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This study aimed to describe the level of physical activity and its relation to fatigue and frailty during the COVID-19 pandemic in community-dwelling older adults aged 80 years and over. Three hundred and ninety-one older adults (aged 86.5 ± 3.00) completed a survey including physical activity, the Mobility Tiredness scale, and the FRAIL scale. Linear regression analysis was conducted to assess whether the variables age, sex, and physical activity (independent factors) were significantly related to fatigue and frailty. Respectively, 30.5% and 24.7% of the participants reported a decrease in walking and in energy-intensive activities; 25.4% reported increased sedentary behavior. A lower level of physical activity was associated with higher levels of fatigue and increased frailty risk (p <.05), independently from psychological symptoms. These results are important because participants with lower levels of physical activity and more sedentary behavior are more likely to feel fatigued and have higher risk to be frail. [ABSTRACT FROM AUTHOR]

Introduction: Lifestyle interventions combining caloric restriction with resistance exercise have the potential to preserve lean mass during weight loss. Additional protein intake can further improve lean mass. However, it is unclear whether these effects are sustained after completion of the intervention. This study aimed to evaluate the long‐term effect of a 3‐month lifestyle intervention, with or without supplementation of a protein drink, to preserve lean mass in older adults with obesity and type 2 diabetes at 6 months post‐intervention. Methods: Adults (n = 123) aged ≥55 years with obesity and type 2 diabetes were enrolled in a 3‐month intensive lifestyle intervention including a hypocaloric diet, resistance exercise and high‐intensity interval training. Participants were randomized to either receive a leucine and vitamin D‐enriched protein drink or an isocaloric control drink. The 3‐month intervention was followed by a 6‐month phase without intervention. At baseline, 3 and 9 months (follow‐up) body composition, physical functioning, physical activity and quality of life were assessed. Statistical analyses were performed using linear mixed models. Results: Body weight loss was largely sustained at follow‐up (−2.1 kg compared to baseline, 95% CI [−2.8, −1.5]) and comprised a sustained loss of fat mass (−2.6 kg, 95% CI [−3.2, −2.0]) with a simultaneous gain of lean mass (+0.7 kg, 95% CI [+0.2, +1.2]). Improvements in 400 m walk speed (+0.05 m/s, 95% CI [+0.03, +0.08]) and chair stand test time (−1.5 s, 95% CI [−1.9, −1.1]) were sustained at follow‐up. There were no differences in these changes between the protein supplementation group and the control group at follow‐up. Conclusions: Older adults with obesity and type 2 diabetes preserved their lean mass, their loss of fat mass and their improvements in physical functioning at 6 months post‐intervention. Protein supplementation during intervention did not affect outcomes at follow‐up. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to evaluate the association of respiratory muscle strength with sarcopenia and its indicators in the oldest old. Methods: Maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and sarcopenia-related factors (handgrip strength and appendicular lean mass) were evaluated in a cohort of n = 286 (45.5% female) non-frail, community-dwelling persons aged 83.6 ± 3.0 years (age range 80–97 years). Results: The sample presented a sarcopenia prevalence of 32.2%. Sarcopenic subjects showed comparable MIP and MEP as non-sarcopenic ones (female: MIP 43.9 ± 18.9 vs. 50.3 ± 19.5, p = 0.053; MEP 63.0 ± 23.0 vs. 69.2 ± 19.1, p = 0.067; male: MIP, 65.1 ± 24.4 vs. 64.4 ± 23.9, p = 0.433; MEP 87.7 ± 33.3 vs. 93.8 ± 30.9, p = 0.124). Statistically significant but very low associations were found between grip strength and MIP (r = 0.193 for male, p <0.05 and r = 0.257 for female participants, p <0.01) and MEP (r = 0.200 for male, p <0.01 and r = 0.191 for female participants, p <0.05). Lean mass was significantly correlated to MIP and MEP in female (r = 0.253, p <0.01 and r = 0.343, p <0.01, respectively), whereas this association was not found in male participants. Grip strength was the only statistically significant predictor of MEP (r2 = 0.212, p <0.001), while MIP was independently predicted by age, male sex, and grip strength (r2 = 0.177, p <0.001). Conclusions: Peripheral muscle strength is a statistically significant, albeit weak predictor for respiratory muscle strength in well-functioning, community-dwelling persons aged 80+. When confronted to a low grip strength, one should be aware of concomitant respiratory muscle weakness, as this is a known risk factor for atelectasis and pneumonia. Given the relatively low association with handgrip strength, respiratory muscle strength testing might be indicated. [ABSTRACT FROM AUTHOR]

