Association between self-reported urinary incontinence and musculoskeletal conditions in community-dwelling elderly women: a cross-sectional study.

AIMS: Urinary incontinence (UI) and musculoskeletal conditions, particularly low back pain (LBP), and osteoarthritis (OA), are common problems that have been associated with mobility limitations and future dependence in activities of daily living in the elderly. The purpose of this study was to explore the relationship between UI, UI types, and musculoskeletal conditions in elderly community-dwelling women. METHODS: A cross-sectional study was performed on 1,399 community-dwelling Japanese women aged 75-84 years. Face-to-face interviews, body composition, and physical function, including grip strength, and usual walking speed, were conducted. UI was defined as experience of urine leakage episodes more than once per week. Self-reported presence and degree of pain, LBP, and OA were assessed. Student's t-tests and chi-square tests were used to analyze continuous and categorical variables. Associations between selected variables, UI, and UI types were assessed using stepwise multiple logistic regression models. RESULTS: A total of 260 participants had UI (18.6%) and 399 had LBP (28.5%). Participants with UI were more likely to experience pain (76.0%) and LBP (36.2%) than those without UI (P < 0.001 and P = 0.002, respectively). Age, body mass index, falls, walking speed, grip strength, LBP, and pain coupled with OA were significantly associated with UI. There were significant associations between urge UI and mild (odds ratio (OR) = 1.653, 95% confidence interval (CI) = 1.031-2.650) and severe LBP (OR = 2.617, 95% CI = 1.193-5.739). CONCLUSIONS: This study showed that UI was significantly associated with musculoskeletal conditions, including LBP, and the combination of pain and OA. The risk of urge UI was greater with increasing severity of LBP.

The effects of exercise and milk-fat globule membrane (MFGM) on walking parameters in community-dwelling elderly Japanese women with declines in walking ability: A randomized placebo controlled trial.

OBJECTIVE: To investigate the effects of exercise and milk fat globule membrane (MFGM) supplementation on walking ability and walking parameters in community-dwelling elderly Japanese women with declined walking ability. METHODS: A randomized placebo controlled trial was performed on 126 elderly community-dwelling women over 79 years old. Participants were randomly assigned to one of four three-month interventions: exercise and MFGM (Ex + MFGM), exercise and placebo (Ex + P), MFGM, and placebo interventions. The exercise intervention group performed one-hour progressive exercise classes twice a week. The MFGM supplementation included ingesting 1 g of MFGM per day. Medical history, physical function measurements included grip strength, knee extension strength, walking speed, as well as walking parameters, and blood components were analyzed. RESULTS: Significant group × time interactions were observed in usual walking speed, stride, and foot progression angle between the groups. Walking speed improved in both exercise groups (P < 0.001). Similarly, stride significantly increased in the exercise groups compared to the MFGM and placebo groups (P < 0.001). Foot progression angle decreased in the exercise groups (P = 0.023) but not in MFGM or placebo groups. Participants with decreased or unchanged walking speed had significantly lower knee extension strength at baseline (P = 0.016), and a higher prevalence of knee OA (P = 0.033, P = 0.010, respectively). CONCLUSION: The exercise interventions alone or combined with nutrition were effective in improving walking speed as well as other walking parameters. Improvement in stride and foot progression angle may have contributed to the increase in walking speed. However, augmented effects of MFGM with exercise could not be confirmed.

Cognitive frailty in community-dwelling older Japanese people: Prevalence and its association with falls.

AIM: To investigate the prevalence and associated factors of cognitive frailty and cognitive frailty-related falls in community-dwelling older people. METHODS: A total of 25 out of 1192 community-dwelling older people aged >70 years with cognitive frailty participated in the present cross-sectional study. Cognitive function was assessed using the Mini-Mental State Examination. Physical function measures included calf circumference, Timed Up and Go (TUG) and usual walking speed. Interviews were carried out to assess Council on Nutrition Appetite Questionnaire (CNAQ); chronic diseases including hypertension, diabetes and falls; as well as physical frailty, defined as having three of five criteria: muscle weakness, slowness, exhaustion, low activity and weight loss. RESULTS: The prevalence of cognitive frailty was 2.1%. Participants with cognitive frailty had significantly reduced Mini-Mental State Examination and calf circumference; and higher instrumental activities of daily living disability and falls. Old age (OR 1.151, 95% CI 1.053-1.257), fall history (OR 3.577, 95% CI 1.381-9.263), having four or more chronic diseases (OR 7.419, 95% CI 2.117-26.005) and slower TUG (OR 1.234, 95% CI 1.041-1.462) were significantly associated with cognitive frailty, whereas greater calf circumference (OR 0.748, 95% CI 0.625-0.895) and CNAQ (OR 0.736, 95% CI 0.628-0.8631) had protective effects. Old age (OR 1.132, 95% CI 1.002-1.280), hospitalization (OR 10.090, 95% CI 2.554-39.854), having four or more chronic diseases (OR 5.120, 95% CI 1.113-23.557) and slower TUG (OR 1.394, 95% CI 1.167-1.665) were significantly associated with cognitive frailty-related falls, whereas CNAQ (OR 0.704, 0.571-0.868) had protective effects. CONCLUSIONS: Age, chronic disease, TUG and CNAQ were significantly associated with cognitive frailty and cognitive frailty-related falls. The TUG and CNAQ have the greatest potential for improvement by intervention or lifestyle change. Further research is necessary to determine the efficacy of positive changes in these factors for symptomatic improvements. Geriatr Gerontol Int 2019; 19: 647-653.

