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Background CAPARFI study explored whether sonoelastographic data collected using the acoustic radiation force impulse (ARFI) system are reliable when evaluating skeletal muscles and whether the technique can detect muscle changes with aging. Methods Twenty young (YH; 18–30 years) and 30 old (OH; ≥70 years) healthy volunteers and 15 old patients with cancer (OP; ≥70 years) were assessed through quantitative ARFI measurements (m s−1) of the relaxed rectus femoris, tibialis anterior, and soleus muscles, and Short Physical Performance Battery (SPPB) test. The reliability in ARFI measurements was evaluated by intra‐class correlation coefficient. Among‐group differences in ARFI measurements and SPPB were evaluated using a global linear model. Results Acoustic radiation force impulse measurements demonstrated high reliability in all groups (intra‐class correlation coefficient > 0.82). ARFI measurements of the rectus femoris muscle were significantly lower in both the OH and OP groups than in the YH group (1.46 ± 0.12 and 1.50 ± 0.32 vs. 1.80 ± 0.35 m s−1). The ARFI measurements of the soleus muscle were significantly lower in the OP group than in the YH group (1.37 ± 0.37 vs. 1.70 ± 0.53 m s−1). No significant difference was observed for tibialis anterior muscle. Significantly lower SPPB scores were observed in the OP group (10.3 ± 1.4 out of 12) than in the YH (12.0 ± 0.0) and OH groups (11.5 ± 1.0). Conclusions This study demonstrated that ARFI quantitative measurements are reliable in relaxed skeletal muscle and may be reliably used to explore muscle changes with aging and/or neoplasia in clinical practice.

Type 2 diabetes (T2D) is a risk factor of frailty and cognitive impairment. Impaired gait in older people is associated with incident vascular dementia. We aimed to assess whether in frail or prefrail older subjects with T2D, lower gait speed can be associated with faster cognitive decline. Case-control study nested in a large randomized control trial (RCT, MID-frail); post hoc analysis. Older frail and prefrail subjects (>70y) with T2D and with no history of cognitive problems were enrolled in a single recruiting center. Participants were divided into two groups depending on their walking speed — above (fast walkers) or below (slow walkers) using a cut off of 1 m/sec. Cognitive function was assessed at baseline and during follow-up with the MMSE, category and letter fluencies at 15 sec (initiation) and 15–60 sec (late). 48 subjects were included, 22 were fast walkers, 26 were slow walkers. The mean follow-up was 60.9 (SD 17.5) weeks. The baseline 0–15 sec letter fluency was higher in fast walkers (p=0.008). There was no difference at baseline with MMSE scores and category fluency. The MID-Frail intervention did not change the evolution of any cognitive changes. Comparisons were adjusted for age, sex and baseline performance, and showed a steeper decline of category fluency score in slow walkers (fast walkers +0.04 (−1.49 to1.56) compared with −0.89 (−2.15 to 0.38), p=0.049) with a moderate effect size. In frail or prefrail older adults with diabetes, we observed a decline in category fluency in those with low gait speed.

Introduction Frail older people with diabetes often present with or develop walking impairments, in part due to lower-limb sensory-motor neuropathy. Several studies suggest a possible improvement of balance control using somatosensory stimulation. We undertook a novel randomized control trial, the aim of which was to observe whether use of this device for 1 month improves walking speed as measured in the 10-m fast walking speed test standardized to body size at month 1 (M1) (FWS). Secondary outcomes were the differences between intervention (VS) and control (C) in the 10-m normal walking speed test, step length, short physical performance battery, timed up and go test, and posturographic measures. Methods Subjects were aged ≥ 70 years and had had type 2 diabetes for at least 2 years. The intervention (VS) at home consisted of 22-min daily vibrating sequences with noise intensity set at 90% of the tactile threshold for each foot. The same device was used in group C but noise was set to 0. Compliance was retrieved from the device. Results Among 56 subjects, 27 were in the VS group and 29 in the C group; 35 subjects were frail, 15 were prefrail ,and 6 were non-frail. Bilateral neuropathy was present in 17 subjects. More than half of sessions were done in 36 subjects with no discernible difference according to intervention. At M1 there were no discernible differences in FWS between the groups [VS: 0.96 (0.53) cm s−1 cm−1, C: 0.94 (0.47) cm s−1 cm−1]. There were also no discernible differences in other outcomes, irrespective of the presence of bilateral neuropathy. Conclusion In a cohort of frail, prefrail, or non-frail older subjects with diabetes, a 1-month intervention using a vibrating insole device did not alter measures of walking speed and related measures. Larger studies with longer term and different stimulation protocols are required to test this hypothesis more fully. Sponsorship was received for this study from EU 7th Framework Programme (contract no. 278803). CHU of Bordeaux paid the journal’s Rapid Service Fee

