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PURPOSE: The performance metric associated with the execution of the 1-min sit-to-stand (1STS) typically relies on the number repetitions completed in 1 min. This parameter presents certain limitations (e.g., ceiling effect, motivational factors) which can impede its interpretation. Introducing additional parameters, such as neuromuscular fatigability level, could enhance the informative value of the 1STS and facilitate its interpretation. This study aimed to assess (i) whether the 1STS induces fatigability and (ii) the reliability of the fatigability level. METHODS: Forty young, healthy, and active participants underwent the 1STS twice during the same session. Isolated sit-to-stand maneuvers were performed before, immediately, and 1 min after completing the 1STS. A mobile app was utilized to obtain time (STST), velocity (STSV), and muscle power (STSP) from these sit-to-stand maneuvers. The pre-post change in these parameters served as the fatigability marker. Reliability was assessed using the intra-class correlation coefficient (ICC) and the coefficient of variation (CV). RESULTS: The mean number of repetitions during the 1STS was 63 ± 9. Significant decline in performance was observed for STST (13 ± 8%), STSV (-11.2 ± 6%), and STSP (-5.2 ± 3%), with more than 74% of participants exhibiting a decline beyond the minimal detectable change. Excellent between-session reliability (ICC ≥ 0.9; CV ≤ 5.3) was observed for the mobile app variables. CONCLUSION: The 1STS induces significant levels of fatigability. The fatigability indicators derived from the mobile app demonstrated remarkable reliability. Utilizing this user-friendly interface for computing fatigability may empower professionals to acquire insightful complementary indicators from the 1STS.
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INTRODUCTION: Nowadays, smartphones are equipped with the most sophisticated hardware which provides the opportunity to develop specific smartphone apps to analyze kinetic and kinematic parameters during sit-to-stand test in a clinical setting. The aims were to ascertain whether a new Android video-analysis based-App is comparable to the previously validated Apple-App for measuring time, velocity and power during sit-to-stand test, to determine its reliability and discriminant validity. METHODS: One-hundred sixty-one older adults (61-86 years) were recruited from an elderly social center. Sit-to-stand variables were simultaneously recorded through the Android and Apple-App. Their validity and inter-rater, intra-rater, and test-retest reliability was tested using an intraclass correlation coefficient (ICC2-1). Low gait speed (< 1.0 m/s), low physical performance (Short Physical Performance Battery < 10 points), and sarcopenia (EWGSOP2 guideline) were used to determine discriminant validity which was reported as the area under the curves (AUC) and their effect sizes (Hedges' g) for independent sample t-test. RESULTS: Excellent reproducibility (ICC2-1 > 0.85) and strong agreement (ICC2-1 > 0.90) between operating systems for sit-to-stand variables derived from the App was found. Older adults classified as sarcopenic (11.2%), low physical performance (15.5%), or reduced gait speed (14.3%) showed worse sit-to-stand time, velocity and power with large effect sizes (Hedges' g: > 0.8) compared to their respective counterpart. These variables showed the acceptable-to-excellent ability to identify low gait speed, low physical performance, and sarcopenic older adults (AUC-range: 0.73-0.82). CONCLUSION: The new Sit-to-Stand App running on the Android operating system is comparable to the previously validated Apple App. Excellent reproducibility and acceptable-to-excellent discriminant validity were found.
