Handgrip strength conditional tolerance regions suggest the need for personalized sarcopenia definition: an analysis of the American NHANES database.

BACKGROUND: Handgrip strength (HGS) is a well-established clinical biomarker that assesses functional capacity in older populations. In addition, HGS is a diagnostic tool that forecasts aging health conditions, such as sarcopenia. AIMS: This paper provides HGS statistical tolerance regions and presents the need to establish HGS reference values according to patients' characteristics. METHODS: For this purpose, we used a conditional tolerance algorithm for HGS, and we observed the tolerances regions in different age strata and sex of non-sarcopenic individuals from the National Health and Nutrition Examination Survey (NHANES, wave 2011-2012). RESULTS AND DISCUSSION: Our results have critical implications for sarcopenia, since conventional and available HGS cut-offs do not consider age range. CONCLUSIONS: This paper offers new perspectives on the evolution of traditional definitions of sarcopenia according to the principles of precision medicine.

Validity of the two-minute step test for healthy older adults.

BACKGROUND: In healthy older adults, the two-minute step test (2MST) does not have its concurrent validity tested against the six-minute walk test (6MWT), which is a valid cardiorespiratory fitness test frequently applied in geriatric samples. OBJECTIVE: To derive an equation to predict 6MWT from 2MST and to observe the agreement between observed and estimated 6MWT distances. METHODS: 6MWT and 2MST were measured in 51 older adults (72.9±4.6 years) from community multicomponent exercise programs. Multiple linear regression derives the predictive equation of 6MWT walked distance (dependent outcome) from steps obtained in 2MST, age, sex, and body mass index (independent outcomes). RESULTS: Correlation between 6MWT and 2MST was strong (r=0.696, p<0.001). The regression equation showed good agreement with measured values, when 6MWT was below 600 m. CONCLUSION: The equation stands as a novel approach to obtaining a valid 6MWT estimation from the 2MST. 2MST is easier and faster, representing an alternative approach when time and space are limited.

Foreign allometric exponents adequately normalize isokinetic knee extension strength to identify muscle weakness and mobility limitation in Portuguese older adults: a cross-sectional study.

BACKGROUND: Identifying muscle weakness is challenging, because the reduction of strength with aging does not depend only on sarcopenia, but also on sensorimotor deficits. Nevertheless, this identification is improved by adjusting muscle strength allometrically, by removing the influence of body size. However, the effectiveness of foreign models to normalize these (dys)functionalities is not yet tested. This study aimed to compare and apply foreign allometric exponents for normalizing isokinetic knee extension strength in Portuguese older adults to identify muscle weakness/mobility limitation. Additionally, to attest any populational difference, data of these people and Brazilian older adults were compared METHODS: This is a cross-sectional study encompassing 226 Portuguese (n = 132) and Brazilian (n = 94) older adults. Mobility limitation (six-minute walk test, at lowest quartile), lower limb strength (knee extension isokinetic strength at 60º/s), and body dimensions measures were taken. Foreign allometric exponents (b) were used to normalize Portuguese strength (strength/body-size variablesb). Non-normalized and normalized strength were compared (ROC) to generate the most accurate cut-point for identifying muscle weakness/mobility limitation. RESULTS: Older Portuguese men and women had better mobility than their Brazilian counterparts. Older Portuguese women had superior muscle strength to Brazilian women. Normalization from 11 foreign models removed the influence of body size on muscle strength, with a negligible correlation (r ≤ 0.30). In contrast to the non-normalized strength, the normalized strength cut-off points were sufficiently accurate (AUC ≥ 0.70) to avoid identifying false-negative cases of weakness/mobility limitation. CONCLUSIONS: Portuguese older women were stronger and had superior functional capacity compared to Brazilian ones. Normalized foreign models improved the accuracy in identifying muscle weakness/mobility limitation in Portuguese older adults. The isokinetic knee extension muscle strength normalized, even using foreign allometric exponents, should be better than no adjustment.

Nutritional status, health risk behaviors, and eating habits are correlated with physical activity and exercise of brazilian older hypertensive adults: a cross-sectional study.

