;r=-0.472,P=0.04;r=-0.478,P=0.00),TUG-cognitive与BI无相关性(r=-0.585,P=0.13)。结论 TUG-motor测试可用于评估脑卒中患者运动功能、平衡功能及日常生活能力,TUG-cognitive测试可用于评估脑卒中患者运动功能及平衡功能。     

贵阳市城区老年人高血压与动态活动和静态活动的相关性

目的调查贵阳市城区老年人高血压发生情况与动态活动和静态活动的关系。方法以贵阳市7个社区为研究现场,采用随机抽样法,对年龄在60～69岁的老年人进行静态活动和动态活动及体育锻炼频度进行问卷调查,并进行血压测试。结果 Logistic回归分析发现性别、超重或肥胖、参加体育锻炼的频度与高血压存在显著关联(P<0. 05),静态活动及步行和轻家务劳动未见显著性差异(P>0. 05)。结论贵阳市城区老年人高血压发生率男性高于女性,超重或肥胖者高于正常体重者;增加体育锻炼的频度可显著降低高血压发病风险。     

老年人脉搏波速度与颈动脉内膜厚度的相关性

目的 分析老年人臂踝脉搏波速度(baPWV)与颈动脉内膜-中层厚度(IMT)的相关性.方法 选择年龄60～89岁、平均(71±6)岁人员为研究对象,共纳入450例,其中男性234例,女性216例.所有受检对象均签署知情同意书,进行baPWV、IMT、身高、体质量、腰围、血压、心率等一般指标的检测.分析baPwV与颈动脉...     

心衰患者HRT与6分钟步行试验的相关性

目的探讨老年慢性心力衰竭(CHF)患者窦性心率震荡(HRT)与心功能、运动耐量的相关性。方法 42例心衰患者(心衰组),30例健康对照组。CHF组根据HRT组成不同分为:HRT0组、HRT1组、HRT2组。比较CHF组和健康对照组及CHF各亚组间HRT指标[震荡初始(TO)、震荡斜率(TS)]差异,进一步分析HRT与6分钟步行试验(6-MWT),左心室射血分数(LVEF),左室舒张末期内径(LVDED)等因素的相关性并通过随访6~12月心血管事件的发生率分为高危组,低危组进行组间比较。结果心衰组TO,LVDED明显高于对照组(0.04±0.018vs.-0.02±0.011;60.36±8.25vs.42.84±6.43p<0.05),TS,6-MWT,LVEF明显低于对照组(9.63±5.14vs.18.12±6.56;207.13±46.12vs.415.50±62.19;39.58±9.76vs.62.17±5.32<0.05)。高危组中HRT现象亦比低危组明显减弱。心衰组6-MWT与LVDED,TO呈负相关,与LVEF,TS呈正相关。结论在慢性心衰患者中监测HRT和6分钟步行试验,动态评估心衰进展,可以采取相应的社区干预模式,尤其适合于基层医院制定最佳治疗方案。     

心力衰竭患者脑钠素水平与6 min步行试验相关性研究

目的探讨心力衰竭(心衰)患者血浆脑钠素(BNP)水平与6 min步行试验的相关性,进一步说明BNP测定对心衰的重要性.方法随机选择106例住院心衰患者及65例无器质性心脏病患者作为研究对象.入院当日采集血标本以备血浆BNP、血糖、血脂等检查,并于当日完成6 min步行试验.采用ELISA法测定血浆BNP水平.血浆BNP水平与6 min步行距离的相关性采用SPSS for Windows V10.0软件包分析.结果随着心衰程度的加重,血浆BNP水平逐渐升高,与6 min步行距离具有良好的相关性(r=-0.804,P＜0.01).结论血浆BNP水平可以判断心衰患者的严重程度,与6 min步行试验相比,具有更广泛的临床应用价值.     

Correlates of gait speed in a sample of physically active elderly

ObjectivesGait speed (GS) is an important predictor of disability, falls, institutionalization and death among elderly people. Our aim was to assess which factors are associated with higher GS in a sample of physically active elderly.Subjects and methodsA cross-sectional study was performed in a sample of 43 self-sufficient and active elderly (12 men and 31 women) aged 65–82 years. Anthropometric features (weight and height), mobility (Tinetti test), physical and mental health (Short Form 12 - SF12 questionnaire), physical activity (Physical Activity Scale for Elderly - PASE questionnaire), strength and power of lower limbs (Myotest Pro accelerometer) and GS were measured. A multivariable linear regression model was built in order to identify which variables were associated with higher GS.ResultsThe final multivariable linear regression model included gender, fall in the previous year, hypertension, age, BMI and Mental Health score. Furthermore, it explained nearly 2/3 of the variability in GS (R² = 0.64). Male sex, hypertension and a higher Mental Health score were associated with higher GS, whereas fall in the previous year and higher values of both age and BMI were associated with lower GS. A further model which included an interaction between sex and BMI (R² = 0.68) revealed that the negative association between GS and BMI was found among women but not among men.ConclusionsIn addition to the well-known associations between GS and demographic and anthropometric characteristics, we reported a positive association between mental health and GS among generally healthy and physically active community-dwelling elderly.     

