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Sarcopenia may increase non-alcoholic fatty liver disease (NAFLD) risk, but prevalence likely varies with different diagnostic criteria. This study examined the prevalence of sarcopenia and its defining components in adults with and without NAFLD and whether it varied by the method of muscle mass assessment [bioelectrical impedance (BIA) versus dual-energy X-ray absorptiometry (DXA)] and adjustment (height2 versus BMI). Adults (n = 7266) in the UK Biobank study (45–79 years) with and without NAFLD diagnosed by MRI, were included. Sarcopenia was defined by the 2018 European Working Group on Sarcopenia in Older People definition, with low appendicular skeletal muscle mass (ASM) assessed by BIA and DXA and adjusted for height2 or BMI. Overall, 21% of participants had NAFLD and the sex-specific prevalence of low muscle strength (3.6–7.2%) and sarcopenia (0.1–1.4%) did not differ by NAFLD status. However, NAFLD was associated with 74% (males) and 370% (females) higher prevalence of low ASM when adjusted for BMI but an 82% (males) to 89% (females) lower prevalence when adjusted for height2 (all P < 0.05). The prevalence of impaired physical function was 40% (males, P = 0.08) to 123% (females, P < 0.001) higher in NAFLD. In middle-aged and older adults, NAFLD was not associated with a higher prevalence of low muscle strength or sarcopenia but was associated with an increased risk of impaired physical function and low muscle mass when adjusted for BMI. These findings support the use of adiposity-based adjustments when assessing low muscle mass and the assessment of physical function in NAFLD. [ABSTRACT FROM AUTHOR]

Introduction: Patients on hemodialysis (HD) have a higher incidence of fractures than the general population. Sarcopenia is frequently observed in patients on HD; however, the association of falls with sarcopenia and its diagnostic factors, including muscle mass, muscle strength, and physical function, are incompletely understood. Methods: This prospective cohort study was conducted at a single center. Sarcopenia was assessed according to the 2019 Asian Working Group for Sarcopenia diagnostic criteria. Muscle mass was measured the bioelectrical impedance method. Grip strength was evaluated to assess muscle strength, while the Short Physical Performance Battery (SPPB) was used to assess physical function. Falls and their detailed information were surveyed every other week. Results: This study analyzed 65 HD patients (median age, 74.5 [67.5–80.0] years; 33 women [49.2%]). Sarcopenia was diagnosed in 36 (55.4%) patients. During the 1-year observation period, 31 (47.7%) patients experienced accidental falls. The falls group had lower median grip strength than the non-falls group (14.7 [11.4–21.8] kg vs. 22.2 [17.9–27.6] kg; p < 0.001). The median SPPB score was also lower in the falls versus non-falls group (7.0 [5.0–11.0] vs. 11.0 [8.0–12.0]; p = 0.009). In adjusted multiple regression analysis, diagnostic factors, including grip strength (B = 0.96, p = 0.04, R2 = 0.19) and SPPB (B = 1.11, p = 0.006, R2 = 0.23), but not muscle mass, were independently associated with fall frequency. Conclusions: The frequency of falls in HD patients was related to muscle strength and physical function, but not muscle mass. [ABSTRACT FROM AUTHOR]

Sarcopenia is a skeletal muscle disease categorized by low muscle strength, muscle quantity or quality, and physical performance. Sarcopenia etiology is multifaceted, and while resistance training is widely agreed upon for prevention and treatment, disease progression is also highly related to poor diet. The incidence of sarcopenia appears sex-specific and may be increased in females, which is problematic because dietary quality is often altered later in life, particularly after menopause. Identifying effective nutrition or supplementation interventions could be an important strategy to delay sarcopenia and related comorbidities in this vulnerable population. This systematic review examined randomized controlled trials (RCTs) of nutrition strategies on muscle-related components of sarcopenia in middle-aged and older females. A protocol was registered (PROSPERO CRD42022382943) and a systematic search of MEDLINE and CINAHL was undertaken. RCTs from 2013 to 2023 that assessed nutrition-only interventions on muscle mass, muscle strength, and physical function in female participants were included. Fourteen RCTs were included based on selection criteria. Study designs and interventions were heterogeneous in supplementation type and amount, age, and duration. Six RCTs reported beneficial effects of protein, Vitamin D, Vitamin D and Magnesium (Mg), and fish oil on muscle protein synthesis, muscle strength, and/or muscle function. Eight studies that examined various protein interventions, VitD alone, Mg alone, and dairy derivatives did not demonstrate any effect. Exercise appeared to modulate results in several studies. Nutrition interventions alone are likely to have a limited but positive effect on muscle-related components of sarcopenia in females. Current evidence suggests that a combination of dietary intervention and exercise is likely to be key to preventing and treating sarcopenia in middle aged and older females and there is a need for well-designed nutrition based studies in this population. [ABSTRACT FROM AUTHOR]

