Sarcopenic dysphagia is described as difficulty swallowing due to generalized sarcopenia of skeletal muscles and thus swallowing muscles. It is a recently recognized condition. It draws attention due to its important complications.The risk factors of dysphagia include age, history of clinical disease, and physical frailty, including reduced activities of daily living. It is a common syndrome among the elderly and demands multidisciplinary therapeutic interventions, including nutritional support and rehabilitation programs, which are non-invasive but effective methods, mandatory for the best outcome. The prevention, assessment, and intervention methods for sarcopenic dysphagia are very important. Recent studies demonstrate that new concepts in rehabilitation and nutritional support render promising results.

In clinical practice, hip fracture is a very common reason for hospital admission in the elderly. Most subjects over the age of 65 years, experience an injury at the hip mostly after a fall. Many elderly persons suffer from osteoporosis, which is characterised by loss of bone mass and deterioration of bone microarchitecture thus increasing the susceptibility to fracture. Osteoporosis is defined by WHO as a Bone Mineral Density (BMD) of 2.5 standard deviations (SD) below that of a young adult as assessed by dual energy x-ray absorptiometry (DXA). It has been shown that some patients with a hip fracture have either normal or "osteopenic" hips as defined by DXA (-2.5<T-score<1). Other diseases that usually affect the elderly population may constitute independent risk factors for falls and fractures, such as diabetes mellitus, neurologic conditions, sarcopenia, use of medication. The clinician"s role apart from treating osteoporosis is also to address secondary causes related to increase risk of fracture including falls in order to decrease the incidence of hip fractures. This article addresses some common pathological conditions that have been shown to predispose for hip fractures individuals regardless of their DXA BMD status.

Homozygous beta-thalassemia represents a serious hemoglobinopathy, in which an amazing prolongation in the survival rate of patients has been achieved over recent decades. A result of this otherwise positive evolution is the fact that bone problems have become a major issue in this group of patients. Through an in-depth review of the related literature, the purpose of this study is to present and comment on the totality of the data that have been published to date pertaining to the prevention and treatment of thalassemia bone-disease, focusing on: the contribution of diet and lifestyle, the treatment of hematologic disease and its complications, the management of hypercalciuria, the role of vitamins and minerals and the implementation of anti-osteoporosis medical regimen. In order to comprehensively gather the above information, we mainly reviewed the international literature through the PubMed database, searching for the preventive and therapeutic data that have been published pertaining to thalassemia bone-disease over the last twenty-nine years. There is no doubt that thalassemia bone-disease is a complication of a multi-factorial etiopathology, which does not follow the rules of classical postmenopausal osteoporosis. Bisphosphonates have been the first line of treatment for many years now, with varied and usually satisfactory results. In addition, over the last few years, more data have arisen for the use of denosumab, teriparatide, and other molecules that are in the clinical trial phase, in beta-thalassemia.

Objectives: This pilot study aimed to evaluate the effect of a sedentary behaviour (SB) reduction intervention (Stomp Out (Prolonged) Sitting (SOS)) in frail older adults. Methods: Participants (>65years) were recruited from sheltered housing complexes and randomized into 2 groups. On weeks 2, 6 and 10 both groups had face-to-face 40min motivational sessions, including feedback on physical function and SB. One group had the addition of real-time tactile feedback on sitting. Total sedentary time and patterns of SB were recorded by activPAL, along with validated measures of function: Timed Up and Go (TUG), Sit-to-Stand (STS) and balance tests. Outcomes were analyzed by intention-to-treat mixed model analysis. Results: Twenty-three participants started the SOS intervention. Health issues led to high attrition in this frail population. TUG (4 seconds faster) and STS (>2 rises more in 30 seconds) scores improved significantly in both groups. There were no significant changes in SB parameters. Conclusion: Motivational interviewing alongside functional test feedback, visual and real-time feedback on SB improved physical function over the study. This pilot study suggests that sit-to-stand transitions to break prolonged sitting time may help reduce frailty and functional decline in people who are often unable to engage in more intense exercise interventions.

