[Relevance of the five-repetition sit-to-stand test for diagnosing sarcopenia in elderly inpatients with cardiac disease].

PURPOSE: The aim of this study was to determine the reference values for diagnosing sarcopenia using the five-repetition sit-to-stand test in elderly inpatients with cardiac disease. METHODS: We studied 71 inpatients with cardiac disease ≥65 years of age (mean age 78.0±7.9 years, 42.3% women) who were admitted between April 2015 and March 2016. Patients were assessed for sarcopenia, and we performed the five-repetition sit-to-stand test. We defined sarcopenia using the Asian Working Group for Sarcopenia-suggested diagnostic algorithm. A logistic regression analysis was performed to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of the relationship between sarcopenia and the five-repetition sit-to-stand test. A multivariate analysis showed that the age, admission diagnosis, the New York Heart Association classification, the Charlson comorbidity index, and the ratio of extracellular to total body water were relevant covariates. The cut-off value of the five-repetition sit-to-stand test to diagnose sarcopenia was determined using a receiver operating characteristic curve. RESULTS: Sarcopenia was diagnosed in 25 patients (35.2%). A multivariate logistic regression analysis showed that the five-repetition sit-to-stand test was significantly associated with sarcopenia (p=0.024), and the OR (95% CI) was 1.31 (1.04-1.65). The cut-off value of the five-repetition sit-to-stand test to diagnose sarcopenia was 10.9 s (sensitivity 80.0%, specificity 70.0%, area under the curve 0.83). CONCLUSIONS: The five-repetition sit-to-stand test is a useful screening tool for sarcopenia in elderly inpatients with cardiac disease. The cut-off value to diagnose sarcopenia was 10.9 s in this study.

[The isometric knee extension strength threshold for maintaining walking speed and step length in older male inpatients].

AIM: To clarify the minimum knee extension muscle strength needed to maintain walking speed and step length in older male inpatients. METHOD: The participants were 786 male inpatients of ≥65 years of age without cerebrovascular disorder, orthopedic disease, malignancy, or dementia. We investigated the participants' isometric knee extension muscle force (kgf/kg), maximum walking speed (m/s) and step length, based on their medical records. The relationship of walking speed and step length to isometric knee extension muscle force was fitted to linear and nonlinear models, and the respective R2 values were compared. Next, the muscle force data were divided into two groups, and two linear functions were calculated. Then, the muscle force value that minimized the sum of the residual sum of squares of the two linear function expressions was obtained. RESULTS: The R2 values of each equation in the nonlinear model were higher than those in the linear model. Among all participants, the muscle force values that minimized the sum of the residual sum of squares for walking speed and step length were 0.33 kgf/kg and 0.43 kgf/kg, respectively. Among participants of ≤74 years of age, the muscle force value that minimized the sum of the residual sum of squares was 0.30 kgf/kg for both walking speed and step length, whereas the values were 0.32 kgf/kg and 0.43 kgf/kg, respectively, in participants of ≥75 years of age. CONCLUSION: Walking speed and step length were significantly decreased in male inpatients of 65-74 years of age when the isometric knee extension force values for both were <0.30 kgf/kg. In contrast, among male inpatients of ≥75 years of age, these values were significantly decreased when the respective isometric knee extension muscle force values were <0.32 kgf/kg and <0.43 kgf/kg.

Impairment in Physical Function and Mental Status in a Survivor of Severe COVID-19 at Discharge from an Acute Care a Hospital: A Case Report.

BACKGROUND: Early mobilization and rehabilitation interventions should be provided to patients who survived severe COVID-19 to improve their physical function and activities of daily living (ADL). However, their physical and mental status at discharge has not been well described in Japan. We report the intervention provided for a survivor of severe COVID-19 and his physical and mental status at discharge from an acute care hospital. CASE REPORT: A 62-year-old man was admitted to our emergency department with a diagnosis of COVID-19 with severe acute respiratory dysfunction. He had complicated intensive care unit-acquired weakness (ICU-AW) and delirium during mechanical ventilation therapy. Rehabilitation intervention was initiated on the seventh day post-admission and was gradually performed according to his respiratory and hemodynamic status. As a result of the rehabilitation intervention, ICU-AW and cognitive function gradually improved. On hospital day 37, he independently performed basic ADL and was discharged. However, he lost approximately 9% of his body weight at discharge. In addition, his hand grip strength and six-minute walking distance were lower and shorter than the reference values, respectively. His mental component summary of the Short Form-8™ was lower than the national standard deviation for the Japanese population. CONCLUSION: Although survivors of severe COVID-19 who undergo early rehabilitation can be discharged from an acute care hospital, they may have several impairments in their physical and mental status, including muscle function, diffusion capacity, exercise tolerance, and health-related quality of life.

