Body Mass Index,Muscle Strength and Physical Performance in Older Adults from Eight Cohort Studies: The HALCyon Programme

Objective

To investigate the associations of body mass index (BMI) and grip strength with objective measures of physical performance (chair rise time, walking speed and balance) including an assessment of sex differences and non-linearity.

Methods

Cross-sectional data from eight UK cohort studies (total N = 16 444) participating in the Healthy Ageing across the Life Course (HALCyon) research programme, ranging in age from 50 to 90+ years at the time of physical capability assessment, were used. Regression models were fitted within each study and meta-analysis methods used to pool regression coefficients across studies and to assess the extent of heterogeneity between studies.

Results

Higher BMI was associated with poorer performance on chair rise (N = 10 773), walking speed (N = 9 761) and standing balance (N = 13 921) tests. Higher BMI was associated with stronger grip strength in men only. Stronger grip strength was associated with better performance on all tests with a tendency for the associations to be stronger in women than men; for example, walking speed was higher by 0.43 cm/s (0.14, 0.71) more per kg in women than men. Both BMI and grip strength remained independently related with performance after mutual adjustment, but there was no evidence of effect modification. Both BMI and grip strength exhibited non-linear relations with performance; those in the lowest fifth of grip strength and highest fifth of BMI having particularly poor performance. Findings were similar when waist circumference was examined in place of BMI.

Conclusion

Older men and women with weak muscle strength and high BMI have considerably poorer performance than others and associations were observed even in the youngest cohort (age 53). Although causality cannot be inferred from observational cross-sectional studies, our findings suggest the likely benefit of early assessment and interventions to reduce fat mass and improve muscle strength in the prevention of future functional limitations.     

Feasibility and Inter-Rater Reliability of Physical Performance Measures in Acutely Admitted Older Medical Patients

ObjectivePhysical performance measures can be used to predict functional decline and increased dependency in older persons. However, few studies have assessed the feasibility or reliability of such measures in hospitalized older patients. Here we assessed the feasibility and inter-rater reliability of four simple measures of physical performance in acutely admitted older medical patients.DesignDuring the first 24 hours of hospitalization, the following were assessed twice by different raters in 52 (≥ 65 years) patients admitted for acute medical illness: isometric hand grip strength, 4-meter gait speed, 30-s chair stand and Cumulated Ambulation Score. Relative reliability was expressed as weighted kappa for the Cumulated Ambulation Score or as intra-class correlation coefficient (ICC_1,1) and lower limit of the 95%-confidence interval (LL_95%) for grip strength, gait speed, and 30-s chair stand. Absolute reliability was expressed as the standard error of measurement and the smallest real difference as a percentage of their respective means (SEM% and SRD%).ResultsThe primary reasons for admission of the 52 included patients were infectious disease and cardiovascular illness. The mean± SD age was 78±8.3 years, and 73.1% were women. All patients performed grip strength and Cumulated Ambulation Score testing, 81% performed the gait speed test, and 54% completed the 30-s chair stand test (46% were unable to rise without using the armrests). No systematic bias was found between first and second tests or between raters. The weighted kappa for the Cumulated Ambulation Score was 0.76 (0.60–0.92). The ICC1,1 values were as follows: grip strength, 0.95 (LL_95% 0.92); gait speed, 0.92 (LL_95% 0.73), and 30-s chair stand, 0.82 (LL_95% 0.67). The SEM% values for grip strength, gait speed, and 30-s chair stand were 8%, 7%, and 18%, and the SRD_95% values were 22%, 17%, and 49%.ConclusionIn acutely admitted older medical patients, grip strength, gait speed, and the Cumulated Ambulation Score measurements were feasible and showed high inter-rater reliability when administered by different raters. The feasibility and inter-rater reliability of the 30-s chair stand were moderate, complicating the use of the 30-s chair stand in acutely admitted older medical patients. However, the predefined modified version of the chair stand test was both feasible and with high inter-rater reliability in this population.     