The need to be fit, strong, fast and agile has been an evolutionary requirement since early history. In this paper we identify the effectiveness of different types of physical activity on muscle, bone and balance outcomes, and what types of physical activity contribute to the development and maintenance of these outcomes. We undertook a purposive search of PubMed, international evidence reviews of physical activity, and asked international experts to identify review level relevant literature on the effectiveness of muscle, bone and balance training and physical activity on health outcomes. We found consistent review level evidence that strength/resistance training as a single intervention or in combination with other activities, two/three occasions per week, were effective for muscular strength, with higher intensities of training producing greater gains. We found consistent review level evidence that strength training as a single intervention or in combination with high impact loading activities taken at least 3 times per week were effective for bone health. Physical activities with a high challenge to balance done in standing three times per week were beneficial for balance training and falls reduction. The current UK 2011 Chief Medical Officer’s physical activity guidelines remain consistent with the most up to date review level evidence for muscle and balance health.

Many activities of daily living require muscular strength and power as well as balance. Consequently, preserving musculoskeletal function is a prerequisite for maintaining mobility and independent living during ageing. Estimates suggest that the prevalence of physical activity guidelines for strength and balance is low. Review of reviews of: a) observation studies of the prospective association between measures of musculoskeletal fitness and health outcomes and b) randomised controlled trials of resistance, balance and skeletal impact training exercises on bone health, risk of falls, physical function, motor and cognitive function, quality of life and activities of daily living. Preserving muscular strength/power in middle and older age is associated with a reduced risk of all-cause and cardiovascular mortality. Impaired muscular strength/power and balance is associated with an increased risk of falls and lower bone mineral content. Regular supervised exercise incorporating high intensity resistance training, vertical impacts and a balance challenge are most likely to be beneficial to health and wellbeing, bone health and reduce the risks of falls. Adults in late middle and older age would benefit from a regular program of exercise that incorporates high intensity resistance training, impact exercises and balance challenges.

This narrative review focuses on the role of strength and balance activities throughout the lifecycle to improve physical capacity and reduce all-cause mortality. The evidence suggests strong associations in middle and older age, with poor balance, poor strength or poor physical function having strong associations with mortality. Currently in the UK, the proportions of adults (69% of men and 76% of women) not meeting the strength and balance guidelines (of 2 or more sessions/week) is concerning. This report identifies specific time points in the lifecycle where specific promotion of and engagement with strength and balance activities would be most beneficial for health: 18-24y to maximize bone and muscle mass gains, 40-50y to maintain strength and reduce that downward cycle, and over 65s to preserve balance and strength and maintain independence). This review also suggests specific transition points/events in life where there may be an increase in sedentary behaviour or loss of muscle function (pregnancy, menopause, onset of on diagnosis of disease, retirement, on becoming a carer and following hospitalization), where it would be useful to initiate additional strength and balance exercises to improve future health outcomes.

Physical activity guidelines advocate the inclusion of strength and balance activities, twice a week, for adults and older adults, but with caveat that in some individuals there will be certain movements and activities that could lead to adverse events. This scoping review summarizes the evidence about how safe and efficacious these activities are in older adults with specific challenges that might make them more prone to injury (e.g. having recently fractured or at risk of fracture (osteoporosis) or those who are frail or who have cognitive impairment). The review identified that for prevention of falls in people with a falls history and/or frailer older adults, structured exercise programmes that incorporate progressive resistance training (PRT) with increasing balance challenges over time are safe and effective if performed regularly, with supervision and support, over at least 6 months. Some minor adverse effects mainly transient musculoskeletal pain) have been reported. For those with a higher risk of falls and fractures (very poor balance, vertebral fractures), supervised structured exercise programmes are most appropriate. People with diagnosed osteoporosis should be as active as possible and only avoid activities with a high risk of falls if they are naive to those activities. For those in transition to frailty who have poor strength and balance, exercises that are known to help maintain strength and balance (such as Tai Chi) are effective in preventing a decline in falls risk. For the very frail older adult, supervised structured exercise that has PRT, balance training and some endurance work, supervised and progressed by a trained person are advocated.