The global aging population faces significant health challenges, including an increasing vulnerability to disability due to natural aging processes. Wearable lower limb exoskeletons (LLEs) have emerged as a promising solution to enhance physical function in older individuals. This systematic review synthesizes the use of LLEs in alignment with the WHO's healthy aging vision, examining their impact on intrinsic capacities and functional abilities. We conducted a comprehensive literature search in six databases, yielding 36 relevant articles covering older adults (65+) with various health conditions, including sarcopenia, stroke, Parkinson's Disease, osteoarthritis, and more. The interventions, spanning one to forty sessions, utilized a range of LLE technologies such as Ekso®, HAL®, Stride Management Assist®, Honda Walking Assist®, Lokomat®, Walkbot®, Healbot®, Keeogo Rehab®, EX1®, overground wearable exoskeletons, Eksoband®, powered ankle–foot orthoses, HAL® lumbar type, Human Body Posturizer®, Gait Enhancing and Motivation System®, soft robotic suits, and active pelvis orthoses. The findings revealed substantial positive outcomes across diverse health conditions. LLE training led to improvements in key performance indicators, such as the 10 Meter Walk Test, Five Times Sit-to-Stand test, Timed Up and Go test, and more. Additionally, enhancements were observed in gait quality, joint mobility, muscle strength, and balance. These improvements were accompanied by reductions in sedentary behavior, pain perception, muscle exertion, and metabolic cost while walking. While longer intervention durations can aid in the rehabilitation of intrinsic capacities, even the instantaneous augmentation of functional abilities can be observed in a single session. In summary, this review demonstrates consistent and significant enhancements in critical parameters across a broad spectrum of health conditions following LLE interventions in older adults. These findings underscore the potential of LLE in promoting healthy aging and enhancing the well-being of older adults. [ABSTRACT FROM AUTHOR]

Introduction: Engaging in meaningful activities contributes to health and well-being. Therefore, it is important to measure this with reliable and valid evaluation tools. The Engagement in Meaningful Activities Survey (EMAS-VL) has been cross-culturally validated in Flemish and the psychometric properties determined. Method: The adaptation process followed the guidelines 'Translation and Adaptation of Instruments' and 'Cross-Cultural Adaptation of Self Report'. A forward and backward translation was performed. Three authors of the original EMAS were in close contact. Pretesting and cognitive interviews were performed on a sample of 10 chronically ill individuals. Psychometric analysis of survey data, collected during the COVID-19 lockdown (N = 1938 Belgian adults, Flemish speaking), was performed. Internal consistency, factorial validity and construct validity were examined. Results: The adaptation process involved an accurate analysis of the items of the EMAS by the expert panel and EMAS authors. The EMAS-VL showed high reliability (Cronbach's α = 0.91). Exploratory factor analysis discerned an interpretable two-factorial structure of the EMAS-VL. As hypothesized, moderate associations were found between GHQ-12 (r = −0.57) and CD-RISC (r = 0.50) so the EMAS-VL possesses satisfactory construct validity as well. Conclusion: EMAS-VL is shown to be a reliable and valid instrument for evaluating meaning in activities in Flanders. [ABSTRACT FROM AUTHOR]

Introduction: Fatigue 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. Methods: A cohort of young healthy controls (Y, <30 y, 24 ± 3 y, 54% women), middle-aged (MA, 30–65 y, 47 ± 11 y, 54% women), and older (OLD, >65 y, 77 ± 7 y, 50% women) community-dwelling persons, and hospitalized geriatric patients (HOSP, 84 ± 5 y, 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% to 75% and from 75% to 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., 1/5,000 s) and corrected for body weight (GW/body weight). Results: For both systems, we found fair associations between FR100–50 and FR100–75 (Pneu mean difference = 50.1 s [95% CI: 47.9–52.4], r2 = 0.48; Hydr mean difference = 28.4 s [95% CI: 27.0–29.7], r2 = 0.52, all p < 0.001) and also moderate associations between GW(100–50)/body weight and GW(100–75)/body weight (Pneu mean difference = 32.1 kPa*s/kg [95% CI: 30.6–33.6], r2 = 0.72; Hydr mean difference = 8.1 kg*s/kg [95% CI: 7.7–8.6], r2 = 0.68, all p < 0.001). Between MA and OLD, we found a significant age-related difference in the GW results in the first 25% strength decay for Pneu (10.2 ± 0.6 kPa*s/kg against 7.1 ± 1.2 kPa*s/kg, respectively). Conclusion: The brief test protocol is valid. Differences within the first 25% strength decay in GW between OLD and HOSP were identified when using Pneu but not when using Hydr. Therefore, a brief FR test protocol using a continuous registration of the strength decay seems to be sufficiently informative in a clinical setting to appraise muscle fatigability, however, only when using a Pneu system. [ABSTRACT FROM AUTHOR]