Introduction: Knee osteoarthritis affects the elderly, potentially leading to disability, with varying symptoms and fatigue. The hip and knee joints experience discomfort, stiffness, reduced mobility, and depression. Muscle weakness, linked to lower limb atrophy, heightens the risk of falls. Self-efficacy, which is confidence in performing tasks despite discomfort, impacts knee strength and function. Factors such as age, education, depression, and physical decline shape self-efficacy. However, the impact of self-efficacy on osteoarthritis health outcomes is unclear due to reduced activity levels. The present study aims to explore the influence of self-efficacy on knee osteoarthritis function and strength. Aim: To identify the influence of self-efficacy on physical function and muscle strength in individuals with knee osteoarthritis. Materials and Methods: A cross-sectional study was conducted in Department of Physiotheraphy with 73 participants who met the inclusion criteria. The study took place between October 2022 and April 2023, spanning a period of six months, at KS Hegde Charitable Hospital in Mangaluru, Karnataka, India. Hip-knee muscle strength was measured using a push-pull dynamometer, physical function was assessed using the Timed Up and Go (TUG) test, and self-efficacy was evaluated using the Arthritis Self-efficacy Scale-8. All tests were performed once on the same day, with a five-minute rest between each test. Withingroup differences were identified using an Independent T-test, and between-group analysis was conducted using Analysis of Variance (ANOVA). Results: The mean age of the participants was 60.2±6.5 years, and the Basal Metabolic Index (BMI) was 25.2±2.0 kg/m2. A statistically significant difference with a p-value of 0.001 was observed in hip abductor, knee flexor, knee extensor, and TUG tests between the high and low self-efficacy grades. The time taken for the TUG test also showed significance with a p-value of 0.001. Individuals with high levels of self-efficacy had better scores in physical function as well as muscle strength. No association was found between self-efficacy and KL grading. Conclusion: Participants with higher self-efficacy demonstrated good muscle strength in the hip muscles and good physical function. The study concluded that individuals with high selfefficacy grades had better muscle strength and mobility compared to those with low scores in both strength and mobility. [ABSTRACT FROM AUTHOR]

Background Based on studies from animal models, growth differentiation factor-11 (GDF-11) may have rejuvenating effects in humans. GDF-11 has high sequence homology with GDF-8 (also known as myostatin); follistatin and follistatin-like protein-3 (FSTL-3) are inhibitory proteins of both GDF-8 and GDF-11. Methods Using highly specific liquid chromatography with tandem mass spectrometry assays for GDF-11 and GDF-8 and immunoassays for follistatin and FSTL-3, we quantified the association of these factors with muscle size, strength, and physical performance in 2 prospective cohort studies of community-dwelling older adults (Health, Aging, and Body Composition study [Health ABC] and Cardiovascular Health Study [CHS]). Results GDF-8 levels were positively associated with thigh muscle cross-sectional area and density in Health ABC (data not available in CHS). GDF-8 levels were positively associated with lean mass (a surrogate of muscle mass) in Health ABC but not CHS, and grip strength in CHS but not Health ABC. FSTL-3 (and perhaps follistatin) was negatively associated with lean mass and had variable associations with other variables. In contrast, GDF-11 was not significantly associated with strength or performance. Conclusions GDF-8 and its binding proteins, follistatin and FSTL-3, may constitute a counterregulatory system (chalones) to restrain age-related loss of muscle mass and strength. [ABSTRACT FROM AUTHOR]

