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Intrinsic capacity, a crucial concept in healthy ageing, is defined by WHO as “the composite of all the physical and mental capacities that an individual can draw on at any point in time”. Vitality capacity is considered the underlying physiological determinant of intrinsic capacity. To advance the measurement and monitoring of vitality capacity, a working group of WHO staff members and twenty experts representing six WHO regions was convened to discuss and clarify the attributes of vitality capacity and to develop a clear working definition of the concept. Potential biomarkers to measure vitality capacity were identified, and the following consensual working definition was developed: vitality capacity is a physiological state (due to normal or accelerated biological ageing processes) resulting from the interaction between multiple physiological systems, reflected in (the level of) energy and metabolism, neuromuscular function, and immune and stress response functions of the body.

Background: Frailty and hypertension are interrelated, but it remains unclear whether this relationship is modified by antihypertensive drugs. Methods and results: A systematic review of PubMed and Web of Science databases was performed to review the influence of hypertension management on preventing the occurrence or progression of frailty in older people aged 65 and over. Studies providing information on this association regardless of the study setting, or definition of hypertension and frailty were included. Among the initial 2298 articles identified, 7 were included in the review. Three observational studies assessed the association between frailty and hypertension. Two of them reported no relationship between Aldosterone Antagonists use and frailty prevention. No relationship between BP and incidence frailty after adjustment for hypertension treatment was observed in two other articles. An indirect relationship was reported in the RCTs included. Higher AT11RaAb levels (control group), can lead to a generalized weakness/frailty risk shown by a decrease in grip strength (r = –0.57, p < 0.005) and walking speed (r = – 0.47, p < 0.005). No significant differences between int-hypertensive intervention and control were observed in frailty status after a 12-weeks follow-up after applying three different frailty measurement tools in the other RCT. Conclusions: Based on the results of this systematic review we conclude that BP and frailty occur together but whether the treatment with anti-hypertensive drugs modifies this relationship remains unclear and needs to be further investigated.

Autonomic dysfunction and frailty are two common and complex geriatric syndromes. Their prevalence increases with age and they have similar negative health outcomes. In PubMed and Web of Science we screened studies identifying a relationship between autonomic function (AF) and frailty in adults aged ≥ 65 years. Twenty-two studies of which two prospective and 20 cross-sectional were included (n = 8375). We performed a meta-analysis for the articles addressing orthostatic hypotension (OH). Frailty was associated with 1.6 higher odds of suffering from consensus OH (COH) {OR= 1.607 95%CI [1.15-2.24]; 7 studies; n = 3488}. When measured for each type of OH the largest trend was seen between initial OH (IOH) and frailty {OR= 3.08; 95%CI [1.50-6.36]; 2 studies; n = 497}. Fourteen studies reported other autonomic function alterations in frail older adults with 4-22% reduction in orthostatic heart rate increase, 6% reduction in systolic blood pressure recovery, 9-75% reduction in most common used heart rate variability (HRV) parameters. Frail older adults were more likely to have impaired AF. Diagnosis of frailty should promptly lead to orthostatic testing as OH implicates specific treatment modalities, which differ from frailty management. As IOH is most strongly correlated with frailty, continuous beat to beat blood pressure measurements should be performed when present at least until cut-off values for heart rate variability testing are defined.

INTRODUCTIONFatigue resistance (FR) can be assessed as the time during which grip strength (GS) drops to 50% of its maximum during a sustained maximal voluntary contraction. For the first time we compared force-time characteristics during FR test between two different handgrip systems, and investigated age- and clinical-related differences in order to verify if a briefer test protocol (i.e. until 75%) could be sufficiently informative. METHODSA cohort of young healthy (Y, 65y, 77 +/- 7y, 50% women) community-dwelling persons, and hospitalized patients (HOSP, 84 +/- 5y, 50% women) performed the FR test. For this purpose, an adapted Vigorimeter (original rubber bulb of the Martin Vigorimeter connected to a Unik 5000 pressure gauge) here defined as "pneumatic handgrip system" (Pneu) and Dynamometer G200 system (original Jamar Dynamometer handle with an in-build strength gauge) here defined as "hydraulic handgrip system" (Hydr) were used. Force-time curves were analysed from 100%-75% and from 75%-50% of the initial maximal GS during the FR test. The area under the curve (GW) was calculated by integrating the actual GS at each time interval (i.e. 1/5000s) and corrected for body weight (GW/body weight). RESULTSFor both systems we found fair associations between FR100-50 and FR100-75 (Pneu mean difference=50.1s (95%CI:47.9-52.4), r2=0.48; Hydr mean difference=28.4s (95%CI:27.0-29.7), r2=0.52, all p

Objectives This study analyzed cognitive differences between hearing-aid (HA) and non-HA users. We hypothesized that HA-use attenuates the auditory-cognitive cascade, thereby, the latter is more conspicuous in non-HA users. Since hearing impairment (HI) shows male predominance, we hypothesized gender differences within the auditory-cognitive relationship. Methods Non-frail community-dwellers >= 80 years were assessed for HI (pure tone audiogram-PTA; speech reception threshold-SRT) and global and domain-specific cognitive impairments (Mini-Mental State Examination-MMSE; Montreal Cognitive Assessment-MOCA; Reaction Time Test-RT1-4). Pearson and partial correlations (correcting for age and PTA) assessed auditory-cognitive associations within gender and HA subgroups. Fisher's z test compared correlations between HA and non-HA users. Results 126 participants (age range 80-91 years) were included. HA-use prevalence was 21%. HA-users were older with worse HI (mean PTA 49.5dBHL). HA-users exhibited no significant auditory (PTA, SRT) and cognitive (MMSE, MOCA, RT1- RT4) correlations. Male non-HA users, displayed a significant association between HI and global cognition, processing speed, selective and alternating attention. Significant differences were noted between MMSE and PTA and SRT (z-score 2.28, 3.33, p = 0.02

