Comparing remote and face-to-face assessments of physical performance in older adults: A reliability study.

INTRODUCTION: Older people often experience a decline in their physical performance. Tests have been approved to evaluate this performance in person. Yet, the constraints associated with in-person assessments (e.g. lack of medical facilities, pandemic lockdown, and contagion risk) are making us contemplate setting up assessments remotely. OBJECTIVES: To determine whether remote physical performance measurements of older adults are reliable and valid compared to face-to-face measurements. METHODS: Forty-five subjects aged 65 and over completed the normal/fast speed test (NWT/FWT), the unipodal balance test (UBT), the normal/fast timed up and go test (NTUG/FTUG), the 5 and 10 rep sit to stand test (5STS and 10STS), the 30 sec chair stand (30CS), the 2 minute step test (2MST) and the flexibility before standing (SAD) once face-to-face and twice remotely, by two different observers. The intraclass correlation coefficients (ICC), the standard errors of measurement (SEM%) and minimum detectable changes (MDC%) were calculated for both intra- and inter-observer conditions, to assess the relative and the absolute reliability. An ICC value exceeding 0.90 indicates a very high reliability, while an ICC between 0.70 and 0.89 signifies a high reliability. In clinical practice, a SEM % of less than 10% is considered acceptable. A smaller MDC % indicates a measurement that is more sensitive to detecting changes. RESULTS: Intra-observer relative reliability was very high (ICC>0.9) for the UBT, NWT, NTUG, FTUG, 5STS, 10STS, 30CS and the SAD; and high (ICC>0.7) for the 2MST and FWS. SEM% values ranged from 0% to 24.03% and MDC from 0% to 9.93%. Inter-observer relative reliability was considered very high (ICC>0.9) for all tests. SEM% values ranged from 0% to 17.68% and MDC from 0% to 7.32%. CONCLUSION: Our findings demonstrate that remote assessments exhibited consistently high to very high levels of intra- and inter-observer relative reliability when compared to face-to-face assessments. Additionally, certain remote evaluations showed acceptable absolute reliability, making them viable alternatives for healthcare professionals when in-person assessments are not feasible in clinical practice.

Assessment of risk factors associated with long-term mortality in nursing homes: result from the SENIOR cohort.

BACKGROUND: Previous studies on risk factors for death in nursing homes have focused on short-term observation and limited number risk factors. AIMS: This study aims to identify factors predictive of 8-year survival in nursing homes. METHODS: The study used the baseline measurements from the SENIOR cohort collected in 2013-2014. Data included clinical assessments (i.e., body composition, nutritional status, physical performance, level of dependence and cognition, frailty phenotype) as well as demographic information, number of medications and medical history. Mortality data were collected annually for 8 years. Univariate analyses were initially performed to assess potential predictive factors, followed by a Cox regression model using stepwise selection. RESULTS: Of the 662 participants enrolled in the cohort, 58 (8.8%) were not further assessed due to the withdrawal of 2 nursing homes and 71 (10.7%) had no mortality data available (i.e., relocation, refusal to continue the study). Among the 533 patients included, 111 (20.8%) were still alive in 2022. Median survival time was 4 years (1.93-6.94). Multivariate regression showed that younger age (HR = 1.04 (1.03-1.06)), higher body mass index (HR = 0.96 (0.94-0.98)), higher score on the Mini-Mental State-Examination (HR = 0.97 (0.94-0.99)) and higher score on the Short Physical Performance Battery (HR = 0.93 (0.90-0.97)) were protective factors against mortality. CONCLUSIONS: This study highlights that certain modifiable factors related to physical or mental health contribute to increased survival in nursing homes. Because of its ability to improve physical performance and partly cognitive function, promoting physical activity in nursing homes appears to be a public health priority.

[Study on the occurrence of adverse health events in nursing homes : contributions from the Liège SENIOR cohort]. / Étude de la survenue des événements de santé indésirables en maison de repos : apports de la cohorte Liégeoise SENIOR.