BACKGROUND: Older adults with cancer experience negative long-term functional effects of both cancer and treatments. Exercise may minimize their age-related and cancer-related functional decline. METHODS: We conducted a multicentre open-label 12month randomized clinical trial with two parallel arms including participants aged ≥70years with lymphoma or carcinoma requiring curative treatment. The study started at the beginning of any phase of cancer treatment (surgery, chemotherapy, or radiotherapy). The usual care group (UCG) received the current national recommendations in physical activity (a guideline without specific counselling). The intervention group (IG) received 1year phoned physical activity advice individually adapted to physical assessment (twice a month during the first 6months and then monthly). The primary outcome was the proportion of subjects with a 1year decreased short physical performance battery (SPPB) score of 1 point or more. Physical, cognitive, and clinical secondary outcomes were also investigated. RESULTS: We allocated 301 participants (age 76.7±5.0, female 60.6%) to each group. At baseline, the median SPPB was 10/12 in both groups. Breast was the most frequent tumour site (35.7%). After 1year, 14.0% of participants in the UCG and 18.7% in the IG had a decrease in SPPB score of 1 point or more (P=0.772). At 2years, there was no difference in SPPB, gait speed, International Physical Activity Questionnaire score, and verbal fluency. Subgroup analyses after 2years showed a decline in SPPB for 29.8% of UCG and 5.0% of IG breast cancer participants (P=0.006), in 21.7% of UCG and 6.2% of IG female participants (P=0.019), and in 24.5% of UCG and 11.1% of IG normal nutritional status participants (P=0.009). Falls, hospitalization, institutionalization, and death rates were similar in both groups. CONCLUSIONS: Personalized phoned physical activity advice had not reduced functional decline at 1year but provided preliminary evidence that may prevent physical performance decline at 2years in older adults with breast cancer. © 2019 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. This work was funded by the National Hospital Program of Clinical Research (Programme Hospitalier de Recherche Clinique 2010) and sponsored by the University Hospital of Bordeaux (CHU Bordeaux). Haritz Arrieta was supported by a fellowship from University of the Basque Country (UPV/EHU).

Summary Background & aims Several studies with diabetes-specific formulas (DSFs) for hyperglycaemic patients in need of nutritional support have been conducted in non-malnourished patients, mainly comparing products with varying macronutrient compositions. Here, the effect of a high energy, high protein DSF on postprandial responses was compared to a product with a similar macronutrient composition in malnourished or at risk of malnutrition patients with type 2 diabetes. Methods In this randomised, double-blind cross-over study, 20 patients were included. After overnight fasting, patients consumed 200 mL of a DSF or standard supplement (control) (19.6 g protein, 31.2 g carbohydrates and 10.6 g fat), while continuing their anti-diabetic medication. The formulas differed in type of carbohydrates and presence of fibre. The postprandial glucose, insulin and glucagon responses were monitored over 4 h. Data were analysed with a Linear Mixed Model, and results of the modified ITT population (n = 19) are shown. Results Postprandial glucose response as incremental area under the curve (iAUC), was lower after consumption of DSF compared with control (489.7 ± 268.5 (mean ± SD) vs 581.3 ± 273.9 mmol/L min, respectively; p = 0.008). Also, the incremental maximum concentration of glucose (iCmax) was lower for DSF vs control (3.5 ± 1.4 vs 4.0 ± 1.4 mmol/L; p = 0.007). Postprandial insulin and glucagon levels, expressed as iAUC or iCmax, were not significantly different between groups. Conclusions Consumption of a high energy, high protein DSF by older malnourished or at risk of malnutrition type 2 diabetes patients resulted in a significantly lower glucose response compared to control. These data suggest that the use of a DSF is preferred for patients with diabetes in need of nutritional support.

Decreased health-related quality of life (HRQoL) is common in patients with cancer. We investigated the effects of dietary intervention and baseline nutritional status on worsening of HRQoL in older patients during chemotherapy. In this randomized control trial assessing the effect on mortality of dietary advice to increase dietary intake during chemotherapy, this post hoc analysis included 155 patients with cancer at risk of malnutrition. The effects of dietary intervention, baseline Mini Nutritional Assessment item scores, weight loss, and protein and energy intake before treatment on the worsening of HRQoL (physical functioning, fatigue) and secondary outcomes (Timed Up and Go test, one-leg stance time, depressive symptoms, basic (ADL), or instrumental (IADL) activities of daily living) were analyzed by multinomial regressions. Dietary intervention increased total energy and protein intake but had no effect on any examined outcomes. Worsening of fatigue and ADL was predicted by very low protein intake (

