Resistance training as a tool for changing muscle mass and frailty status in sarcopenic older women: a quasi-experimental study / Exercícios resistidos modificam a massa muscular e a classificação de fragilidade em idosas sarcopênicas: estudo quase-experimental / Los ejercicios de fuerza provocan cambios en la masa muscular y la clasificación de la fragilidad en ancianas con sarcopenia: un estudio cuasiexperimental

ABSTRACT Frailty and sarcopenia are geriatric syndromes highly prevalent, complex, and hard to diagnose and treat. The literature still lacks a consensus on which resistance training program is better for older people, especially when considering frailty status and sarcopenia. We aimed to evaluate the effectiveness of a progressive resistance training program on muscle mass and frailty status in older sarcopenic women. This study included 18 community-dwelling sarcopenic women aged 65 or older enrolled in the progressive resistance training program. The intervention was based on 75% of each subject's maximum repetition test (3 times/week, for 12 weeks). Before the intervention, 16.7% were frail, and 61.1% were pre-frail; after the intervention, 5.6% were frail, and 50% were pre-frail. The result shows that the intervention reduced frailty status and increased muscle mass (p=0.01). Hence, after the intervention, we observed both a decrease in frailty and a positive change in function, since the percentage of robust women increased twice (p=0.01). We conclude that the progressive resistance training program might be the best strategy to prevent frailty and sarcopenia. Therefore, we suggest using weight resistance training in daily clinical practice to improve muscle mass and decrease frailty status in sarcopenic women.

RESUMO Fragilidade e sarcopenia são consideradas síndromes geriátricas que apresentam grande prevalência e complexidade e são de difícil diagnóstico e tratamento. Ainda não existe consenso quanto ao melhor programa de exercícios resistidos, especialmente quando se considera a fragilidade e a sarcopenia. O objetivo deste estudo foi avaliar a efetividade de um programa de carga na massa muscular e na classificação de fragilidade em idosas sarcopênicas. Participaram 18 idosas sarcopênicas, com idade a partir de 65 anos, que completaram um programa de carga progressiva. A intervenção utilizou o cálculo de 75% de uma repetição máxima (1RM) para cada participante (3 vezes/semana, por 12 semanas). Antes da intervenção, 16,7% foram consideradas frágeis e 61,1% pré-frágeis; após, 5,6% passaram a ser consideradas frágeis e 50% pré-frágeis. Os resultados mostraram que a intervenção alterou a classificação de fragilidade e aumentou a massa muscular das idosas (p=0,01). Observou-se diminuição nos itens de classificação da fragilidade e consequente melhora no perfil funcional, havendo o aumento da porcentagem daquelas consideradas não frágeis após a intervenção (p=0,01). Conclui-se que o programa de exercício resistido progressivo é provavelmente uma das melhores estratégias para prevenir a fragilidade e a sarcopenia. Desta forma, recomenda-se o seu uso na prática clínica diária para melhorar a massa muscular e diminuir o status de fragilidade em mulheres sarcopênicas.

RESUMEN La fragilidad y la sarcopenia son síndromes geriátricos de alta prevalencia y complejidad, además de ser de difícil diagnóstico y tratamiento. Todavía no hay un consenso sobre el programa de ejercicios de fuerza más indicado, especialmente teniendo en cuenta la fragilidad y la sarcopenia. El objetivo de este estudio fue evaluar la efectividad de un programa de carga sobre la masa muscular y la clasificación de la fragilidad en ancianas con sarcopenia. Participaron 18 ancianas con sarcopenia, de más de 65 años y que completaron un programa de carga progresiva. La intervención utilizó el cálculo del 75% de repetición máxima (1RM) para cada participante (3 veces/semana, durante 12 semanas). Antes de la intervención, el 16,7% de las participantes se consideraban frágiles y el 61,1% prefrágiles; después de la intervención, el 5,6% se consideraban frágiles y el 50% prefrágiles. Los resultados mostraron que la intervención produjo cambios en la clasificación de la fragilidad y aumentó la masa muscular de las ancianas (p=0,01). Hubo una reducción en los ítems de clasificación de la fragilidad y una mejora en el perfil funcional, con un aumento del porcentaje de aquellas consideradas no frágiles después de la intervención (p=0,01). Se concluye que el programa de ejercicios de fuerza progresiva se mostró una de las mejores estrategias para prevenir la fragilidad y la sarcopenia. Por tanto, se recomienda aplicarlo en la práctica clínica cotidiana para mejorar la masa muscular y disminuir el estado de fragilidad de mujeres con sarcopenia.

Do Older Brazilian Women Who Participate in a Regular Physical Exercise Program Have Higher Habitual Physical Activity Levels? A Cross-Sectional Study Based on Accelerometer Data.

A cross-sectional study was conducted to compare the habitual physical activity level, measured by accelerometry, gait performance, assessed by the GAITRite® system, handgrip strength, and static balance between older Brazilian women who participate (n = 50; 70.7 ± 5.5 years) and do not participate (n = 50; 70.1 ± 5.6 years) in a regular physical exercise program, and to investigate whether participation in a regular exercise program ensures compliance with physical activity recommendations. Older women who participated in a regular physical exercise program had significantly shorter sedentary activity time (effect size [ES] = 0.54), longer moderate activity time (ES = 0.85), and higher energy expenditure (ES = 0.64), number of steps (ES = 0.82), gait speed (ES = 0.49), and step length (ES = 0.45). However, regular participation in an exercise program did not guarantee compliance with physical activity recommendations. Behavioral changes to increase physical activity levels among older women who do and do not participate in a regular exercise program are necessary.

Attitudes and beliefs of older adults with acute low back pain: 12-month results from the Brazilian cohort back complaints in the elders.

BACKGROUND: Psychosocial factors have been identified as important predictors of onset, course and persistence of low back pain (LBP) in the general population. OBJECTIVE: To identify factors associated with attitudes/beliefs in older adults with LBP throughout a 12-month follow-up. METHODS: A longitudinal investigation was conducted with 500 participants aged ≥60 years reporting a new (acute) episode of nonspecific LBP. Data were obtained at baseline, 6-week, 3-, 6-, 9-, and 12-month interviews. The study variables were: [dependent] LBP-related attitudes/beliefs that were assessed by the Back Beliefs Questionnaire (BBQ); [independent] age; sex; LBP intensity 'at-the-present-time' of interview and 'over-the-past-week' before interview; LBP frequency; LBP-related treatments; disability; mobility; depressive symptoms; self-perceived recovery; expectation of pain improvement; and expectation for returning to activities. Data were analysed by multiple linear regression analysis. RESULTS: At baseline, 85.7% of the participants were female, had mean age of 69.0 (6.3) years, mean BBQ score of 24.5 (6.5), and 79.6% reported pain complaints after an acute episode of LBP. After 12 months, participants maintained a mean BBQ score of 24.6 (6.6) and 63.3% still reported pain complaints after an acute episode of LBP at baseline. Multivariate analysis showed that disability, advancing age, poor expectation of pain improvement in 3 months, and mobility decline were significantly associated with worse BBQ scores during all follow-ups. CONCLUSION: Ageing, hopelessness, and physical and functional impairment impact pain-related behaviours among older patients seeking healthcare due to acute LBP complaints. Their screening may assist in strategies to manage symptoms and prevent the persistence of pain.

