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Background: Reduced mobility is the first sign of functional decline and can lead to dependency in elderly people. Screening for the risk of mobility limitation in this population is an important public health issue to prevent further disabilities. Despite the current lack of guidelines, primary care healthcare providers may have a central role to play in this type of screening. Multi-domain physical exercise interventions in older persons have shown some efficacy/effectiveness on frailty status, yet, to the best of our knowledge, no published study has focused on patients screened in primary care., Method: The PRISME-3P study is a national, interventional, multicenter, cluster randomized trial. Patients over 70 years of age will be systematically screened by their general practitioner (GP) on the basis of clinical criteria of mobility limitation. To avoid contamination bias, the unit of randomization will be the GP practice. In the intervention group, patients will consult a geriatrician and a dietician, and will receive a physical training program from a personal trainer who will demonstrate the exercises and provide follow-up coaching. The control group will receive standard care. The primary outcome will be the change in Short Physical Performance Battery (SPPB) scores between inclusion and 6-months follow-up., Discussion: We expect an improvement of the SPPB between inclusion and 6 months of follow-up., Trial Registration: This study is registered in ClinicalTrials.gov ( NCT02847871 , 27 July 2016).

Background: There is evidence that adipokines have roles in brain functioning and cognitive decline., Objective: Assess the role of leptin and adiponectin levels in predicting changes in neuro-cognitive disorders (NCD)., Methods: The study included 205 patients over 65 years of age presenting for a one-day hospitalization for current assessment of cognitive function. Peripheral blood leptin and adiponectin levels were measured at admission. Demographic variables, body mass index (BMI), and history of hypertension were also recorded. Cognitive function was assessed by the Mini-Mental State Examination (MMSE) at admission and at later scheduled visits over a median follow-up period of 14.5 months. Conventional univariate comparisons were made between diagnosis groups (Alzheimer's disease (AD), mild NCD, vascular/mixed dementia). Changes in MMSE scores over time were examined with regard to the above variables using a linear mixed model., Results: The mean BMI was significantly lower (by 2 kg/m2, p = 0.01) in patients with AD than in patients with either mild-NCD or vascular/mixed dementia. Leptin levels were significantly higher (p = 0.043) and adiponectin levels significantly lower (p = 0.045) in patients with mild-NCD than in patients with major-NCD (AD or vascular/mixed dementia). However, the mixed model suggested no influence of the baseline levels of these two biomarkers on the course of cognitive decline., Conclusion: The present study confirms the associations between leptin and adiponectin and AD or AD-related disorders but did not confirm that these peptides may be used as predictive biomarkers of cognitive decline.

Background: Undernutrition prior to major abdominal surgery is frequent and increases morbidity and mortality, especially in older patients. The management of undernutrition reduces postoperative complications. Nutritional management should be a priority in patient care during the preoperative period. However undernutrition is rarely detected and the guidelines are infrequently followed. Preoperative undernutrition screening should allow a better implementation of the guidelines., Methods/design: The ANC ("Age Nutrition Chirurgie") study is an interventional, comparative, prospective, multicenter, randomized protocol based on the stepped wedge trial design. For the intervention, the surgeon will inform the patient of the establishment of a systematic preoperative geriatric assessment that will allow the preoperative diagnosis of the nutritional status and the implementation of an adjusted nutritional support in accordance with the nutritional guidelines. The primary outcome measure is to determine the impact of the geriatric intervention on the level of perioperative nutritional management, in accordance with the current European guidelines. The implementation of the intervention in the five participating centers will be rolled-out sequentially over six time periods (every six months). Investigators must recommend that all patients aged 70 years or over and who are consulting for a surgery for a colorectal cancer should consider participating in this study., Discussion: The ANC study is based on an original methodology, the stepped wedge trial design, which is appropriate for evaluating the implementation of a geriatric and nutritional assessment during the perioperative period. We describe the purpose of this geriatric intervention, which is expected to apply the ESPEN and SFNEP recommendations through the establishment of an undernutrition screening and a management program for patients with cancer. This intervention should allow a decrease in patient morbidity and mortality due to undernutrition., Trial Registration: This study is registered in ClinicalTrials.gov NCT02084524 on March 11, 2014 (retrospectively registered).

In the case of disequilibrium, the capacity to step quickly is critical to avoid falling in elderly. This capacity can be simply assessed through the choice stepping reaction time test (CSRT), where elderly fallers (F) take longer to step than elderly non-fallers (NF). However, the reasons why elderly F elongate their stepping time remain unclear. The purpose of this study is to assess the characteristics of anticipated postural adjustments (APA) that elderly F develop in a stepping context and their consequences on the dynamic stability. Forty-four community-dwelling elderly subjects (20 F and 24 NF) performed a CSRT where kinematics and ground reaction forces were collected. Variables were analyzed using two-way repeated measures ANOVAs. Results for F compared to NF showed that stepping time is elongated, due to a longer APA phase. During APA, they seem to use two distinct balance strategies, depending on the axis: in the anteroposterior direction, we measured a smaller backward movement and slower peak velocity of the center of pressure (CoP); in the mediolateral direction, the CoP movement was similar in amplitude and peak velocity between groups but lasted longer. The biomechanical consequence of both strategies was an increased margin of stability (MoS) at foot-off, in the respective direction. By elongating their APA, elderly F use a safer balance strategy that prioritizes dynamic stability conditions instead of the objective of the task. Such a choice in balance strategy probably comes from muscular limitations and/or a higher fear of falling and paradoxically indicates an increased risk of fall.

