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In older adults, arm circumference and arm muscle circumference are common nutritional assessment tools. Bioelectrical impedance analysis devices can automatically measure arm circumference and arm muscle circumference. However, the interchangeability of the measurements made by bioelectrical impedance analysis with the actual manual measurements has not been clarified. This study examined the interchangeability of these two measurements and their relationship with sarcopenia.The interchangeability between bioelectrical impedance analysis and manual arm circumference and arm muscle circumference measurements was calculated using Bland-Altman analysis in 112 older adults certified to require long-term care in the Japanese system. Furthermore, multivariate analysis was used to investigate the association between arm circumference and arm muscle circumference obtained using the bioelectrical impedance analysis method and sarcopenia.The bioelectrical impedance analysis and manual methods were interchangeable, with a percentage error of15% (arm circumference 13.54% and arm muscle circumference 13.54%) for the upper arm anthropometric measurement. In multivariate analysis, decreased arm muscle circumference was significantly associated with sarcopenia risk.Values obtained using the bioelectrical impedance analysis method were interchangeable with the values obtained using manual measurement. This shows that upper arm anthropometric measurement using bioelectrical impedance analysis might be useful as a nutritional assessment tool for older adults requiring long-term care. Geriatr Gerontol Int 2022; 22: 938-942.

[Purpose] This study aimed to investigate the problems associated with osteosarcopenia and its effect on physical performance, nutritional status, and support or care required by older community-dwelling adults. [Participants and Methods] This study investigated 141 older community-dwelling adults requiring support or care using an ambulatory rehabilitation service. The patients were divided into a control, osteopenia only, sarcopenia only, and osteosarcopenia group. We investigated the associations of each condition with the baseline information, grip strength, gait speed, Mini Nutritional Assessment-Short Form score, and support or care level required. [Results] The osteosarcopenia group consisted of 43.3% of the total study participants. Osteosarcopenia was more closely associated with body mass index, support or care level, grip strength, gait speed, skeletal muscle mass index, and Mini Nutritional Assessment-Short Form score than osteopenia or sarcopenia alone. [Conclusion] Osteosarcopenia is highly prevalent in older community-dwelling adults requiring support or care, which may suggest a greater effect on physical performance, nutritional status, and support or care required than that exerted by osteopenia or sarcopenia alone.

AIM The present study investigated the rejuvenation of physical function in terms of walking speed and grip strength. Specifically, it examined the rejuvenation of physical functions in community-dwelling older individuals between 2006 and 2019. The study is novel, because it analyzes this by focusing on gait balance. METHODS Data were collected from 339 participants (52 men, 287 women) in 2006, and 382 participants (83 men, 299 women) in 2019. They were categorized according to age: early-stage and late-stage groups for men, and early-stage, late-stage and latest-stage groups for women. These groups were analyzed by participants' walking speed, grip strength, Timed Up and Go test, Functional Reach test and One-Leg Standing test. The results were compared based on two factors: time (2006 to 2019) and age group. RESULTS The scores for the Timed Up and Go and One-Leg Standing tests were better in 2019 than in 2006 for all age groups in both older men and women. However, improvement in walking speed was observed only in women. Additionally, the decline in physical function with age was slower for walking speed among men, and Functional Reach and One-Leg Standing tests among women. CONCLUSIONS The changes over this 13-year period showed that the physical function of community-dwelling older individuals was rejuvenated in terms of improved standing and walking balance. These rejuvenations will aid in preventing falls among community-dwelling older individuals. Geriatr Gerontol Int 2021; 21: 975-980.