The SENIOR study followed a cohort of older people living in nursing homes for 8 years and examined their adverse health events. The results were analysed after 1, 3 and 8 years to identify predictive factors and improve care. After 1 year, residents with poorer motor and muscle function had a higher incidence of adverse health events such as death and falls. Sarcopenia predicted mortality, while poor physical performance was associated with falls. At 3 years, poor nutritional status and poor balance were important predictors of mortality, falls and loss of independence. At 8 years, younger age, higher body mass index, and good physical and cognitive performance were associated with longer survival. The study also examined the impact of the COVID-19 pandemic in nursing homes and found no significant association between frailty, nutrition, muscle strength and COVID-19. In conclusion, functional capacity and nutrition play a crucial role in predicting adverse events in nursing home residents. The results will guide public health policies and clinical interventions to improve quality of life.

L'étude SENIOR a suivi pendant 8 ans une cohorte de personnes âgées en maison de repos, examinant leurs événements de santé indésirables. Les résultats ont été analysés à 1 an, 3 ans et 8 ans pour identifier les facteurs déterminants et améliorer la prise en charge. Après 1 an, les résidents ayant de moins bonnes capacités motrices et musculaires présentaient une fréquence plus élevée d'événements indésirables tels que les décès et les chutes. La sarcopénie prédisait la mortalité, tandis que des performances physiques médiocres étaient liées aux chutes. Après 3 ans, un mauvais état nutritionnel et un équilibre affaibli étaient des prédicteurs majeurs de mortalité, chutes et perte d'autonomie. Après 8 ans, un âge plus jeune, un indice de masse corporelle élevé et de bonnes performances physiques et cognitives étaient associés à une survie prolongée. L'étude a également examiné l'impact de la pandémie de COVID-19 en maison de repos, ne trouvant pas de lien significatif entre fragilité, nutrition, force musculaire et COVID-19. En conclusion, les capacités fonctionnelles et la nutrition jouent un rôle crucial dans la prédiction d'événements indésirables chez les résidents de maisons de repos. Les résultats guideront les politiques de santé publique et les interventions cliniques pour améliorer la qualité de vie.

Relationship between protein intake and bone architecture or bone mineral density among dynapenic-obese older adults.

OBJECTIVE: The current study aimed to assess the relationship between protein intake and bone parameters among dynapenic-obese older adults. DESIGN: The current study is a secondary analysis with an a posteriori and exploratory design. SETTING: Subjects were recruited from the community via social communication (flyers and meetings in community centres) in the Great Montreal area. PARTICIPANTS: Twenty-six subjects were divided a posteriori into two groups according to their usual protein intake: PROT-: < 1 g/kg per d (n 13; women: 53·8 %; 66·5 (sd 3·3) years) and PROT+: > 1·2 g/kg per d (n 13; women: 61·5 %; 67·2 (sd 2·7) years). RESULTS: Both groups were comparable for age (PROT-: 66·5 (sd 3·3) v. PROT+: 67·2 (sd 2·7) years, P = 0·61) and gender (women: PROT-: n 7; 53·8 % v. PROT+: n 8; 61·5 %, P = 0·69). The PROT- group had a higher marrow area (P = 0·049), a greater bone compressive strength (P = 0·048) and a larger total bone area (P = 0·045) than the PROT+ group. However, no significant difference between the two groups was observed regarding body composition (fat and lean masses) or muscle composition. CONCLUSIONS: A lower protein intake seems to be associated with bone sizes, which influence bone strength, but do not influence bone density among dynapenic-obese older people.

Effects of Citrulline alone or combined with exercise on muscle mass, muscle strength, and physical performance among older adults: a systematic review.

