Influence of chronic medical conditions on older patients' willingness to deprescribe medications: a cross-sectional study.

BACKGROUND: Aging correlates with a heightened prevalence of chronic diseases, resulting in multimorbidity affecting 60% of those aged 65 or older. Multimorbidity often leads to polypharmacy, elevating the risk of potentially inappropriate medication (PIM) use and adverse health outcomes. To address these issues, deprescribing has emerged as a patient-centered approach that considers patients' beliefs and attitudes toward medication and reduces inappropriate polypharmacy in older adults. Our study aims to investigate whether certain chronic medical conditions are associated with older patients' willingness to deprescribe medications. METHODS: A cross-sectional study enrolled 192 community-dwelling individuals aged 65 or older taking at least one regular medication. Data included demographics, clinical characteristics, and responses to the Portuguese revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Descriptive statistics characterized participants, while multiple binary logistic regression identified associations between chronic medical conditions and willingness to deprescribe. RESULTS: Among the participants (median age: 72 years, 65.6% female), 91.6% had multimorbidity. The analysis revealed that willingness to deprescribe significantly increased with the presence of gastric disease (adjusted odds ratio [aOR] = 4.123; 95% CI 1.221, 13.915) and age (aOR = 1.121; 95% CI 1.009, 1.246). Conversely, prostatic pathology (aOR = 0.266; 95% CI 0.077, 0.916), higher scores in the rPATD appropriateness factor (aOR = 0.384; 95% CI 0.190, 0.773), and rPATD concerns about stopping factor (aOR = 0.450; 95% CI 0.229, 0.883) diminished patients' willingness to deprescribe. CONCLUSIONS: This study highlights the intricate relationship between older patients' attitudes toward deprescribing and chronic medical conditions. We found that gastric disease was associated with an increased willingness to deprescribe medications, while prostate disease was associated with the opposite effect. Future research should explore how patients with specific diseases or groups of diseases perceive deprescribing of medications general and for specific medications, aiding in the development of targeted interventions.

Monocytes in the Characterization of Pain in Palliative Patients with Severe Dementia-A Pilot Study.

In assessing and managing pain, when obtaining a self-report is impossible, therapeutic decision-making becomes more challenging. This study aimed to investigate whether monocytes and some membrane monocyte proteins, identified as a cluster of differentiation (CD), could be potential non-invasive peripheral biomarkers in identifying and characterizing pain in patients with severe dementia. We used 53 blood samples from non-oncological palliative patients, 44 patients with pain (38 of whom had dementia) and 0 without pain or dementia (controls). We evaluated the levels of monocytes and their subtypes, including classic, intermediate, and non-classic, and characterized the levels of specific phenotypic markers, namely CD11c, CD86, CD163, and CD206. We found that the relative concentrations of monocytes, particularly the percentage of classic monocytes, may be a helpful pain biomarker. Furthermore, the CD11c expression levels were significantly higher in patients with mixed pain, while CD163 and CD206 expression levels were significantly higher in patients with nociceptive pain. These findings suggest that the levels of monocytes, particularly the classic subtype, and their phenotype markers CD11c, CD163, and CD206 could serve as pain biomarkers in patients with severe dementia.

Association between anticholinergic burden and anticholinergic adverse outcomes in the elderly: Pharmacological basis of their predictive value for adverse outcomes.

The use of anticholinergic drugs and other drugs with anticholinergic activity is highly prevalent in older people. Cumulative anticholinergic effects, known as anticholinergic burden, are associated with important peripheral and central adverse effects and outcomes. Several methods have been developed to quantify anticholinergic burden and to estimate the risk of adverse anticholinergic effects. Serum anticholinergic activity (SAA) and anticholinergic burden scoring systems are the most commonly used methods to predict the occurrence of important negative outcomes. These tools could guide clinicians in making more rational prescriptions to enhance patient safety, especially in older people. However, the literature has reported conflicting results about the predictive ability of these tools. The majority of these instruments ignore relevant pharmacologic aspects such as the doses used, differential muscarinic receptor subtype affinities, and blood-brain barrier permeability. To increase the clinical relevance of these tools, mechanistic and clinical pharmacology should collaborate. This narrative review describes the rational and pharmacological basis of anticholinergic burden tools and provides insight about their predictive value for adverse outcomes.

Arousal changes and delirium in acute medically-ill male older patients with and without dementia: a prospective study during hospitalization.

