老年住院患者营养不良状况分析

目的:利用简易营养评价精法(short-form mini-nutritional assessment,MNA-SF)评价住院老年患者营养状况,并探讨老年患者营养状况与躯体功能的关系。方法:选取我院老年病及内科收治的年龄≥65岁的住院患者共104例,使用MNA-SF评价患者的营养状况,根据患者年龄、性别、慢性病等情况入组营养不良患者36例,营养良好患者68例,比较两组患者的饮食习惯、躯体功能,并对营养评分与握力、步速进行相关性分析。结果:与营养良好组相比,营养不良组进食肉食次数较少(16%vs 48%, P=0.012),握力[(11.67±9.89)kg vs (20.46±9.89)kg, P0.001]及步速(0.46±0.641m/s vs 1.16±0.65m/s,P0.001)均显著降低。老年住院患者MNA-SF得分与握力及步速呈显著正相关(r=0.562, P0.001)和(r=0.600,P0.001)。结论:住院老年患者的营养状况与进食肉食次数、握力和步速相关。     

The probability of conception after discontinuance of oral contraception: A note on “oral contraception,coital frequency,and the time required to conceive,” by Westoff,Bumpass, and Ryder

The apolipoprotein E (ApoE) gene, which has three common alleles (?2, ?3, and ?4), has been linked to a number of health outcomes and longevity. The ?2 allele has been reported to have neuroprotective effects, whereas the ?4 allele has been shown to be a risk factor for cardiovascular disease and Alzheimer's disease in various populations. The relationships between ApoE and mortality and ApoE and physical function, however, are not clear-cut. We used the Social Environment and Biomarkers of Aging Study (SEBAS) to examine the relationship between ApoE polymorphisms and physical and pulmonary function in approximately 1,000 Taiwanese adults aged 53 years and older in 2006. In the 2006 SEBAS wave, measures of physical function included self-reported difficulties with respect to activities of daily living (ADLs) and other physical function indicators, as well as performance-based measures of grip strength (kg), walking speed (m/s) over a distance of 3 m, and chair stand speed (stand/s). Peak expiratory flow (PEF; L/min) rate was also examined as an indicator of pulmonary function. We used logistic regression models to determine the association between ApoE and inability to complete each of the tests of physical and pulmonary function. These models revealed no significant association between ApoE carrier status and any of the indicators of function. Among participants able to complete a given task, we next used linear regression models to examine self-reported limitations with ADLs and performance on the given test by ApoE carrier status. Similarly, there were no significant relationships between ApoE carrier status and the measures of function. Our estimates provide further confirmation that the ApoE gene may not be a risk factor for functional decline among older Taiwanese adults.     

Validation of ACR/EULAR definition of remission in rheumatoid arthritis from RA practice: the ESPOIR cohort

Introduction

In development of the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) remission definitions using clinical trials data, one criterion used to compare different remission definitions was whether, compared with those not in remission, those in remission had evidence of later disease stability defined by x-ray and functional status. Validation of the RA remission criteria using observational study data is necessary before recommending their use in practice.

Methods

Using data from those who met RA criteria in the ESPOIR cohort, we matched each person in remission with a person not in remission and then carried out analyses comparing later stability of x-ray and health assessment questionnaire (HAQ) between the two groups. We compared the predictive validity of the same candidate definitions of remission evaluated in the ACR/EULAR process. To minimize potential bias and produce more stable results, we used a bootstrap resampling approach to select those not in remission, repeating the sample matching analysis process 500 times.

Results

Results were similar to those of clinical trials analyzed for the ACR/EULAR remission criteria. Specifically, the ACR/EULAR remission definitions using either an simple disease activity index (SDAI) ≤ 3.3, clinical disease activity index (CDAI) ≤ 2.8 or a definition of remission requiring tender joint count, swollen joint count, patient global assessment all ≤ 1 performed as well or better than other candidate definitions of remission in terms of predicting later x-ray and function stability.

Conclusions

ACR/EULAR definitions of remission developed for trials are similarly valid in observational studies in RA and could be used in practice.     

