Prevalence and determinants of physical frailty among people living in residential aged care facilities: a large-scale retrospective audit.

BACKGROUND: Physical frailty is associated with increased risk of falls, hospitalisation and mortality. There is a dearth of information on physical frailty of older adults living in residential aged care. This study aimed to describe physical frailty in aged care residents and investigate possible determinants of frailty. METHOD: A retrospective audit of resident records was undertaken across 14 residential aged care facilities. Data were extracted on all consenting residents who had completed measures relating to frailty (Short Physical Performance Battery SPPB; grip strength). All data of the first record of measures were extracted, resident characteristics, and the time from admission to assessment. Summary statistics were completed. Differences between sub-groups were explored (Mann-Whitney U, Kruskall-Wallis Ranked tests). Associations between variables were explored with Chi-squared and Pearson correlations. Determinants of physical frailty were determined with linear regression analyses. Alpha (2-sided) was 0.05. RESULTS: Data were extracted for 1241 residents (67% female), with a mean age of 86.0 (7.6) years. Males had a significantly lower time from admission to assessment of frailty (p ≤ 0.001). The average SPPB score was 4.1 (3.3), 75% of residents were frail and 19% pre-frail. Bivariate analyses indicated no significant relationships between grip strength and SPPB score, but significant differences for grip strength, where males were significantly stronger (males 20.2 ± 8.3 kg; females 12.4 ± 5.4 kg; p ≤ 0.001). There was a significant positive relationship between SPPB total score and grip strength, gender (p ≤ 0.001), and marital status (p = 0.049) and a negative relationship between time from admission to assessment and SPPB total score (p ≤ 0.001). There were significant negative relationships between gender (p ≤ 0.001) and age (p ≤ 0.001), and time from admission to assessment (p ≤ 0.001) with grip strength. CONCLUSION: Older adults living in residential aged care have a high level of physical frailty which may lead to increased risk of adverse outcomes. Time in the residential aged care setting and age appear to predict physical frailty. There is a need for a consistent battery of measures to continually monitor frailty and programs to address the high levels of frailty in residential aged care.

Re-thinking reablement strategies for older adults in residential aged care: a scoping review.

BACKGROUND: The number of older adults in residential aged care is increasing. Aged care residents have been shown to spend most of the day sedentary and have many co-morbidities. This review aimed to systematically explore the effectiveness of reablement strategies in residential aged care for older adults' physical function, quality of life and mental health, the features of effective interventions and feasibility (compliance, acceptability, adverse events and cost effectiveness). METHOD: This scoping review was undertaken according to PRISMA guidelines (extension for scoping reviews). Five e-databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and CINAHL) were searched from 2010 onwards. Randomised controlled trials investigating reablement strategies addressing physical deconditioning for older adults (mean age ≥ 65 yrs) in residential aged care on physical function, quality of life or mental health were included. Feasibility of the interventions (compliance, acceptability, satisfaction, adverse events and cost effectiveness) was explored. RESULTS: Five thousand six hundred thirty-one citations were retrieved, and 63 studies included. Sample sizes ranged from 15 to 322 and intervention duration from one to 12 months. Exercise sessions were most often conducted two to three times per week (44 studies) and physiotherapist-led (27 studies). Interventions were predominately multi-component (28 studies, combinations of strength, balance, aerobic, functional exercises). Five interventions used technology. 60% of studies measuring physical function reported significant improvement in the intervention versus control, 40% of studies measuring quality of life reported significant improvements in favour of the intervention, and 26% of studies measuring mental health reported significant intervention benefits. Over half of the studies measured compliance and adverse events, four measured acceptability and none reported cost effectiveness. CONCLUSIONS: There has been a research surge investigating reablement strategies in residential aged care with wide variability in the types and features of strategies and outcome measures. Few studies have measured acceptability, or cost effectiveness. Exploration of core outcomes, mapping stakeholders and co-designing a scalable intervention is warranted. TRIAL REGISTRATION: Prospectively registered review protocol (Open Science Framework: DOI https://doi.org/10.17605/OSF.IO/7NX9M ).

Progressive Resistance Plus Balance Training for Older Australians Receiving In-Home Care Services: Cost-Effectiveness Analyses Alongside the Muscling Up Against Disability Stepped-Wedge Randomized Control Trial.

