108 results on '"Greig CA"'
Search Results
2. Physical fitness training for stroke patients
- Author
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Saunders, DH, primary, Greig, CA, additional, Young, A, additional, and Mead, GE, additional
- Published
- 2001
- Full Text
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3. Does Increased Strength and Power Improve Functional Ability in Healthy Elderly Women?
- Author
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Skelton, DA, primary, Greig, CA, additional, Malbut, KE, additional, and Young, A, additional
- Published
- 1994
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4. Training Increases Strength and Power in Very Elderly Women
- Author
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Malbut, KE, primary, Greig, CA, additional, Pippet, E, additional, Butler, F, additional, Young, A, additional, Dinan, S, additional, Barker, C, additional, and Oliver, K, additional
- Published
- 1993
- Full Text
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5. Effect of Cooling on the Power of Voluntary and Electrically Stimulated Contractions of the Lower Limb Extensors
- Author
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Skelton, DA, primary, Aston, H, additional, Greig, CA, additional, and Young, A, additional
- Published
- 1992
- Full Text
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6. Serum concentrations of myostatin and myostatin-interacting proteins do not differ between young and sarcopenic elderly men.
- Author
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Ratkevicius A, Joyson A, Selmer I, Dhanani T, Grierson C, Tommasi AM, DeVries A, Rauchhaus P, Crowther D, Alesci S, Yaworsky P, Gilbert F, Redpath TW, Brady J, Fearon KC, Reid DM, Greig CA, Wackerhage H, Ratkevicius, A, and Joyson, A
- Abstract
Sarcopenia is the loss of muscle size and function during ageing. The aim of this study was to test whether serum concentrations of myostatin and interacting proteins (GASP-1, FLRG, and follistatin) differed between young and elderly sarcopenic men. Isometric knee extensor maximal voluntary contraction and quadriceps cross-sectional area (magnetic resonance imaging measurement) were significantly higher in young (22 ± 2 years; 266 ± 54 N/m; 8,686 ± 1,154 mm(2)) than in mildly sarcopenic (69 ± 3 years; 183 ± 17 N/m; 6,621±718 mm(2)) and severely sarcopenic men (76 ± 6 years; 127 ± 23 N/m; 5,846 ± 591 mm(2)), respectively (p ≤ .01 for all comparisons). There was a trend (p = .06) toward higher FLRG in young (20 ± 8 ng/mL) than in mildly (15 ± 6 ng/mL) and severely sarcopenic men (17 ± 8 ng/mL). Myostatin, follistatin, GASP-1, tumor necrosis factor α, and interleukin-6 did not differ significantly. Insulin-like growth factor-1 and free testosterone were both significantly lower in sarcopenic men (p < .001). This suggests that altered serum concentrations of myostatin and myostatin-interacting proteins are not contributing to sarcopenia with the possible exception of FLRG. [ABSTRACT FROM AUTHOR]
- Published
- 2011
- Full Text
- View/download PDF
7. Physical fitness training for patients with stroke: updated review.
- Author
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Brazzelli M, Saunders DH, Greig CA, Mead GE, Brazzelli, Miriam, Saunders, David H, Greig, Carolyn A, and Mead, Gillian E
- Published
- 2012
- Full Text
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8. Accelerated aging of skeletal muscle and the immune system in patients with chronic liver disease.
- Author
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Nicholson T, Dhaliwal A, Quinlan JI, Allen SL, Williams FR, Hazeldine J, McGee KC, Sullivan J, Breen L, Elsharkawy AM, Armstrong MJ, Jones SW, Greig CA, and Lord JM
- Subjects
- Humans, Male, Female, Middle Aged, Immune System metabolism, Immune System immunology, Transcriptome, Adult, Aged, Chronic Disease, Liver Diseases immunology, Liver Diseases pathology, Case-Control Studies, Gene Expression Profiling, Muscle, Skeletal metabolism, Muscle, Skeletal immunology, Muscle, Skeletal pathology, Epigenesis, Genetic, Aging immunology
- Abstract
Patients with chronic liver disease (CLD) often present with significant frailty, sarcopenia, and impaired immune function. However, the mechanisms driving the development of these age-related phenotypes are not fully understood. To determine whether accelerated biological aging may play a role in CLD, epigenetic, transcriptomic, and phenotypic assessments were performed on the skeletal muscle tissue and immune cells of CLD patients and age-matched healthy controls. Accelerated biological aging of the skeletal muscle tissue of CLD patients was detected, as evidenced by an increase in epigenetic age compared with chronological age (mean +2.2 ± 4.8 years compared with healthy controls at -3.0 ± 3.2 years, p = 0.0001). Considering disease etiology, age acceleration was significantly greater in both the alcohol-related (ArLD) (p = 0.01) and nonalcoholic fatty liver disease (NAFLD) (p = 0.0026) subgroups than in the healthy control subgroup, with no age acceleration observed in the immune-mediated subgroup or healthy control subgroup (p = 0.3). The skeletal muscle transcriptome was also enriched for genes associated with cellular senescence. Similarly, blood cell epigenetic age was significantly greater than that in control individuals, as calculated using the PhenoAge (p < 0.0001), DunedinPACE (p < 0.0001), or Hannum (p = 0.01) epigenetic clocks, with no difference using the Horvath clock. Analysis of the IMM-Age score indicated a prematurely aged immune phenotype in CLD patients that was 2-fold greater than that observed in age-matched healthy controls (p < 0.0001). These findings suggested that accelerated cellular aging may contribute to a phenotype associated with advanced age in CLD patients. Therefore, therapeutic interventions to reduce biological aging in CLD patients may improve health outcomes., (© 2024. The Author(s).)
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- 2024
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9. Impaired lower limb muscle mass, quality and function in end stage liver disease: A cross-sectional study.
- Author
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Quinlan JI, Dhaliwal A, Williams FR, Allen SL, Choudhary S, Rowlands A, Breen L, Lavery GG, Lord JM, Elsharkawy AM, Armstrong MJ, and Greig CA
- Subjects
- Humans, Male, Female, Cross-Sectional Studies, Hand Strength, Quality of Life, Case-Control Studies, Lower Extremity, Muscle, Skeletal physiology, Quadriceps Muscle physiology, Muscle Strength physiology, Sarcopenia, End Stage Liver Disease
- Abstract
New Findings: What is the central question of this study? To what extent does musculoskeletal impairment occur (i.e., muscle mass, quality and function) in patients with end stage liver disease (ESLD) by comparison to a healthy age/sex-matched control group? What is the main finding and its importance? Muscle mass, quality and function are impaired in patients with ESLD (compared to age/sex matched controls). Importantly, greater impairments were seen in lower limb compared to arm and trunk muscle groups. These findings may suggest that there should be greater consideration of muscle health in functionally relevant lower limb muscle groups., Abstract: Sarcopenia is associated with reduced quality of life and increased mortality in patients with end stage liver disease (ESLD). Historically, sarcopenia identification in ESLD utilised L3 skeletal muscle index (SMI). There are few data on muscle quality and function within lower limb muscle groups with high functional relevance. The aim of this prospective case-control study was to evaluate the quadriceps muscle in patients with ESLD. Muscle mass and quality were evaluated using MRI (quadriceps anatomical cross sectional area (ACSA), quadriceps volume index, L3 SMI, quadriceps intermuscular adipose tissue (IMAT)), mid-arm muscle circumference (MAMC) and ultrasonography (vastus lateralis (VL) thickness and quadriceps ACSA). Muscle strength/function was assessed by handgrip strength, peak quadriceps isokinetic torque and chair rise time. Thirty-nine patients with ESLD (55 years, 61% male, 48% alcoholic related liver disease (ArLD), 71% Child-Pugh B/C) and 18 age/sex-matched healthy control participants (HC) were studied. Quadriceps mass was significantly reduced in ESLD versus HC (-17%), but L3 SMI and MAMC were unchanged. Quadriceps IMAT percentage was increased in ESLD (+103%). Handgrip strength (-15%), peak isokinetic torque (-29%), and chair rise time (+56%) were impaired in ESLD. Ultrasound measures of VL thickness (r = 0.56, r = 0.57, r = 0.42) and quadriceps ACSA (r = 0.98, r = 0.86, r = 0.67) correlated to MRI quadriceps ACSA, quadriceps volume and L3 SMI, respectively. Quadriceps muscle mass, quality, and function were impaired in patients with ESLD, whereas conventional assessments of muscle (L3 SMI and MAMC) highlighted no differences between ESLD and HC. Full evaluation of lower limb muscle health is essential in ESLD in order to accurately assess sarcopenia and target future interventions., (© 2023 The Authors. Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.)
- Published
- 2023
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10. Response to letter by Lo et al. : Investigating seasonal association between vitamin D concentration, muscle mass and strength in postmenopausal women: a critical analysis.
- Author
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Welford A, Darling AL, Allison S, Lanham-New SA, and Greig CA
- Subjects
- Female, Humans, Seasons, Vitamins, Muscles, Vitamin D, Postmenopause physiology
- Published
- 2023
- Full Text
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11. Frailty: Pathophysiology, Theoretical and Operational Definition(s), Impact, Prevalence, Management and Prevention, in an Increasingly Economically Developed and Ageing World.
- Author
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Doody P, Lord JM, Greig CA, and Whittaker AC
- Subjects
- Humans, Aged, Prevalence, Aging physiology, Longevity physiology, Health Status, Frail Elderly, Frailty epidemiology, Frailty prevention & control
- Abstract
The world's population is ageing, and most older adults experience a later life burdened with disease and disability. Frailty is a multidimensional and dynamic condition characterized by declines in reserve and function across multiple physiological systems, such that the ability to cope with every day or acute stressors becomes compromised. It is projected to become one of the most serious public health challenges economically developed societies will face in the coming century. This review provides a comprehensive overview of frailty, exploring its pathophysiology, theoretical and operational definition(s), impact, prevalence, management, and prevention, within the context of its emergence as a major public health challenge, in an increasingly economically developed and ageing world. Further, this review discusses the major limitations, deficiencies, and knowledge gaps presently within the field, and future research directions pertinent to the advancement of frailty research and the promotion of healthy longevity among the increasing global population of older adults., (© 2022 The Author(s). Published by S. Karger AG, Basel.)
- Published
- 2023
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12. Lack of significant seasonal association between serum 25(OH)D concentration, muscle mass and strength in postmenopausal women from the D-FINES longitudinal study.
- Author
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Welford AE, Darling AL, Allison SJ, Lanham-New SA, and Greig CA
- Subjects
- Humans, Female, Aged, Seasons, Hand Strength physiology, Longitudinal Studies, Postmenopause, Vitamin D, Vitamins, Muscles, Sarcopenia epidemiology
- Abstract
The aim of the present study was to assess the seasonal relationship between serum 25(OH)D concentration, lean mass and muscle strength. This was a secondary data analysis of a subgroup of 102 postmenopausal women participating in the 2006-2007 D-FINES (Vitamin D, Food Intake, Nutrition and Exposure to Sunlight in Southern England) study. The cohort was assessed as two age subgroups: <65 years ( n =80) and ≥65 years ( n =22). Outcome measures included lean mass (DXA), muscle strength (handgrip dynamometry) and serum 25(OH)D concentration (enzymeimmunoassay). Derived outcomes included appendicular skeletal muscle mass (ASM) and relative appendicular skeletal muscle index (RASM). Sarcopenia status was assessed using the European Working Group on Sarcopenia in Older People 2018 criteria. Non-parametric partial correlation using BMI as a covariate was used to evaluate the study aims. There were no statistically significant associations between total lean mass, ASM or RASM and 25(OH)D in any group at any season. There was a trend for handgrip strength to be positively associated with serum 25(OH)D concentration. There was a trend showing a higher prevalence of sarcopenia in women ≥65 years. Sarcopenia status appeared transient for five women. In conclusion, the present study found no significant association between vitamin D status and functional indicators of musculoskeletal health, which were additionally not affected by season., (© The Author(s) 2022.)
