Assessment of the components of sarcopenia and quality of life perceived of individuals on hemodialysis / Evaluación de componentes de sarcopenia y calidad de vida percibida de individuos en hemodiálisis / Avaliação dos componentes da sarcopenia e qualidade de vida percebida de indivíduos em hemodiálise

ABSTRACT Objectives: to evaluate the prevalence of sarcopenia in individuals aged 50 years or older on hemodialysis; to verify the association between sarcopenia and sociodemographic, clinical, anthropometric factors, components of sarcopenia and quality of life (QoL); and to correlate the components of sarcopenia with QoL. Methods: Participated 83 individuals on hemodialysis. Sarcopenia was established according to the current European consensus. Dynamometry to determine strength, calf circumference (CC) and appendicular skeletal muscle mass index (ASMMI) to obtain muscle mass and gait speed (GS) for physical performance. For QoL used the WHOQOL-bref. Results: the prevalence of sarcopenia was 32.6% (CC) and 18.1% (ASMMI). There was no association between sarcopenia and QoL. Both handgrip strength (r=0.25) and GS (r=0.36) showed a correlation with physical domain. Conclusions: sarcopenia was expressive, and the aspects of functionality determine the physical impairment in this population.

RESUMEN Objetivos: evaluar la prevalencia de sarcopenia en individuos de 50 años o más en hemodiálisis, verificar la asociación entre la sarcopenia y factores sociodemográficos, clínicos, antropométricos, componentes de la sarcopenia y la calidad de vida (CV), y para correlacionar los componentes de la sarcopenia con la CV. Métodos: Participaron 83 individuos en hemodiálisis. La sarcopenia se estableció de acuerdo con el consenso europeo vigente. Dinamometría para determinar la fuerza, la circunferencia de la pantorrilla (CP) y el índice de masa muscular esquelética apendicular (IMMEA) para obtener la masa muscular y la velocidad de la marcha (VM) para el rendimiento físico. Para CV el WHOQOL-bref. Resultados: la prevalencia de sarcopenia fue de 32,6% (CP) y 18,1% (IMMEA). No hubo asociación entre sarcopenia y CV. Tanto la fuerza de prensión manual (r=0,25) como la VM (r=0,36) se correlacionaron con el dominio físico. Conclusiones: la sarcopenia fue significativa y los aspectos de funcionalidad, determinan el deterioro físico en esta población.

RESUMO Objetivos: avaliar a prevalência de sarcopenia em indivíduos com 50 anos ou mais em hemodiálise, verificar a associação entre a sarcopenia e os fatores sociodemográficos, clínicos, antropométricos, componentes da sarcopenia e qualidade de vida (QV), e correlacionar os componentes da sarcopenia com a QV. Métodos: Participaram 83 indivíduos em hemodiálise. A sarcopenia foi estabelecida segundo consenso europeu vigente. A dinamometria para determinação da força, a circunferência da panturrilha (CP) e o índice de massa muscular esquelética apendicular (IMMEA) para a obtenção da massa muscular e a velocidade de caminhada (VC) para o desempenho físico. Para QV utilizou-se WHOQOL-bref. Resultados: a prevalência de sarcopenia foi de 32,6% (CP) e 18,1% (IMMEA). Não houve associação entre a sarcopenia e QV. Tanto a força de preensão manual (r=0,25) quanto a VC (r=0,36) apresentaram correlação com domínio físico. Conclusões: a sarcopenia foi expressiva e os aspectos da funcionalidade determinam o comprometimento físico nessa população.

Concordância na velocidade da marcha de mulheres diabéticas tipo 2 em diferentes testes de caminhada / Agreement in the gait speed of type 2 diabetic women from different walking tests