Background: A systematic review and network meta-analysis was undertaken to examine the effectiveness of different modes of resistance exercise velocity in fast walking speed, timed-up and go, five-times sit-to-stand, 30-sec sit-to-stand and 6-min walking tests in older adults.Methods: CINAHL, Embase, LILACS, PubMed, Scielo, SPORTDiscus and Web of Science databases were searched up to February 2022. Eligible randomised trials examined the effects of supervised high-velocity or traditional resistance exercise in older adults (i.e., ≥ 60 years). The primary outcome for this review was physical function measured by fast walking speed, timed up and go, five times sit-to-stand, 30-sec sit-to-stand and 6-minute walking tests, while maximal muscle power and muscle strength were secondary. A random-effects network meta-analysis was undertaken to examine the effects of different resistance exercise interventions.Results: Eighty articles describing 79 trials (n= 3,575) were included. High-velocity resistance exercise was the most effective for improving fast walking speed [standardised mean difference (SMD) -0.44, 95% CI: 0.00 to 0.87], timed-up and go (SMD -0.76, 95% CI: -1.05 to -0.47) and five times sit-to-stand (SMD -0.74, 95% CI: -1.20 to -0.27), while traditional resistance exercise was the most effective for 30-sec sit-to-stand (SMD 1.01, 95% CI: 0.68 to 1.34) and 6-min walking (SMD 0.68, 95% CI: 0.34 to 1.03).Conclusion: Our study provides evidence that resistance exercise velocity effects are specific in older adults as evidenced by physical function test dependence. We suggest that prescription based on the velocity of contraction should be individualised to address specific functional needs of participants. [ABSTRACT FROM AUTHOR]

Introduction: Peripheral artery disease (PAD) is commonly observed in patients undergoing hemodialysis. PAD impairs the vasculature and leads to pathophysiologic changes in the skeletal muscles, causing physical function impairment and physical inactivity in general. However, it is unclear whether PAD adversely affects physical function and physical activity in patients on hemodialysis. Methods: We performed a cross‐sectional study with a retrospective review of the data to determine whether PAD is associated with impaired physical function and physical activity in patients undergoing hemodialysis. The study population comprised 310 patients and 88 healthy subjects. PAD was diagnosed based on an ankle‐brachial index of <1.00 in patients on hemodialysis. Measurements of physical function included maximum walking speed, muscle strength in the lower extremities, and balance while standing. Findings: Of the 310 patients, 84 (27.1%) had PAD. When patients undergoing hemodialysis were divided into those without PAD and those with PAD, both groups had poorer physical function and physical activity than the healthy control subjects. After adjustments for potential confounders, it was found that patients on hemodialysis with PAD had slower walking speed, poorer standing balance, and less physical activity than those without PAD. However, there was no significant difference in lower extremity muscle strength between the two groups. Discussion: PAD diagnosed based on an ankle‐brachial index of <1.00 was independently associated with impaired physical function and reduced physical activity in patients undergoing hemodialysis. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to investigate (1) trajectories of physical activity (PA) over 96 months and (2) study to what extent knee pain, muscle strength, physical function, and radiographic disease were associated with PA trajectories in adults with or at risk of knee osteoarthritis (KOA). Methods: Using the Osteoarthritis Initiative (OAI) database, we described PA trajectories with the Physical Activity Scale for the Elderly (PASE) over 96 months. Knee pain was categorized into three groups: "no pain" [visual numeric pain rating scale (VAS = 0)], "little to some pain" (VAS = 1-3), or "moderate to severe pain" (VAS = 4). Knee extensor strength was classified into high [>16.21 (men) and >10.82 (women) N/kg/m2] and low [<16.21 (men) and <10.82 (women) N/kg/m2] groups. Gait speed was classified into slow (<1.22 m/s) and fast (=1.22 m/s) groups. Chair stand time was classified into slow (>12 seconds) and fast (<12 seconds) groups. Radiographic disease was classified as present [Kellgren-Lawrence (KL) =2] or absent (KL grade <2) of KOA. Results: Among 3755 participants (age 61.0 ± 9.0 years, body mass index 28.5±4.8 kg/m2, 58% female), we identified three trajectories: sedentary PA with slow decline (44.3%), low PA with slow decline (41.3%), and high PA with slow decline (14.4%). Poorer gait speed (OR: 2.32; 95% CI: 1.71-3.16), chair stand time (OR: 1.45; 95% CI: 1.07-1.96), and knee extensor strength (OR: 1.35; 95% CI: 1.03-1.76), but not pain or radiographic disease, were associated with PA trajectory of sedentary PA with slow decline. Conclusion: Physical function and strength, but not pain and radiographic disease, were associated with a trajectory of decline in PA among adults with or at risk of KOA. [ABSTRACT FROM AUTHOR]