- Published
- 2022
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13. The prevalence of frailty and pre-frailty among geriatric hospital inpatients and its association with economic prosperity and healthcare expenditure: A systematic review and meta-analysis of 467,779 geriatric hospital inpatients.
- Author
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Doody P, Asamane EA, Aunger JA, Swales B, Lord JM, Greig CA, and Whittaker AC
- Subjects
- Aged, Frail Elderly, Geriatric Assessment, Health Expenditures, Hospitals, Humans, Inpatients, Prevalence, Frailty epidemiology
- Abstract
Background: Frailty is a common and clinically significant condition among geriatric populations. Although well-evidenced pooled estimates of the prevalence of frailty exist within various settings and populations, presently there are none assessing the overall prevalence of frailty among geriatric hospital inpatients. The purpose of this review was to systematically search and analyse the prevalence of frailty among geriatric hospital inpatients within the literature and examine its associations with national economic indicators., Methods: Systematic searches were conducted on Ovid, Web of Science, Scopus, CINAHL Plus, and the Cochrane Library, encompassing all literature published prior to 22 November 2018, supplemented with manual reference searches. Included studies utilised a validated operational definition of frailty, reported the prevalence of frailty, had a minimum age ≥ 65 years, attempted to assess the whole ward/clinical population, and occurred among hospital inpatients. Two reviewers independently extracted data and assessed study quality., Results: Ninety-six studies with a pooled sample of 467,779 geriatric hospital inpatients were included. The median critical appraisal score was 8/9 (range 7-9). The pooled prevalence of frailty, and pre-frailty, among geriatric hospital inpatients was 47.4% (95% CI 43.7-51.1%), and 25.8% (95% CI 22.0-29.6%), respectively. Significant differences were observed in the prevalence of frailty stratified by age, prevalent morbidity, ward type, clinical population, and operational definition. No significant differences were observed in stratified analyses by sex or continent, or significant associations between the prevalence of frailty and economic indicators., Conclusions: Frailty is highly prevalent among geriatric hospital inpatients. High heterogeneity exists within this setting based on various clinical and demographic characteristics. Pooled estimates reported in this review place the prevalence of frailty among geriatric hospital inpatients between that reported for community-dwelling older adults and older adults in nursing homes, outlining an increase in the relative prevalence of frailty with progression through the healthcare system., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)
- Published
- 2022
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14. Randomised Controlled Trial of Fish Oil Supplementation on Responsiveness to Resistance Exercise Training in Sarcopenic Older Women.
- Author
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da Cruz Alves NM, Pfrimer K, Santos PC, de Freitas EC, Neves T, Pessini RA, Junqueira-Franco MVM, Nogueira-Barbosa MH, Greig CA, and Ferriolli E
- Subjects
- Aged, Body Composition, Cytokines metabolism, Dietary Supplements, Double-Blind Method, Female, Humans, Muscle Strength, Muscle, Skeletal physiology, Fish Oils pharmacology, Resistance Training methods, Sarcopenia therapy
- Abstract
This study aims to investigate the effects of fish oil supplementation on the muscle adaptive response to resistance exercise training, physical performance and serum levels of inflammatory cytokines in sarcopenic older women. A randomised, double-blind, placebo-controlled trial is performed with thirty-four sarcopenic women (2010 European Consensus of Sarcopenia), aged ≥ 65 years. The participants are allocated into the following two groups: Exercise and Fish Oil (EFO) and Exercise and Placebo (EP). Both groups undertook a resistance exercise programme over 14 weeks. All participants are instructed to ingest 4 g/day of food supplements; the EP group received sunflower oil capsules, and the EFO group, fish oil capsules. The cross-sectional area (CSA) of the quadriceps muscle is calculated using magnetic resonance imaging (MRI). The strength of the lower limbs is measured using isokinetic dynamometry. Both groups show improvements in CSA and strength after the intervention. Changes in EFO are significantly greater compared with EP for muscle strength (peak torque, 19.46 Nm and 5.74 Nm, respectively, p < 0.001). CSA increased after the intervention in both groups (EFO; 6.11% and EP; 2.91%), although there is no significant difference between the groups (p = 0.23). There are no significant intra-group, inter-group or time differences in any of the cytokines measured. The use of fish oil supplementation potentiates the neuromuscular response to the anabolic stimulus from training, increasing muscle strength and physical performance in sarcopenic older women.
- Published
- 2022
- Full Text
- View/download PDF
15. The Impact of Slice Interval and Equation on the Accuracy of Magnetic Resonance Image Estimation of Quadriceps Muscle Volume in End Stage Liver Disease.
- Author
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Quinlan JI, Jones C, Bissonnette E, Dhaliwal A, Williams F, Choudhary S, Breen L, Lavery GG, Armstrong MJ, Elsharkawy AM, Lord JM, and Greig CA
- Abstract
Introduction: End stage liver disease (ESLD) is associated with loss of muscle mass and function, known as sarcopenia, which can increase the risk of complications of ESLD, hospitalization and mortality. Therefore, the accurate assessment of muscle mass is essential to evaluate sarcopenia in ESLD. However, manual segmentation of muscle volume (MV) can be laborious on cross-sectional imaging, due to the number of slices that require analysis. This study aimed to investigate the impact of reducing the number of slices required for MV estimation. Further, we aimed to compare two equations utilized in estimating MV (cylindrical and truncated cone)., Methods: Thirty eight ESLD patients (23 males; 54.8 ± 10.7 years) were recruited from the Queen Elizabeth University Hospital Birmingham. A 3T MRI scan was completed of the lower limbs. Quadriceps MV was estimated utilizing 1-, 2-, 3-, and 4 cm slice intervals with both cylindrical and truncated cone equations. Absolute and relative error (compared to 1 cm slice interval) was generated for 2-, 3-, and 4 cm slice intervals. L3 skeletal muscle index (SMI) was also calculated in 30 patients., Results: Relative error increased with slice interval using the cylindrical (0.45 vs. 1.06 vs. 1.72%) and truncated cone equation (0.27 vs. 0.58 vs. 0.74%) for 2, 3, and 4 cm, respectively. Significantly, the cylindrical equation produced approximately twice the error compared to truncated cone, with 3 cm (0.58 vs. 1.06%, P < 0.01) and 4 cm intervals (0.74 vs. 1.72%, P < 0.001). Finally, quadriceps MV was significantly correlated to L3 SMI ( r
2 = 0.44, P < 0.0001)., Conclusion: The use of the truncated equation with a 4 cm slice interval on MRI offers an efficient but accurate estimation of quadricep muscle volume in ESLD patients., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Quinlan, Jones, Bissonnette, Dhaliwal, Williams, Choudhary, Breen, Lavery, Armstrong, Elsharkawy, Lord and Greig.)- Published
- 2022
- Full Text
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16. The Effect of Ex Vivo Human Serum from Liver Disease Patients on Cellular Protein Synthesis and Growth.
- Author
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Allen SL, Seabright AP, Quinlan JI, Dhaliwal A, Williams FR, Fine NHF, Hodson DJ, Armstrong MJ, Elsharkaway AM, Greig CA, Lai YC, Lord JM, Lavery GG, and Breen L
- Subjects
- Humans, Muscle Fibers, Skeletal, Protein Biosynthesis, End Stage Liver Disease, Non-alcoholic Fatty Liver Disease complications, Sarcopenia complications
- Abstract
Sarcopenia is a common complication affecting liver disease patients, yet the underlying mechanisms remain unclear. We aimed to elucidate the cellular mechanisms that drive sarcopenia progression using an in vitro model of liver disease. C2C12 myotubes were serum and amino acid starved for 1-h and subsequently conditioned with fasted ex vivo serum from four non-cirrhotic non-alcoholic fatty liver disease patients (NAFLD), four decompensated end-stage liver disease patients (ESLD) and four age-matched healthy controls (CON) for 4- or 24-h. After 4-h C2C12 myotubes were treated with an anabolic stimulus (5 mM leucine) for 30-min. Myotube diameter was reduced following treatment with serum from ESLD compared with CON (−45%) and NAFLD (−35%; p < 0.001 for both). A reduction in maximal mitochondrial respiration (24% and 29%, respectively), coupling efficiency (~12%) and mitophagy (~13%) was identified in myotubes conditioned with NAFLD and ESLD serum compared with CON (p < 0.05 for both). Myostatin (43%, p = 0.04) and MuRF-1 (41%, p = 0.03) protein content was elevated in myotubes treated with ESLD serum compared with CON. Here we highlight a novel, experimental platform to further probe changes in circulating markers associated with liver disease that may drive sarcopenia and develop targeted therapeutic interventions.
- Published
- 2022
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17. Feasibility, Efficacy, and Safety of Percutaneous Muscle Biopsies in Patients With Chronic Liver Disease.
- Author
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Quinlan JI, Dhaliwal A, Williams F, Allen SL, Breen L, Greig CA, Lord JM, Armstrong MJ, and Elsharkawy AM
- Abstract
Introduction: Sarcopenia is present in many chronic disease states including decompensated end stage liver disease (ESLD) and non-cirrhotic non-alcoholic fatty liver disease (NAFLD). Sarcopenia in ESLD can negatively impact quality of life and increase mortality. Despite this, very little is understood about the mechanisms of sarcopenia in these conditions. One key reason for this is the reluctance to undertake percutaneous muscle biopsies due to the perceived increased risks. ESLD can induce thrombocytopaenia and coagulopathy which significantly increases the risk of bleeding. In addition, patients with either NAFLD or ESLD often have co-morbidities that would require additional care and risk assessment. Thus, the aim of this study was to establish an effective and safe protocol for the implementation of percutaneous muscle biopsies in patients with NAFLD and ESLD., Methods: A total of 47 patients with ESLD and 9 patients with non-cirrhotic NAFLD were recruited from the Liver Unit, Queen Elizabeth Hospital (Birmingham, United Kingdom). A total of 71 percutaneous vastus lateralis biopsies were attempted over two study visits. A vigorous safety screening occurred prior to and during each visit and a strict protocol was followed to mitigate against complications and risk., Results: A total of 85% of patients consented to the muscle biopsy at either visit (48/56). A total of 9% of consented biopsies could not occur due to medical considerations, including high international normalised ratio (INR) ( n = 3) and the use of aspirin ( n = 4). Muscle tissue was obtained from 90% of attempts, with a mean average yield (wet weight tissue) of 98.1 ± 52.9 mg., Conclusion: Percutaneous muscle biopsies are both feasible and yield sufficient tissue in an ESLD population. The procedure is effective for obtaining muscle tissue whilst also safe, with only one adverse event. This study provides evidence for the successful use of muscle biopsies in this population, even in consideration of disease specific complications, medications, and comorbidities., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer BS declared a past collaboration with one of the authors, LB, to the handling editor., (Copyright © 2022 Quinlan, Dhaliwal, Williams, Allen, Breen, Greig, Lord, Armstrong and Elsharkawy.)
- Published
- 2022
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18. Determining the Influence of Habitual Dietary Protein Intake on Physiological Muscle Parameters in Youth and Older Age.