BACKGROUND: Nutritional status, health risk behaviors, eating habits, and other comorbidities (such as diabetes) may be associated with recommended amounts of physical activity (PA) and exercise (EX) in healthy older adults. However, these associations are still unclear for older hypertensive adults, who require greater care from health professionals. The purpose of this study was to associate the nutritional status, health risk behaviors, eating habits, and the presence of diabetes with recommended amounts of physical activity and exercise practice of older hypertensive adults. METHODS: Ten thousand seven hundred eighty-nine older hypertensive adults (70.9 ± 7.4 years) from the VIGITEL telephone survey were classified according to PA levels (insufficiently active/sufficiently active) and EX practice (non-practitioners/practitioners). Binary logistic regression was used to observe the odds ratio (OR) between independent variables (nutritional status [body mass index], sociodemographic characteristics [age/sex/years of study], risk behaviors [screen time/alcohol/tobacco consumption], eating habits [minimally/ultra-processed foods consumption score], and the presence of diabetes) with recommended amounts of PA/EX (dependent variable). RESULTS: Highest nutritional status (ORPA = 0.975 [95%-CI: 0.965 - 0.985]; OREX = 0.981[95%-CI: 0.972 - 0.991]), age (ORPA = 0.955 [95%-CI: 0.949 - 0.961]; OREX = 0.980[95%-CI: 0.975 - 0.986]), screen time (ORPA = 0.909[95%-CI: 0.835 - 0.990]), alcohol consumption (ORPA = 0.683[95%-CI: 0.621 - 0.758]; OREX = 0.702[95%-CI: 0.637 - 0.779]), tobacco (ORPA = 0.601 [95%-CI: 0.492 - 0.736]; OREX = 0.464[95%-CI: 0.384 - 0.562]) ultra-processed foods consumption score (ORPA = 0.896[95%-CI: 0.871 - 0.921]; OREX = 0.886[95%-CI: 0.863 - 0.909]) and having diabetes (ORPA = 0.780[95%-CI: 0.708 - 0.859]; OREX = 0.831[95%-CI: 0.759 - 0.909]) reduced the odds of being sufficiently active/practicing exercise (p < 0.05). Male sex (ORPA = 1.633[95%-CI: 1.491 - 1.789]; OREX = 1.247[95%-CI: 1.140 - 1.363]), years of study (ORPA = 1.026[95%-CI: 1.018 - 1.035]; OREX = 1.050[95%-CI: 1.041 - 1.058]), and minimally processed foods consumption score increased the odds of being sufficiently active/practicing exercise (ORPA = 1.132[95%-CI: 1.109 - 1.155]; OREX = 1.167[95%-CI: 1.145 - 1.191], respectively; p < 0.05). CONCLUSION: Nutritional status, health risk behaviors, eating habits, and the presence of diabetes were associated with the odds of older hypertensive adults complying with PA and EX recommendations. The results may help health professionals understand how these factors are associated with the changes of older hypertensive adults participating in physical activity and exercise.

"Body & Brain": effects of a multicomponent exercise intervention on physical and cognitive function of adults with dementia - study protocol for a quasi-experimental controlled trial.

BACKGROUND: Dementia is a leading cause of death and disability that was declared as one of the greatest health and social care challenges of the twenty-first century. Regular physical activity and exercise have been proposed as a non-pharmacological strategy in disease prevention and management. Multicomponent Training (MT) combines aerobic, strength, balance and postural exercises and might be an effective training to improve both functional capacity and cognitive function in individuals with dementia (IwD). Nevertheless, data on the effects of MT in IwD are still limited and the extent to which IwD can retain improvements after an exercise intervention still needs to be elucidated. The aim of "Body & Brain" study is to investigate the effects of a 6-month MT intervention and 3-month detraining on the physical and cognitive function of IwD. Additionally, we aim to explore the impact of this intervention on psychosocial factors and physiologic markers related to dementia. METHODS: This study is a quasi-experimental controlled trial using a parallel-group design. The study sample consists of community-dwelling individuals aged ≥60 years who are clinically diagnosed with dementia or major neurocognitive disorder. Participants will be either allocated into the intervention group or the control group. The intervention group will participate in MT biweekly exercise sessions, whereas the control group will receive monthly sessions regarding physical activity and health-related topics for 6 months. The main outcomes will be physical function as measured by the Short Physical Performance Battery (SPPB) and cognitive function evaluated using the Alzheimer Disease Assessment Scale - Cognitive (ADAS-Cog) at baseline, after 6-months and 3-months after the end of intervention. Secondary outcomes will be body composition, physical fitness, daily functionality, quality of life, neuropsychiatric symptoms and caregiver's burden. Cardiovascular, inflammatory and neurotrophic blood-based biomarkers, and arterial stiffness will also be evaluated in subsamples. DISCUSSION: If our hypothesis is correct, this project will provide evidence regarding the efficacy of MT training in improving physical and cognitive function and give insights about its impact on novel molecular biomarkers related to dementia. This project may also contribute to provide guidelines on exercise prescription for IwD. TRIAL REGISTRATION: ClinicalTrials.gov - identifier number NCT04095962 ; retrospectively registered on 19 September 2019.

Active Older Adults Keep Aerobic Capacity and Experience Small Reductions in Body Strength During Confinement Due to COVID-19 Outbreak.