Background interventions targeting older adults with cognitive frailty have grown rapidly in recent years with inconsistent findings. However, there is no meta-analysis that has synthesised pooled estimates. Objective to synthesise the pooled effect of current targeted interventions in older people with cognitive frailty. Methods we conducted a systematic search in PubMed, Embase, Web of Science, the Cochrane Library, the JBI database and three Chinese databases (CNKI, Wan-Fang and VIP) for literature from the inception of the database until 8 March 2022. The mean difference or standardised mean difference with 95% CIs was calculated. The methodological quality was assessed by the Cochrane RoB 2.0. The certainty of evidence was assessed using the GRADE criteria. Results thirteen randomised controlled trials with a total of 1,089 participants were included. The results of the meta-analysis showed that older adults with cognitive frailty in the intervention groups had significant improvement in frailty score [MD = −1.67, 95% CI (−2.39, −0.95), P  < 0.00001, I 2 = 97%], global cognitive function [MD = 3.38, 95% CI (1.90, 4.85), P  < 0.00001, I 2 = 93%], mobility [MD = −0.96, 95% CI (−1.27, −1.66), P  < 0.00001, I 2 = 0%], muscle strength [SMD = 0.75, 95% CI (0.09, 1.41), P  = 0.03, I 2 = 85%] and nutritional status [MNA:MD = 5.64, 95% CI (3.99, 7.29), P  < 0.00001, I 2 = 89%; ALB: MD = 3.23, 95% CI (0.76, 5.71), P  = 0.01, I 2 = 93%; PALB: MD = 54.52, 95% CI (25.26, 83.77), P  = 0.0003, I 2 = 96%; TRF: MD = 0.64, 95% CI (0.22, 1.06), P  = 0.003, I 2 = 97%]. The overall certainty of the evidence ranged from low to moderate. Conclusions interventions targeting older adults with cognitive frailty are effective in improving physical frailty, global cognitive function, physical function and nutritional status with low to moderate certainty. More research is still needed in the future to further enrich the evidence in these fields. PROSPERO number CRD42022318758. [ABSTRACT FROM AUTHOR]

Robotic technology has developed rapidly in recent years, and several robotic devices have been applied to improve physical, sensory, intellectual, psychological, and social functioning in the elderly and people with disabilities. In this study, we investigated the effects of EX1-assisted exercise in various environments on physical function, muscle strength, and walking efficiency in older adults. We designated four experimental conditions and randomly assigned participants to one of four groups: A (overground walking without an EX1), B (overground walking using the resistance mode of EX1), C (stair ascent using the assistance mode of EX1), and Group D (inclined treadmill walking using the assistance mode of EX1). A total of 60 community-dwelling elderly persons participated in 10 exercise intervention sessions for 4 weeks, and all participants were assessed before and after the exercise intervention. Physical function was measured by the 10-meter walk test for self-selected velocity (10MWT-SSV), short physical performance battery (SPPB), Berg balance scale (BBS), timed up and go (TUG), functional reach test (FRT), geriatric depression scale—short form (GDS-SF), and muscle strength of trunk and lower extremity. Cardiopulmonary metabolic energy efficiency was measured using a portable telemetric gas analyzer system. A significant increase in the 10MWT-SSV and TUG test was observed in groups B, C, and D. A statistically significant improvement in the SPPB and FRT was seen only in group D, and GDS-SF scores decreased significantly after exercise with an EX1 in groups B and D. Trunk and lower limb muscle strength increased more in the groups that exercised with EX1 assistance than those without an EX1, particularly in group B. The net metabolic energy costs and energy expenditure measurement during walking significantly improved in exercise groups C and D. The findings in this study support the application of the EX1 to physical activity and exercise to improve age-related changes in physical function, muscle strength, and walking efficiency among older adults. In addition, personalized exercise programs using different modes and training environments with an EX1 can enhance physical performance and walking efficiency in the elderly. [ABSTRACT FROM AUTHOR]