Cross-cultural adaptation, validity and reproducibility of the Back Beliefs Questionnaire among older Brazilians with acute low back pain. A cross-sectional study.

BACKGROUND: Low back pain (LBP) has emerging as an epidemic, multifactorial and multidimensional condition in older age. Assessment of attitudes and beliefs of patients with back pain is necessary for understanding the impact of psychosocial factors on pain perception and management. OBJECTIVES: To cross-culturally adapt and examine the validity and reproducibility (intra and interrater reliability and agreement) of the Back Beliefs Questionnaire (BBQ) in older Brazilians with acute LBP. DESIGN AND SETTING: Cross-sectional methodological report conducted at the Department of Physical Therapy of the Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. METHODS: The present study was conducted for translating, adapting, and examining the psychometric properties of a questionnaire. Participants aged ≥ 60 years experiencing an acute episode of LBP were recruited. Coefficients of internal consistency, reliability and agreement were obtained using Cronbach's α, intraclass correlations, and standard error of measurement and the smallest detectable change, respectively. RESULTS: Twenty-six participants aged between 60-84 years and reporting a mean of 9.8 (4.3) years of schooling completed the study. The Brazilian Portuguese-language version of the BBQ (BBQ-Brazil) was proposed and presented with adequate conceptual, semantic, operational, and measurement equivalence from the original version. Intra and interrater evaluations showed moderate (0.74) and excellent (0.91) intraclass correlation coefficients, respectively, with small standard error of measurement for both evaluations. Internal consistency was considered adequate (0.70). CONCLUSION: BBQ-Brazil had consistent measurements of validity and reproducibility, and proved to be a valuable tool in clinical practice for addressing attitudes and beliefs of older patients with acute LBP.

Declínio da velocidade da marcha e desfechos de saúde em idosos: dados da Rede Fibra / Disminución de la velocidad de la marcha y resultados en la salud de los ancianos: datos de la Red Fibra / Decreased gait speed and health outcomes in older adults: Rede FIBRA's data

RESUMO A velocidade da marcha (VM) tem sido considerada um marcador de saúde em idosos capaz de predizer desfechos adversos de saúde, mas a compreensão de fatores associados a ela ainda é limitada e controversa. O objetivo deste trabalho é identificar desfechos adversos de saúde relacionados ao declínio da velocidade de marcha em idosos comunitários. Trata-se de estudo transversal e multicêntrico, que avaliou o autorrelato de doenças crônicas e de hospitalização no último ano, polifarmácia e velocidade de marcha. Utilizou-se análise de regressão logística para estimar os efeitos de cada variável independente na chance de os idosos apresentarem declínio na velocidade de marcha inferior (VM<0,8m/s) (α=0,05). Participaram da pesquisa 5.501 idosos. A menor velocidade da marcha mostrou-se associada a portadores de doenças cardíacas (OR=2,06; IC: 1,67-2,54), respiratórias (OR=3,25; IC: 2,02-5,29), reumáticas (OR=2,16; IC: 1,79-2,52) e/ou depressão (OR=2,51; IC: 2,10-3,14), hospitalizados no último ano (OR=1,51; IC: 1,21-1,85) e polifarmácia (OR=2,14; IC: 1,80-2,54). Assim, os resultados indicaram que idosos com velocidade de marcha menor que 0,8m/s apresentam maior risco de eventos adversos de saúde. Dessa forma, sugere-se que a velocidade de marcha não seja negligenciada na avaliação de idosos comunitários, inclusive na atenção básica.

RESUMEN La velocidad de la marcha (VM) se ha considerado un marcador de salud en los ancianos capaz de predecir resultados adversos en la salud, pero la comprensión de sus factores asociados todavía es limitada y controvertida. El presente estudio tiene como objetivo identificar los resultados adversos para la salud relacionados con la disminución de la velocidad de la marcha en los ancianos comunitarios. Se trata de un estudio transversal y multicéntrico, el que evaluó el autoinforme de enfermedades crónicas y de la hospitalización en el último año, la polifarmacia y la velocidad de la marcha. Se utilizó el análisis de regresión logística para estimar los efectos de cada variable independiente sobre la posibilidad de que los ancianos presenten una disminución más baja en la velocidad de la marcha (VM<0,8 m/s) (α=0,05). Participaron en el estudio 5.501 ancianos. La velocidad de marcha más baja estuvo asociada a portadores de enfermedades cardíacas (OR=2,06; IC: 1,67-2,54), respiratorias (OR=3,25; IC: 2,02-5,29), reumáticas (OR=2,16; IC: 1,79-2,52) y/o depresión (OR=2,51; IC: 2,10-3,14), hospitalizados en el último año (OR=1,51; IC: 1,21-1,85) y polifarmacia (OR=2,14; IC: 1,80-2,54). De esta manera, los resultados indicaron que los ancianos con velocidades de marcha por debajo de 0,8m/s presentan un mayor riesgo de eventos adversos para la salud. Por lo tanto, se sugiere que la velocidad de la marcha no debe ser descuidada en la evaluación de ancianos comunitarios, incluso en la atención primaria.

Abstract Gait speed (GS) can predict adverse health outcomes. However, an understanding of its associated factors is still limited and with some controversy. The objective of this study was to identify adverse health outcomes related to the decline in gait speed in community-dwelling older adults. This is a cross-sectional study that evaluated records of chronic diseases and hospitalization in the last year, polypharmacy, and gait speed. Logistic regression analysis was used to estimate the effects of each independent variable on the chance of older adults presenting a decline in gait speed (GS<0.8 m/s) (α=5%). In total, 5,501 older adults participated. Brazilian older adults with heart diseases (OR=2.06; 1.67-2.54 CI), respiratory diseases (OR=3.25; 2.02-5.29 CI), rheumatic (OR=2.16; 1.79-2.52 CI) and/ or depression diseases (OR=2.51; 2.10-3.14 CI); hospitalized in the last year (OR=1.51; 1.21-1.85 CI) and under polypharmacy (OR=2.14; 1.80-2.54 CI) were associated with lower gait speed. Thus, the results showed that those with gait speed lower than 0.8 m/s are at higher risk of some adverse health events. Therefore, it is suggested that gait speed should not be neglected in the evaluation in community-dwelling older adults, including basic health care.

Prediction equation for the mini-mental state examination: influence of education, age, and sex / Equação de predição para o miniexame do estado mental: influência da educação, idade e sexo / Ecuación de predicción para el mini-examen del estado mental: influencia de la educación, edad y sexo

ABSTRACT The mini-mental state examination (MMSE) is a screening test used worldwide for identifying changes in the scope of cognition. Studies have shown the influence of education, age and sex in the MMSE score. However, in Brazil, the studies consider only one factor to score it. The aim of this study was to establish a prediction equation for the MMSE. An exploratory cross-sectional study was developed and trained researchers examined participants at the community. The volunteers were evaluated by the MMSE and also by the Geriatric Depression Scale (GDS). The MMSE score was the dependent variable. Age, educational level, sex, and GDS score were the independent variables. Multivariate regression analysis was used to determine the model of best prediction value for MMSE scores. A total of 250 participants aged 20-99 years, without cognitive impairment, were assessed. The educational level, age, and sex explained 38% of the total variance of the MMSE score (p<0.0001) and resulted in the following equation: MMSE=23.350+0.265(years of schooling)-0.042(age)+1.323(sex), in which female=1 and male=2. The MMSE scores can be better explained and predicted when educational level, age, and sex are considered. These results enhance the knowledge regarding the variables that influence the MMSE score, as well as provide a way to consider all of them in the test score, providing a better screening of these patients.