In this prospective longitudinal cohort study, we explored the characteristics of older people with lower respiratory muscle strength, according to sarcopenia severity, over the course of 1 year. The maximum expiratory pressure (MEP), grip strength, walking speed, and skeletal muscle mass index of 58 participants (28 men, 30 women; mean age, 76.9 ± 7.7 years) were measured at baseline and at the 1-year follow-up. Participants were classified into a decreased MEP group (n = 29; MEP decreased by ≥10% after 1 year) and a non-decreased MEP group (n = 29; MEP decreased by

The coronavirus (COVID-19) pandemic significantly affected the physical and mental functions in older adults, resulting in “corona-frailty”. This 2-year prospective study characterized changes in quantitative measures and corona-frailty among a cohort of community-dwelling older women. Changes were evaluated using face-to-face interactions with 39 Japanese women (mean age: 76.1 ± 5.9) in 2019 (pre-pandemic baseline) and 2021 (follow-up during the pandemic). Quantitative measurements of handgrip strength, walking speed, calf circumference, body composition, and background factors were evaluated. Body weight and trunk muscle mass significantly decreased at follow-up. Multiple regression analysis, using change in trunk muscle mass as the dependent variable and background factors as independent variables, identified that decrease in trunk muscle mass was associated with “being robust at baseline” and answering “Yes” to the question of “Do you go out less frequently compared with last year”? The 2-year trunk muscle mass change for each baseline frailty stage showed a significant decrease only in the robust group (−8.0%). The decrease in trunk muscle mass might be related to pandemic-induced lifestyle restraint, suggesting that robust older adults who are healthy and active should take measures that focus on trunk muscles to avoid “corona-frailty”.

The performance and physical status of professional cyclists in Japan who train with pycnogenol-containing supplements have not been evaluated. This pilot study aimed to investigate how off-season training and ingesting PycnoRacer™ containing branched-chain amino acids (BCAAs) and pycnogenol can influence cycling performance in cyclists. Eight professional male cyclists (mean age, 24.0 ± 2.4 years) were included in this study. All athletes received and ingested PycnoRacer™ containing 60 mg of pycnogenol, 4,800 mg of BCAA, and 1,200 mg of arginine daily for 28 days. We evaluated the cycling performance and other parameters of each athlete before using PycnoRacer™ and after 28 days of training with the supplement. Measures of performance, such as maximum oxygen consumption, maximum aerobic power, and maximum heart rate, were evaluated with breath-by-breath exercise tolerance tests using a gas analyzer. Additionally, other parameters, including body composition, respiratory function, and degree of cycling training, were measured. The maximum oxygen consumption, maximum aerobic power, and caloric expenditure during cycling training increased significantly after 28 days of training with PycnoRacer™. However, no significant differences were found in the maximum heart rate, body composition, and respiratory function before and after using PycnoRacer™. Pycnogenol-containing supplements enhance off-season cycling performance and caloric expenditure during cycling training of professional cyclists.

This study aimed to reveal the extent of the adverse effects caused by the restrictions on going out due to the COVID-19 pandemic on physical function. The participants were 129 healthy older adults, aged 65 years and older, who lived independently without the need for long-term care. The presence or absence of disuse syndrome was investigated using a partially modified “Disuse Syndrome Inventory.” The address, age, and gender of the participants were also surveyed in a factor analysis of disuse syndrome. The effective response rate was 90.6% (n = 117). Disuse syndrome was observed in 38.5% (n = 45) of the participants, which was significantly higher in women compared to men, and in medium-sized to depopulated cities compared to large cities. It has become clear that a large number of older adults have disuse syndrome because of the travel and commute restrictions due to the COVID-19 pandemic. To return to normal life sooner, it is necessary to consider countermeasures as soon as possible. Keywords: Coronavirus disease 2019, infection, physical function, restrictions on going out.