- Author
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Mathewson SL, Gordon AL, Smith K, Atherton PJ, Greig CA, and Phillips BE
- Subjects
- Adolescent, Adult, Aged, Body Weight drug effects, Humans, Muscle, Skeletal anatomy & histology, Muscle, Skeletal drug effects, Organ Size, Dietary Proteins pharmacology, Eating, Feeding Behavior, Muscle, Skeletal physiology
- Abstract
Protein ingestion is a potent stimulator of skeletal muscle protein synthesis (MPS). However, older adults demonstrate resistance to anabolic stimuli. Some evidence has demonstrated that a larger acute protein dose is required in older compared to younger adults to elicit the same synthetic response, suggesting that older adults should be consuming higher habitual dietary protein to optimise muscle mass. However, limited research has explored dietary habits in different age groups or the relationship between habitual dietary intake and mechanistic physiological parameters associated with muscle mass and function. This work investigated the effect of habitual dietary intake in young ( n = 10, 25.9 (3.2y)) and older ( n = 16, 70.2 (3.2y)) community-dwelling adults (16:10 male: female) on physiological muscle parameters. Dietary intake was assessed using four-day diet diaries. Post-absorptive MPS and MPS responses to feeding (4.25x basal metabolic rate; 16% protein) were determined in muscle biopsies of the m. vastus lateralis via stable isotope tracer ([1, 2
-13 C2 ]-leucine) infusions with mass-spectrometric analyses. Body composition was measured by dual-energy x-ray absorptiometry. Whole body strength was assessed via 1-repetition maximum assessments. No significant differences in habitual dietary intake (protein, fat, carbohydrate and leucine as g.kgWBLM-1 .day-1 ) were observed between age groups. Whole-body lean mass (61.8 ± 9.9 vs. 49.8 ± 11.9 kg, p = 0.01) and knee-extensor strength (87.7 ± 28.3 vs. 56.8 ± 16.4 kg, p = 0.002) were significantly higher in young adults. Habitual protein intake (g.kg-1 .day-1 ) was not associated with whole-body lean mass, upper-leg lean mass, whole-body strength, knee-extensor strength, basal MPS or fed-state MPS across both age groups. These findings suggest that differences in muscle mass and strength parameters between youth and older age are not explained by differences in habitual dietary protein intake. Further research with a larger sample size is needed to fully explore these relationships and inform on interventions to mitigate sarcopenia development.- Published
- 2021
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19. Overcoming protein-energy malnutrition in older adults in the residential care setting: A narrative review of causes and interventions.
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Mathewson SL, Azevedo PS, Gordon AL, Phillips BE, and Greig CA
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- Aged, Dietary Supplements, Energy Intake, Humans, Nutritional Status, Frailty, Malnutrition diagnosis, Malnutrition epidemiology, Malnutrition therapy, Protein-Energy Malnutrition diagnosis, Protein-Energy Malnutrition epidemiology, Protein-Energy Malnutrition therapy, Sarcopenia diagnosis, Sarcopenia epidemiology, Sarcopenia therapy
- Abstract
Malnutrition, in particular protein-energy malnutrition, is a highly prevalent condition in older adults, and is associated with low muscle mass and function, and increased prevalence of physical frailty. Malnutrition is often exacerbated in the residential care setting due to factors including lack of dentition and appetite, and increased prevalence of dementia and dysphagia. This review aims to provide an overview of the available literature in older adults in the residential care setting regarding the following: links between sarcopenia, frailty, and malnutrition (in particular, protein-energy malnutrition (PEM)), recognition and diagnosis of malnutrition, factors contributing to PEM, and the effectiveness of different forms of protein supplementation (in particular, oral nutritional supplementation (ONS) and protein-fortified foods (PFF)) to target PEM. This review found a lack of consensus on effective malnutrition diagnostic tools and lack of universal requirement for malnutrition screening in the residential care setting, making identifying and treating malnutrition in this population a challenge. When assessing the use of protein supplementation in the residential care setting, the two primary forms of supplementation were ONS and PFF. There is evidence that ONS and PFF increase protein and energy intakes in residential care setting, yet compliance with supplementation and their impact on functional status is unclear and conflicting. Further research comparing the use of ONS and PFF is needed to fully determine feasibility and efficacy of protein supplementation in the residential care setting., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)
- Published
- 2021
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20. Sedentary behaviour and bone health in older adults: a systematic review.
- Author
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McMichan L, Dick M, Skelton DA, Chastin SFM, Owen N, Dunstan DW, Fraser WD, Tang JCY, Greig CA, Agyapong-Badu S, and Mavroeidi A
- Subjects
- Absorptiometry, Photon, Aged, Cross-Sectional Studies, Female, Femur Neck, Humans, Male, Prospective Studies, Bone Density, Sedentary Behavior
- Abstract
Older adults spend more than 8 h/day in sedentary behaviours. Detrimental effects of sedentary behaviour (SB) on health are established, yet little is known about SB and bone health (bone mineral density; BMD) in older adults. The purpose of this review is to examine associations of SB with BMD in older adults. Five electronic databases were searched: Web of Science (Core Collection); PubMed; EMBASE; Sports Medicine and Education and PsycInfo. Inclusion criteria were healthy older adults mean age ≥ 65 years; measured SB and measured BMD using dual-energy X-ray absorptiometry. Quality was assessed using National Institute of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. After excluding duplicates 17813 papers were assessed; 17757 were excluded on title/abstract, 49 at full text, resulting in two prospective and five cross-sectional observational studies reviewed. Four were rated 'good' and three were rated 'fair' using the quality assessment criteria. Findings varied across the studies and differed by gender. In women, four studies reported significant positive associations of SB with BMD at different sites, and two found significant negative associations. Five studies which examined both men and women, men reported negative or no associations of SB with femoral neck, pelvic, whole body, spine or leg BMD. Whilst these findings suggest differences between men and women in the associations of SB with BMD, they may be due to the varying anatomical sections examined for BMD, the different methods used to measure SB, the varied quality of the studies included and the limited number of published findings., (© 2021. International Osteoporosis Foundation and National Osteoporosis Foundation.)
- Published
- 2021
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21. A prospective, phase II, single-centre, cross-sectional, randomised study investigating Dehydroepiandrosterone supplementation and its Profile in Trauma: ADaPT.
- Author
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Bentley C, Potter C, Yakoub KM, Brock K, Homer V, Toman E, Taylor AE, Shaheen F, Gilligan LC, Athwal A, Barton D, Carrera R, Young K, Desai A, McGee K, Ermogenous C, Sur G, Greig CA, Hazeldine J, Arlt W, Lord JM, and Foster MA
- Subjects
- Cross-Sectional Studies, Dehydroepiandrosterone Sulfate, Female, Humans, Male, Prospective Studies, Dehydroepiandrosterone, Dietary Supplements
- Abstract
Introduction: The improvements in short-term outcome after severe trauma achieved through early resuscitation and acute care can be offset over the following weeks by an acute systemic inflammatory response with immuneparesis leading to infection, multiorgan dysfunction/multiorgan failure (MOF) and death. Serum levels of the androgen precursor dehydroepiandrosterone (DHEA) and its sulfate ester DHEAS, steroids with immune-enhancing activity, are low after traumatic injury at a time when patients are catabolic and immunosuppressed. Addressing this deficit and restoring the DHEA(S) ratio to cortisol may provide a range of physiological benefits, including immune modulatory effects., Objective: Our primary objective is to establish a dose suitable for DHEA supplementation in patients after acute trauma to raise circulating DHEA levels to at least 15 nmol/L. Secondary objectives are to assess if DHEA supplementation has any effect on neutrophil function, metabolic and cytokine profiles and which route of administration (oral vs sublingual) is more effective in restoring circulating levels of DHEA, DHEAS and downstream androgens., Methods and Analysis: A prospective, phase II, single-centre, cross-sectional, randomised study investigating Dehydroepiandrosterone supplementation and its profile in trauma, with a planned recruitment between April 2019 and July 2021, that will investigate DHEA supplementation and its effect on serum DHEA, DHEAS and downstream androgens in trauma. A maximum of 270 patients will receive sublingual or oral DHEA at 50, 100 or 200 mg daily over 3 days. Females aged ≥50 years with neck of femur fracture and male and female major trauma patients, aged 16-50 years with an injury severity score ≥16, will be recruited., Ethics and Dissemination: This protocol was approved by the West Midlands - Coventry and Warwickshire Research Ethics Committee (Reference 18/WM/0102) on 8 June 2018. Results will be disseminated via peer-reviewed publications and presented at national and international conferences., Trial Registration: This trial is registered with the European Medicines Agency (EudraCT: 2016-004250-15) and ISRCTN (12961998). It has also been adopted on the National Institute of Health Research portfolio (CPMS ID:38158)., Trial Progression: The study recruited its first patient on 2 April 2019 and held its first data monitoring committee on 8 November 2019. DHEA dosing has increased to 100 mg in both male cohorts and remains on 50 mg in across all female groups., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)
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- 2021
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22. Factors associated with electrical stimulation-induced performance fatigability are dependent upon stimulation location.
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Inns TB, McCormick D, Greig CA, Atherton PJ, Phillips BE, and Piasecki M
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- Electric Stimulation methods, Electromyography, Humans, Muscle, Skeletal physiology, Muscle Contraction, Muscle Fatigue physiology
- Abstract
New Findings: What is the central question of this study? How does peripheral nerve stimulation (PNS) compare with neuromuscular electrical stimulation (NMES) used clinically to reduce muscle atrophy? What is the main finding and its importance? NMES resulted in progressive increases in M-wave duration and delay of muscle relaxation throughout a single stimulation protocol, findings not observed with PNS. This suggests PNS recruits from a wider pool of muscle fibres/motor units, providing a more favourable alternative to NMES for rehabilitation intervention., Abstract: Neuromuscular electrical stimulation (NMES) is increasingly viewed as a central tenet to minimise muscle loss during periods of disuse/illness - typically applied directly over a muscle belly. Peripheral nerve stimulation (PNS) is afforded less attention, despite providing a more global contractile stimulus to muscles. We investigated NMES versus PNS in relation to performance fatigability and peripheral contributions to voluntary force capacity. Two fatigue protocols were assessed separately: (1) over-quadriceps NMES and (2) peripheral (femoral) nerve stimulation (PNS). Before and after each session, a maximal voluntary contraction (MVC) was performed to assess force loss. Knee-extensor force was measured throughout to assess contractile function in response to submaximal electrical stimulation, and M-wave features quantified myoelectrical activity. NMES and PNS induced similar voluntary (MVC, NMES: -12 ± 9%, PNS: -10 ± 8%, both P < 0.001) and stimulated (NMES: -45 ± 12%, PNS -27 ± 27%, both P < 0.001) force reductions. Although distinct between protocols, myoelectrical indicators of muscle recruitment (M-wave area and amplitude) and nerve conduction time did not change throughout either protocol. Myoelectrical propagation speed, represented as M-wave duration, and the delay before muscle relaxation began both progressively increased during NMES only (P < 0.05 and P < 0.001, respectively). NMES myoelectrical changes suggested performance fatigability, indicating activation of superficial fibres only, which was not observed with PNS. This suggests PNS recruits a wider pool of muscle fibres and motor units and is a favourable alternative for rehabilitation. Future work should focus on implementing PNS interventions in clinically relevant scenarios such as immobilisation, care homes and critical illness., (© 2021 The Authors. Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.)