International audience; Background: In older people, diabetes is associated with an increased risk of falls and frailty. The value of using posturography for evaluating the risk of falling is unclear. In theory, a time-scale analysis should increase the metrological properties of the posturography assessment. Objectives: This study aimed to determine which posturographic parameters can be used to identify fall-risk patients in a frail diabetic older population and to assess their interest in comparison to usual clinical trials for gait and balance. Design: This is a prospective observational cohort. Settings: frail or pre-frail diabetic patients, in Bordeaux, France. Participants: 84 patients were included in the study (mean age 80.09 years, 64.5% of men).Criteria for inclusion were: age over 70 years, diabetes mellitus for over 2 years, and at least one of the Fried’s frailty criteria. Measurements: Gait and balance assessments were undertaken at baseline: Static posturography, the timed up and go test, short physical performance battery, and (gait) walking speed. Raw data from posturography were used for wavelet analysis. Data on self reported new falls were collected prospectively during 6 months. Results: The posturography parameter most useful was area of 90% confidence ellipse of statokinesigram (COP90area): area under the ROC curve AUC = 0.617 (95% CI, 0.445-0.789) and OR=1.003 (95%CI 1.000-1.005) p =0.05. The optimum clinical test was the time to walk over 4m AUC=0.735 (95%CI, 0.587-0.882) and OR=1.42 (95%CI 1.08-1.87) p= 0.013. Conclusion: Posturography has limited utility for assessment of falls risk in frail older people with diabetes. Gait and balance clinical assessments such as walking speed continue to retain their value.

Depression symptoms and lower health-related quality of life (HRQoL) are associated with inflammation. This multicenter dietary intervention was shown to reduce inflammation in older people. This was the main outcome. Here, we describe the effects on HRQoL, anxiety, and depressive symptoms according to inflammation status. Overall, 125 healthy older subjects (65−80 year) were recruited (Italy, France, and Germany) and randomized into four arms (A, Healthy diet (HD); B, HD plus De Simone Formulation probiotic blend; C, HD plus AISA d-Limonene; D, HD plus Argan oil). The HD was weight maintaining, rich in antioxidant vitamins, polyphenols, polyunsaturated fatty acids (n6: n3 ratio = 3:1), and fiber. Data on inflammatory parameters, mental (MCS) and physical (PCS) component summaries of HRQoL (SF−36), anxiety symptoms (STAI state), and depressive symptoms (CES-D) were collected before and after 56 days of intervention. Body fat mass proportion (BFM) was considered a co-variable. A decrease of CES-D score was seen in the four arms (A: −40.0%, p = 0.001; B: −32.5%, p = 0.023; C: −42.8%, p = 0.004; and D: −33.3%, p = 0.21). Within the subgroups of subjects with medium/high inflammation a similar decrease in CES-D score occurred in all groups (A: −44.8%, p = 0.021; B, −46.7%, p = 0.024; C, −52.2%, p = 0.039; D, −43.8%, p = 0.037). The effect of interventions on CES-D was not related to baseline inflammation. MCS-HRQoL improved in A and C. There was no change in anxiety or PCS-HRQoL. In this trial with no control group, a decrease in depressive symptoms in healthy older volunteers was observed after a 2-month healthy diet intervention, independently of inflammation but with possible limitations due to participation.

Decreased health-related quality of life (HRQoL) is common in patients with cancer. We investigated the effects of dietary intervention and baseline nutritional status on worsening of HRQoL in older patients during chemotherapy. In this randomized control trial assessing the effect on mortality of dietary advice to increase dietary intake during chemotherapy, this post hoc analysis included 155 patients with cancer at risk of malnutrition. The effects of dietary intervention, baseline Mini Nutritional Assessment item scores, weight loss, and protein and energy intake before treatment on the worsening of HRQoL (physical functioning, fatigue) and secondary outcomes (Timed Up and Go test, one-leg stance time, depressive symptoms, basic (ADL), or instrumental (IADL) activities of daily living) were analyzed by multinomial regressions. Dietary intervention increased total energy and protein intake but had no effect on any examined outcomes. Worsening of fatigue and ADL was predicted by very low protein intake ( 0.8 g kg

Diabetes and frailty are highly prevalent conditions that impact the health status of older adults. Perturbations in protein/amino acid metabolism are associated with both functional impairment and type 2 diabetes mellitus (T2DM). In the present study, we compared the concentrations of a panel of circulating 37 amino acids and derivatives between frail/pre-frail older adults with T2DM and robust non-diabetic controls. Sixty-six functionally impaired older persons aged 70+ with T2DM and 30 age and sex-matched controls were included in the analysis. We applied a partial least squares-discriminant analysis (PLS-DA)-based analytical strategy to characterize the metabotype of study participants. The optimal complexity of the PLS-DA model was found to be two latent variables. The proportion of correct classification was 94.1 &plusmn, 1.9% for frail/pre-frail persons with T2DM and 100% for control participants. Functionally impaired older persons with T2DM showed higher levels of 3-methyl histidine, alanine, arginine, glutamic acid, ethanolamine sarcosine, and tryptophan. Control participants had higher levels of ornithine and taurine. These findings indicate that a specific profile of amino acids and derivatives characterizes pre-frail/frail older persons with T2DM. The dissection of these pathways may provide novel insights into the metabolic perturbations involved in the disabling cascade in older persons with T2DM.