Objectives: To analyze prefrailty’s relationship with limitations in activities of daily living (ADLs) and restrictions in social participation. Method: Robust (Fried 0/4; n = 214; Mage = 82.3 years [ SD ±2.1]) and prefrail (Fried 1–2/4; n = 191; Mage = 83.8 years [ SD ±3.2]) community-dwelling older individuals were included. Frailty scores were obtained from weight loss, exhaustion, gait speed, and grip strength. A total disability index (DI) expressed dependency for basic (b-), instrumental (i-), and advanced (a-)ADLs. Total participation score, being a member, total number of memberships, being a board member, level of participation, membership over time, volunteering, and formal participation represented social participation. Results: Logistic regression retained age (OR = 1.224; 95% CI = [1.122, 1.335]), sex (OR = 3.818; 95% CI = [2.437, 5.982]), and a-ADL-DI (OR = 1.230; 95% CI = [1.018, 1.486]) as variables significantly related to prefrailty (68.3%; χ2 = 68.25; df = 3; p < .001). Discussion: Subtle limitations in a-ADLs, higher age, and being a man were associated with prefrailty, revealing the possible role of personal and culturally related a-ADLs as red flags for (pre)frailty.

Correction: Volume: 48 Issue: 4 Article Number: UNSP 601 DOI: 10.1093/ageing/afz046 Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

Context: Sarcopenia is a progressive and generalized skeletal muscle disorder associated with an increased risk of adverse outcomes such as falls, disability, and death. The Belgian Society of Gerontology and Geriatrics has developed evidence-based guidelines for the prevention and treatment of sarcopenia. This umbrella review presents the results of the Working Group on Nutritional Interventions. Objective: The aim of this umbrella review was to provide an evidence-based overview of nutritional interventions targeting sarcopenia or at least 1 of the 3 sarcopenia criteria (ie, muscle mass, muscle strength, or physical performance) in persons aged ≥ 65 years. Data sources: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed and Web of Science databases were searched for systematic reviews and meta-analyses reporting the effect of nutritional supplementation on sarcopenia or muscle mass, strength, or physical performance. Data extraction: Two authors extracted data on the key characteristics of the reviews, including participants, treatment, and outcomes. Methodological quality of the reviews was assessed using the product A Measurement Tool to Assess Systematic Reviews. Three authors synthesized the extracted data and generated recommendations on the basis of an overall synthesis of the effects of each intervention. Quality of evidence was rated with the Grading of Recommendations Assessment, Development and Evaluation approach. Data analysis: A total of 15 systematic reviews were included. The following supplements were examined: proteins, essential amino acids, leucine, β-hydroxy-β-methylbutyrate, creatine, and multinutrient supplementation (with or without physical exercise). Because of both the low amount and the low to moderate quality of the reviews, the level of evidence supporting most recommendations was low to moderate. Conclusions: Best evidence is available to recommend leucine, because it has a significant effect on muscle mass in elderly people with sarcopenia. Protein supplementation on top of resistance training is recommended to increase muscle mass and strength, in particular for obese persons and for ≥ 24 weeks. Effects on sarcopenia as a construct were not reported in the included reviews., SCOPUS: re.j, info:eu-repo/semantics/published

Background Type 2 diabetes, a highly prevalent chronic disease, is associated with increasing frailty and functional decline in older people. We aimed to evaluate the effectiveness of a multimodal intervention on functional performance in frail and pre‐frail participants aged ≥70 years with type 2 diabetes mellitus. Methods The MID‐Frail study was a cluster‐randomized multicenter clinical trial conducted in 74 trial sites across seven European countries. The trial recruited 964 participants who were aged >70 years [mean age in intervention group, 78.4 (SD 5.6) years, 49.2% male and 77.6 (SD 5.29) years, 52.4% male in usual care group], with type diabetes mellitus and determined to be frail or pre‐frail using Fried's frailty phenotype. Participants were allocated by trial site to follow either usual care (UCG) or intervention procedures (IG). Intervention group participants received a multimodal intervention composed of (i) an individualized and progressive resistance exercise programme for 16 weeks; (ii) a structured diabetes and nutritional educational programme over seven sessions; and (iii) Investigator‐linked training to ensure optimal diabetes care. Short Physical Performance Battery (SPPB) scores were used to assess change in functional performance at 12 months between the groups. An analysis of the cost‐effectiveness of the intervention was undertaken using the incremental cost‐effectiveness ratio (ICER). Secondary outcomes included mortality, hospitalization, institutionalization, quality of life, burden on caregivers, the frequency and severity of hypoglycaemia episodes, and the cost‐effectiveness of the intervention. Results After 12 months, IG participants had mean SPPB scores 0.85 points higher than those in the UCG (95% CI, 0.44 to 1.26, P

BACKGROUND: Sarcopenia, defined as the pathological decline in muscle mass, muscle strength and physical performance with aging, has become one of the geriatric giants because of its increasing prevalence and devastating health effects. The Belgian Society of Gerontology and Geriatrics (BSGG) is currently developing evidence-based guidelines for the prevention and therapy of sarcopenia for use in broad clinical practice. This systematic review summarizes the results of the Working Group on Pharmacology. OBJECTIVE: Our objective was to provide an evidence-based overview of the possible pharmacological interventions for sarcopenia with a focus on interventions that have already been studied in systematic reviews or meta-analyses. METHODS: We conducted a systematic umbrella review. Using the electronic databases PubMed and Web of Science, we identified systematic reviews and meta-analyses that assessed the effect of pharmacological interventions on criteria for sarcopenia in subjects aged ≥ 65 years. Study selection, quality assessment and data extraction were performed by two independent reviewers. RESULTS: We identified seven systematic reviews or meta-analyses, encompassing ten pharmacological interventions: vitamin D, combined estrogen-progesterone, dehydroepiandrosterone, growth hormone, growth hormone-releasing hormone, combined testosterone-growth hormone, insulin-like growth factor-1, pioglitazone, testosterone and angiotensin-converting enzyme inhibitors. Importantly, very few systematic reviews or meta-analyses clearly mentioned baseline sarcopenia status. Therefore, our recommendations are generalised to older people, without specifying whether the muscle effect is more effective in healthy, pre-sarcopenic or sarcopenic older people. Vitamin D had a significant effect on muscle strength and physical performance, especially in women with low baseline values (