Objectives: Previous research has characterized the prevalence, natural course and outcomes of delirium superimposed in dementia but much less is known about the relation between preexisting dementia and the emergence of altered arousal (such as drowsiness, obtundation, stupor or agitation) during acute medical illness. This study aimed to determine the natural course of delirium and abnormal arousal states in acute medically-ill older patients with and without prior dementia during hospital stay.Methods: Observational prospective study in an acute male geriatric ward. Patients aged ≥ 65 years old were assessed by a psychiatrist within the first 72h of admission and in every other day until discharge to determine the level of arousal and the presence of delirium. Prior cognitive impairment, sociodemographic data, chronic comorbidities, psychotropic prescription and functional status were assessed at baseline.Results: 43.5% of participants in the final sample (n= 269) had dementia. Prior dementia was associated with higher rates of moderate/severe hypoarousal (29.9% vs. 4.6%; p<0.001) and delirium (20.5% vs. 7.2%; p<0.001) at admission. RASS ≤ -3 at admission predicted a 4-fold increased intra-hospital mortality risk and RASS ≠ 0 had a sensitivity of 82.8% and a specificity of85.9% for delirium.Conclusions: Moderate/severe hypoarousal is associated with adverse outcomes and should be assessed as part of delirium spectrum, particularly in subjects with prior dementia.

Statin combined with exercise training is more effective to improve functional status in dyslipidemic older adults.

BACKGROUND: Exercise training (EX) and statins are first-line therapies to manage dyslipidemia. PURPOSE: This study aims to analyze the effect of EX and statins on functional status and cardiovascular risk (CVR) in dyslipidemic older adults with comorbidities. METHODS: Participants (n = 981) underwent one of 3 conditions: (a) multicomponent exercise training (EX; n = 298; 74% females); (b) statins (ST; n = 178; 65% females); (c) combined therapy-exercise plus ST therapy (ST+EX; n = 505; 79% females). Functional fitness, anthropometry, hemodynamic and lipid profiles, and were assessed at baseline and after 2-years. RESULTS: EX and ST+EX participants improved all the functional status variables, whereas ST participants aggravated all the outcomes. Triglycerides and HDL-cholesterol maintained unchanged and total cholesterol decreased in the three groups, whereas LDL-cholesterol (LDL-C) decreased in EX and ST+EX groups but not in ST group. EX and ST+EX groups decreased body mass index (BMI), systolic and diastolic blood pressure; contrarily, ST group increased these variables. CONCLUSION: Statins combined with exercise training or exercise alone are more effective to improve functional status, to manage cholesterol levels and overall cardiovascular risk factors in dyslipidemic older adults with comorbidities than ST alone. Furthermore, current results suggest that isolated statin therapy decreases functional status and other cardiovascular risk factors.

Functional status improves in hypertensive older adults: the long-term effects of antihypertensive therapy combined with multicomponent exercise intervention.

BACKGROUND: The increasing prevalence of functionally-limited hypertensive individuals highlights the need for interventions to reduce the burden of hypertension-aging-disability and to maximize the chances of healthy aging. AIM: This study aims to compare the effects of multicomponent exercise and different pharmacological treatments on functional status and cardiovascular risk outcomes in hypertensive older adults with comorbidities. METHODS: Participants (n = 96) engage in a 3 days/week multicomponent (aerobic + resistance) exercise program and for one of the following three conditions: (1) thiazide-related diuretics (TDs; n = 33, 69.9 ± 9.5 years); (2) calcium channel blockers (CCBs; n = 23, 67.0 ± 9.0 years); (3) and ß-blockers (ßBs; n = 40, 65.6 ± 7.2 years) medication. Baseline and 2-year follow-up evaluations included the Senior Fitness Test battery, anthropometrics and hemodynamic profile, health-related quality of life (HRQoL; Short-Form Health Survey 36) and health history questionnaires. RESULTS: All groups have significantly improved the physical functional status; particularly upper and lower body strength and aerobic endurance and systolic blood pressure. The TDs and ßBs groups have diminished the waist circumference and body mass. The CCBs decreased total cholesterol (P = 0.028), perceived better physical functioning, physical component score but also augmented bodily pain (P < 0.05). The ßB group decreased triglycerides (P = 0.013). No group differences were found. CONCLUSION: Multicomponent exercise training has improved functional status regardless of the antihypertensive medication options. Hypertensive older adults should add exercise training to pharmacological antihypertensive therapy to reduce the rate of physical disability.

