The Predictive Value of Sarcopenia and Falls for 2-Year Major Osteoporotic Fractures in Community-Dwelling Older Adults.

To evaluate the associations of sarcopenia and previous falls with 2-year major osteoporotic fractures (MOFs) in community-dwelling older adults. Four thousand Chinese men and women ≥ 65 years recruited from Hong Kong communities were prospectively followed up. Measures of muscle mass, grip strength, gait speed and falls in the previous year were recorded at baseline, the 2nd year and the 4th year visit for each subject. The associations of fall history, sarcopenia and its components with 2-year MOFs were evaluated using generalized linear mixed models. Poor grip strength and poor gait speed were significantly associated with a higher 2-year MOFs risk, with an adjusted OR (95% CI) per one SD decrease of 1.48 (1.17, 1.87) and 1.17 (1.00, 1.36), respectively. Falls in the previous year was a significant predictor for 2-year MOFs risk, with an adjusted OR (95% CI) per one added fall of 1.85 (1.40, 2.44) in men and 1.26 (1.01, 1.58) in women. The adjusted OR (95% CI) of height adjusted appendicular lean muscle mass (ALM/height2) per one SD decrease and sarcopenia for 2-year MOFs risk were 1.34 (0.87, 2.06) and 1.72 (0.92, 3.21) in men, and were 0.73 (0.57, 0.93) and 0.76 (0.39, 1.47) in women, respectively (P for interaction by gender = 0.012 and 0.017, respectively). Poor sarcopenia-related physical performance and falls in the previous year were significant predictors for 2-year MOFs in community-dwelling older adults. The predictive value of ALM by DXA for near-term fracture risk is limited and different across genders.

Effects of adding whole-body vibration to routine day activity program on physical functioning in elderly with mild or moderate dementia: a randomized controlled trial.

OBJECTIVE: To evaluate the effects of whole-body vibration (WBV) added to a routine activity program on lower limb strength, balance, and mobility among community-dwelling individuals with mild or moderate dementia, compared with the routine program alone. METHODS: Fifty-four older adults (40 women; mean (SD) age: 79.8 (6.1) years) with mild or moderate dementia were recruited from two daycare centers. The participants were randomly allocated to undergo a routine day activity program combined with WBV training (WBV at 30 Hz, 2-mm peak-to-peak amplitude) or the routine program only without WBV for 9 weeks (18 sessions). The primary outcome was functional mobility, measured using the timed up-and-go test. The following secondary outcomes were evaluated: Berg Balance Scale, Tinetti balance assessment, time to complete 5 repetitions of sit-to-stand, Quality of Life in Alzheimer's disease questionnaire, and Activities-specific Balance Confidence scale. The attendance rate and incidence of adverse events were also recorded. RESULTS: The attendance rate for the training was high (86.0%). The incidence of adverse events was low, with only two of the 27 participants in the WBV group reporting mild knee pain. While significant improvement in timed up-and-go, Berg Balance Scale, and Tinetti balance score was found in both groups, none of the outcomes demonstrated a significant group by time interaction. CONCLUSIONS: WBV training is feasible and safe to use with people with mild or moderate dementia. However, it did not lead to further improvement in physical function and quality of life than the usual activity program provided at the daycare centers. Copyright © 2017 John Wiley & Sons, Ltd.

Correlation between tibial measurements using peripheral quantitative computed tomography and hip areal bone density measurements in ambulatory chronic stroke patients.

OBJECTIVE: Peripheral quantitative computed tomography (pQCT) has been increasingly used in stroke research. The correlations between tibial bone measurements by pQCT and hip areal bone mineral density (aBMD) measurements by dual-energy x-ray absorptiometry (DXA) (gold standard for diagnosing osteoporosis) in chronic stroke patients were examined in this study. If the correlations were strong, there may be potential for further pursuit of clinical use of pQCT. METHODS: Seventy-four chronic stroke patients who are household ambulators (22 women, 52 men; ≥ 6 months after onset) underwent pQCT scanning of the tibial distal epiphysis (4% site) and diaphysis (66% site) and DXA hip scans on both sides. Pearson's correlation coefficients were used to investigate the correlations between the pQCT-derived variables and the DXA-derived total hip and femoral neck aBMD. RESULTS: All pQCT tibial variables, except the total area, were significantly associated with total hip and femoral neck aBMD. Cortical bone mineral content (66% site) was the only variable that yielded good-to-excellent correlations with total hip and femoral neck aBMD on both sides (r = 0.750-0.833). CONCLUSIONS: Based on the good correlations between tibial pQCT variables and hip aBMD, the clinical use of pQCT in assessing bone health in this population should be further pursued.