The Kihon Checklist (KCL) is used to assess frailty in daily life. We aimed to identify KCL items associated with the development of frailty and recovery to robust status during the COVID-19 pandemic.We conducted a 1-year prospective cohort study of community-dwelling adults aged 70 and 75 years in Otawara City, Tochigi Prefecture, Japan. Information regarding age, sex, presence of disease and KCL items was collected in May 2020 (baseline) and June 2021 (follow-up) using a mailed questionnaire. Changes in frailty status as determined by the KCL at baseline and follow-up were evaluated. To clarify factors related to changes in the frailty status, we conducted two sets of binomial logistic regression analyses with the presence/absence of development of frailty and presence/absence of recovery to robust status at follow-up as the dependent variables and the KCL items as the independent variables.The analysis included 716 participants who provided complete responses to both questionnaires. The KCL Items 6, 10, 20, 23 and 24 were related to the development of frailty, and the KCL Items 6, 15, 21 and 23 were associated with the recovery to robust status.The baseline KCL items regarding physical function and associated mental aspects were related to both development of frailty and recovery to robust status during the COVID-19 pandemic. Cognitive and depressive declines were associated with the development of frailty, while good oral environment and sense of fulfillment in life were associated with the recovery to robust status. Geriatr Gerontol Int 2022; 22: 745-752.

Several studies have established the advantage of using anthropometric measurements as indicators of sarcopenia. Nevertheless, no study has explored the association between sarcopenia and neck circumference. In this cross-sectional study, we examined the data of 90 older adults requiring long-term care to evaluate this association and establish cut-off points for individuals at risk of sarcopenia as defined by the Asian Working Group for Sarcopenia (AWGS) 2019. A significant association was found between sarcopenia and neck circumference using binomial logistic regression and receiver operating characteristic analyses. The optimal cut-off value for neck circumference associated with increased risk for sarcopenia among older adults was 32.8 cm for females and 38.0 cm for males. Given the potential of declining neck circumference as an anthropometric marker of sarcopenia, it has clinical applications in screening for sarcopenia in older adults requiring long-term care.

[Purpose] To investigate the difference by degrees in total hip rotation range of motion (ROM) between sides and with regard to gender in healthy young Japanese adults. [Participants and Methods] Data from previously published studies were used. We utilized the left and right hip rotation ROM of 205 Japanese participants aged 18 to 25 years, who satisfied the inclusion criteria and were randomly measured three times in the prone position by the double-blind method. The average value of the three measurements was used to calculate the left-right difference of the hip total rotation ROM in the hip joints, which is the sum of the hip internal and external rotation ROM. We investigated the distribution of the total hip rotation considering the flexibility factor and its relationship with gender. [Results] We confirmed that there were seven participants with 2 SD or more and two with 3 SD or more. No significant difference was found in the left-right difference in the total hip rotation ROM, regardless of gender. [Conclusion] The distribution of left-right differences in the total hip rotation ROM in healthy young adults showed the existence of a significant left-right difference of 2 SD or more.

[Purpose] To clarify the effects of longitudinal changes in older adults by evaluating the relationship between changes in spinal kyphosis and respiratory function over time in patients with certified need of care in the long-term care insurance system. [Participants and Methods] We included 57 older adults (28 males and 29 females) aged ≥65 years who were identified as requiring long-term care or support. The participants were community-dwelling individuals undergoing ambulatory rehabilitation. We assessed the longitudinal changes in spinal kyphosis index, respiratory function and muscle strength, and body composition over 1 year. [Results] The spinal kyphosis index was 10.5 at the first measurement and 14.6 at 1 year after the first measurement, showing a significant increase. We did not detect any significant differences in respiratory function and muscle strength, or body composition. [Conclusion] This 1 year longitudinal comparison suggests that the spinal kyphosis indexes were high, and the respiratory function and trunk muscle mass remained unchanged. Therefore, the relationships were negligible.

[Purpose] To characterize depression related to nutritional status in older adults requiring long-term care. [Participants and Methods] One hundred and six individuals (66 males and 40 females) over the age of 65 who required support level 1/2 or care level 1 and were receiving day care through the long-term care insurance (LTCI) system, were enrolled. The survey items included basic attributes, comorbidities, previous medical history, requiring support/care under Japan's LTCI system, the Mini Nutritional Assessment-Short Form, the Geriatric Depression Scale 15 (GDS-15), and body mass index (BMI). The factors associated with malnutrition/risk of malnutrition were evaluated. In addition, the relationship between nutritional status and the GDS-15 items was evaluated. [Results] Depression, LTCI, BMI, and gender were identified as related factors for malnutrition/risk of malnutrition. Compared with the favorable nutritional status group, the malnutrition/risk of malnutrition group reported GDS-15 items such as "Dropped activities and interests", "Feel that life is empty", "In good spirits most of the time (reversed)", "Afraid of something bad", "Prefer to stay at home", and "Feel full of energy (reversed)". [Conclusion] The results show certain parameters characteristic of depression in Japanese older adults with malnutrition requiring long-term care/support. These data will help guide future research and interventions.

