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JFSF 2023

Original Article JFSF, Vol 8, No 1, March 2023, p.1-8
Muscle power predicts frailty status over four years: A retrospective cohort study of the National Health and Aging Trends Study
Caitlin M. Burbank, Adam Branscum, Marit L. Bovbjerg, Karen Hooker, Ellen Smit
Keywords: Aged, Chair rise, Frailty, Functional status, Muscle power
Objectives: Muscle power is a critical measure of physical capacity in older adults, however the association between muscle power and frailty is not well explored. The purpose of this study is to estimate the association between muscle power and frailty in community-dwelling older adults in the National Health and Aging Trends Study from 2011-2015. Methods: Cross-sectional and prospective analyses were performed on 4,803 community-dwelling older adults. Mean muscle power was calculated using the five-time sit-to-stand test, height, weight, and chair height and dichotomized into high-watt and low-watt groups. Frailty was defined using the five Fried criteria. Results: The low watt-group had higher odds of pre-frailty and frailty at baseline year 2011. In prospective analyses, the low-watt group that was pre-frail at baseline had increased hazards of frailty (AHR 1.62, 95% CI 1.31, 1.99) and decreased hazards of non-frailty (AHR 0.71, 95% CI 0.59, 0.86). The low-watt group that was non-frail at baseline had increased hazards of pre-frailty (1.24, 95% CI 1.04, 1.47) and frailty (1.70, 1.07, 2.70). Conclusions: Lower muscle power is associated with higher odds of pre-frailty and frailty and increased hazards of becoming frail or pre-frail over four years in those who are pre-frail or non-frail at baseline.
Original Article JFSF, Vol 8, No 1, March 2023, p.9-22
Instructor and client views of a community falls prevention service and the impact of the COVID-19 pandemic: A qualitative exploration of a service in England
Leah Jayes, Joanne R. Morling, Sophie Carlisle, Ilze Bogdanovica, Tessa Langley
Keywords: COVID-19, Exercise, Falls Prevention, Frailty
Objectives: Falls are the most common cause of injury related deaths in people over 75 years. The aim of this study was to explore the experience of providers (instructors) and service users (clients) of a fall’s prevention exercise programme and the impact of the COVID-19 pandemic in Derbyshire, UK. Methods: Ten one-to-one interviews with class instructors and five focus groups with clients (n=41). Transcripts were analysed using inductive thematic analysis. Results: Most clients were initially motivated to attend the programme to improve their physical health. All clients reported improvements in their physical health as a result of attending the classes; additional benefits to social cohesion were also widely discussed. Clients referred to the support provided by instructors during the pandemic (online classes and telephone calls) as a ‘life-line’. Clients and instructors thought more could be done to advertise the programme, especially linking in with community and healthcare services. Conclusions: The benefits of attending exercise classes went beyond the intended purpose of improving fitness and reducing the risk of falls, extending into improved mental and social wellbeing. During the pandemic the programme also prevented feelings of isolation. Participants felt more could be done to advertise the service and increase referrals from healthcare settings.
Original Article JFSF, Vol 8, No 1, March 2023, p.23-31
Balance performance and grip strength as predictors of cognitive function among community-dwelling older adults in the USA
Jennifer Blackwood, Reza Amini, Gerry Conti, Quinn Counseller, Rebekah Taylor, Deena Fayyad
Keywords: Cognition, Memory, Health, Postural stability, Successful aging
Objectives: To investigate how balance and grip strength predicts the probability of cognitive function impairment (i.e., executive function: mild and mild-to-moderate impairment, and delayed recall) over eight years in community-dwelling older adults in the US, controlling for sex and race/ethnicity. Methods: The National Health and Aging Trends Study dataset (2011 – 2018) was employed. Dependent variables included the Clock Drawing Test (Executive Function) and Delayed Word Recall Test. Longitudinal ordered logistic regression examined the association between cognitive function and predictors (i.e., balance and grip strength) over eight waves (n=9800, 1,225 per wave). Results: Those who could complete side-by-side standing and semi-tandem tasks were 33% and 38% less likely to have mild or mild-to-moderate executive function impairment, respectively, relative to those who could not complete these tests. One score decrease in grip strength increased the executive function impairment risk by 13% (Odds Ratio: 0.87, CI: 0.79-0.95). Those who completed the side-by-side tasks were 35% (Odds Ratio: 0.65, CI: 0.44-0.95) less likely to experience delayed recall impairments than those who could not complete this test. With one score decrease in grip strength, the risk of delayed recall impairment was increased by 11% (OR: 0.89, CI: 0.80-1.00). Conclusions: A combination of these two simple tests (i.e., semi-tandem stance and grip strength) can screen for cognitive impairment among community-dwelling older adults to identify people with mild and mild-to-moderate cognitive impairment in clinical settings.