Antihypertensive monotherapy or combined therapy: which is more effective on functional status?

BACKGROUND: This study aims to analyze the effects of anti-hypertensive monotherapy and combined therapy on functional status, and cardiovascular risk outcomes in older adults. METHODS: This longitudinal non-randomized cohort study, involved hypertensive older adults (n = 440) aged 60 or more years with comorbidities. Participants underwent a community exercise training program and one of the following 2 conditions: i) use of daily mono-dose angiotensin-converting enzyme inhibitors (ACEi; n= 232); ii) combined therapy including ACEi plus other class agent (Combined; n= 208). Baseline and 2-year follow-up evaluations included the functional fitness, health-related quality of life (HRQoL), health history questionnaires, anthropometric and hemodynamic profile. RESULTS: Both experimental groups have significantly improved physical functional status, and have significantly decreased blood pressure and waist circumference. ACEi group has significantly reduced body mass and body mass index, the Combined group significantly reduced the waist-to-hip ratio. Additionally, both groups perceived better physical HRQoL. CONCLUSIONS: Functional status has improved with ACEi medication and exercise training, regardless the ACEi medication therapy. Exercise training plus ACEi antihypertensive therapy should be recommended into the standard prescription practice to reduce the rate of physical disability among hypertensive older adults.

Effects of long-term multicomponent exercise on health-related quality of life in older adults with type 2 diabetes: evidence from a cohort study.

PURPOSE: To establish the effect of a long-term multicomponent exercise (LTMEX) intervention (24 months) on health-related quality of life (HRQoL), in older adults with type 2 diabetes (T2D). METHODS: This longitudinal retrospective cohort study analyzes the effects of a supervised LTMEX program on HRQoL in older adults with T2D (n = 279). Participants underwent one of two conditions: LTMEX (n = 241) trained three times per week; and unchanged lifestyle-the control group (CO; n = 38). Participants completed baseline, and 2-year follow-up evaluations including the Short Form Health Survey 36 (SF-36), anthropometric, hemodynamic components, and cardiorespiratory fitness (VO2 peak). RESULTS: LTMEX improves HRQoL, specifically physical functioning (P < 0.001), general health (P < 0.05), vitality (P < 0.001), mental health (MH; P < 0.05), physical component score (P < 0.001), mental component score (P < 0.001), and total SF-36 (P < 0.001). LTMEX group also decreased body weight (BW; P < 0.005), waist circumference (WC; P < 0.001), waist-to-hip ratio (WHR; P < 0.001), and systolic blood pressure (SBP; P < 0.001), and increased VO2 peak (P < 0.001). CO group increased WC (P = 0.012), BMI (P = 0.024), waist-to-hip ratio (WHR; P = 0.003) and SBP (P < 0.001), and decreased vitality (P < 0.001) and MH (P < 0.05). CONCLUSIONS: A LTMEX intervention improves physical and mental HRQoL in older adults with T2D, and also anthropometric, hemodynamic profile, and cardiorespiratory fitness.

Translation, cross-cultural adaptation and validation of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire to Portuguese: Older adults version.

BACKGROUND: Deprescribing is a patient-centered approach to managing inappropriate polypharmacy that faces several barriers, including patients' attitudes and beliefs about medications that need to be considered. For this purpose, the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire is a helpful instrument, but until now, there is no Portuguese version. OBJECTIVES: To translate and validate the rPATD questionnaire (older adults version) to Portuguese. METHODS: The rPATD questionnaire was translated and cross-culturally adapted using forward-backward translation and pre-testing. A cross-sectional study with 192 older adults aged ≥65 years taking at least 1 regular medication was conducted for validity assessment. Participants were recruited by convenience sampling in 3 Portuguese outpatient rehabilitation medicine clinics. Psychometric properties were evaluated through face and content validity; construct validity, by assessing structural validity through exploratory factor analysis, hypotheses testing, including concurrent validity and cross cultural validity; reliability with internal consistency; and item-total correlation. Floor and ceiling effects were examined. RESULTS: The exploratory factor analysis (EFA) revealed a 4-factor structure that explains 51.08% of the total variance, as in the original rPATD. These 4 factors are related to the level of involvement in medication management, beliefs in the appropriateness of medication, perceived burden of medication, and concerns about stopping medications. Factor loadings ranged from 0.226 to 0.800; 2 items scored <0.3, and no cross-loading was found. The exclusion of the 2 items loading <0.3 in the EFA showed no significant improvement in factor loading or internal consistency, so the item structure was maintained. In hypothesis testing, 78% of the correlations were correctly predicted. The 4 factors internal consistency was generally acceptable, with Cronbach's alpha ranging from 0.638 to 0.830. The item-total correlation ranged between 0.223 and 0.7. CONCLUSION: The Portuguese rPATD questionnaire for older adults presents globally good or acceptable psychometric properties.