Functional Changes during Hospital Stay in Older Patients Admitted to an Acute Care Ward: A Multicenter Observational Study

Objectives

Changes in physical performance during hospital stay have rarely been evaluated. In this study, we examined functional changes during hospital stay by assessing both physical performance and activities of daily living. Additionally, we investigated characteristics of older patients associated with meaningful in-hospital improvement in physical performance.

Methods

The CRiteria to assess appropriate Medication use among Elderly complex patients project recruited 1123 patients aged ≥65 years, consecutively admitted to geriatric or internal medicine acute care wards of seven Italian hospitals. We analyzed data from 639 participating participants with a Mini Mental State Examination score ≥18/30. Physical performance was assessed by walking speed and grip strength, and functional status by activities of daily living at hospital admission and at discharge. Meaningful improvement was defined as a measured change of at least 1 standard deviation. Multivariable logistic regression models predicting meaningful improvement, included age, gender, type of admission (through emergency room or elective), and physical performance at admission.

Results

Mean age of the study participants was 79 years (range 65–98), 52% were female. Overall, mean walking speed and grip strength performance improved during hospital stay (walking speed improvement: 0.04±0.20 m/s, p<0.001; grip strength improvement: 0.43±5.66 kg, p = 0.001), no significant change was observed in activities of daily living. Patients with poor physical performance at admission had higher odds for in-hospital improvement.

Conclusion

Overall, physical performance measurements show an improvement during hospital stay. The margin for meaningful functional improvement is larger in patients with poor physical function at admission. Nevertheless, most of these patients continue to have poor performance at discharge.     

Age and gender differences in physical capability levels from mid-life onwards: the harmonisation and meta-analysis of data from eight UK cohort studies

Using data from eight UK cohorts participating in the Healthy Ageing across the Life Course (HALCyon) research programme, with ages at physical capability assessment ranging from 50 to 90+ years, we harmonised data on objective measures of physical capability (i.e. grip strength, chair rising ability, walking speed, timed get up and go, and standing balance performance) and investigated the cross-sectional age and gender differences in these measures. Levels of physical capability were generally lower in study participants of older ages, and men performed better than women (for example, results from meta-analyses (N = 14,213 (5 studies)), found that men had 12.62 kg (11.34, 13.90) higher grip strength than women after adjustment for age and body size), although for walking speed, this gender difference was attenuated after adjustment for body size. There was also evidence that the gender difference in grip strength diminished with increasing age,whereas the gender difference in walking speed widened (p<0.01 for interactions between age and gender in both cases). This study highlights not only the presence of age and gender differences in objective measures of physical capability but provides a demonstration that harmonisation of data from several large cohort studies is possible. These harmonised data are now being used within HALCyon to understand the lifetime social and biological determinants of physical capability and its changes with age.     

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.     

A 23-year study of mortality and development of co-morbidities in patients with obesity undergoing bariatric surgery (laparoscopic gastric banding) in comparison with medical treatment of obesity

Although obesity-related type 2 diabetes mellitus (T2DM) and sarcopenia in the elderly have been increasing worldwide, the associations among visceral fat accumulation, skeletal muscle indices (mass, strength, and quality) and cardiovascular diseases in T2DM remain poorly investigated. We enrolled 183 Japanese T2DM inpatients (126 men, 57 women; mean age 64.7 ± 12.6 years, ± SD). The estimated-visceral fat area (eVFA) and skeletal muscle mass were measured by each device using bioelectrical impedance analysis method. We also measured grip strength by dynamometer and motor nerve conduction velocity (MCV). We analyzed the difference in skeletal muscle indices between T2DM patients with and without visceral fat accumulation, and examined the impact of skeletal muscle indices on cardiovascular diseases in patients with visceral fat accumulation. The prevalence of sarcopenia defined by the Consensus of Asian Working Group for Sarcopenia and low skeletal muscle mass were both lower in the visceral fat accumulation (+) group than in (−) group. However, the prevalence of weak hand grip strength was similar in the visceral fat accumulation (−) and (+) groups, indicating that considerable patients with visceral fat accumulation had weak grip strength in spite of fair skeletal muscle mass. Muscle quality [grip strength (kg)/arm muscle mass (kg)] was significantly lower in patients with visceral fat accumulation. Multiple regression analysis identified eVFA, MCV and sex as significant and independent determinants of muscle quality. In visceral fat accumulation (+) group, the patients with low muscle quality had longer duration of diabetes, lower eGFR, higher serum adiponectin, lower MCV and higher prevalence of cardiovascular diseases, compared to the patients with high muscle quality. Finally, sex- and age-adjusted models showed significant association between low muscle quality and cardiovascular diseases in all subjects (odds ratio 2.28, p = 0.012), especially in patients with visceral fat accumulation (odds ratio 2.72, p = 0.018). T2DM patients with visceral fat accumulation had low muscle quality, and patients with low muscle quality were more affected with cardiovascular diseases.     