BMI, body composition, and physical functioning in older adults

Objective: Recent studies have emphasized the importance of muscle and fat mass in relation to age‐related decline in physical function. Our objective was to determine whether BMI, as a surrogate measurement of fat mass, may be used as a measure of risk factor for physical functioning in older adults and whether body composition measurements confer any advantage over BMI. Research Methods and Procedures: Four thousand men and women ≥65 years of age living in the community, stratified by age and sex, underwent the following measurements: body composition by DXA; grip strength; and timed 6‐m walk. Subjects were grouped into five categories of BMI using Asian criteria for health‐related risks, and between‐group differences in physical performance measures and body composition were analyzed using analysis of covariance adjusting for age, physical activity level, and presence of chronic disease. Results: Subjects in the two obese categories had a significantly greater number of instrumental activities of daily living (IADL) impairments compared with the underweight and normal‐weight groups. Those with BMI ≥30 kg/m² had the worst walking performance, and the groups with BMI in the normal and overweight range had optimal performance. Fat mass, but not appendicular muscle mass, was associated with walking speed after adjusting for BMI. Discussion: Fat mass seems to be a more important factor than appendicular muscle mass in determining walking speed in community‐living older adults, even after adjusting for BMI.     

Correlation between Muscle Strength and Muscle Mass,and Their Association with Walking Speed,in Community-Dwelling Elderly Japanese Individuals

Objectives

We aimed to assess the correlation between muscle strength and muscle mass based on sex and age, and their association with walking speed, which is a health predictor for independent living, in elderly Japanese individuals.

Methods

The participants included 318 (111 men, 207 women) community-dwelling elderly Japanese individuals aged ≥65 years. Knee extension strength was assessed as an indicator of muscle strength, and bioelectrical impedance analysis was used to measure muscle mass. The maximum walking speed of participants was recorded. All measurements were categorized based on sex and age groups as follows: young-old (age, 65–74 years) and old-old (age, ≥75 years).

Results

Appendicular muscle mass and knee extension strength decreased with age in both men and women. In men, knee extension strength showed significant positive correlations with leg and appendicular muscle mass in both young-old and old-old age groups. However, in women, only the old-old age group showed significant positive correlations between knee extension strength and leg and appendicular muscle mass. Muscle strength was significantly positively correlated with maximum walking speed in all groups, whereas muscle mass was not significantly correlated with maximum walking speed in men and women.

Conclusions

Muscle strength was significantly correlated with muscle mass in both age groups in men. However, in women, the correlation between muscle strength and muscle mass differed according to age. This finding suggests that the relationship between muscle strength and muscle mass differs according to sex and age. Muscle strength showed significant correlation with walking speed in both men and women in both age groups. These findings suggest that it is necessary to recognize that muscle strength is different from muscle mass, and that an individualized approach to prevent decline of muscle strength and muscle mass is necessary for health promotion in elderly.     

Muscle quality. I.Age-associated differences between arm and leg muscle groups

To determine the differences between armand leg muscle quality (MQ) across the adult life span in men andwomen, concentric (Con) and eccentric (Ecc) peak torque (PT) weremeasured in 703 subjects (364 men and 339 women, age range 19-93yr) and appendicular skeletal muscle mass (MM) was determined in thearm and leg in a subgroup of 502 of these subjects (224 men and 278 women). Regression analysis showed that MQ, defined as PT per unit ofMM, was significantly higher in the arm (~30%) than in the legacross age in both genders (P < 0.01). Arm and leg MQ declined at a similar rate with age in men,whereas leg MQ declined ~20% more than arm MQ with increasing age inwomen (P  0.01 andP < 0.05 for Con and Ecc PT,respectively). Moreover, the age-associated decrease in arm MQ wassteeper in men than in women whether Con or Ecc PT was used (bothP < 0.05). Arm MQ as determined byCon PT showed a linear age-related decline in men and women (28 and20%, respectively, P < 0.001),whereas arm MQ as determined by Ecc PT showed a linear age-relateddecline in men (25%, P < 0.001) butnot in women (not significant). In contrast, both genders exhibited anage-related quadratic decline in leg MQ as determined by Con PT(~40%) and Ecc PT (~25%; both P < 0.001), and the rate of decline was similar for men and women. ThusMQ is affected by age and gender, but the magnitude of this effectdepends on the muscle group studied and the type of muscle action (Convs. Ecc) used to assess strength.