In this article, the authors assessed the cost-effectiveness of center-based exercise training for older Australians. The participants were recipients of in-home care services, and they completed 24 weeks of progressive resistance plus balance training. Transport was offered to all participants. A stepped-wedge randomized control trial produced pre-, post-, and follow-up outcomes and cost data, which were used to calculate incremental cost-effectiveness ratios per quality-adjusted life year gained. Analyses were conducted from a health provider perspective and from a government perspective. From a health-service provider perspective, the direct cost of program provision was $303 per person, with transport adding an additional $1,920 per person. The incremental cost-utility ratio of the program relative to usual care was $70,540 per quality-adjusted life year over 6 months, decreasing to $37,816 per quality-adjusted life year over 12 months. The findings suggest that Muscling Up Against Disability offers good value for the money within commonly accepted threshold values.

active@home: Investigating the Value of a Home Care Worker-Led Exercise Program for Older Adults With Complex Care Needs.

Exercise has proven health benefits for older adults independent of age, disability, and disease. However, barriers to exercise participation exist, including travel to, and access to, appropriate facilities and programs. Evidence shows that in-home exercise delivered by allied health professionals can improve physical health and prolong independence among individuals with government supported aged care packages. A less costly alternative is program delivery by home care workers. However, effective training for workers and resources to guide the consumer is required. This project evaluated an exercise training module for home care workers and a consumer resource to promote in-home exercise participation among older Australians with government supported aged care packages. Outcomes included a significant improvement in functional capacity as measured by the short physical performance battery (mean increase of 1.4 points), a 19% reduction in participants classified as frail and a reduction in healthcare service access of 47% across the intervention.

Engineering Improved Balance Confidence in Older Adults With Complex Health Care Needs: Learning From the Muscling Up Against Disability Study.

OBJECTIVE: To investigate the associations of balance confidence with physical and cognitive markers of well-being in older adults receiving government-funded aged care services and whether progressive resistance plus balance training could positively influence change. DESIGN: Intervention study. SETTING: Community-based older adult-specific exercise clinic. PARTICIPANTS: Older adults (N=245) with complex care needs who were receiving government-funded aged care support. INTERVENTIONS: Twenty-four weeks of twice weekly progressive resistance plus balance training carried out under the supervision of accredited exercise physiologists. MAIN OUTCOME MEASURES: The primary measure was the Activity-specific Balance Confidence Scale. Secondary measures included the Short Physical Performance Battery; fall history gathered as part of the health history questionnaire; hierarchical timed balance tests; Geriatric Anxiety Index; Geriatric Depression Scale; Fatigue, Resistance, Ambulation, Illness, Loss of Weight scale; and EuroQoL-5 dimension 3 level. RESULTS: At baseline, better physical performance (r=.54; P<.01) and quality of life (r=.52; P<.01) predicted better balance confidence. In contrast, at baseline, higher levels of frailty predicted worse balance confidence (r=-.55; P<.01). Change in balance confidence after the exercise intervention was accompanied by improved physical performance (+12%) and reduced frailty (-11%). Baseline balance confidence was identified as the most consistent negative predictor of change scores across the intervention. CONCLUSIONS: This study shows that reduced physical performance and quality of life and increased frailty are predictive of worse balance confidence in older adults with aged care needs. However, when a targeted intervention of resistance and balance exercise is implemented that reduces frailty and improves physical performance, balance confidence will also improve. Given the influence of balance confidence on a raft of well-being determinants, including the capacity for positive physical and cognitive change, this study offers important insight to those looking to reduce falls in older adults.

Consequences of sarcopenia among nursing home residents at long-term follow-up.

The consequences of and transition into sarcopenia with long-term survival was investigated in the nursing home setting. Eligible residents from 11 nursing homes were followed-up 18-months after their assessment for sarcopenia using the European Working Group on Sarcopenia in Older People criteria, with other demographic, physical and cognitive health measures collected. Of the 102 older adults who consented at baseline, 22 had died and 58 agreed to participate at follow-up, 51.7% of whom had sarcopenic. Sarcopenia at baseline was associated with a depression (p < .001), but not mortality, hospitalization, falls or cognitive decline at follow-up. Age was the strongest predictor of mortality (p = .05) with the relative risk of death increasing 5.2% each year. The prevalence of sarcopenia is high and increases with long-term survival in end-of-life care. However, the risk of sarcopenia-related mortality is not as great as from increasing age alone.