PURPOSE OF REVIEW: To Establish the potential of Citrulline supplementation (CIT) combined or not with exercise on muscle function and physical performance via a systematic review of randomized controlled trials (RCTs) in human aged 50 years and older. RECENT FINDINGS: Based on Preferred Reporting Items for Systematic Reviews and Meta-analysis guideline, 103 references have been identified. Among this number, only six RCTs (250 participants) matched the inclusion criteria and were included in the present systematic review. Among the included studies, five of six reported beneficial effects of CIT on muscle mass. Then, four of six studies reported CIT effects on muscle strength but also that CIT when combined to exercise results in further improvements in upper muscle strength. Finally, three of six studies reported beneficial CIT effect on physical performance and suggested that CIT with exercise displayed greater improvements in walking speed than exercise alone. SUMMARY: CIT supplementation seems to be able to improve muscular and physical factors in frail elderly people (malnourished, hypertensive, obese, dynapenic-obese) compared to placebo. More importantly, CIT combined to exercise is more efficient than exercise or CIT alone. However, because of the small number (six) and heterogeneity (dose, duration, population) of the studies realized in older adults, further studies are needed to confirm its promising potential.

Physical performance trajectories and mortality among nursing home residents: results of the SENIOR cohort.

BACKGROUND: Previous studies have shown that older people can experience a considerable change in their physical performance (PP) over time. OBJECTIVES: To identify PP trajectories and their association with mortality among nursing home residents who were followed up for 3 years. DESIGN: Three-year longitudinal observational study. SETTING: Subjects of the SENIOR cohort. SUBJECTS: Six hundred and four nursing home residents with a mean age of 82.9 ± 9.1 years. METHODS: Baseline characteristics and the date of death were collected from the medical records. PP was assessed annually by the short physical performance battery (SPPB) test. Multiple imputations were performed to manage the missing data. PP trajectory groups were estimated using latent growth curve analysis. Cox proportional hazard regression models were applied to examine the risk of mortality according to the PP trajectory groups. RESULTS: Three PP trajectory groups were identified: slow decline (N = 96), moderate decline (N = 234) and fast decline (N = 274). After adjustments for potential confounding variables and the baseline SPPB scores, the residents in the fast decline and moderate decline trajectory groups had an increased risk of mortality compared to those in the slow decline trajectory group, with hazard ratio values of 1.78 (95% confidence interval [CI] = 1.34-2.26) and 1.37 (95% CI = 1.10-1.66), respectively. CONCLUSIONS: PP trajectories provide value-added information to baseline geriatric assessments and could be used for predicting 3-year mortality among nursing home residents. It may be important to regularly monitor the SPPB score and signal an alert when a fast decline in PP is detected in older people.

Senior physical activity contests in nursing homes: a feasibility study.

BACKGROUND: Competition has been shown to improve motivation and physical performance in young people. This method has been rarely studied in older people. AIMS: To evaluate the feasibility of senior physical activity (PA) contests between two nursing homes and to assess changes in the motivational level and physical performance of the residents over time. METHODS: Residents from two Belgian nursing homes were invited to participate in PA contests. A pretest and three contest sessions were organized over a period of 3 months. The activities proposed were body balance, gait speed, sit-to-stand performance, arm curl and address tests. Feasibility was measured by contest session adherence (expected score > 80%), difficulty scores (expected score < 40%) and appreciation scores (expected score > 80%). Motivational questionnaires were administered: the BREQ-2 (assessing amotivation, introjected regulation, identified regulation, intrinsic motivation and external motivation) and the A-PMCEQ (assessing ego- and task-involving climates). Friedman's analysis of variance was performed to evaluate the changes in physical performance and motivational levels. RESULTS: Of the 24 participants, seven did not complete all sessions because of medical or personal reasons not related to the study. During the three sessions, the adherence was 86%, the mean difficulty score was 30.8% and the satisfaction score was 87%. After three sessions, residents experienced a significant decrease ranged from 3 to 0 point for amotivation (p = 0.03), 1 to 0 point for external motivation (p = 0.03) and 2.5 to 2 points for ego-involving climate (p = 0.02) and a significant improvement ranged from 0.7 to 0.9 m/s for gait speed (p < 0.001), 18.5 to 15.6 s for sit-to-stand performance (p < 0.001) and 11.5 to 15 curls for arm curl scores (p < 0.001). CONCLUSIONS: In nursing home settings, senior PA contests are feasible and may improve the motivational climate and physical performance.

