Effects of Radio-Taiso on Health-Related Quality of Life in Older Adults with Frailty: A Randomized Controlled Trial.

BACKGROUND: Radio-Taiso could be a sustainable public health strategy for maintaining quality of life (QoL) in older adults with frailty. This study aimed to investigate whether Radio-Taiso provided greater benefits for health-related quality of life (HR-QoL) and to identify the mechanisms underlying the effectiveness in this population. METHODS: A 12-week randomized controlled trial enrolled 226 older Japanese adults with pre-frailty or frailty, assessed using the modified frailty phenotype. Participants were randomly allocated to the intervention (Radio-Taiso + nutrition program) or control (nutrition program) groups. The Radio-Taiso program comprised five 60-min group sessions and daily practice at the participants' homes. The primary outcome was the change in the mental domain of HR-QoL, assessed using the SF-36®. The secondary outcomes included six physical fitness items and exercise self-efficacy. RESULTS: Overall, 104 and 105 participants in the intervention and control groups, respectively, were analyzed based on the intention-to-treat principle. The median (interquartile range) daily practice rate of Radio-Taiso was 94.1% (73.2-98.8%). Although general linear models adjusted for baseline values and allocation stratification factors showed that the intervention group obtained greater benefits (adjusted mean differences [95% confidence intervals]) in the up-and-go (0.3 [0.1, 0.6] s), 2-min step-in-place (-3.2 [-6.2, -0.2] steps) tests, and exercise self-efficacy scale (-1.4 [-2.6, -0.1] points) than the control group, there were no group differences in changes in the mental domain score of HR-QoL. CONCLUSIONS: Radio-Taiso provided greater benefits for agility/dynamic balance, aerobic endurance, and exercise self-efficacy in older adults with frailty; however, these changes do not improve HR-QoL.

Associations of polypharmacy with frailty severity and each frailty phenotype in community-dwelling older adults: Itabashi Longitudinal Study on Aging.

AIM: Although polypharmacy and frailty are concerns in older adults, there is limited understanding of their association, particularly regarding frailty severity and its phenotypes within this population. This study aimed to examine the association between polypharmacy and frailty severity or frailty phenotypes in community-dwelling older Japanese adults. METHODS: This cross-sectional study included 1021 older adults from the Itabashi Longitudinal Study on Aging. Men accounted for 45.4%, and the mean age (standard deviation) was 77.9 (5.1) years. Participants were classified into frail (n = 67), pre-frail (n = 543), and robust (n = 411) groups using the revised Japanese Cardiovascular Health Study criteria. Polypharmacy was defined as using five or more self-reported prescription drugs. Ordinal and binomial logistic regression analyses examined the association between polypharmacy and frailty severity or frailty phenotypes (weight loss, weakness, exhaustion, slowness, and low activity). These models were adjusted for age, sex, body mass index, number of comorbidities, living status, employment status, years of education, as well as drinking and smoking habits. RESULTS: The prevalence of frailty in participants with and without polypharmacy was 10.1% and 5.0%, respectively. Participants with polypharmacy were more likely to have frailty (adjusted odds ratio [95% confidence interval], 1.89 [1.40-2.57]), weight loss (1.81 [1.00-3.27]), weakness (1.50 [1.08-2.09]), and slowness (2.25 [1.29-3.94]) compared with the no-polypharmacy group. CONCLUSIONS: Polypharmacy was associated with frailty severity and three frailty phenotypes. Longitudinal studies are required to investigate whether polypharmacy can predict the development and progression of frailty. Geriatr Gerontol Int 2024; 24: 196-201.

Association between dynapenia and cognitive decline in community-dwelling older Japanese adults: The IRIDE Cohort Study.