Original Article JFSF, Vol 8, No 1, March 2023, p.32-37
Risk of sarcopenia, fear of COVID-19, anxiety, depression and physical activity levels: Associations across patients on hemodialysis within Greece
Maria Tsekoura, Nikolaos Kalampakos, Konstantinos Fousekis, Konstantinos Mylonas, Pavlos Angelopoulos, Charalampos Matzaroglou, Theodora Bita, John Gliatis, Elias Tsepis, Evdokia Billis
Keywords: SARC-F, Fear of COVID-19, Sarcopenia risk, Anxiety, Depression
Objectives: The purpose of this multicenter cross-sectional study was to investigate the association between SARC-F, fear of COVID 19, anxiety, depression and physical activity in patients undergoing hemodialysis. Methods: This study was conducted in 3 hemodialysis centers in Greece during the period of the COVID-19 pandemic. Sarcopenia risk was assessed using the Greek version of SARC-F (≥4). Demographic and medical history were collected from the patient’s medical charts. The participants were also asked to fill the Fear of COVID-19 Scale (FCV-19S), the Hospital Anxiety and Depression Scale (HADS), and the International Physical Activity Questionnaire (IPAQ) questionnaire. Results: A hundred and thirty-two (132) patients on hemodialysis (92 men, 70.75±13.14 years) were enrolled. Sarcopenia risk (utilizing the SARC-F) was found in 41.7% of patients on hemodialysis. The average duration of hemodialysis was 3.94±4.58 years. The mean score values for SARC-F, FCV-19S and HADS were 3.9±2.57, 21.08±5.32, and 15.02±6.69, respectively. The majority of patients were physically inactive. The SARC-F scores were strongly associated with age (r=56; p<0.001), HADS (r=0.55; p<0.001), levels of physical activity (r=0.5; p<0.001), but not with FCV-19S (r=0.27; p<0.001). Conclusion: A statistically significant relationship was recorded between sarcopenia risk and age, anxiety/depression and levels of physical inactivity in patients on hemodialysis. Future studies are necessary in order to evaluate the association of specific characteristics of patients.
Original Article JFSF, Vol 8, No 1, March 2023, p.38-43
Sarcopenia: An Assessment into the Prevalence and Disease Burden in Chronic Pancreatitis Patients
Taiwo Oyebola, Akash Mavilakandy, James A. Stephenson, Ruth Boyce, Neil Bhardwaj, Giuseppe Garcea
Keywords: Chronic Pancreatitis, Frailty, Nutrition, Sarcopenia
Objectives: To evaluate the prevalence of sarcopenia in patients referred to a Multidisciplinary Chronic Pancreatitis (CP) Clinic at the University Hospitals of Leicester. Methods: All patients who had undergone CT scans were identified. Controls were identified from CT colonograms with no features of malignancy or pancreatic pathology. The psoas muscle index (PMI) was calculated using the formula: total psoas muscle cross-sectional area at the third lumbar vertebral level (cm2)/ the patient’s height squared (m2). PMI cut-offs were <6.31cm2/m2 and <3.91cm2/m2 for males and females, respectively. Results: 58 CP CT scans were available for analysis along with 62 control scans. 71.9% of CP patients had a PMI below the cut-off for their gender, compared to 45.2% of the controls. The mean PMI (±SD) for male CP patients and male controls were 5.54cm2/m2 (±1.60) and 6.73 cm2/m2 (±1.54), (P=0.0023). The mean PMI (±SD) for female CP patients and female controls were 3.82 cm2/m2 (+/-1.46) and 4.98 cm2/m2 (+/-1.43), (P=0.0021). Conclusions: CP patients had a mean PMI below the cut-off value, suggesting that CP patients are largely sarcopenic. As malnutrition is a significant feature of CP, optimisation of nutrition may help to ameliorate sarcopenia in CP patients.
Review Article JFSF, Vol 8, No 1, March 2023, p.44-52
Sarcopenia in Rheumatoid arthritis. A narrative review
Dimitra Moschou, Michail Krikelis, Christos Georgakopoulos, Evangelia Mole, Efstathios Chronopoulos, Symeon Tournis, Clio Mavragani, Konstantinos Makris, Ismene Dontas, Susana Gazi
Keywords: Autoimmune disease, Inflammation, Rheumatoid arthritis, Sarcopenia
Sarcopenia was recently identified as an entity in the ICD-10 classification of October 2016. According to the recommendation of the European Working Group on Sarcopenia in Older People (EWGSOP2), sarcopenia is defined as low muscle strength and low muscle mass, while physical performance is used to categorize the severity of sarcopenia. In recent years, sarcopenia has become increasingly common in younger patients with autoimmune diseases such as Rheumatoid arthritis (RA). Due to the chronic inflammation caused by RA, patients have reduced physical activity, immobility, stiffness, and joint destruction and all of that lead to the loss of muscle mass, muscle strength, disability and significantly lowering the patients’ quality of life. This article is a narrative review about sarcopenia in RA, with a special focus in its pathogenesis and management.
Research Protocol JFSF, Vol 8, No 1, March 2023, p.53-59
The Rheumatoid Arthritis and MUScle (RAMUS) Study: Protocol for an observational single-arm study of skeletal muscle in patients with rheumatoid arthritis receiving tofacitinib
Joshua L. Bennett, Maha Egail, Amy E. Anderson, Richard Dodds, Catherine Feeney, Gráinne S. Gorman, Arthur G. Pratt, Avan A. Sayer, Kieren G. Hollingsworth, John D. Isaacs
Keywords: Body composition, Magnetic resonance imaging, Rheumatoid arthritis, Sarcopenia, Tofacitinib
People with rheumatoid arthritis (RA) are disproportionately affected by sarcopenia, the generalised loss of muscle strength and mass, consequently facing an increased risk of falls, functional decline and death. Currently, there are no approved pharmacological treatments for sarcopenia. RA patients who start tofacitinib (a Janus kinase inhibitor) develop small increases in serum creatinine that are not explained by renal function changes and could reflect sarcopenia improvement. The RAMUS Study is a proof of concept, single-arm observational study in which patients with RA who commence tofacitinib according to routine care will be offered participation according to eligibility criteria. Participants will undergo lower limb quantitative magnetic resonance imaging, whole-body dual energy x-ray absorptiometry, joint examination, muscle function testing and blood tests at three time points: prior to starting tofacitinib and 1 and 6 months afterwards. Muscle biopsy will be performed before and 6 months after starting tofacitinib. The primary outcome will be lower limb muscle volume changes following treatment initiation. The RAMUS Study will investigate whether muscle health improves following tofacitinib treatment for RA. Identifying a potential pharmacological treatment for sarcopenia could have important implications for individuals with RA and for older people in general.ISRCTN registry ID: 13364395.