Arthritis is a common chronic condition in the ageing population. Its impact on physical function varies according to sociodemographic and race/ethnic factors. The study objective was to examine the impact of arthritis on physical function and disability among non-disabled older Mexican Americans over time. A 23-year prospective cohort study of 2230 Mexican Americans aged 65 years and older from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1993/94–2016). The independent variable was self-reported physician-diagnosed arthritis, and the outcomes included Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), mobility, Short Physical Performance Battery (SPPB), and handgrip strength. Covariates were sociodemographic, medical conditions, body mass index, depressive symptoms, and cognitive function. General linear mixed models were performed to estimate the change in SPPB and muscle strength. General Equation Estimation models estimated the odds ratios (OR) of becoming ADL- or IADL- or mobility – disabled as a function of arthritis. All variables were used as time-varying except for sex, education, and nativity. Overall, participants with arthritis had higher odds ratio (OR) of any ADL [OR = 1.35, 95% Confidence Interval (CI) = 1.09–1.68] and mobility (OR = 1.34, 95% CI = 1.18–1.52) disability over time than those without arthritis, after controlling for all covariates. Women, but not men, reporting arthritis had increased risk for ADL and mobility disability. The total SPPB score declined 0.18 points per year among those with arthritis than those without arthritis, after controlling for all covariates (p-value <.010). Our study demonstrates the independent effect of arthritis in increasing ADL and mobility disability and decreased physical function in older Mexican Americans over 23-years of follow-up. [ABSTRACT FROM AUTHOR]

Background regular physical exercise is essential to maintain or improve functional capacity in older adults. Multimorbidity, functional limitation, social barriers and currently, coronavirus disease of 2019, among others, have increased the need for home-based exercise (HBE) programmes and digital health interventions (DHI). Our objective was to evaluate the effectiveness of HBE programs delivered by DHI on physical function, health-related quality of life (HRQoL) improvement and falls reduction in older adults. Design systematic review and meta-analysis. Participants community-dwelling older adults over 65 years. Intervention exercises at home through DHI. Outcomes measures physical function, HRQoL and falls. Results twenty-six studies have met the inclusion criteria, including 5,133 participants (range age 69.5 ± 4.0–83.0 ± 6.7). The HBE programmes delivered with DHI improve muscular strength (five times sit-to-stand test, −0.56 s, 95% confidence interval, CI −1.00 to −0.11; P  = 0.01), functional capacity (Barthel index, 5.01 points, 95% CI 0.24–9.79; P  = 0.04) and HRQoL (SMD 0.18; 95% CI 0.05–0.30; P  = 0.004); and reduce events of falls (odds ratio, OR 0.77, 95% CI 0.64–0.93; P  = 0.008). In addition, in the subgroup analysis, older adults with diseases improve mobility (SMD −0.23; 95% CI −0.45 to −0.01; P  = 0.04), and balance (SMD 0.28; 95% CI 0.09–0.48; P  = 0.004). Conclusion the HBE programmes carried out by DHI improve physical function in terms of lower extremity strength and functional capacity. It also significantly reduces the number of falls and improves the HRQoL. In addition, in analysis of only older adults with diseases, it also improves the balance and mobility. [ABSTRACT FROM AUTHOR]