Alterations in musculoskeletal health with advanced age contribute to sarcopenia and decline in bone mineral density (BMD) and bone strength. This decline may be modifiable via dietary supplementation. To test the hypothesis that a specific oral nutritional supplement can result in improvements in measures of bone health. Participants (n 380) were participants of the PROVIDE study, a 13-week, multicenter, randomized, controlled, double-blind, 2 parallel-group study among non-malnourished older participants (≥ 65 years) with sarcopenia [determined by Short Physical Performance Battery (SPPB; 0-12) scores between 4 and 9, and a low skeletal muscle mass index (SMI; skeletal muscle mass/BW × 100) ≤ 37% in men and ≤ 28% in women using bioelectric impedance analysis] Supplementation of a vitamin D, calcium and leucine-enriched whey protein drink that comprises a full range of micronutrients (active; 2/day) was compared with an iso-caloric control. Serum 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), biochemical markers of bone formation (osteocalcin; OC, procollagen type 1 amino-terminal propeptide; P1NP) and resorption (carboxy-terminal collagen crosslinks; CTX), insulin like growth factor 1 (IGF-1) and total-body BMD were analysed pre- and post-intervention. Serum 25(OH)D concentrations increased from 51.1 ± 22.9 nmol/L (mean ± SD) to 78.9 ± 21.1 nmol/L in the active group (p

Objectives: The aim of this systematic review is to provide an overview of the efficacy of different exercise interventions to counter sarcopenia in older adults. This review will allow the Belgian Society of Gerontology and Geriatrics and other scientific societies to formulate specific exercise recommendations in their Clinical Guidelines for Sarcopenia. Design: We used the method of a systematic umbrella-review. Based on the level of evidence, we formulated specific recommendations for clinical practice. Methods: Two databases (Pubmed and Web Of Science) were searched systematically and methodological quality of the reviews was assessed. Extracted data was than mapped to an exercise category and an overall synthesis (bottom line statements) was formulated for each of these exercise categories. Subsequently, we assigned a rating of the quality of the evidence supporting each bottom line statement. Results: We identified 14 systematic reviews or meta-analyses, encompassing four exercise categories: resistance training, resistance training + nutritional supplementation, multimodal exercise programmes and bloodflow restriction training. Importantly, very few systematic reviews or meta-analyses clearly mentioned baseline sarcopenia status. There is high quality evidence for a positive and significant effect of resistance training on muscle mass, muscle strength, and physical performance. The added effect of nutritional supplementation for resistance training on muscle function appears limited. Blood flow restriction training is a novel training method that has a significant impact on muscle strength. Conclusion: Since sarcopenia is affecting all skeletal muscles in the body, we recommend training the large muscle groups in a total body approach. Although low-intensity resistance training (≤50% 1RM) is sufficient to induce strength gains, we recommend a high-intensity resistance training program (i.e. 80% 1RM) to obtain maximal strength gains. Multimodal exercises and blood flow restriction resistance training may be considered as well.

ObjectivesThe Sarcopenia Quality of Life (SarQoL) questionnaire, a sarcopenia-specific patient-reported outcome measure, evaluates quality of life with 55 items. It produces 7 domain scores and 1 overall quality of life score, all between 0 and 100 points. This study aims to contribute to the interpretation of the SarQoL scores by calculating the standard error of measurement (SEM) and smallest detectable change (SDC) in a sample of subjects from 9 studies.MethodsSubjects from 9 studies (conducted in Belgium, Brazil, Czech Republic, England, Greece, Lithuania, Poland and Spain) were included. The SEM, a measure of the error in the scores that is not due to true changes, was calculated by dividing the standard deviation of the difference between test and retest scores (SDdiff) by √2. The SDC, defined as change beyond measurement error, was calculated by multiplying SDdiff by 1.96. Bland-Altman plots were assessed for the presence of systematic errors.ResultsA total of 278 sarcopenic subjects, aged 77.67 ± 7.64 years and 61.5% women, were included. The SEM for the overall SarQoL score ranged from 0.18 to 4.20 points for the individual studies, and was 2.65 points when all subjects were analyzed together. The SDC for the overall score ranged from 0.49 to 11.65 points for the individual studies, and was 7.35 points for all subjects. The Bland-Altman plots revealed no systematic errors in the questionnaire.ConclusionThis study shows that, for individual subjects, a change in overall quality of life of at least 7.35 points (on a scale from 0 to 100) would have to be observed to confirm that a true change, beyond measurement error, has occurred. It also demonstrated that the SarQoL questionnaire is a precise instrument, with the observed scores within less than 3 points of the theoretical “true score”.

Objectives Sarcopenia, defined as an age-associated loss of skeletal muscle function and muscle mass, occurs in approximately 6 - 22 % of older adults. This paper presents evidence-based clinical practice guidelines for screening, diagnosis and management of sarcopenia from the task force of the International Conference on Sarcopenia and Frailty Research (ICSFR). Methods To develop the guidelines, we drew upon the best available evidence from two systematic reviews paired with consensus statements by international working groups on sarcopenia. Eight topics were selected for the recommendations: (i) defining sarcopenia; (ii) screening and diagnosis; (iii) physical activity prescription; (iv) protein supplementation; (v) vitamin D supplementation; (vi) anabolic hormone prescription; (vii) medications under development; and (viii) research. The ICSFR task force evaluated the evidence behind each topic including the quality of evidence, the benefitharm balance of treatment, patient preferences/values, and cost-effectiveness. Recommendations were graded as either strong or conditional (weak) as per the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Consensus was achieved via one face-to-face workshop and a modified Delphi process. Recommendations We make a conditional recommendation for the use of an internationally accepted measurement tool for the diagnosis of sarcopenia including the EWGSOP and FNIH definitions, and advocate for rapid screening using gait speed or the SARC-F. To treat sarcopenia, we strongly recommend the prescription of resistance-based physical activity, and conditionally recommend protein supplementation/a protein-rich diet. No recommendation is given for Vitamin D supplementation or for anabolic hormone prescription. There is a lack of robust evidence to assess the strength of other treatment options. Journal of Nutrition, Health & Aging. December 2018, 22 (10), pp 1148–1161