In this paper, we review a physiological task that is predominant in preventing humans from falling, but that simultaneously also challenges balance: taking a step. In particular, two variants of this task are presented and compared: the voluntary step versus a step induced by an external and unpredictable perturbation. We show that, while these contribute different information, it is interesting to compare these. Indeed, they both are relevant in a global balance assessment and should be included within this, at the same level as tests usually dispensed in the clinical environment such as posturography. We choose to focus on the community-dwelling elderly population, to discuss means of early detection of risk of falls, in order to prescribe an appropriate prevention. An overview of posture-movement coordination and balance recovery strategies is also provided. Finally, a working hypothesis is suggested on how "compensatory protective" steps are controlled and how their evaluation could bring additional information to the global balance assessment of risk of fall., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Virchow-Robin spaces (VRS) are extensions of the subarachnoid space surrounding perforating blood vessels entering the brain parenchyma. VRS are fluid filled, but almost virtual and only visible on MRI of the brain when dilated. Such dilations are commonly asymptomatic. In rare cases, extreme dilations can be observed; the clinical repercussions of which remain unclear. We report the case of a patient presenting symptoms of normal pressure hydrocephalus due to extreme VRS mesencephalon dilations., (2015 BMJ Publishing Group Ltd.)

Background: Abnormal oxidative stress is an established feature of Alzheimer's disease (AD). Markers of lipoperoxidation and deficits in serum antioxidants could have a predictive value for identifying subjects at risk of dementia and to predict cognitive decline., Objective: Search for relationships between the levels of some oxidative stress biomarkers and cognitive function decline that would help predict this decline., Methods: The study solicited and included 97 patients aged 63 to 93 years with various suspected neurodegenerative diseases (35 with AD). They were followed up at six-month intervals over two years (2010-2012). The study: i) assessed the blood levels of glutathione peroxidase, glutathione, and malondialdehyde; ii) performed the Mini-Mental Status Examination (MMSE), the Clock Drawing test, the free/cued recall task with 16-item lists, the cue percentage; and the Trail Making Test; and iii) acquired brain magnetic resonance imaging or tomodensitometry. The primary outcome measure was the MMSE score., Results: The MMSE score was correlated with the score of each neuropsychological test, the age at baseline, and the glutathione level. On average, the decline in the MMSE score was 1.63 points per six months. A 100 International Unit increase in glutathione peroxidase was associated with an average loss of 1.19 MMSE points per six months (p = 0.002). A 100 μmol/L increase in glutathione was associated with an average loss of 1.80 MMSE points per six months (p = 0.014)., Conclusion: Oxidative stress biomarkers, especially glutathione peroxidase and glutathione, may predict the course of cognitive decline in patients with AD or other neurodegenerative disorders.

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiological entity. It associates, to varying extents, neurological symptoms such as headaches, confusion, seizures and visual alterations from haemianopsia to cortical blindness. The diagnosis relies on brain MRI, showing signs of subcortical and cortical oedema in the posterior regions of the brain, with hypersignals in T2/fluid attenuated inversion recovery (FLAIR) or diffusion sequences. With early diagnosis and control of the causal factors, the symptoms and radiological signs can be - as the name implies - totally regressive. PRES can be caused by various heterogeneous factors, such as hypertension, side effect of drug therapies, eclampsia, sepsis or autoimmune diseases. The authors report here the case of an 86-year-old woman, presenting totally regressive cortical blindness and seizures, with compatible imaging.

Objective: Our main objective was to assess whether a home-based program supervised by home helpers (HH) during their normal working hours can prevent excessive sedentariness (mainly maximum walking time and distance) and preserve functional status in elderly people at risk for frailty or disability and using domestic services., Design: A four-month, open label, randomised trial with two groups called "prevention" and "control"., Setting: In the homes of study participants., Participants: The participants were all over 78 years old, lived independently at home, and received the visits of HHs at least once a week., Intervention: The intervention combined a self-administered exercise program, with 10 g amino-acid supplementation under the supervision of HHs., Measurements: Main outcome measures included physical activity (the PASE questionnaire), functional tests, nutritional and autonomy scores, and compliance (50% or more was considered satisfactory). Non-parametric methods were used for comparisons between the two groups. A linear regression model was fitted to assess the effect of the intervention on the relative variation of outcomes, adjusted for unbalanced baseline co-variables., Results: One hundred and two persons (prevention n=53, control n=49) with a median age of 85 years were included. Their median Activities of Daily Living and Instrumental Activities of Daily Living (IADL) scores were 6 and 7 respectively. Twenty-three (44%) were good compliers for both interventions. The maximum walking time remained stable while decreasing by 25% in the control group (p=0.0015); and fewer participants had a worsened IADL score in the prevention group (p=0.05). The baseline IADL Score was significantly associated with good compliance to the prevention program (p=0.0011). In good compliers, maximum walking distance and maximum walking time increased by 29.15% (0.0 to 66.7) and 33.3% (-20.0 to 50.0) respectively., Conclusion: This study confirms the feasibility of a prevention program supervised by HHs, and some benefit from the intervention and identifies predictors for better compliance. It will help in the design of prevention trials for elderly people at risk for frailty.