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Aplicativos Móveis , Sarcopenia , Humanos , Idoso , Reprodutibilidade dos Testes , Vida Independente , Teste de EsforçoRESUMO
BACKGROUND: Probable sarcopenia is determined by a reduction in muscle strength assessed with the handgrip strength test or 5 times sit-to-stand test, and it is confirmed with a reduction in muscle quantity determined by dual-energy X-ray absorptiometry or bioelectrical impedance analysis. However, these parameters are not implemented in clinical practice mainly due to a lack of equipment and time constraints. Nowadays, the technical innovations incorporated in most smartphone devices, such as high-speed video cameras, provide the opportunity to develop specific smartphone apps for measuring kinematic parameters related with sarcopenia during a simple sit-to-stand transition. OBJECTIVE: We aimed to create and validate a sit-to-stand video analysis-based app for diagnosing sarcopenia in community-dwelling older adults and to analyze its construct validity with health-related risk factors and frailty. METHODS: A total of 686 community-dwelling older adults (median age: 72 years; 59.2% [406/686] female) were recruited from elderly social centers. The index test was a sit-to-stand video analysis-based app using muscle power and calf circumference as proxies of muscle strength and muscle quantity, respectively. The reference standard was obtained by different combinations of muscle strength (handgrip strength or 5 times sit-to-stand test result) and muscle quantity (appendicular skeletal mass or skeletal muscle index) as recommended by the European Working Group on Sarcopenia in Older People-2 (EWGSOP2). Sensitivity, specificity, positive and negative predictive values, and area under the curve (AUC) of the receiver operating characteristic curve were calculated to determine the diagnostic accuracy of the app. Construct validity was evaluated using logistic regression to identify the risks associated with health-related outcomes and frailty (Fried phenotype) among those individuals who were classified as having sarcopenia by the index test. RESULTS: Sarcopenia prevalence varied from 2% to 11% according to the different combinations proposed by the EWGSOP2 guideline. Sensitivity, specificity, and AUC were 70%-83.3%, 77%-94.9%, and 80.5%-87.1%, respectively, depending on the diagnostic criteria used. Likewise, positive and negative predictive values were 10.6%-43.6% and 92.2%-99.4%, respectively. These results proved that the app was reliable to rule out the disease. Moreover, those individuals who were diagnosed with sarcopenia according to the index test showed more odds of having health-related adverse outcomes and frailty compared to their respective counterparts, regardless of the definition proposed by the EWGSOP2. CONCLUSIONS: The app showed good diagnostic performance for detecting sarcopenia in well-functioning Spanish community-dwelling older adults. Individuals with sarcopenia diagnosed by the app showed more odds of having health-related risk factors and frailty compared to their respective counterparts. These results highlight the potential use of this app in clinical settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT05148351; https://clinicaltrials.gov/study/NCT05148351. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.3390/s22166010.
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Fragilidade , Aplicativos Móveis , Sarcopenia , Humanos , Feminino , Idoso , Sarcopenia/diagnóstico , Sarcopenia/epidemiologia , Vida Independente , Força da Mão , Fatores de RiscoRESUMO
ABSTRACT: Makaraci, Y, Nas, K, Ruiz-Cárdenas, JD, Gündüz, K, Aydemir, M, and Orange, ST. Test-retest reliability and convergent validity of piezoelectric force plate measures of single-leg sit-to-stand performance in trained adults. J Strength Cond Res 37(12): 2373-2380, 2023-The single-leg sit-to-stand (STS) test has emerged as a promising method of assessing lower-limb functional strength and asymmetry. However, the reliability of its performance parameters on a force plate has not been explored. This study examined the test-retest reliability and convergent validity of the single-leg STS test performed on a piezoelectric-based force plate in trained subjects. Thirty trained male adults (age: 21.4 ± 1.7 years) performed 3 separate single-leg STS days of testing to assess both intraday and interday reliability. Performance parameters included STS time, ground reaction force (GRF), and center of pressure (CoP) sway velocity. The relationship between single-leg STS parameters and unilateral countermovement jump (CMJ) variables was assessed for convergent validity. Intraclass correlation coefficient (ICC) and coefficient of variation (CV) were calculated for reliability analyses, and convergent validity was assessed with Spearman's correlation coefficient (ρ). In the dominant leg, single-leg performance parameters showed moderate-to-excellent intraday reliability (ICC = 0.65-0.90, CV = 4.3-11.2%) and moderate interday reliability (ICC = 0.54-0.74, CV = 5.8-13.5%). In the nondominant leg, all single-leg STS performance parameters showed good intraday (ICC = 0.79-0.86, CV = 3.8-9.8%) and interday reliability (ICC = 0.75-0.82, CV = 4.6-9.7%). STS times in the dominant and nondominant legs were inversely related to unilateral CMJ velocity (ρ = -0.47 and -0.38, respectively). CoP sway velocity in the nondominant leg showed positive correlations with unilateral CMJ power and velocity (ρ = 0.38 and 0.54, respectively). In conclusion, the force plate-based single-leg STS test provides reliable measures of STS time, GRF, and CoP sway velocity in trained adults and could be used to assess lower-limb function and asymmetry.