[Purpose] To identify changes in the efficacy of the Asia Working Group for Sarcopenia (AWGS) screening tools and the differences between the different screening tools following the updates from the AWGS 2014 to 2019 criteria for community-dwelling older adults. [Participants and Methods] We included 139 community-dwelling older adults aged ≥65 years. We assessed the lower calf circumference, SARC-F score, SARC-CalF score, skeletal muscle mass, grip strength, and gait speed. Moreover, we investigated the sensitivity, specificity, likelihood ratios, and area under the ROC curve of the lower calf circumference, SARC-F score, and SARC-CalF score using the AWGS 2014 and 2019 criteria for sarcopenia diagnosis. [Results] The prevalences of sarcopenia were 10.8% and 12.9%, and 5.0% using the AWGS 2014 and 2019, and 2019 severe sarcopenia diagnostic criteria, respectively. Using AWGS 2014 criteria, the sensitivity and specificity of lower calf circumference, SARC-F score, and SARC-CalF score, were 86.7% and 62.1%, 13.3% and 91.9%, and 66.7% and 80.6%, respectively. Using AWGS 2019 criteria, the sensitivity and specificity of lower calf circumference, SARC-F score, and SARC-CalF score were 83.3% and 62.8%, 11.1% and 91.7%, and 66.7% and 81.8%, respectively. Using AWGS 2019 severe sarcopenia criteria, the sensitivity and specificity of lower calf circumference, SARC-F score, and SARC-CalF score were 100% and 59.8%, 14.3% and 91.7%, and 71.4% and 78.0%, respectively. [Conclusion] All screening tools used in AWGS 2014 and 2019 were similar in terms of efficacy; however, the AWGS 2019 severe sarcopenia criteria had different characteristics.

[Purpose] Changes in the muscle performance of professional motorized athletes using pycnogenol-containing supplements have not been clarified. The purpose of this study was to evaluate the changes in muscle strength and endurance of professional cyclists during 4 weeks of training with the use of PycnoRacerTM. [Participants and Methods] Eight professional cyclists were requested to consume PycnoRacerTM twice/day for 4 weeks. The muscle endurance test consisted of 50 consecutive knee flexion and extension exercises at 180°/sec using an isokinetic torque machine before and after PycnoRacerTM administration. The athletes' body composition, including leg muscle mass, was also measured. [Results] The maximum flexor muscle torque and 41st-50th flexion muscle torque values significantly improved after supplement consumption (average improvement of 8.5%; range, 13.3-67.2%). The leg muscle mass and body composition did not differ significantly between the two conditions. The participants showed an average improvement of 31.8% (range, 0.9-67.8%) in their total work with cycling training. No adverse events were observed. [Conclusion] The use of PycnoRacerTM may improve training, muscle strength, and endurance, but not muscle mass.

[Purpose] We aimed to clarify the characteristics of age-related changes based on the body composition data of old and super-old nursing home residents. [Participants and Methods] This cross-sectional study included 53 female nursing home residents aged 75 years and above (mean age: 89.4 years; standard deviation: 5.6 years). They were divided into the old and super-old groups. The old group consisted of 24 participants aged between 75 and 89 years (mean age: 84.4 years; standard deviation: 3.7 years). The super-old group consisted of 29 participants aged 90 years and above (mean age: 93.5 years; standard deviation: 2.7 years). The parameters such as phase angle, skeletal muscle mass index, skeletal muscle mass, body fat percentage, body mass index, and Barthel index were examined in the two groups. The relationship between age and phase angle was determined, and the partial correlation coefficient was analyzed using the items for which a significant difference was found between the two groups as adjustment variables. [Results] The overall phase angle was 3.2 degrees, and that of the super-old group alone was 2.6 degrees. Age-related difference was observed in the phase angle and Barthel index. A significant correlation of -0.53 was observed between age and phase angle. The Barthel index-adjusted partial correlation coefficient between age and phase angle was -0.35. [Conclusion] The results of this study indicated that phase angle is an indicator of physical condition associated with aging in female nursing home residents aged 75 to 100 years.

