Search

Background: Frailty increases the risk of falls, disability and death in older adults. The Cardiovascular Health Study identified a frailty phenotype (the Fried Phenotype) that was primarily based on physical domains. Instruments that incorporate additional domains (e.g., cognitive, disability or mood) may more accurately identify falls., Objectives: The study aimed i) to evaluate the association between falls and the number of phenotypes identified by the Fried Phenotype and CFVI-20 scores and ii) to compare the strength of the association between falls and each frailty instrument., Methods: This study used the CFVI-20 and the Fried Phenotype and reported falls during the last twelve months. Logistic regression models, odds ratios (ORs), and ROC curves were used to identify associations and perform comparisons (p<0.05). The reporting of the study followed the Strobe guidelines., Results: This study included 1,826 individuals (mean 70.9 (SD 7.3) years old). Prevalence of pre-frailty and low vulnerability was high (72% and 69%) and comparable between frailty instruments. The number of Fried phenotypes increased the odds of having fallen in the past 12 months (OR: 1.5 to 29.5) and the CFVI-20 scores (11% increase/unit change). The CFVI-20 identified falls more accurately than the Fried Phenotype (AUC: 0.68 vs. 0.60, p < 0.001)., Conclusions: The number of phenotypes and the CFVI-20 scores were associated with falls; continuous scores identified falls more accurately than categorical classifications. The CFVI-20 was more strongly associated with falls in community-dwelling older adults than the Fried Phenotype., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Objective: Individual unsupervised home-based exercise programs can enhance muscle strength, physical function, gait, and balance in older adults. However, the effectiveness of such programs may be limited by the lack of supervision. This study aims to verify the effectiveness of individual unsupervised home-based programs, compare the effects of individual unsupervised home-based to supervised programs, and verify the influence of supervision over individual unsupervised home-based programs on the physical function of older adults., Methods: A systematic literature search was performed in four electronic databases, and the trials involved randomized controlled comparing the home-based programs to supervised, control groups, or home-based + supervised evaluating the muscle strength, physical function, gait, and balance in older adults., Results: Eleven studies met the inclusion criteria. The meta-analysis revealed no differences between home-based program versus supervised program in gait, mobility, and balance, revealing a trend of significance to supervised program on strength (standardized mean difference [SMD] = 0.27, p = .05). The analysis revealed effects in mobility (SMD = 0.40, p = .003), balance (SMD = 0.58, p = .0002), and muscle strength (SMD = 0.36, p = .02) favoring home-based program versus control group. Significant effects between home-based program versus home-based + supervised program were observed in balance (SMD = 0.74, p = .002) and muscle strength (SMD = 0.58, p = .01) in favor of home-based + supervised program., Conclusion: Home-based programs effectively improve older adults' physical function compared with control groups. However, supervised programs were more effective for muscle strength.

The aim of this study was to describe the muscle function, architecture, and composition of long-distance master runners, and verify the association between age and these variables. Additionally, different clusters of runners were compared based on age and training variables. Forty male runners (≥50 years) reported their training routine and had their muscle function evaluated through maximum knee extensor isometric peak torque (PT) assessed with an isokinetic dynamometer. The cross-sectional area (CSA), pennation angle (PA), fascicle length (FL), muscle thickness (MT), and echo intensity (EI) were evaluated through ultrasound (muscle architecture and composition). The participants were 58.7±6.2 years old and had been training for 18.4±10.3 years, 4 sessions/week with 298.8±164.7 min/week of training. The absolute torque was 226.92±63.44 N·m, and the specific torque (PT/CSA) was 7.29±3.78 N·m/cm2. Regarding muscle architecture, the phase angle was 17.34±4°, the fascicle angle 6.78±1.04 cm, muscle thickness 2.93±0.56 cm, and the cross-sectional area 21.24±5.88 cm2. Concerning muscle composition, the master runners showed echo intensity values of 62.05±11.68 AU. The analysis demonstrated a weak and negative association between age and some muscle architecture variables (CSA and MT) and muscle function (PT). No association was verified between age and muscle composition (EI). Age partially explained CSA, MT, and muscle function changes (13, 11, and 14%, respectively). Participants' high level of physical training might have contributed to the low association between these variables and the lack of association with muscle composition.