Research Protocol JFSF, Vol 8, No 1, March 2023, p.60-65
The effectiveness of mental imagery on motor, cognitive and emotional status of older people with early-stage dementia: A study protocol
Anna Christakou, Christina Bouzineki, Marousa Pavlou, George Stranjalis, Vasiliki Sakellari
Keywords: Balance, Cognitive status, Dementia, Mental Imagery, Physiotherapy
Dementia involves the loss of cognitive abilities and represents a decline from the prior level of function which impairs functional abilities in day-to-day life. No previous experimental research has been done to assess mental imagery (MI) effectiveness in the motor, cognitive and emotional status of individuals with early-stage dementia. One hundred and forty older individuals with early-stage dementia from the Day Care Centre of the Alzheimer Association in Athens will take part in this study. The sample will be randomly divided into three groups: MI and physical exercise (intervention group), only physical exercise (1st control group), and neither MI nor physical exercise (2nd control group). Assessment will be obtained one week prior to the program, in the middle of the program (6th week of the intervention program) and after the end of the program (13th week of the intervention program). Participants of the intervention group will perform a 30-minute MI programme after the end of every physiotherapy session. Reliable and valid instruments will be used to assess the primary outcomes, i.e., balance and functional status as well as the secondary outcomes i.e., cognitive ability, emotional state and quality of life. The two-way Mixed ANOVA with factors ‘intervention’ (between groups) and ‘time’ (within group) will be used as a statistical analysis. Approvals of clinical trial protocol: a) UNIWA Research Committee study protocol approval: 93292 - 26/10/2021. b) ID NCT05232526.
Original Article JFSF, Vol 8, No 2, June 2023, p.66-73
Head mounted display effect on vestibular rehabilitation exercises performance
Christos Nikitas, Dimitris Kikidis, Athanasios Pardalis, Michalis Tsoukatos, Sofia Papadopoulou, Athanasios Bibas, Doris E. Bamiou
Keywords: Augmented Reality, Exercise, Head Mounted Display, Rehabilitation, Vestibular
Objectives: Vestibular rehabilitation clinical guidelines document the additional benefit offered by the Mixed Reality environments in the reduction of symptoms and the improvement of balance in peripheral vestibular hypofunction. The HOLOBalance platform offers vestibular rehabilitation exercises, in an Augmented Reality (AR) environment, projecting them using a low- cost Head Mounted Display. The effect of the AR equipment on the performance in three of the commonest vestibular rehabilitation exercises is investigated in this pilot study. Methods: Twenty-five healthy adults (12/25 women) participated, executing the predetermined exercises with or without the use of the AR equipment. Results: Statistically significant difference was obtained only in the frequency of head movements in the yaw plane during the execution of a vestibular adaptation exercise by healthy adults (0.97 Hz; 95% CI=(0.56, 1.39), p<0.001). In terms of difficulty in exercise execution, the use of the equipment led to statistically significant differences at the vestibular-oculomotor adaptation exercise in the pitch plane (OR=3.64, 95% CI (-0.22, 7.50), p=0.049), and in the standing exercise (OR=28.28. 95% CI (23.6, 32.96), p=0.0001). Conclusion: Τhe use of AR equipment in vestibular rehabilitation protocols should be adapted to the clinicians' needs.
Original Article JFSF, Vol 8, No 2, June 2023, p.74-82
Risk factors for developing symptomatic COVID-19 in older residents of nursing homes: A hypothesis-generating observational study
Anna Escribà-Salvans, Sandra Rierola-Fochs, Pau Farrés-Godayol, Miriam Molas-Tuneu, Dyego Leandro Bezerra de Souza, Dawn A. Skelton, Ester Goutan-Roura, Eduard Minobes-Molina, Javier Jerez-Roig
Keywords: COVID-19, Geriatric Medicine, Infectious Disease, Nursing Care
Objectives: To identify which risk factors were associated with developing Coronavirus Disease-19 (COVID-19) infection, with symptoms, in institutionalized older people. Methods: A 1-year longitudinal multi-center study was conducted in 5 nursing homes (NHs) over the period December 2019 to March 2021. Inclusion criteria included being a permanent resident in the NH, aged 65 years or older, and a positive diagnosis of COVID-19 objectively confirmed by a diagnostic test. A descriptive and bivariate analysis was performed, calculating relative risk (RR) with 95% confidence intervals and statistical significance at p<0.05. Results: Of the total sample of 78 individuals who tested positive for COVID-19, the mean age was 84.6 years (SD=±7.8), 62 (79.5%) were female; 40 (51.3%) participants presented with COVID-19 symptoms. Living in a private NH (RR=3.6, 95% CI [1.2-11.0], p=0.023) and having suffered a stroke (RR=4.1, 95% CI [1.1-14.7], p=0.033) were positively associated with developing COVID-19 infection with symptoms. Conclusions: Having suffered a stroke and living permanently in a private NH were positively associated with symptomatic COVID-19 in this sample of institutionalized older people. Clinical Trials ID: NCT04297904
Original Article JFSF, Vol 8, No 2, June 2023, p.83-93
Frailty as a risk-stratification tool in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS)
Aalam Sohal, Hunza Chaudhry, Isha Kohli, Kirti Arora, Jay Patel, Nimrat Dhillon, Ishandeep Singh, Dino Dukovic, Marina Roytman
Keywords: Cirrhosis, Emerging, Frailty, National Inpatient Sample, TIPS