[Purpose] The quality of physical functions was evaluated prospectively in older females over a 5 year period to identify the physical functions that are more likely to consistently decline or be maintained in females aged 65‒74 years and more than 75 years. [Participants and Methods] Physical functions, including grip strength, walking speed, and balance, were measured for older females aged 65-74 years group and more than 75 years group from 2015 to 2019. T-scores of the physical performances were calculated to analyze the changes in the physical functions over 5 years. [Results] Based on the T-scores, physical functions in terms of the 5-m walking speed, timed up-and-go test, and functional reach test, improved from 2015 to 2019 in the 65-74 group, whereas all physical functions consistently deteriorated in the older than 75 group. [Conclusion] There was no significant decline of the physical functions in both groups; however, the T-score variations for physical functions during the 5 year observation period differed in each group.

Objective: The maximum phonation time (MPT) is used to assess simple respiratory functions and can be performed anywhere without special instruments. We investigated the association between MPT and respiration, considering the future utilization of simple respiratory assessments during home-based physical therapy. Method: This cross-sectional study included 140 older adults enrolled in Japanese long-term care insurance (77 men, 63 women; mean age, 77.9±8.0 years). The participants performed the MPT, followed by spirometry. We analyzed the MPT of the three age groups, relative reliability of the MPT values, and the association between MPT and respiratory function. Results: We found that the MPT of older men requiring long-term care or support was related to age. The intraclass correlation coefficient of MPT was >0.8 for all groups. Only forced vital capacity was associated with MPT in the partial correlation and multiple regression analyses. Conclusion: MPT could be an alternative assessment of respiratory function in home-based physical therapy for older adults requiring long-term care or support.

Aim We aimed to determine systematic bias and the range of random error in tongue pressure measurements among young healthy adults and elderly patients with certification of requiring long-term care or support, considering sex, and to establish a measurement method. Methods Subjects were 226 adults (88 young healthy adults and 138 elderly patients with certification of requiring long-term care or support). Tongue pressure was measured thrice. Bland-Altman analysis was performed for the first and second trials, and second and third trials. Results Fixed bias was revealed for the first and second trials among young healthy adults. Systematic bias was not found for the second and third trials. Fixed bias was revealed for the first and second trials among elderly patients, with a proportional bias with a negative slope for the second and third trials. For young healthy adults, the minimal detectable change was 6.0 and 5.4 kPa in males and females, respectively. For elderly patients, the limit of agreement ranged from -5.9 to 8.6 and from -5.4 to 8.8 kPa in males and females, respectively. Conclusions There was a difference in systematic bias in tongue pressure measurement between young healthy adults and elderly patients with certification of needing long-term care or support. In young healthy adults, the third trial results showed stability, whereas they decreased in elderly patients. In elderly patients, it was suggested that the number of measurements reduced from three to two when a maximum value was adopted. No differences were observed among sexes in either young or elderly patients. Geriatr Gerontol Int 2020; 20: 488-493.