RESUMO O mini-exame do estado mental (MEEM) é um teste de rastreio mundialmente utilizado para identificar alterações no âmbito da cognição. Estudos têm demonstrado a influência da educação, idade e gênero na pontuação do MEEM. No entanto, no Brasil, os estudos consideram apenas um fator para a pontuação no teste. O objetivo do estudo foi estabelecer uma equação preditiva para o MEEM. Um estudo transversal exploratório foi desenvolvido e examinadores treinados avaliaram participantes da comunidade. Os voluntários foram avaliados pelo MEEM e pela Escala de Depressão Geriátrica (EDG). A pontuação do MEEM foi a variável dependente. A idade, nível educacional, gênero e pontuação na EDG foram as variáveis independentes. A análise de regressão multivariada foi utilizada para determinar o modelo de melhor valor preditivo para os escores do MEEM. Foram avaliados 250 indivíduos entre 20 e 99 anos, sem comprometimento cognitivo. O nível educacional, a idade e o sexo explicaram 38% da variância total da pontuação do MEEM (p<0,0001) e resultaram na equação: MEEM=23,350+0,265(anos de escolaridade)-0,042(idade)+1,323(gênero), em que mulher=1 e homem=2. A pontuação do MEEM pode ser melhor explicada e predita quando o nível educacional, idade e gênero são considerados. Os resultados contribuem para o conhecimento sobre as variáveis que influenciam o escore do MEEM, bem como fornece uma maneira de considerá-las na pontuação do teste, proporcionando uma melhor triagem desses pacientes.

RESUMEN El mini-examen del estado mental (MEEM) es una prueba de rastreo mundialmente utilizada para identificar alteraciones en el ámbito de la cognición. Los estudios han demostrado la influencia de la educación, la edad y el sexo en la puntuación del MEEM. Sin embargo, en Brasil, los estudios consideran sólo un factor para la puntuación en la prueba. El objetivo del estudio fue establecer una ecuación predictiva para el MEEM. Un estudio transversal exploratorio fue desarrollado y examinadores entrenados evaluaron a participantes de la comunidad. Los participantes fueron evaluados por el MEEM y la Escala de Depresión Geriátrica (EDG). La puntuación del MEEM fue la variable dependiente. La edad, nivel educativo, sexo y puntuación en la EDG fueron las variables independientes. El análisis de regresión multivariada fue utilizado para determinar el modelo de mejor valor predictivo para los escores del MEEM. Se evaluaron 250 individuos entre 20 y 99 años, sin comprometimiento cognitivo. El nivel educativo, la edad y el sexo explicaron el 38% de la varianza total de la puntuación del MEEM (p <0,0001) y resultaron en la ecuación: MEEM=23,350+0,265(años de escolaridad)-0,042 (edad)+1,323 (sexo), en que mujer = 1 y hombre = 2. La puntuación del MEEM puede ser mejor explicada y predecible cuando se considera el nivel educativo, la edad y el sexo. Los resultados contribuyen para el conocimiento sobre las variables que influencian el score del MEEM, así como proporciona una manera de considerar las variables en la puntuación de la prueba, proporcionando una mejor forma de triar a estos pacientes.

Energy Expenditure in Older Adults Who Are Frail: A Doubly Labeled Water Study.

BACKGROUND AND PURPOSE: Frailty is a common and important geriatric syndrome, distinct from any single chronic disease, and an independent predictor of mortality. It is characterized by age-associated decline in physiological reserve and function across multiple systems, culminating in a vicious cycle of altered energy expenditure. The total energy expenditure (TEE) of an individual includes the resting metabolic rate (RMR), the thermic effect of feeding, and the energy expenditure in physical activity (PAEE). The investigation of the energy expenditure of older adults who are frail is essential for better understanding the syndrome. Therefore, we compared the RMR, the PAEE, the physical activity level (PAL), and the TEE of older adults who were frail with those who were not frail. METHODS: A cross-sectional study was conducted with 26 community-dwelling older adults (66-86 years of age). Older adults in the frail and nonfrail groups were matched for age and gender, and the matched pairs were randomly selected to continue the study. The RMR was measured by indirect calorimetry. The TEE was obtained by the multipoint, doubly labeled water method. After collecting a baseline urine sample, each participant received an oral dose of doubly labeled water composed of deuterium oxide and oxygen-18 (H2O). Subsequently, urine samples were collected on the 1st, 2nd, 3rd, 7th, 12th, 13th, and 14th days after the baseline collection and analyzed by mass spectrometry. RESULTS AND DISCUSSION: The older adults who were frail presented significantly lower PAEE (1453.7 [1561.9] vs 3336.1 [1829.3] kj/d, P < .01), PAL (1.4 [0.3] vs 1.9 [0.6], P = .04), and TEE (7919.0 [2151.9] vs 10442.4 [2148.0] kj/d, P < .01) than the older adults who were nonfrail. There was no difference in their RMRs (5673.3 [1569.2] vs 6062.0 [1891.7] kj/d, P = .57). Frailty has been associated with a smaller lean body mass and with a disease-related hypermetabolic state, which might explain the lack of difference in the RMR. The PAL of the older adults who were frail was below the recommended level for older adults and determined a lower PAEE and TEE when compared with older adults who were not frail. CONCLUSION: This study showed that low energy expenditure in physical activity is a main component of frailty. The PAL of the older adults who were frail was far below the recommended level for older adults.

Prevalência e transição para a fragilidade em idosos com alteração cognitiva em uma coorte de um ano / Prevalence and transition to frailty in older adults with cognitive impairment: a 1-year cohort study

Alteração cognitiva e fragilidade são frequentemente encontradas em idosos e parece haver uma relação entre elas. Entretanto, pouco se sabe sobre a prevalência e a transição para a fragilidade nos idosos com alteração cognitiva, principalmente para a população brasileira. O objetivo do estudo foi avaliar a prevalência e a transição entre os estados de fragilidade em um grupo de idosos com alteração cognitiva em uma coorte prospectiva de um ano. Neste estudo de coorte foram avaliados 59 idosos comunitários com alteração cognitiva (≥ 65 anos). O indivíduo frágil foi identificado por apresentar pelo menos três dos seguintes critérios: perda de peso não intencional, fraqueza da força de preensão palmar, exaustão, lentidão na marcha e baixo nível de atividade física. Quando o indivíduo apresentou um ou dois critérios, foi considerado pré-frágil; quando não apresentou nenhum critério, foi considerado não frágil. A função cognitiva foi avaliada pelo Mini Exame do Estado Mental e a gravidade, pela Clinical Dementia Rating Scale. Do total de 59 idosos avaliados na linha de base, 28 (47,5%) eram frágeis, a mesma quantidade era de pré-frágeis e apenas 3 idosos eram não frágeis. Em 12 meses, verificou-se uma transição para fragilidade de 33,3%. Este estudo mostrou que a prevalência de fragilidade é alta entre os idosos com alteração cognitiva e, em um período de 12 meses, novos casos de fragilidade ocorreram entre os idosos com alteração cognitiva. Entretanto, mais estudos são necessários para investigar com melhor precisão uma relação existente entre o declínio cognitivo e a fragilidade