     

Body Mass Index Is Associated with Physical Performance in Suburb-Dwelling Older Chinese: A Cross-Sectional Study

Background

Physical performance is reported to have various beneficial effects on human health, especially in older individuals. Although such effects are associated with body mass index (BMI), the relationship between BMI and physical performance has not been clarified.

Design

We conducted a cross-sectional study of 966 suburb-dwelling Tianjin individuals aged ≥ 60 years (average age 67.5±6.02, men 435, women 531). Mobility, balance, and muscle strength were assessed by walking speed, timed up-and-go test (TUGT), and grip strength, respectively. The subjects were categorized into three groups based on BMI (kg/m²) as follows: normal weight, 18.5 ≤ BMI ≤ 23.9; overweight, 24.0 ≤ BMI ≤ 27.9; and obese, BMI ≥ 28.0.

Result

After adjusting for all other variables, relative grip strength decreased when BMI increased in both men and women (P for trend <0.001 and <0.001, respectively). BMI may be negatively associated with TUGT performance in the women only. There was no apparent association between walking speed and BMI in either sex, but after adjusting for age, walking speed was faster when BMI increased in women (P for trend= 0.0162).

Conclusion

This study suggests that in older individuals, higher BMI is associated with poor muscle strength in both sexes.     

Association between body mass index and muscularity in healthy older Japanese women and men

Background

Body mass index (BMI), expressed as the ratio of body mass to height squared (kg/m²), involves not only fat but also lean mass. The present study aimed to clarify how BMI is associated with total muscle mass (TMM) in older Japanese women and men.

Findings

Using a B-mode ultrasound apparatus, muscle thickness was measured at nine sites (forearm, upper arm anterior and posterior, thigh anterior and posterior, lower leg anterior and posterior, abdomen, and subscapular) for 346 women (BMI 16.40 to 33.11 kg/m²) and 286 men (BMI 16.86 to 31.18 kg/m²) aged 60.0 to 79.5 yrs. TMM was estimated using the product of the sum of the muscle thicknesses at the nine sites with height as an independent variable. For both sexes, the estimated TMM relative to height squared was significantly correlated with BMI (r = 0.688, P<0.0001 for women; r = 0.696, P<0.0001 for men), but the percentage of the estimated TMM in body mass was not.

Conclusion

These results indicate that, for older Japanese women and men, BMI is a simple and convenient index for assessing total muscularity.     

Longitudinal changes in muscle power compared to muscle strength and mass

Objectives:The study reports longitudinal changes in grip strength, muscle mass and muscle power of lower extremities. The aim is to identify early muscular changes to improve the diagnosis and treatment of sarcopenia.Methods:Grip strength was measured by hand dynamometer, muscle mass by dual-energy X-ray absorptiometry and muscle power by performing a chair rise test and two-leg jumps (2LJP) on the Leonardo Mechanograph®. Longitudinal changes were analysed using paired t-tests by age group and sex. Differences between groups in terms of the annual change were tested by Analysis of Variance and the Dunnett’s test. Comparisons between the variables were performed using one sample t-tests.Results:Six-year changes were determined in 318 randomly selected healthy participants aged 20-90 years from Berlin. 2LJP declined significantly earlier in 20-39 years old women (-3.70 W/kg) and men (-5.97 W/kg, both p<0.001). This is an absolute annual decline of -0.46 W/kg in females and -0.75 W/kg in males. In the oldest age group, 2LJP showed the highest absolute annual loss with -0.99 W/kg in women and -0.88 W/kg in men. 2LJP was significantly different compared to all variables of muscle mass and strength (p<0.01).Conclusions:The results underline the importance of assessing muscle power using 2LJP during aging.     