[Purpose] The Asian Working Group for Sarcopenia (AWGS) criteria were recently updated. However, whether these changes would result in a difference in sarcopenia prevalence was unclear. We therefore focused on Japanese older adults who required long-term care/support and determined the differences in sarcopenia prevalence between the new and old criteria. [Participants and Methods] This cross-sectional study included 161 Japanese older adults aged ≥65 years who required long-term care/support along with ongoing daycare. Handgrip strength, usual gait speed, and skeletal muscle mass index were measured. We analyzed the difference in sarcopenia prevalence between the 2019 and 2014 AWGS criteria using the McNemar test. [Results] The overall sarcopenia prevalence rates were 60.2% and 53.4%, and the prevalence rates of sex-specific sarcopenia were 63.6% and 55.7% among males and 56.2% and 50.7% among females when the 2019 and 2014 AWGS criteria were used, respectively. Overall, males exhibited a significantly higher prevalence with the new than criteria than with the old. [Conclusion] With the 2019 AWGS criteria, more older males who required long-term care/support were diagnosed as having sarcopenia. Conversely, the sarcopenia diagnosis in females statistically remained unchanged. Thus, a mismatch might exist between the two criteria regarding sarcopenia prevalence in males.

[Purpose] The purpose of this study is to investigate the effect of decreased inspiratory capacity on the backward reach distance in healthy young individuals, as patients with chronic obstructive pulmonary disease have a high risk of falling. [Participants and Methods] Thirteen healthy volunteers (age, 19.2 ± 0.4 years: mean ± SD) participated in this study. We recorded the backward reach distance at the resting expiration level and at two different inspiratory capacity levels: −1/3 and −2/3 of inspiratory capacity, when the air is inhaled at resting expiration level. We assessed the backward reach distance for each inspiratory capacity, using one-way repeated measures analysis of variance and post-hoc analysis. [Results] We found that inspiratory capacity has a significant effect on backward reach distance. The backward reach distance was significantly decreased in participants with a −2/3 inspiratory capacity, compared with the backward reach distance in participants with a resting expiration level. [Conclusion] Patients with lung volume fractionation and decreased inspiratory capacity lack postural stability during backward reach. Therefore, the link between decreased inspiratory capacity and loss of balance in patients with chronic obstructive pulmonary disease may, in part, be due to decreased postural stability, and the resulting tendency to plan movements, which create a loss of balance.

[Purpose] We focused on skeletal muscle mass index, one of the biomarkers of sarcopenia, and investigated the association between skeletal muscle mass index and the parameters of lung function and respiratory muscle strength. [Participants and Methods] After applying the exclusion criteria, we included, in this cross-sectional study, 120 community-dwelling older adults aged ≥65 years who required long-term care/support and underwent ambulatory rehabilitation under the long-term care insurance system in Japan. We measured the skeletal muscle mass index, forced vital capacity, forced expiratory volume in 1 second, peak expiratory flow rate, maximum expiratory pressure, and maximum inspiratory pressure. The data were analyzed using Pearson correlation coefficient and multiple regression analysis. [Results] The skeletal muscle mass index was positively correlated with only maximum expiratory pressure for both male and female participants by Pearson's correlation coefficient. With the skeletal muscle mass index as a dependent variable, only the maximum expiratory pressure was significant for both male and female participants by the multiple regression analysis. [Conclusion] Therefore, the findings of this study suggested that compared with lung function tests, maximum expiratory pressure, which is an indicator of respiratory muscle strength, is related to muscle mass. Maximum expiratory pressure might be the most useful indicator for sarcopenia.

[Purpose] This study aimed to identify the factors associated with exercise behavior in patients with peripheral arterial disease. [Participants and Methods] The study included 43 patients with peripheral arterial disease (mean age, 75.2 ± 5.6 years) who were admitted for endovascular treatment from January 2020 to June 2021. Participants were surveyed through questionnaires to assess their physical function for determining their exercise behavior and the presence of physical, personal, and environmental factors that might have affected their stage of change regarding exercise behavior. [Results] A comparison of physical, personal, and environmental factors between the two groups classified by the presence or absence of exercise behavior showed that subjective health and exercise self-efficacy were significantly lower in the group without exercise. Furthermore, a difference was noted in the presence or absence of work. The adjusted binomial logistic regression analysis results using each of the factors differing between the groups, plus the walking impairment questionnaire total score as explanatory variables, showed a significant relationship with exercise self-efficacy only. [Conclusion] The results of this study showed that exercise self-efficacy presented a useful predictive relationship with the presence of exercise behavior in patients with peripheral arterial disease.