Aim: To compare differences between frailty, functional capacity, and fall prevalence among community-dwelling oldest-old adults regarding their physical activity levels., Methods: Two hundred and thirty-nine octogenarians (80+ years) were allocated according to their physical activity as insufficiently active (<150 min week -1 ; n = 98; 84.4 ± 3.7 years), active (150 to 300 min week -1 , n = 81, 83.9 ± 3.1 years), and very active (>300 min week -1 , n = 60; 83.8 ± 3.4 years). Frailty (CFVI-20 questionnaire), functional capacity (Five Times Sit-to-Stand Test, Timed Up and Go, Balance, and handgrip strength), fall history, and physical activity were assessed., Results: The insufficiently active group was the frailest and presented the worst functional performance compared to the other groups. The fall prevalence was higher in the insufficiently active (60.9%) compared to the active (26.4%) and very active (12.7%) groups., Conclusions: The group of insufficiently active octogenarians showed the greatest frailty, worst functional capacity, and higher fall prevalence than the active and very active groups. The engagement in physical activity of at least 300 min week -1 is essential to reverse or minimize the deleterious effects of aging on frailty, functional capacity, and falls in octogenarians.

Objectives: The study aimed to determine which domains, sets, and isolated or combined questions of the Clinical-Functional Vulnerability Index (CFVI-20) are associated with falls history in older adults. Methods: Instruments used were the CFVI-20 assessment and reported falls during the last year. The receiver operating characteristics (ROC) curves identified the performance of the CFVI-20 domains and questions in identifying older adults with and without falls history, while logistic regression identified relevant questions to identify fall history. Results: This study included 1725 individuals (71.9 ± 7.3 years). The area under the curve (AUC) between the CFVI-20 and fall history was 0.69. The mobility domain presented the largest AUC (0.71; p < 0.01), and most isolated domains showed low AUCs (0.51 to 0.58). Isolated questions were limited to identifying fallers. The regression analysis identified 7 questions of the CFVI-20 with falls. Conclusions: The CFVI-20 general score identified older adults with a fall history. When considered in isolation, most domains were limited to identifying falls, except for the mobility domain. Combining the CFVI-20 questions enabled identification of fallers.

This study described the kinematic variables of disabled swimmers' performance and correlated them with their functional classification. Twenty-one impaired swimmers (S5-S10) performed 50-m maximum front-crawl swimming while being recorded by four underwater cameras. Swimming velocity, stroke rate, stroke length, intracycle velocity variation, stroke dimensions, hand velocity, and coordination index were analyzed. Kendall rank was used to correlate stroke parameters and functional classification with p < .05. Swimming velocity, stroke length, and submerged phase were positively correlated with the para swimmers functional classification (.61, .50, and .41; p < .05, respectively), while stroke rate, velocity hand for each phase, coordination index, and intracyclic velocity variation were not (τ between -.11 and .45; p > .05). Thus, some objective kinematic variables of the impaired swimmers help to support current classification. Improving hand velocity seems to be a crucial point to be improved among disabled swimmers.

Aim: The aim of this cross-sectional study was to determine which functional tests are able to predict falls in nursing home residents (NHR) and community-dwelling (CDW) older adults grouped by age. Methods: Two hundred and fifty-two older adults were assessed in the following tests, Mini-Mental State Examination, anthropometric characteristics, fall history and functional tests. The participants were assigned to one of the following groups: Young Older Adults (YOA; 60-69 years, n = 102; 27.5% NHR), Old Older Adults (OOA; 70-79 years; n = 100; 23.5% NHR) and Very Older Adults (VOA, ≥80 years; n = 50; 52% NHR). Results: The five times sit-to-stand showed 1.41 odds to experience a fall in the NHR of the VOA. In the CDW, the handgrip strength score decreased the odds to fall occurrence (0.92 odds) in the YOA, while the low score in timed up and go test of the OOA showed 1.21 odds to experience a fall. Conclusions: Therefore, the five times sit-to-stand test can predict falls in NHR of VOA groups, while handgrip strength and timed up and go tests can predict falls in CDW of YOA and OOA groups, respectively.