Cognitive impairment and frailty are often found in older people, and they appear to be related to each other. However, little is known about the prevalence and transition to frailty in older adults with cognitive impairment, especially in the Brazilian population. The present study aimed to determine the prevalence and transitions between frailty states in a cohort of older adults with cognitive impairment followed prospectively for 1 year. A cohort of 59 community-dwelling older adults (aged ≥ 65 years) with cognitive impairment was evaluated. Individuals were classified as frail by the presence of 3 or more of the following criteria: unintentional weight loss; reduced grip strength; exhaustion; slowness; and low physical activity level. Individuals meeting 1 or 2 criteria were classified as prefrail, and those meeting 0 criteria as nonfrail. Cognitive function was assessed by the Mini-Mental State Examination, and severity, by the Clinical Dementia Rating scale. Of 59 older adults evaluated at baseline, 28 (47.5%) were classified as frail, 28 (47.5%) as prefrail, and only 3 (5%) as nonfrail. Over 12 months, 33.3% of participants transitioned from prefrail to frail. The present study showed a high prevalence of frailty in older adults with cognitive impairment and, within 12 months, new cases of frailty were identified in this population. Therefore, more research is needed to further investigate the relationship between cognitive decline and frailty.

Pontos de corte alternativos para massa muscular apendicular para verificação da sarcopenia em idosos brasileiros: dados da Rede Fibra - Belo Horizonte/Brasil / Puntos de corte alternativos para la masa muscular apendicular para la certificación de la sarcopenia en ancianos brasileños: datos de Red Fibra - Belo Horizonte/Brasil / Alternative appendicular muscle mass cut-off points for verification of sarcopenia in older Brazilians: data from Rede Fibra - Belo Horizonte/Brazil

RESUMO Estabeleceram-se pontos de corte alternativos para o cálculo da massa muscular apendicular (MMA) em idosos brasileiros para classificar a sarcopenia. Foram analisados dados de 562 idosos participantes do estudo Fibra (Fragilidade em Idosos Brasileiros), no polo Belo Horizonte. Por meio da equação de Lee, determinaram-se pontos de corte para MMA baseado na percentil 20 de sua distribuição na população estudada. Em seguida, os sujeitos foram classificados para sarcopenia de acordo com os critérios do Consenso Europeu sobre Definição e Diagnóstico da Sarcopenia em Idosos, além de avaliadas as possíveis associações desta com a capacidade funcional e comorbidades. A maioria da amostra foi composta por mulheres (65,5%) com idade média de 74,1 (±6,4) e média de 1,5 (±1,4) comorbidades. Os pontos de corte para MMA foram <6.47kg/m2 para mulheres e <8.76kg/m2 para homens. A prevalência de sarcopenia foi de 14,9%, sendo 13,5% da população parcialmente dependente para atividades básicas de vida diária (ABVD), 30,6% para atividades instrumentais de vida diária (AIVD) e 66,7% para atividades avançadas de aida diária (AAVD). A sarcopenia se correlacionou apenas com AIVD (r=0,081, p= 0.05), e encontrou-se uma correlação negativa entre sarcopenia e comorbidades (r= −0,103, p=0,014). Foram propostos pontos de corte específicos para MMA para a população de idosos brasileiros e não foram encontradas correlações entre as variáveis do estudo, exceto para AIVD e comorbidades.

RESUMEN Se establecieron puntos de corte alternativos para el cálculo de la masa muscular apendicular (MMA) en ancianos brasileños para clasificar la sarcopenia. Fueron analizados datos de 562 ancianos participantes del estudio Fibra (Debilidad en Ancianos Brasileños), en el polo Belo Horizonte. Por medio de la ecuación de Lee, se determinaron puntos de corte para MMA basado en la percentil 20 de su distribución en la población estudiada. Luego, los sujetos fueron clasificados para sarcopenia de acuerdo con los criterios del Consenso Europeo sobre Definición y Diagnóstico de la Sarcopenia en Ancianos, además de evaluadas las posibles asociaciones de esta con la capacidad funcional y comorbidades. La gran parte de la muestra fue compuesta por mujeres (el 65,5%) con edad media de 74,1 (±6,4) y promedio de 1,5 (±1,4) comorbidades. Los puntos de corte para MMA fueron <6.47kg/m2 para mujeres y <8.76kg/m2 para hombres. La prevalencia de sarcopenia fue del 14,9%, siendo el 13,5% de la población parcialmente dependiente para actividades básicas de vida diaria (ABVD), el 30,6% para actividades instrumentales de vida diaria (AIVD) y el 66,7% para actividades avanzadas de vida diaria (AAVD). La sarcopenia se correlacionó solamente con AIVD (r=0,081, p= 0.05), y se encontró una correlación negativa entre sarcopenia y comorbidades (r= −0,103, p=0,014). Fueron propuestos los puntos de corte específicos para MMA para la población de ancianos brasileños y no fueron encontradas correlaciones entre las variables del estudio, excepto para AIVD y comorbidades.

ABSTRACT Alternative cut-off points for the calculation of appendicular muscle mass (AMM) in older Brazilians were established to classify sarcopenia. Data from 562 older adults from Belo Horizonte who participated in the Fibra study (Fragilidade em Idosos Brasileiros [Fragility in Older Brazilians) were analyzed. Through Lee's equation, cut-off points for AMM were determined based on the 20th percentile of their distribution in the studied population. Then, the subjects were classified for sarcopenia according to the criteria of the European Consensus on Definition and Diagnosis of Sarcopenia in Older Adults, and its possible associations with functional capacity and comorbidities were evaluated. Most of the sample was composed by women (65.5%) with 74.1 years of age (±6.4) and 1.5 (±1.4) comorbidities on average. The cut-off points for AMM were <6.47kg/m2 for women and <8.76kg/m2 for men. The prevalence of sarcopenia was 14.9%, 13.5% of the population being partially dependent for basic activities of daily living (BADL), 30.6% for instrumental activities of daily living (IADL) and 66.7% for advanced activities of daily living (AADL). Sarcopenia was correlated with IADL only (r=0.081, p=0.05), and a negative correlation was found between sarcopenia and comorbidities (r=−0.103, p=0.014). Cut-off points specific to AAM for the population of older Brazilians were proposed, and no correlations between the variables of the study were found, except for IADL and comorbidities.