Modifiable risk factors for mild cognitive impairment among cognitively normal community-dwelling older adults: A systematic review and meta-analysis.

Although numerous studies have investigated modifiable risk factors for mild cognitive impairment (MCI) among community-dwelling seniors, no meta-analysis has summarized these findings. Five databases were searched from January 1, 2000, to December 30, 2023. The protocol was registered with PROSPERO. Data were extracted and reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant meta-analyses of modifiable risk factors were performed. The evidence of each factor was assessed by the GRADE for cohort studies. Of 16,651 citations, 87 studies involving 225,584 community-dwelling seniors were included. Fourteen meta-analyses involving 20 studies with 44,199 participants were performed. The analyses revealed low-to-moderate-quality evidence supporting that diabetes, 2 or more comorbidities, anxiety, apathy, depressive symptoms, and physical frailty were risk factors for incident MCI in older adults. Conversely, hypertension, agitation, and irritability might not be risk factors. Additionally, moderate-quality evidence supports the protective effect of engaging in cognitive-demanding activities on the onset of MCI. Collectively, this study constitutes the first extensive compilation of evidence regarding the various risk factors for the development of MCI in older adults. Our findings hold significant potential to guide the formulation of prevention and management strategies to either prevent or potentially reverse the onset of MCI.

Balance Confidence Modulates the Association of Gait Speed With Falls in Older Fallers: A Prospective Cohort Study.

OBJECTIVES: Self-perceived balance confidence (BC) and gait speed influence falls. Whether they modulate each other in fall prediction stays uncertain. This study examined whether and how BC modulated the association between gait speed and falls. DESIGN: Prospective observational cohort study. SETTING AND PARTICIPANTS: Older adults who were community-dwelling, ≥65 years old, able to walk for 10 meters independently, and had 1 or more falls in the past year were assessed at a research clinic. METHODS: Participants were followed up trimonthly for 12 months after the baseline. Optimal cutoff values for gait speed for prospective falls were identified by classification and regression tree analysis. Associations among gait speed, BC, and falls were estimated with negative binomial regression models. Subgroup analyses for high and low BC were performed. Covariates such as basic demographics, generic cognition, fall histories, and other physical functions were adjusted. RESULTS: During the follow-up period, 65 (14%) of the 461 included participants (median age 69.0 ± 10.0 years, range 60-92) reported 83 falls in total. In both the pooled and subgroup analyses for the low- and high-BC groups, the high-speed subgroup (≥1.30 m/s) showed an increased fall risk compared with the moderate-speed subgroup (≥0.81 and <1.30 m/s) [adjusted odds ratio (OR), 1.84-2.37; 95% CI, 1.26-3.09]. A statistically significant linear association between gait speed and falls was shown in the high-BC group. In the low-BC group, a u-shaped association was evident (adjusted OR, 2.19-2.44; 95% CI, 1.73-3.19) with elevated fall risks in both the high- and low-speed subgroups compared with the moderate-speed subgroup (adjusted OR, 1.84-3.29; 95% CI, 1.26-4.60). CONCLUSIONS AND IMPLICATIONS: BC modulated the association between gait speed and falls. There were linear and nonlinear associations between gait speed and falls in people with high and low BC, respectively. Clinicians and researchers should consider the effects of BC when predicting falls with gait speed.

The effectiveness of high-intensity laser therapy in individuals with neck pain: a systematic review and meta-analysis.