Predictors of older patients' willingness to have medications deprescribed: A cross-sectional study.

BACKGROUND: Deprescribing is a complex process requiring a patient-centred approach. One frequently expressed deprescribing barrier is patients' attitudes and beliefs towards deprescribing. This study aimed to identify the predictors of patients' willingness to have medications deprescribed. METHODS: A cross-sectional study was conducted with community-dwelling patients aged ≥65 who are taking at least one regular medication. Data collection included patients' demographic and clinical characteristics and the Portuguese revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Descriptive statistics were used to present the patients' characteristics. Multiple binary logistic regression analysis was performed to identify the predictors of the patients' willingness to have medications deprescribed. RESULTS: One hundred ninety-two participants (median age 72 years; 65.6% female) were included. Most (83.33%) were willing to have medications deprescribed, and the predictors were age (adjusted odds ratio [aOR] = 1.136; 95% CI 1.026, 1.258), female sex (aOR = 3.036; 95% CI 1.059, 8.708) and the rPATD concerns about stopping factor (aOR = 0.391; 95% CI 0.203, 0.754). CONCLUSIONS: Most patients were willing to have their medications deprescribed if it is recommended by their doctors. Older age and female sex increased the odds of willingness to deprescribe; higher concerns about stopping medications decreased the odds. These findings suggest that addressing patients' concerns about stopping their medicines may contribute to deprescribing success.

A Universal Pharmacological-Based List of Drugs with Anticholinergic Activity.

Anticholinergic burden tools have relevant pharmacological gaps that may explain their limited predictive ability for clinical outcomes. The aim of this study was to provide a universal pharmacological-based list of drugs with their documented affinity for muscarinic receptors. A comprehensive literature review was performed to identify the anticholinergic burden tools. Drugs included in these instruments were searched in four pharmacological databases, and the investigation was supplemented with PubMed. The evidence regarding the potential antagonism of the five muscarinic receptors of each drug was assessed. The proportion of drugs included in the tools with an affinity for muscarinic receptors was evaluated. A universal list of drugs with anticholinergic activity was developed based on their documented affinity for the different subtypes of muscarinic receptors and their ability to cross the blood-brain barrier. A total of 23 tools were identified, including 304 different drugs. Only 48.68%, 47.70%, 48.03%, 43.75%, and 42.76% of the drugs had an affinity to the M1, M2, M3, M4, and M5 receptor, respectively, reported in any pharmacological database. The proportion of drugs with confirmed antagonism varied among the tools (36.8% to 100%). A universal pharmacological-based list of 133 drugs is presented. It should be further validated in different clinical settings.

Platelet Membrane Proteins as Pain Biomarkers in Patients with Severe Dementia.

Pain is one of the most frequent health problems, and its evaluation and therapeutic approach largely depend on patient self-report. When it is not possible to obtain a self-report, the therapeutic decision becomes more difficult and limited. This study aims to evaluate whether some membrane platelet proteins could be of value in pain characterization. To achieve this goal, we used 53 blood samples obtained from palliative patients, 44 with non-oncological pain and nine without pain. We observed in patients with pain a decrease in the percentage of platelets expressing CD36, CD49f, and CD61 and in the expression levels of CD49f and CD61 when compared with patients without pain. Besides that, an increase in the percentage of platelets expressing CD62p was observed in patients with pain. These results suggest that the levels of these platelet cluster differentiations (CDs) could have some value as pain biomarkers objectively since they are not dependent on the patient's participation. Likewise, CD40 seems to have some importance as a biomarker of moderate and/or severe pain. The identification of pain biomarkers such as CD40, CD49f, CD62p and CD61 can lead to an adjustment of the therapeutic strategy, contributing to a faster and more adequate control of pain and reduction in patient-associated suffering.

Glycated hemoglobin and associated risk factors in older adults.