The fabric of resilience among the elderly and the reinvention of the self despite the difficulties faced / A tessitura da resiliência em idosos, a reinvenção de si "apesar de"

Abstract Objective :To seek an understanding of how frail elderly persons construct resilience. Method: The "signs, meanings and actions" model was used. The population was randomly selected among elderly persons classified as robust or pre-frail in the FIBRA-study, Belo Horizonte, Minas Gerais, Brazil. Thirteen elderly persons (aged 69 to 86) were interviewed. Results: a) the construction of bonds - a healthy relationship with spouses, sons, daughters, grandchildren and great-grandchildren brings meaning to and sustains life and contributes to its organization; b) the reinvention of oneself - when suffering trauma, elderly people seek paths that can give sense to life, even if difficult memories persist; c) religiosity: catholic, evangelical or spiritualist experiences strengthen; cures, protections and so-called miracles are valued, and the religious community represents a space for belonging. Conclusion: Resilience is constructed through the bonds between the elderly person and those close to them, and in the search for solutions, including through the religious experience.

Resumo Objetivo: Buscar uma compreensão, a partir da visão de idosos em processo de fragilização, sobre como tecem sua resiliência. Método: Foram entrevistados 13 idosos (69 a 86 anos), selecionados aleatoriamente entre idosos classificados como robustos ou pré-frágeis em Belo Horizonte, Minas Gerais, Brasil, na Rede FIBRA. A coleta e a análise dos dados foram fundamentadas no modelo de "Signos, significados e ações". Resultados: a) Construção de vínculos - a relação saudável com os cônjuges, filhos, netos e bisnetos traz sentido à vida, sustenta e se torna um organizador; b) reinvenção de si mesmo - ao sofrer um trauma, uma parte da pessoa busca caminhos que possam dar sentido à vida, mesmo se persistem as memórias sofridas; c) a religiosidade - católica, evangélica ou espírita - fortalece para trabalhar na solução de problemas e aceitar o imutável: valorizam-se curas, proteções, milagres e a comunidade religiosa como espaço de pertença. Conclusão: Os idosos constroem resiliência na sua ligação com as pessoas próximas, na busca de soluções, e na experiência religiosa.

Factor analysis of the minnesota leisure time activities questionnaire - brazilian portuguese / Análise fatorial do minnesota leisure time activities questionnaire - português-brasil / Análisis factorial del minnesota leisure time activities questionnaire - portugués-brasil

ABSTRACT Introduction: Accurate measures of physical activity to establish dose-response relationship in health outcomes are still controversial. Scales that estimate caloric expenditure are proposed with a view to categorizing the phenomenon globally. Objective: To carry out a factor analysis of the structure of the Minnesota Leisure Time Activities Questionnaire - Brazilian Portuguese, and propose a new adapted version for the Brazilian elderly community. Methods: Participants were elderly female members of the community, without any distinction in terms of ethnic group and/or social class, who frequented extension projects of two higher education institutions. Those with cognitive impairments; dependence on walking aids; musculoskeletal pain in the last two weeks and neurological diseases were excluded from the study. All participants answered the questionnaire with sociodemographic and clinical data and the Minnesota Leisure Time Activities Questionnaire - Brazilian Portuguese version. We determined whether each activity had been undertaken by the participants and the average number of times it was performed over the last two weeks, considering average time, in minutes, on each occasion. Each activity was considered a single item and energy expenditure was calculated according to the authors' instructions. We used factor analysis with Varimax orthogonal rotation, excluding items whose variance was equal to zero. Correlation between items was determined using the Pearson correlation matrix. Internal consistency between items, before and after the factor analysis, was verified using Cronbach's α coefficient. 5% significance level. Results: Participants were 220 women (70.8 ± 5.9 years). The factor analysis resulted in 10 components, which explained, in total, 61.87% of the variance of the total score on the scale. Each component was composed of one, two or three aggregate items. Internal consistency by Cronbach's α coefficient was 0.30. Conclusion: The factor analysis of the structure of the Minnesota Leisure Time Activities Questionnaire - Brazilian Portuguese- has shown a new range with 10 components, which explained, in total, more than 60% of the variance of the total score on the scale, yet with low internal consistency. Level of Evidence III; Study of nonconsecutive patients; without consistently applied reference ''gold'' standard.

RESUMO Introdução: Medidas acuradas de atividade física para estabelecer relação dose-resposta em desfechos de saúde ainda são controversas. Escalas que estimam o gasto calórico são propostas visando categorizar o fenômeno de forma global. Objetivo: Realizar a análise fatorial da estrutura do Minnesota Leisure Time Activities Questionnaire - português-Brasil e propor uma nova versão adaptada aos idosos comunitários brasileiros. Métodos: Participaram idosas, residentes da comunidade, sem distinção de raça e/ou classe social e frequentadoras de projetos de extensão de duas escolas de ensino superior. Excluíram-se aquelas com alterações cognitivas, marcha dependente, dores musculoesqueléticas nas últimas duas semanas e doenças neurológicas. Todas responderam ao questionário com dados sócio-clínico-demográficos e ao Minnesota Leisure Time Activities Questionnaire - versão português-Brasil. Foi identificado se cada atividade tinha sido realizada e o número médio de vezes nas últimas duas semanas, considerando tempo médio, em minutos, em cada ocasião. Cada atividade foi considerada como um item e o gasto energético foi calculado de acordo com as instruções dos autores. Utilizou-se a análise fatorial com rotação ortogonal Varimax excluindo os itens cuja variância era igual a zero. A correlação entre os itens foi realizada pela matriz de correlação de Pearson. A consistência interna entre os itens, antes e depois da análise fatorial foi realizada através do coeficiente α de Cronbach. Nível de significância de 5%. Resultados: Participaram 220 mulheres (70,8 ± 5,9 anos). A análise fatorial resultou em 10 componentes que explicaram no total 61,87% da variância da pontuação total na escala. Cada componente era composto por um, dois ou três itens agregados. A consistência interna pelo coeficiente α de Cronbach foi de 0,30. Conclusão: A análise fatorial da estrutura do Minnesota Leisure Time Activities Questionnaire - português-Brasil apresentou uma nova escala com 10 componentes que explicou no total mais de 60% da variância da pontuação total na escala, porém com uma baixa consistência interna. Nível de Evidência Nível III; Estudo de pacientes não consecutivos; sem padrão de referência "ouro" aplicado uniformemente.