OBJECTIVES: The primary objective of this meta-analysis was to determine whether high-intensity laser therapy (HILT) was effective in improving pain intensity, cervical range of motion (ROM), functional activity, and quality of life (QOL) in individuals with neck pain. DATA SOURCES: PubMed, PEDro, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched from inception to March 26, 2022. STUDY SELECTION: Randomized controlled trials (RCTs) involving HILT for neck pain were selected. DATA EXTRACTION AND DATA SYNTHESIS: Two raters were independent in data extraction. The methodological quality was evaluated using the PEDro scale, and the level of evidence was assessed using the GRADE system. RevMan5.4 was used for meta-analysis. RESULTS: Eight RCTs were included and their PEDro scores were moderate to high. Compared with placebo, HILT was effective in improving pain intensity (SMD 2.12, 95%CI 1.24 to 3.00; moderate quality evidence), cervical flexion (SMD 1.31, 95%CI 0.27 to 2.35; moderate quality evidence), extension (SMD 1.43, 95%CI 0.24 to 2.63; moderate quality evidence), right lateral flexion (SMD 1.36, 95%CI 0.15 to 2.56; low-quality evidence). There was a trend of better outcome in functional activity after HILT (SMD 1.73, 95%CI -0.05 to 3.54; low quality evidence). LIMITATIONS: There was limited information available on QOL. CONCLUSION: HILT may be considered as an adjunctive treatment modality for neck pain. There was moderate quality evidence that HILT may improve pain intensity and cervical ROM in individuals with neck pain, but there was low quality evidence that HILT was not effective in improving functional activity. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021254078 CONTRIBUTION OF THE PAPER.

The Resilience and the Subsequent Hospitalization of Older People with Different Frailty Status: A Prospective Cohort Study.

OBJECTIVE: To evaluate the difference in resilience across frailty status by measuring the impact of unplanned hospitalization across people with different frailty condition on (1) 2-year changes in lean mass, physical performance, and quality of life, and (2) subsequent hospitalization. DESIGN: A prospective cohort study. SETTING AND PARTICIPANTS: Three thousand seventeen older people (73.7 ± 4.9 years) were recruited from the community in Hong Kong. METHODS: Frailty status was defined using the Cardiovascular Health Study scale at baseline. Unplanned hospitalization between the 2 visits was obtained from the Hong Kong Hospital Authority. The interaction of frailty and hospitalization status on the 2-year changes in lean mass, physical performance, and quality of life were examined using 2-way analysis of covariance. Risk of subsequent hospitalization was estimated using Poisson regression. The effect of prolonged hospitalization, which was defined as 6 or more total hospitalized days, was also examined. RESULTS: Upon unplanned hospitalization, frail older people had significantly augmented decline than prefrail and robust people in appendicular skeletal mass (-0.44 ± 0.08 kg), height-adjusted appendicular skeletal mas (-0.13 ± 0.03 kg/m2), 5-time chair-stand (4.79 ± 0.60 s), and mental health (-3.72 ± 0.88). The reduction increased with the length of hospitalization. Unplanned hospitalization conferred an augmented risk of subsequent hospitalization for those who were prefrail and frail (IRR = 1.44, 95% confidence interval = 1.30-1.59 and IRR = 1.69, 95% confidence interval = 1.45-1.97, respectively). CONCLUSIONS AND IMPLICATIONS: The resilience of older people varies according to their frailty status, and the poor resilience may translate to a higher chance of having subsequent hospitalization for prefrail and frail people. These findings emphasized the importance of having the frailty screening in making posthospitalization plans for older people depending on their frailty status and encouraging prefrail and frail older people to build up their resilience.

The U-Shaped Relationship Between Levels of Bouted Activity and Fall Incidence in Community-Dwelling Older Adults: A Prospective Cohort Study.