BACKGROUND: The aim of this study is to investigate the relationships between HbA1c and other risk factors like obesity, functional fitness, lipid profile, and inflammatory status in older adults. Epidemiological evidence suggests that HbA1c is associated with cardiovascular and ischemic heart disease risk. Excess of body weight and obesity are considered to play a central role in the development of these conditions. Age is associated with several risk factors as increased body fat and abdominal fat, deterioration of the lipid profile, diabetes, raising in inflammatory activity, or decreased functional fitness. METHODS: Data were available from 118 participants aged 65-95 years, including 72 women and 46 men. Anthropometric variables were taken, as was functional fitness, blood pressure and heart rate. Blood samples were collected after 12 h fasting, and HbA1c, hs-CRP, TG, TC, HDL-C, LDL-C, and glycaemia were calculated. Bivariate and partial correlations were performed to explore associations amongst the variables of interest. Differences between groups were explored by performing factorial analysis of variance. RESULTS: HbA1c levels ranged from 4.6%-9.4% with 93% of the cases below 6.5%. Women had higher HbA1c, glycaemia, TC, BMI, and lower and upper flexibility than men. Men had higher BW, WC, 6-min walking distance, and VO2peak than women. Age, SBP, DBP, HRrest, HRpeak, HDL-C, LDL-C, TG, TG/HDL-C ratio, Log10 hs-CRP, upper and lower strength, and agility and dynamic balance were similar in men and women. HbA1c had positive associations with glycaemia, HDL-C, TG/HDL-C, BW, WC, BMI, but not with functional fitness, TC, LDL-C, Log10 hs-CRP, PAD, or PAS. Obese participants had higher HbA1c than non-obese only when IDF and not USDHHS criteria were applied. CONCLUSIONS: Older women had higher HbA1c than men, even after controlling for BMI. HbA1c associates equally with BW, BMI or WC. Population-based criteria are recommended to classify obesity and to identify higher levels of HbA1c in obese older adults. HbA1c associates with atherogenic dyslipidemia particularly with TG and TG/HDL-C ratio, but not with TC, HDL-C, or LDL-C. HbA1c is not associated with hs-CRP, and with functional fitness and aerobic endurance.

Non-steroidal anti-inflammatory drugs (NSAIDs), pain and aging: Adjusting prescription to patient features.

A narrative review of papers published from January 2011 to December 2021, after a literature search in selected databases using the terms "pharmacokinetics", "ibuprofen", "diclofenac", "acemetacin", "naproxen", "etodolac" and "etoricoxib" was performed. From 828 articles identified, only eight met the inclusion criteria. Selective COX-2 inhibitors are associated with higher cardiovascular risk, while non-selective COX inhibitors are associated with higher gastrointestinal risk. NSAIDs with lower renal excretion with phase 2 metabolism are less likely to induce adverse effects and drug-drug interactions. Patients with frequent NSAID use needs, such as elderly patients and patients with cardiovascular disease or impaired renal function, will benefit from lower renal excretion (e.g. acemethacin, diclofenac, and etodolac) (level of evidence 3). Polymedicated patients, elderly patients, and patients with chronic alcohol abuse will be at a lower risk for adverse effects with NSAIDs that undergo phase 2 liver biotransformation, namely, acemethacin and diclofenac (level of evidence 3). Young patients, patients dealing with acute pain, or with active and/or chronic symptomatic gastritis, selective COX-2 inhibitors (celecoxib or etoricoxib) may be a better option (level of evidence 2). Knowing the individual characteristics of the patients, combined with knowledge on basic pharmacology, offers greater safety and better adherence to therapy. PERSPECTIVE: Although there are several NSAIDs options to treat pain, physicians usually take special care to its prescription regarding cardiovascular and gastrointestinal side effects, despite the age of the patient. In this paper, based on the best evidence, the authors present a review of the safest NSAIDs to use in the elderly.

Size of the associations between anticholinergic burden tool scores and adverse outcomes in older patients.