Sedentariness at Work: How Much Do We Really Sit?

Sedentariness is associated with obesity. We examined whether people with sedentary jobs are equally inactive during their work days and leisure days. We enrolled 21 subjects of varying weight and body fat (11 men:10 women, 38 ± 8 years, 83 ± 17 kg, BMI 28 ± 5 kg/m², 29 ± 11 fat kg, 35 ± 9% fat). All subjects continued their usual work and leisure‐time activities whilst we measured daily activity and body postures for 10 days. The data supported our hypothesis that people sit more at work compared to leisure (597 ± 122 min/day cf 484 ± 83 min/day; P < 0.0001). The mean difference was 110 ± 99 min/day. Similarly, work days were associated with less standing (341 ± 97 min/day; P = 0.002) than leisure days (417 ± 101 min/day). Although the walking bouts did not differ significantly between work and leisure (46 ± 9 vs. 42 ± 9 walking bouts/day); the mean free‐living velocity of a walk at work was 1.08 ± 0.28 mph and on leisure days was 0.94 ± 0.24 mph (P = 0.03) and the average time spent walking was 322 ± 91 min on work days and 380 ± 108 min on leisure days (P = 0.03). Estimates of the daily energetic cost of walking approximated 527 ± 220 kcal/day for work days and 586 ± 326 kcal/day for leisure days (r = 0.72, P < 0.001). Work days are associated with more sitting and less walking/standing time than leisure days. We suggest a need to develop approaches to free people from their chairs and render them more active.     

Physical Predictors of Cognitive Performance in Healthy Older Adults: A Cross-Sectional Analysis

There is ample evidence that physical and cognitive performance are related, but the results of studies investigating this relationship show great variability. Both physical performance and cognitive performance are constructs consisting of several subdomains, but it is presently unknown if the relationship between physical and cognitive performance depends on subdomain of either construct and whether gender and age moderate this relationship. The aim of this study is to identify the strongest physical predictors of cognitive performance, to determine the specificity of these predictors for various cognitive subdomains, and to examine gender and age as potential moderators of the relationship between physical and cognitive performance in a sample of community-dwelling older adults. In total, 98 men and 122 women (average age 74.0±5.6 years) were subjected to a series of performance-based physical fitness and neuropsychological tests. Muscle strength, balance, functional reach, and walking ability (combined score of walking speed and endurance) were considered to predict cognitive performance across several domains (i.e. memory, verbal attention, visual attention, set-shifting, visuo-motor attention, inhibition and intelligence). Results showed that muscle strength was a significant predictor of cognitive performance for men and women. Walking ability and balance were significant predictors of cognitive performance for men, whereas only walking ability was significant for women. We did not find a moderating effect of age, nor did we find support for a differential effect of the physical predictors across different cognitive subdomains. In summary, our results showed a significant relationship between cognitive and physical performance, with a moderating effect of gender.     

Causal associations of sarcopenia-related traits with cardiometabolic disease and Alzheimer's disease and the mediating role of insulin resistance: A Mendelian randomization study