BACKGROUND: It remains uncertain whether the association between physical activity (PA) and falls is U-shaped, and few studies have explored the potential mediation of PA accumulation pattern. METHODS: We measured PA in 671 community-dwelling older adults (82.7 ± 3.8 years) using wrist-worn accelerometer for 7 days. PA was further classified to bouted PA (≥10 minutes bout length) and sporadic PA (<10 minutes bout length) for subanalysis. Fall incidence in the following 12-month was recorded through tri-monthly telephone interviews. Classification and Regression Tree analysis was used to identify two optimal cutoff values of each PA measurement to predict falls. Participants were then divided into "inactive," "moderately active," and "highly active" groups accordingly. Negative binomial regression models were used to estimate the association between the PA measures and fall incidence. RESULTS: Six hundred and thirty-nine participants completed 12-month follow-up. Ninety-three (14.6%) experienced a total of 118 falls. Inactive and highly active older adults had higher falls per person month relative to the moderately active group (inactive: incidence rate ratios [IRR] = 2.372, 95% confidence interval [CI] = 1.317-4.271; highly active: IRR = 2.731, 95% CI = 1.196-6.232). Subanalyses found similar significant finding with bouted PA (p < .001) but not sporadic PA (p ≥ .221). The association between bouted PA and falls remained significant even after adjusting fall incidence for bouted activity time (inactive: IRR = 3.636, 95% CI = 2.238-5.907; highly active: IRR = 1.823, 95% CI = 1.072-3.1). Further adjustments for fall-related risk factors did not meaningfully change the results. CONCLUSION: A U-shaped relationship was identified between bouted but not sporadic PA and fall incidence. There is an approximately twofold increase in fall rate in highly active older adults even after adjusting for activity time.

Cumulative and Incremental Value of Sarcopenia Components on Predicting Adverse Outcomes.

OBJECTIVES: To examine the incremental value of sarcopenia components, following the diagnosis algorithm of the Asian consensus, on predicting adverse outcomes. DESIGN: A prospective cohort study. SETTING AND PARTICIPANTS: Four thousand community-dwelling Chinese adults (2000 men) aged 65 years or older in Hong Kong (mean age = 72.5 ± 5.2). METHODS: SARC-F was used as the initial predictor of 9 adverse outcomes. In step 2, muscle strength (ie, grip strength) and/or functions (ie, chair-stand, walking speed) were added on top of SARC-F. In step 3, height-, weight-, and body mass index-adjusted appendicular skeletal mass (ASM) measured by dual-energy x-ray absorptiometry (DXA) were added separately to all models formulated in step 2. The areas under the receiver operating characteristic curve (AUCs) were calculated for the models formulated in all steps. Each cumulative AUC would be compared with the AUC yielded in the previous step to evaluate the incremental prediction value. RESULTS: On top of SARC-F, assessing grip strength, walking speed, or 5-time chair-stand significantly increased the AUC for most adverse outcomes. In particular, assessing both grip strength and gait speed yielded the highest AUC in most prediction models (AUC = 0.539-0.770) and significantly increased the AUC for all outcomes except for recurrent falls. With both muscle strength and function assessed, adding ASM failed to significantly increase the AUC except for 2 conditions. In the 2 conditions, however, a higher height-adjusted ASM was associated with a higher risk of having worsened physical limitations [OR 1.25, 95% confidence interval (CI) 1.12-1.40] and decline in the physical quality of life (OR 1.18, 95% CI 1.06-1.33) in women. CONCLUSIONS AND IMPLICATIONS: Assessing muscle strength and function provides additional power to predict adverse outcomes on top of SARC-F. Further assessment of muscle mass with DXA provides no extra constructive value ito bettering the prediction regardless of the adjustment parameters. Alternative technologies to measure muscle mass might be required.

The Clinical Potential of Frailty Indicators on Identifying Recurrent Fallers in the Community: The Mr. Os and Ms. OS Cohort Study in Hong Kong.