Physical exercise is a potential intervention to revert or attenuate frailty syndrome, which may be accomplished by traditional center-based and home-based programs. This study aimed to compare the effectiveness of a home-based and center-based exercise program on frailty status, physical and muscle function of frail older women. Thirty-one frail older women were allocated in two different groups: home-based group ( n  = 17, 71.5 ± 6.5 years) or center-based group ( n  = 14, 68.4 ± 6.4 years). The exercise program lasted 12 weeks (3 days/week), 60 minutes/session, including strengthening, balance, and gait exercises. Frailty status, knee, and hip strength, and physical function were assessed before and after the intervention. After the exercise program, frailty was reversed in 76% of the participants independently of the exercise group. Muscle strength and physical function improved in both groups, where the home-based program presented a high adherence rate, and the center-based program was more suitable to reverse the frailty status. In conclusion, a home-based exercise program is as effective as center based to improve strength, physical function, and to reverse frailty status.

Research highlights the benefits of regular traditional multicomponent training in older adults. The potential effect of exergames on perceptive-cognitive and physical function in prefrail older adults is still little explored. The study aimed to compare the effects of two physical exercise training programs (exergaming vs. traditional multicomponent) on perceptive-cognitive and physical functions of prefrail older adults. This study was a randomized controlled trial having 66 prefrail older adults assigned to two groups (exergame group [EG]: n  = 32, 70.84 ± 4.53 years; multicomponent group [MG]: n  = 34, 70.76 ± 5.60 years). Frailty phenotype, fall history, basic and advanced cognition, perceptual, physical (mobility, gait speed, and balance), and muscle (strength and power) functions were evaluated. Intervention was conducted during 12 weeks. The EG and MG performed similar exercise routines involving the main lower limb muscle groups required in daily activities. A mixed model analysis of variance (ANOVA) and effect size ( d ) revealed that both programs were effective in postponing frailty status, reducing the fear of falling (EG: d  = 1.65; MG: d  = 1.40), increasing fall risk awareness (EG: d  = 2.14; MG: d  = 1.60), improving cognitive status (EG: d  = 0.83-2.61; MG: d  = 0.86-1.43), muscle (EG: d  = 0.54; MG: d  = 0.51-0.73), and physical function (EG: d  = 0.97-1.55; MG: d  = 1.01-2.23). The exergame training might be a better alternative to improve cognition, whereas the multicomponent program may be a better option to provide physical function gains.

Purpose : The aim of this study was to determine changes in swimming parameters, stroke coordination, and symmetry after repeated high-intensity swimming efforts in swimmers of different performance levels and para-swimmers. Method : Forty swimmers (20 able-bodied, allocated to higher and lower performance groups-G1 and G2, respectively-and 20 impaired swimmers-S5 to S10) were recorded by four underwater cameras while performing repeated 50 m maximum front-crawl swimming with a ten-second interval for each time endured by the swimmer. A cycle stroke was digitized using SIMI Reality Motion Systems in the first and last trials to analyze the kinematic parameters. The comparison among groups and conditions was performed by Mixed ANOVA Models with p < .05. Results : For all groups, swimming velocity, stroke rate, and stroke index showed reduction over time, while stroke length and intracyclic velocity variation did not show significant changes. Conclusions : Training to maintain stroke rate is necessary to support performance since it is the main cause of velocity decrease. Stroke dimensions and individual underwater phases were not sufficient to distinguish groups or conditions. Hand velocity decreased probably due to a decline in energy capacity, propulsive force and passive drag caused by the fatigue process.