Normative data for isometric strength of 8 different muscle groups and their usefulness as a predictor of loss of autonomy among physically active nursing home residents: the SENIOR cohort.

OBJECTIVES: To provide normative values for isometric strength of 8 different muscle groups among nursing home residents and to investigate their predictive value for the decline of autonomy. METHODS: This is an analysis of the 1-year follow-up of the SENIOR cohort. At baseline, isometric muscle strength of residents has been assessed for 8 muscle groups using the MicroFET2. The cut-off threshold for low relative isometric muscle strength was defined as the lower quartile. The outcome was the 1-year loss of autonomy (i.e. a decrease of ≥1 point on the ADL scale between baseline and 12-month follow-up). Logistic regressions were carried out to assess the predictive value of isometric muscle strength for the loss of autonomy. RESULTS: 204 subjects (83.2±8.99 years, 72.5% women) were included. Threshold values of isometric strength were: knee flexors=0.94, knee extensors=1.07, ankle flexors=0.77, ankle extensors=0.88, hip abductors=0.78, hip extensors=0.79, elbow flexors=0.99 and elbow extensors= 0.71 N/kg. After adjustment for age and sex, the cut-off values for knee extensors (p=0.04) and for ankle extensors (p=0.03) were significantly predictive of loss of autonomy. CONCLUSIONS: The normative values for knee extensors and ankle extensors are independent predictors for loss of autonomy.

Myostatin and Insulin-Like Growth Factor 1 Are Biomarkers of Muscle Strength, Muscle Mass, and Mortality in Patients on Hemodialysis.

OBJECTIVE: Muscle strength is frequently altered in hemodialysis patients. In the present work, five potential muscle biomarkers have been studied in their ability to assess muscular strength, muscular mass and to predict mortality of hemodialysis patients: activin-A, procollagen III N-terminal peptide, follistatin, myostatin and insulin-like growth factor-1 (IGF-1). DESIGN AND METHODS: Three independent cohorts of prevalent hemodialysis patients (2 from Liège, Belgium and 1 from Marseille, France) were considered in this observational prospective study. The biomarkers were first measured in the Liege1 cohort. Two of them, myostatin and IGF-1, were then assessed in the whole population of patients (Liege1, Liege2 and Marseille). Muscle strength was assessed with handgrip strength (HGS) and muscle mass with bioimpedance analysis. One-year mortality predictive value of biomarkers was also studied in the Liège1 and Marseille cohorts. RESULTS: In the Liège1 cohort (n=67), HGS was only associated with concentrations of myostatin and IGF-1. These associations were confirmed in the whole population of 204 patients (r=0.37, P<0.001 and r=0.46, P<0.001, respectively) and remained significant (P<0.05) in multivariable models. The association between muscle mass and concentrations of myostatin and IGF-1were also significant. The ability of myostatin, IGF-1 and serum creatinine to detect a low HGS compared by Receiver Operating Characteristic curves analysis were not significantly different. Both myostatin and IGF-1 had a significant and comparable area under the curve to predict one-year mortality: 0.73 (95% CI: 0.64 to 0.83) and 0.72 (95% CI: 0.61 to 0.82), respectively. CONCLUSION: Our results suggest that myostatin and IGF-1 are two biomarkers of interest to assess muscle status of dialysis patients. Both biomarkers are associated with HGS, muscular mass, and one-year mortality.

Own attitude toward aging among nursing home residents: results of the SENIOR cohort.