The Relationship between Walking Speed and Step Length in Older Aged Patients.

Compared with elderly people who have not experienced falls, those who have were reported to have a shortened step length, large fluctuations in their pace, and a slow walking speed. The purpose of this study was to elucidate the step length required to maintain a walking speed of 1.0 m/s in patients aged 75 years or older. We measured the 10 m maximum walking speed in patients aged 75 years or older and divided them into the following two groups: Those who could walk 1.0 m/s or faster (fast group) and those who could not (slow group). Step length was determined from the number of steps taken during the 10 m-maximum walking speed test, and the step length-to-height ratio was calculated. Isometric knee extension muscle force (kgf), modified functional reach (cm), and one-leg standing time (s) were also measured. We included 261 patients (average age: 82.1 years, 50.6% men) in this study. The fast group included 119 participants, and the slow group included 142 participants. In a regression logistic analysis, knee extension muscle force (p = 0.03) and step length-to-height ratio (p < 0.01) were determined as factors significantly related to the fast group. As a result of ROC curve analysis, a step length-to-height ratio of 31.0% could discriminate between the two walking speed groups. The results suggest that the step length-to-height ratio required to maintain a walking speed of 1.0 m/s is 31.0% in patients aged 75 years or older.

Preadmission frailty status as a powerful predictor of dependency after discharge among hospitalized older patients: A clinical-based prospective study.

AIM: Frailty is a predictor of several adverse health outcomes in older adults. However, the relationship between preadmission frailty status and the incidence of dependency after discharge in hospitalized older patients remains unclear. The aim of the present study was to determine whether preadmission frailty status can predict dependency after discharge among hospitalized older patients. METHODS: We analyzed the cohort data for hospitalized older patients (aged ≥65 years) with internal medical problems obtained from a prospective study. The main outcome was the incidence of dependency from admission to a month after discharge. The frailty status was assessed using the Kihon Checklist. We defined scores of ≥8 as frail, 4-7 as pre-frail and 0-3 as robust. The Cox proportional hazards regression model was used to estimate the hazard ratios and confidence intervals of the relationships between preadmission frailty status and the incidence of dependency. RESULTS: A total of 151 participants who completed follow ups were analyzed (mean age 77.2 years [SD 6.9 years]). The prevalence of frailty, pre-frailty and robust was 22.5%, 37.8% and 39.7%, respectively. During the follow-up period, 39 participants (25.8%) had an incidence of dependency. Participants with frailty (adjusted hazard ratio 4.29, 95% confidence interval 1.72-10.69) had a significantly elevated incidence of dependency compared with that of robust participants. Participants with pre-frailty (adjusted hazard ratio 1.27, 95% confidence interval 0.51-10.69) had no significantly elevated incidence of dependency compared with robust participants. CONCLUSIONS: The preadmission frailty status using the Kihon Checklist can predict the incidence of dependency after discharge among hospitalized older patients. Geriatr Gerontol Int 2018; 18: 1609-1613.

Upper and lower extremity muscle strength levels associated with an exercise capacity of 5 metabolic equivalents in male patients with heart failure.

PURPOSE: Exercise capacity of fewer than 5 metabolic equivalents (METs) has been associated with high risk of death and poor physical functioning in male patients with heart failure (HF). Therefore, we aimed to determine upper and lower extremity muscle strength levels required to attain an exercise capacity of 5 or more METs in male outpatients with HF. METHODS: We enrolled 148 male HF patients (age 60.1 ± 1.0 years). Peak oxygen uptake (peak (Equation is included in full-text article.)o2) was assessed by cardiopulmonary exercise testing (CPX). After CPX, we further divided the patients into groups according to exercise capacity: 5 or more METs (group A, n = 85) and fewer than 5 METs (group B, n = 63). Handgrip strength and knee extensor and flexor muscle strengths were assessed as indices of upper and lower extremity muscle strength, respectively. Receiver operating characteristic curves were used to select cutoff values for upper and lower extremity muscle strength resulting in an exercise capacity of 5 or more METs in these patients. RESULTS: Exercise capacity of 5 or more METs in male HF patients was equivalent to approximately 35.2 kgf of handgrip strength and 1.70 Nm/kg of knee extensor and 0.90 Nm/kg of knee flexor muscle strengths. CONCLUSIONS: These upper and lower extremity muscle strength values may be useful target goals for improvement of exercise capacity, risk management, and activities of daily living in male HF patients.