Objectives: This review sought to investigate the question: what are the key barriers to, and enablers for, older adults undertaking muscle strengthening and balance activities, and how can these be addressed by individuals and practitioners? Methods: A search of PubMed for review-level evidence on professional and personal barriers and motivators for strength and balance activities among older people. Results: The search and expert consultation found 46 studies; after screening, twelve papers were included. Many of the barriers and motivators to strength and balance activities are familiar ones that can also apply to physical activity more generally, such as not having the time. More specific barriers to strength and balance activities for older people were perceived risk of a heart attack, stroke, or death, and fear of looking too muscular; with motivators being improved ability to complete daily activities, preventing deterioration and disability, and decreasing the risk or fear of falling. Conclusions: This review of reviews has found a small but consistent body of literature describing the motivators and barriers to older adults taking part in strength and balance activities. This may be used as the basis for planning and delivering physical activity programmes for older adults.

Introduction: Despite the importance of muscle strengthening and balance activities for health, these elements of the physical activity recommendations are often omitted from communication campaigns and national surveillance systems. This paper reviews national physical activity surveillance systems to determine which tools assess muscle strengthening and balance activities. Methods: We reviewed each tool that was used to inform the Global Observatory for Physical Activity (GoPA) country card prevalence estimates. Results: Of the 139 countries with GoPA country cards, 21 countries reported having no physical activity prevalence data. The prevalence estimates for 74 countries came from the World Health Organization 2014 Global Status Report on Non-Communicable Diseases. For the remaining 44 countries, a range of national and international surveys were used. A limited number of tools sought to assess muscle strengthening activities, and even fewer assessed balance and coordination activities. Discussion: Several issues arise from this review, including the need to: verify the strength of the evidence to inform whether muscle strength and balance should be given equal prominence to the aerobic recommendation; establish which activities count towards different aspects of the guidelines; and confirm whether the muscle strengthening and balance components of the guidelines are ‘in addition’ to the aerobic component.

On July 13^th 2010, Lazlo Andor (Commissioner for Employment, Social Affairs and Inclusion) declared that active ageing could make the baby-boomers generation a part of the solution of the demographic problem, instead of identifying with it. This is the reason why the “Europe 2020” strategy draws the attention to the necessity of ensuring that the elderly will remain healthy and active for as long as possible. The purpose of this article is to define the exact concept of “active ageing”, its content, as well as some beneficial tips by applying innovative programs in order to promote it in the European Union. Reading the published papers the impression is that despite the increasing number of the elderly in Europe, the potential of an active life while ageing can be beneficial in many ways for the society. It is required that the local and regional authorities create the appropriate conditions for participation, while making thoughtful use of the European funding programs.

Objectives: Sarcopenia is characterised by loss of skeletal muscle mass and strength with adverse outcomes: physical disability, poor quality of life and death. Low muscle mass and strength are risk factors for falls, although there are few data available on the prevalence of sarcopenia in fallers. This study aimed to determine prevalence of sarcopenia in older people referred to a falls clinic. Methods: Consecutive patients referred to a secondary care falls unit were recruited. Sarcopenia was diagnosed using the European Working Group on Sarcopenia definition (low muscle mass and function) and cut-off points. Bio-impedance measured appendicular skeletal muscle mass. Gait speed and grip strength were functional measures. Results: Fifty-eight patients were recruited. Mean (SD) grip strength for women and men respectively were 17.9 (4.9) and 29.9(8.7) kg, mean (SD) gait speeds were 0.61(0.18) and 0.72 (0.4) m/s, mean (SD) appendicular skeletal muscle index in women and men were 6.98(1.0) and 7.85 (1.0) kg/m² (p=0.018). Prevalence of sarcopenia was 9.8% (95% CI=1.6%-18%). Conclusions: Sarcopenia, as measured by bio-impedance is not uncommon in older people accessing a secondary care falls clinic. Bio-impedance was simple to perform, although further validation against gold standard methods is needed. As nutritional and exercise interventions for sarcopenia are available, simple methods for diagnosing sarcopenia in fallers should be considered.

