Prevalence of sarcopenia in patients with chronic kidney disease: a global systematic review and meta-analysis.

Sarcopenia is a risk factor for adverse clinical outcomes in chronic kidney disease (CKD) patients, including mortality. Diagnosis depends on adopted consensus definition and cutoff values; thus, prevalence rates are generally heterogeneous. We conducted a systematic review and meta-analysis to investigate the global prevalence of sarcopenia and its traits across the wide spectrum of CKD. A systematic search was conducted using databases, including MEDLINE and EMBASE, for observational studies reporting the prevalence of sarcopenia. We considered sarcopenia according to the consensus definition of the European Working Group on Sarcopenia in Older People (EWGSOP), the Asian Working Group for Sarcopenia, the Foundation for the National Institutes of Health Sarcopenia Project, and the International Working Group on Sarcopenia (IWGS). Subgroup analyses by CKD stages, consensus, and gender were performed. Pooled prevalence was obtained from random-effect models. A total of 140 studies (42 041 patients) across 25 countries were included in this systematic review and meta-analyses. Global prevalence of sarcopenia was 24.5% [95% confidence interval (CI): 20.9-28.3) and did not differ among stages (P = 0.33). Prevalence varied according to the consensus definition from 11% to 30%, with no significant difference (P = 0.42). Prevalence of severe sarcopenia was 21.0% (95% CI: 11.7-32.0), with higher rates for patients on dialysis (26.2%, 95% CI: 16.6-37.1) compared to non-dialysis (3.0%, 95% CI: 0-11.1; P < 0.01). Sarcopenic obesity was observed in 10.8% (95% CI: 3.5-21.2). Regarding sarcopenia traits, low muscle strength was found in 43.4% (95%CI: 35.0-51.9), low muscle mass in 29.1% (95% CI: 23.9-34.5), and low physical performance in 38.6 (95% CI: 30.9-46.6) for overall CKD. Prevalence was only higher in patients on dialysis (50.0%, 95% CI: 41.7-57.4) compared to non-dialysis (19.6%, 95% CI: 12.8-27.3; P < 0.01) for low muscle strength. We found a high global prevalence of sarcopenia in the wide spectrum of CKD. Low muscle strength, the primary sarcopenia trait, was found in almost half of the overall population with CKD. Patients on dialysis were more prevalent to low muscle strength and severe sarcopenia. Nephrology professionals should be aware of regularly assessing sarcopenia and its traits in patients with CKD, especially those on dialysis.

Predictive Factors of Recurrence After Laparoscopic Incisional Hernia Repair: A Retrospective Multicentre Cohort Study.

Background: The main purpose of this study was to analyze patient-related factors that may influence the risk of hernia recurrence following laparoscopic incisional hernia repair (LIHR), including the potential role of chosen materials. Materials and Methods: A multicenter, retrospective cohort study was conducted on all patients who were aged >18 years and who underwent elective laparoscopic incisional hernia mesh repair at the Departments of Surgery of the S. Anna University Hospital in Ferrara and Sassuolo Hospital in Modena, Italy. Exclusion criteria were as follows: patients undergoing an open or emergency incisional hernia repair or with primary ventral hernia. All hernia and operative variables that may favor hernia recurrence were collected and analyzed. Follow-up was conducted through a standardized telephone interview, followed by an outpatient visit and diagnostic imaging if needed. Results: From September 2002 to September 2017, 312 consecutive patients underwent elective laparoscopic incisional hernia mesh repair. At a mean 22-month follow-up, 273 patients presented no recurrence of incisional hernia and 39 had relapsed. Intra- and postoperative complications were similar between groups. Unadjusted Cox regression analysis showed a statistically significant association between both the partially absorbable mesh (P < .0001) and absorbable tacks (P = .001) and recurrence, while after adjusting for potential confounders, only the partially absorbable mesh was significantly associated with recurrence (P = .007). Conclusions: The laparoscopic approach may be considered safe for incisional hernia mesh repair. In this multicenter, retrospective cohort study, the use of a partially absorbable mesh in LIHR was the only predictor of hernia recurrence. The partially absorbable mesh that was investigated, however, has been withdrawn from the market.