Objective: The aim of this study was to compare the effects of multicomponent and strength training programs on dynamic balance, functional capacity, and gait ability in older women., Methods: Thirty individuals (67 ± 4.3 years; 30.6 ± 3.9 kg/m 2 ) were trained for 12 weeks (3 times per week), following multicomponent (MG: exercises focusing on agility, balance, muscle strength, and aerobic) and strength programs (SG: lower limbs strength exercise)., Results: Peak torque of hip flexors ( p =0.020) and extensors ( p =0.009) and knee flexors ( p =0.001) of SG was greater than that of MG at posttraining. In addition, both groups increased peak torque of knee extensors ( p =0.002) and plantar extensors with higher effect size for SG ( d  = -0.41 and -0.48), whereas MG presented higher effect size for plantar flexors muscles ( d  = -0.55). Only the SG improved the rate of torque development of knee extensors (29%; p =0.002), and this variable was also greater to SG than MG at posttraining (106%). The SG and MG improved dynamic balance although SG presented higher effect size ( d  = 0.61). Both groups improved the performance on 30 s sit to stand test ( p =0.010) with higher effect size for MG ( d  = -0.54). Only the MG improved the stride length (4%; p =0.011) and gait speed (10%; p =0.024). In addition, the groups improved toe clearance ( p =0.035) and heel contact ( p =0.010) with higher effect sizes for MG ( d  = -0.066 and 1.07)., Conclusion: Strength training should be considered to increase muscle function and dynamic balance in older women, whereas multicomponent training should be considered to increase functional capacity and gait ability in this population., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2020 Renata Wolf et al.)

Aims: To compare the static and dynamic postural control of people with Parkinson's disease and community old adults., Methods: Thirty-five people were in the Parkinson's disease group (PDG; 12 women, 62.4 ± 11.0 years, 77.9 ± 15.6 kg, 166.5 ± 11.0 cm, 27.9 ± 3.8 kg/m 2 , 1.9 ± 0.5 Hoehn & Yahr) and 32 were in the old adults group (OAG; 13 women, 69.5 ± 6.0 years, 74.2 ± 12.3 kg, 165.0 ± 8.3 cm, 27.2 ± 4.0 kg/m 2 ). The static balance was measured on a force platform, three 30-s trials in four conditions: feet side-by-side (FSBS) and semi-tandem stance (ST) positioning, eyes open (EO) and eyes closed (EC). The total sway path length (SPL), sway area (SA), anterior-posterior (APSR) and medial-lateral (MLSR) sway range of the centre of pressure were obtained. Dynamic balance was assessed using the timed-up-and-go test (TUG). For comparison between groups and repeated-measures, a mixed-design ANOVA was carried out and the Mann-Whitney U test to compare TUG between groups. The significance level was set at p ≤ .05., Results: Between groups, PDG presented higher mean values for SPL, APSR and SA in feet side-by-side eyes open compared to the OAG, for SPL in feet side-by-side eyes closed, for SPL and SA in STEO. For repeated-measures, both groups had higher mean values in the EC condition compared to EO and MLSR compared to APSR. No significant difference was found between groups for TUG., Conclusion: Balance disorders are found early in people with Parkinson's disease compared to healthy older adults. Thus, Parkinson's disease seems to advance the process of alterations in the postural control system., (© 2020 John Wiley & Sons, Ltd.)

Although swimming is recognized as a symmetrical sport, equivalence between each body side cannot be insured. Swimmers with physical and motor impairment may present asymmetries that are even more pronounced. Therefore, the objective of this study was to assess the symmetry of temporal coordination in the front crawl stroke phases and their dimensional characteristics among swimmers of different levels of skill and disabled swimmers. Forty-one swimmers (28 men and 13 women, 18,8 ± 3,3 years, divided 21 of them into groups of high and low level of skill and 20 in disabled swimmers group) performed a 50m maximum of front-crawl test while they were recorded by six synchronized cameras (four underwater and two above water) for analysis of the stroke phases, stroke dimensions (anteroposterior, mediolateral and vertical amplitude), index of coordination and hand speed. The symmetry index was calculated by the difference between the right and the left strokes. Comparisons were made using the Kruskal-Wallis test and multivariate comparisons were made using the Mann-Whitney test, with p <0.05. Asymmetry was noted in anteroposterior and mediolateral amplitudes of the stroke, index of coordination, duration of the recovery phase, each of the underwater phases and in the hand speed during the downseep phase, regardless of the level of skill or impairment. The disabled swimmers also showed asymmetry in the vertical amplitude of the stroke as well as in the insweep and upsweep speed. The reasons for these asymmetries may be the preference for unilateral breathing, force imbalance between pairs of homologous muscles and motor control deficit. The training with stereotypic movements may explain the similarity of asymmetries among the different groups of swimmers., Competing Interests: The authors have declared that no competing interests exist.