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Teste de Esforço , Perna (Membro) , Humanos , Adulto , Masculino , Adulto Jovem , Reprodutibilidade dos Testes , Teste de Esforço/métodos , Força MuscularRESUMO
Prefrailty and sarcopenia in combination are more predictive of mortality than either condition alone. Early detection of these syndromes determines the prognosis of health-related adverse events since both conditions can be reversed through appropriate interventions. Nowadays, there is a lack of cheap, portable, rapid, and easy-to-use tools for detecting prefrailty and sarcopenia in combination. The aim of this study is to validate an iPhone App to detect prefrailty and sarcopenia syndromes in community-dwelling older adults. A diagnostic test accuracy study will include at least 400 participants aged 60 or over without cognitive impairment and physical disability recruited from elderly social centers of Murcia (Spain). Sit-to-stand muscle power measured through a slow-motion video analysis mobile application will be considered as the index test in combination with muscle mass (calf circumference or upper mid-arm circumference). Frailty syndrome (Fried's Phenotype) and sarcopenia (EWGSOP2) will both be considered as reference standards. Sensibility, specificity, positive and negative predictive values and likelihood ratios will be calculated as well as the area under the curve of the receiver operating characteristic. This mobile application will add the benefit for screening large populations in short time periods within a field-based setting, where space and technology are often constrained (NCT05148351).
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Aplicativos Móveis , Sarcopenia , Idoso , Idoso Fragilizado , Avaliação Geriátrica/métodos , Humanos , Vida Independente , Sarcopenia/diagnóstico , SíndromeRESUMO
The objectives of this systematic review were to analyse existing evidence on the efficacy of smartphone devices in promoting physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) and to identify the validity and precision of their measurements. A systematic review was undertaken across nine electronic databases: WOS Core Collection, PubMed, CINAHL, AMED, Academic Search Complete, Cochrane Central Register of Controlled Trials, SciELO, LILACS and ScienceDirect. Randomized and non-randomized controlled clinical trials were identified. To obtain additional eligible articles, the reference lists of the selected studies were also checked. Eligibility criteria and risk of bias were assessed by two independent authors. A total of eight articles met eligibility criteria. The studies were focused on promoting PA (n = 5) and the precision of device measurements (n = 3). The effectiveness of smartphones in increasing PA level (steps/day) at short and long term is very limited. Mobile-based exercise programs reported improvements in exercise capacity (i.e. incremental Shuttle-Walk-Test) at short and long term (18.3% and 21%, respectively). The precision of device measurements was good-to-excellent (r = 0.69-0.99); however, these data should be interpreted with caution due to methodological limitations of studies. The effectiveness of smartphone devices in promoting PA levels in patients with COPD is scarce. Further high-quality studies are needed to evaluate the effectiveness of smartphone devices in promoting PA levels. Registration number: CRD42016050048.