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- 2021
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23. Sarcopenia in chronic liver disease: mechanisms and countermeasures.
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Allen SL, Quinlan JI, Dhaliwal A, Armstrong MJ, Elsharkawy AM, Greig CA, Lord JM, Lavery GG, and Breen L
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- Energy Metabolism, Humans, Liver Diseases metabolism, Liver Diseases pathology, Proteostasis, Sarcopenia metabolism, Sarcopenia pathology, Sarcopenia therapy, Liver Diseases complications, Sarcopenia complications
- Abstract
Sarcopenia, a condition of low muscle mass, quality, and strength, is commonly found in patients with cirrhosis and is associated with adverse clinical outcomes including reduction in quality of life, increased mortality, and posttransplant complications. In chronic liver disease (CLD), sarcopenia is most commonly defined through the measurement of the skeletal muscle index of the third lumbar spine. A major contributor to sarcopenia in CLD is the imbalance in muscle protein turnover, which likely occurs due to a decrease in muscle protein synthesis and an elevation in muscle protein breakdown. This imbalance is assumed to arise due to several factors including accelerated starvation, hyperammonemia, amino acid deprivation, chronic inflammation, excessive alcohol intake, and physical inactivity. In particular, hyperammonemia is a key mediator of the liver-gut axis and is known to contribute to mitochondrial dysfunction and an increase in myostatin expression. Currently, the use of nutritional interventions such as late-evening snacks, branched-chain amino acid supplementation, and physical activity have been proposed to help the management and treatment of sarcopenia. However, little evidence exists to comprehensively support their use in clinical settings. Several new pharmacological strategies, including myostatin inhibition and the nutraceutical Urolithin A, have recently been proposed to treat age-related sarcopenia and may also be of use in CLD. This review highlights the potential molecular mechanisms contributing to sarcopenia in CLD alongside a discussion of existing and potential new treatment strategies.
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- 2021
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24. A novel behavioural INTErvention to REduce Sitting Time in older adults undergoing orthopaedic surgery (INTEREST): results of a randomised-controlled feasibility study.
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Aunger JA, Greaves CJ, Davis ET, Asamane EA, Whittaker AC, and Greig CA
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- Aged, Feasibility Studies, Humans, Research Design, Sedentary Behavior, Orthopedics, Sitting Position
- Abstract
Background: Osteoarthritis is a prevalent condition in older adults that causes many patients to require a hip or knee replacement. Reducing patients' sedentariness prior to surgery may improve physical function and post-operative outcomes., Methods: We conducted a pragmatic randomised-controlled feasibility study with 2:1 allocation into intervention or usual care groups. The intervention, based on Self-Determination Theory, involved techniques to reduce sedentary behaviour, including motivational interviewing, setting of behavioural goals, and more. The primary outcome was feasibility, assessed using mixed methods. We included exploratory measures to inform a future definitive trial, such as ActivPal3 accelerometry to measure movement, the Short Physical Performance Battery (SPPB), Basic Psychological Needs, and cardiometabolic biomarkers. Assessments were at baseline, 1-week pre-surgery, and 6-week post-surgery., Results: We recruited 35 participants aged ≥ 60 years approximately 8 weeks before hip or knee arthroplasty. Participant uptake rate was 14.2%, and retention rate 85.7%. Participants were very satisfied with the study which was found to be feasible with some modifications. Exploratory within-group comparisons found that the intervention has potential to improve SPPB by 0.71 points from baseline to pre-surgery, a clinically significant increase, and reduce sedentary time by up to 66 min d
-1 ., Conclusion: In this older surgical population, it is feasible to use behavioural techniques to displace sedentary time to activity and to conduct a trial spanning the period of surgical intervention. This may improve physical function and surgical outcomes. The INTEREST intervention is now ready for evaluation in a full-scale randomised-controlled trial., Registration: This trial was registered on Clinicaltrials.gov on 13/11/2018. ID: NCT03740412.- Published
- 2020
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25. The association between nutrient intake, nutritional status and physical function of community-dwelling ethnically diverse older adults.
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Asamane EA, Greig CA, and Thompson JL
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Background: There are limited longitudinal data regarding nutrient intake, nutritional status and physical function in community-dwelling ethnically diverse older adults. This study explored these variables and their relationship at baseline ( n = 100) and 8-months' follow-up ( n = 81) among community-dwelling ethnically diverse older adults (≥60 years) in Birmingham, United Kingdom., Methods: Multiple-pass 24-h dietary recalls and the Mini Nutritional Assessment-Short Form assessed nutritional intake and status, respectively. Short Physical Performance Battery (SPPB) and handgrip strength measured physical function. Linear and multinomial regressions were used to predict relationships between physical function, nutritional status and nutrient intake., Results: Complete data were collected at baseline ( n = 100) and 8-months' follow-up ( n = 81). Mean (SD) age was 70 (8.1) years (60% male), with 62% being obese. Statistically significant decreases in intakes of vitamin B6, vitamin B1, iron, folate, and magnesium occurred over time. Daily intake of all micronutrients except vitamin B12, phosphorus and manganese were below the Recommended Nutrient Intakes (RNI). SPPB (Z = -4.01, p < 0.001) and nutritional status (Z = -2.37, p = 0.018) declined over time. Higher SPPB scores at baseline (OR = 0.54 95% CI 0.35, 0.81) were associated with a slower decline in nutritional status., Conclusion: The observed declines and inadequate nutrient intakes in the absence of weight loss in just 8 months may pose serious challenges to healthy ageing, identifying an urgent need to re-evaluate and tailor appropriate dietary advice for this population. Additionally, the associations of nutrition and physical function observed in this study serves as an essential resource to design and implement community/faith-based interventions targeting early screening of nutritional status and physical function to ensure most older adults are assessed and treated accordingly., Competing Interests: Competing interestsThe authors declare no competing interest., (© The Author(s) 2020.)
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- 2020
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26. Protocol for understanding acute sarcopenia: a cohort study to characterise changes in muscle quantity and physical function in older adults following hospitalisation.
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Welch C, Greig CA, Masud T, Pinkney T, and Jackson TA
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- Aged, Aged, 80 and over, Cohort Studies, Hospitalization, Humans, Muscle Strength, Muscle, Skeletal, Muscles, Sarcopenia diagnosis, Sarcopenia epidemiology, Sarcopenia therapy
- Abstract
Background: Older adults are vulnerable to the effects of acute sarcopenia (acute muscle insufficiency) following hospitalisation. However, this condition remains poorly characterised to date. It is hypothesised that acute sarcopenia arises due to a combination of bed rest and inflammatory surge. This study aims to characterise changes in muscle quantity and function, determining which factors (clinical and biological) are most predictive, and how these relate to change in physical function at 13 weeks., Methods: This study will include three groups of patients aged 70 years and older; patients undergoing elective colorectal surgery, patients admitted for emergency abdominal surgery, and patients admitted under general medicine with acute bacterial infections. Changes in muscle quantity (Bilateral Anterior Thigh Thickness with ultrasound and bioelectrical impedance analysis) and muscle function (muscle strength, physical performance) within 1 week of hospitalisation or surgery will be characterised, with follow-up of patients at 13 weeks. Physical function will be measured using the Patient Reported Outcome Measures Information System, and the Short Physical Performance Battery (or gait speed alone within 1 week of surgery)., Discussion: This study will fully characterise changes in muscle quantity and function in hospitalised older adults and enable risk stratification towards targeted interventions in clinical practice. The results of this study will inform further research involving interventions to ameliorate changes., Trial Registration: ClinicalTrials.gov Identifier: NCT03858192 ; Prospectively registered 28th February 2019.
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- 2020
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27. Social networks and their influences on nutrient intake, nutritional status and physical function in community-dwelling ethnically diverse older adults: a mixed-methods longitudinal study.
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Asamane EA, Greig CA, and Thompson JL
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- Aged, Aged, 80 and over, Energy Intake, Female, Hand Strength, Humans, Longitudinal Studies, Male, Nutrition Assessment, United Kingdom, Diet, Healthy statistics & numerical data, Ethnicity statistics & numerical data, Feeding Behavior psychology, Independent Living statistics & numerical data, Nutritional Status, Social Networking
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Background: The United Kingdom population is ageing and becoming increasingly diverse; thus, it is vital to develop and implement interventions supporting this population shift. Social networks (SN) significantly impact health outcomes in later life, however relatively little is known about SN of community-dwelling ethnically diverse older adults. This study aimed to: 1) profile SN and changes in SN in this population over 8 months; 2) examine associations between SN, dietary intake, nutritional status, and physical function., Methods: SN were assessed using the Wenger Practitioner Assessment of Network Type. Energy and nutrient intakes were measured using multiple-pass 24-h recalls. The Mini Nutritional Assessment-Short Form (MNA-SF) assessed nutritional status. Physical function was measured using the Short Physical Performance Battery (SPPB) and handgrip strength. Data were collected at baseline and 8-months. Correlation and regression analyses examined relationships between SN, physical function, nutrient intake and nutritional status. Semi-structured interviews were conducted at baseline (n = 92) and follow-up (n = 81) to identify potential influences of SN. Interviews were transcribed verbatim and analysed using directed content analysis., Results: Quantitative data were obtained from 100 participants at baseline and 81 at follow-up. Mean (SD) age was 70.8 (8.1) years (59% male), comprising African/Caribbean (60%), South Asian (34%), and other ethnicities (6%). Five SN typologies were identified under two broad areas: integrated-SN consisting of locally integrated (44%) and wider community (8%); and non-integrated-SN consisting of family dependent (25%), local self-contained (17%), and private restricted (6%). At follow-up, 37% remained in non-integrated networks, 19% transitioned to non-integrated networks, 11% transitioned to, and 33% remained in, integrated networks. Participants within integrated networks at baseline had higher SPPB scores at follow-up. Compared to the private restricted, local self-contained SN significantly predicted zinc, riboflavin and vitamin B6 intakes. Participants remaining in, or transitioning to, non-integrated networks had low MNA-SF scores. Qualitative findings indicate that participants with reductions in SN perceived it as causing poorer physical function and eating behaviours., Conclusion: In the present study, integrated SN were associated with higher physical function and nutritional status at 8-month's follow-up. These results can inform the design of interventions to improve social networks, physical function and healthy nutrition within this population.
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- 2020
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28. Physical Activity Intervention for Loneliness (PAIL) in community-dwelling older adults: a randomised feasibility study.