AIM: Muscle mass and strength correlate with cognitive function; however, it remains unclear whether dynapenia (i.e., muscle weakness with preserved muscle mass) is relevant. This study aimed to explore whether dynapenia is associated with global cognitive function in community-dwelling older Japanese adults. METHODS: This cross-sectional study used data from the Integrated Research Initiative for Living Well with Dementia Cohort Study, which pooled data from five community-based geriatric cohorts. Dynapenia was defined as muscle weakness without muscle mass loss according to the Asian Working Group for Sarcopenia criteria. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). An ordered logistic regression analysis was conducted with dynapenia as the exposure and with cognitive decline stages, defined as an MMSE score of 27-30 for normal cognition, 24-26 for possible cognitive decline, and <24 for cognitive decline, as the outcome, stratified by sex and adjusted for age, muscle mass, education, alcohol consumption, smoking habits, living alone, and non-communicable diseases. RESULTS: We analyzed data for 3338 participants (2162 female) with preserved muscle mass. Of these, 449 (13.5%) had dynapenia, and 79 (2.4%) exhibited cognitive decline. Multivariate odds ratios (95% confidence interval) for cognitive decline among those with dynapenia, compared with those without dynapenia, were 1.51 (1.02-2.24) for males and 2.08 (1.51-2.86) for females. CONCLUSIONS: Muscle weakness is associated with cognitive decline, even in individuals with preserved muscle mass. Further studies are needed to better understand the association between muscle weakness and cognitive decline over time in order to develop dementia prevention strategies for those with dynapenia. Geriatr Gerontol Int 2024; 24: 123-129.

Development and validation of a rapid sarcopenia screening questionnaire: The Otassha study.

AIM: To develop a rapid and easy screening tool to detect sarcopenia. METHODS: In total, 683 community-dwelling older adults who participated in our cohort study, the "Otassha Study," in 2019, completely responded to a questionnaire, and were diagnosed with sarcopenia were included. Participants responded to a nine-item questionnaire, including candidate items for a new sarcopenia screening tool named rapid sarcopenia screening, based on items of the Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) questionnaire. To select appropriate items for the new screeening tool, multiple logistic regression analyses were performed, with sarcopenia as the dependent variable and questionnaire responses as independent variables. The area under the curve using 10 000 bootstraps was used to assess the rapid sarcopenia screening diagnostic ability for detecting sarcopenia. RESULTS: Responses to question nos 2 (how much can you squeeze a wet towel?), 5 (how much muscle strength do you think you have compared with that of people of your age and sex?), 7 (how fast do you usually walk?), and 9 (age-related item) were related to sarcopenia in multiple logistic regression analysis. The area under the curve of the total score of rapid sarcopenia screening was 0.82, 0.80, and 0.81 for men, women, and overall, respectively. At a cut-off value of 14/15, the sensitivity and specificity for sarcopenia detection were 0.73 and 0.73, respectively. CONCLUSIONS: The newly developed sarcopenia screening tool has a better diagnostic ability for sarcopenia than the SARC-F. Rapid sarcopenia screening does not require physical function measurements, making it a useful and accessible tool among older adults to detect sarcopenia. Geriatr Gerontol Int 2023; 23: 945-950.

Predictive Capability of 5 Sarcopenia Diagnostic Criteria for Fall Incidents in Older Japanese Women: The Otassha Study.

OBJECTIVES: The association between sarcopenia diagnosis according to various diagnostic criteria and falls is unclear. We examined the association between sarcopenia defined by 5 different international criteria, and fall and injurious fall numbers among older community-dwelling Japanese women. DESIGN: Prospective observational study. SETTING AND PARTICIPANTS: Two population-based cohort studies in Itabashi, Japan, were integrated, including 552 community-dwelling Japanese women >75 years of age. METHODS: Muscle mass, muscle strength, and physical performance were assessed by bioimpedance analysis, handgrip strength, and gait speed, respectively. We recorded the fall and injurious fall numbers for 1 year using a diary. The association between sarcopenia diagnosis defined by the Asian Working Group for Sarcopenia (AWGS) 2019, European Working Group on Sarcopenia in Older People 2, Foundation for the National Institutes of Health (FNIH), International Working Group on Sarcopenia, and Society on Sarcopenia, Cachexia, and Wasting Disorders, and fall numbers was assessed by Poisson regression analysis to estimate the incidence rate ratio (IRR) and 95% CI for the presence or absence of sarcopenia. RESULTS: Of 470 participants (mean age 77.1 ± 8.1 years), 144 reported a combined 352 falls. Overall, 80 individuals experienced a single fall, 64 experienced multiple falls, and 91 experienced injurious falls. Sarcopenia defined by the AWGS 2019 (IRR 1.39, 95% CI 1.10-1.76) and FNIH (IRR 2.55, 95% CI 1.99-3.26) was significantly associated with the number of falls. In addition, sarcopenia defined by the FNIH (IRR 2.72, 95% CI 1.84-4.03) was significantly associated also with the number of injurious falls. No significant association was observed between sarcopenia diagnosis based on the other definitions and fall outcomes. CONCLUSIONS AND IMPLICATIONS: The AWGS 2019 and FNIH sarcopenia definitions were associated with the fall and injurious fall numbers in older Japanese women, indicating they can help in predicting falls in this population.