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Exercício Físico , Promoção da Saúde/métodos , Aplicativos Móveis , Doença Pulmonar Obstrutiva Crônica/reabilitação , Smartphone , Tolerância ao Exercício , Humanos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Teste de CaminhadaRESUMO
INTRODUCTION: Fibromyalgia is characterized by chronic widespread pain accompanied by reduced levels of physical activity and associated comorbidities such as overweight and obesity which have been associated to sarcopenia development. The aim of this systematic review is to ascertain whether Europeans with fibromyalgia show a reduction in sarcopenia determinants compared to apparently-healthy controls and to determine the risk of sarcopenia and its possible risk factors (PROSPERO: CRD42023439839). EVIDENCE ACQUISITION: Systematic searches were conducted on six databases (Academic-Search-Ultimate, CENTRAL, PubMed, SciELO, WOS-Core Collection, and ClinicalTrials.gov last-search February-2024) looking for original studies developed in European countries which assessed any of the sarcopenia determinants proposed by the EWGSOP2-guidelines (handgrip strength, five sit-to-stand, appendicular skeletal mass [ASM], skeletal muscle index [SMI]) and included fibromyalgia and healthy-control individuals. Studies mixing fibromyalgia with other diagnoses were excluded. Random-effects meta-analyses and meta-regressions were used to analyze possible differences and associated risk factors. The risk of bias was assessed using the Cochrane-Rob tool and the Quality Assessment Tool for Observational Studies, and the certainty of the evidence using GRADE-approach. EVIDENCE SYNTHESIS: A total of 25 studies (6393 individuals; 97% women; 20-65 years) were included. Fibromyalgia individuals showed reduced muscle strength ([handgrip] SMD: -1.16 [-1.29, -1.03]; high-certainty; [five sit-to-stand] not-assessed) and muscle quantity ([ASM] mean-difference: -0.83 kg [-1.41, -0.37]; [SMI] mean-difference: -0.26 kg/m2 [-0.41, -0.10]; both low-certainty) compared to healthy-controls. Fibromyalgia individuals had nine-times greater risk for probable sarcopenia (OR: 9.23 [6.85, 12.45]; high-certainty), but not for confirmed sarcopenia ([ASM] OR: 0.91 [0.49, 1.67]; [SMI] OR: 0.67 [0.19, 2.33]; both low-certainty) according to the EWGSOP2 cut-off points. Reduced muscle strength was strongly associated to fibromyalgia-severity (ß=-0.953 [-0.069, -0.038]). Studies were rated as high-risk of bias overall because did not account for some potential confounders (physical activity, sedentary time, Body Mass Index) which could influence the estimated effect. CONCLUSIONS: Europeans with fibromyalgia have a large reduction in muscle strength and may have a reduction in muscle quantity. The risk of probable sarcopenia according to the EWGSOP2 cut-off points was nine-times higher, but may have no difference in risk of reduced muscle quantity relative to healthy-controls. Muscle strength was strongly associated to disease severity.
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Fibromialgia , Sarcopenia , Humanos , Fibromialgia/complicações , Fibromialgia/fisiopatologia , Sarcopenia/fisiopatologia , Sarcopenia/complicações , Europa (Continente) , Fatores de Risco , Força da Mão/fisiologia , População EuropeiaRESUMO
Objectives: Sarcopenia and frailty have been associated with an increased risk of suffering health-related adverse events but the combination of both conditions results in worse health-related outcomes than either condition alone. Since both syndromes are reversible states, their early detection is fundamental. This study aims to validate a video analysis-based App to detect the presence of frailty or prefrailty plus sarcopenia syndromes and to analyze its construct validity with health-related risk factors. Methods: A total of 686 community-dwelling older adults (median-age: 72, 59% female) were enrolled. Muscle power generated during a sit-to-stand test using the App and calf circumference were considered the index test. The reference standards were the EWGSOP2 criteria (five-chair stand test plus appendicular skeletal mass or skeletal muscle index) and Fried's frailty phenotype. Area under the curve (AUC), sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated. Results: The prevalence of both syndromes varied from 2.9% to 7.2% depending on the diagnostic criteria used for sarcopenia assessment. Excellent-to-outstanding AUC values were observed (range 0.80-0.92). Sensitivity and specificity ranged from 75% to 100% and 81.7% to 87.2%, respectively. PPV and NPV ranged from 12.1% to 37.5% and 97.9% to 100%, respectively. Individuals diagnosed by the App showed an increased risk of polypharmacy, depression, comorbidities, falls, hospitalization, low socioeconomical and educational levels, and smoking and poor self-perceived health compared to their healthy counterparts. Conclusions: This App seems to be reliable to detect the simultaneous presence of both syndromes in community-dwelling older adults. Individuals diagnosed by the App showed more odds to have health-related risk factors.