Background Several anticholinergic scales and equations to evaluate the anticholinergic burden have been previously created. Association of these instruments with the anticholinergic outcomes are usually estimated by means of hypothesis contrast tests, which ignore the size of the association effect. Objective To evaluate the effect size of the associations between the scores on cumulative anticholinergic burden instruments with peripheral or central anticholinergic adverse outcomes in older patients. Setting Internal medicine ward of a Tertiary University Hospital. Methods A case-control study was conducted in patients over 65 years who were admitted to two internal medicine wards of a Portuguese university hospital. The Anticholinergic Drug Scale, Anticholinergic Risk Scale, Anticholinergic Cognitive Burden scale and Drug Burden Index were used to calculate the patients' anticholinergic burden. Peripheral (dry mouth-swab technique; dry eye-Schirmer test) and central (falls and cognitive impairment-Mini-Mental State Examination) anticholinergic adverse outcomes were investigated. The Barthel Index was used to assess overall physical functionality. The Mann-Whitney test was used to evaluate probabilistic differences in the anticholinergic scores between case and control individuals. To establish the effect size of the associations, the area under the curve of the receiver operating characteristics curve was calculated. Main outcome measure Anticholinergic adverse effects. Results A total of 250 patients (mean age 81.67 years, standard deviation 7.768; 50% females) were included. In total, 148 patients (59.2%) presented with dry mouth, 85 (34%) with dry eye, 141 (56.4%) with impaired functionality, 44 (17.6%) with a history of falls and 219 (87.6%) with cognitive impairment. Significant differences (p < 0.05) were obtained for the majority of the associations between Anticholinergic Drug Scale, Anticholinergic Risk Scale, Anticholinergic Cognitive Burden and Drug Burden Index and adverse effects. Conversely, the effect sizes of these associations ranged from "fail" (area under the curve 0.5 to 0.6) to "fair" (area under the curve 0.7 to 0.8). Conclusion Although significant differences in the scores of anticholinergic burden instruments and adverse outcomes may exist, the effect sizes of these associations ranged from 'fail' to 'fair', which limits their utility in preventing anticholinergic adverse outcomes with medication review interventions.

Atherosclerosis: The cost of illness in Portugal.

INTRODUCTION AND OBJECTIVES: Cardiovascular disease is the leading cause of death in Portugal and atherosclerosis is the most common underlying pathophysiological process. The aim of this study was to quantify the economic impact of atherosclerosis in Portugal by estimating disease-related costs. METHODS: Costs were estimated based on a prevalence approach and following a societal perspective. Three national epidemiological sources were used to estimate the prevalence of the main clinical manifestations of atherosclerosis. The annual costs of atherosclerosis included both direct costs (resource consumption) and indirect costs (impact on population productivity). These costs were estimated for 2016, based on data from the Hospital Morbidity Database, the health care database (SIARS) of the Regional Health Administration of Lisbon and Tagus Valley including real-world data from primary care, the 2014 National Health Interview Survey, and expert opinion. RESULTS: The total cost of atherosclerosis in 2016 reached 1.9 billion euros (58% and 42% of which was direct and indirect costs, respectively). Most of the direct costs were associated with primary care (55%), followed by hospital outpatient care (27%) and hospitalizations (18%). Indirect costs were mainly driven by early exit from the labor force (91%). CONCLUSIONS: Atherosclerosis has a major economic impact, being responsible for health expenditure equivalent to 1% of Portuguese gross domestic product and 11% of current health expenditure in 2016.

Effects of aerobic and strength-based training on metabolic health indicators in older adults.

BACKGROUND: The weakening of the cardiovascular system associated with aging could be countered by increasing levels of physical activity and functional fitness. However, inconsistent findings have been found, and the variety of characteristics of exercise used in previous studies may partly explain that inconsistent results. OBJECTIVE: To investigate the training effect of sixteen weeks of moderate intensity, progressive aerobic and strength-based training on metabolic health of older women and men. METHODS: Sixty three sedentary individuals (mean (SD) age 76 (8) years) were randomly assigned to control (n = 31) or exercising (n = 32) groups. The training group was separated to aerobic (n = 18) or strength-based (n = 14). Training took place three times a week. Subjects agreed not to change their diet or lifestyle over the experimental period. RESULTS: Exercising group attained after treatment significant differences on body weight, waist circumference, body mass index, diastolic blood pressure, triglycerides, total cholesterol, HDL-cholesterol, LDL-cholesterol, total cholesterol/HDL-cholesterol relationship, high sensitivity C-reactive protein, and 6-minute walk distance. The control group only had significant differences on waist circumference. CONCLUSION: The training programs produced significant benefits on metabolic health indicators of sedentary older women and men.

The effect of aerobic versus strength-based training on high-sensitivity C-reactive protein in older adults.