An 87-year-old patient was found to have an unusually protrusive hyperostosis frontalis interna, discovered on MRI examination during an assessment of cognitive decline. Neuropsychological evaluation suggested direct repercussions of the frontal lobe compression on executive functions, as well as psychiatric disorders and possibly memory loss.

Purpose: To review the current concepts in the biological diagnosis of Alzheimer's disease (AD) and related disorders., Current Knowledge and Key Points: As new therapeutics specific of AD may be available soon, early diagnosis of AD in the context of mild cognitive impairment (MCI) or dementia appears to be challenging. The high amount of atypical clinical forms of AD leads to develop new tools allowing in vivo diagnosis. New CerebroSpinal Fluid (CSF) biomarkers seem to reflect specific aspects of deep neuropathological changes observed in AD, i.e. amyloid deposits and neurofibrillary tangles. Amyloid beta-peptide 1-42 (Abeta(1-42)) and hyperphosphorylated tubulin associated unit (tau) isoforms appear to be the most sensitive and specific CSF biomarkers, the combination of these biomarkers depicting the best diagnosis value for AD. These molecules are also efficient in the prediction of the conversion from the MCI state to the dementia state of AD. Combined to clinical and neuro-imaging information, CSF biomarkers appear thus to be highly relevant in improving the early etiological diagnosis of dementia., Future Prospects and Projects: The current research focalises on the development of new molecules coming from Abeta and tau protein families, in the CSF and in the serum, as well as molecules reflecting other pathological metabolism changes, as alpha-synuclein in Lewy Body Disease. The diagnosis value of CSF biological markers is so promising that they have been recently included in the research diagnosis criteria of AD.

Alzheimer's disease has major social and family consequences. However, therapeutic strategies are still limited. Non-pharmacological therapeutic approaches are known to be useful to protect the intellectual abilities of the patients, or at least, to slow down their decline. Therefore, it is important to pay attention to the consequences of sensory impairment in these old patients. Indeed, sensory troubles, mainly concerning hearing, may have an impact on the cognitive and behavioral symptoms. Several studies showed that the management of hearing impairment could afford cognitive and behavioral benefits in demented subjects as well as for the non-demented people. These results are encouraging, and suggest that hearing management should be applied to all hearing impaired patients with Alzheimer's disease.

Fighting against inactivity and inadequate nutritional intake are of utmost importance in the elderly. To our knowledge, the few studies which have been performed were conducted for only a short period and the results do not permit formal conclusions to be drawn. We therefore tried to fill this gap in our knowledge by determining whether an intervention combining an acceptable progressive exercise programme and nutritional supplements would be feasible for a long-term period in the very frail elderly, and would bring about concomitant benefits in body composition and muscle power. Accordingly, this exercise and nutritional combination was assessed in the frail elderly in a 9-month randomised trial with a factorial design. Fifty-seven elderly volunteers over 72 years, from sixteen retirement homes in Lyon, France participated in the study. Dietary supplements were compared with placebo, and physical exercise was compared with memory training. Main outcome measures were fat-free mass (FFM) and muscle power. FFM was determined by labelled water, and muscle power was measured by a leg-extensor machine. At 9 months, the compliance was 63 % for exercise sessions, and 54 % for nutritional supplements. In patients with dietary supplements, muscle power increased by 57 % at 3 months (P=0.03), and showed only a tendency at 9 months; although FFM increased by 2.7 % at 9 months, the difference was not significant (P=0.10). Exercise did not improve muscle power at 9 months, but improved functional tests (five-time-chair rise, P=0.01). BMI increased with supplements (+3.65 %), but decreased with placebo (-0.5 %) at 9 months (P=0.007). A long-term combined intervention is feasible in frail elderly individuals with a good rate of compliance. Nutritional supplements and exercise may improve muscle function. Despite no significant results on FFM, due to the limited number of volunteers, combined intervention should be suggested to counteract muscle weakness in the frail elderly.