Objectives: The concept of frailty has gained importance, especially in patients with liver disease. Our study systematically investigated the effect of frailty on post-procedural outcomes in patients undergoing transjugular intrahepatic portosystemic shunt (TIPS). Methods: We used National Inpatient Sample(NIS) 2016-2019 data to identify patients who underwent TIPS. Hospital frailty risk score (HFRS) was used to classify patients as frail (HFRS>=5) and non-frail (HFRS<5). The relationship between frailty and outcomes such as death, post-procedural shock, non-home discharge, length of stay (LOS), post-procedural LOS, and total hospitalization charges (THC) was assessed. Results: A total of 13,700 patients underwent TIPS during 2016-2019. Of them, 5,995 (43.76%) patients were frail, while 7,705 (56.24%) were non-frail. There were no significant differences between the two groups based on age, gender, race, insurance, and income. Frail patients had higher mortality (15.18% vs. 2.07%, p<0.001), a higher incidence of non-home discharge (53.38% vs. 19.08%, p<0.001), a longer overall LOS (12.5 days vs. 3.35,p<0.001), longer post-procedural stay (8.2 days vs. 3.4 days, p<0.001), and higher THC ($240,746.7 vs. $121,763.1, p<0.001) compared to the non-frail patients. On multivariate analysis, frail patients had a statistically significant higher risk of mortality (aOR-3.22, 95% CI-1.98- 5.00, p<0.001). Conclusion: Frailty assessment can be beneficial in risk stratification in patients undergoing TIPS.
Review Article JFSF, Vol 8, No 2, June 2023, p.94-106
Women's perceptions or experiences of physical activity and exercise interventions to improve bone health: a systematic review
C. Ryanne Plesh, Rebecca A. Withers, Dawn A. Skelton
Keywords: Bone health, Exercise, Experiences, Perceptions, Physical activity
Exercise is an important intervention to maintain bone health in women with osteopenia and osteoporosis. This systematic review aims to gain insight into the experiences or perceptions females have toward bone health interventions, to promote uptake and adherence. Four electronic databases were searched: MEDLINE, CINAHL, PubMed and PsycInfo. Inclusion Criteria: Qualitative studies examining perceptions or views of women to physical activity or exercise interventions aimed at improving bone health. 1,406 papers were identified. After screening, data were extracted from 2 studies considering experiences and 2 papers presenting perceptions of exercise for bone health. All studies scored >8 out of 10 on the CASP Quality Tool. Older women perceived barriers such as safety and advice, and facilitators of tangible results and feedback within supervised group sessions. Older womens' experiences of a digitally delivered exercise intervention included social interactions and voice reminders, with barriers of lack of feedback and knowledge. Younger women expressed enablers as feeling the benefits and physical literacy, and barriers of previous experience participating in tedious exercise. Supervised sessions, with different intensity levels and variety, offering feedback to promote confidence, are valuable to uptake and adherence in both younger and older females.
Review Article JFSF, Vol 8, No 2, June 2023, p.107-117
The effectiveness of blood flow restriction training in cardiovascular disease patients: A scoping review
Pavlos Angelopoulos, Maria Tsekoura, Konstantinos Mylonas, Grigorios Tsigkas, Evdokia Billis, Elias Tsepis, Konstantinos Fousekis
Keywords: Blood flow restriction exercise, Cardiac rehabilitation, Cardiovascular patients
Therapeutic exercise is integral to the comprehensive rehabilitation of patients with cardiovascular disease and, as such, is recommended by the American Heart Association as a valuable and effective treatment method for such patients. The type of exercise applied to these patients is aerobic and resistance exercise with mild intensities and loads to avoid overloading the cardiovascular system. Blood flow restriction exercise is a novel exercise modality in clinical settings that has in many studies a similar effect on muscle hypertrophy, strength, and cardiovascular response to training at a 70% strength level without blood flow restriction. Since this exercise mode does not require high-intensity loads, it can be a safe method for improving muscle strength, cardiovascular endurance, and functionality in cardiovascular patients. Given that, the objective of this review is to assess and summarize existing evidence for the use of blood flow restriction in cardiovascular patients. A scoping review of existing clinical trials was conducted. Eleven studies were examined that suggested the use of blood flow restrictions in cardiovascular patients to achieve improvements in muscle strength, functionality, and cardiovascular parameters such as blood pressure decrease.
Review Article JFSF, Vol 8, No 2, June 2023, p.118-126
The effect of an exercise-based rehabilitation programme in functional recovery and prevention of secondary falls after a hip fracture in older adults: A systematic review
Anna Pantouvaki, Evridiki Patelarou, Grigorios Kastanis, Kalliopi Alpantaki, Michail Zografakis Sfakianakis
Keywords: Exercise, Functional outcome, Fall prevention, Hip fracture, Review
We performed a systematic review to evaluate whether an exercise-based intervention programme, for older people with a hip fracture, is effective in functional recovery and in preventing secondary fall-related injuries. This systematic review was conducted according to Cochrane review guidelines and based on the PRISMA statement. Six electronic databases (Medline, PubMed, Cochrane Library, CIHNAL, Embase, Google Scholar) from 2010 to 31 December 2021 were searched for randomised controlled trials (RCTs) of functional recovery or fall prevention exercises after a hip fracture surgery in older people (≥65 years). Thirty-four references were identified initially, however, only 8 studies (1617 patients) met the eligibility criteria. Despite the heterogeneity of the onset, duration and of the characteristics of exercise-based intervention, as well as the type of setting it was delivered in, there was evidence that an exercise-based rehabilitation programme improved physical function and gait ability. There was no evidence about preventing a secondary fall after a hip fracture. In conclusion, an exercise-based intervention programme can generally improve functional recovery after a hip fracture. It remains uncertain if it affects the prevention of a secondary fall over a 1-year follow-up period.