The objective of this study was to observe the home-confinement effects on physical fitness, physical activity (PA), and body composition in active older adults, and to compare physical fitness and PA according to quality of life (QoL) during confinement. A total of 72 physically active older adults (61.1% females; 74.24 ± 5.57 years) were assessed pre- and postconfinement for aerobic capacity (6-min walk test), lower (30-s sit-to-stand), and upper (30-s arm-curl) body strength, PA (short-version of the International Physical Activity Questionnaire), and QoL (EQ-5D-visual analogue scale). The pre- and postconfinement comparisons show declines in upper (-2.24 ± 0.45 repetitions; p < .001; η2 = .276) and lower body strength (-2.65 ± 0.42 repetitions; p < .001; η2 = .378) in both genders, but not in aerobic capacity. Ninety percentage of older adults perceived a decline in PA. Older adults reporting high QoL increased 19.27 ± 97.04 m in the 6-min walk test, while the participants with low QoL reduced 28.32 ± 63.27 m (p = .018; η2 = .090). Previously active older adults did not have their aerobic capacity decrease significantly despite a decline in upper and lower body strength during an 11-week home confinement period.

Comparison of questionnaire and accelerometer-based assessments of physical activity in patients with heart failure with preserved ejection fraction: clinical and prognostic implications.

Objective. (i) To compare daily physical activity (PA) levels evaluated by the International Physical Activity Questionnaire (IPAQ) and by triaxial accelerometry in heart failure with preserved ejection fraction (HFpEF) patients; (ii) to describe daily PA patterns based in objective measurements; and (iii) to observe the association between prognostic indicators and PA measurements. Design. This is a cross-sectional study with 24 stable HFpEF patients. PA was assessed through the IPAQ short version and triaxial accelerometer. Time spent in moderate-to-vigorous PA (MVPA) from IPAQ was computed as self-reported walking and MVPA. Prognostic indicators were: distance on the 6-minute-walking test (6MWT), oxygen consumption (VO2) during the test, quality of life (QoL), BNP plasma level, and E/e' ratio. Results. Compared to accelerometry, IPAQ underestimated sedentary time (253 ± 156 vs. 392 ± 104 min/day, p = .001) and overestimated MVPA (44 ± 56 vs. 19.3 ± 26 min/day, p < .001). Accelerometer-derived data showed that HFpEF patients spent 50% of their waking time in sedentary behaviours and 2.5% in MVPA. Of measured surrogate prognostic markers, functional capacity (6MWT, r = 0.652, p = .04; VO2, r = 0.512, p = .02) and QoL (r=-0.490, p = .04) were correlated with MVPA. Conclusions. The IPAQ underestimated sedentary time and over-estimated MVPA in HFpEF patients. Using accelerometer-derived data, HFpEF patients spent only a minority of their time involved in MVPA, which was the only PA pattern positively associated with prognostic indicators.

Sedentary Behavior and Arterial Stiffness in Adults with and without Metabolic Syndrome.

This study aimed to investigate whether sedentary time (Sed) and physical activity (PA) are associated with arterial stiffness in individuals with and without metabolic syndrome (MetS). This cross-sectional study comprised 197 individuals (47±13 years; 58% female) from a primary health care centre. Arterial stiffness was assessed using carotid-femoral pulse wave velocity (cfPWV). Metabolic syndrome was determined as clustering of at least 3 out of 5 risk factors (central obesity, hypertension, impaired glucose, triglycerides and high-density lipoprotein cholesterol). Daily PA was objectively assessed and classified in Sed, light and moderate-to-vigorous PA. Physical activity was used as a continuous variable for multiple regression analysis. For mean comparisons of cfPWV between subjects with and without MetS, a binary split at the median of Sed and PA was used. Sedentary time was associated with cfPWV (ß=0.11; p=0.01) explaining 1.3% of its variance; independently of age (ß=0.49; p<0.001), systolic blood pressure (ß=0.27; p<0.001) and fasting glucose (ß=0.19; p<0.001). Participants with MetS and more Sed had higher cfPWV than those with MetS and less Sed (9.9±1.0 vs. 8.9±1.0 m/s; p<0.05). Sedentary time is associated with cfPWV independently of age and metabolic risk factors. A higher Sed in MetS individuals lead to a worse arterial stiffness profile.

Fear of Falling in Older Adults Living in a Community-Dwelling Facility: Prevalence and Its Impact on Activity Behavior and Physical Function.

This study examined the prevalence and the impact of fear of falling (FOF) on physical activity (PA), sedentary behavior (PA), and physical function in older adults living in a continuing care retirement community (CCRC). Ninety-three older adults were included and self-reported assessed on PA and SB. Further, participants' physical function was assessed using a collection of measures of valid objective tests. Independent t test was used to compare the dependent variables between FOF groups, and analysis of covariance (ANCOVA) was used to control for assistive device usage. FOF was prevalent in 47.3% of the sample and PA and SB did not differ between FOF groups (p > .05). ANCOVA revealed that performance on several physical function tests remained significantly better (p < .05) for the no FOF group compared to the yes group. Our findings demonstrated similar levels of PA and SB between FOF groups, but worse physical function for older adults reporting FOF.