Introduction: Efforts to study performance fatigability have been limited because of measurement constrains. Accelerometry and advanced statistical methods may enable us to quantify performance fatigability more granularly via objective detection of performance decline. Thus, we developed the Pittsburgh Performance Fatigability Index (PPFI) using triaxial raw accelerations from wrist-worn accelerometer from two in-laboratory 400-m walks. Methods: Sixty-three older adults from our cross-sectional study (mean age, 78 yr; 56% women; 88% White) completed fast-paced (n = 59) and/or usual-paced 400-m walks (n = 56) with valid accelerometer data. Participants wore ActiGraph GT3X+ accelerometers (The ActiGraph LLC, Pensacola, FL) on nondominant wrist during the walking task. Triaxial raw accelerations from accelerometers were used to compute PPFI, which quantifies percentage of area under the observed gait cadence-versus-time trajectory during a 400-m walk to a hypothetical area that would be produced if the participant sustained maximal cadence throughout the entire walk. Results: Higher PPFI scores (higher score = greater fatigability) correlated with worse physical function, slower chair stands speed and gait speed, worse cardiorespiratory fitness and mobility, and lower leg peak power (| ρ | = 0.36–0.61 from fast-paced and | ρ | = 0.28–0.67 from usual-paced walks, all P < 0.05). PPFI scores from both walks remained associated with chair stands speed, gait speed, fitness, and mobility, after adjustment for sex, age, race, weight, height, and smoking status; PPFI scores from the fast-paced walk were associated with leg peak power. Conclusions: Our findings revealed that the objective PPFI is a sensitive measure of performance fatigability for older adults and can serve as a risk assessment tool or outcome measure in future studies and clinical practice. [ABSTRACT FROM AUTHOR]

Muscle power training with emphasis on high‐velocity of concentric movement improves physical functionality in healthy older adults, and, maybe superior to traditional exercise programs. Power training may also be advantageous for patients with acute and chronic illnesses, as well as frail individuals. To determine the efficacy of power training compared with traditional resistance training on physical function outcomes in individuals diagnosed with frailty, acute illness or chronic disease. PubMed (MEDLINE), CINAHL, PEDro, Web of Science, and Google Scholar. (1) at least one study group receives muscle power training of randomized controlled trial (RCT) (2) study participants diagnosed as prefrail, frail or have an ongoing acute or chronic disease, condition or illness; (3) study participants over the age of 18; (4) publication in English language; (5) included physical function as the primary or secondary outcome measures. Two independent reviewers assessed articles for inclusion and graded the methodological quality using Cochrane Risk‐of‐Bias tool for RCTs. Fourteen RCTs met the inclusion criteria. In seven studies, muscle power training was more effective at improving physical function compared to control activities with a mean fixed effect size (ES) of 0.41 (p = 0.006; 95% CI 0.12 to 0.71). Power training and conventional resistance training had similar effectiveness in eight studies with a mean fixed ES of 0.10 (p = 0.061; 95% CI –0.01 to 0.40). Muscle power training is just as efficacious for improving physical function in individuals diagnosed with frailty and chronic disease when compared to traditional resistance training. The advantages of power training with reduced work per session may support power training as a preferential exercise modality for clinical populations. The findings should be interpreted with caution since generalizability is questioned due to the heterogeneity of patient populations enrolled and participants were relatively mobile at baseline. [ABSTRACT FROM AUTHOR]