The Effects of Mold-Fermented Cheese on Brain-Derived Neurotrophic Factor in Community-Dwelling Older Japanese Women With Mild Cognitive Impairment: A Randomized, Controlled, Crossover Trial.

OBJECTIVES: To investigate the effects of mold-fermented cheese (MFC) on brain-derived neurotrophic factor (BDNF) in community-dwelling older Japanese women with mild cognitive impairment (MCI). DESIGN: Randomized controlled crossover trial. INTERVENTION: Participants were randomly assigned to 2 groups. The MFC group was provided with 33.4 g MFC (camembert cheese) daily for 3 months, and the non-MFC group was provided with the same amount of non-MFC (processed cheese made from mozzarella cheese and cream cheese) for 3 months. After the post-intervention analysis (primary analysis), there was a 3-month washout period, followed by a crossover period (secondary analysis). SETTING AND PARTICIPANTS: Urban community in Tokyo, Japan. A total of 71 older women aged ≥70 years with MCI based on selected criteria in 689 community-dwelling women. MEASURES: Face-to-face interviews were conducted to administer the Geriatric Depression Scale (GDS) and Mini-Mental State Examination (MMSE) and collect data on medical history. Physical function measures included grip strength, knee extension strength, and usual walking speed. Blood samples were obtained to determine the levels of albumin, vitamin D, high-sensitivity C-reactive protein, and BDNF. RESULTS: Significant interactions were observed in BDNF after intervention of MFC intake in the secondary (F = 5.368, P = .024) and combined analyses (F = 4.354, P = .039) but not the primary analysis. There were no significant changes in the 3 categories of MMSE score (normal, MCI, moderate or severe cognitive impairment), GDS score, physical function, and blood indicators. CONCLUSIONS AND IMPLICATIONS: Three months of MFC ingestion had beneficial effects on BDNF levels in community-dwelling older women with MCI; however, the BDNF increases did not translate into MMSE scores. Further study into the effects of interventions on cognitive function and depression in older people with MCI is necessary.

Long-term effects of exercise and amino acid supplementation on muscle mass, physical function and falls in community-dwelling elderly Japanese sarcopenic women: A 4-year follow-up study.

AIM: To determine the long-term effects of interventions carried out for the improvement of muscle mass, strength, walking ability and fall rate, 4 years after the completion of the intervention. METHODS: Out of 304 elderly sarcopenic women aged over 75 years, 155 participated in an intervention and 149 were excluded from the intervention. Those excluded were considered as non-participants and included in the analysis. Follow-up data were available for 259 women (135 intervention participants; 124 non-participants). Muscle mass was determined by bioelectrical impedance analysis. Physical fitness measurements and interview surveys were carried out at baseline and at 4-year follow up. RESULTS: Compared with the non-participants, women in the intervention group had significantly smaller reductions in measures of muscle mass, strength and walking speed from baseline to follow up. The absolute mean difference between the two groups was 3.7% (95% confidence interval -6.5 to -0.8; P = 0.012) for leg muscle mass, 10.7% (-21.0 to -0.3; P = 0.011) for knee extension strength and 8.4% (-16.0 to -0.9; P = 0.029) for usual walking speed. Instrumental activities of daily living disability significantly increased in both participants and non-participants in 4 years. The fall rate of the previous 1 year in intervention participants was 18.5% in 2008 and 23.0% in 2012 (χ(2) = 2.122, P = 0.145), and 17.7% in 2008 and 29.0% in 2012 among non-participants (χ(2) = 15.415, P < 0.001). CONCLUSION: Participation in an intervention could prevent significant declines in lower extremity muscle mass, strength and mobility, even in the long-term, and might be beneficial in suppressing otherwise significant rises in fall rates.

Sarcopenia: Prevalence and associated factors based on different suggested definitions in community-dwelling older adults.