Research Protocol JFSF, Vol 8, No 2, June 2023, p.127-135
Feasibility of engaging older adults living with multiple long-term conditions, frailty, and a recent deterioration in health in a study of lifestyle: protocol for the LiLL-OPM study
Christopher Hurst, Lorelle Dismore, Antoneta Granic, Ellen Tullo, Jane M. Noble, Susan J. Hillman, Miles D. Witham, Avan A. Sayer, Richard M. Dodds, Sian M. Robinson
Keywords: Feasibility study, Frailty, Lifestyle, Multimorbidity, Multiple long-term conditions
Community-dwelling older adults living with multiple long-term conditions (MLTC), frailty and a recent deterioration in health are underserved by research. This results in a limited evidence base for their care, including the potential benefits of lifestyle interventions such as structured exercise. The aims of the LiLL-OPM (Lifestyle in Later Life - Older People's Medicine) study are to determine if it is feasible to carry out a research project with these patients, describe their health and lifestyle, their attitudes to engaging in exercise and their experiences of taking part in the research. Older adults who are attending an Older People's Medicine Day Unit service in Newcastle, UK, and their informal carers will be invited to take part. The study will use mixed methods with semi-structured interviews and a health and lifestyle questionnaire, carried out in a way that is most convenient to participants, including in their own homes and with a flexible schedule of study visits. The findings from the feasibility study will provide invaluable data on how to design research, including the most suitable approaches to recruitment and data collection. This will improve the inclusion in research of older adults living with MLTC, frailty and a recent deterioration in health.
Original Article JFSF, Vol 8, No 3, September 2023, p.139-147
Older Hospitalised Patients' Reported Confidence in Managing Discharge Needs: A Retrospective Observational Study
Peter Hartley, Olivia Sharpe, Roman Romero-Ortuno
Keywords: Aged, Confidence, Hospital, Patient Reported Outcome Measure
Objectives: To evaluate the introduction of a patient-reported outcome measure (PROM) of self-confidence in managing discharge needs in an acutely hospitalised older adult population. Methods: A retrospective service evaluation in an English hospital. The PROM measure consisted of a visual analogue scale asking patients to rate their confidence with managing the things that they would need to do at home. This was collected on admission and discharge. Results: Of 923 patients, 461 had both admission and discharge confidence scores. Median confidence was higher at discharge (8.00, IQR: 6.20-9.80) than on admission (7.20, 5.00-9.00) (P<0.001). Predictors of high confidence with managing discharge needs at admission were: being male; having a lower number of morbidities; self-reporting fewer falls over the last year; and a higher level of functional mobility. Low confidence score on admission, being from one's own home, and a higher number of physiotherapy contacts were associated with improvement in PROM scores. Self-confidence in managing discharge needs at discharge was not associated with readmission within 30 days. Conclusions: Measuring patient-reported confidence to manage discharge needs is feasible in an older inpatient population. Confidence improved from admission to discharge, and more frequent physiotherapy input was associated with improved confidence.
Original Article JFSF, Vol 8, No 3, September 2023, p.148-154
Do low levels of alanine aminotransferase, a baseline marker of sarcopenia and frailty, associate with worse clinical outcomes among hospitalized COVID-19 patients? A Retrospective Cohort Study
Ehud Raz Gatt, Eyal Zilber, Max Perelman, Nitsan Landau, Maya Yakir, Noam Glick, Liat Negru, Gad Segal, Edward Itelman
Keywords: ALT, Clinical outcomes, Corona virus, Frailty, Sacrcopenia
Objectives: COVID-19 geoperdize lives. Not all the risk factors for negative outcomes are known. Sarcopenia and frailty are common, negatively affecting clinical outcomes. Studies have shown that sarcopenia and frailty are associated with worse outcomes. Our objective was to examine whether low ALT (Alanine-aminotranferase), a surrogate marker for sarcopenia, is associated with worse clinical outcomes among hospitalized COVID-19 patients. Methods: We reviewed cases of COVID-19 in a tertiary hospital, during three COVID-19 waves and examined correlations between ALT and mortality using crude, univariate and multivariate analysis for age, gender, hypertension, Chronic obstructive pulmonary disease and Congestive heart failure. Results: 357 patients were included in this analysis. Median age was 69, 54% were males. Median ALT was 19 IU/L. During follow-up, 73 (20%) died. Patients with low ALT were more likely to die (HR 1.82, 95% CI 1.06-3.09, P=0.028). Other predictors for mortality were low albumin, background COPD, dyslipidemia, dementia, and malignancy. The multivariate analysis showed that low ALT was still an independent predictor of poor prognosis (HR 1.7, 95% CI 1.0-2.9, P=0.049). Conclusions: In our analysis of COVID-19 patients, low ALT levels were independently associated with increased risk of mortality, both as standalone and when incorporated into a multivariate analysis.