Prevalence of low bone mineral density (T-score ≤ - 2.5) in the whole spectrum of chronic kidney disease: a systematic review and meta-analysis.

The prevalence of low bone mineral density (LBMD) in people with chronic kidney disease (CKD) remains unknown. We identified a high prevalence of LBMD in CKD population. Thus, public health strategies should include efforts to prevent, early detect, and manage LBMD in CKD patients, especially in patients undergoing kidney replacement therapy. Mineral and bone disorders are common among patients with CKD, which affects bone mineral density. We conducted a systematic review and meta-analysis to estimate the prevalence of low bone mineral density (LBMD) in adults with CKD. We searched MEDLINE, EMBASE, Web of Science, CINAHL, and LILACS databases from inception to February 2021. Observational studies that reported the prevalence of LBMD in adults with CKD stages 3a-5D were included. The LBMD was defined according to the World Health Organization criterion (T-score ≤ - 2.5). Random-effect model meta-analyses were used to estimate the pooled prevalence of LBMD. Meta-regressions and subgroup analyses were conducted for stages of CKD, dialysis modality, gender, bone sites and morphology, and geographical region. This study was registered in PROSPERO, number CRD42020211077. One-hundred and fifty-three studies with 78,092 patients were included. The pooled global prevalence of LBMD in CKD was 24.5% (95% CI, 21.3 - 27.8%). Subgroup analyses indicated a higher prevalence of LBMD in dialysis patients (30%, 95% CI 25 - 35%) compared with non-dialysis CKD patients (12%, 95% CI 8 - 16%), cortical bone sites (28%, 95% CI 23 - 35%) relative to trabecular sites (19%, 95% CI 14 - 24%), while similar estimates in the European and the Asiatic continents (26%, 95% CI 21 - 30% vs 25%, 95% CI 21 - 29). The prevalence of LBMD in CKD patients is high, particularly in those undergoing dialysis and in cortical bone sites. Therefore, efforts to early diagnosis and management strategies should be implemented in clinical routine for an epidemiological control of LBMD in CKD patients.

Association between isokinetic strength measures and functional performance in community-dwelling older adults / Asociación entre las medidas de fuerza isocinética y el rendimiento funcional en personas mayores en la comunidad / Associação entre medidas de força isocinética e desempenho funcional em pessoas idosas da comunidade

ABSTRACT Previous studies have shown an association between lower limb muscle strength and functional performance, but a dose-response relationship between the strength of each lower limb muscle group and performance in daily life activities in older adults has not been well established. Thus, this study aimed to investigate the association between isokinetic muscle strength of all eight major lower limb muscle groups and functional performance in community-dwelling older adults. The muscle strength of the plantar flexors and dorsiflexors of the ankle, flexors and extensors of the knee, and flexors, extensors, adductors, and abductors of the hip were evaluated using a Biodex System 4 Pro® isokinetic dynamometer. Functional performance was evaluated in 109 participants using the five-times sit-to-stand test (STS) and 4-meter usual walking speed (UWS). The multiple linear regression analyses showed that the hip abductors strength predicted 31.3% of the variability for UWS (p=0.011), and the knee extensors strength (p=0.015) predicted 31.6% of the variability for the STS. We conclude that hip abductors and knee extensors could be the key muscle groups involved in sit to stand and walking speed performance in older adults.

