Journal of frailty, sarcopenia and falls最新文献

Objectives: Functional asymmetry is a hallmark of aging-related motor decline, contributing to impaired gait, balance deficits, and increased fall risk. This study aimed to evaluate the effects of a single session of Neuro Postural Optimization (NPO), a non-invasive neuromodulation protocol based on Radio Electric Asymmetric Conveyer (REAC) technology, on central neurophysiological balance and functional symmetry in older adults.

Methods: Eighteen participants (mean age: 72.4 ± 6.1 years) underwent a standardized REAC-NPO session. Assessments were performed immediately before and after treatment using the Timed Up and Go (TUG) test, the Gait Speed test, the Five Times Sit-to-Stand (FTSTS), and Handgrip dynamometry.

Results: Statistically significant improvements were found in TUG (p=0.026), Gait Speed (p=0.041), and FTSTS (p=0.003). No significant change was observed in handgrip strength (p=0.530), supporting a central rather than peripheral mechanism of action. Functional dysmetria, a reproducible and quantifiable indicator of maladaptive central motor control, was completely corrected in all participants immediately after the REAC-NPO session.

Conclusions: A single REAC-NPO session can restore functional symmetry and improve mobility-related outcomes in older adults. The immediate and complete correction of functional dysmetria supports the potential role of REAC-NPO in fall prevention strategies and functional recovery programs for aging populations.

Objectives: The objective of this study was to quantify the impact of shifting time away from sedentary behavior to physical activity on frailty in older adults.

Methods: Participants from the All of Us Research Program with Fitbit data were included in the analysis. Fitbit data was used to measure time spent in sleep, sedentary behavior, light-intensity physical activity, and moderate-to-vigorous physical activity. Frailty was assessed using a 33-item frailty index. A compositional isotemporal substitution model was created to assess the estimated effects of substituting 30 minutes of sedentary behavior with an equal amount of time in physical activity on frailty.

Results: Reductions in frailty index were seen by shifting 30 minutes from sedentary behavior to light activity (-0.003 [95% CI: -0.004, -0.002]) and moderate-to-vigorous activity (-0.016 [-0.017, -0.014]). Lower odds of frailty were also seen from shifting time from sedentary behavior to light activity or moderate-to-vigorous activity. Associations between physical activity and frailty were generally more pronounced in those participants who were frail or pre-frail than in those who were robust.

Conclusions: Shifting time from sedentary behavior to physical activity is associated with lower odds of frailty, and shifting time to higher intensity activities may have a greater benefit to frailty.

Objective: To develop and evaluate the initial psychometric properties of the Multidimensional Falls Efficacy Scale (MdFES).

Methods: Stage 1 involved content development and validation through literature review and expert consensus. Stage 2 included psychometric testing with 179 older adults. Analyses included exploratory factor analysis (EFA), internal consistency, construct validity, and ROC analysis for clinical cut-offs.

Results: EFA supported a two-factor structure, explaining 65.4% of the variance. The MdFES showed good internal consistency (α = 0.84). Construct validity was supported by moderate correlations with the Activities-specific Balance Confidence scale (ρ = 0.51), the Balance Recovery Confidence scale (ρ = 0.67), and a negative correlation with the Short Falls Efficacy Scale-International (ρ = -0.46). ROC analyses demonstrated moderate discriminative ability for identifying fallers (AUC = 0.65), high concerns about falling (AUC = 0.73), and poor balance (AUC = 0.71). A cut-off score of ≤13 balanced sensitivity and specificity.

Conclusion: The MdFES is a brief, valid instrument capturing the multidimensional nature of falls efficacy. It may support clinical screening and guide targeted intervention. Further research is needed to elucidate the value of the MdFES.