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Shvedko AV, Thompson JL, Greig CA, and Whittaker AC
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Background: Low quality social relationships in older adults are strongly associated with feelings of loneliness. Physical activity interventions could reduce loneliness and improve psychological well-being, among other health benefits. The aim of this study was to examine the feasibility of a Physical Activity Intervention for Loneliness (PAIL) in community-dwelling older adults at risk of loneliness., Methods: The PAIL feasibility study was a 12-week randomized controlled feasibility trial (RCT) conducted in Birmingham, United Kingdom, from February 2018 to August 2018, and ran in two waves of data collection. Eligible participants were community-dwelling adults aged 60 years and older, sedentary (less than 20 min of moderate-to-vigorous PA (MVPA) a week), and at risk of loneliness. The intervention included once-weekly group walk and health education workshop up to 90 min per session in total, with a wait-listed (WL) control group. The primary feasibility outcomes were to estimate recruitment, retention rates and adherence to the intervention. Secondary outcome measures (not blinded assessment) were body mass index, blood pressure, physical activity and psychosocial variables. Process and outcome evaluations were conducted using focus groups interviews. The recruitment and retention progression criteria for the definitive large-scale RCT was set a-priori., Results: Forty-eight participants were recruited over 4 months with a recruitment rate of 25% (48/195); 52% (25/48) met the inclusion criteria and 100% (25/25) were randomised into the intervention ( n = 12) and WL control groups ( n = 13). Participants were 25 older adults (mean (SD) 68.5(8.05) years), 14 (56%) female, and 18 (72%) white. At 12 weeks, 10/12 (83.3%) intervention and 10/13 (76.9%) control participants completed the final assessments. The average attendance rate was 58.3% for the intervention group (range 33.0%-75.0%) and 42.3% (range 23.1%-69.2%) among controls. The a priori recruitment and retention criteria for progression were not met. No serious adverse events occurred. The focus group results identified three themes which showed overall positive experiences of participation in PAIL in terms of (1) study design and intervention; (2) walking sessions; and (3) health education workshops., Conclusions: The findings suggest that community-dwelling older adults at risk of loneliness found the intervention and measures acceptable and could safely participate. However, a more extensive and robust strategy would be needed to support adequate recruitment of lonely older adults and adherence into a definitive RCT., Trial Registration: Clinicaltrials.gov, NCT03458793., Competing Interests: Competing interestsThe authors of this article declare that they have no competing interests., (© The Author(s) 2020.)
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- 2020
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29. Superior Aerobic Capacity and Indices of Skeletal Muscle Morphology in Chronically Trained Master Endurance Athletes Compared With Untrained Older Adults.
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McKendry J, Joanisse S, Baig S, Liu B, Parise G, Greig CA, and Breen L
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- Adipose Tissue physiology, Adolescent, Adult, Aged, Aged, 80 and over, Body Composition, Cross-Sectional Studies, Hand Strength, Humans, Male, Middle Aged, Muscle Strength physiology, Young Adult, Athletes, Exercise physiology, Muscle, Skeletal anatomy & histology, Physical Endurance physiology
- Abstract
The study aim was to comprehensively assess physiological function and muscle morphology in chronically trained older individuals against untrained young and older individuals. In a cross-sectional design, 15 young untrained controls (YC) (20 ± 2.7 years, 78.9 ± 13.3 kg), 12 untrained older controls (OC) (69.8 ± 4.1 years, 77.5 ± 14.2 kg), and 14 endurance-trained master athletes (MA) (67.1 ± 4.1 years, 68.7 ± 6.5 kg) underwent assessments of body composition, aerobic capacity, strength, muscle architecture, and fiber-type morphology. Skeletal muscle index was lower and body fat greater in OC versus MA. Estimated VO2max (mL·kg-1·minute-1) was similar between MA and YC, but lower in OC. Isometric leg strength normalized to fat-free mass was similar between groups, whereas normalized isometric arm strength was greater in YC than MA. Myosin heavy chain (MHC) I fiber area was greater in MA than OC, while MHC II fiber area was greater in YC than OC. MHC II fiber myonuclear domain size was greater in YC than OC and MA, whereas MA had greater MHC I and MHC II fiber capillarization than OC and YC. Satellite cell content was similar between groups. Chronic endurance training enhances indices of muscle morphology and improves body composition and aerobic capacity in older age, with potentially important implications for healthspan extension., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2020
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30. Influence of combined vitamin D 3 supplementation and resistance exercise training on musculoskeletal health in older men and women (EXVITD): protocol for a randomised controlled trial.
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Welford AE, Lanham-New S, Lord J, Doyle A, Robinson J, Nightingale P, Gittoes N, and Greig CA
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- Aged, Female, Humans, Male, Muscle Strength, Quality of Life, Randomized Controlled Trials as Topic, Cholecalciferol administration & dosage, Dietary Supplements, Musculoskeletal System, Resistance Training
- Abstract
Introduction: Sarcopenia is a progressive loss in muscle mass, strength and function, the adverse consequences of which are severe, affecting quality of life and placing an increasing burden on social and healthcare systems. Vitamin D status is known to be associated with markers of sarcopenia, namely muscle mass, strength and function. Also, resistance exercise training (RET) is currently the only proven intervention to treat sarcopenia. However, very little data exist on the influence of combining the two interventions of vitamin D supplementation and resistance exercise training, although a recent systematic review provides tentative support for the current study's hypothesis that the combined intervention may further improve musculoskeletal function above exercise training alone. The aim of the present study is to determine whether vitamin D
3 supplementation is any more effective in improving musculoskeletal function when combined with RET compared with exercise training alone in older adults., Methods and Analysis: This double-blinded randomised placebo-controlled trial will recruit a target of 127 eligible men and women aged ≥65 years living independently or in sheltered housing within the Birmingham area to two groups: (1) 6 months RET and placebo or (2) 6 months RET and 800 IU/d vitamin D3 . Measures of muscle power (Nottingham Power Rig), body composition (dual energy X-ray absorptiometry), muscle function (short physical performance battery, timed up and go), falls and fractures as events will be assessed. Assessments will take place at baseline and postintervention, with intermittent monitoring of bone turnover, calcium and vitamin D. The primary outcome will be lower limb extensor power output. Analyses of within-group changes and between-group differences in outcome measures are planned., Ethics and Dissemination: The EXVITD study has ethical approval granted by the Black Country National Health Service Research Ethics Committee (14/WM/1220). Results of this trial will be submitted for publication in peer-reviewed journals and presented at conferences. The study is being conducted according to the principles of the Declaration of Helsinki. Trial registration number NCT02467153; Post-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2020
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31. Amount, Source and Pattern of Dietary Protein Intake Across the Adult Lifespan: A Cross-Sectional Study.
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Smeuninx B, Greig CA, and Breen L
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Objectives: Sub-optimal dietary protein consumption may partially underlie the age-related loss of muscle mass and function (sarcopenia). Specifically, dose, timing, source and distribution of dietary protein across the day might influence muscle anabolism in individuals from across the lifespan. Design: The present study aimed to assess daily and meal-specific protein intake, protein source and protein intake pattern in 40 young (23.8 ± 4.3 years), 40 middle-aged (51.6 ± 4.1 years), and 40 old (77.4 ± 7.4 years) individuals using 3-day weighed food diaries. Results: Old individuals consumed on average 83.4 ± 24.6 g of daily protein, which was significantly lower compared with young but not middle-aged individuals who consumed, respectively, 105.1 ± 43.0 g and 97.0 ± 31.1 g of daily protein ( P = 0.013). No significant difference in daily protein intake was found with middle-aged individuals. Dietary protein intake pattern was uneven across meals for all groups ( P < 0.001 for all). Sources of protein consumption were similar between groups except at lunch where old individuals ingested lower quality proteins compared with middle aged and young individuals. Conclusion: Although total daily protein intake was sufficient in the majority of participants, per-meal protein intake and protein distribution contend the current knowledge regarding optimal protein intakes. Increasing protein intake, especially at breakfast and lunch, could mitigate age-related muscle loss., (Copyright © 2020 Smeuninx, Greig and Breen.)
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- 2020
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32. Magnetic resonance elastography (MRE) shows significant reduction of thigh muscle stiffness in healthy older adults.
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Kennedy P, Barnhill E, Gray C, Brown C, van Beek EJR, Roberts N, and Greig CA
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- Aged, Humans, Magnetic Resonance Imaging, Male, Muscle, Skeletal diagnostic imaging, Quadriceps Muscle diagnostic imaging, Elasticity Imaging Techniques, Thigh diagnostic imaging
- Abstract
Determining the effect of ageing on thigh muscle stiffness using magnetic resonance elastography (MRE) and investigate whether fat fraction and muscle cross-sectional area (CSA) are related to stiffness. Six healthy older adults in their eighth and ninth decade and eight healthy young men were recruited and underwent a 3 T MRI protocol including MRE and Dixon fat fraction imaging. Muscle stiffness, fat fraction and muscle CSA were calculated in ROIs corresponding to the four quadriceps muscles (i.e. vastus lateralis (VL), vastus medialis (VM), vastus intermedius (VI), rectus femoris (RF)), combined quadriceps, combined hamstrings and adductors and whole thigh. Muscle stiffness was significantly reduced (p < 0.05) in the older group in all measured ROIs except the VI (p = 0.573) and RF (p = 0.081). Similarly, mean fat fraction was significantly increased (p < 0.05) in the older group over all ROIs with the exception of the VI (p = 0.059) and VL muscle groups (p = 0.142). Muscle CSA was significantly reduced in older participants in the VM (p = 0.003) and the combined quadriceps (p = 0.001), hamstrings and adductors (p = 0.008) and whole thigh (p = 0.003). Over the whole thigh, stiffness was significantly negatively correlated with fat fraction (r = - 0.560, p = 0.037) and positively correlated with CSA (r = 0.749, p = 0.002). Stepwise regression analysis revealed that age was the most significant predictor of muscle stiffness (p = 0.001). These results suggest that muscle stiffness is significantly decreased in healthy older adults. Muscle fat fraction and muscle CSA are also significantly changed in older adults; however, age is the most significant predictor of muscle stiffness.
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- 2020
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33. Assessing the feasibility and impact of specially adapted exercise interventions, aimed at improving the multi-dimensional health and functional capacity of frail geriatric hospital inpatients: protocol for a feasibility study.
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Doody P, Lord JM, Greig CA, and Whittaker AC
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- Aged, Feasibility Studies, Health Status, Hospitalization, Humans, Physical Functional Performance, Exercise Therapy methods, Frailty therapy, Resistance Training methods
- Abstract
Background: Frailty is a common and clinically significant condition in older adults, predominantly due to its association with adverse health outcomes such as hospitalisation, disability and mortality. Exercise interventions have been shown to be a beneficial treatment for frailty. However, more high-quality studies are needed to assess the feasibility and impact of these interventions in frail geriatric populations within different settings, and their impact on broader aspects of health and well-being., Methods and Analysis: This study will use a 2-week, interventional, independent measures research design in order to assess the feasibility and impact of two specially adapted exercise training interventions (a specially adapted resistance training intervention, and Move It Or Lose It: an established community-based exercise intervention for older adults) aimed at improving the multidimensional health and functional capacity of frail geriatric hospital inpatients., Ethics and Dissemination: This study has received a favourable ethical opinion by the Coventry and Warwickshire NHS Research Ethics Committee and sponsorship by the University of Birmingham after review by the sponsors research governance office. The findings will be disseminated through publication in open access scientific journals, public engagement events, online via social media, conference presentations and directly to study participants on request., Trial Registration Number: NCT03141866., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)
- Published
- 2019
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34. Frailty Levels In Geriatric Hospital paTients (FLIGHT)-the prevalence of frailty among geriatric populations within hospital ward settings: a systematic review protocol.