BACKGROUND: Stereotypes associated with aging are of great concern as extensive literature emphasizes its deleterious effects on physical and mental health of the elderly. AIM: To assess the relationship between the attitude toward aging and the frailty status of nursing homes residents. METHODS: A cross-sectional analysis of the data collected at baseline in the SENIOR cohort was conducted. All subjects received a diagnosis of frailty based on the Fried's criteria. They also responded to the Attitude to Aging Questionnaire (AAQ) and other questions assessing their subjective age, the age at which someone stops being considered young or is considered old and the open-ended Image-of-Aging question to evaluate the relationship between their perception of aging and their frailty status. RESULTS: 272 nursing home residents (83.9 ± 8.19 years; 75% women) participated in this study. Out of them, 54 (19.9%) were frail, 182 (66.9%) were pre-frail, and 36 (13.2%) were robust. According to the AAQ questionnaire, frail subjects have a more negative perception of aging (score of 80.3 ± 10.2 points) than pre-frail subjects (83.6 ± 10.8) and robust subjects (86.5 ± 10.5) (p = 0.02). However, the three groups did not differ in the age that would mark, to their opinion, the end of youth (p = 0.93) or the beginning of old age (p = 0.98). The subjective age, rapported by nursing home residents, was not significantly different according to their frailty status. At least, based on the Open-Ended Image of Aging question, the residents' vision of aging was not different according to the frailty status (p = 0.52). CONCLUSION: Based on the AAQ, frail subjects have more negative attitude to ageing compared to non-frail ones.

Relevance of vitamin D in the pathogenesis and therapy of frailty.

PURPOSE OF REVIEW: This article reviews recently published evidence regarding the role of vitamin D in the physiopathology of physical frailty in elderly populations and its role in the management of this geriatric condition. RECENT FINDINGS: Some recent studies have found a low level of 25-hydroxyvitamin D, considered the best marker of vitamin D status, in frail individuals. All prospective studies consistently report that low vitamin D status is associated with an increased risk of becoming frail. Recent studies also suggest that the relationship between vitamin D status and frailty is largely mediated by the development of sarcopenia. Very few well designed randomized controlled trials are available that assess the effectiveness of vitamin D supplementation in the prevention or management of frailty. In the absence of specific guidelines, a minimal serum 25-hydroxyvitamin D level of 75 nmol/l is proposed for frail elderly patients by some scientific societies. The doses necessary to reach this target are between 800 and 2000 IU/day. SUMMARY: Several studies suggest a potential effect of vitamin D on physical frailty but large clinical trials are lacking at this time to provide solid evidence of clinical benefit.

How clinical practitioners assess frailty in their daily practice: an international survey.

INTRODUCTION: Various operational definitions have been proposed to assess the frailty condition among older individuals. Our objective was to assess how practitioners measure the geriatric syndrome of frailty in their daily routine. METHODS: An online survey was sent to national geriatric societies affiliated to the European Union Geriatric Medicine Society (EUGMS) and to members of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). RESULTS: A total of 388 clinicians from 44 countries answered to the survey. Most of them were medical doctors (93%), and their primary field of practice was geriatrics (83%). Two hundred and five clinicians (52.8%) always assessed frailty in their daily practice, 38.1% reported to "sometimes" measure it, and 9.1% never assess it. A substantial proportion of clinicians (64.9%) diagnose frailty using more than one instrument. The most widely used tool was the gait speed test, adopted by 43.8% of the clinicians, followed by clinical frailty scale (34.3%), the SPPB test (30.2%), the frailty phenotype (26.8%) and the frailty index (16.8%). CONCLUSION: A variety of tools is used to assess frailty of older patients in clinical practice highlighting the need for standardisation and guidelines.

Osteoporosis and sarcopenia: two diseases or one?