Background and Aims: The influence of acute low-volume resistance exercise on serum growth hormone (GH), insulin-like growth factor I (IGF-I), dehydroepiandrosterone sulphate (DHEAS), total testosterone (TT) and cortisol was ascertained in elderly subjects., Methods: Forty-seven independent, community-dwelling volunteers aged >65 years were recruited: 23 (11 men, 12 women) were sedentary individuals, and 24 (12 men, 12 women) had been regularly involved in physical activity for several years. The protocol consisted of two sets of leg extensions: one graded by loading to reach maximal power; the other consisted of 10 consecutive leg extensions using a load corresponding to maximal power., Results: IGF-I levels increased immediately after exercise, returning almost completely to pre-exercise values by the 15-minute post-exercise time point. The changes in all four study groups were similar. Not any of the groups presented systematic exercise-induced changes in circulating GH, DHEAS and TT levels. With respect to pre-exercise cortisol levels, significant decreases were observed both at the immediate and at the 15-minute post-exercise time points. These changes were independent of gender and physical activity level., Conclusions: Our data indicate that low-volume resistance exercise may decrease cortisol levels and increase serum anabolic/catabolic hormone ratios. In view of the experimental character of our resistance training protocol and the lack of control-day data, these results should be corroborated by long-term low-volume resistance training programs.

Purpose: Hypocholesterolemia is a common finding in hospitalized elderly people and is associated with increased mortality. Changes in plasma lipid levels are well known in the acute phase response. It has also been suggested that malnutrition is a cause of hypocholesterolemia. However, malnutrition is the reflect of general condition, and the respective roles of malnutrition and inflammation have not yet been clearly established. This research project was undertaken to examine the impact of nutritional and inflammatory status on the hypocholesterolemia., Methods: In a prospective study, 597 elderly patients (83 +/- 7 years) consecutively admitted in a geriatric acute care unit were included. Clinical and anthropometric data: Body Mass Index (BMI), Tricipital Skinfold Thickness (TSF), Sub-Scapular Skinfold Thickness (SSF), Mid Arm Circumference (MAC) have been collected. The blood samples were obtained within the 72 hours following the admission. Nutritional proteins (albumin, prealbumin, transferrin, retinol binding protein); inflammatory proteins (CRP, alpha-1 acid glycoprotein), and blood lipids (cholesterol, LDL, HDL cholesterol, triglycerides, apoproteins A1 and B) were dosed., Results: The anthropometric and biologic parameters have been compared on the two sexes, significant differences were observed only for blood lipids. The analyses are thus realized and presented by sex separately. Four groups of patients are generated according to the quartile of total cholesterol. Means and standard deviation for all factors are calculated within each group. Both, the trend of means and analyses of correlation show associations with cholesterol in the two sexes. The analysis of variance showed that the cholesterolemia is associated with 1/ decrease in the values of the anthropometrics, and nutritional proteins and 2/ upward trends of the inflammatory parameters. Significant correlations were observed for all transport proteins and CRP with total cholesterol in men and women. The multiple linear regression of the total cholesterol retained albumin, APO A1, APO B and RBP as predictor factors of cholesterolemia for women and APO A1, APO B and tryglicerid for men. When patients with infectious diseases were compared to the others, significant differences have been observed for total cholesterol and all blood lipids, as well as for nutritional and inflammatory proteins., Conclusion: The results confirm an association between nutritional status and hypocholesterolemia, and suggest also the responsability of inflammation as a cause of hypocholesterolemia.

Objective: Lower amounts of circulating anabolic hormones are thought to accelerate the age related decline in muscle mass and function. Replacement therapies are promising interventions but there are problems with these therapies. Thus alternative strategies should be developed. The age related changes in hormonal status may be probably influenced by exercise. The purpose of this study was: a) to confirm with other methods, more adapted for elderly people, the results of a previous study that has shown relationship between physical activity (PA) and quadriceps muscle function with dehydroepiandrosterone sulphate (DHEAS), insulin like growth factor-1 (IGF-1). Quadriceps muscle power (Pmax) is measured in this new work with a recently developed leg extensor machine and, b) to complete the results of the first study examining simultaneously the relationship between PA, Pmax and cardiorespiratory fitness (VO2max) with DHEAS, IGF-1 and testosterone in a group of healthy elderly people., Methods: Fifty independent, community dwelling elderly subjects (25 mens and 25 womens) aged from 66 to 84 volunteered to participate in the study. PA was evaluated by the questionnaire and expressed using two activity indices: mean habitual daily energy expenditure (MHDEE) and the daily energy expenditure corresponding to leisure time sports activities (Sports Activity). Pmax and optimal shortening velocity (vopt) were measured on a Ergopower dynamometer. The Pmax was expressed relative to body mass, Pmax/kg (W kg-1), and relative to the mass of the two quadriceps muscles, Pmax/Quadr (W.kgQuadr-1). VO2max has been measured during a maximal treadmill exercise., Results: In women, IGF-1 correlated significantly with MHDEE (r = 0.54, P = 0.004), Pmax/kg (r = 0.54, P = 0.004) and Pmax/Quadr (r = 0.46, P = 0.02), whereas DHEAS with MHDEE (r = 0.54, P = 0.004), Sports Activity (r = 0.65, P < 0.001), VO2max (r = 0.46, P = 0.02), Pmax/kg (r = 0.46, P = 0.02) and Pmax/Quadr (r = 0.55, P = 0.004). No such correlation was found in men., Conclusion: These findings confirm that in healthy elderly women physical activity, cardiorespiratory fitness and quadriceps muscle function are similarly related to levels of circulating DHEAS and IGF-1 suggesting a favourable influence of exercise on anabolic hormonal production in the elderly.