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Doody P, Aunger J, Asamane E, Greig CA, Lord J, and Whittaker A
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- Aged, Aged, 80 and over, Geriatric Assessment, Hospitalization statistics & numerical data, Humans, Prevalence, Systematic Reviews as Topic, Frailty epidemiology, Inpatients statistics & numerical data
- Abstract
Introduction: Frailty is a common and clinically significant condition in geriatric populations, associated with adverse health outcomes such as hospitalisation, disability and mortality. Although there are systematic reviews/meta-analyses assessing the prevalence of frailty in community-dwelling older adults, nursing home residents, and cancer and general surgery patients, there are none assessing the overall prevalence of frailty in geriatric hospital inpatients., Methods and Analysis: This review will systematically search and analyse the prevalence of frailty within geriatric hospital inpatients within the literature. A search will be employed on the platforms of Ovid, Web of Science and databases of Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, SCOPUS and the Cochrane Library. Any observational or experimental study design which utilises a validated operational definition of frailty, reports the prevalence of frailty, has a minimum age ≥65 years, attempts to assess the whole ward/clinical population and occurs in hospital inpatients, will be included. Title and abstract and full-text screenings will be conducted by three reviewers. Methodological quality of eligible studies will be assessed using the Joanna Briggs Institute critical appraisal tool. Data extraction will be performed by two reviewers. If sufficient data are available, a meta-analysis synthesising pooled estimates of the prevalence of frailty and pre-frailty, as well as the prevalence of frailty stratified by age, sex, operational frailty definition, prevalent morbidities, ward type and location, among older hospitalised inpatients will be conducted. Clinical heterogeneity will be assessed by two reviewers. Statistical heterogeneity will be assessed through a Cochran Q test, and an I
2 test performed to assess its magnitude., Ethics and Dissemination: Ethical approval was not required as primary data will not be collected. Findings will be disseminated through publication in peer reviewed open access scientific journals, public engagement events, conference presentations and social media., Prospero Registration Number: 79202., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.)- Published
- 2019
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35. Perceptions and Factors Influencing Eating Behaviours and Physical Function in Community-Dwelling Ethnically Diverse Older Adults: A Longitudinal Qualitative Study.
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Asamane EA, Greig CA, Aunger JA, and Thompson JL
- Subjects
- Age Factors, Aged, Aged, 80 and over, Cultural Characteristics, England, Female, Humans, Interviews as Topic, Longitudinal Studies, Male, Middle Aged, Qualitative Research, Sex Factors, Social Behavior, Social Networking, Diet, Healthy ethnology, Exercise, Feeding Behavior ethnology, Health Knowledge, Attitudes, Practice ethnology, Independent Living, Minority Health ethnology
- Abstract
Ethnic minorities have a high prevalence of non-communicable diseases relating to unhealthy lifestyle practices. Several factors have been identified as influencing unhealthy lifestyle practices among this population; however, there is little evidence about how these factors differ among a heterogeneous sample living in a super-diverse city. This study aimed to: (1) identify and compare factors influencing eating behaviours and physical function among ethnic older minorities living in Birmingham, United Kingdom; and (2) understand how these factors and their association with healthy eating and physical function changed over 8-months. An in-depth interviewing approach was used at baseline ( n = 92) and after 8-months ( n = 81). Interviews were transcribed verbatim and analysed using directed content analysis. Healthy eating was viewed as more important than, and unrelated to, physical function. Personal, social and cultural/environmental factors were identified as the main factors influencing eating behaviours and physical function, which differed by ethnicity, age, and sex. At 8-month interviews, more men than women reported adverse changes. The study provides unique and useful insights regarding perceived eating behaviours and physical function in a relatively large and diverse sample of older adults that can be used to design new, and adapt existing, culturally-tailored community interventions to support healthy ageing.
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- 2019
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36. A novel behavioural INTErvention to REduce Sitting Time in older adults undergoing orthopaedic surgery (INTEREST): protocol for a randomised controlled feasibility study.
- Author
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Aunger JA, Greaves CJ, Davis ET, and Greig CA
- Abstract
Background: Osteoarthritis is a highly prevalent condition in older adults, that causes many sufferers to require a hip or knee replacement in order to improve their quality of life and reduce pain. Individuals waiting for hip or knee replacements are often highly sedentary; thus, it is pertinent to assess whether reducing their sedentariness prior to surgery may aid in improving post-operative outcomes., Methods/design: The study will be a randomised controlled feasibility trial design, with 2:1 randomisation into an intervention and usual care group respectively. A target of 45 patients aged 60 years or older waiting for elective hip and knee replacements will be recruited from Russells Hall Hospital, Dudley, UK, approximately 8-10 weeks before surgery. The intervention, informed by Self-Determination Theory (SDT), will be composed of multiple behaviour change techniques, namely, motivational interviewing, feedback on current objectively measured sedentary behaviour and activity, goal-setting, environmental modification, self-monitoring, and social support. Assessments will occur at baseline, 1 week pre-surgery, and 6 weeks post-surgery. The primary outcome will be the feasibility of intervention delivery and of the trial procedures, assessed quantitatively based on rates of recruitment, retention, measures-completion, and intervention fidelity assessment, and with mixed-methods assessment of acceptability, practicality, adaption, satisfaction, and safety. Exploratory outcomes will include physical function, cardiometabolic biomarkers, measurement of SDT constructs, and both objective and subjective measurement of physical activity and sedentariness. The study will last up to 18 weeks per participant. No formal between-group comparisons are planned, but the variance in within-group changes and differences between groups in outcome measures will be explored and reported with 95% confidence intervals., Discussion: This is the first study assessing the feasibility of an intervention to reduce sedentary behaviour in older adults with mobility limitations, and the first to assess whether such a reduction could work in a prehabilitative context prior to surgery. The results of this study will help inform the design of a definitive randomised controlled trial., Trial Registration: This trial is registered on Clinicaltrials.gov. Registration number: NCT03740412. Date of registration: 13/11/2018., Competing Interests: Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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- 2019
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37. A pilot observational study measuring acute sarcopenia in older colorectal surgery patients.
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Welch C, Greig CA, Hassan-Smith ZK, Pinkney TD, Lord JM, and Jackson TA
- Subjects
- Acute Disease, Aged, Biomarkers, Feasibility Studies, Female, Follow-Up Studies, Geriatric Assessment, Humans, Male, Pilot Projects, Colorectal Surgery adverse effects, Postoperative Complications blood, Postoperative Complications diagnostic imaging, Postoperative Complications etiology, Postoperative Complications physiopathology, Sarcopenia blood, Sarcopenia diagnostic imaging, Sarcopenia etiology, Sarcopenia physiopathology, Walking Speed physiology
- Abstract
Objective: To explore variability in acute changes in muscle mass and function in older patients undergoing elective colorectal surgery, as well as feasibility of measures, in order to refine study processes to inform the protocol for a larger study., Results: Results are presented for seven participants recruited to this pilot study. It is possible to perform serial measurements of bilateral anterior thigh thickness (BATT) and handgrip strength prior to, within 24 h of surgery, and 1 week postoperatively. Gait speed can be reliably measured preoperatively and at 1 week postoperatively. In this pilot study, BATT and gait speed declined at 1 week postoperatively (median BATT 4.17 cm, 3.47 cm, p = 0.028; median gait speed 0.89 m/s, 0.83 m/s, p = 0.043). Baseline hsCRP correlated with change in BATT (τb = 0.73, p = 0.04) and baseline DHEA-S correlated with change in gait speed (τb = 0.87, p = 0.02). This pilot study has assisted to refine the protocol for our larger study, which will further characterise these changes.
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- 2019
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38. Physical Activity Intervention for Loneliness (PAIL) in community-dwelling older adults: protocol for a feasibility study.
- Author
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Shvedko AV, Thompson JL, Greig CA, and Whittaker AC
- Abstract
Background: Low-quality social relationships in older adults are strongly associated with feelings of loneliness. Physical activity interventions could reduce loneliness and improve psychological well-being, among other health benefits. The aim of this study is to examine the feasibility of a Physical Activity Intervention for Loneliness (PAIL) in community-dwelling older adults at risk for loneliness., Methods/design: This feasibility study is a two-arm randomised controlled trial (RCT) with a wait-list control group using a mixed-methods research design. The primary aim of the feasibility study is to estimate recruitment, retention and adherence rates; the appropriateness of the intervention design and its practicality; the acceptability of the intervention by participants; and the set of instruments and measures and primary outcome measures to inform a future large-scale randomised trial. After eligibility screening, randomisation will be conducted using computer-based random sequence generation. Baseline and post-intervention assessments for intervention and control groups will include height, weight, body mass index, resting blood pressure, physical activity using accelerometry, loneliness, social support, social networks, anxiety and depression, self-efficacy for exercise, satisfaction with social contacts, and expected outcomes and barriers for exercise using questionnaires. Focus groups will be conducted at the mid-point and post-intervention period using a phenomenological approach to analyse the participants' experiences of taking part in PAIL., Discussion: This trial will provide important information regarding the feasibility of PAIL in community-dwelling older adults at risk for loneliness using a mixed-methods approach combining quantitative and qualitative research methods., Trial Registration: Clinicaltrials.gov NCT03458793., Competing Interests: AW is a Professor in Behavioural Medicine. JT is a Professor of Public Health Nutrition and Exercise. CG is a Reader in Musculoskeletal Ageing and Health, all at the School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, UK.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
- Published
- 2018
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39. Effect of a combined programme of dietary restriction and physical activity on the physical function and body composition of obese middle-aged and older adults with knee OA (DRPA): protocol for a feasibility study.
- Author
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Alrushud AS, Rushton AB, Bhogal G, Pressdee F, and Greig CA
- Subjects
- Aged, Aged, 80 and over, Clinical Trials as Topic, Combined Modality Therapy, England, Feasibility Studies, Female, Humans, Male, Middle Aged, Patient Education as Topic, Physical Therapy Modalities, Body Composition, Diet, Reducing, Exercise, Osteoarthritis, Knee rehabilitation
- Abstract
Introduction: Knee osteoarthritis (OA) is the most common chronic illness among older adults. Up to the submission date of this protocol, there are no published UK studies reporting the efficacy of a combined intervention programme of physical activity and dietary restriction on the musculoskeletal function of obese older adults with knee OA in spite of the clinical recommendation for exercise and diet for people with knee OA. The aim of this study is to assess the feasibility and acceptability of a combined dietary restriction and physical activity intervention programme and collect preliminary data., Method and Analysis: This single-arm intervention study is scheduled to begin in September 2017 and conclude in November 2018. It will take place at the Royal Orthopaedic Hospital (ROH), Birmingham and the School of Sport, Exercise and Rehabilitation Sciences (SportExR), University of Birmingham. Participants will receive a physiotherapy usual care programme for knee OA for 1 month, after which they will continue to exercise in their local gym/leisure facility for 3 months. Participants will also follow dietary restriction throughout the 4-month intervention. Mixed analysis techniques will be used to analyse the quantitative and qualitative outcome measures., Ethics and Dissemination: It is approved by ROH R&D Foundation Trust and the Health Research Authority. The Consort Guidelines and checklist will be reviewed prior to generating any publications for the trial to ensure they meet the standards required for submission to high-quality peer-reviewed journals., Trial Registration Number: ISRCTN12906938., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2018
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40. Interventions targeting sedentary behavior in non-working older adults: a systematic review.
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Aunger JA, Doody P, and Greig CA
- Subjects
- Aged, Clinical Studies as Topic, Exercise, Humans, Retirement, Sedentary Behavior
- Abstract
Sedentary behavior has been found to be associated with negative health outcomes independently of physical activity in older adults. This systematic review collates interventions to reduce sedentary behavior in non-working older adults, assessing whether they are effective, feasible, and safe. A systematic search identified 2560 studies across five databases. Studies were included where participants were ≥60 years on average with none younger than 45, and participants did not work >2 days per week. A total of six studies were identified, three of which included control groups, while the other three were repeated-measures pre-post designs. Only one study randomised participants. The overall level of quality of included studies was poor. A narrative synthesis was conducted, as the level of heterogeneity in outcomes and outcome reporting were too high for a meta-analysis to be performed. The narrative synthesis suggested that interventions have the potential to reduce sitting time in non-working older adults. Included studies reported feasible and safe implementations of their interventions in most samples, except for one subsample from a study of people in sheltered housing. Objectively measured reductions in sitting time were between 3.2% and 5.3% of waking time, or up to 53.9 min per day. Future studies should employ more rigorous designs to assess the effects of reducing sedentary behavior on health and physical function, and should include follow-ups to measure the duration of behavior change., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)
- Published
- 2018
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41. Muscle morphology and performance in master athletes: A systematic review and meta-analyses.