The causal influence of sarcopenia on cardiometabolic disease and Alzheimer's disease and whether and to what extent insulin resistance plays a mediating role therein were unclear. We performed two-step, two-sample Mendelian randomization applying genetic instruments of sarcopenia-related traits based on GWASs from the UK Biobank (up to 461,026 European participants) to examine their causal associations with six cardiometabolic diseases and Alzheimer's disease extracted from large-scale European descent GWASs with adjustment for body fat percentage and physical activity, and to assess proportions of the causal effects mediated by insulin resistance. Genetic instruments of insulin resistance were derived from the GWASs by Meta-Analyses of Glucose and Insulin-related traits Consortium and Global Lipids Genetics Consortium. Each 1-SD lower grip strength, appendicular lean mass (ALM) and whole-body lean mass (WBLM), as well as lower walking pace, were causally associated with higher risks of diabetes (odds ratio [OR] range: 1.20 [95% confidence interval: 1.10–1.32] for ALM to 2.30 [1.14–4.68] for walking pace), nonalcoholic fatty liver disease ([NAFLD], 1.33 [1.08–1.64] for ALM to 2.30 [1.02–5.18] for grip strength), hypertension (1.12 [1.05–1.20] for ALM to 4.43 [2.68–7.33] for walking pace), coronary heart disease ([CHD], 1.20 [1.13–1.27] for ALM to 2.73 [1.84–4.05] for walking pace), myocardial infarction ([MI], 1.18 [1.11–1.25] for ALM to 2.47 [1.63–3.73] for walking pace), small vessel stroke (1.25 [1.15–1.37] for ALM to 1.29 [1.10–1.52] for WBLM), and Alzheimer's disease (1.10 [1.05–1.15] for ALM to 1.28 [1.19–1.38] for WBLM). These causal associations were largely independent of body fat percentage and physical activity. Insulin resistance mediated 16%–34% of the effect of grip strength and 7%–28% of the effect of ALM on diabetes, NAFLD, hypertension, CHD, and MI. The direct effect of WBLM on diabetes diminished toward null with adjustment for insulin resistance. We found no evidence that insulin resistance was on the causal pathways from walking pace to the studied disease outcomes. Causal findings from the inverse-variance weighted method were validated by sensitivity analyses. These findings support improving sarcopenia-related traits as precautions against major cardiometabolic diseases and Alzheimer's disease, with particular emphasis on insulin resistance as a target in the intervention of sarcopenia-related cardiometabolic risk.     

Forearm electromyographic activity during the deadlift exercise is affected by grip type and sex

Muscle activation, peak velocity (PV) and perceived technical difficulty while using three grip variations and three loads during a deadlift exercise (DL) were examined. Twenty-nine resistance-trained athletes (15 males, age: 22.2 ± 2.7 years; 14 females, age: 24.8 ± 7.0 years) performed the DL with 50%, 70% and 90% of their one repetition maximum (1RM) using hook grip (HG), mixed grip (MG) and double overhand (DOH) grip. Surface electromyography (EMG) of the brachialis (BS), brachioradialis (BR) and flexor carpi ulnaris (FCU) was recorded. PV and perceived technical difficulty of each grip were also measured. Regardless of load and grip, females exhibited greater BS activation compared to males (p < 0.05; ES = 0.69) while males displayed greater BR activation, significant at 90% load (p < 0.01; ES = 1.01). MG elicited the least BR and FCU activation regardless of load and sex (p < 0.01; ES = 0.64–0.68) and was consistently ranked as the easiest grip for any load. Males achieved significantly greater PV than females at 50% and 70% (p < 0.01; ES = 1.72–1.92). Hand orientation did not significantly impact PV. A MG may be beneficial in reducing the overall perceived technical difficulty when performing a maximal DL. Athletes aiming to maximise muscle activation and potentially develop their grip strength should utilise a DOH grip or HG.     

Childhood socioeconomic position and objectively measured physical capability levels in adulthood: a systematic review and meta-analysis

Background

Grip strength, walking speed, chair rising and standing balance time are objective measures of physical capability that characterise current health and predict survival in older populations. Socioeconomic position (SEP) in childhood may influence the peak level of physical capability achieved in early adulthood, thereby affecting levels in later adulthood. We have undertaken a systematic review with meta-analyses to test the hypothesis that adverse childhood SEP is associated with lower levels of objectively measured physical capability in adulthood.