Instrumental and Non-Instrumental Evaluation of 4-Meter Walking Speed in Older Individuals

BackgroundManual measurement of 4-meter gait speed by a stopwatch is the gold standard test for functional assessment in older adults. However, the accuracy of this technique may be biased by several factors, including intra- and inter-operator variability. Instrumental techniques of measurement using accelerometers may have a higher accuracy. Studies addressing the concordance between these two techniques are missing. The aim of the present community-based observational study was to compare manual and instrumental measurements of 4-meter gait speed in older individuals and to assess their relationship with other indicators of physical performance.MethodsOne-hundred seventy-two (69 men, 103 women) non-disabled community-dwellers aged ≥65 years were enrolled. They underwent a comprehensive geriatric assessment including physical function by Short Physical Performance Battery (SPPB), hand grip strength, and 6-minute walking test (6MWT). Timed usual walking speed on a 4-meter course was assessed by using both a stopwatch (4-meter manual measurement, 4-MM) and a tri-axial accelerometer (4-meter automatic measurement, 4-MA). Correlations between these performance measures were evaluated separately in men and women by partial correlation coefficients.ResultsIn both genders, 4-MA was associated with 4-MM (men r = 0.62, p<0.001; women r = 0.73, p<0.001), handgrip strength (men r = 0.40, p = 0.005; women r = 0.29, p = 0.001) and 6MWT (men r = 0.50, p = 0.0004; women r = 0.22, p = 0.048). 4-MM was associated with handgrip strength and 6MWT in both men and women. Considering gait speed <0.6 m/s as diagnostic of dismobility syndrome, the two methods of assessment disagreed, with a different categorization of subjects, in 19% of men and 23% of women. The use of accelerometer resulted in 29 (13 M, 16 F) additional diagnoses of dismobility, compared with the 4-MM.ConclusionsIn an older population, the concordance of gait speeds manually or instrumentally assessed is not optimal. The results suggest that manual measures might lead to misclassification of a substantial number of subjects. However, longitudinal studies using standardized and validated procedures aimed at the comparison of different techniques are needed before recommending the use of accelerometers in comprehensive geriatric assessment.     

Muscle quality. II. Effects of strength training in 65-to 75-yr-old men and women

To determine theeffects of strength training (ST) on muscle quality (MQ,strength/muscle volume of the trained muscle group), 12 healthy oldermen (69 ± 3 yr, range 65-75 yr) and 11 healthy older women (68 ± 3 yr, range 65-73 yr) were studied before and after aunilateral leg ST program. After a warm-up set, four sets ofheavy-resistance knee extensor ST exercise were performed 3 days/wk for9 wk on the Keiser K-300 leg extension machine. The men exhibitedgreater absolute increases in the knee extension one-repetition maximum(1-RM) strength test (75 ± 2 and 94 ± 3 kg before andafter training, respectively) and in quadriceps muscle volume measuredby magnetic resonance imaging (1,753 ± 44 and 1,955 ± 43 cm³) than the women (42 ± 2 and 55 ± 3 kg for the 1-RM test and 1,125 ± 53 vs.1,261 ± 65 cm³ forquadriceps muscle volume before and after training, respectively, inwomen; both P < 0.05). However,percent increases were similar for men and women in the 1-RM test (27 and 29% for men and women, respectively), muscle volume (12% forboth), and MQ (14 and 16% for men and women, respectively).Significant increases in MQ were observed in both groups in the trainedleg (both P < 0.05) and in the 1-RMtest for the untrained leg (both P < 0.05), but no significant differences were observed between groups,suggesting neuromuscular adaptations in both gender groups. Thus,although older men appear to have a greater capacity for absolutestrength and muscle mass gains than older women in response to ST, the relative contribution of neuromuscular and hypertrophic factors to theincrease in strength appears to be similar between genders.