It is well recognized that poor muscle function and poor physical performance are strong predictors of clinically relevant adverse events in older people. Given the large number of approaches to measure muscle function and physical performance, clinicians often struggle to choose a tool that is appropriate and validated for the population of older people they deal with. In this paper, an overview of different methods available and applicable in clinical settings is proposed. This paper is based on literature reviews performed by members of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) working group on frailty and sarcopenia. Face-to-face meetings were organized afterwards where the whole group could amend and discuss the recommendations further. Several characteristics should be considered when choosing a tool: (1) purpose of the assessment (intervention, screening, diagnosis); (2) patient characteristics (population, settings, functional ability, etc.); (3) psychometric properties of the tool (test–retest reliability, inter-rater reliability, responsiveness, floor and ceiling effects, etc.); (4) applicability of the tool in clinical settings (overall cost, time required for the examination, level of training, equipment, patient acceptance, etc.); (5) prognostic reliability for relevant clinical outcomes. Based on these criteria and the available evidence, the expert group advises the use of grip strength to measure muscle strength and the use of 4-m gait speed or the Short Physical Performance Battery test to measure physical performance in daily practice. The tools proposed are relevant for the assessment of muscle weakness and physical performance. Subjects with low values should receive additional diagnostic workups to achieve a full diagnosis of the underlying condition responsible (sarcopenia, frailty or other).

Background A specific self‐administrated health‐related quality of life questionnaire for sarcopenia, the Sarcopenia and Quality Of Life (SarQoL®), has been recently developed. This questionnaire is composed of 55 items translated into 22 questions and organized into seven domains of quality of life. The objective of the present work is to evaluate the psychometric properties (discriminative power, validity, reliability, floor and ceiling effects) of the SarQoL® questionnaire. Methods Sarcopenic subjects were recruited in an outpatient clinic in Liège, Belgium and were diagnosed according to the algorithm developed by the European Working Group on Sarcopenia in Older People. We compared the score of the SarQoL® between sarcopenic and non‐sarcopenic subjects using a logistic regression after adjustment for potential confounding variables. Internal consistency reliability was determined using Cronbach's alpha coefficient; construct validity was assessed using convergent and divergent validities. Test–retest reliability was verified after a two‐week interval using the intra‐class correlation coefficient (ICC). At last, floor and ceiling effects were also tested. Results A total of 296 subjects with a median age of 73.3 (68.9–78.6) years were recruited for this study. Among them, 43 were diagnosed sarcopenic. After adjustment for potential confounding factors, the total score and the scores of the different dimensions of the SarQoL® questionnaire were significantly lower for sarcopenic than for non‐sarcopenic subjects (54.7 (45.9–66.3) for sarcopenic vs. 67.8 (57.3 – 79.0) for non sarcopenic, OR 0.93 (95%CI 0.90–0.96)). Regarding internal consistency, the Cronbach's alpha coefficient was 0.87. The SarQoL® questionnaire data showed good correlation with some domains of the Short‐Form 36 (SF‐36) and the EuroQoL 5‐dimension (EQ‐5D) questionnaires and with the mobility test. An excellent agreement between the test and the retest was found with an ICC of 0.91 (95% CI 0.82–0.95). At last, neither floor nor ceiling effects were detected. Conclusions The SarQoL® questionnaire is valid, consistent, and reliable and can therefore be recommended for clinical and research purposes. However, its sensitivity to change needs to be assessed in future longitudinal studies.

info:eu-repo/semantics/published

This international joint research group (IJRG) Movement-Related impairment in Ageing, in short ‘Move in Age’, is an initiative of the Frailty in Ageing research group (FRIA) of the Vrije Universiteit Brussel (VUB), the department of General Practice and Elderly Care Medicine of the University Medical Center Groningen (UMCG) and the Research Group Healthy Ageing, Allied Health Care and Nursing of the Hanze University of Applied Sciences Groningen (HUAS). This initiative emerged from the PhD project on paratonia and Advanced Glycation Endproducts (AGE’s) of Hans Drenth.The IJRG will allow a comprehensive and inter-disciplinary approach of movement impairments at higher age. In the first 3-5 years, the focus will be on the movement-related impairments that occur in patients with dementia. The program will be extended towards movement-related impairments in the context of other geriatric syndromes .The first research line will be focused on untangling the underlying pathophysiological mechanisms, it consequences in functional decline and the development of preventive and therapeutic strategies to counter paratonia in patients with Alzheimer’s dementia.To enrich the discussion and ideas on this topic we decided to kick-start this research line with an invitational expert inspirational day on March 14th 2018 in Brussel (Belgium)

BACKGROUND: A specific self-administrated health-related quality of life questionnaire for sarcopenia, the Sarcopenia and Quality Of Life (SarQoL®), has been recently developed. This questionnaire is composed of 55 items translated into 22 questions and organized into seven domains of quality of life. The objective of the present work is to evaluate the psychometric properties (discriminative power, validity, reliability, floor and ceiling effects) of the SarQoL® questionnaire. METHODS: Sarcopenic subjects were recruited in an outpatient clinic in Liège, Belgium and were diagnosed according to the algorithm developed by the European Working Group on Sarcopenia in Older People. We compared the score of the SarQoL® between sarcopenic and non-sarcopenic subjects using a logistic regression after adjustment for potential confounding variables. Internal consistency reliability was determined using Cronbach's alpha coefficient; construct validity was assessed using convergent and divergent validities. Test-retest reliability was verified after a two-week interval using the intra-class correlation coefficient (ICC). At last, floor and ceiling effects were also tested. RESULTS: A total of 296 subjects with a median age of 73.3 (68.9-78.6) years were recruited for this study. Among them, 43 were diagnosed sarcopenic. After adjustment for potential confounding factors, the total score and the scores of the different dimensions of the SarQoL® questionnaire were significantly lower for sarcopenic than for non-sarcopenic subjects (54.7 (45.9-66.3) for sarcopenic vs. 67.8 (57.3 - 79.0) for non sarcopenic, OR 0.93 (95%CI 0.90-0.96)). Regarding internal consistency, the Cronbach's alpha coefficient was 0.87. The SarQoL® questionnaire data showed good correlation with some domains of the Short-Form 36 (SF-36) and the EuroQoL 5-dimension (EQ-5D) questionnaires and with the mobility test. An excellent agreement between the test and the retest was found with an ICC of 0.91 (95% CI 0.82-0.95). At last, neither floor nor ceiling effects were detected. CONCLUSIONS: The SarQoL® questionnaire is valid, consistent, and reliable and can therefore be recommended for clinical and research purposes. However, its sensitivity to change needs to be assessed in future longitudinal studies.