O objetivo desse estudo foi verificar a concordância na velocidade da marcha (VM) a partir dos testes de caminhada de seis minutos (6MWT) e de quatro metros (4MWT) em mulheres diabéticas tipo 2 (DM2). Os testes foram realizados antes e após intervenção de 12 semanas com exercícios físicos. O 4MWT foi realizado em espaço de quatro metros, sendo o resultado do teste medido como o tempo gasto (segundos) no percurso. O 6MWT foi realizado em modelo de ir e vir em uma distância de 15 metros e o resultado foi a distância total (metros) percorrida. Os resultados foram padronizados para velocidade de deslocamento (m/s). Para avaliar a concordância (6MWTpré x 4MWTpré) e (6MWTpósx 4MWTpós), utilizou-se o teste de Bland-Altman (B-A) e o coeficiente de concordância de correlação de Lin. O nível de significância aceito para o estudo foi α 5%. Foram medidas 39 mulheres, com idade média de 58,79 ± 10,03 anos e diagnóstico de DM2 a 8,64 ± 8,53 anos. Verificou-se, pelo teste de B-A, diferenças na VM dos testes de -0,001 ± 0,19 m/s (IC95%: -0,37 a 0,37 m/s) no início e 0,02 ± 0,21 m/s (IC95%: -0,39 a 0,42 m/s) ao final e concordância de 0,60 (IC95%: 0,41 a 0,79; p < 0,001) e 0,52 (IC95%: 0,31 a 0,73; p < 0,001) pré e pós, respectivamente, pelo coeficiente de concordância de correlação Lin. Através dos dados obtidos, sugere-se que os dois testes podem ser utilizados para avaliar a VM das mulheres DM2, porém o 6MWT apresentou maior reprodutibilidade para detectar mudanças na VM ao longo do tempo

This study aimed to test the agreement in the gait speed (GS) between the 6-minute walk test and the 4-me-ter gait speed (6MWT - 4MWT) in type 2 diabetic women (T2DM). The tests were performed before and after a 12-week physical exercise intervention. The 4MWT was performed in a space of four meters, with results based on the time spent (seconds) to complete a 4-meter distance. The 6MWT was carried out similar to a yo-yo test in 15 meters and the result was operationalized by the total distance (meters) covered. The results of the tests were standardized as speed (m/s). To evaluate agreements (6MWTbefore x 4MWTbefore) and (6MWTafter x 4MWTafter), Bland-Altman (B-A), and Lin's agreements were used. The level of significance was set at 5%. A total of 39 women were evaluated, mean age 58.79 ± 10.03 years, diagnosis of diabetes at 8.64 ± 8.53 years.The B-A test showed a mean difference in GS of -0.001 ± 0.19 m/s (95%CI: -0.37 to 0.37 m/s) before and 0.02 ± 0.21 m/s (95%CI: -0.39 to 0.42 m/s) after, and Lin's agreements of 0.60 (95%CI: 0.41 to 0.79; p < 0.001) and 0.52 (95%CI: 0.31 to 0.73; p < 0.001) before and after, respectively. Based on our data it is suggested that the two tests can be used to evaluate the GS of T2DM women, but the 6MWT was more reproductible to detect changes in GS over time

Fiabilidad de dos pruebas de velocidad de marcha de diferentes fases cronometradas e iguales fases no cronometradas en personas mayores que viven en la comunidad / Reliability of two gait speed tests of different timed phases and equal non-timed phases in community-dwelling older persons