Background People with chronic kidney disease (CKD) experience skeletal muscle wasting, reduced levels of physical function and performance, and chronic systemic inflammation. While it is known that a relationship exists between inflammation and muscle wasting, the association between inflammation and physical function or performance in CKD has not been well studied. Exercise has anti-inflammatory effects, but little is known regarding the effect of moderate intensity exercise. This study aimed to (i) compare systemic and intramuscular inflammation between CKD stage G3b–5 and non-CKD controls; (ii) establish whether a relationship exists between physical performance, exercise capacity and inflammation in CKD; (iii) determine changes in systemic and intramuscular inflammation following 12 weeks of exercise; and (iv) investigate whether improving inflammatory status via training contributes to improvements in physical performance and muscle mass. Methods This is a secondary analysis of previously collected data. CKD patients stages G3b–5 (n  = 84, n  = 43 males) and non-CKD controls (n  = 26, n  = 17 males) underwent tests of physical performance, exercise capacity, muscle strength and muscle size. In addition, a subgroup of CKD participants underwent 12 weeks of exercise training, randomized to aerobic (AE, n  = 21) or combined (CE, n  = 20) training. Plasma and intramuscular inflammation and myostatin were measured at rest and following exercise. Results Tumour necrosis factor-α was negatively associated with lower |$^{^{^{.}}}{\rm V}$| O2Peak (P = 0.01), Rectus femoris-cross sectional area (P = 0.002) and incremental shuttle walk test performance (P < 0.001). Interleukin-6 was negatively associated with sit-to-stand 60 performances (P = 0.006) and hand grip strength (P = 0.001). Unaccustomed exercise created an intramuscular inflammatory response that was attenuated following 12 weeks of training. Exercise training did not reduce systemic inflammation, but AE training did significantly reduce mature myostatin levels (P = 0.02). Changes in inflammation were not associated with changes in physical performance. Conclusions Systemic inflammation may contribute to reduced physical function in CKD. Twelve weeks of exercise training was unable to reduce the level of chronic systemic inflammation in these patients, but did reduce plasma myostatin concentrations. Further research is required to further investigate this. [ABSTRACT FROM AUTHOR]

In recent years the focus of healthcare and nutritional science in older adults has shifted from mortality towards physical performance and quality of life. The aim of this review was to summarize observational studies on physical performance in malnourished (MN) or at risk of malnutrition (RMN) older adults compared with well-nourished (WN) older adults. Eligible studies had to report on nutritional status and objectively measured physical performance in older adults (≥60 y). MN or RMN groups had to be compared with a WN group, measured with a validated nutrition screener. Ovid Medline and Web of Science were searched until 13 November, 2020. Study quality was scored using a modified Newcastle–Ottawa Scale (NOS). Results were analyzed by meta-analysis when possible, or narratively reviewed otherwise. Forty-five studies (16,911 participants in total) were included from studies in outpatient clinics (n = 6), nursing homes (n = 3), community-dwelling older adults (n = 20), hospitalized patients (n = 15), or a combination (n = 1). Studies used 11 different screeners of malnutrition, and 8 types of physical performance measures. Meta-analysis showed that compared with MN, WN groups had better hand grip strength (mean difference [MD] = 4.92 kg; 95% CI: 3.43, 6.41; P < 0.001; n = 23), faster gait speed (MD = 0.16 m/s; 95% CI: 0.05, 0.27; P = 0.0033; n = 7), performed faster on timed-up-and-go (MD = –5.94 s; 95% CI: –8.98, –2.89; P < 0.001; n = 8), and scored 1.2 more short physical performance battery points (95% CI: 1.32, 2.73; P < 0.001; n = 6). Results were less pronounced when compared with RMN. Narratively, all studies showed an association for knee extension strength, 6-min walking test, and multicomponent tests, except for the chair stand test. Study limitations include no studies scoring "good" on NOS, lack of confounder adjustment, and high heterogeneity. Overall, evidence from cross-sectional studies indicate an association between malnutrition and worse physical performance in older adults. This study is registered in PROSPERO as CRD42020192893. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the effects of virtual reality (VR) training and resistance exercises training on lymphedema symptom severity as well as physical functioning and QoL in women with breast cancer-related lymphedema (BCRL).Methods: In a single blinded randomized trial, women diagnosed with unilateral BCRL were randomly divided into two groups: the Xbox Kinect group received VR Kinect-based games (n = 30) and resistance exercise group received resistance training (n = 30). In addition, both groups received complex decongestive physiotherapy (manual lymphatic drainage, compression bandages, skin care, and exercises). The intervention was conducted five sessions per week for 8 weeks. The outcome measures included excessive limb volume, visual analogue scale (VAS), the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, shoulder range of motion (ROM), shoulder muscles strength, hand grip strength, and Study Short-Form (SF-36). The outcomes were evaluated pre and post intervention (week 8).Results: Statistical significant differences were recorded in VAS (pain intensity), DASH, shoulder ROM (p < 0.001), bodily pain (p = 0.002), general health (p < 0.001), and vitality (p = 0.006) in favor of the Xbox Kinect group. However, there were statistically significant differences in shoulder flexion strength (p = 0.002), external rotation strength (p = 0.004), and abduction strength and handgrip strength (p < 0.001) in favor of the resistance exercise group.Conclusions: The VR training was superior to resistance exercises training in BCRL management. The empirical findings support the VR as a new effective and encouraging intervention modality which can assist in improving physical functioning and quality of life in women with BCRL.Trial Registration: This study is retrospectively registered at ClinicalTrials.gov (ID: NCT04724356). [ABSTRACT FROM AUTHOR]