Frailty, a complex phenomenon

Physical activity has been proven to be effective in improving and sustaining physical and cognitive performance in dementia.

Objectif: L’objectif de cette étude est de déterminer les preuves disponibles pour le pouvoir prédictif concernant l'état de fragilité (pré-fragile et fragile) chez les personnes vivant à domicile pour l’incidence des limitations dans les AVQ (Activités de base de la vie quotidienne) et l'institutionnalisation. Méthodes: Web of Science, PubMed et PsycInfo ont été examinés systématiquement pour des études prospectives au sujet de la relation entre la fragilité et des limitations des AVQ/institutionnalisation. Les Odds Ratios (OR) et les Risk Ratios (RR) ont été extrahés et/ou calculés, et des méta-analyses ont été réalisées avec Open MetaAnalyst pour évaluer l’association de l’état de fragilité avec la probabilité de développer une limitation des AVQ ou d’être institutionnalisé. Résultats: Treize études décrivant l’association entre la fragilité et la limitation de l'AVQ/institutionnalisation ont été incluses dans la méta-analyse. Les études comprenaient des échelles de fragilité physique, multi-domaine et d’accumulation des déficits. Le niveau d’hétérogénéité (I2) était modéré à élevé dans toutes les méta-analyses. En général, l’état de fragilité augmente le risque de développer une limitation des AVQ (OR=2,05 (1,73-2,44); RR=1,62 (1,50-1,76)) et d’institutionnalisation (OR=1,69 (1,02-2,81); RR=1,65 (1,48-1,84)). Il semble qu’un état fragile est accompagné de OR et RR légèrement élevés par rapport à un état pré-fragile. Conclusion: Notre méta-analyse des études prospectives indique qu’un état de (pré)fragilité augmente le risque pour développer des limitations des AVQ (1.6-2.1) et d’institutionnalisation (1.6-1.7). Ainsi, l’identification et l’intervention prémature pour contrer la (pré)fragilité devraient être des priorités pour permettre les personnes âgées de vivre indépendamment à domicile.

Objectif: L’objectif de cette étude est de déterminer les preuves disponibles pour le pouvoir prédictif concernant l'état de fragilité (pré-fragile et fragile) chez les personnes vivantes à domicile pour l’incidence d’hospitalisation et de mortalité. Méthodes: Web of Science, PubMed et PsycInfo ont été examinés systematiquement pour des études prospectives au sujet de la relation entre la fragilité et l’hospitalisation/la mortalité. Les Odds Ratios (OR) et les Risk Ratios (RR) ont été extrahés et/ou calculés, et des méta-analyses ont été réalisées avec Open MetaAnalyst pour évaluer l’association de l’état de fragilité avec la probabilité d’une hospitalisation ou de mortalité prématurée. Résultats: Trente études décrivant l’association entre la fragilité et l’hospitalisation ou la mortalité ont été incluses dans la méta-analyse. Les études comprenaient des échelles de fragilité physique, multi-domaine et d’accumulation des déficits. Le niveau d’hétérogénéité (I2) était modéré à élevé dans toutes les méta-analyses. En général, l’état de fragilité augmente le risque d’hospitalisation (OR=1.82 (1.53-2.15); RR=1.18 (1,10-1,28)) et de mortalité (OR=2,34 (1,77-3,09); RR=1,83 (1,68-1,98)). Il semble qu’un état fragile est accompagné des OR et RR légèrement élevés par rapport à un état pré-fragile. Conclusion: Notre méta-analyse des études prospectives indique qu’un état de (pré)fragilité augmente le risque pour l’hospitalisation (1.2-1.8) et la mortalité (1.8-2.3). Ainsi, l’identification et l’intervention prémature pour contrer la (pré)fragilité devraient être des priorités pour permettre les personnes âgées de vivre indépendamment à domicile.

Contexte: Un des défis majeurs pour l’utilisation clinique du concept de la fragilité est l’absence de langage commun pour décrire et évaluer ses composantes. Bien que le nombre de publications utilisant les mots-clés (MeSH term) frail elderly a augmenté de façon exponentielle durant ces 30 dernières années, de nouvelles définitions et échelles d’évaluation de la fragilité sont perpétuellement proposées. La Classification Internationale du Fonctionnement, de l’handicap et de la santé de l’OMS (CIF) offre un cadre et un langage universel pour une description précise de l’état de santé et des facteurs associés. But de la recherche: effectuer une revue systématique des échelles de fragilité utilisées chez des personnes d’au moins 65 ans et relier leurs items aux codes de la CIF. Analyser le degré de congruence entre les différentes échelles de fragilité et les domaines de la CIF. Méthode: Une recherche des publications relatives aux échelles de la fragilité a été conduite dans PubMed, Web of Knowledge et PsycINFO en utilisant les mots-clés suivants : ‘frailty, frail elderly, aged, assessment, risk assessment, classification, et diagnosis’. Les items des échelles ainsi identifiées ont été reliés aux codes de la CIF par 3 chercheurs indépendants en utilisant les règles publiées par Cieza ea. (2005). Résultats: 1,984 articles ont été identifiés et les titres, et si nécessaire les abstracts, ont été évalués. 67 publications pertinentes ont été retenues et inclues dans la revue systématique. 79 échelles originales ou adaptées ont ainsi été identifiées par lequel deux échelles ne sont pas suffisamment décrites pour être inclus dans les résultats. Parmi celles-ci 27 échelles utilisent des données subjectives, 6 des données objectives et 44 utilisent une combinaison des deux pour identifier la fragilité. 25 échelles seulement identifient un état de pré-fragilité. Le phénotype de la fragilité décrit par Fried est à la base de 24 échelles pour la fragilité, qui s’adressent exclusivement aux aspects physiques. Une échelle est basée uniquement sur la comorbidité et toutes les autres échelles évaluent deux ou plusieurs domaines de la fragilité (p.ex. combinaison d’aspects médicaux, fonctionnels, cognitifs, psychologiques, ou sociaux). 75 échelles ont pu être liées au domaine Fonction organique de la CIF, 19 aux domaines Structure anatomique et Capacité, 72 échelles étaient liées à Performance, 14 à Facteurs environnementaux et 32 à Facteurs personnels. Une vaste diversité a donc été observée parmi les échelles de la fragilité. Tandis que les domaines Fonction organique et Performance sont bien représentés parmi les items des échelles de la fragilité, d’autres domaines de la CIF, tels Structure organique, Capacité, Facteurs environnementaux et Facteurs personnels sont représentés de façon beaucoup plus limitée. La majorité des échelles de la fragilité distinguent entre personnes âgées robustes et fragiles, sans considérer l’état de pré-fragilité (état intermédiaire sub-clinique) durant lequel les interventions adéquates sont probablement les plus efficaces. Conclusions: Plus de 70 échelles de la fragilité différentes ont été identifiées, potentiellement indiquant une grande diversité dans l’approche clinique. Les domaines de la CIF portant sur la Structure organique, les Capacités et les Facteurs environnementaux sont peu représentés et méritent plus d’attention dans l’élaboration d’un consensus futur pour l’évaluation de la fragilité.