OBJECTIVES: To compare the clinical value of 3 frailty indicators in a screening pathway for identifying older men and women who are at risk of falls. DESIGN: A prospective cohort study. SETTING AND PARTICIPANTS: Four thousand Chinese adults (2000 men) aged ≥65 years were recruited from the community in Hong Kong. METHODS: The Cardiovascular Health Study Criteria, the FRAIL scale, and the Study for Osteoporosis and Fracture Criteria (SOF) were included for evaluation. Fall history was used as a comparative predictor. Recurrent falls during the second year after baseline was the primary outcome. The area under the receiver operating characteristic curve (AUC) was used to evaluate the ability of the frailty indicators and fall history to predict recurrent falls. Independent predictors identified in logistic regression were put in the Classification and Regression Tree (CART) analysis to evaluate their performance in screening high-risk fallers. RESULTS: Fall history predicts recurrent falls in both men and women (AUC: men = 0.681; women = 0.645) better than all frailty indicators (AUC ≤ 0.641). After adjusting for fall history, only FRAIL (AUC = 0.676) and SOF (AUC = 0.673) remained as significant predictors for women whereas no frailty indicator remained significant in men. FRAIL could classify older women into 2 groups with distinct chances of being a recurrent faller in people with no fall history (3.8% vs 7.5%), a single fall history (9.5% vs 37.5%), and history of recurrent falls (16.0% vs 30.8%). SOF has limited ability in identifying recurrent fallers in the group of older adults with a single fall history (no fall history: 3.9% vs 8.6%; single fall history: 10.2% vs 10.9%; history of recurrent falls: 16.5% vs 20.6%). CONCLUSIONS AND IMPLICATIONS: SOF and FRAIL could provide some additional prediction value to fall history in older women but not men. FRAIL could be clinically useful in identifying older women at risk of recurrent falls, especially in those with a single fall history.

The effect of vertical whole-body vibration on lower limb muscle activation in elderly adults: Influence of vibration frequency, amplitude and exercise.

OBJECTIVE: This study aimed to investigate how whole-body vibration (WBV) and exercise and their interactions influenced leg muscle activity in elderly adults. STUDY DESIGN: An experimental study with repeated measures design that involved a group of ambulatory, community-dwelling elderly adults (n=30; 23 women; mean age=61.4±5.3years). MAIN OUTCOME MEASURES: Muscle activity of the vastus lateralis (VL), biceps femoris (BF), tibialis anterior (TA), and gastrocnemius (GS) was measured by surface electromyography (EMG), while participants were performing seven different exercises during 4 WBV conditions (condition 1: frequency=30Hz, amplitude=0.6mm, intensity=2.25 units of Earth's gravity (g); condition 2: 30Hz, 0.9mm, 3.40g; condition 3: 40Hz, 0.6mm, 3.65g; condition 4: 40Hz, 0.9mm, 5.50g) and a no-WBV condition in a single experimental session. RESULTS: Significantly greater muscle activity was recorded in VL (3%-148%), BF (16%-202%), and GS (19% -164%) when WBV was added to the exercises, compared with the same exercises without WBV (p≤0.015). The effect of vibration intensity on EMG amplitude was exercise-dependent in VL (p=0.002), and this effect was marginally significant in GS (p=0.052). The EMG activity induced by the four WBV intensities was largely similar, and was the most pronounced during static erect standing and static single-leg standing. CONCLUSIONS: The EMG amplitude of majority of leg muscles tested was significantly greater during WBV exposure compared with the no-WBV condition. Low-intensity WBV can induce muscle activity as effectively as higher-intensity protocols, and may be the preferred choice for frail elderly adults.

Effects of whole-body vibration therapy on body functions and structures, activity, and participation poststroke: a systematic review.