ANTECEDENTES La velocidad de la marcha es una medida rápida, económica y precisa para evaluar la capacidad funcional de las personas mayores, tanto saludables como con diferentes comorbilidades. Estudios previos han evaluado la velocidad de la marcha medida a lo largo de cursos de diferentes distancias, pero las fases no cronometradas no se miden de manera uniforme y se desconoce si esto afecta los resultados de la prueba. OBJETIVO El objetivo de este estudio fue evaluar la confiabilidad de la prueba de velocidad de marcha de diferentes fases cronometradas e iguales fases no cronometradas. MÉTODOS Estudio de confiabilidad descriptivo, con diseño observacional analítico y de corte transversal. Se incluyeron 136 personas mayores. Se realizaron pruebas de 4 y 10 metros, con 2 metros para la fase de aceleración/desaceleración de ambas. El promedio de dos intentos se obtuvo como la medida final de cada prueba. Los resultados se obtuvieron mediante el coeficiente de correlación intraclase (CCI) con un modelo de efectos fijos y el método Bland y Altman (con un intervalo de confianza del 95%). Se complementaron con los valores de error estándar de la media y del cambio mínimo detectable (CMD95). RESULTADOS Los resultados indican un excelente nivel de acuerdo entre los intentos de las pruebas de 4 y 10 metros (CCI = 0,959 y 0,976, respectivamente), así como entre el promedio de las dos pruebas (CCI = 0,867). Destaca un nivel de acuerdo ligeramente mejor entre los dos intentos de la prueba de 10 metros. Por lo tanto, el número de intentos no es capaz de afectar los resultados de la velocidad de la marcha; sin embargo, se requieren análisis adicionales para concluir lo mismo con respecto a la distancia de la prueba. La diferencia del análisis Bland Altman para el promedio de las pruebas de 4 y 10 metros fue 1,5945 m/s (intervalo de confianza 95%: 0,9759 a 2,2130 m/s), siendo demasiado grande y más alto que el valor CMD95. CONCLUSIONES El CCI fue excelente en todos los casos, pero se requiere un análisis adicional para concluir lo mismo con respecto a la distancia de la prueba. Existe un acuerdo insuficiente entre las dos pruebas para permitir que se utilicen indistintamente en poblaciones con las características de este estudio.

BACKGROUND Gait speed is a fast, low cost and accurate measurement for evaluating older persons' functional ability, both health and with comorbidities. Previous studies have evaluated gait speed measured over courses of varying distances, but the non-timed phases are not measured uniformly. It is unknown if this affects the results of the test. OBJECTIVE This study aims to evaluate the reliability of the running speed test of two different timed phases compared to the same nontimed phases. METHODS We conducted a descriptive reliability study, with an observational and cross-sectional analytical design. One hundred thirty-six older persons were included. Two gait speed tests were taken, one of 4 and 10 meters, and 2 meters for the acceleration/deceleration phase for both tests. The average of two attempts was obtained as a final measure of each test. The intraclass correlation coefficient was used to express the results (ICC) with a fixed effects model and the Bland and Altman method (confidence interval of 95%), complemented with the standard error of the mean and minimal detectable change with 95% confidence values (MDC95). RESULTS The results indicate an excellent level of agreement between the attempts of the tests of 4- and 10-m (ICC = 0.959 and 0.976, respectively), as well as between the average of the two tests (ICC = 0.867). The agreement was slightly better between the two attempts in the 10-meter test. The number of attempts does not affect the results of gait speed. Further analysis is required to conclude the same regarding the distance of the test (4 and 10 meters). The difference in the results of the Bland Altman analysis for the average of the 4 and 10-meter tests was 1.5945 m/s (95% confidence interval: 0.9759 to 2.2130 m/s), which is too wide and higher than the MDC95 value. CONCLUSIONS The ICC value was excellent in all cases, and the number of attempts does not affect the results of gait speed. However, further analysis is required to conclude the same regarding the distance of the test. There is an insufficient agreement between the two tests to allow them to be used interchangeably in populations with the characteristics of this study.

Relationship between gait speed and physical function in patients with symptomatic peripheral artery disease

OBJECTIVE: The aim of the study was to analyze the relationship between gait speed and measurements of physical function in patients with symptomatic peripheral artery disease (PAD). METHODS: One hundred sixty-nine patients (age 66.6±9.4 years) with symptomatic PAD were recruited. Usual and fast gait speeds were assessed with a 4-meter walk test. Objective (balance, sit-to-stand, handrip strength, and six-minute walk test) and subjective (WIQ - Walking Impairment Questionnaire and WELCH - Walking Estimated-Limitation Calculated by History) measurements of physical function were obtained. Crude and adjusted linear regression analyses were used to confirm significant associations. RESULTS: Usual and fast gait speeds were significantly correlated with all objective and subjective physical function variables examined (r<0.55, p<0.05). In the multivariate model, usual gait speed was associated with six-minute walking distance (β=0.001, p<0.001), sit-to-stand test score (β=-0.005, p=0.012), and WIQ stairs score (β=0.002, p=0.006) adjusted by age, ankle brachial index, body mass index, and gender. Fast gait speed was associated with six-minute walking distance (β=0.002, p<0.001), WIQ stairs score (β=0.003, p=0.010), and WELCH total score (β=0.004, p=0.026) adjusted by age, ankle brachial index, body mass index, and gender. CONCLUSION: Usual and fast gait speeds assessed with the 4-meter test were moderately associated with objective and subjective measurements of physical function in symptomatic PAD patients.