The relationship between the stipulated tempo step test, daily activity ability and gait time in elderly

This study is aimed at examining the relationship between stipulated tempo step tests, daily activity ability, and gait time. One hundred and thirty healthy elderly women performed the step test in which they stepped in place for 20 s while matching a metronome beat to tempos of 40, 60, and 120 bpm, respectively. The evaluation parameter was the time difference between the metronome sound and the time when subject's foot hit the ground. The subjects were divided into four groups according to (1) whether they had experienced a fall and (2) activity level. The time difference showed significantly greater variance in the order of 40, 60 and 120 bpm in both groups of high activity and low activity. A significant time difference between groups was found only in the 40 bpm tempo where the low activity group's value was higher. The correlations between the time difference and gait time were significant in all tempos of both groups (r = 0.24-0.41). The time differences in 40 and 60 bpm step tests showed significant and moderate correlations (r = 0.52-0.60) with gait time in the low activity group, but low correlations (r = 0.29-0.30) in the high activity group. In conclusion, the stipulated step test can evaluate the level of daily activity ability in the elderly at home and it is effective in evaluating their balance ability.     

Frailty and cardiovascular disease: potential role of gait speed in surgical risk stratification in older adults

Frailty is a state of late life decline and vulnerability, typified by physical weakness and decreased physiologic reserve. The epidemiology and pathophysiology of frailty share features with those of cardiovascular disease. Gait speed can be used as a measure of frailty and is a powerful predictor of mortality. Advancing age is a potent risk factor for cardiovascular disease and has been associated with an increased risk of adverse outcomes. Older adults comprise approximately half of cardiac surgery patients, and account for nearly 80% of the major complications and deaths following surgery. The ability of traditional risk models to predict mortality and major morbidity in older patients being considered for cardiac surgery may improve if frailty, as measured by gait speed, is included in their assessment. It is possible that in the future frailty assessment may assist in choosing among therapies (e.g., surgical vs. percutaneous aortic valve replacement for patients with aortic stenosis).     

Health status,activity limitations,and disability in work and housework among Latinos and non‐Latinos with arthritis: An analysis of national data

Objective

To document disparities in health status, activity limitations, and disability in work and housework between Latinos and non‐Latino whites with arthritis. We examined whether sociodemographic factors (age, income, and education) account for the disparities between the ethnic groups, and whether comorbid conditions, disease duration, health care utilization, and functional abilities predict health status, activity limitations, and work and housework disability after controlling for sociodemographic variables.

Methods

We analyzed data from the Condition file of the 1994 National Health Interview Survey on Disability, Phase I.

Results

The risk of worse health, activity limitations, and work and housework disability was >2 times greater among Latinos compared with non‐Latino whites. In the regression models accounting for potential confounders, Latino ethnicity remained significantly associated with poorer health status, but not activity limitations or disability in work or housekeeping. Of the socioeconomic status variables, education had a significant protective effect on work disability and health status. Comorbid conditions and health care utilization increased the likelihood of worse health, activity limitations, and work disability. Limitations in physical function were associated with poorer health and disability in work and homemaking.

Conclusion

Social status differences between Latinos and non‐Latinos may account for disparities in activity limitations and disability in work and housework. Education may provide various health benefits, including access to a range of occupations that do not require physical demands. The findings help to address the great gap in knowledge concerning factors related to the health and disability status of Latinos with arthritis.

     

The nonlinear relationship between gait speed and falls: the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study