PURPOSE OF REVIEW: This article reviews recently published evidence for common pathways explaining bone and muscle wasting in normal ageing and pathological conditions. RECENT FINDINGS: Numerous studies support the concept of a bone-muscle unit, where constant cross-talking between the two tissues takes place, involving molecules released by the skeletal muscle secretome, which affects bone, and osteokines secreted by the osteoblasts and osteocytes, which, in turn, impact muscle cells. SUMMARY: New chemical entities aiming at concomitantly treating osteoporosis and sarcopenia could be developed by targeting pathways that centrally regulate bone and muscle or emerging pathways that facilitate the communication between the two tissues.

Cross-cultural adaptation and validation of the Patient-Rated Tennis Elbow Evaluation Questionnaire on lateral elbow tendinopathy for French-speaking patients.

STUDY DESIGN: Translation and validation of algo-functional questionnaire. INTRODUCTION: The lateral elbow tendinopathy is a common injury in tennis players and physical workers. The Patient-Rated Tennis Elbow Evaluation (PRTEE) Questionnaire was specifically designed to measure pain and functional limitations in patients with lateral epicondylitis (tennis elbow). First developed in English, this questionnaire has since been translated into several languages. PURPOSE OF THE STUDY: The aims of the study were to translate and cross-culturally adapt the PRTEE questionnaire into French and to evaluate the reliability and validity of this translated version of the questionnaire (PRTEE-F). METHODS: The PRTEE was translated and cross-culturally adapted into French according to international guidelines. To assess the reliability and validity of the PRTEE-F, 115 participants were asked twice to fill in the PRTEE-F, and once the Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) and the Short Form Health Survey (SF-36). Internal consistency (using Cronbach's alpha), test-retest reliability (using intraclass correlation coefficient (ICC), standard error of measurement and minimal detectable change), and convergent and divergent validity (using the Spearman's correlation coefficients respectively with the DASH and with some subscales of the SF-36) were assessed. RESULTS: The PRTEE was translated into French without any problems. PRTEE-F showed a good test-retest reliability for the overall score (ICC 0.86) and for each item (ICC 0.8-0.96) and a high internal consistency (Cronbach's alpha = 0.98). The correlation analyses revealed high correlation coefficients between PRTEE-F and DASH (convergent validity) and, as expected, a low or moderate correlation with the divergent subscales of the SF-36 (discriminant validity). There was no floor or ceiling effect. DISCUSSION AND CONCLUSIONS: The PRTEE questionnaire was successfully cross-culturally adapted into French. The PRTEE-F is reliable and valid for evaluating French-speaking patients with lateral elbow tendinopathy.

Development of a self-administrated quality of life questionnaire for sarcopenia in elderly subjects: the SarQoL.

BACKGROUND: The impact of sarcopenia on quality of life is currently assessed by generic tools. However, these tools may not detect subtle effects of this specific condition on quality of life. OBJECTIVE: The aim of this study was to develop a sarcopenia-specific quality of life questionnaire (SarQoL, Sarcopenia Quality of Life) designed for community-dwelling elderly subjects aged 65 years and older. SETTINGS: Participants were recruited in an outpatient clinic in Liège, Belgium. SUBJECTS: Sarcopenic subjects aged 65 years or older. METHODS: The study was articulated in the following four stages: (i) Item generation-based on literature review, sarcopenic subjects' opinion, experts' opinion, focus groups; (ii) Item reduction-based on sarcopenic subjects' and experts' preferences; (iii) Questionnaire generation-developed during an expert meeting; (iv) Pretest of the questionnaire-based on sarcopenic subjects' opinion. RESULTS: The final version of the questionnaire consists of 55 items translated into 22 questions rated on a 4-point Likert scale. These items are organised into seven domains of dysfunction: Physical and mental health, Locomotion, Body composition, Functionality, Activities of daily living, Leisure activities and Fears. In view of the pretest, the SarQoL is easy to complete, independently, in ∼10 min. CONCLUSIONS: The first version of the SarQoL, a specific quality of life questionnaire for sarcopenic subjects, has been developed and has been shown to be comprehensible by the target population. Investigations are now required to test the psychometric properties (internal consistency, test-retest reliability, divergent and convergent validity, discriminant validity, floor and ceiling effects) of this questionnaire.