Original Article JFSF, Vol 8, No 3, September 2023, p.155-162
The relationship between quadriceps femoris thickness measured by US and femoral cartilage thickness in knee osteoarthritis, its effect on radiographic stage and clinical parameters: comparison with healthy young population
Ahmet Bozan, Belgin Erhan
Keywords: Cartilge thickness, Knee osteoarthritis, Quadriceps muscule thickness, US
Objective: In this study, we aimed to investigate the relationship between quadriceps muscle thickness and femoral cartilage thickness measured by ultrasonography (US) in knee osteoarthritis (OA), to correlate this relationship with radiographic stage and clinical parameters, and to compare these values with those in healthy young adults. Methods: A total of 71 patients with knee osteoarthritis and 31 healthy young adults were included in the study. Patients with knee osteoarthritis (Group 1) and healthy young adults (Group 2) were divided into two groups. Muscle thickness measurements of the quadriceps femoris muscle (M. vastus intermedius + M. rectus femoris) were performed by US. Results: Bilateral quadriceps muscle thickness and bilateral femoral cartilage thickness values were significantly lower in Group 1 than in Group 2. The 10-metre walk test score and Time Up and Go (TUG) test score were significantly higher in Group 1 than in Group 2. A strong positive correlation was found between bilateral quadriceps (RF+VI) muscle thickness and bilateral femoral cartilage thickness (medial, intercondylar, lateral) in Group 1. Conclusions: This study showed a strong positive correlation between quadriceps thickness and femoral cartilage thickness. According to these results, we conclude that US may have a place in the diagnosis of knee osteoarthritis.
Original Article JFSF, Vol 8, No 3, September 2023, p.163-173
Superimposed electromyostimulation of the thigh muscles during passive isokinetic cycling increases muscle strength without effort
Kazuyuki Ogiso, Takuto Horasawa
Keywords: Electromyostimulation, Kinesthesia, Muscle Strength, Passive Isokinetic Cycle Exercise, Sarcopenia Prevention
Objectives: This study was designed to investigate the effects of a completely passive isokinetic cycle (PIC) exercise with electromyostimulation (EMS) on improving muscle strength and the changes in kinesthesia during daily activities. Methods: Twenty-nine sedentary females were divided into three groups. The EMS anterior and whole groups performed the PIC exercise without EMS 3 times a week for 3 weeks, followed by a 1-week break, and then performed it with EMS applied to the anterior and entire thigh muscles, respectively, 3 times a week for 3 weeks. The control group did not perform any training. Results: The PIC exercise with EMS significantly increased the 30s chair stand test scores by 12-16% and the maximum isometric knee extension and flexion torques by 38-68% in both EMS-applied groups. The participants found its exercise easy and felt more comfortable with daily physical activities. The exercise without EMS did not show similar improvements. Muscle soreness was significantly greater in the EMS anterior group than in the EMS whole group; however, it was not severe. Conclusions: The PIC exercise with EMS resulted in significant increases in muscle strength, facilitating a perceived ease of daily physical activities, while minimizing difficulties, effort, and notable muscle soreness.
Review Article JFSF, Vol 8, No 3, September 2023, p.174-187
Does stretching of anterior structures alone, or in combination with strengthening of posterior structures, decrease hyperkyphosis and improve posture in adults? A Systematic Review and Meta-analysis
Rebecca A. Withers, C. Ryanne Plesh, Dawn A. Skelton
Keywords: Adults, Exercise, Hyperkyphosis, Posture, Stretching
Kyphosis can lead to back pain, poor posture, and increased falls risk. This systematic review aimed to synthesize research on stretching alone, or in combination with strengthening, as a management for hyperkyphosis in the adult population (≥18 years old). An electronic database search was conducted from February to March 2022. The author and an independent reviewer screened titles and abstracts for inclusion criteria - those whose intervention involved stretching alone or with strengthening exercises. The author appraised and extracted data from included articles and performed a meta-analysis where appropriate. The database and citation search yielded 327 articles, 18 of which met inclusion criteria. One study included performed stretching as a standalone intervention; the remainder used a combination of stretching and strengthening. The meta-analysis (n=3, with 5 exercise groups) found a statistically significant difference (MD = -6.97 (95% CI -9.84, -4.10), p<0.00001) in post-intervention measures of hyperkyphosis favouring the exercise group. The narrative review of studies agrees with this finding, demonstrating statistically significant improvement in hyperkyphosis following various exercise programs. This review suggests that stretching and strengthening exercises improve hyperkyphosis in the short and long term. Low-quality evidence supports stretching as a standalone intervention. Further, more robust research is required to recommend procedures and determine if stretching alone is effective for treating hyperkyphosis in adults.
Review Article JFSF, Vol 8, No 3, September 2023, p.188-194
Resistance Training in Post-COVID Recovery: Rationale and Current Evidence
George Mills, Enya Daynes, Hamish J.C. McAuley, Neil J. Greening, Samuel Briggs-Price, Molly M. Baldwin, Sally J. Singh
Keywords: COVID-19, Exercise, Muscle, Resistance training, Rehabilitation
During hospitalisation with COVID-19, individuals may experience prolonged periods of immobilisation. Combined with the inflammatory effects of the virus, this may lead to a significant reduction in both muscle mass and strength. Data from several long-term studies suggest that these symptoms may not fully resolve within one year. Owing to its effectiveness at inducing muscle fibre hypertrophy and improving neuromuscular efficiency, resistance training is of great interest in the rehabilitation of this population. This narrative review aims to identify the rationale and potential efficacy of resistance training for restoring physical function following infection with SARS-CoV-2, as well as evidence of its use in clinical practice. The studies included in this narrative review consisted mostly of multi-component rehabilitation trials. Of these, widespread improvements in muscle strength were reported using intensities of up to 80% of participants' 1-repetition-maximum. Evidence thus far indicates that resistance training may be safe and effective in patients following COVID-19, although its individual contribution is difficult to discern. Future exercise intervention studies investigating the efficacy of resistance training as a sole modality are needed.