The age-related loss of muscle mass and/or strength and performance, sarcopenia, has been associated with geriatric syndromes, morbidity and mortality. Although sarcopenia has been researched for many years, currently there is a lack of consensus on its definition. Some studies define sarcopenia as low muscle mass alone, whereas other studies have recently combined low muscle mass, strength and physical performance suggested by the European Working Group on Sarcopenia in Older People, as well as the Asian Working Group for Sarcopenia. The arbitrary use of various available sarcopenia definitions within the literature can cause discrepancies in the prevalence and associated risk factors. The application of population-specific cut-off values in any sample population can be problematic, particularly among different ethnicities. Using commonly used cut-off points to define sarcopenia, including solely muscle mass and combined definitions, on a community-dwelling elderly Japanese population, the prevalence of sarcopenia ranged from 2.5 to 28.0% in men and 2.3 to 11.7% in women, with muscle mass measured by dual-energy X-ray absorptiometry, and 7.1-98.0% in men and 19.8-88.0% in women measured by bioelectrical impedance analysis. Body mass index was the most prominent related factor for sarcopenia across the definitions in this Japanese sample. However, other associated hematological and chronic condition factors varied depending on the definition.

Exercise and Nutritional Supplementation on Community-Dwelling Elderly Japanese Women With Sarcopenic Obesity: A Randomized Controlled Trial.

OBJECTIVES: To investigate the effects of exercise and/or nutritional supplementation on body composition, blood components, and physical function in community-dwelling elderly Japanese women with sarcopenic obesity. DESIGN: Randomized controlled trial. SETTING: Urban community in Tokyo, Japan. PARTICIPANTS: Among 1213 community-dwelling elderly women over 70 years of age, 307 were defined with sarcopenic obesity, and 139 women participated in the study. INTERVENTION: Participants were randomly assigned to one of four intervention groups. The exercise and nutrition (Ex + N) and exercise only (Ex) groups attended 60-minute exercise classes twice a week for 3 months. The Ex + N and nutrition only (N) groups were provided with essential amino acid supplementation and tea fortified with catechins to be taken daily for 3 months. Health education classes were provided to the control (HE) group every 2 weeks. MEASUREMENTS: Bioelectric impedance analysis was used to measure body composition. Skeletal muscle mass index was calculated using measures of muscle mass and height. Physical function measures included grip strength, knee extension strength, usual walking speed, and walking parameters (stride, step length, width, walking angles). Blood samples were obtained to analyze levels of albumin, triglycerides, cholesterol, hemoglobin A1c, leptin, cystatin C, vitamin D, interleukin-6, and high-sensitivity C-reactive protein. RESULTS: Significant between-group × time interactions were observed in usual walking speed (P = .012), stride (P = .004), right step length (P = .003), average number of steps (P = .029), and vitamin D (P < .001). Compared to the HE group, the Ex + N intervention significantly decreased total body fat mass (P = .036) and increased stride (P = .038) and vitamin D (P < .001). Significant reductions in trunk fat were observed in the Ex group compared with HE (P = .014). The Ex + N and Ex interventions were over four times as likely (odds ratio [95% confidence interval]) to reduce body fat mass than the HE group (4.42 [1.21-16.19]; 4.50 [1.13-17.9], respectively). Significant odds ratios of the Ex + N intervention improving walking speed (3.05 [1.01-9.19]), vitamin D (14.22 [1.64-123.02]), and leptin (3.86 [1.19-12.47]) were also observed. CONCLUSION: Although exercise and nutrition have beneficial effects on individual variables of body composition, blood components, and physical function, improvements in muscle mass and variable combinations such as percent fat + skeletal muscle mass index or percent fat + physical functions were not observed in this population. Further large-scale and long-term investigation is necessary.

Effects of exercise and milk fat globule membrane (MFGM) supplementation on body composition, physical function, and hematological parameters in community-dwelling frail Japanese women: a randomized double blind, placebo-controlled, follow-up trial.

OBJECTIVE: To investigate the combined and separate effects of exercise and milk fat globule membrane (MFGM) supplementation on frailty, physical function, physical activity level, and hematological parameters in community-dwelling elderly Japanese women. METHODS: A total of 131 frail, elderly women over 75 years were randomly assigned to one of four groups: exercise and MFGM supplementation (Ex+MFGM), exercise and placebo (Ex+Plac), MFGM supplementation, or the placebo group. The exercise group attended a 60-minute training program twice a week for three months, and the MFGM group ingested 1g of the MFGM supplement in pill form, daily for 3 months. The primary outcome measure was change in frailty status based on Fried's frailty phenotype. Secondary outcome measures included body composition, physical function and hematological parameters, and interview survey components assessing lifestyle factors. Participants were followed for 4 months post-intervention. RESULTS: Significant group × time interactions were observed for usual walking speed (P = 0.005), timed up & go (P<0.001), and insulin-like growth factor-binding protein 3/insulin-like growth factor 1 ratio (P = 0.013). The frailty components revealed that weight loss, exhaustion, low physical activity, and slow walking speed were reversed, but low muscle strength did not significantly changed. Frailty reversal rate was significantly higher in the Ex+MFGM (57.6%) than in the MFGM (28.1%) or placebo (30.3%) groups at post-intervention (χ2 = 8.827, P = 0.032), and at the follow-up was also significantly greater in the Ex+MFGM (45.5%) and Ex+Plac (39.4%) groups compared with the placebo (15.2%) group (χ2 = 8.607, P = 0.035). The exercise+MFGM group had the highest odds ratio (OR) for frailty reversal at post-intervention and follow-up (OR = 3.12, 95% confidence interval (CI) = 1.13-8.60; and OR = 4.67, 95% CI = 1.45-15.08, respectively). CONCLUSION: This study suggests that interventions including exercise and nutrition can improve frailty status. Statistically significant additive effects of MFGM with exercise could not be confirmed in this population, and further investigation in larger samples is necessary. TRIAL REGISTRATION: The Japan Medical Association Clinical Trial Registry (JMACCT)JMA-IIA00069.