Group-based physical activity interventions improve symptoms, quality of life and function, and are a cost-effective treatment approach for the management for Fibromyalgia Syndrome. Multiple forms of physical activity have been examined in the Fibromyalgia population; however, a comprehensive review of these approaches is lacking. This review aimed to map the current research and descriptively report on attrition data. A scoping review was undertaken searching Medline, CINAHL, SCOPUS, SPORTDiscus and Web-of-Science for studies meeting the following criteria: English language; peer-reviewed; published January 1, 2000 - February 23, 2023; adults (≥18 years) diagnosed with Fibromyalgia; group-based exercise or group-based physical activity. Study selection and data extraction were performed independently by two reviewers. Data were recorded into spreadsheets, then descriptively analysed and tabulated. 17 studies were included enrolling a total of 893 participants. Most examined multi-component intervention designs. Twelve included resistance exercise, ten included flexibility, eight included aerobic, six included hydrotherapy, four included balance training, three included "mindful movement" (e.g. Qi-Gong), one included Pilates, and one included exergames. Mean attrition was 21%. Current literature on group-based physical activity for Fibromyalgia examines mostly multi-component programmes delivered by multi-disciplinary teams in community settings, matching best-practice guidelines. Future studies should explore attrition further, examining influential variables.

Objective: To evaluate frailty status and its association with heart rate variability (HRV), body composition, and metabolic profile in patients with Type 2 Diabetes Mellitus (T2DM).

Methods: In this cross-sectional study, 139 T2DM patients (age 50-65 years) were recruited. Frailty status was classified as non-frail, pre-frail, or frail using the Physical Frailty Phenotype (PFP) criteria. Outcome measures included HRV from a 5-minute ECG, body composition via bioelectrical impedance analysis, and a full metabolic profile.

Results: The prevalence of pre-frailty or frailty was 95%. Increasing frailty status was significantly associated with autonomic dysfunction, characterized by reduced parasympathetic and increased sympathetic HRV indices (e.g., higher LF:HF ratio, p=0.003). Frail patients had a significantly higher fat percentage (p=0.015) and lower lean percentage (p=0.015) compared to non-frail participants. Poorer glycemic control (HbA1c: p=0.003) and a more adverse lipid profile were also significantly associated with worsening frailty.

Conclusion: Frailty is highly prevalent in this T2DM cohort and is associated with significant adverse changes in autonomic function, body composition, and cardiometabolic health, highlighting the need for a multifaceted management approach.

This study aimed to compile evidence on the effectiveness of neuromuscular electrical stimulation (NMES) for improving muscle strength in older adults, with or without systemic pathologies. A systematic search of PubMed, Cochrane Library, and Scopus databases was conducted for randomized controlled trials (RCTs) published between 2017 and 2023. Eligible studies included: older adults over 55 years, the use of either static stimulation (neuromuscular electrical stimulation NMES) in a stationary position or dynamic stimulation (functional electrical stimulation - FES applied during single or multi-joint movement), examined at least one muscle strength outcome, reported stimulation parameters (e.g., frequency, duration, amplitude), and involved participants with or at risk for sarcopenia. This review included 12 RCTs with Physiotherapy Evidence Database (PEDro) scores ranging from 5-9 (good quality). 9 studies reported significant increase in isometric muscle strength following electrical stimulation. Common parameters were 50-100 Hz with variable intensity and pulse duration. The findings suggest that both dynamic stimulation, or static stimulation delivered prior to strength or endurance training, respectively, proved more effective than static stimulation alone. However, parameter selection varied widely and was often unjustified, highlighting the need for standardization to optimize outcomes in community-dwelling older adults.

Objectives: This exploratory cohort study aimed to identify the physical factors associated with persistent falls, defined as falls occurring over two consecutive years, in the older population.

Methods: We conducted a 1-year prospective cohort of community-dwelling adults aged ≥65 years who were living independently at enrolment. Baseline assessments included gait speed, handgrip strength, and muscle-specific strength (MSS). The participants were classified as persistent falls if they reported ≥1 fall in both periods.

Results: Persistent fallers exhibited significantly decreased gait speed (0.88 [0.59-1.10] m/s vs. 1.15 [1.00-1.27]; p = 0.006, r = 0.337), handgrip strength (19.9 [17.0-27.8] kg vs. 25.0 [21.5-30.0] kg; p = 0.041, r = 0.253), and MSS (64.6 [58.2-69.2] % vs. 73.0 [66.6-79.2] %; p = 0.008, r = 0.327) compared to non-persistent fallers. Slower gait speed was most strongly associated with persistent falls (OR = 0.01, p=0.035), while handgrip strength (OR = 0.84, p = 0.096) and MSS (OR = 0.91, p = 0.066) were only mildly associated.