RESUMEN Estudios previos ya demostraron la asociación entre la fuerza muscular de los miembros inferiores y el rendimiento funcional, sin embargo, no está bien establecida la contribución de los principales músculos de los miembros inferiores sobre el rendimiento de las personas mayores en las actividades diarias. El objetivo de este estudio fue evaluar la asociación entre la fuerza muscular isocinética de los ocho principales grupos musculares de los miembros inferiores y el rendimiento funcional en personas mayores que viven en la comunidad. La fuerza muscular de los plantiflexores y dorsiflexores del tobillo, los flexores y extensores de la rodilla y los flexores, extensores, aductores y abductores de la cadera se evaluaron por medio del dinamómetro isocinético Biodex System 4 Pro®. El rendimiento funcional de 109 participantes se evaluó mediante el test de sentarse y pararse cinco veces (STS) y la velocidad de marcha habitual de 4 metros. Los análisis de regresión lineal múltiple mostraron que la fuerza de los abductores de la cadera predijo el 31,3% de la variabilidad para la velocidad de marcha habitual (p=0,011); y la fuerza de los extensores de la rodilla (p=0,015), el 31,6% de variabilidad para STS. Se concluyó que los abductores de la cadera y los extensores de la rodilla pueden ser los principales grupos musculares involucrados en el rendimiento de los adultos mayores para sentarse, pararse y caminar.

RESUMO Estudos anteriores já demonstraram a associação entre força muscular de membros inferiores e desempenho funcional, mas a contribuição dos principais músculos dos membros inferiores para o desempenho de pessoas idosas nas atividades cotidianas não foi bem estabelecida. O objetivo deste estudo foi investigar a associação entre a força muscular isocinética dos oito principais grupos musculares dos membros inferiores e o desempenho funcional em pessoas idosas da comunidade. A força muscular dos plantiflexores e dorsiflexores do tornozelo, flexores e extensores do joelho e flexores, extensores, adutores e abdutores do quadril foi avaliada utilizando um dinamômetro isocinético Biodex System 4 Pro®. O desempenho funcional de 109 participantes foi avaliado usando o teste de sentar e levantar cinco vezes (TSL) e de velocidade de marcha habitual de 4 metros (VMH). As análises de regressão linear múltipla mostraram que a força dos abdutores do quadril previu 31,3% da variabilidade para a VMH (p=0,011), e a força dos extensores do joelho (p=0,015) 31,6% da variabilidade para o TSL. Concluímos que os abdutores do quadril e os extensores do joelho podem ser os principais grupos musculares envolvidos no desempenho de pessoas idosas para sentar-levantar e caminhar.

Balance Exercise Circuit for fall prevention in older adults: a randomized controlled crossover trial.

Objectives: This study aimed to assess the immediate and short-term effects of the Balance Exercise Circuit (BEC) on muscle strength, postural balance, and quality of life, with the aim of preventing falls in older adults. Methods: Twenty-two volunteers participated in this randomized controlled crossover study. Group A performed BEC training in the initial 3 months and received no intervention in the following 3 months. Group B received no intervention during the first 3 months and then participated in BEC training for the next 3 months. In addition, participants were followed for an additional 3 months. Muscle strength, postural balance, functional mobility, and quality of life were assessed, respectively, using an isokinetic dynamometer, force platform, TUG test, and the WHOQOL. Results: After 3 months of training, Group A presented improved balance and rate of force development (RFD), while Group B presented improvements in RFD, TUG performance, and WHOQOL physical and psychological domains. Regarding the short-term effects, the participants maintained the training effects in WHOQOL balance, RFD, and the social domain. In addition, the number of falls decreased during follow-up. Conclusion: The BEC intervention improved muscle strength, postural balance, and quality of life in older adults, in addition to reducing the risk of falls. Trial registration: Brazilian Registry of Clinical Trials (ReBEC) - RBR-5nvrwm.

Effect of physical exercise on muscle strength in adults following bariatric surgery: A systematic review and meta-analysis of different muscle strength assessment tests.