Impact of resistance training on sarcopenia in nursing care facilities: A pilot study.

The impact of progressive resistance training on sarcopenia among very old institutionalized adults was investigated. Residents of Nursing Care Facilities were included in a controlled trial of twice weekly resistance and balance exercise program for six months (Age: 85.9 ± 7.5 years, Time in care: 707.1 ± 707.5 days, N = 21 per group). Sarcopenia was measured based on the European Working Group on Sarcopenia in Older People criteria. Of the recruited 42 participants, 35.7% had sarcopenia at baseline, with prevalence increasing in the control group post-intervention (42.9%-52.4%). Following training, the exercise group experienced a significant increase in grip strength when compared to controls (p = .02), and a within-group decrease in body mass index and increase in grip strength (p ≤ .007). Resistance and balance exercise has positive benefits for older adults residing in a nursing care facilities which may transfer to reduce disability and sarcopenia transition, but more work is needed to ensure improved program uptake among residents.

Physical and functional implications of aquatic exercise for nursing home residents with dementia.

Exercise has reported benefits for those with dementia. In the current study we investigated the feasibility of delivery and the physical and functional benefits of an innovative aquatic exercise program for adults with moderate to severe dementia living in a nursing home aged care facility. Ten adults (88.4 years, inter quartile range 12.3) participated twice weekly for 12 weeks. Anthropometric and grip strength data, and measures of physical function and balance were collected at baseline and post-intervention. Feasibility was assessed by attendance, participation, enjoyment and recruitment. Following exercise, participant's left hand grip strength had improved significantly (p = .017). Small to moderate effect sizes were observed for other measures. A number of delivery challenges emerged, but participant enjoyment, benefits and attendance suggest feasibility. Aquatic exercise shows promise as an intervention among those with dementia who live in a nursing home aged care facility. Greater program investigation is warranted.

Prioritising restorative care programs in light of current age care reform.

BACKGROUND: Short-term restorative care (STRC) aims to reduce the demand for long-term aged care services through 8 weeks of intensive, multidisciplinary services designed to enhance the independence of community-dwelling older Australians at risk of functional decline. Evidence surrounding the effectiveness and feasibility of STRC is limited. OBJECTIVE: This study aimed to examine the effectiveness of an existing exercise-based STRC model and help inform successful service delivery to maximise participant outcomes nationally. METHODS: An observational cohort study was conducted to evaluate the potential benefits accrued by community-dwelling older adults accessing Southern Cross Care's current exercise-based STRC model in Adelaide, South Australia. Program effectiveness was determined via improvements in outcome measures specific to functional decline risk factors from baseline (Week 0) to discharge (Week 8). RESULTS: Results demonstrated significant improvements (p < 0.001) in participants' (n = 62) lower extremity function (44.9%), depressive symptoms (52.4%), anxiety (45.8%), frailty stage (57.9%), independence in activities of daily living (17.3%) and health-related quality of life (24.0%). No significant change was found for grip strength or BMI post-intervention. The most frequent services were exercise-based (54.3% of total services), with participants receiving an average of two to three exercise services per week. CONCLUSIONS: An exercise-based STRC model is an effective mechanism to reverse functional decline and associated risk factors among community-dwelling older Australians. Adoption of multidisciplinary intervention as a standardised STRC service model could help improve client outcomes nationally and offset expected increases in community and long-term aged care demand.

Watermemories: a swimming club for adults with dementia.

The purpose of this article is to describe the conceptual model and implementation strategies of an evidence-based, aquatic exercise program specifically targeting individuals with dementia-The Watermemories Swimming Club (WSC). Physical exercise not only improves the functional capacity of people with dementia but also has significant effects on other aspects of quality of life such as sleep, appetite, behavioral and psychological symptoms, depression, and falls. Additionally, exercise can improve a person's overall sense of well-being and positively enhance their sociability. The WSC was designed to increase physical exercise while being easy to implement, safe, and pleasurable. Many challenges were faced along the way, and we discuss how these were overcome. Implications for nurses are also provided.

Consensus guidelines for sarcopenia prevention, diagnosis and management in Australia and New Zealand.