Objective: Chronic low back pain (CLBP) is a disabling and costly condition for older adults that is difficult to properly classify and treat. In a cohort study, a subgroup of older adults with CLBP who had elevated hip pain and hip muscle weakness was identified; this subgroup differentiated itself by being at higher risk for future mobility decline. The primary purpose of this clinical trial is to evaluate whether a hip-focused low back pain (LBP) treatment provides better disability and physical performance outcomes for this at-risk group compared with a spine-focused LBP treatment. Methods: This study is a multisite, single-blinded, randomized controlled, parallel arm, Phase II trial conducted across 3 clinical research sites. A total of 180 people aged between 60 and 85 years with CLBP and hip pain are being recruited. Participants undergo a comprehensive baseline assessment and are randomized into 1 of 2 intervention arms: hip-focused or spine-focused. They are treated twice weekly by a licensed physical therapist for 8 weeks and undergo follow-up assessments at 8 weeks and 6 months after randomization. Primary outcome measures include the Quebec Low Back Disability Scale and the 10-Meter Walk Test, which are measures of self-report and performance-based physical function, respectively. Impact: This multicenter, randomized clinical trial will determine whether a hip-focused or spine-focused physical therapist intervention results in improved disability and physical performance for a subgroup of older adults with CLBP and hip pain who are at increased risk of mobility decline. This trial will help further the development of effective interventions for this subgroup of older adults with CLBP. [ABSTRACT FROM AUTHOR]

Background: The prevalence of sarcopenia increases as renal function decreases, and a considerable number of hemodialysis (HD) patients have sarcopenia. Exercise and nutritional support are established interventions to prevent and treat sarcopenia. Recently, many studies evaluating intradialytic neuromuscular electrical stimulation (NMES) showed improvement of muscular strength and mass, functional capacity, and quality of life (QOL). However, there has been no research about the effect of simultaneous nutritional support and NMES in HD patients.Methods: This is a 12-week, randomized controlled, parallel-group, multicenter trial of intradialytic NMES and protein supplementation for HD patients. Seventy-two patients receiving HD will be randomly assigned in a 1:1:1:1 ratio to control, intradialytic NMES only, protein supplementation only, and intradialytic NMES combined with protein supplementation groups. NMES will be delivered to a total of four areas of the bilateral vastus medialis and vastus lateralis using a 4-channel NMES instrument. A total of 25 g of protein supplements will be provided at the beginning of every dialysis session or after the NMES. The primary endpoint is the difference of hand grip and leg muscle strength at 12 weeks among 4 treatment groups. Secondary endpoints include muscle mass, physical performances, and questionnaires about QOL and physical activity.Discussion: In this study, we will evaluate the differential effectiveness of nutritional support and NMES during HD on muscle strength, muscle mass, physical function, and QOL. We expect that this study can provide guidelines for a new therapeutic option for HD patients who are unable or hesitant to exercise. Furthermore, this option can offer an opportunity to improve the physical function, QOL, and prognosis of HD patients.Trial Registration: Clinical Research Information Service (CRIS), Korea, KCT0005573 . Retrospectively registered on 03 November 2020. [ABSTRACT FROM AUTHOR]