Background: Malnutrition is a widespread but largely unrecognized problem in aged patients, more so as it is a contributing factor to the increased morbidity and mortality in this age group. Since direct measurements of body composition are not possible in a large number of patients, good anthropometric reference data are fundamental in assessing the nutritional state of elderly people., Objective: To examine the efficacy of calf circumference (CC) measurement for assessing the nutritional state of the elderly., Methods: The nutritional state was assessed by anthropometric and biological measurements in 911 elderly patients consecutively admitted to a geriatric unit. In the first instance, univariate analysis was performed for CC and other nutritional parameters. Linear and multiple stepwise regressions were performed to study the association between anthropometric or biological parameters and CC. At a later stage, the specificity, sensitivity and the optimal cutoff CC were established for 2 groups of patients: malnourished and controls. Finally, patients were classified according to this cutoff in order to verify the efficacy of CC in assessing their nutritional state., Results: The results of univariate analysis showed significant correlations between CC and other nutritional anthropometric markers (r = 0.706, p < 0.0001 with body mass index (BMI) and r = 0.661, p < 0.0001 with fat free mass) and biological markers (r = 0.219, p < 0.0001 with albumin and r = 0.162, p < 0.0001 with transthyretin). Multiple regression confirmed associations between CC and tricipital skinfold thickness (p < 0.0001), fat free mass (p < 0.0001), BMI (p < 0.0001), and serum albumin (p < 0.0001; r(2) = 0.561). The optimal cutoff for CC was found to be 30.5 cm for both men (sensitivity 73.2%, specificity 72.8%) and women (sensitivity 78.8%, specificity 61.1%). The classification of patients according to this discriminating factor was confirmed for the optimal cutoff value., Conclusion: Calf circumference is a pertinent marker of nutritional state. The cutoff of 30.5 cm provides a good diagnostic capacity., (Copyright 2002 S. Karger AG, Basel)

Background: To examine the influence of long-term modifications in habitual physical activity (PA) on resting total testosterone (TT) concentrations in a group of healthy elderly subjects., Experimental Design: 6-month prospective study., Setting: University research departments of exercise physiology and geriatric medicine., Participants: thirty-one independent, community dwelling elderly subjects (16 men and 15 women) aged > 65 who volunteered to participate., Interventions: correlational study., Measures: PA was evaluated by a questionnaire QAPSE (Questionnaire d Activité Physique Saint-Etienne) and expressed by two activity indices: mean habitual daily energy expenditure (MHDEE) and daily energy expenditure corresponding to leisure time sports activities (Sports activity index)., Results: Changes in resting TT concentrations were not related to changes in MHDEE (r = -0.28; p = 0.30 and r = -0.001; p=0.99) and Sports activity (r = -0.30; p = 0.26 and r = -0.05; p = 0.85) in men and women, respectively. Similarly, relative (%) changes in TT were not related to relative changes in MHDEE (r = -0.16; p=0.55 and r = 0.17; p=0.55) and Sports activity (r = -0.11; p=0.68 and r = 0.02; p = 0.92)., Conclusions: The levels of habitual PA undertaken by an average senior do not appear to affect TT levels in healthy active elderly men and women.

AGE-RELATED LOSS IN MUSCLE MASS: Aging is associated with a progressive decline in muscle mass (sarcopenia). Age-related sarcopenia results in a 50% decrease in muscle fiber area, especially type II fiber area. There are many consequences related to this reduction in muscle mass including decline in muscle strength and function and impaired functional capacity. PROTEIN INTAKE: Sarcopenia also results in a reduction in the body's major protein pool. Adequate dietary protein to replace obligatory nitrogen loss and to support protein turnover is essential for maintaining muscle mass. It is usually suggested that protein requirements in older subjects are above 1 g/kg/d. PHYSICAL EXERCISE: Sedentary lifestyle may contribute to loss of skeletal mass in elderly people. Exercise can help reverse this deficit and may improve the regeneration potential of muscle fibers.

The relationship of quadriceps maximal muscle power (Pmax), corresponding optimal shortening velocity (v(opt)), and relative fatigability (Pmax%D) to maximal oxygen uptake (VO2max) and habitual physical activity (PA) was examined in healthy community-dwelling subjects (29 women and 25 men) aged more than 65 years old. PA was evaluated by a questionnaire and expressed using two activity indices: mean habitual daily energy expenditure (MHDEE) and the daily energy expenditure corresponding to leisure time sports activities (Sports Activity). In women, Pmax correlated positively with VO2max (r = .56) and with Sports Activity (rho = .41). Both Sports Activity and Pmax were significant independent predictors of VO2max and accounted for 62% of variance in VO2max. In men, v(opt) was significantly negatively related to MHDEE (r = -.59) and to Sports Activity (rho = -.40). Neither in women nor in men was Pmax%D correlated with VO2max or PA indices. The different relationship of Pmax and v(opt) with VO2max and PA indices suggests that habitual PA may be sufficient in active older women, but not in men, to positively influence quadriceps muscle function. These gender differences may suggest different approaches in exercise programming for elderly women and men.