     

Light Intensity Physical Activity and Sedentary Behavior in Relation to Body Mass Index and Grip Strength in Older Adults: Cross-Sectional Findings from the Lifestyle Interventions and Independence for Elders (LIFE) Study

BackgroundIdentifying modifiable determinants of fat mass and muscle strength in older adults is important given their impact on physical functioning and health. Light intensity physical activity and sedentary behavior are potential determinants, but their relations to these outcomes are poorly understood. We evaluated associations of light intensity physical activity and sedentary time—assessed both objectively and by self-report—with body mass index (BMI) and grip strength in a large sample of older adults.MethodsWe used cross-sectional baseline data from 1130 participants of the Lifestyle Interventions and Independence for Elders (LIFE) study, a community-dwelling sample of relatively sedentary older adults (70-89 years) at heightened risk of mobility disability. Time spent sedentary and in light intensity activity were assessed using an accelerometer worn for 3–7 days (Actigraph GT3X) and by self-report. Associations between these exposures and measured BMI and grip strength were evaluated using linear regression.ResultsGreater time spent in light intensity activity and lower sedentary times were both associated with lower BMI. This was evident using objective measures of lower-light intensity, and both objective and self-reported measures of higher-light intensity activity. Time spent watching television was positively associated with BMI, while reading and computer use were not. Greater time spent in higher but not lower intensities of light activity (assessed objectively) was associated with greater grip strength in men but not women, while neither objectively assessed nor self-reported sedentary time was associated with grip strength.ConclusionsIn this cross-sectional study, greater time spent in light intensity activity and lower sedentary times were associated with lower BMI. These results are consistent with the hypothesis that replacing sedentary activities with light intensity activities could lead to lower BMI levels and obesity prevalence among the population of older adults. However, longitudinal and experimental studies are needed to strengthen causal inferences.     

Identification of Hemoglobin Levels Based on Anthropometric Indices in Elderly Koreans

ObjectivesAnemia is independently and strongly associated with an increased risk of mortality in older people and is also strongly associated with obesity. The objectives of the present study were to examine the associations between the hemoglobin level and various anthropometric indices, to predict low and normal hemoglobin levels using combined anthropometric indices, and to assess differences in the hemoglobin level and anthropometric indices between Korean men and women.MethodsA total of 7,156 individuals ranging in age from 53–90 years participated in this retrospective cross-sectional study. Binary logistic regression (LR) and naïve Bayes (NB) models were used to identify significant differences in the anthropometric indices between subjects with low and normal hemoglobin levels and to assess the predictive power of these indices for the hemoglobin level.ResultsAmong all of the variables, age displayed the strongest association with the hemoglobin level in both men (p < 0.0001, odds ratio [OR] = 0.487, area under the receiver operating characteristic curve based on the LR [LR-AUC] = 0.702, NB-AUC = 0.701) and women (p < 0.0001, OR = 0.636, LR-AUC = 0.625, NB-AUC = 0.624). Among the anthropometric indices, weight and body mass index (BMI) were the best predictors of the hemoglobin level. The predictive powers of all of the variables were higher in men than in women. The AUC values for the NB-Wrapper and LR-Wrapper predictive models generated using combined anthropometric indices were 0.734 and 0.723, respectively, for men and 0.649 and 0.652, respectively, for women. The use of combined anthropometric indices may improve the predictive power for the hemoglobin level.DiscussionAmong the various anthropometric indices, with the exception of age, we did not identify any indices that were better predictors than weight and BMI for low and normal hemoglobin levels. In addition, none of the ratios between pairs of indices were good indicators of the hemoglobin level. Finally, the Korean men tended to have higher associations between the anthropometric indices and anemia than the women.     