Incidence and predictors of sarcopenia onset in community-dwelling elderly Japanese women: 4-year follow-up study.

OBJECTIVES: Several studies have explored the prevalence and risk factors of sarcopenia, but they have been based on cross-sectional data. The objective of this study was to determine the incidence and predictors of the onset of sarcopenia over 4 years in community-dwelling elderly women. DESIGN: Four-year longitudinal follow-up study. SETTING: Urban community in Tokyo, Japan. PARTICIPANTS: A total of 538 nonsarcopenic women older than 75 years. MEASUREMENTS: Body composition was determined by bioelectrical impedance analysis. Functional fitness measurements, including grip strength, usual walking speed, timed up and go (TUG), and interview surveys were conducted at baseline and 4-year follow-up. Blood samples were obtained to analyze serum albumin and hemoglobin A1c, and kidney function was analyzed using serum creatinine and cystatin C. Sarcopenia was defined based on the criteria suggested by the European Working Group on Sarcopenia in Older People, and the development of all stages, that is, presarcopenia, sarcopenia, and severe sarcopenia as well as the components of sarcopenia skeletal muscle index (SMI), grip strength, and walking speed, were analyzed. RESULTS: The incidence of total sarcopenia was 39.6% (presarcopenia 23.8%, sarcopenia 11.2%, severe sarcopenia 4.6%). Older age was significantly predictive of the development of presarcopenia and severe sarcopenia. Body mass index (BMI) lower than 21.0 kg/m(2) was significantly predictive of the development of all stages of sarcopenia, as well as declines in SMI, grip strength, and walking speed. Slow TUG was a predictor of the development of presarcopenia and severe sarcopenia. Increased calf circumference showed protective effects from the development of all stages of sarcopenia. Greater albumin levels also showed lower risk of declines in SMI, walking speed, and development of presarcopenia. Cystatin C was positively associated with the development of severe sarcopenia (odds ratio 1.83, 95% confidence interval 1.08-3.12). Heart disease and hyperlipidemia history were associated with presarcopenia and sarcopenia, respectively. CONCLUSION: Age, BMI, calf circumference, and TUG were consistent predictors of the various stages and components of sarcopenia. The data also suggest that cystatin C was associated with higher odds of incident severe sarcopenia, and further study into kidney function and onset of sarcopenia in large populations is needed.

Effectiveness of exercise with or without thermal therapy for community-dwelling elderly Japanese women with non-specific knee pain: a randomized controlled trial.

UNLABELLED: Knee pain is a common health problem in the elderly population, for which non-invasive treatments are recommended as a first line treatment in the management of knee pain. A randomized controlled trial was conducted to determine the effects of exercise with or without thermal therapy in community-dwelling elderly women with chronic knee pain. Women over 75 years of age with knee pain (n=150) were randomly assigned into four groups; exercise (Ex) and heat/steam generating sheet (HSGS) (n=38), Ex (n=37), HSGS (n=38), or health education (HE) (n=37). The Ex group attended a 60-min comprehensive training program twice a week for 3-months. The HSGS group placed two sheets on the knee for five hours per day. Functional fitness, visual analog scale (VAS), and Japanese knee osteoarthritis measure (JKOM) were assessed at baseline and post-intervention. The results showed VAS improvements in the Ex+HSGS and HSGS groups. Total JKOM score, muscle strength, and functional mobility significantly improved in the Ex+HSGS group compared with the HE group. The odds ratio (OR) for VAS and functional mobility improvement was more than eight times as great in the Ex+HSGS group (OR=8.60, 95% confidence interval (CI)=2.82-32.73) compared with the education group. Ex or HSGS alone were insufficient in enhancing functional fitness or improving pain and quality of life. The combined effects of both Ex and heat therapy seems to have an added benefit of decreasing pain, improving physical function and increasing quality of life. TRIAL REGISTRATION NUMBER: JMA-IIA00110.