BACKGROUND: Sarcopenia is an age-associated skeletal muscle condition characterized by low muscle mass, strength, and physical performance. There is no international consensus on a sarcopenia definition and no contemporaneous clinical and research guidelines specific to Australia and New Zealand. The Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Sarcopenia Diagnosis and Management Task Force aimed to develop consensus guidelines for sarcopenia prevention, assessment, management and research, informed by evidence, consumer opinion, and expert consensus, for use by health professionals and researchers in Australia and New Zealand. METHODS: A four-phase modified Delphi process involving topic experts and informed by consumers, was undertaken between July 2020 and August 2021. Phase 1 involved a structured meeting of 29 Task Force members and a systematic literature search from which the Phase 2 online survey was developed (Qualtrics). Topic experts responded to 18 statements, using 11-point Likert scales with agreement threshold set a priori at >80%, and five multiple-choice questions. Statements with moderate agreement (70%-80%) were revised and re-introduced in Phase 3, and statements with low agreement (<70%) were rejected. In Phase 3, topic experts responded to six revised statements and three additional questions, incorporating results from a parallel Consumer Expert Delphi study. Phase 4 involved finalization of consensus statements. RESULTS: Topic experts from Australia (n = 62, 92.5%) and New Zealand (n = 5, 7.5%) with a mean ± SD age of 45.7 ± 11.8 years participated in Phase 2; 38 (56.7%) were women, 38 (56.7%) were health professionals and 27 (40.3%) were researchers/academics. In Phase 2, 15 of 18 (83.3%) statements on sarcopenia prevention, screening, assessment, management and future research were accepted with strong agreement. The strongest agreement related to encouraging a healthy lifestyle (100%) and offering tailored resistance training to people with sarcopenia (92.5%). Forty-seven experts participated in Phase 3; 5/6 (83.3%) revised statements on prevention, assessment and management were accepted with strong agreement. A majority of experts (87.9%) preferred the revised European Working Group for Sarcopenia in Older Persons (EWGSOP2) definition. Seventeen statements with strong agreement (>80%) were confirmed by the Task Force in Phase 4. CONCLUSIONS: The ANZSSFR Task Force present 17 sarcopenia management and research recommendations for use by health professionals and researchers which includes the recommendation to adopt the EWGSOP2 sarcopenia definition in Australia and New Zealand. This rigorous Delphi process that combined evidence, consumer expert opinion and topic expert consensus can inform similar initiatives in countries/regions lacking consensus on sarcopenia.

The Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) sarcopenia diagnosis and management task force: Findings from the consumer expert Delphi process.

OBJECTIVES: To develop guidelines, informed by health-care consumer values and preferences, for sarcopenia prevention, assessment and management for use by clinicians and researchers in Australia and New Zealand. METHODS: A three-phase Consumer Expert Delphi process was undertaken between July 2020 and August 2021. Consumer experts included adults with lived experience of sarcopenia or health-care utilisation. Phase 1 involved a structured meeting of the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Sarcopenia Diagnosis and Management Task Force and consumer representatives from which the Phase 2 survey was developed. In Phase 2, consumers from Australia and New Zealand were surveyed online with opinions sought on sarcopenia outcome priorities, consultation preferences and interventions. Findings were confirmed and disseminated in Phase 3. Descriptive statistical analyses were performed. RESULTS: Twenty-four consumers (mean ± standard deviation age 67.5 ± 12.8 years, 18 women) participated in Phase 2. Ten (42%) identified as being interested in sarcopenia, 7 (29%) were health-care consumers and 6 (25%) self-reported having/believing they have sarcopenia. Consumers identified physical performance, living circumstances, morale, quality of life and social connectedness as the most important outcomes related to sarcopenia. Consumers either had no preference (46%) or preferred their doctor (40%) to diagnose sarcopenia and preferred to undergo assessments at least yearly (54%). For prevention and treatment, 46% of consumers preferred resistance exercise, 2-3 times per week (54%). CONCLUSIONS: Consumer preferences reported in this study can inform the implementation of sarcopenia guidelines into clinical practice at local, state and national levels across Australia and New Zealand.

What makes a healthier nurse, workplace or leisure physical activity? Informed by the Australian and New Zealand e-Cohort Study.