Age- and sex-specific associations between sarcopenia severity and poor cognitive function among community-dwelling older adults in Japan: The IRIDE Cohort Study.

Introduction: This study examined whether the association between sarcopenia severity and cognitive function differed according to sex and age in community-dwelling older adults in Japan. Methods: This is a cross-sectional study of older adults (age ≥ 65 years) consisting of five regional cohorts integrated as the Integrated Research Initiative for Living Well with Dementia (IRIDE) Cohort Study. Sarcopenia severity was determined based on the Asian Working Group for Sarcopenia 2019, which assessed grip strength, walking speed, and skeletal muscle mass index. Poor cognitive function was defined as a Mini-Mental State Examination score of ≤ 23. Odds ratios (ORs) and 95% confidence intervals (CIs) for poor cognitive function were calculated by sex and age group (65-74 and ≥75 years) using binomial logistic regression models, which were adjusted for age, educational attainment, history of non-communicable diseases, smoking and drinking habits, living alone, frequency of going outdoors, exercise habits, and depressive symptom. Results: Of the 8,180 participants, 6,426 (1,157 men aged 65-74 and 1,063 men aged 75 or older; 2,281 women aged 65-74 and 1,925 women aged 75 or older) were analyzed. The prevalence ratio of sarcopenia and severe sarcopenia were 309 (13.9%) and 92 (4.1%) among men and 559 (13.3%) and 166 (3.7%) among women, respectively. A total of 127 (5.8%) men and 161 (3.9%) women had a poor cognitive function. Setting non-sarcopenia as a reference, the adjusted ORs (95% CI) of poor cognitive function were 2.20 (1.54, 3.15) for sarcopenia and 3.56 (2.20, 5.71) for severe sarcopenia. A similar trend was observed in analyses stratified by sex and age, with linear associations (P for trend <0.05) in both categories. Furthermore, there was a significant interaction (P < 0.05) between sex and sarcopenia severity, indicating a stronger linear association of sarcopenia severity with poor cognitive function in women compared with men. Discussion and conclusion: Sarcopenia severity was linearly associated with poor cognitive function in adults aged ≥ 65 years, with a stronger association in women compared with men.

Adherence, safety and potential effectiveness of a home-based Radio-Taiso exercise program in older adults with frailty: A pilot randomized controlled trial.

AIM: Radio-Taiso, a traditional exercise program in Japan, may serve as a coping strategy for older adults with frailty during the COVID-19 pandemic. This phase II trial tested program adherence and safety and explored the potential effectiveness of a home-based Radio-Taiso. METHODS: This assessor-blind parallel randomized controlled trial included community-dwelling Jolder Japanese adults with frailty and pre-frailty. Fifty-eight eligible participants were randomly allocated to intervention and control groups. Intervention participants performed 3-5-min sessions of Radio-Taiso one to four times per day for 12 weeks. Feasibility criteria were set at practice and retention rates of ≥75%. Safety was monitored by assessing all adverse events reported by participants during the intervention period, irrespective of causality. Potential effectiveness was exploratorily assessed using items that allow clinical interpretation of changes: mobility and health-related quality of life (HR-QoL), assessed using the modified short physical performance battery (SPPB) and the SF-36, respectively. RESULTS: Both practice (83%) and retention rates (100%) met the predetermined feasibility criteria. Eleven adverse events were reported but were supposedly unrelated to the intervention. In the intention-to-treat analysis, there was no clinically significant difference in the change in SPPB score between groups (-0.4 points, 95% confidence interval [CI], -1.2, 0.3); however, the intervention group scored higher in the mental component of HR-QoL than did the control group (3.4 points, 95% CI: -1.1, 7.8). CONCLUSIONS: The preliminary data indicate that a phase III trial is feasible, focusing on the mental aspect of HR-QoL as the primary outcome. Geriatr Gerontol Int 2023; 23: 32-37.

Effects of a home-based Radio-Taiso exercise programme on health-related quality of life in older adults with frailty: protocol for an assessor-blind randomised controlled trial.