Individuals following bariatric surgery are considered at high risk for the development of sarcopenic obesity (excess fat mass, low muscle mass and low physical function), and exercise may play an important role in its prevention and treatment. We systematically reviewed 5 scientific databases (Embase, Medline, Scopus, SPORTDiscus, and Web of Science) and 2 grey literature databases (ProQuest and Google Scholar) for clinical trials that evaluated the effect of exercise on muscle strength in adults following bariatric surgery and conducted a separate meta-analysis for studies that used different muscle strength tests. Random-effect models, restricted maximum likelihood method and Hedges' g were used. The review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42020152142). Fifteen studies were included (638 patients), none had a low risk of bias, and all were included in at least 1 of the 5 meta-analyses (repetition maximum [lower and upper limbs], sit-to-stand, dynamometer, and handgrip tests). Exercise interventions improved both upper (effect size, 0.71; 95% CI, 0.41-1.01; I2 = 0%) and lower (effect size, 1.37; 95% CI, 0.84-1.91; I2 = 46.14) limb muscle strength, as measured by repetition maximum tests. Results were similar for the sit-to-stand (effect size, 0.60; 95% CI, 0.20-1.01; I2 = 68.89%) and dynamometer (effect size, 0.46; 95% CI, 0.06-0.87; I2 = 31.03%), but not for the handgrip test (effect size, 0.11; 95% CI, -0.42-0.63; I2 = 73.27%). However, the certainty level of the meta-analyses was very low. Exercise with a resistance training component performed post bariatric surgery may improve muscle strength, which is related to sarcopenic obesity, functional capacity, and mortality risk, therefore should be included in the follow-up.

Association between sarcopenia and clinical outcomes in chronic kidney disease patients: A systematic review and meta-analysis.

BACKGROUND & AIMS: Sarcopenia is a risk factor for adverse outcomes in older adults, but this has yet to be confirmed in chronic kidney disease (CKD). We conducted a systematic review to investigate the association between sarcopenia and its traits with mortality, hospitalization, and end-stage kidney disease (ESKD) progression in CKD patients. METHODS: Five electronic databases were searched, including MEDLINE and Embase. Observational cohort studies with CKD patients were included. The sarcopenia traits assessed were low muscle strength, low muscle mass, and low physical performance, as well as diagnosed sarcopenia (combined low muscle mass and low strength/performance). Hazard ratios (HR), risk ratios (RR), odds ratios (OR), and 95% confidence intervals (CI) were pooled using random-effect meta-analyses. RESULTS: From a total of 4922 screened studies, 50 (72,347 patients) were included in the review and 38 (59,070 patients) in the meta-analyses. Most of the included studies were in dialysis patients (n = 36, 72%). Pooled analyses showed that low muscle strength (15 studies; HR:1.99; 95%CI:1.65 to 2.41; I2:45%), low muscle mass (20 studies; HR:1.51; 95%CI:1.36 to 1.68; I2:26%) and low physical performance (five studies; HR:2.09; 95%CI:1.68 to 2.59; I2:0%) were associated with increased mortality risk in CKD patients. Diagnosed sarcopenia was also associated with the mortality risk in dialysis patients (eight studies; HR:1.87; 95%CI:1.35 to 2.59; I2:40%). On the other hand, it was uncertain whether low muscle mass was associated with hospitalization (two studies in dialysis patients; RR:1.81; 95% CI:0.78 to 4.22; I2:59%). Further, limited ESKD progression measures prevented meta-analysis for this outcome. CONCLUSIONS: Low muscle strength, low muscle mass, and low physical performance were associated with higher mortality in CKD patients. In dialysis patients, diagnosed sarcopenia also represented higher mortality risk. Evidence to conclude associations with hospitalization and ESKD progression is currently lacking. PROSPERO REGISTRATION: CRD42020192198.

Predictive factors of recurrence for laparoscopic repair of primary and incisional ventral hernias with single mesh from a multicenter study.

Laparoscopic ventral hernia repair (LVHR) is a widely practiced treatment for primary (PH) and incisional (IH) hernias, with acceptable outcomes. Prevention of recurrence is crucial and still highly debated. Purpose of this study was to evaluate predictive factors of recurrence following LVHR with intraperitoneal onlay mesh with a single type of mesh for both PH and IH. A retrospective, multicentre study of data collected from patients who underwent LVHR for PH and IH with an intraperitoneal monofilament polypropylene mesh from January 2014 to December 2018 at 8 referral centers was conducted, and statistical analysis for risk factors of recurrence and post-operative outcomes was performed. A total of 1018 patients were collected, with 665 cases of IH (65.3%) and 353 of PH (34.7%). IH patients were older (p < 0.001), less frequently obese (p = 0.031), at higher ASA class (p < 0.001) and presented more frequently with large, swiss cheese type and border site defects (p < 0.001), compared to PH patients. Operative time and hospital stay were longer for IH (p < 0.001), but intraoperative and early post-operative complications and reinterventions were comparable. IH group presented at major risk of recurrence than PH (6.7% vs 0.9%, p < 0.001) and application of absorbable tacks resulted a significative predictive factor for recurrence increasing the risk by 2.94 (95% CI 1.18-7.31). LVHR with a light-weight polypropylene mesh has low intra- and post-operative complications and is appropriate for both IH and PH. Non absorbable tacks and mixed fixation system seem to be preferable to absorbable tacks alone.