AIM AND OBJECTIVE: To investigate health differences between nurses who report meeting the daily physical activity recommendations in or away from the workplace. BACKGROUND: Adhering to the national physical activity recommendations has known health benefits. Whilst often considered a workplace active profession, data are emerging of poor health amongst nurses. However, health differences between workplace or leisure-time physically active nurses are understudied. DESIGN: The investigation is an observation study of Australian and New Zealand nurses. Data were generated from the longitudinal, population-based, observational e-Cohort nursing survey. METHODS: Data were informed and groups defined by the self-reported minutes per day of moderate physical activity collected from a large international survey of practicing nurses (n = 2264). Groups were: Group (G) 1--high workplace (≥30 minutes/day)/high leisure (≥30 minutes/day), G2--high workplace/low leisure (<30 minutes/day), G3--low workplace/low leisure (<30 minutes/day) and G4--low workplace/high leisure. RESULTS: G2 had a high BMI and were younger than G4. G4 were significantly more active away from work and more likely to report cycling to work than G2. In contrast, G2 were most likely to have taken sick days because of their health (χ(2) = 19·101), have difficulty sleeping most of the time and have a medical history of diagnosed anxiety and depression. CONCLUSIONS: This study shows that improved well-being can be achieved in nursing cohort through leisure-time physical activity. RELEVANCE TO CLINICAL PRACTICE: This research shows that nurse should consider leisure-time physical activity necessary to maintain and prolong health and that workplace activity is not a sufficient stimulus. This has important implications for workforce planners and administrators.

Predicting the progressive resistance and balance training response of community-dwelling older adults accessing aged care support services: A stepped-wedge randomised controlled trial.

OBJECTIVE: To quantify the variation in body composition, physical function and cognitive health changes resulting from the Muscling Up Against Disability (MUAD) resistance and balance training program and the potential for baseline characteristics to predict the magnitude of training-related response. METHODS: The study represented a secondary analysis of a stepped-wedge randomised controlled trial involving 245 community-dwelling adults receiving Australian Government-funded aged care services who performed 26 weeks of supervised progressive resistance and balance training (PRBT). The primary outcome was the proportion of response that described the number of individuals expected to make any positive change due to the intervention and not external factors. RESULTS: For all outcomes, the observed average change in the PRBT group was more favourable than the control. Analyses identified that most participants completing the PRBT program would be expected to respond positively to the intervention (86%-99%) with respect to their physical performance (SPPB summary, grip strength, chair stand and isometric knee strength). A smaller proportion completing the PRBT program group would be expected to respond positively in aspects of body composition (45%-60%) or cognitive function (44%-84%). The strongest predictors of positive change were baseline physical function, whereby those with the poorest baseline function experienced the greatest benefits. CONCLUSIONS: This study strongly supports the promotion of PRBT as a standard component of any care plan for community-dwelling older adults, especially those with low levels of physical function.

Alterations in muscle attenuation following detraining and retraining in resistance-trained older adults.

BACKGROUND: Aging skeletal muscle is characterized not only by a reduction in size (sarcopenia) and strength but also by an increase in fatty infiltration (myosteatosis). An effective countermeasure to sarcopenia is resistance exercise; however, its effect on fatty infiltration is less clear. OBJECTIVE: To examine in resistance-trained older persons whether muscle attenuation, a noninvasive measure of muscle density reflecting intramuscular lipid content, is altered with training status. METHODS: Thirteen healthy community-dwelling men and women aged 65-83 years (body mass index 27.0+/-1.2, mean+/-SE) had computed-tomography scans of the mid-thigh performed following 24 weeks of training, 24 weeks of detraining, and 12 weeks of retraining. Training and retraining were undertaken twice weekly for several upper- and lower-body muscle groups. Skeletal muscle attenuation in Hounsfield units (HU) as well as mid-thigh muscle volume was obtained for the quadriceps and hamstrings. Muscle strength was assessed by 1-repetition maximum and physical function by a battery of tests. RESULTS: The average change in muscle strength following training, detraining and retraining was 48.8+/-2.9%, -17.6+/-1.3%, and 19.8+/-2.0%, respectively. Strength changes were accompanied by significant alterations in muscle density (p<0.001), with the quadriceps HU decreasing by 7.7+/-1.0% following detraining and increasing by 5.4+/-0.5% with retraining. For the hamstrings HU measure, detraining and retraining resulted in an 11.9+/-1.4% loss and a 5.5+/-1.8% gain, respectively. There was no significant change in muscle volume. CONCLUSION: Cessation of resistance exercise in trained older persons increases the fatty infiltration of muscle, while resumption of exercise decreases it. Monitoring changes in both muscle size and fat infiltration may enable a more comprehensive assessment of exercise in combating age-related muscular changes.

Regional differences among employed nurses: a Queensland study.