Short Communication JFSF, Vol 8, No 3, September 2023, p.195-199
Turkish version of the SHARE-Frailty Instrument for primary care: reliability and validity in the nursing home setting
Gülendam Hakverdioğlu Yönt, Román Romero Ortuño, Fisun Şenuzun Aykar, Duygu İlbay
Keywords: Care dependency, Frailty, Geriatric care, Nursing home, Validation studies
In Turkey, physical frailty instruments have not been studied in the nursing home setting. We determined the reliability and validity of a Turkish version of the SHARE-Frailty Instrument for primary care (SHARE-FI) in Turkish nursing home residents. Cronbach's alpha reliability analysis was performed to determine internal consistency. Factor analysis was conducted to explore construct validity. Concurrent validity was assessed by correlation with the Care Dependency Scale (CDS). One hundred and fifty-one residents were included (mean age 73 years, 41% women). Fifty (33.1%) were identified as non-frail, 49 (32.5%) as pre-frail, and 52 (34.4%) as frail by SHARE-FI. The overall Cronbach's alpha coefficient was 0.81. Factor analysis identified two components accounting for 69% of the variance, with the first and most important component being handgrip strength. SHARE-FI groups were significantly correlated with CDS scores (p<0.05). The Turkish version of SHARE-FI had good reliability and validity in a nursing home setting.
Original Article JFSF, Vol 8, No 4, December 2023, p.204-210
Validation of SARC-F-Proxy for the Screening of Sarcopenia in Older Patients with Cognitive Impairment
Scott Lamers, Zaid Kasim, Wendy Daniella Rodríguez-García, Pishtiwan Kalmet, Stany Perkisas, Anne-Marie De Cock, Maurits Vandewoude
Keywords: Cognition, Dementia, Geriatric population, SARC-F, Sarcopenia
Objectives: The SARC-F is a validated questionnaire for the screening of sarcopenia in an older population. However, the clinical relevance of this self-reported questionnaire in patients with cognitive problems is questionable. This study aims to validate the SARC-F-Proxy as an alternative screening tool for sarcopenia in patients with cognitive impairment. Methods: This cross-sectional study included hospitalised community-dwelling older adults aged 60 years or older with confirmed cognitive impairment. Three SARC-F questionnaires were completed: one by patients, one by informal caregivers and one by formal caregivers. Muscle strength, mass and physical performance were measured by handgrip strength, anthropometric measurements, and gait speed respectively. The recently updated EWGSOP2 diagnostic criteria were used as the “gold standard” for diagnosis of sarcopenia. Results: The prevalence of sarcopenia using SARC-F-Proxy was 75.4% for SARC-F-Proxy-Formal caregiver and 66% for SARC-F-Proxy-Informal caregiver. SARC-F-Proxy had high sensitivity (85.9% for SARC-F-Proxy-Formal caregiver and 77% for SARC-F-proxy-informal caregiver) and low specificity (46.5% for SARC-F-Proxy-Formal caregiver and 54.7% for SARC-F-Proxy-Informal caregiver). Conclusions: the proxy-reported SARC-F questionnaire can be applied as a surrogate for the SARC-F in the screening of sarcopenia in hospitalised community-dwelling older people with known or suspected cognitive impairment. Second, the results in this study suggest a higher reliability when the proxy-reported questionnaire is performed by the formal caregiver.
Original Article JFSF, Vol 8, No 4, December 2023, p.211-220
The diagnostic cut-off points for components of sarcopenia in Finnish Caucasian women: A retrospective cross-sectional study
Samu Sjöblom, Juha Suuronen, Toni Rikkonen, Risto Honkanen, Heikki Kröger, Joonas Sirola
Keywords: Body composition, Grip strength, Muscle mass, Muscle strength, Sarcopenia
Objectives: To determine the diagnostic cut-off values of components for sarcopenia in Caucasian women. Methods: The present retrospective cross-sectional study based on the REFERENCE sample included 400 healthy women aged 20 to 40 years, and the OSTPRE sample included 344 women aged 63 to 75. The subjects of the OSTPRE population were re-measured five and ten years later after the baseline. Both samples underwent grip strength (GS), quadriceps strength (QS), and total-body DXA (TB-DXA) measurements, from which Relative Skeletal Muscle Mass Index (RSMI) was calculated. Results: In the REFERENCE population, the -1 SD / -2 SD cut-off points were for RSMI 5.8 kg/m2 / 5.1 kg/m2, for GS 32.0 kg / 26.4 kg, and for QS 39.8 kg / 29.8 kg. The prevalence of under -2 SD distributions in REFERENCE were: RSMI 1.8%, GS 1.3%, and QS 2.0%, and in OSTPRE (15/20/25 years measurements): RSMI 1.2 %/1.9 %/0.5 %, GS 52.2%/42.3%/48.8%, and QS 47.4%/55.2%/not available. The distributions of GS and QS were statistically significantly different between REFERENCE and all OSTPRE measurement points (p<0.001 in Chi-squared). Conclusions: The diagnostic cut-offs for components of sarcopenia are RSMI 5.1 kg/m2, grip strength 26.4 kg, and quadriceps strength 29.8 kg in Finnish Caucasian women.