We examined the association between quadriceps muscle function and serum levels of dehydroepiandrosterone sulphate (DHEAS), insulin-like growth factor I (IGF-I) and testosterone in a group of healthy elderly people. Fifty-three independent, community-dwelling elderly subjects (26 men and 27 women) aged from 66 to 84 years volunteered to participate in the study. Physical activity (PA) was evaluated by a questionnaire. Quadriceps maximal muscle power (Wmax) and optimal shortening velocity (v(opt)) were measured on a friction-loaded non-isokinetic cycle ergometer. The Wmax is expressed in relation to body mass (W(max/kg), W x kg(-1)), and in relation to the mass of the two quadriceps muscles (W(max/Quadr), W x kg(Quadr(-1))). In women, when adjusted for age, anthropometric measurements and PA indices, IGF-I correlated significantly with W(max/kg) (partial correlation: r = 0.59; P = 0.001), W(max/Quadr) (r = 0.58; P = 0.002) and v(opt) (r = 0.53; P = 0.004), whereas DHEAS was correlated significantly with W(max/kg) (r = 0.54; P = 0.003) and W(max/Quadr) (r = 0.58; P = 0.002). No such correlation was found in men. These findings indicate that in healthy elderly women lower values for quadriceps muscle Wmax and v(opt) are related, independently of age, anthropometric measurements and PA indices, to lower circulating levels of DHEAS and IGF-I.

The relationship of oxidative stress and the anti-oxidant defence system to maximal oxygen consumption (VO2max) and habitual physical activity was assessed in 26 elderly men (71.0 +/- 4.2 years) and compared to that of 12 young men (22.1 +/- 5.1 years). Physical activity was assessed by a questionnaire. Malondialdehyde (MDA), plasma total anti-oxidant status (TAS), the levels of red blood cell (RBC) superoxide dismutase (SOD) and glutathione peroxidase (GPX), as well as serum GPX activities were determined under resting conditions. The older and young men had similar TAS and RBC SOD, while MDA, RBC GPX and plasma GPX were higher, and RBC SOD/GPX ratio was significantly lower in the older men. Neither MDA nor anti-oxidants were associated with any of the physical activity/aerobic capacity measures in the elderly men. We conclude that in healthy elderly men with a good nutritional status, indicators of the anti-oxidant defence system are not lower in comparison with young men. Increased RBC and plasma GPX coupled with a high level of lipid peroxidation marker may indicate an adaptation of anti-oxidant defences to sustained oxidative stress. Furthermore, the results of the present study suggest that the level of habitual physical activity and aerobic capacity have no major influence on the resting balance between radical generation and blood anti-oxidant potential in healthy older men.

Purpose: To analyze, both by a retrospective and prospective study design, the relationship of maximal oxygen consumption (VO2max) and physical activity (PA) to upper respiratory tract infections (URTI) symptomatology in elderly subjects., Methods: 61 (33 men and 28 women) healthy and weight-stable active elderly volunteers aged 66-84 yr participated in the study. PA was evaluated by a questionnaire QAPSE (Questionnaire d'Activite Physique Saint-Etienne) and expressed by two QAPSE activity indices: MHDEE (mean habitual daily energy expenditure) and sports activity (daily energy expenditure corresponding to leisure time sports activities). Log books for daily recording of URTI symptomatology were used in prospective design., Results: In a 1-yr retrospective study a significant correlation was found between number of weeks with URTI per year and Sports activity index (r = -0.27, P = 0.037). In a prospective 12-month follow-up, the number of episodes per year and number of days with URTI per year were significantly negatively associated with sports activity index (r = -0.29, P = 0.022 and r = -0.26, P = 0.041, respectively)., Conclusions: In healthy active elderly subjects the symptomatology of URTI over long periods of time is inversly related to energy expenditure utilized during moderately intensive physical exercise.

We examined the influence of physical activity (PA) and acute resistance exercise on insulin-like growth factor I (IGF-I) in 39 healthy, independent, community-dwelling elderly volunteers (14 men and 25 women) aged from 66 to 84. In a longitudinal non-interventional study, we compared the fluctuations in IGF-I levels and changes in habitual PA over a 6-month period. PA was evaluated by a questionnaire QAPSE (Questionnaire d'Activité Physique Saint-Etienne), and expressed by two activity indices: mean habitual daily energy expenditure (MHDEE), and daily energy expenditure corresponding to leisure time sports activities (sports activity index). In an experimental design we compared IGF-I levels before, at 1 and 15 minutes after short quadriceps muscle exertion (10 consecutive repetitions) carried out with optimal muscle power development. Changes in IGF-I levels over a 6-month period were positively related to changes in MHDEE (r = 0.41; p<0.01), and sports activity (r = 0.40; p<0.02). When analyzed by gender, these correlations were still statistically significant in women (r = 0.39; p = 0.05 and r = 0.41; p<0.05), but not in men (r = 0.36; p = 0.21 and r = 0.20; p = 0.50). No changes (p = 0.17) were observed in serum IGF-I concentrations after the acute exercise protocol. These findings indicate that IGF-I levels are positively related to fluctuations in habitual PA, at least in women. Further research is needed to establish the best intensity and duration of exercise training to induce these changes.