Introduction: The main goals of obesity intervention programs are decreasing body weight, fat mass and increasing lean mass. It is generally accepted that fat mass decreases with weight loss, but results on lean mass are inconsistent. The relation between weight-loss induced changes in body composition and fatigue sensations in obese adolescents remain unexplored. This study examined the effect of a 6 months weight loss program on self-perceived fatigue, grip performance and body composition.Methods: 81 obese boys (15±2 years) were examined for body composition (DXA), maximal grip strength, fatigue resistance (the time during which grip strength decreased to 50% of its maximum value during sustained maximal contraction), grip work (calculated as fatigue resistance x 0.75 x maximal grip strength, corresponding to the area under the curve) and self-perceived fatigue (Multidimensional Fatigue Inventory, MFI-20). The boys were divided into 2 groups; a high weight loss group (HWL, >20% body weight) and a low weight loss group (LWL

Background: The ageing world population brings along many challenges. Active ageing and independent living is the way forward to reduce the burdens of an ageing population. One of the most prominent barriers to active ageing is frailty, recognised as a major geriatric syndrome. The consensus and operationalisation of frailty and pre-frailty still lacks consensus. Fried’s Phenotype (FP), the most accepted frailty approach (2029 WoS citations), consists of 5 components: exhaustion, weight loss, low physical activity, slow walking speed and low grip strength. Pre-frail elderly, defined as an incomplete FP (only 1-2 criteria), are not well described in literature. As an “absolute reserve capacity” approach, FP defines frailty as meeting 3 or more and robust as meeting 0 deficits (figure 1). Since maximal absolute reserve capacity at young age varies considerably amongst individuals, it remains unclear where to draw the line between robust and early frailty (when deficits are not yet apparent). This project, witha focus on physical frailty, is part of a larger multidisciplinary project, exploring frailty in multiple domains (medical, psychosocial, cognitive, environmental).Objectives: Notwithstanding frailty is linked to several domains (social, medical, psychological, etc.), the physical aspect of frailty is a dominating component, which is reflected by the fact that a loss in physical reserve capacity is an indispensable component of all comprehensive frailty scales that exist today. The objective of this study is to identify the early markers of physical frailty in order to enable the oldest old to remain independent as long and as good as possible.This project introduces a new concept of “relative reserve capacity”, reflected by a loss over time. Above 80, loss rates of 2%/year reflect biological ageing. We consider higher loss in relative reserve capacity (e.g. 10%) an early sign of frailty, which can occur without changes in FP- score (which will appear later, when reversibility is more challenging) (figure 1). To detect elderly without deficits, but showing excessive loss in reserve capacity, sensitive and responsive measures covering the 5 components of FP are used in the study. Methods: We target the (apparently) robust elderly and will calculate the odds for developing (pre)frailty over 2 years for the robust, showing high loss compared to those with normal loss in relative reserve. Future plans: The results of this study will allow for a better understanding of the mechanisms by which elderly persons develop pre-frailty and frailty, and will enable us in the future to develop new interventions to prevent or delay the occurrence of frailty in the oldest old. More participants will be recruited and results will be translated into scientific publications on frailty.

Rationale: No BIA equations exist to predict appendicular skeletal muscle mass (ASMM) and appendicular fat mass (AFM) in older adults with sarcopenia. NHANES public reference values for body composition are applicable only to Hologic DXA systems. Therefore we 1) developed and cross-validated appendicular soft tissue BIA equations with both Hologic and GE Lunar systems as their reference and 2) compared the new ASMMHOLOGIC equation to two previously published BIA equations. Methods: Participants with sarcopenia class I or II were recruited from 18 European study centers for the PROVIDE intervention study (NTR2329). In total, 291 cases having both an evaluable BIA (50kHz) and DXA measurement were included (mean age 77.6±6.9yrs; mean %fat 37.2±5.9%). BIA equations, using DXA-derived ASMM and AFM as the dependent variable, and age, gender, weight, height²/resistance and reactance as independent variables, were developed using multiple linear regressions. Results: Cross-validation resulted in 4 equations using the whole sample. Hologic (n=104): ASMM (kg) = 4.957 + (0.196*Height²/Resistance) + (0.060*Weight) – (2.554*Sex) (R²=0.90; SEE=1.28) AFM (kg) = -4.716 + (0.142*Height²/Resistance) + (0.316*Weight) + (4.453*Sex) – (0.040*Reactance) (R²=0.73; SEE=1.54) GE Lunar (n=187): ASMM (kg) = 1.821 + (0.168*Height²/Resistance) + (0.132*Weight) –(1.931*Sex) + (0.017*Reactance) (R²=0.86; SEE=1.37) AFM (kg) = -6.553 + (0.093*Height²/Resistance) + (0.272*Weight) + (4.295*Sex) (R²=0.70; SEE=1.53) Sex: women=1, men=0 Previously published BIA-equations overestimated significantly ASMMHOLOGIC with mean biases of -0.36 kg and -1.05 kg. Conclusion: We propose new BIA equations for the accurate estimation of limb soft tissue masses in sarcopenic older adults. Users of both Hologic and GE Lunar may benefit from these equations in field research.