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INTRODUCTION: Sarcopenia prevalence varies according to differences in diagnostic criteria used. In order to overcome this issue, the European Working Group on Sarcopenia in Older People-2 (EWGSOP2) published a consensus to increase harmonization for sarcopenia diagnosis. This study aimed to determine the prevalence and risk factors across the different sarcopenia diagnosis criteria recommended by EWGSOP2 and to analyze its agreement. METHODS: A total of 699 community-dwelling older adults (median-age: 72, 60% female) were recruited in this cross-sectional study. Sarcopenia prevalence was obtained by different combinations of muscle strength (handgrip strength or 5-times sit-to-stand) and muscle quantity (appendicular skeletal mass or skeletal muscle index) as recommended by the EWGSOP2. Cohen's Kappa coefficient was calculated to analyze agreement among the four sarcopenia diagnostic criteria and logistic regressions were performed to identify risks associated to health-related outcomes for each diagnostic criterion. RESULTS: Sarcopenia prevalence varied from 2.1% to 11.6%, depending on the diagnostic criteria used. Weak-to-moderate agreements (κ-range: 0.13-0.66) were observed among the four sarcopenia diagnosis criteria. There was scarce overlap in sarcopenic people when different diagnostic criteria were used leading to up to 10.4% of underdiagnosis. Sarcopenia defined by 5-times sit-to-stand was more associated with health-related outcomes compared to handgrip strength. CONCLUSIONS: Sarcopenia prevalence rates vary considerably depending on the diagnostic criteria used. These criteria should not be used in an interchangeable way due to their weak agreement. Sarcopenia diagnosis criteria defined by 5-times sit-to-stand could be more suitable in Spanish community-dwelling older adults due their associations with health-related outcomes.
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Sarcopenia , Humanos , Feminino , Idoso , Masculino , Sarcopenia/diagnóstico , Sarcopenia/epidemiologia , Vida Independente , Força da Mão/fisiologia , Estudos Transversais , Força Muscular , PrevalênciaRESUMO
Exercise therapy and education are recommended from several guidelines for managing symptoms in chronic nonspecific spinal pain (CNSP) patients. However, no systematic reviews have previously analyzed the effectiveness of pain science education (PSE) plus exercise therapy for managing CNSP related symptoms. Systematic searches were conducted on 10 databases looking for randomized control trials (RCTs) aimed to evaluate the effectiveness on pain, disability, kinesiophobia, and catastrophizing. Data were analyzed using random-effects meta-analyses and studies were appraised using the Cochrane ROB tool and GRADE. A total of eight RCTs (n = 622) were included in the qualitative-analysis and five were selected for meta-analysis. PSE plus exercise therapy showed improvements in pain (5RCTs: short-term: SMD: -0.53 [-0.86,-0.2]; 4RCTs: intermediate-term: SMD: -0.57 [-1.01,-0.14]; low quality), disability (4RCTs: short-term: SMD: -0.24 [-0.53,0.05]; 4RCTs: intermediate-term: SMD: -0.93 [-1.08,-0.03]; low-to-very-low quality), kinesiophobia (3RCTs: short-term: SMD: -0.7 [-1.51,0.11]; 4RCTs: intermediate-term: SMD: -0.93 [-1.57,-0.30]; moderate-to-very-low quality), and catastrophizing (2RCTs: short-term: MD: -3.26 points [-6.15,-0.37]; 3RCTs: intermediate-term: MD: -4.94 points [-8.08,-1.81]; low-to-very-low quality) compared to exercise alone. A qualitative-analysis showed improvements in the experimental group compared to multimodal physiotherapy (1RCT; low-to-very-low quality), whereas no clear benefits were reported compared to PSE alone (1RCT; very-low quality) or no intervention (1RCT; very-low quality). There is low to very-low certainty of the evidence suggesting that PSE plus exercise therapy reduces CNSP related-symptoms. PERSPECTIVE: Based on low-quality data from small samples, PSE plus exercise therapy reduces CNSP related symptoms. The evidence requires further investigation due to the limited number of studies with short follow-up periods (CRD42020168968).