Purpose: To determine, both by a cross-sectional and longitudinal study design, the relationship of maximal oxygen consumption (VO2max) and physical activity (PA) to blood lipids and lipoprotein(a) [Lp(a)] in a population of healthy and weight-stable elderly volunteers aged 66-84 yr., Methods: In a cross-sectional study in 52 subjects (23 men and 29 women), all independent variables (age, anthropometric, VO2max, and PA indices) were used in a multiple stepwise regression analysis to select variables influencing lipid and lipoprotein parameters. In a prospective nonintervention study, 38 subjects (17 men and 21 women) were reexamined after 6 months., Results: In a cross-sectional study, sports activity index contributed significantly to total cholesterol (TC), low density lipoprotein (LDL) cholesterol (LDL-C), TC/high density lipoprotein (HDL) cholesterol (HDL-C) ratio, and LDL-C/HDL-C ratio variance in men, whereas VO2max accounted for 23% variance of apolipoprotein A-I in women. In a prospective study, there was no indication that any measured variable was correlated with absolute or relative changes in PA indices in the total group or when analyzed by gender., Conclusions: These data confirm that favorable relationship between PA/fitness and blood lipid profile is visible in elderly people but spontaneous changes in habitual PA are not a sufficient stimulus to alter serum lipid and lipoprotein levels in this population. Furthermore, there is no direct association between Lp(a) levels and PA, fitness, or body composition in the elderly men and women.

Objective: to examine the association of physical activity and cardio-respiratory fitness with dehydroepiandrosterone sulphate (DHEAS), insulin-like growth factor I (IGF-I) and testosterone in healthy elderly people., Design: cross-sectional study., Setting: university research department and department of geriatric medicine., Participants: 60 independent, community-dwelling elderly subjects (26 men and 34 women) aged 66-84 who volunteered to participate., Measurements: physical activity was evaluated by the Questionnaire d'Activité Physique Saint-Etienne and expressed by three indices: mean habitual daily energy expenditure (MHDEE), daily energy expenditure (DEE) [comprising activities with intensities corresponding to at least three metabolic equivalents (MET; 3.5 ml.kg1 x min1 of oxygen consumption)] and sport activity. Cardio-respiratory fitness was expressed by maximal oxygen consumption (VO2max)., Results: In women, DHEAS correlated with VO2max (partial correlation: r=0.33; P=0.05), MHDEE (r=0.50; P=0.002), DEE > 3 METs (r=0.49; P=0.003) and sport activity (r=0.35; P=0.04) whereas IGF-I correlated with MHDEE (r=0.48; P=0.004). DHEAS was correlated with IGF-I (r=0.43; P < 0.02) and with testosterone (r=0.41; P < 0.02). No such correlation was found in men., Conclusion: lower habitual physical activity is related to lower levels of circulating DHEAS and IGF-I independently of age and anthropometric measures. Lower maximal aerobic capacity is associated with lower DHEAS concentrations, in healthy elderly women.

We have related the oxidative stress and antioxidant defence system to maximal oxygen consumption (VO2max) and physical activity in elderly women. Twenty-nine community dwelling, healthy, active women aged 66-82 years participated in this study. Physical activity was measured by a questionnaire and expressed using two physical activity indices: mean habitual daily energy expenditure (MHDEE) and daily energy expenditure corresponding to leisure time sports activities (Sports activity index). Malondialdehyde (MDA), plasma total antioxidant status (TAS), the red blood cell (RBC) superoxide dismutase (SOD) and glutathione peroxidase (GPX) as well as serum GPX activities were determined under resting conditions. MDA was correlated positively with VO2max (r = 0.42), while RBC GPX was significantly negatively associated with VO2max (r =-0.39), MHDEE (r=-0.38) and sports activity index (rho=-0.36). Our data suggest that in healthy active older women the relationship between physical activity/fitness and antioxidant defence system may be complex, and that for some parameters an unfavourable influence of strenuous exercise may exist. The findings of this cross-sectional design need to be supported in further prospective studies before the associations are accepted as real.