RESUMEN Introducción: Las medidas precisas de actividad física para establecer relación dosis-respuesta en los resultados de salud aún son controvertidas. Las escalas que estiman el gasto calórico son propuestas buscando categorizar el fenómeno de forma global. Objetivo: Realizar el análisis factorial de la estructura del Minnesota Leisure Time Activities Questionnaire - Portugués-Brasil y proponer una nueva versión adaptada a los individuos de tercera edad comunitarios brasileños. Métodos: Participaron mujeres de tercera edad, residentes en comunidad, sin distinción de raza y/o clase social y frecuentadoras de proyectos de extensión de dos escuelas de enseñanza superior. Se excluyeron aquellas con alteraciones cognitivas, marcha dependiente, dolores musculoesqueléticos en las últimas dos semanas y enfermedades neurológicas. Todas respondieron el cuestionario con datos socio-clínico-demográficos y el Minnesota Leisure Time Activities Questionnaire - versión en portugués de Brasil. Se identificó si cada actividad había sido realizada y el número promedio de veces en las últimas dos semanas, considerando tiempo promedio, en minutos, en cada ocasión. Cada actividad fue considerada como un ítem y se calculó el gasto energético de acuerdo con las instrucciones de los autores. Se utilizó análisis factorial con rotación ortogonal Varimax excluyendo los ítems cuya varianza fue igual a cero. La correlación entre los elementos fue realizada por la matriz de correlación de Pearson. La consistencia interna entre los elementos, antes y después del análisis factorial fue realizada a través del coeficiente α de Cronbach. Nivel de significancia de 5%. Resultados: Participaron 220 mujeres (70,8 ± 5,9 años). El análisis factorial resultó en 10 componentes que explicaron en total 61,87% de la varianza de puntuación total en la escala. Cada componente era compuesto por uno, dos o tres elementos agregados. La consistencia interna por el coeficiente α de Cronbach fue de 0,30. Conclusión: El análisis factorial de la estructura del Minnesota Leisure Time Activities Questionnaire - Portugués-Brasil presentó una nueva escala con 10 componentes que explicó en total más de 60% de la varianza de la puntuación total de la escala, aunque con una baja consistencia interna. Nivel de Evidencia Nivel III; Estudio de pacientes no consecutivos; sin estándar de referencia "oro" aplicado uniformemente.

The perception of the elderly about suffering related to frailty / A percepção de idosos sobre sofrimentos ligados à sua fragilização

Objective: To understand how elderly persons perceive subjective aspects linked to current and other life experiences related to the process of becoming frail. Method: A qualitative study, anchored in interpretative anthropology, was performed. The elderly were selected from the FIBRA Network database from those classified as robust or pre-frail, according to the frailty phenotype of Fried et al., in Belo Horizonte, Minas Gerais, Brazil in 2009. We interviewed 15 elderly people of different genders, ages, income, religion and functional status, in 2016. In data collection and analysis, the "signs, meanings and actions" analysis model was used, which allows the understanding of the elements that are significant for a population to read a given situation and to position themselves in relation to it. Results: From the analysis the following categories emerged: a) suffering throughout life and b) suffering and the resources to deal with them. Conclusion: The interviewees described sufferings of different aspects that constitute their life, from birth to aging, according to experiences related to pain, loss and learning. The perception of current frailty refers to their life history, marked by physical or mental suffering, whether insidious or temporary - as well as illnesses, how they manifest themselves today, and a lack of financial resources and urban security. The narratives bring us closer to the perception of frailty as being constitutive of human beings, who can easily break.

Objetivo: Compreender como a pessoa idosa percebe aspectos subjetivos ligados a sofrimentos atuais e outros experimentados ao longo da vida e que se remetem ao processo de fragilização. Método: Estudo qualitativo, ancorado na Antropologia interpretativa. Foram selecionados idosos participantes no banco de dados da Rede FIBRA - entre aqueles classificados como robustos ou pré-frágeis em 2009, no polo Belo Horizonte, Minas Gerais, Brasil, segundo o referencial do fenótipo de fragilidade de Fried et al. Foram entrevistados 15 idosos, de diferentes sexos, idades, renda, religião, condição funcional. Foi utilizado o modelo de análise "Signos, significados e ações que possibilitam a compreensão dos elementos significativos para uma população ler uma determinada situação e se posicionar diante dela". Resultados: Da análise emergiram as categorias: a) o sofrimento ao longo da vida e b) adoecimentos e os recursos para lidar com eles. Conclusão: Os entrevistados narram sofrimentos de diferentes aspectos que constituem a sua vida, do nascer ao envelhecer, conforme experiências que significam dores, perdas, aprendizado. A percepção de fragilização atual remete à história de vida marcada por sofrimentos físicos e/ou mentais, insidiosos ou pontuais - bem como aos adoecimentos, como se manifestam hoje, e à falta de recursos financeiros e de segurança urbana. As narrativas nos aproximam da percepção da fragilidade como sendo constitutiva do ser humano - que pode facilmente trincar.

Effect of a resistance exercise program for sarcopenic elderly women: quasi-experimental study / Efeito de um programa de exercícios resistidos para idosas sarcopênicas: estudo quase-experimental / Efecto de un programa de ejercicios resistidos para ancianas sarcopénicas: estudio cuasiexperimental

Abstract Introduction: Resistance training is quoted as one of the best pathways to manage sarcopenia and progressive resistance training is supposed to improve muscle mass, strength and performance in older adults. Objective: The aim was to examine the impact of a progressive resistance exercise program (PREP) on muscle and function performance in sarcopenic community-dwelling elder women. Methods: Quasi-experimental study (pre - post intervention). Participated 18 sarcopenic community-dwelling elder women (65 years or older). PREP based on 75% of the participant's maximum load (12/wk, 3 times/wk). Main outcome measures: muscle strength of knee extensors (isokinetic dynamometry), muscle mass (dual-x ray absorptiometry - DXA), functional performance (Short Physical Performance Battery - SPPB). Paired t-test was used to evaluate differences pre and post intervention. Results: Improvements on power (p = 0.01) and peak torque (p = 0.01) were observed when measured by the isokinetic dynamometer at low speed (60º/s). Improvements on DXA (pre PREP: 5.49 kg/m2 vs. post PREP: 6.01 kg/m2; p = 0.03) and SPPB scores (pre PREP: 9.06 vs. post PREP: 10.28; p = 0.01) were also observed. Conclusion: The PREP was able to improve muscle and functional performance in sarcopenic community-dwelling elder women. This program should be considered in clinical practice.

Resumo Introdução: Exercícios com carga são uma das boas indicações de tratamento no caso da sarcopenia e o treinamento com carga progressiva pode aumentar a massa muscular, força e desempenho em idosos. Objetivo: Avaliar o impacto de um programa de exercícios com carga progressiva (PECP) no desempenho muscular e funcional de idosas sarcopênicas da comunidade. Métodos: Estudo quasi-experimental (pré-pós intervenção). Participaram 18 idosas sarcopênicas, da comunidade (65 anos e mais). PECP foi baseado em 75% de uma resistência máxima (12/semanas, 3 x/ semana). Medidas de desfecho: força muscular dos extensores de joelho (dinamômetro isocinético), massa muscular (dual-x ray absorptiometry - DXA), desempenho funcional (Short Physical Performance Battery - SPPB). Comparações pré-pós intervenção foi por meio do teste t-test pareado. Resultados: Houve aumento na potência (p = 0,01) e no torque (p = 0,01), observados nas medidas do isocinético em baixa velocidade (60º/s). Observou-se também aumento no DXA (5,49 kg/m2 vs. 6,01 kg/m2; p = 0,03) e melhora nos escores do SPPB (9,06 vs. 10,28; p = 0,01). Conclusão: O PECP aumentou o desempenho funcional e muscular das idosas sarcopênicas comunitárias. Este programa deve ser considerado para a prática clínica.