Sarcopenic/Obesity and Physical Capacity in Older Men and Women: Data From the Nutrition as a Determinant of Successful Aging (NuAge)—the Quebec Longitudinal Study

Sarcopenia and obesity have been independently associated with physical capacity impairments. However, few studies have investigated the impact of sarcopenic/obesity on physical capacity in older individuals using objective measures of physical capacity and body composition. This study included 904 older individuals aged between 68 and 82 years old. Body composition (fat mass (FM) and lean body mass (LBM) by dual‐energy X‐ray absorptiometry (DXA)), physical capacity (timed up and go, chair stands, walking speed at normal and fastest pace, and one leg stand), sum of reported chronic conditions and physical activity level were measured. A global physical capacity score was then calculated giving a maximal score of 20. Finally, four groups were created within genders based on sarcopenia and obesity ((i) nonsarcopenic/nonobese; (ii) sarcopenic/nonobese; (iii) nonsarcopenic/obese; (iv) sarcopenic/obese). The four groups were significantly different for the sit‐to‐stand test and the one leg stand test (P < 0.05) and only for the one leg stand test in women (P < 0.05). In both genders results for the global physical capacity score revealed that both obese groups (sarcopenic and nonsarcopenic) were similar (P = 0.14 in men and P = 0.19 in women) and had a lower global physical capacity score compared to nonsarcopenic/nonobese individuals (P < 0.05). In addition, sarcopenic women displayed a higher score than both obese nonsarcopenic and obese sarcopenic groups (P < 0.01). Sarcopenic/obese men and women do not display lower physical capacity compared to nonsarcopenic/obese individuals in this cohort of well‐functioning older men and women. Obesity per se appears to contribute more to lower physical capacity than sarcopenia.     

Vitamin D and physical performance in elderly subjects: the Pro.V.A study

Background

The role of Vitamin D in musculoskeletal functionality among elderly people is still controversial. We investigated the association between serum 25-hydroxyvitamin D (25OHD) levels and physical performance in older adults.

Methods

2694 community-dwelling elderly women and men from the Progetto Veneto Anziani (Pro.V.A.) were included. Physical performances were assessed by: tandem test, 5 timed chair stands (TCS), gait speed, 6-minute walking (6 mW) distance, handgrip strength, and quadriceps strength. For each test, separate general linear models and loess plots were obtained in both genders, in relation to serum 25OHD concentrations, controlling for several potential confounders.

Results

Linear associations with 25OHD levels were observed for TCS, gait speed, 6 mW test and handgrip strength, but not for tandem test and quadriceps strength. After adjusting for potential confounders, linear associations with 25OHD levels were still evident for the 6 mW distance in both genders (p = .0002 in women; <.0001 in men), for TCS in women (p = .004) and for gait speed (p = .0006) and handgrip strength (p = .03) in men. In loess analyses, performance in TCS in women, in gait speed and handgrip strength in men and in 6 mW in both genders, improved with increasing levels of 25OHD, with most of the improvements occurring for 25OHD levels from 20 to 100 nmol/L.

Conclusion

lower 25OHD levels are associated with a worse coordination and weaker strength (TCS) in women, a slower walking time and a lower upper limb strength in men, and a weaker aerobic capacity (6 mW) in both genders. For optimal physical performances, 25OHD concentrations of 100 nmol/L appear to be more advantageous in elderly men and women, and Vitamin D supplementation should be encouraged to maintain their 25OHD levels as high as this threshold.     

Fat mass limits lower-extremity relative strength and maximal walking performance in older women