Background Vitality capacity (VC) is a key domain of intrinsic capacity (IC) and is the underlying biophysiological aspect of IC. Energy and metabolism (E&M) is one of the domains of VC. Fatigue is one of the main characteristics of E&M. Objective The aims of this umbrella review are (i) to identify the available instruments suitable for measuring fatigue in community-dwelling older adults and (ii) to critically review the measurement properties of the identified instruments. Design Umbrella review. Setting Healthcare. Subjects Community-dwelling older adults. Methods PubMed and Web of Knowledge were systematically screened for systematic reviews and meta-analysis reporting on fatigue instruments resulting in 2,263 articles (last search 5 December 2022). The COSMIN checklist was used to appraise psychometric properties and the AMSTAR for assessing methodological quality. Data on fatigue instruments, construct, reference period, assessment method, validated population, reliability, validity, responsiveness and predictive validity on negative health outcomes were extracted. Results 10 systematic reviews and 1 meta-analysis were included in this study. 70 fatigue instruments were identified in the literature and 21 were originally designed for fatigue. The Fatigue Severity Scale (FSS), Pittsburgh Fatigability Scale (PFS) and Visual Analogue scale (VAS-F), Fatigue Impact Scale (FIS) and the Functional Assessment of Chronic Illness Therapy Fatigue (FACIT-F) presented good psychometric properties. Conclusions The FSS, FIS, FACIT-F, PFS and the VAS-F presented good psychometric properties in various conditions. Therefore, these instruments could be used to quantify trajectories in the domain E&M in the context of VC in community-dwelling older adults. [ABSTRACT FROM AUTHOR]

To investigate the impact of COVID-19 lockdown on quality of life (QoL), meaningful daily activities, and (pre)frailty in community-dwelling octogenarians. Cross-sectional design with bivariate and multiple linear regression modeling using a stepwise approach examining the level of QoL during the COVID-19 lockdown in a group of 215 community-dwelling octogenarians (Mage = 86.49 ± 3.02). A comprehensive set of biopsychosocial variables (FRAIL scale, general health, engagement in meaningful activities survey, questions on loneliness, and feelings) were used as explaining variables. Particularly, a decrease in daily activities, social activities, and an increase in free times activities were observed, but the decrease in QoL could be explained by the meaningfulness in activities, together with experiencing emptiness in life, taking ≥ 4 medications a day and feeling down or depressed. We tried to understand which components contribute to and might affect a person's QoL caused by restrictions imposed by the governance and its influence on the lives of the community-dwelling octogenarians. As such, this output could be a baseline for the development of minimally impacting countermeasures during future lockdowns. Studying lifestyle changes and thus also variables related to QoL during a pandemic, may support policymakers and practitioners to develop relevant interventions. [ABSTRACT FROM AUTHOR]

Background: Fatigue might influence the losses in activities of daily living (ADL). When fatigue parameters are present before the experience of losses in ADL and gait speed they can be used as early warning signals. This study aimed to explore the predictive value of muscle endurance and fatigue on changes in ADL and gait speed in community-dwelling older adults aged 80 and over.Methods: 324 community-dwelling older adults aged 80 and older of the BUTTERFLY study were assessed after one year for muscle endurance, self-perceived fatigue, Activities of Daily Living and gait speed. Exploratory factor analysis (EFA) was performed to explore, whether there is an underlying arrangement of the fatigue parameters. Mediating logistic regression analyses were used to investigate whether muscle endurance mediated by self-perceived fatigue predicts decline in gait speed and ADL after one year follow-up.Results: Exploratory factor analysis indicated a 2-factor model (muscle endurance factor and self-perceived fatigue factor) and had a moderate fit (X 2: 374.81, df: 2, CFI; 0.710, TLI: 0.961, RSMEA(90%): 0.048 (0.00-0.90)). Muscle endurance mediated by self-perceived fatigue had an indirect effect on the prediction of decline in Basal- (-0.27), Instrumental-ADL (-0.25) and gait speed (-0.28) after one year follow-up.Conclusion: This study showed that low muscle endurance combined with high self-perceived fatigue can predict changes in ADL after one-year follow-up. These parameters might be very suitable for use in evaluating intrinsic capacity and can help to reduce the limitations in clinical usage of the vitality domain in the framework of intrinsic capacity. [ABSTRACT FROM AUTHOR]