Prevalence of sarcopenia and its associated factors: the impact of muscle mass, gait speed, and handgrip strength reference values on reported frequencies

OBJECTIVES: Sarcopenia is a common treatable geriatric condition. The aim of this study was to estimate the prevalence of sarcopenia and its associated factors in community-dwelling elderly living in Rio de Janeiro, Brazil, and to discuss the impact of different muscle mass, handgrip strength and gait speed cut-off values on the reported frequency of sarcopenia. METHODS: The health habits, functional capacity, and anthropometric measurements of 745 individuals aged ≥65 years from the Frailty in Brazilian Older People study were analyzed. The participants were classified into the following four groups: no sarcopenia, pre-sarcopenia, sarcopenia and severe sarcopenia. Univariate and multivariate regression analyses were performed. Muscle mass, handgrip strength and gait speed cut-off thresholds tailored to the sample and those proposed by the European Working Group on Sarcopenia in Older People were used to compare the prevalence rates of sarcopenia. RESULTS: Seventy-three percent of the participants were female, 61.9% were Caucasian, and the mean age was 76.6 years. The prevalence rates of sarcopenia were 10.8% and 18% using the sample-tailored and European consensus cut-off values, respectively. Sarcopenia was associated with advanced age (OR: 37.2; CI95%12.35-112.48), Caucasian race (OR: 1.89; CI 95% 1.02-3.52), single marital status (OR:6; CI95% 2.2-16.39), low income (OR:3.64; CI 95% 1.58-8.39), and the presence of comorbidities (OR:3.26; CI 95%1.28-8.3). CONCLUSION: In this study, the estimated prevalence of sarcopenia was similar to that reported in most studies after the tailored handgrip strength and gait speed cut-off values were adopted. A higher prevalence was observed when the cut-off values suggested by the European consensus were used. This indicates that the prevalence of sarcopenia must be estimated using population-specific reference values.

Associação entre adiposidade, índice de massa corporal, força de preensão palmar e velocidade de marcha em idosos comunitários / Association between adiposity, body mass index, grip strength and walking speed in community-dwelling elderly

Esta pesquisa objetivou avaliar a relação entre índice de massa corporal e adiposidade com força de preensão palmar e velocidade de marcha em idosos. É um estudo transversal aninhado em um estudo de intervenção com idosos comunitários assistidos por Unidades Básicas de Saúde no Município de Diamantina/MG. Foram avaliados dados socioeconômicos, antropométricos, de adiposidade, clínicos, bioquímicos, de força de preensão palmar e de velocidade de marcha. Testes de correlação de Pearson ou Spearman e regressão linear foram utilizados na análise dos dados. Foram estudados 49 idosos, com idade média de 77,21 ± 6,24 anos e predomínio de mulheres (69,29%). Valores elevados de adiposidade e índice de massa corporal ocorreram respectivamente em 69,39% e 34,69% dos idosos. A análise de regressão, estratificada por gênero e ajustada por variáveis de controle, indica que os índices de massa corporal e adiposidade não se associaram à força de preensão palmar e à velocidade de marcha dos idosos. No entanto, na análise considerando a amostra geral, a adiposidade influenciou negativamente na força de preensão palmar (para cada aumento de 1% na adiposidade, há uma redução de 0,226 kg no valor desta variável). Em relação à velocidade de marcha, a cada aumento de um ano de vida há uma redução de 0,014 m/s no valor desta variável, e o aumento de cada kg na força causa um aumento de 0,0193 m/s na velocidade de marcha. Pode-se concluir que a adiposidade e a idade influenciaram negativamente na força de preensão palmar dos idosos avaliados, e maior força influenciou positivamente na velocidade de marcha. (AU)