The aims of this study were to compare the effects of a multicomponent exercise program provided at a center (CB) versus done part at home and part at a center (H+CB) on frailty status, strength, physical function, and gait of prefrail older women. Twenty-five women were randomly allocated into the CB (n = 14; 69 ± 6 years) and the H+CB (n = 11; 69 ± 7 years) groups. Both groups completed an exercise program including strengthening, balance, and gait exercises. The program was 12 weeks long, done three times per week, for 60 min per session. Frailty, knee and hip muscle strength, spatiotemporal parameters of the usual and maximum speed dual-task gait, and physical function were assessed at baseline and after program completion. The exercise program reversed the prefrail status of most participants independently of the mode of delivery. Strength increased in both groups, but the CB group had more pronounced improvements in gait and physical function. H+CB exercise programs are good options for prefrail older women.

Objectives: To determine the prevalence of frailty and the association of sociodemographic characteristics, clinical aspects, and functional capacity with the frailty status of community-dwelling older adults from Curitiba, Southern Brazil., Methods: This cross-sectional observational study included 1,716 participants aged ≥60 years. Frailty was assessed using the Fried phenotype indicators of weakness, exhaustion, low activity, slowness, and weight loss. Sociodemographic characteristics, clinical aspects, and functional capacity and functionality were evaluated and compared between the sexes and the different frailty statuses (non-frail, prefrail, and frail). Multinomial logistic regression models were used to identify associations (p<0.05)., Results: A high prevalence of frailty (15.8%) and prefrailty (65.3%) were observed, and both were higher in female than in male individuals. The most predominant frailty criterion was weakness, followed by exhaustion. Compared with the non-frail elderly, the prefrail and frail elderly were older in age and presented more health problems, greater dependency for basic and instrumental activities of daily living, and reduced lower extremity strength performance and functional mobility. The highest proportion of illiterate individuals, individuals with 1-4 years of education, widowed individuals, polypharmacy, and possible cognition problems and diseases were seen in the frail elderly group. Moreover, the risk of being prefrail and frail was higher in those who were older and had more health problems, higher body mass index, and reduced lower extremity strength performance. Greater calf circumference and independence in activities of daily living were protective factors for prefrailty and frailty. Furthermore, lower functional mobility increased the chances of being frail., Conclusions: The prevalence of frailty was more pronounced in female than in male individuals, mainly because of a decline in force. Prefrailty was 4 times more prevalent than frailty, and the presence of health problems and reduced functional capacity increased the chances of being prefrail and frail.

Background: The combination of interval training and resistance training has showed interesting results in chronic heart failure patients, corroborating the benefits of physiological adaptations of both protocols., Objective: To evaluate the effect of the combination of interval training and resistance training program when compared to interval training alone and/or without intervention group on cardiorespiratory fitness in patients with chronic heart failure., Methods: We search MEDLINE via PubMed, ScienceDirect, Sportdiscus, BIREME and Scielo, from their inception to December 2018. Were included both randomized and non-randomized controlled trials comparing the effect of combined training, interval training alone and/or WI group on VO 2peak (expressed in ml/kg/min), in people with chronic heart failure patients. The meta-analysis was conducted via Review Manager v 5.3 software, using random effect model., Results: Ten articles were selected (nine randomized controlled trial), involving 401 participants. Six studies compared combined training with interval training and six studies compared combined training with the without intervention group. Eighty percent of the trials presented moderate risk of bias and twenty percent low risk of bias. Data showed significant difference and major increase in VO 2peak in favor to combined training group compared to interval training group (SMD=0.25; CI=0.04-0.46) and without intervention group (SMD=0.46; CI=0.29-0.64), respectively., Conclusion: The combination of interval training and resistance training showed more effective in increasing cardiorespiratory fitness in patients with heart failure than interval training alone and non-exercise therapy. However, further studies should be conducted to increase the understanding of this combined training method., (Copyright © 2019 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.)