Review Article JFSF, Vol 8, No 4, December 2023, p.221-229
A Narrative Review of the Utilisation of the SHARE Frailty Instruments (SHARE-FI and SHARE-FI75+) in the Literature
Helen Doherty, Aurora Higgins Jennings, Matej Kocka, Auriane Neichel, Juliette Scauso, Elena Lionetti, Chenhui Chenhuichen, Roman Romero-Ortuno
Keywords: Frailty, Geriatric assessment, Review, SHARE-FI, SHARE-FI75+
This narrative literature review aimed to examine the utilisation of the Survey of Health, Ageing and Retirement in Europe (SHARE) frailty instruments: SHARE-FI and SHARE-FI75+. We used the Google Scholar “cited by” function (accessed on February 20th, 2023) to identify all citations of the original SHARE-FI and SHARE-FI75+ studies. Included articles were categorised into four themes: epidemiological studies (prevalence and associated factors); associations with geriatric syndromes, diseases and health outcomes; randomised clinical trials (RCTs); and expert consensus and practice guidelines. Of 529 articles screened (446 citing SHARE-FI and 83 citing SHARE-FI75+), 64 (12.1%) were included. Sixteen (25.0%) were epidemiological; 35 (54.7%) described associations; 10 (15.6%) were RCTs; and 3 (4.7%) were expert consensus or practice guidelines. Frailty was associated with older age; female sex; higher morbidity; lower education; social isolation; worse nutrition and mobility; rheumatological, cardiovascular, and endocrine diseases; and greater healthcare utilisation and mortality. SHARE-FI was used in RCTs as entry criterion, controlling variable, and intervention outcome. SHARE-FI and SHARE-FI75+ have been recommended to aid the management of atrial fibrillation anticoagulation and hypertension, respectively. SHARE-FI and SHARE-FI75+, two open access phenotypical frailty measurement tools, have been utilised for a range of purposes, and mostly in epidemiological/ associational studies.
Review Article JFSF, Vol 8, No 4, December 2023, p.230-239
Why are older adults living with the complexity of multiple long-term conditions, frailty and a recent deterioration in health under-served by research? A narrative synthesis review of the literature
Lorelle Dismore, Christopher Hurst, Antoneta Granic, Ellen Tullo, Miles D. Witham, Richard M. Dodds, Avan A. Sayer, Sian M. Robinson
Keywords: Frailty, Multiple long-term conditions, Older people, Recent deterioration in health, Under-served by research
Older adults living with the complexity of multiple long-term conditions (MLTC), frailty and a recent deterioration in health are under-served by research. As a result, current treatment guidelines are often based on data from studies of younger and less frail participants, and often single disease focused. The aims of this review were (i) to identify why older adults living with the complexity of MLTC, frailty and a recent deterioration in health are under-served by research and (ii) to identify strategies for increasing their recruitment and retention. Although a range of factors have been suggested to affect the participation of older adults with MLTC and frailty in research, this review shows that much less is known about the inclusion of older adults living with the complexity of MLTC, frailty and a recent deterioration in health. Researchers should focus on strategies that minimise participation burden for these patients, maintaining an adaptive and flexible approach, to increase their recruitment and retention. Future research should include qualitative interviews to provide further insights into how best to design and conduct research to suit the needs of this population group.
Review Article JFSF, Vol 8, No 4, December 2023, p.240-253
Fall risk question-based tools for fall screening in community-dwelling older adults: a systematic review of the literature
Chrysoula Argyrou, Yannis Dionyssiotis, Antonios Galanos, John Vlamis, Ioannis K. Triantafyllopoulos, Ismene A. Dontas, Efstathios Chronopoulos
Keywords: Community-dwelling older adults, Elderly, Fall risk, Fall risk screening, Questionnaires
Fall screening tools aim to accurately identify the high fall risk individuals. To increase ease of administration and cost-effectiveness many studies focus on question-based tools. The purpose of this systematic review was to identify question-based tools for fall risk assessment in community-dwelling older adults over the age of 60 and the risk factors that are covered by these tools. The PRISMA guidelines were followed. A literature search was conducted in PubMed/MEDLINE, Web of Science and Google Scholar. Data quality assessment was performed with the Ottawa-Newcastle scale. The results identified 20 studies that used 22 question-based tools to assess fall risk. The number of questions per tool varied from 1 to 41 questions. Data quality varied greatly, with values 3-9 for cohort and 2-7 for cross-sectional studies. The most commonly reported fall risk factors were fall history, feeling of unsteadiness, fear of falling, muscle strength, gait limitation and incontinence. Healthcare providers should use the above tools with caution regarding the limitations of each tool. Further studies should be designed to address individuals with high fall risk, such as individuals with cognitive impairment, as they are under-represented or excluded from most of the existing studies.
Perspective Article JFSF, Vol 8, No 4, December 2023, p.254-260
Muscle quality an evolving concept
Roberto Coronado-Zarco, Andrea Olascoaga-Gómez de León
Keywords: Functional, Morphological, Muscle ageing, Muscle quality, Sarcopenia
Muscle quality concept can be analyzed from a morphological and functional perspectives that include relation between these properties. Morphological muscle quality considers muscle composition, architectural and structural properties. Functional muscle quality has been defined as a ratio between muscle strength or power per unit of muscle mass or area. Biological and adaptative changes to ageing must be considered when interpretation of muscle quality assessment is done in a clinical or research context. One of the conditions that requires an adequate homologation in terminology is sarcopenia, to establish definition and cut-off points.