Aims: This systematic review and meta‐analysis evaluates the additional effect of exercise to hypocaloric diet on body weight, body composition, glycaemic control and cardio‐respiratory fitness in adults with overweight or obesity and type 2 diabetes. Methods: Embase, Medline, Web of Science and Cochrane Central databases were evaluated, and 11 studies were included. Random‐effects meta‐analysis was performed on body weight and measures of body composition and glycaemic control, to compare the effect of hypocaloric diet plus exercise with hypocaloric diet alone. Results: Exercise interventions consisted of walking or jogging, cycle ergometer training, football training or resistance training and duration varied from 2 to 52 weeks. Body weight and measures of body composition and glycaemic control decreased during both the combined intervention and hypocaloric diet alone. Mean difference in change of body weight (−0.77 kg [95% CI: −2.03; 0.50]), BMI (−0.34 kg/m2 [95% CI: −0.73; 0.05]), waist circumference (−1.42 cm [95% CI: −3.84; 1.00]), fat‐free mass (−0.18 kg [95% CI: −0.52; 0.17]), fat mass (−1.61 kg [95% CI: −4.42; 1.19]), fasting glucose (+0.14 mmol/L [95% CI: −0.02; 0.30]), HbA1c (−1 mmol/mol [95% CI: −3; 1], −0.1% [95% CI: −0.2; 0.1]) and HOMA‐IR (+0.01 [95% CI: −0.40; 0.42]) was not statistically different between the combined intervention and hypocaloric diet alone. Two studies reported VO2max and showed significant increases upon the addition of exercise to hypocaloric diet. Conclusions: Based on limited data, we did not find additional effects of exercise to hypocaloric diet in adults with overweight or obesity and type 2 diabetes on body weight, body composition or glycaemic control, while cardio‐respiratory fitness improved. [ABSTRACT FROM AUTHOR]

Background: In the pathogenesis of knee osteoarthritis (KOA), inflammatory mediators play an important role. However, the precise underlying mechanism by which regular exercise therapy (ET) exert effects on the immune system in KOA patients is unknown. Objectives: The aim of this systematic review was to investigate the basal and acute effects of ET on inflammatory biomarkers and brain derived neurotrophic factor (BDNF) in KOA patients. Methods: PubMed, Web Of Science and PEDro were systematically searched for appropriate studies. If possible, a meta-analysis was performed or an approximation of the effect size (ES) was calculated. Risk of bias was scored using the Cochrane ROB 2.0 or ROBINS-I tools. Results: Twenty-one studies involving 1374 participants were included. Fifteen articles focused on basal exercise effects, four on acute effects, and two on both. Biomarker analysis (n=18) was performed in synovial fluid (n=4) or serum/plasma (n=17). A meta-analysis demonstrated that basal CRP was reduced in KOA patients 6-18 weeks weeks after ET (MD: -0.17;95%CI[-0.31;-0.03]), while IL-6 (MD: 0.21;95%CI[-0.44;0.85]), and TNF-a (MD: -0.57;95%CI[-1.47;0.32]), levels did not significantly change. Also, sTNFR1/2 did not change significantly after ET. For other biomarkers, insufficient data were available to perform a meta-analysis. Nevertheless, a low degree of evidence was found for a decrease in IL-6 (ES:-0.596 & -0.259 & -0.513), an increase in sTNFR1 (ES:2.325), a decrease in sTNFR2 (ES:-0.997) and an increase in BDNF (ES:1.412). Locally, intra-articular IL-10 (ES:9.163) increased, and IL-1ß (ES:-6.199) and TNF-a decreased (ES:-2.322) after ET. An acute exercise session elicited a myokine response (ES IL-6:0.314), and an increase in BDNF (no ES-data). No inflammatory effect (ES CRP:0.052; ES TNF-a:-0.019 & 0.081) following an acute bout of training was found. However, a single bout of exercise elicited a decrease in intra-articular IL-10 (no ES-data). Conclusion: ET can induce circulatory and intra-articular anti-inflammatory effects in patients with KOA. The antiinflammatory properties have important implications for informing these patients and clinicians about the underlying effects of ET. [ABSTRACT FROM AUTHOR]

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. 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. 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, <0.01, respectively) between HA and non-HA users. Male non-HA users displayed an association between HI and global and domain-specific (processing speed; selective and alternating attention) cognitive decline. Associations between global cognition and HI were significantly different between HA and non-HA users. This may be partially attributable to underlying subgroups sample sizes and statistical power disparity. If larger scale longitudinal or interventional studies confirm these findings, timely HI assessment and management may be the cornerstone for delaying cognitive decline. [ABSTRACT FROM AUTHOR]