Concordance between muscle mass assessed by bioelectrical impedance analysis and by dual energy X-ray absorptiometry: a cross-sectional study.

BACKGROUND: Besides magnetic resonance imaging, dual energy X-ray absorptiometry (DXA) seems the most reliable tool to evaluate body composition and is often considered as the gold standard in clinical practice. Bioelectrical impedance analysis (BIA) could provide a simpler, portative, and less expensive alternative. Because the body composition assessment by BIA is device-dependent, the aim of this study was to appraise the concordance between the specific bioelectrical impedance device InBody S10 and DXA for the body composition evaluation. METHODS: Body composition, included appendicular lean mass divided by height squared (ALM/ht(2)) was measured by DXA (Hologic QDR Discovery device) and by BIA (InBody S10 Biospace device). Agreement between tools was assessed by means of the Bland Altman method and reliability was determined using the IntraClass Coefficient (ICC). ICC was also computed to assess the reliability of the test-retest performed by the same operator or by two different ones. RESULTS: A total of 219 subjects were enrolled in this study (mean age: 43.7 ± 19.1 years old, 51.6% of women). For the ALM/ht(2), reliability of the test-retest of the BIA was high with an ICC of 0.89 (95%CI: 0.86-0.92) when performed by the same operator and an ICC of 0.77 (95%CI: 0.72-0.82) when performed by two different operators. Agreement between ALM/ht(2) assessed by DXA and BIA was low (ICC = 0.37 (95%CI: 0.25-0.48)). Mean ALM/ht(2) was 9.19 ± 1.39 kg/m(2) with BIA and 7.34 ± 1.34 kg/m(2) with DXA, (p < 0001). A formula developed using a multiple regression analysis, and taking into account muscle mass assessed by BIA, as well as sex and body mass index, explains 89% of the ALM/ht(2) assessed by DXA. CONCLUSIONS: Although our results show that the measure of ALM/ht(2) by BIA is reliable, the agreement between DXA and BIA is low. Indeed, BIA seems to overestimate ALM/ht(2) compared to DXA and, consequently, it is important to use an adapted formula to obtain measurement of the appendicular lean mass by BIA close to that measured by DXA.

Effects of nutritional counseling on physical performance and muscle strength in older adults: a systematic review protocol.

OBJECTIVE: The objective of this review is to synthesize the effects of nutritional counseling compared with no intervention (maintaining lifestyle habits) or nutritional counseling in combination with other interventions (eg, nutritional supplementation, physical activity) on physical performance and muscle strength in older adults. INTRODUCTION: Nutritional counseling, which is considered the first line of nutrition therapy, could play an important role in geriatric care programs by helping older adults understand the importance of nutrition and by promoting healthy, sustainable eating habits. However, the effects of nutritional counseling on physical function and muscle strength among older adults are not clear. INCLUSION CRITERIA: This review will consider randomized controlled trials and non-randomized controlled trials. Participants aged 65 years or older, who have received nutritional counseling alone or in combination with another intervention (eg, nutritional supplementation, physical exercise) will be considered for inclusion. Comparators will include another intervention or no intervention, but physical performance (ie, gait, endurance, balance) or muscle strength must be measured. METHODS: This systematic review will be conducted in accordance with the JBI methodology for systematic reviews of effectiveness. The databases to be searched will include MEDLINE (Ovid), Embase, CENTRAL (Ovid), CINAHL (EBSCOhost), and Scopus. Sources of unpublished studies and gray literature will include Google Scholar and protocol registers. Two independent reviewers will select relevant studies, critically appraise the studies, and extract data. Studies will be pooled in a statistical meta-analysis or presented in narrative format. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach will be used to grade the certainty of the evidence. REVIEW REGISTRATION: PROSPERO CRD42022374527.

Changes in structure and symptoms in knee osteoarthritis and prediction of future knee replacement over 8 years.