Methods and Findings

Relevant studies published by May 2010 were identified through literature searches using EMBASE and MEDLINE. Unpublished results were obtained from study investigators. Results were provided by all study investigators in a standard format and pooled using random-effects meta-analyses. 19 studies were included in the review. Total sample sizes in meta-analyses ranged from N = 17,215 for chair rise time to N = 1,061,855 for grip strength. Although heterogeneity was detected, there was consistent evidence in age adjusted models that lower childhood SEP was associated with modest reductions in physical capability levels in adulthood: comparing the lowest with the highest childhood SEP there was a reduction in grip strength of 0.13 standard deviations (95% CI: 0.06, 0.21), a reduction in mean walking speed of 0.07 m/s (0.05, 0.10), an increase in mean chair rise time of 6% (4%, 8%) and an odds ratio of an inability to balance for 5s of 1.26 (1.02, 1.55). Adjustment for the potential mediating factors, adult SEP and body size attenuated associations greatly. However, despite this attenuation, for walking speed and chair rise time, there was still evidence of moderate associations.

Conclusions

Policies targeting socioeconomic inequalities in childhood may have additional benefits in promoting the maintenance of independence in later life.     

Hip kinematics and kinetics in total hip replacement patients stratified by age and functional capacity

To examine functional differences in total hip replacement patients (THR) when stratified either by age or by functional ability as defined by self-selected walking speed. THR patients and a control group underwent three-dimensional motion analysis under self-selected normal and fast walking conditions. Patients were stratified into five age groups for comparison with existing literature. The THR cohort was also stratified into three functional groups determined by their self-selected gait speed (low function <1SD of total cohort’s mean walking speed; high function >1SD; normal function within 1SD). Hip kinematics, ground reaction forces, joint moments and joint powers in all three planes (x-y-z) were analysed. 137 THR and 27 healthy control patients participated. When stratified by age, during normal walking the youngest two age groups walked quicker than the oldest two groups (p < 0.0001) but between-group differences were not consistent across age strata. The differences were diminished under the fast walking condition. When stratified by function, under normal walking conditions, the low function and normal function THR groups had a reduced extension angle (mean = 1.75°, SD = ±7.75, 1.26° ± 7.42, respectively) compared to the control group (−6.07° ± 6.43; p < 0.0001). The low function group had a reduced sagittal plane hip power (0.75 W/kg ± 0.24), reduced flexor (0.60 Nm/kg ± 0.85) and extensor moment (0.51 Nm/kg ± 0.17) compared to controls (p < 0.0001). These differences persisted under the fast walking condition. There were systematic differences between patients when stratified by function, in both walking conditions. Age-related differences were less systematic. Stratifying by biomechanical factors such as gait speed, rather than age, might be more robust for investigating functional differences.     

Plasma heat shock protein 72 as a biomarker of sarcopenia in elderly people

Sarcopenia is a geriatric syndrome in which there is a decrease of muscle mass and strength with aging. In age-related loss of muscle strength, there are numerous observations supporting the assertion that neural factors mediate muscle strength. A possible contributing cause may be that aging changes systemic extracellular heat shock protein (eHsp)72 activity. The present study was designed to assess the plasma levels of eHsp72 in elderly people and to investigate its potential interaction with components of sarcopenia. A total of 665 men and women participated in an official medical health examination and an integrated health examination, including psychological and physical fitness tests. Blood samples were assayed for levels of plasma Hsp72, serum C-reactive protein, interleukin 6, tumor necrosis factor α, and regular biomedical parameters. We found that higher Hsp72 in plasma is associated with lower muscle mass, weaker grip strength, and slower walking speed, and may be a potential biomarker of sarcopenia in elderly people. This finding was supported by other results in the present study: (1) older age and shrinking body and lower hemoglobin levels, all of which characterize sarcopenia, were related to higher eHsp72 tertiles and (2) the ORs of the highest tertile of eHsp72 for the lowest tertiles of muscle mass, grip strength, and walking speed were 2.7, 2.6, and 1.8, respectively. These ORs were independent of age, sex, and the incidence of related diseases. Our results would reveal that eHsp72 in plasma is linked to sarcopenia factors and is a potential biomarker or predictor of sarcopenia.     

Telomere Length and Physical Performance at Older Ages: An Individual Participant Meta-Analysis

Background

Telomeres are involved in cellular ageing and shorten with increasing age. If telomere length is a valuable biomarker of ageing, then telomere shortening should be associated with worse physical performance, an ageing trait, but evidence for such an association is lacking. The purpose of this study was to examine whether change in telomere length is associated with physical performance.