The purpose of this study was to determine if excess fat negatively affects relative strength and walking gait performance in overweight, older women. Twenty-five older women (65–80 yr) were separated into normal weight (BMI < 25 kg m⁻², n = 11) and overweight groups (BMI ? 25 kg m⁻², n = 14). Strength and rate of torque development (RTD) of the knee extensors and flexors, ankle plantarflexors and dorsiflexors were measured. Participants walked at standard and maximal speeds during which muscle activation, spatiotemporal and kinetic gait variables were measured. Relative to mass, overweight older women had 24% lower maximal torque and 38% lower RTD than normal weight women. Maximal walking speed was slower in overweight (1.25 ± 0.22 vs. 1.54 ± 0.25 m s⁻¹, P = 0.004) and was correlated to strength (r = 0.53, P < 0.01) and fat mass (r = −0.65, P = 0.001). At maximal speed, overweight had 11% lower vertical ground reaction force relative to mass, 8% slower stride rate, 12% shorter strides, 13% longer foot–ground contact times, 21% longer double-limb support times, 65% greater knee extensor and 78% greater plantarflexor activation (P < 0.05). Overweight, older women demonstrated altered gait and reduced walking performance related to poor relative strength and rate of torque development of lower-extremity muscles.     

Associations of calf inter- and intra-muscular adipose tissue with cardiometabolic health and physical function in community-dwelling older adults

Objectives:To determine associations of inter- and intra-muscular adipose tissue (IMAT) with cardiometabolic health and physical function in older adults.Methods:48 community-dwelling older adults aged ≥65 years (mean 71.6±4.8 years; 52% women) underwent whole-body dual-energy X-ray absorptiometry, to assess appendicular lean mass (ALM), and peripheral quantitative computed tomography (pQCT; 66% tibia), to assess calf IMAT cross-sectional area ([CSA]; cm²) and muscle density (mg/cm³; higher values indicate lower fat infiltration). Fasting glucose, lipids, triglycerides and C-reactive protein (CRP) were analysed. Physical function was assessed by postural sway (computerised posturography; N=41), and gait analysis (GAITRite Electronic Walkway; N=40).Results:Higher IMAT CSA and muscle density were associated with significantly higher (B=0.85 95%CI [0.34, 1.36]) and lower (-2.14 [-4.20, -0.08]) CRP and higher (0.93 [0.56, 1.30]) and lower postural sway (-3.12 [-4.74, -1.50]), respectively, after adjustment for age, sex and ALM/BMI. Higher IMAT CSA was associated with slower gait speed and cadence, and greater step time and step width (all P<0.03), while higher muscle density was associated with smaller step width (P<0.01) only.Conclusions:Older adults with higher calf IMAT have poorer balance, mobility and inflammatory status. Interventions aimed at improving physical function in older adults should incorporate strategies to reduce IMAT.     

Menopausal Status and Physical Performance in Middle Aged Women: A Cross-Sectional Community-Based Study in Northeast Brazil

Objective

To examine associations between menopausal status and physical performance in middle-aged women from the Northeast region of Brazil.

Methods

Cross-sectional study of women between 40 to 65 years old living in Parnamirim. Women were recruited by advertisements in primary care neighborhood centers across the city. Physical performance was assessed by grip strength, gait speed and chair stands. Menopausal status was determined using the Stages of Reproductive Aging Workshop classification and women were classified in: premenopausal, perimenopausal or postmenopausal. Multiple linear regression analyses were performed to model the effect of menopausal status on each physical performance measure, adjusting for covariates (age, family income, education, body mass index, parity and age at first birth).

Results

The premenopausal women were significantly stronger and performed better in chair stands than perimenopausal and postmenopausal women. Gait speed did not vary significantly by menopausal status. In multivariate analyses, menopausal status remained statistically significant only for grip strength. In fully adjusted analyses, premenopausal women had grip strength mean of 2.226 Kgf (95% CI: 0.361 – 4.091) higher than the postmenopausal group.

Conclusions

This study provides further evidence for the associations between menopause and physical performance in middle-aged women, since grip strength is weaker in peri and postmenopausal women compared to premenopausal, even adjusted for age and other covariates.     