Resumen Introducción: Ejercicios con carga es una de las buenas indicaciones de tratamiento en el caso de la sarcopenia y el entrenamiento con carga progresiva puede aumentar la masa muscular, fuerza y desempeño en ancianos. Objetivo: Evaluar el impacto de un programa de ejercicios con carga progresiva (PECP) en el desempeño muscular y funcional de ancianas sarcopénicas de la comunidad. Métodos: Estudio cuasiexperimental (pre-pos intervención). Participaron 18 ancianas sarcopénicas, de La comunidad (65 años y más). PECP se basó en 75% de una resistencia máxima (12/semanas, 3 x/semana). Las medidas de desenlace: fuerza muscular de los extensores de rodilla (dinamómetro isocinético), masa muscular (dual-x ray absorptiometry - DXA), desempeño funcional (Short Physical Performance Battery - SPPB). Las comparaciones pre-post-intervención fueron a través de La prueba t-test pareado. Resultados: Hubo aumento en la potencia (p = 0,01) y en el par de apriete - torque (p= 0,01), observados en las medidas del isocinético a baja velocidad (60º/s). Se observo también un aumento en el DXA (5,49 kg/m² vs. 6,01 kg/m², p = 0,03) y mejora en los escores del SPPB (9,06 vs. 10,28, p = 0,01. Conclusión: El PECP aumento el desempeño funcional y muscular de las ancianas sarcopénicas comunitarias. Este programa debe ser considerado para la práctica clínica.

Effects of aerobic exercise on functional capacity, anthropometric measurements and inflammatory markers in diabetic elderly women.

This study investigated the effects of an aerobic training program on functional capacity [Timed Up and Go test (TUG), timed 10-m walk test (10MWT), five-repetition sit-to-stand test (5-STS), handgrip strength test (HGS) and one-legged stance test (OLS)], anthropometric measurements [body mass, body mass index (BMI), waist and hip circumferences and waist-to-hip ratio] and plasma levels of inflammatory markers [soluble tumor necrosis factor receptors 1 and 2, and interleukins 6 and 10] in 43 elderly women with type 2 diabetes mellitus. After the training, a significant improvement was observed in the performance of the participants on the TUG, 10MWT, 5-STS and HGS and in the anthropometric measures of body mass, BMI and hip circumference. None of the inflammatory markers showed a significant difference between pre- and post-training. The aerobic exercise program improved the functional capacity of diabetic elderly women, but was ineffective to change the levels of the inflammatory markers evaluated.

What are the sociodemographic and health determinants for older adults continue to participate in work?

OBJECTIVE: This study aimed to determine the sociodemographic and health factors that influence older adults who continue to participate in the workforce. METHODS: Data were collected and evaluated for 1762 older adults aged 65 years and older who were living in the community and were enrolled in a population-based study (FIBRA Network Study). Older adults who participated in the workforce were compared with those who did not in terms of sociodemographic characteristics, physical and mental health, and physical functioning and performance in advanced and instrumental activities characteristic of daily living. A multivariate hierarchical logistic regression analysis was performed. RESULTS: Factors associated with not participating in the workforce were aged (OR: 1.71, [95% CI: 1.26-2.30], p<0.001), female gender (OR: 1.70, [95% CI: 1.22-2.37], p=0.002), poor visual perception (OR: 1.31, [95% CI: 1.00-1.72], p=0.046), using 4 or more medications regularly (OR: 1.41, [95% CI: 1.489-2.247], p=0.034), having 3 or more comorbidities (OR: 1.44, [95% CI: 1.01-2.04], p=0.040), and a handgrip strength below 24.6kg/f (18.1-24.6kg/f (2nd tertile): OR: 1.52, [95% CI: 1.06-2.18], p=0.022; 0-18kg/f (1st tertile): OR: 1.60, [95% CI: 1.08-2.38], p=0.019). The probability estimates of the final model explained 67.9% of the events related to not participating in the workforce, as observed by the area under the ROC curve. CONCLUSION: Our results highlight that work in later life is influenced by sociodemographic characteristics, intrinsic capacity, and multimorbidity. We suggest that strategies for optimizing healthy and active aging may help older people to continue participating in the workforce and contributing toward their communities.

Body composition and frailty profiles in Brazilian older people: Frailty in Brazilian Older People Study-FIBRA-BR.

OBJECTIVE: To determine the association between body composition and frailty in older Brazilian subjects. MATERIAL AND METHODS: This is a Cross-sectional study called FIBRA-BR and developed in community Brazilian aged ≥65 (n=5638). Frailty was assessed according to Fried et al. definition and body composition was determined by BMI, waist circumference and waist-hip ratio. RESULTS: The lowest prevalence of frailty was observed in subjects with BMI between 25.0 and 29.9kg/m2. Subjects with a BMI <18.5 and those with elevated WC presented a higher risk of frailty compared to eutrophic subjects (odds ratio (OR)=3.10; 95% CI: 2.06-4.67) and (OR=1.15; 95% CI: 1.03-1.27), respectively. Being overweight was protective for pre-frailty (OR=0.48; 95% CI: 0.4-0.58) and frailty (OR=0.77; 95% CI: 0.67-0.9). Obese older people presented a higher risk of pre-frailty only (OR=1.29; 95% CI: 1.09-1.51). Older people with high WC showed a greater proportion of frailty regardless of the BMI range. CONCLUSION: Undernutrition is associated with pre-frailty and frailty in Brazilian elderly subjects, whereas obesity is associated only with pre-frailty. Overweight seems to have a protective effect against the syndrome. The excess of abdominal fat is associated with both profiles independent of the BMI.

ADAPTAÇÃO TRANSCULTURAL E CONFIABILIDADE DO ACTIVE AUSTRALIA QUESTIONNAIRE PARA IDOSOS / CROSS-CULTURAL ADAPTATION AND RELIABILITY OF THE ACTIVE AUSTRALIA QUESTIONNAIRE FOR THE ELDERLY / ADAPTACIÓN TRANSCULTURAL Y FIABILIDAD DEL ACTIVE AUSTRALIA QUESTIONNAIRE PARA ANCIANOS

RESUMO Introdução: A atividade física é um importante parâmetro a ser quantificado em idosos. São necessários instrumentos de medida confiáveis para avaliar e elaborar metas de intervenções terapêuticas efetivas e verificar a evolução do paciente. Objetivo: Adaptar transculturalmente e determinar a confiabilidade teste-reteste e interexaminadores do Active Australia Questionnaire em idosos da comunidade. Métodos: A adaptação transcultural foi realizada de acordo com os critérios propostos por Guillemin e Beaton, a saber, tradução, retrotradução, síntese das traduções, apresentação ao comitê de especialistas e aplicação da versão pré-final para testar o questionário. Para a confiabilidade teste-reteste foi dado um intervalo de quatro horas para as coletas e um intervalo de seis horas para a análise interexaminador, após o reteste. Foram consideradas as informações de atividade física nos últimos sete dias. A caracterização da amostra foi feita pela análise descritiva. Para a análise da confiabilidade utilizou-se o coeficiente de correlação intraclasse (CCI). Participaram do estudo 22 idosos (72,5 ± 5,3 anos) e com 7,6 ± 3,9 anos de escolaridade. Resultados: A confiabilidade teste-reteste foi CCI = 0,97 e interexaminadores CCI = 0,82. Conclusão: O instrumento mostrou-se semântica e linguisticamente adequado e confiável, para avaliar o nível de atividade física em idosos na comunidade.