Incidence and Risk Factors for Venous Thromboembolism in Female Patients Undergoing Breast Surgery.

Albeit it does not have the highest venous thromboembolism (VTE) incidence compared to other neoplasms, breast cancer contributes to many VTE events because it is the most diagnosed tumor in women. We aim to analyze the occurrence and timing of VTE during the follow-up of patients who underwent breast surgery, the possible correlated factors, and the overall survival. This retrospective study included all female patients diagnosed with mammary pathology and surgically treated in our clinic between January 2002 and January 2012. Of 5039 women who underwent breast surgery, 1056 were found to have no evidence of malignancy, whereas 3983 were diagnosed with breast cancer. VTE rate resulted significantly higher in patients with invasive breast cancer than in women with benign breast disease or carcinoma in situ. Invasive cancers other than lobular or ductal were associated with a higher VTE rate. In addition, chronic hypertension, high BMI, cancer type, and evidence of metastasis turned out to be the most significant risk factors for VTE in women who underwent breast surgery. Moreover, VTE occurrence significantly impacted survival in invasive breast cancer patients. Compared to women with benign mammary pathology, VTE prevalence in women with breast cancer is significantly higher. The knowledge about the risk factors of VTE could be helpful as prognostic information, but also to eventually target preventive treatment strategies for VTE, as far as the co-existence of invasive breast cancer and VTE has a significantly negative impact on survival.

Novel concepts in red blood cell clearance.

PURPOSE OF REVIEW: Red blood cell (RBC) clearance has been studied for decades in many different pathologies, which has revealed different routes of RBC degradation, depending on the situation. This review summarizes the latest mechanistic insights on RBC clearance in different contexts; during homeostatic removal, immune-mediated destruction, and systemic inflammation. RECENT FINDINGS: Besides the recognition of a variety of potential 'eat me' signals on RBCs, recent evidence suggests that normal RBC degradation is driven by the increase of the adhesive properties of RBCs, mediating the retention in the spleen and leading to RBC hemolysis. Furthermore, immune-mediated degradation of RBCs seems to be fine-tuned by the balance between the density of the antigens expressed on RBCs and the presence of 'don't eat me' signals. Moreover, besides RBC clearance by macrophages, neutrophils seem to play a much more prominent role in immune-mediated RBC removal than anticipated. Lastly, RBC clearance during systemic inflammation appears to be driven by a combination of extreme macrophage activity in response to proinflammatory cytokines as well as direct damage of RBC by the inflammation or inflammatory agent. SUMMARY: Recent studies on RBC clearance have expanded our knowledge on their destruction in different contexts.

Poor handgrip strength determined clinically is associated with falls in older women.

OBJECTIVES: To assess the association between poor handgrip strength (HGS) determined by clinical criterion and incidence of falls in older women. METHODS: The cohort included 195 women (68.1±6.2 years) who were assessed for HGS (Jamar Dynamometer) at baseline and were prospectively followed for 18 months. FNIH Sarcopenia threshold of HGS adjusted for body mass index (<0.56) was used for clinical determination of poor HGS. Association between poor HGS and incidence of falls was analyzed using Cox hazard models in the total cohort and in a stratified analysis by balance status. RESULTS: During the follow-up, 53 (27%) women experienced at least one fall. In a multivariable model, poor HGS was associated with approximately 3-fold increased risk for falls [Hazard Ratio (HR)=2.73, 95% Confidence Interval (CI)=1.28-5.82, p=0.009]. In a stratified analysis, women with impaired balance exhibited even greater risk for falls (HR=3.85, 95%CI=1.47-10.12, p=0.011), although no association was found in women with normal balance (p=0.459). CONCLUSIONS: Poor HGS based on clinical criterion is independently associated with higher risk of falls in older women, particularly in those with impaired balance. These results suggest potential prognostic value of FNIH Sarcopenia threshold for risk stratification and referring high-risk individuals to fall prevention programs.