Sex differences in self-perceived fatigue and handgrip performance and its relation with body composition in obese children Introduction: Maximal strength is an important factor to perform daily activities, especially in obese persons whose muscles must carry heavier loads, which can induce higher levels of fatigue. Weight excess consists mainly of fat mass but also lean mass which can influence the muscle performance positively in non-weight bearing activities. Studies correlating grip strength with segmental and total body composition (estimated using DXA) in obese children are scarce. This study explores the self-perceived fatigue, body composition and muscle performance in obese adolescents Methods: 117 obese children (70 girls and 47 boys) were examined for body composition (DXA), muscle performance (maximal grip strength, fatigue resistance and grip work) and self-perceived fatigue (Multidimensional Fatigue Inventory, MFI-20). Results: Girls showed no difference in absolute muscle performance compared with boys, even correction for lean arm mass. No significant difference was found between the 2 sexes for absolute fat mass, but girls showed significant lower lean mass and higher fat percentage than boys. Grip strength shows good correlations with lean and BMC in as well appendicular segments as total body composition and a negative correlation is found for fat% in both sexes. In boys fatigue parameters show correlation with body composition, not in girls. Conclusion: Based on our results we can state that self-perceived fatigue and handgrip performance has an influence on segmental and total body composition. Further studies are necessary to evaluate whether self-perceived fatigue is affected by weight loss and/or physical exercise interventions.

Purpose of the study Exercise reduces pain and improves functioning in osteoarthritis of the knee (OAk). Underlying mechanisms are still under debate and better understanding of the pathways involved may contribute to more targeted treatment strategies. This qualitative analysis of the literature aims to provide an overview of theoretical models that are put forward to explain the treatment effects of exercise in OAk. Methods An inductive qualitative approach, based on the 'grounded theory' of Glaser and Straus, was used. Studies emphasizing on exercise therapy for OAk, collected from three Cochrane reviews and nine guidelines of the Physiotherapy Evidence Database (PEDRO) published between 2000 and 2012, were included. The introduction and discussion parts of these papers were screened for explanations of exercise-induced benefits in OAk patients. Results Twenty-two studies were included and 73 key points were identified which were subdivided into 16 core theoretical concepts. Finally, 5 categories were formed: neuromuscular, peri-articular, intra-articular, and psychosocial components, and general fitness and health. Conclusion Future research on exercise in OAk should allow distinguishing the contribution of different potential pathways to the treatment effects.

Background Exercise reduces pain and improves functioning in osteoarthritis of the knee (OAk). Underlying mechanisms are still under debate and better understanding of the pathways involved may contribute to more targeted treatment strategies. This qualitative analysis of the literature aims to provide an overview of theoretical models that are put forward to explain the treatment effects of exercise in OAk. Methods An inductive qualitative approach, based on the 'grounded theory' of Glaser and Straus, was used. Studies emphasizing on exercise therapy for OAk, collected from three Cochrane reviews and nine guidelines of the Physiotherapy Evidence Database (PEDRO) published between 2000 and 2012, were included. The introduction and discussion parts of these papers were screened for explanations of exercise-induced benefits in OAk patients. Results Twenty-two studies were included and 73 key points were identified which were subdivided into 16 core theoretical concepts. Finally, 5 categories were formed: neuromuscular, peri-articular, intra-articular, and psychosocial components, and general fitness and health. Conclusion Future research on exercise in OAk should allow distinguishing the contribution of different potential pathways to the treatment effects.

There is growing evidence for the involvement of inflammatory processes in the development and progression of several age-related conditions, among which sarcopenia (age-related loss of muscle mass) and frailty (one of the major geriatric syndromes) (Bautmans et al., 2009). In fact, ageing, even in healthy persons, is commonly accompanied by slightly elevated concentrations of circulating pro-inflammatory mediators (such as Interleukin[IL]-6 and Tumor Necrosis Factor-?), a phenomenon corresponding to a chronic low-grade inflammatory profile (CLIP) (Beyer et al., 2012). Older persons presenting more pronounced CLIP show indeed lower muscle mass and muscle strength; and are more likely to become frail. Elderly people possess an important residual, but latent, physical potential, which can be mobilized by training, even at very high ages (>90years). Physical exercise has also strong regulating and favourable effects on CLIP. Besides providing anabolic stimuli, it is well known that intensive physical training provokes an inflammatory reaction, accompanied by the liberation of pro-inflammatory cytokines (especially IL-6) and complex changes in the cellular components of the immune system. In this context, IL-6 is thought to be mainly released from the contracting muscles and would act as a "myokine", exerting a different function from that seen during e.g. acute infections. The acute phase response to exercise is positively related to the intensity of the muscle work delivered. Recently, it has been shown that older persons, similar to young adults, are able to respond to physical stress by a significant exercise-induced increase of circulating IL-6 (Bautmans et al., 2005). In fact, the exposure to (repetitive) mild stress has been shown to improve survival and longevity both at the cellular and organism level. In this context, an improved wound healing by physical training, has recently been described in old mice and in older humans; the underlying mechanisms, possible immune-related, have not been elucidated yet. Exercise can probably lower infection-induced cytokine release by peripheral mononuclear blood cells. Physical exercise would thus reduce sarcopenia as well as CLIP and the acute inflammatory response upon infection in the aged; thus enlarging considerably the scope of geriatric rehabilitation professionals in designing health-enhancing physical exercise programs. To date, however, optimal dosage of exercise to obtain most beneficial effects remains elusive, and more research is warranted to unravel the exact dose-response relationship.