Conclusions: These exploratory findings suggest slow gait speed exhibited a significant association and MSS and handgrip strength exhibited potential associations with persistent falls in community-dwelling older adults.

Objectives: To prospectively evaluate the diagnostic accuracy of the sarcopenia echography (SARCHO) point-of-care ultrasound protocol for diagnosing sarcopenia, in accordance with the European Working Group on Sarcopenia in Older People 2.

Methods: This study was conducted as a single-center prospective, feasibility diagnostic accuracy study among referred patients for falls assessment. They underwent an assessment for sarcopenia according to the EWGSOP2 criteria. Participants were subjected to physical testing: 30-second chair stand test, short physical performance battery (SPPB), timed-up and go (TUG) test, and imaging procedures using DXA(gold standard) and SARCHO.

Results: 24 participants (15 women) with a mean age of 81 (± 5.2) years were included. Nine participants were classified as sarcopenic by DXA and physical testing, whereas seven participants were classified as sarcopenic by SARCHO and physical testing, according to the EWGSOP2 criteria. SARCHO showed a diagnostic accuracy of 91.7% (95% CI: 81.9 - 97.2). When assessing the muscle architectural components, sarcopenic individuals showed lower muscle thickness, cross-sectional area, and pennation angle and a higher shear-wave kiloPascal value indicating higher degree of muscle stiffness.

Conclusion: The SARCHO protocol is a promising point-of-care, bedside tool with high diagnostic accuracy, providing a valuable standardized and evidence-based approach for assessing sarcopenia.

Objectives: Few studies have examined whether older adults requiring care who have hypertension have lower muscle mass, muscle strength, physical function, and activities of daily living (ADL) capacity than those without hypertension.

Methods: This study included 163 participants aged ≥65 years who required care. The appendicular muscle mass was measured using bioelectrical impedance analysis. Handgrip and leg muscle strength (LMS) were used to assess muscle strength, and short physical performance batteries were used to assess physical function. The ADL capacity was evaluated using the Barthel Index. Participants were divided into two groups based on the absence or presence of hypertension (non-HY and HY groups, respectively).

Results: LMS and ADL capacity were significantly lower in HY group than that in non-HY group. Multiple logistic regression analysis showed that LMS and ADL capacity were significantly associated with the absence or presence of hypertension, even after adjusting for confounding factors (p < 0.05). Moreover, LMS was a significant independent predictor of ADL capacity (bathing and ascending and descending stairs, p < 0.05).

Conclusions: These results suggest that maintaining or improving LMS may help preserve ADL capacity in older adults requiring care who have hypertension.

Cancer is a common disease with significant impact on patients and society. Cancer and oncological treatment can negatively affect muscle, and muscle health impacts oncologic outcomes. This review studied the effect of different muscle parameters on oncologic outcomes. A systematic search was performed until April 2023. Parameters included were muscle thickness, cross-sectional area, skeletal muscle index, skeletal muscle mass, pennation angle, fascicle length, muscle density, echo intensity and elastography. Imaging methods included were computerized tomography, magnetic resonance imaging, ultrasound and dual-energy X-ray absorptiometry. Outcome parameters assessed were survival, chemotoxicity, surgical outcome, treatment response, duration of hospitalization, and quality of life. This review included 117 articles. Individuals with reduced skeletal muscle index or muscle density had lower survival rates, higher chemotoxicity and surgical complications, more hospitalizations, less treatment response and lower quality of life. Reduced muscle quantity and quality can impact oncological outcomes, either through primary or secondary sarcopenia. These findings warrant the need for holistic assessment by using comprehensive geriatric assessment to establish a correct treatment dosage. These results also suggest a beneficial effect of exercise and nutritional support. Further research can be useful to better understand the underlying mechanisms and optimize specific treatments for muscle in oncological patients.