Effects of hippotherapy on postural balance, functional mobility, self-perceived fatigue, and quality of life in people with relapsing-remitting multiple sclerosis: Secondary results of an exploratory clinical trial.

BACKGROUND: Multiple sclerosis (MS) results in worsening of postural balance, functional mobility, and self-perceived fatigue as influences of quality of life. OBJECTIVE: To examine the effects of hippotherapy on postural balance, functional mobility, self-perceived fatigue, and quality of life in people with MS. METHODS: Participants were assigned into a hippotherapy intervention group (n= 17) or a control group (n= 16). The intervention included 16 sessions of 30-minutes of hippotherapy conducted twice a week whereas the control group was maintained their therapeutic routine. Postural balance was evaluated as CoP speed (cm/s) and CoP 95% elliptical area (cm2) using a force platform under 4 experimental conditions: stable surface/ eyes open, stable surface/ eyes closed, foam surface/ eyes open, and foam surface/ eyes closed. Functional mobility was evaluated by the Timed Up and Go (TUG) test. The Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS) measured perceived fatigue, and the Functional Assessment of Multiple Sclerosis (FAMS) measured quality of life. The data were examined using mixed model ANOVA with Bonferroni post hoc. RESULTS: CoP speed and CoP 95% elliptical area (p < .05) significantly decreased across all testing conditions for the intervention group compared with control. The TUG improved over time in the intervention group (p = .001) as did the FSS (p < .001). In addition, there was also an improvement for the score and all the MFIS domains (p < .005) for the intervention group compared with control and for FAMS improved over time in the intervention group (p < .05). CONCLUSION: Hippotherapy improved postural balance, functional mobility, fatigue, and quality of life in people with relapsing-remitting MS. This suggests that hippotherapy may be a useful approach for complimentary treatment among people with MS.

The Influence of Body Fat Distribution on Postural Balance and Muscle Quality in Women Aged 60 Years and Over.

The aim of this study was to investigate the influence of body fat distribution on postural balance and lower-limb muscle quality in women aged 60 years and over. Two hundred and twenty-two volunteers took part in this cross-sectional analysis. Participants underwent body fat distribution assessment using dual-energy x-ray absorptiometry and were classified as nonobese, gynoid obese, or android obese. Postural balance was assessed during quiet standing, with and without vision restriction, using a force platform. Specific torque was defined as the ratio of knee extensors peak torque (evaluated by an isokinetic dynamometer) to the lean mass of the same limb (evaluated by dual-energy x-ray absorptiometry). Compared with nonobese participants, both obese groups exhibited higher range of postural sway along the anteroposterior and mediolateral axes (P < .05). However, there were no differences between participants with gynoid and android obesity. The android obese group exhibited greater speed of postural sway in the condition without vision restriction than both nonobese (P = .040) and gynoid obese (P = .004) groups. Regarding muscle quality, only participants with gynoid obesity (P = .004) presented lower specific torque than their nonobese peers. These results may be clinically useful when designing falls prevention exercises targeting the obese population.

Body fat distribution in obesity and the association with falls: A cohort study of Brazilian women aged 60 years and over.