Background: There is a growing demand for long-term care settings. Care-home residents are a vulnerable group with high levels of physical dependency and cognitive impairment. Long-term care facilities need to adapt and offer more effective and sustainable interventions to address older residents’ complex physical and mental health needs. Despite the increasing emphasis on patient and public involvement, marginalised groups such as care-home residents, can be overlooked when including people in the research process. The GET READY project aims to integrate servicelearning methodology into Physical Therapy and Sport Sciences University degrees by offering students individual service opportunities with residential care homes, in order to co-create the best suited intervention with researchers, older adults of both genders (end-users) in care homes, health professionals, caregivers, relatives and policy makers. Methods: Stage 1 will integrate a service-learning methodology within a Physical Therapy module in Glasgow and Sport Sciences module in Barcelona, design two workshops for care home residents and one workshop for staff members, relatives and policy makers and conduct a co-creation procedure. Stage 2 will assess the feasibility, safety and preliminary effects of the co-created intervention in a group of 60 care home residents, within a two-armed pragmatic randomized clinical trial. ClinicalTrials.gov Identifier: NCT03505385.

Sarcopenia and osteoporosis are two major health problems worldwide, responsible for a serious clinical and financial burden due to the increasing life expectancy. Both when presented as a single entity and, in particular, in the form of “osteosarcopenia”, they lead to an important increased risk of falls, fractures, hospitalization and mortality. In dealing with these two pathological conditions, it is important to understand that between bone and muscle there is not only a functional correlation but also a close relationship in the development and in maintenance, which is well expressed by the concept of “bone-muscle unit”. This close relationship agrees with the existence of a linear association between sarcopenia and osteoporosis, in particular in elderly population. It is mandatory, in the clinical assessment of both diseases, to do an early diagnosis or to delay as far as possible the appearance of an established form in order to prevent the onset of complications. The aim of this review is to present the different imaging modalities available for a non-invasive investigation of bone and muscle mass and quality in osteoporosis and sarcopenia, with their application and limitations.

The purpose of this review is to examine the correlation between tobacco smoking and hip fractures. The literature that was used for this article was based on studies that investigated not only the direct correlation between smoking and hip fractures but also the effect of smoking on bone mineral density. In general, the incidence of hip fracture was found to be higher in current smokers in both genders. Compared with never smokers, former smokers had a slightly higher risk of hip fracture that was inversely proportional to the cessation span. The relative risk (RR) of hip fracture in current male smokers was higher than the RR for nonsmokers (never and former smokers). In postmenopausal women former and current smoking increased the RR. In premenopausal and postmenopausal women, cessation of smoking decreases the risk of hip fracture. Risk rises with greater cigarette consumption. Risk declines among former smokers, but the benefit is not observed until 10 years after cessation.

Objectives: We conducted a systematic review to identify adverse effects of physical activity and/or exercise for adults with osteoporosis/osteopenia. We synthesised evidence from observational studies, and updated three previously published systematic reviews. Methods: We searched MEDLINE, EMBASE, CINAHL, Web of Science, grey literature and reference lists of relevant studies. Selection criteria were: (1) observational studies in patients with osteoporosis/osteopenia; and (2) in accordance with the criteria used in the previous reviews. A narrative synthesis was conducted for the observational data. Random effects meta-analysis was undertaken for the review updates. Results: For the observational synthesis 14 studies were included. The majority of studies reported no adverse events, reduced incidence/improvement, or no significant change after physical activity or exercise. Activities that involved spinal flexion (certain yoga moves and sit-ups) were associated with a greater risk of vertebral fractures but these events were rare. For the update of reviews, 57 additional studies were identified. Exercise was generally associated with a greater number of minor adverse events including mild muscle/joint pain. Serious adverse events were rare and could not be attributed to the intervention. Conclusion: Patients with osteoporosis/osteopenia can safely participate in structured exercise programmes, whether at home or in supervised facilities. Systematic review registration for observational studies: PROSPERO 2017: CRD42017070551

