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Subclinical vitamin B-12 deficiency is common in the elderly. Encouraged by early indications, we investigated the plasma vitamin B-12 status in association with bone mineral content (BMC) and bone mineral density (BMD) in frail elderly people. Data of 194 free-living Dutch frail elderly (143 women and 51 men) were available. BMC and BMD were measured by dual energy X-ray analysis. Biochemical analyses were performed on plasma or serum including vitamin B-12, methylmalonic acid, homocysteine, 25-hydroxy vitamin D and parathyroid hormone. Women had higher plasma vitamin B-12 (288 and 238 pmol/L, respectively) and lower plasma homocysteine levels (15.8 and 21.3 [micro]mol/L, respectively) than men. Of the total explained variance of BMC and BMD in women (46 and 22%, respectively), 1.3-3.1% was explained by plasma vitamin B-12, in addition to weight and height or energy intake. In men, the variance of BMC and BMD was explained by weight, smoking and/or height (total [R.sup.2] was 53 and 25%, respectively), but not by plasma vitamin B-12. Osteoporosis occurred more often among women whose vitamin B-12 status was considered marginal or deficient than in women with a normal status, i.e., the prevalence odds ratios (after adjustment for weight, age and calcium intake) (95% confidence intervals) were 4.5 (0.8;24.8) and 6.9 (1.2;39.4), respectively. These results suggest that vitamin B-12 status is associated with bone health in elderly women. Future studies on bone health should take into account a possible role of vitamin B-12 status in different populations. KEY WORDS: * cobalamin * osteoporosis * multiple regression analysis * logistic analysis

A decline in dietary intake due to inactivity and, consequently, development of a suboptimal nutritional status is a major problem in frail elderly people. However, benefits of micronutrient supplementation, all-round physical exercise or a combination of both on functional biochemical and hematologic indicators of nutritional and health status in frail elderly subjects have not been tested thoroughly. A 17-wk randomized controlled trial was performed in 145 free-living frail elderly people (43 men, 102 women, mean age, 78 +/- 5.7 y). Based on a 2 x 2 factorial design, subjects were assigned to one of the following: 1) nutrient-dense foods, 2) exercise, 3) both (1) and (2) or 4) a control group. Foods were enriched with micronutrients, frequently characterized as deficient [25-100% of the recommended daily allowance (RDA)] in elderly people. Exercises focused on skill training, including strength, endurance, coordination and flexibility. Dietary intake, blood vitamin levels and nutritional and health indicators, including (pre)albumin, ferritin, transferrin, C-reactive protein, hemoglobin and lymphocytes were measured. At baseline, 28% of the total population had an energy intake below 6.3 MJ, up to a maximum of 93% having vitamin intakes below two thirds of the Dutch RDA. Individual deficiencies in blood at baseline ranged from 3% for erythrocyte glutathione reductase-(alpha) to 39% for 25-hydroxy vitamin D and 42% for vitamin B-12. These were corrected after 17 wk in the two groups receiving the nutrient-dense foods, whereas no significant changes were observed in the control or exercise group. Biochemical and hematologic indicators at baseline were within the reference ranges (mean albumin, 46 g/L; prealbumin, 0.25 g/L; hemoglobin, 8.6 mmol/L) and were not affected by any of the interventions. The long-term protective effects of nutrient supplementation and exercise, by maintaining optimal nutrient levels and thereby reducing the initial chance of developing critical biochemical values, require further investigation. Other indicative functional variables for suboptimal nutritional status, in addition to those currently selected, should also be explored. KEY WORDS: biochemical indicators; eiderly humans; nutrient-dense foods; physical exercise; dietary intake

The article presents a review of the relationship of various physical exercises and cognition in older adults with and without cognitive decline. Exercise programs include aerobic, strength, flexibility or balance exercise, or combinations thereof. The effects of the programs on neuropsychological outcomes were then determined. Results showed that improvements were observed in memory, information processing abilities and executive function or word fluency among cognitively healthy adults. In older adults with cognitive decline, improvements were seen in general cognitive function and executive functions, such as category fluency, trail making and clock drawing.

An increase in the physical activity of individuals has many health benefits, but a drawback of an increase in physical activity is the risk of related injuries. To reduce the short- and long-term effects in terms of social and economic consequences, prevention of physical activity injuries is an important challenge. A sequence of prevention model has been proposed that aims to prevent physical activity injuries in different steps. The model includes (i) identification of the problem in terms of incidence and severity of physical activity injuries, (ii) identification of the risk factors and injury mechanisms that play a role in the occurrence of physical activity injuries, (iii) introduction of measures that are likely to reduce the future risk and (or) severity of physical activity injuries, and (iv) evaluation of the effectiveness of the measures by conducting a randomized controlled trial (RCT). This review describes what is currently known about all of the various aspects of the sequence of prevention in children (steps i-iv). [ABSTRACT FROM AUTHOR]