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Mckendry J, Breen L, Shad BJ, and Greig CA
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- Aged, Aged, 80 and over, Exercise physiology, Exercise Test methods, Female, Humans, Male, Middle Aged, Muscle Fibers, Skeletal metabolism, Aging metabolism, Athletes, Muscle Strength physiology, Physical Endurance physiology, Physical Functional Performance
- Abstract
Introduction: The extent to which chronic exercise training preserves age-related decrements in physical function, muscle strength, mass and morphology is unclear. Our aim was to conduct a systematic review of the literature to determine to what extent chronically trained master athletes (strength/power and endurance) preserve levels of physical function, muscle strength, muscle mass and morphology in older age, compared with older and younger controls and young trained individuals., Methods: The systematic data search included Medline, EMBASE, SPORTDiscus, CINAHL and Web of Science databases., Inclusion Criteria: i) master athletes mean exercise training duration ≥20 years ii) master athletes mean age of cohort >59 years) iii) at least one measurement of muscle mass/volume/fibre-type morphology and/or strength/physical function., Results: Fifty-five eligible studies were identified. Meta-analyses were carried out on maximal aerobic capacity, maximal voluntary contraction and body composition. Master endurance athletes (42.0 ± 6.6 ml kg
-1 min- 1) exhibited VO2max values comparable with young healthy controls (43.1 ± 6.8 ml kg-1 min-1 , P = .84), greater than older controls (27.1 ± 4.3 ml kg-1 min-1 , P < 0.01) and master strength/power athletes (26.5 ± 2.3 mlkg-1 min-1 , P < 0.01), and lower than young endurance trained individuals (60.0 ± 5.4 ml kg-1 min-1 , P < 0.01). Master strength/power athletes (0.60 (0.28-0.93) P < 0.01) and young controls (0.71 (0.06-1.36) P < 0.05) were significantly stronger compared with the other groups. Body fat% was greater in master endurance athletes than young endurance trained (-4.44% (-8.44 to -0.43) P < 0.05) but lower compared with older controls (7.11% (5.70-8.52) P < 0.01)., Conclusion: Despite advancing age, this review suggests that chronic exercise training preserves physical function, muscular strength and body fat levels similar to that of young, healthy individuals in an exercise mode-specific manner., (Copyright © 2018 Elsevier B.V. All rights reserved.)- Published
- 2018
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42. Characteristics of a protocol to collect objective physical activity/sedentary behaviour data in a large study: Seniors USP (understanding sedentary patterns).
- Author
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Dall PM, Skelton DA, Dontje ML, Coulter EH, Stewart S, Cox SR, Shaw RJ, Čukić I, Fitzsimons CF, Greig CA, Granat MH, Der G, Deary IJ, and Chastin S
- Abstract
The Seniors USP study measured sedentary behaviour (activPAL3, 9 day wear) in older adults. The measurement protocol had three key characteristics: enabling 24-hour wear (monitor location, waterproofing); minimising data loss (reducing monitor failure, staff training, communication); and quality assurance (removal by researcher, confidence about wear). Two monitors were not returned; 91% (n=700) of returned monitors had 7 valid days of data. Sources of data loss included monitor failure (n=11), exclusion after quality assurance (n=5), early removal for skin irritation (n=8) or procedural errors (n=10). Objective measurement of physical activity and sedentary behaviour in large studies requires decisional trade-offs between data quantity (collecting representative data) and utility (derived outcomes that reflect actual behaviour).
- Published
- 2018
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43. Systematic comparative validation of self-report measures of sedentary time against an objective measure of postural sitting (activPAL).
- Author
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Chastin SFM, Dontje ML, Skelton DA, Čukić I, Shaw RJ, Gill JMR, Greig CA, Gale CR, Deary IJ, Der G, and Dall PM
- Subjects
- Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Male, Mental Recall, Middle Aged, Population Surveillance, Posture, Reproducibility of Results, Surveys and Questionnaires, Television, Time, Exercise, Sedentary Behavior, Self Report standards
- Abstract
Background: Sedentary behaviour is a public health concern that requires surveillance and epidemiological research. For such large scale studies, self-report tools are a pragmatic measurement solution. A large number of self-report tools are currently in use, but few have been validated against an objective measure of sedentary time and there is no comparative information between tools to guide choice or to enable comparison between studies. The aim of this study was to provide a systematic comparison, generalisable to all tools, of the validity of self-report measures of sedentary time against a gold standard sedentary time objective monitor., Methods: Cross sectional data from three cohorts (N = 700) were used in this validation study. Eighteen self-report measures of sedentary time, based on the TAxonomy of Self-report SB Tools (TASST) framework, were compared against an objective measure of postural sitting (activPAL) to provide information, generalizable to all existing tools, on agreement and precision using Bland-Altman statistics, on criterion validity using Pearson correlation, and on data loss., Results: All self-report measures showed poor accuracy compared with the objective measure of sedentary time, with very wide limits of agreement and poor precision (random error > 2.5 h). Most tools under-reported total sedentary time and demonstrated low correlations with objective data. The type of assessment used by the tool, whether direct, proxy, or a composite measure, influenced the measurement characteristics. Proxy measures (TV time) and single item direct measures using a visual analogue scale to assess the proportion of the day spent sitting, showed the best combination of precision and data loss. The recall period (e.g. previous week) had little influence on measurement characteristics., Conclusion: Self-report measures of sedentary time result in large bias, poor precision and low correlation with an objective measure of sedentary time. Choice of tool depends on the research context, design and question. Choice can be guided by this systematic comparative validation and, in the case of population surveillance, it recommends to use a visual analog scale and a 7 day recall period. Comparison between studies and improving population estimates of average sedentary time, is possible with the comparative correction factors provided.
- Published
- 2018
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44. Alterations in the in vitro and in vivo regulation of muscle regeneration in healthy ageing and the influence of sarcopenia.
- Author
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Brzeszczyńska J, Meyer A, McGregor R, Schilb A, Degen S, Tadini V, Johns N, Langen R, Schols A, Glass DJ, Roubenoff R, Ross JA, Fearon KCH, Greig CA, and Jacobi C
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Healthy Aging, Muscle, Skeletal physiopathology, Regeneration physiology, Sarcopenia physiopathology
- Abstract
Background: Sarcopenia is defined as the age-related loss of skeletal muscle mass and function. While all humans lose muscle with age, 2-5% of elderly adults develop functional consequences (disabilities). The aim of this study was to investigate muscle myogenesis in healthy elderly adults, with or without sarcopenia, compared with middle-aged controls using both in vivo and in vitro approaches to explore potential biomarker or causative molecular pathways associated with sarcopenic versus non-sarcopenic skeletal muscle phenotypes during ageing., Methods: Biomarkers of multiple molecular pathways associated with muscle regeneration were analysed using quantitative polymerase chain reaction in quadriceps muscle samples obtained from healthy elderly sarcopenic (HSE, n = 7) or non-sarcopenic (HENS, n = 21) and healthy middle-aged control (HMC, n = 22) groups. An in vitro system of myogenesis (using myoblasts from human donors aged 17-83 years) was used to mimic the environmental challenges of muscle regeneration over time., Results: The muscle biopsies showed evidence of satellite cell activation in HENS (Pax3, P < 0.01, Pax7, P < 0.0001) compared with HMC. Early myogenesis markers Myogenic Differentiation 1 (MyoD1) and Myogenic factor 5 (Myf5) (P < 0.0001) and the late myogenesis marker myogenin (MyoG) (P < 0.01) were increased in HENS. In addition, there was a 30-fold upregulation of TNF-α in HENS compared with HMC (P < 0.0001). The in vitro system demonstrated age-related upregulation of pro-inflammatory cytokines (2-fold upregulation of interleukin (IL)-6, IL-8 mRNA, increased secretion of tumor necrosis factor-α (TNF-α) and IL-6, all P < 0.05) associated with impaired kinetics of myotube differentiation. The HSE biopsy samples showed satellite cell activation (Pax7, P < 0.05) compared with HMC. However, no significant upregulation of the early myogenesis (MyoD and Myf5) markers was evident; only the late myogenesis marker myogenin was upregulated (P < 0.05). Higher activation of the oxidative stress pathway was found in HENS compared with the HSE group. In contrast, there was 10-fold higher upregulation of HSPA1A a stress-induced chaperone acting upon misfolded proteins in HSE compared with the HENS group., Conclusions: Both pathological and adaptive processes are active in skeletal muscle during healthy ageing. Muscle regeneration pathways are activated during healthy ageing, but there is evidence of dysregulation in sarcopenia. In addition, increased cellular stress, with an impaired oxidative-stress and mis-folded protein response (HSPA1A), may be associated with the development of sarcopenia. The in vitro system of young and old myoblasts replicated some of the differences between young and old muscle., (© 2017 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders.)
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- 2018
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45. Comprehensive proteome analysis of human skeletal muscle in cachexia and sarcopenia: a pilot study.
- Author
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Ebhardt HA, Degen S, Tadini V, Schilb A, Johns N, Greig CA, Fearon KCH, Aebersold R, and Jacobi C
- Subjects
- Aged, Aged, 80 and over, Aging metabolism, Aging pathology, Cachexia pathology, Cells, Cultured, Female, Humans, Male, Middle Aged, Muscle Proteins analysis, Muscle, Skeletal pathology, Muscular Atrophy metabolism, Muscular Atrophy pathology, Pilot Projects, Sarcopenia pathology, Cachexia metabolism, Muscle Proteins metabolism, Muscle, Skeletal metabolism, Proteome analysis, Sarcopenia metabolism
- Abstract
Background: Cancer cachexia (cancer-induced muscle wasting) is found in a subgroup of cancer patients leaving the patients with a poor prognosis for survival due to a lower tolerance of the chemotherapeutic drug. The cause of the muscle wasting in these patients is not fully understood, and no predictive biomarker exists to identify these patients early on. Skeletal muscle loss is an inevitable consequence of advancing age. As cancer frequently occurs in old age, identifying and differentiating the molecular mechanisms mediating muscle wasting in cancer cachexia vs. age-related sarcopenia are a challenge. However, the ability to distinguish between them is critical for early intervention, and simple measures of body weight may not be sufficiently sensitive to detect cachexia early., Methods: We used a range of omics approaches: (i) undepleted proteome was quantified using advanced high mass accuracy mass spectrometers in SWATH-MS acquisition mode; (ii) phospho epitopes were quantified using protein arrays; and (iii) morphology was assessed using fluorescent microscopy., Results: We quantified the soluble proteome of muscle biopsies from cancer cachexia patients and compared them with cohorts of cancer patients and healthy individuals with and without age-related muscle loss (aka age-related sarcopenia). Comparing the proteomes of these cohorts, we quantified changes in muscle contractile myosins and energy metabolism allowing for a clear identification of cachexia patients. In an in vitro time lapse experiment, we mimicked cancer cachexia and identified signal transduction pathways governing cell fusion to play a pivotal role in preventing muscle regeneration., Conclusions: The work presented here lays the foundation for further understanding of muscle wasting diseases and holds the promise of overcoming ambiguous weight loss as a measure for defining cachexia to be replaced by a precise protein signature., (© 2017 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders.)