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Dor Crônica , Pessoas com Deficiência , Dor Crônica/terapia , Terapia por Exercício , Humanos , Manejo da Dor , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVES: This study aimed i) to compare relative sit-to-stand power (STSrel) values yielded by the different equations reported in the literature; ii) to examine the associations between STSrel, derived from the equations, and age, sex, frailty and habitual gait speed (HGS); and iii) to compare the ability of the different STSrel equations to detect frailty and low HGS in older adults. METHODS: 1568 participants (>65 years) were included. STSrel was calculated according to four validated equations. Frailty was assessed using the Frailty Trait Scale and HGS as the time to complete 3 m. ANOVA tests, regression analyses and receiver operator characteristic curves were used. RESULTS: There were significant differences among the STSrel values yielded by all the equations, which were higher in men compared to women and negatively associated with age (r = -0.21 to -0.37). STSrel was positively and negative associated to HGS and frailty, respectively, in both men (r = 0.29 to 0.36 and r = -0.18 to -0.45) and women (r = 0.23 to 0.45 and r = -0.09 to -0.57) regardless of the equation used. Area under the curve values varied between 0.68 and 0.80 for Alcazar's, 0.67-0.80 for Ruiz-Cárdenas's, 0.51-0.65 for Smith's, and 0.68-0.80 for Takai's equations. Low STSrel indicated an increased probability of having both low HGS and frailty (OR [95%CI] = 1.6 to 4.5 [1.21 to 5.79]) for all equations with the exception of Smith's equations for frailty in women. CONCLUSIONS: All the equations presented adequate criterion validity, however, the Alcazar's equation showed the highest level of clinical relevance according to its ability to identify older people with frailty and low HGS.
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Fragilidade , Idoso , Feminino , Fragilidade/diagnóstico , Força da Mão/fisiologia , Humanos , Masculino , Músculos , Modalidades de Fisioterapia , Velocidade de CaminhadaRESUMO
The objectives of this study were to determine whether there were differences in handgrip strength and functional mobility between patients with cystic fibrosis (CF) and healthy controls with regard to sex and to ascertain whether these differences were related to lung function. Thirty-eight patients with CF (21 women) and 38 healthy controls aged 18-65 years were included. Muscle weakness and functional mobility were assessed through handgrip strength; walking speed; and time, velocity, and power derived from a single sit-to-stand (STS) test. Patients with CF showed differences for STS variables and walking speed but not for handgrip strength, compared with healthy controls. Considering sex differences, female patients showed differences for all variables analyzed while males with CF only exhibited differences for STS variables, compared with healthy controls. Females with CF showed moderate relationship between muscle weakness, functional mobility, and lung function (|r| = 0.45-0.49; p ≤ 0.05) whereas no relationships were observed for males with CF. The influence of chronic infection with Pseudomonas aeruginosa and pancreatic insufficiency on muscle weakness and functional mobility was similar in both sexes. Differences in muscle strength and functional mobility were predominantly observed in females with CF. These results suggest an important effect of sex gap on muscle weakness and functional mobility in patients with CF. Novelty The influence of sex gap on muscle weakness in CF has been shown. Muscle weakness was predominantly observed in females with CF.