Características de los programas de entrenamiento de fuerza muscular en personas mayores con sarcopenia. Revisión de alcance

ObjectiveThe aim of this scoping review was to analyze the resistance training-based programs’ characteristics and outcomes of physical and psychological health and cognitive functions measured in older adults with sarcopenia.MethodThis scoping review was carried out following the criteria and flow diagram established in the PRISMA guidelines and included studies from 2011 until 2020 from electronic databases, including PubMed, Scopus, and Web of Science.ResultsA total of 13 randomized controlled trials were included. The sample's average age was 72.2 years, with an age range between 71 and 80 years, considering a total sample of 1029 older adults (57% women). Resistance training-based programs were carried out mainly in university facilities, presented high adherence (91.2%) and were able to induce increase in strength and muscle mass. The most frequent parameters used were 2-3 weekly, 50-90-min-long sessions for 3-9 months, using between 8 and 15 repetitions, in an intense training zone with 1-RM between 60% and 85%. The most measured physical health outcomes were muscle strength, muscle mass, and BMI. Cognitive impairment was frequently evaluated, and few studies evaluated mental health.ConclusionThis review characterized resistance training-based programs in older people with sarcopenia, highlighting the extension, frequency, duration, and intensity of these, as well the most frequently used outcome measures and instruments. These results could be useful for prescribing future resistance training-based programs in older adults with sarcopenia.     

Age and sex differentially affect regional changes in one repetition maximum strength

To assess the influences of age and sex on regional changes in 1 repetition maximum (1RM) strength, 10 young men (20-30 years), 8 young women (20-30 years), 11 older men (65- 75 years), and 10 older women (65-75 years) were studied before and after a 24-week whole-body strength training program. Changes in 1RM strength were analyzed for each individual exercise, as well as by calculating a total body score (TBS), an upper body score (UBS), and a lower body score (LBS). The effect of age and sex on changes in 1RM strength was analyzed using a repeated measures analysis of variance. When changes in strength for individual exercises were analyzed, the chest press, lat pulldown, shoulder press, and triceps pushdown were affected by both age (p < 0.05) and sex (p < 0.05), while the biceps curls were only influenced by age (p < 0.05). For the lower body, the leg press changes in 1RM strength were influenced by age (p < 0.0001), while leg extension was influenced by sex (p < 0.05). Total body score, UBS, and LBS showed significant increases with 24 weeks of ST (p < 0.001, all). Changes in TBS and UBS were affected by age (p < 0.001, both) and sex (p < 0.05 and p < 0.001, respectively). Younger subjects showed a greater increase in strength than older subjects, and men showed a greater increase in strength compared with women. Changes in LBS were affected by age (p < 0.001), with younger subjects showing a greater increase in strength compared with the older subjects, but not by sex (p = 0.464). These data indicate that regional increases in strength are differentially affected by age and sex.     

Muscle Strength,Muscle Mass and Physical Impairment in Women with hypermobile Ehlers-Danlos syndrome and Hypermobility Spectrum Disorder

Objectives:To evaluate differences in physical impairment, muscle strength, muscle mass and muscle density between patients with hypermobile Ehlers Danlos Syndrome (hEDS), hypermobile spectrum disorder (HSD), and healthy controls.Methods:Female adults with hEDS (n=20) and HSD (n=23), diagnosed to the most recent criteria, and age-matched healthy controls (n=28) completed the Arthritis Impact Measurement Scale (physical functioning) and performed maximal muscle strength and strength endurance tests of lower and upper limbs (hand grip, posture maintenance, 30 seconds chair rise and isokinetic tests). Muscle mass and density were evaluated by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography.Results:No differences in physical functioning and muscle strength were found between adults with hEDS and HSD. Furthermore, no differences in muscle mass and density were observed between the three groups. Nevertheless, when both patient groups were compared to controls, physical functioning, maximal muscle strength and muscle strength endurance were significantly lower (all p<0.001), except for the hand flexors.Conclusion:Physical functioning, muscle strength, density and mass did not significantly differ between individuals with hEDS and HSD. Compared to controls, physical functioning and muscle strength (maximal and endurance) were significantly lower. Consequently, (functional) strength training in individuals with hEDS and HSD is necessary.