The aims of this study were to examine whether: i) functional capacity and physical activity level differ between fallers and non-fallers older adults, by controlling for fall risk awareness; ii) functional capacity, fall risk awareness and physical activity differ between fallers and non-fallers older adults, by controlling for age; iii) variables and which may predict falls in different age groups. 1826 older adults performed a series of functional tests and reported their fall episodes, fall risk awareness and physical activity level. The overall incidence of falls was high (40.2%), and falls risk awareness scores reduced with age. The older adults with greater falls risk awareness and non-fallers presented better scores in all functional tests and physical activity level (P < .05). Functional tests and falls risk awareness differed among age groups and differed between fallers and non-fallers, irrespective of age group (P < .05). Falls risk awareness predicted falls in all age groups (odds ranging: 1.05-1.09). Handgrip strength and balance scores predicted falls until 79 years (OR = 1.04, 95%CI = 1.01-1.06). The physical activity level predicted falls up to 70 years (OR = 1.09, 95%CI = 1.06-1.12). Functional mobility was able to predict falls up to 80 years (OR = 1.06, 95%CI = 1.01-1.08). Therefore, according to age, functional capacity, physical activity level and falls risk awareness can be a predictor of falls in older adults., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Aim: The aim of this study was to verify the effects of a multisensory exercise programme on the cognition and functionality of institutionalized older adults., Methods: Forty-five volunteers were randomly allocated to 2 groups, the multisensory exercise programme (n = 24) and the control group that received no treatment (n = 21). The programme consisted of 3 50-min sessions of progressive exercises per week for 16 weeks that challenged their strength, balance, coordination, multisensory stimulation, and flexibility in different tasks. Cognition (Montreal Cognitive Assessment), balance (Berg Scale), mobility (Timed Up and Go), and functional performance (Physical Performance Test) were measured preintervention and postintervention. Statistical analyses were performed using Student's t test and 2-way ANOVA., Results: The multisensory exercise programme showed statistically significant improvements (p < .05) on cognition (effect size [ES]: 0.92), balance (ES: 0.77), mobility (ES: 0.51), and functional performance (ES: 0.86) as compared with the control group, which showed no statistical significant differences at the postintervention time point., Conclusions: The multisensory exercise programme improved the cognition and functionality of institutionalized older adults. The introduction of a motor and multisensory-based approach in care routines may improve residents' health and engagement to the environment., (Copyright © 2018 John Wiley & Sons, Ltd.)

The aims of this study were to investigate whether land-based and tethered swimming strength tests can explain swimming performance in 200-meter front crawl and, whether these tests were able to identify bilateral symmetry in force production. In the first session, eighteen swimmers completed a maximum effort 200 m front crawl swim (swimming performance) and 15 seconds maximal effort tethered front crawl swim. In the second session, participants performed the upper extremity isometric strength test. Peak force production of tethered swimming and isometric strength tests were significantly correlated for the strongest and weakest sides (r = 0.58 and r = 0.63, respectively; p < 0.05), but only peak force production during tethered swimming correlated with 200 m swimming performance time (r = -0.55, p < 0.05). Bilateral asymmetries in peak force and rate of force development were similar between the tethered swimming and isometric strength tests (peak force: 13%, p = 0.24; rate of force development: 15%, p = 0.88) However, both tests detected significant difference of peak force and rate of force development between body sides. The tethered swimming test can partially explain the 200 m front crawl swimming performance. In addition, the land-based and tethered swimming tests may be used to identify bilateral asymmetry of swimming.