OBJECTIVES: Obesity is associated with an increased risk of falls in older women; however, it is not certain how body fat distribution affects this relationship. This study examined the association between android and gynoid obesity and the incidence of falls in women aged 60 years and over. STUDY DESIGN: Participants were recruited from the community in Brasilia, Brazil. At baseline, participants underwent obesity screening using dual-energy x-ray absorptiometry. Participants identified as obese (body fat percentage >42 %) were classified as android or gynoid type, based on the median of the android-gynoid fat percent ratio (0.99). Incident falls were recorded at the end of the 18-month follow-up period via participant recall. Chi-square test and modified Poisson regression were used to examine the association between obesity and falls. RESULTS: A total of 246 participants were recruited and 204 completed the follow-up. The gynoid obese group had a larger proportion of fallers (n = 27, 41 %) than the android obese (n = 17, 24 %) and non-obese (n = 12, 18 %) groups (p = .009). Compared with non-obese women, participants with gynoid obesity were more likely to experience a fall (RR: 2.09, 95 %CI: 1.13-3.87). The risk of falling did not differ between non-obese participants and those with android obesity (RR: 1.26, 95 %CI: 0.64-2.50). CONCLUSIONS: Gynoid obesity is associated with an increased risk of falls in women aged 60 years and over. Screening for body fat distribution as a supplement to other risk factors for falls may help to identify older adults at a greater risk of falling and to prompt early implementation of fall prevention programs.

Effect of hippotherapy on walking performance and gait parameters in people with multiple sclerosis.

BACKGROUND: Walking dysfunction is one of the most common symptoms of multiple sclerosis (MS). OBJECTIVE: To evaluate the effects of an 8-week hippotherapy intervention on walking performance and spatiotemporal gait parameters in people with relapsing-remitting MS; and to examine whether the effects of hippotherapy on walking performance are mediated by changes in spatiotemporal gait parameters. METHODS: Participants were assigned into a hippotherapy intervention group (n = 17) or a control group (n = 16). The intervention included 16 sessions of 30-minutes of hippotherapy conducted twice a week. Participants underwent the 25-foot walk test (T25FW) and 6-minute walk test (6MWT), as primary outcomes, and spatiotemporal gait evaluation using GaitRite system, as secondary outcomes, before and after intervention. The data were examined using mixed model ANOVA with Bonferroni post hoc. Mediation analysis was conducted as per Baron and Kenny's criteria. RESULTS: Compared with control, the intervention group significantly increased 6MWT distance (+9.70%, p<0.001) and decreased T25FW time (-15.86%, p<0.001).Regarding spatiotemporal gait parameters, the intervention group exhibited significantly greater improvements in most variables (Δ% from 3.66 and 41.43%; all p<0.005) than control. Only balance time (p = 0.043), stance time (p = 0.031), and absolute (p = 0.004) and relative (p = 0.017) double support time were identified as significant mediators of the effects of hippotherapy on walking performance evaluated by T25FW. There was no significant mediator for 6MWT (all p>0.05). CONCLUSION: Hippotherapy improved walking performance and spatiotemporal gait parameters in people with relapsing-remitting MS, and changes in walking performance, evaluated by T25FW, were partially driven by reduction in stance time and double support time and increase in balance time. Hippotherapy may be a useful complimentary treatment approach for improving walking in people with MS.

Obesity and falls in older women: Mediating effects of muscle quality, foot loads and postural control.

BACKGROUND: Obesity is associated with an increased risk of falls in older women. However, it is not certain whether factors commonly associated with obesity and falls mediate this risk. RESEARCH QUESTION: Do lower-limb muscle quality, foot loads and postural control mediate the relationship between obesity and falls in women aged 60 years and older? METHODS: At baseline, 246 female participants underwent obesity screening (BMI≥30 kg/m²), and measurements of muscle quality (isokinetic dynamometer and dual-energy X-ray absorptiometry), foot loads (pressure platform) and postural balance (force platform). Incident falls were recorded at the end of the 18-month follow-up period via participant recall. To test whether, and to what extent, biomechanical factors mediated the relationship between obesity and falls, the Natural Indirect Effects (NIE), Natural Direct Effect (NDE) and proportion mediated were calculated using the counterfactual approach. Significance level was set at p < .05. RESULTS: 204 participants (83 %) completed the follow-up. As expected, obesity was associated with a higher risk of being a faller (RR: 2.13, 95 % CI: 1.39-3.27). Using the counterfactual approach, only specific torque (NIE: 1.11, 95 % CI: 1.01-1.38) and flatfoot (NIE: 1.10, 95 % CI: 1.01-1.32) were significant mediators of the relationship between obesity and falls. Specific torque and flatfoot mediated 19 % and 21 % of the relationship, respectively. SIGNIFICANCE: Lower-limb muscle quality (specific torque) and foot loads (flatfoot) mediate the relationship between obesity and falls in older women. The inclusion of muscle strengthening and podiatry interventions as part of a fall prevention program may benefit this population.