OBJECTIVE: To ascertain differences in the working lives of geographically dispersed nurses. DESIGN: Cross-sectional. SETTING: Registered, enrolled and assistants-in-nursing members of the Queensland Nurses' Union employed in nursing in Queensland, Australia. PARTICIPANTS: A total of 3000 members of the Union, equally stratified by sector (public, private, aged care). Among them, 1192 responded and 1039 supplied postcodes matching the Australian Standard Geographical Classification. MAIN OUTCOME MEASURES: Statistically significant differences in working lives of nurses employed in different geographical locations. RESULTS: Nurses in outer regional/remote/very remote localities are more likely to be employed as permanent full-time staff and self-report higher levels of work stress. These levels could be explained by: lack of replacement staff for leave, longer working and on call hours and lack of support for new staff. Distance remains a major barrier to accessing continuing professional education. However, outer regional/remote/very remote nurses were more likely to be provided employer support for professional education. Inner regional nurses were more likely to work part time, would work more hours if offered and were more likely to have taken a break from nursing as a result of family commitments. CONCLUSION: The data confirm that current policies are not addressing the differences in the working lives of geographically dispersed nurses. Policies addressing orientation, mentoring and workloads should be implemented to address these issues.

Exploring the feasibility, sustainability and the benefits of the GrACE + GAIT exercise programme in the residential aged care setting.

BACKGROUND: The feasibility and benefits of a 24-week targeted progressive supervised resistance and weight-bearing exercise programme (Group Aged Care Exercise + GAIT (GrACE + GAIT)) in the residential aged care (RAC) setting was investigated as very little peer-reviewed research has been conducted in relation to exercise programmes of this duration in this cohort. METHODS: A quasi-experimental study design consisting of two groups (control and exercise) explored a 24-week targeted progressive supervised resistance and weight-bearing exercise programme (GrACE + GAIT) in two RAC facilities in Northern New South Wales, Australia. A total of 42 adults consented to participate from a total of 68 eligible residents (61.7%). The primary outcome measures were feasibility and sustainability of the exercise programme via intervention uptake, session adherence, attrition, acceptability and adverse events. Secondary measures included gait speed and the spatio-temporal parameters of gait, handgrip muscle strength and sit to stand performance. RESULTS: Twenty-three residents participated in the exercise intervention (mean (SD) 85.4 (8.1) years, 15 females) and 19 in the control group (87.4 (6.6) years 13 females). Exercise adherence was 79.3%, with 65% of exercise participants attending ≥70% of the sessions; 100% of those originally enrolled completed the programme and strongly agreed with the programme acceptability. Zero exercise-related adverse events were reported. ANCOVA results indicated that post-intervention gait speed significantly increased (p < 0.001) with an 18.8% increase in gait speed (m/s). DISCUSSION: The GrACE + GAIT programme was shown to be feasible and significantly improve adults living in RAC facilities gait speed, handgrip strength and sit to stand performance. These results suggest that the GrACE + GAIT programme is suitable for use in the RAC sector and that it has the potential to reduce disability and improve function and quality of life of the residents.

Sarc-F and muscle function in community dwelling adults with aged care service needs: baseline and post-training relationship.