BACKGROUND: Whole-body vibration (WBV) has gained increasing popularity in rehabilitation. Recent studies have investigated the application of WBV in individuals with chronic illnesses, including stroke. PURPOSE: The purpose of this study was to compare WBV exercise with the same exercise condition without WBV and with other types of physical exercise in enhancing body functions and structures, activity, and participation in individuals with stroke and examine its safety. DATA SOURCE: Electronic searches were conducted on MEDLINE, CINAHL, PEDro, PubMed, PsycINFO, and Science Citation Index. STUDY SELECTION: Randomized controlled trials (RCTs) that investigated the effects of WBV among individuals with stroke were identified by 2 independent researchers. Ten articles (9 studies, totaling 333 study participants) satisfied the selection criteria and were included in this review. DATA EXTRACTION: The methodological quality was rated using the PEDro scale. The results were extracted by 2 independent researchers and confirmed with the principal investigator. DATA SYNTHESIS: Only 2 RCTs were considered as demonstrating level 1 evidence (PEDro score ≥6 and sample size >50). Two RCTs examined the effects of a single WBV session, and 7 RCTs examined the effects of WBV programs spanning 3 to 12 weeks. No consistent benefits on bone turnover, leg motor function, balance, mobility, sensation, fall rate, activities of daily living, or societal participation were found, regardless of the nature of the comparison group. Adverse events were minor. LIMITATIONS: A broad approach was used, with stroke as an inclusion criterion for review. No solid evidence was found concerning the effects of WBV on subgroups of people with specific stroke-related deficits due to the heterogeneity of patient groups. CONCLUSIONS: Based on the review, there is insufficient evidence to support clinical use of WBV in enhancing body functions and structures, activity, and participation after stroke.

Leg muscle activity during whole-body vibration in individuals with chronic stroke.

PURPOSE: It has been previously shown that whole-body vibration (WBV) can augment muscle activity in young healthy adults. However, the EMG response of leg muscles during WBV in individuals with stroke is unknown. The objective of this study was to determine the influence of WBV on the activity of the vastus lateralis (VL) and gastrocnemius (GS) muscles during the performance of different exercises in chronic stroke patients. METHODS: Forty-five chronic stroke patients were studied. Each subject was exposed to three WBV conditions of 1) no WBV, 2) low-intensity WBV protocol (peak acceleration: 0.96 unit of gravitational constant [g]), and 3) high-intensity WBV protocol (peak acceleration: 1.61g) while performing eight different static exercises involving upright standing, semisquat, deep squat, weight shifted forward, weight shifted backward, weight shifted to the side, forward lunge, and single-leg standing. Bilateral VL and GS muscle activity was recorded with surface EMG and expressed as a percentage of the EMG amplitude recorded during a maximal voluntary contraction of the respective muscles. RESULTS: Two-way repeated-measures ANOVA revealed that exposure to WBV (low- and high-intensity protocols) significantly increased VL and GS EMG amplitude (large effect size, partial η = 0.135-0.643, P < 0.001) on both the paretic and nonparetic sides in different exercise conditions compared with no WBV. No significant difference in EMG magnitude was found between the high- and the low-intensity WBV protocols (P > 0.05). With a few exceptions, WBV enhanced EMG activity in the paretic and nonparetic leg muscles to a similar extent in different exercise conditions. CONCLUSIONS: Leg muscle activity was increased significantly with the addition of WBV. Further clinical trials are needed to determine the effectiveness of different WBV protocols for strengthening leg muscles in chronic stroke patients.

The effect of whole body vibration on balance, mobility and falls in older adults: a systematic review and meta-analysis.

This systematic review aimed to examine the effect of WBV on balance, mobility and falls among older adults. The databases used included MEDLINE, the Excerpta Medica database, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library Databases of Systematic Reviews, Physiotherapy Evidence Database (PEDro), PubMed, and Science Citation Index (last search in October 2011). Randomized controlled trials that investigated the effect of WBV on balance, mobility or falls in older adults were included in this review. The PEDro score was used to examine the methodological quality of the selected studies. The effect of WBV on balance, mobility and fall-related outcomes were extracted. The data extraction and rating were performed by a researcher and the results were confirmed by the principal investigator. Meta-analysis was done if 3 or more studies measured the same outcome of interest. Among 920 articles screened, fifteen articles (thirteen trials) satisfied the criteria and were included in this review. Methodological quality was good for six of the studies (PEDro score=6-7). Meta-analysis revealed that WBV has a significant treatment effect in Tinetti Total Score (p<0.001), Tinetti Body Balance Score (p=0.010) and Timed-Up-and-Go test (p=0.004). No significant improvement was noted in Tinetti Gait Score after WBV training (p=0.120). The effect of WBV on other balance/mobility outcomes and fall rate remains inconclusive. To conclude, WBV may be effective in improving relatively basic balance ability and mobility among older adults, particularly frailer ones. More good-quality WBV trials are required.