Methods

Using data from four UK adult cohorts (ages 53–80 years at baseline), we undertook cross-sectional and longitudinal analyses. We analysed each study separately and then used meta-analytic methods to pool the results. Physical performance was measured using walking and chair rise speed, standing balance time and grip strength. Telomere length was measured by quantitative real-time polymerase chain reaction (PCR) in whole blood at baseline and follow-up (time 1, time 2).

Results

Total sample sizes in meta-analyses ranged from 1,217 to 3,707. There was little evidence that telomere length was associated with walking speed, balance or grip strength, though weak associations were seen with chair rise speed and grip strength at baseline (p = 0.02 and 0.01 respectively). Faster chair rise speed at follow-up, was associated with a smaller decline in telomere length between time 1 and time 2 (standardised coefficient per SD increase 0.061, 95% CI 0.006, 0.115, p = 0.03) but this was consistent with chance (p = 0.08) after further adjustment.

Conclusions

Whereas shortening of leukocyte telomeres might be an important measure of cellular ageing, there is little evidence that it is a strong biomarker for physical performance.     

Nordic Walking Improves Cardiometabolic Parameters,Fitness Performance,and Quality of Life in Older Adults With Type 2 Diabetes

ObjectiveTo assess the effect of Nordic walking (NW) on cardiometabolic health, physical performance, and well-being in sedentary older adults with type 2 diabetes (T2D).MethodsFifteen subjects with T2D (female, 5; male, 10; age, 65 ± 6.2 years [mean ± standard deviation]; body mass index, 27.3 ± 4.9 kg/m² [mean ± standard deviation]) were enrolled in a 6-month NW training program. The fasting glucose and glycosylated hemoglobin levels, lipid profile (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides), systolic blood pressure (SBP), and diastolic blood pressures were measured before and after the intervention. Participants’ quality of life (Short-Form Health Survey) and physical fitness (6-minute walking test) were also evaluated.ResultsCompared with baseline, NW significantly improved the fasting glucose level (103.5 ± 18.5 vs 168.7 ± 37.7 mg/dL, P = .01), SBP (121.8 ± 12.2 vs 133 ± 14.4 mm Hg, P = .02), physical fitness (759.88 ± 69 vs 615.5 ± 62.6 m, P < .001), and both mental health (54.5 ± 4.4 vs 45.7 ± 5.6, P < .01) and physical health (49.8 ± 4.7 vs 40.3 ± 5.9, P < .01). The levels of glycosylated hemoglobin (6.15% ± 0.8% vs 6.4% ± 1%, P = .46), total cholesterol (162.2 ± 31.2 vs 175.5 ± 28.8 mg/dL, P = .13), low-density lipoprotein cholesterol (95.2 ± 24.2 vs 106.3 ± 32.3 mg/dL, P = .43), and triglycerides (135.5 ± 60.8 vs 127.6 ± 57.4 mg/dL, P = 0.26) improved without reaching significance.ConclusionNW training improved the glycemic levels, SBP, physical fitness, and perception of quality of life in older adults with T2D. NW represents a suitable complementary strategy to improve the global health status in this population.     

Effect of grip strength and grip strengthening exercises on instantaneous bat velocity of collegiate baseball players

Bat velocity is considered to be an important factor for successful hitting. The relationship between grip strength and bat velocity has not been conclusively established. The purposes of this study were to determine the relationship of grip strength to bat velocity and to ascertain whether the performance of resistance training exercises designed to specifically target the forearms and grip would significantly alter bat velocity. The subjects for this study were 23 male members (mean +/- SD, age = 19.7 +/- 1.3 years, height = 182.5 +/- 5.9 cm, weight = 85.4 +/- 15.5 kg, experience = 14.4 +/- 1.7 years) of a varsity baseball team at a National Collegiate Athletic Association Division II school. The Jamar hand dynamometer was used to test grip strength, and the SETPRO Rookie was used to measure instantaneous bat velocity at the point of contact with the ball. Subjects were randomly divided into an experimental group and a control group. For 6 weeks, both groups participated in their usual baseball practice sessions, but the experimental group also performed extra forearm and grip strengthening exercises, whereas the control group did not. Pretest and posttest correlations between grip strength and bat velocity revealed no significant relationship between grip strength and bat velocity (pretest r = 0.054, p = 0.807; posttest r = 0.315, p = 0.145). A dependent t-test performed on all subjects revealed that a significant (p = 0.001) increase in bat velocity did occur over the course of the study. A covariate analysis, employing pretest bat velocity as the covariate, revealed no significant difference (p = 0.795) in posttest bat velocity scores between the experimental and control groups. Thus, increases in bat velocity occurred, but the differences were similar for both the experimental and control groups. The findings of this study suggest that grip strength and bat velocity are not significantly related, and that the allocation of time and energy for added training of the forearms in order to improve grip strength for the purpose of increasing bat velocity may not be warranted.     