The objective of this research is to evaluate the relationship between body mass index and adiposity with handgrip strength and gait speed in the elderly. It is a cross-sectional study nested in an intervention study with community-based elderly people assisted by Basic Health Units in the municipality of Diamantina/MG. Socioeconomic, anthropometric, adiposity, clinical, biochemical, handgrip strength and gait velocity data were evaluated. Pearson or Spearman correlation tests and linear regression were used in data analysis. We studied 49 elderly people, with mean age of 77.21 ± 6.24 years and predominance of women (69.29%). High values of adiposity and body mass index occurred respectively in 69.39% and 34.69% of the elderly. The results of the regression analysis, stratified by gender and adjusted for control variables, indicate that body mass index and adiposity were not associated with handgrip strength and gait speed of elderly. However, in the analysis considering the general sample, adiposity negatively influenced handgrip strength (for each increase of 1% in adiposity, there is a reduction of 0.226 kg in the value of this variable). Regarding the gait speed, for every full year of life, there is a reduction of 0.014 m/s in the value of this variable, and, for each kg increased in force, there is an increase of 0.0193 m/s in gait speed. It can be concluded that adiposity and age negatively influenced the handgrip strength of the evaluated elderly, and greater strength influenced positively in gait speed. (AU)

Factores asociados a velocidad de marcha lenta en adultos mayores de un distrito en Lima, Perú / Factors associated with slow walking speed in older adults of a district in Lima, Peru

RESUMEN Objetivos. Determinar los factores asociados a velocidad de marcha lenta en adultos mayores de la comunidad residentes en un distrito de Lima, Perú. Materiales y métodos. Estudio de análisis de base de datos secundario. Se incluyó a los adultos mayores de 60 años y se excluyó aquellos con condiciones que no garantizaban la evaluación de la marcha. La variable dependiente fue la velocidad de marcha lenta, menor a 1 m/s, y las variables independientes fueron sociodemográficas, clínicas y de valoración geriátrica integral. Se calcularon las razones de prevalencia (RP) crudas y ajustadas con intervalos de confianza al 95% (IC95%). Resultados. Se incluyeron 416 adultos mayores, el rango de edad fue de 60 a 99 años y un 41% presentaba velocidad de marcha lenta. Se encontró que los factores asociados a una velocidad de marcha lenta en adultos mayores de la comunidad son el sexo femenino (RP 1,45, IC95%: 1,13-1,88), la edad mayor de 70 años (RP 1,73, IC95%: 1,30-2,30), un menor grado de instrucción (RP. 2.07, IC95%: 1,20-3,55), la presencia de problema socio familiar (RP 1,66, IC95%: 1,08-2,54), la presencia de diabetes mellitus (RP 1,35, IC95%: 1,01-1,80) y de depresión (RP: 1.41, IC95%: 1,02-1,95). Conclusiones. Los factores modificables asociados a una velocidad de marcha lenta en el adulto mayor en la comunidad son tanto clínicos como sociofamiliares, susceptibles de intervención desde etapas precoces en el curso de la vida.

ABSTRACT Objectives. To determine the factors associated with slow walking speed in older adults living in a district of Lima, Peru. Materials and methods. Analysis of secondary data. Adults older than 60 years were included in the study, while adults with physical conditions who did not allow the evaluation of the walking speed were excluded. The dependent variable was slow walking speed (less than 1 m/s), and the independent variables were sociodemographic, clinical, and geriatric data. Raw and adjusted prevalence ratios (PR) were calculated with 95% confidence intervals (95% CI). Results. The study sample included 416 older adults aged 60 to 99 years, and 41% of the participants met the slow walking speed criterion. The factors associated with slow walking speed in this sample were female gender (PR, 1.45; 95% CI, 1.13-1.88), age > 70 years (PR, 1.73; 95% CI, 1.30- 2.30), lower level of education (PR, 2.07, 95% CI, 1.20-3.55), social-familial problems (PR, 1.66; 95% CI, 1.08-2.54), diabetes mellitus (PR, 1.35; 95% CI, 1.01-1.80), and depression (PR, 1.41; 95% CI, 1.02-1.95). Conclusions. The modifiable factors associated with slow walking speed in older adults included clinical and social-familial problems, and these factors are susceptible to interventions from the early stages of life.