INTRODUCTION: Few clinical trials have examined the effects of home-based exercise programmes on health-related quality of life (HR-QoL) in older adults with frailty. Radio-Taiso is the most famous exercise programme in Japan. A home-based Radio-Taiso exercise programme may serve as an accessible, scalable and sustainable care intervention for older adults with frailty. The primary aim of this trial is to test whether older adults with frailty who are prescribed our home-based Radio-Taiso exercise programme will receive greater benefits for HR-QoL compared with those who are not prescribed the exercise programme. Potential mechanisms underlying the effectiveness of the programme and the effects of the programme on daily lifestyle will also be investigated. METHODS AND ANALYSIS: This assessor-blind randomised controlled trial will be conducted at the Tokyo Metropolitan Institute of Gerontology (TMIG) in Itabashi-ku, Tokyo, Japan. From April to May 2022, 226 older adults with prefrailty or frailty according to the revised Japanese version of the Cardiovascular Health Study criteria will be included from a large database. After a baseline assessment in June 2022, participants will be randomly assigned to the intervention (home-based Radio-Taiso exercise and nutrition programme) or control (nutrition programme) groups at a 1:1 ratio. After intervention completion, a follow-up assessment will be conducted in September 2022. The primary outcome is the change in the mental domain of HR-QoL assessed using SF-36. Secondary outcomes include physical and role/social domains and subscales of HR-QoL, frailty phenotype, physical fitness, posture, cognition, exercise self-efficacy, depressive symptoms, brain-derived neurotrophic factor, social network, habitual energy intake, physical activity and sleep conditions. ETHICS AND DISSEMINATION: The Research Ethics Committee of TMIG has approved the research protocol. This trial will be conducted in accordance with the principles of the Declaration of Helsinki. The findings will be presented at international academic conferences and published in peer-reviewed international journals. TRIAL REGISTRATION NUMBER: UMIN000047229.

Modifiable intrinsic factors related to occupational falls in older workers.

AIM: Identification of modifiable intrinsic factors for occupational falls is required for initiating effective fall prevention strategies for older workers. This study aimed to identify modifiable intrinsic factors related to falls during occupational activities among older workers. METHODS: This retrospective study involved 1164 older workers (aged ≥60 years, workdays ≥4/month) sampled from 18 public employment agencies for seniors in Saitama, Japan. Participants were assessed regarding the following 10 modifiable intrinsic factors: multimorbidity, polypharmacy, fall-risk-increasing medication use, self-rated vision and hearing, functional strength, bilateral stepping, standing balance, executive function and visuospatial ability. The number of falls during occupational activities in the past year was also recorded. RESULTS: In total, 111 falls occurred in 73 of the 1164 participants during occupational activities in the past year. A negative binomial regression model showed that use of fall-risk-increasing medications (incidence rate ratio [IRR]: 2.23, 95% confidence interval [CI]: 1.08, 4.60, P = 0.031), reduced functional strength (IRR: 1.81, 95% CI: 1.02, 3.21, P = 0.042), poor standing balance (IRR: 1.83, 95% CI: 1.09, 3.09, P = 0.023) and poor visuospatial ability (IRR: 1.56, 95% CI: 1.03, 2.36, P = 0.034) were independently associated with occupational falls. CONCLUSIONS: Our findings suggest that the assessment of medication use, functional strength, standing balance and visuospatial ability in regular health checks in the workplace may be useful for screening older workers at risk of occupational falls. Geriatr Gerontol Int 2022; 22: 338-343.

Oral frailty and gait performance in community-dwelling older adults: findings from the Takashimadaira study.

Purpose This cross-sectional study compared gait performance between community-dwelling older adults with and without accumulated deficits in oral health, defined as oral frailty.Methods A total of 1,082 individuals (439 men and 643 women; mean age, 77.1 years) from the Takashimadaira study were included in the current analysis. Based on a multifaceted oral health assessment, oral frailty was defined as having three or more of the following six components: (i) fewer teeth, (ii) low masticatory performance, (iii) low articulatory oral motor skills, (iv) low tongue pressure, (v) difficulties in eating, and (vi) swallowing. Eight gait parameters were assessed using an electronic walkway. Gait characteristics comparison between groups with and without oral frailty was performed using multiple linear regression models. Models were adjusted for age, sex, educational status, income, smoking, drinking, physical activity level, height, body mass index, comorbidities, and the presence of chronic pain.Results Oral frailty was observed in 227 (21.0%) participants. After adjusting for potential confounders, the participants with oral frailty had slower gait speed, shorter stride and step length, wider step width, and longer double support duration as well as higher variability of stride length and step length.Conclusions Oral frailty was associated with poor gait performance among community-dwelling older adults.