OBJECTIVES: To examine the relationship between gait speed and falls risk. DESIGN: Longitudinal analysis of the association between gait speed and subsequent falls and analysis of gait speed decline as a predictor of future falls. SETTING: Population‐based cohort study. PARTICIPANTS: Seven hundred sixty‐three community‐dwelling older adults underwent baseline assessments and were followed for falls; 600 completed an 18‐month follow‐up assessment to determine change in gait speed and were followed for subsequent falls. MEASUREMENTS: Gait speed was measured during a 4‐m walk, falls data were collected from monthly post‐card calendars, and covariates were collected from in‐home and clinic visits. RESULTS: There was a U‐shaped relationship between gait speed and falls, with participants with faster (≥1.3 m/s, incident rate ratio (IRR)=2.12, 95% confidence interval (CI)=1.48–3.04) and slower (<0.6 m/s, IRR=1.60, 95% CI=1.06–2.42) gait speeds at higher risk than those with normal gait speeds (1.0–<1.3 m/s). In adjusted analyses, slower gait speeds were associated with greater risk of indoor falls (<0.6 m/s, IRR=2.17, 95% CI=1.33–3.55; 0.6–<1.0 m/s, IRR=1.45, 95% CI=1.08–1.94), and faster gait speed was associated with greater risk of outdoor falls (IRR=2.11, 95% CI=1.40–3.16). A gait speed decline of more than 0.15 m/s per year predicted greater risk of all falls (IRR=1.86, 95% CI=1.15–3.01). CONCLUSION: There is a nonlinear relationship between gait speed and falls, with a greater risk of outdoor falls in fast walkers and a greater risk of indoor falls in slow walkers.     

老年糖尿病患者降糖治疗与认知功能的关系

目的研究老年糖尿病降糖治疗与认知功能得分的关系。方法用简易智能状态检查量表对贵阳市城区60岁以上DM患者461例进行认知功能测定并行“检验及协方差分析。结果治疗组注意力和计算力得分高于未治疗组,胰岛素治疗组定向力、即时记忆力得分均高于未治疗组与非胰岛素治疗组;未治疗组与非胰岛素治疗组的注意力和计算力评分也有统计学差异（P均〈0．05）。结论降糖治疗可能是总体认知功能的保护性因素,可以有效改善注意力和计算力;胰岛素治疗可以明显提高定向力和即时记忆力。     

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.     

The relationship between sensory impairment and functional independence among elderly

Background  

It has been well established that increasing age is associated with decreasing functional ability in older adults. It is important to understand the specific factors that affect instrumental activities of daily living (IADL) and functional independence among older adults with sensory disabilities.     

The effect of obstacle gait training on the plantar pressure and contact time of elderly women

ObjectiveThe aim of the present study was to examine the effect of gait training using obstacle on the plantar pressure and contact time in elderly women.MethodsA total of 24 elderly women who were residing in communities in D city, South Korea aged 79.9 ± 2.2, 154.5 ± 7.6 cm in height, and 56.2 ± 5.2 kg in weight participated in this study. The participants conducted obstacle gait training for 8 weeks and foot contact time and foot pressure right before and after crossing the obstacle were measured for 3 times: before the intervention, at the 4 weeks, and 8 weeks using F-scan (Tekscan, USA).ResultsThe results show that foot contact time did not decrease right before crossing the obstacle but decreased right after crossing the obstacle (p < 0.05). Foot pressure moved from the end of the frontal foot to the midfoot (MF) and heel (HL) right before crossing the obstacle (p < 0.05). Foot pressure increased in lesser toe (LT) right after crossing the obstacle (p < 0.05).ConclusionThese results indicate proper weight distribution in feet, increased foot stability due to increased muscle power and flexibility, and improved strategy to cope with the obstacle. The obstacle gait training may be helpful to the elderly who would either fear for or limit outdoor activities due to the risk of falls based on the result of this study.     

Contributions of mild parkinsonian signs to gait performance in the elderly

Mild parkinsonian signs (MPS) and gait abnormalities are common in aging, but the association between MPS and objective gait measures is not established in the elderly. This study aims to identify the link between MPS and quantitative gait measures, as well as to determine the pathogenesis of MPS in non-demented community-dwelling older adults without idiopathic Parkinson’s disease or other parkinsonian syndromes. Three hundred seventy-four non-demented older adults (mean age, 76.44 ± 6.71 years, 57 % women) participated in this study, where comprehensive neurological and medical assessments were conducted. We defined MPS based on the presence of any one of bradykinesia, rigidity, or rest tremor. Velocity and spatial, temporal, and variability gait parameters were recorded using an instrumented walkway. The associations of MPS and gait parameters as well as the relationship of individual MPS with medical illnesses were assessed with linear regressions controlling for key covariates. Participants with MPS walked slower and with disturbed spatial and variability components of gait compared to those without MPS. Bradykinesia was associated with worse spatial and variability gait parameters. This association was only significant for axial bradykinesia, but not for the presence of bradykinesia in the limbs. Cerebrovascular disease (β = .20, p < .01) was associated with bradykinesia, whereas cardiovascular disease (β = .15, p < .05) was associated with rigidity. Among MPS, bradykinesia but not rigidity or tremor was associated with worse quantitative gait performance in older adults. Cerebrovascular disease, a preventable condition, was specifically associated with bradykinesia.