BACKGROUND: This study sought to better understand the psychometric properties of the SARC-F, by examining the baseline and training-related relationships between the five SARC-F items and objective measures of muscle function. Each of the five items of the SARC-F are scored from 0 to 2, with total score of four or more indicative of likely sarcopenia. METHODS: This manuscript describes a sub-study of a larger step-wedge, randomised controlled 24-week progressive resistance and balance training (PRBT) program trial for Australian community dwelling older adults accessing government supported aged care. Muscle function was assessed using handgrip strength, isometric knee extension, 5-time repeated chair stand and walking speed over 4 m. Associations within and between SARC-F categories and muscle function were assessed using multiple correspondence analysis (MCA) and multinomial regression, respectively. RESULTS: Significant associations were identified at baseline between SARC-F total score and measures of lower-body muscle function (r =  - 0.62 to 0.57; p ≤ 0.002) in 245 older adults. MCA analysis indicated the first three dimensions of the SARC-F data explained 48.5% of the cumulative variance. The initial dimension represented overall sarcopenia diagnosis, Dimension 2 the ability to displace the body vertically, and Dimension 3 walking ability and falls status. The majority of the 168 older adults who completed the PRBT program reported no change in their SARC-F diagnosis or individual item scores (56.5-79.2%). However, significant associations were obtained between training-related changes in SARC-F total and item scores and changes in walking speed and chair stand test performance (r =  - 0.30 to 0.33; p < 0.001 and relative risk ratio = 0.40-2.24; p < 0.05, respectively). MCA analysis of the change score data indicated that the first two dimensions explained 32.2% of the cumulative variance, with these dimensions representing whether a change occurred and the direction of change, respectively. DISCUSSION: The results advance our comprehension of the psychometric properties on the SARC-F, particularly its potential use in assessing changes in muscle function. Older adults' perception of their baseline and training-related changes in their function, as self-reported by the SARC-F, closely matched objectively measured muscle function tests. This is important as there may be a lack of concordance between self-reported and clinician-measured assessments of older adults' muscle function. However, the SARC-F has a relative lack of sensitivity to detecting training-related changes, even over a period of 24 weeks. CONCLUSIONS: Results of this study may provide clinicians and researchers a greater understanding of how they may use the SARC-F and its potential limitations. Future studies may wish to further examine the SARC-F's sensitivity of change, perhaps by adding a few additional items or an additional category of performance to each item.

Detraining and retraining in older adults following long-term muscle power or muscle strength specific training.

BACKGROUND: Training cessation among older adults is associated with the loss of functional ability. However, exercise programs undertaken prior to activity cessation may offer functional protection. In the present study, the residual effects of muscle power or muscle strength training were investigated following extended detraining and subsequent retraining. METHODS: Thirty-eight healthy independent older adults (65-84 years) entered a 24-week detraining period subsequent to 24 weeks of training. Following detraining, participants recommenced training using either the high-velocity muscle power (HV) or muscle strength (ST) protocol, as undertaken during the initial training period, twice weekly for 12 weeks. Isometric and dynamic muscle strength, muscle power, movement velocity, muscle endurance, electromyographic activity, and the results of a battery of functional performance tasks were assessed. RESULTS: Muscle function and functional performance increased following initial training, however, no group differences were observed. Detraining resulted in similar declines in muscle power and muscle strength for both groups (p <.05) (power, HV 17.8 +/- 1.8%, ST 15.5 +/- 2.2%; and strength, HV 17.1 +/- 2.2%, ST 16.5 +/- 1.8%), with comparable accrual following retraining. No significant changes in functional ability were observed following detraining (average change; HV 3.1 +/- 3.5% and ST 2.1 +/- 3.5%) or retraining. No group differences emerged in this study. CONCLUSION: Cessation of training resulted in only a modest loss of muscle power and strength that was recouped following 12 weeks of retraining. Importantly, training-induced gains in functional performance were preserved during detraining. The residual effects of power or strength training appear comparable, and both may be suitable exercise modes prior to a period of activity cessation to promote physical independence.

Strength versus muscle power-specific resistance training in community-dwelling older adults.

BACKGROUND: Loss of muscle power due to normal aging has greater functional impact than loss of strength alone. The present study compared two resistance training programs, one aimed at enhancing muscle power and one at increasing muscle strength, on muscle function and functional performance in older adults. METHODS: Sixty-seven healthy, independent older adults (65-84 years) were randomized to a high-velocity varied resistance (HV), constant resistance (ST), or nontraining control (CO) group. Participants trained twice weekly for 24 weeks using six exercises. Dynamic and isometric muscle strength, muscle power, movement velocity, muscle endurance, and a battery of functional performance tasks were assessed. Secondary outcomes included body composition, quality of life, and balance confidence. RESULTS: Muscle strength increased significantly (p <.001) and similarly in the training groups compared to controls (HV, 51.0 +/- 9.0%; ST, 48.3 +/- 6.8%; CO, 1.2 +/- 5.1%). Peak muscle power also increased with training (p <.05), with no difference between training groups. The change in peak power was 50.5 +/- 4.1%, 33.8 +/- 3.8%, and -2.5 +/- 3.9% in the HV, ST, and CO groups, respectively. Training also improved selected functional performance tasks in the HV and ST groups compared to controls (p <.05), and the HV group reported improved quality of life (p =.018). CONCLUSION: Muscle power and muscle strength improved similarly using either resistance training protocol, and these changes were accompanied by improvements in several functional performance tasks. However, improvements in the HV group occurred with less total work performed per training session.