Increased levels of inflammatory markers, namely, high-sensitive C-reactive protein (hs-CRP), have been associated with several chronic diseases including atherosclerosis, type 2 diabetes and hypertension. Forty-five women and men aged >64 years participated in the study and were randomly assigned to two exercise intervention groups and a non-exercising control group. The participants assigned to the exercising groups followed a 16-week exercise protocol based either on aerobic training (AT) or strength training (ST) followed by a further 16 weeks off-training period. The control group (C) remained sedentary throughout the study. Evaluation of body mass, BMI, waist circumference, aerobic endurance, lower-body strength, upper-body strength, triglycerides, total cholesterol, LDL-cholesterol, HDL-cholesterol and hs-CRP were performed at baseline, after 16 weeks (post-training for the exercise groups) and at 32 weeks (follow-up). Both, AT and ST groups significantly increased functional fitness at the end of the exercise programs when compared to baseline values. hs-CRP concentrations were maintained throughout the study for the C group, while decreasing 10% at 16 weeks and 51% at 32 weeks for the AT group. In the ST group the hs-CRP concentrations decreased by 11 and 39% at 16 and 32 weeks, respectively. Decreases in hs-CRP concentrations were statistically significant for the AT and ST groups at the 32-week evaluation when compared to baseline. Reduction in hs-CRP concentrations seemed to be associated with strength gains and adiposity loss.

The Effects of Concurrent Training Combining Both Resistance Exercise and High-Intensity Interval Training or Moderate-Intensity Continuous Training on Metabolic Syndrome.

To date, there are several knowledge gaps on how to properly prescribe concurrent training to achieve the best dose-response, especially regarding the optimal intensity or volume of the aerobic component. Thus, the objective of this study is to analyze the effects of different aerobic exercise modes and intensities [i.e. aerobic high-intensity interval training (HIIT) versus moderate-intensity continuous aerobic training (MICT) combined with a resistance training (RT) program] on metabolic outcomes in participants with metabolic syndrome (MetS). Thirty-nine men and women (67.0 ± 6.7 years) volunteered to a 12-weeks exercise intervention (3 week-1, 50 min/session) and were randomly assigned to one of three groups: (a) RT plus MICT (RT+MICT) (2 males; 11 females); (b) RT plus HIIT (RT+HIIT) (4 males; 9 females); and (c) control group (CON) - without formal exercise (4 males; 9 females). Intensity was established between 60 and 70% of maximum heart rate (HRmax) in RT+MICT and ranged from 55-65% to 80-90% HRmax in the RT+HIIT group. Dependent outcomes included morphological, metabolic and hemodynamic variables. Both training groups improved waist circumference (RT+MICT: P = 0.019; RT+HIIT: P = 0.003), but not body weight, fat mass or fat-free mass (P ≥ 0.114). RT+HIIT group improved fasting glucose (P = 0.014), low density lipoprotein [LDL (P = 0.022)], insulin (P = 0.034) and homeostatic model assessment (P = 0.028). RT+MICT group reduced triglycerides (P = 0.053). Both exercise interventions did not change high sensitivity C-reactive protein, glycated hemoglobin, high density lipoprotein and total cholesterol, systolic, diastolic or mean arterial blood pressure (P ≥ 0.05). The CON group reduced the LDL (P = 0.031). This trial suggests that short-term exercise mode and intensity may differently impact the metabolic profile of individuals with MetS. Further, our data suggests that both concurrent trainings promote important cardiometabolic gains, particularly in the RT+HIIT. Nonetheless, due to the small-to-moderate effect size and the short-term intervention length, our data suggests that the intervention length also has an important modulating role in these benefits in older adults with MetS. Therefore, more research is needed to confirm our results using longer exercise interventions and larger groups.

A Severe Presentation of Drug-Induced Lupus Erythematosus.

Drug-induced lupus erythematosus is a rare condition associated with the exposure to certain drugs capable of triggering an autoimmune disease similar to systemic lupus erythematosus. Although there are no available diagnostic criteria, clinical and serological findings and its temporal association with the initiation of the suspected drug are important to establish the diagnosis. The withdrawal of the drug usually resolves the symptoms. However, in some cases, therapy with corticosteroids and immunosuppressive agents may be required. We present a 74-year-old female with a bilateral venous thrombosis, ischemic stroke, polyserositis and diarrhea due to drug-induced lupus erythematosus that required immunosuppressive therapy.