Objectives: There is a lack of knowledge about how falls are associated with the older person’s physical, mental, and social functioning which would help find effective methods for identifying rehabilitation needs in the older population to ensure appropriate follow-up. The aim was to investigate and compare functioning in women with and without a falls history. Methods: This was an observational case-control study. Study participants were fallers aged ≥65 years recruited consecutively from a hospital; age matched randomly selected community controls (fallers without contact with the healthcare system due to falls and non-fallers). Fallers were classified as once only fallers and recurrent fallers. Results: The sample constituted a group of older women with and without a falls history; 117 fallers from the Falls Clinic, and 99 fallers and 106 non-fallers community controls, median age 80 years. Both fallers from the clinic and the community had significantly lower functioning compared to non-fallers in all three domains. Recurrent fallers had poorer functioning compared to once only fallers. Conclusion: This study contributes to knowledge about older people’s functioning and disability in conjunction with a high fall-risk and highlights the importance of rehabilitation and prevention strategies that focus on early identification of disability in the older population regardless of falls history.

Objective: To explore relationships between the instrumented timed up and go test (iTUG) and the following risk factors for falls: cognitive functioning, fear of falling (FoF), and quality of life (QoL) in people with dementia. Methods: 83 community-dwelling older adults with dementia (mean±sd age 78.00±7.96 years; 60.2% male) completed an interview to capture global cognition (Mini-Addenbrooke’s Cognitive Evaluation), FoF (Iconographical Falls Efficacy Scale) and QoL (ICEpopCAPability measure for Older people). Participants completed an iTUG whilst wearing an inertial sensor on their trunk. Linear accelerations and rotational velocities demarcated sub-phases of the iTUG. Relationships were explored through correlations and regression modelling. Results: Cognition was related to duration of walking sub-phases and total time to complete iTUG (r=0.25-0.28) suggesting gait speed was related to cognition. FoF was most strongly related to turning velocity (r=0.39-0.44), but also to sit-to-stand, gait sub-phases and total time to complete iTUG. Sub-phases explained 27% of the variance in FoF. There were no correlations between iTUG and QoL. Conclusions: Cognition and FoF were related to time to complete walking sub-phases but FoF was more closely related to turning velocity and standing acceleration. iTUG may offer unique insights into motor behaviour in people with dementia.

Objectives: There is little information about the risk factors for sarcopenia and dynapenia. This study aimed to assess the prevalence of sarcopenia and dynapenia and to verify which risk factors are associated with the elderly population. Methods: A total of 387 elderly people were evaluated. We used a questionnaire to identify sociodemographic and behavioral aspects. For physical performance, we used the Short Physical Performance Battery. Using the European Working Group of Sarcopenia in Older People consensus, we defined sarcopenia that includes the occurrence of low muscle mass, added to low muscle strength or low physical performance. Dynapenia was defined using handgrip strength. Results: Sarcopenia and dynapenia were identified in 15.3% and 38.2% of the elderly people, respectively; 15.8% of women and 14.2% of men had sarcopenia, and 52.4% of women and 13.5% of men had dynapenia. Sarcopenia was associated with the increase in aging, white race, smoking, and risk of malnutrition. Dynapenia is more likely to occur in women and hospitalized patients. Conclusion: Sarcopenia had a greater association with the risk factors evaluated here, mainly with smoking and nutritional status. On the other hand, dynapenia was different, having a greater association with hospital intervention.