Introduction: Point-of-care (POC) devices such as the Accutrend® Plus are helpful in the measurement of lipid levels and have been validated in the laboratory setting, but not in a busy general practitioners office. Since the Accutrend® Plus device has recently been recommended as an additional tool in the personal management of dyslipidemias, it's of the utmost importance to ensure that the precision and accuracy of this POC device is satisfactory. Materials and methods: The sample consisted of 61 randomly chosen individuals (? 18 years) without known history of cardiovascular disease events. Simultaneous capillary and venous blood testing was undertaken on the Accutrend® Plus handheld lipid analyzer and a reference instrument (Vitros® 5.1 FSchemistry system) respectively. To stimulate a true picture of the usual clinical setting all blood samples were taken in the private office of each subject's general practitioner after a fasting period of at least eight hours. Results: The results show that the Accutrend® Plus system provided significantly lower values (P 0.05) as compared to the values determined in the laboratory. The agreement between methods fell outside clinically acceptable limits for blood lipid measurement (TC ? 8.9%, TG ? 15%), as stated by NCEP recommendations. However, a good between- day reproducibility (ICC: TC = 0.85, TG = 0.68, P

No abstract available

There is growing evidence for the involvement of inflammatory processes in the development and progression of several age-related conditions, among which sarcopenia (age-related loss of muscle mass) and frailty (one of the major geriatric syndromes) (Bautmans et al., 2009). In fact, ageing, even in healthy persons, is commonly accompanied by slightly elevated concentrations of circulating pro-inflammatory mediators (such as Interleukin[IL]-6 and Tumor Necrosis Factor-alpha), a phenomenon corresponding to a chronic low-grade inflammatory profile (CLIP) (Beyer et al., 2012). Older persons presenting more pronounced CLIP show indeed lower muscle mass and muscle strength; and are more likely to become frail. Elderly people possess an important residual, but latent, physical potential, which can be mobilized by training, even at very high ages (>90years). Physical exercise has also strong regulating and favourable effects on CLIP. Besides providing anabolic stimuli, it is well known that intensive physical training provokes an inflammatory reaction, accompanied by the liberation of pro-inflammatory cytokines (especially IL-6) and complex changes in the cellular components of the immune system. In this context, IL-6 is thought to be mainly released from the contracting muscles and would act as a "myokine", exerting a different function from that seen during e.g. acute infections. The acute phase response to exercise is positively related to the intensity of the muscle work delivered. Recently, it has been shown that older persons, similar to young adults, are able to respond to physical stress by a significant exercise-induced increase of circulating IL-6 (Bautmans et al., 2005). In fact, the exposure to (repetitive) mild stress has been shown to improve survival and longevity both at the cellular and organism level. In this context, an improved wound healing by physical training, has recently been described in old mice and in older humans; the underlying mechanisms, possible immune-related, have not been elucidated yet. Exercise can probably lower infection-induced cytokine release by peripheral mononuclear blood cells. Physical exercise would thus reduce sarcopenia as well as CLIP and the acute inflammatory response upon infection in the aged; thus enlarging considerably the scope of geriatric rehabilitation professionals in designing health-enhancing physical exercise programs. To date, however, optimal dosage of exercise to obtain most beneficial effects remains elusive, and more research is warranted to unravel the exact dose-response relationship.

Spierzwakte, spieratrofie en vermoeidheid zijn sleutelelementen in de klinische manifestatie van de kwetsbare oudere patiënt. Uit wetenschappelijk onderzoek blijkt dat de fysieke interventies thans bij de meest belovende behandelstrategieën horen voor de revalidatie van kwetsbare ouderen. Het spierapparaat in het bijzonder blijkt nog een zeer hoog potentieel aan trainbaarheid te vertonen, met spectaculaire effecten; zelfs bij hoogbejaarde en/of kwetsbare geriatrische patiënten. Kennis en inzicht over de specifieke biologische veranderingen die plaatsvinden in het spierstelsel bij het ouder worden en in combinatie met pathologie zijn basisvoorwaarden om kwetsbare oudere patiënten adequaat te kunnen revalideren.

Background Central sensitization has recently been documented in patients with knee osteoarthritis (OAk). So far, the presence of central sensitization has not been considered as a confounding factor in studies assessing the pain inhibitory effect of transcutaneous electrical nerve stimulation (TENS) on osteoarthritis of the knee. Aims This study will explore the prognostic value of central sensitization on the pain inhibitory effect of TENS in Oak patients. Methods Patients with knee pain due to OAk will be recruited through advertisements in local media. Central sensitization will be measured by temporal summation (TS), before and after a heterotopic noxious conditioning stimulation (HNCS). In addition, pain on a numeric rating score and WOMAC subscores for pain and function will be assessed. Patients will be randomly allocated to one of two treatment groups (TENS, sham TENS). Follow-up measurements will be scheduled after 6 and 12 weeks. The prognostic value of TS and HNCS on the pain inhibitory effect of TENS will be statistically analyzed. Conclusion TENS influences pain through the electrical stimulation of low-threshold A-beta cutaneous fibers. The responsiveness of central pain-signaling neurons of OAk patients who are centrally sensitized may be augmented to the input of these electrical stimuli. This would encompass an adverse therapy effect of TENS. Therefore it might be interesting to identify a subgroup of symptomatic OAk patients, i.e. non-sensitized patients, who are likely to benefit from TENS.

Purpose:To identify central and peripheral muscle activation deficits in inflammation-induced muscle fatigue. Methods: Hospitalized geriatric patients (N=10) and elderly community-dwelling controls (N=18) performed a sustained maximal isometric contraction of the M. Adductor Pollicis until the strength dropped to 50% of its maximal value. Voluntary muscle activation was studied before and at the end of the fatigue test using the twitch interpolation method (by stimulation of the Ulnar Nerve). Muscle activity was continuously monitored using surface (s)EMG. Circulating levels of pro- and anti-inflammatory cytokines/chemokines were analyzed. Results: We found no significant difference in central muscular activation between both groups. Geriatric patients showed a significant (p Conclusions: Inflammation-induced muscle fatigue is probably due to local processes, acting at the level of the muscle itself. Further studies are required to unravel the exact pathways involved.

no abstract available