- Published
- 2017
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46. The effect of combined resistance exercise training and vitamin D 3 supplementation on musculoskeletal health and function in older adults: a systematic review and meta-analysis.
- Author
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Antoniak AE and Greig CA
- Subjects
- Aged, Body Composition, Humans, Muscle Strength, Quality of Life, Randomized Controlled Trials as Topic, Vitamin D blood, Cholecalciferol therapeutic use, Dietary Supplements, Resistance Training, Sarcopenia rehabilitation, Vitamins therapeutic use
- Abstract
Objectives: In older adults, there is a blunted responsiveness to resistance training and reduced muscle hypertrophy compared with younger adults. There is evidence that both exercise training and vitamin D supplementation may benefit musculoskeletal health in older adults, and it is plausible that in combination their effects may be additive. The aim of this systematic review was to evaluate the effectiveness of combined resistance exercise training and vitamin D
3 supplementation on musculoskeletal health in older adults., Data Sources: A comprehensive search of electronic databases, including Science Direct, Medline, PubMed, Google Scholar and Cochrane Central Register of Controlled Trials (Cochrane CENTRAL accessed by Wiley Science) was conducted. Eligible studies were randomised controlled trials including men and women (aged ≥65 years or mean age ≥65 years); enlisting resistance exercise training and vitamin D3 supplementation; including outcomes of muscle strength, function, muscle power, body composition, serum vitamin D/calcium status or quality of life comparing results with a control group. The review was informed by a preregistered protocol (http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015020157)., Results: Seven studies including a total of 792 participants were identified. Studies were categorised into two groups; group 1 compared vitamin D3 supplementation and exercise training versus exercise alone (describing the additive effect of vitamin D3 supplementation when combined with resistance exercise training) and group 2 compared vitamin D3 supplementation and exercise training versus vitamin D3 supplementation alone (describing the additive effect of resistance exercise training when combined with vitamin D3 supplementation).Meta-analyses for group 1 found muscle strength of the lower limb to be significantly improved within the intervention group (0.98, 95% CI 0.73 to 1.24, p<0.001); all other outcomes showed small but non-significant positive effects for the intervention group. The short physical performance battery (SPPB), timed up and go (TUG), muscle strength of the lower limb and femoral neck bone mineral density showed significantly greater improvements in the intervention group for group 2 comparisons., Conclusions: This review provides tentative support for the additive effect of resistance exercise and vitamin D3 supplementation for the improvement of muscle strength in older adults. For other functional variables, such as SPPB and TUG, no additional benefit beyond exercise was shown. Further evidence is required to draw firm conclusions or make explicit recommendations regarding combined exercise and vitamin D3 supplementation., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)- Published
- 2017
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47. Effectiveness of nutritional and exercise interventions to improve body composition and muscle strength or function in sarcopenic obese older adults: A systematic review.
- Author
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Theodorakopoulos C, Jones J, Bannerman E, and Greig CA
- Subjects
- Aged, Humans, Randomized Controlled Trials as Topic, Body Composition, Exercise Therapy, Muscle Strength, Obesity therapy, Sarcopenia therapy
- Abstract
Although sarcopenic obesity (SO) poses a major public health concern, a robust approach for the optimization of body composition and strength/function in SO has not yet been established. The purpose of this systematic review was to assess the effectiveness of nutritional (focusing on energy and protein modulation) and exercise interventions, either individually or combined, on body composition and strength/function in older adults with SO. MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL and SPORTDiscus were searched. Main inclusion criteria comprised sarcopenia as defined by the European Working Group on Sarcopenia in Older People (EWGSOP) and obesity defined as % body fat ≥40% (women) and ≥28% (men). Randomized controlled trials (RCTs), randomized controlled crossover trials and controlled clinical trials with older adults (mean age ≥65 years) following a nutritional regimen and/or an exercise training program were considered. Out of 109 full text articles identified, only two RCTs (61 participants) met the inclusion criteria. One study was a nutritional intervention adding 15 g protein·day
-1 (via cheese consumption) to the participants' habitual diet. The second study was a high-speed circuit resistance training intervention. Body composition did not change significantly in either of the studies. However, the exercise intervention improved significantly muscle strength and physical function. Although this review was limited by the small number of eligible studies, it provides evidence for the potential benefits of exercise and highlights the necessity for future research to develop effective interventions including dietary and exercise regimens to combat sarcopenic obesity., (Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.)- Published
- 2017
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48. Effect of physical activity and dietary restriction interventions on weight loss and the musculoskeletal function of overweight and obese older adults with knee osteoarthritis: a systematic review and mixed method data synthesis.
- Author
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Alrushud AS, Rushton AB, Kanavaki AM, and Greig CA
- Subjects
- Aged, Arthralgia, Body Mass Index, Body Weight, Female, Humans, Male, Middle Aged, Muscle Strength physiology, Obesity complications, Osteoarthritis, Knee etiology, Quality of Life, Range of Motion, Articular physiology, Diet, Reducing, Exercise physiology, Osteoarthritis, Knee physiopathology, Overweight complications, Weight Loss physiology
- Abstract
Background: Despite the clinical recommendation of exercise and diet for people with knee osteoarthritis (OA), there are no systematic reviews synthesising the effectiveness of combining physical activity and dietary restriction interventions on the musculoskeletal function of overweight and obese older adults with knee OA., Objective: To evaluate the effectiveness of combined physical activity and dietary restriction programmes on body weight, body mass index (BMI) and the musculoskeletal function of overweight and obese older adults with knee OA., Information Sources: A detailed search strategy was applied to key electronic databases (Ovid, Embase, Web of Science andCumulative Index to Nursing and Allied Health Literature (CINAHL)) for randomised controlled trials (RCTs) published in English prior to 15 January 2017., Participants: Participants with BMI ≥25 kg/m
2 , aged ≥55 years of age and with radiographic evidence of knee OA., Interventions: Physical activity plus dietary restriction programmes with usual care or exercise as the comparators., Outcome Measures: Primary outcome measures were body weight, BMI or musculoskeletal function. Secondary outcome measures were pain and quality of life., Results: One pilot and two definitive trials with n=794 participants were included. Two articles reporting additional data and outcome measures for one of the RCTs were identified. All included RCTs had an unclear risk of bias. Meta-analysis was only possible to evaluate mobility (6 min walk test) at 6 months and the pooled random effect 15.05 (95% CI -11.77 to 41.87) across two trials with n=155 participants did not support the combined intervention programme. Narrative synthesis showed clear differences in favour of a reduced body weight and an increased 6 min walk in the intervention group compared with control groups., Conclusion: The quality of evidence of benefit of combining exercise and dietary interventions in older overweight/obese adults with knee OA is unclear., Trail Registration Number: CRD42015019088 and ISRCTN, ISRCTN12906938., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)- Published
- 2017
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49. Dietary Protein in Older Adults: Adequate Daily Intake but Potential for Improved Distribution.
- Author
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Cardon-Thomas DK, Riviere T, Tieges Z, and Greig CA
- Subjects
- Aged, Exercise, Female, Humans, Male, Meals, Sarcopenia diet therapy, Sedentary Behavior, Dietary Proteins administration & dosage, Recommended Dietary Allowances
- Abstract
Daily distribution of dietary protein may be important in protecting against sarcopenia, specifically in terms of per meal amounts relative to a proposed threshold for maximal response. The aims of this study were to determine total and per meal protein intake in older adults, as well as identifying associations with physical activity and sedentary behavior. Three-day food diaries recorded protein intake in 38 participants. Protein distribution, coefficient of variation (CV), and per meal amounts were calculated. Accelerometry was used to collect physical activity data as well as volume and patterns of sedentary time. Average intake was 1.14 g·kg
-1 ·day-1 . Distribution was uneven (CV = 0.67), and 79% of participants reported <0.4 g·kg-1 protein content in at least 2/3 daily meals. Protein intake was significantly correlated with step count ( r = 0.439, p = 0.007) and negatively correlated with sedentary time ( r = -0.456, p = 0.005) and Gini index G, which describes the pattern of accumulation of sedentary time ( r = -0.421, p = 0.011). Total daily protein intake was sufficient; however, distribution did not align with the current literature; increasing protein intake may help to facilitate optimization of distribution. Associations between protein and other risk factors for sarcopenia may also inform protective strategies.- Published
- 2017
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50. Sex differences in the effect of fish-oil supplementation on the adaptive response to resistance exercise training in older people: a randomized controlled trial.
- Author
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Da Boit M, Sibson R, Sivasubramaniam S, Meakin JR, Greig CA, Aspden RM, Thies F, Jeromson S, Hamilton DL, Speakman JR, Hambly C, Mangoni AA, Preston T, and Gray SR
- Subjects
- Adipose Tissue, Aged, Body Composition drug effects, Body Mass Index, Dietary Fats blood, Exercise physiology, Fatty Acids, Omega-3 blood, Fatty Acids, Omega-3 pharmacology, Female, Fish Oils blood, Humans, Lower Extremity, Male, Movement, Muscle, Skeletal metabolism, Muscle, Skeletal physiology, Sex Factors, Torque, Triglycerides blood, Adaptation, Physiological drug effects, Dietary Fats pharmacology, Dietary Supplements, Fish Oils pharmacology, Muscle Strength drug effects, Muscle, Skeletal drug effects, Resistance Training
- Abstract
Background: Resistance exercise increases muscle mass and function in older adults, but responses are attenuated compared with younger people. Data suggest that long-chain n-3 polyunsaturated fatty acids (PUFAs) may enhance adaptations to resistance exercise in older women. To our knowledge, this possibility has not been investigated in men., Objective: We sought to determine the effects of long-chain n-3 PUFA supplementation on resistance exercise training-induced increases in muscle mass and function and whether these effects differ between older men and women., Design: Fifty men and women [men: n = 27, mean ± SD age: 70.6 ± 4.5 y, mean ± SD body mass index (BMI; in kg/m
2 ): 25.6 ± 4.2; women: n = 23, mean ± SD age: 70.7 ± 3.3 y, mean ± SD BMI: 25.3 ± 4.7] were randomly assigned to either long-chain n-3 PUFA (n = 23; 3 g fish oil/d) or placebo (n = 27; 3 g safflower oil/d) and participated in lower-limb resistance exercise training twice weekly for 18 wk. Muscle size, strength, and quality (strength per unit muscle area), functional abilities, and circulating metabolic and inflammatory markers were measured before and after the intervention., Results: Maximal isometric torque increased after exercise training to a greater (P < 0.05) extent in the long-chain n-3 PUFA group than in the placebo group in women, with no differences (P > 0.05) between groups in men. In both sexes, the effect of exercise training on maximal isokinetic torque at 30, 90, and 240° s-1 , 4-m walk time, chair-rise time, muscle anatomic cross-sectional area, and muscle fat did not differ (P > 0.05) between groups. There was a greater (P < 0.05) increase in muscle quality in women after exercise training in the long-chain n-3 PUFA group than in the placebo group, with no such differences in men (P > 0.05). Long-chain n-3 PUFAs resulted in a greater decrease (P < 0.05) than the placebo in plasma triglyceride concentrations in both sexes, with no differences (P > 0.05) in glucose, insulin, or inflammatory markers., Conclusion: Long-chain n-3 PUFA supplementation augments increases in muscle function and quality in older women but not in older men after resistance exercise training. This trial was registered at clinicaltrials.gov as NCT02843009.- Published
- 2017
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