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.     

食管癌切除术患者运动能力、肌肉力量和生活质量的相关性分析

摘要 目的：探讨食管癌患者术前功能锻炼能力、肌力、焦虑、抑郁和健康相关生活质量（QOL）的特点,并评估食管癌根治术对这些参数的影响。方法：我们对2019年1-12月36例新诊断的可切除食管癌患者进行回顾性分析,这些患者接受了食管切除术并进行了术后康复治疗。术前、术后2周分别进行6 min步行距离（6MWD）、膝伸肌肌力、握力、医院焦虑抑郁量表（HADS）和慢性阻塞性肺疾病（COPD）评定量表（CAT）测试。术前进行肺功能测试,并对MOS 36项目健康问卷（SF-36）的组成部分进行一般健康评定。结果：患者平均年龄66.1±9.2岁。患者以男性为主（75.0%）,有较高的吸烟史（80.6%）,鳞状细胞癌（94.4%）。COPD 15例。临床分期：0-I期11例,II期6例,III期15例,IV期4例。29例行开腹手术。SF-36评分的组成部分与CAT和HADS评分显著相关,COPD患者的身体状况明显差于非COPD患者（P<0.05）。比较术前和术后的数值,发现术后6MWD、握力、等长膝伸肌肌力显著降低,CAT评分显著升高（P<0.05）,HADS评分无明显升高（P>0.05）。在多元回归分析中,术后6MWD的下降与术前SF-36的生理成分总结显著相关。结论：从微创手术和围手术期处理的角度来看,有必要进一步改进围手术期的康复。在手术后两周,食管切除术对健康相关的QOL和身体健康有害,需建立围手术期康复策略,以改善术后结果。     

Toward a realistic optoelectronic-based kinematic model of the hand: representing the transverse metacarpal arch reduces accessory rotations of the metacarpophalangeal joints

A kinematic model representing the versatility of the human hand is needed to evaluate biomechanical function and predict injury risk in the workplace. We improved upon an existing optoelectronic-based kinematic hand model with grouped metacarpals by defining segmented metacarpals and adding the trapeziometacarpal joint of the thumb. Eight participants performed three static postures (neutral pose, cylinder grip, cap grip) to evaluate kinematic performance of three different models, with one, two, and four metacarpal segment(s). Mean distal transverse metacarpal arch angles in the four-segment metacarpal model were between 22.0° ± 3.3° (neutral pose) and 32.1° ± 3.7° (cap grip). Representation of the metacarpals greatly influenced metacarpophalangeal joint rotations. Both the two- and four-segment metacarpal models displayed significantly lower metacarpophalangeal joint ‘supination’ angles (than the one-segment model) for the fourth and fifth fingers. However, the largest reductions were for the four- versus one-segment models, with mean differences ranging from 9.3° (neutral pose) to 17.0° (cap grip) for the fourth finger and 16.3° (neutral pose) to 33.0° (cylinder grip) for the fifth finger. MCP joint abduction/adduction angles of the fourth and fifth fingers also decreased with segmentation of the metacarpals, although the lowest magnitudes generally occurred in the four-segment model. Overall, the four-segment metacarpal model produced the lowest accessory rotations in non-dominant axes, and best matched previous radiological studies that found MCP joint pronation/supination angles were typically less than 10°. The four-segment metacarpal model, with improved anatomic fidelity, will better serve future studies of detailed actions of the hand in clinical or work applications.