Type 2 diabetes mellitus (T2DM) is a leading cause of disability globally. Frailty is a high-impact geriatric condition that increases the risk of negative health outcomes and imposes remarkable health and social burden. Both frailty and T2DM show multifaceted pathophysiology, phenotypic heterogeneity, and fluctuating manifestations that challenge their management, especially when the two conditions co-occur. Muscle wasting and its correlates (e.g., metabolic perturbations and functional decline) that underlie frailty may exacerbates clinical manifestations of T2DM in older people, resulting in worse prognosis. The intrinsic complexity of frailty and T2DM has hampered the identification of clinically meaningful biomarkers to track the clinical progression of the two conditions over time and to monitor the efficacy of pharmacological and lifestyle interventions. Here, we propose an innovative approach for biomarker identification that couples multi-platform analytical determinations with chemometric modeling strategies. This novel multi-marker discovery process is described in the context of the "Metabolic biomarkers of frailty in older people with type 2 diabetes mellitus" (MetaboFrail) study that aimed at identifying metabolic biomarkers of frailty in functionally limited older persons with T2DM.

Diabetes may become a disabling disease due to diverse mechanisms. Many patients have evidence of physical or cognitive impairments that can markedly influence their ability to diabetes self manage and adversely affect possible outcomes of diabetes care. A screening process for impairment is therefore needed and in frail patients a comprehensive gerontological assessment should be used to improve the efficiency of care. A diabetes educational programme adapted to this population, which has involved the main care-giver has shown its efficacy to improve risk factor control and quality of life in a safer way. The experience of case-managers according to a model of heart failure may be promising for the future. Br J Diabetes Vasc Dis 2012;12:135-140

Background: Cancer in older patient favours the development of frailty: feeling of exhaustion, loss of weight, decreased muscle strength, slow gait speed, and low physical activity. Objectives: To evaluate the efficacy of adapted physical activity phone advices in limiting the cancer-induced loss of autonomy and frailty phenotype development. Design: Multicenter randomized controlled trial. Setting: Patients (>70y) undergoing curative treatment for cancer (n=400) will be recruited from 12 centres. Intervention: The intervention consists in phoned personalized physical activity advices related to strength, aerobic, balance, proprioception, and flexibility. The contacts are performed twice a month during six months and then monthly until 1 year. The intervention complements the PNNS booklet advices (National Nutritional Health Program). The trial compares "individualized phone advices + PNNS" to "usual care + PNNS". Measurements: Functional, cognitive, clinical and self-reported data are assessed before treatment and at 3, 6, 12, 18, and 24 month follow-up. The primary outcome is the proportion of subjects with a one-year decreased SPPB (Short Physical Performance Battery) score of one point or more, as compared to baseline. The secondary outcomes include quality of life items, rate of hospitalizations, institutionalizations, mortality, Fried phenotype at 1 and 2 years, and the SPPB score at 2 years. Discussion: This large trial will provide clinical data of the effects of an exercise advices intervention in older patients during cancer therapy on function and cognition evolution, and quality of life. The possibilities of minimizing the development of frailty phenotype due to these advices will be explored.

10031Background: Cancer in older patient favors the loose of physical function. Physical activity could be a key factor to diminish the age and cancer-related decline. Methods: We conducted a multi...

In this study, we examined the effects of three recovery intensities on time spent at a high percentage of maximal oxygen uptake (t90[Vdot]O(2max)) during a short intermittent session. Eight endurance-trained male adolescents (16 +/- 1 years) performed four field tests until exhaustion: a graded test to determine maximal oxygen uptake ([Vdot]O(2max); 57.4 +/- 6.1 ml x min(-1) . kg(-1)) and maximal aerobic velocity (17.9 +/- 0.4 km x h(-1)), and three intermittent exercises consisting of repeat 30-s runs at 105% of maximal aerobic velocity alternating with 30 s active recovery at 50% (IE(50)), 67% (IE(67)), and 84% (IE(84)) of maximal aerobic velocity. In absolute values, mean t90[Vdot]O(2max) was not significantly different between IE(50) and IE(67), but both values were significantly longer compared with IE(84). When expressed in relative values (as a percentage of time to exhaustion), mean t90[Vdot]O(2max) was significantly higher during IE(67) than during IE(50). Our results show that both 50% and 67% of maximal aerobic velocity of active recovery induced extensive solicitation of the cardiorespiratory system. Our results suggest that the choice of recovery intensity depends on the exercise objective. 26;12