Exercise Types and the Risk of Developing Cognitive Decline in Older Women: A Prospective Study.

BACKGROUND: Participation in exercise may be useful for dementia prevention; however, the specific exercise types which may best to reduce the risk of developing cognitive decline have remained unidentified in the literature. OBJECTIVE: To examine the relationships of specific exercise types with the risk of developing cognitive decline in older women. METHODS: This 1- to 2-year population-based cohort study included 687 community-dwelling older Japanese women without disability, neurological disease, dementia, or cognitive impairment assessed as <24 points on the Mini-Mental State Examination (MMSE) at the baseline survey. Developing cognitive decline was defined as a decrease of ≥3 points in the participant's MMSE score during the follow-up. We classified individuals into participation (≥3 months) and non-participation (<3 months) groups for 17 different exercise types. Log-binominal regression analyses were applied to compare risk ratios and confidence intervals of developing cognitive decline between the two groups. RESULTS: Thirty-nine participants (5.7%) developed cognitive decline during the follow-up period. After adjusting for confounders (age, MMSE score, depressive symptoms, body mass index, heart disease, hypertension, diabetes, smoking, low educational level, and the follow-up period in the baseline survey), those who participated in calisthenics demonstrated a significantly lower risk of developing cognitive decline than those who did not participate in calisthenics. No significant relationships between other exercise types and the risk of developing cognitive decline were found. CONCLUSION: Participation in calisthenics significantly reduced the risk of cognitive decline in community-dwelling older Japanese women, indicating that calisthenics may be a useful type of exercise for promoting dementia prevention.

Sedentary behaviour, physical activity, and renal function in older adults: isotemporal substitution modelling.

BACKGROUND: Physical inactivity and sedentary behaviour (too much sitting) can contribute to renal dysfunction. However, the potential benefits of behavioural change (e.g. replacing sedentary behaviour with physical activity) on renal function are not well understood. We used isotemporal substitution to model potential impacts of behaviours on renal function by replacing time spent in one behaviour to another. METHODS: In 174 older Japanese adults (age, 50-83 years; females, 76%), the time spent in sedentary behaviour, light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) were assessed using an uniaxial accelerometer. Renal function was evaluated by the estimated glomerular filtration rate (eGFR) from serum creatinine and cystatin C levels. RESULTS: In univariate analyses, eGFR was significantly, albeit weakly, correlated with time spent in sedentary behaviour (rs = - 0.229), LPA (rs = 0.265), and MVPA (rs = 0.353). In the isotemporal substitution models, replacement of 30 min/day of sedentary behaviour with an equivalent LPA time was not significantly associated with eGFR (ß = 2.26, p = 0.112); however, replacement with an equivalent time of MVPA was beneficially associated with eGFR (ß = 5.49, p < 0.05). CONCLUSIONS: These cross-sectional findings suggest that sedentary behaviour (detrimentally) and physical activity (beneficially) may affect renal function and that replacing sedentary behaviour with MVPA may benefit renal health in older adults.

Limitations of SARC-F in the diagnosis of sarcopenia in community-dwelling older adults.

PURPOSE: The SARC-F is a recommended screening tool for sarcopenia; however, its sensitivity is reported to be very low. This study aimed to confirm the diagnostic efficacy of the SARC-F and whether it is affected by population characteristics. METHODS: In this study, 2 cohorts of 1060 community-dwelling older adults, who were monitored by the Tokyo Metropolitan Institute of Gerontology, were included. In addition to the overall dataset, receiver operating characteristic curve analysis was performed to obtain the SARC-F results for sarcopenia among the datasets for only those older in age (over 75 years), those with higher frailty points (above the median total score for the Kihon Checklist points), those with lower grip strength (below the median), lower gait speed (below the median), and those with comorbidities (hypertension, cerebral vascular disease, heart disease, and diabetes mellitus). RESULTS: In the overall dataset, sensitivity and specificity were 3.9% and 97.3%, respectively. In analyzing the area under the curve, sensitivity and specificity for older age and low physical function datasets were significant, but had low values. The diabetes dataset had higher values but did not effectively diagnose sarcopenia at a cutoff value of 4. CONCLUSION: The SARC-F had high specificity for the diagnosis of sarcopenia in community-dwelling older adults with low physical function. However, its sensitivity was low. Despite these limitations, it may be used as a screening tool for sarcopenia in selected populations, such as adults in hospitals or nursing homes.