Summary: The purpose of this pilot study was to evaluate the effect of a weekly multiplayer class on the motivation of children aged 9–12 years to play an interactive dance simulation video game (IDSVG) at home over a period of 12 weeks. A sample of 27 children was randomly assigned to (1) a home group instructed to play the IDSVG at home; (2) a multiplayer group instructed to play the IDSVG at home and to participate in a weekly IDSVG multiplayer class. Participants were asked to play the IDSVG as often as they liked and report the playing time daily on a calendar for a 12-week period. Motivation to play was assessed by the playing duration of IDSVG in minutes and the dropout during the study. Mean age of the 16 children who completed the study was 10.6±0.8 years. During the 12-week intervention period, the multiplayer group played approximately twice as many minutes (901min) as the home group (376min, p =0.13). Dropout was significantly (p =0.02) lower in the multiplayer group (15%) than in the home group (64%). Our findings suggest that multiplayer classes may increase children''s motivation to play interactive dance simulation video games. [Copyright &y& Elsevier]

Abstract: Objective: To evaluate the effectiveness of three different training protocols on physical function of older adults living in long-term care facilities. Emphasis was placed on feasibility in real-life situations. Methods: Subjects (N =224) were randomised to 6 months of twice weekly (1) resistance training; (2) all-round functional-skills training; (3) a combination of both; or (4) a control program. Fitness and performance measures and self-reported disability were measured at baseline and after 24 weeks intervention. Results: Attendance to the strength training was 76%, to the functional-skills training 70% and to the combined training 73%. In those who attended at least 75% of all classes (n =97) the functional-skills and combined training program improved several fitness and performance measures compared to the control group. Conclusion: Twice weekly functional-skills training, or a combination of resistance and functional-skills training can improve several fitness and performance measures of institutionalised older people. Practice implications: An important finding from our study was that less than twice a week exercise training is not enough for functional improvement, while it proved difficult for the elderly subjects to exercise twice weekly. Education on the health benefits of regular exercise, and a larger availability of classes in long-term care facilities may improve attendance. [Copyright &y& Elsevier]

Background: the prevalence of individuals with cognitive decline is increasing since the number of elderly adults is growing considerably. The literature provides promising results on the beneficial effect of exercise and vitamin supplementation on cognitive function both in cognitively healthy as well as in the demented elderly. Methods/Design: the design is a two-by-two factorial randomised controlled trial. The study population consists of independently living elderly, between 70 and 80 years old, with mild cognitive impairment (MCI). In the RCT the effect of two interventions, a walking program and vitamin supplementation, is examined. The walking program (WP) is a group-based program aimed at improving cardiovascular endurance; frequency two lessons a week; lesson duration one hour; program duration one year. Non-walking groups receive a placebo activity program (PAP) (i.e. low intensive non-aerobic group exercises, like stretching) with the same frequency, lesson and program duration. Vitamin supplementation consists of a single daily vitamin supplement containing 50 mg B6, 5 mg folic acid and 0,4 mg B12 for one year. Subjects not receiving vitamin supplements are daily taking an identically looking placebo pill, also for a year. Participants are randomised to four groups 1) WP and vitamin supplements; 2) WP and placebo supplements; 3) PAP and vitamin supplements; 4) PAP and placebo supplements. Primary outcome measures are measures of cognitive function. Secondary outcomes include psychosocial wellbeing, physical activity, cardiovascular endurance and blood vitamin levels. Discussion: no large intervention study has been conducted yet on the effect of physical activity and vitamin supplementation in a population-based sample of adults with MCI. The objective of the present article is to describe the design of a randomised controlled trial examining the effect of a walking program and vitamin B supplementation on the rate of cognitive decline in older adults with MCI. [ABSTRACT FROM AUTHOR]

Background: It is now widely believed that health promotion strategies should go beyond education or communication to achieve significant behavioral changes among the target population. Environmental modifications are thought to be an important addition to a worksite health promotion program (WHPP). This review aimed to systematically assess the effectiveness of WHPPs with environmental modifications, on physical activity, dietary intake, and health risk indicators. Methods: Online searches were performed for articles published up to January 2004 using the following inclusion criteria: (1) (randomized) controlled trial (RCT/CT); (2) intervention should include environmental modifications; (3) main outcome must include physical activity, dietary intake, and health risk indicators; and (4) healthy working population. Methodologic quality was assessed using a checklist derived from the methodologic guidelines for systematic reviews (Cochrane Back Review Group), and conclusions on the effectiveness were based on a rating system of five levels of evidence. Results: Thirteen relevant, mostly multicenter, trials were included. All studies aimed to stimulate healthy dietary intake, and three trials focused on physical activity. Follow-up measurements of most studies took place after an average 1-year period. Methodologic quality of most included trials was rated as poor. However, strong evidence was found for an effect on dietary intake, inconclusive evidence for an effect on physical activity, and no evidence for an effect on health risk indicators. Conclusions: It is difficult to draw general conclusions based on the small number of studies included in this review. However, evidence exists that WHPPs that include environmental modifications can influence dietary intake. More controlled studies of high methodologic quality need to be initiated that investigate the effects of environmental interventions on dietary intake and especially on physical activity in an occupational setting. [Copyright &y& Elsevier]