ABSTRACT Introduction: Physical activity is an important parameter to be quantified in the elderly. Reliable measurement instruments are needed to evaluate, and design effective therapeutic intervention targets and to monitor patient outcomes. Objective: To adapt cross-culturally and determine the test-retest and inter-rater reliability of the Active Australia Questionnaire in community elders. Methods: A cross-cultural adaptation was performed according to the criteria proposed by Guillemin and Beaton, namely, translation, back-translation, synthesis of translations, submission to the expert committee and implementation of the pre-final version to test the questionnaire. For test-retest reliability, a four-hour interval was given for collection, and a six-hour interval for inter-rater analysis, following the retest. Physical activity information was considered in the last seven days. The characterization of the sample was done by descriptive analysis. For the analysis of reliability we used the intraclass correlation coefficient (ICC). The study included 22 elderly (72.5 ± 5.3 years) and 7.6 ± 3.9 years of education. Results: Test-retest reliability was ICC = 0.97 and the inter-rater reliability was ICC= 0.82. Conclusion: The instrument was semantically and linguistically adequate and reliable to evaluate the level of physical activity in the elderly in the community.

RESUMEN Introducción: La actividad física es un parámetro importante a ser cuantificado en los ancianos. Son necesarias herramientas de medición fiables para evaluar y desarrollar los objetivos de las intervenciones terapéuticas eficaces y comprobar el progreso del paciente. Objetivo: Adaptar culturalmente y determinar la fiabilidad test-retest y entre los evaluadores del Active Australia Questionnaire en ancianos de la comunidad. Métodos: Una adaptación cultural se llevó a cabo de acuerdo con los criterios propuestos por Guillemin y Beaton, a saber, traducción, traducción inversa, síntesis de las traducciones, presentación al comité de expertos y aplicación de la versión pre-final para poner a prueba el cuestionario. Para la fiabilidad del test-retest fue dado un intervalo de cuatro horas para la recolección y un intervalo de seis horas para el análisis entre evaluadores, después del retest. La información sobre la actividad física fue considerada en los últimos siete días. La caracterización de la muestra se realizó mediante el análisis descriptivo. Para el análisis de fiabilidad se utilizó el coeficiente de correlación intraclase (CCI). El estudio incluyó a 22 ancianos (72,5 ± 5,3 años) y 7,6 ± 3,9 años de estudio. Resultados: La fiabilidad test-retest fue CCI = 0,97 y entre evaluadores fue CCI = 0,82. Conclusión: El instrumento resultó ser semánticamente y lingüísticamente apropiado y fiable para evaluar el nivel de actividad física de los ancianos en la comunidad.

Factors associated with fear of falling in community-dwelling older adults with and without diabetes mellitus: Findings from the Frailty in Brazilian Older People Study (FIBRA-BR).

PURPOSE: This study aimed to investigate the associated factors with fear of falling in community-dwelling older adults with and without diabetes mellitus. METHODS: Data from the Frailty in Brazilian Older People Study (FIBRA-BR), involving 4449 individuals aged 65years or older (19.2% with diabetes), were analyzed. The potential factors associated with fear of falling included sociodemographic data, chronic diseases, health-related variables and functional capacity measures. Logistic regression analysis was performed to identify the factors associated with fear of falling. RESULTS: Female gender, arthritis or rheumatism, negative health self-perception, frailty, lower Lawton Scale score and reduced gait speed were independently associated with fear of falling in both groups. Factors associated with fear of falling specific to non-diabetic older adults were depression, visual impairment, falls in the previous 12months, obesity, depressive symptoms, higher Katz Index score and decreased handgrip strength. Lower Mini-Mental State Examination score was an associated factor with fear of falling only in those with diabetes. CONCLUSION: The factors associated with fear of falling did differ between non-diabetic and diabetic older adults. Health care professionals should consider such differences when planning their therapeutic approaches for a successful management of fear of falling in these older populations.

Impact of Type-2 Diabetes Time Since Diagnosis on Elderly Women Gait and Functional Status.

BACKGROUND AND PURPOSE: The gait, mobility and lower-limb strength alterations of diabetic elderly women without symptoms of diabetic neuropathy in different periods of the chronic disease can contribute to an early functional diagnosis, allowing prevention of adverse outcomes like falls and disability. This could also contribute to the development of interventions, cures and physiotherapy practice for this population. The aim of this study was to verify the impact of type-2 diabetes mellitus time since diagnosis on gait and functional status of elderly women. METHODS: Eighty-two diabetic elderly women without neuropathic symptoms participated and divided in two groups: 1) 49 elderly (71.4 ± 4.8 years) with less than 10 years of type-2 diabetes mellitus diagnosis, and 2) 33 elderly (70 ± 4.5 years) with 10 or more years of type-2 diabetes mellitus diagnosis. Outcomes were spatiotemporal gait parameters (speed, cadence, step length, base of support, stance time, swing time, and double support time) assessed through GAITRite® system, and functional status assessed using the Timed Up and Go test and five times sit-to-stand test. To compare spatiotemporal gait variables and performance on functional tests between groups, multivariate analysis of variance and Mann-Whitney test were performed, respectively. RESULTS: The group with 10 or more years of diagnosis showed lower gait speed and smaller step length (112.3 cm/s; 59.2 cm) compared with the group with less than 10 years of diagnosis (122.9 cm/s; 62.4 cm). In relation to Timed Up and Go test and five times sit-to-stand test, there were no statistically significant differences between the groups. CONCLUSION: Type-2 diabetes mellitus time since diagnosis has a negative impact on gait speed and step length, but not on functional status of the elderly women. Copyright © 2015 John Wiley & Sons, Ltd.

Prevalence of sarcopenia in older Brazilians: A systematic review and meta-analysis.

AIM: Sarcopenia is the age-related loss of muscle mass and function that evolves into disability, loss of independence and death. In Brazil the number of older people is rapidly growing, resulting in an increased prevalence of chronic conditions associated with old age. As prevalence estimates provide essential information to policymakers when developing healthcare strategies, this systematic review and meta-analysis aimed to estimate the prevalence of sarcopenia in older Brazilians. METHODS: Electronic database searches and hand-searching in relevant journals and reference lists were carried out without language restriction. Studies that reported the prevalence of sarcopenia in Brazilians aged 60 years or older were considered for inclusion. Sarcopenia was defined as low muscle mass, low muscle function or low muscle mass and function. Meta-analysis was carried out using a random-effects model. RESULTS: A total of 31 studies were included pooling 9416 participants. The overall prevalence of sarcopenia in older Brazilians was 17.0% (95% CI 13.0-22.0). Sensitivity analysis showed rates of 20.0% (95% CI 11.0-32.0) in women and 12.0% (95% CI 9.0-16.0) in men. Prevalence was 16.0% (95% CI 12.0-23.0) based on low muscle mass and function; and 17.0% (95% CI 9.0-31.0) based only on low muscle mass. The difference between these two criteria was not significant (P = 0.96). CONCLUSIONS: Sarcopenia is an emerging public health issue in Brazil. Attention should be paid to changes in prevalence rates over the next years because of the increase in the older population. Geriatr Gerontol Int 2017; 17: 5-16.