Does Obesity Increase the Risk and Severity of Falls in People Aged 60 Years and Older? A Systematic Review and Meta-analysis of Observational Studies.

BACKGROUND: Recent investigations suggest that obesity may be associated with an increased risk of falls; however, this theory has yet to be definitively confirmed. This systematic review and meta-analysis examined the strength of the association between obesity and falls, multiple falls, fall-related injuries, and fall-related fractures among older adults. METHODS: MEDLINE, Embase, CINAHL, PsycINFO, SPORTDiscus, LILACS, and Web of Science databases were searched to identify observational studies that assessed the association between obesity and fall-related outcomes in participants aged 60 years and older. Two independent reviewers performed data extraction and quality assessment. Relative risks and 95% confidence intervals (CI) were pooled using random effect meta-analyses. RESULTS: Thirty-one studies including a total of 1,758,694 participants were selected from 7,815 references. Pooled estimates showed that obese older adults have an increased risk of falls compared with nonobese counterparts (24 studies; relative risk: 1.16; 95% CI: 1.07-1.26; I2: 90%). Obesity was also associated with an increased risk of multiple falls (four studies; relative risk: 1.18; 95% CI: 1.08-1.29; I2: 0%). There was no evidence, however, of an association between obesity and fall-related injuries (seven studies; relative risk: 1.04; 95% CI: 0.92-1.18; I2: 65%). Fall-related fractures were reported in only one study, which demonstrated a lower risk of hip fracture with obesity (odds ratio: 0.65; 95% CI: 0.63-0.68). CONCLUSIONS: Obesity increases the risk of falls and multiple falls in people aged 60 years and older; however, there is insufficient evidence of an association with fall-related injuries or fractures. Prevention and treatment of obesity may play a role in preventing falls in older age.

Dynapenic abdominal obesity and the incidence of falls in older women: a prospective study.

BACKGROUND: Dynapenic abdominal obesity (D/AO) has been associated with negative outcomes in older people, including trait of falls. AIMS: To assess the association between D/AO and the incidence of falls over 18 months in older community-dwelling women. METHODS: A total of 201 older women (67.97 ± 6.02 years; 27.70 kg/m2) underwent waist circumference measurement, and had handgrip strength assessed using a hydraulic dynamometer. Dynapenia was classified using the lower tertile of handgrip strength, while abdominal obesity was considered as a waist circumference > 88 cm. D/AO was the combination of both aforementioned criteria. Volunteers were classified into four groups: normal, abdominal obesity, dynapenic, and D/AO. Participants were then tracked by phone calls for ascertainment of falls during a follow-up period of 18 months. Chi-square and multivariable Cox proportional regressions were conducted. RESULTS: The overall incidence of falls over the follow-up was 27.5%; and for normal, dynapenic, abdominal obesity, and D/AO were 14.7%, 17.2%, 27.5%, and 40.4% (X2 = 8.341; P = 0.039), respectively. D/AO was associated with a higher risk of falls (hazard ratio: 3.595 [95% CI: 1.317-9.815], even after adjustments for age, body mass index, physical activity level, regular use of medications, peripheral sensation, chronic diseases, and history of lower-limbs pain. CONCLUSIONS: D/AO is more closely related to falls than either dynapenia or abdominal obesity alone, and is independently associated with an increased incidence of falls in older women. These results provide support for the concept that the combined evaluation of muscle strength and central obesity may be clinically relevant in this population.