The objective of this study was to assess the association between changes in joint space width (JSW, i.e., structure) or Western Ontario and McMaster Universities (WOMAC) score (i.e., symptoms) over 3 years in patients with knee osteoarthritis and the occurrence of knee replacement over 8 years. We followed 133 subjects with primary knee osteoarthritis prospectively for a mean of 8 years. JSW (standard radiography) and symptoms (total WOMAC score) were assessed every year for 3 years. The rate of knee replacement was recorded for the following 5 years. Logistic regressions were performed according to the intention-to-treat principle. After 8 years' follow-up, ten patients (7.5 %) had undergone a knee replacement. The changes in JSW or WOMAC score over 3 years were significantly associated with the occurrence of knee replacement during the following 5 years (p = 0.02 and p = 0.03, respectively). Each 0.1-mm narrowing of JSW over 3 years was associated with a 14 % (95 % CI 3-25 %) increased risk for knee replacement. For every 10 % increase in WOMAC score, the risk for joint replacement was increased by 16 % (95 % CI 1-33 %). When JSW and WOMAC score were included in the same statistical model, they were still significantly associated with risk for knee replacement (p = 0.02 and p = 0.03, respectively), but JSW change was the only variable that remained significant after adjusting for all potential confounders. Our results suggest that changes in symptoms and, more particularly, in structure over 3 years in patients with osteoarthritis reflect a clinically relevant progression of the disease.

Effects of 3 months of short sessions of controlled whole body vibrations on the risk of falls among nursing home residents.

BACKGROUND: Fatigue, lack of motivation and low compliance can be observed in nursing home residents during the practice of physical activity. Because exercises should not be too vigorous, whole body vibration could potentially be an effective alternative. The objective of this randomized controlled trial was to assess the impact of 3-month training by whole body vibration on the risk of falls among nursing home residents. METHODS: Patients were randomized into two groups: the whole body vibration group which received 3 training sessions every week composed of 5 series of only 15 seconds of vibrations at 30 Hz frequency and a control group with normal daily life for the whole study period. The impact of this training on the risk of falls was assessed blindly by three tests: the Tinetti Test, the Timed Up and Go test and a quantitative evaluation of a 10-second walk performed with a tri-axial accelerometer. RESULTS: 62 subjects (47 women and 15 men; mean age 83.2 ± 7.99 years) were recruited for the study. No significant change in the studied parameters was observed between the treated (n=31) and the control group (n=31) after 3 months of training by controlled whole-body-vibrations. Actually, the Tinetti test increased of + 0.93 ± 3.14 points in the treated group against + 0.88 ± 2.33 points in the control group (p = 0.89 when adjusted). The Timed Up and Go test showed a median evolution of - 1.14 (- 4.75-3.73) seconds in the treated group against + 0.41 (- 3.57- 2.41) seconds in the control group (p = 0.06). For the quantitative evaluation of the walk, no significant change was observed between the treated and the control group in single task as well as in dual task conditions. CONCLUSIONS: The whole body vibration training performed with the exposition settings such as those used in this research was feasible but seems to have no impact on the risk of falls among nursing home residents. Further investigations, in which, for example, the exposure parameters would be changed, seem necessary. TRIAL REGISTRATION NUMBER: NCT01759680.

Investigation of the relationships between frailty, nutritional status and muscle strength and the incidence and severity of Covid-19 among the residents of nursing homes. Results from the SENIOR cohort.

Few studies have investigated the factors associated with the incidence of Covid-19 in nursing homes. The aim of this study was to investigate the relationships between frailty, nutritional status, muscle strength and the Covid-19 incidence and severity in nursing home residents. Data from the last two years of follow-up of the SENIOR (Sample of Elderly Nursing homes individuals: an Observational Research) cohort were used. A total of 75 participants of the cohort were included, 56 % of whom had Covid-19. After adjustment for covariates, no association was found between frailty, nutritional status or grip strength and the incidence and severity of Covid-19.