The relationship of maximal anaerobic power (Pmax) of the quadriceps muscle and corresponding optimal shortening velocity (vopt) with age, habitual physical activity (PA) and maximal oxygen consumption (VO2max) were assessed in 37 healthy older [71.1 (SD 3.8) years] men and compared to those of 16 young [22.7 (SD 3.4) years] men. The PA was evaluated using a questionnaire. The Pmax and vopt were measured on a friction loaded non-isokinetic cycle ergometer. The Pmax was expressed relative to body mass - Pmax x kg(-1), and relative to the mass of the two quadriceps muscles - Pmax x kgquad(-1). The decline of Pmax x kg(-1) from youth to advanced age (8.3% per decade) was greater than the decrease in quadriceps muscle mass (3.8% per decade), in Pmax x kgquad(-1) (5.9% per decade) and in vopt (4.3% per decade). In the older men, a negative relationship of Pmax x kg(-1) (r = -0.33) and Pmax x kgquad(-1) (r = -0.44) with age was found. Ergometer measurements were not correlated with PA activity indices or VO2max, while VO2max was positively associated with PA. In a multiple stepwise regression analysis age was the only variable that contributed significantly to Pmax x kg(-1) and Pmax x kgquad(-1) variances. Our findings indicated that in these healthy elderly men, unlike the fall in VO2max, habitual PA did not attenuate the decline in Pmax of the quadriceps muscle with age. This finding was different from a previously described relationship in older women and would suggest sex differences in determining Pmax in healthy older subjects.

The aim of this study was to investigate the relationship between maximal anaerobic power (Pmax) and corresponding optimal velocity (Vopt) and habitual physical activity (PA) on the one hand and with maximal oxygen consumption (VO2max) on the other hand, in elderly women. Twenty-nine community dwelling, healthy women aged 66-82 years participated in the study. PA was evaluated using the Questionnaire d'Activite Physique Saint-Etienne (QAPSE) and expressed using two QAPSE activity indices: mean habitual daily energy expenditure (MHDEE) and daily energy expenditure corresponding to leisure time sports activities (sports activity). The subjects' Pmax and Vopt were measured while they cycled on a friction-loaded non-isokinetic cycle ergometer. Pmax was expressed relative to body mass [Pmax/kg(W.kg-1)], and relative to the mass of two quadriceps muscles [Pmax/Quadr(W.kg-1Quadr)]. A negative relationship between Pmax/kg (Spearman's r = -0.56; P < 0.01), Pmax/Quadr (r = -0.53; P < 0.01) and Vopt (r = -0.45; P < 0.05) and age was found. Pmax/kg was positively associated with MHDEE (r = 0.51; P < 0.01) and sports activity (r = 0.58; P < 0.01), as were Pmax/Quadr and Vopt (r = 0.55; P < 0.01 and r = 0.54; P < 0.01, respectively). Pmax/kg, Pmax/Quadr and Vopt correlated positively with VO2max. The positive relationship between ergometer measurements and PA indices was similar to that between VO2max and PA. Pmax/kg was, moreover, closely related to Vopt (r = 0.77; P < 0.001). When a multiple stepwise regression analysis was used to select the variables influencing ergometer measurements, MHDEE contributed significantly to Pmax/kg variance, whereas sports activity contributed to Pmax/Quadr and Vopt variances. In conclusion, the data from this cross-sectional study suggest that in healthy elderly women habitual PA, and especially leisure time PA, alleviates the decline of the Pmax of the quadriceps muscles.

The purpose of this study was to validate a physical activity (PA) questionnaire, Questionnaire d'Activité Physique Saint-Etienne (QAPSE), in an homogenous population of elderly subjects and to estimate its potential for application in routine PA assessments in that age group. A group of 65 (31 men and 34 women) community dwelling, healthy people aged 65-84 years volunteered to participate in a validation substudy comparing maximal oxygen uptake (VO2 max) and anthropometric data. VO2 max correlated positively with mean habitual daily energy expenditure (MHDEE) (r = 0.56, P < 0.0001), greater than 3MET (metabolic equivalent) daily energy expenditure (DEE) activity (r = 0.371, P = 0.002), leisure activity (r = 0.368, P = 0.003), sports activity (r = 0.461, P < 0.0001), basic daily activity (r = 0.325, P = 0.008) and moving DEE activity (r = 0.273, P = 0.028) in both sexes, with MHDEE (r = 0.366, P = 0.043) and moving DEE activity (r = 0.388, P = 0.031) in the men and with MHDEE (r = 0.624; P < .0001), greater than 3MET DEE activity (r = 0.513, P = 0.002), leisure activity (r = 0.388, P = 0.024) and sports activity (r = 0.683, P < 0.001) in the women. The MHDEE was positively correlated with body mass (r = 0.464) and with fat free mass (r = 0.639) and negatively correlated with percentage body fat (r = -0.501). In a reproducibility sub-study (n = 44) a paired Student's t-test, based on mean differences between the two administrations of the questionnaire did not reach statistical significance for any of the QAPSE activity scores studied. Test-retest correlation coefficients ranged from 0.648 for moving score to 0.967 for MHDEE with correlation coefficient P values being less than 0.001 for all of the QAPSE activity scores. We concluded that QAPSE demonstrated excellent repeatability and good validity in relation to physical fitness and anthropometric data in the population of these healthy elderly volunteers.